Grady Health System																																							
"Updated April 15,2023"																																							
Procedure	Code Type	Code	NDC	Procedure Description	IP/OP	Charge	Cash Discount (74%)	 Payor Rate Min	Payor Rate Max 	Aetna Exp Reimbursement	Coventry Exp Reimbursement	Aetna Advantage	Coventry Advantage	Ambetter  Exp Reimbursement 	Amerigroup Exp Reimbursement 	Anthem BCBS HMO Exp Reimbursement	Anthem BCBS POS Exp Reimbursement	BCBS PPO Exp Reimbursement	BCBS Advantage 	CareSource CMO Exp Reimbursement	CareSource Advantage Exp Reimbursement 	Cigna Exp Reimbursement	Cigna Advantage	Eon Health Exp Reimbursement	Humana Exp Reimbursement	Kaiser Exp Reimbursement	Multiplan Exp Reimbursement	NaphCare Exp Reimbursement	Oscar Exp Reimbursement	USP Exp Reimbursement	Peachstate Exp Reimbursement	Tricare Choice Exp Reimbursement	Veteran's Choice Exp Reimbursement	Wellcare Medicaid Exp Reimbursement	Wellcare Medicare Exp Reimbusrement 	CIGNA	CLOVER	MEDICAID	SONDER
MS003	DRG	MS003		"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES"	INPATIENT ONLY	"$846,619.47"	"$626,498.41"	$0.00	"$633,310.40"	"$545,963.96"	"$545,963.96"	"$246,500.86"	"$246,500.86"	"$226,063.68"	$0.00	$0.00	$0.00	"$633,310.40"	"$169,544.23"	$0.00	"$200,521.93"	"$552,556.41"	"$552,556.41"	"$136,503.65"	"$413,995.33"	"$504,437.36"	"$573,019.79"	"$182,532.67"	"$552,556.41"	"$182,532.67"	"$185,417.02"	"$167,931.68"	"$167,931.68"	"$136,503.65"	"$194,687.78"	$0.00	$0.00	$0.00	$0.00
MS004	DRG	MS004		"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES"	INPATIENT ONLY	"$560,790.65"	"$414,985.08"	$0.00	"$500,611.30"	"$303,701.56"	"$303,701.56"	"$102,651.23"	"$102,651.23"	"$117,598.72"	"$139,546.44"	$0.00	$0.00	$0.00	"$93,123.67"	"$139,546.44"	"$106,877.24"	"$307,479.91"	"$307,479.91"	"$112,641.38"	"$410,855.25"	"$500,611.30"	$0.00	"$134,386.24"	"$307,479.91"	"$134,386.24"	"$32,473.86"	"$147,233.83"	"$147,233.83"	"$107,277.50"	"$34,561.30"	$0.00	$0.00	$0.00	$0.00
MS011	DRG	MS011		"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC"	INPATIENT ONLY	"$341,624.34"	"$252,802.01"	$0.00	"$53,518.70"	$0.00	$0.00	"$45,708.66"	"$45,708.66"	$0.00	$0.00	$0.00	$0.00	$0.00	"$45,618.98"	$0.00	"$46,622.83"	$0.00	$0.00	"$47,587.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$53,518.70"	"$53,518.70"	"$45,321.23"	$0.00	$0.00	$0.00	$0.00	$0.00
MS012	DRG	MS012		"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC"	INPATIENT ONLY	"$435,854.28"	"$322,532.17"	$0.00	"$527,844.11"	$0.00	$0.00	"$64,752.45"	"$64,752.45"	$0.00	$0.00	$0.00	$0.00	"$527,844.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$112,717.74"	"$124,172.81"	"$124,172.81"	$0.00	"$40,861.37"	$0.00	$0.00	$0.00	$0.00
MS013	DRG	MS013		"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC"	INPATIENT ONLY	"$427,041.11"	"$316,010.42"	$0.00	"$28,929.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$28,929.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$28,929.99"	$0.00	$0.00	$0.00	$0.00	$0.00
MS020	DRG	MS020		INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC	INPATIENT ONLY	"$640,592.00"	"$474,038.08"	$0.00	"$461,392.05"	$0.00	$0.00	"$117,892.75"	"$117,892.75"	"$130,119.32"	$0.00	$0.00	$0.00	"$445,362.06"	"$82,209.64"	$0.00	"$84,042.11"	"$354,069.74"	"$354,069.74"	"$87,750.60"	"$378,667.73"	"$461,392.05"	$0.00	"$121,357.54"	"$354,069.74"	"$121,357.54"	$0.00	"$101,514.63"	"$101,514.63"	"$83,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
MS021	DRG	MS021		INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC	INPATIENT ONLY	"$829,388.27"	"$613,747.32"	$0.00	"$583,001.67"	"$432,052.38"	"$432,052.38"	$0.00	$0.00	"$185,501.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$538,738.80"	"$538,738.80"	$0.00	"$478,473.59"	"$583,001.67"	$0.00	"$152,156.12"	"$538,738.80"	"$152,156.12"	$0.00	"$91,625.03"	"$91,625.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS022	DRG	MS022		INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC	INPATIENT ONLY	"$262,016.11"	"$193,891.92"	$0.00	"$95,010.54"	$0.00	$0.00	"$44,476.05"	"$44,476.05"	$0.00	$0.00	$0.00	$0.00	$0.00	"$88,779.12"	$0.00	$0.00	$0.00	$0.00	"$95,010.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$38,549.28"	$0.00	$0.00	"$90,486.22"	"$40,476.72"	$0.00	$0.00	$0.00	$0.00
MS023	DRG	MS023		CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR	INPATIENT ONLY	"$218,569.58"	"$161,741.49"	$0.00	"$201,607.59"	"$122,687.67"	"$122,687.67"	"$50,198.05"	"$50,198.05"	"$63,817.39"	$0.00	$0.00	$0.00	"$44,292.45"	"$50,096.77"	$0.00	"$67,359.13"	"$201,607.59"	"$201,607.59"	"$52,188.44"	"$105,398.91"	"$128,424.52"	"$123,922.26"	"$56,307.53"	"$201,607.59"	"$56,307.53"	"$53,114.71"	"$59,017.16"	"$59,017.16"	"$49,703.28"	"$55,770.42"	$0.00	$0.00	$0.00	$0.00
MS024	DRG	MS024		CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC	INPATIENT ONLY	"$157,585.04"	"$116,612.93"	$0.00	"$101,279.86"	"$101,279.86"	"$101,279.86"	"$38,238.47"	"$38,238.47"	$0.00	$0.00	$0.00	$0.00	"$76,208.16"	"$38,168.13"	$0.00	"$39,003.24"	$0.00	$0.00	"$41,250.33"	"$33,522.62"	"$79,948.14"	"$86,190.36"	"$40,262.62"	$0.00	"$40,262.62"	$0.00	"$45,945.91"	"$45,945.91"	"$39,286.03"	$0.00	$0.00	$0.00	$0.00	$0.00
MS025	DRG	MS025		CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC	INPATIENT ONLY	"$478,309.25"	"$353,948.85"	$0.00	"$226,592.28"	"$226,592.28"	"$226,592.28"	"$54,020.48"	"$54,020.48"	$0.00	"$111,176.48"	$0.00	$0.00	"$124,468.05"	"$42,011.95"	"$140,855.50"	"$55,104.90"	$0.00	$0.00	"$43,833.50"	"$153,273.67"	"$186,758.08"	"$99,788.97"	"$44,051.81"	$0.00	"$44,051.81"	$0.00	"$49,032.85"	"$49,032.85"	"$41,746.19"	$0.00	$0.00	$0.00	$0.00	$0.00
MS026	DRG	MS026		CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC	INPATIENT ONLY	"$270,390.78"	"$200,089.18"	$0.00	"$374,897.72"	"$363,866.18"	"$363,866.18"	"$32,699.36"	"$32,699.36"	"$115,593.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$33,354.58"	"$374,897.72"	"$374,897.72"	$0.00	$0.00	$0.00	$0.00	$0.00	"$374,897.72"	$0.00	$0.00	"$38,018.73"	"$38,018.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS027	DRG	MS027		CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$150,043.04"	"$111,031.85"	$0.00	"$232,805.15"	$0.00	$0.00	"$28,405.90"	"$28,405.90"	$0.00	"$54,890.22"	$0.00	$0.00	$0.00	$0.00	"$69,843.08"	"$28,974.02"	$0.00	$0.00	"$30,181.04"	"$191,064.82"	"$232,805.15"	"$82,819.30"	"$36,977.13"	$0.00	"$36,977.13"	$0.00	"$32,717.89"	"$32,717.89"	"$28,743.85"	$0.00	$0.00	$0.00	$0.00	$0.00
MS028	DRG	MS028		SPINAL PROCEDURES WITH MCC	INPATIENT ONLY	"$378,830.18"	"$280,334.33"	$0.00	"$240,380.32"	$0.00	$0.00	"$50,062.96"	"$50,062.96"	"$77,466.83"	$0.00	$0.00	$0.00	"$238,773.51"	$0.00	$0.00	$0.00	"$240,380.32"	"$240,380.32"	"$52,005.99"	"$141,041.44"	"$171,853.56"	$0.00	"$56,039.87"	"$240,380.32"	"$56,039.87"	$0.00	"$58,799.12"	"$58,799.12"	"$49,529.51"	$0.00	$0.00	$0.00	$0.00	$0.00
MS029	DRG	MS029		SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS	INPATIENT ONLY	"$255,521.10"	"$189,085.61"	$0.00	"$229,583.19"	$0.00	$0.00	"$33,806.33"	"$33,806.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$34,482.46"	$0.00	$0.00	"$35,718.41"	$0.00	$0.00	"$229,583.19"	$0.00	$0.00	$0.00	$0.00	"$39,335.16"	"$39,335.16"	"$34,017.53"	$0.00	$0.00	$0.00	$0.00	$0.00
MS030	DRG	MS030		SPINAL PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$247,560.24"	"$183,194.58"	$0.00	"$29,329.56"	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,797.75"	$0.00	$0.00	$0.00	$0.00	"$19,797.75"	$0.00	$0.00	$0.00	"$29,329.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,932.91"	$0.00	$0.00	$0.00	$0.00	$0.00
MS031	DRG	MS031		VENTRICULAR SHUNT PROCEDURES WITH MCC	INPATIENT ONLY	"$411,152.28"	"$304,252.69"	$0.00	"$59,024.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,834.72"	"$59,024.65"	"$59,024.65"	$0.00	"$23,976.45"	$0.00	$0.00	$0.00	$0.00
MS032	DRG	MS032		VENTRICULAR SHUNT PROCEDURES WITH CC	INPATIENT ONLY	"$213,869.28"	"$158,263.27"	$0.00	"$14,380.55"	"$14,380.55"	"$14,380.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS033	DRG	MS033		VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$184,494.76"	"$136,526.12"	$0.00	"$12,635.25"	"$9,990.32"	"$9,990.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$12,033.57"	$0.00	$0.00	$0.00	"$12,635.25"	$0.00	$0.00	$0.00	$0.00
MS034	DRG	MS034		CAROTID ARTERY STENT PROCEDURES WITH MCC	INPATIENT ONLY	"$284,867.36"	"$210,801.85"	$0.00	"$160,900.01"	"$160,900.01"	"$160,900.01"	"$38,508.31"	"$38,508.31"	$0.00	$0.00	$0.00	$0.00	$0.00	"$38,437.26"	$0.00	"$39,278.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$43,799.77"	"$43,799.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS035	DRG	MS035		CAROTID ARTERY STENT PROCEDURES WITH CC	INPATIENT ONLY	"$129,223.20"	"$95,625.17"	$0.00	"$31,946.16"	$0.00	$0.00	"$27,200.91"	"$27,200.91"	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,159.12"	$0.00	"$27,744.93"	$0.00	$0.00	"$29,535.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$31,946.16"	"$31,946.16"	"$28,128.81"	$0.00	$0.00	$0.00	$0.00	$0.00
MS036	DRG	MS036		CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$63,272.72"	"$46,821.81"	$0.00	"$9,048.30"	"$9,048.30"	"$9,048.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS037	DRG	MS037		EXTRACRANIAL PROCEDURES WITH MCC	INPATIENT ONLY	"$179,064.31"	"$132,507.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS038	DRG	MS038		EXTRACRANIAL PROCEDURES WITH CC	INPATIENT ONLY	"$162,863.49"	"$120,518.98"	$0.00	"$26,825.78"	$0.00	$0.00	"$22,501.67"	"$22,501.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,951.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,825.78"	"$26,825.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS039	DRG	MS039		EXTRACRANIAL PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$99,295.23"	"$73,478.47"	$0.00	"$53,458.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,293.26"	$0.00	$0.00	$0.00	"$43,873.91"	"$53,458.66"	$0.00	"$11,340.50"	$0.00	"$11,340.50"	$0.00	"$22,384.03"	"$22,384.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS040	DRG	MS040		"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC"	INPATIENT ONLY	"$181,156.10"	"$134,055.51"	$0.00	"$120,959.00"	"$114,037.71"	"$114,037.71"	"$37,726.38"	"$37,726.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$38,480.91"	$0.00	$0.00	"$40,730.30"	"$99,271.90"	"$120,959.00"	$0.00	"$39,499.78"	$0.00	"$39,499.78"	"$26,844.41"	"$45,324.46"	"$45,324.46"	"$38,790.76"	"$28,186.61"	$0.00	$0.00	$0.00	$0.00
MS041	DRG	MS041		"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR"	INPATIENT ONLY	"$127,537.44"	"$94,377.71"	$0.00	"$72,242.00"	"$37,578.12"	"$37,578.12"	"$27,269.91"	"$27,269.91"	$0.00	"$27,327.64"	$0.00	$0.00	$0.00	"$27,227.95"	"$27,327.64"	"$27,815.31"	$0.00	$0.00	"$30,008.81"	"$6,724.57"	"$72,242.00"	$0.00	"$23,772.63"	$0.00	"$23,772.63"	"$26,156.21"	"$32,512.09"	"$32,512.09"	"$28,579.82"	"$27,464.00"	$0.00	$0.00	$0.00	$0.00
MS042	DRG	MS042		"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC"	INPATIENT ONLY	"$105,060.67"	"$77,744.90"	$0.00	"$125,934.52"	"$18,514.80"	"$18,514.80"	"$24,174.58"	"$24,174.58"	"$16,589.36"	"$107,683.75"	$0.00	$0.00	$0.00	$0.00	"$107,684.43"	"$24,658.07"	"$67,315.38"	"$67,315.38"	$0.00	$0.00	$0.00	"$125,934.52"	$0.00	"$67,315.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS052	DRG	MS052		SPINAL DISORDERS AND INJURIES WITH CC/MCC	INPATIENT ONLY	"$156,658.67"	"$115,927.42"	$0.00	"$83,265.35"	$0.00	$0.00	"$23,845.39"	"$23,845.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,322.30"	$0.00	$0.00	"$24,934.09"	"$68,336.46"	"$83,265.35"	$0.00	"$16,328.58"	$0.00	"$16,328.58"	$0.00	"$26,447.68"	"$26,447.68"	"$23,746.75"	$0.00	$0.00	$0.00	$0.00	$0.00
MS053	DRG	MS053		SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC	INPATIENT ONLY	"$178,803.45"	"$132,314.55"	$0.00	"$18,896.33"	$0.00	$0.00	"$18,896.33"	"$18,896.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS054	DRG	MS054		NERVOUS SYSTEM NEOPLASMS WITH MCC	INPATIENT ONLY	"$57,218.00"	"$42,341.32"	$0.00	"$32,180.45"	"$28,652.18"	"$28,652.18"	"$20,496.79"	"$20,496.79"	"$11,646.29"	$0.00	$0.00	$0.00	$0.00	"$20,472.36"	$0.00	"$20,906.73"	"$20,524.50"	"$20,524.50"	"$22,960.49"	"$15,497.86"	"$32,180.45"	$0.00	"$13,433.57"	"$20,524.50"	"$13,433.57"	"$16,209.33"	"$24,089.19"	"$24,089.19"	"$21,867.13"	"$16,209.33"	$0.00	$0.00	$0.00	$0.00
MS055	DRG	MS055		NERVOUS SYSTEM NEOPLASMS WITHOUT MCC	INPATIENT ONLY	"$29,991.33"	"$22,193.58"	$0.00	"$20,540.66"	"$12,259.80"	"$12,259.80"	"$18,262.77"	"$18,262.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,628.03"	$0.00	$0.00	"$20,540.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$12,303.42"	$0.00	$0.00	"$19,562.53"	"$12,918.59"	$0.00	$0.00	$0.00	$0.00
MS056	DRG	MS056		DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC	INPATIENT ONLY	"$74,193.16"	"$54,902.94"	$0.00	"$32,929.50"	"$12,532.35"	"$12,532.35"	"$26,204.32"	"$26,204.32"	"$15,722.67"	"$27,637.01"	$0.00	$0.00	"$16,742.05"	"$26,165.12"	"$27,637.01"	"$26,728.41"	"$32,929.50"	"$32,929.50"	"$28,784.91"	$0.00	$0.00	$0.00	$0.00	"$32,929.50"	$0.00	"$3,891.53"	"$31,049.49"	"$31,049.49"	"$27,414.20"	"$4,141.69"	$0.00	$0.00	$0.00	$0.00
MS057	DRG	MS057		DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC	INPATIENT ONLY	"$48,700.14"	"$36,038.10"	$0.00	"$24,142.42"	"$24,142.42"	"$24,142.42"	"$19,801.12"	"$19,801.12"	"$9,014.09"	$0.00	$0.00	$0.00	$0.00	"$19,778.49"	$0.00	"$20,197.14"	"$19,012.50"	"$19,012.50"	"$20,335.16"	"$9,564.24"	"$17,411.42"	$0.00	"$12,137.42"	"$19,012.50"	"$12,137.42"	$0.00	"$18,349.35"	"$18,349.35"	"$19,366.82"	$0.00	$0.00	$0.00	$0.00	$0.00
MS058	DRG	MS058		MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC	INPATIENT ONLY	"$57,255.06"	"$42,368.74"	$0.00	"$35,850.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,006.13"	"$27,593.07"	$0.00	"$19,594.52"	$0.00	"$19,594.52"	$0.00	"$35,850.39"	"$35,850.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS059	DRG	MS059		MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC	INPATIENT ONLY	"$42,378.53"	"$31,360.11"	$0.00	"$63,687.23"	"$63,687.23"	"$63,687.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,348.41"	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,254.77"	"$16,079.42"	"$33,948.36"	$0.00	"$10,931.50"	$0.00	"$10,931.50"	$0.00	"$22,050.83"	"$22,050.83"	"$20,242.64"	$0.00	$0.00	$0.00	$0.00	$0.00
MS060	DRG	MS060		MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC	INPATIENT ONLY	"$17,859.37"	"$13,215.93"	$0.00	"$17,386.96"	$0.00	$0.00	"$17,386.96"	"$17,386.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS061	DRG	MS061		"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC"	INPATIENT ONLY	"$95,693.84"	"$70,813.44"	$0.00	"$215,011.32"	"$92,084.48"	"$92,084.48"	"$31,007.07"	"$31,007.07"	$0.00	$0.00	$0.00	$0.00	$0.00	"$30,955.43"	$0.00	"$31,627.21"	$0.00	$0.00	"$32,892.67"	"$176,461.31"	"$215,011.32"	$0.00	"$32,518.99"	$0.00	"$32,518.99"	$0.00	"$35,958.33"	"$35,958.33"	"$31,326.35"	$0.00	$0.00	$0.00	$0.00	$0.00
MS062	DRG	MS062		"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC"	INPATIENT ONLY	"$103,906.20"	"$76,890.59"	$0.00	"$73,869.50"	"$19,584.47"	"$19,584.47"	"$24,775.73"	"$24,775.73"	"$16,561.69"	$0.00	$0.00	$0.00	$0.00	"$24,740.22"	$0.00	"$25,271.24"	"$29,824.50"	"$29,824.50"	"$27,546.62"	"$15,607.97"	"$73,869.50"	$0.00	"$20,160.87"	"$29,824.50"	"$20,160.87"	$0.00	"$29,569.72"	"$29,569.72"	"$26,234.88"	$0.00	$0.00	$0.00	$0.00	$0.00
MS063	DRG	MS063		"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC"	INPATIENT ONLY	"$95,685.66"	"$70,807.39"	$0.00	"$50,374.27"	"$8,398.95"	"$8,398.95"	"$22,852.96"	"$22,852.96"	"$13,476.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,310.02"	"$25,645.50"	"$25,645.50"	$0.00	"$18,358.07"	"$50,374.27"	$0.00	"$16,848.86"	"$25,645.50"	"$16,848.86"	$0.00	"$26,871.51"	"$26,871.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS064	DRG	MS064		INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC	INPATIENT ONLY	"$123,857.52"	"$91,654.56"	$0.00	"$110,327.78"	"$110,327.78"	"$110,327.78"	"$25,320.78"	"$25,320.78"	"$15,513.81"	"$25,409.92"	$0.00	$0.00	"$17,959.97"	"$25,286.52"	"$25,409.92"	"$24,782.69"	"$28,783.50"	"$28,783.50"	"$26,614.49"	"$27,643.93"	"$64,405.47"	$0.00	"$18,793.56"	"$28,783.50"	"$18,793.56"	"$44,500.15"	"$28,455.79"	"$28,455.79"	"$25,347.13"	"$25,793.36"	$0.00	$0.00	$0.00	$0.00
MS065	DRG	MS065		INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS	INPATIENT ONLY	"$79,103.20"	"$58,536.37"	$0.00	"$60,123.35"	"$27,569.45"	"$27,569.45"	"$18,093.01"	"$18,093.01"	"$9,499.65"	"$13,734.30"	$0.00	$0.00	"$6,993.69"	"$18,074.80"	"$13,734.30"	"$18,454.87"	"$15,300.00"	"$15,300.00"	"$20,825.64"	"$15,153.44"	"$60,123.35"	"$54,112.55"	"$10,301.98"	"$15,300.00"	"$10,301.98"	$0.00	"$21,537.99"	"$21,537.99"	"$19,833.94"	$0.00	$0.00	$0.00	$0.00	$0.00
MS066	DRG	MS066		INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC	INPATIENT ONLY	"$41,730.17"	"$30,880.33"	$0.00	"$30,837.84"	$0.00	$0.00	"$15,964.58"	"$15,964.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,283.87"	$0.00	$0.00	"$18,702.38"	"$8,810.14"	"$30,837.84"	$0.00	"$7,187.44"	$0.00	"$7,187.44"	$0.00	"$19,000.67"	"$19,000.67"	"$17,811.79"	$0.00	$0.00	$0.00	$0.00	$0.00
MS067	DRG	MS067		NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC	INPATIENT ONLY	"$113,443.89"	"$83,948.48"	$0.00	"$25,105.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,105.11"	"$25,105.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS068	DRG	MS068		NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC	INPATIENT ONLY	"$68,653.56"	"$50,803.63"	$0.00	"$20,522.91"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,976.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,522.91"	"$20,522.91"	"$19,024.95"	$0.00	$0.00	$0.00	$0.00	$0.00
MS069	DRG	MS069		TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC	INPATIENT ONLY	"$52,701.73"	"$38,999.28"	$0.00	"$19,517.62"	"$4,165.08"	"$4,165.08"	"$16,485.64"	"$16,485.64"	$0.00	$0.00	$0.00	$0.00	"$3,348.41"	"$16,471.58"	$0.00	"$16,815.35"	$0.00	$0.00	"$19,134.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,517.62"	"$19,517.62"	"$18,223.78"	$0.00	$0.00	$0.00	$0.00	$0.00
MS070	DRG	MS070		NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC	INPATIENT ONLY	"$118,539.35"	"$87,719.12"	$0.00	"$36,315.50"	"$16,579.68"	"$16,579.68"	"$22,645.22"	"$22,645.22"	"$14,672.11"	$0.00	$0.00	$0.00	$0.00	"$36,315.50"	$0.00	"$23,098.12"	"$25,194.00"	"$25,194.00"	"$25,234.77"	$0.00	$0.00	$0.00	$0.00	"$25,194.00"	$0.00	$0.00	"$32,577.11"	"$32,577.11"	"$28,582.72"	$0.00	$0.00	$0.00	$0.00	$0.00
MS071	DRG	MS071		NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC	INPATIENT ONLY	"$54,131.74"	"$40,057.49"	$0.00	"$35,678.57"	"$4,086.60"	"$4,086.60"	"$18,036.40"	"$18,036.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,018.34"	$0.00	"$18,397.13"	$0.00	$0.00	"$20,600.14"	$0.00	$0.00	"$35,678.57"	$0.00	$0.00	$0.00	$0.00	"$21,268.52"	"$21,268.52"	"$19,619.18"	$0.00	$0.00	$0.00	$0.00	$0.00
MS072	DRG	MS072		NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC	INPATIENT ONLY	"$61,347.12"	"$45,396.87"	$0.00	"$18,849.31"	$0.00	$0.00	"$16,379.34"	"$16,379.34"	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,365.57"	$0.00	"$16,706.93"	$0.00	$0.00	"$18,849.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,951.72"	$0.00	$0.00	$0.00	$0.00	$0.00
MS073	DRG	MS073		CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC	INPATIENT ONLY	"$41,000.17"	"$30,340.13"	$0.00	"$24,705.77"	$0.00	$0.00	"$21,080.64"	"$21,080.64"	$0.00	"$14,136.39"	$0.00	$0.00	$0.00	$0.00	"$14,136.39"	"$21,502.25"	$0.00	$0.00	"$23,476.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,705.77"	"$24,705.77"	"$22,358.52"	$0.00	$0.00	$0.00	$0.00	$0.00
MS074	DRG	MS074		CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC	INPATIENT ONLY	"$33,436.38"	"$24,742.92"	$0.00	"$36,882.23"	"$25,719.00"	"$25,719.00"	$0.00	$0.00	$0.00	"$8,974.55"	$0.00	$0.00	"$6,696.82"	"$18,067.90"	"$8,974.55"	$0.00	$0.00	$0.00	"$20,555.00"	"$14,569.53"	"$36,882.23"	$0.00	"$9,905.01"	$0.00	"$9,905.01"	"$8,589.85"	"$21,214.59"	"$21,214.59"	"$19,576.19"	"$9,019.34"	$0.00	$0.00	$0.00	$0.00
MS075	DRG	MS075		VIRAL MENINGITIS WITH CC/MCC	INPATIENT ONLY	"$63,854.38"	"$47,252.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS077	DRG	MS077		HYPERTENSIVE ENCEPHALOPATHY WITH MCC	INPATIENT ONLY	"$29,147.98"	"$21,569.51"	$0.00	"$25,742.09"	"$13,255.89"	"$13,255.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,065.43"	$0.00	$0.00	"$24,343.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,742.09"	"$25,742.09"	"$23,184.42"	$0.00	$0.00	$0.00	$0.00	$0.00
MS078	DRG	MS078		HYPERTENSIVE ENCEPHALOPATHY WITH CC	INPATIENT ONLY	"$59,520.47"	"$44,045.15"	$0.00	"$20,376.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,376.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,406.35"	$0.00	$0.00	$0.00	$0.00	$0.00
MS080	DRG	MS080		NONTRAUMATIC STUPOR AND COMA WITH MCC	INPATIENT ONLY	"$109,992.22"	"$81,394.24"	$0.00	"$29,003.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$29,003.98"	"$29,003.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS081	DRG	MS081		NONTRAUMATIC STUPOR AND COMA WITHOUT MCC	INPATIENT ONLY	"$65,998.93"	"$48,839.21"	$0.00	"$20,324.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,324.45"	"$20,324.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS082	DRG	MS082		TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC	INPATIENT ONLY	"$109,243.85"	"$80,840.45"	$0.00	"$73,345.89"	"$12,231.51"	"$12,231.51"	"$26,677.77"	"$26,677.77"	"$17,085.63"	$0.00	$0.00	$0.00	"$16,934.46"	"$26,637.35"	$0.00	"$33,757.89"	"$33,958.50"	"$33,958.50"	"$29,190.82"	"$60,195.49"	"$73,345.89"	$0.00	"$22,572.74"	"$33,958.50"	"$22,572.74"	$0.00	"$31,534.56"	"$31,534.56"	"$27,800.78"	$0.00	$0.00	$0.00	$0.00	$0.00
MS083	DRG	MS083		TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC	INPATIENT ONLY	"$91,871.44"	"$67,984.87"	$0.00	"$83,592.12"	"$19,781.66"	"$19,781.66"	"$20,329.09"	"$20,329.09"	"$11,068.80"	$0.00	$0.00	$0.00	"$16,307.27"	"$20,305.08"	$0.00	"$20,735.67"	"$20,160.00"	"$20,160.00"	"$22,759.59"	"$68,604.63"	"$83,592.12"	$0.00	"$13,138.85"	"$20,160.00"	"$13,138.85"	$0.00	"$23,849.11"	"$23,849.11"	"$21,675.80"	$0.00	$0.00	$0.00	$0.00	$0.00
MS084	DRG	MS084		TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC	INPATIENT ONLY	"$60,065.16"	"$44,448.22"	$0.00	"$105,860.74"	"$105,860.74"	"$105,860.74"	"$17,303.46"	"$17,303.46"	$0.00	$0.00	$0.00	$0.00	"$21,552.95"	"$17,287.29"	$0.00	"$17,649.53"	$0.00	$0.00	"$18,985.24"	"$74,022.47"	"$90,193.56"	$0.00	"$8,994.81"	$0.00	"$8,994.81"	$0.00	"$20,473.08"	"$20,473.08"	"$18,985.24"	$0.00	$0.00	$0.00	$0.00	$0.00
MS085	DRG	MS085		TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC	INPATIENT ONLY	"$133,066.60"	"$98,469.28"	$0.00	"$189,335.99"	"$129,464.98"	"$129,464.98"	"$27,007.67"	"$27,007.67"	$0.00	$0.00	$0.00	$0.00	"$46,184.90"	"$26,966.37"	$0.00	"$27,547.82"	$0.00	$0.00	"$29,149.82"	"$155,389.38"	"$189,335.99"	$0.00	"$23,840.21"	$0.00	"$23,840.21"	"$6,719.03"	"$39,231.69"	"$39,231.69"	"$27,761.73"	"$7,054.97"	$0.00	$0.00	$0.00	$0.00
MS086	DRG	MS086		TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC	INPATIENT ONLY	"$91,005.46"	"$67,344.04"	$0.00	"$156,793.36"	"$16,054.95"	"$16,054.95"	"$19,849.42"	"$19,849.42"	"$9,979.86"	$0.00	$0.00	$0.00	"$39,612.08"	"$19,826.66"	$0.00	"$20,246.41"	"$66,216.14"	"$66,216.14"	"$22,261.41"	"$21,878.17"	"$26,657.70"	"$156,793.36"	"$12,408.08"	"$66,216.14"	"$12,408.08"	$0.00	"$23,253.77"	"$23,253.77"	"$21,201.34"	$0.00	$0.00	$0.00	$0.00	$0.00
MS087	DRG	MS087		TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC	INPATIENT ONLY	"$54,038.57"	"$39,988.54"	$0.00	"$54,184.31"	"$10,442.68"	"$10,442.68"	"$17,013.59"	"$17,013.59"	"$6,658.59"	"$6,337.82"	$0.00	$0.00	"$4,618.49"	$0.00	"$6,337.82"	"$17,353.86"	"$12,954.00"	"$12,954.00"	"$19,537.48"	"$44,469.44"	"$54,184.31"	$0.00	"$8,412.39"	"$12,954.00"	"$8,412.39"	"$6,066.14"	"$19,998.62"	"$19,998.62"	"$18,607.12"	"$6,369.44"	$0.00	$0.00	$0.00	$0.00
MS088	DRG	MS088		CONCUSSION WITH MCC	INPATIENT ONLY	"$61,942.49"	"$45,837.44"	$0.00	"$12,687.93"	$0.00	$0.00	$0.00	$0.00	$0.00	"$12,687.93"	$0.00	$0.00	$0.00	$0.00	"$12,687.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS089	DRG	MS089		CONCUSSION WITH CC	INPATIENT ONLY	"$82,992.64"	"$61,414.55"	$0.00	"$74,998.20"	"$74,998.20"	"$74,998.20"	"$18,393.22"	"$18,393.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,761.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS090	DRG	MS090		CONCUSSION WITHOUT CC/MCC	INPATIENT ONLY	"$63,676.92"	"$47,120.92"	$0.00	"$19,599.65"	$0.00	$0.00	$0.00	$0.00	"$6,563.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$12,819.00"	"$12,819.00"	"$19,599.65"	$0.00	$0.00	$0.00	$0.00	"$12,819.00"	$0.00	$0.00	$0.00	$0.00	"$18,666.33"	$0.00	$0.00	$0.00	$0.00	$0.00
MS091	DRG	MS091		OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC	INPATIENT ONLY	"$52,693.58"	"$38,993.25"	$0.00	"$26,373.98"	$0.00	$0.00	"$26,373.98"	"$26,373.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,895.40"	$0.00	$0.00	"$24,498.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,926.64"	"$25,926.64"	"$23,331.51"	$0.00	$0.00	$0.00	$0.00	$0.00
MS092	DRG	MS092		OTHER DISORDERS OF NERVOUS SYSTEM WITH CC	INPATIENT ONLY	"$112,379.69"	"$83,160.97"	$0.00	"$60,857.94"	"$4,119.13"	"$4,119.13"	"$17,878.35"	"$17,878.35"	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,860.69"	$0.00	"$18,235.92"	$0.00	$0.00	"$20,404.67"	"$3,652.60"	"$60,857.94"	$0.00	"$9,684.47"	$0.00	"$9,684.47"	$0.00	"$21,034.94"	"$21,034.94"	"$19,433.02"	$0.00	$0.00	$0.00	$0.00	$0.00
MS093	DRG	MS093		OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC	INPATIENT ONLY	"$23,227.89"	"$17,188.64"	$0.00	"$21,343.61"	"$5,791.65"	"$5,791.65"	"$16,451.82"	"$16,451.82"	$0.00	"$7,940.48"	$0.00	$0.00	$0.00	"$16,437.85"	"$7,940.48"	"$16,780.86"	$0.00	$0.00	"$19,004.44"	"$4,008.53"	"$21,343.61"	$0.00	"$7,630.49"	$0.00	"$7,630.49"	$0.00	"$19,361.64"	"$19,361.64"	"$18,099.47"	$0.00	$0.00	$0.00	$0.00	$0.00
MS094	DRG	MS094		BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC	INPATIENT ONLY	"$208,527.33"	"$154,310.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS095	DRG	MS095		BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC	INPATIENT ONLY	"$128,295.60"	"$94,938.74"	$0.00	"$28,357.59"	$0.00	$0.00	"$28,357.59"	"$28,357.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS097	DRG	MS097		NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC	INPATIENT ONLY	"$40,298.97"	"$29,821.24"	$0.00	"$141,271.31"	"$13,337.55"	"$13,337.55"	"$37,005.85"	"$37,005.85"	$0.00	$0.00	$0.00	$0.00	"$141,271.31"	"$36,938.70"	$0.00	"$37,745.97"	$0.00	$0.00	"$38,239.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$46,143.44"	$0.00	$0.00	$0.00	$0.00	$0.00
MS098	DRG	MS098		NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC	INPATIENT ONLY	"$81,880.42"	"$60,591.51"	$0.00	"$27,162.57"	$0.00	$0.00	"$25,632.89"	"$25,632.89"	$0.00	$0.00	$0.00	$0.00	"$6,696.82"	$0.00	$0.00	"$26,145.55"	$0.00	$0.00	"$27,162.57"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,869.11"	$0.00	$0.00	$0.00	$0.00	$0.00
MS099	DRG	MS099		NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC	INPATIENT ONLY	"$174,672.76"	"$129,257.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS100	DRG	MS100		SEIZURES WITH MCC	INPATIENT ONLY	"$113,408.24"	"$83,922.10"	$0.00	"$127,077.03"	"$41,317.50"	"$41,317.50"	"$28,871.11"	"$28,871.11"	"$13,659.94"	"$16,066.40"	$0.00	$0.00	"$16,742.05"	"$23,969.93"	"$16,066.40"	"$24,483.50"	"$28,146.00"	"$28,146.00"	"$26,241.38"	"$104,293.01"	"$127,077.03"	$0.00	"$18,246.24"	"$28,146.00"	"$18,246.24"	$0.00	"$28,009.92"	"$28,009.92"	"$24,991.79"	$0.00	$0.00	$0.00	$0.00	$0.00
MS101	DRG	MS101		SEIZURES WITHOUT MCC	INPATIENT ONLY	"$40,436.43"	"$29,922.96"	$0.00	"$30,456.31"	"$20,980.25"	"$20,980.25"	"$17,184.76"	"$17,184.76"	$0.00	"$7,244.17"	$0.00	$0.00	$0.00	"$17,168.90"	"$7,244.17"	"$17,528.46"	$0.00	$0.00	"$19,836.12"	"$3,828.93"	"$30,456.31"	"$28,419.72"	"$8,850.46"	$0.00	"$8,850.46"	"$6,933.64"	"$20,355.50"	"$20,355.50"	"$18,891.54"	"$7,280.31"	$0.00	$0.00	$0.00	$0.00
MS102	DRG	MS102		HEADACHES WITH MCC	INPATIENT ONLY	"$29,362.26"	"$21,728.07"	$0.00	"$19,391.81"	"$8,589.34"	"$8,589.34"	"$19,011.58"	"$19,011.58"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,990.99"	$0.00	"$19,391.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS103	DRG	MS103		HEADACHES WITHOUT MCC	INPATIENT ONLY	"$49,370.41"	"$36,534.10"	$0.00	"$19,674.42"	"$15,663.02"	"$15,663.02"	"$16,778.24"	"$16,778.24"	"$6,172.14"	$0.00	$0.00	$0.00	"$6,696.82"	"$16,763.43"	$0.00	"$17,113.80"	"$12,442.50"	"$12,442.50"	$0.00	$0.00	$0.00	$0.00	$0.00	"$12,442.50"	$0.00	"$6,384.88"	"$19,674.42"	"$19,674.42"	$0.00	"$6,704.13"	$0.00	$0.00	$0.00	$0.00
MS113	DRG	MS113		ORBITAL PROCEDURES WITH CC/MCC	INPATIENT ONLY	"$138,306.42"	"$102,346.75"	$0.00	"$276,386.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$134,305.87"	$0.00	$0.00	"$28,372.83"	"$191,344.73"	"$233,146.18"	"$276,386.52"	"$36,547.34"	$0.00	"$36,547.34"	$0.00	"$30,557.04"	"$30,557.04"	"$27,021.74"	$0.00	$0.00	$0.00	$0.00	$0.00
MS114	DRG	MS114		ORBITAL PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$87,408.31"	"$64,682.15"	$0.00	"$22,869.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,940.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,869.95"	"$22,869.95"	"$20,895.44"	$0.00	$0.00	$0.00	$0.00	$0.00
MS115	DRG	MS115		EXTRAOCULAR PROCEDURES EXCEPT ORBIT	INPATIENT ONLY	"$67,898.23"	"$50,244.69"	$0.00	"$105,509.24"	"$105,509.24"	"$105,509.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS116	DRG	MS116		INTRAOCULAR PROCEDURES WITH CC/MCC	INPATIENT ONLY	"$82,320.88"	"$60,917.45"	$0.00	"$30,595.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,725.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$30,595.31"	$0.00	$0.00	$0.00	$0.00	$0.00
MS117	DRG	MS117		INTRAOCULAR PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$367,970.92"	"$272,298.48"	$0.00	"$239,144.21"	$0.00	$0.00	$0.00	$0.00	"$61,633.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$239,144.21"	"$239,144.21"	$0.00	$0.00	$0.00	$0.00	$0.00	"$239,144.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS121	DRG	MS121		ACUTE MAJOR EYE INFECTIONS WITH CC/MCC	INPATIENT ONLY	"$15,973.21"	"$11,820.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS123	DRG	MS123		NEUROLOGICAL EYE DISORDERS	INPATIENT ONLY	"$44,663.68"	"$33,051.12"	$0.00	"$16,672.44"	$0.00	$0.00	"$16,345.53"	"$16,345.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,672.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS124	DRG	MS124		OTHER DISORDERS OF THE EYE WITH MCC	INPATIENT ONLY	"$29,314.17"	"$21,692.49"	$0.00	"$26,180.77"	"$26,180.77"	"$26,180.77"	"$20,729.36"	"$20,729.36"	"$10,203.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,143.95"	"$21,030.00"	"$21,030.00"	$0.00	"$3,939.75"	"$21,706.29"	$0.00	"$13,927.76"	"$21,030.00"	"$13,927.76"	$0.00	"$24,491.81"	"$24,491.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS125	DRG	MS125		OTHER DISORDERS OF THE EYE WITHOUT MCC	INPATIENT ONLY	"$41,942.08"	"$31,037.14"	$0.00	"$19,591.92"	$0.00	$0.00	"$16,830.03"	"$16,830.03"	$0.00	$0.00	$0.00	$0.00	"$6,552.22"	$0.00	$0.00	"$17,166.63"	$0.00	$0.00	"$19,197.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,591.92"	"$19,591.92"	"$18,282.99"	$0.00	$0.00	$0.00	$0.00	$0.00
MS137	DRG	MS137		MOUTH PROCEDURES WITH CC/MCC	INPATIENT ONLY	"$21,396.53"	"$15,833.43"	$0.00	"$22,914.03"	"$13,358.33"	"$13,358.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,914.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,380.67"	$0.00	$0.00	"$21,822.89"	"$8,799.70"	$0.00	$0.00	$0.00	$0.00
MS138	DRG	MS138		MOUTH PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$106,064.54"	"$78,487.76"	$0.00	"$17,303.89"	"$8,601.10"	"$8,601.10"	"$16,964.60"	"$16,964.60"	$0.00	$0.00	$0.00	$0.00	"$17,079.99"	"$16,949.30"	$0.00	"$17,303.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS139	DRG	MS139		SALIVARY GLAND PROCEDURES	INPATIENT ONLY	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS140	DRG	MS140		MAJOR HEAD AND NECK PROCEDURES WITH MCC	INPATIENT ONLY	"$309,670.31"	"$229,156.03"	$0.00	"$213,352.18"	"$194,628.71"	"$194,628.71"	"$60,708.75"	"$60,708.75"	"$194,363.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$213,352.18"	"$213,352.18"						"$213,352.18"	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS141	DRG	MS141		MAJOR HEAD AND NECK PROCEDURES WITH CC	INPATIENT ONLY	"$205,684.54"	"$152,206.56"	$0.00	"$93,559.19"	$0.00	$0.00	"$26,278.86"	"$26,278.86"	$0.00	$0.00	$0.00	$0.00	"$93,559.19"	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS142	DRG	MS142		MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$165,428.82"	"$122,417.33"	$0.00	"$124,242.12"	"$91,709.28"	"$91,709.28"	$0.00	$0.00	"$24,814.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$124,242.12"	"$124,242.12"						"$124,242.12"	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS143	DRG	MS143		"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC"	INPATIENT ONLY	"$304,173.95"	"$225,088.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS144	DRG	MS144		"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC"	INPATIENT ONLY	"$18,109.68"	"$13,401.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS145	DRG	MS145		"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC"	INPATIENT ONLY	"$93,894.95"	"$69,482.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS146	DRG	MS146		"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC"	INPATIENT ONLY	"$179,849.11"	"$133,088.34"	$0.00	"$28,926.04"	$0.00	$0.00	"$25,140.12"	"$25,140.12"	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,103.67"	$0.00	"$25,642.92"	$0.00	$0.00	"$26,982.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$28,926.04"	"$28,926.04"	"$25,697.29"	$0.00	$0.00	$0.00	$0.00	$0.00
MS147	DRG	MS147		"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC"	INPATIENT ONLY	"$66,379.23"	"$49,120.63"	$0.00	"$97,982.21"	"$97,982.21"	"$97,982.21"	"$20,033.00"	"$20,033.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,009.77"	$0.00	"$20,433.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS149	DRG	MS149		DYSEQUILIBRIUM	INPATIENT ONLY	"$20,824.61"	"$15,410.21"	$0.00	"$19,110.92"	$0.00	$0.00	"$16,139.87"	"$16,139.87"	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,126.71"	$0.00	"$16,462.67"	$0.00	$0.00	"$18,794.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,110.92"	"$19,110.92"	"$17,899.66"	$0.00	$0.00	$0.00	$0.00	$0.00
MS150	DRG	MS150		EPISTAXIS WITH MCC	INPATIENT ONLY	"$39,367.10"	"$29,131.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS152	DRG	MS152		OTITIS MEDIA AND URI WITH MCC	INPATIENT ONLY	"$24,484.17"	"$18,118.29"	$0.00	"$20,902.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$13,393.64"	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,902.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,907.48"	$0.00	$0.00	$0.00	$0.00	$0.00
MS153	DRG	MS153		OTITIS MEDIA AND URI WITHOUT MCC	INPATIENT ONLY	"$23,118.21"	"$17,107.48"	$0.00	"$18,914.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$10,415.87"	"$16,796.75"	$0.00	"$7,081.17"	$0.00	"$7,081.17"	$0.00	"$18,914.10"	"$18,914.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS154	DRG	MS154		"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC"	INPATIENT ONLY	"$93,847.35"	"$69,447.04"	$0.00	"$22,163.26"	$0.00	$0.00	"$21,728.69"	"$21,728.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,163.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS155	DRG	MS155		"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC"	INPATIENT ONLY	"$43,876.11"	"$32,468.32"	$0.00	"$20,504.12"	$0.00	$0.00	"$17,330.38"	"$17,330.38"	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,314.14"	$0.00	"$17,676.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,166.65"	"$20,504.12"	"$20,504.12"	$0.00	"$6,474.98"	$0.00	$0.00	$0.00	$0.00
MS156	DRG	MS156		"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC"	INPATIENT ONLY	"$23,686.23"	"$17,527.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS157	DRG	MS157		DENTAL AND ORAL DISEASES WITH MCC	INPATIENT ONLY	"$74,941.49"	"$55,456.70"	$0.00	"$25,908.70"	$0.00	$0.00	"$21,931.61"	"$21,931.61"	$0.00	$0.00	$0.00	$0.00	"$21,981.73"	"$21,903.46"	$0.00	"$22,370.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,908.70"	"$25,908.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS158	DRG	MS158		DENTAL AND ORAL DISEASES WITH CC	INPATIENT ONLY	"$78,110.53"	"$57,801.79"	$0.00	"$20,222.38"	$0.00	$0.00	"$17,266.18"	"$17,266.18"	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,250.11"	$0.00	"$17,611.50"	$0.00	$0.00	"$19,724.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,376.14"	"$20,222.38"	"$20,222.38"	"$18,785.45"	"$8,794.95"	$0.00	$0.00	$0.00	$0.00
MS159	DRG	MS159		DENTAL AND ORAL DISEASES WITHOUT CC/MCC	INPATIENT ONLY	"$77,636.24"	"$57,450.82"	$0.00	"$49,192.35"	"$17,283.48"	"$17,283.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,401.02"	"$7,632.24"	"$49,192.35"	$0.00	"$6,745.36"	$0.00	"$6,745.36"	$0.00	"$18,640.54"	"$18,640.54"	"$17,524.78"	$0.00	$0.00	$0.00	$0.00	$0.00
MS163	DRG	MS163		MAJOR CHEST PROCEDURES WITH MCC	INPATIENT ONLY	"$279,043.80"	"$206,492.41"	$0.00	"$296,439.13"	"$137,000.36"	"$137,000.36"	$0.00	$0.00	$0.00	"$51,285.84"	$0.00	$0.00	"$112,921.68"	$0.00	"$53,850.16"	"$48,524.14"	$0.00	$0.00	$0.00	"$243,289.68"	"$296,439.13"	$0.00	"$60,731.26"	$0.00	"$60,731.26"	$0.00	"$52,946.21"	"$52,946.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS164	DRG	MS164		MAJOR CHEST PROCEDURES WITH CC	INPATIENT ONLY	"$282,327.09"	"$208,922.05"	$0.00	"$223,039.12"	"$220,306.22"	"$220,306.22"	$0.00	$0.00	"$62,096.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$223,039.12"	"$223,039.12"	"$31,102.90"	"$182,933.69"	"$222,897.67"	$0.00	"$34,322.38"	"$223,039.12"	"$34,322.38"	$0.00	"$33,819.53"	"$33,819.53"	"$29,621.81"	$0.00	$0.00	$0.00	$0.00	$0.00
MS165	DRG	MS165		MAJOR CHEST PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$65,007.56"	"$48,105.59"	$0.00	"$28,246.73"	$0.00	$0.00	"$24,280.88"	"$24,280.88"	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,246.64"	$0.00	"$24,766.50"	$0.00	$0.00	"$26,439.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$28,246.73"	"$28,246.73"	"$25,180.51"	$0.00	$0.00	$0.00	$0.00	$0.00
MS166	DRG	MS166		OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC	INPATIENT ONLY	"$178,026.71"	"$131,739.77"	$0.00	"$55,255.73"	$0.00	$0.00	"$36,751.19"	"$36,751.19"	$0.00	$0.00	$0.00	$0.00	$0.00	"$36,684.69"	$0.00	"$37,486.21"	$0.00	$0.00	"$39,297.27"	"$16,179.17"	"$55,255.73"	$0.00	"$37,397.68"	$0.00	"$37,397.68"	$0.00	"$43,611.96"	"$43,611.96"	"$47,571.93"	$0.00	$0.00	$0.00	$0.00	$0.00
MS167	DRG	MS167		OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC	INPATIENT ONLY	"$133,062.87"	"$98,466.52"	$0.00	"$32,510.42"	$0.00	$0.00	"$23,605.22"	"$23,605.22"	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,572.75"	$0.00	"$24,077.32"	$0.00	$0.00	"$26,885.12"	"$16,604.60"	"$32,510.42"	$0.00	"$19,190.53"	$0.00	"$19,190.53"	"$17,468.56"	"$28,779.21"	"$28,779.21"	"$25,604.88"	"$18,341.98"	$0.00	$0.00	$0.00	$0.00
MS168	DRG	MS168		OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$296,531.05"	"$219,432.98"	$0.00	"$22,868.93"	$0.00	$0.00	"$20,400.85"	"$20,400.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,511.55"	$0.00	$0.00	"$22,868.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,779.93"	$0.00	$0.00	$0.00	$0.00	$0.00
MS175	DRG	MS175		PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE	INPATIENT ONLY	"$46,945.21"	"$34,739.46"	$0.00	"$38,070.00"	"$26,408.34"	"$26,408.34"	"$21,723.17"	"$21,723.17"	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,695.56"	$0.00	"$22,157.63"	$0.00	$0.00	"$23,432.41"	"$16,704.06"	"$38,070.00"	$0.00	"$14,479.10"	$0.00	"$14,479.10"	$0.00	"$24,940.97"	"$24,940.97"	"$22,316.58"	$0.00	$0.00	$0.00	$0.00	$0.00
MS176	DRG	MS176		PULMONARY EMBOLISM WITHOUT MCC	INPATIENT ONLY	"$35,673.42"	"$26,398.33"	$0.00	"$18,666.99"	$0.00	$0.00	"$17,180.62"	"$17,180.62"	$0.00	$0.00	$0.00	$0.00	"$3,348.41"	"$16,508.75"	$0.00	"$17,524.23"	$0.00	$0.00	"$18,666.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,736.43"	"$18,474.68"	"$18,474.68"	"$18,666.99"	"$8,233.74"	$0.00	$0.00	$0.00	$0.00
MS177	DRG	MS177		RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC	INPATIENT ONLY	"$54,920.67"	"$40,641.30"	$0.00	"$35,112.81"	"$24,674.54"	"$24,674.54"	"$29,566.11"	"$29,566.11"	"$17,398.03"	"$18,110.89"	$0.00	$0.00	"$24,142.73"	"$29,518.11"	"$18,110.89"	"$30,157.43"	"$27,736.50"	"$27,736.50"	"$26,726.58"	"$8,082.82"	"$21,757.37"	"$11,693.56"	"$18,957.97"	"$27,736.50"	"$18,957.97"	"$2,527.77"	"$35,112.81"	"$35,112.81"	"$30,597.17"	"$2,690.25"	$0.00	$0.00	$0.00	$0.00
MS178	DRG	MS178		RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC	INPATIENT ONLY	"$41,304.99"	"$30,565.69"	$0.00	"$31,014.33"	"$4,086.60"	"$4,086.60"	"$23,653.50"	"$23,653.50"	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,367.53"	$0.00	"$30,157.43"	$0.00	$0.00	"$22,298.99"	"$10,783.80"	"$31,014.33"	"$27,319.11"	"$12,463.21"	$0.00	"$12,463.21"	"$3,578.23"	"$27,587.02"	"$27,587.02"	"$24,618.39"	"$3,808.24"	$0.00	$0.00	$0.00	$0.00
MS179	DRG	MS179		RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC	INPATIENT ONLY	"$14,995.29"	"$11,096.51"	$0.00	"$27,548.37"	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,204.24"	$0.00	$0.00	$0.00	$0.00	"$6,880.87"	$858.97	$0.00	$0.00	"$19,721.29"	"$12,770.64"	"$27,548.37"	"$11,997.43"	"$8,682.05"	$0.00	"$8,682.05"	$0.00	"$23,205.61"	"$23,205.61"	"$21,137.62"	$0.00	$0.00	$0.00	$0.00	$0.00
MS180	DRG	MS180		RESPIRATORY NEOPLASMS WITH MCC	INPATIENT ONLY	"$96,534.84"	"$71,435.78"	$0.00	"$27,231.65"	$0.00	$0.00	"$23,061.38"	"$23,061.38"	$0.00	$0.00	$0.00	$0.00	"$23,438.87"	"$23,030.30"	$0.00	"$23,522.61"	$0.00	$0.00	"$25,590.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,231.65"	"$27,231.65"	"$24,371.54"	$0.00	$0.00	$0.00	$0.00	$0.00
MS181	DRG	MS181		RESPIRATORY NEOPLASMS WITH CC	INPATIENT ONLY	"$48,052.18"	"$35,558.61"	$0.00	"$22,553.09"	"$4,515.45"	"$4,515.45"	"$18,783.83"	"$18,783.83"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,763.84"	$0.00	"$19,159.51"	$0.00	$0.00	"$21,675.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,553.09"	"$22,553.09"	"$20,642.93"	$0.00	$0.00	$0.00	$0.00	$0.00
MS182	DRG	MS182		RESPIRATORY NEOPLASMS WITHOUT CC/MCC	INPATIENT ONLY	"$48,193.46"	"$35,663.16"	$0.00	"$19,562.08"	"$16,511.68"	"$16,511.68"	$0.00	$0.00	"$7,219.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,880.00"	"$11,880.00"	"$19,562.08"	$0.00	$0.00	$0.00	$0.00	"$11,880.00"	$0.00	$0.00	$0.00	$0.00	"$18,630.55"	$0.00	$0.00	$0.00	$0.00	$0.00
MS183	DRG	MS183		MAJOR CHEST TRAUMA WITH MCC	INPATIENT ONLY	"$71,723.96"	"$53,075.73"	$0.00	"$24,116.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,601.98"	$0.00	$0.00	"$24,116.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,967.71"	$0.00	$0.00	$0.00	$0.00	$0.00
MS184	DRG	MS184		MAJOR CHEST TRAUMA WITH CC	INPATIENT ONLY	"$80,313.41"	"$59,431.92"	$0.00	"$68,413.61"	"$22,437.76"	"$22,437.76"	"$18,237.24"	"$18,237.24"	$0.00	$0.00	$0.00	$0.00	"$68,413.61"	"$18,218.65"	$0.00	"$18,601.98"	$0.00	$0.00	"$20,760.71"	"$52,951.87"	"$64,519.81"	$0.00	"$10,206.75"	$0.00	"$10,206.75"	$0.00	"$21,460.41"	"$21,460.41"	"$19,772.10"	$0.00	$0.00	$0.00	$0.00	$0.00
MS185	DRG	MS185		MAJOR CHEST TRAUMA WITHOUT CC/MCC	INPATIENT ONLY	"$50,595.65"	"$37,440.78"	$0.00	"$19,139.50"	"$12,596.89"	"$12,596.89"	"$16,401.44"	"$16,401.44"	"$5,915.97"	$0.00	$0.00	$0.00	"$16,934.46"	"$16,387.60"	$0.00	"$16,729.47"	"$11,623.50"	"$11,623.50"	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,623.50"	$0.00	$0.00	"$19,139.50"	"$19,139.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS186	DRG	MS186		PLEURAL EFFUSION WITH MCC	INPATIENT ONLY	"$30,155.37"	"$22,314.97"	$0.00	"$39,070.27"	$0.00	$0.00	"$18,487.14"	"$18,487.14"	$0.00	$0.00	$0.00	$0.00	$0.00	"$39,070.27"	$0.00	"$18,856.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$31,067.06"	"$31,067.06"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS187	DRG	MS187		PLEURAL EFFUSION WITH CC	INPATIENT ONLY	"$66,163.36"	"$48,960.89"	$0.00	"$20,826.98"	$0.00	$0.00	"$18,182.03"	"$18,182.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,545.67"	$0.00	$0.00	"$20,826.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,835.22"	$0.00	$0.00	$0.00	$0.00	$0.00
MS188	DRG	MS188		PLEURAL EFFUSION WITHOUT CC/MCC	INPATIENT ONLY	"$23,754.99"	"$17,578.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS189	DRG	MS189		PULMONARY EDEMA AND RESPIRATORY FAILURE	INPATIENT ONLY	"$40,618.71"	"$30,057.85"	$0.00	"$36,477.30"	"$25,196.85"	"$25,196.85"	"$19,549.83"	"$19,549.83"	"$9,782.23"	"$12,640.58"	$0.00	$0.00	"$3,348.41"	"$19,493.51"	"$13,272.61"	"$19,905.70"	"$9,782.23"	"$9,782.23"	"$22,110.38"	"$15,587.39"	"$36,477.30"	"$26,164.57"	"$12,186.54"	"$9,782.23"	"$12,186.54"	$0.00	"$23,073.29"	"$23,073.29"	"$21,057.50"	$0.00	$0.00	$0.00	$0.00	$0.00
MS190	DRG	MS190		CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC	INPATIENT ONLY	"$22,075.42"	"$16,335.81"	$0.00	"$22,487.76"	"$8,385.55"	"$8,385.55"	"$17,727.21"	"$17,727.21"	$0.00	"$10,092.46"	$0.00	$0.00	$0.00	"$18,798.25"	"$10,597.09"	"$19,194.71"	$0.00	$0.00	"$21,620.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,487.76"	"$22,487.76"	"$20,590.86"	$0.00	$0.00	$0.00	$0.00	$0.00
MS191	DRG	MS191		CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC	INPATIENT ONLY	"$27,212.46"	"$20,137.22"	$0.00	"$20,436.33"	$0.00	$0.00	"$17,156.46"	"$17,156.46"	$0.00	"$14,254.34"	$0.00	$0.00	$0.00	"$17,140.67"	"$8,483.54"	"$17,499.59"	$0.00	$0.00	"$19,903.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,436.33"	"$20,436.33"	"$18,955.96"	$0.00	$0.00	$0.00	$0.00	$0.00
MS192	DRG	MS192		CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC	INPATIENT ONLY	"$39,809.35"	"$29,458.92"	$0.00	"$18,936.98"	"$8,173.20"	"$8,173.20"	"$15,854.15"	"$15,854.15"	$0.00	$0.00	$0.00	$0.00	"$3,348.41"	$0.00	$0.00	"$16,171.23"	$0.00	$0.00	"$18,649.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,936.98"	"$18,936.98"	"$17,761.04"	$0.00	$0.00	$0.00	$0.00	$0.00
MS193	DRG	MS193		SIMPLE PNEUMONIA AND PLEURISY WITH MCC	INPATIENT ONLY	"$53,920.15"	"$39,900.91"	$0.00	"$43,491.25"	"$24,519.60"	"$24,519.60"	"$20,108.24"	"$20,108.24"	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,084.80"	$0.00	"$20,510.40"	$0.00	$0.00	"$22,915.39"	"$3,781.24"	"$33,085.28"	"$43,491.25"	"$13,367.42"	$0.00	"$13,367.42"	"$12,168.50"	"$24,035.30"	"$24,035.30"	"$21,824.18"	"$12,776.92"	$0.00	$0.00	$0.00	$0.00
MS194	DRG	MS194		SIMPLE PNEUMONIA AND PLEURISY WITH CC	INPATIENT ONLY	"$23,780.48"	"$17,597.56"	$0.00	"$20,557.21"	$0.00	$0.00	"$17,015.67"	"$17,015.67"	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,000.25"	$0.00	"$17,355.98"	$0.00	$0.00	"$19,875.06"	"$6,896.00"	"$20,557.21"	$0.00	"$8,907.60"	$0.00	"$8,907.60"	"$2,899.29"	"$20,402.05"	"$20,402.05"	"$18,928.63"	"$3,085.65"	$0.00	$0.00	$0.00	$0.00
MS195	DRG	MS195		SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC	INPATIENT ONLY	"$27,752.98"	"$20,537.21"	$0.00	"$18,715.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$10,045.23"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,463.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,926.47"	"$18,715.67"	"$18,715.67"	"$17,584.66"	"$3,114.59"	$0.00	$0.00	$0.00	$0.00
MS196	DRG	MS196		INTERSTITIAL LUNG DISEASE WITH MCC	INPATIENT ONLY	"$62,019.94"	"$45,894.76"	$0.00	"$50,112.69"	"$4,298.95"	"$4,298.95"	"$23,052.43"	"$23,052.43"	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,021.37"	$0.00	"$23,513.48"	$0.00	$0.00	"$25,251.85"	"$24,703.77"	"$50,112.69"	$0.00	"$16,794.73"	$0.00	"$16,794.73"	$0.00	"$26,827.41"	"$26,827.41"	"$24,049.38"	$0.00	$0.00	$0.00	$0.00	$0.00
MS197	DRG	MS197		INTERSTITIAL LUNG DISEASE WITH CC	INPATIENT ONLY	"$33,882.40"	"$25,072.98"	$0.00	"$21,487.37"	$0.00	$0.00	"$18,003.28"	"$18,003.28"	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,985.30"	$0.00	"$18,363.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,487.37"	"$21,487.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS198	DRG	MS198		INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC	INPATIENT ONLY	"$58,135.75"	"$43,020.46"	$0.00	"$6,417.29"	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,111.70"	$0.00	$0.00	$0.00	$0.00	"$6,417.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS199	DRG	MS199		PNEUMOTHORAX WITH MCC	INPATIENT ONLY	"$87,933.44"	"$65,070.75"	$0.00	"$71,834.87"	"$22,271.35"	"$22,271.35"	"$28,615.62"	"$28,615.62"	"$16,374.25"	"$20,990.30"	$0.00	$0.00	$0.00	"$33,369.82"	"$20,995.35"	"$29,187.93"	"$26,850.00"	"$26,850.00"	$0.00	"$19,741.79"	"$71,834.87"	$0.00	"$17,984.61"	"$26,850.00"	"$17,984.61"	"$13,711.52"	"$27,796.78"	"$27,796.78"	$0.00	"$14,397.09"	$0.00	$0.00	$0.00	$0.00
MS200	DRG	MS200		PNEUMOTHORAX WITH CC	INPATIENT ONLY	"$88,938.55"	"$65,814.53"	$0.00	"$41,863.22"	"$26,577.44"	"$26,577.44"	"$18,482.92"	"$18,482.92"	"$9,000.71"	"$7,212.00"	$0.00	$0.00	"$7,290.56"	$0.00	"$7,212.00"	"$18,852.58"	"$16,147.50"	"$16,147.50"	"$21,197.39"	"$7,597.89"	"$33,230.54"	"$41,863.22"	"$10,847.31"	"$16,147.50"	"$10,847.31"	"$6,902.85"	"$21,982.26"	"$21,982.26"	"$20,187.99"	"$7,247.99"	$0.00	$0.00	$0.00	$0.00
MS201	DRG	MS201		PNEUMOTHORAX WITHOUT CC/MCC	INPATIENT ONLY	"$18,226.67"	"$13,487.74"	$0.00	"$28,659.30"	"$28,659.30"	"$28,659.30"	$0.00	$0.00	$0.00	"$5,832.61"	$0.00	$0.00	$0.00	$0.00	"$5,832.61"	"$16,269.80"	$0.00	$0.00	"$18,709.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,818.31"	$0.00	$0.00	$0.00	$0.00	$0.00
MS202	DRG	MS202		BRONCHITIS AND ASTHMA WITH CC/MCC	INPATIENT ONLY	"$27,125.85"	"$20,073.13"	$0.00	"$20,887.13"	"$8,642.61"	"$8,642.61"	"$17,727.21"	"$17,727.21"	$0.00	"$7,793.93"	$0.00	$0.00	$0.00	$0.00	"$8,183.63"	"$18,081.75"	$0.00	$0.00	"$20,280.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,887.13"	"$20,887.13"	"$19,315.22"	$0.00	$0.00	$0.00	$0.00	$0.00
MS203	DRG	MS203		BRONCHITIS AND ASTHMA WITHOUT CC/MCC	INPATIENT ONLY	"$17,147.67"	"$12,689.28"	$0.00	"$18,811.21"	$0.00	$0.00	"$15,932.82"	"$15,932.82"	$0.00	"$3,735.21"	$0.00	$0.00	"$3,348.41"	"$15,920.20"	"$5,866.67"	"$16,251.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,811.21"	"$18,811.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS204	DRG	MS204		RESPIRATORY SIGNS AND SYMPTOMS	INPATIENT ONLY	"$12,787.21"	"$9,462.54"	$0.00	"$116,821.39"	"$114,402.61"	"$114,402.61"	"$16,530.50"	"$16,530.50"	"$19,192.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,861.11"	"$116,821.39"	"$116,821.39"	"$19,354.99"	$0.00	$0.00	$0.00	$0.00	"$116,821.39"	$0.00	$0.00	"$19,780.56"	"$19,780.56"	"$18,433.32"	$0.00	$0.00	$0.00	$0.00	$0.00
MS205	DRG	MS205		OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC	INPATIENT ONLY	"$71,391.42"	"$52,829.65"	$0.00	"$46,642.66"	"$16,664.62"	"$16,664.62"	"$27,050.39"	"$27,050.39"	"$12,495.13"	$0.00	$0.00	$0.00	$0.00	"$22,651.02"	$0.00	"$27,591.40"	"$25,272.00"	"$25,272.00"	"$24,970.31"	"$12,908.72"	"$46,642.66"	$0.00	"$16,381.71"	"$25,272.00"	"$16,381.71"	$0.00	"$26,490.96"	"$26,490.96"	"$23,781.25"	$0.00	$0.00	$0.00	$0.00	$0.00
MS206	DRG	MS206		OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC	INPATIENT ONLY	"$30,695.99"	"$22,715.03"	$0.00	"$34,911.74"	$0.00	$0.00	"$17,168.19"	"$17,168.19"	$0.00	"$6,502.44"	$0.00	$0.00	"$10,045.23"	"$17,152.37"	"$6,502.44"	$0.00	$0.00	$0.00	"$19,765.04"	"$4,150.00"	"$34,911.74"	$0.00	"$8,746.21"	$0.00	"$8,746.21"	$0.00	"$20,270.57"	"$20,270.57"	"$18,823.85"	$0.00	$0.00	$0.00	$0.00	$0.00
MS207	DRG	MS207		RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS	INPATIENT ONLY	"$381,382.83"	"$282,223.29"	$0.00	"$350,029.12"	"$136,076.60"	"$136,076.60"	"$50,641.13"	"$50,641.13"	$0.00	"$62,949.70"	$0.00	$0.00	"$7,290.56"	"$50,538.71"	"$66,097.21"	"$51,653.95"	$0.00	$0.00	"$50,474.52"	"$287,271.37"	"$350,029.12"	$0.00	"$78,281.84"	$0.00	"$78,281.84"	$0.00	"$59,984.89"	"$59,984.89"	"$50,474.52"	$0.00	$0.00	$0.00	$0.00	$0.00
MS208	DRG	MS208		RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS	INPATIENT ONLY	"$129,996.22"	"$96,197.20"	$0.00	"$33,431.63"	"$26,856.98"	"$26,856.98"	"$28,616.41"	"$28,616.41"	$0.00	$0.00	$0.00	$0.00	$0.00	"$28,570.95"	$0.00	"$29,188.74"	$0.00	$0.00	"$30,778.29"	"$5,386.48"	"$22,287.15"	$0.00	"$24,901.37"	$0.00	"$24,901.37"	$0.00	"$33,431.63"	"$33,431.63"	"$29,312.66"	$0.00	$0.00	$0.00	$0.00	$0.00
MS215	DRG	MS215		OTHER HEART ASSIST SYSTEM IMPLANT	INPATIENT ONLY	"$302,673.62"	"$223,978.48"	$0.00	"$426,802.21"	"$177,689.39"	"$177,689.39"	"$83,922.24"	"$83,922.24"	$0.00	$0.00	$0.00	$0.00	"$3,645.28"	$0.00	$0.00	"$85,600.68"	$0.00	$0.00	"$101,862.99"	"$350,279.60"	"$426,802.21"	$0.00	"$129,174.20"	$0.00	"$129,174.20"	$0.00	"$118,379.20"	"$118,379.20"	"$97,012.37"	$0.00	$0.00	$0.00	$0.00	$0.00
MS216	DRG	MS216		CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	INPATIENT ONLY	"$844,071.58"	"$624,612.97"	$0.00	"$363,816.68"	"$363,816.68"	"$363,816.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$95,156.23"	"$95,156.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS219	DRG	MS219		CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC	INPATIENT ONLY	"$652,285.78"	"$482,691.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS220	DRG	MS220		CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC	INPATIENT ONLY	"$834,118.48"	"$617,247.68"	$0.00	"$314,960.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$258,490.53"	"$314,960.76"	$0.00	"$67,066.33"	$0.00	"$67,066.33"	$0.00	"$56,475.77"	"$56,475.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS222	DRG	MS222		"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITH MCC"	INPATIENT ONLY	"$557,934.66"	"$412,871.65"	$0.00	"$652,154.79"	"$652,154.79"	"$652,154.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$81,291.22"	"$81,291.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS224	DRG	MS224		"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITH MCC"	INPATIENT ONLY	"$224,109.48"	"$165,841.02"	$0.00	"$66,349.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$66,349.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$63,190.05"	$0.00	$0.00	$0.00	$0.00	$0.00
MS225	DRG	MS225		"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITHOUT MCC"	INPATIENT ONLY	"$304,647.12"	"$225,438.87"	$0.00	"$59,276.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$49,909.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$59,276.04"	"$59,276.04"	"$49,909.59"	$0.00	$0.00	$0.00	$0.00	$0.00
MS226	DRG	MS226		CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC	INPATIENT ONLY	"$262,894.89"	"$194,542.22"	$0.00	"$59,504.66"	$0.00	$0.00	"$56,361.78"	"$56,361.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$57,489.02"	$0.00	$0.00	"$59,504.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$56,671.10"	$0.00	$0.00	$0.00	$0.00	$0.00
MS227	DRG	MS227		CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC	INPATIENT ONLY	"$237,743.92"	"$175,930.50"	$0.00	"$47,965.26"	$0.00	$0.00	"$47,024.76"	"$47,024.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$47,965.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS228	DRG	MS228		OTHER CARDIOTHORACIC PROCEDURES WITH MCC	INPATIENT ONLY	"$357,913.50"	"$264,855.99"	$0.00	"$66,076.66"	$0.00	$0.00	"$47,840.51"	"$47,840.51"	$0.00	$0.00	$0.00	$0.00	$0.00	"$47,745.32"	$0.00	"$48,797.32"	$0.00	$0.00	"$66,076.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$64,482.16"	"$64,482.16"	"$66,076.66"	$0.00	$0.00	$0.00	$0.00	$0.00
MS233	DRG	MS233		CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITH MCC	INPATIENT ONLY	"$709,784.74"	"$525,240.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS234	DRG	MS234		CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITHOUT MCC	INPATIENT ONLY	"$480,271.74"	"$355,401.09"	$0.00	"$55,662.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$55,662.39"	"$55,662.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS235	DRG	MS235		CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC	INPATIENT ONLY	"$433,659.48"	"$320,908.02"	$0.00	"$82,191.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$46,536.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$82,191.24"	"$82,191.24"	"$44,320.66"	$0.00	$0.00	$0.00	$0.00	$0.00
MS236	DRG	MS236		CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC	INPATIENT ONLY	"$407,163.36"	"$301,300.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS239	DRG	MS239		AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC	INPATIENT ONLY	"$309,142.02"	"$228,765.09"	$0.00	"$520,828.58"	$0.00	$0.00	"$40,051.71"	"$40,051.71"	$0.00	$0.00	$0.00	$0.00	$0.00	"$40,042.67"	$0.00	"$30,906.38"	$0.00	$0.00	"$45,984.42"	"$427,447.72"	"$520,828.58"	$0.00	"$126,573.84"	$0.00	"$126,573.84"	$0.00	"$51,280.25"	"$51,280.25"	"$43,794.69"	$0.00	$0.00	$0.00	$0.00	$0.00
MS240	DRG	MS240		AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC	INPATIENT ONLY	"$156,536.31"	"$115,836.87"	$0.00	"$197,317.38"	$0.00	$0.00	"$30,300.37"	"$30,300.37"	$0.00	$0.00	$0.00	$0.00	"$197,317.38"	"$30,250.57"	$0.00	"$30,906.38"	$0.00	$0.00	"$32,140.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$35,684.78"	"$35,684.78"	"$32,140.33"	$0.00	$0.00	$0.00	$0.00	$0.00
MS241	DRG	MS241		AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC	INPATIENT ONLY	"$120,662.24"	"$89,290.06"	$0.00	"$25,528.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,528.14"	"$25,528.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS242	DRG	MS242		PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC	INPATIENT ONLY	"$265,067.17"	"$196,149.71"	$0.00	"$43,451.88"	$0.00	$0.00	"$36,779.50"	"$36,779.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$43,451.88"	"$43,451.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS243	DRG	MS243		PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC	INPATIENT ONLY	"$158,068.54"	"$116,970.72"	$0.00	"$29,003.59"	$0.00	$0.00	"$28,434.89"	"$28,434.89"	$0.00	$0.00	$0.00	$0.00	$0.00	"$28,389.92"	$0.00	"$29,003.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS244	DRG	MS244		PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC	INPATIENT ONLY	"$95,847.00"	"$70,926.78"	$0.00	"$30,094.00"	$0.00	$0.00	"$25,293.32"	"$25,293.32"	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,256.47"	$0.00	"$25,799.19"	$0.00	$0.00	"$27,985.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$30,094.00"	"$30,094.00"	"$26,652.72"	$0.00	$0.00	$0.00	$0.00	$0.00
MS245	DRG	MS245		AICD GENERATOR PROCEDURES	INPATIENT ONLY	"$152,256.14"	"$112,669.54"	$0.00	"$49,413.28"	$0.00	$0.00	"$48,444.39"	"$48,444.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$49,413.28"	$0.00	$0.00	"$49,391.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$47,039.42"	$0.00	$0.00	$0.00	$0.00	$0.00
MS246	DRG	MS246		PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS	INPATIENT ONLY	"$209,787.55"	"$155,242.79"	$0.00	"$121,561.11"	"$24,732.19"	"$24,732.19"	"$32,615.82"	"$32,615.82"	$0.00	$0.00	$0.00	$0.00	"$121,561.11"	"$32,560.02"	$0.00	"$33,268.14"	$0.00	$0.00	"$35,484.73"	"$17,653.94"	"$81,055.22"	$0.00	"$31,805.11"	$0.00	"$31,805.11"	$0.00	"$39,055.90"	"$39,055.90"	"$33,794.98"	$0.00	$0.00	$0.00	$0.00	$0.00
MS247	DRG	MS247		PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC	INPATIENT ONLY	"$113,312.93"	"$83,851.57"	$0.00	"$74,539.79"	"$15,580.11"	"$15,580.11"	"$24,671.50"	"$24,671.50"	$0.00	$0.00	$0.00	$0.00	"$3,348.41"	"$24,636.27"	$0.00	"$25,164.93"	$0.00	$0.00	"$27,707.22"	"$30,001.65"	"$74,539.79"	"$58,858.96"	"$20,396.45"	$0.00	"$20,396.45"	$0.00	"$29,761.63"	"$29,761.63"	"$26,387.83"	$0.00	$0.00	$0.00	$0.00	$0.00
MS248	DRG	MS248		PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS	INPATIENT ONLY	"$176,079.18"	"$130,298.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS249	DRG	MS249		PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC	INPATIENT ONLY	"$68,186.12"	"$50,457.73"	$0.00	"$26,900.15"	$0.00	$0.00	"$23,984.81"	"$23,984.81"	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,951.35"	$0.00	"$24,464.51"	$0.00	$0.00	"$26,900.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,619.19"	$0.00	$0.00	$0.00	$0.00	$0.00
MS250	DRG	MS250		PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC	INPATIENT ONLY	"$159,798.37"	"$118,250.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS251	DRG	MS251		PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC	INPATIENT ONLY	"$72,880.41"	"$53,931.50"	$0.00	"$14,906.70"	$0.00	$0.00	$0.00	$0.00	$0.00	"$14,894.34"	$0.00	$0.00	$0.00	$0.00	"$14,906.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS252	DRG	MS252		OTHER VASCULAR PROCEDURES WITH MCC	INPATIENT ONLY	"$145,151.23"	"$107,411.91"	$0.00	"$169,852.02"	"$12,259.80"	"$12,259.80"	"$34,005.79"	"$34,005.79"	$0.00	$0.00	$0.00	$0.00	"$169,852.02"	"$33,946.40"	$0.00	"$34,685.91"	$0.00	$0.00	"$36,220.00"	$0.00	$0.00	"$100,414.90"	$0.00	$0.00	$0.00	$0.00	"$39,934.57"	"$39,934.57"	"$34,495.24"	$0.00	$0.00	$0.00	$0.00	$0.00
MS253	DRG	MS253		OTHER VASCULAR PROCEDURES WITH CC	INPATIENT ONLY	"$129,099.23"	"$95,533.43"	$0.00	"$34,432.01"	$0.00	$0.00	"$29,367.29"	"$29,367.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$29,954.64"	$0.00	$0.00	"$31,615.43"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$34,432.01"	"$34,432.01"	"$30,109.93"	$0.00	$0.00	$0.00	$0.00	$0.00
MS254	DRG	MS254		OTHER VASCULAR PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$209,675.21"	"$155,159.66"	$0.00	"$27,238.50"	"$7,561.44"	"$7,561.44"	"$23,585.90"	"$23,585.90"	"$15,445.08"	$0.00	$0.00	$0.00	$0.00	"$23,553.48"	$0.00	"$24,057.62"	"$27,238.50"	"$27,238.50"	"$26,240.69"	$0.00	$0.00	$0.00	$0.00	"$27,238.50"	$0.00	"$17,128.08"	$0.00	$0.00	"$24,991.13"	"$17,984.48"	$0.00	$0.00	$0.00	$0.00
MS255	DRG	MS255		UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC	INPATIENT ONLY	"$101,664.29"	"$75,231.57"	$0.00	"$85,925.68"	"$85,925.68"	"$85,925.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$31,909.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$30,389.81"	$0.00	$0.00	$0.00	$0.00	$0.00
MS256	DRG	MS256		UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC	INPATIENT ONLY	"$55,860.77"	"$41,336.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS258	DRG	MS258		CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC	INPATIENT ONLY	"$237,539.00"	"$175,778.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS259	DRG	MS259		CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC	INPATIENT ONLY	"$113,151.42"	"$83,732.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS260	DRG	MS260		CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC	INPATIENT ONLY	"$163,381.24"	"$120,902.12"	$0.00	"$43,357.97"	$0.00	$0.00	"$18,747.12"	"$18,747.12"	$0.00	$0.00	$0.00	$0.00	$0.00	"$35,609.47"	$0.00	"$19,122.06"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$43,357.97"	"$43,357.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS261	DRG	MS261		CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC	INPATIENT ONLY	"$51,477.15"	"$38,093.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS262	DRG	MS262		CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC	INPATIENT ONLY	"$57,243.02"	"$42,359.83"	$0.00	"$11,542.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,542.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS264	DRG	MS264		OTHER CIRCULATORY SYSTEM O.R. PROCEDURES	INPATIENT ONLY	$0.00	$0.00	$0.00	"$39,670.80"	$0.00	$0.00	"$33,508.18"	"$33,508.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$34,178.34"	$0.00	$0.00	"$35,999.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$39,670.80"	"$39,670.80"	"$34,285.03"	$0.00	$0.00	$0.00	$0.00	$0.00
MS265	DRG	MS265		AICD LEAD PROCEDURES	INPATIENT ONLY	"$281,375.98"	"$208,218.23"	$0.00	"$35,132.77"	$0.00	$0.00	"$34,280.46"	"$34,280.46"	$0.00	$0.00	$0.00	$0.00	$0.00	"$34,220.36"	$0.00	$0.00	$0.00	$0.00	"$35,132.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$33,459.78"	$0.00	$0.00	$0.00	$0.00	$0.00
MS269	DRG	MS269		AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC	INPATIENT ONLY	"$295,971.85"	"$219,019.17"	$0.00	"$42,958.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$42,958.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$40,912.47"	$0.00	$0.00	$0.00	$0.00	$0.00
MS270	DRG	MS270		OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC	INPATIENT ONLY	"$509,550.86"	"$377,067.64"	$0.00	"$340,524.80"	"$340,524.80"	"$340,524.80"	"$46,851.53"	"$46,851.53"	$0.00	$0.00	$0.00	$0.00	$0.00	"$54,034.64"	$0.00	$0.00	$0.00	$0.00	"$48,724.42"	"$160,865.70"	"$196,008.66"	$0.00	"$51,226.20"	$0.00	"$51,226.20"	$0.00	"$54,877.59"	"$54,877.59"	"$46,404.21"	$0.00	$0.00	$0.00	$0.00	$0.00
MS271	DRG	MS271		OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC	INPATIENT ONLY	"$275,679.20"	"$204,002.61"	$0.00	"$188,211.42"	"$185,320.36"	"$185,320.36"	"$35,698.21"	"$35,698.21"	"$185,320.36"	"$5,081.42"	$0.00	$0.00	$0.00	$0.00	"$5,081.42"	$0.00	"$188,211.42"	"$188,211.42"	"$38,048.73"	$0.00	$0.00	"$161,466.25"	$0.00	"$188,211.42"	$0.00	$0.00	"$42,119.94"	"$42,119.94"	"$36,236.89"	$0.00	$0.00	$0.00	$0.00	$0.00
MS272	DRG	MS272		OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$163,285.34"	"$120,831.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS273	DRG	MS273		PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC	INPATIENT ONLY	"$346,813.41"	"$256,641.92"	$0.00	"$91,804.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$39,157.85"	"$44,119.66"	"$91,804.70"	$0.00	"$37,193.18"	$0.00	"$37,193.18"	$0.00	"$43,445.35"	"$43,445.35"	"$37,293.19"	$0.00	$0.00	$0.00	$0.00	$0.00
MS274	DRG	MS274		PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC	INPATIENT ONLY	"$132,117.47"	"$97,766.93"	$0.00	"$35,395.88"	$0.00	$0.00	"$33,735.93"	"$33,735.93"	$0.00	$0.00	$0.00	$0.00	$0.00	"$33,677.24"	$0.00	"$34,410.65"	$0.00	$0.00	"$35,395.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$33,710.36"	$0.00	$0.00	$0.00	$0.00	$0.00
MS280	DRG	MS280		"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC"	INPATIENT ONLY	"$61,063.46"	"$45,186.96"	$0.00	"$306,336.59"	"$306,336.59"	"$306,336.59"	"$22,143.49"	"$22,143.49"	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,114.79"	$0.00	"$22,586.36"	$0.00	$0.00	"$24,947.74"	"$17,813.05"	"$20,968.38"	$0.00	"$16,348.64"	$0.00	"$16,348.64"	$0.00	"$32,089.26"	"$32,089.26"	"$23,759.75"	$0.00	$0.00	$0.00	$0.00	$0.00
MS281	DRG	MS281		"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC"	INPATIENT ONLY	"$26,455.86"	"$19,577.34"	$0.00	"$42,566.21"	"$12,468.89"	"$12,468.89"	"$17,475.99"	"$17,475.99"	"$9,146.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,825.51"	"$13,959.00"	"$13,959.00"	"$20,422.44"	"$13,390.76"	"$42,566.21"	$0.00	"$9,710.54"	"$13,959.00"	"$9,710.54"	$0.00	"$21,056.17"	"$21,056.17"	"$19,449.94"	$0.00	$0.00	$0.00	$0.00	$0.00
MS282	DRG	MS282		"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC"	INPATIENT ONLY	"$93,190.71"	"$68,961.13"	$0.00	"$19,171.35"	$0.00	$0.00	"$16,064.63"	"$16,064.63"	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,051.66"	$0.00	"$16,385.92"	$0.00	$0.00	"$18,845.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,171.35"	"$19,171.35"	"$17,947.82"	$0.00	$0.00	$0.00	$0.00	$0.00
MS283	DRG	MS283		"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC"	INPATIENT ONLY	"$189,098.49"	"$139,932.88"	$0.00	"$96,797.90"	$0.00	$0.00	"$23,922.70"	"$23,922.70"	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,889.39"	$0.00	"$24,401.15"	$0.00	$0.00	"$28,357.09"	"$11,537.64"	"$96,797.90"	$0.00	"$18,040.74"	$0.00	"$18,040.74"	$0.00	"$27,842.50"	"$27,842.50"	"$27,006.75"	$0.00	$0.00	$0.00	$0.00	$0.00
MS286	DRG	MS286		"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC"	INPATIENT ONLY	"$170,797.89"	"$126,390.44"	$0.00	"$146,910.87"	"$145,102.74"	"$145,102.74"	"$25,797.14"	"$25,797.14"	"$34,337.57"	$0.00	$0.00	$0.00	$0.00	"$25,758.99"	$0.00	"$26,313.08"	"$146,910.87"	"$146,910.87"	"$28,819.07"	$0.00	$0.00	$0.00	$0.00	"$146,910.87"	$0.00	$0.00	"$31,090.31"	"$31,090.31"	"$27,446.73"	$0.00	$0.00	$0.00	$0.00	$0.00
MS287	DRG	MS287		"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC"	INPATIENT ONLY	"$67,028.40"	"$49,601.02"	$0.00	"$29,646.46"	$0.00	$0.00	"$18,749.32"	"$18,749.32"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,729.41"	$0.00	"$19,124.31"	$0.00	$0.00	"$21,676.42"	"$5,663.06"	"$29,646.46"	$0.00	"$11,550.01"	$0.00	"$11,550.01"	$0.00	"$22,554.71"	"$22,554.71"	"$20,644.21"	$0.00	$0.00	$0.00	$0.00	$0.00
MS288	DRG	MS288		ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC	INPATIENT ONLY	"$106,406.72"	"$78,740.97"	$0.00	"$35,135.48"	$0.00	$0.00	"$34,446.55"	"$34,446.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$35,135.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$34,846.87"	"$34,846.87"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS291	DRG	MS291		HEART FAILURE AND SHOCK WITH MCC	INPATIENT ONLY	"$40,413.15"	"$29,905.73"	$0.00	"$59,590.83"	"$19,939.50"	"$19,939.50"	"$19,806.64"	"$19,806.64"	"$13,475.17"	"$13,083.40"	$0.00	$0.00	"$13,855.47"	"$19,783.99"	"$13,083.40"	"$20,202.77"	"$19,024.50"	"$19,024.50"	"$21,904.23"	"$19,843.82"	"$59,590.83"	$0.00	"$13,490.72"	"$19,024.50"	"$13,490.72"	"$12,522.56"	"$24,135.73"	"$24,135.73"	"$21,904.23"	"$13,148.68"	$0.00	$0.00	$0.00	$0.00
MS292	DRG	MS292		HEART FAILURE AND SHOCK WITH CC	INPATIENT ONLY	"$31,089.32"	"$23,006.10"	$0.00	"$83,990.57"	"$16,088.88"	"$16,088.88"	"$17,012.91"	"$17,012.91"	"$8,768.64"	$0.00	$0.00	$0.00	"$23,092.45"	"$16,997.50"	$0.00	"$17,353.17"	"$83,990.57"	"$83,990.57"	"$19,990.54"	"$3,423.49"	"$22,244.34"	"$25,542.17"	"$9,077.01"	"$83,990.57"	"$9,077.01"	$0.00	"$20,540.04"	"$20,540.04"	"$19,038.61"	$0.00	$0.00	$0.00	$0.00	$0.00
MS293	DRG	MS293		HEART FAILURE AND SHOCK WITHOUT CC/MCC	INPATIENT ONLY	"$25,091.99"	"$18,568.07"	$0.00	"$19,670.90"	"$15,852.90"	"$15,852.90"	"$15,124.67"	"$15,124.67"	$0.00	$0.00	$0.00	$0.00	"$3,348.41"	"$15,114.12"	$0.00	"$15,427.16"	$0.00	$0.00	"$18,280.74"	$0.00	$0.00	"$19,670.90"	$0.00	$0.00	$0.00	$0.00	"$18,496.80"	"$18,496.80"	"$17,410.23"	$0.00	$0.00	$0.00	$0.00	$0.00
MS294	DRG	MS294		DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC	INPATIENT ONLY	"$51,250.50"	"$37,925.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS296	DRG	MS296		"CARDIAC ARREST, UNEXPLAINED WITH MCC"	INPATIENT ONLY	"$60,132.19"	"$44,497.82"	$0.00	"$55,644.87"	$0.00	$0.00	"$22,062.74"	"$22,062.74"	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,034.25"	$0.00	"$22,503.99"	$0.00	$0.00	"$24,534.30"	$0.00	$0.00	"$55,644.87"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00
MS299	DRG	MS299		PERIPHERAL VASCULAR DISORDERS WITH MCC	INPATIENT ONLY	"$61,640.61"	"$45,614.05"	$0.00	"$24,984.23"	$0.00	$0.00	"$16,477.47"	"$16,477.47"	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,603.33"	$0.00	"$22,063.32"	$0.00	$0.00	"$23,709.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,984.23"	"$24,984.23"	"$22,580.44"	$0.00	$0.00	$0.00	$0.00	$0.00
MS300	DRG	MS300		PERIPHERAL VASCULAR DISORDERS WITH CC	INPATIENT ONLY	"$33,127.53"	"$24,514.37"	$0.00	"$48,648.19"	"$48,648.19"	"$48,648.19"	"$18,257.24"	"$18,257.24"	"$8,720.44"	$0.00	$0.00	$0.00	"$6,696.82"	"$18,238.60"	$0.00	"$18,622.38"	"$15,657.00"	"$15,657.00"	"$20,824.93"	$0.00	$0.00	$0.00	$0.00	"$15,657.00"	$0.00	"$9,354.11"	"$21,537.17"	"$21,537.17"	"$19,833.27"	"$9,821.82"	$0.00	$0.00	$0.00	$0.00
MS301	DRG	MS301		PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC	INPATIENT ONLY	"$26,808.70"	"$19,838.44"	$0.00	"$18,762.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,762.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,869.07"	$0.00	$0.00	$0.00	$0.00	$0.00
MS302	DRG	MS302		ATHEROSCLEROSIS WITH MCC	INPATIENT ONLY	"$27,989.74"	"$20,712.41"	$0.00	"$22,147.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,981.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,147.21"	"$22,147.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS303	DRG	MS303		ATHEROSCLEROSIS WITHOUT MCC	INPATIENT ONLY	"$9,872.00"	"$7,305.28"	$0.00	"$18,663.40"	"$8,245.79"	"$8,245.79"	$0.00	$0.00	"$5,445.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$10,164.00"	"$10,164.00"	"$18,420.15"	$0.00	$0.00	$0.00	$0.00	"$10,164.00"	$0.00	$0.00	"$18,663.40"	"$18,663.40"	"$17,543.00"	$0.00	$0.00	$0.00	$0.00	$0.00
MS304	DRG	MS304		HYPERTENSION WITH MCC	INPATIENT ONLY	"$53,951.20"	"$39,923.89"	$0.00	"$22,059.01"	$0.00	$0.00	"$18,624.42"	"$18,624.42"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,604.83"	$0.00	"$18,996.91"	$0.00	$0.00	"$21,261.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,059.01"	"$22,059.01"	"$20,249.16"	$0.00	$0.00	$0.00	$0.00	$0.00
MS305	DRG	MS305		HYPERTENSION WITHOUT MCC	INPATIENT ONLY	"$25,501.90"	"$18,871.41"	$0.00	"$19,723.81"	"$16,899.41"	"$16,899.41"	"$16,589.44"	"$16,589.44"	"$5,598.22"	$0.00	$0.00	$0.00	"$3,348.41"	"$16,146.66"	$0.00	"$16,765.12"	"$11,098.50"	"$11,098.50"	"$12,322.90"	"$3,994.80"	"$19,723.81"	$0.00	"$7,332.77"	"$11,098.50"	"$7,332.77"	$0.00	"$19,119.10"	"$19,119.10"	"$12,322.90"	$0.00	$0.00	$0.00	$0.00	$0.00
MS306	DRG	MS306		CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC	INPATIENT ONLY	"$21,558.58"	"$15,953.35"	$0.00	"$21,885.92"	$0.00	$0.00	"$21,456.78"	"$21,456.78"	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,458.56"	$0.00	"$21,885.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS307	DRG	MS307		CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC	INPATIENT ONLY	"$33,309.85"	"$24,649.29"	$0.00	"$20,349.78"	"$4,312.35"	"$4,312.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,349.78"	"$20,349.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS308	DRG	MS308		CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC	INPATIENT ONLY	"$49,289.07"	"$36,473.91"	$0.00	"$23,133.27"	"$4,086.60"	"$4,086.60"	"$19,341.47"	"$19,341.47"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,133.27"	$0.00	$0.00	"$21,919.03"	"$3,891.70"	"$14,418.05"	$0.00	"$11,905.86"	$0.00	"$11,905.86"	$0.00	"$22,844.63"	"$22,844.63"	"$20,875.27"	$0.00	$0.00	$0.00	$0.00	$0.00
MS309	DRG	MS309		CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC	INPATIENT ONLY	"$32,971.70"	"$24,399.06"	$0.00	"$19,321.62"	$0.00	$0.00	"$16,233.04"	"$16,233.04"	$0.00	$0.00	$0.00	$0.00	"$7,290.56"	$0.00	$0.00	"$16,557.70"	$0.00	$0.00	"$18,970.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,321.62"	"$19,321.62"	"$18,067.58"	$0.00	$0.00	$0.00	$0.00	$0.00
MS310	DRG	MS310		CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC	INPATIENT ONLY	"$26,112.51"	"$19,323.26"	$0.00	"$22,828.20"	"$4,086.60"	"$4,086.60"	"$14,912.79"	"$14,912.79"	"$4,902.90"	"$5,253.92"	$0.00	$0.00	"$6,255.35"	"$14,902.81"	"$5,516.62"	"$15,211.05"	"$8,388.00"	"$8,388.00"	"$17,624.69"	"$3,748.58"	"$22,828.20"	$0.00	"$5,606.59"	"$8,388.00"	"$5,606.59"	"$3,051.09"	"$17,712.81"	"$17,712.81"	"$16,785.42"	"$3,247.21"	$0.00	$0.00	$0.00	$0.00
MS311	DRG	MS311		ANGINA PECTORIS	INPATIENT ONLY	"$52,330.57"	"$38,724.62"	$0.00	"$16,191.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,191.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS312	DRG	MS312		SYNCOPE AND COLLAPSE	INPATIENT ONLY	"$61,214.52"	"$45,298.74"	$0.00	"$21,765.49"	"$8,863.70"	"$8,863.70"	"$16,841.76"	"$16,841.76"	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,826.78"	$0.00	"$17,178.60"	$0.00	$0.00	"$19,383.03"	$0.00	$0.00	"$21,765.49"	$0.00	$0.00	$0.00	"$6,911.00"	"$19,814.06"	"$19,814.06"	"$18,460.03"	"$7,256.54"	$0.00	$0.00	$0.00	$0.00
MS313	DRG	MS313		CHEST PAIN	INPATIENT ONLY	"$33,212.42"	"$24,577.19"	$0.00	"$18,986.78"	$0.00	$0.00	"$16,032.21"	"$16,032.21"	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,019.33"	$0.00	"$16,352.85"	$0.00	$0.00	"$18,707.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,986.78"	"$18,986.78"	"$17,816.56"	$0.00	$0.00	$0.00	$0.00	$0.00
MS314	DRG	MS314		OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC	INPATIENT ONLY	"$76,851.46"	"$56,870.08"	$0.00	"$90,518.61"	$0.00	$0.00	"$25,441.03"	"$25,441.03"	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,403.80"	$0.00	"$25,949.85"	$0.00	$0.00	"$27,671.68"	"$27,623.06"	"$90,518.61"	$0.00	"$20,344.32"	$0.00	"$20,344.32"	$0.00	"$29,719.16"	"$29,719.16"	"$26,353.98"	$0.00	$0.00	$0.00	$0.00	$0.00
MS315	DRG	MS315		OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC	INPATIENT ONLY	"$25,527.92"	"$18,890.66"	$0.00	"$54,485.36"	"$54,485.36"	"$54,485.36"	"$17,791.75"	"$17,791.75"	"$8,580.30"	$0.00	$0.00	$0.00	"$10,045.23"	$0.00	$0.00	"$18,126.81"	"$14,601.00"	"$14,601.00"	"$20,434.06"	$0.00	$0.00	$0.00	$0.00	"$14,601.00"	$0.00	"$9,679.17"	"$21,070.06"	"$21,070.06"	"$19,461.01"	"$10,301.36"	$0.00	$0.00	$0.00	$0.00
MS316	DRG	MS316		OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC	INPATIENT ONLY	"$10,452.75"	"$7,735.04"	$0.00	"$56,774.44"	$0.00	$0.00	"$16,046.01"	"$16,046.01"	$0.00	$0.00	$0.00	$0.00	"$10,604.42"	$0.00	$0.00	"$16,366.93"	$0.00	$0.00	$0.00	"$10,943.74"	"$56,774.44"	$0.00	"$7,440.03"	$0.00	"$7,440.03"	$0.00	"$19,206.47"	"$19,206.47"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS326	DRG	MS326		"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC"	INPATIENT ONLY	"$251,818.24"	"$186,345.50"	$0.00	"$291,990.40"	"$291,990.40"	"$291,990.40"	"$47,743.90"	"$47,743.90"	$0.00	$0.00	$0.00	$0.00	"$112,752.12"	"$47,648.96"	$0.00	"$48,698.78"	$0.00	$0.00	"$49,819.86"	"$125,184.57"	"$152,532.58"	$0.00	"$52,833.10"	$0.00	"$52,833.10"	$0.00	"$74,365.49"	"$74,365.49"	"$47,447.49"	$0.00	$0.00	$0.00	$0.00	$0.00
MS327	DRG	MS327		"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC"	INPATIENT ONLY	"$345,047.66"	"$255,335.27"	$0.00	"$181,704.09"	"$181,704.09"	"$181,704.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$31,385.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$34,156.81"	"$34,156.81"	"$29,890.60"	$0.00	$0.00	$0.00	$0.00	$0.00
MS328	DRG	MS328		"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC"	INPATIENT ONLY	"$223,193.30"	"$165,163.04"	$0.00	"$94,605.75"	$0.00	$0.00	"$22,557.58"	"$22,557.58"	$0.00	$0.00	$0.00	$0.00	"$33,357.43"	"$22,527.81"	$0.00	"$23,008.73"	$0.00	$0.00	$0.00	$0.00	$0.00	"$94,605.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS329	DRG	MS329		MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC	INPATIENT ONLY	"$274,008.89"	"$202,766.58"	$0.00	"$350,555.03"	"$136,237.60"	"$136,237.60"	"$44,775.57"	"$44,775.57"	"$114,248.26"	"$46,129.16"	$0.00	$0.00	"$88,406.87"	"$44,688.31"	"$46,129.16"	"$45,671.08"	"$350,555.03"	"$350,555.03"	"$47,337.16"	"$119,188.76"	"$145,226.91"	$0.00	"$49,191.26"	"$350,555.03"	"$49,191.26"	"$44,151.78"	"$53,219.79"	"$53,219.79"	"$45,083.01"	"$46,359.35"	$0.00	$0.00	$0.00	$0.00
MS330	DRG	MS330		MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC	INPATIENT ONLY	"$213,414.08"	"$157,926.42"	$0.00	"$229,756.74"	"$229,756.74"	"$229,756.74"	"$28,647.46"	"$28,647.46"	$0.00	$0.00	$0.00	$0.00	"$96,654.18"	"$28,601.93"	$0.00	"$29,220.41"	$0.00	$0.00	"$31,070.11"	"$108,768.24"	"$132,529.93"	$0.00	"$25,329.40"	$0.00	"$25,329.40"	$0.00	"$33,780.33"	"$33,780.33"	"$29,590.58"	$0.00	$0.00	$0.00	$0.00	$0.00
MS331	DRG	MS331		MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$192,463.33"	"$142,422.86"	$0.00	"$148,688.87"	"$107,640.79"	"$107,640.79"	"$30,696.66"	"$30,696.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,315.65"	$0.00	$0.00	"$25,346.16"	"$122,030.00"	"$148,688.87"	$0.00	"$16,933.05"	$0.00	"$16,933.05"	"$15,266.31"	"$26,940.12"	"$26,940.12"	"$24,139.20"	"$16,029.62"	$0.00	$0.00	$0.00	$0.00
MS332	DRG	MS332		RECTAL RESECTION WITH MCC	INPATIENT ONLY	"$887,584.06"	"$656,812.20"	$0.00	"$103,355.68"	$0.00	$0.00	"$103,349.75"	"$103,349.75"	$0.00	$0.00	$0.00	$0.00	$0.00	"$103,355.68"	$0.00	"$64,185.57"	$0.00	$0.00	"$90,845.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$86,519.75"	$0.00	$0.00	$0.00	$0.00	$0.00
MS333	DRG	MS333		RECTAL RESECTION WITH CC	INPATIENT ONLY	"$620,492.87"	"$459,164.72"	$0.00	"$65,011.79"	$0.00	$0.00	"$65,011.79"	"$65,011.79"	$0.00	$0.00	$0.00	$0.00	$0.00	"$65,006.35"	$0.00	$0.00	$0.00	$0.00	"$56,104.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$53,432.55"	$0.00	$0.00	$0.00	$0.00	$0.00
MS335	DRG	MS335		PERITONEAL ADHESIOLYSIS WITH MCC	INPATIENT ONLY	"$532,766.31"	"$394,247.07"	$0.00	"$110,895.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$91,012.77"	"$110,895.56"	$0.00	"$40,549.32"	$0.00	"$40,549.32"	$0.00	"$46,179.48"	"$46,179.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS336	DRG	MS336		PERITONEAL ADHESIOLYSIS WITH CC	INPATIENT ONLY	"$219,777.95"	"$162,635.68"	$0.00	"$31,652.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$29,289.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$31,652.16"	"$31,652.16"	"$27,894.51"	$0.00	$0.00	$0.00	$0.00	$0.00
MS337	DRG	MS337		PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC	INPATIENT ONLY	"$186,895.48"	"$138,302.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS338	DRG	MS338		APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC	INPATIENT ONLY	"$181,523.85"	"$134,327.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS339	DRG	MS339		APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC	INPATIENT ONLY	"$125,577.54"	"$92,927.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS340	DRG	MS340		APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC	INPATIENT ONLY	"$100,873.09"	"$74,646.09"	$0.00	"$86,067.33"	"$86,067.33"	"$86,067.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$48,704.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS341	DRG	MS341		APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC	INPATIENT ONLY	"$126,465.33"	"$93,584.34"	$0.00	"$36,751.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$31,284.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$36,751.27"	$0.00	$0.00	$0.00	$0.00	$0.00
MS342	DRG	MS342		APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC	INPATIENT ONLY	"$99,896.38"	"$73,923.32"	$0.00	"$75,672.75"	"$4,542.21"	"$4,542.21"	$0.00	$0.00	"$11,703.42"	$0.00	$0.00	$0.00	"$3,348.41"	$0.00	$0.00	$0.00	"$75,672.75"	"$75,672.75"	$0.00	"$5,521.83"	"$60,127.78"	$0.00	"$16,142.14"	"$75,672.75"	"$16,142.14"	$0.00	"$26,295.79"	"$26,295.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS343	DRG	MS343		APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC	INPATIENT ONLY	"$99,694.46"	"$73,773.90"	$0.00	"$70,753.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,348.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,075.14"	"$70,753.35"	"$58,511.81"	"$11,543.98"	$0.00	"$11,543.98"	$0.00	"$22,549.80"	"$22,549.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS344	DRG	MS344		MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC	INPATIENT ONLY	"$63,631.33"	"$47,087.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS345	DRG	MS345		MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC	INPATIENT ONLY	"$164,994.22"	"$122,095.72"	$0.00	"$22,388.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,388.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS346	DRG	MS346		MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$74,406.10"	"$55,060.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS347	DRG	MS347		ANAL AND STOMAL PROCEDURES WITH MCC	INPATIENT ONLY	"$26,552.02"	"$19,648.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS348	DRG	MS348		ANAL AND STOMAL PROCEDURES WITH CC	INPATIENT ONLY	"$83,349.83"	"$61,678.87"	$0.00	"$24,654.33"	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,830.84"	$0.00	$0.00	$0.00	$0.00	"$23,744.82"	$0.00	$0.00	$0.00	"$23,433.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,654.33"	"$24,654.33"	"$22,317.52"	$0.00	$0.00	$0.00	$0.00	$0.00
MS349	DRG	MS349		ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$65,922.10"	"$48,782.35"	$0.00	"$40,375.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,168.36"	$0.00	$0.00	$0.00	"$6,026.40"	"$40,375.68"	$0.00	"$9,832.84"	$0.00	"$9,832.84"	$0.00	"$21,155.80"	"$21,155.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS350	DRG	MS350		INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC	INPATIENT ONLY	"$281,616.81"	"$208,396.44"	$0.00	"$30,472.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$30,472.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$29,021.10"	$0.00	$0.00	$0.00	$0.00	$0.00
MS351	DRG	MS351		INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC	INPATIENT ONLY	"$141,041.73"	"$104,370.88"	$0.00	"$114,048.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$93,600.21"	"$114,048.28"	$0.00	"$14,618.44"	$0.00	"$14,618.44"	$0.00	"$25,054.47"	"$25,054.47"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS352	DRG	MS352		INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$80,949.32"	"$59,902.50"	$0.00	"$120,426.90"	"$120,426.90"	"$120,426.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,938.97"	"$21,938.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS353	DRG	MS353		HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC	INPATIENT ONLY	"$250,528.06"	"$185,390.76"	$0.00	"$77,604.07"	$0.00	$0.00	"$31,929.81"	"$31,929.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$34,077.63"	"$5,681.42"	"$77,604.07"	$0.00	"$29,741.12"	$0.00	"$29,741.12"	$0.00	"$37,374.40"	"$37,374.40"	"$32,454.89"	$0.00	$0.00	$0.00	$0.00	$0.00
MS354	DRG	MS354		HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC	INPATIENT ONLY	"$283,035.02"	"$209,445.91"	$0.00	"$101,424.28"	"$101,424.28"	"$101,424.28"	"$23,371.27"	"$23,371.27"	$0.00	$0.00	$0.00	$0.00	"$53,576.10"	"$23,339.39"	$0.00	"$23,838.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,208.78"	"$27,208.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS355	DRG	MS355		HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC	INPATIENT ONLY	"$131,335.21"	"$97,188.06"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS356	DRG	MS356		OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC	INPATIENT ONLY	"$231,882.30"	"$171,592.90"	$0.00	"$46,441.63"	$0.00	$0.00	"$40,783.74"	"$40,783.74"	$0.00	$0.00	$0.00	$0.00	$0.00	"$40,706.81"	$0.00	"$41,599.41"	$0.00	$0.00	"$39,681.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$46,441.63"	"$46,441.63"	"$39,681.10"	$0.00	$0.00	$0.00	$0.00	$0.00
MS357	DRG	MS357		OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC	INPATIENT ONLY	"$246,036.70"	"$182,067.16"	$0.00	"$27,791.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,669.02"	$0.00	$0.00	$0.00	$0.00	"$27,791.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,791.66"	$0.00	$0.00	$0.00	$0.00	$0.00
MS358	DRG	MS358		OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$305,696.80"	"$226,215.63"	$0.00	"$66,333.91"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,778.35"	"$66,333.91"	$0.00	"$13,749.33"	$0.00	"$13,749.33"	$0.00	"$24,346.43"	"$24,346.43"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS368	DRG	MS368		MAJOR ESOPHAGEAL DISORDERS WITH MCC	INPATIENT ONLY	"$44,626.39"	"$33,023.53"	$0.00	"$28,691.00"	"$17,417.13"	"$17,417.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,857.51"	$0.00	$0.00	$0.00	"$4,678.10"	"$21,077.61"	$0.00	"$19,082.27"	$0.00	"$19,082.27"	$0.00	"$28,691.00"	"$28,691.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS369	DRG	MS369		MAJOR ESOPHAGEAL DISORDERS WITH CC	INPATIENT ONLY	"$33,210.98"	"$24,576.13"	$0.00	"$21,827.08"	$0.00	$0.00	"$18,487.75"	"$18,487.75"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,468.52"	$0.00	"$18,857.51"	$0.00	$0.00	$0.00	"$8,473.19"	"$17,181.21"	$0.00	"$10,656.83"	$0.00	"$10,656.83"	$0.00	"$21,827.08"	"$21,827.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS370	DRG	MS370		MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC	INPATIENT ONLY	"$70,028.29"	"$51,820.93"	$0.00	"$9,760.80"	"$9,760.80"	"$9,760.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS371	DRG	MS371		MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC	INPATIENT ONLY	"$90,719.83"	"$67,132.67"	$0.00	"$27,236.55"	$0.00	$0.00	"$23,001.33"	"$23,001.33"	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,970.42"	$0.00	"$23,461.36"	$0.00	$0.00	"$25,594.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,236.55"	"$27,236.55"	"$24,375.45"	$0.00	$0.00	$0.00	$0.00	$0.00
MS372	DRG	MS372		MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC	INPATIENT ONLY	"$41,041.65"	"$30,370.82"	$0.00	"$21,495.52"	$0.00	$0.00	"$18,157.17"	"$18,157.17"	$0.00	"$3,697.23"	$0.00	$0.00	$0.00	"$18,138.79"	"$9,522.34"	"$18,520.31"	$0.00	$0.00	"$20,790.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,495.52"	"$21,495.52"	"$19,800.09"	$0.00	$0.00	$0.00	$0.00	$0.00
MS373	DRG	MS373		MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC	INPATIENT ONLY	"$25,826.81"	"$19,111.84"	$0.00	"$18,871.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,871.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,973.20"	$0.00	$0.00	$0.00	$0.00	$0.00
MS374	DRG	MS374		DIGESTIVE MALIGNANCY WITH MCC	INPATIENT ONLY	"$130,953.52"	"$96,905.60"	$0.00	"$103,204.32"	"$8,173.20"	"$8,173.20"	"$25,365.10"	"$25,365.10"	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,328.06"	$0.00	"$25,872.40"	$0.00	$0.00	"$27,453.01"	$0.00	$0.00	"$103,204.32"	$0.00	$0.00	$0.00	$0.00	"$25,228.00"	"$25,228.00"	"$26,145.72"	$0.00	$0.00	$0.00	$0.00	$0.00
MS375	DRG	MS375		DIGESTIVE MALIGNANCY WITH CC	INPATIENT ONLY	"$43,263.16"	"$32,014.74"	$0.00	"$23,004.69"	$0.00	$0.00	"$19,387.71"	"$19,387.71"	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,366.15"	$0.00	"$19,775.46"	$0.00	$0.00	"$22,052.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,004.69"	"$23,004.69"	"$21,002.83"	$0.00	$0.00	$0.00	$0.00	$0.00
MS376	DRG	MS376		DIGESTIVE MALIGNANCY WITHOUT CC/MCC	INPATIENT ONLY	"$50,921.70"	"$37,682.06"	$0.00	"$20,645.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,241.18"	$0.00	"$17,602.37"	$0.00	$0.00	"$20,645.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,662.12"	$0.00	$0.00	$0.00	$0.00	$0.00
MS377	DRG	MS377		GASTROINTESTINAL HEMORRHAGE WITH MCC	INPATIENT ONLY	"$78,283.67"	"$57,929.92"	$0.00	"$56,749.25"	"$20,646.76"	"$20,646.76"	"$23,484.44"	"$23,484.44"	$0.00	"$15,384.27"	$0.00	$0.00	$0.00	"$23,452.27"	"$15,384.27"	"$23,954.13"	$0.00	$0.00	"$25,897.63"	$0.00	$0.00	"$56,749.25"	$0.00	$0.00	$0.00	$0.00	"$27,599.14"	"$27,599.14"	"$24,664.41"	$0.00	$0.00	$0.00	$0.00	$0.00
MS378	DRG	MS378		GASTROINTESTINAL HEMORRHAGE WITH CC	INPATIENT ONLY	"$34,470.23"	"$25,507.97"	$0.00	"$34,384.78"	"$17,023.65"	"$17,023.65"	"$17,910.11"	"$17,910.11"	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,892.36"	$0.00	"$18,268.31"	$0.00	$0.00	"$19,576.19"	"$14,569.53"	"$34,384.78"	$0.00	"$9,905.01"	$0.00	"$9,905.01"	"$8,932.14"	"$21,214.59"	"$21,214.59"	"$19,576.19"	"$9,378.74"	$0.00	$0.00	$0.00	$0.00
MS379	DRG	MS379		GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC	INPATIENT ONLY	"$37,486.96"	"$27,740.35"	$0.00	"$18,418.41"	"$8,963.57"	"$8,963.57"	"$15,451.11"	"$15,451.11"	"$6,048.07"	$0.00	$0.00	$0.00	"$10,935.84"	"$15,439.72"	$0.00	"$15,760.13"	"$9,558.00"	"$9,558.00"	"$18,215.14"	$0.00	$0.00	$0.00	$0.00	"$9,558.00"	$0.00	$0.00	"$18,418.41"	"$18,418.41"	"$17,347.75"	$0.00	$0.00	$0.00	$0.00	$0.00
MS380	DRG	MS380		COMPLICATED PEPTIC ULCER WITH MCC	INPATIENT ONLY	"$26,794.24"	"$19,827.74"	$0.00	"$194,237.98"	$0.00	$0.00	"$29,530.88"	"$29,530.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,555.31"	$0.00	$0.00	$0.00	"$159,412.49"	"$194,237.98"	$0.00	"$24,569.41"	$0.00	"$24,569.41"	$0.00	"$28,560.33"	"$28,560.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS381	DRG	MS381		COMPLICATED PEPTIC ULCER WITH CC	INPATIENT ONLY	"$46,100.59"	"$34,114.44"	$0.00	"$21,938.15"	"$8,173.20"	"$8,173.20"	"$18,364.22"	"$18,364.22"	$0.00	$0.00	$0.00	$0.00	"$13,393.64"	$0.00	$0.00	"$18,731.50"	$0.00	$0.00	"$21,160.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,938.15"	"$21,938.15"	"$20,152.85"	$0.00	$0.00	$0.00	$0.00	$0.00
MS382	DRG	MS382		COMPLICATED PEPTIC ULCER WITHOUT CC/MCC	INPATIENT ONLY	"$31,452.30"	"$23,274.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS383	DRG	MS383		UNCOMPLICATED PEPTIC ULCER WITH MCC	INPATIENT ONLY	"$24,431.24"	"$18,079.12"	$0.00	"$23,976.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,976.51"	"$23,976.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS384	DRG	MS384		UNCOMPLICATED PEPTIC ULCER WITHOUT MCC	INPATIENT ONLY	"$33,274.53"	"$24,623.15"	$0.00	"$26,787.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,787.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS385	DRG	MS385		INFLAMMATORY BOWEL DISEASE WITH MCC	INPATIENT ONLY	"$67,760.04"	"$50,142.43"	$0.00	"$24,806.99"	$0.00	$0.00	"$22,249.76"	"$22,249.76"	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,220.79"	$0.00	"$22,694.76"	$0.00	$0.00	"$24,806.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,625.70"	$0.00	$0.00	$0.00	$0.00	$0.00
MS386	DRG	MS386		INFLAMMATORY BOWEL DISEASE WITH CC	INPATIENT ONLY	"$56,023.07"	"$41,457.07"	$0.00	"$21,190.92"	"$20,433.00"	"$20,433.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,696.82"	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,535.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,190.92"	"$21,190.92"	"$19,557.33"	$0.00	$0.00	$0.00	$0.00	$0.00
MS387	DRG	MS387		INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC	INPATIENT ONLY	"$23,208.03"	"$17,173.94"	$0.00	"$16,305.69"	$0.00	$0.00	"$15,985.97"	"$15,985.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,305.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS388	DRG	MS388		GASTROINTESTINAL OBSTRUCTION WITH MCC	INPATIENT ONLY	"$77,758.35"	"$57,541.18"	$0.00	"$25,918.43"	"$25,918.43"	"$25,918.43"	"$21,506.47"	"$21,506.47"	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,479.43"	$0.00	"$21,936.60"	$0.00	$0.00	"$24,224.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,599.99"	"$25,599.99"	"$23,071.18"	$0.00	$0.00	$0.00	$0.00	$0.00
MS389	DRG	MS389		GASTROINTESTINAL OBSTRUCTION WITH CC	INPATIENT ONLY	"$39,413.46"	"$29,165.96"	$0.00	"$20,002.70"	$0.00	$0.00	"$16,734.77"	"$16,734.77"	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,720.07"	$0.00	"$17,069.47"	$0.00	$0.00	"$19,540.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,002.70"	"$20,002.70"	"$18,610.37"	$0.00	$0.00	$0.00	$0.00	$0.00
MS390	DRG	MS390		GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC	INPATIENT ONLY	"$29,912.81"	"$22,135.48"	$0.00	"$95,740.02"	"$95,740.02"	"$95,740.02"	"$15,077.74"	"$15,077.74"	$0.00	"$5,565.81"	$0.00	$0.00	"$3,348.41"	"$15,067.32"	"$5,565.81"	"$15,379.29"	$0.00	$0.00	"$17,763.43"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,327.23"	$0.00	$0.00	"$16,917.55"	"$5,593.59"	$0.00	$0.00	$0.00	$0.00
MS391	DRG	MS391		"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC"	INPATIENT ONLY	"$41,863.55"	"$30,979.03"	$0.00	"$23,230.90"	$0.00	$0.00	"$19,674.82"	"$19,674.82"	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,652.52"	$0.00	"$20,068.32"	$0.00	$0.00	"$22,242.27"	"$7,432.68"	"$17,525.21"	$0.00	"$12,380.02"	$0.00	"$12,380.02"	$0.00	"$23,230.90"	"$23,230.90"	"$21,183.11"	$0.00	$0.00	$0.00	$0.00	$0.00
MS392	DRG	MS392		"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC"	INPATIENT ONLY	"$33,170.14"	"$24,545.90"	$0.00	"$41,242.74"	"$12,630.39"	"$12,630.39"	"$16,338.64"	"$16,338.64"	$0.00	"$2,286.70"	$0.00	$0.00	"$6,696.82"	$0.00	"$7,045.49"	"$16,665.41"	$0.00	$0.00	"$19,006.49"	"$11,228.32"	"$41,242.74"	"$23,420.75"	"$7,633.51"	$0.00	"$7,633.51"	"$4,002.23"	"$19,364.08"	"$19,364.08"	"$18,101.42"	"$4,259.49"	$0.00	$0.00	$0.00	$0.00
MS393	DRG	MS393		OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC	INPATIENT ONLY	"$50,282.24"	"$37,208.86"	$0.00	"$26,411.73"	"$16,829.88"	"$16,829.88"	"$22,518.23"	"$22,518.23"	"$15,078.24"	$0.00	$0.00	$0.00	$0.00	"$22,488.57"	$0.00	"$22,968.59"	"$20,121.93"	"$20,121.93"	"$24,904.01"	$0.00	$0.00	$0.00	$0.00	"$20,121.93"	$0.00	$0.00	"$26,411.73"	"$26,411.73"	"$23,718.10"	$0.00	$0.00	$0.00	$0.00	$0.00
MS394	DRG	MS394		OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC	INPATIENT ONLY	"$43,731.97"	"$32,361.66"	$0.00	"$21,956.06"	$0.00	$0.00	"$17,547.08"	"$17,547.08"	$0.00	$0.00	$0.00	$0.00	"$13,393.64"	"$17,530.28"	$0.00	"$17,898.02"	$0.00	$0.00	"$20,213.34"	"$7,280.15"	"$21,956.06"	$0.00	"$9,403.81"	$0.00	"$9,403.81"	"$5,243.56"	"$20,806.29"	"$20,806.29"	"$19,250.80"	"$5,580.62"	$0.00	$0.00	$0.00	$0.00
MS395	DRG	MS395		OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC	INPATIENT ONLY	"$22,243.70"	"$16,460.34"	$0.00	"$24,982.77"	"$24,982.77"	"$24,982.77"	"$15,549.79"	"$15,549.79"	"$5,867.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,327.28"	"$9,772.50"	"$9,772.50"	$0.00	"$7,147.50"	"$12,116.27"	$0.00	"$6,559.90"	"$9,772.50"	"$6,559.90"	"$4,462.69"	"$18,489.46"	"$18,489.46"	$0.00	"$4,749.55"	$0.00	$0.00	$0.00	$0.00
MS405	DRG	MS405		"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC"	INPATIENT ONLY	"$200,263.23"	"$148,194.79"	$0.00	"$50,890.72"	$0.00	$0.00	"$50,651.50"	"$50,651.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$50,890.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$48,467.35"	$0.00	$0.00	$0.00	$0.00	$0.00
MS406	DRG	MS406		"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC"	INPATIENT ONLY	"$83,962.91"	"$62,132.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS407	DRG	MS407		"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC"	INPATIENT ONLY	"$379,474.22"	"$280,810.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS408	DRG	MS408		BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC	INPATIENT ONLY	"$436,154.41"	"$322,754.26"	$0.00	"$50,500.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$50,500.02"	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS410	DRG	MS410		BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC	INPATIENT ONLY	"$300,972.34"	"$222,719.53"	$0.00	"$201,119.77"	"$193,135.50"	"$193,135.50"	$0.00	$0.00	"$49,341.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$195,549.45"	"$195,549.45"	$0.00	"$165,060.42"	"$201,119.77"	$0.00	"$26,144.96"	"$195,549.45"	"$26,144.96"	$0.00	"$26,701.64"	"$26,701.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS414	DRG	MS414		CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC	INPATIENT ONLY	"$156,040.59"	"$115,470.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS415	DRG	MS415		CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC	INPATIENT ONLY	"$136,109.70"	"$100,721.18"	$0.00	"$120,290.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$98,722.88"	"$120,290.03"	$0.00	"$20,566.86"	$0.00	"$20,566.86"	$0.00	"$29,900.46"	"$29,900.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS416	DRG	MS416		CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC	INPATIENT ONLY	"$292,085.37"	"$216,143.17"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS417	DRG	MS417		LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC	INPATIENT ONLY	"$137,676.65"	"$101,880.72"	$0.00	"$146,623.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,096.73"	$0.00	$0.00	"$44,529.93"	$0.00	"$21,096.73"	$0.00	$0.00	$0.00	"$30,276.71"	"$120,335.03"	"$146,623.60"	$0.00	"$24,165.59"	$0.00	"$24,165.59"	$0.00	"$32,832.21"	"$32,832.21"	"$28,834.96"	$0.00	$0.00	$0.00	$0.00	$0.00
MS418	DRG	MS418		LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC	INPATIENT ONLY	"$146,973.04"	"$108,760.05"	$0.00	"$84,039.69"	"$84,039.69"	"$84,039.69"	"$22,710.10"	"$22,710.10"	$0.00	"$28,650.88"	$0.00	$0.00	$0.00	$0.00	"$28,651.56"	"$23,164.30"	$0.00	$0.00	"$25,207.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,007.06"	$0.00	$0.00	$0.00	$0.00	$0.00
MS419	DRG	MS419		LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC	INPATIENT ONLY	"$132,793.00"	"$98,266.82"	$0.00	"$104,723.37"	"$91,322.65"	"$91,322.65"	$0.00	$0.00	"$12,698.94"	"$10,708.77"	$0.00	$0.00	$0.00	$0.00	"$11,244.21"	$0.00	"$92,670.16"	"$92,670.16"	"$22,732.94"	"$85,947.21"	"$104,723.37"	"$67,774.35"	"$13,099.76"	"$92,670.16"	"$13,099.76"	"$10,762.21"	"$23,817.26"	"$23,817.26"	"$21,650.42"	"$11,300.32"	$0.00	$0.00	$0.00	$0.00
MS420	DRG	MS420		HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC	INPATIENT ONLY	"$138,545.38"	"$102,523.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS423	DRG	MS423		OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC	INPATIENT ONLY	"$287,776.74"	"$212,954.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS432	DRG	MS432		CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC	INPATIENT ONLY	"$71,759.88"	"$53,102.31"	$0.00	"$28,036.05"	"$8,624.70"	"$8,624.70"	"$24,159.76"	"$24,159.76"	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,000.21"	$0.00	$784.10	$0.00	$0.00	"$26,263.25"	"$17,070.50"	"$27,475.36"	$0.00	"$18,278.31"	$0.00	"$18,278.31"	$0.00	"$28,036.05"	"$28,036.05"	"$25,012.62"	$0.00	$0.00	$0.00	$0.00	$0.00
MS433	DRG	MS433		CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC	INPATIENT ONLY	"$45,714.27"	"$33,828.56"	$0.00	"$29,212.66"	"$4,086.60"	"$4,086.60"	"$18,161.31"	"$18,161.31"	"$8,187.57"	$0.00	$0.00	$0.00	"$13,393.64"	"$18,142.93"	$0.00	"$18,524.54"	"$15,448.50"	"$15,448.50"	"$20,855.02"	"$14,492.23"	"$29,212.66"	$0.00	"$10,345.09"	"$15,448.50"	"$10,345.09"	$0.00	"$21,573.12"	"$21,573.12"	"$19,861.92"	$0.00	$0.00	$0.00	$0.00	$0.00
MS434	DRG	MS434		CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC	INPATIENT ONLY	"$20,195.51"	"$14,944.68"	$0.00	"$18,175.50"	"$4,086.60"	"$4,086.60"	$0.00	$0.00	$0.00	"$6,206.31"	$0.00	$0.00	$0.00	"$15,326.14"	"$6,206.31"	$0.00	$0.00	$0.00	"$18,175.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,310.00"	$0.00	$0.00	$0.00	$0.00	$0.00
MS435	DRG	MS435		MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC	INPATIENT ONLY	"$95,710.06"	"$70,825.44"	$0.00	"$27,004.64"	"$13,847.40"	"$13,847.40"	"$23,154.55"	"$23,154.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,617.64"	$0.00	$0.00	"$25,400.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,004.64"	"$27,004.64"	"$24,190.62"	$0.00	$0.00	$0.00	$0.00	$0.00
MS436	DRG	MS436		MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC	INPATIENT ONLY	"$52,499.34"	"$38,849.51"	$0.00	"$21,514.22"	$0.00	$0.00	"$18,793.50"	"$18,793.50"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,773.47"	$0.00	$0.00	$0.00	$0.00	"$21,514.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,489.83"	$0.00	$0.00	$0.00	$0.00	$0.00
MS437	DRG	MS437		MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC	INPATIENT ONLY	"$67,843.68"	"$50,204.32"	$0.00	"$19,475.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,475.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,475.99"	$0.00	$0.00	$0.00	$0.00	$0.00
MS438	DRG	MS438		DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC	INPATIENT ONLY	"$45,592.09"	"$33,738.15"	$0.00	"$26,524.44"	$0.00	$0.00	"$22,080.67"	"$22,080.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,522.28"	$0.00	$0.00	"$24,998.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,524.44"	"$26,524.44"	"$23,807.93"	$0.00	$0.00	$0.00	$0.00	$0.00
MS439	DRG	MS439		DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC	INPATIENT ONLY	"$35,242.46"	"$26,079.42"	$0.00	"$27,105.60"	"$27,105.60"	"$27,105.60"	"$16,886.61"	"$16,886.61"	$0.00	"$8,501.51"	$0.00	$0.00	$0.00	"$16,871.51"	"$8,501.51"	"$17,224.34"	$0.00	$0.00	"$19,592.13"	"$3,287.36"	"$18,691.33"	$0.00	"$8,492.59"	$0.00	"$8,492.59"	"$8,137.08"	"$20,063.94"	"$20,063.94"	"$18,659.17"	"$8,543.93"	$0.00	$0.00	$0.00	$0.00
MS440	DRG	MS440		DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC	INPATIENT ONLY	"$36,890.80"	"$27,299.19"	$0.00	"$8,173.20"	"$8,173.20"	"$8,173.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS441	DRG	MS441		"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC"	INPATIENT ONLY	"$49,349.00"	"$36,518.26"	$0.00	"$236,480.96"	$0.00	$0.00	"$24,024.82"	"$24,024.82"	$0.00	$0.00	$0.00	$0.00	"$236,480.96"	$0.00	$0.00	"$29,751.07"	$0.00	$0.00	"$26,532.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,575.49"	"$19,575.49"	"$26,532.44"	$0.00	$0.00	$0.00	$0.00	$0.00
MS442	DRG	MS442		"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC"	INPATIENT ONLY	"$39,164.06"	"$28,981.40"	$0.00	"$20,767.89"	"$16,346.40"	"$16,346.40"	"$17,471.86"	"$17,471.86"	$0.00	$0.00	$0.00	$0.00	"$16,742.05"	"$17,455.25"	$0.00	$171.72	$0.00	$0.00	"$20,181.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,767.89"	"$20,767.89"	"$19,220.20"	$0.00	$0.00	$0.00	$0.00	$0.00
MS443	DRG	MS443		"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC"	INPATIENT ONLY	"$37,763.49"	"$27,944.98"	$0.00	"$38,930.80"	"$12,711.30"	"$12,711.30"	"$15,630.55"	"$15,630.55"	"$5,812.44"	$0.00	$0.00	$0.00	$0.00	"$15,618.70"	$0.00	"$15,943.16"	"$9,948.00"	"$9,948.00"	$0.00	"$10,031.02"	"$38,930.80"	$0.00	"$6,819.53"	"$9,948.00"	"$6,819.53"	"$6,169.37"	"$18,700.96"	"$18,700.96"	$0.00	"$6,477.83"	$0.00	$0.00	$0.00	$0.00
MS444	DRG	MS444		DISORDERS OF THE BILIARY TRACT WITH MCC	INPATIENT ONLY	"$40,567.37"	"$30,019.85"	$0.00	"$24,914.95"	"$16,346.40"	"$16,346.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,041.82"	$0.00	$0.00	"$24,914.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,728.52"	$0.00	$0.00	$0.00	$0.00	$0.00
MS445	DRG	MS445		DISORDERS OF THE BILIARY TRACT WITH CC	INPATIENT ONLY	"$39,233.35"	"$29,032.68"	$0.00	"$21,920.18"	$0.00	$0.00	"$18,489.83"	"$18,489.83"	$0.00	"$10,502.48"	$0.00	$0.00	$0.00	$0.00	"$10,502.48"	"$18,859.63"	$0.00	$0.00	"$21,145.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,920.18"	"$21,920.18"	"$20,138.52"	$0.00	$0.00	$0.00	$0.00	$0.00
MS446	DRG	MS446		DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC	INPATIENT ONLY	"$46,325.27"	"$34,280.70"	$0.00	"$13,393.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$13,393.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS453	DRG	MS453		COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC	INPATIENT ONLY	"$438,917.25"	"$324,798.77"	$0.00	"$236,554.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$236,554.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS454	DRG	MS454		COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC	INPATIENT ONLY	"$407,718.97"	"$301,712.04"	$0.00	"$271,075.74"	$0.00	$0.00	$0.00	$0.00	$0.00	"$104,673.75"	$0.00	$0.00	"$271,075.74"	$0.00	"$104,674.30"	$0.00	$0.00	$0.00	"$55,659.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$63,264.79"	"$63,164.90"	"$63,164.90"	"$53,008.86"	"$50,919.68"	$0.00	$0.00	$0.00	$0.00
MS455	DRG	MS455		COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC	INPATIENT ONLY	"$334,789.12"	"$247,743.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS456	DRG	MS456		"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC"	INPATIENT ONLY	"$340,429.20"	"$251,917.61"	$0.00	"$71,814.47"	$0.00	$0.00	"$70,406.34"	"$70,406.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$71,814.47"	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS457	DRG	MS457		"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC"	INPATIENT ONLY	"$334,299.43"	"$247,381.58"	$0.00	"$69,502.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$69,502.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS459	DRG	MS459		SPINAL FUSION EXCEPT CERVICAL WITH MCC	INPATIENT ONLY	"$590,788.39"	"$437,183.41"	$0.00	"$294,344.86"	"$294,344.86"	"$294,344.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$259,255.92"	$0.00	$0.00	$0.00	$0.00	$0.00	"$60,627.44"	"$173,392.23"	"$211,271.76"	$0.00	"$68,686.54"	$0.00	"$68,686.54"	$0.00	"$69,101.93"	"$69,101.93"	"$57,740.42"	$0.00	$0.00	$0.00	$0.00	$0.00
MS460	DRG	MS460		SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	INPATIENT ONLY	"$243,368.62"	"$180,092.78"	$0.00	"$66,414.60"	$0.00	$0.00	"$38,181.18"	"$38,181.18"	$0.00	"$49,968.85"	$0.00	$0.00	$0.00	$0.00	"$66,414.60"	"$38,944.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS463	DRG	MS463		WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC	INPATIENT ONLY	"$340,239.14"	"$251,776.96"	$0.00	"$407,660.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$55,832.33"	"$334,570.22"	"$407,660.93"	$0.00	"$94,279.70"	$0.00	"$94,279.70"	$0.00	"$55,837.96"	"$55,837.96"	"$53,173.65"	$0.00	$0.00	$0.00	$0.00	$0.00
MS464	DRG	MS464		WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC	INPATIENT ONLY	"$323,690.26"	"$239,530.79"	$0.00	"$146,335.63"	"$115,976.76"	"$115,976.76"	"$31,591.63"	"$31,591.63"	$0.00	"$88,498.29"	$0.00	$0.00	$0.00	$0.00	"$88,498.29"	"$32,223.46"	$0.00	$0.00	$0.00	"$120,098.69"	"$146,335.63"	$0.00	"$29,598.76"	$0.00	"$29,598.76"	"$27,265.48"	"$37,258.44"	"$37,258.44"	$0.00	"$28,628.74"	$0.00	$0.00	$0.00	$0.00
MS465	DRG	MS465		WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC	INPATIENT ONLY	"$180,920.22"	"$133,880.96"	$0.00	"$117,446.30"	"$101,350.92"	"$101,350.92"	$0.00	$0.00	"$23,618.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$117,446.30"	"$117,446.30"	$0.00	"$28,239.62"	"$77,963.23"	$0.00	"$19,198.54"	"$117,446.30"	"$19,198.54"	"$13,287.73"	"$28,785.73"	"$28,785.73"	$0.00	"$13,952.11"	$0.00	$0.00	$0.00	$0.00
MS466	DRG	MS466		REVISION OF HIP OR KNEE REPLACEMENT WITH MCC	INPATIENT ONLY	"$222,148.64"	"$164,389.99"	$0.00	"$54,786.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$54,786.94"	"$54,786.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS467	DRG	MS467		REVISION OF HIP OR KNEE REPLACEMENT WITH CC	INPATIENT ONLY	"$270,187.14"	"$199,938.48"	$0.00	"$41,826.76"	$0.00	$0.00	"$35,743.58"	"$35,743.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$36,458.45"	$0.00	$0.00	"$37,803.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$41,826.76"	"$41,826.76"	"$36,003.24"	$0.00	$0.00	$0.00	$0.00	$0.00
MS468	DRG	MS468		REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC	INPATIENT ONLY	"$240,260.62"	"$177,792.86"	$0.00	"$36,110.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$36,110.24"	"$36,110.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS469	DRG	MS469		MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT	INPATIENT ONLY	"$181,244.35"	"$134,120.82"	$0.00	"$38,787.20"	$0.00	$0.00	"$32,350.79"	"$32,350.79"	$0.00	$0.00	$0.00	$0.00	$0.00	"$32,295.68"	$0.00	"$32,859.14"	$0.00	$0.00	"$35,259.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$38,787.20"	"$38,787.20"	"$33,580.84"	$0.00	$0.00	$0.00	$0.00	$0.00
MS470	DRG	MS470		MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	INPATIENT ONLY	"$140,929.21"	"$104,287.62"	$0.00	"$90,107.90"	"$90,107.90"	"$90,107.90"	"$24,168.39"	"$24,168.39"	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,134.45"	$0.00	"$26,686.88"	$0.00	$0.00	"$27,254.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$29,220.19"	"$29,220.19"	"$25,956.32"	$0.00	$0.00	$0.00	$0.00	$0.00
MS471	DRG	MS471		CERVICAL SPINAL FUSION WITH MCC	INPATIENT ONLY	"$357,681.21"	"$264,684.10"	$0.00	"$46,610.85"	$0.00	$0.00	"$45,696.91"	"$45,696.91"	$0.00	$0.00	$0.00	$0.00	$0.00	"$45,607.28"	$0.00	"$46,610.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS472	DRG	MS472		CERVICAL SPINAL FUSION WITH CC	INPATIENT ONLY	"$261,184.95"	"$193,276.86"	$0.00	"$160,311.29"	$0.00	$0.00	"$32,128.57"	"$32,128.57"	$0.00	"$97,395.39"	$0.00	$0.00	$0.00	"$32,074.03"	"$97,407.75"	"$32,771.14"	$0.00	$0.00	"$34,587.43"	"$131,568.61"	"$160,311.29"	$0.00	"$30,488.93"	$0.00	"$30,488.93"	$0.00	"$37,983.62"	"$37,983.62"	"$32,940.41"	$0.00	$0.00	$0.00	$0.00	$0.00
MS473	DRG	MS473		CERVICAL SPINAL FUSION WITHOUT CC/MCC	INPATIENT ONLY	"$239,665.96"	"$177,352.81"	$0.00	"$107,627.95"	"$99,766.44"	"$99,766.44"	"$28,576.36"	"$28,576.36"	$0.00	"$40,046.68"	$0.00	$0.00	"$107,627.95"	"$28,531.02"	"$40,046.68"	"$29,147.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS474	DRG	MS474		AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC	INPATIENT ONLY	"$201,974.02"	"$149,460.77"	$0.00	"$40,282.68"	$0.00	$0.00	"$39,184.68"	"$39,184.68"	$0.00	$0.00	$0.00	$0.00	$0.00	"$39,111.88"	$0.00	"$39,968.37"	$0.00	$0.00	"$40,282.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$38,364.46"	$0.00	$0.00	$0.00	$0.00	$0.00
MS475	DRG	MS475		AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC	INPATIENT ONLY	"$105,803.89"	"$78,294.88"	$0.00	"$326,501.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$28,160.30"	"$267,962.31"	"$326,501.77"	$0.00	"$64,048.46"	$0.00	"$64,048.46"	$0.00	"$30,303.06"	"$30,303.06"	"$26,819.33"	$0.00	$0.00	$0.00	$0.00	$0.00
MS476	DRG	MS476		AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC	INPATIENT ONLY	"$108,051.26"	"$79,957.93"	$0.00	"$9,120.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,685.83"	$0.00	$0.00	$0.00	"$9,120.12"	$0.00	$0.00	$0.00	$0.00
MS477	DRG	MS477		BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC	INPATIENT ONLY	"$61,538.76"	"$45,538.68"	$0.00	"$39,729.61"	$0.00	$0.00	"$34,234.90"	"$34,234.90"	$0.00	$0.00	$0.00	$0.00	$0.00	"$34,174.93"	$0.00	"$34,919.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$39,729.61"	"$39,729.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS478	DRG	MS478		BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC	INPATIENT ONLY	"$39,367.17"	"$29,131.71"	$0.00	"$224,555.14"	"$217,556.76"	"$217,556.76"	$0.00	$0.00	"$61,408.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$224,555.14"	"$224,555.14"	"$29,637.06"	$0.00	$0.00	$0.00	$0.00	"$224,555.14"	$0.00	"$20,384.36"	"$32,067.82"	"$32,067.82"	"$28,225.77"	"$21,403.57"	$0.00	$0.00	$0.00	$0.00
MS479	DRG	MS479		BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC	INPATIENT ONLY	"$106,309.92"	"$78,669.34"	$0.00	"$71,699.35"	$0.00	$0.00	$0.00	$0.00	"$15,452.22"	"$15,243.66"	$0.00	$0.00	$0.00	$0.00	"$20,028.55"	$0.00	"$69,077.11"	"$69,077.11"	$0.00	"$18,769.33"	"$71,699.35"	$0.00	"$17,864.32"	"$69,077.11"	"$17,864.32"	$0.00	"$27,698.78"	"$27,698.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS480	DRG	MS480		HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC	INPATIENT ONLY	"$243,911.55"	"$180,494.55"	$0.00	"$155,993.30"	"$155,993.30"	"$155,993.30"	"$31,936.01"	"$31,936.01"	$0.00	"$68,695.36"	$0.00	$0.00	"$113,747.24"	"$31,881.99"	"$68,695.36"	"$32,574.73"	$0.00	$0.00	"$34,430.27"	"$117,923.11"	"$143,684.76"	$0.00	"$30,258.36"	$0.00	"$30,258.36"	$0.00	"$37,795.79"	"$37,795.79"	"$32,790.73"	$0.00	$0.00	$0.00	$0.00	$0.00
MS481	DRG	MS481		HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC	INPATIENT ONLY	"$187,285.44"	"$138,591.23"	$0.00	"$103,487.69"	"$103,487.69"	"$103,487.69"	"$25,519.71"	"$25,519.71"	$0.00	"$34,406.15"	$0.00	$0.00	"$69,006.41"	"$25,482.27"	"$44,024.27"	"$26,030.10"	$0.00	$0.00	"$28,070.09"	"$19,240.38"	"$68,283.40"	"$91,568.13"	"$20,928.74"	$0.00	"$20,928.74"	"$16,097.59"	"$30,195.26"	"$30,195.26"	"$26,733.42"	"$16,920.75"	$0.00	$0.00	$0.00	$0.00
MS482	DRG	MS482		HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC	INPATIENT ONLY	"$152,211.21"	"$112,636.30"	$0.00	"$106,385.28"	"$106,385.28"	"$106,385.28"	"$22,411.96"	"$22,411.96"	"$94,795.46"	"$28,317.96"	$0.00	$0.00	"$10,396.95"	"$22,382.56"	"$21,211.70"	"$22,860.20"	"$94,795.46"	"$94,795.46"	"$25,046.15"	"$20,216.62"	"$82,311.01"	"$82,947.32"	"$16,492.99"	"$94,795.46"	"$16,492.99"	"$15,016.39"	"$26,581.60"	"$26,581.60"	"$23,853.48"	"$15,767.20"	$0.00	$0.00	$0.00	$0.00
MS483	DRG	MS483		MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES	INPATIENT ONLY	"$217,236.63"	"$160,755.11"	$0.00	"$32,680.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,475.77"	$0.00	$0.00	$0.00	$0.00	"$30,149.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$32,680.33"	"$32,680.33"	"$28,713.91"	$0.00	$0.00	$0.00	$0.00	$0.00
MS485	DRG	MS485		KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC	INPATIENT ONLY	"$181,169.09"	"$134,065.13"	$0.00	"$34,584.81"	$0.00	$0.00	"$34,584.81"	"$34,584.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS486	DRG	MS486		KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC	INPATIENT ONLY	"$132,640.30"	"$98,153.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS487	DRG	MS487		KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC	INPATIENT ONLY	"$66,172.30"	"$48,967.50"	$0.00	"$24,785.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,344.01"	$0.00	$0.00	$0.00	$0.00	"$24,785.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,605.52"	$0.00	$0.00	$0.00	$0.00	$0.00
MS488	DRG	MS488		KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC	INPATIENT ONLY	"$194,584.23"	"$143,992.33"	$0.00	"$263,384.75"	"$137,696.34"	"$137,696.34"	"$24,688.76"	"$24,688.76"	$0.00	"$31,065.50"	$0.00	$0.00	$0.00	$0.00	"$37,012.28"	"$25,182.54"	$0.00	$0.00	"$27,259.61"	"$135,883.23"	"$165,568.51"	"$263,384.75"	"$19,739.85"	$0.00	"$19,739.85"	"$13,685.26"	"$29,226.72"	"$29,226.72"	"$25,961.53"	"$14,369.52"	$0.00	$0.00	$0.00	$0.00
MS489	DRG	MS489		KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC	INPATIENT ONLY	"$85,707.36"	"$63,423.45"	$0.00	"$242,647.77"	"$199,162.73"	"$199,162.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,406.27"	"$101,383.95"	"$123,532.45"	"$242,647.77"	"$12,620.61"	$0.00	"$12,620.61"	$0.00	"$23,426.88"	"$23,426.88"	"$21,339.30"	$0.00	$0.00	$0.00	$0.00	$0.00
MS492	DRG	MS492		"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC"	INPATIENT ONLY	"$180,446.20"	"$133,530.19"	$0.00	"$167,518.79"	"$137,567.97"	"$137,567.97"	"$35,001.66"	"$35,001.66"	$0.00	"$28,627.59"	$0.00	$0.00	"$132,023.09"	"$34,939.69"	"$30,058.98"	"$27,647.07"	$0.00	$0.00	"$37,346.90"	"$137,483.85"	"$167,518.79"	"$97,394.98"	"$42,010.85"	$0.00	"$42,010.85"	$0.00	"$41,281.24"	"$41,281.24"	"$35,568.48"	$0.00	$0.00	$0.00	$0.00	$0.00
MS493	DRG	MS493		"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC"	INPATIENT ONLY	"$173,538.94"	"$128,418.82"	$0.00	"$136,591.07"	"$118,634.14"	"$118,634.14"	"$27,104.97"	"$27,104.97"	"$30,494.41"	"$20,250.93"	$0.00	$0.00	"$22,271.98"	"$27,063.44"	"$20,250.93"	"$27,647.07"	"$136,591.07"	"$136,591.07"	"$28,127.50"	"$89,392.64"	"$108,921.50"	"$67,758.80"	"$23,075.96"	"$136,591.07"	"$23,075.96"	"$12,466.42"	"$31,944.52"	"$31,944.52"	"$28,127.50"	"$13,089.73"	$0.00	$0.00	$0.00	$0.00
MS494	DRG	MS494		"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC"	INPATIENT ONLY	"$138,260.52"	"$102,312.78"	$0.00	"$95,441.38"	"$26,344.79"	"$26,344.79"	"$23,832.96"	"$23,832.96"	"$13,742.95"	"$16,007.13"	$0.00	$0.00	"$10,821.20"	"$23,799.89"	"$16,007.13"	"$24,309.62"	"$81,035.66"	"$81,035.66"	"$26,181.24"	"$8,346.59"	"$77,751.89"	"$95,441.38"	"$18,158.03"	"$81,035.66"	"$18,158.03"	"$12,466.42"	"$27,938.05"	"$27,938.05"	"$24,934.51"	"$13,089.73"	$0.00	$0.00	$0.00	$0.00
MS495	DRG	MS495		LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC	INPATIENT ONLY	"$91,782.64"	"$67,919.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS496	DRG	MS496		LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC	INPATIENT ONLY	"$169,241.03"	"$125,238.36"	$0.00	"$29,808.99"	"$19,806.91"	"$19,806.91"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$13,025.13"	"$29,808.99"	"$29,808.99"	$0.00	"$13,676.38"	$0.00	$0.00	$0.00	$0.00
MS497	DRG	MS497		LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC	INPATIENT ONLY	"$75,872.17"	"$56,145.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS498	DRG	MS498		LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC	INPATIENT ONLY	"$117,318.76"	"$86,815.88"	$0.00	"$146,260.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$28,838.72"	$0.00	$0.00	$0.00	$0.00	"$30,532.28"	"$120,037.39"	"$146,260.94"	$0.00	"$24,540.49"	$0.00	"$24,540.49"	$0.00	"$33,137.63"	"$33,137.63"	"$29,078.36"	$0.00	$0.00	$0.00	$0.00	$0.00
MS499	DRG	MS499		LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC	INPATIENT ONLY	"$81,325.84"	"$60,181.12"	$0.00	"$11,045.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,045.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS500	DRG	MS500		SOFT TISSUE PROCEDURES WITH MCC	INPATIENT ONLY	"$578,168.03"	"$427,844.34"	$0.00	"$311,174.26"	"$102,731.36"	"$102,731.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$311,174.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$80,884.60"	"$80,884.60"	$0.00	"$80,884.60"	$0.00	"$80,884.60"	$0.00	"$37,768.84"	"$37,768.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS501	DRG	MS501		SOFT TISSUE PROCEDURES WITH CC	INPATIENT ONLY	"$72,783.50"	"$53,859.79"	$0.00	"$116,069.81"	"$4,437.05"	"$4,437.05"	"$23,011.70"	"$23,011.70"	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,980.75"	$0.00	"$23,471.93"	$0.00	$0.00	"$25,269.62"	"$95,259.31"	"$116,069.81"	"$62,879.13"	"$16,820.79"	$0.00	"$16,820.79"	$0.00	"$26,848.64"	"$26,848.64"	"$24,066.30"	$0.00	$0.00	$0.00	$0.00	$0.00
MS502	DRG	MS502		SOFT TISSUE PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$101,560.84"	"$75,155.02"	$0.00	"$164,767.02"	"$98,313.18"	"$98,313.18"	"$20,251.78"	"$20,251.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,656.82"	$0.00	$0.00	"$22,827.91"	"$135,225.45"	"$164,767.02"	$0.00	"$14,731.48"	$0.00	"$14,731.48"	$0.00	"$23,930.76"	"$23,930.76"	"$21,740.87"	$0.00	$0.00	$0.00	$0.00	$0.00
MS503	DRG	MS503		FOOT PROCEDURES WITH MCC	INPATIENT ONLY	"$73,724.81"	"$54,556.36"	$0.00	"$187,255.41"	$0.00	$0.00	"$29,277.56"	"$29,277.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$29,863.11"	$0.00	$0.00	"$32,367.16"	"$187,255.41"	"$148,306.29"	$0.00	"$187,255.41"	$0.00	"$187,255.41"	$0.00	"$35,330.35"	"$35,330.35"	"$30,825.87"	$0.00	$0.00	$0.00	$0.00	$0.00
MS504	DRG	MS504		FOOT PROCEDURES WITH CC	INPATIENT ONLY	"$113,617.68"	"$84,077.08"	$0.00	"$148,692.35"	"$142,601.36"	"$142,601.36"	"$23,303.62"	"$23,303.62"	"$33,045.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,769.69"	"$148,692.35"	"$148,692.35"	$0.00	"$94,993.22"	"$115,745.60"	$0.00	"$17,407.21"	"$148,692.35"	"$17,407.21"	$0.00	"$27,326.39"	"$27,326.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS505	DRG	MS505		FOOT PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$141,271.98"	"$104,541.27"	$0.00	"$133,223.81"	"$14,075.15"	"$14,075.15"	"$23,303.62"	"$23,303.62"	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,271.93"	$0.00	"$23,769.69"	$0.00	$0.00	$0.00	"$109,337.71"	"$133,223.81"	$0.00	"$16,855.87"	$0.00	"$16,855.87"	$0.00	"$26,878.91"	"$26,878.91"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS506	DRG	MS506		MAJOR THUMB OR JOINT PROCEDURES	INPATIENT ONLY	"$77,651.23"	"$57,461.91"	$0.00	"$21,718.38"	$0.00	$0.00	"$21,292.53"	"$21,292.53"	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,266.04"	$0.00	"$21,718.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS507	DRG	MS507		MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC	INPATIENT ONLY	"$147,482.67"	"$109,137.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS508	DRG	MS508		MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$152,347.28"	"$112,736.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS510	DRG	MS510		"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC"	INPATIENT ONLY	"$272,856.35"	"$201,913.70"	$0.00	"$179,649.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$142,790.15"	$0.00	$0.00	"$30,588.88"	$0.00	$0.00	$0.00	"$147,439.34"	"$179,649.18"	$0.00	"$27,947.77"	$0.00	"$27,947.77"	$0.00	"$35,913.41"	"$35,913.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS511	DRG	MS511		"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC"	INPATIENT ONLY	"$155,199.53"	"$114,847.65"	$0.00	"$119,097.38"	"$119,097.38"	"$119,097.38"	"$24,631.47"	"$24,631.47"	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,596.33"	$0.00	"$25,124.10"	$0.00	$0.00	"$26,678.75"	"$83,340.79"	"$101,547.55"	$0.00	"$18,887.80"	$0.00	"$18,887.80"	"$14,202.32"	"$28,532.58"	"$28,532.58"	"$25,408.33"	"$14,912.43"	$0.00	$0.00	$0.00	$0.00
MS512	DRG	MS512		"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC"	INPATIENT ONLY	"$130,533.10"	"$96,594.49"	$0.00	"$69,039.85"	"$4,526.08"	"$4,526.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$43,076.17"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,928.39"	"$69,039.85"	"$47,895.51"	"$15,174.79"	$0.00	"$15,174.79"	"$9,356.83"	"$25,507.72"	"$25,507.72"	$0.00	"$9,824.67"	$0.00	$0.00	$0.00	$0.00
MS513	DRG	MS513		"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC"	INPATIENT ONLY	"$82,233.47"	"$60,852.77"	$0.00	"$95,133.80"	$0.00	$0.00	"$21,902.63"	"$21,902.63"	$0.00	$0.00	$0.00	$0.00	"$9,665.56"	"$21,874.54"	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,775.22"	"$34,223.36"	"$95,133.80"	"$15,809.32"	$0.00	"$15,809.32"	$0.00	"$26,024.64"	"$26,024.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS514	DRG	MS514		"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC"	INPATIENT ONLY	"$65,501.95"	"$48,471.44"	$0.00	"$38,957.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,109.64"	"$5,825.91"	"$38,957.44"	$0.00	"$10,693.93"	$0.00	"$10,693.93"	$0.00	"$21,857.31"	"$21,857.31"	"$20,104.47"	$0.00	$0.00	$0.00	$0.00	$0.00
MS515	DRG	MS515		OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC	INPATIENT ONLY	"$247,874.96"	"$183,427.47"	$0.00	"$265,646.77"	"$265,646.77"	"$265,646.77"	"$32,728.31"	"$32,728.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$33,382.88"	$0.00	$0.00	"$35,356.23"	"$171,828.87"	"$209,366.89"	$0.00	"$31,616.65"	$0.00	"$31,616.65"	$0.00	"$38,902.35"	"$38,902.35"	"$33,672.60"	$0.00	$0.00	$0.00	$0.00	$0.00
MS516	DRG	MS516		OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC	INPATIENT ONLY	"$202,001.98"	"$149,481.47"	$0.00	"$192,718.78"	"$6,477.57"	"$6,477.57"	"$24,599.75"	"$24,599.75"	"$18,238.84"	"$59,746.59"	$0.00	$0.00	"$40,231.44"	$0.00	"$59,758.95"	"$25,091.75"	"$82,828.31"	"$82,828.31"	"$27,053.91"	"$6,215.66"	"$41,578.09"	"$192,718.78"	"$19,438.14"	"$82,828.31"	"$19,438.14"	$0.00	"$28,980.91"	"$28,980.91"	"$25,765.63"	$0.00	$0.00	$0.00	$0.00	$0.00
MS517	DRG	MS517		OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$105,666.11"	"$78,192.92"	$0.00	"$260,109.45"	"$260,109.45"	"$260,109.45"	"$20,703.15"	"$20,703.15"	$0.00	$0.00	$0.00	$0.00	"$44,163.99"	"$20,678.18"	$0.00	"$21,117.21"	$0.00	$0.00	$0.00	"$100,967.39"	"$123,024.86"	"$194,960.94"	"$14,187.39"	$0.00	"$14,187.39"	$0.00	"$24,703.31"	"$24,703.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS518	DRG	MS518		BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR	INPATIENT ONLY	"$305,899.54"	"$226,365.66"	$0.00	"$53,149.12"	$0.00	$0.00	"$35,808.45"	"$35,808.45"	$0.00	"$34,583.75"	$0.00	$0.00	$0.00	"$35,744.40"	"$53,149.12"	"$36,524.62"	$0.00	$0.00	"$35,329.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$35,329.63"	$0.00	$0.00	$0.00	$0.00	$0.00
MS519	DRG	MS519		BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC	INPATIENT ONLY	"$247,143.59"	"$182,886.26"	$0.00	"$259,633.24"	"$259,633.24"	"$259,633.24"	"$24,580.40"	"$24,580.40"	$0.00	$0.00	$0.00	$0.00	"$153,503.88"	$0.00	$0.00	"$25,072.01"	$0.00	$0.00	$0.00	"$120,293.25"	"$146,572.73"	"$101,333.30"	"$19,133.38"	$0.00	"$19,133.38"	$0.00	"$28,732.65"	"$28,732.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS520	DRG	MS520		BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC	INPATIENT ONLY	"$263,064.66"	"$194,667.85"	$0.00	"$195,326.87"	$0.00	$0.00	"$20,841.86"	"$20,841.86"	$0.00	$0.00	$0.00	$0.00	"$195,326.87"	"$20,816.53"	$0.00	"$21,258.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS522	DRG	MS522		HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC	INPATIENT ONLY	"$164,480.28"	"$121,715.41"	$0.00	"$110,446.07"	"$110,446.07"	"$110,446.07"	"$26,163.61"	"$26,163.61"	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,124.50"	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS533	DRG	MS533		FRACTURES OF FEMUR WITH MCC	INPATIENT ONLY	"$19,588.32"	"$14,495.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS534	DRG	MS534		FRACTURES OF FEMUR WITHOUT MCC	INPATIENT ONLY	"$31,460.66"	"$23,280.89"	$0.00	"$19,117.88"	$0.00	$0.00	"$16,507.02"	"$16,507.02"	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,492.92"	$0.00	$0.00	$0.00	$0.00	"$19,117.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,207.50"	$0.00	$0.00	$0.00	$0.00	$0.00
MS535	DRG	MS535		FRACTURES OF HIP AND PELVIS WITH MCC	INPATIENT ONLY	"$54,105.68"	"$40,038.20"	$0.00	"$55,410.08"	$0.00	$0.00	"$19,561.65"	"$19,561.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,952.88"	$0.00	$0.00	"$22,188.27"	"$45,475.45"	"$55,410.08"	$0.00	"$12,300.82"	$0.00	"$12,300.82"	$0.00	"$23,166.38"	"$23,166.38"	"$21,131.69"	$0.00	$0.00	$0.00	$0.00	$0.00
MS536	DRG	MS536		FRACTURES OF HIP AND PELVIS WITHOUT MCC	INPATIENT ONLY	"$55,004.91"	"$40,703.63"	$0.00	"$51,105.97"	"$10,159.55"	"$10,159.55"	"$16,379.34"	"$16,379.34"	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,365.57"	$0.00	"$16,706.93"	$0.00	$0.00	"$18,985.98"	"$41,943.03"	"$51,105.97"	$0.00	"$7,603.43"	$0.00	"$7,603.43"	$0.00	"$19,339.59"	"$19,339.59"	"$18,081.89"	$0.00	$0.00	$0.00	$0.00	$0.00
MS539	DRG	MS539		OSTEOMYELITIS WITH MCC	INPATIENT ONLY	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS540	DRG	MS540		OSTEOMYELITIS WITH CC	INPATIENT ONLY	"$56,790.13"	"$42,024.70"	$0.00	"$23,761.72"	$0.00	$0.00	"$20,036.46"	"$20,036.46"	$0.00	"$12,280.17"	$0.00	$0.00	$0.00	"$20,013.22"	"$12,280.17"	"$20,437.19"	$0.00	$0.00	"$22,686.47"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,761.72"	"$23,761.72"	"$21,606.16"	$0.00	$0.00	$0.00	$0.00	$0.00
MS541	DRG	MS541		OSTEOMYELITIS WITHOUT CC/MCC	INPATIENT ONLY	"$16,708.96"	"$12,364.63"	$0.00	"$20,549.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$10,045.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,521.61"	"$13,050.54"	$0.00	"$9,089.03"	$0.00	"$9,089.03"	$0.00	"$20,549.86"	"$20,549.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS542	DRG	MS542		PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC	INPATIENT ONLY	"$48,347.24"	"$35,776.96"	$0.00	"$28,047.49"	"$20,433.00"	"$20,433.00"	"$23,539.66"	"$23,539.66"	"$17,380.18"	$0.00	$0.00	$0.00	$0.00	"$23,507.35"	$0.00	"$24,010.45"	"$27,138.00"	"$27,138.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,138.00"	$0.00	$0.00	"$28,047.49"	"$28,047.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS543	DRG	MS543		PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC	INPATIENT ONLY	"$138,113.94"	"$102,204.32"	$0.00	"$57,212.40"	"$57,212.40"	"$57,212.40"	"$18,266.92"	"$18,266.92"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,248.25"	$0.00	"$19,775.46"	$0.00	$0.00	"$21,021.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,020.07"	$0.00	$0.00	$0.00	$0.00	$0.00
MS544	DRG	MS544		PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC	INPATIENT ONLY	"$34,792.01"	"$25,746.09"	$0.00	"$20,893.70"	"$20,893.70"	"$20,893.70"	$0.00	$0.00	"$7,083.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,665.50"	"$11,665.50"	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,665.50"	$0.00	$0.00	"$19,338.77"	"$19,338.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS545	DRG	MS545		CONNECTIVE TISSUE DISORDERS WITH MCC	INPATIENT ONLY	"$64,829.08"	"$47,973.52"	$0.00	"$55,923.33"	"$26,284.20"	"$26,284.20"	$0.00	$0.00	"$22,618.69"	"$41,824.02"	$0.00	$0.00	$0.00	$0.00	"$55,923.33"	$0.00	"$37,546.50"	"$37,546.50"	$0.00	$0.00	$0.00	$0.00	$0.00	"$37,546.50"	$0.00	"$20,564.56"	"$33,790.14"	"$33,790.14"	$0.00	"$21,592.78"	$0.00	$0.00	$0.00	$0.00
MS546	DRG	MS546		CONNECTIVE TISSUE DISORDERS WITH CC	INPATIENT ONLY	"$55,499.36"	"$41,069.53"	$0.00	"$39,074.00"	"$20,716.21"	"$20,716.21"	"$19,390.49"	"$19,390.49"	$0.00	"$11,246.10"	$0.00	$0.00	$0.00	"$19,368.91"	"$11,246.10"	"$19,778.30"	$0.00	$0.00	$0.00	"$17,744.13"	"$39,074.00"	"$23,690.09"	"$12,063.24"	$0.00	"$12,063.24"	"$10,764.02"	"$22,972.84"	"$22,972.84"	$0.00	"$11,302.22"	$0.00	$0.00	$0.00	$0.00
MS547	DRG	MS547		CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC	INPATIENT ONLY	"$25,917.84"	"$19,179.20"	$0.00	"$21,983.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,338.61"	"$3,981.64"	"$21,983.21"	$0.00	"$8,120.69"	$0.00	"$8,120.69"	$0.00	"$19,760.97"	"$19,760.97"	"$18,417.72"	$0.00	$0.00	$0.00	$0.00	$0.00
MS548	DRG	MS548		SEPTIC ARTHRITIS WITH MCC	INPATIENT ONLY	"$413,977.48"	"$306,343.34"	$0.00	"$33,605.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$33,605.39"	"$33,605.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS549	DRG	MS549		SEPTIC ARTHRITIS WITH CC	INPATIENT ONLY	"$59,228.85"	"$43,829.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS550	DRG	MS550		SEPTIC ARTHRITIS WITHOUT CC/MCC	INPATIENT ONLY	"$68,433.98"	"$50,641.15"	$0.00	"$20,201.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,746.96"	"$9,998.30"	$0.00	"$8,661.00"	$0.00	"$8,661.00"	$0.00	"$20,201.14"	"$20,201.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS551	DRG	MS551		MEDICAL BACK PROBLEMS WITH MCC	INPATIENT ONLY	"$114,513.50"	"$84,739.99"	$0.00	"$26,358.23"	"$26,358.23"	"$26,358.23"	"$22,284.97"	"$22,284.97"	$0.00	$0.00	$0.00	$0.00	"$11,045.89"	"$22,255.91"	$0.00	"$22,730.67"	$0.00	$0.00	"$24,664.14"	$0.00	$0.00	"$25,317.60"	$0.00	$0.00	$0.00	"$10,043.22"	"$26,125.09"	"$26,125.09"	"$23,489.66"	"$10,545.38"	$0.00	$0.00	$0.00	$0.00
MS552	DRG	MS552		MEDICAL BACK PROBLEMS WITHOUT MCC	INPATIENT ONLY	"$72,301.05"	"$53,502.78"	$0.00	"$46,583.09"	"$42,175.25"	"$42,175.25"	"$17,564.33"	"$17,564.33"	"$7,763.60"	"$8,531.79"	$0.00	$0.00	"$23,389.21"	"$17,547.49"	"$8,531.79"	"$17,915.62"	"$14,151.00"	"$14,151.00"	"$20,034.27"	"$3,841.70"	"$46,583.09"	"$46,274.32"	"$9,141.16"	"$14,151.00"	"$9,141.16"	"$8,166.06"	"$41,185.53"	"$41,185.53"	"$19,080.26"	"$8,574.36"	$0.00	$0.00	$0.00	$0.00
MS553	DRG	MS553		BONE DISEASES AND ARTHROPATHIES WITH MCC	INPATIENT ONLY	"$51,045.58"	"$37,773.73"	$0.00	"$28,077.22"	$0.00	$0.00	"$19,860.48"	"$19,860.48"	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,806.02"	$0.00	"$20,225.30"	$0.00	$0.00	"$22,587.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$28,077.22"	"$28,077.22"	"$21,511.79"	$0.00	$0.00	$0.00	$0.00	$0.00
MS554	DRG	MS554		BONE DISEASES AND ARTHROPATHIES WITHOUT MCC	INPATIENT ONLY	"$34,943.63"	"$25,858.29"	$0.00	"$19,573.95"	"$8,173.20"	"$8,173.20"	"$16,522.90"	"$16,522.90"	"$6,492.58"	$0.00	$0.00	$0.00	$0.00	"$16,508.75"	$0.00	"$16,853.36"	"$11,887.50"	"$11,887.50"	"$19,182.11"	$0.00	$0.00	$0.00	$0.00	"$11,887.50"	$0.00	"$7,215.26"	"$19,573.95"	"$19,573.95"	"$18,268.68"	"$7,576.01"	$0.00	$0.00	$0.00	$0.00
MS555	DRG	MS555		SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC	INPATIENT ONLY	"$55,014.70"	"$40,710.88"	$0.00	"$25,282.80"	$0.00	$0.00	"$20,498.16"	"$20,498.16"	$0.00	"$10,813.74"	$0.00	$0.00	$0.00	"$20,473.72"	"$10,813.74"	"$20,908.12"	$0.00	$0.00	"$22,791.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,282.80"	$0.00	$0.00	$0.00	$0.00	$0.00
MS556	DRG	MS556		SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC	INPATIENT ONLY	"$15,857.45"	"$11,734.51"	$0.00	"$19,611.52"	$0.00	$0.00	"$16,634.69"	"$16,634.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,967.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,611.52"	"$19,611.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS557	DRG	MS557		"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC"	INPATIENT ONLY	"$24,976.66"	"$18,482.73"	$0.00	"$25,053.66"	$0.00	$0.00	"$20,709.35"	"$20,709.35"	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,684.37"	$0.00	"$17,338.39"	$0.00	$0.00	$0.00	"$7,288.53"	"$23,483.23"	$0.00	"$14,617.44"	$0.00	"$14,617.44"	"$8,981.94"	"$25,053.66"	"$25,053.66"	$0.00	"$9,431.03"	$0.00	$0.00	$0.00	$0.00
MS558	DRG	MS558		"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC"	INPATIENT ONLY	"$29,084.09"	"$21,522.23"	$0.00	"$20,179.91"	$0.00	$0.00	"$16,998.42"	"$16,998.42"	$0.00	"$7,373.78"	$0.00	$0.00	"$3,348.41"	"$16,983.03"	"$7,373.78"	"$17,338.39"	$0.00	$0.00	"$19,689.18"	"$6,684.92"	"$14,709.82"	$0.00	"$8,634.93"	$0.00	"$8,634.93"	"$7,057.69"	"$20,179.91"	"$20,179.91"	"$18,751.60"	"$7,410.57"	$0.00	$0.00	$0.00	$0.00
MS559	DRG	MS559		"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC"	INPATIENT ONLY	"$71,553.76"	"$52,949.78"	$0.00	"$26,115.65"	$0.00	$0.00	"$23,926.84"	"$23,926.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,405.38"	$0.00	$0.00	"$26,115.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,872.05"	$0.00	$0.00	$0.00	$0.00	$0.00
MS560	DRG	MS560		"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC"	INPATIENT ONLY	"$37,994.06"	"$28,115.60"	$0.00	"$19,176.18"	$0.00	$0.00	"$18,479.48"	"$18,479.48"	$0.00	"$4,841.55"	$0.00	$0.00	$0.00	"$18,460.26"	"$19,176.18"	"$18,849.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS561	DRG	MS561		"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC"	INPATIENT ONLY	"$13,202.24"	"$9,769.66"	$0.00	"$16,852.65"	$0.00	$0.00	"$16,522.21"	"$16,522.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,852.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS562	DRG	MS562		"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC"	INPATIENT ONLY	"$19,338.11"	"$14,310.20"	$0.00	"$29,572.12"	"$21,147.88"	"$21,147.88"	"$20,797.00"	"$20,797.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,212.94"	$0.00	$0.00	"$23,008.32"	"$24,270.04"	"$29,572.12"	$0.00	"$13,503.74"	$0.00	"$13,503.74"	$0.00	"$24,146.36"	"$24,146.36"	"$21,912.69"	$0.00	$0.00	$0.00	$0.00	$0.00
MS563	DRG	MS563		"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC"	INPATIENT ONLY	"$45,179.03"	"$33,432.48"	$0.00	"$30,007.85"	"$8,550.54"	"$8,550.54"	"$17,072.96"	"$17,072.96"	"$6,922.80"	"$10,446.77"	$0.00	$0.00	"$11,045.89"	$0.00	"$8,103.21"	"$17,414.42"	"$13,083.00"	"$13,083.00"	"$19,638.62"	"$24,627.66"	"$30,007.85"	"$29,566.02"	"$8,560.76"	"$13,083.00"	"$8,560.76"	"$7,755.86"	"$20,119.49"	"$20,119.49"	"$18,703.45"	"$8,143.64"	$0.00	$0.00	$0.00	$0.00
MS564	DRG	MS564		OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC	INPATIENT ONLY	"$28,508.20"	"$21,096.07"	$0.00	"$33,697.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$33,697.98"	$0.00	$0.00	"$24,135.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$10,269.60"	"$25,493.02"	"$25,493.02"	"$22,985.93"	"$10,783.08"	$0.00	$0.00	$0.00	$0.00
MS565	DRG	MS565		OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC	INPATIENT ONLY	"$58,776.46"	"$43,494.58"	$0.00	"$58,773.78"	$0.00	$0.00	"$18,019.16"	"$18,019.16"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,001.13"	$0.00	"$18,379.54"	$0.00	$0.00	$0.00	"$42,888.55"	"$52,258.04"	"$58,773.78"	"$9,828.83"	$0.00	"$9,828.83"	"$10,269.60"	"$21,152.55"	"$21,152.55"	$0.00	"$10,783.08"	$0.00	$0.00	$0.00	$0.00
MS566	DRG	MS566		OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC	INPATIENT ONLY	"$52,050.86"	"$38,517.64"	$0.00	"$19,333.07"	"$14,242.21"	"$14,242.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,333.07"	"$19,333.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS570	DRG	MS570		SKIN DEBRIDEMENT WITH MCC	INPATIENT ONLY	"$176,422.47"	"$130,552.63"	$0.00	"$37,352.79"	$0.00	$0.00	"$30,665.46"	"$30,665.46"	$0.00	$0.00	$0.00	$0.00	$0.00	"$30,614.70"	$0.00	"$31,278.77"	$0.00	$0.00	"$29,679.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$37,352.79"	"$37,352.79"	"$29,679.42"	$0.00	$0.00	$0.00	$0.00	$0.00
MS571	DRG	MS571		SKIN DEBRIDEMENT WITH CC	INPATIENT ONLY	"$85,212.35"	"$63,057.14"	$0.00	"$92,480.47"	$0.00	$0.00	"$59,862.87"	"$59,862.87"	$0.00	"$14,515.09"	$0.00	$0.00	"$11,045.89"	"$59,924.61"	"$14,515.09"	"$61,129.05"	$0.00	$0.00	"$25,230.67"	"$7,827.96"	"$92,480.47"	$0.00	"$16,763.65"	$0.00	"$16,763.65"	$0.00	"$26,802.10"	"$26,802.10"	"$24,029.21"	$0.00	$0.00	$0.00	$0.00	$0.00
MS572	DRG	MS572		SKIN DEBRIDEMENT WITHOUT CC/MCC	INPATIENT ONLY	"$94,703.95"	"$70,080.92"	$0.00	"$187,600.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,045.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$187,600.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS574	DRG	MS574		SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC	INPATIENT ONLY	"$148,433.14"	"$109,840.52"	$0.00	"$96,481.54"	"$94,618.60"	"$94,618.60"	$0.00	$0.00	"$23,472.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$96,481.54"	"$96,481.54"						"$96,481.54"	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS575	DRG	MS575		SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC	INPATIENT ONLY	"$159,802.59"	"$118,253.92"	$0.00	"$106,610.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$106,610.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS576	DRG	MS576		SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC	INPATIENT ONLY	"$201,124.76"	"$148,832.32"	$0.00	"$191,834.21"	$0.00	$0.00	"$187,666.77"	"$187,666.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$191,834.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$52,745.32"	"$52,745.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS577	DRG	MS577		SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC	INPATIENT ONLY	"$326,238.97"	"$241,416.84"	$0.00	"$210,439.66"	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,509.22"	$0.00	$0.00	"$152,022.01"	$0.00	"$21,509.22"	$0.00	$0.00	$0.00	"$30,310.19"	"$172,709.30"	"$210,439.66"	$0.00	"$30,411.56"	$0.00	"$30,411.56"	"$20,587.20"	"$32,872.23"	"$32,872.23"	"$28,866.85"	"$21,616.55"	$0.00	$0.00	$0.00	$0.00
MS578	DRG	MS578		SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC	INPATIENT ONLY	"$195,675.49"	"$144,799.86"	$0.00	"$89,151.39"	$0.00	$0.00	$0.00	$0.00	$0.00	"$15,734.20"	$0.00	$0.00	$0.00	$0.00	"$15,734.20"	$0.00	$0.00	$0.00	$0.00	"$6,314.74"	"$89,151.39"	$0.00	"$16,313.56"	$0.00	"$16,313.56"	$0.00	"$26,435.44"	"$26,435.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS579	DRG	MS579		"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC"	INPATIENT ONLY	"$204,580.32"	"$151,389.44"	$0.00	"$37,531.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,506.89"	$0.00	$0.00	"$34,208.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$37,531.20"	"$37,531.20"	"$32,579.85"	$0.00	$0.00	$0.00	$0.00	$0.00
MS580	DRG	MS580		"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC"	INPATIENT ONLY	"$135,202.42"	"$100,049.79"	$0.00	"$103,996.14"	"$103,996.14"	"$103,996.14"	"$22,984.77"	"$22,984.77"	$0.00	"$17,934.78"	$0.00	$0.00	$0.00	"$22,953.89"	"$17,934.78"	"$23,444.47"	$0.00	$0.00	"$24,796.03"	"$13,426.57"	"$96,657.78"	$0.00	"$16,126.10"	$0.00	"$16,126.10"	"$13,096.07"	"$26,282.71"	"$26,282.71"	"$23,615.27"	"$13,137.34"	$0.00	$0.00	$0.00	$0.00
MS581	DRG	MS581		"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC"	INPATIENT ONLY	"$103,131.58"	"$76,317.37"	$0.00	"$289,721.02"	"$98,764.64"	"$98,764.64"	$0.00	$0.00	$0.00	"$34,620.26"	$0.00	$0.00	$0.00	$0.00	"$44,809.25"	"$17,283.48"	$0.00	$0.00	"$22,377.58"	"$237,776.11"	"$289,721.02"	$0.00	"$51,492.35"	$0.00	"$51,492.35"	"$8,905.88"	"$23,392.60"	"$23,392.60"	"$21,311.98"	"$9,351.17"	$0.00	$0.00	$0.00	$0.00
MS582	DRG	MS582		MASTECTOMY FOR MALIGNANCY WITH CC/MCC	INPATIENT ONLY	"$129,566.31"	"$95,879.07"	$0.00	"$22,841.19"	$0.00	$0.00	"$22,393.32"	"$22,393.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,841.19"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS583	DRG	MS583		MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC	INPATIENT ONLY	"$162,444.59"	"$120,209.00"	$0.00	"$29,509.94"	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,037.12"	$0.00	$0.00	$0.00	$0.00	"$29,509.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS584	DRG	MS584		"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC"	INPATIENT ONLY	"$94,531.64"	"$69,953.41"	$0.00	"$474,664.05"	"$474,664.05"	"$474,664.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$15,496.32"	$0.00	$0.00	$0.00	"$16,271.13"	$0.00	$0.00	$0.00	$0.00
MS585	DRG	MS585		"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC"	INPATIENT ONLY	"$165,756.69"	"$122,659.95"	$0.00	"$66,928.30"	$0.00	$0.00	$0.00	$0.00	$0.00	"$32,770.74"	$0.00	$0.00	$0.00	$0.00	"$32,770.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$66,928.30"	$0.00	$0.00	$0.00	"$15,175.67"	$0.00	$0.00	$0.00	$0.00
MS592	DRG	MS592		SKIN ULCERS WITH MCC	INPATIENT ONLY	"$22,209.32"	"$16,434.90"	$0.00	"$23,226.65"	$0.00	$0.00	"$22,784.82"	"$22,784.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,226.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,094.03"	"$21,094.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS593	DRG	MS593		SKIN ULCERS WITH CC	INPATIENT ONLY	"$15,697.87"	"$11,616.42"	$0.00	"$22,518.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,646.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,518.78"	"$22,518.78"	"$20,615.57"	$0.00	$0.00	$0.00	$0.00	$0.00
MS594	DRG	MS594		SKIN ULCERS WITHOUT CC/MCC	INPATIENT ONLY	"$24,390.66"	"$18,049.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS595	DRG	MS595		MAJOR SKIN DISORDERS WITH MCC	INPATIENT ONLY	"$29,157.59"	"$21,576.62"	$0.00	"$525,887.27"	"$525,887.27"	"$525,887.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS596	DRG	MS596		MAJOR SKIN DISORDERS WITHOUT MCC	INPATIENT ONLY	"$18,558.10"	"$13,732.99"	$0.00	"$21,100.29"	$0.00	$0.00	"$17,918.39"	"$17,918.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,276.76"	$0.00	$0.00	"$20,459.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,100.29"	"$21,100.29"	"$19,485.10"	$0.00	$0.00	$0.00	$0.00	$0.00
MS597	DRG	MS597		MALIGNANT BREAST DISORDERS WITH MCC	INPATIENT ONLY	"$151,439.02"	"$112,064.87"	$0.00	"$26,970.32"	$0.00	$0.00	"$22,399.52"	"$22,399.52"	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,370.18"	$0.00	"$22,847.51"	$0.00	$0.00	"$25,371.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,123.52"	"$26,970.32"	"$26,970.32"	"$24,163.28"	"$11,679.69"	$0.00	$0.00	$0.00	$0.00
MS598	DRG	MS598		MALIGNANT BREAST DISORDERS WITH CC	INPATIENT ONLY	"$10,043.51"	"$7,432.20"	$0.00	"$35,696.67"	$0.00	$0.00	"$18,765.23"	"$18,765.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$851.31	$0.00	$0.00	"$21,241.80"	"$10,944.14"	"$35,696.67"	$0.00	"$10,912.47"	$0.00	"$10,912.47"	$0.00	"$22,035.33"	"$22,035.33"	"$20,230.29"	$0.00	$0.00	$0.00	$0.00	$0.00
MS600	DRG	MS600		NON-MALIGNANT BREAST DISORDERS WITH CC/MCC	INPATIENT ONLY	"$24,329.27"	"$18,003.66"	$0.00	"$18,292.24"	$0.00	$0.00	"$17,933.57"	"$17,933.57"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,292.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS601	DRG	MS601		NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC	INPATIENT ONLY	"$11,235.84"	"$8,314.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS602	DRG	MS602		CELLULITIS WITH MCC	INPATIENT ONLY	"$39,242.55"	"$29,039.49"	$0.00	"$24,821.74"	"$4,323.53"	"$4,323.53"	"$21,060.64"	"$21,060.64"	"$12,993.19"	$0.00	$0.00	$0.00	$0.00	"$21,073.09"	$0.00	"$17,283.48"	"$21,750.00"	"$21,750.00"	"$23,573.49"	$0.00	$0.00	"$18,754.05"	$0.00	"$21,750.00"	$0.00	$0.00	"$24,821.74"	"$24,821.74"	"$22,450.94"	$0.00	$0.00	$0.00	$0.00	$0.00
MS603	DRG	MS603		CELLULITIS WITHOUT MCC	INPATIENT ONLY	"$33,623.54"	"$24,881.42"	$0.00	"$20,033.73"	"$16,457.97"	"$16,457.97"	"$16,944.59"	"$16,944.59"	"$7,539.56"	$0.00	$0.00	$0.00	"$16,809.02"	"$16,929.35"	$0.00	"$17,283.48"	"$12,804.00"	"$12,804.00"	"$19,566.86"	"$6,546.00"	"$17,835.13"	$0.00	"$8,455.50"	"$12,804.00"	"$8,455.50"	"$8,000.35"	"$20,033.73"	"$20,033.73"	"$18,635.10"	"$8,400.36"	$0.00	$0.00	$0.00	$0.00
MS604	DRG	MS604		"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC"	INPATIENT ONLY	"$58,470.55"	"$43,268.21"	$0.00	"$101,032.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,678.25"	$0.00	$0.00	"$23,810.62"	"$82,918.27"	"$101,032.73"	$0.00	"$14,680.60"	$0.00	"$14,680.60"	$0.00	"$25,105.11"	"$25,105.11"	"$22,676.78"	$0.00	$0.00	$0.00	$0.00	$0.00
MS605	DRG	MS605		"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC"	INPATIENT ONLY	"$44,177.90"	"$32,691.65"	$0.00	"$33,846.48"	"$11,723.60"	"$11,723.60"	"$17,291.74"	"$17,291.74"	$0.00	"$6,598.94"	$0.00	$0.00	"$9,236.98"	"$17,275.60"	"$6,598.94"	"$17,637.57"	$0.00	$0.00	"$19,786.89"	"$27,778.04"	"$33,846.48"	$0.00	"$8,778.29"	$0.00	"$8,778.29"	"$6,316.06"	"$20,354.44"	"$20,354.44"	"$18,844.66"	"$6,631.86"	$0.00	$0.00	$0.00	$0.00
MS606	DRG	MS606		MINOR SKIN DISORDERS WITH MCC	INPATIENT ONLY	"$38,821.50"	"$28,727.91"	$0.00	"$25,358.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,358.28"	"$25,358.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS607	DRG	MS607		MINOR SKIN DISORDERS WITHOUT MCC	INPATIENT ONLY	"$24,146.53"	"$17,868.43"	$0.00	"$19,891.64"	"$4,312.35"	"$4,312.35"	"$16,769.28"	"$16,769.28"	$0.00	"$6,557.31"	$0.00	$0.00	"$6,696.82"	"$16,754.48"	"$6,557.31"	"$17,104.67"	$0.00	$0.00	"$19,447.95"	"$6,767.14"	"$9,573.60"	$0.00	"$8,281.08"	$0.00	"$8,281.08"	$0.00	"$19,891.64"	"$19,891.64"	"$18,521.86"	$0.00	$0.00	$0.00	$0.00	$0.00
MS614	DRG	MS614		ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC	INPATIENT ONLY	"$332,589.59"	"$246,116.30"	$0.00	"$187,016.76"	$0.00	$0.00	$0.00	$0.00	$0.00	"$39,122.95"	$0.00	$0.00	"$187,016.76"	$0.00	"$50,125.70"	$0.00	$0.00	$0.00	"$30,431.14"	"$137,820.12"	"$167,928.51"	$0.00	"$24,392.14"	$0.00	"$24,392.14"	$0.00	"$33,016.77"	"$33,016.77"	"$28,982.04"	$0.00	$0.00	$0.00	$0.00	$0.00
MS615	DRG	MS615		ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$152,983.56"	"$113,207.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS616	DRG	MS616		"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC"	INPATIENT ONLY	"$192,155.28"	"$142,194.91"	$0.00	"$45,817.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$41,143.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$45,817.70"	"$45,817.70"	"$39,183.85"	$0.00	$0.00	$0.00	$0.00	$0.00
MS617	DRG	MS617		"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC"	INPATIENT ONLY	"$70,219.82"	"$51,962.67"	$0.00	"$78,850.16"	$0.00	$0.00	"$25,062.13"	"$25,062.13"	$0.00	$0.00	$0.00	$0.00	"$3,348.41"	"$25,025.87"	$0.00	"$25,563.37"	$0.00	$0.00	"$27,820.65"	"$30,246.42"	"$78,850.16"	$0.00	"$20,562.86"	$0.00	"$20,562.86"	$0.00	"$29,897.18"	"$29,897.18"	"$26,495.86"	$0.00	$0.00	$0.00	$0.00	$0.00
MS622	DRG	MS622		"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC"	INPATIENT ONLY	"$231,450.41"	"$171,273.30"	$0.00	"$150,442.75"	$0.00	$0.00	$0.00	$0.00	"$41,216.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$150,442.75"	"$150,442.75"						"$150,442.75"	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS623	DRG	MS623		"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC"	INPATIENT ONLY	"$112,314.61"	"$83,112.81"	$0.00	"$25,933.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,933.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,698.30"	$0.00	$0.00	$0.00	$0.00	$0.00
MS626	DRG	MS626		"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC"	INPATIENT ONLY	"$190,024.42"	"$140,618.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS627	DRG	MS627		"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC"	INPATIENT ONLY	"$133,664.81"	"$98,911.96"	$0.00	"$29,066.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$29,066.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS628	DRG	MS628		"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC"	INPATIENT ONLY	"$110,871.85"	"$82,045.17"	$0.00	"$39,014.36"	$0.00	$0.00	"$36,446.84"	"$36,446.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$37,175.78"	$0.00	$0.00	"$39,014.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$37,156.53"	$0.00	$0.00	$0.00	$0.00	$0.00
MS629	DRG	MS629		"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC"	INPATIENT ONLY	"$112,509.13"	"$83,256.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS630	DRG	MS630		"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC"	INPATIENT ONLY	"$158,798.79"	"$117,511.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS637	DRG	MS637		DIABETES WITH MCC	INPATIENT ONLY	"$36,108.73"	"$26,720.46"	$0.00	"$40,133.70"	"$16,572.15"	"$16,572.15"	"$20,554.07"	"$20,554.07"	"$12,446.04"	"$23,792.53"	$0.00	$0.00	$0.00	"$20,529.49"	"$23,792.53"	"$20,965.15"	"$20,649.00"	"$20,649.00"	"$23,272.11"	"$20,432.15"	"$40,133.70"	$0.00	"$13,890.67"	"$20,649.00"	"$13,890.67"	"$12,230.98"	"$24,461.58"	"$24,461.58"	"$22,163.91"	"$12,842.52"	$0.00	$0.00	$0.00	$0.00
MS638	DRG	MS638		DIABETES WITH CC	INPATIENT ONLY	"$34,793.06"	"$25,746.86"	$0.00	"$22,063.63"	"$12,998.32"	"$12,998.32"	"$17,122.64"	"$17,122.64"	$0.00	"$7,457.98"	$0.00	$0.00	"$12,069.23"	"$17,106.93"	"$7,457.98"	"$17,465.09"	$0.00	$0.00	"$19,844.30"	"$3,621.13"	"$22,063.63"	$0.00	"$8,862.48"	$0.00	"$8,862.48"	"$2,865.07"	"$20,365.28"	"$20,365.28"	"$18,899.33"	"$3,049.24"	$0.00	$0.00	$0.00	$0.00
MS639	DRG	MS639		DIABETES WITHOUT CC/MCC	INPATIENT ONLY	"$23,626.99"	"$17,483.97"	$0.00	"$31,516.95"	$0.00	$0.00	"$15,260.63"	"$15,260.63"	$0.00	"$4,826.72"	$0.00	$0.00	"$3,348.41"	$0.00	"$5,194.00"	"$15,565.84"	$0.00	$0.00	"$17,993.04"	"$7,233.31"	"$31,516.95"	$0.00	"$6,146.90"	$0.00	"$6,146.90"	"$4,971.35"	"$18,153.00"	"$18,153.00"	"$17,136.23"	"$5,219.92"	$0.00	$0.00	$0.00	$0.00
MS640	DRG	MS640		"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC"	INPATIENT ONLY	"$49,024.53"	"$36,278.15"	$0.00	"$79,244.98"	"$8,356.69"	"$8,356.69"	"$19,547.83"	"$19,547.83"	$0.00	"$9,176.07"	$0.00	$0.00	$0.00	"$19,525.85"	"$9,176.07"	"$19,963.83"	$0.00	$0.00	"$22,100.13"	"$17,903.38"	"$79,244.98"	$0.00	"$12,171.50"	$0.00	"$12,171.50"	"$8,782.73"	"$23,061.04"	"$23,061.04"	"$21,047.74"	"$9,221.86"	$0.00	$0.00	$0.00	$0.00
MS641	DRG	MS641		"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC"	INPATIENT ONLY	"$51,782.41"	"$38,318.98"	$0.00	"$120,359.68"	"$12,711.30"	"$12,711.30"	"$16,258.58"	"$16,258.58"	"$6,293.53"	$0.00	$0.00	$0.00	"$6,696.82"	"$16,245.11"	$0.00	"$16,583.75"	"$11,313.00"	"$11,313.00"	"$17,809.69"	"$98,780.05"	"$120,359.68"	$0.00	"$7,584.39"	"$11,313.00"	"$7,584.39"	"$6,726.27"	"$19,324.07"	"$19,324.07"	"$16,961.90"	"$7,062.58"	$0.00	$0.00	$0.00	$0.00
MS642	DRG	MS642		INBORN AND OTHER DISORDERS OF METABOLISM	INPATIENT ONLY	"$38,588.82"	"$28,555.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS643	DRG	MS643		ENDOCRINE DISORDERS WITH MCC	INPATIENT ONLY	"$53,294.85"	"$39,438.19"	$0.00	"$82,100.01"	$0.00	$0.00	"$22,563.09"	"$22,563.09"	$0.00	$0.00	$0.00	$0.00	"$10,045.23"	"$22,533.31"	$0.00	"$23,014.35"	$0.00	$0.00	"$24,910.85"	"$22,826.66"	"$82,100.01"	$0.00	"$16,294.50"	$0.00	"$16,294.50"	$0.00	"$26,419.91"	"$26,419.91"	"$23,724.62"	$0.00	$0.00	$0.00	$0.00	$0.00
MS644	DRG	MS644		ENDOCRINE DISORDERS WITH CC	INPATIENT ONLY	"$30,234.31"	"$22,373.39"	$0.00	"$21,541.26"	$0.00	$0.00	"$18,091.62"	"$18,091.62"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,073.40"	$0.00	"$18,453.45"	$0.00	$0.00	"$20,828.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,541.26"	"$21,541.26"	"$19,836.54"	$0.00	$0.00	$0.00	$0.00	$0.00
MS645	DRG	MS645		ENDOCRINE DISORDERS WITHOUT CC/MCC	INPATIENT ONLY	"$20,021.98"	"$14,816.27"	$0.00	"$19,394.31"	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,885.00"	$0.00	$0.00	$0.00	$0.00	"$6,576.23"	$0.00	$0.00	$0.00	"$19,031.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,394.31"	"$19,394.31"	"$18,125.50"	$0.00	$0.00	$0.00	$0.00	$0.00
MS653	DRG	MS653		MAJOR BLADDER PROCEDURES WITH MCC	INPATIENT ONLY	"$422,791.72"	"$312,865.87"	$0.00	"$120,632.51"	"$120,632.51"	"$120,632.51"	"$87,387.01"	"$87,387.01"	$0.00	"$45,216.19"	$0.00	$0.00	$0.00	$0.00	"$45,216.19"	"$89,154.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$58,358.97"	"$58,358.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS654	DRG	MS654		MAJOR BLADDER PROCEDURES WITH CC	INPATIENT ONLY	"$254,371.61"	"$188,234.99"	$0.00	"$398,005.53"	$0.00	$0.00	"$31,087.15"	"$31,087.15"	$0.00	$0.00	$0.00	$0.00	$0.00	"$31,035.30"	$0.00	"$31,708.89"	$0.00	$0.00	"$33,020.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$398,005.53"	"$38,871.58"	"$38,871.58"	"$31,448.06"	"$398,005.53"	$0.00	$0.00	$0.00	$0.00
MS655	DRG	MS655		MAJOR BLADDER PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$248,905.14"	"$184,189.80"	$0.00	"$27,896.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,896.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,568.11"	$0.00	$0.00	$0.00	$0.00	$0.00
MS656	DRG	MS656		KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC	INPATIENT ONLY	"$508,652.91"	"$376,403.15"	$0.00	"$322,334.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$322,334.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS657	DRG	MS657		KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC	INPATIENT ONLY	"$225,332.95"	"$166,746.38"	$0.00	"$25,489.18"	$0.00	$0.00	"$24,986.36"	"$24,986.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,489.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS658	DRG	MS658		KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC	INPATIENT ONLY	"$296,090.66"	"$219,107.09"	$0.00	"$24,530.88"	$0.00	$0.00	"$21,943.35"	"$21,943.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,382.22"	$0.00	$0.00	"$24,530.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,362.74"	$0.00	$0.00	$0.00	$0.00	$0.00
MS659	DRG	MS659		KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC	INPATIENT ONLY	"$74,221.21"	"$54,923.70"	$0.00	"$66,773.39"	$0.00	$0.00	"$29,455.62"	"$29,455.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$66,773.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,657.76"	"$35,029.80"	"$35,029.80"	$0.00	"$9,090.65"	$0.00	$0.00	$0.00	$0.00
MS660	DRG	MS660		KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC	INPATIENT ONLY	"$15,538.14"	"$11,498.22"	$0.00	"$175,248.02"	"$175,248.02"	"$175,248.02"	"$21,013.02"	"$21,013.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,511.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$75,856.50"	"$75,856.50"	"$22,391.71"	$0.00	$0.00	$0.00	$0.00	$0.00
MS661	DRG	MS661		KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC	INPATIENT ONLY	"$84,694.84"	"$62,674.18"	$0.00	"$160,446.31"	"$115,839.73"	"$115,839.73"	"$19,282.45"	"$19,282.45"	"$21,549.38"	"$40,633.76"	$0.00	$0.00	$0.00	$0.00	"$40,633.76"	"$19,668.10"	"$117,270.70"	"$117,270.70"	$0.00	"$131,679.42"	"$160,446.31"	$0.00	"$12,993.46"	"$117,270.70"	"$12,993.46"	$0.00	"$44,096.27"	"$44,096.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS663	DRG	MS663		MINOR BLADDER PROCEDURES WITH CC	INPATIENT ONLY	"$199,962.84"	"$147,972.50"	$0.00	"$132,197.62"	$0.00	$0.00	"$22,092.41"	"$22,092.41"	"$26,512.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,534.26"	"$129,949.73"	"$129,949.73"	$0.00	"$108,495.52"	"$132,197.62"	$0.00	"$15,271.03"	"$129,949.73"	"$15,271.03"	$0.00	"$25,586.10"	"$25,586.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS664	DRG	MS664		MINOR BLADDER PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	$0.00	$0.00	$0.00	"$88,508.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$88,508.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS667	DRG	MS667		PROSTATECTOMY WITHOUT CC/MCC	INPATIENT ONLY	"$77,902.65"	"$57,647.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS668	DRG	MS668		TRANSURETHRAL PROCEDURES WITH MCC	INPATIENT ONLY	"$158,833.08"	"$117,536.48"	$0.00	"$35,915.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$31,029.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$35,915.88"	"$35,915.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS669	DRG	MS669		TRANSURETHRAL PROCEDURES WITH CC	INPATIENT ONLY	"$91,302.59"	"$67,563.92"	$0.00	"$22,280.82"	$0.00	$0.00	"$21,843.94"	"$21,843.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,280.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS670	DRG	MS670		TRANSURETHRAL PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$139,074.86"	"$102,915.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS671	DRG	MS671		URETHRAL PROCEDURES WITH CC/MCC	INPATIENT ONLY	"$232,859.23"	"$172,315.83"	$0.00	"$156,574.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,291.95"	"$128,501.69"	"$156,574.35"	$0.00	"$18,320.42"	$0.00	"$18,320.42"	$0.00	"$28,070.35"	"$28,070.35"	"$25,039.95"	$0.00	$0.00	$0.00	$0.00	$0.00
MS672	DRG	MS672		URETHRAL PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$137,707.44"	"$101,903.51"	$0.00	"$177,791.94"	"$177,791.94"	"$177,791.94"	$0.00	$0.00	"$36,697.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$166,277.84"	"$166,277.84"	$0.00	"$112,067.60"	"$136,550.05"	$0.00	"$10,357.11"	"$166,277.84"	"$10,357.11"	$0.00	"$21,582.93"	"$21,582.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS673	DRG	MS673		OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC	INPATIENT ONLY	"$110,049.20"	"$81,436.41"	$0.00	"$71,089.21"	"$34,498.80"	"$34,498.80"	"$34,989.93"	"$34,989.93"	"$31,260.58"	"$25,130.83"	$0.00	$0.00	"$26,787.28"	"$34,927.98"	"$25,130.83"	"$35,689.73"	"$71,089.21"	"$71,089.21"	"$36,410.02"	$0.00	$0.00	$0.00	$0.00	"$71,089.21"	$0.00	$0.00	"$42,337.17"	"$42,337.17"	"$36,410.02"	$0.00	$0.00	$0.00	$0.00	$0.00
MS674	DRG	MS674		OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC	INPATIENT ONLY	"$131,367.95"	"$97,212.28"	$0.00	"$27,501.12"	$0.00	$0.00	"$27,501.12"	"$27,501.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS675	DRG	MS675		OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$139,199.75"	"$103,007.82"	$0.00	"$26,473.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,473.00"	"$26,473.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS682	DRG	MS682		RENAL FAILURE WITH MCC	INPATIENT ONLY	"$43,843.12"	"$32,443.91"	$0.00	"$45,225.20"	"$45,225.20"	"$45,225.20"	"$21,217.30"	"$21,217.30"	"$13,561.75"	$0.00	$0.00	$0.00	$0.00	"$21,191.00"	$0.00	"$21,641.65"	"$22,090.50"	"$22,090.50"	"$23,902.86"	"$21,793.11"	"$26,628.42"	$0.00	"$14,815.93"	"$22,090.50"	"$14,815.93"	"$11,998.26"	"$25,215.35"	"$25,215.35"	"$22,764.63"	"$12,616.02"	$0.00	$0.00	$0.00	$0.00
MS683	DRG	MS683		RENAL FAILURE WITH CC	INPATIENT ONLY	"$43,023.52"	"$31,837.40"	$0.00	"$31,160.10"	"$16,589.21"	"$16,589.21"	"$17,121.96"	"$17,121.96"	$0.00	$0.00	$0.00	$0.00	"$13,393.64"	"$17,106.27"	$0.00	"$17,464.40"	$0.00	$0.00	"$19,934.50"	"$10,177.45"	"$31,160.10"	$0.00	"$8,994.81"	$0.00	"$8,994.81"	$0.00	"$20,236.40"	"$20,236.40"	"$18,985.24"	$0.00	$0.00	$0.00	$0.00	$0.00
MS684	DRG	MS684		RENAL FAILURE WITHOUT CC/MCC	INPATIENT ONLY	"$10,087.95"	"$7,465.08"	$0.00	"$18,170.14"	$0.00	$0.00	"$15,248.89"	"$15,248.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$15,553.87"	$0.00	$0.00	$0.00	"$3,360.22"	"$8,379.35"	$0.00	"$6,167.96"	$0.00	"$6,167.96"	$0.00	"$18,170.14"	"$18,170.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS686	DRG	MS686		KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC	INPATIENT ONLY	"$27,117.25"	"$20,066.77"	$0.00	"$24,475.76"	$0.00	$0.00	"$23,995.84"	"$23,995.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,475.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS687	DRG	MS687		KIDNEY AND URINARY TRACT NEOPLASMS WITH CC	INPATIENT ONLY	"$34,699.96"	"$25,677.97"	$0.00	"$21,741.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,741.34"	"$21,741.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS689	DRG	MS689		KIDNEY AND URINARY TRACT INFECTIONS WITH MCC	INPATIENT ONLY	"$52,264.96"	"$38,676.07"	$0.00	"$22,280.33"	"$12,330.23"	"$12,330.23"	"$18,743.11"	"$18,743.11"	$0.00	$0.00	$0.00	$0.00	"$3,348.41"	"$18,723.22"	$0.00	"$19,117.97"	$0.00	$0.00	"$21,446.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,280.33"	"$22,280.33"	"$20,425.54"	$0.00	$0.00	$0.00	$0.00	$0.00
MS690	DRG	MS690		KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC	INPATIENT ONLY	"$34,630.42"	"$25,626.51"	$0.00	"$38,475.04"	"$4,086.60"	"$4,086.60"	"$16,533.26"	"$16,533.26"	$0.00	$0.00	$0.00	$0.00	"$20,090.46"	"$16,519.08"	$0.00	"$16,863.93"	$0.00	$0.00	"$19,206.72"	"$6,663.05"	"$38,475.04"	$0.00	"$7,927.21"	$0.00	"$7,927.21"	$0.00	"$17,599.41"	"$17,599.41"	"$18,292.11"	$0.00	$0.00	$0.00	$0.00	$0.00
MS693	DRG	MS693		URINARY STONES WITH MCC	INPATIENT ONLY	"$37,763.02"	"$27,944.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS694	DRG	MS694		URINARY STONES WITHOUT MCC	INPATIENT ONLY	"$27,812.82"	"$20,581.49"	$0.00	"$22,027.43"	"$4,116.30"	"$4,116.30"	"$16,375.91"	"$16,375.91"	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,362.14"	$0.00	"$16,703.43"	$0.00	$0.00	"$18,862.29"	"$8,086.81"	"$22,027.43"	$0.00	"$7,422.00"	$0.00	"$7,422.00"	$0.00	"$19,191.77"	"$19,191.77"	"$17,964.09"	$0.00	$0.00	$0.00	$0.00	$0.00
MS695	DRG	MS695		KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC	INPATIENT ONLY	"$30,389.68"	"$22,488.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS696	DRG	MS696		KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC	INPATIENT ONLY	"$8,697.46"	"$6,436.12"	$0.00	"$15,828.61"	$0.00	$0.00	"$15,828.61"	"$15,828.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS698	DRG	MS698		OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC	INPATIENT ONLY	"$62,273.78"	"$46,082.60"	$0.00	"$26,856.59"	$0.00	$0.00	"$22,169.02"	"$22,169.02"	$0.00	$0.00	$0.00	$0.00	"$16,742.05"	"$26,856.59"	$0.00	"$22,612.40"	$0.00	$0.00	"$24,863.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,363.55"	"$26,363.55"	"$23,679.70"	$0.00	$0.00	$0.00	$0.00	$0.00
MS699	DRG	MS699		OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC	INPATIENT ONLY	"$34,407.79"	"$25,461.76"	$0.00	"$21,922.34"	"$8,173.20"	"$8,173.20"	"$18,141.30"	"$18,141.30"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,122.96"	$0.00	"$18,504.13"	$0.00	$0.00	"$20,859.81"	"$10,876.54"	"$19,704.17"	$0.00	"$10,352.10"	$0.00	"$10,352.10"	"$3,969.84"	"$21,922.34"	"$21,922.34"	"$19,866.49"	"$4,225.02"	$0.00	$0.00	$0.00	$0.00
MS700	DRG	MS700		OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC	INPATIENT ONLY	"$33,843.09"	"$25,043.89"	$0.00	"$35,130.91"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,871.19"	"$7,542.32"	"$35,130.91"	$0.00	"$7,435.02"	$0.00	"$7,435.02"	$0.00	"$19,202.40"	"$19,202.40"	"$17,972.56"	$0.00	$0.00	$0.00	$0.00	$0.00
MS707	DRG	MS707		MAJOR MALE PELVIC PROCEDURES WITH CC/MCC	INPATIENT ONLY	"$245,462.36"	"$181,642.15"	$0.00	"$26,581.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.04	$0.00	$0.00	$0.00	$0.00	"$26,581.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,315.26"	$0.00	$0.00	$0.00	$0.00	$0.00
MS708	DRG	MS708		MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$191,309.76"	"$141,569.22"	$0.00	"$25,003.02"	$0.00	$0.00	"$21,344.99"	"$21,344.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,771.89"	$0.00	$0.00	"$23,725.19"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,003.02"	"$25,003.02"	"$22,595.42"	$0.00	$0.00	$0.00	$0.00	$0.00
MS709	DRG	MS709		PENIS PROCEDURES WITH CC/MCC	INPATIENT ONLY	"$184,084.60"	"$136,222.60"	$0.00	"$32,790.56"	$0.00	$0.00	"$27,036.64"	"$27,036.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,577.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$32,790.56"	"$32,790.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS710	DRG	MS710		PENIS PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$64,254.48"	"$47,548.32"	$0.00	"$120,205.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,549.05"	$0.00	$0.00	$0.00	$0.00	$0.00	"$120,205.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS711	DRG	MS711		TESTES PROCEDURES WITH CC/MCC	INPATIENT ONLY	"$99,610.22"	"$73,711.56"	$0.00	"$85,899.31"	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,621.76"	$0.00	$0.00	$0.00	$0.00	"$17,621.76"	$0.00	$0.00	$0.00	$0.00	"$4,158.09"	"$85,899.31"	$0.00	"$21,484.09"	$0.00	"$21,484.09"	$0.00	"$30,647.69"	"$30,647.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS713	DRG	MS713		TRANSURETHRAL PROSTATECTOMY WITH CC/MCC	INPATIENT ONLY	"$82,750.61"	"$61,235.45"	$0.00	"$25,084.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$12,211.96"	"$25,084.68"	"$25,084.68"	$0.00	"$12,822.56"	$0.00	$0.00	$0.00	$0.00
MS714	DRG	MS714		TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC	INPATIENT ONLY	"$112,034.77"	"$82,905.73"	$0.00	"$20,620.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,620.89"	"$20,620.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS715	DRG	MS715		OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC	INPATIENT ONLY	"$40,796.73"	"$30,189.58"	$0.00	"$148,588.40"	$0.00	$0.00	"$25,005.54"	"$25,005.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$121,947.55"	"$148,588.40"	$0.00	"$21,416.93"	$0.00	"$21,416.93"	$0.00	"$30,592.97"	"$30,592.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS717	DRG	MS717		OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC	INPATIENT ONLY	"$2,327,046.38"	"$1,722,014.32"	$0.00	"$326,740.55"	"$178,318.50"	"$178,318.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,674.83"	$0.00	$0.00	"$326,740.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,674.83"	$0.00	$0.00	$0.00	$0.00	$0.00
MS718	DRG	MS718		OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC	INPATIENT ONLY	"$158,309.83"	"$117,149.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS722	DRG	MS722		"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC"	INPATIENT ONLY	"$13,710.93"	"$10,146.09"	$0.00	"$26,136.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,136.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,892.20"	$0.00	$0.00	$0.00	$0.00	$0.00
MS723	DRG	MS723		"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC"	INPATIENT ONLY	"$21,568.66"	"$15,960.81"	$0.00	"$22,188.86"	$0.00	$0.00	"$18,589.21"	"$18,589.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,960.99"	$0.00	$0.00	"$21,370.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,188.86"	"$22,188.86"	"$20,352.65"	$0.00	$0.00	$0.00	$0.00	$0.00
MS725	DRG	MS725		BENIGN PROSTATIC HYPERTROPHY WITH MCC	INPATIENT ONLY	"$120,705.19"	"$89,321.84"	$0.00	"$23,861.50"	$0.00	$0.00	"$19,925.34"	"$19,925.34"	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,902.39"	$0.00	$0.00	$0.00	$0.00	"$22,381.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,861.50"	"$23,861.50"	"$21,315.89"	$0.00	$0.00	$0.00	$0.00	$0.00
MS727	DRG	MS727		INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC	INPATIENT ONLY	"$19,627.88"	"$14,524.63"	$0.00	"$23,556.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,556.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,434.67"	$0.00	$0.00	$0.00	$0.00	$0.00
MS728	DRG	MS728		INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC	INPATIENT ONLY	"$17,324.91"	"$12,820.43"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS729	DRG	MS729		OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC	INPATIENT ONLY	"$53,996.15"	"$39,957.15"	$0.00	"$21,997.01"	$0.00	$0.00	"$21,565.70"	"$21,565.70"	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,538.45"	$0.00	"$21,997.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS730	DRG	MS730		OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC	INPATIENT ONLY	"$55,239.20"	"$40,877.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS736	DRG	MS736		UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC	INPATIENT ONLY	"$342,516.71"	"$253,462.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS737	DRG	MS737		UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC	INPATIENT ONLY	"$149,825.85"	"$110,871.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS738	DRG	MS738		UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC	INPATIENT ONLY	"$190,239.02"	"$140,776.87"	$0.00	"$23,225.63"	$0.00	$0.00	"$21,239.38"	"$21,239.38"	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,213.03"	$0.00	$0.00	$0.00	$0.00	"$23,225.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,119.65"	$0.00	$0.00	$0.00	$0.00	$0.00
MS739	DRG	MS739		UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC	INPATIENT ONLY	"$345,645.71"	"$255,777.83"	$0.00	"$76,002.23"	$0.00	$0.00	"$37,444.79"	"$37,444.79"	$0.00	$0.00	$0.00	$0.00	$0.00	"$37,376.50"	$0.00	$0.00	$0.00	$0.00	"$39,391.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$76,002.23"	"$76,002.23"	"$37,515.77"	$0.00	$0.00	$0.00	$0.00	$0.00
MS740	DRG	MS740		UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC	INPATIENT ONLY	"$289,589.03"	"$214,295.88"	$0.00	"$27,721.64"	$0.00	$0.00	"$23,487.20"	"$23,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,455.02"	$0.00	"$23,956.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,721.64"	"$27,721.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS741	DRG	MS741		UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC	INPATIENT ONLY	"$220,233.64"	"$162,972.89"	$0.00	"$156,113.16"	"$141,373.62"	"$141,373.62"	$0.00	$0.00	"$29,872.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$143,113.04"	"$143,113.04"	$0.00	"$128,123.16"	"$156,113.16"	$0.00	"$13,327.31"	"$143,113.04"	"$13,327.31"	$0.00	"$24,002.64"	"$24,002.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS742	DRG	MS742		UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC	INPATIENT ONLY	"$178,499.01"	"$132,089.27"	$0.00	"$144,571.35"	"$4,086.60"	"$4,086.60"	"$22,910.93"	"$22,910.93"	$0.00	"$14,751.72"	$0.00	$0.00	$0.00	"$22,880.25"	"$21,251.43"	"$23,369.15"	$0.00	$0.00	"$25,364.14"	"$118,650.74"	"$144,571.35"	"$135,777.03"	"$16,936.07"	$0.00	"$16,936.07"	$0.00	"$26,942.56"	"$26,942.56"	"$24,156.36"	$0.00	$0.00	$0.00	$0.00	$0.00
MS743	DRG	MS743		UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	INPATIENT ONLY	"$215,798.10"	"$159,690.59"	$0.00	"$113,095.63"	"$113,095.63"	"$113,095.63"	"$27,072.03"	"$27,072.03"	$0.00	"$22,501.93"	$0.00	$0.00	$0.00	"$27,069.04"	"$22,968.22"	"$27,614.54"	$0.00	$0.00	$0.00	"$16,934.63"	"$94,504.91"	$0.00	"$11,512.92"	$0.00	"$11,512.92"	"$8,031.14"	"$22,524.51"	"$22,524.51"	$0.00	"$8,432.69"	$0.00	$0.00	$0.00	$0.00
MS744	DRG	MS744		"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC"	INPATIENT ONLY	"$235,639.36"	"$174,373.13"	$0.00	"$10,045.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$10,045.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS745	DRG	MS745		"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC"	INPATIENT ONLY	"$91,531.43"	"$67,733.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS746	DRG	MS746		"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC"	INPATIENT ONLY	$0.00	$0.00	$0.00	"$75,281.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,948.45"	$0.00	$0.00	"$75,281.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,760.43"	$0.00	$0.00	$0.00	$0.00	$0.00
MS748	DRG	MS748		FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES	INPATIENT ONLY	"$154,956.04"	"$114,667.47"	$0.00	"$101,307.70"	$0.00	$0.00	$0.00	$0.00	"$14,571.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$99,574.54"	"$99,574.54"	$0.00	"$83,143.95"	"$101,307.70"	$0.00	"$13,249.13"	"$99,574.54"	"$13,249.13"	$0.00	"$23,938.94"	"$23,938.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS749	DRG	MS749		OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC	INPATIENT ONLY	"$113,765.76"	"$84,186.66"	$0.00	"$104,733.83"	"$104,733.83"	"$104,733.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$31,516.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$30,015.58"	$0.00	$0.00	$0.00	$0.00	$0.00
MS754	DRG	MS754		"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC"	INPATIENT ONLY	"$172,896.37"	"$127,943.31"	$0.00	"$27,533.80"	$0.00	$0.00	"$23,656.98"	"$23,656.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,631.52"	"$27,533.80"	"$27,533.80"	$0.00	"$12,213.09"	$0.00	$0.00	$0.00	$0.00
MS755	DRG	MS755		"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC"	INPATIENT ONLY	"$31,589.96"	"$23,376.57"	$0.00	"$20,798.98"	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,164.57"	$0.00	$0.00	$0.00	"$18,827.17"	"$10,971.74"	$0.00	$0.00	$0.00	"$20,798.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,808.55"	$0.00	$0.00	$0.00	$0.00	$0.00
MS756	DRG	MS756		"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC"	INPATIENT ONLY	"$13,121.56"	"$9,709.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS757	DRG	MS757		"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC"	INPATIENT ONLY	"$32,053.15"	"$23,719.33"	$0.00	"$29,643.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,508.57"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$29,643.01"	"$29,643.01"	"$22,389.11"	$0.00	$0.00	$0.00	$0.00	$0.00
MS758	DRG	MS758		"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC"	INPATIENT ONLY	"$32,039.33"	"$23,709.10"	$0.00	"$20,399.89"	"$12,259.80"	"$12,259.80"	$0.00	$0.00	"$9,388.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$14,545.50"	"$14,545.50"	"$20,399.89"	$0.00	$0.00	$0.00	$0.00	"$14,545.50"	$0.00	$0.00	$0.00	$0.00	"$19,428.47"	$0.00	$0.00	$0.00	$0.00	$0.00
MS759	DRG	MS759		"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC"	INPATIENT ONLY	"$31,529.67"	"$23,331.96"	$0.00	"$5,834.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,556.33"	$0.00	$0.00	$0.00	"$5,834.14"	$0.00	$0.00	$0.00	$0.00
MS760	DRG	MS760		MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC	INPATIENT ONLY	"$22,036.45"	"$16,306.97"	$0.00	"$12,958.36"	"$12,958.36"	"$12,958.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS761	DRG	MS761		MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC	INPATIENT ONLY	"$26,444.46"	"$19,568.90"	$0.00	"$12,489.77"	"$12,489.77"	"$12,489.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS768	DRG	MS768		VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C	INPATIENT ONLY	"$40,711.25"	"$30,126.33"	$0.00	"$21,373.04"	"$19,822.68"	"$19,822.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,061.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$14,855.59"	"$20,902.18"	$0.00	"$10,099.48"	$0.00	"$10,099.48"	"$5,802.63"	"$21,373.04"	"$21,373.04"	$0.00	"$6,092.76"	$0.00	$0.00	$0.00	$0.00
MS769	DRG	MS769		POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES	INPATIENT ONLY	"$269,978.86"	"$199,784.36"	$0.00	"$175,470.46"	"$172,148.03"	"$172,148.03"	$0.00	$0.00	"$43,372.20"	"$12,300.04"	$0.00	$0.00	$0.00	$0.00	"$12,300.04"	$0.00	"$175,470.46"	"$175,470.46"	$0.00	$0.00	$0.00	$0.00	$0.00	"$175,470.46"	$0.00	"$11,772.78"	$0.00	$0.00	$0.00	"$12,361.42"	$0.00	$0.00	$0.00	$0.00
MS770	DRG	MS770		"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY"	INPATIENT ONLY	"$31,584.85"	"$23,372.79"	$0.00	"$6,160.27"	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,129.68"	$0.00	$0.00	$0.00	$0.00	"$6,129.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,866.92"	$0.00	$0.00	$0.00	"$6,160.27"	$0.00	$0.00	$0.00	$0.00
MS776	DRG	MS776		POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES	INPATIENT ONLY	"$15,568.58"	"$11,520.75"	$0.00	"$18,942.70"	"$8,173.20"	"$8,173.20"	$0.00	$0.00	$0.00	"$2,725.88"	$0.00	$0.00	"$3,348.41"	$0.00	"$6,136.30"	$0.00	$0.00	$0.00	$0.00	"$3,376.61"	"$3,044.04"	"$13,481.20"	"$3,843.48"	$0.00	"$3,843.48"	"$5,873.26"	"$18,942.70"	"$18,942.70"	$0.00	"$6,166.92"	$0.00	$0.00	$0.00	$0.00
MS779	DRG	MS779		ABORTION WITHOUT D&C	INPATIENT ONLY	"$16,003.04"	"$11,842.25"	$0.00	"$23,300.47"	"$4,106.40"	"$4,106.40"	$0.00	$0.00	$0.00	"$5,080.47"	$0.00	$0.00	$0.00	$0.00	"$5,080.47"	$0.00	$0.00	$0.00	$0.00	"$16,835.84"	"$23,300.47"	$0.00	"$11,445.75"	$0.00	"$11,445.75"	"$1,430.21"	"$22,469.79"	"$22,469.79"	$0.00	"$1,522.14"	$0.00	$0.00	$0.00	$0.00
MS783	DRG	MS783		CESAREAN SECTION WITH STERILIZATION WITH MCC	INPATIENT ONLY	"$71,796.43"	"$53,129.36"	$0.00	"$13,830.75"	"$13,830.75"	"$13,830.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,087.89"	$0.00	$0.00	$0.00	"$9,542.28"	$0.00	$0.00	$0.00	$0.00
MS784	DRG	MS784		CESAREAN SECTION WITH STERILIZATION WITH CC	INPATIENT ONLY	"$69,676.31"	"$51,560.47"	$0.00	"$37,137.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,288.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,705.74"	"$37,137.03"	"$12,460.97"	"$10,477.40"	$0.00	"$10,477.40"	"$9,087.89"	"$21,680.91"	"$21,680.91"	$0.00	"$9,542.28"	$0.00	$0.00	$0.00	$0.00
MS785	DRG	MS785		CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC	INPATIENT ONLY	"$66,138.83"	"$48,942.73"	$0.00	"$52,378.97"	"$14,254.51"	"$14,254.51"	$0.00	$0.00	"$52,378.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$13,752.00"	"$13,752.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$13,752.00"	$0.00	"$9,087.89"	$0.00	$0.00	$0.00	"$9,542.28"	$0.00	$0.00	$0.00	$0.00
MS786	DRG	MS786		CESAREAN SECTION WITHOUT STERILIZATION WITH MCC	INPATIENT ONLY	"$64,226.23"	"$47,527.41"	$0.00	"$51,796.52"	"$13,929.31"	"$13,929.31"	"$22,095.35"	"$22,095.35"	"$7,050.47"	$0.00	$0.00	$0.00	"$13,985.42"	"$22,067.08"	$0.00	$0.00	"$23,916.00"	"$23,916.00"	$0.00	"$24,076.48"	"$51,796.52"	"$27,565.16"	"$17,186.67"	"$23,916.00"	"$17,186.67"	"$9,087.89"	"$27,146.72"	"$27,146.72"	$0.00	"$9,542.28"	$0.00	$0.00	$0.00	$0.00
MS787	DRG	MS787		CESAREAN SECTION WITHOUT STERILIZATION WITH CC	INPATIENT ONLY	"$60,021.02"	"$44,415.55"	$0.00	"$38,858.99"	"$13,908.48"	"$13,908.48"	"$18,399.43"	"$18,399.43"	"$9,500.59"	$0.00	$0.00	$0.00	"$7,288.60"	$0.00	$0.00	$0.00	"$15,966.00"	"$15,966.00"	"$20,947.28"	"$7,707.95"	"$38,858.99"	$0.00	"$10,480.42"	"$15,966.00"	"$10,480.42"	"$9,087.89"	"$21,683.37"	"$21,683.37"	"$19,949.79"	"$9,542.28"	$0.00	$0.00	$0.00	$0.00
MS788	DRG	MS788		CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC	INPATIENT ONLY	"$53,940.94"	"$39,916.30"	$0.00	"$37,750.88"	"$13,582.80"	"$13,582.80"	$0.00	$0.00	"$7,920.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$13,311.00"	"$13,311.00"	$0.00	"$13,361.92"	"$37,750.88"	$0.00	"$9,084.02"	"$13,311.00"	"$9,084.02"	"$7,405.42"	"$20,545.77"	"$20,545.77"	$0.00	"$7,775.68"	$0.00	$0.00	$0.00	$0.00
MS789	DRG	MS789		"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY"	INPATIENT ONLY	"$12,236.12"	"$9,054.73"	$0.00	"$20,596.05"	"$4,334.40"	"$4,334.40"	$0.00	$0.00	$0.00	"$18,997.58"	$0.00	$0.00	"$14,581.12"	$0.00	"$18,997.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,596.05"	$0.00	$0.00	$0.00	$219.20	$0.00	$0.00	$0.00	$0.00
MS790	DRG	MS790		"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE"	INPATIENT ONLY	"$47,484.99"	"$35,138.89"	$0.00	"$345,528.12"	"$227,852.34"	"$227,852.34"	$0.00	$0.00	$0.00	"$6,824.32"	$0.00	$0.00	$0.00	$0.00	"$6,824.32"	$0.00	$0.00	$0.00	$0.00	"$283,577.38"	"$345,528.12"	$0.00	"$76,626.93"	$0.00	"$76,626.93"	"$24,017.10"	"$58,657.03"	"$58,657.03"	$0.00	"$25,214.25"	$0.00	$0.00	$0.00	$0.00
MS791	DRG	MS791		PREMATURITY WITH MAJOR PROBLEMS	INPATIENT ONLY	"$106,775.51"	"$79,013.88"	$0.00	"$131,833.16"	"$86,741.10"	"$86,741.10"	$0.00	$0.00	$0.00	"$3,625.61"	$0.00	$0.00	$0.00	$0.00	"$3,625.61"	$0.00	$0.00	$0.00	$0.00	"$16,878.92"	"$15,649.71"	"$131,833.16"	"$19,759.75"	$0.00	"$19,759.75"	"$21,244.37"	"$44,228.51"	"$44,228.51"	$0.00	"$22,302.88"	$0.00	$0.00	$0.00	$0.00
MS792	DRG	MS792		PREMATURITY WITHOUT MAJOR PROBLEMS	INPATIENT ONLY	"$9,474.02"	"$7,010.77"	$0.00	"$31,899.59"	"$5,534.55"	"$5,534.55"	$0.00	$0.00	$0.00	"$2,752.37"	$0.00	$0.00	$0.00	$0.00	"$2,752.37"	$0.00	$0.00	$0.00	$0.00	"$5,340.18"	"$4,229.42"	$0.00	"$5,340.18"	$0.00	"$5,340.18"	"$3,473.37"	"$31,899.59"	"$31,899.59"	$0.00	"$3,643.33"	$0.00	$0.00	$0.00	$0.00
MS793	DRG	MS793		FULL TERM NEONATE WITH MAJOR PROBLEMS	INPATIENT ONLY	"$31,960.27"	"$23,650.60"	$0.00	"$73,489.93"	"$32,199.00"	"$32,199.00"	$0.00	$0.00	"$16,677.00"	$0.00	$0.00	$0.00	"$48,678.47"	$0.00	$0.00	$0.00	"$73,489.93"	"$73,489.93"	$0.00	"$4,386.25"	"$3,473.91"	"$19,810.22"	"$4,386.25"	"$73,489.93"	"$4,386.25"	"$21,244.37"	"$45,073.74"	"$45,073.74"	$0.00	"$22,302.88"	$0.00	$0.00	$0.00	$0.00
MS794	DRG	MS794		NEONATE WITH OTHER SIGNIFICANT PROBLEMS	INPATIENT ONLY	"$6,506.03"	"$4,814.46"	$0.00	"$24,446.07"	"$3,699.60"	"$3,699.60"	$0.00	$0.00	"$4,761.00"	$0.00	$0.00	$0.00	"$2,023.02"	$0.00	$0.00	$0.00	"$21,126.00"	"$21,126.00"	$0.00	"$5,394.25"	"$4,272.25"	$0.00	"$5,394.25"	"$21,126.00"	"$5,394.25"	"$2,637.56"	"$24,446.07"	"$24,446.07"	$0.00	"$2,765.74"	$0.00	$0.00	$0.00	$0.00
MS795	DRG	MS795		NORMAL NEWBORN	INPATIENT ONLY	"$4,674.03"	"$3,458.78"	$0.00	"$14,674.90"	"$3,689.70"	"$3,689.70"	$0.00	$0.00	"$1,012.00"	"$1,296.58"	$0.00	$0.00	"$2,023.02"	$0.00	"$2,139.31"	$0.00	"$2,860.50"	"$2,860.50"	$0.00	"$1,781.77"	"$3,743.93"	"$2,259.28"	"$1,877.55"	"$2,860.50"	"$1,877.55"	"$2,050.78"	"$14,674.90"	"$14,674.90"	$0.00	"$2,149.62"	$0.00	$0.00	$0.00	$0.00
MS796	DRG	MS796		VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC	INPATIENT ONLY	"$54,907.25"	"$40,631.37"	$0.00	"$8,366.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,061.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,967.75"	$0.00	$0.00	$0.00	"$8,366.13"	$0.00	$0.00	$0.00	$0.00
MS797	DRG	MS797		VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC	INPATIENT ONLY	"$45,318.16"	"$33,535.44"	$0.00	"$8,366.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,967.75"	$0.00	$0.00	$0.00	"$8,366.13"	$0.00	$0.00	$0.00	$0.00
MS798	DRG	MS798		VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC	INPATIENT ONLY	"$52,110.07"	"$38,561.45"	$0.00	"$8,366.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,061.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,967.75"	$0.00	$0.00	$0.00	"$8,366.13"	$0.00	$0.00	$0.00	$0.00
MS799	DRG	MS799		SPLENECTOMY WITH MCC	INPATIENT ONLY	"$327,183.49"	"$242,115.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS801	DRG	MS801		SPLENECTOMY WITHOUT CC/MCC	INPATIENT ONLY	"$172,895.48"	"$127,942.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS802	DRG	MS802		OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC	INPATIENT ONLY	"$596,528.35"	"$441,430.98"	$0.00	"$96,469.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$96,469.48"	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS803	DRG	MS803		OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC	INPATIENT ONLY	"$251,863.58"	"$186,379.05"	$0.00	"$27,694.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,694.69"	"$27,694.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS805	DRG	MS805		VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC	INPATIENT ONLY	"$30,983.57"	"$22,927.84"	$0.00	"$29,462.16"	"$11,805.47"	"$11,805.47"	$0.00	$0.00	"$29,462.16"	$0.00	$0.00	$0.00	"$7,076.75"	$0.00	$0.00	$0.00	"$15,448.50"	"$15,448.50"	$0.00	"$7,672.56"	"$14,281.34"	$0.00	"$10,432.30"	"$15,448.50"	"$10,432.30"	"$6,630.28"	"$25,233.70"	"$25,233.70"	$0.00	"$6,961.79"	$0.00	$0.00	$0.00	$0.00
MS806	DRG	MS806		VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC	INPATIENT ONLY	"$25,294.22"	"$18,717.72"	$0.00	"$21,350.23"	"$8,052.96"	"$8,052.96"	$0.00	$0.00	"$6,550.61"	$0.00	$0.00	$0.00	"$5,061.36"	$0.00	$0.00	$0.00	"$11,019.00"	"$11,019.00"	"$18,649.09"	"$7,746.04"	"$13,604.81"	"$21,350.23"	"$7,109.24"	"$11,019.00"	"$7,109.24"	"$5,802.63"	"$18,936.98"	"$18,936.98"	"$17,761.04"	"$6,092.76"	$0.00	$0.00	$0.00	$0.00
MS807	DRG	MS807		VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC	INPATIENT ONLY	"$22,303.67"	"$16,504.72"	$0.00	"$18,264.05"	"$8,254.49"	"$8,254.49"	$0.00	$0.00	"$5,733.00"	$0.00	$0.00	$0.00	"$5,061.36"	$0.00	$0.00	$0.00	"$9,634.50"	"$9,634.50"	$0.00	"$8,401.97"	"$11,615.99"	"$17,521.13"	"$6,283.23"	"$9,634.50"	"$6,283.23"	"$5,802.63"	"$18,264.05"	"$18,264.05"	$0.00	"$6,092.76"	$0.00	$0.00	$0.00	$0.00
MS808	DRG	MS808		MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC	INPATIENT ONLY	"$34,593.18"	"$25,598.95"	$0.00	"$30,536.62"	$0.00	$0.00	"$26,138.77"	"$26,138.77"	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,099.74"	$0.00	"$26,661.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$30,536.62"	"$30,536.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS809	DRG	MS809		MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC	INPATIENT ONLY	"$75,870.07"	"$56,143.85"	$0.00	"$22,111.75"	$0.00	$0.00	"$19,496.75"	"$19,496.75"	$0.00	"$12,843.09"	$0.00	$0.00	$0.00	"$19,474.91"	"$12,843.09"	"$19,886.69"	$0.00	$0.00	"$22,111.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,058.81"	$0.00	$0.00	$0.00	$0.00	$0.00
MS810	DRG	MS810		MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC	INPATIENT ONLY	"$26,038.35"	"$19,268.38"	$0.00	"$20,194.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,194.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,233.22"	$0.00	$0.00	$0.00	$0.00	$0.00
MS811	DRG	MS811		RED BLOOD CELL DISORDERS WITH MCC	INPATIENT ONLY	"$37,057.02"	"$27,422.19"	$0.00	"$78,735.41"	"$23,615.76"	"$23,615.76"	"$20,572.70"	"$20,572.70"	"$11,450.82"	"$3,403.76"	$0.00	$0.00	"$10,045.23"	"$20,548.08"	"$14,177.07"	"$20,984.15"	"$20,689.50"	"$20,689.50"	"$22,961.85"	"$19,762.72"	"$78,735.41"	$0.00	"$13,435.57"	"$20,689.50"	"$13,435.57"	"$30,963.95"	"$24,090.82"	"$24,090.82"	"$21,868.43"	"$30,963.95"	$0.00	$0.00	$0.00	$0.00
MS812	DRG	MS812		RED BLOOD CELL DISORDERS WITHOUT MCC	INPATIENT ONLY	"$30,116.25"	"$22,286.03"	$0.00	"$24,519.60"	"$24,519.60"	"$24,519.60"	"$17,128.85"	"$17,128.85"	"$7,285.18"	"$8,031.31"	$0.00	$0.00	"$13,393.64"	"$17,113.13"	"$8,031.31"	"$17,471.43"	"$13,204.50"	"$13,204.50"	"$19,752.74"	"$3,776.02"	"$13,151.79"	$0.00	"$8,728.17"	"$13,204.50"	"$8,728.17"	"$7,687.04"	"$20,255.87"	"$20,255.87"	"$18,812.13"	"$8,071.38"	$0.00	$0.00	$0.00	$0.00
MS813	DRG	MS813		COAGULATION DISORDERS	INPATIENT ONLY	"$130,887.07"	"$96,856.43"	$0.00	"$87,448.69"	$0.00	$0.00	"$21,716.98"	"$21,716.98"	$0.00	"$11,549.79"	$0.00	$0.00	$0.00	"$21,689.39"	"$11,549.79"	"$22,151.32"	$0.00	$0.00	$0.00	"$23,373.77"	"$87,448.69"	$0.00	"$15,890.52"	$0.00	"$15,890.52"	$0.00	"$52,183.21"	"$52,183.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS814	DRG	MS814		RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC	INPATIENT ONLY	"$30,605.13"	"$22,647.80"	$0.00	"$27,429.29"	$0.00	$0.00	"$24,109.04"	"$24,109.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,591.22"	$0.00	$0.00	"$25,755.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,429.29"	"$27,429.29"	"$24,529.05"	$0.00	$0.00	$0.00	$0.00	$0.00
MS815	DRG	MS815		RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC	INPATIENT ONLY	"$62,708.27"	"$46,404.12"	$0.00	"$21,416.31"	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,825.34"	$0.00	$0.00	"$16,742.05"	$0.00	"$18,141.81"	$0.00	$0.00	$0.00	"$20,723.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,416.31"	"$21,416.31"	"$19,736.96"	$0.00	$0.00	$0.00	$0.00	$0.00
MS816	DRG	MS816		RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC	INPATIENT ONLY	"$36,966.21"	"$27,355.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS817	DRG	MS817		OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC	INPATIENT ONLY	"$331,165.41"	"$245,062.40"	$0.00	"$196,880.15"	"$12,259.80"	"$12,259.80"	$0.00	$0.00	"$196,880.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$196,880.15"	"$196,880.15"	$0.00	"$32,736.50"	"$78,339.09"	$0.00	"$25,223.16"	"$196,880.15"	"$25,223.16"	"$11,253.79"	"$33,693.78"	"$33,693.78"	$0.00	"$7,558.26"	$0.00	$0.00	$0.00	$0.00
MS818	DRG	MS818		OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC	INPATIENT ONLY	"$97,432.35"	"$72,099.94"	$0.00	"$86,024.42"	$0.00	$0.00	$0.00	$0.00	"$86,024.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,397.00"	"$20,397.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,397.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS819	DRG	MS819		OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$70,909.67"	"$52,473.16"	$0.00	"$7,495.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,138.29"	$0.00	$0.00	$0.00	"$7,495.20"	$0.00	$0.00	$0.00	$0.00
MS821	DRG	MS821		LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC	INPATIENT ONLY	"$162,576.13"	"$120,306.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS823	DRG	MS823		LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC	INPATIENT ONLY	"$630,888.82"	"$466,857.73"	$0.00	"$65,586.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$65,586.69"	"$65,586.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS824	DRG	MS824		LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC	INPATIENT ONLY	"$51,601.70"	"$38,185.26"	$0.00	"$28,418.19"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$28,418.19"	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS826	DRG	MS826		MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC	INPATIENT ONLY	"$379,947.04"	"$281,160.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS827	DRG	MS827		MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC	INPATIENT ONLY	"$423,291.52"	"$313,235.72"	$0.00	"$32,906.05"	$0.00	$0.00	"$32,906.05"	"$32,906.05"	$0.00	$0.00	$0.00	$0.00	$0.00	"$32,906.05"	$0.00	$0.00	$0.00	$0.00	"$32,906.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$32,906.05"	$0.00	$0.00	$0.00	$0.00	$0.00
MS828	DRG	MS828		MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$247,026.79"	"$182,799.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
MS829	DRG	MS829		MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC	INPATIENT ONLY	"$279,328.65"	"$206,703.20"	$0.00	"$38,787.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$38,787.20"	"$38,787.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS830	DRG	MS830		MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$211,300.46"	"$156,362.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS831	DRG	MS831		OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC	INPATIENT ONLY	"$29,160.39"	"$21,578.69"	$0.00	"$21,952.85"	"$20,552.75"	"$20,552.75"	$0.00	$0.00	"$10,012.94"	$0.00	$0.00	$0.00	"$14,394.30"	$0.00	$0.00	$0.00	"$16,827.00"	"$16,827.00"	$0.00	"$9,939.05"	"$19,151.15"	$0.00	"$10,811.22"	"$16,827.00"	"$10,811.22"	"$7,138.29"	"$21,952.85"	"$21,952.85"	$0.00	"$7,495.20"	$0.00	$0.00	$0.00	$0.00
MS832	DRG	MS832		OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC	INPATIENT ONLY	"$20,347.40"	"$15,057.08"	$0.00	"$18,988.42"	"$12,259.80"	"$12,259.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,696.82"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,692.12"	"$2,930.57"	"$10,159.89"	$0.00	"$7,172.39"	$0.00	"$7,172.39"	"$7,138.29"	"$18,988.42"	"$18,988.42"	"$17,802.02"	"$7,495.20"	$0.00	$0.00	$0.00	$0.00
MS833	DRG	MS833		OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$14,743.82"	"$10,910.43"	$0.00	"$10,045.23"	"$8,272.70"	"$8,272.70"	$0.00	$0.00	"$2,152.00"	$0.00	$0.00	$0.00	"$10,045.23"	$0.00	$0.00	$0.00	"$4,723.00"	"$4,723.00"	$0.00	"$7,048.80"	"$7,048.80"	"$6,068.80"	"$7,048.80"	"$4,723.00"	"$7,048.80"	"$5,802.63"	"$7,048.80"	"$7,048.80"	$0.00	"$6,092.76"	$0.00	$0.00	$0.00	$0.00
MS834	DRG	MS834		ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC	INPATIENT ONLY	"$507,748.30"	"$375,733.74"	$0.00	"$56,196.91"	$0.00	$0.00	"$55,070.71"	"$55,070.71"	$0.00	$0.00	$0.00	$0.00	$0.00	"$55,066.67"	$0.00	"$56,196.91"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS835	DRG	MS835		ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC	INPATIENT ONLY	"$40,262.10"	"$29,793.95"	$0.00	"$10,045.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$10,045.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS836	DRG	MS836		ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$18,640.57"	"$13,794.02"	$0.00	"$23,905.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,905.45"	"$23,905.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS837	DRG	MS837		CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC	INPATIENT ONLY	"$51,339.82"	"$37,991.47"	$0.00	"$62,068.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$62,068.97"	"$62,068.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS838	DRG	MS838		CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT	INPATIENT ONLY	"$48,284.50"	"$35,730.53"	$0.00	"$31,012.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$31,012.72"	"$31,012.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS839	DRG	MS839		CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC	INPATIENT ONLY	"$46,940.94"	"$34,736.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS840	DRG	MS840		LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC	INPATIENT ONLY	"$189,074.54"	"$139,915.16"	$0.00	"$34,299.15"	$0.00	$0.00	"$33,279.73"	"$33,279.73"	$0.00	$0.00	$0.00	$0.00	$0.00	"$33,222.22"	$0.00	"$22,689.83"	$0.00	$0.00	"$34,299.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$28,807.13"	"$28,807.13"	"$34,299.15"	$0.00	$0.00	$0.00	$0.00	$0.00
MS841	DRG	MS841		LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC	INPATIENT ONLY	"$15,184.92"	"$11,236.84"	$0.00	"$22,689.83"	$0.00	$0.00	"$22,244.93"	"$22,244.93"	$0.00	"$13,446.69"	$0.00	$0.00	$0.00	$0.00	"$13,446.69"	"$22,689.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,565.68"	"$19,565.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS842	DRG	MS842		LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC	INPATIENT ONLY	"$38,523.96"	"$28,507.73"	$0.00	"$21,645.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,645.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,614.66"	$0.00	$0.00	$0.00	$0.00	$0.00
MS843	DRG	MS843		OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC	INPATIENT ONLY	"$90,251.16"	"$66,785.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS844	DRG	MS844		OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC	INPATIENT ONLY	"$25,954.84"	"$19,206.58"	$0.00	"$22,057.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,057.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$21,007.37"	$0.00	$0.00	$0.00	$0.00	$0.00
MS846	DRG	MS846		CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC	INPATIENT ONLY	"$30,411.91"	"$22,504.81"	$0.00	"$30,090.51"	$0.00	$0.00	"$29,500.50"	"$29,500.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$30,090.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS847	DRG	MS847		CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC	INPATIENT ONLY	"$31,407.44"	"$23,241.51"	$0.00	"$45,264.16"	"$8,173.20"	"$8,173.20"	$0.00	$0.00	"$5,107.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,107.14"	"$5,107.14"	$0.00	"$19,402.95"	"$45,264.16"	"$34,827.46"	"$13,190.98"	"$5,107.14"	"$13,190.98"	$0.00	"$23,891.56"	"$23,891.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS848	DRG	MS848		CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC	INPATIENT ONLY	"$30,134.29"	"$22,299.37"	$0.00	"$22,966.96"	"$12,259.80"	"$12,259.80"	$0.00	$0.00	"$7,545.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$15,484.50"	"$15,484.50"	$0.00	"$12,768.30"	"$22,966.96"	$0.00	"$9,837.86"	"$15,484.50"	"$9,837.86"	$0.00	"$21,159.88"	"$21,159.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS853	DRG	MS853		INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC	INPATIENT ONLY	"$349,119.20"	"$258,348.21"	$0.00	"$565,069.81"	"$17,269.35"	"$17,269.35"	"$45,338.71"	"$45,338.71"	$0.00	"$50,464.10"	$0.00	$0.00	$0.00	"$45,250.00"	"$52,987.33"	"$46,245.48"	$0.00	$0.00	"$48,645.14"	"$463,756.79"	"$565,069.81"	"$228,902.42"	"$140,496.05"	$0.00	"$140,496.05"	$0.00	"$54,782.85"	"$54,782.85"	"$46,328.70"	$0.00	$0.00	$0.00	$0.00	$0.00
MS854	DRG	MS854		INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC	INPATIENT ONLY	"$172,549.34"	"$127,686.51"	$0.00	"$28,571.70"	$0.00	$0.00	"$25,699.83"	"$25,699.83"	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,661.94"	$0.00	"$26,213.83"	$0.00	$0.00	"$28,571.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,211.14"	$0.00	$0.00	$0.00	$0.00	$0.00
MS856	DRG	MS856		POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC	INPATIENT ONLY	"$469,903.79"	"$347,728.80"	$0.00	"$49,287.63"	"$21,079.29"	"$21,079.29"	"$43,241.35"	"$43,241.35"	$0.00	"$37,955.94"	$0.00	$0.00	$0.00	$0.00	"$37,955.94"	"$44,106.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$49,287.63"	"$49,287.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS857	DRG	MS857		POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC	INPATIENT ONLY	"$110,455.26"	"$81,736.89"	$0.00	"$409,840.86"	"$90,864.72"	"$90,864.72"	"$25,563.20"	"$25,563.20"	$0.00	$0.00	$0.00	$0.00	"$30,135.69"	"$26,369.16"	$0.00	"$26,074.46"	$0.00	$0.00	"$27,697.65"	"$336,359.28"	"$409,840.86"	$0.00	"$88,518.80"	$0.00	"$88,518.80"	$0.00	"$53,140.71"	"$53,140.71"	"$26,378.71"	$0.00	$0.00	$0.00	$0.00	$0.00
MS858	DRG	MS858		POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC	INPATIENT ONLY	"$300,169.86"	"$222,125.70"	$0.00	"$206,438.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,090.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$206,438.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS862	DRG	MS862		POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC	INPATIENT ONLY	"$41,178.47"	"$30,472.07"	$0.00	"$28,258.17"	$0.00	$0.00	"$24,143.55"	"$24,143.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$28,258.17"	"$28,258.17"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS863	DRG	MS863		POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC	INPATIENT ONLY	"$26,750.77"	"$19,795.57"	$0.00	"$20,554.34"	$0.00	$0.00	"$18,033.63"	"$18,033.63"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,015.57"	$0.00	"$18,394.30"	$0.00	$0.00	"$20,554.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,575.56"	$0.00	$0.00	$0.00	$0.00	$0.00
MS864	DRG	MS864		FEVER AND INFLAMMATORY CONDITIONS	INPATIENT ONLY	"$19,333.68"	"$14,306.92"	$0.00	"$47,628.02"	$0.00	$0.00	"$17,102.64"	"$17,102.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,444.69"	$0.00	$0.00	"$47,628.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$29,690.76"	$0.00	$0.00	$0.00	$0.00	$0.00
MS865	DRG	MS865		VIRAL ILLNESS WITH MCC	INPATIENT ONLY	"$14,496.05"	"$10,727.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS866	DRG	MS866		VIRAL ILLNESS WITHOUT MCC	INPATIENT ONLY	"$34,717.88"	"$25,691.23"	$0.00	"$26,124.06"	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,802.34"	$0.00	$0.00	$0.00	$0.00	"$6,802.34"	$0.00	$0.00	$0.00	$0.00	"$10,651.53"	"$26,124.06"	$0.00	"$8,206.90"	$0.00	"$8,206.90"	$0.00	"$19,831.20"	"$19,831.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS867	DRG	MS867		OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC	INPATIENT ONLY	"$63,136.42"	"$46,720.95"	$0.00	"$112,359.77"	"$112,359.77"	"$112,359.77"	"$26,492.82"	"$26,492.82"	$0.00	"$16,751.36"	$0.00	$0.00	$0.00	$0.00	"$16,751.36"	"$27,022.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS868	DRG	MS868		OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC	INPATIENT ONLY	"$30,779.69"	"$22,776.97"	$0.00	"$69,508.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,175.27"	"$69,508.29"	$0.00	"$10,996.66"	$0.00	"$10,996.66"	$0.00	"$22,103.93"	"$22,103.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS869	DRG	MS869		OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC	INPATIENT ONLY	"$15,619.28"	"$11,558.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS870	DRG	MS870		SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS	INPATIENT ONLY	"$342,603.24"	"$253,526.40"	$0.00	"$437,462.32"	"$222,926.65"	"$222,926.65"	"$55,492.21"	"$55,492.21"	$0.00	"$53,865.50"	$0.00	$0.00	"$387,832.33"	"$55,377.23"	"$56,558.79"	"$56,602.05"	$0.00	$0.00	"$57,021.26"	"$359,028.42"	"$437,462.32"	$0.00	"$105,276.97"	$0.00	"$105,276.97"	$0.00	"$64,792.48"	"$64,792.48"	"$71,505.46"	$0.00	$0.00	$0.00	$0.00	$0.00
MS871	DRG	MS871		SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC	INPATIENT ONLY	"$99,302.62"	"$73,483.94"	$0.00	"$69,468.99"	"$49,039.20"	"$49,039.20"	"$23,974.45"	"$23,974.45"	"$16,130.58"	"$17,521.48"	$0.00	$0.00	"$16,742.05"	"$23,941.03"	"$17,521.48"	"$24,453.94"	"$28,083.00"	"$28,083.00"	"$26,556.42"	"$27,518.59"	"$69,468.99"	"$47,721.33"	"$18,708.37"	"$28,083.00"	"$18,708.37"	"$16,770.40"	"$28,386.40"	"$28,386.40"	"$30,367.39"	"$17,608.91"	$0.00	$0.00	$0.00	$0.00
MS872	DRG	MS872		SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC	INPATIENT ONLY	"$39,146.17"	"$28,968.17"	$0.00	"$25,653.18"	"$12,923.98"	"$12,923.98"	"$18,136.48"	"$18,136.48"	"$9,397.01"	"$9,417.32"	$0.00	$0.00	$0.00	"$18,118.16"	"$9,417.32"	"$18,499.21"	"$15,394.50"	"$15,394.50"	"$20,904.90"	"$7,127.66"	"$25,653.18"	$0.00	"$10,418.26"	"$15,394.50"	"$10,418.26"	"$6,963.04"	"$21,632.73"	"$21,632.73"	"$19,909.43"	"$7,410.63"	$0.00	$0.00	$0.00	$0.00
MS876	DRG	MS876		O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS	INPATIENT ONLY	"$147,401.50"	"$109,077.11"	$0.00	"$46,127.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$46,127.21"	"$46,127.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS880	DRG	MS880		ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION	INPATIENT ONLY	"$37,752.98"	"$27,937.21"	$0.00	"$50,316.83"	"$4,100.18"	"$4,100.18"	"$17,019.80"	"$17,019.80"	$0.00	"$5,575.59"	$0.00	$0.00	"$10,045.23"	$0.00	"$5,854.37"	"$17,360.20"	$0.00	$0.00	"$50,316.83"	"$7,019.44"	"$50,065.60"	"$33,004.93"	"$8,589.83"	$0.00	"$8,589.83"	"$5,603.41"	"$20,143.15"	"$20,143.15"	"$49,378.27"	"$5,883.58"	$0.00	$0.00	$0.00	$0.00
MS881	DRG	MS881		DEPRESSIVE NEUROSES	INPATIENT ONLY	"$19,663.24"	"$14,550.80"	$0.00	"$19,401.50"	"$12,913.95"	"$12,913.95"	$0.00	$0.00	"$5,769.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$12,030.00"	"$12,030.00"	"$19,401.50"	$0.00	$0.00	"$5,860.95"	$0.00	"$12,030.00"	$0.00	"$4,833.71"	$0.00	$0.00	"$18,477.62"	"$5,075.40"	$0.00	$0.00	$0.00	$0.00
MS882	DRG	MS882		NEUROSES EXCEPT DEPRESSIVE	INPATIENT ONLY	"$20,130.12"	"$14,896.29"	$0.00	"$12,620.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$12,620.55"	"$12,620.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS883	DRG	MS883		DISORDERS OF PERSONALITY AND IMPULSE CONTROL	INPATIENT ONLY	"$21,248.40"	"$15,723.82"	$0.00	"$22,936.59"	"$16,782.35"	"$16,782.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,936.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,140.10"	"$7,183.84"	"$7,183.84"	"$21,844.37"	"$7,497.10"	$0.00	$0.00	$0.00	$0.00
MS884	DRG	MS884		ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY	INPATIENT ONLY	"$38,142.56"	"$28,225.49"	$0.00	"$69,644.94"	"$69,644.94"	"$69,644.94"	"$21,042.01"	"$21,042.01"	"$9,624.61"	"$10,098.77"	$0.00	$0.00	$0.00	"$21,016.17"	"$10,603.71"	"$21,462.85"	"$25,969.50"	"$25,969.50"	"$23,629.52"	$0.00	$0.00	$0.00	$0.00	"$25,969.50"	$0.00	$0.00	"$24,888.70"	"$24,888.70"	"$22,504.30"	$0.00	$0.00	$0.00	$0.00	$0.00
MS885	DRG	MS885		PSYCHOSES	INPATIENT ONLY	"$27,249.99"	"$20,164.99"	$0.00	"$19,607.18"	"$5,534.55"	"$5,534.55"	"$19,607.18"	"$19,607.18"	"$9,119.42"	"$6,833.56"	$0.00	$0.00	"$6,556.06"	"$15,565.31"	"$6,833.56"	"$8,019.25"	"$18,591.00"	"$18,591.00"	"$9,222.35"	"$12,800.77"	"$14,261.38"	"$11,383.39"	"$9,000.00"	"$18,591.00"	"$9,000.00"	"$6,540.64"	"$4,851.36"	"$4,851.36"	"$8,783.19"	"$6,867.66"	$0.00	$0.00	$0.00	$0.00
MS886	DRG	MS886		BEHAVIORAL AND DEVELOPMENTAL DISORDERS	INPATIENT ONLY	"$18,427.83"	"$13,636.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS887	DRG	MS887		OTHER MENTAL DISORDER DIAGNOSES	INPATIENT ONLY	"$41,241.49"	"$30,518.70"	$0.00	"$57,514.90"	$0.00	$0.00	$0.00	$0.00	"$8,326.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,197.00"	"$16,197.00"	$0.00	"$16,044.03"	"$57,514.90"	$0.00	"$10,907.45"	"$16,197.00"	"$10,907.45"	$0.00	"$22,031.26"	"$22,031.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS894	DRG	MS894		"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA"	INPATIENT ONLY	"$21,543.05"	"$15,941.86"	$0.00	"$17,768.90"	"$4,086.60"	"$4,086.60"	"$16,734.90"	"$16,734.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,069.60"	$0.00	$0.00	"$17,768.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$12,658.39"	$0.00	$0.00	"$16,922.76"	"$13,291.30"	$0.00	$0.00	$0.00	$0.00
MS896	DRG	MS896		"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC"	INPATIENT ONLY	"$49,326.69"	"$36,501.75"	$0.00	"$40,932.53"	"$4,136.10"	"$4,136.10"	"$23,340.19"	"$23,340.19"	"$13,606.38"	$0.00	$0.00	$0.00	$0.00	"$23,308.40"	$0.00	"$23,806.99"	"$25,043.92"	"$25,043.92"	"$25,554.59"	"$15,138.49"	"$40,932.53"	$0.00	"$17,238.80"	"$25,043.92"	"$17,238.80"	$0.00	"$27,189.19"	"$27,189.19"	"$24,337.70"	$0.00	$0.00	$0.00	$0.00	$0.00
MS897	DRG	MS897		"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC"	INPATIENT ONLY	"$30,584.36"	"$22,632.43"	$0.00	"$41,618.80"	"$12,711.30"	"$12,711.30"	"$16,782.58"	"$16,782.58"	"$6,163.22"	$0.00	$0.00	$0.00	"$10,638.97"	"$16,746.23"	$0.00	$0.00	"$12,405.00"	"$12,405.00"	"$19,418.55"	"$41,618.80"	"$32,962.09"	"$14,261.88"	"$41,618.80"	"$12,405.00"	"$41,618.80"	"$6,496.27"	"$4,824.19"	"$4,824.19"	"$18,493.86"	"$6,821.08"	$0.00	$0.00	$0.00	$0.00
MS901	DRG	MS901		WOUND DEBRIDEMENTS FOR INJURIES WITH MCC	INPATIENT ONLY	"$368,092.68"	"$272,388.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS902	DRG	MS902		WOUND DEBRIDEMENTS FOR INJURIES WITH CC	INPATIENT ONLY	"$122,560.83"	"$90,695.01"	$0.00	"$116,932.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$116,932.68"	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,243.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$29,207.95"	"$29,207.95"	"$25,946.57"	$0.00	$0.00	$0.00	$0.00	$0.00
MS903	DRG	MS903		WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC	INPATIENT ONLY	"$69,084.55"	"$51,122.57"	$0.00	"$342,304.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$280,931.70"	"$342,304.46"	$0.00	"$66,795.60"	$0.00	"$66,795.60"	$0.00	"$40,627.42"	"$40,627.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS904	DRG	MS904		SKIN GRAFTS FOR INJURIES WITH CC/MCC	INPATIENT ONLY	"$587,248.63"	"$434,563.99"	$0.00	"$136,934.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$112,383.02"	"$136,934.37"	$0.00	"$35,459.97"	$0.00	"$35,459.97"	"$23,848.01"	"$42,033.36"	"$42,033.36"	$0.00	"$25,040.40"	$0.00	$0.00	$0.00	$0.00
MS905	DRG	MS905		SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC	INPATIENT ONLY	"$130,398.68"	"$96,495.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS906	DRG	MS906		HAND PROCEDURES FOR INJURIES	INPATIENT ONLY	"$173,990.59"	"$128,753.04"	$0.00	"$201,237.38"	"$184,096.43"	"$184,096.43"	"$23,502.39"	"$23,502.39"	"$49,807.27"	$0.00	$0.00	$0.00	"$13,855.47"	$0.00	$0.00	"$23,972.44"	"$201,237.38"	"$201,237.38"	$0.00	"$128,086.32"	"$156,068.25"	$0.00	"$17,451.31"	"$201,237.38"	"$17,451.31"	$0.00	"$27,362.32"	"$27,362.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS907	DRG	MS907		OTHER O.R. PROCEDURES FOR INJURIES WITH MCC	INPATIENT ONLY	"$314,976.43"	"$233,082.56"	$0.00	"$388,246.60"	"$217,751.34"	"$217,751.34"	"$38,301.96"	"$38,301.96"	$0.00	"$30,419.81"	$0.00	$0.00	"$98,592.46"	"$38,231.45"	"$41,160.33"	"$39,068.00"	$0.00	$0.00	$0.00	"$205,770.40"	"$250,723.31"	$0.00	"$45,461.07"	$0.00	"$45,461.07"	"$39,395.94"	"$388,246.60"	"$388,246.60"	$0.00	"$41,365.72"	$0.00	$0.00	$0.00	$0.00
MS908	DRG	MS908		OTHER O.R. PROCEDURES FOR INJURIES WITH CC	INPATIENT ONLY	"$152,656.61"	"$112,965.89"	$0.00	"$182,669.21"	$0.00	$0.00	"$25,204.31"	"$25,204.31"	$0.00	"$34,521.96"	$0.00	$0.00	"$71,256.39"	$0.00	"$34,521.96"	"$25,708.40"	$0.00	$0.00	"$27,901.30"	"$97,496.00"	"$118,795.12"	"$182,669.21"	"$20,681.15"	$0.00	"$20,681.15"	"$15,861.25"	"$29,993.55"	"$29,993.55"	"$26,572.67"	"$16,654.30"	$0.00	$0.00	$0.00	$0.00
MS909	DRG	MS909		OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC	INPATIENT ONLY	"$15,837.75"	"$11,719.94"	$0.00	"$58,188.52"	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,600.88"	$0.00	$0.00	$0.00	$0.00	"$11,600.88"	$0.00	$0.00	$0.00	"$22,814.25"	"$47,755.73"	"$58,188.52"	$0.00	"$13,219.05"	$0.00	"$13,219.05"	"$15,861.25"	"$23,914.43"	"$23,914.43"	"$21,727.86"	"$16,654.30"	$0.00	$0.00	$0.00	$0.00
MS913	DRG	MS913		TRAUMATIC INJURY WITH MCC	INPATIENT ONLY	"$58,527.66"	"$43,310.47"	$0.00	"$35,408.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$35,408.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,201.47"	"$25,201.47"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS914	DRG	MS914		TRAUMATIC INJURY WITHOUT MCC	INPATIENT ONLY	"$50,070.45"	"$37,052.13"	$0.00	"$42,063.45"	"$19,477.40"	"$19,477.40"	"$17,174.42"	"$17,174.42"	$0.00	$0.00	$0.00	$0.00	"$12,315.97"	"$17,158.58"	$0.00	"$17,517.91"	$0.00	$0.00	$0.00	"$34,521.77"	"$42,063.45"	$0.00	"$8,637.95"	$0.00	"$8,637.95"	$0.00	"$20,182.36"	"$20,182.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS915	DRG	MS915		ALLERGIC REACTIONS WITH MCC	INPATIENT ONLY	"$13,523.90"	"$10,007.69"	$0.00	"$27,685.69"	$0.00	$0.00	"$27,685.69"	"$27,685.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,782.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS916	DRG	MS916		ALLERGIC REACTIONS WITHOUT MCC	INPATIENT ONLY	"$18,896.57"	"$13,983.46"	$0.00	"$18,988.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,129.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,316.33"	"$18,316.33"	"$18,988.45"	$0.00	$0.00	$0.00	$0.00	$0.00
MS917	DRG	MS917		POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC	INPATIENT ONLY	"$41,023.80"	"$30,357.61"	$0.00	"$51,372.18"	"$17,715.70"	"$17,715.70"	"$21,257.33"	"$21,257.33"	"$12,541.54"	"$6,253.67"	$0.00	$0.00	"$20,090.46"	"$21,230.93"	"$11,939.58"	"$21,682.48"	"$22,177.50"	"$22,177.50"	"$23,801.74"	"$17,979.07"	"$51,372.18"	$0.00	"$14,667.56"	"$22,177.50"	"$14,667.56"	"$11,427.78"	"$25,094.49"	"$25,094.49"	"$22,668.32"	"$11,999.16"	$0.00	$0.00	$0.00	$0.00
MS918	DRG	MS918		POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC	INPATIENT ONLY	"$26,175.61"	"$19,369.95"	$0.00	"$24,709.73"	"$4,453.30"	"$4,453.30"	"$24,709.73"	"$24,709.73"	"$2,488.34"	"$6,225.23"	$0.00	$0.00	"$3,348.41"	"$24,675.25"	"$6,225.23"	"$23,946.92"	"$11,044.46"	"$11,044.46"	"$19,160.25"	"$3,729.06"	"$12,112.06"	"$13,648.19"	"$6,834.23"	"$11,044.46"	"$6,834.23"	"$5,958.38"	"$19,547.84"	"$19,547.84"	"$18,247.86"	"$6,256.30"	$0.00	$0.00	$0.00	$0.00
MS919	DRG	MS919		COMPLICATIONS OF TREATMENT WITH MCC	INPATIENT ONLY	"$64,348.49"	"$47,617.88"	$0.00	"$69,950.28"	"$5,749.93"	"$5,749.93"	"$23,780.51"	"$23,780.51"	$0.00	"$11,257.45"	$0.00	$0.00	$0.00	"$23,747.59"	"$11,257.45"	"$24,256.12"	$0.00	$0.00	"$26,276.23"	"$26,914.05"	"$69,950.28"	$0.00	"$18,297.37"	$0.00	"$18,297.37"	$0.00	"$28,051.57"	"$28,051.57"	"$25,024.98"	$0.00	$0.00	$0.00	$0.00	$0.00
MS920	DRG	MS920		COMPLICATIONS OF TREATMENT WITH CC	INPATIENT ONLY	"$24,394.92"	"$18,052.24"	$0.00	"$28,277.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,687.60"	"$14,855.59"	"$28,277.30"	$0.00	"$10,099.48"	$0.00	"$10,099.48"	$0.00	"$21,373.04"	"$21,373.04"	"$19,702.48"	$0.00	$0.00	$0.00	$0.00	$0.00
MS921	DRG	MS921		COMPLICATIONS OF TREATMENT WITHOUT CC/MCC	INPATIENT ONLY	"$34,245.21"	"$25,341.46"	$0.00	"$18,521.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$10,898.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,521.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,639.98"	$0.00	$0.00	$0.00	$0.00	$0.00
MS922	DRG	MS922		"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC"	INPATIENT ONLY	"$72,838.99"	"$53,900.85"	$0.00	"$61,719.57"	$0.00	$0.00	"$22,014.43"	"$22,014.43"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,454.72"	$0.00	$0.00	$0.00	"$3,753.19"	"$61,719.57"	$0.00	"$16,074.98"	$0.00	"$16,074.98"	"$1,335.32"	"$26,241.08"	"$26,241.08"	$0.00	"$1,421.16"	$0.00	$0.00	$0.00	$0.00
MS923	DRG	MS923		"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC"	INPATIENT ONLY	"$20,532.46"	"$15,194.02"	$0.00	"$17,890.29"	$0.00	$0.00	"$17,539.50"	"$17,539.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,890.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS927	DRG	MS927		EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT	INPATIENT ONLY	"$756,935.58"	"$560,132.33"	$0.00	"$636,813.54"	"$636,813.54"	"$636,813.54"	$0.00	$0.00	$0.00	"$122,178.14"	$0.00	$0.00	$0.00	$0.00	"$128,287.10"	$0.00	$0.00	$0.00	$0.00	"$300,908.95"	"$366,645.98"	$0.00	"$199,919.71"	$0.00	"$199,919.71"	"$122,787.92"	"$176,013.20"	"$176,013.20"	$0.00	"$128,927.26"	$0.00	$0.00	$0.00	$0.00
MS928	DRG	MS928		FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC	INPATIENT ONLY	"$201,318.93"	"$148,976.01"	$0.00	"$242,850.15"	"$242,850.15"	"$242,850.15"	"$56,131.28"	"$56,131.28"	"$48,038.28"	"$21,161.06"	$0.00	$0.00	"$198,393.73"	"$56,014.65"	"$21,161.06"	"$57,253.91"	"$81,797.38"	"$81,797.38"	"$56,136.99"	"$103,838.89"	"$126,523.70"	$0.00	"$62,099.56"	"$81,797.38"	"$62,099.56"	"$20,253.97"	"$63,735.75"	"$63,735.75"	"$53,463.80"	"$21,266.66"	$0.00	$0.00	$0.00	$0.00
MS929	DRG	MS929		FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC	INPATIENT ONLY	"$110,995.12"	"$82,136.39"	$0.00	"$94,527.37"	"$67,878.36"	"$67,878.36"	"$31,853.89"	"$31,853.89"	"$20,836.22"	"$9,637.44"	$0.00	$0.00	"$94,527.37"	$0.00	"$10,119.31"	"$32,490.97"	"$68,724.23"	"$68,724.23"	"$33,904.08"	"$52,200.82"	"$63,604.70"	"$60,897.37"	"$62,099.56"	"$68,724.23"	"$62,099.56"	"$9,685.54"	"$63,735.75"	"$63,735.75"	"$32,289.60"	"$10,169.81"	$0.00	$0.00	$0.00	$0.00
MS933	DRG	MS933		EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT	INPATIENT ONLY	"$239,425.50"	"$177,174.87"	$0.00	"$35,261.93"	$0.00	$0.00	"$26,670.86"	"$26,670.86"	$0.00	"$34,672.09"	$0.00	$0.00	$0.00	$0.00	"$34,672.09"	"$27,204.28"	$0.00	$0.00	"$35,261.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$33,582.79"	$0.00	$0.00	$0.00	$0.00	$0.00
MS934	DRG	MS934		FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY	INPATIENT ONLY	"$21,519.08"	"$15,924.12"	$0.00	"$32,060.98"	"$32,060.98"	"$32,060.98"	"$28,769.31"	"$28,769.31"	$0.00	"$9,096.60"	$0.00	$0.00	"$24,196.92"	"$24,413.93"	"$9,096.60"	$516.01	$0.00	$0.00	"$26,170.31"	"$4,043.26"	"$16,532.51"	$0.00	"$18,141.99"	$0.00	"$18,141.99"	"$2,220.06"	"$27,924.99"	"$27,924.99"	"$24,924.10"	"$2,362.77"	$0.00	$0.00	$0.00	$0.00
MS935	DRG	MS935		NON-EXTENSIVE BURNS	INPATIENT ONLY	"$41,960.79"	"$31,050.98"	$0.00	"$28,925.37"	"$15,650.93"	"$15,650.93"	"$24,393.38"	"$24,393.38"	$0.00	"$8,178.90"	$0.00	$0.00	"$8,531.60"	"$24,358.86"	"$8,178.90"	"$24,881.25"	$0.00	$0.00	"$27,007.44"	"$15,169.68"	"$18,483.67"	"$7,817.30"	"$19,369.96"	$0.00	"$19,369.96"	"$2,410.65"	"$28,925.37"	"$28,925.37"	"$25,721.37"	"$2,565.61"	$0.00	$0.00	$0.00	$0.00
MS940	DRG	MS940		O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC	INPATIENT ONLY	"$94,350.10"	"$69,819.07"	$0.00	"$27,930.95"	"$20,433.00"	"$20,433.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,930.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,930.95"	$0.00	$0.00	$0.00	$0.00	$0.00
MS941	DRG	MS941		O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC	INPATIENT ONLY	"$142,894.44"	"$105,741.89"	$0.00	"$26,996.52"	$0.00	$0.00	"$24,325.75"	"$24,325.75"	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,291.39"	$0.00	$0.00	$0.00	$0.00	"$26,996.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,710.97"	$0.00	$0.00	$0.00	$0.00	$0.00
MS947	DRG	MS947		SIGNS AND SYMPTOMS WITH MCC	INPATIENT ONLY	"$47,907.15"	"$35,451.29"	$0.00	"$22,923.01"	$0.00	$0.00	"$19,293.84"	"$19,293.84"	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,272.53"	$0.00	"$19,679.72"	$0.00	$0.00	"$21,984.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$13,833.77"	"$22,923.01"	"$22,923.01"	"$20,937.74"	"$14,525.45"	$0.00	$0.00	$0.00	$0.00
MS948	DRG	MS948		SIGNS AND SYMPTOMS WITHOUT MCC	INPATIENT ONLY	"$17,563.09"	"$12,996.69"	$0.00	"$31,248.40"	"$20,433.00"	"$20,433.00"	"$16,485.64"	"$16,485.64"	$0.00	"$7,783.43"	$0.00	$0.00	$0.00	$0.00	"$7,783.43"	"$16,815.35"	$0.00	$0.00	"$19,130.18"	"$3,483.39"	"$31,248.40"	"$17,149.01"	"$6,011.26"	$0.00	"$6,011.26"	$0.00	"$19,511.90"	"$19,511.90"	"$18,219.22"	$0.00	$0.00	$0.00	$0.00	$0.00
MS950	DRG	MS950		AFTERCARE WITHOUT CC/MCC	INPATIENT ONLY	"$41,083.74"	"$30,401.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS951	DRG	MS951		OTHER FACTORS INFLUENCING HEALTH STATUS	INPATIENT ONLY	"$55,607.65"	"$41,149.66"	$0.00	"$20,033.73"	$0.00	$0.00	"$17,291.74"	"$17,291.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,033.73"	"$20,033.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS955	DRG	MS955		CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA	INPATIENT ONLY	"$622,062.28"	"$460,326.09"	$0.00	"$646,654.77"	"$646,654.77"	"$646,654.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$74,994.21"	$0.00	$0.00	"$74,415.79"	"$361,311.27"	"$440,243.88"	"$303,884.19"	"$105,609.45"	$0.00	"$105,609.45"	"$53,840.04"	"$62,801.51"	"$62,801.51"	"$70,872.18"	"$56,532.01"	$0.00	$0.00	$0.00	$0.00
MS956	DRG	MS956		"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA"	INPATIENT ONLY	"$228,564.82"	"$169,137.97"	$0.00	"$294,666.51"	"$147,277.43"	"$147,277.43"	"$37,624.23"	"$37,624.23"	$0.00	"$117,843.05"	$0.00	$0.00	"$294,666.51"	$0.00	"$116,900.81"	"$38,376.71"	$0.00	$0.00	"$40,613.44"	"$174,522.63"	"$212,649.13"	"$278,577.75"	"$39,328.35"	$0.00	"$39,328.35"	"$84,114.71"	"$45,184.81"	"$45,184.81"	"$38,679.47"	"$53,545.64"	$0.00	$0.00	$0.00	$0.00
MS957	DRG	MS957		OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC	INPATIENT ONLY	"$302,297.61"	"$223,700.23"	$0.00	"$661,644.95"	"$303,164.25"	"$303,164.25"	"$62,268.78"	"$62,268.78"	"$144,907.91"	"$80,138.05"	$0.00	$0.00	"$432,660.03"	$0.00	"$80,138.05"	"$63,514.16"	"$422,490.48"	"$422,490.48"	"$65,286.01"	"$278,370.30"	"$339,183.51"	"$661,644.95"	"$78,684.59"	"$422,490.48"	"$78,684.59"	"$76,702.83"	"$74,669.01"	"$74,669.01"	"$62,177.15"	"$80,537.94"	$0.00	$0.00	$0.00	$0.00
MS958	DRG	MS958		OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC	INPATIENT ONLY	"$285,394.08"	"$211,191.62"	$0.00	"$243,925.14"	"$243,925.14"	"$243,925.14"	"$40,437.04"	"$40,437.04"	$0.00	"$33,019.28"	$0.00	$0.00	"$171,009.88"	"$40,424.16"	"$33,019.28"	"$41,247.95"	$0.00	$0.00	"$42,442.17"	"$130,622.58"	"$159,158.58"	"$179,708.38"	"$42,010.85"	$0.00	"$42,010.85"	"$31,603.87"	"$47,370.16"	"$47,370.16"	"$40,421.11"	"$33,184.05"	$0.00	$0.00	$0.00	$0.00
MS959	DRG	MS959		OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC	INPATIENT ONLY	"$198,587.32"	"$146,954.62"	$0.00	"$121,673.30"	"$117,245.71"	"$117,245.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$99,858.13"	"$121,673.30"	$0.00	"$28,073.07"	$0.00	"$28,073.07"	"$19,466.16"	"$36,015.52"	"$36,015.52"	$0.00	"$20,439.46"	$0.00	$0.00	$0.00	$0.00
MS963	DRG	MS963		OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC	INPATIENT ONLY	"$102,608.59"	"$75,930.36"	$0.00	"$206,519.43"	"$29,282.40"	"$29,282.40"	"$29,893.87"	"$29,893.87"	"$24,162.84"	$0.00	$0.00	$0.00	"$206,519.43"	"$37,659.87"	$0.00	"$30,491.75"	"$40,948.50"	"$40,948.50"	"$32,425.24"	"$64,598.93"	"$78,711.32"	"$113,231.89"	"$27,317.23"	"$40,948.50"	"$27,317.23"	"$29,432.41"	"$35,399.75"	"$35,399.75"	"$30,881.18"	"$30,904.01"	$0.00	$0.00	$0.00	$0.00
MS964	DRG	MS964		OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC	INPATIENT ONLY	"$102,198.77"	"$75,627.09"	$0.00	"$62,293.64"	"$19,477.40"	"$19,477.40"	"$21,349.12"	"$21,349.12"	"$13,182.41"	"$17,222.51"	$0.00	$0.00	"$13,855.47"	"$21,322.49"	"$17,222.51"	"$21,776.10"	"$22,377.00"	"$22,377.00"	$0.00	"$51,124.83"	"$62,293.64"	"$33,880.61"	"$14,971.29"	"$22,377.00"	"$14,971.29"	"$4,058.08"	"$25,341.92"	"$25,341.92"	$0.00	"$4,318.93"	$0.00	$0.00	$0.00	$0.00
MS965	DRG	MS965		OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC	INPATIENT ONLY	"$110,685.47"	"$81,907.25"	$0.00	"$46,222.92"	"$15,656.33"	"$15,656.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,618.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$37,935.50"	"$46,222.92"	$0.00	"$9,193.30"	$0.00	"$9,193.30"	"$8,185.98"	"$20,634.78"	"$20,634.78"	$0.00	"$8,595.28"	$0.00	$0.00	$0.00	$0.00
MS969	DRG	MS969		HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC	INPATIENT ONLY	"$353,828.86"	"$261,833.36"	$0.00	"$67,855.17"	$0.00	$0.00	"$67,855.17"	"$67,855.17"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS970	DRG	MS970		HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC	INPATIENT ONLY	"$159,032.74"	"$117,684.23"	$0.00	"$36,966.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$36,966.90"	"$36,966.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS974	DRG	MS974		HIV WITH MAJOR RELATED CONDITION WITH MCC	INPATIENT ONLY	"$73,178.08"	"$54,151.78"	$0.00	"$583,583.70"	"$35,613.99"	"$35,613.99"	"$37,227.84"	"$37,227.84"	$0.00	$0.00	$0.00	$0.00	"$583,583.70"	"$29,573.90"	$0.00	"$30,214.39"	$0.00	$0.00	"$27,554.25"	"$13,595.40"	"$64,425.98"	$0.00	"$26,803.98"	$0.00	"$26,803.98"	$0.00	"$44,204.35"	"$44,204.35"	"$27,554.25"	$0.00	$0.00	$0.00	$0.00	$0.00
MS975	DRG	MS975		HIV WITH MAJOR RELATED CONDITION WITH CC	INPATIENT ONLY	"$51,952.99"	"$38,445.21"	$0.00	"$25,529.20"	"$16,572.15"	"$16,572.15"	"$19,901.89"	"$19,901.89"	$0.00	"$11,270.70"	$0.00	$0.00	$0.00	$0.00	"$11,270.70"	"$20,299.93"	$0.00	$0.00	"$22,973.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$24,104.72"	"$24,104.72"	"$25,529.20"	$0.00	$0.00	$0.00	$0.00	$0.00
MS976	DRG	MS976		HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC	INPATIENT ONLY	"$22,299.59"	"$16,501.70"	$0.00	"$36,779.40"	"$36,779.40"	"$36,779.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,764.33"	"$23,764.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS977	DRG	MS977		HIV WITH OR WITHOUT OTHER RELATED CONDITION	INPATIENT ONLY	"$39,015.42"	"$28,871.41"	$0.00	"$23,765.79"	"$8,399.10"	"$8,399.10"	"$20,193.12"	"$20,193.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,596.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,765.79"	"$23,765.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS981	DRG	MS981		EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC	INPATIENT ONLY	"$206,905.41"	"$153,110.00"	$0.00	"$389,857.92"	"$389,857.92"	"$389,857.92"	"$47,995.46"	"$47,995.46"	$0.00	"$47,997.68"	$0.00	$0.00	$0.00	"$42,818.02"	"$47,997.68"	"$56,112.45"	$0.00	$0.00	"$44,568.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$47,748.94"	"$47,748.94"	"$42,445.83"	$0.00	$0.00	$0.00	$0.00	$0.00
MS982	DRG	MS982		EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC	INPATIENT ONLY	"$141,904.77"	"$105,009.53"	$0.00	"$52,490.00"	$0.00	$0.00	"$28,559.81"	"$28,559.81"	$0.00	$0.00	$0.00	$0.00	"$52,490.00"	"$28,514.50"	$0.00	"$26,802.53"	$0.00	$0.00	"$30,463.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$20,815.40"	"$33,055.16"	"$33,055.16"	"$29,012.63"	"$21,856.15"	$0.00	$0.00	$0.00	$0.00
MS983	DRG	MS983		EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC	INPATIENT ONLY	"$191,096.52"	"$141,411.42"	$0.00	"$84,648.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,786.79"	"$84,648.54"	$0.00	"$16,410.80"	$0.00	"$16,410.80"	$0.00	"$26,514.63"	"$26,514.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS987	DRG	MS987		NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC	INPATIENT ONLY	"$116,755.62"	"$86,399.16"	$0.00	"$130,780.00"	"$111,671.84"	"$111,671.84"	"$33,662.08"	"$33,662.08"	$0.00	$0.00	$0.00	$0.00	"$130,780.00"	$0.00	$0.00	"$83,339.54"	$0.00	$0.00	"$62,005.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$129,871.79"	"$129,871.79"	"$59,052.55"	$0.00	$0.00	$0.00	$0.00	$0.00
MS988	DRG	MS988		NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC	INPATIENT ONLY	"$301,856.57"	"$223,373.86"	$0.00	"$101,160.63"	$0.00	$0.00	"$22,830.18"	"$22,830.18"	$0.00	$0.00	$0.00	$0.00	$0.00	"$22,799.71"	$0.00	"$23,286.78"	$0.00	$0.00	"$24,328.59"	"$83,023.25"	"$101,160.63"	$0.00	"$17,224.76"	$0.00	"$17,224.76"	$0.00	"$27,177.75"	"$27,177.75"	"$24,328.59"	$0.00	$0.00	$0.00	$0.00	$0.00
MS989	DRG	MS989		NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC	INPATIENT ONLY	"$35,912.44"	"$26,575.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS998	DRG	MS998		PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS	INPATIENT ONLY	"$72,064.04"	"$53,327.39"	$0.00	"$6,092.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,802.63"	$0.00	$0.00	$0.00	"$6,092.76"	$0.00	$0.00	$0.00	$0.00
MS999	DRG	MS999		UNGROUPABLE	INPATIENT ONLY	"$30,544.21"	"$22,602.72"	$0.00	"$62,801.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$62,801.51"	"$62,801.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
812	EAP	CPT® 00812		ANESTHESIA LOWER INTST ENDOSCOPIC PX SCR COLSC	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$446.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00	$0.00	$0.00	$97.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
813	EAP	CPT® 00813		ANESTHESIA COMBINED UPPER&LOWER GI ENDOSCOPIC PX	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$446.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00	$0.00	$0.00	$97.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11200	EAP	CPT®11200		"PR DEBRIDEMENT OF NAILS, 6 OR MORE"	BOTH IP/OP	$255.00 	$188.70	$0.00	$255.00	255	$255.00	$174.88	$174.88	175.86	53.15	255	$255.00	$255.00	$172.08	53.14	$111.85	$113.00	$113.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
11976	EAP	CPT®11976		CHEM CAUTERY GRANULATN TISSUE	BOTH IP/OP	$408.00 	$301.92	$0.00	$606.01	$408.00	$408.00	$606.01	$606.01	$408.00	$0.00	$408.00	$408.00	$408.00	$596.11	$85.03	$387.47	$408.00	$408.00	$175.24	$305.00	$241.56	$244.00	$243.48	$408.00	$243.48	$37.05	$38.57	$38.57	$48.56	$166.90	$0.00	$0.00	$0.00	$0.00
11981	EAP	CPT®11981		PR REMOVAL OF BREAST LESION	BOTH IP/OP	$286.00 	$211.64	$0.00	$286.00	286	$286.00	$109.81	$109.81	110.43	59.61	$0.00	$0.00	$0.00	$107.30	59.6	$69.74	$113.00	$113.00						$286.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
11983	EAP	CPT®11983		INJECT CARPAL TUNNEL	BOTH IP/OP	$402.00 	$297.48	$0.00	$402.00	$402.00	$402.00	$264.30	$264.30	$265.79	$83.79	$0.00	$0.00	$0.00	$258.98	$83.78	$168.34	$113.00	$113.00	$262.54	$284.00	$224.93	$227.20	$284.00	$402.00	$284.00	$44.45	$59.49	$59.49	$45.21	$250.04	$0.00	$0.00	$0.00	$0.00
17250	EAP	CPT® 17250		INJECT TENDON ORIGIN/INSERT	BOTH IP/OP	$256.00 	$189.44	$0.00	$262.54	$256.00	$256.00	$174.88	$174.88	$175.86	$53.36	$0.00	$0.00	$0.00	$172.08	$53.35	$111.85	$113.00	$113.00	$262.54	$202.00	$159.98	$161.60	$202.00	$0.00	$202.00	$0.00	$41.47	$41.47	$32.16	$250.04	$0.00	$0.00	$0.00	$0.00
20526	EAP	CPT® 20526		"INJECT TRIGGER POINTS, > 3"	BOTH IP/OP	$232.00 	$171.68	$0.00	$262.54	$232.00	$232.00	$254.43	$254.43	$232.00	$48.35	$0.00	$0.00	$0.00	$250.31	$48.35	$162.70	$232.00	$232.00	$262.54	$230.00	$182.16	$184.00	$230.00	$0.00	$230.00	$66.56	$45.07	$45.07	$36.62	$250.04	$0.00	$0.00	$0.00	$0.00
20550	EAP	CPT® 20550		ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	BOTH IP/OP	$162.00 	$119.88	$28.97	$262.54	$162.00	$162.00	$254.43	$254.43	$162.00	$33.76	$162.00	$162.00	$162.00	$250.31	$33.76	$162.70	$162.00	$162.00	$262.54	$182.00	$144.14	$145.60	$182.00	$162.00	$182.00	$54.79	$37.50	$37.50	$28.97	$250.04	$0.00	$0.00	$0.00	$0.00
20551	EAP	CPT® 20551		ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT	BOTH IP/OP	$164.00 	$121.36	$0.00	$274.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.54	$274.00	$217.01	$219.20	$274.00	$0.00	$274.00	$69.40	$47.60	$47.60	$43.62	$250.04	$0.00	$0.00	$0.00	$0.00
20552	EAP	CPT® 20552		ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US	BOTH IP/OP	$152.00 	$112.48	$0.00	$626.89	$0.00	$0.00	$0.00	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$250.31	$31.68	$162.70	$152.00	$152.00	$626.89	$303.00	$239.98	$242.40	$303.00	$152.00	$303.00	$76.82	$54.81	$54.81	$48.24	$597.04	$0.00	$0.00	$0.00	$0.00
20553	EAP	CPT® 20553		PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	BOTH IP/OP	$175.00 	$129.50	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
20600	EAP	CPT® 20600		ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	BOTH IP/OP	$150.00 	$111.00	$31.26	$262.54	$150.00	$150.00	$254.43	$254.43	$150.00	$31.26	$150.00	$150.00	$150.00	$250.31	$31.26	$162.70	$150.00	$150.00	$262.54	$223.00	$176.62	$178.40	$223.00	$150.00	$223.00	$70.76	$47.59	$47.59	$35.50	$250.04	$0.00	$0.00	$0.00	$0.00
20604	EAP	CPT® 20604		ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US	BOTH IP/OP	$232.00 	$171.68	$0.00	$338.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.31	$48.35	$162.70	$113.00	$113.00	$262.54	$338.00	$267.70	$270.40	$338.00	$0.00	$338.00	$88.61	$62.38	$62.38	$53.81	$250.04	$0.00	$0.00	$0.00	$0.00
20606	EAP	CPT® 20606		CLOSED RX METATARSAL FX	BOTH IP/OP	$252.00 	$186.48	$0.00	$790.00	$252.00	$252.00	$618.38	$618.38	$252.00	$52.52	$0.00	$0.00	$0.00	$608.20	$52.52	$395.33	$113.00	$113.00	$216.27	$790.00	$625.68	$632.00	$300.48	$0.00	$300.48	$214.80	$210.83	$210.83	$125.77	$205.98	$0.00	$0.00	$0.00	$0.00
20610	EAP	CPT® 20610		PR SHOULDER SCOPE BONE SHAVING	BOTH IP/OP	$183.00 	$135.42	$0.00	$254.43	183	$183.00	$254.43	$254.43	183	38.14	183	$183.00	$183.00	$250.31	38.14	$162.70	$183.00	$183.00						$183.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
20610	EAP	CPT®20610		CLOSED RX TOE FX	BOTH IP/OP	$183.00 	$135.42	$0.00	$346.90	$183.00	$183.00	$254.43	$254.43	$183.00	$38.14	$183.00	$183.00	$183.00	$250.31	$38.14	$162.70	$183.00	$183.00	$0.00	$0.00	$346.90	$0.00	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20611	EAP	CPT® 20611		PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG	BOTH IP/OP	$281.00 	$207.94	$0.00	$281.00	281	$281.00	$254.43	$254.43	255.86	58.57	$0.00	$0.00	$0.00	$250.31	58.56	$162.70	$113.00	$113.00						$281.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
20612	EAP	CPT®20612		"PR CATHETER ASPIRATN,NASOTRACH"	BOTH IP/OP	$181.00 	$133.94	$0.00	$254.43	181	$181.00	$254.43	$254.43	181	0	$0.00	$0.00	$0.00	$250.31	37.72	$162.70	$181.00	$181.00						$181.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
25600	EAP	CPT®25600		"PHLEB, VENIPUNCTURE"	BOTH IP/OP	$970.00 	$717.80	$0.00	$202.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.62	$202.15	$128.45	$113.00	$113.00	$3.15	$5.50	$8.71	$8.80	$4.35	$0.00	$4.35	$1.72	$3.00	$3.00	$1.75	$3.00	$0.00	$0.00	$0.00	$0.00
28470	EAP	CPT® 28470		PR INSERT NON-TUNNEL CV CATH	BOTH IP/OP	$620.00 	$458.80	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
28490	EAP	CPT®28490		"REMOVE TONSILS/ADENOIDS,<12 Y/O"	BOTH IP/OP	$401.00 	$296.74	$0.00	$401.00	401	$401.00	$200.72	$200.72	201.85	0	$0.00	$0.00	$0.00	$0.00	83.57	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
28510	EAP	CPT® 28510		PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	BOTH IP/OP	$340.00 	$251.60	$0.00	$340.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	70.86	$0.00	$0.00	$0.00						$340.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
36415	EAP	CPT® 36415		PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD	BOTH IP/OP	$11.00 	$8.14	$0.00	$7.15	5.97	$5.97	$3.00	$3.00	1.5	1.35	3.12	$3.12	$3.24	$3.00	2.29	$1.95	$6.51	$6.51						$7.15	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
43235	EAP	CPT®43235		COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	BOTH IP/OP	$867.00 	$641.58	$0.00	"$1,530.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$775.94	$180.68	$504.36	$867.00	$867.00	"$1,007.17"	"$1,530.00"	"$1,211.76"	"$1,224.00"	"$1,399.33"	$0.00	"$1,399.33"	$353.17	$208.77	$208.77	$243.58	$959.21	$0.00	$0.00	$0.00	$0.00
43239	EAP	CPT® 43239		COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ	BOTH IP/OP	"$1,110.00 "	$821.40	$0.00	"$1,598.00"	"$1,110.00"	"$1,110.00"	$787.99	$787.99	$792.43	$0.00	"$1,110.00"	"$1,110.00"	"$1,110.00"	$775.94	$231.32	$504.36	"$1,110.00"	"$1,110.00"	"$1,007.17"	"$1,598.00"	"$1,265.62"	"$1,278.40"	"$1,399.33"	$0.00	"$1,399.33"	$450.95	$265.02	$265.02	$254.40	$959.21	$0.00	$0.00	$0.00	$0.00
43239	EAP	CPT®43239		PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ	BOTH IP/OP	"$1,110.00 "	$821.40	$0.00	"$1,110.00"	1110	"$1,110.00"	$787.99	$787.99	792.43	0	1110	"$1,110.00"	"$1,110.00"	$775.94	231.32	$504.36	"$1,110.00"	"$1,110.00"						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
43246	EAP	CPT®43246		PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX	BOTH IP/OP	$557.00 	$412.18	$0.00	"$1,581.72"	557	$557.00	"$1,581.72"	"$1,581.72"	557	0	557	$557.00	$557.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
45330	EAP	CPT® 45330		"PR LAP,CHOLECYSTECTOMY"	BOTH IP/OP	$542.00 	$401.08	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
45331	EAP	CPT®45331		"PR REPAIR ING HERNIA,5+Y/O,REDUCIBL"	BOTH IP/OP	$844.00 	$624.56	$0.00	$175.89	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	175.89	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
45335	EAP	CPT®45335		"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"	BOTH IP/OP	$860.00 	$636.40	$0.00	$179.22	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	179.22	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
45378	EAP	CPT® 45378		"BIOPSY VULVA/PERINEUM,ONE LESN"	BOTH IP/OP	$984.00 	$728.16	$0.00	$984.00	$984.00	$984.00	$772.82	$772.82	$777.17	$0.00	$984.00	$984.00	$984.00	$760.65	$205.07	$494.42	$984.00	$984.00	$640.34	$328.00	$259.78	$262.40	$328.00	$0.00	$328.00	$84.36	$63.10	$63.10	$52.22	$609.84	$0.00	$0.00	$0.00	$0.00
45378	EAP	CPT®45378		"PR LAP,PROSTATECTOMY,RADICAL,W/NERVE SPARE,INCL ROBOTIC"	BOTH IP/OP	$984.00 	$728.16	$0.00	$984.00	984	$984.00	$772.82	$772.82	777.17	0	984	$984.00	$984.00	$760.65	205.07	$494.42	$984.00	$984.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
45380	EAP	CPT® 45380		"COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX"	BOTH IP/OP	"$1,268.00 "	$938.32	$0.00	"$1,268.00"	"$1,268.00"	"$1,268.00"	"$1,009.84"	"$1,009.84"	"$1,015.53"	$0.00	"$1,268.00"	"$1,268.00"	"$1,268.00"	$993.84	$264.25	$646.00	"$1,268.00"	"$1,268.00"	$271.52	$560.00	$443.52	$448.00	$377.23	$0.00	$377.23	$145.54	$115.02	$115.02	$89.15	$258.59	$0.00	$0.00	$0.00	$0.00
45380	EAP	CPT®45380		"COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG"	BOTH IP/OP	"$1,268.00 "	$938.32	$0.00	"$1,268.00"	"$1,268.00"	"$1,268.00"	"$1,009.84"	"$1,009.84"	"$1,015.53"	$0.00	"$1,268.00"	"$1,268.00"	"$1,268.00"	$993.84	$264.25	$646.00	"$1,268.00"	"$1,268.00"	$271.52	$594.00	$470.45	$475.20	$377.23	$0.00	$377.23	$99.94	$140.25	$140.25	$94.56	$258.59	$0.00	$0.00	$0.00	$0.00
45381	EAP	CPT®45381		"COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG"	BOTH IP/OP	"$1,294.00 "	$957.56	$0.00	"$1,294.00"	"$1,294.00"	"$1,294.00"	"$1,009.84"	"$1,009.84"	"$1,015.53"	$0.00	"$1,294.00"	"$1,294.00"	"$1,294.00"	$993.84	$269.67	$646.00	"$1,294.00"	"$1,294.00"	$271.52	$526.00	$416.59	$420.80	$377.23	$0.00	$377.23	$137.69	$106.36	$106.36	$83.74	$258.59	$0.00	$0.00	$0.00	$0.00
45385	EAP	CPT® 45385		BIOPSY OF UTERUS LINING	BOTH IP/OP	"$1,318.00 "	$975.32	$0.00	"$1,318.00"	"$1,318.00"	"$1,318.00"	"$1,009.84"	"$1,009.84"	"$1,015.53"	$0.00	"$1,318.00"	"$1,318.00"	"$1,318.00"	$993.84	$274.67	$646.00	"$1,318.00"	"$1,318.00"	$166.54	$353.00	$279.58	$282.40	$231.38	$0.00	$231.38	$59.72	$67.07	$67.07	$56.20	$158.61	$0.00	$0.00	$0.00	$0.00
45385	EAP	CPT®45385		BIOPSY/EXCIS CERVICAL LESN	BOTH IP/OP	"$1,318.00 "	$975.32	$0.00	"$1,318.00"	"$1,318.00"	"$1,318.00"	"$1,009.84"	"$1,009.84"	"$1,015.53"	$0.00	"$1,318.00"	"$1,318.00"	"$1,318.00"	$993.84	$274.67	$646.00	"$1,318.00"	"$1,318.00"	$640.34	$518.00	$410.26	$414.40	$518.00	$0.00	$518.00	$71.26	$78.23	$78.23	$82.47	$609.84	$0.00	$0.00	$0.00	$0.00
56605	EAP	CPT® 56605		"PR OBSTETRICAL CARE,VAG DELIV ONLY"	BOTH IP/OP	$276.00 	$204.24	$0.00	$617.38	276	$276.00	$617.38	$617.38	276	57.53	276	$276.00	$276.00	$607.07	57.52	$394.60	$276.00	$276.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
57454	EAP	CPT® 57454		"PR FULL ROUT OBSTE CARE,CESAREAN DELIV"	BOTH IP/OP	$482.00 	$356.68	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
57455	EAP	CPT® 57455		"PR ROUT OB CARE,VAG DELIV,PREV C-SEC"	BOTH IP/OP	$461.00 	$341.14	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
57456	EAP	CPT® 57456		PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	BOTH IP/OP	$432.00 	$319.68	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
57500	EAP	CPT® 57500		PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	BOTH IP/OP	$448.00 	$331.52	$0.00	$617.38	448	$448.00	$617.38	$617.38	448	93.37	448	$448.00	$448.00	$607.07	93.36	$394.60	$448.00	$448.00						$448.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
57505	EAP	CPT®57505		INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH	BOTH IP/OP	$449.00 	$332.26	$0.00	$626.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$626.89	$275.00	$217.80	$220.00	$275.00	$0.00	$275.00	$85.27	$44.35	$44.35	$43.78	$597.04	$0.00	$0.00	$0.00	$0.00
58100	EAP	CPT® 58100		"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"	BOTH IP/OP	$292.00 	$216.08	$0.00	$292.00	292	$292.00	$165.90	$165.90	166.84	60.86	292	$292.00	$292.00	$163.24	60.85	$106.10	$113.00	$113.00						$292.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
58110	EAP	CPT® 58110		"PR DISCISSION,2ND CATARACT,LASER"	BOTH IP/OP	$141.00 	$104.34	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
58300	EAP	CPT® 58300		PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP	BOTH IP/OP	$265.00 	$196.10	$0.00	$265.00	265	$265.00	$0.00	$0.00	51.66	55.23	$0.00	$0.00	$0.00	$0.00	55.23	$0.00	$113.00	$113.00						$265.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
58301	EAP	CPT® 58301		PR INJECT INTRAVITREAL PHARMCOLOGIC	BOTH IP/OP	$316.00 	$233.84	$0.00	$316.00	316	$316.00	$274.65	$274.65	276.2	65.86	$0.00	$0.00	$0.00	$269.78	65.85	$175.35	$316.00	$316.00						$316.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
64450	EAP	CPT® 64450		"PR CT ANGIO,HEAD COMBO,INCL IMAGE PROCESS"	BOTH IP/OP	$216.00 	$159.84	$0.00	$618.38	216	$216.00	$618.38	$618.38	216	45.02	216	$216.00	$216.00	$608.20	45.01	$395.33	$216.00	$216.00						$216.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
69210	EAP	CPT® 69210		CHG RADIOLOGIC EXAM CHEST 2 VIEWS	BOTH IP/OP	$134.00 	$99.16	$0.00	$134.00	134	$134.00	$54.21	$54.21	54.51	27.93	$0.00	$0.00	$0.00	$53.35	27.93	$34.67	$113.00	$113.00						$134.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
70360	EAP	CPT® 70360		"X-RAY RIBS, CHEST 4+ VW"	BOTH IP/OP	$90.00 	$66.60	$18.76	$137.87	$63.70	$63.70	$78.77	$78.77	$79.21	$18.76	$45.06	$45.06	$46.80	$77.54	$18.76	$50.40	$53.24	$53.24	$112.41	$29.76	$98.21	$99.20	$124.00	$137.87	$124.00	$50.44	$35.30	$35.30	$19.74	$107.06	$0.00	$0.00	$0.00	$0.00
70450	EAP	CPT® 70450		"CT SCAN,THORAX,W/O CONTRAST"	BOTH IP/OP	$313.00 	$231.62	$55.40	$313.00	$313.00	$313.00	$106.02	$106.02	$106.62	$65.24	$313.00	$313.00	$313.00	$104.44	$65.23	$67.89	$313.00	$313.00	$112.41	$84.96	$280.37	$283.20	$156.18	$313.00	$156.18	$55.40	$101.21	$101.21	$56.36	$107.06	$0.00	$0.00	$0.00	$0.00
70450	EAP	CPT®70450		"PR CT SCAN,THORAX,W/O CONTRAST"	BOTH IP/OP	$313.00 	$231.62	$0.00	$313.00	313	$313.00	$106.02	$106.02	106.62	65.24	313	$313.00	$313.00	$104.44	65.23	$67.89	$313.00	$313.00						$313.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
70487	EAP	CPT®70487		CAT SCAN OF CHEST CONTRAST	BOTH IP/OP	$451.00 	$333.74	$0.00	$451.00	$451.00	$451.00	$173.95	$173.95	$174.93	$94.00	$451.00	$451.00	$451.00	$171.13	$93.99	$111.23	$451.00	$451.00	$202.33	$113.52	$374.62	$378.40	$281.11	$0.00	$281.11	$74.02	$135.06	$135.06	$75.30	$192.70	$0.00	$0.00	$0.00	$0.00
70491	EAP	CPT®70491		"PR CT ANGIO, CHEST (NON-CORON), COMBO, INCL IMG PROC"	BOTH IP/OP	$550.00 	$407.00	$0.00	$550.00	550	$550.00	$173.95	$173.95	174.93	114.63	550	$550.00	$550.00	$171.13	114.62	$111.23	$550.00	$550.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
70492	EAP	CPT® 70492		"CT ANGIO, CHEST, COMBO, INCL IMAGE PROC"	BOTH IP/OP	$661.00 	$489.14	$0.00	$509.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.33	$152.88	$504.50	$509.60	$281.11	$0.00	$281.11	$99.69	$214.30	$214.30	$101.41	$192.70	$0.00	$0.00	$0.00	$0.00
71045	EAP	CPT®71045		CHG X-RAY THORACIC SPINE 2 VW	BOTH IP/OP	$74.00 	$54.76	$0.00	$78.77	45.3	$45.30	$78.77	$78.77	74	15.42	26.8	$26.80	$27.83	$77.54	15.42	$50.40	$43.77	$43.77						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
71046	EAP	CPT® 71046		X-RAY THOR-LUMB SP 2 VW	BOTH IP/OP	$96.00 	$71.04	$13.05	$137.87	$69.46	$69.46	$78.77	$78.77	$79.21	$20.01	$49.06	$49.06	$50.94	$77.54	$20.01	$50.40	$56.78	$56.78	$80.04	$19.68	$64.94	$65.60	$82.00	$137.87	$82.00	$36.61	$23.41	$23.41	$13.05	$76.23	$0.00	$0.00	$0.00	$0.00
71046	EAP	CPT®71046		X-RAY THORACIC SPINE 2 VW	BOTH IP/OP	$96.00 	$71.04	$12.10	$137.87	$69.46	$69.46	$78.77	$78.77	$79.21	$20.01	$49.06	$49.06	$50.94	$77.54	$20.01	$50.40	$56.78	$56.78	$112.41	$18.24	$60.19	$60.80	$76.00	$137.87	$76.00	$35.88	$21.61	$21.61	$12.10	$107.06	$0.00	$0.00	$0.00	$0.00
71110	EAP	CPT®71110		CHG X-RAY LUMBAR SPINE 2/3 VW	BOTH IP/OP	$126.00 	$93.24	$0.00	$169.61	85.46	$85.46	$106.02	$106.02	106.62	26.26	67.28	$67.28	$69.87	$104.44	26.26	$67.89	$74.53	$74.53						$169.61	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
71111	EAP	CPT® 71111		X-RAY LUMBAR SPINE 2/3 VW	BOTH IP/OP	$150.00 	$111.00	$0.00	$112.41	$109.64	$109.64	$106.02	$106.02	$106.62	$31.26	$88.90	$88.90	$92.32	$104.44	$31.26	$67.89	$88.73	$88.73	$112.41	$22.80	$75.24	$76.00	$95.00	$0.00	$95.00	$36.61	$27.01	$27.01	$15.12	$107.06	$0.00	$0.00	$0.00	$0.00
71250	EAP	CPT® 71250		X-RAY LUMBAR SPINE 4 VW	BOTH IP/OP	$393.00 	$290.82	$19.90	$393.00	$393.00	$393.00	$106.02	$106.02	$106.62	$81.91	$393.00	$393.00	$393.00	$104.44	$81.90	$67.89	$393.00	$393.00	$112.41	$30.00	$99.00	$100.00	$125.00	$393.00	$125.00	$50.44	$35.66	$35.66	$19.90	$107.06	$0.00	$0.00	$0.00	$0.00
71250	EAP	CPT®71250		CHG X-RAY LUMBAR SPINE 4 VW	BOTH IP/OP	$393.00 	$290.82	$0.00	$393.00	393	$393.00	$106.02	$106.02	106.62	81.91	393	$393.00	$393.00	$104.44	81.9	$67.89	$393.00	$393.00						$393.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
71260	EAP	CPT® 71260		"CT SCAN,LUMBAR SPINE,W/O CONTRAST"	BOTH IP/OP	$494.00 	$365.56	$0.00	$494.00	$494.00	$494.00	$173.95	$173.95	$174.93	$102.96	$494.00	$494.00	$494.00	$171.13	$102.95	$111.23	$494.00	$494.00	$112.41	$371.00	$293.83	$296.80	$156.18	$0.00	$156.18	$58.06	$105.89	$105.89	$59.06	$107.06	$0.00	$0.00	$0.00	$0.00
71260	EAP	CPT®71260		"PR CT SCAN,CERVICAL SPINE,W/O CONTRAST"	BOTH IP/OP	$494.00 	$365.56	$0.00	$494.00	494	$494.00	$173.95	$173.95	174.93	102.96	494	$494.00	$494.00	$171.13	102.95	$111.23	$494.00	$494.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
71275	EAP	CPT®71275		"PR MRI, CERV SPINE"	BOTH IP/OP	$763.00 	$564.62	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
72040	EAP	CPT®72040		CHG X-RAY PELVIS 1/2 VW	BOTH IP/OP	$113.00 	$83.62	$0.00	$137.87	74.98	$74.98	$78.77	$78.77	79.21	23.55	62.89	$62.89	$65.31	$77.54	23.55	$50.40	$66.84	$66.84						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
72050	EAP	CPT® 72050		PR CT SCAN OF PELVIS CONTRAST	BOTH IP/OP	$152.00 	$112.48	$0.00	$106.62	103.2	$103.20	$106.02	$106.02	106.62	31.68	89.81	$89.81	$93.27	$104.44	31.68	$67.89	$89.91	$89.91						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
72052	EAP	CPT® 72052		X-RAY SACRUM/COCCYX 2+ VW	BOTH IP/OP	$177.00 	$130.98	$0.00	$104.70	$0.00	$0.00	$0.00	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$104.44	$36.89	$67.89	$104.70	$104.70	$80.04	$18.96	$62.57	$63.20	$79.00	$0.00	$79.00	$30.55	$22.69	$22.69	$12.58	$76.23	$0.00	$0.00	$0.00	$0.00
72070	EAP	CPT® 72070		CHG X-RAY SHOULDER 2+ VW	BOTH IP/OP	$94.00 	$69.56	$0.00	$169.61	77.4	$77.40	$106.02	$106.02	94	19.59	55.63	$55.63	$57.77	$104.44	19.59	$67.89	$55.60	$55.60						$169.61	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
72070	EAP	CPT®72070		X-RAY CLAVICLE	BOTH IP/OP	$94.00 	$69.56	$12.90	$169.61	$77.40	$77.40	$106.02	$106.02	$94.00	$19.59	$55.63	$55.63	$57.77	$104.44	$19.59	$67.89	$55.60	$55.60	$80.04	$19.44	$64.15	$64.80	$81.00	$169.61	$81.00	$27.72	$23.05	$23.05	$12.90	$76.23	$0.00	$0.00	$0.00	$0.00
72080	EAP	CPT® 72080		X-RAY SHOULDER 2+ VW	BOTH IP/OP	$100.00 	$74.00	$0.00	$83.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.04	$19.92	$65.74	$66.40	$83.00	$0.00	$83.00	$30.90	$23.77	$23.77	$13.21	$76.23	$0.00	$0.00	$0.00	$0.00
72100	EAP	CPT® 72100		X-RAY HUMERUS	BOTH IP/OP	$114.00 	$84.36	$12.90	$169.61	$79.81	$79.81	$106.02	$106.02	$106.62	$23.76	$67.44	$67.44	$70.04	$104.44	$23.76	$67.89	$67.43	$67.43	$80.04	$19.44	$64.15	$64.80	$81.00	$169.61	$81.00	$30.55	$23.05	$23.05	$12.90	$76.23	$0.00	$0.00	$0.00	$0.00
72100	EAP	CPT®72100		CHG X-RAY HUMERUS	BOTH IP/OP	$114.00 	$84.36	$0.00	$169.61	79.81	$79.81	$106.02	$106.02	106.62	23.76	67.44	$67.44	$70.04	$104.44	23.76	$67.89	$67.43	$67.43						$169.61	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
72110	EAP	CPT® 72110		X-RAY ELBOW 2 VW	BOTH IP/OP	$147.00 	$108.78	$0.00	$169.61	$111.25	$111.25	$106.02	$106.02	$106.62	$0.00	$94.35	$94.35	$97.98	$0.00	$0.00	$0.00	$0.00	$0.00	$80.04	$17.04	$56.23	$56.80	$71.00	$169.61	$71.00	$27.38	$20.17	$20.17	$11.30	$76.23	$0.00	$0.00	$0.00	$0.00
72110	EAP	CPT®72110		CHG X-RAY ELBOW 2 VW	BOTH IP/OP	$147.00 	$108.78	$0.00	$169.61	111.25	$111.25	$106.02	$106.02	106.62	0	94.35	$94.35	$97.98	$0.00	$0.00	$0.00	$0.00	$0.00						$169.61	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
72114	EAP	CPT®72114		X-RAY ELBOW 3+ VW	BOTH IP/OP	$177.00 	$130.98	$12.42	$169.61	$141.08	$141.08	$106.02	$106.02	$106.62	$36.89	$127.92	$127.92	$132.84	$104.44	$36.89	$67.89	$104.70	$104.70	$80.04	$18.72	$61.78	$62.40	$78.00	$169.61	$78.00	$30.55	$22.33	$22.33	$12.42	$76.23	$0.00	$0.00	$0.00	$0.00
72125	EAP	CPT®72125		CHG X-RAY FOREARM 2 VW	BOTH IP/OP	$385.00 	$284.90	$0.00	$385.00	385	$385.00	$106.02	$106.02	106.62	80.24	385	$385.00	$385.00	$104.44	80.23	$67.89	$385.00	$385.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
72131	EAP	CPT® 72131		X-RAY FOREARM 2 VW	BOTH IP/OP	$383.00 	$283.42	$0.00	$383.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.04	$17.28	$57.02	$57.60	$72.00	$383.00	$72.00	$27.72	$20.53	$20.53	$11.46	$76.23	$0.00	$0.00	$0.00	$0.00
72170	EAP	CPT®72170		X-RAY WRIST 3+ VW	BOTH IP/OP	$80.00 	$59.20	$0.00	$169.61	$72.57	$72.57	$106.02	$106.02	$80.00	$0.00	$42.34	$42.34	$43.97	$0.00	$0.00	$0.00	$0.00	$0.00	$80.04	$25.44	$83.95	$84.80	$106.00	$169.61	$106.00	$28.79	$30.25	$30.25	$16.88	$76.23	$0.00	$0.00	$0.00	$0.00
72190	EAP	CPT®72190		X-RAY HAND 2 VW	BOTH IP/OP	$121.00 	$89.54	$0.00	$112.41	$86.28	$86.28	$106.02	$106.02	$106.62	$25.22	$70.16	$70.16	$72.86	$104.44	$25.22	$67.89	$71.57	$71.57	$112.41	$18.48	$60.98	$61.60	$77.00	$0.00	$77.00	$27.37	$21.97	$21.97	$12.26	$107.06	$0.00	$0.00	$0.00	$0.00
72220	EAP	CPT® 72220		X-RAY HAND 3+ VW	BOTH IP/OP	$93.00 	$68.82	$0.00	$137.87	$63.70	$63.70	$78.77	$78.77	$79.21	$0.00	$51.11	$51.11	$53.07	$0.00	$0.00	$0.00	$0.00	$0.00	$80.04	$22.08	$72.86	$73.60	$92.00	$137.87	$92.00	$28.79	$26.29	$26.29	$14.65	$76.23	$0.00	$0.00	$0.00	$0.00
73000	EAP	CPT® 73000		CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW	BOTH IP/OP	$92.00 	$68.08	$0.00	$137.87	62.88	$62.88	$78.77	$78.77	79.21	19.18	46.88	$46.88	$48.69	$77.54	19.17	$50.40	$54.42	$54.42						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73030	EAP	CPT® 73030		RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS	BOTH IP/OP	$99.00 	$73.26	$19.10	$137.87	$66.11	$66.11	$78.77	$78.77	$79.21	$20.63	$50.19	$50.19	$52.12	$77.54	$20.63	$50.40	$58.56	$58.56	$80.04	$28.80	$95.04	$96.00	$111.21	$137.87	$111.21	$39.45	$34.22	$34.22	$19.10	$76.23	$0.00	$0.00	$0.00	$0.00
73030	EAP	CPT®73030		CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS	BOTH IP/OP	$99.00 	$73.26	$0.00	$137.87	66.11	$66.11	$78.77	$78.77	79.21	20.63	50.19	$50.19	$52.12	$77.54	20.63	$50.40	$58.56	$58.56						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73060	EAP	CPT® 73060		RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS	BOTH IP/OP	$91.00 	$67.34	$18.96	$137.87	$66.11	$66.11	$78.77	$78.77	$79.21	$18.97	$50.19	$50.19	$52.12	$77.54	$18.96	$50.40	$53.83	$53.83	$112.41	$31.44	$103.75	$104.80	$131.00	$137.87	$131.00	$46.58	$37.46	$37.46	$20.86	$107.06	$0.00	$0.00	$0.00	$0.00
73060	EAP	CPT®73060		RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS	BOTH IP/OP	$91.00 	$67.34	$16.08	$137.87	$66.11	$66.11	$78.77	$78.77	$79.21	$18.97	$50.19	$50.19	$52.12	$77.54	$18.96	$50.40	$53.83	$53.83	$112.41	$24.24	$79.99	$80.80	$101.00	$137.87	$101.00	$37.75	$28.81	$28.81	$16.08	$107.06	$0.00	$0.00	$0.00	$0.00
73070	EAP	CPT® 73070		RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS	BOTH IP/OP	$83.00 	$61.42	$14.17	$137.87	$62.09	$62.09	$78.77	$78.77	$79.21	$17.30	$46.88	$46.88	$48.69	$77.54	$17.30	$50.40	$49.09	$49.09	$80.04	$21.36	$70.49	$71.20	$89.00	$137.87	$89.00	$30.93	$25.57	$25.57	$14.17	$76.23	$0.00	$0.00	$0.00	$0.00
73070	EAP	CPT®73070		CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS	BOTH IP/OP	$83.00 	$61.42	$0.00	$137.87	62.09	$62.09	$78.77	$78.77	79.21	17.3	46.88	$46.88	$48.69	$77.54	17.3	$50.40	$49.09	$49.09						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73080	EAP	CPT® 73080		CHG X-RAY KNEE 1 OR 2 VIEW	BOTH IP/OP	$93.00 	$68.82	$0.00	$137.87	70.96	$70.96	$78.77	$78.77	79.21	19.38	62.89	$62.89	$65.31	$77.54	19.38	$50.40	$55.01	$55.01						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73090	EAP	CPT® 73090		X-RAY KNEE 3 VIEW	BOTH IP/OP	$83.00 	$61.42	$16.72	$137.87	$58.87	$58.87	$78.77	$78.77	$79.21	$17.30	$46.88	$46.88	$48.69	$77.54	$17.30	$50.40	$49.09	$49.09	$80.04	$25.20	$83.16	$84.00	$105.00	$137.87	$105.00	$31.26	$29.89	$29.89	$16.72	$76.23	$0.00	$0.00	$0.00	$0.00
73090	EAP	CPT®73090		X-RAY KNEE 1 OR 2 VIEW	BOTH IP/OP	$83.00 	$61.42	$17.30	$137.87	$58.87	$58.87	$78.77	$78.77	$79.21	$17.30	$46.88	$46.88	$48.69	$77.54	$17.30	$50.40	$49.09	$49.09	$80.04	$31.68	$69.70	$105.60	$111.21	$137.87	$111.21	$28.43	$25.21	$25.21	$21.01	$76.23	$0.00	$0.00	$0.00	$0.00
73100	EAP	CPT® 73100		X-RAY KNEE 4+ VIEW	BOTH IP/OP	$97.00 	$71.78	$18.31	$137.87	$66.11	$66.11	$78.77	$78.77	$79.21	$20.22	$48.68	$48.68	$50.55	$77.54	$20.21	$50.40	$57.38	$57.38	$112.41	$27.60	$91.08	$92.00	$115.00	$137.87	$115.00	$34.81	$32.78	$32.78	$18.31	$107.06	$0.00	$0.00	$0.00	$0.00
73110	EAP	CPT® 73110		"X-RAY TIB + FIB, 2VW"	BOTH IP/OP	$117.00 	$86.58	$12.58	$137.87	$80.63	$80.63	$78.77	$78.77	$79.21	$24.39	$61.39	$61.39	$63.75	$77.54	$24.38	$50.40	$69.21	$69.21	$80.04	$18.96	$62.57	$63.20	$79.00	$137.87	$79.00	$28.43	$22.69	$22.69	$12.58	$76.23	$0.00	$0.00	$0.00	$0.00
73110	EAP	CPT®73110		"CHG X-RAY TIB + FIB, 2VW"	BOTH IP/OP	$117.00 	$86.58	$0.00	$137.87	80.63	$80.63	$78.77	$78.77	79.21	24.39	61.39	$61.39	$63.75	$77.54	24.38	$50.40	$69.21	$69.21						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73120	EAP	CPT® 73120		CHG X-RAY ANKLE 2 VW	BOTH IP/OP	$89.00 	$65.86	$0.00	$169.61	59.66	$59.66	$106.02	$106.02	89	18.55	45.96	$45.96	$47.73	$104.44	18.55	$67.89	$52.64	$52.64						$169.61	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73130	EAP	CPT® 73130		CHG X-RAY ANKLE 3+ VW	BOTH IP/OP	$105.00 	$77.70	$0.00	$137.87	70.14	$70.14	$78.77	$78.77	79.21	21.88	54.14	$54.14	$56.22	$77.54	21.88	$50.40	$62.11	$62.11						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73130	EAP	CPT®73130		X-RAY ANKLE 2 VW	BOTH IP/OP	$105.00 	$77.70	$13.05	$137.87	$70.14	$70.14	$78.77	$78.77	$79.21	$21.88	$54.14	$54.14	$56.22	$77.54	$21.88	$50.40	$62.11	$62.11	$80.04	$19.68	$64.94	$65.60	$82.00	$137.87	$82.00	$27.37	$23.41	$23.41	$13.05	$76.23	$0.00	$0.00	$0.00	$0.00
73140	EAP	CPT®73140		X-RAY ANKLE 3+ VW	BOTH IP/OP	$107.00 	$79.18	$14.65	$137.87	$71.76	$71.76	$78.77	$78.77	$79.21	$22.30	$53.24	$53.24	$55.29	$77.54	$22.30	$50.40	$63.29	$63.29	$80.04	$22.08	$72.86	$73.60	$92.00	$137.87	$92.00	$28.79	$26.29	$26.29	$14.65	$76.23	$0.00	$0.00	$0.00	$0.00
73200	EAP	CPT®73200		CHG X-RAY FOOT 2 VW	BOTH IP/OP	$451.00 	$333.74	$0.00	$815.94	451	$451.00	$106.02	$106.02	106.62	0	785.72	$785.72	$815.94	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73501	EAP	CPT®73501		X-RAY FOOT 2 VW	BOTH IP/OP	$93.00 	$68.82	$11.30	$137.87	$67.72	$67.72	$78.77	$78.77	$79.21	$19.38	$50.89	$50.89	$52.84	$77.54	$19.38	$50.40	$55.01	$55.01	$80.04	$17.04	$56.23	$56.80	$71.00	$137.87	$71.00	$27.37	$20.17	$20.17	$11.30	$76.23	$0.00	$0.00	$0.00	$0.00
73502	EAP	CPT® 73502		X-RAY FOOT 3+ VW	BOTH IP/OP	$134.00 	$99.16	$13.69	$137.87	$94.33	$94.33	$78.77	$78.77	$79.21	$27.93	$75.00	$75.00	$77.89	$77.54	$27.93	$50.40	$79.26	$79.26	$80.04	$20.64	$68.11	$68.80	$86.00	$137.87	$86.00	$28.79	$24.49	$24.49	$13.69	$76.23	$0.00	$0.00	$0.00	$0.00
73502	EAP	CPT®73502		CHG X-RAY FOOT 3+ VW	BOTH IP/OP	$134.00 	$99.16	$0.00	$137.87	94.33	$94.33	$78.77	$78.77	79.21	27.93	75	$75.00	$77.89	$77.54	27.93	$50.40	$79.26	$79.26						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73521	EAP	CPT® 73521		X-RAY TOE(S)	BOTH IP/OP	$118.00 	$87.32	$12.10	$169.61	$90.29	$90.29	$106.02	$106.02	$106.62	$24.59	$70.54	$70.54	$73.26	$104.44	$24.59	$67.89	$69.80	$69.80	$80.04	$18.24	$60.19	$60.80	$76.00	$169.61	$76.00	$23.09	$21.61	$21.61	$12.10	$76.23	$0.00	$0.00	$0.00	$0.00
73522	EAP	CPT® 73522		"CT SCAN,LOWER EXTREMITY,W/O CONTRAST"	BOTH IP/OP	$153.00 	$113.22	$31.89	$371.00	$111.25	$111.25	$106.02	$106.02	$106.62	$31.89	$83.92	$83.92	$87.15	$104.44	$31.89	$67.89	$90.50	$90.50	$112.41	$371.00	$293.83	$296.80	$156.18	$169.61	$156.18	$58.06	$105.89	$105.89	$59.06	$107.06	$0.00	$0.00	$0.00	$0.00
73552	EAP	CPT®73552		"PR MRI LOWER EXTREM JT, W/O CONTRAST"	BOTH IP/OP	$101.00 	$74.74	$0.00	$137.87	74.18	$74.18	$78.77	$78.77	79.21	21.05	57.14	$57.14	$59.34	$77.54	21.05	$50.40	$59.74	$59.74						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73560	EAP	CPT® 73560		RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES	BOTH IP/OP	$98.00 	$72.52	$0.00	$137.87	$70.14	$70.14	$78.77	$78.77	$79.21	$20.43	$47.79	$47.79	$49.63	$77.54	$20.42	$50.40	$57.97	$57.97	$112.41	$27.60	$91.08	$92.00	$115.00	$137.87	$115.00	$44.36	$32.78	$32.78	$0.00	$107.06	$0.00	$0.00	$0.00	$0.00
73560	EAP	CPT®73560		CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES	BOTH IP/OP	$98.00 	$72.52	$0.00	$137.87	70.14	$70.14	$78.77	$78.77	79.21	20.43	47.79	$47.79	$49.63	$77.54	20.42	$50.40	$57.97	$57.97						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73562	EAP	CPT® 73562		"CT SCAN,ABDOMEN,W/O CONTRAST"	BOTH IP/OP	$117.00 	$86.58	$24.38	$316.00	$81.42	$81.42	$78.77	$78.77	$79.21	$24.39	$60.18	$60.18	$62.50	$77.54	$24.38	$50.40	$69.21	$69.21	$112.41	$316.00	$250.27	$252.80	$156.18	$137.87	$156.18	$49.45	$90.40	$90.40	$50.31	$107.06	$0.00	$0.00	$0.00	$0.00
73564	EAP	CPT® 73564		CT SCAN OF ABDOMEN CONTRAST	BOTH IP/OP	$132.00 	$97.68	$27.51	$637.00	$90.29	$90.29	$106.02	$106.02	$106.62	$27.51	$69.25	$69.25	$71.92	$104.44	$27.51	$67.89	$78.08	$78.08	$202.33	$637.00	$504.50	$509.60	$281.11	$169.61	$281.11	$99.69	$185.49	$185.49	$101.41	$192.70	$0.00	$0.00	$0.00	$0.00
73590	EAP	CPT® 73590		PR CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES	BOTH IP/OP	$90.00 	$66.60	$0.00	$137.87	65.31	$65.31	$78.77	$78.77	79.21	18.76	45.06	$45.06	$46.80	$77.54	18.76	$50.40	$53.24	$53.24						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73590	EAP	CPT®73590		CT SCAN OF ABDOMEN COMBO	BOTH IP/OP	$90.00 	$66.60	$18.76	$637.00	$65.31	$65.31	$78.77	$78.77	$79.21	$18.76	$45.06	$45.06	$46.80	$77.54	$18.76	$50.40	$53.24	$53.24	$202.33	$637.00	$504.50	$509.60	$281.11	$137.87	$281.11	$99.69	$211.06	$211.06	$101.41	$192.70	$0.00	$0.00	$0.00	$0.00
73600	EAP	CPT® 73600		"CHG CT SCAN,ABDOMENT AND PELVIS,W/O CONTRAST"	BOTH IP/OP	$92.00 	$68.08	$0.00	$137.87	67.72	$67.72	$78.77	$78.77	79.21	19.18	45.96	$45.96	$47.73	$77.54	19.17	$50.40	$54.42	$54.42						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73600	EAP	CPT®73600		CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES	BOTH IP/OP	$92.00 	$68.08	$19.17	$836.80	$67.72	$67.72	$78.77	$78.77	$79.21	$19.18	$45.96	$45.96	$47.73	$77.54	$19.17	$50.40	$54.42	$54.42	$387.01	$251.04	$828.43	$836.80	$537.70	$137.87	$537.70	$163.70	$298.94	$298.94	$166.52	$368.58	$0.00	$0.00	$0.00	$0.00
73610	EAP	CPT® 73610		"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"	BOTH IP/OP	$105.00 	$77.70	$0.00	$137.87	71.76	$71.76	$78.77	$78.77	79.21	21.88	54.14	$54.14	$56.22	$77.54	21.88	$50.40	$62.11	$62.11						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73610	EAP	CPT®73610		"CT SCAN,ABDOMENT AND PELVIS,W/O CONTRAST"	BOTH IP/OP	$105.00 	$77.70	$0.00	$315.22	$71.76	$71.76	$78.77	$78.77	$79.21	$21.88	$54.14	$54.14	$56.22	$77.54	$21.88	$50.40	$62.11	$62.11	$0.00	$95.52	$315.22	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73620	EAP	CPT® 73620		"PR MRI, ABDOMEN, COMBO"	BOTH IP/OP	$81.00 	$59.94	$0.00	$137.87	58.87	$58.87	$78.77	$78.77	79.21	16.88	44.15	$44.15	$45.85	$77.54	16.88	$50.40	$47.91	$47.91						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73620	EAP	CPT®73620		"CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"	BOTH IP/OP	$81.00 	$59.94	$0.00	$661.32	$58.87	$58.87	$78.77	$78.77	$79.21	$16.88	$44.15	$44.15	$45.85	$77.54	$16.88	$50.40	$47.91	$47.91	$0.00	$200.40	$661.32	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73630	EAP	CPT® 73630		"US,HEAD/NECK TISSUES,B-SCAN/REAL TIME"	BOTH IP/OP	$99.00 	$73.26	$20.63	$248.80	$66.11	$66.11	$78.77	$78.77	$79.21	$20.63	$53.24	$53.24	$55.29	$77.54	$20.63	$50.40	$58.56	$58.56	$112.41	$74.64	$246.31	$248.80	$156.18	$137.87	$156.18	$82.37	$88.96	$88.96	$49.51	$107.06	$0.00	$0.00	$0.00	$0.00
73630	EAP	CPT®73630		"US, HEAD/NECK TISSUES,REAL TIME"	BOTH IP/OP	$99.00 	$73.26	$0.00	$137.87	66.11	$66.11	$78.77	$78.77	79.21	20.63	53.24	$53.24	$55.29	$77.54	20.63	$50.40	$58.56	$58.56						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73660	EAP	CPT® 73660		CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED	BOTH IP/OP	$83.00 	$61.42	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
73700	EAP	CPT® 73700		"PR US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"	BOTH IP/OP	$383.00 	$283.42	$0.00	$383.00	383	$383.00	$106.02	$106.02	106.62	79.83	383	$383.00	$383.00	$104.44	79.82	$67.89	$383.00	$383.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
74018	EAP	CPT®74018		"PR US, ABDOMEN LIMITED"	BOTH IP/OP	$86.00 	$63.64	$0.00	$137.87	62.2	$62.20	$78.77	$78.77	79.21	17.92	45.51	$45.51	$47.26	$77.54	17.92	$50.40	$50.87	$50.87						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
74022	EAP	CPT® 74022		US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA	BOTH IP/OP	$143.00 	$105.82	$29.80	$244.80	$101.59	$101.59	$106.02	$106.02	$106.62	$29.80	$79.08	$79.08	$82.12	$104.44	$29.80	$67.89	$84.58	$84.58	$112.41	$73.44	$242.35	$244.80	$156.18	$169.61	$156.18	$90.50	$87.52	$87.52	$48.72	$107.06	$0.00	$0.00	$0.00	$0.00
74022	EAP	CPT®74022		SONO ABDOMEN LIMITED	BOTH IP/OP	$143.00 	$105.82	$29.80	$175.20	$101.59	$101.59	$106.02	$106.02	$106.62	$29.80	$79.08	$79.08	$82.12	$104.44	$29.80	$67.89	$84.58	$84.58	$112.41	$52.56	$173.45	$175.20	$156.18	$169.61	$156.18	$83.78	$62.67	$62.67	$34.86	$107.06	$0.00	$0.00	$0.00	$0.00
74150	EAP	CPT® 74150		"PR US,RETROPERIT,REAL TIME,COMPLETE"	BOTH IP/OP	$406.00 	$300.44	$0.00	$406.00	406	$406.00	$106.02	$106.02	106.62	84.62	406	$406.00	$406.00	$104.44	84.61	$67.89	$406.00	$406.00						$406.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
74160	EAP	CPT® 74160		"US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE"	BOTH IP/OP	$691.00 	$511.34	$0.00	$691.00	$691.00	$691.00	$173.95	$173.95	$174.93	$0.00	$691.00	$691.00	$691.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.41	$65.04	$214.63	$216.80	$156.18	$540.00	$156.18	$112.23	$77.44	$77.44	$43.14	$107.06	$0.00	$0.00	$0.00	$0.00
74170	EAP	CPT® 74170		SONO ABD RETROPERITNL LTD	BOTH IP/OP	$708.00 	$523.92	$0.00	$112.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.41	$25.44	$83.95	$84.80	$106.00	$0.00	$106.00	$83.43	$30.25	$30.25	$16.88	$107.06	$0.00	$0.00	$0.00	$0.00
74174	EAP	CPT®74174		"CHG US, OB >/= 14 WKS, SNGL FETUS"	BOTH IP/OP	"$1,140.00 "	$843.60	$0.00	"$1,140.00"	1140	"$1,140.00"	$358.61	$358.61	360.63	237.6	785.72	$785.72	$815.94	$352.81	237.58	$229.33	"$1,106.00"	"$1,106.00"						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
74176	EAP	CPT®74176		"CHG US,PREGNANT UTERUS,F/U,TRANSABD APP"	BOTH IP/OP	$242.00 	$179.08	$0.00	$370.58	242	$242.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$370.58	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
74177	EAP	CPT®74177		"CHG FETAL BIOPHYS PROF,W/O NST"	BOTH IP/OP	$920.00 	$680.80	$0.00	$920.00	920	$920.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$920.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
74178	EAP	CPT®74178		"CHG ECHOGRAPHY,TRANSVAGINAL"	BOTH IP/OP	"$1,030.00 "	$762.20	$0.00	"$1,030.00"	1030	"$1,030.00"	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						"$1,030.00"	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
76536	EAP	CPT® 76536		"ECHO,PELVIC (NONOBSTETRIC)"	BOTH IP/OP	$322.00 	$238.28	$42.51	$266.85	$266.85	$266.85	$106.02	$106.02	$106.62	$67.11	$204.76	$204.76	$212.63	$104.44	$67.10	$67.89	$190.46	$190.46	$112.41	$64.08	$211.46	$213.60	$156.18	$183.00	$156.18	$92.96	$76.36	$76.36	$42.51	$107.06	$0.00	$0.00	$0.00	$0.00
76536	EAP	CPT®76536		"PR US,PELVIC (NONOBSTETRIC),REAL TIME,COMPLETE"	BOTH IP/OP	$322.00 	$238.28	$0.00	$266.85	266.85	$266.85	$106.02	$106.02	106.62	67.11	204.76	$204.76	$212.63	$104.44	67.1	$67.89	$190.46	$190.46						$183.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
76700	EAP	CPT® 76700		"CHG US GUIDE, VASCULAR ACCESS"	BOTH IP/OP	$338.00 	$250.12	$0.00	$280.53	280.53	$280.53	$106.02	$106.02	106.62	70.45	236.95	$236.95	$246.07	$104.44	70.44	$67.89	$199.93	$199.93						$169.61	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
76700	EAP	CPT®76700		"US,EXTREMITY,NONVASCULAR,REAL-TIME IMAGE,LIMITED"	BOTH IP/OP	$338.00 	$250.12	$0.00	$280.53	$280.53	$280.53	$106.02	$106.02	$106.62	$70.45	$236.95	$236.95	$246.07	$104.44	$70.44	$67.89	$199.93	$199.93	$0.00	$27.84	$91.87	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76705	EAP	CPT® 76705		SCREENING DIGITAL BREAST TOMOSYNTHESIS BI	BOTH IP/OP	$252.00 	$186.48	$14.01	$209.59	$209.59	$209.59	$106.02	$106.02	$106.62	$52.52	$182.05	$182.05	$189.05	$104.44	$52.52	$67.89	$149.06	$149.06	$26.75	$21.12	$69.70	$70.40	$25.21	$183.00	$25.21	$53.24	$25.21	$25.21	$14.01	$25.21	$0.00	$0.00	$0.00	$0.00
76705	EAP	CPT®76705		SONO GUIDE NEEDLE BIOPSY	BOTH IP/OP	$252.00 	$186.48	$0.00	$209.59	$209.59	$209.59	$106.02	$106.02	$106.62	$52.52	$182.05	$182.05	$189.05	$104.44	$52.52	$67.89	$149.06	$149.06	$0.00	$21.84	$72.07	$72.80	$0.00	$183.00	$0.00	$92.25	$25.93	$25.93	$14.49	$0.00	$0.00	$0.00	$0.00	$0.00
76706	EAP	CPT® 76706		CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI	BOTH IP/OP	$307.00 	$227.18	$0.00	$214.45	214.45	$214.45	$106.02	$106.02	106.62	63.99	166.71	$166.71	$173.12	$104.44	63.98	$67.89	$181.59	$181.59						$169.61	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
76770	EAP	CPT®76770		CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	BOTH IP/OP	$313.00 	$231.62	$0.00	$259.59	259.59	$259.59	$106.02	$106.02	106.62	65.24	231.49	$231.49	$240.40	$104.44	65.23	$67.89	$185.14	$185.14						$169.61	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
76775	EAP	CPT® 76775		CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	BOTH IP/OP	$165.00 	$122.10	$0.00	$209.79	133.82	$133.82	$106.02	$106.02	106.62	34.39	202.02	$202.02	$209.79	$104.44	34.39	$67.89	$97.60	$97.60						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
76830	EAP	CPT®76830		CHG DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL	BOTH IP/OP	$345.00 	$255.30	$0.00	$280.55	280.55	$280.55	$106.02	$106.02	106.62	71.91	211.68	$211.68	$219.82	$104.44	71.9	$67.89	$204.07	$204.07						$169.61	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
76856	EAP	CPT®76856		ASSAY OF VANCOMYCIN	BOTH IP/OP	$305.00 	$225.70	$0.00	$253.12	253.12	$253.12	$106.02	$106.02	106.62	63.57	212.59	$212.59	$220.76	$104.44	63.56	$67.89	$180.41	$180.41						$169.61	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
76857	EAP	CPT®76857		URINALYSIS WITH MICROSCOPY	BOTH IP/OP	$136.00 	$100.64	$3.17	$208.22	$110.46	$110.46	$106.02	$106.02	$106.62	$28.35	$200.51	$200.51	$208.22	$104.44	$28.34	$67.89	$80.44	$80.44	$3.33	$8.86	$8.71	$8.80	$4.60	$169.61	$4.60	$4.99	$3.17	$3.17	$3.49	$3.17	$0.00	$0.00	$0.00	$0.00
76870	EAP	CPT® 76870		CHG URINALYSIS NONAUTO W/O SCOPE	BOTH IP/OP	$291.00 	$215.34	$0.00	$223.60	156.39	$156.39	$106.02	$106.02	106.62	60.65	215.32	$215.32	$223.60	$104.44	60.64	$67.89	$172.13	$172.13						$169.61	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
76882	EAP	CPT® 76882		URINALYSIS	BOTH IP/OP	$160.00 	$118.40	$0.00	$106.62	$82.24	$82.24	$106.02	$106.02	$106.62	$10.15	$0.00	$0.00	$0.00	$104.44	$0.00	$67.89	$0.00	$0.00	$2.36	$6.28	$6.34	$6.40	$3.26	$104.00	$3.26	$3.55	$2.25	$2.25	$2.48	$2.25	$0.00	$0.00	$0.00	$0.00
76942	EAP	CPT® 76942		URINE PREGNANCY TEST	BOTH IP/OP	$165.00 	$122.10	$0.00	$389.47	137.83	$137.83	$0.00	$0.00	0	34.39	375.04	$375.04	$389.47	$0.00	34.39	$0.00	$97.60	$97.60						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
77063	EAP	CPT® 77063		PREGNANCY TEST-URINE	BOTH IP/OP	$149.00 	$110.26	$6.98	$149.00	$126.56	$126.56	$25.21	$25.21	$46.99	$31.06	$64.15	$64.15	$66.61	$25.21	$31.05	$16.39	$88.13	$88.13	$9.04	$17.68	$23.76	$24.00	$12.48	$149.00	$12.48	$9.97	$8.61	$8.61	$6.98	$8.61	$0.00	$0.00	$0.00	$0.00
77063	EAP	CPT®77063		URINALYSIS VOLUME MEASURE	BOTH IP/OP	$149.00 	$110.26	$0.00	$149.00	126.56	$126.56	$25.21	$25.21	46.99	31.06	64.15	$64.15	$66.61	$25.21	31.05	$16.39	$88.13	$88.13						$149.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
77067	EAP	CPT®77067		"INSERT,IMPLANT CONTRACEPTIVE"	BOTH IP/OP	$366.00 	$270.84	$0.00	$366.00	310.36	$310.36	$99.77	$99.77	113.86	76.28	249.62	$249.62	$259.22	$99.77	76.27	$64.85	$216.49	$216.49						$366.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
77080	EAP	CPT® 77080		"ASPIRATION/INJ.,GANGION CYST"	BOTH IP/OP	$105.00 	$77.70	$0.00	$169.61	93.51	$93.51	$106.02	$106.02	105	21.88	152.48	$152.48	$158.35	$104.44	21.88	$67.89	$62.11	$62.11						$169.61	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
77081	EAP	CPT® 77081		TREAT FRACTURE RADIUS/ULNA	BOTH IP/OP	$88.00 	$65.12	$0.00	$137.87	63.7	$63.70	$78.77	$78.77	79.21	0	48.21	$48.21	$50.07	$0.00	$0.00	$0.00	$0.00	$0.00						$137.87	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
80048	EAP	CPT®80048		G-TUBE INSERTION	BOTH IP/OP	$26.00 	$19.24	$0.00	$17.45	17.45	$17.45	$8.46	$8.46	4.23	4.23	12.85	$12.85	$13.35	$8.46	12.52	$5.50	$15.38	$15.38						$13.96	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
80053	EAP	CPT®80053		#N/A	BOTH IP/OP	$32.00 	$23.68	$0.00	$21.81	21.81	$21.81	$10.56	$10.56	5.28	5.28	16.06	$16.06	$16.68	$10.56	15.61	$6.86	$18.93	$18.93						$17.42	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
80061	EAP	CPT®80061		SIGMOIDOSCOPY W/SUBMUC INJ	BOTH IP/OP	$41.00 	$30.34	$0.00	$27.64	27.64	$27.64	$13.39	$13.39	6.7	6.7	20.35	$20.35	$21.14	$13.39	19.79	$8.70	$24.25	$24.25						$22.09	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
80069	EAP	CPT®80069		#N/A	BOTH IP/OP	$27.00 	$19.98	$0.00	$17.93	17.93	$17.93	$8.68	$8.68	4.34	4.34	13.19	$13.19	$13.69	$8.68	12.83	$5.64	$15.97	$15.97						$14.32	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
80076	EAP	CPT®80076		ECC CERVICAL SCRAPE	BOTH IP/OP	$25.00 	$18.50	$0.00	$16.87	16.87	$16.87	$8.17	$8.17	4.09	4.09	12.41	$12.41	$12.88	$8.17	12.08	$5.31	$14.79	$14.79						$13.48	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
81001	EAP	CPT® 81001		FINGER  3 VIEWS	BOTH IP/OP	$10.00 	$7.40	$0.00	$6.55	6.55	$6.55	$3.17	$3.17	1.59	1.58	4.82	$4.82	$5.00	$3.17	4.68	$2.06	$5.92	$5.92						$5.23	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
81003	EAP	CPT®81003		US PELVIS LTD/FU NON-OB	BOTH IP/OP	$7.00 	$5.18	$0.00	$4.65	4.65	$4.65	$2.25	$2.25	1.13	1.12	3.41	$3.41	$3.54	$2.25	3.33	$1.46	$4.14	$4.14						$3.71	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
81025	EAP	CPT®81025		BASIC METABOLIC PANEL	BOTH IP/OP	$26.00 	$19.24	$0.00	$15.38	13.04	$13.04	$8.61	$8.61	4.31	3.87	9.61	$9.61	$9.98	$8.61	9.36	$5.60	$15.38	$15.38						$14.21	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
82150	EAP	CPT®82150		"RETICULOCYTES, AUTOMATED"	BOTH IP/OP	$20.00 	$14.80	$0.00	$13.38	13.38	$13.38	$6.48	$6.48	3.24	3.24	9.84	$9.84	$10.22	$6.48	9.58	$4.21	$11.83	$11.83						$10.69	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
82274	EAP	CPT® 82274		VFC FLU. VAC. 3-21 YRS	BOTH IP/OP	$48.00 	$35.52	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
82565	EAP	CPT®82565		"NICU/PED/DEVELOP.TESTING,LIMI"	BOTH IP/OP	$16.00 	$11.84	$0.00	$10.59	10.59	$10.59	$5.12	$5.12	2.56	2.56	7.78	$7.78	$8.08	$5.12	7.46	$3.33	$9.46	$9.46						$8.45	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
82947	EAP	CPT®82947		"BLOOD,OCCULT,FECAL HGB,FECES,1-3 SIMULT"	BOTH IP/OP	$12.00 	$8.88	$0.00	$44.80	$8.10	$8.10	$3.93	$3.93	$1.97	$0.00	$5.96	$5.96	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00	$16.72	$44.44	$44.35	$44.80	$23.08	$0.00	$23.08	$27.15	$15.92	$15.92	$19.01	$15.92	$0.00	$0.00	$0.00	$0.00
82977	EAP	CPT®82977		ASSAY OF IONIZED CALCIUM	BOTH IP/OP	$22.00 	$16.28	$0.00	$14.86	14.86	$14.86	$7.20	$7.20	3.6	3.6	10.93	$10.93	$11.35	$7.20	7.46	$4.68	$13.01	$13.01						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
83036	EAP	CPT®83036		ASSAY OF CK (CPK)	BOTH IP/OP	$30.00 	$22.20	$0.00	$20.04	20.04	$20.04	$9.71	$9.71	4.86	4.86	14.74	$14.74	$15.30	$9.71	14.33	$6.31	$17.75	$17.75						$16.02	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
83540	EAP	CPT®83540		CREATINE MB FRACTION	BOTH IP/OP	$20.00 	$14.80	$0.00	$13.36	13.36	$13.36	$6.47	$6.47	3.24	3.24	9.84	$9.84	$10.22	$6.47	9.58	$4.21	$11.83	$11.83						$10.68	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
83615	EAP	CPT®83615		ASSAY OF URINE CREATININE	BOTH IP/OP	$19.00 	$14.06	$0.00	$12.46	12.46	$12.46	$6.04	$6.04	3.02	3.02	9.16	$9.16	$9.51	$6.04	7.46	$3.93	$11.24	$11.24						$9.97	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
83690	EAP	CPT®83690		ASSAY OF FERRITIN	BOTH IP/OP	$21.00 	$15.54	$0.00	$14.23	14.23	$14.23	$6.89	$6.89	3.45	3.44	10.46	$10.46	$10.86	$6.89	10.17	$4.48	$12.42	$12.42						$11.37	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
83721	EAP	CPT®83721		ASSAY OF FOLIC ACID SERUM	BOTH IP/OP	$32.00 	$23.68	$0.00	$19.69	19.69	$19.69	$10.50	$10.50	5.25	4.77	14.49	$14.49	$15.04	$10.50	14.1	$6.83	$18.93	$18.93						$17.33	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
83735	EAP	CPT®83735		BLOOD PH	BOTH IP/OP	$21.00 	$15.54	$0.00	$13.83	13.83	$13.83	$6.70	$6.70	3.35	3.35	10.17	$10.17	$10.56	$6.70	9.89	$4.36	$12.42	$12.42						$11.06	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
84100	EAP	CPT®84100		ASSAY OF HAPTOGLOBIN QUANT	BOTH IP/OP	$15.00 	$11.10	$0.00	$9.79	9.79	$9.79	$4.74	$4.74	2.37	2.37	7.21	$7.21	$7.48	$4.74	7.01	$3.08	$8.87	$8.87						$7.82	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
84132	EAP	CPT®84132		HEMOGLOBIN ELECTROPHORESIS	BOTH IP/OP	$15.00 	$11.10	$0.00	$9.50	9.5	$9.50	$4.76	$4.76	2.38	2.3	6.97	$6.97	$7.24	$4.76	6.79	$3.09	$8.87	$8.87						$7.85	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
84155	EAP	CPT®84155		LACTATE (LD) (LDH) ENZYME	BOTH IP/OP	$12.00 	$8.88	$0.00	$7.58	7.58	$7.58	$3.67	$3.67	1.84	0	5.56	$5.56	$5.78	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
84550	EAP	CPT®84550		ASSAY OF SERUM POTASSIUM	BOTH IP/OP	$14.00 	$10.36	$0.00	$9.32	9.32	$9.32	$4.52	$4.52	2.26	2.26	6.85	$6.85	$7.12	$4.52	6.67	$2.94	$8.28	$8.28						$7.46	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
85018	EAP	CPT®85018		PROTEIN ELECTROPHORESIS SERUM	BOTH IP/OP	$8.00 	$5.92	$0.00	$4.88	4.88	$4.88	$2.37	$2.37	1.19	1.18	3.6	$3.60	$3.74	$2.37	3.5	$1.54	$4.73	$4.73						$3.91	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
85025	EAP	CPT®85025		ASSAY OF URINE SODIUM	BOTH IP/OP	$24.00 	$17.76	$0.00	$16.05	16.05	$16.05	$7.77	$7.77	3.89	3.88	9.97	$9.97	$10.36	$7.77	11.48	$5.05	$14.20	$14.20						$12.82	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
85027	EAP	CPT®85027		ASSAY OF FREE THYROXINE	BOTH IP/OP	$20.00 	$14.80	$0.00	$13.36	13.36	$13.36	$6.47	$6.47	3.24	3.23	9.83	$9.83	$10.21	$6.47	9.57	$4.21	$11.83	$11.83						$10.68	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
85046	EAP	CPT®85046		ASSAY THYROID STIM HORMONE	BOTH IP/OP	$17.00 	$12.58	$0.00	$11.48	11.48	$11.48	$5.57	$5.57	2.79	2.79	8.48	$8.48	$8.80	$5.57	8.24	$3.62	$10.06	$10.06						$9.19	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
85610	EAP	CPT®85610		ASSAY OF BLOOD/URIC ACID	BOTH IP/OP	$13.00 	$9.62	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
87070	EAP	CPT® 87070		THROMBOPLASTIN TIME PARTIAL	BOTH IP/OP	$26.00 	$19.24	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
87210	EAP	CPT®87210		VIRUS ANTIBODY NOS	BOTH IP/OP	$18.00 	$13.32	$0.00	$10.65	8.82	$8.82	$5.82	$5.82	2.91	2.62	6.48	$6.48	$6.73	$5.82	6.3	$3.78	$10.65	$10.65						$9.60	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
87430	EAP	CPT® 87430		Culture Other Specimen Aerobic	BOTH IP/OP	$51.00 	$37.74	$0.00	$24.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.05	$24.06	$23.76	$24.00	$12.50	$0.00	$12.50	$13.56	$8.62	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90460	EAP	CPT® 90460		TISSUE HOMOGENIZATION CULTURE	BOTH IP/OP	$47.00 	$34.78	$0.00	$17.04	0	$0.00	$14.42	$14.42	17.04	0	16.28	$16.28	$16.90	$14.42	9.79	$9.37	$0.00	$0.00						$14.25	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
90461	EAP	CPT® 90461		MICROBE SUSCEPTIBLE MIC	BOTH IP/OP	$36.00 	$26.64	$0.00	$16.90	0	$0.00	$12.98	$12.98	12.86	0	16.28	$16.28	$16.90	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
90471	EAP	CPT®90471		SMEAR GRAM STAIN	BOTH IP/OP	$47.00 	$34.78	$0.00	$39.19	25.52	$25.52	$38.97	$38.97	39.19	9.8	34.88	$34.88	$36.23	$38.34	9.79	$24.92	$27.80	$27.80						$30.55	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
90472	EAP	CPT®90472		SMEAR WET MOUNT SALINE/INK	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75	19.55	$19.55	$0.00	$0.00	0	7.5	26.72	$26.72	$27.75	$0.00	7.5	$0.00	$21.29	$21.29						$23.40	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
90620	EAP	CPT® 90620		CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE	BOTH IP/OP	$30.00 	$22.20	$0.00	$171.96	13.5	$13.50	$0.00	$0.00	171.96	6.25	22.27	$22.27	$23.12	$0.00	30	$0.00	$17.75	$17.75						$13.50	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
90621	EAP	CPT® 90621		IAAD IA STREPTOCOCCUS GROUP A	BOTH IP/OP	$30.00 	$22.20	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$30.00	$0.00	$0.00	$0.00	$17.65	$33.52	$46.73	$47.20	$24.37	$13.50	$24.37	$18.87	$16.81	$16.81	$13.21	$16.81	$0.00	$0.00	$0.00	$0.00
90632	EAP	CPT® 90632		"CHG CYTOPATH FLUIDS,SMEAR,INTERP"	BOTH IP/OP	$30.00 	$22.20	$0.00	$56.67	13.5	$13.50	$0.00	$0.00	0	56.67	22.27	$22.27	$23.12	$0.00	30	$0.00	$17.75	$17.75						$13.50	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
90633	EAP	CPT® 90633		"CHG CYTOPATH, CELL ENHANCE TECH"	BOTH IP/OP	$30.00 	$22.20	$0.00	$23.12	13.5	$13.50	$0.00	$0.00	0	9.4	22.27	$22.27	$23.12	$0.00	6.25	$0.00	$17.75	$17.75						$13.50	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
90636	EAP	CPT® 90636		CYTOPATH C/V THIN LAYER	BOTH IP/OP	$30.00 	$22.20	$0.00	$13.50	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$13.50	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
90647	EAP	CPT® 90647		CYTOPATH FNA MISC	BOTH IP/OP	$30.00 	$22.20	$0.00	$23.12	13.5	$13.50	$0.00	$0.00	0	0	22.27	$22.27	$23.12	$0.00	6.25	$0.00	$0.00	$0.00						$13.50	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
90648	EAP	CPT® 90648		BODY FLUID CELL COUNT	BOTH IP/OP	$30.00 	$22.20	$0.00	$23.12	13.5	$13.50	$0.00	$0.00	0	6.25	22.27	$22.27	$23.12	$0.00	6.25	$0.00	$17.75	$17.75						$13.50	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
90651	EAP	CPT® 90651		IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX	BOTH IP/OP	$30.00 	$22.20	$0.00	$229.60	$13.50	$13.50	$0.00	$0.00	$229.60	$6.25	$22.27	$22.27	$23.12	$0.00	$30.00	$0.00	$17.75	$17.75	$21.90	$10.97	$17.37	$17.54	$14.42	$13.50	$14.42	$7.83	$14.42	$14.42	$0.00	$14.42	$0.00	$0.00	$0.00	$0.00
90658	EAP	CPT®90658		IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT	BOTH IP/OP	$30.00 	$22.20	$0.00	$23.12	$13.50	$13.50	$0.00	$0.00	$15.36	$0.00	$22.27	$22.27	$23.12	$0.00	$0.00	$0.00	$0.00	$0.00	$13.61	$10.97	$17.37	$17.54	$12.98	$0.00	$12.98	$0.00	$12.98	$12.98	$0.00	$12.98	$0.00	$0.00	$0.00	$0.00
90670	EAP	CPT® 90670		"PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID"	BOTH IP/OP	$30.00 	$22.20	$0.00	$230.14	13.5	$13.50	$7.80	$7.80	230.14	6.25	22.27	$22.27	$23.12	$7.80	30	$5.07	$17.75	$17.75						$13.50	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
90674	EAP	CPT® 90674		"IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID"	BOTH IP/OP	$30.00 	$22.20	$5.07	$50.00	$13.50	$13.50	$7.80	$7.80	$29.23	$6.25	$22.27	$22.27	$23.12	$7.80	$30.00	$5.07	$17.75	$17.75	$38.22	$25.00	$39.60	$40.00	$50.00	$13.50	$50.00	$7.83	$14.42	$14.42	$7.96	$36.40	$0.00	$0.00	$0.00	$0.00
90680	EAP	CPT® 90680		"PR IMMUNIZ,ADMIN,EACH ADDL"	BOTH IP/OP	$30.00 	$22.20	$0.00	$23.12	13.5	$13.50	$0.00	$0.00	0	6.25	22.27	$22.27	$23.12	$0.00	6.25	$0.00	$17.75	$17.75						$13.50	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
90681	EAP	CPT® 90681		"IMMUNIZ,ADMIN,EACH ADDL"	BOTH IP/OP	$30.00 	$22.20	$0.00	$119.46	$13.50	$13.50	$0.00	$0.00	$119.46	$6.25	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$22.50	$35.64	$36.00	$0.00	$0.00	$0.00	$7.04	$12.98	$12.98	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00
90685	EAP	CPT® 90685		MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM	BOTH IP/OP	$30.00 	$22.20	$0.00	$200.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$18.00	$0.00	$18.00	$200.63	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
90686	EAP	CPT® 90686		MENB RECOMBINANT LIPOPROTEIN VACCINE IM	BOTH IP/OP	$25.00 	$18.50	$0.00	$163.94	$11.25	$11.25	$6.50	$6.50	$19.58	$5.21	$18.56	$18.56	$19.27	$6.50	$24.12	$4.23	$14.79	$14.79	$0.00	$15.00	$23.76	$24.00	$18.00	$11.25	$18.00	$163.94	$0.00	$0.00	$156.09	$0.00	$0.00	$0.00	$0.00	$0.00
90696	EAP	CPT® 90696		HEPA VACCINE ADULT IM	BOTH IP/OP	$30.00 	$22.20	$0.00	$70.39	$13.50	$13.50	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00	$13.50	$0.00	$70.39	$0.00	$0.00	$67.03	$0.00	$0.00	$0.00	$0.00	$0.00
90698	EAP	CPT® 90698		HEPA VACCINE PED/ADOL-2 DOSE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$19.50	$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
90700	EAP	CPT® 90700		HEPA/HEPB VACCINE ADULT IM	BOTH IP/OP	$30.00 	$22.20	$0.00	$122.20	$13.50	$13.50	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00	$13.50	$0.00	$122.20	$0.00	$0.00	$116.36	$0.00	$0.00	$0.00	$0.00	$0.00
90707	EAP	CPT® 90707		"HIB VACCINE, PRP-OMP, IM"	BOTH IP/OP	$30.00 	$22.20	$0.00	$30.00	$13.50	$13.50	$0.00	$0.00	$0.00	$11.75	$22.27	$22.27	$23.12	$0.00	$30.00	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00	$13.50	$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
90710	EAP	CPT® 90710		"HIB VACCINE, PRP-T, IM"	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$13.50	$13.50	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00	$13.50	$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
90713	EAP	CPT® 90713		HUMAN PAPILLOMA VIRUS NONAVALENT HPV 3 DOSE IM	BOTH IP/OP	$30.00 	$22.20	$0.00	$267.82	$13.50	$13.50	$0.00	$0.00	$0.00	$9.40	$22.27	$22.27	$23.12	$0.00	$30.00	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$18.00	$13.50	$18.00	$267.82	$0.00	$0.00	$255.01	$0.00	$0.00	$0.00	$0.00	$0.00
90715	EAP	CPT® 90715		PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM	BOTH IP/OP	$30.00 	$22.20	$0.00	$252.18	$13.50	$13.50	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$23.12	$0.00	$30.00	$0.00	$17.75	$17.75	$4.38	$15.00	$23.76	$24.00	$4.38	$13.50	$4.38	$252.18	$7.80	$7.80	$240.12	$7.80	$0.00	$0.00	$0.00	$0.00
90716	EAP	CPT® 90716		CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE	BOTH IP/OP	$30.00 	$22.20	$0.00	$136.66	$13.50	$13.50	$0.00	$0.00	$136.66	$9.40	$22.27	$22.27	$23.12	$0.00	$30.00	$0.00	$17.75	$17.75	$4.38	$15.00	$23.76	$24.00	$4.38	$13.50	$4.38	$33.05	$7.80	$7.80	$31.47	$7.80	$0.00	$0.00	$0.00	$0.00
90723	EAP	CPT® 90723		"ROTOVIRUS VACCINE, ORAL"	BOTH IP/OP	$30.00 	$22.20	$0.00	$79.00	$13.50	$13.50	$0.00	$0.00	$79.00	$6.25	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00	$13.50	$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
90732	EAP	CPT® 90732		"ROTOVIRUS VACCINE, HUMAN ATTENUATED, 2 DOSE, ORAL"	BOTH IP/OP	$30.00 	$22.20	$0.00	$119.92	$13.50	$13.50	$7.80	$7.80	$119.92	$9.40	$22.27	$22.27	$23.12	$7.80	$30.00	$5.07	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$18.00	$13.50	$18.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
90734	EAP	CPT® 90734		IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE	BOTH IP/OP	$30.00 	$22.20	$0.00	$129.14	$13.50	$13.50	$0.00	$0.00	$129.14	$9.40	$22.27	$22.27	$23.12	$0.00	$30.00	$0.00	$17.75	$17.75	$0.00	$0.00	$23.76	$0.00	$0.00	$13.50	$0.00	$4.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90744	EAP	CPT® 90744		IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE	BOTH IP/OP	$30.00 	$22.20	$0.00	$28.21	$13.50	$13.50	$7.80	$7.80	$28.21	$0.00	$22.27	$22.27	$23.12	$0.00	$0.00	$0.00	$0.00	$0.00	$3.65	$12.50	$19.80	$20.00	$3.65	$13.50	$3.65	$22.36	$6.50	$6.50	$21.29	$6.50	$0.00	$0.00	$0.00	$0.00
90746	EAP	CPT® 90746		"DTAP-IPV, IM, AGE 4-6 YEAR"	BOTH IP/OP	$227.00 	$167.98	$0.00	$174.97	$102.15	$102.15	$59.02	$59.02	$69.65	$70.16	$168.48	$168.48	$174.97	$59.02	$81.84	$38.36	$134.27	$134.27	$0.00	$15.00	$23.76	$24.00	$0.00	$102.15	$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
90791	EAP	CPT® 90791		"DTAP-HIB-IP VACCINE, IM"	BOTH IP/OP	$494.00 	$365.56	$0.00	$380.78	$268.24	$268.24	$130.30	$130.30	$131.03	$102.96	$366.65	$366.65	$380.78	$128.07	$0.00	$83.25	$292.20	$292.20	$0.00	$15.00	$23.76	$24.00	$0.00	$321.10	$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
90792	EAP	CPT®90792		"DTAP IMMUNIZATION, IM"	BOTH IP/OP	$553.00 	$409.22	$0.00	$426.25	$300.28	$300.28	$130.30	$130.30	$131.03	$115.26	$410.44	$410.44	$426.25	$128.07	$0.00	$83.25	$327.10	$327.10	$0.00	$15.00	$23.76	$24.00	$0.00	$359.45	$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
90832	EAP	CPT® 90832		"COMBINED VACCINE,MMR+VARICELLA,SQ"	BOTH IP/OP	$215.00 	$159.10	$0.00	$165.72	$116.75	$116.75	$130.30	$130.30	$131.03	$44.81	$159.57	$159.57	$165.72	$128.07	$0.00	$83.25	$127.17	$127.17	$0.00	$15.00	$23.76	$24.00	$0.00	$139.75	$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
90832	EAP	CPT®90832		"MMR VIRUS IMMUNIZATION, SUBCUT"	BOTH IP/OP	$215.00 	$159.10	$0.00	$165.72	$116.75	$116.75	$130.30	$130.30	$131.03	$44.81	$159.57	$159.57	$165.72	$128.07	$0.00	$83.25	$127.17	$127.17	$0.00	$15.00	$23.76	$24.00	$0.00	$139.75	$0.00	$92.45	$0.00	$0.00	$88.03	$0.00	$0.00	$0.00	$0.00	$0.00
90834	EAP	CPT®90834		"POLIOMYELITIS IMMUNIZATN,INACTV,SQ"	BOTH IP/OP	$284.00 	$210.16	$0.00	$218.91	$154.21	$154.21	$130.30	$130.30	$131.03	$59.19	$210.78	$210.78	$218.91	$128.07	$0.00	$83.25	$167.99	$167.99	$0.00	$15.00	$23.76	$24.00	$0.00	$184.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90837	EAP	CPT®90837		TDAP VACCINE >7 IM	BOTH IP/OP	$417.00 	$308.58	$0.00	$321.42	$226.43	$226.43	$130.30	$130.30	$131.03	$86.91	$309.50	$309.50	$321.42	$128.07	$0.00	$83.25	$246.66	$246.66	$0.00	$15.00	$23.76	$24.00	$0.00	$271.05	$0.00	$39.53	$0.00	$0.00	$37.64	$0.00	$0.00	$0.00	$0.00	$0.00
91111	EAP	CPT® 91111		"HEP B VACCINE,PED/ADOL,IM"	BOTH IP/OP	"$2,479.00 "	"$1,834.46"	$0.00	"$2,479.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$18.00	"$2,479.00"	$18.00	$4.70	$7.80	$7.80	$0.00	$7.80	$0.00	$0.00	$0.00	$0.00
92250	EAP	CPT®92250		PR PSYCHOTHERAPY W/PATIENT 45 MINUTES	BOTH IP/OP	$105.00 	$77.70	$0.00	$109.81	57.02	$57.02	$109.81	$109.81	105	21.88	77.93	$77.93	$80.93	$107.30	21.88	$69.74	$62.11	$62.11						$68.25	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
92551	EAP	CPT® 92551		PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	BOTH IP/OP	$40.00 	$29.60	$0.00	$30.83	21.72	$21.72	$0.00	$0.00	11.81	8.34	29.69	$29.69	$30.83	$0.00	8.34	$0.00	$23.66	$23.66						$26.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
92552	EAP	CPT® 92552		PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	BOTH IP/OP	$95.00 	$70.30	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
93000	EAP	CPT® 93000		"PR EYE EXAM, EST PATIENT,COMPREHESV"	BOTH IP/OP	$40.00 	$29.60	$0.00	$37.57	37.57	$37.57	$17.30	$17.30	14.92	0	29.69	$29.69	$30.83	$17.30	8.34	$11.25	$0.00	$0.00						$26.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
93015	EAP	CPT® 93015		PR COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE	BOTH IP/OP	$200.00 	$148.00	$0.00	$169.04	169.04	$169.04	$72.09	$72.09	71.62	0	148.44	$148.44	$154.16	$72.09	41.68	$46.86	$0.00	$0.00						$130.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
93225	EAP	CPT®93225		PR FUNDAL PHOTOGRAPHY	BOTH IP/OP	$59.00 	$43.66	$0.00	$109.81	58.71	$58.71	$109.81	$109.81	59	12.3	43.79	$43.79	$45.48	$107.30	12.3	$69.74	$34.90	$34.90						$38.35	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
93227	EAP	CPT®93227		FUNDAL PHOTOGRAPHY	BOTH IP/OP	$56.00 	$41.44	$0.00	$151.93	$56.00	$56.00	$27.05	$27.05	$18.80	$0.00	$0.00	$0.00	$0.00	$0.00	$11.67	$0.00	$0.00	$0.00	$109.35	$80.00	$126.72	$128.00	$151.93	$36.40	$151.93	$59.03	$23.77	$23.77	$25.47	$104.14	$0.00	$0.00	$0.00	$0.00
93242	EAP	CPT®93242		PR SPEECH/HEARING THERAPY	BOTH IP/OP	$43.00 	$31.82	$0.00	$33.14	0	$0.00	$0.00	$0.00	0	0	31.91	$31.91	$33.14	$0.00	8.96	$0.00	$0.00	$0.00						$27.95	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
93244	EAP	CPT®93244		"PURE TONE HEARING TEST, AIR"	BOTH IP/OP	$73.00 	$54.02	$0.00	$47.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.21	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$26.40	$47.45	$26.40	$9.01	$0.00	$0.00	$7.00	$0.00	$0.00	$0.00	$0.00	$0.00
93246	EAP	CPT®93246		"PURE TONE AUDIOMETRY, AIR"	BOTH IP/OP	$43.00 	$31.82	$0.00	$112.00	$0.00	$0.00	$54.21	$54.21	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$109.35	$56.00	$88.70	$89.60	$112.00	$27.95	$112.00	$17.48	$32.05	$32.05	$17.83	$104.14	$0.00	$0.00	$0.00	$0.00
93248	EAP	CPT®93248		PR TYMPANOMETRY	BOTH IP/OP	$81.00 	$59.94	$0.00	$52.65	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	16.88	$0.00	$0.00	$0.00						$52.65	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
93306	EAP	CPT®93306		"PR AUDITORY EVOKED POTENTIAL, LIMITED"	BOTH IP/OP	$566.00 	$418.84	$0.00	$504.77	504.77	$504.77	$470.55	$470.55	473.2	117.97	420.09	$420.09	$436.27	$462.81	117.95	$300.83	$334.79	$334.79						$367.90	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
93880	EAP	CPT® 93880		CV STRS TST XERS&/OR RX CONT ECG W/SI&R	BOTH IP/OP	$116.00 	$85.84	$0.00	$562.53	$116.00	$116.00	$224.08	$224.08	$116.00	$24.18	$541.69	$541.69	$562.53	$220.56	$24.17	$143.36	$68.61	$68.61	$76.29	$126.00	$199.58	$201.60	$72.09	$75.40	$72.09	$110.83	$72.09	$72.09	$0.00	$72.09	$0.00	$0.00	$0.00	$0.00
93926	EAP	CPT® 93926		"PR CARDIAC STRESS TST,TRACING ONLY"	BOTH IP/OP	$381.00 	$281.94	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
93970	EAP	CPT®93970		"PR ECHO HEART XTHORACIC,COMPLETE W DOPPLER"	BOTH IP/OP	$102.00 	$75.48	$0.00	$565.47	102	$102.00	$224.08	$224.08	102	21.26	544.52	$544.52	$565.47	$220.56	21.26	$143.36	$60.33	$60.33						$66.30	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
93971	EAP	CPT®93971		"PR ECHO HEART XTHORACIC,LIMITED"	BOTH IP/OP	$343.00 	$253.82	$0.00	$374.41	266.11	$266.11	$106.02	$106.02	106.62	71.49	360.55	$360.55	$374.41	$104.44	71.48	$67.89	$202.88	$202.88						$222.95	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
94640	EAP	CPT® 94640		DUPLEX LO EXTREM ART UNILAT/LTD	BOTH IP/OP	$32.00 	$23.68	$0.00	$383.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.41	$239.50	$379.37	$383.20	$156.18	$0.00	$156.18	$120.13	$127.86	$127.86	$76.26	$107.06	$0.00	$0.00	$0.00	$0.00
94664	EAP	CPT®94664		"DUPLEX EXTREM VENOUS,BILAT"	BOTH IP/OP	$48.00 	$35.52	$0.00	$556.00	$26.06	$26.06	$183.05	$183.05	$48.00	$10.00	$35.63	$35.63	$37.00	$180.07	$10.00	$117.04	$28.39	$28.39	$233.72	$347.50	$550.44	$556.00	$324.73	$0.00	$324.73	$199.35	$163.16	$163.16	$110.64	$222.60	$0.00	$0.00	$0.00	$0.00
96110	EAP	CPT®96110		"PR POS AIRWAY PRESSURE, CPAP"	BOTH IP/OP	$35.00 	$25.90	$0.00	$26.98	0	$0.00	$0.00	$0.00	10.07	0	25.98	$25.98	$26.98	$0.00	7.29	$0.00	$0.00	$0.00						$22.75	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
96127	EAP	CPT®96127		"PR EXHALED AIR ANALYSIS: O2, CO2"	BOTH IP/OP	$14.00 	$10.36	$0.00	$32.96	0	$0.00	$32.96	$32.96	14	0	$0.00	$0.00	$0.00	$32.43	$0.00	$21.08	$0.00	$0.00						$9.10	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
96161	EAP	CPT® 96161		PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST	BOTH IP/OP	$8.00 	$5.92	$0.00	$25.59	0	$0.00	$25.59	$25.59	8	0	5.94	$5.94	$6.17	$25.14	1.67	$16.34	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
96361	EAP	CPT® 96361		PR DIFFUSING CAPACITY	BOTH IP/OP	$37.00 	$27.38	$0.00	$38.34	0	$0.00	$0.00	$0.00	0	7.71	$0.00	$0.00	$0.00	$38.34	7.71	$24.92	$21.89	$21.89						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
96372	EAP	CPT® 96372		PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND	BOTH IP/OP	$41.00 	$30.34	$0.00	$60.38	22.26	$22.26	$60.38	$60.38	41	8.55	30.43	$30.43	$31.60	$59.39	$0.00	$38.61	$24.25	$24.25						$26.65	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
97802	EAP	CPT® 97802		PR DEBRIDEMENT OPEN WOUND 20 SQ CM<	BOTH IP/OP	$104.00 	$76.96	$0.00	$80.16	56.47	$56.47	$34.61	$34.61	33.05	21.68	77.19	$77.19	$80.16	$34.61	21.67	$22.50	$61.52	$61.52						$67.60	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
97803	EAP	CPT® 97803		"PR ORTHOTIC MGMT AND TRAINING, EACH 15 MIN"	BOTH IP/OP	$90.00 	$66.60	$0.00	$69.37	48.87	$48.87	$29.21	$29.21	28.17	18.76	66.8	$66.80	$69.37	$29.21	18.76	$18.99	$53.24	$53.24						$58.50	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
98966	EAP	CPT® 98966		PR ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN	BOTH IP/OP	$37.00 	$27.38	$0.00	$24.05	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$24.05	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
98967	EAP	CPT® 98967		"MED NUTR THER, 1ST, INDIV, EA 15 MIN"	BOTH IP/OP	$67.00 	$49.58	$0.00	$107.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.55	$67.00	$106.13	$107.20	$34.61	$43.55	$34.61	$20.97	$34.61	$34.61	$21.33	$34.61	$0.00	$0.00	$0.00	$0.00
98968	EAP	CPT® 98968		"MED NUTR THER, SUBSQ, INDIV, EA 15 MIN"	BOTH IP/OP	$95.00 	$70.30	$0.00	$92.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.06	$58.00	$91.87	$92.80	$29.21	$61.75	$29.21	$18.15	$29.21	$29.21	$18.47	$29.21	$0.00	$0.00	$0.00	$0.00
99024	EAP	CPT® 99024		NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN	BOTH IP/OP	$0.01 	$0.01	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99173	EAP	CPT® 99173		NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN	BOTH IP/OP	$11.00 	$8.14	$0.00	$212.80	$0.00	$0.00	$0.00	$0.00	$3.10	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$133.00	$210.67	$212.80	$159.60	$7.15	$159.60	$41.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99202	EAP	CPT® 99202		"VISUAL SCREENING TEST, BILAT"	BOTH IP/OP	$204.00 	$150.96	$0.00	$323.29	$0.00	$0.00	$51.57	$51.57	$49.57	$67.13	$311.31	$311.31	$323.29	$51.57	$0.00	$33.52	$120.67	$120.67	$0.00	$5.50	$8.71	$8.80	$6.60	$204.00	$6.60	$1.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99202	EAP	CPT®99202		POST-OP FOLLOW-UP VISIT	BOTH IP/OP	$204.00 	$150.96	$0.00	$323.29	$0.00	$0.00	$51.57	$51.57	$49.57	$67.13	$311.31	$311.31	$323.29	$51.57	$0.00	$33.52	$120.67	$120.67	$0.00	$0.00	$0.01	$0.00	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99203	EAP	CPT®99203		OFFICE OUTPATIENT NEW 10 MINUTES	BOTH IP/OP	$314.00 	$232.36	$0.00	$323.29	$0.00	$0.00	$77.17	$77.17	$83.89	$67.13	$311.31	$311.31	$323.29	$77.17	$0.00	$50.16	$185.73	$185.73	$28.83	$164.50	$260.57	$263.20	$27.04	$314.00	$27.04	$108.52	$27.04	$27.04	$99.16	$27.04	$0.00	$0.00	$0.00	$0.00
99204	EAP	CPT®99204		OFFICE OUTPATIENT NEW 20 MINUTES	BOTH IP/OP	$467.00 	$345.58	$0.00	$467.00	$0.00	$0.00	$131.98	$131.98	$136.63	$67.13	$311.31	$311.31	$323.29	$131.98	$0.00	$85.79	$276.23	$276.23	$54.20	$189.00	$299.38	$302.40	$51.57	$467.00	$51.57	$108.52	$51.57	$51.57	$99.16	$51.57	$0.00	$0.00	$0.00	$0.00
99205	EAP	CPT®99205		OFFICE OUTPATIENT NEW 30 MINUTES	BOTH IP/OP	$618.00 	$457.32	$0.00	$618.00	$0.00	$0.00	$172.37	$172.37	$185.53	$67.13	$311.31	$311.31	$323.29	$172.37	$0.00	$112.04	$365.55	$365.55	$82.35	$221.00	$350.06	$353.60	$77.17	$618.00	$77.17	$108.52	$77.17	$77.17	$99.16	$77.17	$0.00	$0.00	$0.00	$0.00
99211	EAP	CPT®99211		OFFICE OUTPATIENT NEW 45 MINUTES	BOTH IP/OP	$65.00 	$48.10	$0.00	$455.20	$0.00	$0.00	$9.38	$9.38	$9.03	$67.13	$311.31	$311.31	$323.29	$9.38	$0.00	$6.10	$38.45	$38.45	$138.78	$284.50	$450.65	$455.20	$131.98	$65.00	$131.98	$108.52	$131.98	$131.98	$99.16	$131.98	$0.00	$0.00	$0.00	$0.00
99212	EAP	CPT®99212		OFFICE OUTPATIENT NEW 60 MINUTES	BOTH IP/OP	$159.00 	$117.66	$0.00	$548.80	$0.00	$0.00	$26.32	$26.32	$36.10	$67.13	$311.31	$311.31	$323.29	$26.32	$0.00	$17.11	$94.05	$94.05	$181.26	$343.00	$543.31	$548.80	$172.37	$159.00	$172.37	$108.52	$172.37	$172.37	$99.16	$172.37	$0.00	$0.00	$0.00	$0.00
99213	EAP	CPT®99213		OFFICE OUTPATIENT VISIT 5 MINUTES	BOTH IP/OP	$254.00 	$187.96	$0.00	$323.29	$0.00	$0.00	$52.29	$52.29	$67.67	$67.13	$311.31	$311.31	$323.29	$52.29	$0.00	$33.99	$150.24	$150.24	$9.84	$145.00	$229.68	$232.00	$9.38	$254.00	$9.38	$108.52	$9.38	$9.38	$99.16	$9.38	$0.00	$0.00	$0.00	$0.00
99214	EAP	CPT®99214		OFFICE OUTPATIENT VISIT 10 MINUTES	BOTH IP/OP	$358.00 	$264.92	$0.00	$358.00	$0.00	$0.00	$80.42	$80.42	$99.97	$67.13	$311.31	$311.31	$323.29	$80.42	$0.00	$52.27	$211.76	$211.76	$27.29	$156.50	$247.90	$250.40	$26.32	$358.00	$26.32	$108.52	$26.32	$26.32	$99.16	$26.32	$0.00	$0.00	$0.00	$0.00
99215	EAP	CPT®99215		OFFICE OUTPATIENT VISIT 15 MINUTES	BOTH IP/OP	$505.00 	$373.70	$0.00	$505.00	$0.00	$0.00	$113.60	$113.60	$147.16	$67.13	$311.31	$311.31	$323.29	$113.60	$0.00	$73.84	$298.71	$298.71	$54.93	$199.50	$316.01	$319.20	$52.29	$505.00	$52.29	$108.52	$52.29	$52.29	$99.16	$52.29	$0.00	$0.00	$0.00	$0.00
99242	EAP	CPT®99242		OFFICE OUTPATIENT VISIT 25 MINUTES	BOTH IP/OP	$288.00 	$213.12	$0.00	$392.80	$0.00	$0.00	$0.00	$0.00	$67.99	$0.00	$311.31	$311.31	$323.29	$0.00	$60.02	$0.00	$0.00	$0.00	$84.06	$245.50	$388.87	$392.80	$80.42	$187.20	$80.42	$108.52	$80.42	$80.42	$99.16	$80.42	$0.00	$0.00	$0.00	$0.00
99243	EAP	CPT®99243		PR OFFICE OUTPATIENT VISIT 40 MINUTES	BOTH IP/OP	$436.00 	$322.64	$0.00	$0.00	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
99244	EAP	CPT® 99244		OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN	BOTH IP/OP	$652.00 	$482.48	$0.00	$423.80	$0.00	$0.00	$0.00	$0.00	$152.96	$0.00	$311.31	$311.31	$323.29	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$218.00	$345.31	$348.80	$261.60	$423.80	$261.60	$112.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99381	EAP	CPT® 99381		PR OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN	BOTH IP/OP	$395.00 	$292.30	$0.00	$323.29	0	$0.00	$0.00	$0.00	76.64	0	311.31	$311.31	$323.29	$0.00	82.32	$0.00	$0.00	$0.00						$256.75	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
99382	EAP	CPT® 99382		OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN	BOTH IP/OP	$413.00 	$305.62	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$81.52	$0.00	$311.31	$311.31	$323.29	$0.00	$86.07	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$391.20	$268.45	$391.20	$155.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99383	EAP	CPT® 99383		"PREVENTIVE VISIT,NEW,INFANT < 1 YR"	BOTH IP/OP	$429.00 	$317.46	$0.00	$323.29	$0.00	$0.00	$0.00	$0.00	$86.72	$0.00	$311.31	$311.31	$323.29	$0.00	$89.40	$0.00	$0.00	$0.00	$0.00	$197.50	$312.84	$316.00	$237.00	$278.85	$237.00	$61.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99384	EAP	CPT® 99384		"PREVENTIVE VISIT,NEW,AGE 1-4"	BOTH IP/OP	$485.00 	$358.90	$0.00	$330.40	$0.00	$0.00	$0.00	$0.00	$101.65	$0.00	$311.31	$311.31	$323.29	$0.00	$101.07	$0.00	$0.00	$0.00	$0.00	$206.50	$327.10	$330.40	$247.80	$315.25	$247.80	$64.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99385	EAP	CPT®99385		"PREVENTIVE VISIT,NEW,AGE5-11"	BOTH IP/OP	$469.00 	$347.06	$0.00	$343.20	$0.00	$0.00	$0.00	$0.00	$97.50	$0.00	$311.31	$311.31	$323.29	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$214.50	$339.77	$343.20	$257.40	$304.85	$257.40	$67.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99386	EAP	CPT®99386		"PR PREVENTIVE VISIT,NEW,18-39"	BOTH IP/OP	$545.00 	$403.30	$0.00	$354.25	0	$0.00	$0.00	$0.00	118.64	0	311.31	$311.31	$323.29	$0.00	113.58	$0.00	$0.00	$0.00						$354.25	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
99387	EAP	CPT® 99387		"PR PREVENTIVE VISIT,NEW,40-64"	BOTH IP/OP	$591.00 	$437.34	$0.00	$123.16	0	$0.00	$0.00	$0.00	0	0	$0.00	$0.00	$0.00	$0.00	123.16	$0.00	$0.00	$0.00						$0.00	$0.00			$0.00			$0.00	$0.00	$0.00	$0.00
99391	EAP	CPT® 99391		"PREVENTIVE VISIT,NEW,40-64"	BOTH IP/OP	$354.00 	$261.96	$0.00	$436.00	$0.00	$0.00	$0.00	$0.00	$69.73	$0.00	$311.31	$311.31	$323.29	$0.00	$73.77	$0.00	$0.00	$0.00	$0.00	$272.50	$431.64	$436.00	$327.00	$230.10	$327.00	$84.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99392	EAP	CPT® 99392		"PREVENTIVE VISIT,NEW,65 & OVER"	BOTH IP/OP	$378.00 	$279.72	$0.00	$472.80	$0.00	$0.00	$0.00	$0.00	$76.64	$0.00	$311.31	$311.31	$323.29	$0.00	$78.78	$0.00	$0.00	$0.00	$0.00	$295.50	$468.07	$472.80	$0.00	$245.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99393	EAP	CPT® 99393		"PREVENTIVE VISIT,EST, INFANT < 1 YR"	BOTH IP/OP	$377.00 	$278.98	$0.00	$323.29	$0.00	$0.00	$0.00	$0.00	$76.64	$0.00	$311.31	$311.31	$323.29	$0.00	$78.57	$0.00	$0.00	$0.00	$0.00	$177.00	$280.37	$283.20	$212.40	$245.05	$212.40	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99394	EAP	CPT® 99394		"PREVENTIVE VISIT,EST,AGE 1-4"	BOTH IP/OP	$414.00 	$306.36	$0.00	$323.29	$0.00	$0.00	$0.00	$0.00	$86.72	$0.00	$311.31	$311.31	$323.29	$0.00	$86.28	$0.00	$0.00	$0.00	$0.00	$189.00	$299.38	$302.40	$226.80	$269.10	$226.80	$59.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99395	EAP	CPT® 99395		"PREVENTIVE VISIT,EST,AGE5-11"	BOTH IP/OP	$423.00 	$313.02	$0.00	$323.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.31	$311.31	$323.29	$0.00	$88.15	$0.00	$0.00	$0.00	$0.00	$188.50	$298.58	$301.60	$226.20	$274.95	$226.20	$59.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99396	EAP	CPT® 99396		"PREVENTIVE VISIT,EST,12-17"	BOTH IP/OP	$450.00 	$333.00	$0.00	$331.20	$0.00	$0.00	$0.00	$0.00	$96.80	$0.00	$311.31	$311.31	$323.29	$0.00	$93.78	$0.00	$0.00	$0.00	$0.00	$207.00	$327.89	$331.20	$248.40	$292.50	$248.40	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99397	EAP	CPT®99397		"PREVENTIVE VISIT,EST,18-39"	BOTH IP/OP	$486.00 	$359.64	$0.00	$338.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.31	$311.31	$323.29	$0.00	$101.28	$0.00	$0.00	$0.00	$0.00	$211.50	$335.02	$338.40	$253.80	$315.90	$253.80	$84.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99406	EAP	CPT® 99406		"PREVENTIVE VISIT,EST,40-64"	BOTH IP/OP	$43.00 	$31.82	$0.00	$360.00	$0.00	$0.00	$25.59	$25.59	$0.00	$0.00	$311.31	$311.31	$323.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.00	$356.40	$360.00	$270.00	$27.95	$270.00	$84.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99441	EAP	CPT® 99441		TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES	BOTH IP/OP	$157.00 	$116.18	$0.00	$102.05	$0.00	$0.00	$0.00	$0.00	$36.10	$0.00	$0.00	$0.00	$0.00	$0.00	$32.72	$0.00	$0.00	$0.00	$0.00	$27.00	$42.77	$43.20	$0.00	$102.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99442	EAP	CPT® 99442		PHYS/QHP TELEPHONE EVALUATION 5-10 MIN	BOTH IP/OP	$253.00 	$187.22	$0.00	$164.45	$0.00	$0.00	$0.00	$0.00	$67.98	$0.00	$0.00	$0.00	$0.00	$0.00	$52.73	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$96.60	$164.45	$96.60	$25.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99443	EAP	CPT® 99443		PHYS/QHP TELEPHONE EVALUATION 11-20 MIN	BOTH IP/OP	$358.00 	$264.92	$0.00	$232.70	$0.00	$0.00	$0.00	$0.00	$100.28	$0.00	$0.00	$0.00	$0.00	$0.00	$74.61	$0.00	$0.00	$0.00	$0.00	$133.00	$210.67	$212.80	$159.60	$232.70	$159.60	$41.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99495	EAP	CPT® 99495		PHYS/QHP TELEPHONE EVALUATION 21-30 MIN	BOTH IP/OP	$576.00 	$426.24	$0.00	$576.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$120.04	$73.97	$340.70	$340.70	$0.00	$193.00	$305.71	$308.80	$231.60	$576.00	$231.60	$60.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99496	EAP	CPT® 99496		TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE	BOTH IP/OP	$777.00 	$574.98	$0.00	$777.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.27	$328.00	$519.55	$524.80	$161.54	$777.00	$161.54	$102.66	$125.50	$125.50	$104.44	$110.73	$0.00	$0.00	$0.00	$0.00
99497	EAP	CPT®99497		TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE	BOTH IP/OP	$236.00 	$174.64	$0.00	$693.60	$0.00	$0.00	$72.87	$72.87	$73.28	$67.13	$311.31	$311.31	$323.29	$71.76	$49.18	$46.64	$139.59	$139.59	$116.27	$433.50	$686.66	$693.60	$161.54	$236.00	$161.54	$135.69	$165.53	$165.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10932085	EAP	HCPCS C1729		Catheter Urethral 8fr Foley 2 Way Latex Dover Silicone	BOTH IP/OP	$107.00 	$79.18	$0.00	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.50	$84.74	$85.60	$0.00	$0.00	$0.00	$16.75	$0.00	$0.00	$17.03	$0.00	$0.00	$0.00	$0.00	$0.00
10933190	EAP	HCPCS C1729		Catheter Urethral 18fr Foley 2 Way Medium Olive Coude Tip 1	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.00	$20.59	$20.80	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$4.14	$0.00	$0.00	$0.00	$0.00	$0.00
10945160	EAP	HCPCS C1751		Catheter Umb 3.5fr 15in .15ml Clr Strl Lf Arg 1 Lum Ll Hub	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$5.32	$0.00	$0.00	$5.41	$0.00	$0.00	$0.00	$0.00	$0.00
10945178	EAP	HCPCS C1751		Cap Tube 13mm Blu Eztpr Dbl Flng Sl Thb Tab Pe	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$5.32	$0.00	$0.00	$5.41	$0.00	$0.00	$0.00	$0.00	$0.00
10945194	EAP	HCPCS C1729		System Drn 35cm 700ml Blu Strl Lf Be2 Mntr Trndcr Atch Vntrc	BOTH IP/OP	$742.00 	$549.08	$0.00	"$1,045.60"	$402.91	$402.91	$0.00	$0.00	$0.00	$154.65	$550.71	$550.71	$571.93	$0.00	$154.63	$0.00	$438.89	$438.89	$0.00	$653.50	"$1,035.14"	"$1,045.60"	$0.00	$482.30	$0.00	$204.55	$0.00	$0.00	$208.07	$0.00	$0.00	$0.00	$0.00	$0.00
10961170	EAP	HCPCS C1751		Kit Arterial Line .018in 20ga 22ga 1.75in Catheter Radiopq	BOTH IP/OP	$38.00 	$28.12	$0.00	$45.60	$20.63	$20.63	$0.00	$0.00	$0.00	$7.92	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$22.48	$22.48	$0.00	$28.50	$45.14	$45.60	$0.00	$24.70	$0.00	$8.92	$0.00	$0.00	$9.07	$0.00	$0.00	$0.00	$0.00	$0.00
11100001	EAP	Custom 11100001		HB MED-SUR-GY/PVT	BOTH IP/OP	"$3,058.00 "	"$2,262.92"	$0.00	"$2,135.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11100003	EAP	Custom 11100003		Tele Private Med Surg	BOTH IP/OP	"$3,378.00 "	"$2,499.72"	$0.00	"$2,358.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,358.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11100021	EAP	Custom 11100021		HB  PVT GYN	BOTH IP/OP	"$3,058.00 "	"$2,262.92"	$0.00	"$2,135.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11100023	EAP	Custom 11100023		Tele Private  Gyn	BOTH IP/OP	"$3,378.00 "	"$2,499.72"	$0.00	"$2,358.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,358.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11100501	EAP	Custom 11100501		Trauma Private Med Surg	BOTH IP/OP	"$3,398.00 "	"$2,514.52"	$0.00	"$2,372.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,372.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11100503	EAP	Custom 11100503		Trauma Tele Private Med Surg	BOTH IP/OP	"$3,718.00 "	"$2,751.32"	$0.00	"$2,596.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,596.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11100521	EAP	Custom 11100521		Trauma Private  Gyn	BOTH IP/OP	"$3,398.00 "	"$2,514.52"	$0.00	"$2,372.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,372.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11100523	EAP	Custom 11100523		Trauma Tele Private  Gyn	BOTH IP/OP	"$3,718.00 "	"$2,751.32"	$0.00	"$2,596.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,596.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11200001	EAP	Custom 11200001		Private Ob	BOTH IP/OP	"$3,218.00 "	"$2,381.32"	$0.00	"$2,247.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11200002	EAP	Custom 11200002		Tele Private Ob	BOTH IP/OP	"$3,533.00 "	"$2,614.42"	$0.00	"$2,467.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,467.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11200501	EAP	Custom 11200501		Trauma Private Ob	BOTH IP/OP	"$3,559.00 "	"$2,633.66"	$0.00	"$2,485.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,485.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11200502	EAP	Custom 11200502		Trauma Tele Private Ob	BOTH IP/OP	"$3,873.00 "	"$2,866.02"	$0.00	"$2,704.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,704.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11400002	EAP	Custom 11400002		Private Psy	BOTH IP/OP	"$2,837.00 "	"$2,099.38"	$0.00	"$1,980.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,980.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11400502	EAP	Custom 11400502		Trauma Private Psy	BOTH IP/OP	"$3,177.00 "	"$2,350.98"	$0.00	"$2,218.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,218.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11500001	EAP	Custom 11500001		Inpatient Hospice	BOTH IP/OP	"$3,065.00 "	"$2,268.10"	$0.00	"$2,139.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,139.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11500501	EAP	Custom 11500501		TRAUMA INPATIENT HOSPICE	BOTH IP/OP	"$3,176.00 "	"$2,350.24"	$0.00	"$2,217.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12100001	EAP	Custom 12100001		Semiprivate Medsurg	BOTH IP/OP	"$2,166.00 "	"$1,602.84"	$0.00	"$1,512.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,512.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12100003	EAP	Custom 12100003		Tele Semiprivate	BOTH IP/OP	"$2,550.00 "	"$1,887.00"	$0.00	"$1,780.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,780.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12100021	EAP	Custom 12100021		Semiprivate Gyn	BOTH IP/OP	"$2,166.00 "	"$1,602.84"	$0.00	"$1,512.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,512.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12100023	EAP	Custom 12100023		Tele Semiprivate Gyn	BOTH IP/OP	"$2,550.00 "	"$1,887.00"	$0.00	"$1,780.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,780.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12100501	EAP	Custom 12100501		Trauma Semiprivate Medsurg	BOTH IP/OP	"$2,507.00 "	"$1,855.18"	$0.00	"$1,750.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,750.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12100503	EAP	Custom 12100503		Trauma Tele Semiprivate	BOTH IP/OP	"$2,890.00 "	"$2,138.60"	$0.00	"$2,018.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12100521	EAP	Custom 12100521		Trauma Semiprivate Gyn	BOTH IP/OP	"$2,507.00 "	"$1,855.18"	$0.00	"$1,750.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,750.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12100523	EAP	Custom 12100523		Trauma Tele Semiprivate Gyn	BOTH IP/OP	"$2,890.00 "	"$2,138.60"	$0.00	"$2,018.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12200001	EAP	Custom 12200001		Semiprivate Ob	BOTH IP/OP	"$2,359.00 "	"$1,745.66"	$0.00	"$1,647.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,647.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12200002	EAP	Custom 12200002		Tele Semiprivate Ob	BOTH IP/OP	"$2,391.00 "	"$1,769.34"	$0.00	"$1,669.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12200501	EAP	Custom 12200501		Trauma Semiprivate Ob	BOTH IP/OP	"$2,700.00 "	"$1,998.00"	$0.00	"$1,884.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,884.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12200502	EAP	Custom 12200502		Trauma Tele Semiprivate Ob	BOTH IP/OP	"$2,732.00 "	"$2,021.68"	$0.00	"$1,907.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,907.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12400002	EAP	Custom 12400002		Semiprivate Psych	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$1,833.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,833.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12400502	EAP	Custom 12400502		Trauma Semiprivate Psych	BOTH IP/OP	"$2,966.00 "	"$2,194.84"	$0.00	"$2,071.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,071.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400001	EAP	Custom 16400001		Tele.isolation	BOTH IP/OP	"$3,488.00 "	"$2,581.12"	$0.00	"$2,435.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,435.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400002	EAP	Custom 16400002		Isolation Med Surg	BOTH IP/OP	"$3,362.00 "	"$2,487.88"	$0.00	"$2,347.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,347.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400004	EAP	Custom 16400004		Isolation Med Surg	BOTH IP/OP	"$3,362.00 "	"$2,487.88"	$0.00	"$2,347.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,347.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400005	EAP	Custom 16400005		Isolation Ob	BOTH IP/OP	"$3,563.00 "	"$2,636.62"	$0.00	"$2,488.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,488.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400006	EAP	Custom 16400006		Tele.isolation Ob	BOTH IP/OP	"$3,581.00 "	"$2,649.94"	$0.00	"$2,500.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,500.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400007	EAP	Custom 16400007		Isolation High-risk Scu	BOTH IP/OP	"$3,953.00 "	"$2,925.22"	$0.00	"$2,760.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,760.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400022	EAP	Custom 16400022		Isolation  Gyn	BOTH IP/OP	"$3,362.00 "	"$2,487.88"	$0.00	"$2,347.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,347.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400501	EAP	Custom 16400501		Trauma Tele.isolation	BOTH IP/OP	"$3,828.00 "	"$2,832.72"	$0.00	"$2,673.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,673.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400502	EAP	Custom 16400502		Trauma Isolation Med Surg	BOTH IP/OP	"$3,702.00 "	"$2,739.48"	$0.00	"$2,585.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400504	EAP	Custom 16400504		Trauma Isolation Med Surg	BOTH IP/OP	"$3,702.00 "	"$2,739.48"	$0.00	"$2,585.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400505	EAP	Custom 16400505		Trauma Isolation Ob	BOTH IP/OP	"$3,904.00 "	"$2,888.96"	$0.00	"$2,726.06"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,726.06"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400506	EAP			Trauma Tele.isolation Ob	BOTH IP/OP	"$3,457.00 "	"$2,558.18"	$0.00	"$2,737.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,737.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400507	EAP	Custom 16400507		Trauma Isolation High-risk Scu	BOTH IP/OP	"$4,293.00 "	"$3,176.82"	$0.00	"$2,997.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,997.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16400522	EAP	Custom 16400522		Trauma Isolation  Gyn	BOTH IP/OP	"$3,702.00 "	"$2,739.48"	$0.00	"$2,585.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17000001	EAP	Custom 17000001		General Nursery	BOTH IP/OP	$849.00 	$628.26	$0.00	$592.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$592.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17100001	EAP	Custom 17100001		NURSERY/LEVEL I	BOTH IP/OP	"$1,331.00 "	$984.94	$0.00	$812.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$812.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17100002	EAP	Custom 17100002		Nursery Level I	BOTH IP/OP	"$1,331.00 "	$984.94	$0.00	$812.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$812.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200002	EAP	Custom 17200002		Nursery Level Ii	BOTH IP/OP	"$3,458.00 "	"$2,558.92"	$0.00	"$2,414.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,414.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17300001	EAP	Custom 17300001		Nursery Level Iii	BOTH IP/OP	"$5,760.00 "	"$4,262.40"	$0.00	"$4,021.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,021.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17400001	EAP	Custom 17400001		Nursery/level Iv	BOTH IP/OP	"$6,717.00 "	"$4,970.58"	$0.00	"$4,690.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,690.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18000010	EAP	Custom 18000010		Leave Of Absence	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19818887	EAP	HCPCS A6197		Dressing Wound Square 6x6in 2 Layer Absorbent Nonwoven Soft	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$42.39	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$28.00	$44.35	$44.80	$0.00	$35.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19979858	EAP	HCPCS C1729		Kit Pressure Monitr Transducer Tipped Catheter Drill Bit	BOTH IP/OP	"$2,403.00 "	"$1,778.22"	$0.00	"$1,922.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,201.50"	"$1,903.18"	"$1,922.40"	$0.00	$0.00	$0.00	$376.07	$0.00	$0.00	$382.56	$0.00	$0.00	$0.00	$0.00	$0.00
19988898	EAP	Custom 19988898		Catheter Pressure 3.5mm 5mm 82cm 2cm Sensor Tip External	BOTH IP/OP	$58.00 	$42.92	$0.00	$46.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.05	$43.05	$44.71	$0.00	$12.09	$0.00	$0.00	$0.00	$0.00	$29.00	$45.94	$46.40	$0.00	$37.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19993849	EAP	HCPCS C1751		Kit Arterial Line .018in 20ga 22ga 1.75in Catheter Radiopq	BOTH IP/OP	$29.00 	$21.46	$0.00	$23.20	$15.75	$15.75	$0.00	$0.00	$0.00	$6.04	$21.52	$21.52	$22.35	$0.00	$6.04	$0.00	$17.15	$17.15	$0.00	$14.50	$22.97	$23.20	$0.00	$18.85	$0.00	$4.54	$0.00	$0.00	$4.62	$0.00	$0.00	$0.00	$0.00	$0.00
19993898	EAP	HCPCS C1729		Tray Catheterization 16fr Foley Antireflux Evident Seal	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$14.12	$14.12	$0.00	$0.00	$0.00	$5.42	$19.30	$19.30	$20.04	$0.00	$5.42	$0.00	$15.38	$15.38	$0.00	$13.00	$20.59	$20.80	$0.00	$16.90	$0.00	$4.07	$0.00	$0.00	$4.14	$0.00	$0.00	$0.00	$0.00	$0.00
19994800	EAP	Custom 19994800		Kit Crntmy 25ga 5/8in Strl Rzr Ndl Drp	BOTH IP/OP	$701.00 	$518.74	$0.00	"$1,652.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$520.28	$520.28	$540.33	$0.00	$146.09	$0.00	$0.00	$0.00	$0.00	"$1,032.50"	"$1,635.48"	"$1,652.00"	$0.00	$455.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20000001	EAP	Custom 20000001		Intensive Care Icu Ob	BOTH IP/OP	"$6,502.00 "	"$4,811.48"	$0.00	"$4,539.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,539.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20000501	EAP	Custom 20000501		Trauma Intensive Care Icu Ob	BOTH IP/OP	"$6,842.00 "	"$5,063.08"	$0.00	"$4,777.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,777.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20100001	EAP	Custom 20100001		Intensive Care Icu Surgical	BOTH IP/OP	"$6,502.00 "	"$4,811.48"	$0.00	"$4,539.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,539.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20100501	EAP	Custom 20100501		Trauma Intensive Care Icu Surgical	BOTH IP/OP	"$6,875.00 "	"$5,087.50"	$0.00	"$4,777.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,777.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20200001	EAP	Custom 20200001		Intensive Care Icu Medical	BOTH IP/OP	"$6,502.00 "	"$4,811.48"	$0.00	"$4,539.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,539.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20200501	EAP	Custom 20200501		Trauma Intensive Care Icu Medical	BOTH IP/OP	"$6,875.00 "	"$5,087.50"	$0.00	"$4,777.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,777.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20600001	EAP	Custom 20600001		Intermediate Care	BOTH IP/OP	"$4,007.00 "	"$2,965.18"	$0.00	"$2,782.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,782.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20600002	EAP	Custom 20600002		Intermediate Care Burn	BOTH IP/OP	"$9,266.00 "	"$6,856.84"	$0.00	"$6,450.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,450.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20600005	EAP	Custom 20600005		Intermediate Care	BOTH IP/OP	"$4,007.00 "	"$2,965.18"	$0.00	"$2,782.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,782.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20600501	EAP	Custom 20600501		Trauma Intermediate Care	BOTH IP/OP	"$4,708.00 "	"$3,483.92"	$0.00	"$3,019.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,019.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20600502	EAP	Custom 20600502		Trauma Intermediate Care Burn	BOTH IP/OP	"$9,580.00 "	"$7,089.20"	$0.00	"$6,688.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,688.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20700001	EAP	Custom 20700001		Intensive Care Icu Burn	BOTH IP/OP	"$10,118.00 "	"$7,487.32"	$0.00	"$7,036.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,036.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20700501	EAP	Custom 20700501		Trauma Intensive Care Icu Burn	BOTH IP/OP	"$10,421.00 "	"$7,711.54"	$0.00	"$7,273.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,273.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21000001	EAP	Custom 21000001		Intensive Care Icu Medical	BOTH IP/OP	"$6,502.00 "	"$4,811.48"	$0.00	"$4,539.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,539.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21400005	EAP			Intermediate Coronary Care Unit	BOTH IP/OP	"$4,793.00 "	"$3,546.82"	$0.00	"$3,318.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,318.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21400505	EAP	Custom 21400505		Trauma Intermediate Coronary Care Unit	BOTH IP/OP	"$5,219.00 "	"$3,862.06"	$0.00	"$3,556.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,556.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21900001	EAP	Custom 21900001		Intermediate Care	BOTH IP/OP	"$3,741.00 "	"$2,768.34"	$0.00	"$2,782.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,782.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000134	EAP	Custom 25000134		Rocephin 250mg	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000141	EAP	Custom 25000141		Toradol 30 Mg	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.46	$27.46	$28.52	$0.00	$7.71	$0.00	$0.00	$0.00	$0.00	$18.50	$29.30	$29.60	$0.00	$24.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000153	EAP	Custom 25000153		"Rocephin 250mg, Im"	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$38.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000157	EAP	Custom 25000157		Depoprovera 150mg	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$138.74	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00	$117.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000169	EAP	Custom 25000169		Vit B 12 100mcg	BOTH IP/OP	$46.00 	$34.04	$0.00	$36.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.14	$34.14	$35.46	$0.00	$9.59	$0.00	$0.00	$0.00	$0.00	$23.00	$36.43	$36.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000182	EAP	Custom 25000182		Rocephin Injection	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$38.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000187	EAP	Custom 25000187		Rocephin 250mg	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$15.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000189	EAP	Custom 25000189		Bicillin Injection	BOTH IP/OP	$44.00 	$32.56	$0.00	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.66	$32.66	$33.92	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$0.00	$28.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000224	EAP	Custom 25000224		Rocephin 250mg (cef	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000226	EAP	Custom 25000226		Depo Provera Inject	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$131.81	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00	$111.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000227	EAP	Custom 25000227		Oral Contraceptives	BOTH IP/OP	$13.00 	$9.62	$0.00	$10.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.71	$0.00	$0.00	$0.00	$0.00	$6.50	$10.30	$10.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000229	EAP	Custom 25000229		Plan B	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$25.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000230	EAP	Custom 25000230		Evra Transdermal Pa	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000327	EAP	Custom 25000327		Oral Contraceptives	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00	$7.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000908	EAP	Custom 25000908		Evra Trandermal Pat	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000960	EAP	Custom 25000960		Hetastarch (hespan)	BOTH IP/OP	$435.00 	$321.90	$0.00	$348.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$322.86	$322.86	$335.30	$0.00	$90.65	$0.00	$0.00	$0.00	$0.00	$217.50	$344.52	$348.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000961	EAP	Custom 25000961		Hetastarch	BOTH IP/OP	$435.00 	$321.90	$0.00	$348.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$322.86	$322.86	$335.30	$0.00	$90.65	$0.00	$0.00	$0.00	$0.00	$217.50	$344.52	$348.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000966	EAP	Custom 25000966		"Rocephin 250mg, 1gm"	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25000990	EAP	Custom 25000990		Nitric Oxide (per Hr)	BOTH IP/OP	$789.00 	$583.86	$0.00	$631.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$585.60	$585.60	$608.16	$0.00	$164.43	$0.00	$0.00	$0.00	$0.00	$394.50	$624.89	$631.20	$0.00	$512.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25002130	EAP	Custom 25002130		Zithromax	BOTH IP/OP	$24.00 	$17.76	$0.00	$19.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.81	$17.81	$18.50	$0.00	$5.00	$0.00	$0.00	$0.00	$0.00	$12.00	$19.01	$19.20	$0.00	$15.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25500016	EAP	HCPCS Q9965		Locm 150-199mg/ml I	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$0.00	$0.00	$1.05	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25500039	EAP	HCPCS Q9965		Locm 150-199mg/ml I	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$0.00	$0.00	$1.05	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800010	EAP	Custom 25800010		Solutions Sodium Ch	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800013	EAP	Custom 25800013		Solution Iv D 5% In	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800016	EAP	Custom 25800016		Solution Iv Lactate	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800017	EAP	Custom 25800017		Solution Iv Nacl 0.	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800018	EAP	Custom 25800018		Solution Iv Nacl 0.	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800019	EAP	Custom 25800019		Solution Iv Nacl 0.	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800020	EAP	Custom 25800020		Solution Iv Nacl 0.	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800031	EAP	Custom 25800031		Solution Iv D 5% In	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800033	EAP	Custom 25800033		Solution Iv Lactate	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800034	EAP	Custom 25800034		Solution Iv Nacl 0.	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800037	EAP	Custom 25800037		Solution Iv Nacl 0.	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800038	EAP	Custom 25800038		Solution Iv Nacl 0.	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800039	EAP	Custom 25800039		Solution Iv Nacl 0.	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800060	EAP	Custom 25800060		Iv Fluids	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.27	$45.27	$47.02	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$39.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800061	EAP	Custom 25800061		Iv Fluids	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.27	$45.27	$47.02	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800062	EAP	Custom 25800062		I.v. Fluids 500ml	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800063	EAP	Custom 25800063		I.v. Fluid 100ml	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800080	EAP	Custom 25800080		Iv Fluids 1000ml	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800095	EAP	Custom 25800095		Solution Iv Water For Irr	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800260	EAP	Custom 25800260		Iv Fluid 500ml	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800262	EAP	Custom 25800262		Solutions  Advantage Glou	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800263	EAP	Custom 25800263		Solution Irrigation Water 150	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800264	EAP	Custom 25800264		Solutions Iv Water For Inject	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800265	EAP	Custom 25800265		Solutions Sodium Chloride	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.46	$27.46	$28.52	$0.00	$7.71	$0.00	$0.00	$0.00	$0.00	$18.50	$29.30	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800267	EAP	Custom 25800267		"Iv Fluids, 100cc"	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800268	EAP	Custom 25800268		"Iv Fluids, 500cc"	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800269	EAP	Custom 25800269		"Iv Fluids, 1000cc"	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800274	EAP	Custom 25800274		Solution Iv Nacl 0.9% Gla	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800277	EAP	Custom 25800277		Solution Iv Nacl 0.9% 50m	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800278	EAP	Custom 25800278		"Iv Fluids, 50cc"	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800401	EAP	Custom 25800401		I.v. Fluids	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800402	EAP	Custom 25800402		I.v. Fluids 1000cc	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800403	EAP	Custom 25800403		I.v. Fluids 500ml	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800404	EAP	Custom 25800404		Iv Fluid 1000cc	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800405	EAP	Custom 25800405		"Iv Fluid, # Bags"	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.27	$45.27	$47.02	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$39.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800406	EAP	Custom 25800406		"Iv Fluid, #bags"	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.27	$45.27	$47.02	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800407	EAP	Custom 25800407		Iv Fluids 1000ml	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800408	EAP	Custom 25800408		Iv Fluids 500cc	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800409	EAP	Custom 25800409		Iv Fluids 50cc	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800410	EAP	Custom 25800410		Iv Fluids-500ml	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800411	EAP	Custom 25800411		Solution Intravenous Viaflex Latex Free Plasma-lyte A	BOTH IP/OP	$29.00 	$21.46	$0.00	$23.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.52	$21.52	$22.35	$0.00	$6.04	$0.00	$0.00	$0.00	$0.00	$14.50	$22.97	$23.20	$0.00	$18.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25800412	EAP	Custom 25800412		Solution Irr 0.9% Na Chlor Urmtc 3l Strl Lf	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25900227	EAP	Custom 25900227		Oral Contraceptives	BOTH IP/OP	$12.00 	$8.88	$0.00	$9.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.91	$8.91	$9.25	$0.00	$2.50	$0.00	$0.00	$0.00	$0.00	$6.00	$9.50	$9.60	$0.00	$7.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25900255	EAP	Custom 25900255		Insulin 5 Units	BOTH IP/OP	$4.00 	$2.96	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.97	$2.97	$3.08	$0.00	$0.83	$0.00	$0.00	$0.00	$0.00	$2.00	$3.17	$3.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26000001	EAP	CPT® 96360		Iv Hydra Initial (31 Min To 1 Hr)	BOTH IP/OP	"$1,030.00 "	$762.20	$34.59	$793.92	$559.29	$559.29	$199.22	$199.22	$200.34	$214.68	$764.47	$764.47	$793.92	$195.04	$214.65	$126.78	$609.25	$609.25	$184.28	$440.50	$697.75	$704.80	$256.03	$669.50	$256.03	$53.93	$34.59	$34.59	$140.26	$175.50	$0.00	$0.00	$0.00	$0.00
26000003	EAP	CPT® 96361		Iv Hydra Add'l (31 Min To 1 Hr)	BOTH IP/OP	$347.00 	$256.78	$13.69	$267.47	$188.42	$188.42	$38.97	$38.97	$39.19	$72.32	$257.54	$257.54	$267.47	$38.34	$72.31	$24.92	$205.25	$205.25	$38.22	$148.00	$234.43	$236.80	$53.10	$225.55	$53.10	$15.67	$13.69	$13.69	$47.12	$36.40	$0.00	$0.00	$0.00	$0.00
26000005	EAP	CPT® 96365		"Iv Infus Ther,prophylax,dx Initial (16 Min To 1 Hr)"	BOTH IP/OP	"$1,796.00 "	"$1,329.04"	$65.68	"$1,384.36"	$975.23	$975.23	$199.22	$199.22	$200.34	$374.33	"$1,332.99"	"$1,332.99"	"$1,384.36"	$195.04	$374.29	$126.78	"$1,062.33"	"$1,062.33"	$184.28	$769.00	"$1,218.10"	"$1,230.40"	$256.03	"$1,167.40"	$256.03	$65.68	$72.05	$72.05	$244.85	$175.50	$0.00	$0.00	$0.00	$0.00
26000006	EAP	CPT® 96366		"Iv Infus Ther,prophylax,dx Add'l (31 Min To 1 Hr)"	BOTH IP/OP	$347.00 	$256.78	$20.85	$267.47	$188.42	$188.42	$38.97	$38.97	$39.19	$72.32	$257.54	$257.54	$267.47	$38.34	$72.31	$24.92	$205.25	$205.25	$38.22	$148.00	$234.43	$236.80	$53.10	$225.55	$53.10	$20.85	$21.98	$21.98	$47.12	$36.40	$0.00	$0.00	$0.00	$0.00
26000007	EAP	CPT® 96367		"Iv Infus Ther,prophylax,dx Add'l New Med (31 Min To 1 Hr)"	BOTH IP/OP	$523.00 	$387.02	$31.35	$403.13	$283.99	$283.99	$60.38	$60.38	$60.72	$109.01	$388.17	$388.17	$403.13	$59.39	$108.99	$38.61	$309.35	$309.35	$60.65	$223.50	$354.02	$357.60	$84.26	$339.95	$84.26	$32.97	$31.35	$31.35	$71.16	$57.76	$0.00	$0.00	$0.00	$0.00
26000008	EAP	CPT® 96368		"Iv Infus Ther,prophylax,dx Add'l Concur (31 Min To 1 Hr)"	BOTH IP/OP	$630.00 	$466.20	$0.00	$485.60	$342.09	$342.09	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$485.60	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$245.00	$388.08	$392.00	$0.00	$480.35	$0.00	$19.47	$21.26	$21.26	$78.01	$0.00	$0.00	$0.00	$0.00	$0.00
26000111	EAP	CPT® 96374		"Iv Push - Ther,prophylax,dx 1st Med"	BOTH IP/OP	$630.00 	$466.20	$39.99	$485.60	$342.09	$342.09	$199.22	$199.22	$200.34	$131.31	$467.59	$467.59	$485.60	$195.04	$131.29	$126.78	$372.65	$372.65	$184.28	$245.00	$388.08	$392.00	$256.03	$409.50	$256.03	$52.02	$39.99	$39.99	$78.01	$175.50	$0.00	$0.00	$0.00	$0.00
26000112	EAP	CPT® 96375		"Iv Push - Ther,prophylax,dx Add'l Med"	BOTH IP/OP	$523.00 	$387.02	$16.57	$403.13	$283.99	$283.99	$38.97	$38.97	$39.19	$109.01	$388.17	$388.17	$403.13	$38.34	$108.99	$24.92	$309.35	$309.35	$38.22	$223.50	$354.02	$357.60	$53.10	$339.95	$53.10	$22.60	$16.57	$16.57	$71.16	$36.40	$0.00	$0.00	$0.00	$0.00
26000113	EAP	CPT® 96376		"Iv Push - Ther,prophylax,dx Ea Push Same Med"	BOTH IP/OP	$349.00 	$258.26	$0.00	$269.01	$189.51	$189.51	$0.00	$0.00	$0.00	$72.74	$259.03	$259.03	$269.01	$0.00	$72.73	$0.00	$206.43	$206.43	$0.00	$149.00	$236.02	$238.40	$0.00	$226.85	$0.00	$46.64	$0.00	$0.00	$47.44	$0.00	$0.00	$0.00	$0.00	$0.00
26000114	EAP	CPT® 96523		Picc/portacath Line Flush	BOTH IP/OP	$282.00 	$208.68	$27.46	$319.15	$73.05	$73.05	$54.21	$54.21	$54.51	$58.78	$209.30	$209.30	$217.37	$53.35	$58.77	$34.67	$166.80	$166.80	$55.17	$120.50	$190.87	$192.80	$76.65	$319.15	$76.65	$27.46	$28.10	$28.10	$38.37	$52.54	$0.00	$0.00	$0.00	$0.00
27000010	EAP	Custom 27000010		Tube Salem Sump 48 Lengt	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000011	EAP	Custom 27000011		Tube Salem Silicone Size	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000012	EAP	Custom 27000012		Tubes Salem Sump 48 Leng	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000015	EAP	Custom 27000015		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000016	EAP	Custom 27000016		Scaple Surg W/handle Atta	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.81	$112.81	$117.16	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$76.00	$120.38	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000019	EAP	Custom 27000019		Kit L.f. Trach Care	BOTH IP/OP	$511.00 	$378.14	$0.00	$408.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$379.26	$379.26	$393.88	$0.00	$106.49	$0.00	$0.00	$0.00	$0.00	$255.50	$404.71	$408.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000024	EAP	Custom 27000024		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000026	EAP	Custom 27000026		Kit Triple Lumen Catheter	BOTH IP/OP	$587.00 	$434.38	$0.00	$469.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$435.67	$435.67	$452.46	$0.00	$122.33	$0.00	$0.00	$0.00	$0.00	$293.50	$464.90	$469.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000027	EAP	Custom 27000027		Filter Set 0.22 Micron	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000029	EAP	Custom 27000029		Set T-port Small Bore Ext	BOTH IP/OP	$14.00 	$10.36	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.39	$10.39	$10.79	$0.00	$2.92	$0.00	$0.00	$0.00	$0.00	$7.00	$11.09	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000031	EAP	Custom 27000031		Tray Douch Disposable	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000033	EAP	Custom 27000033		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000034	EAP	Custom 27000034		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000035	EAP	Custom 27000035		Tray Thoracentesis Dispos	BOTH IP/OP	$134.00 	$99.16	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.45	$99.45	$103.29	$0.00	$27.93	$0.00	$0.00	$0.00	$0.00	$117.50	$186.12	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000036	EAP	Custom 27000036		Central Line Dressing Tray With Biopatch	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$30.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000045	EAP	Custom 27000045		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000046	EAP	Custom 27000046		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000047	EAP	Custom 27000047		Sleeve Thigh Regular Dvt	BOTH IP/OP	$553.00 	$409.22	$0.00	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.44	$410.44	$426.25	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000048	EAP	Custom 27000048		Sleeve Thigh X-large Dvt	BOTH IP/OP	$663.00 	$490.62	$0.00	$530.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$492.08	$492.08	$511.04	$0.00	$138.17	$0.00	$0.00	$0.00	$0.00	$331.50	$525.10	$530.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000066	EAP	Custom 27000066		"Tray,instrumen 13-1/2x9/34x5/8"	BOTH IP/OP	$391.00 	$289.34	$0.00	$312.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.20	$290.20	$301.38	$0.00	$81.48	$0.00	$0.00	$0.00	$0.00	$195.50	$309.67	$312.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000076	EAP	HCPCS C1729		Catheter Coude Size 14fr	BOTH IP/OP	$44.00 	$32.56	$0.00	$35.20	$23.89	$23.89	$0.00	$0.00	$0.00	$9.17	$32.66	$32.66	$33.92	$0.00	$9.17	$0.00	$26.03	$26.03	$0.00	$22.00	$34.85	$35.20	$0.00	$0.00	$0.00	$6.89	$0.00	$0.00	$7.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000078	EAP	Custom 27000078		Tubes Salem Sump 48 Leng	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000079	EAP	Custom 27000079		Kit Tracheotomy Care Ster	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000081	EAP	Custom 27000081		Scapel Surg W/ Handle Attached	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.97	$97.97	$101.75	$0.00	$27.51	$0.00	$0.00	$0.00	$0.00	$66.00	$104.54	$105.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000087	EAP	Custom 27000087		Kit Thoracotomy	BOTH IP/OP	$203.00 	$150.22	$0.00	$162.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.67	$150.67	$156.47	$0.00	$42.31	$0.00	$0.00	$0.00	$0.00	$101.50	$160.78	$162.40	$0.00	$131.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000093	EAP	Custom 27000093		Bag 1000ml Pump Set	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.78	$20.78	$21.58	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000094	EAP	Custom 27000094		Chest Unit Drainage Pleur	BOTH IP/OP	$455.00 	$336.70	$0.00	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.70	$337.70	$350.71	$0.00	$94.82	$0.00	$0.00	$0.00	$0.00	$227.50	$360.36	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000097	EAP	Custom 27000097		Kit Triple Lumen Catheter	BOTH IP/OP	$299.00 	$221.26	$0.00	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.92	$221.92	$230.47	$0.00	$62.31	$0.00	$0.00	$0.00	$0.00	$149.50	$236.81	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000098	EAP	Custom 27000098		Vest Econo Cotton Small	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.77	$69.77	$72.46	$0.00	$19.59	$0.00	$0.00	$0.00	$0.00	$47.00	$74.45	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000101	EAP	Custom 27000101		Vest Econo Cotton X-large	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$0.00	$0.00	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000103	EAP	Custom 27000103		Filter Set 0.22 Micron	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000107	EAP	Custom 27000107		Tray Foley Perconnected 1	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000109	EAP	Custom 27000109		Tray Thoracentesis Dispos	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.42	$174.42	$181.14	$0.00	$48.97	$0.00	$0.00	$0.00	$0.00	$117.50	$186.12	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000119	EAP	Custom 27000119		3ml Posiflush Saline Syringe	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000125	EAP	Custom 27000125		Sleeve Thigh Regular Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000127	EAP	Custom 27000127		"Tray,catheter Instrument Dulmn"	BOTH IP/OP	$718.00 	$531.32	$0.00	$574.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$532.90	$532.90	$553.43	$0.00	$149.63	$0.00	$0.00	$0.00	$0.00	$359.00	$568.66	$574.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000150	EAP	Custom 27000150		Catheter Urethral Two-eye	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000151	EAP	HCPCS C1729		Catheter Coude Size 14fr	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$59.19	$59.19	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
27000152	EAP	HCPCS C1729		Catheter Coude 30cc 24fr	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$47.24	$47.24	$0.00	$0.00	$0.00	$18.13	$64.57	$64.57	$67.06	$0.00	$18.13	$0.00	$51.46	$51.46	$0.00	$43.50	$68.90	$69.60	$0.00	$0.00	$0.00	$13.62	$0.00	$0.00	$13.85	$0.00	$0.00	$0.00	$0.00	$0.00
27000153	EAP	Custom 27000153		Tube Salem Silicone Size	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000154	EAP	Custom 27000154		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000155	EAP	Custom 27000155		Kit Tracheotomy Care Ster	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000168	EAP	Custom 27000168		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000169	EAP	Custom 27000169		Chest Unit Drainage Pleur	BOTH IP/OP	$455.00 	$336.70	$0.00	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.70	$337.70	$350.71	$0.00	$94.82	$0.00	$0.00	$0.00	$0.00	$227.50	$360.36	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000173	EAP	Custom 27000173		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000174	EAP	Custom 27000174		Kit Triple Lumen Catheter	BOTH IP/OP	$299.00 	$221.26	$0.00	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.92	$221.92	$230.47	$0.00	$62.31	$0.00	$0.00	$0.00	$0.00	$149.50	$236.81	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000179	EAP	Custom 27000179		Filter Set 0.22 Micron	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000181	EAP	Custom 27000181		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000182	EAP	Custom 27000182		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000184	EAP	Custom 27000184		Tray Thoracentesis Dispos	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.42	$174.42	$181.14	$0.00	$48.97	$0.00	$0.00	$0.00	$0.00	$117.50	$186.12	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000191	EAP	Custom 27000191		"Suture,silk, 0"	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000197	EAP	Custom 27000197		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000198	EAP	Custom 27000198		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000199	EAP	Custom 27000199		Sleeve Thigh Regular Dvt	BOTH IP/OP	$553.00 	$409.22	$0.00	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.44	$410.44	$426.25	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000200	EAP	Custom 27000200		Sleeve Thigh X-large Dvt	BOTH IP/OP	$663.00 	$490.62	$0.00	$530.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$492.08	$492.08	$511.04	$0.00	$138.17	$0.00	$0.00	$0.00	$0.00	$331.50	$525.10	$530.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000222	EAP	Custom 27000222		Catheter Urethral 14fr	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000223	EAP	Custom 27000223		Catheter Urethral Two-eye	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000224	EAP	Custom 27000224		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000225	EAP	Custom 27000225		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000226	EAP	Custom 27000226		Kit Tracheotomy Care Ster	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000228	EAP	Custom 27000228		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000232	EAP	Custom 27000232		Cream Baza 5oz	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$0.00	$0.00	$0.00	$28.00	$44.35	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000240	EAP	Custom 27000240		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000241	EAP	Custom 27000241		Needle Port-cath 20ga X 1	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000242	EAP	Custom 27000242		Chest Unit Drainage Pleur	BOTH IP/OP	$455.00 	$336.70	$0.00	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.70	$337.70	$350.71	$0.00	$94.82	$0.00	$0.00	$0.00	$0.00	$227.50	$360.36	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000245	EAP	Custom 27000245		Kit Triple Lumen Catheter	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.72	$311.72	$323.74	$0.00	$87.53	$0.00	$0.00	$0.00	$0.00	$210.00	$332.64	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000250	EAP	Custom 27000250		Tray Foley Preconnected W	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000251	EAP	Custom 27000251		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000252	EAP	Custom 27000252		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000253	EAP	Custom 27000253		Tray Thoracentesis/parace	BOTH IP/OP	$67.00 	$49.58	$0.00	$53.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.73	$49.73	$51.64	$0.00	$13.96	$0.00	$0.00	$0.00	$0.00	$33.50	$53.06	$53.60	$0.00	$43.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000254	EAP	Custom 27000254		Central Line Dressing Tray With Biopatch	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$30.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000259	EAP	Custom 27000259		"Suture, Silk, 0"	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000265	EAP	Custom 27000265		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000266	EAP	Custom 27000266		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000267	EAP	Custom 27000267		Sleeve Thigh Regular Dvt	BOTH IP/OP	$553.00 	$409.22	$0.00	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.44	$410.44	$426.25	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000268	EAP	Custom 27000268		Sleeve Thigh X-large Dvt	BOTH IP/OP	$284.00 	$210.16	$0.00	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.78	$210.78	$218.91	$0.00	$59.19	$0.00	$0.00	$0.00	$0.00	$142.00	$224.93	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000293	EAP	Custom 27000293		Catheter Urethral Two-eye	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000294	EAP	HCPCS C1729		Catheter Coude Size 14fr	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$59.19	$59.19	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
27000295	EAP	HCPCS C1729		Catheter Coude 30cc 24fr	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$47.24	$47.24	$0.00	$0.00	$0.00	$18.13	$64.57	$64.57	$67.06	$0.00	$18.13	$0.00	$51.46	$51.46	$0.00	$43.50	$68.90	$69.60	$0.00	$0.00	$0.00	$13.62	$0.00	$0.00	$13.85	$0.00	$0.00	$0.00	$0.00	$0.00
27000296	EAP	Custom 27000296		Tube Salem Silicone Size	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000297	EAP	Custom 27000297		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000298	EAP	Custom 27000298		Kit Tracheotomy Care Ster	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.27	$45.27	$47.02	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000300	EAP	Custom 27000300		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000314	EAP	Custom 27000314		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000315	EAP	Custom 27000315		Chest Unit Drainage Pleur	BOTH IP/OP	$455.00 	$336.70	$0.00	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.70	$337.70	$350.71	$0.00	$94.82	$0.00	$0.00	$0.00	$0.00	$227.50	$360.36	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000318	EAP	Custom 27000318		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000319	EAP	Custom 27000319		Kit Triple Lumen Catheter	BOTH IP/OP	$697.00 	$515.78	$0.00	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.31	$517.31	$537.25	$0.00	$145.25	$0.00	$0.00	$0.00	$0.00	$348.50	$552.02	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000323	EAP	Custom 27000323		Vest Econo Cotton X-large	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$51.00	$80.78	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000324	EAP	Custom 27000324		Filter Set 0.22 Micron	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000326	EAP	Custom 27000326		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000327	EAP	Custom 27000327		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000330	EAP	Custom 27000330		Central Line Dressing Tray With Biopatch	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000335	EAP	Custom 27000335		"Suture, Silk, 0"	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000341	EAP	Custom 27000341		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000342	EAP	Custom 27000342		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000343	EAP	Custom 27000343		Sleeve Thigh Regular Dvt	BOTH IP/OP	$553.00 	$409.22	$0.00	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.44	$410.44	$426.25	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000344	EAP	Custom 27000344		Sleeve Thigh X-large Dvt	BOTH IP/OP	$284.00 	$210.16	$0.00	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.78	$210.78	$218.91	$0.00	$59.19	$0.00	$0.00	$0.00	$0.00	$142.00	$224.93	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000345	EAP	Custom 27000345		Tubes Extension Plain Pla	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000358	EAP	Custom 27000358		Catheter  Thoracic 16f	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000359	EAP	Custom 27000359		Catheter  Thoracic 20fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000360	EAP	Custom 27000360		Catheter Thoracic 36fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000361	EAP	Custom 27000361		Catheter Ventricular 20cm	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$566.54	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000362	EAP	Custom 27000362		Catheter Edm 11 Becker	BOTH IP/OP	"$1,339.00 "	$990.86	$0.00	"$1,071.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$993.81	$993.81	"$1,032.10"	$0.00	$279.05	$0.00	$0.00	$0.00	$0.00	$669.50	"$1,060.49"	"$1,071.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000363	EAP	Custom 27000363		Tube Feeding Plastic 8fr	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000364	EAP	Custom 27000364		Artery Arterial Catheriza	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000365	EAP	Custom 27000365		Artery Radial Catherizati	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000366	EAP	Custom 27000366		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000367	EAP	Custom 27000367		Tube Salem Silicone Size	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000368	EAP	Custom 27000368		Tubes Salem Sump 48 Leng	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000369	EAP	Custom 27000369		Kit Tracheotomy Care Ster	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.27	$45.27	$47.02	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000371	EAP	Custom 27000371		Bag Drainage Becker	BOTH IP/OP	$197.00 	$145.78	$0.00	$157.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.21	$146.21	$151.85	$0.00	$41.05	$0.00	$0.00	$0.00	$0.00	$98.50	$156.02	$157.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000372	EAP	Custom 27000372		Tray Catheter Insrtn Dulm	BOTH IP/OP	$377.00 	$278.98	$0.00	$301.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.81	$279.81	$290.59	$0.00	$78.57	$0.00	$0.00	$0.00	$0.00	$188.50	$298.58	$301.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000373	EAP	Custom 27000373		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000374	EAP	Custom 27000374		Scaple Surg W/handle Atta	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.81	$112.81	$117.16	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$76.00	$120.38	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000376	EAP	Custom 27000376		Set Blood Administration	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000378	EAP	Custom 27000378		Cream Baza 5oz	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.30	$19.30	$20.04	$0.00	$5.42	$0.00	$0.00	$0.00	$0.00	$13.00	$20.59	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000386	EAP	Custom 27000386		Pouch Fecal Incontinence	BOTH IP/OP	$21.00 	$15.54	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.59	$15.59	$16.19	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$10.50	$16.63	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000387	EAP	Custom 27000387		Kit Pressure Monitoring T	BOTH IP/OP	$177.00 	$130.98	$0.00	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.37	$131.37	$136.43	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$88.50	$140.18	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000388	EAP	Custom 27000388		Transducer  Disp For Icp	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000389	EAP	Custom 27000389		Bridge Kit Bifurated Resp	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.23	$97.23	$100.97	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$65.50	$103.75	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000390	EAP	Custom 27000390		Kit Transducer Monitoring	BOTH IP/OP	$339.00 	$250.86	$0.00	$271.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$251.61	$251.61	$261.30	$0.00	$70.65	$0.00	$0.00	$0.00	$0.00	$169.50	$268.49	$271.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000392	EAP	Custom 27000392		Kit  Pressure Monitoring	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000394	EAP	Custom 27000394		Bag 1000ml Pump Set	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000395	EAP	Custom 27000395		Kit Pecutaneous Introduce	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.96	$74.96	$77.85	$0.00	$21.05	$0.00	$0.00	$0.00	$0.00	$50.50	$79.99	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000396	EAP	Custom 27000396		Chest Unit Drainage Pleur	BOTH IP/OP	$455.00 	$336.70	$0.00	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.70	$337.70	$350.71	$0.00	$94.82	$0.00	$0.00	$0.00	$0.00	$227.50	$360.36	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000403	EAP	Custom 27000403		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.27	$45.27	$47.02	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000404	EAP	Custom 27000404		Kit Triple Lumen Catheter	BOTH IP/OP	$299.00 	$221.26	$0.00	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.92	$221.92	$230.47	$0.00	$62.31	$0.00	$0.00	$0.00	$0.00	$149.50	$236.81	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000405	EAP	Custom 27000405		Catheter Swan Ganz	BOTH IP/OP	$674.00 	$498.76	$0.00	$539.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.24	$500.24	$519.52	$0.00	$140.46	$0.00	$0.00	$0.00	$0.00	$337.00	$533.81	$539.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000406	EAP	Custom 27000406		Delivery System Closed In	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$42.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000407	EAP	Custom 27000407		Probe V-pacing	BOTH IP/OP	"$1,403.00 "	"$1,038.22"	$0.00	"$1,122.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,041.31"	"$1,041.31"	"$1,081.43"	$0.00	$292.39	$0.00	$0.00	$0.00	$0.00	$701.50	"$1,111.18"	"$1,122.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000410	EAP	Custom 27000410		Filter Set 0.22 Micron	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000412	EAP	Custom 27000412		Kit Ventriculostomy	BOTH IP/OP	"$1,652.00 "	"$1,222.48"	$0.00	"$1,321.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,226.11"	"$1,226.11"	"$1,273.36"	$0.00	$344.28	$0.00	$0.00	$0.00	$0.00	$826.00	"$1,308.38"	"$1,321.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000414	EAP	Custom 27000414		"Suture, Silk, 0"	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000454	EAP	Custom 27000454		Catheter  Thoracic 28fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000455	EAP	Custom 27000455		Catheter Thoracic 32fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000456	EAP	Custom 27000456		Catheter Thoracic 36fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000457	EAP	Custom 27000457		Catheter Urethral 14fr	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000458	EAP	Custom 27000458		Catheter Urethral Two-eye	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000459	EAP	Custom 27000459		Tube Salem Sump 48 Lengt	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000460	EAP	Custom 27000460		Tube Salem Silicone Size	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.78	$20.78	$21.58	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000461	EAP	Custom 27000461		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000462	EAP	Custom 27000462		Kit Tracheotomy Care Ster	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.27	$45.27	$47.02	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000464	EAP	Custom 27000464		Scaple Surg W/handle Atta	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.81	$112.81	$117.16	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$76.00	$120.38	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000474	EAP	Custom 27000474		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000475	EAP	Custom 27000475		Needle Port-cath 20ga X 1	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000476	EAP	Custom 27000476		Chest Unit Drainage Pleur	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$144.73	$144.73	$150.31	$0.00	$40.64	$0.00	$0.00	$0.00	$0.00	$97.50	$154.44	$156.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000481	EAP	Custom 27000481		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000482	EAP	Custom 27000482		Kit Triple Lumen Catheter	BOTH IP/OP	$299.00 	$221.26	$0.00	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.92	$221.92	$230.47	$0.00	$62.31	$0.00	$0.00	$0.00	$0.00	$149.50	$236.81	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000483	EAP	Custom 27000483		Filter Set 0.22 Micron	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000484	EAP	Custom 27000484		Tray Catheter Urethral 14	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000487	EAP	Custom 27000487		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000488	EAP	Custom 27000488		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000489	EAP	Custom 27000489		Tray Thoracentesis Dispos	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.42	$174.42	$181.14	$0.00	$48.97	$0.00	$0.00	$0.00	$0.00	$117.50	$186.12	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000491	EAP	Custom 27000491		Central Line Dressing Tray With Biopatch	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000495	EAP	Custom 27000495		"Suture, Silk, 0"	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000501	EAP	Custom 27000501		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000502	EAP	Custom 27000502		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000503	EAP	Custom 27000503		Sleeve Thigh Regular Dvt	BOTH IP/OP	$228.00 	$168.72	$0.00	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.22	$169.22	$175.74	$0.00	$47.52	$0.00	$0.00	$0.00	$0.00	$114.00	$180.58	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000504	EAP	Custom 27000504		Sleeve Thigh X-large Dvt	BOTH IP/OP	$616.00 	$455.84	$0.00	$492.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$457.20	$457.20	$474.81	$0.00	$128.37	$0.00	$0.00	$0.00	$0.00	$308.00	$487.87	$492.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000530	EAP	Custom 27000530		Catheter  Thoracic 28fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000531	EAP	Custom 27000531		Catheter Thoracic 32fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000532	EAP	Custom 27000532		Catheter Thoracic 36fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000533	EAP	Custom 27000533		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000534	EAP	Custom 27000534		Tubes Salem Sump 48 Leng	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000535	EAP	Custom 27000535		Kit Tracheotomy Care Ster	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000538	EAP	Custom 27000538		Scapel Surg W/ Handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000543	EAP	Custom 27000543		Kit Thoracotomy	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$23.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000549	EAP	Custom 27000549		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000551	EAP	Custom 27000551		Chest Unit Drainage Pleur	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$44.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000556	EAP	Custom 27000556		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000557	EAP	Custom 27000557		Kit Triple Lumen Catheter	BOTH IP/OP	$299.00 	$221.26	$0.00	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.92	$221.92	$230.47	$0.00	$62.31	$0.00	$0.00	$0.00	$0.00	$149.50	$236.81	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000558	EAP	Custom 27000558		Filter Set 0.22 Micron	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000559	EAP	Custom 27000559		Tray Catheter Urethral 14	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000560	EAP	Custom 27000560		Tray Douch Disposable	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000562	EAP	Custom 27000562		Tray Foley Preconnected 1	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00	$14.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000563	EAP	Custom 27000563		Tray Foley Perconnected 1	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000564	EAP	Custom 27000564		Tray Thoracentesis Dispos	BOTH IP/OP	$261.00 	$193.14	$0.00	$208.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$193.71	$193.71	$201.18	$0.00	$54.39	$0.00	$0.00	$0.00	$0.00	$130.50	$206.71	$208.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000570	EAP	Custom 27000570		"Suture, Silk, 0"	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000577	EAP	Custom 27000577		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$252.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000578	EAP	Custom 27000578		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$304.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000579	EAP	Custom 27000579		Sleeve Thigh Regular Dvt	BOTH IP/OP	$238.00 	$176.12	$0.00	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.64	$176.64	$183.45	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$119.00	$188.50	$190.40	$0.00	$154.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000580	EAP	Custom 27000580		Sleeve Thigh X-large Dvt	BOTH IP/OP	$616.00 	$455.84	$0.00	$492.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$457.20	$457.20	$474.81	$0.00	$128.37	$0.00	$0.00	$0.00	$0.00	$308.00	$487.87	$492.80	$0.00	$400.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000604	EAP	Custom 27000604		Catheter  Thoracic 28fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000605	EAP	Custom 27000605		Catheter Thoracic 32fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000606	EAP	Custom 27000606		Catheter Thoracic 36fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000607	EAP	Custom 27000607		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000608	EAP	Custom 27000608		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000612	EAP	Custom 27000612		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000613	EAP	Custom 27000613		Scaple Surg W/handle Atta	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.81	$112.81	$117.16	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$76.00	$120.38	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000618	EAP	Custom 27000618		Kit Thoracotomy	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.02	$69.02	$71.68	$0.00	$19.38	$0.00	$0.00	$0.00	$0.00	$46.50	$73.66	$74.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000624	EAP	Custom 27000624		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000625	EAP	Custom 27000625		Chest Unit Drainage Pleur	BOTH IP/OP	$332.00 	$245.68	$0.00	$265.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$246.41	$246.41	$255.91	$0.00	$69.19	$0.00	$0.00	$0.00	$0.00	$166.00	$262.94	$265.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000630	EAP	Custom 27000630		Dressing X-large	BOTH IP/OP	$697.00 	$515.78	$0.00	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.31	$517.31	$537.25	$0.00	$145.25	$0.00	$0.00	$0.00	$0.00	$348.50	$552.02	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000632	EAP	Custom 27000632		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000633	EAP	Custom 27000633		Kit Triple Lumen Catheter	BOTH IP/OP	$299.00 	$221.26	$0.00	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.92	$221.92	$230.47	$0.00	$62.31	$0.00	$0.00	$0.00	$0.00	$149.50	$236.81	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000637	EAP	Custom 27000637		Tray Catheter Urethral 14	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000638	EAP	Custom 27000638		Tray Douch Disposable	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000640	EAP	Custom 27000640		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000641	EAP	Custom 27000641		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000642	EAP	Custom 27000642		Tray Thoracentesis Dispos	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.42	$174.42	$181.14	$0.00	$48.97	$0.00	$0.00	$0.00	$0.00	$117.50	$186.12	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000648	EAP	Custom 27000648		"Suture, Silk, 0"	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000653	EAP	Custom 27000653		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000654	EAP	Custom 27000654		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000655	EAP	Custom 27000655		Sleeve Thigh Regular Dvt	BOTH IP/OP	$553.00 	$409.22	$0.00	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.44	$410.44	$426.25	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000656	EAP	Custom 27000656		Sleeve Thigh X-large Dvt	BOTH IP/OP	$663.00 	$490.62	$0.00	$530.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$492.08	$492.08	$511.04	$0.00	$138.17	$0.00	$0.00	$0.00	$0.00	$331.50	$525.10	$530.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000666	EAP	Custom 27000666		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000667	EAP	Custom 27000667		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000679	EAP	Custom 27000679		Kit Triple Lumen Catheter	BOTH IP/OP	$646.00 	$478.04	$0.00	$516.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$479.46	$479.46	$497.94	$0.00	$134.63	$0.00	$0.00	$0.00	$0.00	$323.00	$511.63	$516.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000680	EAP	Custom 27000680		Filter Set 0.22 Micron	BOTH IP/OP	$7.00 	$5.18	$0.00	$5.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.20	$5.20	$5.40	$0.00	$1.46	$0.00	$0.00	$0.00	$0.00	$3.50	$5.54	$5.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000683	EAP	Custom 27000683		Tray Catheter Urethral 14	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000686	EAP	Custom 27000686		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000687	EAP	Custom 27000687		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000689	EAP	Custom 27000689		Tray Thoracentesis Dispos	BOTH IP/OP	$216.00 	$159.84	$0.00	$172.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.32	$160.32	$166.49	$0.00	$45.01	$0.00	$0.00	$0.00	$0.00	$108.00	$171.07	$172.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000691	EAP	Custom 27000691		Bag Drainage Ureteral	BOTH IP/OP	$92.00 	$68.08	$0.00	$73.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.28	$68.28	$70.91	$0.00	$19.17	$0.00	$0.00	$0.00	$0.00	$46.00	$72.86	$73.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000696	EAP	Custom 27000696		"Suture, Silk, 0"	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000697	EAP	Custom 27000697		10ml Posiflush Saline Syringe	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$6.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000701	EAP	Custom 27000701		Sleeve Knee Regular Dvt	BOTH IP/OP	$378.00 	$279.72	$0.00	$302.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.55	$280.55	$291.36	$0.00	$78.78	$0.00	$0.00	$0.00	$0.00	$189.00	$299.38	$302.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000702	EAP	Custom 27000702		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000703	EAP	Custom 27000703		Sleeve Thigh Regular Dvt	BOTH IP/OP	$553.00 	$409.22	$0.00	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.44	$410.44	$426.25	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000704	EAP	Custom 27000704		Sleeve Thigh X-large Dvt	BOTH IP/OP	$284.00 	$210.16	$0.00	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.78	$210.78	$218.91	$0.00	$59.19	$0.00	$0.00	$0.00	$0.00	$142.00	$224.93	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000705	EAP	Custom 27000705		Sucrose Analgesia	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000709	EAP	Custom 27000709		Tray Circumcision	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$30.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000710	EAP	Custom 27000710		Needle Spinal 22g 25/bx	BOTH IP/OP	$3.00 	$2.22	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.50	$2.38	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000712	EAP	Custom 27000712		Tubes Capillary Hepariniz	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$123.33	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000714	EAP	Custom 27000714		Tube Feeding Plastic 8fr	BOTH IP/OP	$3.00 	$2.22	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.23	$2.23	$2.31	$0.00	$0.63	$0.00	$0.00	$0.00	$0.00	$1.50	$2.38	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000715	EAP	Custom 27000715		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000721	EAP	Custom 27000721		Tray Catheter Urethral 14	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000723	EAP	Custom 27000723		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000724	EAP	Custom 27000724		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000725	EAP	HCPCS C1751		Catheter  Iv 26g 120/cs	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$0.00	$0.00	$0.00	$4.38	$0.00	$0.00	$4.46	$0.00	$0.00	$0.00	$0.00	$0.00
27000726	EAP	Custom 27000726		Sleeve Knee Regular Dvt	BOTH IP/OP	$166.00 	$122.84	$0.00	$132.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.21	$123.21	$127.95	$0.00	$34.59	$0.00	$0.00	$0.00	$0.00	$83.00	$131.47	$132.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000727	EAP	Custom 27000727		Sleeve Knee X-large Dvt	BOTH IP/OP	$201.00 	$148.74	$0.00	$160.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.18	$149.18	$154.93	$0.00	$41.89	$0.00	$0.00	$0.00	$0.00	$100.50	$159.19	$160.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000728	EAP	Custom 27000728		Sleeve Thigh X-large Dvt	BOTH IP/OP	$284.00 	$210.16	$0.00	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.78	$210.78	$218.91	$0.00	$59.19	$0.00	$0.00	$0.00	$0.00	$142.00	$224.93	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000741	EAP	Custom 27000741		Catheter  Thoracic 28fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000742	EAP	Custom 27000742		Catheter Thoracic 32fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000743	EAP	Custom 27000743		Catheter Thoracic 36fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000744	EAP	Custom 27000744		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000745	EAP	Custom 27000745		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000748	EAP	Custom 27000748		Scapel Surg W/handle Att	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000760	EAP	Custom 27000760		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000762	EAP	Custom 27000762		Chest Unit Drainage Pleur	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.72	$311.72	$323.74	$0.00	$87.53	$0.00	$0.00	$0.00	$0.00	$210.00	$332.64	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000765	EAP	Custom 27000765		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000766	EAP	Custom 27000766		Kit Triple Lumen Catheter	BOTH IP/OP	$299.00 	$221.26	$0.00	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.92	$221.92	$230.47	$0.00	$62.31	$0.00	$0.00	$0.00	$0.00	$149.50	$236.81	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000770	EAP	Custom 27000770		Filter Set 0.22 Micron	BOTH IP/OP	$7.00 	$5.18	$0.00	$5.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.20	$5.20	$5.40	$0.00	$1.46	$0.00	$0.00	$0.00	$0.00	$3.50	$5.54	$5.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000771	EAP	Custom 27000771		Tray Catheter Urethral 14	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000772	EAP	Custom 27000772		Tray Douch Disposable	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000773	EAP	Custom 27000773		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000774	EAP	Custom 27000774		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000775	EAP	Custom 27000775		Tray Thoracentesis Dispos	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.42	$174.42	$181.14	$0.00	$48.97	$0.00	$0.00	$0.00	$0.00	$117.50	$186.12	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000776	EAP	Custom 27000776		Central Line Dressing Tray With Biopatch	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000781	EAP	Custom 27000781		"Suture, Silk, 0"	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000784	EAP	Custom 27000784		3ml Posiflush Saline Syringe	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000787	EAP	Custom 27000787		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000788	EAP	Custom 27000788		Sleeve Knee X-ray Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000789	EAP	Custom 27000789		Sleeve Thigh Regular Dvt	BOTH IP/OP	$553.00 	$409.22	$0.00	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.44	$410.44	$426.25	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000790	EAP	Custom 27000790		Sleeve Thigh X-large Dvt	BOTH IP/OP	$284.00 	$210.16	$0.00	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.78	$210.78	$218.91	$0.00	$59.19	$0.00	$0.00	$0.00	$0.00	$142.00	$224.93	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000791	EAP	Custom 27000791		First Step Select Overlay	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.23	$97.23	$100.97	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$65.50	$103.75	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000792	EAP	Custom 27000792		Telemetry Med Supplies	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000793	EAP	Custom 27000793		Med/surg Isolation Supplies	BOTH IP/OP	$281.00 	$207.94	$0.00	$224.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.56	$208.56	$216.59	$0.00	$58.56	$0.00	$0.00	$0.00	$0.00	$140.50	$222.55	$224.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000803	EAP	Custom 27000803		Dialysis Filter	BOTH IP/OP	$699.00 	$517.26	$0.00	$559.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$518.80	$518.80	$538.79	$0.00	$145.67	$0.00	$0.00	$0.00	$0.00	$349.50	$553.61	$559.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000810	EAP	Custom 27000810		Needle Spinal 18ga	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$10.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000811	EAP	Custom 27000811		Needle Spinal Sterile 20g	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$6.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000815	EAP	Custom 27000815		Catheter  Thoracic 28fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000816	EAP	Custom 27000816		Catheter Thoracic 32fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000817	EAP	Custom 27000817		Catheter Thoracic 36fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000818	EAP	HCPCS C1729		Catheter Foley 30cc 28fr	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$21.18	$21.18	$0.00	$0.00	$0.00	$8.13	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$23.07	$23.07	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$6.10	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
27000819	EAP	Custom 27000819		Artery Arterial Catheriza	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$0.00	$0.00	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000820	EAP	Custom 27000820		Artery Radial Catherizati	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000821	EAP	Custom 27000821		Tube Salem Silicone Size	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000822	EAP	Custom 27000822		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000826	EAP	Custom 27000826		Tray Catheter Insrtn Dulm	BOTH IP/OP	$434.00 	$321.16	$0.00	$347.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$322.11	$322.11	$334.53	$0.00	$90.45	$0.00	$0.00	$0.00	$0.00	$217.00	$343.73	$347.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000828	EAP	Custom 27000828		Catheter Peritoneal Adult	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.86	$155.86	$161.87	$0.00	$43.76	$0.00	$0.00	$0.00	$0.00	$105.00	$166.32	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000829	EAP	Custom 27000829		Triconnector With Valve	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000830	EAP	Custom 27000830		Set Blood Administration	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000834	EAP	Custom 27000834		Kit L.f. Trach Care	BOTH IP/OP	$237.00 	$175.38	$0.00	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.90	$175.90	$182.68	$0.00	$49.39	$0.00	$0.00	$0.00	$0.00	$118.50	$187.70	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000836	EAP	Custom 27000836		Kit Thoracotomy	BOTH IP/OP	$217.00 	$160.58	$0.00	$173.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.06	$161.06	$167.26	$0.00	$45.22	$0.00	$0.00	$0.00	$0.00	$108.50	$171.86	$173.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000841	EAP	Custom 27000841		Pouch Fecal Incontinence	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000842	EAP	Custom 27000842		Kit Pressure Monitoring T	BOTH IP/OP	$177.00 	$130.98	$0.00	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.37	$131.37	$136.43	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$88.50	$140.18	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000843	EAP	Custom 27000843		Kit Transducer Monitoring	BOTH IP/OP	$339.00 	$250.86	$0.00	$271.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$251.61	$251.61	$261.30	$0.00	$70.65	$0.00	$0.00	$0.00	$0.00	$169.50	$268.49	$271.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000844	EAP	Custom 27000844		Kit  Pressure Monitoring	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000846	EAP	Custom 27000846		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000847	EAP	Custom 27000847		Kit Pecutaneous Introduce	BOTH IP/OP	$298.00 	$220.52	$0.00	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.18	$221.18	$229.70	$0.00	$62.10	$0.00	$0.00	$0.00	$0.00	$149.00	$236.02	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000848	EAP	Custom 27000848		Chest Unit Drainage Pleur	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.72	$311.72	$323.74	$0.00	$87.53	$0.00	$0.00	$0.00	$0.00	$210.00	$332.64	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000849	EAP	Custom 27000849		Chest Unit Dry Suction Sy	BOTH IP/OP	$316.00 	$233.84	$0.00	$252.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$234.54	$234.54	$243.57	$0.00	$65.85	$0.00	$0.00	$0.00	$0.00	$158.00	$250.27	$252.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000854	EAP	Custom 27000854		Trac Dressing Xl	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.95	$51.95	$53.96	$0.00	$14.59	$0.00	$0.00	$0.00	$0.00	$35.00	$55.44	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000857	EAP	Custom 27000857		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000858	EAP	Custom 27000858		Kit Triple Lumen Catheter	BOTH IP/OP	$697.00 	$515.78	$0.00	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.31	$517.31	$537.25	$0.00	$145.25	$0.00	$0.00	$0.00	$0.00	$348.50	$552.02	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000859	EAP	Custom 27000859		Catheter Swan Ganz	BOTH IP/OP	$726.00 	$537.24	$0.00	$580.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$538.84	$538.84	$559.60	$0.00	$151.30	$0.00	$0.00	$0.00	$0.00	$363.00	$574.99	$580.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000860	EAP	Custom 27000860		Delivery System Closed In	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.81	$112.81	$117.16	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$76.00	$120.38	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000866	EAP	Custom 27000866		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000868	EAP	Custom 27000868		Tray Urine Meter 18fr	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.77	$69.77	$72.46	$0.00	$19.59	$0.00	$0.00	$0.00	$0.00	$47.00	$74.45	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000869	EAP	Custom 27000869		Kit Ventriculostomy	BOTH IP/OP	$763.00 	$564.62	$0.00	$610.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$566.30	$566.30	$588.12	$0.00	$159.01	$0.00	$0.00	$0.00	$0.00	$381.50	$604.30	$610.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000870	EAP	Custom 27000870		Tray Thoracentesis Dispos	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.96	$74.96	$77.85	$0.00	$21.05	$0.00	$0.00	$0.00	$0.00	$50.50	$79.99	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000872	EAP	Custom 27000872		Central Line Dressing Tray With Biopatch	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000880	EAP	Custom 27000880		Femoral Arterial Line Kit	BOTH IP/OP	$178.00 	$131.72	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.11	$132.11	$137.20	$0.00	$37.10	$0.00	$0.00	$0.00	$0.00	$89.00	$140.98	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000881	EAP	Custom 27000881		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000882	EAP	Custom 27000882		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000883	EAP	Custom 27000883		Sleeve Thigh Regular Dvt	BOTH IP/OP	$553.00 	$409.22	$0.00	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.44	$410.44	$426.25	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000884	EAP	Custom 27000884		Sleeve Thigh X-large Dvt	BOTH IP/OP	$284.00 	$210.16	$0.00	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.78	$210.78	$218.91	$0.00	$59.19	$0.00	$0.00	$0.00	$0.00	$142.00	$224.93	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000886	EAP	Custom 27000886		Med/surg Isolation Supplies	BOTH IP/OP	$281.00 	$207.94	$0.00	$224.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.56	$208.56	$216.59	$0.00	$58.56	$0.00	$0.00	$0.00	$0.00	$140.50	$222.55	$224.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000887	EAP	Custom 27000887		Med/pri Supplies	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000888	EAP	Custom 27000888		Med/surg Semi-supplies	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000902	EAP	Custom 27000902		Catheter  Thoracic 28fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000903	EAP	Custom 27000903		Catheter Thoracic 32fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000904	EAP	Custom 27000904		Catheter Thoracic 36fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000905	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27000906	EAP	HCPCS C1729		Catheter Coude Size 14fr	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$59.19	$59.19	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
27000907	EAP	HCPCS C1729		Catheter Coude Size 16fr	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$59.19	$59.19	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
27000908	EAP	Custom 27000908		Artery Arterial Catheriza	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$0.00	$0.00	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000909	EAP	Custom 27000909		Artery Radial Catherizati	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000910	EAP	Custom 27000910		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000911	EAP	Custom 27000911		Tube Salem Silicone Size	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000912	EAP	Custom 27000912		Tubes Salem Sump 48 Leng	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000915	EAP	Custom 27000915		Tray Catheter Insrtn Dulm	BOTH IP/OP	$937.00 	$693.38	$0.00	$749.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$695.44	$695.44	$722.24	$0.00	$195.27	$0.00	$0.00	$0.00	$0.00	$468.50	$742.10	$749.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000916	EAP	Custom 27000916		Scaple Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000918	EAP	Custom 27000918		Triconnector With Valve	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000922	EAP	Custom 27000922		Pouch Active Life Squib Drain	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000926	EAP	Custom 27000926		Kit Thoracotomy	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.86	$155.86	$161.87	$0.00	$43.76	$0.00	$0.00	$0.00	$0.00	$105.00	$166.32	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000931	EAP	Custom 27000931		Pouch Fecal Incontinence	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000932	EAP	Custom 27000932		Kit Pressure Monitoring T	BOTH IP/OP	$177.00 	$130.98	$0.00	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.37	$131.37	$136.43	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$88.50	$140.18	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000933	EAP	Custom 27000933		Kit  Pressure Monitoring	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000934	EAP	Custom 27000934		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000935	EAP	Custom 27000935		Needle Port-cath 20ga X 1	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000936	EAP	Custom 27000936		Chest Unit Drainage Pleur	BOTH IP/OP	$455.00 	$336.70	$0.00	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.70	$337.70	$350.71	$0.00	$94.82	$0.00	$0.00	$0.00	$0.00	$227.50	$360.36	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000941	EAP	Custom 27000941		Dressing X-large	BOTH IP/OP	$321.00 	$237.54	$0.00	$256.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.25	$238.25	$247.43	$0.00	$66.90	$0.00	$0.00	$0.00	$0.00	$160.50	$254.23	$256.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000942	EAP	Custom 27000942		Trac Dressing Xl	BOTH IP/OP	$157.00 	$116.18	$0.00	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.53	$116.53	$121.02	$0.00	$32.72	$0.00	$0.00	$0.00	$0.00	$78.50	$124.34	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000945	EAP	Custom 27000945		Tube Feeding Ng 8fr 36in Entri	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000946	EAP	Custom 27000946		Kit Triple Lumen Catheter	BOTH IP/OP	$697.00 	$515.78	$0.00	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.31	$517.31	$537.25	$0.00	$145.25	$0.00	$0.00	$0.00	$0.00	$348.50	$552.02	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000949	EAP	Custom 27000949		Filter Set 0.22 Micron	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000951	EAP	Custom 27000951		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000952	EAP	Custom 27000952		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000953	EAP	Custom 27000953		Tray Thoracentesis Dispos	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.42	$174.42	$181.14	$0.00	$48.97	$0.00	$0.00	$0.00	$0.00	$117.50	$186.12	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000955	EAP	Custom 27000955		Central Line Dressing Tray With Biopatch	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000962	EAP	Custom 27000962		Sleeve Knee Regular Dvt	BOTH IP/OP	$370.00 	$273.80	$0.00	$296.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$274.61	$274.61	$285.20	$0.00	$77.11	$0.00	$0.00	$0.00	$0.00	$185.00	$293.04	$296.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000963	EAP	Custom 27000963		Sleeve Knee X-large Dvt	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$333.99	$333.99	$346.86	$0.00	$93.78	$0.00	$0.00	$0.00	$0.00	$225.00	$356.40	$360.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000964	EAP	Custom 27000964		Sleeve Thigh Regular Dvt	BOTH IP/OP	$529.00 	$391.46	$0.00	$423.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$392.62	$392.62	$407.75	$0.00	$110.24	$0.00	$0.00	$0.00	$0.00	$264.50	$418.97	$423.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000965	EAP	Custom 27000965		Sleeve Thigh X-large Dvt	BOTH IP/OP	$488.00 	$361.12	$0.00	$390.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$362.19	$362.19	$376.15	$0.00	$101.70	$0.00	$0.00	$0.00	$0.00	$244.00	$386.50	$390.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000968	EAP	Custom 27000968		Dialysis Fluid Bag	BOTH IP/OP	$166.00 	$122.84	$0.00	$132.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.21	$123.21	$127.95	$0.00	$34.59	$0.00	$0.00	$0.00	$0.00	$83.00	$131.47	$132.80	$0.00	$107.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000969	EAP	Custom 27000969		Dialysis Filter	BOTH IP/OP	$699.00 	$517.26	$0.00	$559.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$518.80	$518.80	$538.79	$0.00	$145.67	$0.00	$0.00	$0.00	$0.00	$349.50	$553.61	$559.20	$0.00	$454.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000975	EAP	Custom 27000975		Ioban 2 Drape Incise Smal	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000977	EAP	Custom 27000977		Ioban 2 Drape Incise Larg	BOTH IP/OP	$462.00 	$341.88	$0.00	$369.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.90	$342.90	$356.11	$0.00	$96.28	$0.00	$0.00	$0.00	$0.00	$231.00	$365.90	$369.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000978	EAP	Custom 27000978		Needle Spinal 18ga	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000982	EAP	Custom 27000982		Catheter Thoracic 32fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000983	EAP	Custom 27000983		Catheter Thoracic 36fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000984	EAP	Custom 27000984		Catheter Urethral Two-eye	BOTH IP/OP	$7.00 	$5.18	$0.00	$5.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.20	$5.20	$5.40	$0.00	$1.46	$0.00	$0.00	$0.00	$0.00	$3.50	$5.54	$5.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000985	EAP	HCPCS C1729		Catheter Foley 5cc 14fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27000986	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$11.70	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27000987	EAP	HCPCS C1729		Catheter Foley 5cc 18fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27000988	EAP	HCPCS C1729		Catheter Foley 3-way 30cc	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$20.09	$20.09	$0.00	$0.00	$0.00	$7.71	$27.46	$27.46	$28.52	$0.00	$7.71	$0.00	$21.89	$21.89	$0.00	$18.50	$29.30	$29.60	$0.00	$0.00	$0.00	$5.79	$0.00	$0.00	$5.89	$0.00	$0.00	$0.00	$0.00	$0.00
27000989	EAP	Custom 27000989		Catheter Ventricular 20cm	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.31	$232.31	$241.26	$0.00	$65.23	$0.00	$0.00	$0.00	$0.00	$156.50	$247.90	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000990	EAP	Custom 27000990		Catheter Edm Ii Becker	BOTH IP/OP	$617.00 	$456.58	$0.00	$493.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$457.94	$457.94	$475.58	$0.00	$128.58	$0.00	$0.00	$0.00	$0.00	$308.50	$488.66	$493.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000991	EAP	Custom 27000991		Artery Arterial Catheriza	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$0.00	$0.00	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000992	EAP	Custom 27000992		Artery Radial Catherizati	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000993	EAP	Custom 27000993		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000994	EAP	Custom 27000994		Tube Salem Silicone Size	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000995	EAP	Custom 27000995		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000996	EAP	Custom 27000996		Kit Percuatane Trache 7fr	BOTH IP/OP	"$1,219.00 "	$902.06	$0.00	$975.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$904.74	$904.74	$939.61	$0.00	$254.04	$0.00	$0.00	$0.00	$0.00	$609.50	$965.45	$975.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000997	EAP	Custom 27000997		Kit Percuatane Trache 8fr	BOTH IP/OP	"$1,424.00 "	"$1,053.76"	$0.00	"$1,139.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,056.89"	"$1,056.89"	"$1,097.62"	$0.00	$296.76	$0.00	$0.00	$0.00	$0.00	$712.00	"$1,127.81"	"$1,139.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27000998	EAP	Custom 27000998		Kit Tracheotomy Care Ster	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001001	EAP	Custom 27001001		Bag Drainage Becker	BOTH IP/OP	$213.00 	$157.62	$0.00	$170.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.09	$158.09	$164.18	$0.00	$44.39	$0.00	$0.00	$0.00	$0.00	$106.50	$168.70	$170.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001002	EAP	Custom 27001002		Tray Catheter Insrtn Dulm	BOTH IP/OP	$937.00 	$693.38	$0.00	$749.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$695.44	$695.44	$722.24	$0.00	$195.27	$0.00	$0.00	$0.00	$0.00	$468.50	$742.10	$749.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001006	EAP	Custom 27001006		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001007	EAP	Custom 27001007		Scaple Surg W/handle Atta	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.81	$112.81	$117.16	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$76.00	$120.38	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001009	EAP	Custom 27001009		Triconnector With Valve	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001012	EAP	Custom 27001012		Cream Baza 5oz	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$31.50	$49.90	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001016	EAP	Custom 27001016		Valve Anti-reflux Salem S	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001017	EAP	Custom 27001017		Kit L.f. Trach Care	BOTH IP/OP	$237.00 	$175.38	$0.00	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.90	$175.90	$182.68	$0.00	$49.39	$0.00	$0.00	$0.00	$0.00	$118.50	$187.70	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001019	EAP	Custom 27001019		Kit Thoracotomy	BOTH IP/OP	$217.00 	$160.58	$0.00	$173.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.50	$171.86	$173.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001025	EAP	Custom 27001025		Pouch Fecal Incontinence	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001026	EAP	Custom 27001026		Kit Pressure Monitoring T	BOTH IP/OP	$177.00 	$130.98	$0.00	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.37	$131.37	$136.43	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$88.50	$140.18	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001027	EAP	Custom 27001027		Transducer  Disp For Icp	BOTH IP/OP	$79.00 	$58.46	$0.00	$63.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.63	$58.63	$60.89	$0.00	$16.46	$0.00	$0.00	$0.00	$0.00	$39.50	$62.57	$63.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001028	EAP	Custom 27001028		Kit Transducer Monitoring	BOTH IP/OP	$339.00 	$250.86	$0.00	$271.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$251.61	$251.61	$261.30	$0.00	$70.65	$0.00	$0.00	$0.00	$0.00	$169.50	$268.49	$271.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001029	EAP	Custom 27001029		Kit  Pressure Monitoring	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001031	EAP	Custom 27001031		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001032	EAP	Custom 27001032		Kit Pecutaneous Introduce	BOTH IP/OP	$298.00 	$220.52	$0.00	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.18	$221.18	$229.70	$0.00	$62.10	$0.00	$0.00	$0.00	$0.00	$149.00	$236.02	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001033	EAP	Custom 27001033		Chest Unit Drainage Pleur	BOTH IP/OP	$455.00 	$336.70	$0.00	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.70	$337.70	$350.71	$0.00	$94.82	$0.00	$0.00	$0.00	$0.00	$227.50	$360.36	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001034	EAP	Custom 27001034		Chest Unit Dry Suction Sy	BOTH IP/OP	$333.00 	$246.42	$0.00	$266.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.15	$247.15	$256.68	$0.00	$69.40	$0.00	$0.00	$0.00	$0.00	$166.50	$263.74	$266.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001035	EAP	Custom 27001035		Bag  Auto-transfusion Ple	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.84	$181.84	$188.85	$0.00	$51.06	$0.00	$0.00	$0.00	$0.00	$122.50	$194.04	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001040	EAP	Custom 27001040		Dressing X-large	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001041	EAP	Custom 27001041		Trac Dressing Xl	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.17	$126.17	$131.04	$0.00	$35.43	$0.00	$0.00	$0.00	$0.00	$85.00	$134.64	$136.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001044	EAP	Custom 27001044		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001045	EAP	Custom 27001045		Kit Triple Lumen Catheter	BOTH IP/OP	$697.00 	$515.78	$0.00	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.31	$517.31	$537.25	$0.00	$145.25	$0.00	$0.00	$0.00	$0.00	$348.50	$552.02	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001046	EAP	Custom 27001046		Wire Guide Dual Purpose	BOTH IP/OP	$362.00 	$267.88	$0.00	$289.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.68	$268.68	$279.03	$0.00	$75.44	$0.00	$0.00	$0.00	$0.00	$181.00	$286.70	$289.60	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001047	EAP	Custom 27001047		Kit Monitoring Intracrani	BOTH IP/OP	$426.00 	$315.24	$0.00	$340.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$316.18	$316.18	$328.36	$0.00	$88.78	$0.00	$0.00	$0.00	$0.00	$213.00	$337.39	$340.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001048	EAP	Custom 27001048		Cath  Trauma Ventricular	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001049	EAP	Custom 27001049		Catheter Swan Ganz	BOTH IP/OP	$309.00 	$228.66	$0.00	$247.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.34	$229.34	$238.18	$0.00	$64.40	$0.00	$0.00	$0.00	$0.00	$154.50	$244.73	$247.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001050	EAP	Custom 27001050		Delivery System Closed In	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.81	$112.81	$117.16	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$76.00	$120.38	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001051	EAP	Custom 27001051		Probe V-pacing	BOTH IP/OP	"$1,277.00 "	$944.98	$0.00	"$1,021.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$947.79	$947.79	$984.31	$0.00	$266.13	$0.00	$0.00	$0.00	$0.00	$638.50	"$1,011.38"	"$1,021.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001055	EAP	Custom 27001055		Filter Set 0.22 Micron	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001057	EAP	Custom 27001057		Tray Foley Preconnected 1	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001058	EAP	Custom 27001058		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001060	EAP	Custom 27001060		Tray Urine Meter 18fr	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.77	$69.77	$72.46	$0.00	$19.59	$0.00	$0.00	$0.00	$0.00	$47.00	$74.45	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001061	EAP	Custom 27001061		Kit Ventriculostomy	BOTH IP/OP	"$1,782.00 "	"$1,318.68"	$0.00	"$1,425.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,322.60"	"$1,322.60"	"$1,373.57"	$0.00	$371.37	$0.00	$0.00	$0.00	$0.00	$891.00	"$1,411.34"	"$1,425.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001062	EAP	Custom 27001062		Tray Thoracentesis Dispos	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.96	$74.96	$77.85	$0.00	$21.05	$0.00	$0.00	$0.00	$0.00	$50.50	$79.99	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001063	EAP	Custom 27001063		Central Line Dressing Tray With Biopatch	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001064	EAP	Custom 27001064		Bag Drainage Ureteral	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001078	EAP	Custom 27001078		Femoral Arterial Line Kit	BOTH IP/OP	$172.00 	$127.28	$0.00	$137.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.66	$127.66	$132.58	$0.00	$35.84	$0.00	$0.00	$0.00	$0.00	$86.00	$136.22	$137.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001079	EAP	Custom 27001079		Kit Percutane Trache 9fr	BOTH IP/OP	"$3,007.00 "	"$2,225.18"	$0.00	"$2,405.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,231.80"	"$2,231.80"	"$2,317.80"	$0.00	$626.66	$0.00	$0.00	$0.00	$0.00	"$1,503.50"	"$2,381.54"	"$2,405.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001081	EAP	Custom 27001081		Cath Cco Swan Ganz 8fr	BOTH IP/OP	"$2,182.00 "	"$1,614.68"	$0.00	"$1,745.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,091.00"	"$1,728.14"	"$1,745.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001082	EAP	Custom 27001082		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001083	EAP	Custom 27001083		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001084	EAP	Custom 27001084		Sleeve Thigh Regular Dvt	BOTH IP/OP	$553.00 	$409.22	$0.00	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.44	$410.44	$426.25	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001085	EAP	Custom 27001085		Sleeve Thigh X-large Dvt	BOTH IP/OP	$284.00 	$210.16	$0.00	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.78	$210.78	$218.91	$0.00	$59.19	$0.00	$0.00	$0.00	$0.00	$142.00	$224.93	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001086	EAP	Custom 27001086		First Step Select Overlay	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001096	EAP	Custom 27001096		Dialysis Filter	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001101	EAP	Custom 27001101		Needle Spinal 22ga X 3-1/	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001106	EAP	Custom 27001106		Catheter  Thoracic 28fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001107	EAP	Custom 27001107		Catheter Thoracic 32fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001108	EAP	Custom 27001108		Catheter Thoracic 36fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001109	EAP	HCPCS C1729		Catheter Foley 5cc 14fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27001110	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27001111	EAP	HCPCS C1729		Catheter Foley 5cc 18fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$12.35	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27001112	EAP	HCPCS C1729		Catheter Foley 30cc 28fr	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$21.18	$21.18	$0.00	$0.00	$0.00	$8.13	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$23.07	$23.07	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$6.10	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
27001113	EAP	Custom 27001113		Catheter Ventricular 20cm	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$566.54	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001114	EAP	Custom 27001114		Catheter Edm Ii Becker	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	"$1,109.95"	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001115	EAP	Custom 27001115		Tube  Feeding Ng  8fr 43in En	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$42.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001116	EAP	Custom 27001116		Artery Arterial Catheriza	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$0.00	$0.00	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001117	EAP	Custom 27001117		Artery Radial Catherizati	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001118	EAP	Custom 27001118		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001119	EAP	Custom 27001119		Tube Salem Silicone Size	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001120	EAP	Custom 27001120		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001124	EAP	Custom 27001124		Bag Drainage Becker	BOTH IP/OP	$213.00 	$157.62	$0.00	$170.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.09	$158.09	$164.18	$0.00	$44.39	$0.00	$0.00	$0.00	$0.00	$106.50	$168.70	$170.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001125	EAP	Custom 27001125		Blades Surgical #10 W/o H	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001126	EAP	Custom 27001126		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001127	EAP	Custom 27001127		Triconnector With Valve	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001129	EAP	Custom 27001129		Set Blood Administration	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001135	EAP	Custom 27001135		Valve Anti-reflux Salem S	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001137	EAP	Custom 27001137		Kit Thoracotomy	BOTH IP/OP	$217.00 	$160.58	$0.00	$173.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.06	$161.06	$167.26	$0.00	$45.22	$0.00	$0.00	$0.00	$0.00	$108.50	$171.86	$173.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001142	EAP	Custom 27001142		Pouch Fecal Incontinence	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001143	EAP	Custom 27001143		Kit Pressure Monitoring T	BOTH IP/OP	$177.00 	$130.98	$0.00	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.37	$131.37	$136.43	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$88.50	$140.18	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001144	EAP	Custom 27001144		Transducer  Disp For Icp	BOTH IP/OP	$79.00 	$58.46	$0.00	$63.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.63	$58.63	$60.89	$0.00	$16.46	$0.00	$0.00	$0.00	$0.00	$39.50	$62.57	$63.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001145	EAP	Custom 27001145		Bridge Kit Bifurated Resp	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$0.00	$0.00	$0.00	$60.00	$95.04	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001146	EAP	Custom 27001146		Kit Transducer Monitoring	BOTH IP/OP	$339.00 	$250.86	$0.00	$271.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$251.61	$251.61	$261.30	$0.00	$70.65	$0.00	$0.00	$0.00	$0.00	$169.50	$268.49	$271.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001147	EAP	Custom 27001147		Kit  Pressure Monitoring	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001149	EAP	Custom 27001149		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001150	EAP	Custom 27001150		Kit Pecutaneous Introduce	BOTH IP/OP	$276.00 	$204.24	$0.00	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.85	$204.85	$212.74	$0.00	$57.52	$0.00	$0.00	$0.00	$0.00	$138.00	$218.59	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001151	EAP	Custom 27001151		Chest Unit Drainage Pleur	BOTH IP/OP	$401.00 	$296.74	$0.00	$320.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$297.62	$297.62	$309.09	$0.00	$83.57	$0.00	$0.00	$0.00	$0.00	$200.50	$317.59	$320.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001152	EAP	Custom 27001152		Chest Unit Dry Suction Sy	BOTH IP/OP	$316.00 	$233.84	$0.00	$252.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$234.54	$234.54	$243.57	$0.00	$65.85	$0.00	$0.00	$0.00	$0.00	$158.00	$250.27	$252.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001157	EAP	Custom 27001157		Dressing X-large	BOTH IP/OP	$697.00 	$515.78	$0.00	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.31	$517.31	$537.25	$0.00	$145.25	$0.00	$0.00	$0.00	$0.00	$348.50	$552.02	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001158	EAP	Custom 27001158		Trac Dressing Xl	BOTH IP/OP	$157.00 	$116.18	$0.00	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.53	$116.53	$121.02	$0.00	$32.72	$0.00	$0.00	$0.00	$0.00	$78.50	$124.34	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001161	EAP	Custom 27001161		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001162	EAP	Custom 27001162		Kit Triple Lumen Catheter	BOTH IP/OP	$344.00 	$254.56	$0.00	$275.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$255.32	$255.32	$265.16	$0.00	$71.69	$0.00	$0.00	$0.00	$0.00	$172.00	$272.45	$275.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001163	EAP	Custom 27001163		Wire Guide Dual Purpose	BOTH IP/OP	$392.00 	$290.08	$0.00	$313.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.94	$290.94	$302.15	$0.00	$81.69	$0.00	$0.00	$0.00	$0.00	$196.00	$310.46	$313.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001164	EAP	Custom 27001164		Kit Monitoring Intracrani	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$354.57	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001165	EAP	Custom 27001165		Cath  Trauma Ventricular	BOTH IP/OP	"$1,014.00 "	$750.36	$0.00	$811.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.00	$803.09	$811.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001166	EAP	Custom 27001166		Catheter Swan Ganz	BOTH IP/OP	$309.00 	$228.66	$0.00	$247.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.34	$229.34	$238.18	$0.00	$64.40	$0.00	$0.00	$0.00	$0.00	$154.50	$244.73	$247.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001167	EAP	Custom 27001167		Delivery System Closed In	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001173	EAP	Custom 27001173		Filter Set 0.22 Micron	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001174	EAP	Custom 27001174		Tray Catheter Urethral 14	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001176	EAP	Custom 27001176		Kit Ventriculostomy	BOTH IP/OP	"$1,782.00 "	"$1,318.68"	$0.00	"$1,425.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,322.60"	"$1,322.60"	"$1,373.57"	$0.00	$371.37	$0.00	$0.00	$0.00	$0.00	$891.00	"$1,411.34"	"$1,425.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001178	EAP	Custom 27001178		Central Line Dressing Tray With Biopatch	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$30.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001179	EAP	Custom 27001179		Kit Lumbar Drainage Edm	BOTH IP/OP	$788.00 	$583.12	$0.00	$630.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$584.85	$584.85	$607.39	$0.00	$164.22	$0.00	$0.00	$0.00	$0.00	$394.00	$624.10	$630.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001190	EAP	Custom 27001190		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001191	EAP	Custom 27001191		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001192	EAP	Custom 27001192		Sleeve Thigh Regular Dvt	BOTH IP/OP	$553.00 	$409.22	$0.00	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.44	$410.44	$426.25	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001193	EAP	Custom 27001193		Sleeve Thigh X-large Dvt	BOTH IP/OP	$663.00 	$490.62	$0.00	$530.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$492.08	$492.08	$511.04	$0.00	$138.17	$0.00	$0.00	$0.00	$0.00	$331.50	$525.10	$530.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001194	EAP	Custom 27001194		First Step Select Overlay	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.23	$97.23	$100.97	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$65.50	$103.75	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001205	EAP	Custom 27001205		Dialysis Filter	BOTH IP/OP	$651.00 	$481.74	$0.00	$520.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.17	$483.17	$501.79	$0.00	$135.67	$0.00	$0.00	$0.00	$0.00	$325.50	$515.59	$520.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001206	EAP	Custom 27001206		Tubes Extension Plain Pla	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001218	EAP	Custom 27001218		Catheter Thoracic 16f	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001219	EAP	Custom 27001219		Catheter Thoracic 20fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001220	EAP	Custom 27001220		Catheter Thoracic 24fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001221	EAP	Custom 27001221		Catheter Thoracic 28fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001222	EAP	Custom 27001222		Catheter Thoracic 32fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001223	EAP	Custom 27001223		Catheter Urethral 8fr	BOTH IP/OP	$31.00 	$22.94	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.01	$23.01	$23.89	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.50	$24.55	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001224	EAP	Custom 27001224		Entriflex	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001225	EAP	Custom 27001225		Tube  Feeding Nasogastric	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$6.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001226	EAP	Custom 27001226		Artery Arterial Catheriza	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$0.00	$0.00	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001227	EAP	Custom 27001227		Artery Radial Catherizati	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001228	EAP	Custom 27001228		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001229	EAP	Custom 27001229		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001231	EAP	Custom 27001231		Set Urinary Drain W/conta	BOTH IP/OP	$21.00 	$15.54	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.59	$15.59	$16.19	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$10.50	$16.63	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001232	EAP	Custom 27001232		Tray Catheter Insrtn Dulm	BOTH IP/OP	$434.00 	$321.16	$0.00	$347.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$322.11	$322.11	$334.53	$0.00	$90.45	$0.00	$0.00	$0.00	$0.00	$217.00	$343.73	$347.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001234	EAP	Custom 27001234		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001235	EAP	Custom 27001235		Stapler Skin Disposable 3	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$24.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001236	EAP	Custom 27001236		Triconnector With Valve	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001240	EAP	Custom 27001240		Aquacel Ag 4x4	BOTH IP/OP	$92.00 	$68.08	$0.00	$73.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.28	$68.28	$70.91	$0.00	$19.17	$0.00	$0.00	$0.00	$0.00	$46.00	$72.86	$73.60	$0.00	$59.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001243	EAP	Custom 27001243		Electrodes Operative	BOTH IP/OP	$289.00 	$213.86	$0.00	$231.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.50	$214.50	$222.76	$0.00	$60.23	$0.00	$0.00	$0.00	$0.00	$144.50	$228.89	$231.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001249	EAP	Custom 27001249		Kit Pressure Monitoring T	BOTH IP/OP	$177.00 	$130.98	$0.00	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.37	$131.37	$136.43	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$88.50	$140.18	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001250	EAP	Custom 27001250		Kit Transducer Monitoring	BOTH IP/OP	$339.00 	$250.86	$0.00	$271.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$251.61	$251.61	$261.30	$0.00	$70.65	$0.00	$0.00	$0.00	$0.00	$169.50	$268.49	$271.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001252	EAP	Custom 27001252		Kit  Pressure Monitoring	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001254	EAP	Custom 27001254		Bag 1000ml Pump Set	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.78	$20.78	$21.58	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001255	EAP	Custom 27001255		Kit Pecutaneous Introduce	BOTH IP/OP	$276.00 	$204.24	$0.00	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.85	$204.85	$212.74	$0.00	$57.52	$0.00	$0.00	$0.00	$0.00	$138.00	$218.59	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001256	EAP	Custom 27001256		Chest Unit Drainage Pleur	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$144.73	$144.73	$150.31	$0.00	$40.64	$0.00	$0.00	$0.00	$0.00	$97.50	$154.44	$156.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001257	EAP	Custom 27001257		Bag Pressure  500cc	BOTH IP/OP	$82.00 	$60.68	$0.00	$65.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.86	$60.86	$63.21	$0.00	$17.09	$0.00	$0.00	$0.00	$0.00	$41.00	$64.94	$65.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001258	EAP	Custom 27001258		Bag Pressure 1000cc	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001260	EAP	Custom 27001260		Tube Feeding Ng 8fr 36in Entri	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001261	EAP	Custom 27001261		Multi Lumen Cvc W/o Silver Su	BOTH IP/OP	$751.00 	$555.74	$0.00	$600.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$557.39	$557.39	$578.87	$0.00	$156.51	$0.00	$0.00	$0.00	$0.00	$375.50	$594.79	$600.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001262	EAP	Custom 27001262		Kit Triple Lumen Catheter	BOTH IP/OP	$697.00 	$515.78	$0.00	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.31	$517.31	$537.25	$0.00	$145.25	$0.00	$0.00	$0.00	$0.00	$348.50	$552.02	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001263	EAP	Custom 27001263		Catheter Swan Ganz	BOTH IP/OP	$726.00 	$537.24	$0.00	$580.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$538.84	$538.84	$559.60	$0.00	$151.30	$0.00	$0.00	$0.00	$0.00	$363.00	$574.99	$580.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001264	EAP	Custom 27001264		Delivery System Closed In	BOTH IP/OP	$141.00 	$104.34	$0.00	$112.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$104.65	$104.65	$108.68	$0.00	$29.38	$0.00	$0.00	$0.00	$0.00	$70.50	$111.67	$112.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001265	EAP	Custom 27001265		Set T-port Small Bore Ext	BOTH IP/OP	$14.00 	$10.36	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.39	$10.39	$10.79	$0.00	$2.92	$0.00	$0.00	$0.00	$0.00	$7.00	$11.09	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001268	EAP	Custom 27001268		Tray Catheter Urethral 14	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001270	EAP	Custom 27001270		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001271	EAP	Custom 27001271		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001272	EAP	Custom 27001272		Tray Thoracentesis Dispos	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$0.00	$0.00	$0.00	$103.50	$163.94	$165.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001273	EAP	Custom 27001273		Sponges Laparotomy 6522	BOTH IP/OP	$119.00 	$88.06	$0.00	$95.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.32	$88.32	$91.73	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$59.50	$94.25	$95.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001274	EAP	Custom 27001274		Bovie Pencil Valleylab	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001283	EAP	Custom 27001283		Dressing Acticoat 16x16	BOTH IP/OP	$678.00 	$501.72	$0.00	$542.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$503.21	$503.21	$522.60	$0.00	$141.30	$0.00	$0.00	$0.00	$0.00	$339.00	$536.98	$542.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001284	EAP	Custom 27001284		Kit Vascular Conform	BOTH IP/OP	$108.00 	$79.92	$0.00	$86.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.16	$80.16	$83.25	$0.00	$22.51	$0.00	$0.00	$0.00	$0.00	$54.00	$85.54	$86.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001285	EAP	Custom 27001285		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001286	EAP	Custom 27001286		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001287	EAP	Custom 27001287		Sleeve Thigh Regular Dvt	BOTH IP/OP	$553.00 	$409.22	$0.00	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.44	$410.44	$426.25	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001288	EAP	Custom 27001288		Sleeve Thigh X-large Dvt	BOTH IP/OP	$284.00 	$210.16	$0.00	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.78	$210.78	$218.91	$0.00	$59.19	$0.00	$0.00	$0.00	$0.00	$142.00	$224.93	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001289	EAP	Custom 27001289		1st First Select Overlay	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.23	$97.23	$100.97	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$65.50	$103.75	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001298	EAP	Custom 27001298		Therapy For Cvvh/cvvhd 4	BOTH IP/OP	$166.00 	$122.84	$0.00	$132.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.21	$123.21	$127.95	$0.00	$34.59	$0.00	$0.00	$0.00	$0.00	$83.00	$131.47	$132.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001299	EAP	Custom 27001299		Dialysis Filter	BOTH IP/OP	$699.00 	$517.26	$0.00	$559.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$518.80	$518.80	$538.79	$0.00	$145.67	$0.00	$0.00	$0.00	$0.00	$349.50	$553.61	$559.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001312	EAP	Custom 27001312		Catheter  Thoracic 20fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001313	EAP	Custom 27001313		Catheter Thoracic 32fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001314	EAP	Custom 27001314		Catheter Thoracic 36fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001315	EAP	HCPCS C1729		Catheter Foley 5cc 14fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27001316	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27001317	EAP	HCPCS C1729		Catheter Foley 5cc 18fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27001318	EAP	Custom 27001318		Catheter Ventricular 20cm	BOTH IP/OP	$683.00 	$505.42	$0.00	$546.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.92	$506.92	$526.46	$0.00	$142.34	$0.00	$0.00	$0.00	$0.00	$341.50	$540.94	$546.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001319	EAP	Custom 27001319		Catheter Edm Ii Becker	BOTH IP/OP	"$1,339.00 "	$990.86	$0.00	"$1,071.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$993.81	$993.81	"$1,032.10"	$0.00	$279.05	$0.00	$0.00	$0.00	$0.00	$669.50	"$1,060.49"	"$1,071.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001320	EAP	Custom 27001320		Artery Arterial Catheriza	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001321	EAP	Custom 27001321		Artery Radial Catherizati	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001322	EAP	Custom 27001322		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001323	EAP	Custom 27001323		Tube Salem Silicone Size	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001324	EAP	Custom 27001324		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001328	EAP	Custom 27001328		Bag Drainage Becker	BOTH IP/OP	$202.00 	$149.48	$0.00	$161.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.92	$149.92	$155.70	$0.00	$42.10	$0.00	$0.00	$0.00	$0.00	$101.00	$159.98	$161.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001329	EAP	Custom 27001329		Tray Catheter Insrtn Dulm	BOTH IP/OP	$937.00 	$693.38	$0.00	$749.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$695.44	$695.44	$722.24	$0.00	$195.27	$0.00	$0.00	$0.00	$0.00	$468.50	$742.10	$749.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001330	EAP	Custom 27001330		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001331	EAP	Custom 27001331		Triconnector With Valve	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001337	EAP	Custom 27001337		Cable Patient 12 Pin #r53	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001341	EAP	Custom 27001341		Kit Thoracotomy	BOTH IP/OP	$217.00 	$160.58	$0.00	$173.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.06	$161.06	$167.26	$0.00	$45.22	$0.00	$0.00	$0.00	$0.00	$108.50	$171.86	$173.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001347	EAP	Custom 27001347		Pouch Fecal Incontinence	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001348	EAP	Custom 27001348		Kit Pressure Monitoring T	BOTH IP/OP	$177.00 	$130.98	$0.00	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.37	$131.37	$136.43	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$88.50	$140.18	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001349	EAP	Custom 27001349		Transducer  Disp For Icp	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001350	EAP	Custom 27001350		Bridge Kit Bifurated Resp	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$0.00	$0.00	$0.00	$60.00	$95.04	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001351	EAP	Custom 27001351		Kit Transducer Monitoring	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$0.00	$0.00	$0.00	$162.00	$256.61	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001352	EAP	Custom 27001352		Kit  Pressure Monitoring	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001354	EAP	Custom 27001354		Bag Feeding Gavage 500ml	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.78	$20.78	$21.58	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001355	EAP	Custom 27001355		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001356	EAP	Custom 27001356		Kit Pecutaneous Introduce	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.74	$95.74	$99.43	$0.00	$26.88	$0.00	$0.00	$0.00	$0.00	$64.50	$102.17	$103.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001357	EAP	Custom 27001357		Chest Unit Drainage Pleur	BOTH IP/OP	$455.00 	$336.70	$0.00	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.70	$337.70	$350.71	$0.00	$94.82	$0.00	$0.00	$0.00	$0.00	$227.50	$360.36	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001358	EAP	Custom 27001358		Chest Imot Dry Suction Sy	BOTH IP/OP	$316.00 	$233.84	$0.00	$252.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$234.54	$234.54	$243.57	$0.00	$65.85	$0.00	$0.00	$0.00	$0.00	$158.00	$250.27	$252.80	$0.00	$205.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001363	EAP	Custom 27001363		Trac Dressing Xl	BOTH IP/OP	$157.00 	$116.18	$0.00	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.53	$116.53	$121.02	$0.00	$32.72	$0.00	$0.00	$0.00	$0.00	$78.50	$124.34	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001366	EAP	Custom 27001366		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001367	EAP	Custom 27001367		Kit Triple Lumen Catheter	BOTH IP/OP	$697.00 	$515.78	$0.00	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.31	$517.31	$537.25	$0.00	$145.25	$0.00	$0.00	$0.00	$0.00	$348.50	$552.02	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001369	EAP	Custom 27001369		Kit Monitoring Intracrani	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$354.57	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001370	EAP	Custom 27001370		Catheter Swan Ganz	BOTH IP/OP	$674.00 	$498.76	$0.00	$539.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.24	$500.24	$519.52	$0.00	$140.46	$0.00	$0.00	$0.00	$0.00	$337.00	$533.81	$539.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001371	EAP	Custom 27001371		Delivery System Closed In	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.81	$112.81	$117.16	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$76.00	$120.38	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001372	EAP	Custom 27001372		Probe V-pacing	BOTH IP/OP	"$1,403.00 "	"$1,038.22"	$0.00	"$1,122.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,041.31"	"$1,041.31"	"$1,081.43"	$0.00	$292.39	$0.00	$0.00	$0.00	$0.00	$701.50	"$1,111.18"	"$1,122.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001374	EAP	Custom 27001374		Filter Set 0.22 Micron	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001376	EAP	Custom 27001376		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001377	EAP	Custom 27001377		Kit Ventriculostomy	BOTH IP/OP	"$1,782.00 "	"$1,318.68"	$0.00	"$1,425.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,322.60"	"$1,322.60"	"$1,373.57"	$0.00	$371.37	$0.00	$0.00	$0.00	$0.00	$891.00	"$1,411.34"	"$1,425.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001379	EAP	Custom 27001379		Tray Pericardiocentesis	BOTH IP/OP	"$1,235.00 "	$913.90	$0.00	$988.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$916.62	$916.62	$951.94	$0.00	$257.37	$0.00	$0.00	$0.00	$0.00	$617.50	$978.12	$988.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001380	EAP	Custom 27001380		Central Line Dressing Tray With Biopatch	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001391	EAP	Custom 27001391		.014 Nitrex Guidewire	BOTH IP/OP	"$2,554.00 "	"$1,889.96"	$0.00	"$2,043.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,895.58"	"$1,895.58"	"$1,968.62"	$0.00	$532.25	$0.00	$0.00	$0.00	$0.00	"$1,277.00"	"$2,022.77"	"$2,043.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001392	EAP	Custom 27001392		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001393	EAP	Custom 27001393		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001394	EAP	Custom 27001394		Sleeve Thigh Regular Dvt	BOTH IP/OP	$553.00 	$409.22	$0.00	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.44	$410.44	$426.25	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001395	EAP	Custom 27001395		Sleeve Thigh X-large Dvt	BOTH IP/OP	$616.00 	$455.84	$0.00	$492.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$457.20	$457.20	$474.81	$0.00	$128.37	$0.00	$0.00	$0.00	$0.00	$308.00	$487.87	$492.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001399	EAP	Custom 27001399		Tray Circumcision	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001400	EAP	Custom 27001400		Needle Neo-natal Lumbar P	BOTH IP/OP	$21.00 	$15.54	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.59	$15.59	$16.19	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$10.50	$16.63	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001401	EAP	Custom 27001401		Tubes Capillary Hepariniz	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001403	EAP	Custom 27001403		Tube Feeding Plastic 8fr	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001408	EAP	Custom 27001408		Bag Feeding Gavage 500ml	BOTH IP/OP	$14.00 	$10.36	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.39	$10.39	$10.79	$0.00	$2.92	$0.00	$0.00	$0.00	$0.00	$7.00	$11.09	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001409	EAP	Custom 27001409		Set Breast Pump Complete	BOTH IP/OP	$71.00 	$52.54	$0.00	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.70	$52.70	$54.73	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$35.50	$56.23	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001410	EAP	Custom 27001410		Cassettes Imed #9260 20/c	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001411	EAP	Custom 27001411		Catheter Quick Iv 22ga	BOTH IP/OP	$7.00 	$5.18	$0.00	$5.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.20	$5.20	$5.40	$0.00	$1.46	$0.00	$0.00	$0.00	$0.00	$3.50	$5.54	$5.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001412	EAP	Custom 27001412		Filter Set 0.22 Micron	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001413	EAP	Custom 27001413		Set T-port Small Bore Ext	BOTH IP/OP	$14.00 	$10.36	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.39	$10.39	$10.79	$0.00	$2.92	$0.00	$0.00	$0.00	$0.00	$7.00	$11.09	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001415	EAP	Custom 27001415		Tube Sump Gastric 50/cs	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001418	EAP	Custom 27001418		Precision Introd.26g(1.9f)	BOTH IP/OP	$149.00 	$110.26	$0.00	$119.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$110.59	$110.59	$114.85	$0.00	$31.05	$0.00	$0.00	$0.00	$0.00	$74.50	$118.01	$119.20	$0.00	$96.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001419	EAP	Custom 27001419		26g Catheter(1.9f 1st Picc Bd)	BOTH IP/OP	$260.00 	$192.40	$0.00	$208.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.97	$192.97	$200.41	$0.00	$54.18	$0.00	$0.00	$0.00	$0.00	$130.00	$205.92	$208.00	$0.00	$169.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001420	EAP	Custom 27001420		Picc Tray (bd Procedure Tray)	BOTH IP/OP	$219.00 	$162.06	$0.00	$175.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.54	$162.54	$168.81	$0.00	$45.64	$0.00	$0.00	$0.00	$0.00	$109.50	$173.45	$175.20	$0.00	$142.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001421	EAP	Custom 27001421		Precision Introducer 22g(2.8f)	BOTH IP/OP	$183.00 	$135.42	$0.00	$146.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$135.82	$135.82	$141.06	$0.00	$38.14	$0.00	$0.00	$0.00	$0.00	$91.50	$144.94	$146.40	$0.00	$118.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001422	EAP	Custom 27001422		22g Catheter(2.8f 1st Picc Bd)	BOTH IP/OP	$343.00 	$253.82	$0.00	$274.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.57	$254.57	$264.38	$0.00	$71.48	$0.00	$0.00	$0.00	$0.00	$171.50	$271.66	$274.40	$0.00	$222.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001423	EAP	Custom 27001423		Argyle Picc 1.9frx39cm Dual Lu	BOTH IP/OP	$423.00 	$313.02	$0.00	$338.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$313.95	$313.95	$326.05	$0.00	$88.15	$0.00	$0.00	$0.00	$0.00	$211.50	$335.02	$338.40	$0.00	$274.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001424	EAP	Custom 27001424		20g(3fr)bdl Cath Picc Dual Lum	BOTH IP/OP	$154.00 	$113.96	$0.00	$123.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.30	$114.30	$118.70	$0.00	$32.09	$0.00	$0.00	$0.00	$0.00	$77.00	$121.97	$123.20	$0.00	$100.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001428	EAP	Custom 27001428		Tray Circumcision	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001429	EAP	Custom 27001429		Needle Neo-natal Lumbar P	BOTH IP/OP	$21.00 	$15.54	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.59	$15.59	$16.19	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$10.50	$16.63	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001430	EAP	Custom 27001430		Needle Spinal 22g 25/bx	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001431	EAP	Custom 27001431		Tubes Capillary Hepariniz	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001432	EAP	Custom 27001432		Tube Nasogastric Feeding	BOTH IP/OP	$91.00 	$67.34	$0.00	$72.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.54	$67.54	$70.14	$0.00	$18.96	$0.00	$0.00	$0.00	$0.00	$45.50	$72.07	$72.80	$0.00	$59.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001435	EAP	Custom 27001435		Catheter Urethral 8fr	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001436	EAP	Custom 27001436		Catheter Umbilical 15 3-	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001437	EAP	Custom 27001437		Catheter Umbilical 15 5f	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$31.50	$49.90	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001438	EAP	Custom 27001438		Tube Feeding Plastic 8fr	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001441	EAP	Custom 27001441		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001443	EAP	Custom 27001443		Pouch Little Ones  Cut To	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001446	EAP	Custom 27001446		Transducer With Interg 43	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.46	$27.46	$28.52	$0.00	$7.71	$0.00	$0.00	$0.00	$0.00	$18.50	$29.30	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001447	EAP	Custom 27001447		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001448	EAP	Custom 27001448		Catheter  Thoracic Trocar	BOTH IP/OP	$134.00 	$99.16	$0.00	$107.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.00	$106.13	$107.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001449	EAP	Custom 27001449		Catheter Thoracic Trocar 10 F	BOTH IP/OP	$177.00 	$130.98	$0.00	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.37	$131.37	$136.43	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$88.50	$140.18	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001450	EAP	Custom 27001450		Chest Unit  Drainage Pleur	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001451	EAP	Custom 27001451		Cassettes Imed #9260 20/c	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001452	EAP	Custom 27001452		Catheter Quick Iv 22gax1-	BOTH IP/OP	$3.00 	$2.22	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.23	$2.23	$2.31	$0.00	$0.63	$0.00	$0.00	$0.00	$0.00	$1.50	$2.38	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001453	EAP	Custom 27001453		Catheter Introducer Steri	BOTH IP/OP	$3.00 	$2.22	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.23	$2.23	$2.31	$0.00	$0.63	$0.00	$0.00	$0.00	$0.00	$1.50	$2.38	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001454	EAP	Custom 27001454		Filter Set 0.22 Micron	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001455	EAP	Custom 27001455		Set T-port Small Bore Ext	BOTH IP/OP	$14.00 	$10.36	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.39	$10.39	$10.79	$0.00	$2.92	$0.00	$0.00	$0.00	$0.00	$7.00	$11.09	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001456	EAP	Custom 27001456		Tray Transfusion Sterile	BOTH IP/OP	$597.00 	$441.78	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$443.09	$443.09	$460.17	$0.00	$124.41	$0.00	$0.00	$0.00	$0.00	$298.50	$472.82	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001458	EAP	Custom 27001458		Tube Sump Gastric 50/cs	BOTH IP/OP	$44.00 	$32.56	$0.00	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.66	$32.66	$33.92	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001459	EAP	HCPCS C1751		Catheter  Iv 26g 120/cs	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$0.00	$0.00	$0.00	$4.38	$0.00	$0.00	$4.46	$0.00	$0.00	$0.00	$0.00	$0.00
27001466	EAP	Custom 27001466		Catheter Suction 5fr Ster	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001468	EAP	Custom 27001468		Catheter  Suction Plastic 14	BOTH IP/OP	$3.00 	$2.22	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.50	$2.38	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001469	EAP	Custom 27001469		Catheter Urethral Two-eye	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001471	EAP	Custom 27001471		Set Urinary Drain W/conta	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001473	EAP	Custom 27001473		Scaple Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001475	EAP	Custom 27001475		Stapler Skin Disposable 3	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.57	$64.57	$67.06	$0.00	$18.13	$0.00	$0.00	$0.00	$0.00	$43.50	$68.90	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001486	EAP	Custom 27001486		Speculum Pediatric	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001487	EAP	Custom 27001487		Bag Hyperinflation	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.09	$63.09	$65.52	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001490	EAP	Custom 27001490		Tray Catheter Urethral 14	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001492	EAP	Custom 27001492		Tray Foley Preconnected 1	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$0.00	$0.00	$0.00	$25.50	$40.39	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001494	EAP	Custom 27001494		Sponges Laparotomy 6522	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001501	EAP	Custom 27001501		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001502	EAP	Custom 27001502		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001503	EAP	Custom 27001503		Sleeve Thigh Regular Dvt	BOTH IP/OP	$238.00 	$176.12	$0.00	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.64	$176.64	$183.45	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$119.00	$188.50	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001618	EAP	Custom 27001618		Triadyne Ii (bed)	BOTH IP/OP	$737.00 	$545.38	$0.00	$589.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.00	$547.00	$568.08	$0.00	$153.59	$0.00	$0.00	$0.00	$0.00	$368.50	$583.70	$589.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001620	EAP	Custom 27001620		Fluidair Elite (bed)	BOTH IP/OP	$772.00 	$571.28	$0.00	$617.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$572.98	$572.98	$595.06	$0.00	$160.88	$0.00	$0.00	$0.00	$0.00	$386.00	$611.42	$617.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001635	EAP	Custom 27001635		Tube Salem Sump 48 Lengt	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001636	EAP	Custom 27001636		Set Urinary Drain W/conta	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001641	EAP	Custom 27001641		Tray Douch Disposable	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001644	EAP	Custom 27001644		Tray Foley Preconnected 1	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001645	EAP	Custom 27001645		Tray Foley Perconnected 1	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001647	EAP	Custom 27001647		Arrow Super/extreme Cath Kit	BOTH IP/OP	$802.00 	$593.48	$0.00	$641.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$595.24	$595.24	$618.18	$0.00	$167.14	$0.00	$0.00	$0.00	$0.00	$401.00	$635.18	$641.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001649	EAP	Custom 27001649		Central Line Dressing Tray	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001650	EAP	Custom 27001650		Continuous Cardiac O/put Swans	BOTH IP/OP	$604.00 	$446.96	$0.00	$483.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$448.29	$448.29	$465.56	$0.00	$125.87	$0.00	$0.00	$0.00	$0.00	$302.00	$478.37	$483.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001652	EAP	Custom 27001652		Pressure Transclucer Kits	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001653	EAP	Custom 27001653		Percutaneous Introducer Kits	BOTH IP/OP	"$2,364.00 "	"$1,749.36"	$0.00	"$1,891.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,754.56"	"$1,754.56"	"$1,822.17"	$0.00	$492.66	$0.00	$0.00	$0.00	$0.00	"$1,182.00"	"$1,872.29"	"$1,891.20"	$0.00	"$1,536.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001655	EAP	Custom 27001655		Sutures	BOTH IP/OP	$211.00 	$156.14	$0.00	$168.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.60	$156.60	$162.64	$0.00	$43.97	$0.00	$0.00	$0.00	$0.00	$105.50	$167.11	$168.80	$0.00	$137.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001657	EAP	Custom 27001657		Swan Ganz Catheters	BOTH IP/OP	$604.00 	$446.96	$0.00	$483.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$448.29	$448.29	$465.56	$0.00	$125.87	$0.00	$0.00	$0.00	$0.00	$302.00	$478.37	$483.20	$0.00	$392.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001658	EAP	Custom 27001658		Guidewire .35x.68cm	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001660	EAP	Custom 27001660		Huber Needle	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$11.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001665	EAP	Custom 27001665		14fx15cm Schon Xl Dbl Lmn Vasc	BOTH IP/OP	"$6,497.00 "	"$4,807.78"	$0.00	"$5,197.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,007.89"	$0.00	"$1,353.97"	$0.00	$0.00	$0.00	$0.00	"$3,248.50"	"$5,145.62"	"$5,197.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001666	EAP	Custom 27001666		14fx24cm Schon Xl Dbl Lmn Vasc	BOTH IP/OP	"$6,497.00 "	"$4,807.78"	$0.00	"$5,197.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,007.89"	$0.00	"$1,353.97"	$0.00	$0.00	$0.00	$0.00	"$3,248.50"	"$5,145.62"	"$5,197.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001667	EAP	Custom 27001667		14fx20cm Schon Xl Dbl Lmn Vasc	BOTH IP/OP	"$6,497.00 "	"$4,807.78"	$0.00	"$5,197.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,007.89"	$0.00	"$1,353.97"	$0.00	$0.00	$0.00	$0.00	"$3,248.50"	"$5,145.62"	"$5,197.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001670	EAP	Custom 27001670		Twist Lock Cath Gard Catheter	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$61.66	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001671	EAP	Custom 27001671		Needles 18 Ga/7cm (cook)	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001672	EAP	Custom 27001672		Cook Tlc Tray	BOTH IP/OP	$457.00 	$338.18	$0.00	$365.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$339.19	$339.19	$352.26	$0.00	$95.24	$0.00	$0.00	$0.00	$0.00	$228.50	$361.94	$365.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001675	EAP	Custom 27001675		Tubes Extension Plain Pla	BOTH IP/OP	$5.00 	$3.70	$0.00	$4.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.71	$3.71	$3.85	$0.00	$1.04	$0.00	$0.00	$0.00	$0.00	$2.50	$3.96	$4.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001679	EAP	Custom 27001679		Meter Astech Peak Flow	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.77	$69.77	$72.46	$0.00	$19.59	$0.00	$0.00	$0.00	$0.00	$47.00	$74.45	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001692	EAP	Custom 27001692		Catheter  Thoracic 28fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001693	EAP	Custom 27001693		Catheter Thoracic 32fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001694	EAP	Custom 27001694		Catheter Thoracic 36fr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001695	EAP	HCPCS C1729		Catheter Foley 5cc 14fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27001696	EAP	HCPCS C1729		Catheter Coude Size 14fr	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$59.19	$59.19	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
27001697	EAP	HCPCS C1729		Catheter Coude Size 16fr	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$59.19	$59.19	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
27001698	EAP	Custom 27001698		Artery Arterial Catheriza	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$51.00	$80.78	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001699	EAP	Custom 27001699		Artery Radial Catherizati	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001700	EAP	Custom 27001700		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001701	EAP	Custom 27001701		Tube Salem Silicone Size	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001702	EAP	Custom 27001702		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001703	EAP	Custom 27001703		Kit Tracheotomy Care Ster	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001706	EAP	Custom 27001706		Tray Catheter Insrtn Dulm	BOTH IP/OP	"$1,009.00 "	$746.66	$0.00	$807.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$748.88	$748.88	$777.74	$0.00	$210.28	$0.00	$0.00	$0.00	$0.00	$504.50	$799.13	$807.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001707	EAP	Custom 27001707		Scapel Surg W/handle Attached	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001709	EAP	Custom 27001709		Triconnector With Valve	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001713	EAP	Custom 27001713		Pouch Active Life Squib Drain	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001715	EAP	Custom 27001715		Cable Patient 12 Pin #r53	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001716	EAP	Custom 27001716		Electrodes Operative	BOTH IP/OP	$122.00 	$90.28	$0.00	$97.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.55	$90.55	$94.04	$0.00	$25.42	$0.00	$0.00	$0.00	$0.00	$61.00	$96.62	$97.60	$0.00	$79.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001721	EAP	Custom 27001721		Pouch Fecal Incontinence	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001722	EAP	Custom 27001722		Kit Pressure Monitoring T	BOTH IP/OP	$177.00 	$130.98	$0.00	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.37	$131.37	$136.43	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$88.50	$140.18	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001723	EAP	Custom 27001723		Kit  Pressure Monitoring	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001725	EAP	Custom 27001725		Bag 1000ml Pump Set	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001726	EAP	Custom 27001726		Needle Port-cath 20ga X 1	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$10.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001727	EAP	Custom 27001727		Chest Unit Drainage Pleur	BOTH IP/OP	$455.00 	$336.70	$0.00	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.70	$337.70	$350.71	$0.00	$94.82	$0.00	$0.00	$0.00	$0.00	$227.50	$360.36	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001732	EAP	Custom 27001732		Dressing X-large	BOTH IP/OP	$697.00 	$515.78	$0.00	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.31	$517.31	$537.25	$0.00	$145.25	$0.00	$0.00	$0.00	$0.00	$348.50	$552.02	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001733	EAP	Custom 27001733		Trac Dressing Xl	BOTH IP/OP	$157.00 	$116.18	$0.00	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.53	$116.53	$121.02	$0.00	$32.72	$0.00	$0.00	$0.00	$0.00	$78.50	$124.34	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001735	EAP	Custom 27001735		Tube Feeding Ng 8fr 36in Entri	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001736	EAP	Custom 27001736		Kit Triple Lumen Catheter	BOTH IP/OP	$697.00 	$515.78	$0.00	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.31	$517.31	$537.25	$0.00	$145.25	$0.00	$0.00	$0.00	$0.00	$348.50	$552.02	$557.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001740	EAP	Custom 27001740		Tube Trach #8 Dct	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.64	$248.64	$258.22	$0.00	$69.81	$0.00	$0.00	$0.00	$0.00	$167.50	$265.32	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001741	EAP	Custom 27001741		Tube Trach #6 Dct	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.64	$248.64	$258.22	$0.00	$69.81	$0.00	$0.00	$0.00	$0.00	$167.50	$265.32	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001742	EAP	Custom 27001742		Tube Trach #10 Dct	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.64	$248.64	$258.22	$0.00	$69.81	$0.00	$0.00	$0.00	$0.00	$167.50	$265.32	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001743	EAP	Custom 27001743		Tube Tracheostomy 4-dcfs	BOTH IP/OP	$326.00 	$241.24	$0.00	$260.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.96	$241.96	$251.28	$0.00	$67.94	$0.00	$0.00	$0.00	$0.00	$163.00	$258.19	$260.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001744	EAP	Custom 27001744		Filter Set 0.22 Micron	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001746	EAP	Custom 27001746		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001747	EAP	Custom 27001747		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001748	EAP	Custom 27001748		Tray Thoracentesis Dispos	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.96	$74.96	$77.85	$0.00	$21.05	$0.00	$0.00	$0.00	$0.00	$50.50	$79.99	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001763	EAP	Custom 27001763		Sleeve Knee Regular Dvt	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$0.00	$0.00	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001764	EAP	Custom 27001764		Sleeve Knee X-large Dvt	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001765	EAP	Custom 27001765		Sleeve Thigh Regular Dvt	BOTH IP/OP	$238.00 	$176.12	$0.00	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.64	$176.64	$183.45	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$119.00	$188.50	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001766	EAP	Custom 27001766		Sleeve Thigh X-large Dvt	BOTH IP/OP	$284.00 	$210.16	$0.00	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.78	$210.78	$218.91	$0.00	$59.19	$0.00	$0.00	$0.00	$0.00	$142.00	$224.93	$227.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001768	EAP	HCPCS A4300		Temporary Ven Cath Removal	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001769	EAP	Custom 27001769		Tray Catheter Insrtn Dulm	BOTH IP/OP	"$1,048.00 "	$775.52	$0.00	$838.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.83	$777.83	$807.80	$0.00	$218.40	$0.00	$0.00	$0.00	$0.00	$524.00	$830.02	$838.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001770	EAP	Custom 27001770		Central Line Dressing Tray	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001771	EAP	Custom 27001771		Catheter Repair Kit	BOTH IP/OP	$803.00 	$594.22	$0.00	$642.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$595.99	$595.99	$618.95	$0.00	$167.35	$0.00	$0.00	$0.00	$0.00	$401.50	$635.98	$642.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001773	EAP	Custom 27001773		Occult Blood Supply	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001778	EAP	Custom 27001778		Needle Port-cath 20ga X 1	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001779	EAP	Custom 27001779		Tray Catheter Urethral 14	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$10.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001781	EAP	Custom 27001781		Ace Wrap	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001782	EAP	Custom 27001782		Splint	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001783	EAP	Custom 27001783		Splint - Supply	BOTH IP/OP	$266.00 	$196.84	$0.00	$212.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.43	$197.43	$205.03	$0.00	$55.43	$0.00	$0.00	$0.00	$0.00	$133.00	$210.67	$212.80	$0.00	$172.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001785	EAP	Custom 27001785		Ace Wrap	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001786	EAP	Custom 27001786		Ace Wrap Supply	BOTH IP/OP	$31.00 	$22.94	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.01	$23.01	$23.89	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.50	$24.55	$24.80	$0.00	$20.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001788	EAP	Custom 27001788		Wrist Brace	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27001789	EAP	Custom 27001789		Sling/fig. 8	BOTH IP/OP	$83.00 	$61.42	$0.00	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.60	$61.60	$63.98	$0.00	$17.30	$0.00	$0.00	$0.00	$0.00	$41.50	$65.74	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002257	EAP	Custom 27002257		Cast Application Supply	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$420.83	$420.83	$437.04	$0.00	$118.16	$0.00	$0.00	$0.00	$0.00	$283.50	$449.06	$453.60	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002259	EAP	Custom 27002259		Sling	BOTH IP/OP	$108.00 	$79.92	$0.00	$86.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.16	$80.16	$83.25	$0.00	$22.51	$0.00	$0.00	$0.00	$0.00	$54.00	$85.54	$86.40	$0.00	$70.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002260	EAP	Custom 27002260		Ace Bandage	BOTH IP/OP	$14.00 	$10.36	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.39	$10.39	$10.79	$0.00	$2.92	$0.00	$0.00	$0.00	$0.00	$7.00	$11.09	$11.20	$0.00	$9.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002261	EAP	Custom 27002261		Urinary Drainage Bag	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.78	$20.78	$21.58	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$0.00	$18.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002263	EAP	Custom 27002263		Gastric Lavage Kit	BOTH IP/OP	$234.00 	$173.16	$0.00	$187.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.67	$173.67	$180.37	$0.00	$48.77	$0.00	$0.00	$0.00	$0.00	$117.00	$185.33	$187.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002265	EAP	Custom 27002265		Pelvic Tray	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00	$89.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002266	EAP	Custom 27002266		Peak Flow Meter	BOTH IP/OP	$343.00 	$253.82	$0.00	$274.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.57	$254.57	$264.38	$0.00	$71.48	$0.00	$0.00	$0.00	$0.00	$171.50	$271.66	$274.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002267	EAP	Custom 27002267		Ortho Traction Pins	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.82	$302.82	$314.49	$0.00	$85.03	$0.00	$0.00	$0.00	$0.00	$204.00	$323.14	$326.40	$0.00	$265.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002268	EAP	Custom 27002268		Ace Bandage	BOTH IP/OP	$147.00 	$108.78	$0.00	$117.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.10	$109.10	$113.31	$0.00	$30.63	$0.00	$0.00	$0.00	$0.00	$73.50	$116.42	$117.60	$0.00	$95.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002473	EAP	Custom 27002473		Angiocath Iv Bb 18gx1.25in Nw	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002510	EAP	Custom 27002510		Nuva Ring	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$6.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002515	EAP	Custom 27002515		Clavical Straps	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.78	$20.78	$21.58	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002516	EAP	Custom 27002516		Fiberglass Casting	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.74	$95.74	$99.43	$0.00	$26.88	$0.00	$0.00	$0.00	$0.00	$64.50	$102.17	$103.20	$0.00	$83.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002517	EAP	Custom 27002517		Ankle Stirrup	BOTH IP/OP	$149.00 	$110.26	$0.00	$119.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$110.59	$110.59	$114.85	$0.00	$31.05	$0.00	$0.00	$0.00	$0.00	$74.50	$118.01	$119.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002518	EAP	Custom 27002518		Knee Immobilizer	BOTH IP/OP	$232.00 	$171.68	$0.00	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.19	$172.19	$178.83	$0.00	$48.35	$0.00	$0.00	$0.00	$0.00	$116.00	$183.74	$185.60	$0.00	$150.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002519	EAP	Custom 27002519		Philadephia Collar	BOTH IP/OP	$193.00 	$142.82	$0.00	$154.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.24	$143.24	$148.76	$0.00	$40.22	$0.00	$0.00	$0.00	$0.00	$96.50	$152.86	$154.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002520	EAP	Custom 27002520		Cervical Collar	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002521	EAP	Custom 27002521		Pavlik Harness	BOTH IP/OP	$178.00 	$131.72	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.11	$132.11	$137.20	$0.00	$37.10	$0.00	$0.00	$0.00	$0.00	$89.00	$140.98	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002522	EAP	Custom 27002522		Cast Shoe	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$0.00	$0.00	$0.00	$25.50	$40.39	$40.80	$0.00	$33.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002523	EAP	Custom 27002523		Shoulder Immobilizer	BOTH IP/OP	$232.00 	$171.68	$0.00	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.19	$172.19	$178.83	$0.00	$48.35	$0.00	$0.00	$0.00	$0.00	$116.00	$183.74	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002524	EAP	Custom 27002524		Post Op Shoe	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$24.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002525	EAP	Custom 27002525		Hinged Knee Brace	BOTH IP/OP	$705.00 	$521.70	$0.00	$564.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$523.25	$523.25	$543.41	$0.00	$146.92	$0.00	$0.00	$0.00	$0.00	$352.50	$558.36	$564.00	$0.00	$458.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002526	EAP	Custom 27002526		Sling/fig. 8	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.31	$65.31	$67.83	$0.00	$18.34	$0.00	$0.00	$0.00	$0.00	$44.00	$69.70	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002527	EAP	Custom 27002527		Hinged Knee Sleeve	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.74	$95.74	$99.43	$0.00	$26.88	$0.00	$0.00	$0.00	$0.00	$64.50	$102.17	$103.20	$0.00	$83.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002528	EAP	Custom 27002528		Universal Knee Brace	BOTH IP/OP	$728.00 	$538.72	$0.00	$582.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$540.32	$540.32	$561.14	$0.00	$151.72	$0.00	$0.00	$0.00	$0.00	$364.00	$576.58	$582.40	$0.00	$473.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002529	EAP	Custom 27002529		Universal Knee Brace	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.36	$275.36	$285.97	$0.00	$77.32	$0.00	$0.00	$0.00	$0.00	$185.50	$293.83	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002530	EAP	Custom 27002530		3d Walking Boot	BOTH IP/OP	$197.00 	$145.78	$0.00	$157.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.21	$146.21	$151.85	$0.00	$41.05	$0.00	$0.00	$0.00	$0.00	$98.50	$156.02	$157.60	$0.00	$128.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002531	EAP	Custom 27002531		Knee Immobilizer	BOTH IP/OP	$232.00 	$171.68	$0.00	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.19	$172.19	$178.83	$0.00	$48.35	$0.00	$0.00	$0.00	$0.00	$116.00	$183.74	$185.60	$0.00	$150.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002532	EAP	Custom 27002532		Shoulder Immobilizer	BOTH IP/OP	$232.00 	$171.68	$0.00	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.19	$172.19	$178.83	$0.00	$48.35	$0.00	$0.00	$0.00	$0.00	$116.00	$183.74	$185.60	$0.00	$150.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002533	EAP	Custom 27002533		Philadelphia Collar	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$0.00	$0.00	$0.00	$103.50	$163.94	$165.60	$0.00	$134.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002534	EAP	Custom 27002534		Soft Collar	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.49	$96.49	$100.20	$0.00	$27.09	$0.00	$0.00	$0.00	$0.00	$65.00	$102.96	$104.00	$0.00	$84.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002535	EAP	Custom 27002535		Arm Sling	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.77	$69.77	$72.46	$0.00	$19.59	$0.00	$0.00	$0.00	$0.00	$47.00	$74.45	$75.20	$0.00	$61.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002536	EAP	Custom 27002536		Active Ankle Brace	BOTH IP/OP	$417.00 	$308.58	$0.00	$333.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$309.50	$309.50	$321.42	$0.00	$86.90	$0.00	$0.00	$0.00	$0.00	$208.50	$330.26	$333.60	$0.00	$271.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002537	EAP	Custom 27002537		Buck's Traction Splint	BOTH IP/OP	$172.00 	$127.28	$0.00	$137.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.66	$127.66	$132.58	$0.00	$35.84	$0.00	$0.00	$0.00	$0.00	$86.00	$136.22	$137.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002538	EAP	Custom 27002538		Knee Brace	BOTH IP/OP	$762.00 	$563.88	$0.00	$609.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$565.56	$565.56	$587.35	$0.00	$158.80	$0.00	$0.00	$0.00	$0.00	$381.00	$603.50	$609.60	$0.00	$495.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002539	EAP	Custom 27002539		Jacksonville Sling	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.31	$65.31	$67.83	$0.00	$18.34	$0.00	$0.00	$0.00	$0.00	$44.00	$69.70	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002541	EAP	Custom 27002541		Cast Over Wrap	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.00	$74.45	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002542	EAP	Custom 27002542		Cast Over Wrap-fiberglass	BOTH IP/OP	$117.00 	$86.58	$0.00	$93.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.50	$92.66	$93.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002543	EAP	Custom 27002543		Sandbag	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002544	EAP	Custom 27002544		Aspen Collar	BOTH IP/OP	$154.00 	$113.96	$0.00	$123.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.30	$114.30	$118.70	$0.00	$32.09	$0.00	$0.00	$0.00	$0.00	$77.00	$121.97	$123.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002545	EAP	Custom 27002545		Miami J. Collar	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$144.73	$144.73	$150.31	$0.00	$40.64	$0.00	$0.00	$0.00	$0.00	$97.50	$154.44	$156.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002546	EAP	Custom 27002546		Atlas Collar	BOTH IP/OP	$194.00 	$143.56	$0.00	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.99	$143.99	$149.54	$0.00	$40.43	$0.00	$0.00	$0.00	$0.00	$97.00	$153.65	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002547	EAP	Custom 27002547		Pediatric Pmt Collar	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$31.50	$49.90	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002548	EAP	Custom 27002548		Abduction Pillow	BOTH IP/OP	$96.00 	$71.04	$0.00	$76.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.25	$71.25	$74.00	$0.00	$20.01	$0.00	$0.00	$0.00	$0.00	$48.00	$76.03	$76.80	$0.00	$62.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002549	EAP	Custom 27002549		Neoprene Knee Sleeve	BOTH IP/OP	$68.00 	$50.32	$0.00	$54.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.47	$50.47	$52.41	$0.00	$14.17	$0.00	$0.00	$0.00	$0.00	$34.00	$53.86	$54.40	$0.00	$44.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002550	EAP	Custom 27002550		Cuff And Collar	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$24.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002551	EAP	Custom 27002551		Post Op Shoe	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$24.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002552	EAP	Custom 27002552		Tlso Pre Fab	BOTH IP/OP	"$2,419.00 "	"$1,790.06"	$0.00	"$1,935.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,795.38"	"$1,795.38"	"$1,864.57"	$0.00	$504.12	$0.00	$0.00	$0.00	$0.00	"$1,209.50"	"$1,915.85"	"$1,935.20"	$0.00	"$1,572.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002564	EAP	CPT® C1751		"Cvp Kit, Double Lumen"	BOTH IP/OP	$569.00 	$421.06	$0.00	$455.20	$308.97	$308.97	$0.00	$0.00	$0.00	$118.59	$422.31	$422.31	$438.59	$0.00	$118.58	$0.00	$336.56	$336.56	$0.00	$284.50	$450.65	$455.20	$0.00	$369.85	$0.00	$89.05	$0.00	$0.00	$90.58	$0.00	$0.00	$0.00	$0.00	$0.00
27002565	EAP	Custom 27002565		"Ett, Double-lumen"	BOTH IP/OP	$837.00 	$619.38	$0.00	$669.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$621.22	$621.22	$645.16	$0.00	$174.43	$0.00	$0.00	$0.00	$0.00	$418.50	$662.90	$669.60	$0.00	$544.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002572	EAP	Custom 27002572		Introducer Kit	BOTH IP/OP	$261.00 	$193.14	$0.00	$208.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$193.71	$193.71	$201.18	$0.00	$54.39	$0.00	$0.00	$0.00	$0.00	$130.50	$206.71	$208.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002573	EAP	Custom 27002573		Radial Artery Set (arrow)	BOTH IP/OP	$92.00 	$68.08	$0.00	$73.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.28	$68.28	$70.91	$0.00	$19.17	$0.00	$0.00	$0.00	$0.00	$46.00	$72.86	$73.60	$0.00	$59.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002576	EAP	Custom 27002576		Epidural Tray	BOTH IP/OP	$316.00 	$233.84	$0.00	$252.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$234.54	$234.54	$243.57	$0.00	$65.85	$0.00	$0.00	$0.00	$0.00	$158.00	$250.27	$252.80	$0.00	$205.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002579	EAP	Custom 27002579		Level One Inserts	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.96	$74.96	$77.85	$0.00	$21.05	$0.00	$0.00	$0.00	$0.00	$50.50	$79.99	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002587	EAP	HCPCS C1751		Kit Quad Lumen Cather	BOTH IP/OP	$148.00 	$109.52	$0.00	$118.40	$80.36	$80.36	$0.00	$0.00	$0.00	$30.85	$109.85	$109.85	$114.08	$0.00	$30.84	$0.00	$87.54	$87.54	$0.00	$74.00	$117.22	$118.40	$0.00	$96.20	$0.00	$23.16	$0.00	$0.00	$23.56	$0.00	$0.00	$0.00	$0.00	$0.00
27002589	EAP	Custom 27002589		Aintree Intubation Changer	BOTH IP/OP	$83.00 	$61.42	$0.00	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.60	$61.60	$63.98	$0.00	$17.30	$0.00	$0.00	$0.00	$0.00	$41.50	$65.74	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002590	EAP	Custom 27002590		Kit Triple Lumen Catheter	BOTH IP/OP	$646.00 	$478.04	$0.00	$516.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$479.46	$479.46	$497.94	$0.00	$134.63	$0.00	$0.00	$0.00	$0.00	$323.00	$511.63	$516.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002593	EAP	Custom 27002593		"Cvp Kit, Double Lumen"	BOTH IP/OP	$307.00 	$227.18	$0.00	$245.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.86	$227.86	$236.64	$0.00	$63.98	$0.00	$0.00	$0.00	$0.00	$153.50	$243.14	$245.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002594	EAP	Custom 27002594		"Transducer And Tubing, Disp"	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002595	EAP	Custom 27002595		Fiberoptic Intubation Scope	BOTH IP/OP	$321.00 	$237.54	$0.00	$256.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.25	$238.25	$247.43	$0.00	$66.90	$0.00	$0.00	$0.00	$0.00	$160.50	$254.23	$256.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002598	EAP	Custom 27002598		Air Embolism Detector	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002599	EAP	Custom 27002599		Introducer Kit	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002600	EAP	Custom 27002600		Radial Artery Set (arrow)	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002602	EAP	Custom 27002602		Disp. Sao2 Probe	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.27	$45.27	$47.02	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002604	EAP	Custom 27002604		Epidural Tray	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.97	$97.97	$101.75	$0.00	$27.51	$0.00	$0.00	$0.00	$0.00	$66.00	$104.54	$105.60	$0.00	$85.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002605	EAP	Custom 27002605		Spinal Tray	BOTH IP/OP	$190.00 	$140.60	$0.00	$152.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.02	$141.02	$146.45	$0.00	$39.60	$0.00	$0.00	$0.00	$0.00	$95.00	$150.48	$152.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002609	EAP	Custom 27002609		Thoracotomy Tray	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.97	$97.97	$101.75	$0.00	$27.51	$0.00	$0.00	$0.00	$0.00	$66.00	$104.54	$105.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002610	EAP	Custom 27002610		Tracheotomy Tray	BOTH IP/OP	$394.00 	$291.56	$0.00	$315.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$292.43	$292.43	$303.70	$0.00	$82.11	$0.00	$0.00	$0.00	$0.00	$197.00	$312.05	$315.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002618	EAP	Custom 27002618		Ioban 2 Drape Incise Smal	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002620	EAP	Custom 27002620		Ioban 2 Drape Incise Larg	BOTH IP/OP	$434.00 	$321.16	$0.00	$347.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$322.11	$322.11	$334.53	$0.00	$90.45	$0.00	$0.00	$0.00	$0.00	$217.00	$343.73	$347.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002621	EAP	Custom 27002621		Needle Spinal 18ga	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002624	EAP	Custom 27002624		Catheter Texas Large	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002625	EAP	Custom 27002625		Catheter Thoracic 32fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002626	EAP	Custom 27002626		Catheter Thoracic 36fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002627	EAP	Custom 27002627		Catheter Urethral Two-eye	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002628	EAP	Custom 27002628		Artery Arterial Catheriza	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$51.00	$80.78	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002629	EAP	Custom 27002629		Artery Radial Catherizati	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002630	EAP	Custom 27002630		Tube Salem Sump 48 Lengt	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002631	EAP	Custom 27002631		Tube Salem Silicone Size	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002632	EAP	Custom 27002632		Tubes Salem Sump 48 Leng	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002636	EAP	Custom 27002636		Bag Drainage Becker	BOTH IP/OP	$197.00 	$145.78	$0.00	$157.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.21	$146.21	$151.85	$0.00	$41.05	$0.00	$0.00	$0.00	$0.00	$98.50	$156.02	$157.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002637	EAP	Custom 27002637		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002640	EAP	Custom 27002640		Set Blood Administration	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002643	EAP	Custom 27002643		Cream Baza 5oz	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002646	EAP	Custom 27002646		Electrodes Operative	BOTH IP/OP	$266.00 	$196.84	$0.00	$212.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.43	$197.43	$205.03	$0.00	$55.43	$0.00	$0.00	$0.00	$0.00	$133.00	$210.67	$212.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002647	EAP	Custom 27002647		Valve Anti-reflux Salem S	BOTH IP/OP	$46.00 	$34.04	$0.00	$36.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.14	$34.14	$35.46	$0.00	$9.59	$0.00	$0.00	$0.00	$0.00	$23.00	$36.43	$36.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002649	EAP	Custom 27002649		Kit Thoracotomy	BOTH IP/OP	$203.00 	$150.22	$0.00	$162.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.67	$150.67	$156.47	$0.00	$42.31	$0.00	$0.00	$0.00	$0.00	$101.50	$160.78	$162.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002653	EAP	Custom 27002653		Set Pediatric Measured Fi	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002656	EAP	Custom 27002656		Pouch Fecal Incontinence	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.11	$37.11	$38.54	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$25.00	$39.60	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002657	EAP	Custom 27002657		Kit Pressure Monitoring T	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002658	EAP	Custom 27002658		Transducer Disp For Icp	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.95	$51.95	$53.96	$0.00	$14.59	$0.00	$0.00	$0.00	$0.00	$35.00	$55.44	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002659	EAP	Custom 27002659		Kit Transducer Monitoring	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.31	$232.31	$241.26	$0.00	$65.23	$0.00	$0.00	$0.00	$0.00	$156.50	$247.90	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002660	EAP	Custom 27002660		Kit Pressure Monitoring	BOTH IP/OP	$234.00 	$173.16	$0.00	$187.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.67	$173.67	$180.37	$0.00	$48.77	$0.00	$0.00	$0.00	$0.00	$117.00	$185.33	$187.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002662	EAP	Custom 27002662		Bag 1000ml Pump Set	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.46	$27.46	$28.52	$0.00	$7.71	$0.00	$0.00	$0.00	$0.00	$18.50	$29.30	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002663	EAP	Custom 27002663		Kit Pecutaneous Introduce	BOTH IP/OP	$276.00 	$204.24	$0.00	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.85	$204.85	$212.74	$0.00	$57.52	$0.00	$0.00	$0.00	$0.00	$138.00	$218.59	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002664	EAP	Custom 27002664		Chest Unit Drainage Pleur	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.72	$311.72	$323.74	$0.00	$87.53	$0.00	$0.00	$0.00	$0.00	$210.00	$332.64	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002665	EAP	Custom 27002665		Chest Unit Dry Suction Sy	BOTH IP/OP	$309.00 	$228.66	$0.00	$247.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.34	$229.34	$238.18	$0.00	$64.40	$0.00	$0.00	$0.00	$0.00	$154.50	$244.73	$247.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002666	EAP	Custom 27002666		Bag Auto-transfusion Ple	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.84	$181.84	$188.85	$0.00	$51.06	$0.00	$0.00	$0.00	$0.00	$122.50	$194.04	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002670	EAP	Custom 27002670		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.27	$45.27	$47.02	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002671	EAP	Custom 27002671		Kit Triple Lumen Catheter	BOTH IP/OP	$646.00 	$478.04	$0.00	$516.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$479.46	$479.46	$497.94	$0.00	$134.63	$0.00	$0.00	$0.00	$0.00	$323.00	$511.63	$516.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002672	EAP	Custom 27002672		Catheter Swan Ganz	BOTH IP/OP	$674.00 	$498.76	$0.00	$539.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.24	$500.24	$519.52	$0.00	$140.46	$0.00	$0.00	$0.00	$0.00	$337.00	$533.81	$539.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002673	EAP	Custom 27002673		Delivery System Closed In	BOTH IP/OP	$141.00 	$104.34	$0.00	$112.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$104.65	$104.65	$108.68	$0.00	$29.38	$0.00	$0.00	$0.00	$0.00	$70.50	$111.67	$112.80	$0.00	$91.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002676	EAP	Custom 27002676		Filter Set 0.22 Micron	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002677	EAP	Custom 27002677		Tray Catheter Urethral 14	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002678	EAP	Custom 27002678		Tray Foley Preconnected W	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002679	EAP	Custom 27002679		Tray Foley Perconnected 1	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002681	EAP	Custom 27002681		Tray Urine Meter 18fr	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.09	$63.09	$65.52	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002682	EAP	Custom 27002682		Tray Thoracentesis Dispos	BOTH IP/OP	$216.00 	$159.84	$0.00	$172.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.32	$160.32	$166.49	$0.00	$45.01	$0.00	$0.00	$0.00	$0.00	$108.00	$171.07	$172.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002684	EAP	Custom 27002684		Bag Drainage Ureteral	BOTH IP/OP	$92.00 	$68.08	$0.00	$73.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.28	$68.28	$70.91	$0.00	$19.17	$0.00	$0.00	$0.00	$0.00	$46.00	$72.86	$73.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002687	EAP	Custom 27002687		Sleeve Knee Regular Dvt	BOTH IP/OP	$358.00 	$264.92	$0.00	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$265.71	$265.71	$275.95	$0.00	$74.61	$0.00	$0.00	$0.00	$0.00	$179.00	$283.54	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002688	EAP	Custom 27002688		Sleeve Knee X-large Dvt	BOTH IP/OP	$439.00 	$324.86	$0.00	$351.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$325.83	$325.83	$338.38	$0.00	$91.49	$0.00	$0.00	$0.00	$0.00	$219.50	$347.69	$351.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002689	EAP	Custom 27002689		Sleeve Thigh Regular Dvt	BOTH IP/OP	$512.00 	$378.88	$0.00	$409.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.01	$380.01	$394.65	$0.00	$106.70	$0.00	$0.00	$0.00	$0.00	$256.00	$405.50	$409.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002697	EAP	Custom 27002697		Catheter  Suction Plastic 14	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002701	EAP	Custom 27002701		Set Pediatric Micro Drip	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.78	$20.78	$21.58	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002702	EAP	Custom 27002702		Set Pediatric Measured Fi	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002703	EAP	Custom 27002703		Stockings Antiembolism Thigh	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002704	EAP	Custom 27002704		Stockings Antiembolism Thigh	BOTH IP/OP	$44.00 	$32.56	$0.00	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.66	$32.66	$33.92	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002705	EAP	Custom 27002705		Stockings Antiembolism Thigh	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.11	$37.11	$38.54	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$25.00	$39.60	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002706	EAP	Custom 27002706		Stockings Antiembolish Ex	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$23.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002707	EAP	Custom 27002707		Needle Port-cath 20ga X 1	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002708	EAP	Custom 27002708		Tray Catheter Urethral 14	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002709	EAP	Custom 27002709		Tray Foley Preconnected 1	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002710	EAP	Custom 27002710		Bag Urine Leg	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$9.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002884	EAP	Custom 27002884		Et/co2 Sensors	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002885	EAP	Custom 27002885		Cpap Circuit	BOTH IP/OP	"$1,347.00 "	$996.78	$0.00	"$1,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$999.74	$999.74	"$1,038.27"	$0.00	$280.71	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00	$875.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002886	EAP	Custom 27002886		Flutter Valve	BOTH IP/OP	$167.00 	$123.58	$0.00	$133.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.95	$123.95	$128.72	$0.00	$34.80	$0.00	$0.00	$0.00	$0.00	$83.50	$132.26	$133.60	$0.00	$108.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002892	EAP	Custom 27002892		Fecal Occult Blood Supply	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002893	EAP	Custom 27002893		Tubes Extension Plain Pla	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002908	EAP	Custom 27002908		Kit Iv Start Custom	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002938	EAP	Custom 27002938		Inflation Device	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002939	EAP	Custom 27002939		"Catheter, Thrombectomy"	BOTH IP/OP	"$1,076.00 "	$796.24	$0.00	$860.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$798.61	$798.61	$829.38	$0.00	$224.24	$0.00	$0.00	$0.00	$0.00	$538.00	$852.19	$860.80	$0.00	$699.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002940	EAP	HCPCS C1751		Catheter Iv 180ga X 1x1/4	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$8.69	$8.69	$0.00	$0.00	$0.00	$3.33	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$2.50	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$0.00
27002941	EAP	HCPCS C1751		Catheter Iv 20ga X 1	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$2.50	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$0.00
27002942	EAP	HCPCS C1751		Catheter Iv 22ga X 1	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$8.69	$8.69	$0.00	$0.00	$0.00	$3.33	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$2.50	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$0.00
27002943	EAP	Custom 27002943		Ioban 2 Drape Incise Medi	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$0.00	$0.00	$0.00	$28.00	$44.35	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002944	EAP	Custom 27002944		Needle Spinal 18ga	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002945	EAP	Custom 27002945		Lancet  Grady Orange	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002946	EAP	HCPCS C1751		Catheter Iv Cut-down 14g	BOTH IP/OP	$44.00 	$32.56	$0.00	$35.20	$23.89	$23.89	$0.00	$0.00	$0.00	$9.17	$32.66	$32.66	$33.92	$0.00	$9.17	$0.00	$26.03	$26.03	$0.00	$22.00	$34.85	$35.20	$0.00	$0.00	$0.00	$6.89	$0.00	$0.00	$7.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002947	EAP	HCPCS C1751		Catheter Iv Cut-down 8 1	BOTH IP/OP	$44.00 	$32.56	$0.00	$35.20	$23.89	$23.89	$0.00	$0.00	$0.00	$9.17	$32.66	$32.66	$33.92	$0.00	$9.17	$0.00	$26.03	$26.03	$0.00	$22.00	$34.85	$35.20	$0.00	$0.00	$0.00	$6.89	$0.00	$0.00	$7.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002951	EAP	HCPCS C1729		Catheter Foley 5cc 14fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27002952	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27002953	EAP	HCPCS C1729		Catheter Foley 5cc 18fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27002954	EAP	Custom 27002954		Tube Salem Silicone Size	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002955	EAP	Custom 27002955		Tubes Salem Sump 48 Leng	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002957	EAP	Custom 27002957		Scaple Surg W/handle Atta	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.81	$112.81	$117.16	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$76.00	$120.38	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002958	EAP	Custom 27002958		Scaple Surg W/handle Attached	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002959	EAP	Custom 27002959		Bore Y Extension Small	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.30	$19.30	$20.04	$0.00	$5.42	$0.00	$0.00	$0.00	$0.00	$13.00	$20.59	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002961	EAP	Custom 27002961		Pad Defi	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.11	$37.11	$38.54	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$25.00	$39.60	$40.00	$0.00	$32.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002962	EAP	Custom 27002962		Valve Reflux	BOTH IP/OP	$3.00 	$2.22	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.23	$2.23	$2.31	$0.00	$0.63	$0.00	$0.00	$0.00	$0.00	$1.50	$2.38	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002963	EAP	Custom 27002963		"Filter,micron .22 Fluid A"	BOTH IP/OP	$14.00 	$10.36	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.39	$10.39	$10.79	$0.00	$2.92	$0.00	$0.00	$0.00	$0.00	$7.00	$11.09	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002964	EAP	Custom 27002964		Set Scalp  Vein Infusion 21 G	BOTH IP/OP	$3.00 	$2.22	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.23	$2.23	$2.31	$0.00	$0.63	$0.00	$0.00	$0.00	$0.00	$1.50	$2.38	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002965	EAP	Custom 27002965		Mask Sub-micron Small	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002966	EAP	Custom 27002966		Kit Triple Lumen Catheter	BOTH IP/OP	$646.00 	$478.04	$0.00	$516.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$479.46	$479.46	$497.94	$0.00	$134.63	$0.00	$0.00	$0.00	$0.00	$323.00	$511.63	$516.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002967	EAP	Custom 27002967		Catheter Swan Ganz	BOTH IP/OP	$674.00 	$498.76	$0.00	$539.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.24	$500.24	$519.52	$0.00	$140.46	$0.00	$0.00	$0.00	$0.00	$337.00	$533.81	$539.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002968	EAP	Custom 27002968		Probe V-pacing	BOTH IP/OP	"$1,403.00 "	"$1,038.22"	$0.00	"$1,122.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,041.31"	"$1,041.31"	"$1,081.43"	$0.00	$292.39	$0.00	$0.00	$0.00	$0.00	$701.50	"$1,111.18"	"$1,122.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002969	EAP	Custom 27002969		Filter Set 0.22 Micron	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002970	EAP	Custom 27002970		Tray Foley Preconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002971	EAP	Custom 27002971		Tray Foley Perconnected 1	BOTH IP/OP	$14.00 	$10.36	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.39	$10.39	$10.79	$0.00	$2.92	$0.00	$0.00	$0.00	$0.00	$7.00	$11.09	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002972	EAP	Custom 27002972		Bag Urine Leg	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002973	EAP	Custom 27002973		Pounches Sterilization 12	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002974	EAP	Custom 27002974		Bag Drainage Ureteral	BOTH IP/OP	$103.00 	$76.22	$0.00	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.45	$76.45	$79.39	$0.00	$21.47	$0.00	$0.00	$0.00	$0.00	$51.50	$81.58	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002975	EAP	Custom 27002975		Needle Hypodermic Sterile	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002976	EAP	Custom 27002976		Drape Half	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002978	EAP	Custom 27002978		Jcd 5.0-38-20	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002979	EAP	Custom 27002979		Jcd 7.0-38-20	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$11.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002980	EAP	Custom 27002980		Jcd 8.0-38-20	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002982	EAP	Custom 27002982		Avantiplus Introducer 6fr 23cm	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$61.66	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002984	EAP	Custom 27002984		Nail Cleaner Plastic Non-steri	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002985	EAP	Custom 27002985		Super Arrow Flex Introducer-c	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$276.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002986	EAP	Custom 27002986		6fr-24cm Flexsheath Introducer	BOTH IP/OP	$185.00 	$136.90	$0.00	$148.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.31	$137.31	$142.60	$0.00	$38.55	$0.00	$0.00	$0.00	$0.00	$92.50	$146.52	$148.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002987	EAP	Custom 27002987		8fr-35cm Flexsheath Introducer	BOTH IP/OP	$185.00 	$136.90	$0.00	$148.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.31	$137.31	$142.60	$0.00	$38.55	$0.00	$0.00	$0.00	$0.00	$92.50	$146.52	$148.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002990	EAP	Custom 27002990		Adapter Morse - Y	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$61.66	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002991	EAP	Custom 27002991		Drape C-arm 42 X 64	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002993	EAP	Custom 27002993		Kit Catheter Suction 14fr	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$601.18	$601.18	$624.35	$0.00	$168.80	$0.00	$0.00	$0.00	$0.00	$405.00	$641.52	$648.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002994	EAP	Custom 27002994		Kit Percutaneous Introducer	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$601.18	$601.18	$624.35	$0.00	$168.80	$0.00	$0.00	$0.00	$0.00	$405.00	$641.52	$648.00	$0.00	$526.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27002995	EAP	Custom 27002995		Kanguru Web	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003005	EAP	Custom 27003005		Filter Set 0.22 Micron	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003006	EAP	Custom 27003006		Tray Foley Preconnected 1	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$0.00	$0.00	$0.00	$28.00	$44.35	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003007	EAP	Custom 27003007		Tray Foley Perconnected 1	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003008	EAP	Custom 27003008		Central Line Dressing Tray	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$31.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003028	EAP	Custom 27003028		Lumbo-sacral Support	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$25.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003040	EAP	Custom 27003040		"Walker, For Platform Only"	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.35	$180.35	$187.30	$0.00	$50.64	$0.00	$0.00	$0.00	$0.00	$121.50	$192.46	$194.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003045	EAP	Custom 27003045		Foot Plate-prefb	BOTH IP/OP	$577.00 	$426.98	$0.00	$461.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$428.25	$428.25	$444.75	$0.00	$120.25	$0.00	$0.00	$0.00	$0.00	$288.50	$456.98	$461.60	$0.00	$375.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003049	EAP	Custom 27003049		Dressing Stick	BOTH IP/OP	$31.00 	$22.94	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.01	$23.01	$23.89	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.50	$24.55	$24.80	$0.00	$20.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003050	EAP	Custom 27003050		Leg Lifter	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$33.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003051	EAP	Custom 27003051		Reacher	BOTH IP/OP	$117.00 	$86.58	$0.00	$93.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.84	$86.84	$90.18	$0.00	$24.38	$0.00	$0.00	$0.00	$0.00	$58.50	$92.66	$93.60	$0.00	$76.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003053	EAP	Custom 27003053		Abduction Pillow	BOTH IP/OP	$404.00 	$298.96	$0.00	$323.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$299.85	$299.85	$311.40	$0.00	$84.19	$0.00	$0.00	$0.00	$0.00	$202.00	$319.97	$323.20	$0.00	$262.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003054	EAP	Custom 27003054		Compression Glove	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.13	$0.00	$0.00	$0.00	$0.00	$43.50	$68.90	$69.60	$0.00	$56.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003055	EAP	Custom 27003055		Dowel	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$31.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003063	EAP	Custom 27003063		Simple Hand-based Splint	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$33.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003065	EAP	Custom 27003065		Custom Finger Splint	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003069	EAP	Custom 27003069		Compression Glove	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.13	$0.00	$0.00	$0.00	$0.00	$43.50	$68.90	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003070	EAP	Custom 27003070		Dowel	BOTH IP/OP	$46.00 	$34.04	$0.00	$36.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.14	$34.14	$35.46	$0.00	$9.59	$0.00	$0.00	$0.00	$0.00	$23.00	$36.43	$36.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003073	EAP	Custom 27003073		Foot Drop Splint	BOTH IP/OP	$233.00 	$172.42	$0.00	$186.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.93	$172.93	$179.60	$0.00	$48.56	$0.00	$0.00	$0.00	$0.00	$116.50	$184.54	$186.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003080	EAP	Custom 27003080		Custom Finger Splint	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$6.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003081	EAP	Custom 27003081		Safe Position Splint	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.96	$74.96	$77.85	$0.00	$21.05	$0.00	$0.00	$0.00	$0.00	$50.50	$79.99	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003084	EAP	Custom 27003084		Compression Glove	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.13	$0.00	$0.00	$0.00	$0.00	$43.50	$68.90	$69.60	$0.00	$56.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003085	EAP	Custom 27003085		Dowel	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$31.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003087	EAP	Custom 27003087		"Tubigrip, Per Piece"	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003089	EAP	Custom 27003089		Helsper Button	BOTH IP/OP	$710.00 	$525.40	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.96	$526.96	$547.27	$0.00	$147.96	$0.00	$0.00	$0.00	$0.00	$355.00	$562.32	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003090	EAP	Custom 27003090		Laryngectomy Tube	BOTH IP/OP	$667.00 	$493.58	$0.00	$533.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$495.05	$495.05	$514.12	$0.00	$139.00	$0.00	$0.00	$0.00	$0.00	$333.50	$528.26	$533.60	$0.00	$433.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003091	EAP	Custom 27003091		Inhealth Advan.indwelling Pros	BOTH IP/OP	$859.00 	$635.66	$0.00	$687.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$637.55	$637.55	$662.12	$0.00	$179.02	$0.00	$0.00	$0.00	$0.00	$429.50	$680.33	$687.20	$0.00	$558.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003092	EAP	Custom 27003092		Inhealth Indwelling Prosthesis	BOTH IP/OP	$878.00 	$649.72	$0.00	$702.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$651.65	$651.65	$676.76	$0.00	$182.98	$0.00	$0.00	$0.00	$0.00	$439.00	$695.38	$702.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003093	EAP	Custom 27003093		Inhealth Low Pressure Prosthesis	BOTH IP/OP	$491.00 	$363.34	$0.00	$392.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$364.42	$364.42	$378.46	$0.00	$102.32	$0.00	$0.00	$0.00	$0.00	$245.50	$388.87	$392.80	$0.00	$319.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003094	EAP	Custom 27003094		Duckbill Prosthesis	BOTH IP/OP	$309.00 	$228.66	$0.00	$247.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.34	$229.34	$238.18	$0.00	$64.40	$0.00	$0.00	$0.00	$0.00	$154.50	$244.73	$247.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003095	EAP	Custom 27003095		Provox/atox Prosthesis	BOTH IP/OP	$893.00 	$660.82	$0.00	$714.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$662.78	$662.78	$688.32	$0.00	$186.10	$0.00	$0.00	$0.00	$0.00	$446.50	$707.26	$714.40	$0.00	$580.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003096	EAP	Custom 27003096		Insufflation Test Kit	BOTH IP/OP	$863.00 	$638.62	$0.00	$690.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.52	$640.52	$665.20	$0.00	$179.85	$0.00	$0.00	$0.00	$0.00	$431.50	$683.50	$690.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003097	EAP	Custom 27003097		Plug Insert	BOTH IP/OP	$339.00 	$250.86	$0.00	$271.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$251.61	$251.61	$261.30	$0.00	$70.65	$0.00	$0.00	$0.00	$0.00	$169.50	$268.49	$271.20	$0.00	$220.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003098	EAP	Custom 27003098		Catheters	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003100	EAP	Custom 27003100		Barton-mayo Button	BOTH IP/OP	$849.00 	$628.26	$0.00	$679.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$630.13	$630.13	$654.41	$0.00	$176.93	$0.00	$0.00	$0.00	$0.00	$424.50	$672.41	$679.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003101	EAP	Custom 27003101		Oral Tubing	BOTH IP/OP	$5.00 	$3.70	$0.00	$4.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.71	$3.71	$3.85	$0.00	$1.04	$0.00	$0.00	$0.00	$0.00	$2.50	$3.96	$4.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003103	EAP	Custom 27003103		Occult Blood Supply	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003104	EAP	Custom 27003104		Interceed Sup/admin	BOTH IP/OP	$424.00 	$313.76	$0.00	$339.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$314.69	$314.69	$326.82	$0.00	$88.36	$0.00	$0.00	$0.00	$0.00	$212.00	$335.81	$339.20	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003105	EAP	Custom 27003105		Pudendal Kit	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$51.00	$80.78	$81.60	$0.00	$66.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003108	EAP	Custom 27003108		Dressing Hemostasis	BOTH IP/OP	$441.00 	$326.34	$0.00	$352.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$327.31	$327.31	$339.92	$0.00	$91.90	$0.00	$0.00	$0.00	$0.00	$220.50	$349.27	$352.80	$0.00	$286.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003113	EAP	Custom 27003113		Tegaderm Dressing	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$0.00	$0.00	$0.00	$25.50	$40.39	$40.80	$0.00	$33.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003114	EAP	Custom 27003114		Tegaderm Dressing	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003115	EAP	Custom 27003115		"Wound Gel, Carrington"	BOTH IP/OP	$103.00 	$76.22	$0.00	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.45	$76.45	$79.39	$0.00	$21.47	$0.00	$0.00	$0.00	$0.00	$51.50	$81.58	$82.40	$0.00	$66.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003116	EAP	Custom 27003116		"Kara Klenz, Wound Cleanser"	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$51.00	$80.78	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003117	EAP	Custom 27003117		"Little Ones, White Collar 4x4"	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$25.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003118	EAP	Custom 27003118		"Pouch, Cut To Fit, Little Ones"	BOTH IP/OP	$31.00 	$22.94	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.01	$23.01	$23.89	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.50	$24.55	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003119	EAP	Custom 27003119		"Pouch, Active Life"	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$23.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003120	EAP	Custom 27003120		"Flange, Sur-fit"	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003121	EAP	Custom 27003121		Pouch Drainable Opaque	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003124	EAP	Custom 27003124		Barrier With Convexity	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003127	EAP	Custom 27003127		High Flow Continuous	BOTH IP/OP	$406.00 	$300.44	$0.00	$324.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.33	$301.33	$312.94	$0.00	$84.61	$0.00	$0.00	$0.00	$0.00	$203.00	$321.55	$324.80	$0.00	$263.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003128	EAP	Custom 27003128		Low Flow Continous	BOTH IP/OP	$406.00 	$300.44	$0.00	$324.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.33	$301.33	$312.94	$0.00	$84.61	$0.00	$0.00	$0.00	$0.00	$203.00	$321.55	$324.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003130	EAP	Custom 27003130		Mdi Spacer Supply	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$144.73	$144.73	$150.31	$0.00	$40.64	$0.00	$0.00	$0.00	$0.00	$97.50	$154.44	$156.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003131	EAP	Custom 27003131		Occult Blood Supply	BOTH IP/OP	$44.00 	$32.56	$0.00	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.66	$32.66	$33.92	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003132	EAP	Custom 27003132		Wrist Brace	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003134	EAP	HCPCS J2798		Mirena (iud) Kit	BOTH IP/OP	$994.00 	$735.56	$0.00	$795.20	$0.00	$0.00	$0.00	$0.00	$0.00	$207.17	$0.00	$0.00	$0.00	$10.69	$12.56	$6.95	$587.95	$587.95	$0.00	$497.00	$787.25	$795.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27003153	EAP	Custom 27003153		Nuva Ring Fp	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27004266	EAP	Custom 27004266		13.5mm/3.2mm Wire Guide	BOTH IP/OP	"$1,747.00 "	"$1,292.78"	$0.00	"$1,397.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,296.62"	"$1,296.62"	"$1,346.59"	$0.00	$364.07	$0.00	$0.00	$0.00	$0.00	$873.50	"$1,383.62"	"$1,397.60"	$0.00	"$1,135.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27004311	EAP	Custom 27004311		Long Forceps 230mm	BOTH IP/OP	"$2,779.00 "	"$2,056.46"	$0.00	"$2,223.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,062.57"	"$2,062.57"	"$2,142.05"	$0.00	$579.14	$0.00	$0.00	$0.00	$0.00	"$1,389.50"	"$2,200.97"	"$2,223.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27004327	EAP	Custom 27004327		Medium Wire Cutter 160mm	BOTH IP/OP	"$4,148.00 "	"$3,069.52"	$0.00	"$3,318.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,078.65"	"$3,078.65"	"$3,197.28"	$0.00	$864.44	$0.00	$0.00	$0.00	$0.00	"$2,074.00"	"$3,285.22"	"$3,318.40"	$0.00	"$2,696.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27004640	EAP	Custom 27004640		Large Anchoring Hook 30mm	BOTH IP/OP	$509.00 	$376.66	$0.00	$407.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$377.78	$377.78	$392.34	$0.00	$106.08	$0.00	$0.00	$0.00	$0.00	$254.50	$403.13	$407.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007212	EAP	Custom 27007212		10.0mm Circular Saw 28mm	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007213	EAP	Custom 27007213		12.0mm Circular Saw 28mm	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007214	EAP	Custom 27007214		15.0mm Circular Saw 28mm	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007219	EAP	Custom 27007219		Tibial Nail Driving Adaptor	BOTH IP/OP	"$4,208.00 "	"$3,113.92"	$0.00	"$3,366.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,123.18"	"$3,123.18"	"$3,243.53"	$0.00	$876.95	$0.00	$0.00	$0.00	$0.00	"$2,104.00"	"$3,332.74"	"$3,366.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007220	EAP	Custom 27007220		Saw Blade 27mm Width 50mm/0.6m	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007221	EAP	Custom 27007221		Saw Blade 10mm Width 25mm/0.6m	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007222	EAP	Custom 27007222		Saw Blade 10mm Width 50mm/0.6m	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007223	EAP	Custom 27007223		Saw Blade 20mm Width 50mm/0.6m	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007224	EAP	Custom 27007224		Saw Blade 19mm Width 70mm/1.0m	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007225	EAP	Custom 27007225		Saw Blade 19mm Width 95mm/0.9m	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007226	EAP	Custom 27007226		Saw Blade 25mm Width 95mm/0.9	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007227	EAP	Custom 27007227		Saw Blade 25mm Width 60mm/0.9	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007228	EAP	Custom 27007228		Saw Blade 18mm Width 70mm/1.2	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007229	EAP	Custom 27007229		Saw Blade 19mm Width 95mm/1.25	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007230	EAP	Custom 27007230		Saw Blade 25mm Width 95mm/1.25	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007231	EAP	Custom 27007231		Saw Blade 19mm Width 95mm/1.4	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007232	EAP	Custom 27007232		Saw Blade 25mm Width 95mm/1.4	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007233	EAP	Custom 27007233		Saw Blade 12.5mm Wdth 90mm/0.9	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007234	EAP	Custom 27007234		Saw Blade 14mm Width 50mm/0.6	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007235	EAP	Custom 27007235		Saw Blade 27mm Width 70mm/0.8	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007236	EAP	Custom 27007236		Saw Blade 50mm Width 70mm/0.8	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007237	EAP	Custom 27007237		Saw Blade 27mm Width 70mm/1.0	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007238	EAP	Custom 27007238		Saw Blade 27mm Width 70mm/1.2	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007239	EAP	Custom 27007239		Saw Blade 6mm Width 25mm/0.6m	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007240	EAP	Custom 27007240		Saw Blade 14mm Width 25mm/0.6m	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007241	EAP	Custom 27007241		Saw Blade 6mm Width 10mm/0.4mm	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007242	EAP	Custom 27007242		Saw Blade 6mm Width 10mm/0.4mm	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007243	EAP	Custom 27007243		Saw Blade 10mm Width 10mm/0.4m	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007244	EAP	Custom 27007244		Saw Blade 10mm Width 10mm/0.4m	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007245	EAP	Custom 27007245		Saw Blade 16mm Width 10mm/0.4m	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007246	EAP	Custom 27007246		Saw Blade 16mm Width 10mm/0.4m	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007247	EAP	Custom 27007247		Saw Blade 4mm Width 15mm/0.4mm	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007248	EAP	Custom 27007248		Saw Blade 4mm Width 15mm/0.4m	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007249	EAP	Custom 27007249		Saw Blade 8mm Width 20mm/0.4mm	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007250	EAP	Custom 27007250		Saw Blade 8mm Width 20mm/0.4	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007251	EAP	Custom 27007251		Saw Blade 12mm Width 20mm/0.4	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007252	EAP	Custom 27007252		Saw Blade 12mm Width 20mm/0.4	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007253	EAP	Custom 27007253		Saw Blade 6mm Width 30mm/0.4	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007254	EAP	Custom 27007254		Saw Blade 6mm Width 30mm/0.4	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007255	EAP	Custom 27007255		Saw Blade 10mm Width 30mm/0.4	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007256	EAP	Custom 27007256		Saw Blade 10mm Width 30mm/0.4	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007257	EAP	Custom 27007257		Saw Blade 6mm Width 25mm/0.6	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007258	EAP	Custom 27007258		Saw Blade 6mm Width 25mm/0.6	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007259	EAP	Custom 27007259		Saw Blade 10mm Width 25mm/0.6	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007260	EAP	Custom 27007260		Saw Blade 10mm Width 25mm/0.6	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007261	EAP	Custom 27007261		Saw Blade 14mm Width 25mm/0.6	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007262	EAP	Custom 27007262		Saw Blade 14mm Width 25mm/0.6	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007263	EAP	Custom 27007263		Saw Blade 10mm Width 50mm/0.6	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007264	EAP	Custom 27007264		Saw Bld 10 Wdth 50/0.6cut Thk	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007265	EAP	Custom 27007265		Saw Bld 14 Wdth 50/0.6cut Thk	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007266	EAP	Custom 27007266		Saw Bld 14 Wdth 50/0.6 Cut Thk	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007267	EAP	Custom 27007267		Saw Bld 20 Wdth 50/0.6 Cut Thk	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007268	EAP	Custom 27007268		Saw Bld 20 Wdth 50/0.6 Cut Thk	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007269	EAP	Custom 27007269		Saw Bld 27 Wdth 50/0.6 Cut Thk	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007270	EAP	Custom 27007270		Saw Bld 27 Wdth 50/0.6 Cut Thk	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007451	EAP	Custom 27007451		"Peg Fully Thread 2.5mm, 24mm"	BOTH IP/OP	$398.00 	$294.52	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.40	$295.40	$306.78	$0.00	$82.94	$0.00	$0.00	$0.00	$0.00	$199.00	$315.22	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007489	EAP	Custom 27007489		Mini-clip Str 3mm	BOTH IP/OP	"$1,693.00 "	"$1,252.82"	$0.00	"$1,354.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,256.54"	"$1,256.54"	"$1,304.96"	$0.00	$352.82	$0.00	$0.00	$0.00	$0.00	$846.50	"$1,340.86"	"$1,354.40"	$0.00	"$1,100.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007557	EAP	Custom 27007557		Screwdriver Blade	BOTH IP/OP	"$1,268.00 "	$938.32	$0.00	"$1,014.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$941.11	$941.11	$977.37	$0.00	$264.25	$0.00	$0.00	$0.00	$0.00	$634.00	"$1,004.26"	"$1,014.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007632	EAP	Custom 27007632		Rotary Mixer	BOTH IP/OP	"$8,539.00 "	"$6,318.86"	$0.00	"$6,831.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,581.86"	$0.00	"$1,779.53"	$0.00	$0.00	$0.00	$0.00	"$4,269.50"	"$6,762.89"	"$6,831.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007633	EAP	Custom 27007633		Srs? Fast Set Putty 3cc Steril	BOTH IP/OP	"$3,760.00 "	"$2,782.40"	$0.00	"$3,008.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,790.67"	"$2,790.67"	"$2,898.21"	$0.00	$783.58	$0.00	$0.00	$0.00	$0.00	"$1,880.00"	"$2,977.92"	"$3,008.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007634	EAP	Custom 27007634		Nor? Srs? Bne Void Fill Ro 3cc	BOTH IP/OP	"$3,852.00 "	"$2,850.48"	$0.00	"$3,081.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,858.95"	"$2,858.95"	"$2,969.12"	$0.00	$802.76	$0.00	$0.00	$0.00	$0.00	"$1,926.00"	"$3,050.78"	"$3,081.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007635	EAP	Custom 27007635		Srs? Fast Set Putty 5cc Steril	BOTH IP/OP	"$6,218.00 "	"$4,601.32"	$0.00	"$4,974.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,792.83"	$0.00	"$1,295.83"	$0.00	$0.00	$0.00	$0.00	"$3,109.00"	"$4,924.66"	"$4,974.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007636	EAP	Custom 27007636		Nor? Srs? Bne Void Fill Ro 5cc	BOTH IP/OP	"$6,310.00 "	"$4,669.40"	$0.00	"$5,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,863.75"	$0.00	"$1,315.00"	$0.00	$0.00	$0.00	$0.00	"$3,155.00"	"$4,997.52"	"$5,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007637	EAP	Custom 27007637		Srs? Fast Set Putty 10cc Steri	BOTH IP/OP	"$12,321.00 "	"$9,117.54"	$0.00	"$9,856.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$9,497.03"	$0.00	"$2,567.70"	$0.00	$0.00	$0.00	$0.00	"$6,160.50"	"$9,758.23"	"$9,856.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007638	EAP	Custom 27007638		Nor? Srs? Bne Vd Fill Ro Mx 10	BOTH IP/OP	"$12,413.00 "	"$9,185.62"	$0.00	"$9,930.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$9,567.94"	$0.00	"$2,586.87"	$0.00	$0.00	$0.00	$0.00	"$6,206.50"	"$9,831.10"	"$9,930.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007639	EAP	Custom 27007639		Srs? Fast Set Putty 15cc Ster	BOTH IP/OP	"$18,167.00 "	"$13,443.58"	$0.00	"$14,533.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,003.12"	$0.00	"$3,786.00"	$0.00	$0.00	$0.00	$0.00	"$9,083.50"	"$14,388.26"	"$14,533.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007640	EAP	Custom 27007640		Pressure Measurement	BOTH IP/OP	$904.00 	$668.96	$0.00	$723.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$670.95	$670.95	$696.80	$0.00	$188.39	$0.00	$0.00	$0.00	$0.00	$452.00	$715.97	$723.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007719	EAP	Custom 27007719		Univ Lock Troch Stab Pl 131mm	BOTH IP/OP	"$2,620.00 "	"$1,938.80"	$0.00	"$2,096.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,944.56"	"$1,944.56"	"$2,019.50"	$0.00	$546.01	$0.00	$0.00	$0.00	$0.00	"$1,310.00"	"$2,075.04"	"$2,096.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007749	EAP	Custom 27007749		T15/2.5m Hex Cerclage But- Ste	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007795	EAP	Custom 27007795		Swans Bur S?2.0m Hd Lgh 6.3mm	BOTH IP/OP	$366.00 	$270.84	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007796	EAP	Custom 27007796		Swans Bur M?2.0m Hd Lgh 6.3mm	BOTH IP/OP	$366.00 	$270.84	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007797	EAP	Custom 27007797		Swans Bur L?2.0m Hd Lgh 6.3mm	BOTH IP/OP	$366.00 	$270.84	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007798	EAP	Custom 27007798		Swans Bur S?3.0m Hd Lgh 9.7mm	BOTH IP/OP	$366.00 	$270.84	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007799	EAP	Custom 27007799		Swans Bur M?3.0m Hd Lgh 9.7mm	BOTH IP/OP	$366.00 	$270.84	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007800	EAP	Custom 27007800		Swans Bur L?3.0m Hd Lgh 9.7mm	BOTH IP/OP	$366.00 	$270.84	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007801	EAP	Custom 27007801		Swans Bur S?4.0m Hd Lgh 12.7mm	BOTH IP/OP	$366.00 	$270.84	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007802	EAP	Custom 27007802		Swans Bur M?4.0m Hd Lgh 12.7mm	BOTH IP/OP	$148.00 	$109.52	$0.00	$118.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.85	$109.85	$114.08	$0.00	$30.84	$0.00	$0.00	$0.00	$0.00	$74.00	$117.22	$118.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007803	EAP	Custom 27007803		Swans Bur L?4.0m Hd Lgh 12.7mm	BOTH IP/OP	$366.00 	$270.84	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007810	EAP	Custom 27007810		Swans Bur S?5.0m Hd Lgh 15.8mm	BOTH IP/OP	$366.00 	$270.84	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007811	EAP	Custom 27007811		Swans Bur M?5.0m Hd Lgh 15.8mm	BOTH IP/OP	$366.00 	$270.84	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007812	EAP	Custom 27007812		Swans Bur L?5.0m Hd Lgh 15.8mm	BOTH IP/OP	$366.00 	$270.84	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007840	EAP	Custom 27007840		Lindeman Rmer Lgh 45m ?2.3m	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007853	EAP	Custom 27007853		Saw Blade  F/sagittal Saw	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007854	EAP	Custom 27007854		Saw Blde Cresc F/oscillat Saw	BOTH IP/OP	$366.00 	$270.84	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007864	EAP	Custom 27007864		Tibial Nail-ex Insertion Handl	BOTH IP/OP	"$5,201.00 "	"$3,848.74"	$0.00	"$4,160.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,860.18"	"$3,860.18"	"$4,008.93"	$0.00	"$1,083.89"	$0.00	$0.00	$0.00	$0.00	"$2,600.50"	"$4,119.19"	"$4,160.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007865	EAP	Custom 27007865		Rad Ruler Ti Cannul Fem Nails	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007866	EAP	Custom 27007866		Rad Ruler Ti Cannul Tib Nails	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007867	EAP	Custom 27007867		Rad Ruler Ti Cannul Hum Nails	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007868	EAP	Custom 27007868		Rad Canal Wdth Estimat Im Nail	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007869	EAP	Custom 27007869		Hold Devic Gde Wire & Ream Rod	BOTH IP/OP	"$3,375.00 "	"$2,497.50"	$0.00	"$2,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,504.93"	"$2,504.93"	"$2,601.45"	$0.00	$703.35	$0.00	$0.00	$0.00	$0.00	"$1,687.50"	"$2,673.00"	"$2,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007871	EAP	Custom 27007871		15.0 Cannul Drl Bit Lg Qc/280m	BOTH IP/OP	"$1,969.00 "	"$1,457.06"	$0.00	"$1,575.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,461.39"	"$1,461.39"	"$1,517.71"	$0.00	$410.34	$0.00	$0.00	$0.00	$0.00	$984.50	"$1,559.45"	"$1,575.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007872	EAP	Custom 27007872		17.0m Cannul Drl Bit Lg Qc/280	BOTH IP/OP	"$2,461.00 "	"$1,821.14"	$0.00	"$1,968.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,826.55"	"$1,826.55"	"$1,896.94"	$0.00	$512.87	$0.00	$0.00	$0.00	$0.00	"$1,230.50"	"$1,949.11"	"$1,968.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007873	EAP	Custom 27007873		13.0mm Protection Sleeve	BOTH IP/OP	"$1,490.00 "	"$1,102.60"	$0.00	"$1,192.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,105.88"	"$1,105.88"	"$1,148.49"	$0.00	$310.52	$0.00	$0.00	$0.00	$0.00	$745.00	"$1,180.08"	"$1,192.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007874	EAP	Custom 27007874		13.0/3.2 Wire Gude W/ Troc Tip	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$0.00	$0.00	$0.00	$295.50	$468.07	$472.80	$0.00	$384.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007875	EAP	Custom 27007875		13 Flex Can Drl Bit Lg Qc/465	BOTH IP/OP	"$2,762.00 "	"$2,043.88"	$0.00	"$2,209.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,049.96"	"$2,049.96"	"$2,128.95"	$0.00	$575.60	$0.00	$0.00	$0.00	$0.00	"$1,381.00"	"$2,187.50"	"$2,209.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007876	EAP	Custom 27007876		13 Flex Can Drl Bit Lg Qc/465	BOTH IP/OP	"$2,891.00 "	"$2,139.34"	$0.00	"$2,312.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,145.70"	"$2,145.70"	"$2,228.38"	$0.00	$602.48	$0.00	$0.00	$0.00	$0.00	"$1,445.50"	"$2,289.67"	"$2,312.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007877	EAP	Custom 27007877		12.0mm Protection Sleeve	BOTH IP/OP	"$1,490.00 "	"$1,102.60"	$0.00	"$1,192.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,105.88"	"$1,105.88"	"$1,148.49"	$0.00	$310.52	$0.00	$0.00	$0.00	$0.00	$745.00	"$1,180.08"	"$1,192.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007878	EAP	Custom 27007878		12.0 Cannul Drl Bit Lg Qc/190	BOTH IP/OP	"$2,211.00 "	"$1,636.14"	$0.00	"$1,768.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,641.00"	"$1,641.00"	"$1,704.24"	$0.00	$460.77	$0.00	$0.00	$0.00	$0.00	"$1,105.50"	"$1,751.11"	"$1,768.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007879	EAP	Custom 27007879		10.0mm Protection Sleeve	BOTH IP/OP	"$1,490.00 "	"$1,102.60"	$0.00	"$1,192.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,105.88"	"$1,105.88"	"$1,148.49"	$0.00	$310.52	$0.00	$0.00	$0.00	$0.00	$745.00	"$1,180.08"	"$1,192.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007880	EAP	Custom 27007880		10.0mm Cannulated Awl	BOTH IP/OP	"$1,747.00 "	"$1,292.78"	$0.00	"$1,397.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,296.62"	"$1,296.62"	"$1,346.59"	$0.00	$364.07	$0.00	$0.00	$0.00	$0.00	$873.50	"$1,383.62"	"$1,397.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007881	EAP	Custom 27007881		12.0mm Cannulated Awl	BOTH IP/OP	"$1,778.00 "	"$1,315.72"	$0.00	"$1,422.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,319.63"	"$1,319.63"	"$1,370.48"	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$889.00	"$1,408.18"	"$1,422.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007882	EAP	Custom 27007882		14.0mm Cannulated Awl	BOTH IP/OP	"$1,855.00 "	"$1,372.70"	$0.00	"$1,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,376.78"	"$1,376.78"	"$1,429.83"	$0.00	$386.58	$0.00	$0.00	$0.00	$0.00	$927.50	"$1,469.16"	"$1,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007884	EAP	Custom 27007884		Standard Insertion Handle	BOTH IP/OP	"$5,201.00 "	"$3,848.74"	$0.00	"$4,160.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,860.18"	"$3,860.18"	"$4,008.93"	$0.00	"$1,083.89"	$0.00	$0.00	$0.00	$0.00	"$2,600.50"	"$4,119.19"	"$4,160.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007885	EAP	Custom 27007885		Percutaneous Insertion Handle	BOTH IP/OP	"$5,201.00 "	"$3,848.74"	$0.00	"$4,160.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,860.18"	"$3,860.18"	"$4,008.93"	$0.00	"$1,083.89"	$0.00	$0.00	$0.00	$0.00	"$2,600.50"	"$4,119.19"	"$4,160.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007887	EAP	Custom 27007887		Rec Loc Aim Arm Lat Ent Fem Nl	BOTH IP/OP	"$4,071.00 "	"$3,012.54"	$0.00	"$3,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,021.50"	"$3,021.50"	"$3,137.93"	$0.00	$848.40	$0.00	$0.00	$0.00	$0.00	"$2,035.50"	"$3,224.23"	"$3,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007893	EAP	Custom 27007893		Insert Hdle Ti Cann Hum Nls-ex	BOTH IP/OP	"$4,522.00 "	"$3,346.28"	$0.00	"$3,617.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,356.23"	"$3,356.23"	"$3,485.56"	$0.00	$942.38	$0.00	$0.00	$0.00	$0.00	"$2,261.00"	"$3,581.42"	"$3,617.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007894	EAP	Custom 27007894		Sprl Blde Aim Arm Ti Can Hum N	BOTH IP/OP	"$4,071.00 "	"$3,012.54"	$0.00	"$3,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,021.50"	"$3,021.50"	"$3,137.93"	$0.00	$848.40	$0.00	$0.00	$0.00	$0.00	"$2,035.50"	"$3,224.23"	"$3,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007900	EAP	Custom 27007900		12.0mm/8.0mm Protectn Slve 188	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$715.30	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007904	EAP	Custom 27007904		11.5/8.5 Protectn Slve Rec Lck	BOTH IP/OP	$635.00 	$469.90	$0.00	$508.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$471.30	$471.30	$489.46	$0.00	$132.33	$0.00	$0.00	$0.00	$0.00	$317.50	$502.92	$508.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007909	EAP	Custom 27007909		Tap For 6.5mm Recon Screws	BOTH IP/OP	"$1,997.00 "	"$1,477.78"	$0.00	"$1,597.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,482.17"	"$1,482.17"	"$1,539.29"	$0.00	$416.17	$0.00	$0.00	$0.00	$0.00	$998.50	"$1,581.62"	"$1,597.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007910	EAP	Custom 27007910		15.0/13.0 Pro Slve F/spir Bld	BOTH IP/OP	"$1,616.00 "	"$1,195.84"	$0.00	"$1,292.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,199.40"	"$1,199.40"	"$1,245.61"	$0.00	$336.77	$0.00	$0.00	$0.00	$0.00	$808.00	"$1,279.87"	"$1,292.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007911	EAP	Custom 27007911		13.0/3.2 Wre Gde Spir Blde Aim	BOTH IP/OP	"$1,222.00 "	$904.28	$0.00	$977.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$906.97	$906.97	$941.92	$0.00	$254.66	$0.00	$0.00	$0.00	$0.00	$611.00	$967.82	$977.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007912	EAP	Custom 27007912		Spir Blde Insert Retrgrde Fem	BOTH IP/OP	"$3,061.00 "	"$2,265.14"	$0.00	"$2,448.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,271.87"	"$2,271.87"	"$2,359.42"	$0.00	$637.91	$0.00	$0.00	$0.00	$0.00	"$1,530.50"	"$2,424.31"	"$2,448.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007913	EAP	Custom 27007913		Speclty Lck Meas Dev Ti Fem Nl	BOTH IP/OP	$616.00 	$455.84	$0.00	$492.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$457.20	$457.20	$474.81	$0.00	$128.37	$0.00	$0.00	$0.00	$0.00	$308.00	$487.87	$492.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007914	EAP	Custom 27007914		14.0mm/8.0mm Drill Sleeve 130m	BOTH IP/OP	$679.00 	$502.46	$0.00	$543.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$503.95	$503.95	$523.37	$0.00	$141.50	$0.00	$0.00	$0.00	$0.00	$339.50	$537.77	$543.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007919	EAP	Custom 27007919		Spir Bld Mea Dev Ti Can Hum Nl	BOTH IP/OP	"$2,296.00 "	"$1,699.04"	$0.00	"$1,836.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,704.09"	"$1,704.09"	"$1,769.76"	$0.00	$478.49	$0.00	$0.00	$0.00	$0.00	"$1,148.00"	"$1,818.43"	"$1,836.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007920	EAP	Custom 27007920		Stan Aim Arm Ti Can Hum Nls-ex	BOTH IP/OP	"$4,071.00 "	"$3,012.54"	$0.00	"$3,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,021.50"	"$3,021.50"	"$3,137.93"	$0.00	$848.40	$0.00	$0.00	$0.00	$0.00	"$2,035.50"	"$3,224.23"	"$3,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007921	EAP	Custom 27007921		Ream Rod Push Rod Wth Ball Hdl	BOTH IP/OP	"$1,484.00 "	"$1,098.16"	$0.00	"$1,187.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,101.42"	"$1,101.42"	"$1,143.87"	$0.00	$309.27	$0.00	$0.00	$0.00	$0.00	$742.00	"$1,175.33"	"$1,187.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007932	EAP	Custom 27007932		Hold Slve W/ Lcking Device	BOTH IP/OP	"$3,354.00 "	"$2,481.96"	$0.00	"$2,683.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,489.34"	"$2,489.34"	"$2,585.26"	$0.00	$698.97	$0.00	$0.00	$0.00	$0.00	"$1,677.00"	"$2,656.37"	"$2,683.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007935	EAP	Custom 27007935		Lrg Hexa Scwdrvr 3.5 Wdth Acrs	BOTH IP/OP	"$1,199.00 "	$887.26	$0.00	$959.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$889.90	$889.90	$924.19	$0.00	$249.87	$0.00	$0.00	$0.00	$0.00	$599.50	$949.61	$959.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007937	EAP	Custom 27007937		Shrt Compres Dev Ti Can Tib Nl	BOTH IP/OP	"$1,799.00 "	"$1,331.26"	$0.00	"$1,439.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,335.22"	"$1,335.22"	"$1,386.67"	$0.00	$374.91	$0.00	$0.00	$0.00	$0.00	$899.50	"$1,424.81"	"$1,439.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007938	EAP	Custom 27007938		Lng Compres Dev Ti Can Tib Nl	BOTH IP/OP	"$1,799.00 "	"$1,331.26"	$0.00	"$1,439.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,335.22"	"$1,335.22"	"$1,386.67"	$0.00	$374.91	$0.00	$0.00	$0.00	$0.00	$899.50	"$1,424.81"	"$1,439.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007941	EAP	Custom 27007941		15.0can Flex Dl Bit Lrg Qc/310	BOTH IP/OP	"$2,711.00 "	"$2,006.14"	$0.00	"$2,168.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,012.10"	"$2,012.10"	"$2,089.64"	$0.00	$564.97	$0.00	$0.00	$0.00	$0.00	"$1,355.50"	"$2,147.11"	"$2,168.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007942	EAP	Custom 27007942		17 Can Flex Drl Bit Lrg Qc/310	BOTH IP/OP	"$2,711.00 "	"$2,006.14"	$0.00	"$2,168.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,012.10"	"$2,012.10"	"$2,089.64"	$0.00	$564.97	$0.00	$0.00	$0.00	$0.00	"$1,355.50"	"$2,147.11"	"$2,168.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007943	EAP	Custom 27007943		11/8 Pro Slve 188mm For Asls	BOTH IP/OP	$889.00 	$657.86	$0.00	$711.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$659.82	$659.82	$685.24	$0.00	$185.27	$0.00	$0.00	$0.00	$0.00	$444.50	$704.09	$711.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007945	EAP	Custom 27007945		Insert Hndl F/4.5 Lcp Prox Tib	BOTH IP/OP	"$5,623.00 "	"$4,161.02"	$0.00	"$4,498.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,173.39"	"$4,173.39"	"$4,334.21"	$0.00	"$1,171.83"	$0.00	$0.00	$0.00	$0.00	"$2,811.50"	"$4,453.42"	"$4,498.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007947	EAP	Custom 27007947		Strt Ball Spike Low Pro Pelvic	BOTH IP/OP	"$1,511.00 "	"$1,118.14"	$0.00	"$1,208.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,121.46"	"$1,121.46"	"$1,164.68"	$0.00	$314.89	$0.00	$0.00	$0.00	$0.00	$755.50	"$1,196.71"	"$1,208.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007948	EAP	Custom 27007948		Strt Ball Spike Low Pro Pelvic	BOTH IP/OP	"$1,608.00 "	"$1,189.92"	$0.00	"$1,286.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,193.46"	"$1,193.46"	"$1,239.45"	$0.00	$335.11	$0.00	$0.00	$0.00	$0.00	$804.00	"$1,273.54"	"$1,286.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007949	EAP	Custom 27007949		Strt Reduc Forceps Low Pro Pel	BOTH IP/OP	"$6,337.00 "	"$4,689.38"	$0.00	"$5,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,884.56"	$0.00	"$1,320.63"	$0.00	$0.00	$0.00	$0.00	"$3,168.50"	"$5,018.90"	"$5,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007952	EAP	Custom 27007952		Reduct Forceps For Low Pro Pel	BOTH IP/OP	"$8,489.00 "	"$6,281.86"	$0.00	"$6,791.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,543.32"	$0.00	"$1,769.11"	$0.00	$0.00	$0.00	$0.00	"$4,244.50"	"$6,723.29"	"$6,791.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007954	EAP	Custom 27007954		Lo Pro Pel Sys Rd Frcp 3.5 Scw	BOTH IP/OP	"$7,620.00 "	"$5,638.80"	$0.00	"$6,096.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,873.50"	$0.00	"$1,588.01"	$0.00	$0.00	$0.00	$0.00	"$3,810.00"	"$6,035.04"	"$6,096.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007955	EAP	Custom 27007955		Round Disk	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007956	EAP	Custom 27007956		Rectangular Disk	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007966	EAP	Custom 27007966		Instn Hndl F/4.5 Lcp Prox Tib	BOTH IP/OP	"$5,623.00 "	"$4,161.02"	$0.00	"$4,498.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,173.39"	"$4,173.39"	"$4,334.21"	$0.00	"$1,171.83"	$0.00	$0.00	$0.00	$0.00	"$2,811.50"	"$4,453.42"	"$4,498.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007967	EAP	Custom 27007967		Solid 4.0 Hex Scwdrvr Shft 200	BOTH IP/OP	"$1,131.00 "	$836.94	$0.00	$904.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$839.43	$839.43	$871.77	$0.00	$235.70	$0.00	$0.00	$0.00	$0.00	$565.50	$895.75	$904.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007969	EAP	Custom 27007969		Spiked Round Disk	BOTH IP/OP	"$1,247.00 "	$922.78	$0.00	$997.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.52	$925.52	$961.19	$0.00	$259.87	$0.00	$0.00	$0.00	$0.00	$623.50	$987.62	$997.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007970	EAP	Custom 27007970		Spiked Rectangular Disk	BOTH IP/OP	"$1,247.00 "	$922.78	$0.00	$997.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.52	$925.52	$961.19	$0.00	$259.87	$0.00	$0.00	$0.00	$0.00	$623.50	$987.62	$997.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007974	EAP	Custom 27007974		Ped Lcp Hip Pl Gdng Blk 3.5scw	BOTH IP/OP	"$1,986.00 "	"$1,469.64"	$0.00	"$1,588.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,474.01"	"$1,474.01"	"$1,530.81"	$0.00	$413.88	$0.00	$0.00	$0.00	$0.00	$993.00	"$1,572.91"	"$1,588.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007975	EAP	Custom 27007975		Ped Lcp Hip Pl Gdng Blck 5scw	BOTH IP/OP	"$1,986.00 "	"$1,469.64"	$0.00	"$1,588.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,474.01"	"$1,474.01"	"$1,530.81"	$0.00	$413.88	$0.00	$0.00	$0.00	$0.00	$993.00	"$1,572.91"	"$1,588.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007977	EAP	Custom 27007977		Reduction Sleeve 4.3mm/2.8mm	BOTH IP/OP	$647.00 	$478.78	$0.00	$517.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$480.20	$480.20	$498.71	$0.00	$134.83	$0.00	$0.00	$0.00	$0.00	$323.50	$512.42	$517.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007979	EAP	Custom 27007979		Positioning Device Gdng Blck	BOTH IP/OP	"$1,727.00 "	"$1,277.98"	$0.00	"$1,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,281.78"	"$1,281.78"	"$1,331.17"	$0.00	$359.91	$0.00	$0.00	$0.00	$0.00	$863.50	"$1,367.78"	"$1,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007980	EAP	Custom 27007980		Medialization Gde 3.5&5.0 Lcp	BOTH IP/OP	"$1,727.00 "	"$1,277.98"	$0.00	"$1,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,281.78"	"$1,281.78"	"$1,331.17"	$0.00	$359.91	$0.00	$0.00	$0.00	$0.00	$863.50	"$1,367.78"	"$1,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007981	EAP	Custom 27007981		Osteotomy Measuring Device	BOTH IP/OP	"$1,061.00 "	$785.14	$0.00	$848.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$787.47	$787.47	$817.82	$0.00	$221.11	$0.00	$0.00	$0.00	$0.00	$530.50	$840.31	$848.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007984	EAP	Custom 27007984		Meas Dev 3.0 Hdles Compres Scw	BOTH IP/OP	$722.00 	$534.28	$0.00	$577.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$535.87	$535.87	$556.52	$0.00	$150.46	$0.00	$0.00	$0.00	$0.00	$361.00	$571.82	$577.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007990	EAP	Custom 27007990		Meas Dev F/drl Gde W/stp 3.0m	BOTH IP/OP	$642.00 	$475.08	$0.00	$513.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$476.49	$476.49	$494.85	$0.00	$133.79	$0.00	$0.00	$0.00	$0.00	$321.00	$508.46	$513.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007991	EAP	Custom 27007991		Medium Open Compressor	BOTH IP/OP	"$4,431.00 "	"$3,278.94"	$0.00	"$3,544.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,288.69"	"$3,288.69"	"$3,415.41"	$0.00	$923.42	$0.00	$0.00	$0.00	$0.00	"$2,215.50"	"$3,509.35"	"$3,544.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007992	EAP	Custom 27007992		Lo-pro Wrst Fxtr/schan Scr/200	BOTH IP/OP	"$4,535.00 "	"$3,355.90"	$0.00	"$3,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,365.88"	"$3,365.88"	"$3,495.58"	$0.00	$945.09	$0.00	$0.00	$0.00	$0.00	"$2,267.50"	"$3,591.72"	"$3,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007993	EAP	Custom 27007993		Lo-pro Wrst Fxtr/schan Scr/220	BOTH IP/OP	"$4,535.00 "	"$3,355.90"	$0.00	"$3,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,365.88"	"$3,365.88"	"$3,495.58"	$0.00	$945.09	$0.00	$0.00	$0.00	$0.00	"$2,267.50"	"$3,591.72"	"$3,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007994	EAP	Custom 27007994		Low-pro Wrst Fxtr/slf-drlg/200	BOTH IP/OP	"$5,757.00 "	"$4,260.18"	$0.00	"$4,605.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,437.50"	$0.00	"$1,199.76"	$0.00	$0.00	$0.00	$0.00	"$2,878.50"	"$4,559.54"	"$4,605.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007995	EAP	Custom 27007995		Low-pro Wrst Fxtr/slf-drlg/220	BOTH IP/OP	"$5,757.00 "	"$4,260.18"	$0.00	"$4,605.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,437.50"	$0.00	"$1,199.76"	$0.00	$0.00	$0.00	$0.00	"$2,878.50"	"$4,559.54"	"$4,605.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007996	EAP	Custom 27007996		Tensioner	BOTH IP/OP	"$16,191.00 "	"$11,981.34"	$0.00	"$12,952.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,480.02"	$0.00	"$3,374.20"	$0.00	$0.00	$0.00	$0.00	"$8,095.50"	"$12,823.27"	"$12,952.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007997	EAP	Custom 27007997		Slotted Socket Wrench 11mm	BOTH IP/OP	"$2,314.00 "	"$1,712.36"	$0.00	"$1,851.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,717.45"	"$1,717.45"	"$1,783.63"	$0.00	$482.24	$0.00	$0.00	$0.00	$0.00	"$1,157.00"	"$1,832.69"	"$1,851.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007998	EAP	Custom 27007998		Patient Wrench 8mm/11mm	BOTH IP/OP	$604.00 	$446.96	$0.00	$483.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$448.29	$448.29	$465.56	$0.00	$125.87	$0.00	$0.00	$0.00	$0.00	$302.00	$478.37	$483.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27007999	EAP	Custom 27007999		Ratchet Wrench 11mm	BOTH IP/OP	"$2,891.00 "	"$2,139.34"	$0.00	"$2,312.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,145.70"	"$2,145.70"	"$2,228.38"	$0.00	$602.48	$0.00	$0.00	$0.00	$0.00	"$1,445.50"	"$2,289.67"	"$2,312.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008000	EAP	Custom 27008000		Split Tissue Protect Slve 2.5m	BOTH IP/OP	"$2,314.00 "	"$1,712.36"	$0.00	"$1,851.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,717.45"	"$1,717.45"	"$1,783.63"	$0.00	$482.24	$0.00	$0.00	$0.00	$0.00	"$1,157.00"	"$1,832.69"	"$1,851.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008001	EAP	Custom 27008001		Split Tissue Protect Slve 5mm	BOTH IP/OP	"$2,314.00 "	"$1,712.36"	$0.00	"$1,851.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,717.45"	"$1,717.45"	"$1,783.63"	$0.00	$482.24	$0.00	$0.00	$0.00	$0.00	"$1,157.00"	"$1,832.69"	"$1,851.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008004	EAP	Custom 27008004		Schanz Screw Bolt Mr Safe	BOTH IP/OP	$906.00 	$670.44	$0.00	$724.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$672.43	$672.43	$698.34	$0.00	$188.81	$0.00	$0.00	$0.00	$0.00	$453.00	$717.55	$724.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008005	EAP	Custom 27008005		Pivot Schanz Screw Clamp Mr Sa	BOTH IP/OP	"$1,830.00 "	"$1,354.20"	$0.00	"$1,464.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,358.23"	"$1,358.23"	"$1,410.56"	$0.00	$381.37	$0.00	$0.00	$0.00	$0.00	$915.00	"$1,449.36"	"$1,464.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008006	EAP	Custom 27008006		Locking Hinge Mr Safe	BOTH IP/OP	$906.00 	$670.44	$0.00	$724.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$672.43	$672.43	$698.34	$0.00	$188.81	$0.00	$0.00	$0.00	$0.00	$453.00	$717.55	$724.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008007	EAP	Custom 27008007		Schanz Screw Bolt Post Mount M	BOTH IP/OP	"$1,045.00 "	$773.30	$0.00	$836.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$775.60	$775.60	$805.49	$0.00	$217.78	$0.00	$0.00	$0.00	$0.00	$522.50	$827.64	$836.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008008	EAP	Custom 27008008		Smth Wire/1.5mm Diameter 400m	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.60	$228.60	$237.41	$0.00	$64.19	$0.00	$0.00	$0.00	$0.00	$154.00	$243.94	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008009	EAP	Custom 27008009		Smth Wire/1.8mm Diameter 400m	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.60	$228.60	$237.41	$0.00	$64.19	$0.00	$0.00	$0.00	$0.00	$154.00	$243.94	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008010	EAP	Custom 27008010		Smth Wire/2.0mm Diameter 400m	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.60	$228.60	$237.41	$0.00	$64.19	$0.00	$0.00	$0.00	$0.00	$154.00	$243.94	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008011	EAP	Custom 27008011		Smth Wire 1.5m Dia Hlf Pnt Tip	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.60	$228.60	$237.41	$0.00	$64.19	$0.00	$0.00	$0.00	$0.00	$154.00	$243.94	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008012	EAP	Custom 27008012		Smth Wire 1.8m Dia Hlf Pnt Tip	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.60	$228.60	$237.41	$0.00	$64.19	$0.00	$0.00	$0.00	$0.00	$154.00	$243.94	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008013	EAP	Custom 27008013		Smth Wire 2.0m Dia Hlf Pnt Tip	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.60	$228.60	$237.41	$0.00	$64.19	$0.00	$0.00	$0.00	$0.00	$154.00	$243.94	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008014	EAP	Custom 27008014		Reductn Wre/1.5mm Diam 400m	BOTH IP/OP	$962.00 	$711.88	$0.00	$769.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$714.00	$714.00	$741.51	$0.00	$200.48	$0.00	$0.00	$0.00	$0.00	$481.00	$761.90	$769.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008015	EAP	Custom 27008015		Reductn Wre/1.8mm Diam 400m	BOTH IP/OP	$962.00 	$711.88	$0.00	$769.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$714.00	$714.00	$741.51	$0.00	$200.48	$0.00	$0.00	$0.00	$0.00	$481.00	$761.90	$769.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008016	EAP	Custom 27008016		Reductn Wire/2.0mm Diam 400m	BOTH IP/OP	$962.00 	$711.88	$0.00	$769.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$714.00	$714.00	$741.51	$0.00	$200.48	$0.00	$0.00	$0.00	$0.00	$481.00	$761.90	$769.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008017	EAP	Custom 27008017		Reductn Wre 1.5mm Dia Half Pnt	BOTH IP/OP	$962.00 	$711.88	$0.00	$769.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$714.00	$714.00	$741.51	$0.00	$200.48	$0.00	$0.00	$0.00	$0.00	$481.00	$761.90	$769.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008018	EAP	Custom 27008018		Reductn Wre 1.8mm Dia Hlf Pnt	BOTH IP/OP	$962.00 	$711.88	$0.00	$769.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$714.00	$714.00	$741.51	$0.00	$200.48	$0.00	$0.00	$0.00	$0.00	$481.00	$761.90	$769.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008019	EAP	Custom 27008019		Reductn Wre 2.0mm Dia Half Pnt	BOTH IP/OP	$962.00 	$711.88	$0.00	$769.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$714.00	$714.00	$741.51	$0.00	$200.48	$0.00	$0.00	$0.00	$0.00	$481.00	$761.90	$769.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008020	EAP	Custom 27008020		Wire Bolt/slotted Mr Safe	BOTH IP/OP	$197.00 	$145.78	$0.00	$157.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.21	$146.21	$151.85	$0.00	$41.05	$0.00	$0.00	$0.00	$0.00	$98.50	$156.02	$157.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008021	EAP	Custom 27008021		Wire Bolt/offset Mr Safe	BOTH IP/OP	$183.00 	$135.42	$0.00	$146.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$135.82	$135.82	$141.06	$0.00	$38.14	$0.00	$0.00	$0.00	$0.00	$91.50	$144.94	$146.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008024	EAP	Custom 27008024		Schanz Scrw Bolt Can Rng Mnt	BOTH IP/OP	$906.00 	$670.44	$0.00	$724.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$672.43	$672.43	$698.34	$0.00	$188.81	$0.00	$0.00	$0.00	$0.00	$453.00	$717.55	$724.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008025	EAP	Custom 27008025		Schanz Scrw Bolt Can Post Mnt	BOTH IP/OP	"$1,045.00 "	$773.30	$0.00	$836.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$775.60	$775.60	$805.49	$0.00	$217.78	$0.00	$0.00	$0.00	$0.00	$522.50	$827.64	$836.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008026	EAP	Custom 27008026		Square Nut Mr Safe	BOTH IP/OP	$337.00 	$249.38	$0.00	$269.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.12	$250.12	$259.76	$0.00	$70.23	$0.00	$0.00	$0.00	$0.00	$168.50	$266.90	$269.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008027	EAP	Custom 27008027		Nut Mr Safe	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008028	EAP	Custom 27008028		Nut 10 Pack Mr Safe	BOTH IP/OP	$154.00 	$113.96	$0.00	$123.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.30	$114.30	$118.70	$0.00	$32.09	$0.00	$0.00	$0.00	$0.00	$77.00	$121.97	$123.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008029	EAP	Custom 27008029		Speed Nut Mr Safe	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008030	EAP	Custom 27008030		Wire Post-short Mr Safe	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008031	EAP	Custom 27008031		Wire Post-tall Mr Safe	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$715.30	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008032	EAP	Custom 27008032		Spacing Washer 1mm Mr Safe	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008033	EAP	Custom 27008033		Spacing Washer 2mm Mr Safe	BOTH IP/OP	$21.00 	$15.54	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.59	$15.59	$16.19	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$10.50	$16.63	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008034	EAP	Custom 27008034		Spacing Washer 4mm Mr Safe	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008035	EAP	Custom 27008035		Spherical Washer Couple Mr Saf	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.62	$107.62	$111.77	$0.00	$30.22	$0.00	$0.00	$0.00	$0.00	$72.50	$114.84	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008036	EAP	Custom 27008036		Oblique Support Mr Safe	BOTH IP/OP	"$2,314.00 "	"$1,712.36"	$0.00	"$1,851.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,717.45"	"$1,717.45"	"$1,783.63"	$0.00	$482.24	$0.00	$0.00	$0.00	$0.00	"$1,157.00"	"$1,832.69"	"$1,851.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008038	EAP	Custom 27008038		Thread Rod 80 Lng/slot Mr Safe	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.82	$207.82	$215.82	$0.00	$58.35	$0.00	$0.00	$0.00	$0.00	$140.00	$221.76	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008039	EAP	Custom 27008039		Thread Rod 100 Lng/slot Mr Sfe	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.82	$207.82	$215.82	$0.00	$58.35	$0.00	$0.00	$0.00	$0.00	$140.00	$221.76	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008040	EAP	Custom 27008040		Threaded Rod 120mm Lng Mr Safe	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.82	$207.82	$215.82	$0.00	$58.35	$0.00	$0.00	$0.00	$0.00	$140.00	$221.76	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008041	EAP	Custom 27008041		Threaded Rod 150mm Lng Mr Safe	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.82	$207.82	$215.82	$0.00	$58.35	$0.00	$0.00	$0.00	$0.00	$140.00	$221.76	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008042	EAP	Custom 27008042		Threaded Rod 200mm Lng Mr Safe	BOTH IP/OP	$301.00 	$222.74	$0.00	$240.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$223.40	$223.40	$232.01	$0.00	$62.73	$0.00	$0.00	$0.00	$0.00	$150.50	$238.39	$240.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008043	EAP	Custom 27008043		Threaded Rod 250mm Lng Mr Safe	BOTH IP/OP	$301.00 	$222.74	$0.00	$240.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$223.40	$223.40	$232.01	$0.00	$62.73	$0.00	$0.00	$0.00	$0.00	$150.50	$238.39	$240.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008044	EAP	Custom 27008044		Threaded Rod 300mm Lng Mr Safe	BOTH IP/OP	$347.00 	$256.78	$0.00	$277.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.54	$257.54	$267.47	$0.00	$72.31	$0.00	$0.00	$0.00	$0.00	$173.50	$274.82	$277.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008045	EAP	Custom 27008045		Threaded Rod 350mm Lng Mr Safe	BOTH IP/OP	$347.00 	$256.78	$0.00	$277.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.54	$257.54	$267.47	$0.00	$72.31	$0.00	$0.00	$0.00	$0.00	$173.50	$274.82	$277.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008046	EAP	Custom 27008046		Threaded Rod 400mm Lng Mr Safe	BOTH IP/OP	$441.00 	$326.34	$0.00	$352.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$327.31	$327.31	$339.92	$0.00	$91.90	$0.00	$0.00	$0.00	$0.00	$220.50	$349.27	$352.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008051	EAP	Custom 27008051		Standoff 20mm Long Mr Safe	BOTH IP/OP	$185.00 	$136.90	$0.00	$148.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.31	$137.31	$142.60	$0.00	$38.55	$0.00	$0.00	$0.00	$0.00	$92.50	$146.52	$148.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008052	EAP	Custom 27008052		Standoff 30mm Long Mr Safe	BOTH IP/OP	$208.00 	$153.92	$0.00	$166.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.38	$154.38	$160.33	$0.00	$43.35	$0.00	$0.00	$0.00	$0.00	$104.00	$164.74	$166.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008053	EAP	Custom 27008053		Standoff 40mm Long Mr Safe	BOTH IP/OP	$234.00 	$173.16	$0.00	$187.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.67	$173.67	$180.37	$0.00	$48.77	$0.00	$0.00	$0.00	$0.00	$117.00	$185.33	$187.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008054	EAP	Custom 27008054		Standoff 50mm Long Mr Safe	BOTH IP/OP	$301.00 	$222.74	$0.00	$240.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$223.40	$223.40	$232.01	$0.00	$62.73	$0.00	$0.00	$0.00	$0.00	$150.50	$238.39	$240.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008055	EAP	Custom 27008055		Ti Half Ring/80m Diam Mr Safe	BOTH IP/OP	"$1,505.00 "	"$1,113.70"	$0.00	"$1,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,117.01"	"$1,117.01"	"$1,160.05"	$0.00	$313.64	$0.00	$0.00	$0.00	$0.00	$752.50	"$1,191.96"	"$1,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008056	EAP	Custom 27008056		Ti Half Ring/100m Diam Mr Safe	BOTH IP/OP	"$1,624.00 "	"$1,201.76"	$0.00	"$1,299.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,205.33"	"$1,205.33"	"$1,251.78"	$0.00	$338.44	$0.00	$0.00	$0.00	$0.00	$812.00	"$1,286.21"	"$1,299.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008057	EAP	Custom 27008057		Ti Half Ring/110m Diam Mr Safe	BOTH IP/OP	"$1,667.00 "	"$1,233.58"	$0.00	"$1,333.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,237.25"	"$1,237.25"	"$1,284.92"	$0.00	$347.40	$0.00	$0.00	$0.00	$0.00	$833.50	"$1,320.26"	"$1,333.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008058	EAP	Custom 27008058		Ti Half Ring/120m Diam Mr Safe	BOTH IP/OP	"$1,735.00 "	"$1,283.90"	$0.00	"$1,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,287.72"	"$1,287.72"	"$1,337.34"	$0.00	$361.57	$0.00	$0.00	$0.00	$0.00	$867.50	"$1,374.12"	"$1,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008059	EAP	Custom 27008059		Ti Half Ring/130m Diam Mr Safe	BOTH IP/OP	"$1,783.00 "	"$1,319.42"	$0.00	"$1,426.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,323.34"	"$1,323.34"	"$1,374.34"	$0.00	$371.58	$0.00	$0.00	$0.00	$0.00	$891.50	"$1,412.14"	"$1,426.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008060	EAP	Custom 27008060		Ti Half Ring/140m Diam Mr Safe	BOTH IP/OP	"$1,850.00 "	"$1,369.00"	$0.00	"$1,480.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,373.07"	"$1,373.07"	"$1,425.98"	$0.00	$385.54	$0.00	$0.00	$0.00	$0.00	$925.00	"$1,465.20"	"$1,480.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008061	EAP	Custom 27008061		Ti Half Ring/150m Diam Mr Safe	BOTH IP/OP	"$1,969.00 "	"$1,457.06"	$0.00	"$1,575.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,461.39"	"$1,461.39"	"$1,517.71"	$0.00	$410.34	$0.00	$0.00	$0.00	$0.00	$984.50	"$1,559.45"	"$1,575.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008062	EAP	Custom 27008062		Ti Half Ring/160m Diam Mr Safe	BOTH IP/OP	"$2,153.00 "	"$1,593.22"	$0.00	"$1,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.96"	"$1,597.96"	"$1,659.53"	$0.00	$448.69	$0.00	$0.00	$0.00	$0.00	"$1,076.50"	"$1,705.18"	"$1,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008063	EAP	Custom 27008063		Ti Half Ring/180m Diam Mr Safe	BOTH IP/OP	"$2,314.00 "	"$1,712.36"	$0.00	"$1,851.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,717.45"	"$1,717.45"	"$1,783.63"	$0.00	$482.24	$0.00	$0.00	$0.00	$0.00	"$1,157.00"	"$1,832.69"	"$1,851.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008064	EAP	Custom 27008064		Ti Half Ring/200m Diam Mr Safe	BOTH IP/OP	"$2,498.00 "	"$1,848.52"	$0.00	"$1,998.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.02"	"$1,854.02"	"$1,925.46"	$0.00	$520.58	$0.00	$0.00	$0.00	$0.00	"$1,249.00"	"$1,978.42"	"$1,998.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008065	EAP	Custom 27008065		Ti Half Ring/220m Diam Mr Safe	BOTH IP/OP	"$2,663.00 "	"$1,970.62"	$0.00	"$2,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,976.48"	"$1,976.48"	"$2,052.64"	$0.00	$554.97	$0.00	$0.00	$0.00	$0.00	"$1,331.50"	"$2,109.10"	"$2,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008066	EAP	Custom 27008066		Ti Half Ring/240m Diam Mr Safe	BOTH IP/OP	"$2,779.00 "	"$2,056.46"	$0.00	"$2,223.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,062.57"	"$2,062.57"	"$2,142.05"	$0.00	$579.14	$0.00	$0.00	$0.00	$0.00	"$1,389.50"	"$2,200.97"	"$2,223.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008067	EAP	Custom 27008067		Ti Full Ring/140m Diam Mr Safe	BOTH IP/OP	"$3,704.00 "	"$2,740.96"	$0.00	"$2,963.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,749.11"	"$2,749.11"	"$2,855.04"	$0.00	$771.91	$0.00	$0.00	$0.00	$0.00	"$1,852.00"	"$2,933.57"	"$2,963.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008068	EAP	Custom 27008068		Ti Full Ring/160m Diam Mr Safe	BOTH IP/OP	"$4,303.00 "	"$3,184.22"	$0.00	"$3,442.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,193.69"	"$3,193.69"	"$3,316.75"	$0.00	$896.75	$0.00	$0.00	$0.00	$0.00	"$2,151.50"	"$3,407.98"	"$3,442.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008069	EAP	Custom 27008069		Ti Full Ring/180m Diam Mr Safe	BOTH IP/OP	"$4,627.00 "	"$3,423.98"	$0.00	"$3,701.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,434.16"	"$3,434.16"	"$3,566.49"	$0.00	$964.27	$0.00	$0.00	$0.00	$0.00	"$2,313.50"	"$3,664.58"	"$3,701.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008070	EAP	Custom 27008070		Ti Full Ring/200m Diam Mr Safe	BOTH IP/OP	"$5,022.00 "	"$3,716.28"	$0.00	"$4,017.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,727.33"	"$3,727.33"	"$3,870.96"	$0.00	"$1,046.58"	$0.00	$0.00	$0.00	$0.00	"$2,511.00"	"$3,977.42"	"$4,017.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008071	EAP	Custom 27008071		Ti 5/8 Ring/130m Diam Mr Safe	BOTH IP/OP	"$2,430.00 "	"$1,798.20"	$0.00	"$1,944.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,803.55"	"$1,803.55"	"$1,873.04"	$0.00	$506.41	$0.00	$0.00	$0.00	$0.00	"$1,215.00"	"$1,924.56"	"$1,944.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008072	EAP	Custom 27008072		Ti 5/8 Ring/150mm Diam Mr Safe	BOTH IP/OP	"$2,663.00 "	"$1,970.62"	$0.00	"$2,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,976.48"	"$1,976.48"	"$2,052.64"	$0.00	$554.97	$0.00	$0.00	$0.00	$0.00	"$1,331.50"	"$2,109.10"	"$2,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008073	EAP	Custom 27008073		Ti 5/8 Ring/160mm Diam Mr Safe	BOTH IP/OP	"$2,891.00 "	"$2,139.34"	$0.00	"$2,312.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,145.70"	"$2,145.70"	"$2,228.38"	$0.00	$602.48	$0.00	$0.00	$0.00	$0.00	"$1,445.50"	"$2,289.67"	"$2,312.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008074	EAP	Custom 27008074		Ti 5/8 Ring/180mm Diam Mr Safe	BOTH IP/OP	"$3,358.00 "	"$2,484.92"	$0.00	"$2,686.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,492.31"	"$2,492.31"	"$2,588.35"	$0.00	$699.81	$0.00	$0.00	$0.00	$0.00	"$1,679.00"	"$2,659.54"	"$2,686.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008075	EAP	Custom 27008075		Ti 5/8 Ring/200mm Diam Mr Safe	BOTH IP/OP	"$3,470.00 "	"$2,567.80"	$0.00	"$2,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,575.43"	"$2,575.43"	"$2,674.68"	$0.00	$723.15	$0.00	$0.00	$0.00	$0.00	"$1,735.00"	"$2,748.24"	"$2,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008076	EAP	Custom 27008076		Ti Fem Arch Pl 180 Dia/90 Degr	BOTH IP/OP	"$4,165.00 "	"$3,082.10"	$0.00	"$3,332.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,091.26"	"$3,091.26"	"$3,210.38"	$0.00	$867.99	$0.00	$0.00	$0.00	$0.00	"$2,082.50"	"$3,298.68"	"$3,332.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008077	EAP	Custom 27008077		Ti Fem Arch Pl 180 Dia/120 Deg	BOTH IP/OP	"$4,281.00 "	"$3,167.94"	$0.00	"$3,424.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,177.36"	"$3,177.36"	"$3,299.79"	$0.00	$892.16	$0.00	$0.00	$0.00	$0.00	"$2,140.50"	"$3,390.55"	"$3,424.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008078	EAP	Custom 27008078		Ti Fem Arch Pl 240 Dia/90 Degr	BOTH IP/OP	"$4,515.00 "	"$3,341.10"	$0.00	"$3,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,351.03"	"$3,351.03"	"$3,480.16"	$0.00	$940.93	$0.00	$0.00	$0.00	$0.00	"$2,257.50"	"$3,575.88"	"$3,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008079	EAP	Custom 27008079		Ti Fem Arch Pl 240 Dia/120 Deg	BOTH IP/OP	"$4,627.00 "	"$3,423.98"	$0.00	"$3,701.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,434.16"	"$3,434.16"	"$3,566.49"	$0.00	$964.27	$0.00	$0.00	$0.00	$0.00	"$2,313.50"	"$3,664.58"	"$3,701.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008080	EAP	Custom 27008080		Linear Distrac 60 Lng 25mm Tr	BOTH IP/OP	"$2,663.00 "	"$1,970.62"	$0.00	"$2,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,976.48"	"$1,976.48"	"$2,052.64"	$0.00	$554.97	$0.00	$0.00	$0.00	$0.00	"$1,331.50"	"$2,109.10"	"$2,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008081	EAP	Custom 27008081		Linear Distrac 120lng 85mm Tra	BOTH IP/OP	"$2,891.00 "	"$2,139.34"	$0.00	"$2,312.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,145.70"	"$2,145.70"	"$2,228.38"	$0.00	$602.48	$0.00	$0.00	$0.00	$0.00	"$1,445.50"	"$2,289.67"	"$2,312.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008082	EAP	Custom 27008082		Linear Distrac 180 Lng 145 Tra	BOTH IP/OP	"$3,241.00 "	"$2,398.34"	$0.00	"$2,592.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,405.47"	"$2,405.47"	"$2,498.16"	$0.00	$675.42	$0.00	$0.00	$0.00	$0.00	"$1,620.50"	"$2,566.87"	"$2,592.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008083	EAP	Custom 27008083		Linear Distrac 250 Lng 215 Tra	BOTH IP/OP	"$3,934.00 "	"$2,911.16"	$0.00	"$3,147.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,919.81"	"$2,919.81"	"$3,032.33"	$0.00	$819.85	$0.00	$0.00	$0.00	$0.00	"$1,967.00"	"$3,115.73"	"$3,147.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008118	EAP	Custom 27008118		Sft Tissue Sprder Trocar 35mm	BOTH IP/OP	"$1,247.00 "	$922.78	$0.00	$997.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.52	$925.52	$961.19	$0.00	$259.87	$0.00	$0.00	$0.00	$0.00	$623.50	$987.62	$997.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008119	EAP	Custom 27008119		Sft Tissue Sprder Trocar 75	BOTH IP/OP	"$1,247.00 "	$922.78	$0.00	$997.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.52	$925.52	$961.19	$0.00	$259.87	$0.00	$0.00	$0.00	$0.00	$623.50	$987.62	$997.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008122	EAP	Custom 27008122		Straight Sharp Hook	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$462.48	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008124	EAP	Custom 27008124		Small Screw Removal Forceps	BOTH IP/OP	"$1,770.00 "	"$1,309.80"	$0.00	"$1,416.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,313.69"	"$1,313.69"	"$1,364.32"	$0.00	$368.87	$0.00	$0.00	$0.00	$0.00	$885.00	"$1,401.84"	"$1,416.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008125	EAP	Custom 27008125		Large Screw Removal Forceps	BOTH IP/OP	"$2,123.00 "	"$1,571.02"	$0.00	"$1,698.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,575.69"	"$1,575.69"	"$1,636.41"	$0.00	$442.43	$0.00	$0.00	$0.00	$0.00	"$1,061.50"	"$1,681.42"	"$1,698.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008126	EAP	Custom 27008126		Ti End Cap T25 Strdr 0mext Hu	BOTH IP/OP	$631.00 	$466.94	$0.00	$504.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.33	$468.33	$486.37	$0.00	$131.50	$0.00	$0.00	$0.00	$0.00	$315.50	$499.75	$504.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008127	EAP	Custom 27008127		Ti End Cap T25 Strdrv 0mm Ext	BOTH IP/OP	$759.00 	$561.66	$0.00	$607.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$563.33	$563.33	$585.04	$0.00	$158.18	$0.00	$0.00	$0.00	$0.00	$379.50	$601.13	$607.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008128	EAP	Custom 27008128		Ti End Cap T25 Strdrv 5mm Ext	BOTH IP/OP	$631.00 	$466.94	$0.00	$504.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.33	$468.33	$486.37	$0.00	$131.50	$0.00	$0.00	$0.00	$0.00	$315.50	$499.75	$504.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008129	EAP	Custom 27008129		Ti End Cap T25 Strdrv 5mm Ext	BOTH IP/OP	$759.00 	$561.66	$0.00	$607.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$563.33	$563.33	$585.04	$0.00	$158.18	$0.00	$0.00	$0.00	$0.00	$379.50	$601.13	$607.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008130	EAP	Custom 27008130		Ti End Cap T25 Strdrv 10mm Ex	BOTH IP/OP	$631.00 	$466.94	$0.00	$504.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.33	$468.33	$486.37	$0.00	$131.50	$0.00	$0.00	$0.00	$0.00	$315.50	$499.75	$504.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008131	EAP	Custom 27008131		Ti End Cap T25 Strdrv 10mm Ex	BOTH IP/OP	$759.00 	$561.66	$0.00	$607.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$563.33	$563.33	$585.04	$0.00	$158.18	$0.00	$0.00	$0.00	$0.00	$379.50	$601.13	$607.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008132	EAP	Custom 27008132		Ti End Cap T25 Strdrv 15mm Ext	BOTH IP/OP	$631.00 	$466.94	$0.00	$504.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.33	$468.33	$486.37	$0.00	$131.50	$0.00	$0.00	$0.00	$0.00	$315.50	$499.75	$504.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008133	EAP	Custom 27008133		Ti End Cap T25 Strdrv 15mm Ex	BOTH IP/OP	$759.00 	$561.66	$0.00	$607.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$563.33	$563.33	$585.04	$0.00	$158.18	$0.00	$0.00	$0.00	$0.00	$379.50	$601.13	$607.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008138	EAP	Custom 27008138		11m Ti Can Prox Hum Nl-ex/150m	BOTH IP/OP	"$7,722.00 "	"$5,714.28"	$0.00	"$6,177.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,952.12"	$0.00	"$1,609.26"	$0.00	$0.00	$0.00	$0.00	"$3,861.00"	"$6,115.82"	"$6,177.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008139	EAP	Custom 27008139		11m Ti Can Hum Nail-ex/190-320	BOTH IP/OP	"$7,722.00 "	"$5,714.28"	$0.00	"$6,177.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,952.12"	$0.00	"$1,609.26"	$0.00	$0.00	$0.00	$0.00	"$3,861.00"	"$6,115.82"	"$6,177.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008140	EAP	Custom 27008140		Ti End Cap T40 Sdrv 0mext Fem	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008141	EAP	Custom 27008141		Ti End Cap T40 Sdrv 0mext Ste	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008142	EAP	Custom 27008142		12 Ti End Cap T40 Sdrv 5m Ext	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008143	EAP	Custom 27008143		12 Ti End Cap T40 Sdrv 5m Ext	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008144	EAP	Custom 27008144		12 Ti End Cap T40 Sdrv 10mm Ex	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008145	EAP	Custom 27008145		12 Ti End Cap T40 Sdrv 10mm Ex	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008146	EAP	Custom 27008146		12 Ti End Cap T40 Sdrv 15mm Ex	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008147	EAP	Custom 27008147		12 Ti End Cap T40 Sdrv 15mm Ex	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008148	EAP	Custom 27008148		12 Ti End Cap T40 Sdrv 20mm Ex	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008149	EAP	Custom 27008149		12 Ti End Cap T40 Sdrv 20mm Ex	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008150	EAP	Custom 27008150		16 Ti End Cap T40 Sdrv 5m Ext	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008151	EAP	Custom 27008151		16m Ti End Cap T40 Sdrv 5m Ext	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008152	EAP	Custom 27008152		16m Ti End Cap T40 Sdrv 10mm	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008153	EAP	Custom 27008153		16m Ti End Cap T40 Sdrv 10mm	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008154	EAP	Custom 27008154		16m Ti End Cap T40 Sdrv 15mm	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008155	EAP	Custom 27008155		16m Ti End Cap T40 Sdrv 15mm	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008156	EAP	Custom 27008156		16 Ti End Cap T40 Sdrv 20mm Ex	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008157	EAP	Custom 27008157		16 Ti End Cap T40 Sdrv 20mm Ex	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008185	EAP	Custom 27008185		10ti Lat En Fem Nl-ex/300m-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008186	EAP	Custom 27008186		11ti Lat En Fem Nl-ex/300m-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008187	EAP	Custom 27008187		11ti Lat En Fem Nl-ex/300m-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008188	EAP	Custom 27008188		12 Ti Lat En Fem Nl-ex/300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008189	EAP	Custom 27008189		12 Ti Lat En Fem Nl-ex/300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008190	EAP	Custom 27008190		13ti Lat Ent Fem Nl-ex/300m480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008191	EAP	Custom 27008191		13ti Lat Ent Fem Nl-ex/300m480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008192	EAP	Custom 27008192		14ti Lat Ent Fem Nl-ex/300m480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008193	EAP	Custom 27008193		14ti Lat Ent Fem Nl-ex/300m480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008194	EAP	Custom 27008194		15ti Lat Ent Fem Nl-ex/300m480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008195	EAP	Custom 27008195		15ti Lat Ent Fem Nl-ex/300m480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008196	EAP	Custom 27008196		16ti Lat Ent Fem Nl-ex/300m480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008197	EAP	Custom 27008197		16ti Lat Ent Fem Nl-ex/300m480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008198	EAP	Custom 27008198		Ti En Cp W/t40 Sdr 0m Ext F/t	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008199	EAP	Custom 27008199		Ti En Cap W/t40 Sdr 0m Ext F/t	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008200	EAP	Custom 27008200		Ti En Cap W/t40 Sdr 5m Ext F/t	BOTH IP/OP	$882.00 	$652.68	$0.00	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$654.62	$654.62	$679.85	$0.00	$183.81	$0.00	$0.00	$0.00	$0.00	$441.00	$698.54	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008201	EAP	Custom 27008201		Ti En Cap W/t40 Sdr 5m Ext-ste	BOTH IP/OP	"$1,010.00 "	$747.40	$0.00	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$749.62	$749.62	$778.51	$0.00	$210.48	$0.00	$0.00	$0.00	$0.00	$505.00	$799.92	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008202	EAP	Custom 27008202		Ti En Cap W/ T40 Sdr Ext F/ti	BOTH IP/OP	$882.00 	$652.68	$0.00	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$654.62	$654.62	$679.85	$0.00	$183.81	$0.00	$0.00	$0.00	$0.00	$441.00	$698.54	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008203	EAP	Custom 27008203		Ti En Cap W/t40 Sdr 10m Ext-st	BOTH IP/OP	"$1,010.00 "	$747.40	$0.00	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$749.62	$749.62	$778.51	$0.00	$210.48	$0.00	$0.00	$0.00	$0.00	$505.00	$799.92	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008204	EAP	Custom 27008204		Ti En Cap W/t40 Sdr 15m Ext	BOTH IP/OP	$882.00 	$652.68	$0.00	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$654.62	$654.62	$679.85	$0.00	$183.81	$0.00	$0.00	$0.00	$0.00	$441.00	$698.54	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008205	EAP	Custom 27008205		Ti En Cap W/t40 Sdr 15m Ext-st	BOTH IP/OP	"$1,010.00 "	$747.40	$0.00	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$749.62	$749.62	$778.51	$0.00	$210.48	$0.00	$0.00	$0.00	$0.00	$505.00	$799.92	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008206	EAP	Custom 27008206		Ti En Cap Tib Nl-ex T40 Sdr 0m	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008207	EAP	Custom 27008207		Ti En Cap Tib Nl-ex T40 Sdr 0	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.67	$602.67	$625.89	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$406.00	$643.10	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008208	EAP	Custom 27008208		Ti En Cap Tib Nl-ex T40 Sdr 5m	BOTH IP/OP	$882.00 	$652.68	$0.00	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$654.62	$654.62	$679.85	$0.00	$183.81	$0.00	$0.00	$0.00	$0.00	$441.00	$698.54	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008209	EAP	Custom 27008209		Ti En Cap Tib Nl-ex T40 Sdr 5m	BOTH IP/OP	"$1,010.00 "	$747.40	$0.00	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$749.62	$749.62	$778.51	$0.00	$210.48	$0.00	$0.00	$0.00	$0.00	$505.00	$799.92	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008210	EAP	Custom 27008210		Ti En Cap Tib Nl-ex T40 Sdr 10	BOTH IP/OP	$882.00 	$652.68	$0.00	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$654.62	$654.62	$679.85	$0.00	$183.81	$0.00	$0.00	$0.00	$0.00	$441.00	$698.54	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008211	EAP	Custom 27008211		Ti En Cap Tib Nl-ex T40 Sdr 10	BOTH IP/OP	"$1,010.00 "	$747.40	$0.00	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$749.62	$749.62	$778.51	$0.00	$210.48	$0.00	$0.00	$0.00	$0.00	$505.00	$799.92	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008212	EAP	Custom 27008212		Ti En Cap Tib Nl-ex T40 Sdr 15	BOTH IP/OP	$882.00 	$652.68	$0.00	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$654.62	$654.62	$679.85	$0.00	$183.81	$0.00	$0.00	$0.00	$0.00	$441.00	$698.54	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008213	EAP	Custom 27008213		Ti En Cap Tib Nl-ex T40 Sdr 15	BOTH IP/OP	"$1,010.00 "	$747.40	$0.00	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$749.62	$749.62	$778.51	$0.00	$210.48	$0.00	$0.00	$0.00	$0.00	$505.00	$799.92	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008216	EAP	Custom 27008216		10m Ti Can Tib Nl-ex/255-435mm	BOTH IP/OP	"$6,110.00 "	"$4,521.40"	$0.00	"$4,888.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,709.59"	$0.00	"$1,273.32"	$0.00	$0.00	$0.00	$0.00	"$3,055.00"	"$4,839.12"	"$4,888.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008217	EAP	Custom 27008217		12m Ti Can Tib Nl-ex/255-435mm	BOTH IP/OP	"$6,110.00 "	"$4,521.40"	$0.00	"$4,888.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,709.59"	$0.00	"$1,273.32"	$0.00	$0.00	$0.00	$0.00	"$3,055.00"	"$4,839.12"	"$4,888.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008219	EAP	Custom 27008219		Ti En Cap T25 Sdr Hndft Art Nl	BOTH IP/OP	$712.00 	$526.88	$0.00	$569.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.45	$528.45	$548.81	$0.00	$148.38	$0.00	$0.00	$0.00	$0.00	$356.00	$563.90	$569.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008220	EAP	Custom 27008220		Ti En Cap T25 Sdr Hndft Art Nl	BOTH IP/OP	$842.00 	$623.08	$0.00	$673.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$624.93	$624.93	$649.01	$0.00	$175.47	$0.00	$0.00	$0.00	$0.00	$421.00	$666.86	$673.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008221	EAP	Custom 27008221		Ti En Cap T25 Sdr Hndft Art Nl	BOTH IP/OP	$712.00 	$526.88	$0.00	$569.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.45	$528.45	$548.81	$0.00	$148.38	$0.00	$0.00	$0.00	$0.00	$356.00	$563.90	$569.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008222	EAP	Custom 27008222		Ti En Cap T25 Sdr Hndft Art Nl	BOTH IP/OP	$842.00 	$623.08	$0.00	$673.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$624.93	$624.93	$649.01	$0.00	$175.47	$0.00	$0.00	$0.00	$0.00	$421.00	$666.86	$673.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008223	EAP	Custom 27008223		10ti Hft Art Can Nl-ex150-240m	BOTH IP/OP	"$6,453.00 "	"$4,775.22"	$0.00	"$5,162.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,973.97"	$0.00	"$1,344.81"	$0.00	$0.00	$0.00	$0.00	"$3,226.50"	"$5,110.78"	"$5,162.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008224	EAP	Custom 27008224		Ti En Cap T40 Sdr 0m Ext Retr	BOTH IP/OP	$682.00 	$504.68	$0.00	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.18	$506.18	$525.69	$0.00	$142.13	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008225	EAP	Custom 27008225		Ti Spir Bld 45m Ti Retr Fem Nl	BOTH IP/OP	"$2,318.00 "	"$1,715.32"	$0.00	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,720.42"	"$1,720.42"	"$1,786.71"	$0.00	$483.07	$0.00	$0.00	$0.00	$0.00	"$1,159.00"	"$1,835.86"	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008226	EAP	Custom 27008226		Ti Spir Bld 50m Ti Retr Fem Nl	BOTH IP/OP	"$2,318.00 "	"$1,715.32"	$0.00	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,720.42"	"$1,720.42"	"$1,786.71"	$0.00	$483.07	$0.00	$0.00	$0.00	$0.00	"$1,159.00"	"$1,835.86"	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008227	EAP	Custom 27008227		Ti Spir Bld 50m-ster F/ti Retr	BOTH IP/OP	"$2,447.00 "	"$1,810.78"	$0.00	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,816.16"	"$1,816.16"	"$1,886.15"	$0.00	$509.95	$0.00	$0.00	$0.00	$0.00	"$1,223.50"	"$1,938.02"	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008228	EAP	Custom 27008228		Ti Spir Bld 55m Ti Retr Fem	BOTH IP/OP	"$2,318.00 "	"$1,715.32"	$0.00	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,720.42"	"$1,720.42"	"$1,786.71"	$0.00	$483.07	$0.00	$0.00	$0.00	$0.00	"$1,159.00"	"$1,835.86"	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008229	EAP	Custom 27008229		Ti Spir Bld 55m-ster F/ti Retr	BOTH IP/OP	"$2,447.00 "	"$1,810.78"	$0.00	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,816.16"	"$1,816.16"	"$1,886.15"	$0.00	$509.95	$0.00	$0.00	$0.00	$0.00	"$1,223.50"	"$1,938.02"	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008230	EAP	Custom 27008230		Ti Spir Bld 65m Ti Retr Fem Nl	BOTH IP/OP	"$2,318.00 "	"$1,715.32"	$0.00	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,720.42"	"$1,720.42"	"$1,786.71"	$0.00	$483.07	$0.00	$0.00	$0.00	$0.00	"$1,159.00"	"$1,835.86"	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008231	EAP	Custom 27008231		Ti Spir Bld 65f/ti Ret Fem Nls	BOTH IP/OP	"$2,447.00 "	"$1,810.78"	$0.00	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,816.16"	"$1,816.16"	"$1,886.15"	$0.00	$509.95	$0.00	$0.00	$0.00	$0.00	"$1,223.50"	"$1,938.02"	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008232	EAP	Custom 27008232		Ti Spir Bld 70m Ti Retr Fem Nl	BOTH IP/OP	"$2,318.00 "	"$1,715.32"	$0.00	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,720.42"	"$1,720.42"	"$1,786.71"	$0.00	$483.07	$0.00	$0.00	$0.00	$0.00	"$1,159.00"	"$1,835.86"	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008233	EAP	Custom 27008233		Ti Spir Bld 70m F/ti Retr Fem	BOTH IP/OP	"$2,447.00 "	"$1,810.78"	$0.00	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,816.16"	"$1,816.16"	"$1,886.15"	$0.00	$509.95	$0.00	$0.00	$0.00	$0.00	"$1,223.50"	"$1,938.02"	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008234	EAP	Custom 27008234		Ti Spir Bld 75m Ti Retr Fem Nl	BOTH IP/OP	"$2,318.00 "	"$1,715.32"	$0.00	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,720.42"	"$1,720.42"	"$1,786.71"	$0.00	$483.07	$0.00	$0.00	$0.00	$0.00	"$1,159.00"	"$1,835.86"	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008235	EAP	Custom 27008235		Ti Spir Bld 75 F/ti Ret Fem Nl	BOTH IP/OP	"$2,447.00 "	"$1,810.78"	$0.00	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,816.16"	"$1,816.16"	"$1,886.15"	$0.00	$509.95	$0.00	$0.00	$0.00	$0.00	"$1,223.50"	"$1,938.02"	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008236	EAP	Custom 27008236		Ti Spir Bld 80m Ti Retr Fem Nl	BOTH IP/OP	"$2,318.00 "	"$1,715.32"	$0.00	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,720.42"	"$1,720.42"	"$1,786.71"	$0.00	$483.07	$0.00	$0.00	$0.00	$0.00	"$1,159.00"	"$1,835.86"	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008237	EAP	Custom 27008237		Ti Spir Bld 80 F/ti Ret Fem Nl	BOTH IP/OP	"$2,447.00 "	"$1,810.78"	$0.00	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,816.16"	"$1,816.16"	"$1,886.15"	$0.00	$509.95	$0.00	$0.00	$0.00	$0.00	"$1,223.50"	"$1,938.02"	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008238	EAP	Custom 27008238		Ti Spir Bld 85 Ti Retr Fem Nl	BOTH IP/OP	"$2,318.00 "	"$1,715.32"	$0.00	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,720.42"	"$1,720.42"	"$1,786.71"	$0.00	$483.07	$0.00	$0.00	$0.00	$0.00	"$1,159.00"	"$1,835.86"	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008239	EAP	Custom 27008239		Ti Spir Bld 85m F/ti Retr Fem	BOTH IP/OP	"$2,447.00 "	"$1,810.78"	$0.00	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,816.16"	"$1,816.16"	"$1,886.15"	$0.00	$509.95	$0.00	$0.00	$0.00	$0.00	"$1,223.50"	"$1,938.02"	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008240	EAP	Custom 27008240		Ti Spir Bld 90m Ti Retr Fem Nl	BOTH IP/OP	"$2,318.00 "	"$1,715.32"	$0.00	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,720.42"	"$1,720.42"	"$1,786.71"	$0.00	$483.07	$0.00	$0.00	$0.00	$0.00	"$1,159.00"	"$1,835.86"	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008241	EAP	Custom 27008241		Ti Spir Bld 90m F/ti Retr Fem	BOTH IP/OP	"$2,447.00 "	"$1,810.78"	$0.00	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,816.16"	"$1,816.16"	"$1,886.15"	$0.00	$509.95	$0.00	$0.00	$0.00	$0.00	"$1,223.50"	"$1,938.02"	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008242	EAP	Custom 27008242		Ti Spir Bld 95m Ti Retr Fem Nl	BOTH IP/OP	"$2,318.00 "	"$1,715.32"	$0.00	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,720.42"	"$1,720.42"	"$1,786.71"	$0.00	$483.07	$0.00	$0.00	$0.00	$0.00	"$1,159.00"	"$1,835.86"	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008243	EAP	Custom 27008243		Ti Spir Bld 100m Ti Retr Fem	BOTH IP/OP	"$2,318.00 "	"$1,715.32"	$0.00	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,720.42"	"$1,720.42"	"$1,786.71"	$0.00	$483.07	$0.00	$0.00	$0.00	$0.00	"$1,159.00"	"$1,835.86"	"$1,854.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008244	EAP	Custom 27008244		Ti Spir Bld 100m-st F/ti Ret	BOTH IP/OP	"$2,447.00 "	"$1,810.78"	$0.00	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,816.16"	"$1,816.16"	"$1,886.15"	$0.00	$509.95	$0.00	$0.00	$0.00	$0.00	"$1,223.50"	"$1,938.02"	"$1,957.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008247	EAP	Custom 27008247		10ti Can Ret Fem Nl-ex/160-280	BOTH IP/OP	"$6,897.00 "	"$5,103.78"	$0.00	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,316.21"	$0.00	"$1,437.33"	$0.00	$0.00	$0.00	$0.00	"$3,448.50"	"$5,462.42"	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008248	EAP	Custom 27008248		10ti Can Ret/ant Fem Nl300-480	BOTH IP/OP	"$6,897.00 "	"$5,103.78"	$0.00	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,316.21"	$0.00	"$1,437.33"	$0.00	$0.00	$0.00	$0.00	"$3,448.50"	"$5,462.42"	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008249	EAP	Custom 27008249		11ti Can Ret Fem Nl-ex/160-280	BOTH IP/OP	"$6,897.00 "	"$5,103.78"	$0.00	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,316.21"	$0.00	"$1,437.33"	$0.00	$0.00	$0.00	$0.00	"$3,448.50"	"$5,462.42"	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008250	EAP	Custom 27008250		12mmti Can Retr Fem Nl 160-280	BOTH IP/OP	"$6,897.00 "	"$5,103.78"	$0.00	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,316.21"	$0.00	"$1,437.33"	$0.00	$0.00	$0.00	$0.00	"$3,448.50"	"$5,462.42"	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008251	EAP	Custom 27008251		13ti Can Retr Fem Nl-ex160-280	BOTH IP/OP	"$6,897.00 "	"$5,103.78"	$0.00	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,316.21"	$0.00	"$1,437.33"	$0.00	$0.00	$0.00	$0.00	"$3,448.50"	"$5,462.42"	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008252	EAP	Custom 27008252		13ti Can Ret/ant Fem Nl300-480	BOTH IP/OP	"$6,897.00 "	"$5,103.78"	$0.00	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,316.21"	$0.00	"$1,437.33"	$0.00	$0.00	$0.00	$0.00	"$3,448.50"	"$5,462.42"	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008253	EAP	Custom 27008253		14ti Can Retr Fem Nl-ex160-280	BOTH IP/OP	"$6,897.00 "	"$5,103.78"	$0.00	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,316.21"	$0.00	"$1,437.33"	$0.00	$0.00	$0.00	$0.00	"$3,448.50"	"$5,462.42"	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008254	EAP	Custom 27008254		14ti Can Ret/ant Fem Nl300-480	BOTH IP/OP	"$6,897.00 "	"$5,103.78"	$0.00	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,316.21"	$0.00	"$1,437.33"	$0.00	$0.00	$0.00	$0.00	"$3,448.50"	"$5,462.42"	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008255	EAP	Custom 27008255		15ti Can Retr Fem Nl-160-280mm	BOTH IP/OP	"$6,897.00 "	"$5,103.78"	$0.00	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,316.21"	$0.00	"$1,437.33"	$0.00	$0.00	$0.00	$0.00	"$3,448.50"	"$5,462.42"	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008256	EAP	Custom 27008256		15ti Can Ret/ant Fem Nl300-480	BOTH IP/OP	"$6,897.00 "	"$5,103.78"	$0.00	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,316.21"	$0.00	"$1,437.33"	$0.00	$0.00	$0.00	$0.00	"$3,448.50"	"$5,462.42"	"$5,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008258	EAP	Custom 27008258		10ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008259	EAP	Custom 27008259		10ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008260	EAP	Custom 27008260		11ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008261	EAP	Custom 27008261		12ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008262	EAP	Custom 27008262		12ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008263	EAP	Custom 27008263		13ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008264	EAP	Custom 27008264		13ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008265	EAP	Custom 27008265		14ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008266	EAP	Custom 27008266		14ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008267	EAP	Custom 27008267		15ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008268	EAP	Custom 27008268		15ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008269	EAP	Custom 27008269		16ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008270	EAP	Custom 27008270		16ti Can Lat Ent Fem Nl300-480	BOTH IP/OP	"$6,829.00 "	"$5,053.46"	$0.00	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,263.79"	$0.00	"$1,423.16"	$0.00	$0.00	$0.00	$0.00	"$3,414.50"	"$5,408.57"	"$5,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008275	EAP	Custom 27008275		T15/2.5m Hex Ti Cerclage Buttn	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008276	EAP	Custom 27008276		T25/3.5m Hex Ti Cerclage Buttn	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008281	EAP	Custom 27008281		Saw Bld 95x19 0.89m Cut Thknes	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008282	EAP	Custom 27008282		Saw Bld 95x19 1.19m Cut Thknes	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008283	EAP	Custom 27008283		Saw Bld 95x19 1.27m Cut Thknes	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008284	EAP	Custom 27008284		Saw Bld 95x19 1.37m Cut Thknes	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008285	EAP	Custom 27008285		Saw Bld 95x 19 1.47 Cut Thknes	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008286	EAP	Custom 27008286		Saw Bld 80x19 0.89 Cut Thkness	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008287	EAP	Custom 27008287		Saw Bld 95x19 1.00 Cut Thkness	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008288	EAP	Custom 27008288		Saw Bld 95 X 19 1.07cut Thknes	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008289	EAP	Custom 27008289		Saw Bld 95x25 0.89 Cut Thkness	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008290	EAP	Custom 27008290		Saw Bld 95x25 1.19 Cut Thcknes	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008291	EAP	Custom 27008291		Saw Bld 95x25 1.27 Cut Thcknes	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008292	EAP	Custom 27008292		Saw Bld 95x25 1.37 Cut Thcknes	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008293	EAP	Custom 27008293		Saw Bld 95x25 1.47cut Thckness	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008294	EAP	Custom 27008294		Saw Blade 95mm X 25mm 1.00mm	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008295	EAP	Custom 27008295		Saw Blade 95mm X 25mm 1.07mm	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008296	EAP	Custom 27008296		Saw Blade 90mm X 12.5mm 0.89m	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008297	EAP	Custom 27008297		Saw Blade 90mm X 12.5mm 1.19m	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008298	EAP	Custom 27008298		Saw Blade 90mm X 12.5mm 1.27m	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008299	EAP	Custom 27008299		Saw Blade 90mm X 12.5mm 1.37m	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008300	EAP	Custom 27008300		Saw Blade 90mm X 12.5mm 1.47m	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008301	EAP	Custom 27008301		Saw Blade 90m X 19-12.5m 0.89m	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008302	EAP	Custom 27008302		Saw Blade 90m X19-12.5mm 1.19m	BOTH IP/OP	$328.00 	$242.72	$0.00	$262.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$243.44	$243.44	$252.82	$0.00	$68.36	$0.00	$0.00	$0.00	$0.00	$164.00	$259.78	$262.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008303	EAP	Custom 27008303		Saw Blade 90mx19-12.5mm 1.27m	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008304	EAP	Custom 27008304		Saw Blade 90m X19-12.5m 1.37m	BOTH IP/OP	$310.00 	$229.40	$0.00	$248.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.08	$230.08	$238.95	$0.00	$64.60	$0.00	$0.00	$0.00	$0.00	$155.00	$245.52	$248.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008305	EAP	Custom 27008305		Saw Blade 90mx19-12.5mm 1.47m	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008306	EAP	Custom 27008306		Saw Blade 90mx19-12.5mm 1.00m	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008307	EAP	Custom 27008307		Saw Blade 90mm X 12.5mm 1.00m	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008308	EAP	Custom 27008308		Saw Blade 60mm X 25mm 0.89mm	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008309	EAP	Custom 27008309		Plan&reduct Tech In Fx Surgery	BOTH IP/OP	$781.00 	$577.94	$0.00	$624.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$579.66	$579.66	$601.99	$0.00	$162.76	$0.00	$0.00	$0.00	$0.00	$390.50	$618.55	$624.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008312	EAP	Custom 27008312		The Rational Operative Fx Care	BOTH IP/OP	$781.00 	$577.94	$0.00	$624.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$579.66	$579.66	$601.99	$0.00	$162.76	$0.00	$0.00	$0.00	$0.00	$390.50	$618.55	$624.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008316	EAP	Custom 27008316		Minimax Fracture Fixation	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$467.59	$467.59	$485.60	$0.00	$131.29	$0.00	$0.00	$0.00	$0.00	$315.00	$498.96	$504.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008318	EAP	Custom 27008318		Intern Fixatn Osteoporotic Bne	BOTH IP/OP	$538.00 	$398.12	$0.00	$430.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$399.30	$399.30	$414.69	$0.00	$112.12	$0.00	$0.00	$0.00	$0.00	$269.00	$426.10	$430.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008321	EAP	Custom 27008321		Oper Approach Orth Surg&trauma	BOTH IP/OP	$635.00 	$469.90	$0.00	$508.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$471.30	$471.30	$489.46	$0.00	$132.33	$0.00	$0.00	$0.00	$0.00	$317.50	$502.92	$508.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008324	EAP	Custom 27008324		1.5mm Cortex Scw 6-20mm	BOTH IP/OP	$83.00 	$61.42	$0.00	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.60	$61.60	$63.98	$0.00	$17.30	$0.00	$0.00	$0.00	$0.00	$41.50	$65.74	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008325	EAP	Custom 27008325		1.0cor Scw Self-tapg 6-14mm	BOTH IP/OP	$340.00 	$251.60	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.35	$252.35	$262.07	$0.00	$70.86	$0.00	$0.00	$0.00	$0.00	$170.00	$269.28	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008326	EAP	Custom 27008326		1.3mm Cort Scw Slf-tapg 6-18	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008327	EAP	Custom 27008327		1.5mm Cort Scw Slf-tapg 6-24	BOTH IP/OP	$97.00 	$71.78	$0.00	$77.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.99	$71.99	$74.77	$0.00	$20.21	$0.00	$0.00	$0.00	$0.00	$48.50	$76.82	$77.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008335	EAP	Custom 27008335		1.8mm Buttress Pin/12-30mm	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.17	$126.17	$131.04	$0.00	$35.43	$0.00	$0.00	$0.00	$0.00	$85.00	$134.64	$136.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008367	EAP	Custom 27008367		Schuhli Assembly - 4.5 Cor Scw	BOTH IP/OP	"$1,039.00 "	$768.86	$0.00	$831.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$771.15	$771.15	$800.86	$0.00	$216.53	$0.00	$0.00	$0.00	$0.00	$519.50	$822.89	$831.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008368	EAP	Custom 27008368		Schuhli Assembly- 3.5 Cor Scw	BOTH IP/OP	"$1,039.00 "	$768.86	$0.00	$831.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$771.15	$771.15	$800.86	$0.00	$216.53	$0.00	$0.00	$0.00	$0.00	$519.50	$822.89	$831.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008369	EAP	Custom 27008369		Thrded Wash 3.0 Cannul Scw	BOTH IP/OP	$560.00 	$414.40	$0.00	$448.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$415.63	$415.63	$431.65	$0.00	$116.70	$0.00	$0.00	$0.00	$0.00	$280.00	$443.52	$448.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008370	EAP	Custom 27008370		Spiked Washer 8.0mm/3.2mm	BOTH IP/OP	$497.00 	$367.78	$0.00	$397.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$368.87	$368.87	$383.09	$0.00	$103.57	$0.00	$0.00	$0.00	$0.00	$248.50	$393.62	$397.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008371	EAP	Custom 27008371		Spiked Washer 13.5mm/4.0mm	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$386.17	$0.00	$104.41	$0.00	$0.00	$0.00	$0.00	$250.50	$396.79	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008372	EAP	Custom 27008372		Spiked Washer 13.5mm/5.5mm	BOTH IP/OP	$492.00 	$364.08	$0.00	$393.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$365.16	$365.16	$379.23	$0.00	$102.53	$0.00	$0.00	$0.00	$0.00	$246.00	$389.66	$393.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008373	EAP	Custom 27008373		Spher Wash/sm Oval 6.5/ 0.3mm	BOTH IP/OP	$608.00 	$449.92	$0.00	$486.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$451.26	$451.26	$468.65	$0.00	$126.71	$0.00	$0.00	$0.00	$0.00	$304.00	$481.54	$486.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008374	EAP	Custom 27008374		Spher Washer/lrg Rnd 6.5/7.3	BOTH IP/OP	$608.00 	$449.92	$0.00	$486.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$451.26	$451.26	$468.65	$0.00	$126.71	$0.00	$0.00	$0.00	$0.00	$304.00	$481.54	$486.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008375	EAP	Custom 27008375		Nut For 4.5mm Cortex Screws	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$0.00	$0.00	$0.00	$60.00	$95.04	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008376	EAP	Custom 27008376		Washer 6.5mm	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$0.00	$0.00	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008377	EAP	Custom 27008377		1.3mm Straight Plate 6 Holes	BOTH IP/OP	$789.00 	$583.86	$0.00	$631.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$585.60	$585.60	$608.16	$0.00	$164.43	$0.00	$0.00	$0.00	$0.00	$394.50	$624.89	$631.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008378	EAP	Custom 27008378		1.3mm Straight Plate 12 Holes	BOTH IP/OP	$996.00 	$737.04	$0.00	$796.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$739.23	$739.23	$767.72	$0.00	$207.57	$0.00	$0.00	$0.00	$0.00	$498.00	$788.83	$796.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008379	EAP	Custom 27008379		1.3mm Extended H-plate/right	BOTH IP/OP	$954.00 	$705.96	$0.00	$763.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.06	$708.06	$735.34	$0.00	$198.81	$0.00	$0.00	$0.00	$0.00	$477.00	$755.57	$763.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008380	EAP	Custom 27008380		1.3mm Extended H-plate/left	BOTH IP/OP	$954.00 	$705.96	$0.00	$763.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.06	$708.06	$735.34	$0.00	$198.81	$0.00	$0.00	$0.00	$0.00	$477.00	$755.57	$763.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008381	EAP	Custom 27008381		1.3mm T-plte 3 Hles Hd/ 8hles	BOTH IP/OP	$913.00 	$675.62	$0.00	$730.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$677.63	$677.63	$703.74	$0.00	$190.27	$0.00	$0.00	$0.00	$0.00	$456.50	$723.10	$730.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008382	EAP	Custom 27008382		1.3mm T-plte 4hles Head/8hles	BOTH IP/OP	$954.00 	$705.96	$0.00	$763.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.06	$708.06	$735.34	$0.00	$198.81	$0.00	$0.00	$0.00	$0.00	$477.00	$755.57	$763.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008383	EAP	Custom 27008383		1.3mm Y-plte 3 Hles Head/8hle	BOTH IP/OP	$913.00 	$675.62	$0.00	$730.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$677.63	$677.63	$703.74	$0.00	$190.27	$0.00	$0.00	$0.00	$0.00	$456.50	$723.10	$730.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008384	EAP	Custom 27008384		Semi-tubul Plate 2 Holes 39m	BOTH IP/OP	$228.00 	$168.72	$0.00	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.22	$169.22	$175.74	$0.00	$47.52	$0.00	$0.00	$0.00	$0.00	$114.00	$180.58	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008385	EAP	Custom 27008385		Semi-tubul Plate 3 Holes 55m	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.42	$174.42	$181.14	$0.00	$48.97	$0.00	$0.00	$0.00	$0.00	$117.50	$186.12	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008386	EAP	Custom 27008386		Semi-tubul Plate 4 Holes 71m	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$196.55	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008387	EAP	Custom 27008387		Semi-tubul Plate 5 Holes 87m	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008388	EAP	Custom 27008388		Semi-tubulplate 6 Holes 103m	BOTH IP/OP	$283.00 	$209.42	$0.00	$226.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.04	$210.04	$218.14	$0.00	$58.98	$0.00	$0.00	$0.00	$0.00	$141.50	$224.14	$226.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008389	EAP	Custom 27008389		Semi-tubul Plate 7 Holes 119m	BOTH IP/OP	$307.00 	$227.18	$0.00	$245.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.86	$227.86	$236.64	$0.00	$63.98	$0.00	$0.00	$0.00	$0.00	$153.50	$243.14	$245.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008390	EAP	Custom 27008390		Semi-tubul Plate 8 Holes 135m	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008391	EAP	Custom 27008391		Semi-tubul Plate 9 Holes 151m	BOTH IP/OP	$337.00 	$249.38	$0.00	$269.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.12	$250.12	$259.76	$0.00	$70.23	$0.00	$0.00	$0.00	$0.00	$168.50	$266.90	$269.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008392	EAP	Custom 27008392		Semi-tubul Plate 10 Holes 167m	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008393	EAP	Custom 27008393		Semi-tubul Plate 11 Holes/183m	BOTH IP/OP	$356.00 	$263.44	$0.00	$284.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.22	$264.22	$274.40	$0.00	$74.19	$0.00	$0.00	$0.00	$0.00	$178.00	$281.95	$284.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008394	EAP	Custom 27008394		Semi-tubular Plate 12 Hles/199	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008662	EAP	Custom 27008662		100deg Adoles Osteo Plt 50/10	BOTH IP/OP	"$2,088.00 "	"$1,545.12"	$0.00	"$1,670.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,549.71"	"$1,549.71"	"$1,609.43"	$0.00	$435.14	$0.00	$0.00	$0.00	$0.00	"$1,044.00"	"$1,653.70"	"$1,670.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008663	EAP	Custom 27008663		100deg Adoles Osteo Plt 50/10	BOTH IP/OP	"$2,219.00 "	"$1,642.06"	$0.00	"$1,775.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,646.94"	"$1,646.94"	"$1,710.41"	$0.00	$462.44	$0.00	$0.00	$0.00	$0.00	"$1,109.50"	"$1,757.45"	"$1,775.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008666	EAP	Custom 27008666		100deg Adoles Osteo Plt 40/10	BOTH IP/OP	"$2,088.00 "	"$1,545.12"	$0.00	"$1,670.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,549.71"	"$1,549.71"	"$1,609.43"	$0.00	$435.14	$0.00	$0.00	$0.00	$0.00	"$1,044.00"	"$1,653.70"	"$1,670.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008667	EAP	Custom 27008667		100deg Adoles Osteo Plt 40/10	BOTH IP/OP	"$2,219.00 "	"$1,642.06"	$0.00	"$1,775.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,646.94"	"$1,646.94"	"$1,710.41"	$0.00	$462.44	$0.00	$0.00	$0.00	$0.00	"$1,109.50"	"$1,757.45"	"$1,775.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008670	EAP	Custom 27008670		100deg Adoles Osteo Plt 50/15	BOTH IP/OP	"$2,088.00 "	"$1,545.12"	$0.00	"$1,670.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,549.71"	"$1,549.71"	"$1,609.43"	$0.00	$435.14	$0.00	$0.00	$0.00	$0.00	"$1,044.00"	"$1,653.70"	"$1,670.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008671	EAP	Custom 27008671		100deg Adoles Osteo Plt 50/15	BOTH IP/OP	"$2,219.00 "	"$1,642.06"	$0.00	"$1,775.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,646.94"	"$1,646.94"	"$1,710.41"	$0.00	$462.44	$0.00	$0.00	$0.00	$0.00	"$1,109.50"	"$1,757.45"	"$1,775.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008674	EAP	Custom 27008674		100deg Adoles Osteo Plt 60/15	BOTH IP/OP	"$2,088.00 "	"$1,545.12"	$0.00	"$1,670.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,549.71"	"$1,549.71"	"$1,609.43"	$0.00	$435.14	$0.00	$0.00	$0.00	$0.00	"$1,044.00"	"$1,653.70"	"$1,670.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008675	EAP	Custom 27008675		100deg Adoles Osteo Plt 60/15	BOTH IP/OP	"$2,219.00 "	"$1,642.06"	$0.00	"$1,775.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,646.94"	"$1,646.94"	"$1,710.41"	$0.00	$462.44	$0.00	$0.00	$0.00	$0.00	"$1,109.50"	"$1,757.45"	"$1,775.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008678	EAP	Custom 27008678		100deg Adoles Osteo Plt 40/15	BOTH IP/OP	"$2,088.00 "	"$1,545.12"	$0.00	"$1,670.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,549.71"	"$1,549.71"	"$1,609.43"	$0.00	$435.14	$0.00	$0.00	$0.00	$0.00	"$1,044.00"	"$1,653.70"	"$1,670.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008679	EAP	Custom 27008679		100deg Adoles Osteo Plt 40/15	BOTH IP/OP	"$2,219.00 "	"$1,642.06"	$0.00	"$1,775.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,646.94"	"$1,646.94"	"$1,710.41"	$0.00	$462.44	$0.00	$0.00	$0.00	$0.00	"$1,109.50"	"$1,757.45"	"$1,775.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008680	EAP	Custom 27008680		115 Deg Bifurcatd Plte 30/5	BOTH IP/OP	"$1,187.00 "	$878.38	$0.00	$949.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$880.99	$880.99	$914.94	$0.00	$247.37	$0.00	$0.00	$0.00	$0.00	$593.50	$940.10	$949.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008681	EAP	Custom 27008681		115 Deg Bifurcatd Plte 30/5	BOTH IP/OP	"$1,318.00 "	$975.32	$0.00	"$1,054.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$978.22	$978.22	"$1,015.91"	$0.00	$274.67	$0.00	$0.00	$0.00	$0.00	$659.00	"$1,043.86"	"$1,054.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008682	EAP	Custom 27008682		115 Deg Bifurcatd Plte 35/5	BOTH IP/OP	"$1,187.00 "	$878.38	$0.00	$949.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$880.99	$880.99	$914.94	$0.00	$247.37	$0.00	$0.00	$0.00	$0.00	$593.50	$940.10	$949.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27008683	EAP	Custom 27008683		115 Deg Bifurcatd Plte 35/5	BOTH IP/OP	"$1,318.00 "	$975.32	$0.00	"$1,054.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$978.22	$978.22	"$1,015.91"	$0.00	$274.67	$0.00	$0.00	$0.00	$0.00	$659.00	"$1,043.86"	"$1,054.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27010225	EAP	Custom 27010225		0.8mm Guide Wire 100mm	BOTH IP/OP	$611.00 	$452.14	$0.00	$488.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$453.48	$453.48	$470.96	$0.00	$127.33	$0.00	$0.00	$0.00	$0.00	$305.50	$483.91	$488.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27010807	EAP	Custom 27010807		"Bipolar Cord,disposable"	BOTH IP/OP	$683.00 	$505.42	$0.00	$546.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.92	$506.92	$526.46	$0.00	$142.34	$0.00	$0.00	$0.00	$0.00	$341.50	$540.94	$546.40	$0.00	$443.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27010828	EAP	Custom 27010828		Cast App'l-spica Adult	BOTH IP/OP	$749.00 	$554.26	$0.00	$599.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.50	$593.21	$599.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27010880	EAP	Custom 27010880		Colostomy Bag & Supplies	BOTH IP/OP	$509.00 	$376.66	$0.00	$407.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$377.78	$377.78	$392.34	$0.00	$106.08	$0.00	$0.00	$0.00	$0.00	$254.50	$403.13	$407.20	$0.00	$330.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27010881	EAP	Custom 27010881		Gen-supp-guide Wire	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$123.33	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27010943	EAP	Custom 27010943		Endo Stitch* Polysorb* 3/0 7 V	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.96	$146.96	$152.62	$0.00	$41.26	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27010987	EAP	Custom 27010987		3.2mm Guide Wire 290mm	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$386.17	$0.00	$104.41	$0.00	$0.00	$0.00	$0.00	$250.50	$396.79	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27010993	EAP	Custom 27010993		Humeral Fracture Brace	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.47	$145.47	$151.08	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$98.00	$155.23	$156.80	$0.00	$127.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27010994	EAP	Custom 27010994		Wound Care Shoe	BOTH IP/OP	$309.00 	$228.66	$0.00	$247.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.34	$229.34	$238.18	$0.00	$64.40	$0.00	$0.00	$0.00	$0.00	$154.50	$244.73	$247.20	$0.00	$200.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27010997	EAP	Custom 27010997		3mmx20cm Tunneler	BOTH IP/OP	$656.00 	$485.44	$0.00	$524.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$486.88	$486.88	$505.64	$0.00	$136.71	$0.00	$0.00	$0.00	$0.00	$328.00	$519.55	$524.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011002	EAP	Custom 27011002		4fr Catheter Cobra 2	BOTH IP/OP	$166.00 	$122.84	$0.00	$132.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.21	$123.21	$127.95	$0.00	$34.59	$0.00	$0.00	$0.00	$0.00	$83.00	$131.47	$132.80	$0.00	$107.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011008	EAP	Custom 27011008		5fr-100cm Sim 1 Cath	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011009	EAP	Custom 27011009		5mmx19cmx90cm Monorail Bilary	BOTH IP/OP	"$4,654.00 "	"$3,443.96"	$0.00	"$3,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,454.20"	"$3,454.20"	"$3,587.30"	$0.00	$969.89	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,685.97"	"$3,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011010	EAP	Custom 27011010		5x135x40cm Unifuse Kit	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.21	$408.21	$423.94	$0.00	$114.62	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011011	EAP	Custom 27011011		5x135x50cm Unifuse Kit	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.21	$408.21	$423.94	$0.00	$114.62	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011013	EAP	Custom 27011013		6fr Al1 Catheter	BOTH IP/OP	$31.00 	$22.94	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.01	$23.01	$23.89	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.50	$24.55	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011015	EAP	Custom 27011015		6fr Ar1 Catheter	BOTH IP/OP	$31.00 	$22.94	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.01	$23.01	$23.89	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.50	$24.55	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011028	EAP	Custom 27011028		7.1 Fr 100cm Pigtail Cath	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011029	EAP	Custom 27011029		8fr X 40cm Skater Biliary Drai	BOTH IP/OP	$254.00 	$187.96	$0.00	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.52	$188.52	$195.78	$0.00	$52.93	$0.00	$0.00	$0.00	$0.00	$127.00	$201.17	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011032	EAP	Custom 27011032		Air Guard Valved Introducer	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.64	$248.64	$258.22	$0.00	$69.81	$0.00	$0.00	$0.00	$0.00	$167.50	$265.32	$268.00	$0.00	$217.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011033	EAP	Custom 27011033		Bag Drainage Ureteral	BOTH IP/OP	$103.00 	$76.22	$0.00	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.45	$76.45	$79.39	$0.00	$21.47	$0.00	$0.00	$0.00	$0.00	$51.50	$81.58	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011037	EAP	Custom 27011037		Balloon Dial Cath Xxl 12mmx4cm	BOTH IP/OP	$856.00 	$633.44	$0.00	$684.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$635.32	$635.32	$659.80	$0.00	$178.39	$0.00	$0.00	$0.00	$0.00	$428.00	$677.95	$684.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011039	EAP	Custom 27011039		Balloon Polar Cath 4x60x120	BOTH IP/OP	"$2,002.00 "	"$1,481.48"	$0.00	"$1,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,485.88"	"$1,485.88"	"$1,543.14"	$0.00	$417.22	$0.00	$0.00	$0.00	$0.00	"$1,001.00"	"$1,585.58"	"$1,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011040	EAP	Custom 27011040		Balloon Polar Cath 5x40x120	BOTH IP/OP	"$2,002.00 "	"$1,481.48"	$0.00	"$1,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,485.88"	"$1,485.88"	"$1,543.14"	$0.00	$417.22	$0.00	$0.00	$0.00	$0.00	"$1,001.00"	"$1,585.58"	"$1,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011041	EAP	Custom 27011041		Balloon Polar Cath 5x60x120	BOTH IP/OP	"$2,002.00 "	"$1,481.48"	$0.00	"$1,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,485.88"	"$1,485.88"	"$1,543.14"	$0.00	$417.22	$0.00	$0.00	$0.00	$0.00	"$1,001.00"	"$1,585.58"	"$1,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011051	EAP	Custom 27011051		Basket Stone Removal 8-wire	BOTH IP/OP	$963.00 	$712.62	$0.00	$770.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$714.74	$714.74	$742.28	$0.00	$200.69	$0.00	$0.00	$0.00	$0.00	$481.50	$762.70	$770.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011052	EAP	Custom 27011052		Bead Block 100-300	BOTH IP/OP	$667.00 	$493.58	$0.00	$533.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$495.05	$495.05	$514.12	$0.00	$139.00	$0.00	$0.00	$0.00	$0.00	$333.50	$528.26	$533.60	$0.00	$433.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011053	EAP	Custom 27011053		Bead Block 300-500	BOTH IP/OP	$667.00 	$493.58	$0.00	$533.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$495.05	$495.05	$514.12	$0.00	$139.00	$0.00	$0.00	$0.00	$0.00	$333.50	$528.26	$533.60	$0.00	$433.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011054	EAP	Custom 27011054		Bead Block 500-700	BOTH IP/OP	$667.00 	$493.58	$0.00	$533.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$495.05	$495.05	$514.12	$0.00	$139.00	$0.00	$0.00	$0.00	$0.00	$333.50	$528.26	$533.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011055	EAP	Custom 27011055		Bead Block 700-900	BOTH IP/OP	$667.00 	$493.58	$0.00	$533.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$495.05	$495.05	$514.12	$0.00	$139.00	$0.00	$0.00	$0.00	$0.00	$333.50	$528.26	$533.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011056	EAP	Custom 27011056		Bead Block 900-1200	BOTH IP/OP	$667.00 	$493.58	$0.00	$533.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$495.05	$495.05	$514.12	$0.00	$139.00	$0.00	$0.00	$0.00	$0.00	$333.50	$528.26	$533.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011058	EAP	Custom 27011058		Cath 20fr 24cm Tenacath Hsg	BOTH IP/OP	$157.00 	$116.18	$0.00	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$78.50	$124.34	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011061	EAP	Custom 27011061		Cath 5fr 100cm Berenstein	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011062	EAP	Custom 27011062		Cath 5fr 100cm Sim2	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011063	EAP	Custom 27011063		Cath 5fr 100cm Sim3	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011065	EAP	Custom 27011065		Cath 5fr 40cm Berenstein	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011067	EAP	Custom 27011067		Cath 5fr 65cm Berenstein	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011068	EAP	Custom 27011068		Cath 5fr 65cm Cobra1	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011069	EAP	Custom 27011069		Cath 5fr 65cm Cobra2	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011070	EAP	Custom 27011070		Cath 5fr 65cm Ns Straight	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011071	EAP	Custom 27011071		Cath 5fr 65cm Pig	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011073	EAP	Custom 27011073		Cath 5fr 80 Cm Mikalesson	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011074	EAP	Custom 27011074		Cath 5fr 80cm Sos1	BOTH IP/OP	$166.00 	$122.84	$0.00	$132.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.21	$123.21	$127.95	$0.00	$34.59	$0.00	$0.00	$0.00	$0.00	$83.00	$131.47	$132.80	$0.00	$107.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011075	EAP	Custom 27011075		Cath 5fr 80cm Sos2	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011077	EAP	Custom 27011077		Cath Polar Dilator Bal4x80x120	BOTH IP/OP	"$2,335.00 "	"$1,727.90"	$0.00	"$1,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,167.50"	"$1,849.32"	"$1,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011078	EAP	Custom 27011078		Cath Polar Dilator Bal5x80x120	BOTH IP/OP	"$2,002.00 "	"$1,481.48"	$0.00	"$1,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,001.00"	"$1,585.58"	"$1,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011083	EAP	Custom 27011083		Cath Triple Lumen 11fr	BOTH IP/OP	$413.00 	$305.62	$0.00	$330.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.50	$327.10	$330.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011084	EAP	Custom 27011084		Catheter Repair Kit	BOTH IP/OP	$349.00 	$258.26	$0.00	$279.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.03	$259.03	$269.01	$0.00	$72.73	$0.00	$0.00	$0.00	$0.00	$174.50	$276.41	$279.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011086	EAP	Custom 27011086		Chest Unit Drainage Pleur	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.09	$348.09	$361.51	$0.00	$97.74	$0.00	$0.00	$0.00	$0.00	$234.50	$371.45	$375.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011088	EAP	Custom 27011088		Coil 15-250 Micron (2vl/bx)	BOTH IP/OP	$477.00 	$352.98	$0.00	$381.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.03	$354.03	$367.67	$0.00	$99.41	$0.00	$0.00	$0.00	$0.00	$238.50	$377.78	$381.60	$0.00	$310.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011089	EAP	Custom 27011089		Coil 250-355 Micron (5vl/bx)	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$0.00	$0.00	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011090	EAP	Custom 27011090		Coil 355-500 Micron (5vl/bx)	BOTH IP/OP	$384.00 	$284.16	$0.00	$307.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$285.00	$285.00	$295.99	$0.00	$80.03	$0.00	$0.00	$0.00	$0.00	$192.00	$304.13	$307.20	$0.00	$249.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011091	EAP	Custom 27011091		Coil 500-710 Micron (2vl/bx)	BOTH IP/OP	$477.00 	$352.98	$0.00	$381.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.50	$377.78	$381.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011092	EAP	Custom 27011092		Coil 710-1000 Micron (2vl/bx)	BOTH IP/OP	$477.00 	$352.98	$0.00	$381.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.50	$377.78	$381.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011093	EAP	Custom 27011093		Coil Pusher 16	BOTH IP/OP	$544.00 	$402.56	$0.00	$435.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$403.76	$403.76	$419.32	$0.00	$113.37	$0.00	$0.00	$0.00	$0.00	$272.00	$430.85	$435.20	$0.00	$353.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011094	EAP	Custom 27011094		Coil Pusher Trupush	BOTH IP/OP	"$1,228.00 "	$908.72	$0.00	$982.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$911.42	$911.42	$946.54	$0.00	$255.92	$0.00	$0.00	$0.00	$0.00	$614.00	$972.58	$982.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011095	EAP	Custom 27011095		Connector Ureteral Catheter	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011096	EAP	Custom 27011096		Connectory Tuohy	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$58.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011097	EAP	Custom 27011097		Contra 2	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011098	EAP	Custom 27011098		Contra Flush Catheter	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$0.00	$0.00	$0.00	$99.50	$157.61	$159.20	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011099	EAP	Custom 27011099		Cope Suture Anchor Set	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$0.00	$0.00	$0.00	$99.50	$157.61	$159.20	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011105	EAP	Custom 27011105		Embolization 38-4-3	BOTH IP/OP	$194.00 	$143.56	$0.00	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.99	$143.99	$149.54	$0.00	$40.43	$0.00	$0.00	$0.00	$0.00	$97.00	$153.65	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011106	EAP	Custom 27011106		Embolization 38-8-15	BOTH IP/OP	$194.00 	$143.56	$0.00	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.99	$143.99	$149.54	$0.00	$40.43	$0.00	$0.00	$0.00	$0.00	$97.00	$153.65	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011107	EAP	Custom 27011107		Embolization Coil 38-5-5	BOTH IP/OP	$194.00 	$143.56	$0.00	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.99	$143.99	$149.54	$0.00	$40.43	$0.00	$0.00	$0.00	$0.00	$97.00	$153.65	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011108	EAP	Custom 27011108		Embolization Coils 38-2-3	BOTH IP/OP	$194.00 	$143.56	$0.00	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.99	$143.99	$149.54	$0.00	$40.43	$0.00	$0.00	$0.00	$0.00	$97.00	$153.65	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011109	EAP	Custom 27011109		Embolization Coils 38-4-2	BOTH IP/OP	$194.00 	$143.56	$0.00	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.99	$143.99	$149.54	$0.00	$40.43	$0.00	$0.00	$0.00	$0.00	$97.00	$153.65	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011110	EAP	Custom 27011110		Embolization Coils 38-5-10	BOTH IP/OP	$194.00 	$143.56	$0.00	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.99	$143.99	$149.54	$0.00	$40.43	$0.00	$0.00	$0.00	$0.00	$97.00	$153.65	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011111	EAP	Custom 27011111		Face Shields	BOTH IP/OP	$14.00 	$10.36	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.39	$10.39	$10.79	$0.00	$2.92	$0.00	$0.00	$0.00	$0.00	$7.00	$11.09	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011112	EAP	Custom 27011112		Filling Station Plus (neuro)	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.77	$69.77	$72.46	$0.00	$19.59	$0.00	$0.00	$0.00	$0.00	$47.00	$74.45	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011113	EAP	Custom 27011113		Filter Jugular G-2	BOTH IP/OP	"$4,337.00 "	"$3,209.38"	$0.00	"$3,469.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,218.92"	"$3,218.92"	"$3,342.96"	$0.00	$903.83	$0.00	$0.00	$0.00	$0.00	"$2,168.50"	"$3,434.90"	"$3,469.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011114	EAP	Custom 27011114		Flo-switch Hp	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.04	$282.04	$292.90	$0.00	$79.19	$0.00	$0.00	$0.00	$0.00	$190.00	$300.96	$304.00	$0.00	$247.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011120	EAP	Custom 27011120		Forearm Based Outrigger	BOTH IP/OP	$172.00 	$127.28	$0.00	$137.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.66	$127.66	$132.58	$0.00	$35.84	$0.00	$0.00	$0.00	$0.00	$86.00	$136.22	$137.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011121	EAP	Custom 27011121		Gtgw.180cm-45deg Angle	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$386.17	$0.00	$104.41	$0.00	$0.00	$0.00	$0.00	$250.50	$396.79	$400.80	$0.00	$325.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011122	EAP	Custom 27011122		Hemostasis V-pad	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$123.33	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011124	EAP	Custom 27011124		Igtcfs-65-fem Celect Perm Cook	BOTH IP/OP	"$4,005.00 "	"$2,963.70"	$0.00	"$3,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,972.51"	"$2,972.51"	"$3,087.05"	$0.00	$834.64	$0.00	$0.00	$0.00	$0.00	"$2,002.50"	"$3,171.96"	"$3,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011125	EAP	HCPCS C1880		Igtcfs-65-jugcelet Perm Cook	BOTH IP/OP	"$4,536.00 "	"$3,356.64"	$0.00	"$3,628.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,268.00"	"$3,592.51"	"$3,628.80"	$0.00	$0.00	$0.00	$709.88	$0.00	$0.00	$722.13	$0.00	$0.00	$0.00	$0.00	$0.00
27011126	EAP	Custom 27011126		Inflation Device Monarch-25	BOTH IP/OP	$184.00 	$136.16	$0.00	$147.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.35	$0.00	$0.00	$0.00	$0.00	$92.00	$145.73	$147.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011127	EAP	Custom 27011127		Introducer Mpis-401	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.77	$69.77	$72.46	$0.00	$19.59	$0.00	$0.00	$0.00	$0.00	$47.00	$74.45	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011128	EAP	Custom 27011128		Introducer Pinnacle 5fr 10cm	BOTH IP/OP	$67.00 	$49.58	$0.00	$53.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.73	$49.73	$51.64	$0.00	$13.96	$0.00	$0.00	$0.00	$0.00	$33.50	$53.06	$53.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011129	EAP	Custom 27011129		Jcd 10.0-38-20	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011130	EAP	Custom 27011130		Jcd 12.0-38-20	BOTH IP/OP	$44.00 	$32.56	$0.00	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.66	$32.66	$33.92	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011131	EAP	Custom 27011131		Jcd 14.0-38-20	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$0.00	$0.00	$0.00	$25.50	$40.39	$40.80	$0.00	$33.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011132	EAP	Custom 27011132		Jcd 16.0-38-20	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$0.00	$0.00	$0.00	$25.50	$40.39	$40.80	$0.00	$33.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011133	EAP	Custom 27011133		Jcd 4.0-25-20	BOTH IP/OP	$31.00 	$22.94	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.01	$23.01	$23.89	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.50	$24.55	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011134	EAP	Custom 27011134		Jcd 5.0-38-20	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011135	EAP	Custom 27011135		Jcd 6.0-38-20	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011136	EAP	Custom 27011136		Jcd 7.0-38-20	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011137	EAP	Custom 27011137		Jcd 8.0-38-20	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011138	EAP	Custom 27011138		Jcd 9.0-38-20	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011139	EAP	Custom 27011139		Jcd-20.0-38-20 Dilator	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$23.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011140	EAP	Custom 27011140		Jcd-22.0-38-20 Dilator	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.40	$33.40	$34.69	$0.00	$9.38	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011141	EAP	Custom 27011141		Jcd-24.0-38-20 Dilator	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.40	$33.40	$34.69	$0.00	$9.38	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011142	EAP	Custom 27011142		Jcd-d18.0-38-20 Dilator	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$0.00	$0.00	$0.00	$25.50	$40.39	$40.80	$0.00	$33.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011143	EAP	Custom 27011143		Kinair Iii W/o Scale	BOTH IP/OP	$192.00 	$142.08	$0.00	$153.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.50	$142.50	$147.99	$0.00	$40.01	$0.00	$0.00	$0.00	$0.00	$96.00	$152.06	$153.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011148	EAP	Custom 27011148		Kit Angio Saftey With J Wire	BOTH IP/OP	$178.00 	$131.72	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.11	$132.11	$137.20	$0.00	$37.10	$0.00	$0.00	$0.00	$0.00	$89.00	$140.98	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011149	EAP	Custom 27011149		Kit Fallopian Tube	BOTH IP/OP	$349.00 	$258.26	$0.00	$279.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.03	$259.03	$269.01	$0.00	$72.73	$0.00	$0.00	$0.00	$0.00	$174.50	$276.41	$279.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011150	EAP	Custom 27011150		Kit Gastrostomy 18fr	BOTH IP/OP	$541.00 	$400.34	$0.00	$432.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$401.53	$401.53	$417.00	$0.00	$112.74	$0.00	$0.00	$0.00	$0.00	$270.50	$428.47	$432.80	$0.00	$351.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011151	EAP	Custom 27011151		Kit Mahurkar 12f Triple Lumen	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011152	EAP	Custom 27011152		Kit Pressure Monitoring T	BOTH IP/OP	$71.00 	$52.54	$0.00	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.70	$52.70	$54.73	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$35.50	$56.23	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011153	EAP	Custom 27011153		Kit Pressure Monitoring T	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011154	EAP	Custom 27011154		Kit Triple Lumen Catheter	BOTH IP/OP	$726.00 	$537.24	$0.00	$580.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$538.84	$538.84	$559.60	$0.00	$151.30	$0.00	$0.00	$0.00	$0.00	$363.00	$574.99	$580.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011156	EAP	Custom 27011156		Lancet  Grady Orange	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011157	EAP	Custom 27011157		Line Connecting 36 Hp	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011158	EAP	Custom 27011158		Line Connecting 48 Hp	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011160	EAP	Custom 27011160		Mask Sub-micron Small	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011161	EAP	Custom 27011161		Med/surg Semi Supplies	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011162	EAP	Custom 27011162		Microsphere Embogold 500-700	BOTH IP/OP	$734.00 	$543.16	$0.00	$587.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$544.77	$544.77	$565.77	$0.00	$152.97	$0.00	$0.00	$0.00	$0.00	$367.00	$581.33	$587.20	$0.00	$477.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011163	EAP	Custom 27011163		Microsphere Embogold 700-900	BOTH IP/OP	$734.00 	$543.16	$0.00	$587.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$544.77	$544.77	$565.77	$0.00	$152.97	$0.00	$0.00	$0.00	$0.00	$367.00	$581.33	$587.20	$0.00	$477.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011164	EAP	Custom 27011164		Microsphere Embogold 900-1200	BOTH IP/OP	"$3,669.00 "	"$2,715.06"	$0.00	"$2,935.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,834.50"	"$2,905.85"	"$2,935.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011165	EAP	Custom 27011165		Needle Chiba 22ga X 15cm	BOTH IP/OP	$82.00 	$60.68	$0.00	$65.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.86	$60.86	$63.21	$0.00	$17.09	$0.00	$0.00	$0.00	$0.00	$41.00	$64.94	$65.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011166	EAP	Custom 27011166		Needle Hypodermic Sterile	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011167	EAP	Custom 27011167		Needle Hypodermic Sterile	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011168	EAP	Custom 27011168		Needle Port-cath 20ga X 1	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011169	EAP	Custom 27011169		Needle Port-cath 20ga X 1	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011172	EAP	Custom 27011172		Olcott Torque Device	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$42.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011176	EAP	Custom 27011176		Perc Gastrostomy Set	BOTH IP/OP	"$1,079.00 "	$798.46	$0.00	$863.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$800.83	$800.83	$831.69	$0.00	$224.86	$0.00	$0.00	$0.00	$0.00	$539.50	$854.57	$863.20	$0.00	$701.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011177	EAP	Custom 27011177		Polar Cath Inflation Unit	BOTH IP/OP	"$7,912.00 "	"$5,854.88"	$0.00	"$6,329.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,098.57"	$0.00	"$1,648.86"	$0.00	$0.00	$0.00	$0.00	"$3,956.00"	"$6,266.30"	"$6,329.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011178	EAP	Custom 27011178		Port Peritoneal/drain/ascites	BOTH IP/OP	"$1,070.00 "	$791.80	$0.00	$856.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$794.15	$794.15	$824.76	$0.00	$222.99	$0.00	$0.00	$0.00	$0.00	$535.00	$847.44	$856.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011179	EAP	Custom 27011179		Pressure Tubing	BOTH IP/OP	$555.00 	$410.70	$0.00	$444.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$411.92	$411.92	$427.79	$0.00	$115.66	$0.00	$0.00	$0.00	$0.00	$277.50	$439.56	$444.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011181	EAP	Custom 27011181		Rapad Shield	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.50	$103.75	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011182	EAP	Custom 27011182		Recovery Cone Removal System	BOTH IP/OP	"$1,985.00 "	"$1,468.90"	$0.00	"$1,588.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,473.27"	"$1,473.27"	"$1,530.04"	$0.00	$413.67	$0.00	$0.00	$0.00	$0.00	$992.50	"$1,572.12"	"$1,588.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011183	EAP	Custom 27011183		Retention Device 10fr	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011184	EAP	Custom 27011184		Retention Device 12fr	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011185	EAP	Custom 27011185		Retention Device 8fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011190	EAP	Custom 27011190		Ring Transjugular Set	BOTH IP/OP	"$1,404.00 "	"$1,038.96"	$0.00	"$1,123.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,042.05"	"$1,042.05"	"$1,082.20"	$0.00	$292.59	$0.00	$0.00	$0.00	$0.00	$702.00	"$1,111.97"	"$1,123.20"	$0.00	$912.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011194	EAP	Custom 27011194		Safety Angio Kit	BOTH IP/OP	$127.00 	$93.98	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.26	$94.26	$97.89	$0.00	$26.47	$0.00	$0.00	$0.00	$0.00	$63.50	$100.58	$101.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011195	EAP	Custom 27011195		Safety Peg Kit Moni Bolster	BOTH IP/OP	"$1,497.00 "	"$1,107.78"	$0.00	"$1,197.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,111.07"	"$1,111.07"	"$1,153.89"	$0.00	$311.97	$0.00	$0.00	$0.00	$0.00	$748.50	"$1,185.62"	"$1,197.60"	$0.00	$973.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011196	EAP	Custom 27011196		Scaple Surg W/handle Attached	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011197	EAP	Custom 27011197		Set Blood Administration	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011198	EAP	Custom 27011198		Set Blood Adminstration	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011199	EAP	Custom 27011199		Set Blood Adminstration	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011200	EAP	Custom 27011200		Set Liver Biopsy Labs-100	BOTH IP/OP	"$1,409.00 "	"$1,042.66"	$0.00	"$1,127.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,045.76"	"$1,045.76"	"$1,086.06"	$0.00	$293.64	$0.00	$0.00	$0.00	$0.00	$704.50	"$1,115.93"	"$1,127.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011201	EAP	Custom 27011201		Set Mediport Infusion W/i	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011202	EAP	Custom 27011202		Set Neff Perc Access	BOTH IP/OP	$244.00 	$180.56	$0.00	$195.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.10	$181.10	$188.08	$0.00	$50.85	$0.00	$0.00	$0.00	$0.00	$122.00	$193.25	$195.20	$0.00	$158.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011203	EAP	Custom 27011203		Set Pca Mini-bore W/int A	BOTH IP/OP	$44.00 	$32.56	$0.00	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.66	$32.66	$33.92	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011204	EAP	Custom 27011204		Set Scalp  Vein Infusion 21 G	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011207	EAP	Custom 27011207		Set Scalp Vein Infusion 2	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011208	EAP	Custom 27011208		Set Secondary Piggy Back	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011209	EAP	Custom 27011209		Set Urinary Drain W/conta	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011212	EAP	Custom 27011212		Simon-nitinol Vena Cava Filte	BOTH IP/OP	"$3,605.00 "	"$2,667.70"	$0.00	"$2,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,675.63"	"$2,675.63"	"$2,778.73"	$0.00	$751.28	$0.00	$0.00	$0.00	$0.00	"$1,802.50"	"$2,855.16"	"$2,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011213	EAP	Custom 27011213		Simon-nitinol Vena Filter An	BOTH IP/OP	"$3,085.00 "	"$2,282.90"	$0.00	"$2,468.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,289.69"	"$2,289.69"	"$2,377.92"	$0.00	$642.91	$0.00	$0.00	$0.00	$0.00	"$1,542.50"	"$2,443.32"	"$2,468.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011214	EAP	Custom 27011214		Skater Introducer System	BOTH IP/OP	$254.00 	$187.96	$0.00	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.52	$188.52	$195.78	$0.00	$52.93	$0.00	$0.00	$0.00	$0.00	$127.00	$201.17	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011215	EAP	HCPCS C1729		Skater Nephro Cath 8fr X 35cm	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$156.38	$156.38	$0.00	$0.00	$0.00	$60.03	$213.75	$213.75	$221.99	$0.00	$60.02	$0.00	$170.35	$170.35	$0.00	$144.00	$228.10	$230.40	$0.00	$187.20	$0.00	$45.07	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$0.00
27011216	EAP	Custom 27011216		Snare Amplatz 10mm	BOTH IP/OP	$916.00 	$677.84	$0.00	$732.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$679.86	$679.86	$706.05	$0.00	$190.89	$0.00	$0.00	$0.00	$0.00	$458.00	$725.47	$732.80	$0.00	$595.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011217	EAP	Custom 27011217		Snare Amplatz 5mm	BOTH IP/OP	$916.00 	$677.84	$0.00	$732.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$679.86	$679.86	$706.05	$0.00	$190.89	$0.00	$0.00	$0.00	$0.00	$458.00	$725.47	$732.80	$0.00	$595.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011226	EAP	Custom 27011226		Sponge Gelfoam Gelatin	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.09	$63.09	$65.52	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011227	EAP	HCPCS C1876		Stent Vascular Covera Covered 10mm X 60mm 80cm Delivery	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	"$5,202.90"	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00	$0.00	$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
27011228	EAP	Custom 27011228		Stent Luminex 12x60	BOTH IP/OP	"$3,986.00 "	"$2,949.64"	$0.00	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,958.41"	"$2,958.41"	"$3,072.41"	$0.00	$830.68	$0.00	$0.00	$0.00	$0.00	"$1,993.00"	"$3,156.91"	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011229	EAP	Custom 27011229		Stent Luminexx 7x30	BOTH IP/OP	"$3,986.00 "	"$2,949.64"	$0.00	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,958.41"	"$2,958.41"	"$3,072.41"	$0.00	$830.68	$0.00	$0.00	$0.00	$0.00	"$1,993.00"	"$3,156.91"	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011230	EAP	Custom 27011230		Stent Luminexx 7x40	BOTH IP/OP	"$3,986.00 "	"$2,949.64"	$0.00	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,958.41"	"$2,958.41"	"$3,072.41"	$0.00	$830.68	$0.00	$0.00	$0.00	$0.00	"$1,993.00"	"$3,156.91"	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011231	EAP	Custom 27011231		Stent Luminexx 8x40	BOTH IP/OP	"$3,986.00 "	"$2,949.64"	$0.00	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,958.41"	"$2,958.41"	"$3,072.41"	$0.00	$830.68	$0.00	$0.00	$0.00	$0.00	"$1,993.00"	"$3,156.91"	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011232	EAP	Custom 27011232		Stent Luminexx Stent 8x30	BOTH IP/OP	"$3,986.00 "	"$2,949.64"	$0.00	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,958.41"	"$2,958.41"	"$3,072.41"	$0.00	$830.68	$0.00	$0.00	$0.00	$0.00	"$1,993.00"	"$3,156.91"	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011233	EAP	Custom 27011233		Stiff Micropunture 5fr	BOTH IP/OP	$153.00 	$113.22	$0.00	$122.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.50	$121.18	$122.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011234	EAP	Custom 27011234		Stopcock 1-way Hp	BOTH IP/OP	$14.00 	$10.36	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.39	$10.39	$10.79	$0.00	$2.92	$0.00	$0.00	$0.00	$0.00	$7.00	$11.09	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011236	EAP	Custom 27011236		Stopcock 3-way Hp	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011237	EAP	Custom 27011237		"Supplies, Non-sterile Penumbra"	BOTH IP/OP	$66.00 	$48.84	$0.00	$52.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.99	$48.99	$50.87	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$33.00	$52.27	$52.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011241	EAP	Custom 27011241		Threapulse Ii	BOTH IP/OP	$581.00 	$429.94	$0.00	$464.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$431.22	$431.22	$447.83	$0.00	$121.08	$0.00	$0.00	$0.00	$0.00	$290.50	$460.15	$464.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011242	EAP	Custom 27011242		Tray Catheter Urethral 14	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011243	EAP	Custom 27011243		Tray Foley Perconnected 1	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011244	EAP	Custom 27011244		Tray Foley Perconnected 1	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011245	EAP	Custom 27011245		Tray Foley Preconnected 1	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011246	EAP	Custom 27011246		Tray Foley Preconnected 1	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011252	EAP	Custom 27011252		Triple Lumen Catheter Size 24	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011253	EAP	Custom 27011253		Tube  Feeding Ng  8fr 43in En	BOTH IP/OP	$68.00 	$50.32	$0.00	$54.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.47	$50.47	$52.41	$0.00	$14.17	$0.00	$0.00	$0.00	$0.00	$34.00	$53.86	$54.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011254	EAP	Custom 27011254		Tube Feeding Ng 8fr 36in Entr	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011255	EAP	Custom 27011255		Tube Gastrostomy 18fr	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$61.66	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011256	EAP	Custom 27011256		Tube Gastrostomy 22fr	BOTH IP/OP	$76.00 	$56.24	$0.00	$60.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.41	$56.41	$58.58	$0.00	$15.84	$0.00	$0.00	$0.00	$0.00	$38.00	$60.19	$60.80	$0.00	$49.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011257	EAP	Custom 27011257		Tube Jejunal Feeding 18 Fr O.d	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00	$195.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011258	EAP	Custom 27011258		Tube Jejunostomy Feed 14 Fr	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$386.17	$0.00	$104.41	$0.00	$0.00	$0.00	$0.00	$250.50	$396.79	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011259	EAP	Custom 27011259		Tube Salem Silicone Size	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011260	EAP	Custom 27011260		Tube Salem Sump 48 Lengt	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011261	EAP	Custom 27011261		Tube Tj Feeding 18 Fr 45cm End	BOTH IP/OP	$651.00 	$481.74	$0.00	$520.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.17	$483.17	$501.79	$0.00	$135.67	$0.00	$0.00	$0.00	$0.00	$325.50	$515.59	$520.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011262	EAP	Custom 27011262		Tube Tj Feeding 22 Fr 45cm End	BOTH IP/OP	$651.00 	$481.74	$0.00	$520.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.17	$483.17	$501.79	$0.00	$135.67	$0.00	$0.00	$0.00	$0.00	$325.50	$515.59	$520.80	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011263	EAP	Custom 27011263		Tubes Extension Plain Pla	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011265	EAP	Custom 27011265		Tubes Extension Plain Pla	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011266	EAP	Custom 27011266		Tubes Salem Sump 48 Leng	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011267	EAP	Custom 27011267		Ultrasound Probe Covers	BOTH IP/OP	$46.00 	$34.04	$0.00	$36.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.14	$34.14	$35.46	$0.00	$9.59	$0.00	$0.00	$0.00	$0.00	$23.00	$36.43	$36.80	$0.00	$29.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011268	EAP	Custom 27011268		Valve Reflux	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011269	EAP	Custom 27011269		Valve Reflux	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011270	EAP	Custom 27011270		.014 Nitrex Guidewire	BOTH IP/OP	"$1,219.00 "	$902.06	$0.00	$975.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$904.74	$904.74	$939.61	$0.00	$254.04	$0.00	$0.00	$0.00	$0.00	$609.50	$965.45	$975.20	$0.00	$792.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011301	EAP	Custom 27011301		Drsg Anti Sft Sil 8x20 20x50cm	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.07	$184.07	$191.16	$0.00	$51.68	$0.00	$0.00	$0.00	$0.00	$124.00	$196.42	$198.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011302	EAP	Custom 27011302		Drsg Anti Sft Sil 8x20 20x50cm	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.07	$184.07	$191.16	$0.00	$51.68	$0.00	$0.00	$0.00	$0.00	$124.00	$196.42	$198.40	$0.00	$161.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011304	EAP	Custom 27011304		Blood Administration Set	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.38	$82.38	$85.56	$0.00	$23.13	$0.00	$0.00	$0.00	$0.00	$55.50	$87.91	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011305	EAP	Custom 27011305		Drsng Anti Sft Sil 6x6 15x15cm	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$31.50	$49.90	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011306	EAP	Custom 27011306		Drsng Anti Sft Sil 6x6 15x15cm	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$31.50	$49.90	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011308	EAP	Custom 27011308		Drsng Anti Sft Sil 4x4 10x10cm	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.78	$20.78	$21.58	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011309	EAP	Custom 27011309		Drsng Anti Sft Sil 4x4 10x10cm	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.78	$20.78	$21.58	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$0.00	$18.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011310	EAP	HCPCS C1769		Volcano Combowire	BOTH IP/OP	"$3,669.00 "	"$2,715.06"	$0.00	"$2,935.20"	"$1,992.27"	"$1,992.27"	$0.00	$0.00	$0.00	$764.71	"$2,723.13"	"$2,723.13"	"$2,828.07"	$0.00	$764.62	$0.00	"$2,170.21"	"$2,170.21"	$0.00	"$1,834.50"	"$2,905.85"	"$2,935.20"	$0.00	$0.00	$0.00	$574.20	$0.00	$0.00	$584.10	$0.00	$0.00	$0.00	$0.00	$0.00
27011320	EAP	Custom 27011320		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011323	EAP	Custom 27011323		Jcd 9.0-38-20	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011324	EAP	Custom 27011324		Jcd 6.0-38-20	BOTH IP/OP	$167.00 	$123.58	$0.00	$133.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$132.26	$133.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011325	EAP	Custom 27011325		Tube Salem Sump 48 Lengt	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011326	EAP	Custom 27011326		Tubes Salem Sump 48 Leng	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011327	EAP	Custom 27011327		Jcd 9.0-38-20	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011328	EAP	Custom 27011328		Jcd 6.0-38-20	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011401	EAP	Custom 27011401		Super Arrow Flex Introducer -	BOTH IP/OP	$251.00 	$185.74	$0.00	$200.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.29	$186.29	$193.47	$0.00	$52.31	$0.00	$0.00	$0.00	$0.00	$125.50	$198.79	$200.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011410	EAP	Custom 27011410		Tube Trach #8 Dct	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.23	$97.23	$100.97	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$65.50	$103.75	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011411	EAP	Custom 27011411		Tube Trache 8-dcfs	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.52	$93.52	$97.12	$0.00	$26.26	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011413	EAP	Custom 27011413		Bag Resusitator Adult	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011421	EAP	Custom 27011421		Blade On Titanium Lopro S3	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.51	$70.51	$73.23	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$47.50	$75.24	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011422	EAP	Custom 27011422		Blade On Titanium Lopro S4	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.51	$70.51	$73.23	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$47.50	$75.24	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011423	EAP	Custom 27011423		Kit 135cm 2.7fr 20mm Img 1 Syr Rapex Tip Radiopq	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	$0.00	$0.00	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011425	EAP	Custom 27011425		Mic Transgastric Jejunal Feeding Kit 18f 45cm	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$385.40	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00	$325.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011426	EAP	HCPCS C1729		Catheter Urethral 16fr Foley 2	BOTH IP/OP	$224.00 	$165.76	$0.00	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.00	$177.41	$179.20	$0.00	$0.00	$0.00	$35.06	$0.00	$0.00	$35.66	$0.00	$0.00	$0.00	$0.00	$0.00
27011427	EAP	HCPCS A4649		Medihoney Dressing 1.5oz Tube	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$0.00	$0.00	$0.00	$4.38	$0.00	$0.00	$4.46	$0.00	$0.00	$0.00	$0.00	$0.00
27011428	EAP			Tube Gstrm 12fr 10cm 5-7ml Entuit Bln Rtnt	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011429	EAP			Tube Fd Std 14fr 10cm 5ml Entuit Thrive Bln Rtnt Sm Gstrm	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011430	EAP			Tube Fd Std 16fr 10cm 5ml Entuit Thrive Bln Rtnt Med Gstrm	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011431	EAP			Tube Gstrm Std 18fr 10cm 5ml 60ml Entuit Thrive Bln Rtnt	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$58.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011432	EAP			Tube Fd Std 20fr 10cm 20ml Entuit Thrive Bln Rtnt Lg Gstrm	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$58.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011433	EAP			Tube Fd Std 22fr 10cm 20ml Entuit Thrive Bln Rtnt Lg Gstrm	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$58.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011434	EAP			Tube Fd Std 24fr 10cm 20ml Entuit Thrive Bln Rtnt Lg Gstrm	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011435	EAP			Kit Tracheostomy 12.3mm 9mm Complete Set Inner Cannu	BOTH IP/OP	"$1,255.00 "	$928.70	$0.00	"$1,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$931.46	$931.46	$967.35	$0.00	$261.54	$0.00	$0.00	$0.00	$0.00	$627.50	$993.96	"$1,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011436	EAP			Kit Crntmy 25ga 5/8in Strl Rzr Ndl Drp	BOTH IP/OP	$701.00 	$518.74	$0.00	$560.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$350.50	$555.19	$560.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27011437	EAP	Custom 27011437		Blanket Wrm 84x36in Clr Strl Lf 24x48in 3m Br Hgr Full Acc	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$31.50	$49.90	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27100021	EAP	Custom 27100021		Pad Gel Hypo-hyperthermia Large	BOTH IP/OP	"$2,481.00 "	"$1,835.94"	$0.00	"$1,984.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,841.40"	"$1,841.40"	"$1,912.35"	$0.00	$517.04	$0.00	$0.00	$0.00	$0.00	"$1,240.50"	"$1,964.95"	"$1,984.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27100022	EAP	HCPCS A4467		POSTERIOR ELBOW SPLINT	BOTH IP/OP	$112.00 	$82.88	$0.00	$89.60	$60.82	$60.82	$0.00	$0.00	$0.00	$0.00	$83.13	$83.13	$86.33	$0.00	$23.34	$0.00	$0.00	$0.00	$0.00	$56.00	$88.70	$89.60	$0.00	$72.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27100023	EAP	Custom 27100023		Mölnlycke Z-flo Fluidized Positioner Pad	BOTH IP/OP	$122.00 	$90.28	$0.00	$97.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.55	$90.55	$94.04	$0.00	$25.42	$0.00	$0.00	$0.00	$0.00	$61.00	$96.62	$97.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27100031	EAP	Custom 27100031		Resuscitator Manual Medium 10f	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27100040	EAP			Sup Ortho Universal Abd Binder Velcro Closure	BOTH IP/OP	$538.00 	$398.12	$0.00	$430.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$399.30	$399.30	$414.69	$0.00	$112.12	$0.00	$0.00	$0.00	$0.00	$269.00	$426.10	$430.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200003	EAP	Custom 27200003		Chest Unit Drainage Pleur	BOTH IP/OP	$76.00 	$56.24	$0.00	$60.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.41	$56.41	$58.58	$0.00	$15.84	$0.00	$0.00	$0.00	$0.00	$38.00	$60.19	$60.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200008	EAP	HCPCS C1769		.014 Nitrex Guidewire	BOTH IP/OP	"$1,295.00 "	$958.30	$0.00	"$1,036.00"	$703.19	$703.19	$0.00	$0.00	$0.00	$269.91	$961.15	$961.15	$998.19	$0.00	$269.88	$0.00	$765.99	$765.99	$0.00	$647.50	"$1,025.64"	"$1,036.00"	$0.00	$0.00	$0.00	$202.67	$0.00	$0.00	$206.16	$0.00	$0.00	$0.00	$0.00	$0.00
27200011	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$11.70	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27200019	EAP	HCPCS C1729		Catheter Foley 5cc 14fr	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$3.26	$3.26	$0.00	$0.00	$0.00	$1.25	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00	$0.00	$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
27200021	EAP	HCPCS C1729		Catheter Foley 30cc 28fr	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$19.55	$19.55	$0.00	$0.00	$0.00	$7.50	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$21.29	$21.29	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$5.63	$0.00	$0.00	$5.73	$0.00	$0.00	$0.00	$0.00	$0.00
27200024	EAP	HCPCS C1729		Catheter Foley 3cc 10 Fr	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$18.46	$18.46	$0.00	$0.00	$0.00	$7.09	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$20.11	$20.11	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$5.32	$0.00	$0.00	$5.41	$0.00	$0.00	$0.00	$0.00	$0.00
27200025	EAP	HCPCS C1729		Catheter Foley 5cc 12fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27200026	EAP	Custom 27200026		Dress Sofsorb Absorb Buttoc Sm	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200027	EAP	Custom 27200027		Dress Sofsorb Absorb Butto Lg	BOTH IP/OP	$97.00 	$71.78	$0.00	$77.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.99	$71.99	$74.77	$0.00	$20.21	$0.00	$0.00	$0.00	$0.00	$48.50	$76.82	$77.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200028	EAP	Custom 27200028		Dress Sofsorb Absorb Chest Ssm	BOTH IP/OP	$41.00 	$30.34	$0.00	$32.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.43	$30.43	$31.60	$0.00	$8.54	$0.00	$0.00	$0.00	$0.00	$20.50	$32.47	$32.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200029	EAP	Custom 27200029		Dress Sofsorb Absors Chest Ilg	BOTH IP/OP	$41.00 	$30.34	$0.00	$32.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.43	$30.43	$31.60	$0.00	$8.54	$0.00	$0.00	$0.00	$0.00	$20.50	$32.47	$32.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200030	EAP	Custom 27200030		Dress Sofsorb Absorb Xl Chest	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200031	EAP	Custom 27200031		Dressing Leg/hip Adult	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.57	$64.57	$67.06	$0.00	$18.13	$0.00	$0.00	$0.00	$0.00	$43.50	$68.90	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200032	EAP	Custom 27200032		Dressing Burn Gauze 17 Ply 36'	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200033	EAP	HCPCS C1751		Kit Cath Triple Lumen 5.5 Pedi	BOTH IP/OP	$159.00 	$117.66	$0.00	$127.20	$86.34	$86.34	$0.00	$0.00	$0.00	$33.14	$118.01	$118.01	$122.56	$0.00	$33.14	$0.00	$94.05	$94.05	$0.00	$79.50	$125.93	$127.20	$0.00	$0.00	$0.00	$24.88	$0.00	$0.00	$25.31	$0.00	$0.00	$0.00	$0.00	$0.00
27200035	EAP	HCPCS C1751		Femoral Arterial Line Cath Kit	BOTH IP/OP	$873.00 	$646.02	$0.00	$698.40	$474.04	$474.04	$0.00	$0.00	$0.00	$181.96	$647.94	$647.94	$672.91	$0.00	$181.93	$0.00	$516.38	$516.38	$0.00	$436.50	$691.42	$698.40	$0.00	$0.00	$0.00	$136.62	$0.00	$0.00	$138.98	$0.00	$0.00	$0.00	$0.00	$0.00
27200040	EAP	Custom 27200040		Kit Transducer Monitoring	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.62	$107.62	$111.77	$0.00	$30.22	$0.00	$0.00	$0.00	$0.00	$72.50	$114.84	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200041	EAP	Custom 27200041		Kit  Pressure Monitoring	BOTH IP/OP	$108.00 	$79.92	$0.00	$86.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.16	$80.16	$83.25	$0.00	$22.51	$0.00	$0.00	$0.00	$0.00	$54.00	$85.54	$86.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200043	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$3.26	$3.26	$0.00	$0.00	$0.00	$1.25	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00	$0.00	$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
27200045	EAP	Custom 27200045		Paracentesis Tray	BOTH IP/OP	$214.00 	$158.36	$0.00	$171.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.83	$158.83	$164.95	$0.00	$44.60	$0.00	$0.00	$0.00	$0.00	$107.00	$169.49	$171.20	$0.00	$139.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200047	EAP	Custom 27200047		Biliary Plastic Stents	BOTH IP/OP	"$1,091.00 "	$807.34	$0.00	$872.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$809.74	$809.74	$840.94	$0.00	$227.36	$0.00	$0.00	$0.00	$0.00	$545.50	$864.07	$872.80	$0.00	$709.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200048	EAP	HCPCS C1769		Hydratomes Rx Cannulating Sphi	BOTH IP/OP	"$3,556.00 "	"$2,631.44"	$0.00	"$2,844.80"	"$1,930.91"	"$1,930.91"	$0.00	$0.00	$0.00	$741.16	"$2,639.26"	"$2,639.26"	"$2,740.96"	$0.00	$741.07	$0.00	"$2,103.37"	"$2,103.37"	$0.00	"$1,778.00"	"$2,816.35"	"$2,844.80"	$0.00	$0.00	$0.00	$556.51	$0.00	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00
27200049	EAP	HCPCS C1769		Jagtomes Rx Cannulating Sphinc	BOTH IP/OP	"$1,255.00 "	$928.70	$0.00	"$1,004.00"	$681.47	$681.47	$0.00	$0.00	$0.00	$261.57	$931.46	$931.46	$967.35	$0.00	$261.54	$0.00	$742.33	$742.33	$0.00	$627.50	$993.96	"$1,004.00"	$0.00	$815.75	$0.00	$196.41	$0.00	$0.00	$199.80	$0.00	$0.00	$0.00	$0.00	$0.00
27200050	EAP	Custom 27200050		Extractor Balloon	BOTH IP/OP	"$1,388.00 "	"$1,027.12"	$0.00	"$1,110.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,030.17"	"$1,030.17"	"$1,069.87"	$0.00	$289.26	$0.00	$0.00	$0.00	$0.00	$694.00	"$1,099.30"	"$1,110.40"	$0.00	$902.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200051	EAP	Custom 27200051		Trapezoid Retrieval Baskets	BOTH IP/OP	"$2,263.00 "	"$1,674.62"	$0.00	"$1,810.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,679.60"	"$1,679.60"	"$1,744.32"	$0.00	$471.61	$0.00	$0.00	$0.00	$0.00	"$1,131.50"	"$1,792.30"	"$1,810.40"	$0.00	"$1,470.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200052	EAP	Custom 27200052		Endoprosthesis Metal Stent	BOTH IP/OP	"$9,693.00 "	"$7,172.82"	$0.00	"$7,754.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$7,471.36"	$0.00	"$2,020.02"	$0.00	$0.00	$0.00	$0.00	"$4,846.50"	"$7,676.86"	"$7,754.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200053	EAP	Custom 27200053		Esophageal Stent	BOTH IP/OP	"$11,672.00 "	"$8,637.28"	$0.00	"$9,337.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,996.78"	$0.00	"$2,432.44"	$0.00	$0.00	$0.00	$0.00	"$5,836.00"	"$9,244.22"	"$9,337.60"	$0.00	"$7,586.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200054	EAP	Custom 27200054		Colonic And Duodenal Stent	BOTH IP/OP	"$16,179.00 "	"$11,972.46"	$0.00	"$12,943.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,470.77"	$0.00	"$3,371.70"	$0.00	$0.00	$0.00	$0.00	"$8,089.50"	"$12,813.77"	"$12,943.20"	$0.00	"$10,516.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200055	EAP	HCPCS C1726		Cre Balloons	BOTH IP/OP	"$1,523.00 "	"$1,127.02"	$0.00	"$1,218.40"	$826.99	$826.99	$0.00	$0.00	$0.00	$317.43	"$1,130.37"	"$1,130.37"	"$1,173.93"	$0.00	$317.39	$0.00	$900.85	$900.85	$0.00	$761.50	"$1,206.22"	"$1,218.40"	$0.00	$989.95	$0.00	$238.35	$0.00	$0.00	$242.46	$0.00	$0.00	$0.00	$0.00	$0.00
27200056	EAP	Custom 27200056		Esophageal/pyloric Balloon Dil	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	"$1,137.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200057	EAP	Custom 27200057		Esophageal/pyloric/colonic  Ba	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	"$1,137.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200058	EAP	Custom 27200058		O2 Supply-each	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200060	EAP	Custom 27200060		Venous Port - Maintenance	BOTH IP/OP	$184.00 	$136.16	$0.00	$147.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.56	$136.56	$141.83	$0.00	$38.35	$0.00	$0.00	$0.00	$0.00	$92.00	$145.73	$147.20	$0.00	$119.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200061	EAP	Custom 27200061		Dressing	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200062	EAP	Custom 27200062		"Dressing, Burn Supplies"	BOTH IP/OP	$206.00 	$152.44	$0.00	$164.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.89	$152.89	$158.78	$0.00	$42.93	$0.00	$0.00	$0.00	$0.00	$103.00	$163.15	$164.80	$0.00	$133.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200063	EAP	Custom 27200063		Iv Start Supply	BOTH IP/OP	$228.00 	$168.72	$0.00	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.22	$169.22	$175.74	$0.00	$47.52	$0.00	$0.00	$0.00	$0.00	$114.00	$180.58	$182.40	$0.00	$148.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200064	EAP	Custom 27200064		"Dressing, Burn Supplies"	BOTH IP/OP	$193.00 	$142.82	$0.00	$154.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.24	$143.24	$148.76	$0.00	$40.22	$0.00	$0.00	$0.00	$0.00	$96.50	$152.86	$154.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200065	EAP	Custom 27200065		Splint Supply	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200066	EAP	Custom 27200066		Nephrostomy Bag	BOTH IP/OP	$299.00 	$221.26	$0.00	$239.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.92	$221.92	$230.47	$0.00	$62.31	$0.00	$0.00	$0.00	$0.00	$149.50	$236.81	$239.20	$0.00	$194.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200067	EAP	Custom 27200067		Dressing Change	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200068	EAP	HCPCS C1729		Catheter Foley	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$18.46	$18.46	$0.00	$0.00	$0.00	$7.09	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$20.11	$20.11	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$5.32	$0.00	$0.00	$5.41	$0.00	$0.00	$0.00	$0.00	$0.00
27200069	EAP	Custom 27200069		Leg Bag	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200070	EAP	Custom 27200070		Urinary Drainage Bag	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200074	EAP	Custom 27200074		Acticoat Dressing	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.79	$233.79	$242.80	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00	$204.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200075	EAP	Custom 27200075		Feeding/ng Tube	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200076	EAP	Custom 27200076		Triple Lumen Cath	BOTH IP/OP	$222.00 	$164.28	$0.00	$177.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.77	$164.77	$171.12	$0.00	$46.26	$0.00	$0.00	$0.00	$0.00	$111.00	$175.82	$177.60	$0.00	$144.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200077	EAP	Custom 27200077		Transvenous Pacing Electrode	BOTH IP/OP	$389.00 	$287.86	$0.00	$311.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$288.72	$288.72	$299.84	$0.00	$81.07	$0.00	$0.00	$0.00	$0.00	$194.50	$308.09	$311.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200080	EAP	Custom 27200080		"Injection, Iv, Antibiotic"	BOTH IP/OP	$214.00 	$158.36	$0.00	$171.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.83	$158.83	$164.95	$0.00	$44.60	$0.00	$0.00	$0.00	$0.00	$107.00	$169.49	$171.20	$0.00	$139.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200081	EAP	Custom 27200081		"Steroid Injection, Iv Supply"	BOTH IP/OP	$192.00 	$142.08	$0.00	$153.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.50	$142.50	$147.99	$0.00	$40.01	$0.00	$0.00	$0.00	$0.00	$96.00	$152.06	$153.60	$0.00	$124.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200082	EAP	Custom 27200082		"Iv Start, Supply"	BOTH IP/OP	$228.00 	$168.72	$0.00	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.52	$0.00	$0.00	$0.00	$0.00	$114.00	$180.58	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200084	EAP	Custom 27200084		Emerg Infus Catheter	BOTH IP/OP	$264.00 	$195.36	$0.00	$211.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.00	$209.09	$211.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200085	EAP	Custom 27200085		"Ett, Laser"	BOTH IP/OP	$897.00 	$663.78	$0.00	$717.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$665.75	$665.75	$691.41	$0.00	$186.93	$0.00	$0.00	$0.00	$0.00	$448.50	$710.42	$717.60	$0.00	$583.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200086	EAP	Custom 27200086		"Ett, Rae"	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.58	$87.58	$90.95	$0.00	$24.59	$0.00	$0.00	$0.00	$0.00	$59.00	$93.46	$94.40	$0.00	$76.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200087	EAP	Custom 27200087		"Ett, Wire Reinf"	BOTH IP/OP	$362.00 	$267.88	$0.00	$289.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.68	$268.68	$279.03	$0.00	$75.44	$0.00	$0.00	$0.00	$0.00	$181.00	$286.70	$289.60	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200088	EAP	Custom 27200088		"Ett, Endotrol/mlt"	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00	$89.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200090	EAP	Custom 27200090		"Cvp Kit, Single Lumen"	BOTH IP/OP	$238.00 	$176.12	$0.00	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.64	$176.64	$183.45	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$119.00	$188.50	$190.40	$0.00	$154.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200091	EAP	HCPCS C1756		Swan Paceport Cath	BOTH IP/OP	$666.00 	$492.84	$0.00	$532.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$494.31	$494.31	$513.35	$0.00	$138.79	$0.00	$0.00	$0.00	$0.00	$333.00	$527.47	$532.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200092	EAP	HCPCS C1751		Cvp Kit Triple Lumen	BOTH IP/OP	$569.00 	$421.06	$0.00	$455.20	$308.97	$308.97	$0.00	$0.00	$0.00	$118.59	$422.31	$422.31	$438.59	$0.00	$118.58	$0.00	$336.56	$336.56	$0.00	$284.50	$450.65	$455.20	$0.00	$369.85	$0.00	$89.05	$0.00	$0.00	$90.58	$0.00	$0.00	$0.00	$0.00	$0.00
27200093	EAP	HCPCS C1756		Swan Ganz Cath-bipolar Pacing	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$909.20	$909.20	$944.23	$0.00	$255.29	$0.00	$0.00	$0.00	$0.00	$612.50	$970.20	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200094	EAP	HCPCS C1756		Swan Pacing Td	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	"$1,856.86"	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200096	EAP	Custom 27200096		Adult Iv Set-up	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.30	$19.30	$20.04	$0.00	$5.42	$0.00	$0.00	$0.00	$0.00	$13.00	$20.59	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200097	EAP	Custom 27200097		"Ett, Endotrol/mlt"	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200098	EAP	Custom 27200098		"Cvp Kit, Single Lumen"	BOTH IP/OP	$238.00 	$176.12	$0.00	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.64	$176.64	$183.45	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$119.00	$188.50	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200099	EAP	HCPCS C1756		Swan Paceport Cath	BOTH IP/OP	$634.00 	$469.16	$0.00	$507.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$470.55	$470.55	$488.69	$0.00	$132.13	$0.00	$0.00	$0.00	$0.00	$317.00	$502.13	$507.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200100	EAP	Custom 27200100		Cvp Kit Triple Lumen	BOTH IP/OP	$141.00 	$104.34	$0.00	$112.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$104.65	$104.65	$108.68	$0.00	$29.38	$0.00	$0.00	$0.00	$0.00	$70.50	$111.67	$112.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200101	EAP	HCPCS C1756		Swan Bipolar	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$909.20	$909.20	$944.23	$0.00	$255.29	$0.00	$0.00	$0.00	$0.00	$612.50	$970.20	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200102	EAP	HCPCS C1756		Swan Pacing Td	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	"$1,856.86"	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200104	EAP	HCPCS C1729		Catheter Foley 30cc 28fr	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$20.09	$20.09	$0.00	$0.00	$0.00	$7.71	$27.46	$27.46	$28.52	$0.00	$7.71	$0.00	$21.89	$21.89	$0.00	$18.50	$29.30	$29.60	$0.00	$0.00	$0.00	$5.79	$0.00	$0.00	$5.89	$0.00	$0.00	$0.00	$0.00	$0.00
27200107	EAP	HCPCS L8680		Implt Neurostim Elctr Each	BOTH IP/OP	"$1,605.00 "	"$1,187.70"	$0.00	"$1,284.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,191.23"	"$1,191.23"	"$1,237.13"	$0.00	$334.48	$0.00	$0.00	$0.00	$0.00	$802.50	"$1,271.16"	"$1,284.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200108	EAP	Custom 27200108		Regional Nerve Block Tray	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.31	$65.31	$67.83	$0.00	$18.34	$0.00	$0.00	$0.00	$0.00	$44.00	$69.70	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200109	EAP	Custom 27200109		Epidural Tray	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$123.33	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200110	EAP	Custom 27200110		Insulated Block Needle	BOTH IP/OP	$46.00 	$34.04	$0.00	$36.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.14	$34.14	$35.46	$0.00	$9.59	$0.00	$0.00	$0.00	$0.00	$23.00	$36.43	$36.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200111	EAP	Custom 27200111		O2 Therapy-ea 8 Hrs	BOTH IP/OP	$296.00 	$219.04	$0.00	$236.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.69	$219.69	$228.16	$0.00	$61.69	$0.00	$0.00	$0.00	$0.00	$148.00	$234.43	$236.80	$0.00	$192.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200113	EAP	Custom 27200113		Peak Flow Meter	BOTH IP/OP	$487.00 	$360.38	$0.00	$389.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.45	$361.45	$375.38	$0.00	$101.49	$0.00	$0.00	$0.00	$0.00	$243.50	$385.70	$389.60	$0.00	$316.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200114	EAP	Custom 27200114		Heart Nebulizer	BOTH IP/OP	$440.00 	$325.60	$0.00	$352.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$326.57	$326.57	$339.15	$0.00	$91.70	$0.00	$0.00	$0.00	$0.00	$220.00	$348.48	$352.00	$0.00	$286.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200115	EAP	Custom 27200115		Mini Heart	BOTH IP/OP	$424.00 	$313.76	$0.00	$339.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$314.69	$314.69	$326.82	$0.00	$88.36	$0.00	$0.00	$0.00	$0.00	$212.00	$335.81	$339.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200116	EAP	Custom 27200116		Mdi Spacer	BOTH IP/OP	$192.00 	$142.08	$0.00	$153.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.50	$142.50	$147.99	$0.00	$40.01	$0.00	$0.00	$0.00	$0.00	$96.00	$152.06	$153.60	$0.00	$124.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200117	EAP	Custom 27200117		Inc Spir-disposable	BOTH IP/OP	$319.00 	$236.06	$0.00	$255.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.76	$236.76	$245.89	$0.00	$66.48	$0.00	$0.00	$0.00	$0.00	$159.50	$252.65	$255.20	$0.00	$207.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200118	EAP	Custom 27200118		Inner Cannula	BOTH IP/OP	$134.00 	$99.16	$0.00	$107.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.45	$99.45	$103.29	$0.00	$27.93	$0.00	$0.00	$0.00	$0.00	$67.00	$106.13	$107.20	$0.00	$87.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200119	EAP	Custom 27200119		Nasal Prongs	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.30	$19.30	$20.04	$0.00	$5.42	$0.00	$0.00	$0.00	$0.00	$13.00	$20.59	$20.80	$0.00	$16.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200120	EAP	Custom 27200120		Vent Kit Only	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$385.40	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00	$325.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200124	EAP	Custom 27200124		Meter Astech Peak Flow	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200125	EAP	Custom 27200125		Sleep Apnea Supply Kit	BOTH IP/OP	"$1,443.00 "	"$1,067.82"	$0.00	"$1,154.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,070.99"	"$1,070.99"	"$1,112.26"	$0.00	$300.72	$0.00	$0.00	$0.00	$0.00	$721.50	"$1,142.86"	"$1,154.40"	$0.00	$937.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200126	EAP	Custom 27200126		Tracheostomy-pipe Cleaner	BOTH IP/OP	$84.00 	$62.16	$0.00	$67.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.34	$62.34	$64.75	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$42.00	$66.53	$67.20	$0.00	$54.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200128	EAP	Custom 27200128		Tube Trach #8 Dct	BOTH IP/OP	$377.00 	$278.98	$0.00	$301.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.81	$279.81	$290.59	$0.00	$78.57	$0.00	$0.00	$0.00	$0.00	$188.50	$298.58	$301.60	$0.00	$245.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200129	EAP	Custom 27200129		Tube Trach #6 Dct	BOTH IP/OP	$377.00 	$278.98	$0.00	$301.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.81	$279.81	$290.59	$0.00	$78.57	$0.00	$0.00	$0.00	$0.00	$188.50	$298.58	$301.60	$0.00	$245.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200130	EAP	Custom 27200130		Tube Trach #10 Dct	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.64	$248.64	$258.22	$0.00	$69.81	$0.00	$0.00	$0.00	$0.00	$167.50	$265.32	$268.00	$0.00	$217.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200131	EAP	Custom 27200131		Tube Tracheostomy 4-dcfs	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$263.61	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00	$222.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200132	EAP	Custom 27200132		Tube Tracheostomy 8-dcfs	BOTH IP/OP	$326.00 	$241.24	$0.00	$260.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.96	$241.96	$251.28	$0.00	$67.94	$0.00	$0.00	$0.00	$0.00	$163.00	$258.19	$260.80	$0.00	$211.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200133	EAP	Custom 27200133		Mini Bal-broncho-alveolar Lava	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200134	EAP	Custom 27200134		Cont Oxy Hood-pediatrics	BOTH IP/OP	$866.00 	$640.84	$0.00	$692.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$642.75	$642.75	$667.51	$0.00	$180.47	$0.00	$0.00	$0.00	$0.00	$433.00	$685.87	$692.80	$0.00	$562.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200135	EAP	Custom 27200135		He-ox Rx Airway Obs + Supply	BOTH IP/OP	$947.00 	$700.78	$0.00	$757.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$702.86	$702.86	$729.95	$0.00	$197.35	$0.00	$0.00	$0.00	$0.00	$473.50	$750.02	$757.60	$0.00	$615.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200136	EAP	Custom 27200136		Trach Tube/passy Muir	BOTH IP/OP	$554.00 	$409.96	$0.00	$443.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$411.18	$411.18	$427.02	$0.00	$115.45	$0.00	$0.00	$0.00	$0.00	$277.00	$438.77	$443.20	$0.00	$360.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200137	EAP	Custom 27200137		Intubation Specialty Tube	BOTH IP/OP	"$1,545.00 "	"$1,143.30"	$0.00	"$1,236.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,146.70"	"$1,146.70"	"$1,190.89"	$0.00	$321.98	$0.00	$0.00	$0.00	$0.00	$772.50	"$1,223.64"	"$1,236.00"	$0.00	"$1,004.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200138	EAP	Custom 27200138		Pulse Oximetry Sensor	BOTH IP/OP	$292.00 	$216.08	$0.00	$233.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.72	$216.72	$225.07	$0.00	$60.85	$0.00	$0.00	$0.00	$0.00	$146.00	$231.26	$233.60	$0.00	$189.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200139	EAP	Custom 27200139		Vent Circuit Kit	BOTH IP/OP	$423.00 	$313.02	$0.00	$338.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$313.95	$313.95	$326.05	$0.00	$88.15	$0.00	$0.00	$0.00	$0.00	$211.50	$335.02	$338.40	$0.00	$274.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200140	EAP	Custom 27200140		Specialty Vent Circuit Kit	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$734.78	$734.78	$763.09	$0.00	$206.32	$0.00	$0.00	$0.00	$0.00	$495.00	$784.08	$792.00	$0.00	$643.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200143	EAP	Custom 27200143		Blood Gas Kit	BOTH IP/OP	$112.00 	$82.88	$0.00	$89.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.13	$83.13	$86.33	$0.00	$23.34	$0.00	$0.00	$0.00	$0.00	$56.00	$88.70	$89.60	$0.00	$72.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200144	EAP	HCPCS C1729		Red Rubber Catheter	BOTH IP/OP	$54.00 	$39.96	$0.00	$43.20	$29.32	$29.32	$0.00	$0.00	$0.00	$11.25	$40.08	$40.08	$41.62	$0.00	$11.25	$0.00	$31.94	$31.94	$0.00	$27.00	$42.77	$43.20	$0.00	$35.10	$0.00	$8.45	$0.00	$0.00	$8.60	$0.00	$0.00	$0.00	$0.00	$0.00
27200145	EAP	Custom 27200145		Air Vest-disposable	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.99	$500.99	$520.29	$0.00	$140.67	$0.00	$0.00	$0.00	$0.00	$337.50	$534.60	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200148	EAP	Custom 27200148		"Iv Start, Supply"	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200149	EAP	HCPCS C1769		Guidewire:pressurewire:radi	BOTH IP/OP	"$2,511.00 "	"$1,858.14"	$0.00	"$2,008.80"	"$1,363.47"	"$1,363.47"	$0.00	$0.00	$0.00	$523.36	"$1,863.66"	"$1,863.66"	"$1,935.48"	$0.00	$523.29	$0.00	"$1,485.26"	"$1,485.26"	$0.00	"$1,255.50"	"$1,988.71"	"$2,008.80"	$0.00	$0.00	$0.00	$392.97	$0.00	$0.00	$399.75	$0.00	$0.00	$0.00	$0.00	$0.00
27200150	EAP	Custom 27200150		Pericardiocentesis Kit	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$0.00	$0.00	$0.00	$295.50	$468.07	$472.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200151	EAP	HCPCS C1769		Choice Pt X-support Guidewire	BOTH IP/OP	$605.00 	$447.70	$0.00	$484.00	$328.52	$328.52	$0.00	$0.00	$0.00	$126.10	$449.03	$449.03	$466.33	$0.00	$126.08	$0.00	$357.86	$357.86	$0.00	$302.50	$479.16	$484.00	$0.00	$393.25	$0.00	$94.68	$0.00	$0.00	$96.32	$0.00	$0.00	$0.00	$0.00	$0.00
27200152	EAP	HCPCS C1769		Choice Pt Guidewire	BOTH IP/OP	$605.00 	$447.70	$0.00	$484.00	$328.52	$328.52	$0.00	$0.00	$0.00	$126.10	$449.03	$449.03	$466.33	$0.00	$126.08	$0.00	$357.86	$357.86	$0.00	$302.50	$479.16	$484.00	$0.00	$393.25	$0.00	$94.68	$0.00	$0.00	$96.32	$0.00	$0.00	$0.00	$0.00	$0.00
27200153	EAP	HCPCS C1769		Glidewire .035 150cm  Angled	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.00	$93.46	$94.40	$0.00	$0.00	$0.00	$18.47	$0.00	$0.00	$18.79	$0.00	$0.00	$0.00	$0.00	$0.00
27200154	EAP	HCPCS C1892		Custom Left Heart Kit W/transd	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$37.47	$37.47	$0.00	$0.00	$0.00	$14.38	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$40.81	$40.81	$0.00	$34.50	$54.65	$55.20	$0.00	$44.85	$0.00	$10.80	$0.00	$0.00	$10.98	$0.00	$0.00	$0.00	$0.00	$0.00
27200155	EAP	HCPCS C1892		Custom Right Heart Kit W/trans	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$25.52	$25.52	$0.00	$0.00	$0.00	$9.80	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$27.80	$27.80	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$7.36	$0.00	$0.00	$7.48	$0.00	$0.00	$0.00	$0.00	$0.00
27200156	EAP	HCPCS C2629		Micropuncture Set	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$21.26	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$60.33	$60.33	$0.00	$51.00	$80.78	$81.60	$0.00	$66.30	$0.00	$15.96	$0.00	$0.00	$16.24	$0.00	$0.00	$0.00	$0.00	$0.00
27200157	EAP	HCPCS C1769		.025 X 260CM 7CM EMERALD GUIDEWIRE	BOTH IP/OP	$21.00 	$15.54	$0.00	$16.80	$11.40	$11.40	$0.00	$0.00	$0.00	$4.38	$15.59	$15.59	$16.19	$0.00	$4.38	$0.00	$12.42	$12.42	$0.00	$10.50	$16.63	$16.80	$0.00	$13.65	$0.00	$3.29	$0.00	$0.00	$3.34	$0.00	$0.00	$0.00	$0.00	$0.00
27200158	EAP	HCPCS C1887		6fr Al 1 St Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$129.35	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200159	EAP	HCPCS C1887		6fr Ar 2 Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200160	EAP	HCPCS C1894		6fr - 10cm  Avanti + Sheath In	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$18.46	$18.46	$0.00	$0.00	$0.00	$7.09	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$20.11	$20.11	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$5.32	$0.00	$0.00	$5.41	$0.00	$0.00	$0.00	$0.00	$0.00
27200161	EAP	HCPCS C1887		6fr Jl4 St Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200162	EAP	HCPCS C1887		6fr Mpa-1 Guiding Cath	BOTH IP/OP	$189.00 	$139.86	$0.00	$151.20	$102.63	$102.63	$0.00	$0.00	$0.00	$39.39	$140.28	$140.28	$145.68	$0.00	$39.39	$0.00	$111.79	$111.79	$0.00	$94.50	$149.69	$151.20	$0.00	$122.85	$0.00	$29.58	$0.00	$0.00	$30.09	$0.00	$0.00	$0.00	$0.00	$0.00
27200163	EAP	HCPCS C1887		6ft Jr 4 St Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$129.35	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200164	EAP	HCPCS C1887		7fr Ar 1 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200165	EAP	HCPCS C1887		7fr Jr 3.5 Guiding Cath	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$97.74	$97.74	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$138.74	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00	$0.00	$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
27200166	EAP	HCPCS C1887		7fr H-stick Guiding Cath	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$97.74	$97.74	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$138.74	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00	$0.00	$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
27200167	EAP	HCPCS C1887		7fr Jl5 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200168	EAP	HCPCS C1887		7fr Jr 4 St Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200169	EAP	HCPCS C1887		7fr Jr 5 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200170	EAP	HCPCS C1887		7fr Mpa-1 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200171	EAP	HCPCS C1887		7fr Xb 3.5 Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200172	EAP	HCPCS C1887		7fr Xb 3.0 Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200173	EAP	HCPCS C1887		7fr Al 1 St Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200174	EAP	HCPCS C1887		7fr Al 2 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200175	EAP	HCPCS C1887		7fr Jr 4 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200176	EAP	HCPCS C1887		7fr Im Guiding Cath	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$97.74	$97.74	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$138.74	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00	$117.00	$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
27200177	EAP	HCPCS C1887		6fr Ar 1 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200178	EAP	HCPCS C1887		6fr Jl4 Sh Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200179	EAP	HCPCS C1887		6fr Jr 4 Sh Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200180	EAP	HCPCS C1769		.035 X 260CM 3CM  EMERALD GUIDEWIRE	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$11.95	$11.95	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00	$14.30	$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
27200181	EAP	HCPCS C1887		6fr Xb 3 Sh Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200182	EAP	HCPCS C1887		7fr Xb 3.5 Sh Guilding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200183	EAP	HCPCS C1887		6fr Xb 3.5 Sh Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200184	EAP	HCPCS C1769		.035 X 150CM 3CM EMERALD GUIDEWIRE	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$11.95	$11.95	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00	$14.30	$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
27200185	EAP	HCPCS C1887		7fr Jl4 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200186	EAP	HCPCS C1887		7fr Jl4 Sh Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200187	EAP	HCPCS C1887		7fr Xb 4.0 Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200188	EAP	HCPCS C1887		7fr Jr 4 Sh Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200189	EAP	HCPCS C1887		7fr Ar 1 Sh Guiding Cath	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$97.74	$97.74	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$138.74	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00	$0.00	$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
27200190	EAP	HCPCS C1887		6fr Al 1 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200191	EAP	HCPCS C1887		6fr Xb 4.0 Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200192	EAP	HCPCS C1887		7fr Al 1 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200193	EAP	HCPCS C1887		6fr Jl4 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200194	EAP	HCPCS C1887		6fr Jr 4 Guiding Cath	BOTH IP/OP	$189.00 	$139.86	$0.00	$151.20	$102.63	$102.63	$0.00	$0.00	$0.00	$39.39	$140.28	$140.28	$145.68	$0.00	$39.39	$0.00	$111.79	$111.79	$0.00	$94.50	$149.69	$151.20	$0.00	$122.85	$0.00	$29.58	$0.00	$0.00	$30.09	$0.00	$0.00	$0.00	$0.00	$0.00
27200195	EAP	HCPCS C1887		6fr Xb 3 Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$129.35	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200196	EAP	HCPCS C1887		6fr Xb 3.5 Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$129.35	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200197	EAP	HCPCS C1887		6fr H-stick Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200198	EAP	HCPCS C1887		6fr Jl3.5 Guiding Cath	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$97.74	$97.74	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$138.74	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00	$117.00	$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
27200199	EAP	HCPCS C1887		6fr Jr 3.5 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200200	EAP	HCPCS C1887		6fr Al .75 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200201	EAP	HCPCS C1887		7fr Al .75 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200202	EAP	HCPCS C1894		7fr - 10cm Avanti + Sheath Int	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$18.46	$18.46	$0.00	$0.00	$0.00	$7.09	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$20.11	$20.11	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$5.32	$0.00	$0.00	$5.41	$0.00	$0.00	$0.00	$0.00	$0.00
27200203	EAP	HCPCS C1894		8fr - 10cm Avanti + Sheath Int	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$18.46	$18.46	$0.00	$0.00	$0.00	$7.09	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$20.11	$20.11	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$5.32	$0.00	$0.00	$5.41	$0.00	$0.00	$0.00	$0.00	$0.00
27200204	EAP	HCPCS C1769		.025 X 150cm Emerald Guidewire	BOTH IP/OP	$21.00 	$15.54	$0.00	$16.80	$11.40	$11.40	$0.00	$0.00	$0.00	$4.38	$15.59	$15.59	$16.19	$0.00	$4.38	$0.00	$12.42	$12.42	$0.00	$10.50	$16.63	$16.80	$0.00	$13.65	$0.00	$3.29	$0.00	$0.00	$3.34	$0.00	$0.00	$0.00	$0.00	$0.00
27200205	EAP	HCPCS C1769		300cm Balanced Middleweight (b	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$156.38	$156.38	$0.00	$0.00	$0.00	$60.03	$213.75	$213.75	$221.99	$0.00	$60.02	$0.00	$170.35	$170.35	$0.00	$144.00	$228.10	$230.40	$0.00	$0.00	$0.00	$45.07	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$0.00
27200206	EAP	HCPCS C1769		Amplatz Guidewire Super Stiff	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$47.24	$47.24	$0.00	$0.00	$0.00	$18.13	$64.57	$64.57	$67.06	$0.00	$18.13	$0.00	$51.46	$51.46	$0.00	$43.50	$68.90	$69.60	$0.00	$0.00	$0.00	$13.62	$0.00	$0.00	$13.85	$0.00	$0.00	$0.00	$0.00	$0.00
27200207	EAP	HCPCS C1751		7fr-100cm Swan-ganz Td Cathete	BOTH IP/OP	$189.00 	$139.86	$0.00	$151.20	$102.63	$102.63	$0.00	$0.00	$0.00	$39.39	$140.28	$140.28	$145.68	$0.00	$39.39	$0.00	$111.79	$111.79	$0.00	$94.50	$149.69	$151.20	$0.00	$122.85	$0.00	$29.58	$0.00	$0.00	$30.09	$0.00	$0.00	$0.00	$0.00	$0.00
27200208	EAP	HCPCS C1894		5fr - 10cm Avanti+sheath Intro	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$18.46	$18.46	$0.00	$0.00	$0.00	$7.09	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$20.11	$20.11	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$5.32	$0.00	$0.00	$5.41	$0.00	$0.00	$0.00	$0.00	$0.00
27200209	EAP	HCPCS C1887		7fr Jl4 St Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200214	EAP	HCPCS C1884		Filter Wire Ex-300cm	BOTH IP/OP	"$5,361.00 "	"$3,967.14"	$0.00	"$4,288.80"	"$2,911.02"	"$2,911.02"	$0.00	$0.00	$0.00	"$1,117.37"	"$3,978.93"	"$3,978.93"	"$4,132.26"	$0.00	"$1,117.23"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,680.50"	"$4,245.91"	"$4,288.80"	$0.00	"$3,484.65"	$0.00	$839.00	$0.00	$0.00	$853.47	$0.00	$0.00	$0.00	$0.00	$0.00
27200215	EAP	HCPCS C1727		2.50 X 15mm Cutting Balloon	BOTH IP/OP	"$2,869.00 "	"$2,123.06"	$0.00	"$2,295.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,129.37"	"$2,129.37"	"$2,211.43"	$0.00	$597.90	$0.00	$0.00	$0.00	$0.00	"$1,434.50"	"$2,272.25"	"$2,295.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200216	EAP	HCPCS C1727		2.50 X 10cm Cutting Balloon	BOTH IP/OP	"$2,869.00 "	"$2,123.06"	$0.00	"$2,295.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,129.37"	"$2,129.37"	"$2,211.43"	$0.00	$597.90	$0.00	$0.00	$0.00	$0.00	"$1,434.50"	"$2,272.25"	"$2,295.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200218	EAP	HCPCS C1757		.014-145cm Export Catheter	BOTH IP/OP	"$1,865.00 "	"$1,380.10"	$0.00	"$1,492.00"	"$1,012.70"	"$1,012.70"	$0.00	$0.00	$0.00	$388.71	"$1,384.20"	"$1,384.20"	"$1,437.54"	$0.00	$388.67	$0.00	"$1,103.15"	"$1,103.15"	$0.00	$932.50	"$1,477.08"	"$1,492.00"	$0.00	"$1,212.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200219	EAP	HCPCS C1756		Temporary Pace Eletrode Cathet	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$0.00	$0.00	$0.00	$295.50	$468.07	$472.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200220	EAP	HCPCS C1727		"Balloon Cutting Ultra Tube, 2."	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,910.42"	"$1,910.42"	"$1,984.04"	$0.00	$536.42	$0.00	$0.00	$0.00	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200226	EAP	HCPCS C1725		4.00 X 15mm Voyager Rx Balloon	BOTH IP/OP	$699.00 	$517.26	$0.00	$559.20	$379.56	$379.56	$0.00	$0.00	$0.00	$145.69	$518.80	$518.80	$538.79	$0.00	$145.67	$0.00	$413.46	$413.46	$0.00	$349.50	$553.61	$559.20	$0.00	$0.00	$0.00	$109.39	$0.00	$0.00	$111.28	$0.00	$0.00	$0.00	$0.00	$0.00
27200227	EAP	HCPCS C1769		190cm All-star Guidewire	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$156.38	$156.38	$0.00	$0.00	$0.00	$60.03	$213.75	$213.75	$221.99	$0.00	$60.02	$0.00	$170.35	$170.35	$0.00	$144.00	$228.10	$230.40	$0.00	$0.00	$0.00	$45.07	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$0.00
27200228	EAP	HCPCS C1769		Choice X-support Guidewire	BOTH IP/OP	$605.00 	$447.70	$0.00	$484.00	$328.52	$328.52	$0.00	$0.00	$0.00	$126.10	$449.03	$449.03	$466.33	$0.00	$126.08	$0.00	$357.86	$357.86	$0.00	$302.50	$479.16	$484.00	$0.00	$0.00	$0.00	$94.68	$0.00	$0.00	$96.32	$0.00	$0.00	$0.00	$0.00	$0.00
27200229	EAP	HCPCS C1769		Choice Standard Guidewire	BOTH IP/OP	$605.00 	$447.70	$0.00	$484.00	$328.52	$328.52	$0.00	$0.00	$0.00	$126.10	$449.03	$449.03	$466.33	$0.00	$126.08	$0.00	$357.86	$357.86	$0.00	$302.50	$479.16	$484.00	$0.00	$0.00	$0.00	$94.68	$0.00	$0.00	$96.32	$0.00	$0.00	$0.00	$0.00	$0.00
27200230	EAP	HCPCS C1887		7fr Xb 3.0 Sh Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200231	EAP	HCPCS C1887		6fr Al 2 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200238	EAP	HCPCS C1887		7fr Ar 2 Guiding Cath	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$97.74	$97.74	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$138.74	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00	$0.00	$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
27200239	EAP	HCPCS C1887		7fr Jl3.5 Guiding Cath	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$97.74	$97.74	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$138.74	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00	$0.00	$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
27200247	EAP	HCPCS C1887		7fr Lcb Guiding Cath	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$108.06	$108.06	$0.00	$0.00	$0.00	$41.48	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$117.71	$117.71	$0.00	$99.50	$157.61	$159.20	$0.00	$129.35	$0.00	$31.14	$0.00	$0.00	$31.68	$0.00	$0.00	$0.00	$0.00	$0.00
27200248	EAP	HCPCS C1887		7fr Jr 4 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200249	EAP	HCPCS C1887		7fr Ar 1 Guiding Cath	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200250	EAP	HCPCS C1769		"Glide Wire,.035 Straight"	BOTH IP/OP	$112.00 	$82.88	$0.00	$89.60	$60.82	$60.82	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$86.33	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$56.00	$88.70	$89.60	$0.00	$72.80	$0.00	$17.53	$0.00	$0.00	$17.83	$0.00	$0.00	$0.00	$0.00	$0.00
27200251	EAP	HCPCS C1887		6fr Mpa- 1 Guiding Cath	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$97.74	$97.74	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$138.74	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00	$0.00	$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
27200252	EAP	HCPCS C1769		190cm J Tip Bmw Guidewire	BOTH IP/OP	$348.00 	$257.52	$0.00	$278.40	$188.96	$188.96	$0.00	$0.00	$0.00	$72.53	$258.29	$258.29	$268.24	$0.00	$72.52	$0.00	$205.84	$205.84	$0.00	$174.00	$275.62	$278.40	$0.00	$226.20	$0.00	$54.46	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
27200253	EAP	HCPCS C1726		12frx28mmx70cm Inoue Balloon	BOTH IP/OP	"$19,725.00 "	"$14,596.50"	$0.00	"$15,780.00"	"$10,710.68"	"$10,710.68"	$0.00	$0.00	$0.00	"$4,111.18"	"$4,181.12"	"$4,181.12"	"$15,204.03"	$0.00	"$4,110.69"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$9,862.50"	"$15,622.20"	"$15,780.00"	$0.00	$0.00	$0.00	"$3,086.96"	$0.00	$0.00	"$3,140.22"	$0.00	$0.00	$0.00	$0.00	$0.00
27200254	EAP	HCPCS C1887		6fr H Stick Sh Guiding Cathete	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200255	EAP	HCPCS C1887		6fr Al 1 Sh Guiding Catheter	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200256	EAP	HCPCS C1887		6fr Al 2 Sh Guiding Catheter	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200257	EAP	HCPCS C1725		2.0 X 9mm Maverick Monorail	BOTH IP/OP	$916.00 	$677.84	$0.00	$732.80	$497.39	$497.39	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$706.05	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$458.00	$725.47	$732.80	$0.00	$0.00	$0.00	$143.35	$0.00	$0.00	$145.83	$0.00	$0.00	$0.00	$0.00	$0.00
27200258	EAP	HCPCS C1725		2.5 X 9mm Maverick Monorail	BOTH IP/OP	$916.00 	$677.84	$0.00	$732.80	$497.39	$497.39	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$706.05	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$458.00	$725.47	$732.80	$0.00	$0.00	$0.00	$143.35	$0.00	$0.00	$145.83	$0.00	$0.00	$0.00	$0.00	$0.00
27200259	EAP	HCPCS C1725		3.0 X 9mm Maverick Monorail	BOTH IP/OP	$872.00 	$645.28	$0.00	$697.60	$473.50	$473.50	$0.00	$0.00	$0.00	$181.75	$647.20	$647.20	$672.14	$0.00	$181.72	$0.00	$515.79	$515.79	$0.00	$436.00	$690.62	$697.60	$0.00	$0.00	$0.00	$136.47	$0.00	$0.00	$138.82	$0.00	$0.00	$0.00	$0.00	$0.00
27200283	EAP	HCPCS C1769		Hi-torque Pilot 50 Guide Wire	BOTH IP/OP	$302.00 	$223.48	$0.00	$241.60	$163.99	$163.99	$0.00	$0.00	$0.00	$62.94	$224.14	$224.14	$232.78	$0.00	$62.94	$0.00	$178.63	$178.63	$0.00	$151.00	$239.18	$241.60	$0.00	$196.30	$0.00	$47.26	$0.00	$0.00	$48.08	$0.00	$0.00	$0.00	$0.00	$0.00
27200285	EAP	HCPCS C1769		Doc Guide Wire Extension	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$175.93	$175.93	$0.00	$0.00	$0.00	$67.53	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$191.65	$191.65	$0.00	$162.00	$256.61	$259.20	$0.00	$210.60	$0.00	$50.71	$0.00	$0.00	$51.58	$0.00	$0.00	$0.00	$0.00	$0.00
27200292	EAP	HCPCS C1725		1.5 X 6 Sprinter Balloon	BOTH IP/OP	$853.00 	$631.22	$0.00	$682.40	$463.18	$463.18	$0.00	$0.00	$0.00	$177.79	$633.10	$633.10	$657.49	$0.00	$177.77	$0.00	$504.55	$504.55	$0.00	$426.50	$675.58	$682.40	$0.00	$0.00	$0.00	$133.49	$0.00	$0.00	$135.80	$0.00	$0.00	$0.00	$0.00	$0.00
27200294	EAP	HCPCS C1751		7fr Wedge Pressure Cath	BOTH IP/OP	$153.00 	$113.22	$0.00	$122.40	$83.08	$83.08	$0.00	$0.00	$0.00	$31.89	$113.56	$113.56	$117.93	$0.00	$31.89	$0.00	$90.50	$90.50	$0.00	$76.50	$121.18	$122.40	$0.00	$99.45	$0.00	$23.94	$0.00	$0.00	$24.36	$0.00	$0.00	$0.00	$0.00	$0.00
27200295	EAP	Custom 27200295		Cardiac Cath Pack	BOTH IP/OP	$190.00 	$140.60	$0.00	$152.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.02	$141.02	$146.45	$0.00	$39.60	$0.00	$0.00	$0.00	$0.00	$95.00	$150.48	$152.00	$0.00	$123.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200296	EAP	Custom 27200296		Contrast Inject Line-low Press	BOTH IP/OP	$7.00 	$5.18	$0.00	$5.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.20	$5.20	$5.40	$0.00	$1.46	$0.00	$0.00	$0.00	$0.00	$3.50	$5.54	$5.60	$0.00	$4.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200297	EAP	Custom 27200297		Implant Tray	BOTH IP/OP	$212.00 	$156.88	$0.00	$169.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.00	$167.90	$169.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200298	EAP	HCPCS C1893		5fr - 10cm Pinnacle Introducer	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$20.63	$20.63	$0.00	$0.00	$0.00	$7.92	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$22.48	$22.48	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$5.95	$0.00	$0.00	$6.05	$0.00	$0.00	$0.00	$0.00	$0.00
27200299	EAP	HCPCS C1893		6fr - 10cm Pinnacle Introducer	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$21.72	$21.72	$0.00	$0.00	$0.00	$8.34	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$23.66	$23.66	$0.00	$20.00	$31.68	$32.00	$0.00	$26.00	$0.00	$6.26	$0.00	$0.00	$6.37	$0.00	$0.00	$0.00	$0.00	$0.00
27200300	EAP	HCPCS C1893		7fr - 10cm Pinnacle Introducer	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$20.63	$20.63	$0.00	$0.00	$0.00	$7.92	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$22.48	$22.48	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$5.95	$0.00	$0.00	$6.05	$0.00	$0.00	$0.00	$0.00	$0.00
27200301	EAP	HCPCS C1893		8fr - 10cm Pinnacle Introducer	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$20.63	$20.63	$0.00	$0.00	$0.00	$7.92	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$22.48	$22.48	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$5.95	$0.00	$0.00	$6.05	$0.00	$0.00	$0.00	$0.00	$0.00
27200302	EAP	HCPCS C1893		6fr - 25cm Pinnacle Introducer	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$37.47	$37.47	$0.00	$0.00	$0.00	$14.38	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$40.81	$40.81	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$10.80	$0.00	$0.00	$10.98	$0.00	$0.00	$0.00	$0.00	$0.00
27200303	EAP	HCPCS C1893		7fr - 25cm Pinnacle Introducer	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$37.47	$37.47	$0.00	$0.00	$0.00	$14.38	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$40.81	$40.81	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$10.80	$0.00	$0.00	$10.98	$0.00	$0.00	$0.00	$0.00	$0.00
27200304	EAP	HCPCS C1893		8fr - 25cm Pinnacle Introducer	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$37.47	$37.47	$0.00	$0.00	$0.00	$14.38	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$40.81	$40.81	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$10.80	$0.00	$0.00	$10.98	$0.00	$0.00	$0.00	$0.00	$0.00
27200305	EAP	HCPCS C1887		6fr Ebu 3.0 Guiding Catheter	BOTH IP/OP	$189.00 	$139.86	$0.00	$151.20	$102.63	$102.63	$0.00	$0.00	$0.00	$39.39	$140.28	$140.28	$145.68	$0.00	$39.39	$0.00	$111.79	$111.79	$0.00	$94.50	$149.69	$151.20	$0.00	$122.85	$0.00	$29.58	$0.00	$0.00	$30.09	$0.00	$0.00	$0.00	$0.00	$0.00
27200306	EAP	HCPCS C1887		6fr Ebu 3.5 Guiding Catheter	BOTH IP/OP	$169.00 	$125.06	$0.00	$135.20	$91.77	$91.77	$0.00	$0.00	$0.00	$35.22	$125.43	$125.43	$130.27	$0.00	$35.22	$0.00	$99.96	$99.96	$0.00	$84.50	$133.85	$135.20	$0.00	$109.85	$0.00	$26.45	$0.00	$0.00	$26.90	$0.00	$0.00	$0.00	$0.00	$0.00
27200307	EAP	HCPCS C1887		6fr Ebu 4.0 Guiding Catheter	BOTH IP/OP	$169.00 	$125.06	$0.00	$135.20	$91.77	$91.77	$0.00	$0.00	$0.00	$35.22	$125.43	$125.43	$130.27	$0.00	$35.22	$0.00	$99.96	$99.96	$0.00	$84.50	$133.85	$135.20	$0.00	$109.85	$0.00	$26.45	$0.00	$0.00	$26.90	$0.00	$0.00	$0.00	$0.00	$0.00
27200308	EAP	HCPCS C1887		7fr Ebu 3.0 Guiding Catheter	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200309	EAP	HCPCS C1887		7fr Ebu 3.5 Guiding Catheter	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200310	EAP	HCPCS C1887		7fr Ebu 4.0 Guiding Catheter	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$104.65	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27200311	EAP	HCPCS C1887		8fr Ebu 3.5 Guiding Catheter	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$97.74	$97.74	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$138.74	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00	$0.00	$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
27200312	EAP	HCPCS C1887		8fr Ebu 4.0 Guiding Catheter	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$97.74	$97.74	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$138.74	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00	$0.00	$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
27200313	EAP	HCPCS C1727		3.0 X 10cm Cutting Balloon Otw	BOTH IP/OP	$986.00 	$729.64	$0.00	$788.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$731.81	$731.81	$760.01	$0.00	$205.48	$0.00	$0.00	$0.00	$0.00	$493.00	$780.91	$788.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200314	EAP	HCPCS C1757		7fr Export Xt Catheter	BOTH IP/OP	"$2,850.00 "	"$2,109.00"	$0.00	"$2,280.00"	"$1,547.55"	"$1,547.55"	$0.00	$0.00	$0.00	$594.01	"$2,115.27"	"$2,115.27"	"$2,196.78"	$0.00	$593.94	$0.00	"$1,685.78"	"$1,685.78"	$0.00	"$1,425.00"	"$2,257.20"	"$2,280.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200315	EAP	HCPCS C1769		.014 - 300cm Asahi Miraclebros	BOTH IP/OP	$691.00 	$511.34	$0.00	$552.80	$375.21	$375.21	$0.00	$0.00	$0.00	$144.02	$512.86	$512.86	$532.62	$0.00	$144.00	$0.00	$408.73	$408.73	$0.00	$345.50	$547.27	$552.80	$0.00	$449.15	$0.00	$108.14	$0.00	$0.00	$110.01	$0.00	$0.00	$0.00	$0.00	$0.00
27200316	EAP	HCPCS C1769		.014 - 300cm Asahi Soft Wire	BOTH IP/OP	$268.00 	$198.32	$0.00	$214.40	$145.52	$145.52	$0.00	$0.00	$0.00	$55.86	$198.91	$198.91	$206.57	$0.00	$55.85	$0.00	$158.52	$158.52	$0.00	$134.00	$212.26	$214.40	$0.00	$0.00	$0.00	$41.94	$0.00	$0.00	$42.67	$0.00	$0.00	$0.00	$0.00	$0.00
27200317	EAP	HCPCS C1769		.014 - 300cm Whisper Ms	BOTH IP/OP	$331.00 	$244.94	$0.00	$264.80	$179.73	$179.73	$0.00	$0.00	$0.00	$68.99	$245.67	$245.67	$255.13	$0.00	$68.98	$0.00	$195.79	$195.79	$0.00	$165.50	$262.15	$264.80	$0.00	$0.00	$0.00	$51.80	$0.00	$0.00	$52.70	$0.00	$0.00	$0.00	$0.00	$0.00
27200318	EAP	HCPCS C1769		.014 - 300cm All-star Wire	BOTH IP/OP	$307.00 	$227.18	$0.00	$245.60	$166.70	$166.70	$0.00	$0.00	$0.00	$63.99	$227.86	$227.86	$236.64	$0.00	$63.98	$0.00	$181.59	$181.59	$0.00	$153.50	$243.14	$245.60	$0.00	$199.55	$0.00	$48.05	$0.00	$0.00	$48.87	$0.00	$0.00	$0.00	$0.00	$0.00
27200319	EAP	HCPCS C1753		Eagle Eye Coronary Imaging Cat	BOTH IP/OP	"$2,449.00 "	"$1,812.26"	$0.00	"$1,959.20"	"$1,329.81"	"$1,329.81"	$0.00	$0.00	$0.00	$510.43	"$1,817.65"	"$1,817.65"	"$1,887.69"	$0.00	$510.37	$0.00	"$1,448.58"	"$1,448.58"	$0.00	"$1,224.50"	"$1,939.61"	"$1,959.20"	$0.00	"$1,591.85"	$0.00	$383.27	$0.00	$0.00	$389.88	$0.00	$0.00	$0.00	$0.00	$0.00
27200320	EAP	Custom 27200320		Primewire	BOTH IP/OP	"$2,332.00 "	"$1,725.68"	$0.00	"$1,865.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,730.81"	"$1,730.81"	"$1,797.51"	$0.00	$485.99	$0.00	$0.00	$0.00	$0.00	"$1,166.00"	"$1,846.94"	"$1,865.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200321	EAP	HCPCS C1893		8fr-35cm Super Arrow Flex Intr	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$135.21	$135.21	$0.00	$0.00	$0.00	$51.90	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$147.28	$147.28	$0.00	$124.50	$197.21	$199.20	$0.00	$0.00	$0.00	$38.97	$0.00	$0.00	$39.64	$0.00	$0.00	$0.00	$0.00	$0.00
27200322	EAP	Custom 27200322		Platinum Plus St .018 Guidewir	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.75	$213.75	$221.99	$0.00	$60.02	$0.00	$0.00	$0.00	$0.00	$144.00	$228.10	$230.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200323	EAP	Custom 27200323		Platinum Plus St .014 Guidewir	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.75	$213.75	$221.99	$0.00	$60.02	$0.00	$0.00	$0.00	$0.00	$144.00	$228.10	$230.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200324	EAP	Custom 27200324		V-18 Control Wire	BOTH IP/OP	$340.00 	$251.60	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.35	$252.35	$262.07	$0.00	$70.86	$0.00	$0.00	$0.00	$0.00	$170.00	$269.28	$272.00	$0.00	$221.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200325	EAP	Custom 27200325		Steel Core 18 Guidewire	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200329	EAP	Custom 27200329		14fr Sheath Introducer	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.57	$64.57	$67.06	$0.00	$18.13	$0.00	$0.00	$0.00	$0.00	$43.50	$68.90	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200338	EAP	HCPCS C1725		Voyager Nc 2.5 X 15mm Balloon	BOTH IP/OP	$634.00 	$469.16	$0.00	$507.20	$344.26	$344.26	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$488.69	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$317.00	$502.13	$507.20	$0.00	$412.10	$0.00	$99.22	$0.00	$0.00	$100.93	$0.00	$0.00	$0.00	$0.00	$0.00
27200373	EAP	HCPCS C1726		Catheter Baldilat 12 Atm 1.5mm 142cm 12mm Rapex	BOTH IP/OP	$413.00 	$305.62	$0.00	$330.40	$224.26	$224.26	$0.00	$0.00	$0.00	$86.08	$306.53	$306.53	$318.34	$0.00	$86.07	$0.00	$244.29	$244.29	$0.00	$206.50	$327.10	$330.40	$0.00	$268.45	$0.00	$64.63	$0.00	$0.00	$65.75	$0.00	$0.00	$0.00	$0.00	$0.00
27200376	EAP	HCPCS C1726		Catheter Blndil 21cm .022in 2mm 142cm Lf 12mm Spntr Lgnd	BOTH IP/OP	$413.00 	$305.62	$0.00	$330.40	$224.26	$224.26	$0.00	$0.00	$0.00	$86.08	$306.53	$306.53	$318.34	$0.00	$86.07	$0.00	$244.29	$244.29	$0.00	$206.50	$327.10	$330.40	$0.00	$268.45	$0.00	$64.63	$0.00	$0.00	$65.75	$0.00	$0.00	$0.00	$0.00	$0.00
27200382	EAP	HCPCS C1726		Sprinter Legend Balloon Rx 3.0	BOTH IP/OP	$569.00 	$421.06	$0.00	$455.20	$308.97	$308.97	$0.00	$0.00	$0.00	$118.59	$422.31	$422.31	$438.59	$0.00	$118.58	$0.00	$336.56	$336.56	$0.00	$284.50	$450.65	$455.20	$0.00	$0.00	$0.00	$89.05	$0.00	$0.00	$90.58	$0.00	$0.00	$0.00	$0.00	$0.00
27200406	EAP	HCPCS C1726		Sprinter Nc Balloon Rx 3.50x06	BOTH IP/OP	$627.00 	$463.98	$0.00	$501.60	$340.46	$340.46	$0.00	$0.00	$0.00	$130.68	$465.36	$465.36	$483.29	$0.00	$130.67	$0.00	$370.87	$370.87	$0.00	$313.50	$496.58	$501.60	$0.00	$0.00	$0.00	$98.13	$0.00	$0.00	$99.82	$0.00	$0.00	$0.00	$0.00	$0.00
27200408	EAP	HCPCS C1726		Sprinter Nc Balloon Rx 3.50x12	BOTH IP/OP	$627.00 	$463.98	$0.00	$501.60	$340.46	$340.46	$0.00	$0.00	$0.00	$130.68	$465.36	$465.36	$483.29	$0.00	$130.67	$0.00	$370.87	$370.87	$0.00	$313.50	$496.58	$501.60	$0.00	$0.00	$0.00	$98.13	$0.00	$0.00	$99.82	$0.00	$0.00	$0.00	$0.00	$0.00
27200417	EAP	HCPCS C1726		Sprinter Nc Balloon Rx 4.00x15	BOTH IP/OP	$627.00 	$463.98	$0.00	$501.60	$340.46	$340.46	$0.00	$0.00	$0.00	$130.68	$465.36	$465.36	$483.29	$0.00	$130.67	$0.00	$370.87	$370.87	$0.00	$313.50	$496.58	$501.60	$0.00	$0.00	$0.00	$98.13	$0.00	$0.00	$99.82	$0.00	$0.00	$0.00	$0.00	$0.00
27200422	EAP	Custom 27200422		Spacer (mdi)	BOTH IP/OP	$215.00 	$159.10	$0.00	$172.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.57	$159.57	$165.72	$0.00	$44.81	$0.00	$0.00	$0.00	$0.00	$107.50	$170.28	$172.00	$0.00	$139.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200423	EAP	Custom 27200423		FOOT DROP SPLINT-CUSTOM	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.35	$180.35	$187.30	$0.00	$50.64	$0.00	$0.00	$0.00	$0.00	$121.50	$192.46	$194.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200425	EAP	Custom 27200425		"Catheterization Kit, Straight"	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200426	EAP	Custom 27200426		Blood Administration Set Up	BOTH IP/OP	$3.00 	$2.22	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.23	$2.23	$2.31	$0.00	$0.63	$0.00	$0.00	$0.00	$0.00	$1.50	$2.38	$2.40	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200427	EAP	Custom 27200427		Intra-uterine Press Cath	BOTH IP/OP	$92.00 	$68.08	$0.00	$73.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.28	$68.28	$70.91	$0.00	$19.17	$0.00	$0.00	$0.00	$0.00	$46.00	$72.86	$73.60	$0.00	$59.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200428	EAP	Custom 27200428		"Pack, C-section"	BOTH IP/OP	$157.00 	$116.18	$0.00	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.53	$116.53	$121.02	$0.00	$32.72	$0.00	$0.00	$0.00	$0.00	$78.50	$124.34	$125.60	$0.00	$102.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200430	EAP	Custom 27200430		"Catheterization Kit, Foley"	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200431	EAP	Custom 27200431		"Catheterization Kit, Straight"	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$138.74	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00	$117.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200432	EAP	Custom 27200432		Blood Administration Set Up	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200433	EAP	Custom 27200433		Karmen Cannula	BOTH IP/OP	"$1,131.00 "	$836.94	$0.00	$904.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$839.43	$839.43	$871.77	$0.00	$235.70	$0.00	$0.00	$0.00	$0.00	$565.50	$895.75	$904.80	$0.00	$735.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200434	EAP	HCPCS A4405		Stomahesive Paste 2 Oz Tube	BOTH IP/OP	$108.00 	$79.92	$0.00	$86.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.16	$80.16	$83.25	$0.00	$22.51	$0.00	$0.00	$0.00	$0.00	$54.00	$85.54	$86.40	$0.00	$70.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200435	EAP	Custom 27200435		"Little Ones, Pouch Flange"	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200436	EAP	Custom 27200436		"Pouch, Urostomy Opaque"	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200437	EAP	Custom 27200437		Flexible Flange	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200438	EAP	Custom 27200438		"Irrigator, Visiflow W/cone"	BOTH IP/OP	$201.00 	$148.74	$0.00	$160.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.18	$149.18	$154.93	$0.00	$41.89	$0.00	$0.00	$0.00	$0.00	$100.50	$159.19	$160.80	$0.00	$130.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200439	EAP	Custom 27200439		Irrigation Sleeve	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$0.00	$0.00	$0.00	$103.50	$163.94	$165.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200440	EAP	HCPCS A4371		Stomahesive Powder	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$0.00	$0.00	$0.00	$28.00	$44.35	$44.80	$0.00	$36.40	$0.00	$8.76	$0.00	$0.00	$8.92	$0.00	$0.00	$0.00	$0.00	$0.00
27200441	EAP	Custom 27200441		Mini Pouch	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$0.00	$0.00	$0.00	$28.00	$44.35	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200442	EAP	Custom 27200442		Wound Pouch Med.	BOTH IP/OP	$68.00 	$50.32	$0.00	$54.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.47	$50.47	$52.41	$0.00	$14.17	$0.00	$0.00	$0.00	$0.00	$34.00	$53.86	$54.40	$0.00	$44.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200443	EAP	HCPCS A4364		Medical Adhesive	BOTH IP/OP	$68.00 	$50.32	$0.00	$54.40	$36.92	$36.92	$0.00	$0.00	$0.00	$14.17	$50.47	$50.47	$52.41	$0.00	$14.17	$0.00	$40.22	$40.22	$0.00	$34.00	$53.86	$54.40	$0.00	$44.20	$0.00	$10.64	$0.00	$0.00	$10.83	$0.00	$0.00	$0.00	$0.00	$0.00
27200444	EAP	Custom 27200444		Drain Tube Attachment	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$6.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200446	EAP	HCPCS A4364		"Skin Bond Cement, 4oz"	BOTH IP/OP	$76.00 	$56.24	$0.00	$60.80	$41.27	$41.27	$0.00	$0.00	$0.00	$15.84	$56.41	$56.41	$58.58	$0.00	$15.84	$0.00	$44.95	$44.95	$0.00	$38.00	$60.19	$60.80	$0.00	$0.00	$0.00	$11.89	$0.00	$0.00	$12.10	$0.00	$0.00	$0.00	$0.00	$0.00
27200447	EAP	HCPCS A4455		"Uni-solve Wipes,adhes. Remover"	BOTH IP/OP	$103.00 	$76.22	$0.00	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.45	$76.45	$79.39	$0.00	$21.47	$0.00	$0.00	$0.00	$0.00	$51.50	$81.58	$82.40	$0.00	$66.95	$0.00	$16.12	$0.00	$0.00	$16.40	$0.00	$0.00	$0.00	$0.00	$0.00
27200448	EAP	HCPCS A6197		Alginate Dressing>16<= 48 Sq In	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200449	EAP	Custom 27200449		Ace Wrap Supply	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200450	EAP	HCPCS C1728		"Catheter,brachytherapy Seed Ad"	BOTH IP/OP	"$10,554.00 "	"$7,809.96"	$0.00	"$8,443.20"	"$5,730.82"	"$5,730.82"	$0.00	$0.00	$0.00	"$2,199.72"	"$4,181.12"	"$4,181.12"	"$8,135.02"	$0.00	"$2,199.45"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,277.00"	"$8,358.77"	"$8,443.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200452	EAP	HCPCS C1757		Catheter 6fr X 65 Cm 9mm Cleaner Sterile	BOTH IP/OP	"$1,756.00 "	"$1,299.44"	$0.00	"$1,404.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$878.00	"$1,390.75"	"$1,404.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200453	EAP	HCPCS C1757		Catheter 6fr X 135 Cm 9mm Cleaner Sterile	BOTH IP/OP	"$2,351.00 "	"$1,739.74"	$0.00	"$1,880.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,175.50"	"$1,861.99"	"$1,880.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200454	EAP	HCPCS C1757		Catheter 7 Fr X 65 Cm 9mm Cleaner Sterile	BOTH IP/OP	"$2,143.00 "	"$1,585.82"	$0.00	"$1,714.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,071.50"	"$1,697.26"	"$1,714.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200455	EAP	HCPCS C1757		Catheter 7fr X 135 Cm 9mm Cleaner Sterile	BOTH IP/OP	"$2,660.00 "	"$1,968.40"	$0.00	"$2,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,330.00"	"$2,106.72"	"$2,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200456	EAP	HCPCS C2629		Mic G-18 Introducer Kit	BOTH IP/OP	$585.00 	$432.90	$0.00	$468.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.93	$434.19	$434.19	$450.92	$0.00	$121.91	$0.00	$346.03	$346.03	$0.00	$292.50	$463.32	$468.00	$0.00	$380.25	$0.00	$91.55	$0.00	$0.00	$93.13	$0.00	$0.00	$0.00	$0.00	$0.00
27200457	EAP	HCPCS C1751		Cath Cen Ven 4fr 1 Lum Try 3cg Shrlk Sty Maximal Brr Pic	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$135.21	$135.21	$0.00	$0.00	$0.00	$51.90	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$147.28	$147.28	$0.00	$124.50	$197.21	$199.20	$0.00	$161.85	$0.00	$38.97	$0.00	$0.00	$39.64	$0.00	$0.00	$0.00	$0.00	$0.00
27200458	EAP	HCPCS C1751		Cath 5fr 1lum Try 3cg Shrlk Sty Maximal Brr Picc P	BOTH IP/OP	$260.00 	$192.40	$0.00	$208.00	$141.18	$141.18	$0.00	$0.00	$0.00	$54.19	$192.97	$192.97	$200.41	$0.00	$54.18	$0.00	$153.79	$153.79	$0.00	$130.00	$205.92	$208.00	$0.00	$169.00	$0.00	$40.69	$0.00	$0.00	$41.39	$0.00	$0.00	$0.00	$0.00	$0.00
27200459	EAP	HCPCS C1751		Cath 6fr 1lum Try 3cg Shrlk Sty Maximal Brr Picc P	BOTH IP/OP	$260.00 	$192.40	$0.00	$208.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.00	$205.92	$208.00	$0.00	$0.00	$0.00	$40.69	$0.00	$0.00	$41.39	$0.00	$0.00	$0.00	$0.00	$0.00
27200460	EAP	HCPCS C1894		Micro Microintruducer 7cm 5.0fr Flecura Guidewire	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$21.18	$21.18	$0.00	$0.00	$0.00	$8.13	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$23.07	$23.07	$0.00	$19.50	$30.89	$31.20	$0.00	$25.35	$0.00	$6.10	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
27200461	EAP	HCPCS C1751		Tray Cath 5fr 12cm Cen Ven Spctrm 3 Lum Pu .025in Disp D	BOTH IP/OP	$320.00 	$236.80	$0.00	$256.00	$173.76	$173.76	$0.00	$0.00	$0.00	$66.70	$237.50	$237.50	$246.66	$0.00	$66.69	$0.00	$189.28	$189.28	$0.00	$160.00	$253.44	$256.00	$0.00	$0.00	$0.00	$50.08	$0.00	$0.00	$50.94	$0.00	$0.00	$0.00	$0.00	$0.00
27200462	EAP	HCPCS C1887		Sheath Guid 65cm 6fr Pn Dstn .038in Str Hydphi	BOTH IP/OP	$224.00 	$165.76	$0.00	$179.20	$121.63	$121.63	$0.00	$0.00	$0.00	$46.69	$166.25	$166.25	$172.66	$0.00	$46.68	$0.00	$132.50	$132.50	$0.00	$112.00	$177.41	$179.20	$0.00	$145.60	$0.00	$35.06	$0.00	$0.00	$35.66	$0.00	$0.00	$0.00	$0.00	$0.00
27200467	EAP	HCPCS C1769		Guidewire Vascular Angle Standard .035in 180cm 3cm	BOTH IP/OP	$103.00 	$76.22	$0.00	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$21.47	$0.00	$0.00	$0.00	$0.00	$21.47	$0.00	$60.92	$60.92	$0.00	$51.50	$81.58	$82.40	$0.00	$0.00	$0.00	$16.12	$0.00	$0.00	$16.40	$0.00	$0.00	$0.00	$0.00	$0.00
27200470	EAP	HCPCS C1884		Embosphere Pre-filled Syringe 300-500 Microns/2ml	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$339.38	$339.38	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$481.75	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00	$406.25	$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
27200471	EAP	HCPCS C1894		Introducer Sheath 7fr .1in 80cm Tuohy Borst Sidearm Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27200472	EAP	HCPCS C1769		Guidewire Vascular 45d .016in 180cm 2mm Angled Flexible Tip	BOTH IP/OP	$725.00 	$536.50	$0.00	$580.00	$393.68	$393.68	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$558.83	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$362.50	$574.20	$580.00	$0.00	$0.00	$0.00	$113.46	$0.00	$0.00	$115.42	$0.00	$0.00	$0.00	$0.00	$0.00
27200473	EAP	HCPCS C1887		Catheter Guid Mpc Curve 5fr .056in 90cm Braid Radiopq Soft	BOTH IP/OP	$893.00 	$660.82	$0.00	$714.40	$484.90	$484.90	$0.00	$0.00	$0.00	$186.12	$662.78	$662.78	$688.32	$0.00	$186.10	$0.00	$528.21	$528.21	$0.00	$446.50	$707.26	$714.40	$0.00	$580.45	$0.00	$139.75	$0.00	$0.00	$142.17	$0.00	$0.00	$0.00	$0.00	$0.00
27200474	EAP	HCPCS C1725		Catheter Angiographic Motarjeme Curve 5fr .046in 100cm Braid	BOTH IP/OP	$310.00 	$229.40	$0.00	$238.95	$168.33	$168.33	$0.00	$0.00	$0.00	$64.61	$230.08	$230.08	$238.95	$0.00	$64.60	$0.00	$183.37	$183.37	$0.00	$15.50	$24.55	$24.80	$0.00	$201.50	$0.00	$4.85	$0.00	$0.00	$4.94	$0.00	$0.00	$0.00	$0.00	$0.00
27200475	EAP	HCPCS C1725		Catheter Angiographic .035in Pigtail 5fr .052in 90cm Ultra	BOTH IP/OP	$305.00 	$225.70	$0.00	$244.00	$165.62	$165.62	$0.00	$0.00	$0.00	$63.57	$226.37	$226.37	$235.09	$0.00	$63.56	$0.00	$180.41	$180.41	$0.00	$152.50	$241.56	$244.00	$0.00	$198.25	$0.00	$47.73	$0.00	$0.00	$48.56	$0.00	$0.00	$0.00	$0.00	$0.00
27200476	EAP	HCPCS C1769		Guidewire Vascular Str .018in 180cm 25cm Shapeable Shaft	BOTH IP/OP	$398.00 	$294.52	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.00	$315.22	$318.40	$0.00	$0.00	$0.00	$62.29	$0.00	$0.00	$63.36	$0.00	$0.00	$0.00	$0.00	$0.00
27200477	EAP	HCPCS C1769		Guidewire Vascular .014in 300cm 20cm Exchange Radiopq Distal	BOTH IP/OP	$896.00 	$663.04	$0.00	$716.80	$486.53	$486.53	$0.00	$0.00	$0.00	$186.75	$665.01	$665.01	$690.64	$0.00	$186.73	$0.00	$529.98	$529.98	$0.00	$448.00	$709.63	$716.80	$0.00	$582.40	$0.00	$140.22	$0.00	$0.00	$142.64	$0.00	$0.00	$0.00	$0.00	$0.00
27200478	EAP	HCPCS C1887		Catheter Infus 45d .014in Micro Str 1.9-2.4fr .017in 155cm	BOTH IP/OP	"$1,773.00 "	"$1,312.02"	$0.00	"$1,418.40"	$962.74	$962.74	$0.00	$0.00	$0.00	$369.54	"$1,315.92"	"$1,315.92"	"$1,366.63"	$0.00	$369.49	$0.00	"$1,048.73"	"$1,048.73"	$0.00	$886.50	"$1,404.22"	"$1,418.40"	$0.00	$0.00	$0.00	$277.47	$0.00	$0.00	$282.26	$0.00	$0.00	$0.00	$0.00	$0.00
27200479	EAP	HCPCS C1887		Catheter Infus 90d .014in Micro Str 1.9-2.4fr .017in 155cm	BOTH IP/OP	"$1,688.00 "	"$1,249.12"	$0.00	"$1,350.40"	$916.58	$916.58	$0.00	$0.00	$0.00	$351.82	"$1,252.83"	"$1,252.83"	"$1,301.11"	$0.00	$351.78	$0.00	$998.45	$998.45	$0.00	$844.00	"$1,336.90"	"$1,350.40"	$0.00	"$1,097.20"	$0.00	$264.17	$0.00	$0.00	$268.73	$0.00	$0.00	$0.00	$0.00	$0.00
27200481	EAP	Custom 27200481		Catheter Vascular Occlusion 1028 Flocontrol Tn	BOTH IP/OP	"$6,988.00 "	"$5,171.12"	$0.00	"$5,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,386.35"	$0.00	"$1,456.30"	$0.00	$0.00	$0.00	$0.00	"$3,494.00"	"$5,534.50"	"$5,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200482	EAP	HCPCS C1757		Catheter Reperfusion 4max	BOTH IP/OP	"$3,225.00 "	"$2,386.50"	$0.00	"$2,580.00"	"$1,751.18"	"$1,751.18"	$0.00	$0.00	$0.00	$672.17	"$2,393.60"	"$2,393.60"	"$2,485.83"	$0.00	$672.09	$0.00	"$1,907.59"	"$1,907.59"	$0.00	"$1,612.50"	"$2,554.20"	"$2,580.00"	$0.00	"$2,096.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200484	EAP	Custom 27200484		Adhesive Ostomy Med Remain Flexible Silicone	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.40	$33.40	$34.69	$0.00	$9.38	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200485	EAP	HCPCS C1887		Catheter Guid 9fr Balloon Cello	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27200496	EAP	HCPCS C1894		Introducer Sheath .035in 7fr .1in 70cm Anl1 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$105.95	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27200714	EAP	Custom 27200714		Compression Hose Lg/xlg Knee	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.23	$97.23	$100.97	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$65.50	$103.75	$104.80	$0.00	$85.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200751	EAP	Custom 27200751		"Grasping Forceps, 10mm X 120cm"	BOTH IP/OP	$744.00 	$550.56	$0.00	$595.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$552.20	$552.20	$573.48	$0.00	$155.05	$0.00	$0.00	$0.00	$0.00	$372.00	$589.25	$595.20	$0.00	$483.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200753	EAP	Custom 27200753		"Grasping Forceps, 8mm X 120cm"	BOTH IP/OP	$708.00 	$523.92	$0.00	$566.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.48	$525.48	$545.73	$0.00	$147.55	$0.00	$0.00	$0.00	$0.00	$354.00	$560.74	$566.40	$0.00	$460.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200755	EAP	Custom 27200755		"Grasp Forceps, Stone Retrieval"	BOTH IP/OP	$705.00 	$521.70	$0.00	$564.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$523.25	$523.25	$543.41	$0.00	$146.92	$0.00	$0.00	$0.00	$0.00	$352.50	$558.36	$564.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200766	EAP	Custom 27200766		"Probe, Electrohydraulic Lithot"	BOTH IP/OP	$428.00 	$316.72	$0.00	$342.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.66	$317.66	$329.90	$0.00	$89.20	$0.00	$0.00	$0.00	$0.00	$214.00	$338.98	$342.40	$0.00	$278.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200769	EAP	Custom 27200769		Bipolar Forceps	BOTH IP/OP	$573.00 	$424.02	$0.00	$458.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$425.28	$425.28	$441.67	$0.00	$119.41	$0.00	$0.00	$0.00	$0.00	$286.50	$453.82	$458.40	$0.00	$372.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27200834	EAP	Custom 27200834		Wet Field Cautery	BOTH IP/OP	$136.00 	$100.64	$0.00	$108.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.94	$100.94	$104.83	$0.00	$28.34	$0.00	$0.00	$0.00	$0.00	$68.00	$107.71	$108.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201077	EAP	HCPCS C1769		"Guide Wire, 292.653"	BOTH IP/OP	$183.00 	$135.42	$0.00	$146.40	$99.37	$99.37	$0.00	$0.00	$0.00	$38.14	$135.82	$135.82	$141.06	$0.00	$38.14	$0.00	$108.24	$108.24	$0.00	$91.50	$144.94	$146.40	$0.00	$0.00	$0.00	$28.64	$0.00	$0.00	$29.13	$0.00	$0.00	$0.00	$0.00	$0.00
27201301	EAP	Custom 27201301		"Drill Bit, 357.047"	BOTH IP/OP	"$1,952.00 "	"$1,444.48"	$0.00	"$1,561.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,448.77"	"$1,448.77"	"$1,504.60"	$0.00	$406.80	$0.00	$0.00	$0.00	$0.00	$976.00	"$1,545.98"	"$1,561.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201369	EAP	Custom 27201369		Endo Disposable Lap. Instr.	BOTH IP/OP	$977.00 	$722.98	$0.00	$781.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$725.13	$725.13	$753.07	$0.00	$203.61	$0.00	$0.00	$0.00	$0.00	$488.50	$773.78	$781.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201377	EAP	Custom 27201377		Ta Premium Dlu Staples	BOTH IP/OP	"$1,093.00 "	$808.82	$0.00	$874.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$811.22	$811.22	$842.48	$0.00	$227.78	$0.00	$0.00	$0.00	$0.00	$546.50	$865.66	$874.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201399	EAP	Custom 27201399		Bipolar Bovie	BOTH IP/OP	$14.00 	$10.36	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.39	$10.39	$10.79	$0.00	$2.92	$0.00	$0.00	$0.00	$0.00	$7.00	$11.09	$11.20	$0.00	$9.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201400	EAP	Custom 27201400		Micro Clips	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$25.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201403	EAP	Custom 27201403		Abd Binder	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$25.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201407	EAP	Custom 27201407		Dermabond	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.57	$64.57	$67.06	$0.00	$18.13	$0.00	$0.00	$0.00	$0.00	$43.50	$68.90	$69.60	$0.00	$56.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201456	EAP	Custom 27201456		"Grasping Forceps, 10mm X 120cm"	BOTH IP/OP	$744.00 	$550.56	$0.00	$595.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$552.20	$552.20	$573.48	$0.00	$155.05	$0.00	$0.00	$0.00	$0.00	$372.00	$589.25	$595.20	$0.00	$483.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201458	EAP	Custom 27201458		"Grasping Forceps, Stone Retrie"	BOTH IP/OP	$705.00 	$521.70	$0.00	$564.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$523.25	$523.25	$543.41	$0.00	$146.92	$0.00	$0.00	$0.00	$0.00	$352.50	$558.36	$564.00	$0.00	$458.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201474	EAP	Custom 27201474		"Grasping Forceps, 8mm X 120cm"	BOTH IP/OP	$707.00 	$523.18	$0.00	$565.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$524.74	$524.74	$544.96	$0.00	$147.34	$0.00	$0.00	$0.00	$0.00	$353.50	$559.94	$565.60	$0.00	$459.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201489	EAP	Custom 27201489		Irrigation Clip	BOTH IP/OP	$214.00 	$158.36	$0.00	$171.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.83	$158.83	$164.95	$0.00	$44.60	$0.00	$0.00	$0.00	$0.00	$107.00	$169.49	$171.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201492	EAP	Custom 27201492		Jp Drain (hemaduct)	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$58.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201536	EAP	Custom 27201536		Compression Hose Reg. Knee	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.96	$74.96	$77.85	$0.00	$21.05	$0.00	$0.00	$0.00	$0.00	$50.50	$79.99	$80.80	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201626	EAP	Custom 27201626		"Cath,intra-aortic Balloon"	BOTH IP/OP	"$4,716.00 "	"$3,489.84"	$0.00	"$3,772.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,358.00"	"$3,735.07"	"$3,772.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201630	EAP	Custom 27201630		"Cath,chest Tube Rt. Angled"	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$104.06	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00	$87.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201680	EAP	Custom 27201680		Catheter Angio .038in Ka2 Crv 5fr .046in 40cm Impr	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201681	EAP	Custom 27201681		Catheter Angio .038in Ka2 Crv 5fr .046in 65cm Prfm	BOTH IP/OP	$153.00 	$113.22	$0.00	$122.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$113.56	$113.56	$117.93	$0.00	$31.89	$0.00	$0.00	$0.00	$0.00	$76.50	$121.18	$122.40	$0.00	$99.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201700	EAP	Custom 27201700		Rbc Filter Unit	BOTH IP/OP	$83.00 	$61.42	$0.00	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.60	$61.60	$63.98	$0.00	$17.30	$0.00	$0.00	$0.00	$0.00	$41.50	$65.74	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201701	EAP	Custom 27201701		Plat Filter Unit	BOTH IP/OP	$215.00 	$159.10	$0.00	$172.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.57	$159.57	$165.72	$0.00	$44.81	$0.00	$0.00	$0.00	$0.00	$107.50	$170.28	$172.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201702	EAP	Custom 27201702		Plf1 Filter Unit	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201800	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$3.26	$3.26	$0.00	$0.00	$0.00	$1.25	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00	$0.00	$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
27201801	EAP	HCPCS C1769		Guidewire .35x150cm Bentson	BOTH IP/OP	$76.00 	$56.24	$0.00	$60.80	$41.27	$41.27	$0.00	$0.00	$0.00	$15.84	$56.41	$56.41	$58.58	$0.00	$15.84	$0.00	$44.95	$44.95	$0.00	$38.00	$60.19	$60.80	$0.00	$49.40	$0.00	$11.89	$0.00	$0.00	$12.10	$0.00	$0.00	$0.00	$0.00	$0.00
27201802	EAP	HCPCS C1750		24cm Duraflow Catheter	BOTH IP/OP	"$2,096.00 "	"$1,551.04"	$0.00	"$1,676.80"	"$1,138.13"	"$1,138.13"	$0.00	$0.00	$0.00	$436.86	"$1,555.65"	"$1,555.65"	"$1,615.60"	$0.00	$436.81	$0.00	"$1,239.78"	"$1,239.78"	$0.00	"$1,048.00"	"$1,660.03"	"$1,676.80"	$0.00	$0.00	$0.00	$328.02	$0.00	$0.00	$333.68	$0.00	$0.00	$0.00	$0.00	$0.00
27201803	EAP	HCPCS C1750		28cm Duraflow Catheter	BOTH IP/OP	"$1,720.00 "	"$1,272.80"	$0.00	"$1,376.00"	$933.96	$933.96	$0.00	$0.00	$0.00	$358.49	"$1,276.58"	"$1,276.58"	"$1,325.78"	$0.00	$358.45	$0.00	"$1,017.38"	"$1,017.38"	$0.00	$860.00	"$1,362.24"	"$1,376.00"	$0.00	$0.00	$0.00	$269.18	$0.00	$0.00	$273.82	$0.00	$0.00	$0.00	$0.00	$0.00
27201804	EAP	HCPCS C1752		24cm Schon Xl Temp Cath	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.79	$233.79	$242.80	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201805	EAP	HCPCS C1751		5x1235x20cm Unifuse Kit	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$298.65	$298.65	$0.00	$0.00	$0.00	$114.63	$408.21	$408.21	$423.94	$0.00	$114.62	$0.00	$325.33	$325.33	$0.00	$275.00	$435.60	$440.00	$0.00	$357.50	$0.00	$86.08	$0.00	$0.00	$87.56	$0.00	$0.00	$0.00	$0.00	$0.00
27201806	EAP	HCPCS C1751		5x135x10cm Unifuse Kit	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$298.65	$298.65	$0.00	$0.00	$0.00	$114.63	$408.21	$408.21	$423.94	$0.00	$114.62	$0.00	$325.33	$325.33	$0.00	$275.00	$435.60	$440.00	$0.00	$357.50	$0.00	$86.08	$0.00	$0.00	$87.56	$0.00	$0.00	$0.00	$0.00	$0.00
27201807	EAP	HCPCS C1725		8-4/5/75 Workhorse Pta	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27201808	EAP	HCPCS C1752		Temporary Dialysis Cath	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.79	$233.79	$242.80	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00	$204.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201809	EAP	HCPCS C1752		Temporay Dialysis Cath	BOTH IP/OP	$740.00 	$547.60	$0.00	$592.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.23	$549.23	$570.39	$0.00	$154.22	$0.00	$0.00	$0.00	$0.00	$370.00	$586.08	$592.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201810	EAP	HCPCS C1725		Workhorse Pta Balloon	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27201811	EAP	HCPCS C1725		Workhorse Pta Balloon	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27201812	EAP	HCPCS C1725		Wrkhorse Balloon 5-2/5/75	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27201813	EAP	HCPCS C1725		Wrkhrse Balloon 10-4/5/75	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27201814	EAP	HCPCS C1725		Wrkhrse Balloon 5-2/5/100	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27201815	EAP	HCPCS C1725		Wrkhrse Balloon 6-2/5/75	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27201816	EAP	HCPCS C1751		5fr Dual Lumen Picc Line	BOTH IP/OP	$533.00 	$394.42	$0.00	$426.40	$289.42	$289.42	$0.00	$0.00	$0.00	$111.09	$395.59	$395.59	$410.84	$0.00	$111.08	$0.00	$315.27	$315.27	$0.00	$266.50	$422.14	$426.40	$0.00	$0.00	$0.00	$83.41	$0.00	$0.00	$84.85	$0.00	$0.00	$0.00	$0.00	$0.00
27201817	EAP	HCPCS C1751		5fr Sgle Lumen Pic Line	BOTH IP/OP	$419.00 	$310.06	$0.00	$335.20	$227.52	$227.52	$0.00	$0.00	$0.00	$87.33	$310.98	$310.98	$322.97	$0.00	$87.32	$0.00	$247.84	$247.84	$0.00	$209.50	$331.85	$335.20	$0.00	$0.00	$0.00	$65.57	$0.00	$0.00	$66.70	$0.00	$0.00	$0.00	$0.00	$0.00
27201818	EAP	HCPCS C1757		Thrombex Device	BOTH IP/OP	"$5,955.00 "	"$4,406.70"	$0.00	"$4,764.00"	"$3,233.57"	"$3,233.57"	$0.00	$0.00	$0.00	"$1,241.17"	"$4,181.12"	"$4,181.12"	"$4,590.11"	$0.00	"$1,241.02"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,977.50"	"$4,716.36"	"$4,764.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201819	EAP	HCPCS C1769		Guidewire .035/260m Exchange	BOTH IP/OP	$149.00 	$110.26	$0.00	$119.20	$80.91	$80.91	$0.00	$0.00	$0.00	$31.06	$110.59	$110.59	$114.85	$0.00	$31.05	$0.00	$88.13	$88.13	$0.00	$74.50	$118.01	$119.20	$0.00	$96.85	$0.00	$23.32	$0.00	$0.00	$23.72	$0.00	$0.00	$0.00	$0.00	$0.00
27201820	EAP	HCPCS C1769		Guidewire .035-150cm Angled Stiff	BOTH IP/OP	$167.00 	$123.58	$0.00	$133.60	$90.68	$90.68	$0.00	$0.00	$0.00	$34.81	$123.95	$123.95	$128.72	$0.00	$34.80	$0.00	$98.78	$98.78	$0.00	$83.50	$132.26	$133.60	$0.00	$108.55	$0.00	$26.14	$0.00	$0.00	$26.59	$0.00	$0.00	$0.00	$0.00	$0.00
27201821	EAP	HCPCS C1751		12cm Katzen Infusion Cath	BOTH IP/OP	"$1,506.00 "	"$1,114.44"	$0.00	"$1,204.80"	$817.76	$817.76	$0.00	$0.00	$0.00	$313.89	"$1,117.75"	"$1,117.75"	"$1,160.82"	$0.00	$313.85	$0.00	$890.80	$890.80	$0.00	$753.00	"$1,192.75"	"$1,204.80"	$0.00	$0.00	$0.00	$235.69	$0.00	$0.00	$239.76	$0.00	$0.00	$0.00	$0.00	$0.00
27201822	EAP	HCPCS C1751		150/20 Tracker-18 Infusio	BOTH IP/OP	"$3,033.00 "	"$2,244.42"	$0.00	"$2,426.40"	"$1,646.92"	"$1,646.92"	$0.00	$0.00	$0.00	$632.15	"$2,251.09"	"$2,251.09"	"$2,337.84"	$0.00	$632.08	$0.00	"$1,794.02"	"$1,794.02"	$0.00	"$1,516.50"	"$2,402.14"	"$2,426.40"	$0.00	$0.00	$0.00	$474.66	$0.00	$0.00	$482.85	$0.00	$0.00	$0.00	$0.00	$0.00
27201823	EAP	HCPCS C1769		32-150 Angled Guidewire	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$155.84	$155.84	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$221.22	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00	$0.00	$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
27201824	EAP	HCPCS C1894		5fr Pinnacle Introducer	BOTH IP/OP	$67.00 	$49.58	$0.00	$53.60	$36.38	$36.38	$0.00	$0.00	$0.00	$13.96	$49.73	$49.73	$51.64	$0.00	$13.96	$0.00	$39.63	$39.63	$0.00	$33.50	$53.06	$53.60	$0.00	$0.00	$0.00	$10.49	$0.00	$0.00	$10.67	$0.00	$0.00	$0.00	$0.00	$0.00
27201825	EAP	HCPCS C1887		5fr-100cm At Catheter	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$20.09	$20.09	$0.00	$0.00	$0.00	$7.71	$27.46	$27.46	$28.52	$0.00	$7.71	$0.00	$21.89	$21.89	$0.00	$18.50	$29.30	$29.60	$0.00	$24.05	$0.00	$5.79	$0.00	$0.00	$5.89	$0.00	$0.00	$0.00	$0.00	$0.00
27201826	EAP	HCPCS C1751		A50/20 Fastracker-18 Infu	BOTH IP/OP	"$1,590.00 "	"$1,176.60"	$0.00	"$1,272.00"	$863.37	$863.37	$0.00	$0.00	$0.00	$331.40	"$1,180.10"	"$1,180.10"	"$1,225.57"	$0.00	$331.36	$0.00	$940.49	$940.49	$0.00	$795.00	"$1,259.28"	"$1,272.00"	$0.00	$0.00	$0.00	$248.84	$0.00	$0.00	$253.13	$0.00	$0.00	$0.00	$0.00	$0.00
27201827	EAP	HCPCS C1769		Amplatz Guidewire 260cm	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$70.05	$70.05	$0.00	$0.00	$0.00	$26.89	$95.74	$95.74	$99.43	$0.00	$26.88	$0.00	$76.30	$76.30	$0.00	$64.50	$102.17	$103.20	$0.00	$83.85	$0.00	$20.19	$0.00	$0.00	$20.54	$0.00	$0.00	$0.00	$0.00	$0.00
27201828	EAP	HCPCS C1725		Catheter  Balloon 6-10/5	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.50	$539.35	$544.80	$0.00	$0.00	$0.00	$106.58	$0.00	$0.00	$108.42	$0.00	$0.00	$0.00	$0.00	$0.00
27201829	EAP	HCPCS C1887		Glidecath C2 Hydeophilic	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$95.03	$95.03	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$134.89	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00	$113.75	$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
27201830	EAP	HCPCS C1769		Glidewire .035 150cm  Angled	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$54.84	$54.84	$0.00	$0.00	$0.00	$21.05	$74.96	$74.96	$77.85	$0.00	$21.05	$0.00	$59.74	$59.74	$0.00	$50.50	$79.99	$80.80	$0.00	$0.00	$0.00	$15.81	$0.00	$0.00	$16.08	$0.00	$0.00	$0.00	$0.00	$0.00
27201831	EAP	HCPCS C1769		Guidewire  Amplatz Super	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$276.25	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
27201832	EAP	HCPCS C1769		Guidewire-long Taper	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$169.96	$169.96	$0.00	$0.00	$0.00	$65.24	$232.31	$232.31	$241.26	$0.00	$65.23	$0.00	$185.14	$185.14	$0.00	$156.50	$247.90	$250.40	$0.00	$0.00	$0.00	$48.98	$0.00	$0.00	$49.83	$0.00	$0.00	$0.00	$0.00	$0.00
27201833	EAP	HCPCS C1769		Transcend Steerable	BOTH IP/OP	$546.00 	$404.04	$0.00	$533.60	$296.48	$296.48	$0.00	$0.00	$0.00	$113.80	$405.24	$405.24	$420.86	$0.00	$113.79	$0.00	$322.96	$322.96	$0.00	$333.50	$528.26	$533.60	$0.00	$354.90	$0.00	$104.39	$0.00	$0.00	$106.19	$0.00	$0.00	$0.00	$0.00	$0.00
27201834	EAP	HCPCS C1725		Xxl 14-4/5.8/120	BOTH IP/OP	$856.00 	$633.44	$0.00	$684.80	$464.81	$464.81	$0.00	$0.00	$0.00	$178.41	$635.32	$635.32	$659.80	$0.00	$178.39	$0.00	$506.32	$506.32	$0.00	$428.00	$677.95	$684.80	$0.00	$0.00	$0.00	$133.96	$0.00	$0.00	$136.28	$0.00	$0.00	$0.00	$0.00	$0.00
27201835	EAP	HCPCS C1725		Xxl/12-5/5.8/120 Balloon	BOTH IP/OP	$856.00 	$633.44	$0.00	$684.80	$464.81	$464.81	$0.00	$0.00	$0.00	$178.41	$635.32	$635.32	$659.80	$0.00	$178.39	$0.00	$506.32	$506.32	$0.00	$428.00	$677.95	$684.80	$0.00	$0.00	$0.00	$133.96	$0.00	$0.00	$136.28	$0.00	$0.00	$0.00	$0.00	$0.00
27201836	EAP	HCPCS C1769		Guidewire .035-260cm Bentson E	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$47.78	$47.78	$0.00	$0.00	$0.00	$18.34	$65.31	$65.31	$67.83	$0.00	$18.34	$0.00	$52.05	$52.05	$0.00	$44.00	$69.70	$70.40	$0.00	$57.20	$0.00	$13.77	$0.00	$0.00	$14.01	$0.00	$0.00	$0.00	$0.00	$0.00
27201837	EAP	HCPCS C1729		10.2fr Mp Drain Catheter	BOTH IP/OP	$296.00 	$219.04	$0.00	$236.80	$160.73	$160.73	$0.00	$0.00	$0.00	$61.69	$219.69	$219.69	$228.16	$0.00	$61.69	$0.00	$175.08	$175.08	$0.00	$148.00	$234.43	$236.80	$0.00	$192.40	$0.00	$46.32	$0.00	$0.00	$47.12	$0.00	$0.00	$0.00	$0.00	$0.00
27201838	EAP	HCPCS C1894		11fr-70cm Introducer Set	BOTH IP/OP	$233.00 	$172.42	$0.00	$186.40	$126.52	$126.52	$0.00	$0.00	$0.00	$48.56	$172.93	$172.93	$179.60	$0.00	$48.56	$0.00	$137.82	$137.82	$0.00	$116.50	$184.54	$186.40	$0.00	$151.45	$0.00	$36.46	$0.00	$0.00	$37.09	$0.00	$0.00	$0.00	$0.00	$0.00
27201839	EAP	HCPCS C1729		14.0fr Mp Drain Catheter	BOTH IP/OP	$289.00 	$213.86	$0.00	$231.20	$156.93	$156.93	$0.00	$0.00	$0.00	$60.23	$214.50	$214.50	$222.76	$0.00	$60.23	$0.00	$170.94	$170.94	$0.00	$144.50	$228.89	$231.20	$0.00	$0.00	$0.00	$45.23	$0.00	$0.00	$46.01	$0.00	$0.00	$0.00	$0.00	$0.00
27201840	EAP	Custom 27201840		35-3-5 Embolization Coil	BOTH IP/OP	$172.00 	$127.28	$0.00	$137.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.66	$127.66	$132.58	$0.00	$35.84	$0.00	$0.00	$0.00	$0.00	$86.00	$136.22	$137.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201841	EAP	Custom 27201841		35-5-10 Embolization Coil	BOTH IP/OP	$279.00 	$206.46	$0.00	$223.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.07	$207.07	$215.05	$0.00	$58.14	$0.00	$0.00	$0.00	$0.00	$139.50	$220.97	$223.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201842	EAP	Custom 27201842		35-5-3 Embolization Coil	BOTH IP/OP	$228.00 	$168.72	$0.00	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.22	$169.22	$175.74	$0.00	$47.52	$0.00	$0.00	$0.00	$0.00	$114.00	$180.58	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201843	EAP	Custom 27201843		35-5-8 Embolization Coil	BOTH IP/OP	$167.00 	$123.58	$0.00	$133.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.95	$123.95	$128.72	$0.00	$34.80	$0.00	$0.00	$0.00	$0.00	$83.50	$132.26	$133.60	$0.00	$75.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201844	EAP	HCPCS C1893		5fr80cm Neff Catheter	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00	$0.00	$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
27201845	EAP	HCPCS C1894		6fr Balkan Introducer Set	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$32.58	$32.58	$0.00	$0.00	$0.00	$12.51	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$35.49	$35.49	$0.00	$30.00	$47.52	$48.00	$0.00	$39.00	$0.00	$9.39	$0.00	$0.00	$9.55	$0.00	$0.00	$0.00	$0.00	$0.00
27201846	EAP	HCPCS C1894		7fr Balkan Introducer Set	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$92.31	$92.31	$0.00	$0.00	$0.00	$35.43	$126.17	$126.17	$131.04	$0.00	$35.43	$0.00	$100.56	$100.56	$0.00	$85.00	$134.64	$136.00	$0.00	$0.00	$0.00	$26.61	$0.00	$0.00	$27.06	$0.00	$0.00	$0.00	$0.00	$0.00
27201847	EAP	HCPCS C1729		8.5fr Mp Drain Catheter	BOTH IP/OP	$311.00 	$230.14	$0.00	$248.80	$168.87	$168.87	$0.00	$0.00	$0.00	$64.82	$230.82	$230.82	$239.72	$0.00	$64.81	$0.00	$183.96	$183.96	$0.00	$155.50	$246.31	$248.80	$0.00	$202.15	$0.00	$48.67	$0.00	$0.00	$49.51	$0.00	$0.00	$0.00	$0.00	$0.00
27201848	EAP	HCPCS C1729		9.5fr Biliary Drain Cath.	BOTH IP/OP	$296.00 	$219.04	$0.00	$236.80	$160.73	$160.73	$0.00	$0.00	$0.00	$61.69	$219.69	$219.69	$228.16	$0.00	$61.69	$0.00	$175.08	$175.08	$0.00	$148.00	$234.43	$236.80	$0.00	$192.40	$0.00	$46.32	$0.00	$0.00	$47.12	$0.00	$0.00	$0.00	$0.00	$0.00
27201849	EAP	HCPCS C1757		Coil  Embolization 35-4-3	BOTH IP/OP	$172.00 	$127.28	$0.00	$137.60	$93.40	$93.40	$0.00	$0.00	$0.00	$35.85	$127.66	$127.66	$132.58	$0.00	$35.84	$0.00	$101.74	$101.74	$0.00	$86.00	$136.22	$137.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201850	EAP	HCPCS C1769		Dtdw35-80-10 Deflecting	BOTH IP/OP	$520.00 	$384.80	$0.00	$416.00	$282.36	$282.36	$0.00	$0.00	$0.00	$108.38	$385.94	$385.94	$400.82	$0.00	$108.37	$0.00	$307.58	$307.58	$0.00	$260.00	$411.84	$416.00	$0.00	$0.00	$0.00	$81.38	$0.00	$0.00	$82.78	$0.00	$0.00	$0.00	$0.00	$0.00
27201851	EAP	HCPCS C1773		Filter Retrieval Set	BOTH IP/OP	$886.00 	$655.64	$0.00	$708.80	$481.10	$481.10	$0.00	$0.00	$0.00	$184.66	$657.59	$657.59	$682.93	$0.00	$184.64	$0.00	$524.07	$524.07	$0.00	$443.00	$701.71	$708.80	$0.00	$575.90	$0.00	$138.66	$0.00	$0.00	$141.05	$0.00	$0.00	$0.00	$0.00	$0.00
27201852	EAP	HCPCS C1769		Guidewire  Cope Mandril	BOTH IP/OP	$116.00 	$85.84	$0.00	$92.80	$62.99	$62.99	$0.00	$0.00	$0.00	$24.18	$86.10	$86.10	$89.41	$0.00	$24.17	$0.00	$68.61	$68.61	$0.00	$58.00	$91.87	$92.80	$0.00	$75.40	$0.00	$18.15	$0.00	$0.00	$18.47	$0.00	$0.00	$0.00	$0.00	$0.00
27201853	EAP	HCPCS C1769		Lewis Micropunture Set	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$70.59	$70.59	$0.00	$0.00	$0.00	$27.10	$96.49	$96.49	$100.20	$0.00	$27.09	$0.00	$76.90	$76.90	$0.00	$65.00	$102.96	$104.00	$0.00	$84.50	$0.00	$20.35	$0.00	$0.00	$20.70	$0.00	$0.00	$0.00	$0.00	$0.00
27201854	EAP	HCPCS C2629		Micropuncture Set	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$21.26	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$60.33	$60.33	$0.00	$51.00	$80.78	$81.60	$0.00	$66.30	$0.00	$15.96	$0.00	$0.00	$16.24	$0.00	$0.00	$0.00	$0.00	$0.00
27201855	EAP	HCPCS C1894		8fr-23cmavanti-introducer	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$5.43	$5.43	$0.00	$0.00	$0.00	$2.08	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$5.92	$5.92	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$1.57	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00
27201856	EAP	HCPCS C1894		9fr-23cm Avanti Introduce	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$5.43	$5.43	$0.00	$0.00	$0.00	$2.08	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$5.92	$5.92	$0.00	$5.00	$7.92	$8.00	$0.00	$0.00	$0.00	$1.57	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00
27201857	EAP	HCPCS C1773		12-20mmx120cm Std Snare	BOTH IP/OP	"$1,119.00 "	$828.06	$0.00	$895.20	$607.62	$607.62	$0.00	$0.00	$0.00	$233.23	$830.52	$830.52	$862.53	$0.00	$233.20	$0.00	$661.89	$661.89	$0.00	$559.50	$886.25	$895.20	$0.00	$727.35	$0.00	$175.12	$0.00	$0.00	$178.14	$0.00	$0.00	$0.00	$0.00	$0.00
27201858	EAP	HCPCS C1773		9-15mmx120cm Std Snare	BOTH IP/OP	"$1,119.00 "	$828.06	$0.00	$895.20	$607.62	$607.62	$0.00	$0.00	$0.00	$233.23	$830.52	$830.52	$862.53	$0.00	$233.20	$0.00	$661.89	$661.89	$0.00	$559.50	$886.25	$895.20	$0.00	$727.35	$0.00	$175.12	$0.00	$0.00	$178.14	$0.00	$0.00	$0.00	$0.00	$0.00
27201859	EAP	HCPCS C1725		Wrkhorse Balloon 10-4/5/100	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27201860	EAP	HCPCS C1894		Pinnacle Introducer 5fr 10cm	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$43.44	$43.44	$0.00	$0.00	$0.00	$16.67	$59.38	$59.38	$61.66	$0.00	$16.67	$0.00	$47.32	$47.32	$0.00	$40.00	$63.36	$64.00	$0.00	$52.00	$0.00	$12.52	$0.00	$0.00	$12.74	$0.00	$0.00	$0.00	$0.00	$0.00
27201861	EAP	HCPCS C1725		Conquest Pta Balloon Dilatatio	BOTH IP/OP	$753.00 	$557.22	$0.00	$602.40	$408.88	$408.88	$0.00	$0.00	$0.00	$156.94	$558.88	$558.88	$580.41	$0.00	$156.93	$0.00	$445.40	$445.40	$0.00	$376.50	$596.38	$602.40	$0.00	$489.45	$0.00	$117.84	$0.00	$0.00	$119.88	$0.00	$0.00	$0.00	$0.00	$0.00
27201862	EAP	HCPCS C1725		Opti-plast  Balloon Dilatation	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$272.04	$272.04	$0.00	$0.00	$0.00	$104.42	$371.84	$371.84	$386.17	$0.00	$104.41	$0.00	$296.34	$296.34	$0.00	$250.50	$396.79	$400.80	$0.00	$0.00	$0.00	$78.41	$0.00	$0.00	$79.76	$0.00	$0.00	$0.00	$0.00	$0.00
27201863	EAP	HCPCS C1725		Workhorse Pta Workhorse Balloo	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27201864	EAP	HCPCS C1769		Guidewire Straight Fixed Core	BOTH IP/OP	$86.00 	$63.64	$0.00	$68.80	$46.70	$46.70	$0.00	$0.00	$0.00	$17.92	$63.83	$63.83	$66.29	$0.00	$17.92	$0.00	$50.87	$50.87	$0.00	$43.00	$68.11	$68.80	$0.00	$0.00	$0.00	$13.46	$0.00	$0.00	$13.69	$0.00	$0.00	$0.00	$0.00	$0.00
27201865	EAP	HCPCS C1769		Guidewire 3mm J Fixed Core .03	BOTH IP/OP	$46.00 	$34.04	$0.00	$36.80	$24.98	$24.98	$0.00	$0.00	$0.00	$9.59	$34.14	$34.14	$35.46	$0.00	$9.59	$0.00	$27.21	$27.21	$0.00	$23.00	$36.43	$36.80	$0.00	$29.90	$0.00	$7.20	$0.00	$0.00	$7.32	$0.00	$0.00	$0.00	$0.00	$0.00
27201866	EAP	HCPCS C1894		Pinnacle Introducer 6fr 10cm	BOTH IP/OP	$76.00 	$56.24	$0.00	$60.80	$41.27	$41.27	$0.00	$0.00	$0.00	$15.84	$56.41	$56.41	$58.58	$0.00	$15.84	$0.00	$44.95	$44.95	$0.00	$38.00	$60.19	$60.80	$0.00	$0.00	$0.00	$11.89	$0.00	$0.00	$12.10	$0.00	$0.00	$0.00	$0.00	$0.00
27201867	EAP	HCPCS C1894		8fr 10cm Pinnacle Introducer	BOTH IP/OP	$72.00 	$53.28	$0.00	$57.60	$39.10	$39.10	$0.00	$0.00	$0.00	$15.01	$53.44	$53.44	$55.50	$0.00	$15.00	$0.00	$42.59	$42.59	$0.00	$36.00	$57.02	$57.60	$0.00	$46.80	$0.00	$11.27	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$0.00
27201868	EAP	HCPCS C1894		Pinnacle Introducer 8fr 10cm	BOTH IP/OP	$67.00 	$49.58	$0.00	$53.60	$36.38	$36.38	$0.00	$0.00	$0.00	$13.96	$49.73	$49.73	$51.64	$0.00	$13.96	$0.00	$39.63	$39.63	$0.00	$33.50	$53.06	$53.60	$0.00	$0.00	$0.00	$10.49	$0.00	$0.00	$10.67	$0.00	$0.00	$0.00	$0.00	$0.00
27201869	EAP	HCPCS C1894		Pinnacle Introducer 9fr 10cm	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00	$0.00	$0.00	$12.52	$0.00	$0.00	$12.74	$0.00	$0.00	$0.00	$0.00	$0.00
27201870	EAP	HCPCS C1757		Fogarty 5.5-40cm	BOTH IP/OP	$352.00 	$260.48	$0.00	$281.60	$191.14	$191.14	$0.00	$0.00	$0.00	$73.37	$261.25	$261.25	$271.32	$0.00	$73.36	$0.00	$208.21	$208.21	$0.00	$176.00	$278.78	$281.60	$0.00	$228.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201871	EAP	HCPCS C1757		Fogarty 5.5 80cm	BOTH IP/OP	$352.00 	$260.48	$0.00	$281.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.00	$278.78	$281.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201872	EAP	HCPCS C1757		Arrow Trerotola Thromolytic De	BOTH IP/OP	"$1,805.00 "	"$1,335.70"	$0.00	"$1,444.00"	$980.12	$980.12	$0.00	$0.00	$0.00	$376.21	"$1,339.67"	"$1,339.67"	"$1,391.29"	$0.00	$376.16	$0.00	"$1,067.66"	"$1,067.66"	$0.00	$902.50	"$1,429.56"	"$1,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201873	EAP	HCPCS C1757		Complex Fiber Coil 18 X 3mm X	BOTH IP/OP	"$1,212.00 "	$896.88	$0.00	$969.60	$658.12	$658.12	$0.00	$0.00	$0.00	$252.61	$899.55	$899.55	$934.21	$0.00	$252.58	$0.00	$716.90	$716.90	$0.00	$606.00	$959.90	$969.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201874	EAP	HCPCS C1729		Skater 10fr	BOTH IP/OP	$605.00 	$447.70	$0.00	$484.00	$328.52	$328.52	$0.00	$0.00	$0.00	$126.10	$449.03	$449.03	$466.33	$0.00	$126.08	$0.00	$357.86	$357.86	$0.00	$302.50	$479.16	$484.00	$0.00	$0.00	$0.00	$94.68	$0.00	$0.00	$96.32	$0.00	$0.00	$0.00	$0.00	$0.00
27201875	EAP	HCPCS C1887		Lima Guiding Catheter 7fr-55cm	BOTH IP/OP	$417.00 	$308.58	$0.00	$333.60	$226.43	$226.43	$0.00	$0.00	$0.00	$86.91	$309.50	$309.50	$321.42	$0.00	$86.90	$0.00	$246.66	$246.66	$0.00	$208.50	$330.26	$333.60	$0.00	$0.00	$0.00	$65.26	$0.00	$0.00	$66.39	$0.00	$0.00	$0.00	$0.00	$0.00
27201876	EAP	HCPCS C1892		Meditech Accustick Ii Introduc	BOTH IP/OP	$209.00 	$154.66	$0.00	$167.20	$113.49	$113.49	$0.00	$0.00	$0.00	$43.56	$155.12	$155.12	$161.10	$0.00	$43.56	$0.00	$123.62	$123.62	$0.00	$104.50	$165.53	$167.20	$0.00	$135.85	$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
27201877	EAP	HCPCS C1769		22g X 10cm Chiba Needle	BOTH IP/OP	$27.00 	$19.98	$0.00	$56.00	$14.66	$14.66	$0.00	$0.00	$0.00	$5.63	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$15.97	$15.97	$0.00	$35.00	$55.44	$56.00	$0.00	$0.00	$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
27201878	EAP	HCPCS C1769		.038-145 Amplatz Extra Stiff	BOTH IP/OP	$76.00 	$56.24	$0.00	$60.80	$41.27	$41.27	$0.00	$0.00	$0.00	$15.84	$56.41	$56.41	$58.58	$0.00	$15.84	$0.00	$44.95	$44.95	$0.00	$38.00	$60.19	$60.80	$0.00	$49.40	$0.00	$11.89	$0.00	$0.00	$12.10	$0.00	$0.00	$0.00	$0.00	$0.00
27201879	EAP	HCPCS C1751		9fr Single Lumen Hickman	BOTH IP/OP	$241.00 	$178.34	$0.00	$192.80	$130.86	$130.86	$0.00	$0.00	$0.00	$50.23	$178.87	$178.87	$185.76	$0.00	$50.22	$0.00	$142.55	$142.55	$0.00	$120.50	$190.87	$192.80	$0.00	$156.65	$0.00	$37.72	$0.00	$0.00	$38.37	$0.00	$0.00	$0.00	$0.00	$0.00
27201880	EAP	HCPCS C1751		9fr Dual Lumen Hickman	BOTH IP/OP	$528.00 	$390.72	$0.00	$422.40	$286.70	$286.70	$0.00	$0.00	$0.00	$110.05	$391.88	$391.88	$406.98	$0.00	$110.04	$0.00	$312.31	$312.31	$0.00	$264.00	$418.18	$422.40	$0.00	$0.00	$0.00	$82.63	$0.00	$0.00	$84.06	$0.00	$0.00	$0.00	$0.00	$0.00
27201881	EAP	HCPCS C1769		.035-150cm 3mm J Guidewire	BOTH IP/OP	$68.00 	$50.32	$0.00	$54.40	$36.92	$36.92	$0.00	$0.00	$0.00	$14.17	$50.47	$50.47	$52.41	$0.00	$14.17	$0.00	$40.22	$40.22	$0.00	$34.00	$53.86	$54.40	$0.00	$44.20	$0.00	$10.64	$0.00	$0.00	$10.83	$0.00	$0.00	$0.00	$0.00	$0.00
27201882	EAP	HCPCS C1769		.035-150cm Rosen Guidewire	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$10.17	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$0.00
27201883	EAP	HCPCS C1752		"12cm Niagra, Temp Dialysis Cat"	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201884	EAP	HCPCS C1752		"15cm Niagra, Temp Dialysis Cat"	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201885	EAP	HCPCS C1725		8-2/5/100 Workhorse Balloon	BOTH IP/OP	$427.00 	$315.98	$0.00	$341.60	$231.86	$231.86	$0.00	$0.00	$0.00	$89.00	$316.92	$316.92	$329.13	$0.00	$88.99	$0.00	$252.57	$252.57	$0.00	$213.50	$338.18	$341.60	$0.00	$0.00	$0.00	$66.83	$0.00	$0.00	$67.98	$0.00	$0.00	$0.00	$0.00	$0.00
27201886	EAP	HCPCS C1725		4-2/5/75 Opti-plast Balloon	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$272.04	$272.04	$0.00	$0.00	$0.00	$104.42	$371.84	$371.84	$386.17	$0.00	$104.41	$0.00	$296.34	$296.34	$0.00	$250.50	$396.79	$400.80	$0.00	$0.00	$0.00	$78.41	$0.00	$0.00	$79.76	$0.00	$0.00	$0.00	$0.00	$0.00
27201887	EAP	HCPCS C1725		3-way Hp Stopcock	BOTH IP/OP	$934.00 	$691.16	$0.00	$747.20	$507.16	$507.16	$0.00	$0.00	$0.00	$194.67	$693.21	$693.21	$719.93	$0.00	$194.65	$0.00	$552.46	$552.46	$0.00	$467.00	$739.73	$747.20	$0.00	$0.00	$0.00	$146.17	$0.00	$0.00	$148.69	$0.00	$0.00	$0.00	$0.00	$0.00
27201888	EAP	HCPCS C1894		7fr 10cm Pinnacle Introducer	BOTH IP/OP	$71.00 	$52.54	$0.00	$56.80	$38.55	$38.55	$0.00	$0.00	$0.00	$14.80	$52.70	$52.70	$54.73	$0.00	$14.80	$0.00	$42.00	$42.00	$0.00	$35.50	$56.23	$56.80	$0.00	$46.15	$0.00	$11.11	$0.00	$0.00	$11.30	$0.00	$0.00	$0.00	$0.00	$0.00
27201889	EAP	HCPCS C1894		7fr 10cm Pinnacle Introducer	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$73.31	$73.31	$0.00	$0.00	$0.00	$28.14	$100.20	$100.20	$104.06	$0.00	$28.13	$0.00	$79.85	$79.85	$0.00	$67.50	$106.92	$108.00	$0.00	$0.00	$0.00	$21.13	$0.00	$0.00	$21.49	$0.00	$0.00	$0.00	$0.00	$0.00
27201890	EAP	HCPCS C1725		12-2/5.8/75 Udt Dilatation Bal	BOTH IP/OP	$889.00 	$657.86	$0.00	$711.20	$482.73	$482.73	$0.00	$0.00	$0.00	$185.29	$659.82	$659.82	$685.24	$0.00	$185.27	$0.00	$525.84	$525.84	$0.00	$444.50	$704.09	$711.20	$0.00	$0.00	$0.00	$139.13	$0.00	$0.00	$141.53	$0.00	$0.00	$0.00	$0.00	$0.00
27201891	EAP	HCPCS C1729		8fr Flexima Biliary Catheter	BOTH IP/OP	$271.00 	$200.54	$0.00	$216.80	$147.15	$147.15	$0.00	$0.00	$0.00	$56.48	$201.14	$201.14	$208.89	$0.00	$56.48	$0.00	$160.30	$160.30	$0.00	$135.50	$214.63	$216.80	$0.00	$176.15	$0.00	$42.41	$0.00	$0.00	$43.14	$0.00	$0.00	$0.00	$0.00	$0.00
27201892	EAP	HCPCS C1729		Cx 18.0-38-40-p-32s-bcl	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$162.90	$162.90	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
27201893	EAP	Custom 27201893		Tibia Fracture Brace	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.97	$359.97	$373.84	$0.00	$101.07	$0.00	$0.00	$0.00	$0.00	$242.50	$384.12	$388.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201905	EAP	Custom 27201905		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201906	EAP	HCPCS A6250		Wound Paste	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$24.59	$87.58	$87.58	$90.95	$0.00	$24.59	$0.00	$69.80	$69.80	$0.00	$59.00	$93.46	$94.40	$0.00	$76.70	$0.00	$18.47	$0.00	$0.00	$18.79	$0.00	$0.00	$0.00	$0.00	$0.00
27201914	EAP	Custom 27201914		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27201930	EAP	HCPCS C1729		Catheter Foley 5cc 14fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27201931	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$11.70	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27201932	EAP	HCPCS C1729		Catheter Foley 5cc 18fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27202362	EAP	Custom 27202362		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202368	EAP	Custom 27202368		Scapel Surg W/handle Att	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202375	EAP	HCPCS C1729		Catheter Foley 5cc 14fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27202376	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27202377	EAP	HCPCS C1729		Catheter Foley 5cc 18fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27202384	EAP	HCPCS C1729		Catheter Foley 30cc 28fr	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$21.18	$21.18	$0.00	$0.00	$0.00	$8.13	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$23.07	$23.07	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$6.10	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
27202388	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$12.35	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27202389	EAP	HCPCS C1729		Catheter Coude Size 14fr	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$59.19	$59.19	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
27202390	EAP	HCPCS C1729		Catheter Coude Size 16fr	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$59.19	$59.19	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
27202395	EAP	HCPCS C1729		Catheter Coude Size 14fr	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$59.19	$59.19	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
27202396	EAP	HCPCS C1729		Catheter Coude 30cc 24fr	BOTH IP/OP	$82.00 	$60.68	$0.00	$65.60	$44.53	$44.53	$0.00	$0.00	$0.00	$17.09	$60.86	$60.86	$63.21	$0.00	$17.09	$0.00	$48.50	$48.50	$0.00	$41.00	$64.94	$65.60	$0.00	$0.00	$0.00	$12.83	$0.00	$0.00	$13.05	$0.00	$0.00	$0.00	$0.00	$0.00
27202397	EAP	Custom 27202397		Scapel Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202403	EAP	Custom 27202403		Scaple Surg W/handle Atta	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202406	EAP	HCPCS C1729		Catheter Coude Size 14fr	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$25.52	$25.52	$0.00	$0.00	$0.00	$9.80	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$27.80	$27.80	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$7.36	$0.00	$0.00	$7.48	$0.00	$0.00	$0.00	$0.00	$0.00
27202407	EAP	HCPCS C1729		Catheter Coude 30cc 24fr	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$47.24	$47.24	$0.00	$0.00	$0.00	$18.13	$64.57	$64.57	$67.06	$0.00	$18.13	$0.00	$51.46	$51.46	$0.00	$43.50	$68.90	$69.60	$0.00	$0.00	$0.00	$13.62	$0.00	$0.00	$13.85	$0.00	$0.00	$0.00	$0.00	$0.00
27202418	EAP	HCPCS C1729		Catheter Foley 5cc 14fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27202419	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$11.70	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27202420	EAP	HCPCS C1729		Catheter Foley 5cc 18fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27202421	EAP	HCPCS C1729		Catheter Foley 3-way 30cc	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$20.09	$20.09	$0.00	$0.00	$0.00	$7.71	$27.46	$27.46	$28.52	$0.00	$7.71	$0.00	$21.89	$21.89	$0.00	$18.50	$29.30	$29.60	$0.00	$0.00	$0.00	$5.79	$0.00	$0.00	$5.89	$0.00	$0.00	$0.00	$0.00	$0.00
27202432	EAP	HCPCS C1729		Catheter Foley 5cc 14fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27202433	EAP	HCPCS C1729		Catheter Coude Size 14fr	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$59.19	$59.19	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00	$0.00	$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
27202434	EAP	HCPCS C1729		Catheter Coude Size 16fr	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$55.39	$55.39	$0.00	$0.00	$0.00	$21.26	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$60.33	$60.33	$0.00	$51.00	$80.78	$81.60	$0.00	$0.00	$0.00	$15.96	$0.00	$0.00	$16.24	$0.00	$0.00	$0.00	$0.00	$0.00
27202435	EAP	Custom 27202435		Scapel Surg W/handle Attached	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202446	EAP	HCPCS C1729		Catheter Foley 5cc 14fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27202447	EAP	HCPCS C1729		Catheter Foley 16fr	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$9.77	$9.77	$0.00	$0.00	$0.00	$3.75	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$10.65	$10.65	$0.00	$9.00	$14.26	$14.40	$0.00	$11.70	$0.00	$2.82	$0.00	$0.00	$2.87	$0.00	$0.00	$0.00	$0.00	$0.00
27202448	EAP	HCPCS C1729		Catheter Foley 5cc 18fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27202449	EAP	HCPCS C1729		Catheter Foley 30cc 28fr	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$21.18	$21.18	$0.00	$0.00	$0.00	$8.13	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$23.07	$23.07	$0.00	$19.50	$30.89	$31.20	$0.00	$0.00	$0.00	$6.10	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
27202462	EAP	HCPCS C1729		Catheter Foley 5cc 14fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27202463	EAP	HCPCS C1729		Catheter Foley 5cc 18fr	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$10.32	$10.32	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
27202470	EAP	HCPCS C1751		Cragg-mcnamara 5-65-5 Infusion	BOTH IP/OP	$740.00 	$547.60	$0.00	$592.00	$401.82	$401.82	$0.00	$0.00	$0.00	$154.23	$549.23	$549.23	$570.39	$0.00	$154.22	$0.00	$437.71	$437.71	$0.00	$370.00	$586.08	$592.00	$0.00	$0.00	$0.00	$115.81	$0.00	$0.00	$117.81	$0.00	$0.00	$0.00	$0.00	$0.00
27202471	EAP	HCPCS C1751		Cragg-mcnamara 5-40-20 Infusio	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$171.05	$171.05	$0.00	$0.00	$0.00	$65.65	$233.79	$233.79	$242.80	$0.00	$65.65	$0.00	$186.32	$186.32	$0.00	$157.50	$249.48	$252.00	$0.00	$204.75	$0.00	$49.30	$0.00	$0.00	$50.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202472	EAP	HCPCS C1751		Cragg-mcnamara 5-100-10 Infusi	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$171.05	$171.05	$0.00	$0.00	$0.00	$65.65	$233.79	$233.79	$242.80	$0.00	$65.65	$0.00	$186.32	$186.32	$0.00	$157.50	$249.48	$252.00	$0.00	$0.00	$0.00	$49.30	$0.00	$0.00	$50.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202473	EAP	HCPCS C1773		15mm Amplatz Snare	BOTH IP/OP	$916.00 	$677.84	$0.00	$732.80	$497.39	$497.39	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$706.05	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$458.00	$725.47	$732.80	$0.00	$595.40	$0.00	$143.35	$0.00	$0.00	$145.83	$0.00	$0.00	$0.00	$0.00	$0.00
27202474	EAP	HCPCS C1773		25mm Amplatz Snare	BOTH IP/OP	$916.00 	$677.84	$0.00	$732.80	$497.39	$497.39	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$706.05	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$458.00	$725.47	$732.80	$0.00	$595.40	$0.00	$143.35	$0.00	$0.00	$145.83	$0.00	$0.00	$0.00	$0.00	$0.00
27202475	EAP	HCPCS C1729		10fr X 35cm Skater Nephrostomy	BOTH IP/OP	$254.00 	$187.96	$0.00	$203.20	$137.92	$137.92	$0.00	$0.00	$0.00	$52.94	$188.52	$188.52	$195.78	$0.00	$52.93	$0.00	$150.24	$150.24	$0.00	$127.00	$201.17	$203.20	$0.00	$165.10	$0.00	$39.75	$0.00	$0.00	$40.44	$0.00	$0.00	$0.00	$0.00	$0.00
27202476	EAP	HCPCS C1750		Chron Carbothane Cath 14.5f X 19cm	BOTH IP/OP	"$1,054.00 "	$779.96	$0.00	$843.20	$572.32	$572.32	$0.00	$0.00	$0.00	$219.68	$782.28	$782.28	$812.42	$0.00	$219.65	$0.00	$623.44	$623.44	$0.00	$527.00	$834.77	$843.20	$0.00	$685.10	$0.00	$164.95	$0.00	$0.00	$167.80	$0.00	$0.00	$0.00	$0.00	$0.00
27202477	EAP	HCPCS C1750		23cm Sport Pack Perm Dialysis	BOTH IP/OP	$921.00 	$681.54	$0.00	$736.80	$500.10	$500.10	$0.00	$0.00	$0.00	$191.96	$683.57	$683.57	$709.91	$0.00	$191.94	$0.00	$544.77	$544.77	$0.00	$460.50	$729.43	$736.80	$0.00	$598.65	$0.00	$144.14	$0.00	$0.00	$146.62	$0.00	$0.00	$0.00	$0.00	$0.00
27202478	EAP	HCPCS C1750		28cm Sport Pack Perm Dialysis	BOTH IP/OP	"$2,263.00 "	"$1,674.62"	$0.00	"$1,810.40"	"$1,228.81"	"$1,228.81"	$0.00	$0.00	$0.00	$471.67	"$1,679.60"	"$1,679.60"	"$1,744.32"	$0.00	$471.61	$0.00	"$1,338.56"	"$1,338.56"	$0.00	"$1,131.50"	"$1,792.30"	"$1,810.40"	$0.00	$0.00	$0.00	$354.16	$0.00	$0.00	$360.27	$0.00	$0.00	$0.00	$0.00	$0.00
27202479	EAP	HCPCS C1752		19cm Q-plus Temp Dialysis Kit	BOTH IP/OP	$254.00 	$187.96	$0.00	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.52	$188.52	$195.78	$0.00	$52.93	$0.00	$0.00	$0.00	$0.00	$127.00	$201.17	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202480	EAP	HCPCS C1894		Sheath Flex 6fr 11cm	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$74.93	$74.93	$0.00	$0.00	$0.00	$28.76	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$81.63	$81.63	$0.00	$69.00	$109.30	$110.40	$0.00	$0.00	$0.00	$21.60	$0.00	$0.00	$21.97	$0.00	$0.00	$0.00	$0.00	$0.00
27202481	EAP	HCPCS C1751		Hickman 10.0 French Triple Lum	BOTH IP/OP	"$1,357.00 "	"$1,004.18"	$0.00	"$1,085.60"	$736.85	$736.85	$0.00	$0.00	$0.00	$282.83	"$1,007.17"	"$1,007.17"	"$1,045.98"	$0.00	$282.80	$0.00	$802.67	$802.67	$0.00	$678.50	"$1,074.74"	"$1,085.60"	$0.00	$0.00	$0.00	$212.37	$0.00	$0.00	$216.03	$0.00	$0.00	$0.00	$0.00	$0.00
27202482	EAP	HCPCS C1725		Balloon Udt 4-2/5/120	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$389.33	$389.33	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$0.00	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202483	EAP	HCPCS C1725		Conquest Dialation Balloon 5mm	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$358.50	$567.86	$573.60	$0.00	$0.00	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202484	EAP	HCPCS C1725		Conquest Dialation Balloon 5mm	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$389.33	$389.33	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$466.05	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202485	EAP	HCPCS C1725		Conquest Dialation Balloon 6mm	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$389.33	$389.33	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$466.05	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202486	EAP	HCPCS C1725		Conquest Dialation Balloon 6mm	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$0.00	$0.00	$0.00	$0.00	$0.00	$149.44	$0.00	$0.00	$0.00	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$0.00	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202487	EAP	HCPCS C1725		Conquest Dialation Balloon 7mm	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$358.50	$567.86	$573.60	$0.00	$0.00	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202488	EAP	HCPCS C1725		Conquest Dialation Balloon 7mm	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$389.33	$389.33	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$466.05	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202489	EAP	HCPCS C1725		Conquest Dialation Balloon 8mm	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$389.33	$389.33	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$466.05	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202490	EAP	HCPCS C1725		Conquest Dialation Balloon 8mm	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$389.33	$389.33	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$466.05	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202491	EAP	HCPCS C1725		Conquest Dialation Balloon 10m	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$389.33	$389.33	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$466.05	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202492	EAP	HCPCS C1725		Conquest Dialation Balloon 10m	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$389.33	$389.33	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$466.05	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202493	EAP	HCPCS C1725		Conquest Dialation Balloon 12m	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$389.33	$389.33	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$466.05	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202494	EAP	HCPCS C1725		Balloon Dial Cath 4mmx10cmx120	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$389.33	$389.33	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$0.00	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202495	EAP	HCPCS C1751		Vaxcel Central Venous Cath	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$3.26	$3.26	$0.00	$0.00	$0.00	$1.25	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00	$0.00	$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
27202496	EAP	HCPCS C1725		4mmx2cmx90xm Monorail Balloon	BOTH IP/OP	"$1,407.00 "	"$1,041.18"	$0.00	"$1,125.60"	$764.00	$764.00	$0.00	$0.00	$0.00	$293.25	"$1,044.28"	"$1,044.28"	"$1,084.52"	$0.00	$293.22	$0.00	$832.24	$832.24	$0.00	$703.50	"$1,114.34"	"$1,125.60"	$0.00	$0.00	$0.00	$220.20	$0.00	$0.00	$223.99	$0.00	$0.00	$0.00	$0.00	$0.00
27202497	EAP	HCPCS C1725		5mmx2cmx90cm Monorail Balloon	BOTH IP/OP	"$1,407.00 "	"$1,041.18"	$0.00	"$1,125.60"	$764.00	$764.00	$0.00	$0.00	$0.00	$293.25	"$1,044.28"	"$1,044.28"	"$1,084.52"	$0.00	$293.22	$0.00	$832.24	$832.24	$0.00	$703.50	"$1,114.34"	"$1,125.60"	$0.00	$0.00	$0.00	$220.20	$0.00	$0.00	$223.99	$0.00	$0.00	$0.00	$0.00	$0.00
27202498	EAP	HCPCS C1725		5mmx15cmx90xcm Monorail Biliar	BOTH IP/OP	"$4,654.00 "	"$3,443.96"	$0.00	"$3,723.20"	"$2,527.12"	"$2,527.12"	$0.00	$0.00	$0.00	$970.01	"$3,454.20"	"$3,454.20"	"$3,587.30"	$0.00	$969.89	$0.00	"$2,752.84"	"$2,752.84"	$0.00	"$2,327.00"	"$3,685.97"	"$3,723.20"	$0.00	$0.00	$0.00	$728.35	$0.00	$0.00	$740.92	$0.00	$0.00	$0.00	$0.00	$0.00
27202499	EAP	HCPCS C1725		6mmx14cmx90cm Monorail Biliary	BOTH IP/OP	"$4,654.00 "	"$3,443.96"	$0.00	"$3,723.20"	"$2,527.12"	"$2,527.12"	$0.00	$0.00	$0.00	$970.01	"$3,454.20"	"$3,454.20"	"$3,587.30"	$0.00	$969.89	$0.00	"$2,752.84"	"$2,752.84"	$0.00	"$2,327.00"	"$3,685.97"	"$3,723.20"	$0.00	$0.00	$0.00	$728.35	$0.00	$0.00	$740.92	$0.00	$0.00	$0.00	$0.00	$0.00
27202500	EAP	HCPCS C1725		6mmx18cmx90cm Monorail Bilary	BOTH IP/OP	"$4,654.00 "	"$3,443.96"	$0.00	"$3,723.20"	"$2,527.12"	"$2,527.12"	$0.00	$0.00	$0.00	$970.01	"$3,454.20"	"$3,454.20"	"$3,587.30"	$0.00	$969.89	$0.00	"$2,752.84"	"$2,752.84"	$0.00	"$2,327.00"	"$3,685.97"	"$3,723.20"	$0.00	$0.00	$0.00	$728.35	$0.00	$0.00	$740.92	$0.00	$0.00	$0.00	$0.00	$0.00
27202501	EAP	HCPCS C1769		.018x190cm Thruway Guidewire	BOTH IP/OP	$291.00 	$215.34	$0.00	$232.80	$158.01	$158.01	$0.00	$0.00	$0.00	$60.65	$215.98	$215.98	$224.30	$0.00	$60.64	$0.00	$172.13	$172.13	$0.00	$145.50	$230.47	$232.80	$0.00	$0.00	$0.00	$45.54	$0.00	$0.00	$46.33	$0.00	$0.00	$0.00	$0.00	$0.00
27202502	EAP	HCPCS C1893		6frx45cm Renal Guiding Sheath	BOTH IP/OP	$260.00 	$192.40	$0.00	$208.00	$141.18	$141.18	$0.00	$0.00	$0.00	$54.19	$192.97	$192.97	$200.41	$0.00	$54.18	$0.00	$153.79	$153.79	$0.00	$130.00	$205.92	$208.00	$0.00	$169.00	$0.00	$40.69	$0.00	$0.00	$41.39	$0.00	$0.00	$0.00	$0.00	$0.00
27202503	EAP	HCPCS C1725		6x40x80 Polar Cath Balloon	BOTH IP/OP	"$4,496.00 "	"$3,327.04"	$0.00	"$3,596.80"	"$2,441.33"	"$2,441.33"	$0.00	$0.00	$0.00	$937.08	"$3,336.93"	"$3,336.93"	"$3,465.52"	$0.00	$936.97	$0.00	"$2,659.38"	"$2,659.38"	$0.00	"$2,248.00"	"$3,560.83"	"$3,596.80"	$0.00	$0.00	$0.00	$703.62	$0.00	$0.00	$715.76	$0.00	$0.00	$0.00	$0.00	$0.00
27202504	EAP	HCPCS C1725		7x60x80 Polar Cath Balloon	BOTH IP/OP	"$4,496.00 "	"$3,327.04"	$0.00	"$3,596.80"	"$2,441.33"	"$2,441.33"	$0.00	$0.00	$0.00	$937.08	"$3,336.93"	"$3,336.93"	"$3,465.52"	$0.00	$936.97	$0.00	"$2,659.38"	"$2,659.38"	$0.00	"$2,248.00"	"$3,560.83"	"$3,596.80"	$0.00	$0.00	$0.00	$703.62	$0.00	$0.00	$715.76	$0.00	$0.00	$0.00	$0.00	$0.00
27202505	EAP	HCPCS C2629		Banana Peel Sheath	BOTH IP/OP	$151.00 	$111.74	$0.00	$120.80	$0.00	$0.00	$0.00	$0.00	$0.00	$31.47	$112.07	$112.07	$116.39	$0.00	$31.47	$0.00	$89.32	$89.32	$0.00	$75.50	$119.59	$120.80	$0.00	$0.00	$0.00	$23.63	$0.00	$0.00	$24.04	$0.00	$0.00	$0.00	$0.00	$0.00
27202506	EAP	HCPCS C1769		Guidewite .014x180 Segway Gt	BOTH IP/OP	$417.00 	$308.58	$0.00	$333.60	$226.43	$226.43	$0.00	$0.00	$0.00	$86.91	$309.50	$309.50	$321.42	$0.00	$86.90	$0.00	$246.66	$246.66	$0.00	$208.50	$330.26	$333.60	$0.00	$0.00	$0.00	$65.26	$0.00	$0.00	$66.39	$0.00	$0.00	$0.00	$0.00	$0.00
27202507	EAP	HCPCS C1769		Guidewire .018x180cm Segway Gt	BOTH IP/OP	$417.00 	$308.58	$0.00	$333.60	$226.43	$226.43	$0.00	$0.00	$0.00	$86.91	$309.50	$309.50	$321.42	$0.00	$86.90	$0.00	$246.66	$246.66	$0.00	$208.50	$330.26	$333.60	$0.00	$271.05	$0.00	$65.26	$0.00	$0.00	$66.39	$0.00	$0.00	$0.00	$0.00	$0.00
27202508	EAP	HCPCS C1769		Str Guidewire .014x180 Segway	BOTH IP/OP	$417.00 	$308.58	$0.00	$333.60	$226.43	$226.43	$0.00	$0.00	$0.00	$86.91	$309.50	$309.50	$321.42	$0.00	$86.90	$0.00	$246.66	$246.66	$0.00	$208.50	$330.26	$333.60	$0.00	$0.00	$0.00	$65.26	$0.00	$0.00	$66.39	$0.00	$0.00	$0.00	$0.00	$0.00
27202509	EAP	HCPCS C1751		Infusion Embo Cath Segway	BOTH IP/OP	$835.00 	$617.90	$0.00	$668.00	$453.41	$453.41	$0.00	$0.00	$0.00	$174.03	$619.74	$619.74	$643.62	$0.00	$174.01	$0.00	$493.90	$493.90	$0.00	$417.50	$661.32	$668.00	$0.00	$0.00	$0.00	$130.68	$0.00	$0.00	$132.93	$0.00	$0.00	$0.00	$0.00	$0.00
27202510	EAP	HCPCS C1757		Complex Helical Coil	BOTH IP/OP	$239.00 	$176.86	$0.00	$191.20	$129.78	$129.78	$0.00	$0.00	$0.00	$49.81	$177.39	$177.39	$184.22	$0.00	$49.81	$0.00	$141.37	$141.37	$0.00	$119.50	$189.29	$191.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202511	EAP	HCPCS C1894		6fr Dial Ease Introducer Sheat	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$23.35	$23.35	$0.00	$0.00	$0.00	$8.96	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$25.43	$25.43	$0.00	$21.50	$34.06	$34.40	$0.00	$27.95	$0.00	$6.73	$0.00	$0.00	$6.85	$0.00	$0.00	$0.00	$0.00	$0.00
27202512	EAP	HCPCS C1725		7-2/7/75 Workhorse Balloon	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27202513	EAP	HCPCS C1725		7-4/5/75 Workhorse Balloon	BOTH IP/OP	$427.00 	$315.98	$0.00	$341.60	$231.86	$231.86	$0.00	$0.00	$0.00	$89.00	$316.92	$316.92	$329.13	$0.00	$88.99	$0.00	$252.57	$252.57	$0.00	$213.50	$338.18	$341.60	$0.00	$0.00	$0.00	$66.83	$0.00	$0.00	$67.98	$0.00	$0.00	$0.00	$0.00	$0.00
27202514	EAP	HCPCS C1894		10fr 25cm Pinnacle Sheath Intr	BOTH IP/OP	$67.00 	$49.58	$0.00	$53.60	$36.38	$36.38	$0.00	$0.00	$0.00	$13.96	$49.73	$49.73	$51.64	$0.00	$13.96	$0.00	$39.63	$39.63	$0.00	$33.50	$53.06	$53.60	$0.00	$43.55	$0.00	$10.49	$0.00	$0.00	$10.67	$0.00	$0.00	$0.00	$0.00	$0.00
27202515	EAP	HCPCS C1894		5fr 25cm Pinnacle Introducer S	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$32.04	$32.04	$0.00	$0.00	$0.00	$12.30	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$34.90	$34.90	$0.00	$29.50	$46.73	$47.20	$0.00	$38.35	$0.00	$9.23	$0.00	$0.00	$9.39	$0.00	$0.00	$0.00	$0.00	$0.00
27202516	EAP	HCPCS C1894		9fr 25cm Pinnacle Introducer S	BOTH IP/OP	$67.00 	$49.58	$0.00	$53.60	$36.38	$36.38	$0.00	$0.00	$0.00	$13.96	$49.73	$49.73	$51.64	$0.00	$13.96	$0.00	$39.63	$39.63	$0.00	$33.50	$53.06	$53.60	$0.00	$0.00	$0.00	$10.49	$0.00	$0.00	$10.67	$0.00	$0.00	$0.00	$0.00	$0.00
27202517	EAP	HCPCS C1894		6fr 25cm Pinnacle Introducer S	BOTH IP/OP	$67.00 	$49.58	$0.00	$53.60	$36.38	$36.38	$0.00	$0.00	$0.00	$13.96	$49.73	$49.73	$51.64	$0.00	$13.96	$0.00	$39.63	$39.63	$0.00	$33.50	$53.06	$53.60	$0.00	$0.00	$0.00	$10.49	$0.00	$0.00	$10.67	$0.00	$0.00	$0.00	$0.00	$0.00
27202518	EAP	HCPCS C1894		7fr 25cm Pinnacle Introducer S	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$32.04	$32.04	$0.00	$0.00	$0.00	$12.30	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$34.90	$34.90	$0.00	$29.50	$46.73	$47.20	$0.00	$38.35	$0.00	$9.23	$0.00	$0.00	$9.39	$0.00	$0.00	$0.00	$0.00	$0.00
27202519	EAP	HCPCS C1750		23cm Hemoglide Perm Cath	BOTH IP/OP	"$2,140.00 "	"$1,583.60"	$0.00	"$1,712.00"	"$1,162.02"	"$1,162.02"	$0.00	$0.00	$0.00	$446.03	"$1,588.31"	"$1,588.31"	"$1,649.51"	$0.00	$445.98	$0.00	"$1,265.81"	"$1,265.81"	$0.00	"$1,070.00"	"$1,694.88"	"$1,712.00"	$0.00	$0.00	$0.00	$334.91	$0.00	$0.00	$340.69	$0.00	$0.00	$0.00	$0.00	$0.00
27202520	EAP	HCPCS C1750		19cm Hemoglide Perm Cath	BOTH IP/OP	$916.00 	$677.84	$0.00	$732.80	$497.39	$497.39	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$706.05	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$458.00	$725.47	$732.80	$0.00	$0.00	$0.00	$143.35	$0.00	$0.00	$145.83	$0.00	$0.00	$0.00	$0.00	$0.00
27202521	EAP	HCPCS C1769		Nitrex Guidewire	BOTH IP/OP	$728.00 	$538.72	$0.00	$582.40	$395.30	$395.30	$0.00	$0.00	$0.00	$151.73	$540.32	$540.32	$561.14	$0.00	$151.72	$0.00	$430.61	$430.61	$0.00	$364.00	$576.58	$582.40	$0.00	$0.00	$0.00	$113.93	$0.00	$0.00	$115.90	$0.00	$0.00	$0.00	$0.00	$0.00
27202522	EAP	HCPCS C1769		Disposable Tip Deflecting Wire	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$307.88	$307.88	$0.00	$0.00	$0.00	$118.18	$420.83	$420.83	$437.04	$0.00	$118.16	$0.00	$335.38	$335.38	$0.00	$283.50	$449.06	$453.60	$0.00	$368.55	$0.00	$88.74	$0.00	$0.00	$90.27	$0.00	$0.00	$0.00	$0.00	$0.00
27202523	EAP	HCPCS C1894		10fr Pinnacle Introducer	BOTH IP/OP	$76.00 	$56.24	$0.00	$60.80	$41.27	$41.27	$0.00	$0.00	$0.00	$15.84	$56.41	$56.41	$58.58	$0.00	$15.84	$0.00	$44.95	$44.95	$0.00	$38.00	$60.19	$60.80	$0.00	$49.40	$0.00	$11.89	$0.00	$0.00	$12.10	$0.00	$0.00	$0.00	$0.00	$0.00
27202524	EAP	HCPCS C1752		Niagra Dialysis Catheter	BOTH IP/OP	$203.00 	$150.22	$0.00	$162.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.67	$150.67	$156.47	$0.00	$42.31	$0.00	$0.00	$0.00	$0.00	$101.50	$160.78	$162.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202525	EAP	HCPCS C2629		5fr Tear-away Introducer	BOTH IP/OP	$81.00 	$59.94	$0.00	$64.80	$0.00	$0.00	$0.00	$0.00	$0.00	$16.88	$60.12	$60.12	$62.43	$0.00	$16.88	$0.00	$47.91	$47.91	$0.00	$40.50	$64.15	$64.80	$0.00	$52.65	$0.00	$12.68	$0.00	$0.00	$12.90	$0.00	$0.00	$0.00	$0.00	$0.00
27202526	EAP	HCPCS C2629		6fr Tear-away Introducer	BOTH IP/OP	$856.00 	$633.44	$0.00	$684.80	$0.00	$0.00	$0.00	$0.00	$0.00	$178.41	$635.32	$635.32	$659.80	$0.00	$178.39	$0.00	$506.32	$506.32	$0.00	$428.00	$677.95	$684.80	$0.00	$556.40	$0.00	$133.96	$0.00	$0.00	$136.28	$0.00	$0.00	$0.00	$0.00	$0.00
27202527	EAP	HCPCS C2629		8 Fr Tear Away Introducer	BOTH IP/OP	$397.00 	$293.78	$0.00	$317.60	$0.00	$0.00	$0.00	$0.00	$0.00	$82.74	$294.65	$294.65	$306.01	$0.00	$82.73	$0.00	$234.83	$234.83	$0.00	$198.50	$314.42	$317.60	$0.00	$0.00	$0.00	$62.13	$0.00	$0.00	$63.20	$0.00	$0.00	$0.00	$0.00	$0.00
27202528	EAP	HCPCS C2629		9fr Tear-away Introducer	BOTH IP/OP	$81.00 	$59.94	$0.00	$64.80	$0.00	$0.00	$0.00	$0.00	$0.00	$16.88	$60.12	$60.12	$62.43	$0.00	$16.88	$0.00	$47.91	$47.91	$0.00	$40.50	$64.15	$64.80	$0.00	$52.65	$0.00	$12.68	$0.00	$0.00	$12.90	$0.00	$0.00	$0.00	$0.00	$0.00
27202529	EAP	HCPCS C2629		10fr-16cm Introducer	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.72	$63.09	$63.09	$65.52	$0.00	$17.71	$0.00	$50.28	$50.28	$0.00	$42.50	$67.32	$68.00	$0.00	$0.00	$0.00	$13.30	$0.00	$0.00	$13.53	$0.00	$0.00	$0.00	$0.00	$0.00
27202530	EAP	Custom 27202530		18 Ga Needle  Sterile  Guide	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$42.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202531	EAP	HCPCS C1729		12fr Flexima Biliary Cath	BOTH IP/OP	$291.00 	$215.34	$0.00	$232.80	$158.01	$158.01	$0.00	$0.00	$0.00	$60.65	$215.98	$215.98	$224.30	$0.00	$60.64	$0.00	$172.13	$172.13	$0.00	$145.50	$230.47	$232.80	$0.00	$0.00	$0.00	$45.54	$0.00	$0.00	$46.33	$0.00	$0.00	$0.00	$0.00	$0.00
27202532	EAP	HCPCS C1757		2mmx20mm Complex Helical	BOTH IP/OP	$257.00 	$190.18	$0.00	$205.60	$139.55	$139.55	$0.00	$0.00	$0.00	$53.57	$190.75	$190.75	$198.10	$0.00	$53.56	$0.00	$152.02	$152.02	$0.00	$128.50	$203.54	$205.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202533	EAP	HCPCS C1725		4-4/5/75 Balloon Catheter	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$369.78	$369.78	$0.00	$0.00	$0.00	$141.94	$505.44	$505.44	$524.91	$0.00	$141.92	$0.00	$402.81	$402.81	$0.00	$340.50	$539.35	$544.80	$0.00	$0.00	$0.00	$106.58	$0.00	$0.00	$108.42	$0.00	$0.00	$0.00	$0.00	$0.00
27202534	EAP	HCPCS C1769		46fr-65cm C2 Glidecath	BOTH IP/OP	$167.00 	$123.58	$0.00	$133.60	$90.68	$90.68	$0.00	$0.00	$0.00	$34.81	$123.95	$123.95	$128.72	$0.00	$34.80	$0.00	$98.78	$98.78	$0.00	$83.50	$132.26	$133.60	$0.00	$0.00	$0.00	$26.14	$0.00	$0.00	$26.59	$0.00	$0.00	$0.00	$0.00	$0.00
27202535	EAP	HCPCS C1757		4mmx30mm Complex Helical	BOTH IP/OP	$265.00 	$196.10	$0.00	$212.00	$143.90	$143.90	$0.00	$0.00	$0.00	$55.23	$196.68	$196.68	$204.26	$0.00	$55.23	$0.00	$156.75	$156.75	$0.00	$132.50	$209.88	$212.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202536	EAP	HCPCS C1725		Bmx 8-3/5.8/75 Balloon Ca	BOTH IP/OP	$916.00 	$677.84	$0.00	$732.80	$497.39	$497.39	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$706.05	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$458.00	$725.47	$732.80	$0.00	$0.00	$0.00	$143.35	$0.00	$0.00	$145.83	$0.00	$0.00	$0.00	$0.00	$0.00
27202537	EAP	HCPCS C1725		Bmx14-4/7/100 Ballon Gath	BOTH IP/OP	"$1,008.00 "	$745.92	$0.00	$806.40	$547.34	$547.34	$0.00	$0.00	$0.00	$210.09	$748.14	$748.14	$776.97	$0.00	$210.07	$0.00	$596.23	$596.23	$0.00	$504.00	$798.34	$806.40	$0.00	$0.00	$0.00	$157.75	$0.00	$0.00	$160.47	$0.00	$0.00	$0.00	$0.00	$0.00
27202538	EAP	HCPCS C1729		Catheter  10fr Flexima	BOTH IP/OP	$291.00 	$215.34	$0.00	$232.80	$158.01	$158.01	$0.00	$0.00	$0.00	$60.65	$215.98	$215.98	$224.30	$0.00	$60.64	$0.00	$172.13	$172.13	$0.00	$145.50	$230.47	$232.80	$0.00	$189.15	$0.00	$45.54	$0.00	$0.00	$46.33	$0.00	$0.00	$0.00	$0.00	$0.00
27202539	EAP	HCPCS C1729		Catheter  14fr Flexima	BOTH IP/OP	$282.00 	$208.68	$0.00	$225.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.00	$223.34	$225.60	$0.00	$0.00	$0.00	$44.13	$0.00	$0.00	$44.89	$0.00	$0.00	$0.00	$0.00	$0.00
27202540	EAP	HCPCS C1751		Catheter  9cm Katzen	BOTH IP/OP	"$1,506.00 "	"$1,114.44"	$0.00	"$1,204.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$753.00	"$1,192.75"	"$1,204.80"	$0.00	$0.00	$0.00	$235.69	$0.00	$0.00	$239.76	$0.00	$0.00	$0.00	$0.00	$0.00
27202541	EAP	HCPCS C1725		Catheter  Balloon  Dc/20	BOTH IP/OP	"$2,062.00 "	"$1,525.88"	$0.00	"$1,649.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,031.00"	"$1,633.10"	"$1,649.60"	$0.00	$0.00	$0.00	$322.70	$0.00	$0.00	$328.27	$0.00	$0.00	$0.00	$0.00	$0.00
27202542	EAP	HCPCS C1725		Catheter  Balloon Ultra-	BOTH IP/OP	$718.00 	$531.32	$0.00	$574.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.00	$568.66	$574.40	$0.00	$0.00	$0.00	$112.37	$0.00	$0.00	$114.31	$0.00	$0.00	$0.00	$0.00	$0.00
27202543	EAP	HCPCS C1887		Glidecath: 100cm Straight	BOTH IP/OP	$838.00 	$620.12	$0.00	$670.40	$455.03	$455.03	$0.00	$0.00	$0.00	$174.66	$621.96	$621.96	$645.93	$0.00	$174.64	$0.00	$495.68	$495.68	$0.00	$419.00	$663.70	$670.40	$0.00	$544.70	$0.00	$131.15	$0.00	$0.00	$133.41	$0.00	$0.00	$0.00	$0.00	$0.00
27202544	EAP	HCPCS C1887		Guidecath  5fr-100cm	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$95.03	$95.03	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$134.89	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00	$113.75	$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
27202545	EAP	HCPCS C1769		Guidewire .035/150cm	BOTH IP/OP	"$1,424.00 "	"$1,053.76"	$0.00	"$1,139.20"	$773.23	$773.23	$0.00	$0.00	$0.00	$296.80	"$1,056.89"	"$1,056.89"	"$1,097.62"	$0.00	$296.76	$0.00	$842.30	$842.30	$0.00	$712.00	"$1,127.81"	"$1,139.20"	$0.00	$925.60	$0.00	$222.86	$0.00	$0.00	$226.70	$0.00	$0.00	$0.00	$0.00	$0.00
27202546	EAP	HCPCS C1769		Transcend -ex Guidewire	BOTH IP/OP	"$1,759.00 "	"$1,301.66"	$0.00	"$1,407.20"	$955.14	$955.14	$0.00	$0.00	$0.00	$366.62	"$1,305.53"	"$1,305.53"	"$1,355.84"	$0.00	$366.58	$0.00	"$1,040.45"	"$1,040.45"	$0.00	$879.50	"$1,393.13"	"$1,407.20"	$0.00	$0.00	$0.00	$275.28	$0.00	$0.00	$280.03	$0.00	$0.00	$0.00	$0.00	$0.00
27202547	EAP	HCPCS C1725		Udt6-10/5/120 Ballon Cath	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$389.33	$389.33	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$0.00	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202548	EAP	HCPCS C1769		V-18 Control Guidewires	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$169.96	$169.96	$0.00	$0.00	$0.00	$65.24	$232.31	$232.31	$241.26	$0.00	$65.23	$0.00	$185.14	$185.14	$0.00	$156.50	$247.90	$250.40	$0.00	$0.00	$0.00	$48.98	$0.00	$0.00	$49.83	$0.00	$0.00	$0.00	$0.00	$0.00
27202549	EAP	HCPCS C1725		Xxl 18-4/5.8/120e Ball Ga	BOTH IP/OP	$934.00 	$691.16	$0.00	$747.20	$507.16	$507.16	$0.00	$0.00	$0.00	$194.67	$693.21	$693.21	$719.93	$0.00	$194.65	$0.00	$552.46	$552.46	$0.00	$467.00	$739.73	$747.20	$0.00	$0.00	$0.00	$146.17	$0.00	$0.00	$148.69	$0.00	$0.00	$0.00	$0.00	$0.00
27202550	EAP	HCPCS C1769		Guidewire .035-260cm Rosen	BOTH IP/OP	$68.00 	$50.32	$0.00	$54.40	$36.92	$36.92	$0.00	$0.00	$0.00	$14.17	$50.47	$50.47	$52.41	$0.00	$14.17	$0.00	$40.22	$40.22	$0.00	$34.00	$53.86	$54.40	$0.00	$44.20	$0.00	$10.64	$0.00	$0.00	$10.83	$0.00	$0.00	$0.00	$0.00	$0.00
27202551	EAP	HCPCS C1729		10.2fr Biliary Drain Cath	BOTH IP/OP	$289.00 	$213.86	$0.00	$231.20	$156.93	$156.93	$0.00	$0.00	$0.00	$60.23	$214.50	$214.50	$222.76	$0.00	$60.23	$0.00	$170.94	$170.94	$0.00	$144.50	$228.89	$231.20	$0.00	$187.85	$0.00	$45.23	$0.00	$0.00	$46.01	$0.00	$0.00	$0.00	$0.00	$0.00
27202552	EAP	HCPCS C1729		12.0fr Biliary Drain Cath	BOTH IP/OP	$296.00 	$219.04	$0.00	$236.80	$160.73	$160.73	$0.00	$0.00	$0.00	$61.69	$219.69	$219.69	$228.16	$0.00	$61.69	$0.00	$175.08	$175.08	$0.00	$148.00	$234.43	$236.80	$0.00	$192.40	$0.00	$46.32	$0.00	$0.00	$47.12	$0.00	$0.00	$0.00	$0.00	$0.00
27202553	EAP	HCPCS C1729		12.0fr Mp Drain Catheter	BOTH IP/OP	$296.00 	$219.04	$0.00	$236.80	$160.73	$160.73	$0.00	$0.00	$0.00	$61.69	$219.69	$219.69	$228.16	$0.00	$61.69	$0.00	$175.08	$175.08	$0.00	$148.00	$234.43	$236.80	$0.00	$192.40	$0.00	$46.32	$0.00	$0.00	$47.12	$0.00	$0.00	$0.00	$0.00	$0.00
27202554	EAP	HCPCS C1729		14.0fr Biliary Drain	BOTH IP/OP	$296.00 	$219.04	$0.00	$236.80	$160.73	$160.73	$0.00	$0.00	$0.00	$61.69	$219.69	$219.69	$228.16	$0.00	$61.69	$0.00	$175.08	$175.08	$0.00	$148.00	$234.43	$236.80	$0.00	$192.40	$0.00	$46.32	$0.00	$0.00	$47.12	$0.00	$0.00	$0.00	$0.00	$0.00
27202555	EAP	HCPCS C1769		35-180 Coons Wire	BOTH IP/OP	$192.00 	$142.08	$0.00	$153.60	$104.26	$104.26	$0.00	$0.00	$0.00	$40.02	$142.50	$142.50	$147.99	$0.00	$40.01	$0.00	$113.57	$113.57	$0.00	$96.00	$152.06	$153.60	$0.00	$0.00	$0.00	$30.05	$0.00	$0.00	$30.57	$0.00	$0.00	$0.00	$0.00	$0.00
27202556	EAP	HCPCS C1757		35-2-3 Embolization Coil	BOTH IP/OP	$172.00 	$127.28	$0.00	$137.60	$93.40	$93.40	$0.00	$0.00	$0.00	$35.85	$127.66	$127.66	$132.58	$0.00	$35.84	$0.00	$101.74	$101.74	$0.00	$86.00	$136.22	$137.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202557	EAP	HCPCS C1725		7fr-100cm Montef 10re Cat	BOTH IP/OP	$54.00 	$39.96	$0.00	$43.20	$29.32	$29.32	$0.00	$0.00	$0.00	$11.25	$40.08	$40.08	$41.62	$0.00	$11.25	$0.00	$31.94	$31.94	$0.00	$27.00	$42.77	$43.20	$0.00	$35.10	$0.00	$8.45	$0.00	$0.00	$8.60	$0.00	$0.00	$0.00	$0.00	$0.00
27202558	EAP	HCPCS C1894		8fr Balkanintroducer	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$92.31	$92.31	$0.00	$0.00	$0.00	$35.43	$126.17	$126.17	$131.04	$0.00	$35.43	$0.00	$100.56	$100.56	$0.00	$85.00	$134.64	$136.00	$0.00	$0.00	$0.00	$26.61	$0.00	$0.00	$27.06	$0.00	$0.00	$0.00	$0.00	$0.00
27202559	EAP	HCPCS C1894		9fr Flexor Introducer	BOTH IP/OP	$159.00 	$117.66	$0.00	$127.20	$86.34	$86.34	$0.00	$0.00	$0.00	$33.14	$118.01	$118.01	$122.56	$0.00	$33.14	$0.00	$94.05	$94.05	$0.00	$79.50	$125.93	$127.20	$0.00	$0.00	$0.00	$24.88	$0.00	$0.00	$25.31	$0.00	$0.00	$0.00	$0.00	$0.00
27202560	EAP	HCPCS C1757		Coil  Embolization 35-5-5	BOTH IP/OP	$172.00 	$127.28	$0.00	$137.60	$93.40	$93.40	$0.00	$0.00	$0.00	$35.85	$127.66	$127.66	$132.58	$0.00	$35.84	$0.00	$101.74	$101.74	$0.00	$86.00	$136.22	$137.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202561	EAP	HCPCS C1751		135 Cm Mass Transit Max	BOTH IP/OP	"$2,960.00 "	"$2,190.40"	$0.00	"$2,368.00"	"$1,607.28"	"$1,607.28"	$0.00	$0.00	$0.00	$616.94	"$2,196.91"	"$2,196.91"	"$2,281.57"	$0.00	$616.86	$0.00	"$1,750.84"	"$1,750.84"	$0.00	"$1,480.00"	"$2,344.32"	"$2,368.00"	$0.00	$0.00	$0.00	$463.24	$0.00	$0.00	$471.23	$0.00	$0.00	$0.00	$0.00	$0.00
27202562	EAP	HCPCS C1894		Introducer Pinnacle 7fr 10cm	BOTH IP/OP	$67.00 	$49.58	$0.00	$53.60	$36.38	$36.38	$0.00	$0.00	$0.00	$13.96	$49.73	$49.73	$51.64	$0.00	$13.96	$0.00	$39.63	$39.63	$0.00	$33.50	$53.06	$53.60	$0.00	$0.00	$0.00	$10.49	$0.00	$0.00	$10.67	$0.00	$0.00	$0.00	$0.00	$0.00
27202563	EAP	HCPCS C1725		Balloon Udt 4-4/5/120	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$389.33	$389.33	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$0.00	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202564	EAP	HCPCS C1887		5fr.100cmhinck Headhunter	BOTH IP/OP	$167.00 	$123.58	$0.00	$133.60	$90.68	$90.68	$0.00	$0.00	$0.00	$34.81	$123.95	$123.95	$128.72	$0.00	$34.80	$0.00	$98.78	$98.78	$0.00	$83.50	$132.26	$133.60	$0.00	$108.55	$0.00	$26.14	$0.00	$0.00	$26.59	$0.00	$0.00	$0.00	$0.00	$0.00
27202565	EAP	HCPCS C1894		8fr 25cm Pinnacle Introducer S	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$32.04	$32.04	$0.00	$0.00	$0.00	$12.30	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$34.90	$34.90	$0.00	$29.50	$46.73	$47.20	$0.00	$38.35	$0.00	$9.23	$0.00	$0.00	$9.39	$0.00	$0.00	$0.00	$0.00	$0.00
27202566	EAP	HCPCS C1887		5f-90cm Ruc Catheter	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$70.05	$70.05	$0.00	$0.00	$0.00	$26.89	$95.74	$95.74	$99.43	$0.00	$26.88	$0.00	$76.30	$76.30	$0.00	$64.50	$102.17	$103.20	$0.00	$0.00	$0.00	$20.19	$0.00	$0.00	$20.54	$0.00	$0.00	$0.00	$0.00	$0.00
27202567	EAP	HCPCS C2629		Introducer Tear Away 120fx30cm	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$29.60	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$83.99	$83.99	$0.00	$71.00	$112.46	$113.60	$0.00	$0.00	$0.00	$22.22	$0.00	$0.00	$22.61	$0.00	$0.00	$0.00	$0.00	$0.00
27202568	EAP	HCPCS C2629		Introducer Tear Away 16f X15cm	BOTH IP/OP	$68.00 	$50.32	$0.00	$54.40	$0.00	$0.00	$0.00	$0.00	$0.00	$14.17	$50.47	$50.47	$52.41	$0.00	$14.17	$0.00	$40.22	$40.22	$0.00	$34.00	$53.86	$54.40	$0.00	$0.00	$0.00	$10.64	$0.00	$0.00	$10.83	$0.00	$0.00	$0.00	$0.00	$0.00
27202569	EAP	HCPCS C2629		Introducer Tear Away 14f X15cm	BOTH IP/OP	$68.00 	$50.32	$0.00	$54.40	$0.00	$0.00	$0.00	$0.00	$0.00	$14.17	$50.47	$50.47	$52.41	$0.00	$14.17	$0.00	$40.22	$40.22	$0.00	$34.00	$53.86	$54.40	$0.00	$0.00	$0.00	$10.64	$0.00	$0.00	$10.83	$0.00	$0.00	$0.00	$0.00	$0.00
27202570	EAP	HCPCS C2629		Introducer Tear Away12.5fx15cm	BOTH IP/OP	$103.00 	$76.22	$0.00	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$21.47	$76.45	$76.45	$79.39	$0.00	$21.47	$0.00	$60.92	$60.92	$0.00	$51.50	$81.58	$82.40	$0.00	$0.00	$0.00	$16.12	$0.00	$0.00	$16.40	$0.00	$0.00	$0.00	$0.00	$0.00
27202571	EAP	HCPCS C2629		Introducer Tear Away 6f X 10cm	BOTH IP/OP	$159.00 	$117.66	$0.00	$127.20	$0.00	$0.00	$0.00	$0.00	$0.00	$33.14	$118.01	$118.01	$122.56	$0.00	$33.14	$0.00	$94.05	$94.05	$0.00	$79.50	$125.93	$127.20	$0.00	$0.00	$0.00	$24.88	$0.00	$0.00	$25.31	$0.00	$0.00	$0.00	$0.00	$0.00
27202572	EAP	HCPCS C1769		"Amplatz Sup Guidewire,035/75gw"	BOTH IP/OP	$331.00 	$244.94	$0.00	$255.13	$179.73	$179.73	$0.00	$0.00	$0.00	$68.99	$245.67	$245.67	$255.13	$0.00	$68.98	$0.00	$195.79	$195.79	$0.00	$33.00	$52.27	$52.80	$0.00	$215.15	$0.00	$10.33	$0.00	$0.00	$10.51	$0.00	$0.00	$0.00	$0.00	$0.00
27202573	EAP	HCPCS C1726		Merci Balloon Guide Catheter	BOTH IP/OP	"$2,251.00 "	"$1,665.74"	$0.00	"$1,800.80"	"$1,222.29"	"$1,222.29"	$0.00	$0.00	$0.00	$469.16	"$1,670.69"	"$1,670.69"	"$1,735.07"	$0.00	$469.11	$0.00	"$1,331.47"	"$1,331.47"	$0.00	"$1,125.50"	"$1,782.79"	"$1,800.80"	$0.00	$0.00	$0.00	$352.28	$0.00	$0.00	$358.36	$0.00	$0.00	$0.00	$0.00	$0.00
27202574	EAP	HCPCS C1751		Merci Microcatheter	BOTH IP/OP	"$1,641.00 "	"$1,214.34"	$0.00	"$1,312.80"	$891.06	$891.06	$0.00	$0.00	$0.00	$342.03	"$1,217.95"	"$1,217.95"	"$1,264.88"	$0.00	$341.98	$0.00	$970.65	$970.65	$0.00	$820.50	"$1,299.67"	"$1,312.80"	$0.00	$0.00	$0.00	$256.82	$0.00	$0.00	$261.25	$0.00	$0.00	$0.00	$0.00	$0.00
27202575	EAP	HCPCS C1757		Meri V-series Retrieval V2.0	BOTH IP/OP	"$10,341.00 "	"$7,652.34"	$0.00	"$8,272.80"	"$5,615.16"	"$5,615.16"	$0.00	$0.00	$0.00	"$2,155.32"	"$4,181.12"	"$4,181.12"	"$7,970.84"	$0.00	"$2,155.06"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,170.50"	"$8,190.07"	"$8,272.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202576	EAP	HCPCS C1757		Meri V-series Retrieval V2.5	BOTH IP/OP	"$10,708.00 "	"$7,923.92"	$0.00	"$8,566.40"	"$5,814.44"	"$5,814.44"	$0.00	$0.00	$0.00	"$2,231.81"	"$4,181.12"	"$4,181.12"	"$8,253.73"	$0.00	"$2,231.55"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,354.00"	"$8,480.74"	"$8,566.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202577	EAP	HCPCS C1757		Meri V-series Retrieval V3.0	BOTH IP/OP	"$10,708.00 "	"$7,923.92"	$0.00	"$8,566.40"	"$5,814.44"	"$5,814.44"	$0.00	$0.00	$0.00	"$2,231.81"	"$4,181.12"	"$4,181.12"	"$8,253.73"	$0.00	"$2,231.55"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,354.00"	"$8,480.74"	"$8,566.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202578	EAP	HCPCS C1757		Meri V-series Retrieval V2.5	BOTH IP/OP	"$10,341.00 "	"$7,652.34"	$0.00	"$8,272.80"	"$5,615.16"	"$5,615.16"	$0.00	$0.00	$0.00	"$2,155.32"	"$4,181.12"	"$4,181.12"	"$7,970.84"	$0.00	"$2,155.06"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,170.50"	"$8,190.07"	"$8,272.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202579	EAP	HCPCS C1751		Catheter Reperfusion 026	BOTH IP/OP	"$3,767.00 "	"$2,787.58"	$0.00	"$3,013.60"	"$2,045.48"	"$2,045.48"	$0.00	$0.00	$0.00	$785.14	"$2,795.87"	"$2,795.87"	"$2,903.60"	$0.00	$785.04	$0.00	"$2,228.18"	"$2,228.18"	$0.00	"$1,883.50"	"$2,983.46"	"$3,013.60"	$0.00	$0.00	$0.00	$589.54	$0.00	$0.00	$599.71	$0.00	$0.00	$0.00	$0.00	$0.00
27202580	EAP	HCPCS C1751		Catheter Reperfusion 032	BOTH IP/OP	"$3,635.00 "	"$2,689.90"	$0.00	"$2,908.00"	"$1,973.81"	"$1,973.81"	$0.00	$0.00	$0.00	$757.62	"$2,697.90"	"$2,697.90"	"$2,801.86"	$0.00	$757.53	$0.00	"$2,150.10"	"$2,150.10"	$0.00	"$1,817.50"	"$2,878.92"	"$2,908.00"	$0.00	$0.00	$0.00	$568.88	$0.00	$0.00	$578.69	$0.00	$0.00	$0.00	$0.00	$0.00
27202581	EAP	HCPCS C1751		Catheter Reperfusion 041	BOTH IP/OP	"$3,635.00 "	"$2,689.90"	$0.00	"$2,908.00"	"$1,973.81"	"$1,973.81"	$0.00	$0.00	$0.00	$757.62	"$2,697.90"	"$2,697.90"	"$2,801.86"	$0.00	$757.53	$0.00	"$2,150.10"	"$2,150.10"	$0.00	"$1,817.50"	"$2,878.92"	"$2,908.00"	$0.00	$0.00	$0.00	$568.88	$0.00	$0.00	$578.69	$0.00	$0.00	$0.00	$0.00	$0.00
27202582	EAP	Custom 27202582		Separator 026	BOTH IP/OP	"$7,910.00 "	"$5,853.40"	$0.00	"$6,328.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,097.03"	$0.00	"$1,648.44"	$0.00	$0.00	$0.00	$0.00	"$3,955.00"	"$6,264.72"	"$6,328.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202583	EAP	Custom 27202583		Separator 032	BOTH IP/OP	"$7,639.00 "	"$5,652.86"	$0.00	"$6,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,888.14"	$0.00	"$1,591.97"	$0.00	$0.00	$0.00	$0.00	"$3,819.50"	"$6,050.09"	"$6,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202584	EAP	Custom 27202584		Separator 041	BOTH IP/OP	"$7,639.00 "	"$5,652.86"	$0.00	"$6,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,888.14"	$0.00	"$1,591.97"	$0.00	$0.00	$0.00	$0.00	"$3,819.50"	"$6,050.09"	"$6,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202585	EAP	Custom 27202585		"Tubing, Aspiration"	BOTH IP/OP	"$1,279.00 "	$946.46	$0.00	"$1,023.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$949.27	$949.27	$985.85	$0.00	$266.54	$0.00	$0.00	$0.00	$0.00	$639.50	"$1,012.97"	"$1,023.20"	$0.00	$831.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202586	EAP	Custom 27202586		"Pump, Penumbra Aspiration"	BOTH IP/OP	"$8,340.00 "	"$6,171.60"	$0.00	"$6,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,428.47"	$0.00	"$1,738.06"	$0.00	$0.00	$0.00	$0.00	"$4,170.00"	"$6,605.28"	"$6,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202587	EAP	HCPCS C1751		"Microcatheter, Microvention"	BOTH IP/OP	"$2,353.00 "	"$1,741.22"	$0.00	"$1,882.40"	"$1,277.68"	"$1,277.68"	$0.00	$0.00	$0.00	$490.42	"$1,746.40"	"$1,746.40"	"$1,813.69"	$0.00	$490.37	$0.00	"$1,391.80"	"$1,391.80"	$0.00	"$1,176.50"	"$1,863.58"	"$1,882.40"	$0.00	$0.00	$0.00	$368.24	$0.00	$0.00	$374.60	$0.00	$0.00	$0.00	$0.00	$0.00
27202588	EAP	Custom 27202588		"Controller, V-grip Detachment"	BOTH IP/OP	$560.00 	$414.40	$0.00	$448.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$415.63	$415.63	$431.65	$0.00	$116.70	$0.00	$0.00	$0.00	$0.00	$280.00	$443.52	$448.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202589	EAP	HCPCS C1751		"Catheter, Echelon Micro"	BOTH IP/OP	"$2,072.00 "	"$1,533.28"	$0.00	"$1,657.60"	"$1,125.10"	"$1,125.10"	$0.00	$0.00	$0.00	$431.86	"$1,537.84"	"$1,537.84"	"$1,597.10"	$0.00	$431.80	$0.00	"$1,225.59"	"$1,225.59"	$0.00	"$1,036.00"	"$1,641.02"	"$1,657.60"	$0.00	$0.00	$0.00	$324.27	$0.00	$0.00	$329.86	$0.00	$0.00	$0.00	$0.00	$0.00
27202590	EAP	HCPCS C1726		"Balloon, Hyperform 4mm X 7mm"	BOTH IP/OP	"$4,005.00 "	"$2,963.70"	$0.00	"$3,204.00"	"$2,174.72"	"$2,174.72"	$0.00	$0.00	$0.00	$834.74	"$2,972.51"	"$2,972.51"	"$3,087.05"	$0.00	$834.64	$0.00	"$2,368.96"	"$2,368.96"	$0.00	"$2,002.50"	"$3,171.96"	"$3,204.00"	$0.00	$0.00	$0.00	$626.78	$0.00	$0.00	$637.60	$0.00	$0.00	$0.00	$0.00	$0.00
27202591	EAP	HCPCS C1726		"Balloon, Hyperform 7mm X 7mm"	BOTH IP/OP	"$4,005.00 "	"$2,963.70"	$0.00	"$3,204.00"	"$2,174.72"	"$2,174.72"	$0.00	$0.00	$0.00	$834.74	"$2,972.51"	"$2,972.51"	"$3,087.05"	$0.00	$834.64	$0.00	"$2,368.96"	"$2,368.96"	$0.00	"$2,002.50"	"$3,171.96"	"$3,204.00"	$0.00	"$2,603.25"	$0.00	$626.78	$0.00	$0.00	$637.60	$0.00	$0.00	$0.00	$0.00	$0.00
27202592	EAP	HCPCS C1726		"Balloon, Hyperglide 4mm X 15mm"	BOTH IP/OP	"$3,336.00 "	"$2,468.64"	$0.00	"$2,668.80"	"$1,811.45"	"$1,811.45"	$0.00	$0.00	$0.00	$695.31	"$2,475.98"	"$2,475.98"	"$2,571.39"	$0.00	$695.22	$0.00	"$1,973.24"	"$1,973.24"	$0.00	"$1,668.00"	"$2,642.11"	"$2,668.80"	$0.00	$0.00	$0.00	$522.08	$0.00	$0.00	$531.09	$0.00	$0.00	$0.00	$0.00	$0.00
27202593	EAP	HCPCS C1887		"Catheter, Envoy 6f Guiding"	BOTH IP/OP	$884.00 	$654.16	$0.00	$707.20	$480.01	$480.01	$0.00	$0.00	$0.00	$184.25	$656.10	$656.10	$681.39	$0.00	$184.23	$0.00	$522.89	$522.89	$0.00	$442.00	$700.13	$707.20	$0.00	$574.60	$0.00	$138.35	$0.00	$0.00	$140.73	$0.00	$0.00	$0.00	$0.00	$0.00
27202594	EAP	HCPCS C1751		"Microcatheter, Rapidtransit"	BOTH IP/OP	"$2,002.00 "	"$1,481.48"	$0.00	"$1,601.60"	"$1,087.09"	"$1,087.09"	$0.00	$0.00	$0.00	$417.27	"$1,485.88"	"$1,485.88"	"$1,543.14"	$0.00	$417.22	$0.00	"$1,184.18"	"$1,184.18"	$0.00	"$1,001.00"	"$1,585.58"	"$1,601.60"	$0.00	$0.00	$0.00	$313.31	$0.00	$0.00	$318.72	$0.00	$0.00	$0.00	$0.00	$0.00
27202595	EAP	Custom 27202595		"System,trufill N-bca Liquid Em"	BOTH IP/OP	$281.00 	$207.94	$0.00	$224.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.56	$208.56	$216.59	$0.00	$58.56	$0.00	$0.00	$0.00	$0.00	$140.50	$222.55	$224.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202596	EAP	HCPCS C1887		"Catheter, Envoy Xb Guiding"	BOTH IP/OP	$988.00 	$731.12	$0.00	$790.40	$536.48	$536.48	$0.00	$0.00	$0.00	$205.92	$733.29	$733.29	$761.55	$0.00	$205.90	$0.00	$584.40	$584.40	$0.00	$494.00	$782.50	$790.40	$0.00	$0.00	$0.00	$154.62	$0.00	$0.00	$157.29	$0.00	$0.00	$0.00	$0.00	$0.00
27202597	EAP	HCPCS C1751		"Microcatheter, Prowler"	BOTH IP/OP	"$2,169.00 "	"$1,605.06"	$0.00	"$1,735.20"	"$1,177.77"	"$1,177.77"	$0.00	$0.00	$0.00	$452.07	"$1,609.83"	"$1,609.83"	"$1,671.87"	$0.00	$452.02	$0.00	"$1,282.96"	"$1,282.96"	$0.00	"$1,084.50"	"$1,717.85"	"$1,735.20"	$0.00	$0.00	$0.00	$339.45	$0.00	$0.00	$345.30	$0.00	$0.00	$0.00	$0.00	$0.00
27202598	EAP	HCPCS C1751		"Microcatheter, Prowler"	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,236.41"	"$1,236.41"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	"$1,755.11"	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00	$0.00	$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
27202599	EAP	HCPCS C1769		Guidewire Bentson .038 260 Exc	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$47.78	$47.78	$0.00	$0.00	$0.00	$18.34	$65.31	$65.31	$67.83	$0.00	$18.34	$0.00	$52.05	$52.05	$0.00	$44.00	$69.70	$70.40	$0.00	$0.00	$0.00	$13.77	$0.00	$0.00	$14.01	$0.00	$0.00	$0.00	$0.00	$0.00
27202600	EAP	HCPCS C1769		Guidwire Glide .038 150 Angle	BOTH IP/OP	$154.00 	$113.96	$0.00	$123.20	$83.62	$83.62	$0.00	$0.00	$0.00	$32.10	$114.30	$114.30	$118.70	$0.00	$32.09	$0.00	$91.09	$91.09	$0.00	$77.00	$121.97	$123.20	$0.00	$100.10	$0.00	$24.10	$0.00	$0.00	$24.52	$0.00	$0.00	$0.00	$0.00	$0.00
27202601	EAP	HCPCS C1769		Guidwire Glide .038 180 Angle	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$20.09	$20.09	$0.00	$0.00	$0.00	$7.71	$27.46	$27.46	$28.52	$0.00	$7.71	$0.00	$21.89	$21.89	$0.00	$18.50	$29.30	$29.60	$0.00	$0.00	$0.00	$5.79	$0.00	$0.00	$5.89	$0.00	$0.00	$0.00	$0.00	$0.00
27202602	EAP	HCPCS C1769		Guidewire Transend Ex .014	BOTH IP/OP	"$1,036.00 "	$766.64	$0.00	$828.80	$562.55	$562.55	$0.00	$0.00	$0.00	$215.93	$768.92	$768.92	$798.55	$0.00	$215.90	$0.00	$612.79	$612.79	$0.00	$518.00	$820.51	$828.80	$0.00	$0.00	$0.00	$162.13	$0.00	$0.00	$164.93	$0.00	$0.00	$0.00	$0.00	$0.00
27202603	EAP	HCPCS C1769		Guidewire Transend Ex .014st	BOTH IP/OP	"$1,036.00 "	$766.64	$0.00	$828.80	$562.55	$562.55	$0.00	$0.00	$0.00	$215.93	$768.92	$768.92	$798.55	$0.00	$215.90	$0.00	$612.79	$612.79	$0.00	$518.00	$820.51	$828.80	$0.00	$673.40	$0.00	$162.13	$0.00	$0.00	$164.93	$0.00	$0.00	$0.00	$0.00	$0.00
27202604	EAP	HCPCS C1769		Guidewire Transend Es 300cm	BOTH IP/OP	"$1,320.00 "	$976.80	$0.00	"$1,056.00"	$716.76	$716.76	$0.00	$0.00	$0.00	$275.12	$979.70	$979.70	"$1,017.46"	$0.00	$275.09	$0.00	$780.78	$780.78	$0.00	$660.00	"$1,045.44"	"$1,056.00"	$0.00	$0.00	$0.00	$206.58	$0.00	$0.00	$210.14	$0.00	$0.00	$0.00	$0.00	$0.00
27202605	EAP	HCPCS C1887		"Catheter, 7fr Guider Softip"	BOTH IP/OP	$667.00 	$493.58	$0.00	$533.60	$362.18	$362.18	$0.00	$0.00	$0.00	$139.02	$495.05	$495.05	$514.12	$0.00	$139.00	$0.00	$394.53	$394.53	$0.00	$333.50	$528.26	$533.60	$0.00	$0.00	$0.00	$104.39	$0.00	$0.00	$106.19	$0.00	$0.00	$0.00	$0.00	$0.00
27202606	EAP	HCPCS C1751		"Catheter, Renegade Micro"	BOTH IP/OP	"$1,202.00 "	$889.48	$0.00	$961.60	$652.69	$652.69	$0.00	$0.00	$0.00	$250.53	$892.12	$892.12	$926.50	$0.00	$250.50	$0.00	$710.98	$710.98	$0.00	$601.00	$951.98	$961.60	$0.00	$0.00	$0.00	$188.11	$0.00	$0.00	$191.36	$0.00	$0.00	$0.00	$0.00	$0.00
27202607	EAP	HCPCS C1751		"Microcatheter, Excelsior 1018"	BOTH IP/OP	"$2,169.00 "	"$1,605.06"	$0.00	"$1,735.20"	"$1,177.77"	"$1,177.77"	$0.00	$0.00	$0.00	$452.07	"$1,609.83"	"$1,609.83"	"$1,671.87"	$0.00	$452.02	$0.00	"$1,282.96"	"$1,282.96"	$0.00	"$1,084.50"	"$1,717.85"	"$1,735.20"	$0.00	$0.00	$0.00	$339.45	$0.00	$0.00	$345.30	$0.00	$0.00	$0.00	$0.00	$0.00
27202608	EAP	HCPCS C1769		"Guidewire, Synchro2"	BOTH IP/OP	"$1,251.00 "	$925.74	$0.00	"$1,000.80"	$679.29	$679.29	$0.00	$0.00	$0.00	$260.74	$928.49	$928.49	$964.27	$0.00	$260.71	$0.00	$739.97	$739.97	$0.00	$625.50	$990.79	"$1,000.80"	$0.00	$813.15	$0.00	$195.78	$0.00	$0.00	$199.16	$0.00	$0.00	$0.00	$0.00	$0.00
27202609	EAP	Custom 27202609		26x12x12cm Aaa Endoprosthesis	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202610	EAP	Custom 27202610		26x12x14cm Aaa Endoprosthesis	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202611	EAP	Custom 27202611		12x12x13.5cm Lliac Limb Aaa St	BOTH IP/OP	"$21,112.00 "	"$15,622.88"	$0.00	"$16,889.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$16,273.13"	$0.00	"$4,399.74"	$0.00	$0.00	$0.00	$0.00	"$10,556.00"	"$16,720.70"	"$16,889.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202612	EAP	Custom 27202612		18x24x13.5cm Iliac Limb Aaa St	BOTH IP/OP	"$24,857.00 "	"$18,394.18"	$0.00	"$19,885.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,159.78"	$0.00	"$5,180.20"	$0.00	$0.00	$0.00	$0.00	"$12,428.50"	"$19,686.74"	"$19,885.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202613	EAP	HCPCS C1751		Cath 6fr 1lum Try 3cg Shrlk Maximal Brr Picc P	BOTH IP/OP	"$1,010.00 "	$747.40	$0.00	$808.00	$548.43	$548.43	$0.00	$0.00	$0.00	$210.51	$749.62	$749.62	$778.51	$0.00	$210.48	$0.00	$597.42	$597.42	$0.00	$505.00	$799.92	$808.00	$0.00	$656.50	$0.00	$158.07	$0.00	$0.00	$160.79	$0.00	$0.00	$0.00	$0.00	$0.00
27202614	EAP	Custom 27202614		"Cather, Balloon, Ultra-thin Di"	BOTH IP/OP	"$1,580.00 "	"$1,169.20"	$0.00	"$1,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$790.00	"$1,251.36"	"$1,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202615	EAP	Custom 27202615		23x12x12cm Aaa Endoprosthesis	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202616	EAP	Custom 27202616		23x12x14cm Aaa Endoprosthesis	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202617	EAP	Custom 27202617		23x12x16cm Aaa Endoprosthesis	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202618	EAP	Custom 27202618		23x12x18cm Aaa Endoprosthesis	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202619	EAP	Custom 27202619		23x14.5x12cm Aaa Endoprosthesi	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202620	EAP	Custom 27202620		23x14.5x14cm Aaa Endoprosthesi	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202621	EAP	Custom 27202621		23x14.5x16cm Aaa Endoprosthesi	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202622	EAP	Custom 27202622		23x14.5x18cm Aaa Endoprosthesi	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202623	EAP	Custom 27202623		26x12x12cm Aaa Endoprosthesis	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202624	EAP	Custom 27202624		26x12x14cm Aaa Endoprosthesis	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202625	EAP	Custom 27202625		26x12x16cm Aaa Endoprosthesis	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202626	EAP	Custom 27202626		26x12x18cm Aaa Endoprosthesis	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202627	EAP	Custom 27202627		26x14.5x12cm Aaa Endoprosthesi	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202628	EAP	Custom 27202628		26x14.5x14cm Aaa Endoprosthesi	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202629	EAP	Custom 27202629		26x14.5x16cm Aaa Endoprosthesi	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202630	EAP	Custom 27202630		26x14.4x18cm Aaa Endoprosthesi	BOTH IP/OP	"$25,581.00 "	"$18,929.94"	$0.00	"$20,464.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,717.83"	$0.00	"$5,331.08"	$0.00	$0.00	$0.00	$0.00	"$12,790.50"	"$20,260.15"	"$20,464.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202631	EAP	Custom 27202631		28.5x12x12cm Aaa Endoprosthesi	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202632	EAP	Custom 27202632		28.5x12x14cm Aaa Endoprosthesi	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202633	EAP	Custom 27202633		28.5x12x16cm Aaa Endoprosthesi	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202634	EAP	Custom 27202634		28.5x12x18cm Aaa Endoprosthesi	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202635	EAP	Custom 27202635		28.5x14.5x12cm Aaa Endoprosthe	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202636	EAP	Custom 27202636		28.5x14.5x14cm Aaa Endoprosthe	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202637	EAP	Custom 27202637		28.5x14.5x16cm Aaa Endoprosthe	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202638	EAP	Custom 27202638		28.5x14.4x18cm Aaa Endoprosthe	BOTH IP/OP	"$23,752.00 "	"$17,576.48"	$0.00	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,308.04"	$0.00	"$4,949.92"	$0.00	$0.00	$0.00	$0.00	"$11,876.00"	"$18,811.58"	"$19,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202639	EAP	Custom 27202639		12x10cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202640	EAP	Custom 27202640		12x12cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202641	EAP	Custom 27202641		12x14cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202642	EAP	Custom 27202642		14.5x10cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202643	EAP	Custom 27202643		14.4x12 Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202644	EAP	Custom 27202644		14.5x14 Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202645	EAP	Custom 27202645		16x9.5cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202646	EAP	Custom 27202646		16x11.5cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202647	EAP	Custom 27202647		16x13.5cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202648	EAP	Custom 27202648		18x9.5cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202649	EAP	Custom 27202649		18x11.5cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202650	EAP	Custom 27202650		18x13.5cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202651	EAP	Custom 27202651		20x9.5cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202652	EAP	Custom 27202652		20x11.5cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202653	EAP	Custom 27202653		20x13.5cm Aaa Endoprosthesis	BOTH IP/OP	"$22,940.00 "	"$16,975.60"	$0.00	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,682.15"	$0.00	"$4,780.70"	$0.00	$0.00	$0.00	$0.00	"$11,470.00"	"$18,168.48"	"$18,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202654	EAP	Custom 27202654		12x12x8.5cm Iliac Limb Aaa Ste	BOTH IP/OP	"$18,214.00 "	"$13,478.36"	$0.00	"$14,571.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,039.35"	$0.00	"$3,795.80"	$0.00	$0.00	$0.00	$0.00	"$9,107.00"	"$14,425.49"	"$14,571.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202655	EAP	Custom 27202655		13x13x8.5cm Iliac Limb Aaa Ste	BOTH IP/OP	"$18,214.00 "	"$13,478.36"	$0.00	"$14,571.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,039.35"	$0.00	"$3,795.80"	$0.00	$0.00	$0.00	$0.00	"$9,107.00"	"$14,425.49"	"$14,571.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202656	EAP	Custom 27202656		14x14x8.5cm Iliac Limb Aaa Ste	BOTH IP/OP	"$18,214.00 "	"$13,478.36"	$0.00	"$14,571.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,039.35"	$0.00	"$3,795.80"	$0.00	$0.00	$0.00	$0.00	"$9,107.00"	"$14,425.49"	"$14,571.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202657	EAP	Custom 27202657		15x15x8.5cm Iliac Limb Aaa Ste	BOTH IP/OP	"$18,214.00 "	"$13,478.36"	$0.00	"$14,571.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,039.35"	$0.00	"$3,795.80"	$0.00	$0.00	$0.00	$0.00	"$9,107.00"	"$14,425.49"	"$14,571.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202658	EAP	Custom 27202658		16x16x8.5cm Iliac Limb Aaa Ste	BOTH IP/OP	"$18,214.00 "	"$13,478.36"	$0.00	"$14,571.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,039.35"	$0.00	"$3,795.80"	$0.00	$0.00	$0.00	$0.00	"$9,107.00"	"$14,425.49"	"$14,571.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202659	EAP	Custom 27202659		18x18x8.5cm Iliac Limb Aaa Ste	BOTH IP/OP	"$18,898.00 "	"$13,984.52"	$0.00	"$15,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,566.58"	$0.00	"$3,938.34"	$0.00	$0.00	$0.00	$0.00	"$9,449.00"	"$14,967.22"	"$15,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202660	EAP	Custom 27202660		20x20x8.5cm Iliac Limb Aaa Ste	BOTH IP/OP	"$18,898.00 "	"$13,984.52"	$0.00	"$15,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,566.58"	$0.00	"$3,938.34"	$0.00	$0.00	$0.00	$0.00	"$9,449.00"	"$14,967.22"	"$15,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202661	EAP	Custom 27202661		12x12x11.5cm Iliac Limb Aaa St	BOTH IP/OP	"$19,236.00 "	"$14,234.64"	$0.00	"$15,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,827.11"	$0.00	"$4,008.78"	$0.00	$0.00	$0.00	$0.00	"$9,618.00"	"$15,234.91"	"$15,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202662	EAP	Custom 27202662		13x13x11.5cmm Iliac Limb Aaa S	BOTH IP/OP	"$19,236.00 "	"$14,234.64"	$0.00	"$15,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,827.11"	$0.00	"$4,008.78"	$0.00	$0.00	$0.00	$0.00	"$9,618.00"	"$15,234.91"	"$15,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202663	EAP	Custom 27202663		14x14x11.5cm Iliac Limb Aaa St	BOTH IP/OP	"$19,236.00 "	"$14,234.64"	$0.00	"$15,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,827.11"	$0.00	"$4,008.78"	$0.00	$0.00	$0.00	$0.00	"$9,618.00"	"$15,234.91"	"$15,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202664	EAP	Custom 27202664		15x15x11.5cm Iliac Limb Aaa St	BOTH IP/OP	"$19,236.00 "	"$14,234.64"	$0.00	"$15,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,827.11"	$0.00	"$4,008.78"	$0.00	$0.00	$0.00	$0.00	"$9,618.00"	"$15,234.91"	"$15,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202665	EAP	Custom 27202665		16x16x11.5cm Iliac Limb Aaa St	BOTH IP/OP	"$19,236.00 "	"$14,234.64"	$0.00	"$15,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,827.11"	$0.00	"$4,008.78"	$0.00	$0.00	$0.00	$0.00	"$9,618.00"	"$15,234.91"	"$15,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202666	EAP	Custom 27202666		18x18x11.5cm Iliac Limb Aaa St	BOTH IP/OP	"$19,916.00 "	"$14,737.84"	$0.00	"$15,932.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$15,351.25"	$0.00	"$4,150.49"	$0.00	$0.00	$0.00	$0.00	"$9,958.00"	"$15,773.47"	"$15,932.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202667	EAP	Custom 27202667		20x20x11.5cm Iliac Limb Aaa St	BOTH IP/OP	"$19,916.00 "	"$14,737.84"	$0.00	"$15,932.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$15,351.25"	$0.00	"$4,150.49"	$0.00	$0.00	$0.00	$0.00	"$9,958.00"	"$15,773.47"	"$15,932.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202668	EAP	Custom 27202668		13x13x13.5cm Iliac Limb Aaa St	BOTH IP/OP	"$21,112.00 "	"$15,622.88"	$0.00	"$16,889.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$16,273.13"	$0.00	"$4,399.74"	$0.00	$0.00	$0.00	$0.00	"$10,556.00"	"$16,720.70"	"$16,889.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202669	EAP	Custom 27202669		14x14x13.5cm Iliac Limb Aaa St	BOTH IP/OP	"$21,112.00 "	"$15,622.88"	$0.00	"$16,889.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$16,273.13"	$0.00	"$4,399.74"	$0.00	$0.00	$0.00	$0.00	"$10,556.00"	"$16,720.70"	"$16,889.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202670	EAP	Custom 27202670		15x15x13.5cm Iliac Limb Aaa St	BOTH IP/OP	"$21,112.00 "	"$15,622.88"	$0.00	"$16,889.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$16,273.13"	$0.00	"$4,399.74"	$0.00	$0.00	$0.00	$0.00	"$10,556.00"	"$16,720.70"	"$16,889.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202671	EAP	Custom 27202671		16x16x13.5cm Iliac Limb Aaa St	BOTH IP/OP	"$21,112.00 "	"$15,622.88"	$0.00	"$16,889.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$16,273.13"	$0.00	"$4,399.74"	$0.00	$0.00	$0.00	$0.00	"$10,556.00"	"$16,720.70"	"$16,889.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202672	EAP	Custom 27202672		18x18x13.5cm Iliac Limb Aaa St	BOTH IP/OP	"$21,790.00 "	"$16,124.60"	$0.00	"$17,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$16,795.73"	$0.00	"$4,541.04"	$0.00	$0.00	$0.00	$0.00	"$10,895.00"	"$17,257.68"	"$17,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202673	EAP	Custom 27202673		20x20x13.5cm Iliac Limb Aaa St	BOTH IP/OP	"$21,790.00 "	"$16,124.60"	$0.00	"$17,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$16,795.73"	$0.00	"$4,541.04"	$0.00	$0.00	$0.00	$0.00	"$10,895.00"	"$17,257.68"	"$17,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202674	EAP	Custom 27202674		16x20x11.5cm Iliac Limb Aaa St	BOTH IP/OP	"$23,492.00 "	"$17,384.08"	$0.00	"$18,793.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,107.63"	$0.00	"$4,895.73"	$0.00	$0.00	$0.00	$0.00	"$11,746.00"	"$18,605.66"	"$18,793.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202675	EAP	Custom 27202675		18x22x11.5cm Iliac Limb Aaa St	BOTH IP/OP	"$23,492.00 "	"$17,384.08"	$0.00	"$18,793.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,107.63"	$0.00	"$4,895.73"	$0.00	$0.00	$0.00	$0.00	"$11,746.00"	"$18,605.66"	"$18,793.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202676	EAP	Custom 27202676		18x24x11.5cm Iliac Limb Aaa St	BOTH IP/OP	"$23,492.00 "	"$17,384.08"	$0.00	"$18,793.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,107.63"	$0.00	"$4,895.73"	$0.00	$0.00	$0.00	$0.00	"$11,746.00"	"$18,605.66"	"$18,793.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202677	EAP	Custom 27202677		16x20x13.5cm Iliac Limb Aaa St	BOTH IP/OP	"$24,857.00 "	"$18,394.18"	$0.00	"$19,885.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,159.78"	$0.00	"$5,180.20"	$0.00	$0.00	$0.00	$0.00	"$12,428.50"	"$19,686.74"	"$19,885.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202678	EAP	Custom 27202678		18x22x13.5cm Iliac Limb Aaa St	BOTH IP/OP	"$24,857.00 "	"$18,394.18"	$0.00	"$19,885.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,159.78"	$0.00	"$5,180.20"	$0.00	$0.00	$0.00	$0.00	"$12,428.50"	"$19,686.74"	"$19,885.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202679	EAP	Custom 27202679		18x24x13.5cm Iliac Limb Aaa St	BOTH IP/OP	"$24,857.00 "	"$18,394.18"	$0.00	"$19,885.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,159.78"	$0.00	"$5,180.20"	$0.00	$0.00	$0.00	$0.00	"$12,428.50"	"$19,686.74"	"$19,885.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202680	EAP	Custom 27202680		12x12x5.5cm Iliac Cuff Aaa Ste	BOTH IP/OP	"$15,151.00 "	"$11,211.74"	$0.00	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,678.39"	$0.00	"$3,157.47"	$0.00	$0.00	$0.00	$0.00	"$7,575.50"	"$11,999.59"	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202681	EAP	Custom 27202681		13x13x5.5cm Ilaic Cuff Aaa Ste	BOTH IP/OP	"$15,151.00 "	"$11,211.74"	$0.00	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,678.39"	$0.00	"$3,157.47"	$0.00	$0.00	$0.00	$0.00	"$7,575.50"	"$11,999.59"	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202682	EAP	Custom 27202682		14x14x5.5cm Iliac Cuff Aaa Ste	BOTH IP/OP	"$15,151.00 "	"$11,211.74"	$0.00	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,678.39"	$0.00	"$3,157.47"	$0.00	$0.00	$0.00	$0.00	"$7,575.50"	"$11,999.59"	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202683	EAP	Custom 27202683		15x15x5.5cm Iliac Cuff Aaa Ste	BOTH IP/OP	"$15,151.00 "	"$11,211.74"	$0.00	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,678.39"	$0.00	"$3,157.47"	$0.00	$0.00	$0.00	$0.00	"$7,575.50"	"$11,999.59"	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202684	EAP	Custom 27202684		16x15x5.5cm Iliac Cuff Aaa Ste	BOTH IP/OP	"$15,151.00 "	"$11,211.74"	$0.00	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,678.39"	$0.00	"$3,157.47"	$0.00	$0.00	$0.00	$0.00	"$7,575.50"	"$11,999.59"	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202685	EAP	Custom 27202685		18x18x5.5cm Iliac Cuff Aaa Ste	BOTH IP/OP	"$15,832.00 "	"$11,715.68"	$0.00	"$12,665.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,203.31"	$0.00	"$3,299.39"	$0.00	$0.00	$0.00	$0.00	"$7,916.00"	"$12,538.94"	"$12,665.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202686	EAP	Custom 27202686		20x20x5.5cm Iliac Cuff Aaa Ste	BOTH IP/OP	"$15,832.00 "	"$11,715.68"	$0.00	"$12,665.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,203.31"	$0.00	"$3,299.39"	$0.00	$0.00	$0.00	$0.00	"$7,916.00"	"$12,538.94"	"$12,665.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202687	EAP	HCPCS C1769		6mmx5cmx110cm 0.035 Guidewire	BOTH IP/OP	"$15,219.00 "	"$11,262.06"	$0.00	"$12,175.20"	"$8,263.92"	"$8,263.92"	$0.00	$0.00	$0.00	"$3,172.02"	"$4,181.12"	"$4,181.12"	"$11,730.81"	$0.00	"$3,171.64"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,609.50"	"$12,053.45"	"$12,175.20"	$0.00	$0.00	$0.00	"$2,381.77"	$0.00	$0.00	"$2,422.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27202688	EAP	HCPCS C1769		6mmx10cmx110cm 0.035 Guidewire	BOTH IP/OP	"$18,251.00 "	"$13,505.74"	$0.00	"$14,600.80"	"$9,910.29"	"$9,910.29"	$0.00	$0.00	$0.00	"$3,803.96"	"$4,181.12"	"$4,181.12"	"$14,067.87"	$0.00	"$3,803.51"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$9,125.50"	"$14,454.79"	"$14,600.80"	$0.00	$0.00	$0.00	"$2,856.28"	$0.00	$0.00	"$2,905.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27202689	EAP	HCPCS C1769		6mmx15cmx110cm 0.035 Guidewire	BOTH IP/OP	"$21,246.00 "	"$15,722.04"	$0.00	"$16,996.80"	"$11,536.58"	"$11,536.58"	$0.00	$0.00	$0.00	"$4,428.20"	"$4,181.12"	"$4,181.12"	"$16,376.42"	$0.00	"$4,427.67"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$10,623.00"	"$16,826.83"	"$16,996.80"	$0.00	$0.00	$0.00	"$3,325.00"	$0.00	$0.00	"$3,382.36"	$0.00	$0.00	$0.00	$0.00	$0.00
27202690	EAP	HCPCS C1769		7mmx5cmx110cm 0.035 Guidewire	BOTH IP/OP	"$15,219.00 "	"$11,262.06"	$0.00	"$12,175.20"	"$8,263.92"	"$8,263.92"	$0.00	$0.00	$0.00	"$3,172.02"	"$4,181.12"	"$4,181.12"	"$11,730.81"	$0.00	"$3,171.64"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,609.50"	"$12,053.45"	"$12,175.20"	$0.00	$0.00	$0.00	"$2,381.77"	$0.00	$0.00	"$2,422.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27202691	EAP	HCPCS C1769		7mmx10cmx110cm 0.035 Guidewire	BOTH IP/OP	"$18,251.00 "	"$13,505.74"	$0.00	"$14,600.80"	"$9,910.29"	"$9,910.29"	$0.00	$0.00	$0.00	"$3,803.96"	"$4,181.12"	"$4,181.12"	"$14,067.87"	$0.00	"$3,803.51"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$9,125.50"	"$14,454.79"	"$14,600.80"	$0.00	$0.00	$0.00	"$2,856.28"	$0.00	$0.00	"$2,905.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27202692	EAP	HCPCS C1769		7mmx15cmx110cm 0.035 Guidewire	BOTH IP/OP	"$21,246.00 "	"$15,722.04"	$0.00	"$16,996.80"	"$11,536.58"	"$11,536.58"	$0.00	$0.00	$0.00	"$4,428.20"	"$4,181.12"	"$4,181.12"	"$16,376.42"	$0.00	"$4,427.67"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$10,623.00"	"$16,826.83"	"$16,996.80"	$0.00	$0.00	$0.00	"$3,325.00"	$0.00	$0.00	"$3,382.36"	$0.00	$0.00	$0.00	$0.00	$0.00
27202693	EAP	HCPCS C1769		8mmx5cmx110cm 0.035 Guidewire	BOTH IP/OP	"$15,219.00 "	"$11,262.06"	$0.00	"$12,175.20"	"$8,263.92"	"$8,263.92"	$0.00	$0.00	$0.00	"$3,172.02"	"$4,181.12"	"$4,181.12"	"$11,730.81"	$0.00	"$3,171.64"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,609.50"	"$12,053.45"	"$12,175.20"	$0.00	$0.00	$0.00	"$2,381.77"	$0.00	$0.00	"$2,422.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27202694	EAP	HCPCS C1769		8mmx10cmx110cm 0.035 Guidewire	BOTH IP/OP	"$18,251.00 "	"$13,505.74"	$0.00	"$14,600.80"	"$9,910.29"	"$9,910.29"	$0.00	$0.00	$0.00	"$3,803.96"	"$4,181.12"	"$4,181.12"	"$14,067.87"	$0.00	"$3,803.51"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$9,125.50"	"$14,454.79"	"$14,600.80"	$0.00	$0.00	$0.00	"$2,856.28"	$0.00	$0.00	"$2,905.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27202695	EAP	HCPCS C1769		8mmx15cmx110cm 0.035 Guidewire	BOTH IP/OP	"$21,246.00 "	"$15,722.04"	$0.00	"$16,996.80"	"$11,536.58"	"$11,536.58"	$0.00	$0.00	$0.00	"$4,428.20"	"$4,181.12"	"$4,181.12"	"$16,376.42"	$0.00	"$4,427.67"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$10,623.00"	"$16,826.83"	"$16,996.80"	$0.00	$0.00	$0.00	"$3,325.00"	$0.00	$0.00	"$3,382.36"	$0.00	$0.00	$0.00	$0.00	$0.00
27202696	EAP	HCPCS C1769		10mmx5cmx110cm 0.025 Guidewire	BOTH IP/OP	"$15,219.00 "	"$11,262.06"	$0.00	"$12,175.20"	"$8,263.92"	"$8,263.92"	$0.00	$0.00	$0.00	"$3,172.02"	"$4,181.12"	"$4,181.12"	"$11,730.81"	$0.00	"$3,171.64"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,609.50"	"$12,053.45"	"$12,175.20"	$0.00	"$9,892.35"	$0.00	"$2,381.77"	$0.00	$0.00	"$2,422.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27202697	EAP	HCPCS C1769		10mmx10cmx110cm 0.025 Guidewir	BOTH IP/OP	"$18,251.00 "	"$13,505.74"	$0.00	"$14,600.80"	"$9,910.29"	"$9,910.29"	$0.00	$0.00	$0.00	"$3,803.96"	"$4,181.12"	"$4,181.12"	"$14,067.87"	$0.00	"$3,803.51"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$9,125.50"	"$14,454.79"	"$14,600.80"	$0.00	"$11,863.15"	$0.00	"$2,856.28"	$0.00	$0.00	"$2,905.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27202698	EAP	HCPCS C1769		13mmx5cmx110cm 0.025 Guidewire	BOTH IP/OP	"$15,219.00 "	"$11,262.06"	$0.00	"$12,175.20"	"$8,263.92"	"$8,263.92"	$0.00	$0.00	$0.00	"$3,172.02"	"$4,181.12"	"$4,181.12"	"$11,730.81"	$0.00	"$3,171.64"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,609.50"	"$12,053.45"	"$12,175.20"	$0.00	"$9,892.35"	$0.00	"$2,381.77"	$0.00	$0.00	"$2,422.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27202699	EAP	HCPCS C1769		13mmx2.5cmx110cm 0.025 Guidewi	BOTH IP/OP	"$15,219.00 "	"$11,262.06"	$0.00	"$12,175.20"	"$8,263.92"	"$8,263.92"	$0.00	$0.00	$0.00	"$3,172.02"	"$4,181.12"	"$4,181.12"	"$11,730.81"	$0.00	"$3,171.64"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,609.50"	"$12,053.45"	"$12,175.20"	$0.00	$0.00	$0.00	"$2,381.77"	$0.00	$0.00	"$2,422.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27202700	EAP	Custom 27202700		16mmx20mmx8.5cm Aaa Stent Graf	BOTH IP/OP	"$22,131.00 "	"$16,376.94"	$0.00	"$17,704.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,058.57"	$0.00	"$4,612.10"	$0.00	$0.00	$0.00	$0.00	"$11,065.50"	"$17,527.75"	"$17,704.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202701	EAP	Custom 27202701		18mmx22mmx8.5cm Aaa Stent Graf	BOTH IP/OP	"$22,131.00 "	"$16,376.94"	$0.00	"$17,704.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,058.57"	$0.00	"$4,612.10"	$0.00	$0.00	$0.00	$0.00	"$11,065.50"	"$17,527.75"	"$17,704.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202702	EAP	Custom 27202702		18mmx24mmx8.5cm Aaa Stent Graf	BOTH IP/OP	"$22,131.00 "	"$16,376.94"	$0.00	"$17,704.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,058.57"	$0.00	"$4,612.10"	$0.00	$0.00	$0.00	$0.00	"$11,065.50"	"$17,527.75"	"$17,704.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202703	EAP	Custom 27202703		20mmx4.0cm Aaa Stent Graft	BOTH IP/OP	"$15,151.00 "	"$11,211.74"	$0.00	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,678.39"	$0.00	"$3,157.47"	$0.00	$0.00	$0.00	$0.00	"$7,575.50"	"$11,999.59"	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202704	EAP	Custom 27202704		22mmx4.0cm Aaa Stent Graft	BOTH IP/OP	"$15,151.00 "	"$11,211.74"	$0.00	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,678.39"	$0.00	"$3,157.47"	$0.00	$0.00	$0.00	$0.00	"$7,575.50"	"$11,999.59"	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202705	EAP	Custom 27202705		24mmx4.0cm Aaa Stent Graft	BOTH IP/OP	"$15,151.00 "	"$11,211.74"	$0.00	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,678.39"	$0.00	"$3,157.47"	$0.00	$0.00	$0.00	$0.00	"$7,575.50"	"$11,999.59"	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202706	EAP	Custom 27202706		26mmx4.0cm Aaa Stent Graft	BOTH IP/OP	"$15,151.00 "	"$11,211.74"	$0.00	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,678.39"	$0.00	"$3,157.47"	$0.00	$0.00	$0.00	$0.00	"$7,575.50"	"$11,999.59"	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202707	EAP	Custom 27202707		28mmx4.0cm Aaa Stent Graft	BOTH IP/OP	"$15,151.00 "	"$11,211.74"	$0.00	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,678.39"	$0.00	"$3,157.47"	$0.00	$0.00	$0.00	$0.00	"$7,575.50"	"$11,999.59"	"$12,120.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202708	EAP	Custom 27202708		23x3.3cm Aaa Endoprosthesis	BOTH IP/OP	"$17,322.00 "	"$12,818.28"	$0.00	"$13,857.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,351.80"	$0.00	"$3,609.90"	$0.00	$0.00	$0.00	$0.00	"$8,661.00"	"$13,719.02"	"$13,857.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202709	EAP	Custom 27202709		26x3.3cm Aaa Endprosthesis	BOTH IP/OP	"$17,322.00 "	"$12,818.28"	$0.00	"$13,857.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,351.80"	$0.00	"$3,609.90"	$0.00	$0.00	$0.00	$0.00	"$8,661.00"	"$13,719.02"	"$13,857.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202710	EAP	Custom 27202710		28.5x3.3cm Aaa Endoprosthesis	BOTH IP/OP	"$16,083.00 "	"$11,901.42"	$0.00	"$12,866.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,396.78"	$0.00	"$3,351.70"	$0.00	$0.00	$0.00	$0.00	"$8,041.50"	"$12,737.74"	"$12,866.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202711	EAP	Custom 27202711		10x7cm Aaa Endoprosthesis	BOTH IP/OP	"$16,083.00 "	"$11,901.42"	$0.00	"$12,866.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,396.78"	$0.00	"$3,351.70"	$0.00	$0.00	$0.00	$0.00	"$8,041.50"	"$12,737.74"	"$12,866.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202712	EAP	Custom 27202712		12x7cm Aaa Endoprosthesis	BOTH IP/OP	"$16,083.00 "	"$11,901.42"	$0.00	"$12,866.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,396.78"	$0.00	"$3,351.70"	$0.00	$0.00	$0.00	$0.00	"$8,041.50"	"$12,737.74"	"$12,866.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202713	EAP	Custom 27202713		14.5x7cm Aaa Endoprosthesis	BOTH IP/OP	"$16,083.00 "	"$11,901.42"	$0.00	"$12,866.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,396.78"	$0.00	"$3,351.70"	$0.00	$0.00	$0.00	$0.00	"$8,041.50"	"$12,737.74"	"$12,866.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202714	EAP	Custom 27202714		12frx30cm Introducer Sheath	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$404.67	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202715	EAP	Custom 27202715		18frx30cm Intruder Sheath	BOTH IP/OP	$902.00 	$667.48	$0.00	$721.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$669.46	$669.46	$695.26	$0.00	$187.98	$0.00	$0.00	$0.00	$0.00	$451.00	$714.38	$721.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202716	EAP	Custom 27202716		26x10cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202717	EAP	Custom 27202717		28x10cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202718	EAP	Custom 27202718		28x15cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202719	EAP	Custom 27202719		31x10cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202720	EAP	Custom 27202720		31x15cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202721	EAP	Custom 27202721		34x10cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202722	EAP	Custom 27202722		34x15cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202723	EAP	Custom 27202723		34x20cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202724	EAP	Custom 27202724		37x10cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202725	EAP	Custom 27202725		37x15cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202726	EAP	Custom 27202726		37x20cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202727	EAP	Custom 27202727		40x10cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202728	EAP	Custom 27202728		40x15cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202729	EAP	Custom 27202729		40x20cm Thoracic Endoprosthesi	BOTH IP/OP	"$23,023.00 "	"$17,037.02"	$0.00	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,746.13"	$0.00	"$4,797.99"	$0.00	$0.00	$0.00	$0.00	"$11,511.50"	"$18,234.22"	"$18,418.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202730	EAP	Custom 27202730		20frx30cm Introducer Sheath	BOTH IP/OP	"$2,043.00 "	"$1,511.82"	$0.00	"$1,634.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,516.31"	"$1,516.31"	"$1,574.74"	$0.00	$425.76	$0.00	$0.00	$0.00	$0.00	"$1,021.50"	"$1,618.06"	"$1,634.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202731	EAP	Custom 27202731		22frx30cm Introducer Sheath	BOTH IP/OP	"$2,043.00 "	"$1,511.82"	$0.00	"$1,634.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,516.31"	"$1,516.31"	"$1,574.74"	$0.00	$425.76	$0.00	$0.00	$0.00	$0.00	"$1,021.50"	"$1,618.06"	"$1,634.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202732	EAP	Custom 27202732		24frx30cm Introducer Sheath	BOTH IP/OP	"$2,043.00 "	"$1,511.82"	$0.00	"$1,634.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,516.31"	"$1,516.31"	"$1,574.74"	$0.00	$425.76	$0.00	$0.00	$0.00	$0.00	"$1,021.50"	"$1,618.06"	"$1,634.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202733	EAP	Custom 27202733		Gore Tri-lobe Ballon Catheter	BOTH IP/OP	"$3,391.00 "	"$2,509.34"	$0.00	"$2,712.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,516.80"	"$2,516.80"	"$2,613.78"	$0.00	$706.68	$0.00	$0.00	$0.00	$0.00	"$1,695.50"	"$2,685.67"	"$2,712.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202734	EAP	Custom 27202734		20x12x135mm Aaa Stent Graft	BOTH IP/OP	"$25,471.00 "	"$18,848.54"	$0.00	"$20,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,633.05"	$0.00	"$5,308.16"	$0.00	$0.00	$0.00	$0.00	"$12,735.50"	"$20,173.03"	"$20,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202735	EAP	Custom 27202735		22x13x135mm Aaa Stent Graft	BOTH IP/OP	"$25,471.00 "	"$18,848.54"	$0.00	"$20,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,633.05"	$0.00	"$5,308.16"	$0.00	$0.00	$0.00	$0.00	"$12,735.50"	"$20,173.03"	"$20,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202736	EAP	Custom 27202736		24x14x135mm Aaa Stent Graft	BOTH IP/OP	"$25,471.00 "	"$18,848.54"	$0.00	"$20,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,633.05"	$0.00	"$5,308.16"	$0.00	$0.00	$0.00	$0.00	"$12,735.50"	"$20,173.03"	"$20,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202737	EAP	Custom 27202737		26x15x135mm Aaa Stent Graft	BOTH IP/OP	"$25,471.00 "	"$18,848.54"	$0.00	"$20,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,633.05"	$0.00	"$5,308.16"	$0.00	$0.00	$0.00	$0.00	"$12,735.50"	"$20,173.03"	"$20,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202738	EAP	Custom 27202738		28x16x135mm Aaa Stent Graft	BOTH IP/OP	"$25,471.00 "	"$18,848.54"	$0.00	"$20,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,633.05"	$0.00	"$5,308.16"	$0.00	$0.00	$0.00	$0.00	"$12,735.50"	"$20,173.03"	"$20,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202739	EAP	Custom 27202739		20x12x165mm Aaa Stent Graft	BOTH IP/OP	"$1,232.00 "	$911.68	$0.00	$985.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$914.39	$914.39	$949.63	$0.00	$256.75	$0.00	$0.00	$0.00	$0.00	$616.00	$975.74	$985.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202740	EAP	Custom 27202740		22x13x165mm Aaa Stent Graft	BOTH IP/OP	"$1,232.00 "	$911.68	$0.00	$985.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$914.39	$914.39	$949.63	$0.00	$256.75	$0.00	$0.00	$0.00	$0.00	$616.00	$975.74	$985.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202741	EAP	Custom 27202741		24x14x165mm Aaa Stent Graft	BOTH IP/OP	"$1,232.00 "	$911.68	$0.00	$985.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$914.39	$914.39	$949.63	$0.00	$256.75	$0.00	$0.00	$0.00	$0.00	$616.00	$975.74	$985.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202742	EAP	Custom 27202742		26x15x165mm Aaa Stent Graft	BOTH IP/OP	"$1,232.00 "	$911.68	$0.00	$985.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$914.39	$914.39	$949.63	$0.00	$256.75	$0.00	$0.00	$0.00	$0.00	$616.00	$975.74	$985.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202743	EAP	Custom 27202743		28x16x165mm Aaa Stent Graft	BOTH IP/OP	"$1,232.00 "	$911.68	$0.00	$985.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$914.39	$914.39	$949.63	$0.00	$256.75	$0.00	$0.00	$0.00	$0.00	$616.00	$975.74	$985.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202744	EAP	Custom 27202744		"Cath, Angioplasty Spv"	BOTH IP/OP	"$1,074.00 "	$794.76	$0.00	$859.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$537.00	$850.61	$859.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202745	EAP	HCPCS C1729		Catheter Drainage Spv	BOTH IP/OP	$333.00 	$246.42	$0.00	$266.40	$180.82	$180.82	$0.00	$0.00	$0.00	$69.41	$247.15	$247.15	$256.68	$0.00	$69.40	$0.00	$196.97	$196.97	$0.00	$166.50	$263.74	$266.40	$0.00	$0.00	$0.00	$52.11	$0.00	$0.00	$53.01	$0.00	$0.00	$0.00	$0.00	$0.00
27202746	EAP	Custom 27202746		"Cath, Hemodial, Long-term Spv"	BOTH IP/OP	"$1,131.00 "	$836.94	$0.00	$904.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$565.50	$895.75	$904.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202747	EAP	Custom 27202747		"Cath, Infusion Non-hemo Spv"	BOTH IP/OP	$431.00 	$318.94	$0.00	$344.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.50	$341.35	$344.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202748	EAP	Custom 27202748		"Cath, Hemodial, Short-term Spv"	BOTH IP/OP	$587.00 	$434.38	$0.00	$469.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$293.50	$464.90	$469.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202749	EAP	Custom 27202749		"Cath,thrombect/embolect Spv"	BOTH IP/OP	"$2,336.00 "	"$1,728.64"	$0.00	"$1,868.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,168.00"	"$1,850.11"	"$1,868.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202750	EAP	Custom 27202750		Retrieval Device Spv	BOTH IP/OP	$391.00 	$289.34	$0.00	$312.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.20	$290.20	$301.38	$0.00	$81.48	$0.00	$0.00	$0.00	$0.00	$195.50	$309.67	$312.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202751	EAP	Custom 27202751		"Port, Implantable Spv"	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	"$1,487.64"	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202752	EAP	Custom 27202752		"Stent, Covrd, W/delv Spv"	BOTH IP/OP	"$7,595.00 "	"$5,620.30"	$0.00	"$6,076.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,854.23"	$0.00	"$1,582.80"	$0.00	$0.00	$0.00	$0.00	"$3,797.50"	"$6,015.24"	"$6,076.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202753	EAP	Custom 27202753		"Stent, Non-covrd W/delv Spv"	BOTH IP/OP	"$5,824.00 "	"$4,309.76"	$0.00	"$4,659.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,489.14"	$0.00	"$1,213.72"	$0.00	$0.00	$0.00	$0.00	"$2,912.00"	"$4,612.61"	"$4,659.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202754	EAP	Custom 27202754		"Stent, Non-covrd W/o Delv Spv"	BOTH IP/OP	"$3,412.00 "	"$2,524.88"	$0.00	"$2,729.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,532.39"	"$2,532.39"	"$2,629.97"	$0.00	$711.06	$0.00	$0.00	$0.00	$0.00	"$1,706.00"	"$2,702.30"	"$2,729.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202755	EAP	HCPCS C1887		"Catheter, Guiding Spv"	BOTH IP/OP	$431.00 	$318.94	$0.00	$344.80	$234.03	$234.03	$0.00	$0.00	$0.00	$89.83	$319.89	$319.89	$332.21	$0.00	$89.82	$0.00	$254.94	$254.94	$0.00	$215.50	$341.35	$344.80	$0.00	$0.00	$0.00	$67.45	$0.00	$0.00	$68.62	$0.00	$0.00	$0.00	$0.00	$0.00
27202756	EAP	Custom 27202756		Workhorse Balloon Catheter	BOTH IP/OP	"$1,462.00 "	"$1,081.88"	$0.00	"$1,169.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,085.10"	"$1,085.10"	"$1,126.91"	$0.00	$304.68	$0.00	$0.00	$0.00	$0.00	$731.00	"$1,157.90"	"$1,169.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202757	EAP	Custom 27202757		Opta 5 Balloon Catheter	BOTH IP/OP	"$1,462.00 "	"$1,081.88"	$0.00	"$1,169.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,085.10"	"$1,085.10"	"$1,126.91"	$0.00	$304.68	$0.00	$0.00	$0.00	$0.00	$731.00	"$1,157.90"	"$1,169.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202758	EAP	Custom 27202758		Arrow-trerotola Device	BOTH IP/OP	"$3,506.00 "	"$2,594.44"	$0.00	"$2,804.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,602.15"	"$2,602.15"	"$2,702.42"	$0.00	$730.65	$0.00	$0.00	$0.00	$0.00	"$1,753.00"	"$2,776.75"	"$2,804.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202759	EAP	Custom 27202759		Flexima Biliary Drain Cath W/l	BOTH IP/OP	$439.00 	$324.86	$0.00	$351.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$325.83	$325.83	$338.38	$0.00	$91.49	$0.00	$0.00	$0.00	$0.00	$219.50	$347.69	$351.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202760	EAP	Custom 27202760		"Catheter, Occlusion Spv"	BOTH IP/OP	"$2,336.00 "	"$1,728.64"	$0.00	"$1,868.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,733.78"	"$1,733.78"	"$1,800.59"	$0.00	$486.82	$0.00	$0.00	$0.00	$0.00	"$1,168.00"	"$1,850.11"	"$1,868.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202761	EAP	Custom 27202761		"G - Feeding Kit, 18fr, 2.5l"	BOTH IP/OP	"$1,090.00 "	$806.60	$0.00	$872.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$809.00	$809.00	$840.17	$0.00	$227.16	$0.00	$0.00	$0.00	$0.00	$545.00	$863.28	$872.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202786	EAP	HCPCS C1892		8fr-14cm Peel Away Sheath	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$54.84	$54.84	$0.00	$0.00	$0.00	$21.05	$74.96	$74.96	$77.85	$0.00	$21.05	$0.00	$59.74	$59.74	$0.00	$50.50	$79.99	$80.80	$0.00	$0.00	$0.00	$15.81	$0.00	$0.00	$16.08	$0.00	$0.00	$0.00	$0.00	$0.00
27202790	EAP	Custom 27202790		Alligator Retrieval	BOTH IP/OP	"$8,967.00 "	"$6,635.58"	$0.00	"$7,173.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,911.76"	$0.00	"$1,868.72"	$0.00	$0.00	$0.00	$0.00	"$4,483.50"	"$7,101.86"	"$7,173.60"	$0.00	"$5,828.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202791	EAP	HCPCS C1769		Cadence Precision	BOTH IP/OP	"$1,703.00 "	"$1,260.22"	$0.00	"$1,362.40"	$924.73	$924.73	$0.00	$0.00	$0.00	$354.95	"$1,263.97"	"$1,263.97"	"$1,312.67"	$0.00	$354.91	$0.00	"$1,007.32"	"$1,007.32"	$0.00	$851.50	"$1,348.78"	"$1,362.40"	$0.00	$0.00	$0.00	$266.52	$0.00	$0.00	$271.12	$0.00	$0.00	$0.00	$0.00	$0.00
27202792	EAP	HCPCS C1751		Catheter Echelon 10 Micro	BOTH IP/OP	"$2,423.00 "	"$1,793.02"	$0.00	"$1,938.40"	"$1,315.69"	"$1,315.69"	$0.00	$0.00	$0.00	$505.01	"$1,798.35"	"$1,798.35"	"$1,867.65"	$0.00	$504.95	$0.00	"$1,433.20"	"$1,433.20"	$0.00	"$1,211.50"	"$1,919.02"	"$1,938.40"	$0.00	$0.00	$0.00	$379.20	$0.00	$0.00	$385.74	$0.00	$0.00	$0.00	$0.00	$0.00
27202794	EAP	Custom 27202794		Catheter Marathon	BOTH IP/OP	"$2,152.00 "	"$1,592.48"	$0.00	"$1,721.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.21"	"$1,597.21"	"$1,658.76"	$0.00	$448.48	$0.00	$0.00	$0.00	$0.00	"$1,076.00"	"$1,704.38"	"$1,721.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202795	EAP	HCPCS C2628		Catheter Marksman 105cm	BOTH IP/OP	"$3,587.00 "	"$2,654.38"	$0.00	"$2,869.60"	"$1,947.74"	"$1,947.74"	$0.00	$0.00	$0.00	$747.62	"$2,662.27"	"$2,662.27"	"$2,764.86"	$0.00	$747.53	$0.00	"$2,121.71"	"$2,121.71"	$0.00	"$1,793.50"	"$2,840.90"	"$2,869.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202796	EAP	HCPCS C2628		Catheter Marksman 135cm	BOTH IP/OP	"$3,587.00 "	"$2,654.38"	$0.00	"$2,869.60"	"$1,947.74"	"$1,947.74"	$0.00	$0.00	$0.00	$747.62	"$2,662.27"	"$2,662.27"	"$2,764.86"	$0.00	$747.53	$0.00	"$2,121.71"	"$2,121.71"	$0.00	"$1,793.50"	"$2,840.90"	"$2,869.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202797	EAP	Custom 27202797		Catheter Marksman 150cm	BOTH IP/OP	"$3,587.00 "	"$2,654.38"	$0.00	"$2,869.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,662.27"	"$2,662.27"	"$2,764.86"	$0.00	$747.53	$0.00	$0.00	$0.00	$0.00	"$1,793.50"	"$2,840.90"	"$2,869.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202798	EAP	HCPCS C1751		Catheter Rebar-027 130cm Micro	BOTH IP/OP	$989.00 	$731.86	$0.00	$791.20	$537.03	$537.03	$0.00	$0.00	$0.00	$206.13	$734.04	$734.04	$762.32	$0.00	$206.11	$0.00	$584.99	$584.99	$0.00	$494.50	$783.29	$791.20	$0.00	$0.00	$0.00	$154.78	$0.00	$0.00	$157.45	$0.00	$0.00	$0.00	$0.00	$0.00
27202799	EAP	HCPCS C1751		Catheter Rebar-027 145cm Micro	BOTH IP/OP	$989.00 	$731.86	$0.00	$791.20	$537.03	$537.03	$0.00	$0.00	$0.00	$206.13	$734.04	$734.04	$762.32	$0.00	$206.11	$0.00	$584.99	$584.99	$0.00	$494.50	$783.29	$791.20	$0.00	$0.00	$0.00	$154.78	$0.00	$0.00	$157.45	$0.00	$0.00	$0.00	$0.00	$0.00
27202800	EAP	HCPCS C1751		Catheter Rebar-10 153cm Micro	BOTH IP/OP	"$1,777.00 "	"$1,314.98"	$0.00	"$1,421.60"	$964.91	$964.91	$0.00	$0.00	$0.00	$370.37	"$1,318.89"	"$1,318.89"	"$1,369.71"	$0.00	$370.33	$0.00	"$1,051.10"	"$1,051.10"	$0.00	$888.50	"$1,407.38"	"$1,421.60"	$0.00	$0.00	$0.00	$278.10	$0.00	$0.00	$282.90	$0.00	$0.00	$0.00	$0.00	$0.00
27202801	EAP	HCPCS C1751		Catheter Rebar-14 153cm Micro	BOTH IP/OP	"$1,777.00 "	"$1,314.98"	$0.00	"$1,421.60"	$964.91	$964.91	$0.00	$0.00	$0.00	$370.37	"$1,318.89"	"$1,318.89"	"$1,369.71"	$0.00	$370.33	$0.00	"$1,051.10"	"$1,051.10"	$0.00	$888.50	"$1,407.38"	"$1,421.60"	$0.00	$0.00	$0.00	$278.10	$0.00	$0.00	$282.90	$0.00	$0.00	$0.00	$0.00	$0.00
27202802	EAP	HCPCS C1751		Catheter Rebar-18 130cm Micro	BOTH IP/OP	"$1,023.00 "	$757.02	$0.00	$818.40	$555.49	$555.49	$0.00	$0.00	$0.00	$213.22	$759.27	$759.27	$788.53	$0.00	$213.19	$0.00	$605.10	$605.10	$0.00	$511.50	$810.22	$818.40	$0.00	$0.00	$0.00	$160.10	$0.00	$0.00	$162.86	$0.00	$0.00	$0.00	$0.00	$0.00
27202803	EAP	HCPCS C1751		Catheter Rebar-18 153 Micro	BOTH IP/OP	"$1,292.00 "	$956.08	$0.00	"$1,033.60"	$701.56	$701.56	$0.00	$0.00	$0.00	$269.29	$958.92	$958.92	$995.87	$0.00	$269.25	$0.00	$764.22	$764.22	$0.00	$646.00	"$1,023.26"	"$1,033.60"	$0.00	$0.00	$0.00	$202.20	$0.00	$0.00	$205.69	$0.00	$0.00	$0.00	$0.00	$0.00
27202804	EAP	HCPCS C1751		Catheter Rebar-18 153cm Micro	BOTH IP/OP	"$1,435.00 "	"$1,061.90"	$0.00	"$1,148.00"	$779.21	$779.21	$0.00	$0.00	$0.00	$299.09	"$1,065.06"	"$1,065.06"	"$1,106.10"	$0.00	$299.05	$0.00	$848.80	$848.80	$0.00	$717.50	"$1,136.52"	"$1,148.00"	$0.00	$0.00	$0.00	$224.58	$0.00	$0.00	$228.45	$0.00	$0.00	$0.00	$0.00	$0.00
27202806	EAP	Custom 27202806		Dribath Onyx Heater Us	BOTH IP/OP	"$1,793.00 "	"$1,326.82"	$0.00	"$1,434.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,330.76"	"$1,330.76"	"$1,382.04"	$0.00	$373.66	$0.00	$0.00	$0.00	$0.00	$896.50	"$1,420.06"	"$1,434.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202808	EAP	HCPCS C1751		Extended Ultraflow	BOTH IP/OP	"$1,793.00 "	"$1,326.82"	$0.00	"$1,434.40"	$973.60	$973.60	$0.00	$0.00	$0.00	$373.71	"$1,330.76"	"$1,330.76"	"$1,382.04"	$0.00	$373.66	$0.00	"$1,060.56"	"$1,060.56"	$0.00	$896.50	"$1,420.06"	"$1,434.40"	$0.00	$0.00	$0.00	$280.60	$0.00	$0.00	$285.45	$0.00	$0.00	$0.00	$0.00	$0.00
27202809	EAP	HCPCS C1769		Guidewire Silverspeed .010	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$447.98	$447.98	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$635.91	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$412.50	$653.40	$660.00	$0.00	$0.00	$0.00	$129.11	$0.00	$0.00	$131.34	$0.00	$0.00	$0.00	$0.00	$0.00
27202810	EAP	HCPCS C1769		Guidewire Silverspeed .014	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$447.98	$447.98	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$635.91	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$412.50	$653.40	$660.00	$0.00	$0.00	$0.00	$129.11	$0.00	$0.00	$131.34	$0.00	$0.00	$0.00	$0.00	$0.00
27202811	EAP	HCPCS C1769		Guidewire Silverspeed .016	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$399.11	$399.11	$0.00	$0.00	$0.00	$153.19	$545.52	$545.52	$566.54	$0.00	$153.17	$0.00	$434.75	$434.75	$0.00	$367.50	$582.12	$588.00	$0.00	$477.75	$0.00	$115.03	$0.00	$0.00	$117.01	$0.00	$0.00	$0.00	$0.00	$0.00
27202812	EAP	HCPCS C1769		Guidewire X-celerator .010r	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$643.46	$643.46	$0.00	$0.00	$0.00	$246.98	$879.51	$879.51	$913.40	$0.00	$246.95	$0.00	$700.93	$700.93	$0.00	$592.50	$938.52	$948.00	$0.00	$0.00	$0.00	$185.45	$0.00	$0.00	$188.65	$0.00	$0.00	$0.00	$0.00	$0.00
27202813	EAP	HCPCS C1769		Guidewire X-celerator-14 Re	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$643.46	$643.46	$0.00	$0.00	$0.00	$246.98	$879.51	$879.51	$913.40	$0.00	$246.95	$0.00	$700.93	$700.93	$0.00	$592.50	$938.52	$948.00	$0.00	$0.00	$0.00	$185.45	$0.00	$0.00	$188.65	$0.00	$0.00	$0.00	$0.00	$0.00
27202814	EAP	HCPCS C1769		Guidewire X-pedion 14 2	BOTH IP/OP	$897.00 	$663.78	$0.00	$717.60	$487.07	$487.07	$0.00	$0.00	$0.00	$186.96	$665.75	$665.75	$691.41	$0.00	$186.93	$0.00	$530.58	$530.58	$0.00	$448.50	$710.42	$717.60	$0.00	$0.00	$0.00	$140.38	$0.00	$0.00	$142.80	$0.00	$0.00	$0.00	$0.00	$0.00
27202815	EAP	HCPCS C1769		Guidewire X-pedion-10 Re 2	BOTH IP/OP	$897.00 	$663.78	$0.00	$717.60	$487.07	$487.07	$0.00	$0.00	$0.00	$186.96	$665.75	$665.75	$691.41	$0.00	$186.93	$0.00	$530.58	$530.58	$0.00	$448.50	$710.42	$717.60	$0.00	$0.00	$0.00	$140.38	$0.00	$0.00	$142.80	$0.00	$0.00	$0.00	$0.00	$0.00
27202816	EAP	HCPCS C1726		Hyperglide 3.0 X 10mm	BOTH IP/OP	"$3,837.00 "	"$2,839.38"	$0.00	"$3,069.60"	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$0.00	$799.73	"$2,847.82"	"$2,847.82"	"$2,957.56"	$0.00	$799.63	$0.00	"$2,269.59"	"$2,269.59"	$0.00	"$1,918.50"	"$3,038.90"	"$3,069.60"	$0.00	$0.00	$0.00	$600.49	$0.00	$0.00	$610.85	$0.00	$0.00	$0.00	$0.00	$0.00
27202817	EAP	HCPCS C1726		Hyperglide 3.0 X 15mm	BOTH IP/OP	"$3,837.00 "	"$2,839.38"	$0.00	"$3,069.60"	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$0.00	$799.73	"$2,847.82"	"$2,847.82"	"$2,957.56"	$0.00	$799.63	$0.00	"$2,269.59"	"$2,269.59"	$0.00	"$1,918.50"	"$3,038.90"	"$3,069.60"	$0.00	$0.00	$0.00	$600.49	$0.00	$0.00	$610.85	$0.00	$0.00	$0.00	$0.00	$0.00
27202818	EAP	HCPCS C1726		Hyperglide 4.0 X 10mm	BOTH IP/OP	"$3,837.00 "	"$2,839.38"	$0.00	"$3,069.60"	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$0.00	$799.73	"$2,847.82"	"$2,847.82"	"$2,957.56"	$0.00	$799.63	$0.00	"$2,269.59"	"$2,269.59"	$0.00	"$1,918.50"	"$3,038.90"	"$3,069.60"	$0.00	$0.00	$0.00	$600.49	$0.00	$0.00	$610.85	$0.00	$0.00	$0.00	$0.00	$0.00
27202819	EAP	HCPCS C1726		Hyperglide 4.0 X 20mm	BOTH IP/OP	"$3,676.00 "	"$2,720.24"	$0.00	"$2,940.80"	"$1,996.07"	"$1,996.07"	$0.00	$0.00	$0.00	$766.17	"$2,728.33"	"$2,728.33"	"$2,833.46"	$0.00	$766.08	$0.00	"$2,174.35"	"$2,174.35"	$0.00	"$1,838.00"	"$2,911.39"	"$2,940.80"	$0.00	$0.00	$0.00	$575.29	$0.00	$0.00	$585.22	$0.00	$0.00	$0.00	$0.00	$0.00
27202820	EAP	HCPCS C1726		Hyperglide 5.0 X 15mm	BOTH IP/OP	"$3,837.00 "	"$2,839.38"	$0.00	"$3,069.60"	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$0.00	$799.73	"$2,847.82"	"$2,847.82"	"$2,957.56"	$0.00	$799.63	$0.00	"$2,269.59"	"$2,269.59"	$0.00	"$1,918.50"	"$3,038.90"	"$3,069.60"	$0.00	$0.00	$0.00	$600.49	$0.00	$0.00	$610.85	$0.00	$0.00	$0.00	$0.00	$0.00
27202821	EAP	HCPCS C1726		Hyperglide 5.0 X 20mm	BOTH IP/OP	"$1,472.00 "	"$1,089.28"	$0.00	"$1,177.60"	$799.30	$799.30	$0.00	$0.00	$0.00	$306.80	"$1,092.52"	"$1,092.52"	"$1,134.62"	$0.00	$306.76	$0.00	$870.69	$870.69	$0.00	$736.00	"$1,165.82"	"$1,177.60"	$0.00	$0.00	$0.00	$230.37	$0.00	$0.00	$234.34	$0.00	$0.00	$0.00	$0.00	$0.00
27202822	EAP	HCPCS C1751		Hyperglide 5.0 X 30	BOTH IP/OP	"$4,627.00 "	"$3,423.98"	$0.00	"$3,701.60"	"$2,512.46"	"$2,512.46"	$0.00	$0.00	$0.00	$964.38	"$3,434.16"	"$3,434.16"	"$3,566.49"	$0.00	$964.27	$0.00	"$2,736.87"	"$2,736.87"	$0.00	"$2,313.50"	"$3,664.58"	"$3,701.60"	$0.00	$0.00	$0.00	$724.13	$0.00	$0.00	$736.62	$0.00	$0.00	$0.00	$0.00	$0.00
27202823	EAP	HCPCS C1726		Hyperglide System - 30mm	BOTH IP/OP	"$3,676.00 "	"$2,720.24"	$0.00	"$2,940.80"	"$1,996.07"	"$1,996.07"	$0.00	$0.00	$0.00	$766.17	"$2,728.33"	"$2,728.33"	"$2,833.46"	$0.00	$766.08	$0.00	"$2,174.35"	"$2,174.35"	$0.00	"$1,838.00"	"$2,911.39"	"$2,940.80"	$0.00	$0.00	$0.00	$575.29	$0.00	$0.00	$585.22	$0.00	$0.00	$0.00	$0.00	$0.00
27202825	EAP	HCPCS C1769		Meridian .014 Re	BOTH IP/OP	"$1,777.00 "	"$1,314.98"	$0.00	"$1,421.60"	$964.91	$964.91	$0.00	$0.00	$0.00	$370.37	"$1,318.89"	"$1,318.89"	"$1,369.71"	$0.00	$370.33	$0.00	"$1,051.10"	"$1,051.10"	$0.00	$888.50	"$1,407.38"	"$1,421.60"	$0.00	$0.00	$0.00	$278.10	$0.00	$0.00	$282.90	$0.00	$0.00	$0.00	$0.00	$0.00
27202826	EAP	HCPCS C1884		Microcatheter Nautica	BOTH IP/OP	"$1,882.00 "	"$1,392.68"	$0.00	"$1,505.60"	"$1,021.93"	"$1,021.93"	$0.00	$0.00	$0.00	$392.26	"$1,396.82"	"$1,396.82"	"$1,450.65"	$0.00	$392.21	$0.00	"$1,113.20"	"$1,113.20"	$0.00	$941.00	"$1,490.54"	"$1,505.60"	$0.00	$0.00	$0.00	$294.53	$0.00	$0.00	$299.61	$0.00	$0.00	$0.00	$0.00	$0.00
27202827	EAP	HCPCS C1769		Mirage Re .008	BOTH IP/OP	"$1,490.00 "	"$1,102.60"	$0.00	"$1,192.00"	$809.07	$809.07	$0.00	$0.00	$0.00	$310.55	"$1,105.88"	"$1,105.88"	"$1,148.49"	$0.00	$310.52	$0.00	$881.34	$881.34	$0.00	$745.00	"$1,180.08"	"$1,192.00"	$0.00	$0.00	$0.00	$233.19	$0.00	$0.00	$237.21	$0.00	$0.00	$0.00	$0.00	$0.00
27202828	EAP	Custom 27202828		Mixer Us 15-17 Mm Vial	BOTH IP/OP	"$1,793.00 "	"$1,326.82"	$0.00	"$1,434.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,330.76"	"$1,330.76"	"$1,382.04"	$0.00	$373.66	$0.00	$0.00	$0.00	$0.00	$896.50	"$1,420.06"	"$1,434.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202829	EAP	HCPCS C1884		Onyx 18 Kit Avm Us	BOTH IP/OP	"$8,071.00 "	"$5,972.54"	$0.00	"$6,456.80"	"$4,382.55"	"$4,382.55"	$0.00	$0.00	$0.00	"$1,682.20"	"$4,181.12"	"$4,181.12"	"$6,221.13"	$0.00	"$1,682.00"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$4,035.50"	"$6,392.23"	"$6,456.80"	$0.00	$0.00	$0.00	"$1,263.11"	$0.00	$0.00	"$1,284.90"	$0.00	$0.00	$0.00	$0.00	$0.00
27202830	EAP	HCPCS C1884		Onyx 34 Kit Avm Us	BOTH IP/OP	"$3,227.00 "	"$2,387.98"	$0.00	"$2,581.60"	"$1,752.26"	"$1,752.26"	$0.00	$0.00	$0.00	$672.59	"$2,395.08"	"$2,395.08"	"$2,487.37"	$0.00	$672.51	$0.00	"$1,908.77"	"$1,908.77"	$0.00	"$1,613.50"	"$2,555.78"	"$2,581.60"	$0.00	$0.00	$0.00	$505.03	$0.00	$0.00	$513.74	$0.00	$0.00	$0.00	$0.00	$0.00
27202831	EAP	HCPCS C1751		Onyx Hd500 Kit Aneurys	BOTH IP/OP	"$9,325.00 "	"$6,900.50"	$0.00	"$7,460.00"	"$5,063.48"	"$5,063.48"	$0.00	$0.00	$0.00	"$1,943.56"	"$4,181.12"	"$4,181.12"	"$7,187.71"	$0.00	"$1,943.33"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$4,662.50"	"$7,385.40"	"$7,460.00"	$0.00	$0.00	$0.00	"$1,459.36"	$0.00	$0.00	"$1,484.54"	$0.00	$0.00	$0.00	$0.00	$0.00
27202833	EAP	Custom 27202833		Syringe 1ml Single Pa	BOTH IP/OP	$268.00 	$198.32	$0.00	$214.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.91	$198.91	$206.57	$0.00	$55.85	$0.00	$0.00	$0.00	$0.00	$134.00	$212.26	$214.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202834	EAP	HCPCS C1726		Syringe Adapter-carton	BOTH IP/OP	"$1,793.00 "	"$1,326.82"	$0.00	"$1,434.40"	$973.60	$973.60	$0.00	$0.00	$0.00	$373.71	"$1,330.76"	"$1,330.76"	"$1,382.04"	$0.00	$373.66	$0.00	"$1,060.56"	"$1,060.56"	$0.00	$896.50	"$1,420.06"	"$1,434.40"	$0.00	$0.00	$0.00	$280.60	$0.00	$0.00	$285.45	$0.00	$0.00	$0.00	$0.00	$0.00
27202835	EAP	Custom 27202835		Ultraflow Hpc 1.5f Flow	BOTH IP/OP	"$1,793.00 "	"$1,326.82"	$0.00	"$1,434.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,330.76"	"$1,330.76"	"$1,382.04"	$0.00	$373.66	$0.00	$0.00	$0.00	$0.00	$896.50	"$1,420.06"	"$1,434.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202850	EAP	Custom 27202850		Adjustable Outrigger(flex/ext)	BOTH IP/OP	$365.00 	$270.10	$0.00	$292.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.90	$270.90	$281.34	$0.00	$76.07	$0.00	$0.00	$0.00	$0.00	$182.50	$289.08	$292.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202852	EAP	Custom 27202852		Adjustable Wrist Hinge	BOTH IP/OP	$412.00 	$304.88	$0.00	$329.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.79	$305.79	$317.57	$0.00	$85.86	$0.00	$0.00	$0.00	$0.00	$206.00	$326.30	$329.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202853	EAP	Custom 27202853		Alumafoam Splint	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$11.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202854	EAP	Custom 27202854		Aquacel Silver 4x4	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$0.00	$0.00	$0.00	$25.50	$40.39	$40.80	$0.00	$33.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202855	EAP	Custom 27202855		Aquacel Silver 6x6	BOTH IP/OP	$117.00 	$86.58	$0.00	$93.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.84	$86.84	$90.18	$0.00	$24.38	$0.00	$0.00	$0.00	$0.00	$58.50	$92.66	$93.60	$0.00	$76.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202856	EAP	Custom 27202856		Aquacel Silver 8x12	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202857	EAP	Custom 27202857		Aquacel Silver Rope	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202858	EAP	Custom 27202858		Bioconcept Brief	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$51.00	$80.78	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202859	EAP	Custom 27202859		Bioconcept Sleeved Vest	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.62	$107.62	$111.77	$0.00	$30.22	$0.00	$0.00	$0.00	$0.00	$72.50	$114.84	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202860	EAP	Custom 27202860		Bioconcepts Brief	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$51.00	$80.78	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202861	EAP	Custom 27202861		Bioconcepts Digi - Sleeve	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202862	EAP	Custom 27202862		"Bioconcepts Digi Sleeves 3"""	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202863	EAP	Custom 27202863		Bioconcepts Forearm Sleeve	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202865	EAP	Custom 27202865		Bioconcepts Gloves	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$0.00	$0.00	$0.00	$28.00	$44.35	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202867	EAP	Custom 27202867		Bioconcepts Sleeved Vest	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.62	$107.62	$111.77	$0.00	$30.22	$0.00	$0.00	$0.00	$0.00	$72.50	$114.84	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202868	EAP	Custom 27202868		Bioconcepts Ue Sleeve	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$0.00	$0.00	$0.00	$28.00	$44.35	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202869	EAP	Custom 27202869		Chin Strap	BOTH IP/OP	$54.00 	$39.96	$0.00	$43.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.08	$40.08	$41.62	$0.00	$11.25	$0.00	$0.00	$0.00	$0.00	$27.00	$42.77	$43.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202870	EAP	Custom 27202870		Clear Acrylic Cone	BOTH IP/OP	$67.00 	$49.58	$0.00	$53.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.73	$49.73	$51.64	$0.00	$13.96	$0.00	$0.00	$0.00	$0.00	$33.50	$53.06	$53.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202871	EAP	Custom 27202871		Desensitization Kits	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.30	$19.30	$20.04	$0.00	$5.42	$0.00	$0.00	$0.00	$0.00	$13.00	$20.59	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202872	EAP	Custom 27202872		Digi Sleeve	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202874	EAP	Custom 27202874		Double Finger Stall	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202875	EAP	Custom 27202875		Dynamic Finger Flexion Strap	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202876	EAP	Custom 27202876		Dynamic Mp Flexion Spring	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.49	$96.49	$100.20	$0.00	$27.09	$0.00	$0.00	$0.00	$0.00	$65.00	$102.96	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202877	EAP	Custom 27202877		Elbow Pad	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202878	EAP	Custom 27202878		External Fixator Splint	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.01	$213.01	$221.22	$0.00	$59.81	$0.00	$0.00	$0.00	$0.00	$143.50	$227.30	$229.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202879	EAP	Custom 27202879		Ezy Wrap Tigger Splint	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202881	EAP	Custom 27202881		Finger Cylinder Cast	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202882	EAP	Custom 27202882		Finger Knuckle Bender Splint	BOTH IP/OP	$104.00 	$76.96	$0.00	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.19	$77.19	$80.16	$0.00	$21.67	$0.00	$0.00	$0.00	$0.00	$52.00	$82.37	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202883	EAP	Custom 27202883		Green Stick Splint	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$123.33	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202884	EAP	Custom 27202884		Individual Outigger-each Digit	BOTH IP/OP	$71.00 	$52.54	$0.00	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.70	$52.70	$54.73	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$35.50	$56.23	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202885	EAP	Custom 27202885		Indivisual Outrigger	BOTH IP/OP	$71.00 	$52.54	$0.00	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.70	$52.70	$54.73	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$35.50	$56.23	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202886	EAP	Custom 27202886		Joint Jack	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.63	$130.63	$135.66	$0.00	$36.68	$0.00	$0.00	$0.00	$0.00	$88.00	$139.39	$140.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202887	EAP	Custom 27202887		Knee Hypercontrol Brace	BOTH IP/OP	$217.00 	$160.58	$0.00	$173.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.06	$161.06	$167.26	$0.00	$45.22	$0.00	$0.00	$0.00	$0.00	$108.50	$171.86	$173.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202888	EAP	Custom 27202888		Lmb Ulnar Deviation Splint	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.63	$130.63	$135.66	$0.00	$36.68	$0.00	$0.00	$0.00	$0.00	$88.00	$139.39	$140.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202889	EAP	Custom 27202889		Merit Static Pro Component	BOTH IP/OP	$149.00 	$110.26	$0.00	$119.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$110.59	$110.59	$114.85	$0.00	$31.05	$0.00	$0.00	$0.00	$0.00	$74.50	$118.01	$119.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202890	EAP	Custom 27202890		Merit Static Progressive Comp	BOTH IP/OP	$149.00 	$110.26	$0.00	$119.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$110.59	$110.59	$114.85	$0.00	$31.05	$0.00	$0.00	$0.00	$0.00	$74.50	$118.01	$119.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202891	EAP	Custom 27202891		Neoprene Tennis Elbow Strap	BOTH IP/OP	$135.00 	$99.90	$0.00	$104.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$104.06	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$27.00	$42.77	$43.20	$0.00	$87.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202892	EAP	Custom 27202892		Preformed Elbow Hinge Splint	BOTH IP/OP	$515.00 	$381.10	$0.00	$412.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.23	$382.23	$396.96	$0.00	$107.33	$0.00	$0.00	$0.00	$0.00	$257.50	$407.88	$412.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202893	EAP	Custom 27202893		Profore	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202894	EAP	Custom 27202894		Redi-fit Breifs	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$51.00	$80.78	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202897	EAP	Custom 27202897		Redi-fit Forearm Sleeves	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202898	EAP	Custom 27202898		Redi-fit Sleeved Vest	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.62	$107.62	$111.77	$0.00	$30.22	$0.00	$0.00	$0.00	$0.00	$72.50	$114.84	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202899	EAP	Custom 27202899		Redi-fit Ue Sleeves	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$0.00	$0.00	$0.00	$28.00	$44.35	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202900	EAP	Custom 27202900		Reverse Knuckle Bender Splint	BOTH IP/OP	$104.00 	$76.96	$0.00	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.19	$77.19	$80.16	$0.00	$21.67	$0.00	$0.00	$0.00	$0.00	$52.00	$82.37	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202901	EAP	Custom 27202901		Ring Splint	BOTH IP/OP	$157.00 	$116.18	$0.00	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.53	$116.53	$121.02	$0.00	$32.72	$0.00	$0.00	$0.00	$0.00	$78.50	$124.34	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202902	EAP	Custom 27202902		Soft Ulnar Deviation Support	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202903	EAP	Custom 27202903		Supination / Pronation Kit	BOTH IP/OP	$276.00 	$204.24	$0.00	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.85	$204.85	$212.74	$0.00	$57.52	$0.00	$0.00	$0.00	$0.00	$138.00	$218.59	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202905	EAP	Custom 27202905		Tap Splint	BOTH IP/OP	$211.00 	$156.14	$0.00	$168.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.60	$156.60	$162.64	$0.00	$43.97	$0.00	$0.00	$0.00	$0.00	$105.50	$167.11	$168.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202906	EAP	Custom 27202906		Ulnar Deviation Slint	BOTH IP/OP	$184.00 	$136.16	$0.00	$147.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.56	$136.56	$141.83	$0.00	$38.35	$0.00	$0.00	$0.00	$0.00	$92.00	$145.73	$147.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202908	EAP	Custom 27202908		Wrap Finger Hooks	BOTH IP/OP	$21.00 	$15.54	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.59	$15.59	$16.19	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$10.50	$16.63	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202909	EAP	Custom 27202909		Wrap On Finger Hooks(each)	BOTH IP/OP	$21.00 	$15.54	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.59	$15.59	$16.19	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$10.50	$16.63	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202910	EAP	Custom 27202910		Wrist Hinge W/ Dynamic Springs	BOTH IP/OP	$480.00 	$355.20	$0.00	$384.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$356.26	$356.26	$369.98	$0.00	$100.03	$0.00	$0.00	$0.00	$0.00	$240.00	$380.16	$384.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202911	EAP	HCPCS C1769		Gwire Vasc 185cm .014in Prss Clip Conctr Radiopq Tip Trq Dev	BOTH IP/OP	"$1,772.00 "	"$1,311.28"	$0.00	"$1,417.60"	$962.20	$962.20	$0.00	$0.00	$0.00	$369.33	"$1,315.18"	"$1,315.18"	"$1,365.86"	$0.00	$369.28	$0.00	"$1,048.14"	"$1,048.14"	$0.00	$886.00	"$1,403.42"	"$1,417.60"	$0.00	"$1,151.80"	$0.00	$277.32	$0.00	$0.00	$282.10	$0.00	$0.00	$0.00	$0.00	$0.00
27202912	EAP	HCPCS C1769		Abbott Vascular	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$134.55	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27202913	EAP	HCPCS C1725		Cath Baldilat .035in 5fr 9mm 75cm 40mm Pta Lp Nc Mustang	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$285.08	$285.08	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$404.67	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00	$341.25	$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
27202914	EAP	HCPCS C1725		Cath Baldilat .035in 5fr 8mm 75cm 40mm Pta Lp Nc Mustang	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$285.08	$285.08	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$404.67	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00	$341.25	$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
27202915	EAP	HCPCS C1726		Catheter Baldilat Lp 5.3fr 4mm 75cm 40mm High Pressure	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$285.08	$285.08	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$404.67	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00	$341.25	$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
27202916	EAP	HCPCS C1725		Cath Baldilat 2.5mm 150cm 80mm Otw Cyte	BOTH IP/OP	$720.00 	$532.80	$0.00	$576.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$360.00	$570.24	$576.00	$0.00	$0.00	$0.00	$112.68	$0.00	$0.00	$114.62	$0.00	$0.00	$0.00	$0.00	$0.00
27202917	EAP	HCPCS C1725		Catheter Balloon Dilit Coyote 2 X 220 150cm Otw	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$488.70	$488.70	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$693.72	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00	$585.00	$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
27202918	EAP	HCPCS C1725		"Balloon Coyote 2.5 X 220, 150cm, Otw"	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$488.70	$488.70	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$693.72	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00	$585.00	$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
27202919	EAP	HCPCS C1725		Catheter Balloon Dilit Coyote 3 X 100 150cm Otw	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$488.70	$488.70	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$693.72	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00	$585.00	$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
27202920	EAP	HCPCS C1725		Cath Baldilat .035in 5fr 5mm 135cm 200mm Pta Lp Nc Mustang	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$285.08	$285.08	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$404.67	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00	$341.25	$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
27202921	EAP	HCPCS C1725		Cath Baldilat .035in 5fr 6mm 135cm 100mm Pta Lp Nc Mustang	BOTH IP/OP	$486.00 	$359.64	$0.00	$388.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$243.00	$384.91	$388.80	$0.00	$0.00	$0.00	$76.06	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$0.00
27202922	EAP	HCPCS C1768		Set Introd 40cm 4fr Mpnch Psh+ .018in Ntnl Trnstls Stf Cannu	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$57.02	$57.02	$0.00	$0.00	$0.00	$21.88	$77.93	$77.93	$80.93	$0.00	$21.88	$0.00	$62.11	$62.11	$0.00	$52.50	$83.16	$84.00	$0.00	$68.25	$0.00	$16.43	$0.00	$0.00	$16.72	$0.00	$0.00	$0.00	$0.00	$0.00
27202923	EAP	HCPCS C1769		Gwire Vasc 1.5mm Rsn Curve .035in 180cm 1.5mm Cvd Cath Exch	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$24.44	$24.44	$0.00	$0.00	$0.00	$9.38	$33.40	$33.40	$34.69	$0.00	$9.38	$0.00	$26.62	$26.62	$0.00	$22.50	$35.64	$36.00	$0.00	$29.25	$0.00	$7.04	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00
27202924	EAP	Custom 27202924		Cath Angio .035in Vcf Curve 5fr 65cm 8 Spiraled Sdprt Hflo	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202925	EAP	Custom 27202925		Cath Angio .038in Kmp Curve 5fr 65cm Ang Multpur Nyl Ss Trnb	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202926	EAP	HCPCS C1894		Sheath Guid 45cm 6fr .087in Chk-flo Flxr .018/.038in Anl0	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$96.35	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00	$81.25	$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
27202927	EAP	HCPCS C1894		Sheath Guid 45cm 5fr .074in Chk-flo Flxr .018/.038in Anl0	BOTH IP/OP	$119.00 	$88.06	$0.00	$95.20	$64.62	$64.62	$0.00	$0.00	$0.00	$24.80	$88.32	$88.32	$91.73	$0.00	$24.80	$0.00	$70.39	$70.39	$0.00	$59.50	$94.25	$95.20	$0.00	$0.00	$0.00	$18.62	$0.00	$0.00	$18.94	$0.00	$0.00	$0.00	$0.00	$0.00
27202928	EAP	HCPCS C1769		Gwire Vasc .035in 145cm 20cm Str Flexibile Tip Flpy Bntsn Lg	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$27.69	$27.69	$0.00	$0.00	$0.00	$10.63	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$30.17	$30.17	$0.00	$25.50	$40.39	$40.80	$0.00	$33.15	$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
27202929	EAP	HCPCS C1894		Introd Shth 5fr .074in 70cm Anl1 Curve Multpur Tip Ansel	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$92.31	$92.31	$0.00	$0.00	$0.00	$35.43	$126.17	$126.17	$131.04	$0.00	$35.43	$0.00	$100.56	$100.56	$0.00	$85.00	$134.64	$136.00	$0.00	$0.00	$0.00	$26.61	$0.00	$0.00	$27.06	$0.00	$0.00	$0.00	$0.00	$0.00
27202930	EAP	HCPCS C1887		Cath Guid .035in 5mm Spc 3.1fr 150cm Lp Tpr Tip Sprt Radiopq	BOTH IP/OP	"$2,257.00 "	"$1,670.18"	$0.00	"$1,805.60"	"$1,225.55"	"$1,225.55"	$0.00	$0.00	$0.00	$470.42	"$1,675.15"	"$1,675.15"	"$1,739.70"	$0.00	$470.36	$0.00	"$1,335.02"	"$1,335.02"	$0.00	"$1,128.50"	"$1,787.54"	"$1,805.60"	$0.00	"$1,467.05"	$0.00	$353.22	$0.00	$0.00	$359.31	$0.00	$0.00	$0.00	$0.00	$0.00
27202931	EAP	HCPCS C1887		Cath Guid .014in 3-1.9fr 150cm 3 Radiopq Mrkr Low Cx Prfl	BOTH IP/OP	"$2,257.00 "	"$1,670.18"	$0.00	"$1,805.60"	"$1,225.55"	"$1,225.55"	$0.00	$0.00	$0.00	$470.42	"$1,675.15"	"$1,675.15"	"$1,739.70"	$0.00	$470.36	$0.00	"$1,335.02"	"$1,335.02"	$0.00	"$1,128.50"	"$1,787.54"	"$1,805.60"	$0.00	"$1,467.05"	$0.00	$353.22	$0.00	$0.00	$359.31	$0.00	$0.00	$0.00	$0.00	$0.00
27202932	EAP	HCPCS C1769		Gwire Vasc Std .035in 150cm 3cm Ang Tip Kink Rst Gldwr	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$226.97	$226.97	$0.00	$0.00	$0.00	$87.12	$310.24	$310.24	$322.19	$0.00	$87.11	$0.00	$247.25	$247.25	$0.00	$209.00	$331.06	$334.40	$0.00	$0.00	$0.00	$65.42	$0.00	$0.00	$66.55	$0.00	$0.00	$0.00	$0.00	$0.00
27202933	EAP	HCPCS C1769		Gwire Vasc Std .035in 260cm 3cm Ang Tip Stf Shft Gldwr	BOTH IP/OP	$699.00 	$517.26	$0.00	$559.20	$379.56	$379.56	$0.00	$0.00	$0.00	$145.69	$518.80	$518.80	$538.79	$0.00	$145.67	$0.00	$413.46	$413.46	$0.00	$349.50	$553.61	$559.20	$0.00	$0.00	$0.00	$109.39	$0.00	$0.00	$111.28	$0.00	$0.00	$0.00	$0.00	$0.00
27202934	EAP	HCPCS C1887		Cath Angio .038in 5fr 100cm 40cm Tpr Ang Tip Gwire Hydphi	BOTH IP/OP	$644.00 	$476.56	$0.00	$515.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$322.00	$510.05	$515.20	$0.00	$0.00	$0.00	$100.79	$0.00	$0.00	$102.52	$0.00	$0.00	$0.00	$0.00	$0.00
27202935	EAP	HCPCS C1769		Gwire Vasc Endoscopic Terumo L260 Cm Od.035 In Straight	BOTH IP/OP	$623.00 	$461.02	$0.00	$498.40	$338.29	$338.29	$0.00	$0.00	$0.00	$129.85	$462.39	$462.39	$480.21	$0.00	$129.83	$0.00	$368.50	$368.50	$0.00	$311.50	$493.42	$498.40	$0.00	$0.00	$0.00	$97.50	$0.00	$0.00	$99.18	$0.00	$0.00	$0.00	$0.00	$0.00
27202936	EAP	Custom 27202936		Burn Pad 36x24in Abs Drsg Slvr Strl	BOTH IP/OP	$221.00 	$163.54	$0.00	$176.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.03	$164.03	$170.35	$0.00	$46.06	$0.00	$0.00	$0.00	$0.00	$110.50	$175.03	$176.80	$0.00	$143.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202940	EAP	Custom 27202940		"Bioconcepts Digi-sleeve (per Digit - 3"")."	BOTH IP/OP	$17.00 	$12.58	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.62	$12.62	$13.10	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202941	EAP	HCPCS C1769		Stdj-185-4076	BOTH IP/OP	$223.00 	$165.02	$0.00	$178.40	$121.09	$121.09	$0.00	$0.00	$0.00	$46.48	$165.51	$165.51	$171.89	$0.00	$46.47	$0.00	$131.90	$131.90	$0.00	$111.50	$176.62	$178.40	$0.00	$0.00	$0.00	$34.90	$0.00	$0.00	$35.50	$0.00	$0.00	$0.00	$0.00	$0.00
27202942	EAP	HCPCS C1769		Stdj-300-4076	BOTH IP/OP	$223.00 	$165.02	$0.00	$178.40	$121.09	$121.09	$0.00	$0.00	$0.00	$46.48	$165.51	$165.51	$171.89	$0.00	$46.47	$0.00	$131.90	$131.90	$0.00	$111.50	$176.62	$178.40	$0.00	$0.00	$0.00	$34.90	$0.00	$0.00	$35.50	$0.00	$0.00	$0.00	$0.00	$0.00
27202943	EAP	HCPCS C1769		Stdj-86-15 40785	BOTH IP/OP	$281.00 	$207.94	$0.00	$224.80	$152.58	$152.58	$0.00	$0.00	$0.00	$58.57	$208.56	$208.56	$216.59	$0.00	$58.56	$0.00	$166.21	$166.21	$0.00	$140.50	$222.55	$224.80	$0.00	$0.00	$0.00	$43.98	$0.00	$0.00	$44.74	$0.00	$0.00	$0.00	$0.00	$0.00
27202944	EAP	HCPCS C1769		Sdj-86-5 40785	BOTH IP/OP	$281.00 	$207.94	$0.00	$224.80	$152.58	$152.58	$0.00	$0.00	$0.00	$58.57	$208.56	$208.56	$216.59	$0.00	$58.56	$0.00	$166.21	$166.21	$0.00	$140.50	$222.55	$224.80	$0.00	$0.00	$0.00	$43.98	$0.00	$0.00	$44.74	$0.00	$0.00	$0.00	$0.00	$0.00
27202945	EAP	HCPCS C1725		Coronary Sinus Balloon Venography Catheter	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
27202950	EAP	Custom 27202950		C-36-152 Coil Interlock Detach	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202951	EAP	Custom 27202951		C-36-154 Coil Interlock Detach	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202952	EAP	Custom 27202952		C-36-156 Coil Interlock Detach	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202953	EAP	Custom 27202953		C-36-157 Coil Interlock Detach	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202954	EAP	HCPCS C1887		Cg510 Glide Catheter Simmon1	BOTH IP/OP	"$1,253.00 "	$927.22	$0.00	"$1,002.40"	$680.38	$680.38	$0.00	$0.00	$0.00	$261.16	$929.98	$929.98	$965.81	$0.00	$261.13	$0.00	$741.15	$741.15	$0.00	$626.50	$992.38	"$1,002.40"	$0.00	$814.45	$0.00	$196.09	$0.00	$0.00	$199.48	$0.00	$0.00	$0.00	$0.00	$0.00
27202955	EAP	HCPCS C1725		Cg514 Benson-hanafee 1	BOTH IP/OP	"$1,193.00 "	$882.82	$0.00	$954.40	$536.85	$536.85	$0.00	$0.00	$0.00	$248.65	$885.44	$885.44	$919.56	$0.00	$248.62	$0.00	$705.66	$705.66	$0.00	$596.50	$944.86	$954.40	$0.00	$0.00	$0.00	$186.70	$0.00	$0.00	$189.93	$0.00	$0.00	$0.00	$0.00	$0.00
27202956	EAP	HCPCS C1880		Option Ivc Filter	BOTH IP/OP	"$1,429.00 "	"$1,057.46"	$0.00	"$1,143.20"	$643.05	$643.05	$0.00	$0.00	$0.00	$297.84	"$1,060.60"	"$1,060.60"	"$1,101.47"	$0.00	$297.80	$0.00	$845.25	$845.25	$0.00	$714.50	"$1,131.77"	"$1,143.20"	$0.00	$0.00	$0.00	$223.64	$0.00	$0.00	$227.50	$0.00	$0.00	$0.00	$0.00	$0.00
27202957	EAP	HCPCS C1894		Introducer Sheath 5fr	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$5.63	$0.00	$0.00	$5.73	$0.00	$0.00	$0.00	$0.00	$0.00
27202958	EAP	HCPCS C1894		Introducer Sheath 6fr	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$5.63	$0.00	$0.00	$5.73	$0.00	$0.00	$0.00	$0.00	$0.00
27202959	EAP	HCPCS C1725		Catheter Glide Simmons 2	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$76.95	$76.95	$0.00	$0.00	$0.00	$35.64	$126.92	$126.92	$131.81	$0.00	$35.64	$0.00	$101.15	$101.15	$0.00	$85.50	$135.43	$136.80	$0.00	$76.95	$0.00	$26.76	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$0.00
27202960	EAP	HCPCS C1725		Catheter Vertebral 5fr	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$18.00	$18.00	$0.00	$0.00	$0.00	$8.34	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$23.66	$23.66	$0.00	$20.00	$31.68	$32.00	$0.00	$18.00	$0.00	$6.26	$0.00	$0.00	$6.37	$0.00	$0.00	$0.00	$0.00	$0.00
27202961	EAP	HCPCS C1751		Microcatheter Stc	BOTH IP/OP	"$1,264.00 "	$935.36	$0.00	"$1,011.20"	$686.35	$686.35	$0.00	$0.00	$0.00	$263.45	$938.14	$938.14	$974.29	$0.00	$263.42	$0.00	$747.66	$747.66	$0.00	$632.00	"$1,001.09"	"$1,011.20"	$0.00	$0.00	$0.00	$197.82	$0.00	$0.00	$201.23	$0.00	$0.00	$0.00	$0.00	$0.00
27202962	EAP	HCPCS C1751		System Drg Dlv L106 Cm 30cm Ekosonic Intlgnt Cath Microsonic	BOTH IP/OP	"$7,074.00 "	"$5,234.76"	$0.00	"$5,659.20"	"$3,841.18"	"$3,841.18"	$0.00	$0.00	$0.00	"$1,474.40"	"$4,181.12"	"$4,181.12"	"$5,452.64"	$0.00	"$1,474.22"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,537.00"	"$5,602.61"	"$5,659.20"	$0.00	$0.00	$0.00	"$1,107.08"	$0.00	$0.00	"$1,126.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27202963	EAP	HCPCS C1751		System Drg Dlv L106 Cm 40cm Ekosonic Intlgnt Cath Microsonic	BOTH IP/OP	"$6,738.00 "	"$4,986.12"	$0.00	"$5,390.40"	"$3,658.73"	"$3,658.73"	$0.00	$0.00	$0.00	"$1,404.37"	"$4,181.12"	"$4,181.12"	"$5,193.65"	$0.00	"$1,404.20"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,369.00"	"$5,336.50"	"$5,390.40"	$0.00	$0.00	$0.00	"$1,054.50"	$0.00	$0.00	"$1,072.69"	$0.00	$0.00	$0.00	$0.00	$0.00
27202964	EAP	HCPCS C1751		System Drg Dlv L106 Cm 50cm Ekosonic Mach 4 Intlgnt Cath	BOTH IP/OP	"$6,738.00 "	"$4,986.12"	$0.00	"$5,390.40"	"$3,658.73"	"$3,658.73"	$0.00	$0.00	$0.00	"$1,404.37"	"$4,181.12"	"$4,181.12"	"$5,193.65"	$0.00	"$1,404.20"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,369.00"	"$5,336.50"	"$5,390.40"	$0.00	$0.00	$0.00	"$1,054.50"	$0.00	$0.00	"$1,072.69"	$0.00	$0.00	$0.00	$0.00	$0.00
27202965	EAP	HCPCS C1751		System Drg Dlv L135 Cm 12cm Ekosonic Mach 4 Intlgnt Cath	BOTH IP/OP	"$6,738.00 "	"$4,986.12"	$0.00	"$5,390.40"	"$3,658.73"	"$3,658.73"	$0.00	$0.00	$0.00	"$1,404.37"	"$4,181.12"	"$4,181.12"	"$5,193.65"	$0.00	"$1,404.20"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,369.00"	"$5,336.50"	"$5,390.40"	$0.00	"$4,379.70"	$0.00	"$1,054.50"	$0.00	$0.00	"$1,072.69"	$0.00	$0.00	$0.00	$0.00	$0.00
27202966	EAP	HCPCS C1751		System Drg Dlv L135 Cm 30cm Ekosonic Intlgnt Cath Microsonic	BOTH IP/OP	"$7,074.00 "	"$5,234.76"	$0.00	"$5,659.20"	"$3,841.18"	"$3,841.18"	$0.00	$0.00	$0.00	"$1,474.40"	"$4,181.12"	"$4,181.12"	"$5,452.64"	$0.00	"$1,474.22"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,537.00"	"$5,602.61"	"$5,659.20"	$0.00	$0.00	$0.00	"$1,107.08"	$0.00	$0.00	"$1,126.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27202967	EAP	HCPCS C1751		System Drg Dlv L135 Cm 40cm Ekosonic Intlgnt Cath Microsonic	BOTH IP/OP	"$7,074.00 "	"$5,234.76"	$0.00	"$5,659.20"	"$3,841.18"	"$3,841.18"	$0.00	$0.00	$0.00	"$1,474.40"	"$4,181.12"	"$4,181.12"	"$5,452.64"	$0.00	"$1,474.22"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,537.00"	"$5,602.61"	"$5,659.20"	$0.00	"$4,598.10"	$0.00	"$1,107.08"	$0.00	$0.00	"$1,126.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27202968	EAP	HCPCS C1751		SYSTEM DRG DLV L135 CM 50CM EKOSONIC TX ZN EVAS DEV CATH GWI	BOTH IP/OP	"$7,074.00 "	"$5,234.76"	$0.00	"$5,659.20"	"$3,841.18"	"$3,841.18"	$0.00	$0.00	$0.00	"$1,474.40"	"$4,181.12"	"$4,181.12"	"$5,452.64"	$0.00	"$1,474.22"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,537.00"	"$5,602.61"	"$5,659.20"	$0.00	$0.00	$0.00	"$1,107.08"	$0.00	$0.00	"$1,126.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27202969	EAP	HCPCS C1751		System Drg Dlv L106 Cm 6cm Ekosonic Intlgnt Cath Microsonic	BOTH IP/OP	"$7,074.00 "	"$5,234.76"	$0.00	"$5,659.20"	"$3,841.18"	"$3,841.18"	$0.00	$0.00	$0.00	"$1,474.40"	"$4,181.12"	"$4,181.12"	"$5,452.64"	$0.00	"$1,474.22"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,537.00"	"$5,602.61"	"$5,659.20"	$0.00	"$4,598.10"	$0.00	"$1,107.08"	$0.00	$0.00	"$1,126.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27202970	EAP	HCPCS C1751		System Drg Dlv L106 Cm 12cm Ekosonic Cath Us Thrmbs 106cm 12	BOTH IP/OP	"$7,074.00 "	"$5,234.76"	$0.00	"$5,659.20"	"$3,841.18"	"$3,841.18"	$0.00	$0.00	$0.00	"$1,474.40"	"$4,181.12"	"$4,181.12"	"$5,452.64"	$0.00	"$1,474.22"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,537.00"	"$5,602.61"	"$5,659.20"	$0.00	"$4,598.10"	$0.00	"$1,107.08"	$0.00	$0.00	"$1,126.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27202971	EAP	HCPCS C1751		System Drg Dlv L106 Cm 18cm Ekosonic Intlgnt Cath Microsonic	BOTH IP/OP	"$7,074.00 "	"$5,234.76"	$0.00	"$5,659.20"	"$3,841.18"	"$3,841.18"	$0.00	$0.00	$0.00	"$1,474.40"	"$4,181.12"	"$4,181.12"	"$5,452.64"	$0.00	"$1,474.22"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,537.00"	"$5,602.61"	"$5,659.20"	$0.00	$0.00	$0.00	"$1,107.08"	$0.00	$0.00	"$1,126.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27202972	EAP	HCPCS C1751		System Drg Dlv L106 Cm 24cm Ekosonic Intlgnt Cath Microsonic	BOTH IP/OP	"$7,074.00 "	"$5,234.76"	$0.00	"$5,659.20"	"$3,841.18"	"$3,841.18"	$0.00	$0.00	$0.00	"$1,474.40"	"$4,181.12"	"$4,181.12"	"$5,452.64"	$0.00	"$1,474.22"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,537.00"	"$5,602.61"	"$5,659.20"	$0.00	$0.00	$0.00	"$1,107.08"	$0.00	$0.00	"$1,126.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27202973	EAP	HCPCS C1729		Kit Cath Peritoneum Strt Pleurx 1000ml	BOTH IP/OP	"$2,226.00 "	"$1,647.24"	$0.00	"$1,780.80"	"$1,208.72"	"$1,208.72"	$0.00	$0.00	$0.00	$463.95	"$1,652.14"	"$1,652.14"	"$1,715.80"	$0.00	$463.90	$0.00	"$1,316.68"	"$1,316.68"	$0.00	"$1,113.00"	"$1,762.99"	"$1,780.80"	$0.00	"$1,446.90"	$0.00	$348.37	$0.00	$0.00	$354.38	$0.00	$0.00	$0.00	$0.00	$0.00
27202974	EAP	Custom 27202974		Cable Pcng 6ft Pc Lc Trnvns Sf Dev Temp Conctr Clip Adpr	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202976	EAP	Custom 27202976		Shld Rad16x16in Drp Armr Rdbrrier L Pstn Prtc Strl	BOTH IP/OP	$72.00 	$53.28	$0.00	$57.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.44	$53.44	$55.50	$0.00	$15.00	$0.00	$0.00	$0.00	$0.00	$36.00	$57.02	$57.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202977	EAP	Custom 27202977		Trvo Prvue 4x20mm Rtrvr Kit & Trvo Pro 18 Mc	BOTH IP/OP	"$13,399.00 "	"$9,915.26"	$0.00	"$10,719.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,327.95"	$0.00	"$2,792.35"	$0.00	$0.00	$0.00	$0.00	"$6,699.50"	"$10,612.01"	"$10,719.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202978	EAP	Custom 27202978		Trvo Xp Prvue 4x20mm Rtrvr Kit & Trvo Pro 18 Mc	BOTH IP/OP	"$13,399.00 "	"$9,915.26"	$0.00	"$10,719.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,327.95"	$0.00	"$2,792.35"	$0.00	$0.00	$0.00	$0.00	"$6,699.50"	"$10,612.01"	"$10,719.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202979	EAP	Custom 27202979		Trvo Xp Prvue 3x20mm Rtrvr Kit & Trvo Pro 14 Mc	BOTH IP/OP	"$13,399.00 "	"$9,915.26"	$0.00	"$10,719.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,327.95"	$0.00	"$2,792.35"	$0.00	$0.00	$0.00	$0.00	"$6,699.50"	"$10,612.01"	"$10,719.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202980	EAP	HCPCS C1769		Guidewire Vasc 190cm .035in Strbl Str Htrq Scr	BOTH IP/OP	$197.00 	$145.78	$0.00	$157.60	$106.97	$106.97	$0.00	$0.00	$0.00	$41.06	$146.21	$146.21	$151.85	$0.00	$41.05	$0.00	$116.53	$116.53	$0.00	$98.50	$156.02	$157.60	$0.00	$0.00	$0.00	$30.83	$0.00	$0.00	$31.36	$0.00	$0.00	$0.00	$0.00	$0.00
27202981	EAP	HCPCS C1887		"Turnpike Catheter, Smooth Shaft, 135cm"	BOTH IP/OP	"$1,377.00 "	"$1,018.98"	$0.00	"$1,101.60"	$747.71	$747.71	$0.00	$0.00	$0.00	$287.00	"$1,022.01"	"$1,022.01"	"$1,061.39"	$0.00	$286.97	$0.00	$814.50	$814.50	$0.00	$688.50	"$1,090.58"	"$1,101.60"	$0.00	$895.05	$0.00	$215.50	$0.00	$0.00	$219.22	$0.00	$0.00	$0.00	$0.00	$0.00
27202982	EAP	HCPCS C1887		"Turnpike Catheter, Smooth Shaft, 155cm"	BOTH IP/OP	"$1,561.00 "	"$1,155.14"	$0.00	"$1,248.80"	$847.62	$847.62	$0.00	$0.00	$0.00	$325.35	"$1,158.57"	"$1,158.57"	"$1,203.22"	$0.00	$325.31	$0.00	$923.33	$923.33	$0.00	$780.50	"$1,236.31"	"$1,248.80"	$0.00	"$1,014.65"	$0.00	$244.30	$0.00	$0.00	$248.51	$0.00	$0.00	$0.00	$0.00	$0.00
27202983	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Hbrd Radiopq Str Tip	BOTH IP/OP	$394.00 	$291.56	$0.00	$315.20	$213.94	$213.94	$0.00	$0.00	$0.00	$82.12	$292.43	$292.43	$303.70	$0.00	$82.11	$0.00	$233.05	$233.05	$0.00	$197.00	$312.05	$315.20	$0.00	$256.10	$0.00	$61.66	$0.00	$0.00	$62.72	$0.00	$0.00	$0.00	$0.00	$0.00
27202984	EAP			Gdwire Vasc Strght; Sprg L200cm L9 Cm Od.008 In	BOTH IP/OP	"$1,238.00 "	$916.12	$0.00	$990.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.84	$918.84	$954.25	$0.00	$258.00	$0.00	$0.00	$0.00	$0.00	$619.00	$980.50	$990.40	$0.00	$804.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202985	EAP	HCPCS C1769		Gdwire Vasc 25d L150 Cm Rnd Curve L200 Cm L170	BOTH IP/OP	"$1,337.00 "	$989.38	$0.00	"$1,069.60"	$725.99	$725.99	$0.00	$0.00	$0.00	$278.66	$992.32	$992.32	"$1,030.56"	$0.00	$278.63	$0.00	$790.84	$790.84	$0.00	$668.50	"$1,058.90"	"$1,069.60"	$0.00	$869.05	$0.00	$209.24	$0.00	$0.00	$212.85	$0.00	$0.00	$0.00	$0.00	$0.00
27202986	EAP	HCPCS C1769		"Gdwire Vasc Slip Coat Stnlss Stl Polymer 25 D, L"	BOTH IP/OP	"$1,337.00 "	$989.38	$0.00	"$1,069.60"	$725.99	$725.99	$0.00	$0.00	$0.00	$278.66	$992.32	$992.32	"$1,030.56"	$0.00	$278.63	$0.00	$790.84	$790.84	$0.00	$668.50	"$1,058.90"	"$1,069.60"	$0.00	$869.05	$0.00	$209.24	$0.00	$0.00	$212.85	$0.00	$0.00	$0.00	$0.00	$0.00
27202987	EAP	HCPCS C1769		Gdwire Vasc Slip-coat; Stnlss Stl; Polymer 25 D;	BOTH IP/OP	$919.00 	$680.06	$0.00	$735.20	$499.02	$499.02	$0.00	$0.00	$0.00	$191.54	$682.08	$682.08	$708.37	$0.00	$191.52	$0.00	$543.59	$543.59	$0.00	$459.50	$727.85	$735.20	$0.00	$597.35	$0.00	$143.82	$0.00	$0.00	$146.30	$0.00	$0.00	$0.00	$0.00	$0.00
27202988	EAP	HCPCS C1887		Arc Catheter	BOTH IP/OP	"$4,712.00 "	"$3,486.88"	$0.00	"$3,769.60"	"$2,558.62"	"$2,558.62"	$0.00	$0.00	$0.00	$982.10	"$3,497.25"	"$3,497.25"	"$3,632.01"	$0.00	$981.98	$0.00	"$2,787.15"	"$2,787.15"	$0.00	"$2,356.00"	"$3,731.90"	"$3,769.60"	$0.00	$0.00	$0.00	$737.43	$0.00	$0.00	$750.15	$0.00	$0.00	$0.00	$0.00	$0.00
27202989	EAP	HCPCS C1887		Arc Mini Catheter	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,968.38"	"$1,968.38"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$2,144.19"	"$2,144.19"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27202990	EAP	HCPCS C1887		Marksman Catheter	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	"$1,086.00"	"$1,086.00"	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	"$1,541.60"	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00	"$1,300.00"	$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
27202991	EAP	HCPCS C1769		Guidewire Vasc 200cm .014in Str 3cm Traxcess Ntnl	BOTH IP/OP	$844.00 	$624.56	$0.00	$675.20	$458.29	$458.29	$0.00	$0.00	$0.00	$175.91	$626.42	$626.42	$650.56	$0.00	$175.89	$0.00	$499.23	$499.23	$0.00	$422.00	$668.45	$675.20	$0.00	$548.60	$0.00	$132.09	$0.00	$0.00	$134.36	$0.00	$0.00	$0.00	$0.00	$0.00
27202992	EAP	HCPCS C1769		Guidewire Vasc Traxcess 3x200 Ex	BOTH IP/OP	$878.00 	$649.72	$0.00	$702.40	$476.75	$476.75	$0.00	$0.00	$0.00	$183.00	$651.65	$651.65	$676.76	$0.00	$182.98	$0.00	$519.34	$519.34	$0.00	$439.00	$695.38	$702.40	$0.00	$570.70	$0.00	$137.41	$0.00	$0.00	$139.78	$0.00	$0.00	$0.00	$0.00	$0.00
27202993	EAP	HCPCS C1769		Guidewire Vasc Dck Traxcess	BOTH IP/OP	$338.00 	$250.12	$0.00	$270.40	$183.53	$183.53	$0.00	$0.00	$0.00	$70.45	$250.86	$250.86	$260.53	$0.00	$70.44	$0.00	$199.93	$199.93	$0.00	$169.00	$267.70	$270.40	$0.00	$0.00	$0.00	$52.90	$0.00	$0.00	$53.81	$0.00	$0.00	$0.00	$0.00	$0.00
27202994	EAP	HCPCS C1725		Catheter 3.4fr 2.4fr 135cm Crossboss Intvn Rnd	BOTH IP/OP	"$3,412.00 "	"$2,524.88"	$0.00	"$2,729.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.00"	"$2,702.30"	"$2,729.60"	$0.00	$0.00	$0.00	$533.98	$0.00	$0.00	$543.19	$0.00	$0.00	$0.00	$0.00	$0.00
27202995	EAP	HCPCS C1725		Catheter Baldilat 3.7fr 2.9fr 135cm Coron Sdprt	BOTH IP/OP	"$4,738.00 "	"$3,506.12"	$0.00	"$3,790.40"	"$2,572.73"	"$2,572.73"	$0.00	$0.00	$0.00	$987.52	"$3,516.54"	"$3,516.54"	"$3,652.05"	$0.00	$987.40	$0.00	"$2,802.53"	"$2,802.53"	$0.00	"$2,369.00"	"$3,752.50"	"$3,790.40"	$0.00	$0.00	$0.00	$741.50	$0.00	$0.00	$754.29	$0.00	$0.00	$0.00	$0.00	$0.00
27202996	EAP	HCPCS C1769		Guidewire Vasc 185cm .014in True Lum Slf Ornt	BOTH IP/OP	"$1,013.00 "	$749.62	$0.00	$810.40	$550.06	$550.06	$0.00	$0.00	$0.00	$211.13	$751.85	$751.85	$780.82	$0.00	$211.11	$0.00	$599.19	$599.19	$0.00	$506.50	$802.30	$810.40	$0.00	$0.00	$0.00	$158.53	$0.00	$0.00	$161.27	$0.00	$0.00	$0.00	$0.00	$0.00
27202997	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in True Lum Slf Ornt	BOTH IP/OP	"$1,013.00 "	$749.62	$0.00	$810.40	$550.06	$550.06	$0.00	$0.00	$0.00	$211.13	$751.85	$751.85	$780.82	$0.00	$211.11	$0.00	$599.19	$599.19	$0.00	$506.50	$802.30	$810.40	$0.00	$0.00	$0.00	$158.53	$0.00	$0.00	$161.27	$0.00	$0.00	$0.00	$0.00	$0.00
27202998	EAP	HCPCS C1769		Guidewire Vasc 20cm .014in Extn 28d Stingray	BOTH IP/OP	$305.00 	$225.70	$0.00	$244.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.50	$241.56	$244.00	$0.00	$0.00	$0.00	$47.73	$0.00	$0.00	$48.56	$0.00	$0.00	$0.00	$0.00	$0.00
27202999	EAP	HCPCS C1769		Coronary Intervention Wire.	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.01	$0.01	$0.00	$0.01	$0.01	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203000	EAP	HCPCS C1887		Cath Angiogrphc .038in Pigtail 145d Cv 6fr 110cm 2	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27203001	EAP	Custom 27203001		Unit Therapeutic Incision Mngmnt Sys Peel Plc Kt	BOTH IP/OP	"$1,238.00 "	$916.12	$0.00	$990.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.84	$918.84	$954.25	$0.00	$258.00	$0.00	$0.00	$0.00	$0.00	$619.00	$980.50	$990.40	$0.00	$804.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203002	EAP	HCPCS C1725		Catheter Baldilat Lp 5.3fr 3mm 75cm 60mm High Pressure	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$385.40	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00	$0.00	$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
27203003	EAP	HCPCS C1725		Catheter Baldilat .035in 5mm 75cm 40mm High Pressure Lp	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$385.40	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00	$325.00	$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
27203004	EAP	HCPCS C1725		Catheter Baldilat .035in 6mm 75cm 20mm High Pressure Lp	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00	$0.00	$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
27203005	EAP	HCPCS C1725		Catheter Baldilat Lp 5.3fr 6mm 135cm 40mm High Pressure	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$385.40	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00	$325.00	$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
27203006	EAP	HCPCS C1725		Catheter Baldilat Lp 5.3fr 8mm 75cm 20mm High Pressure	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$385.40	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00	$325.00	$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
27203050	EAP	Custom 27203050		Chiba Needle 22g X 10cm	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203051	EAP	Custom 27203051		Chiba Needle 18g X 10cm	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203052	EAP	Custom 27203052		Chiba Needle 18g X 15cm	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203053	EAP	Custom 27203053		Chiba Needle 18g X 20cm	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203054	EAP	Custom 27203054		Chiba Needle 20g X 10cm	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203055	EAP	Custom 27203055		Chiba Needle 20g X 15cm	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203056	EAP	Custom 27203056		Chiba Needle 20g X 20cm	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203057	EAP	Custom 27203057		6f Dilator	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.42	$7.42	$7.71	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$5.00	$7.92	$8.00	$0.00	$6.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203058	EAP	Custom 27203058		7f Dilator	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203059	EAP	Custom 27203059		8f Dilator	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.36	$13.36	$13.87	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203060	EAP	Custom 27203060		10f Dilator	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00	$14.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203061	EAP	Custom 27203061		12f Dilator	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203062	EAP	Custom 27203062		14f Dilator	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.46	$27.46	$28.52	$0.00	$7.71	$0.00	$0.00	$0.00	$0.00	$18.50	$29.30	$29.60	$0.00	$24.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203063	EAP	Custom 27203063		Introducer Needle 17g X 10cm	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.22	$74.22	$77.08	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203064	EAP	Custom 27203064		Introducer Needle 17g X 15cm	BOTH IP/OP	$115.00 	$85.10	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.35	$85.35	$88.64	$0.00	$23.97	$0.00	$0.00	$0.00	$0.00	$57.50	$91.08	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203065	EAP	Custom 27203065		Introducer Needle 19g X 6cm	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$0.00	$0.00	$0.00	$60.00	$95.04	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203066	EAP	Custom 27203066		Introducer Needle 19g X 10cm	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.49	$96.49	$100.20	$0.00	$27.09	$0.00	$0.00	$0.00	$0.00	$65.00	$102.96	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203067	EAP	Custom 27203067		Introducer Needle 19g X 15cm	BOTH IP/OP	$136.00 	$100.64	$0.00	$108.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.94	$100.94	$104.83	$0.00	$28.34	$0.00	$0.00	$0.00	$0.00	$68.00	$107.71	$108.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203068	EAP	Custom 27203068		Coaxial Sets 19x10x20x15	BOTH IP/OP	$79.00 	$58.46	$0.00	$63.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.63	$58.63	$60.89	$0.00	$16.46	$0.00	$0.00	$0.00	$0.00	$39.50	$62.57	$63.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203069	EAP	Custom 27203069		Coaxial Sets 19x15x20x20	BOTH IP/OP	$71.00 	$52.54	$0.00	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.70	$52.70	$54.73	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$35.50	$56.23	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203070	EAP	Custom 27203070		Achieve Gun 18g X 9cm	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$104.06	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203071	EAP	Custom 27203071		Achieve Gun 18g X 11cm	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203072	EAP	Custom 27203072		Achieve Gun 18g X 15cm	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203073	EAP	Custom 27203073		Achieve Gun 18g X 20cm	BOTH IP/OP	$214.00 	$158.36	$0.00	$171.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.83	$158.83	$164.95	$0.00	$44.60	$0.00	$0.00	$0.00	$0.00	$107.00	$169.49	$171.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203074	EAP	Custom 27203074		Achieve Gun 20g X 11cm	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$0.00	$0.00	$0.00	$115.00	$182.16	$184.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203075	EAP	Custom 27203075		Achieve Gun 20g X 15cm	BOTH IP/OP	$237.00 	$175.38	$0.00	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.90	$175.90	$182.68	$0.00	$49.39	$0.00	$0.00	$0.00	$0.00	$118.50	$187.70	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203076	EAP	Custom 27203076		Achieve Gun 20g X 20cm	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.84	$181.84	$188.85	$0.00	$51.06	$0.00	$0.00	$0.00	$0.00	$122.50	$194.04	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203077	EAP	Custom 27203077		Franseen Lung Bx Needle	BOTH IP/OP	$122.00 	$90.28	$0.00	$97.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.55	$90.55	$94.04	$0.00	$25.42	$0.00	$0.00	$0.00	$0.00	$61.00	$96.62	$97.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203078	EAP	Custom 27203078		Vansonnenberg Needle Set	BOTH IP/OP	$146.00 	$108.04	$0.00	$116.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.36	$108.36	$112.54	$0.00	$30.43	$0.00	$0.00	$0.00	$0.00	$73.00	$115.63	$116.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203079	EAP	Custom 27203079		Bonopty Bx Set	BOTH IP/OP	"$1,154.00 "	$853.96	$0.00	$923.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$856.50	$856.50	$889.50	$0.00	$240.49	$0.00	$0.00	$0.00	$0.00	$577.00	$913.97	$923.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203080	EAP	Custom 27203080		Bonopty Bx Penetration Set	BOTH IP/OP	"$1,505.00 "	"$1,113.70"	$0.00	"$1,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,117.01"	"$1,117.01"	"$1,160.05"	$0.00	$313.64	$0.00	$0.00	$0.00	$0.00	$752.50	"$1,191.96"	"$1,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203081	EAP	Custom 27203081		Soft Tissue Bx Tray	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$31.50	$49.90	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203082	EAP	Custom 27203082		Lumbar Puncture Tray	BOTH IP/OP	$229.00 	$169.46	$0.00	$183.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.96	$169.96	$176.51	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$114.50	$181.37	$183.20	$0.00	$148.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203083	EAP	Custom 27203083		Para/thoracentesis Tray	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203084	EAP	Custom 27203084		Uresil Drainage Bag	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.38	$82.38	$85.56	$0.00	$23.13	$0.00	$0.00	$0.00	$0.00	$55.50	$87.91	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203085	EAP	Custom 27203085		Gelfoam Sponge	BOTH IP/OP	$464.00 	$343.36	$0.00	$371.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$344.38	$344.38	$357.65	$0.00	$96.70	$0.00	$0.00	$0.00	$0.00	$232.00	$367.49	$371.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203086	EAP	Custom 27203086		Suture Silk 2-0 30in Black	BOTH IP/OP	$21.00 	$15.54	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.50	$16.63	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203087	EAP	Custom 27203087		Steri-drape	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203088	EAP	Custom 27203088		Drainge Catheters	BOTH IP/OP	$228.00 	$168.72	$0.00	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.22	$169.22	$175.74	$0.00	$47.52	$0.00	$0.00	$0.00	$0.00	$114.00	$180.58	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203090	EAP	Custom 27203090		Cre Wg 6-8mm Dilation Balloon	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$0.00	$0.00	$0.00	$162.00	$256.61	$259.20	$0.00	$210.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203091	EAP	Custom 27203091		Cre Wg 8-10 Dilation Balloon	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$0.00	$0.00	$0.00	$162.00	$256.61	$259.20	$0.00	$210.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203092	EAP	Custom 27203092		Cre Wg 10-12 Dilation Balloon	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$0.00	$0.00	$0.00	$162.00	$256.61	$259.20	$0.00	$210.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203093	EAP	Custom 27203093		Cre 12-15mm Dilation Balloon	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$0.00	$0.00	$0.00	$162.00	$256.61	$259.20	$0.00	$210.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203094	EAP	Custom 27203094		Cre 15-18 Mm Dilation Balloon	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$0.00	$0.00	$0.00	$162.00	$256.61	$259.20	$0.00	$210.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203095	EAP	Custom 27203095		Cre 18-20 Mm Dilation Balloon	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$0.00	$0.00	$0.00	$162.00	$256.61	$259.20	$0.00	$210.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203096	EAP	Custom 27203096		Alliance Inflation Syringe	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00	$33.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203097	EAP	Custom 27203097		2.3mm Interject Inj Needle23g	BOTH IP/OP	$732.00 	$541.68	$0.00	$585.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$543.29	$543.29	$564.23	$0.00	$152.55	$0.00	$0.00	$0.00	$0.00	$366.00	$579.74	$585.60	$0.00	$475.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203098	EAP	Custom 27203098		Dreamwire .035 260str Stnd	BOTH IP/OP	$281.00 	$207.94	$0.00	$224.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.56	$208.56	$216.59	$0.00	$58.56	$0.00	$0.00	$0.00	$0.00	$140.50	$222.55	$224.80	$0.00	$182.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203099	EAP	Custom 27203099		Extractor Rx 9-12 Mm	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.13	$178.13	$184.99	$0.00	$50.02	$0.00	$0.00	$0.00	$0.00	$120.00	$190.08	$192.00	$0.00	$156.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203100	EAP	Custom 27203100		Extractor Rx 12-15 Mm	BOTH IP/OP	$229.00 	$169.46	$0.00	$183.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.96	$169.96	$176.51	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$114.50	$181.37	$183.20	$0.00	$148.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203101	EAP	Custom 27203101		Extractor Rx 15-18 Mm	BOTH IP/OP	$229.00 	$169.46	$0.00	$183.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.96	$169.96	$176.51	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$114.50	$181.37	$183.20	$0.00	$148.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203102	EAP	Custom 27203102		22g Blue Sheath (stiffer)	BOTH IP/OP	$386.00 	$285.64	$0.00	$308.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.49	$286.49	$297.53	$0.00	$80.44	$0.00	$0.00	$0.00	$0.00	$193.00	$305.71	$308.80	$0.00	$250.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203103	EAP	Custom 27203103		22g Green Spring Coil Sheath	BOTH IP/OP	$386.00 	$285.64	$0.00	$308.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.49	$286.49	$297.53	$0.00	$80.44	$0.00	$0.00	$0.00	$0.00	$193.00	$305.71	$308.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203104	EAP	Custom 27203104		Celiac Plexus Neurolysis Needl	BOTH IP/OP	$392.00 	$290.08	$0.00	$313.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.94	$290.94	$302.15	$0.00	$81.69	$0.00	$0.00	$0.00	$0.00	$196.00	$310.46	$313.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203105	EAP	Custom 27203105		19g Bx Needle	BOTH IP/OP	$515.00 	$381.10	$0.00	$412.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.23	$382.23	$396.96	$0.00	$107.33	$0.00	$0.00	$0.00	$0.00	$257.50	$407.88	$412.00	$0.00	$334.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203106	EAP	Custom 27203106		Cytology Brush Echo -19	BOTH IP/OP	$244.00 	$180.56	$0.00	$195.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.10	$181.10	$188.08	$0.00	$50.85	$0.00	$0.00	$0.00	$0.00	$122.00	$193.25	$195.20	$0.00	$158.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203108	EAP	Custom 27203108		Olympus Endo Jaw(cold Forceps)	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$11.56	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00	$9.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203109	EAP	Custom 27203109		Roth Net	BOTH IP/OP	"$1,278.00 "	$945.72	$0.00	"$1,022.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$948.53	$948.53	$985.08	$0.00	$266.34	$0.00	$0.00	$0.00	$0.00	$639.00	"$1,012.18"	"$1,022.40"	$0.00	$830.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203110	EAP	Custom 27203110		Erbe Probe	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.75	$213.75	$221.99	$0.00	$60.02	$0.00	$0.00	$0.00	$0.00	$144.00	$228.10	$230.40	$0.00	$187.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203111	EAP	Custom 27203111		Ercp Forcep	BOTH IP/OP	$691.00 	$511.34	$0.00	$552.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$512.86	$512.86	$532.62	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$345.50	$547.27	$552.80	$0.00	$449.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203112	EAP	Custom 27203112		Rx Dilatation Balloon 4-4/5.8	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.27	$307.27	$319.11	$0.00	$86.28	$0.00	$0.00	$0.00	$0.00	$207.00	$327.89	$331.20	$0.00	$269.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203113	EAP	Custom 27203113		Rx Dilatation Balloon 6-4/5.8	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.27	$307.27	$319.11	$0.00	$86.28	$0.00	$0.00	$0.00	$0.00	$207.00	$327.89	$331.20	$0.00	$269.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203114	EAP	Custom 27203114		Rx Dilatation Balloon 8-4/5.8	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.27	$307.27	$319.11	$0.00	$86.28	$0.00	$0.00	$0.00	$0.00	$207.00	$327.89	$331.20	$0.00	$269.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203115	EAP	Custom 27203115		Rx Dilatation Balloon 10-4/5.8	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.27	$307.27	$319.11	$0.00	$86.28	$0.00	$0.00	$0.00	$0.00	$207.00	$327.89	$331.20	$0.00	$269.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203116	EAP	Custom 27203116		Encore 26 Single	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203117	EAP	Custom 27203117		Injection Probe 10fr	BOTH IP/OP	$431.00 	$318.94	$0.00	$344.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.89	$319.89	$332.21	$0.00	$89.82	$0.00	$0.00	$0.00	$0.00	$215.50	$341.35	$344.80	$0.00	$280.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203118	EAP	Custom 27203118		Injection Probe 7fr	BOTH IP/OP	$431.00 	$318.94	$0.00	$344.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.89	$319.89	$332.21	$0.00	$89.82	$0.00	$0.00	$0.00	$0.00	$215.50	$341.35	$344.80	$0.00	$280.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203120	EAP	HCPCS C1769		.014 Nitrex Guidewire	BOTH IP/OP	"$1,295.00 "	$958.30	$0.00	"$1,036.00"	$703.19	$703.19	$0.00	$0.00	$0.00	$269.91	$961.15	$961.15	$998.19	$0.00	$269.88	$0.00	$765.99	$765.99	$0.00	$647.50	"$1,025.64"	"$1,036.00"	$0.00	$0.00	$0.00	$202.67	$0.00	$0.00	$206.16	$0.00	$0.00	$0.00	$0.00	$0.00
27203121	EAP	Custom 27203121		Coil Axium Helical  Qc-1.5-2-helix	BOTH IP/OP	"$3,686.00 "	"$2,727.64"	$0.00	"$2,948.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,735.75"	"$2,735.75"	"$2,841.17"	$0.00	$768.16	$0.00	$0.00	$0.00	$0.00	"$1,843.00"	"$2,919.31"	"$2,948.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203122	EAP	Custom 27203122		Coil Axium Helical  Qc-2-1-helix	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	$0.00	$0.00	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203123	EAP	Custom 27203123		Coil Axium Helical  Qc-2-2-helix	BOTH IP/OP	"$3,885.00 "	"$2,874.90"	$0.00	"$3,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,883.45"	"$2,883.45"	"$2,994.56"	$0.00	$809.63	$0.00	$0.00	$0.00	$0.00	"$1,942.50"	"$3,076.92"	"$3,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203124	EAP	Custom 27203124		Coil Axium Helical  Qc-2-3-helix	BOTH IP/OP	"$3,770.00 "	"$2,789.80"	$0.00	"$3,016.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,798.09"	"$2,798.09"	"$2,905.92"	$0.00	$785.67	$0.00	$0.00	$0.00	$0.00	"$1,885.00"	"$2,985.84"	"$3,016.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203125	EAP	Custom 27203125		Coil Axium Helical  Qc-2-4-helix	BOTH IP/OP	"$3,885.00 "	"$2,874.90"	$0.00	"$3,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,883.45"	"$2,883.45"	"$2,994.56"	$0.00	$809.63	$0.00	$0.00	$0.00	$0.00	"$1,942.50"	"$3,076.92"	"$3,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203126	EAP	Custom 27203126		Coil Axium Helical  Qc-2-6-helix	BOTH IP/OP	"$3,819.00 "	"$2,826.06"	$0.00	"$3,055.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,834.46"	"$2,834.46"	"$2,943.69"	$0.00	$795.88	$0.00	$0.00	$0.00	$0.00	"$1,909.50"	"$3,024.65"	"$3,055.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203127	EAP	Custom 27203127		Coil Axium Helical  Qc-2-8-helix	BOTH IP/OP	"$3,986.00 "	"$2,949.64"	$0.00	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,958.41"	"$2,958.41"	"$3,072.41"	$0.00	$830.68	$0.00	$0.00	$0.00	$0.00	"$1,993.00"	"$3,156.91"	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203128	EAP	Custom 27203128		Coil Axium Helical  Qc-3-4-helix	BOTH IP/OP	"$3,854.00 "	"$2,851.96"	$0.00	"$3,083.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,860.44"	"$2,860.44"	"$2,970.66"	$0.00	$803.17	$0.00	$0.00	$0.00	$0.00	"$1,927.00"	"$3,052.37"	"$3,083.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203129	EAP	Custom 27203129		Coil Axium Helical  Qc-3-6-helix	BOTH IP/OP	"$3,986.00 "	"$2,949.64"	$0.00	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,958.41"	"$2,958.41"	"$3,072.41"	$0.00	$830.68	$0.00	$0.00	$0.00	$0.00	"$1,993.00"	"$3,156.91"	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203130	EAP	Custom 27203130		Coil Axium Helical  Qc-3-8-helix	BOTH IP/OP	"$3,885.00 "	"$2,874.90"	$0.00	"$3,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,883.45"	"$2,883.45"	"$2,994.56"	$0.00	$809.63	$0.00	$0.00	$0.00	$0.00	"$1,942.50"	"$3,076.92"	"$3,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203131	EAP	Custom 27203131		Coil Axium Helical  Qc-4-8-helix	BOTH IP/OP	"$4,071.00 "	"$3,012.54"	$0.00	"$3,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,021.50"	"$3,021.50"	"$3,137.93"	$0.00	$848.40	$0.00	$0.00	$0.00	$0.00	"$2,035.50"	"$3,224.23"	"$3,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203132	EAP	Custom 27203132		Coil Axium Helical  Qc-4-10-helix	BOTH IP/OP	"$3,885.00 "	"$2,874.90"	$0.00	"$3,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,883.45"	"$2,883.45"	"$2,994.56"	$0.00	$809.63	$0.00	$0.00	$0.00	$0.00	"$1,942.50"	"$3,076.92"	"$3,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203133	EAP	Custom 27203133		Coil Axium Helical  Qc-4-12-helix	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,909.42"	"$2,909.42"	"$3,021.54"	$0.00	$816.93	$0.00	$0.00	$0.00	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203134	EAP	Custom 27203134		Coil Axium Helical  Qc-5-15-helix	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,909.42"	"$2,909.42"	"$3,021.54"	$0.00	$816.93	$0.00	$0.00	$0.00	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203135	EAP	Custom 27203135		Coil Axium Helical  Qc-5-20-helix	BOTH IP/OP	"$3,955.00 "	"$2,926.70"	$0.00	"$3,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,935.40"	"$2,935.40"	"$3,048.51"	$0.00	$824.22	$0.00	$0.00	$0.00	$0.00	"$1,977.50"	"$3,132.36"	"$3,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203136	EAP	Custom 27203136		Coil Axium Helical  Qc-6-20-helix	BOTH IP/OP	"$4,005.00 "	"$2,963.70"	$0.00	"$3,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,972.51"	"$2,972.51"	"$3,087.05"	$0.00	$834.64	$0.00	$0.00	$0.00	$0.00	"$2,002.50"	"$3,171.96"	"$3,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203137	EAP	Custom 27203137		Coil Axium Helical  Qc-7 -30-helix	BOTH IP/OP	"$4,020.00 "	"$2,974.80"	$0.00	"$3,216.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,983.64"	"$2,983.64"	"$3,098.62"	$0.00	$837.77	$0.00	$0.00	$0.00	$0.00	"$2,010.00"	"$3,183.84"	"$3,216.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203138	EAP	Custom 27203138		Coil Axium Helical  Qc-8-30-helix	BOTH IP/OP	"$4,071.00 "	"$3,012.54"	$0.00	"$3,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,021.50"	"$3,021.50"	"$3,137.93"	$0.00	$848.40	$0.00	$0.00	$0.00	$0.00	"$2,035.50"	"$3,224.23"	"$3,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203139	EAP	Custom 27203139		Coil Axium Helical  Qc-9-30-helix	BOTH IP/OP	"$4,071.00 "	"$3,012.54"	$0.00	"$3,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,021.50"	"$3,021.50"	"$3,137.93"	$0.00	$848.40	$0.00	$0.00	$0.00	$0.00	"$2,035.50"	"$3,224.23"	"$3,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203140	EAP	Custom 27203140		Coil Axium Helical  Qc-10-30-helix	BOTH IP/OP	"$3,885.00 "	"$2,874.90"	$0.00	"$3,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,883.45"	"$2,883.45"	"$2,994.56"	$0.00	$809.63	$0.00	$0.00	$0.00	$0.00	"$1,942.50"	"$3,076.92"	"$3,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203141	EAP	Custom 27203141		Coil Axium Helical  Qc-12-30-helix	BOTH IP/OP	"$3,885.00 "	"$2,874.90"	$0.00	"$3,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,883.45"	"$2,883.45"	"$2,994.56"	$0.00	$809.63	$0.00	$0.00	$0.00	$0.00	"$1,942.50"	"$3,076.92"	"$3,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203142	EAP	Custom 27203142		Coil Axium Helical  Qc-14-30-helix	BOTH IP/OP	"$3,903.00 "	"$2,888.22"	$0.00	"$3,122.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,896.81"	"$2,896.81"	"$3,008.43"	$0.00	$813.39	$0.00	$0.00	$0.00	$0.00	"$1,951.50"	"$3,091.18"	"$3,122.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203143	EAP	Custom 27203143		Coil Axium Helical  Qc-16-30-helix	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,909.42"	"$2,909.42"	"$3,021.54"	$0.00	$816.93	$0.00	$0.00	$0.00	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203144	EAP	Custom 27203144		Coil Axium Helical  Qc-16-40-helix	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,909.42"	"$2,909.42"	"$3,021.54"	$0.00	$816.93	$0.00	$0.00	$0.00	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203145	EAP	Custom 27203145		Coil Axium Helical  Qc-18-40-helix	BOTH IP/OP	"$3,955.00 "	"$2,926.70"	$0.00	"$3,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,935.40"	"$2,935.40"	"$3,048.51"	$0.00	$824.22	$0.00	$0.00	$0.00	$0.00	"$1,977.50"	"$3,132.36"	"$3,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203146	EAP	Custom 27203146		Coil Axium Helical  Qc-20-40-helix	BOTH IP/OP	"$3,936.00 "	"$2,912.64"	$0.00	"$3,148.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,921.30"	"$2,921.30"	"$3,033.87"	$0.00	$820.26	$0.00	$0.00	$0.00	$0.00	"$1,968.00"	"$3,117.31"	"$3,148.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203147	EAP	Custom 27203147		Coil Axium Helical  Qc-20-50-helix	BOTH IP/OP	"$4,005.00 "	"$2,963.70"	$0.00	"$3,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,972.51"	"$2,972.51"	"$3,087.05"	$0.00	$834.64	$0.00	$0.00	$0.00	$0.00	"$2,002.50"	"$3,171.96"	"$3,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203148	EAP	Custom 27203148		Coil Axium 3d  Qc-2-2-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203149	EAP	Custom 27203149		Coil Axium 3d  Qc-2-4-3d	BOTH IP/OP	"$4,105.00 "	"$3,037.70"	$0.00	"$3,284.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,046.73"	"$3,046.73"	"$3,164.13"	$0.00	$855.48	$0.00	$0.00	$0.00	$0.00	"$2,052.50"	"$3,251.16"	"$3,284.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203150	EAP	Custom 27203150		Coil Axium 3d  Qc-2-6-3d	BOTH IP/OP	"$4,020.00 "	"$2,974.80"	$0.00	"$3,216.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,983.64"	"$2,983.64"	"$3,098.62"	$0.00	$837.77	$0.00	$0.00	$0.00	$0.00	"$2,010.00"	"$3,183.84"	"$3,216.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203151	EAP	Custom 27203151		Coil Axium 3d  Qc-3-4-3d	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	$0.00	$0.00	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203152	EAP	Custom 27203152		Coil Axium 3d  Qc-3-6-3d	BOTH IP/OP	"$3,245.00 "	"$2,401.30"	$0.00	"$2,596.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,408.44"	"$2,408.44"	"$2,501.25"	$0.00	$676.26	$0.00	$0.00	$0.00	$0.00	"$1,622.50"	"$2,570.04"	"$2,596.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203153	EAP	Custom 27203153		Coil Axium 3d  Qc-3-8-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203154	EAP	Custom 27203154		Coil Axium 3d  Qc-4-8-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$906.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203155	EAP	Custom 27203155		Coil Axium 3d  Qc-4-12-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203156	EAP	Custom 27203156		Coil Axium 3d  Qc-5-10-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203157	EAP	Custom 27203157		Coil Axium 3d  Qc-5-15-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203158	EAP	Custom 27203158		Coil Axium 3d  Qc-6-15-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203159	EAP	Custom 27203159		Coil Axium 3d  Qc-6-20-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203160	EAP	Custom 27203160		Coil Axium 3d  Qc-7-20-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$906.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203161	EAP	Custom 27203161		Coil Axium 3d  Qc-7-30-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$906.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203162	EAP	Custom 27203162		Coil Axium 3d  Qc-8-20-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203163	EAP	Custom 27203163		Coil Axium 3d  Qc-8-30-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$906.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203164	EAP	Custom 27203164		Coil Axium 3d  Qc-9-20-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$906.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203165	EAP	Custom 27203165		Coil Axium 3d  Qc-9-30-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$906.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203166	EAP	Custom 27203166		Coil Axium 3d  Qc-10-20-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$906.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203167	EAP	Custom 27203167		Coil Axium 3d  Qc-10-30-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203168	EAP	Custom 27203168		Coil Axium 3d  Qc-12-40-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$906.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203169	EAP	Custom 27203169		Coil Axium 3d  Qc-14-40-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203170	EAP	Custom 27203170		Coil Axium 3d  Qc-16-40-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203171	EAP	Custom 27203171		Coil Axium 3d  Qc-18-40-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203172	EAP	Custom 27203172		Coil Axium 3d  Qc-20-50-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203173	EAP	Custom 27203173		Coil Axium 3d  Qc-22-50-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203174	EAP	Custom 27203174		Coil Axium 3d  Qc-25-50-3d	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.37"	"$1,035.37"	"$1,075.27"	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203180	EAP	HCPCS C1726		Roth Net	BOTH IP/OP	"$1,278.00 "	$945.72	$0.00	"$1,022.40"	$693.95	$693.95	$0.00	$0.00	$0.00	$266.37	$948.53	$948.53	$985.08	$0.00	$266.34	$0.00	$755.94	$755.94	$0.00	$639.00	"$1,012.18"	"$1,022.40"	$0.00	$830.70	$0.00	$200.01	$0.00	$0.00	$203.46	$0.00	$0.00	$0.00	$0.00	$0.00
27203181	EAP	HCPCS C1726		2.3mm Interject Inj Needle23g	BOTH IP/OP	$732.00 	$541.68	$0.00	$585.60	$397.48	$397.48	$0.00	$0.00	$0.00	$152.57	$543.29	$543.29	$564.23	$0.00	$152.55	$0.00	$432.98	$432.98	$0.00	$366.00	$579.74	$585.60	$0.00	$475.80	$0.00	$114.56	$0.00	$0.00	$116.53	$0.00	$0.00	$0.00	$0.00	$0.00
27203182	EAP	HCPCS C1726		Ercp Forcep	BOTH IP/OP	$691.00 	$511.34	$0.00	$552.80	$375.21	$375.21	$0.00	$0.00	$0.00	$144.02	$512.86	$512.86	$532.62	$0.00	$144.00	$0.00	$408.73	$408.73	$0.00	$345.50	$547.27	$552.80	$0.00	$0.00	$0.00	$108.14	$0.00	$0.00	$110.01	$0.00	$0.00	$0.00	$0.00	$0.00
27203183	EAP	HCPCS C1726		19g Bx Needle	BOTH IP/OP	$515.00 	$381.10	$0.00	$412.00	$279.65	$279.65	$0.00	$0.00	$0.00	$107.34	$382.23	$382.23	$396.96	$0.00	$107.33	$0.00	$304.62	$304.62	$0.00	$257.50	$407.88	$412.00	$0.00	$0.00	$0.00	$80.60	$0.00	$0.00	$81.99	$0.00	$0.00	$0.00	$0.00	$0.00
27203184	EAP	HCPCS C1751		Cather Cco Swan-ganz Sv02 W/o	BOTH IP/OP	$479.00 	$354.46	$0.00	$383.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.50	$379.37	$383.20	$0.00	$0.00	$0.00	$74.96	$0.00	$0.00	$76.26	$0.00	$0.00	$0.00	$0.00	$0.00
27203185	EAP	HCPCS C1751		Injection Probe 10fr	BOTH IP/OP	$431.00 	$318.94	$0.00	$344.80	$234.03	$234.03	$0.00	$0.00	$0.00	$89.83	$319.89	$319.89	$332.21	$0.00	$89.82	$0.00	$254.94	$254.94	$0.00	$215.50	$341.35	$344.80	$0.00	$0.00	$0.00	$67.45	$0.00	$0.00	$68.62	$0.00	$0.00	$0.00	$0.00	$0.00
27203186	EAP	HCPCS C1751		Injection Probe 7fr	BOTH IP/OP	$431.00 	$318.94	$0.00	$344.80	$234.03	$234.03	$0.00	$0.00	$0.00	$89.83	$319.89	$319.89	$332.21	$0.00	$89.82	$0.00	$254.94	$254.94	$0.00	$215.50	$341.35	$344.80	$0.00	$280.15	$0.00	$67.45	$0.00	$0.00	$68.62	$0.00	$0.00	$0.00	$0.00	$0.00
27203187	EAP	HCPCS C1726		Rx Dilatation Balloon 4-4/5.8	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$224.80	$224.80	$0.00	$0.00	$0.00	$86.29	$307.27	$307.27	$319.11	$0.00	$86.28	$0.00	$244.88	$244.88	$0.00	$207.00	$327.89	$331.20	$0.00	$0.00	$0.00	$64.79	$0.00	$0.00	$65.91	$0.00	$0.00	$0.00	$0.00	$0.00
27203188	EAP	HCPCS C1726		Rx Dilatation Balloon 6-4/5.8	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$224.80	$224.80	$0.00	$0.00	$0.00	$86.29	$307.27	$307.27	$319.11	$0.00	$86.28	$0.00	$244.88	$244.88	$0.00	$207.00	$327.89	$331.20	$0.00	$0.00	$0.00	$64.79	$0.00	$0.00	$65.91	$0.00	$0.00	$0.00	$0.00	$0.00
27203189	EAP	HCPCS C1726		Rx Dilatation Balloon 8-4/5.8	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$224.80	$224.80	$0.00	$0.00	$0.00	$86.29	$307.27	$307.27	$319.11	$0.00	$86.28	$0.00	$244.88	$244.88	$0.00	$207.00	$327.89	$331.20	$0.00	$0.00	$0.00	$64.79	$0.00	$0.00	$65.91	$0.00	$0.00	$0.00	$0.00	$0.00
27203190	EAP	HCPCS C1726		Rx Dilatation Balloon 10-4/5.8	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$224.80	$224.80	$0.00	$0.00	$0.00	$86.29	$307.27	$307.27	$319.11	$0.00	$86.28	$0.00	$244.88	$244.88	$0.00	$207.00	$327.89	$331.20	$0.00	$0.00	$0.00	$64.79	$0.00	$0.00	$65.91	$0.00	$0.00	$0.00	$0.00	$0.00
27203191	EAP	HCPCS C1726		Celiac Plexus Neurolysis Needl	BOTH IP/OP	$392.00 	$290.08	$0.00	$313.60	$212.86	$212.86	$0.00	$0.00	$0.00	$81.70	$290.94	$290.94	$302.15	$0.00	$81.69	$0.00	$231.87	$231.87	$0.00	$196.00	$310.46	$313.60	$0.00	$0.00	$0.00	$61.35	$0.00	$0.00	$62.41	$0.00	$0.00	$0.00	$0.00	$0.00
27203192	EAP	HCPCS C1726		22g Blue Sheath (stiffer)	BOTH IP/OP	$386.00 	$285.64	$0.00	$308.80	$209.60	$209.60	$0.00	$0.00	$0.00	$80.45	$286.49	$286.49	$297.53	$0.00	$80.44	$0.00	$228.32	$228.32	$0.00	$193.00	$305.71	$308.80	$0.00	$0.00	$0.00	$60.41	$0.00	$0.00	$61.45	$0.00	$0.00	$0.00	$0.00	$0.00
27203193	EAP	HCPCS C1726		22g Green Spring Coil Sheath	BOTH IP/OP	$386.00 	$285.64	$0.00	$308.80	$209.60	$209.60	$0.00	$0.00	$0.00	$80.45	$286.49	$286.49	$297.53	$0.00	$80.44	$0.00	$228.32	$228.32	$0.00	$193.00	$305.71	$308.80	$0.00	$0.00	$0.00	$60.41	$0.00	$0.00	$61.45	$0.00	$0.00	$0.00	$0.00	$0.00
27203194	EAP	HCPCS C1726		Cre Wg 8-10 Dilation Balloon	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$175.93	$175.93	$0.00	$0.00	$0.00	$67.53	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$191.65	$191.65	$0.00	$162.00	$256.61	$259.20	$0.00	$0.00	$0.00	$50.71	$0.00	$0.00	$51.58	$0.00	$0.00	$0.00	$0.00	$0.00
27203195	EAP	HCPCS C1726		Cre Wg 10-12 Dilation Balloon	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$175.93	$175.93	$0.00	$0.00	$0.00	$67.53	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$191.65	$191.65	$0.00	$162.00	$256.61	$259.20	$0.00	$210.60	$0.00	$50.71	$0.00	$0.00	$51.58	$0.00	$0.00	$0.00	$0.00	$0.00
27203196	EAP	HCPCS C1726		Cre 12-15mm Dilation Balloon	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$175.93	$175.93	$0.00	$0.00	$0.00	$67.53	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$191.65	$191.65	$0.00	$162.00	$256.61	$259.20	$0.00	$0.00	$0.00	$50.71	$0.00	$0.00	$51.58	$0.00	$0.00	$0.00	$0.00	$0.00
27203197	EAP	HCPCS C1726		Cre 15-18 Mm Dilation Balloon	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$175.93	$175.93	$0.00	$0.00	$0.00	$67.53	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$191.65	$191.65	$0.00	$162.00	$256.61	$259.20	$0.00	$0.00	$0.00	$50.71	$0.00	$0.00	$51.58	$0.00	$0.00	$0.00	$0.00	$0.00
27203198	EAP	HCPCS C1726		Cre 18-20 Mm Dilation Balloon	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$175.93	$175.93	$0.00	$0.00	$0.00	$67.53	$240.47	$240.47	$249.74	$0.00	$67.52	$0.00	$191.65	$191.65	$0.00	$162.00	$256.61	$259.20	$0.00	$0.00	$0.00	$50.71	$0.00	$0.00	$51.58	$0.00	$0.00	$0.00	$0.00	$0.00
27203199	EAP	HCPCS C1726		Erbe Probe	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$156.38	$156.38	$0.00	$0.00	$0.00	$60.03	$213.75	$213.75	$221.99	$0.00	$60.02	$0.00	$170.35	$170.35	$0.00	$144.00	$228.10	$230.40	$0.00	$0.00	$0.00	$45.07	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$0.00
27203200	EAP	HCPCS C1769		Dreamwire .035 260str Stnd	BOTH IP/OP	$281.00 	$207.94	$0.00	$224.80	$152.58	$152.58	$0.00	$0.00	$0.00	$58.57	$208.56	$208.56	$216.59	$0.00	$58.56	$0.00	$166.21	$166.21	$0.00	$140.50	$222.55	$224.80	$0.00	$0.00	$0.00	$43.98	$0.00	$0.00	$44.74	$0.00	$0.00	$0.00	$0.00	$0.00
27203201	EAP	HCPCS C1726		Cytology Brush Echo -19	BOTH IP/OP	$232.00 	$171.68	$0.00	$185.60	$125.98	$125.98	$0.00	$0.00	$0.00	$48.35	$172.19	$172.19	$178.83	$0.00	$48.35	$0.00	$137.23	$137.23	$0.00	$116.00	$183.74	$185.60	$0.00	$0.00	$0.00	$36.31	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
27203202	EAP	HCPCS C1726		Extractor Rx 9-12 Mm	BOTH IP/OP	$229.00 	$169.46	$0.00	$183.20	$124.35	$124.35	$0.00	$0.00	$0.00	$47.73	$169.96	$169.96	$176.51	$0.00	$47.72	$0.00	$135.45	$135.45	$0.00	$114.50	$181.37	$183.20	$0.00	$148.85	$0.00	$35.84	$0.00	$0.00	$36.46	$0.00	$0.00	$0.00	$0.00	$0.00
27203203	EAP	HCPCS C1726		Extractor Rx 12-15 Mm	BOTH IP/OP	$229.00 	$169.46	$0.00	$183.20	$124.35	$124.35	$0.00	$0.00	$0.00	$47.73	$169.96	$169.96	$176.51	$0.00	$47.72	$0.00	$135.45	$135.45	$0.00	$114.50	$181.37	$183.20	$0.00	$0.00	$0.00	$35.84	$0.00	$0.00	$36.46	$0.00	$0.00	$0.00	$0.00	$0.00
27203204	EAP	HCPCS C1726		Extractor Rx 15-18 Mm	BOTH IP/OP	$229.00 	$169.46	$0.00	$183.20	$124.35	$124.35	$0.00	$0.00	$0.00	$47.73	$169.96	$169.96	$176.51	$0.00	$47.72	$0.00	$135.45	$135.45	$0.00	$114.50	$181.37	$183.20	$0.00	$0.00	$0.00	$35.84	$0.00	$0.00	$36.46	$0.00	$0.00	$0.00	$0.00	$0.00
27203205	EAP	HCPCS C1726		Alliance Inflation Syringe	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$28.24	$28.24	$0.00	$0.00	$0.00	$10.84	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00	$0.00	$0.00	$8.14	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
27203206	EAP	HCPCS C1726		Encore 26 Single	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$19.01	$19.01	$0.00	$0.00	$0.00	$7.29	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$20.70	$20.70	$0.00	$17.50	$27.72	$28.00	$0.00	$0.00	$0.00	$5.48	$0.00	$0.00	$5.57	$0.00	$0.00	$0.00	$0.00	$0.00
27203207	EAP	HCPCS C1726		Rx Lckng Dvce &bx Cap/olympus	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$8.69	$8.69	$0.00	$0.00	$0.00	$3.33	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$2.50	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$0.00
27203208	EAP	HCPCS C1726		Olympus Endo Jaw(cold Forceps)	BOTH IP/OP	$14.00 	$10.36	$0.00	$11.20	$7.60	$7.60	$0.00	$0.00	$0.00	$2.92	$10.39	$10.39	$10.79	$0.00	$2.92	$0.00	$8.28	$8.28	$0.00	$7.00	$11.09	$11.20	$0.00	$9.10	$0.00	$2.19	$0.00	$0.00	$2.23	$0.00	$0.00	$0.00	$0.00	$0.00
27203210	EAP	HCPCS C1773		Kit Snr Agn 90d Mic 200cm 2.3-3fr 2mm Cath Loop	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	$0.00	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
27203211	EAP	HCPCS C1729		Cath Drain Edm (ventricular) L 26cm	BOTH IP/OP	$480.00 	$355.20	$0.00	$384.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.00	$380.16	$384.00	$0.00	$0.00	$0.00	$75.12	$0.00	$0.00	$76.42	$0.00	$0.00	$0.00	$0.00	$0.00
27203212	EAP	HCPCS C1729		"Catheter, Evd Bactiseal 82-1750"	BOTH IP/OP	"$1,924.00 "	"$1,423.76"	$0.00	"$1,539.20"	"$1,044.73"	"$1,044.73"	$0.00	$0.00	$0.00	$401.01	"$1,427.99"	"$1,427.99"	"$1,483.02"	$0.00	$400.96	$0.00	"$1,138.05"	"$1,138.05"	$0.00	$962.00	"$1,523.81"	"$1,539.20"	$0.00	$0.00	$0.00	$301.11	$0.00	$0.00	$306.30	$0.00	$0.00	$0.00	$0.00	$0.00
27203213	EAP	HCPCS C1773		Kit Snr Agn 90d 200cm 2.3-3fr 4mm Mcth Loop Coil	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	$0.00	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
27203214	EAP	HCPCS C1773		Kit Snr Agn 90d 200cm 2.3-3fr 7mm Mcth Loop Coil	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	"$1,056.25"	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
27203215	EAP	HCPCS C1887		Catheter Guid Sim2 Curve 6fr 90cm Env	BOTH IP/OP	$901.00 	$666.74	$0.00	$720.80	$489.24	$489.24	$0.00	$0.00	$0.00	$187.79	$668.72	$668.72	$694.49	$0.00	$187.77	$0.00	$532.94	$532.94	$0.00	$450.50	$713.59	$720.80	$0.00	$585.65	$0.00	$141.01	$0.00	$0.00	$143.44	$0.00	$0.00	$0.00	$0.00	$0.00
27203216	EAP	HCPCS C1887		Catheter Guid Sim2 Curve 6fr 100cm Env	BOTH IP/OP	$901.00 	$666.74	$0.00	$720.80	$489.24	$489.24	$0.00	$0.00	$0.00	$187.79	$668.72	$668.72	$694.49	$0.00	$187.77	$0.00	$532.94	$532.94	$0.00	$450.50	$713.59	$720.80	$0.00	$585.65	$0.00	$141.01	$0.00	$0.00	$143.44	$0.00	$0.00	$0.00	$0.00	$0.00
27203217	EAP	HCPCS C1769		Guidewire Vasc 175cm Rnd Prfl Agile Tip Smtr Rot	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$855.23	$855.23	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	"$1,214.01"	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00	"$1,023.75"	$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
27203220	EAP	HCPCS C1894		Introducer Shth Lng 5fr 30cm Gry Lf Traw Hi Kink Rst Ulsmth	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$55.39	$55.39	$0.00	$0.00	$0.00	$21.26	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$60.33	$60.33	$0.00	$51.00	$80.78	$81.60	$0.00	$66.30	$0.00	$15.96	$0.00	$0.00	$16.24	$0.00	$0.00	$0.00	$0.00	$0.00
27203221	EAP	HCPCS C1894		Introducer Shth Lng 6fr 30cm Lf Traw Unq Lck Hi Kink Rst	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$55.39	$55.39	$0.00	$0.00	$0.00	$21.26	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$60.33	$60.33	$0.00	$51.00	$80.78	$81.60	$0.00	$66.30	$0.00	$15.96	$0.00	$0.00	$16.24	$0.00	$0.00	$0.00	$0.00	$0.00
27203222	EAP	HCPCS C1894		Sheath Intro Lng 7fr 30cm Traw Fnl Ulsmth Dil Tpr Ptfe	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$55.39	$55.39	$0.00	$0.00	$0.00	$21.26	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$60.33	$60.33	$0.00	$51.00	$80.78	$81.60	$0.00	$66.30	$0.00	$15.96	$0.00	$0.00	$16.24	$0.00	$0.00	$0.00	$0.00	$0.00
27203251	EAP	Custom 27203251		Coil Axium Helical  Qc-1.5-2-helix	BOTH IP/OP	"$1,034.00 "	$765.16	$0.00	$827.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$767.43	$767.43	$797.01	$0.00	$215.49	$0.00	$0.00	$0.00	$0.00	$517.00	$818.93	$827.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203270	EAP	Custom 27203270		Mpc Envoy Guiding Cath	BOTH IP/OP	$303.00 	$224.22	$0.00	$242.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.89	$224.89	$233.55	$0.00	$63.15	$0.00	$0.00	$0.00	$0.00	$151.50	$239.98	$242.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203271	EAP	Custom 27203271		Control Wire .018 V-18	BOTH IP/OP	$783.00 	$579.42	$0.00	$626.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$581.14	$581.14	$603.54	$0.00	$163.18	$0.00	$0.00	$0.00	$0.00	$391.50	$620.14	$626.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203290	EAP	Custom 27203290		Foot Drop Splint-prefab	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203400	EAP	Custom 27203400		Interlock Detach 36-156 Coil	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203401	EAP	Custom 27203401		Dfs100406-20 Micrus Microcoil	BOTH IP/OP	$483.00 	$357.42	$0.00	$386.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$358.48	$358.48	$372.30	$0.00	$100.66	$0.00	$0.00	$0.00	$0.00	$241.50	$382.54	$386.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203402	EAP	Custom 27203402		Dfs100310-20 Micrus Microcoil	BOTH IP/OP	"$1,429.00 "	"$1,057.46"	$0.00	"$1,143.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,060.60"	"$1,060.60"	"$1,101.47"	$0.00	$297.80	$0.00	$0.00	$0.00	$0.00	$714.50	"$1,131.77"	"$1,143.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203403	EAP	Custom 27203403		Dpl100151-20 Micrus Microcoil	BOTH IP/OP	"$1,571.00 "	"$1,162.54"	$0.00	"$1,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,166.00"	"$1,166.00"	"$1,210.93"	$0.00	$327.40	$0.00	$0.00	$0.00	$0.00	$785.50	"$1,244.23"	"$1,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203404	EAP	Custom 27203404		Hel180620-2o Micrus Microcoil	BOTH IP/OP	$834.00 	$617.16	$0.00	$667.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$618.99	$618.99	$642.85	$0.00	$173.81	$0.00	$0.00	$0.00	$0.00	$417.00	$660.53	$667.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203405	EAP	Custom 27203405		Brs000609-00 Balloon Ascnt	BOTH IP/OP	"$1,900.00 "	"$1,406.00"	$0.00	"$1,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,410.18"	"$1,410.18"	"$1,464.52"	$0.00	$395.96	$0.00	$0.00	$0.00	$0.00	$950.00	"$1,504.80"	"$1,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203406	EAP	Custom 27203406		4.5x20 4.5x20 Viatrac Balloon	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$975.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203407	EAP	Custom 27203407		5x20 Viatrac Balloon	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$975.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203408	EAP	Custom 27203408		6x20 Viatrac Balloon	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$975.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203409	EAP	Custom 27203409		.038 150cm Stiff Angled Glide	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203410	EAP	Custom 27203410		.038 150cm Guidewire Bntsn	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203411	EAP	Custom 27203411		9fr-30 Tear-away Introducer	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$0.00	$0.00	$0.00	$25.50	$40.39	$40.80	$0.00	$33.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203412	EAP	Custom 27203412		10fr-30cm Tear-away Introducer	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203413	EAP	Custom 27203413		16fr-30cm Tear-away Introducer	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$31.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203414	EAP	Custom 27203414		2.0 Mm X9 Maverick Balloon Catheter	BOTH IP/OP	$916.00 	$677.84	$0.00	$732.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$679.86	$679.86	$706.05	$0.00	$190.89	$0.00	$0.00	$0.00	$0.00	$458.00	$725.47	$732.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203415	EAP	Custom 27203415		2.5 Mm X9 Maverick Balloon Catheter	BOTH IP/OP	$916.00 	$677.84	$0.00	$732.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$679.86	$679.86	$706.05	$0.00	$190.89	$0.00	$0.00	$0.00	$0.00	$458.00	$725.47	$732.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203416	EAP	Custom 27203416		Stent Microdelivery System Neurform2 System 3.5 X 30mm	BOTH IP/OP	"$8,535.00 "	"$6,315.90"	$0.00	"$6,828.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,578.78"	$0.00	"$1,778.69"	$0.00	$0.00	$0.00	$0.00	"$4,267.50"	"$6,759.72"	"$6,828.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203417	EAP	Custom 27203417		3.0 Mm X9 Maverick Balloon Catheter	BOTH IP/OP	$916.00 	$677.84	$0.00	$732.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$679.86	$679.86	$706.05	$0.00	$190.89	$0.00	$0.00	$0.00	$0.00	$458.00	$725.47	$732.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203418	EAP	Custom 27203418		Stent Stabilizer Catheter Neurform	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	$0.00	$0.00	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203419	EAP	Custom 27203419		Mpc Envoy Guiding Cath	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$333.99	$333.99	$346.86	$0.00	$93.78	$0.00	$0.00	$0.00	$0.00	$225.00	$356.40	$360.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203420	EAP	Custom 27203420		5.5 Accunet Distal Protection Device	BOTH IP/OP	"$5,171.00 "	"$3,826.54"	$0.00	"$4,136.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,837.92"	"$3,837.92"	"$3,985.81"	$0.00	"$1,077.64"	$0.00	$0.00	$0.00	$0.00	"$2,585.50"	"$4,095.43"	"$4,136.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203421	EAP	Custom 27203421		2.25 Minivision Stent	BOTH IP/OP	"$1,256.00 "	$929.44	$0.00	"$1,004.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.20	$932.20	$968.12	$0.00	$261.75	$0.00	$0.00	$0.00	$0.00	$628.00	$994.75	"$1,004.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203422	EAP	Custom 27203422		4.0x20mm Viatrac Balloon	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$975.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203423	EAP	Custom 27203423		125cm Vetebral Catheter	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$42.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203425	EAP	HCPCS C1887		Catheter Intvn 5fr .056in .046in 150cm 25cm Rapex	BOTH IP/OP	"$1,023.00 "	$757.02	$0.00	$818.40	$555.49	$555.49	$0.00	$0.00	$0.00	$213.22	$759.27	$759.27	$788.53	$0.00	$213.19	$0.00	$605.10	$605.10	$0.00	$511.50	$810.22	$818.40	$0.00	$664.95	$0.00	$160.10	$0.00	$0.00	$162.86	$0.00	$0.00	$0.00	$0.00	$0.00
27203426	EAP	HCPCS C1887		Catheter Intvn 7fr .078in .062in 150cm 25cm Rapex	BOTH IP/OP	"$1,023.00 "	$757.02	$0.00	$818.40	$555.49	$555.49	$0.00	$0.00	$0.00	$213.22	$759.27	$759.27	$788.53	$0.00	$213.19	$0.00	$605.10	$605.10	$0.00	$511.50	$810.22	$818.40	$0.00	$0.00	$0.00	$160.10	$0.00	$0.00	$162.86	$0.00	$0.00	$0.00	$0.00	$0.00
27203427	EAP	HCPCS C1887		Catheter Intvn 8fr .088in .071in 150cm 25cm Rapex	BOTH IP/OP	"$1,023.00 "	$757.02	$0.00	$818.40	$555.49	$555.49	$0.00	$0.00	$0.00	$213.22	$759.27	$759.27	$788.53	$0.00	$213.19	$0.00	$605.10	$605.10	$0.00	$511.50	$810.22	$818.40	$0.00	$664.95	$0.00	$160.10	$0.00	$0.00	$162.86	$0.00	$0.00	$0.00	$0.00	$0.00
27203428	EAP	HCPCS C1887		Sheath Guid 90cm 3 Radiopq Xcut Vlv Pn Dstn 8fr	BOTH IP/OP	$239.00 	$176.86	$0.00	$191.20	$129.78	$129.78	$0.00	$0.00	$0.00	$49.81	$177.39	$177.39	$184.22	$0.00	$49.81	$0.00	$141.37	$141.37	$0.00	$119.50	$189.29	$191.20	$0.00	$0.00	$0.00	$37.40	$0.00	$0.00	$38.05	$0.00	$0.00	$0.00	$0.00	$0.00
27203429	EAP	HCPCS C1887		Sheath Guid 65cm 8fr Pn Dstn .038in Str Hydphi	BOTH IP/OP	$224.00 	$165.76	$0.00	$179.20	$121.63	$121.63	$0.00	$0.00	$0.00	$46.69	$166.25	$166.25	$172.66	$0.00	$46.68	$0.00	$132.50	$132.50	$0.00	$112.00	$177.41	$179.20	$0.00	$145.60	$0.00	$35.06	$0.00	$0.00	$35.66	$0.00	$0.00	$0.00	$0.00	$0.00
27203434	EAP	HCPCS C1769		Moo326420 Guidewire Standard P	BOTH IP/OP	"$1,299.00 "	$961.26	$0.00	"$1,039.20"	$705.36	$705.36	$0.00	$0.00	$0.00	$270.74	$964.12	$964.12	"$1,001.27"	$0.00	$270.71	$0.00	$768.36	$768.36	$0.00	$649.50	"$1,028.81"	"$1,039.20"	$0.00	$0.00	$0.00	$203.29	$0.00	$0.00	$206.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203450	EAP	HCPCS C1751		105-5092-150 Echelon 14 Micro	BOTH IP/OP	"$1,751.00 "	"$1,295.74"	$0.00	"$1,400.80"	$950.79	$950.79	$0.00	$0.00	$0.00	$364.95	"$1,299.59"	"$1,299.59"	"$1,349.67"	$0.00	$364.91	$0.00	"$1,035.72"	"$1,035.72"	$0.00	$875.50	"$1,386.79"	"$1,400.80"	$0.00	"$1,138.15"	$0.00	$274.03	$0.00	$0.00	$278.76	$0.00	$0.00	$0.00	$0.00	$0.00
27203467	EAP	HCPCS C1884		Spd2-us-050-320 Device Protect	BOTH IP/OP	"$1,411.00 "	"$1,044.14"	$0.00	"$1,128.80"	$766.17	$766.17	$0.00	$0.00	$0.00	$294.09	"$1,047.24"	"$1,047.24"	"$1,087.60"	$0.00	$294.05	$0.00	$834.61	$834.61	$0.00	$705.50	"$1,117.51"	"$1,128.80"	$0.00	$0.00	$0.00	$220.82	$0.00	$0.00	$224.63	$0.00	$0.00	$0.00	$0.00	$0.00
27203477	EAP	Custom 27203477		36-152 Coil Detachable Interlo	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$968.90	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203478	EAP	Custom 27203478		36-154 Coil Detachable Interlo	BOTH IP/OP	"$1,320.00 "	$976.80	$0.00	"$1,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$979.70	$979.70	"$1,017.46"	$0.00	$275.09	$0.00	$0.00	$0.00	$0.00	$660.00	"$1,045.44"	"$1,056.00"	$0.00	$594.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203479	EAP	Custom 27203479		36-156 Coil Detachable Interlo	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$968.90	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203480	EAP	Custom 27203480		36-157 Coil Detachable Interlo	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$968.90	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203481	EAP	Custom 27203481		Marker Straight 2-tip 150cm/6c	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$843.88	$843.88	$876.40	$0.00	$236.95	$0.00	$0.00	$0.00	$0.00	$568.50	$900.50	$909.60	$0.00	$739.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203483	EAP	HCPCS C1887		Mpc Envoy Guiding Wire	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$244.35	$244.35	$0.00	$0.00	$0.00	$93.79	$333.99	$333.99	$346.86	$0.00	$93.78	$0.00	$266.18	$266.18	$0.00	$225.00	$356.40	$360.00	$0.00	$0.00	$0.00	$70.43	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$0.00
27203484	EAP	Custom 27203484		Starclose Se	BOTH IP/OP	$700.00 	$518.00	$0.00	$560.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$519.54	$519.54	$539.56	$0.00	$145.88	$0.00	$0.00	$0.00	$0.00	$350.00	$554.40	$560.00	$0.00	$455.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203485	EAP	Custom 27203485		Lc Bead 300-500	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$990.84	$990.84	"$1,029.02"	$0.00	$278.21	$0.00	$0.00	$0.00	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203487	EAP	HCPCS C1769		Guidewire Silverspeed .014	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$447.98	$447.98	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$635.91	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$412.50	$653.40	$660.00	$0.00	$0.00	$0.00	$129.11	$0.00	$0.00	$131.34	$0.00	$0.00	$0.00	$0.00	$0.00
27203488	EAP	HCPCS C1769		Guidewire Silverspeed .014	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$447.98	$447.98	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$635.91	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$412.50	$653.40	$660.00	$0.00	$0.00	$0.00	$129.11	$0.00	$0.00	$131.34	$0.00	$0.00	$0.00	$0.00	$0.00
27203489	EAP	HCPCS C1751		Catheter Echelon 10 Micro	BOTH IP/OP	"$2,423.00 "	"$1,793.02"	$0.00	"$1,938.40"	"$1,315.69"	"$1,315.69"	$0.00	$0.00	$0.00	$505.01	"$1,798.35"	"$1,798.35"	"$1,867.65"	$0.00	$504.95	$0.00	"$1,433.20"	"$1,433.20"	$0.00	"$1,211.50"	"$1,919.02"	"$1,938.40"	$0.00	$0.00	$0.00	$379.20	$0.00	$0.00	$385.74	$0.00	$0.00	$0.00	$0.00	$0.00
27203490	EAP	HCPCS C1751		Catheter Echelon 10 Micro	BOTH IP/OP	"$2,423.00 "	"$1,793.02"	$0.00	"$1,938.40"	"$1,315.69"	"$1,315.69"	$0.00	$0.00	$0.00	$505.01	"$1,798.35"	"$1,798.35"	"$1,867.65"	$0.00	$504.95	$0.00	"$1,433.20"	"$1,433.20"	$0.00	"$1,211.50"	"$1,919.02"	"$1,938.40"	$0.00	$0.00	$0.00	$379.20	$0.00	$0.00	$385.74	$0.00	$0.00	$0.00	$0.00	$0.00
27203491	EAP	HCPCS C1751		Catheter Echelon 14 Micro	BOTH IP/OP	"$2,423.00 "	"$1,793.02"	$0.00	"$1,938.40"	"$1,315.69"	"$1,315.69"	$0.00	$0.00	$0.00	$505.01	"$1,798.35"	"$1,798.35"	"$1,867.65"	$0.00	$504.95	$0.00	"$1,433.20"	"$1,433.20"	$0.00	"$1,211.50"	"$1,919.02"	"$1,938.40"	$0.00	$0.00	$0.00	$379.20	$0.00	$0.00	$385.74	$0.00	$0.00	$0.00	$0.00	$0.00
27203492	EAP	HCPCS C1751		Catheter Echelon 10micro	BOTH IP/OP	"$2,423.00 "	"$1,793.02"	$0.00	"$1,938.40"	"$1,315.69"	"$1,315.69"	$0.00	$0.00	$0.00	$505.01	"$1,798.35"	"$1,798.35"	"$1,867.65"	$0.00	$504.95	$0.00	"$1,433.20"	"$1,433.20"	$0.00	"$1,211.50"	"$1,919.02"	"$1,938.40"	$0.00	$0.00	$0.00	$379.20	$0.00	$0.00	$385.74	$0.00	$0.00	$0.00	$0.00	$0.00
27203493	EAP	HCPCS C1751		Catheter Echelon 14 Micro	BOTH IP/OP	"$2,423.00 "	"$1,793.02"	$0.00	"$1,938.40"	"$1,315.69"	"$1,315.69"	$0.00	$0.00	$0.00	$505.01	"$1,798.35"	"$1,798.35"	"$1,867.65"	$0.00	$504.95	$0.00	"$1,433.20"	"$1,433.20"	$0.00	"$1,211.50"	"$1,919.02"	"$1,938.40"	$0.00	$0.00	$0.00	$379.20	$0.00	$0.00	$385.74	$0.00	$0.00	$0.00	$0.00	$0.00
27203494	EAP	Custom 27203494		Alligator Retrieval	BOTH IP/OP	"$8,340.00 "	"$6,171.60"	$0.00	"$6,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,428.47"	$0.00	"$1,738.06"	$0.00	$0.00	$0.00	$0.00	"$4,170.00"	"$6,605.28"	"$6,672.00"	$0.00	"$5,421.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203495	EAP	Custom 27203495		Alligator Retrieval	BOTH IP/OP	"$8,340.00 "	"$6,171.60"	$0.00	"$6,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,428.47"	$0.00	"$1,738.06"	$0.00	$0.00	$0.00	$0.00	"$4,170.00"	"$6,605.28"	"$6,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203496	EAP	Custom 27203496		Alligator Retrieval	BOTH IP/OP	"$8,340.00 "	"$6,171.60"	$0.00	"$6,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,428.47"	$0.00	"$1,738.06"	$0.00	$0.00	$0.00	$0.00	"$4,170.00"	"$6,605.28"	"$6,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203497	EAP	Custom 27203497		Alligator Retrieval	BOTH IP/OP	"$8,340.00 "	"$6,171.60"	$0.00	"$6,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,428.47"	$0.00	"$1,738.06"	$0.00	$0.00	$0.00	$0.00	"$4,170.00"	"$6,605.28"	"$6,672.00"	$0.00	"$5,421.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203498	EAP	HCPCS C1725		Catheter Balloon Pta 3.50 X 15	BOTH IP/OP	"$3,387.00 "	"$2,506.38"	$0.00	"$2,709.60"	"$1,839.14"	"$1,839.14"	$0.00	$0.00	$0.00	$705.94	"$2,513.83"	"$2,513.83"	"$2,610.70"	$0.00	$705.85	$0.00	"$2,003.41"	"$2,003.41"	$0.00	"$1,693.50"	"$2,682.50"	"$2,709.60"	$0.00	$0.00	$0.00	$530.07	$0.00	$0.00	$539.21	$0.00	$0.00	$0.00	$0.00	$0.00
27203499	EAP	HCPCS C1725		Catheter Balloon Pta 3.00 X 15	BOTH IP/OP	"$3,387.00 "	"$2,506.38"	$0.00	"$2,709.60"	"$1,839.14"	"$1,839.14"	$0.00	$0.00	$0.00	$705.94	"$2,513.83"	"$2,513.83"	"$2,610.70"	$0.00	$705.85	$0.00	"$2,003.41"	"$2,003.41"	$0.00	"$1,693.50"	"$2,682.50"	"$2,709.60"	$0.00	$0.00	$0.00	$530.07	$0.00	$0.00	$539.21	$0.00	$0.00	$0.00	$0.00	$0.00
27203500	EAP	HCPCS C1725		Catheter Balloon Pta 2.50 X 15	BOTH IP/OP	"$3,387.00 "	"$2,506.38"	$0.00	"$2,709.60"	"$1,839.14"	"$1,839.14"	$0.00	$0.00	$0.00	$705.94	"$2,513.83"	"$2,513.83"	"$2,610.70"	$0.00	$705.85	$0.00	"$2,003.41"	"$2,003.41"	$0.00	"$1,693.50"	"$2,682.50"	"$2,709.60"	$0.00	$0.00	$0.00	$530.07	$0.00	$0.00	$539.21	$0.00	$0.00	$0.00	$0.00	$0.00
27203501	EAP	HCPCS C1725		Catheter Balloon Pta 3.50 X 9.	BOTH IP/OP	"$3,387.00 "	"$2,506.38"	$0.00	"$2,709.60"	"$1,839.14"	"$1,839.14"	$0.00	$0.00	$0.00	$705.94	"$2,513.83"	"$2,513.83"	"$2,610.70"	$0.00	$705.85	$0.00	"$2,003.41"	"$2,003.41"	$0.00	"$1,693.50"	"$2,682.50"	"$2,709.60"	$0.00	$0.00	$0.00	$530.07	$0.00	$0.00	$539.21	$0.00	$0.00	$0.00	$0.00	$0.00
27203502	EAP	HCPCS C1725		Catheter Balloon Pta 3.00 X 9.	BOTH IP/OP	"$3,387.00 "	"$2,506.38"	$0.00	"$2,709.60"	"$1,839.14"	"$1,839.14"	$0.00	$0.00	$0.00	$705.94	"$2,513.83"	"$2,513.83"	"$2,610.70"	$0.00	$705.85	$0.00	"$2,003.41"	"$2,003.41"	$0.00	"$1,693.50"	"$2,682.50"	"$2,709.60"	$0.00	$0.00	$0.00	$530.07	$0.00	$0.00	$539.21	$0.00	$0.00	$0.00	$0.00	$0.00
27203503	EAP	HCPCS C1725		Catheter Balloon 2.50 X 9.0mm	BOTH IP/OP	"$3,387.00 "	"$2,506.38"	$0.00	"$2,709.60"	"$1,839.14"	"$1,839.14"	$0.00	$0.00	$0.00	$705.94	"$2,513.83"	"$2,513.83"	"$2,610.70"	$0.00	$705.85	$0.00	"$2,003.41"	"$2,003.41"	$0.00	"$1,693.50"	"$2,682.50"	"$2,709.60"	$0.00	$0.00	$0.00	$530.07	$0.00	$0.00	$539.21	$0.00	$0.00	$0.00	$0.00	$0.00
27203504	EAP	HCPCS C1725		Catheter Balloon 2.00 X 9.0mm	BOTH IP/OP	"$3,387.00 "	"$2,506.38"	$0.00	"$2,709.60"	"$1,839.14"	"$1,839.14"	$0.00	$0.00	$0.00	$705.94	"$2,513.83"	"$2,513.83"	"$2,610.70"	$0.00	$705.85	$0.00	"$2,003.41"	"$2,003.41"	$0.00	"$1,693.50"	"$2,682.50"	"$2,709.60"	$0.00	$0.00	$0.00	$530.07	$0.00	$0.00	$539.21	$0.00	$0.00	$0.00	$0.00	$0.00
27203505	EAP	HCPCS C1725		Catheter Balloon Pta 1.50 X 9.	BOTH IP/OP	"$3,387.00 "	"$2,506.38"	$0.00	"$2,709.60"	"$1,839.14"	"$1,839.14"	$0.00	$0.00	$0.00	$705.94	"$2,513.83"	"$2,513.83"	"$2,610.70"	$0.00	$705.85	$0.00	"$2,003.41"	"$2,003.41"	$0.00	"$1,693.50"	"$2,682.50"	"$2,709.60"	$0.00	$0.00	$0.00	$530.07	$0.00	$0.00	$539.21	$0.00	$0.00	$0.00	$0.00	$0.00
27203506	EAP	HCPCS C1751		Microcatheter Hi-flo Distal Fl	BOTH IP/OP	"$2,270.00 "	"$1,679.80"	$0.00	"$1,816.00"	"$1,232.61"	"$1,232.61"	$0.00	$0.00	$0.00	$473.12	"$1,684.79"	"$1,684.79"	"$1,749.72"	$0.00	$473.07	$0.00	"$1,342.71"	"$1,342.71"	$0.00	"$1,135.00"	"$1,797.84"	"$1,816.00"	$0.00	$0.00	$0.00	$355.26	$0.00	$0.00	$361.38	$0.00	$0.00	$0.00	$0.00	$0.00
27203507	EAP	HCPCS C1751		Microcathter Hi-pro Distal Fl	BOTH IP/OP	"$2,270.00 "	"$1,679.80"	$0.00	"$1,816.00"	"$1,232.61"	"$1,232.61"	$0.00	$0.00	$0.00	$473.12	"$1,684.79"	"$1,684.79"	"$1,749.72"	$0.00	$473.07	$0.00	"$1,342.71"	"$1,342.71"	$0.00	"$1,135.00"	"$1,797.84"	"$1,816.00"	$0.00	$0.00	$0.00	$355.26	$0.00	$0.00	$361.38	$0.00	$0.00	$0.00	$0.00	$0.00
27203508	EAP	HCPCS C1751		Microcatheter Pre-shaped 45 2-	BOTH IP/OP	"$2,837.00 "	"$2,099.38"	$0.00	"$2,269.60"	"$1,540.49"	"$1,540.49"	$0.00	$0.00	$0.00	$591.30	"$2,105.62"	"$2,105.62"	"$2,186.76"	$0.00	$591.23	$0.00	"$1,678.09"	"$1,678.09"	$0.00	"$1,418.50"	"$2,246.90"	"$2,269.60"	$0.00	"$1,844.05"	$0.00	$443.99	$0.00	$0.00	$451.65	$0.00	$0.00	$0.00	$0.00	$0.00
27203509	EAP	HCPCS C1769		Guidewire Standard Pre-shap 1	BOTH IP/OP	"$2,151.00 "	"$1,591.74"	$0.00	"$1,720.80"	"$1,167.99"	"$1,167.99"	$0.00	$0.00	$0.00	$448.32	"$1,596.47"	"$1,596.47"	"$1,657.99"	$0.00	$448.27	$0.00	"$1,272.32"	"$1,272.32"	$0.00	"$1,075.50"	"$1,703.59"	"$1,720.80"	$0.00	"$1,398.15"	$0.00	$336.63	$0.00	$0.00	$342.44	$0.00	$0.00	$0.00	$0.00	$0.00
27203510	EAP	HCPCS C1769		Guidewire Standard Pre-shap 2	BOTH IP/OP	"$1,838.00 "	"$1,360.12"	$0.00	"$1,470.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$919.00	"$1,455.70"	"$1,470.40"	$0.00	$0.00	$0.00	$287.65	$0.00	$0.00	$292.61	$0.00	$0.00	$0.00	$0.00	$0.00
27203511	EAP	HCPCS C1769		Guidewire Soft Pre-shaped 200c	BOTH IP/OP	"$1,838.00 "	"$1,360.12"	$0.00	"$1,470.40"	$998.03	$998.03	$0.00	$0.00	$0.00	$383.09	"$1,364.16"	"$1,364.16"	"$1,416.73"	$0.00	$383.04	$0.00	"$1,087.18"	"$1,087.18"	$0.00	$919.00	"$1,455.70"	"$1,470.40"	$0.00	"$1,194.70"	$0.00	$287.65	$0.00	$0.00	$292.61	$0.00	$0.00	$0.00	$0.00	$0.00
27203512	EAP	HCPCS C1887		Catheter Utk Slip 5f 125cm	BOTH IP/OP	$740.00 	$547.60	$0.00	$592.00	$401.82	$401.82	$0.00	$0.00	$0.00	$154.23	$549.23	$549.23	$570.39	$0.00	$154.22	$0.00	$437.71	$437.71	$0.00	$370.00	$586.08	$592.00	$0.00	$0.00	$0.00	$115.81	$0.00	$0.00	$117.81	$0.00	$0.00	$0.00	$0.00	$0.00
27203513	EAP	HCPCS C1887		Catheter Davis 5f .038 100cm	BOTH IP/OP	$328.00 	$242.72	$0.00	$262.40	$178.10	$178.10	$0.00	$0.00	$0.00	$68.36	$243.44	$243.44	$252.82	$0.00	$68.36	$0.00	$194.01	$194.01	$0.00	$164.00	$259.78	$262.40	$0.00	$0.00	$0.00	$51.33	$0.00	$0.00	$52.22	$0.00	$0.00	$0.00	$0.00	$0.00
27203514	EAP	HCPCS C1894		Sheath Shuttle 7f 90cm	BOTH IP/OP	$413.00 	$305.62	$0.00	$330.40	$224.26	$224.26	$0.00	$0.00	$0.00	$86.08	$306.53	$306.53	$318.34	$0.00	$86.07	$0.00	$244.29	$244.29	$0.00	$206.50	$327.10	$330.40	$0.00	$268.45	$0.00	$64.63	$0.00	$0.00	$65.75	$0.00	$0.00	$0.00	$0.00	$0.00
27203515	EAP	HCPCS C1894		Sheath Shuttle 6f 90cm	BOTH IP/OP	$483.00 	$357.42	$0.00	$386.40	$262.27	$262.27	$0.00	$0.00	$0.00	$100.67	$358.48	$358.48	$372.30	$0.00	$100.66	$0.00	$285.69	$285.69	$0.00	$241.50	$382.54	$386.40	$0.00	$313.95	$0.00	$75.59	$0.00	$0.00	$76.89	$0.00	$0.00	$0.00	$0.00	$0.00
27203516	EAP	HCPCS C1894		Sheath Shuttle 6fr 80cm.	BOTH IP/OP	$595.00 	$440.30	$0.00	$476.00	$323.09	$323.09	$0.00	$0.00	$0.00	$124.01	$441.61	$441.61	$458.63	$0.00	$124.00	$0.00	$351.94	$351.94	$0.00	$297.50	$471.24	$476.00	$0.00	$386.75	$0.00	$93.12	$0.00	$0.00	$94.72	$0.00	$0.00	$0.00	$0.00	$0.00
27203517	EAP	HCPCS C1884		Roadrunners Conners.035x260cm	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$86.88	$86.88	$0.00	$0.00	$0.00	$33.35	$118.75	$118.75	$123.33	$0.00	$33.34	$0.00	$94.64	$94.64	$0.00	$80.00	$126.72	$128.00	$0.00	$104.00	$0.00	$25.04	$0.00	$0.00	$25.47	$0.00	$0.00	$0.00	$0.00	$0.00
27203518	EAP	HCPCS C1887		Catheter Envoy 6fr X13-mp	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$244.35	$244.35	$0.00	$0.00	$0.00	$93.79	$333.99	$333.99	$346.86	$0.00	$93.78	$0.00	$266.18	$266.18	$0.00	$225.00	$356.40	$360.00	$0.00	$0.00	$0.00	$70.43	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$0.00
27203519	EAP	HCPCS C1887		Catheter Envoy 5fr Mipd 9	BOTH IP/OP	"$1,048.00 "	$775.52	$0.00	$838.40	$569.06	$569.06	$0.00	$0.00	$0.00	$218.43	$777.83	$777.83	$807.80	$0.00	$218.40	$0.00	$619.89	$619.89	$0.00	$524.00	$830.02	$838.40	$0.00	$681.20	$0.00	$164.01	$0.00	$0.00	$166.84	$0.00	$0.00	$0.00	$0.00	$0.00
27203520	EAP	HCPCS C1887		Catheter Envoy Straight 9	BOTH IP/OP	"$1,048.00 "	$775.52	$0.00	$838.40	$569.06	$569.06	$0.00	$0.00	$0.00	$218.43	$777.83	$777.83	$807.80	$0.00	$218.40	$0.00	$619.89	$619.89	$0.00	$524.00	$830.02	$838.40	$0.00	$681.20	$0.00	$164.01	$0.00	$0.00	$166.84	$0.00	$0.00	$0.00	$0.00	$0.00
27203521	EAP	HCPCS C1751		Microcathter Prowler Select L	BOTH IP/OP	"$2,578.00 "	"$1,907.72"	$0.00	"$2,062.40"	"$1,399.85"	"$1,399.85"	$0.00	$0.00	$0.00	$537.32	"$1,913.39"	"$1,913.39"	"$1,987.12"	$0.00	$537.26	$0.00	"$1,524.89"	"$1,524.89"	$0.00	"$1,289.00"	"$2,041.78"	"$2,062.40"	$0.00	$0.00	$0.00	$403.46	$0.00	$0.00	$410.42	$0.00	$0.00	$0.00	$0.00	$0.00
27203522	EAP	HCPCS C1751		Microcatht.prowler Select L 2	BOTH IP/OP	"$2,578.00 "	"$1,907.72"	$0.00	"$2,062.40"	"$1,399.85"	"$1,399.85"	$0.00	$0.00	$0.00	$537.32	"$1,913.39"	"$1,913.39"	"$1,987.12"	$0.00	$537.26	$0.00	"$1,524.89"	"$1,524.89"	$0.00	"$1,289.00"	"$2,041.78"	"$2,062.40"	$0.00	$0.00	$0.00	$403.46	$0.00	$0.00	$410.42	$0.00	$0.00	$0.00	$0.00	$0.00
27203523	EAP	HCPCS C1751		Microcatht.prowler Select L 3	BOTH IP/OP	"$2,578.00 "	"$1,907.72"	$0.00	"$2,062.40"	"$1,399.85"	"$1,399.85"	$0.00	$0.00	$0.00	$537.32	"$1,913.39"	"$1,913.39"	"$1,987.12"	$0.00	$537.26	$0.00	"$1,524.89"	"$1,524.89"	$0.00	"$1,289.00"	"$2,041.78"	"$2,062.40"	$0.00	$0.00	$0.00	$403.46	$0.00	$0.00	$410.42	$0.00	$0.00	$0.00	$0.00	$0.00
27203524	EAP	HCPCS C1751		Microcatht.prowler Select L 4	BOTH IP/OP	"$2,526.00 "	"$1,869.24"	$0.00	"$2,020.80"	"$1,371.62"	"$1,371.62"	$0.00	$0.00	$0.00	$526.48	"$1,874.80"	"$1,874.80"	"$1,947.04"	$0.00	$526.42	$0.00	"$1,494.13"	"$1,494.13"	$0.00	"$1,263.00"	"$2,000.59"	"$2,020.80"	$0.00	$0.00	$0.00	$395.32	$0.00	$0.00	$402.14	$0.00	$0.00	$0.00	$0.00	$0.00
27203525	EAP	HCPCS C1751		Microcathet.prowler Select P 1	BOTH IP/OP	"$2,454.00 "	"$1,815.96"	$0.00	"$1,963.20"	"$1,332.52"	"$1,332.52"	$0.00	$0.00	$0.00	$511.47	"$1,821.36"	"$1,821.36"	"$1,891.54"	$0.00	$511.41	$0.00	"$1,451.54"	"$1,451.54"	$0.00	"$1,227.00"	"$1,943.57"	"$1,963.20"	$0.00	$0.00	$0.00	$384.05	$0.00	$0.00	$390.68	$0.00	$0.00	$0.00	$0.00	$0.00
27203526	EAP	HCPCS C1751		Microcath.prowler Select P 2	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$572.87	$572.87	$0.00	$0.00	$0.00	$219.89	$783.02	$783.02	$813.19	$0.00	$219.86	$0.00	$624.03	$624.03	$0.00	$527.50	$835.56	$844.00	$0.00	$0.00	$0.00	$165.11	$0.00	$0.00	$167.96	$0.00	$0.00	$0.00	$0.00	$0.00
27203527	EAP	HCPCS C1751		Catheter Echelon 14 Micro	BOTH IP/OP	"$2,120.00 "	"$1,568.80"	$0.00	"$1,696.00"	"$1,151.16"	"$1,151.16"	$0.00	$0.00	$0.00	$441.86	"$1,573.46"	"$1,573.46"	"$1,634.10"	$0.00	$441.81	$0.00	"$1,253.98"	"$1,253.98"	$0.00	"$1,060.00"	"$1,679.04"	"$1,696.00"	$0.00	$0.00	$0.00	$331.78	$0.00	$0.00	$337.50	$0.00	$0.00	$0.00	$0.00	$0.00
27203528	EAP	HCPCS C1751		Microcath.prowler Select P 3	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$572.87	$572.87	$0.00	$0.00	$0.00	$219.89	$783.02	$783.02	$813.19	$0.00	$219.86	$0.00	$624.03	$624.03	$0.00	$527.50	$835.56	$844.00	$0.00	$685.75	$0.00	$165.11	$0.00	$0.00	$167.96	$0.00	$0.00	$0.00	$0.00	$0.00
27203529	EAP	HCPCS C1751		Micrcathters Rapidtransit 17	BOTH IP/OP	"$2,235.00 "	"$1,653.90"	$0.00	"$1,788.00"	"$1,213.61"	"$1,213.61"	$0.00	$0.00	$0.00	$465.83	"$1,658.82"	"$1,658.82"	"$1,722.74"	$0.00	$465.77	$0.00	"$1,322.00"	"$1,322.00"	$0.00	"$1,117.50"	"$1,770.12"	"$1,788.00"	$0.00	$0.00	$0.00	$349.78	$0.00	$0.00	$355.81	$0.00	$0.00	$0.00	$0.00	$0.00
27203530	EAP	HCPCS C1751		Micrcatheter Rapidtransit 150	BOTH IP/OP	"$2,235.00 "	"$1,653.90"	$0.00	"$1,788.00"	"$1,213.61"	"$1,213.61"	$0.00	$0.00	$0.00	$465.83	"$1,658.82"	"$1,658.82"	"$1,722.74"	$0.00	$465.77	$0.00	"$1,322.00"	"$1,322.00"	$0.00	"$1,117.50"	"$1,770.12"	"$1,788.00"	$0.00	$0.00	$0.00	$349.78	$0.00	$0.00	$355.81	$0.00	$0.00	$0.00	$0.00	$0.00
27203531	EAP	HCPCS C1769		Guidewire Hydrophilic Coat S 1	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$0.00	$0.00	$5.48	$0.00	$0.00	$5.57	$0.00	$0.00	$0.00	$0.00	$0.00
27203532	EAP	HCPCS C1769		Guidewire Hydrophilic Coat S 2	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$21.18	$21.18	$0.00	$0.00	$0.00	$8.13	$28.95	$28.95	$30.06	$0.00	$8.13	$0.00	$23.07	$23.07	$0.00	$19.50	$30.89	$31.20	$0.00	$25.35	$0.00	$6.10	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
27203533	EAP	HCPCS C1769		Guidewire Hydrophilic Coated T	BOTH IP/OP	$585.00 	$432.90	$0.00	$468.00	$317.66	$317.66	$0.00	$0.00	$0.00	$121.93	$434.19	$434.19	$450.92	$0.00	$121.91	$0.00	$346.03	$346.03	$0.00	$292.50	$463.32	$468.00	$0.00	$380.25	$0.00	$91.55	$0.00	$0.00	$93.13	$0.00	$0.00	$0.00	$0.00	$0.00
27203534	EAP	HCPCS C1769		Guidewire Hydrophilic Coat 0 1	BOTH IP/OP	$33.00 	$24.42	$0.00	$26.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.50	$26.14	$26.40	$0.00	$0.00	$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
27203535	EAP	HCPCS C1769		Guidewire Hydrophilic Coat 0 2	BOTH IP/OP	$149.00 	$110.26	$0.00	$119.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.50	$118.01	$119.20	$0.00	$0.00	$0.00	$23.32	$0.00	$0.00	$23.72	$0.00	$0.00	$0.00	$0.00	$0.00
27203536	EAP	HCPCS C1769		Guidewire Hydrophilic Coat 3	BOTH IP/OP	$29.00 	$21.46	$0.00	$23.20	$15.75	$15.75	$0.00	$0.00	$0.00	$6.04	$21.52	$21.52	$22.35	$0.00	$6.04	$0.00	$17.15	$17.15	$0.00	$14.50	$22.97	$23.20	$0.00	$0.00	$0.00	$4.54	$0.00	$0.00	$4.62	$0.00	$0.00	$0.00	$0.00	$0.00
27203537	EAP	Custom 27203537		Catheter Separator 054	BOTH IP/OP	"$8,337.00 "	"$6,169.38"	$0.00	"$6,669.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,426.16"	$0.00	"$1,737.43"	$0.00	$0.00	$0.00	$0.00	"$4,168.50"	"$6,602.90"	"$6,669.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203538	EAP	HCPCS C1757		Catheter Reperfilision 054	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$2,264.31"	"$2,264.31"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,466.56"	"$2,466.56"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203539	EAP	HCPCS C1887		Cath.lumen Delivery Neuron 1	BOTH IP/OP	"$1,719.00 "	"$1,272.06"	$0.00	"$1,375.20"	$933.42	$933.42	$0.00	$0.00	$0.00	$358.28	"$1,275.84"	"$1,275.84"	"$1,325.01"	$0.00	$358.24	$0.00	"$1,016.79"	"$1,016.79"	$0.00	$859.50	"$1,361.45"	"$1,375.20"	$0.00	"$1,117.35"	$0.00	$269.02	$0.00	$0.00	$273.66	$0.00	$0.00	$0.00	$0.00	$0.00
27203540	EAP	HCPCS C1887		Catheter Delivery Neuron 6f St	BOTH IP/OP	"$3,436.00 "	"$2,542.64"	$0.00	"$2,748.80"	"$1,865.75"	"$1,865.75"	$0.00	$0.00	$0.00	$716.15	"$2,550.20"	"$2,550.20"	"$2,648.47"	$0.00	$716.06	$0.00	"$2,032.39"	"$2,032.39"	$0.00	"$1,718.00"	"$2,721.31"	"$2,748.80"	$0.00	$0.00	$0.00	$537.73	$0.00	$0.00	$547.01	$0.00	$0.00	$0.00	$0.00	$0.00
27203541	EAP	HCPCS C1887		Cath.select Neuron 5f 120 1	BOTH IP/OP	$417.00 	$308.58	$0.00	$333.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.50	$330.26	$333.60	$0.00	$0.00	$0.00	$65.26	$0.00	$0.00	$66.39	$0.00	$0.00	$0.00	$0.00	$0.00
27203542	EAP	HCPCS C1887		Cath.select Neuron 5f 120 2	BOTH IP/OP	$417.00 	$308.58	$0.00	$333.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.50	$330.26	$333.60	$0.00	$0.00	$0.00	$65.26	$0.00	$0.00	$66.39	$0.00	$0.00	$0.00	$0.00	$0.00
27203543	EAP	HCPCS C1887		Cath.lumen Delivery Neuron 2	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00	$0.00	$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
27203544	EAP	HCPCS C1887		Cath.lumen Delivery Neuron 3	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00	$0.00	$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
27203545	EAP	HCPCS C1884		Device Protection Spider Fx 5.	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$2,264.31"	"$2,264.31"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,466.56"	"$2,466.56"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	"$2,710.50"	$0.00	$652.61	$0.00	$0.00	$663.86	$0.00	$0.00	$0.00	$0.00	$0.00
27203546	EAP	HCPCS C1884		Device Distal Protection Spide	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$2,264.31"	"$2,264.31"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,466.56"	"$2,466.56"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	"$2,710.50"	$0.00	$652.61	$0.00	$0.00	$663.86	$0.00	$0.00	$0.00	$0.00	$0.00
27203547	EAP	HCPCS C2628		Cath.balloon Guide Concent 1	BOTH IP/OP	"$2,364.00 "	"$1,749.36"	$0.00	"$1,891.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,182.00"	"$1,872.29"	"$1,891.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203548	EAP	HCPCS C2628		Catheter Balloon Guide 9f 80cm	BOTH IP/OP	"$2,364.00 "	"$1,749.36"	$0.00	"$1,891.20"	"$1,283.65"	"$1,283.65"	$0.00	$0.00	$0.00	$492.72	"$1,754.56"	"$1,754.56"	"$1,822.17"	$0.00	$492.66	$0.00	"$1,398.31"	"$1,398.31"	$0.00	"$1,182.00"	"$1,872.29"	"$1,891.20"	$0.00	"$1,536.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203549	EAP	HCPCS C2628		Cath.balloon Guide Concent 2	BOTH IP/OP	"$2,251.00 "	"$1,665.74"	$0.00	"$1,800.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.50"	"$1,782.79"	"$1,800.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203550	EAP	HCPCS C2628		Cath.balloon Guide Concent 3	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203551	EAP	HCPCS C1751		Cath.distal Access Dac 057 1	BOTH IP/OP	"$3,321.00 "	"$2,457.54"	$0.00	"$2,656.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.50"	"$2,630.23"	"$2,656.80"	$0.00	$0.00	$0.00	$519.74	$0.00	$0.00	$528.70	$0.00	$0.00	$0.00	$0.00	$0.00
27203552	EAP	HCPCS C1751		Cath.distal Access Dac 057 2	BOTH IP/OP	"$3,321.00 "	"$2,457.54"	$0.00	"$2,656.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.50"	"$2,630.23"	"$2,656.80"	$0.00	$0.00	$0.00	$519.74	$0.00	$0.00	$528.70	$0.00	$0.00	$0.00	$0.00	$0.00
27203553	EAP	HCPCS C1751		Catheter Dac 044 - 130cm	BOTH IP/OP	"$1,429.00 "	"$1,057.46"	$0.00	"$1,143.20"	$775.95	$775.95	$0.00	$0.00	$0.00	$297.84	"$1,060.60"	"$1,060.60"	"$1,101.47"	$0.00	$297.80	$0.00	$845.25	$845.25	$0.00	$714.50	"$1,131.77"	"$1,143.20"	$0.00	$0.00	$0.00	$223.64	$0.00	$0.00	$227.50	$0.00	$0.00	$0.00	$0.00	$0.00
27203554	EAP	HCPCS C1751		Catheter Dac 038 - 136cm	BOTH IP/OP	"$3,321.00 "	"$2,457.54"	$0.00	"$2,656.80"	"$1,803.30"	"$1,803.30"	$0.00	$0.00	$0.00	$692.18	"$2,464.85"	"$2,464.85"	"$2,559.83"	$0.00	$692.10	$0.00	"$1,964.37"	"$1,964.37"	$0.00	"$1,660.50"	"$2,630.23"	"$2,656.80"	$0.00	$0.00	$0.00	$519.74	$0.00	$0.00	$528.70	$0.00	$0.00	$0.00	$0.00	$0.00
27203555	EAP	HCPCS C1884		Sph100200-20 Microcoil Platino	BOTH IP/OP	"$3,586.00 "	"$2,653.64"	$0.00	"$2,868.80"	"$1,947.20"	"$1,947.20"	$0.00	$0.00	$0.00	$747.41	"$2,661.53"	"$2,661.53"	"$2,764.09"	$0.00	$747.32	$0.00	"$2,121.12"	"$2,121.12"	$0.00	"$1,793.00"	"$2,840.11"	"$2,868.80"	$0.00	$0.00	$0.00	$561.21	$0.00	$0.00	$570.89	$0.00	$0.00	$0.00	$0.00	$0.00
27203556	EAP	Custom 27203556		Marker Strght 2-tip 150cm/6cm	BOTH IP/OP	"$2,518.00 "	"$1,863.32"	$0.00	"$2,014.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,868.86"	"$1,868.86"	"$1,940.87"	$0.00	$524.75	$0.00	$0.00	$0.00	$0.00	"$1,259.00"	"$1,994.26"	"$2,014.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203557	EAP	Custom 27203557		Axium Coil Detacher	BOTH IP/OP	$166.00 	$122.84	$0.00	$132.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.21	$123.21	$127.95	$0.00	$34.59	$0.00	$0.00	$0.00	$0.00	$83.00	$131.47	$132.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203558	EAP	HCPCS C1887		Mpc Envoy Guiding Wire	BOTH IP/OP	"$1,048.00 "	$775.52	$0.00	$838.40	$569.06	$569.06	$0.00	$0.00	$0.00	$218.43	$777.83	$777.83	$807.80	$0.00	$218.40	$0.00	$619.89	$619.89	$0.00	$524.00	$830.02	$838.40	$0.00	$0.00	$0.00	$164.01	$0.00	$0.00	$166.84	$0.00	$0.00	$0.00	$0.00	$0.00
27203559	EAP	Custom 27203559		Starclose Se	BOTH IP/OP	$266.00 	$196.84	$0.00	$212.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.43	$197.43	$205.03	$0.00	$55.43	$0.00	$0.00	$0.00	$0.00	$133.00	$210.67	$212.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203560	EAP	Custom 27203560		Wrap On Finger Hooks(each)	BOTH IP/OP	$21.00 	$15.54	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.59	$15.59	$16.19	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$10.50	$16.63	$16.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203561	EAP	HCPCS C1729		Shunt Prtnvn Dnvr Asct 25-40ml/min Ample Flowrate	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	"$3,054.38"	"$3,054.38"	$0.00	$0.00	$0.00	"$1,172.39"	"$4,174.88"	"$4,174.88"	"$4,335.75"	$0.00	"$1,172.25"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00	"$3,656.25"	$0.00	$880.31	$0.00	$0.00	$895.50	$0.00	$0.00	$0.00	$0.00	$0.00
27203562	EAP	HCPCS C1729		"Cath, Drainage"	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.00	$20.59	$20.80	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$4.14	$0.00	$0.00	$0.00	$0.00	$0.00
27203563	EAP	HCPCS C1769		Tray Tracheostomy 24-26-28fr 2 Cannu Tube Shiley C	BOTH IP/OP	"$1,219.00 "	$902.06	$0.00	$975.20	$661.92	$661.92	$0.00	$0.00	$0.00	$254.07	$904.74	$904.74	$939.61	$0.00	$254.04	$0.00	$721.04	$721.04	$0.00	$609.50	$965.45	$975.20	$0.00	$0.00	$0.00	$190.77	$0.00	$0.00	$194.06	$0.00	$0.00	$0.00	$0.00	$0.00
27203564	EAP	Custom 27203564		Cannula Prfsn 22fr Vns 20d Dilat Crct Bbl Trp Fnl	BOTH IP/OP	"$32,500.00 "	"$24,050.00"	$0.00	"$26,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$25,051.00"	$0.00	"$6,773.00"	$0.00	$0.00	$0.00	$0.00	"$16,250.00"	"$25,740.00"	"$26,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203565	EAP	HCPCS C1725		Catheter Angio Vtk Curve 5fr 125cm Cerebrum Trnb	BOTH IP/OP	$33.00 	$24.42	$0.00	$26.40	$17.92	$17.92	$0.00	$0.00	$0.00	$6.88	$24.49	$24.49	$25.44	$0.00	$6.88	$0.00	$19.52	$19.52	$0.00	$16.50	$26.14	$26.40	$0.00	$21.45	$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
27203580	EAP	Custom 27203580		Safeguard 24cm Pressure Devce	BOTH IP/OP	$66.00 	$48.84	$0.00	$52.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.99	$48.99	$50.87	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$33.00	$52.27	$52.80	$0.00	$42.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203590	EAP	Custom 27203590		Needle 25g	BOTH IP/OP	$119.00 	$88.06	$0.00	$95.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.32	$88.32	$91.73	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$59.50	$94.25	$95.20	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203591	EAP	Custom 27203591		Resolution235cm	BOTH IP/OP	$228.00 	$168.72	$0.00	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.22	$169.22	$175.74	$0.00	$47.52	$0.00	$0.00	$0.00	$0.00	$114.00	$180.58	$182.40	$0.00	$148.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203592	EAP	Custom 27203592		Rx Lithotripter Basket3	BOTH IP/OP	$379.00 	$280.46	$0.00	$303.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.29	$281.29	$292.13	$0.00	$78.98	$0.00	$0.00	$0.00	$0.00	$189.50	$300.17	$303.20	$0.00	$246.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203593	EAP	Custom 27203593		Rx Lithotripter Basket4	BOTH IP/OP	$379.00 	$280.46	$0.00	$303.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.29	$281.29	$292.13	$0.00	$78.98	$0.00	$0.00	$0.00	$0.00	$189.50	$300.17	$303.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203594	EAP	Custom 27203594		Rx Lithotripter Basket5	BOTH IP/OP	$379.00 	$280.46	$0.00	$303.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.29	$281.29	$292.13	$0.00	$78.98	$0.00	$0.00	$0.00	$0.00	$189.50	$300.17	$303.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203595	EAP	Custom 27203595		Rx Lithotripter Basket6	BOTH IP/OP	$379.00 	$280.46	$0.00	$303.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.29	$281.29	$292.13	$0.00	$78.98	$0.00	$0.00	$0.00	$0.00	$189.50	$300.17	$303.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203596	EAP	Custom 27203596		Autotome Rx 44-20mm	BOTH IP/OP	$622.00 	$460.28	$0.00	$497.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$461.65	$461.65	$479.44	$0.00	$129.62	$0.00	$0.00	$0.00	$0.00	$311.00	$492.62	$497.60	$0.00	$404.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203597	EAP	Custom 27203597		Autotome Rx 44-20mm	BOTH IP/OP	$592.00 	$438.08	$0.00	$473.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$439.38	$439.38	$456.31	$0.00	$123.37	$0.00	$0.00	$0.00	$0.00	$296.00	$468.86	$473.60	$0.00	$384.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203598	EAP	Custom 27203598		Hydro Tome Rx 450cm	BOTH IP/OP	$592.00 	$438.08	$0.00	$473.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$439.38	$439.38	$456.31	$0.00	$123.37	$0.00	$0.00	$0.00	$0.00	$296.00	$468.86	$473.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203599	EAP	Custom 27203599		Needleknife Rx	BOTH IP/OP	$260.00 	$192.40	$0.00	$208.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.97	$192.97	$200.41	$0.00	$54.18	$0.00	$0.00	$0.00	$0.00	$130.00	$205.92	$208.00	$0.00	$169.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203621	EAP	Custom 27203621		Laceration Tray	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203624	EAP	Custom 27203624		Standard Peg Kit 20	BOTH IP/OP	$517.00 	$382.58	$0.00	$413.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$383.72	$383.72	$398.50	$0.00	$107.74	$0.00	$0.00	$0.00	$0.00	$258.50	$409.46	$413.60	$0.00	$336.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203680	EAP	HCPCS C1769		Hydra-jag/.035/260cm/str	BOTH IP/OP	$647.00 	$478.78	$0.00	$517.60	$351.32	$351.32	$0.00	$0.00	$0.00	$134.85	$480.20	$480.20	$498.71	$0.00	$134.83	$0.00	$382.70	$382.70	$0.00	$323.50	$512.42	$517.60	$0.00	$0.00	$0.00	$101.26	$0.00	$0.00	$103.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203681	EAP	HCPCS C1769		Hydra-jag/.035/450cm/str	BOTH IP/OP	$749.00 	$554.26	$0.00	$599.20	$406.71	$406.71	$0.00	$0.00	$0.00	$156.11	$555.91	$555.91	$577.33	$0.00	$156.09	$0.00	$443.03	$443.03	$0.00	$374.50	$593.21	$599.20	$0.00	$0.00	$0.00	$117.22	$0.00	$0.00	$119.24	$0.00	$0.00	$0.00	$0.00	$0.00
27203682	EAP	HCPCS C1769		Jag Hini 025/260 St Bx2	BOTH IP/OP	$352.00 	$260.48	$0.00	$281.60	$191.14	$191.14	$0.00	$0.00	$0.00	$73.37	$261.25	$261.25	$271.32	$0.00	$73.36	$0.00	$208.21	$208.21	$0.00	$176.00	$278.78	$281.60	$0.00	$0.00	$0.00	$55.09	$0.00	$0.00	$56.04	$0.00	$0.00	$0.00	$0.00	$0.00
27203683	EAP	HCPCS C1769		Jagwire/025/straight  450cm	BOTH IP/OP	$533.00 	$394.42	$0.00	$426.40	$289.42	$289.42	$0.00	$0.00	$0.00	$111.09	$395.59	$395.59	$410.84	$0.00	$111.08	$0.00	$315.27	$315.27	$0.00	$266.50	$422.14	$426.40	$0.00	$346.45	$0.00	$83.41	$0.00	$0.00	$84.85	$0.00	$0.00	$0.00	$0.00	$0.00
27203684	EAP	HCPCS C1769		Pathfinder 018/450	BOTH IP/OP	$544.00 	$402.56	$0.00	$435.20	$295.39	$295.39	$0.00	$0.00	$0.00	$113.38	$403.76	$403.76	$419.32	$0.00	$113.37	$0.00	$321.78	$321.78	$0.00	$272.00	$430.85	$435.20	$0.00	$0.00	$0.00	$85.14	$0.00	$0.00	$86.60	$0.00	$0.00	$0.00	$0.00	$0.00
27203701	EAP	Custom 27203701		Barrier Adh Abs Plvs Intcd 4x3	BOTH IP/OP	$745.00 	$551.30	$0.00	$596.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$552.94	$552.94	$574.25	$0.00	$155.26	$0.00	$0.00	$0.00	$0.00	$372.50	$590.04	$596.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203702	EAP	HCPCS C1877		Catheter Tr Renegade Hi Flo 13	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$682.55	$682.55	$0.00	$0.00	$0.00	$261.99	$932.95	$932.95	$968.90	$0.00	$261.96	$0.00	$743.52	$743.52	$0.00	$628.50	$995.54	"$1,005.60"	$0.00	$817.05	$0.00	$196.72	$0.00	$0.00	$200.11	$0.00	$0.00	$0.00	$0.00	$0.00
27203703	EAP	Custom 27203703		Catheter Embolic F-idc 2d 3mm	BOTH IP/OP	"$1,321.00 "	$977.54	$0.00	"$1,056.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$980.45	$980.45	"$1,018.23"	$0.00	$275.30	$0.00	$0.00	$0.00	$0.00	$660.50	"$1,046.23"	"$1,056.80"	$0.00	$858.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203704	EAP	Custom 27203704		Catheter Embolic 2/5mm X 5.8cm	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$817.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203705	EAP	Custom 27203705		Cm Catheter Embolic 2/5mm X 5.8	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203706	EAP	Custom 27203706		Coil Axium Helical Detachable  Qc-3-8-helix	BOTH IP/OP	"$2,404.00 "	"$1,778.96"	$0.00	"$1,923.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,784.25"	"$1,784.25"	"$1,853.00"	$0.00	$500.99	$0.00	$0.00	$0.00	$0.00	"$1,202.00"	"$1,903.97"	"$1,923.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203707	EAP	Custom 27203707		Microcoil Platinum Deltaplush 2mmx4cm	BOTH IP/OP	"$3,217.00 "	"$2,380.58"	$0.00	"$2,573.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,387.66"	"$2,387.66"	"$2,479.66"	$0.00	$670.42	$0.00	$0.00	$0.00	$0.00	"$1,608.50"	"$2,547.86"	"$2,573.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203708	EAP	Custom 27203708		Microcoil Platinum Deltaplush 2mmx6cm	BOTH IP/OP	"$3,217.00 "	"$2,380.58"	$0.00	"$2,573.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,387.66"	"$2,387.66"	"$2,479.66"	$0.00	$670.42	$0.00	$0.00	$0.00	$0.00	"$1,608.50"	"$2,547.86"	"$2,573.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203740	EAP	HCPCS C1887		Catheter Renegade Stc-18 130/2	BOTH IP/OP	"$1,664.00 "	"$1,231.36"	$0.00	"$1,331.20"	$903.55	$903.55	$0.00	$0.00	$0.00	$346.82	"$1,235.02"	"$1,235.02"	"$1,282.61"	$0.00	$346.78	$0.00	$984.26	$984.26	$0.00	$832.00	"$1,317.89"	"$1,331.20"	$0.00	"$1,081.60"	$0.00	$260.42	$0.00	$0.00	$264.91	$0.00	$0.00	$0.00	$0.00	$0.00
27203741	EAP	Custom 27203741		Catheter Embolic F-3mm X 12cm	BOTH IP/OP	"$1,321.00 "	$977.54	$0.00	"$1,056.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$980.45	$980.45	"$1,018.23"	$0.00	$275.30	$0.00	$0.00	$0.00	$0.00	$660.50	"$1,046.23"	"$1,056.80"	$0.00	$858.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203742	EAP	Custom 27203742		Catheter Embolic F-4mm X 8cm	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$817.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203743	EAP	Custom 27203743		4mm X 15cm Catheter Embolic F-	BOTH IP/OP	"$1,321.00 "	$977.54	$0.00	"$1,056.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$980.45	$980.45	"$1,018.23"	$0.00	$275.30	$0.00	$0.00	$0.00	$0.00	$660.50	"$1,046.23"	"$1,056.80"	$0.00	$858.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203744	EAP	Custom 27203744		Catheter Embolic F-5mm X 8cm	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203745	EAP	Custom 27203745		Coil Embolization 2d Helix 5mm 15cm 8 Coil Occlusion System	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$817.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203746	EAP	Custom 27203746		Coil Embolization 2d Helix 6mm 10cm 18 Coil Occlusion System	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$817.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203747	EAP	Custom 27203747		Coil Embolization 2d Helix 6mm 20cm 18 Coil Occlusion System	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$817.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203748	EAP	Custom 27203748		8MM X 20CM CATHETER EMBOLIC F-	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$817.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203749	EAP	Custom 27203749		10MM X 20CM CATHETER EMBOLIC F	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203750	EAP	Custom 27203750		10MM X 30CM CATHETER EMBOLIC F	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203751	EAP	Custom 27203751		CATHETER EMBOLIC F12M X 20CM	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203752	EAP	Custom 27203752		Catheter Embolic F 12m X 30cm	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203753	EAP	Custom 27203753		Catheter Embolic F 14mm X 20cm	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203754	EAP	Custom 27203754		Catheter Embolic F 14mm X 30cm	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203755	EAP	Custom 27203755		CATHETER EMBOLIC F-IDC VORTX DCM	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$817.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203756	EAP	Custom 27203756		Catheter Embolic F-2/4mm X 4.1cm	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$969.67	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00	$817.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203766	EAP	Custom 27203766		Catheter Swan Ganz	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$0.00	$0.00	$0.00	$103.50	$163.94	$165.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203769	EAP	Custom 27203769		Tray Thoracentesis/parace	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.22	$74.22	$77.08	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203770	EAP	HCPCS C1769		Miraclebros Guiding Wire 14937-01	BOTH IP/OP	"$2,251.00 "	"$1,665.74"	$0.00	"$1,800.80"	"$1,222.29"	"$1,222.29"	$0.00	$0.00	$0.00	$469.16	"$1,670.69"	"$1,670.69"	"$1,735.07"	$0.00	$469.11	$0.00	"$1,331.47"	"$1,331.47"	$0.00	"$1,125.50"	"$1,782.79"	"$1,800.80"	$0.00	$0.00	$0.00	$352.28	$0.00	$0.00	$358.36	$0.00	$0.00	$0.00	$0.00	$0.00
27203773	EAP	Custom 27203773		Catheter Guid 14fr Acty Pro 130d Cs-ic Curve Inr	BOTH IP/OP	$613.00 	$453.62	$0.00	$490.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$454.97	$454.97	$472.50	$0.00	$127.75	$0.00	$0.00	$0.00	$0.00	$306.50	$485.50	$490.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203774	EAP	Custom 27203774		Catheter Gd 16fr 1.5cm Bln Loprfl	BOTH IP/OP	"$1,238.00 "	$916.12	$0.00	$990.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.84	$918.84	$954.25	$0.00	$258.00	$0.00	$0.00	$0.00	$0.00	$619.00	$980.50	$990.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203775	EAP	Custom 27203775		Catheter Gd 16fr 3.5cm Bln Loprfl	BOTH IP/OP	"$1,238.00 "	$916.12	$0.00	$990.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.84	$918.84	$954.25	$0.00	$258.00	$0.00	$0.00	$0.00	$0.00	$619.00	$980.50	$990.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203776	EAP	HCPCS C1724		Catheter Athrcm 145cm Stlth 360 1.25mm Orbtl Cls	BOTH IP/OP	"$9,488.00 "	"$7,021.12"	$0.00	"$7,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$7,313.35"	$0.00	"$1,977.30"	$0.00	$0.00	$0.00	$0.00	"$4,744.00"	"$7,514.50"	"$7,590.40"	$0.00	"$6,167.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203777	EAP	HCPCS C1769		Guidewire Vasc 360 Orbtl	BOTH IP/OP	$488.00 	$361.12	$0.00	$390.40	$264.98	$264.98	$0.00	$0.00	$0.00	$101.71	$362.19	$362.19	$376.15	$0.00	$101.70	$0.00	$288.65	$288.65	$0.00	$244.00	$386.50	$390.40	$0.00	$317.20	$0.00	$76.37	$0.00	$0.00	$77.69	$0.00	$0.00	$0.00	$0.00	$0.00
27203780	EAP	HCPCS C1766		Sheath Flex 7fr 10cm	BOTH IP/OP	$700.00 	$518.00	$0.00	$560.00	$380.10	$380.10	$0.00	$0.00	$0.00	$145.90	$519.54	$519.54	$539.56	$0.00	$145.88	$0.00	$414.05	$414.05	$0.00	$350.00	$554.40	$560.00	$0.00	$0.00	$0.00	$109.55	$0.00	$0.00	$111.44	$0.00	$0.00	$0.00	$0.00	$0.00
27203790	EAP	HCPCS C1751		Microcatheter Microvention	BOTH IP/OP	"$2,390.00 "	"$1,768.60"	$0.00	"$1,912.00"	"$1,297.77"	"$1,297.77"	$0.00	$0.00	$0.00	$498.14	"$1,773.86"	"$1,773.86"	"$1,842.21"	$0.00	$498.08	$0.00	"$1,413.69"	"$1,413.69"	$0.00	"$1,195.00"	"$1,892.88"	"$1,912.00"	$0.00	"$1,553.50"	$0.00	$374.04	$0.00	$0.00	$380.49	$0.00	$0.00	$0.00	$0.00	$0.00
27203795	EAP	HCPCS C1751		Microcatheter Merci	BOTH IP/OP	"$1,585.00 "	"$1,172.90"	$0.00	"$1,268.00"	$860.66	$860.66	$0.00	$0.00	$0.00	$330.35	"$1,176.39"	"$1,176.39"	"$1,221.72"	$0.00	$330.31	$0.00	$937.53	$937.53	$0.00	$792.50	"$1,255.32"	"$1,268.00"	$0.00	$0.00	$0.00	$248.05	$0.00	$0.00	$252.33	$0.00	$0.00	$0.00	$0.00	$0.00
27203796	EAP	HCPCS C1757		2.5 Meri V-series Retrieval Sy	BOTH IP/OP	"$10,341.00 "	"$7,652.34"	$0.00	"$8,272.80"	"$5,615.16"	"$5,615.16"	$0.00	$0.00	$0.00	"$2,155.32"	"$4,181.12"	"$4,181.12"	"$7,970.84"	$0.00	"$2,155.06"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,170.50"	"$8,190.07"	"$8,272.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203797	EAP	HCPCS C1757		3.0 Meri V-series Retrieval Sy	BOTH IP/OP	"$10,341.00 "	"$7,652.34"	$0.00	"$8,272.80"	"$5,615.16"	"$5,615.16"	$0.00	$0.00	$0.00	"$2,155.32"	"$4,181.12"	"$4,181.12"	"$7,970.84"	$0.00	"$2,155.06"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,170.50"	"$8,190.07"	"$8,272.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203798	EAP	HCPCS C1757		Meri V-series Retrieval System	BOTH IP/OP	"$10,341.00 "	"$7,652.34"	$0.00	"$8,272.80"	"$5,615.16"	"$5,615.16"	$0.00	$0.00	$0.00	"$2,155.32"	"$4,181.12"	"$4,181.12"	"$7,970.84"	$0.00	"$2,155.06"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,170.50"	"$8,190.07"	"$8,272.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203799	EAP	HCPCS C1751		026 Catheter Reperfusion	BOTH IP/OP	"$3,635.00 "	"$2,689.90"	$0.00	"$2,908.00"	"$1,973.81"	"$1,973.81"	$0.00	$0.00	$0.00	$757.62	"$2,697.90"	"$2,697.90"	"$2,801.86"	$0.00	$757.53	$0.00	"$2,150.10"	"$2,150.10"	$0.00	"$1,817.50"	"$2,878.92"	"$2,908.00"	$0.00	$0.00	$0.00	$568.88	$0.00	$0.00	$578.69	$0.00	$0.00	$0.00	$0.00	$0.00
27203800	EAP	HCPCS C1751		032 Catheter Reperfusion	BOTH IP/OP	"$3,817.00 "	"$2,824.58"	$0.00	"$3,053.60"	"$2,072.63"	"$2,072.63"	$0.00	$0.00	$0.00	$795.56	"$2,832.98"	"$2,832.98"	"$2,942.14"	$0.00	$795.46	$0.00	"$2,257.76"	"$2,257.76"	$0.00	"$1,908.50"	"$3,023.06"	"$3,053.60"	$0.00	"$2,481.05"	$0.00	$597.36	$0.00	$0.00	$607.67	$0.00	$0.00	$0.00	$0.00	$0.00
27203801	EAP	HCPCS C1751		041 Catheter Reperfusion	BOTH IP/OP	"$3,635.00 "	"$2,689.90"	$0.00	"$2,908.00"	"$1,973.81"	"$1,973.81"	$0.00	$0.00	$0.00	$757.62	"$2,697.90"	"$2,697.90"	"$2,801.86"	$0.00	$757.53	$0.00	"$2,150.10"	"$2,150.10"	$0.00	"$1,817.50"	"$2,878.92"	"$2,908.00"	$0.00	$0.00	$0.00	$568.88	$0.00	$0.00	$578.69	$0.00	$0.00	$0.00	$0.00	$0.00
27203802	EAP	Custom 27203802		026 Separator	BOTH IP/OP	"$7,639.00 "	"$5,652.86"	$0.00	"$6,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,888.14"	$0.00	"$1,591.97"	$0.00	$0.00	$0.00	$0.00	"$3,819.50"	"$6,050.09"	"$6,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203803	EAP	Custom 27203803		032 Separator	BOTH IP/OP	"$7,639.00 "	"$5,652.86"	$0.00	"$6,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,888.14"	$0.00	"$1,591.97"	$0.00	$0.00	$0.00	$0.00	"$3,819.50"	"$6,050.09"	"$6,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203804	EAP	Custom 27203804		"Tubing, Aspiration"	BOTH IP/OP	"$1,297.00 "	$959.78	$0.00	"$1,037.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$962.63	$962.63	$999.73	$0.00	$270.29	$0.00	$0.00	$0.00	$0.00	$648.50	"$1,027.22"	"$1,037.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203805	EAP	Custom 27203805		"Supplies, Non-sterile Penumbra"	BOTH IP/OP	$913.00 	$675.62	$0.00	$730.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$677.63	$677.63	$703.74	$0.00	$190.27	$0.00	$0.00	$0.00	$0.00	$456.50	$723.10	$730.40	$0.00	$593.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203806	EAP	Custom 27203806		"Pump, Penumbra Aspiration"	BOTH IP/OP	"$8,340.00 "	"$6,171.60"	$0.00	"$6,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,428.47"	$0.00	"$1,738.06"	$0.00	$0.00	$0.00	$0.00	"$4,170.00"	"$6,605.28"	"$6,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203807	EAP	Custom 27203807		Device Accunet Distal Protecti	BOTH IP/OP	"$7,006.00 "	"$5,184.44"	$0.00	"$5,604.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,400.22"	$0.00	"$1,460.05"	$0.00	$0.00	$0.00	$0.00	"$3,503.00"	"$5,548.75"	"$5,604.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203808	EAP	Custom 27203808		1008195-20 Balloon Viatrac	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$975.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203809	EAP	Custom 27203809		Qc-2-1 Helix Coil Axium Helica	BOTH IP/OP	"$2,404.00 "	"$1,778.96"	$0.00	"$1,923.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,784.25"	"$1,784.25"	"$1,853.00"	$0.00	$500.99	$0.00	$0.00	$0.00	$0.00	"$1,202.00"	"$1,903.97"	"$1,923.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203810	EAP	Custom 27203810		Qc-3-4-helix Coil Axium Helica	BOTH IP/OP	"$2,404.00 "	"$1,778.96"	$0.00	"$1,923.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,784.25"	"$1,784.25"	"$1,853.00"	$0.00	$500.99	$0.00	$0.00	$0.00	$0.00	"$1,202.00"	"$1,903.97"	"$1,923.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203815	EAP	Custom 27203815		Ballon-trek Mini Rx 2.0mm X 12mm	BOTH IP/OP	$685.00 	$506.90	$0.00	$548.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$508.41	$508.41	$528.00	$0.00	$142.75	$0.00	$0.00	$0.00	$0.00	$342.50	$542.52	$548.00	$0.00	$445.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203816	EAP	Custom 27203816		Ballon-TREK MINI RX 2.0MM X 15MM	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203817	EAP	Custom 27203817		Ballon-TREK RX 2.50MM X 12MM	BOTH IP/OP	$685.00 	$506.90	$0.00	$548.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$508.41	$508.41	$528.00	$0.00	$142.75	$0.00	$0.00	$0.00	$0.00	$342.50	$542.52	$548.00	$0.00	$445.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203818	EAP	Custom 27203818		Ballon-TREK RX 2.50MM X 15MM	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203819	EAP	Custom 27203819		Ballon-TREK RX 3.0MM X 12MM	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203820	EAP	HCPCS C1757		Set Thrombectomy Dvx	BOTH IP/OP	"$5,308.00 "	"$3,927.92"	$0.00	"$4,246.40"	"$2,882.24"	"$2,882.24"	$0.00	$0.00	$0.00	"$1,106.32"	"$3,939.60"	"$3,939.60"	"$4,091.41"	$0.00	"$1,106.19"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,654.00"	"$4,203.94"	"$4,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203821	EAP	HCPCS C1757		Set Thrombectomy Avx	BOTH IP/OP	"$2,452.00 "	"$1,814.48"	$0.00	"$1,961.60"	"$1,331.44"	"$1,331.44"	$0.00	$0.00	$0.00	$511.06	"$1,819.87"	"$1,819.87"	"$1,890.00"	$0.00	$511.00	$0.00	"$1,450.36"	"$1,450.36"	$0.00	"$1,226.00"	"$1,941.98"	"$1,961.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203822	EAP	HCPCS C1757		Set Thrombectomy Spiroflex	BOTH IP/OP	"$6,464.00 "	"$4,783.36"	$0.00	"$5,171.20"	"$3,509.95"	"$3,509.95"	$0.00	$0.00	$0.00	"$1,347.26"	"$4,181.12"	"$4,181.12"	"$4,982.45"	$0.00	"$1,347.10"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,232.00"	"$5,119.49"	"$5,171.20"	$0.00	"$4,201.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203823	EAP	HCPCS C1757		Set Thrombectomy Spiroflex Vg	BOTH IP/OP	"$6,156.00 "	"$4,555.44"	$0.00	"$4,924.80"	"$3,342.71"	"$3,342.71"	$0.00	$0.00	$0.00	"$1,283.06"	"$4,181.12"	"$4,181.12"	"$4,745.04"	$0.00	"$1,282.91"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,078.00"	"$4,875.55"	"$4,924.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203824	EAP	Custom 27203824		Ballon-TREK RX 3.0MM X 15MM	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203825	EAP	HCPCS C1725		Balloon Nc Trek 2.0 X 6mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203826	EAP	HCPCS C1725		Balloon Nc Trek 2.5 X 6mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203827	EAP	HCPCS C1725		Balloon Nc Trek 2.5 X 8mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203828	EAP	HCPCS C1725		Balloon Nc Trek 2.5 X 12mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203829	EAP	HCPCS C1725		Balloon Nc Trek 2.5 X 20mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203830	EAP	HCPCS C1725		Balloon Nc Trek 2.5 X 25mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203831	EAP	HCPCS C1725		Balloon Nc Trek 2.75 X 6mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203832	EAP	HCPCS C1725		Balloon Nc Trek 2.75 X 12mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203833	EAP	HCPCS C1725		"Balloon, Mini Trek Otw 1.50 X"	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203834	EAP	HCPCS C1725		"Balloon, Mini Trek Otw 1.50 X"	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203835	EAP	HCPCS C1725		"Balloon, Mini Trek Otw 2.00 X"	BOTH IP/OP	$685.00 	$506.90	$0.00	$548.00	$371.96	$371.96	$0.00	$0.00	$0.00	$142.77	$508.41	$508.41	$528.00	$0.00	$142.75	$0.00	$405.18	$405.18	$0.00	$342.50	$542.52	$548.00	$0.00	$0.00	$0.00	$107.20	$0.00	$0.00	$109.05	$0.00	$0.00	$0.00	$0.00	$0.00
27203836	EAP	HCPCS C1725		"Balloon, Mini Trek Otw 2.00 X"	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203837	EAP	HCPCS C1725		"Balloon, Mini Trek Otw 2.00 X"	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203838	EAP	HCPCS C1725		Balloon Nc Trek 2.75 X 15mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203839	EAP	HCPCS C1725		Balloon Nc Trek 2.75 X 20mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203840	EAP	HCPCS C1725		Balloon Nc Trek 3.0 X 6mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203841	EAP	HCPCS C1725		Balloon Nc Trek 3.0 X 8mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203842	EAP	HCPCS C1725		Balloon Nc Trek 3.0 X 12mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203843	EAP	HCPCS C1725		Balloon Nc Trek 3.0 X 15mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203844	EAP	HCPCS C1725		Balloon Nc Trek 3.0 X 20mm	BOTH IP/OP	$685.00 	$506.90	$0.00	$548.00	$371.96	$371.96	$0.00	$0.00	$0.00	$142.77	$508.41	$508.41	$528.00	$0.00	$142.75	$0.00	$405.18	$405.18	$0.00	$342.50	$542.52	$548.00	$0.00	$445.25	$0.00	$107.20	$0.00	$0.00	$109.05	$0.00	$0.00	$0.00	$0.00	$0.00
27203845	EAP	HCPCS C1725		Balloon Nc Trek 3.0 X 25mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203846	EAP	HCPCS C1725		Balloon Nc Trek 3.25 X 12mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203847	EAP	HCPCS C1725		Balloon Nc Trek 3.25 X 15mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203848	EAP	HCPCS C1725		Balloon Nc Trek 3.5 X 6mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203849	EAP	HCPCS C1725		Balloon Nc Trek 3.5 X 8mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203850	EAP	HCPCS C1725		Balloon Nc Trek 3.5 X 12mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203851	EAP	HCPCS C1725		Balloon Nc Trek 3.5 X 15mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203852	EAP	HCPCS C1725		Balloon Nc Trek 3.5 X 20mm	BOTH IP/OP	$685.00 	$506.90	$0.00	$548.00	$371.96	$371.96	$0.00	$0.00	$0.00	$142.77	$508.41	$508.41	$528.00	$0.00	$142.75	$0.00	$405.18	$405.18	$0.00	$342.50	$542.52	$548.00	$0.00	$445.25	$0.00	$107.20	$0.00	$0.00	$109.05	$0.00	$0.00	$0.00	$0.00	$0.00
27203853	EAP	HCPCS C1725		Balloon Nc Trek 3.5 X 25mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203854	EAP	HCPCS C1725		Balloon Nc Trek 3.75 X 12mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203855	EAP	HCPCS C1725		Balloon Nc Trek 3.75 X 15mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203856	EAP	HCPCS C1725		Balloon Nc Trek 3.75 X 20mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203857	EAP	HCPCS C1725		Balloon Nc Trek 4.0 X 8mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203858	EAP	HCPCS C1725		Balloon Nc Trek 4.0 X 12mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203859	EAP	HCPCS C1725		Balloon Nc Trek 4.0 X 15mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203860	EAP	HCPCS C1725		Balloon Nc Trek 4.0 X 20mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203861	EAP	HCPCS C1725		Balloon Nc Trek 5.0 X 8mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$0.00	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203862	EAP	HCPCS C1725		Balloon Nc Trek 5.0 X 12mm	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$354.04	$354.04	$0.00	$0.00	$0.00	$135.89	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$385.66	$385.66	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$102.04	$0.00	$0.00	$103.80	$0.00	$0.00	$0.00	$0.00	$0.00
27203863	EAP	HCPCS C1725		Stent Xcience 2.25 X 8mm	BOTH IP/OP	"$6,940.00 "	"$5,135.60"	$0.00	"$5,552.00"	"$3,768.42"	"$3,768.42"	$0.00	$0.00	$0.00	"$1,446.47"	"$4,181.12"	"$4,181.12"	"$5,349.35"	$0.00	"$1,446.30"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,470.00"	"$5,496.48"	"$5,552.00"	$0.00	$0.00	$0.00	"$1,086.11"	$0.00	$0.00	"$1,104.85"	$0.00	$0.00	$0.00	$0.00	$0.00
27203864	EAP	HCPCS C1887		Catheter Guid Ebu3.75 Curve 8fr .09in 90cm Left	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$105.95	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27203865	EAP	HCPCS C1887		Atheter Guid Xb3.5 Curve 8fr 90cm Coron Lnchr	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27203867	EAP	HCPCS C1887		Catheter Guid Jl4 Curve 8fr 90cm Coron Shr Nx Bal	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27203868	EAP	HCPCS C1887		Catheter Guid Mb1 Curve 8fr .088in 90cm Coron Shr	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27203869	EAP	HCPCS C1887		Catheter Angio Jacky Radl 3.5 Curve 5fr 110cm	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$47.78	$47.78	$0.00	$0.00	$0.00	$18.34	$65.31	$65.31	$67.83	$0.00	$18.34	$0.00	$52.05	$52.05	$0.00	$44.00	$69.70	$70.40	$0.00	$57.20	$0.00	$13.77	$0.00	$0.00	$14.01	$0.00	$0.00	$0.00	$0.00	$0.00
27203870	EAP	HCPCS C1725		Chocolate Ptca Balloon Catheter 2.0x10 Mm 5f	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$407.25	$407.25	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$578.10	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00	$487.50	$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
27203871	EAP	HCPCS C1725		Chocolate Ptca Balloon Catheter 2.0x15 Mm 5f	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$407.25	$407.25	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$578.10	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00	$487.50	$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
27203872	EAP	HCPCS C1725		Chocolate Ptca Balloon Catheter 2.0x20 Mm 5f	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00	$0.00	$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
27203873	EAP	HCPCS C1725		Chocolate Ptca Balloon Catheter 2.5x10 Mm 5f	BOTH IP/OP	$788.00 	$583.12	$0.00	$630.40	$427.88	$427.88	$0.00	$0.00	$0.00	$164.24	$584.85	$584.85	$607.39	$0.00	$164.22	$0.00	$466.10	$466.10	$0.00	$394.00	$624.10	$630.40	$0.00	$512.20	$0.00	$123.32	$0.00	$0.00	$125.45	$0.00	$0.00	$0.00	$0.00	$0.00
27203874	EAP	HCPCS C1725		Chocolate Ptca Balloon Catheter 2.5x15 Mm 5f	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$407.25	$407.25	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$578.10	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00	$487.50	$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
27203875	EAP	HCPCS C1725		Chocolate Ptca Balloon Catheter 2.5x20 Mm 5f	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$407.25	$407.25	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$578.10	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00	$487.50	$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
27203876	EAP	HCPCS C1725		Chocolate Ptca Balloon Catheter 3.0x10 Mm 6f	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$407.25	$407.25	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$578.10	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00	$487.50	$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
27203878	EAP	HCPCS C1725		Chocolate Ptca Balloon Catheter 3.0x20 Mm 6f	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$407.25	$407.25	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$578.10	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00	$487.50	$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
27203879	EAP	HCPCS C1725		Chocolate Ptca Balloon Catheter 3.5x10 Mm 6f	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$407.25	$407.25	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$578.10	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00	$487.50	$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
27203880	EAP	HCPCS C1725		Chocolate Ptca Balloon Catheter 3.5x15 Mm 6f	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$407.25	$407.25	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$578.10	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00	$487.50	$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
27203881	EAP	HCPCS C1725		Chocolate Ptca Balloon Catheter 3.5x20 Mm 6f	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$407.25	$407.25	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$578.10	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00	$487.50	$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
27203882	EAP	HCPCS C1887		Catheter Dlv Sys .062in 5max Max Trk Tch 125cm 129	BOTH IP/OP	"$4,175.00 "	"$3,089.50"	$0.00	"$3,340.00"	"$2,267.03"	"$2,267.03"	$0.00	$0.00	$0.00	$870.17	"$3,098.69"	"$3,098.69"	"$3,218.09"	$0.00	$870.07	$0.00	"$2,469.51"	"$2,469.51"	$0.00	"$2,087.50"	"$3,306.60"	"$3,340.00"	$0.00	"$2,713.75"	$0.00	$653.39	$0.00	$0.00	$664.66	$0.00	$0.00	$0.00	$0.00	$0.00
27203890	EAP	Custom 27203890		Kit Gel Pad Medium Arctic Sun	BOTH IP/OP	"$6,305.00 "	"$4,665.70"	$0.00	"$5,044.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,152.50"	"$4,993.56"	"$5,044.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203891	EAP	Custom 27203891		Kit Gel Pad Large Arctic Sun	BOTH IP/OP	"$6,305.00 "	"$4,665.70"	$0.00	"$5,044.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,859.89"	$0.00	"$1,313.96"	$0.00	$0.00	$0.00	$0.00	"$3,152.50"	"$4,993.56"	"$5,044.00"	$0.00	"$4,098.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203892	EAP	Custom 27203892		Pad Gel Universal	BOTH IP/OP	"$6,005.00 "	"$4,443.70"	$0.00	"$4,804.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,002.50"	"$4,755.96"	"$4,804.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203895	EAP	Custom 27203895		Ballon-TREK RX 3.50MM X 12MM	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203896	EAP	Custom 27203896		Ballon-TREK RX 3.50MM X 15MM	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203897	EAP	Custom 27203897		Ballon-TREK RX 4.0MM X 15MM	BOTH IP/OP	$652.00 	$482.48	$0.00	$521.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.91	$483.91	$502.56	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$326.00	$516.38	$521.60	$0.00	$423.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203899	EAP	Custom 27203899		"Catheter, Tiger 4.5 Radial Access"	BOTH IP/OP	$31.00 	$22.94	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.01	$23.01	$23.89	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.50	$24.55	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203900	EAP	Custom 27203900		Device Spec Rtrvl Xtrt Pro Xl 7-6fr 12-15mm 200cm	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,855.50"	"$1,855.50"	"$1,927.00"	$0.00	$521.00	$0.00	$0.00	$0.00	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203901	EAP	Custom 27203901		Tray Foley 16fr With Unrinemeter	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203902	EAP	HCPCS C1751		Fa-55150-1030 Catheter Marksman	BOTH IP/OP	"$3,104.00 "	"$2,296.96"	$0.00	"$2,483.20"	"$1,685.47"	"$1,685.47"	$0.00	$0.00	$0.00	$646.95	"$2,303.79"	"$2,303.79"	"$2,392.56"	$0.00	$646.87	$0.00	"$1,836.02"	"$1,836.02"	$0.00	"$1,552.00"	"$2,458.37"	"$2,483.20"	$0.00	$0.00	$0.00	$485.78	$0.00	$0.00	$494.16	$0.00	$0.00	$0.00	$0.00	$0.00
27203903	EAP	HCPCS C1725		Catheter Balloon Udt 16-449 5-10/5/75	BOTH IP/OP	$634.00 	$469.16	$0.00	$507.20	$344.26	$344.26	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$488.69	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$317.00	$502.13	$507.20	$0.00	$0.00	$0.00	$99.22	$0.00	$0.00	$100.93	$0.00	$0.00	$0.00	$0.00	$0.00
27203904	EAP	HCPCS C1894		Cl-07690 Sheath Set Super Arrow Flex 90cm	BOTH IP/OP	$347.00 	$256.78	$0.00	$277.60	$188.42	$188.42	$0.00	$0.00	$0.00	$72.32	$257.54	$257.54	$267.47	$0.00	$72.31	$0.00	$205.25	$205.25	$0.00	$173.50	$274.82	$277.60	$0.00	$0.00	$0.00	$54.31	$0.00	$0.00	$55.24	$0.00	$0.00	$0.00	$0.00	$0.00
27203905	EAP	HCPCS C1894		Cl - 07665 Sheath Set Super Arrow Flex 65cm	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$157.47	$157.47	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00	$188.50	$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
27203906	EAP	Custom 27203906		Catheter Tiger Radial Access 5fr 100cm 4.0 40-5011	BOTH IP/OP	$33.00 	$24.42	$0.00	$26.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.50	$26.14	$26.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203907	EAP	Custom 27203907		Catheter Siteseer Al 1 5 Fr 5a0018	BOTH IP/OP	$31.00 	$22.94	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.01	$23.01	$23.89	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.50	$24.55	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203908	EAP	HCPCS C1769		Guidewire Asahi Grand Slam .014x300cm 14940	BOTH IP/OP	$234.00 	$173.16	$0.00	$187.20	$127.06	$127.06	$0.00	$0.00	$0.00	$48.77	$173.67	$173.67	$180.37	$0.00	$48.77	$0.00	$138.41	$138.41	$0.00	$117.00	$185.33	$187.20	$0.00	$152.10	$0.00	$36.62	$0.00	$0.00	$37.25	$0.00	$0.00	$0.00	$0.00	$0.00
27203909	EAP	HCPCS C1887		La6ebu375 Catheter Guidingebu 3.75	BOTH IP/OP	$464.00 	$343.36	$0.00	$371.20	$251.95	$251.95	$0.00	$0.00	$0.00	$96.71	$344.38	$344.38	$357.65	$0.00	$96.70	$0.00	$274.46	$274.46	$0.00	$232.00	$367.49	$371.20	$0.00	$301.60	$0.00	$72.62	$0.00	$0.00	$73.87	$0.00	$0.00	$0.00	$0.00	$0.00
27203912	EAP	HCPCS C1887		Catheter Guideliner 5571	BOTH IP/OP	"$1,227.00 "	$907.98	$0.00	$981.60	$666.26	$666.26	$0.00	$0.00	$0.00	$255.74	$910.68	$910.68	$945.77	$0.00	$255.71	$0.00	$725.77	$725.77	$0.00	$613.50	$971.78	$981.60	$0.00	$797.55	$0.00	$192.03	$0.00	$0.00	$195.34	$0.00	$0.00	$0.00	$0.00	$0.00
27203913	EAP	HCPCS C1887		La7ebu375 Catheter Guiding Ebu 3.75	BOTH IP/OP	$464.00 	$343.36	$0.00	$371.20	$251.95	$251.95	$0.00	$0.00	$0.00	$96.71	$344.38	$344.38	$357.65	$0.00	$96.70	$0.00	$274.46	$274.46	$0.00	$232.00	$367.49	$371.20	$0.00	$0.00	$0.00	$72.62	$0.00	$0.00	$73.87	$0.00	$0.00	$0.00	$0.00	$0.00
27203914	EAP	Custom 27203914		Catheter Siteseer Angled Pigtailed 5fr 5a0070	BOTH IP/OP	$31.00 	$22.94	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.01	$23.01	$23.89	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.50	$24.55	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203916	EAP	HCPCS C1892		French Large Peel Away Introducer 20	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$27.69	$27.69	$0.00	$0.00	$0.00	$10.63	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$30.17	$30.17	$0.00	$25.50	$40.39	$40.80	$0.00	$0.00	$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
27203917	EAP	HCPCS C1892		French Large Peel Away Introducer 22	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$27.69	$27.69	$0.00	$0.00	$0.00	$10.63	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$30.17	$30.17	$0.00	$25.50	$40.39	$40.80	$0.00	$33.15	$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
27203918	EAP	HCPCS C1892		French Large Peel Away Introducer 24	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$27.69	$27.69	$0.00	$0.00	$0.00	$10.63	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$30.17	$30.17	$0.00	$25.50	$40.39	$40.80	$0.00	$0.00	$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
27203919	EAP	HCPCS C1892		French Large Peel Away Introducer 26	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$27.69	$27.69	$0.00	$0.00	$0.00	$10.63	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$30.17	$30.17	$0.00	$25.50	$40.39	$40.80	$0.00	$0.00	$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
27203920	EAP	HCPCS C1894		Flexor Ceckflo Introducer	BOTH IP/OP	$76.00 	$56.24	$0.00	$60.80	$41.27	$41.27	$0.00	$0.00	$0.00	$15.84	$56.41	$56.41	$58.58	$0.00	$15.84	$0.00	$44.95	$44.95	$0.00	$38.00	$60.19	$60.80	$0.00	$49.40	$0.00	$11.89	$0.00	$0.00	$12.10	$0.00	$0.00	$0.00	$0.00	$0.00
27203921	EAP	HCPCS C1750		French X 36 Cm Titan Hemodialysis Catheter	BOTH IP/OP	$237.00 	$175.38	$0.00	$189.60	$128.69	$128.69	$0.00	$0.00	$0.00	$49.40	$175.90	$175.90	$182.68	$0.00	$49.39	$0.00	$140.19	$140.19	$0.00	$118.50	$187.70	$189.60	$0.00	$0.00	$0.00	$37.09	$0.00	$0.00	$37.73	$0.00	$0.00	$0.00	$0.00	$0.00
27203922	EAP	HCPCS C1750		French X 40 Cm Titan Hemodialysis Catheter	BOTH IP/OP	$237.00 	$175.38	$0.00	$189.60	$128.69	$128.69	$0.00	$0.00	$0.00	$49.40	$175.90	$175.90	$182.68	$0.00	$49.39	$0.00	$140.19	$140.19	$0.00	$118.50	$187.70	$189.60	$0.00	$0.00	$0.00	$37.09	$0.00	$0.00	$37.73	$0.00	$0.00	$0.00	$0.00	$0.00
27203923	EAP	HCPCS C1750		Set Catheter 15.5fr 55cm 2 Lumen Titan Hd Long Term	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$366.13	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00	$213.75	$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
27203925	EAP	HCPCS C1752		French X 32 Cm Titan Hemodialysis Catheter T- 3 Triple 5	BOTH IP/OP	$237.00 	$175.38	$0.00	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.90	$175.90	$182.68	$0.00	$49.39	$0.00	$0.00	$0.00	$0.00	$118.50	$187.70	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203926	EAP	HCPCS C1752		Titan Hemodialysis Catheter 14f X 30 Cm	BOTH IP/OP	$237.00 	$175.38	$0.00	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.90	$175.90	$182.68	$0.00	$49.39	$0.00	$0.00	$0.00	$0.00	$118.50	$187.70	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203927	EAP	HCPCS C1892		Tear Away Sheath Introducer	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$95.03	$95.03	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$134.89	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00	$0.00	$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
27203928	EAP	Custom 27203928		Dressing Adherent Mepilex Border 9.2 X 9.2 282400	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.46	$27.46	$28.52	$0.00	$7.71	$0.00	$0.00	$0.00	$0.00	$18.50	$29.30	$29.60	$0.00	$24.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203929	EAP	HCPCS C1892		Large Peel Away Introducer	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$27.69	$27.69	$0.00	$0.00	$0.00	$10.63	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$30.17	$30.17	$0.00	$25.50	$40.39	$40.80	$0.00	$0.00	$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
27203930	EAP	HCPCS C1769		G131660  Introducer Tracheostomy Percutaneous Ciaglia Bm	BOTH IP/OP	"$1,124.00 "	$831.76	$0.00	$899.20	$610.33	$610.33	$0.00	$0.00	$0.00	$234.27	$834.23	$834.23	$866.38	$0.00	$234.24	$0.00	$664.85	$664.85	$0.00	$562.00	$890.21	$899.20	$0.00	$0.00	$0.00	$175.91	$0.00	$0.00	$178.94	$0.00	$0.00	$0.00	$0.00	$0.00
27203931	EAP	HCPCS C1769		G12565  Introducer Tracheostomy Percutaneous Ciaglia Blm	BOTH IP/OP	"$1,124.00 "	$831.76	$0.00	$899.20	$610.33	$610.33	$0.00	$0.00	$0.00	$234.27	$834.23	$834.23	$866.38	$0.00	$234.24	$0.00	$664.85	$664.85	$0.00	$562.00	$890.21	$899.20	$0.00	$730.60	$0.00	$175.91	$0.00	$0.00	$178.94	$0.00	$0.00	$0.00	$0.00	$0.00
27203933	EAP	HCPCS C1769		Um-04018  Femoral Arterial Line Kit	BOTH IP/OP	$91.00 	$67.34	$0.00	$72.80	$49.41	$49.41	$0.00	$0.00	$0.00	$18.97	$67.54	$67.54	$70.14	$0.00	$18.96	$0.00	$53.83	$53.83	$0.00	$45.50	$72.07	$72.80	$0.00	$0.00	$0.00	$14.24	$0.00	$0.00	$14.49	$0.00	$0.00	$0.00	$0.00	$0.00
27203937	EAP	Custom 27203937		M827057/10.s  T.r.a.c. Pad	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.31	$42.31	$43.94	$0.00	$11.88	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203938	EAP	HCPCS C1887		Fa-55150-1030 Catheter Marksman	BOTH IP/OP	"$3,259.00 "	"$2,411.66"	$0.00	"$2,607.20"	"$1,769.64"	"$1,769.64"	$0.00	$0.00	$0.00	$679.26	"$2,418.83"	"$2,418.83"	"$2,512.04"	$0.00	$679.18	$0.00	"$1,927.70"	"$1,927.70"	$0.00	"$1,629.50"	"$2,581.13"	"$2,607.20"	$0.00	"$2,118.35"	$0.00	$510.03	$0.00	$0.00	$518.83	$0.00	$0.00	$0.00	$0.00	$0.00
27203939	EAP	HCPCS C1725		Baloon 2.5 X 15mm Raptor 573-125	BOTH IP/OP	$743.00 	$549.82	$0.00	$594.40	$403.45	$403.45	$0.00	$0.00	$0.00	$154.86	$551.45	$551.45	$572.70	$0.00	$154.84	$0.00	$439.48	$439.48	$0.00	$371.50	$588.46	$594.40	$0.00	$0.00	$0.00	$116.28	$0.00	$0.00	$118.29	$0.00	$0.00	$0.00	$0.00	$0.00
27203940	EAP	Custom 27203940		Catheter Siteseer Al1 5fr 5a0018	BOTH IP/OP	$31.00 	$22.94	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.01	$23.01	$23.89	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.50	$24.55	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203941	EAP	Custom 27203941		Cl-07665 Sheath Set Super Arrow Flex 65cm	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203942	EAP	Custom 27203942		Needle Guide Sterile 9001c0212	BOTH IP/OP	$48.00 	$35.52	$0.00	$38.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.63	$35.63	$37.00	$0.00	$10.00	$0.00	$0.00	$0.00	$0.00	$24.00	$38.02	$38.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203943	EAP	HCPCS C1895		"Reliance Lead,aicd, Endo Dual Coil"	BOTH IP/OP	"$11,794.00 "	"$8,727.56"	$0.00	"$9,435.20"	"$6,404.14"	"$6,404.14"	$0.00	$0.00	$0.00	"$2,458.16"	"$4,181.12"	"$4,181.12"	"$9,090.82"	$0.00	"$2,457.87"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,897.00"	"$9,340.85"	"$9,435.20"	$0.00	$0.00	$0.00	"$1,845.76"	$0.00	$0.00	"$1,877.60"	$0.00	$0.00	$0.00	$0.00	$0.00
27203945	EAP	HCPCS C1887		"6fr Acuity Cath, Guiding W Del Sys"	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$263.36	$263.36	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$373.84	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00	$0.00	$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
27203946	EAP	HCPCS C1887		"8fr Acuity Cath, Guiding W Del Sys"	BOTH IP/OP	"$1,104.00 "	$816.96	$0.00	$883.20	$599.47	$599.47	$0.00	$0.00	$0.00	$230.10	$819.39	$819.39	$850.96	$0.00	$230.07	$0.00	$653.02	$653.02	$0.00	$552.00	$874.37	$883.20	$0.00	$0.00	$0.00	$172.78	$0.00	$0.00	$175.76	$0.00	$0.00	$0.00	$0.00	$0.00
27203947	EAP	HCPCS C1887		"Ep Ds2c002 Slit/outer Cath, Guiding"	BOTH IP/OP	"$1,551.00 "	"$1,147.74"	$0.00	"$1,240.80"	$842.19	$842.19	$0.00	$0.00	$0.00	$323.27	"$1,151.15"	"$1,151.15"	"$1,195.51"	$0.00	$323.23	$0.00	$917.42	$917.42	$0.00	$775.50	"$1,228.39"	"$1,240.80"	$0.00	$0.00	$0.00	$242.73	$0.00	$0.00	$246.92	$0.00	$0.00	$0.00	$0.00	$0.00
27203950	EAP	HCPCS C1769		Neuroscout 14 Standard 601314	BOTH IP/OP	"$1,111.00 "	$822.14	$0.00	$888.80	$603.27	$603.27	$0.00	$0.00	$0.00	$231.56	$824.58	$824.58	$856.36	$0.00	$231.53	$0.00	$657.16	$657.16	$0.00	$555.50	$879.91	$888.80	$0.00	$0.00	$0.00	$173.87	$0.00	$0.00	$176.87	$0.00	$0.00	$0.00	$0.00	$0.00
27203951	EAP	HCPCS C1769		Neuroscout 14 Soft Xl 601414	BOTH IP/OP	"$1,111.00 "	$822.14	$0.00	$888.80	$499.95	$499.95	$0.00	$0.00	$0.00	$231.56	$824.58	$824.58	$856.36	$0.00	$231.53	$0.00	$657.16	$657.16	$0.00	$555.50	$879.91	$888.80	$0.00	$0.00	$0.00	$173.87	$0.00	$0.00	$176.87	$0.00	$0.00	$0.00	$0.00	$0.00
27203952	EAP	HCPCS C1887		Prowler 27 Microcatheter	BOTH IP/OP	"$2,468.00 "	"$1,826.32"	$0.00	"$1,974.40"	"$1,340.12"	"$1,340.12"	$0.00	$0.00	$0.00	$514.39	"$1,831.75"	"$1,831.75"	"$1,902.33"	$0.00	$514.33	$0.00	"$1,459.82"	"$1,459.82"	$0.00	"$1,234.00"	"$1,954.66"	"$1,974.40"	$0.00	$0.00	$0.00	$386.24	$0.00	$0.00	$392.91	$0.00	$0.00	$0.00	$0.00	$0.00
27203953	EAP	HCPCS C1887		Catheter Delivery System Px Slim 130 D 0-.02 In Micro Lm	BOTH IP/OP	"$2,749.00 "	"$2,034.26"	$0.00	"$2,199.20"	"$1,492.71"	"$1,492.71"	$0.00	$0.00	$0.00	$572.96	"$2,040.31"	"$2,040.31"	"$2,118.93"	$0.00	$572.89	$0.00	"$1,626.03"	"$1,626.03"	$0.00	"$1,374.50"	"$2,177.21"	"$2,199.20"	$0.00	$0.00	$0.00	$430.22	$0.00	$0.00	$437.64	$0.00	$0.00	$0.00	$0.00	$0.00
27203954	EAP	HCPCS C1887		Catheter Delivery Sys Px Slim 45 D 0-.02 In Micro L150 M	BOTH IP/OP	"$2,749.00 "	"$2,034.26"	$0.00	"$2,199.20"	"$1,492.71"	"$1,492.71"	$0.00	$0.00	$0.00	$572.96	"$2,040.31"	"$2,040.31"	"$2,118.93"	$0.00	$572.89	$0.00	"$1,626.03"	"$1,626.03"	$0.00	"$1,374.50"	"$2,177.21"	"$2,199.20"	$0.00	$0.00	$0.00	$430.22	$0.00	$0.00	$437.64	$0.00	$0.00	$0.00	$0.00	$0.00
27203955	EAP	HCPCS C1887		Catheter Delivery Syspx Slim 90 D 0-.02 In Micro L150 Cm	BOTH IP/OP	"$2,749.00 "	"$2,034.26"	$0.00	"$2,199.20"	"$1,492.71"	"$1,492.71"	$0.00	$0.00	$0.00	$572.96	"$2,040.31"	"$2,040.31"	"$2,118.93"	$0.00	$572.89	$0.00	"$1,626.03"	"$1,626.03"	$0.00	"$1,374.50"	"$2,177.21"	"$2,199.20"	$0.00	$0.00	$0.00	$430.22	$0.00	$0.00	$437.64	$0.00	$0.00	$0.00	$0.00	$0.00
27203956	EAP	HCPCS C1887		Catheter Delivery Sys Px Slim 130 D 0-.02 In Micro L150m	BOTH IP/OP	"$2,749.00 "	"$2,034.26"	$0.00	"$2,199.20"	"$1,492.71"	"$1,492.71"	$0.00	$0.00	$0.00	$572.96	"$2,040.31"	"$2,040.31"	"$2,118.93"	$0.00	$572.89	$0.00	"$1,626.03"	"$1,626.03"	$0.00	"$1,374.50"	"$2,177.21"	"$2,199.20"	$0.00	$0.00	$0.00	$430.22	$0.00	$0.00	$437.64	$0.00	$0.00	$0.00	$0.00	$0.00
27203957	EAP	HCPCS C1887		Coil Detachment Handle	BOTH IP/OP	$739.00 	$546.86	$0.00	$591.20	$401.28	$401.28	$0.00	$0.00	$0.00	$154.03	$548.49	$548.49	$569.62	$0.00	$154.01	$0.00	$437.12	$437.12	$0.00	$369.50	$585.29	$591.20	$0.00	$480.35	$0.00	$115.65	$0.00	$0.00	$117.65	$0.00	$0.00	$0.00	$0.00	$0.00
27203958	EAP	HCPCS C1725		Catheter Delivery System .038in Sims Curve 5fr .04	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$178.65	$178.65	$0.00	$0.00	$0.00	$68.57	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$194.60	$194.60	$0.00	$164.50	$260.57	$263.20	$0.00	$213.85	$0.00	$51.49	$0.00	$0.00	$52.38	$0.00	$0.00	$0.00	$0.00	$0.00
27203979	EAP	HCPCS C1725		Catheter Baldilat 12mm 75cm 40mm High Pressure Lp	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00	$0.00	$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
27203980	EAP	HCPCS C1725		Catheter Baldilat 10mm 75cm 40mm High Pressure Lp	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00	$0.00	$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
27203999	EAP	Custom 27203999		Turnpike Catheter Lp 150cm	BOTH IP/OP	"$1,488.00 "	"$1,101.12"	$0.00	"$1,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,104.39"	"$1,104.39"	"$1,146.95"	$0.00	$310.10	$0.00	$0.00	$0.00	$0.00	$744.00	"$1,178.50"	"$1,190.40"	$0.00	$967.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204010	EAP	Custom 27204010		Camino Icp Catheter With Licox Bolt Fitting	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,745.65"	"$1,745.65"	"$1,812.92"	$0.00	$490.16	$0.00	$0.00	$0.00	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204011	EAP	Custom 27204011		Brain Tissue Monitoring Kit	BOTH IP/OP	"$3,646.00 "	"$2,698.04"	$0.00	"$2,916.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,706.06"	"$2,706.06"	"$2,810.34"	$0.00	$759.83	$0.00	$0.00	$0.00	$0.00	"$1,823.00"	"$2,887.63"	"$2,916.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204012	EAP	Custom 27204012		Tube Blakemore Adult 20 Fr	BOTH IP/OP	$975.00 	$721.50	$0.00	$780.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.65	$723.65	$751.53	$0.00	$203.19	$0.00	$0.00	$0.00	$0.00	$487.50	$772.20	$780.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204013	EAP	Custom 27204013		"Retriever, Clot,trevo Pro 4 Kit, W Guidewire Tip"	BOTH IP/OP	"$15,192.00 "	"$11,242.08"	$0.00	"$12,153.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,709.99"	$0.00	"$3,166.01"	$0.00	$0.00	$0.00	$0.00	"$7,596.00"	"$12,032.06"	"$12,153.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204014	EAP	HCPCS C1886		S-1304-cps-7-25-ls-bd Safire Blu	BOTH IP/OP	"$4,717.00 "	"$3,490.58"	$0.00	"$3,773.60"	"$2,561.33"	"$2,561.33"	$0.00	$0.00	$0.00	$983.14	"$3,500.96"	"$3,500.96"	"$3,635.86"	$0.00	$983.02	$0.00	"$2,790.11"	"$2,790.11"	$0.00	"$2,358.50"	"$3,735.86"	"$3,773.60"	$0.00	$0.00	$0.00	$738.21	$0.00	$0.00	$750.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204015	EAP	HCPCS C1886		S-1304-cps-7-25-ms-bd Safire Blu	BOTH IP/OP	"$4,717.00 "	"$3,490.58"	$0.00	"$3,773.60"	"$2,561.33"	"$2,561.33"	$0.00	$0.00	$0.00	$983.14	"$3,500.96"	"$3,500.96"	"$3,635.86"	$0.00	$983.02	$0.00	"$2,790.11"	"$2,790.11"	$0.00	"$2,358.50"	"$3,735.86"	"$3,773.60"	$0.00	$0.00	$0.00	$738.21	$0.00	$0.00	$750.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204016	EAP	HCPCS C1886		Medium Sweep Therapy Cool Path Bi-directional	BOTH IP/OP	"$4,717.00 "	"$3,490.58"	$0.00	"$3,773.60"	"$2,561.33"	"$2,561.33"	$0.00	$0.00	$0.00	$983.14	"$3,500.96"	"$3,500.96"	"$3,635.86"	$0.00	$983.02	$0.00	"$2,790.11"	"$2,790.11"	$0.00	"$2,358.50"	"$3,735.86"	"$3,773.60"	$0.00	$0.00	$0.00	$738.21	$0.00	$0.00	$750.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204017	EAP	HCPCS C1886		Large Sweep     Therapy Cool Path Bi-directional	BOTH IP/OP	"$4,717.00 "	"$3,490.58"	$0.00	"$3,773.60"	"$2,561.33"	"$2,561.33"	$0.00	$0.00	$0.00	$983.14	"$3,500.96"	"$3,500.96"	"$3,635.86"	$0.00	$983.02	$0.00	"$2,790.11"	"$2,790.11"	$0.00	"$2,358.50"	"$3,735.86"	"$3,773.60"	$0.00	$0.00	$0.00	$738.21	$0.00	$0.00	$750.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204020	EAP	HCPCS C1733		Safire Tx Catheter 8mm Large Curl	BOTH IP/OP	"$3,388.00 "	"$2,507.12"	$0.00	"$2,710.40"	"$1,839.68"	"$1,839.68"	$0.00	$0.00	$0.00	$706.14	"$2,514.57"	"$2,514.57"	"$2,611.47"	$0.00	$706.06	$0.00	"$2,004.00"	"$2,004.00"	$0.00	"$1,694.00"	"$2,683.30"	"$2,710.40"	$0.00	"$2,202.20"	$0.00	$530.22	$0.00	$0.00	$539.37	$0.00	$0.00	$0.00	$0.00	$0.00
27204021	EAP	HCPCS C1733		Safire Cath 7f 4mm Lgcrl (us)	BOTH IP/OP	"$2,138.00 "	"$1,582.12"	$0.00	"$1,710.40"	"$1,160.93"	"$1,160.93"	$0.00	$0.00	$0.00	$445.61	"$1,586.82"	"$1,586.82"	"$1,647.97"	$0.00	$445.56	$0.00	"$1,264.63"	"$1,264.63"	$0.00	"$1,069.00"	"$1,693.30"	"$1,710.40"	$0.00	"$1,389.70"	$0.00	$334.60	$0.00	$0.00	$340.37	$0.00	$0.00	$0.00	$0.00	$0.00
27204022	EAP	HCPCS C1733		Safire Tx Catheter 8mm Xlarge Curl	BOTH IP/OP	"$3,227.00 "	"$2,387.98"	$0.00	"$2,581.60"	"$1,752.26"	"$1,752.26"	$0.00	$0.00	$0.00	$672.59	"$2,395.08"	"$2,395.08"	"$2,487.37"	$0.00	$672.51	$0.00	"$1,908.77"	"$1,908.77"	$0.00	"$1,613.50"	"$2,555.78"	"$2,581.60"	$0.00	$0.00	$0.00	$505.03	$0.00	$0.00	$513.74	$0.00	$0.00	$0.00	$0.00	$0.00
27204023	EAP	HCPCS C1733		Safire Cath 7f 5mm Lg Swp (us)	BOTH IP/OP	"$2,062.00 "	"$1,525.88"	$0.00	"$1,649.60"	"$1,119.67"	"$1,119.67"	$0.00	$0.00	$0.00	$429.77	"$1,530.42"	"$1,530.42"	"$1,589.39"	$0.00	$429.72	$0.00	"$1,219.67"	"$1,219.67"	$0.00	"$1,031.00"	"$1,633.10"	"$1,649.60"	$0.00	$0.00	$0.00	$322.70	$0.00	$0.00	$328.27	$0.00	$0.00	$0.00	$0.00	$0.00
27204024	EAP	HCPCS C1733		Safire Cath 7f 5mm Lg Crl (us)	BOTH IP/OP	"$2,165.00 "	"$1,602.10"	$0.00	"$1,732.00"	"$1,175.60"	"$1,175.60"	$0.00	$0.00	$0.00	$451.24	"$1,606.86"	"$1,606.86"	"$1,668.78"	$0.00	$451.19	$0.00	"$1,280.60"	"$1,280.60"	$0.00	"$1,082.50"	"$1,714.68"	"$1,732.00"	$0.00	"$1,407.25"	$0.00	$338.82	$0.00	$0.00	$344.67	$0.00	$0.00	$0.00	$0.00	$0.00
27204025	EAP	HCPCS C1733		Safire Cath 7f 4mm Mdcrl (us)	BOTH IP/OP	"$2,036.00 "	"$1,506.64"	$0.00	"$1,628.80"	"$1,105.55"	"$1,105.55"	$0.00	$0.00	$0.00	$424.35	"$1,511.12"	"$1,511.12"	"$1,569.35"	$0.00	$424.30	$0.00	"$1,204.29"	"$1,204.29"	$0.00	"$1,018.00"	"$1,612.51"	"$1,628.80"	$0.00	$0.00	$0.00	$318.63	$0.00	$0.00	$324.13	$0.00	$0.00	$0.00	$0.00	$0.00
27204026	EAP	HCPCS C1733		Safire Cath 7f 4mm Sm Crl (us)	BOTH IP/OP	"$2,036.00 "	"$1,506.64"	$0.00	"$1,628.80"	"$1,105.55"	"$1,105.55"	$0.00	$0.00	$0.00	$424.35	"$1,511.12"	"$1,511.12"	"$1,569.35"	$0.00	$424.30	$0.00	"$1,204.29"	"$1,204.29"	$0.00	"$1,018.00"	"$1,612.51"	"$1,628.80"	$0.00	$0.00	$0.00	$318.63	$0.00	$0.00	$324.13	$0.00	$0.00	$0.00	$0.00	$0.00
27204041	EAP	HCPCS C1893		"Agilis Nxt 8.5f Steer Sm Crl,g2"	BOTH IP/OP	"$2,914.00 "	"$2,156.36"	$0.00	"$2,331.20"	"$1,582.30"	"$1,582.30"	$0.00	$0.00	$0.00	$607.35	"$2,162.77"	"$2,162.77"	"$2,246.11"	$0.00	$607.28	$0.00	"$1,723.63"	"$1,723.63"	$0.00	"$1,457.00"	"$2,307.89"	"$2,331.20"	$0.00	"$1,894.10"	$0.00	$456.04	$0.00	$0.00	$463.91	$0.00	$0.00	$0.00	$0.00	$0.00
27204042	EAP	HCPCS C1893		"Trns Intro 8.5f 63cm Sl1 032gw,g2"	BOTH IP/OP	$497.00 	$367.78	$0.00	$397.60	$269.87	$269.87	$0.00	$0.00	$0.00	$103.59	$368.87	$368.87	$383.09	$0.00	$103.57	$0.00	$293.98	$293.98	$0.00	$248.50	$393.62	$397.60	$0.00	$0.00	$0.00	$77.78	$0.00	$0.00	$79.12	$0.00	$0.00	$0.00	$0.00	$0.00
27204043	EAP	HCPCS C1893		"Trns Intro 8f 62 Cm Sl1 Tm,g2"	BOTH IP/OP	$397.00 	$293.78	$0.00	$317.60	$215.57	$215.57	$0.00	$0.00	$0.00	$82.74	$294.65	$294.65	$306.01	$0.00	$82.73	$0.00	$234.83	$234.83	$0.00	$198.50	$314.42	$317.60	$0.00	$0.00	$0.00	$62.13	$0.00	$0.00	$63.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204044	EAP	HCPCS C1893		"Trns Intro 8f 62cm Sl2 Tm,g2"	BOTH IP/OP	$397.00 	$293.78	$0.00	$317.60	$215.57	$215.57	$0.00	$0.00	$0.00	$82.74	$294.65	$294.65	$306.01	$0.00	$82.73	$0.00	$234.83	$234.83	$0.00	$198.50	$314.42	$317.60	$0.00	$0.00	$0.00	$62.13	$0.00	$0.00	$63.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204045	EAP	HCPCS C1766		"Trns Intro 8f 63cm Sl1 032gw,g2"	BOTH IP/OP	$497.00 	$367.78	$0.00	$397.60	$269.87	$269.87	$0.00	$0.00	$0.00	$103.59	$368.87	$368.87	$383.09	$0.00	$103.57	$0.00	$293.98	$293.98	$0.00	$248.50	$393.62	$397.60	$0.00	$0.00	$0.00	$77.78	$0.00	$0.00	$79.12	$0.00	$0.00	$0.00	$0.00	$0.00
27204046	EAP	HCPCS C1894		C-lock Hemo 8f 12cm 038gw-g2	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$32.04	$32.04	$0.00	$0.00	$0.00	$12.30	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$34.90	$34.90	$0.00	$29.50	$46.73	$47.20	$0.00	$38.35	$0.00	$9.23	$0.00	$0.00	$9.39	$0.00	$0.00	$0.00	$0.00	$0.00
27204047	EAP	HCPCS C1894		C-lock Hemo 7f 12cm 038gw-g2	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$30.41	$30.41	$0.00	$0.00	$0.00	$11.67	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$33.12	$33.12	$0.00	$28.00	$44.35	$44.80	$0.00	$0.00	$0.00	$8.76	$0.00	$0.00	$8.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204048	EAP	HCPCS C1894		C-lock Hemo 6f 12cm 038gw-g2	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$30.41	$30.41	$0.00	$0.00	$0.00	$11.67	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$33.12	$33.12	$0.00	$28.00	$44.35	$44.80	$0.00	$36.40	$0.00	$8.76	$0.00	$0.00	$8.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204049	EAP	HCPCS C1894		"Duo Hemo 8f 12cm 038gw,g2"	BOTH IP/OP	$91.00 	$67.34	$0.00	$72.80	$49.41	$49.41	$0.00	$0.00	$0.00	$18.97	$67.54	$67.54	$70.14	$0.00	$18.96	$0.00	$53.83	$53.83	$0.00	$45.50	$72.07	$72.80	$0.00	$0.00	$0.00	$14.24	$0.00	$0.00	$14.49	$0.00	$0.00	$0.00	$0.00	$0.00
27204050	EAP	HCPCS C1893		"Hemo Intro 8f 60cm Sept Gw,g2"	BOTH IP/OP	$482.00 	$356.68	$0.00	$385.60	$261.73	$261.73	$0.00	$0.00	$0.00	$100.46	$357.74	$357.74	$371.53	$0.00	$100.45	$0.00	$285.10	$285.10	$0.00	$241.00	$381.74	$385.60	$0.00	$0.00	$0.00	$75.43	$0.00	$0.00	$76.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204051	EAP	HCPCS C1893		"Hemo Intro 8f 60cm Sr0 Tm,g2"	BOTH IP/OP	$397.00 	$293.78	$0.00	$317.60	$215.57	$215.57	$0.00	$0.00	$0.00	$82.74	$294.65	$294.65	$306.01	$0.00	$82.73	$0.00	$234.83	$234.83	$0.00	$198.50	$314.42	$317.60	$0.00	$0.00	$0.00	$62.13	$0.00	$0.00	$63.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204052	EAP	HCPCS C1893		"Hemo Intro 8f 60cm Ramp 038gw,g2"	BOTH IP/OP	$497.00 	$367.78	$0.00	$397.60	$269.87	$269.87	$0.00	$0.00	$0.00	$103.59	$368.87	$368.87	$383.09	$0.00	$103.57	$0.00	$293.98	$293.98	$0.00	$248.50	$393.62	$397.60	$0.00	$0.00	$0.00	$77.78	$0.00	$0.00	$79.12	$0.00	$0.00	$0.00	$0.00	$0.00
27204053	EAP	HCPCS C1893		"Hemo Intro 8.5f 60cm Sept Gw,g2"	BOTH IP/OP	$482.00 	$356.68	$0.00	$385.60	$261.73	$261.73	$0.00	$0.00	$0.00	$100.46	$357.74	$357.74	$371.53	$0.00	$100.45	$0.00	$285.10	$285.10	$0.00	$241.00	$381.74	$385.60	$0.00	$0.00	$0.00	$75.43	$0.00	$0.00	$76.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204054	EAP	HCPCS C1893		"Hemo Intro 8f 60cm Sr4 Tm,g2"	BOTH IP/OP	$397.00 	$293.78	$0.00	$317.60	$215.57	$215.57	$0.00	$0.00	$0.00	$82.74	$294.65	$294.65	$306.01	$0.00	$82.73	$0.00	$234.83	$234.83	$0.00	$198.50	$314.42	$317.60	$0.00	$0.00	$0.00	$62.13	$0.00	$0.00	$63.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204055	EAP	HCPCS C1893		"Hemo Intro 8.5f 63cm Sr0 038gw,g2"	BOTH IP/OP	$508.00 	$375.92	$0.00	$406.40	$275.84	$275.84	$0.00	$0.00	$0.00	$105.88	$377.04	$377.04	$391.57	$0.00	$105.87	$0.00	$300.48	$300.48	$0.00	$254.00	$402.34	$406.40	$0.00	$0.00	$0.00	$79.50	$0.00	$0.00	$80.87	$0.00	$0.00	$0.00	$0.00	$0.00
27204056	EAP	HCPCS C1893		"Hemo Intro 8f 60cm Safl 038gw,g2"	BOTH IP/OP	$508.00 	$375.92	$0.00	$406.40	$275.84	$275.84	$0.00	$0.00	$0.00	$105.88	$377.04	$377.04	$391.57	$0.00	$105.87	$0.00	$300.48	$300.48	$0.00	$254.00	$402.34	$406.40	$0.00	$0.00	$0.00	$79.50	$0.00	$0.00	$80.87	$0.00	$0.00	$0.00	$0.00	$0.00
27204057	EAP	HCPCS C1893		"Hemo Intro 8.5f 63cm Sr2 038gw,g2"	BOTH IP/OP	$508.00 	$375.92	$0.00	$406.40	$275.84	$275.84	$0.00	$0.00	$0.00	$105.88	$377.04	$377.04	$391.57	$0.00	$105.87	$0.00	$300.48	$300.48	$0.00	$254.00	$402.34	$406.40	$0.00	$0.00	$0.00	$79.50	$0.00	$0.00	$80.87	$0.00	$0.00	$0.00	$0.00	$0.00
27204058	EAP	HCPCS C1893		"Hemo Intro 8.5f 60cm Csta Gw,g2"	BOTH IP/OP	$508.00 	$375.92	$0.00	$406.40	$275.84	$275.84	$0.00	$0.00	$0.00	$105.88	$377.04	$377.04	$391.57	$0.00	$105.87	$0.00	$300.48	$300.48	$0.00	$254.00	$402.34	$406.40	$0.00	$330.20	$0.00	$79.50	$0.00	$0.00	$80.87	$0.00	$0.00	$0.00	$0.00	$0.00
27204059	EAP	HCPCS C1893		"Hemo Intro 8f 60cm Sr2 Tm,g2"	BOTH IP/OP	$397.00 	$293.78	$0.00	$317.60	$215.57	$215.57	$0.00	$0.00	$0.00	$82.74	$294.65	$294.65	$306.01	$0.00	$82.73	$0.00	$234.83	$234.83	$0.00	$198.50	$314.42	$317.60	$0.00	$0.00	$0.00	$62.13	$0.00	$0.00	$63.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204060	EAP	HCPCS C1766		Epicardial Catheter System	BOTH IP/OP	"$3,278.00 "	"$2,425.72"	$0.00	"$2,622.40"	"$1,779.95"	"$1,779.95"	$0.00	$0.00	$0.00	$683.22	"$2,432.93"	"$2,432.93"	"$2,526.68"	$0.00	$683.14	$0.00	"$1,938.94"	"$1,938.94"	$0.00	"$1,639.00"	"$2,596.18"	"$2,622.40"	$0.00	$0.00	$0.00	$513.01	$0.00	$0.00	$521.86	$0.00	$0.00	$0.00	$0.00	$0.00
27204061	EAP	HCPCS C1730		"Ep 5f Quad 5mm 120cm Crd,g2"	BOTH IP/OP	$795.00 	$588.30	$0.00	$636.00	$431.69	$431.69	$0.00	$0.00	$0.00	$165.70	$590.05	$590.05	$612.79	$0.00	$165.68	$0.00	$470.24	$470.24	$0.00	$397.50	$629.64	$636.00	$0.00	$516.75	$0.00	$124.42	$0.00	$0.00	$126.56	$0.00	$0.00	$0.00	$0.00	$0.00
27204062	EAP	HCPCS C1730		"Ep 6f Dec 2/8mm 65cm Csl,g2"	BOTH IP/OP	"$1,087.00 "	$804.38	$0.00	$869.60	$590.24	$590.24	$0.00	$0.00	$0.00	$226.56	$806.77	$806.77	$837.86	$0.00	$226.53	$0.00	$642.96	$642.96	$0.00	$543.50	$860.90	$869.60	$0.00	$0.00	$0.00	$170.12	$0.00	$0.00	$173.05	$0.00	$0.00	$0.00	$0.00	$0.00
27204063	EAP	HCPCS C1730		"Ep 5f Quad 5mm 120cm Jsn,g2"	BOTH IP/OP	$835.00 	$617.90	$0.00	$668.00	$453.41	$453.41	$0.00	$0.00	$0.00	$174.03	$619.74	$619.74	$643.62	$0.00	$174.01	$0.00	$493.90	$493.90	$0.00	$417.50	$661.32	$668.00	$0.00	$542.75	$0.00	$130.68	$0.00	$0.00	$132.93	$0.00	$0.00	$0.00	$0.00	$0.00
27204064	EAP	HCPCS C1730		"Eps 4f Quad 5mm Crd,g2"	BOTH IP/OP	"$1,031.00 "	$762.94	$0.00	$824.80	$559.83	$559.83	$0.00	$0.00	$0.00	$214.89	$765.21	$765.21	$794.69	$0.00	$214.86	$0.00	$609.84	$609.84	$0.00	$515.50	$816.55	$824.80	$0.00	$0.00	$0.00	$161.35	$0.00	$0.00	$164.14	$0.00	$0.00	$0.00	$0.00	$0.00
27204065	EAP	HCPCS C1730		"Eps 4f Hex 5mm Crd-2,g2"	BOTH IP/OP	"$1,093.00 "	$808.82	$0.00	$874.40	$593.50	$593.50	$0.00	$0.00	$0.00	$227.81	$811.22	$811.22	$842.48	$0.00	$227.78	$0.00	$646.51	$646.51	$0.00	$546.50	$865.66	$874.40	$0.00	$0.00	$0.00	$171.05	$0.00	$0.00	$174.01	$0.00	$0.00	$0.00	$0.00	$0.00
27204066	EAP	HCPCS C1730		"Eps 5f Hex Uni 120cm Jsn X,g2"	BOTH IP/OP	$931.00 	$688.94	$0.00	$744.80	$505.53	$505.53	$0.00	$0.00	$0.00	$194.04	$690.99	$690.99	$717.61	$0.00	$194.02	$0.00	$550.69	$550.69	$0.00	$465.50	$737.35	$744.80	$0.00	$0.00	$0.00	$145.70	$0.00	$0.00	$148.22	$0.00	$0.00	$0.00	$0.00	$0.00
27204067	EAP	HCPCS C1730		"Eps 4f Quad 5mm Jsn,g2"	BOTH IP/OP	"$1,031.00 "	$762.94	$0.00	$824.80	$559.83	$559.83	$0.00	$0.00	$0.00	$214.89	$765.21	$765.21	$794.69	$0.00	$214.86	$0.00	$609.84	$609.84	$0.00	$515.50	$816.55	$824.80	$0.00	$0.00	$0.00	$161.35	$0.00	$0.00	$164.14	$0.00	$0.00	$0.00	$0.00	$0.00
27204068	EAP	HCPCS C1730		"Eps 4f Quad 2mm Jsn,g2"	BOTH IP/OP	"$1,031.00 "	$762.94	$0.00	$824.80	$559.83	$559.83	$0.00	$0.00	$0.00	$214.89	$765.21	$765.21	$794.69	$0.00	$214.86	$0.00	$609.84	$609.84	$0.00	$515.50	$816.55	$824.80	$0.00	$0.00	$0.00	$161.35	$0.00	$0.00	$164.14	$0.00	$0.00	$0.00	$0.00	$0.00
27204069	EAP	HCPCS C1730		"Ep 6f Dec 5/5mm 120cm Csl,g2"	BOTH IP/OP	"$1,087.00 "	$804.38	$0.00	$869.60	$590.24	$590.24	$0.00	$0.00	$0.00	$226.56	$806.77	$806.77	$837.86	$0.00	$226.53	$0.00	$642.96	$642.96	$0.00	$543.50	$860.90	$869.60	$0.00	$0.00	$0.00	$170.12	$0.00	$0.00	$173.05	$0.00	$0.00	$0.00	$0.00	$0.00
27204070	EAP	HCPCS C1730		"Eps 5f Quad 5mm Crd Superior,g2"	BOTH IP/OP	$844.00 	$624.56	$0.00	$675.20	$458.29	$458.29	$0.00	$0.00	$0.00	$175.91	$626.42	$626.42	$650.56	$0.00	$175.89	$0.00	$499.23	$499.23	$0.00	$422.00	$668.45	$675.20	$0.00	$0.00	$0.00	$132.09	$0.00	$0.00	$134.36	$0.00	$0.00	$0.00	$0.00	$0.00
27204071	EAP	HCPCS C1730		"Eps 6f Hex Uni 120cm Jsn X,g2"	BOTH IP/OP	$931.00 	$688.94	$0.00	$744.80	$505.53	$505.53	$0.00	$0.00	$0.00	$194.04	$690.99	$690.99	$717.61	$0.00	$194.02	$0.00	$550.69	$550.69	$0.00	$465.50	$737.35	$744.80	$0.00	$0.00	$0.00	$145.70	$0.00	$0.00	$148.22	$0.00	$0.00	$0.00	$0.00	$0.00
27204072	EAP	HCPCS C1730		"Eps 5f Dec 2/8mm 120cm Csl X,g2"	BOTH IP/OP	"$1,119.00 "	$828.06	$0.00	$895.20	$607.62	$607.62	$0.00	$0.00	$0.00	$233.23	$830.52	$830.52	$862.53	$0.00	$233.20	$0.00	$661.89	$661.89	$0.00	$559.50	$886.25	$895.20	$0.00	$0.00	$0.00	$175.12	$0.00	$0.00	$178.14	$0.00	$0.00	$0.00	$0.00	$0.00
27204080	EAP	HCPCS C1731		"Epl 7f Duo 2/10 2m 95 S-lgcrl,g2"	BOTH IP/OP	"$2,932.00 "	"$2,169.68"	$0.00	"$2,345.60"	"$1,592.08"	"$1,592.08"	$0.00	$0.00	$0.00	$611.10	"$2,176.13"	"$2,176.13"	"$2,259.99"	$0.00	$611.03	$0.00	"$1,734.28"	"$1,734.28"	$0.00	"$1,466.00"	"$2,322.14"	"$2,345.60"	$0.00	"$1,905.80"	$0.00	$458.86	$0.00	$0.00	$466.77	$0.00	$0.00	$0.00	$0.00	$0.00
27204081	EAP	Custom 27204081		"Eps Ext Cable B/t/q Blu 150 Us,g2 Supreme Quad Cable"	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204082	EAP	HCPCS C1731		"Epl 7f Duo Dec 2/2 115cm Med,g2 ""caterpillar"""	BOTH IP/OP	"$2,792.00 "	"$2,066.08"	$0.00	"$2,233.60"	"$1,516.06"	"$1,516.06"	$0.00	$0.00	$0.00	$581.92	"$2,072.22"	"$2,072.22"	"$2,152.07"	$0.00	$581.85	$0.00	"$1,651.47"	"$1,651.47"	$0.00	"$1,396.00"	"$2,211.26"	"$2,233.60"	$0.00	$0.00	$0.00	$436.95	$0.00	$0.00	$444.49	$0.00	$0.00	$0.00	$0.00	$0.00
27204083	EAP	HCPCS C1731		Inquiry Afocusil Diagnostic Catheter 20 Pole With Double Loop	BOTH IP/OP	"$4,717.00 "	"$3,490.58"	$0.00	"$3,773.60"	"$2,561.33"	"$2,561.33"	$0.00	$0.00	$0.00	$983.14	"$3,500.96"	"$3,500.96"	"$3,635.86"	$0.00	$983.02	$0.00	"$2,790.11"	"$2,790.11"	$0.00	"$2,358.50"	"$3,735.86"	"$3,773.60"	$0.00	$0.00	$0.00	$738.21	$0.00	$0.00	$750.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204084	EAP	HCPCS C1731		Inquiry AFocus II EB Fixed Radius Loop Circular Mapping Catheter 20 POLE 20MM DIAMETER	BOTH IP/OP	"$2,979.00 "	"$2,204.46"	$0.00	"$2,383.20"	"$1,617.60"	"$1,617.60"	$0.00	$0.00	$0.00	$620.90	"$2,211.01"	"$2,211.01"	"$2,296.21"	$0.00	$620.82	$0.00	"$1,762.08"	"$1,762.08"	$0.00	"$1,489.50"	"$2,359.37"	"$2,383.20"	$0.00	$0.00	$0.00	$466.21	$0.00	$0.00	$474.26	$0.00	$0.00	$0.00	$0.00	$0.00
27204085	EAP	HCPCS C1730		Inquiry AFocus II EB Fixed Radius Loop Circular Mapping Catheter 10 POLE 20MM DIAMETER	BOTH IP/OP	"$2,979.00 "	"$2,204.46"	$0.00	"$2,383.20"	"$1,617.60"	"$1,617.60"	$0.00	$0.00	$0.00	$620.90	"$2,211.01"	"$2,211.01"	"$2,296.21"	$0.00	$620.82	$0.00	"$1,762.08"	"$1,762.08"	$0.00	"$1,489.50"	"$2,359.37"	"$2,383.20"	$0.00	$0.00	$0.00	$466.21	$0.00	$0.00	$474.26	$0.00	$0.00	$0.00	$0.00	$0.00
27204086	EAP	HCPCS C1730		Inquiry AFocus II EB Fixed Radius Loop Circular Mapping Catheter 10 POLE 15MM DIAMETER	BOTH IP/OP	"$2,979.00 "	"$2,204.46"	$0.00	"$2,383.20"	"$1,617.60"	"$1,617.60"	$0.00	$0.00	$0.00	$620.90	"$2,211.01"	"$2,211.01"	"$2,296.21"	$0.00	$620.82	$0.00	"$1,762.08"	"$1,762.08"	$0.00	"$1,489.50"	"$2,359.37"	"$2,383.20"	$0.00	$0.00	$0.00	$466.21	$0.00	$0.00	$474.26	$0.00	$0.00	$0.00	$0.00	$0.00
27204087	EAP	Custom 27204087		Ensite Navx Surface Electrode Kit	BOTH IP/OP	"$2,948.00 "	"$2,181.52"	$0.00	"$2,358.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,188.01"	"$2,188.01"	"$2,272.32"	$0.00	$614.36	$0.00	$0.00	$0.00	$0.00	"$1,474.00"	"$2,334.82"	"$2,358.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204088	EAP	Custom 27204088		"Velocity, Assembly, Navx Patch, Ensite"	BOTH IP/OP	"$2,948.00 "	"$2,181.52"	$0.00	"$2,358.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,188.01"	"$2,188.01"	"$2,272.32"	$0.00	$614.36	$0.00	$0.00	$0.00	$0.00	"$1,474.00"	"$2,334.82"	"$2,358.40"	$0.00	"$1,916.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204089	EAP	Custom 27204089		EnSite Array Catheter - Domestic	BOTH IP/OP	"$10,553.00 "	"$7,809.22"	$0.00	"$8,442.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,134.25"	$0.00	"$2,199.25"	$0.00	$0.00	$0.00	$0.00	"$5,276.50"	"$8,357.98"	"$8,442.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204090	EAP	HCPCS C1888		11403001 - KIT PROCEDURE NEVERTOUCLVET L45 CM	BOTH IP/OP	"$1,197.00 "	$885.78	$0.00	$957.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$888.41	$888.41	$922.65	$0.00	$249.45	$0.00	$0.00	$0.00	$0.00	$598.50	$948.02	$957.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204091	EAP	HCPCS C1888		11403002 - KIT PROCEDURE NEVERTOUC	BOTH IP/OP	"$1,197.00 "	$885.78	$0.00	$957.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$888.41	$888.41	$922.65	$0.00	$249.45	$0.00	$0.00	$0.00	$0.00	$598.50	$948.02	$957.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204092	EAP	Custom 27204092		Coil Detachment Handle	BOTH IP/OP	$739.00 	$546.86	$0.00	$591.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$548.49	$548.49	$569.62	$0.00	$154.01	$0.00	$0.00	$0.00	$0.00	$369.50	$585.29	$591.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204093	EAP	Custom 27204093		Quatro Cath Kit	BOTH IP/OP	"$2,341.00 "	"$1,732.34"	$0.00	"$1,872.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,737.49"	"$1,737.49"	"$1,804.44"	$0.00	$487.86	$0.00	$0.00	$0.00	$0.00	"$1,170.50"	"$1,854.07"	"$1,872.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204095	EAP	HCPCS C1887		Orion 21 Microcatheter	BOTH IP/OP	"$2,172.00 "	"$1,607.28"	$0.00	"$1,737.60"	"$1,179.40"	"$1,179.40"	$0.00	$0.00	$0.00	$452.70	"$1,612.06"	"$1,612.06"	"$1,674.18"	$0.00	$452.64	$0.00	"$1,284.74"	"$1,284.74"	$0.00	"$1,086.00"	"$1,720.22"	"$1,737.60"	$0.00	"$1,411.80"	$0.00	$339.92	$0.00	$0.00	$345.78	$0.00	$0.00	$0.00	$0.00	$0.00
27204096	EAP	Custom 27204096		Mini Attachable Catheter 5f	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$0.00	$0.00	$0.00	$295.50	$468.07	$472.80	$0.00	$384.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204097	EAP	Custom 27204097		Captivator Snare Large Oval Stiff	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00	$10.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204098	EAP	HCPCS C1726		Cre Wg 8-10mm	BOTH IP/OP	$266.00 	$196.84	$0.00	$212.80	$144.44	$144.44	$0.00	$0.00	$0.00	$55.44	$197.43	$197.43	$205.03	$0.00	$55.43	$0.00	$157.34	$157.34	$0.00	$133.00	$210.67	$212.80	$0.00	$0.00	$0.00	$41.63	$0.00	$0.00	$42.35	$0.00	$0.00	$0.00	$0.00	$0.00
27204099	EAP	HCPCS C1726		Cre Wg 10-12mm	BOTH IP/OP	$266.00 	$196.84	$0.00	$212.80	$144.44	$144.44	$0.00	$0.00	$0.00	$55.44	$197.43	$197.43	$205.03	$0.00	$55.43	$0.00	$157.34	$157.34	$0.00	$133.00	$210.67	$212.80	$0.00	$0.00	$0.00	$41.63	$0.00	$0.00	$42.35	$0.00	$0.00	$0.00	$0.00	$0.00
27204100	EAP	HCPCS C1726		Cre Wg 12-15mm	BOTH IP/OP	$266.00 	$196.84	$0.00	$212.80	$144.44	$144.44	$0.00	$0.00	$0.00	$55.44	$197.43	$197.43	$205.03	$0.00	$55.43	$0.00	$157.34	$157.34	$0.00	$133.00	$210.67	$212.80	$0.00	$0.00	$0.00	$41.63	$0.00	$0.00	$42.35	$0.00	$0.00	$0.00	$0.00	$0.00
27204101	EAP	HCPCS C1726		Cre Wf 15-18mm	BOTH IP/OP	$266.00 	$196.84	$0.00	$212.80	$144.44	$144.44	$0.00	$0.00	$0.00	$55.44	$197.43	$197.43	$205.03	$0.00	$55.43	$0.00	$157.34	$157.34	$0.00	$133.00	$210.67	$212.80	$0.00	$0.00	$0.00	$41.63	$0.00	$0.00	$42.35	$0.00	$0.00	$0.00	$0.00	$0.00
27204102	EAP	HCPCS C1769		Dreamwire .035 260 Str Stnd	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$124.89	$124.89	$0.00	$0.00	$0.00	$47.94	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$0.00	$149.50	$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
27204103	EAP	HCPCS C1769		Glidewire .035 260 Str	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$124.89	$124.89	$0.00	$0.00	$0.00	$47.94	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$0.00	$149.50	$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
27204105	EAP	Custom 27404105		Extractor Rx 9-12 Mm	BOTH IP/OP	$189.00 	$139.86	$0.00	$151.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$140.28	$140.28	$145.68	$0.00	$39.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00	$122.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204106	EAP	Custom 27204106		Extractor Rx 12-15 Mm	BOTH IP/OP	$189.00 	$139.86	$0.00	$151.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$140.28	$140.28	$145.68	$0.00	$39.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00	$122.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204107	EAP	Custom 272040107		Cytology Brush	BOTH IP/OP	$134.00 	$99.16	$0.00	$107.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.45	$99.45	$103.29	$0.00	$27.93	$0.00	$0.00	$0.00	$0.00	$67.00	$106.13	$107.20	$0.00	$87.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204108	EAP	Custom 27204108		Roth Net	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.93	$77.93	$80.93	$0.00	$21.88	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00	$68.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204109	EAP	Custom 27204109		Fiapc Probe	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.84	$181.84	$188.85	$0.00	$51.06	$0.00	$0.00	$0.00	$0.00	$122.50	$194.04	$196.00	$0.00	$159.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204110	EAP	HCPCS C1757		Solitaire Fr 4x15	BOTH IP/OP	"$11,643.00 "	"$8,615.82"	$0.00	"$9,314.40"	"$6,322.15"	"$6,322.15"	$0.00	$0.00	$0.00	"$2,426.69"	"$4,181.12"	"$4,181.12"	"$8,974.42"	$0.00	"$2,426.40"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,821.50"	"$9,221.26"	"$9,314.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204111	EAP	HCPCS C1757		Solitaire Fr 4x20	BOTH IP/OP	"$12,225.00 "	"$9,046.50"	$0.00	"$9,780.00"	"$6,638.18"	"$6,638.18"	$0.00	$0.00	$0.00	"$2,548.00"	"$4,181.12"	"$4,181.12"	"$9,423.03"	$0.00	"$2,547.69"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$6,112.50"	"$9,682.20"	"$9,780.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204112	EAP	HCPCS C1757		Solitaire Fr 6x20	BOTH IP/OP	"$11,643.00 "	"$8,615.82"	$0.00	"$9,314.40"	"$6,322.15"	"$6,322.15"	$0.00	$0.00	$0.00	"$2,426.69"	"$4,181.12"	"$4,181.12"	"$8,974.42"	$0.00	"$2,426.40"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,821.50"	"$9,221.26"	"$9,314.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204113	EAP	HCPCS C1757		Solitaire Fr 6x30	BOTH IP/OP	"$12,225.00 "	"$9,046.50"	$0.00	"$9,780.00"	"$6,638.18"	"$6,638.18"	$0.00	$0.00	$0.00	"$2,548.00"	"$4,181.12"	"$4,181.12"	"$9,423.03"	$0.00	"$2,547.69"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$6,112.50"	"$9,682.20"	"$9,780.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204114	EAP	HCPCS C1887		NAVIEN INTRACRANIAL CATHETER 6FX 1	BOTH IP/OP	$680.00 	$503.20	$0.00	$544.00	$369.24	$369.24	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$524.14	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$340.00	$538.56	$544.00	$0.00	$442.00	$0.00	$106.42	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00
27204115	EAP	HCPCS C1887		Navien Intracranial Catheter 6fx 115cm	BOTH IP/OP	$714.00 	$528.36	$0.00	$571.20	$387.70	$387.70	$0.00	$0.00	$0.00	$148.82	$529.93	$529.93	$550.35	$0.00	$148.80	$0.00	$422.33	$422.33	$0.00	$357.00	$565.49	$571.20	$0.00	$464.10	$0.00	$111.74	$0.00	$0.00	$113.67	$0.00	$0.00	$0.00	$0.00	$0.00
27204116	EAP	HCPCS C1887		Navien Intracranial Catheter 5fx 115cm	BOTH IP/OP	"$1,176.00 "	$870.24	$0.00	$940.80	$638.57	$638.57	$0.00	$0.00	$0.00	$245.11	$872.83	$872.83	$906.46	$0.00	$245.08	$0.00	$695.60	$695.60	$0.00	$588.00	$931.39	$940.80	$0.00	$764.40	$0.00	$184.04	$0.00	$0.00	$187.22	$0.00	$0.00	$0.00	$0.00	$0.00
27204117	EAP	HCPCS C1887		Navien Intracranial Catheter 5fx 125cm	BOTH IP/OP	"$1,235.00 "	$913.90	$0.00	$988.00	$670.61	$670.61	$0.00	$0.00	$0.00	$257.40	$916.62	$916.62	$951.94	$0.00	$257.37	$0.00	$730.50	$730.50	$0.00	$617.50	$978.12	$988.00	$0.00	$802.75	$0.00	$193.28	$0.00	$0.00	$196.61	$0.00	$0.00	$0.00	$0.00	$0.00
27204118	EAP	HCPCS C1887		Navien Intracranial Catheter 5fx 130cm	BOTH IP/OP	"$1,176.00 "	$870.24	$0.00	$940.80	$638.57	$638.57	$0.00	$0.00	$0.00	$245.11	$872.83	$872.83	$906.46	$0.00	$245.08	$0.00	$695.60	$695.60	$0.00	$588.00	$931.39	$940.80	$0.00	$0.00	$0.00	$184.04	$0.00	$0.00	$187.22	$0.00	$0.00	$0.00	$0.00	$0.00
27204119	EAP	HCPCS C2629		Pinnacle Rdc Sheath 6fr	BOTH IP/OP	"$2,374.00 "	"$1,756.76"	$0.00	"$1,899.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$494.80	"$1,761.98"	"$1,761.98"	"$1,829.88"	$0.00	$494.74	$0.00	"$1,404.22"	"$1,404.22"	$0.00	"$1,187.00"	"$1,880.21"	"$1,899.20"	$0.00	"$1,543.10"	$0.00	$371.53	$0.00	$0.00	$377.94	$0.00	$0.00	$0.00	$0.00	$0.00
27204120	EAP	Custom 27204120		Tc Catheter	BOTH IP/OP	$151.00 	$111.74	$0.00	$120.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.07	$112.07	$116.39	$0.00	$31.47	$0.00	$0.00	$0.00	$0.00	$75.50	$119.59	$120.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204121	EAP	HCPCS C1887		Van Aman Cathter	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$30.41	$30.41	$0.00	$0.00	$0.00	$11.67	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$33.12	$33.12	$0.00	$28.00	$44.35	$44.80	$0.00	$0.00	$0.00	$8.76	$0.00	$0.00	$8.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204122	EAP	HCPCS C1894		Neuron Max 088 6f Sheath	BOTH IP/OP	"$1,226.00 "	$907.24	$0.00	$980.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$613.00	$970.99	$980.80	$0.00	$0.00	$0.00	$191.87	$0.00	$0.00	$195.18	$0.00	$0.00	$0.00	$0.00	$0.00
27204124	EAP	HCPCS C1788		Dignity Port 6.6f	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$385.40	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00	$325.00	$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
27204125	EAP	Custom 27204125		Long Rodch Left Gastric Catheter 5fr 65cm	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$0.00	$0.00	$0.00	$28.00	$44.35	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204126	EAP	Custom 27204126		Long Rodch Left Gastric Catheter 5fr 80cm	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$0.00	$0.00	$0.00	$28.00	$44.35	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204127	EAP	HCPCS C1769		Avigo Guidewire	BOTH IP/OP	"$1,168.00 "	$864.32	$0.00	$934.40	$634.22	$634.22	$0.00	$0.00	$0.00	$243.44	$866.89	$866.89	$900.29	$0.00	$243.41	$0.00	$690.87	$690.87	$0.00	$584.00	$925.06	$934.40	$0.00	$0.00	$0.00	$182.79	$0.00	$0.00	$185.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204128	EAP	HCPCS C1887		Exceisior Xt-27 Microcatheter 135cm/6cm Straight	BOTH IP/OP	"$2,807.00 "	"$2,077.18"	$0.00	"$2,245.60"	"$1,524.20"	"$1,524.20"	$0.00	$0.00	$0.00	$585.05	"$2,083.36"	"$2,083.36"	"$2,163.64"	$0.00	$584.98	$0.00	"$1,660.34"	"$1,660.34"	$0.00	"$1,403.50"	"$2,223.14"	"$2,245.60"	$0.00	$0.00	$0.00	$439.30	$0.00	$0.00	$446.87	$0.00	$0.00	$0.00	$0.00	$0.00
27204129	EAP	HCPCS C1887		Exceisior Xt-27 Microcatheter 135cm/6cm Pre-shaped	BOTH IP/OP	"$2,807.00 "	"$2,077.18"	$0.00	"$2,245.60"	"$1,524.20"	"$1,524.20"	$0.00	$0.00	$0.00	$585.05	"$2,083.36"	"$2,083.36"	"$2,163.64"	$0.00	$584.98	$0.00	"$1,660.34"	"$1,660.34"	$0.00	"$1,403.50"	"$2,223.14"	"$2,245.60"	$0.00	$0.00	$0.00	$439.30	$0.00	$0.00	$446.87	$0.00	$0.00	$0.00	$0.00	$0.00
27204130	EAP	HCPCS C1887		Exceisior Xt-27 Microcatheter 150 Cm/80cm Straight	BOTH IP/OP	"$2,807.00 "	"$2,077.18"	$0.00	"$2,245.60"	"$1,524.20"	"$1,524.20"	$0.00	$0.00	$0.00	$585.05	"$2,083.36"	"$2,083.36"	"$2,163.64"	$0.00	$584.98	$0.00	"$1,660.34"	"$1,660.34"	$0.00	"$1,403.50"	"$2,223.14"	"$2,245.60"	$0.00	"$1,824.55"	$0.00	$439.30	$0.00	$0.00	$446.87	$0.00	$0.00	$0.00	$0.00	$0.00
27204131	EAP	HCPCS C1887		Exceisior Xt-27 Microcatheter 150cm/18cm Straight	BOTH IP/OP	"$2,807.00 "	"$2,077.18"	$0.00	"$2,245.60"	"$1,524.20"	"$1,524.20"	$0.00	$0.00	$0.00	$585.05	"$2,083.36"	"$2,083.36"	"$2,163.64"	$0.00	$584.98	$0.00	"$1,660.34"	"$1,660.34"	$0.00	"$1,403.50"	"$2,223.14"	"$2,245.60"	$0.00	"$1,824.55"	$0.00	$439.30	$0.00	$0.00	$446.87	$0.00	$0.00	$0.00	$0.00	$0.00
27204132	EAP	HCPCS C1887		Exceisior Xt-27 Microcatheter 135cm/6cm Pre-shaped	BOTH IP/OP	"$2,807.00 "	"$2,077.18"	$0.00	"$2,245.60"	"$1,524.20"	"$1,524.20"	$0.00	$0.00	$0.00	$585.05	"$2,083.36"	"$2,083.36"	"$2,163.64"	$0.00	$584.98	$0.00	"$1,660.34"	"$1,660.34"	$0.00	"$1,403.50"	"$2,223.14"	"$2,245.60"	$0.00	$0.00	$0.00	$439.30	$0.00	$0.00	$446.87	$0.00	$0.00	$0.00	$0.00	$0.00
27204140	EAP	Custom 27204140		Kit Catheter Presep Oligon Heparin L16 Cm Od8.5 Fr Centl	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204141	EAP	Custom 27204141		Kit Catheter Presep Oligon L20 Cm Od8.5 Fr Arterial 3 Ln	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204142	EAP	HCPCS C1894		Introd Shth 8fr 150cm 12cm 2 Distal Gwire Hmst Vlv Sdprt	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$30.41	$30.41	$0.00	$0.00	$0.00	$11.67	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$33.12	$33.12	$0.00	$28.00	$44.35	$44.80	$0.00	$0.00	$0.00	$8.76	$0.00	$0.00	$8.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204143	EAP	HCPCS C1894		Introd Shth 9fr 150cm 12cm 2 Distal Gwire Hmst Vlv Sdprt	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$34.21	$34.21	$0.00	$0.00	$0.00	$13.13	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$37.26	$37.26	$0.00	$31.50	$49.90	$50.40	$0.00	$0.00	$0.00	$9.86	$0.00	$0.00	$10.03	$0.00	$0.00	$0.00	$0.00	$0.00
27204144	EAP	HCPCS C1894		Introd Cath 12cm 10fr .038in Trnspt Fstcth Hmsts	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$38.01	$38.01	$0.00	$0.00	$0.00	$14.59	$51.95	$51.95	$53.96	$0.00	$14.59	$0.00	$41.41	$41.41	$0.00	$35.00	$55.44	$56.00	$0.00	$0.00	$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
27204145	EAP	HCPCS C1893		Introd Shth 8.5fr 180cm 63cm Superstiff Guiewire Guid Braid	BOTH IP/OP	$532.00 	$393.68	$0.00	$425.60	$288.88	$288.88	$0.00	$0.00	$0.00	$110.88	$394.85	$394.85	$410.07	$0.00	$110.87	$0.00	$314.68	$314.68	$0.00	$266.00	$421.34	$425.60	$0.00	$0.00	$0.00	$83.26	$0.00	$0.00	$84.69	$0.00	$0.00	$0.00	$0.00	$0.00
27204146	EAP	Custom 27204146		Needle 71cm 18ga Curve Prc Trnspt Brk-1 Adlt	BOTH IP/OP	$576.00 	$426.24	$0.00	$460.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.51	$427.51	$443.98	$0.00	$120.04	$0.00	$0.00	$0.00	$0.00	$288.00	$456.19	$460.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204147	EAP	HCPCS C1766		Introd Shth 8.5fr 91cm 71cm Dual Reach Bidir Erg Hndl Atrm	BOTH IP/OP	"$2,642.00 "	"$1,955.08"	$0.00	"$2,113.60"	"$1,434.61"	"$1,434.61"	$0.00	$0.00	$0.00	$550.66	"$1,960.89"	"$1,960.89"	"$2,036.45"	$0.00	$550.59	$0.00	"$1,562.74"	"$1,562.74"	$0.00	"$1,321.00"	"$2,092.46"	"$2,113.60"	$0.00	"$1,717.30"	$0.00	$413.47	$0.00	$0.00	$420.61	$0.00	$0.00	$0.00	$0.00	$0.00
27204148	EAP	HCPCS C1766		Introd Shth 8.5fr 71cm 50mm Strbl Erg Hndl Atrm Tip Intgr	BOTH IP/OP	"$2,642.00 "	"$1,955.08"	$0.00	"$2,113.60"	"$1,434.61"	"$1,434.61"	$0.00	$0.00	$0.00	$550.66	"$1,960.89"	"$1,960.89"	"$2,036.45"	$0.00	$550.59	$0.00	"$1,562.74"	"$1,562.74"	$0.00	"$1,321.00"	"$2,092.46"	"$2,113.60"	$0.00	"$1,717.30"	$0.00	$413.47	$0.00	$0.00	$420.61	$0.00	$0.00	$0.00	$0.00	$0.00
27204149	EAP	HCPCS C1730		Cable Cath Blue 150cm Rspn Ep Bipol Trplr Qdpl	BOTH IP/OP	$213.00 	$157.62	$0.00	$170.40	$115.66	$115.66	$0.00	$0.00	$0.00	$44.39	$158.09	$158.09	$164.18	$0.00	$44.39	$0.00	$125.99	$125.99	$0.00	$106.50	$168.70	$170.40	$0.00	$0.00	$0.00	$33.33	$0.00	$0.00	$33.91	$0.00	$0.00	$0.00	$0.00	$0.00
27204150	EAP	Custom 27204150		Cable Cath Blk 150cm Rspn Ep Hexpl	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00	$146.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204151	EAP	Custom 27204151		Cable Cath Blk 150cm Rspn Ep Hexpl Octpl Dcapl	BOTH IP/OP	$266.00 	$196.84	$0.00	$212.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.00	$210.67	$212.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204152	EAP	Custom 27204152		Cable Cath Red 150cm Rspn Ep Hexpl Octpl Dcapl Extn	BOTH IP/OP	$266.00 	$196.84	$0.00	$212.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.43	$197.43	$205.03	$0.00	$55.43	$0.00	$0.00	$0.00	$0.00	$133.00	$210.67	$212.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204153	EAP	HCPCS C1730		Cath Ep 2-5-2mm Spc 1mm 6fr 115cm 4mm Qdpl Med Swp Strbl	BOTH IP/OP	"$1,490.00 "	"$1,102.60"	$0.00	"$1,192.00"	$809.07	$809.07	$0.00	$0.00	$0.00	$310.55	"$1,105.88"	"$1,105.88"	"$1,148.49"	$0.00	$310.52	$0.00	$881.34	$881.34	$0.00	$745.00	"$1,180.08"	"$1,192.00"	$0.00	$968.50	$0.00	$233.19	$0.00	$0.00	$237.21	$0.00	$0.00	$0.00	$0.00	$0.00
27204154	EAP	HCPCS C1730		Cath Ep 5mm Spc 1mm 5fr 115cm 2mm Hexpl Med Swp Strbl Lvwr	BOTH IP/OP	"$1,608.00 "	"$1,189.92"	$0.00	"$1,286.40"	$873.14	$873.14	$0.00	$0.00	$0.00	$335.15	"$1,193.46"	"$1,193.46"	"$1,239.45"	$0.00	$335.11	$0.00	$951.13	$951.13	$0.00	$804.00	"$1,273.54"	"$1,286.40"	$0.00	"$1,045.20"	$0.00	$251.65	$0.00	$0.00	$255.99	$0.00	$0.00	$0.00	$0.00	$0.00
27204155	EAP	HCPCS C1730		Cath Ep 4mm Spc 7fr 20mm 110cm 20 Eltrd Mp Inq Afocus 2	BOTH IP/OP	"$4,493.00 "	"$3,324.82"	$0.00	"$3,594.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,246.50"	"$3,558.46"	"$3,594.40"	$0.00	$0.00	$0.00	$703.15	$0.00	$0.00	$715.29	$0.00	$0.00	$0.00	$0.00	$0.00
27204156	EAP	HCPCS C1731		Cath Ep 99cm 7fr 15-25mm Reflexion Sprl 1-4-1mm Spc 1mm Smtr	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$693.76	$0.00	$0.00	$705.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204157	EAP	Custom 27204157		Cable Cath Safire Ep Gntr Intfc	BOTH IP/OP	$449.00 	$332.26	$0.00	$359.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$333.25	$333.25	$346.09	$0.00	$93.57	$0.00	$0.00	$0.00	$0.00	$224.50	$355.61	$359.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204158	EAP	Custom 27204158		Cable Cath Safire Ep Extn	BOTH IP/OP	$461.00 	$341.14	$0.00	$368.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.15	$342.15	$355.34	$0.00	$96.07	$0.00	$0.00	$0.00	$0.00	$230.50	$365.11	$368.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204159	EAP	HCPCS C2630		Cath Ablt 110cm 7fr 4mm 2-5-2mm Spc 2mm Med Curl Thrp Cl Pth	BOTH IP/OP	"$4,493.00 "	"$3,324.82"	$0.00	"$3,594.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,246.50"	"$3,558.46"	"$3,594.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204160	EAP	HCPCS C2630		Cath Ablt 110cm 7fr 4mm 2-5-2mm Spc 2mm Lg Curl Thrp Cl Pth	BOTH IP/OP	"$4,493.00 "	"$3,324.82"	$0.00	"$3,594.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,246.50"	"$3,558.46"	"$3,594.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204161	EAP	HCPCS C1759		Cath Us 120d Intrcrd Stab 1 Hnd Cntrl M Mode Pls Wv Dplr Ice	BOTH IP/OP	"$6,242.00 "	"$4,619.08"	$0.00	"$4,993.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,121.00"	"$4,943.66"	"$4,993.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204162	EAP	HCPCS C1730		Cath Ep 2-5-2mm Spc Csl Curve 5fr 65cm Mp Dcapl Fix Curve	BOTH IP/OP	"$1,183.00 "	$875.42	$0.00	$946.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$591.50	$936.94	$946.40	$0.00	$0.00	$0.00	$185.14	$0.00	$0.00	$188.33	$0.00	$0.00	$0.00	$0.00	$0.00
27204164	EAP	HCPCS C1887		Catheter Reperfusion	BOTH IP/OP	"$6,176.00 "	"$4,570.24"	$0.00	"$4,940.80"	"$3,353.57"	"$3,353.57"	$0.00	$0.00	$0.00	"$1,287.23"	"$4,181.12"	"$4,181.12"	"$4,760.46"	$0.00	"$1,287.08"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,088.00"	"$4,891.39"	"$4,940.80"	$0.00	"$4,014.40"	$0.00	$966.54	$0.00	$0.00	$983.22	$0.00	$0.00	$0.00	$0.00	$0.00
27204168	EAP	HCPCS C1894		Flexor Ansel Guiding Sheath/ Str	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$134.66	$134.66	$0.00	$0.00	$0.00	$51.69	$184.07	$184.07	$191.16	$0.00	$51.68	$0.00	$146.69	$146.69	$0.00	$124.00	$196.42	$198.40	$0.00	$161.20	$0.00	$38.81	$0.00	$0.00	$39.48	$0.00	$0.00	$0.00	$0.00	$0.00
27204169	EAP	HCPCS C1894		Flexor Ansel Guiding Sheath/ Mp	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$134.66	$134.66	$0.00	$0.00	$0.00	$51.69	$184.07	$184.07	$191.16	$0.00	$51.68	$0.00	$146.69	$146.69	$0.00	$124.00	$196.42	$198.40	$0.00	$0.00	$0.00	$38.81	$0.00	$0.00	$39.48	$0.00	$0.00	$0.00	$0.00	$0.00
27204170	EAP	HCPCS C1894		Introducer Shth 10 Fr/ 40cm	BOTH IP/OP	$216.00 	$159.84	$0.00	$172.80	$117.29	$117.29	$0.00	$0.00	$0.00	$45.02	$160.32	$160.32	$166.49	$0.00	$45.01	$0.00	$127.76	$127.76	$0.00	$108.00	$171.07	$172.80	$0.00	$0.00	$0.00	$33.80	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$0.00
27204171	EAP	HCPCS C1887		Catheter Angio Sim 3 Crv 5fr	BOTH IP/OP	$123.00 	$91.02	$0.00	$98.40	$66.79	$66.79	$0.00	$0.00	$0.00	$25.64	$91.29	$91.29	$94.81	$0.00	$25.63	$0.00	$72.75	$72.75	$0.00	$61.50	$97.42	$98.40	$0.00	$79.95	$0.00	$19.25	$0.00	$0.00	$19.58	$0.00	$0.00	$0.00	$0.00	$0.00
27204210	EAP	HCPCS C1769		Guidewire Vascular X-celer Hydro L300 Cm L10 Cm Od.01	BOTH IP/OP	$975.00 	$721.50	$0.00	$780.00	$529.43	$529.43	$0.00	$0.00	$0.00	$203.21	$723.65	$723.65	$751.53	$0.00	$203.19	$0.00	$576.71	$576.71	$0.00	$487.50	$772.20	$780.00	$0.00	$0.00	$0.00	$152.59	$0.00	$0.00	$155.22	$0.00	$0.00	$0.00	$0.00	$0.00
27204211	EAP	HCPCS C2629		Set Introducer Aprima Hydrophilic L15 Cm Od6 Fr Odsec22a	BOTH IP/OP	$212.00 	$156.88	$0.00	$169.60	$0.00	$0.00	$0.00	$0.00	$0.00	$44.19	$157.35	$157.35	$163.41	$0.00	$44.18	$0.00	$125.40	$125.40	$0.00	$106.00	$167.90	$169.60	$0.00	$0.00	$0.00	$33.18	$0.00	$0.00	$33.75	$0.00	$0.00	$0.00	$0.00	$0.00
27204212	EAP	Custom 27204212		Biotronik Lead Delivery System	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$0.00	$0.00	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204213	EAP	HCPCS C1751		Cath Cen Ven 4fr 1 Lum Try 3cg Shrlk Sty Maximal Brr Pip	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.50	$0.79	$0.80	$0.00	$0.00	$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
27204214	EAP	HCPCS C1769		Gwire Vasc .035in 15mm 260cm 4cm 2 Cvd Exch Xstif Lndrqs Ss	BOTH IP/OP	$620.00 	$458.80	$0.00	$496.00	$336.66	$336.66	$0.00	$0.00	$0.00	$129.22	$460.16	$460.16	$477.90	$0.00	$129.21	$0.00	$366.73	$366.73	$0.00	$310.00	$491.04	$496.00	$0.00	$403.00	$0.00	$97.03	$0.00	$0.00	$98.70	$0.00	$0.00	$0.00	$0.00	$0.00
27204216	EAP	Custom 27204216		Site-rite 6 Ultrasound System 21 Ga Needle Guide Kit	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204217	EAP	HCPCS C1894		Micro Microintruducer 7cm 5.0fr Flecura Guidewire	BOTH IP/OP	$98.00 	$72.52	$0.00	$78.40	$53.21	$53.21	$0.00	$0.00	$0.00	$20.43	$72.74	$72.74	$75.54	$0.00	$20.42	$0.00	$57.97	$57.97	$0.00	$49.00	$77.62	$78.40	$0.00	$0.00	$0.00	$15.34	$0.00	$0.00	$15.60	$0.00	$0.00	$0.00	$0.00	$0.00
27204218	EAP	HCPCS C1726		Balloon Dilatation Catheter  6mmx40mmx135cm	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$298.65	$298.65	$0.00	$0.00	$0.00	$114.63	$408.21	$408.21	$423.94	$0.00	$114.62	$0.00	$325.33	$325.33	$0.00	$275.00	$435.60	$440.00	$0.00	$357.50	$0.00	$86.08	$0.00	$0.00	$87.56	$0.00	$0.00	$0.00	$0.00	$0.00
27204220	EAP	HCPCS C1769		Sphntm 30mm 5mm 3.9fr Atme Bil Pncr Gwire Cann Chnl C Md	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	"$2,407.12"	"$2,407.12"	$0.00	$0.00	$0.00	$923.95	"$3,290.17"	"$3,290.17"	"$3,416.96"	$0.00	$923.84	$0.00	"$2,622.12"	"$2,622.12"	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$693.76	$0.00	$0.00	$705.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204221	EAP	HCPCS C1887		CATH GUID CS-A6 CURVE 8FR 49CM CORON SIN OUTR ACTY BRKWY	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204222	EAP	HCPCS C1887		CATH GUID CS-A6 CURVE 8FR 54CM CORON SIN OUTR ACTY BRKWY	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204223	EAP	HCPCS C1887		CATH GUID CS-EH CURVE 8FR 49CM OUTR ACTY BRKWY	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204224	EAP	HCPCS C1887		CATH GUID OUTR ACTY BRKWY CS-EH 61CM 8FR	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204225	EAP	HCPCS C1887		CATH GUID CS-H CURVE 8FR 6.78FR 55CM 49CM IS-1 AND LV-1 LEAD	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204226	EAP	HCPCS C1887		CATH GUID CS-H CURVE 8FR 54CM CORON SIN OUTR ACTY BRKWY	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204227	EAP	HCPCS C1887		CATH GUID 130D CS-IC CURVE 6FR 63CM INR ACTY BRKWY	BOTH IP/OP	$461.00 	$341.14	$0.00	$368.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.50	$365.11	$368.80	$0.00	$0.00	$0.00	$72.15	$0.00	$0.00	$73.39	$0.00	$0.00	$0.00	$0.00	$0.00
27204228	EAP	HCPCS C1894		INTROD LEAD BL CODE 9.7% HE 21% OZ 27% CO 42.35% N2	BOTH IP/OP	"$2,660.00 "	"$1,968.40"	$0.00	"$2,128.00"	"$1,444.38"	"$1,444.38"	$0.00	$0.00	$0.00	$554.41	"$1,974.25"	"$1,974.25"	"$2,050.33"	$0.00	$554.34	$0.00	"$1,573.39"	"$1,573.39"	$0.00	"$1,330.00"	"$2,106.72"	"$2,128.00"	$0.00	$0.00	$0.00	$416.29	$0.00	$0.00	$423.47	$0.00	$0.00	$0.00	$0.00	$0.00
27204229	EAP	HCPCS C1769		CATH ENDSCP 8.5FR NSL BIL GWIRE STRL	BOTH IP/OP	"$1,463.00 "	"$1,082.62"	$0.00	"$1,170.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$731.50	"$1,158.70"	"$1,170.40"	$0.00	$0.00	$0.00	$228.96	$0.00	$0.00	$232.91	$0.00	$0.00	$0.00	$0.00	$0.00
27204230	EAP	HCPCS C1769		CATH ENDSCP 7.5FR NSL BIL GWIRE STRL	BOTH IP/OP	"$1,463.00 "	"$1,082.62"	$0.00	"$1,170.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$731.50	"$1,158.70"	"$1,170.40"	$0.00	$0.00	$0.00	$228.96	$0.00	$0.00	$232.91	$0.00	$0.00	$0.00	$0.00	$0.00
27204231	EAP	HCPCS C1887		CATH GUID CS-MP CURVE 8FR 49CM CORON SIN OUTR ACTY BRKWY	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204232	EAP	HCPCS C1887		CATH GUID CS-MP 8FR 54CM 61CM OUTR ACTY BRKWY	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204233	EAP	HCPCS C1887		CATH GUID STR 8FR 49CM CORON SIN OUTR ACTY BRKWY	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204234	EAP	HCPCS C1887		CATH GUID CS-ST CURVE 8FR 54CM CORON SIN OUTR ACTY BRKWY	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204235	EAP	HCPCS C1887		CATH GUID CS-EH ST R CURVE 8FR 49CM CORON SIN OUTR ACTY	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204236	EAP	HCPCS C1887		CATH GUID CS-EH ST R CURVE 8FR 54CM OUTR ACTY BRKWY	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204237	EAP	HCPCS C1887		CATH GUID CS-W CURVE 8FR 49CM CORON SIN OUTR ACTY BRKWY	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$164.79	$0.00	$0.00	$167.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204238	EAP	HCPCS C1769		CATH ENDSCP 6FR NSL BIL GWIRE STRL	BOTH IP/OP	"$1,463.00 "	"$1,082.62"	$0.00	"$1,170.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$731.50	"$1,158.70"	"$1,170.40"	$0.00	$0.00	$0.00	$228.96	$0.00	$0.00	$232.91	$0.00	$0.00	$0.00	$0.00	$0.00
27204239	EAP	HCPCS C1887		ACUITY CUTAWAY LEAD DELIVERY SYSTEM - PERCUTANEOUS CATHETERS	BOTH IP/OP	"$5,010.00 "	"$3,707.40"	$0.00	"$4,008.00"	"$2,720.43"	"$2,720.43"	$0.00	$0.00	$0.00	"$1,044.21"	"$3,718.42"	"$3,718.42"	"$3,861.71"	$0.00	"$1,044.08"	$0.00	"$2,963.42"	"$2,963.42"	$0.00	"$2,505.00"	"$3,967.92"	"$4,008.00"	$0.00	"$3,256.50"	$0.00	$784.07	$0.00	$0.00	$797.59	$0.00	$0.00	$0.00	$0.00	$0.00
27204240	EAP	HCPCS C1769		SPHNTM 20MM 7-5FR BIL PNCR GWIRE 3 LUM SHRT NOSE CANN RAPEX	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	"$2,407.12"	"$2,407.12"	$0.00	$0.00	$0.00	$923.95	"$3,290.17"	"$3,290.17"	"$3,416.96"	$0.00	$923.84	$0.00	"$2,622.12"	"$2,622.12"	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$693.76	$0.00	$0.00	$705.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204241	EAP	Custom 27204241		DEVICE LCK BIOP CAP RAPEX RX BL BIL PNTX ESCP	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,290.17"	"$3,290.17"	"$3,416.96"	$0.00	$923.84	$0.00	$0.00	$0.00	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204242	EAP	HCPCS C1725		CATH BIL 12 ATM 5.8FR 8MM 180CM 2CM RAPEX NVSC BALDILAT HRCN	BOTH IP/OP	"$5,911.00 "	"$4,374.14"	$0.00	"$4,728.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,955.50"	"$4,681.51"	"$4,728.80"	$0.00	$0.00	$0.00	$925.07	$0.00	$0.00	$941.03	$0.00	$0.00	$0.00	$0.00	$0.00
27204243	EAP	HCPCS C1769		Sphntm 30mm 5mm 4.4fr Atme Rx	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	"$2,407.12"	"$2,407.12"	$0.00	$0.00	$0.00	$923.95	"$3,290.17"	"$3,290.17"	"$3,416.96"	$0.00	$923.84	$0.00	"$2,622.12"	"$2,622.12"	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$693.76	$0.00	$0.00	$705.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204245	EAP	HCPCS C1725		Mustang Balloon Catheter 3.0mm X 20mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$356.20	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204246	EAP	HCPCS C1725		Mustang Balloon Catheter 3.0mm X 40mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$356.20	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204247	EAP	HCPCS C1725		Mustang Balloon Catheter 4.0mm X 20mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$0.00	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204248	EAP	HCPCS C1725		Mustang Balloon Catheter 4.0mm X 40mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$356.20	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204249	EAP	HCPCS C1725		Mustang Balloon Catheter 4.0mm X 80mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$356.20	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204250	EAP	HCPCS C1887		Cxi Support Catheter Str / 2.6fr-.018-150cm	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$272.04	$272.04	$0.00	$0.00	$0.00	$104.42	$371.84	$371.84	$386.17	$0.00	$104.41	$0.00	$296.34	$296.34	$0.00	$250.50	$396.79	$400.80	$0.00	$0.00	$0.00	$78.41	$0.00	$0.00	$79.76	$0.00	$0.00	$0.00	$0.00	$0.00
27204251	EAP	HCPCS C1725		Cxi Support Catheter  Ang/ 2.6fr-.018-150cm	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$272.04	$272.04	$0.00	$0.00	$0.00	$104.42	$371.84	$371.84	$386.17	$0.00	$104.41	$0.00	$296.34	$296.34	$0.00	$250.50	$396.79	$400.80	$0.00	$0.00	$0.00	$78.41	$0.00	$0.00	$79.76	$0.00	$0.00	$0.00	$0.00	$0.00
27204252	EAP	HCPCS C1887		Cxi Support Catheter  Str/ 4.0fr-.035-135cm	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.50	$396.79	$400.80	$0.00	$0.00	$0.00	$78.41	$0.00	$0.00	$79.76	$0.00	$0.00	$0.00	$0.00	$0.00
27204253	EAP	HCPCS C1725		Mustang Balloon Catheter 6.0mm X 80mm X 135cm	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$272.04	$272.04	$0.00	$0.00	$0.00	$104.42	$371.84	$371.84	$386.17	$0.00	$104.41	$0.00	$296.34	$296.34	$0.00	$250.50	$396.79	$400.80	$0.00	$325.65	$0.00	$78.41	$0.00	$0.00	$79.76	$0.00	$0.00	$0.00	$0.00	$0.00
27204254	EAP	HCPCS C1725		Mustang Balloon Catheter 6.0mm X 100mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$356.20	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204255	EAP	HCPCS C1725		Mustang Balloon Catheter 6.0mm X 120mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$0.00	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204256	EAP	HCPCS C1725		Mustang Balloon Catheter 6.0mm X 150mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$0.00	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204257	EAP	HCPCS C1725		Mustang Balloon Catheter 6.0mm X 220mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$356.20	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204258	EAP	HCPCS C1725		Mustang Balloon Catheter 7.0mm X 40mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$356.20	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204259	EAP	HCPCS C1725		Mustang Balloon Catheter 8.0mm X 40mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$356.20	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204260	EAP	HCPCS C1725		Mustang Balloon Catheter 9.0mm X 40mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$356.20	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204261	EAP	HCPCS C1725		Mustang Balloon Catheter 5.0mm X 40mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$356.20	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204262	EAP	HCPCS C1725		Mustang Balloon Catheter 5.0mm X 100mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$356.20	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204263	EAP	HCPCS C1725		Mustang Balloon Catheter 6.0mm X 40mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$0.00	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204270	EAP	HCPCS C1725		Mustang Balloon Catheter 10.0mm X 40mm X 135cm	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$297.56	$297.56	$0.00	$0.00	$0.00	$114.22	$406.73	$406.73	$422.40	$0.00	$114.20	$0.00	$324.14	$324.14	$0.00	$274.00	$434.02	$438.40	$0.00	$356.20	$0.00	$85.76	$0.00	$0.00	$87.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204280	EAP	HCPCS C1755		Kyphopast First Fracture Kit-kpe1003	BOTH IP/OP	"$10,626.00 "	"$7,863.24"	$0.00	"$8,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,190.52"	$0.00	"$2,214.46"	$0.00	$0.00	$0.00	$0.00	"$5,313.00"	"$8,415.79"	"$8,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204281	EAP	HCPCS C1755		Kyphopasty Additonal Fracture Kit-kpe1003	BOTH IP/OP	"$7,079.00 "	"$5,238.46"	$0.00	"$5,663.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,456.49"	$0.00	"$1,475.26"	$0.00	$0.00	$0.00	$0.00	"$3,539.50"	"$5,606.57"	"$5,663.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204282	EAP	HCPCS C1713		Kyphoplasty Cememnt Mixer-a07a	BOTH IP/OP	$237.00 	$175.38	$0.00	$189.60	$128.69	$128.69	$0.00	$0.00	$0.00	$49.40	$175.90	$175.90	$182.68	$0.00	$49.39	$0.00	$140.19	$140.19	$0.00	$118.50	$187.70	$189.60	$0.00	$0.00	$0.00	$37.09	$0.00	$0.00	$37.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204283	EAP	HCPCS C1713		Kyphoasty Activos Cement-c10a	BOTH IP/OP	$901.00 	$666.74	$0.00	$720.80	$489.24	$489.24	$0.00	$0.00	$0.00	$187.79	$668.72	$668.72	$694.49	$0.00	$187.77	$0.00	$532.94	$532.94	$0.00	$450.50	$713.59	$720.80	$0.00	$0.00	$0.00	$141.01	$0.00	$0.00	$143.44	$0.00	$0.00	$0.00	$0.00	$0.00
27204284	EAP	HCPCS C1884		Rx Emosheild Nav6 5.0 Mm	BOTH IP/OP	"$4,581.00 "	"$3,389.94"	$0.00	"$3,664.80"	"$2,487.48"	"$2,487.48"	$0.00	$0.00	$0.00	$954.79	"$3,400.02"	"$3,400.02"	"$3,531.03"	$0.00	$954.68	$0.00	"$2,709.66"	"$2,709.66"	$0.00	"$2,290.50"	"$3,628.15"	"$3,664.80"	$0.00	$0.00	$0.00	$716.93	$0.00	$0.00	$729.30	$0.00	$0.00	$0.00	$0.00	$0.00
27204286	EAP	HCPCS C1884		Rx Embosheild Nav6 7.2 Mm	BOTH IP/OP	"$4,581.00 "	"$3,389.94"	$0.00	"$3,664.80"	"$2,487.48"	"$2,487.48"	$0.00	$0.00	$0.00	$954.79	"$3,400.02"	"$3,400.02"	"$3,531.03"	$0.00	$954.68	$0.00	"$2,709.66"	"$2,709.66"	$0.00	"$2,290.50"	"$3,628.15"	"$3,664.80"	$0.00	$0.00	$0.00	$716.93	$0.00	$0.00	$729.30	$0.00	$0.00	$0.00	$0.00	$0.00
27204292	EAP	HCPCS C1769		Guidewire X-pedion-10 Re 2	BOTH IP/OP	$778.00 	$575.72	$0.00	$622.40	$422.45	$422.45	$0.00	$0.00	$0.00	$162.15	$577.43	$577.43	$599.68	$0.00	$162.14	$0.00	$460.19	$460.19	$0.00	$389.00	$616.18	$622.40	$0.00	$505.70	$0.00	$121.76	$0.00	$0.00	$123.86	$0.00	$0.00	$0.00	$0.00	$0.00
27204293	EAP	HCPCS C1769		Mirage Re .008	BOTH IP/OP	"$1,288.00 "	$953.12	$0.00	"$1,030.40"	$699.38	$699.38	$0.00	$0.00	$0.00	$268.45	$955.95	$955.95	$992.79	$0.00	$268.42	$0.00	$761.85	$761.85	$0.00	$644.00	"$1,020.10"	"$1,030.40"	$0.00	$837.20	$0.00	$201.57	$0.00	$0.00	$205.05	$0.00	$0.00	$0.00	$0.00	$0.00
27204294	EAP	HCPCS C1887		Catheter Marathon	BOTH IP/OP	"$1,861.00 "	"$1,377.14"	$0.00	"$1,488.80"	"$1,010.52"	"$1,010.52"	$0.00	$0.00	$0.00	$387.88	"$1,381.23"	"$1,381.23"	"$1,434.46"	$0.00	$387.83	$0.00	"$1,100.78"	"$1,100.78"	$0.00	$930.50	"$1,473.91"	"$1,488.80"	$0.00	$0.00	$0.00	$291.25	$0.00	$0.00	$296.27	$0.00	$0.00	$0.00	$0.00	$0.00
27204295	EAP	HCPCS C1757		Cath Thrmb 130cm 4.3fr .044in Dac Multitransition Radio Pq	BOTH IP/OP	"$2,941.00 "	"$2,176.34"	$0.00	"$2,352.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.50"	"$2,329.27"	"$2,352.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204298	EAP	HCPCS C1894		Sheath Long Neuronmax 90/4 Mp 6f 088	BOTH IP/OP	"$1,109.00 "	$820.66	$0.00	$887.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$554.50	$878.33	$887.20	$0.00	$0.00	$0.00	$173.56	$0.00	$0.00	$176.55	$0.00	$0.00	$0.00	$0.00	$0.00
27204299	EAP	Custom 27204299		Turnpike Catheter Lp 135cm	BOTH IP/OP	"$1,313.00 "	$971.62	$0.00	"$1,050.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$974.51	$974.51	"$1,012.06"	$0.00	$273.63	$0.00	$0.00	$0.00	$0.00	$656.50	"$1,039.90"	"$1,050.40"	$0.00	$853.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204300	EAP	Custom 27204300		Torque Delivery System 10 Fr	BOTH IP/OP	"$1,797.00 "	"$1,329.78"	$0.00	"$1,437.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,333.73"	"$1,333.73"	"$1,385.13"	$0.00	$374.49	$0.00	$0.00	$0.00	$0.00	$898.50	"$1,423.22"	"$1,437.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204301	EAP	Custom 27204301		Spider Standard Surgical Platform	BOTH IP/OP	"$1,034.00 "	$765.16	$0.00	$827.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$767.43	$767.43	$797.01	$0.00	$215.49	$0.00	$0.00	$0.00	$0.00	$517.00	$818.93	$827.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204302	EAP	HCPCS C1884		System Embolic Spiderfx.014 In L320 Cm	BOTH IP/OP	"$4,124.00 "	"$3,051.76"	$0.00	"$3,299.20"	"$2,239.33"	"$2,239.33"	$0.00	$0.00	$0.00	$859.54	"$3,060.83"	"$3,060.83"	"$3,178.78"	$0.00	$859.44	$0.00	"$2,439.35"	"$2,439.35"	$0.00	"$2,062.00"	"$3,266.21"	"$3,299.20"	$0.00	$0.00	$0.00	$645.41	$0.00	$0.00	$656.54	$0.00	$0.00	$0.00	$0.00	$0.00
27204303	EAP	HCPCS C1725		Cath Ball Dilatation Viatrac 14 Plus Xcelon .014 In L	BOTH IP/OP	$739.00 	$546.86	$0.00	$591.20	$401.28	$401.28	$0.00	$0.00	$0.00	$154.03	$548.49	$548.49	$569.62	$0.00	$154.01	$0.00	$437.12	$437.12	$0.00	$369.50	$585.29	$591.20	$0.00	$480.35	$0.00	$115.65	$0.00	$0.00	$117.65	$0.00	$0.00	$0.00	$0.00	$0.00
27204304	EAP	HCPCS C1894		Sheath Check-flo Flexor .035 In L55 Cm Od6 Fr  Multi	BOTH IP/OP	$68.00 	$50.32	$0.00	$54.40	$36.92	$36.92	$0.00	$0.00	$0.00	$14.17	$50.47	$50.47	$52.41	$0.00	$14.17	$0.00	$40.22	$40.22	$0.00	$34.00	$53.86	$54.40	$0.00	$0.00	$0.00	$10.64	$0.00	$0.00	$10.83	$0.00	$0.00	$0.00	$0.00	$0.00
27204305	EAP	HCPCS C1894		Sheath Check-flo Flexor .035 In L55 Cm Od6 Fr Curv Strat	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$105.95	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204306	EAP	HCPCS C1887		Cath Cxi Stainless Steel Polymer L135 Cm Od4 Fr	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204307	EAP	HCPCS C1769		Guidewire Vas Pt Graph Hydro Poly Straight	BOTH IP/OP	"$2,572.00 "	"$1,903.28"	$0.00	"$2,057.60"	"$1,396.60"	"$1,396.60"	$0.00	$0.00	$0.00	$536.07	"$1,908.94"	"$1,908.94"	"$1,982.50"	$0.00	$536.00	$0.00	"$1,521.34"	"$1,521.34"	$0.00	"$1,286.00"	"$2,037.02"	"$2,057.60"	$0.00	$0.00	$0.00	$402.52	$0.00	$0.00	$409.46	$0.00	$0.00	$0.00	$0.00	$0.00
27204308	EAP	HCPCS C1769		Guidewire Vascular Pt Graphix Hydro Polymer J L300 Cm	BOTH IP/OP	"$2,572.00 "	"$1,903.28"	$0.00	"$2,057.60"	"$1,396.60"	"$1,396.60"	$0.00	$0.00	$0.00	$536.07	"$1,908.94"	"$1,908.94"	"$1,982.50"	$0.00	$536.00	$0.00	"$1,521.34"	"$1,521.34"	$0.00	"$1,286.00"	"$2,037.02"	"$2,057.60"	$0.00	$0.00	$0.00	$402.52	$0.00	$0.00	$409.46	$0.00	$0.00	$0.00	$0.00	$0.00
27204309	EAP	HCPCS C2628		Transform Compliant 3mm X 10mm	BOTH IP/OP	"$4,222.00 "	"$3,124.28"	$0.00	"$3,377.60"	"$2,292.55"	"$2,292.55"	$0.00	$0.00	$0.00	$879.97	"$3,133.57"	"$3,133.57"	"$3,254.32"	$0.00	$879.86	$0.00	"$2,497.31"	"$2,497.31"	$0.00	"$2,111.00"	"$3,343.82"	"$3,377.60"	$0.00	"$2,744.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204310	EAP	HCPCS C2628		Transform Compliant 3mm X 15mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	"$2,613.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204311	EAP	HCPCS C2628		Transform Compliant 4mm X 10mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	"$2,613.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204312	EAP	HCPCS C2628		Transform Compliant 4mm X 15mm	BOTH IP/OP	"$4,222.00 "	"$3,124.28"	$0.00	"$3,377.60"	"$2,292.55"	"$2,292.55"	$0.00	$0.00	$0.00	$879.97	"$3,133.57"	"$3,133.57"	"$3,254.32"	$0.00	$879.86	$0.00	"$2,497.31"	"$2,497.31"	$0.00	"$2,111.00"	"$3,343.82"	"$3,377.60"	$0.00	"$2,744.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204313	EAP	HCPCS C2628		Transform Compliant 4mm X 20mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204314	EAP	HCPCS C2628		Transform Compliant 4mm X 30mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204315	EAP	HCPCS C2628		Transform Compliant 5mm X 10mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204316	EAP	HCPCS C2628		TransForm Compliant 5mm x 10mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204317	EAP	HCPCS C2628		Transform Compliant 5mm X 20mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204318	EAP	HCPCS C2628		Transform Compliant 5mm X 30mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204319	EAP	HCPCS C2628		Transform Super Compliant 3mm X 5mm	BOTH IP/OP	"$4,222.00 "	"$3,124.28"	$0.00	"$3,377.60"	"$2,292.55"	"$2,292.55"	$0.00	$0.00	$0.00	$879.97	"$3,133.57"	"$3,133.57"	"$3,254.32"	$0.00	$879.86	$0.00	"$2,497.31"	"$2,497.31"	$0.00	"$2,111.00"	"$3,343.82"	"$3,377.60"	$0.00	"$2,744.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204320	EAP	HCPCS C2628		Transform Super Compliant 4mm X 10mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204321	EAP	HCPCS C2628		Transform Super Compliant 4mm X 7mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	"$2,613.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204322	EAP	HCPCS C2628		Transform Super Compliant 7mm X 10mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204323	EAP	HCPCS C2628		Transform Super Compliant 7mm X 15mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204324	EAP	HCPCS C2628		Transform Super Compliant 7mm X 7mm	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,183.40"	"$2,183.40"	$0.00	$0.00	$0.00	$838.08	"$2,984.39"	"$2,984.39"	"$3,099.39"	$0.00	$837.98	$0.00	"$2,378.42"	"$2,378.42"	$0.00	"$2,010.50"	"$3,184.63"	"$3,216.80"	$0.00	"$2,613.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204330	EAP	Custom 27204330		Probe Stereo Mammo Revolve L9 Cm Od8 Ga	BOTH IP/OP	"$1,378.00 "	"$1,019.72"	$0.00	"$1,102.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,022.75"	"$1,022.75"	"$1,062.16"	$0.00	$287.18	$0.00	$0.00	$0.00	$0.00	$689.00	"$1,091.38"	"$1,102.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204332	EAP	HCPCS C1887		Cath Cantata 2.5f Superselective Micro 135 Cm	BOTH IP/OP	$882.00 	$652.68	$0.00	$705.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$441.00	$698.54	$705.60	$0.00	$0.00	$0.00	$138.03	$0.00	$0.00	$140.41	$0.00	$0.00	$0.00	$0.00	$0.00
27204333	EAP	Custom 27204333		Cath Cantata 2.8f Superselective Micro 135 Cm	BOTH IP/OP	$897.00 	$663.78	$0.00	$717.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$448.50	$710.42	$717.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204334	EAP	Custom 27204334		Glidesheath Slender 6f	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$123.33	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204335	EAP	Custom 27204335		Torque Delivery System 12 Fr	BOTH IP/OP	"$1,797.00 "	"$1,329.78"	$0.00	"$1,437.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,333.73"	"$1,333.73"	"$1,385.13"	$0.00	$374.49	$0.00	$0.00	$0.00	$0.00	$898.50	"$1,423.22"	"$1,437.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204336	EAP	Custom 27204336		Amplatzer Sizing Balloons 34 Mm	BOTH IP/OP	$821.00 	$607.54	$0.00	$656.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$609.35	$609.35	$632.83	$0.00	$171.10	$0.00	$0.00	$0.00	$0.00	$410.50	$650.23	$656.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204337	EAP	HCPCS C1759		Viewflex Ice Plus Catheter	BOTH IP/OP	"$8,102.00 "	"$5,995.48"	$0.00	"$6,481.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,245.02"	$0.00	"$1,688.46"	$0.00	$0.00	$0.00	$0.00	"$4,051.00"	"$6,416.78"	"$6,481.60"	$0.00	"$5,266.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204338	EAP	Custom 27204338		System Fec Mgmt 60cc Ns Lf Dignishield Cath Syr Cl	BOTH IP/OP	$298.00 	$220.52	$0.00	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.18	$221.18	$229.70	$0.00	$62.10	$0.00	$0.00	$0.00	$0.00	$149.00	$236.02	$238.40	$0.00	$193.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204351	EAP	HCPCS C1725		Cath Baldilat .014in 5fr 2mm 8mm Coron Rapex Ult Lp Guid	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.00	$308.88	$312.00	$0.00	$0.00	$0.00	$61.04	$0.00	$0.00	$62.09	$0.00	$0.00	$0.00	$0.00	$0.00
27204352	EAP	HCPCS C1725		Cath Baldilat .021in 5fr 2mm 20mm Coron Rapex Flxb Tung Mrkr	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.50	$293.83	$296.80	$0.00	$0.00	$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204354	EAP	HCPCS C1725		Cath Baldilat .014in 5fr 2.5mm 20mm Coron Rapex Ult Lp Guid	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$211.77	$211.77	$0.00	$0.00	$0.00	$81.29	$289.46	$289.46	$300.61	$0.00	$81.28	$0.00	$230.69	$230.69	$0.00	$195.00	$308.88	$312.00	$0.00	$253.50	$0.00	$61.04	$0.00	$0.00	$62.09	$0.00	$0.00	$0.00	$0.00	$0.00
27204356	EAP	HCPCS C1725		Cath Baldilat .014in 5fr 3mm 8mm Coron Rapex Ult Lp Guid	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.50	$293.83	$296.80	$0.00	$0.00	$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204358	EAP	HCPCS C1725		Cath Baldilat .021in 5fr 3mm 25mm Coron Rapex Lp Flxb Tung	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.50	$279.58	$282.40	$0.00	$0.00	$0.00	$55.24	$0.00	$0.00	$56.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204359	EAP	HCPCS C1725		Cath Baldilat .021in 5fr 3.5mm 8mm Coron Rapex Lp Flxb Tung	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.50	$279.58	$282.40	$0.00	$0.00	$0.00	$55.24	$0.00	$0.00	$56.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204360	EAP	HCPCS C1725		Cath Baldilat .014in 5fr 3.5mm 20mm Coron Rapex Ult Lp Guid	BOTH IP/OP	$336.00 	$248.64	$0.00	$268.80	$182.45	$182.45	$0.00	$0.00	$0.00	$70.03	$249.38	$249.38	$258.99	$0.00	$70.02	$0.00	$198.74	$198.74	$0.00	$168.00	$266.11	$268.80	$0.00	$218.40	$0.00	$52.58	$0.00	$0.00	$53.49	$0.00	$0.00	$0.00	$0.00	$0.00
27204361	EAP	HCPCS C1725		Cath Baldilat .021in 5fr 3.5mm 25mm Coron Rapex Lp Flxb Tung	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.50	$279.58	$282.40	$0.00	$0.00	$0.00	$55.24	$0.00	$0.00	$56.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204362	EAP	HCPCS C1725		Cath Baldilat .021in 5fr 4mm 8mm Coron Rapex Hypotube Slim	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$201.45	$201.45	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$285.97	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$185.50	$293.83	$296.80	$0.00	$241.15	$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204363	EAP	HCPCS C1725		Cath Baldilat .021in 5fr 4mm 12mm Coron Rapex Lp Flxb Tung	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$191.68	$191.68	$0.00	$0.00	$0.00	$73.57	$262.00	$262.00	$272.09	$0.00	$73.57	$0.00	$208.80	$208.80	$0.00	$176.50	$279.58	$282.40	$0.00	$229.45	$0.00	$55.24	$0.00	$0.00	$56.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204364	EAP	HCPCS C1725		Cath Baldilat .021in 5fr 1.5mm 8mm Coron Otw Flxb Tung Mrkr	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.50	$293.83	$296.80	$0.00	$0.00	$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204365	EAP	HCPCS C1725		Cath Baldilat 2mm 8mm Coron Rapex Dual Tung Mrkr Flxb Smth	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.50	$293.83	$296.80	$0.00	$0.00	$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204366	EAP	HCPCS C1725		Cath Baldilat 2.25mm 8mm Coron Rapex Flxb Dual Tung Mrkr	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.50	$293.83	$296.80	$0.00	$0.00	$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204367	EAP	HCPCS C1725		Cath Baldilat 2.25mm 12mm Coron Rapex Flxb Dual Tung Mrkr	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.50	$293.83	$296.80	$0.00	$0.00	$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204368	EAP	HCPCS C1725		Cath Baldilat 2.25mm 15mm Coron Rapex Flxb Dual Tung Mrkr	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$201.45	$201.45	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$285.97	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$185.50	$293.83	$296.80	$0.00	$241.15	$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204369	EAP	HCPCS C1725		Cath Baldilat 2.25mm 20mm Coron Rapex Flxb Dual Tung Mrkr	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.50	$293.83	$296.80	$0.00	$0.00	$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204370	EAP	HCPCS C1725		Cath Baldilat 2.75mm 8mm Coron Rapex Flxb Dual Tung Mrkr	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.50	$293.83	$296.80	$0.00	$0.00	$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204371	EAP	HCPCS C1725		Cath Baldilat 3.25mm 8mm Coron Rapex Dual Tung Mrkr Flxb	BOTH IP/OP	$336.00 	$248.64	$0.00	$268.80	$182.45	$182.45	$0.00	$0.00	$0.00	$70.03	$249.38	$249.38	$258.99	$0.00	$70.02	$0.00	$198.74	$198.74	$0.00	$168.00	$266.11	$268.80	$0.00	$218.40	$0.00	$52.58	$0.00	$0.00	$53.49	$0.00	$0.00	$0.00	$0.00	$0.00
27204372	EAP	HCPCS C1725		Cath Baldilat 3.25mm 20mm Coron Rapex Dual Tung Mrkr Flxb	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$201.45	$201.45	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$285.97	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$185.50	$293.83	$296.80	$0.00	$241.15	$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204374	EAP	HCPCS C1725		Cath Baldilat 4.5mm 8mm Coron Rapex Flxb Dual Tung Mrkr Smth	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$191.68	$191.68	$0.00	$0.00	$0.00	$73.57	$262.00	$262.00	$272.09	$0.00	$73.57	$0.00	$208.80	$208.80	$0.00	$176.50	$279.58	$282.40	$0.00	$229.45	$0.00	$55.24	$0.00	$0.00	$56.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204375	EAP	HCPCS C1725		Cath Baldilat 4.5mm 15mm Coron Rapex Dual Tung Mrkr Flxb	BOTH IP/OP	$336.00 	$248.64	$0.00	$268.80	$182.45	$182.45	$0.00	$0.00	$0.00	$70.03	$249.38	$249.38	$258.99	$0.00	$70.02	$0.00	$198.74	$198.74	$0.00	$168.00	$266.11	$268.80	$0.00	$218.40	$0.00	$52.58	$0.00	$0.00	$53.49	$0.00	$0.00	$0.00	$0.00	$0.00
27204376	EAP	HCPCS C1725		Cath Baldilat 5mm 15mm Coron Rapex Flxb Dual Tung Mrkr Smth	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$201.45	$201.45	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$285.97	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$185.50	$293.83	$296.80	$0.00	$241.15	$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204390	EAP	Custom 27204390		Cath Cantata Double Markers 2.5 Fr X 100 Cm	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.50	$279.58	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204391	EAP	Custom 27204391		Cath Cantata Double Markers  2.5 Fr  X 110 Cm	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.50	$279.58	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204392	EAP	Custom 27204392		Cath Cantata Double Markers  2.5 X 135 Cm	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.50	$279.58	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204393	EAP	Custom 27204393		Cath Cantata Double Markers 2.5 X 150 Cm	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.50	$279.58	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204394	EAP	Custom 27204394		Cath Cantata Double Markers 2.8 Fr X 108 Cm	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.50	$279.58	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204395	EAP	Custom 27204395		Cath Cantata Double Markers  2.8 X 110 Cm	BOTH IP/OP	$358.00 	$264.92	$0.00	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.00	$283.54	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204396	EAP	Custom 27204396		Cath Cantata Double Markers 2.8 X 135 Cm	BOTH IP/OP	$358.00 	$264.92	$0.00	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.00	$283.54	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204397	EAP	Custom 27204397		Cath Cantata Double Markers 2.8 X 150 Cm	BOTH IP/OP	$358.00 	$264.92	$0.00	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.00	$283.54	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204398	EAP	Custom 27204398		Cath Cantata  Markers. 2.5 X 100 Cm	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.50	$279.58	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204399	EAP	Custom 27204399		Cath Cantata  Markers. 2.5 X 110 Cm	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.50	$279.58	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204400	EAP	Custom 27204400		Cath Cantata  Markers.  2.5 X 150 Cm	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.50	$279.58	$282.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204401	EAP	Custom 27204401		Cath Cantata  Markers. 2.8 X100 Cm	BOTH IP/OP	$358.00 	$264.92	$0.00	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.00	$283.54	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204402	EAP	Custom 27204402		Cath Cantata  Markers.  2.8 X 110  Cm	BOTH IP/OP	$358.00 	$264.92	$0.00	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.00	$283.54	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204403	EAP	Custom 27204403		Cath Cantata  Markers.  2.8 X 150 Cm	BOTH IP/OP	$358.00 	$264.92	$0.00	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.00	$283.54	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204404	EAP	HCPCS C1892		Sheath Long Neuronmax 90/4 Straight 6f 088	BOTH IP/OP	"$1,086.00 "	$803.64	$0.00	$868.80	$589.70	$589.70	$0.00	$0.00	$0.00	$226.35	$806.03	$806.03	$837.09	$0.00	$226.32	$0.00	$642.37	$642.37	$0.00	$543.00	$860.11	$868.80	$0.00	$705.90	$0.00	$169.96	$0.00	$0.00	$172.89	$0.00	$0.00	$0.00	$0.00	$0.00
27204405	EAP	HCPCS C1753		Catheter Ultrasound Eagle Eye Gold Od5 Fr Short Tip	BOTH IP/OP	"$1,999.00 "	"$1,479.26"	$0.00	"$1,599.20"	"$1,085.46"	"$1,085.46"	$0.00	$0.00	$0.00	$416.64	"$1,483.66"	"$1,483.66"	"$1,540.83"	$0.00	$416.59	$0.00	"$1,182.41"	"$1,182.41"	$0.00	$999.50	"$1,583.21"	"$1,599.20"	$0.00	"$1,299.35"	$0.00	$312.84	$0.00	$0.00	$318.24	$0.00	$0.00	$0.00	$0.00	$0.00
27204406	EAP	Custom 27204406		Catheter Steerable 3.2 Outer Diam 2mm Working Channel	BOTH IP/OP	"$1,653.00 "	"$1,223.22"	$0.00	"$1,322.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,226.86"	"$1,226.86"	"$1,274.13"	$0.00	$344.49	$0.00	$0.00	$0.00	$0.00	$826.50	"$1,309.18"	"$1,322.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204407	EAP	HCPCS C1887		Trevo Microcatheter	BOTH IP/OP	"$1,147.00 "	$848.78	$0.00	$917.60	$622.82	$622.82	$0.00	$0.00	$0.00	$239.06	$851.30	$851.30	$884.11	$0.00	$239.03	$0.00	$678.45	$678.45	$0.00	$573.50	$908.42	$917.60	$0.00	$745.55	$0.00	$179.51	$0.00	$0.00	$182.60	$0.00	$0.00	$0.00	$0.00	$0.00
27204408	EAP	HCPCS C1757		Retriever Stent Trevo Xp 4 X 20	BOTH IP/OP	"$12,766.00 "	"$9,446.84"	$0.00	"$10,212.80"	"$6,931.94"	"$6,931.94"	$0.00	$0.00	$0.00	"$2,660.75"	"$4,181.12"	"$4,181.12"	"$9,840.03"	$0.00	"$2,660.43"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$6,383.00"	"$10,110.67"	"$10,212.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204409	EAP	HCPCS C1757		Retriever Stent Trevo Xp 3 X 20	BOTH IP/OP	"$14,776.00 "	"$10,934.24"	$0.00	"$11,820.80"	"$8,023.37"	"$8,023.37"	$0.00	$0.00	$0.00	"$3,079.69"	"$4,181.12"	"$4,181.12"	"$11,389.34"	$0.00	"$3,079.32"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,388.00"	"$11,702.59"	"$11,820.80"	$0.00	"$9,604.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204416	EAP	HCPCS C1757		Set Cath 135cm 5fr 3mm Spiroflex Vg Angjt .014in Thrmb Gwire	BOTH IP/OP	"$5,925.00 "	"$4,384.50"	$0.00	"$4,740.00"	"$3,217.28"	"$3,217.28"	$0.00	$0.00	$0.00	"$1,234.92"	"$4,181.12"	"$4,181.12"	"$4,566.99"	$0.00	"$1,234.77"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,962.50"	"$4,692.60"	"$4,740.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204417	EAP	HCPCS C1714		CATHETER TURBOHAWK  High Efficiency Cutter- Large Vessel Standard Calcium	BOTH IP/OP	"$9,081.00 "	"$6,719.94"	$0.00	"$7,264.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,999.63"	$0.00	"$1,892.48"	$0.00	$0.00	$0.00	$0.00	"$4,540.50"	"$7,192.15"	"$7,264.80"	$0.00	$0.00	$0.00	"$1,421.18"	$0.00	$0.00	"$1,445.70"	$0.00	$0.00	$0.00	$0.00	$0.00
27204418	EAP	HCPCS C1714		Catheter Turbohawk  high Efficiency Cutter- Large Vessel Xtended Calcium Tip Lx-c	BOTH IP/OP	"$9,081.00 "	"$6,719.94"	$0.00	"$7,264.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,999.63"	$0.00	"$1,892.48"	$0.00	$0.00	$0.00	$0.00	"$4,540.50"	"$7,192.15"	"$7,264.80"	$0.00	$0.00	$0.00	"$1,421.18"	$0.00	$0.00	"$1,445.70"	$0.00	$0.00	$0.00	$0.00	$0.00
27204419	EAP	HCPCS C1714		Catheter Turbohawk  Smooth Cutter- Large Vessel Xtended Tip  lx-m	BOTH IP/OP	"$9,081.00 "	"$6,719.94"	$0.00	"$7,264.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,999.63"	$0.00	"$1,892.48"	$0.00	$0.00	$0.00	$0.00	"$4,540.50"	"$7,192.15"	"$7,264.80"	$0.00	$0.00	$0.00	"$1,421.18"	$0.00	$0.00	"$1,445.70"	$0.00	$0.00	$0.00	$0.00	$0.00
27204420	EAP	HCPCS C1714		Catheter Turbohawk   High Efficiency Cutter- Small Vessel Xtended Calcium Tip Sx-c	BOTH IP/OP	"$9,081.00 "	"$6,719.94"	$0.00	"$7,264.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,999.63"	$0.00	"$1,892.48"	$0.00	$0.00	$0.00	$0.00	"$4,540.50"	"$7,192.15"	"$7,264.80"	$0.00	$0.00	$0.00	"$1,421.18"	$0.00	$0.00	"$1,445.70"	$0.00	$0.00	$0.00	$0.00	$0.00
27204421	EAP	HCPCS C1714		Catheter Turbohawk  High Efficiency Cutter Small Vessel Standard Calcium Tip Long Catheter  Ss-cl	BOTH IP/OP	"$9,081.00 "	"$6,719.94"	$0.00	"$7,264.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,999.63"	$0.00	"$1,892.48"	$0.00	$0.00	$0.00	$0.00	"$4,540.50"	"$7,192.15"	"$7,264.80"	$0.00	$0.00	$0.00	"$1,421.18"	$0.00	$0.00	"$1,445.70"	$0.00	$0.00	$0.00	$0.00	$0.00
27204422	EAP	HCPCS C1714		Catheter Turbohawk  Smooth Cutter- Large Vessel Standard Tip   ls-m	BOTH IP/OP	"$9,081.00 "	"$6,719.94"	$0.00	"$7,264.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,999.63"	$0.00	"$1,892.48"	$0.00	$0.00	$0.00	$0.00	"$4,540.50"	"$7,192.15"	"$7,264.80"	$0.00	$0.00	$0.00	"$1,421.18"	$0.00	$0.00	"$1,445.70"	$0.00	$0.00	$0.00	$0.00	$0.00
27204423	EAP	HCPCS C1769		Gwire Vasc 190cm .014in Core To Tip Str 16cm A Fldr Xt	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$224.80	$224.80	$0.00	$0.00	$0.00	$86.29	$307.27	$307.27	$319.11	$0.00	$86.28	$0.00	$244.88	$244.88	$0.00	$207.00	$327.89	$331.20	$0.00	$269.10	$0.00	$64.79	$0.00	$0.00	$65.91	$0.00	$0.00	$0.00	$0.00	$0.00
27204424	EAP	HCPCS C1769		Gwire Vasc 300cm .014in Core To Tip Str 16cm A Fldr Xt	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$224.80	$224.80	$0.00	$0.00	$0.00	$86.29	$307.27	$307.27	$319.11	$0.00	$86.28	$0.00	$244.88	$244.88	$0.00	$207.00	$327.89	$331.20	$0.00	$269.10	$0.00	$64.79	$0.00	$0.00	$65.91	$0.00	$0.00	$0.00	$0.00	$0.00
27204426	EAP	Custom 27204426		Certus Lk Ablation 15cm-17 Gauge	BOTH IP/OP	"$6,063.00 "	"$4,486.62"	$0.00	"$4,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,673.36"	$0.00	"$1,263.53"	$0.00	$0.00	$0.00	$0.00	"$3,031.50"	"$4,801.90"	"$4,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204427	EAP	Custom 27204427		Certus Lk Ablation 20cm-17 Gauge	BOTH IP/OP	"$6,063.00 "	"$4,486.62"	$0.00	"$4,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,673.36"	$0.00	"$1,263.53"	$0.00	$0.00	$0.00	$0.00	"$3,031.50"	"$4,801.90"	"$4,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204428	EAP	Custom 27204428		Certus Ln  Ablation 15cm-17 Gauge	BOTH IP/OP	"$6,063.00 "	"$4,486.62"	$0.00	"$4,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,673.36"	$0.00	"$1,263.53"	$0.00	$0.00	$0.00	$0.00	"$3,031.50"	"$4,801.90"	"$4,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204429	EAP	Custom 27204429		Certus Ln Ablation 20cm-17 Gauge	BOTH IP/OP	"$6,063.00 "	"$4,486.62"	$0.00	"$4,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,673.36"	$0.00	"$1,263.53"	$0.00	$0.00	$0.00	$0.00	"$3,031.50"	"$4,801.90"	"$4,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204430	EAP	HCPCS C1769		Gwire Vasc .035in 150cm 1.5mm Rsn Curve Jtp Fix Core Ptfe	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.50	$29.30	$29.60	$0.00	$0.00	$0.00	$5.79	$0.00	$0.00	$5.89	$0.00	$0.00	$0.00	$0.00	$0.00
27204431	EAP	HCPCS C1769		Gwire Vasc Rsn Curve J Curve Lng .035in 260cm 1.5mm Exch	BOTH IP/OP	$82.00 	$60.68	$0.00	$65.60	$44.53	$44.53	$0.00	$0.00	$0.00	$17.09	$60.86	$60.86	$63.21	$0.00	$17.09	$0.00	$48.50	$48.50	$0.00	$41.00	$64.94	$65.60	$0.00	$53.30	$0.00	$12.83	$0.00	$0.00	$13.05	$0.00	$0.00	$0.00	$0.00	$0.00
27204432	EAP	HCPCS C1773		Kit Vasc 120cm 15mm 6fr Agn Ntnl Gold Tung Loop Cath Ntnl	BOTH IP/OP	$882.00 	$652.68	$0.00	$705.60	$478.93	$478.93	$0.00	$0.00	$0.00	$183.83	$654.62	$654.62	$679.85	$0.00	$183.81	$0.00	$521.70	$521.70	$0.00	$441.00	$698.54	$705.60	$0.00	$0.00	$0.00	$138.03	$0.00	$0.00	$140.41	$0.00	$0.00	$0.00	$0.00	$0.00
27204433	EAP	HCPCS C1773		Kit Vasc 120cm 25mm 6fr Agn Ntnl Gold Tung Loop Cath Ntnl	BOTH IP/OP	$882.00 	$652.68	$0.00	$705.60	$478.93	$478.93	$0.00	$0.00	$0.00	$183.83	$654.62	$654.62	$679.85	$0.00	$183.81	$0.00	$521.70	$521.70	$0.00	$441.00	$698.54	$705.60	$0.00	$0.00	$0.00	$138.03	$0.00	$0.00	$140.41	$0.00	$0.00	$0.00	$0.00	$0.00
27204434	EAP	HCPCS C1773		Kit Vasc 120cm 10mm 4fr Agn Ntnl Gold Tung Loop Cath Ntnl	BOTH IP/OP	$882.00 	$652.68	$0.00	$705.60	$478.93	$478.93	$0.00	$0.00	$0.00	$183.83	$654.62	$654.62	$679.85	$0.00	$183.81	$0.00	$521.70	$521.70	$0.00	$441.00	$698.54	$705.60	$0.00	$0.00	$0.00	$138.03	$0.00	$0.00	$140.41	$0.00	$0.00	$0.00	$0.00	$0.00
27204436	EAP	HCPCS C1757		Trevo Xp - 4mm X 20mm	BOTH IP/OP	"$14,072.00 "	"$10,413.28"	$0.00	"$11,257.60"	"$7,641.10"	"$7,641.10"	$0.00	$0.00	$0.00	"$2,932.96"	"$4,181.12"	"$4,181.12"	"$10,846.70"	$0.00	"$2,932.60"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,036.00"	"$11,145.02"	"$11,257.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204437	EAP	HCPCS C1887		Flowgate Balloon Guide Catheter 8f X 95cm	BOTH IP/OP	"$2,746.00 "	"$2,032.04"	$0.00	"$2,196.80"	"$1,491.08"	"$1,491.08"	$0.00	$0.00	$0.00	$572.34	"$2,038.08"	"$2,038.08"	"$2,116.62"	$0.00	$572.27	$0.00	"$1,624.26"	"$1,624.26"	$0.00	"$1,373.00"	"$2,174.83"	"$2,196.80"	$0.00	"$1,784.90"	$0.00	$429.75	$0.00	$0.00	$437.16	$0.00	$0.00	$0.00	$0.00	$0.00
27204438	EAP	CPT® C1725		Bln Splxxx Sprinter Legend Xxxxxx	BOTH IP/OP	$456.00 	$337.44	$0.00	$364.80	$247.61	$247.61	$0.00	$0.00	$0.00	$95.04	$338.44	$338.44	$351.48	$0.00	$95.03	$0.00	$269.72	$269.72	$0.00	$228.00	$361.15	$364.80	$0.00	$0.00	$0.00	$71.36	$0.00	$0.00	$72.60	$0.00	$0.00	$0.00	$0.00	$0.00
27204439	EAP	HCPCS C1887		Flowgate Balloon Guide Catheter 8f X 85cm	BOTH IP/OP	"$2,746.00 "	"$2,032.04"	$0.00	"$2,196.80"	"$1,491.08"	"$1,491.08"	$0.00	$0.00	$0.00	$572.34	"$2,038.08"	"$2,038.08"	"$2,116.62"	$0.00	$572.27	$0.00	"$1,624.26"	"$1,624.26"	$0.00	"$1,373.00"	"$2,174.83"	"$2,196.80"	$0.00	$0.00	$0.00	$429.75	$0.00	$0.00	$437.16	$0.00	$0.00	$0.00	$0.00	$0.00
27204440	EAP	Custom 27204440		Certus Pr Ablation 15cm-17 Gauge	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	"$4,239.40"	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00	"$3,575.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204441	EAP	Custom 27204441		Certus Pr Ablation 20cm-17 Gauge	BOTH IP/OP	"$6,063.00 "	"$4,486.62"	$0.00	"$4,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,673.36"	$0.00	"$1,263.53"	$0.00	$0.00	$0.00	$0.00	"$3,031.50"	"$4,801.90"	"$4,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204442	EAP	HCPCS C1724		Cath Athrcm 135cm .58in Rtbl Rtl 1.25mm Ptfe Shth Precnct	BOTH IP/OP	"$1,364.00 "	"$1,009.36"	$0.00	"$1,091.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,012.36"	"$1,012.36"	"$1,051.37"	$0.00	$284.26	$0.00	$0.00	$0.00	$0.00	$682.00	"$1,080.29"	"$1,091.20"	$0.00	$886.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204443	EAP	HCPCS C1724		Cath Athrcm 135cm .58in Rtbl Rtl 1.5mm Ptfe Shth Precnct	BOTH IP/OP	"$1,364.00 "	"$1,009.36"	$0.00	"$1,091.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,012.36"	"$1,012.36"	"$1,051.37"	$0.00	$284.26	$0.00	$0.00	$0.00	$0.00	$682.00	"$1,080.29"	"$1,091.20"	$0.00	$886.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204444	EAP	HCPCS C1724		Cath Athrcm 135cm .58in Rtbl Rtl 1.75mm Precnct Exchgl Rot	BOTH IP/OP	"$1,364.00 "	"$1,009.36"	$0.00	"$1,091.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,012.36"	"$1,012.36"	"$1,051.37"	$0.00	$284.26	$0.00	$0.00	$0.00	$0.00	$682.00	"$1,080.29"	"$1,091.20"	$0.00	$886.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204445	EAP	Custom 27204445		Pcmkr Crd Thk6mm Sm 50x46mm Endurity 2 Chmbr Is-1 Conctr W Adapter	BOTH IP/OP	"$6,669.00 "	"$4,935.06"	$0.00	"$5,335.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,140.47"	$0.00	"$1,389.82"	$0.00	$0.00	$0.00	$0.00	"$3,334.50"	"$5,281.85"	"$5,335.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204446	EAP	HCPCS C1887		Catheter Guid .035in 4.8-3.7fr 90cm Low Crossing P	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$226.97	$226.97	$0.00	$0.00	$0.00	$87.12	$310.24	$310.24	$322.19	$0.00	$87.11	$0.00	$247.25	$247.25	$0.00	$209.00	$331.06	$334.40	$0.00	$271.70	$0.00	$65.42	$0.00	$0.00	$66.55	$0.00	$0.00	$0.00	$0.00	$0.00
27204447	EAP	HCPCS C1887		Catheter Gd .035in Mpb 9fr 7.2fr 45cm Atn Cmnd Sur	BOTH IP/OP	$588.00 	$435.12	$0.00	$470.40	$319.28	$319.28	$0.00	$0.00	$0.00	$122.55	$436.41	$436.41	$453.23	$0.00	$122.54	$0.00	$347.80	$347.80	$0.00	$294.00	$465.70	$470.40	$0.00	$382.20	$0.00	$92.02	$0.00	$0.00	$93.61	$0.00	$0.00	$0.00	$0.00	$0.00
27204448	EAP	HCPCS C1887		Catheter Gd 90d 2.4mm 1.9mm 65cm Strl Atn Slct Ii	BOTH IP/OP	$540.00 	$399.60	$0.00	$432.00	$293.22	$293.22	$0.00	$0.00	$0.00	$112.55	$400.79	$400.79	$416.23	$0.00	$112.54	$0.00	$319.41	$319.41	$0.00	$270.00	$427.68	$432.00	$0.00	$0.00	$0.00	$84.51	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$0.00
27204449	EAP	Custom 27204449		Catheter Gd 3drc Crv 6fr .070in 100cm Blu Ylw Strl	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$0.00	$0.00	$0.00	$60.00	$95.04	$96.00	$0.00	$78.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204450	EAP	HCPCS C1750		Pack Cath 28/45cm 14.5fr Carbothane Mh Mxd 2 Lum Sh Hmdial	BOTH IP/OP	$921.00 	$681.54	$0.00	$736.80	$500.10	$500.10	$0.00	$0.00	$0.00	$191.96	$683.57	$683.57	$709.91	$0.00	$191.94	$0.00	$544.77	$544.77	$0.00	$460.50	$729.43	$736.80	$0.00	$598.65	$0.00	$144.14	$0.00	$0.00	$146.62	$0.00	$0.00	$0.00	$0.00	$0.00
27204451	EAP	HCPCS C1750		Pack Cath 33/50cm 14.5fr Carbothane Mh Mxd 2 Lum Sh Hmdial	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$134.66	$134.66	$0.00	$0.00	$0.00	$51.69	$184.07	$184.07	$191.16	$0.00	$51.68	$0.00	$146.69	$146.69	$0.00	$124.00	$196.42	$198.40	$0.00	$161.20	$0.00	$38.81	$0.00	$0.00	$39.48	$0.00	$0.00	$0.00	$0.00	$0.00
27204452	EAP	Custom 27204452		Obt Shth 10cm 5fr Flxb 5mm	BOTH IP/OP	"$4,675.00 "	"$3,459.50"	$0.00	"$3,740.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,337.50"	"$3,702.60"	"$3,740.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204453	EAP	Custom 27204453		Obt Shth 10cm 6fr Flxb 5mm	BOTH IP/OP	"$4,908.00 "	"$3,631.92"	$0.00	"$3,926.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,642.72"	"$3,642.72"	"$3,783.09"	$0.00	"$1,022.83"	$0.00	$0.00	$0.00	$0.00	"$2,454.00"	"$3,887.14"	"$3,926.40"	$0.00	"$3,190.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204454	EAP	HCPCS C1769		Gwire Vasc 300cm .014in Shp Tip Str 3cm Runthrough Ns Ptfe	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$127.61	$127.61	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$181.14	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00	$152.75	$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
27204455	EAP	HCPCS C1887		Cath Ep .014in 2.6-1.8fr .021-.018in 130cm 90cm Coron Mic	BOTH IP/OP	"$1,621.00 "	"$1,199.54"	$0.00	"$1,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$810.50	"$1,283.83"	"$1,296.80"	$0.00	$0.00	$0.00	$253.69	$0.00	$0.00	$258.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204456	EAP	HCPCS C1887		Cath Ep .014in 2.6-1.8fr .021-.018in 150cm 70cm Coron Mic	BOTH IP/OP	"$1,621.00 "	"$1,199.54"	$0.00	"$1,296.80"	$880.20	$880.20	$0.00	$0.00	$0.00	$337.86	"$1,203.11"	"$1,203.11"	"$1,249.47"	$0.00	$337.82	$0.00	$958.82	$958.82	$0.00	$810.50	"$1,283.83"	"$1,296.80"	$0.00	"$1,053.65"	$0.00	$253.69	$0.00	$0.00	$258.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204457	EAP	HCPCS C1769		Gwire Vasc .014in 180cm 3cm Str Shp Tip Runthrough Ns Coron	BOTH IP/OP	$247.00 	$182.78	$0.00	$197.60	$134.12	$134.12	$0.00	$0.00	$0.00	$51.48	$183.32	$183.32	$190.39	$0.00	$51.47	$0.00	$146.10	$146.10	$0.00	$123.50	$195.62	$197.60	$0.00	$160.55	$0.00	$38.66	$0.00	$0.00	$39.32	$0.00	$0.00	$0.00	$0.00	$0.00
27204458	EAP	HCPCS C1733		Arctic Front Advance Cryoablation Catheter 23mm	BOTH IP/OP	"$12,401.00 "	"$9,176.74"	$0.00	"$9,920.80"	"$6,733.74"	"$6,733.74"	$0.00	$0.00	$0.00	"$2,584.68"	"$4,181.12"	"$4,181.12"	"$9,558.69"	$0.00	"$2,584.37"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$6,200.50"	"$9,821.59"	"$9,920.80"	$0.00	$0.00	$0.00	"$1,940.76"	$0.00	$0.00	"$1,974.24"	$0.00	$0.00	$0.00	$0.00	$0.00
27204459	EAP	HCPCS C1733		Arctic Front Advance Cryoablation Catheter 28mm	BOTH IP/OP	"$12,401.00 "	"$9,176.74"	$0.00	"$9,920.80"	"$6,733.74"	"$6,733.74"	$0.00	$0.00	$0.00	"$2,584.68"	"$4,181.12"	"$4,181.12"	"$9,558.69"	$0.00	"$2,584.37"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$6,200.50"	"$9,821.59"	"$9,920.80"	$0.00	"$8,060.65"	$0.00	"$1,940.76"	$0.00	$0.00	"$1,974.24"	$0.00	$0.00	$0.00	$0.00	$0.00
27204460	EAP	HCPCS C1733		Freezor Max Cardiac Cryoablation Catheter Med	BOTH IP/OP	"$5,236.00 "	"$3,874.64"	$0.00	"$4,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,618.00"	"$4,146.91"	"$4,188.80"	$0.00	$0.00	$0.00	$819.43	$0.00	$0.00	$833.57	$0.00	$0.00	$0.00	$0.00	$0.00
27204461	EAP	HCPCS C1733		Freezor Max Cardiac Cryoablation Catheter Lrg	BOTH IP/OP	"$5,236.00 "	"$3,874.64"	$0.00	"$4,188.80"	"$2,843.15"	"$2,843.15"	$0.00	$0.00	$0.00	"$1,091.31"	"$3,886.16"	"$3,886.16"	"$4,035.91"	$0.00	"$1,091.18"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,618.00"	"$4,146.91"	"$4,188.80"	$0.00	$0.00	$0.00	$819.43	$0.00	$0.00	$833.57	$0.00	$0.00	$0.00	$0.00	$0.00
27204462	EAP	HCPCS C1733		Freezor Cardiac Cryoablation Catheter Sm	BOTH IP/OP	"$3,444.00 "	"$2,548.56"	$0.00	"$2,755.20"	"$1,870.09"	"$1,870.09"	$0.00	$0.00	$0.00	$717.82	"$2,556.14"	"$2,556.14"	"$2,654.64"	$0.00	$717.73	$0.00	"$2,037.13"	"$2,037.13"	$0.00	"$1,722.00"	"$2,727.65"	"$2,755.20"	$0.00	$0.00	$0.00	$538.99	$0.00	$0.00	$548.28	$0.00	$0.00	$0.00	$0.00	$0.00
27204463	EAP	HCPCS C1733		Freezor Cardiac Cryoablation Catheter Med	BOTH IP/OP	"$3,444.00 "	"$2,548.56"	$0.00	"$2,755.20"	"$1,870.09"	"$1,870.09"	$0.00	$0.00	$0.00	$717.82	"$2,556.14"	"$2,556.14"	"$2,654.64"	$0.00	$717.73	$0.00	"$2,037.13"	"$2,037.13"	$0.00	"$1,722.00"	"$2,727.65"	"$2,755.20"	$0.00	$0.00	$0.00	$538.99	$0.00	$0.00	$548.28	$0.00	$0.00	$0.00	$0.00	$0.00
27204464	EAP	HCPCS C1733		Freezor Cardiac Cryoablation Catheter Lrg	BOTH IP/OP	"$3,444.00 "	"$2,548.56"	$0.00	"$2,755.20"	"$1,870.09"	"$1,870.09"	$0.00	$0.00	$0.00	$717.82	"$2,556.14"	"$2,556.14"	"$2,654.64"	$0.00	$717.73	$0.00	"$2,037.13"	"$2,037.13"	$0.00	"$1,722.00"	"$2,727.65"	"$2,755.20"	$0.00	$0.00	$0.00	$538.99	$0.00	$0.00	$548.28	$0.00	$0.00	$0.00	$0.00	$0.00
27204472	EAP	HCPCS C1766		Flexcath Advance 12 Steerable Sheath - 12 Fr	BOTH IP/OP	"$3,307.00 "	"$2,447.18"	$0.00	"$2,645.60"	"$1,795.70"	"$1,795.70"	$0.00	$0.00	$0.00	$689.26	"$2,454.46"	"$2,454.46"	"$2,549.04"	$0.00	$689.18	$0.00	"$1,956.09"	"$1,956.09"	$0.00	"$1,653.50"	"$2,619.14"	"$2,645.60"	$0.00	"$2,149.55"	$0.00	$517.55	$0.00	$0.00	$526.47	$0.00	$0.00	$0.00	$0.00	$0.00
27204473	EAP	HCPCS C1766		Flexcath 10 Steerable Sheath - 10 Fr	BOTH IP/OP	"$2,067.00 "	"$1,529.58"	$0.00	"$1,653.60"	"$1,122.38"	"$1,122.38"	$0.00	$0.00	$0.00	$430.81	"$1,534.13"	"$1,534.13"	"$1,593.24"	$0.00	$430.76	$0.00	"$1,222.63"	"$1,222.63"	$0.00	"$1,033.50"	"$1,637.06"	"$1,653.60"	$0.00	$0.00	$0.00	$323.49	$0.00	$0.00	$329.07	$0.00	$0.00	$0.00	$0.00	$0.00
27204474	EAP	HCPCS C1730		Achieve Mapping Catheter Sm	BOTH IP/OP	"$2,618.00 "	"$1,937.32"	$0.00	"$2,094.40"	"$1,421.57"	"$1,421.57"	$0.00	$0.00	$0.00	$545.66	"$1,943.08"	"$1,943.08"	"$2,017.95"	$0.00	$545.59	$0.00	"$1,548.55"	"$1,548.55"	$0.00	"$1,309.00"	"$2,073.46"	"$2,094.40"	$0.00	"$1,701.70"	$0.00	$409.72	$0.00	$0.00	$416.79	$0.00	$0.00	$0.00	$0.00	$0.00
27204475	EAP	HCPCS C1730		Achieve Mapping Catheter Lrg	BOTH IP/OP	"$2,618.00 "	"$1,937.32"	$0.00	"$2,094.40"	"$1,421.57"	"$1,421.57"	$0.00	$0.00	$0.00	$545.66	"$1,943.08"	"$1,943.08"	"$2,017.95"	$0.00	$545.59	$0.00	"$1,548.55"	"$1,548.55"	$0.00	"$1,309.00"	"$2,073.46"	"$2,094.40"	$0.00	$0.00	$0.00	$409.72	$0.00	$0.00	$416.79	$0.00	$0.00	$0.00	$0.00	$0.00
27204478	EAP	HCPCS C1730		Cath Ep 5-5-5mm Spc Csl Curve 6fr 65cm Mp Dcapl Fix Curve	BOTH IP/OP	$965.00 	$714.10	$0.00	$772.00	$524.00	$524.00	$0.00	$0.00	$0.00	$201.13	$716.22	$716.22	$743.82	$0.00	$201.11	$0.00	$570.80	$570.80	$0.00	$482.50	$764.28	$772.00	$0.00	$627.25	$0.00	$151.02	$0.00	$0.00	$153.63	$0.00	$0.00	$0.00	$0.00	$0.00
27204479	EAP	HCPCS C1769		Gwire Vasc 325cm .009in Flpy Wrclp Trq Flxb Lng Tpr 2.8cm	BOTH IP/OP	$457.00 	$338.18	$0.00	$365.60	$248.15	$248.15	$0.00	$0.00	$0.00	$95.25	$339.19	$339.19	$352.26	$0.00	$95.24	$0.00	$270.32	$270.32	$0.00	$228.50	$361.94	$365.60	$0.00	$297.05	$0.00	$71.52	$0.00	$0.00	$72.75	$0.00	$0.00	$0.00	$0.00	$0.00
27204480	EAP	HCPCS C1769		Gwire Vasc 325cm .009in Flpy Wrclp Trq Flxb Lng Tpr 2.2cm	BOTH IP/OP	$457.00 	$338.18	$0.00	$365.60	$248.15	$248.15	$0.00	$0.00	$0.00	$95.25	$339.19	$339.19	$352.26	$0.00	$95.24	$0.00	$270.32	$270.32	$0.00	$228.50	$361.94	$365.60	$0.00	$297.05	$0.00	$71.52	$0.00	$0.00	$72.75	$0.00	$0.00	$0.00	$0.00	$0.00
27204481	EAP	Custom 27204481		Lubricant Rotaglide	BOTH IP/OP	$301.00 	$222.74	$0.00	$240.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$223.40	$223.40	$232.01	$0.00	$62.73	$0.00	$0.00	$0.00	$0.00	$150.50	$238.39	$240.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204482	EAP	HCPCS C1887		Cath Infus Mic 1.9fr 1.25mm .5mm 1.5cm Dlv Drblty Dtch Tip	BOTH IP/OP	"$5,498.00 "	"$4,068.52"	$0.00	"$4,398.40"	"$2,985.41"	"$2,985.41"	$0.00	$0.00	$0.00	"$1,145.92"	"$4,080.62"	"$4,080.62"	"$4,237.86"	$0.00	"$1,145.78"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,749.00"	"$4,354.42"	"$4,398.40"	$0.00	"$3,573.70"	$0.00	$860.44	$0.00	$0.00	$875.28	$0.00	$0.00	$0.00	$0.00	$0.00
27204483	EAP	HCPCS C1887		Cath Infus Mic 1.9fr 1.25mm .5mm 3cm Dlv Drblty Dtch Tip	BOTH IP/OP	"$5,498.00 "	"$4,068.52"	$0.00	"$4,398.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,749.00"	"$4,354.42"	"$4,398.40"	$0.00	$0.00	$0.00	$860.44	$0.00	$0.00	$875.28	$0.00	$0.00	$0.00	$0.00	$0.00
27204484	EAP	HCPCS C1769		Gwire Vasc 190cm .014in Radiopq Mrkr Core To Tip Str 3cm	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$134.55	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204485	EAP	HCPCS C1769		Gwire Vasc 300cm .014in Radiopq Mrkr Core To Tip Str 3cm	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$134.55	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204486	EAP	HCPCS C1769		Gwire Vasc 300cm .014in Strbl Core To Tip Radiopq Str 3cm	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$134.55	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204487	EAP	HCPCS C1769		Gwire Vasc 180cm .014in Radiopq Mrkr Str 3cm A Fldr Fc	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$134.55	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204488	EAP	HCPCS C1769		Gwire Vasc 300cm .014in Radiopq Mrkr Str 3cm A Fldr Fc	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$0.00	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204489	EAP	HCPCS C1769		Gwire Vasc 190cm .014in Str 3cm Htorq Whspr Ms Ss Hydphi	BOTH IP/OP	$217.00 	$160.58	$0.00	$173.60	$117.83	$117.83	$0.00	$0.00	$0.00	$45.23	$161.06	$161.06	$167.26	$0.00	$45.22	$0.00	$128.36	$128.36	$0.00	$108.50	$171.86	$173.60	$0.00	$141.05	$0.00	$33.96	$0.00	$0.00	$34.55	$0.00	$0.00	$0.00	$0.00	$0.00
27204490	EAP	HCPCS C1757		Cath Guid .014in Rnd 6fr .07+ In 140cm 6mm S Tp Aspirat Cmpt	BOTH IP/OP	"$1,513.00 "	"$1,119.62"	$0.00	"$1,210.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$756.50	"$1,198.30"	"$1,210.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204491	EAP	HCPCS C1757		Cath Guid .014in 1mm 7fr 140cm 6mm Lg Xtrt Lum Rnd S Tp Shrt	BOTH IP/OP	"$1,441.00 "	"$1,066.34"	$0.00	"$1,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$720.50	"$1,141.27"	"$1,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204492	EAP	HCPCS C1769		Gwire Vasc 180cm .035in Jkt Core To Tip Atrm 1.5mm Rad Std J	BOTH IP/OP	$117.00 	$86.58	$0.00	$93.60	$63.53	$63.53	$0.00	$0.00	$0.00	$24.39	$86.84	$86.84	$90.18	$0.00	$24.38	$0.00	$69.21	$69.21	$0.00	$58.50	$92.66	$93.60	$0.00	$76.05	$0.00	$18.31	$0.00	$0.00	$18.63	$0.00	$0.00	$0.00	$0.00	$0.00
27204493	EAP	HCPCS C1769		Gwire Vasc 260cm .035in Jkt Core To Tip Atrm 1.5mm Rad Std J	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$71.13	$71.13	$0.00	$0.00	$0.00	$27.30	$97.23	$97.23	$100.97	$0.00	$27.30	$0.00	$77.49	$77.49	$0.00	$65.50	$103.75	$104.80	$0.00	$85.15	$0.00	$20.50	$0.00	$0.00	$20.86	$0.00	$0.00	$0.00	$0.00	$0.00
27204494	EAP	HCPCS C1769		Guidewire Vasc .014in 300cm 3cm Strg Med Sprt Htorq Whspr Ms	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$134.55	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204495	EAP	HCPCS C1887		Microcatheter Headway 21	BOTH IP/OP	"$2,288.00 "	"$1,693.12"	$0.00	"$1,830.40"	"$1,242.38"	"$1,242.38"	$0.00	$0.00	$0.00	$476.88	"$1,698.15"	"$1,698.15"	"$1,763.59"	$0.00	$476.82	$0.00	"$1,353.35"	"$1,353.35"	$0.00	"$1,144.00"	"$1,812.10"	"$1,830.40"	$0.00	"$1,487.20"	$0.00	$358.07	$0.00	$0.00	$364.25	$0.00	$0.00	$0.00	$0.00	$0.00
27204496	EAP	HCPCS C1887		Microcatheter Headway Duo 17	BOTH IP/OP	"$2,563.00 "	"$1,896.62"	$0.00	"$2,050.40"	"$1,391.71"	"$1,391.71"	$0.00	$0.00	$0.00	$534.19	"$1,902.26"	"$1,902.26"	"$1,975.56"	$0.00	$534.13	$0.00	"$1,516.01"	"$1,516.01"	$0.00	"$1,281.50"	"$2,029.90"	"$2,050.40"	$0.00	"$1,665.95"	$0.00	$401.11	$0.00	$0.00	$408.03	$0.00	$0.00	$0.00	$0.00	$0.00
27204497	EAP	HCPCS C1887		6fr Jr 5 Guide Catheter	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$67.33	$67.33	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$95.58	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00	$80.60	$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
27204498	EAP	HCPCS C1887		6fr Lcb Guide Catheter	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$67.33	$67.33	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$95.58	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00	$80.60	$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
27204499	EAP	HCPCS C1887		7fr Al2 Guide Catheter	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$67.33	$67.33	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$95.58	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00	$0.00	$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
27204500	EAP	HCPCS C1887		7fr Al 1.5 Guide Catheter	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$67.33	$67.33	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$95.58	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00	$0.00	$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
27204501	EAP	HCPCS C1887		7fr Al 1.0 Guide Catheter	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$67.33	$67.33	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$95.58	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00	$80.60	$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
27204502	EAP	HCPCS C1887		6fr Mradial Guide Catheter	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$70.59	$70.59	$0.00	$0.00	$0.00	$27.10	$96.49	$96.49	$100.20	$0.00	$27.09	$0.00	$76.90	$76.90	$0.00	$65.00	$102.96	$104.00	$0.00	$84.50	$0.00	$20.35	$0.00	$0.00	$20.70	$0.00	$0.00	$0.00	$0.00	$0.00
27204503	EAP	HCPCS C1887		6fr Lara Curve Guide Catheter	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$67.33	$67.33	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$95.58	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00	$0.00	$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
27204504	EAP	HCPCS C1887		6fr Mac3030 Guide Catheter	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$67.33	$67.33	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$95.58	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00	$80.60	$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
27204505	EAP	HCPCS C1887		6fr Ima Guide Catheter	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$67.33	$67.33	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$95.58	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00	$80.60	$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
27204506	EAP	HCPCS C1887		5fr Jr4 Diagnostic Catheter 125cm	BOTH IP/OP	$193.00 	$142.82	$0.00	$154.40	$104.80	$104.80	$0.00	$0.00	$0.00	$40.23	$143.24	$143.24	$148.76	$0.00	$40.22	$0.00	$114.16	$114.16	$0.00	$96.50	$152.86	$154.40	$0.00	$125.45	$0.00	$30.20	$0.00	$0.00	$30.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204507	EAP	HCPCS C1887		5fr Jl4 Diagnostic Catheter 125cm	BOTH IP/OP	$193.00 	$142.82	$0.00	$154.40	$104.80	$104.80	$0.00	$0.00	$0.00	$40.23	$143.24	$143.24	$148.76	$0.00	$40.22	$0.00	$114.16	$114.16	$0.00	$96.50	$152.86	$154.40	$0.00	$0.00	$0.00	$30.20	$0.00	$0.00	$30.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204508	EAP	HCPCS C1724		Cath Athrcm 135cm .58in Rtbl Rtl+ 2mm Precnct Exchgl Rot	BOTH IP/OP	"$3,409.00 "	"$2,522.66"	$0.00	"$2,727.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,704.50"	"$2,699.93"	"$2,727.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204509	EAP	HCPCS C1724		Cath Athrcm 135cm Rtbl Rtl+ 2.15mm Bur Precnct Exchgl Rot	BOTH IP/OP	"$3,409.00 "	"$2,522.66"	$0.00	"$2,727.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,704.50"	"$2,699.93"	"$2,727.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204510	EAP	HCPCS C1724		Cath Athrcm 135cm Rtbl Rtl+ 2.25mm Bur Precnct Exchgl Rot	BOTH IP/OP	"$3,409.00 "	"$2,522.66"	$0.00	"$2,727.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,530.16"	"$2,530.16"	"$2,627.66"	$0.00	$710.44	$0.00	$0.00	$0.00	$0.00	"$1,704.50"	"$2,699.93"	"$2,727.20"	$0.00	"$2,215.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204511	EAP	HCPCS C1724		Cath Athrcm 135cm Rtbl Rtl+ 2.38mm Bur Precnct Exchgl Rot	BOTH IP/OP	"$3,409.00 "	"$2,522.66"	$0.00	"$2,727.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,704.50"	"$2,699.93"	"$2,727.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204512	EAP	HCPCS C1724		Cath Athrcm 135cm Rtbl Rtl+ 2.5mm Bur Precnct Exchgl Rot Adv	BOTH IP/OP	"$3,409.00 "	"$2,522.66"	$0.00	"$2,727.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,704.50"	"$2,699.93"	"$2,727.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204513	EAP	HCPCS C1725		Otw Mini Trek Ii 1.20 X 6mm Bdc	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$299.19	$299.19	$0.00	$0.00	$0.00	$114.84	$408.95	$408.95	$424.71	$0.00	$114.83	$0.00	$325.92	$325.92	$0.00	$275.50	$436.39	$440.80	$0.00	$0.00	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204514	EAP	HCPCS C1725		Otw Mini Trek Ii 1.20 X 8mm Bdc	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$299.19	$299.19	$0.00	$0.00	$0.00	$114.84	$408.95	$408.95	$424.71	$0.00	$114.83	$0.00	$325.92	$325.92	$0.00	$275.50	$436.39	$440.80	$0.00	$358.15	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204515	EAP	HCPCS C1725		Otw Mini Trek Ii 1.20 X 12mm Bdc	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.50	$436.39	$440.80	$0.00	$0.00	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204516	EAP	HCPCS C1725		Otw Mini Trek Ii 1.20 X 15mm Bdc	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$299.19	$299.19	$0.00	$0.00	$0.00	$114.84	$408.95	$408.95	$424.71	$0.00	$114.83	$0.00	$325.92	$325.92	$0.00	$275.50	$436.39	$440.80	$0.00	$0.00	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204517	EAP	HCPCS C1725		Otw Mini Trek Ii 1.20 X 20mm Bdc	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$299.19	$299.19	$0.00	$0.00	$0.00	$114.84	$408.95	$408.95	$424.71	$0.00	$114.83	$0.00	$325.92	$325.92	$0.00	$275.50	$436.39	$440.80	$0.00	$0.00	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204518	EAP	HCPCS C1725		Otw Mini Trek Ii 1.50 X 6mm Bdc	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$299.19	$299.19	$0.00	$0.00	$0.00	$114.84	$408.95	$408.95	$424.71	$0.00	$114.83	$0.00	$325.92	$325.92	$0.00	$275.50	$436.39	$440.80	$0.00	$358.15	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204519	EAP	HCPCS C1725		Otw Mini Trek Ii 1.50 X 20mm Bdc	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$299.19	$299.19	$0.00	$0.00	$0.00	$114.84	$408.95	$408.95	$424.71	$0.00	$114.83	$0.00	$325.92	$325.92	$0.00	$275.50	$436.39	$440.80	$0.00	$0.00	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204520	EAP	HCPCS C1725		Otw Mini Trek Ii 2.00 X 6mm Bdc	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$299.19	$299.19	$0.00	$0.00	$0.00	$114.84	$408.95	$408.95	$424.71	$0.00	$114.83	$0.00	$325.92	$325.92	$0.00	$275.50	$436.39	$440.80	$0.00	$0.00	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204521	EAP	HCPCS C1725		Otw Mini Trek Ii 2.00 X 20mm Bdc	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$299.19	$299.19	$0.00	$0.00	$0.00	$114.84	$408.95	$408.95	$424.71	$0.00	$114.83	$0.00	$325.92	$325.92	$0.00	$275.50	$436.39	$440.80	$0.00	$0.00	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204522	EAP	HCPCS C1725		Mini Trek Rx 1.20 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204523	EAP	HCPCS C1725		Mini Trek Rx 1.20 X 8mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204524	EAP	HCPCS C1725		Mini Trek Rx 1.20 X 12mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204525	EAP	HCPCS C1725		Mini Trek Rx 1.20 X 15mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204526	EAP	HCPCS C1725		Mini Trek Rx 1.20 X 20mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204527	EAP	HCPCS C1725		Mini Trek Rx 1.50 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204528	EAP	HCPCS C1725		Mini Trek Rx 1.50 X 8mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204529	EAP	HCPCS C1725		Mini Trek Rx 1.50 X 12mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204530	EAP	HCPCS C1725		Mini Trek Rx 1.50 X 20mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204531	EAP	HCPCS C1725		Mini Trek Rx 2.00 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204532	EAP	HCPCS C1725		Mini Trek Rx 2.00 X 25mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204533	EAP	HCPCS C1725		Mini Trek Rx 2.00 X 30mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204534	EAP	HCPCS C1725		Mini Trek Rx 2.25 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204535	EAP	HCPCS C1725		Mini Trek Rx 2.25 X 8mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204536	EAP	HCPCS C1725		Mini Trek Rx 2.25 X 12mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204537	EAP	HCPCS C1725		Mini Trek Rx 2.25 X 15mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204538	EAP	HCPCS C1725		Mini Trek Rx 2.25 X 20mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204539	EAP	HCPCS C1725		Mini Trek Rx 2.25 X 25mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204540	EAP	HCPCS C1725		Mini Trek Rx 2.25 X 30mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204541	EAP	HCPCS C1725		Trek Rx 2.50 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204542	EAP	HCPCS C1725		Trek Rx 2.50 X 30mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204543	EAP	HCPCS C1725		Trek Rx 2.75 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204544	EAP	HCPCS C1725		Trek Rx 2.75 X 8mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204545	EAP	HCPCS C1725		Trek Rx 2.75 X 12mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204546	EAP	HCPCS C1725		Trek Rx 2.75 X 15mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204547	EAP	HCPCS C1725		Trek Rx 2.75 X 20mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204548	EAP	HCPCS C1725		Trek Rx 2.75 X 25mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204549	EAP	HCPCS C1725		Trek Rx 2.75 X 30mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204550	EAP	HCPCS C1725		Trek Rx 3.00 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204551	EAP	HCPCS C1725		Trek Rx 3.00 X 30mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204552	EAP	HCPCS C1725		Trek Rx 3.25 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204553	EAP	HCPCS C1725		Trek Rx 3.25 X 8mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204554	EAP	HCPCS C1725		Trek Rx 3.25 X 12mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204555	EAP	HCPCS C1725		Trek Rx 3.25 X 15mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204556	EAP	HCPCS C1725		Trek Rx 3.25 X 20mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204557	EAP	HCPCS C1725		Trek Rx 3.25 X 25mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204558	EAP	HCPCS C1725		Trek Rx 3.25 X 30mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204559	EAP	HCPCS C1725		Trek Rx 3.50 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204560	EAP	HCPCS C1725		Trek Rx 3.50 X 30mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204561	EAP	HCPCS C1725		Trek Rx 3.75 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204562	EAP	HCPCS C1725		Trek Rx 3.75 X 8mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204563	EAP	HCPCS C1725		Trek Rx 3.75 X 12mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204564	EAP	HCPCS C1725		Trek Rx 3.75 X 15mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204565	EAP	HCPCS C1725		Trek Rx 3.75 X 20mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204566	EAP	HCPCS C1725		Trek Rx 3.75 X 25mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204567	EAP	HCPCS C1725		Trek Rx 3.75 X 30mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204568	EAP	HCPCS C1725		Trek Rx 4.00 X 06mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204569	EAP	HCPCS C1725		Trek Rx 4.00 X 20mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204570	EAP	HCPCS C1725		Trek Rx 4.00 X 25mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204571	EAP	HCPCS C1725		Trek Rx 4.00 X 30mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204572	EAP	HCPCS C1725		Nc Trek Rx 1.50 X 06mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204573	EAP	HCPCS C1725		Nc Trek Rx 1.50 X 08mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204574	EAP	HCPCS C1725		Nc Trek Rx 1.50 X 12mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204575	EAP	HCPCS C1725		Nc Trek Rx 1.50 X 15mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204576	EAP	HCPCS C1725		Nc Trek Rx 1.50 X 20mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204577	EAP	HCPCS C1725		Nc Trek Rx 2.00 X 15mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204578	EAP	HCPCS C1725		Nc Trek Rx 2.00 X 20mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204579	EAP	HCPCS C1725		Nc Trek Rx 2.25 X 06mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204580	EAP	HCPCS C1725		Nc Trek Rx 3.00 X 8mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204581	EAP	HCPCS C1725		Nc Trek Rx 3.25 X 06mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204582	EAP	HCPCS C1725		Nc Trek Rx 4.50 X 20mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204583	EAP	HCPCS C1725		Nc Trek Rx 5.00 X 20mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204584	EAP	HCPCS C1769		Asahi Prowater Ptca Guide Wire 180cm	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$134.55	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204585	EAP	HCPCS C1769		Hi-torque Iron Man Guide Wire	BOTH IP/OP	$217.00 	$160.58	$0.00	$173.60	$117.83	$117.83	$0.00	$0.00	$0.00	$45.23	$161.06	$161.06	$167.26	$0.00	$45.22	$0.00	$128.36	$128.36	$0.00	$108.50	$171.86	$173.60	$0.00	$141.05	$0.00	$33.96	$0.00	$0.00	$34.55	$0.00	$0.00	$0.00	$0.00	$0.00
27204586	EAP	HCPCS C1769		Asahi Prowater Ptca Guide Wire 300cm	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$0.00	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204587	EAP	Custom 27204587		Temporary Pacing Catheter 5fr	BOTH IP/OP	$509.00 	$376.66	$0.00	$407.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$377.78	$377.78	$392.34	$0.00	$106.08	$0.00	$0.00	$0.00	$0.00	$254.50	$403.13	$407.20	$0.00	$330.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204588	EAP	HCPCS C1757		Cath Dx 135cm 4.2fr Fetch 2 .014in Hydphi Rapex Aspirat	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$34.21	$34.21	$0.00	$0.00	$0.00	$13.13	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$37.26	$37.26	$0.00	$31.50	$49.90	$50.40	$0.00	$40.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204589	EAP	HCPCS C1769		Hi Torque 150 Gide Wire 0.014 Straight Tip 3.0 X 190cm	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$134.55	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204590	EAP	HCPCS C1725		Nc Trek Rx 2.00 X 06mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204591	EAP	HCPCS C1725		Nc Trek Rx 2.50 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204592	EAP	HCPCS C1725		Nc Trek Rx 2.75 X 06mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204593	EAP	HCPCS C1725		Nc Trek Rx 3.00 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204594	EAP	HCPCS C1725		Nc Trek Rx 3.50 X 6mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204595	EAP	HCPCS C1725		Nc Trek Rx 3.50 X 25mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204596	EAP	HCPCS C1725		Nc Trek Rx 3.75 X 20mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204597	EAP	HCPCS C1725		Nc Trek Rx 5.00 X 08mm Bdc	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204598	EAP	HCPCS C1769		Extn Gwire Vasc Asa	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$0.00	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204599	EAP	HCPCS C1877		Headway Duo Microtheter	BOTH IP/OP	"$2,307.00 "	"$1,707.18"	$0.00	"$1,845.60"	"$1,252.70"	"$1,252.70"	$0.00	$0.00	$0.00	$480.84	"$1,712.26"	"$1,712.26"	"$1,778.24"	$0.00	$480.78	$0.00	"$1,364.59"	"$1,364.59"	$0.00	"$1,153.50"	"$1,827.14"	"$1,845.60"	$0.00	"$1,499.55"	$0.00	$361.05	$0.00	$0.00	$367.27	$0.00	$0.00	$0.00	$0.00	$0.00
27204600	EAP	HCPCS C2628		Compliant Occlusion Balloon 4.0mm X 10mm	BOTH IP/OP	"$3,473.00 "	"$2,570.02"	$0.00	"$2,778.40"	"$1,885.84"	"$1,885.84"	$0.00	$0.00	$0.00	$723.86	"$2,577.66"	"$2,577.66"	"$2,676.99"	$0.00	$723.77	$0.00	"$2,054.28"	"$2,054.28"	$0.00	"$1,736.50"	"$2,750.62"	"$2,778.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204601	EAP	HCPCS C2628		Compliant Occlusion Balloon 4.0mm X 15mm	BOTH IP/OP	"$3,473.00 "	"$2,570.02"	$0.00	"$2,778.40"	"$1,885.84"	"$1,885.84"	$0.00	$0.00	$0.00	$723.86	"$2,577.66"	"$2,577.66"	"$2,676.99"	$0.00	$723.77	$0.00	"$2,054.28"	"$2,054.28"	$0.00	"$1,736.50"	"$2,750.62"	"$2,778.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204602	EAP	HCPCS C2628		Compliant Occlusion Balloon 4.0mm X 20mm	BOTH IP/OP	"$3,473.00 "	"$2,570.02"	$0.00	"$2,778.40"	"$1,885.84"	"$1,885.84"	$0.00	$0.00	$0.00	$723.86	"$2,577.66"	"$2,577.66"	"$2,676.99"	$0.00	$723.77	$0.00	"$2,054.28"	"$2,054.28"	$0.00	"$1,736.50"	"$2,750.62"	"$2,778.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204603	EAP	HCPCS C2628		Occlusion Balloon Xc Catheter 4mm X 11mm	BOTH IP/OP	"$3,647.00 "	"$2,698.78"	$0.00	"$2,917.60"	"$1,980.32"	"$1,980.32"	$0.00	$0.00	$0.00	$760.13	"$2,706.80"	"$2,706.80"	"$2,811.11"	$0.00	$760.03	$0.00	"$2,157.20"	"$2,157.20"	$0.00	"$1,823.50"	"$2,888.42"	"$2,917.60"	$0.00	"$2,370.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204604	EAP	HCPCS C1725		Cath Baldilat 5fr 2mm 25mm Otw Flxb Tung Mrkr Trnstls Tip	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.50	$436.39	$440.80	$0.00	$0.00	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204605	EAP	HCPCS C1725		Cath Baldilat 5fr 2mm 30mm Otw Flxb Tung Mrkr Trnstls Tip	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.50	$436.39	$440.80	$0.00	$0.00	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204606	EAP	HCPCS C1725		Cath Baldilat Ult Lp 5fr 4.5mm 12mm Coron 2 Lum Rapex Flxb	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204607	EAP	HCPCS C1725		Cath Baldilat Ult Lp 5fr 4.5mm 15mm Coron 2 Lum Rapex Flxb	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204608	EAP	HCPCS C1725		Cath Baldilat Ult Lp 5fr 5mm 12mm Coron 2 Lum Rapex Flxb	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204609	EAP	HCPCS C1725		Cath Baldilat Ult Lp 5fr 5mm 15mm Coron 2 Lum Rapex Flxb	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204610	EAP	HCPCS C1725		Cath Baldilat Rnd 4.5mm 12mm 2 Mrkr Rapex Ml Lr Smth Flxb	BOTH IP/OP	$362.00 	$267.88	$0.00	$289.60	$196.57	$196.57	$0.00	$0.00	$0.00	$75.45	$268.68	$268.68	$279.03	$0.00	$75.44	$0.00	$214.12	$214.12	$0.00	$181.00	$286.70	$289.60	$0.00	$235.30	$0.00	$56.65	$0.00	$0.00	$57.63	$0.00	$0.00	$0.00	$0.00	$0.00
27204611	EAP	HCPCS C1769		Cath Baldilat Rnd 2mm 12mm 2 Mrkr Rapex Ml Lr Smth Flxb	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00	$224.25	$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204612	EAP	Custom 27204612		Valve Hmsts Coplt 1 Un Bldbck Cntrl Vlv	BOTH IP/OP	$137.00 	$101.38	$0.00	$109.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.50	$108.50	$109.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204613	EAP	HCPCS C1757		Solitaire Fr 4x40	BOTH IP/OP	"$11,643.00 "	"$8,615.82"	$0.00	"$9,314.40"	"$6,322.15"	"$6,322.15"	$0.00	$0.00	$0.00	"$2,426.69"	"$4,181.12"	"$4,181.12"	"$8,974.42"	$0.00	"$2,426.40"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,821.50"	"$9,221.26"	"$9,314.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204614	EAP	Custom 27204614		Needle Biop 17ga 13.8cm Trgd Coax Disp Mnpty Mxcor	BOTH IP/OP	$153.00 	$113.22	$0.00	$122.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$113.56	$113.56	$117.93	$0.00	$31.89	$0.00	$0.00	$0.00	$0.00	$76.50	$121.18	$122.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204615	EAP	Custom 27204615		Needle Biop 18ga 16cm 22mm Mxcor Automate Strl Disp	BOTH IP/OP	$412.00 	$304.88	$0.00	$329.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.79	$305.79	$317.57	$0.00	$85.86	$0.00	$0.00	$0.00	$0.00	$206.00	$326.30	$329.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204616	EAP	HCPCS C1769		Gwire Vasc .012in 200cm 55cm Sft Pshp Acces Lgth Synchro2	BOTH IP/OP	"$1,283.00 "	$949.42	$0.00	"$1,026.40"	$696.67	$696.67	$0.00	$0.00	$0.00	$267.41	$952.24	$952.24	$988.94	$0.00	$267.38	$0.00	$758.89	$758.89	$0.00	$641.50	"$1,016.14"	"$1,026.40"	$0.00	$833.95	$0.00	$200.79	$0.00	$0.00	$204.25	$0.00	$0.00	$0.00	$0.00	$0.00
27204617	EAP	HCPCS C1769		Gwire Vasc .012in 300cm 55cm Sft Pshp Acces Lgth Synchro2	BOTH IP/OP	"$1,593.00 "	"$1,178.82"	$0.00	"$1,274.40"	$865.00	$865.00	$0.00	$0.00	$0.00	$332.02	"$1,182.32"	"$1,182.32"	"$1,227.88"	$0.00	$331.98	$0.00	$942.26	$942.26	$0.00	$796.50	"$1,261.66"	"$1,274.40"	$0.00	"$1,035.45"	$0.00	$249.30	$0.00	$0.00	$253.61	$0.00	$0.00	$0.00	$0.00	$0.00
27204618	EAP	Custom 27204618		Drsg 6x3.5in Gntl Ps Strp Anmc Flxb Brthbl Ionic Slvr Sil	BOTH IP/OP	$53.00 	$39.22	$0.00	$42.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.34	$39.34	$40.85	$0.00	$11.05	$0.00	$0.00	$0.00	$0.00	$26.50	$41.98	$42.40	$0.00	$34.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204619	EAP	Custom 27204619		Drsg 10x3.5in Gntl Ps Strp Anmc Flxb Brthbl Ionic Slvr Sil	BOTH IP/OP	$62.00 	$45.88	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.02	$46.02	$47.79	$0.00	$12.92	$0.00	$0.00	$0.00	$0.00	$31.00	$49.10	$49.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204620	EAP	Custom 27204620		Drsg 14x3.5in Gntl Ps Nstn Adh Hi Abs Sil Latex Optfm Ag	BOTH IP/OP	$72.00 	$53.28	$0.00	$57.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.44	$53.44	$55.50	$0.00	$15.00	$0.00	$0.00	$0.00	$0.00	$36.00	$57.02	$57.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204621	EAP	Custom 27204621		Sensor Flw Microflow Bynt Hndl Flxb Neck 1.5mm Disp	BOTH IP/OP	"$2,612.00 "	"$1,932.88"	$0.00	"$2,089.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,938.63"	"$1,938.63"	"$2,013.33"	$0.00	$544.34	$0.00	$0.00	$0.00	$0.00	"$1,306.00"	"$2,068.70"	"$2,089.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204622	EAP	Custom 27204622		Probe Surg Microflow Bynt Hndl Flxb Neck Disp 2mm	BOTH IP/OP	"$2,612.00 "	"$1,932.88"	$0.00	"$2,089.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,938.63"	"$1,938.63"	"$2,013.33"	$0.00	$544.34	$0.00	$0.00	$0.00	$0.00	"$1,306.00"	"$2,068.70"	"$2,089.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204623	EAP	Custom 27204623		Probe Surg Microflow Bynt Hndl Flxb Neck Disp 3mm	BOTH IP/OP	"$2,612.00 "	"$1,932.88"	$0.00	"$2,089.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,938.63"	"$1,938.63"	"$2,013.33"	$0.00	$544.34	$0.00	$0.00	$0.00	$0.00	"$1,306.00"	"$2,068.70"	"$2,089.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204624	EAP	HCPCS C1769		"Gwire Vsc 190cm .014"" Mkr Tp Str 3cm Htrq Bl Mwt U"	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$134.55	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204625	EAP	HCPCS C1788		Tray Infus Port Std 1 Lum Plflw Cath Introd Ndl	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$404.67	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00	$0.00	$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
27204626	EAP	HCPCS C1788		Tray Infus Port Lp 1 Lum Introd Ndl Tnl Tl Cath 6	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00	$0.00	$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
27204627	EAP	HCPCS C1788		Tray Infus Port J Lp 1 Lum Cath Introd Ndl Gwire	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$285.08	$285.08	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$404.67	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00	$0.00	$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
27204628	EAP	HCPCS C1757		Flow Restoration Catheter (6-10mm) X 155cm	BOTH IP/OP	"$11,238.00 "	"$8,316.12"	$0.00	"$8,990.40"	"$6,102.23"	"$6,102.23"	$0.00	$0.00	$0.00	"$2,342.28"	"$4,181.12"	"$4,181.12"	"$8,662.25"	$0.00	"$2,342.00"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,619.00"	"$8,900.50"	"$8,990.40"	$0.00	"$7,304.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204629	EAP	HCPCS C1757		Flow Restoration Catheter (11-14mm) X 155cm	BOTH IP/OP	"$11,238.00 "	"$8,316.12"	$0.00	"$8,990.40"	"$6,102.23"	"$6,102.23"	$0.00	$0.00	$0.00	"$2,342.28"	"$4,181.12"	"$4,181.12"	"$8,662.25"	$0.00	"$2,342.00"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,619.00"	"$8,900.50"	"$8,990.40"	$0.00	"$7,304.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204630	EAP	HCPCS C1757		Flow Restoration Catheter (15-18mm) X 155cm	BOTH IP/OP	"$11,238.00 "	"$8,316.12"	$0.00	"$8,990.40"	"$6,102.23"	"$6,102.23"	$0.00	$0.00	$0.00	"$2,342.28"	"$4,181.12"	"$4,181.12"	"$8,662.25"	$0.00	"$2,342.00"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,619.00"	"$8,900.50"	"$8,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204631	EAP	HCPCS C1757		Aspiration Guide Catheter 20f X 95cm	BOTH IP/OP	"$5,738.00 "	"$4,246.12"	$0.00	"$4,590.40"	"$3,115.73"	"$3,115.73"	$0.00	$0.00	$0.00	"$1,195.94"	"$4,181.12"	"$4,181.12"	"$4,422.85"	$0.00	"$1,195.80"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,869.00"	"$4,544.50"	"$4,590.40"	$0.00	"$3,729.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204632	EAP	HCPCS C1773		Retraction Aspirator Device	BOTH IP/OP	$787.00 	$582.38	$0.00	$629.60	$427.34	$427.34	$0.00	$0.00	$0.00	$164.03	$584.11	$584.11	$606.62	$0.00	$164.01	$0.00	$465.51	$465.51	$0.00	$393.50	$623.30	$629.60	$0.00	$0.00	$0.00	$123.17	$0.00	$0.00	$125.29	$0.00	$0.00	$0.00	$0.00	$0.00
27204633	EAP	HCPCS C1757		Trevo Xp 6mm X 25mm	BOTH IP/OP	"$13,402.00 "	"$9,917.48"	$0.00	"$10,721.60"	"$7,277.29"	"$7,277.29"	$0.00	$0.00	$0.00	"$2,793.31"	"$4,181.12"	"$4,181.12"	"$10,330.26"	$0.00	"$2,792.98"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$6,701.00"	"$10,614.38"	"$10,721.60"	$0.00	"$8,711.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204634	EAP	HCPCS C1757		Trevo Xp Provue Retriever 4.0 X 30mm	BOTH IP/OP	"$14,072.00 "	"$10,413.28"	$0.00	"$11,257.60"	"$7,641.10"	"$7,641.10"	$0.00	$0.00	$0.00	"$2,932.96"	"$4,181.12"	"$4,181.12"	"$10,846.70"	$0.00	"$2,932.60"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,036.00"	"$11,145.02"	"$11,257.60"	$0.00	"$9,146.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204635	EAP	HCPCS C1887		"Micrcatheter Std Straight, 2 Tip-marker, 150cm-15cm"	BOTH IP/OP	"$2,324.00 "	"$1,719.76"	$0.00	"$1,859.20"	"$1,261.93"	"$1,261.93"	$0.00	$0.00	$0.00	$484.38	"$1,724.87"	"$1,724.87"	"$1,791.34"	$0.00	$484.32	$0.00	"$1,374.65"	"$1,374.65"	$0.00	"$1,162.00"	"$1,840.61"	"$1,859.20"	$0.00	$0.00	$0.00	$363.71	$0.00	$0.00	$369.98	$0.00	$0.00	$0.00	$0.00	$0.00
27204636	EAP	HCPCS C1887		"Microcatheter Standard Pre-shaped 45, 2-tip Mkr, 150cm/7.5cm"	BOTH IP/OP	"$2,381.00 "	"$1,761.94"	$0.00	"$1,904.80"	"$1,292.88"	"$1,292.88"	$0.00	$0.00	$0.00	$496.26	"$1,767.18"	"$1,767.18"	"$1,835.27"	$0.00	$496.20	$0.00	"$1,408.36"	"$1,408.36"	$0.00	"$1,190.50"	"$1,885.75"	"$1,904.80"	$0.00	$0.00	$0.00	$372.63	$0.00	$0.00	$379.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204637	EAP	HCPCS C1887		"Micrcatheter Std Pre-shp 90, 2-tip Mkr, 150cm/7.5cm"	BOTH IP/OP	"$2,381.00 "	"$1,761.94"	$0.00	"$1,904.80"	"$1,292.88"	"$1,292.88"	$0.00	$0.00	$0.00	$496.26	"$1,767.18"	"$1,767.18"	"$1,835.27"	$0.00	$496.20	$0.00	"$1,408.36"	"$1,408.36"	$0.00	"$1,190.50"	"$1,885.75"	"$1,904.80"	$0.00	$0.00	$0.00	$372.63	$0.00	$0.00	$379.06	$0.00	$0.00	$0.00	$0.00	$0.00
27204639	EAP	HCPCS C1769		Guidewire Vascular Str .035in 150cm Bentson Smooth	BOTH IP/OP	$33.00 	$24.42	$0.00	$26.40	$17.92	$17.92	$0.00	$0.00	$0.00	$6.88	$24.49	$24.49	$25.44	$0.00	$6.88	$0.00	$19.52	$19.52	$0.00	$16.50	$26.14	$26.40	$0.00	$21.45	$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
27204640	EAP	HCPCS C1725		Catheter Baldilat .035in 8fr 18mm 80cm 4cm Gold	BOTH IP/OP	$722.00 	$534.28	$0.00	$577.60	$392.05	$392.05	$0.00	$0.00	$0.00	$150.48	$535.87	$535.87	$556.52	$0.00	$150.46	$0.00	$427.06	$427.06	$0.00	$361.00	$571.82	$577.60	$0.00	$469.30	$0.00	$112.99	$0.00	$0.00	$114.94	$0.00	$0.00	$0.00	$0.00	$0.00
27204641	EAP	HCPCS C1725		Catheter Baldilat .035in 8fr 16mm 80cm 4cm Gold	BOTH IP/OP	$722.00 	$534.28	$0.00	$577.60	$392.05	$392.05	$0.00	$0.00	$0.00	$150.48	$535.87	$535.87	$556.52	$0.00	$150.46	$0.00	$427.06	$427.06	$0.00	$361.00	$571.82	$577.60	$0.00	$469.30	$0.00	$112.99	$0.00	$0.00	$114.94	$0.00	$0.00	$0.00	$0.00	$0.00
27204642	EAP	HCPCS C1725		Catheter Baldilat .035in 7fr 14mm 80cm 4cm Gold	BOTH IP/OP	$688.00 	$509.12	$0.00	$550.40	$373.58	$373.58	$0.00	$0.00	$0.00	$143.40	$510.63	$510.63	$530.31	$0.00	$143.38	$0.00	$406.95	$406.95	$0.00	$344.00	$544.90	$550.40	$0.00	$447.20	$0.00	$107.67	$0.00	$0.00	$109.53	$0.00	$0.00	$0.00	$0.00	$0.00
27204643	EAP	HCPCS C1725		Catheter Xtrt 120cm 14fr Xl .035in Str Tip Gwire	BOTH IP/OP	"$1,956.00 "	"$1,447.44"	$0.00	"$1,564.80"	"$1,062.11"	"$1,062.11"	$0.00	$0.00	$0.00	$407.68	"$1,451.74"	"$1,451.74"	"$1,507.68"	$0.00	$407.63	$0.00	"$1,156.97"	"$1,156.97"	$0.00	$978.00	"$1,549.15"	"$1,564.80"	$0.00	$0.00	$0.00	$306.11	$0.00	$0.00	$311.40	$0.00	$0.00	$0.00	$0.00	$0.00
27204644	EAP	HCPCS C1757		Set Introd 70cm 14fr 15mm Ck-z Trchbr Gnt Rsch	BOTH IP/OP	$749.00 	$554.26	$0.00	$599.20	$406.71	$406.71	$0.00	$0.00	$0.00	$156.11	$555.91	$555.91	$577.33	$0.00	$156.09	$0.00	$443.03	$443.03	$0.00	$374.50	$593.21	$599.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204645	EAP	HCPCS C1757		Coil Embl 132cm .064mm Penumbra Ruby Ace 5max	BOTH IP/OP	"$5,484.00 "	"$4,058.16"	$0.00	"$4,387.20"	"$2,977.81"	"$2,977.81"	$0.00	$0.00	$0.00	"$1,143.00"	"$4,070.22"	"$4,070.22"	"$4,227.07"	$0.00	"$1,142.87"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,742.00"	"$4,343.33"	"$4,387.20"	$0.00	"$3,564.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204647	EAP	HCPCS C1894		Introducer Shth Ped 5fr 21ga 40cm 7cm Gry Hub	BOTH IP/OP	$103.00 	$76.22	$0.00	$82.40	$55.93	$55.93	$0.00	$0.00	$0.00	$21.47	$76.45	$76.45	$79.39	$0.00	$21.47	$0.00	$60.92	$60.92	$0.00	$51.50	$81.58	$82.40	$0.00	$66.95	$0.00	$16.12	$0.00	$0.00	$16.40	$0.00	$0.00	$0.00	$0.00	$0.00
27204648	EAP	HCPCS C1894		Introducer Shth Ped 6fr 21ga 40cm 7cm Grn Hub	BOTH IP/OP	$108.00 	$79.92	$0.00	$86.40	$58.64	$58.64	$0.00	$0.00	$0.00	$22.51	$80.16	$80.16	$83.25	$0.00	$22.51	$0.00	$63.88	$63.88	$0.00	$54.00	$85.54	$86.40	$0.00	$70.20	$0.00	$16.90	$0.00	$0.00	$17.19	$0.00	$0.00	$0.00	$0.00	$0.00
27204649	EAP	HCPCS C1884		System Embl Prtc 190cm .014in 110um Crtd Gwire	BOTH IP/OP	"$4,397.00 "	"$3,253.78"	$0.00	"$3,517.60"	"$2,387.57"	"$2,387.57"	$0.00	$0.00	$0.00	$916.44	"$3,263.45"	"$3,263.45"	"$3,389.21"	$0.00	$916.33	$0.00	"$2,600.83"	"$2,600.83"	$0.00	"$2,198.50"	"$3,482.42"	"$3,517.60"	$0.00	$0.00	$0.00	$688.13	$0.00	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204650	EAP	HCPCS C1884		System Embl Prtc 190cm .014in 110um Sprg Crtd	BOTH IP/OP	"$4,397.00 "	"$3,253.78"	$0.00	"$3,517.60"	"$2,387.57"	"$2,387.57"	$0.00	$0.00	$0.00	$916.44	"$3,263.45"	"$3,263.45"	"$3,389.21"	$0.00	$916.33	$0.00	"$2,600.83"	"$2,600.83"	$0.00	"$2,198.50"	"$3,482.42"	"$3,517.60"	$0.00	$0.00	$0.00	$688.13	$0.00	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204651	EAP	HCPCS C2630		Catheter Ablt 115cm 7fr 3.5mm 75mm Curve 2-5-2mm	BOTH IP/OP	"$6,561.00 "	"$4,855.14"	$0.00	"$5,248.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,280.50"	"$5,196.31"	"$5,248.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204652	EAP	HCPCS C2630		Catheter Ablt 115cm 7fr 3.5mm 65mm Curve 2-5-2mm	BOTH IP/OP	"$6,561.00 "	"$4,855.14"	$0.00	"$5,248.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,280.50"	"$5,196.31"	"$5,248.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204653	EAP	HCPCS C2630		Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc D-d Curve	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204654	EAP	HCPCS C2630		Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc D-f Curve	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204655	EAP	HCPCS C2630		Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc F-f Curve	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204656	EAP	HCPCS C2630		Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc F-j Curve	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204657	EAP	HCPCS C2630		Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc J-j Curve	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204658	EAP	HCPCS C2630		Catheter Ablt 115cm 8fr 4mm D Curve Flexability 4	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,895.81"	"$3,895.81"	"$4,045.93"	$0.00	"$1,093.89"	$0.00	$0.00	$0.00	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	"$3,411.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204659	EAP	HCPCS C2630		Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc F Curve	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204660	EAP	HCPCS C2630		Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc J Curve	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204661	EAP	HCPCS C1885		Catheter Angio Jacky Radl Curve 5fr 3.5mm 100cm 2	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$284.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204662	EAP	HCPCS C1725		Coronary Balloon	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.01	$0.01	$0.00	$0.01	$0.01	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204663	EAP	CPT® C1769		Guidewire Vasc 80cm .035in Jkt Core To Tip Atrm	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$43.44	$43.44	$0.00	$0.00	$0.00	$16.67	$59.38	$59.38	$61.66	$0.00	$16.67	$0.00	$47.32	$47.32	$0.00	$40.00	$63.36	$64.00	$0.00	$52.00	$0.00	$12.52	$0.00	$0.00	$12.74	$0.00	$0.00	$0.00	$0.00	$0.00
27204664	EAP	HCPCS C1769		035IN 150CM 7CM STANDARD TIP FIX	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$10.86	$10.86	$0.00	$0.00	$0.00	$4.17	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$11.83	$11.83	$0.00	$10.00	$15.84	$16.00	$0.00	$13.00	$0.00	$3.13	$0.00	$0.00	$3.18	$0.00	$0.00	$0.00	$0.00	$0.00
27204665	EAP	HCPCS C1887		Cath Angio Jr3.5 Curve 6fr 100cm Stsr	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00	$0.00	$0.00	$16.43	$0.00	$0.00	$16.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204666	EAP	HCPCS C1887		Catheter Angiographic Jl3.5 Curve 6fr 100cm Siteseer	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.50	$102.17	$103.20	$0.00	$0.00	$0.00	$20.19	$0.00	$0.00	$20.54	$0.00	$0.00	$0.00	$0.00	$0.00
27204667	EAP	HCPCS C1887		Catheter Angiographic Jl4 Curve 6fr 100cm Siteseer	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.50	$194.04	$196.00	$0.00	$0.00	$0.00	$38.34	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204668	EAP	HCPCS C1887		Catheter Angiographic Jr5 Curve 5fr 100cm Siteseer	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00	$0.00	$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
27204669	EAP	Custom 27204669		Kit Pricrdcts 8.3fr Perivc Flxm Pgtl Curve 3w	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204670	EAP	HCPCS C1887		Catheter 6a0083 Ss 6f Jl 5.0 100cm	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.00	$55.44	$56.00	$0.00	$0.00	$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
27204671	EAP	HCPCS C1887		Catheter Angiographic Mpa1 Curve 5fr 100cm Siteseer	BOTH IP/OP	$193.00 	$142.82	$0.00	$154.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.50	$152.86	$154.40	$0.00	$0.00	$0.00	$30.20	$0.00	$0.00	$30.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204673	EAP	HCPCS C1887		Catheter Guid Jr4 Curve 6fr 100cm Siteseer Stainless Steel	BOTH IP/OP	$294.00 	$217.56	$0.00	$235.20	$159.64	$159.64	$0.00	$0.00	$0.00	$61.28	$218.21	$218.21	$226.62	$0.00	$61.27	$0.00	$173.90	$173.90	$0.00	$147.00	$232.85	$235.20	$0.00	$0.00	$0.00	$46.01	$0.00	$0.00	$46.80	$0.00	$0.00	$0.00	$0.00	$0.00
27204674	EAP	HCPCS C1887		"Catheter,6fr Al2 Siteseer"	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$85.79	$85.79	$0.00	$0.00	$0.00	$32.93	$117.27	$117.27	$121.79	$0.00	$32.93	$0.00	$93.46	$93.46	$0.00	$79.00	$125.14	$126.40	$0.00	$0.00	$0.00	$24.73	$0.00	$0.00	$25.15	$0.00	$0.00	$0.00	$0.00	$0.00
27204675	EAP	HCPCS C1894		Set Introd .018in 4fr 10cm 40c	BOTH IP/OP	$123.00 	$91.02	$0.00	$98.40	$66.79	$66.79	$0.00	$0.00	$0.00	$25.64	$91.29	$91.29	$94.81	$0.00	$25.63	$0.00	$72.75	$72.75	$0.00	$61.50	$97.42	$98.40	$0.00	$0.00	$0.00	$19.25	$0.00	$0.00	$19.58	$0.00	$0.00	$0.00	$0.00	$0.00
27204676	EAP	HCPCS C1769		Set Introd 24-26-28fr Cgl Brhn	BOTH IP/OP	$905.00 	$669.70	$0.00	$724.00	$491.42	$491.42	$0.00	$0.00	$0.00	$188.62	$671.69	$671.69	$697.57	$0.00	$188.60	$0.00	$535.31	$535.31	$0.00	$452.50	$716.76	$724.00	$0.00	$0.00	$0.00	$141.63	$0.00	$0.00	$144.08	$0.00	$0.00	$0.00	$0.00	$0.00
27204677	EAP	HCPCS C1894		Set Introd .018in 4fr 21ga 40c	BOTH IP/OP	$83.00 	$61.42	$0.00	$66.40	$45.07	$45.07	$0.00	$0.00	$0.00	$17.30	$61.60	$61.60	$63.98	$0.00	$17.30	$0.00	$49.09	$49.09	$0.00	$41.50	$65.74	$66.40	$0.00	$0.00	$0.00	$12.99	$0.00	$0.00	$13.21	$0.00	$0.00	$0.00	$0.00	$0.00
27204678	EAP	Custom 27204678		Set Introd .018in Long 5fr 21g	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.51	$70.51	$73.23	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$47.50	$75.24	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204679	EAP	Custom 27204679		Set Introd .018in Long 5fr 70c	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.51	$70.51	$73.23	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$47.50	$75.24	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204680	EAP	HCPCS C1894		Set Introd 6fr 13cm 20cm Sidea	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$21.72	$21.72	$0.00	$0.00	$0.00	$8.34	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$23.66	$23.66	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$6.26	$0.00	$0.00	$6.37	$0.00	$0.00	$0.00	$0.00	$0.00
27204681	EAP	HCPCS C1894		Set Introd .038in 11fr 15.5cm	BOTH IP/OP	$106.00 	$78.44	$0.00	$84.80	$57.56	$57.56	$0.00	$0.00	$0.00	$22.09	$78.67	$78.67	$81.70	$0.00	$22.09	$0.00	$62.70	$62.70	$0.00	$53.00	$83.95	$84.80	$0.00	$0.00	$0.00	$16.59	$0.00	$0.00	$16.88	$0.00	$0.00	$0.00	$0.00	$0.00
27204682	EAP	HCPCS C1894		Set Introd .038in 12fr 15.5cm	BOTH IP/OP	$106.00 	$78.44	$0.00	$84.80	$57.56	$57.56	$0.00	$0.00	$0.00	$22.09	$78.67	$78.67	$81.70	$0.00	$22.09	$0.00	$62.70	$62.70	$0.00	$53.00	$83.95	$84.80	$0.00	$0.00	$0.00	$16.59	$0.00	$0.00	$16.88	$0.00	$0.00	$0.00	$0.00	$0.00
27204683	EAP	HCPCS C1894		Set Introd .038in 14fr 15.5cm	BOTH IP/OP	$106.00 	$78.44	$0.00	$84.80	$57.56	$57.56	$0.00	$0.00	$0.00	$22.09	$78.67	$78.67	$81.70	$0.00	$22.09	$0.00	$62.70	$62.70	$0.00	$53.00	$83.95	$84.80	$0.00	$0.00	$0.00	$16.59	$0.00	$0.00	$16.88	$0.00	$0.00	$0.00	$0.00	$0.00
27204684	EAP	HCPCS C1894		Set Introd 18fr 15.5cm Peel-aw	BOTH IP/OP	$106.00 	$78.44	$0.00	$84.80	$57.56	$57.56	$0.00	$0.00	$0.00	$22.09	$78.67	$78.67	$81.70	$0.00	$22.09	$0.00	$62.70	$62.70	$0.00	$53.00	$83.95	$84.80	$0.00	$0.00	$0.00	$16.59	$0.00	$0.00	$16.88	$0.00	$0.00	$0.00	$0.00	$0.00
27204685	EAP	HCPCS C1769		Set Introd 8fr J Tip Needle Gu	BOTH IP/OP	"$1,198.00 "	$886.52	$0.00	$958.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.00	$948.82	$958.40	$0.00	$0.00	$0.00	$187.49	$0.00	$0.00	$190.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204686	EAP	Custom 27204686		Set Introd .018in Micro Str 7f	BOTH IP/OP	$153.00 	$113.22	$0.00	$122.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$113.56	$113.56	$117.93	$0.00	$31.89	$0.00	$0.00	$0.00	$0.00	$76.50	$121.18	$122.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204687	EAP	HCPCS C1894		Set Introd 16fr 20-35mm 70cm G	BOTH IP/OP	$713.00 	$527.62	$0.00	$570.40	$387.16	$387.16	$0.00	$0.00	$0.00	$148.61	$529.19	$529.19	$549.58	$0.00	$148.59	$0.00	$421.74	$421.74	$0.00	$356.50	$564.70	$570.40	$0.00	$463.45	$0.00	$111.58	$0.00	$0.00	$113.51	$0.00	$0.00	$0.00	$0.00	$0.00
27204688	EAP	HCPCS C1894		Set Introd 6fr 8fr 13.75in 3 W	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$135.21	$135.21	$0.00	$0.00	$0.00	$51.90	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$147.28	$147.28	$0.00	$124.50	$197.21	$199.20	$0.00	$161.85	$0.00	$38.97	$0.00	$0.00	$39.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204689	EAP	HCPCS C1894		Set Introd 6fr 8fr 17.75in 3 W	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$135.21	$135.21	$0.00	$0.00	$0.00	$51.90	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$147.28	$147.28	$0.00	$124.50	$197.21	$199.20	$0.00	$0.00	$0.00	$38.97	$0.00	$0.00	$39.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204690	EAP	HCPCS C1887		"Catherer, Guiding"	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204691	EAP	HCPCS C1887		Catheter Angiographic Cobra 2 Curve 4fr .041in 65c	BOTH IP/OP	$613.00 	$453.62	$0.00	$490.40	$332.86	$332.86	$0.00	$0.00	$0.00	$127.76	$454.97	$454.97	$472.50	$0.00	$127.75	$0.00	$362.59	$362.59	$0.00	$306.50	$485.50	$490.40	$0.00	$398.45	$0.00	$95.93	$0.00	$0.00	$97.59	$0.00	$0.00	$0.00	$0.00	$0.00
27204694	EAP	HCPCS C1769		Guidewire Vasc 300cm Rnd Prfl Agile Tip Smtr Rot	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$814.50	$814.50	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
27204695	EAP	HCPCS C1757		"Indigo Catheter 8, Xtorq Tip 115cm"	BOTH IP/OP	"$7,255.00 "	"$5,368.70"	$0.00	"$5,804.00"	"$3,939.47"	"$3,939.47"	$0.00	$0.00	$0.00	"$1,512.12"	"$4,181.12"	"$4,181.12"	"$5,592.15"	$0.00	"$1,511.94"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,627.50"	"$5,745.96"	"$5,804.00"	$0.00	"$4,715.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204696	EAP	Custom 27204696		Indigo Separator 8	BOTH IP/OP	"$4,700.00 "	"$3,478.00"	$0.00	"$3,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,488.34"	"$3,488.34"	"$3,622.76"	$0.00	$979.48	$0.00	$0.00	$0.00	$0.00	"$2,350.00"	"$3,722.40"	"$3,760.00"	$0.00	"$3,055.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204697	EAP	Custom 27204697		Max Aspiration Tubing 3	BOTH IP/OP	"$1,095.00 "	$810.30	$0.00	$876.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$812.71	$812.71	$844.03	$0.00	$228.20	$0.00	$0.00	$0.00	$0.00	$547.50	$867.24	$876.00	$0.00	$711.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204698	EAP	Custom 27204698		Sealant Hemostatic Needle Free Adapter Floseal Matrix 10ml	BOTH IP/OP	$913.00 	$675.62	$0.00	$730.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$677.63	$677.63	$703.74	$0.00	$190.27	$0.00	$0.00	$0.00	$0.00	$456.50	$723.10	$730.40	$0.00	$593.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204699	EAP	Custom 27204699		Sealant Hemostatic Needle Free Adapter Floseal Matrix 5ml	BOTH IP/OP	$499.00 	$369.26	$0.00	$399.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$370.36	$370.36	$384.63	$0.00	$103.99	$0.00	$0.00	$0.00	$0.00	$249.50	$395.21	$399.20	$0.00	$324.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204700	EAP	HCPCS C1887		Catheter Interventional 6fr .07in .056in 145cm 20c	BOTH IP/OP	"$1,183.00 "	$875.42	$0.00	$946.40	$642.37	$642.37	$0.00	$0.00	$0.00	$246.57	$878.02	$878.02	$911.86	$0.00	$246.54	$0.00	$699.74	$699.74	$0.00	$591.50	$936.94	$946.40	$0.00	$768.95	$0.00	$185.14	$0.00	$0.00	$188.33	$0.00	$0.00	$0.00	$0.00	$0.00
27204702	EAP	HCPCS C1766		Introducer Shth 8.8fr 7fr 55cm Hi Flx Dilat	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$74.93	$74.93	$0.00	$0.00	$0.00	$28.76	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$81.63	$81.63	$0.00	$69.00	$109.30	$110.40	$0.00	$0.00	$0.00	$21.60	$0.00	$0.00	$21.97	$0.00	$0.00	$0.00	$0.00	$0.00
27204705	EAP			Catheter Echelon 10 Micro	BOTH IP/OP	"$1,687.00 "	"$1,248.38"	$0.00	"$1,349.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,252.09"	"$1,252.09"	"$1,300.34"	$0.00	$351.57	$0.00	$0.00	$0.00	$0.00	$843.50	"$1,336.10"	"$1,349.60"	$0.00	"$1,096.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204707	EAP			Amplatz Super Stiff Exchange Guidewire .038x260	BOTH IP/OP	$96.00 	$71.04	$0.00	$76.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.00	$76.03	$76.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204708	EAP	HCPCS C1769		Guidewire .016 Fathom	BOTH IP/OP	$893.00 	$660.82	$0.00	$714.40	$484.90	$484.90	$0.00	$0.00	$0.00	$186.12	$662.78	$662.78	$688.32	$0.00	$186.10	$0.00	$528.21	$528.21	$0.00	$446.50	$707.26	$714.40	$0.00	$580.45	$0.00	$139.75	$0.00	$0.00	$142.17	$0.00	$0.00	$0.00	$0.00	$0.00
27204709	EAP	Custom 27204709		Valve Rotating Hemostatic	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204710	EAP	Custom 27204710		Manifold Kit	BOTH IP/OP	$58.00 	$42.92	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.05	$43.05	$44.71	$0.00	$12.09	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$37.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204711	EAP	HCPCS C1887		Axs Catalyst 5 Distal Access Catheter 0.058in X 11	BOTH IP/OP	"$3,878.00 "	"$2,869.72"	$0.00	"$3,102.40"	"$2,105.75"	"$2,105.75"	$0.00	$0.00	$0.00	$808.27	"$2,878.25"	"$2,878.25"	"$2,989.16"	$0.00	$808.18	$0.00	"$2,293.84"	"$2,293.84"	$0.00	"$1,939.00"	"$3,071.38"	"$3,102.40"	$0.00	"$2,520.70"	$0.00	$606.91	$0.00	$0.00	$617.38	$0.00	$0.00	$0.00	$0.00	$0.00
27204712	EAP	HCPCS C1769		Contol Wire 200cm .018 V-18	BOTH IP/OP	$227.00 	$167.98	$0.00	$181.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$113.50	$179.78	$181.60	$0.00	$0.00	$0.00	$35.53	$0.00	$0.00	$36.14	$0.00	$0.00	$0.00	$0.00	$0.00
27204714	EAP	HCPCS C1894		Introducer Shth 8fr 2.9mm 80cm Flxr Strl Acpt .038	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$96.35	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00	$0.00	$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
27204715	EAP	HCPCS C1894		Introducer Shth 8fr 90cm Sm Vlv Asmbly Radiopq	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$78.74	$78.74	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$111.77	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00	$0.00	$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
27204716	EAP	Custom 27204716		Kit Pricrdcts 40cm 8fr Pgtl Curve Cath	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.31	$232.31	$241.26	$0.00	$65.23	$0.00	$0.00	$0.00	$0.00	$156.50	$247.90	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204717	EAP	Custom 27204717		Catheter Angiographic Cobra 2 Curve 5fr 80cm Torcon Nb	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204718	EAP	HCPCS C1887		Catheter Angiographic .046in Uac Curve 5fr .046in 90cm	BOTH IP/OP	$150.00 	$111.00	$0.00	$115.62	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$17.50	$27.72	$28.00	$0.00	$97.50	$0.00	$5.48	$0.00	$0.00	$5.57	$0.00	$0.00	$0.00	$0.00	$0.00
27204719	EAP	HCPCS C1725		Cath Baldilat 4mm 8mm Coron Rapex Nc Trek Angiopls	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
27204720	EAP	HCPCS C1725		Cath Baldilat 4mm 15mm Coron Rapex Nc Trek Angiopl	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
27204721	EAP	HCPCS C1725		Cath Baldilat 4mm 20mm Coron Rapex Nc Trek Angiopl	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
27204722	EAP	HCPCS C1894		Introducer Sheath .035in 10fr .134in 45cm Anl0 Curve Str Tip	BOTH IP/OP	$113.00 	$83.62	$0.00	$90.40	$61.36	$61.36	$0.00	$0.00	$0.00	$23.55	$83.87	$83.87	$87.10	$0.00	$23.55	$0.00	$66.84	$66.84	$0.00	$56.50	$89.50	$90.40	$0.00	$73.45	$0.00	$17.68	$0.00	$0.00	$17.99	$0.00	$0.00	$0.00	$0.00	$0.00
27204723	EAP	HCPCS C1894		Introducer Sheath .035in 12fr .162in 45cm Anl0 Curve Str Tip	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$74.93	$74.93	$0.00	$0.00	$0.00	$28.76	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$81.63	$81.63	$0.00	$69.00	$109.30	$110.40	$0.00	$89.70	$0.00	$21.60	$0.00	$0.00	$21.97	$0.00	$0.00	$0.00	$0.00	$0.00
27204724	EAP	Custom 27204724		Set Ndl 45mm 15ga Ezio Ss 1 Port Shrp Block Drsg	BOTH IP/OP	"$1,663.00 "	"$1,230.62"	$0.00	"$1,330.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,234.28"	"$1,234.28"	"$1,281.84"	$0.00	$346.57	$0.00	$0.00	$0.00	$0.00	$831.50	"$1,317.10"	"$1,330.40"	$0.00	"$1,080.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204725	EAP	HCPCS C1773		Snare Endscp .98in 47in 1 Loop Gold Plated Tungsten	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$488.70	$488.70	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$693.72	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00	$585.00	$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
27204726	EAP	HCPCS C1773		Separator Thrmb Indg 6 Latex Free	BOTH IP/OP	"$2,700.00 "	"$1,998.00"	$0.00	"$2,160.00"	"$1,466.10"	"$1,466.10"	$0.00	$0.00	$0.00	$562.75	"$2,003.94"	"$2,003.94"	"$2,081.16"	$0.00	$562.68	$0.00	"$1,597.05"	"$1,597.05"	$0.00	"$1,350.00"	"$2,138.40"	"$2,160.00"	$0.00	"$1,755.00"	$0.00	$422.55	$0.00	$0.00	$429.84	$0.00	$0.00	$0.00	$0.00	$0.00
27204729	EAP	HCPCS C1757		Catheter Thrmb 6fr Indg Aspirat Latex Free	BOTH IP/OP	"$4,725.00 "	"$3,496.50"	$0.00	"$3,780.00"	"$2,565.68"	"$2,565.68"	$0.00	$0.00	$0.00	$984.81	"$3,506.90"	"$3,506.90"	"$3,642.03"	$0.00	$984.69	$0.00	"$2,794.84"	"$2,794.84"	$0.00	"$2,362.50"	"$3,742.20"	"$3,780.00"	$0.00	"$3,071.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204730	EAP	HCPCS C1757		Catheter Thrmb 132cm 5-6fr .064in .054in Peri Unq	BOTH IP/OP	"$2,908.00 "	"$2,151.92"	$0.00	"$2,326.40"	"$1,579.04"	"$1,579.04"	$0.00	$0.00	$0.00	$606.10	"$2,158.32"	"$2,158.32"	"$2,241.49"	$0.00	$606.03	$0.00	"$1,720.08"	"$1,720.08"	$0.00	"$1,454.00"	"$2,303.14"	"$2,326.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204731	EAP	HCPCS C1757		Catheter Thrmb 150cm 3.4-4.1fr .041in .032in Peri	BOTH IP/OP	"$2,908.00 "	"$2,151.92"	$0.00	"$2,326.40"	"$1,579.04"	"$1,579.04"	$0.00	$0.00	$0.00	$606.10	"$2,158.32"	"$2,158.32"	"$2,241.49"	$0.00	$606.03	$0.00	"$1,720.08"	"$1,720.08"	$0.00	"$1,454.00"	"$2,303.14"	"$2,326.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204733	EAP	HCPCS C1757		Catheter Thrmb 85cm 8fr Indg Aspirat Trq Tip Latex	BOTH IP/OP	"$7,225.00 "	"$5,346.50"	$0.00	"$5,780.00"	"$3,923.18"	"$3,923.18"	$0.00	$0.00	$0.00	"$1,505.87"	"$4,181.12"	"$4,181.12"	"$5,569.03"	$0.00	"$1,505.69"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,612.50"	"$5,722.20"	"$5,780.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204736	EAP	HCPCS C1887		Six Fr Asahi Fubuki Guide Catheter Dilator Kit/90cm/straight 	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$162.90	$162.90	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
27204737	EAP	HCPCS C1887		Six Fr Asahi Fubuki Guide Catheter Dilator Kit 80cm/straight	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$162.90	$162.90	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$195.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
27204738	EAP	HCPCS C1894		Introducer Shth 7fr 2.5cm 10cm Dilat Radiopq Mrkr	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$30.41	$30.41	$0.00	$0.00	$0.00	$11.67	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$33.12	$33.12	$0.00	$28.00	$44.35	$44.80	$0.00	$36.40	$0.00	$8.76	$0.00	$0.00	$8.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204739	EAP	HCPCS C1894		Introducer Shth 8fr 2.5cm 10cm Gwire Dilat Radiopq	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$30.41	$30.41	$0.00	$0.00	$0.00	$11.67	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$33.12	$33.12	$0.00	$28.00	$44.35	$44.80	$0.00	$36.40	$0.00	$8.76	$0.00	$0.00	$8.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204740	EAP	HCPCS C1894		Introducer Shth 7fr 2.5cm 25cm Dilat Radiopq Mrkr	BOTH IP/OP	$71.00 	$52.54	$0.00	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.50	$56.23	$56.80	$0.00	$0.00	$0.00	$11.11	$0.00	$0.00	$11.30	$0.00	$0.00	$0.00	$0.00	$0.00
27204741	EAP	HCPCS C1894		Introducer Shth 8fr 2.5cm 25cm Dilat Radiopq Mrkr	BOTH IP/OP	$71.00 	$52.54	$0.00	$56.80	$38.55	$38.55	$0.00	$0.00	$0.00	$14.80	$52.70	$52.70	$54.73	$0.00	$14.80	$0.00	$42.00	$42.00	$0.00	$35.50	$56.23	$56.80	$0.00	$46.15	$0.00	$11.11	$0.00	$0.00	$11.30	$0.00	$0.00	$0.00	$0.00	$0.00
27204742	EAP	HCPCS C1887		Catheter Angiographic Judkins Right 4 Curve 5fr 10	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$60.27	$60.27	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$85.56	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00	$72.15	$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
27204747	EAP	Custom 27204747		Kit Pressure Monitr 14ga Basic Transducer Tuohy Needle	BOTH IP/OP	"$1,883.00 "	"$1,393.42"	$0.00	"$1,506.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,397.56"	"$1,397.56"	"$1,451.42"	$0.00	$392.42	$0.00	$0.00	$0.00	$0.00	$941.50	"$1,491.34"	"$1,506.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204748	EAP	Custom 27204748		Kit Craniotomy Cranial Acces Codman	BOTH IP/OP	$635.00 	$469.90	$0.00	$508.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$471.30	$471.30	$489.46	$0.00	$132.33	$0.00	$0.00	$0.00	$0.00	$317.50	$502.92	$508.00	$0.00	$412.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204749	EAP	Custom 27204749		System Drain Complete Nonvented Catheter Latex Free Eds Iii	BOTH IP/OP	$373.00 	$276.02	$0.00	$298.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.50	$295.42	$298.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204750	EAP	HCPCS C1751		Catheter Cen Ven .032in 9.3fr 38cm 75cm 3 Infus Lumen Extn	BOTH IP/OP	"$1,995.00 "	"$1,476.30"	$0.00	"$1,596.00"	"$1,083.29"	"$1,083.29"	$0.00	$0.00	$0.00	$415.81	"$1,480.69"	"$1,480.69"	"$1,537.75"	$0.00	$415.76	$0.00	"$1,180.04"	"$1,180.04"	$0.00	$997.50	"$1,580.04"	"$1,596.00"	$0.00	$0.00	$0.00	$312.22	$0.00	$0.00	$317.60	$0.00	$0.00	$0.00	$0.00	$0.00
27204751	EAP	HCPCS C1751		Catheter Cen Ven 9.3fr 22cm 58mm Ods	BOTH IP/OP	"$1,228.00 "	$908.72	$0.00	$982.40	$666.80	$666.80	$0.00	$0.00	$0.00	$255.95	$911.42	$911.42	$946.54	$0.00	$255.92	$0.00	$726.36	$726.36	$0.00	$614.00	$972.58	$982.40	$0.00	$0.00	$0.00	$192.18	$0.00	$0.00	$195.50	$0.00	$0.00	$0.00	$0.00	$0.00
27204752	EAP	HCPCS C1757		"Dawn Ide, Trevo Xp 6x25 Kit"	BOTH IP/OP	"$12,766.00 "	"$9,446.84"	$0.00	"$10,212.80"	"$6,931.94"	"$6,931.94"	$0.00	$0.00	$0.00	"$2,660.75"	"$4,181.12"	"$4,181.12"	"$9,840.03"	$0.00	"$2,660.43"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$6,383.00"	"$10,110.67"	"$10,212.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204753	EAP	HCPCS C1757		"Dawn Ide, Trevo Xp 4x30 Kit"	BOTH IP/OP	"$12,766.00 "	"$9,446.84"	$0.00	"$10,212.80"	"$6,931.94"	"$6,931.94"	$0.00	$0.00	$0.00	"$2,660.75"	"$4,181.12"	"$4,181.12"	"$9,840.03"	$0.00	"$2,660.43"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$6,383.00"	"$10,110.67"	"$10,212.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204754	EAP	HCPCS C1769		Guidewire Vascular .014in 300cm 11cm Radiopq Str T	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$244.35	$244.35	$0.00	$0.00	$0.00	$93.79	$333.99	$333.99	$346.86	$0.00	$93.78	$0.00	$266.18	$266.18	$0.00	$225.00	$356.40	$360.00	$0.00	$292.50	$0.00	$70.43	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204755	EAP	HCPCS C1769		Guidewire Vasc 180cm Asahi Ptca Sion Blue	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$243.75	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27204756	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Str 3cm Sion Asahi Ss	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$243.75	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27204757	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in 3 Radiopq Seg Str 3cm	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27204758	EAP	HCPCS C1769		Guidewire Vasc Rg3	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$312.23	$312.23	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$443.21	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$287.50	$455.40	$460.00	$0.00	$0.00	$0.00	$89.99	$0.00	$0.00	$91.54	$0.00	$0.00	$0.00	$0.00	$0.00
27204759	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Radiopq Str Tip 11cm	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$244.35	$244.35	$0.00	$0.00	$0.00	$93.79	$333.99	$333.99	$346.86	$0.00	$93.78	$0.00	$266.18	$266.18	$0.00	$225.00	$356.40	$360.00	$0.00	$0.00	$0.00	$70.43	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$0.00
27204760	EAP	HCPCS C1769		Catheter Guid Extra Backup 4.5 Left Curve 6fr .071	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204761	EAP	HCPCS C1769		Catheter Guid Xb 5 Left Curve 6fr .071in 100cm	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204762	EAP	HCPCS C1769		Catheter Atherectomy .017in .018in 165cm Shapable	BOTH IP/OP	"$4,800.00 "	"$3,552.00"	$0.00	"$3,840.00"	"$2,606.40"	"$2,606.40"	$0.00	$0.00	$0.00	"$1,000.44"	"$3,562.56"	"$3,562.56"	"$3,699.84"	$0.00	"$1,000.32"	$0.00	"$2,839.20"	"$2,839.20"	$0.00	"$2,400.00"	"$3,801.60"	"$3,840.00"	$0.00	$0.00	$0.00	$751.20	$0.00	$0.00	$764.16	$0.00	$0.00	$0.00	$0.00	$0.00
27204763	EAP	HCPCS C1882		Catheter Angio .035in Vert Curve 5fr .046in 125cm	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$19.01	$19.01	$0.00	$0.00	$0.00	$7.29	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$20.70	$20.70	$0.00	$17.50	$27.72	$28.00	$0.00	$22.75	$0.00	$5.48	$0.00	$0.00	$5.57	$0.00	$0.00	$0.00	$0.00	$0.00
27204764	EAP	HCPCS C1887		Catheter Guid Jr4 Curve 8fr 90cm Coron Sh Lnchr	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204765	EAP	HCPCS C1887		Catheter Guid Al1 Curve 8fr 90cm Coron Sh Lnchr	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$105.95	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204766	EAP	HCPCS C1887		Catheter Guid 3drc Curve 8fr 90cm Coron Lnchr	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204767	EAP	HCPCS C1887		Catheter Guid 3 Dmn Right Curve 8fr .09in 90cm	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204768	EAP	HCPCS C1887		Catheter Guid Al1.5 Curve 8fr .09in 90cm Coron	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204769	EAP	HCPCS C1887		Catheter Guid Al1.5 Curve 8fr 90cm Coron Sh Lnchr	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204770	EAP	HCPCS C1887		Catheter Guid Al2 Curve 8fr 90cm Coron Lnchr	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204771	EAP	HCPCS C1887		Catheter Guid Al2 Curve 8fr .09in 90cm Coron Sh	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204772	EAP	HCPCS C1887		Catheter Guid Xb4 Curve 8fr 90cm Coron Lnchr	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204773	EAP	HCPCS C1887		Catheter Guid Xb3.5 Curve 8fr 90cm Coron Sh Lnchr	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204774	EAP	HCPCS C1887		Catheter Guid Ebu3.75 Curve 8fr .09in 90cm Coron	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204775	EAP	HCPCS C1887		Catheter Guid Xb4 Curve 8fr 90cm Coron Sh Lnchr	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204776	EAP	HCPCS C1887		Catheter Guid Al1 Curve 8fr 90cm Coron Lnchr	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204777	EAP	HCPCS C1725		Catheter Baldilat Lp Taper 4.8fr 6mm 135cm 80mm Ot	BOTH IP/OP	$686.00 	$507.64	$0.00	$548.80	$372.50	$372.50	$0.00	$0.00	$0.00	$142.98	$509.15	$509.15	$528.77	$0.00	$142.96	$0.00	$405.77	$405.77	$0.00	$343.00	$543.31	$548.80	$0.00	$0.00	$0.00	$107.36	$0.00	$0.00	$109.21	$0.00	$0.00	$0.00	$0.00	$0.00
27204778	EAP	Custom 27204778		Catheter Angio Bcn Sim2 Curve 5fr 125cm Ss Nyl	BOTH IP/OP	$33.00 	$24.42	$0.00	$26.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.50	$26.14	$26.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204779	EAP	HCPCS C1887		Catheter Thrmb 125cm 6fr Neuron Sim Curve Slct	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$169.96	$169.96	$0.00	$0.00	$0.00	$65.24	$232.31	$232.31	$241.26	$0.00	$65.23	$0.00	$185.14	$185.14	$0.00	$156.50	$247.90	$250.40	$0.00	$203.45	$0.00	$48.98	$0.00	$0.00	$49.83	$0.00	$0.00	$0.00	$0.00	$0.00
27204782	EAP	HCPCS C1725		Catheter Baldilat Lp Taper 3.8fr 4mm 135cm 80mm Otw Inflat	BOTH IP/OP	$686.00 	$507.64	$0.00	$548.80	$372.50	$372.50	$0.00	$0.00	$0.00	$142.98	$509.15	$509.15	$528.77	$0.00	$142.96	$0.00	$405.77	$405.77	$0.00	$343.00	$543.31	$548.80	$0.00	$0.00	$0.00	$107.36	$0.00	$0.00	$109.21	$0.00	$0.00	$0.00	$0.00	$0.00
27204783	EAP	HCPCS C1753		Catheter Ultrasound .035in 8.5fr 90cm 100cm Otw Radiopq	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,357.50"	"$1,357.50"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	"$1,927.00"	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00	"$1,625.00"	$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204785	EAP	HCPCS C1725		Catheter Baldilat Ultra Lp Taper 6fr 4mm 150cm 220mm Coyote	BOTH IP/OP	$857.00 	$634.18	$0.00	$685.60	$465.35	$465.35	$0.00	$0.00	$0.00	$178.62	$636.07	$636.07	$660.58	$0.00	$178.60	$0.00	$506.92	$506.92	$0.00	$428.50	$678.74	$685.60	$0.00	$557.05	$0.00	$134.12	$0.00	$0.00	$136.43	$0.00	$0.00	$0.00	$0.00	$0.00
27204786	EAP	HCPCS C1769		Guidewire Vascular Str Short Taper .014in 300cm 8cm Robust	BOTH IP/OP	$343.00 	$253.82	$0.00	$274.40	$186.25	$186.25	$0.00	$0.00	$0.00	$71.49	$254.57	$254.57	$264.38	$0.00	$71.48	$0.00	$202.88	$202.88	$0.00	$171.50	$271.66	$274.40	$0.00	$222.95	$0.00	$53.68	$0.00	$0.00	$54.61	$0.00	$0.00	$0.00	$0.00	$0.00
27204787	EAP	Custom 27204787		Omni Flush (vcf) 5fr 100cm	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204790	EAP	HCPCS C1884		System Embl Prtc 104.5cm .035in Prox Crbrl Cath	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	"$2,172.00"	"$2,172.00"	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	"$3,083.20"	$0.00	$833.60	$0.00	"$2,366.00"	"$2,366.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00	"$2,600.00"	$0.00	$626.00	$0.00	$0.00	$636.80	$0.00	$0.00	$0.00	$0.00	$0.00
27204791	EAP	CPT® C1894		Set Introd .018in 5fr 21ga 40c	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00	$0.00	$0.00	$16.43	$0.00	$0.00	$16.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204792	EAP	Custom 27204792		Band Compression Regular 24cm 2 Balloon Air Injec Port	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.50	$59.40	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204793	EAP	Custom 27204793		Catheter Angiographic .038in 21ml/sec Radial Tiger Curve Str	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.00	$69.70	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204795	EAP	HCPCS C1894		Introducer Sheath .021in Str Thin Wall 6fr 20ga 10cm 45cm	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$74.93	$74.93	$0.00	$0.00	$0.00	$28.76	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$81.63	$81.63	$0.00	$69.00	$109.30	$110.40	$0.00	$89.70	$0.00	$21.60	$0.00	$0.00	$21.97	$0.00	$0.00	$0.00	$0.00	$0.00
27204796	EAP	Custom 27204796		Tray Amniocentesis 20ga 3.5in	BOTH IP/OP	$32.00 	$23.68	$0.00	$25.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.75	$23.75	$24.67	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$16.00	$25.34	$25.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204797	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Strbl Radiopq Kink Rst	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$20.63	$20.63	$0.00	$0.00	$0.00	$7.92	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$22.48	$22.48	$0.00	$19.00	$30.10	$30.40	$0.00	$24.70	$0.00	$5.95	$0.00	$0.00	$6.05	$0.00	$0.00	$0.00	$0.00	$0.00
27204798	EAP	Custom 27204798		Tube Gastrostomy 20fr 14.25x11.25x9in Handrail Chr	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.40	$33.40	$34.69	$0.00	$9.38	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$0.00	$29.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204799	EAP	Custom 27204799		Needle Intraosseous 15ga 25mm Ez Connect Wrist Ban	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	"$1,059.85"	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00	$893.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204802	EAP	HCPCS C1725		Catheter Baldilat 5fr 4mm 130cm 80mm Pcltxl	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,900.50"	"$1,900.50"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	"$2,070.25"	"$2,070.25"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204806	EAP	HCPCS C1725		Catheter Baldilat 5fr 5mm 130cm 40mm Pcltxl	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,900.50"	"$1,900.50"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	"$2,070.25"	"$2,070.25"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204807	EAP	HCPCS C1725		Catheter Baldilat 5fr 5mm 130cm 60mm Pcltxl	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,900.50"	"$1,900.50"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	"$2,070.25"	"$2,070.25"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204810	EAP	HCPCS C1757		Solitaire Revascularization Device 4-20-10	BOTH IP/OP	"$10,563.00 "	"$7,816.62"	$0.00	"$8,450.40"	"$5,735.71"	"$5,735.71"	$0.00	$0.00	$0.00	"$2,201.59"	"$4,181.12"	"$4,181.12"	"$8,141.96"	$0.00	"$2,201.33"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,281.50"	"$8,365.90"	"$8,450.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204811	EAP	HCPCS C1757		SOLITAIRE PLATINUM 6X20	BOTH IP/OP	"$10,563.00 "	"$7,816.62"	$0.00	"$8,450.40"	"$5,735.71"	"$5,735.71"	$0.00	$0.00	$0.00	"$2,201.59"	"$4,181.12"	"$4,181.12"	"$8,141.96"	$0.00	"$2,201.33"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,281.50"	"$8,365.90"	"$8,450.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204812	EAP	HCPCS C1757		Solitaire Platinum Revascularization Device 4-40	BOTH IP/OP	"$10,563.00 "	"$7,816.62"	$0.00	"$8,450.40"	"$4,753.35"	"$4,753.35"	$0.00	$0.00	$0.00	"$2,201.59"	"$4,181.12"	"$4,181.12"	"$8,141.96"	$0.00	"$2,201.33"	$0.00	"$5,207.56"	"$5,207.56"	$0.00	"$5,281.50"	"$8,365.90"	"$8,450.40"	$0.00	"$4,753.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204813	EAP	HCPCS C1758		Catheter Urethral 16fr Foley 2 Way Medium Olive Coude Tip 1	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$14.12	$14.12	$0.00	$0.00	$0.00	$5.42	$19.30	$19.30	$20.04	$0.00	$5.42	$0.00	$15.38	$15.38	$0.00	$13.00	$20.59	$20.80	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$4.14	$0.00	$0.00	$0.00	$0.00	$0.00
27204814	EAP	HCPCS C1887		Catheter Angiographic Cobra 2 Curve 4fr .041in 65cm 2 Braid	BOTH IP/OP	$613.00 	$453.62	$0.00	$490.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.50	$485.50	$490.40	$0.00	$0.00	$0.00	$95.93	$0.00	$0.00	$97.59	$0.00	$0.00	$0.00	$0.00	$0.00
27204817	EAP	HCPCS C1725		Catheter Baldilat 6mm 130cm 40mm Lutonix Acpt 6fr	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,900.50"	"$1,900.50"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	"$2,070.25"	"$2,070.25"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204818	EAP	HCPCS C1725		Catheter Baldilat 6fr 6mm 130cm 60mm Pcltxl	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,900.50"	"$1,900.50"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	"$2,070.25"	"$2,070.25"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204819	EAP	HCPCS C1725		Catheter Baldilat 6fr 6mm 130cm 80mm Pcltxl	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,900.50"	"$1,900.50"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	"$2,070.25"	"$2,070.25"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204822	EAP	HCPCS C1725		Catheter Baldilat 6fr 6mm 130cm 150mm Pcltxl	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,900.50"	"$1,900.50"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	"$2,070.25"	"$2,070.25"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27204823	EAP	HCPCS C1894		Introducer Sheath .038in Stand	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$24.44	$24.44	$0.00	$0.00	$0.00	$9.38	$33.40	$33.40	$34.69	$0.00	$9.38	$0.00	$26.62	$26.62	$0.00	$22.50	$35.64	$36.00	$0.00	$29.25	$0.00	$7.04	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00
27204824	EAP	Custom 27204824		Set Tubing 2.6mr 2 Way Communication Irrigation Pump	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204825	EAP	HCPCS C1751		Axs Catalyst 6 Distal Access Catheter	BOTH IP/OP	"$4,875.00 "	"$3,607.50"	$0.00	"$3,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,437.50"	"$3,861.00"	"$3,900.00"	$0.00	$0.00	$0.00	$762.94	$0.00	$0.00	$776.10	$0.00	$0.00	$0.00	$0.00	$0.00
27204826	EAP	HCPCS C1751		Axs Catalyst 5 Distal Access Catheter	BOTH IP/OP	"$4,875.00 "	"$3,607.50"	$0.00	"$3,900.00"	"$2,647.13"	"$2,647.13"	$0.00	$0.00	$0.00	"$1,016.07"	"$3,618.23"	"$3,618.23"	"$3,757.65"	$0.00	"$1,015.95"	$0.00	"$2,883.56"	"$2,883.56"	$0.00	"$2,437.50"	"$3,861.00"	"$3,900.00"	$0.00	"$3,168.75"	$0.00	$762.94	$0.00	$0.00	$776.10	$0.00	$0.00	$0.00	$0.00	$0.00
27204827	EAP	HCPCS C1885		Catheter Angio Kmp Curve Ang 4fr 65cm Radiopq	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.00	$55.44	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204828	EAP	Custom 27204828		Bit Drill 25mm 4mm Strl	BOTH IP/OP	$143.00 	$105.82	$0.00	$114.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.13	$106.13	$110.22	$0.00	$29.80	$0.00	$0.00	$0.00	$0.00	$71.50	$113.26	$114.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204830	EAP	Custom 27204830		Impella Rp Us Hde Pump Set	BOTH IP/OP	"$62,500.00 "	"$46,250.00"	$0.00	"$66,625.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$48,175.00"	$0.00	"$13,025.00"	$0.00	$0.00	$0.00	$0.00	"$31,250.00"	"$49,500.00"	"$50,000.00"	$0.00	"$66,625.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204832	EAP	HCPCS C1894		Sheath Introd 16fr 6.2mm 5.3mm 28cm Dryseal Dilat	BOTH IP/OP	$668.00 	$494.32	$0.00	$534.40	$362.72	$362.72	$0.00	$0.00	$0.00	$139.23	$495.79	$495.79	$514.89	$0.00	$139.21	$0.00	$395.12	$395.12	$0.00	$334.00	$529.06	$534.40	$0.00	$434.20	$0.00	$104.54	$0.00	$0.00	$106.35	$0.00	$0.00	$0.00	$0.00	$0.00
27204833	EAP	Custom 27204833		Catheter Baldilat Tpr 10-50mm 65cm Stent Gft Flx	BOTH IP/OP	"$1,213.00 "	$897.62	$0.00	$970.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$900.29	$900.29	$934.98	$0.00	$252.79	$0.00	$0.00	$0.00	$0.00	$606.50	$960.70	$970.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204835	EAP	HCPCS C1757		System Thrmb Zelantedvt	BOTH IP/OP	"$7,313.00 "	"$5,411.62"	$0.00	"$5,850.40"	"$3,970.96"	"$3,970.96"	$0.00	$0.00	$0.00	"$1,524.21"	"$4,181.12"	"$4,181.12"	"$5,636.86"	$0.00	"$1,524.03"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,656.50"	"$5,791.90"	"$5,850.40"	$0.00	"$4,753.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204840	EAP	HCPCS C1884		Axs Infinity Ls .088 Long Guide Sheath 90cm	BOTH IP/OP	"$1,463.00 "	"$1,082.62"	$0.00	"$1,170.40"	$794.41	$794.41	$0.00	$0.00	$0.00	$304.93	"$1,085.84"	"$1,085.84"	"$1,127.68"	$0.00	$304.89	$0.00	$865.36	$865.36	$0.00	$731.50	"$1,158.70"	"$1,170.40"	$0.00	$950.95	$0.00	$228.96	$0.00	$0.00	$232.91	$0.00	$0.00	$0.00	$0.00	$0.00
27204841	EAP	HCPCS C1894		Axs Infinity Ls .088 Long Guide Sheath 80cm	BOTH IP/OP	"$1,463.00 "	"$1,082.62"	$0.00	"$1,170.40"	$794.41	$794.41	$0.00	$0.00	$0.00	$304.93	"$1,085.84"	"$1,085.84"	"$1,127.68"	$0.00	$304.89	$0.00	$865.36	$865.36	$0.00	$731.50	"$1,158.70"	"$1,170.40"	$0.00	$950.95	$0.00	$228.96	$0.00	$0.00	$232.91	$0.00	$0.00	$0.00	$0.00	$0.00
27204842	EAP	HCPCS C1773		Snare Vasc 175cm .16-.32in 3.2fr Ensnr Mini Ntnl 3	BOTH IP/OP	"$1,638.00 "	"$1,212.12"	$0.00	"$1,310.40"	$889.43	$889.43	$0.00	$0.00	$0.00	$341.40	"$1,215.72"	"$1,215.72"	"$1,262.57"	$0.00	$341.36	$0.00	$968.88	$968.88	$0.00	$819.00	"$1,297.30"	"$1,310.40"	$0.00	$0.00	$0.00	$256.35	$0.00	$0.00	$260.77	$0.00	$0.00	$0.00	$0.00	$0.00
27204843	EAP	HCPCS C2628		Er-reboa Catheter	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,708.48"	"$2,708.48"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,950.40"	"$2,950.40"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	"$3,242.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204844	EAP	HCPCS C1773		Snare Vasc 47in .71-1.18in .055in .074in Ensnr	BOTH IP/OP	$888.00 	$657.12	$0.00	$710.40	$482.18	$482.18	$0.00	$0.00	$0.00	$185.08	$659.07	$659.07	$684.47	$0.00	$185.06	$0.00	$525.25	$525.25	$0.00	$444.00	$703.30	$710.40	$0.00	$0.00	$0.00	$138.97	$0.00	$0.00	$141.37	$0.00	$0.00	$0.00	$0.00	$0.00
27204845	EAP	HCPCS C1894		Percutaneous Sheath Intro Kit 6f .035in X 10cm	BOTH IP/OP	$788.00 	$583.12	$0.00	$630.40	$427.88	$427.88	$0.00	$0.00	$0.00	$164.24	$584.85	$584.85	$607.39	$0.00	$164.22	$0.00	$466.10	$466.10	$0.00	$394.00	$624.10	$630.40	$0.00	$0.00	$0.00	$123.32	$0.00	$0.00	$125.45	$0.00	$0.00	$0.00	$0.00	$0.00
27204846	EAP	HCPCS C1769		Pericardio Set And Tray	BOTH IP/OP	$474.00 	$350.76	$0.00	$379.20	$257.38	$257.38	$0.00	$0.00	$0.00	$98.79	$351.80	$351.80	$365.36	$0.00	$98.78	$0.00	$280.37	$280.37	$0.00	$237.00	$375.41	$379.20	$0.00	$308.10	$0.00	$74.18	$0.00	$0.00	$75.46	$0.00	$0.00	$0.00	$0.00	$0.00
27204847	EAP	HCPCS C1894		Set Catheter .035in 15cm 70cm Sidehole Removable Stylet Tip	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27204848	EAP			"Flexor Ansel Guiding Sheath W/hfd, Check-flo 8f 2.9mm X 70cm Mp"	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204849	EAP	HCPCS C1894		Flexor Ansel Guiding Sheath W/check-flo 7f 2.5mm X 45cm Str	BOTH IP/OP	$113.00 	$83.62	$0.00	$90.40	$61.36	$61.36	$0.00	$0.00	$0.00	$23.55	$83.87	$83.87	$87.10	$0.00	$23.55	$0.00	$66.84	$66.84	$0.00	$56.50	$89.50	$90.40	$0.00	$73.45	$0.00	$17.68	$0.00	$0.00	$17.99	$0.00	$0.00	$0.00	$0.00	$0.00
27204850	EAP	HCPCS C1725		Viatrac 14 Plus Rx 5mm X 30mm X 135cm	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$339.38	$339.38	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$481.75	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00	$406.25	$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
27204851	EAP	HCPCS C1769		X-celerator .010 10cm X 300cm	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$447.98	$447.98	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$635.91	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$412.50	$653.40	$660.00	$0.00	$0.00	$0.00	$129.11	$0.00	$0.00	$131.34	$0.00	$0.00	$0.00	$0.00	$0.00
27204852	EAP	HCPCS C1725		"Mustang 7fr 12.0mm X 60mm, 135cm"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$385.40	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00	$325.00	$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
27204853	EAP	Custom 27204853		Sterling Otw 4mm X 60mm X 135cm	BOTH IP/OP	$685.00 	$506.90	$0.00	$548.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$508.41	$508.41	$528.00	$0.00	$142.75	$0.00	$0.00	$0.00	$0.00	$342.50	$542.52	$548.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204854	EAP	HCPCS C1725		Sterling Otw 5mm X 100mm X 135cm	BOTH IP/OP	$685.00 	$506.90	$0.00	$548.00	$371.96	$371.96	$0.00	$0.00	$0.00	$142.77	$508.41	$508.41	$528.00	$0.00	$142.75	$0.00	$405.18	$405.18	$0.00	$342.50	$542.52	$548.00	$0.00	$445.25	$0.00	$107.20	$0.00	$0.00	$109.05	$0.00	$0.00	$0.00	$0.00	$0.00
27204855	EAP	HCPCS C1725		Sterling Otw 6mm X 100mm X 135cm	BOTH IP/OP	$685.00 	$506.90	$0.00	$548.00	$371.96	$371.96	$0.00	$0.00	$0.00	$142.77	$508.41	$508.41	$528.00	$0.00	$142.75	$0.00	$405.18	$405.18	$0.00	$342.50	$542.52	$548.00	$0.00	$445.25	$0.00	$107.20	$0.00	$0.00	$109.05	$0.00	$0.00	$0.00	$0.00	$0.00
27204856	EAP	HCPCS C1725		Coyote 3.5mm X 220mm X 150cm	BOTH IP/OP	$856.00 	$633.44	$0.00	$684.80	$464.81	$464.81	$0.00	$0.00	$0.00	$178.41	$635.32	$635.32	$659.80	$0.00	$178.39	$0.00	$506.32	$506.32	$0.00	$428.00	$677.95	$684.80	$0.00	$0.00	$0.00	$133.96	$0.00	$0.00	$136.28	$0.00	$0.00	$0.00	$0.00	$0.00
27204857	EAP	HCPCS C1894		Tear-away Intro Sheath 8f 30cm	BOTH IP/OP	$477.00 	$352.98	$0.00	$381.60	$259.01	$259.01	$0.00	$0.00	$0.00	$99.42	$354.03	$354.03	$367.67	$0.00	$99.41	$0.00	$282.15	$282.15	$0.00	$238.50	$377.78	$381.60	$0.00	$310.05	$0.00	$74.65	$0.00	$0.00	$75.94	$0.00	$0.00	$0.00	$0.00	$0.00
27204858	EAP			Sterling Otw 4mm X 220mm X 135cm	BOTH IP/OP	$830.00 	$614.20	$0.00	$664.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$616.03	$616.03	$639.76	$0.00	$172.97	$0.00	$0.00	$0.00	$0.00	$415.00	$657.36	$664.00	$0.00	$539.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204860	EAP	HCPCS C1887		Catheter Guid 47cm Cps Dir 115d Upsize Latex Free	BOTH IP/OP	"$1,721.00 "	"$1,273.54"	$0.00	"$1,376.80"	$934.50	$934.50	$0.00	$0.00	$0.00	$358.70	"$1,277.33"	"$1,277.33"	"$1,326.55"	$0.00	$358.66	$0.00	"$1,017.97"	"$1,017.97"	$0.00	$860.50	"$1,363.03"	"$1,376.80"	$0.00	$0.00	$0.00	$269.34	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
27204863	EAP	Custom 27204863		Needle Port 1in 20ga 5ml/sec Grpr Plus Deltec Pcth	BOTH IP/OP	$203.00 	$150.22	$0.00	$162.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.67	$150.67	$156.47	$0.00	$42.31	$0.00	$0.00	$0.00	$0.00	$101.50	$160.78	$162.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204864	EAP	Custom 27204864		Needle Port 1.25in 20ga 5ml/sec Grpr Plus Deltec	BOTH IP/OP	$203.00 	$150.22	$0.00	$162.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.67	$150.67	$156.47	$0.00	$42.31	$0.00	$0.00	$0.00	$0.00	$101.50	$160.78	$162.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204865	EAP	Custom 27204865		Introd Shth 9fr 14cm Hmsts Gwire Plwy .038in Trnsp	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.67	$55.67	$57.81	$0.00	$15.63	$0.00	$0.00	$0.00	$0.00	$37.50	$59.40	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204870	EAP	HCPCS C1887		Catheter Delivery System 0-.02in Micro Str 2.6-2.95fr .025in	BOTH IP/OP	"$2,325.00 "	"$1,720.50"	$0.00	"$1,860.00"	"$1,262.48"	"$1,262.48"	$0.00	$0.00	$0.00	$484.59	"$1,725.62"	"$1,725.62"	"$1,792.11"	$0.00	$484.53	$0.00	"$1,375.24"	"$1,375.24"	$0.00	"$1,162.50"	"$1,841.40"	"$1,860.00"	$0.00	"$1,511.25"	$0.00	$363.86	$0.00	$0.00	$370.14	$0.00	$0.00	$0.00	$0.00	$0.00
27204871	EAP	Custom 27204871		Axs Catalyst 5 Distal Access Catheter 0.058in X 115cm	BOTH IP/OP	"$3,878.00 "	"$2,869.72"	$0.00	"$3,102.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,878.25"	"$2,878.25"	"$2,989.16"	$0.00	$808.18	$0.00	$0.00	$0.00	$0.00	"$1,939.00"	"$3,071.38"	"$3,102.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204873	EAP	HCPCS C1887		Terumo Medical Corp- Div Terumo Group	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204874	EAP	HCPCS C1887		Catheter Angio Radl Tiger 4.5 Curve 5fr 110cm	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204875	EAP	HCPCS C1887		Catheter Angio Sarah Radl 4 Curve 5fr 110cm Coron	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204876	EAP	HCPCS C1887		Catheter Angio Radialtiger Curve 6fr 4mm 110cm	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$284.70	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204879	EAP	HCPCS C1887		Catheter Angio Sarah Radl Curve 6fr 4mm 110cm	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204880	EAP	HCPCS C1769		Gui Vas St Str .035in 260cm Flexible Tip	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$54.30	$54.30	$0.00	$0.00	$0.00	$20.84	$74.22	$74.22	$77.08	$0.00	$20.84	$0.00	$59.15	$59.15	$0.00	$50.00	$79.20	$80.00	$0.00	$65.00	$0.00	$15.65	$0.00	$0.00	$15.92	$0.00	$0.00	$0.00	$0.00	$0.00
27204881	EAP	HCPCS C1725		Cat Baldi Lp 5.3fr 8mm 75cm 100mm High Pres	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.50	$366.70	$370.40	$0.00	$0.00	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204883	EAP	HCPCS C1894		Int Sheath .035in 7fr .1in 70cm Anl0 Curve Str Tip	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$105.95	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204884	EAP	HCPCS C1725		Cat Bald .018in 6fr 5mm 135mm 60mm Otw Lp Infl	BOTH IP/OP	$713.00 	$527.62	$0.00	$570.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$356.50	$564.70	$570.40	$0.00	$0.00	$0.00	$111.58	$0.00	$0.00	$113.51	$0.00	$0.00	$0.00	$0.00	$0.00
27204885	EAP	HCPCS C1725		Cat Bald 6mm 75cm 40mm High Pres Lp Infla Pt	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204886	EAP	HCPCS C1887		Cat Guid Micro Str 3-2.4fr .021in 130cm 30cm Rad	BOTH IP/OP	$806.00 	$596.44	$0.00	$644.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$403.00	$638.35	$644.80	$0.00	$0.00	$0.00	$126.14	$0.00	$0.00	$128.32	$0.00	$0.00	$0.00	$0.00	$0.00
27204887	EAP	HCPCS C1725		Cat Bald 5fr 9mm 75cm 60mm High Pres Lp Infl	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204888	EAP	HCPCS C1725		Cat Bald Lp 5.8fr 12mm 75cm 60mm High Pres	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204889	EAP	HCPCS C1894		Sth Gui .018-.038in Anl2 Crve 6fr .087in 90cm Radi	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27204890	EAP	HCPCS C1725		Cat Bald Ult Lp Tap 6fr 2.5mm 150cm 100mm Otw	BOTH IP/OP	$686.00 	$507.64	$0.00	$548.80	$372.50	$372.50	$0.00	$0.00	$0.00	$142.98	$509.15	$509.15	$528.77	$0.00	$142.96	$0.00	$405.77	$405.77	$0.00	$343.00	$543.31	$548.80	$0.00	$445.90	$0.00	$107.36	$0.00	$0.00	$109.21	$0.00	$0.00	$0.00	$0.00	$0.00
27204891	EAP	HCPCS C1725		Cat Bald Lp 5.3fr 7mm 135cm 150mm High Pres	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00	$0.00	$0.00	$86.08	$0.00	$0.00	$87.56	$0.00	$0.00	$0.00	$0.00	$0.00
27204892	EAP	HCPCS C1725		Cat Bald Lp 5.3fr 5mm 75cm 20mm High Pres	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204893	EAP	HCPCS C1725		Cat Bald Lp 5.3fr 9mm 75cm 20mm High Pres	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204894	EAP	HCPCS C1725		Cat Bald 5.8fr 10mm 75cm 60mm High Pres Lp	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.50	$366.70	$370.40	$0.00	$0.00	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204896	EAP	HCPCS C1725		Cat Bald Lp 5.3fr 7mm 135cm 100mm High Pres	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204898	EAP	HCPCS C1725		Cat Bald 14 Atm Ult Lp 6fr 2.5mm 143cm 20mm	BOTH IP/OP	$713.00 	$527.62	$0.00	$570.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$356.50	$564.70	$570.40	$0.00	$0.00	$0.00	$111.58	$0.00	$0.00	$113.51	$0.00	$0.00	$0.00	$0.00	$0.00
27204899	EAP	HCPCS C1725		Cat Bald Lp 5.3fr 6mm 135cm 60mm High Pres	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204900	EAP	HCPCS C1892		Introd Shth 7fr .092in 13cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$14.09	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00
27204901	EAP	HCPCS C1892		Introd Shth 7fr .092in 25cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$57.02	$57.02	$0.00	$0.00	$0.00	$21.88	$77.93	$77.93	$80.93	$0.00	$21.88	$0.00	$62.11	$62.11	$0.00	$52.50	$83.16	$84.00	$0.00	$0.00	$0.00	$16.43	$0.00	$0.00	$16.72	$0.00	$0.00	$0.00	$0.00	$0.00
27204902	EAP	Custom 27204902		Starclose Se	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204903	EAP	Custom 27204903		System Embolization Nonadhesive Delivery Syringe L	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,174.88"	"$4,174.88"	"$4,335.75"	$0.00	"$1,172.25"	$0.00	$0.00	$0.00	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204910	EAP	HCPCS C1894		Shth Gu .018/.038in Anl1 Cve 6fr .087in 45cm Rad	BOTH IP/OP	$113.00 	$83.62	$0.00	$90.40	$61.36	$61.36	$0.00	$0.00	$0.00	$23.55	$83.87	$83.87	$87.10	$0.00	$23.55	$0.00	$66.84	$66.84	$0.00	$56.50	$89.50	$90.40	$0.00	$73.45	$0.00	$17.68	$0.00	$0.00	$17.99	$0.00	$0.00	$0.00	$0.00	$0.00
27204911	EAP	HCPCS C1725		Cat Bald Ula Lp Tper 6fr 2mm 150cm 100mm	BOTH IP/OP	$686.00 	$507.64	$0.00	$548.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.00	$543.31	$548.80	$0.00	$0.00	$0.00	$107.36	$0.00	$0.00	$109.21	$0.00	$0.00	$0.00	$0.00	$0.00
27204912	EAP	HCPCS C1725		Catr Bald 14 Atm Lp Taer 7fr 5mm 150cm 150mm	BOTH IP/OP	$754.00 	$557.96	$0.00	$603.20	$409.42	$409.42	$0.00	$0.00	$0.00	$157.15	$559.62	$559.62	$581.18	$0.00	$157.13	$0.00	$445.99	$445.99	$0.00	$377.00	$597.17	$603.20	$0.00	$490.10	$0.00	$118.00	$0.00	$0.00	$120.04	$0.00	$0.00	$0.00	$0.00	$0.00
27204913	EAP	HCPCS C1725		Catbald Lp 5.3fr 7mm 135cm 60mm High Pres	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204914	EAP	HCPCS C1725		Cat Bald .035in 7mm 75cm 60mm High Pres Lp	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204916	EAP	HCPCS C1725		Cat Bald .035in 8mm 75cm 60mm High Pre Lp	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204917	EAP	HCPCS C1725		Cat Bald Lp 5.8fr 9mm 135cm 60mm High Pres	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204918	EAP	HCPCS C1725		Cat Guid Ebu3.75 Curve 7fr .081in 100cm Luch	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$105.95	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27204919	EAP	HCPCS C1725		Cat Bald .035in 6mm 75cm 60mm High Pres Lp	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204920	EAP	HCPCS C1830		Biopsy System Comprehensive Tray 102mm	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$269.78	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204921	EAP	HCPCS C1830		Biopsy System Comprehensive Tray 152mm	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$269.78	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204923	EAP	HCPCS C1830		Oncontrol Biopsy System Tray 152mm	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204924	EAP	Custom 27204924		Oncontrol Coaxial Tray 6cm 11/13 Gauge	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$0.00	$0.00	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204925	EAP	Custom 27204925		Oncontrol Coaxial Tray 10cm 11/13 Gauge	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$0.00	$0.00	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204926	EAP	Custom 27204926		Oncontrol Coaxial Tray 15cm 11/13 Gauge	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$0.00	$0.00	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204927	EAP	HCPCS C1769		Guidewire Vasc 185cm Strl Lf Verrata + Prss Disp	BOTH IP/OP	"$1,688.00 "	"$1,249.12"	$0.00	"$1,350.40"	$916.58	$916.58	$0.00	$0.00	$0.00	$351.82	"$1,252.83"	"$1,252.83"	"$1,301.11"	$0.00	$351.78	$0.00	$998.45	$998.45	$0.00	$844.00	"$1,336.90"	"$1,350.40"	$0.00	"$1,097.20"	$0.00	$264.17	$0.00	$0.00	$268.73	$0.00	$0.00	$0.00	$0.00	$0.00
27204928	EAP	HCPCS C2628		Catheter Baldilat 9fr 32mm 120cm 2 Lum Radiopq	BOTH IP/OP	"$1,430.00 "	"$1,058.20"	$0.00	"$1,144.00"	$776.49	$776.49	$0.00	$0.00	$0.00	$298.05	"$1,061.35"	"$1,061.35"	"$1,102.24"	$0.00	$298.01	$0.00	$845.85	$845.85	$0.00	$715.00	"$1,132.56"	"$1,144.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204930	EAP	HCPCS C1769		Gwire Vasc .038in 180cm Strl 3cm Merit Laurea	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$43.44	$43.44	$0.00	$0.00	$0.00	$16.67	$59.38	$59.38	$61.66	$0.00	$16.67	$0.00	$47.32	$47.32	$0.00	$40.00	$63.36	$64.00	$0.00	$0.00	$0.00	$12.52	$0.00	$0.00	$12.74	$0.00	$0.00	$0.00	$0.00	$0.00
27204932	EAP	HCPCS C1769		Gdwre Vasc Tper .038in 145cm 6cm Str Tip Am	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.50	$48.31	$48.80	$0.00	$0.00	$0.00	$9.55	$0.00	$0.00	$9.71	$0.00	$0.00	$0.00	$0.00	$0.00
27204933	EAP	HCPCS C1769		Set Cat 15.5fr 24cm 3 Lumen Bas Gwire Dil Scal	BOTH IP/OP	$278.00 	$205.72	$0.00	$222.40	$150.95	$150.95	$0.00	$0.00	$0.00	$57.94	$206.33	$206.33	$214.28	$0.00	$57.94	$0.00	$164.44	$164.44	$0.00	$139.00	$220.18	$222.40	$0.00	$180.70	$0.00	$43.51	$0.00	$0.00	$44.26	$0.00	$0.00	$0.00	$0.00	$0.00
27204941	EAP	HCPCS C1769		Set Cath 20cm 15.5fr 3 Lum Basic Gwire Dilat Scpl	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$0.00	$0.00	$0.00	$0.00	$0.00	$60.03	$0.00	$0.00	$0.00	$0.00	$60.02	$0.00	$170.35	$170.35	$0.00	$144.00	$228.10	$230.40	$0.00	$0.00	$0.00	$45.07	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$0.00
27204942	EAP	HCPCS C1753		Catheter Us Kodama	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$814.50	$814.50	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$975.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
27204943	EAP	Custom 27204943		Glove Compression Large Open Finger Seamless Latex Free Pr	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$27.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204944	EAP	Custom 27204944		Glove Cmpr Xs 5-6in Lf Istnr F F Thrp Mach Wshbl 80% Nyl 20% Pr	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204945	EAP	Custom 27204945		Glove Cmpr Med Lf Istnr Anemb F F L/r Hnd Edema Cntrl Pr	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204946	EAP	Custom 27204946		Glove Cmpr Sm 23-32 Mmhg 6-7in Lf Istnr F F Thrp Nyl Spndx Pr	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204947	EAP	Custom 27204947		Glove Cmpr Lg 23-32 Mmhg 8-9in Lf Istnr F F Thrp Nyl Spndx Pr	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204948	EAP	Custom 27204948		Glove Cmpr Xs 5-6in Lf Istnr Opn Fngr Ltwt Blnd Smls Sprt Pr	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204949	EAP	Custom 27204949		Glove Cmpr Sm Lf Istnr Opn Fngr Smls 80% Nyl 20% Spndx 23-32 Pr	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204950	EAP	Custom 27204950		Glove Cmpr Md Lf Istnr Opn Fngr Smls 80% Nyl 20% Spndx 23-32 Pr	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204951	EAP	Custom 27204951		Sphere Embl Ylw Embsph 100-300um Mcsph Ns Prefl	BOTH IP/OP	$608.00 	$449.92	$0.00	$486.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$451.26	$451.26	$468.65	$0.00	$126.71	$0.00	$0.00	$0.00	$0.00	$304.00	$481.54	$486.40	$0.00	$395.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204952	EAP	Custom 27204952		Sphere Embl Blue Embsph 300-500um Mcsph Ns Prefl	BOTH IP/OP	$608.00 	$449.92	$0.00	$486.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$451.26	$451.26	$468.65	$0.00	$126.71	$0.00	$0.00	$0.00	$0.00	$304.00	$481.54	$486.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204953	EAP	CPT® C1894		Set Intro 5fr Mcstk Ntnl Wre Radopq Tip Coax Stf	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$0.00	$0.00	$5.95	$0.00	$0.00	$6.05	$0.00	$0.00	$0.00	$0.00	$0.00
27204954	EAP	CPT® C1894		Set Intro 5fr Mcstk Radopq Coax Stf Wre Ntnl	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$8.34	$0.00	$23.66	$23.66	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$6.26	$0.00	$0.00	$6.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205000	EAP	HCPCS C1769		Guidewire Vasc 175cm .014in Radiopq Tip Snsr Elmt	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27205001	EAP	Custom 27205001		Introd Shth 11fr .144in 25cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.93	$77.93	$80.93	$0.00	$21.88	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205003	EAP	Custom 27205003		Introd Shth 10fr .131in 25cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.93	$77.93	$80.93	$0.00	$21.88	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205004	EAP	Custom 27205004		Introd Shth 10.5fr .138in 13cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205005	EAP	Custom 27205005		Introd Shth 10fr .131in 13cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205006	EAP	Custom 27205006		Introd Shth 11fr .144in 13cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205007	EAP	Custom 27205007		Introd Shth 12.5fr .164in 13cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205008	EAP	Custom 27205008		Introd Shth 12fr .158in 13cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205009	EAP	Custom 27205009		Introd Shth 6fr .083in 13cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205010	EAP	Custom 27205010		Introd Shth 8.5fr .112in 13cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205011	EAP	Custom 27205011		Introd Shth 8fr .105in 13cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$193.00 	$142.82	$0.00	$148.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.24	$143.24	$148.76	$0.00	$40.22	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205012	EAP	Custom 27205012		Introd Shth 9.5fr .125in 13cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205013	EAP	Custom 27205013		Introd Shth 9fr .118in 13cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$191.00 	$141.34	$0.00	$147.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.76	$141.76	$147.22	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205014	EAP	Custom 27205014		Introd Shth 6fr .083in 25cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.93	$77.93	$80.93	$0.00	$21.88	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205015	EAP	Custom 27205015		Introd Shth 9fr .118in 25cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.93	$77.93	$80.93	$0.00	$21.88	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205016	EAP	Custom 27205016		Introd Shth 8fr .083in 25cm Rbst Vlv Splt Sdprt	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.93	$77.93	$80.93	$0.00	$21.88	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205017	EAP	HCPCS C1894		Introd Shth 7fr 13cm 19.5cm 3w Stpck Traw Hmst Vlv	BOTH IP/OP	$146.00 	$108.04	$0.00	$116.80	$79.28	$79.28	$0.00	$0.00	$0.00	$30.43	$108.36	$108.36	$112.54	$0.00	$30.43	$0.00	$86.36	$86.36	$0.00	$73.00	$115.63	$116.80	$0.00	$0.00	$0.00	$22.85	$0.00	$0.00	$23.24	$0.00	$0.00	$0.00	$0.00	$0.00
27205018	EAP	HCPCS C1894		Introd Shth 9fr 13cm 19.5cm 3w Stpck Traw Hmst Vlv	BOTH IP/OP	$146.00 	$108.04	$0.00	$116.80	$79.28	$79.28	$0.00	$0.00	$0.00	$30.43	$108.36	$108.36	$112.54	$0.00	$30.43	$0.00	$86.36	$86.36	$0.00	$73.00	$115.63	$116.80	$0.00	$0.00	$0.00	$22.85	$0.00	$0.00	$23.24	$0.00	$0.00	$0.00	$0.00	$0.00
27205019	EAP	HCPCS C1894		Introd Lead 23cm 7fr Sfshth Ult Hmst Vlv Lp Traw	BOTH IP/OP	$146.00 	$108.04	$0.00	$116.80	$79.28	$79.28	$0.00	$0.00	$0.00	$30.43	$108.36	$108.36	$112.54	$0.00	$30.43	$0.00	$86.36	$86.36	$0.00	$73.00	$115.63	$116.80	$0.00	$0.00	$0.00	$22.85	$0.00	$0.00	$23.24	$0.00	$0.00	$0.00	$0.00	$0.00
27205021	EAP	HCPCS C1887		Catheter Infus Mic .027in Phenom	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	"$1,086.00"	"$1,086.00"	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	"$1,541.60"	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00	"$1,300.00"	$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
27205022	EAP	HCPCS C1887		Catheter Infus 30cm .040in .036in .027in Phenom	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	"$1,086.00"	"$1,086.00"	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	"$1,541.60"	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00	$0.00	$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
27205023	EAP	HCPCS C1887		Catheter Infs Mic .17in Phenom	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	"$1,086.00"	"$1,086.00"	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	"$1,541.60"	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00	$0.00	$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
27205024	EAP	HCPCS C1887		Catheter Infus 105cm .061in .055in .044in Phenom	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	"$1,086.00"	"$1,086.00"	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	"$1,541.60"	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00	$0.00	$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
27205025	EAP	HCPCS C1887		Catheter Infs Mic .45in Phenom	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	"$1,086.00"	"$1,086.00"	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	"$1,541.60"	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00	"$1,300.00"	$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
27205026	EAP	HCPCS C1769		Kit Cath 13.5fr 16cm Strl Mh Q+ Strg Xtn Pu Hmdial	BOTH IP/OP	$115.00 	$85.10	$0.00	$92.00	$62.45	$62.45	$0.00	$0.00	$0.00	$23.97	$85.35	$85.35	$88.64	$0.00	$23.97	$0.00	$68.02	$68.02	$0.00	$57.50	$91.08	$92.00	$0.00	$0.00	$0.00	$18.00	$0.00	$0.00	$18.31	$0.00	$0.00	$0.00	$0.00	$0.00
27205027	EAP	HCPCS C1769		Kit Cath 19.5cm 13.5fr Pu Mh Q+ Str Extn Hmdial	BOTH IP/OP	$115.00 	$85.10	$0.00	$92.00	$62.45	$62.45	$0.00	$0.00	$0.00	$23.97	$85.35	$85.35	$88.64	$0.00	$23.97	$0.00	$68.02	$68.02	$0.00	$57.50	$91.08	$92.00	$0.00	$0.00	$0.00	$18.00	$0.00	$0.00	$18.31	$0.00	$0.00	$0.00	$0.00	$0.00
27205028	EAP	HCPCS C1769		Kit Cath Strg 13.5fr 24cm 7cm Mh Q+ 2 Lum Xtn Pu Hmdial	BOTH IP/OP	$115.00 	$85.10	$0.00	$92.00	$62.45	$62.45	$0.00	$0.00	$0.00	$23.97	$85.35	$85.35	$88.64	$0.00	$23.97	$0.00	$68.02	$68.02	$0.00	$57.50	$91.08	$92.00	$0.00	$0.00	$0.00	$18.00	$0.00	$0.00	$18.31	$0.00	$0.00	$0.00	$0.00	$0.00
27205029	EAP	HCPCS C1769		Guidewire Vascular 15d .018in 180cm 5cm Intermedia	BOTH IP/OP	$216.00 	$159.84	$0.00	$172.80	$117.29	$117.29	$0.00	$0.00	$0.00	$45.02	$160.32	$160.32	$166.49	$0.00	$45.01	$0.00	$127.76	$127.76	$0.00	$108.00	$171.07	$172.80	$0.00	$140.40	$0.00	$33.80	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$0.00
27205032	EAP	Custom 27205032		Kit Biopsy Tlab Metal Straight Curve L60 Cm L65 Cm	BOTH IP/OP	"$1,350.00 "	$999.00	$0.00	"$1,080.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,001.97"	"$1,001.97"	"$1,040.58"	$0.00	$281.34	$0.00	$0.00	$0.00	$0.00	$675.00	"$1,069.20"	"$1,080.00"	$0.00	$877.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205033	EAP	HCPCS C1884		System Embolic Protection 3.2-4.2fr 6mm 320cm 190c	BOTH IP/OP	"$3,488.00 "	"$2,581.12"	$0.00	"$2,790.40"	"$1,893.98"	"$1,893.98"	$0.00	$0.00	$0.00	$726.99	"$2,588.79"	"$2,588.79"	"$2,688.55"	$0.00	$726.90	$0.00	"$2,063.15"	"$2,063.15"	$0.00	"$1,744.00"	"$2,762.50"	"$2,790.40"	$0.00	"$2,267.20"	$0.00	$545.87	$0.00	$0.00	$555.29	$0.00	$0.00	$0.00	$0.00	$0.00
27205035	EAP	Custom 27205035		Catheter Intvn 180- D 2.4-2.9fr .021in 125cm Swift	BOTH IP/OP	"$6,000.00 "	"$4,440.00"	$0.00	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,624.80"	$0.00	"$1,250.40"	$0.00	$0.00	$0.00	$0.00	"$3,000.00"	"$4,752.00"	"$4,800.00"	$0.00	"$3,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205036	EAP	HCPCS C1725		Catheter Baldilat Ultra Lp 5fr 1.5mm 12mm 2 Lumen	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$162.90	$162.90	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$195.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
27205037	EAP	HCPCS C1725		Catheter Baldilat Ultra Lp 5fr 1.5mm 15mm 2 Lumen	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$162.90	$162.90	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$195.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
27205038	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 10mm Rapex Legend Semicom	BOTH IP/OP	"$1,033.00 "	$764.42	$0.00	$826.40	$560.92	$560.92	$0.00	$0.00	$0.00	$215.30	$766.69	$766.69	$796.24	$0.00	$215.28	$0.00	$611.02	$611.02	$0.00	$516.50	$818.14	$826.40	$0.00	$671.45	$0.00	$161.66	$0.00	$0.00	$164.45	$0.00	$0.00	$0.00	$0.00	$0.00
27205039	EAP	HCPCS C1725		Catheter Baldilat Lp 5.3fr 4mm 75cm 20mm High Pres	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27205040	EAP	HCPCS C1725		Catheter Baldilat Ultra Lp 5fr 1.5mm 20mm 2 Lumen	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$162.90	$162.90	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$195.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
27205041	EAP	HCPCS C1725		Catheter Baldilat Ultra Lp 5fr 1.5mm 6mm 2 Lumen R	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$162.90	$162.90	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
27205042	EAP	HCPCS C1725		Catheter Baldilat Ultra Lp 5fr 1.5mm 8mm 2 Lumen R	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$162.90	$162.90	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$195.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
27205051	EAP	HCPCS C1769		Catheter Gd Strg 6fr 115cm Strl Lf Sofia Disp Strk	BOTH IP/OP	"$4,990.00 "	"$3,692.60"	$0.00	"$3,992.00"	"$2,709.57"	"$2,709.57"	$0.00	$0.00	$0.00	"$1,040.04"	"$3,703.58"	"$3,703.58"	"$3,846.29"	$0.00	"$1,039.92"	$0.00	"$2,951.59"	"$2,951.59"	$0.00	"$2,495.00"	"$3,952.08"	"$3,992.00"	$0.00	"$3,243.50"	$0.00	$780.94	$0.00	$0.00	$794.41	$0.00	$0.00	$0.00	$0.00	$0.00
27205052	EAP	HCPCS C1887		Catheter Angio Sim 1 Crv 5fr .043in 100cm Gldcath Xp Gld Tch	BOTH IP/OP	$122.00 	$90.28	$0.00	$97.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.00	$96.62	$97.60	$0.00	$0.00	$0.00	$19.09	$0.00	$0.00	$19.42	$0.00	$0.00	$0.00	$0.00	$0.00
27205054	EAP	HCPCS C1887		Catheter Angio Ang 5fr .043in 100cm Gldcath Xp Gld Tch 1 Brd	BOTH IP/OP	$122.00 	$90.28	$0.00	$97.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.00	$96.62	$97.60	$0.00	$0.00	$0.00	$19.09	$0.00	$0.00	$19.42	$0.00	$0.00	$0.00	$0.00	$0.00
27205055	EAP	HCPCS C1769		Guidewire Vasc 90d .018in 180cm 25cm Gldwr Gt Hdrph	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$233.49	$233.49	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$331.44	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$215.00	$340.56	$344.00	$0.00	$0.00	$0.00	$67.30	$0.00	$0.00	$68.46	$0.00	$0.00	$0.00	$0.00	$0.00
27205056	EAP	Custom 27205056		Catheter Balloon  6x100mm 135c	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$0.00	$0.00	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205057	EAP	HCPCS C1887		Catheter Angio .035in 135cm Navicross Strg Tip	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00	$0.00	$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
27205058	EAP	HCPCS C1887		Catheter Angio .035in 65cm Navicross Strg Tip	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00	$0.00	$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
27205059	EAP	HCPCS C1887		Catheter Angio .038in 1 Crv 5fr 100cm 15cm Gldcath Xp 2	BOTH IP/OP	$121.88 	$90.19	$0.00	$97.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.94	$96.53	$97.50	$0.00	$0.00	$0.00	$19.07	$0.00	$0.00	$19.40	$0.00	$0.00	$0.00	$0.00	$0.00
27205060	EAP	HCPCS C1887		Catheter Angio .038in 5fr 100cm 15cm Gldcath Xp 2 Braid Pu	BOTH IP/OP	$121.88 	$90.19	$0.00	$97.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.94	$96.53	$97.50	$0.00	$0.00	$0.00	$19.07	$0.00	$0.00	$19.40	$0.00	$0.00	$0.00	$0.00	$0.00
27205061	EAP	HCPCS C1887		Catheter Angio .038in 5fr 65cm 15cm Gldcath Xp 2 Braid Pu	BOTH IP/OP	$121.88 	$90.19	$0.00	$97.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.94	$96.53	$97.50	$0.00	$0.00	$0.00	$19.07	$0.00	$0.00	$19.40	$0.00	$0.00	$0.00	$0.00	$0.00
27205062	EAP	HCPCS C1887		Catheter Angio .038in 5fr 70cm Gldcath Yashiro Tip	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00	$0.00	$0.00	$21.91	$0.00	$0.00	$22.29	$0.00	$0.00	$0.00	$0.00	$0.00
27205063	EAP	HCPCS C1887		Catheter Angio .038in J Crv 4fr 65cm 15cm Gldcath Gw Hdrph	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205064	EAP	HCPCS C1887		Catheter Angio .038in J Crv 5fr 65cm 25cm Gldcath Gw Hdrph	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205065	EAP	HCPCS C1887		Catheter Angio .038in Jb2 Crv 4fr 100cm 15cm Gldcath Gw	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205066	EAP	HCPCS C1887		Catheter Angio .038in Jb2 Crv 5fr 100cm 40cm Gldcath Tpr Gw	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205067	EAP	HCPCS C1887		Catheter Angio .038in Mani Crv 4fr 100cm 15cm Gldcath Gw	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205068	EAP	HCPCS C1887		Catheter Angio .038in Mani Crv 5fr 100cm 40cm Gldcath Gw	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205069	EAP	HCPCS C1887		Catheter Angio .038in Sim1 Crv 4fr 100cm 15cm Gldcath Gw	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205070	EAP	HCPCS C1887		Catheter Angio .038in Sim2 Crv 5fr 65cm Gldcath 1 Braid	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205071	EAP	HCPCS C1887		Catheter Angio .038in Sim3 Crv 4fr 100cm 15cm Gldcath Gw	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205072	EAP	HCPCS C1887		Catheter Angio 150cm Navicross Radopq Strg Tip Ss Hdrph	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00	$0.00	$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
27205073	EAP	HCPCS C1887		Catheter Angio 30d 12mm 135cm Navicross 3 Radopq Sprt Ss	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00	$0.00	$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
27205074	EAP	HCPCS C1887		Catheter Angio 30d 12mm 65cm Navicross 3 Radopq Sprt Ss	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00	$0.00	$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
27205075	EAP	HCPCS C1887		Catheter Angio 30d 150cm Navicross Sprt Radopq Ang Tip Hdrph	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00	$0.00	$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
27205076	EAP	HCPCS C1887		Catheter Angio 4fr	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00	$0.00	$0.00	$21.91	$0.00	$0.00	$22.29	$0.00	$0.00	$0.00	$0.00	$0.00
27205077	EAP	HCPCS C1887		Catheter Angio 4fr .041in 150cm Gldcath Gld Tch Ang Tip 2	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205078	EAP	HCPCS C1887		Catheter Angio Ang 4fr .041in 120cm Gldcath Gld Tch 2 Brd Ss	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205080	EAP	HCPCS C1887		Catheter Angio Cbr 1 Crv 4fr .041in 65cm Gldcath Gld Tch 2	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205081	EAP	HCPCS C1887		Catheter Angio Cbr 1 Crv 5fr .047in 65cm Gldcath Gld Tch 1	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205082	EAP	HCPCS C1887		Catheter Angio Cbr 2 Crv 4fr .041in 100cm Gldcath Gld Tch 2	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205083	EAP	HCPCS C1887		Catheter Angio Cbr 2 Crv 5fr .047in 100cm Gldcath Gld Tch 1	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205084	EAP	HCPCS C1887		Catheter Angio Cbr 2 Crv 5fr 65cm 15cm Gldcath Xp 2 Brd Jkt	BOTH IP/OP	$121.88 	$90.19	$0.00	$97.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.94	$96.53	$97.50	$0.00	$0.00	$0.00	$19.07	$0.00	$0.00	$19.40	$0.00	$0.00	$0.00	$0.00	$0.00
27205085	EAP	HCPCS C1887		Catheter Angio Hdhntr 1 Crv 4fr .041in 100cm Gldcath Gld Tch	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205086	EAP	HCPCS C1887		Catheter Angio Mp Crv 4fr .041in 100cm Gldcath Gld Tch 2 Brd	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205088	EAP	HCPCS C1887		Catheter Angio Pv Mc 4fr 150cm Gldcath 2 Braid Hdrph Ss	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205089	EAP			Catheter Angio Rbt Crv 5fr 90cm Trnb Ad Acpt .035in Gw	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.12	$24.12	$25.05	$0.00	$6.77	$0.00	$0.00	$0.00	$0.00	$16.25	$25.74	$26.00	$0.00	$21.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205090	EAP	HCPCS C1887		Catheter Angio Sim2 Crv 4fr 100cm 15cm Gldcath 2 Ss Braid Pu	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205091	EAP	HCPCS C1887		Catheter Angio Strg 4fr 150cm Gldcath 2 Braid Hdrph Ss	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205092	EAP	HCPCS C1887		Catheter Angio Strg 5fr 150cm Gldcath Xp 2 Braid Hdrph Ss	BOTH IP/OP	$121.88 	$90.19	$0.00	$97.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.94	$96.53	$97.50	$0.00	$0.00	$0.00	$19.07	$0.00	$0.00	$19.40	$0.00	$0.00	$0.00	$0.00	$0.00
27205093	EAP	HCPCS C1887		Catheter Angio Strg Crv 4fr .041in 100cm Gldcath Gld Tch 2	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205094	EAP	HCPCS C1887		Catheter Angio Strg Crv 4fr .041in 120cm Gldcath Gld Tch 2	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205095	EAP	HCPCS C1887		Catheter Angio Strg Crv 4fr .041in 65cm Gldcath Gld Tch 2	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205096	EAP	HCPCS C1887		Catheter Angio Strg Crv 5fr .043in 65cm Gldcath Xp Gld Tch 1	BOTH IP/OP	$121.88 	$90.19	$0.00	$97.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.94	$96.53	$97.50	$0.00	$0.00	$0.00	$19.07	$0.00	$0.00	$19.40	$0.00	$0.00	$0.00	$0.00	$0.00
27205097	EAP	HCPCS C1887		Catheter Angio Strg Crv 5fr .047in 65cm Gldcath Gld Tch 1	BOTH IP/OP	$121.38 	$89.82	$0.00	$97.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$96.13	$97.10	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
27205098	EAP	HCPCS C1725		Catheter Blndil .035in 6fr 3mm 90cm 120mm Metacross Rx Peri	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205099	EAP	HCPCS C1725		Catheter Blndil 2.5mm 150cm 200mm Crosperio Otw Pta	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205100	EAP	HCPCS C1725		Catheter Blndil 3.5fr 1.5mm 150cm 20mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205101	EAP	HCPCS C1725		Catheter Blndil 3.5fr 1.5mm 150cm 40mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205102	EAP	HCPCS C1725		Catheter Blndil 3.5fr 1.5mm 150cm 80mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205103	EAP	HCPCS C1725		Catheter Blndil 3.5fr 1.5mm 90cm 120mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205104	EAP	HCPCS C1725		Catheter Blndil 3.5fr 1.5mm 90cm 20mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205105	EAP	HCPCS C1725		Catheter Blndil 3.5fr 1.5mm 90cm 40mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205106	EAP	HCPCS C1725		Catheter Blndil 3.5fr 1.5mm 90cm 80mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205107	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2.5mm 150cm 120mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205108	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2.5mm 150cm 200mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205109	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2.5mm 150cm 40mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205110	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2.5mm 150cm 80mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205111	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2.5mm 90cm 120mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205112	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2.5mm 90cm 150mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205113	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2.5mm 90cm 200mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205114	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2.5mm 90cm 40mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205115	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2.5mm 90cm 80mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205116	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2mm 150cm 150mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205117	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2mm 150cm 40mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205118	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2mm 150cm 80mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205119	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2mm 90cm 120mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205120	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2mm 90cm 150mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205121	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2mm 90cm 200mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205122	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2mm 90cm 40mm Crosperio Rx Tpr Cor Wre	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205123	EAP	HCPCS C1725		Catheter Blndil 3.5fr 2mm 90cm 80mm Crosperio Rx Tpr Cor Wre	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205124	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3.5mm 150cm 40mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205125	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3.5mm 150cm 80mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205126	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3.5mm 90cm 120mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205127	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3.5mm 90cm 150mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205128	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3.5mm 90cm 200mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205129	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3.5mm 90cm 40mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205130	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3.5mm 90cm 80mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205131	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3mm 150cm 150mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205132	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3mm 150cm 40mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205133	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3mm 150cm 80mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205134	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3mm 90cm 120mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205135	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3mm 90cm 150mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205136	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3mm 90cm 200mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205138	EAP	HCPCS C1725		Catheter Blndil 3.5fr 3mm 90cm 80mm Crosperio Rx Tpr Cor Wre	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205139	EAP	HCPCS C1725		Catheter Blndil 3.5fr 4mm 150cm 40mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205140	EAP	HCPCS C1725		Catheter Blndil 3.5fr 4mm 150cm 80mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205141	EAP	HCPCS C1725		Catheter Blndil 3.5fr 4mm 90cm 120mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205142	EAP	HCPCS C1725		Catheter Blndil 3.5fr 4mm 90cm 150mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205143	EAP	HCPCS C1725		Catheter Blndil 3.5fr 4mm 90cm 40mm Crosperio Rx Tpr Cor Wre	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205144	EAP	HCPCS C1725		Catheter Blndil 3.5fr 4mm 90cm 80mm Crosperio Rx Tpr Cor Wre	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205145	EAP	HCPCS C1725		Catheter Blndil 3.8fr 1.5mm 150cm 120mm Crosperio Otw Tpr	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205146	EAP	HCPCS C1725		Catheter Blndil 3.8fr 1.5mm 150cm 20mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205147	EAP	HCPCS C1725		Catheter Blndil 3.8fr 1.5mm 150cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205148	EAP	HCPCS C1725		Catheter Blndil 3.8fr 1.5mm 150cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205149	EAP	HCPCS C1725		Catheter Blndil 3.8fr 1.5mm 65cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205150	EAP	HCPCS C1725		Catheter Blndil 3.8fr 1.5mm 65cm 20mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205151	EAP	HCPCS C1725		Catheter Blndil 3.8fr 1.5mm 65cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205152	EAP	HCPCS C1725		Catheter Blndil 3.8fr 1.5mm 65cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205153	EAP	HCPCS C1725		Catheter Blndil 3.8fr 1.5mm 90cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205154	EAP	HCPCS C1725		Catheter Blndil 3.8fr 1.5mm 90cm 20mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205155	EAP	HCPCS C1725		Catheter Blndil 3.8fr 1.5mm 90cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205156	EAP	HCPCS C1725		Catheter Blndil 3.8fr 1.5mm 90cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205157	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 150cm 120mm Crosperio Otw Tpr	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205158	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 150cm 150mm Crosperio Otw Tpr	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205159	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 150cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205161	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 65cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205162	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 65cm 150mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205163	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 65cm 200mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205164	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 65cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205165	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 65cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205166	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 90cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205167	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 90cm 150mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205168	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 90cm 200mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205169	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 90cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205170	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2.5mm 90cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205171	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 150cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205172	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 150cm 150mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205173	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 150cm 200mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205174	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 150cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205175	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 150cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205176	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 65cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205177	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 65cm 150mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205178	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 65cm 200mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205179	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 65cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205180	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 65cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205181	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 90cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205182	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 90cm 150mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205183	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 90cm 200mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205184	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 90cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205185	EAP	HCPCS C1725		Catheter Blndil 3.8fr 2mm 90cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205186	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 150cm 120mm Crosperio Otw Tpr	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205187	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 150cm 150mm Crosperio Otw Tpr	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205188	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 150cm 200mm Crosperio Otw Tpr	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205189	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 150cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205190	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 150cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205191	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 65cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205192	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 65cm 150mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205193	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 65cm 200mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205194	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 65cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205195	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 65cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205196	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 90cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205197	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 90cm 150mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205198	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 90cm 200mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205199	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 90cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205200	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3.5mm 90cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205201	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 150cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205202	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 150cm 150mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205203	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 150cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205204	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 150cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205205	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 65cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205206	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 65cm 150mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205207	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 65cm 200mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205208	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 65cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205209	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 65cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205210	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 90cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205211	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 90cm 150mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205212	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 90cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205213	EAP	HCPCS C1725		Catheter Blndil 3.8fr 3mm 90cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205214	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 150cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205215	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 150cm 150mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205216	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 150cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205217	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 150cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205218	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 65cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205219	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 65cm 150mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205220	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 65cm 200mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205221	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 65cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205222	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 65cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205223	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 90cm 120mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205224	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 90cm 200mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205225	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 90cm 40mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205226	EAP	HCPCS C1725		Catheter Blndil 3.8fr 4mm 90cm 80mm Crosperio Otw Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205227	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 150cm 100mm Crosstella Otw Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205228	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 150cm 120mm Crosstella Otw Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205229	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 150cm 150mm Crosstella Otw Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205230	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 150cm 200mm Crosstella Otw Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205231	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 150cm 20mm Crosstella Otw Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205232	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 150cm 40mm Crosstella Otw Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205233	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 150cm 60mm Crosstella Otw Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205234	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 150cm 80mm Crosstella Otw Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205235	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 90cm 100mm Crosstella Otw Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205236	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 90cm 120mm Crosstella Otw Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205237	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 90cm 150mm Crosstella Otw Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205238	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 90cm 200mm Crosstella Otw Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205239	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 90cm 20mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205240	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 90cm 40mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205241	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 90cm 60mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205242	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2.5mm 90cm 80mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205243	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 150cm 100mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205244	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 150cm 120mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205245	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 150cm 150mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205246	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 150cm 200mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205247	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 150cm 20mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205248	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 150cm 40mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205249	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 150cm 60mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205250	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 150cm 80mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205251	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 90cm 100mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205252	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 90cm 120mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205253	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 90cm 150mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205254	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 90cm 200mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205255	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 90cm 20mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205256	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 90cm 40mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205257	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 90cm 60mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205258	EAP	HCPCS C1725		Catheter Blndil 3.9fr 2mm 90cm 80mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205259	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 150cm 100mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205260	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 150cm 120mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205261	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 150cm 150mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205262	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 150cm 200mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205263	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 150cm 20mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205264	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 150cm 40mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205265	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 150cm 60mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205266	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 150cm 80mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205267	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 90cm 100mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205268	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 90cm 120mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205269	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 90cm 150mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205270	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 90cm 200mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205271	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 90cm 20mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205272	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 90cm 40mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205273	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 90cm 60mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205274	EAP	HCPCS C1725		Catheter Blndil 3.9fr 3mm 90cm 80mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205275	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 150cm 100mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205276	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 150cm 120mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205277	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 150cm 150mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205278	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 150cm 200mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205279	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 150cm 20mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205280	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 150cm 40mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205281	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 150cm 60mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205282	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 150cm 80mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205283	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 90cm 100mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205284	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 90cm 120mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205285	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 90cm 150mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205286	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 90cm 200mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205287	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 90cm 20mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205288	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 90cm 40mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205289	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 90cm 60mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205290	EAP	HCPCS C1725		Catheter Blndil 3.9fr 4mm 90cm 80mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205291	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 150cm 100mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205292	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 150cm 120mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205293	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 150cm 150mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205294	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 150cm 200mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205295	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 150cm 20mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205296	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 150cm 20mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205297	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 150cm 40mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205298	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 150cm 40mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205299	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 150cm 60mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205300	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 150cm 80mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205301	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 90cm 100mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205302	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 90cm 120mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205303	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 90cm 150mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205304	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 90cm 200mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205305	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 90cm 20mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205306	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 90cm 40mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205307	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 90cm 40mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205308	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 90cm 60mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205309	EAP	HCPCS C1725		Catheter Blndil 4.3fr 5mm 90cm 80mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205310	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 150cm 100mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205311	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 150cm 120mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205312	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 150cm 150mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205313	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 150cm 200mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205314	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 150cm 60mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205315	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 150cm 80mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205316	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 90cm 100mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205317	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 90cm 120mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205318	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 90cm 150mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205319	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 90cm 200mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205320	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 90cm 20mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205321	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 90cm 60mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205322	EAP	HCPCS C1725		Catheter Blndil 4.3fr 6mm 90cm 80mm Crosstella Otw Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205323	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 150cm 100mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205324	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 150cm 120mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205325	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 150cm 150mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205326	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 150cm 200mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205327	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 150cm 20mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205328	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 150cm 40mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205329	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 150cm 60mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205330	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 150cm 80mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205331	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 90cm 100mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205332	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 90cm 120mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205333	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 90cm 150mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205334	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 90cm 200mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205335	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 90cm 20mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205336	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 90cm 40mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205337	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 90cm 60mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205338	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2.5mm 90cm 80mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205339	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 150cm 100mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205340	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 150cm 120mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205341	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 150cm 150mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205342	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 150cm 200mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205343	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 150cm 200mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205344	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 150cm 20mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205345	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 150cm 40mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205346	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 150cm 60mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205347	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 150cm 80mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205348	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 90cm 100mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205349	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 90cm 120mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205350	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 90cm 150mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205351	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 90cm 200mm Crosperio Rx Tpr Cor	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205352	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 90cm 200mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205353	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 90cm 20mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205354	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 90cm 40mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205355	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 90cm 60mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205356	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 2mm 90cm 80mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205357	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 150cm 100mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205358	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 150cm 120mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205359	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 150cm 150mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205360	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 150cm 200mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205361	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 150cm 20mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205362	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 150cm 40mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205363	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 150cm 60mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205364	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 150cm 80mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205365	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 90cm 100mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205366	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 90cm 120mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205367	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 90cm 150mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205368	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 90cm 200mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205369	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 90cm 20mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205370	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 90cm 40mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205371	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 90cm 60mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205372	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 3mm 90cm 80mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205373	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 150cm 100mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205374	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 150cm 120mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205375	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 150cm 150mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205376	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 150cm 200mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205377	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 150cm 20mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205378	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 150cm 40mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205379	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 150cm 60mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205380	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 150cm 80mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205381	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 90cm 100mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205382	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 90cm 120mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205383	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 90cm 150mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205384	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 90cm 200mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205385	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 90cm 20mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205386	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 90cm 40mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205387	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 90cm 60mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205388	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 4mm 90cm 80mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205389	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 5mm 150cm 100mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205390	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 5mm 150cm 20mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205391	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 5mm 150cm 40mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205392	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 5mm 150cm 60mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205393	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 5mm 150cm 80mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205394	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 5mm 90cm 40mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205395	EAP	HCPCS C1725		Catheter Blndil 4-3.4fr 5mm 90cm 60mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205396	EAP	HCPCS C1725		Catheter Blndil 4-3.9fr 6mm 150cm 20mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205397	EAP	HCPCS C1725		Catheter Blndil 4-3.9fr 6mm 150cm 40mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205398	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 5mm 150cm 120mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205399	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 5mm 150cm 150mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205401	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 5mm 90cm 100mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205402	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 5mm 90cm 120mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205403	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 5mm 90cm 150mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205404	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 5mm 90cm 200mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205405	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 5mm 90cm 20mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205406	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 5mm 90cm 80mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205407	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 6mm 150cm 100mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205408	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 6mm 150cm 120mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205409	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 6mm 150cm 150mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205410	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 6mm 150cm 200mm Crosstella Rx Tpr	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205411	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 6mm 150cm 60mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205412	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 6mm 150cm 80mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205413	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 6mm 90cm 100mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205414	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 6mm 90cm 120mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205415	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 6mm 90cm 150mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205416	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 6mm 90cm 200mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205417	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 6mm 90cm 20mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205419	EAP	HCPCS C1725		Catheter Blndil 4-4.1fr 6mm 90cm 80mm Crosstella Rx Tpr Cor	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205420	EAP	HCPCS C1725		Catheter Blndil 4fr 1.5mm 150cm 120mm Crosperio Rx Acpt .014	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205421	EAP	HCPCS C1725		Catheter Blndil 4fr 2.5mm 150cm 150mm Crosperio Rx Acpt .014	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205422	EAP	HCPCS C1725		Catheter Blndil 4fr 2mm 150cm 120mm Crosperio Rx Acpt .014in	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205423	EAP	HCPCS C1725		Catheter Blndil 4fr 2mm 150cm 200mm Crosperio Rx Acpt .014in	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205424	EAP	HCPCS C1725		Catheter Blndil 4fr 3.5mm 150cm 120mm Crosperio Rx Acpt .014	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205425	EAP	HCPCS C1725		Catheter Blndil 4fr 3.5mm 150cm 150mm Crosperio Rx Acpt .014	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205427	EAP	HCPCS C1725		Catheter Blndil 4fr 3mm 150cm 120mm Crosperio Rx Acpt .014in	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205428	EAP	HCPCS C1725		Catheter Blndil 4fr 3mm 150cm 200mm Crosperio Rx Acpt .014in	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205429	EAP	HCPCS C1725		Catheter Blndil 4fr 3mm 150cm 200mm Crosperio Rx Otw Acpt	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205430	EAP	HCPCS C1725		Catheter Blndil 4fr 3mm 90cm 200mm Crosperio Rx Otw Acpt	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205431	EAP	HCPCS C1725		Catheter Blndil 4fr 4mm 150cm 120mm Crosperio Rx Acpt .014in	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205432	EAP	HCPCS C1725		Catheter Blndil 4fr 4mm 150cm 150mm Crosperio Rx Acpt .014in	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205433	EAP	HCPCS C1725		Catheter Blndil 4fr 4mm 150cm 200mm Crosperio Rx Otw Acpt	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205434	EAP	HCPCS C1725		Catheter Blndil 4mm 90cm 150mm Crosperio Otw Pta	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$414.31	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00	$0.00	$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
27205435	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 135cm 100mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205436	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 135cm 120mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205437	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 135cm 150mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205438	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 135cm 200mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205439	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 135cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205440	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 135cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205441	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 135cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205442	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 65cm 100mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205443	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 65cm 120mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205444	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 65cm 150mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205445	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 65cm 200mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205446	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 65cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205447	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 65cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205448	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 65cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205449	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 65cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205450	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 90cm 100mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205451	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 90cm 120mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205452	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 90cm 120mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205453	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 90cm 150mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205454	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 90cm 200mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205455	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 90cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205456	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 90cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205457	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 90cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205458	EAP	HCPCS C1725		Catheter Blndil 5.4fr 3mm 90cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205459	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 135cm 100mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205460	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 135cm 150mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205461	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 135cm 200mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205462	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 135cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205463	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 135cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205464	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 135cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205465	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 135cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205466	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 65cm 100mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205467	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 65cm 120mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205468	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 65cm 150mm Metacross Otw Tpr Cor	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205469	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 65cm 200mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205470	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 65cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205471	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 65cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205472	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 65cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205473	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 65cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205474	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 90cm 100mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205475	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 90cm 120mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205476	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 90cm 150mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205477	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 90cm 200mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205478	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 90cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205479	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 90cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205480	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 90cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205481	EAP	HCPCS C1725		Catheter Blndil 5.4fr 4mm 90cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205482	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 135cm 100mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205483	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 135cm 120mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205484	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 135cm 150mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205485	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 135cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205486	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 135cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205487	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 135cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205488	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 65cm 100mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205489	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 65cm 120mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205490	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 65cm 150mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205491	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 65cm 200mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205492	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 65cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205493	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 65cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205494	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 65cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205495	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 65cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205496	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 90cm 100mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205497	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 90cm 120mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205498	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 90cm 150mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205499	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 90cm 200mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205500	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 90cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205501	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 90cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205502	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 90cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205503	EAP	HCPCS C1725		Catheter Blndil 5.4fr 5mm 90cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205504	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 135cm 100mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205505	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 135cm 120mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205506	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 135cm 150mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205507	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 135cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205508	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 135cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205509	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 135cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205510	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 135cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205511	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 135cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205512	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 65cm 100mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205513	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 65cm 120mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205514	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 65cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205515	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 65cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205516	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 90cm 120mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205518	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 90cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205519	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 90cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205520	EAP	HCPCS C1725		Catheter Blndil 5.4fr 6mm 90cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205521	EAP	HCPCS C1725		Catheter Blndil 5.7-3.6-9fr 9mm 90cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205522	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 10mm 135cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205523	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 10mm 135cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205524	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 10mm 135cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205526	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 10mm 90cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205527	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 10mm 90cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205528	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 10mm 90cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205529	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 10mm 90cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205530	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 12mm 135cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205531	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 12mm 135cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205532	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 12mm 90cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205534	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 3mm 135cm 100mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205535	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 3mm 135cm 120mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205536	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 3mm 135cm 150mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205537	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 3mm 135cm 200mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205538	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 3mm 135cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205539	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 3mm 135cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205540	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 3mm 135cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205542	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 3mm 90cm 150mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205543	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 3mm 90cm 200mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205544	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 3mm 90cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205545	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 3mm 90cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205546	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 3mm 90cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205547	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 135cm 100mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205548	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 135cm 120mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205549	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 135cm 150mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205550	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 135cm 200mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205551	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 135cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205552	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 135cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205553	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 135cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205554	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 135cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205555	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 90cm 100mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205556	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 90cm 120mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205557	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 90cm 150mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205559	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 90cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205560	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 90cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205561	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 90cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205562	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 90cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205563	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 4mm 90cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205564	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 135cm 100mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205565	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 135cm 120mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205567	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 135cm 200mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205568	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 135cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205569	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 135cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205570	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 135cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205571	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 135cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205572	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 90cm 100mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205573	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 90cm 120mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205575	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 90cm 200mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205576	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 90cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205577	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 90cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205578	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 90cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205579	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 5mm 90cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205580	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 135cm 120mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205581	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 135cm 150mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205583	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 135cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205584	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 135cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205585	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 135cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205586	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 90cm 100mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205587	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 90cm 120mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205588	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 90cm 150mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205589	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 90cm 200mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205590	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 90cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205591	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 90cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205592	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 90cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205593	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 6mm 90cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205594	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 135cm 100mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205595	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 135cm 120mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205596	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 135cm 150mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205597	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 135cm 200mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205598	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 135cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205599	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 135cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205600	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 135cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205601	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 135cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205602	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 90cm 100mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205603	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 90cm 120mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205604	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 90cm 150mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205605	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 90cm 200mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205606	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 90cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205607	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 90cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205608	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 90cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205609	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 7mm 90cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205610	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 8mm 135cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205611	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 8mm 135cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205612	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 8mm 135cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205613	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 8mm 135cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205614	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 8mm 90cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205615	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 8mm 90cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205616	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 8mm 90cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205617	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 8mm 90cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205618	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 9mm 135cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205619	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 9mm 135cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205620	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 9mm 135cm 60mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205621	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 9mm 135cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205622	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 9mm 90cm 20mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205623	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 9mm 90cm 40mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205624	EAP	HCPCS C1725		Catheter Blndil 5.7-3.9fr 9mm 90cm 80mm Metacross Rx Gw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205625	EAP	HCPCS C1725		Catheter Blndil 5.7fr 10mm 135cm 20mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205626	EAP	HCPCS C1725		Catheter Blndil 5.7fr 10mm 135cm 40mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205627	EAP	HCPCS C1725		Catheter Blndil 5.7fr 10mm 135cm 60mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205628	EAP	HCPCS C1725		Catheter Blndil 5.7fr 10mm 135cm 80mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205629	EAP	HCPCS C1725		Catheter Blndil 5.7fr 10mm 65cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205630	EAP	HCPCS C1725		Catheter Blndil 5.7fr 10mm 65cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205631	EAP	HCPCS C1725		Catheter Blndil 5.7fr 10mm 65cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205633	EAP	HCPCS C1725		Catheter Blndil 5.7fr 10mm 90cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205634	EAP	HCPCS C1725		Catheter Blndil 5.7fr 10mm 90cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205635	EAP	HCPCS C1725		Catheter Blndil 5.7fr 10mm 90cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205636	EAP	HCPCS C1725		Catheter Blndil 5.7fr 10mm 90cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205637	EAP	HCPCS C1725		Catheter Blndil 5.7fr 12mm 135cm 20mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205638	EAP	HCPCS C1725		Catheter Blndil 5.7fr 12mm 135cm 40mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205639	EAP	HCPCS C1725		Catheter Blndil 5.7fr 12mm 65cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205641	EAP	HCPCS C1725		Catheter Blndil 5.7fr 12mm 90cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205642	EAP	HCPCS C1725		Catheter Blndil 5.7fr 12mm 90cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205643	EAP	HCPCS C1725		Catheter Blndil 5.7fr 6mm 135cm 200mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205644	EAP	HCPCS C1725		Catheter Blndil 5.7fr 6mm 65cm 150mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205645	EAP	HCPCS C1725		Catheter Blndil 5.7fr 6mm 65cm 200mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205646	EAP	HCPCS C1725		Catheter Blndil 5.7fr 6mm 65cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205647	EAP	HCPCS C1725		Catheter Blndil 5.7fr 6mm 90cm 100mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205648	EAP	HCPCS C1725		Catheter Blndil 5.7fr 6mm 90cm 150mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205649	EAP	HCPCS C1725		Catheter Blndil 5.7fr 6mm 90cm 200mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205650	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 135cm 100mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205651	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 135cm 120mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205652	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 135cm 150mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205653	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 135cm 200mm Metacross 2 Lum Otw	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205654	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 135cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205655	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 135cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205656	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 135cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205658	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 65cm 120mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205659	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 65cm 150mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205660	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 65cm 200mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205661	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 65cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205662	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 65cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205663	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 65cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205664	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 65cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205666	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 90cm 120mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205667	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 90cm 150mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205668	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 90cm 200mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205669	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 90cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205670	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 90cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205671	EAP	HCPCS C1725		Catheter Blndil 5.7fr 7mm 90cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205672	EAP	HCPCS C1725		Catheter Blndil 5.7fr 8mm 135cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205673	EAP	HCPCS C1725		Catheter Blndil 5.7fr 8mm 135cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205674	EAP	HCPCS C1725		Catheter Blndil 5.7fr 8mm 135cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205675	EAP	HCPCS C1725		Catheter Blndil 5.7fr 8mm 135cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205676	EAP	HCPCS C1725		Catheter Blndil 5.7fr 8mm 65cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205677	EAP	HCPCS C1725		Catheter Blndil 5.7fr 8mm 65cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205678	EAP	HCPCS C1725		Catheter Blndil 5.7fr 8mm 65cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205679	EAP	HCPCS C1725		Catheter Blndil 5.7fr 8mm 65cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205680	EAP	HCPCS C1725		Catheter Blndil 5.7fr 8mm 90cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205682	EAP	HCPCS C1725		Catheter Blndil 5.7fr 8mm 90cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205683	EAP	HCPCS C1725		Catheter Blndil 5.7fr 8mm 90cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205684	EAP	HCPCS C1725		Catheter Blndil 5.7fr 9mm 135cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205685	EAP	HCPCS C1725		Catheter Blndil 5.7fr 9mm 135cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205686	EAP	HCPCS C1725		Catheter Blndil 5.7fr 9mm 135cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205687	EAP	HCPCS C1725		Catheter Blndil 5.7fr 9mm 135cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205688	EAP	HCPCS C1725		Catheter Blndil 5.7fr 9mm 65cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205689	EAP	HCPCS C1725		Catheter Blndil 5.7fr 9mm 65cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205690	EAP	HCPCS C1725		Catheter Blndil 5.7fr 9mm 65cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205691	EAP	HCPCS C1725		Catheter Blndil 5.7fr 9mm 65cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205692	EAP	HCPCS C1725		Catheter Blndil 5.7fr 9mm 90cm 20mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205693	EAP	HCPCS C1725		Catheter Blndil 5.7fr 9mm 90cm 40mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205694	EAP	HCPCS C1725		Catheter Blndil 5.7fr 9mm 90cm 60mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205695	EAP	HCPCS C1725		Catheter Blndil 5.7fr 9mm 90cm 80mm Metacross 2 Lum Otw Tpr	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205696	EAP	HCPCS C1725		Catheter Blndil 5fr 4mm 135cm 120mm Metacross Otw 2 Lum Shft	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205697	EAP	HCPCS C1725		Catheter Blndil 5fr 5mm 135cm 200mm Metacross Otw 2 Lum Shft	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205698	EAP	HCPCS C1725		Catheter Blndil 5fr 5mm 135cm 20mm Metacross Otw 2 Lum Shft	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205700	EAP	HCPCS C1725		Catheter Blndil 5fr 6mm 90cm 40mm Crosstella Rx Tpr Cor Wre	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$356.50	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00	$0.00	$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
27205701	EAP	HCPCS C1725		Catheter Blndil 5fr 6mm 90cm 40mm Metacross Otw 2 Lum Shft	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205702	EAP	HCPCS C1725		Catheter Blndil 6fr 4mm 135cm 60mm Metacross Rx Loow Prfl	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205703	EAP	HCPCS C1725		Catheter Blndil 6mm 135cm 40mm Metacross Rx Sm Prfl Acpt	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$154.76	$154.76	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$219.68	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00	$0.00	$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
27205704	EAP	HCPCS C1887		Catheter Intvn .021in 2.8fr 150cm 160cm Progreat Gldwr	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$705.90	$705.90	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	"$1,002.04"	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00	$0.00	$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
27205705	EAP	HCPCS C1887		Catheter Intvn .021in 750 Psi 2.4fr 150cm 90cm Progreat Mcth	BOTH IP/OP	$775.00 	$573.50	$0.00	$620.00	$420.83	$420.83	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$597.37	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$387.50	$613.80	$620.00	$0.00	$503.75	$0.00	$121.29	$0.00	$0.00	$123.38	$0.00	$0.00	$0.00	$0.00	$0.00
27205706	EAP	HCPCS C1887		Catheter Intvn .021in Mic 2.4-2.9fr .022in 130cm Progreat	BOTH IP/OP	$775.00 	$573.50	$0.00	$620.00	$420.83	$420.83	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$597.37	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$387.50	$613.80	$620.00	$0.00	$503.75	$0.00	$121.29	$0.00	$0.00	$123.38	$0.00	$0.00	$0.00	$0.00	$0.00
27205708	EAP	HCPCS C1887		Catheter Intvn 2.7-2.9fr .021in 130cm Progreat Mcth Coax	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$705.90	$705.90	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	"$1,002.04"	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00	$0.00	$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
27205709	EAP	HCPCS C1887		Catheter Intvn 2.7-2.9fr .025in 110cm Progreat Mcth Coax	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$705.90	$705.90	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	"$1,002.04"	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00	$0.00	$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
27205710	EAP	HCPCS C1887		Catheter Intvn 2.7fr .021in 110cm 50cm Progreat Mcth Shp Tip	BOTH IP/OP	$775.00 	$573.50	$0.00	$620.00	$420.83	$420.83	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$597.37	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$387.50	$613.80	$620.00	$0.00	$0.00	$0.00	$121.29	$0.00	$0.00	$123.38	$0.00	$0.00	$0.00	$0.00	$0.00
27205711	EAP	HCPCS C1887		Catheter Intvn Mic 2.4-2.9fr .022in 110cm Progreat Coax	BOTH IP/OP	$775.00 	$573.50	$0.00	$620.00	$420.83	$420.83	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$597.37	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$387.50	$613.80	$620.00	$0.00	$0.00	$0.00	$121.29	$0.00	$0.00	$123.38	$0.00	$0.00	$0.00	$0.00	$0.00
27205712	EAP	HCPCS C1887		Catheter Intvn Mic 2.8-3fr .027in 110cm 50cm Progreat Coax	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$705.90	$705.90	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	"$1,002.04"	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00	$0.00	$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
27205713	EAP	HCPCS C1887		Catheter Intvn Mic 2.8-3fr .027in 130cm 17cm Progreat Mrkr	BOTH IP/OP	$775.00 	$573.50	$0.00	$620.00	$420.83	$420.83	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$597.37	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$387.50	$613.80	$620.00	$0.00	$0.00	$0.00	$121.29	$0.00	$0.00	$123.38	$0.00	$0.00	$0.00	$0.00	$0.00
27205714	EAP	HCPCS C1887		Catheter Intvn Mic 2.8fr .027in 150cm 90cm Progreat Hmst Vlv	BOTH IP/OP	$775.00 	$573.50	$0.00	$620.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$387.50	$613.80	$620.00	$0.00	$0.00	$0.00	$121.29	$0.00	$0.00	$123.38	$0.00	$0.00	$0.00	$0.00	$0.00
27205715	EAP	HCPCS C1887		Catheter Sprt 30d 12mm 90cm Strl Lf 40cm Navicross Radopq	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$232.13	$232.13	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$329.52	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$213.75	$338.58	$342.00	$0.00	$0.00	$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
27205716	EAP	Custom 27205716		Device Infl 25cc Strl Solopath Stpck	BOTH IP/OP	$110.00 	$81.40	$0.00	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.64	$81.64	$84.79	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$55.00	$87.12	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205717	EAP	Custom 27205717		Device Infl 30 Atm 25ml Strl Solopath Excel Stpck	BOTH IP/OP	$110.00 	$81.40	$0.00	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.64	$81.64	$84.79	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$55.00	$87.12	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205718	EAP	HCPCS C1769		Form Submission .018 Ang 300cm Gw Cert	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00	$0.00	$0.00	$86.08	$0.00	$0.00	$87.56	$0.00	$0.00	$0.00	$0.00	$0.00
27205719	EAP	HCPCS C1769		Guidewire Srg 45d .018in 180cm 3cm Gldwr Gl Ang Flx Tp Hdrph	BOTH IP/OP	$301.25 	$222.93	$0.00	$241.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.63	$238.59	$241.00	$0.00	$0.00	$0.00	$47.15	$0.00	$0.00	$47.96	$0.00	$0.00	$0.00	$0.00	$0.00
27205720	EAP	HCPCS C1769		Guidewire Srg 45d .018in 180cm 5cm Gldwr Hdrph	BOTH IP/OP	$301.25 	$222.93	$0.00	$241.00	$163.58	$163.58	$0.00	$0.00	$0.00	$62.79	$223.59	$223.59	$232.20	$0.00	$62.78	$0.00	$178.19	$178.19	$0.00	$150.63	$238.59	$241.00	$0.00	$0.00	$0.00	$47.15	$0.00	$0.00	$47.96	$0.00	$0.00	$0.00	$0.00	$0.00
27205721	EAP	HCPCS C1769		Guidewire Srg 70d .018in 180cm 3cm Gldwr Au Tip Ang Hdrph	BOTH IP/OP	$301.25 	$222.93	$0.00	$241.00	$163.58	$163.58	$0.00	$0.00	$0.00	$62.79	$223.59	$223.59	$232.20	$0.00	$62.78	$0.00	$178.19	$178.19	$0.00	$150.63	$238.59	$241.00	$0.00	$0.00	$0.00	$47.15	$0.00	$0.00	$47.96	$0.00	$0.00	$0.00	$0.00	$0.00
27205722	EAP	HCPCS C1769		Guidewire Srg Ang .018in 180cm 5cm Gldwr Hdrph	BOTH IP/OP	$301.25 	$222.93	$0.00	$241.00	$163.58	$163.58	$0.00	$0.00	$0.00	$62.79	$223.59	$223.59	$232.20	$0.00	$62.78	$0.00	$178.19	$178.19	$0.00	$150.63	$238.59	$241.00	$0.00	$0.00	$0.00	$47.15	$0.00	$0.00	$47.96	$0.00	$0.00	$0.00	$0.00	$0.00
27205723	EAP	HCPCS C1769		Guidewire Vasc 3mm Std .035in 150cm 3cm Gldwr Jtp Ntnl Hdrph	BOTH IP/OP	$72.50 	$53.65	$0.00	$58.00	$39.37	$39.37	$0.00	$0.00	$0.00	$15.11	$53.81	$53.81	$55.88	$0.00	$15.11	$0.00	$42.88	$42.88	$0.00	$36.25	$57.42	$58.00	$0.00	$0.00	$0.00	$11.35	$0.00	$0.00	$11.54	$0.00	$0.00	$0.00	$0.00	$0.00
27205724	EAP	HCPCS C1769		Guidewire Vasc 3mm Std .038in 150cm 3cm Gldwr Jtp Ntnl Hdrph	BOTH IP/OP	$72.50 	$53.65	$0.00	$58.00	$39.37	$39.37	$0.00	$0.00	$0.00	$15.11	$53.81	$53.81	$55.88	$0.00	$15.11	$0.00	$42.88	$42.88	$0.00	$36.25	$57.42	$58.00	$0.00	$0.00	$0.00	$11.35	$0.00	$0.00	$11.54	$0.00	$0.00	$0.00	$0.00	$0.00
27205725	EAP	HCPCS C1769		Guidewire Vasc 45d .018in 300cm 3cm Gldwr Hdrph	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$232.13	$232.13	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$329.52	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$213.75	$338.58	$342.00	$0.00	$0.00	$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
27205726	EAP	HCPCS C1769		Guidewire Vasc 45d .018in 300cm 5cm Gldwr Hdrph	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$232.13	$232.13	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$329.52	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$213.75	$338.58	$342.00	$0.00	$0.00	$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
27205727	EAP	HCPCS C1769		Guidewire Vasc 45d Std .018in 180cm 25cm Grind Flxb	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$264.71	$264.71	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$375.77	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00	$0.00	$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
27205728	EAP	HCPCS C1769		Guidewire Vasc 70d .018in 300cm 3cm Gldwr Hdrph	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$232.13	$232.13	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$329.52	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$213.75	$338.58	$342.00	$0.00	$0.00	$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
27205729	EAP	HCPCS C1769		Guidewire Vasc 70d .018in 300cm 5cm Gldwr Hdrph	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$232.13	$232.13	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$329.52	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$213.75	$338.58	$342.00	$0.00	$0.00	$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
27205730	EAP	HCPCS C1769		Guidewire Vasc Ang .014in 180cm	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$385.40	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00	$0.00	$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
27205731	EAP	HCPCS C1769		Guidewire Vasc Ang .014in 300cm	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$305.44	$305.44	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$433.58	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00	$0.00	$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
27205732	EAP	HCPCS C1769		Guidewire Vasc Ang .018in 150cm 3cm Gldwr Hdrph	BOTH IP/OP	$134.38 	$99.44	$0.00	$107.50	$72.97	$72.97	$0.00	$0.00	$0.00	$28.01	$99.74	$99.74	$103.58	$0.00	$28.00	$0.00	$79.49	$79.49	$0.00	$67.19	$106.43	$107.50	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$21.39	$0.00	$0.00	$0.00	$0.00	$0.00
27205733	EAP	HCPCS C1769		Guidewire Vasc Ang .018in 80cm 3cm Gldwr Hdrph	BOTH IP/OP	$134.38 	$99.44	$0.00	$107.50	$72.97	$72.97	$0.00	$0.00	$0.00	$28.01	$99.74	$99.74	$103.58	$0.00	$28.00	$0.00	$79.49	$79.49	$0.00	$67.19	$106.43	$107.50	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$21.39	$0.00	$0.00	$0.00	$0.00	$0.00
27205734	EAP	HCPCS C1769		Guidewire Vasc Ang .025in 150cm 3cm Gldwr Hdrph	BOTH IP/OP	$101.13 	$74.84	$0.00	$80.90	$54.91	$54.91	$0.00	$0.00	$0.00	$21.08	$75.06	$75.06	$77.95	$0.00	$21.08	$0.00	$59.82	$59.82	$0.00	$50.57	$80.09	$80.90	$0.00	$65.73	$0.00	$15.83	$0.00	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$0.00
27205735	EAP	HCPCS C1769		Guidewire Vasc Ang .025in 180cm 3cm Gldwr Hdrph	BOTH IP/OP	$134.38 	$99.44	$0.00	$107.50	$72.97	$72.97	$0.00	$0.00	$0.00	$28.01	$99.74	$99.74	$103.58	$0.00	$28.00	$0.00	$79.49	$79.49	$0.00	$67.19	$106.43	$107.50	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$21.39	$0.00	$0.00	$0.00	$0.00	$0.00
27205736	EAP	HCPCS C1769		Guidewire Vasc Ang .025in 260cm 3cm Gldwr Hdrph	BOTH IP/OP	$144.00 	$106.56	$0.00	$115.20	$78.19	$78.19	$0.00	$0.00	$0.00	$30.01	$106.88	$106.88	$111.00	$0.00	$30.01	$0.00	$85.18	$85.18	$0.00	$72.00	$114.05	$115.20	$0.00	$93.60	$0.00	$22.54	$0.00	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$0.00
27205737	EAP	HCPCS C1769		Guidewire Vasc Ang .035in 80cm 3cm Gldwr Stf Shft Hdrph	BOTH IP/OP	$112.88 	$83.53	$0.00	$90.30	$61.29	$61.29	$0.00	$0.00	$0.00	$23.53	$83.78	$83.78	$87.01	$0.00	$23.52	$0.00	$66.77	$66.77	$0.00	$56.44	$89.40	$90.30	$0.00	$0.00	$0.00	$17.67	$0.00	$0.00	$17.97	$0.00	$0.00	$0.00	$0.00	$0.00
27205738	EAP	HCPCS C1769		Guidewire Vasc Ang .038in 150cm 3cm Gldwr Hdrph	BOTH IP/OP	$72.50 	$53.65	$0.00	$58.00	$39.37	$39.37	$0.00	$0.00	$0.00	$15.11	$53.81	$53.81	$55.88	$0.00	$15.11	$0.00	$42.88	$42.88	$0.00	$36.25	$57.42	$58.00	$0.00	$0.00	$0.00	$11.35	$0.00	$0.00	$11.54	$0.00	$0.00	$0.00	$0.00	$0.00
27205739	EAP	HCPCS C1769		Guidewire Vasc Ang .038in 80cm 3cm Gldwr Hdrph	BOTH IP/OP	$72.50 	$53.65	$0.00	$58.00	$39.37	$39.37	$0.00	$0.00	$0.00	$15.11	$53.81	$53.81	$55.88	$0.00	$15.11	$0.00	$42.88	$42.88	$0.00	$36.25	$57.42	$58.00	$0.00	$0.00	$0.00	$11.35	$0.00	$0.00	$11.54	$0.00	$0.00	$0.00	$0.00	$0.00
27205740	EAP	HCPCS C1769		Guidewire Vasc Ang .038in 80cm 3cm Gldwr Stf Shft Hdrph	BOTH IP/OP	$112.88 	$83.53	$0.00	$90.30	$61.29	$61.29	$0.00	$0.00	$0.00	$23.53	$83.78	$83.78	$87.01	$0.00	$23.52	$0.00	$66.77	$66.77	$0.00	$56.44	$89.40	$90.30	$0.00	$0.00	$0.00	$17.67	$0.00	$0.00	$17.97	$0.00	$0.00	$0.00	$0.00	$0.00
27205741	EAP	HCPCS C1769		Guidewire Vasc Ang Lng Tpr .035in 150cm 5cm Gldwr Stf Shft	BOTH IP/OP	$112.88 	$83.53	$0.00	$90.30	$61.29	$61.29	$0.00	$0.00	$0.00	$23.53	$83.78	$83.78	$87.01	$0.00	$23.52	$0.00	$66.77	$66.77	$0.00	$56.44	$89.40	$90.30	$0.00	$0.00	$0.00	$17.67	$0.00	$0.00	$17.97	$0.00	$0.00	$0.00	$0.00	$0.00
27205742	EAP	HCPCS C1769		Guidewire Vasc Ang Lng Tpr .035in 260cm 5cm Gldwr Stf Shft	BOTH IP/OP	$124.63 	$92.23	$0.00	$99.70	$67.67	$67.67	$0.00	$0.00	$0.00	$25.98	$92.50	$92.50	$96.06	$0.00	$25.97	$0.00	$73.72	$73.72	$0.00	$62.32	$98.71	$99.70	$0.00	$0.00	$0.00	$19.50	$0.00	$0.00	$19.84	$0.00	$0.00	$0.00	$0.00	$0.00
27205743	EAP	HCPCS C1769		Guidewire Vasc Ang Lng Tpr .038in 150cm 5cm Gldwr Stf Shft	BOTH IP/OP	$112.88 	$83.53	$0.00	$90.30	$61.29	$61.29	$0.00	$0.00	$0.00	$23.53	$83.78	$83.78	$87.01	$0.00	$23.52	$0.00	$66.77	$66.77	$0.00	$56.44	$89.40	$90.30	$0.00	$0.00	$0.00	$17.67	$0.00	$0.00	$17.97	$0.00	$0.00	$0.00	$0.00	$0.00
27205744	EAP	HCPCS C1769		Guidewire Vasc Ang Std .035in 120cm 3cm Gldwr Jkt Cor To Tip	BOTH IP/OP	$72.50 	$53.65	$0.00	$58.00	$39.37	$39.37	$0.00	$0.00	$0.00	$15.11	$53.81	$53.81	$55.88	$0.00	$15.11	$0.00	$42.88	$42.88	$0.00	$36.25	$57.42	$58.00	$0.00	$0.00	$0.00	$11.35	$0.00	$0.00	$11.54	$0.00	$0.00	$0.00	$0.00	$0.00
27205745	EAP	HCPCS C1769		Guidewire Vasc Ang Std .035in 150cm 1cm Gldwr Jkt Cor To Tip	BOTH IP/OP	$72.50 	$53.65	$0.00	$58.00	$39.37	$39.37	$0.00	$0.00	$0.00	$15.11	$53.81	$53.81	$55.88	$0.00	$15.11	$0.00	$42.88	$42.88	$0.00	$36.25	$57.42	$58.00	$0.00	$0.00	$0.00	$11.35	$0.00	$0.00	$11.54	$0.00	$0.00	$0.00	$0.00	$0.00
27205746	EAP	HCPCS C1769		Guidewire Vasc Ang Std .035in 180cm 1cm Gldwr Jkt Cor To Tip	BOTH IP/OP	$99.25 	$73.45	$0.00	$79.40	$53.89	$53.89	$0.00	$0.00	$0.00	$20.69	$73.66	$73.66	$76.50	$0.00	$20.68	$0.00	$58.71	$58.71	$0.00	$49.63	$78.61	$79.40	$0.00	$0.00	$0.00	$15.53	$0.00	$0.00	$15.80	$0.00	$0.00	$0.00	$0.00	$0.00
27205747	EAP	HCPCS C1769		Guidewire Vasc Ang Std .035in 260cm 1cm Gldwr Jkt Cor To Tip	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$60.27	$60.27	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$85.56	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00	$0.00	$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
27205748	EAP	HCPCS C1769		Guidewire Vasc Ang Tpr .035in 150cm 1cm Gldwr Hdrph	BOTH IP/OP	$112.88 	$83.53	$0.00	$90.30	$61.29	$61.29	$0.00	$0.00	$0.00	$23.53	$83.78	$83.78	$87.01	$0.00	$23.52	$0.00	$66.77	$66.77	$0.00	$56.44	$89.40	$90.30	$0.00	$0.00	$0.00	$17.67	$0.00	$0.00	$17.97	$0.00	$0.00	$0.00	$0.00	$0.00
27205749	EAP	HCPCS C1769		Guidewire Vasc Bolia Crv Std .035in 180cm 5cm Gldwr Jkt Cor	BOTH IP/OP	$101.13 	$74.84	$0.00	$80.90	$54.91	$54.91	$0.00	$0.00	$0.00	$21.08	$75.06	$75.06	$77.95	$0.00	$21.08	$0.00	$59.82	$59.82	$0.00	$50.57	$80.09	$80.90	$0.00	$0.00	$0.00	$15.83	$0.00	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$0.00
27205750	EAP	HCPCS C1769		Guidewire Vasc Bolia Crv Std .035in 180cm 8cm Gldwr Jkt Cor	BOTH IP/OP	$101.13 	$74.84	$0.00	$80.90	$54.91	$54.91	$0.00	$0.00	$0.00	$21.08	$75.06	$75.06	$77.95	$0.00	$21.08	$0.00	$59.82	$59.82	$0.00	$50.57	$80.09	$80.90	$0.00	$0.00	$0.00	$15.83	$0.00	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$0.00
27205751	EAP	HCPCS C1769		Guidewire Vasc Std Ang .018in 180cm 3cm Gldwr Trmo Gld Tch	BOTH IP/OP	$134.38 	$99.44	$0.00	$107.50	$72.97	$72.97	$0.00	$0.00	$0.00	$28.01	$99.74	$99.74	$103.58	$0.00	$28.00	$0.00	$79.49	$79.49	$0.00	$67.19	$106.43	$107.50	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$21.39	$0.00	$0.00	$0.00	$0.00	$0.00
27205752	EAP	HCPCS C1769		Guidewire Vasc Std Strg .035in 150cm 1cm Gldwr Jkt Cor To	BOTH IP/OP	$72.50 	$53.65	$0.00	$58.00	$39.37	$39.37	$0.00	$0.00	$0.00	$15.11	$53.81	$53.81	$55.88	$0.00	$15.11	$0.00	$42.88	$42.88	$0.00	$36.25	$57.42	$58.00	$0.00	$47.13	$0.00	$11.35	$0.00	$0.00	$11.54	$0.00	$0.00	$0.00	$0.00	$0.00
27205753	EAP	HCPCS C1769		Guidewire Vasc Std Strg .035in 180cm 1cm Gldwr Jkt Cor To	BOTH IP/OP	$99.25 	$73.45	$0.00	$79.40	$53.89	$53.89	$0.00	$0.00	$0.00	$20.69	$73.66	$73.66	$76.50	$0.00	$20.68	$0.00	$58.71	$58.71	$0.00	$49.63	$78.61	$79.40	$0.00	$0.00	$0.00	$15.53	$0.00	$0.00	$15.80	$0.00	$0.00	$0.00	$0.00	$0.00
27205754	EAP	HCPCS C1769		Guidewire Vasc Std Strg .035in 260cm 1cm Gldwr Jkt Cor To	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$60.27	$60.27	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$85.56	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00	$0.00	$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
27205755	EAP	HCPCS C1769		Guidewire Vasc Strg .018in 150cm 3cm Gldwr Hdrph	BOTH IP/OP	$134.38 	$99.44	$0.00	$107.50	$72.97	$72.97	$0.00	$0.00	$0.00	$28.01	$99.74	$99.74	$103.58	$0.00	$28.00	$0.00	$79.49	$79.49	$0.00	$67.19	$106.43	$107.50	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$21.39	$0.00	$0.00	$0.00	$0.00	$0.00
27205756	EAP	HCPCS C1769		Guidewire Vasc Strg .018in 150cm 3cm Gldwr Shp Tip Hdrph	BOTH IP/OP	$137.38 	$101.66	$0.00	$109.90	$74.60	$74.60	$0.00	$0.00	$0.00	$28.63	$101.96	$101.96	$105.89	$0.00	$28.63	$0.00	$81.26	$81.26	$0.00	$68.69	$108.80	$109.90	$0.00	$0.00	$0.00	$21.50	$0.00	$0.00	$21.87	$0.00	$0.00	$0.00	$0.00	$0.00
27205757	EAP	HCPCS C1769		Guidewire Vasc Strg .018in 180cm 3cm Gldwr Hdrph	BOTH IP/OP	$134.38 	$99.44	$0.00	$107.50	$72.97	$72.97	$0.00	$0.00	$0.00	$28.01	$99.74	$99.74	$103.58	$0.00	$28.00	$0.00	$79.49	$79.49	$0.00	$67.19	$106.43	$107.50	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$21.39	$0.00	$0.00	$0.00	$0.00	$0.00
27205758	EAP	HCPCS C1769		Guidewire Vasc Strg .018in 260cm 3cm Gldwr Hdrph	BOTH IP/OP	$185.00 	$136.90	$0.00	$148.00	$100.46	$100.46	$0.00	$0.00	$0.00	$38.56	$137.31	$137.31	$142.60	$0.00	$38.55	$0.00	$109.43	$109.43	$0.00	$92.50	$146.52	$148.00	$0.00	$0.00	$0.00	$28.95	$0.00	$0.00	$29.45	$0.00	$0.00	$0.00	$0.00	$0.00
27205759	EAP	HCPCS C1769		Guidewire Vasc Strg .025in 150cm 3cm Gldwr Hdrph	BOTH IP/OP	$101.13 	$74.84	$0.00	$80.90	$54.91	$54.91	$0.00	$0.00	$0.00	$21.08	$75.06	$75.06	$77.95	$0.00	$21.08	$0.00	$59.82	$59.82	$0.00	$50.57	$80.09	$80.90	$0.00	$0.00	$0.00	$15.83	$0.00	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$0.00
27205760	EAP	HCPCS C1769		Guidewire Vasc Strg .025in 180cm 3cm Gldwr Hdrph	BOTH IP/OP	$134.38 	$99.44	$0.00	$107.50	$72.97	$72.97	$0.00	$0.00	$0.00	$28.01	$99.74	$99.74	$103.58	$0.00	$28.00	$0.00	$79.49	$79.49	$0.00	$67.19	$106.43	$107.50	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$21.39	$0.00	$0.00	$0.00	$0.00	$0.00
27205761	EAP	HCPCS C1769		Guidewire Vasc Strg .025in 260cm 3cm Gldwr Hdrph	BOTH IP/OP	$144.00 	$106.56	$0.00	$115.20	$78.19	$78.19	$0.00	$0.00	$0.00	$30.01	$106.88	$106.88	$111.00	$0.00	$30.01	$0.00	$85.18	$85.18	$0.00	$72.00	$114.05	$115.20	$0.00	$0.00	$0.00	$22.54	$0.00	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$0.00
27205762	EAP	HCPCS C1769		Guidewire Vasc Strg .032in 150cm 3cm Gldwr Hdrph	BOTH IP/OP	$74.00 	$54.76	$0.00	$59.20	$40.18	$40.18	$0.00	$0.00	$0.00	$15.42	$54.92	$54.92	$57.04	$0.00	$15.42	$0.00	$43.77	$43.77	$0.00	$37.00	$58.61	$59.20	$0.00	$0.00	$0.00	$11.58	$0.00	$0.00	$11.78	$0.00	$0.00	$0.00	$0.00	$0.00
27205763	EAP	HCPCS C1769		Guidewire Vasc Strg .035in 150cm 3cm Gldwr Shp Tip Hdrph	BOTH IP/OP	$79.75 	$59.02	$0.00	$63.80	$43.30	$43.30	$0.00	$0.00	$0.00	$16.62	$59.19	$59.19	$61.47	$0.00	$16.62	$0.00	$47.17	$47.17	$0.00	$39.88	$63.16	$63.80	$0.00	$0.00	$0.00	$12.48	$0.00	$0.00	$12.70	$0.00	$0.00	$0.00	$0.00	$0.00
27205764	EAP	HCPCS C1769		Guidewire Vasc Strg .035in 180cm 3cm Gldwr Shp Tip Hdrph	BOTH IP/OP	$107.00 	$79.18	$0.00	$85.60	$58.10	$58.10	$0.00	$0.00	$0.00	$22.30	$79.42	$79.42	$82.48	$0.00	$22.30	$0.00	$63.29	$63.29	$0.00	$53.50	$84.74	$85.60	$0.00	$69.55	$0.00	$16.75	$0.00	$0.00	$17.03	$0.00	$0.00	$0.00	$0.00	$0.00
27205765	EAP	HCPCS C1769		Guidewire Vasc Strg .038in 150cm 3cm Gldwr Hdrph	BOTH IP/OP	$72.50 	$53.65	$0.00	$58.00	$39.37	$39.37	$0.00	$0.00	$0.00	$15.11	$53.81	$53.81	$55.88	$0.00	$15.11	$0.00	$42.88	$42.88	$0.00	$36.25	$57.42	$58.00	$0.00	$0.00	$0.00	$11.35	$0.00	$0.00	$11.54	$0.00	$0.00	$0.00	$0.00	$0.00
27205766	EAP	HCPCS C1769		Guidewire Vasc Strg .038in 150cm 3cm Gldwr Shp Tip Hdrph	BOTH IP/OP	$79.75 	$59.02	$0.00	$63.80	$43.30	$43.30	$0.00	$0.00	$0.00	$16.62	$59.19	$59.19	$61.47	$0.00	$16.62	$0.00	$47.17	$47.17	$0.00	$39.88	$63.16	$63.80	$0.00	$0.00	$0.00	$12.48	$0.00	$0.00	$12.70	$0.00	$0.00	$0.00	$0.00	$0.00
27205767	EAP	HCPCS C1769		Guidewire Vasc Strg .038in 150cm 3cm Gldwr Stf Shft Hdrph	BOTH IP/OP	$112.88 	$83.53	$0.00	$90.30	$61.29	$61.29	$0.00	$0.00	$0.00	$23.53	$83.78	$83.78	$87.01	$0.00	$23.52	$0.00	$66.77	$66.77	$0.00	$56.44	$89.40	$90.30	$0.00	$0.00	$0.00	$17.67	$0.00	$0.00	$17.97	$0.00	$0.00	$0.00	$0.00	$0.00
27205768	EAP	HCPCS C1769		Guidewire Vasc Strg .038in 180cm 3cm Gldwr Hdrph	BOTH IP/OP	$99.25 	$73.45	$0.00	$79.40	$53.89	$53.89	$0.00	$0.00	$0.00	$20.69	$73.66	$73.66	$76.50	$0.00	$20.68	$0.00	$58.71	$58.71	$0.00	$49.63	$78.61	$79.40	$0.00	$0.00	$0.00	$15.53	$0.00	$0.00	$15.80	$0.00	$0.00	$0.00	$0.00	$0.00
27205769	EAP	HCPCS C1769		Guidewire Vasc Strg .038in 180cm 3cm Gldwr Stf Shft Hdrph	BOTH IP/OP	$116.75 	$86.40	$0.00	$93.40	$63.40	$63.40	$0.00	$0.00	$0.00	$24.33	$86.65	$86.65	$89.99	$0.00	$24.33	$0.00	$69.06	$69.06	$0.00	$58.38	$92.47	$93.40	$0.00	$0.00	$0.00	$18.27	$0.00	$0.00	$18.59	$0.00	$0.00	$0.00	$0.00	$0.00
27205770	EAP	HCPCS C1769		Guidewire Vasc Strg .038in 260cm 3cm Gldwr Hdrph	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$60.27	$60.27	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$85.56	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00	$0.00	$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
27205771	EAP	HCPCS C1769		Guidewire Vasc Strg Lng Tpr .035in 150cm 5cm Gldwr Stf Shft	BOTH IP/OP	$112.88 	$83.53	$0.00	$90.30	$61.29	$61.29	$0.00	$0.00	$0.00	$23.53	$83.78	$83.78	$87.01	$0.00	$23.52	$0.00	$66.77	$66.77	$0.00	$56.44	$89.40	$90.30	$0.00	$0.00	$0.00	$17.67	$0.00	$0.00	$17.97	$0.00	$0.00	$0.00	$0.00	$0.00
27205772	EAP	HCPCS C1769		Guidewire Vasc Strg Lng Tpr .035in 150cm 8cm Gldwr Jkt Cor	BOTH IP/OP	$81.75 	$60.50	$0.00	$65.40	$44.39	$44.39	$0.00	$0.00	$0.00	$17.04	$60.67	$60.67	$63.01	$0.00	$17.04	$0.00	$48.36	$48.36	$0.00	$40.88	$64.75	$65.40	$0.00	$0.00	$0.00	$12.79	$0.00	$0.00	$13.01	$0.00	$0.00	$0.00	$0.00	$0.00
27205773	EAP	HCPCS C1769		Guidewire Vasc Strg Lng Tpr .038in 150cm 5cm Gldwr Stf Shft	BOTH IP/OP	$112.88 	$83.53	$0.00	$90.30	$61.29	$61.29	$0.00	$0.00	$0.00	$23.53	$83.78	$83.78	$87.01	$0.00	$23.52	$0.00	$66.77	$66.77	$0.00	$56.44	$89.40	$90.30	$0.00	$0.00	$0.00	$17.67	$0.00	$0.00	$17.97	$0.00	$0.00	$0.00	$0.00	$0.00
27205774	EAP	HCPCS C1769		Guidewire Vasc Strg Tpr .038in 150cm 8cm Gldwr Hdrph	BOTH IP/OP	$81.75 	$60.50	$0.00	$65.40	$44.39	$44.39	$0.00	$0.00	$0.00	$17.04	$60.67	$60.67	$63.01	$0.00	$17.04	$0.00	$48.36	$48.36	$0.00	$40.88	$64.75	$65.40	$0.00	$0.00	$0.00	$12.79	$0.00	$0.00	$13.01	$0.00	$0.00	$0.00	$0.00	$0.00
27205775	EAP	HCPCS C1894		Introducer Cath 17fr 5.3fr 14fr 25cm Solopath Bln Expandable	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$719.48	$719.48	$0.00	$0.00	$0.00	$276.16	$983.42	$983.42	"$1,021.31"	$0.00	$276.13	$0.00	$783.74	$783.74	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00	$0.00	$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205776	EAP	HCPCS C1894		Introducer Cath 21fr 13fr 18fr 25cm Strl 20cm Solopath	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$719.48	$719.48	$0.00	$0.00	$0.00	$276.16	$983.42	$983.42	"$1,021.31"	$0.00	$276.13	$0.00	$783.74	$783.74	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00	$0.00	$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205777	EAP	HCPCS C1894		Introducer Cath 21fr 5.3fr 18fr 35cm Strl 30cm Solopath Bln	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$719.48	$719.48	$0.00	$0.00	$0.00	$276.16	$983.42	$983.42	"$1,021.31"	$0.00	$276.13	$0.00	$783.74	$783.74	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00	$0.00	$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205778	EAP	HCPCS C1894		Introducer Cath 22fr 14fr 19fr 35cm Strl 30cm Solopath	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$719.48	$719.48	$0.00	$0.00	$0.00	$276.16	$983.42	$983.42	"$1,021.31"	$0.00	$276.13	$0.00	$783.74	$783.74	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00	$0.00	$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205779	EAP	HCPCS C1894		Introducer Cath 22fr 5.3fr 19fr 25cm 20cm Solopath Bln	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$719.48	$719.48	$0.00	$0.00	$0.00	$276.16	$983.42	$983.42	"$1,021.31"	$0.00	$276.13	$0.00	$783.74	$783.74	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00	$0.00	$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205780	EAP	HCPCS C1894		Introducer Cath 23fr 5.3fr 20fr 35cm Strl 25cm Solopath Bln	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$719.48	$719.48	$0.00	$0.00	$0.00	$276.16	$983.42	$983.42	"$1,021.31"	$0.00	$276.13	$0.00	$783.74	$783.74	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00	$0.00	$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205781	EAP	HCPCS C1894		Introducer Cath 24fr 14fr 21fr 35cm Strl 30cm Solopath	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$719.48	$719.48	$0.00	$0.00	$0.00	$276.16	$983.42	$983.42	"$1,021.31"	$0.00	$276.13	$0.00	$783.74	$783.74	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00	$0.00	$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205782	EAP	HCPCS C1894		Introducer Cath 24fr 5.3fr 21fr 25cm 20cm Solopath Bln	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$719.48	$719.48	$0.00	$0.00	$0.00	$276.16	$983.42	$983.42	"$1,021.31"	$0.00	$276.13	$0.00	$783.74	$783.74	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00	$0.00	$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205783	EAP	HCPCS C1894		Introducer Cath Loprfl 11.5-17fr 5.3fr 14fr 35cm 30cm	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$719.48	$719.48	$0.00	$0.00	$0.00	$276.16	$983.42	$983.42	"$1,021.31"	$0.00	$276.13	$0.00	$783.74	$783.74	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00	$0.00	$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205784	EAP	HCPCS C1894		Introducer Cath Loprfl 15-19fr 5.3fr 16fr 25cm 20cm Solopath	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$719.48	$719.48	$0.00	$0.00	$0.00	$276.16	$983.42	$983.42	"$1,021.31"	$0.00	$276.13	$0.00	$783.74	$783.74	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00	$0.00	$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205785	EAP	HCPCS C1894		Introducer Cath Loprfl 15-19fr 5.3fr 16fr 35cm 30cm Solopath	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$719.48	$719.48	$0.00	$0.00	$0.00	$276.16	$983.42	$983.42	"$1,021.31"	$0.00	$276.13	$0.00	$783.74	$783.74	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00	$0.00	$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205786	EAP	HCPCS C1894		Introducer Cath Loprfl 15-23fr 5.3fr 20fr 25cm 20cm Solopath	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$719.48	$719.48	$0.00	$0.00	$0.00	$276.16	$983.42	$983.42	"$1,021.31"	$0.00	$276.13	$0.00	$783.74	$783.74	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00	$0.00	$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205787	EAP	HCPCS C1894		Introducer Shth .035in 4fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq	BOTH IP/OP	$57.50 	$42.55	$0.00	$46.00	$31.22	$31.22	$0.00	$0.00	$0.00	$11.98	$42.68	$42.68	$44.32	$0.00	$11.98	$0.00	$34.01	$34.01	$0.00	$28.75	$45.54	$46.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$9.15	$0.00	$0.00	$0.00	$0.00	$0.00
27205788	EAP	HCPCS C1894		Introducer Shth .035in 4fr 6cm 2.5cm Pncl R/o Ii Gw Dil	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$28.51	$28.51	$0.00	$0.00	$0.00	$10.94	$38.97	$38.97	$40.47	$0.00	$10.94	$0.00	$31.05	$31.05	$0.00	$26.25	$41.58	$42.00	$0.00	$0.00	$0.00	$8.22	$0.00	$0.00	$8.36	$0.00	$0.00	$0.00	$0.00	$0.00
27205789	EAP	HCPCS C1894		Introducer Shth .035in Shrt 7fr 4cm 40cm Pncl R/o Ii Hiflo	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$32.58	$32.58	$0.00	$0.00	$0.00	$12.51	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$35.49	$35.49	$0.00	$30.00	$47.52	$48.00	$0.00	$0.00	$0.00	$9.39	$0.00	$0.00	$9.55	$0.00	$0.00	$0.00	$0.00	$0.00
27205790	EAP	HCPCS C1894		Introducer Shth .035in Shrt 8fr 4cm 2.5cm Pncl R/o Ii Hiflo	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$32.58	$32.58	$0.00	$0.00	$0.00	$12.51	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$35.49	$35.49	$0.00	$30.00	$47.52	$48.00	$0.00	$0.00	$0.00	$9.39	$0.00	$0.00	$9.55	$0.00	$0.00	$0.00	$0.00	$0.00
27205791	EAP	HCPCS C1894		Introducer Shth .038in 5fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq	BOTH IP/OP	$57.50 	$42.55	$0.00	$46.00	$31.22	$31.22	$0.00	$0.00	$0.00	$11.98	$42.68	$42.68	$44.32	$0.00	$11.98	$0.00	$34.01	$34.01	$0.00	$28.75	$45.54	$46.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$9.15	$0.00	$0.00	$0.00	$0.00	$0.00
27205792	EAP	HCPCS C1894		Introducer Shth .038in 5fr 6cm 2.5cm Pn Ro2 Gw Dil Radopq	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$28.51	$28.51	$0.00	$0.00	$0.00	$10.94	$38.97	$38.97	$40.47	$0.00	$10.94	$0.00	$31.05	$31.05	$0.00	$26.25	$41.58	$42.00	$0.00	$0.00	$0.00	$8.22	$0.00	$0.00	$8.36	$0.00	$0.00	$0.00	$0.00	$0.00
27205793	EAP	HCPCS C1894		Introducer Shth .038in 6fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq	BOTH IP/OP	$57.50 	$42.55	$0.00	$46.00	$31.22	$31.22	$0.00	$0.00	$0.00	$11.98	$42.68	$42.68	$44.32	$0.00	$11.98	$0.00	$34.01	$34.01	$0.00	$28.75	$45.54	$46.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$9.15	$0.00	$0.00	$0.00	$0.00	$0.00
27205794	EAP	HCPCS C1894		Introducer Shth .038in 6fr 4cm Pncl R/o Ii Hiflo Dil Radopq	BOTH IP/OP	$58.13 	$43.02	$0.00	$46.50	$31.56	$31.56	$0.00	$0.00	$0.00	$12.12	$43.14	$43.14	$44.81	$0.00	$12.11	$0.00	$34.38	$34.38	$0.00	$29.07	$46.04	$46.50	$0.00	$0.00	$0.00	$9.10	$0.00	$0.00	$9.25	$0.00	$0.00	$0.00	$0.00	$0.00
27205795	EAP	HCPCS C1894		Introducer Shth .038in 6fr 6cm 2.5cm Pn Ro2 Gw Dil Radopq	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$28.51	$28.51	$0.00	$0.00	$0.00	$10.94	$38.97	$38.97	$40.47	$0.00	$10.94	$0.00	$31.05	$31.05	$0.00	$26.25	$41.58	$42.00	$0.00	$0.00	$0.00	$8.22	$0.00	$0.00	$8.36	$0.00	$0.00	$0.00	$0.00	$0.00
27205796	EAP	HCPCS C1894		Introducer Shth .038in 7fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq	BOTH IP/OP	$57.50 	$42.55	$0.00	$46.00	$31.22	$31.22	$0.00	$0.00	$0.00	$11.98	$42.68	$42.68	$44.32	$0.00	$11.98	$0.00	$34.01	$34.01	$0.00	$28.75	$45.54	$46.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$9.15	$0.00	$0.00	$0.00	$0.00	$0.00
27205797	EAP	HCPCS C1894		Introducer Shth .038in 7fr 6cm 2.5cm Pn Ro2 Gw Dil Radopq	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$28.51	$28.51	$0.00	$0.00	$0.00	$10.94	$38.97	$38.97	$40.47	$0.00	$10.94	$0.00	$31.05	$31.05	$0.00	$26.25	$41.58	$42.00	$0.00	$0.00	$0.00	$8.22	$0.00	$0.00	$8.36	$0.00	$0.00	$0.00	$0.00	$0.00
27205798	EAP	HCPCS C1894		Introducer Shth .038in 8fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq	BOTH IP/OP	$57.50 	$42.55	$0.00	$46.00	$31.22	$31.22	$0.00	$0.00	$0.00	$11.98	$42.68	$42.68	$44.32	$0.00	$11.98	$0.00	$34.01	$34.01	$0.00	$28.75	$45.54	$46.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$9.15	$0.00	$0.00	$0.00	$0.00	$0.00
27205799	EAP	HCPCS C1894		Introducer Shth .038in 8fr 6cm 2.5cm Pncl R/o Ii Gw Dil	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$28.51	$28.51	$0.00	$0.00	$0.00	$10.94	$38.97	$38.97	$40.47	$0.00	$10.94	$0.00	$31.05	$31.05	$0.00	$26.25	$41.58	$42.00	$0.00	$0.00	$0.00	$8.22	$0.00	$0.00	$8.36	$0.00	$0.00	$0.00	$0.00	$0.00
27205800	EAP	HCPCS C1894		Introducer Shth .038in 9fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq	BOTH IP/OP	$57.50 	$42.55	$0.00	$46.00	$31.22	$31.22	$0.00	$0.00	$0.00	$11.98	$42.68	$42.68	$44.32	$0.00	$11.98	$0.00	$34.01	$34.01	$0.00	$28.75	$45.54	$46.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$9.15	$0.00	$0.00	$0.00	$0.00	$0.00
27205801	EAP	HCPCS C1894		Introducer Shth .038in 9fr 6cm 2.5cm Pncl R/o Ii Gw Dil	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$28.51	$28.51	$0.00	$0.00	$0.00	$10.94	$38.97	$38.97	$40.47	$0.00	$10.94	$0.00	$31.05	$31.05	$0.00	$26.25	$41.58	$42.00	$0.00	$0.00	$0.00	$8.22	$0.00	$0.00	$8.36	$0.00	$0.00	$0.00	$0.00	$0.00
27205802	EAP	HCPCS C1894		Introducer Shth 11fr 25cm 2.5cm Pncl Dil Kink Rst Hdrph Ptfe	BOTH IP/OP	$49.88 	$36.91	$0.00	$39.90	$27.08	$27.08	$0.00	$0.00	$0.00	$10.40	$37.02	$37.02	$38.45	$0.00	$10.39	$0.00	$29.50	$29.50	$0.00	$24.94	$39.50	$39.90	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$7.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205803	EAP	HCPCS C1894		Introducer Shth 4fr 10cm 2.5cm Pncl R/o Ii Dil Radopq	BOTH IP/OP	$53.50 	$39.59	$0.00	$42.80	$29.05	$29.05	$0.00	$0.00	$0.00	$11.15	$39.71	$39.71	$41.24	$0.00	$11.15	$0.00	$31.65	$31.65	$0.00	$26.75	$42.37	$42.80	$0.00	$0.00	$0.00	$8.37	$0.00	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$0.00
27205804	EAP	HCPCS C1894		Introducer Shth 4fr 25cm 2.5cm Pncl R/o Ii Dil Radopq	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$35.30	$35.30	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$10.17	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$0.00
27205805	EAP	HCPCS C1894		Introducer Shth 4fr 6cm 2.5cm Pncl R/o Ii Dil Radopq	BOTH IP/OP	$46.88 	$34.69	$0.00	$37.50	$25.46	$25.46	$0.00	$0.00	$0.00	$9.77	$34.79	$34.79	$36.14	$0.00	$9.77	$0.00	$27.73	$27.73	$0.00	$23.44	$37.13	$37.50	$0.00	$0.00	$0.00	$7.34	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00
27205806	EAP	HCPCS C1894		Introducer Shth 5fr 10cm 2.5cm Pncl Radopq Dil No Mn Gw	BOTH IP/OP	$53.50 	$39.59	$0.00	$42.80	$29.05	$29.05	$0.00	$0.00	$0.00	$11.15	$39.71	$39.71	$41.24	$0.00	$11.15	$0.00	$31.65	$31.65	$0.00	$26.75	$42.37	$42.80	$0.00	$0.00	$0.00	$8.37	$0.00	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$0.00
27205807	EAP	HCPCS C1894		Introducer Shth 5fr 25cm 2.5cm Pn Ro2 Dil Radopq Kink Rst	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$35.30	$35.30	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$10.17	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$0.00
27205808	EAP	HCPCS C1894		Introducer Shth 5fr 6cm 2.5cm Pncl Radopq Dil No Mn Gw	BOTH IP/OP	$46.88 	$34.69	$0.00	$37.50	$25.46	$25.46	$0.00	$0.00	$0.00	$9.77	$34.79	$34.79	$36.14	$0.00	$9.77	$0.00	$27.73	$27.73	$0.00	$23.44	$37.13	$37.50	$0.00	$0.00	$0.00	$7.34	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00
27205809	EAP	HCPCS C1894		Introducer Shth 6fr 10cm 2.5cm Pn Ro2 Dil Radopq Kink Rst	BOTH IP/OP	$53.50 	$39.59	$0.00	$42.80	$29.05	$29.05	$0.00	$0.00	$0.00	$11.15	$39.71	$39.71	$41.24	$0.00	$11.15	$0.00	$31.65	$31.65	$0.00	$26.75	$42.37	$42.80	$0.00	$0.00	$0.00	$8.37	$0.00	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$0.00
27205810	EAP	HCPCS C1894		Introducer Shth 6fr 25cm 2.5cm Pn Ro2 Dil Radopq Kink Rst	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$35.30	$35.30	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$10.17	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$0.00
27205811	EAP	HCPCS C1894		Introducer Shth 6fr 45cm Destination Gd Hdrph Ptfe	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205812	EAP	HCPCS C1894		Introducer Shth 6fr 45cm Pn Dstn Gd Hdrph Ptfe	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205813	EAP	HCPCS C1894		Introducer Shth 6fr 45cm Pn Dstn Gd Lima Crv Xcut Vlv Hdrph	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205814	EAP	HCPCS C1894		Introducer Shth 6fr 45cm Pn Dstn Gd Mp Crv T-b Vlv Hdrph	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205815	EAP	HCPCS C1894		Introducer Shth 6fr 45cm Pn Dstn Gd Rdc Crv T-b Vlv Hdrph	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205816	EAP	HCPCS C1894		Introducer Shth 6fr 45cm Pn Dstn Hdrph Ptfe	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205817	EAP	HCPCS C1894		Introducer Shth 6fr 4cm 40cm Pncl Radopq Dil Gw	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$32.58	$32.58	$0.00	$0.00	$0.00	$12.51	$44.53	$44.53	$46.25	$0.00	$12.50	$0.00	$35.49	$35.49	$0.00	$30.00	$47.52	$48.00	$0.00	$0.00	$0.00	$9.39	$0.00	$0.00	$9.55	$0.00	$0.00	$0.00	$0.00	$0.00
27205818	EAP	HCPCS C1894		Introducer Shth 6fr 65cm Pn Dstn Gd Strg T-b Vlv Hdrph Ptfe	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
27205819	EAP	HCPCS C1894		Introducer Shth 6fr 6cm 2.5cm Pn Ro2 Dil Radopq Kink Rst	BOTH IP/OP	$46.88 	$34.69	$0.00	$37.50	$25.46	$25.46	$0.00	$0.00	$0.00	$9.77	$34.79	$34.79	$36.14	$0.00	$9.77	$0.00	$27.73	$27.73	$0.00	$23.44	$37.13	$37.50	$0.00	$0.00	$0.00	$7.34	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00
27205820	EAP	HCPCS C1894		Introducer Shth 7fr 45cm Pn Dstn Gd Hs Crv T-b Vlv Hdrph	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205821	EAP	HCPCS C1894		Introducer Shth 7fr 45cm Pn Dstn Gd Lima Crv T-b Vlv Hdrph	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205822	EAP	HCPCS C1894		Introducer Shth 7fr 45cm Pn Dstn Gd Mp Crv T-b Vlv Hdrph	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205823	EAP	HCPCS C1894		Introducer Shth 7fr 45cm Pn Dstn Gd Rdc Crv T-b Vlv Hdrph	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205824	EAP	HCPCS C1894		Introducer Shth 7fr 45cm Pn Dstn Gd Strg T-b Vlv Hdrph Ptfe	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205825	EAP	HCPCS C1894		Introducer Shth 7fr 4cm Pncl R/o Ii Hiflo Dil Radopq	BOTH IP/OP	$58.13 	$43.02	$0.00	$46.50	$31.56	$31.56	$0.00	$0.00	$0.00	$12.12	$43.14	$43.14	$44.81	$0.00	$12.11	$0.00	$34.38	$34.38	$0.00	$29.07	$46.04	$46.50	$0.00	$0.00	$0.00	$9.10	$0.00	$0.00	$9.25	$0.00	$0.00	$0.00	$0.00	$0.00
27205826	EAP	HCPCS C1894		Introducer Shth 7fr 65cm Pn Dstn Gd Hdrph Ptfe	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
27205827	EAP	HCPCS C1894		Introducer Shth 7fr 6cm 2.5cm Pncl Radopq Dil No Mn Gw	BOTH IP/OP	$46.88 	$34.69	$0.00	$37.50	$25.46	$25.46	$0.00	$0.00	$0.00	$9.77	$34.79	$34.79	$36.14	$0.00	$9.77	$0.00	$27.73	$27.73	$0.00	$23.44	$37.13	$37.50	$0.00	$0.00	$0.00	$7.34	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00
27205828	EAP	HCPCS C1894		Introducer Shth 8fr 4cm 2.5cm Pncl R/o Ii Hiflo Dil Radopq	BOTH IP/OP	$58.13 	$43.02	$0.00	$46.50	$31.56	$31.56	$0.00	$0.00	$0.00	$12.12	$43.14	$43.14	$44.81	$0.00	$12.11	$0.00	$34.38	$34.38	$0.00	$29.07	$46.04	$46.50	$0.00	$0.00	$0.00	$9.10	$0.00	$0.00	$9.25	$0.00	$0.00	$0.00	$0.00	$0.00
27205829	EAP	HCPCS C1894		Introducer Shth 8fr 6cm 2.5cm Pn Ro2 Dil Radopq Kink Rst	BOTH IP/OP	$46.88 	$34.69	$0.00	$37.50	$25.46	$25.46	$0.00	$0.00	$0.00	$9.77	$34.79	$34.79	$36.14	$0.00	$9.77	$0.00	$27.73	$27.73	$0.00	$23.44	$37.13	$37.50	$0.00	$0.00	$0.00	$7.34	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00
27205830	EAP	HCPCS C1894		Introducer Shth 9fr 10cm 2.5cm Pn Ro2 Dil Radopq Kink Rst	BOTH IP/OP	$53.50 	$39.59	$0.00	$42.80	$29.05	$29.05	$0.00	$0.00	$0.00	$11.15	$39.71	$39.71	$41.24	$0.00	$11.15	$0.00	$31.65	$31.65	$0.00	$26.75	$42.37	$42.80	$0.00	$0.00	$0.00	$8.37	$0.00	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$0.00
27205831	EAP	HCPCS C1894		Introducer Shth 9fr 25cm 2.5cm Pn Ro2 Dil Radopq Kink Rst	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$35.30	$35.30	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$10.17	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$0.00
27205832	EAP	HCPCS C1894		Introducer Shth 9fr 6cm 2.5cm Pncl R/o Ii Dil Radopq	BOTH IP/OP	$46.88 	$34.69	$0.00	$37.50	$25.46	$25.46	$0.00	$0.00	$0.00	$9.77	$34.79	$34.79	$36.14	$0.00	$9.77	$0.00	$27.73	$27.73	$0.00	$23.44	$37.13	$37.50	$0.00	$0.00	$0.00	$7.34	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00
27205833	EAP	HCPCS C1894		Sheath Escp 7fr 45cm Pn Dstn Gd Destination Hdrph Ptfe	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205834	EAP	HCPCS C1887		Sheath Gd .038in 6fr 45cm 2cm Pn Dstn T-b Vlv Strg Hdrph	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205835	EAP	HCPCS C1887		Sheath Gd .038in 7fr 45cm 2cm Pn Dstn T-b Vlv Strg Hdrph	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205836	EAP	HCPCS C1894		Sheath Gd .038in Hs Crv 5fr 45cm 2cm Pn Dstn Xcut Vlv Hdrph	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205837	EAP	HCPCS C1894		Sheath Gd .038in Lima Crv 5fr 45cm 2cm Pn Dstn Xcut Vlv	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205838	EAP	HCPCS C1894		Sheath Gd .038in Mp Crv 5fr 45cm 2cm Pn Dstn Xcut Vlv Kink	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205839	EAP	HCPCS C1894		Sheath Gd .038in Mp Crv 6fr 90cm 5cm Pn Dstn T-b Vlv Hdrph	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$124.89	$124.89	$0.00	$0.00	$0.00	$47.94	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$0.00	$0.00	$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
27205840	EAP	HCPCS C1894		Sheath Gd .038in Mp Crv 7fr 90cm 5cm Pn Dstn T-b Vlv Hdrph	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$124.89	$124.89	$0.00	$0.00	$0.00	$47.94	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$0.00	$0.00	$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
27205841	EAP	HCPCS C1894		Sheath Gd .038in Mp Crv 7fr 90cm 5cm Pn Dstn Xcut Vlv Hdrph	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$124.89	$124.89	$0.00	$0.00	$0.00	$47.94	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$0.00	$0.00	$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
27205842	EAP	HCPCS C1894		Sheath Gd 22fr X 35cm Solopath	BOTH IP/OP	"$1,525.00 "	"$1,128.50"	$0.00	"$1,220.00"	$828.08	$828.08	$0.00	$0.00	$0.00	$317.85	"$1,131.86"	"$1,131.86"	"$1,175.47"	$0.00	$317.81	$0.00	$902.04	$902.04	$0.00	$762.50	"$1,207.80"	"$1,220.00"	$0.00	$0.00	$0.00	$238.66	$0.00	$0.00	$242.78	$0.00	$0.00	$0.00	$0.00	$0.00
27205843	EAP	HCPCS C1894		Sheath Gd 23fr 13.5fr 19fr 25cm 20cm Solopath Expandable	BOTH IP/OP	"$1,525.00 "	"$1,128.50"	$0.00	"$1,220.00"	$828.08	$828.08	$0.00	$0.00	$0.00	$317.85	"$1,131.86"	"$1,131.86"	"$1,175.47"	$0.00	$317.81	$0.00	$902.04	$902.04	$0.00	$762.50	"$1,207.80"	"$1,220.00"	$0.00	$0.00	$0.00	$238.66	$0.00	$0.00	$242.78	$0.00	$0.00	$0.00	$0.00	$0.00
27205844	EAP	HCPCS C1894		Sheath Gd 23fr 13.5fr 19fr 35cm 30cm Solopath Expandable	BOTH IP/OP	"$1,525.00 "	"$1,128.50"	$0.00	"$1,220.00"	$828.08	$828.08	$0.00	$0.00	$0.00	$317.85	"$1,131.86"	"$1,131.86"	"$1,175.47"	$0.00	$317.81	$0.00	$902.04	$902.04	$0.00	$762.50	"$1,207.80"	"$1,220.00"	$0.00	$0.00	$0.00	$238.66	$0.00	$0.00	$242.78	$0.00	$0.00	$0.00	$0.00	$0.00
27205845	EAP	HCPCS C1894		Sheath Gd 24fr X 35cm Solopath	BOTH IP/OP	"$1,525.00 "	"$1,128.50"	$0.00	"$1,220.00"	$828.08	$828.08	$0.00	$0.00	$0.00	$317.85	"$1,131.86"	"$1,131.86"	"$1,175.47"	$0.00	$317.81	$0.00	$902.04	$902.04	$0.00	$762.50	"$1,207.80"	"$1,220.00"	$0.00	$0.00	$0.00	$238.66	$0.00	$0.00	$242.78	$0.00	$0.00	$0.00	$0.00	$0.00
27205846	EAP	HCPCS C1894		Sheath Gd 26fr 15fr 22fr 35cm 30cm Solopath Expandable	BOTH IP/OP	"$1,525.00 "	"$1,128.50"	$0.00	"$1,220.00"	$828.08	$828.08	$0.00	$0.00	$0.00	$317.85	"$1,131.86"	"$1,131.86"	"$1,175.47"	$0.00	$317.81	$0.00	$902.04	$902.04	$0.00	$762.50	"$1,207.80"	"$1,220.00"	$0.00	$0.00	$0.00	$238.66	$0.00	$0.00	$242.78	$0.00	$0.00	$0.00	$0.00	$0.00
27205847	EAP	HCPCS C1894		Sheath Gd 28.5fr 15fr 24fr 25cm 20cm Solopath Expandable	BOTH IP/OP	"$1,525.00 "	"$1,128.50"	$0.00	"$1,220.00"	$828.08	$828.08	$0.00	$0.00	$0.00	$317.85	"$1,131.86"	"$1,131.86"	"$1,175.47"	$0.00	$317.81	$0.00	$902.04	$902.04	$0.00	$762.50	"$1,207.80"	"$1,220.00"	$0.00	$0.00	$0.00	$238.66	$0.00	$0.00	$242.78	$0.00	$0.00	$0.00	$0.00	$0.00
27205848	EAP	HCPCS C1894		Sheath Gd 4fr Strl Pncl Prcs Acc Sys Tl Intgr Fit Echgn Tpr	BOTH IP/OP	$81.25 	$60.13	$0.00	$65.00	$44.12	$44.12	$0.00	$0.00	$0.00	$16.93	$60.30	$60.30	$62.63	$0.00	$16.93	$0.00	$48.06	$48.06	$0.00	$40.63	$64.35	$65.00	$0.00	$0.00	$0.00	$12.72	$0.00	$0.00	$12.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205849	EAP	HCPCS C1894		Sheath Gd Hs Crv 7fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205850	EAP	HCPCS C1894		Sheath Gd Mp Crv 6fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205851	EAP	HCPCS C1894		Sheath Gd Mp Crv 6fr 90cm 15cm Pn Dstn Radopq Xcut Vlv Ss	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$124.89	$124.89	$0.00	$0.00	$0.00	$47.94	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$0.00	$0.00	$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
27205852	EAP	HCPCS C1894		Sheath Gd Mp Crv 7fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205853	EAP	HCPCS C1894		Sheath Gd Rnl 2 Crv 5fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205854	EAP	HCPCS C1894		Sheath Gd Strg 5fr 45cm 35cm Pn Dstn Radopq Xcut Vlv Ss Ptfe	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205855	EAP	HCPCS C1894		Sheath Gd Strg 6fr 45cm 35cm Pn Dstn Radopq Xcut Vlv Ss Ptfe	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205856	EAP	HCPCS C1894		Sheath Gd Strg 6fr 90cm 15cm Pn Dstn Radopq Xcut Vlv Ss Ptfe	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$124.89	$124.89	$0.00	$0.00	$0.00	$47.94	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$0.00	$0.00	$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
27205857	EAP	HCPCS C1894		Sheath Gd Strg 6fr 90cm 15cm Pn Dstn T-b Radopq Vlv Ss Ptfe	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$124.89	$124.89	$0.00	$0.00	$0.00	$47.94	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$0.00	$0.00	$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
27205858	EAP	HCPCS C1894		Sheath Gd Strg 7fr 45cm 35cm Pn Dstn Radopq Xcut Vlv Ss Ptfe	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205859	EAP	HCPCS C1894		Sheath Gd Strg 7fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss Ptfe	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205860	EAP	HCPCS C1894		Sheath Gd Strg 7fr 65cm 35cm Pn Dstn Radopq Xcut Vlv Ss Ptfe	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
27205861	EAP	HCPCS C1894		Sheath Gd Strg 7fr 90cm 15cm Pn Dstn Radopq Xcut Vlv Ss Ptfe	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$124.89	$124.89	$0.00	$0.00	$0.00	$47.94	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$0.00	$0.00	$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
27205862	EAP	HCPCS C1894		Sheath Gd Strg 7fr 90cm 15cm Pn Dstn T-b Radopq Vlv Ss Ptfe	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$124.89	$124.89	$0.00	$0.00	$0.00	$47.94	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$0.00	$0.00	$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
27205863	EAP	HCPCS C1894		Sheath Gd Strg 8fr 45cm 35cm Pn Dstn T-b Radopq Vlv Ss Ptfe	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205864	EAP	HCPCS C1894		Sheath Gd Strg 8fr 65cm 35cm Pn Dstn T-b Radopq Vlv Ss Ptfe	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
27205865	EAP	HCPCS C1894		Sheath Gd Strg 8fr 90cm 60cm Pn Dstn T-b Radopq Vlv Ss Ptfe	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$124.89	$124.89	$0.00	$0.00	$0.00	$47.94	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$0.00	$0.00	$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
27205866	EAP	HCPCS C1894		System Intro .018in 4fr 21ga 40cm Glideaccess Echgn Ndl Gw	BOTH IP/OP	$66.25 	$49.03	$0.00	$53.00	$35.97	$35.97	$0.00	$0.00	$0.00	$13.81	$49.17	$49.17	$51.07	$0.00	$13.81	$0.00	$39.19	$39.19	$0.00	$33.13	$52.47	$53.00	$0.00	$0.00	$0.00	$10.37	$0.00	$0.00	$10.55	$0.00	$0.00	$0.00	$0.00	$0.00
27205867	EAP	HCPCS C1894		System Intro .018in 4fr 21ga 40cm Glideaccess Non Echgn Ndl	BOTH IP/OP	$76.88 	$56.89	$0.00	$61.50	$41.75	$41.75	$0.00	$0.00	$0.00	$16.02	$57.06	$57.06	$59.26	$0.00	$16.02	$0.00	$45.47	$45.47	$0.00	$38.44	$60.89	$61.50	$0.00	$0.00	$0.00	$12.03	$0.00	$0.00	$12.24	$0.00	$0.00	$0.00	$0.00	$0.00
27205868	EAP	HCPCS C1894		System Intro .018in 4fr 40cm Glideaccess Coax Gw Echgn Ndl	BOTH IP/OP	$79.38 	$58.74	$0.00	$63.50	$43.10	$43.10	$0.00	$0.00	$0.00	$16.54	$58.92	$58.92	$61.19	$0.00	$16.54	$0.00	$46.95	$46.95	$0.00	$39.69	$62.87	$63.50	$0.00	$0.00	$0.00	$12.42	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205869	EAP	HCPCS C1894		System Intro .018in 5fr 21ga 40cm Glideaccess Echgn Ndl Gw	BOTH IP/OP	$66.25 	$49.03	$0.00	$53.00	$35.97	$35.97	$0.00	$0.00	$0.00	$13.81	$49.17	$49.17	$51.07	$0.00	$13.81	$0.00	$39.19	$39.19	$0.00	$33.13	$52.47	$53.00	$0.00	$0.00	$0.00	$10.37	$0.00	$0.00	$10.55	$0.00	$0.00	$0.00	$0.00	$0.00
27205870	EAP	HCPCS C1894		System Intro .018in 5fr 21ga 40cm Glideaccess Non Echgn Ndl	BOTH IP/OP	$76.88 	$56.89	$0.00	$61.50	$41.75	$41.75	$0.00	$0.00	$0.00	$16.02	$57.06	$57.06	$59.26	$0.00	$16.02	$0.00	$45.47	$45.47	$0.00	$38.44	$60.89	$61.50	$0.00	$0.00	$0.00	$12.03	$0.00	$0.00	$12.24	$0.00	$0.00	$0.00	$0.00	$0.00
27205871	EAP	HCPCS C1894		System Intro .018in 5fr 40cm Glideaccess Coax Gw Echgn Ndl	BOTH IP/OP	$79.38 	$58.74	$0.00	$63.50	$43.10	$43.10	$0.00	$0.00	$0.00	$16.54	$58.92	$58.92	$61.19	$0.00	$16.54	$0.00	$46.95	$46.95	$0.00	$39.69	$62.87	$63.50	$0.00	$0.00	$0.00	$12.42	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
27205872	EAP	HCPCS C1894		System Intro 5fr 21-19ga 45cm 10cm Pncl Prcs Acc Sys Stf	BOTH IP/OP	$81.25 	$60.13	$0.00	$65.00	$44.12	$44.12	$0.00	$0.00	$0.00	$16.93	$60.30	$60.30	$62.63	$0.00	$16.93	$0.00	$48.06	$48.06	$0.00	$40.63	$64.35	$65.00	$0.00	$0.00	$0.00	$12.72	$0.00	$0.00	$12.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205873	EAP	HCPCS C1894		System Intro Reg 4fr Echgn Ndl Fxcr Gw Ninitol	BOTH IP/OP	$81.25 	$60.13	$0.00	$65.00	$44.12	$44.12	$0.00	$0.00	$0.00	$16.93	$60.30	$60.30	$62.63	$0.00	$16.93	$0.00	$48.06	$48.06	$0.00	$40.63	$64.35	$65.00	$0.00	$0.00	$0.00	$12.72	$0.00	$0.00	$12.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205874	EAP	HCPCS C1894		System Intro Reg 4fr Echgn Ndl Gw Ss	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$40.73	$40.73	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$57.81	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00	$0.00	$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205875	EAP	HCPCS C1894		System Intro Reg 5fr Echgn Ndl Fxcr Gw Ninitol	BOTH IP/OP	$81.25 	$60.13	$0.00	$65.00	$44.12	$44.12	$0.00	$0.00	$0.00	$16.93	$60.30	$60.30	$62.63	$0.00	$16.93	$0.00	$48.06	$48.06	$0.00	$40.63	$64.35	$65.00	$0.00	$0.00	$0.00	$12.72	$0.00	$0.00	$12.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205876	EAP	HCPCS C1894		System Intro Reg 5fr Echgn Ndl Gw Ss	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$40.73	$40.73	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$57.81	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00	$0.00	$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205877	EAP	HCPCS C1894		System Intro Reg 6fr Echgn Ndl Fxcr Gw Ninitol	BOTH IP/OP	$81.25 	$60.13	$0.00	$65.00	$44.12	$44.12	$0.00	$0.00	$0.00	$16.93	$60.30	$60.30	$62.63	$0.00	$16.93	$0.00	$48.06	$48.06	$0.00	$40.63	$64.35	$65.00	$0.00	$0.00	$0.00	$12.72	$0.00	$0.00	$12.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205878	EAP	HCPCS C1894		System Intro Reg 6fr Echgn Ndl Gw Ss	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$40.73	$40.73	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$57.81	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00	$0.00	$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205879	EAP	HCPCS C1894		System Intro Reg 7fr Echgn Ndl Fxcr Gw Ninitol	BOTH IP/OP	$81.25 	$60.13	$0.00	$65.00	$44.12	$44.12	$0.00	$0.00	$0.00	$16.93	$60.30	$60.30	$62.63	$0.00	$16.93	$0.00	$48.06	$48.06	$0.00	$40.63	$64.35	$65.00	$0.00	$0.00	$0.00	$12.72	$0.00	$0.00	$12.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205880	EAP	HCPCS C1894		System Intro Reg 7fr Echgn Ndl Gw Ss	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$40.73	$40.73	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$57.81	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00	$0.00	$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205881	EAP	HCPCS C1894		System Intro Reg 8fr Echgn Ndl Gw Ss	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$40.73	$40.73	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$57.81	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00	$0.00	$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205882	EAP	HCPCS C1894		System Intro Strg 4fr Echgn Ndl Fxcr Gw Ss	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$40.73	$40.73	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$57.81	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00	$0.00	$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205883	EAP	HCPCS C1894		System Intro Strg 5fr Echgn Ndl Fxcr Gw Ss	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$33.75	$33.75	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$57.81	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00	$0.00	$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205884	EAP	HCPCS C1894		System Intro Tpr 8fr 19-21ga 45cm 10cm Prcs Acc Sys Pncl	BOTH IP/OP	$81.25 	$60.13	$0.00	$65.00	$36.56	$36.56	$0.00	$0.00	$0.00	$16.93	$60.30	$60.30	$62.63	$0.00	$16.93	$0.00	$48.06	$48.06	$0.00	$40.63	$64.35	$65.00	$0.00	$0.00	$0.00	$12.72	$0.00	$0.00	$12.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205908	EAP			Stabilit Full Fracture Kit - 2 Level Kit	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	"$3,468.60"	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205910	EAP	Custom 27205910		Set Ndl 15ga 15mm Strl Lf Arw	BOTH IP/OP	"$1,563.00 "	"$1,156.62"	$0.00	"$1,250.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,160.06"	"$1,160.06"	"$1,204.76"	$0.00	$325.73	$0.00	$0.00	$0.00	$0.00	$781.50	"$1,237.90"	"$1,250.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205911	EAP	Custom 27205911		Kit Peritoneal Lavage .035in 8	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.09	$63.09	$65.52	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205912	EAP	Custom 27205912		Lens Irrigation Therapeutic Tu	BOTH IP/OP	$780.00 	$577.20	$0.00	$624.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$578.92	$578.92	$601.22	$0.00	$162.55	$0.00	$0.00	$0.00	$0.00	$390.00	$617.76	$624.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205913	EAP	Custom 27205913		Dressing Nasal Standard 8cm Co	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.15	$319.15	$331.44	$0.00	$89.61	$0.00	$0.00	$0.00	$0.00	$215.00	$340.56	$344.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205914	EAP	HCPCS C1769		Tray Surg 14fr 18ga 29cm 5cm 1	BOTH IP/OP	$417.00 	$308.58	$0.00	$333.60	$226.43	$226.43	$0.00	$0.00	$0.00	$86.91	$309.50	$309.50	$321.42	$0.00	$86.90	$0.00	$246.66	$246.66	$0.00	$208.50	$330.26	$333.60	$0.00	$0.00	$0.00	$65.26	$0.00	$0.00	$66.39	$0.00	$0.00	$0.00	$0.00	$0.00
27205915	EAP	Custom 27205915		Kit Incision And Drainage Ecc	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205916	EAP	HCPCS C1727		Balloon Catheter Introducer Ki	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205917	EAP	Custom 27205917		Kit Introd .035in 9fr 18ga 10c	BOTH IP/OP	$309.00 	$228.66	$0.00	$247.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.34	$229.34	$238.18	$0.00	$64.40	$0.00	$0.00	$0.00	$0.00	$154.50	$244.73	$247.20	$0.00	$200.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205918	EAP	Custom 27205918		Kit Prss Monitr 1 Ln Trndcr 1	BOTH IP/OP	$261.00 	$193.14	$0.00	$208.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$193.71	$193.71	$201.18	$0.00	$54.39	$0.00	$0.00	$0.00	$0.00	$130.50	$206.71	$208.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205920	EAP	HCPCS C1769		Guidewire Vasc .038in 180cm Strl 3cm Merit Laureat	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$43.44	$43.44	$0.00	$0.00	$0.00	$16.67	$59.38	$59.38	$61.66	$0.00	$16.67	$0.00	$47.32	$47.32	$0.00	$40.00	$63.36	$64.00	$0.00	$0.00	$0.00	$12.52	$0.00	$0.00	$12.74	$0.00	$0.00	$0.00	$0.00	$0.00
27205921	EAP	HCPCS C1769		Guidewire Vasc Ang .035in 150cm 3cm Laureate Fxcr	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$40.73	$40.73	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$57.81	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00	$48.75	$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
27205922	EAP	HCPCS C1751		Catheter Cen Ven 9fr 3mm 1.3mm .7mm 90cm 2 Lumen T	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$192.77	$192.77	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$273.63	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00	$230.75	$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
27205923	EAP	HCPCS C1769		Guidewire Vascular Taper .038in 145cm 6cm Str Tip	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00	$0.00	$0.00	$9.39	$0.00	$0.00	$9.55	$0.00	$0.00	$0.00	$0.00	$0.00
27205930	EAP	HCPCS C1729		Catheter Urethral Standard 24f	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$140.64	$140.64	$0.00	$0.00	$0.00	$53.98	$192.23	$192.23	$199.64	$0.00	$53.98	$0.00	$153.20	$153.20	$0.00	$129.50	$205.13	$207.20	$0.00	$0.00	$0.00	$40.53	$0.00	$0.00	$41.23	$0.00	$0.00	$0.00	$0.00	$0.00
27205931	EAP	Custom 27205931		Needle Biop 13 1/16in 15ga 15/	BOTH IP/OP	$214.00 	$158.36	$0.00	$171.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.83	$158.83	$164.95	$0.00	$44.60	$0.00	$0.00	$0.00	$0.00	$107.00	$169.49	$171.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205932	EAP	Custom 27205932		Speculum Vag Med Grn Ns Lf Er-	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.69	$124.69	$129.49	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00	$109.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205933	EAP	Custom 27205933		Needle Spinal Long Bevel Quinc	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205934	EAP	HCPCS C1729		Tray Catheterization 16fr 2 Co	BOTH IP/OP	$73.00 	$54.02	$0.00	$58.40	$39.64	$39.64	$0.00	$0.00	$0.00	$15.22	$54.18	$54.18	$56.27	$0.00	$15.21	$0.00	$43.18	$43.18	$0.00	$36.50	$57.82	$58.40	$0.00	$47.45	$0.00	$11.42	$0.00	$0.00	$11.62	$0.00	$0.00	$0.00	$0.00	$0.00
27205938	EAP	Custom 27205938		Sensor Oximeter 18in Adhesive	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205939	EAP	Custom 27205939		Kit Laceration	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.30	$19.30	$20.04	$0.00	$5.42	$0.00	$0.00	$0.00	$0.00	$13.00	$20.59	$20.80	$0.00	$16.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205940	EAP	HCPCS C1729		Catheter Urethral 12fr 2 Way 1	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.00	$20.59	$20.80	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$4.14	$0.00	$0.00	$0.00	$0.00	$0.00
27205941	EAP	HCPCS C1729		Catheter Urethral 14fr Foley 2	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$14.12	$14.12	$0.00	$0.00	$0.00	$5.42	$19.30	$19.30	$20.04	$0.00	$5.42	$0.00	$15.38	$15.38	$0.00	$13.00	$20.59	$20.80	$0.00	$16.90	$0.00	$4.07	$0.00	$0.00	$4.14	$0.00	$0.00	$0.00	$0.00	$0.00
27205942	EAP	Custom 27205942		Kit Arterial Line .018in 20ga	BOTH IP/OP	$25.00 	$18.50	$0.00	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.50	$19.80	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205943	EAP			Envelope Defibrillator 3.35x3in Resorb Aigisrx Mino	BOTH IP/OP	"$2,488.00 "	"$1,841.12"	$0.00	"$1,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,846.59"	"$1,846.59"	"$1,917.75"	$0.00	$518.50	$0.00	$0.00	$0.00	$0.00	"$1,244.00"	"$1,970.50"	"$1,990.40"	$0.00	"$1,617.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205944	EAP	HCPCS c1769		Guidewire Vasc 190cm Mic J Asahi Gaia 1st Coron	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205945	EAP	HCPCS c1769		Guidewire Vasc 300cm Jtp Mic Asahi Gaia 1st Coron	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27205946	EAP	HCPCS C1769		Guidewire Vasc 190cm Gaia 2 Mctip J Asahi	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27205947	EAP	HCPCS C1769		Guidewire Vasc 300cm Jtp Mic Asahi Gaia Sec Coron	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27205948	EAP	HCPCS C1769		Guidewire Vasc 190cm Gaia 3 Mctip J Asahi	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27205949	EAP	HCPCS C1769		Guidewire Vasc 300cm 3rd Mic J Asahi Gaia Coron	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27205950	EAP			Catheter Angio Brnstn 1 Crv 5fr .046in 125cm Prfm Wng Hub	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00	$89.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27206307	EAP	Custom 27206307		Sheath Guid Str 8fr 45cm 35cm 3 Radiopq Cross Cut	BOTH IP/OP	"$1,550.00 "	"$1,147.00"	$0.00	"$1,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,150.41"	"$1,150.41"	"$1,194.74"	$0.00	$323.02	$0.00	$0.00	$0.00	$0.00	$775.00	"$1,227.60"	"$1,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27206308	EAP	HCPCS C1894		Introducer Shth 23fr 55.7cm 69.9cm Micra Stpck Radopq Dil	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$814.50	$814.50	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
27206309	EAP	HCPCS C1769		"Guidewire Hi-torque Comm Es .014"" 300cm"	BOTH IP/OP	$988.00 	$731.12	$0.00	$790.40	$536.48	$536.48	$0.00	$0.00	$0.00	$205.92	$733.29	$733.29	$761.55	$0.00	$205.90	$0.00	$584.40	$584.40	$0.00	$494.00	$782.50	$790.40	$0.00	$642.20	$0.00	$154.62	$0.00	$0.00	$157.29	$0.00	$0.00	$0.00	$0.00	$0.00
27219613	EAP	HCPCS C1751		Tray Catheterization 16fr Urine Meter Foley Statlo	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$21.72	$21.72	$0.00	$0.00	$0.00	$8.34	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$23.66	$23.66	$0.00	$20.00	$31.68	$32.00	$0.00	$26.00	$0.00	$6.26	$0.00	$0.00	$6.37	$0.00	$0.00	$0.00	$0.00	$0.00
27219614	EAP	Custom 27219614		5fr Micro Stick	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.11	$37.11	$38.54	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$25.00	$39.60	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219615	EAP			Tube Gstrm 18fr 10cm 5-10ml Entuit Enfit Bln Rtnt Fd	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$58.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219616	EAP			Tube Fd 20fr 10cm 20ml Entuit Bln Rtnt Mr Conditional Lg	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219617	EAP			Tube Fd 22fr 10cm 20ml Entuit Bln Rtnt Mr Conditional Lg	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219618	EAP	HCPCS C1769		Set Gstrm Lg 20-24fr 22-26fr Strl Entuit Srt Coons Dil Plwy	BOTH IP/OP	$213.00 	$157.62	$0.00	$170.40	$115.66	$115.66	$0.00	$0.00	$0.00	$44.39	$158.09	$158.09	$164.18	$0.00	$44.39	$0.00	$125.99	$125.99	$0.00	$106.50	$168.70	$170.40	$0.00	$138.45	$0.00	$33.33	$0.00	$0.00	$33.91	$0.00	$0.00	$0.00	$0.00	$0.00
27219620	EAP			Inst Ablat Spinestar 5-10 Gen2	BOTH IP/OP	"$7,250.00 "	"$5,365.00"	$0.00	"$5,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,588.30"	$0.00	"$1,510.90"	$0.00	$0.00	$0.00	$0.00	"$3,625.00"	"$5,742.00"	"$5,800.00"	$0.00	"$4,712.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219621	EAP			Kit Angio 65in Acist Cvi Angiotouch 3w Hi-prs Stpck Prm	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219622	EAP	HCPCS C2623		Catheter Blndil 5mm 40cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219623	EAP	HCPCS C2623		Catheter Blndil 5mm 40cm 60mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219624	EAP	HCPCS C2623		Catheter Blndil 5mm 40cm 80mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219625	EAP	HCPCS C2623		Catheter Blndil 5mm 40cm 100mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	"$2,275.00"	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219626	EAP	HCPCS C2623		Catheter Blndil 6mm 40cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219627	EAP	HCPCS C2623		Catheter Blndil 6mm 40cm 60mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219628	EAP	HCPCS C2623		Catheter Blndil 6mm 40cm 80mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219629	EAP	HCPCS C2623		Catheter Blndil 6mm 40cm 100mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219630	EAP	HCPCS C2623		Catheter Blndil 7mm 40cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219631	EAP	HCPCS C2623		Catheter Blndil 7mm 40cm 60mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	"$2,275.00"	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219632	EAP	HCPCS C2623		Catheter Blndil 8mm 40cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219633	EAP	HCPCS C2623		Catheter Blndil 7fr 8mm 40cm 60mm Lutonix Drg Coat Acpt .035	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219634	EAP	HCPCS C2623		Catheter Blndil 4mm 75cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219635	EAP	HCPCS C2623		Catheter Blndil 4mm 75cm 60mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219636	EAP	HCPCS C2623		Catheter Blndil 4mm 75cm 80mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219637	EAP	HCPCS C2623		Catheter Blndil 4mm 75cm 100mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219638	EAP	HCPCS C2623		Catheter Blndil 5mm 75cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219639	EAP	HCPCS C2623		Catheter Blndil 5mm 75cm 60mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219640	EAP	HCPCS C2623		Catheter Blndil 5mm 75cm 80mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219641	EAP	HCPCS C2623		Catheter Blndil 5mm 75cm 100mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219642	EAP	HCPCS C2623		Catheter Blndil 6mm 75cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219643	EAP	HCPCS C2623		Catheter Blndil 6mm 75cm 60mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219644	EAP	HCPCS C2623		Catheter Blndil 6mm 75cm 80mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219645	EAP	HCPCS C2623		Catheter Blndil 6mm 75cm 100mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	"$2,275.00"	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219646	EAP	HCPCS C2623		Catheter Blndil 7mm 75cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219647	EAP	HCPCS C2623		Catheter Blndil 7mm 75cm 60mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	"$2,275.00"	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219648	EAP	HCPCS C2623		Catheter Blndil 8mm 75cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219649	EAP	HCPCS C2623		Catheter Blndil 8mm 75cm 60mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	"$2,275.00"	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219650	EAP	HCPCS C2623		Catheter Blndil 9mm 75cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219651	EAP	HCPCS C2623		Catheter Blndil 9mm 75cm 60mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219652	EAP	HCPCS C2623		Catheter Blndil 10mm 75cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219653	EAP	HCPCS C2623		Catheter Blndil 10mm 75cm 60mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219654	EAP	HCPCS C2623		Catheter Blndil 12mm 75cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219655	EAP	HCPCS C2623		Catheter Blndil 8mm 100cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219656	EAP	HCPCS C2623		Catheter Blndil 8mm 100cm 60mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219657	EAP	HCPCS C2623		Catheter Blndil 9mm 100cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219658	EAP	HCPCS C2623		Catheter Blndil 9mm 100cm 60mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219659	EAP	HCPCS C2623		Catheter Blndil 10mm 100cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219660	EAP	HCPCS C2623		Catheter Blndil 8fr 10mm 100cm 60mm Lutonix Drg Coat Acpt	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219661	EAP	HCPCS C2623		Catheter Blndil 12mm 100cm 40mm Lutonix Drg Coat Acpt .035in	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
27219662	EAP			Tube Fd 24fr 10cm 20ml Entuit Bln Rtnt Mr Conditional Lg	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219663	EAP			Catheter Infs 2 2/3fr 45cm Clarivein	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219664	EAP			Catheter Infs 4 4/3fr 65cm Clarivein	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219665	EAP	HCPCS C1729		Stent Intracranial Pulserider T L10 Mm Od4 Mm	BOTH IP/OP	"$31,250.00 "	"$23,125.00"	$0.00	"$25,000.00"	"$16,968.75"	"$16,968.75"	$0.00	$0.00	$0.00	"$6,513.28"	"$4,181.12"	"$4,181.12"	"$24,087.50"	$0.00	"$6,512.50"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$15,625.00"	"$24,750.00"	"$25,000.00"	$0.00	$0.00	$0.00	"$4,890.63"	$0.00	$0.00	"$4,975.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27219667	EAP	HCPCS C1769		Guidewire Vasc Strg .035in 260cm 6cm Hiwire Bntsn Atrm X	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$30.95	$30.95	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$43.94	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$28.50	$45.14	$45.60	$0.00	$37.05	$0.00	$8.92	$0.00	$0.00	$9.07	$0.00	$0.00	$0.00	$0.00	$0.00
27219668	EAP	HCPCS C1887		Catheter Gd 10d 2.1-3.5fr 135cm 7mm Twnps 2 Lum Otw Trq Brd	BOTH IP/OP	"$1,123.00 "	$831.02	$0.00	$898.40	$609.79	$609.79	$0.00	$0.00	$0.00	$234.06	$833.49	$833.49	$865.61	$0.00	$234.03	$0.00	$664.25	$664.25	$0.00	$561.50	$889.42	$898.40	$0.00	$0.00	$0.00	$175.75	$0.00	$0.00	$178.78	$0.00	$0.00	$0.00	$0.00	$0.00
27219669	EAP			Drill Srg Vertecor Bn	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.21	$408.21	$423.94	$0.00	$114.62	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219670	EAP			Catheter Chlgm Spyscope Ds Acc Dlv Disp	BOTH IP/OP	"$6,875.00 "	"$5,087.50"	$0.00	"$5,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,299.25"	$0.00	"$1,432.75"	$0.00	$0.00	$0.00	$0.00	"$3,437.50"	"$5,445.00"	"$5,500.00"	$0.00	"$4,468.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219671	EAP	HCPCS C1887		Catheter Intvn 5.1fr 150cm 13cm Trapliner Rx Gd Xtn Radopq	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	$0.00	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219672	EAP	HCPCS C1887		Catheter Intvn 5.7fr 150cm 13cm Trapliner Rx Gd Xtn Radopq	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	$0.00	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219673	EAP	HCPCS C1887		Catheter Intvn 6.5fr 150cm 13cm Trapliner Rx Gd Xtn Radopq	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	$0.00	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219674	EAP	HCPCS C1750		Catheter Hmdial 14.5fr 19cm Mh Mxd Sportpack 2 Lum Kink Rst	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00	$146.25	$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
27219675	EAP	HCPCS C1894		Sheath Gd 8fr 2.9mm 40cm Strl Flxr Chfl Blkn Disp Acpt .038	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$122.20	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219676	EAP	HCPCS C1887		Microcatheter Crbrvasc Thnwl 2fr .019in 130cm 70cm Progreat	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	"$1,056.25"	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219677	EAP	HCPCS C1887		Microcatheter Crbrvasc Thnwl 2fr .019in 150cm 90cm Progreat	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	$0.00	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219678	EAP	HCPCS C1769		Embrotrap Ii Revascularization Device (5x21)	BOTH IP/OP	"$9,500.00 "	"$7,030.00"	$0.00	"$7,600.00"	"$5,158.50"	"$5,158.50"	$0.00	$0.00	$0.00	"$1,980.04"	"$4,181.12"	"$4,181.12"	"$7,322.60"	$0.00	"$1,979.80"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$4,750.00"	"$7,524.00"	"$7,600.00"	$0.00	$0.00	$0.00	"$1,486.75"	$0.00	$0.00	"$1,512.40"	$0.00	$0.00	$0.00	$0.00	$0.00
27219679	EAP	HCPCS C1769		Embrotrap Ii Revascularization Device (5x33)	BOTH IP/OP	"$9,500.00 "	"$7,030.00"	$0.00	"$7,600.00"	"$5,158.50"	"$5,158.50"	$0.00	$0.00	$0.00	"$1,980.04"	"$4,181.12"	"$4,181.12"	"$7,322.60"	$0.00	"$1,979.80"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$4,750.00"	"$7,524.00"	"$7,600.00"	$0.00	"$6,175.00"	$0.00	"$1,486.75"	$0.00	$0.00	"$1,512.40"	$0.00	$0.00	$0.00	$0.00	$0.00
27219680	EAP			Catheter Angio.038in Chgb Crv 5fr	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.31	$232.31	$241.26	$0.00	$65.23	$0.00	$0.00	$0.00	$0.00	$156.50	$247.90	$250.40	$0.00	$203.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219681	EAP			Catheter Angio Rosch Infr Mes Crv Tpr 5fr 65cm Strl 41	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.31	$232.31	$241.26	$0.00	$65.23	$0.00	$0.00	$0.00	$0.00	$156.50	$247.90	$250.40	$0.00	$203.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219682	EAP	HCPCS C1725		Catheter Angiographic Angle 4fr.041in 65cm 15cm 2 Braid	BOTH IP/OP	$123.00 	$91.02	$0.00	$98.40	$66.79	$66.79	$0.00	$0.00	$0.00	$25.64	$91.29	$91.29	$94.81	$0.00	$25.63	$0.00	$72.75	$72.75	$0.00	$61.50	$97.42	$98.40	$0.00	$79.95	$0.00	$19.25	$0.00	$0.00	$19.58	$0.00	$0.00	$0.00	$0.00	$0.00
27219690	EAP	Custom 27219690		Device Indfltr Plus 30 10ml Inflat 30 Atm Disp	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.89	$129.89	$134.89	$0.00	$36.47	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219691	EAP	Custom 27219691		Kit Inflat Indfltr Plus 30 .096in Coron Rot Hmst	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219692	EAP	Custom 27219692		Device Indfltr Plus 30 10ml Rot Hmst Vlv Gwire	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219693	EAP	Custom 27219693		Kit Inflat Indfltr .096in Rot Hmst Vlv Gwire	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219694	EAP	Custom 27219694		Device 20/30 Indfltr 20ml Rot Hmst Vlv Gwire	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219695	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Str Rbn 3cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219696	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq J Rbn 4.5cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219697	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Str Rbn 3cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219698	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Jtp Shaping Rbn	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219699	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Strbl Core To Tip	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219700	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Jtp Core To Tip	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219701	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Core To Tip Radiopq J	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219702	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Kink Rst J 3cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219703	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Kink Rst Str 3	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219704	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in J 3cm Htrq Bl Mwt	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219705	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Jtp Shaping Rbn	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219706	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Kink Rst Str 3	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219707	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Jtp Shaping Rbn	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219708	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Jtp Shaping Rbn	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219709	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in .01in Radiopq Coil Str	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219710	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in .01in Radiopq Coil J	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219711	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in .01in Radiopq Coil Str	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219712	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Jtp Core To Tip	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219713	EAP	Custom 27219713		Valve Hmsts .096- In Coplt 20 Atm Inflat Trq Dev	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.69	$124.69	$129.49	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219714	EAP	Custom 27219714		Valve Hmsts .096- In Coplt Kit Bldbck Cntrl Vlv	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219715	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str 3cm Htorq Whspr Ls	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219716	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in J 3cm Htorq Whspr Ls	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219717	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str 3cm Htorq Whspr Ls	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219718	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in J 3cm Htorq Whspr Ms	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219719	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in J 3cm Htorq Whspr Ms	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219720	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in J 3cm Htrq Bl Mwt U	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219721	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq J 3cm Htrq Bl	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219722	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in W/o Mrkr Shaping Rbn	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219723	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str 3cm Htrq Bl Mwt U	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219724	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in J 3cm Htrq Bl Mwt U	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219725	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Cover Str Rbn	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219726	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq J 3cm Htrq Bl	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219727	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Str 3cm Htrq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219728	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq J 3cm Htrq Bl	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219729	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Mrkr Tip Str 3cm Htrq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219730	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in J 3cm Htrq Bl Mwt U Ii	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219731	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str 3cm Htrq Bl Mwt U	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219732	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in J 3cm Htrq Bl Mwt U Ii	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219733	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Mrkr Core To	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219734	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Mrkr Core To	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219735	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Jtp Core To Tip	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219736	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Core To Tip	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$122.20	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219737	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Mrkr Core To	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219738	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Mrkr Core To	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219739	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Mrkr Core To	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219740	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Mrkr Core To	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219741	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Mrkr Str 3cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219742	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Mrkr J 3cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219743	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Mrkr Str 3cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219744	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Mrkr J 3cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219745	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Mrkr Str 3cm	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219746	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Mrkr Str 3cm	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219747	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Mrkr Str 3cm	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219748	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Mrkr Str 3cm	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219749	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Mrkr Str Tpr 3	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219750	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Mrkr Str Tpr 3	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219751	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Str Tpr 3cm	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219752	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Mrkr Str Tpr 3	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219753	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Mrkr Str 3cm	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219754	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Mrkr Str 3cm	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219755	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Mrkr Str 3cm Htrq Bl	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219756	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq J 3cm Htrq Bl	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219757	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Str 3cm Htrq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219758	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq J 3cm Htrq Bl	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219759	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in W/o Mrkr Str 3cm Htrq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219760	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in J 3cm Htrq Bl Mwt Elt	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219761	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str 3cm Htrq Bl Mwt	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219762	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in J 3cm Htrq Bl Mwt Elt	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219763	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str 3cm Htorq Bal	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219764	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str 3cm Htorq Bal	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219765	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in J 3cm Htorq Bal	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219766	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in J 3cm Htorq Bal	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219767	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str 3cm Htorq Bal	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219768	EAP	HCPCS C1769		Guidewire Vasc 175cm .014in Str 3cm Htorq Bal	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219769	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq Str 3cm Htorq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219770	EAP	Custom 27219770		Valve Hmsts .115in Duostat Rot	BOTH IP/OP	$58.00 	$42.92	$0.00	$46.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.05	$43.05	$44.71	$0.00	$12.09	$0.00	$0.00	$0.00	$0.00	$29.00	$45.94	$46.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219771	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str 30cm Htrq Wg Ss	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219772	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in J Tpr 3cm Htrq Trns Ss	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219773	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str Tpr 3cm Htrq Trns	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219774	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str Tip Tpr 3cm Htrq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219775	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Jtp Lght Sprt Shaping	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219776	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str 2cm Htrq Wg Ss	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219777	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in X Sprt Str 2cm Htrq Fl	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219778	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str Tip Lght Sprt	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219779	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str Sprg Tpr 3cm Htrq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219780	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str Sprg Tpr 3cm Htrq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219781	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Jtp Lght Sprt Shaping	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219782	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Lght Sprt Str 30cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219783	EAP	HCPCS C1769		Guidewire Vasc 190cm .018in Lght Sprt Str 2cm Htrq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219784	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str Tip Str 2cm Htrq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219785	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str 2cm Htrq Fl2 Ss	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219786	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str 2cm Htorq Std Ss	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219787	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in J 2cm Htorq Std Ss	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219788	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str 2cm Htorq Std Ss	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219789	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Radiopq J 3cm Htrq Inm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219790	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str 3cm Htrq Inm Mcgld	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219791	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in J 3cm Htrq Inm Hdrct	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219792	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str 3cm Htrq Inm Hdrct	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219793	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str 3cm Htrq Inm Hdrct	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219794	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str Rbn 30cm Htrq Wg	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219795	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str Shaping Rbn 2cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219796	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Lght Sprt Str 30cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219797	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Lght Sprt Str Tip 2cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219798	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str 2cm Htrq Fl2 Ss	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219799	EAP	Custom 27219799		Kit Gwire .009-.018in .115in Introd Trq Dev Rot	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.31	$65.31	$67.83	$0.00	$18.34	$0.00	$0.00	$0.00	$0.00	$44.00	$69.70	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219800	EAP	Custom 27219800		Kit Gwire .01-.018in	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.31	$65.31	$67.83	$0.00	$18.34	$0.00	$0.00	$0.00	$0.00	$44.00	$69.70	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219801	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in X Sprt J 3cm Htorq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219802	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str Tip Core To Tip	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219803	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in X Sprt J 3cm Htrq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219804	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str Tip Str 3cm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219805	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 143cm 6mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219806	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 143cm 8mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219807	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 143cm 12mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219808	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 143cm 15mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219809	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 143cm 20mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219810	EAP	HCPCS C1725		Catheter Baldilat 2mm 143cm 6mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219811	EAP	HCPCS C1725		Catheter Baldilat 2mm 143cm 12mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219812	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 143cm 6mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219813	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 143cm 20mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219814	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 143cm 15mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219815	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 143cm 20mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219816	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 143cm 25mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219817	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 143cm 6mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219818	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 143cm 8mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219819	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 143cm 12mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219820	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 143cm 20mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219821	EAP	HCPCS C1725		Catheter Baldilat 3mm 143cm 6mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219822	EAP	HCPCS C1725		Catheter Baldilat 3mm 143cm 12mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219823	EAP	HCPCS C1725		Catheter Baldilat 3mm 143cm 15mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219824	EAP	HCPCS C1725		Catheter Baldilat 3mm 143cm 20mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219825	EAP	HCPCS C1725		Catheter Baldilat 3mm 143cm 25mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219826	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 143cm 8mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219827	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 143cm 12mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219828	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 143cm 15mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219829	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 143cm 20mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219830	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 143cm 6mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219831	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 143cm 12mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219832	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 143cm 15mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219833	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 143cm 20mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219834	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 143cm 25mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219835	EAP	HCPCS C1725		Catheter Baldilat 3.75mm 143cm 12mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219836	EAP	HCPCS C1725		Catheter Baldilat 3.75mm 143cm 15mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219837	EAP	HCPCS C1725		Catheter Baldilat 3.75mm 143cm 20mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219838	EAP	HCPCS C1725		Catheter Baldilat 4mm 143cm 8mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219839	EAP	HCPCS C1725		Catheter Baldilat 4mm 143cm 12mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219840	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 143cm 8mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219841	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 143cm 12mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219842	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 143cm 15mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219843	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 143cm 20mm Otw Smth Rnd	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219844	EAP	HCPCS C1725		Catheter Baldilat 5mm 143cm 8mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219845	EAP	HCPCS C1725		Catheter Baldilat 5mm 143cm 20mm Otw Smth Rnd Tip	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
27219846	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str 3cm Htorq Adv Lt	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219847	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Str 3cm Htorq Adv	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219848	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in J 3cm Htorq Adv	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219849	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Str 3cm Htorq Adv	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219850	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in J 3cm Htorq Adv	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
27219851	EAP	HCPCS C1769		Guidewire Vasc 300cm Ptca Asahi Ultimatebros 3	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219852	EAP	HCPCS C1769		Guidewire Vasc 180cm Ptca Asahi Ultimatebros 3	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219853	EAP	HCPCS C1769		Guidewire Vasc 300cm 3cm Str Asahi Suoh Ptca	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219854	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Sion Asahi Ptca Blue	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219855	EAP	HCPCS C1769		Guidewire Vasc 300cm Wire J Asahi Ptca Sion Blue	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219856	EAP	HCPCS C1769		Guidewire Vasc 190cm Str 3cm Asahi Suoh Ptca	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219857	EAP	HCPCS C1769		Guidewire Vasc 190cm Pshp Mini 3cm Asahi Suoh Ptca	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219858	EAP	HCPCS C1769		Guidewire Vasc 180cm Wire J Asahi Ptca Sion Blue	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219859	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Core To Tip J 3cm A	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219860	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Jtp 3cm A Fldr Fc Plmr	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219861	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Core To Tip	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219862	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Core To Tip Str 11cm A	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219863	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Hbrd Radiopq Str Tip	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219864	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Core To Tip J 3cm A	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219865	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Core To Tip J 3cm A	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219866	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Core To Tip Str 3cm A	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219867	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Core To Tip Str 3cm A	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219868	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Core To Tip J 3cm	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219869	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Core To Tip J 3cm	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219870	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Hbrd Radiopq Str Tip 3	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219871	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Hbrd Radiopq Str Tip 3	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219872	EAP	HCPCS C1769		Guidewire Vasc 300cm Ptca A Cfnz Pro	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219873	EAP	HCPCS C1769		Guidewire Vasc 180cm .009in Radiopq Str Tip 20cm A	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219874	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Radiopq Core To Tip J	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219875	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Radiopq Str Tip 11cm	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219876	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Radiopq Str Tip 11cm	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219877	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Radiopq Str Tip 3cm	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219878	EAP	HCPCS C1769		Guidewire Vasc 180cm J Asahi Sft Ptca	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219879	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Radiopq Core To Tip	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219880	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Radiopq Core To Tip J	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219881	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Radiopq Str Tip 3cm	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219882	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Radiopq Core To Tip	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219883	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in .009in Radiopq Str Tip	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219884	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Radiopq Str Tip 3cm	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219885	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Core To Tip J	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219886	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Core To Tip	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219887	EAP	HCPCS C1769		Guidewire Vasc 300cm J Asahi Sft Ptca	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219888	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Core To Tip J	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219889	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Core To Tip	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219890	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Core To Tip	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219891	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Str Tpr Tip 3	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
27219892	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Radiopq Core To Tip	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$509.33	$509.33	$0.00	$0.00	$0.00	$195.50	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$0.00	$0.00	$0.00	$146.80	$0.00	$0.00	$149.33	$0.00	$0.00	$0.00	$0.00	$0.00
27219893	EAP	HCPCS C1769		Introd Gwire .009-.018in Coron	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$40.73	$40.73	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$57.81	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00	$0.00	$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
27219894	EAP	Custom 27219894		Device Trq Gwire Acpt .009-.018 In Gwire	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$96.35	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219896	EAP	HCPCS C1887		Catheter Infs Mic 2.1-1.7fr 5fr .017in 155cm .34ml 150cm	BOTH IP/OP	"$1,588.00 "	"$1,175.12"	$0.00	"$1,270.40"	$862.28	$862.28	$0.00	$0.00	$0.00	$330.98	"$1,178.61"	"$1,178.61"	"$1,224.03"	$0.00	$330.94	$0.00	$939.30	$939.30	$0.00	$794.00	"$1,257.70"	"$1,270.40"	$0.00	"$1,032.20"	$0.00	$248.52	$0.00	$0.00	$252.81	$0.00	$0.00	$0.00	$0.00	$0.00
27219897	EAP	HCPCS C1757		Retriever Escp Trevo Xp Provue	BOTH IP/OP	"$13,641.00 "	"$10,094.34"	$0.00	"$10,912.80"	"$7,407.06"	"$7,407.06"	$0.00	$0.00	$0.00	"$2,843.13"	"$4,181.12"	"$4,181.12"	"$10,514.48"	$0.00	"$2,842.78"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$6,820.50"	"$10,803.67"	"$10,912.80"	$0.00	"$8,866.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219898	EAP	HCPCS C1725		Catheter Baldilat Lp 5.3fr 4mm 75cm 60mm High Pressure	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$300.95	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27219899	EAP	HCPCS C1894		Introducer Sheath .035in Anl1 Curve 11.4fr 10fr 45cm High	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00	$130.00	$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
27219900	EAP	HCPCS C1751		Catheter Cv 9.3fr 22cm Strl Lf Cl Ln Heat Exch Kt	BOTH IP/OP	"$1,288.00 "	$953.12	$0.00	"$1,030.40"	$699.38	$699.38	$0.00	$0.00	$0.00	$268.45	$955.95	$955.95	$992.79	$0.00	$268.42	$0.00	$761.85	$761.85	$0.00	$644.00	"$1,020.10"	"$1,030.40"	$0.00	$0.00	$0.00	$201.57	$0.00	$0.00	$205.05	$0.00	$0.00	$0.00	$0.00	$0.00
27219901	EAP	HCPCS C1751		Kit Cath 9.3fr 38cm Icy Cv	BOTH IP/OP	"$2,053.00 "	"$1,519.22"	$0.00	"$1,642.40"	"$1,114.78"	"$1,114.78"	$0.00	$0.00	$0.00	$427.90	"$1,523.74"	"$1,523.74"	"$1,582.45"	$0.00	$427.85	$0.00	"$1,214.35"	"$1,214.35"	$0.00	"$1,026.50"	"$1,625.98"	"$1,642.40"	$0.00	$0.00	$0.00	$321.29	$0.00	$0.00	$326.84	$0.00	$0.00	$0.00	$0.00	$0.00
27219902	EAP	HCPCS C1887		Kit Cath 9.3fr 45cm Quattro Heat Exch 3 Lum Ll Applause Hep	BOTH IP/OP	"$2,299.00 "	"$1,701.26"	$0.00	"$1,839.20"	"$1,248.36"	"$1,248.36"	$0.00	$0.00	$0.00	$479.17	"$1,706.32"	"$1,706.32"	"$1,772.07"	$0.00	$479.11	$0.00	"$1,359.86"	"$1,359.86"	$0.00	"$1,149.50"	"$1,820.81"	"$1,839.20"	$0.00	$0.00	$0.00	$359.79	$0.00	$0.00	$366.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219903	EAP			Kit Iv Clgrd 3k Srt	BOTH IP/OP	$455.00 	$336.70	$0.00	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.70	$337.70	$350.71	$0.00	$94.82	$0.00	$0.00	$0.00	$0.00	$227.50	$360.36	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219904	EAP			Tubing Xtn 9ft	BOTH IP/OP	$511.00 	$378.14	$0.00	$408.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$379.26	$379.26	$393.88	$0.00	$106.49	$0.00	$0.00	$0.00	$0.00	$255.50	$404.71	$408.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219905	EAP			Pack Srg 6ft Ivtm Cool Line Srt Up Disp	BOTH IP/OP	"$6,725.00 "	"$4,976.50"	$0.00	"$5,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,183.63"	$0.00	"$1,401.49"	$0.00	$0.00	$0.00	$0.00	"$3,362.50"	"$5,326.20"	"$5,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219906	EAP			Pack Srg 6ft Ivtm Icy Srt Up Disp	BOTH IP/OP	"$9,640.00 "	"$7,133.60"	$0.00	"$7,712.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$7,430.51"	$0.00	"$2,008.98"	$0.00	$0.00	$0.00	$0.00	"$4,820.00"	"$7,634.88"	"$7,712.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219907	EAP			Pack Srg 6ft Ivtm Quattro Srt Up Disp	BOTH IP/OP	"$10,579.00 "	"$7,828.46"	$0.00	"$8,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,154.29"	$0.00	"$2,204.66"	$0.00	$0.00	$0.00	$0.00	"$5,289.50"	"$8,378.57"	"$8,463.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219908	EAP	HCPCS C1887		Catheter Advanced Support Guidewire Center Cross Ultra	BOTH IP/OP	$498.00 	$368.52	$0.00	$398.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.00	$394.42	$398.40	$0.00	$0.00	$0.00	$77.94	$0.00	$0.00	$79.28	$0.00	$0.00	$0.00	$0.00	$0.00
27219909	EAP	HCPCS C1887		Catheter Angioplasty Microcross 0.014 In	BOTH IP/OP	$988.00 	$731.12	$0.00	$790.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$494.00	$782.50	$790.40	$0.00	$0.00	$0.00	$154.62	$0.00	$0.00	$157.29	$0.00	$0.00	$0.00	$0.00	$0.00
27219910	EAP	HCPCS C1887		Catheter Angioplasty Microcross 0.018 In	BOTH IP/OP	$988.00 	$731.12	$0.00	$790.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$494.00	$782.50	$790.40	$0.00	$0.00	$0.00	$154.62	$0.00	$0.00	$157.29	$0.00	$0.00	$0.00	$0.00	$0.00
27219911	EAP			Drain Incs Strl Lf Oas Bld Rcvr Dry Sct Ats Cmpt 1 Pt Tube	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.02	$69.02	$71.68	$0.00	$19.38	$0.00	$0.00	$0.00	$0.00	$46.50	$73.66	$74.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219912	EAP			Separator Thrmb Strl Lf Indg Sys 4 Disp	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	"$1,695.76"	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219913	EAP			Catheter Sct 16mm 105cm Strl Lf Clottriever Disp	BOTH IP/OP	"$11,988.00 "	"$8,871.12"	$0.00	"$9,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$9,240.35"	$0.00	"$2,498.30"	$0.00	$0.00	$0.00	$0.00	"$5,994.00"	"$9,494.50"	"$9,590.40"	$0.00	"$7,792.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219914	EAP			Catheter Sct 4.6mm 15cm Strl Lf Clottriever Shth Disp	BOTH IP/OP	"$3,238.00 "	"$2,396.12"	$0.00	"$2,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,403.24"	"$2,403.24"	"$2,495.85"	$0.00	$674.80	$0.00	$0.00	$0.00	$0.00	"$1,619.00"	"$2,564.50"	"$2,590.40"	$0.00	"$2,104.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219915	EAP	HCPCS C1757		Set Thrombectomy 6fr 3mm 120cm 15mm Otw Contrast Injec Port	BOTH IP/OP	"$5,013.00 "	"$3,709.62"	$0.00	"$4,010.40"	"$2,722.06"	"$2,722.06"	$0.00	$0.00	$0.00	"$1,044.83"	"$3,720.65"	"$3,720.65"	"$3,864.02"	$0.00	"$1,044.71"	$0.00	"$2,965.19"	"$2,965.19"	$0.00	"$2,506.50"	"$3,970.30"	"$4,010.40"	$0.00	"$3,258.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219916	EAP	HCPCS C1769		Guidewire Vasc Ang .035in 150cm Hiwire Radopq Flx Tp Stf	BOTH IP/OP	$423.00 	$313.02	$0.00	$338.40	$229.69	$229.69	$0.00	$0.00	$0.00	$88.16	$313.95	$313.95	$326.05	$0.00	$88.15	$0.00	$250.20	$250.20	$0.00	$211.50	$335.02	$338.40	$0.00	$274.95	$0.00	$66.20	$0.00	$0.00	$67.34	$0.00	$0.00	$0.00	$0.00	$0.00
27219917	EAP			Catheter Angiographic Kmp Curve 5fr 40cm Torcon Nb Advantage	BOTH IP/OP	$194.00 	$143.56	$0.00	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.99	$143.99	$149.54	$0.00	$40.43	$0.00	$0.00	$0.00	$0.00	$97.00	$153.65	$155.20	$0.00	$126.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219918	EAP	HCPCS C1769		Guidewire Vasc 3cm Strg .014in 190cm 25cm Spectre 2 Cor Kink	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$25.52	$25.52	$0.00	$0.00	$0.00	$9.80	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$27.80	$27.80	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$7.36	$0.00	$0.00	$7.48	$0.00	$0.00	$0.00	$0.00	$0.00
27219919	EAP	HCPCS C1769		Guidewire Vasc 3cm Strg .014in 300cm 25cm Spectre 2 Cor Kink	BOTH IP/OP	$48.00 	$35.52	$0.00	$38.40	$26.06	$26.06	$0.00	$0.00	$0.00	$10.00	$35.63	$35.63	$37.00	$0.00	$10.00	$0.00	$28.39	$28.39	$0.00	$24.00	$38.02	$38.40	$0.00	$0.00	$0.00	$7.51	$0.00	$0.00	$7.64	$0.00	$0.00	$0.00	$0.00	$0.00
27219920	EAP	HCPCS C1753		Catheter Ultrasound 20mhz 3.4fr 135cm Scanner Transducer	BOTH IP/OP	"$1,688.00 "	"$1,249.12"	$0.00	"$1,350.40"	$916.58	$916.58	$0.00	$0.00	$0.00	$351.82	"$1,252.83"	"$1,252.83"	"$1,301.11"	$0.00	$351.78	$0.00	$998.45	$998.45	$0.00	$844.00	"$1,336.90"	"$1,350.40"	$0.00	"$1,097.20"	$0.00	$264.17	$0.00	$0.00	$268.73	$0.00	$0.00	$0.00	$0.00	$0.00
27219921	EAP	HCPCS C1887		Catheter Gd Mpc Crv 6fr 100cm Env Lg Inr Lum Radopq Brd Sft	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$503.90	$503.90	$0.00	$0.00	$0.00	$193.42	$688.76	$688.76	$715.30	$0.00	$193.40	$0.00	$548.91	$548.91	$0.00	$464.00	$734.98	$742.40	$0.00	$603.20	$0.00	$145.23	$0.00	$0.00	$147.74	$0.00	$0.00	$0.00	$0.00	$0.00
27219922	EAP	HCPCS C1725		Catheter Blndil 8mm 90cm 20mm Pr Ctbln Otw Tpr Tip Infl Port	BOTH IP/OP	"$1,759.00 "	"$1,301.66"	$0.00	"$1,407.20"	$955.14	$955.14	$0.00	$0.00	$0.00	$366.62	"$1,305.53"	"$1,305.53"	"$1,355.84"	$0.00	$366.58	$0.00	"$1,040.45"	"$1,040.45"	$0.00	$879.50	"$1,393.13"	"$1,407.20"	$0.00	$0.00	$0.00	$275.28	$0.00	$0.00	$280.03	$0.00	$0.00	$0.00	$0.00	$0.00
27219923	EAP			Pad Thrp Unv Sm Ns Lf Arcticgel Inlt/otlt Cnct Ddrgl Disp	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.80	$161.80	$168.03	$0.00	$45.43	$0.00	$0.00	$0.00	$0.00	$109.00	$172.66	$174.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219924	EAP	HCPCS C1769		Guidewire Vasc .014in 180cm Strl Lf Cnfnz Pro 12 Disp	BOTH IP/OP	$333.00 	$246.42	$0.00	$266.40	$180.82	$180.82	$0.00	$0.00	$0.00	$69.41	$247.15	$247.15	$256.68	$0.00	$69.40	$0.00	$196.97	$196.97	$0.00	$166.50	$263.74	$266.40	$0.00	$216.45	$0.00	$52.11	$0.00	$0.00	$53.01	$0.00	$0.00	$0.00	$0.00	$0.00
27219925	EAP	HCPCS C1769		Guidewire Vasc .014in 300cm Strl Lf Fielder Fc Disp	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00	$0.00	$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
27219926	EAP	HCPCS C1769		Guidewire Vasc .014in 180cm Strl Lf Fielder Fc Disp	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00	$130.00	$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
27219927	EAP	HCPCS C1769		Guidewire Vasc .014in 300cm Strl Lf Grand Slam Disp	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$156.38	$156.38	$0.00	$0.00	$0.00	$60.03	$213.75	$213.75	$221.99	$0.00	$60.02	$0.00	$170.35	$170.35	$0.00	$144.00	$228.10	$230.40	$0.00	$187.20	$0.00	$45.07	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$0.00
27219928	EAP	HCPCS C1769		Guidewire Vasc .014in 180cm Strl Lf Mrclbrs 6 Disp	BOTH IP/OP	$333.00 	$246.42	$0.00	$266.40	$180.82	$180.82	$0.00	$0.00	$0.00	$69.41	$247.15	$247.15	$256.68	$0.00	$69.40	$0.00	$196.97	$196.97	$0.00	$166.50	$263.74	$266.40	$0.00	$216.45	$0.00	$52.11	$0.00	$0.00	$53.01	$0.00	$0.00	$0.00	$0.00	$0.00
27219929	EAP	HCPCS C1769		Guidewire Vasc .014in 300cm Strl Lf Mrclbrs 6 Disp	BOTH IP/OP	$333.00 	$246.42	$0.00	$266.40	$180.82	$180.82	$0.00	$0.00	$0.00	$69.41	$247.15	$247.15	$256.68	$0.00	$69.40	$0.00	$196.97	$196.97	$0.00	$166.50	$263.74	$266.40	$0.00	$0.00	$0.00	$52.11	$0.00	$0.00	$53.01	$0.00	$0.00	$0.00	$0.00	$0.00
27219930	EAP	HCPCS C1769		Guidewire Vasc .014in 300cm Strl Lf Mrclbrs 3 Disp	BOTH IP/OP	$333.00 	$246.42	$0.00	$266.40	$180.82	$180.82	$0.00	$0.00	$0.00	$69.41	$247.15	$247.15	$256.68	$0.00	$69.40	$0.00	$196.97	$196.97	$0.00	$166.50	$263.74	$266.40	$0.00	$0.00	$0.00	$52.11	$0.00	$0.00	$53.01	$0.00	$0.00	$0.00	$0.00	$0.00
27219931	EAP	HCPCS C1769		Guidewire Vasc .014in 180cm Strl Lf P-h2o Disp	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00	$130.00	$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
27219932	EAP	HCPCS C1769		Guidewire Vasc .014in 300cm Strl Lf P-h2o Disp	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00	$130.00	$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
27219933	EAP	HCPCS C1769		Guidewire Vasc .014in 300cm 45cm Snchr14	BOTH IP/OP	"$1,798.00 "	"$1,330.52"	$0.00	"$1,438.40"	$976.31	$976.31	$0.00	$0.00	$0.00	$374.75	"$1,334.48"	"$1,334.48"	"$1,385.90"	$0.00	$374.70	$0.00	"$1,063.52"	"$1,063.52"	$0.00	$899.00	"$1,424.02"	"$1,438.40"	$0.00	$0.00	$0.00	$281.39	$0.00	$0.00	$286.24	$0.00	$0.00	$0.00	$0.00	$0.00
27219934	EAP			Medtronic Aortic And Peripheral Vascular - Div Med	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	"$3,661.30"	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00	"$3,087.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219935	EAP	HCPCS C1894		Introducer Gw Grdn Ii Nc Hmsts Vlv	BOTH IP/OP	"$1,688.00 "	"$1,249.12"	$0.00	"$1,350.40"	$916.58	$916.58	$0.00	$0.00	$0.00	$351.82	"$1,252.83"	"$1,252.83"	"$1,301.11"	$0.00	$351.78	$0.00	$998.45	$998.45	$0.00	$844.00	"$1,336.90"	"$1,350.40"	$0.00	$0.00	$0.00	$264.17	$0.00	$0.00	$268.73	$0.00	$0.00	$0.00	$0.00	$0.00
27219936	EAP			Bronchoscope Flxb 600mm 3.8mm 1.2mm Slim Ambu	BOTH IP/OP	$650.00 	$481.00	$0.00	$520.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.43	$482.43	$501.02	$0.00	$135.46	$0.00	$0.00	$0.00	$0.00	$325.00	$514.80	$520.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219937	EAP			Bronchoscope Flxb 600mm 5mm 2.2mm Ambu Ascope 3	BOTH IP/OP	$985.00 	$728.90	$0.00	$788.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$731.07	$731.07	$759.24	$0.00	$205.27	$0.00	$0.00	$0.00	$0.00	$492.50	$780.12	$788.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219938	EAP			Blade Lrnscp Mac S3 Spctrm Ti Disp Glidescope	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.22	$74.22	$77.08	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219939	EAP			Blade Lrnscp Mac S4 Spctrm Ti Disp Glidescope	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.22	$74.22	$77.08	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219940	EAP			Introducer Tube 15fr 70cm Strl Lf Clbrt Cde Boug Ldpe Adlt	BOTH IP/OP	$322.00 	$238.28	$0.00	$257.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.99	$238.99	$248.20	$0.00	$67.10	$0.00	$0.00	$0.00	$0.00	$161.00	$255.02	$257.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219941	EAP			Catheter Primafit Sage	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00	$17.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219942	EAP	HCPCS C1729		Drain Incision Small Stature 1 Chamber Suction Control	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$27.69	$27.69	$0.00	$0.00	$0.00	$10.63	$37.85	$37.85	$39.31	$0.00	$10.63	$0.00	$30.17	$30.17	$0.00	$25.50	$40.39	$40.80	$0.00	$33.15	$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
27219943	EAP	HCPCS C1729		Catheter External Drain Large 1.9mm Latex Free Bactiseal Evd	BOTH IP/OP	"$1,229.00 "	$909.46	$0.00	$983.20	$667.35	$667.35	$0.00	$0.00	$0.00	$256.15	$912.16	$912.16	$947.31	$0.00	$256.12	$0.00	$726.95	$726.95	$0.00	$614.50	$973.37	$983.20	$0.00	$798.85	$0.00	$192.34	$0.00	$0.00	$195.66	$0.00	$0.00	$0.00	$0.00	$0.00
27219945	EAP	Custom 27219945		Tracheostomy Tray	BOTH IP/OP	$279.00 	$206.46	$0.00	$223.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.50	$220.97	$223.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219946	EAP	Custom 27219946		Canister Wound Drain C500ml Gel Tube Clmp Conctr Charcoal	BOTH IP/OP	$84.00 	$62.16	$0.00	$67.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.34	$62.34	$64.75	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$42.00	$66.53	$67.20	$0.00	$54.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219947	EAP	Custom 27219947		Pad Wound Drain Tube Clmp Conctr Sensatrac Vac Sterile	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$27.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219948	EAP	Custom 27219948		Airway Esophageal 3 Standard Str Mask Latex Free Auraonce	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219949	EAP	HCPCS C1769		Guidewire Vascular .035in 26 13/16in 1 End Mark Spring Str	BOTH IP/OP	$44.00 	$32.56	$0.00	$35.20	$23.89	$23.89	$0.00	$0.00	$0.00	$9.17	$32.66	$32.66	$33.92	$0.00	$9.17	$0.00	$26.03	$26.03	$0.00	$22.00	$34.85	$35.20	$0.00	$0.00	$0.00	$6.89	$0.00	$0.00	$7.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219950	EAP	Custom 27219950		Kit Arterial Line .018in 20ga 22ga 1.75in Catheter Radiopq	BOTH IP/OP	$29.00 	$21.46	$0.00	$23.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.52	$21.52	$22.35	$0.00	$6.04	$0.00	$0.00	$0.00	$0.00	$14.50	$22.97	$23.20	$0.00	$18.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219953	EAP	Custom 27219953		Solution Dialysate 2 Compartment Bag Peel Seam Pureflow	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$96.35	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219954	EAP	Custom 27219954		Device Securing 6fr Kit Blue Retrival Probe White Catheter	BOTH IP/OP	$232.00 	$171.68	$0.00	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.19	$172.19	$178.83	$0.00	$48.35	$0.00	$0.00	$0.00	$0.00	$116.00	$183.74	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219955	EAP	Custom 27219955		Device Securing Standard 8fr Kit Retrieval Probe Catheter	BOTH IP/OP	$232.00 	$171.68	$0.00	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.19	$172.19	$178.83	$0.00	$48.35	$0.00	$0.00	$0.00	$0.00	$116.00	$183.74	$185.60	$0.00	$150.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219956	EAP	Custom 27219956		Device Securing Standard 10fr Kit Retrieval Probe Catheter	BOTH IP/OP	$232.00 	$171.68	$0.00	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.19	$172.19	$178.83	$0.00	$48.35	$0.00	$0.00	$0.00	$0.00	$116.00	$183.74	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219957	EAP	Custom 27219957		Device Scr Std 14fr Ylw Ns Lf Amt Bridle Preattach Clip Sty	BOTH IP/OP	$232.00 	$171.68	$0.00	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.19	$172.19	$178.83	$0.00	$48.35	$0.00	$0.00	$0.00	$0.00	$116.00	$183.74	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219959	EAP	Custom 27219959		Kit Cath .032in 8.5fr 18ga 16cm Lf 2.5in Blu Flxtp Arwg+ard	BOTH IP/OP	$327.00 	$241.98	$0.00	$261.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.70	$242.70	$252.05	$0.00	$68.15	$0.00	$0.00	$0.00	$0.00	$163.50	$258.98	$261.60	$0.00	$212.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219960	EAP	Custom 27219960		Kit Urostomy Cut To Fit 2.25- In 2.75in 9in 2 Piece Belt Tab	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219961	EAP	Custom 27219961		Suture Absorbable 3-0 Sh-1 27in Braid Coated Vicryl Undyed	BOTH IP/OP	$185.00 	$136.90	$0.00	$148.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.31	$137.31	$142.60	$0.00	$38.55	$0.00	$0.00	$0.00	$0.00	$92.50	$146.52	$148.00	$0.00	$120.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219962	EAP	Custom 27219962		Kit Repr 21-18ga Pilt Tube Syr Reinflate Cuf 10ml	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219963	EAP	Custom 27219963		Dressing Abthera Snsa Trc Foam Opn Abd Neg Prss	BOTH IP/OP	$920.00 	$680.80	$0.00	$736.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$682.82	$682.82	$709.14	$0.00	$191.73	$0.00	$0.00	$0.00	$0.00	$460.00	$728.64	$736.00	$0.00	$598.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219964	EAP	Custom 27219964		Dressing Hdrcld 8x8in Cmfl Plus Abs Wtprf Top Flm	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219967	EAP	Custom 27219967		Device Securing 12fr Kit Dk Blue	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219968	EAP	Custom 27219968		Device Securing 18fr Kit Lt Blue	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219969	EAP	HCPCS C1752		Kit Cath Strg 13fr 30cm Strl Pwr-trialysis 3 Lum Kink Rst	BOTH IP/OP	$563.00 	$416.62	$0.00	$450.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.86	$417.86	$433.96	$0.00	$117.33	$0.00	$0.00	$0.00	$0.00	$281.50	$445.90	$450.40	$0.00	$365.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219970	EAP	HCPCS C1752		Kit Cath 13fr 20cm Strl Pwr-trialysis 3 Lum Shrt Term Dlys	BOTH IP/OP	$563.00 	$416.62	$0.00	$450.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.50	$445.90	$450.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219971	EAP	HCPCS C1752		Catheter Hmdial 15cm Schn Xl Kink Rst Tip Clip Sh Rem Sty	BOTH IP/OP	$119.00 	$88.06	$0.00	$95.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.32	$88.32	$91.73	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$59.50	$94.25	$95.20	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219972	EAP	HCPCS C1752		Set Cath 24cm Schn Xl Bsc Sil Acute Hmdial	BOTH IP/OP	$238.00 	$176.12	$0.00	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.64	$176.64	$183.45	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$119.00	$188.50	$190.40	$0.00	$154.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219974	EAP	HCPCS C1755		Kit Epidural Catheterization	BOTH IP/OP	$146.00 	$108.04	$0.00	$116.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.36	$108.36	$112.54	$0.00	$30.43	$0.00	$0.00	$0.00	$0.00	$73.00	$115.63	$116.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219975	EAP	Custom 27219975		Kit Dressing Midline Custom Change Tray	BOTH IP/OP	$48.00 	$35.52	$0.00	$38.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.63	$35.63	$37.00	$0.00	$10.00	$0.00	$0.00	$0.00	$0.00	$24.00	$38.02	$38.40	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219976	EAP	HCPCS C1725		Catheter Blndil 2.25mm 142cm 35mm Mozec Rx Nyl Ptca	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$134.66	$134.66	$0.00	$0.00	$0.00	$51.69	$184.07	$184.07	$191.16	$0.00	$51.68	$0.00	$146.69	$146.69	$0.00	$124.00	$196.42	$198.40	$0.00	$0.00	$0.00	$38.81	$0.00	$0.00	$39.48	$0.00	$0.00	$0.00	$0.00	$0.00
27219977	EAP	HCPCS C1725		Catheter Blndil 2.5mm 142cm 35mm Mozec Rx Nyl Ptca	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$134.66	$134.66	$0.00	$0.00	$0.00	$51.69	$184.07	$184.07	$191.16	$0.00	$51.68	$0.00	$146.69	$146.69	$0.00	$124.00	$196.42	$198.40	$0.00	$0.00	$0.00	$38.81	$0.00	$0.00	$39.48	$0.00	$0.00	$0.00	$0.00	$0.00
27219978	EAP	HCPCS C1725		Catheter Blndil 2.75mm 142cm 35mm Mozec Rx Nyl Ptca	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$134.66	$134.66	$0.00	$0.00	$0.00	$51.69	$184.07	$184.07	$191.16	$0.00	$51.68	$0.00	$146.69	$146.69	$0.00	$124.00	$196.42	$198.40	$0.00	$0.00	$0.00	$38.81	$0.00	$0.00	$39.48	$0.00	$0.00	$0.00	$0.00	$0.00
27219979	EAP	HCPCS C1725		Catheter Blndil 3mm Lf Crds Mozec Rx Ptca	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$134.66	$134.66	$0.00	$0.00	$0.00	$51.69	$184.07	$184.07	$191.16	$0.00	$51.68	$0.00	$146.69	$146.69	$0.00	$124.00	$196.42	$198.40	$0.00	$0.00	$0.00	$38.81	$0.00	$0.00	$39.48	$0.00	$0.00	$0.00	$0.00	$0.00
27219980	EAP	HCPCS C1725		Catheter Blndil 3.5mm 142cm 35mm Mozec Rx Nyl Ptca	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$134.66	$134.66	$0.00	$0.00	$0.00	$51.69	$184.07	$184.07	$191.16	$0.00	$51.68	$0.00	$146.69	$146.69	$0.00	$124.00	$196.42	$198.40	$0.00	$0.00	$0.00	$38.81	$0.00	$0.00	$39.48	$0.00	$0.00	$0.00	$0.00	$0.00
27219981	EAP	HCPCS C1725		Catheter Blndil 4mm 142cm 35mm Mozec Rx Nyl Ptca	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$134.66	$134.66	$0.00	$0.00	$0.00	$51.69	$184.07	$184.07	$191.16	$0.00	$51.68	$0.00	$146.69	$146.69	$0.00	$124.00	$196.42	$198.40	$0.00	$0.00	$0.00	$38.81	$0.00	$0.00	$39.48	$0.00	$0.00	$0.00	$0.00	$0.00
27219982	EAP	HCPCS C1894		Set Intro 8fr 80cm Lf S Arwflx 3w Stpck Shth Radopq Intgr	BOTH IP/OP	$331.00 	$244.94	$0.00	$264.80	$179.73	$179.73	$0.00	$0.00	$0.00	$68.99	$245.67	$245.67	$255.13	$0.00	$68.98	$0.00	$195.79	$195.79	$0.00	$165.50	$262.15	$264.80	$0.00	$0.00	$0.00	$51.80	$0.00	$0.00	$52.70	$0.00	$0.00	$0.00	$0.00	$0.00
27219983	EAP	Custom 27219983		Cath Umb 3.5f Pu 15in	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219984	EAP	Custom 27219984		Cath Umb 5f Pu 15in	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$22.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219985	EAP	Custom 27219985		"Catheter, 8f Thoracic"	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219986	EAP	Custom 27219986		Cath Trocar Fnl 10f 9in	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219987	EAP	Custom 27219987		Cath Trocar 12fr	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219988	EAP	Custom 27219988		"Kit, Chest Tube"	BOTH IP/OP	$74.00 	$54.76	$0.00	$59.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.92	$54.92	$57.04	$0.00	$15.42	$0.00	$0.00	$0.00	$0.00	$37.00	$58.61	$59.20	$0.00	$48.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219989	EAP	Custom 27219989		Umbilical Vessel Catheter Tray 88-160408	BOTH IP/OP	$127.00 	$93.98	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.26	$94.26	$97.89	$0.00	$26.47	$0.00	$0.00	$0.00	$0.00	$63.50	$100.58	$101.60	$0.00	$82.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219990	EAP	HCPCS C1887		Catheter Gd Strg 5fr .068in .055in 115cm 17cm Sofia Dist Acc	BOTH IP/OP	"$3,040.00 "	"$2,249.60"	$0.00	"$2,432.00"	"$1,650.72"	"$1,650.72"	$0.00	$0.00	$0.00	$633.61	"$2,256.29"	"$2,256.29"	"$2,343.23"	$0.00	$633.54	$0.00	"$1,798.16"	"$1,798.16"	$0.00	"$1,520.00"	"$2,407.68"	"$2,432.00"	$0.00	"$1,976.00"	$0.00	$475.76	$0.00	$0.00	$483.97	$0.00	$0.00	$0.00	$0.00	$0.00
27219991	EAP	HCPCS C1887		Catheter Gd Strg 5fr .068in .055in 125cm 17cm Sofia Dist Acc	BOTH IP/OP	"$3,230.00 "	"$2,390.20"	$0.00	"$2,584.00"	"$1,753.89"	"$1,753.89"	$0.00	$0.00	$0.00	$673.21	"$2,397.31"	"$2,397.31"	"$2,489.68"	$0.00	$673.13	$0.00	"$1,910.55"	"$1,910.55"	$0.00	"$1,615.00"	"$2,558.16"	"$2,584.00"	$0.00	"$2,099.50"	$0.00	$505.50	$0.00	$0.00	$514.22	$0.00	$0.00	$0.00	$0.00	$0.00
27219992	EAP	HCPCS C1725		Catheter Blndil 1mm 5mm Strl Lf Sphr Ii Pro Perc Ptca	BOTH IP/OP	$563.00 	$416.62	$0.00	$450.40	$305.71	$305.71	$0.00	$0.00	$0.00	$117.34	$417.86	$417.86	$433.96	$0.00	$117.33	$0.00	$333.01	$333.01	$0.00	$281.50	$445.90	$450.40	$0.00	$0.00	$0.00	$88.11	$0.00	$0.00	$89.63	$0.00	$0.00	$0.00	$0.00	$0.00
27219993	EAP	HCPCS C1725		Catheter Blndil 1mm 8mm Strl Lf Sphr Ii Pro Perc Ptca	BOTH IP/OP	$563.00 	$416.62	$0.00	$450.40	$305.71	$305.71	$0.00	$0.00	$0.00	$117.34	$417.86	$417.86	$433.96	$0.00	$117.33	$0.00	$333.01	$333.01	$0.00	$281.50	$445.90	$450.40	$0.00	$0.00	$0.00	$88.11	$0.00	$0.00	$89.63	$0.00	$0.00	$0.00	$0.00	$0.00
27219994	EAP	HCPCS C1725		Catheter Blndil 1mm 10mm Strl Lf Sphr Ii Pro Perc Ptca	BOTH IP/OP	$563.00 	$416.62	$0.00	$450.40	$305.71	$305.71	$0.00	$0.00	$0.00	$117.34	$417.86	$417.86	$433.96	$0.00	$117.33	$0.00	$333.01	$333.01	$0.00	$281.50	$445.90	$450.40	$0.00	$0.00	$0.00	$88.11	$0.00	$0.00	$89.63	$0.00	$0.00	$0.00	$0.00	$0.00
27219995	EAP	HCPCS C1725		Catheter Blndil 1mm 15mm Strl Lf Sphr Ii Pro Perc Ptca	BOTH IP/OP	$563.00 	$416.62	$0.00	$450.40	$305.71	$305.71	$0.00	$0.00	$0.00	$117.34	$417.86	$417.86	$433.96	$0.00	$117.33	$0.00	$333.01	$333.01	$0.00	$281.50	$445.90	$450.40	$0.00	$0.00	$0.00	$88.11	$0.00	$0.00	$89.63	$0.00	$0.00	$0.00	$0.00	$0.00
27219996	EAP	HCPCS C1725		Catheter Blndil 1.25mm 5mm Sphr Ii Pro Cor	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27219997	EAP	HCPCS C1725		Catheter Blndil 1.25mm 8mm Sphr Ii Pro Cor	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27219998	EAP	HCPCS C1725		Catheter Blndil 1.25mm 10mm Sphr Ii Pro Cor	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27219999	EAP	HCPCS C1725		Catheter Blndil 1.25mm 15mm Sphr Ii Pro Cor	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220000	EAP	HCPCS C1725		Catheter Blndil 1.5mm Strl Lf 10mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220001	EAP	HCPCS C1725		Catheter Blndil 1.5mm Strl Lf 12mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220002	EAP	HCPCS C1725		Catheter Blndil 1.5mm Strl Lf 15mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220003	EAP	HCPCS C1725		Catheter Blndil 1.5mm Strl Lf 20mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220004	EAP	HCPCS C1725		Catheter Blndil 1.75mm Strl Lf 10mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220005	EAP	HCPCS C1725		Catheter Blndil 1.75mm Strl Lf 15mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220006	EAP	HCPCS C1725		Catheter Blndil 1.75mm Strl Lf 20mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220007	EAP	HCPCS C1725		Catheter Blndil 2mm Strl Lf 10mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220008	EAP	HCPCS C1725		Catheter Blndil 2mm Strl Lf 12mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220009	EAP	HCPCS C1725		Catheter Blndil 2mm Strl Lf 15mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220010	EAP	HCPCS C1725		Catheter Blndil 2mm Strl Lf 20mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220011	EAP	HCPCS C1725		Catheter Blndil 2.25mm Strl Lf 10mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220012	EAP	HCPCS C1725		Catheter Blndil 2.25mm Strl Lf 15mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220013	EAP	HCPCS C1725		Catheter Blndil 2.25mm Strl Lf 20mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220014	EAP	HCPCS C1725		Catheter Blndil 2.5mm Strl Lf 10mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220015	EAP	HCPCS C1725		Catheter Blndil 2.5mm Strl Lf 12mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220016	EAP	HCPCS C1725		Catheter Blndil 2.5mm Strl Lf 15mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220017	EAP	HCPCS C1725		Catheter Blndil 2.5mm Strl Lf 20mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220018	EAP	HCPCS C1725		Catheter Blndil 2.5mm Strl Lf 30mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220019	EAP	HCPCS C1725		Catheter Blndil 2.75mm Strl Lf 10mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220020	EAP	HCPCS C1725		Catheter Blndil 2.75mm Strl Lf 15mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220021	EAP	HCPCS C1725		Catheter Blndil 2.75mm Strl Lf 20mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220022	EAP	HCPCS C1725		Catheter Blndil 3mm Strl Lf 10mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220023	EAP	HCPCS C1725		Catheter Blndil 3mm Strl Lf 12mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220024	EAP	HCPCS C1725		Catheter Blndil 3mm Strl Lf 15mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220025	EAP	HCPCS C1725		Catheter Blndil 3mm Strl Lf 20mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220026	EAP	HCPCS C1725		Catheter Blndil 3mm Strl Lf 30mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220027	EAP	HCPCS C1725		Catheter Blndil 3.25mm Strl Lf 10mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220028	EAP	HCPCS C1725		Catheter Blndil 3.25mm Strl Lf 15mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220029	EAP	HCPCS C1725		Catheter Blndil 3.25mm Strl Lf 15mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220030	EAP	HCPCS C1725		Catheter Blndil 3.5mm Strl Lf 10mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220031	EAP	HCPCS C1725		Catheter Blndil 3.5mm Strl Lf 15mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220032	EAP	HCPCS C1725		Catheter Blndil 3.5mm Strl Lf 20mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220033	EAP	HCPCS C1725		Catheter Blndil 3.5mm Strl Lf 30mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220034	EAP	HCPCS C1725		Catheter Blndil 4mm Strl Lf 10mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220035	EAP	HCPCS C1725		Catheter Blndil 4mm Strl Lf 15mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220036	EAP	HCPCS C1725		Catheter Blndil 4mm Strl Lf 20mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220037	EAP	HCPCS C1725		Catheter Blndil 2mm Strl Lf 8mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220038	EAP	HCPCS C1725		Catheter Blndil 2mm Strl Lf 10mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220039	EAP	HCPCS C1725		Catheter Blndil 2mm Strl Lf 12mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220040	EAP	HCPCS C1725		Catheter Blndil 2mm Strl Lf 15mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220041	EAP	HCPCS C1725		Catheter Blndil 2mm Strl Lf 18mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220042	EAP	HCPCS C1725		Catheter Blndil 2.25mm Strl Lf 8mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220043	EAP	HCPCS C1725		Catheter Blndil 2.25mm Strl Lf 10mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220044	EAP	HCPCS C1725		Catheter Blndil 2.25mm Strl Lf 12mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220045	EAP	HCPCS C1725		Catheter Blndil 2.25mm Strl Lf 15mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220046	EAP	HCPCS C1725		Catheter Blndil 2.25mm Strl Lf 18mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220047	EAP	HCPCS C1725		Catheter Blndil 2.5mm Strl Lf 8mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220048	EAP	HCPCS C1725		Catheter Blndil 2.5mm Strl Lf 10mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220049	EAP	HCPCS C1725		Catheter Blndil 2.5mm Strl Lf 12mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220050	EAP	HCPCS C1725		Catheter Blndil 2.5mm Strl Lf 16mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220051	EAP	HCPCS C1725		Catheter Blndil 2.5mm Strl Lf 18mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220052	EAP	HCPCS C1725		Catheter Blndil 2.75mm Strl Lf 8mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220053	EAP	HCPCS C1725		Catheter Blndil 2.75mm Strl Lf 10mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220054	EAP	HCPCS C1725		Catheter Blndil 2.75mm Strl Lf 12mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220055	EAP	HCPCS C1725		Catheter Blndil 2.75mm Strl Lf 15mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220056	EAP	HCPCS C1725		Catheter Blndil 2.75mm Strl Lf 18mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220057	EAP	HCPCS C1725		Catheter Blndil 3mm Strl Lf 8mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220058	EAP	HCPCS C1725		Catheter Blndil 3mm Strl Lf 10mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220059	EAP	HCPCS C1725		Catheter Blndil 3mm Strl Lf 12mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220060	EAP	HCPCS C1725		Catheter Blndil 3mm Strl Lf 15mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220061	EAP	HCPCS C1725		Catheter Blndil 3mm Strl Lf 18mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220062	EAP	HCPCS C1725		Catheter Blndil 3.25mm Strl Lf 8mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220063	EAP	HCPCS C1725		Catheter Blndil 3.25mm Strl Lf 10mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220064	EAP	HCPCS C1725		Catheter Blndil 3.25mm Strl Lf 12mm Sphr Ii Pro Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220065	EAP	HCPCS C1725		Catheter Blndil 3.25mm Strl Lf 15mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220066	EAP	HCPCS C1725		Catheter Blndil 3.25mm Strl Lf 18mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220067	EAP	HCPCS C1725		Catheter Blndil 3.5mm Strl Lf 8mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220068	EAP	HCPCS C1725		Catheter Blndil 3.5mm Strl Lf 10mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220069	EAP	HCPCS C1725		Catheter Blndil 3.5mm Strl Lf 12mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220070	EAP	HCPCS C1725		Catheter Blndil 3.5mm Strl Lf 15mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220071	EAP	HCPCS C1725		Catheter Blndil 3.5mm Strl Lf 18mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220072	EAP	HCPCS C1725		Catheter Blndil 3.75mm Ns Lf 8mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220073	EAP	HCPCS C1725		Catheter Blndil 3.75mm Strl Lf 10mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220074	EAP	HCPCS C1725		Catheter Blndil 3.75mm Strl Lf 12mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220075	EAP	HCPCS C1725		Catheter Blndil 3.75mm Strl Lf 15mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220076	EAP	HCPCS C1725		Catheter Blndil 3.75mm Strl Lf 18mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220077	EAP	HCPCS C1725		Catheter Blndil 4mm Strl Lf 8mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220078	EAP	HCPCS C1725		Catheter Blndil 4mm Strl Lf 10mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220079	EAP	HCPCS C1725		Catheter Blndil 4mm Strl Lf 12mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220080	EAP	HCPCS C1725		Catheter Blndil 4mm Strl Lf 15mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220081	EAP	HCPCS C1725		Catheter Blndil 4mm Strl Lf 18mm Sphr Nc + Ptca	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
27220082	EAP	HCPCS C1757		Catheter Asp .082-.085in .071in 115cm Axs Vecta 71 Scout	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220083	EAP	HCPCS C1757		Catheter Asp .082-.085in .071in 125cm Axs Vecta 71 Scout	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,665.25"	"$3,665.25"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	"$5,202.90"	$0.00	"$1,406.70"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00	"$4,387.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220084	EAP	HCPCS C1757		Cath Thromb Axs Vecta 71 2-4 Mm L132 Cm L150 Cm Od.082-.085	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,665.25"	"$3,665.25"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	"$5,202.90"	$0.00	"$1,406.70"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00	"$4,387.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220085	EAP	HCPCS C1730		"Cath, Ep, 5-5-5mm Spc Cs Lt Crv 6fr 65cm Rspn Mp Dcapl Fx"	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.00	$102.96	$104.00	$0.00	$0.00	$0.00	$20.35	$0.00	$0.00	$20.70	$0.00	$0.00	$0.00	$0.00	$0.00
27220086	EAP	HCPCS C1730		"Cath, Ep, 5-5-5-5-5mm Spc Crnnd 2 Crv 5fr 115cm Strbl 8"	BOTH IP/OP	$365.00 	$270.10	$0.00	$292.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.50	$289.08	$292.00	$0.00	$0.00	$0.00	$57.12	$0.00	$0.00	$58.11	$0.00	$0.00	$0.00	$0.00	$0.00
27220087	EAP	HCPCS C1730		"Cath, Ep, 2-10-2mm Spc Sup Lg Curl Crv 7fr 95cm 2mm Lvwr"	BOTH IP/OP	$804.00 	$594.96	$0.00	$643.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$402.00	$636.77	$643.20	$0.00	$0.00	$0.00	$125.83	$0.00	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220088	EAP	HCPCS C1730		Catheter Ep 5mm Spc Crnnd Crv 5fr 120cm Rspn Qdpl	BOTH IP/OP	$98.00 	$72.52	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.00	$77.62	$78.40	$0.00	$0.00	$0.00	$15.34	$0.00	$0.00	$15.60	$0.00	$0.00	$0.00	$0.00	$0.00
27220089	EAP	HCPCS C1730		"Cath, Ep, 5mm Spacing Jsn Curve 5fr 120cm"	BOTH IP/OP	$98.00 	$72.52	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.00	$77.62	$78.40	$0.00	$0.00	$0.00	$15.34	$0.00	$0.00	$15.60	$0.00	$0.00	$0.00	$0.00	$0.00
27220090	EAP			Cable Cath 150cm Blk Rspn Hexpl Octpl Dcapl Ep Repro	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.48	$73.48	$76.31	$0.00	$20.63	$0.00	$0.00	$0.00	$0.00	$49.50	$78.41	$79.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220091	EAP			Catheter Ep 150cm Rspn Lvwr Hexpl Octpl Dcapl	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.48	$73.48	$76.31	$0.00	$20.63	$0.00	$0.00	$0.00	$0.00	$49.50	$78.41	$79.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220092	EAP			Cable Cath Xtn Sjm Gntr	BOTH IP/OP	$222.00 	$164.28	$0.00	$177.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.77	$164.77	$171.12	$0.00	$46.26	$0.00	$0.00	$0.00	$0.00	$111.00	$175.82	$177.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220093	EAP	HCPCS C1894		Introducer Sheath .038in Large 18fr 30cm 42cm Radiopq Band	BOTH IP/OP	$318.00 	$235.32	$0.00	$254.40	$172.67	$172.67	$0.00	$0.00	$0.00	$66.28	$236.02	$236.02	$245.11	$0.00	$66.27	$0.00	$188.10	$188.10	$0.00	$159.00	$251.86	$254.40	$0.00	$0.00	$0.00	$49.77	$0.00	$0.00	$50.63	$0.00	$0.00	$0.00	$0.00	$0.00
27220094	EAP			Catheter Angio Chuang 2.5 Crv 5fr 80cm Trnb Ad Bcntp Mp Ss	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.31	$232.31	$241.26	$0.00	$65.23	$0.00	$0.00	$0.00	$0.00	$156.50	$247.90	$250.40	$0.00	$203.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220095	EAP			Ft Retraction Aspirator Device Se	BOTH IP/OP	"$3,238.00 "	"$2,396.12"	$0.00	"$2,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,403.24"	"$2,403.24"	"$2,495.85"	$0.00	$674.80	$0.00	$0.00	$0.00	$0.00	"$1,619.00"	"$2,564.50"	"$2,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220096	EAP			Flowtriever Bundle	BOTH IP/OP	"$22,500.00 "	"$16,650.00"	$0.00	"$18,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,343.00"	$0.00	"$4,689.00"	$0.00	$0.00	$0.00	$0.00	"$11,250.00"	"$17,820.00"	"$18,000.00"	$0.00	"$14,625.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220097	EAP			Tube Nasogastric 10fr 1.22mr 24 Port Vented Vinyl Pediatric	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.46	$27.46	$28.52	$0.00	$7.71	$0.00	$0.00	$0.00	$0.00	$18.50	$29.30	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220098	EAP			Tube Ng 8fr 36in Lf Entflx Fd Sty Y St	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00	$17.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220099	EAP			Cuff Blood Pressure Clearsight Small Finger	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$481.75	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220100	EAP			Cuff Blood Pressure Clearsight Medium Finger	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$481.75	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220101	EAP			Cuff Blood Pressure Clearsight Large Finger	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$481.75	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220102	EAP			Powermidline Catheter Max Barrier Tray 4f Sl	BOTH IP/OP	$333.00 	$246.42	$0.00	$266.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.50	$263.74	$266.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220103	EAP			Central Line 10cm 18g Basic	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.62	$107.62	$111.77	$0.00	$30.22	$0.00	$0.00	$0.00	$0.00	$72.50	$114.84	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220104	EAP			Central Line 10cm 18g Full	BOTH IP/OP	$238.00 	$176.12	$0.00	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.64	$176.64	$183.45	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$119.00	$188.50	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220105	EAP			Central Line 8cm 18g Basic	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.62	$107.62	$111.77	$0.00	$30.22	$0.00	$0.00	$0.00	$0.00	$72.50	$114.84	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220106	EAP			Central Line 8cm 18g Full	BOTH IP/OP	$238.00 	$176.12	$0.00	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.64	$176.64	$183.45	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$119.00	$188.50	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220107	EAP			Soehendra Biliary Dilation Catheter	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.96	$146.96	$152.62	$0.00	$41.26	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00	$128.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220108	EAP			Spybite Biopsy Forceps	BOTH IP/OP	"$1,338.00 "	$990.12	$0.00	"$1,070.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$993.06	$993.06	"$1,031.33"	$0.00	$278.84	$0.00	$0.00	$0.00	$0.00	$669.00	"$1,059.70"	"$1,070.40"	$0.00	$869.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220109	EAP			Pancreatic Stent 5fr	BOTH IP/OP	$115.00 	$85.10	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.35	$85.35	$88.64	$0.00	$23.97	$0.00	$0.00	$0.00	$0.00	$57.50	$91.08	$92.00	$0.00	$74.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220110	EAP			Ligating Device	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$169.58	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220111	EAP			Echotip Procore Biopsy Needle	BOTH IP/OP	"$1,013.00 "	$749.62	$0.00	$810.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$751.85	$751.85	$780.82	$0.00	$211.11	$0.00	$0.00	$0.00	$0.00	$506.50	$802.30	$810.40	$0.00	$658.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220112	EAP			Misc Central Line Supply	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$169.58	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220113	EAP	HCPCS C1726		Catheter Blndil 5mm 135cm 20mm Pr Ctbln Otw Tpr Tip Infl	BOTH IP/OP	"$1,759.00 "	"$1,301.66"	$0.00	"$1,407.20"	$955.14	$955.14	$0.00	$0.00	$0.00	$366.62	"$1,305.53"	"$1,305.53"	"$1,355.84"	$0.00	$366.58	$0.00	"$1,040.45"	"$1,040.45"	$0.00	$879.50	"$1,393.13"	"$1,407.20"	$0.00	$0.00	$0.00	$275.28	$0.00	$0.00	$280.03	$0.00	$0.00	$0.00	$0.00	$0.00
27220114	EAP	HCPCS C1753		Catheter Baldilat Lp 5.3fr 4mm 135cm 60mm High Pressure	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$251.41	$251.41	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$356.88	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.70	$370.40	$0.00	$0.00	$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
27220117	EAP	HCPCS C1887		Catheter Axs Catalyst 7 .068 Id X132cm	BOTH IP/OP	"$5,288.00 "	"$3,913.12"	$0.00	"$4,230.40"	"$2,871.38"	"$2,871.38"	$0.00	$0.00	$0.00	"$1,102.15"	"$3,924.75"	"$3,924.75"	"$4,075.99"	$0.00	"$1,102.02"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,644.00"	"$4,188.10"	"$4,230.40"	$0.00	"$3,437.20"	$0.00	$827.57	$0.00	$0.00	$841.85	$0.00	$0.00	$0.00	$0.00	$0.00
27220118	EAP	HCPCS C1887		Catheter Axs Catalyst 7 .068 Id X125cm	BOTH IP/OP	"$5,288.00 "	"$3,913.12"	$0.00	"$4,230.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,644.00"	"$4,188.10"	"$4,230.40"	$0.00	$0.00	$0.00	$827.57	$0.00	$0.00	$841.85	$0.00	$0.00	$0.00	$0.00	$0.00
27220119	EAP	HCPCS C1887		Catheter Axs Catalyst 7 .068 Id X115cm	BOTH IP/OP	"$5,288.00 "	"$3,913.12"	$0.00	"$4,230.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,644.00"	"$4,188.10"	"$4,230.40"	$0.00	$0.00	$0.00	$827.57	$0.00	$0.00	$841.85	$0.00	$0.00	$0.00	$0.00	$0.00
27220120	EAP	HCPCS C1751		"Kit Triple Lumen Cvc, 7fr 20 Cm"	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$195.48	$195.48	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$277.49	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00	$234.00	$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
27220121	EAP	HCPCS C1751		Misc Swan Ganz Catheter	BOTH IP/OP	$700.00 	$518.00	$0.00	$560.00	$380.10	$380.10	$0.00	$0.00	$0.00	$145.90	$519.54	$519.54	$539.56	$0.00	$145.88	$0.00	$414.05	$414.05	$0.00	$350.00	$554.40	$560.00	$0.00	$0.00	$0.00	$109.55	$0.00	$0.00	$111.44	$0.00	$0.00	$0.00	$0.00	$0.00
27220122	EAP	Custom 27220122		Catheter Urethral 8fr Foley 2 Way Latex Dover Silicone	BOTH IP/OP	$107.00 	$79.18	$0.00	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.42	$79.42	$82.48	$0.00	$22.30	$0.00	$0.00	$0.00	$0.00	$53.50	$84.74	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220123	EAP	Custom 27220123		Dressing Wound Square 6x6in 2 Layer Absorbent Nonwoven Soft	BOTH IP/OP	$56.00 	$41.44	$0.00	$44.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.56	$41.56	$43.16	$0.00	$11.67	$0.00	$0.00	$0.00	$0.00	$28.00	$44.35	$44.80	$0.00	$36.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220124	EAP	Custom 27220124		Tray Spnl 20ga 3.5in Strl Lf 3 Spng Stk Prp Well Bndg Adlt	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$31.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220125	EAP	Custom 27220125		Tray Spnl 22ga 1.5in 10ml Strl Spec Vl Prenumber Cap Pt Id	BOTH IP/OP	$44.00 	$32.56	$0.00	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.66	$32.66	$33.92	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220126	EAP	Custom 27220126		Dressing Burn 36x36in 17 Ply Gauze	BOTH IP/OP	$824.00 	$609.76	$0.00	$635.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.57	$611.57	$635.14	$0.00	$171.72	$0.00	$0.00	$0.00	$0.00	$20.50	$32.47	$32.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220127	EAP	Custom 27220127		Bandage Compression 10ydx4in 5ydx4in 1 Self Adherent Elast	BOTH IP/OP	$26.00 	$19.24	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.30	$19.30	$20.04	$0.00	$5.42	$0.00	$0.00	$0.00	$0.00	$13.00	$20.59	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220129	EAP	Custom 27220129		Valve Drn Sm 30ml Pnmst Grad Grmnt Atch Mlt Chst Tube Cnct	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.95	$51.95	$53.96	$0.00	$14.59	$0.00	$0.00	$0.00	$0.00	$35.00	$55.44	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220130	EAP	Custom 27220130		Dressing Prfy H2o Calcium Alg Na Cmc Gntl Dbrd	BOTH IP/OP	$31.00 	$22.94	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.01	$23.01	$23.89	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.50	$24.55	$24.80	$0.00	$20.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220131	EAP	Custom 27220131		Dressing Biatain Ag 4x4in 1 Pc Rem Abs Wnd Alg	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00	$17.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220132	EAP	Custom 27220132		Dressing Brn 48x4in Strl Lf Actct Flx 3 Anmc Brr 1 Lyr Knit	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220133	EAP	Custom 27220133		Dressing Wnd 8x8in Medihoney Abs Lght Ddrgl Clld Sht	BOTH IP/OP	$67.00 	$49.58	$0.00	$53.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.73	$49.73	$51.64	$0.00	$13.96	$0.00	$0.00	$0.00	$0.00	$33.50	$53.06	$53.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220134	EAP	Custom 27220134		Gel Drsg Lf Medihoney Tub 400gm	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220135	EAP	Custom 27220135		Tray Dressing Cardinal Central Line  Grady Custom	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$27.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220136	EAP			Pack Srg Crd Cath Haz	BOTH IP/OP	$173.00 	$128.02	$0.00	$138.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.50	$137.02	$138.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220137	EAP			Device Inflat 12fr 3in Pressure Gauge Latex Free Encore 26	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.77	$69.77	$72.46	$0.00	$19.59	$0.00	$0.00	$0.00	$0.00	$47.00	$74.45	$75.20	$0.00	$61.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220138	EAP			Device Cmpr Lg 29cm Tr Band 2 Bln Trns Adj Strap Air Trtn	BOTH IP/OP	$83.00 	$61.42	$0.00	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.60	$61.60	$63.98	$0.00	$17.30	$0.00	$0.00	$0.00	$0.00	$41.50	$65.74	$66.40	$0.00	$53.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220139	EAP			Umbilical Catheter 3.5	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.09	$63.09	$65.52	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00	$55.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220140	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 25mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220141	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 30mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220142	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 38mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220143	EAP	HCPCS C1725		Catheter Baldilat 4mm 142cm 9mm Rapex Elongate Tip	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220144	EAP	HCPCS C1725		Catheter Baldilat 4mm 142cm 14mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220145	EAP	HCPCS C1725		Catheter Baldilat 4mm 142cm 17mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220146	EAP	HCPCS C1725		Catheter Baldilat 4mm 142cm 20mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220147	EAP	HCPCS C1725		Catheter Baldilat 4mm 142cm 30mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220148	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 142cm 9mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220149	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 142cm 14mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220150	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 142cm 17mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220151	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 142cm 20mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220152	EAP	HCPCS C1725		Catheter Baldilat 2mm 139cm 6mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220153	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 139cm 6mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220154	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 6mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220155	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 139cm 6mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220156	EAP	HCPCS C1725		Catheter Baldilat 3mm 139cm 6mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220157	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 139cm 6mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220158	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 139cm 6mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220159	EAP	HCPCS C1725		Catheter Baldilat 4mm 139cm 6mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220160	EAP	HCPCS C1725		Catheter Baldilat 2mm 139cm 10mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220161	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 139cm 10mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220162	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 10mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220163	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 139cm 10mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220164	EAP	HCPCS C1725		Catheter Baldilat 3mm 139cm 10mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220165	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 139cm 10mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220166	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 139cm 10mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220167	EAP	HCPCS C1725		Catheter Baldilat 3.75mm 139cm 10mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220168	EAP	HCPCS C1725		Catheter Baldilat 4mm 139cm 10mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220169	EAP	HCPCS C1725		Catheter Baldilat 2mm 139cm 12mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220170	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 139cm 12mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220171	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 12mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220172	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 139cm 12mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220173	EAP	HCPCS C1725		Catheter Baldilat 3mm 139cm 12mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220174	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 139cm 12mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220175	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 139cm 12mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220176	EAP	HCPCS C1725		Catheter Baldilat 3.75mm 139cm 12mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220177	EAP	HCPCS C1725		Catheter Baldilat 4mm 139cm 12mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220178	EAP	HCPCS C1725		Catheter Baldilat 2mm 139cm 15mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220179	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 139cm 15mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220180	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 15mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220181	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 139cm 15mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220182	EAP	HCPCS C1725		Catheter Baldilat 3mm 139cm 15mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220183	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 139cm 15mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220184	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 139cm 15mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220185	EAP	HCPCS C1725		Catheter Baldilat 3.75mm 139cm 15mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220186	EAP	HCPCS C1725		Catheter Baldilat 4mm 139cm 15mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220187	EAP	HCPCS C1725		Catheter Baldilat 2mm 139cm 20mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220188	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 139cm 20mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220189	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 20mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220190	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 139cm 20mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220191	EAP	HCPCS C1725		Catheter Baldilat 3mm 139cm 20mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220192	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 139cm 20mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220193	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 139cm 20mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220194	EAP	HCPCS C1725		Catheter Baldilat 3.75mm 139cm 20mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220195	EAP	HCPCS C1725		Catheter Baldilat 4mm 139cm 20mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220196	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 139cm 25mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220197	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 25mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220198	EAP	HCPCS C1725		Catheter Baldilat 3mm 139cm 25mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220199	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 139cm 25mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220200	EAP	HCPCS C1725		Catheter Baldilat 4mm 139cm 25mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220201	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 30mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220202	EAP	HCPCS C1725		Catheter Baldilat 3mm 139cm 30mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220203	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 139cm 30mm Rapex Post Dil	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220204	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 139cm 6mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220205	EAP	HCPCS C1725		Catheter Baldilat 2mm 139cm 6mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220206	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 139cm 6mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220207	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 6mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220208	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 139cm 10mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220209	EAP	HCPCS C1725		Catheter Baldilat 2mm 139cm 10mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220210	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 139cm 10mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220211	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 10mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220212	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 139cm 10mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220213	EAP	HCPCS C1725		Catheter Baldilat 3mm 139cm 10mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220214	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 139cm 10mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220215	EAP	HCPCS C1725		Catheter Baldilat 4mm 139cm 10mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220216	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 139cm 12mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220217	EAP	HCPCS C1725		Catheter Baldilat 2mm 139cm 12mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220218	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 139cm 12mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220219	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 12mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220220	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 139cm 12mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220221	EAP	HCPCS C1725		Catheter Baldilat 3mm 139cm 12mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220222	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 139cm 12mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220223	EAP	HCPCS C1725		Catheter Baldilat 4mm 139cm 12mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220224	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 139cm 15mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220225	EAP	HCPCS C1725		Catheter Baldilat 2mm 139cm 15mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220226	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 139cm 15mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220227	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 15mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220228	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 139cm 15mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220229	EAP	HCPCS C1725		Catheter Baldilat 3mm 139cm 15mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220230	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 139cm 15mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220231	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 139cm 15mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220232	EAP	HCPCS C1725		Catheter Baldilat 3.75mm 139cm 15mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220233	EAP	HCPCS C1725		Catheter Baldilat 4mm 139cm 15mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220234	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 139cm 20mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220235	EAP	HCPCS C1725		Catheter Baldilat 2mm 139cm 20mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220236	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 139cm 20mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220237	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 20mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220238	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 139cm 20mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220239	EAP	HCPCS C1725		Catheter Baldilat 3mm 139cm 20mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220240	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 139cm 20mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220241	EAP	HCPCS C1725		Catheter Baldilat 3.75mm 139cm 20mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220242	EAP	HCPCS C1725		Catheter Baldilat 4mm 139cm 20mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220243	EAP	HCPCS C1725		Catheter Baldilat 2mm 139cm 30mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220244	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 139cm 30mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220245	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 139cm 30mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220246	EAP	HCPCS C1725		Catheter Baldilat 3mm 139cm 30mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220247	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 139cm 30mm Rapex	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
27220248	EAP	HCPCS C1725		Catheter Baldilat 2mm 8mm Mozec Ptca	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220249	EAP	HCPCS C1725		Catheter Baldilat 2mm 10mm Mozec Ptca	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220250	EAP	HCPCS C1725		Catheter Baldilat 2mm 142cm 13mm Rapex Radiopq Nc	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220251	EAP	HCPCS C1725		Catheter Baldilat 2mm 15mm Mozec Ptca	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220252	EAP	HCPCS C1725		Catheter Baldilat 2mm 18mm Mozec Ptca	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220253	EAP	HCPCS C1725		Catheter Baldilat 2mm 23mm Mozec Ptca	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220254	EAP	HCPCS C1725		Catheter Baldilat 2mm 28mm Mozec Ptca	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220255	EAP	HCPCS C1725		Catheter Baldilat 2mm 35mm Mozec Ptca	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220256	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 142cm 8mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220257	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 142cm 10mm Rapex Nyl	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220258	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 142cm 13mm Rapex Nyl	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220259	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 142cm 15mm Rapex Nyl	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220260	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 142cm 18mm Rapex Nyl	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220261	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 142cm 23mm Rapex Nyl	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220262	EAP	HCPCS C1725		Catheter Baldilat 2.5mm Rapex Latex Free Crds	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220263	EAP	HCPCS C1725		Catheter Baldilat 2.5mm Rapex Latex Free Crds	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220264	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 10mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220265	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 13mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220266	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 15mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220267	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 18mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220268	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 23mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220269	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 28mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220270	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 142cm 8mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220271	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 142cm 10mm Rapex Nyl	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220272	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 142cm 13mm Rapex Nyl	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220273	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 142cm 15mm Rapex Nyl	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220274	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 142cm 18mm Rapex Nyl	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220275	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 142cm 23mm Rapex Nyl	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220276	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 142cm 28mm Rapex Nyl	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220277	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 8mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220278	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 10mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220279	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 13mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220280	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 15mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220281	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 18mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220282	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 23mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220283	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 28mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220284	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 8mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220285	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 10mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220286	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 13mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220287	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 15mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220288	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 18mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220289	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 23mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220290	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 28mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220291	EAP	HCPCS C1725		Catheter Baldilat 4mm 142cm 8mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220292	EAP	HCPCS C1725		Catheter Baldilat 4mm 142cm 10mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220293	EAP	HCPCS C1725		Catheter Baldilat 4mm 142cm 13mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220294	EAP	HCPCS C1725		Catheter Baldilat 4mm 142cm 15mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220295	EAP	HCPCS C1725		Catheter Baldilat 4mm 142cm 18mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220296	EAP	HCPCS C1725		Catheter Baldilat 4mm 142cm 23mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220297	EAP	HCPCS C1725		Catheter Baldilat 4mm 142cm 28mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220298	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 142cm 8mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220299	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 142cm 10mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220300	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 142cm 13mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220301	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 142cm 15mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220302	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 142cm 18mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220303	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 142cm 23mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220304	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 142cm 28mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220305	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 142cm 35mm Rapex Nyl Mozec	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220306	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 142cm 9mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220307	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 142cm 12mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220308	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 142cm 15mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220309	EAP	HCPCS C1725		Catheter Baldilat 2mm 142cm 9mm Rapex Elongate Tip	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220310	EAP	HCPCS C1725		Catheter Baldilat 2mm 142cm 12mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220311	EAP	HCPCS C1725		Catheter Baldilat 2mm 142cm 15mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220312	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 142cm 9mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220313	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 142cm 14mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220314	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 142cm 17mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220315	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 142cm 20mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220316	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 9mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220317	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 14mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220318	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 17mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220319	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 20mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220320	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 25mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220321	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 30mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220322	EAP	HCPCS C1725		Catheter Baldilat 2.2mm 38mm Mozec Ptca	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220323	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 142cm 41mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220324	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 142cm 9mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220325	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 142cm 14mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220326	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 142cm 17mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220327	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 142cm 20mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220328	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 9mm Rapex Elongate Tip	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220329	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 14mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220330	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 17mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220331	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 20mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220332	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 25mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220333	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 30mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220334	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 38mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220335	EAP	HCPCS C1725		Catheter Baldilat 3mm 142cm 41mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220336	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 9mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220337	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 14mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220338	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 17mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220339	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 142cm 20mm Rapex Elongate	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
27220340	EAP	HCPCS C1725		Catheter Angiographic Angle 5fr .047in 65cm 25cm 1 Braid	BOTH IP/OP	$123.00 	$91.02	$0.00	$98.40	$66.79	$66.79	$0.00	$0.00	$0.00	$25.64	$91.29	$91.29	$94.81	$0.00	$25.63	$0.00	$72.75	$72.75	$0.00	$61.50	$97.42	$98.40	$0.00	$79.95	$0.00	$19.25	$0.00	$0.00	$19.58	$0.00	$0.00	$0.00	$0.00	$0.00
27220341	EAP	HCPCS C1887		Catheter Intvn 900- Psi 2.2-2.9fr 6- Mm .02in 110	BOTH IP/OP	"$2,488.00 "	"$1,841.12"	$0.00	"$1,990.40"	"$1,350.98"	"$1,350.98"	$0.00	$0.00	$0.00	$518.56	"$1,846.59"	"$1,846.59"	"$1,917.75"	$0.00	$518.50	$0.00	"$1,471.65"	"$1,471.65"	$0.00	"$1,244.00"	"$1,970.50"	"$1,990.40"	$0.00	$0.00	$0.00	$389.37	$0.00	$0.00	$396.09	$0.00	$0.00	$0.00	$0.00	$0.00
27220342	EAP	HCPCS C1887		Catheter Blnocc 900- Psi 2.2-2.9fr 6- Mm .02in 130	BOTH IP/OP	"$2,488.00 "	"$1,841.12"	$0.00	"$1,990.40"	"$1,350.98"	"$1,350.98"	$0.00	$0.00	$0.00	$518.56	"$1,846.59"	"$1,846.59"	"$1,917.75"	$0.00	$518.50	$0.00	"$1,471.65"	"$1,471.65"	$0.00	"$1,244.00"	"$1,970.50"	"$1,990.40"	$0.00	"$1,617.20"	$0.00	$389.37	$0.00	$0.00	$396.09	$0.00	$0.00	$0.00	$0.00	$0.00
27220343	EAP	HCPCS C1887		Catheter Blnocc 900- Psi 2.2-2.9fr 6- Mm .02in 150	BOTH IP/OP	"$2,488.00 "	"$1,841.12"	$0.00	"$1,990.40"	"$1,350.98"	"$1,350.98"	$0.00	$0.00	$0.00	$518.56	"$1,846.59"	"$1,846.59"	"$1,917.75"	$0.00	$518.50	$0.00	"$1,471.65"	"$1,471.65"	$0.00	"$1,244.00"	"$1,970.50"	"$1,990.40"	$0.00	$0.00	$0.00	$389.37	$0.00	$0.00	$396.09	$0.00	$0.00	$0.00	$0.00	$0.00
27220344	EAP	HCPCS C1887		Catheter Infus 110cm 2 Lum Ang Tip Radiopq Gwire	BOTH IP/OP	"$2,488.00 "	"$1,841.12"	$0.00	"$1,990.40"	"$1,350.98"	"$1,350.98"	$0.00	$0.00	$0.00	$518.56	"$1,846.59"	"$1,846.59"	"$1,917.75"	$0.00	$518.50	$0.00	"$1,471.65"	"$1,471.65"	$0.00	"$1,244.00"	"$1,970.50"	"$1,990.40"	$0.00	$0.00	$0.00	$389.37	$0.00	$0.00	$396.09	$0.00	$0.00	$0.00	$0.00	$0.00
27220345	EAP	HCPCS C1887		Catheter Infus 130cm 2 Lum Ang Tip Radiopq Gwire	BOTH IP/OP	"$2,488.00 "	"$1,841.12"	$0.00	"$1,990.40"	"$1,350.98"	"$1,350.98"	$0.00	$0.00	$0.00	$518.56	"$1,846.59"	"$1,846.59"	"$1,917.75"	$0.00	$518.50	$0.00	"$1,471.65"	"$1,471.65"	$0.00	"$1,244.00"	"$1,970.50"	"$1,990.40"	$0.00	$0.00	$0.00	$389.37	$0.00	$0.00	$396.09	$0.00	$0.00	$0.00	$0.00	$0.00
27220346	EAP	HCPCS C1887		Catheter Infus 150cm 2 Lum Ang Tip Radiopq Gwire	BOTH IP/OP	"$2,488.00 "	"$1,841.12"	$0.00	"$1,990.40"	"$1,350.98"	"$1,350.98"	$0.00	$0.00	$0.00	$518.56	"$1,846.59"	"$1,846.59"	"$1,917.75"	$0.00	$518.50	$0.00	"$1,471.65"	"$1,471.65"	$0.00	"$1,244.00"	"$1,970.50"	"$1,990.40"	$0.00	$0.00	$0.00	$389.37	$0.00	$0.00	$396.09	$0.00	$0.00	$0.00	$0.00	$0.00
27220347	EAP	HCPCS C1887		Catheter Angio Jl 4 Crv 5fr .047in 100cm Infnt Thrlmn Radopq	BOTH IP/OP	$97.00 	$71.78	$0.00	$77.60	$52.67	$52.67	$0.00	$0.00	$0.00	$20.22	$71.99	$71.99	$74.77	$0.00	$20.21	$0.00	$57.38	$57.38	$0.00	$48.50	$76.82	$77.60	$0.00	$63.05	$0.00	$15.18	$0.00	$0.00	$15.44	$0.00	$0.00	$0.00	$0.00	$0.00
27220348	EAP	HCPCS C1887		Catheter Angio Al 1 Crv 6fr 100cm Infnt Lt Cor	BOTH IP/OP	$97.00 	$71.78	$0.00	$77.60	$52.67	$52.67	$0.00	$0.00	$0.00	$20.22	$71.99	$71.99	$74.77	$0.00	$20.21	$0.00	$57.38	$57.38	$0.00	$48.50	$76.82	$77.60	$0.00	$63.05	$0.00	$15.18	$0.00	$0.00	$15.44	$0.00	$0.00	$0.00	$0.00	$0.00
27220349	EAP			Kit Picc Dressing Change Tray 215	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$29.50	$46.73	$47.20	$0.00	$38.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27220352	EAP	HCPCS C1769		Guidewire Vasc 90d 60d 2cm .018in 180cm 25cm Gldwr Gt Tip	BOTH IP/OP	$393.00 	$290.82	$0.00	$314.40	$213.40	$213.40	$0.00	$0.00	$0.00	$81.91	$291.68	$291.68	$302.92	$0.00	$81.90	$0.00	$232.46	$232.46	$0.00	$196.50	$311.26	$314.40	$0.00	$255.45	$0.00	$61.50	$0.00	$0.00	$62.57	$0.00	$0.00	$0.00	$0.00	$0.00
27220353	EAP			Device Inflat 12fr Pressure Gauge Encore 26 20ml	BOTH IP/OP	$367.00 	$271.58	$0.00	$293.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.39	$272.39	$282.88	$0.00	$76.48	$0.00	$0.00	$0.00	$0.00	$183.50	$290.66	$293.60	$0.00	$238.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27300022	EAP			Stocking Compression 20-30 Mmhg Large Bk Od15.5-18	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$31.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27300023	EAP			Stocking Compression 20-30 Mmhg X-large Bk Od17.5-20	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$31.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400001	EAP	HCPCS A5121		"Skin Barrier, Solid 6X6 or Equival"	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$16.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400002	EAP	HCPCS A5122		"Skin Barrier, Solid 8x8 Or Equivalent"	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$104.06	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00	$60.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400003	EAP	HCPCS L0170		Neck Ext. Splint	BOTH IP/OP	$94.00 	$69.56	$0.00	$556.60	$42.30	$42.30	$0.00	$0.00	$530.92	$556.60	$69.77	$69.77	$72.46	$0.00	$19.59	$0.00	$55.60	$55.60	$0.00	$47.00	$74.45	$75.20	$56.40	$42.30	$56.40	$529.98	$0.00	$0.00	$540.87	$0.00	$0.00	$0.00	$0.00	$0.00
27400004	EAP	HCPCS L0150		Cervical Collar	BOTH IP/OP	$202.00 	$149.48	$0.00	$161.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.92	$149.92	$155.70	$0.00	$42.10	$0.00	$0.00	$0.00	$0.00	$101.00	$159.98	$161.60	$121.20	$90.90	$121.20	$0.00	$0.00	$0.00	$89.77	$0.00	$0.00	$0.00	$0.00	$0.00
27400005	EAP	HCPCS L0172		Aspen Collar	BOTH IP/OP	$524.00 	$387.76	$0.00	$419.20	$235.80	$235.80	$0.00	$0.00	$0.00	$112.86	$388.91	$388.91	$403.90	$0.00	$109.20	$0.00	$309.95	$309.95	$0.00	$262.00	$415.01	$419.20	$314.40	$235.80	$314.40	$107.46	$0.00	$0.00	$109.67	$0.00	$0.00	$0.00	$0.00	$0.00
27400006	EAP	HCPCS L0174		Miami Collar	BOTH IP/OP	$938.00 	$694.12	$0.00	$750.40	$0.00	$0.00	$0.00	$0.00	$0.00	$202.73	$696.18	$696.18	$723.01	$0.00	$195.48	$0.00	$554.83	$554.83	$0.00	$469.00	$742.90	$750.40	$562.80	$422.10	$562.80	$193.04	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
27400007	EAP	HCPCS L0190		Somi Brace	BOTH IP/OP	"$1,827.00 "	"$1,351.98"	$0.00	"$1,461.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,356.00"	"$1,356.00"	"$1,408.25"	$0.00	$380.75	$0.00	$0.00	$0.00	$0.00	$913.50	"$1,446.98"	"$1,461.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400008	EAP	HCPCS L0200		Cervical Thoracic Orthosis(cto	BOTH IP/OP	"$1,679.00 "	"$1,242.46"	$0.00	"$1,343.20"	$755.55	$755.55	$0.00	$0.00	$363.53	$381.11	"$1,246.15"	"$1,246.15"	"$1,294.17"	$0.00	$349.90	$0.00	$993.13	$993.13	$0.00	$839.50	"$1,329.77"	"$1,343.20"	"$1,007.40"	$755.55	"$1,007.40"	$0.00	$0.00	$0.00	$370.34	$0.00	$0.00	$0.00	$0.00	$0.00
27400009	EAP	HCPCS L0450		Tlso Brace	BOTH IP/OP	$929.00 	$687.46	$0.00	$743.20	$418.05	$418.05	$0.00	$0.00	$122.60	$149.21	$689.50	$689.50	$716.07	$0.00	$193.60	$0.00	$549.50	$549.50	$0.00	$464.50	$735.77	$743.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400010	EAP	HCPCS L0472		Jewett Brace	BOTH IP/OP	"$1,496.00 "	"$1,107.04"	$0.00	"$1,196.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,110.33"	"$1,110.33"	"$1,153.12"	$0.00	$311.77	$0.00	$0.00	$0.00	$0.00	$748.00	"$1,184.83"	"$1,196.80"	$0.00	$673.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400011	EAP	HCPCS L0486		Custom To Fit Tlso	BOTH IP/OP	"$6,431.00 "	"$4,758.94"	$0.00	"$5,144.80"	"$2,893.95"	"$2,893.95"	$0.00	$0.00	"$1,327.28"	$0.00	"$4,181.12"	"$4,181.12"	"$4,957.01"	$0.00	"$1,340.22"	$0.00	$0.00	$0.00	$0.00	"$3,215.50"	"$5,093.35"	"$5,144.80"	"$3,858.60"	"$2,893.95"	"$3,858.60"	"$1,324.93"	$0.00	$0.00	"$1,352.17"	$0.00	$0.00	$0.00	$0.00	$0.00
27400012	EAP	HCPCS L0637		Lso Cybertech	BOTH IP/OP	"$4,041.00 "	"$2,990.34"	$0.00	"$3,232.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,999.23"	"$2,999.23"	"$3,114.80"	$0.00	$842.14	$0.00	$0.00	$0.00	$0.00	"$2,020.50"	"$3,200.47"	"$3,232.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400013	EAP	HCPCS L0638		Lso Brace	BOTH IP/OP	"$3,917.00 "	"$2,898.58"	$0.00	"$3,133.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,907.20"	"$2,907.20"	"$3,019.22"	$0.00	$816.30	$0.00	$0.00	$0.00	$0.00	"$1,958.50"	"$3,102.26"	"$3,133.60"	$0.00	"$1,762.65"	$0.00	$996.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400014	EAP	HCPCS L0700		Ctlso Brace	BOTH IP/OP	"$6,393.00 "	"$4,730.82"	$0.00	"$5,114.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,927.72"	$0.00	"$1,332.30"	$0.00	$0.00	$0.00	$0.00	"$3,196.50"	"$5,063.26"	"$5,114.40"	$0.00	"$2,876.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400015	EAP	HCPCS L1686		Hip Abduction Brace	BOTH IP/OP	"$4,383.00 "	"$3,243.42"	$0.00	"$3,506.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,253.06"	"$3,253.06"	"$3,378.42"	$0.00	$913.42	$0.00	$0.00	$0.00	$0.00	"$2,191.50"	"$3,471.34"	"$3,506.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400017	EAP	HCPCS L1830		Knee Immobilizer	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.36	$275.36	$285.97	$0.00	$77.32	$0.00	$0.00	$0.00	$0.00	$185.50	$293.83	$296.80	$0.00	$166.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400019	EAP	HCPCS L1940		Ankle Foot Orthosis	BOTH IP/OP	$345.00 	$255.30	$0.00	$394.54	$0.00	$0.00	$0.00	$0.00	$0.00	$394.54	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$207.00	$155.25	$207.00	$375.67	$0.00	$0.00	$383.39	$0.00	$0.00	$0.00	$0.00	$0.00
27400020	EAP	HCPCS L1834		Knee Ext. Splint	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.35	$180.35	$187.30	$0.00	$50.64	$0.00	$0.00	$0.00	$0.00	$121.50	$192.46	$194.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400021	EAP	HCPCS L3650		Shoulder Immobilizer	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.36	$275.36	$285.97	$0.00	$77.32	$0.00	$0.00	$0.00	$0.00	$185.50	$293.83	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400022	EAP	HCPCS L3670		Shoulder Abduction	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$103.47	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$229.50	$229.50	$0.00	$194.00	$307.30	$310.40	$0.00	$174.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400024	EAP	HCPCS L3702		Custom Elbow	BOTH IP/OP	$97.00 	$71.78	$0.00	$208.54	$43.65	$43.65	$0.00	$0.00	$198.92	$208.54	$71.99	$71.99	$74.77	$0.00	$20.21	$0.00	$57.38	$57.38	$0.00	$48.50	$76.82	$77.60	$58.20	$43.65	$58.20	$198.56	$0.00	$0.00	$202.65	$0.00	$0.00	$0.00	$0.00	$0.00
27400025	EAP	HCPCS L3967		Airplane Splint	BOTH IP/OP	$406.00 	$300.44	$0.00	"$1,392.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.33	$301.33	$312.94	$0.00	$84.61	$0.00	$0.00	$0.00	$0.00	$203.00	$321.55	$324.80	$243.60	$182.70	$243.60	$0.00	$0.00	$0.00	"$1,392.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27400026	EAP	HCPCS L3905		Dynamic Wrist Splint	BOTH IP/OP	$107.00 	$79.18	$0.00	$681.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.42	$79.42	$82.48	$0.00	$22.30	$0.00	$0.00	$0.00	$0.00	$53.50	$84.74	$85.60	$0.00	$48.15	$0.00	$681.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400027	EAP	HCPCS L3935		Any Finger Splint	BOTH IP/OP	$198.00 	$146.52	$0.00	$159.57	$89.10	$89.10	$0.00	$0.00	$152.21	$159.57	$146.96	$146.96	$152.62	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$118.80	$89.10	$118.80	$151.93	$0.00	$0.00	$155.06	$0.00	$0.00	$0.00	$0.00	$0.00
27400028	EAP	HCPCS L3808		Ulnar/radial Gutter	BOTH IP/OP	$69.00 	$51.06	$0.00	$247.75	$31.05	$31.05	$0.00	$0.00	$230.09	$247.75	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$40.81	$40.81	$0.00	$34.50	$54.65	$55.20	$41.40	$31.05	$41.40	$235.90	$0.00	$0.00	$240.75	$0.00	$0.00	$0.00	$0.00	$0.00
27400029	EAP	HCPCS L3906		Wrist Cockup Splint	BOTH IP/OP	$202.00 	$149.48	$0.00	$304.68	$90.90	$90.90	$0.00	$0.00	$290.61	$304.68	$149.92	$149.92	$155.70	$0.00	$42.10	$0.00	$119.48	$119.48	$0.00	$101.00	$159.98	$161.60	$121.20	$90.90	$121.20	$290.10	$0.00	$0.00	$296.07	$0.00	$0.00	$0.00	$0.00	$0.00
27400030	EAP	HCPCS L3925		SPRING WIRE ASSIST SPLINT PREFAB	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$36.39	$39.19	$144.73	$144.73	$150.31	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$117.00	$87.75	$117.00	$37.31	$0.00	$0.00	$38.08	$0.00	$0.00	$0.00	$0.00	$0.00
27400033	EAP	HCPCS L3671		Custom Humerus	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.72	$311.72	$323.74	$0.00	$87.53	$0.00	$0.00	$0.00	$0.00	$210.00	$332.64	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400034	EAP	HCPCS L3982		RESTING HAND SPLINT-CUSTOM	BOTH IP/OP	$214.00 	$158.36	$0.00	$275.84	$0.00	$0.00	$0.00	$0.00	$263.10	$275.84	$158.83	$158.83	$164.95	$0.00	$44.60	$0.00	$126.58	$126.58	$0.00	$107.00	$169.49	$171.20	$0.00	$96.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400038	EAP	HCPCS L3334		Heel Lift	BOTH IP/OP	$127.00 	$93.98	$0.00	$101.60	$57.15	$57.15	$0.00	$0.00	$28.88	$30.28	$94.26	$94.26	$97.89	$0.00	$26.47	$0.00	$75.12	$75.12	$0.00	$63.50	$100.58	$101.60	$0.00	$57.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400039	EAP	HCPCS L3710		Hinged Elbow Brace	BOTH IP/OP	$431.00 	$318.94	$0.00	$344.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.89	$319.89	$332.21	$0.00	$89.82	$0.00	$0.00	$0.00	$0.00	$215.50	$341.35	$344.80	$258.60	$193.95	$258.60	$99.70	$0.00	$0.00	$101.75	$0.00	$0.00	$0.00	$0.00	$0.00
27400040	EAP	HCPCS L3806		Dorsal Block Splint W/kleine	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$21.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400050	EAP	HCPCS L3913		Simple Hand Based Spl	BOTH IP/OP	$55.00 	$40.70	$0.00	$195.60	$24.75	$24.75	$0.00	$0.00	$186.59	$195.60	$40.82	$40.82	$42.39	$0.00	$11.46	$0.00	$32.53	$32.53	$0.00	$27.50	$43.56	$44.00	$33.00	$24.75	$33.00	$186.25	$0.00	$0.00	$190.08	$0.00	$0.00	$0.00	$0.00	$0.00
27400051	EAP	HCPCS L3808		Dorsal Block Splint	BOTH IP/OP	$34.00 	$25.16	$0.00	$247.75	$15.30	$15.30	$0.00	$0.00	$230.09	$247.75	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$20.11	$20.11	$0.00	$17.00	$26.93	$27.20	$20.40	$15.30	$20.40	$235.90	$0.00	$0.00	$240.75	$0.00	$0.00	$0.00	$0.00	$0.00
27400052	EAP	HCPCS L3931		Whfo Finger Exten W/wrist Supp	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.52	$93.52	$97.12	$0.00	$26.26	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400053	EAP	HCPCS L3807		Ball Splint/finger Abd Splint	BOTH IP/OP	$161.00 	$119.14	$0.00	$180.59	$0.00	$0.00	$0.00	$0.00	$0.00	$180.59	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$96.60	$72.45	$96.60	$171.95	$0.00	$0.00	$175.48	$0.00	$0.00	$0.00	$0.00	$0.00
27400054	EAP	HCPCS L3908		Canv/leath/ezy-on Wrist Splint	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$44.55	$44.55	$0.00	$0.00	$41.27	$43.26	$73.48	$73.48	$76.31	$0.00	$20.63	$0.00	$58.56	$58.56	$0.00	$49.50	$78.41	$79.20	$59.40	$44.55	$59.40	$41.19	$0.00	$0.00	$42.04	$0.00	$0.00	$0.00	$0.00	$0.00
27400055	EAP	HCPCS L3808		Gauntlet With Thumb Spica	BOTH IP/OP	$91.00 	$67.34	$0.00	$247.75	$40.95	$40.95	$0.00	$0.00	$230.09	$247.75	$67.54	$67.54	$70.14	$0.00	$18.96	$0.00	$53.83	$53.83	$0.00	$45.50	$72.07	$72.80	$54.60	$40.95	$54.60	$235.90	$0.00	$0.00	$240.75	$0.00	$0.00	$0.00	$0.00	$0.00
27400056	EAP	HCPCS L3807		Prefab Burn Splint	BOTH IP/OP	$349.00 	$258.26	$0.00	$279.20	$0.00	$0.00	$0.00	$0.00	$0.00	$180.59	$259.03	$259.03	$269.01	$0.00	$72.73	$0.00	$206.43	$206.43	$0.00	$174.50	$276.41	$279.20	$209.40	$157.05	$209.40	$171.95	$0.00	$0.00	$175.48	$0.00	$0.00	$0.00	$0.00	$0.00
27400057	EAP	HCPCS L3807		Spasticity Splint	BOTH IP/OP	$164.00 	$121.36	$0.00	$175.48	$73.80	$73.80	$0.00	$0.00	$59.92	$0.00	$121.72	$121.72	$126.41	$0.00	$34.18	$0.00	$0.00	$0.00	$0.00	$82.00	$129.89	$131.20	$98.40	$73.80	$98.40	$171.95	$0.00	$0.00	$175.48	$0.00	$0.00	$0.00	$0.00	$0.00
27400058	EAP	HCPCS L3763		Forearm Sarmiento	BOTH IP/OP	$195.00 	$144.30	$0.00	$926.06	$0.00	$0.00	$0.00	$0.00	$0.00	$926.06	$144.73	$144.73	$150.31	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$117.00	$87.75	$117.00	$881.77	$0.00	$0.00	$899.90	$0.00	$0.00	$0.00	$0.00	$0.00
27400059	EAP	HCPCS L3931		Whfo - Palmer	BOTH IP/OP	$312.00 	$230.88	$0.00	$249.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.57	$231.57	$240.49	$0.00	$65.02	$0.00	$0.00	$0.00	$0.00	$156.00	$247.10	$249.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400060	EAP	HCPCS L3808		Thumb Spica	BOTH IP/OP	$72.00 	$53.28	$0.00	$247.75	$32.40	$32.40	$0.00	$0.00	$230.09	$247.75	$53.44	$53.44	$55.50	$0.00	$15.00	$0.00	$42.59	$42.59	$0.00	$36.00	$57.02	$57.60	$43.20	$32.40	$43.20	$235.90	$0.00	$0.00	$240.75	$0.00	$0.00	$0.00	$0.00	$0.00
27400061	EAP	HCPCS L3808		Whfo Wr Gaunlet/thumb Spica	BOTH IP/OP	$185.00 	$136.90	$0.00	$247.75	$83.25	$83.25	$0.00	$0.00	$230.09	$247.75	$137.31	$137.31	$142.60	$0.00	$38.55	$0.00	$109.43	$109.43	$0.00	$92.50	$146.52	$148.00	$111.00	$83.25	$111.00	$235.90	$0.00	$0.00	$240.75	$0.00	$0.00	$0.00	$0.00	$0.00
27400062	EAP	HCPCS L3808		"Whfo,long Opponens No Attachme"	BOTH IP/OP	$65.00 	$48.10	$0.00	$247.75	$29.25	$29.25	$0.00	$0.00	$230.09	$247.75	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$32.50	$51.48	$52.00	$39.00	$0.00	$39.00	$235.90	$0.00	$0.00	$240.75	$0.00	$0.00	$0.00	$0.00	$0.00
27400066	EAP	HCPCS L3808		Safe Position Splint	BOTH IP/OP	$107.00 	$79.18	$0.00	$247.75	$48.15	$48.15	$0.00	$0.00	$230.09	$247.75	$79.42	$79.42	$82.48	$0.00	$22.30	$0.00	$63.29	$63.29	$0.00	$53.50	$84.74	$85.60	$64.20	$48.15	$64.20	$235.90	$0.00	$0.00	$240.75	$0.00	$0.00	$0.00	$0.00	$0.00
27400067	EAP	HCPCS L4398		Foam Foot Drop Stop-prefab	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.88	$34.88	$36.23	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00	$21.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400070	EAP	HCPCS L3808		Canv/leath/ezy-on Wrist Splint	BOTH IP/OP	$19.00 	$14.06	$0.00	$247.75	$8.55	$8.55	$0.00	$0.00	$230.09	$247.75	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$11.40	$0.00	$11.40	$235.90	$0.00	$0.00	$240.75	$0.00	$0.00	$0.00	$0.00	$0.00
27400071	EAP	HCPCS L3905		Forearm Based Outrigger	BOTH IP/OP	$160.00 	$118.40	$0.00	$681.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$123.33	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00	$72.00	$0.00	$681.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400078	EAP	HCPCS L1834		Knee Extension Splint(s/p Bka)	BOTH IP/OP	$215.00 	$159.10	$0.00	$172.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.57	$159.57	$165.72	$0.00	$44.81	$0.00	$0.00	$0.00	$0.00	$107.50	$170.28	$172.00	$0.00	$96.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400080	EAP	HCPCS L3807		Resting Hand Splint-prefab	BOTH IP/OP	$328.00 	$242.72	$0.00	$262.40	$0.00	$0.00	$0.00	$0.00	$0.00	$180.59	$243.44	$243.44	$252.82	$0.00	$68.36	$0.00	$194.01	$194.01	$0.00	$164.00	$259.78	$262.40	$196.80	$147.60	$196.80	$171.95	$0.00	$0.00	$175.48	$0.00	$0.00	$0.00	$0.00	$0.00
27400085	EAP	HCPCS L3921		Hand Based Outrigger	BOTH IP/OP	$118.00 	$87.32	$0.00	$231.97	$53.10	$53.10	$0.00	$0.00	$221.26	$231.97	$87.58	$87.58	$90.95	$0.00	$24.59	$0.00	$69.80	$69.80	$0.00	$59.00	$93.46	$94.40	$70.80	$53.10	$70.80	$220.87	$0.00	$0.00	$225.41	$0.00	$0.00	$0.00	$0.00	$0.00
27400086	EAP	HCPCS A4467		Posterior Elbow Splint-prefab	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$47.25	$47.25	$0.00	$0.00	$0.00	$0.00	$77.93	$77.93	$80.93	$0.00	$21.88	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00	$47.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400087	EAP	HCPCS L4396		Foot Drop Splint Prefab	BOTH IP/OP	$278.00 	$205.72	$0.00	$222.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.33	$206.33	$214.28	$0.00	$57.94	$0.00	$0.00	$0.00	$0.00	$139.00	$220.18	$222.40	$166.80	$125.10	$166.80	$126.82	$0.00	$0.00	$129.42	$0.00	$0.00	$0.00	$0.00	$0.00
27400090	EAP	HCPCS L1960		Foot Drop Splint-custom	BOTH IP/OP	$237.00 	$175.38	$0.00	$389.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.90	$175.90	$182.68	$0.00	$49.39	$0.00	$0.00	$0.00	$0.00	$118.50	$187.70	$189.60	$0.00	$106.65	$0.00	$389.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400091	EAP	HCPCS L3808		Resting Hand/volar Wrist Custom	BOTH IP/OP	$209.00 	$154.66	$0.00	$247.75	$94.05	$94.05	$0.00	$0.00	$230.09	$247.75	$155.12	$155.12	$161.10	$0.00	$43.56	$0.00	$123.62	$123.62	$0.00	$104.50	$165.53	$167.20	$125.40	$94.05	$125.40	$235.90	$0.00	$0.00	$240.75	$0.00	$0.00	$0.00	$0.00	$0.00
27400097	EAP	HCPCS L3931		Resting Hand Prefab Hand Rehab	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.70	$147.70	$153.39	$0.00	$41.47	$0.00	$0.00	$0.00	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400098	EAP	HCPCS L3808		CUSTOM RESTING HAND	BOTH IP/OP	$198.00 	$146.52	$0.00	$247.75	$89.10	$89.10	$0.00	$0.00	$230.09	$247.75	$146.96	$146.96	$152.62	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$118.80	$89.10	$118.80	$235.90	$0.00	$0.00	$240.75	$0.00	$0.00	$0.00	$0.00	$0.00
27400099	EAP	HCPCS L0810		Halo And Vest	BOTH IP/OP	"$7,045.00 "	"$5,213.30"	$0.00	"$5,636.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,430.29"	$0.00	"$1,468.18"	$0.00	$0.00	$0.00	$0.00	"$3,522.50"	"$5,579.64"	"$5,636.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400105	EAP	HCPCS L3808		Extensor Tendon Splint	BOTH IP/OP	$132.00 	$97.68	$0.00	$247.75	$59.40	$59.40	$0.00	$0.00	$230.09	$247.75	$97.97	$97.97	$101.75	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$79.20	$59.40	$79.20	$235.90	$0.00	$0.00	$240.75	$0.00	$0.00	$0.00	$0.00	$0.00
27400108	EAP	HCPCS L3980		Humeral Fx Brace	BOTH IP/OP	$179.00 	$132.46	$0.00	$216.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.85	$132.85	$137.97	$0.00	$37.30	$0.00	$0.00	$0.00	$0.00	$89.50	$141.77	$143.20	$107.40	$80.55	$107.40	$212.58	$0.00	$0.00	$216.95	$0.00	$0.00	$0.00	$0.00	$0.00
27400109	EAP	HCPCS L3760		Hinged Elbow Brace	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$953.73	$953.73	$990.48	$0.00	$267.79	$0.00	$0.00	$0.00	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00	$578.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400113	EAP	HCPCS A4467		Posterior Elbow Splint-prefab	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$47.25	$47.25	$0.00	$0.00	$0.00	$0.00	$77.93	$77.93	$80.93	$0.00	$21.88	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400114	EAP			Splint Orthopedic 5ydx6in Fast	BOTH IP/OP	$46.00 	$34.04	$0.00	$36.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.14	$34.14	$35.46	$0.00	$9.59	$0.00	$0.00	$0.00	$0.00	$23.00	$36.43	$36.80	$0.00	$20.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400115	EAP	HCPCS L1830		Immobilizer Orthopedic Univers	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.40	$33.40	$34.69	$0.00	$9.38	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$0.00	$20.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400116	EAP	HCPCS L0150		Collar Cerv 2-5yr Short 35-45in Chin Dot Tracheostomy Open	BOTH IP/OP	$108.00 	$79.92	$0.00	$89.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.16	$80.16	$83.25	$0.00	$22.51	$0.00	$0.00	$0.00	$0.00	$54.00	$85.54	$86.40	$64.80	$0.00	$64.80	$0.00	$0.00	$0.00	$89.77	$0.00	$0.00	$0.00	$0.00	$0.00
27400117	EAP	HCPCS L0150		Collar Cerv 3-6yr Regular 37-48in Chin Dot Tracheostomy Open	BOTH IP/OP	$109.00 	$80.66	$0.00	$89.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.90	$80.90	$84.02	$0.00	$22.72	$0.00	$0.00	$0.00	$0.00	$54.50	$86.33	$87.20	$65.40	$0.00	$65.40	$0.00	$0.00	$0.00	$89.77	$0.00	$0.00	$0.00	$0.00	$0.00
27400118	EAP	HCPCS L0172		Collar Cerv Short Latex Free Adult	BOTH IP/OP	$103.00 	$76.22	$0.00	$112.86	$46.35	$46.35	$0.00	$0.00	$0.00	$112.86	$76.45	$76.45	$79.39	$0.00	$21.47	$0.00	$60.92	$60.92	$0.00	$51.50	$81.58	$82.40	$61.80	$0.00	$61.80	$107.46	$0.00	$0.00	$109.67	$0.00	$0.00	$0.00	$0.00	$0.00
27400119	EAP	HCPCS L0172		Collar Cerv Regular Chin Rest Tracheostomy Opening	BOTH IP/OP	$100.00 	$74.00	$0.00	$112.86	$45.00	$45.00	$0.00	$0.00	$0.00	$112.86	$74.22	$74.22	$77.08	$0.00	$20.84	$0.00	$59.15	$59.15	$0.00	$50.00	$79.20	$80.00	$60.00	$0.00	$60.00	$107.46	$0.00	$0.00	$109.67	$0.00	$0.00	$0.00	$0.00	$0.00
27400120	EAP	HCPCS L0172		Collar Cerv Tall Chin Rest Tracheostomy Opening Adjustable	BOTH IP/OP	$97.00 	$71.78	$0.00	$112.86	$43.65	$43.65	$0.00	$0.00	$0.00	$112.86	$71.99	$71.99	$74.77	$0.00	$20.21	$0.00	$57.38	$57.38	$0.00	$48.50	$76.82	$77.60	$58.20	$0.00	$58.20	$107.46	$0.00	$0.00	$109.67	$0.00	$0.00	$0.00	$0.00	$0.00
27400121	EAP	HCPCS L0113		Collar Cerv 1-3yr Tot 33-40in Chin Dot Tracheostomy Open	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.96	$74.96	$77.85	$0.00	$21.05	$0.00	$0.00	$0.00	$0.00	$50.50	$79.99	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27400122	EAP	HCPCS L0172		Collar Cerv Short Chin Rest Tracheostomy Opening Adjustable	BOTH IP/OP	$115.00 	$85.10	$0.00	$112.86	$51.75	$51.75	$0.00	$0.00	$0.00	$112.86	$85.35	$85.35	$88.64	$0.00	$23.97	$0.00	$68.02	$68.02	$0.00	$57.50	$91.08	$92.00	$69.00	$0.00	$69.00	$107.46	$0.00	$0.00	$109.67	$0.00	$0.00	$0.00	$0.00	$0.00
27400123	EAP	HCPCS L0172		Collar Cerv 9-24 Month Regular 29-37in Chin Dot Tracheostomy	BOTH IP/OP	$114.00 	$84.36	$0.00	$112.86	$51.30	$51.30	$0.00	$0.00	$0.00	$112.86	$84.61	$84.61	$87.87	$0.00	$23.76	$0.00	$67.43	$67.43	$0.00	$57.00	$90.29	$91.20	$68.40	$0.00	$68.40	$107.46	$0.00	$0.00	$109.67	$0.00	$0.00	$0.00	$0.00	$0.00
27400124	EAP	HCPCS L0172		Collar Crv Unv Occian Bck Intuitech	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$84.60	$84.60	$0.00	$0.00	$0.00	$112.86	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$112.80	$0.00	$112.80	$107.46	$0.00	$0.00	$109.67	$0.00	$0.00	$0.00	$0.00	$0.00
27500001	EAP	HCPCS C1721		2207-36 Current Dr Icd	BOTH IP/OP	"$52,001.00 "	"$38,480.74"	$0.00	"$41,600.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$40,082.37"	$0.00	"$10,837.01"	$0.00	"$25,636.49"	"$25,636.49"	$0.00	"$26,000.50"	"$41,184.79"	"$41,600.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500003	EAP	HCPCS C1722		1207-36 Current Vr Icd	BOTH IP/OP	"$43,036.00 "	"$31,846.64"	$0.00	"$34,428.80"	"$19,366.20"	"$19,366.20"	$0.00	$0.00	$0.00	"$8,969.78"	"$4,181.12"	"$4,181.12"	"$33,172.15"	$0.00	"$8,968.70"	$0.00	"$21,216.75"	"$21,216.75"	$0.00	"$21,518.00"	"$34,084.51"	"$34,428.80"	$0.00	$0.00	$0.00	"$6,735.13"	$0.00	$0.00	"$6,851.33"	$0.00	$0.00	$0.00	$0.00	$0.00
27500004	EAP	HCPCS C1722		"Aicd, Single Chamber"	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.01	$0.01	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500006	EAP	HCPCS C1779		Capsurenovusfix Lead	BOTH IP/OP	"$8,340.00 "	"$6,171.60"	$0.00	"$6,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,428.47"	$0.00	"$1,738.06"	$0.00	$0.00	$0.00	$0.00	"$4,170.00"	"$6,605.28"	"$6,672.00"	$0.00	"$3,753.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500007	EAP	HCPCS C1785		Philos Dr Pacemaker	BOTH IP/OP	"$10,400.00 "	"$7,696.00"	$0.00	"$8,320.00"	"$4,680.00"	"$4,680.00"	$0.00	$0.00	$0.00	"$2,167.62"	"$4,181.12"	"$4,181.12"	"$8,016.32"	$0.00	"$2,167.36"	$0.00	"$5,127.20"	"$5,127.20"	$0.00	"$5,200.00"	"$8,236.80"	"$8,320.00"	$0.00	$0.00	$0.00	"$1,627.60"	$0.00	$0.00	"$1,655.68"	$0.00	$0.00	$0.00	$0.00	$0.00
27500008	EAP	HCPCS C1785		Rhaspsody Dr 2530 Pacemaker	BOTH IP/OP	"$14,582.00 "	"$10,790.68"	$0.00	"$11,665.60"	"$6,561.90"	"$6,561.90"	$0.00	$0.00	$0.00	"$3,039.25"	"$4,181.12"	"$4,181.12"	"$11,239.81"	$0.00	"$3,038.89"	$0.00	"$7,188.93"	"$7,188.93"	$0.00	"$7,291.00"	"$11,548.94"	"$11,665.60"	$0.00	$0.00	$0.00	"$2,282.08"	$0.00	$0.00	"$2,321.45"	$0.00	$0.00	$0.00	$0.00	$0.00
27500009	EAP	HCPCS C1785		5386 Identity Adx Xlr Pcmkr	BOTH IP/OP	"$12,195.00 "	"$9,024.30"	$0.00	"$9,756.00"	"$5,487.75"	"$5,487.75"	$0.00	$0.00	$0.00	"$2,541.74"	"$4,181.12"	"$4,181.12"	"$9,399.91"	$0.00	"$2,541.44"	$0.00	"$6,012.14"	"$6,012.14"	$0.00	"$6,097.50"	"$9,658.44"	"$9,756.00"	$0.00	$0.00	$0.00	"$1,908.52"	$0.00	$0.00	"$1,941.44"	$0.00	$0.00	$0.00	$0.00	$0.00
27500010	EAP	HCPCS C1785		Philos Ii Dr System	BOTH IP/OP	"$14,735.00 "	"$10,903.90"	$0.00	"$11,788.00"	"$6,630.75"	"$6,630.75"	$0.00	$0.00	$0.00	"$3,071.14"	"$4,181.12"	"$4,181.12"	"$11,357.74"	$0.00	"$3,070.77"	$0.00	"$7,264.36"	"$7,264.36"	$0.00	"$7,367.50"	"$11,670.12"	"$11,788.00"	$0.00	$0.00	$0.00	"$2,306.03"	$0.00	$0.00	"$2,345.81"	$0.00	$0.00	$0.00	$0.00	$0.00
27500011	EAP	HCPCS C1785		Sensia Dr Pacemaker	BOTH IP/OP	"$12,195.00 "	"$9,024.30"	$0.00	"$9,756.00"	"$5,487.75"	"$5,487.75"	$0.00	$0.00	$0.00	"$2,541.74"	"$4,181.12"	"$4,181.12"	"$9,399.91"	$0.00	"$2,541.44"	$0.00	"$6,012.14"	"$6,012.14"	$0.00	"$6,097.50"	"$9,658.44"	"$9,756.00"	$0.00	$0.00	$0.00	"$1,908.52"	$0.00	$0.00	"$1,941.44"	$0.00	$0.00	$0.00	$0.00	$0.00
27500012	EAP	HCPCS C1785		Symphony Dr 2550 Pacemaker	BOTH IP/OP	"$15,349.00 "	"$11,358.26"	$0.00	"$12,279.20"	"$6,907.05"	"$6,907.05"	$0.00	$0.00	$0.00	"$3,199.12"	"$4,181.12"	"$4,181.12"	"$11,831.01"	$0.00	"$3,198.73"	$0.00	"$7,567.06"	"$7,567.06"	$0.00	"$7,674.50"	"$12,156.41"	"$12,279.20"	$0.00	$0.00	$0.00	"$2,402.12"	$0.00	$0.00	"$2,443.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27500013	EAP	HCPCS C1785		Repy Dr Pacemaker	BOTH IP/OP	"$15,063.00 "	"$11,146.62"	$0.00	"$12,050.40"	"$6,778.35"	"$6,778.35"	$0.00	$0.00	$0.00	"$3,139.51"	"$4,181.12"	"$4,181.12"	"$11,610.56"	$0.00	"$3,139.13"	$0.00	"$7,426.06"	"$7,426.06"	$0.00	"$7,531.50"	"$11,929.90"	"$12,050.40"	$0.00	$0.00	$0.00	"$2,357.36"	$0.00	$0.00	"$2,398.03"	$0.00	$0.00	$0.00	$0.00	$0.00
27500014	EAP	HCPCS C1785		Cylos Dr/cls Pacemaker	BOTH IP/OP	"$12,195.00 "	"$9,024.30"	$0.00	"$9,756.00"	"$5,487.75"	"$5,487.75"	$0.00	$0.00	$0.00	"$2,541.74"	"$4,181.12"	"$4,181.12"	"$9,399.91"	$0.00	"$2,541.44"	$0.00	"$6,012.14"	"$6,012.14"	$0.00	"$6,097.50"	"$9,658.44"	"$9,756.00"	$0.00	$0.00	$0.00	"$1,908.52"	$0.00	$0.00	"$1,941.44"	$0.00	$0.00	$0.00	$0.00	$0.00
27500015	EAP	HCPCS C1785		Adapta Dr Pacemaker	BOTH IP/OP	"$16,139.00 "	"$11,942.86"	$0.00	"$12,911.20"	"$7,262.55"	"$7,262.55"	$0.00	$0.00	$0.00	"$3,363.77"	"$4,181.12"	"$4,181.12"	"$12,439.94"	$0.00	"$3,363.37"	$0.00	"$7,956.53"	"$7,956.53"	$0.00	"$8,069.50"	"$12,782.09"	"$12,911.20"	$0.00	$0.00	$0.00	"$2,525.75"	$0.00	$0.00	"$2,569.33"	$0.00	$0.00	$0.00	$0.00	$0.00
27500016	EAP	HCPCS C1785		Philos Dr System	BOTH IP/OP	"$12,195.00 "	"$9,024.30"	$0.00	"$9,756.00"	"$5,487.75"	"$5,487.75"	$0.00	$0.00	$0.00	"$2,541.74"	"$4,181.12"	"$4,181.12"	"$9,399.91"	$0.00	"$2,541.44"	$0.00	"$6,012.14"	"$6,012.14"	$0.00	"$6,097.50"	"$9,658.44"	"$9,756.00"	$0.00	$0.00	$0.00	"$1,908.52"	$0.00	$0.00	"$1,941.44"	$0.00	$0.00	$0.00	$0.00	$0.00
27500017	EAP	HCPCS C1785		Rhaspsody Dr 2530 System	BOTH IP/OP	"$16,497.00 "	"$12,207.78"	$0.00	"$13,197.60"	"$7,423.65"	"$7,423.65"	$0.00	$0.00	$0.00	"$3,438.39"	"$4,181.12"	"$4,181.12"	"$12,715.89"	$0.00	"$3,437.97"	$0.00	"$8,133.02"	"$8,133.02"	$0.00	"$8,248.50"	"$13,065.62"	"$13,197.60"	$0.00	$0.00	$0.00	"$2,581.78"	$0.00	$0.00	"$2,626.32"	$0.00	$0.00	$0.00	$0.00	$0.00
27500018	EAP	HCPCS C1785		Symphony Dr 2550 System	BOTH IP/OP	"$18,420.00 "	"$13,630.80"	$0.00	"$14,736.00"	"$8,289.00"	"$8,289.00"	$0.00	$0.00	$0.00	"$3,839.19"	"$4,181.12"	"$4,181.12"	"$14,198.14"	$0.00	"$3,838.73"	$0.00	"$9,081.06"	"$9,081.06"	$0.00	"$9,210.00"	"$14,588.64"	"$14,736.00"	$0.00	$0.00	$0.00	"$2,882.73"	$0.00	$0.00	"$2,932.46"	$0.00	$0.00	$0.00	$0.00	$0.00
27500019	EAP	HCPCS C1785		Reply Dr System	BOTH IP/OP	"$17,932.00 "	"$13,269.68"	$0.00	"$14,345.60"	"$8,069.40"	"$8,069.40"	$0.00	$0.00	$0.00	"$3,737.48"	"$4,181.12"	"$4,181.12"	"$13,821.99"	$0.00	"$3,737.03"	$0.00	"$8,840.48"	"$8,840.48"	$0.00	"$8,966.00"	"$14,202.14"	"$14,345.60"	$0.00	$0.00	$0.00	"$2,806.36"	$0.00	$0.00	"$2,854.77"	$0.00	$0.00	$0.00	$0.00	$0.00
27500020	EAP	HCPCS C1785		Cylos Dr/cls System	BOTH IP/OP	"$15,063.00 "	"$11,146.62"	$0.00	"$12,050.40"	"$6,778.35"	"$6,778.35"	$0.00	$0.00	$0.00	"$3,139.51"	"$4,181.12"	"$4,181.12"	"$11,610.56"	$0.00	"$3,139.13"	$0.00	"$7,426.06"	"$7,426.06"	$0.00	"$7,531.50"	"$11,929.90"	"$12,050.40"	$0.00	$0.00	$0.00	"$2,357.36"	$0.00	$0.00	"$2,398.03"	$0.00	$0.00	$0.00	$0.00	$0.00
27500021	EAP	HCPCS C1785		S403 Altrua Pacemaker	BOTH IP/OP	"$22,045.00 "	"$16,313.30"	$0.00	"$17,636.00"	"$9,920.25"	"$9,920.25"	$0.00	$0.00	$0.00	"$4,594.73"	"$4,181.12"	"$4,181.12"	"$16,992.29"	$0.00	"$4,594.18"	$0.00	"$10,868.19"	"$10,868.19"	$0.00	"$11,022.50"	"$17,459.64"	"$17,636.00"	$0.00	$0.00	$0.00	"$3,450.04"	$0.00	$0.00	"$3,509.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27500024	EAP	HCPCS C1786		Sensia Sr Pacemaker	BOTH IP/OP	"$11,110.00 "	"$8,221.40"	$0.00	"$8,888.00"	"$4,999.50"	"$4,999.50"	$0.00	$0.00	$0.00	"$2,315.60"	"$4,181.12"	"$4,181.12"	"$8,563.59"	$0.00	"$2,315.32"	$0.00	"$5,477.23"	"$5,477.23"	$0.00	"$5,555.00"	"$8,799.12"	"$8,888.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500025	EAP	HCPCS C1786		Rhapsody Sr 2210 Pacemaker	BOTH IP/OP	"$11,130.00 "	"$8,236.20"	$0.00	"$8,904.00"	"$5,008.50"	"$5,008.50"	$0.00	$0.00	$0.00	"$2,319.77"	"$4,181.12"	"$4,181.12"	"$8,579.00"	$0.00	"$2,319.49"	$0.00	"$5,487.09"	"$5,487.09"	$0.00	"$5,565.00"	"$8,814.96"	"$8,904.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500026	EAP	HCPCS C1786		Philos Sr Pacemaker	BOTH IP/OP	"$11,130.00 "	"$8,236.20"	$0.00	"$8,904.00"	"$5,008.50"	"$5,008.50"	$0.00	$0.00	$0.00	"$2,319.77"	"$4,181.12"	"$4,181.12"	"$8,579.00"	$0.00	"$2,319.49"	$0.00	"$5,487.09"	"$5,487.09"	$0.00	"$5,565.00"	"$8,814.96"	"$8,904.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500027	EAP	HCPCS C1786		Rhapsody Sr 2210 System	BOTH IP/OP	"$11,835.00 "	"$8,757.90"	$0.00	"$9,468.00"	"$5,325.75"	"$5,325.75"	$0.00	$0.00	$0.00	"$2,466.71"	"$4,181.12"	"$4,181.12"	"$9,122.42"	$0.00	"$2,466.41"	$0.00	"$5,834.66"	"$5,834.66"	$0.00	"$5,917.50"	"$9,373.32"	"$9,468.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500028	EAP	HCPCS C1786		Philos Sr System	BOTH IP/OP	"$12,664.00 "	"$9,371.36"	$0.00	"$10,131.20"	"$5,698.80"	"$5,698.80"	$0.00	$0.00	$0.00	"$2,639.49"	"$4,181.12"	"$4,181.12"	"$9,761.41"	$0.00	"$2,639.18"	$0.00	"$6,243.35"	"$6,243.35"	$0.00	"$6,332.00"	"$10,029.89"	"$10,131.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500029	EAP	HCPCS C1786		Philos Ii Sr Pacemaker	BOTH IP/OP	"$12,854.00 "	"$9,511.96"	$0.00	"$10,283.20"	"$5,784.30"	"$5,784.30"	$0.00	$0.00	$0.00	"$2,679.09"	"$4,181.12"	"$4,181.12"	"$9,907.86"	$0.00	"$2,678.77"	$0.00	"$6,337.02"	"$6,337.02"	$0.00	"$6,427.00"	"$10,180.37"	"$10,283.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500030	EAP	HCPCS C1786		Sympnony Sr 2550 Pacemaker	BOTH IP/OP	"$13,047.00 "	"$9,654.78"	$0.00	"$10,437.60"	"$5,871.15"	"$5,871.15"	$0.00	$0.00	$0.00	"$2,719.32"	"$4,181.12"	"$4,181.12"	"$10,056.63"	$0.00	"$2,718.99"	$0.00	"$6,432.17"	"$6,432.17"	$0.00	"$6,523.50"	"$10,333.22"	"$10,437.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500031	EAP	HCPCS C1786		Phillos Ii Sr Pcmkr Syst	BOTH IP/OP	"$13,813.00 "	"$10,221.62"	$0.00	"$11,050.40"	"$6,215.85"	"$6,215.85"	$0.00	$0.00	$0.00	"$2,878.97"	"$4,181.12"	"$4,181.12"	"$10,647.06"	$0.00	"$2,878.63"	$0.00	"$6,809.81"	"$6,809.81"	$0.00	"$6,906.50"	"$10,939.90"	"$11,050.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500032	EAP	HCPCS C1786		Symphony Sr 2550 System	BOTH IP/OP	"$13,628.00 "	"$10,084.72"	$0.00	"$10,902.40"	"$6,132.60"	"$6,132.60"	$0.00	$0.00	$0.00	"$2,840.42"	"$4,181.12"	"$4,181.12"	"$10,504.46"	$0.00	"$2,840.08"	$0.00	"$6,718.60"	"$6,718.60"	$0.00	"$6,814.00"	"$10,793.38"	"$10,902.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500033	EAP	HCPCS C1786		Cylos Vr/cls Pacemaker	BOTH IP/OP	"$12,195.00 "	"$9,024.30"	$0.00	"$9,756.00"	"$5,487.75"	"$5,487.75"	$0.00	$0.00	$0.00	"$2,541.74"	"$4,181.12"	"$4,181.12"	"$9,399.91"	$0.00	"$2,541.44"	$0.00	"$6,012.14"	"$6,012.14"	$0.00	"$6,097.50"	"$9,658.44"	"$9,756.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500034	EAP	HCPCS C1786		Reply Sr System	BOTH IP/OP	"$16,497.00 "	"$12,207.78"	$0.00	"$13,197.60"	"$7,423.65"	"$7,423.65"	$0.00	$0.00	$0.00	"$3,438.39"	"$4,181.12"	"$4,181.12"	"$12,715.89"	$0.00	"$3,437.97"	$0.00	"$8,133.02"	"$8,133.02"	$0.00	"$8,248.50"	"$13,065.62"	"$13,197.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500035	EAP	HCPCS C1786		Cylos Vr/cls System	BOTH IP/OP	"$13,628.00 "	"$10,084.72"	$0.00	"$10,902.40"	"$6,132.60"	"$6,132.60"	$0.00	$0.00	$0.00	"$2,840.42"	"$4,181.12"	"$4,181.12"	"$10,504.46"	$0.00	"$2,840.08"	$0.00	"$6,718.60"	"$6,718.60"	$0.00	"$6,814.00"	"$10,793.38"	"$10,902.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500036	EAP	HCPCS C1786		Reply Sr System	BOTH IP/OP	"$16,497.00 "	"$12,207.78"	$0.00	"$13,197.60"	"$7,423.65"	"$7,423.65"	$0.00	$0.00	$0.00	"$3,438.39"	"$4,181.12"	"$4,181.12"	"$12,715.89"	$0.00	"$3,437.97"	$0.00	"$8,133.02"	"$8,133.02"	$0.00	"$8,248.50"	"$13,065.62"	"$13,197.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500039	EAP	HCPCS C1898		1688tc Pacemaker Lead	BOTH IP/OP	"$1,793.00 "	"$1,326.82"	$0.00	"$1,434.40"	$806.85	$806.85	$0.00	$0.00	$0.00	$373.71	"$1,330.76"	"$1,330.76"	"$1,382.04"	$0.00	$373.66	$0.00	"$1,060.56"	"$1,060.56"	$0.00	$896.50	"$1,420.06"	"$1,434.40"	$0.00	$0.00	$0.00	$280.60	$0.00	$0.00	$285.45	$0.00	$0.00	$0.00	$0.00	$0.00
27500040	EAP	HCPCS C1898		Tendril St Pkg Lead	BOTH IP/OP	"$1,920.00 "	"$1,420.80"	$0.00	"$1,536.00"	$864.00	$864.00	$0.00	$0.00	$0.00	$400.18	"$1,425.02"	"$1,425.02"	"$1,479.94"	$0.00	$400.13	$0.00	"$1,135.68"	"$1,135.68"	$0.00	$960.00	"$1,520.64"	"$1,536.00"	$0.00	$864.00	$0.00	$300.48	$0.00	$0.00	$305.66	$0.00	$0.00	$0.00	$0.00	$0.00
27500041	EAP	HCPCS C1898		Tendril 1688 Lead	BOTH IP/OP	"$1,793.00 "	"$1,326.82"	$0.00	"$1,434.40"	$806.85	$806.85	$0.00	$0.00	$0.00	$373.71	"$1,330.76"	"$1,330.76"	"$1,382.04"	$0.00	$373.66	$0.00	"$1,060.56"	"$1,060.56"	$0.00	$896.50	"$1,420.06"	"$1,434.40"	$0.00	$0.00	$0.00	$280.60	$0.00	$0.00	$285.45	$0.00	$0.00	$0.00	$0.00	$0.00
27500042	EAP	HCPCS C1898		Tendril Sdx Lead	BOTH IP/OP	"$1,793.00 "	"$1,326.82"	$0.00	"$1,434.40"	$806.85	$806.85	$0.00	$0.00	$0.00	$373.71	"$1,330.76"	"$1,330.76"	"$1,382.04"	$0.00	$373.66	$0.00	"$1,060.56"	"$1,060.56"	$0.00	$896.50	"$1,420.06"	"$1,434.40"	$0.00	$0.00	$0.00	$280.60	$0.00	$0.00	$285.45	$0.00	$0.00	$0.00	$0.00	$0.00
27500043	EAP	HCPCS C1898		Tendril St 1700 Lead	BOTH IP/OP	"$1,793.00 "	"$1,326.82"	$0.00	"$1,434.40"	$806.85	$806.85	$0.00	$0.00	$0.00	$373.71	"$1,330.76"	"$1,330.76"	"$1,382.04"	$0.00	$373.66	$0.00	"$1,060.56"	"$1,060.56"	$0.00	$896.50	"$1,420.06"	"$1,434.40"	$0.00	$0.00	$0.00	$280.60	$0.00	$0.00	$285.45	$0.00	$0.00	$0.00	$0.00	$0.00
27500044	EAP	HCPCS C1900		Coronary Sinus Lead System	BOTH IP/OP	"$1,920.00 "	"$1,420.80"	$0.00	"$1,536.00"	$864.00	$864.00	$0.00	$0.00	$0.00	$400.18	"$1,425.02"	"$1,425.02"	"$1,479.94"	$0.00	$400.13	$0.00	"$1,135.68"	"$1,135.68"	$0.00	$960.00	"$1,520.64"	"$1,536.00"	$0.00	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500045	EAP	HCPCS C1900		Scout Pro Lead System	BOTH IP/OP	"$1,920.00 "	"$1,420.80"	$0.00	"$1,536.00"	$864.00	$864.00	$0.00	$0.00	$0.00	$400.18	"$1,425.02"	"$1,425.02"	"$1,479.94"	$0.00	$400.13	$0.00	"$1,135.68"	"$1,135.68"	$0.00	$960.00	"$1,520.64"	"$1,536.00"	$0.00	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500046	EAP	HCPCS C1900		Corox Bipolar Lead	BOTH IP/OP	"$5,739.00 "	"$4,246.86"	$0.00	"$4,591.20"	"$2,582.55"	"$2,582.55"	$0.00	$0.00	$0.00	"$1,196.15"	"$4,181.12"	"$4,181.12"	"$4,423.62"	$0.00	"$1,196.01"	$0.00	"$2,829.33"	"$2,829.33"	$0.00	"$2,869.50"	"$4,545.29"	"$4,591.20"	$0.00	"$2,582.55"	$0.00	$898.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500047	EAP	HCPCS C1900		Corox Unipolar Lead	BOTH IP/OP	"$5,739.00 "	"$4,246.86"	$0.00	"$4,591.20"	"$2,582.55"	"$2,582.55"	$0.00	$0.00	$0.00	"$1,196.15"	"$4,181.12"	"$4,181.12"	"$4,423.62"	$0.00	"$1,196.01"	$0.00	"$2,829.33"	"$2,829.33"	$0.00	"$2,869.50"	"$4,545.29"	"$4,591.20"	$0.00	$0.00	$0.00	$898.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500055	EAP	HCPCS C1882		Crt-d Dtba1qq Viva Quad Xt Us Is4 Df4 Crt	BOTH IP/OP	"$50,260.00 "	"$37,192.40"	$0.00	"$40,208.00"	"$22,617.00"	"$22,617.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,740.41"	$0.00	"$10,474.18"	$0.00	"$24,778.18"	"$24,778.18"	$0.00	"$25,130.00"	"$39,805.92"	"$40,208.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,001.39"	$0.00	$0.00	$0.00	$0.00	$0.00
27500056	EAP	HCPCS C1882		Dfbr Crd Viva Qd Xt Crt-d Icd Df-1 Biphasic Wvfrm 35ml 80gm	BOTH IP/OP	"$50,228.00 "	"$37,168.72"	$0.00	"$40,182.40"	"$22,602.60"	"$22,602.60"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,715.74"	$0.00	"$10,467.52"	$0.00	"$24,762.40"	"$24,762.40"	$0.00	"$25,114.00"	"$39,780.58"	"$40,182.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$7,996.30"	$0.00	$0.00	$0.00	$0.00	$0.00
27500057	EAP	HCPCS C1882		Dfbr Crd Viva Crt D Qd S Is-4 Df1 Us	BOTH IP/OP	"$47,766.00 "	"$35,346.84"	$0.00	"$38,212.80"	"$21,494.70"	"$21,494.70"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$36,818.03"	$0.00	"$9,954.43"	$0.00	"$23,548.64"	"$23,548.64"	$0.00	"$23,883.00"	"$37,830.67"	"$38,212.80"	$0.00	$0.00	$0.00	"$7,475.38"	$0.00	$0.00	"$7,604.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27500058	EAP	HCPCS C1882		Dfbr Crd Viva Crt D Qd S Is-4 Df4 Us	BOTH IP/OP	"$47,766.00 "	"$35,346.84"	$0.00	"$38,212.80"	"$21,494.70"	"$21,494.70"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$36,818.03"	$0.00	"$9,954.43"	$0.00	"$23,548.64"	"$23,548.64"	$0.00	"$23,883.00"	"$37,830.67"	"$38,212.80"	$0.00	$0.00	$0.00	"$7,475.38"	$0.00	$0.00	"$7,604.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27500059	EAP	HCPCS C1900		Lead Attain Performa Usa Crt	BOTH IP/OP	"$5,840.00 "	"$4,321.60"	$0.00	"$4,672.00"	"$2,628.00"	"$2,628.00"	$0.00	$0.00	$0.00	"$1,217.20"	"$4,181.12"	"$4,181.12"	"$4,501.47"	$0.00	"$1,217.06"	$0.00	"$2,879.12"	"$2,879.12"	$0.00	"$2,920.00"	"$4,625.28"	"$4,672.00"	$0.00	"$2,628.00"	$0.00	$913.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500060	EAP	HCPCS C1900		Attain Bipoldr Lead	BOTH IP/OP	"$6,276.00 "	"$4,644.24"	$0.00	"$5,020.80"	"$2,824.20"	"$2,824.20"	$0.00	$0.00	$0.00	"$1,308.08"	"$4,181.12"	"$4,181.12"	"$4,837.54"	$0.00	"$1,307.92"	$0.00	"$3,094.07"	"$3,094.07"	$0.00	"$3,138.00"	"$4,970.59"	"$5,020.80"	$0.00	$0.00	$0.00	$982.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500062	EAP	HCPCS C1900		Lv Quickflex Lead	BOTH IP/OP	"$5,739.00 "	"$4,246.86"	$0.00	"$4,591.20"	"$2,582.55"	"$2,582.55"	$0.00	$0.00	$0.00	"$1,196.15"	"$4,181.12"	"$4,181.12"	"$4,423.62"	$0.00	"$1,196.01"	$0.00	"$2,829.33"	"$2,829.33"	$0.00	"$2,869.50"	"$4,545.29"	"$4,591.20"	$0.00	"$2,582.55"	$0.00	$898.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500063	EAP	HCPCS C1900		Lv Quicksite Leads	BOTH IP/OP	"$5,739.00 "	"$4,246.86"	$0.00	"$4,591.20"	"$2,582.55"	"$2,582.55"	$0.00	$0.00	$0.00	"$1,196.15"	"$4,181.12"	"$4,181.12"	"$4,423.62"	$0.00	"$1,196.01"	$0.00	"$2,829.33"	"$2,829.33"	$0.00	"$2,869.50"	"$4,545.29"	"$4,591.20"	$0.00	$0.00	$0.00	$898.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500070	EAP	HCPCS C1786		Zepher Dr Pacemaker	BOTH IP/OP	"$14,346.00 "	"$10,616.04"	$0.00	"$11,476.80"	"$6,455.70"	"$6,455.70"	$0.00	$0.00	$0.00	"$2,990.07"	"$4,181.12"	"$4,181.12"	"$11,057.90"	$0.00	"$2,989.71"	$0.00	"$7,072.58"	"$7,072.58"	$0.00	"$7,173.00"	"$11,362.03"	"$11,476.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500078	EAP	HCPCS C1721		Teligen Rf He Dr Dual Icd	BOTH IP/OP	"$50,042.00 "	"$37,031.08"	$0.00	"$40,033.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,572.37"	$0.00	"$10,428.75"	$0.00	"$24,670.71"	"$24,670.71"	$0.00	"$25,021.00"	"$39,633.26"	"$40,033.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$7,966.69"	$0.00	$0.00	$0.00	$0.00	$0.00
27500079	EAP	HCPCS C1721		Confient Rf He Dual Icd	BOTH IP/OP	"$41,702.00 "	"$30,859.48"	$0.00	"$33,361.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,691.74"	"$4,181.12"	"$4,181.12"	"$32,143.90"	$0.00	"$8,690.70"	$0.00	"$20,559.09"	"$20,559.09"	$0.00	"$20,851.00"	"$33,027.98"	"$33,361.60"	$0.00	$0.00	$0.00	"$6,526.36"	$0.00	$0.00	"$6,638.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27500080	EAP	HCPCS C1722		Teligen Rf He Vr Icd	BOTH IP/OP	"$41,702.00 "	"$30,859.48"	$0.00	"$33,361.60"	"$18,765.90"	"$18,765.90"	$0.00	$0.00	$0.00	"$8,691.74"	"$4,181.12"	"$4,181.12"	"$32,143.90"	$0.00	"$8,690.70"	$0.00	"$20,559.09"	"$20,559.09"	$0.00	"$20,851.00"	"$33,027.98"	"$33,361.60"	$0.00	$0.00	$0.00	"$6,526.36"	$0.00	$0.00	"$6,638.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27500081	EAP	HCPCS C1722		Vitality 2 El Vr Icd	BOTH IP/OP	"$38,365.00 "	"$28,390.10"	$0.00	"$30,692.00"	"$17,264.25"	"$17,264.25"	$0.00	$0.00	$0.00	"$7,996.23"	"$4,181.12"	"$4,181.12"	"$29,571.74"	$0.00	"$7,995.27"	$0.00	"$18,913.95"	"$18,913.95"	$0.00	"$19,182.50"	"$30,385.08"	"$30,692.00"	$0.00	$0.00	$0.00	"$6,004.12"	$0.00	$0.00	"$6,107.71"	$0.00	$0.00	$0.00	$0.00	$0.00
27500082	EAP	HCPCS C1786		Altrua 40 Sr Pacemaker	BOTH IP/OP	"$11,343.00 "	"$8,393.82"	$0.00	"$9,074.40"	"$5,104.35"	"$5,104.35"	$0.00	$0.00	$0.00	"$2,364.16"	"$4,181.12"	"$4,181.12"	"$8,743.18"	$0.00	"$2,363.88"	$0.00	"$5,592.10"	"$5,592.10"	$0.00	"$5,671.50"	"$8,983.66"	"$9,074.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500083	EAP	HCPCS C1785		Altrua 40 Dr El Dual Pacemaker	BOTH IP/OP	"$6,340.00 "	"$4,691.60"	$0.00	"$5,072.00"	"$2,853.00"	"$2,853.00"	$0.00	$0.00	$0.00	"$1,321.41"	"$4,181.12"	"$4,181.12"	"$4,886.87"	$0.00	"$1,321.26"	$0.00	"$3,125.62"	"$3,125.62"	$0.00	"$3,170.00"	"$5,021.28"	"$5,072.00"	$0.00	$0.00	$0.00	$992.21	$0.00	$0.00	"$1,009.33"	$0.00	$0.00	$0.00	$0.00	$0.00
27500084	EAP	HCPCS C1785		Altrua 40 Dr Dual Pacemaker	BOTH IP/OP	"$6,340.00 "	"$4,691.60"	$0.00	"$5,072.00"	"$2,853.00"	"$2,853.00"	$0.00	$0.00	$0.00	"$1,321.41"	"$4,181.12"	"$4,181.12"	"$4,886.87"	$0.00	"$1,321.26"	$0.00	"$3,125.62"	"$3,125.62"	$0.00	"$3,170.00"	"$5,021.28"	"$5,072.00"	$0.00	$0.00	$0.00	$992.21	$0.00	$0.00	"$1,009.33"	$0.00	$0.00	$0.00	$0.00	$0.00
27500085	EAP	HCPCS C1882		Cognis Rf He Crt-d	BOTH IP/OP	"$73,393.00 "	"$54,310.82"	$0.00	"$58,714.40"	"$33,026.85"	"$33,026.85"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$56,571.32"	$0.00	"$15,295.10"	$0.00	"$36,182.75"	"$36,182.75"	$0.00	"$36,696.50"	"$58,127.26"	"$58,714.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500086	EAP	HCPCS C1882		Livian Rf He Crt-d	BOTH IP/OP	"$56,714.00 "	"$41,968.36"	$0.00	"$45,371.20"	"$25,521.30"	"$25,521.30"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$43,715.15"	$0.00	"$11,819.20"	$0.00	"$27,960.00"	"$27,960.00"	$0.00	"$28,357.00"	"$44,917.49"	"$45,371.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500087	EAP	HCPCS C1882		Livian Rf Crt-d	BOTH IP/OP	"$56,714.00 "	"$41,968.36"	$0.00	"$45,371.20"	"$25,521.30"	"$25,521.30"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$43,715.15"	$0.00	"$11,819.20"	$0.00	"$27,960.00"	"$27,960.00"	$0.00	"$28,357.00"	"$44,917.49"	"$45,371.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500088	EAP	HCPCS C1882		Contak Renewal Tr Crt-p	BOTH IP/OP	"$21,350.00 "	"$15,799.00"	$0.00	"$17,080.00"	"$9,607.50"	"$9,607.50"	$0.00	$0.00	$0.00	"$4,449.87"	"$4,181.12"	"$4,181.12"	"$16,456.58"	$0.00	"$4,449.34"	$0.00	"$10,525.55"	"$10,525.55"	$0.00	"$10,675.00"	"$16,909.20"	"$17,080.00"	$0.00	$0.00	$0.00	"$3,341.28"	$0.00	$0.00	"$3,398.92"	$0.00	$0.00	$0.00	$0.00	$0.00
27500089	EAP	HCPCS C1895		Reliance G Af Lead	BOTH IP/OP	"$15,012.00 "	"$11,108.88"	$0.00	"$12,009.60"	"$6,755.40"	"$6,755.40"	$0.00	$0.00	$0.00	"$3,128.88"	"$4,181.12"	"$4,181.12"	"$11,571.25"	$0.00	"$3,128.50"	$0.00	"$7,400.92"	"$7,400.92"	$0.00	"$7,506.00"	"$11,889.50"	"$12,009.60"	$0.00	$0.00	$0.00	"$2,349.38"	$0.00	$0.00	"$2,389.91"	$0.00	$0.00	$0.00	$0.00	$0.00
27500090	EAP	HCPCS C1895		Reliance G Pf Lead	BOTH IP/OP	"$15,012.00 "	"$11,108.88"	$0.00	"$12,009.60"	"$6,755.40"	"$6,755.40"	$0.00	$0.00	$0.00	"$3,128.88"	"$4,181.12"	"$4,181.12"	"$11,571.25"	$0.00	"$3,128.50"	$0.00	"$7,400.92"	"$7,400.92"	$0.00	"$7,506.00"	"$11,889.50"	"$12,009.60"	$0.00	$0.00	$0.00	"$2,349.38"	$0.00	$0.00	"$2,389.91"	$0.00	$0.00	$0.00	$0.00	$0.00
27500091	EAP	HCPCS C1895		Relaince Af Lead	BOTH IP/OP	"$12,676.00 "	"$9,380.24"	$0.00	"$10,140.80"	"$5,704.20"	"$5,704.20"	$0.00	$0.00	$0.00	"$2,642.00"	"$4,181.12"	"$4,181.12"	"$9,770.66"	$0.00	"$2,641.68"	$0.00	"$6,249.27"	"$6,249.27"	$0.00	"$6,338.00"	"$10,039.39"	"$10,140.80"	$0.00	$0.00	$0.00	"$1,983.79"	$0.00	$0.00	"$2,018.02"	$0.00	$0.00	$0.00	$0.00	$0.00
27500092	EAP	HCPCS C1895		Relaince Pf Lead	BOTH IP/OP	"$12,676.00 "	"$9,380.24"	$0.00	"$10,140.80"	"$5,704.20"	"$5,704.20"	$0.00	$0.00	$0.00	"$2,642.00"	"$4,181.12"	"$4,181.12"	"$9,770.66"	$0.00	"$2,641.68"	$0.00	"$6,249.27"	"$6,249.27"	$0.00	"$6,338.00"	"$10,039.39"	"$10,140.80"	$0.00	$0.00	$0.00	"$1,983.79"	$0.00	$0.00	"$2,018.02"	$0.00	$0.00	$0.00	$0.00	$0.00
27500093	EAP	HCPCS C1898		"Myocardial Lead,pmkr,other Than Trans"	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	"$1,271.82"	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00	$0.00	$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
27500094	EAP	HCPCS C1898		Flexion - Oscor Lead	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	"$1,271.82"	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00	$0.00	$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
27500095	EAP	HCPCS C1898		"Fineline Ii Sterox Lead,pmkr,other Than Trans"	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	"$1,271.82"	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00	$0.00	$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
27500096	EAP	HCPCS C1898		"Fineline Ii Sterox  Ez Lead,pmkr,other Than Trans"	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	"$1,271.82"	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00	$0.00	$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
27500097	EAP	HCPCS C1898		"Flextend Lead,pmkr,other Than Trans"	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00	$0.00	$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
27500098	EAP	HCPCS C1898		"Dextrus Lead,pmkr,other Than Trans"	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00	$0.00	$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
27500099	EAP	HCPCS C1900		Acuity Steerable/spiral Lead	BOTH IP/OP	"$6,672.00 "	"$4,937.28"	$0.00	"$5,337.60"	"$3,002.40"	"$3,002.40"	$0.00	$0.00	$0.00	"$1,390.61"	"$4,181.12"	"$4,181.12"	"$5,142.78"	$0.00	"$1,390.44"	$0.00	"$3,289.30"	"$3,289.30"	$0.00	"$3,336.00"	"$5,284.22"	"$5,337.60"	$0.00	$0.00	$0.00	"$1,044.17"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500100	EAP	HCPCS C1900		Easytrack 3	BOTH IP/OP	"$5,004.00 "	"$3,702.96"	$0.00	"$4,003.20"	"$2,251.80"	"$2,251.80"	$0.00	$0.00	$0.00	"$1,042.96"	"$3,713.97"	"$3,713.97"	"$3,857.08"	$0.00	"$1,042.83"	$0.00	"$2,466.97"	"$2,466.97"	$0.00	"$2,502.00"	"$3,963.17"	"$4,003.20"	$0.00	$0.00	$0.00	$783.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500101	EAP	HCPCS C1900		Easytrack 2	BOTH IP/OP	"$5,004.00 "	"$3,702.96"	$0.00	"$4,003.20"	"$2,251.80"	"$2,251.80"	$0.00	$0.00	$0.00	"$1,042.96"	"$3,713.97"	"$3,713.97"	"$3,857.08"	$0.00	"$1,042.83"	$0.00	"$2,466.97"	"$2,466.97"	$0.00	"$2,502.00"	"$3,963.17"	"$4,003.20"	$0.00	$0.00	$0.00	$783.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500102	EAP	HCPCS C1721		Evera Mri Xt Dr Device- Single Chamber	BOTH IP/OP	"$41,500.00 "	"$30,710.00"	$0.00	"$33,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,649.64"	"$4,181.12"	"$4,181.12"	"$31,988.20"	$0.00	"$8,648.60"	$0.00	"$20,459.50"	"$20,459.50"	$0.00	"$20,750.00"	"$32,868.00"	"$33,200.00"	$0.00	$0.00	$0.00	"$6,494.75"	$0.00	$0.00	"$6,606.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27500103	EAP	HCPCS C1722		Evera Mri Xt Vr Device - Dual Chamber	BOTH IP/OP	"$36,500.00 "	"$27,010.00"	$0.00	"$29,200.00"	"$19,819.50"	"$19,819.50"	$0.00	$0.00	$0.00	"$7,607.51"	"$4,181.12"	"$4,181.12"	"$28,134.20"	$0.00	"$7,606.60"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$18,250.00"	"$28,908.00"	"$29,200.00"	$0.00	$0.00	$0.00	"$5,712.25"	$0.00	$0.00	"$5,810.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27500105	EAP	HCPCS C1721		Fortify Assura Dr 40 Df4 Con Icd/defib/resync	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.01	$0.01	$0.00	$0.01	$0.01	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500106	EAP	HCPCS C1722		Drbr Crd Visia Af Mri Df4 Vr	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.01	$0.01	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500150	EAP	HCPCS C1785		"Pacemaker, Dual Accent Dr"	BOTH IP/OP	"$19,351.00 "	"$14,319.74"	$0.00	"$15,480.80"	"$8,707.95"	"$8,707.95"	$0.00	$0.00	$0.00	"$4,033.23"	"$4,181.12"	"$4,181.12"	"$14,915.75"	$0.00	"$4,032.75"	$0.00	"$9,540.04"	"$9,540.04"	$0.00	"$9,675.50"	"$15,325.99"	"$15,480.80"	$0.00	$0.00	$0.00	"$3,028.43"	$0.00	$0.00	"$3,080.68"	$0.00	$0.00	$0.00	$0.00	$0.00
27500151	EAP	HCPCS C1786		"Pacemaker, Single Accent Sr"	BOTH IP/OP	"$17,681.00 "	"$13,083.94"	$0.00	"$14,144.80"	"$7,956.45"	"$7,956.45"	$0.00	$0.00	$0.00	"$3,685.16"	"$4,181.12"	"$4,181.12"	"$13,628.51"	$0.00	"$3,684.72"	$0.00	"$8,716.73"	"$8,716.73"	$0.00	"$8,840.50"	"$14,003.35"	"$14,144.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500152	EAP	HCPCS C2621		"Pacemaker, Bi-v Anthem Crt-p"	BOTH IP/OP	"$11,209.00 "	"$8,294.66"	$0.00	"$8,967.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,639.90"	$0.00	"$2,335.96"	$0.00	$0.00	$0.00	$0.00	"$5,604.50"	"$8,877.53"	"$8,967.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500153	EAP	HCPCS C1898		Lead Pcng 45cm Bipol Act Fix Solia S Strd Elut	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00	$0.00	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
27500154	EAP	HCPCS C1898		Lead Pcng 53cm Solia S Ecrdl Strd Elute Bipol Act	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00	$506.25	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
27500155	EAP	HCPCS C1898		Lead Pcng 60cm Promri Solia S Strd Elut	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00	$506.25	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
27500160	EAP	HCPCS C1898		Myopore Epicardial Lead 35 Cm	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500162	EAP	HCPCS C1882		Pacemaker Crd Viva Crt-p	BOTH IP/OP	"$28,585.00 "	"$21,152.90"	$0.00	"$22,868.00"	"$12,863.25"	"$12,863.25"	$0.00	$0.00	$0.00	"$5,957.83"	"$4,181.12"	"$4,181.12"	"$22,033.32"	$0.00	"$5,957.11"	$0.00	"$14,092.41"	"$14,092.41"	$0.00	"$14,292.50"	"$22,639.32"	"$22,868.00"	$0.00	$0.00	$0.00	"$4,473.55"	$0.00	$0.00	"$4,550.73"	$0.00	$0.00	$0.00	$0.00	$0.00
27500163	EAP	HCPCS C1786		Pacemaker Crd Advisa Sr Mr Surescan 1 Chmbr Unplr	BOTH IP/OP	"$11,000.00 "	"$8,140.00"	$0.00	"$8,800.00"	"$4,950.00"	"$4,950.00"	$0.00	$0.00	$0.00	"$2,292.68"	"$4,181.12"	"$4,181.12"	"$8,478.80"	$0.00	"$2,292.40"	$0.00	"$5,423.00"	"$5,423.00"	$0.00	"$5,500.00"	"$8,712.00"	"$8,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500200	EAP	HCPCS C1786		Reply Sr System	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500201	EAP	HCPCS C1786		Reply Sr	BOTH IP/OP	"$10,344.00 "	"$7,654.56"	$0.00	"$8,275.20"	"$4,654.80"	"$4,654.80"	$0.00	$0.00	$0.00	"$2,155.95"	"$4,181.12"	"$4,181.12"	"$7,973.16"	$0.00	"$2,155.69"	$0.00	"$5,099.59"	"$5,099.59"	$0.00	"$5,172.00"	"$8,192.45"	"$8,275.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500202	EAP	HCPCS C1722		Paradym Rf Crt 9750 System	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500203	EAP	HCPCS C1722		Paradym Rf Crt 9750	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	"$24,205.95"	"$24,205.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,462.10"	$0.00	"$11,210.04"	$0.00	"$26,518.96"	"$26,518.96"	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500204	EAP	HCPCS C1722		Paradym 9250 Rf Vr	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27500205	EAP	HCPCS C1900		Quickflex+++pmm#:89271	BOTH IP/OP	"$4,729.00 "	"$3,499.46"	$0.00	"$3,783.20"	"$2,128.05"	"$2,128.05"	$0.00	$0.00	$0.00	$985.64	"$3,509.86"	"$3,509.86"	"$3,645.11"	$0.00	$985.52	$0.00	"$2,331.40"	"$2,331.40"	$0.00	"$2,364.50"	"$3,745.37"	"$3,783.20"	$0.00	$0.00	$0.00	$740.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500206	EAP	HCPCS C1900		Quickflex+++pmm#:89272	BOTH IP/OP	"$4,729.00 "	"$3,499.46"	$0.00	"$3,783.20"	"$2,128.05"	"$2,128.05"	$0.00	$0.00	$0.00	$985.64	"$3,509.86"	"$3,509.86"	"$3,645.11"	$0.00	$985.52	$0.00	"$2,331.40"	"$2,331.40"	$0.00	"$2,364.50"	"$3,745.37"	"$3,783.20"	$0.00	$0.00	$0.00	$740.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500207	EAP	HCPCS C1900		Quickflex+++pmm#:89273	BOTH IP/OP	"$4,729.00 "	"$3,499.46"	$0.00	"$3,783.20"	"$2,128.05"	"$2,128.05"	$0.00	$0.00	$0.00	$985.64	"$3,509.86"	"$3,509.86"	"$3,645.11"	$0.00	$985.52	$0.00	"$2,331.40"	"$2,331.40"	$0.00	"$2,364.50"	"$3,745.37"	"$3,783.20"	$0.00	$0.00	$0.00	$740.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500208	EAP	HCPCS C1900		Quickflex Micro	BOTH IP/OP	"$5,202.00 "	"$3,849.48"	$0.00	"$4,161.60"	"$2,340.90"	"$2,340.90"	$0.00	$0.00	$0.00	"$1,084.23"	"$3,860.92"	"$3,860.92"	"$4,009.70"	$0.00	"$1,084.10"	$0.00	"$2,564.59"	"$2,564.59"	$0.00	"$2,601.00"	"$4,119.98"	"$4,161.60"	$0.00	$0.00	$0.00	$814.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500209	EAP	HCPCS C1900		Quickflex Micro	BOTH IP/OP	"$5,202.00 "	"$3,849.48"	$0.00	"$4,161.60"	"$2,340.90"	"$2,340.90"	$0.00	$0.00	$0.00	"$1,084.23"	"$3,860.92"	"$3,860.92"	"$4,009.70"	$0.00	"$1,084.10"	$0.00	"$2,564.59"	"$2,564.59"	$0.00	"$2,601.00"	"$4,119.98"	"$4,161.60"	$0.00	$0.00	$0.00	$814.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500210	EAP	HCPCS C1898		Optisense	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500211	EAP	HCPCS C1898		Optisense	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500212	EAP	HCPCS C1898		Optisense+++pmm#:89078	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500213	EAP	HCPCS C1898		Optisense	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500214	EAP	HCPCS C1898		Optisense	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500215	EAP	HCPCS C1898		Tendril St Optim	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500216	EAP	HCPCS C1898		Tendril St Optim	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500217	EAP	HCPCS C1898		Tendril St Optim	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500218	EAP	HCPCS C1898		Isoflex Optim	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$598.50	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500219	EAP	HCPCS C1898		Isoflex Optim	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500220	EAP	HCPCS C1898		Isoflex Optim	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500221	EAP	HCPCS C1898		Isoflex Optim	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500222	EAP	HCPCS C1898		Isoflex Optim	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500223	EAP	HCPCS C1786		5157m/s	BOTH IP/OP	"$10,344.00 "	"$7,654.56"	$0.00	"$8,275.20"	"$4,654.80"	"$4,654.80"	$0.00	$0.00	$0.00	"$2,155.95"	"$4,181.12"	"$4,181.12"	"$7,973.16"	$0.00	"$2,155.69"	$0.00	"$5,099.59"	"$5,099.59"	$0.00	"$5,172.00"	"$8,192.45"	"$8,275.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500224	EAP	HCPCS C1785		5357m/s	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500225	EAP	HCPCS C1895		Durata	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500226	EAP	HCPCS C1895		Durata	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500227	EAP	HCPCS C1895		Durata+++pmm#:87533	BOTH IP/OP	"$12,413.00 "	"$9,185.62"	$0.00	"$9,930.40"	"$5,585.85"	"$5,585.85"	$0.00	$0.00	$0.00	"$2,587.18"	"$4,181.12"	"$4,181.12"	"$9,567.94"	$0.00	"$2,586.87"	$0.00	"$6,119.61"	"$6,119.61"	$0.00	"$6,206.50"	"$9,831.10"	"$9,930.40"	$0.00	$0.00	$0.00	"$1,942.63"	$0.00	$0.00	"$1,976.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27500228	EAP	HCPCS C1895		Durata	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500229	EAP	HCPCS C1895		Durata	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500230	EAP	HCPCS C1895		Durata Df4 - Active Tbp Single Shock	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500231	EAP	HCPCS C1895		Durata Df4 - Active Tbp Single Shock	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500232	EAP	HCPCS C1895		Durata Df4 - Active Tbp Single Shock	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500233	EAP	HCPCS C1895		Durata	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500234	EAP	HCPCS C1895		Durata	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500235	EAP	HCPCS C1895		Durata	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500236	EAP	HCPCS C1895		Durata+++pmm#:96295	BOTH IP/OP	"$12,413.00 "	"$9,185.62"	$0.00	"$9,930.40"	"$5,585.85"	"$5,585.85"	$0.00	$0.00	$0.00	"$2,587.18"	"$4,181.12"	"$4,181.12"	"$9,567.94"	$0.00	"$2,586.87"	$0.00	"$6,119.61"	"$6,119.61"	$0.00	"$6,206.50"	"$9,831.10"	"$9,930.40"	$0.00	$0.00	$0.00	"$1,942.63"	$0.00	$0.00	"$1,976.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27500237	EAP	HCPCS C1895		Durata+++pmm#:96296	BOTH IP/OP	"$12,413.00 "	"$9,185.62"	$0.00	"$9,930.40"	"$5,585.85"	"$5,585.85"	$0.00	$0.00	$0.00	"$2,587.18"	"$4,181.12"	"$4,181.12"	"$9,567.94"	$0.00	"$2,586.87"	$0.00	"$6,119.61"	"$6,119.61"	$0.00	"$6,206.50"	"$9,831.10"	"$9,930.40"	$0.00	$0.00	$0.00	"$1,942.63"	$0.00	$0.00	"$1,976.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27500238	EAP	HCPCS C1895		Durata	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500239	EAP	HCPCS C1895		Durata Sj4 - Passive	BOTH IP/OP	"$12,413.00 "	"$9,185.62"	$0.00	"$9,930.40"	"$5,585.85"	"$5,585.85"	$0.00	$0.00	$0.00	"$2,587.18"	"$4,181.12"	"$4,181.12"	"$9,567.94"	$0.00	"$2,586.87"	$0.00	"$6,119.61"	"$6,119.61"	$0.00	"$6,206.50"	"$9,831.10"	"$9,930.40"	$0.00	$0.00	$0.00	"$1,942.63"	$0.00	$0.00	"$1,976.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27500240	EAP	HCPCS C1895		Durata Df4 - Passive Tbp Dual Shock	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500241	EAP	HCPCS C1895		Durata Df4 - Passive Tbp Dual Shock	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500242	EAP	HCPCS C1895		Durata Sj4 - Passive	BOTH IP/OP	"$12,413.00 "	"$9,185.62"	$0.00	"$9,930.40"	"$5,585.85"	"$5,585.85"	$0.00	$0.00	$0.00	"$2,587.18"	"$4,181.12"	"$4,181.12"	"$9,567.94"	$0.00	"$2,586.87"	$0.00	"$6,119.61"	"$6,119.61"	$0.00	"$6,206.50"	"$9,831.10"	"$9,930.40"	$0.00	$0.00	$0.00	"$1,942.63"	$0.00	$0.00	"$1,976.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27500243	EAP	HCPCS C1895		Durata Df4 - Passive Tbp Dual Shock	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500244	EAP	HCPCS C1895		Durata Df4 - Passive Tbp Dual Shock	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500245	EAP	HCPCS C1893		Cps Direct? Sl Ii Straight 47cm	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500246	EAP	HCPCS C1893		Cps Direct? Sl Ii 135 Degrees 47cm	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500247	EAP	HCPCS C1893		Cps Direct? Sl Ii Wide 47cm	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500248	EAP	HCPCS C1893		Cps Direct? Sl Ii X-wide 47cm	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500249	EAP	HCPCS C1893		Cps Direct? Sl Ii Right Side 47cm	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500250	EAP	HCPCS C1893		Cps Direct? Sl Ii Straight 54cm	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500251	EAP	HCPCS C1893		Cps Direct? Sl Ii 115 Degrees 54cm	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500252	EAP	HCPCS C1893		Cps Direct? Sl Ii 135 Degrees 54cm	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500253	EAP	HCPCS C1893		Cps Direct? Sl Ii Wide 54cm	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500254	EAP	HCPCS C1893		Cps Direct? Sl Ii X-wide 54cm	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500255	EAP	HCPCS C1893		Cps Aim S	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$265.95	$265.95	$0.00	$0.00	$0.00	$123.18	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$349.58	$349.58	$0.00	$295.50	$468.07	$472.80	$0.00	$0.00	$0.00	$92.49	$0.00	$0.00	$94.09	$0.00	$0.00	$0.00	$0.00	$0.00
27500256	EAP	HCPCS C1893		Cps Aim Sl	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$265.95	$265.95	$0.00	$0.00	$0.00	$123.18	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$349.58	$349.58	$0.00	$295.50	$468.07	$472.80	$0.00	$0.00	$0.00	$92.49	$0.00	$0.00	$94.09	$0.00	$0.00	$0.00	$0.00	$0.00
27500257	EAP	HCPCS C1893		Cps Aim S	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$265.95	$265.95	$0.00	$0.00	$0.00	$123.18	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$349.58	$349.58	$0.00	$295.50	$468.07	$472.80	$0.00	$0.00	$0.00	$92.49	$0.00	$0.00	$94.09	$0.00	$0.00	$0.00	$0.00	$0.00
27500258	EAP	HCPCS C1893		Cps Aim Sl	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$265.95	$265.95	$0.00	$0.00	$0.00	$123.18	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$349.58	$349.58	$0.00	$295.50	$468.07	$472.80	$0.00	$0.00	$0.00	$92.49	$0.00	$0.00	$94.09	$0.00	$0.00	$0.00	$0.00	$0.00
27500259	EAP	HCPCS C1893		Cps Aim Sl	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$265.95	$265.95	$0.00	$0.00	$0.00	$123.18	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$349.58	$349.58	$0.00	$295.50	$468.07	$472.80	$0.00	$0.00	$0.00	$92.49	$0.00	$0.00	$94.09	$0.00	$0.00	$0.00	$0.00	$0.00
27500260	EAP	HCPCS C1893		Cps Aim Sl	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$265.95	$265.95	$0.00	$0.00	$0.00	$123.18	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$349.58	$349.58	$0.00	$295.50	$468.07	$472.80	$0.00	$0.00	$0.00	$92.49	$0.00	$0.00	$94.09	$0.00	$0.00	$0.00	$0.00	$0.00
27500261	EAP	HCPCS C1893		Cps Aim Sl	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$265.95	$265.95	$0.00	$0.00	$0.00	$123.18	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$349.58	$349.58	$0.00	$295.50	$468.07	$472.80	$0.00	$0.00	$0.00	$92.49	$0.00	$0.00	$94.09	$0.00	$0.00	$0.00	$0.00	$0.00
27500262	EAP	HCPCS C1786		Pacemakers Single Accent Sr Rf	BOTH IP/OP	"$15,665.00 "	"$11,592.10"	$0.00	"$12,532.00"	"$7,049.25"	"$7,049.25"	$0.00	$0.00	$0.00	"$3,264.98"	"$4,181.12"	"$4,181.12"	"$12,074.58"	$0.00	"$3,264.59"	$0.00	"$7,722.85"	"$7,722.85"	$0.00	"$7,832.50"	"$12,406.68"	"$12,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500263	EAP	HCPCS C1722		Atlas Plus C Header	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27500264	EAP	HCPCS C1898		Myopore Epicardial Lead 54 Cm	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27500265	EAP	HCPCS C1898		Passive Fixation Pacing Lead  J-shape  Silicone Insulation	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500266	EAP	HCPCS C1898		Passive Fixation Pacing Lead  J-shape  Silicone Insulation	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500267	EAP	HCPCS C1898		Passive Fixation Pacing Lead  Straight  Silicone Insulation	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500268	EAP	HCPCS C1898		Passive Fixation Pacing Lead  Straight  Silicone Insulation	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500269	EAP	HCPCS C1898		Active Fixation Pacing Lead  Electrically Active Helix  Sili	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500270	EAP	HCPCS C1898		Active Fixation Pacing Lead  Electrically Active Helix  Sili	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500271	EAP	HCPCS C1898		Active Fixation Pacing Lead  Electrically Active Helix  Sili	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500272	EAP	HCPCS C1898		Active Fixation  Single Coil  Silicone Insulation  65 Cm	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500273	EAP	HCPCS C1898		Passive Fixation  Dual Coil  Silicone Insulation  65 Cm  18	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500274	EAP	HCPCS C1898		Active Fixation  Dual Coil  Silicone Insulation  60 Cm  16 C	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500275	EAP	HCPCS C1898		Active Fixation  Dual Coil  Silicone Insulation  65 Cm  18 C	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500276	EAP	HCPCS C1900		Left Ventricular Lead With 3d Pre-shaped Helix At Distal End	BOTH IP/OP	"$5,911.00 "	"$4,374.14"	$0.00	"$4,728.80"	"$2,659.95"	"$2,659.95"	$0.00	$0.00	$0.00	"$1,232.00"	"$4,181.12"	"$4,181.12"	"$4,556.20"	$0.00	"$1,231.85"	$0.00	"$2,914.12"	"$2,914.12"	$0.00	"$2,955.50"	"$4,681.51"	"$4,728.80"	$0.00	$0.00	$0.00	$925.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500277	EAP	HCPCS C1900		Left Ventricular Lead With Pre-shaped Bend And Thread Fixati	BOTH IP/OP	"$5,911.00 "	"$4,374.14"	$0.00	"$4,728.80"	"$2,659.95"	"$2,659.95"	$0.00	$0.00	$0.00	"$1,232.00"	"$4,181.12"	"$4,181.12"	"$4,556.20"	$0.00	"$1,231.85"	$0.00	"$2,914.12"	"$2,914.12"	$0.00	"$2,955.50"	"$4,681.51"	"$4,728.80"	$0.00	$0.00	$0.00	$925.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500278	EAP	HCPCS C1900		Left Ventricular Lead With 2d Pre-shaped Bend At Distal End	BOTH IP/OP	"$5,911.00 "	"$4,374.14"	$0.00	"$4,728.80"	"$2,659.95"	"$2,659.95"	$0.00	$0.00	$0.00	"$1,232.00"	"$4,181.12"	"$4,181.12"	"$4,556.20"	$0.00	"$1,231.85"	$0.00	"$2,914.12"	"$2,914.12"	$0.00	"$2,955.50"	"$4,681.51"	"$4,728.80"	$0.00	$0.00	$0.00	$925.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500279	EAP	HCPCS C1895		Is-1  Silicone  35cm  V Placement	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500280	EAP	HCPCS C1895		Is-1  Silicone  54cm  V Placement	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500281	EAP	HCPCS C1892		Is-1  Polyurethane  44cm  7f Introducer  11mm Electrode Spac	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500282	EAP	HCPCS C1892		Is-1  Polyurethane  52cm  7f Introducer  11mm Electrode Spac	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500283	EAP	HCPCS C1892		Is-1  Polyurethane  58cm  7f Introducer  11mm Electrode Spac	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500284	EAP	HCPCS C1892		Is-1  Polyurethane  7f  11mm Electrode Spacing  48cm  Prefor	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500285	EAP	HCPCS C1892		Is-1  Polyurethane  7f  11mm Electrode Spacing  52cm  Prefor	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500286	EAP	HCPCS C1892		Is-1  Polyurethane  7f  11mm Electrode Spacing  52cm  Straig	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500287	EAP	HCPCS C1892		Is-1  Polyurethane  7f  11mm Electrode Spacing  58cm  Straig	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500288	EAP	HCPCS C1892		Is-1  Polyurethane  7f  11mm Electrode Spacing  44cm  Prefor	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500289	EAP	HCPCS C1892		Is-1  Polyurethane  7f  11mm Electrode Spacing  52cm  Prefor	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27500290	EAP	HCPCS C1785		Reply Dr V2	BOTH IP/OP	"$12,413.00 "	"$9,185.62"	$0.00	"$9,930.40"	"$5,585.85"	"$5,585.85"	$0.00	$0.00	$0.00	"$2,587.18"	"$4,181.12"	"$4,181.12"	"$9,567.94"	$0.00	"$2,586.87"	$0.00	"$6,119.61"	"$6,119.61"	$0.00	"$6,206.50"	"$9,831.10"	"$9,930.40"	$0.00	$0.00	$0.00	"$1,942.63"	$0.00	$0.00	"$1,976.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27500291	EAP	HCPCS C1785		Reply Dr V2  System	BOTH IP/OP	"$14,777.00 "	"$10,934.98"	$0.00	"$11,821.60"	"$6,649.65"	"$6,649.65"	$0.00	$0.00	$0.00	"$3,079.90"	"$4,181.12"	"$4,181.12"	"$11,390.11"	$0.00	"$3,079.53"	$0.00	"$7,285.06"	"$7,285.06"	$0.00	"$7,388.50"	"$11,703.38"	"$11,821.60"	$0.00	$0.00	$0.00	"$2,312.60"	$0.00	$0.00	"$2,352.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27500292	EAP	HCPCS C1785		Esprit Dr	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500293	EAP	HCPCS C1785		Esprit Dr System	BOTH IP/OP	"$14,777.00 "	"$10,934.98"	$0.00	"$11,821.60"	"$6,649.65"	"$6,649.65"	$0.00	$0.00	$0.00	"$3,079.90"	"$4,181.12"	"$4,181.12"	"$11,390.11"	$0.00	"$3,079.53"	$0.00	"$7,285.06"	"$7,285.06"	$0.00	"$7,388.50"	"$11,703.38"	"$11,821.60"	$0.00	$0.00	$0.00	"$2,312.60"	$0.00	$0.00	"$2,352.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27500294	EAP	HCPCS C1786		Reply Sr V2	BOTH IP/OP	"$9,753.00 "	"$7,217.22"	$0.00	"$7,802.40"	"$4,388.85"	"$4,388.85"	$0.00	$0.00	$0.00	"$2,032.77"	"$4,181.12"	"$4,181.12"	"$7,517.61"	$0.00	"$2,032.53"	$0.00	"$4,808.23"	"$4,808.23"	$0.00	"$4,876.50"	"$7,724.38"	"$7,802.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500295	EAP	HCPCS C1786		Reply Sr V2 System	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500296	EAP	HCPCS C1786		Esprit Sr	BOTH IP/OP	"$10,344.00 "	"$7,654.56"	$0.00	"$8,275.20"	"$4,654.80"	"$4,654.80"	$0.00	$0.00	$0.00	"$2,155.95"	"$4,181.12"	"$4,181.12"	"$7,973.16"	$0.00	"$2,155.69"	$0.00	"$5,099.59"	"$5,099.59"	$0.00	"$5,172.00"	"$8,192.45"	"$8,275.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500297	EAP	HCPCS C1786		Esprit Sr System	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500298	EAP	HCPCS C1882		Paradym Crt-d 8750	BOTH IP/OP	"$55,268.00 "	"$40,898.32"	$0.00	"$44,214.40"	"$24,870.60"	"$24,870.60"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$42,600.57"	$0.00	"$11,517.85"	$0.00	"$27,247.12"	"$27,247.12"	$0.00	"$27,634.00"	"$43,772.26"	"$44,214.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500299	EAP	HCPCS C1882		Paradym Crt-d 8750 System	BOTH IP/OP	"$65,318.00 "	"$48,335.32"	$0.00	"$52,254.40"	"$29,393.10"	"$29,393.10"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$50,347.11"	$0.00	"$13,612.27"	$0.00	"$32,201.77"	"$32,201.77"	$0.00	"$32,659.00"	"$51,731.86"	"$52,254.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500300	EAP	HCPCS C1882		Paradym 8250 Vr	BOTH IP/OP	"$41,378.00 "	"$30,619.72"	$0.00	"$33,102.40"	"$18,620.10"	"$18,620.10"	$0.00	$0.00	$0.00	"$8,624.21"	"$4,181.12"	"$4,181.12"	"$31,894.16"	$0.00	"$8,623.18"	$0.00	"$20,399.35"	"$20,399.35"	$0.00	"$20,689.00"	"$32,771.38"	"$33,102.40"	$0.00	$0.00	$0.00	"$6,475.66"	$0.00	$0.00	"$6,587.38"	$0.00	$0.00	$0.00	$0.00	$0.00
27500301	EAP	HCPCS C1882		Paradym 8550 Dr	BOTH IP/OP	"$48,767.00 "	"$36,087.58"	$0.00	"$39,013.60"	"$21,945.15"	"$21,945.15"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$37,589.60"	$0.00	"$10,163.04"	$0.00	"$24,042.13"	"$24,042.13"	$0.00	"$24,383.50"	"$38,623.46"	"$39,013.60"	$0.00	$0.00	$0.00	"$7,632.04"	$0.00	$0.00	"$7,763.71"	$0.00	$0.00	$0.00	$0.00	$0.00
27500302	EAP	HCPCS C1785		Reply Dr	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27500303	EAP	HCPCS C1785		Reply Dr System	BOTH IP/OP	"$14,777.00 "	"$10,934.98"	$0.00	"$11,821.60"	"$6,649.65"	"$6,649.65"	$0.00	$0.00	$0.00	"$3,079.90"	"$4,181.12"	"$4,181.12"	"$11,390.11"	$0.00	"$3,079.53"	$0.00	"$7,285.06"	"$7,285.06"	$0.00	"$7,388.50"	"$11,703.38"	"$11,821.60"	$0.00	$0.00	$0.00	"$2,312.60"	$0.00	$0.00	"$2,352.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27500304	EAP	HCPCS C1883		Is-1/df-1  Silicone 58cm Integrated Bipolar  Active Fixation	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	$0.00	$0.00	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500305	EAP	HCPCS C1722		Paradym 9550 Rf Dr	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	"$20,614.95"	"$20,614.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27500310	EAP	HCPCS C1722		Defib Cardiac Protecta Vr Implantable Cardioverter	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27500311	EAP	HCPCS C1882		Defibrillator Cardiac Consulta D.59 In W2.01 In X H2.72d	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	"$20,614.95"	"$20,614.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27500312	EAP	HCPCS C1786		Dfbr Crd Inventra 7 Vr-t Dx Impltable Home Monitr	BOTH IP/OP	"$49,688.00 "	"$36,769.12"	$0.00	"$39,750.40"	"$22,359.60"	"$22,359.60"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,299.51"	$0.00	"$10,354.98"	$0.00	"$24,496.18"	"$24,496.18"	$0.00	"$24,844.00"	"$39,352.90"	"$39,750.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500350	EAP	HCPCS C1721		Evera Xt Dr System - Mmem	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500351	EAP	HCPCS C1721		Evera Xt Dr System - Mmee	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500352	EAP	HCPCS C1721		Evera S Dr System - Mmem	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500353	EAP	HCPCS C1721		Evera S Dr System - Mmee	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500354	EAP	HCPCS C1721		Protecta Xt Dr System - Mmem	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500355	EAP	HCPCS C1721		Protecta Xt Dr System - Mmee	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500356	EAP	HCPCS C1722		Evera Xt Vr System - Mmem	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	"$23,274.90"	"$23,274.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500357	EAP	HCPCS C1722		Evera Xt Vr System - Mmee	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	"$23,274.90"	"$23,274.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500358	EAP	HCPCS C1722		Evera S Vr System - Mmem	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	"$23,274.90"	"$23,274.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500359	EAP	HCPCS C1722		Evera S Vr System - Mmee	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	"$23,274.90"	"$23,274.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500360	EAP	HCPCS C1722		Protecta Xt Vr System - Emem	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	"$23,274.90"	"$23,274.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500361	EAP	HCPCS C1722		Protecta Xt Vr System - Emee	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	"$23,274.90"	"$23,274.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500362	EAP	HCPCS C1721		Icd-dr Ddbb1d1 Evera Xt Us Is1/df1	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27500363	EAP	HCPCS C1721		Icd-dr Ddbb1d4 Evera Xt Us Is1/df4	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27500364	EAP	HCPCS C1721		Icd-dr Ddbc3d1 Evera S Is1/df1 Glob	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27500365	EAP	HCPCS C1721		Icd-dr Ddbc3d4 Evera S Is1/df4 Glob	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27500366	EAP	HCPCS C1721		Icd D314drg Protecta Xt Dr Is-1/df-1 Us	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27500367	EAP	HCPCS C1721		Icd D314drm Protecta Xt Dr Us Mr Df4	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27500368	EAP	HCPCS C1722		Icd-vr Dvbb1d1 Evera Xt Is1/df1 Us	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27500369	EAP	HCPCS C1722		Icd-vr Dvbb1d4 Evera Xt Us Is1/df4	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27500370	EAP	HCPCS C1722		Icd-vr Dvbc3d1 Evera S Is1/df1 Glob	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27500371	EAP	HCPCS C1722		Icd-vr Dvbc3d4 Evera S Df4 Glob	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27500372	EAP	HCPCS C1722		Icd D314vrg Protecta Xt Vr Us Mr Bcp	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27500373	EAP	HCPCS C1722		Icd D314vrm Protecta Xt Vr Us Mr Df4 Bcp	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27500374	EAP	HCPCS C1882		Crt D314trg Protecta Xt Crt-d Us Mr	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	"$24,205.95"	"$24,205.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,462.10"	$0.00	"$11,210.04"	$0.00	"$26,518.96"	"$26,518.96"	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500375	EAP	HCPCS C1882		Crt D314trm Protecta Xt Crt-d Us Mr Df4	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	"$24,205.95"	"$24,205.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,462.10"	$0.00	"$11,210.04"	$0.00	"$26,518.96"	"$26,518.96"	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500376	EAP	HCPCS C1882		Protecta Xt Crtd Sys - Mmmm	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500377	EAP	HCPCS C1882		Protecta Xt Crtd Sys - Mmme	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500378	EAP	HCPCS C1882		Protecta Xt Crtd Sys - Mmpm	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500379	EAP	HCPCS C1882		Protecta Xt Crtd Sys - Mmpe	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500380	EAP	HCPCS C1882		Protecta Xt Crtd Sys - Mmam	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500381	EAP	HCPCS C1882		Protecta Xt Crtd Sys - Mmae	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500382	EAP	HCPCS C1779		Lead 5038s-58 Capsure Vdd Quad Av 11.5cm	BOTH IP/OP	"$2,069.00 "	"$1,531.06"	$0.00	"$1,655.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,535.61"	"$1,535.61"	"$1,594.79"	$0.00	$431.18	$0.00	$0.00	$0.00	$0.00	"$1,034.50"	"$1,638.65"	"$1,655.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500383	EAP	HCPCS C1779		Lead 5038-58  Lead-quad Sngl-p A/v 58cm	BOTH IP/OP	"$2,069.00 "	"$1,531.06"	$0.00	"$1,655.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,535.61"	"$1,535.61"	"$1,594.79"	$0.00	$431.18	$0.00	$0.00	$0.00	$0.00	"$1,034.50"	"$1,638.65"	"$1,655.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500384	EAP	HCPCS C1779		Lead 5038l-65  Capsure Vdd Lead 65cm	BOTH IP/OP	"$2,069.00 "	"$1,531.06"	$0.00	"$1,655.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,535.61"	"$1,535.61"	"$1,594.79"	$0.00	$431.18	$0.00	$0.00	$0.00	$0.00	"$1,034.50"	"$1,638.65"	"$1,655.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500385	EAP	HCPCS C1785		Ipg A2dr01 Advisa Mri Dr.	BOTH IP/OP	"$15,073.00 "	"$11,154.02"	$0.00	"$12,058.40"	"$6,782.85"	"$6,782.85"	$0.00	$0.00	$0.00	"$3,141.59"	"$4,181.12"	"$4,181.12"	"$11,618.27"	$0.00	"$3,141.21"	$0.00	"$7,430.99"	"$7,430.99"	$0.00	"$7,536.50"	"$11,937.82"	"$12,058.40"	$0.00	$0.00	$0.00	"$2,358.92"	$0.00	$0.00	"$2,399.62"	$0.00	$0.00	$0.00	$0.00	$0.00
27500386	EAP	HCPCS C1785		Ipg Rvdr01 Revo Mri 1.5t	BOTH IP/OP	"$14,187.00 "	"$10,498.38"	$0.00	"$11,349.60"	"$6,384.15"	"$6,384.15"	$0.00	$0.00	$0.00	"$2,956.93"	"$4,181.12"	"$4,181.12"	"$10,935.34"	$0.00	"$2,956.57"	$0.00	"$6,994.19"	"$6,994.19"	$0.00	"$7,093.50"	"$11,236.10"	"$11,349.60"	$0.00	$0.00	$0.00	"$2,220.27"	$0.00	$0.00	"$2,258.57"	$0.00	$0.00	$0.00	$0.00	$0.00
27500387	EAP	HCPCS C1785		Advisa Mri System - Peem	BOTH IP/OP	"$18,029.00 "	"$13,341.46"	$0.00	"$14,423.20"	"$8,113.05"	"$8,113.05"	$0.00	$0.00	$0.00	"$3,757.69"	"$4,181.12"	"$4,181.12"	"$13,896.75"	$0.00	"$3,757.24"	$0.00	"$8,888.30"	"$8,888.30"	$0.00	"$9,014.50"	"$14,278.97"	"$14,423.20"	$0.00	$0.00	$0.00	"$2,821.54"	$0.00	$0.00	"$2,870.22"	$0.00	$0.00	$0.00	$0.00	$0.00
27500388	EAP	HCPCS C1785		Revo Mri System - Peem	BOTH IP/OP	"$17,142.00 "	"$12,685.08"	$0.00	"$13,713.60"	"$7,713.90"	"$7,713.90"	$0.00	$0.00	$0.00	"$3,572.82"	"$4,181.12"	"$4,181.12"	"$13,213.05"	$0.00	"$3,572.39"	$0.00	"$8,451.01"	"$8,451.01"	$0.00	"$8,571.00"	"$13,576.46"	"$13,713.60"	$0.00	$0.00	$0.00	"$2,682.72"	$0.00	$0.00	"$2,729.01"	$0.00	$0.00	$0.00	$0.00	$0.00
27500389	EAP	HCPCS C1882		Crt-d Dtbb1d1 Viva Sis1/df1 Us	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	"$24,205.95"	"$24,205.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,462.10"	$0.00	"$11,210.04"	$0.00	"$26,518.96"	"$26,518.96"	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500390	EAP	HCPCS C1882		Crt-d Dtbb1d4 Viva Sis1/df4 Us	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	"$24,205.95"	"$24,205.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,462.10"	$0.00	"$11,210.04"	$0.00	"$26,518.96"	"$26,518.96"	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500391	EAP	HCPCS C1882		Viva S Crtd System - Mmmm	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500392	EAP	HCPCS C1882		Viva S Crtd System - Mmpm	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500393	EAP	HCPCS C1882		Viva S Crtd System - Mmam	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27500394	EAP	HCPCS C1786		Pcmkr Crd Thk6mm Sm 50x41mm Endurity 1 Chmbr Is-1 Conctr	BOTH IP/OP	"$11,942.00 "	"$8,837.08"	$0.00	"$9,553.60"	"$5,373.90"	"$5,373.90"	$0.00	$0.00	$0.00	"$2,489.01"	"$4,181.12"	"$4,181.12"	"$9,204.89"	$0.00	"$2,488.71"	$0.00	"$5,887.41"	"$5,887.41"	$0.00	"$5,971.00"	"$9,458.06"	"$9,553.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500395	EAP	HCPCS C1785		Pcmkr Crd Thk6mm Sm 50x47mm Assurity Dr 2 Chmbr Is-1 Conctr	BOTH IP/OP	"$18,765.00 "	"$13,886.10"	$0.00	"$15,012.00"	"$8,444.25"	"$8,444.25"	$0.00	$0.00	$0.00	"$3,911.10"	"$4,181.12"	"$4,181.12"	"$14,464.06"	$0.00	"$3,910.63"	$0.00	"$9,251.15"	"$9,251.15"	$0.00	"$9,382.50"	"$14,861.88"	"$15,012.00"	$0.00	"$8,444.25"	$0.00	"$2,936.72"	$0.00	$0.00	"$2,987.39"	$0.00	$0.00	$0.00	$0.00	$0.00
27500396	EAP	HCPCS C1785		Pcmkr Crd Thk6mm Sm 46x50x6 Endurity Dr 2 Chmbr Is-1 Conctr	BOTH IP/OP	"$16,141.00 "	"$11,944.34"	$0.00	"$12,912.80"	"$7,263.45"	"$7,263.45"	$0.00	$0.00	$0.00	"$3,364.19"	"$4,181.12"	"$4,181.12"	"$12,441.48"	$0.00	"$3,363.78"	$0.00	"$7,957.51"	"$7,957.51"	$0.00	"$8,070.50"	"$12,783.67"	"$12,912.80"	$0.00	$0.00	$0.00	"$2,526.07"	$0.00	$0.00	"$2,569.65"	$0.00	$0.00	$0.00	$0.00	$0.00
27500397	EAP	HCPCS C1786		Pcmkr Crd Thk6mm Sm 50x47mm Assurity Sr 1 Chmbr Is-1 Conctr	BOTH IP/OP	"$14,960.00 "	"$11,070.40"	$0.00	"$11,968.00"	"$6,732.00"	"$6,732.00"	$0.00	$0.00	$0.00	"$3,118.04"	"$4,181.12"	"$4,181.12"	"$11,531.17"	$0.00	"$3,117.66"	$0.00	"$7,375.28"	"$7,375.28"	$0.00	"$7,480.00"	"$11,848.32"	"$11,968.00"	$0.00	"$6,732.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500398	EAP	HCPCS C1786		Pcmkr Crd Thk6mm Sm 41x50 X6 Endurity Sr 1 Chmbr Is-1 Conctr	BOTH IP/OP	"$12,335.00 "	"$9,127.90"	$0.00	"$9,868.00"	"$5,550.75"	"$5,550.75"	$0.00	$0.00	$0.00	"$2,570.92"	"$4,181.12"	"$4,181.12"	"$9,507.82"	$0.00	"$2,570.61"	$0.00	"$6,081.16"	"$6,081.16"	$0.00	"$6,167.50"	"$9,769.32"	"$9,868.00"	$0.00	"$5,550.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500399	EAP	HCPCS C1785		Pcmkr Crd Thk6mm Sm 50x47mm Assurity Dr Rf Chmbr Is-1 Conctr	BOTH IP/OP	"$19,946.00 "	"$14,760.04"	$0.00	"$15,956.80"	"$8,975.70"	"$8,975.70"	$0.00	$0.00	$0.00	"$4,157.25"	"$4,181.12"	"$4,181.12"	"$15,374.38"	$0.00	"$4,156.75"	$0.00	"$9,833.38"	"$9,833.38"	$0.00	"$9,973.00"	"$15,797.23"	"$15,956.80"	$0.00	"$8,975.70"	$0.00	"$3,121.55"	$0.00	$0.00	"$3,175.40"	$0.00	$0.00	$0.00	$0.00	$0.00
27500400	EAP	HCPCS C1785		Pcmkr Crd Thk6mm Sm Endurity Dr Rf Chmbr Is-1 Conctr Atcpt	BOTH IP/OP	"$17,322.00 "	"$12,818.28"	$0.00	"$13,857.60"	"$7,794.90"	"$7,794.90"	$0.00	$0.00	$0.00	"$3,610.34"	"$4,181.12"	"$4,181.12"	"$13,351.80"	$0.00	"$3,609.90"	$0.00	"$8,539.75"	"$8,539.75"	$0.00	"$8,661.00"	"$13,719.02"	"$13,857.60"	$0.00	"$7,794.90"	$0.00	"$2,710.89"	$0.00	$0.00	"$2,757.66"	$0.00	$0.00	$0.00	$0.00	$0.00
27500401	EAP	HCPCS C1786		Pcmkr Crd Thk6mm Sm 50x47mm Assurity 1 Chmbr Is-1 Conctr	BOTH IP/OP	"$16,141.00 "	"$11,944.34"	$0.00	"$12,912.80"	"$7,263.45"	"$7,263.45"	$0.00	$0.00	$0.00	"$3,364.19"	"$4,181.12"	"$4,181.12"	"$12,441.48"	$0.00	"$3,363.78"	$0.00	"$7,957.51"	"$7,957.51"	$0.00	"$8,070.50"	"$12,783.67"	"$12,912.80"	$0.00	"$7,263.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500402	EAP	HCPCS C1786		Pcmkr Crd Thk6mm Sm 50x47mm Endurity 1 Chmbr Is-1 Conctr	BOTH IP/OP	"$13,516.00 "	"$10,001.84"	$0.00	"$10,812.80"	"$6,082.20"	"$6,082.20"	$0.00	$0.00	$0.00	"$2,817.07"	"$4,181.12"	"$4,181.12"	"$10,418.13"	$0.00	"$2,816.73"	$0.00	"$6,663.39"	"$6,663.39"	$0.00	"$6,758.00"	"$10,704.67"	"$10,812.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500403	EAP	HCPCS C2621		Pcmkr Crd Thk6mm 59x56mm Alr Qd Rf Is4-llll Conctr Is-1	BOTH IP/OP	"$18,372.00 "	"$13,595.28"	$0.00	"$14,697.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,161.14"	$0.00	"$3,828.72"	$0.00	$0.00	$0.00	$0.00	"$9,186.00"	"$14,550.62"	"$14,697.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500404	EAP	HCPCS C2621		Pcmkr Crd Thk6mm 59x55mm Alr Rf Is-1 Conctr Corvue Thor	BOTH IP/OP	"$15,747.00 "	"$11,652.78"	$0.00	"$12,597.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,137.79"	$0.00	"$3,281.67"	$0.00	$0.00	$0.00	$0.00	"$7,873.50"	"$12,471.62"	"$12,597.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500405	EAP	HCPCS C2621		Pcmkr Crd Thk6mm 59x56mm Alr Qd Pkg Is4-llll Conctr Is-1	BOTH IP/OP	"$19,553.00 "	"$14,469.22"	$0.00	"$15,642.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$15,071.45"	$0.00	"$4,074.85"	$0.00	$0.00	$0.00	$0.00	"$9,776.50"	"$15,485.98"	"$15,642.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500406	EAP	HCPCS C2621		Pcmkr Crd Thk6mm 59x55mm Alr Pkg Is-1 Conctr Corvue Thor	BOTH IP/OP	"$16,928.00 "	"$12,526.72"	$0.00	"$13,542.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,048.10"	$0.00	"$3,527.80"	$0.00	$0.00	$0.00	$0.00	"$8,464.00"	"$13,406.98"	"$13,542.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500407	EAP	HCPCS C2621		Pcmkr Crd Thk6mm 59x56mm Alr Qd Rf Sys Is4-llll Conctr Is-1	BOTH IP/OP	"$29,001.00 "	"$21,460.74"	$0.00	"$23,200.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$22,353.97"	$0.00	"$6,043.81"	$0.00	$0.00	$0.00	$0.00	"$14,500.50"	"$22,968.79"	"$23,200.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500408	EAP	HCPCS C2621		Pcmkr Crd Thk6mm 59x55mm Alr Rf Sys Is-1 Conctr Corvue Thor	BOTH IP/OP	"$26,377.00 "	"$19,518.98"	$0.00	"$21,101.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$20,331.39"	$0.00	"$5,496.97"	$0.00	$0.00	$0.00	$0.00	"$13,188.50"	"$20,890.58"	"$21,101.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500409	EAP	HCPCS C2621		Pcmkr Crd Thk6mm 59x56mm Alr Crt-p Sys Is4-llll Conctr Is-1	BOTH IP/OP	"$30,182.00 "	"$22,334.68"	$0.00	"$24,145.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$23,264.29"	$0.00	"$6,289.93"	$0.00	$0.00	$0.00	$0.00	"$15,091.00"	"$23,904.14"	"$24,145.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500410	EAP	HCPCS C2621		Pcmkr Crd Thk6mm 59x55mm Alr Crt-p Sys Is-1 Con Corvue Thor	BOTH IP/OP	"$27,558.00 "	"$20,392.92"	$0.00	"$22,046.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,241.71"	$0.00	"$5,743.09"	$0.00	$0.00	$0.00	$0.00	"$13,779.00"	"$21,825.94"	"$22,046.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500411	EAP	HCPCS C1785		Pcmkr Cd 7.5mm Md Ellipse 44.5x47mm Ing Rythmiq	BOTH IP/OP	"$10,498.00 "	"$7,768.52"	$0.00	"$8,398.40"	"$4,724.10"	"$4,724.10"	$0.00	$0.00	$0.00	"$2,188.05"	"$4,181.12"	"$4,181.12"	"$8,091.86"	$0.00	"$2,187.78"	$0.00	"$5,175.51"	"$5,175.51"	$0.00	"$5,249.00"	"$8,314.42"	"$8,398.40"	$0.00	$0.00	$0.00	"$1,642.94"	$0.00	$0.00	"$1,671.28"	$0.00	$0.00	$0.00	$0.00	$0.00
27500412	EAP	HCPCS C1786		Pcmkr Cd 7.5mm Md Ellipse 44.5x45.7mm Ing Rythmiq	BOTH IP/OP	"$9,186.00 "	"$6,797.64"	$0.00	"$7,348.80"	"$4,133.70"	"$4,133.70"	$0.00	$0.00	$0.00	"$1,914.59"	"$4,181.12"	"$4,181.12"	"$7,080.57"	$0.00	"$1,914.36"	$0.00	"$4,528.70"	"$4,528.70"	$0.00	"$4,593.00"	"$7,275.31"	"$7,348.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500413	EAP	HCPCS C1896		Dual Chamber Adaptive Rate Ingenior Dr System 8n22	BOTH IP/OP	"$13,123.00 "	"$9,711.02"	$0.00	"$10,498.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,735.16"	"$4,181.12"	"$4,181.12"	"$10,115.21"	$0.00	"$2,734.83"	$0.00	"$6,469.64"	"$6,469.64"	$0.00	"$6,561.50"	"$10,393.42"	"$10,498.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500414	EAP	HCPCS C1896		Single Chmbr Adptiv Rt Ingenio Sr System 8n32	BOTH IP/OP	"$10,236.00 "	"$7,574.64"	$0.00	"$8,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,133.44"	"$4,181.12"	"$4,181.12"	"$7,889.91"	$0.00	"$2,133.18"	$0.00	"$5,046.35"	"$5,046.35"	$0.00	"$5,118.00"	"$8,106.91"	"$8,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500415	EAP	HCPCS C1722		Itrevia Vr-t Df-1 Hgh Eng W/ti W/hm Monitoring	BOTH IP/OP	"$34,906.00 "	"$25,830.44"	$0.00	"$27,924.80"	"$15,707.70"	"$15,707.70"	$0.00	$0.00	$0.00	"$7,275.28"	"$4,181.12"	"$4,181.12"	"$26,905.54"	$0.00	"$7,274.41"	$0.00	"$17,208.66"	"$17,208.66"	$0.00	"$17,453.00"	"$27,645.55"	"$27,924.80"	$0.00	$0.00	$0.00	"$5,462.79"	$0.00	$0.00	"$5,557.04"	$0.00	$0.00	$0.00	$0.00	$0.00
27500416	EAP	HCPCS C1721		Dfbr Crd Evera Mri Surescan Df-1 Pin Plg Xt Dr	BOTH IP/OP	"$41,500.00 "	"$30,710.00"	$0.00	"$33,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,649.64"	"$4,181.12"	"$4,181.12"	"$31,988.20"	$0.00	"$8,648.60"	$0.00	"$20,459.50"	"$20,459.50"	$0.00	"$20,750.00"	"$32,868.00"	"$33,200.00"	$0.00	"$18,675.00"	$0.00	"$6,494.75"	$0.00	$0.00	"$6,606.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27500417	EAP	HCPCS C1721		Evera Mri Xt Dr Icd (dual Chamber Icd) Df4 Header	BOTH IP/OP	"$41,500.00 "	"$30,710.00"	$0.00	"$33,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,649.64"	"$4,181.12"	"$4,181.12"	"$31,988.20"	$0.00	"$8,648.60"	$0.00	"$20,459.50"	"$20,459.50"	$0.00	"$20,750.00"	"$32,868.00"	"$33,200.00"	$0.00	"$18,675.00"	$0.00	"$6,494.75"	$0.00	$0.00	"$6,606.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27500418	EAP	HCPCS C1722		Dfbr Crd Visia Af Mri Df4 Vr	BOTH IP/OP	"$36,500.00 "	"$27,010.00"	$0.00	"$29,200.00"	"$16,425.00"	"$16,425.00"	$0.00	$0.00	$0.00	"$7,607.51"	"$4,181.12"	"$4,181.12"	"$28,134.20"	$0.00	"$7,606.60"	$0.00	"$17,994.50"	"$17,994.50"	$0.00	"$18,250.00"	"$28,908.00"	"$29,200.00"	$0.00	"$16,425.00"	$0.00	"$5,712.25"	$0.00	$0.00	"$5,810.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27500419	EAP	HCPCS C1722		Visia Vr Icd (single Chamber Icd)  Df 1 Header	BOTH IP/OP	"$36,500.00 "	"$27,010.00"	$0.00	"$29,200.00"	"$16,425.00"	"$16,425.00"	$0.00	$0.00	$0.00	"$7,607.51"	"$4,181.12"	"$4,181.12"	"$28,134.20"	$0.00	"$7,606.60"	$0.00	"$17,994.50"	"$17,994.50"	$0.00	"$18,250.00"	"$28,908.00"	"$29,200.00"	$0.00	"$16,425.00"	$0.00	"$5,712.25"	$0.00	$0.00	"$5,810.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27500420	EAP	HCPCS C1786		Pacemaker Cardiac .75cm 4.45x4.81cm 1 Chamber Is1 Conctr	BOTH IP/OP	"$8,600.00 "	"$6,364.00"	$0.00	"$6,880.00"	"$3,870.00"	"$3,870.00"	$0.00	$0.00	$0.00	"$1,792.46"	"$4,181.12"	"$4,181.12"	"$6,628.88"	$0.00	"$1,792.24"	$0.00	"$4,239.80"	"$4,239.80"	$0.00	"$4,300.00"	"$6,811.20"	"$6,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500421	EAP	HCPCS C1722		Defibrillator Cardiac .99cm 5.37x7.79cm 1 Chamber Is-1 Df-4	BOTH IP/OP	"$33,750.00 "	"$24,975.00"	$0.00	"$27,000.00"	"$15,187.50"	"$15,187.50"	$0.00	$0.00	$0.00	"$7,034.34"	"$4,181.12"	"$4,181.12"	"$26,014.50"	$0.00	"$7,033.50"	$0.00	"$16,638.75"	"$16,638.75"	$0.00	"$16,875.00"	"$26,730.00"	"$27,000.00"	$0.00	$0.00	$0.00	"$5,281.88"	$0.00	$0.00	"$5,373.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27500422	EAP	HCPCS C1721		Defibrillator Cardiac .99cm 5.37x7.68cm 2 Chamber Extend	BOTH IP/OP	"$37,500.00 "	"$27,750.00"	$0.00	"$30,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,815.94"	"$4,181.12"	"$4,181.12"	"$28,905.00"	$0.00	"$7,815.00"	$0.00	"$18,487.50"	"$18,487.50"	$0.00	"$18,750.00"	"$29,700.00"	"$30,000.00"	$0.00	"$16,875.00"	$0.00	"$5,868.75"	$0.00	$0.00	"$5,970.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27500423	EAP	HCPCS C1721		Defibrillator Cardiac .99cm 5.37x7.79cm 2 Chamber Extend	BOTH IP/OP	"$37,500.00 "	"$27,750.00"	$0.00	"$30,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,815.94"	"$4,181.12"	"$4,181.12"	"$28,905.00"	$0.00	"$7,815.00"	$0.00	"$18,487.50"	"$18,487.50"	$0.00	"$18,750.00"	"$29,700.00"	"$30,000.00"	$0.00	$0.00	$0.00	"$5,868.75"	$0.00	$0.00	"$5,970.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27500424	EAP	HCPCS C1882		Defibrillator Cardiac .99cm 5.37x8.08cm Is-1 Df-1 Lv-1	BOTH IP/OP	"$44,750.00 "	"$33,115.00"	$0.00	"$35,800.00"	"$20,137.50"	"$20,137.50"	$0.00	$0.00	$0.00	"$9,327.02"	"$4,181.12"	"$4,181.12"	"$34,493.30"	$0.00	"$9,325.90"	$0.00	"$22,061.75"	"$22,061.75"	$0.00	"$22,375.00"	"$35,442.00"	"$35,800.00"	$0.00	$0.00	$0.00	"$7,003.38"	$0.00	$0.00	"$7,124.20"	$0.00	$0.00	$0.00	$0.00	$0.00
27500425	EAP	HCPCS C1893		Acuity Pro Implant Tools/lead Delivery System	BOTH IP/OP	"$15,250.00 "	"$11,285.00"	$0.00	"$12,200.00"	"$6,862.50"	"$6,862.50"	$0.00	$0.00	$0.00	"$3,178.48"	"$4,181.12"	"$4,181.12"	"$11,754.70"	$0.00	"$3,178.10"	$0.00	"$7,518.25"	"$7,518.25"	$0.00	"$7,625.00"	"$12,078.00"	"$12,200.00"	$0.00	$0.00	$0.00	"$2,386.63"	$0.00	$0.00	"$2,427.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27500426	EAP	HCPCS C2621		Pacemaker Cardiac 3d .75cm 16.2cu Cm Spiral 2.6fr 4.45x6.13	BOTH IP/OP	"$15,250.00 "	"$11,285.00"	$0.00	"$12,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,754.70"	$0.00	"$3,178.10"	$0.00	$0.00	$0.00	$0.00	"$7,625.00"	"$12,078.00"	"$12,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500427	EAP	HCPCS C1882		Defibrillator Cardiac .99in Mini 5.37x8.18cm Is-1 Df-4 Is-4	BOTH IP/OP	"$44,750.00 "	"$33,115.00"	$0.00	"$35,800.00"	"$20,137.50"	"$20,137.50"	$0.00	$0.00	$0.00	"$9,327.02"	"$4,181.12"	"$4,181.12"	"$34,493.30"	$0.00	"$9,325.90"	$0.00	"$22,061.75"	"$22,061.75"	$0.00	"$22,375.00"	"$35,442.00"	"$35,800.00"	$0.00	$0.00	$0.00	"$7,003.38"	$0.00	$0.00	"$7,124.20"	$0.00	$0.00	$0.00	$0.00	$0.00
27500428	EAP	HCPCS C1882		Defibrillator Cardiac .99in Mini 5.37x8.08cm Is-1 Df-1 Is-4	BOTH IP/OP	"$44,750.00 "	"$33,115.00"	$0.00	"$35,800.00"	"$20,137.50"	"$20,137.50"	$0.00	$0.00	$0.00	"$9,327.02"	"$4,181.12"	"$4,181.12"	"$34,493.30"	$0.00	"$9,325.90"	$0.00	"$22,061.75"	"$22,061.75"	$0.00	"$22,375.00"	"$35,442.00"	"$35,800.00"	$0.00	$0.00	$0.00	"$7,003.38"	$0.00	$0.00	"$7,124.20"	$0.00	$0.00	$0.00	$0.00	$0.00
27500429	EAP	HCPCS C1900		Lead Pacing X4 95 Cmconctr Acuity Left Ventricle Spiral L	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	"$5,202.90"	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00	$0.00	$0.00	"$1,056.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500430	EAP	HCPCS C1900		Lead Pacing X4 86cm Conctr Acuity Left Ventricle Spiral L	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	"$5,202.90"	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00	$0.00	$0.00	"$1,056.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500431	EAP	HCPCS C1900		Lead Pacing X4 95cm Conctr Acuity Left Ventricle Straight	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	"$5,202.90"	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00	$0.00	$0.00	"$1,056.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500432	EAP	HCPCS C1900		Lead Pacing X4 86 Cm Conctr Acuity Left Ventricle Spiral S	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	"$5,202.90"	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00	"$3,037.50"	$0.00	"$1,056.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500433	EAP	HCPCS C1900		Lead Pacing X4 95 Cm Conctr Acuity Left Ventricle Spiral S	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	"$5,202.90"	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00	$0.00	$0.00	"$1,056.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500434	EAP	HCPCS C1900		Lead Pacing X4 86 Cm Conctr Acuity Left Ventricle Straight	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	"$5,202.90"	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00	$0.00	$0.00	"$1,056.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500435	EAP	HCPCS C1882		Inventra 7 Vr-t Dx	BOTH IP/OP	"$49,688.00 "	"$36,769.12"	$0.00	"$39,750.40"	"$22,359.60"	"$22,359.60"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,299.51"	$0.00	"$10,354.98"	$0.00	"$24,496.18"	"$24,496.18"	$0.00	"$24,844.00"	"$39,352.90"	"$39,750.40"	$0.00	"$22,359.60"	$0.00	"$7,751.33"	$0.00	$0.00	"$7,910.33"	$0.00	$0.00	$0.00	$0.00	$0.00
27500440	EAP	HCPCS C1785		Pacemaker Crd Promri 2 Chmbr Eluna Dr-t	BOTH IP/OP	"$14,000.00 "	"$10,360.00"	$0.00	"$11,200.00"	"$6,300.00"	"$6,300.00"	$0.00	$0.00	$0.00	"$2,917.95"	"$4,181.12"	"$4,181.12"	"$10,791.20"	$0.00	"$2,917.60"	$0.00	"$6,902.00"	"$6,902.00"	$0.00	"$7,000.00"	"$11,088.00"	"$11,200.00"	$0.00	$0.00	$0.00	"$2,191.00"	$0.00	$0.00	"$2,228.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27500441	EAP	HCPCS C1785		Pacemaker Crd Promri Eluna Dr-t Lead Cllr Home	BOTH IP/OP	"$16,500.00 "	"$12,210.00"	$0.00	"$13,200.00"	"$7,425.00"	"$7,425.00"	$0.00	$0.00	$0.00	"$3,439.01"	"$4,181.12"	"$4,181.12"	"$12,718.20"	$0.00	"$3,438.60"	$0.00	"$8,134.50"	"$8,134.50"	$0.00	"$8,250.00"	"$13,068.00"	"$13,200.00"	$0.00	$0.00	$0.00	"$2,582.25"	$0.00	$0.00	"$2,626.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27500442	EAP	HCPCS C1786		Pacemaker Crd Eluna Sr-t Promri	BOTH IP/OP	"$12,125.00 "	"$8,972.50"	$0.00	"$9,700.00"	"$5,456.25"	"$5,456.25"	$0.00	$0.00	$0.00	"$2,527.15"	"$4,181.12"	"$4,181.12"	"$9,345.95"	$0.00	"$2,526.85"	$0.00	"$5,977.63"	"$5,977.63"	$0.00	"$6,062.50"	"$9,603.00"	"$9,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27500443	EAP	HCPCS C1786		Pacemaker Crd Promri Eluna Sr-t Lead Cllr Home	BOTH IP/OP	"$13,250.00 "	"$9,805.00"	$0.00	"$10,600.00"	"$5,962.50"	"$5,962.50"	$0.00	$0.00	$0.00	"$2,761.63"	"$4,181.12"	"$4,181.12"	"$10,213.10"	$0.00	"$2,761.30"	$0.00	"$6,532.25"	"$6,532.25"	$0.00	"$6,625.00"	"$10,494.00"	"$10,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503012	EAP	HCPCS C1785		"Altrua 60 Pmkr, Dual, Rate-resp"	BOTH IP/OP	"$12,375.00 "	"$9,157.50"	$0.00	"$9,900.00"	"$5,568.75"	"$5,568.75"	$0.00	$0.00	$0.00	"$2,579.26"	"$4,181.12"	"$4,181.12"	"$9,538.65"	$0.00	"$2,578.95"	$0.00	"$6,100.88"	"$6,100.88"	$0.00	"$6,187.50"	"$9,801.00"	"$9,900.00"	$0.00	$0.00	$0.00	"$1,936.69"	$0.00	$0.00	"$1,970.10"	$0.00	$0.00	$0.00	$0.00	$0.00
27503013	EAP	HCPCS C1786		"Altrua Pmkr, Single, Rate-resp"	BOTH IP/OP	"$10,553.00 "	"$7,809.22"	$0.00	"$8,442.40"	"$4,748.85"	"$4,748.85"	$0.00	$0.00	$0.00	"$2,199.51"	"$4,181.12"	"$4,181.12"	"$8,134.25"	$0.00	"$2,199.25"	$0.00	"$5,202.63"	"$5,202.63"	$0.00	"$5,276.50"	"$8,357.98"	"$8,442.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503014	EAP	HCPCS C1721		Energen Dr Aicd Dual Chamber	BOTH IP/OP	"$46,552.00 "	"$34,448.48"	$0.00	"$37,241.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,882.28"	$0.00	"$9,701.44"	$0.00	"$22,950.14"	"$22,950.14"	$0.00	"$23,276.00"	"$36,869.18"	"$37,241.60"	$0.00	$0.00	$0.00	"$7,285.39"	$0.00	$0.00	"$7,411.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27503015	EAP	HCPCS C1722		Energen Vr Aicd Single Chamber	BOTH IP/OP	"$38,792.00 "	"$28,706.08"	$0.00	"$31,033.60"	"$17,456.40"	"$17,456.40"	$0.00	$0.00	$0.00	"$8,085.22"	"$4,181.12"	"$4,181.12"	"$29,900.87"	$0.00	"$8,084.25"	$0.00	"$19,124.46"	"$19,124.46"	$0.00	"$19,396.00"	"$30,723.26"	"$31,033.60"	$0.00	$0.00	$0.00	"$6,070.95"	$0.00	$0.00	"$6,175.69"	$0.00	$0.00	$0.00	$0.00	$0.00
27503016	EAP	HCPCS C1895		"Reliance Gore Lead,aicd, Endo Dual Coil"	BOTH IP/OP	"$13,964.00 "	"$10,333.36"	$0.00	"$11,171.20"	"$6,283.80"	"$6,283.80"	$0.00	$0.00	$0.00	"$2,910.45"	"$4,181.12"	"$4,181.12"	"$10,763.45"	$0.00	"$2,910.10"	$0.00	"$6,884.25"	"$6,884.25"	$0.00	"$6,982.00"	"$11,059.49"	"$11,171.20"	$0.00	$0.00	$0.00	"$2,185.37"	$0.00	$0.00	"$2,223.07"	$0.00	$0.00	$0.00	$0.00	$0.00
27503017	EAP	HCPCS C2621		Contak Renewal Tr Crt-p	BOTH IP/OP	"$19,861.00 "	"$14,697.14"	$0.00	"$15,888.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$15,308.86"	$0.00	"$4,139.03"	$0.00	$0.00	$0.00	$0.00	"$9,930.50"	"$15,729.91"	"$15,888.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503018	EAP	HCPCS C1900		"Acuity Steerable Lead, Coronary Venous"	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503019	EAP	HCPCS C1900		"Acuity Spiral Lead,coronary Venous"	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503020	EAP	HCPCS C1900		"Easytrak 2 Lead,coronary Venous"	BOTH IP/OP	"$4,656.00 "	"$3,445.44"	$0.00	"$3,724.80"	"$2,095.20"	"$2,095.20"	$0.00	$0.00	$0.00	$970.43	"$3,455.68"	"$3,455.68"	"$3,588.84"	$0.00	$970.31	$0.00	"$2,295.41"	"$2,295.41"	$0.00	"$2,328.00"	"$3,687.55"	"$3,724.80"	$0.00	$0.00	$0.00	$728.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503021	EAP	HCPCS C1900		"Easytrak 3 Lead,coronary Venous"	BOTH IP/OP	"$4,656.00 "	"$3,445.44"	$0.00	"$3,724.80"	"$2,095.20"	"$2,095.20"	$0.00	$0.00	$0.00	$970.43	"$3,455.68"	"$3,455.68"	"$3,588.84"	$0.00	$970.31	$0.00	"$2,295.41"	"$2,295.41"	$0.00	"$2,328.00"	"$3,687.55"	"$3,724.80"	$0.00	$0.00	$0.00	$728.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503022	EAP	HCPCS C1721		Fortify Dr Aicd Dual Chamber	BOTH IP/OP	"$64,394.00 "	"$47,651.56"	$0.00	"$51,515.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$49,634.90"	$0.00	"$13,419.71"	$0.00	"$31,746.24"	"$31,746.24"	$0.00	"$32,197.00"	"$51,000.05"	"$51,515.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503023	EAP	HCPCS C1785		Accent Dr	BOTH IP/OP	"$17,142.00 "	"$12,685.08"	$0.00	"$13,713.60"	"$7,713.90"	"$7,713.90"	$0.00	$0.00	$0.00	"$3,572.82"	"$4,181.12"	"$4,181.12"	"$13,213.05"	$0.00	"$3,572.39"	$0.00	"$8,451.01"	"$8,451.01"	$0.00	"$8,571.00"	"$13,576.46"	"$13,713.60"	$0.00	$0.00	$0.00	"$2,682.72"	$0.00	$0.00	"$2,729.01"	$0.00	$0.00	$0.00	$0.00	$0.00
27503024	EAP	HCPCS C1786		Accent Sr	BOTH IP/OP	"$1,566.00 "	"$1,158.84"	$0.00	"$1,252.80"	$704.70	$704.70	$0.00	$0.00	$0.00	$326.39	"$1,162.29"	"$1,162.29"	"$1,207.07"	$0.00	$326.35	$0.00	$926.29	$926.29	$0.00	$783.00	"$1,240.27"	"$1,252.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503025	EAP	HCPCS C1898		Tendril Sts 2088tc/46	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$665.10	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503028	EAP	HCPCS C1721		Fortify Assura Dr 40	BOTH IP/OP	"$61,328.00 "	"$45,382.72"	$0.00	"$49,062.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$47,271.62"	$0.00	"$12,780.76"	$0.00	"$30,234.70"	"$30,234.70"	$0.00	"$30,664.00"	"$48,571.78"	"$49,062.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503029	EAP	HCPCS C1721		Fortify Assura Dr 40 Df4 Connector	BOTH IP/OP	"$61,328.00 "	"$45,382.72"	$0.00	"$49,062.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$47,271.62"	$0.00	"$12,780.76"	$0.00	"$30,234.70"	"$30,234.70"	$0.00	"$30,664.00"	"$48,571.78"	"$49,062.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503030	EAP	HCPCS C1721		Ellipse Dr 36	BOTH IP/OP	"$61,328.00 "	"$45,382.72"	$0.00	"$49,062.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$47,271.62"	$0.00	"$12,780.76"	$0.00	"$30,234.70"	"$30,234.70"	$0.00	"$30,664.00"	"$48,571.78"	"$49,062.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503031	EAP	HCPCS C1722		Ellipse Dr 36 Df4 Connector	BOTH IP/OP	"$61,328.00 "	"$45,382.72"	$0.00	"$49,062.40"	"$27,597.60"	"$27,597.60"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$47,271.62"	$0.00	"$12,780.76"	$0.00	"$30,234.70"	"$30,234.70"	$0.00	"$30,664.00"	"$48,571.78"	"$49,062.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503032	EAP	HCPCS C1722		Fortify Assura Vr 40	BOTH IP/OP	"$53,200.00 "	"$39,368.00"	$0.00	"$42,560.00"	"$23,940.00"	"$23,940.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,006.56"	$0.00	"$11,086.88"	$0.00	"$26,227.60"	"$26,227.60"	$0.00	"$26,600.00"	"$42,134.40"	"$42,560.00"	$0.00	"$23,940.00"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503033	EAP	HCPCS C1722		Fortify Assura Vr 40 Df4 Connector	BOTH IP/OP	"$53,200.00 "	"$39,368.00"	$0.00	"$42,560.00"	"$23,940.00"	"$23,940.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,006.56"	$0.00	"$11,086.88"	$0.00	"$26,227.60"	"$26,227.60"	$0.00	"$26,600.00"	"$42,134.40"	"$42,560.00"	$0.00	"$23,940.00"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503034	EAP	HCPCS C1722		Ellipse Vr 36	BOTH IP/OP	"$53,200.00 "	"$39,368.00"	$0.00	"$42,560.00"	"$23,940.00"	"$23,940.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,006.56"	$0.00	"$11,086.88"	$0.00	"$26,227.60"	"$26,227.60"	$0.00	"$26,600.00"	"$42,134.40"	"$42,560.00"	$0.00	"$23,940.00"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503035	EAP	HCPCS C1722		Ellipse Vr 36 Df4 Connector	BOTH IP/OP	"$53,200.00 "	"$39,368.00"	$0.00	"$42,560.00"	"$23,940.00"	"$23,940.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,006.56"	$0.00	"$11,086.88"	$0.00	"$26,227.60"	"$26,227.60"	$0.00	"$26,600.00"	"$42,134.40"	"$42,560.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503036	EAP	HCPCS C1882		Quadra Assura Crt-d 40	BOTH IP/OP	"$8,512.00 "	"$6,298.88"	$0.00	"$6,809.60"	"$3,830.40"	"$3,830.40"	$0.00	$0.00	$0.00	"$1,774.11"	"$4,181.12"	"$4,181.12"	"$6,561.05"	$0.00	"$1,773.90"	$0.00	"$4,196.42"	"$4,196.42"	$0.00	"$4,256.00"	"$6,741.50"	"$6,809.60"	$0.00	$0.00	$0.00	"$1,332.13"	$0.00	$0.00	"$1,355.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27503037	EAP	HCPCS C1882		Quadra Assura Crt-d 40 Df4 Connector	BOTH IP/OP	"$85,120.00 "	"$62,988.80"	$0.00	"$68,096.00"	"$38,304.00"	"$38,304.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$65,610.50"	$0.00	"$17,739.01"	$0.00	"$41,964.16"	"$41,964.16"	$0.00	"$42,560.00"	"$67,415.04"	"$68,096.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503038	EAP	HCPCS C1882		Unify Assura Crt-d 40	BOTH IP/OP	"$85,120.00 "	"$62,988.80"	$0.00	"$68,096.00"	"$38,304.00"	"$38,304.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$65,610.50"	$0.00	"$17,739.01"	$0.00	"$41,964.16"	"$41,964.16"	$0.00	"$42,560.00"	"$67,415.04"	"$68,096.00"	$0.00	"$38,304.00"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503039	EAP	HCPCS C1882		Unify Assura Crt-d 40 Df4 Connector	BOTH IP/OP	"$85,120.00 "	"$62,988.80"	$0.00	"$68,096.00"	"$38,304.00"	"$38,304.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$65,610.50"	$0.00	"$17,739.01"	$0.00	"$41,964.16"	"$41,964.16"	$0.00	"$42,560.00"	"$67,415.04"	"$68,096.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503040	EAP	HCPCS C1898		Tendril Sts 2088tc/65	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503041	EAP	HCPCS C1898		Tendril Sts 2088tc/100	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503042	EAP	HCPCS C1785		"Adapta Vdd, Is-i"	BOTH IP/OP	"$4,729.00 "	"$3,499.46"	$0.00	"$3,783.20"	"$2,128.05"	"$2,128.05"	$0.00	$0.00	$0.00	$985.64	"$3,509.86"	"$3,509.86"	"$3,645.11"	$0.00	$985.52	$0.00	"$2,331.40"	"$2,331.40"	$0.00	"$2,364.50"	"$3,745.37"	"$3,783.20"	$0.00	$0.00	$0.00	$740.09	$0.00	$0.00	$752.86	$0.00	$0.00	$0.00	$0.00	$0.00
27503043	EAP	HCPCS C1898		Capsure Vdd2 Lead 5038s-52	BOTH IP/OP	$828.00 	$612.72	$0.00	$662.40	$372.60	$372.60	$0.00	$0.00	$0.00	$172.58	$614.54	$614.54	$638.22	$0.00	$172.56	$0.00	$489.76	$489.76	$0.00	$414.00	$655.78	$662.40	$0.00	$372.60	$0.00	$129.58	$0.00	$0.00	$131.82	$0.00	$0.00	$0.00	$0.00	$0.00
27503044	EAP	HCPCS C1898		Capsure Vdd2 Lead 5032s-58	BOTH IP/OP	$828.00 	$612.72	$0.00	$662.40	$372.60	$372.60	$0.00	$0.00	$0.00	$172.58	$614.54	$614.54	$638.22	$0.00	$172.56	$0.00	$489.76	$489.76	$0.00	$414.00	$655.78	$662.40	$0.00	$0.00	$0.00	$129.58	$0.00	$0.00	$131.82	$0.00	$0.00	$0.00	$0.00	$0.00
27503045	EAP	HCPCS C1898		Capsure Vdd2 Lead 50038-58	BOTH IP/OP	$828.00 	$612.72	$0.00	$662.40	$372.60	$372.60	$0.00	$0.00	$0.00	$172.58	$614.54	$614.54	$638.22	$0.00	$172.56	$0.00	$489.76	$489.76	$0.00	$414.00	$655.78	$662.40	$0.00	$0.00	$0.00	$129.58	$0.00	$0.00	$131.82	$0.00	$0.00	$0.00	$0.00	$0.00
27503046	EAP	HCPCS C1898		Capsure Vdd2 Lead 5038-65	BOTH IP/OP	$828.00 	$612.72	$0.00	$662.40	$372.60	$372.60	$0.00	$0.00	$0.00	$172.58	$614.54	$614.54	$638.22	$0.00	$172.56	$0.00	$489.76	$489.76	$0.00	$414.00	$655.78	$662.40	$0.00	$0.00	$0.00	$129.58	$0.00	$0.00	$131.82	$0.00	$0.00	$0.00	$0.00	$0.00
27503050	EAP	HCPCS C1785		Accent Dr  Pacemaker Generator	BOTH IP/OP	"$17,142.00 "	"$12,685.08"	$0.00	"$13,713.60"	"$7,713.90"	"$7,713.90"	$0.00	$0.00	$0.00	"$3,572.82"	"$4,181.12"	"$4,181.12"	"$13,213.05"	$0.00	"$3,572.39"	$0.00	"$8,451.01"	"$8,451.01"	$0.00	"$8,571.00"	"$13,576.46"	"$13,713.60"	$0.00	"$7,713.90"	$0.00	"$2,682.72"	$0.00	$0.00	"$2,729.01"	$0.00	$0.00	$0.00	$0.00	$0.00
27503051	EAP	HCPCS C1786		Accent Sr Pacemaker Generator	BOTH IP/OP	"$15,665.00 "	"$11,592.10"	$0.00	"$12,532.00"	"$7,049.25"	"$7,049.25"	$0.00	$0.00	$0.00	"$3,264.98"	"$4,181.12"	"$4,181.12"	"$12,074.58"	$0.00	"$3,264.59"	$0.00	"$7,722.85"	"$7,722.85"	$0.00	"$7,832.50"	"$12,406.68"	"$12,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503052	EAP	HCPCS C1898		Tendril Sts 2088tc/46 Lead/electrode/access	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$665.10	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503053	EAP	HCPCS C1898		Tendril Sts 2088tc/52 Lead/electrode/access	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$665.10	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503055	EAP	HCPCS C1721		Fortify Assura Dr 40 Df4 Connector Icd/defib/resync	BOTH IP/OP	"$61,328.00 "	"$45,382.72"	$0.00	"$49,062.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$47,271.62"	$0.00	"$12,780.76"	$0.00	"$30,234.70"	"$30,234.70"	$0.00	"$30,664.00"	"$48,571.78"	"$49,062.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503056	EAP	HCPCS C1721		Fortify Assura Dr 40 Df4 Connector Icd/defib/resync	BOTH IP/OP	"$61,328.00 "	"$45,382.72"	$0.00	"$49,062.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$47,271.62"	$0.00	"$12,780.76"	$0.00	"$30,234.70"	"$30,234.70"	$0.00	"$30,664.00"	"$48,571.78"	"$49,062.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503057	EAP	HCPCS C1721		Ellipse Dr 36 Df4 Connector Icd/defib/resync	BOTH IP/OP	"$61,328.00 "	"$45,382.72"	$0.00	"$49,062.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$47,271.62"	$0.00	"$12,780.76"	$0.00	"$30,234.70"	"$30,234.70"	$0.00	"$30,664.00"	"$48,571.78"	"$49,062.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503058	EAP	HCPCS C1721		Ellipse Dr 36 Df4 Connector Icd/defib/resync	BOTH IP/OP	"$61,328.00 "	"$45,382.72"	$0.00	"$49,062.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$47,271.62"	$0.00	"$12,780.76"	$0.00	"$30,234.70"	"$30,234.70"	$0.00	"$30,664.00"	"$48,571.78"	"$49,062.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503059	EAP	HCPCS C1722		Fortify Assura Vr 40 Df4 Connector Icd/defib/resync	BOTH IP/OP	"$53,200.00 "	"$39,368.00"	$0.00	"$42,560.00"	"$23,940.00"	"$23,940.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,006.56"	$0.00	"$11,086.88"	$0.00	"$26,227.60"	"$26,227.60"	$0.00	"$26,600.00"	"$42,134.40"	"$42,560.00"	$0.00	"$23,940.00"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503060	EAP	HCPCS C1722		Fortify Assura Vr 40 Df4 Connector Icd/defib/resync	BOTH IP/OP	"$53,200.00 "	"$39,368.00"	$0.00	"$42,560.00"	"$23,940.00"	"$23,940.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,006.56"	$0.00	"$11,086.88"	$0.00	"$26,227.60"	"$26,227.60"	$0.00	"$26,600.00"	"$42,134.40"	"$42,560.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503061	EAP	HCPCS C1722		Ellipse Vr 36 Df4 Connector Icd/defib/resync	BOTH IP/OP	"$53,200.00 "	"$39,368.00"	$0.00	"$42,560.00"	"$23,940.00"	"$23,940.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,006.56"	$0.00	"$11,086.88"	$0.00	"$26,227.60"	"$26,227.60"	$0.00	"$26,600.00"	"$42,134.40"	"$42,560.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503062	EAP	HCPCS C1722		Ellipse Vr 36 Df4 Connector Icd/defib/resync	BOTH IP/OP	"$53,200.00 "	"$39,368.00"	$0.00	"$42,560.00"	"$23,940.00"	"$23,940.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,006.56"	$0.00	"$11,086.88"	$0.00	"$26,227.60"	"$26,227.60"	$0.00	"$26,600.00"	"$42,134.40"	"$42,560.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503063	EAP	HCPCS C1882		Quadra Assura Crt-d 40 Df4 Connector Icd/defib/resync	BOTH IP/OP	"$8,512.00 "	"$6,298.88"	$0.00	"$6,809.60"	"$3,830.40"	"$3,830.40"	$0.00	$0.00	$0.00	"$1,774.11"	"$4,181.12"	"$4,181.12"	"$6,561.05"	$0.00	"$1,773.90"	$0.00	"$4,196.42"	"$4,196.42"	$0.00	"$4,256.00"	"$6,741.50"	"$6,809.60"	$0.00	$0.00	$0.00	"$1,332.13"	$0.00	$0.00	"$1,355.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27503064	EAP	HCPCS C1882		Quadra Assura Crt-d 40 Df4 Connector Icd/defib/resync	BOTH IP/OP	"$85,120.00 "	"$62,988.80"	$0.00	"$68,096.00"	"$38,304.00"	"$38,304.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$65,610.50"	$0.00	"$17,739.01"	$0.00	"$41,964.16"	"$41,964.16"	$0.00	"$42,560.00"	"$67,415.04"	"$68,096.00"	$0.00	"$38,304.00"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503065	EAP	HCPCS C1882		Unify Assura Crt-d 40 Df4 Connector    Icd/defib/resync	BOTH IP/OP	"$85,120.00 "	"$62,988.80"	$0.00	"$68,096.00"	"$38,304.00"	"$38,304.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$65,610.50"	$0.00	"$17,739.01"	$0.00	"$41,964.16"	"$41,964.16"	$0.00	"$42,560.00"	"$67,415.04"	"$68,096.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503066	EAP	HCPCS C1882		Unify Assura Crt-d 40 Df4 Connector    Icd/defib/resync	BOTH IP/OP	"$85,120.00 "	"$62,988.80"	$0.00	"$68,096.00"	"$38,304.00"	"$38,304.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$65,610.50"	$0.00	"$17,739.01"	$0.00	"$41,964.16"	"$41,964.16"	$0.00	"$42,560.00"	"$67,415.04"	"$68,096.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503067	EAP	HCPCS C1898		Tendril Sts 2088tc/100  Lead/electrode/access	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503068	EAP	HCPCS C1898		Tendril Sts 2088tc/65    Lead/electrode/access	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503070	EAP	HCPCS C1898		Lead 4076110  Pkg Assy Lead 4076 Mdt Us	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503071	EAP	HCPCS C1898		Lead 407625  Pkg Assy Lead 4076 Mdt Us M	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503072	EAP	HCPCS C1898		Lead 407635 Capsurefix Novus	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503073	EAP	HCPCS C1898		Lead 407645  Pkg Assy Lead 4076 Mdt Us M	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503074	EAP	HCPCS C1898		Lead 407652  Pkg Assy Lead 4076 Mdt Us M	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503075	EAP	HCPCS C1898		Lead 407658  Pkg Assy Lead 4076 Mdt Us M	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503076	EAP	HCPCS C1898		Lead 407665 Capsurefix Novus	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$665.10	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503077	EAP	HCPCS C1898		Lead 407685 Capsurefix Novus	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503081	EAP	HCPCS C1898		Lead 5076-35  Lead-bipolar Sil Screw-in	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$665.10	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503082	EAP	HCPCS C1898		Lead 5076-65  Lead-bipolar Sil Screw-in	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$665.10	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503083	EAP	HCPCS C1898		Lead 5076-85  Lead-bipolar Sil Screw-in	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$665.10	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503084	EAP	HCPCS C1898		Lead 5076110 Capsurefix Novus Pacing	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$665.10	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27503085	EAP	HCPCS C1895		Lead 6947100  Lead-quadripolar Rv/svc 10	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27503086	EAP	HCPCS C1895		Lead 694758  Lead-quadripolar Rv/svc 58c	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27503087	EAP	HCPCS C1895		Lead 694765  Sprint Quad Can Rv/svc	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27503088	EAP	HCPCS C1895		Lead 694775  Lead-quadripolar Rv/svc 75c	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27503089	EAP	HCPCS C1895		Lead 6947m55 Df4 Active Dc Sprint 55 Cm	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	"$5,319.90"	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27503090	EAP	HCPCS C1895		Lead 6947m62 Df4 Active Dc Sprint 62 Cm	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	"$5,319.90"	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27503091	EAP	HCPCS C1895		Lead 6947m72 Df4 Active Dc Sprint 72 Cm	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27503092	EAP	HCPCS C1895		Lead 6947m97 Df4 Active Dc Sprint 97 Cm	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27503093	EAP	HCPCS C1786		Pacemaker Single Chamber Adapta Sr	BOTH IP/OP	"$10,344.00 "	"$7,654.56"	$0.00	"$8,275.20"	"$4,654.80"	"$4,654.80"	$0.00	$0.00	$0.00	"$2,155.95"	"$4,181.12"	"$4,181.12"	"$7,973.16"	$0.00	"$2,155.69"	$0.00	"$5,099.59"	"$5,099.59"	$0.00	"$5,172.00"	"$8,192.45"	"$8,275.20"	$0.00	"$4,654.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503094	EAP	HCPCS C1882		Generator Crt-d Maximo Ii	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	"$24,205.95"	"$24,205.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,462.10"	$0.00	"$11,210.04"	$0.00	"$26,518.96"	"$26,518.96"	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503095	EAP	HCPCS C1721		Icd Dual Chamber Maximo Ii Dr	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27503096	EAP	HCPCS C1721		Dfbr Crd Mxmo 2 Vr Impltable Cardvrt Sys	BOTH IP/OP	"$38,422.00 "	"$28,432.28"	$0.00	"$30,737.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,008.11"	"$4,181.12"	"$4,181.12"	"$29,615.68"	$0.00	"$8,007.14"	$0.00	"$18,942.05"	"$18,942.05"	$0.00	"$19,211.00"	"$30,430.22"	"$30,737.60"	$0.00	$0.00	$0.00	"$6,013.04"	$0.00	$0.00	"$6,116.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27503097	EAP	HCPCS C1900		Philos Dr	BOTH IP/OP	"$8,572.00 "	"$6,343.28"	$0.00	"$6,857.60"	"$3,857.40"	"$3,857.40"	$0.00	$0.00	$0.00	"$1,786.62"	"$4,181.12"	"$4,181.12"	"$6,607.30"	$0.00	"$1,786.40"	$0.00	"$4,226.00"	"$4,226.00"	$0.00	"$4,286.00"	"$6,789.02"	"$6,857.60"	$0.00	$0.00	$0.00	"$1,341.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503098	EAP	HCPCS C1900		Philos Sr	BOTH IP/OP	"$8,276.00 "	"$6,124.24"	$0.00	"$6,620.80"	"$3,724.20"	"$3,724.20"	$0.00	$0.00	$0.00	"$1,724.93"	"$4,181.12"	"$4,181.12"	"$6,379.14"	$0.00	"$1,724.72"	$0.00	"$4,080.07"	"$4,080.07"	$0.00	"$4,138.00"	"$6,554.59"	"$6,620.80"	$0.00	$0.00	$0.00	"$1,295.19"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503099	EAP	HCPCS C1900		Philos Dr System	BOTH IP/OP	"$10,049.00 "	"$7,436.26"	$0.00	"$8,039.20"	"$4,522.05"	"$4,522.05"	$0.00	$0.00	$0.00	"$2,094.46"	"$4,181.12"	"$4,181.12"	"$7,745.77"	$0.00	"$2,094.21"	$0.00	"$4,954.16"	"$4,954.16"	$0.00	"$5,024.50"	"$7,958.81"	"$8,039.20"	$0.00	$0.00	$0.00	"$1,572.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503100	EAP	HCPCS C1900		Philos Sr System	BOTH IP/OP	"$9,458.00 "	"$6,998.92"	$0.00	"$7,566.40"	"$4,256.10"	"$4,256.10"	$0.00	$0.00	$0.00	"$1,971.28"	"$4,181.12"	"$4,181.12"	"$7,290.23"	$0.00	"$1,971.05"	$0.00	"$4,662.79"	"$4,662.79"	$0.00	"$4,729.00"	"$7,490.74"	"$7,566.40"	$0.00	$0.00	$0.00	"$1,480.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503101	EAP	HCPCS C1900		Arox 60 Bp Lead	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503102	EAP	HCPCS C1900		Arox 53 Bp Lead	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503103	EAP	HCPCS C1898		Selox St 53 Lead	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27503104	EAP	HCPCS C1898		Selox St 60 Lead	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27503105	EAP	HCPCS C1898		Selox Jt 53 Lead	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27503106	EAP	HCPCS C1898		Selox Jt 45 Lead	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27503107	EAP	HCPCS C1900		Philos Ii Dr System	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503108	EAP	HCPCS C1900		Cylos Dr With Cls Autonomic Response	BOTH IP/OP	"$10,049.00 "	"$7,436.26"	$0.00	"$8,039.20"	"$4,522.05"	"$4,522.05"	$0.00	$0.00	$0.00	"$2,094.46"	"$4,181.12"	"$4,181.12"	"$7,745.77"	$0.00	"$2,094.21"	$0.00	"$4,954.16"	"$4,954.16"	$0.00	"$5,024.50"	"$7,958.81"	"$8,039.20"	$0.00	$0.00	$0.00	"$1,572.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503109	EAP	HCPCS C1900		Cylos Vr With Cls Autonomic Response	BOTH IP/OP	"$10,049.00 "	"$7,436.26"	$0.00	"$8,039.20"	"$4,522.05"	"$4,522.05"	$0.00	$0.00	$0.00	"$2,094.46"	"$4,181.12"	"$4,181.12"	"$7,745.77"	$0.00	"$2,094.21"	$0.00	"$4,954.16"	"$4,954.16"	$0.00	"$5,024.50"	"$7,958.81"	"$8,039.20"	$0.00	$0.00	$0.00	"$1,572.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503110	EAP	HCPCS C1895		Linox Sd Steroid 65/16	BOTH IP/OP	"$8,867.00 "	"$6,561.58"	$0.00	"$7,093.60"	"$3,990.15"	"$3,990.15"	$0.00	$0.00	$0.00	"$1,848.10"	"$4,181.12"	"$4,181.12"	"$6,834.68"	$0.00	"$1,847.88"	$0.00	"$4,371.43"	"$4,371.43"	$0.00	"$4,433.50"	"$7,022.66"	"$7,093.60"	$0.00	$0.00	$0.00	"$1,387.69"	$0.00	$0.00	"$1,411.63"	$0.00	$0.00	$0.00	$0.00	$0.00
27503111	EAP	HCPCS C1895		Linox Sd Steroid 75/18	BOTH IP/OP	"$8,867.00 "	"$6,561.58"	$0.00	"$7,093.60"	"$3,990.15"	"$3,990.15"	$0.00	$0.00	$0.00	"$1,848.10"	"$4,181.12"	"$4,181.12"	"$6,834.68"	$0.00	"$1,847.88"	$0.00	"$4,371.43"	"$4,371.43"	$0.00	"$4,433.50"	"$7,022.66"	"$7,093.60"	$0.00	$0.00	$0.00	"$1,387.69"	$0.00	$0.00	"$1,411.63"	$0.00	$0.00	$0.00	$0.00	$0.00
27503112	EAP	HCPCS C1898		Setrox S 53 Lead	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27503113	EAP	HCPCS C1898		Setrox S 60 Lead	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27503114	EAP	HCPCS C1777		Linox S 65 Steroid	BOTH IP/OP	"$8,867.00 "	"$6,561.58"	$0.00	"$7,093.60"	"$3,990.15"	"$3,990.15"	$0.00	$0.00	$0.00	"$1,848.10"	"$4,181.12"	"$4,181.12"	"$6,834.68"	$0.00	"$1,847.88"	$0.00	"$4,371.43"	"$4,371.43"	$0.00	"$4,433.50"	"$7,022.66"	"$7,093.60"	$0.00	$0.00	$0.00	"$1,387.69"	$0.00	$0.00	"$1,411.63"	$0.00	$0.00	$0.00	$0.00	$0.00
27503115	EAP	HCPCS C1777		Linox S 75 Steroid	BOTH IP/OP	"$8,867.00 "	"$6,561.58"	$0.00	"$7,093.60"	"$3,990.15"	"$3,990.15"	$0.00	$0.00	$0.00	"$1,848.10"	"$4,181.12"	"$4,181.12"	"$6,834.68"	$0.00	"$1,847.88"	$0.00	"$4,371.43"	"$4,371.43"	$0.00	"$4,433.50"	"$7,022.66"	"$7,093.60"	$0.00	$0.00	$0.00	"$1,387.69"	$0.00	$0.00	"$1,411.63"	$0.00	$0.00	$0.00	$0.00	$0.00
27503116	EAP	HCPCS C1895		Linox Td Steroid 65/16 Cm	BOTH IP/OP	"$8,867.00 "	"$6,561.58"	$0.00	"$7,093.60"	"$3,990.15"	"$3,990.15"	$0.00	$0.00	$0.00	"$1,848.10"	"$4,181.12"	"$4,181.12"	"$6,834.68"	$0.00	"$1,847.88"	$0.00	"$4,371.43"	"$4,371.43"	$0.00	"$4,433.50"	"$7,022.66"	"$7,093.60"	$0.00	$0.00	$0.00	"$1,387.69"	$0.00	$0.00	"$1,411.63"	$0.00	$0.00	$0.00	$0.00	$0.00
27503117	EAP	HCPCS C1777		Linox T 65 Steroid	BOTH IP/OP	"$8,867.00 "	"$6,561.58"	$0.00	"$7,093.60"	"$3,990.15"	"$3,990.15"	$0.00	$0.00	$0.00	"$1,848.10"	"$4,181.12"	"$4,181.12"	"$6,834.68"	$0.00	"$1,847.88"	$0.00	"$4,371.43"	"$4,371.43"	$0.00	"$4,433.50"	"$7,022.66"	"$7,093.60"	$0.00	$0.00	$0.00	"$1,387.69"	$0.00	$0.00	"$1,411.63"	$0.00	$0.00	$0.00	$0.00	$0.00
27503118	EAP	HCPCS C1900		Corox Otw 75 Bp Lead	BOTH IP/OP	"$5,911.00 "	"$4,374.14"	$0.00	"$4,728.80"	"$2,659.95"	"$2,659.95"	$0.00	$0.00	$0.00	"$1,232.00"	"$4,181.12"	"$4,181.12"	"$4,556.20"	$0.00	"$1,231.85"	$0.00	"$2,914.12"	"$2,914.12"	$0.00	"$2,955.50"	"$4,681.51"	"$4,728.80"	$0.00	$0.00	$0.00	$925.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503119	EAP	HCPCS C1900		Corox Otw 85 Bp Lead	BOTH IP/OP	"$5,911.00 "	"$4,374.14"	$0.00	"$4,728.80"	"$2,659.95"	"$2,659.95"	$0.00	$0.00	$0.00	"$1,232.00"	"$4,181.12"	"$4,181.12"	"$4,556.20"	$0.00	"$1,231.85"	$0.00	"$2,914.12"	"$2,914.12"	$0.00	"$2,955.50"	"$4,681.51"	"$4,728.80"	$0.00	$0.00	$0.00	$925.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503120	EAP	HCPCS C1900		Corox Otw 75 Bp-s Lead	BOTH IP/OP	"$5,911.00 "	"$4,374.14"	$0.00	"$4,728.80"	"$2,659.95"	"$2,659.95"	$0.00	$0.00	$0.00	"$1,232.00"	"$4,181.12"	"$4,181.12"	"$4,556.20"	$0.00	"$1,231.85"	$0.00	"$2,914.12"	"$2,914.12"	$0.00	"$2,955.50"	"$4,681.51"	"$4,728.80"	$0.00	$0.00	$0.00	$925.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503121	EAP	HCPCS C1900		Corox Otw 85 Bp-s Lead	BOTH IP/OP	"$5,911.00 "	"$4,374.14"	$0.00	"$4,728.80"	"$2,659.95"	"$2,659.95"	$0.00	$0.00	$0.00	"$1,232.00"	"$4,181.12"	"$4,181.12"	"$4,556.20"	$0.00	"$1,231.85"	$0.00	"$2,914.12"	"$2,914.12"	$0.00	"$2,955.50"	"$4,681.51"	"$4,728.80"	$0.00	$0.00	$0.00	$925.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503122	EAP	HCPCS C1882		Lumax 340 Hf-t High Energy With Hm Landline	BOTH IP/OP	"$52,461.00 "	"$38,821.14"	$0.00	"$41,968.80"	"$23,607.45"	"$23,607.45"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$40,436.94"	$0.00	"$10,932.87"	$0.00	"$25,863.27"	"$25,863.27"	$0.00	"$26,230.50"	"$41,549.11"	"$41,968.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503123	EAP	HCPCS C1900		Cylos Vr System With Cls Autonomic Response	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503124	EAP	HCPCS C1721		Lumax 340 Dr-t High Energy With Hm Mobile Gsm	BOTH IP/OP	"$42,855.00 "	"$31,712.70"	$0.00	"$34,284.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,932.05"	"$4,181.12"	"$4,181.12"	"$33,032.63"	$0.00	"$8,930.98"	$0.00	"$21,127.52"	"$21,127.52"	$0.00	"$21,427.50"	"$33,941.16"	"$34,284.00"	$0.00	$0.00	$0.00	"$6,706.81"	$0.00	$0.00	"$6,822.52"	$0.00	$0.00	$0.00	$0.00	$0.00
27503125	EAP	HCPCS C1721		Lumax 340 Dr-t High Energy System With Hm Mobile Gsm	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503126	EAP	HCPCS C1721		Lumax 340 Dr-t High Energy System With Hm Landline	BOTH IP/OP	"$48,767.00 "	"$36,087.58"	$0.00	"$39,013.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$37,589.60"	$0.00	"$10,163.04"	$0.00	"$24,042.13"	"$24,042.13"	$0.00	"$24,383.50"	"$38,623.46"	"$39,013.60"	$0.00	$0.00	$0.00	"$7,632.04"	$0.00	$0.00	"$7,763.71"	$0.00	$0.00	$0.00	$0.00	$0.00
27503127	EAP	HCPCS C1882		Lumax 340 Hf-t High Energy With Hm Mobile Gsm	BOTH IP/OP	"$56,895.00 "	"$42,102.30"	$0.00	"$45,516.00"	"$25,602.75"	"$25,602.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$43,854.67"	$0.00	"$11,856.92"	$0.00	"$28,049.24"	"$28,049.24"	$0.00	"$28,447.50"	"$45,060.84"	"$45,516.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503128	EAP	HCPCS C1882		Lumax 340 Hf-t High Energy System With Hm Mobile Gsm	BOTH IP/OP	"$74,628.00 "	"$55,224.72"	$0.00	"$59,702.40"	"$33,582.60"	"$33,582.60"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$57,523.26"	$0.00	"$15,552.48"	$0.00	"$36,791.60"	"$36,791.60"	$0.00	"$37,314.00"	"$59,105.38"	"$59,702.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503130	EAP	HCPCS C1882		Lumax 340 Hf-t High Energy System With Hm Landline	BOTH IP/OP	"$68,716.00 "	"$50,849.84"	$0.00	"$54,972.80"	"$30,922.20"	"$30,922.20"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$52,966.29"	$0.00	"$14,320.41"	$0.00	"$33,876.99"	"$33,876.99"	$0.00	"$34,358.00"	"$54,423.07"	"$54,972.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503131	EAP	HCPCS C1722		Lumax 340 Vr-t High Energy With Hm Mobile Gsm	BOTH IP/OP	"$35,467.00 "	"$26,245.58"	$0.00	"$28,373.60"	"$15,960.15"	"$15,960.15"	$0.00	$0.00	$0.00	"$7,392.21"	"$4,181.12"	"$4,181.12"	"$27,337.96"	$0.00	"$7,391.32"	$0.00	"$17,485.23"	"$17,485.23"	$0.00	"$17,733.50"	"$28,089.86"	"$28,373.60"	$0.00	$0.00	$0.00	"$5,550.59"	$0.00	$0.00	"$5,646.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27503132	EAP	HCPCS C1772		Lumax 340 Vr-t High Energy System With Hm Mobile Gsm	BOTH IP/OP	"$44,334.00 "	"$32,807.16"	$0.00	"$35,467.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$34,172.65"	$0.00	"$9,239.21"	$0.00	$0.00	$0.00	$0.00	"$22,167.00"	"$35,112.53"	"$35,467.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503133	EAP	HCPCS C1900		Arox 45 Jbp Lead	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503135	EAP	HCPCS C1882		DEFIBRILLATOR CARDIAC 2.43X3.13IN COGNIS THK.39IN VENTRICULA	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503136	EAP	HCPCS C1722		DFBR CRD THK1.1CM 6.3X7.1CM VTL 2VR HE 1 CHMBR IMPLTABLE 35	BOTH IP/OP	"$33,989.00 "	"$25,151.86"	$0.00	"$27,191.20"	"$15,295.05"	"$15,295.05"	$0.00	$0.00	$0.00	"$7,084.16"	"$4,181.12"	"$4,181.12"	"$26,198.72"	$0.00	"$7,083.31"	$0.00	"$16,756.58"	"$16,756.58"	$0.00	"$16,994.50"	"$26,919.29"	"$27,191.20"	$0.00	$0.00	$0.00	"$5,319.28"	$0.00	$0.00	"$5,411.05"	$0.00	$0.00	$0.00	$0.00	$0.00
27503137	EAP	HCPCS C1722		DFBR CRD .99CM 6.17X7.45CM TELIGEN VR DF-1 IS-1 BIPHASIC	BOTH IP/OP	"$36,945.00 "	"$27,339.30"	$0.00	"$29,556.00"	"$16,625.25"	"$16,625.25"	$0.00	$0.00	$0.00	"$7,700.26"	"$4,181.12"	"$4,181.12"	"$28,477.21"	$0.00	"$7,699.34"	$0.00	"$18,213.89"	"$18,213.89"	$0.00	"$18,472.50"	"$29,260.44"	"$29,556.00"	$0.00	$0.00	$0.00	"$5,781.89"	$0.00	$0.00	"$5,881.64"	$0.00	$0.00	$0.00	$0.00	$0.00
27503138	EAP	HCPCS C1721		DFBR CRD TELIGEN DR HE DF-1 CONCTR NONPROGRAMMBALE CARDVRT	BOTH IP/OP	"$44,334.00 "	"$32,807.16"	$0.00	"$35,467.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,240.31"	"$4,181.12"	"$4,181.12"	"$34,172.65"	$0.00	"$9,239.21"	$0.00	"$21,856.66"	"$21,856.66"	$0.00	"$22,167.00"	"$35,112.53"	"$35,467.20"	$0.00	$0.00	$0.00	"$6,938.27"	$0.00	$0.00	"$7,057.97"	$0.00	$0.00	$0.00	$0.00	$0.00
27503139	EAP	HCPCS C1722		DFBR CRD PUNCTUA VR ICD 1 CHMBR IMPLTABLE CARDVRT	BOTH IP/OP	"$33,989.00 "	"$25,151.86"	$0.00	"$27,191.20"	"$15,295.05"	"$15,295.05"	$0.00	$0.00	$0.00	"$7,084.16"	"$4,181.12"	"$4,181.12"	"$26,198.72"	$0.00	"$7,083.31"	$0.00	"$16,756.58"	"$16,756.58"	$0.00	"$16,994.50"	"$26,919.29"	"$27,191.20"	$0.00	$0.00	$0.00	"$5,319.28"	$0.00	$0.00	"$5,411.05"	$0.00	$0.00	$0.00	$0.00	$0.00
27503140	EAP	HCPCS C1772		DFBR CRD THK9.9MM 61.7MMX32.5MM PUNCTUA AV IMPLTABLE 2CH	BOTH IP/OP	"$36,945.00 "	"$27,339.30"	$0.00	"$29,556.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,477.21"	$0.00	"$7,699.34"	$0.00	$0.00	$0.00	$0.00	"$18,472.50"	"$29,260.44"	"$29,556.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503141	EAP	HCPCS C1882		DFBR CRD PUNCTUA CRT-D RSYN THRP HI ENRG IMPLTABLE CARDVRT	BOTH IP/OP	"$50,244.00 "	"$37,180.56"	$0.00	"$40,195.20"	"$22,609.80"	"$22,609.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,728.08"	$0.00	"$10,470.85"	$0.00	"$24,770.29"	"$24,770.29"	$0.00	"$25,122.00"	"$39,793.25"	"$40,195.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$7,998.84"	$0.00	$0.00	$0.00	$0.00	$0.00
27503142	EAP	HCPCS C1882		DFBR CRD INCEPTA CRT-D IMPLTABLE CARDVRT HI ENRG DF1 IS1 PLS	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	"$24,205.95"	"$24,205.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,462.10"	$0.00	"$11,210.04"	$0.00	"$26,518.96"	"$26,518.96"	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503143	EAP	HCPCS C1722		DFBR CRD THK14.5MM 63.5X77.5MM LIVIAN RF IS-1 DF-1 IMPLTABLE	BOTH IP/OP	"$50,244.00 "	"$37,180.56"	$0.00	"$40,195.20"	"$22,609.80"	"$22,609.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,728.08"	$0.00	"$10,470.85"	$0.00	"$24,770.29"	"$24,770.29"	$0.00	"$25,122.00"	"$39,793.25"	"$40,195.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$7,998.84"	$0.00	$0.00	$0.00	$0.00	$0.00
27503144	EAP	HCPCS C1722		DFBR CRD THK14.5MM 63.5X77.5MM LIVIAN RF IMPLTABLE CRD RSYN	BOTH IP/OP	"$50,244.00 "	"$37,180.56"	$0.00	"$40,195.20"	"$22,609.80"	"$22,609.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,728.08"	$0.00	"$10,470.85"	$0.00	"$24,770.29"	"$24,770.29"	$0.00	"$25,122.00"	"$39,793.25"	"$40,195.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$7,998.84"	$0.00	$0.00	$0.00	$0.00	$0.00
27503145	EAP	HCPCS C1722		DFBR CRD THK14.5MM 67X82.5MM LIVIAN RF HE IMPLTABLE RSYN	BOTH IP/OP	"$50,244.00 "	"$37,180.56"	$0.00	"$40,195.20"	"$22,609.80"	"$22,609.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,728.08"	$0.00	"$10,470.85"	$0.00	"$24,770.29"	"$24,770.29"	$0.00	"$25,122.00"	"$39,793.25"	"$40,195.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$7,998.84"	$0.00	$0.00	$0.00	$0.00	$0.00
27503146	EAP	HCPCS C1722		Dfbr Crd Livian Rf He Cardvrt	BOTH IP/OP	"$50,244.00 "	"$37,180.56"	$0.00	"$40,195.20"	"$22,609.80"	"$22,609.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,728.08"	$0.00	"$10,470.85"	$0.00	"$24,770.29"	"$24,770.29"	$0.00	"$25,122.00"	"$39,793.25"	"$40,195.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$7,998.84"	$0.00	$0.00	$0.00	$0.00	$0.00
27503147	EAP	HCPCS C2621		INVIVE / EASYTRAK or ACUITY: CARDIAC RESYNCHRONIZATION THERA	BOTH IP/OP	"$26,452.00 "	"$19,574.48"	$0.00	"$21,161.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$20,389.20"	$0.00	"$5,512.60"	$0.00	$0.00	$0.00	$0.00	"$13,226.00"	"$20,949.98"	"$21,161.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503148	EAP	HCPCS C1785		PCMKR CRD THK7.5MM 61X44.5MM INVIVE SMRT DELAY BIVENTRICLE	BOTH IP/OP	"$18,324.00 "	"$13,559.76"	$0.00	"$14,659.20"	"$8,245.80"	"$8,245.80"	$0.00	$0.00	$0.00	"$3,819.18"	"$4,181.12"	"$4,181.12"	"$14,124.14"	$0.00	"$3,818.72"	$0.00	"$9,033.73"	"$9,033.73"	$0.00	"$9,162.00"	"$14,512.61"	"$14,659.20"	$0.00	$0.00	$0.00	"$2,867.71"	$0.00	$0.00	"$2,917.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27503149	EAP	HCPCS C1785		PCMKR CRD THK7.5MM 61X44.5MM INVIVE SMRT DELAY BIVENTRICLE	BOTH IP/OP	"$18,324.00 "	"$13,559.76"	$0.00	"$14,659.20"	"$8,245.80"	"$8,245.80"	$0.00	$0.00	$0.00	"$3,819.18"	"$4,181.12"	"$4,181.12"	"$14,124.14"	$0.00	"$3,818.72"	$0.00	"$9,033.73"	"$9,033.73"	$0.00	"$9,162.00"	"$14,512.61"	"$14,659.20"	$0.00	$0.00	$0.00	"$2,867.71"	$0.00	$0.00	"$2,917.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27503150	EAP	HCPCS C1722		DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	"$23,274.90"	"$23,274.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503151	EAP	HCPCS C1721		DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503152	EAP	HCPCS C1722		DFBR CRD THK.39IN 2.43X2.93IN INCEPTA VR 1 CHMBR IMPLTABLE	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27503153	EAP	HCPCS C1722		DFBR CRD THK.39IN 2.43X2.93IN INCEPTA VR 1 CHMBR DF-4	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27503154	EAP	HCPCS C1721		DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503155	EAP	HCPCS C1882		DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	"$23,274.90"	"$23,274.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503156	EAP	HCPCS C1882		INCEPTA LV-1 / EASYTRAK or ACUITY / ENDOTAK: CARDIAC RESYNCH	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503157	EAP	HCPCS C1721		DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503158	EAP	HCPCS C1721		DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503159	EAP	HCPCS C1721		DFBR CRD THK.39IN 2.43X2.69-2.89IN INCEPTA DR 2CH IMPLTABLE	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27503160	EAP	HCPCS C1779		PCMKR CRD 7.5IN MOD ELIP 44.5X47IN ADVANTIO 2CH IS-1 CONCTR	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	$0.00	$0.00	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503161	EAP	HCPCS C2619		ADVANTIO DR IMPLANTABLE PACEMAKER SYSTEM (INCLUDES 2 LEADS)	BOTH IP/OP	"$14,777.00 "	"$10,934.98"	$0.00	"$11,821.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,390.11"	$0.00	"$3,079.53"	$0.00	$0.00	$0.00	$0.00	"$7,388.50"	"$11,703.38"	"$11,821.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503162	EAP	HCPCS C1785		PCMKR CRD THK7.5MM 44.5X45.7MM ADVANTIO RIGHTRATE ATR VNTRC	BOTH IP/OP	"$10,344.00 "	"$7,654.56"	$0.00	"$8,275.20"	"$4,654.80"	"$4,654.80"	$0.00	$0.00	$0.00	"$2,155.95"	"$4,181.12"	"$4,181.12"	"$7,973.16"	$0.00	"$2,155.69"	$0.00	"$5,099.59"	"$5,099.59"	$0.00	"$5,172.00"	"$8,192.45"	"$8,275.20"	$0.00	$0.00	$0.00	"$1,618.84"	$0.00	$0.00	"$1,646.76"	$0.00	$0.00	$0.00	$0.00	$0.00
27503163	EAP	HCPCS C1785		ADVANTIO SR IMPLANTABLE PACEMAKER  SYSTEM (INCLUDES 1 LEAD)	BOTH IP/OP	"$11,527.00 "	"$8,529.98"	$0.00	"$9,221.60"	"$5,187.15"	"$5,187.15"	$0.00	$0.00	$0.00	"$2,402.51"	"$4,181.12"	"$4,181.12"	"$8,885.01"	$0.00	"$2,402.23"	$0.00	"$5,682.81"	"$5,682.81"	$0.00	"$5,763.50"	"$9,129.38"	"$9,221.60"	$0.00	$0.00	$0.00	"$1,803.98"	$0.00	$0.00	"$1,835.10"	$0.00	$0.00	$0.00	$0.00	$0.00
27503164	EAP	HCPCS C1721		DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503165	EAP	HCPCS C1721		DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503166	EAP	HCPCS C1721		DFBR CRD THK.39IN 2.43X2.69-2.89IN INCEPTA DR 2CH IMPLTABLE	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27503167	EAP	HCPCS C1722		DFBR CRD THK9.9MM 61.7MM X 79.5MM ENERGEN VR VNTRC IMPLTABLE	BOTH IP/OP	"$36,945.00 "	"$27,339.30"	$0.00	"$29,556.00"	"$16,625.25"	"$16,625.25"	$0.00	$0.00	$0.00	"$7,700.26"	"$4,181.12"	"$4,181.12"	"$28,477.21"	$0.00	"$7,699.34"	$0.00	"$18,213.89"	"$18,213.89"	$0.00	"$18,472.50"	"$29,260.44"	"$29,556.00"	$0.00	$0.00	$0.00	"$5,781.89"	$0.00	$0.00	"$5,881.64"	$0.00	$0.00	$0.00	$0.00	$0.00
27503168	EAP	HCPCS C1722		ENERGEN VR DF4 ICD SYSTEMS (1 RELIANCE NON-GORE LEAD)	BOTH IP/OP	"$49,062.00 "	"$36,305.88"	$0.00	"$39,249.60"	"$22,077.90"	"$22,077.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$37,816.99"	$0.00	"$10,224.52"	$0.00	"$24,187.57"	"$24,187.57"	$0.00	"$24,531.00"	"$38,857.10"	"$39,249.60"	$0.00	$0.00	$0.00	"$7,678.20"	$0.00	$0.00	"$7,810.67"	$0.00	$0.00	$0.00	$0.00	$0.00
27503169	EAP	HCPCS C1785		PCMKR CRD 2.8V 8MM MOD ELIP 43X49MM ALTRUA 60DR ATR VNTRC	BOTH IP/OP	"$11,527.00 "	"$8,529.98"	$0.00	"$9,221.60"	"$5,187.15"	"$5,187.15"	$0.00	$0.00	$0.00	"$2,402.51"	"$4,181.12"	"$4,181.12"	"$8,885.01"	$0.00	"$2,402.23"	$0.00	"$5,682.81"	"$5,682.81"	$0.00	"$5,763.50"	"$9,129.38"	"$9,221.60"	$0.00	$0.00	$0.00	"$1,803.98"	$0.00	$0.00	"$1,835.10"	$0.00	$0.00	$0.00	$0.00	$0.00
27503170	EAP	HCPCS C1785		PCMKR CRD ALTRUA 60 DDDR 2 CHMBR IS-1 MV BLND SNSR STOR EGMS	BOTH IP/OP	"$11,527.00 "	"$8,529.98"	$0.00	"$9,221.60"	"$5,187.15"	"$5,187.15"	$0.00	$0.00	$0.00	"$2,402.51"	"$4,181.12"	"$4,181.12"	"$8,885.01"	$0.00	"$2,402.23"	$0.00	"$5,682.81"	"$5,682.81"	$0.00	"$5,763.50"	"$9,129.38"	"$9,221.60"	$0.00	$0.00	$0.00	"$1,803.98"	$0.00	$0.00	"$1,835.10"	$0.00	$0.00	$0.00	$0.00	$0.00
27503171	EAP	HCPCS C1785		PCMKR CRD 8MM MOD ELLIPSE 43X49MM ALTRUA 60 ATR VNTRC 2	BOTH IP/OP	"$11,527.00 "	"$8,529.98"	$0.00	"$9,221.60"	"$5,187.15"	"$5,187.15"	$0.00	$0.00	$0.00	"$2,402.51"	"$4,181.12"	"$4,181.12"	"$8,885.01"	$0.00	"$2,402.23"	$0.00	"$5,682.81"	"$5,682.81"	$0.00	"$5,763.50"	"$9,129.38"	"$9,221.60"	$0.00	$0.00	$0.00	"$1,803.98"	$0.00	$0.00	"$1,835.10"	$0.00	$0.00	$0.00	$0.00	$0.00
27503172	EAP	HCPCS C1785		PCMKR CRD THK8MM 49X43MM ALTRUA 60DR ATR VNTRC IMPLTABLE 2	BOTH IP/OP	"$14,482.00 "	"$10,716.68"	$0.00	"$11,585.60"	"$6,516.90"	"$6,516.90"	$0.00	$0.00	$0.00	"$3,018.41"	"$4,181.12"	"$4,181.12"	"$11,162.73"	$0.00	"$3,018.05"	$0.00	"$7,139.63"	"$7,139.63"	$0.00	"$7,241.00"	"$11,469.74"	"$11,585.60"	$0.00	$0.00	$0.00	"$2,266.43"	$0.00	$0.00	"$2,305.53"	$0.00	$0.00	$0.00	$0.00	$0.00
27503173	EAP	HCPCS C1900		PCMKR CRD THK8MM 42X42MM ALTRUA 60SR ATR VNTRC IMPLTABLE 1	BOTH IP/OP	"$10,049.00 "	"$7,436.26"	$0.00	"$8,039.20"	"$4,522.05"	"$4,522.05"	$0.00	$0.00	$0.00	"$2,094.46"	"$4,181.12"	"$4,181.12"	"$7,745.77"	$0.00	"$2,094.21"	$0.00	"$4,954.16"	"$4,954.16"	$0.00	"$5,024.50"	"$7,958.81"	"$8,039.20"	$0.00	$0.00	$0.00	"$1,572.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503174	EAP	HCPCS C1785		PCMKR CRD THK3MM 42MMX42MM ALTRUA 60SR IMPLTABLE 1 CHMBR RR	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27503175	EAP	HCPCS C1722		DFBR CRD .99CM THK.39IN SM 2.43X3.13IN COGNIS ATR VNTRC IS-1	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	"$24,205.95"	"$24,205.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,462.10"	$0.00	"$11,210.04"	$0.00	"$26,518.96"	"$26,518.96"	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503176	EAP	HCPCS C1772		DFBR CRD ENERGEN VR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR	BOTH IP/OP	"$49,062.00 "	"$36,305.88"	$0.00	"$39,249.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$37,816.99"	$0.00	"$10,224.52"	$0.00	$0.00	$0.00	$0.00	"$24,531.00"	"$38,857.10"	"$39,249.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503177	EAP	HCPCS C1882		DFBR CRD COGNIS CNTK RNWL 3 RF HI ENRG	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503178	EAP	HCPCS C1882		DFBR CRD 1.45CM 6.7X8.25CM CONFIENT RF HE ATR VNTRC 2CH	BOTH IP/OP	"$36,945.00 "	"$27,339.30"	$0.00	"$29,556.00"	"$16,625.25"	"$16,625.25"	$0.00	$0.00	$0.00	"$7,700.26"	"$4,181.12"	"$4,181.12"	"$28,477.21"	$0.00	"$7,699.34"	$0.00	"$18,213.89"	"$18,213.89"	$0.00	"$18,472.50"	"$29,260.44"	"$29,556.00"	$0.00	$0.00	$0.00	"$5,781.89"	$0.00	$0.00	"$5,881.64"	$0.00	$0.00	$0.00	$0.00	$0.00
27503179	EAP	HCPCS C2621		PCMKR CRD CNTK RNWL TR ATR VNTRC 2 WRNCH IS-1 IMPLTABLE	BOTH IP/OP	"$18,916.00 "	"$13,997.84"	$0.00	"$15,132.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,580.45"	$0.00	"$3,942.09"	$0.00	$0.00	$0.00	$0.00	"$9,458.00"	"$14,981.47"	"$15,132.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503180	EAP	HCPCS C2621		PCMKR CRD CNTK RNWL TR LV-1 IMPLTABLE	BOTH IP/OP	"$18,916.00 "	"$13,997.84"	$0.00	"$15,132.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,580.45"	$0.00	"$3,942.09"	$0.00	$0.00	$0.00	$0.00	"$9,458.00"	"$14,981.47"	"$15,132.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503181	EAP	HCPCS C1722		DFBR CRD THK.39IN 2.43X2.69-2.89IN ENERGEN VR VNTRC 1 CHMBR	BOTH IP/OP	"$36,945.00 "	"$27,339.30"	$0.00	"$29,556.00"	"$16,625.25"	"$16,625.25"	$0.00	$0.00	$0.00	"$7,700.26"	"$4,181.12"	"$4,181.12"	"$28,477.21"	$0.00	"$7,699.34"	$0.00	"$18,213.89"	"$18,213.89"	$0.00	"$18,472.50"	"$29,260.44"	"$29,556.00"	$0.00	$0.00	$0.00	"$5,781.89"	$0.00	$0.00	"$5,881.64"	$0.00	$0.00	$0.00	$0.00	$0.00
27503182	EAP	HCPCS C1898		LEAD PCNG 53CM 6.7FR 10MM SPC RIGHT AV BIPOL XTD-RETRAC HLX	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27503183	EAP	HCPCS C1722		ENERGEN VR ICD SYSTEM (1 RELIANCE NON-GORE LEAD)	BOTH IP/OP	"$49,062.00 "	"$36,305.88"	$0.00	"$39,249.60"	"$22,077.90"	"$22,077.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$37,816.99"	$0.00	"$10,224.52"	$0.00	"$24,187.57"	"$24,187.57"	$0.00	"$24,531.00"	"$38,857.10"	"$39,249.60"	$0.00	$0.00	$0.00	"$7,678.20"	$0.00	$0.00	"$7,810.67"	$0.00	$0.00	$0.00	$0.00	$0.00
27503184	EAP	HCPCS C1722		DFBR CRD ENERGEN VR IMPLTABLE CARDVRT HI ENRG	BOTH IP/OP	"$49,062.00 "	"$36,305.88"	$0.00	"$39,249.60"	"$22,077.90"	"$22,077.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$37,816.99"	$0.00	"$10,224.52"	$0.00	"$24,187.57"	"$24,187.57"	$0.00	"$24,531.00"	"$38,857.10"	"$39,249.60"	$0.00	$0.00	$0.00	"$7,678.20"	$0.00	$0.00	"$7,810.67"	$0.00	$0.00	$0.00	$0.00	$0.00
27503185	EAP	HCPCS C1721		DFBR CRD THK9.9MM 61.7X74.5MM ENERGEN DR ATR ENTRICULAR	BOTH IP/OP	"$44,334.00 "	"$32,807.16"	$0.00	"$35,467.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,240.31"	"$4,181.12"	"$4,181.12"	"$34,172.65"	$0.00	"$9,239.21"	$0.00	"$21,856.66"	"$21,856.66"	$0.00	"$22,167.00"	"$35,112.53"	"$35,467.20"	$0.00	$0.00	$0.00	"$6,938.27"	$0.00	$0.00	"$7,057.97"	$0.00	$0.00	$0.00	$0.00	$0.00
27503186	EAP	HCPCS C1721		ENERGEN DR DF4 ICD SYSTEMS (2 RELIANCE NON-GORE LEADS)	BOTH IP/OP	"$57,781.00 "	"$42,757.94"	$0.00	"$46,224.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$44,537.59"	$0.00	"$12,041.56"	$0.00	"$28,486.03"	"$28,486.03"	$0.00	"$28,890.50"	"$45,762.55"	"$46,224.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503187	EAP	HCPCS C1721		DFBR CRD ENERGEN DR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR	BOTH IP/OP	"$57,781.00 "	"$42,757.94"	$0.00	"$46,224.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$44,537.59"	$0.00	"$12,041.56"	$0.00	"$28,486.03"	"$28,486.03"	$0.00	"$28,890.50"	"$45,762.55"	"$46,224.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503188	EAP	HCPCS C1721		DFBR CRD SM ENERGEN DR DF-4 2CH IMPLTABLE CARDVRT BTR-PWR	BOTH IP/OP	"$44,334.00 "	"$32,807.16"	$0.00	"$35,467.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,240.31"	"$4,181.12"	"$4,181.12"	"$34,172.65"	$0.00	"$9,239.21"	$0.00	"$21,856.66"	"$21,856.66"	$0.00	"$22,167.00"	"$35,112.53"	"$35,467.20"	$0.00	$0.00	$0.00	"$6,938.27"	$0.00	$0.00	"$7,057.97"	$0.00	$0.00	$0.00	$0.00	$0.00
27503189	EAP	HCPCS C1721		ENERGEN DR ICD SYSTEM (2 RELIANCE NON-GORE LEADS)	BOTH IP/OP	"$57,781.00 "	"$42,757.94"	$0.00	"$46,224.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$44,537.59"	$0.00	"$12,041.56"	$0.00	"$28,486.03"	"$28,486.03"	$0.00	"$28,890.50"	"$45,762.55"	"$46,224.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503190	EAP	HCPCS C1722		DFBR CRD ENERGEN VR IMPLTABLE CARDVRT HI ENRG	BOTH IP/OP	"$57,781.00 "	"$42,757.94"	$0.00	"$46,224.80"	"$26,001.45"	"$26,001.45"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$44,537.59"	$0.00	"$12,041.56"	$0.00	"$28,486.03"	"$28,486.03"	$0.00	"$28,890.50"	"$45,762.55"	"$46,224.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503191	EAP	HCPCS C1882		ENERGEN RF HE DF4 (with brady lead)	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503192	EAP	HCPCS C1882		ENERGEN RF HE DF4 (without brady lead)	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503193	EAP	HCPCS C1721		DFBR CRD THK9.9MM 79.5MMX61.7MM ENERGEN CRT-D VNTRC	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,462.10"	$0.00	"$11,210.04"	$0.00	"$26,518.96"	"$26,518.96"	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503194	EAP	HCPCS C1721		DFBR CRD ENERGEN CRT-D IMPLTABLE CARDVRT	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,462.10"	$0.00	"$11,210.04"	$0.00	"$26,518.96"	"$26,518.96"	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503195	EAP	HCPCS C1882		ENERGEN RF HE  (with brady lead)	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503211	EAP	HCPCS C1721		Fortify Assura Next Nene Dr 40	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27503212	EAP	HCPCS C1721		Fortify Assura Next Gene Dr 40 Df4 Conn	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27503213	EAP	HCPCS C1722		Ellipse Next Gene Dr 36	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	"$20,614.95"	"$20,614.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27503214	EAP	HCPCS C1722		Ellipse Next Gene Dr 36 Df4 Conn	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	"$20,614.95"	"$20,614.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	"$20,614.95"	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27503215	EAP	HCPCS C1722		Fortify Assura Next Gene Vr 40	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	"$17,955.00"	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27503216	EAP	HCPCS C1722		Fortify Assura Next Gene Vr 40 Df4 Conn	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27503217	EAP	HCPCS C1722		Ellipse Next Gene Vr 36	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27503218	EAP	HCPCS C1722		Ellipse Next Gene Vr 36 Df4 Conn	BOTH IP/OP	"$39,900.00 "	"$29,526.00"	$0.00	"$31,920.00"	"$17,955.00"	"$17,955.00"	$0.00	$0.00	$0.00	"$8,316.16"	"$4,181.12"	"$4,181.12"	"$30,754.92"	$0.00	"$8,315.16"	$0.00	"$19,670.70"	"$19,670.70"	$0.00	"$19,950.00"	"$31,600.80"	"$31,920.00"	$0.00	$0.00	$0.00	"$6,244.35"	$0.00	$0.00	"$6,352.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27503219	EAP	HCPCS C1721		Fortify Assura Next Gene Dr 40 System	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503220	EAP	HCPCS C1721		Fortify Assura Next Gene Dr 40 Df4 Conn System	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503221	EAP	HCPCS C1722		Ellipse Next Gene Dr 36 System	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	"$26,500.05"	"$26,500.05"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503222	EAP	HCPCS C1722		Ellipse Next Gene Dr 36 Df4 Conn System	BOTH IP/OP	"$58,889.00 "	"$43,577.86"	$0.00	"$47,111.20"	"$26,500.05"	"$26,500.05"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,391.64"	$0.00	"$12,272.47"	$0.00	"$29,032.28"	"$29,032.28"	$0.00	"$29,444.50"	"$46,640.09"	"$47,111.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503223	EAP	HCPCS C1722		Fortify Assura Next Gene Vr 40 System	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	"$23,274.90"	"$23,274.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	"$23,274.90"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503224	EAP	HCPCS C1722		Fortify Assura Next Gene Vr 40 Df4 Conn System	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	"$23,274.90"	"$23,274.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	"$23,274.90"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503225	EAP	HCPCS C1722		Ellipse Next Gene Vr 36 System	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	"$23,274.90"	"$23,274.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	"$23,274.90"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503226	EAP	HCPCS C1722		Ellipse Next Gene Vr 36 36 Df4 Conn System	BOTH IP/OP	"$51,722.00 "	"$38,274.28"	$0.00	"$41,377.60"	"$23,274.90"	"$23,274.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,867.32"	$0.00	"$10,778.86"	$0.00	"$25,498.95"	"$25,498.95"	$0.00	"$25,861.00"	"$40,963.82"	"$41,377.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503227	EAP	HCPCS C1882		Quadra Assura Next Gene Crt-d 40	BOTH IP/OP	"$59,111.00 "	"$43,742.14"	$0.00	"$47,288.80"	"$26,599.95"	"$26,599.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,562.76"	$0.00	"$12,318.73"	$0.00	"$29,141.72"	"$29,141.72"	$0.00	"$29,555.50"	"$46,815.91"	"$47,288.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503228	EAP	HCPCS C1882		Quadra Assura Next Gene Crt-d 40 Df4 Cc	BOTH IP/OP	"$59,111.00 "	"$43,742.14"	$0.00	"$47,288.80"	"$26,599.95"	"$26,599.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,562.76"	$0.00	"$12,318.73"	$0.00	"$29,141.72"	"$29,141.72"	$0.00	"$29,555.50"	"$46,815.91"	"$47,288.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503229	EAP	HCPCS C1882		Unify Assura Next Gene Crt-d 40	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	"$24,205.95"	"$24,205.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,462.10"	$0.00	"$11,210.04"	$0.00	"$26,518.96"	"$26,518.96"	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503230	EAP	HCPCS C1882		Unify Assura Next Gene Crt-d 40 Df4 Conn	BOTH IP/OP	"$53,791.00 "	"$39,805.34"	$0.00	"$43,032.80"	"$24,205.95"	"$24,205.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,462.10"	$0.00	"$11,210.04"	$0.00	"$26,518.96"	"$26,518.96"	$0.00	"$26,895.50"	"$42,602.47"	"$43,032.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503231	EAP	HCPCS C1882		Quadra Assura Next Gene Crt-d 40 System	BOTH IP/OP	"$78,677.00 "	"$58,220.98"	$0.00	"$62,941.60"	"$35,404.65"	"$35,404.65"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$60,644.23"	$0.00	"$16,396.29"	$0.00	"$38,787.76"	"$38,787.76"	$0.00	"$39,338.50"	"$62,312.18"	"$62,941.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503232	EAP	HCPCS C1882		Quadra Assura Next Gene Crt-d Df4 Conn System	BOTH IP/OP	"$78,677.00 "	"$58,220.98"	$0.00	"$62,941.60"	"$35,404.65"	"$35,404.65"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$60,644.23"	$0.00	"$16,396.29"	$0.00	"$38,787.76"	"$38,787.76"	$0.00	"$39,338.50"	"$62,312.18"	"$62,941.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503233	EAP	HCPCS C1882		Unify Assura Next Gene Crt-d 40 System	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503234	EAP	HCPCS C1882		Unify Assura Next Gene Crt-d 40 Df4 Conn System	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503235	EAP	HCPCS C1722		Generator Pulse Sq-rx And Q-trak Electrode	BOTH IP/OP	"$71,926.00 "	"$53,225.24"	$0.00	"$57,540.80"	"$32,366.70"	"$32,366.70"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,440.56"	$0.00	"$14,989.38"	$0.00	"$35,459.52"	"$35,459.52"	$0.00	"$35,963.00"	"$56,965.39"	"$57,540.80"	$0.00	"$32,366.70"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503236	EAP	CPT® C1722		Generator Pulse Sq-rx	BOTH IP/OP	"$59,249.00 "	"$43,844.26"	$0.00	"$47,399.20"	"$26,662.05"	"$26,662.05"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,669.13"	$0.00	"$12,347.49"	$0.00	"$29,209.76"	"$29,209.76"	$0.00	"$29,624.50"	"$46,925.21"	"$47,399.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27503237	EAP	HCPCS C1785		Pcmkr Crd Thk6mm Sm 50x47mm Assurity 2 Chmbr Is-1 Conctr	BOTH IP/OP	"$19,566.00 "	"$14,478.84"	$0.00	"$15,652.80"	"$8,804.70"	"$8,804.70"	$0.00	$0.00	$0.00	"$4,078.04"	"$4,181.12"	"$4,181.12"	"$15,081.47"	$0.00	"$4,077.55"	$0.00	"$9,646.04"	"$9,646.04"	$0.00	"$9,783.00"	"$15,496.27"	"$15,652.80"	$0.00	"$8,804.70"	$0.00	"$3,062.08"	$0.00	$0.00	"$3,114.91"	$0.00	$0.00	$0.00	$0.00	$0.00
27503238	EAP	HCPCS C1785		Pcmkr Crd Thk6mm Sm 50x46mm Endurity 2 Chmbr Is-1 Conctr	BOTH IP/OP	"$15,432.00 "	"$11,419.68"	$0.00	"$12,345.60"	"$6,944.40"	"$6,944.40"	$0.00	$0.00	$0.00	"$3,216.41"	"$4,181.12"	"$4,181.12"	"$11,894.99"	$0.00	"$3,216.03"	$0.00	"$7,607.98"	"$7,607.98"	$0.00	"$7,716.00"	"$12,222.14"	"$12,345.60"	$0.00	$0.00	$0.00	"$2,415.11"	$0.00	$0.00	"$2,456.77"	$0.00	$0.00	$0.00	$0.00	$0.00
27503239	EAP	HCPCS C1785		Pcmkr Crd Thk6mm Sm 50x47mm Assurity Chmbr Is-1 Conctr Atcpt	BOTH IP/OP	"$20,669.00 "	"$15,295.06"	$0.00	"$16,535.20"	"$9,301.05"	"$9,301.05"	$0.00	$0.00	$0.00	"$4,307.94"	"$4,181.12"	"$4,181.12"	"$15,931.67"	$0.00	"$4,307.42"	$0.00	"$10,189.82"	"$10,189.82"	$0.00	"$10,334.50"	"$16,369.85"	"$16,535.20"	$0.00	$0.00	$0.00	"$3,234.70"	$0.00	$0.00	"$3,290.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27503240	EAP	HCPCS C1785		Pcmkr Crd Thk6mm Sm 50x47mm Assurity 1 Chmbr Is-1 Conctr	BOTH IP/OP	"$17,774.00 "	"$13,152.76"	$0.00	"$14,219.20"	"$7,998.30"	"$7,998.30"	$0.00	$0.00	$0.00	"$3,704.55"	"$4,181.12"	"$4,181.12"	"$13,700.20"	$0.00	"$3,704.10"	$0.00	"$8,762.58"	"$8,762.58"	$0.00	"$8,887.00"	"$14,077.01"	"$14,219.20"	$0.00	"$7,998.30"	$0.00	"$2,781.63"	$0.00	$0.00	"$2,829.62"	$0.00	$0.00	$0.00	$0.00	$0.00
27503241	EAP	HCPCS C1785		Entovis Dr-t Promri With Landline Hm(r) Bradycardia	BOTH IP/OP	"$19,759.00 "	"$14,621.66"	$0.00	"$15,807.20"	"$8,891.55"	"$8,891.55"	$0.00	$0.00	$0.00	"$4,118.27"	"$4,181.12"	"$4,181.12"	"$15,230.24"	$0.00	"$4,117.78"	$0.00	"$9,741.19"	"$9,741.19"	$0.00	"$9,879.50"	"$15,649.13"	"$15,807.20"	$0.00	$0.00	$0.00	"$3,092.28"	$0.00	$0.00	"$3,145.63"	$0.00	$0.00	$0.00	$0.00	$0.00
27503242	EAP	HCPCS C1785		Entovis Dr-t Promri System With Landline Hm(r) Bradycardia	BOTH IP/OP	"$22,460.00 "	"$16,620.40"	$0.00	"$17,968.00"	"$10,107.00"	"$10,107.00"	$0.00	$0.00	$0.00	"$4,681.23"	"$4,181.12"	"$4,181.12"	"$17,312.17"	$0.00	"$4,680.66"	$0.00	"$11,072.78"	"$11,072.78"	$0.00	"$11,230.00"	"$17,788.32"	"$17,968.00"	$0.00	$0.00	$0.00	"$3,514.99"	$0.00	$0.00	"$3,575.63"	$0.00	$0.00	$0.00	$0.00	$0.00
27503243	EAP	HCPCS C1785		Entovis Dr-t Promri System With Cellular Hm(r) Bradycardia	BOTH IP/OP	"$22,460.00 "	"$16,620.40"	$0.00	"$17,968.00"	"$10,107.00"	"$10,107.00"	$0.00	$0.00	$0.00	"$4,681.23"	"$4,181.12"	"$4,181.12"	"$17,312.17"	$0.00	"$4,680.66"	$0.00	"$11,072.78"	"$11,072.78"	$0.00	"$11,230.00"	"$17,788.32"	"$17,968.00"	$0.00	$0.00	$0.00	"$3,514.99"	$0.00	$0.00	"$3,575.63"	$0.00	$0.00	$0.00	$0.00	$0.00
27503244	EAP	HCPCS C1786		Entovis Sr-t Promri With Landline Hm(r) Bradycardia	BOTH IP/OP	"$18,408.00 "	"$13,621.92"	$0.00	"$14,726.40"	"$8,283.60"	"$8,283.60"	$0.00	$0.00	$0.00	"$3,836.69"	"$4,181.12"	"$4,181.12"	"$14,188.89"	$0.00	"$3,836.23"	$0.00	"$9,075.14"	"$9,075.14"	$0.00	"$9,204.00"	"$14,579.14"	"$14,726.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503245	EAP	HCPCS C1786		Entovis Sr-t Promri With Cellular Hm(r) Bradycardia	BOTH IP/OP	"$18,408.00 "	"$13,621.92"	$0.00	"$14,726.40"	"$8,283.60"	"$8,283.60"	$0.00	$0.00	$0.00	"$3,836.69"	"$4,181.12"	"$4,181.12"	"$14,188.89"	$0.00	"$3,836.23"	$0.00	"$9,075.14"	"$9,075.14"	$0.00	"$9,204.00"	"$14,579.14"	"$14,726.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503246	EAP	HCPCS C1786		Entovis Sr-t Promri System With Landline Hm(r) Bradycardia	BOTH IP/OP	"$19,759.00 "	"$14,621.66"	$0.00	"$15,807.20"	"$8,891.55"	"$8,891.55"	$0.00	$0.00	$0.00	"$4,118.27"	"$4,181.12"	"$4,181.12"	"$15,230.24"	$0.00	"$4,117.78"	$0.00	"$9,741.19"	"$9,741.19"	$0.00	"$9,879.50"	"$15,649.13"	"$15,807.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503247	EAP	HCPCS C1786		Entovis Sr-t Promri System With Cellular Hm(r) Bradycardia	BOTH IP/OP	"$19,759.00 "	"$14,621.66"	$0.00	"$15,807.20"	"$8,891.55"	"$8,891.55"	$0.00	$0.00	$0.00	"$4,118.27"	"$4,181.12"	"$4,181.12"	"$15,230.24"	$0.00	"$4,117.78"	$0.00	"$9,741.19"	"$9,741.19"	$0.00	"$9,879.50"	"$15,649.13"	"$15,807.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503248	EAP	HCPCS C1785		Evia Dr-t With Cls With Landline Hmbradycardiadual Chamber	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	"$1,725.10"	$0.00	$0.00	"$1,754.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27503249	EAP	HCPCS C1785		Evia Dr-t With Cls With Cellular Gsm Hmbradycardiadual Chamber	BOTH IP/OP	"$17,003.00 "	"$12,582.22"	$0.00	"$13,602.40"	"$7,651.35"	"$7,651.35"	$0.00	$0.00	$0.00	"$3,543.85"	"$4,181.12"	"$4,181.12"	"$13,105.91"	$0.00	"$3,543.43"	$0.00	"$8,382.48"	"$8,382.48"	$0.00	"$8,501.50"	"$13,466.38"	"$13,602.40"	$0.00	$0.00	$0.00	"$2,660.97"	$0.00	$0.00	"$2,706.88"	$0.00	$0.00	$0.00	$0.00	$0.00
27503250	EAP	HCPCS C1785		Evia Dr-t System With Cls  With Landline Hmbradycardiadual Chamber Sys	BOTH IP/OP	"$13,779.00 "	"$10,196.46"	$0.00	"$11,023.20"	"$6,200.55"	"$6,200.55"	$0.00	$0.00	$0.00	"$2,871.89"	"$4,181.12"	"$4,181.12"	"$10,620.85"	$0.00	"$2,871.54"	$0.00	"$6,793.05"	"$6,793.05"	$0.00	"$6,889.50"	"$10,912.97"	"$11,023.20"	$0.00	$0.00	$0.00	"$2,156.41"	$0.00	$0.00	"$2,193.62"	$0.00	$0.00	$0.00	$0.00	$0.00
27503251	EAP	HCPCS C1785		Evia Dr-t System With Cls A With Cellular Gsm Hmbradycardiadual Cham	BOTH IP/OP	"$19,704.00 "	"$14,580.96"	$0.00	"$15,763.20"	"$8,866.80"	"$8,866.80"	$0.00	$0.00	$0.00	"$4,106.81"	"$4,181.12"	"$4,181.12"	"$15,187.84"	$0.00	"$4,106.31"	$0.00	"$9,714.07"	"$9,714.07"	$0.00	"$9,852.00"	"$15,605.57"	"$15,763.20"	$0.00	$0.00	$0.00	"$3,083.68"	$0.00	$0.00	"$3,136.88"	$0.00	$0.00	$0.00	$0.00	$0.00
27503252	EAP	HCPCS C1786		Evia Sr-t With Cls With Landline Hmbradycardiasingle Chamber	BOTH IP/OP	"$9,646.00 "	"$7,138.04"	$0.00	"$7,716.80"	"$4,340.70"	"$4,340.70"	$0.00	$0.00	$0.00	"$2,010.47"	"$4,181.12"	"$4,181.12"	"$7,435.14"	$0.00	"$2,010.23"	$0.00	"$4,755.48"	"$4,755.48"	$0.00	"$4,823.00"	"$7,639.63"	"$7,716.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503253	EAP	HCPCS C1786		Evia Sr-t With Cls With Cellular Gsm Hmbradycardiasingle Chamber	BOTH IP/OP	"$15,653.00 "	"$11,583.22"	$0.00	"$12,522.40"	"$7,043.85"	"$7,043.85"	$0.00	$0.00	$0.00	"$3,262.48"	"$4,181.12"	"$4,181.12"	"$12,065.33"	$0.00	"$3,262.09"	$0.00	"$7,716.93"	"$7,716.93"	$0.00	"$7,826.50"	"$12,397.18"	"$12,522.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503254	EAP	HCPCS C1786		Evia Sr-t System With Cls  With Landline Hmbradycardiasingle Chamber S	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503255	EAP	HCPCS C1786		Evia Sr-t System With Cls With Cellular Gsm Hmbradycardiasingle Chamb	BOTH IP/OP	"$17,003.00 "	"$12,582.22"	$0.00	"$13,602.40"	"$7,651.35"	"$7,651.35"	$0.00	$0.00	$0.00	"$3,543.85"	"$4,181.12"	"$4,181.12"	"$13,105.91"	$0.00	"$3,543.43"	$0.00	"$8,382.48"	"$8,382.48"	$0.00	"$8,501.50"	"$13,466.38"	"$13,602.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503256	EAP	HCPCS C2621		Evia Hf-t With Landline Hmcrtdevice	BOTH IP/OP	"$21,771.00 "	"$16,110.54"	$0.00	"$17,416.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$16,781.09"	$0.00	"$4,537.08"	$0.00	$0.00	$0.00	$0.00	"$10,885.50"	"$17,242.63"	"$17,416.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503257	EAP	HCPCS C2621		Evia Hf-t With Cellular Gsm Hmcrtdevice	BOTH IP/OP	"$22,597.00 "	"$16,721.78"	$0.00	"$18,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,417.77"	$0.00	"$4,709.21"	$0.00	$0.00	$0.00	$0.00	"$11,298.50"	"$17,896.82"	"$18,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503258	EAP	HCPCS C2621		Evia Hf-t System With Landline Hmcrtsystem	BOTH IP/OP	"$31,141.00 "	"$23,044.34"	$0.00	"$24,912.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$24,003.48"	$0.00	"$6,489.78"	$0.00	$0.00	$0.00	$0.00	"$15,570.50"	"$24,663.67"	"$24,912.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503259	EAP	HCPCS C2621		Evia Hf-t System With Cellular Gsm Hmcrtsystem	BOTH IP/OP	"$31,692.00 "	"$23,452.08"	$0.00	"$25,353.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$24,428.19"	$0.00	"$6,604.61"	$0.00	$0.00	$0.00	$0.00	"$15,846.00"	"$25,100.06"	"$25,353.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503260	EAP	HCPCS C1900		Corox Otw-l 75-bp Leadcrtlead	BOTH IP/OP	"$5,512.00 "	"$4,078.88"	$0.00	"$4,409.60"	"$2,480.40"	"$2,480.40"	$0.00	$0.00	$0.00	"$1,148.84"	"$4,091.01"	"$4,091.01"	"$4,248.65"	$0.00	"$1,148.70"	$0.00	"$2,717.42"	"$2,717.42"	$0.00	"$2,756.00"	"$4,365.50"	"$4,409.60"	$0.00	$0.00	$0.00	$862.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503261	EAP	HCPCS C1900		Corox Otw-l 85-bp Leadcrtlead	BOTH IP/OP	"$5,512.00 "	"$4,078.88"	$0.00	"$4,409.60"	"$2,480.40"	"$2,480.40"	$0.00	$0.00	$0.00	"$1,148.84"	"$4,091.01"	"$4,091.01"	"$4,248.65"	$0.00	"$1,148.70"	$0.00	"$2,717.42"	"$2,717.42"	$0.00	"$2,756.00"	"$4,365.50"	"$4,409.60"	$0.00	$0.00	$0.00	$862.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503262	EAP	HCPCS C1898		Lead Pcng 45cm Ecrdl Bipol Act Fix Is 1 Conctr Ring Eltrd	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$247.95	$247.95	$0.00	$0.00	$0.00	$114.84	$408.95	$408.95	$424.71	$0.00	$114.83	$0.00	$325.92	$325.92	$0.00	$275.50	$436.39	$440.80	$0.00	$0.00	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
27503263	EAP	HCPCS C1785		Gntr Pcmkr Entovis Dr-t Promri Crd	BOTH IP/OP	"$19,759.00 "	"$14,621.66"	$0.00	"$15,807.20"	"$8,891.55"	"$8,891.55"	$0.00	$0.00	$0.00	"$4,118.27"	"$4,181.12"	"$4,181.12"	"$15,230.24"	$0.00	"$4,117.78"	$0.00	"$9,741.19"	"$9,741.19"	$0.00	"$9,879.50"	"$15,649.13"	"$15,807.20"	$0.00	$0.00	$0.00	"$3,092.28"	$0.00	$0.00	"$3,145.63"	$0.00	$0.00	$0.00	$0.00	$0.00
27503265	EAP	HCPCS C1882		Dfbr Crd .99cm Thn 5.37x8.08cm Inogen Easyview Right Atr Rv	BOTH IP/OP	"$38,056.00 "	"$28,161.44"	$0.00	"$30,444.80"	"$17,125.20"	"$17,125.20"	$0.00	$0.00	$0.00	"$7,931.82"	"$4,181.12"	"$4,181.12"	"$29,333.56"	$0.00	"$7,930.87"	$0.00	"$18,761.61"	"$18,761.61"	$0.00	"$19,028.00"	"$30,140.35"	"$30,444.80"	$0.00	$0.00	$0.00	"$5,955.76"	$0.00	$0.00	"$6,058.52"	$0.00	$0.00	$0.00	$0.00	$0.00
27503266	EAP	HCPCS C1785		Pacemaker Crd .75cm 4.45x5.02cm Acld; Ltd Nxt;	BOTH IP/OP	"$10,213.00 "	"$7,557.62"	$0.00	"$8,170.40"	"$4,595.85"	"$4,595.85"	$0.00	$0.00	$0.00	"$2,128.64"	"$4,181.12"	"$4,181.12"	"$7,872.18"	$0.00	"$2,128.39"	$0.00	"$5,035.01"	"$5,035.01"	$0.00	"$5,106.50"	"$8,088.70"	"$8,170.40"	$0.00	$0.00	$0.00	"$1,598.33"	$0.00	$0.00	"$1,625.91"	$0.00	$0.00	$0.00	$0.00	$0.00
27503267	EAP	HCPCS C1721		Pacemaker Crd 7.5mm 42.9x43.3mm Adapta Sr Atr	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	"$6,744.50"	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00	$0.00	$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27503268	EAP	Custom 27503268		Envelope Defibrillator Medium 2.5x2.75in Pacemaker	BOTH IP/OP	"$1,738.00 "	"$1,286.12"	$0.00	"$1,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,289.94"	"$1,289.94"	"$1,339.65"	$0.00	$362.20	$0.00	$0.00	$0.00	$0.00	$869.00	"$1,376.50"	"$1,390.40"	$0.00	$782.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503269	EAP	Custom 27503269		Catheter Balloon Occlusion .01in 2mm 2.5-2.8fr 4mm	BOTH IP/OP	"$3,312.00 "	"$2,450.88"	$0.00	"$2,649.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,458.17"	"$2,458.17"	"$2,552.89"	$0.00	$690.22	$0.00	$0.00	$0.00	$0.00	"$1,656.00"	"$2,623.10"	"$2,649.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503270	EAP	HCPCS C2621		Quadra Allure Mp Rf Crt-p	BOTH IP/OP	"$16,625.00 "	"$12,302.50"	$0.00	"$13,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,312.50"	"$13,167.00"	"$13,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503271	EAP	HCPCS C2621		"Quadra Allure Mp Rf Crt-p, Merlinpkg"	BOTH IP/OP	"$17,625.00 "	"$13,042.50"	$0.00	"$14,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,585.35"	$0.00	"$3,673.05"	$0.00	$0.00	$0.00	$0.00	"$8,812.50"	"$13,959.00"	"$14,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503272	EAP	HCPCS C2621		Quadra Allure Mp Rf Crt-p System	BOTH IP/OP	"$23,875.00 "	"$17,667.50"	$0.00	"$19,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,402.85"	$0.00	"$4,975.55"	$0.00	$0.00	$0.00	$0.00	"$11,937.50"	"$18,909.00"	"$19,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503273	EAP	HCPCS C2621		"Quadra Allure Mp Crt-p System, Merlinpkg"	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,270.00"	$0.00	"$5,210.00"	$0.00	$0.00	$0.00	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503274	EAP	HCPCS C1898		Lead Pcng 45cm Solia S Bp Actfx Strd Elut	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00	$0.00	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
27503275	EAP	HCPCS C1898		Lead Pcng 53cm Solia S Strd Elute Bp Actfx Ecrdl	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00	$0.00	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
27503300	EAP	HCPCS C1785		Pacemaker Crd 2 Chmbr Dr-t Etrinsa	BOTH IP/OP	"$9,500.00 "	"$7,030.00"	$0.00	"$7,600.00"	"$4,275.00"	"$4,275.00"	$0.00	$0.00	$0.00	"$1,980.04"	"$4,181.12"	"$4,181.12"	"$7,322.60"	$0.00	"$1,979.80"	$0.00	"$4,683.50"	"$4,683.50"	$0.00	"$4,750.00"	"$7,524.00"	"$7,600.00"	$0.00	$0.00	$0.00	"$1,486.75"	$0.00	$0.00	"$1,512.40"	$0.00	$0.00	$0.00	$0.00	$0.00
27503301	EAP	HCPCS C1785		Etrinsa Dr-t System With Cls  With Home Monitoring	BOTH IP/OP	"$12,000.00 "	"$8,880.00"	$0.00	"$9,600.00"	"$5,400.00"	"$5,400.00"	$0.00	$0.00	$0.00	"$2,501.10"	"$4,181.12"	"$4,181.12"	"$9,249.60"	$0.00	"$2,500.80"	$0.00	"$5,916.00"	"$5,916.00"	$0.00	"$6,000.00"	"$9,504.00"	"$9,600.00"	$0.00	$0.00	$0.00	"$1,878.00"	$0.00	$0.00	"$1,910.40"	$0.00	$0.00	$0.00	$0.00	$0.00
27503302	EAP	HCPCS C1786		Pacemaker Crd 1 Chmbr Etrinsa Sr-t	BOTH IP/OP	"$8,375.00 "	"$6,197.50"	$0.00	"$6,700.00"	"$3,768.75"	"$3,768.75"	$0.00	$0.00	$0.00	"$1,745.56"	"$4,181.12"	"$4,181.12"	"$6,455.45"	$0.00	"$1,745.35"	$0.00	"$4,128.88"	"$4,128.88"	$0.00	"$4,187.50"	"$6,633.00"	"$6,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503303	EAP	HCPCS C1786		Etrinsa Sr-t System With Cls  With Home Monitoring	BOTH IP/OP	"$9,500.00 "	"$7,030.00"	$0.00	"$7,600.00"	"$4,275.00"	"$4,275.00"	$0.00	$0.00	$0.00	"$1,980.04"	"$4,181.12"	"$4,181.12"	"$7,322.60"	$0.00	"$1,979.80"	$0.00	"$4,683.50"	"$4,683.50"	$0.00	"$4,750.00"	"$7,524.00"	"$7,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503305	EAP	HCPCS C2621		Percepta Bipolar Crtp	BOTH IP/OP	"$29,835.00 "	"$22,077.90"	$0.00	"$23,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$22,996.82"	$0.00	"$6,217.61"	$0.00	$0.00	$0.00	$0.00	"$14,917.50"	"$23,629.32"	"$23,868.00"	$0.00	"$13,425.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503320	EAP	CPT® C1898		Lead Pcng Strg 52cm Ingevity Mri Psv Fx Rv	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00	$0.00	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
27503321	EAP	CPT® C1898		Lead Pcng J Crv 45cm Ingevity Mri Psv Fx Prefrm Atr	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00	$506.25	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
27503322	EAP	CPT® C1898		Lead Pcng J Crv 52cm Ingevity Mri Psv Fx Prefrm Atr	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00	$0.00	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
27503323	EAP			Lead Pcng Strg 45cm Ingevity Mri Act Bp Flx Tp Sty Av	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503324	EAP	CPT® C1898		Lead Pcng Strg 52cm Ingevity Mri Act Bp Flx Tp Sty Av	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00	$506.25	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
27503326	EAP	HCPCS C1785		Pacemaker Crd Azure Wirelessly	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	"$10,598.50"	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00	"$6,187.50"	$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27503327	EAP	HCPCS c1786		Pacemaker Crd Azure	BOTH IP/OP	"$12,000.00 "	"$8,880.00"	$0.00	"$9,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$9,249.60"	$0.00	"$2,500.80"	$0.00	$0.00	$0.00	$0.00	"$6,000.00"	"$9,504.00"	"$9,600.00"	$0.00	"$5,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503329	EAP	HCPCS C1898		Lead Pcng 10mm Spc Sm Strg 6.2fr 2mm 45cm Strl Cp Nv Bp Scr	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$963.50	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00	$562.50	$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503330	EAP	HCPCS C1786		Edora Promri Sr-t-sing Chmbr Pacemaker-rate-ad	BOTH IP/OP	"$13,375.00 "	"$9,897.50"	$0.00	"$10,700.00"	"$6,018.75"	"$6,018.75"	$0.00	$0.00	$0.00	"$2,787.68"	"$4,181.12"	"$4,181.12"	"$10,309.45"	$0.00	"$2,787.35"	$0.00	"$6,593.88"	"$6,593.88"	$0.00	"$6,687.50"	"$10,593.00"	"$10,700.00"	$0.00	"$6,018.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27503331	EAP	HCPCS C1785		Pm Cardiac Acld Lat Nxt Dr-el 4.45 X 5.88 X 0.75	BOTH IP/OP	"$7,625.00 "	"$5,642.50"	$0.00	"$6,100.00"	"$3,431.25"	"$3,431.25"	$0.00	$0.00	$0.00	"$1,589.24"	"$4,181.12"	"$4,181.12"	"$5,877.35"	$0.00	"$1,589.05"	$0.00	"$3,759.13"	"$3,759.13"	$0.00	"$3,812.50"	"$6,039.00"	"$6,100.00"	$0.00	"$3,431.25"	$0.00	"$1,193.31"	$0.00	$0.00	"$1,213.90"	$0.00	$0.00	$0.00	$0.00	$0.00
27503332	EAP	HCPCS C1722		Dfbr Crd .99cm 5.37x7.36cm Resonate Heartlogic	BOTH IP/OP	"$23,893.00 "	"$17,680.82"	$0.00	"$19,114.40"	"$10,751.85"	"$10,751.85"	$0.00	$0.00	$0.00	"$4,979.90"	"$4,181.12"	"$4,181.12"	"$18,416.72"	$0.00	"$4,979.30"	$0.00	"$11,779.25"	"$11,779.25"	$0.00	"$11,946.50"	"$18,923.26"	"$19,114.40"	$0.00	"$10,751.85"	$0.00	"$3,739.25"	$0.00	$0.00	"$3,803.77"	$0.00	$0.00	$0.00	$0.00	$0.00
27800001	EAP	HCPCS V2790		Prokera	BOTH IP/OP	"$2,140.00 "	"$1,583.60"	$0.00	"$1,712.00"	$963.00	$963.00	$0.00	$0.00	$0.00	$446.03	"$1,588.31"	"$1,588.31"	"$1,649.51"	$0.00	$445.98	$0.00	"$1,265.81"	"$1,265.81"	$0.00	"$1,070.00"	"$1,694.88"	"$1,712.00"	$0.00	$963.00	$0.00	$334.91	$0.00	$0.00	$340.69	$0.00	$0.00	$0.00	$0.00	$0.00
27800002	EAP	Custom 27800002		Coil Embl 20mm .014in 3mm Trfl Psh Cmplx Pltn Nyl	BOTH IP/OP	$406.00 	$300.44	$0.00	$324.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.33	$301.33	$312.94	$0.00	$84.61	$0.00	$0.00	$0.00	$0.00	$203.00	$321.55	$324.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800003	EAP	Custom 27800003		Coil Embl 30mm .014in 4mm Trfl Psh Cmplx Pltn Nyl	BOTH IP/OP	$406.00 	$300.44	$0.00	$324.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.33	$301.33	$312.94	$0.00	$84.61	$0.00	$0.00	$0.00	$0.00	$203.00	$321.55	$324.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800004	EAP	Custom 27800004		Pusher Surg 195cm Trupush Embl Coil .016in	BOTH IP/OP	"$1,244.00 "	$920.56	$0.00	$995.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$923.30	$923.30	$958.88	$0.00	$259.25	$0.00	$0.00	$0.00	$0.00	$622.00	$985.25	$995.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800005	EAP	Custom 27800005		Coil Embl 30cm 20mm .038in Azur Frme Elc Dtch Loop	BOTH IP/OP	"$3,188.00 "	"$2,359.12"	$0.00	"$2,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,366.13"	"$2,366.13"	"$2,457.31"	$0.00	$664.38	$0.00	$0.00	$0.00	$0.00	"$1,594.00"	"$2,524.90"	"$2,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800006	EAP	Custom 27800006		Coil Embl 30cm 20mm Azur Dtch Ddrgl Peri 35 Sys	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	$0.00	$0.00	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800007	EAP	Custom 27800007		Coil Embl 30cm 15mm Azur Dtch Ddrgl Peri 35 Sys	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	$0.00	$0.00	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800008	EAP	Custom 27800008		Azur Cx 35 Detachable 20mm/39cm	BOTH IP/OP	"$2,800.00 "	"$2,072.00"	$0.00	"$2,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,078.16"	"$2,078.16"	"$2,158.24"	$0.00	$583.52	$0.00	$0.00	$0.00	$0.00	"$1,400.00"	"$2,217.60"	"$2,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800010	EAP	HCPCS C1882		Defibrillator Cardiac Icd Df-1 Biphasic Waveform V	BOTH IP/OP	"$47,875.00 "	"$35,427.50"	$0.00	"$38,300.00"	"$21,543.75"	"$21,543.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$36,902.05"	$0.00	"$9,977.15"	$0.00	"$23,602.38"	"$23,602.38"	$0.00	"$23,937.50"	"$37,917.00"	"$38,300.00"	$0.00	$0.00	$0.00	"$7,492.44"	$0.00	$0.00	"$7,621.70"	$0.00	$0.00	$0.00	$0.00	$0.00
27800011	EAP	HCPCS C1876		Stent Vasc 8mm 40mm 75cm Slf Xpd Ilc Art Ep Ntnl Acpt 6fr	BOTH IP/OP	"$2,887.00 "	"$2,136.38"	$0.00	"$2,309.60"	"$1,299.15"	"$1,299.15"	$0.00	$0.00	$0.00	$601.72	"$2,142.73"	"$2,142.73"	"$2,225.30"	$0.00	$601.65	$0.00	"$1,423.29"	"$1,423.29"	$0.00	"$1,443.50"	"$2,286.50"	"$2,309.60"	$0.00	$0.00	$0.00	$451.82	$0.00	$0.00	$459.61	$0.00	$0.00	$0.00	$0.00	$0.00
27800012	EAP	HCPCS C1876		Stent Bil 8mm 6fr 37mm 75cm Bln Expandable Prmnt Xpr Ld Mtl	BOTH IP/OP	"$2,955.00 "	"$2,186.70"	$0.00	"$2,364.00"	"$1,329.75"	"$1,329.75"	$0.00	$0.00	$0.00	$615.90	"$2,193.20"	"$2,193.20"	"$2,277.71"	$0.00	$615.82	$0.00	"$1,456.82"	"$1,456.82"	$0.00	"$1,477.50"	"$2,340.36"	"$2,364.00"	$0.00	$0.00	$0.00	$462.46	$0.00	$0.00	$470.44	$0.00	$0.00	$0.00	$0.00	$0.00
27800013	EAP	HCPCS C1876		Stent Bil 8mm 6fr 27mm 75cm Bln Expandable Prmnt Xpr Ld Mtl	BOTH IP/OP	"$2,955.00 "	"$2,186.70"	$0.00	"$2,364.00"	"$1,329.75"	"$1,329.75"	$0.00	$0.00	$0.00	$615.90	"$2,193.20"	"$2,193.20"	"$2,277.71"	$0.00	$615.82	$0.00	"$1,456.82"	"$1,456.82"	$0.00	"$1,477.50"	"$2,340.36"	"$2,364.00"	$0.00	$0.00	$0.00	$462.46	$0.00	$0.00	$470.44	$0.00	$0.00	$0.00	$0.00	$0.00
27800014	EAP	Custom 27800014		Dvc Embl 25mm 4.5mm Ppln Flx 55d 75% Cocr 25% Pltn	BOTH IP/OP	"$37,389.00 "	"$27,667.86"	$0.00	"$29,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,694.50"	"$29,612.09"	"$29,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800015	EAP	HCPCS C1874		Stent Tracheobronchial 16mm Cover Icast 6mm 6fr	BOTH IP/OP	"$6,009.00 "	"$4,446.66"	$0.00	"$4,807.20"	"$2,704.05"	"$2,704.05"	$0.00	$0.00	$0.00	"$1,252.43"	"$4,181.12"	"$4,181.12"	"$4,631.74"	$0.00	"$1,252.28"	$0.00	"$2,962.44"	"$2,962.44"	$0.00	"$3,004.50"	"$4,759.13"	"$4,807.20"	$0.00	$0.00	$0.00	$940.41	$0.00	$0.00	$956.63	$0.00	$0.00	$0.00	$0.00	$0.00
27800016	EAP	Custom 27800016		Dvc Embl 20mm 4.75mm Ppln Flx 55d 75% Ccr 25% Pltn	BOTH IP/OP	"$34,230.00 "	"$25,330.20"	$0.00	"$27,384.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,384.48"	$0.00	"$7,133.53"	$0.00	$0.00	$0.00	$0.00	"$17,115.00"	"$27,110.16"	"$27,384.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800017	EAP	HCPCS C1752		Mahurkar Elite Se Catheter Only 16cm	BOTH IP/OP	$121.00 	$89.54	$0.00	$96.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.81	$89.81	$93.27	$0.00	$25.22	$0.00	$0.00	$0.00	$0.00	$60.50	$95.83	$96.80	$0.00	$54.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800018	EAP	HCPCS C1752		Mahurkar Elite Se Catheter Only 20cm	BOTH IP/OP	$127.00 	$93.98	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.26	$94.26	$97.89	$0.00	$26.47	$0.00	$0.00	$0.00	$0.00	$63.50	$100.58	$101.60	$0.00	$57.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800019	EAP	HCPCS C1752		Mahurkar Elite Se Catheter Only 24cm	BOTH IP/OP	$121.00 	$89.54	$0.00	$96.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.81	$89.81	$93.27	$0.00	$25.22	$0.00	$0.00	$0.00	$0.00	$60.50	$95.83	$96.80	$0.00	$54.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800020	EAP	HCPCS C1874		Stent Tracheobronchial 16mm Cvr Icast 120cm 7mm 7f	BOTH IP/OP	"$6,009.00 "	"$4,446.66"	$0.00	"$4,807.20"	"$2,704.05"	"$2,704.05"	$0.00	$0.00	$0.00	"$1,252.43"	"$4,181.12"	"$4,181.12"	"$4,631.74"	$0.00	"$1,252.28"	$0.00	"$2,962.44"	"$2,962.44"	$0.00	"$3,004.50"	"$4,759.13"	"$4,807.20"	$0.00	$0.00	$0.00	$940.41	$0.00	$0.00	$956.63	$0.00	$0.00	$0.00	$0.00	$0.00
27800021	EAP	HCPCS C2616		"Yttrium-90,per Source"	BOTH IP/OP	"$60,196.00 "	"$44,545.04"	$0.00	"$48,156.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$46,399.08"	$0.00	"$12,544.85"	$0.00	$0.00	$0.00	$0.00	"$30,098.00"	"$47,675.23"	"$48,156.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800022	EAP	HCPCS C1874		Stent Endoprsth 5cm 5mm Hep Ntnl Eptfe Vbhn 120cm	BOTH IP/OP	"$8,123.00 "	"$6,011.02"	$0.00	"$6,498.40"	"$3,655.35"	"$3,655.35"	$0.00	$0.00	$0.00	"$1,693.04"	"$4,181.12"	"$4,181.12"	"$6,261.21"	$0.00	"$1,692.83"	$0.00	"$4,004.64"	"$4,004.64"	$0.00	"$4,061.50"	"$6,433.42"	"$6,498.40"	$0.00	$0.00	$0.00	"$1,271.25"	$0.00	$0.00	"$1,293.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27800023	EAP	HCPCS C1874		Stent Endoprsth 10cm 5mm Hep Ntnl Eptfe Vbhn 120cm	BOTH IP/OP	"$8,123.00 "	"$6,011.02"	$0.00	"$6,498.40"	"$3,655.35"	"$3,655.35"	$0.00	$0.00	$0.00	"$1,693.04"	"$4,181.12"	"$4,181.12"	"$6,261.21"	$0.00	"$1,692.83"	$0.00	"$4,004.64"	"$4,004.64"	$0.00	"$4,061.50"	"$6,433.42"	"$6,498.40"	$0.00	$0.00	$0.00	"$1,271.25"	$0.00	$0.00	"$1,293.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27800024	EAP	HCPCS C1874		Stent Endoprsth 5cm 7mm Hep Ntnl Eptfe Vbhn 120cm	BOTH IP/OP	"$8,123.00 "	"$6,011.02"	$0.00	"$6,498.40"	"$3,655.35"	"$3,655.35"	$0.00	$0.00	$0.00	"$1,693.04"	"$4,181.12"	"$4,181.12"	"$6,261.21"	$0.00	"$1,692.83"	$0.00	"$4,004.64"	"$4,004.64"	$0.00	"$4,061.50"	"$6,433.42"	"$6,498.40"	$0.00	$0.00	$0.00	"$1,271.25"	$0.00	$0.00	"$1,293.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27800025	EAP	HCPCS C1874		Stent Endoprsth 10cm 7mm Hep Ntnl Eptfe Vbhn 120cm	BOTH IP/OP	"$8,123.00 "	"$6,011.02"	$0.00	"$6,498.40"	"$3,655.35"	"$3,655.35"	$0.00	$0.00	$0.00	"$1,693.04"	"$4,181.12"	"$4,181.12"	"$6,261.21"	$0.00	"$1,692.83"	$0.00	"$4,004.64"	"$4,004.64"	$0.00	"$4,061.50"	"$6,433.42"	"$6,498.40"	$0.00	$0.00	$0.00	"$1,271.25"	$0.00	$0.00	"$1,293.18"	$0.00	$0.00	$0.00	$0.00	$0.00
27800026	EAP	HCPCS C1757		Mindframe Capture Lp 3x2 Revascularization Device	BOTH IP/OP	"$11,643.00 "	"$8,615.82"	$0.00	"$9,314.40"	"$5,239.35"	"$5,239.35"	$0.00	$0.00	$0.00	"$2,426.69"	"$4,181.12"	"$4,181.12"	"$8,974.42"	$0.00	"$2,426.40"	$0.00	"$5,740.00"	"$5,740.00"	$0.00	"$5,821.50"	"$9,221.26"	"$9,314.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800029	EAP	HCPCS C1876		Stent Vasc 13mm 2.5mm Lvis Jr Intrlum Ntnl 3 Flr	BOTH IP/OP	"$17,219.00 "	"$12,742.06"	$0.00	"$13,775.20"	"$7,748.55"	"$7,748.55"	$0.00	$0.00	$0.00	"$3,588.87"	"$4,181.12"	"$4,181.12"	"$13,272.41"	$0.00	"$3,588.44"	$0.00	"$8,488.97"	"$8,488.97"	$0.00	"$8,609.50"	"$13,637.45"	"$13,775.20"	$0.00	$0.00	$0.00	"$2,694.77"	$0.00	$0.00	"$2,741.26"	$0.00	$0.00	$0.00	$0.00	$0.00
27800030	EAP	HCPCS C1876		Stent Vasc 17mm 2.5mm Lvis Jr Intrlum Ntnl 3 Flr	BOTH IP/OP	"$17,219.00 "	"$12,742.06"	$0.00	"$13,775.20"	"$7,748.55"	"$7,748.55"	$0.00	$0.00	$0.00	"$3,588.87"	"$4,181.12"	"$4,181.12"	"$13,272.41"	$0.00	"$3,588.44"	$0.00	"$8,488.97"	"$8,488.97"	$0.00	"$8,609.50"	"$13,637.45"	"$13,775.20"	$0.00	$0.00	$0.00	"$2,694.77"	$0.00	$0.00	"$2,741.26"	$0.00	$0.00	$0.00	$0.00	$0.00
27800031	EAP	HCPCS C1876		Stent Vasc 23mm 2.5mm Lvis Jr Intrlum Ntnl 3 Flr	BOTH IP/OP	"$17,219.00 "	"$12,742.06"	$0.00	"$13,775.20"	"$7,748.55"	"$7,748.55"	$0.00	$0.00	$0.00	"$3,588.87"	"$4,181.12"	"$4,181.12"	"$13,272.41"	$0.00	"$3,588.44"	$0.00	"$8,488.97"	"$8,488.97"	$0.00	"$8,609.50"	"$13,637.45"	"$13,775.20"	$0.00	$0.00	$0.00	"$2,694.77"	$0.00	$0.00	"$2,741.26"	$0.00	$0.00	$0.00	$0.00	$0.00
27800032	EAP	HCPCS C1876		Stent Vasc 34mm 2.5mm Lvis Jr Intrlum Ntnl 3 Flr	BOTH IP/OP	"$17,219.00 "	"$12,742.06"	$0.00	"$13,775.20"	"$7,748.55"	"$7,748.55"	$0.00	$0.00	$0.00	"$3,588.87"	"$4,181.12"	"$4,181.12"	"$13,272.41"	$0.00	"$3,588.44"	$0.00	"$8,488.97"	"$8,488.97"	$0.00	"$8,609.50"	"$13,637.45"	"$13,775.20"	$0.00	$0.00	$0.00	"$2,694.77"	$0.00	$0.00	"$2,741.26"	$0.00	$0.00	$0.00	$0.00	$0.00
27800033	EAP	HCPCS C1764		System Crd Monitr Rvl Impltable Ins Loop	BOTH IP/OP	"$13,900.00 "	"$10,286.00"	$0.00	"$11,120.00"	"$6,255.00"	"$6,255.00"	$0.00	$0.00	$0.00	"$2,897.11"	"$4,181.12"	"$4,181.12"	"$10,714.12"	$0.00	"$2,896.76"	$0.00	"$6,852.70"	"$6,852.70"	$0.00	"$6,950.00"	"$11,008.80"	"$11,120.00"	$0.00	"$6,255.00"	$0.00	"$2,175.35"	$0.00	$0.00	"$2,212.88"	$0.00	$0.00	$0.00	$0.00	$0.00
27800035	EAP	HCPCS C1778		Lead Nrstm 50cm Prcs .014in Trl Lnr Str Tip Preld	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$963.50	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800039	EAP	HCPCS C1876		Stent Endo 100cm 12mm 8fr 60mm 75cm Flexible Deliv	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	"$2,023.35"	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00	$0.00	$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
27800040	EAP	HCPCS C1876		Stent Endo 100cm 14mm 40mm 75cm Unconstrain Flex	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	"$2,023.35"	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00	"$1,181.25"	$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
27800041	EAP	HCPCS C1876		Stent Endo 100cm 14mm 9fr 60mm 75cm Cath	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	"$2,023.35"	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00	$0.00	$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
27800042	EAP	HCPCS C1874		Stent Endoprsth 8mm 7fr 5cm 120cm Delivery System	BOTH IP/OP	"$7,738.00 "	"$5,726.12"	$0.00	"$6,190.40"	"$3,482.10"	"$3,482.10"	$0.00	$0.00	$0.00	"$1,612.79"	"$4,181.12"	"$4,181.12"	"$5,964.45"	$0.00	"$1,612.60"	$0.00	"$3,814.83"	"$3,814.83"	$0.00	"$3,869.00"	"$6,128.50"	"$6,190.40"	$0.00	$0.00	$0.00	"$1,211.00"	$0.00	$0.00	"$1,231.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27800043	EAP	HCPCS C1876		Stent Vasc 6.5mm 6fr 100mm 120cm Otw Slf	BOTH IP/OP	"$1,988.00 "	"$1,471.12"	$0.00	"$1,590.40"	$894.60	$894.60	$0.00	$0.00	$0.00	$414.35	"$1,475.49"	"$1,475.49"	"$1,532.35"	$0.00	$414.30	$0.00	"$1,175.90"	"$1,175.90"	$0.00	$994.00	"$1,574.50"	"$1,590.40"	$0.00	$0.00	$0.00	$311.12	$0.00	$0.00	$316.49	$0.00	$0.00	$0.00	$0.00	$0.00
27800044	EAP	HCPCS C1874		Graft Evas 32mm 8.1mm 20fr 124mm Znth 2 Intnl Stnt	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27800045	EAP	HCPCS C1874		Graft Evas 2 Brch 12mm 8.1mm 20fr 91mm 62mm Znth I	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27800046	EAP			Space Oar Hydrogel	BOTH IP/OP	"$7,125.00 "	"$5,272.50"	$0.00	"$5,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,491.95"	$0.00	"$1,484.85"	$0.00	$0.00	$0.00	$0.00	"$3,562.50"	"$5,643.00"	"$5,700.00"	$0.00	"$3,206.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800053	EAP	HCPCS C1757		Ace68 Reperfusion Catheter Kit	BOTH IP/OP	"$6,988.00 "	"$5,171.12"	$0.00	"$5,590.40"	"$3,144.60"	"$3,144.60"	$0.00	$0.00	$0.00	"$1,456.47"	"$4,181.12"	"$4,181.12"	"$5,386.35"	$0.00	"$1,456.30"	$0.00	"$3,445.08"	"$3,445.08"	$0.00	"$3,494.00"	"$5,534.50"	"$5,590.40"	$0.00	"$3,144.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800055	EAP	HCPCS C1880		Option Elite Vena Cava Filter System	BOTH IP/OP	"$2,941.00 "	"$2,176.34"	$0.00	"$2,352.80"	"$1,323.45"	"$1,323.45"	$0.00	$0.00	$0.00	$612.98	"$2,182.81"	"$2,182.81"	"$2,266.92"	$0.00	$612.90	$0.00	"$1,449.91"	"$1,449.91"	$0.00	"$1,470.50"	"$2,329.27"	"$2,352.80"	$0.00	"$1,323.45"	$0.00	$460.27	$0.00	$0.00	$468.21	$0.00	$0.00	$0.00	$0.00	$0.00
27800056	EAP	Custom 27800056		Coil Embl 3cm 2mm Nst 4.8 Loop Sft Enh Radopc Mciol .01n	BOTH IP/OP	$279.00 	$206.46	$0.00	$223.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.07	$207.07	$215.05	$0.00	$58.14	$0.00	$0.00	$0.00	$0.00	$139.50	$220.97	$223.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800057	EAP	Custom 27800057		Coil Embl 3cm 3mm Nst 3.2 Loop Sft Enh Radopc Mciol .01n	BOTH IP/OP	$279.00 	$206.46	$0.00	$223.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.07	$207.07	$215.05	$0.00	$58.14	$0.00	$0.00	$0.00	$0.00	$139.50	$220.97	$223.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800058	EAP	Custom 27800058		Coil Embl 5cm 3mm Nst 5.3 Loop Sft Enh Radopc Mciol .01n	BOTH IP/OP	$271.00 	$200.54	$0.00	$216.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.14	$201.14	$208.89	$0.00	$56.48	$0.00	$0.00	$0.00	$0.00	$135.50	$214.63	$216.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800059	EAP	Custom 27800059		Coil Embl 7cm 6mm Nst 3.7 Loop Sft Enh Radopc .035in Pln	BOTH IP/OP	$294.00 	$217.56	$0.00	$235.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.21	$218.21	$226.62	$0.00	$61.27	$0.00	$0.00	$0.00	$0.00	$147.00	$232.85	$235.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800060	EAP	Custom 27800060		Coil Embl 7cm 8mm Nst 2.8 Loop Sft Enh Radopc .035in Pln	BOTH IP/OP	$294.00 	$217.56	$0.00	$235.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.21	$218.21	$226.62	$0.00	$61.27	$0.00	$0.00	$0.00	$0.00	$147.00	$232.85	$235.20	$0.00	$132.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800061	EAP	Custom 27800061		Coil Embl 14cm 16mm Nst 2.8 Loop Sft Enh Radopc .035in N	BOTH IP/OP	$320.00 	$236.80	$0.00	$256.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$237.50	$237.50	$246.66	$0.00	$66.69	$0.00	$0.00	$0.00	$0.00	$160.00	$253.44	$256.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800062	EAP	HCPCS C1874		Drug Eluting Stent	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.01	$0.01	$0.00	$0.01	$0.01	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800063	EAP	HCPCS C1876		Bare Metal Stent	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.01	$0.01	$0.00	$0.01	$0.01	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800064	EAP	HCPCS C1894		Glidesheath Slender Ss (.021) 5fr 10cm	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$62.10	$62.10	$0.00	$0.00	$0.00	$28.76	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$81.63	$81.63	$0.00	$69.00	$109.30	$110.40	$0.00	$62.10	$0.00	$21.60	$0.00	$0.00	$21.97	$0.00	$0.00	$0.00	$0.00	$0.00
27800065	EAP	HCPCS C1894		Glidesheath Slender Ss (.021) 7fr 10cm	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$62.10	$62.10	$0.00	$0.00	$0.00	$28.76	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$81.63	$81.63	$0.00	$69.00	$109.30	$110.40	$0.00	$62.10	$0.00	$21.60	$0.00	$0.00	$21.97	$0.00	$0.00	$0.00	$0.00	$0.00
27800066	EAP	HCPCS A4648		Visicoil Lung Gold Seeds 0.50mm X 0.50cm Length	BOTH IP/OP	$338.00 	$250.12	$0.00	$270.40	$152.10	$152.10	$0.00	$0.00	$0.00	$70.45	$250.86	$250.86	$260.53	$0.00	$70.44	$0.00	$199.93	$199.93	$0.00	$169.00	$267.70	$270.40	$0.00	$152.10	$0.00	$52.90	$0.00	$0.00	$53.81	$0.00	$0.00	$0.00	$0.00	$0.00
27800100	EAP			Catheter Dlv Sys 130cm 5fr .04in Neuron .035in	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800101	EAP	HCPCS C1817		Occluder Cardio 15mm Spt Sft Wire Frm Flrscp Img	BOTH IP/OP	"$17,493.00 "	"$12,944.82"	$0.00	"$13,994.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,483.60"	$0.00	"$3,645.54"	$0.00	$0.00	$0.00	$0.00	"$8,746.50"	"$13,854.46"	"$13,994.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800102	EAP	HCPCS C1817		Occluder Cardio 20mm Spt Sft Wire Frm Flrscp Img	BOTH IP/OP	"$17,493.00 "	"$12,944.82"	$0.00	"$13,994.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,483.60"	$0.00	"$3,645.54"	$0.00	$0.00	$0.00	$0.00	"$8,746.50"	"$13,854.46"	"$13,994.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800103	EAP	HCPCS C1817		Occluder Cardio 25mm Spt Sft Wire Frm Flrscp Img	BOTH IP/OP	"$17,493.00 "	"$12,944.82"	$0.00	"$13,994.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,483.60"	$0.00	"$3,645.54"	$0.00	$0.00	$0.00	$0.00	"$8,746.50"	"$13,854.46"	"$13,994.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800104	EAP	HCPCS C1817		Occluder Cardio 30mm Spt Sft Wire Frm Flrscp Img	BOTH IP/OP	"$17,493.00 "	"$12,944.82"	$0.00	"$13,994.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,483.60"	$0.00	"$3,645.54"	$0.00	$0.00	$0.00	$0.00	"$8,746.50"	"$13,854.46"	"$13,994.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27800105	EAP	CPT® C1887		Catheter Angiography Guiding Upsized Cps Direct 13	BOTH IP/OP	$730.00 	$540.20	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$365.00	$578.16	$584.00	$0.00	$0.00	$0.00	$114.25	$0.00	$0.00	$116.22	$0.00	$0.00	$0.00	$0.00	$0.00
27801001	EAP	HCPCS C1721		Livian Dual Crt-d Device	BOTH IP/OP	"$102,209.00 "	"$75,634.66"	$0.00	"$81,767.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$78,782.70"	$0.00	"$21,300.36"	$0.00	"$50,389.04"	"$50,389.04"	$0.00	"$51,104.50"	"$80,949.53"	"$81,767.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801002	EAP	HCPCS C1721		Entrust At Dual Icd	BOTH IP/OP	"$63,028.00 "	"$46,640.72"	$0.00	"$50,422.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$48,581.98"	$0.00	"$13,135.04"	$0.00	"$31,072.80"	"$31,072.80"	$0.00	"$31,514.00"	"$49,918.18"	"$50,422.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801003	EAP	HCPCS C1721		Maximo Dr Dual Icd	BOTH IP/OP	"$48,414.00 "	"$35,826.36"	$0.00	"$38,731.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$37,317.51"	$0.00	"$10,089.48"	$0.00	"$23,868.10"	"$23,868.10"	$0.00	"$24,207.00"	"$38,343.89"	"$38,731.20"	$0.00	$0.00	$0.00	"$7,576.79"	$0.00	$0.00	"$7,707.51"	$0.00	$0.00	$0.00	$0.00	$0.00
27801004	EAP	HCPCS C1722		Entrust Vr Single Icd	BOTH IP/OP	"$51,104.00 "	"$37,816.96"	$0.00	"$40,883.20"	"$22,996.80"	"$22,996.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$39,390.96"	$0.00	"$10,650.07"	$0.00	"$25,194.27"	"$25,194.27"	$0.00	"$25,552.00"	"$40,474.37"	"$40,883.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,135.76"	$0.00	$0.00	$0.00	$0.00	$0.00
27801005	EAP	HCPCS C1722		Maximo Vr Sindle Icd	BOTH IP/OP	"$39,450.00 "	"$29,193.00"	$0.00	"$31,560.00"	"$17,752.50"	"$17,752.50"	$0.00	$0.00	$0.00	"$8,222.37"	"$4,181.12"	"$4,181.12"	"$30,408.06"	$0.00	"$8,221.38"	$0.00	"$19,448.85"	"$19,448.85"	$0.00	"$19,725.00"	"$31,244.40"	"$31,560.00"	$0.00	$0.00	$0.00	"$6,173.93"	$0.00	$0.00	"$6,280.44"	$0.00	$0.00	$0.00	$0.00	$0.00
27801006	EAP	HCPCS C1722		Virtuoso Single Icd	BOTH IP/OP	"$51,104.00 "	"$37,816.96"	$0.00	"$40,883.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$25,552.00"	"$40,474.37"	"$40,883.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,135.76"	$0.00	$0.00	$0.00	$0.00	$0.00
27801007	EAP	HCPCS C1721		Ventak Prizm Dr Icd	BOTH IP/OP	"$53,793.00 "	"$39,806.82"	$0.00	"$43,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,463.64"	$0.00	"$11,210.46"	$0.00	"$26,519.95"	"$26,519.95"	$0.00	"$26,896.50"	"$42,604.06"	"$43,034.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801008	EAP	HCPCS C1895		Sprint 6947 Rv Lead	BOTH IP/OP	"$16,139.00 "	"$11,942.86"	$0.00	"$12,911.20"	"$7,262.55"	"$7,262.55"	$0.00	$0.00	$0.00	"$3,363.77"	"$4,181.12"	"$4,181.12"	"$12,439.94"	$0.00	"$3,363.37"	$0.00	"$7,956.53"	"$7,956.53"	$0.00	"$8,069.50"	"$12,782.09"	"$12,911.20"	$0.00	"$7,262.55"	$0.00	"$2,525.75"	$0.00	$0.00	"$2,569.33"	$0.00	$0.00	$0.00	$0.00	$0.00
27801009	EAP	HCPCS C1895		Linox Sd Lead	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	$0.00	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27801010	EAP	HCPCS C1895		Isoline Passive Fix Lead	BOTH IP/OP	"$15,063.00 "	"$11,146.62"	$0.00	"$12,050.40"	"$6,778.35"	"$6,778.35"	$0.00	$0.00	$0.00	"$3,139.51"	"$4,181.12"	"$4,181.12"	"$11,610.56"	$0.00	"$3,139.13"	$0.00	"$7,426.06"	"$7,426.06"	$0.00	"$7,531.50"	"$11,929.90"	"$12,050.40"	$0.00	$0.00	$0.00	"$2,357.36"	$0.00	$0.00	"$2,398.03"	$0.00	$0.00	$0.00	$0.00	$0.00
27801011	EAP	HCPCS C1895		Tachycardia Lead	BOTH IP/OP	"$15,063.00 "	"$11,146.62"	$0.00	"$12,050.40"	"$6,778.35"	"$6,778.35"	$0.00	$0.00	$0.00	"$3,139.51"	"$4,181.12"	"$4,181.12"	"$11,610.56"	$0.00	"$3,139.13"	$0.00	"$7,426.06"	"$7,426.06"	$0.00	"$7,531.50"	"$11,929.90"	"$12,050.40"	$0.00	$0.00	$0.00	"$2,357.36"	$0.00	$0.00	"$2,398.03"	$0.00	$0.00	$0.00	$0.00	$0.00
27801012	EAP	HCPCS C1895		7120 Durata Pkg Lead	BOTH IP/OP	"$15,063.00 "	"$11,146.62"	$0.00	"$12,050.40"	"$6,778.35"	"$6,778.35"	$0.00	$0.00	$0.00	"$3,139.51"	"$4,181.12"	"$4,181.12"	"$11,610.56"	$0.00	"$3,139.13"	$0.00	"$7,426.06"	"$7,426.06"	$0.00	"$7,531.50"	"$11,929.90"	"$12,050.40"	$0.00	$0.00	$0.00	"$2,357.36"	$0.00	$0.00	"$2,398.03"	$0.00	$0.00	$0.00	$0.00	$0.00
27801013	EAP	HCPCS C1721		Atlas Plus Dr Dual Icd	BOTH IP/OP	"$50,207.00 "	"$37,153.18"	$0.00	"$40,165.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,699.56"	$0.00	"$10,463.14"	$0.00	"$24,752.05"	"$24,752.05"	$0.00	"$25,103.50"	"$39,763.94"	"$40,165.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$7,992.95"	$0.00	$0.00	$0.00	$0.00	$0.00
27801014	EAP	HCPCS C1722		Atlas Plus Vr Sngl Icd	BOTH IP/OP	"$39,450.00 "	"$29,193.00"	$0.00	"$31,560.00"	"$17,752.50"	"$17,752.50"	$0.00	$0.00	$0.00	"$8,222.37"	"$4,181.12"	"$4,181.12"	"$30,408.06"	$0.00	"$8,221.38"	$0.00	"$19,448.85"	"$19,448.85"	$0.00	"$19,725.00"	"$31,244.40"	"$31,560.00"	$0.00	$0.00	$0.00	"$6,173.93"	$0.00	$0.00	"$6,280.44"	$0.00	$0.00	$0.00	$0.00	$0.00
27801015	EAP	HCPCS C1722		Atlas Plus C Header Icd	BOTH IP/OP	"$39,450.00 "	"$29,193.00"	$0.00	"$31,560.00"	"$17,752.50"	"$17,752.50"	$0.00	$0.00	$0.00	"$8,222.37"	"$4,181.12"	"$4,181.12"	"$30,408.06"	$0.00	"$8,221.38"	$0.00	"$19,448.85"	"$19,448.85"	$0.00	"$19,725.00"	"$31,244.40"	"$31,560.00"	$0.00	$0.00	$0.00	"$6,173.93"	$0.00	$0.00	"$6,280.44"	$0.00	$0.00	$0.00	$0.00	$0.00
27801016	EAP	HCPCS C1722		Atlas Ii Vr Sngl Icd	BOTH IP/OP	"$39,450.00 "	"$29,193.00"	$0.00	"$31,560.00"	"$17,752.50"	"$17,752.50"	$0.00	$0.00	$0.00	"$8,222.37"	"$4,181.12"	"$4,181.12"	"$30,408.06"	$0.00	"$8,221.38"	$0.00	"$19,448.85"	"$19,448.85"	$0.00	"$19,725.00"	"$31,244.40"	"$31,560.00"	$0.00	$0.00	$0.00	"$6,173.93"	$0.00	$0.00	"$6,280.44"	$0.00	$0.00	$0.00	$0.00	$0.00
27801017	EAP	HCPCS C1722		Lumax 340 Vr-t Single Icd	BOTH IP/OP	"$39,450.00 "	"$29,193.00"	$0.00	"$31,560.00"	"$17,752.50"	"$17,752.50"	$0.00	$0.00	$0.00	"$8,222.37"	"$4,181.12"	"$4,181.12"	"$30,408.06"	$0.00	"$8,221.38"	$0.00	"$19,448.85"	"$19,448.85"	$0.00	"$19,725.00"	"$31,244.40"	"$31,560.00"	$0.00	$0.00	$0.00	"$6,173.93"	$0.00	$0.00	"$6,280.44"	$0.00	$0.00	$0.00	$0.00	$0.00
27801018	EAP	HCPCS C1721		Lumax 340 Dr-t Dual Icd	BOTH IP/OP	"$46,622.00 "	"$34,500.28"	$0.00	"$37,297.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,936.24"	$0.00	"$9,716.02"	$0.00	"$22,984.65"	"$22,984.65"	$0.00	"$23,311.00"	"$36,924.62"	"$37,297.60"	$0.00	$0.00	$0.00	"$7,296.34"	$0.00	$0.00	"$7,422.22"	$0.00	$0.00	$0.00	$0.00	$0.00
27801019	EAP	HCPCS C1721		Atlas Ii+ Dr Dual Icd	BOTH IP/OP	"$66,346.00 "	"$49,096.04"	$0.00	"$53,076.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$51,139.50"	$0.00	"$13,826.51"	$0.00	"$32,708.58"	"$32,708.58"	$0.00	"$33,173.00"	"$52,546.03"	"$53,076.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801020	EAP	HCPCS C1898		Bradycardia Lead	BOTH IP/OP	"$1,920.00 "	"$1,420.80"	$0.00	"$1,536.00"	$864.00	$864.00	$0.00	$0.00	$0.00	$400.18	"$1,425.02"	"$1,425.02"	"$1,479.94"	$0.00	$400.13	$0.00	"$1,135.68"	"$1,135.68"	$0.00	$960.00	"$1,520.64"	"$1,536.00"	$0.00	$864.00	$0.00	$300.48	$0.00	$0.00	$305.66	$0.00	$0.00	$0.00	$0.00	$0.00
27801021	EAP	HCPCS C1721		Ovatio Oh60u Dr 6550 Icd	BOTH IP/OP	"$53,793.00 "	"$39,806.82"	$0.00	"$43,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,463.64"	$0.00	"$11,210.46"	$0.00	"$26,519.95"	"$26,519.95"	$0.00	"$26,896.50"	"$42,604.06"	"$43,034.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801022	EAP	HCPCS C1722		Ovatio Oh61u Vr Icd	BOTH IP/OP	"$43,036.00 "	"$31,846.64"	$0.00	"$34,428.80"	"$19,366.20"	"$19,366.20"	$0.00	$0.00	$0.00	"$8,969.78"	"$4,181.12"	"$4,181.12"	"$33,172.15"	$0.00	"$8,968.70"	$0.00	"$21,216.75"	"$21,216.75"	$0.00	"$21,518.00"	"$34,084.51"	"$34,428.80"	$0.00	$0.00	$0.00	"$6,735.13"	$0.00	$0.00	"$6,851.33"	$0.00	$0.00	$0.00	$0.00	$0.00
27801023	EAP	HCPCS C1882		Ovatio Crt 6750 Icd	BOTH IP/OP	"$69,035.00 "	"$51,085.90"	$0.00	"$55,228.00"	"$31,065.75"	"$31,065.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$53,212.18"	$0.00	"$14,386.89"	$0.00	"$34,034.26"	"$34,034.26"	$0.00	"$34,517.50"	"$54,675.72"	"$55,228.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801024	EAP	HCPCS C1882		Lumax 340 Hf-t Crt	BOTH IP/OP	"$63,656.00 "	"$47,105.44"	$0.00	"$50,924.80"	"$28,645.20"	"$28,645.20"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$49,066.04"	$0.00	"$13,265.91"	$0.00	"$31,382.41"	"$31,382.41"	$0.00	"$31,828.00"	"$50,415.55"	"$50,924.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801025	EAP	HCPCS C1882		Concerto Bi-v Icd	BOTH IP/OP	"$81,588.00 "	"$60,375.12"	$0.00	"$65,270.40"	"$36,714.60"	"$36,714.60"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$62,888.03"	$0.00	"$17,002.94"	$0.00	"$40,222.88"	"$40,222.88"	$0.00	"$40,794.00"	"$64,617.70"	"$65,270.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801026	EAP	HCPCS C1895		Linox S 65	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	$0.00	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27801027	EAP	HCPCS C1895		Kainox S 60	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	$0.00	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27801028	EAP	HCPCS C1882		Promote Bi-v	BOTH IP/OP	"$73,870.00 "	"$54,663.80"	$0.00	"$59,096.00"	"$33,241.50"	"$33,241.50"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$56,939.00"	$0.00	"$15,394.51"	$0.00	"$36,417.91"	"$36,417.91"	$0.00	"$36,935.00"	"$58,505.04"	"$59,096.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801029	EAP	HCPCS C1882		Maximo Ii Crt-d	BOTH IP/OP	"$77,107.00 "	"$57,059.18"	$0.00	"$61,685.60"	"$34,698.15"	"$34,698.15"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$59,434.08"	$0.00	"$16,069.10"	$0.00	"$38,013.75"	"$38,013.75"	$0.00	"$38,553.50"	"$61,068.74"	"$61,685.60"	$0.00	"$34,698.15"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801030	EAP	HCPCS C1895		Setrox S 45 Lead	BOTH IP/OP	"$1,793.00 "	"$1,326.82"	$0.00	"$1,434.40"	$806.85	$806.85	$0.00	$0.00	$0.00	$373.71	"$1,330.76"	"$1,330.76"	"$1,382.04"	$0.00	$373.66	$0.00	"$1,060.56"	"$1,060.56"	$0.00	$896.50	"$1,420.06"	"$1,434.40"	$0.00	$806.85	$0.00	$280.60	$0.00	$0.00	$285.45	$0.00	$0.00	$0.00	$0.00	$0.00
27801031	EAP	HCPCS C1895		Setrox S 53 Lead	BOTH IP/OP	"$1,793.00 "	"$1,326.82"	$0.00	"$1,434.40"	$806.85	$806.85	$0.00	$0.00	$0.00	$373.71	"$1,330.76"	"$1,330.76"	"$1,382.04"	$0.00	$373.66	$0.00	"$1,060.56"	"$1,060.56"	$0.00	$896.50	"$1,420.06"	"$1,434.40"	$0.00	$0.00	$0.00	$280.60	$0.00	$0.00	$285.45	$0.00	$0.00	$0.00	$0.00	$0.00
27801032	EAP	HCPCS C1882		Paradym Crt-d 8750	BOTH IP/OP	"$82,842.00 "	"$61,303.08"	$0.00	"$66,273.60"	"$37,278.90"	"$37,278.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$63,854.61"	$0.00	"$17,264.27"	$0.00	"$40,841.11"	"$40,841.11"	$0.00	"$41,421.00"	"$65,610.86"	"$66,273.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801033	EAP	HCPCS C1721		Maximo Ii Dr Dual Icd	BOTH IP/OP	"$55,588.00 "	"$41,135.12"	$0.00	"$44,470.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$42,847.23"	$0.00	"$11,584.54"	$0.00	"$27,404.88"	"$27,404.88"	$0.00	"$27,794.00"	"$44,025.70"	"$44,470.40"	$0.00	"$25,014.60"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801034	EAP	HCPCS C1722		Maximo Ii Vr Single Icd	BOTH IP/OP	"$46,622.00 "	"$34,500.28"	$0.00	"$37,297.60"	"$20,979.90"	"$20,979.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,936.24"	$0.00	"$9,716.02"	$0.00	"$22,984.65"	"$22,984.65"	$0.00	"$23,311.00"	"$36,924.62"	"$37,297.60"	$0.00	$0.00	$0.00	"$7,296.34"	$0.00	$0.00	"$7,422.22"	$0.00	$0.00	$0.00	$0.00	$0.00
27801035	EAP	HCPCS C1722		1211-36 Current Vr Icd	BOTH IP/OP	"$59,175.00 "	"$43,789.50"	$0.00	"$47,340.00"	"$26,628.75"	"$26,628.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,612.09"	$0.00	"$12,332.07"	$0.00	"$29,173.28"	"$29,173.28"	$0.00	"$29,587.50"	"$46,866.60"	"$47,340.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801040	EAP	HCPCS C1880		Vena Tech Lp Filter	BOTH IP/OP	"$3,618.00 "	"$2,677.32"	$0.00	"$2,894.40"	"$1,628.10"	"$1,628.10"	$0.00	$0.00	$0.00	$754.08	"$2,685.28"	"$2,685.28"	"$2,788.75"	$0.00	$753.99	$0.00	"$1,783.67"	"$1,783.67"	$0.00	"$1,809.00"	"$2,865.46"	"$2,894.40"	$0.00	$0.00	$0.00	$566.22	$0.00	$0.00	$575.99	$0.00	$0.00	$0.00	$0.00	$0.00
27801041	EAP	HCPCS C1876		6fr-75cm 10x49 Wall	BOTH IP/OP	"$3,307.00 "	"$2,447.18"	$0.00	"$2,645.60"	"$1,488.15"	"$1,488.15"	$0.00	$0.00	$0.00	$689.26	"$2,454.46"	"$2,454.46"	"$2,549.04"	$0.00	$689.18	$0.00	"$1,630.35"	"$1,630.35"	$0.00	"$1,653.50"	"$2,619.14"	"$2,645.60"	$0.00	$0.00	$0.00	$517.55	$0.00	$0.00	$526.47	$0.00	$0.00	$0.00	$0.00	$0.00
27801042	EAP	HCPCS C1876		6fr-8x80-75cmwallst	BOTH IP/OP	"$3,307.00 "	"$2,447.18"	$0.00	"$2,645.60"	"$1,488.15"	"$1,488.15"	$0.00	$0.00	$0.00	$689.26	"$2,454.46"	"$2,454.46"	"$2,549.04"	$0.00	$689.18	$0.00	"$1,630.35"	"$1,630.35"	$0.00	"$1,653.50"	"$2,619.14"	"$2,645.60"	$0.00	$0.00	$0.00	$517.55	$0.00	$0.00	$526.47	$0.00	$0.00	$0.00	$0.00	$0.00
27801043	EAP	HCPCS C1876		7fr-75cm 10x94 Wall	BOTH IP/OP	"$5,303.00 "	"$3,924.22"	$0.00	"$4,242.40"	"$2,386.35"	"$2,386.35"	$0.00	$0.00	$0.00	"$1,105.28"	"$3,935.89"	"$3,935.89"	"$4,087.55"	$0.00	"$1,105.15"	$0.00	"$2,614.38"	"$2,614.38"	$0.00	"$2,651.50"	"$4,199.98"	"$4,242.40"	$0.00	$0.00	$0.00	$829.92	$0.00	$0.00	$844.24	$0.00	$0.00	$0.00	$0.00	$0.00
27801044	EAP	HCPCS C2625		8fr-26cm Ureteral S	BOTH IP/OP	$404.00 	$298.96	$0.00	$323.20	$181.80	$181.80	$0.00	$0.00	$0.00	$84.20	$299.85	$299.85	$311.40	$0.00	$84.19	$0.00	$238.97	$238.97	$0.00	$202.00	$319.97	$323.20	$0.00	$0.00	$0.00	$63.23	$0.00	$0.00	$64.32	$0.00	$0.00	$0.00	$0.00	$0.00
27801045	EAP	HCPCS C1876		8mmx40mm Wallstent	BOTH IP/OP	"$5,303.00 "	"$3,924.22"	$0.00	"$4,242.40"	"$2,386.35"	"$2,386.35"	$0.00	$0.00	$0.00	"$1,105.28"	"$3,935.89"	"$3,935.89"	"$4,087.55"	$0.00	"$1,105.15"	$0.00	"$2,614.38"	"$2,614.38"	$0.00	"$2,651.50"	"$4,199.98"	"$4,242.40"	$0.00	$0.00	$0.00	$829.92	$0.00	$0.00	$844.24	$0.00	$0.00	$0.00	$0.00	$0.00
27801046	EAP	HCPCS C1874		9frx16x90-75cm Wall	BOTH IP/OP	"$5,303.00 "	"$3,924.22"	$0.00	"$4,242.40"	"$2,386.35"	"$2,386.35"	$0.00	$0.00	$0.00	"$1,105.28"	"$3,935.89"	"$3,935.89"	"$4,087.55"	$0.00	"$1,105.15"	$0.00	"$2,614.38"	"$2,614.38"	$0.00	"$2,651.50"	"$4,199.98"	"$4,242.40"	$0.00	"$2,386.35"	$0.00	$829.92	$0.00	$0.00	$844.24	$0.00	$0.00	$0.00	$0.00	$0.00
27801047	EAP	HCPCS C1874		Wall Graft  7mm X 3	BOTH IP/OP	"$6,506.00 "	"$4,814.44"	$0.00	"$5,204.80"	"$2,927.70"	"$2,927.70"	$0.00	$0.00	$0.00	"$1,356.01"	"$4,181.12"	"$4,181.12"	"$5,014.82"	$0.00	"$1,355.85"	$0.00	"$3,207.46"	"$3,207.46"	$0.00	"$3,253.00"	"$5,152.75"	"$5,204.80"	$0.00	$0.00	$0.00	"$1,018.19"	$0.00	$0.00	"$1,035.76"	$0.00	$0.00	$0.00	$0.00	$0.00
27801048	EAP	HCPCS C1874		Wallgraft  10 X 50m	BOTH IP/OP	"$6,506.00 "	"$4,814.44"	$0.00	"$5,204.80"	"$2,927.70"	"$2,927.70"	$0.00	$0.00	$0.00	"$1,356.01"	"$4,181.12"	"$4,181.12"	"$5,014.82"	$0.00	"$1,355.85"	$0.00	"$3,207.46"	"$3,207.46"	$0.00	"$3,253.00"	"$5,152.75"	"$5,204.80"	$0.00	$0.00	$0.00	"$1,018.19"	$0.00	$0.00	"$1,035.76"	$0.00	$0.00	$0.00	$0.00	$0.00
27801049	EAP	HCPCS C1874		Wallgraft  12 X 70m	BOTH IP/OP	"$7,505.00 "	"$5,553.70"	$0.00	"$6,004.00"	"$3,377.25"	"$3,377.25"	$0.00	$0.00	$0.00	"$1,564.23"	"$4,181.12"	"$4,181.12"	"$5,784.85"	$0.00	"$1,564.04"	$0.00	"$3,699.97"	"$3,699.97"	$0.00	"$3,752.50"	"$5,943.96"	"$6,004.00"	$0.00	$0.00	$0.00	"$1,174.53"	$0.00	$0.00	"$1,194.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27801050	EAP	HCPCS C1876		21v7-7-80-8.0-30 St	BOTH IP/OP	"$5,245.00 "	"$3,881.30"	$0.00	"$4,196.00"	"$2,360.25"	"$2,360.25"	$0.00	$0.00	$0.00	"$1,093.19"	"$3,892.84"	"$3,892.84"	"$4,042.85"	$0.00	"$1,093.06"	$0.00	"$2,585.79"	"$2,585.79"	$0.00	"$2,622.50"	"$4,154.04"	"$4,196.00"	$0.00	$0.00	$0.00	$820.84	$0.00	$0.00	$835.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801051	EAP	HCPCS C2625		8.5fr-22cm Nephrour	BOTH IP/OP	$361.00 	$267.14	$0.00	$288.80	$162.45	$162.45	$0.00	$0.00	$0.00	$75.24	$267.93	$267.93	$278.26	$0.00	$75.23	$0.00	$213.53	$213.53	$0.00	$180.50	$285.91	$288.80	$0.00	$162.45	$0.00	$56.50	$0.00	$0.00	$57.47	$0.00	$0.00	$0.00	$0.00	$0.00
27801052	EAP	HCPCS C2625		8.5fr-24cm Nephrour	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$269.78	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00	$157.50	$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
27801053	EAP	HCPCS C2625		8.5fr-28cm Nephrour	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$269.78	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00	$157.50	$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
27801054	EAP	HCPCS C1876		Ziv7-80-8.0-60 Sten	BOTH IP/OP	"$5,245.00 "	"$3,881.30"	$0.00	"$4,196.00"	"$2,360.25"	"$2,360.25"	$0.00	$0.00	$0.00	"$1,093.19"	"$3,892.84"	"$3,892.84"	"$4,042.85"	$0.00	"$1,093.06"	$0.00	"$2,585.79"	"$2,585.79"	$0.00	"$2,622.50"	"$4,154.04"	"$4,196.00"	$0.00	$0.00	$0.00	$820.84	$0.00	$0.00	$835.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801055	EAP	HCPCS C1875		6x 40 Fluency Stent Graft Old	BOTH IP/OP	"$7,656.00 "	"$5,665.44"	$0.00	"$6,124.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,901.24"	$0.00	"$1,595.51"	$0.00	$0.00	$0.00	$0.00	"$3,828.00"	"$6,063.55"	"$6,124.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801056	EAP	HCPCS C1876		10 X 40   Luminexx Stent	BOTH IP/OP	"$4,186.00 "	"$3,097.64"	$0.00	"$3,348.80"	"$1,883.70"	"$1,883.70"	$0.00	$0.00	$0.00	$872.47	"$3,106.85"	"$3,106.85"	"$3,226.57"	$0.00	$872.36	$0.00	"$2,063.70"	"$2,063.70"	$0.00	"$2,093.00"	"$3,315.31"	"$3,348.80"	$0.00	$0.00	$0.00	$655.11	$0.00	$0.00	$666.41	$0.00	$0.00	$0.00	$0.00	$0.00
27801057	EAP	HCPCS C1880		Simon Nitinol Filte	BOTH IP/OP	"$2,836.00 "	"$2,098.64"	$0.00	"$2,268.80"	"$1,276.20"	"$1,276.20"	$0.00	$0.00	$0.00	$591.09	"$2,104.88"	"$2,104.88"	"$2,185.99"	$0.00	$591.02	$0.00	"$1,398.15"	"$1,398.15"	$0.00	"$1,418.00"	"$2,246.11"	"$2,268.80"	$0.00	$0.00	$0.00	$443.83	$0.00	$0.00	$451.49	$0.00	$0.00	$0.00	$0.00	$0.00
27801058	EAP	HCPCS C1874		Wall Stent 8fr/ 12x	BOTH IP/OP	"$3,605.00 "	"$2,667.70"	$0.00	"$2,884.00"	"$1,622.25"	"$1,622.25"	$0.00	$0.00	$0.00	$751.37	"$2,675.63"	"$2,675.63"	"$2,778.73"	$0.00	$751.28	$0.00	"$1,777.27"	"$1,777.27"	$0.00	"$1,802.50"	"$2,855.16"	"$2,884.00"	$0.00	"$1,622.25"	$0.00	$564.18	$0.00	$0.00	$573.92	$0.00	$0.00	$0.00	$0.00	$0.00
27801059	EAP	HCPCS C1874		Wall Stent 8fr/ 12x	BOTH IP/OP	"$5,778.00 "	"$4,275.72"	$0.00	"$4,622.40"	"$2,600.10"	"$2,600.10"	$0.00	$0.00	$0.00	"$1,204.28"	"$4,181.12"	"$4,181.12"	"$4,453.68"	$0.00	"$1,204.14"	$0.00	"$2,848.55"	"$2,848.55"	$0.00	"$2,889.00"	"$4,576.18"	"$4,622.40"	$0.00	$0.00	$0.00	$904.26	$0.00	$0.00	$919.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801060	EAP	HCPCS C1875		10x40 Luminexx Sten	BOTH IP/OP	"$7,321.00 "	"$5,417.54"	$0.00	"$5,856.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,643.03"	$0.00	"$1,525.70"	$0.00	$0.00	$0.00	$0.00	"$3,660.50"	"$5,798.23"	"$5,856.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801061	EAP	HCPCS C2625		8.5fr-26cm Nephro-u	BOTH IP/OP	$361.00 	$267.14	$0.00	$288.80	$162.45	$162.45	$0.00	$0.00	$0.00	$75.24	$267.93	$267.93	$278.26	$0.00	$75.23	$0.00	$213.53	$213.53	$0.00	$180.50	$285.91	$288.80	$0.00	$162.45	$0.00	$56.50	$0.00	$0.00	$57.47	$0.00	$0.00	$0.00	$0.00	$0.00
27801062	EAP	HCPCS C1875		8 X 40 Fluency Sten	BOTH IP/OP	"$9,054.00 "	"$6,699.96"	$0.00	"$7,243.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,886.85"	$0.00	$0.00	$0.00	$0.00	"$4,527.00"	"$7,170.77"	"$7,243.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801063	EAP	HCPCS C1880		Filter Recovery Femoral	BOTH IP/OP	"$3,669.00 "	"$2,715.06"	$0.00	"$2,935.20"	"$1,651.05"	"$1,651.05"	$0.00	$0.00	$0.00	$764.71	"$2,723.13"	"$2,723.13"	"$2,828.07"	$0.00	$764.62	$0.00	"$1,808.82"	"$1,808.82"	$0.00	"$1,834.50"	"$2,905.85"	"$2,935.20"	$0.00	$0.00	$0.00	$574.20	$0.00	$0.00	$584.10	$0.00	$0.00	$0.00	$0.00	$0.00
27801064	EAP	HCPCS C2625		8fr-28cm Ureteral S	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$277.49	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00	$0.00	$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
27801065	EAP	HCPCS C1788		Low Profile Port	BOTH IP/OP	$751.00 	$555.74	$0.00	$600.80	$337.95	$337.95	$0.00	$0.00	$0.00	$156.53	$557.39	$557.39	$578.87	$0.00	$156.51	$0.00	$444.22	$444.22	$0.00	$375.50	$594.79	$600.80	$0.00	$0.00	$0.00	$117.53	$0.00	$0.00	$119.56	$0.00	$0.00	$0.00	$0.00	$0.00
27801066	EAP	HCPCS C1880		Filter-femoral	BOTH IP/OP	"$3,156.00 "	"$2,335.44"	$0.00	"$2,524.80"	"$1,420.20"	"$1,420.20"	$0.00	$0.00	$0.00	$657.79	"$2,342.38"	"$2,342.38"	"$2,432.64"	$0.00	$657.71	$0.00	"$1,555.91"	"$1,555.91"	$0.00	"$1,578.00"	"$2,499.55"	"$2,524.80"	$0.00	$0.00	$0.00	$493.91	$0.00	$0.00	$502.44	$0.00	$0.00	$0.00	$0.00	$0.00
27801067	EAP	HCPCS C1880		Greenfield Filter-j	BOTH IP/OP	"$3,156.00 "	"$2,335.44"	$0.00	"$2,524.80"	"$1,420.20"	"$1,420.20"	$0.00	$0.00	$0.00	$657.79	"$2,342.38"	"$2,342.38"	"$2,432.64"	$0.00	$657.71	$0.00	"$1,555.91"	"$1,555.91"	$0.00	"$1,578.00"	"$2,499.55"	"$2,524.80"	$0.00	"$1,420.20"	$0.00	$493.91	$0.00	$0.00	$502.44	$0.00	$0.00	$0.00	$0.00	$0.00
27801068	EAP	HCPCS C2625		Stent Ureteral 8fr 24cm	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$188.10	$188.10	$0.00	$0.00	$0.00	$87.12	$310.24	$310.24	$322.19	$0.00	$87.11	$0.00	$247.25	$247.25	$0.00	$209.00	$331.06	$334.40	$0.00	$0.00	$0.00	$65.42	$0.00	$0.00	$66.55	$0.00	$0.00	$0.00	$0.00	$0.00
27801069	EAP	HCPCS C2625		Stent Ureteral 8fr 22cm	BOTH IP/OP	$398.00 	$294.52	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.00	$315.22	$318.40	$0.00	$0.00	$0.00	$62.29	$0.00	$0.00	$63.36	$0.00	$0.00	$0.00	$0.00	$0.00
27801070	EAP	HCPCS C1876		80-6.0x40cm Stent	BOTH IP/OP	"$5,245.00 "	"$3,881.30"	$0.00	"$4,196.00"	"$2,360.25"	"$2,360.25"	$0.00	$0.00	$0.00	"$1,093.19"	"$3,892.84"	"$3,892.84"	"$4,042.85"	$0.00	"$1,093.06"	$0.00	"$2,585.79"	"$2,585.79"	$0.00	"$2,622.50"	"$4,154.04"	"$4,196.00"	$0.00	$0.00	$0.00	$820.84	$0.00	$0.00	$835.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801071	EAP	HCPCS C1880		Filter Birds Nest Vena Cava Fe	BOTH IP/OP	"$3,442.00 "	"$2,547.08"	$0.00	"$2,753.60"	"$1,548.90"	"$1,548.90"	$0.00	$0.00	$0.00	$717.40	"$2,554.65"	"$2,554.65"	"$2,653.09"	$0.00	$717.31	$0.00	"$1,696.91"	"$1,696.91"	$0.00	"$1,721.00"	"$2,726.06"	"$2,753.60"	$0.00	$0.00	$0.00	$538.67	$0.00	$0.00	$547.97	$0.00	$0.00	$0.00	$0.00	$0.00
27801072	EAP	HCPCS C1880		Filter Birds Nest Vena Cava Ju	BOTH IP/OP	"$3,442.00 "	"$2,547.08"	$0.00	"$2,753.60"	"$1,548.90"	"$1,548.90"	$0.00	$0.00	$0.00	$717.40	"$2,554.65"	"$2,554.65"	"$2,653.09"	$0.00	$717.31	$0.00	"$1,696.91"	"$1,696.91"	$0.00	"$1,721.00"	"$2,726.06"	"$2,753.60"	$0.00	"$1,548.90"	$0.00	$538.67	$0.00	$0.00	$547.97	$0.00	$0.00	$0.00	$0.00	$0.00
27801073	EAP	HCPCS C1880		Filter Gunther-tulip Femoral	BOTH IP/OP	"$3,586.00 "	"$2,653.64"	$0.00	"$2,868.80"	"$1,613.70"	"$1,613.70"	$0.00	$0.00	$0.00	$747.41	"$2,661.53"	"$2,661.53"	"$2,764.09"	$0.00	$747.32	$0.00	"$1,767.90"	"$1,767.90"	$0.00	"$1,793.00"	"$2,840.11"	"$2,868.80"	$0.00	$0.00	$0.00	$561.21	$0.00	$0.00	$570.89	$0.00	$0.00	$0.00	$0.00	$0.00
27801074	EAP	HCPCS C1880		Filter Gunther-tulip Jugular	BOTH IP/OP	"$3,216.00 "	"$2,379.84"	$0.00	"$2,572.80"	"$1,447.20"	"$1,447.20"	$0.00	$0.00	$0.00	$670.29	"$2,386.92"	"$2,386.92"	"$2,478.89"	$0.00	$670.21	$0.00	"$1,585.49"	"$1,585.49"	$0.00	"$1,608.00"	"$2,547.07"	"$2,572.80"	$0.00	$0.00	$0.00	$503.30	$0.00	$0.00	$511.99	$0.00	$0.00	$0.00	$0.00	$0.00
27801075	EAP	HCPCS C1880		Trapeaze Femoralve	BOTH IP/OP	"$4,154.00 "	"$3,073.96"	$0.00	"$3,323.20"	"$1,869.30"	"$1,869.30"	$0.00	$0.00	$0.00	$865.80	"$3,083.10"	"$3,083.10"	"$3,201.90"	$0.00	$865.69	$0.00	"$2,047.92"	"$2,047.92"	$0.00	"$2,077.00"	"$3,289.97"	"$3,323.20"	$0.00	$0.00	$0.00	$650.10	$0.00	$0.00	$661.32	$0.00	$0.00	$0.00	$0.00	$0.00
27801076	EAP	HCPCS C1875		"Covered Stent, 5mmx"	BOTH IP/OP	"$8,174.00 "	"$6,048.76"	$0.00	"$6,539.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,300.52"	$0.00	"$1,703.46"	$0.00	$0.00	$0.00	$0.00	"$4,087.00"	"$6,473.81"	"$6,539.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801077	EAP	HCPCS C1874		"Covered Stent, 6mmx"	BOTH IP/OP	"$8,174.00 "	"$6,048.76"	$0.00	"$6,539.20"	"$3,678.30"	"$3,678.30"	$0.00	$0.00	$0.00	"$1,703.67"	"$4,181.12"	"$4,181.12"	"$6,300.52"	$0.00	"$1,703.46"	$0.00	"$4,029.78"	"$4,029.78"	$0.00	"$4,087.00"	"$6,473.81"	"$6,539.20"	$0.00	$0.00	$0.00	"$1,279.23"	$0.00	$0.00	"$1,301.30"	$0.00	$0.00	$0.00	$0.00	$0.00
27801078	EAP	HCPCS C1874		"Covered Stent, 8mmx"	BOTH IP/OP	"$8,174.00 "	"$6,048.76"	$0.00	"$6,539.20"	"$3,678.30"	"$3,678.30"	$0.00	$0.00	$0.00	"$1,703.67"	"$4,181.12"	"$4,181.12"	"$6,300.52"	$0.00	"$1,703.46"	$0.00	"$4,029.78"	"$4,029.78"	$0.00	"$4,087.00"	"$6,473.81"	"$6,539.20"	$0.00	$0.00	$0.00	"$1,279.23"	$0.00	$0.00	"$1,301.30"	$0.00	$0.00	$0.00	$0.00	$0.00
27801079	EAP	HCPCS C1874		"Covered Stent, 9mmx"	BOTH IP/OP	"$8,174.00 "	"$6,048.76"	$0.00	"$6,539.20"	"$3,678.30"	"$3,678.30"	$0.00	$0.00	$0.00	"$1,703.67"	"$4,181.12"	"$4,181.12"	"$6,300.52"	$0.00	"$1,703.46"	$0.00	"$4,029.78"	"$4,029.78"	$0.00	"$4,087.00"	"$6,473.81"	"$6,539.20"	$0.00	$0.00	$0.00	"$1,279.23"	$0.00	$0.00	"$1,301.30"	$0.00	$0.00	$0.00	$0.00	$0.00
27801080	EAP	HCPCS C1874		"Covered Stent, 10mm"	BOTH IP/OP	"$8,174.00 "	"$6,048.76"	$0.00	"$6,539.20"	"$3,678.30"	"$3,678.30"	$0.00	$0.00	$0.00	"$1,703.67"	"$4,181.12"	"$4,181.12"	"$6,300.52"	$0.00	"$1,703.46"	$0.00	"$4,029.78"	"$4,029.78"	$0.00	"$4,087.00"	"$6,473.81"	"$6,539.20"	$0.00	$0.00	$0.00	"$1,279.23"	$0.00	$0.00	"$1,301.30"	$0.00	$0.00	$0.00	$0.00	$0.00
27801081	EAP	HCPCS C1874		"Covered Stent, 12mm"	BOTH IP/OP	"$18,351.00 "	"$13,579.74"	$0.00	"$14,680.80"	"$8,257.95"	"$8,257.95"	$0.00	$0.00	$0.00	"$3,824.81"	"$4,181.12"	"$4,181.12"	"$14,144.95"	$0.00	"$3,824.35"	$0.00	"$9,047.04"	"$9,047.04"	$0.00	"$9,175.50"	"$14,533.99"	"$14,680.80"	$0.00	$0.00	$0.00	"$2,871.93"	$0.00	$0.00	"$2,921.48"	$0.00	$0.00	$0.00	$0.00	$0.00
27801082	EAP	HCPCS C1874		Coil Complex Helica	BOTH IP/OP	"$1,287.00 "	$952.38	$0.00	"$1,029.60"	$579.15	$579.15	$0.00	$0.00	$0.00	$268.24	$955.21	$955.21	$992.02	$0.00	$268.21	$0.00	$761.26	$761.26	$0.00	$643.50	"$1,019.30"	"$1,029.60"	$0.00	$579.15	$0.00	$201.42	$0.00	$0.00	$204.89	$0.00	$0.00	$0.00	$0.00	$0.00
27801083	EAP	HCPCS C1760		Closure Device Vasc	BOTH IP/OP	"$5,062.00 "	"$3,745.88"	$0.00	"$4,049.60"	"$2,277.90"	"$2,277.90"	$0.00	$0.00	$0.00	"$1,055.05"	"$3,757.02"	"$3,757.02"	"$3,901.79"	$0.00	"$1,054.92"	$0.00	"$2,495.57"	"$2,495.57"	$0.00	"$2,531.00"	"$4,009.10"	"$4,049.60"	$0.00	$0.00	$0.00	$792.20	$0.00	$0.00	$805.87	$0.00	$0.00	$0.00	$0.00	$0.00
27801084	EAP	HCPCS C1876		Zilver Stent 10x40	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$1,876.50"	"$1,876.50"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,055.81"	"$2,055.81"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	$0.00	$0.00	$652.61	$0.00	$0.00	$663.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801085	EAP	HCPCS C1876		Zilver Stent 10x30	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$1,876.50"	"$1,876.50"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,055.81"	"$2,055.81"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	$0.00	$0.00	$652.61	$0.00	$0.00	$663.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801086	EAP	HCPCS C1876		Zilver Stent 8x60	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$1,876.50"	"$1,876.50"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,055.81"	"$2,055.81"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	$0.00	$0.00	$652.61	$0.00	$0.00	$663.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801087	EAP	HCPCS C1876		Zilver Stent 8x40	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$1,876.50"	"$1,876.50"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,055.81"	"$2,055.81"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	$0.00	$0.00	$652.61	$0.00	$0.00	$663.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801088	EAP	HCPCS C1876		Zilver Stent 8x30	BOTH IP/OP	"$3,113.00 "	"$2,303.62"	$0.00	"$2,490.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$648.83	$0.00	$0.00	$0.00	$0.00	$648.75	$0.00	"$1,534.71"	"$1,534.71"	$0.00	"$1,556.50"	"$2,465.50"	"$2,490.40"	$0.00	$0.00	$0.00	$487.18	$0.00	$0.00	$495.59	$0.00	$0.00	$0.00	$0.00	$0.00
27801089	EAP	HCPCS C1876		Zilver Stent 7x40	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$1,876.50"	"$1,876.50"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,055.81"	"$2,055.81"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	"$1,876.50"	$0.00	$652.61	$0.00	$0.00	$663.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801090	EAP	HCPCS C1876		Zilver Stent 7x30	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$1,876.50"	"$1,876.50"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,055.81"	"$2,055.81"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	$0.00	$0.00	$652.61	$0.00	$0.00	$663.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801091	EAP	HCPCS C1876		Zilver Stent 6x40	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$1,876.50"	"$1,876.50"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,055.81"	"$2,055.81"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	"$1,876.50"	$0.00	$652.61	$0.00	$0.00	$663.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801092	EAP	HCPCS C1876		Zilver Stent 6x30	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$1,876.50"	"$1,876.50"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,055.81"	"$2,055.81"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	$0.00	$0.00	$652.61	$0.00	$0.00	$663.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801093	EAP	HCPCS C1760		Bmrang Cls Device5-	BOTH IP/OP	"$5,004.00 "	"$3,702.96"	$0.00	"$4,003.20"	"$2,251.80"	"$2,251.80"	$0.00	$0.00	$0.00	"$1,042.96"	"$3,713.97"	"$3,713.97"	"$3,857.08"	$0.00	"$1,042.83"	$0.00	"$2,466.97"	"$2,466.97"	$0.00	"$2,502.00"	"$3,963.17"	"$4,003.20"	$0.00	$0.00	$0.00	$783.13	$0.00	$0.00	$796.64	$0.00	$0.00	$0.00	$0.00	$0.00
27801094	EAP	HCPCS C1760		Bmrang Cls Dvice 6-	BOTH IP/OP	$113.00 	$83.62	$0.00	$90.40	$50.85	$50.85	$0.00	$0.00	$0.00	$23.55	$83.87	$83.87	$87.10	$0.00	$23.55	$0.00	$66.84	$66.84	$0.00	$56.50	$89.50	$90.40	$0.00	$0.00	$0.00	$17.68	$0.00	$0.00	$17.99	$0.00	$0.00	$0.00	$0.00	$0.00
27801095	EAP	HCPCS C1760		6ft Proglide Closur	BOTH IP/OP	$863.00 	$638.62	$0.00	$690.40	$388.35	$388.35	$0.00	$0.00	$0.00	$179.87	$640.52	$640.52	$665.20	$0.00	$179.85	$0.00	$510.46	$510.46	$0.00	$431.50	$683.50	$690.40	$0.00	$388.35	$0.00	$135.06	$0.00	$0.00	$137.39	$0.00	$0.00	$0.00	$0.00	$0.00
27801096	EAP	Custom 27801096		Coil Microplex 18re	BOTH IP/OP	"$2,050.00 "	"$1,517.00"	$0.00	"$1,640.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,521.51"	"$1,521.51"	"$1,580.14"	$0.00	$427.22	$0.00	$0.00	$0.00	$0.00	"$1,025.00"	"$1,623.60"	"$1,640.00"	$0.00	$922.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801097	EAP	Custom 27801097		Coil Microplex 18re	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801098	EAP	Custom 27801098		Coil Microplex 18so	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801099	EAP	Custom 27801099		Coil Microplex 18so	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801100	EAP	Custom 27801100		Coil Microplex 18so	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801101	EAP	Custom 27801101		Coil Microplex 18so	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801102	EAP	Custom 27801102		Coil Microplex 18so	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801103	EAP	Custom 27801103		Coil Microplex 18so	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801104	EAP	Custom 27801104		"Coil, Trufill Pusha"	BOTH IP/OP	$466.00 	$344.84	$0.00	$372.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.87	$345.87	$359.19	$0.00	$97.11	$0.00	$0.00	$0.00	$0.00	$233.00	$369.07	$372.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801105	EAP	Custom 27801105		Coil Trufil Complx	BOTH IP/OP	$466.00 	$344.84	$0.00	$372.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.87	$345.87	$359.19	$0.00	$97.11	$0.00	$0.00	$0.00	$0.00	$233.00	$369.07	$372.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801106	EAP	Custom 27801106		Coil Trufil Complex	BOTH IP/OP	$466.00 	$344.84	$0.00	$372.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.87	$345.87	$359.19	$0.00	$97.11	$0.00	$0.00	$0.00	$0.00	$233.00	$369.07	$372.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801107	EAP	Custom 27801107		Coil Trufil Complex	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.71	$170.71	$177.28	$0.00	$47.93	$0.00	$0.00	$0.00	$0.00	$115.00	$182.16	$184.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801108	EAP	Custom 27801108		Coil Trufil Embolic	BOTH IP/OP	"$7,924.00 "	"$5,863.76"	$0.00	"$6,339.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,107.82"	$0.00	"$1,651.36"	$0.00	$0.00	$0.00	$0.00	"$3,962.00"	"$6,275.81"	"$6,339.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801109	EAP	HCPCS C1874		Wallstent Iliac Spv	BOTH IP/OP	"$8,767.00 "	"$6,487.58"	$0.00	"$7,013.60"	"$3,945.15"	"$3,945.15"	$0.00	$0.00	$0.00	"$1,827.26"	"$4,181.12"	"$4,181.12"	"$6,757.60"	$0.00	"$1,827.04"	$0.00	"$4,322.13"	"$4,322.13"	$0.00	"$4,383.50"	"$6,943.46"	"$7,013.60"	$0.00	$0.00	$0.00	"$1,372.04"	$0.00	$0.00	"$1,395.71"	$0.00	$0.00	$0.00	$0.00	$0.00
27801110	EAP	HCPCS C1874		"Stent, Biliary, Pal"	BOTH IP/OP	"$9,320.00 "	"$6,896.80"	$0.00	"$7,456.00"	"$4,194.00"	"$4,194.00"	$0.00	$0.00	$0.00	"$1,942.52"	"$4,181.12"	"$4,181.12"	"$7,183.86"	$0.00	"$1,942.29"	$0.00	"$4,594.76"	"$4,594.76"	$0.00	"$4,660.00"	"$7,381.44"	"$7,456.00"	$0.00	"$4,194.00"	$0.00	"$1,458.58"	$0.00	$0.00	"$1,483.74"	$0.00	$0.00	$0.00	$0.00	$0.00
27801111	EAP	HCPCS C1874		"Wallstent, Tracheob"	BOTH IP/OP	"$8,767.00 "	"$6,487.58"	$0.00	"$7,013.60"	"$3,945.15"	"$3,945.15"	$0.00	$0.00	$0.00	"$1,827.26"	"$4,181.12"	"$4,181.12"	"$6,757.60"	$0.00	"$1,827.04"	$0.00	"$4,322.13"	"$4,322.13"	$0.00	"$4,383.50"	"$6,943.46"	"$7,013.60"	$0.00	$0.00	$0.00	"$1,372.04"	$0.00	$0.00	"$1,395.71"	$0.00	$0.00	$0.00	$0.00	$0.00
27801112	EAP	HCPCS C1874		"Wallstent, Enteral"	BOTH IP/OP	"$8,767.00 "	"$6,487.58"	$0.00	"$7,013.60"	"$3,945.15"	"$3,945.15"	$0.00	$0.00	$0.00	"$1,827.26"	"$4,181.12"	"$4,181.12"	"$6,757.60"	$0.00	"$1,827.04"	$0.00	"$4,322.13"	"$4,322.13"	$0.00	"$4,383.50"	"$6,943.46"	"$7,013.60"	$0.00	$0.00	$0.00	"$1,372.04"	$0.00	$0.00	"$1,395.71"	$0.00	$0.00	$0.00	$0.00	$0.00
27801113	EAP	HCPCS C1874		Viatorr Sents 8mmx6	BOTH IP/OP	"$12,472.00 "	"$9,229.28"	$0.00	"$9,977.60"	"$5,612.40"	"$5,612.40"	$0.00	$0.00	$0.00	"$2,599.48"	"$4,181.12"	"$4,181.12"	"$9,613.42"	$0.00	"$2,599.16"	$0.00	"$6,148.70"	"$6,148.70"	$0.00	"$6,236.00"	"$9,877.82"	"$9,977.60"	$0.00	$0.00	$0.00	"$1,951.87"	$0.00	$0.00	"$1,985.54"	$0.00	$0.00	$0.00	$0.00	$0.00
27801114	EAP	HCPCS C1874		Viatorr Sents 8mmx7	BOTH IP/OP	"$16,213.00 "	"$11,997.62"	$0.00	"$12,970.40"	"$7,295.85"	"$7,295.85"	$0.00	$0.00	$0.00	"$3,379.19"	"$4,181.12"	"$4,181.12"	"$12,496.98"	$0.00	"$3,378.79"	$0.00	"$7,993.01"	"$7,993.01"	$0.00	"$8,106.50"	"$12,840.70"	"$12,970.40"	$0.00	$0.00	$0.00	"$2,537.33"	$0.00	$0.00	"$2,581.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27801115	EAP	HCPCS C1874		Viatorr Sents 8mmx8	BOTH IP/OP	"$16,213.00 "	"$11,997.62"	$0.00	"$12,970.40"	"$7,295.85"	"$7,295.85"	$0.00	$0.00	$0.00	"$3,379.19"	"$4,181.12"	"$4,181.12"	"$12,496.98"	$0.00	"$3,378.79"	$0.00	"$7,993.01"	"$7,993.01"	$0.00	"$8,106.50"	"$12,840.70"	"$12,970.40"	$0.00	$0.00	$0.00	"$2,537.33"	$0.00	$0.00	"$2,581.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27801116	EAP	HCPCS C1874		Viatorr Sents 10mmx	BOTH IP/OP	"$16,213.00 "	"$11,997.62"	$0.00	"$12,970.40"	"$7,295.85"	"$7,295.85"	$0.00	$0.00	$0.00	"$3,379.19"	"$4,181.12"	"$4,181.12"	"$12,496.98"	$0.00	"$3,378.79"	$0.00	"$7,993.01"	"$7,993.01"	$0.00	"$8,106.50"	"$12,840.70"	"$12,970.40"	$0.00	$0.00	$0.00	"$2,537.33"	$0.00	$0.00	"$2,581.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27801117	EAP	HCPCS C1874		Viatorr Sents 10mmx	BOTH IP/OP	"$16,213.00 "	"$11,997.62"	$0.00	"$12,970.40"	"$7,295.85"	"$7,295.85"	$0.00	$0.00	$0.00	"$3,379.19"	"$4,181.12"	"$4,181.12"	"$12,496.98"	$0.00	"$3,378.79"	$0.00	"$7,993.01"	"$7,993.01"	$0.00	"$8,106.50"	"$12,840.70"	"$12,970.40"	$0.00	$0.00	$0.00	"$2,537.33"	$0.00	$0.00	"$2,581.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27801118	EAP	HCPCS C1874		Viatorr Sents 10mmx	BOTH IP/OP	"$16,213.00 "	"$11,997.62"	$0.00	"$12,970.40"	"$7,295.85"	"$7,295.85"	$0.00	$0.00	$0.00	"$3,379.19"	"$4,181.12"	"$4,181.12"	"$12,496.98"	$0.00	"$3,378.79"	$0.00	"$7,993.01"	"$7,993.01"	$0.00	"$8,106.50"	"$12,840.70"	"$12,970.40"	$0.00	$0.00	$0.00	"$2,537.33"	$0.00	$0.00	"$2,581.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27801119	EAP	HCPCS C1874		Viatorr Sents 10mmx	BOTH IP/OP	"$16,213.00 "	"$11,997.62"	$0.00	"$12,970.40"	"$7,295.85"	"$7,295.85"	$0.00	$0.00	$0.00	"$3,379.19"	"$4,181.12"	"$4,181.12"	"$12,496.98"	$0.00	"$3,378.79"	$0.00	"$7,993.01"	"$7,993.01"	$0.00	"$8,106.50"	"$12,840.70"	"$12,970.40"	$0.00	$0.00	$0.00	"$2,537.33"	$0.00	$0.00	"$2,581.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27801120	EAP	HCPCS C1874		Viatorr Sents 10mmx	BOTH IP/OP	"$16,213.00 "	"$11,997.62"	$0.00	"$12,970.40"	"$7,295.85"	"$7,295.85"	$0.00	$0.00	$0.00	"$3,379.19"	"$4,181.12"	"$4,181.12"	"$12,496.98"	$0.00	"$3,378.79"	$0.00	"$7,993.01"	"$7,993.01"	$0.00	"$8,106.50"	"$12,840.70"	"$12,970.40"	$0.00	$0.00	$0.00	"$2,537.33"	$0.00	$0.00	"$2,581.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27801121	EAP	HCPCS C1874		Viatorr Sents 12mmx	BOTH IP/OP	"$16,213.00 "	"$11,997.62"	$0.00	"$12,970.40"	"$7,295.85"	"$7,295.85"	$0.00	$0.00	$0.00	"$3,379.19"	"$4,181.12"	"$4,181.12"	"$12,496.98"	$0.00	"$3,378.79"	$0.00	"$7,993.01"	"$7,993.01"	$0.00	"$8,106.50"	"$12,840.70"	"$12,970.40"	$0.00	$0.00	$0.00	"$2,537.33"	$0.00	$0.00	"$2,581.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27801122	EAP	HCPCS C1874		Viatorr Sents 12mmx	BOTH IP/OP	"$16,213.00 "	"$11,997.62"	$0.00	"$12,970.40"	"$7,295.85"	"$7,295.85"	$0.00	$0.00	$0.00	"$3,379.19"	"$4,181.12"	"$4,181.12"	"$12,496.98"	$0.00	"$3,378.79"	$0.00	"$7,993.01"	"$7,993.01"	$0.00	"$8,106.50"	"$12,840.70"	"$12,970.40"	$0.00	$0.00	$0.00	"$2,537.33"	$0.00	$0.00	"$2,581.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27801123	EAP	HCPCS C1874		Viatorr Sents 12mmx	BOTH IP/OP	"$16,213.00 "	"$11,997.62"	$0.00	"$12,970.40"	"$7,295.85"	"$7,295.85"	$0.00	$0.00	$0.00	"$3,379.19"	"$4,181.12"	"$4,181.12"	"$12,496.98"	$0.00	"$3,378.79"	$0.00	"$7,993.01"	"$7,993.01"	$0.00	"$8,106.50"	"$12,840.70"	"$12,970.40"	$0.00	$0.00	$0.00	"$2,537.33"	$0.00	$0.00	"$2,581.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27801124	EAP	HCPCS C1874		Viatorr Sents 8mmx4	BOTH IP/OP	"$15,988.00 "	"$11,831.12"	$0.00	"$12,790.40"	"$7,194.60"	"$7,194.60"	$0.00	$0.00	$0.00	"$3,332.30"	"$4,181.12"	"$4,181.12"	"$12,323.55"	$0.00	"$3,331.90"	$0.00	"$7,882.08"	"$7,882.08"	$0.00	"$7,994.00"	"$12,662.50"	"$12,790.40"	$0.00	$0.00	$0.00	"$2,502.12"	$0.00	$0.00	"$2,545.29"	$0.00	$0.00	$0.00	$0.00	$0.00
27801125	EAP	HCPCS C1874		Viatorr Sents 8mmx5	BOTH IP/OP	"$16,213.00 "	"$11,997.62"	$0.00	"$12,970.40"	"$7,295.85"	"$7,295.85"	$0.00	$0.00	$0.00	"$3,379.19"	"$4,181.12"	"$4,181.12"	"$12,496.98"	$0.00	"$3,378.79"	$0.00	"$7,993.01"	"$7,993.01"	$0.00	"$8,106.50"	"$12,840.70"	"$12,970.40"	$0.00	$0.00	$0.00	"$2,537.33"	$0.00	$0.00	"$2,581.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27801126	EAP	HCPCS C1876		Wall Stent 18mmx40m	BOTH IP/OP	"$3,972.00 "	"$2,939.28"	$0.00	"$3,177.60"	"$1,787.40"	"$1,787.40"	$0.00	$0.00	$0.00	$827.86	"$2,948.02"	"$2,948.02"	"$3,061.62"	$0.00	$827.76	$0.00	"$1,958.20"	"$1,958.20"	$0.00	"$1,986.00"	"$3,145.82"	"$3,177.60"	$0.00	$0.00	$0.00	$621.62	$0.00	$0.00	$632.34	$0.00	$0.00	$0.00	$0.00	$0.00
27801127	EAP	HCPCS C1876		Wall Stent 16mmx20m	BOTH IP/OP	"$3,918.00 "	"$2,899.32"	$0.00	"$3,134.40"	"$1,763.10"	"$1,763.10"	$0.00	$0.00	$0.00	$816.61	"$2,907.94"	"$2,907.94"	"$3,019.99"	$0.00	$816.51	$0.00	"$1,931.57"	"$1,931.57"	$0.00	"$1,959.00"	"$3,103.06"	"$3,134.40"	$0.00	$0.00	$0.00	$613.17	$0.00	$0.00	$623.75	$0.00	$0.00	$0.00	$0.00	$0.00
27801128	EAP	HCPCS C1874		Viabhnend.cov.stent	BOTH IP/OP	"$15,609.00 "	"$11,550.66"	$0.00	"$12,487.20"	"$7,024.05"	"$7,024.05"	$0.00	$0.00	$0.00	"$3,253.31"	"$4,181.12"	"$4,181.12"	"$12,031.42"	$0.00	"$3,252.92"	$0.00	"$7,695.24"	"$7,695.24"	$0.00	"$7,804.50"	"$12,362.33"	"$12,487.20"	$0.00	$0.00	$0.00	"$2,442.81"	$0.00	$0.00	"$2,484.95"	$0.00	$0.00	$0.00	$0.00	$0.00
27801129	EAP	HCPCS C1874		Viabhnend.cov.stent	BOTH IP/OP	"$14,496.00 "	"$10,727.04"	$0.00	"$11,596.80"	"$6,523.20"	"$6,523.20"	$0.00	$0.00	$0.00	"$3,021.33"	"$4,181.12"	"$4,181.12"	"$11,173.52"	$0.00	"$3,020.97"	$0.00	"$7,146.53"	"$7,146.53"	$0.00	"$7,248.00"	"$11,480.83"	"$11,596.80"	$0.00	$0.00	$0.00	"$2,268.62"	$0.00	$0.00	"$2,307.76"	$0.00	$0.00	$0.00	$0.00	$0.00
27801130	EAP	HCPCS C1874		Viabhnend.cov.stent	BOTH IP/OP	"$17,381.00 "	"$12,861.94"	$0.00	"$13,904.80"	"$7,821.45"	"$7,821.45"	$0.00	$0.00	$0.00	"$3,622.63"	"$4,181.12"	"$4,181.12"	"$13,397.27"	$0.00	"$3,622.20"	$0.00	"$8,568.83"	"$8,568.83"	$0.00	"$8,690.50"	"$13,765.75"	"$13,904.80"	$0.00	$0.00	$0.00	"$2,720.13"	$0.00	$0.00	"$2,767.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27801131	EAP	HCPCS C1874		Viabhnend.cov.stent	BOTH IP/OP	"$20,235.00 "	"$14,973.90"	$0.00	"$16,188.00"	"$9,105.75"	"$9,105.75"	$0.00	$0.00	$0.00	"$4,217.48"	"$4,181.12"	"$4,181.12"	"$15,597.14"	$0.00	"$4,216.97"	$0.00	"$9,975.86"	"$9,975.86"	$0.00	"$10,117.50"	"$16,026.12"	"$16,188.00"	$0.00	$0.00	$0.00	"$3,166.78"	$0.00	$0.00	"$3,221.41"	$0.00	$0.00	$0.00	$0.00	$0.00
27801134	EAP	HCPCS C1874		Percut(mmxcm)8x4cov	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	"$6,157.80"	"$6,157.80"	$0.00	$0.00	$0.00	"$2,852.09"	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	"$6,746.21"	"$6,746.21"	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	$0.00	$0.00	"$2,141.55"	$0.00	$0.00	"$2,178.49"	$0.00	$0.00	$0.00	$0.00	$0.00
27801135	EAP	HCPCS C1874		Percut(mmxcm)8x6cov	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	"$6,157.80"	"$6,157.80"	$0.00	$0.00	$0.00	"$2,852.09"	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	"$6,746.21"	"$6,746.21"	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	$0.00	$0.00	"$2,141.55"	$0.00	$0.00	"$2,178.49"	$0.00	$0.00	$0.00	$0.00	$0.00
27801136	EAP	HCPCS C1874		Percut(mmxcm)8x8cov	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	"$6,157.80"	"$6,157.80"	$0.00	$0.00	$0.00	"$2,852.09"	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	"$6,746.21"	"$6,746.21"	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	$0.00	$0.00	"$2,141.55"	$0.00	$0.00	"$2,178.49"	$0.00	$0.00	$0.00	$0.00	$0.00
27801137	EAP	HCPCS C1874		Percut(mmxcm)8x10co	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	"$6,157.80"	"$6,157.80"	$0.00	$0.00	$0.00	"$2,852.09"	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	"$6,746.21"	"$6,746.21"	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	$0.00	$0.00	"$2,141.55"	$0.00	$0.00	"$2,178.49"	$0.00	$0.00	$0.00	$0.00	$0.00
27801138	EAP	HCPCS C1874		Percut(mmxcm)10x4co	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	"$6,157.80"	"$6,157.80"	$0.00	$0.00	$0.00	"$2,852.09"	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	"$6,746.21"	"$6,746.21"	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	$0.00	$0.00	"$2,141.55"	$0.00	$0.00	"$2,178.49"	$0.00	$0.00	$0.00	$0.00	$0.00
27801139	EAP	HCPCS C1874		Percut(mmxcm)10x6 C	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	"$6,157.80"	"$6,157.80"	$0.00	$0.00	$0.00	"$2,852.09"	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	"$6,746.21"	"$6,746.21"	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	$0.00	$0.00	"$2,141.55"	$0.00	$0.00	"$2,178.49"	$0.00	$0.00	$0.00	$0.00	$0.00
27801140	EAP	HCPCS C1875		Percut(mmxcm)10x8 C	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	$0.00	$0.00	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801141	EAP	HCPCS C1874		Percut(mmxcm)10x10	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	"$6,157.80"	"$6,157.80"	$0.00	$0.00	$0.00	"$2,852.09"	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	"$6,746.21"	"$6,746.21"	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	"$6,157.80"	$0.00	"$2,141.55"	$0.00	$0.00	"$2,178.49"	$0.00	$0.00	$0.00	$0.00	$0.00
27801142	EAP	HCPCS C1874		Percut(mmxcm)8x6unc	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	"$6,157.80"	"$6,157.80"	$0.00	$0.00	$0.00	"$2,852.09"	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	"$6,746.21"	"$6,746.21"	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	$0.00	$0.00	"$2,141.55"	$0.00	$0.00	"$2,178.49"	$0.00	$0.00	$0.00	$0.00	$0.00
27801143	EAP	HCPCS C1874		Percut(mmxcm)8x10un	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	"$6,157.80"	"$6,157.80"	$0.00	$0.00	$0.00	"$2,852.09"	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	"$6,746.21"	"$6,746.21"	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	$0.00	$0.00	"$2,141.55"	$0.00	$0.00	"$2,178.49"	$0.00	$0.00	$0.00	$0.00	$0.00
27801144	EAP	HCPCS C1874		Percut(mmxcm)10x6un	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	"$6,157.80"	"$6,157.80"	$0.00	$0.00	$0.00	"$2,852.09"	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	"$6,746.21"	"$6,746.21"	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	$0.00	$0.00	"$2,141.55"	$0.00	$0.00	"$2,178.49"	$0.00	$0.00	$0.00	$0.00	$0.00
27801145	EAP	HCPCS C1874		Percut(mmxcm)10x8un	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	"$6,157.80"	"$6,157.80"	$0.00	$0.00	$0.00	"$2,852.09"	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	"$6,746.21"	"$6,746.21"	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	$0.00	$0.00	"$2,141.55"	$0.00	$0.00	"$2,178.49"	$0.00	$0.00	$0.00	$0.00	$0.00
27801146	EAP	HCPCS C1874		Percut(mmxcm)10x10u	BOTH IP/OP	"$13,684.00 "	"$10,126.16"	$0.00	"$10,947.20"	"$6,157.80"	"$6,157.80"	$0.00	$0.00	$0.00	"$2,852.09"	"$4,181.12"	"$4,181.12"	"$10,547.63"	$0.00	"$2,851.75"	$0.00	"$6,746.21"	"$6,746.21"	$0.00	"$6,842.00"	"$10,837.73"	"$10,947.20"	$0.00	$0.00	$0.00	"$2,141.55"	$0.00	$0.00	"$2,178.49"	$0.00	$0.00	$0.00	$0.00	$0.00
27801147	EAP	HCPCS C1874		Endsc(mmxcm) 8x4 Co	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801148	EAP	HCPCS C1874		Endsc(mmxcm) 8x6 Co	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801149	EAP	HCPCS C1874		Endsc(mmxcm) 8x8 Co	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801150	EAP	HCPCS C1874		Endsc(mmxcm) 8x10 C	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801151	EAP	HCPCS C1874		Endsc(mmxcm) 10x4 C	BOTH IP/OP	"$12,902.00 "	"$9,547.48"	$0.00	"$10,321.60"	"$5,805.90"	"$5,805.90"	$0.00	$0.00	$0.00	"$2,689.10"	"$4,181.12"	"$4,181.12"	"$9,944.86"	$0.00	"$2,688.78"	$0.00	"$6,360.69"	"$6,360.69"	$0.00	"$6,451.00"	"$10,218.38"	"$10,321.60"	$0.00	$0.00	$0.00	"$2,019.16"	$0.00	$0.00	"$2,054.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27801152	EAP	HCPCS C1874		Endsc (mmxcm) 10x6	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801153	EAP	HCPCS C1874		Endsc(mmxcm) 10x8 C	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801154	EAP	HCPCS C1874		Endsc(mmxcm)10x10 C	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801155	EAP	HCPCS C1874		Endsc(mmxcm) 8x6 Un	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801156	EAP	HCPCS C1874		Endsc(mmxcm) 8x8 Un	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801157	EAP	HCPCS C1874		Endsc(mmxcm)8x10 Un	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801158	EAP	HCPCS C1874		Endsc(mmxcm)10x6 Un	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801159	EAP	HCPCS C1874		Endsc(mmxcm)10x8 Un	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801160	EAP	HCPCS C1874		Endsc(mmxcm)10x10un	BOTH IP/OP	"$12,810.00 "	"$9,479.40"	$0.00	"$10,248.00"	"$5,764.50"	"$5,764.50"	$0.00	$0.00	$0.00	"$2,669.92"	"$4,181.12"	"$4,181.12"	"$9,873.95"	$0.00	"$2,669.60"	$0.00	"$6,315.33"	"$6,315.33"	$0.00	"$6,405.00"	"$10,145.52"	"$10,248.00"	$0.00	$0.00	$0.00	"$2,004.77"	$0.00	$0.00	"$2,039.35"	$0.00	$0.00	$0.00	$0.00	$0.00
27801161	EAP	HCPCS C1874		"Stent,iliac,wallste"	BOTH IP/OP	"$6,980.00 "	"$5,165.20"	$0.00	"$5,584.00"	"$3,141.00"	"$3,141.00"	$0.00	$0.00	$0.00	"$1,454.81"	"$4,181.12"	"$4,181.12"	"$5,380.18"	$0.00	"$1,454.63"	$0.00	"$3,441.14"	"$3,441.14"	$0.00	"$3,490.00"	"$5,528.16"	"$5,584.00"	$0.00	$0.00	$0.00	"$1,092.37"	$0.00	$0.00	"$1,111.22"	$0.00	$0.00	$0.00	$0.00	$0.00
27801162	EAP	HCPCS C1880		Vena Cava Filter	BOTH IP/OP	"$4,656.00 "	"$3,445.44"	$0.00	"$3,724.80"	"$2,095.20"	"$2,095.20"	$0.00	$0.00	$0.00	$970.43	"$3,455.68"	"$3,455.68"	"$3,588.84"	$0.00	$970.31	$0.00	"$2,295.41"	"$2,295.41"	$0.00	"$2,328.00"	"$3,687.55"	"$3,724.80"	$0.00	$0.00	$0.00	$728.66	$0.00	$0.00	$741.24	$0.00	$0.00	$0.00	$0.00	$0.00
27801163	EAP	HCPCS C1874		"Ste.,bil Memmotherm"	BOTH IP/OP	"$6,980.00 "	"$5,165.20"	$0.00	"$5,584.00"	"$3,141.00"	"$3,141.00"	$0.00	$0.00	$0.00	"$1,454.81"	"$4,181.12"	"$4,181.12"	"$5,380.18"	$0.00	"$1,454.63"	$0.00	"$3,441.14"	"$3,441.14"	$0.00	"$3,490.00"	"$5,528.16"	"$5,584.00"	$0.00	$0.00	$0.00	"$1,092.37"	$0.00	$0.00	"$1,111.22"	$0.00	$0.00	$0.00	$0.00	$0.00
27801164	EAP	HCPCS C1874		"Ste.,bil Wallstent,"	BOTH IP/OP	"$5,991.00 "	"$4,433.34"	$0.00	"$4,792.80"	"$2,695.95"	"$2,695.95"	$0.00	$0.00	$0.00	"$1,248.67"	"$4,181.12"	"$4,181.12"	"$4,617.86"	$0.00	"$1,248.52"	$0.00	"$2,953.56"	"$2,953.56"	$0.00	"$2,995.50"	"$4,744.87"	"$4,792.80"	$0.00	$0.00	$0.00	$937.59	$0.00	$0.00	$953.77	$0.00	$0.00	$0.00	$0.00	$0.00
27801165	EAP	HCPCS C1874		"Ste,bil W/s Rp-20,4"	BOTH IP/OP	"$5,991.00 "	"$4,433.34"	$0.00	"$4,792.80"	"$2,695.95"	"$2,695.95"	$0.00	$0.00	$0.00	"$1,248.67"	"$4,181.12"	"$4,181.12"	"$4,617.86"	$0.00	"$1,248.52"	$0.00	"$2,953.56"	"$2,953.56"	$0.00	"$2,995.50"	"$4,744.87"	"$4,792.80"	$0.00	$0.00	$0.00	$937.59	$0.00	$0.00	$953.77	$0.00	$0.00	$0.00	$0.00	$0.00
27801166	EAP	HCPCS C1874		"Ste.,bil Wallstent"	BOTH IP/OP	"$10,078.00 "	"$7,457.72"	$0.00	"$8,062.40"	"$4,535.10"	"$4,535.10"	$0.00	$0.00	$0.00	"$2,100.51"	"$4,181.12"	"$4,181.12"	"$7,768.12"	$0.00	"$2,100.26"	$0.00	"$4,968.45"	"$4,968.45"	$0.00	"$5,039.00"	"$7,981.78"	"$8,062.40"	$0.00	$0.00	$0.00	"$1,577.21"	$0.00	$0.00	"$1,604.42"	$0.00	$0.00	$0.00	$0.00	$0.00
27801167	EAP	HCPCS C1874		"Ste.,ent W/stent,un"	BOTH IP/OP	"$10,078.00 "	"$7,457.72"	$0.00	"$8,062.40"	"$4,535.10"	"$4,535.10"	$0.00	$0.00	$0.00	"$2,100.51"	"$4,181.12"	"$4,181.12"	"$7,768.12"	$0.00	"$2,100.26"	$0.00	"$4,968.45"	"$4,968.45"	$0.00	"$5,039.00"	"$7,981.78"	"$8,062.40"	$0.00	$0.00	$0.00	"$1,577.21"	$0.00	$0.00	"$1,604.42"	$0.00	$0.00	$0.00	$0.00	$0.00
27801168	EAP	HCPCS C1874		"St.,wallgraft Unist"	BOTH IP/OP	"$11,656.00 "	"$8,625.44"	$0.00	"$9,324.80"	"$5,245.20"	"$5,245.20"	$0.00	$0.00	$0.00	"$2,429.40"	"$4,181.12"	"$4,181.12"	"$8,984.44"	$0.00	"$2,429.11"	$0.00	"$5,746.41"	"$5,746.41"	$0.00	"$5,828.00"	"$9,231.55"	"$9,324.80"	$0.00	$0.00	$0.00	"$1,824.16"	$0.00	$0.00	"$1,855.64"	$0.00	$0.00	$0.00	$0.00	$0.00
27801169	EAP	HCPCS C1874		"Ste., W/g Unistep-2"	BOTH IP/OP	"$11,656.00 "	"$8,625.44"	$0.00	"$9,324.80"	"$5,245.20"	"$5,245.20"	$0.00	$0.00	$0.00	"$2,429.40"	"$4,181.12"	"$4,181.12"	"$8,984.44"	$0.00	"$2,429.11"	$0.00	"$5,746.41"	"$5,746.41"	$0.00	"$5,828.00"	"$9,231.55"	"$9,324.80"	$0.00	$0.00	$0.00	"$1,824.16"	$0.00	$0.00	"$1,855.64"	$0.00	$0.00	$0.00	$0.00	$0.00
27801170	EAP	HCPCS L8670		Aortic Ext Endopros	BOTH IP/OP	"$10,150.00 "	"$7,511.00"	$0.00	"$8,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$7,823.62"	$0.00	"$2,115.26"	$0.00	$0.00	$0.00	$0.00	"$5,075.00"	"$8,038.80"	"$8,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801171	EAP	Custom 27801171		Pfo Implant	BOTH IP/OP	"$24,270.00 "	"$17,959.80"	$0.00	"$19,416.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$18,707.32"	$0.00	"$5,057.87"	$0.00	$0.00	$0.00	$0.00	"$12,135.00"	"$19,221.84"	"$19,416.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801172	EAP	Custom 27801172		Asd Implant	BOTH IP/OP	"$14,800.00 "	"$10,952.00"	$0.00	"$11,840.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,407.84"	$0.00	"$3,084.32"	$0.00	$0.00	$0.00	$0.00	"$7,400.00"	"$11,721.60"	"$11,840.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801173	EAP	HCPCS C1760		"Closure Device, Vas"	BOTH IP/OP	"$1,363.00 "	"$1,008.62"	$0.00	"$1,090.40"	$613.35	$613.35	$0.00	$0.00	$0.00	$284.08	"$1,011.62"	"$1,011.62"	"$1,050.60"	$0.00	$284.05	$0.00	$806.21	$806.21	$0.00	$681.50	"$1,079.50"	"$1,090.40"	$0.00	$0.00	$0.00	$213.31	$0.00	$0.00	$216.99	$0.00	$0.00	$0.00	$0.00	$0.00
27801190	EAP	HCPCS C1876		3.0x8mm Vision Rx S	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	"$1,314.00"	"$1,314.00"	$0.00	$0.00	$0.00	$608.60	"$2,167.22"	"$2,167.22"	"$2,250.74"	$0.00	$608.53	$0.00	"$1,439.56"	"$1,439.56"	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$456.98	$0.00	$0.00	$464.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801191	EAP	HCPCS C1876		3.5x8mm Vision Rx S	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801192	EAP	HCPCS C1876		4.0x8mm Vision Rx S	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801193	EAP	HCPCS C1876		3.0x12mm Vision Rx	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801194	EAP	HCPCS C1876		3.5x12mm Vision Rx	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	"$1,314.00"	"$1,314.00"	$0.00	$0.00	$0.00	$608.60	"$2,167.22"	"$2,167.22"	"$2,250.74"	$0.00	$608.53	$0.00	"$1,439.56"	"$1,439.56"	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$456.98	$0.00	$0.00	$464.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801195	EAP	HCPCS C1876		4.0x12mm Vision Rx	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801196	EAP	HCPCS C1876		3.0x15mm Vision Rx	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	"$1,314.00"	"$1,314.00"	$0.00	$0.00	$0.00	$608.60	"$2,167.22"	"$2,167.22"	"$2,250.74"	$0.00	$608.53	$0.00	"$1,439.56"	"$1,439.56"	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$456.98	$0.00	$0.00	$464.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801197	EAP	HCPCS C1876		3.5x15mm Vision Rx	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	"$1,314.00"	"$1,314.00"	$0.00	$0.00	$0.00	$608.60	"$2,167.22"	"$2,167.22"	"$2,250.74"	$0.00	$608.53	$0.00	"$1,439.56"	"$1,439.56"	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$456.98	$0.00	$0.00	$464.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801198	EAP	HCPCS C1876		4.0x15mm Vision Rx	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	"$1,314.00"	"$1,314.00"	$0.00	$0.00	$0.00	$608.60	"$2,167.22"	"$2,167.22"	"$2,250.74"	$0.00	$608.53	$0.00	"$1,439.56"	"$1,439.56"	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$456.98	$0.00	$0.00	$464.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801199	EAP	HCPCS C1876		3.0x18mm Vision Rx	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	"$1,314.00"	"$1,314.00"	$0.00	$0.00	$0.00	$608.60	"$2,167.22"	"$2,167.22"	"$2,250.74"	$0.00	$608.53	$0.00	"$1,439.56"	"$1,439.56"	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$456.98	$0.00	$0.00	$464.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801200	EAP	HCPCS C1876		3.5x18mm Vision Rx	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801201	EAP	HCPCS C1876		4.0x18mm Vision Rx	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801202	EAP	HCPCS C1874		3.0x23mm Vision Rx	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801203	EAP	HCPCS C1876		3.5x23mm Vision Rx	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801204	EAP	HCPCS C1876		4.0x23mm Vision Rx	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801205	EAP	HCPCS C1876		3.0x28mm Vision Rx	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	"$1,314.00"	"$1,314.00"	$0.00	$0.00	$0.00	$608.60	"$2,167.22"	"$2,167.22"	"$2,250.74"	$0.00	$608.53	$0.00	"$1,439.56"	"$1,439.56"	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$456.98	$0.00	$0.00	$464.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801206	EAP	HCPCS C1876		3.5x28mm Vision Rx	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801207	EAP	HCPCS C1876		4.0x28mm Vision Rx	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801214	EAP	HCPCS C1874		3.0 X 12mm Graftmas	BOTH IP/OP	"$17,938.00 "	"$13,274.12"	$0.00	"$14,350.40"	"$8,072.10"	"$8,072.10"	$0.00	$0.00	$0.00	"$3,738.73"	"$4,181.12"	"$4,181.12"	"$13,826.61"	$0.00	"$3,738.28"	$0.00	"$8,843.43"	"$8,843.43"	$0.00	"$8,969.00"	"$14,206.90"	"$14,350.40"	$0.00	$0.00	$0.00	"$2,807.30"	$0.00	$0.00	"$2,855.73"	$0.00	$0.00	$0.00	$0.00	$0.00
27801215	EAP	HCPCS C1876		2.50 X 8mm Mini-vis	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801216	EAP	HCPCS C1876		2.50 X 12 Mm Mini V	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	"$1,314.00"	"$1,314.00"	$0.00	$0.00	$0.00	$608.60	"$2,167.22"	"$2,167.22"	"$2,250.74"	$0.00	$608.53	$0.00	"$1,439.56"	"$1,439.56"	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$456.98	$0.00	$0.00	$464.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801217	EAP	HCPCS C1876		2.5 X 15mm Mini-vis	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	"$1,314.00"	"$1,314.00"	$0.00	$0.00	$0.00	$608.60	"$2,167.22"	"$2,167.22"	"$2,250.74"	$0.00	$608.53	$0.00	"$1,439.56"	"$1,439.56"	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$456.98	$0.00	$0.00	$464.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801218	EAP	HCPCS C1876		2.5 X 18mm Mini-vis	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801219	EAP	HCPCS C1876		205 X 23mm Mini-vis	BOTH IP/OP	"$7,782.00 "	"$5,758.68"	$0.00	"$6,225.60"	"$3,501.90"	"$3,501.90"	$0.00	$0.00	$0.00	"$1,621.96"	"$4,181.12"	"$4,181.12"	"$5,998.37"	$0.00	"$1,621.77"	$0.00	"$3,836.53"	"$3,836.53"	$0.00	"$3,891.00"	"$6,163.34"	"$6,225.60"	$0.00	$0.00	$0.00	"$1,217.88"	$0.00	$0.00	"$1,238.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801220	EAP	HCPCS C1876		2.5 X 28mm Mini-vis	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	"$1,314.00"	"$1,314.00"	$0.00	$0.00	$0.00	$608.60	"$2,167.22"	"$2,167.22"	"$2,250.74"	$0.00	$608.53	$0.00	"$1,439.56"	"$1,439.56"	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$456.98	$0.00	$0.00	$464.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801221	EAP	HCPCS C1874		3.0 X 12 Graftmaste	BOTH IP/OP	"$17,938.00 "	"$13,274.12"	$0.00	"$14,350.40"	"$8,072.10"	"$8,072.10"	$0.00	$0.00	$0.00	"$3,738.73"	"$4,181.12"	"$4,181.12"	"$13,826.61"	$0.00	"$3,738.28"	$0.00	"$8,843.43"	"$8,843.43"	$0.00	"$8,969.00"	"$14,206.90"	"$14,350.40"	$0.00	$0.00	$0.00	"$2,807.30"	$0.00	$0.00	"$2,855.73"	$0.00	$0.00	$0.00	$0.00	$0.00
27801222	EAP	HCPCS C1722		Lumax 340 Vr Icd Sy	BOTH IP/OP	"$49,886.00 "	"$36,915.64"	$0.00	"$39,908.80"	"$22,448.70"	"$22,448.70"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,452.13"	$0.00	"$10,396.24"	$0.00	"$24,593.80"	"$24,593.80"	$0.00	"$24,943.00"	"$39,509.71"	"$39,908.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$7,941.85"	$0.00	$0.00	$0.00	$0.00	$0.00
27801223	EAP	HCPCS C1721		Intrinsic Dr Dual I	BOTH IP/OP	"$10,215.00 "	"$7,559.10"	$0.00	"$8,172.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,129.06"	"$4,181.12"	"$4,181.12"	"$7,873.72"	$0.00	"$2,128.81"	$0.00	"$5,036.00"	"$5,036.00"	$0.00	"$5,107.50"	"$8,090.28"	"$8,172.00"	$0.00	$0.00	$0.00	"$1,598.65"	$0.00	$0.00	"$1,626.23"	$0.00	$0.00	$0.00	$0.00	$0.00
27801224	EAP	HCPCS C1721		Gem Iii Dr Dual Icd	BOTH IP/OP	"$3,890.00 "	"$2,878.60"	$0.00	"$3,112.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$810.77	"$2,887.16"	"$2,887.16"	"$2,998.41"	$0.00	$810.68	$0.00	"$1,917.77"	"$1,917.77"	$0.00	"$1,945.00"	"$3,080.88"	"$3,112.00"	$0.00	$0.00	$0.00	$608.79	$0.00	$0.00	$619.29	$0.00	$0.00	$0.00	$0.00	$0.00
27801225	EAP	HCPCS C1722		Gem Iii Vr Single I	BOTH IP/OP	"$11,351.00 "	"$8,399.74"	$0.00	"$9,080.80"	"$5,107.95"	"$5,107.95"	$0.00	$0.00	$0.00	"$2,365.83"	"$4,181.12"	"$4,181.12"	"$8,749.35"	$0.00	"$2,365.55"	$0.00	"$5,596.04"	"$5,596.04"	$0.00	"$5,675.50"	"$8,989.99"	"$9,080.80"	$0.00	$0.00	$0.00	"$1,776.43"	$0.00	$0.00	"$1,807.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27801226	EAP	HCPCS C1721		Confient He Dual Ic	BOTH IP/OP	"$15,364.00 "	"$11,369.36"	$0.00	"$12,291.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,202.24"	"$4,181.12"	"$4,181.12"	"$11,842.57"	$0.00	"$3,201.86"	$0.00	"$7,574.45"	"$7,574.45"	$0.00	"$7,682.00"	"$12,168.29"	"$12,291.20"	$0.00	$0.00	$0.00	"$2,404.47"	$0.00	$0.00	"$2,445.95"	$0.00	$0.00	$0.00	$0.00	$0.00
27801227	EAP	HCPCS C1760		Angioseal Vasc Clos	BOTH IP/OP	"$1,906.00 "	"$1,410.44"	$0.00	"$1,524.80"	$857.70	$857.70	$0.00	$0.00	$0.00	$397.26	"$1,414.63"	"$1,414.63"	"$1,469.14"	$0.00	$397.21	$0.00	"$1,127.40"	"$1,127.40"	$0.00	$953.00	"$1,509.55"	"$1,524.80"	$0.00	$0.00	$0.00	$298.29	$0.00	$0.00	$303.44	$0.00	$0.00	$0.00	$0.00	$0.00
27801228	EAP	HCPCS C1898		Setrox S Lead	BOTH IP/OP	"$2,869.00 "	"$2,123.06"	$0.00	"$2,295.20"	"$1,291.05"	"$1,291.05"	$0.00	$0.00	$0.00	$597.97	"$2,129.37"	"$2,129.37"	"$2,211.43"	$0.00	$597.90	$0.00	"$1,414.42"	"$1,414.42"	$0.00	"$1,434.50"	"$2,272.25"	"$2,295.20"	$0.00	$0.00	$0.00	$449.00	$0.00	$0.00	$456.74	$0.00	$0.00	$0.00	$0.00	$0.00
27801229	EAP	HCPCS C1898		Selox Sr Lead	BOTH IP/OP	"$2,681.00 "	"$1,983.94"	$0.00	"$2,144.80"	"$1,206.45"	"$1,206.45"	$0.00	$0.00	$0.00	$558.79	"$1,989.84"	"$1,989.84"	"$2,066.51"	$0.00	$558.72	$0.00	"$1,321.73"	"$1,321.73"	$0.00	"$1,340.50"	"$2,123.35"	"$2,144.80"	$0.00	$0.00	$0.00	$419.58	$0.00	$0.00	$426.82	$0.00	$0.00	$0.00	$0.00	$0.00
27801230	EAP	HCPCS C1722		Ovatio Vr Single Ic	BOTH IP/OP	"$14,505.00 "	"$10,733.70"	$0.00	"$11,604.00"	"$6,527.25"	"$6,527.25"	$0.00	$0.00	$0.00	"$3,023.20"	"$4,181.12"	"$4,181.12"	"$11,180.45"	$0.00	"$3,022.84"	$0.00	"$7,150.97"	"$7,150.97"	$0.00	"$7,252.50"	"$11,487.96"	"$11,604.00"	$0.00	$0.00	$0.00	"$2,270.03"	$0.00	$0.00	"$2,309.20"	$0.00	$0.00	$0.00	$0.00	$0.00
27801231	EAP	HCPCS C1721		Ovatio Dr Dual Icd	BOTH IP/OP	"$61,398.00 "	"$45,434.52"	$0.00	"$49,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$47,325.58"	$0.00	"$12,795.34"	$0.00	"$30,269.21"	"$30,269.21"	$0.00	"$30,699.00"	"$48,627.22"	"$49,118.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801232	EAP	HCPCS C1721		Vitality 2 El Dr Du	BOTH IP/OP	"$19,454.00 "	"$14,395.96"	$0.00	"$15,563.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,054.70"	"$4,181.12"	"$4,181.12"	"$14,995.14"	$0.00	"$4,054.21"	$0.00	"$9,590.82"	"$9,590.82"	$0.00	"$9,727.00"	"$15,407.57"	"$15,563.20"	$0.00	$0.00	$0.00	"$3,044.55"	$0.00	$0.00	"$3,097.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27801233	EAP	HCPCS C1721		Vitality 2 Dr Dual	BOTH IP/OP	"$12,969.00 "	"$9,597.06"	$0.00	"$10,375.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,703.06"	"$4,181.12"	"$4,181.12"	"$9,996.51"	$0.00	"$2,702.74"	$0.00	"$6,393.72"	"$6,393.72"	$0.00	"$6,484.50"	"$10,271.45"	"$10,375.20"	$0.00	$0.00	$0.00	"$2,029.65"	$0.00	$0.00	"$2,064.66"	$0.00	$0.00	$0.00	$0.00	$0.00
27801234	EAP	HCPCS C1721		Vitality Avt Dr Dua	BOTH IP/OP	"$19,454.00 "	"$14,395.96"	$0.00	"$15,563.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,054.70"	"$4,181.12"	"$4,181.12"	"$14,995.14"	$0.00	"$4,054.21"	$0.00	"$9,590.82"	"$9,590.82"	$0.00	"$9,727.00"	"$15,407.57"	"$15,563.20"	$0.00	$0.00	$0.00	"$3,044.55"	$0.00	$0.00	"$3,097.08"	$0.00	$0.00	$0.00	$0.00	$0.00
27801235	EAP	HCPCS C1721		Vitality He Dual Ic	BOTH IP/OP	"$3,369.00 "	"$2,493.06"	$0.00	"$2,695.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$702.18	"$2,500.47"	"$2,500.47"	"$2,596.83"	$0.00	$702.10	$0.00	"$1,660.92"	"$1,660.92"	$0.00	"$1,684.50"	"$2,668.25"	"$2,695.20"	$0.00	$0.00	$0.00	$527.25	$0.00	$0.00	$536.34	$0.00	$0.00	$0.00	$0.00	$0.00
27801236	EAP	HCPCS C1721		Vitality El Dual Ic	BOTH IP/OP	"$3,243.00 "	"$2,399.82"	$0.00	"$2,594.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$675.92	"$2,406.95"	"$2,406.95"	"$2,499.70"	$0.00	$675.84	$0.00	"$1,598.80"	"$1,598.80"	$0.00	"$1,621.50"	"$2,568.46"	"$2,594.40"	$0.00	$0.00	$0.00	$507.53	$0.00	$0.00	$516.29	$0.00	$0.00	$0.00	$0.00	$0.00
27801237	EAP	HCPCS C1721		Vitality Ds Dr Dual	BOTH IP/OP	"$79,815.00 "	"$59,063.10"	$0.00	"$63,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$61,521.40"	$0.00	"$16,633.45"	$0.00	"$39,348.80"	"$39,348.80"	$0.00	"$39,907.50"	"$63,213.48"	"$63,852.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801238	EAP	HCPCS C1722		Vitality 2 El Vr Sn	BOTH IP/OP	"$3,243.00 "	"$2,399.82"	$0.00	"$2,594.40"	"$1,459.35"	"$1,459.35"	$0.00	$0.00	$0.00	$675.92	"$2,406.95"	"$2,406.95"	"$2,499.70"	$0.00	$675.84	$0.00	"$1,598.80"	"$1,598.80"	$0.00	"$1,621.50"	"$2,568.46"	"$2,594.40"	$0.00	$0.00	$0.00	$507.53	$0.00	$0.00	$516.29	$0.00	$0.00	$0.00	$0.00	$0.00
27801239	EAP	HCPCS C1722		Vitality 2 Vr Sngl	BOTH IP/OP	"$79,815.00 "	"$59,063.10"	$0.00	"$63,852.00"	"$35,916.75"	"$35,916.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$61,521.40"	$0.00	"$16,633.45"	$0.00	"$39,348.80"	"$39,348.80"	$0.00	"$39,907.50"	"$63,213.48"	"$63,852.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801240	EAP	HCPCS C1722		Vitality Ds Vr Sngl	BOTH IP/OP	"$16,836.00 "	"$12,458.64"	$0.00	"$13,468.80"	"$7,576.20"	"$7,576.20"	$0.00	$0.00	$0.00	"$3,509.04"	"$4,181.12"	"$4,181.12"	"$12,977.19"	$0.00	"$3,508.62"	$0.00	"$8,300.15"	"$8,300.15"	$0.00	"$8,418.00"	"$13,334.11"	"$13,468.80"	$0.00	$0.00	$0.00	"$2,634.83"	$0.00	$0.00	"$2,680.29"	$0.00	$0.00	$0.00	$0.00	$0.00
27801241	EAP	HCPCS C1895		Reliance G Active F	BOTH IP/OP	"$9,730.00 "	"$7,200.20"	$0.00	"$7,784.00"	"$4,378.50"	"$4,378.50"	$0.00	$0.00	$0.00	"$2,027.98"	"$4,181.12"	"$4,181.12"	"$7,499.88"	$0.00	"$2,027.73"	$0.00	"$4,796.89"	"$4,796.89"	$0.00	"$4,865.00"	"$7,706.16"	"$7,784.00"	$0.00	$0.00	$0.00	"$1,522.75"	$0.00	$0.00	"$1,549.02"	$0.00	$0.00	$0.00	$0.00	$0.00
27801242	EAP	HCPCS C1895		Reliance G Active F	BOTH IP/OP	"$10,102.00 "	"$7,475.48"	$0.00	"$8,081.60"	"$4,545.90"	"$4,545.90"	$0.00	$0.00	$0.00	"$2,105.51"	"$4,181.12"	"$4,181.12"	"$7,786.62"	$0.00	"$2,105.26"	$0.00	"$4,980.29"	"$4,980.29"	$0.00	"$5,051.00"	"$8,000.78"	"$8,081.60"	$0.00	$0.00	$0.00	"$1,580.96"	$0.00	$0.00	"$1,608.24"	$0.00	$0.00	$0.00	$0.00	$0.00
27801243	EAP	HCPCS C1895		Reliance G Passive	BOTH IP/OP	"$9,730.00 "	"$7,200.20"	$0.00	"$7,784.00"	"$4,378.50"	"$4,378.50"	$0.00	$0.00	$0.00	"$2,027.98"	"$4,181.12"	"$4,181.12"	"$7,499.88"	$0.00	"$2,027.73"	$0.00	"$4,796.89"	"$4,796.89"	$0.00	"$4,865.00"	"$7,706.16"	"$7,784.00"	$0.00	$0.00	$0.00	"$1,522.75"	$0.00	$0.00	"$1,549.02"	$0.00	$0.00	$0.00	$0.00	$0.00
27801244	EAP	HCPCS C1895		Reliance G Passive	BOTH IP/OP	"$9,730.00 "	"$7,200.20"	$0.00	"$7,784.00"	"$4,378.50"	"$4,378.50"	$0.00	$0.00	$0.00	"$2,027.98"	"$4,181.12"	"$4,181.12"	"$7,499.88"	$0.00	"$2,027.73"	$0.00	"$4,796.89"	"$4,796.89"	$0.00	"$4,865.00"	"$7,706.16"	"$7,784.00"	$0.00	$0.00	$0.00	"$1,522.75"	$0.00	$0.00	"$1,549.02"	$0.00	$0.00	$0.00	$0.00	$0.00
27801245	EAP	HCPCS C1895		Reliance Active Fix	BOTH IP/OP	"$6,985.00 "	"$5,168.90"	$0.00	"$5,588.00"	"$3,143.25"	"$3,143.25"	$0.00	$0.00	$0.00	"$1,455.85"	"$4,181.12"	"$4,181.12"	"$5,384.04"	$0.00	"$1,455.67"	$0.00	"$3,443.61"	"$3,443.61"	$0.00	"$3,492.50"	"$5,532.12"	"$5,588.00"	$0.00	$0.00	$0.00	"$1,093.15"	$0.00	$0.00	"$1,112.01"	$0.00	$0.00	$0.00	$0.00	$0.00
27801246	EAP	HCPCS C1895		Reliance Active Fix	BOTH IP/OP	"$7,253.00 "	"$5,367.22"	$0.00	"$5,802.40"	"$3,263.85"	"$3,263.85"	$0.00	$0.00	$0.00	"$1,511.71"	"$4,181.12"	"$4,181.12"	"$5,590.61"	$0.00	"$1,511.53"	$0.00	"$3,575.73"	"$3,575.73"	$0.00	"$3,626.50"	"$5,744.38"	"$5,802.40"	$0.00	$0.00	$0.00	"$1,135.09"	$0.00	$0.00	"$1,154.68"	$0.00	$0.00	$0.00	$0.00	$0.00
27801247	EAP	HCPCS C1895		Reliance Passive Fi	BOTH IP/OP	"$9,730.00 "	"$7,200.20"	$0.00	"$7,784.00"	"$4,378.50"	"$4,378.50"	$0.00	$0.00	$0.00	"$2,027.98"	"$4,181.12"	"$4,181.12"	"$7,499.88"	$0.00	"$2,027.73"	$0.00	"$4,796.89"	"$4,796.89"	$0.00	"$4,865.00"	"$7,706.16"	"$7,784.00"	$0.00	$0.00	$0.00	"$1,522.75"	$0.00	$0.00	"$1,549.02"	$0.00	$0.00	$0.00	$0.00	$0.00
27801248	EAP	HCPCS C1895		Reliance Passive Fi	BOTH IP/OP	"$9,730.00 "	"$7,200.20"	$0.00	"$7,784.00"	"$4,378.50"	"$4,378.50"	$0.00	$0.00	$0.00	"$2,027.98"	"$4,181.12"	"$4,181.12"	"$7,499.88"	$0.00	"$2,027.73"	$0.00	"$4,796.89"	"$4,796.89"	$0.00	"$4,865.00"	"$7,706.16"	"$7,784.00"	$0.00	$0.00	$0.00	"$1,522.75"	$0.00	$0.00	"$1,549.02"	$0.00	$0.00	$0.00	$0.00	$0.00
27801249	EAP	HCPCS C1721		Atlas Dr Dual Icd	BOTH IP/OP	"$9,730.00 "	"$7,200.20"	$0.00	"$7,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,027.98"	"$4,181.12"	"$4,181.12"	"$7,499.88"	$0.00	"$2,027.73"	$0.00	"$4,796.89"	"$4,796.89"	$0.00	"$4,865.00"	"$7,706.16"	"$7,784.00"	$0.00	$0.00	$0.00	"$1,522.75"	$0.00	$0.00	"$1,549.02"	$0.00	$0.00	$0.00	$0.00	$0.00
27801250	EAP	HCPCS C1895		Riata Dual Coil Lea	BOTH IP/OP	"$17,833.00 "	"$13,196.42"	$0.00	"$14,266.40"	"$8,024.85"	"$8,024.85"	$0.00	$0.00	$0.00	"$3,716.84"	"$4,181.12"	"$4,181.12"	"$13,745.68"	$0.00	"$3,716.40"	$0.00	"$8,791.67"	"$8,791.67"	$0.00	"$8,916.50"	"$14,123.74"	"$14,266.40"	$0.00	$0.00	$0.00	"$2,790.86"	$0.00	$0.00	"$2,839.01"	$0.00	$0.00	$0.00	$0.00	$0.00
27801251	EAP	HCPCS C1895		Riata Dual Coil Lea	BOTH IP/OP	"$17,833.00 "	"$13,196.42"	$0.00	"$14,266.40"	"$8,024.85"	"$8,024.85"	$0.00	$0.00	$0.00	"$3,716.84"	"$4,181.12"	"$4,181.12"	"$13,745.68"	$0.00	"$3,716.40"	$0.00	"$8,791.67"	"$8,791.67"	$0.00	"$8,916.50"	"$14,123.74"	"$14,266.40"	$0.00	$0.00	$0.00	"$2,790.86"	$0.00	$0.00	"$2,839.01"	$0.00	$0.00	$0.00	$0.00	$0.00
27801252	EAP	HCPCS C1895		Riata I Dual Coil L	BOTH IP/OP	"$17,833.00 "	"$13,196.42"	$0.00	"$14,266.40"	"$8,024.85"	"$8,024.85"	$0.00	$0.00	$0.00	"$3,716.84"	"$4,181.12"	"$4,181.12"	"$13,745.68"	$0.00	"$3,716.40"	$0.00	"$8,791.67"	"$8,791.67"	$0.00	"$8,916.50"	"$14,123.74"	"$14,266.40"	$0.00	$0.00	$0.00	"$2,790.86"	$0.00	$0.00	"$2,839.01"	$0.00	$0.00	$0.00	$0.00	$0.00
27801253	EAP	HCPCS C1895		Riata Single Coil L	BOTH IP/OP	"$17,833.00 "	"$13,196.42"	$0.00	"$14,266.40"	"$8,024.85"	"$8,024.85"	$0.00	$0.00	$0.00	"$3,716.84"	"$4,181.12"	"$4,181.12"	"$13,745.68"	$0.00	"$3,716.40"	$0.00	"$8,791.67"	"$8,791.67"	$0.00	"$8,916.50"	"$14,123.74"	"$14,266.40"	$0.00	$0.00	$0.00	"$2,790.86"	$0.00	$0.00	"$2,839.01"	$0.00	$0.00	$0.00	$0.00	$0.00
27801254	EAP	HCPCS C1895		Riata Single Coil L	BOTH IP/OP	"$17,833.00 "	"$13,196.42"	$0.00	"$14,266.40"	"$8,024.85"	"$8,024.85"	$0.00	$0.00	$0.00	"$3,716.84"	"$4,181.12"	"$4,181.12"	"$13,745.68"	$0.00	"$3,716.40"	$0.00	"$8,791.67"	"$8,791.67"	$0.00	"$8,916.50"	"$14,123.74"	"$14,266.40"	$0.00	$0.00	$0.00	"$2,790.86"	$0.00	$0.00	"$2,839.01"	$0.00	$0.00	$0.00	$0.00	$0.00
27801255	EAP	HCPCS C1895		Riata St Dual Coil	BOTH IP/OP	"$13,714.00 "	"$10,148.36"	$0.00	"$10,971.20"	"$6,171.30"	"$6,171.30"	$0.00	$0.00	$0.00	"$2,858.34"	"$4,181.12"	"$4,181.12"	"$10,570.75"	$0.00	"$2,858.00"	$0.00	"$6,761.00"	"$6,761.00"	$0.00	"$6,857.00"	"$10,861.49"	"$10,971.20"	$0.00	$0.00	$0.00	"$2,146.24"	$0.00	$0.00	"$2,183.27"	$0.00	$0.00	$0.00	$0.00	$0.00
27801256	EAP	HCPCS C1895		Riata St Sngl Coil	BOTH IP/OP	"$11,221.00 "	"$8,303.54"	$0.00	"$8,976.80"	"$5,049.45"	"$5,049.45"	$0.00	$0.00	$0.00	"$2,338.74"	"$4,181.12"	"$4,181.12"	"$8,649.15"	$0.00	"$2,338.46"	$0.00	"$5,531.95"	"$5,531.95"	$0.00	"$5,610.50"	"$8,887.03"	"$8,976.80"	$0.00	$0.00	$0.00	"$1,756.09"	$0.00	$0.00	"$1,786.38"	$0.00	$0.00	$0.00	$0.00	$0.00
27801257	EAP	HCPCS C1895		Spl Leads	BOTH IP/OP	"$5,189.00 "	"$3,839.86"	$0.00	"$4,151.20"	"$2,335.05"	"$2,335.05"	$0.00	$0.00	$0.00	"$1,081.52"	"$3,851.28"	"$3,851.28"	"$3,999.68"	$0.00	"$1,081.39"	$0.00	"$2,558.18"	"$2,558.18"	$0.00	"$2,594.50"	"$4,109.69"	"$4,151.20"	$0.00	$0.00	$0.00	$812.08	$0.00	$0.00	$826.09	$0.00	$0.00	$0.00	$0.00	$0.00
27801258	EAP	HCPCS C1895		Tvl-adx Leads	BOTH IP/OP	"$5,189.00 "	"$3,839.86"	$0.00	"$4,151.20"	"$2,335.05"	"$2,335.05"	$0.00	$0.00	$0.00	"$1,081.52"	"$3,851.28"	"$3,851.28"	"$3,999.68"	$0.00	"$1,081.39"	$0.00	"$2,558.18"	"$2,558.18"	$0.00	"$2,594.50"	"$4,109.69"	"$4,151.20"	$0.00	$0.00	$0.00	$812.08	$0.00	$0.00	$826.09	$0.00	$0.00	$0.00	$0.00	$0.00
27801259	EAP	HCPCS C1895		Bipolar Endocard Pa	BOTH IP/OP	"$2,792.00 "	"$2,066.08"	$0.00	"$2,233.60"	"$1,256.40"	"$1,256.40"	$0.00	$0.00	$0.00	$581.92	"$2,072.22"	"$2,072.22"	"$2,152.07"	$0.00	$581.85	$0.00	"$1,376.46"	"$1,376.46"	$0.00	"$1,396.00"	"$2,211.26"	"$2,233.60"	$0.00	$0.00	$0.00	$436.95	$0.00	$0.00	$444.49	$0.00	$0.00	$0.00	$0.00	$0.00
27801260	EAP	HCPCS C1721		Lumax 300 Dr-t Dual	BOTH IP/OP	"$3,243.00 "	"$2,399.82"	$0.00	"$2,594.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$675.92	"$2,406.95"	"$2,406.95"	"$2,499.70"	$0.00	$675.84	$0.00	"$1,598.80"	"$1,598.80"	$0.00	"$1,621.50"	"$2,568.46"	"$2,594.40"	$0.00	$0.00	$0.00	$507.53	$0.00	$0.00	$516.29	$0.00	$0.00	$0.00	$0.00	$0.00
27801261	EAP	HCPCS C1722		Lumax 300 Vr-t Sing	BOTH IP/OP	"$15,437.00 "	"$11,423.38"	$0.00	"$12,349.60"	"$6,946.65"	"$6,946.65"	$0.00	$0.00	$0.00	"$3,217.46"	"$4,181.12"	"$4,181.12"	"$11,898.84"	$0.00	"$3,217.07"	$0.00	"$7,610.44"	"$7,610.44"	$0.00	"$7,718.50"	"$12,226.10"	"$12,349.60"	$0.00	$0.00	$0.00	"$2,415.89"	$0.00	$0.00	"$2,457.57"	$0.00	$0.00	$0.00	$0.00	$0.00
27801262	EAP	HCPCS C1895		Riata Lead	BOTH IP/OP	"$14,592.00 "	"$10,798.08"	$0.00	"$11,673.60"	"$6,566.40"	"$6,566.40"	$0.00	$0.00	$0.00	"$3,041.34"	"$4,181.12"	"$4,181.12"	"$11,247.51"	$0.00	"$3,040.97"	$0.00	"$7,193.86"	"$7,193.86"	$0.00	"$7,296.00"	"$11,556.86"	"$11,673.60"	$0.00	$0.00	$0.00	"$2,283.65"	$0.00	$0.00	"$2,323.05"	$0.00	$0.00	$0.00	$0.00	$0.00
27801263	EAP	HCPCS C1895		Riata St Lead	BOTH IP/OP	"$14,592.00 "	"$10,798.08"	$0.00	"$11,673.60"	"$6,566.40"	"$6,566.40"	$0.00	$0.00	$0.00	"$3,041.34"	"$4,181.12"	"$4,181.12"	"$11,247.51"	$0.00	"$3,040.97"	$0.00	"$7,193.86"	"$7,193.86"	$0.00	"$7,296.00"	"$11,556.86"	"$11,673.60"	$0.00	$0.00	$0.00	"$2,283.65"	$0.00	$0.00	"$2,323.05"	$0.00	$0.00	$0.00	$0.00	$0.00
27801264	EAP	HCPCS C1777		Riata St Pkg	BOTH IP/OP	"$14,592.00 "	"$10,798.08"	$0.00	"$11,673.60"	"$6,566.40"	"$6,566.40"	$0.00	$0.00	$0.00	"$3,041.34"	"$4,181.12"	"$4,181.12"	"$11,247.51"	$0.00	"$3,040.97"	$0.00	"$7,193.86"	"$7,193.86"	$0.00	"$7,296.00"	"$11,556.86"	"$11,673.60"	$0.00	$0.00	$0.00	"$2,283.65"	$0.00	$0.00	"$2,323.05"	$0.00	$0.00	$0.00	$0.00	$0.00
27801265	EAP	HCPCS C1721		Atlas Ii Dr Dual Ic	BOTH IP/OP	"$9,730.00 "	"$7,200.20"	$0.00	"$7,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,027.98"	"$4,181.12"	"$4,181.12"	"$7,499.88"	$0.00	"$2,027.73"	$0.00	"$4,796.89"	"$4,796.89"	$0.00	"$4,865.00"	"$7,706.16"	"$7,784.00"	$0.00	$0.00	$0.00	"$1,522.75"	$0.00	$0.00	"$1,549.02"	$0.00	$0.00	$0.00	$0.00	$0.00
27801266	EAP	HCPCS C1779		4457 Fineline 11 Le	BOTH IP/OP	"$2,973.00 "	"$2,200.02"	$0.00	"$2,378.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,206.56"	"$2,206.56"	"$2,291.59"	$0.00	$619.57	$0.00	$0.00	$0.00	$0.00	"$1,486.50"	"$2,354.62"	"$2,378.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801267	EAP	HCPCS C1721		Teligen Is Vr Sngl	BOTH IP/OP	"$61,398.00 "	"$45,434.52"	$0.00	"$49,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$47,325.58"	$0.00	"$12,795.34"	$0.00	"$30,269.21"	"$30,269.21"	$0.00	"$30,699.00"	"$48,627.22"	"$49,118.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801268	EAP	HCPCS C1882		Insync Maximo Dual	BOTH IP/OP	"$68,113.00 "	"$50,403.62"	$0.00	"$54,490.40"	"$30,650.85"	"$30,650.85"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$52,501.50"	$0.00	"$14,194.75"	$0.00	"$33,579.71"	"$33,579.71"	$0.00	"$34,056.50"	"$53,945.50"	"$54,490.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801269	EAP	HCPCS C1721		Ovatio Oh60u Dr 655	BOTH IP/OP	"$40,295.00 "	"$29,818.30"	$0.00	"$32,236.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,398.49"	"$4,181.12"	"$4,181.12"	"$31,059.39"	$0.00	"$8,397.48"	$0.00	"$19,865.44"	"$19,865.44"	$0.00	"$20,147.50"	"$31,913.64"	"$32,236.00"	$0.00	$0.00	$0.00	"$6,306.17"	$0.00	$0.00	"$6,414.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27801270	EAP	HCPCS C1722		Ovatio Oh61u Vr Sys	BOTH IP/OP	"$57,559.00 "	"$42,593.66"	$0.00	"$46,047.20"	"$25,901.55"	"$25,901.55"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$44,366.48"	$0.00	"$11,995.30"	$0.00	"$28,376.59"	"$28,376.59"	$0.00	"$28,779.50"	"$45,586.73"	"$46,047.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801271	EAP	HCPCS C1882		Ovatio Crt 6750 Sys	BOTH IP/OP	"$46,048.00 "	"$34,075.52"	$0.00	"$36,838.40"	"$20,721.60"	"$20,721.60"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,493.80"	$0.00	"$9,596.40"	$0.00	"$22,701.66"	"$22,701.66"	$0.00	"$23,024.00"	"$36,470.02"	"$36,838.40"	$0.00	$0.00	$0.00	"$7,206.51"	$0.00	$0.00	"$7,330.84"	$0.00	$0.00	$0.00	$0.00	$0.00
27801272	EAP	HCPCS C1721		Lumax 340 Dr-t Syst	BOTH IP/OP	"$69,071.00 "	"$51,112.54"	$0.00	"$55,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$53,239.93"	$0.00	"$14,394.40"	$0.00	"$34,052.00"	"$34,052.00"	$0.00	"$34,535.50"	"$54,704.23"	"$55,256.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801273	EAP	HCPCS C1721		Lumos Dr-t System	BOTH IP/OP	"$65,235.00 "	"$48,273.90"	$0.00	"$52,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$50,283.14"	$0.00	"$13,594.97"	$0.00	"$32,160.86"	"$32,160.86"	$0.00	"$32,617.50"	"$51,666.12"	"$52,188.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801274	EAP	HCPCS C1722		Lumax 340 Vr-t Syst	BOTH IP/OP	"$61,398.00 "	"$45,434.52"	$0.00	"$49,118.40"	"$27,629.10"	"$27,629.10"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$47,325.58"	$0.00	"$12,795.34"	$0.00	"$30,269.21"	"$30,269.21"	$0.00	"$30,699.00"	"$48,627.22"	"$49,118.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801275	EAP	HCPCS C1722		Lumos Vr-t System	BOTH IP/OP	"$57,559.00 "	"$42,593.66"	$0.00	"$46,047.20"	"$25,901.55"	"$25,901.55"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$44,366.48"	$0.00	"$11,995.30"	$0.00	"$28,376.59"	"$28,376.59"	$0.00	"$28,779.50"	"$45,586.73"	"$46,047.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801276	EAP	HCPCS C1882		Lumax 340 Hf-t Syst	BOTH IP/OP	"$100,923.00 "	"$74,683.02"	$0.00	"$80,738.40"	"$45,415.35"	"$45,415.35"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$77,791.45"	$0.00	"$21,032.35"	$0.00	"$49,755.04"	"$49,755.04"	$0.00	"$50,461.50"	"$79,931.02"	"$80,738.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801277	EAP	HCPCS C1876		2.25 X 12mm Mini-vi	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	"$1,314.00"	"$1,314.00"	$0.00	$0.00	$0.00	$608.60	"$2,167.22"	"$2,167.22"	"$2,250.74"	$0.00	$608.53	$0.00	"$1,439.56"	"$1,439.56"	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$456.98	$0.00	$0.00	$464.86	$0.00	$0.00	$0.00	$0.00	$0.00
27801278	EAP	HCPCS C1876		4.5 X 13mm Ultra Rx	BOTH IP/OP	"$2,586.00 "	"$1,913.64"	$0.00	"$2,068.80"	"$1,163.70"	"$1,163.70"	$0.00	$0.00	$0.00	$538.99	"$1,919.33"	"$1,919.33"	"$1,993.29"	$0.00	$538.92	$0.00	"$1,274.90"	"$1,274.90"	$0.00	"$1,293.00"	"$2,048.11"	"$2,068.80"	$0.00	$0.00	$0.00	$404.71	$0.00	$0.00	$411.69	$0.00	$0.00	$0.00	$0.00	$0.00
27801279	EAP	HCPCS C1876		4.5 X 18mm Ultra Rx	BOTH IP/OP	"$9,175.00 "	"$6,789.50"	$0.00	"$7,340.00"	"$4,128.75"	"$4,128.75"	$0.00	$0.00	$0.00	"$1,912.30"	"$4,181.12"	"$4,181.12"	"$7,072.09"	$0.00	"$1,912.07"	$0.00	"$4,523.28"	"$4,523.28"	$0.00	"$4,587.50"	"$7,266.60"	"$7,340.00"	$0.00	$0.00	$0.00	"$1,435.89"	$0.00	$0.00	"$1,460.66"	$0.00	$0.00	$0.00	$0.00	$0.00
27801280	EAP	HCPCS C1876		4.5 X 28mm Ultra Rx	BOTH IP/OP	"$9,175.00 "	"$6,789.50"	$0.00	"$7,340.00"	"$4,128.75"	"$4,128.75"	$0.00	$0.00	$0.00	"$1,912.30"	"$4,181.12"	"$4,181.12"	"$7,072.09"	$0.00	"$1,912.07"	$0.00	"$4,523.28"	"$4,523.28"	$0.00	"$4,587.50"	"$7,266.60"	"$7,340.00"	$0.00	$0.00	$0.00	"$1,435.89"	$0.00	$0.00	"$1,460.66"	$0.00	$0.00	$0.00	$0.00	$0.00
27801282	EAP	HCPCS C1874		3.0 X 16mm Graftmas	BOTH IP/OP	"$7,990.00 "	"$5,912.60"	$0.00	"$6,392.00"	"$3,595.50"	"$3,595.50"	$0.00	$0.00	$0.00	"$1,665.32"	"$4,181.12"	"$4,181.12"	"$6,158.69"	$0.00	"$1,665.12"	$0.00	"$3,939.07"	"$3,939.07"	$0.00	"$3,995.00"	"$6,328.08"	"$6,392.00"	$0.00	$0.00	$0.00	"$1,250.44"	$0.00	$0.00	"$1,272.01"	$0.00	$0.00	$0.00	$0.00	$0.00
27801283	EAP	HCPCS C1874		3.5 X 16mm Graftmas	BOTH IP/OP	"$7,990.00 "	"$5,912.60"	$0.00	"$6,392.00"	"$3,595.50"	"$3,595.50"	$0.00	$0.00	$0.00	"$1,665.32"	"$4,181.12"	"$4,181.12"	"$6,158.69"	$0.00	"$1,665.12"	$0.00	"$3,939.07"	"$3,939.07"	$0.00	"$3,995.00"	"$6,328.08"	"$6,392.00"	$0.00	$0.00	$0.00	"$1,250.44"	$0.00	$0.00	"$1,272.01"	$0.00	$0.00	$0.00	$0.00	$0.00
27801284	EAP	HCPCS C1776		2mm Mini Snare	BOTH IP/OP	"$1,870.00 "	"$1,383.80"	$0.00	"$1,496.00"	$841.50	$841.50	$0.00	$0.00	$0.00	$389.75	"$1,387.91"	"$1,387.91"	"$1,441.40"	$0.00	$389.71	$0.00	"$1,106.11"	"$1,106.11"	$0.00	$935.00	"$1,481.04"	"$1,496.00"	$0.00	$841.50	$0.00	$292.66	$0.00	$0.00	$297.70	$0.00	$0.00	$0.00	$0.00	$0.00
27801285	EAP	HCPCS C1776		4mm Mini Snare	BOTH IP/OP	"$1,870.00 "	"$1,383.80"	$0.00	"$1,496.00"	$841.50	$841.50	$0.00	$0.00	$0.00	$389.75	"$1,387.91"	"$1,387.91"	"$1,441.40"	$0.00	$389.71	$0.00	"$1,106.11"	"$1,106.11"	$0.00	$935.00	"$1,481.04"	"$1,496.00"	$0.00	$0.00	$0.00	$292.66	$0.00	$0.00	$297.70	$0.00	$0.00	$0.00	$0.00	$0.00
27801357	EAP	HCPCS C1874		Endeavor Sprint Des	BOTH IP/OP	"$5,755.00 "	"$4,258.70"	$0.00	"$4,604.00"	"$2,589.75"	"$2,589.75"	$0.00	$0.00	$0.00	"$1,199.49"	"$4,181.12"	"$4,181.12"	"$4,435.95"	$0.00	"$1,199.34"	$0.00	"$2,837.22"	"$2,837.22"	$0.00	"$2,877.50"	"$4,557.96"	"$4,604.00"	$0.00	$0.00	$0.00	$900.66	$0.00	$0.00	$916.20	$0.00	$0.00	$0.00	$0.00	$0.00
27801367	EAP	HCPCS C1760		Mynx Vascular Closu	BOTH IP/OP	"$5,839.00 "	"$4,320.86"	$0.00	"$4,671.20"	"$2,627.55"	"$2,627.55"	$0.00	$0.00	$0.00	"$1,216.99"	"$4,181.12"	"$4,181.12"	"$4,500.70"	$0.00	"$1,216.85"	$0.00	"$2,878.63"	"$2,878.63"	$0.00	"$2,919.50"	"$4,624.49"	"$4,671.20"	$0.00	$0.00	$0.00	$913.80	$0.00	$0.00	$929.57	$0.00	$0.00	$0.00	$0.00	$0.00
27801369	EAP	HCPCS C1785		Philos Ii Dr Pacema	BOTH IP/OP	"$11,477.00 "	"$8,492.98"	$0.00	"$9,181.60"	"$5,164.65"	"$5,164.65"	$0.00	$0.00	$0.00	"$2,392.09"	"$4,181.12"	"$4,181.12"	"$8,846.47"	$0.00	"$2,391.81"	$0.00	"$5,658.16"	"$5,658.16"	$0.00	"$5,738.50"	"$9,089.78"	"$9,181.60"	$0.00	$0.00	$0.00	"$1,796.15"	$0.00	$0.00	"$1,827.14"	$0.00	$0.00	$0.00	$0.00	$0.00
27801370	EAP	HCPCS C1882		Insync Maximo	BOTH IP/OP	"$63,656.00 "	"$47,105.44"	$0.00	"$50,924.80"	"$28,645.20"	"$28,645.20"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$49,066.04"	$0.00	"$13,265.91"	$0.00	"$31,382.41"	"$31,382.41"	$0.00	"$31,828.00"	"$50,415.55"	"$50,924.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801371	EAP	Custom 27801371		Coil Embl 14cm 3mm .018in Nst 14.9 Loop Sft Radopc	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801372	EAP	Custom 27801372		Coil Embl 14cm 4mm Nst 11.1 Loop Sft Radopc .018in	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801373	EAP	Custom 27801373		Coil Embl 14cm 5mm Nst 8.9 Loop Sft Enh Radopc	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801374	EAP	Custom 27801374		Coil Embl 5cm 2mm Nst 8 Loop Sft Enh Radopc Mciol	BOTH IP/OP	$229.00 	$169.46	$0.00	$183.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.96	$169.96	$176.51	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$114.50	$181.37	$183.20	$0.00	$103.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801375	EAP	Custom 27801375		Coil Embl 5cm 5mm Nst Pltn Synth Fbr Acpt .018in	BOTH IP/OP	$229.00 	$169.46	$0.00	$183.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.50	$181.37	$183.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801376	EAP	Custom 27801376		Coil Embl 7cm 10mm Nst 2.2 Loop Sft Enh Radopc	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801377	EAP	Custom 27801377		Coil Embl 7cm 2mm Nst 11.1 Loop Sft Enh Radopc	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$112.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801378	EAP	Custom 27801378		Coil Embl 7cm 5mm Nst 4.5 Loop Sft Enh Radopc	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$112.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801379	EAP	Custom 27801379		Coil Embl 7cm 6mm Nst 3.7 Loop Sft Enh Radopc	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$112.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801381	EAP	Custom 27801381		3 CM VERSATILE RNG FILL ADV COILS  1MM-3MM	BOTH IP/OP	"$4,547.00 "	"$3,364.78"	$0.00	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,374.78"	"$3,374.78"	"$3,504.83"	$0.00	$947.59	$0.00	$0.00	$0.00	$0.00	"$2,273.50"	"$3,601.22"	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801382	EAP	Custom 27801382		6cm Versatile Rng Fill Adv Coils  3mm-6mm	BOTH IP/OP	"$4,547.00 "	"$3,364.78"	$0.00	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,374.78"	"$3,374.78"	"$3,504.83"	$0.00	$947.59	$0.00	$0.00	$0.00	$0.00	"$2,273.50"	"$3,601.22"	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801383	EAP	Custom 27801383		10cm Versatile Rng Fill Adv Coils  3mm-6mm	BOTH IP/OP	"$4,547.00 "	"$3,364.78"	$0.00	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,374.78"	"$3,374.78"	"$3,504.83"	$0.00	$947.59	$0.00	$0.00	$0.00	$0.00	"$2,273.50"	"$3,601.22"	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801384	EAP	Custom 27801384		15cm Versatile Rng Fill Adv Coils  3mm-6mm	BOTH IP/OP	"$4,547.00 "	"$3,364.78"	$0.00	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,374.78"	"$3,374.78"	"$3,504.83"	$0.00	$947.59	$0.00	$0.00	$0.00	$0.00	"$2,273.50"	"$3,601.22"	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801385	EAP	Custom 27801385		20cm Versatile Rng Fill Adv Coils  6mm-10mm	BOTH IP/OP	"$4,547.00 "	"$3,364.78"	$0.00	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,374.78"	"$3,374.78"	"$3,504.83"	$0.00	$947.59	$0.00	$0.00	$0.00	$0.00	"$2,273.50"	"$3,601.22"	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801386	EAP	Custom 27801386		30cm Versatile Rng Fill Adv Coils  6mm-10mm	BOTH IP/OP	"$4,547.00 "	"$3,364.78"	$0.00	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,374.78"	"$3,374.78"	"$3,504.83"	$0.00	$947.59	$0.00	$0.00	$0.00	$0.00	"$2,273.50"	"$3,601.22"	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801387	EAP	Custom 27801387		30cm Versatile Rng Fill Adv Coils  10mm-15mm	BOTH IP/OP	"$4,547.00 "	"$3,364.78"	$0.00	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,374.78"	"$3,374.78"	"$3,504.83"	$0.00	$947.59	$0.00	$0.00	$0.00	$0.00	"$2,273.50"	"$3,601.22"	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801388	EAP	Custom 27801388		30cm Versatile Rng Fill Adv Coils  10mm-15mm	BOTH IP/OP	"$4,547.00 "	"$3,364.78"	$0.00	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,374.78"	"$3,374.78"	"$3,504.83"	$0.00	$947.59	$0.00	$0.00	$0.00	$0.00	"$2,273.50"	"$3,601.22"	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801389	EAP	Custom 27801389		40cm Versatile Rng Fill Adv Coils  15mm-20mm	BOTH IP/OP	"$4,547.00 "	"$3,364.78"	$0.00	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,374.78"	"$3,374.78"	"$3,504.83"	$0.00	$947.59	$0.00	$0.00	$0.00	$0.00	"$2,273.50"	"$3,601.22"	"$3,637.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801392	EAP	HCPCS C1757		Catheter Thrombectomy Solitaire 6mm 40mm	BOTH IP/OP	"$10,563.00 "	"$7,816.62"	$0.00	"$8,450.40"	"$4,753.35"	"$4,753.35"	$0.00	$0.00	$0.00	"$2,201.59"	"$4,181.12"	"$4,181.12"	"$8,141.96"	$0.00	"$2,201.33"	$0.00	"$5,207.56"	"$5,207.56"	$0.00	"$5,281.50"	"$8,365.90"	"$8,450.40"	$0.00	"$4,753.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801400	EAP	Custom 27801400		Coil Embl 7cm 8mm Nst 2.8 Loop Sft Enh Radopc	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$112.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801401	EAP	Custom 27801401		Coil Embl 7cm 12mm Nst 1.9 Loop .035in Pltn Peri	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801403	EAP	Custom 27801403		Coil Embl 7cm 14mm Nst 1.6 Loop Sft Enh Radopc	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801404	EAP	Custom 27801404		Coil Embl 7cm 16mm Nst 1.4 Loop Sft Enh Radopc	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801405	EAP	Custom 27801405		Coil Embl 7cm 18mm Nst 1.2 Loop Sft Enh Radopc	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801406	EAP	Custom 27801406		Coil Embl 7cm 20mm Nst 1.1 Loop Sft Enh Radopc	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801407	EAP	Custom 27801407		Coil Embl 7cm 5mm Nst Pltn Synth Fbr Acpt .035in	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$112.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801409	EAP	Custom 27801409		Coil Embl 4cm 4-2mm Trnd Mcl Mlfrm Sft .018in Pltn	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801410	EAP	Custom 27801410		Coil Embl 5cm 5-2mm Trnd Mcl Cath .018in Pltn Strl	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801411	EAP	Custom 27801411		Coil Embl 9cm 7-3mm Trnd Mlfrm Sft Xsect Ideally	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801412	EAP	HCPCS C1887		"Cath, Sofia 6fr 131cm"	BOTH IP/OP	"$5,302.00 "	"$3,923.48"	$0.00	"$4,241.60"	"$2,385.90"	"$2,385.90"	$0.00	$0.00	$0.00	"$1,105.07"	"$3,935.14"	"$3,935.14"	"$4,086.78"	$0.00	"$1,104.94"	$0.00	"$2,613.89"	"$2,613.89"	$0.00	"$2,651.00"	"$4,199.18"	"$4,241.60"	$0.00	"$2,385.90"	$0.00	$829.76	$0.00	$0.00	$844.08	$0.00	$0.00	$0.00	$0.00	$0.00
27801413	EAP	HCPCS C1887		"Cath, Sofia 6fr 125cm"	BOTH IP/OP	"$5,302.00 "	"$3,923.48"	$0.00	"$4,241.60"	"$2,385.90"	"$2,385.90"	$0.00	$0.00	$0.00	"$1,105.07"	"$3,935.14"	"$3,935.14"	"$4,086.78"	$0.00	"$1,104.94"	$0.00	"$2,613.89"	"$2,613.89"	$0.00	"$2,651.00"	"$4,199.18"	"$4,241.60"	$0.00	"$2,385.90"	$0.00	$829.76	$0.00	$0.00	$844.08	$0.00	$0.00	$0.00	$0.00	$0.00
27801414	EAP	Custom 27801414		Plug Cardio 7mm 10mm Amplzr Ntnl Type Ii Dlv Sys	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,543.78"	"$1,543.78"	"$1,603.26"	$0.00	$433.47	$0.00	$0.00	$0.00	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00	$936.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801415	EAP	Custom 27801415		Plug Cardio 9mm 12mm Amplzr Ntnl Type Ii Dlv Sys	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,543.78"	"$1,543.78"	"$1,603.26"	$0.00	$433.47	$0.00	$0.00	$0.00	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801417	EAP	Custom 27801417		Coil Embl 12.5cm 10-5mm Trnd Sm Std Pltn	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801418	EAP	Custom 27801418		Coil Embl 5.8cm 6-3mm Trnd Sft .035in Std Sm Pltn	BOTH IP/OP	$275.00 	$203.50	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.11	$204.11	$211.97	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801419	EAP	Custom 27801419		Coil Embl 8cm 8-4mm Trnd .035in Std Sm Pltn	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801420	EAP	Custom 27801420		Coil Embl 8.2cm 8-5mm Trnd Mlfrm Pltn	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801421	EAP	Custom 27801421		Coil Embl 2cm 1mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801422	EAP	Custom 27801422		Coil Embl 3cm 1mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801423	EAP	Custom 27801423		Coil Embl 4cm 1mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801424	EAP	Custom 27801424		Coil Embl 2cm 1.5mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801425	EAP	Custom 27801425		Coil Embl 3cm 1.5mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801426	EAP	Custom 27801426		Coil Embl 4cm 1.5mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801427	EAP	Custom 27801427		Coil Embl 2cm 2mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801428	EAP	Custom 27801428		Coil Embl 3cm 2mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801429	EAP	Custom 27801429		Coil Embl 4cm 2mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801430	EAP	Custom 27801430		Coil Embl 3cm 2.5mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801431	EAP	Custom 27801431		Coil Embl 6cm 2.5mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801432	EAP	Custom 27801432		Coil Embl 4cm 3mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801433	EAP	Custom 27801433		Coil Embl 6cm 3mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801434	EAP	Custom 27801434		Coil Embl 8cm 3mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801435	EAP	Custom 27801435		Coil Embl 6cm 3.5mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801436	EAP	Custom 27801436		Coil Embl 8cm 3.5mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801437	EAP	Custom 27801437		Coil Embl 10cm 3.5mm Axium Prm X Sft 3d	BOTH IP/OP	"$3,988.00 "	"$2,951.12"	$0.00	"$3,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.89"	"$2,959.89"	"$3,073.95"	$0.00	$831.10	$0.00	$0.00	$0.00	$0.00	"$1,994.00"	"$3,158.50"	"$3,190.40"	$0.00	"$1,794.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801438	EAP	Custom 27801438		Coil Embl 1cm 1mm Axium Prm X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801439	EAP	Custom 27801439		Coil Embl 2cm 1mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801440	EAP	Custom 27801440		Coil Embl 3cm 1mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801441	EAP	Custom 27801441		Coil Embl 1cm 1.5mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801442	EAP	Custom 27801442		Coil Embl 2cm 1.5mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	"$1,344.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801443	EAP	Custom 27801443		Coil Embl 3cm 1.5mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	"$1,344.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801444	EAP	Custom 27801444		Coil Embl 4cm 1.5mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801445	EAP	Custom 27801445		Coil Embl 1cm 2mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801446	EAP	Custom 27801446		Coil Embl 2cm 2mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801447	EAP	Custom 27801447		Coil Embl 3cm 2mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	"$1,344.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801448	EAP	Custom 27801448		Coil Embl 4cm 2mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801449	EAP	Custom 27801449		Coil Embl 6cm 2mm Axium Prm X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	"$1,344.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801450	EAP	HCPCS C1877		"Stent, Non-coat/cov W/o Del"	BOTH IP/OP	"$12,969.00 "	"$9,597.06"	$0.00	"$10,375.20"	"$5,836.05"	"$5,836.05"	$0.00	$0.00	$0.00	"$2,703.06"	"$4,181.12"	"$4,181.12"	"$9,996.51"	$0.00	"$2,702.74"	$0.00	"$6,393.72"	"$6,393.72"	$0.00	"$6,484.50"	"$10,271.45"	"$10,375.20"	$0.00	"$5,836.05"	$0.00	"$2,029.65"	$0.00	$0.00	"$2,064.66"	$0.00	$0.00	$0.00	$0.00	$0.00
27801451	EAP	HCPCS C1876		Mini Vision Rx 2.75 X 08 Mm Us	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27801452	EAP	HCPCS C1876		Mini Vision Rx 2.75 X 12 Mm Us	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27801453	EAP	HCPCS C1876		Mini Vision Rx 2.75 X 15 Mm Us	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27801454	EAP	HCPCS C1876		Mini Vision Rx 2.75 X 18 Mm Us	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27801455	EAP	HCPCS C1876		Mini Vision Rx 2.75 X 23 Mm Us	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27801456	EAP	HCPCS C1876		Mini Vision Rx 2.75 X 28 Mm Us	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$93.15	$93.15	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$0.00	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
27801457	EAP	HCPCS C1721		Ilesto Dr-t High Energy With Ti With Landline Hmtachycardia	BOTH IP/OP	"$54,233.00 "	"$40,132.42"	$0.00	"$43,386.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,802.80"	$0.00	"$11,302.16"	$0.00	"$26,736.87"	"$26,736.87"	$0.00	"$27,116.50"	"$42,952.54"	"$43,386.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801458	EAP	HCPCS C1721		Ilesto Dr-t High Energy With Ti With Cellular Gsm Hmtachycardia	BOTH IP/OP	"$56,934.00 "	"$42,131.16"	$0.00	"$45,547.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$43,884.73"	$0.00	"$11,865.05"	$0.00	"$28,068.46"	"$28,068.46"	$0.00	"$28,467.00"	"$45,091.73"	"$45,547.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801459	EAP	HCPCS C1722		Ilesto Dx High Energy With Atrial Diagnostics & Ti With Landline Hmtac	BOTH IP/OP	"$54,233.00 "	"$40,132.42"	$0.00	"$43,386.40"	"$24,404.85"	"$24,404.85"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$41,802.80"	$0.00	"$11,302.16"	$0.00	"$26,736.87"	"$26,736.87"	$0.00	"$27,116.50"	"$42,952.54"	"$43,386.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801460	EAP	HCPCS C1722		Ilesto Dx High Energy With Atrial Diagnostics & Ti With Cellular Gsm H	BOTH IP/OP	"$56,934.00 "	"$42,131.16"	$0.00	"$45,547.20"	"$25,620.30"	"$25,620.30"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$43,884.73"	$0.00	"$11,865.05"	$0.00	"$28,068.46"	"$28,068.46"	$0.00	"$28,467.00"	"$45,091.73"	"$45,547.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801461	EAP	HCPCS C1722		Ilesto Vr-t High Energy With Ti With Landline Hmtachycardia	BOTH IP/OP	"$50,182.00 "	"$37,134.68"	$0.00	"$40,145.60"	"$22,581.90"	"$22,581.90"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$38,680.29"	$0.00	"$10,457.93"	$0.00	"$24,739.73"	"$24,739.73"	$0.00	"$25,091.00"	"$39,744.14"	"$40,145.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$7,988.97"	$0.00	$0.00	$0.00	$0.00	$0.00
27801462	EAP	HCPCS C1722		Ilesto Vr-t High Energy With Ti With Cellular Gsm Hmtachycardia	BOTH IP/OP	"$52,883.00 "	"$39,133.42"	$0.00	"$42,306.40"	"$23,797.35"	"$23,797.35"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$40,762.22"	$0.00	"$11,020.82"	$0.00	"$26,071.32"	"$26,071.32"	$0.00	"$26,441.50"	"$41,883.34"	"$42,306.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801463	EAP	HCPCS C1895		Linoxsmart Sd Steroid 60/16tachycardialead	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	"$1,725.10"	$0.00	$0.00	"$1,754.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27801464	EAP	HCPCS C1895		Linoxsmart Sd Steroid 65/16tachycardialead	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	"$1,725.10"	$0.00	$0.00	"$1,754.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27801465	EAP	HCPCS C1895		Linoxsmart Sd Steroid 65/18tachycardialead	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	"$1,725.10"	$0.00	$0.00	"$1,754.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27801466	EAP	HCPCS C1895		Linoxsmart Sd Steroid 75/18tachycardialead	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	"$1,725.10"	$0.00	$0.00	"$1,754.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27801467	EAP	HCPCS C1777		Linoxsmart S Steroid 60tachycardialead	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	"$1,725.10"	$0.00	$0.00	"$1,754.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27801468	EAP	HCPCS C1777		Linoxsmart S Steroid 65tachycardialead	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	"$1,725.10"	$0.00	$0.00	"$1,754.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27801469	EAP	HCPCS C1777		Linoxsmart S Steroid 75tachycardialead	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	"$1,725.10"	$0.00	$0.00	"$1,754.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27801470	EAP	HCPCS C1777		Linoxsmart S Dx 65/15tachycardialead	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	"$1,725.10"	$0.00	$0.00	"$1,754.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27801471	EAP	HCPCS C1895		Linoxsmart Td Steroid 65/16 Cmtachycardialead	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	"$1,725.10"	$0.00	$0.00	"$1,754.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27801472	EAP	HCPCS C1895		Linoxsmart Td Steroid 65/18 Cmtachycardialead	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	"$1,725.10"	$0.00	$0.00	"$1,754.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27801473	EAP	HCPCS C1777		Linoxsmart T Steroid 65tachycardialead	BOTH IP/OP	"$11,023.00 "	"$8,157.02"	$0.00	"$8,818.40"	"$4,960.35"	"$4,960.35"	$0.00	$0.00	$0.00	"$2,297.47"	"$4,181.12"	"$4,181.12"	"$8,496.53"	$0.00	"$2,297.19"	$0.00	"$5,434.34"	"$5,434.34"	$0.00	"$5,511.50"	"$8,730.22"	"$8,818.40"	$0.00	$0.00	$0.00	"$1,725.10"	$0.00	$0.00	"$1,754.86"	$0.00	$0.00	$0.00	$0.00	$0.00
27801474	EAP	HCPCS C1882		Ilesto Hf-t High Energy With Ti With Landline Hmcrt Heart Failure	BOTH IP/OP	"$65,477.00 "	"$48,452.98"	$0.00	"$52,381.60"	"$29,464.65"	"$29,464.65"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$50,469.67"	$0.00	"$13,645.41"	$0.00	"$32,280.16"	"$32,280.16"	$0.00	"$32,738.50"	"$51,857.78"	"$52,381.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801475	EAP	HCPCS C1882		Ilesto Hf-t High Energy With Ti With Cellular Gsm Hmcrt Heart Failure	BOTH IP/OP	"$68,178.00 "	"$50,451.72"	$0.00	"$54,542.40"	"$30,680.10"	"$30,680.10"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$52,551.60"	$0.00	"$14,208.30"	$0.00	"$33,611.75"	"$33,611.75"	$0.00	"$34,089.00"	"$53,996.98"	"$54,542.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27801476	EAP	Custom 27801476		Coil Embl 8cm 2mm Axium Prm X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801478	EAP	Custom 27801478		Coil Embl 4cm 2.5mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801479	EAP	Custom 27801479		Coil Embl 6cm 2.5mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801480	EAP	Custom 27801480		Coil Embl 8cm 2.5mm Axium Prm X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801481	EAP	Custom 27801481		Coil Embl 4cm 3mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801482	EAP	Custom 27801482		Coil Embl 6cm 3mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	"$1,344.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801483	EAP	Custom 27801483		Coil Embl 8cm 3mm Axium Prm Dtch X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801484	EAP	Custom 27801484		Coil Embl 10cm 3mm Axium Prm X Sft Hlx	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801486	EAP	Custom 27801486		Coil Embl 2cm 3mm Mreye 2.1 Loop Pltn A/v Strl	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.47	$145.47	$151.08	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$98.00	$155.23	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801487	EAP	Custom 27801487		Coil Embl 3cm 2mm Mreye 4.8 Loop .035in Pltn Strl	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.47	$145.47	$151.08	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$98.00	$155.23	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801488	EAP	Custom 27801488		Coil Embl 3cm 3mm Mreye 3.1 Loop Pltn A/v Strl	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.47	$145.47	$151.08	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$98.00	$155.23	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801489	EAP	Custom 27801489		Coil Embl 4cm 3mm Mreye 4.2 Loop Pltn A/v Strl	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.47	$145.47	$151.08	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$98.00	$155.23	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801490	EAP	Custom 27801490		Coil Embl 5cm 6mm Mreye 2.7 Loop End Hole Grt Radl	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.47	$145.47	$151.08	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$98.00	$155.23	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801491	EAP	Custom 27801491		Coil Embl 5cm 7mm Mreye 2.3 Loop .035in Pltn Strl	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.47	$145.47	$151.08	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$98.00	$155.23	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801492	EAP	Custom 27801492		Coil Embl 5cm 10mm Mreye 1.6 Loop Pltn Acpt .035in	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.47	$145.47	$151.08	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$98.00	$155.23	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801493	EAP	Custom 27801493		Coil Embl 8cm 5mm Mreye 5.1 Loop .035in Pltn Strl	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.47	$145.47	$151.08	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$98.00	$155.23	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801494	EAP	HCPCS C1752		Tray Catheter Power-trialysis Straight L30 Cm Od13	BOTH IP/OP	$693.00 	$512.82	$0.00	$554.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$514.34	$514.34	$534.16	$0.00	$144.42	$0.00	$0.00	$0.00	$0.00	$346.50	$548.86	$554.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801495	EAP	Custom 27801495		Coil Embl 8cm 8mm Mreye 3.2 Loop .035in Pltn Strl	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.47	$145.47	$151.08	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$98.00	$155.23	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801496	EAP	Custom 27801496		Coil Embl 8cm 10mm Mreye 2.5 Loop .035in Pltn Strl	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.47	$145.47	$151.08	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$98.00	$155.23	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801497	EAP	HCPCS C1788		Port Implinfn 11.4fr 12fr Vtx Peelpro 2 Dtch Cath	BOTH IP/OP	"$1,455.00 "	"$1,076.70"	$0.00	"$1,164.00"	$654.75	$654.75	$0.00	$0.00	$0.00	$303.26	"$1,079.90"	"$1,079.90"	"$1,121.51"	$0.00	$303.22	$0.00	$860.63	$860.63	$0.00	$727.50	"$1,152.36"	"$1,164.00"	$0.00	$654.75	$0.00	$227.71	$0.00	$0.00	$231.64	$0.00	$0.00	$0.00	$0.00	$0.00
27801498	EAP	HCPCS C1757		Solitaire Catheter Thrombectomy 6x40	BOTH IP/OP	"$10,563.00 "	"$7,816.62"	$0.00	"$8,450.40"	"$4,753.35"	"$4,753.35"	$0.00	$0.00	$0.00	"$2,201.59"	"$4,181.12"	"$4,181.12"	"$8,141.96"	$0.00	"$2,201.33"	$0.00	"$5,207.56"	"$5,207.56"	$0.00	"$5,281.50"	"$8,365.90"	"$8,450.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801499	EAP	HCPCS C1777		Lead Pcng 62cm Rv Trplr Scr In Xtd-retrac Hlx	BOTH IP/OP	"$6,100.00 "	"$4,514.00"	$0.00	"$4,880.00"	"$2,745.00"	"$2,745.00"	$0.00	$0.00	$0.00	"$1,271.39"	"$4,181.12"	"$4,181.12"	"$4,701.88"	$0.00	"$1,271.24"	$0.00	"$3,007.30"	"$3,007.30"	$0.00	"$3,050.00"	"$4,831.20"	"$4,880.00"	$0.00	"$2,745.00"	$0.00	$954.65	$0.00	$0.00	$971.12	$0.00	$0.00	$0.00	$0.00	$0.00
27801500	EAP	Custom 27801500		Coil Embl .018in 2mm 2cm Azur Cx Hdrcl Dtch Loop S	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801501	EAP	Custom 27801501		Coil Embl .018in 2mm 4cm Azur Cx Hdrcl Dtch Loop S	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801502	EAP	Custom 27801502		Coil Embl .018in 3mm 4cm Azur Cx Hdrcl Dtch Loop S	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801503	EAP	Custom 27801503		Coil Embl .018in 3mm 8cm Azur Cx Hdrcl Dtch Loop S	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801504	EAP	HCPCS C1752		Catheter Hmdial Lg 12.5fr 16cm Grn Mhrkr Elt Dbl-d	BOTH IP/OP	$178.00 	$131.72	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.11	$132.11	$137.20	$0.00	$37.10	$0.00	$0.00	$0.00	$0.00	$89.00	$140.98	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801505	EAP	HCPCS C1752		Catheter Hmdial Lg 12.5fr 20cm Grn Mhrkr Elt Dbl-d	BOTH IP/OP	$178.00 	$131.72	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.11	$132.11	$137.20	$0.00	$37.10	$0.00	$0.00	$0.00	$0.00	$89.00	$140.98	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801507	EAP	HCPCS C1764		System Crd Monitr Rvl Linq Ins	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.01	$0.01	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801508	EAP	Custom 27801508		Device Perclose	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801509	EAP	HCPCS C1760		Device Closure 8fr .038in 70cm Hemostatic Bioabsor	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00	$0.00	$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
27801510	EAP	HCPCS C1876		Stent Vascular Taper 8-6mm 30mm Self Expandable Er	BOTH IP/OP	"$6,113.00 "	"$4,523.62"	$0.00	"$4,841.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,841.50"	$0.00	$0.00	$0.00	$0.00	$956.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801520	EAP	HCPCS C1874		Stent Eprsth 5mm 5cm Strl 120cm Vbhn Flxb Slf Xpd	BOTH IP/OP	"$8,188.00 "	"$6,059.12"	$0.00	"$6,550.40"	"$3,684.60"	"$3,684.60"	$0.00	$0.00	$0.00	"$1,706.58"	"$4,181.12"	"$4,181.12"	"$6,311.31"	$0.00	"$1,706.38"	$0.00	"$4,036.68"	"$4,036.68"	$0.00	"$4,094.00"	"$6,484.90"	"$6,550.40"	$0.00	$0.00	$0.00	"$1,281.42"	$0.00	$0.00	"$1,303.53"	$0.00	$0.00	$0.00	$0.00	$0.00
27801521	EAP	Custom 27801521		Implant Ep Pack	BOTH IP/OP	$162.00 	$119.88	$0.00	$129.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.00	$128.30	$129.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801522	EAP	Custom 27801522		Coil Embl 15cm 12mm .038in Azur Dtch .035in Pltn	BOTH IP/OP	"$2,975.00 "	"$2,201.50"	$0.00	"$2,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,208.05"	"$2,208.05"	"$2,293.13"	$0.00	$619.99	$0.00	$0.00	$0.00	$0.00	"$1,487.50"	"$2,356.20"	"$2,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801523	EAP	Custom 27801523		Coil Embl 20cm 10mm Azur Dtch Ddrgl Peri 35 Sys	BOTH IP/OP	"$3,188.00 "	"$2,359.12"	$0.00	"$2,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,366.13"	"$2,366.13"	"$2,457.31"	$0.00	$664.38	$0.00	$0.00	$0.00	$0.00	"$1,594.00"	"$2,524.90"	"$2,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801524	EAP	Custom 27801524		Coil Embl 15cm 15mm Azur Hdrcl 18 Coils Dtch	BOTH IP/OP	"$2,127.00 "	"$1,573.98"	$0.00	"$1,701.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,578.66"	"$1,578.66"	"$1,639.49"	$0.00	$443.27	$0.00	$0.00	$0.00	$0.00	"$1,063.50"	"$1,684.58"	"$1,701.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801525	EAP	Custom 27801525		Coil Embl 20cm 10mm Azur Hdrcl 18 Coils Dtch	BOTH IP/OP	"$2,249.00 "	"$1,664.26"	$0.00	"$1,799.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.21"	"$1,669.21"	"$1,733.53"	$0.00	$468.69	$0.00	$0.00	$0.00	$0.00	"$1,124.50"	"$1,781.21"	"$1,799.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801526	EAP	Custom 27801526		Coil Embl 20cm 8mm .022in Azur Hdrcl Frme 6 Loop	BOTH IP/OP	"$1,020.00 "	$754.80	$0.00	$816.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$757.04	$757.04	$786.22	$0.00	$212.57	$0.00	$0.00	$0.00	$0.00	$510.00	$807.84	$816.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801527	EAP	Custom 27801527		Coil Embl 34cm 14mm Azur Hdrcl Dtch Nonhydrogel	BOTH IP/OP	"$2,975.00 "	"$2,201.50"	$0.00	"$2,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,208.05"	"$2,208.05"	"$2,293.13"	$0.00	$619.99	$0.00	$0.00	$0.00	$0.00	"$1,487.50"	"$2,356.20"	"$2,380.00"	$0.00	"$1,338.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801528	EAP	Custom 27801528		Coil Embl 4mm .018in 15cm  Azur Dtch Pltn	BOTH IP/OP	"$2,127.00 "	"$1,573.98"	$0.00	"$1,701.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,578.66"	"$1,578.66"	"$1,639.49"	$0.00	$443.27	$0.00	$0.00	$0.00	$0.00	"$1,063.50"	"$1,684.58"	"$1,701.60"	$0.00	$957.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801529	EAP	Custom 27801529		Coil Embl 3mm .018in 10cm  Azur Dtch Pltn	BOTH IP/OP	"$1,987.00 "	"$1,470.38"	$0.00	"$1,589.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,474.75"	"$1,474.75"	"$1,531.58"	$0.00	$414.09	$0.00	$0.00	$0.00	$0.00	$993.50	"$1,573.70"	"$1,589.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801530	EAP	Custom 27801530		Coil Embl 6mm .018in 20cm  Azur Dtch Pltn	BOTH IP/OP	"$2,244.00 "	"$1,660.56"	$0.00	"$1,795.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,665.50"	"$1,665.50"	"$1,729.68"	$0.00	$467.65	$0.00	$0.00	$0.00	$0.00	"$1,122.00"	"$1,777.25"	"$1,795.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27801531	EAP	Custom 27801531		Coil Embl 4mm .018in 20cm  Azur Dtch Pltn	BOTH IP/OP	"$2,244.00 "	"$1,660.56"	$0.00	"$1,795.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,665.50"	"$1,665.50"	"$1,729.68"	$0.00	$467.65	$0.00	$0.00	$0.00	$0.00	"$1,122.00"	"$1,777.25"	"$1,795.20"	$0.00	"$1,009.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802002	EAP	Custom 27802002		Coil Embl 14cm 6mm Nst 7.4 Loop Sft Radopc .018in	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802003	EAP	Custom 27802003		Coil Embl 14cm 8mm Nst 5.6 Loop Sft Radopc .018in	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802004	EAP	Custom 27802004		Coil Embl 14cm 10mm Nst 4.5 Loop Sft Radopc .018in	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802005	EAP	Custom 27802005		Coil Embl 14cm 8mm Nst 5.6 Loop Pltn Synth Fbr Art	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802006	EAP	Custom 27802006		Coil Embl 14cm 10mm Nst 4.5 Loop Sft .035in Pltn	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802008	EAP	Custom 27802008		Coil Embl 9.5cm 8-4mm Trnd Mcl Mciol Sft Spc Push	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802009	EAP	Custom 27802009		Coil Embl 4.1cm 5-3mm Trnd Sft .035in Std Sm Pltn	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802010	EAP	Custom 27802010		Coil Embl 8cm 7-3mm Trnd Pltn Arteriovenous Acpt	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802011	EAP	Custom 27802011		Coil Embl 14cm 6mm Nst Sft Cath Xtd Embl Endhole	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802012	EAP	Custom 27802012		Coil Embl 7cm 4mm Nst 5.6 Loop Sft Enh Radopc .035	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$112.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802013	EAP	Custom 27802013		Coil Embolization .035in 10mm 7cm 2.2 Loop Soft Enhanced	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$112.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802014	EAP	Custom 27802014		Coil Embl 14cm 20mm Nst 2.2 Loop Sft Enh Radopc	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802015	EAP	Custom 27802015		Coil Embl 3cm 2mm Nst 4.8 Loop Sft Enh Radopc	BOTH IP/OP	$229.00 	$169.46	$0.00	$183.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.96	$169.96	$176.51	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$114.50	$181.37	$183.20	$0.00	$103.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802016	EAP	Custom 27802016		Coil Embl 3cm 3mm Nst 3.2 Loop Sft Enh Radopc	BOTH IP/OP	$229.00 	$169.46	$0.00	$183.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.96	$169.96	$176.51	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$114.50	$181.37	$183.20	$0.00	$103.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802017	EAP	Custom 27802017		Coil Embl 5cm 3mm Nst 5.3 Loop Sft Enh Radopc	BOTH IP/OP	$229.00 	$169.46	$0.00	$183.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.96	$169.96	$176.51	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$114.50	$181.37	$183.20	$0.00	$103.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802018	EAP	Custom 27802018		Coil Embl 7cm 6mm Nst 3.7 Loop Sft Enh Radopc .035	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$112.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802020	EAP	Custom 27802020		Coil Embl 14cm 16mm Nst 2.8 Loop Sft Xtd Enh	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802021	EAP	Custom 27802021		Coil Embl 7cm 3mm Nst 7.4 Loop Sft Enh Radopc	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$112.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802022	EAP	Custom 27802022		Coil Embl 7cm 4mm .018in Nst Cath Loop Sft Str Wg	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$112.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802023	EAP	Custom 27802023		Coil Embl 2cm 3-2mm Trnd Mciol Mlfrm Sft .018in	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$208.12	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802024	EAP	Custom 27802024		Coil Embl 7cm 3mm Nst 7.4 Loop Pltn Synth Fbr Strl	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$0.00	$0.00	$0.00	$124.50	$197.21	$199.20	$0.00	$112.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802025	EAP	HCPCS C1882		Quadra Assura Mp Crt-d	BOTH IP/OP	"$42,750.00 "	"$31,635.00"	$0.00	"$34,200.00"	"$19,237.50"	"$19,237.50"	$0.00	$0.00	$0.00	"$8,910.17"	"$4,181.12"	"$4,181.12"	"$32,951.70"	$0.00	"$8,909.10"	$0.00	"$21,075.75"	"$21,075.75"	$0.00	"$21,375.00"	"$33,858.00"	"$34,200.00"	$0.00	"$19,237.50"	$0.00	"$6,690.38"	$0.00	$0.00	"$6,805.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27802026	EAP	HCPCS C1882		Quadra Assura Mp Crt-d Df4 Connector	BOTH IP/OP	"$42,750.00 "	"$31,635.00"	$0.00	"$34,200.00"	"$19,237.50"	"$19,237.50"	$0.00	$0.00	$0.00	"$8,910.17"	"$4,181.12"	"$4,181.12"	"$32,951.70"	$0.00	"$8,909.10"	$0.00	"$21,075.75"	"$21,075.75"	$0.00	"$21,375.00"	"$33,858.00"	"$34,200.00"	$0.00	"$19,237.50"	$0.00	"$6,690.38"	$0.00	$0.00	"$6,805.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27802027	EAP	HCPCS C1882		"Quadra Assura Mp Crt-d, Merlinpkg"	BOTH IP/OP	"$43,875.00 "	"$32,467.50"	$0.00	"$35,100.00"	"$19,743.75"	"$19,743.75"	$0.00	$0.00	$0.00	"$9,144.65"	"$4,181.12"	"$4,181.12"	"$33,818.85"	$0.00	"$9,143.55"	$0.00	"$21,630.38"	"$21,630.38"	$0.00	"$21,937.50"	"$34,749.00"	"$35,100.00"	$0.00	$0.00	$0.00	"$6,866.44"	$0.00	$0.00	"$6,984.90"	$0.00	$0.00	$0.00	$0.00	$0.00
27802028	EAP	HCPCS C1882		"Quadra Assura Mp Crt-d Df4, Merlinpkg"	BOTH IP/OP	"$43,875.00 "	"$32,467.50"	$0.00	"$35,100.00"	"$19,743.75"	"$19,743.75"	$0.00	$0.00	$0.00	"$9,144.65"	"$4,181.12"	"$4,181.12"	"$33,818.85"	$0.00	"$9,143.55"	$0.00	"$21,630.38"	"$21,630.38"	$0.00	"$21,937.50"	"$34,749.00"	"$35,100.00"	$0.00	$0.00	$0.00	"$6,866.44"	$0.00	$0.00	"$6,984.90"	$0.00	$0.00	$0.00	$0.00	$0.00
27802029	EAP	HCPCS C1882		Quadra Assura Mp Crt-d System	BOTH IP/OP	"$56,250.00 "	"$41,625.00"	$0.00	"$45,000.00"	"$25,312.50"	"$25,312.50"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$43,357.50"	$0.00	"$11,722.50"	$0.00	"$27,731.25"	"$27,731.25"	$0.00	"$28,125.00"	"$44,550.00"	"$45,000.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27802030	EAP	HCPCS C1882		Quadra Assura Mp Crt-d Df4 Connector System	BOTH IP/OP	"$56,250.00 "	"$41,625.00"	$0.00	"$45,000.00"	"$25,312.50"	"$25,312.50"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$43,357.50"	$0.00	"$11,722.50"	$0.00	"$27,731.25"	"$27,731.25"	$0.00	"$28,125.00"	"$44,550.00"	"$45,000.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27802031	EAP	HCPCS C1882		"Quadra Assura Mp Crt-d System, Merlinpkg"	BOTH IP/OP	"$58,500.00 "	"$43,290.00"	$0.00	"$46,800.00"	"$26,325.00"	"$26,325.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,091.80"	$0.00	"$12,191.40"	$0.00	"$28,840.50"	"$28,840.50"	$0.00	"$29,250.00"	"$46,332.00"	"$46,800.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27802032	EAP	HCPCS C1882		"Quadra Assura Mp Crt-d Df4 System, Merlinpkg"	BOTH IP/OP	"$58,500.00 "	"$43,290.00"	$0.00	"$46,800.00"	"$26,325.00"	"$26,325.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$45,091.80"	$0.00	"$12,191.40"	$0.00	"$28,840.50"	"$28,840.50"	$0.00	"$29,250.00"	"$46,332.00"	"$46,800.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27802033	EAP	HCPCS C1900		"Quartet, Small-s 75cm"	BOTH IP/OP	"$5,375.00 "	"$3,977.50"	$0.00	"$4,300.00"	"$2,418.75"	"$2,418.75"	$0.00	$0.00	$0.00	"$1,120.28"	"$3,989.33"	"$3,989.33"	"$4,143.05"	$0.00	"$1,120.15"	$0.00	"$2,649.88"	"$2,649.88"	$0.00	"$2,687.50"	"$4,257.00"	"$4,300.00"	$0.00	$0.00	$0.00	$841.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802034	EAP	HCPCS C1900		"Quartet, Small-s 86cm"	BOTH IP/OP	"$5,375.00 "	"$3,977.50"	$0.00	"$4,300.00"	"$2,418.75"	"$2,418.75"	$0.00	$0.00	$0.00	"$1,120.28"	"$3,989.33"	"$3,989.33"	"$4,143.05"	$0.00	"$1,120.15"	$0.00	"$2,649.88"	"$2,649.88"	$0.00	"$2,687.50"	"$4,257.00"	"$4,300.00"	$0.00	$0.00	$0.00	$841.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802035	EAP	HCPCS C1900		"Quartet, Wide Spacing 75cm"	BOTH IP/OP	"$5,375.00 "	"$3,977.50"	$0.00	"$4,300.00"	"$2,418.75"	"$2,418.75"	$0.00	$0.00	$0.00	"$1,120.28"	"$3,989.33"	"$3,989.33"	"$4,143.05"	$0.00	"$1,120.15"	$0.00	"$2,649.88"	"$2,649.88"	$0.00	"$2,687.50"	"$4,257.00"	"$4,300.00"	$0.00	$0.00	$0.00	$841.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802036	EAP	HCPCS C1900		"Quartet, Wide Spacing 86cm"	BOTH IP/OP	"$5,375.00 "	"$3,977.50"	$0.00	"$4,300.00"	"$2,418.75"	"$2,418.75"	$0.00	$0.00	$0.00	"$1,120.28"	"$3,989.33"	"$3,989.33"	"$4,143.05"	$0.00	"$1,120.15"	$0.00	"$2,649.88"	"$2,649.88"	$0.00	"$2,687.50"	"$4,257.00"	"$4,300.00"	$0.00	"$2,418.75"	$0.00	$841.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27802040	EAP	HCPCS C1874		Stent Vasc 80mm 6mm Gore Tigris Cbas Ntnl Flplmr	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
27802041	EAP	HCPCS C1874		Stent Vasc 60mm 5mm Gore Tigris Cbas Ntnl Flplmr	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
27802042	EAP	HCPCS C1874		Stent Vasc 80mm 5mm Gore Tigris Cbas Ntnl Flplmr	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
27802044	EAP	HCPCS C1874		Stent Vasc 40mm 6mm Gore Tigris Cbas Ntnl Flplmr	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
27802045	EAP	HCPCS C1874		Stent Vasc 60mm 6mm Gore Tigris Cbas Ntnl Flplmr	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	"$1,682.10"	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
27802046	EAP	HCPCS C1874		Stent Coron 40mm 5mm Gore Tigris Vasc Cbas Ntnl	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
27802047	EAP	HCPCS C1874		Stent Vasc 100mm 6mm Gore Tigris Cbas Ntnl Flplmr	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	"$1,682.10"	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
27802048	EAP	HCPCS C1874		Stent Vasc 40mm 7mm Gore Tigris Cbas Ntnl Flplmr	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
27802050	EAP	HCPCS C1874		Stent Vasc 80mm 7mm Gore Tigris Cbas Ntnl Flplmr	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
27802051	EAP	HCPCS C1874		Stent Vasc 100mm 7mm Gore Tigris Cbas Ntnl Flplmr	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
27803013	EAP	HCPCS C1781		Mesh Implt	BOTH IP/OP	$650.00 	$481.00	$0.00	$520.00	$292.50	$292.50	$0.00	$0.00	$0.00	$135.48	$482.43	$482.43	$501.02	$0.00	$135.46	$0.00	$384.48	$384.48	$0.00	$325.00	$514.80	$520.00	$0.00	$292.50	$0.00	$101.73	$0.00	$0.00	$103.48	$0.00	$0.00	$0.00	$0.00	$0.00
27803015	EAP	Custom 27803015		Coil Embolization .018in Standard Length 2d 2mm 4c	BOTH IP/OP	$943.00 	$697.82	$0.00	$754.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$699.89	$699.89	$726.86	$0.00	$196.52	$0.00	$0.00	$0.00	$0.00	$471.50	$746.86	$754.40	$0.00	$424.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803030	EAP	HCPCS C1897		Sjm Percutaneous Lead	BOTH IP/OP	"$2,869.00 "	"$2,123.06"	$0.00	"$2,295.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,129.37"	"$2,129.37"	"$2,211.43"	$0.00	$597.90	$0.00	$0.00	$0.00	$0.00	"$1,434.50"	"$2,272.25"	"$2,295.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803050	EAP	Custom 27803050		Biliary Metal Stents	BOTH IP/OP	"$5,087.00 "	"$3,764.38"	$0.00	"$4,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,775.57"	"$3,775.57"	"$3,921.06"	$0.00	"$1,060.13"	$0.00	$0.00	$0.00	$0.00	"$2,543.50"	"$4,028.90"	"$4,069.60"	$0.00	"$2,289.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803051	EAP	Custom 27803051		Ultraflex Diamond Metal Stent	BOTH IP/OP	"$9,045.00 "	"$6,693.30"	$0.00	"$7,236.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,971.89"	$0.00	"$1,884.98"	$0.00	$0.00	$0.00	$0.00	"$4,522.50"	"$7,163.64"	"$7,236.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803052	EAP	Custom 27803052		Polyflex Esophageal Stent	BOTH IP/OP	"$13,618.00 "	"$10,077.32"	$0.00	"$10,894.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,496.75"	$0.00	"$2,837.99"	$0.00	$0.00	$0.00	$0.00	"$6,809.00"	"$10,785.46"	"$10,894.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803053	EAP	Custom 27803053		Stent Coron 8mm 2.5mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	$0.00	$0.00	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803055	EAP	HCPCS C1874		Stent Coron 12mm 2.5mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803056	EAP	HCPCS C1874		Stent Coron 18mm 2.5mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803057	EAP	HCPCS C1874		Stent Coron 23mm 2.5mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803058	EAP	HCPCS C1874		Stent Coron 28mm 2.5mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803059	EAP	HCPCS C1874		Stent Coron 8mm 3mm Abs Gt1 Poly L Lactd Pld Lactd	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803061	EAP	HCPCS C1874		Stent Coron 12mm 3mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803062	EAP	HCPCS C1874		Stent Coron 18mm 3mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803063	EAP	HCPCS C1874		Stent Coron 23mm 3mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803064	EAP	HCPCS C1874		Stent Coron 28mm 3mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803065	EAP	HCPCS C1874		Stent Coron 12mm 3.5mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803066	EAP	HCPCS C1874		Stent Coron 18mm 3.5mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803067	EAP	HCPCS C1874		Stent Coron 23mm 3.5mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803068	EAP	HCPCS C1874		Stent Coron 28mm 3.5mm Abs Gt1 Poly L Lactd Pld	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	"$2,794.15"	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00	$0.00	$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803070	EAP	Custom 27803070		Rx Stent 7x5 Cm	BOTH IP/OP	$169.00 	$125.06	$0.00	$135.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.43	$125.43	$130.27	$0.00	$35.22	$0.00	$0.00	$0.00	$0.00	$84.50	$133.85	$135.20	$0.00	$76.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803071	EAP	Custom 27803071		Rx Stent 7x7 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$72.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803072	EAP	Custom 27803072		Rx Stent 7x12 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$72.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803073	EAP	Custom 27803073		Rx Stent 10x5	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$72.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803074	EAP	Custom 27803074		Rx Stent 10x7cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$72.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803075	EAP	Custom 27803075		Rx Stent 10x10 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803076	EAP	Custom 27803076		Rx Stent 10x12 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$72.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803077	EAP	Custom 27803077		Rx Stent 8.5 X5 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803078	EAP	Custom 27803078		Rx Stent 8.5 X7cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$72.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803079	EAP	Custom 27803079		Rx Stent 8.5 X 10cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803080	EAP	Custom 27803080		Rx Stent 8.5x12 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803081	EAP	Custom 27803081		Rx Stent 7x10 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00	$72.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803082	EAP	HCPCS C1874		Graft Evas 74mm 24mm 16fr Znth Sprlz Z-trk Abd	BOTH IP/OP	"$7,713.00 "	"$5,707.62"	$0.00	"$6,170.40"	"$3,470.85"	"$3,470.85"	$0.00	$0.00	$0.00	"$1,607.58"	"$4,181.12"	"$4,181.12"	"$5,945.18"	$0.00	"$1,607.39"	$0.00	"$3,802.51"	"$3,802.51"	$0.00	"$3,856.50"	"$6,108.70"	"$6,170.40"	$0.00	$0.00	$0.00	"$1,207.08"	$0.00	$0.00	"$1,227.91"	$0.00	$0.00	$0.00	$0.00	$0.00
27803083	EAP	HCPCS C1874		Graft Evas 56mm 24mm 6mm 5.3mm Znth Sprlz Aaa Ilc	BOTH IP/OP	"$7,713.00 "	"$5,707.62"	$0.00	"$6,170.40"	"$3,470.85"	"$3,470.85"	$0.00	$0.00	$0.00	"$1,607.58"	"$4,181.12"	"$4,181.12"	"$5,945.18"	$0.00	"$1,607.39"	$0.00	"$3,802.51"	"$3,802.51"	$0.00	"$3,856.50"	"$6,108.70"	"$6,170.40"	$0.00	$0.00	$0.00	"$1,207.08"	$0.00	$0.00	"$1,227.91"	$0.00	$0.00	$0.00	$0.00	$0.00
27803090	EAP	HCPCS C1777		7120 Durata Pkg Lead	BOTH IP/OP	"$15,063.00 "	"$11,146.62"	$0.00	"$12,050.40"	"$6,778.35"	"$6,778.35"	$0.00	$0.00	$0.00	"$3,139.51"	"$4,181.12"	"$4,181.12"	"$11,610.56"	$0.00	"$3,139.13"	$0.00	"$7,426.06"	"$7,426.06"	$0.00	"$7,531.50"	"$11,929.90"	"$12,050.40"	$0.00	$0.00	$0.00	"$2,357.36"	$0.00	$0.00	"$2,398.03"	$0.00	$0.00	$0.00	$0.00	$0.00
27803091	EAP	HCPCS C1777		7121 Durata Pkg Lead	BOTH IP/OP	"$15,063.00 "	"$11,146.62"	$0.00	"$12,050.40"	"$6,778.35"	"$6,778.35"	$0.00	$0.00	$0.00	"$3,139.51"	"$4,181.12"	"$4,181.12"	"$11,610.56"	$0.00	"$3,139.13"	$0.00	"$7,426.06"	"$7,426.06"	$0.00	"$7,531.50"	"$11,929.90"	"$12,050.40"	$0.00	$0.00	$0.00	"$2,357.36"	$0.00	$0.00	"$2,398.03"	$0.00	$0.00	$0.00	$0.00	$0.00
27803092	EAP	HCPCS C1874		Wallflex Esop Pcoverdstent Spv	BOTH IP/OP	"$9,055.00 "	"$6,700.70"	$0.00	"$7,244.00"	"$4,074.75"	"$4,074.75"	$0.00	$0.00	$0.00	"$1,887.29"	"$4,181.12"	"$4,181.12"	"$6,979.59"	$0.00	"$1,887.06"	$0.00	"$4,464.12"	"$4,464.12"	$0.00	"$4,527.50"	"$7,171.56"	"$7,244.00"	$0.00	$0.00	$0.00	"$1,417.11"	$0.00	$0.00	"$1,441.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27803093	EAP	HCPCS C1896		Subcutaneous Ld System 6996-sq	BOTH IP/OP	"$8,967.00 "	"$6,635.58"	$0.00	"$7,173.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,868.95"	"$4,181.12"	"$4,181.12"	"$6,911.76"	$0.00	"$1,868.72"	$0.00	"$4,420.73"	"$4,420.73"	$0.00	"$4,483.50"	"$7,101.86"	"$7,173.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803094	EAP	HCPCS C1877		Transhepatic Biliary Stent Spv	BOTH IP/OP	"$6,456.00 "	"$4,777.44"	$0.00	"$5,164.80"	"$2,905.20"	"$2,905.20"	$0.00	$0.00	$0.00	"$1,345.59"	"$4,181.12"	"$4,181.12"	"$4,976.28"	$0.00	"$1,345.43"	$0.00	"$3,182.81"	"$3,182.81"	$0.00	"$3,228.00"	"$5,113.15"	"$5,164.80"	$0.00	"$2,905.20"	$0.00	"$1,010.36"	$0.00	$0.00	"$1,027.80"	$0.00	$0.00	$0.00	$0.00	$0.00
27803095	EAP	HCPCS C1897		"Lead, Neurostim Test Kit"	BOTH IP/OP	"$3,411.00 "	"$2,524.14"	$0.00	"$2,728.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,531.64"	"$2,531.64"	"$2,629.20"	$0.00	$710.85	$0.00	$0.00	$0.00	$0.00	"$1,705.50"	"$2,701.51"	"$2,728.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803096	EAP	HCPCS C1725		Pta Dilatation Catheter 18 Spv	BOTH IP/OP	"$1,435.00 "	"$1,061.90"	$0.00	"$1,148.00"	$645.75	$645.75	$0.00	$0.00	$0.00	$299.09	"$1,065.06"	"$1,065.06"	"$1,106.10"	$0.00	$299.05	$0.00	$848.80	$848.80	$0.00	$717.50	"$1,136.52"	"$1,148.00"	$0.00	$0.00	$0.00	$224.58	$0.00	$0.00	$228.45	$0.00	$0.00	$0.00	$0.00	$0.00
27803097	EAP	HCPCS C1725		Pta Dilatation Catheter 16 Spv	BOTH IP/OP	"$1,435.00 "	"$1,061.90"	$0.00	"$1,148.00"	$645.75	$645.75	$0.00	$0.00	$0.00	$299.09	"$1,065.06"	"$1,065.06"	"$1,106.10"	$0.00	$299.05	$0.00	$848.80	$848.80	$0.00	$717.50	"$1,136.52"	"$1,148.00"	$0.00	$0.00	$0.00	$224.58	$0.00	$0.00	$228.45	$0.00	$0.00	$0.00	$0.00	$0.00
27803098	EAP	HCPCS C1880		80078352 - Filter Option Ivc	BOTH IP/OP	"$1,429.00 "	"$1,057.46"	$0.00	"$1,143.20"	$643.05	$643.05	$0.00	$0.00	$0.00	$297.84	"$1,060.60"	"$1,060.60"	"$1,101.47"	$0.00	$297.80	$0.00	$845.25	$845.25	$0.00	$714.50	"$1,131.77"	"$1,143.20"	$0.00	$0.00	$0.00	$223.64	$0.00	$0.00	$227.50	$0.00	$0.00	$0.00	$0.00	$0.00
27803099	EAP	HCPCS A4301		Femoral Arterial Line Kit	BOTH IP/OP	$972.00 	$719.28	$0.00	$777.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$721.42	$721.42	$749.22	$0.00	$202.56	$0.00	$0.00	$0.00	$0.00	$486.00	$769.82	$777.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803100	EAP	HCPCS C2625		Rx Stent 7x5 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$72.45	$72.45	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803101	EAP	HCPCS C2625		Rx Stent 7x7 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$72.45	$72.45	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803102	EAP	HCPCS C2625		Rx Stent 7x10 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$72.45	$72.45	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803103	EAP	HCPCS C2625		Rx Stent 7x12 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$72.45	$72.45	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803104	EAP	HCPCS C2625		Rx Stent 10x5	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$72.45	$72.45	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803105	EAP	HCPCS C2625		Rx Stent 10x7cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$72.45	$72.45	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803106	EAP	HCPCS C2625		Rx Stent 10x10 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$72.45	$72.45	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803107	EAP	HCPCS C2625		Rx Stent 10x12 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$72.45	$72.45	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803108	EAP	HCPCS C2625		Rx Stent 8.5 X5 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$72.45	$72.45	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803109	EAP	HCPCS C2625		Rx Stent 8.5 X7cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$72.45	$72.45	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803110	EAP	HCPCS C2625		Rx Stent 8.5 X 10cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$72.45	$72.45	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803111	EAP	HCPCS C2625		Rx Stent 8.5x12 Cm	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$72.45	$72.45	$0.00	$0.00	$0.00	$33.56	$119.49	$119.49	$124.10	$0.00	$33.55	$0.00	$95.23	$95.23	$0.00	$80.50	$127.51	$128.80	$0.00	$0.00	$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803152	EAP	HCPCS C1760		Starclose Se	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$129.60	$129.60	$0.00	$0.00	$0.00	$60.03	$213.75	$213.75	$221.99	$0.00	$60.02	$0.00	$170.35	$170.35	$0.00	$144.00	$228.10	$230.40	$0.00	$0.00	$0.00	$45.07	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$0.00
27803160	EAP	HCPCS C2625		3.0 Xmm Vision Rx Stent	BOTH IP/OP	"$4,987.00 "	"$3,690.38"	$0.00	"$3,989.60"	"$2,244.15"	"$2,244.15"	$0.00	$0.00	$0.00	"$1,039.42"	"$3,701.35"	"$3,701.35"	"$3,843.98"	$0.00	"$1,039.29"	$0.00	"$2,458.59"	"$2,458.59"	$0.00	"$2,493.50"	"$3,949.70"	"$3,989.60"	$0.00	$0.00	$0.00	$780.47	$0.00	$0.00	$793.93	$0.00	$0.00	$0.00	$0.00	$0.00
27803161	EAP	HCPCS C2625		2.50 X 8mm Mini-vision Stent	BOTH IP/OP	"$4,987.00 "	"$3,690.38"	$0.00	"$3,989.60"	"$2,244.15"	"$2,244.15"	$0.00	$0.00	$0.00	"$1,039.42"	"$3,701.35"	"$3,701.35"	"$3,843.98"	$0.00	"$1,039.29"	$0.00	"$2,458.59"	"$2,458.59"	$0.00	"$2,493.50"	"$3,949.70"	"$3,989.60"	$0.00	$0.00	$0.00	$780.47	$0.00	$0.00	$793.93	$0.00	$0.00	$0.00	$0.00	$0.00
27803162	EAP	Custom 27803162		Lc Bead 500-700	BOTH IP/OP	"$4,654.00 "	"$3,443.96"	$0.00	"$3,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,454.20"	"$3,454.20"	"$3,587.30"	$0.00	$969.89	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,685.97"	"$3,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803163	EAP	Custom 27803163		Lc Bead 300-500	BOTH IP/OP	"$4,654.00 "	"$3,443.96"	$0.00	"$3,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,454.20"	"$3,454.20"	"$3,587.30"	$0.00	$969.89	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,685.97"	"$3,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803164	EAP	HCPCS C1880		80078352 - Filter Option Ivc	BOTH IP/OP	"$1,429.00 "	"$1,057.46"	$0.00	"$1,143.20"	$643.05	$643.05	$0.00	$0.00	$0.00	$297.84	"$1,060.60"	"$1,060.60"	"$1,101.47"	$0.00	$297.80	$0.00	$845.25	$845.25	$0.00	$714.50	"$1,131.77"	"$1,143.20"	$0.00	$0.00	$0.00	$223.64	$0.00	$0.00	$227.50	$0.00	$0.00	$0.00	$0.00	$0.00
27803172	EAP	HCPCS C1874		Vbh081502 Catheter Viabahn 8mm	BOTH IP/OP	"$5,107.00 "	"$3,779.18"	$0.00	"$4,085.60"	"$2,298.15"	"$2,298.15"	$0.00	$0.00	$0.00	"$1,064.43"	"$3,790.42"	"$3,790.42"	"$3,936.48"	$0.00	"$1,064.30"	$0.00	"$2,517.75"	"$2,517.75"	$0.00	"$2,553.50"	"$4,044.74"	"$4,085.60"	$0.00	$0.00	$0.00	$799.25	$0.00	$0.00	$813.03	$0.00	$0.00	$0.00	$0.00	$0.00
27803173	EAP	HCPCS C1874		Vbh071502 Catheter Viabahn 8mm	BOTH IP/OP	"$5,107.00 "	"$3,779.18"	$0.00	"$4,085.60"	"$2,298.15"	"$2,298.15"	$0.00	$0.00	$0.00	"$1,064.43"	"$3,790.42"	"$3,790.42"	"$3,936.48"	$0.00	"$1,064.30"	$0.00	"$2,517.75"	"$2,517.75"	$0.00	"$2,553.50"	"$4,044.74"	"$4,085.60"	$0.00	"$2,298.15"	$0.00	$799.25	$0.00	$0.00	$813.03	$0.00	$0.00	$0.00	$0.00	$0.00
27803184	EAP	HCPCS C1894		9fr-30 Tear-away Introducer	BOTH IP/OP	$579.00 	$428.46	$0.00	$463.20	$260.55	$260.55	$0.00	$0.00	$0.00	$120.68	$429.73	$429.73	$446.29	$0.00	$120.66	$0.00	$342.48	$342.48	$0.00	$289.50	$458.57	$463.20	$0.00	$0.00	$0.00	$90.61	$0.00	$0.00	$92.18	$0.00	$0.00	$0.00	$0.00	$0.00
27803185	EAP	HCPCS C1894		10fr-30cm Tear Away Introducer	BOTH IP/OP	$579.00 	$428.46	$0.00	$463.20	$260.55	$260.55	$0.00	$0.00	$0.00	$120.68	$429.73	$429.73	$446.29	$0.00	$120.66	$0.00	$342.48	$342.48	$0.00	$289.50	$458.57	$463.20	$0.00	$260.55	$0.00	$90.61	$0.00	$0.00	$92.18	$0.00	$0.00	$0.00	$0.00	$0.00
27803186	EAP	HCPCS C1894		16fr-3ocm Tear-away Introducer	BOTH IP/OP	$579.00 	$428.46	$0.00	$463.20	$260.55	$260.55	$0.00	$0.00	$0.00	$120.68	$429.73	$429.73	$446.29	$0.00	$120.66	$0.00	$342.48	$342.48	$0.00	$289.50	$458.57	$463.20	$0.00	$0.00	$0.00	$90.61	$0.00	$0.00	$92.18	$0.00	$0.00	$0.00	$0.00	$0.00
27803187	EAP	HCPCS C1769		Wire Guide Lunderquist Extra S	BOTH IP/OP	$347.00 	$256.78	$0.00	$277.60	$156.15	$156.15	$0.00	$0.00	$0.00	$72.32	$257.54	$257.54	$267.47	$0.00	$72.31	$0.00	$205.25	$205.25	$0.00	$173.50	$274.82	$277.60	$0.00	$0.00	$0.00	$54.31	$0.00	$0.00	$55.24	$0.00	$0.00	$0.00	$0.00	$0.00
27803188	EAP	HCPCS C1894		Sheath Prelude	BOTH IP/OP	$277.00 	$204.98	$0.00	$221.60	$124.65	$124.65	$0.00	$0.00	$0.00	$57.73	$205.59	$205.59	$213.51	$0.00	$57.73	$0.00	$163.85	$163.85	$0.00	$138.50	$219.38	$221.60	$0.00	$0.00	$0.00	$43.35	$0.00	$0.00	$44.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803189	EAP	HCPCS C2625		3.0 X 8mm Vision Rx Stent	BOTH IP/OP	"$2,920.00 "	"$2,160.80"	$0.00	"$2,336.00"	"$1,314.00"	"$1,314.00"	$0.00	$0.00	$0.00	$608.60	"$2,167.22"	"$2,167.22"	"$2,250.74"	$0.00	$608.53	$0.00	"$1,439.56"	"$1,439.56"	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00	$0.00	$0.00	$456.98	$0.00	$0.00	$464.86	$0.00	$0.00	$0.00	$0.00	$0.00
27803190	EAP	HCPCS C2625		2.50 X 8mm Mini-vision Stent	BOTH IP/OP	"$3,836.00 "	"$2,838.64"	$0.00	"$3,068.80"	"$1,726.20"	"$1,726.20"	$0.00	$0.00	$0.00	$799.52	"$2,847.08"	"$2,847.08"	"$2,956.79"	$0.00	$799.42	$0.00	"$1,891.15"	"$1,891.15"	$0.00	"$1,918.00"	"$3,038.11"	"$3,068.80"	$0.00	$0.00	$0.00	$600.33	$0.00	$0.00	$610.69	$0.00	$0.00	$0.00	$0.00	$0.00
27803191	EAP	Custom 27803191		Lc Bead 500-700	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$990.84	$990.84	"$1,029.02"	$0.00	$278.21	$0.00	$0.00	$0.00	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803192	EAP	HCPCS C1876		Stent Microdelive Wingspan 4 1	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	"$9,180.00"	"$9,180.00"	$0.00	$0.00	$0.00	"$4,251.87"	"$4,181.12"	"$4,181.12"	"$15,724.32"	$0.00	"$4,251.36"	$0.00	"$10,057.20"	"$10,057.20"	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00	$0.00	$0.00	"$3,192.60"	$0.00	$0.00	"$3,247.68"	$0.00	$0.00	$0.00	$0.00	$0.00
27803193	EAP	HCPCS C1876		Stent Microdelive Wingspan 4 2	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	"$9,180.00"	"$9,180.00"	$0.00	$0.00	$0.00	"$4,251.87"	"$4,181.12"	"$4,181.12"	"$15,724.32"	$0.00	"$4,251.36"	$0.00	"$10,057.20"	"$10,057.20"	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00	$0.00	$0.00	"$3,192.60"	$0.00	$0.00	"$3,247.68"	$0.00	$0.00	$0.00	$0.00	$0.00
27803194	EAP	HCPCS C1876		Stent Microdelive Wingspan 3 1	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	"$9,180.00"	"$9,180.00"	$0.00	$0.00	$0.00	"$4,251.87"	"$4,181.12"	"$4,181.12"	"$15,724.32"	$0.00	"$4,251.36"	$0.00	"$10,057.20"	"$10,057.20"	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00	$0.00	$0.00	"$3,192.60"	$0.00	$0.00	"$3,247.68"	$0.00	$0.00	$0.00	$0.00	$0.00
27803195	EAP	HCPCS C1876		Stent Microdelive Wingspan 3 2	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	"$9,180.00"	"$9,180.00"	$0.00	$0.00	$0.00	"$4,251.87"	"$4,181.12"	"$4,181.12"	"$15,724.32"	$0.00	"$4,251.36"	$0.00	"$10,057.20"	"$10,057.20"	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00	$0.00	$0.00	"$3,192.60"	$0.00	$0.00	"$3,247.68"	$0.00	$0.00	$0.00	$0.00	$0.00
27803196	EAP	HCPCS C1876		Stent Microdelivery 3.0 X 15.0	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	"$9,180.00"	"$9,180.00"	$0.00	$0.00	$0.00	"$4,251.87"	"$4,181.12"	"$4,181.12"	"$15,724.32"	$0.00	"$4,251.36"	$0.00	"$10,057.20"	"$10,057.20"	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00	$0.00	$0.00	"$3,192.60"	$0.00	$0.00	"$3,247.68"	$0.00	$0.00	$0.00	$0.00	$0.00
27803197	EAP	HCPCS C1876		Stent Microdelive Wingspan 3 3	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	"$9,180.00"	"$9,180.00"	$0.00	$0.00	$0.00	"$4,251.87"	"$4,181.12"	"$4,181.12"	"$15,724.32"	$0.00	"$4,251.36"	$0.00	"$10,057.20"	"$10,057.20"	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00	$0.00	$0.00	"$3,192.60"	$0.00	$0.00	"$3,247.68"	$0.00	$0.00	$0.00	$0.00	$0.00
27803198	EAP	HCPCS C1876		Stent Microdelivery Wingspan	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	"$9,180.00"	"$9,180.00"	$0.00	$0.00	$0.00	"$4,251.87"	"$4,181.12"	"$4,181.12"	"$15,724.32"	$0.00	"$4,251.36"	$0.00	"$10,057.20"	"$10,057.20"	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00	$0.00	$0.00	"$3,192.60"	$0.00	$0.00	"$3,247.68"	$0.00	$0.00	$0.00	$0.00	$0.00
27803199	EAP	HCPCS C1876		Stent Mircrodelivery Wingspan2	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	"$9,180.00"	"$9,180.00"	$0.00	$0.00	$0.00	"$4,251.87"	"$4,181.12"	"$4,181.12"	"$15,724.32"	$0.00	"$4,251.36"	$0.00	"$10,057.20"	"$10,057.20"	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00	$0.00	$0.00	"$3,192.60"	$0.00	$0.00	"$3,247.68"	$0.00	$0.00	$0.00	$0.00	$0.00
27803200	EAP	HCPCS C1876		Stent Microdelivery 4.5x30mm	BOTH IP/OP	"$19,181.00 "	"$14,193.94"	$0.00	"$15,344.80"	"$8,631.45"	"$8,631.45"	$0.00	$0.00	$0.00	"$3,997.80"	"$4,181.12"	"$4,181.12"	"$14,784.71"	$0.00	"$3,997.32"	$0.00	"$9,456.23"	"$9,456.23"	$0.00	"$9,590.50"	"$15,191.35"	"$15,344.80"	$0.00	$0.00	$0.00	"$3,001.83"	$0.00	$0.00	"$3,053.62"	$0.00	$0.00	$0.00	$0.00	$0.00
27803201	EAP	HCPCS C1876		Stent Microdelivery 4.5x20mm	BOTH IP/OP	"$19,181.00 "	"$14,193.94"	$0.00	"$15,344.80"	"$8,631.45"	"$8,631.45"	$0.00	$0.00	$0.00	"$3,997.80"	"$4,181.12"	"$4,181.12"	"$14,784.71"	$0.00	"$3,997.32"	$0.00	"$9,456.23"	"$9,456.23"	$0.00	"$9,590.50"	"$15,191.35"	"$15,344.80"	$0.00	$0.00	$0.00	"$3,001.83"	$0.00	$0.00	"$3,053.62"	$0.00	$0.00	$0.00	$0.00	$0.00
27803202	EAP	HCPCS C1876		Stent Micrdelivery 4.0 X20mm	BOTH IP/OP	"$19,181.00 "	"$14,193.94"	$0.00	"$15,344.80"	"$8,631.45"	"$8,631.45"	$0.00	$0.00	$0.00	"$3,997.80"	"$4,181.12"	"$4,181.12"	"$14,784.71"	$0.00	"$3,997.32"	$0.00	"$9,456.23"	"$9,456.23"	$0.00	"$9,590.50"	"$15,191.35"	"$15,344.80"	$0.00	$0.00	$0.00	"$3,001.83"	$0.00	$0.00	"$3,053.62"	$0.00	$0.00	$0.00	$0.00	$0.00
27803203	EAP	HCPCS C1876		Stent Microdelivery 3.5x20mm	BOTH IP/OP	"$19,181.00 "	"$14,193.94"	$0.00	"$15,344.80"	"$8,631.45"	"$8,631.45"	$0.00	$0.00	$0.00	"$3,997.80"	"$4,181.12"	"$4,181.12"	"$14,784.71"	$0.00	"$3,997.32"	$0.00	"$9,456.23"	"$9,456.23"	$0.00	"$9,590.50"	"$15,191.35"	"$15,344.80"	$0.00	$0.00	$0.00	"$3,001.83"	$0.00	$0.00	"$3,053.62"	$0.00	$0.00	$0.00	$0.00	$0.00
27803204	EAP	HCPCS C1876		Neuroform Atlas Stent System	BOTH IP/OP	"$17,038.00 "	"$12,608.12"	$0.00	"$13,630.40"	"$7,667.10"	"$7,667.10"	$0.00	$0.00	$0.00	"$3,551.15"	"$4,181.12"	"$4,181.12"	"$13,132.89"	$0.00	"$3,550.72"	$0.00	"$8,399.73"	"$8,399.73"	$0.00	"$8,519.00"	"$13,494.10"	"$13,630.40"	$0.00	$0.00	$0.00	"$2,666.45"	$0.00	$0.00	"$2,712.45"	$0.00	$0.00	$0.00	$0.00	$0.00
27803205	EAP	Custom 27803205		Coil Tornado 5/3 .036	BOTH IP/OP	$298.00 	$220.52	$0.00	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.18	$221.18	$229.70	$0.00	$62.10	$0.00	$0.00	$0.00	$0.00	$149.00	$236.02	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803206	EAP	Custom 27803206		Coil Tornado 4/3 .035	BOTH IP/OP	$298.00 	$220.52	$0.00	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.18	$221.18	$229.70	$0.00	$62.10	$0.00	$0.00	$0.00	$0.00	$149.00	$236.02	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803207	EAP	HCPCS C1874		Cath.viabahn 8mm X 15cm 1	BOTH IP/OP	"$5,107.00 "	"$3,779.18"	$0.00	"$4,085.60"	"$2,298.15"	"$2,298.15"	$0.00	$0.00	$0.00	"$1,064.43"	"$3,790.42"	"$3,790.42"	"$3,936.48"	$0.00	"$1,064.30"	$0.00	"$2,517.75"	"$2,517.75"	$0.00	"$2,553.50"	"$4,044.74"	"$4,085.60"	$0.00	"$2,298.15"	$0.00	$799.25	$0.00	$0.00	$813.03	$0.00	$0.00	$0.00	$0.00	$0.00
27803208	EAP	HCPCS C1874		Cath.viabahn 8mm X 15cm 2	BOTH IP/OP	"$5,107.00 "	"$3,779.18"	$0.00	"$4,085.60"	"$2,298.15"	"$2,298.15"	$0.00	$0.00	$0.00	"$1,064.43"	"$3,790.42"	"$3,790.42"	"$3,936.48"	$0.00	"$1,064.30"	$0.00	"$2,517.75"	"$2,517.75"	$0.00	"$2,553.50"	"$4,044.74"	"$4,085.60"	$0.00	"$2,298.15"	$0.00	$799.25	$0.00	$0.00	$813.03	$0.00	$0.00	$0.00	$0.00	$0.00
27803209	EAP	HCPCS C1876		Microcatheter Enterprise 4.5x3	BOTH IP/OP	"$17,347.00 "	"$12,836.78"	$0.00	"$13,877.60"	"$7,806.15"	"$7,806.15"	$0.00	$0.00	$0.00	"$3,615.55"	"$4,181.12"	"$4,181.12"	"$13,371.07"	$0.00	"$3,615.11"	$0.00	"$8,552.07"	"$8,552.07"	$0.00	"$8,673.50"	"$13,738.82"	"$13,877.60"	$0.00	$0.00	$0.00	"$2,714.81"	$0.00	$0.00	"$2,761.64"	$0.00	$0.00	$0.00	$0.00	$0.00
27803210	EAP	HCPCS C1876		Microcath.enterprise 4.5x2 1	BOTH IP/OP	"$17,347.00 "	"$12,836.78"	$0.00	"$13,877.60"	"$7,806.15"	"$7,806.15"	$0.00	$0.00	$0.00	"$3,615.55"	"$4,181.12"	"$4,181.12"	"$13,371.07"	$0.00	"$3,615.11"	$0.00	"$8,552.07"	"$8,552.07"	$0.00	"$8,673.50"	"$13,738.82"	"$13,877.60"	$0.00	$0.00	$0.00	"$2,714.81"	$0.00	$0.00	"$2,761.64"	$0.00	$0.00	$0.00	$0.00	$0.00
27803211	EAP	HCPCS C1876		Microcath.enterprise 4.5x2 2	BOTH IP/OP	"$17,347.00 "	"$12,836.78"	$0.00	"$13,877.60"	"$7,806.15"	"$7,806.15"	$0.00	$0.00	$0.00	"$3,615.55"	"$4,181.12"	"$4,181.12"	"$13,371.07"	$0.00	"$3,615.11"	$0.00	"$8,552.07"	"$8,552.07"	$0.00	"$8,673.50"	"$13,738.82"	"$13,877.60"	$0.00	$0.00	$0.00	"$2,714.81"	$0.00	$0.00	"$2,761.64"	$0.00	$0.00	$0.00	$0.00	$0.00
27803212	EAP	HCPCS C1876		Stent Icast 6mm X 22mm	BOTH IP/OP	"$8,391.00 "	"$6,209.34"	$0.00	"$6,712.80"	"$3,775.95"	"$3,775.95"	$0.00	$0.00	$0.00	"$1,748.89"	"$4,181.12"	"$4,181.12"	"$6,467.78"	$0.00	"$1,748.68"	$0.00	"$4,136.76"	"$4,136.76"	$0.00	"$4,195.50"	"$6,645.67"	"$6,712.80"	$0.00	$0.00	$0.00	"$1,313.19"	$0.00	$0.00	"$1,335.85"	$0.00	$0.00	$0.00	$0.00	$0.00
27803213	EAP	HCPCS C1876		Stent Carot Protege Rx 40x13 1	BOTH IP/OP	"$2,941.00 "	"$2,176.34"	$0.00	"$2,352.80"	"$1,323.45"	"$1,323.45"	$0.00	$0.00	$0.00	$612.98	"$2,182.81"	"$2,182.81"	"$2,266.92"	$0.00	$612.90	$0.00	"$1,449.91"	"$1,449.91"	$0.00	"$1,470.50"	"$2,329.27"	"$2,352.80"	$0.00	$0.00	$0.00	$460.27	$0.00	$0.00	$468.21	$0.00	$0.00	$0.00	$0.00	$0.00
27803214	EAP	HCPCS C1876		Stent Carotid Protege Rx 30x13	BOTH IP/OP	"$6,843.00 "	"$5,063.82"	$0.00	"$5,474.40"	"$3,079.35"	"$3,079.35"	$0.00	$0.00	$0.00	"$1,426.25"	"$4,181.12"	"$4,181.12"	"$5,274.58"	$0.00	"$1,426.08"	$0.00	"$3,373.60"	"$3,373.60"	$0.00	"$3,421.50"	"$5,419.66"	"$5,474.40"	$0.00	$0.00	$0.00	"$1,070.93"	$0.00	$0.00	"$1,089.41"	$0.00	$0.00	$0.00	$0.00	$0.00
27803215	EAP	HCPCS C1876		Stent Carot Protege Rx 40x13 2	BOTH IP/OP	"$2,941.00 "	"$2,176.34"	$0.00	"$2,352.80"	"$1,323.45"	"$1,323.45"	$0.00	$0.00	$0.00	$612.98	"$2,182.81"	"$2,182.81"	"$2,266.92"	$0.00	$612.90	$0.00	"$1,449.91"	"$1,449.91"	$0.00	"$1,470.50"	"$2,329.27"	"$2,352.80"	$0.00	$0.00	$0.00	$460.27	$0.00	$0.00	$468.21	$0.00	$0.00	$0.00	$0.00	$0.00
27803216	EAP	HCPCS C1876		Stent Carotid Protege Rx	BOTH IP/OP	"$6,843.00 "	"$5,063.82"	$0.00	"$5,474.40"	"$3,079.35"	"$3,079.35"	$0.00	$0.00	$0.00	"$1,426.25"	"$4,181.12"	"$4,181.12"	"$5,274.58"	$0.00	"$1,426.08"	$0.00	"$3,373.60"	"$3,373.60"	$0.00	"$3,421.50"	"$5,419.66"	"$5,474.40"	$0.00	$0.00	$0.00	"$1,070.93"	$0.00	$0.00	"$1,089.41"	$0.00	$0.00	$0.00	$0.00	$0.00
27803217	EAP	HCPCS C1760		Sph100250-20 Microcoil Platinu	BOTH IP/OP	"$3,169.00 "	"$2,345.06"	$0.00	"$2,535.20"	"$1,426.05"	"$1,426.05"	$0.00	$0.00	$0.00	$660.50	"$2,352.03"	"$2,352.03"	"$2,442.67"	$0.00	$660.42	$0.00	"$1,562.32"	"$1,562.32"	$0.00	"$1,584.50"	"$2,509.85"	"$2,535.20"	$0.00	$0.00	$0.00	$495.95	$0.00	$0.00	$504.50	$0.00	$0.00	$0.00	$0.00	$0.00
27803218	EAP	HCPCS C1726		Sph100300-20 Microcoil Platinu	BOTH IP/OP	"$3,186.00 "	"$2,357.64"	$0.00	"$2,548.80"	"$1,433.70"	"$1,433.70"	$0.00	$0.00	$0.00	$664.04	"$2,364.65"	"$2,364.65"	"$2,455.77"	$0.00	$663.96	$0.00	"$1,570.70"	"$1,570.70"	$0.00	"$1,593.00"	"$2,523.31"	"$2,548.80"	$0.00	$0.00	$0.00	$498.61	$0.00	$0.00	$507.21	$0.00	$0.00	$0.00	$0.00	$0.00
27803219	EAP	HCPCS C1894		Sph100350-20 Microcoil Platinu	BOTH IP/OP	"$3,198.00 "	"$2,366.52"	$0.00	"$2,558.40"	"$1,439.10"	"$1,439.10"	$0.00	$0.00	$0.00	$666.54	"$2,373.56"	"$2,373.56"	"$2,465.02"	$0.00	$666.46	$0.00	"$1,576.61"	"$1,576.61"	$0.00	"$1,599.00"	"$2,532.82"	"$2,558.40"	$0.00	$0.00	$0.00	$500.49	$0.00	$0.00	$509.12	$0.00	$0.00	$0.00	$0.00	$0.00
27803220	EAP	HCPCS C1769		Wire Guide Lunderquist Extra S	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$12.60	$12.60	$0.00	$0.00	$0.00	$5.84	$20.78	$20.78	$21.58	$0.00	$5.84	$0.00	$16.56	$16.56	$0.00	$14.00	$22.18	$22.40	$0.00	$0.00	$0.00	$4.38	$0.00	$0.00	$4.46	$0.00	$0.00	$0.00	$0.00	$0.00
27803221	EAP	HCPCS C1894		Prelude Sheath	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$23.35	$23.35	$0.00	$0.00	$0.00	$8.96	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$25.43	$25.43	$0.00	$21.50	$34.06	$34.40	$0.00	$27.95	$0.00	$6.73	$0.00	$0.00	$6.85	$0.00	$0.00	$0.00	$0.00	$0.00
27803230	EAP	HCPCS C1729		10.2fr 22cm  Nephroureterostom	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$269.78	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00	$157.50	$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
27803231	EAP	HCPCS C1729		10.2fr 24cm Nephroureterostomy	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00	$0.00	$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
27803232	EAP	HCPCS C1892		16fr Check-flo Sheath 30cm Rad	BOTH IP/OP	$378.00 	$279.72	$0.00	$302.40	$170.10	$170.10	$0.00	$0.00	$0.00	$78.78	$280.55	$280.55	$291.36	$0.00	$78.78	$0.00	$223.59	$223.59	$0.00	$189.00	$299.38	$302.40	$0.00	$0.00	$0.00	$59.16	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$0.00
27803233	EAP	HCPCS C1751		5fr/65cm Mpa Catheter	BOTH IP/OP	$312.00 	$230.88	$0.00	$249.60	$140.40	$140.40	$0.00	$0.00	$0.00	$65.03	$231.57	$231.57	$240.49	$0.00	$65.02	$0.00	$184.55	$184.55	$0.00	$156.00	$247.10	$249.60	$0.00	$140.40	$0.00	$48.83	$0.00	$0.00	$49.67	$0.00	$0.00	$0.00	$0.00	$0.00
27803234	EAP	HCPCS C1892		7fr Tear-away Introducer	BOTH IP/OP	$462.00 	$341.88	$0.00	$369.60	$207.90	$207.90	$0.00	$0.00	$0.00	$96.29	$342.90	$342.90	$356.11	$0.00	$96.28	$0.00	$273.27	$273.27	$0.00	$231.00	$365.90	$369.60	$0.00	$207.90	$0.00	$72.30	$0.00	$0.00	$73.55	$0.00	$0.00	$0.00	$0.00	$0.00
27803235	EAP	HCPCS C1874		8x60 Luminexx Stent	BOTH IP/OP	"$4,186.00 "	"$3,097.64"	$0.00	"$3,348.80"	"$1,883.70"	"$1,883.70"	$0.00	$0.00	$0.00	$872.47	"$3,106.85"	"$3,106.85"	"$3,226.57"	$0.00	$872.36	$0.00	"$2,063.70"	"$2,063.70"	$0.00	"$2,093.00"	"$3,315.31"	"$3,348.80"	$0.00	$0.00	$0.00	$655.11	$0.00	$0.00	$666.41	$0.00	$0.00	$0.00	$0.00	$0.00
27803236	EAP	HCPCS C1769		Amplatz Super Stiff Guidewire	BOTH IP/OP	$92.00 	$68.08	$0.00	$73.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.00	$72.86	$73.60	$0.00	$0.00	$0.00	$14.40	$0.00	$0.00	$14.65	$0.00	$0.00	$0.00	$0.00	$0.00
27803237	EAP	HCPCS C1726		Ballon Cather 4-2/5/75	BOTH IP/OP	$916.00 	$677.84	$0.00	$732.80	$412.20	$412.20	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$706.05	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$458.00	$725.47	$732.80	$0.00	$0.00	$0.00	$143.35	$0.00	$0.00	$145.83	$0.00	$0.00	$0.00	$0.00	$0.00
27803238	EAP	HCPCS C1726		Balloon Bmq 10-4/5.8/75	BOTH IP/OP	$884.00 	$654.16	$0.00	$707.20	$397.80	$397.80	$0.00	$0.00	$0.00	$184.25	$656.10	$656.10	$681.39	$0.00	$184.23	$0.00	$522.89	$522.89	$0.00	$442.00	$700.13	$707.20	$0.00	$0.00	$0.00	$138.35	$0.00	$0.00	$140.73	$0.00	$0.00	$0.00	$0.00	$0.00
27803239	EAP	HCPCS C1726		Balloon Udt 4-10/5/75	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$306.45	$306.45	$0.00	$0.00	$0.00	$141.94	$505.44	$505.44	$524.91	$0.00	$141.92	$0.00	$402.81	$402.81	$0.00	$340.50	$539.35	$544.80	$0.00	$0.00	$0.00	$106.58	$0.00	$0.00	$108.42	$0.00	$0.00	$0.00	$0.00	$0.00
27803240	EAP	HCPCS C1726		Balloon Udt 5-10/5/75	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$306.45	$306.45	$0.00	$0.00	$0.00	$141.94	$505.44	$505.44	$524.91	$0.00	$141.92	$0.00	$402.81	$402.81	$0.00	$340.50	$539.35	$544.80	$0.00	$0.00	$0.00	$106.58	$0.00	$0.00	$108.42	$0.00	$0.00	$0.00	$0.00	$0.00
27803241	EAP	HCPCS C1751		Cath 5fr 100cm Vertebral Curve	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$0.00	$0.00	$0.00	$7.04	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00
27803242	EAP	HCPCS C1751		Cath Dbl Lumen 9fr	BOTH IP/OP	$517.00 	$382.58	$0.00	$413.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.50	$409.46	$413.60	$0.00	$0.00	$0.00	$80.91	$0.00	$0.00	$82.31	$0.00	$0.00	$0.00	$0.00	$0.00
27803243	EAP	HCPCS C1887		Cath Guiding 7fr Sh	BOTH IP/OP	$186.00 	$137.64	$0.00	$148.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.00	$147.31	$148.80	$0.00	$0.00	$0.00	$29.11	$0.00	$0.00	$29.61	$0.00	$0.00	$0.00	$0.00	$0.00
27803244	EAP	HCPCS C1751		Cath Micro Mc 2.8f 130cm	BOTH IP/OP	"$1,890.00 "	"$1,398.60"	$0.00	"$1,512.00"	$850.50	$850.50	$0.00	$0.00	$0.00	$393.92	"$1,402.76"	"$1,402.76"	"$1,456.81"	$0.00	$393.88	$0.00	"$1,117.94"	"$1,117.94"	$0.00	$945.00	"$1,496.88"	"$1,512.00"	$0.00	$850.50	$0.00	$295.79	$0.00	$0.00	$300.89	$0.00	$0.00	$0.00	$0.00	$0.00
27803245	EAP	Custom 27803245		Cytology Brushes 3x120x1.7	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803246	EAP	HCPCS C1751		Dual Picc Line	BOTH IP/OP	$307.00 	$227.18	$0.00	$245.60	$138.15	$138.15	$0.00	$0.00	$0.00	$63.99	$227.86	$227.86	$236.64	$0.00	$63.98	$0.00	$181.59	$181.59	$0.00	$153.50	$243.14	$245.60	$0.00	$138.15	$0.00	$48.05	$0.00	$0.00	$48.87	$0.00	$0.00	$0.00	$0.00	$0.00
27803247	EAP	Custom 27803247		Gasttostomy (peg Kit) Pull Typ	BOTH IP/OP	$271.00 	$200.54	$0.00	$216.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.14	$201.14	$208.89	$0.00	$56.48	$0.00	$0.00	$0.00	$0.00	$135.50	$214.63	$216.80	$0.00	$121.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803248	EAP	Custom 27803248		"Gelfoam, Sponge"	BOTH IP/OP	$103.00 	$76.22	$0.00	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.45	$76.45	$79.39	$0.00	$21.47	$0.00	$0.00	$0.00	$0.00	$51.50	$81.58	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803249	EAP	HCPCS C1874		Ic Ast Stent 5mm X 2mm	BOTH IP/OP	"$8,391.00 "	"$6,209.34"	$0.00	"$6,712.80"	"$3,775.95"	"$3,775.95"	$0.00	$0.00	$0.00	"$1,748.89"	"$4,181.12"	"$4,181.12"	"$6,467.78"	$0.00	"$1,748.68"	$0.00	"$4,136.76"	"$4,136.76"	$0.00	"$4,195.50"	"$6,645.67"	"$6,712.80"	$0.00	$0.00	$0.00	"$1,313.19"	$0.00	$0.00	"$1,335.85"	$0.00	$0.00	$0.00	$0.00	$0.00
27803250	EAP	HCPCS C1721		Paradym Dr Dual Icd	BOTH IP/OP	"$55,047.00 "	"$40,734.78"	$0.00	"$44,037.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$42,430.23"	$0.00	"$11,471.79"	$0.00	"$27,138.17"	"$27,138.17"	$0.00	"$27,523.50"	"$43,597.22"	"$44,037.60"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27803251	EAP	HCPCS C1722		Paradym Vr Single Icd	BOTH IP/OP	"$46,706.00 "	"$34,562.44"	$0.00	"$37,364.80"	"$21,017.70"	"$21,017.70"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$36,000.98"	$0.00	"$9,733.53"	$0.00	"$23,026.06"	"$23,026.06"	$0.00	"$23,353.00"	"$36,991.15"	"$37,364.80"	$0.00	$0.00	$0.00	"$7,309.49"	$0.00	$0.00	"$7,435.60"	$0.00	$0.00	$0.00	$0.00	$0.00
27803252	EAP	Custom 27803252		"Lc Bead,100-300um"	BOTH IP/OP	"$4,887.00 "	"$3,616.38"	$0.00	"$3,909.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,627.13"	"$3,627.13"	"$3,766.90"	$0.00	"$1,018.45"	$0.00	$0.00	$0.00	$0.00	"$2,443.50"	"$3,870.50"	"$3,909.60"	$0.00	"$2,199.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803253	EAP			Picc Line Tray W/o Device	BOTH IP/OP	$134.00 	$99.16	$0.00	$107.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.45	$99.45	$103.29	$0.00	$27.93	$0.00	$0.00	$0.00	$0.00	$67.00	$106.13	$107.20	$0.00	$87.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803254	EAP	HCPCS C1769		Pinnacle Guidewire 6fr Straigh	BOTH IP/OP	$278.00 	$205.72	$0.00	$222.40	$125.10	$125.10	$0.00	$0.00	$0.00	$57.94	$206.33	$206.33	$214.28	$0.00	$57.94	$0.00	$164.44	$164.44	$0.00	$139.00	$220.18	$222.40	$0.00	$125.10	$0.00	$43.51	$0.00	$0.00	$44.26	$0.00	$0.00	$0.00	$0.00	$0.00
27803255	EAP	HCPCS C1894		Sheath Gd Lima Crv 6fr 45cm 5cm Pn Dstn Xcut Vlv Radopq Ss	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$133.25	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
27803256	EAP	HCPCS A4300		Port-a-cath Ii Low Profile Dua	BOTH IP/OP	"$1,429.00 "	"$1,057.46"	$0.00	"$1,143.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,060.60"	"$1,060.60"	"$1,101.47"	$0.00	$297.80	$0.00	$0.00	$0.00	$0.00	$714.50	"$1,131.77"	"$1,143.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803257	EAP	HCPCS C1752		Set Schon Xl Temp Dialysis 15c	BOTH IP/OP	"$1,635.00 "	"$1,209.90"	$0.00	"$1,308.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,213.50"	"$1,213.50"	"$1,260.26"	$0.00	$340.73	$0.00	$0.00	$0.00	$0.00	$817.50	"$1,294.92"	"$1,308.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803258	EAP	HCPCS C1751		Single Picc Line	BOTH IP/OP	$216.00 	$159.84	$0.00	$172.80	$97.20	$97.20	$0.00	$0.00	$0.00	$45.02	$160.32	$160.32	$166.49	$0.00	$45.01	$0.00	$127.76	$127.76	$0.00	$108.00	$171.07	$172.80	$0.00	$97.20	$0.00	$33.80	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$0.00
27803259	EAP	HCPCS C1751		Triple Lumen Catheter Size 20	BOTH IP/OP	$384.00 	$284.16	$0.00	$307.20	$172.80	$172.80	$0.00	$0.00	$0.00	$80.04	$285.00	$285.00	$295.99	$0.00	$80.03	$0.00	$227.14	$227.14	$0.00	$192.00	$304.13	$307.20	$0.00	$0.00	$0.00	$60.10	$0.00	$0.00	$61.13	$0.00	$0.00	$0.00	$0.00	$0.00
27803260	EAP	HCPCS C1729		Tube Gastrostomy 24fr	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$26.55	$26.55	$0.00	$0.00	$0.00	$12.30	$43.79	$43.79	$45.48	$0.00	$12.30	$0.00	$34.90	$34.90	$0.00	$29.50	$46.73	$47.20	$0.00	$26.55	$0.00	$9.23	$0.00	$0.00	$9.39	$0.00	$0.00	$0.00	$0.00	$0.00
27803261	EAP	HCPCS C1751		"Uhf Pigtail Sizing Cath 5 Fr,1"	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$141.75	$141.75	$0.00	$0.00	$0.00	$65.65	$233.79	$233.79	$242.80	$0.00	$65.65	$0.00	$186.32	$186.32	$0.00	$157.50	$249.48	$252.00	$0.00	$141.75	$0.00	$49.30	$0.00	$0.00	$50.15	$0.00	$0.00	$0.00	$0.00	$0.00
27803262	EAP	HCPCS C1751		"Uhf Pigtail Sizing Cath 5fr,2"	BOTH IP/OP	$71.00 	$52.54	$0.00	$56.80	$31.95	$31.95	$0.00	$0.00	$0.00	$14.80	$52.70	$52.70	$54.73	$0.00	$14.80	$0.00	$42.00	$42.00	$0.00	$35.50	$56.23	$56.80	$0.00	$31.95	$0.00	$11.11	$0.00	$0.00	$11.30	$0.00	$0.00	$0.00	$0.00	$0.00
27803263	EAP	HCPCS C1751		Venous Access	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$74.25	$74.25	$0.00	$0.00	$0.00	$34.39	$122.46	$122.46	$127.18	$0.00	$34.39	$0.00	$97.60	$97.60	$0.00	$82.50	$130.68	$132.00	$0.00	$74.25	$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
27803264	EAP	HCPCS A4300		Isp Port Plas Lumen	BOTH IP/OP	$734.00 	$543.16	$0.00	$587.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$544.77	$544.77	$565.77	$0.00	$152.97	$0.00	$0.00	$0.00	$0.00	$367.00	$581.33	$587.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803265	EAP	Custom 27803265		Jcd 12.0-38-20	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00	$8.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803270	EAP	Custom 27803270		Tray Central Line Dressing Without Biopatch	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$51.00	$80.78	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803294	EAP	HCPCS C1725		Band Tr  24cm	BOTH IP/OP	$123.00 	$91.02	$0.00	$98.40	$55.35	$55.35	$0.00	$0.00	$0.00	$25.64	$91.29	$91.29	$94.81	$0.00	$25.63	$0.00	$72.75	$72.75	$0.00	$61.50	$97.42	$98.40	$0.00	$55.35	$0.00	$19.25	$0.00	$0.00	$19.58	$0.00	$0.00	$0.00	$0.00	$0.00
27803295	EAP	HCPCS C1725		Band Tr 29cm	BOTH IP/OP	$123.00 	$91.02	$0.00	$98.40	$55.35	$55.35	$0.00	$0.00	$0.00	$25.64	$91.29	$91.29	$94.81	$0.00	$25.63	$0.00	$72.75	$72.75	$0.00	$61.50	$97.42	$98.40	$0.00	$55.35	$0.00	$19.25	$0.00	$0.00	$19.58	$0.00	$0.00	$0.00	$0.00	$0.00
27803302	EAP	Custom 27803302		Embolization Coil - Azur 35d System 10mm X 20cm	BOTH IP/OP	"$3,754.00 "	"$2,777.96"	$0.00	"$3,003.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,786.22"	"$2,786.22"	"$2,893.58"	$0.00	$782.33	$0.00	$0.00	$0.00	$0.00	"$1,877.00"	"$2,973.17"	"$3,003.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803303	EAP	Custom 27803303		Embolization Coil - Azur 35d System 12mm X 20cm	BOTH IP/OP	"$3,754.00 "	"$2,777.96"	$0.00	"$3,003.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,786.22"	"$2,786.22"	"$2,893.58"	$0.00	$782.33	$0.00	$0.00	$0.00	$0.00	"$1,877.00"	"$2,973.17"	"$3,003.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803304	EAP	Custom 27803304		Embolization Coil - Azur 35d System 15mm X 20cm	BOTH IP/OP	"$3,754.00 "	"$2,777.96"	$0.00	"$3,003.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,786.22"	"$2,786.22"	"$2,893.58"	$0.00	$782.33	$0.00	$0.00	$0.00	$0.00	"$1,877.00"	"$2,973.17"	"$3,003.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803305	EAP	Custom 27803305		Embolization Coil - Azur 35d System 12mm X 30cm	BOTH IP/OP	"$4,005.00 "	"$2,963.70"	$0.00	"$3,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,972.51"	"$2,972.51"	"$3,087.05"	$0.00	$834.64	$0.00	$0.00	$0.00	$0.00	"$2,002.50"	"$3,171.96"	"$3,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803306	EAP	Custom 27803306		Embolization Coil -azur 35d System 15mm X 30cm	BOTH IP/OP	"$4,005.00 "	"$2,963.70"	$0.00	"$3,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,972.51"	"$2,972.51"	"$3,087.05"	$0.00	$834.64	$0.00	$0.00	$0.00	$0.00	"$2,002.50"	"$3,171.96"	"$3,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803307	EAP	Custom 27803307		Embolization Coil - Azur 35d System 20mm X 30cm	BOTH IP/OP	"$4,005.00 "	"$2,963.70"	$0.00	"$3,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,972.51"	"$2,972.51"	"$3,087.05"	$0.00	$834.64	$0.00	$0.00	$0.00	$0.00	"$2,002.50"	"$3,171.96"	"$3,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803308	EAP	HCPCS C1876		Stent Bilinary Xpert Otw 5x30x120 Cm	BOTH IP/OP	"$5,755.00 "	"$4,258.70"	$0.00	"$4,604.00"	"$2,589.75"	"$2,589.75"	$0.00	$0.00	$0.00	"$1,199.49"	"$4,181.12"	"$4,181.12"	"$4,435.95"	$0.00	"$1,199.34"	$0.00	"$2,837.22"	"$2,837.22"	$0.00	"$2,877.50"	"$4,557.96"	"$4,604.00"	$0.00	$0.00	$0.00	$900.66	$0.00	$0.00	$916.20	$0.00	$0.00	$0.00	$0.00	$0.00
27803309	EAP	HCPCS C1876		Stent Bilinary Xpert Otw 5x40x120 Cm	BOTH IP/OP	"$5,755.00 "	"$4,258.70"	$0.00	"$4,604.00"	"$2,589.75"	"$2,589.75"	$0.00	$0.00	$0.00	"$1,199.49"	"$4,181.12"	"$4,181.12"	"$4,435.95"	$0.00	"$1,199.34"	$0.00	"$2,837.22"	"$2,837.22"	$0.00	"$2,877.50"	"$4,557.96"	"$4,604.00"	$0.00	$0.00	$0.00	$900.66	$0.00	$0.00	$916.20	$0.00	$0.00	$0.00	$0.00	$0.00
27803310	EAP	HCPCS C1876		Stent Bilinary Xpert Otw 6x30x120 Cm	BOTH IP/OP	"$5,755.00 "	"$4,258.70"	$0.00	"$4,604.00"	"$2,589.75"	"$2,589.75"	$0.00	$0.00	$0.00	"$1,199.49"	"$4,181.12"	"$4,181.12"	"$4,435.95"	$0.00	"$1,199.34"	$0.00	"$2,837.22"	"$2,837.22"	$0.00	"$2,877.50"	"$4,557.96"	"$4,604.00"	$0.00	$0.00	$0.00	$900.66	$0.00	$0.00	$916.20	$0.00	$0.00	$0.00	$0.00	$0.00
27803311	EAP	HCPCS C1876		Stent Bilinary Xpert Otw 6x40x120 Cm	BOTH IP/OP	"$5,755.00 "	"$4,258.70"	$0.00	"$4,604.00"	"$2,589.75"	"$2,589.75"	$0.00	$0.00	$0.00	"$1,199.49"	"$4,181.12"	"$4,181.12"	"$4,435.95"	$0.00	"$1,199.34"	$0.00	"$2,837.22"	"$2,837.22"	$0.00	"$2,877.50"	"$4,557.96"	"$4,604.00"	$0.00	$0.00	$0.00	$900.66	$0.00	$0.00	$916.20	$0.00	$0.00	$0.00	$0.00	$0.00
27803312	EAP	HCPCS C1876		Stent Corotid Straight Rx Acculink 6x40	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	"$2,965.50"	"$2,965.50"	$0.00	$0.00	$0.00	"$1,373.52"	"$4,181.12"	"$4,181.12"	"$5,079.57"	$0.00	"$1,373.36"	$0.00	"$3,248.87"	"$3,248.87"	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00	"$2,965.50"	$0.00	"$1,031.34"	$0.00	$0.00	"$1,049.13"	$0.00	$0.00	$0.00	$0.00	$0.00
27803313	EAP	HCPCS C1876		Stent Corotid Straight Rx Acculink 7x40	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	"$2,965.50"	"$2,965.50"	$0.00	$0.00	$0.00	"$1,373.52"	"$4,181.12"	"$4,181.12"	"$5,079.57"	$0.00	"$1,373.36"	$0.00	"$3,248.87"	"$3,248.87"	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00	$0.00	$0.00	"$1,031.34"	$0.00	$0.00	"$1,049.13"	$0.00	$0.00	$0.00	$0.00	$0.00
27803314	EAP	HCPCS C1876		Stent Corotid Straight Rx Acculink 8x40	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	"$2,965.50"	"$2,965.50"	$0.00	$0.00	$0.00	"$1,373.52"	"$4,181.12"	"$4,181.12"	"$5,079.57"	$0.00	"$1,373.36"	$0.00	"$3,248.87"	"$3,248.87"	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00	$0.00	$0.00	"$1,031.34"	$0.00	$0.00	"$1,049.13"	$0.00	$0.00	$0.00	$0.00	$0.00
27803315	EAP	HCPCS C1876		Stent Corotid Straight Rx Acculink 9x40	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	"$2,965.50"	"$2,965.50"	$0.00	$0.00	$0.00	"$1,373.52"	"$4,181.12"	"$4,181.12"	"$5,079.57"	$0.00	"$1,373.36"	$0.00	"$3,248.87"	"$3,248.87"	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00	$0.00	$0.00	"$1,031.34"	$0.00	$0.00	"$1,049.13"	$0.00	$0.00	$0.00	$0.00	$0.00
27803316	EAP	HCPCS C1876		Stent Corotid Straight Rx Acculink 10x40	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00	$0.00	$0.00	"$1,031.34"	$0.00	$0.00	"$1,049.13"	$0.00	$0.00	$0.00	$0.00	$0.00
27803317	EAP	HCPCS C1876		Stent Corotid Tapped Rx Acculink 6-8x40	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	"$2,965.50"	"$2,965.50"	$0.00	$0.00	$0.00	"$1,373.52"	"$4,181.12"	"$4,181.12"	"$5,079.57"	$0.00	"$1,373.36"	$0.00	"$3,248.87"	"$3,248.87"	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00	"$2,965.50"	$0.00	"$1,031.34"	$0.00	$0.00	"$1,049.13"	$0.00	$0.00	$0.00	$0.00	$0.00
27803318	EAP	HCPCS C1876		Stent Corotid Tapped Rx Acculink 7-10x40	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	"$2,965.50"	"$2,965.50"	$0.00	$0.00	$0.00	"$1,373.52"	"$4,181.12"	"$4,181.12"	"$5,079.57"	$0.00	"$1,373.36"	$0.00	"$3,248.87"	"$3,248.87"	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00	$0.00	$0.00	"$1,031.34"	$0.00	$0.00	"$1,049.13"	$0.00	$0.00	$0.00	$0.00	$0.00
27803319	EAP	HCPCS C1882		Defibrillator Crd Amplia Mri Crt-d Vntrc Left Df4	BOTH IP/OP	"$52,375.00 "	"$38,757.50"	$0.00	"$41,900.00"	"$23,568.75"	"$23,568.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$40,370.65"	$0.00	"$10,914.95"	$0.00	"$25,820.88"	"$25,820.88"	$0.00	"$26,187.50"	"$41,481.00"	"$41,900.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27803320	EAP	HCPCS C1882		Defibrillator Crd Amplia Mri Crt-d 2 Plr Left	BOTH IP/OP	"$52,375.00 "	"$38,757.50"	$0.00	"$41,900.00"	"$23,568.75"	"$23,568.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$40,370.65"	$0.00	"$10,914.95"	$0.00	"$25,820.88"	"$25,820.88"	$0.00	"$26,187.50"	"$41,481.00"	"$41,900.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27803420	EAP	HCPCS C1769		Guidewire Amplatz Super Stiff 0.038 X 260	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$22.50	$22.50	$0.00	$0.00	$0.00	$10.42	$37.11	$37.11	$38.54	$0.00	$10.42	$0.00	$29.58	$29.58	$0.00	$25.00	$39.60	$40.00	$0.00	$0.00	$0.00	$7.83	$0.00	$0.00	$7.96	$0.00	$0.00	$0.00	$0.00	$0.00
27803421	EAP	HCPCS C1769		Guidewire Hydrophilic Nitinol	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$174.60	$174.60	$0.00	$0.00	$0.00	$80.87	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$229.50	$229.50	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$60.72	$0.00	$0.00	$61.77	$0.00	$0.00	$0.00	$0.00	$0.00
27803441	EAP	Custom 27803441		Stent Metal Bare Int35012ux	BOTH IP/OP	"$2,422.00 "	"$1,792.28"	$0.00	"$1,937.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,797.61"	"$1,797.61"	"$1,866.88"	$0.00	$504.74	$0.00	$0.00	$0.00	$0.00	"$1,211.00"	"$1,918.22"	"$1,937.60"	$0.00	"$1,089.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803450	EAP	Custom 27803450		Target Detachable Colis 360 Soft 4mm X 6cm	BOTH IP/OP	"$2,270.00 "	"$1,679.80"	$0.00	"$1,816.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,684.79"	"$1,684.79"	"$1,749.72"	$0.00	$473.07	$0.00	$0.00	$0.00	$0.00	"$1,135.00"	"$1,797.84"	"$1,816.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803451	EAP	Custom 27803451		Target Detachable Colis Ultra 3mmx8cm	BOTH IP/OP	"$2,401.00 "	"$1,776.74"	$0.00	"$1,920.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,782.02"	"$1,782.02"	"$1,850.69"	$0.00	$500.37	$0.00	$0.00	$0.00	$0.00	"$1,200.50"	"$1,901.59"	"$1,920.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803452	EAP	Custom 27803452		Inzone Detachment System	BOTH IP/OP	$260.00 	$192.40	$0.00	$208.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.97	$192.97	$200.41	$0.00	$54.18	$0.00	$0.00	$0.00	$0.00	$130.00	$205.92	$208.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803490	EAP	HCPCS C2625		Rx Stent/11.5 X 5	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$28.80	$28.80	$0.00	$0.00	$0.00	$13.34	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$37.86	$37.86	$0.00	$32.00	$50.69	$51.20	$0.00	$28.80	$0.00	$10.02	$0.00	$0.00	$10.19	$0.00	$0.00	$0.00	$0.00	$0.00
27803491	EAP	HCPCS C2625		Rx Stent/11.5 X 7	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$28.80	$28.80	$0.00	$0.00	$0.00	$13.34	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$37.86	$37.86	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$10.02	$0.00	$0.00	$10.19	$0.00	$0.00	$0.00	$0.00	$0.00
27803492	EAP	HCPCS C2625		Rx Stent/11.5 X 10	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$28.80	$28.80	$0.00	$0.00	$0.00	$13.34	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$37.86	$37.86	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$10.02	$0.00	$0.00	$10.19	$0.00	$0.00	$0.00	$0.00	$0.00
27803493	EAP	HCPCS C2625		Rx Stent/11.5 X 12	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$28.80	$28.80	$0.00	$0.00	$0.00	$13.34	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$37.86	$37.86	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$10.02	$0.00	$0.00	$10.19	$0.00	$0.00	$0.00	$0.00	$0.00
27803494	EAP	HCPCS C2625		Rx Stent/11.5 X 15	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$28.80	$28.80	$0.00	$0.00	$0.00	$13.34	$47.50	$47.50	$49.33	$0.00	$13.34	$0.00	$37.86	$37.86	$0.00	$32.00	$50.69	$51.20	$0.00	$0.00	$0.00	$10.02	$0.00	$0.00	$10.19	$0.00	$0.00	$0.00	$0.00	$0.00
27803496	EAP	HCPCS C1874		"Icast Covered Stent 6mm X16mm, 120 Cm Cath Length"	BOTH IP/OP	"$8,340.00 "	"$6,171.60"	$0.00	"$6,672.00"	"$3,753.00"	"$3,753.00"	$0.00	$0.00	$0.00	"$1,738.26"	"$4,181.12"	"$4,181.12"	"$6,428.47"	$0.00	"$1,738.06"	$0.00	"$4,111.62"	"$4,111.62"	$0.00	"$4,170.00"	"$6,605.28"	"$6,672.00"	$0.00	$0.00	$0.00	"$1,305.21"	$0.00	$0.00	"$1,327.73"	$0.00	$0.00	$0.00	$0.00	$0.00
27803499	EAP	Custom 27803499		Central Line Tray W /biopatch	BOTH IP/OP	$264.00 	$195.36	$0.00	$211.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.94	$195.94	$203.49	$0.00	$55.02	$0.00	$0.00	$0.00	$0.00	$132.00	$209.09	$211.20	$0.00	$171.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803510	EAP	HCPCS C2628		Boston Scientific Occlusion Balloon Catheter 27mm X 100m	BOTH IP/OP	$885.00 	$654.90	$0.00	$708.00	$398.25	$398.25	$0.00	$0.00	$0.00	$184.46	$656.85	$656.85	$682.16	$0.00	$184.43	$0.00	$523.48	$523.48	$0.00	$442.50	$700.92	$708.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803520	EAP	HCPCS C1876		Wallflex Bil Uncovered 10x60	BOTH IP/OP	"$6,005.00 "	"$4,443.70"	$0.00	"$4,804.00"	"$2,702.25"	"$2,702.25"	$0.00	$0.00	$0.00	"$1,251.59"	"$4,181.12"	"$4,181.12"	"$4,628.65"	$0.00	"$1,251.44"	$0.00	"$2,960.47"	"$2,960.47"	$0.00	"$3,002.50"	"$4,755.96"	"$4,804.00"	$0.00	"$2,702.25"	$0.00	$939.78	$0.00	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803521	EAP	HCPCS C1876		Wallflex Bil Uncovered 10x80	BOTH IP/OP	"$6,005.00 "	"$4,443.70"	$0.00	"$4,804.00"	"$2,702.25"	"$2,702.25"	$0.00	$0.00	$0.00	"$1,251.59"	"$4,181.12"	"$4,181.12"	"$4,628.65"	$0.00	"$1,251.44"	$0.00	"$2,960.47"	"$2,960.47"	$0.00	"$3,002.50"	"$4,755.96"	"$4,804.00"	$0.00	$0.00	$0.00	$939.78	$0.00	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803522	EAP	HCPCS C1876		Wallflex Bil  Uncovered 10x100	BOTH IP/OP	"$6,005.00 "	"$4,443.70"	$0.00	"$4,804.00"	"$2,702.25"	"$2,702.25"	$0.00	$0.00	$0.00	"$1,251.59"	"$4,181.12"	"$4,181.12"	"$4,628.65"	$0.00	"$1,251.44"	$0.00	"$2,960.47"	"$2,960.47"	$0.00	"$3,002.50"	"$4,755.96"	"$4,804.00"	$0.00	"$2,702.25"	$0.00	$939.78	$0.00	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803523	EAP	HCPCS C1876		Wallflex Bil Uncovered 10x40	BOTH IP/OP	"$6,005.00 "	"$4,443.70"	$0.00	"$4,804.00"	"$2,702.25"	"$2,702.25"	$0.00	$0.00	$0.00	"$1,251.59"	"$4,181.12"	"$4,181.12"	"$4,628.65"	$0.00	"$1,251.44"	$0.00	"$2,960.47"	"$2,960.47"	$0.00	"$3,002.50"	"$4,755.96"	"$4,804.00"	$0.00	"$2,702.25"	$0.00	$939.78	$0.00	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803524	EAP	HCPCS C1874		Wallflex Bil Covered 10x40	BOTH IP/OP	"$9,476.00 "	"$7,012.24"	$0.00	"$7,580.80"	"$4,264.20"	"$4,264.20"	$0.00	$0.00	$0.00	"$1,975.04"	"$4,181.12"	"$4,181.12"	"$7,304.10"	$0.00	"$1,974.80"	$0.00	"$4,671.67"	"$4,671.67"	$0.00	"$4,738.00"	"$7,504.99"	"$7,580.80"	$0.00	"$4,264.20"	$0.00	"$1,482.99"	$0.00	$0.00	"$1,508.58"	$0.00	$0.00	$0.00	$0.00	$0.00
27803525	EAP	HCPCS C1874		Wallflex Bil Covered 10x60	BOTH IP/OP	"$9,476.00 "	"$7,012.24"	$0.00	"$7,580.80"	"$4,264.20"	"$4,264.20"	$0.00	$0.00	$0.00	"$1,975.04"	"$4,181.12"	"$4,181.12"	"$7,304.10"	$0.00	"$1,974.80"	$0.00	"$4,671.67"	"$4,671.67"	$0.00	"$4,738.00"	"$7,504.99"	"$7,580.80"	$0.00	"$4,264.20"	$0.00	"$1,482.99"	$0.00	$0.00	"$1,508.58"	$0.00	$0.00	$0.00	$0.00	$0.00
27803526	EAP	HCPCS C1874		Wallflex Bil Covered 10x80	BOTH IP/OP	"$9,476.00 "	"$7,012.24"	$0.00	"$7,580.80"	"$4,264.20"	"$4,264.20"	$0.00	$0.00	$0.00	"$1,975.04"	"$4,181.12"	"$4,181.12"	"$7,304.10"	$0.00	"$1,974.80"	$0.00	"$4,671.67"	"$4,671.67"	$0.00	"$4,738.00"	"$7,504.99"	"$7,580.80"	$0.00	$0.00	$0.00	"$1,482.99"	$0.00	$0.00	"$1,508.58"	$0.00	$0.00	$0.00	$0.00	$0.00
27803527	EAP	HCPCS C1874		Wallflex Bil Pc Covered 10x40	BOTH IP/OP	"$9,142.00 "	"$6,765.08"	$0.00	"$7,313.60"	"$4,113.90"	"$4,113.90"	$0.00	$0.00	$0.00	"$1,905.42"	"$4,181.12"	"$4,181.12"	"$7,046.65"	$0.00	"$1,905.19"	$0.00	"$4,507.01"	"$4,507.01"	$0.00	"$4,571.00"	"$7,240.46"	"$7,313.60"	$0.00	"$4,113.90"	$0.00	"$1,430.72"	$0.00	$0.00	"$1,455.41"	$0.00	$0.00	$0.00	$0.00	$0.00
27803528	EAP	HCPCS C1874		Wallflex Bil Pc Covered 10x60	BOTH IP/OP	"$9,142.00 "	"$6,765.08"	$0.00	"$7,313.60"	"$4,113.90"	"$4,113.90"	$0.00	$0.00	$0.00	"$1,905.42"	"$4,181.12"	"$4,181.12"	"$7,046.65"	$0.00	"$1,905.19"	$0.00	"$4,507.01"	"$4,507.01"	$0.00	"$4,571.00"	"$7,240.46"	"$7,313.60"	$0.00	"$4,113.90"	$0.00	"$1,430.72"	$0.00	$0.00	"$1,455.41"	$0.00	$0.00	$0.00	$0.00	$0.00
27803529	EAP	HCPCS C1874		Wallflex Bil Pc Covered 10x80	BOTH IP/OP	"$9,142.00 "	"$6,765.08"	$0.00	"$7,313.60"	"$4,113.90"	"$4,113.90"	$0.00	$0.00	$0.00	"$1,905.42"	"$4,181.12"	"$4,181.12"	"$7,046.65"	$0.00	"$1,905.19"	$0.00	"$4,507.01"	"$4,507.01"	$0.00	"$4,571.00"	"$7,240.46"	"$7,313.60"	$0.00	$0.00	$0.00	"$1,430.72"	$0.00	$0.00	"$1,455.41"	$0.00	$0.00	$0.00	$0.00	$0.00
27803531	EAP	HCPCS C1876		Wallflex Ent Duo 27/22x6 230cm	BOTH IP/OP	"$8,756.00 "	"$6,479.44"	$0.00	"$7,004.80"	"$3,940.20"	"$3,940.20"	$0.00	$0.00	$0.00	"$1,824.97"	"$4,181.12"	"$4,181.12"	"$6,749.12"	$0.00	"$1,824.75"	$0.00	"$4,316.71"	"$4,316.71"	$0.00	"$4,378.00"	"$6,934.75"	"$7,004.80"	$0.00	$0.00	$0.00	"$1,370.31"	$0.00	$0.00	"$1,393.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27803532	EAP	HCPCS C1876		Wallflex Ent Duo 27/22x9 230cm	BOTH IP/OP	"$8,756.00 "	"$6,479.44"	$0.00	"$7,004.80"	"$3,940.20"	"$3,940.20"	$0.00	$0.00	$0.00	"$1,824.97"	"$4,181.12"	"$4,181.12"	"$6,749.12"	$0.00	"$1,824.75"	$0.00	"$4,316.71"	"$4,316.71"	$0.00	"$4,378.00"	"$6,934.75"	"$7,004.80"	$0.00	$0.00	$0.00	"$1,370.31"	$0.00	$0.00	"$1,393.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27803533	EAP	HCPCS C1876		Wallflex Ent Duo 27/22x12 230cm	BOTH IP/OP	"$8,756.00 "	"$6,479.44"	$0.00	"$7,004.80"	"$3,940.20"	"$3,940.20"	$0.00	$0.00	$0.00	"$1,824.97"	"$4,181.12"	"$4,181.12"	"$6,749.12"	$0.00	"$1,824.75"	$0.00	"$4,316.71"	"$4,316.71"	$0.00	"$4,378.00"	"$6,934.75"	"$7,004.80"	$0.00	"$3,940.20"	$0.00	"$1,370.31"	$0.00	$0.00	"$1,393.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27803534	EAP	HCPCS C1876		Wallflex Ent Col 30/25x6 230cm	BOTH IP/OP	"$8,756.00 "	"$6,479.44"	$0.00	"$7,004.80"	"$3,940.20"	"$3,940.20"	$0.00	$0.00	$0.00	"$1,824.97"	"$4,181.12"	"$4,181.12"	"$6,749.12"	$0.00	"$1,824.75"	$0.00	"$4,316.71"	"$4,316.71"	$0.00	"$4,378.00"	"$6,934.75"	"$7,004.80"	$0.00	$0.00	$0.00	"$1,370.31"	$0.00	$0.00	"$1,393.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27803535	EAP	HCPCS C1876		Wallflex Ent Col 30/25x9 230cm	BOTH IP/OP	"$8,756.00 "	"$6,479.44"	$0.00	"$7,004.80"	"$3,940.20"	"$3,940.20"	$0.00	$0.00	$0.00	"$1,824.97"	"$4,181.12"	"$4,181.12"	"$6,749.12"	$0.00	"$1,824.75"	$0.00	"$4,316.71"	"$4,316.71"	$0.00	"$4,378.00"	"$6,934.75"	"$7,004.80"	$0.00	$0.00	$0.00	"$1,370.31"	$0.00	$0.00	"$1,393.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27803536	EAP	HCPCS C1876		Wallflex Ent Col 30/25x12 230cm	BOTH IP/OP	"$8,756.00 "	"$6,479.44"	$0.00	"$7,004.80"	"$3,940.20"	"$3,940.20"	$0.00	$0.00	$0.00	"$1,824.97"	"$4,181.12"	"$4,181.12"	"$6,749.12"	$0.00	"$1,824.75"	$0.00	"$4,316.71"	"$4,316.71"	$0.00	"$4,378.00"	"$6,934.75"	"$7,004.80"	$0.00	$0.00	$0.00	"$1,370.31"	$0.00	$0.00	"$1,393.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27803537	EAP	HCPCS C1876		Wallflex Ent Col 27/22x6 230cm	BOTH IP/OP	"$8,756.00 "	"$6,479.44"	$0.00	"$7,004.80"	"$3,940.20"	"$3,940.20"	$0.00	$0.00	$0.00	"$1,824.97"	"$4,181.12"	"$4,181.12"	"$6,749.12"	$0.00	"$1,824.75"	$0.00	"$4,316.71"	"$4,316.71"	$0.00	"$4,378.00"	"$6,934.75"	"$7,004.80"	$0.00	$0.00	$0.00	"$1,370.31"	$0.00	$0.00	"$1,393.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27803538	EAP	HCPCS C1876		Wallflex Ent Col 27/22x9 230cm	BOTH IP/OP	"$8,756.00 "	"$6,479.44"	$0.00	"$7,004.80"	"$3,940.20"	"$3,940.20"	$0.00	$0.00	$0.00	"$1,824.97"	"$4,181.12"	"$4,181.12"	"$6,749.12"	$0.00	"$1,824.75"	$0.00	"$4,316.71"	"$4,316.71"	$0.00	"$4,378.00"	"$6,934.75"	"$7,004.80"	$0.00	$0.00	$0.00	"$1,370.31"	$0.00	$0.00	"$1,393.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27803539	EAP	HCPCS C1876		Wallflex Ent Col 27/22x12 230cm	BOTH IP/OP	"$8,756.00 "	"$6,479.44"	$0.00	"$7,004.80"	"$3,940.20"	"$3,940.20"	$0.00	$0.00	$0.00	"$1,824.97"	"$4,181.12"	"$4,181.12"	"$6,749.12"	$0.00	"$1,824.75"	$0.00	"$4,316.71"	"$4,316.71"	$0.00	"$4,378.00"	"$6,934.75"	"$7,004.80"	$0.00	$0.00	$0.00	"$1,370.31"	$0.00	$0.00	"$1,393.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27803541	EAP	HCPCS C1874		Wallflex Esoph Full Cov 18/10	BOTH IP/OP	"$8,507.00 "	"$6,295.18"	$0.00	"$6,805.60"	"$3,828.15"	"$3,828.15"	$0.00	$0.00	$0.00	"$1,773.07"	"$4,181.12"	"$4,181.12"	"$6,557.20"	$0.00	"$1,772.86"	$0.00	"$4,193.95"	"$4,193.95"	$0.00	"$4,253.50"	"$6,737.54"	"$6,805.60"	$0.00	$0.00	$0.00	"$1,331.35"	$0.00	$0.00	"$1,354.31"	$0.00	$0.00	$0.00	$0.00	$0.00
27803542	EAP	HCPCS C1874		Wallflex Esoph Full Cov 18/12	BOTH IP/OP	"$8,507.00 "	"$6,295.18"	$0.00	"$6,805.60"	"$3,828.15"	"$3,828.15"	$0.00	$0.00	$0.00	"$1,773.07"	"$4,181.12"	"$4,181.12"	"$6,557.20"	$0.00	"$1,772.86"	$0.00	"$4,193.95"	"$4,193.95"	$0.00	"$4,253.50"	"$6,737.54"	"$6,805.60"	$0.00	$0.00	$0.00	"$1,331.35"	$0.00	$0.00	"$1,354.31"	$0.00	$0.00	$0.00	$0.00	$0.00
27803543	EAP	HCPCS C1874		Wallflex Esoph Full Cov 18/15	BOTH IP/OP	"$8,507.00 "	"$6,295.18"	$0.00	"$6,805.60"	"$3,828.15"	"$3,828.15"	$0.00	$0.00	$0.00	"$1,773.07"	"$4,181.12"	"$4,181.12"	"$6,557.20"	$0.00	"$1,772.86"	$0.00	"$4,193.95"	"$4,193.95"	$0.00	"$4,253.50"	"$6,737.54"	"$6,805.60"	$0.00	"$3,828.15"	$0.00	"$1,331.35"	$0.00	$0.00	"$1,354.31"	$0.00	$0.00	$0.00	$0.00	$0.00
27803544	EAP	HCPCS C1874		Wallflex Esoph Full Cov 23/10	BOTH IP/OP	"$8,507.00 "	"$6,295.18"	$0.00	"$6,805.60"	"$3,828.15"	"$3,828.15"	$0.00	$0.00	$0.00	"$1,773.07"	"$4,181.12"	"$4,181.12"	"$6,557.20"	$0.00	"$1,772.86"	$0.00	"$4,193.95"	"$4,193.95"	$0.00	"$4,253.50"	"$6,737.54"	"$6,805.60"	$0.00	$0.00	$0.00	"$1,331.35"	$0.00	$0.00	"$1,354.31"	$0.00	$0.00	$0.00	$0.00	$0.00
27803545	EAP	HCPCS C1874		Wallflex Esoph Full Cov 23/12	BOTH IP/OP	"$8,507.00 "	"$6,295.18"	$0.00	"$6,805.60"	"$3,828.15"	"$3,828.15"	$0.00	$0.00	$0.00	"$1,773.07"	"$4,181.12"	"$4,181.12"	"$6,557.20"	$0.00	"$1,772.86"	$0.00	"$4,193.95"	"$4,193.95"	$0.00	"$4,253.50"	"$6,737.54"	"$6,805.60"	$0.00	$0.00	$0.00	"$1,331.35"	$0.00	$0.00	"$1,354.31"	$0.00	$0.00	$0.00	$0.00	$0.00
27803546	EAP	HCPCS C1874		Wallflex Esoph Full Cov 23/15	BOTH IP/OP	"$8,507.00 "	"$6,295.18"	$0.00	"$6,805.60"	"$3,828.15"	"$3,828.15"	$0.00	$0.00	$0.00	"$1,773.07"	"$4,181.12"	"$4,181.12"	"$6,557.20"	$0.00	"$1,772.86"	$0.00	"$4,193.95"	"$4,193.95"	$0.00	"$4,253.50"	"$6,737.54"	"$6,805.60"	$0.00	$0.00	$0.00	"$1,331.35"	$0.00	$0.00	"$1,354.31"	$0.00	$0.00	$0.00	$0.00	$0.00
27803547	EAP	HCPCS C1874		Wallflex Esoph Part Cov 18/10	BOTH IP/OP	"$8,507.00 "	"$6,295.18"	$0.00	"$6,805.60"	"$3,828.15"	"$3,828.15"	$0.00	$0.00	$0.00	"$1,773.07"	"$4,181.12"	"$4,181.12"	"$6,557.20"	$0.00	"$1,772.86"	$0.00	"$4,193.95"	"$4,193.95"	$0.00	"$4,253.50"	"$6,737.54"	"$6,805.60"	$0.00	$0.00	$0.00	"$1,331.35"	$0.00	$0.00	"$1,354.31"	$0.00	$0.00	$0.00	$0.00	$0.00
27803548	EAP	HCPCS C1874		Wallflex Esoph Part Cov 18/12	BOTH IP/OP	"$8,507.00 "	"$6,295.18"	$0.00	"$6,805.60"	"$3,828.15"	"$3,828.15"	$0.00	$0.00	$0.00	"$1,773.07"	"$4,181.12"	"$4,181.12"	"$6,557.20"	$0.00	"$1,772.86"	$0.00	"$4,193.95"	"$4,193.95"	$0.00	"$4,253.50"	"$6,737.54"	"$6,805.60"	$0.00	"$3,828.15"	$0.00	"$1,331.35"	$0.00	$0.00	"$1,354.31"	$0.00	$0.00	$0.00	$0.00	$0.00
27803549	EAP	HCPCS C1874		Wallflex Esoph Part Cov 18/23x103	BOTH IP/OP	"$8,507.00 "	"$6,295.18"	$0.00	"$6,805.60"	"$3,828.15"	"$3,828.15"	$0.00	$0.00	$0.00	"$1,773.07"	"$4,181.12"	"$4,181.12"	"$6,557.20"	$0.00	"$1,772.86"	$0.00	"$4,193.95"	"$4,193.95"	$0.00	"$4,253.50"	"$6,737.54"	"$6,805.60"	$0.00	$0.00	$0.00	"$1,331.35"	$0.00	$0.00	"$1,354.31"	$0.00	$0.00	$0.00	$0.00	$0.00
27803550	EAP	HCPCS C1874		Wallflex Esoph Part Cov 23/128x105	BOTH IP/OP	"$8,507.00 "	"$6,295.18"	$0.00	"$6,805.60"	"$3,828.15"	"$3,828.15"	$0.00	$0.00	$0.00	"$1,773.07"	"$4,181.12"	"$4,181.12"	"$6,557.20"	$0.00	"$1,772.86"	$0.00	"$4,193.95"	"$4,193.95"	$0.00	"$4,253.50"	"$6,737.54"	"$6,805.60"	$0.00	$0.00	$0.00	"$1,331.35"	$0.00	$0.00	"$1,354.31"	$0.00	$0.00	$0.00	$0.00	$0.00
27803551	EAP	HCPCS C1874		Wallflex Esoph Part Cov 23/28x125	BOTH IP/OP	"$8,507.00 "	"$6,295.18"	$0.00	"$6,805.60"	"$3,828.15"	"$3,828.15"	$0.00	$0.00	$0.00	"$1,773.07"	"$4,181.12"	"$4,181.12"	"$6,557.20"	$0.00	"$1,772.86"	$0.00	"$4,193.95"	"$4,193.95"	$0.00	"$4,253.50"	"$6,737.54"	"$6,805.60"	$0.00	$0.00	$0.00	"$1,331.35"	$0.00	$0.00	"$1,354.31"	$0.00	$0.00	$0.00	$0.00	$0.00
27803552	EAP	HCPCS C1874		Wallflex Esoph Part Cov 23/28x155	BOTH IP/OP	"$8,507.00 "	"$6,295.18"	$0.00	"$6,805.60"	"$3,828.15"	"$3,828.15"	$0.00	$0.00	$0.00	"$1,773.07"	"$4,181.12"	"$4,181.12"	"$6,557.20"	$0.00	"$1,772.86"	$0.00	"$4,193.95"	"$4,193.95"	$0.00	"$4,253.50"	"$6,737.54"	"$6,805.60"	$0.00	$0.00	$0.00	"$1,331.35"	$0.00	$0.00	"$1,354.31"	$0.00	$0.00	$0.00	$0.00	$0.00
27803554	EAP	HCPCS C1874		Polyflex Esoph 20/16mm X 90mm	BOTH IP/OP	"$6,756.00 "	"$4,999.44"	$0.00	"$5,404.80"	"$3,040.20"	"$3,040.20"	$0.00	$0.00	$0.00	"$1,408.12"	"$4,181.12"	"$4,181.12"	"$5,207.52"	$0.00	"$1,407.95"	$0.00	"$3,330.71"	"$3,330.71"	$0.00	"$3,378.00"	"$5,350.75"	"$5,404.80"	$0.00	$0.00	$0.00	"$1,057.31"	$0.00	$0.00	"$1,075.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27803555	EAP	HCPCS C1874		Polyflex Esoph 20/16mm X 120mm	BOTH IP/OP	"$6,756.00 "	"$4,999.44"	$0.00	"$5,404.80"	"$3,040.20"	"$3,040.20"	$0.00	$0.00	$0.00	"$1,408.12"	"$4,181.12"	"$4,181.12"	"$5,207.52"	$0.00	"$1,407.95"	$0.00	"$3,330.71"	"$3,330.71"	$0.00	"$3,378.00"	"$5,350.75"	"$5,404.80"	$0.00	$0.00	$0.00	"$1,057.31"	$0.00	$0.00	"$1,075.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27803556	EAP	HCPCS C1874		Polyflex Esoph 20/16mm X 150mm	BOTH IP/OP	"$6,756.00 "	"$4,999.44"	$0.00	"$5,404.80"	"$3,040.20"	"$3,040.20"	$0.00	$0.00	$0.00	"$1,408.12"	"$4,181.12"	"$4,181.12"	"$5,207.52"	$0.00	"$1,407.95"	$0.00	"$3,330.71"	"$3,330.71"	$0.00	"$3,378.00"	"$5,350.75"	"$5,404.80"	$0.00	$0.00	$0.00	"$1,057.31"	$0.00	$0.00	"$1,075.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27803557	EAP	HCPCS C1874		Polyflex Esoph 23/18mm X 90mm	BOTH IP/OP	"$6,756.00 "	"$4,999.44"	$0.00	"$5,404.80"	"$3,040.20"	"$3,040.20"	$0.00	$0.00	$0.00	"$1,408.12"	"$4,181.12"	"$4,181.12"	"$5,207.52"	$0.00	"$1,407.95"	$0.00	"$3,330.71"	"$3,330.71"	$0.00	"$3,378.00"	"$5,350.75"	"$5,404.80"	$0.00	$0.00	$0.00	"$1,057.31"	$0.00	$0.00	"$1,075.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27803558	EAP	HCPCS C1874		Polyflex Esoph 23/18mm X 120mm	BOTH IP/OP	"$6,756.00 "	"$4,999.44"	$0.00	"$5,404.80"	"$3,040.20"	"$3,040.20"	$0.00	$0.00	$0.00	"$1,408.12"	"$4,181.12"	"$4,181.12"	"$5,207.52"	$0.00	"$1,407.95"	$0.00	"$3,330.71"	"$3,330.71"	$0.00	"$3,378.00"	"$5,350.75"	"$5,404.80"	$0.00	$0.00	$0.00	"$1,057.31"	$0.00	$0.00	"$1,075.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27803559	EAP	HCPCS C1874		Polyflex Esoph 23/18mm X 150mm	BOTH IP/OP	"$6,756.00 "	"$4,999.44"	$0.00	"$5,404.80"	"$3,040.20"	"$3,040.20"	$0.00	$0.00	$0.00	"$1,408.12"	"$4,181.12"	"$4,181.12"	"$5,207.52"	$0.00	"$1,407.95"	$0.00	"$3,330.71"	"$3,330.71"	$0.00	"$3,378.00"	"$5,350.75"	"$5,404.80"	$0.00	$0.00	$0.00	"$1,057.31"	$0.00	$0.00	"$1,075.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27803560	EAP	HCPCS C1874		Polyflex Esoph 25/21mm X 90mm	BOTH IP/OP	"$6,756.00 "	"$4,999.44"	$0.00	"$5,404.80"	"$3,040.20"	"$3,040.20"	$0.00	$0.00	$0.00	"$1,408.12"	"$4,181.12"	"$4,181.12"	"$5,207.52"	$0.00	"$1,407.95"	$0.00	"$3,330.71"	"$3,330.71"	$0.00	"$3,378.00"	"$5,350.75"	"$5,404.80"	$0.00	$0.00	$0.00	"$1,057.31"	$0.00	$0.00	"$1,075.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27803561	EAP	HCPCS C1874		Polyflex Esoph 25/21mm X 120mm	BOTH IP/OP	"$6,756.00 "	"$4,999.44"	$0.00	"$5,404.80"	"$3,040.20"	"$3,040.20"	$0.00	$0.00	$0.00	"$1,408.12"	"$4,181.12"	"$4,181.12"	"$5,207.52"	$0.00	"$1,407.95"	$0.00	"$3,330.71"	"$3,330.71"	$0.00	"$3,378.00"	"$5,350.75"	"$5,404.80"	$0.00	$0.00	$0.00	"$1,057.31"	$0.00	$0.00	"$1,075.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27803562	EAP	HCPCS C1874		Polyflex Esoph 25/21mm X 150mm	BOTH IP/OP	"$6,756.00 "	"$4,999.44"	$0.00	"$5,404.80"	"$3,040.20"	"$3,040.20"	$0.00	$0.00	$0.00	"$1,408.12"	"$4,181.12"	"$4,181.12"	"$5,207.52"	$0.00	"$1,407.95"	$0.00	"$3,330.71"	"$3,330.71"	$0.00	"$3,378.00"	"$5,350.75"	"$5,404.80"	$0.00	$0.00	$0.00	"$1,057.31"	$0.00	$0.00	"$1,075.56"	$0.00	$0.00	$0.00	$0.00	$0.00
27803576	EAP	Custom 44697837		Stent Bare Metal  Int30012ux	BOTH IP/OP	"$2,422.00 "	"$1,792.28"	$0.00	"$1,937.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,797.61"	"$1,797.61"	"$1,866.88"	$0.00	$504.74	$0.00	$0.00	$0.00	$0.00	"$1,211.00"	"$1,918.22"	"$1,937.60"	$0.00	"$1,089.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803585	EAP	Custom 44697928		Stent Bare Metal  Int40015ux	BOTH IP/OP	"$2,422.00 "	"$1,792.28"	$0.00	"$1,937.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,797.61"	"$1,797.61"	"$1,866.88"	$0.00	$504.74	$0.00	$0.00	$0.00	$0.00	"$1,211.00"	"$1,918.22"	"$1,937.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803600	EAP	HCPCS C1713		Plate Xlng 134mm Ss 2.7/3.5mm Scr 6 Hole Var Ang	BOTH IP/OP	$840.58 	$622.03	$0.00	$672.46	$378.26	$378.26	$0.00	$0.00	$0.00	$175.20	$623.88	$623.88	$647.92	$0.00	$175.18	$0.00	$497.20	$497.20	$0.00	$420.29	$665.74	$672.46	$0.00	$0.00	$0.00	$131.55	$0.00	$0.00	$133.82	$0.00	$0.00	$0.00	$0.00	$0.00
27803601	EAP	HCPCS C1713		Screw Bone 3.5mm 30mm Lineum Ti Oct Spn Smth Shnk	BOTH IP/OP	"$1,877.60 "	"$1,389.42"	$0.00	"$1,502.08"	$844.92	$844.92	$0.00	$0.00	$0.00	$391.34	"$1,393.55"	"$1,393.55"	"$1,447.25"	$0.00	$391.29	$0.00	"$1,110.60"	"$1,110.60"	$0.00	$938.80	"$1,487.06"	"$1,502.08"	$0.00	$0.00	$0.00	$293.84	$0.00	$0.00	$298.91	$0.00	$0.00	$0.00	$0.00	$0.00
27803602	EAP	HCPCS C1713		Rod Spnl 90mm 4.75mm Str Perc Ccm Plus	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
27803603	EAP	HCPCS C1713		Screw Bone 1.5mm 8mm Hexalobe Pthrd Hand Lag	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$58.05	$58.05	$0.00	$0.00	$0.00	$26.89	$95.74	$95.74	$99.43	$0.00	$26.88	$0.00	$76.30	$76.30	$0.00	$64.50	$102.17	$103.20	$0.00	$0.00	$0.00	$20.19	$0.00	$0.00	$20.54	$0.00	$0.00	$0.00	$0.00	$0.00
27803604	EAP	HCPCS C1713		Screw Bone 1.5mm 11mm Ti Hand Mtcrpl Phalanges	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$58.05	$58.05	$0.00	$0.00	$0.00	$26.89	$95.74	$95.74	$99.43	$0.00	$26.88	$0.00	$76.30	$76.30	$0.00	$64.50	$102.17	$103.20	$0.00	$0.00	$0.00	$20.19	$0.00	$0.00	$20.54	$0.00	$0.00	$0.00	$0.00	$0.00
27803605	EAP	HCPCS C1713		Spacer Spnl 22mmx10mm Cpstn Cntrl 12d Peek Intrbd	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
27803606	EAP	HCPCS C1713		Screw Bone 4.5mm 45mm Solera Cd Hzn Cocr Spn	BOTH IP/OP	"$1,558.20 "	"$1,153.07"	$0.00	"$1,246.56"	$701.19	$701.19	$0.00	$0.00	$0.00	$324.77	"$1,156.50"	"$1,156.50"	"$1,201.06"	$0.00	$324.73	$0.00	$921.68	$921.68	$0.00	$779.10	"$1,234.09"	"$1,246.56"	$0.00	$0.00	$0.00	$243.86	$0.00	$0.00	$248.07	$0.00	$0.00	$0.00	$0.00	$0.00
27803607	EAP	HCPCS C1713		Screw Bone 5.5mm 35mm Ats Spn Multiax 4.75mm Rod	BOTH IP/OP	"$1,558.20 "	"$1,153.07"	$0.00	"$1,246.56"	$701.19	$701.19	$0.00	$0.00	$0.00	$324.77	"$1,156.50"	"$1,156.50"	"$1,201.06"	$0.00	$324.73	$0.00	$921.68	$921.68	$0.00	$779.10	"$1,234.09"	"$1,246.56"	$0.00	$0.00	$0.00	$243.86	$0.00	$0.00	$248.07	$0.00	$0.00	$0.00	$0.00	$0.00
27803608	EAP	HCPCS C1713		Screw Bone 6.5mm 35mm Ats Spn Multiax 4.75mm Rod	BOTH IP/OP	"$1,558.20 "	"$1,153.07"	$0.00	"$1,246.56"	$701.19	$701.19	$0.00	$0.00	$0.00	$324.77	"$1,156.50"	"$1,156.50"	"$1,201.06"	$0.00	$324.73	$0.00	$921.68	$921.68	$0.00	$779.10	"$1,234.09"	"$1,246.56"	$0.00	$0.00	$0.00	$243.86	$0.00	$0.00	$248.07	$0.00	$0.00	$0.00	$0.00	$0.00
27803609	EAP	HCPCS C1713		Cage Spnl 15-20mm 12mm	BOTH IP/OP	"$4,498.00 "	"$3,328.52"	$0.00	"$3,598.40"	"$2,442.41"	"$2,442.41"	$0.00	$0.00	$0.00	$937.50	"$3,338.42"	"$3,338.42"	"$3,467.06"	$0.00	$937.38	$0.00	"$2,660.57"	"$2,660.57"	$0.00	"$2,249.00"	"$3,562.42"	"$3,598.40"	$0.00	$0.00	$0.00	$703.94	$0.00	$0.00	$716.08	$0.00	$0.00	$0.00	$0.00	$0.00
27803610	EAP	HCPCS C1713		Spacer Spnl 50x18x8mm Crnt Xl Peek Tlif Rdlcnt	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$0.00	$937.91	"$3,339.90"	"$3,339.90"	"$3,468.60"	$0.00	$937.80	$0.00	"$2,218.50"	"$2,218.50"	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00	$0.00	$0.00	$704.25	$0.00	$0.00	$716.40	$0.00	$0.00	$0.00	$0.00	$0.00
27803611	EAP	HCPCS C1713		Cage Spnl 45x18x12mm Crnt Xl Peek-optm Lat Lmbr	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$0.00	$937.91	"$3,339.90"	"$3,339.90"	"$3,468.60"	$0.00	$937.80	$0.00	"$2,218.50"	"$2,218.50"	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00	$0.00	$0.00	$704.25	$0.00	$0.00	$716.40	$0.00	$0.00	$0.00	$0.00	$0.00
27803612	EAP	HCPCS C1713		Spacer Spnl 38x16x28mm Brigade 12d Spn Ant	BOTH IP/OP	"$5,513.00 "	"$4,079.62"	$0.00	"$4,410.40"	"$2,480.85"	"$2,480.85"	$0.00	$0.00	$0.00	"$1,149.05"	"$4,091.75"	"$4,091.75"	"$4,249.42"	$0.00	"$1,148.91"	$0.00	"$2,717.91"	"$2,717.91"	$0.00	"$2,756.50"	"$4,366.30"	"$4,410.40"	$0.00	$0.00	$0.00	$862.78	$0.00	$0.00	$877.67	$0.00	$0.00	$0.00	$0.00	$0.00
27803613	EAP	HCPCS C1713		Screw Bone 5mm 62.5mm Trgn Fem Lp	BOTH IP/OP	$259.20 	$191.81	$0.00	$207.36	$116.64	$116.64	$0.00	$0.00	$0.00	$54.02	$192.38	$192.38	$199.79	$0.00	$54.02	$0.00	$153.32	$153.32	$0.00	$129.60	$205.29	$207.36	$0.00	$0.00	$0.00	$40.56	$0.00	$0.00	$41.26	$0.00	$0.00	$0.00	$0.00	$0.00
27803614	EAP	HCPCS C1713		Nail 10mm 38cm Right Troc Trgn Im 130d Set Antgrd	BOTH IP/OP	"$2,280.00 "	"$1,687.20"	$0.00	"$1,824.00"	"$1,026.00"	"$1,026.00"	$0.00	$0.00	$0.00	$475.21	"$1,692.22"	"$1,692.22"	"$1,757.42"	$0.00	$475.15	$0.00	"$1,348.62"	"$1,348.62"	$0.00	"$1,140.00"	"$1,805.76"	"$1,824.00"	$0.00	$0.00	$0.00	$356.82	$0.00	$0.00	$362.98	$0.00	$0.00	$0.00	$0.00	$0.00
27803616	EAP	HCPCS C1713		Nail 10mm 38cm Tib Mt-nail Im Ti	BOTH IP/OP	"$2,108.00 "	"$1,559.92"	$0.00	"$1,686.40"	$948.60	$948.60	$0.00	$0.00	$0.00	$439.36	"$1,564.56"	"$1,564.56"	"$1,624.85"	$0.00	$439.31	$0.00	"$1,246.88"	"$1,246.88"	$0.00	"$1,054.00"	"$1,669.54"	"$1,686.40"	$0.00	$0.00	$0.00	$329.90	$0.00	$0.00	$335.59	$0.00	$0.00	$0.00	$0.00	$0.00
27803618	EAP	HCPCS C1713		Screw Bone 11mm 30mm Intertan Troch Cmpr	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$174.60	$174.60	$0.00	$0.00	$0.00	$80.87	$287.97	$287.97	$299.07	$0.00	$80.86	$0.00	$229.50	$229.50	$0.00	$194.00	$307.30	$310.40	$0.00	$0.00	$0.00	$60.72	$0.00	$0.00	$61.77	$0.00	$0.00	$0.00	$0.00	$0.00
27803620	EAP	HCPCS C1713		Kit Scr 90mm 4.5mm Intertan Troch Ti Lag Cmpr	BOTH IP/OP	$836.00 	$618.64	$0.00	$668.80	$376.20	$376.20	$0.00	$0.00	$0.00	$174.24	$620.48	$620.48	$644.39	$0.00	$174.22	$0.00	$494.49	$494.49	$0.00	$418.00	$662.11	$668.80	$0.00	$0.00	$0.00	$130.83	$0.00	$0.00	$133.09	$0.00	$0.00	$0.00	$0.00	$0.00
27803621	EAP	HCPCS C1713		Plate 2mm Str Frac Bone	BOTH IP/OP	"$1,416.00 "	"$1,047.84"	$0.00	"$1,132.80"	$637.20	$637.20	$0.00	$0.00	$0.00	$295.13	"$1,050.96"	"$1,050.96"	"$1,091.45"	$0.00	$295.09	$0.00	$837.56	$837.56	$0.00	$708.00	"$1,121.47"	"$1,132.80"	$0.00	$0.00	$0.00	$221.60	$0.00	$0.00	$225.43	$0.00	$0.00	$0.00	$0.00	$0.00
27803622	EAP	HCPCS C1713		Nail 10mm 39cm Tib Mt-nail Im Ti	BOTH IP/OP	"$2,108.00 "	"$1,559.92"	$0.00	"$1,686.40"	$948.60	$948.60	$0.00	$0.00	$0.00	$439.36	"$1,564.56"	"$1,564.56"	"$1,624.85"	$0.00	$439.31	$0.00	"$1,246.88"	"$1,246.88"	$0.00	"$1,054.00"	"$1,669.54"	"$1,686.40"	$0.00	$0.00	$0.00	$329.90	$0.00	$0.00	$335.59	$0.00	$0.00	$0.00	$0.00	$0.00
27803788	EAP	HCPCS C1726		Dfs100410-20microcoil Platinum Deltapapaq4m	BOTH IP/OP	"$2,923.00 "	"$2,163.02"	$0.00	"$2,338.40"	"$1,315.35"	"$1,315.35"	$0.00	$0.00	$0.00	$609.23	"$2,169.45"	"$2,169.45"	"$2,253.05"	$0.00	$609.15	$0.00	"$1,441.04"	"$1,441.04"	$0.00	"$1,461.50"	"$2,315.02"	"$2,338.40"	$0.00	$0.00	$0.00	$457.45	$0.00	$0.00	$465.34	$0.00	$0.00	$0.00	$0.00	$0.00
27803789	EAP	HCPCS C1717		"Brachytx, Non-str,hdr Ir-192"	BOTH IP/OP	$700.00 	$518.00	$0.00	$560.00	$315.00	$315.00	$338.30	$338.30	$341.72	$145.90	$519.54	$519.54	$539.56	$334.69	$145.88	$217.55	$414.05	$414.05	$338.12	$350.00	$554.40	$560.00	$466.93	$315.00	$466.93	$109.55	$0.00	$0.00	$111.44	$322.02	$0.00	$0.00	$0.00	$0.00
27803795	EAP	HCPCS C1757		Catheter Thrmb 6fr 65cm Cleanerxt Rot 2 Pwr Cell L	BOTH IP/OP	"$1,488.00 "	"$1,101.12"	$0.00	"$1,190.40"	$669.60	$669.60	$0.00	$0.00	$0.00	$310.14	"$1,104.39"	"$1,104.39"	"$1,146.95"	$0.00	$310.10	$0.00	$880.15	$880.15	$0.00	$744.00	"$1,178.50"	"$1,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803803	EAP	HCPCS C1726		Hel181830-20microcoil Platinum Helipaq18	BOTH IP/OP	"$1,895.00 "	"$1,402.30"	$0.00	"$1,516.00"	$852.75	$852.75	$0.00	$0.00	$0.00	$394.97	"$1,406.47"	"$1,406.47"	"$1,460.67"	$0.00	$394.92	$0.00	"$1,120.89"	"$1,120.89"	$0.00	$947.50	"$1,500.84"	"$1,516.00"	$0.00	$0.00	$0.00	$296.57	$0.00	$0.00	$301.68	$0.00	$0.00	$0.00	$0.00	$0.00
27803857	EAP	HCPCS C1726		Dfs100250-20microcoil Platinum Deltapaq2	BOTH IP/OP	"$2,923.00 "	"$2,163.02"	$0.00	"$2,338.40"	"$1,315.35"	"$1,315.35"	$0.00	$0.00	$0.00	$609.23	"$2,169.45"	"$2,169.45"	"$2,253.05"	$0.00	$609.15	$0.00	"$1,441.04"	"$1,441.04"	$0.00	"$1,461.50"	"$2,315.02"	"$2,338.40"	$0.00	$0.00	$0.00	$457.45	$0.00	$0.00	$465.34	$0.00	$0.00	$0.00	$0.00	$0.00
27803858	EAP	HCPCS C1726		Dfs100408-20 Microcoil Platinum Deltapaq4m	BOTH IP/OP	"$2,923.00 "	"$2,163.02"	$0.00	"$2,338.40"	"$1,315.35"	"$1,315.35"	$0.00	$0.00	$0.00	$609.23	"$2,169.45"	"$2,169.45"	"$2,253.05"	$0.00	$609.15	$0.00	"$1,441.04"	"$1,441.04"	$0.00	"$1,461.50"	"$2,315.02"	"$2,338.40"	$0.00	$0.00	$0.00	$457.45	$0.00	$0.00	$465.34	$0.00	$0.00	$0.00	$0.00	$0.00
27803860	EAP	HCPCS C1726		Dfs100510-20microcoil Platinum Deltapaq5m	BOTH IP/OP	"$2,923.00 "	"$2,163.02"	$0.00	"$2,338.40"	"$1,315.35"	"$1,315.35"	$0.00	$0.00	$0.00	$609.23	"$2,169.45"	"$2,169.45"	"$2,253.05"	$0.00	$609.15	$0.00	"$1,441.04"	"$1,441.04"	$0.00	"$1,461.50"	"$2,315.02"	"$2,338.40"	$0.00	$0.00	$0.00	$457.45	$0.00	$0.00	$465.34	$0.00	$0.00	$0.00	$0.00	$0.00
27803861	EAP	HCPCS C1726		Dfs100515-20 Microcoil Platinum Deltapaq5m	BOTH IP/OP	"$2,923.00 "	"$2,163.02"	$0.00	"$2,338.40"	"$1,315.35"	"$1,315.35"	$0.00	$0.00	$0.00	$609.23	"$2,169.45"	"$2,169.45"	"$2,253.05"	$0.00	$609.15	$0.00	"$1,441.04"	"$1,441.04"	$0.00	"$1,461.50"	"$2,315.02"	"$2,338.40"	$0.00	$0.00	$0.00	$457.45	$0.00	$0.00	$465.34	$0.00	$0.00	$0.00	$0.00	$0.00
27803863	EAP	HCPCS C1726		Dpl 100153-20microcoil Platinum Deltaplush	BOTH IP/OP	"$3,217.00 "	"$2,380.58"	$0.00	"$2,573.60"	"$1,447.65"	"$1,447.65"	$0.00	$0.00	$0.00	$670.50	"$2,387.66"	"$2,387.66"	"$2,479.66"	$0.00	$670.42	$0.00	"$1,585.98"	"$1,585.98"	$0.00	"$1,608.50"	"$2,547.86"	"$2,573.60"	$0.00	$0.00	$0.00	$503.46	$0.00	$0.00	$512.15	$0.00	$0.00	$0.00	$0.00	$0.00
27803864	EAP	HCPCS C1726		Dpl 100201-20 Microcoil Platinum Deltaplush	BOTH IP/OP	"$3,654.00 "	"$2,703.96"	$0.00	"$2,923.20"	"$1,644.30"	"$1,644.30"	$0.00	$0.00	$0.00	$761.58	"$2,712.00"	"$2,712.00"	"$2,816.50"	$0.00	$761.49	$0.00	"$1,801.42"	"$1,801.42"	$0.00	"$1,827.00"	"$2,893.97"	"$2,923.20"	$0.00	$0.00	$0.00	$571.85	$0.00	$0.00	$581.72	$0.00	$0.00	$0.00	$0.00	$0.00
27803865	EAP	HCPCS C1726		Dpl100202-20 Microcoil Platinum Deltaplush	BOTH IP/OP	"$3,654.00 "	"$2,703.96"	$0.00	"$2,923.20"	"$1,644.30"	"$1,644.30"	$0.00	$0.00	$0.00	$761.58	"$2,712.00"	"$2,712.00"	"$2,816.50"	$0.00	$761.49	$0.00	"$1,801.42"	"$1,801.42"	$0.00	"$1,827.00"	"$2,893.97"	"$2,923.20"	$0.00	$0.00	$0.00	$571.85	$0.00	$0.00	$581.72	$0.00	$0.00	$0.00	$0.00	$0.00
27803866	EAP	HCPCS C1726		Dpl 100203-20 Microcoil Platinum Deliaplush	BOTH IP/OP	"$3,217.00 "	"$2,380.58"	$0.00	"$2,573.60"	"$1,447.65"	"$1,447.65"	$0.00	$0.00	$0.00	$670.50	"$2,387.66"	"$2,387.66"	"$2,479.66"	$0.00	$670.42	$0.00	"$1,585.98"	"$1,585.98"	$0.00	"$1,608.50"	"$2,547.86"	"$2,573.60"	$0.00	$0.00	$0.00	$503.46	$0.00	$0.00	$512.15	$0.00	$0.00	$0.00	$0.00	$0.00
27803867	EAP	HCPCS C1726		Dpl 100206-20micocoil Platinum Deltaplush	BOTH IP/OP	"$3,654.00 "	"$2,703.96"	$0.00	"$2,923.20"	"$1,644.30"	"$1,644.30"	$0.00	$0.00	$0.00	$761.58	"$2,712.00"	"$2,712.00"	"$2,816.50"	$0.00	$761.49	$0.00	"$1,801.42"	"$1,801.42"	$0.00	"$1,827.00"	"$2,893.97"	"$2,923.20"	$0.00	$0.00	$0.00	$571.85	$0.00	$0.00	$581.72	$0.00	$0.00	$0.00	$0.00	$0.00
27803868	EAP	HCPCS C1726		Hel 180730-20 Microcoil Platinum Helipaq 7m	BOTH IP/OP	"$1,701.00 "	"$1,258.74"	$0.00	"$1,360.80"	$765.45	$765.45	$0.00	$0.00	$0.00	$354.53	"$1,262.48"	"$1,262.48"	"$1,311.13"	$0.00	$354.49	$0.00	"$1,006.14"	"$1,006.14"	$0.00	$850.50	"$1,347.19"	"$1,360.80"	$0.00	$0.00	$0.00	$266.21	$0.00	$0.00	$270.80	$0.00	$0.00	$0.00	$0.00	$0.00
27803869	EAP	HCPCS C1726		Hel180930-20microcoil Platinum Helipaq9m	BOTH IP/OP	"$1,701.00 "	"$1,258.74"	$0.00	"$1,360.80"	$765.45	$765.45	$0.00	$0.00	$0.00	$354.53	"$1,262.48"	"$1,262.48"	"$1,311.13"	$0.00	$354.49	$0.00	"$1,006.14"	"$1,006.14"	$0.00	$850.50	"$1,347.19"	"$1,360.80"	$0.00	$0.00	$0.00	$266.21	$0.00	$0.00	$270.80	$0.00	$0.00	$0.00	$0.00	$0.00
27803870	EAP	HCPCS C1726		Hel181030-20 Microcoil Platinum Helipaq10	BOTH IP/OP	"$1,701.00 "	"$1,258.74"	$0.00	"$1,360.80"	$765.45	$765.45	$0.00	$0.00	$0.00	$354.53	"$1,262.48"	"$1,262.48"	"$1,311.13"	$0.00	$354.49	$0.00	"$1,006.14"	"$1,006.14"	$0.00	$850.50	"$1,347.19"	"$1,360.80"	$0.00	$0.00	$0.00	$266.21	$0.00	$0.00	$270.80	$0.00	$0.00	$0.00	$0.00	$0.00
27803871	EAP	HCPCS C1726		Hel181230-20 Microcoil Platinum Helipaq12	BOTH IP/OP	"$2,051.00 "	"$1,517.74"	$0.00	"$1,640.80"	$922.95	$922.95	$0.00	$0.00	$0.00	$427.48	"$1,522.25"	"$1,522.25"	"$1,580.91"	$0.00	$427.43	$0.00	"$1,213.17"	"$1,213.17"	$0.00	"$1,025.50"	"$1,624.39"	"$1,640.80"	$0.00	$0.00	$0.00	$320.98	$0.00	$0.00	$326.52	$0.00	$0.00	$0.00	$0.00	$0.00
27803872	EAP	HCPCS C1726		Hel181430-20 Microcoil Platinum Helipaq14	BOTH IP/OP	"$1,805.00 "	"$1,335.70"	$0.00	"$1,444.00"	$812.25	$812.25	$0.00	$0.00	$0.00	$376.21	"$1,339.67"	"$1,339.67"	"$1,391.29"	$0.00	$376.16	$0.00	"$1,067.66"	"$1,067.66"	$0.00	$902.50	"$1,429.56"	"$1,444.00"	$0.00	$0.00	$0.00	$282.48	$0.00	$0.00	$287.36	$0.00	$0.00	$0.00	$0.00	$0.00
27803873	EAP	HCPCS C1726		Hel181630-20 Microcoil Platinum Helipaq16	BOTH IP/OP	"$1,601.00 "	"$1,184.74"	$0.00	"$1,280.80"	$720.45	$720.45	$0.00	$0.00	$0.00	$333.69	"$1,188.26"	"$1,188.26"	"$1,234.05"	$0.00	$333.65	$0.00	$946.99	$946.99	$0.00	$800.50	"$1,267.99"	"$1,280.80"	$0.00	$0.00	$0.00	$250.56	$0.00	$0.00	$254.88	$0.00	$0.00	$0.00	$0.00	$0.00
27803875	EAP	HCPCS C1726		Hel182030-20 Microcoil Platinum Helipaq 20	BOTH IP/OP	"$1,895.00 "	"$1,402.30"	$0.00	"$1,516.00"	$852.75	$852.75	$0.00	$0.00	$0.00	$394.97	"$1,406.47"	"$1,406.47"	"$1,460.67"	$0.00	$394.92	$0.00	"$1,120.89"	"$1,120.89"	$0.00	$947.50	"$1,500.84"	"$1,516.00"	$0.00	$0.00	$0.00	$296.57	$0.00	$0.00	$301.68	$0.00	$0.00	$0.00	$0.00	$0.00
27803876	EAP	HCPCS C1726		Dpl 100152-20 Microcoil Platinum Deltaplush	BOTH IP/OP	"$3,217.00 "	"$2,380.58"	$0.00	"$2,573.60"	"$1,447.65"	"$1,447.65"	$0.00	$0.00	$0.00	$670.50	"$2,387.66"	"$2,387.66"	"$2,479.66"	$0.00	$670.42	$0.00	"$1,585.98"	"$1,585.98"	$0.00	"$1,608.50"	"$2,547.86"	"$2,573.60"	$0.00	$0.00	$0.00	$503.46	$0.00	$0.00	$512.15	$0.00	$0.00	$0.00	$0.00	$0.00
27803880	EAP	Custom 27803880		Device Perclose	BOTH IP/OP	$789.00 	$583.86	$0.00	$631.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$585.60	$585.60	$608.16	$0.00	$164.43	$0.00	$0.00	$0.00	$0.00	$394.50	$624.89	$631.20	$0.00	$355.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803881	EAP	HCPCS C1760		Sph100500-20 Mircrocoil Platin	BOTH IP/OP	"$3,686.00 "	"$2,727.64"	$0.00	"$2,948.80"	"$1,658.70"	"$1,658.70"	$0.00	$0.00	$0.00	$768.25	"$2,735.75"	"$2,735.75"	"$2,841.17"	$0.00	$768.16	$0.00	"$1,817.20"	"$1,817.20"	$0.00	"$1,843.00"	"$2,919.31"	"$2,948.80"	$0.00	$0.00	$0.00	$576.86	$0.00	$0.00	$586.81	$0.00	$0.00	$0.00	$0.00	$0.00
27803882	EAP	HCPCS C1760		Sph100620-20 Microcoil Platinu	BOTH IP/OP	"$3,885.00 "	"$2,874.90"	$0.00	"$3,108.00"	"$1,748.25"	"$1,748.25"	$0.00	$0.00	$0.00	$809.73	"$2,883.45"	"$2,883.45"	"$2,994.56"	$0.00	$809.63	$0.00	"$1,915.31"	"$1,915.31"	$0.00	"$1,942.50"	"$3,076.92"	"$3,108.00"	$0.00	$0.00	$0.00	$608.00	$0.00	$0.00	$618.49	$0.00	$0.00	$0.00	$0.00	$0.00
27803883	EAP	HCPCS C1760		Sph100700-20 Microcoil Platinu	BOTH IP/OP	"$3,770.00 "	"$2,789.80"	$0.00	"$3,016.00"	"$1,696.50"	"$1,696.50"	$0.00	$0.00	$0.00	$785.76	"$2,798.09"	"$2,798.09"	"$2,905.92"	$0.00	$785.67	$0.00	"$1,858.61"	"$1,858.61"	$0.00	"$1,885.00"	"$2,985.84"	"$3,016.00"	$0.00	$0.00	$0.00	$590.01	$0.00	$0.00	$600.18	$0.00	$0.00	$0.00	$0.00	$0.00
27803884	EAP	HCPCS C1760		Sph100720-20 Microcoil Platinu	BOTH IP/OP	"$3,885.00 "	"$2,874.90"	$0.00	"$3,108.00"	"$1,748.25"	"$1,748.25"	$0.00	$0.00	$0.00	$809.73	"$2,883.45"	"$2,883.45"	"$2,994.56"	$0.00	$809.63	$0.00	"$1,915.31"	"$1,915.31"	$0.00	"$1,942.50"	"$3,076.92"	"$3,108.00"	$0.00	$0.00	$0.00	$608.00	$0.00	$0.00	$618.49	$0.00	$0.00	$0.00	$0.00	$0.00
27803885	EAP	HCPCS C1760		Sph100800-20 Microil Platinum	BOTH IP/OP	"$3,819.00 "	"$2,826.06"	$0.00	"$3,055.20"	"$1,718.55"	"$1,718.55"	$0.00	$0.00	$0.00	$795.98	"$2,834.46"	"$2,834.46"	"$2,943.69"	$0.00	$795.88	$0.00	"$1,882.77"	"$1,882.77"	$0.00	"$1,909.50"	"$3,024.65"	"$3,055.20"	$0.00	$0.00	$0.00	$597.67	$0.00	$0.00	$607.98	$0.00	$0.00	$0.00	$0.00	$0.00
27803886	EAP	HCPCS C1760		Sph100825-20 Microcoil Platinu	BOTH IP/OP	"$3,986.00 "	"$2,949.64"	$0.00	"$3,188.80"	"$1,793.70"	"$1,793.70"	$0.00	$0.00	$0.00	$830.78	"$2,958.41"	"$2,958.41"	"$3,072.41"	$0.00	$830.68	$0.00	"$1,965.10"	"$1,965.10"	$0.00	"$1,993.00"	"$3,156.91"	"$3,188.80"	$0.00	$0.00	$0.00	$623.81	$0.00	$0.00	$634.57	$0.00	$0.00	$0.00	$0.00	$0.00
27803887	EAP	HCPCS C1760		Sph100925-20 Microcoil Platinu	BOTH IP/OP	"$3,986.00 "	"$2,949.64"	$0.00	"$3,188.80"	"$1,793.70"	"$1,793.70"	$0.00	$0.00	$0.00	$830.78	"$2,958.41"	"$2,958.41"	"$3,072.41"	$0.00	$830.68	$0.00	"$1,965.10"	"$1,965.10"	$0.00	"$1,993.00"	"$3,156.91"	"$3,188.80"	$0.00	$0.00	$0.00	$623.81	$0.00	$0.00	$634.57	$0.00	$0.00	$0.00	$0.00	$0.00
27803888	EAP	HCPCS C1760		Sph101000-20 Microcoil Platinu	BOTH IP/OP	"$3,885.00 "	"$2,874.90"	$0.00	"$3,108.00"	"$1,748.25"	"$1,748.25"	$0.00	$0.00	$0.00	$809.73	"$2,883.45"	"$2,883.45"	"$2,994.56"	$0.00	$809.63	$0.00	"$1,915.31"	"$1,915.31"	$0.00	"$1,942.50"	"$3,076.92"	"$3,108.00"	$0.00	$0.00	$0.00	$608.00	$0.00	$0.00	$618.49	$0.00	$0.00	$0.00	$0.00	$0.00
27803889	EAP	HCPCS C1760		Sph181100-20 Microcoil Platinu	BOTH IP/OP	"$3,885.00 "	"$2,874.90"	$0.00	"$3,108.00"	"$1,748.25"	"$1,748.25"	$0.00	$0.00	$0.00	$809.73	"$2,883.45"	"$2,883.45"	"$2,994.56"	$0.00	$809.63	$0.00	"$1,915.31"	"$1,915.31"	$0.00	"$1,942.50"	"$3,076.92"	"$3,108.00"	$0.00	$0.00	$0.00	$608.00	$0.00	$0.00	$618.49	$0.00	$0.00	$0.00	$0.00	$0.00
27803890	EAP	HCPCS C1760		Sph181200-20 Microcoil Platinu	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	"$3,021.54"	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00	$0.00	$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
27803891	EAP	HCPCS C1760		Sph181300-20 Microcoil Platinu	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	"$3,021.54"	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00	$0.00	$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
27803892	EAP	HCPCS C1760		Sph181400-20 Microcoil Platinu	BOTH IP/OP	"$3,955.00 "	"$2,926.70"	$0.00	"$3,164.00"	"$1,779.75"	"$1,779.75"	$0.00	$0.00	$0.00	$824.32	"$2,935.40"	"$2,935.40"	"$3,048.51"	$0.00	$824.22	$0.00	"$1,949.82"	"$1,949.82"	$0.00	"$1,977.50"	"$3,132.36"	"$3,164.00"	$0.00	$0.00	$0.00	$618.96	$0.00	$0.00	$629.64	$0.00	$0.00	$0.00	$0.00	$0.00
27803893	EAP	HCPCS C1760		Sph181500-20 Microcoil Platinu	BOTH IP/OP	"$4,005.00 "	"$2,963.70"	$0.00	"$3,204.00"	"$1,802.25"	"$1,802.25"	$0.00	$0.00	$0.00	$834.74	"$2,972.51"	"$2,972.51"	"$3,087.05"	$0.00	$834.64	$0.00	"$1,974.47"	"$1,974.47"	$0.00	"$2,002.50"	"$3,171.96"	"$3,204.00"	$0.00	$0.00	$0.00	$626.78	$0.00	$0.00	$637.60	$0.00	$0.00	$0.00	$0.00	$0.00
27803894	EAP	HCPCS C1760		Sph181600-20 Microcoil Platinu	BOTH IP/OP	"$4,020.00 "	"$2,974.80"	$0.00	"$3,216.00"	"$1,809.00"	"$1,809.00"	$0.00	$0.00	$0.00	$837.87	"$2,983.64"	"$2,983.64"	"$3,098.62"	$0.00	$837.77	$0.00	"$1,981.86"	"$1,981.86"	$0.00	"$2,010.00"	"$3,183.84"	"$3,216.00"	$0.00	$0.00	$0.00	$629.13	$0.00	$0.00	$639.98	$0.00	$0.00	$0.00	$0.00	$0.00
27803895	EAP	HCPCS C1760		Sph181700-20 Microcoil Platinu	BOTH IP/OP	"$4,071.00 "	"$3,012.54"	$0.00	"$3,256.80"	"$1,831.95"	"$1,831.95"	$0.00	$0.00	$0.00	$848.50	"$3,021.50"	"$3,021.50"	"$3,137.93"	$0.00	$848.40	$0.00	"$2,007.00"	"$2,007.00"	$0.00	"$2,035.50"	"$3,224.23"	"$3,256.80"	$0.00	$0.00	$0.00	$637.11	$0.00	$0.00	$648.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803896	EAP	HCPCS C1760		Sph181800-20 Microcoil Platinu	BOTH IP/OP	"$4,071.00 "	"$3,012.54"	$0.00	"$3,256.80"	"$1,831.95"	"$1,831.95"	$0.00	$0.00	$0.00	$848.50	"$3,021.50"	"$3,021.50"	"$3,137.93"	$0.00	$848.40	$0.00	"$2,007.00"	"$2,007.00"	$0.00	"$2,035.50"	"$3,224.23"	"$3,256.80"	$0.00	$0.00	$0.00	$637.11	$0.00	$0.00	$648.10	$0.00	$0.00	$0.00	$0.00	$0.00
27803897	EAP	HCPCS C1760		Src140306-20 Microcoil Platinu	BOTH IP/OP	"$3,885.00 "	"$2,874.90"	$0.00	"$3,108.00"	"$1,748.25"	"$1,748.25"	$0.00	$0.00	$0.00	$809.73	"$2,883.45"	"$2,883.45"	"$2,994.56"	$0.00	$809.63	$0.00	"$1,915.31"	"$1,915.31"	$0.00	"$1,942.50"	"$3,076.92"	"$3,108.00"	$0.00	$0.00	$0.00	$608.00	$0.00	$0.00	$618.49	$0.00	$0.00	$0.00	$0.00	$0.00
27803898	EAP	HCPCS C1760		Src140445-20microcoil Platinum	BOTH IP/OP	"$3,885.00 "	"$2,874.90"	$0.00	"$3,108.00"	"$1,748.25"	"$1,748.25"	$0.00	$0.00	$0.00	$809.73	"$2,883.45"	"$2,883.45"	"$2,994.56"	$0.00	$809.63	$0.00	"$1,915.31"	"$1,915.31"	$0.00	"$1,942.50"	"$3,076.92"	"$3,108.00"	$0.00	$0.00	$0.00	$608.00	$0.00	$0.00	$618.49	$0.00	$0.00	$0.00	$0.00	$0.00
27803899	EAP	HCPCS C1760		Src140406-20 Microcoil Platinu	BOTH IP/OP	"$3,903.00 "	"$2,888.22"	$0.00	"$3,122.40"	"$1,756.35"	"$1,756.35"	$0.00	$0.00	$0.00	$813.48	"$2,896.81"	"$2,896.81"	"$3,008.43"	$0.00	$813.39	$0.00	"$1,924.18"	"$1,924.18"	$0.00	"$1,951.50"	"$3,091.18"	"$3,122.40"	$0.00	$0.00	$0.00	$610.82	$0.00	$0.00	$621.36	$0.00	$0.00	$0.00	$0.00	$0.00
27803900	EAP	HCPCS C1760		Src140408-20 Microcoil Platinu	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	"$3,021.54"	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00	$0.00	$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
27803901	EAP	HCPCS C1760		Src140507-20 Microcoil Micrusp	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	"$3,021.54"	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00	$0.00	$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
27803902	EAP	HCPCS C1760		Src140512-20 Microcoil Platinu	BOTH IP/OP	"$3,955.00 "	"$2,926.70"	$0.00	"$3,164.00"	"$1,779.75"	"$1,779.75"	$0.00	$0.00	$0.00	$824.32	"$2,935.40"	"$2,935.40"	"$3,048.51"	$0.00	$824.22	$0.00	"$1,949.82"	"$1,949.82"	$0.00	"$1,977.50"	"$3,132.36"	"$3,164.00"	$0.00	$0.00	$0.00	$618.96	$0.00	$0.00	$629.64	$0.00	$0.00	$0.00	$0.00	$0.00
27803903	EAP	HCPCS C1760		Src140609-20 Microcoil Platinu	BOTH IP/OP	"$3,936.00 "	"$2,912.64"	$0.00	"$3,148.80"	"$1,771.20"	"$1,771.20"	$0.00	$0.00	$0.00	$820.36	"$2,921.30"	"$2,921.30"	"$3,033.87"	$0.00	$820.26	$0.00	"$1,940.45"	"$1,940.45"	$0.00	"$1,968.00"	"$3,117.31"	"$3,148.80"	$0.00	$0.00	$0.00	$615.98	$0.00	$0.00	$626.61	$0.00	$0.00	$0.00	$0.00	$0.00
27803904	EAP	HCPCS C1760		Src140615-20 Microcoil Plainum	BOTH IP/OP	"$4,005.00 "	"$2,963.70"	$0.00	"$3,204.00"	"$1,802.25"	"$1,802.25"	$0.00	$0.00	$0.00	$834.74	"$2,972.51"	"$2,972.51"	"$3,087.05"	$0.00	$834.64	$0.00	"$1,974.47"	"$1,974.47"	$0.00	"$2,002.50"	"$3,171.96"	"$3,204.00"	$0.00	$0.00	$0.00	$626.78	$0.00	$0.00	$637.60	$0.00	$0.00	$0.00	$0.00	$0.00
27803905	EAP	HCPCS C1760		Src140711-20 Microcoil Platinu	BOTH IP/OP	"$3,955.00 "	"$2,926.70"	$0.00	"$3,164.00"	"$1,779.75"	"$1,779.75"	$0.00	$0.00	$0.00	$824.32	"$2,935.40"	"$2,935.40"	"$3,048.51"	$0.00	$824.22	$0.00	"$1,949.82"	"$1,949.82"	$0.00	"$1,977.50"	"$3,132.36"	"$3,164.00"	$0.00	$0.00	$0.00	$618.96	$0.00	$0.00	$629.64	$0.00	$0.00	$0.00	$0.00	$0.00
27803906	EAP	HCPCS C1760		Src140717-20 Microcoil Platinu	BOTH IP/OP	"$4,105.00 "	"$3,037.70"	$0.00	"$3,284.00"	"$1,847.25"	"$1,847.25"	$0.00	$0.00	$0.00	$855.58	"$3,046.73"	"$3,046.73"	"$3,164.13"	$0.00	$855.48	$0.00	"$2,023.77"	"$2,023.77"	$0.00	"$2,052.50"	"$3,251.16"	"$3,284.00"	$0.00	$0.00	$0.00	$642.43	$0.00	$0.00	$653.52	$0.00	$0.00	$0.00	$0.00	$0.00
27803907	EAP	HCPCS C1760		Src140812-20 Microcoil Platinu	BOTH IP/OP	"$4,020.00 "	"$2,974.80"	$0.00	"$3,216.00"	"$1,809.00"	"$1,809.00"	$0.00	$0.00	$0.00	$837.87	"$2,983.64"	"$2,983.64"	"$3,098.62"	$0.00	$837.77	$0.00	"$1,981.86"	"$1,981.86"	$0.00	"$2,010.00"	"$3,183.84"	"$3,216.00"	$0.00	$0.00	$0.00	$629.13	$0.00	$0.00	$639.98	$0.00	$0.00	$0.00	$0.00	$0.00
27803908	EAP	HCPCS C1760		Src140820-20 Microcoil Platinu	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$1,876.50"	"$1,876.50"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,055.81"	"$2,055.81"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	$0.00	$0.00	$652.61	$0.00	$0.00	$663.86	$0.00	$0.00	$0.00	$0.00	$0.00
27803909	EAP	HCPCS C1760		Src140922-20 Microcoil Platinu	BOTH IP/OP	"$4,204.00 "	"$3,110.96"	$0.00	"$3,363.20"	"$1,891.80"	"$1,891.80"	$0.00	$0.00	$0.00	$876.22	"$3,120.21"	"$3,120.21"	"$3,240.44"	$0.00	$876.11	$0.00	"$2,072.57"	"$2,072.57"	$0.00	"$2,102.00"	"$3,329.57"	"$3,363.20"	$0.00	$0.00	$0.00	$657.93	$0.00	$0.00	$669.28	$0.00	$0.00	$0.00	$0.00	$0.00
27803910	EAP	HCPCS C1760		Src141016-20 Microcoil Platinu	BOTH IP/OP	"$4,105.00 "	"$3,037.70"	$0.00	"$3,284.00"	"$1,847.25"	"$1,847.25"	$0.00	$0.00	$0.00	$855.58	"$3,046.73"	"$3,046.73"	"$3,164.13"	$0.00	$855.48	$0.00	"$2,023.77"	"$2,023.77"	$0.00	"$2,052.50"	"$3,251.16"	"$3,284.00"	$0.00	$0.00	$0.00	$642.43	$0.00	$0.00	$653.52	$0.00	$0.00	$0.00	$0.00	$0.00
27803911	EAP	HCPCS C1760		Src141025-20 Microcoil Platinu	BOTH IP/OP	"$4,255.00 "	"$3,148.70"	$0.00	"$3,404.00"	"$1,914.75"	"$1,914.75"	$0.00	$0.00	$0.00	$886.85	"$3,158.06"	"$3,158.06"	"$3,279.75"	$0.00	$886.74	$0.00	"$2,097.72"	"$2,097.72"	$0.00	"$2,127.50"	"$3,369.96"	"$3,404.00"	$0.00	$0.00	$0.00	$665.91	$0.00	$0.00	$677.40	$0.00	$0.00	$0.00	$0.00	$0.00
27803912	EAP	HCPCS C1760		Src141118-20 Microcoil Platinu	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,336.00"	"$1,876.50"	"$1,876.50"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,055.81"	"$2,055.81"	$0.00	"$2,085.00"	"$3,302.64"	"$3,336.00"	$0.00	$0.00	$0.00	$652.61	$0.00	$0.00	$663.86	$0.00	$0.00	$0.00	$0.00	$0.00
27803913	EAP	HCPCS C1760		Src141127-20 Microcoil Platinu	BOTH IP/OP	"$4,304.00 "	"$3,184.96"	$0.00	"$3,443.20"	"$1,936.80"	"$1,936.80"	$0.00	$0.00	$0.00	$897.06	"$3,194.43"	"$3,194.43"	"$3,317.52"	$0.00	$896.95	$0.00	"$2,121.87"	"$2,121.87"	$0.00	"$2,152.00"	"$3,408.77"	"$3,443.20"	$0.00	$0.00	$0.00	$673.58	$0.00	$0.00	$685.20	$0.00	$0.00	$0.00	$0.00	$0.00
27803914	EAP	HCPCS C1760		Src141219-20 Microcoil [platin	BOTH IP/OP	"$4,204.00 "	"$3,110.96"	$0.00	"$3,363.20"	"$1,891.80"	"$1,891.80"	$0.00	$0.00	$0.00	$876.22	"$3,120.21"	"$3,120.21"	"$3,240.44"	$0.00	$876.11	$0.00	"$2,072.57"	"$2,072.57"	$0.00	"$2,102.00"	"$3,329.57"	"$3,363.20"	$0.00	$0.00	$0.00	$657.93	$0.00	$0.00	$669.28	$0.00	$0.00	$0.00	$0.00	$0.00
27803915	EAP	HCPCS C1760		Src141230-20 Microcoil Platinu	BOTH IP/OP	"$4,355.00 "	"$3,222.70"	$0.00	"$3,484.00"	"$1,959.75"	"$1,959.75"	$0.00	$0.00	$0.00	$907.69	"$3,232.28"	"$3,232.28"	"$3,356.83"	$0.00	$907.58	$0.00	"$2,147.02"	"$2,147.02"	$0.00	"$2,177.50"	"$3,449.16"	"$3,484.00"	$0.00	$0.00	$0.00	$681.56	$0.00	$0.00	$693.32	$0.00	$0.00	$0.00	$0.00	$0.00
27803916	EAP	HCPCS C1760		Fsr100201-20 Microcoil Platinu	BOTH IP/OP	"$3,135.00 "	"$2,319.90"	$0.00	"$2,508.00"	"$1,410.75"	"$1,410.75"	$0.00	$0.00	$0.00	$653.41	"$2,326.80"	"$2,326.80"	"$2,416.46"	$0.00	$653.33	$0.00	"$1,545.56"	"$1,545.56"	$0.00	"$1,567.50"	"$2,482.92"	"$2,508.00"	$0.00	$0.00	$0.00	$490.63	$0.00	$0.00	$499.09	$0.00	$0.00	$0.00	$0.00	$0.00
27803917	EAP	HCPCS C1760		Fsr100202-20 Microcoil Platinu	BOTH IP/OP	"$3,169.00 "	"$2,345.06"	$0.00	"$2,535.20"	"$1,426.05"	"$1,426.05"	$0.00	$0.00	$0.00	$660.50	"$2,352.03"	"$2,352.03"	"$2,442.67"	$0.00	$660.42	$0.00	"$1,562.32"	"$1,562.32"	$0.00	"$1,584.50"	"$2,509.85"	"$2,535.20"	$0.00	$0.00	$0.00	$495.95	$0.00	$0.00	$504.50	$0.00	$0.00	$0.00	$0.00	$0.00
27803918	EAP	HCPCS C1760		Fsr100203-20 Microcoil Platinu	BOTH IP/OP	"$3,186.00 "	"$2,357.64"	$0.00	"$2,548.80"	"$1,433.70"	"$1,433.70"	$0.00	$0.00	$0.00	$664.04	"$2,364.65"	"$2,364.65"	"$2,455.77"	$0.00	$663.96	$0.00	"$1,570.70"	"$1,570.70"	$0.00	"$1,593.00"	"$2,523.31"	"$2,548.80"	$0.00	$0.00	$0.00	$498.61	$0.00	$0.00	$507.21	$0.00	$0.00	$0.00	$0.00	$0.00
27803919	EAP	HCPCS C1760		Frs100204-20 Microcoil Platinu	BOTH IP/OP	"$3,203.00 "	"$2,370.22"	$0.00	"$2,562.40"	"$1,441.35"	"$1,441.35"	$0.00	$0.00	$0.00	$667.59	"$2,377.27"	"$2,377.27"	"$2,468.87"	$0.00	$667.51	$0.00	"$1,579.08"	"$1,579.08"	$0.00	"$1,601.50"	"$2,536.78"	"$2,562.40"	$0.00	$0.00	$0.00	$501.27	$0.00	$0.00	$509.92	$0.00	$0.00	$0.00	$0.00	$0.00
27803920	EAP	HCPCS C1760		Fsr100206-20 Microcoil Platinu	BOTH IP/OP	"$3,236.00 "	"$2,394.64"	$0.00	"$2,588.80"	"$1,456.20"	"$1,456.20"	$0.00	$0.00	$0.00	$674.46	"$2,401.76"	"$2,401.76"	"$2,494.31"	$0.00	$674.38	$0.00	"$1,595.35"	"$1,595.35"	$0.00	"$1,618.00"	"$2,562.91"	"$2,588.80"	$0.00	$0.00	$0.00	$506.43	$0.00	$0.00	$515.17	$0.00	$0.00	$0.00	$0.00	$0.00
27803921	EAP	HCPCS C1760		Fsr100208-20 Microcoil Platinu	BOTH IP/OP	"$3,270.00 "	"$2,419.80"	$0.00	"$2,616.00"	"$1,471.50"	"$1,471.50"	$0.00	$0.00	$0.00	$681.55	"$2,426.99"	"$2,426.99"	"$2,520.52"	$0.00	$681.47	$0.00	"$1,612.11"	"$1,612.11"	$0.00	"$1,635.00"	"$2,589.84"	"$2,616.00"	$0.00	$0.00	$0.00	$511.76	$0.00	$0.00	$520.58	$0.00	$0.00	$0.00	$0.00	$0.00
27803922	EAP	HCPCS C1760		Fsr100252-20 Microcoil Platinu	BOTH IP/OP	"$3,169.00 "	"$2,345.06"	$0.00	"$2,535.20"	"$1,426.05"	"$1,426.05"	$0.00	$0.00	$0.00	$660.50	"$2,352.03"	"$2,352.03"	"$2,442.67"	$0.00	$660.42	$0.00	"$1,562.32"	"$1,562.32"	$0.00	"$1,584.50"	"$2,509.85"	"$2,535.20"	$0.00	$0.00	$0.00	$495.95	$0.00	$0.00	$504.50	$0.00	$0.00	$0.00	$0.00	$0.00
27803923	EAP	HCPCS C1760		Fsr100254-20 Microcoil Platinu	BOTH IP/OP	"$3,203.00 "	"$2,370.22"	$0.00	"$2,562.40"	"$1,441.35"	"$1,441.35"	$0.00	$0.00	$0.00	$667.59	"$2,377.27"	"$2,377.27"	"$2,468.87"	$0.00	$667.51	$0.00	"$1,579.08"	"$1,579.08"	$0.00	"$1,601.50"	"$2,536.78"	"$2,562.40"	$0.00	$0.00	$0.00	$501.27	$0.00	$0.00	$509.92	$0.00	$0.00	$0.00	$0.00	$0.00
27803924	EAP	HCPCS C1760		Fsr100256-20 Microcoil Platinu	BOTH IP/OP	"$3,236.00 "	"$2,394.64"	$0.00	"$2,588.80"	"$1,456.20"	"$1,456.20"	$0.00	$0.00	$0.00	$674.46	"$2,401.76"	"$2,401.76"	"$2,494.31"	$0.00	$674.38	$0.00	"$1,595.35"	"$1,595.35"	$0.00	"$1,618.00"	"$2,562.91"	"$2,588.80"	$0.00	$0.00	$0.00	$506.43	$0.00	$0.00	$515.17	$0.00	$0.00	$0.00	$0.00	$0.00
27803925	EAP	HCPCS C1760		Fsr100258-20 Microcoil Platinu	BOTH IP/OP	"$3,270.00 "	"$2,419.80"	$0.00	"$2,616.00"	"$1,471.50"	"$1,471.50"	$0.00	$0.00	$0.00	$681.55	"$2,426.99"	"$2,426.99"	"$2,520.52"	$0.00	$681.47	$0.00	"$1,612.11"	"$1,612.11"	$0.00	"$1,635.00"	"$2,589.84"	"$2,616.00"	$0.00	$0.00	$0.00	$511.76	$0.00	$0.00	$520.58	$0.00	$0.00	$0.00	$0.00	$0.00
27803926	EAP	HCPCS C1760		Fsr100306-20 Microcoil Platinu	BOTH IP/OP	"$3,236.00 "	"$2,394.64"	$0.00	"$2,588.80"	"$1,456.20"	"$1,456.20"	$0.00	$0.00	$0.00	$674.46	"$2,401.76"	"$2,401.76"	"$2,494.31"	$0.00	$674.38	$0.00	"$1,595.35"	"$1,595.35"	$0.00	"$1,618.00"	"$2,562.91"	"$2,588.80"	$0.00	$0.00	$0.00	$506.43	$0.00	$0.00	$515.17	$0.00	$0.00	$0.00	$0.00	$0.00
27803927	EAP	HCPCS C1760		Fsr100308-20 Microcoil Platinu	BOTH IP/OP	"$3,270.00 "	"$2,419.80"	$0.00	"$2,616.00"	"$1,471.50"	"$1,471.50"	$0.00	$0.00	$0.00	$681.55	"$2,426.99"	"$2,426.99"	"$2,520.52"	$0.00	$681.47	$0.00	"$1,612.11"	"$1,612.11"	$0.00	"$1,635.00"	"$2,589.84"	"$2,616.00"	$0.00	$0.00	$0.00	$511.76	$0.00	$0.00	$520.58	$0.00	$0.00	$0.00	$0.00	$0.00
27803928	EAP	HCPCS C1760		Fsr100406-20 Microcoil Platinu	BOTH IP/OP	"$3,236.00 "	"$2,394.64"	$0.00	"$2,588.80"	"$1,456.20"	"$1,456.20"	$0.00	$0.00	$0.00	$674.46	"$2,401.76"	"$2,401.76"	"$2,494.31"	$0.00	$674.38	$0.00	"$1,595.35"	"$1,595.35"	$0.00	"$1,618.00"	"$2,562.91"	"$2,588.80"	$0.00	$0.00	$0.00	$506.43	$0.00	$0.00	$515.17	$0.00	$0.00	$0.00	$0.00	$0.00
27803929	EAP	HCPCS C1760		Fsr100408-20 Microcoil Platinu	BOTH IP/OP	"$3,270.00 "	"$2,419.80"	$0.00	"$2,616.00"	"$1,471.50"	"$1,471.50"	$0.00	$0.00	$0.00	$681.55	"$2,426.99"	"$2,426.99"	"$2,520.52"	$0.00	$681.47	$0.00	"$1,612.11"	"$1,612.11"	$0.00	"$1,635.00"	"$2,589.84"	"$2,616.00"	$0.00	$0.00	$0.00	$511.76	$0.00	$0.00	$520.58	$0.00	$0.00	$0.00	$0.00	$0.00
27803940	EAP	HCPCS C1888		"Endovascular Laser Catheter, Abl"	BOTH IP/OP	"$1,226.00 "	$907.24	$0.00	$980.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$909.94	$909.94	$945.00	$0.00	$255.50	$0.00	$0.00	$0.00	$0.00	$613.00	$970.99	$980.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27803941	EAP	HCPCS C1874		Viator Stent 10 X 4	BOTH IP/OP	"$11,885.00 "	"$8,794.90"	$0.00	"$9,508.00"	"$5,348.25"	"$5,348.25"	$0.00	$0.00	$0.00	"$2,477.13"	"$4,181.12"	"$4,181.12"	"$9,160.96"	$0.00	"$2,476.83"	$0.00	"$5,859.31"	"$5,859.31"	$0.00	"$5,942.50"	"$9,412.92"	"$9,508.00"	$0.00	$0.00	$0.00	"$1,860.00"	$0.00	$0.00	"$1,892.09"	$0.00	$0.00	$0.00	$0.00	$0.00
27803942	EAP	HCPCS C1874		Viator Stent 10 X 5	BOTH IP/OP	"$11,885.00 "	"$8,794.90"	$0.00	"$9,508.00"	"$5,348.25"	"$5,348.25"	$0.00	$0.00	$0.00	"$2,477.13"	"$4,181.12"	"$4,181.12"	"$9,160.96"	$0.00	"$2,476.83"	$0.00	"$5,859.31"	"$5,859.31"	$0.00	"$5,942.50"	"$9,412.92"	"$9,508.00"	$0.00	$0.00	$0.00	"$1,860.00"	$0.00	$0.00	"$1,892.09"	$0.00	$0.00	$0.00	$0.00	$0.00
27803943	EAP	HCPCS C1874		Viator Stent 10 X 6	BOTH IP/OP	"$11,885.00 "	"$8,794.90"	$0.00	"$9,508.00"	"$5,348.25"	"$5,348.25"	$0.00	$0.00	$0.00	"$2,477.13"	"$4,181.12"	"$4,181.12"	"$9,160.96"	$0.00	"$2,476.83"	$0.00	"$5,859.31"	"$5,859.31"	$0.00	"$5,942.50"	"$9,412.92"	"$9,508.00"	$0.00	"$5,348.25"	$0.00	"$1,860.00"	$0.00	$0.00	"$1,892.09"	$0.00	$0.00	$0.00	$0.00	$0.00
27803944	EAP	HCPCS C1874		Viator Stent 10 X 7	BOTH IP/OP	"$11,885.00 "	"$8,794.90"	$0.00	"$9,508.00"	"$5,348.25"	"$5,348.25"	$0.00	$0.00	$0.00	"$2,477.13"	"$4,181.12"	"$4,181.12"	"$9,160.96"	$0.00	"$2,476.83"	$0.00	"$5,859.31"	"$5,859.31"	$0.00	"$5,942.50"	"$9,412.92"	"$9,508.00"	$0.00	$0.00	$0.00	"$1,860.00"	$0.00	$0.00	"$1,892.09"	$0.00	$0.00	$0.00	$0.00	$0.00
27803945	EAP	HCPCS C1874		Viator Stent 10 X 8	BOTH IP/OP	"$11,885.00 "	"$8,794.90"	$0.00	"$9,508.00"	"$5,348.25"	"$5,348.25"	$0.00	$0.00	$0.00	"$2,477.13"	"$4,181.12"	"$4,181.12"	"$9,160.96"	$0.00	"$2,476.83"	$0.00	"$5,859.31"	"$5,859.31"	$0.00	"$5,942.50"	"$9,412.92"	"$9,508.00"	$0.00	"$5,348.25"	$0.00	"$1,860.00"	$0.00	$0.00	"$1,892.09"	$0.00	$0.00	$0.00	$0.00	$0.00
27803950	EAP	HCPCS V2790		Prokera (amniograft) Ring 16mm	BOTH IP/OP	"$3,167.00 "	"$2,343.58"	$0.00	"$2,533.60"	"$1,425.15"	"$1,425.15"	$0.00	$0.00	$0.00	$660.08	"$2,350.55"	"$2,350.55"	"$2,441.12"	$0.00	$660.00	$0.00	"$1,561.33"	"$1,561.33"	$0.00	"$1,583.50"	"$2,508.26"	"$2,533.60"	$0.00	$0.00	$0.00	$495.64	$0.00	$0.00	$504.19	$0.00	$0.00	$0.00	$0.00	$0.00
27803951	EAP	HCPCS C1882		Crt-d 40 Unify (icd)	BOTH IP/OP	"$89,408.00 "	"$66,161.92"	$0.00	"$71,526.40"	"$40,233.60"	"$40,233.60"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$68,915.69"	$0.00	"$18,632.63"	$0.00	"$44,078.14"	"$44,078.14"	$0.00	"$44,704.00"	"$70,811.14"	"$71,526.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27803952	EAP	HCPCS C1722		Fortify Icd-vr40	BOTH IP/OP	"$60,048.00 "	"$44,435.52"	$0.00	"$48,038.40"	"$27,021.60"	"$27,021.60"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$46,285.00"	$0.00	"$12,514.00"	$0.00	"$29,603.66"	"$29,603.66"	$0.00	"$30,024.00"	"$47,558.02"	"$48,038.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27803960	EAP	HCPCS C1886		"Catheter, Ablation"	BOTH IP/OP	$310.00 	$229.40	$0.00	$248.00	$139.50	$139.50	$0.00	$0.00	$0.00	$64.61	$230.08	$230.08	$238.95	$0.00	$64.60	$0.00	$183.37	$183.37	$0.00	$155.00	$245.52	$248.00	$0.00	$0.00	$0.00	$48.52	$0.00	$0.00	$49.35	$0.00	$0.00	$0.00	$0.00	$0.00
27803961	EAP	HCPCS C2617		Gore Viatorr Tips Endoprosthesis 4cm X  2cm X12mm	BOTH IP/OP	"$4,843.00 "	"$3,583.82"	$0.00	"$3,874.40"	"$2,179.35"	"$2,179.35"	$0.00	$0.00	$0.00	"$1,009.40"	"$3,594.47"	"$3,594.47"	"$3,732.98"	$0.00	"$1,009.28"	$0.00	"$2,387.60"	"$2,387.60"	$0.00	"$2,421.50"	"$3,835.66"	"$3,874.40"	$0.00	$0.00	$0.00	$757.93	$0.00	$0.00	$771.01	$0.00	$0.00	$0.00	$0.00	$0.00
27803962	EAP	HCPCS C2617		Gore Viatorr Tips Endoprosthesis 6cm X 2cm X 12mm	BOTH IP/OP	"$4,843.00 "	"$3,583.82"	$0.00	"$3,874.40"	"$2,179.35"	"$2,179.35"	$0.00	$0.00	$0.00	"$1,009.40"	"$3,594.47"	"$3,594.47"	"$3,732.98"	$0.00	"$1,009.28"	$0.00	"$2,387.60"	"$2,387.60"	$0.00	"$2,421.50"	"$3,835.66"	"$3,874.40"	$0.00	$0.00	$0.00	$757.93	$0.00	$0.00	$771.01	$0.00	$0.00	$0.00	$0.00	$0.00
27803963	EAP	HCPCS C2617		Gore Viatorr Tips Endoprosthesis 8cm X 2cm X 12mm	BOTH IP/OP	"$4,843.00 "	"$3,583.82"	$0.00	"$3,874.40"	"$2,179.35"	"$2,179.35"	$0.00	$0.00	$0.00	"$1,009.40"	"$3,594.47"	"$3,594.47"	"$3,732.98"	$0.00	"$1,009.28"	$0.00	"$2,387.60"	"$2,387.60"	$0.00	"$2,421.50"	"$3,835.66"	"$3,874.40"	$0.00	$0.00	$0.00	$757.93	$0.00	$0.00	$771.01	$0.00	$0.00	$0.00	$0.00	$0.00
27803964	EAP	HCPCS C2617		Gore Viabil Endoprosthesis 10mm X 4cm X 40cm	BOTH IP/OP	"$3,216.00 "	"$2,379.84"	$0.00	"$2,572.80"	"$1,447.20"	"$1,447.20"	$0.00	$0.00	$0.00	$670.29	"$2,386.92"	"$2,386.92"	"$2,478.89"	$0.00	$670.21	$0.00	"$1,585.49"	"$1,585.49"	$0.00	"$1,608.00"	"$2,547.07"	"$2,572.80"	$0.00	"$1,447.20"	$0.00	$503.30	$0.00	$0.00	$511.99	$0.00	$0.00	$0.00	$0.00	$0.00
27803965	EAP	HCPCS C2617		Gore Viabil Endoprosthesis 10mm X 6cm X 40cm	BOTH IP/OP	"$3,216.00 "	"$2,379.84"	$0.00	"$2,572.80"	"$1,447.20"	"$1,447.20"	$0.00	$0.00	$0.00	$670.29	"$2,386.92"	"$2,386.92"	"$2,478.89"	$0.00	$670.21	$0.00	"$1,585.49"	"$1,585.49"	$0.00	"$1,608.00"	"$2,547.07"	"$2,572.80"	$0.00	$0.00	$0.00	$503.30	$0.00	$0.00	$511.99	$0.00	$0.00	$0.00	$0.00	$0.00
27803966	EAP	HCPCS C2617		Gore Viabil Endoprosthesis 10mm X 8cm X 40cm	BOTH IP/OP	"$3,216.00 "	"$2,379.84"	$0.00	"$2,572.80"	"$1,746.29"	"$1,746.29"	$0.00	$0.00	$0.00	$670.29	"$2,386.92"	"$2,386.92"	"$2,478.89"	$0.00	$670.21	$0.00	"$1,902.26"	"$1,902.26"	$0.00	"$1,608.00"	"$2,547.07"	"$2,572.80"	$0.00	"$2,090.40"	$0.00	$503.30	$0.00	$0.00	$511.99	$0.00	$0.00	$0.00	$0.00	$0.00
27803967	EAP	HCPCS C2617		Gore Viabil Endoprosthesis 10mm X 10cm X 40cm	BOTH IP/OP	"$3,216.00 "	"$2,379.84"	$0.00	"$2,572.80"	"$1,447.20"	"$1,447.20"	$0.00	$0.00	$0.00	$670.29	"$2,386.92"	"$2,386.92"	"$2,478.89"	$0.00	$670.21	$0.00	"$1,585.49"	"$1,585.49"	$0.00	"$1,608.00"	"$2,547.07"	"$2,572.80"	$0.00	$0.00	$0.00	$503.30	$0.00	$0.00	$511.99	$0.00	$0.00	$0.00	$0.00	$0.00
27803968	EAP	HCPCS C1713		Amplatz Anchor System 8 X 30	BOTH IP/OP	$117.00 	$86.58	$0.00	$93.60	$52.65	$52.65	$0.00	$0.00	$0.00	$24.39	$86.84	$86.84	$90.18	$0.00	$24.38	$0.00	$69.21	$69.21	$0.00	$58.50	$92.66	$93.60	$0.00	$0.00	$0.00	$18.31	$0.00	$0.00	$18.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803969	EAP	HCPCS C1713		Amplatz Anchor System 10 X 30	BOTH IP/OP	$117.00 	$86.58	$0.00	$93.60	$52.65	$52.65	$0.00	$0.00	$0.00	$24.39	$86.84	$86.84	$90.18	$0.00	$24.38	$0.00	$69.21	$69.21	$0.00	$58.50	$92.66	$93.60	$0.00	$52.65	$0.00	$18.31	$0.00	$0.00	$18.63	$0.00	$0.00	$0.00	$0.00	$0.00
27803970	EAP	HCPCS C1876		M001711300  Stent Wall 6fr 8/80/75cm	BOTH IP/OP	"$4,931.00 "	"$3,648.94"	$0.00	"$3,944.80"	"$2,218.95"	"$2,218.95"	$0.00	$0.00	$0.00	"$1,027.74"	"$3,659.79"	"$3,659.79"	"$3,800.81"	$0.00	"$1,027.62"	$0.00	"$2,430.98"	"$2,430.98"	$0.00	"$2,465.50"	"$3,905.35"	"$3,944.80"	$0.00	$0.00	$0.00	$771.70	$0.00	$0.00	$785.02	$0.00	$0.00	$0.00	$0.00	$0.00
27803971	EAP	HCPCS C1894		Retriever Merci L6 90060	BOTH IP/OP	"$10,536.00 "	"$7,796.64"	$0.00	"$8,428.80"	"$4,741.20"	"$4,741.20"	$0.00	$0.00	$0.00	"$2,195.97"	"$4,181.12"	"$4,181.12"	"$8,121.15"	$0.00	"$2,195.70"	$0.00	"$5,194.25"	"$5,194.25"	$0.00	"$5,268.00"	"$8,344.51"	"$8,428.80"	$0.00	$0.00	$0.00	"$1,648.88"	$0.00	$0.00	"$1,677.33"	$0.00	$0.00	$0.00	$0.00	$0.00
27804055	EAP	HCPCS C1874		Test Name New	BOTH IP/OP	"$7,990.00 "	"$5,912.60"	$0.00	"$6,392.00"	"$3,595.50"	"$3,595.50"	$0.00	$0.00	$0.00	"$1,665.32"	"$4,181.12"	"$4,181.12"	"$6,158.69"	$0.00	"$1,665.12"	$0.00	"$3,939.07"	"$3,939.07"	$0.00	"$3,995.00"	"$6,328.08"	"$6,392.00"	$0.00	$0.00	$0.00	"$1,250.44"	$0.00	$0.00	"$1,272.01"	$0.00	$0.00	$0.00	$0.00	$0.00
27804056	EAP	Custom 27804056		"Retriever Mercl L6, 90060"	BOTH IP/OP	"$10,536.00 "	"$7,796.64"	$0.00	"$8,428.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,121.15"	$0.00	"$2,195.70"	$0.00	$0.00	$0.00	$0.00	"$5,268.00"	"$8,344.51"	"$8,428.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804060	EAP	HCPCS C1764		"Implantable Cardiac Monitor, Confirm Ic"	BOTH IP/OP	"$11,676.00 "	"$8,640.24"	$0.00	"$9,340.80"	"$5,254.20"	"$5,254.20"	$0.00	$0.00	$0.00	"$2,433.57"	"$4,181.12"	"$4,181.12"	"$8,999.86"	$0.00	"$2,433.28"	$0.00	"$5,756.27"	"$5,756.27"	$0.00	"$5,838.00"	"$9,247.39"	"$9,340.80"	$0.00	"$5,254.20"	$0.00	"$1,827.29"	$0.00	$0.00	"$1,858.82"	$0.00	$0.00	$0.00	$0.00	$0.00
27804067	EAP	HCPCS C1880		Md800f Filter Peripheral Vena Cava Femoral	BOTH IP/OP	"$2,933.00 "	"$2,170.42"	$0.00	"$2,346.40"	"$1,319.85"	"$1,319.85"	$0.00	$0.00	$0.00	$611.31	"$2,176.87"	"$2,176.87"	"$2,260.76"	$0.00	$611.24	$0.00	"$1,445.97"	"$1,445.97"	$0.00	"$1,466.50"	"$2,322.94"	"$2,346.40"	$0.00	$0.00	$0.00	$459.01	$0.00	$0.00	$466.93	$0.00	$0.00	$0.00	$0.00	$0.00
27804068	EAP	HCPCS C1880		Md800j Filter Peripheral Vena Cava Jugular	BOTH IP/OP	"$3,080.00 "	"$2,279.20"	$0.00	"$2,464.00"	"$1,386.00"	"$1,386.00"	$0.00	$0.00	$0.00	$641.95	"$2,285.98"	"$2,285.98"	"$2,374.06"	$0.00	$641.87	$0.00	"$1,518.44"	"$1,518.44"	$0.00	"$1,540.00"	"$2,439.36"	"$2,464.00"	$0.00	$0.00	$0.00	$482.02	$0.00	$0.00	$490.34	$0.00	$0.00	$0.00	$0.00	$0.00
27804070	EAP	HCPCS C1757		Sfr-4-15 Device Thrombectomy Solitaire Fr 4x15	BOTH IP/OP	"$18,930.00 "	"$14,008.20"	$0.00	"$15,144.00"	"$8,518.50"	"$8,518.50"	$0.00	$0.00	$0.00	"$3,945.49"	"$4,181.12"	"$4,181.12"	"$14,591.24"	$0.00	"$3,945.01"	$0.00	"$9,332.49"	"$9,332.49"	$0.00	"$9,465.00"	"$14,992.56"	"$15,144.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804071	EAP	HCPCS C1757		Sfr-4-20 Device Thrombectomy Solitaire Fr 4x20	BOTH IP/OP	"$18,930.00 "	"$14,008.20"	$0.00	"$15,144.00"	"$8,518.50"	"$8,518.50"	$0.00	$0.00	$0.00	"$3,945.49"	"$4,181.12"	"$4,181.12"	"$14,591.24"	$0.00	"$3,945.01"	$0.00	"$9,332.49"	"$9,332.49"	$0.00	"$9,465.00"	"$14,992.56"	"$15,144.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804072	EAP	HCPCS C1757		Sfr-6-20 Device Thrombectomy Solitaire Fr 6x20	BOTH IP/OP	"$18,930.00 "	"$14,008.20"	$0.00	"$15,144.00"	"$8,518.50"	"$8,518.50"	$0.00	$0.00	$0.00	"$3,945.49"	"$4,181.12"	"$4,181.12"	"$14,591.24"	$0.00	"$3,945.01"	$0.00	"$9,332.49"	"$9,332.49"	$0.00	"$9,465.00"	"$14,992.56"	"$15,144.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804073	EAP	HCPCS C1757		Sfr-6-30 Device Thrombectomy Solitaire Fr 6x30	BOTH IP/OP	"$18,930.00 "	"$14,008.20"	$0.00	"$15,144.00"	"$8,518.50"	"$8,518.50"	$0.00	$0.00	$0.00	"$3,945.49"	"$4,181.12"	"$4,181.12"	"$14,591.24"	$0.00	"$3,945.01"	$0.00	"$9,332.49"	"$9,332.49"	$0.00	"$9,465.00"	"$14,992.56"	"$15,144.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804080	EAP	Custom 27804080		G08261 Embolization Coil	BOTH IP/OP	$278.00 	$205.72	$0.00	$222.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.33	$206.33	$214.28	$0.00	$57.94	$0.00	$0.00	$0.00	$0.00	$139.00	$220.18	$222.40	$0.00	$125.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804088	EAP	HCPCS C1777		"Reliance Df4 Lead, Aicd, Endo Single Coil"	BOTH IP/OP	"$13,964.00 "	"$10,333.36"	$0.00	"$11,171.20"	"$6,283.80"	"$6,283.80"	$0.00	$0.00	$0.00	"$2,910.45"	"$4,181.12"	"$4,181.12"	"$10,763.45"	$0.00	"$2,910.10"	$0.00	"$6,884.25"	"$6,884.25"	$0.00	"$6,982.00"	"$11,059.49"	"$11,171.20"	$0.00	"$6,283.80"	$0.00	"$2,185.37"	$0.00	$0.00	"$2,223.07"	$0.00	$0.00	$0.00	$0.00	$0.00
27804089	EAP	HCPCS C1777		"Reliance Gore Df4 Lead,aicd, Endo Single Coil"	BOTH IP/OP	"$13,964.00 "	"$10,333.36"	$0.00	"$11,171.20"	"$6,283.80"	"$6,283.80"	$0.00	$0.00	$0.00	"$2,910.45"	"$4,181.12"	"$4,181.12"	"$10,763.45"	$0.00	"$2,910.10"	$0.00	"$6,884.25"	"$6,884.25"	$0.00	"$6,982.00"	"$11,059.49"	"$11,171.20"	$0.00	"$6,283.80"	$0.00	"$2,185.37"	$0.00	$0.00	"$2,223.07"	$0.00	$0.00	$0.00	$0.00	$0.00
27804090	EAP	HCPCS C1882		"Energen Df4 Crt-d Aicd, Other Than Sing/dual"	BOTH IP/OP	"$68,273.00 "	"$50,522.02"	$0.00	"$54,618.40"	"$30,722.85"	"$30,722.85"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$52,624.83"	$0.00	"$14,228.09"	$0.00	"$33,658.59"	"$33,658.59"	$0.00	"$34,136.50"	"$54,072.22"	"$54,618.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27804091	EAP	HCPCS C1882		"Energen Crt-d Aicd, Other Than Sing/dual"	BOTH IP/OP	"$68,273.00 "	"$50,522.02"	$0.00	"$54,618.40"	"$30,722.85"	"$30,722.85"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$52,624.83"	$0.00	"$14,228.09"	$0.00	"$33,658.59"	"$33,658.59"	$0.00	"$34,136.50"	"$54,072.22"	"$54,618.40"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27804092	EAP	HCPCS C1882		"Unify Quadra Aicd, Other Than Sing/dual"	BOTH IP/OP	"$89,376.00 "	"$66,138.24"	$0.00	"$71,500.80"	"$40,219.20"	"$40,219.20"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$68,891.02"	$0.00	"$18,625.96"	$0.00	"$44,062.37"	"$44,062.37"	$0.00	"$44,688.00"	"$70,785.79"	"$71,500.80"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27804093	EAP	HCPCS C1898		"Tc-1888 Tendril Lead Pmkr, Other Than Trans"	BOTH IP/OP	"$1,551.00 "	"$1,147.74"	$0.00	"$1,240.80"	$697.95	$697.95	$0.00	$0.00	$0.00	$323.27	"$1,151.15"	"$1,151.15"	"$1,195.51"	$0.00	$323.23	$0.00	$917.42	$917.42	$0.00	$775.50	"$1,228.39"	"$1,240.80"	$0.00	$0.00	$0.00	$242.73	$0.00	$0.00	$246.92	$0.00	$0.00	$0.00	$0.00	$0.00
27804094	EAP	HCPCS C1900		"Q-1458 Quartet Lead, Aicd, Endo Single Coil"	BOTH IP/OP	"$8,566.00 "	"$6,338.84"	$0.00	"$6,852.80"	"$3,854.70"	"$3,854.70"	$0.00	$0.00	$0.00	"$1,785.37"	"$4,181.12"	"$4,181.12"	"$6,602.67"	$0.00	"$1,785.15"	$0.00	"$4,223.04"	"$4,223.04"	$0.00	"$4,283.00"	"$6,784.27"	"$6,852.80"	$0.00	"$3,854.70"	$0.00	"$1,340.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804098	EAP	HCPCS C1876		Enterprise 22mm Stent No-tip	BOTH IP/OP	"$16,138.00 "	"$11,942.12"	$0.00	"$12,910.40"	"$7,262.10"	"$7,262.10"	$0.00	$0.00	$0.00	"$3,363.56"	"$4,181.12"	"$4,181.12"	"$12,439.17"	$0.00	"$3,363.16"	$0.00	"$7,956.03"	"$7,956.03"	$0.00	"$8,069.00"	"$12,781.30"	"$12,910.40"	$0.00	"$7,262.10"	$0.00	"$2,525.60"	$0.00	$0.00	"$2,569.17"	$0.00	$0.00	$0.00	$0.00	$0.00
27804099	EAP	HCPCS C1876		Enterprise 38mm Stent No-tip	BOTH IP/OP	"$16,138.00 "	"$11,942.12"	$0.00	"$12,910.40"	"$7,262.10"	"$7,262.10"	$0.00	$0.00	$0.00	"$3,363.56"	"$4,181.12"	"$4,181.12"	"$12,439.17"	$0.00	"$3,363.16"	$0.00	"$7,956.03"	"$7,956.03"	$0.00	"$8,069.00"	"$12,781.30"	"$12,910.40"	$0.00	$0.00	$0.00	"$2,525.60"	$0.00	$0.00	"$2,569.17"	$0.00	$0.00	$0.00	$0.00	$0.00
27804100	EAP	HCPCS C1876		Enterprise 37mm Stent No-tip	BOTH IP/OP	"$16,138.00 "	"$11,942.12"	$0.00	"$12,910.40"	"$7,262.10"	"$7,262.10"	$0.00	$0.00	$0.00	"$3,363.56"	"$4,181.12"	"$4,181.12"	"$12,439.17"	$0.00	"$3,363.16"	$0.00	"$7,956.03"	"$7,956.03"	$0.00	"$8,069.00"	"$12,781.30"	"$12,910.40"	$0.00	$0.00	$0.00	"$2,525.60"	$0.00	$0.00	"$2,569.17"	$0.00	$0.00	$0.00	$0.00	$0.00
27804103	EAP	Custom 27804103		"Px 400,straight"	BOTH IP/OP	"$2,749.00 "	"$2,034.26"	$0.00	"$2,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,040.31"	"$2,040.31"	"$2,118.93"	$0.00	$572.89	$0.00	$0.00	$0.00	$0.00	"$1,374.50"	"$2,177.21"	"$2,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804104	EAP	Custom 27804104		"Px 400, 45"	BOTH IP/OP	"$2,749.00 "	"$2,034.26"	$0.00	"$2,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,040.31"	"$2,040.31"	"$2,118.93"	$0.00	$572.89	$0.00	$0.00	$0.00	$0.00	"$1,374.50"	"$2,177.21"	"$2,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804105	EAP	Custom 27804105		"Px 400, J"	BOTH IP/OP	"$2,749.00 "	"$2,034.26"	$0.00	"$2,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,040.31"	"$2,040.31"	"$2,118.93"	$0.00	$572.89	$0.00	$0.00	$0.00	$0.00	"$1,374.50"	"$2,177.21"	"$2,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804106	EAP	Custom 27804106		Start Up Kit	BOTH IP/OP	$798.00 	$590.52	$0.00	$638.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$592.28	$592.28	$615.10	$0.00	$166.30	$0.00	$0.00	$0.00	$0.00	$399.00	$632.02	$638.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804107	EAP	Custom 27804107		Senor Flotrac	BOTH IP/OP	$993.00 	$734.82	$0.00	$794.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$737.00	$737.00	$765.40	$0.00	$206.94	$0.00	$0.00	$0.00	$0.00	$496.50	$786.46	$794.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804108	EAP	Custom 27804108		"Coil 400 Complex Standard, 15mm X 57cm"	BOTH IP/OP	"$7,642.00 "	"$5,655.08"	$0.00	"$6,113.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,890.45"	$0.00	"$1,592.59"	$0.00	$0.00	$0.00	$0.00	"$3,821.00"	"$6,052.46"	"$6,113.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804109	EAP	Custom 27804109		"Coil 400 Complex Standard, 16mm X 60cm"	BOTH IP/OP	"$7,685.00 "	"$5,686.90"	$0.00	"$6,148.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,923.60"	$0.00	"$1,601.55"	$0.00	$0.00	$0.00	$0.00	"$3,842.50"	"$6,086.52"	"$6,148.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804110	EAP	HCPCS C1752		Cath. Schon(5615200) Xl Sil. 035 In L20 Cm Guidewire Inr	BOTH IP/OP	$571.00 	$422.54	$0.00	$456.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$285.50	$452.23	$456.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804111	EAP	HCPCS C1752		Cath. Schon(5615150) Xl Silicone .035 In L15 Cm Guidewir	BOTH IP/OP	$544.00 	$402.56	$0.00	$435.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.00	$430.85	$435.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804112	EAP	HCPCS C1752		Cath. Schon(5605300) 30cm Full Hemo	BOTH IP/OP	$571.00 	$422.54	$0.00	$456.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$285.50	$452.23	$456.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804113	EAP	HCPCS A4648		Implantable Tissue Marker	BOTH IP/OP	$520.00 	$384.80	$0.00	$416.00	$234.00	$234.00	$0.00	$0.00	$0.00	$108.38	$385.94	$385.94	$400.82	$0.00	$108.37	$0.00	$307.58	$307.58	$0.00	$260.00	$411.84	$416.00	$0.00	$234.00	$0.00	$81.38	$0.00	$0.00	$82.78	$0.00	$0.00	$0.00	$0.00	$0.00
27804116	EAP	Custom 27804116		"Coil 400 Complex Standard, 18mm X 57cm"	BOTH IP/OP	"$7,642.00 "	"$5,655.08"	$0.00	"$6,113.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,890.45"	$0.00	"$1,592.59"	$0.00	$0.00	$0.00	$0.00	"$3,821.00"	"$6,052.46"	"$6,113.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804117	EAP	Custom 27804117		"Coil 400 Complex Standard, 20mm X 60cm"	BOTH IP/OP	"$7,685.00 "	"$5,686.90"	$0.00	"$6,148.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,923.60"	$0.00	"$1,601.55"	$0.00	$0.00	$0.00	$0.00	"$3,842.50"	"$6,086.52"	"$6,148.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804118	EAP	Custom 27804118		"Coil 400 Complex Standard, 22mm X 60cm"	BOTH IP/OP	"$7,685.00 "	"$5,686.90"	$0.00	"$6,148.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,923.60"	$0.00	"$1,601.55"	$0.00	$0.00	$0.00	$0.00	"$3,842.50"	"$6,086.52"	"$6,148.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804119	EAP	Custom 27804119		"Coil 400 Complex Standard, 24mm X 57cm"	BOTH IP/OP	"$7,642.00 "	"$5,655.08"	$0.00	"$6,113.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,890.45"	$0.00	"$1,592.59"	$0.00	$0.00	$0.00	$0.00	"$3,821.00"	"$6,052.46"	"$6,113.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804120	EAP	Custom 27804120		"Coil 400 Complex Standard, 28mm X 60 Cm"	BOTH IP/OP	"$8,572.00 "	"$6,343.28"	$0.00	"$6,857.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,607.30"	$0.00	"$1,786.40"	$0.00	$0.00	$0.00	$0.00	"$4,286.00"	"$6,789.02"	"$6,857.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804121	EAP	Custom 27804121		Px 400 90	BOTH IP/OP	"$2,749.00 "	"$2,034.26"	$0.00	"$2,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,040.31"	"$2,040.31"	"$2,118.93"	$0.00	$572.89	$0.00	$0.00	$0.00	$0.00	"$1,374.50"	"$2,177.21"	"$2,199.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804122	EAP	Custom 27804122		"Coil 400 Complex Standard, 32mm X 60 Cm"	BOTH IP/OP	"$8,572.00 "	"$6,343.28"	$0.00	"$6,857.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,607.30"	$0.00	"$1,786.40"	$0.00	$0.00	$0.00	$0.00	"$4,286.00"	"$6,789.02"	"$6,857.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804123	EAP	Custom 27804123		"Coil 400 Complex Soft, 3 Mm X 3 Cm"	BOTH IP/OP	"$7,034.00 "	"$5,205.16"	$0.00	"$5,627.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,421.81"	$0.00	"$1,465.89"	$0.00	$0.00	$0.00	$0.00	"$3,517.00"	"$5,570.93"	"$5,627.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804124	EAP	Custom 27804124		"Coil 400 Complex Extra Soft, 4mm X 10cm"	BOTH IP/OP	"$8,157.00 "	"$6,036.18"	$0.00	"$6,525.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,287.42"	$0.00	"$1,699.92"	$0.00	$0.00	$0.00	$0.00	"$4,078.50"	"$6,460.34"	"$6,525.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804125	EAP	Custom 27804125		"Coil 400 Complex Soft, 13mm X 35cm"	BOTH IP/OP	"$7,980.00 "	"$5,905.20"	$0.00	"$6,384.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,150.98"	$0.00	"$1,663.03"	$0.00	$0.00	$0.00	$0.00	"$3,990.00"	"$6,320.16"	"$6,384.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804126	EAP	Custom 27804126		"Coil 400 Complex Soft, 13mm X 48cm"	BOTH IP/OP	"$8,364.00 "	"$6,189.36"	$0.00	"$6,691.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,446.97"	$0.00	"$1,743.06"	$0.00	$0.00	$0.00	$0.00	"$4,182.00"	"$6,624.29"	"$6,691.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804127	EAP	Custom 27804127		"Coil 400 Complex Soft, 14mm X 40cm"	BOTH IP/OP	"$8,128.00 "	"$6,014.72"	$0.00	"$6,502.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,265.06"	$0.00	"$1,693.88"	$0.00	$0.00	$0.00	$0.00	"$4,064.00"	"$6,437.38"	"$6,502.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804128	EAP	Custom 27804128		"Coil 400 Complex Soft, 14mm X 50cm"	BOTH IP/OP	"$8,424.00 "	"$6,233.76"	$0.00	"$6,739.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,493.22"	$0.00	"$1,755.56"	$0.00	$0.00	$0.00	$0.00	"$4,212.00"	"$6,671.81"	"$6,739.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804129	EAP	Custom 27804129		"Coil 400 Complex Soft, 16mm X 45cm"	BOTH IP/OP	"$8,276.00 "	"$6,124.24"	$0.00	"$6,620.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,379.14"	$0.00	"$1,724.72"	$0.00	$0.00	$0.00	$0.00	"$4,138.00"	"$6,554.59"	"$6,620.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804130	EAP	Custom 27804130		"Coil 400 J, 7cm"	BOTH IP/OP	"$6,680.00 "	"$4,943.20"	$0.00	"$5,344.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,148.94"	$0.00	"$1,392.11"	$0.00	$0.00	$0.00	$0.00	"$3,340.00"	"$5,290.56"	"$5,344.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804131	EAP	Custom 27804131		"Coil 400 J, 10cm"	BOTH IP/OP	"$7,448.00 "	"$5,511.52"	$0.00	"$5,958.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,740.92"	$0.00	"$1,552.16"	$0.00	$0.00	$0.00	$0.00	"$3,724.00"	"$5,898.82"	"$5,958.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804132	EAP	Custom 27804132		"Coil 400 J, 15cm"	BOTH IP/OP	"$7,743.00 "	"$5,729.82"	$0.00	"$6,194.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,968.30"	$0.00	"$1,613.64"	$0.00	$0.00	$0.00	$0.00	"$3,871.50"	"$6,132.46"	"$6,194.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804133	EAP	Custom 27804133		"Coil 400 J, 25cm"	BOTH IP/OP	"$8,334.00 "	"$6,167.16"	$0.00	"$6,667.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,423.85"	$0.00	"$1,736.81"	$0.00	$0.00	$0.00	$0.00	"$4,167.00"	"$6,600.53"	"$6,667.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804134	EAP	Custom 27804134		"Coil 400 Complex Standard, 3 Mm X 6 Cm"	BOTH IP/OP	"$6,532.00 "	"$4,833.68"	$0.00	"$5,225.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,034.87"	$0.00	"$1,361.27"	$0.00	$0.00	$0.00	$0.00	"$3,266.00"	"$5,173.34"	"$5,225.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804135	EAP	Custom 27804135		"Coil 400 Complex Standard, 3 Mm X 10 Cm"	BOTH IP/OP	"$6,651.00 "	"$4,921.74"	$0.00	"$5,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,126.59"	$0.00	"$1,386.07"	$0.00	$0.00	$0.00	$0.00	"$3,325.50"	"$5,267.59"	"$5,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804136	EAP	Custom 27804136		"Coil 400 Complex Standard, 4 Mm X 8 Cm"	BOTH IP/OP	"$6,591.00 "	"$4,877.34"	$0.00	"$5,272.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,080.34"	$0.00	"$1,373.56"	$0.00	$0.00	$0.00	$0.00	"$3,295.50"	"$5,220.07"	"$5,272.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804137	EAP	Custom 27804137		"Coil 400 Complex Standard, 4 Mm X 12 Cm"	BOTH IP/OP	"$6,708.00 "	"$4,963.92"	$0.00	"$5,366.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,170.53"	$0.00	"$1,397.95"	$0.00	$0.00	$0.00	$0.00	"$3,354.00"	"$5,312.74"	"$5,366.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804138	EAP	Custom 27804138		"Coil 400 Complex Standard, 5 Mm X 6 Cm"	BOTH IP/OP	"$6,532.00 "	"$4,833.68"	$0.00	"$5,225.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,034.87"	$0.00	"$1,361.27"	$0.00	$0.00	$0.00	$0.00	"$3,266.00"	"$5,173.34"	"$5,225.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804139	EAP	Custom 27804139		"Coil 400 Complex Standard, 5mm X 10cm"	BOTH IP/OP	"$6,651.00 "	"$4,921.74"	$0.00	"$5,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,126.59"	$0.00	"$1,386.07"	$0.00	$0.00	$0.00	$0.00	"$3,325.50"	"$5,267.59"	"$5,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804140	EAP	Custom 27804140		"Coil 400 Complex Standard, 6mm X 10cm"	BOTH IP/OP	"$6,651.00 "	"$4,921.74"	$0.00	"$5,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,126.59"	$0.00	"$1,386.07"	$0.00	$0.00	$0.00	$0.00	"$3,325.50"	"$5,267.59"	"$5,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804141	EAP	Custom 27804141		"Coil 400 Complex Standard, 6mm X 15cm"	BOTH IP/OP	"$6,798.00 "	"$5,030.52"	$0.00	"$5,438.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,239.90"	$0.00	"$1,416.70"	$0.00	$0.00	$0.00	$0.00	"$3,399.00"	"$5,384.02"	"$5,438.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804142	EAP	Custom 27804142		"Coil 400 Complex Standard, 7mm X 10cm"	BOTH IP/OP	"$6,651.00 "	"$4,921.74"	$0.00	"$5,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,126.59"	$0.00	"$1,386.07"	$0.00	$0.00	$0.00	$0.00	"$3,325.50"	"$5,267.59"	"$5,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804143	EAP	Custom 27804143		"Coil 400 Complex Soft, 3 Mm X 4 Cm"	BOTH IP/OP	"$7,063.00 "	"$5,226.62"	$0.00	"$5,650.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,444.16"	$0.00	"$1,471.93"	$0.00	$0.00	$0.00	$0.00	"$3,531.50"	"$5,593.90"	"$5,650.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804144	EAP	Custom 27804144		"Coil 400 Complex Soft, 3 Mm X 6 Cm"	BOTH IP/OP	"$7,123.00 "	"$5,271.02"	$0.00	"$5,698.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,490.41"	$0.00	"$1,484.43"	$0.00	$0.00	$0.00	$0.00	"$3,561.50"	"$5,641.42"	"$5,698.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804145	EAP	Custom 27804145		"Coil 400 Complex Soft, 3 Mm X 10 Cm"	BOTH IP/OP	"$7,241.00 "	"$5,358.34"	$0.00	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,581.36"	$0.00	"$1,509.02"	$0.00	$0.00	$0.00	$0.00	"$3,620.50"	"$5,734.87"	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804146	EAP	Custom 27804146		"Coil 400 Complex Soft, 4 Mm X 4 Cm"	BOTH IP/OP	"$7,063.00 "	"$5,226.62"	$0.00	"$5,650.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,444.16"	$0.00	"$1,471.93"	$0.00	$0.00	$0.00	$0.00	"$3,531.50"	"$5,593.90"	"$5,650.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804147	EAP	Custom 27804147		"Coil 400 Complex Soft, 4 Mm X 6 Cm"	BOTH IP/OP	"$7,123.00 "	"$5,271.02"	$0.00	"$5,698.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,490.41"	$0.00	"$1,484.43"	$0.00	$0.00	$0.00	$0.00	"$3,561.50"	"$5,641.42"	"$5,698.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804148	EAP	Custom 27804148		"Coil 400 Complex Soft, 4 Mm X 8 Cm"	BOTH IP/OP	"$7,182.00 "	"$5,314.68"	$0.00	"$5,745.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,535.89"	$0.00	"$1,496.73"	$0.00	$0.00	$0.00	$0.00	"$3,591.00"	"$5,688.14"	"$5,745.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804149	EAP	Custom 27804149		"Coil 400 Complex Soft, 4 Mm X 12 Cm"	BOTH IP/OP	"$7,300.00 "	"$5,402.00"	$0.00	"$5,840.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,626.84"	$0.00	"$1,521.32"	$0.00	$0.00	$0.00	$0.00	"$3,650.00"	"$5,781.60"	"$5,840.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804150	EAP	Custom 27804150		"Coil 400 Complex Soft, 5mm X 9cm"	BOTH IP/OP	"$7,211.00 "	"$5,336.14"	$0.00	"$5,768.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,558.24"	$0.00	"$1,502.77"	$0.00	$0.00	$0.00	$0.00	"$3,605.50"	"$5,711.11"	"$5,768.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804151	EAP	Custom 27804151		"Coil 400 Complex Soft, 5mm X 13cm"	BOTH IP/OP	"$7,331.00 "	"$5,424.94"	$0.00	"$5,864.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,650.73"	$0.00	"$1,527.78"	$0.00	$0.00	$0.00	$0.00	"$3,665.50"	"$5,806.15"	"$5,864.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804152	EAP	Custom 27804152		"Coil 400 Complex Standard, 10mm X 30cm"	BOTH IP/OP	"$7,241.00 "	"$5,358.34"	$0.00	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,581.36"	$0.00	"$1,509.02"	$0.00	$0.00	$0.00	$0.00	"$3,620.50"	"$5,734.87"	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804153	EAP	Custom 27804153		"Coil 400 Complex Standard, 10mm X 40cm"	BOTH IP/OP	"$7,389.00 "	"$5,467.86"	$0.00	"$5,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,695.44"	$0.00	"$1,539.87"	$0.00	$0.00	$0.00	$0.00	"$3,694.50"	"$5,852.09"	"$5,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804154	EAP	Custom 27804154		"Coil 400 Complex Standard, 11mm X 35cm"	BOTH IP/OP	"$7,316.00 "	"$5,413.84"	$0.00	"$5,852.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,639.17"	$0.00	"$1,524.65"	$0.00	$0.00	$0.00	$0.00	"$3,658.00"	"$5,794.27"	"$5,852.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804155	EAP	Custom 27804155		"Coil 400 Complex Standard, 11mm X 45cm"	BOTH IP/OP	"$7,464.00 "	"$5,523.36"	$0.00	"$5,971.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,753.25"	$0.00	"$1,555.50"	$0.00	$0.00	$0.00	$0.00	"$3,732.00"	"$5,911.49"	"$5,971.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804156	EAP	Custom 27804156		"Coil 400 Complex Standard, 12mm X 35cm"	BOTH IP/OP	"$7,316.00 "	"$5,413.84"	$0.00	"$5,852.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,639.17"	$0.00	"$1,524.65"	$0.00	$0.00	$0.00	$0.00	"$3,658.00"	"$5,794.27"	"$5,852.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804157	EAP	Custom 27804157		"Coil 400 Complex Standard, 12mm X 45cm"	BOTH IP/OP	"$7,464.00 "	"$5,523.36"	$0.00	"$5,971.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,753.25"	$0.00	"$1,555.50"	$0.00	$0.00	$0.00	$0.00	"$3,732.00"	"$5,911.49"	"$5,971.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804158	EAP	Custom 27804158		"Coil 400 Complex Standard, 13mm X 35cm"	BOTH IP/OP	"$7,316.00 "	"$5,413.84"	$0.00	"$5,852.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,639.17"	$0.00	"$1,524.65"	$0.00	$0.00	$0.00	$0.00	"$3,658.00"	"$5,794.27"	"$5,852.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804159	EAP	Custom 27804159		"Coil 400 Complex Standard, 13mm X 48cm"	BOTH IP/OP	"$7,507.00 "	"$5,555.18"	$0.00	"$6,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,786.40"	$0.00	"$1,564.46"	$0.00	$0.00	$0.00	$0.00	"$3,753.50"	"$5,945.54"	"$6,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804160	EAP	Custom 27804160		"Coil 400 Complex Standard, 14mm X 50cm"	BOTH IP/OP	"$7,537.00 "	"$5,577.38"	$0.00	"$6,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,809.52"	$0.00	"$1,570.71"	$0.00	$0.00	$0.00	$0.00	"$3,768.50"	"$5,969.30"	"$6,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804161	EAP	Custom 27804161		"Coil 400 Complex Soft, 6mm X 10cm"	BOTH IP/OP	"$7,241.00 "	"$5,358.34"	$0.00	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,581.36"	$0.00	"$1,509.02"	$0.00	$0.00	$0.00	$0.00	"$3,620.50"	"$5,734.87"	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804162	EAP	Custom 27804162		"Coil 400 Complex Soft, 6mm X 15cm"	BOTH IP/OP	"$7,389.00 "	"$5,467.86"	$0.00	"$5,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,695.44"	$0.00	"$1,539.87"	$0.00	$0.00	$0.00	$0.00	"$3,694.50"	"$5,852.09"	"$5,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804163	EAP	Custom 27804163		"Coil 400 Complex Soft, 6mm X 20cm"	BOTH IP/OP	"$7,537.00 "	"$5,577.38"	$0.00	"$6,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,809.52"	$0.00	"$1,570.71"	$0.00	$0.00	$0.00	$0.00	"$3,768.50"	"$5,969.30"	"$6,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804164	EAP	Custom 27804164		"Coil 400 Complex Soft, 7 Mm X 10 Cm"	BOTH IP/OP	"$7,241.00 "	"$5,358.34"	$0.00	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,581.36"	$0.00	"$1,509.02"	$0.00	$0.00	$0.00	$0.00	"$3,620.50"	"$5,734.87"	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804165	EAP	Custom 27804165		"Coil 400 Complex Soft, 7mm X 15cm"	BOTH IP/OP	"$7,389.00 "	"$5,467.86"	$0.00	"$5,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,695.44"	$0.00	"$1,539.87"	$0.00	$0.00	$0.00	$0.00	"$3,694.50"	"$5,852.09"	"$5,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804166	EAP	Custom 27804166		"Coil 400 Complex Soft, 7mm X 20cm"	BOTH IP/OP	"$7,537.00 "	"$5,577.38"	$0.00	"$6,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,809.52"	$0.00	"$1,570.71"	$0.00	$0.00	$0.00	$0.00	"$3,768.50"	"$5,969.30"	"$6,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804167	EAP	Custom 27804167		"Coil 400 Complex Soft, 8mm X 15cm"	BOTH IP/OP	"$7,389.00 "	"$5,467.86"	$0.00	"$5,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,695.44"	$0.00	"$1,539.87"	$0.00	$0.00	$0.00	$0.00	"$3,694.50"	"$5,852.09"	"$5,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804168	EAP	Custom 27804168		"Coil 400 Complex Soft, 8mm X 20cm"	BOTH IP/OP	"$7,389.00 "	"$5,467.86"	$0.00	"$5,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,695.44"	$0.00	"$1,539.87"	$0.00	$0.00	$0.00	$0.00	"$3,694.50"	"$5,852.09"	"$5,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804169	EAP	Custom 27804169		"Coil 400 Complex Soft, 8mm X 30cm"	BOTH IP/OP	"$7,832.00 "	"$5,795.68"	$0.00	"$6,265.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,036.91"	$0.00	"$1,632.19"	$0.00	$0.00	$0.00	$0.00	"$3,916.00"	"$6,202.94"	"$6,265.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804170	EAP	Custom 27804170		"Coil 400 Curve Extra Soft, 3mm X 8cm"	BOTH IP/OP	"$7,241.00 "	"$5,358.34"	$0.00	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,581.36"	$0.00	"$1,509.02"	$0.00	$0.00	$0.00	$0.00	"$3,620.50"	"$5,734.87"	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804171	EAP	Custom 27804171		"Coil 400 Curve Extra Soft, 3mm X 10cm"	BOTH IP/OP	"$7,699.00 "	"$5,697.26"	$0.00	"$6,159.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,934.39"	$0.00	"$1,604.47"	$0.00	$0.00	$0.00	$0.00	"$3,849.50"	"$6,097.61"	"$6,159.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804172	EAP	Custom 27804172		"Coil 400 Curve Extra Soft, 4mm X 4cm"	BOTH IP/OP	"$6,000.00 "	"$4,440.00"	$0.00	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,624.80"	$0.00	"$1,250.40"	$0.00	$0.00	$0.00	$0.00	"$3,000.00"	"$4,752.00"	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804173	EAP	Custom 27804173		"Coil 400 Curve Extra Soft, 4mm X 6cm"	BOTH IP/OP	"$6,000.00 "	"$4,440.00"	$0.00	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,624.80"	$0.00	"$1,250.40"	$0.00	$0.00	$0.00	$0.00	"$3,000.00"	"$4,752.00"	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804174	EAP	Custom 27804174		"Coil 400 Curve Extra Soft, 4mm X 8cm"	BOTH IP/OP	"$7,241.00 "	"$5,358.34"	$0.00	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,581.36"	$0.00	"$1,509.02"	$0.00	$0.00	$0.00	$0.00	"$3,620.50"	"$5,734.87"	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804175	EAP	Custom 27804175		"Coil 400 Curve Extra Soft, 4mm X 10cm"	BOTH IP/OP	"$7,699.00 "	"$5,697.26"	$0.00	"$6,159.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,934.39"	$0.00	"$1,604.47"	$0.00	$0.00	$0.00	$0.00	"$3,849.50"	"$6,097.61"	"$6,159.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804176	EAP	Custom 27804176		"Coil 400 Complex Extra Soft, 2mm X 2cm"	BOTH IP/OP	"$5,674.00 "	"$4,198.76"	$0.00	"$4,539.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,373.52"	$0.00	"$1,182.46"	$0.00	$0.00	$0.00	$0.00	"$2,837.00"	"$4,493.81"	"$4,539.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804177	EAP	Custom 27804177		"Coil 400 Complex Extra Soft, 2mm X 3cm"	BOTH IP/OP	"$5,986.00 "	"$4,429.64"	$0.00	"$4,788.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,614.01"	$0.00	"$1,247.48"	$0.00	$0.00	$0.00	$0.00	"$2,993.00"	"$4,740.91"	"$4,788.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804178	EAP	Custom 27804178		"Coil 400 Complex Extra Soft, 2mm X 4cm"	BOTH IP/OP	"$6,296.00 "	"$4,659.04"	$0.00	"$5,036.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,852.96"	$0.00	"$1,312.09"	$0.00	$0.00	$0.00	$0.00	"$3,148.00"	"$4,986.43"	"$5,036.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804179	EAP	Custom 27804179		"Coil 400 Complex Soft, 9mm X 25cm"	BOTH IP/OP	"$7,685.00 "	"$5,686.90"	$0.00	"$6,148.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,923.60"	$0.00	"$1,601.55"	$0.00	$0.00	$0.00	$0.00	"$3,842.50"	"$6,086.52"	"$6,148.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804180	EAP	Custom 27804180		"Coil 400 Complex Soft, 9mm X 35cm"	BOTH IP/OP	"$7,980.00 "	"$5,905.20"	$0.00	"$6,384.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,150.98"	$0.00	"$1,663.03"	$0.00	$0.00	$0.00	$0.00	"$3,990.00"	"$6,320.16"	"$6,384.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804181	EAP	Custom 27804181		"Coil 400 Complex Soft, 10mm X 20cm"	BOTH IP/OP	"$7,537.00 "	"$5,577.38"	$0.00	"$6,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,809.52"	$0.00	"$1,570.71"	$0.00	$0.00	$0.00	$0.00	"$3,768.50"	"$5,969.30"	"$6,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804182	EAP	Custom 27804182		"Coil 400 Complex Soft, 10mm X 30cm"	BOTH IP/OP	"$7,832.00 "	"$5,795.68"	$0.00	"$6,265.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,036.91"	$0.00	"$1,632.19"	$0.00	$0.00	$0.00	$0.00	"$3,916.00"	"$6,202.94"	"$6,265.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804183	EAP	Custom 27804183		"Coil 400 Complex Soft, 10mm X 40cm"	BOTH IP/OP	"$8,128.00 "	"$6,014.72"	$0.00	"$6,502.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,265.06"	$0.00	"$1,693.88"	$0.00	$0.00	$0.00	$0.00	"$4,064.00"	"$6,437.38"	"$6,502.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804184	EAP	Custom 27804184		"Coil 400 Complex Soft, 11mm X 35cm"	BOTH IP/OP	"$7,980.00 "	"$5,905.20"	$0.00	"$6,384.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,150.98"	$0.00	"$1,663.03"	$0.00	$0.00	$0.00	$0.00	"$3,990.00"	"$6,320.16"	"$6,384.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804185	EAP	Custom 27804185		"Coil 400 Complex Soft, 11mm X 45cm"	BOTH IP/OP	"$8,276.00 "	"$6,124.24"	$0.00	"$6,620.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,379.14"	$0.00	"$1,724.72"	$0.00	$0.00	$0.00	$0.00	"$4,138.00"	"$6,554.59"	"$6,620.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804186	EAP	Custom 27804186		"Coil 400 Complex Soft, 12mm X 35cm"	BOTH IP/OP	"$7,980.00 "	"$5,905.20"	$0.00	"$6,384.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,150.98"	$0.00	"$1,663.03"	$0.00	$0.00	$0.00	$0.00	"$3,990.00"	"$6,320.16"	"$6,384.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804187	EAP	Custom 27804187		"Coil 400 Complex Soft, 12mm X 45cm"	BOTH IP/OP	"$8,276.00 "	"$6,124.24"	$0.00	"$6,620.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,379.14"	$0.00	"$1,724.72"	$0.00	$0.00	$0.00	$0.00	"$4,138.00"	"$6,554.59"	"$6,620.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804188	EAP	Custom 27804188		"Coil 400 Curve Extra Soft, 2mm X 1cm"	BOTH IP/OP	"$5,070.00 "	"$3,751.80"	$0.00	"$4,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,762.95"	"$3,762.95"	"$3,907.96"	$0.00	"$1,056.59"	$0.00	$0.00	$0.00	$0.00	"$2,535.00"	"$4,015.44"	"$4,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804189	EAP	Custom 27804189		"Coil 400 Curve Extra Soft, 2mm X 2cm"	BOTH IP/OP	"$5,379.00 "	"$3,980.46"	$0.00	"$4,303.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,992.29"	"$3,992.29"	"$4,146.13"	$0.00	"$1,120.98"	$0.00	$0.00	$0.00	$0.00	"$2,689.50"	"$4,260.17"	"$4,303.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804190	EAP	Custom 27804190		"Coil 400 Curve Extra Soft, 2mm X 3cm"	BOTH IP/OP	"$5,690.00 "	"$4,210.60"	$0.00	"$4,552.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,385.85"	$0.00	"$1,185.80"	$0.00	$0.00	$0.00	$0.00	"$2,845.00"	"$4,506.48"	"$4,552.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804191	EAP	Custom 27804191		"Coil 400 Curve Extra Soft, 2mm X 4cm"	BOTH IP/OP	"$6,000.00 "	"$4,440.00"	$0.00	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,624.80"	$0.00	"$1,250.40"	$0.00	$0.00	$0.00	$0.00	"$3,000.00"	"$4,752.00"	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804192	EAP	Custom 27804192		"Coil 400 Curve Extra Soft, 3mm X 2cm"	BOTH IP/OP	"$5,379.00 "	"$3,980.46"	$0.00	"$4,303.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,992.29"	"$3,992.29"	"$4,146.13"	$0.00	"$1,120.98"	$0.00	$0.00	$0.00	$0.00	"$2,689.50"	"$4,260.17"	"$4,303.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804193	EAP	Custom 27804193		"Coil 400 Curve Extra Soft, 3mm X 3cm"	BOTH IP/OP	"$5,690.00 "	"$4,210.60"	$0.00	"$4,552.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,385.85"	$0.00	"$1,185.80"	$0.00	$0.00	$0.00	$0.00	"$2,845.00"	"$4,506.48"	"$4,552.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804194	EAP	Custom 27804194		"Coil 400 Curve Extra Soft, 3mm X 4cm"	BOTH IP/OP	"$6,000.00 "	"$4,440.00"	$0.00	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,624.80"	$0.00	"$1,250.40"	$0.00	$0.00	$0.00	$0.00	"$3,000.00"	"$4,752.00"	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804195	EAP	Custom 27804195		"Coil 400 Curve Extra Soft, 3mm X 5cm"	BOTH IP/OP	"$6,310.00 "	"$4,669.40"	$0.00	"$5,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,863.75"	$0.00	"$1,315.00"	$0.00	$0.00	$0.00	$0.00	"$3,155.00"	"$4,997.52"	"$5,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804196	EAP	Custom 27804196		"Coil 400 Curve Extra Soft, 3mm X 6cm"	BOTH IP/OP	"$6,620.00 "	"$4,898.80"	$0.00	"$5,296.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,102.70"	$0.00	"$1,379.61"	$0.00	$0.00	$0.00	$0.00	"$3,310.00"	"$5,243.04"	"$5,296.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804197	EAP	Custom 27804197		"Coil 400 Complex Extra Soft, 3mm X 3cm"	BOTH IP/OP	"$5,986.00 "	"$4,429.64"	$0.00	"$4,788.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,614.01"	$0.00	"$1,247.48"	$0.00	$0.00	$0.00	$0.00	"$2,993.00"	"$4,740.91"	"$4,788.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804198	EAP	Custom 27804198		"Coil 400 Complex Extra Soft, 3mm X 4cm"	BOTH IP/OP	"$6,296.00 "	"$4,659.04"	$0.00	"$5,036.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,852.96"	$0.00	"$1,312.09"	$0.00	$0.00	$0.00	$0.00	"$3,148.00"	"$4,986.43"	"$5,036.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804199	EAP	Custom 27804199		"Coil 400 Complex Extra Soft, 3mm X 5cm"	BOTH IP/OP	"$6,606.00 "	"$4,888.44"	$0.00	"$5,284.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,091.90"	$0.00	"$1,376.69"	$0.00	$0.00	$0.00	$0.00	"$3,303.00"	"$5,231.95"	"$5,284.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804200	EAP	Custom 27804200		"Coil 400 Complex Extra Soft, 3mm X 6cm"	BOTH IP/OP	"$6,916.00 "	"$5,117.84"	$0.00	"$5,532.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,330.85"	$0.00	"$1,441.29"	$0.00	$0.00	$0.00	$0.00	"$3,458.00"	"$5,477.47"	"$5,532.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804201	EAP	Custom 27804201		"Coil 400 Complex Extra Soft, 3mm X 8cm"	BOTH IP/OP	"$7,537.00 "	"$5,577.38"	$0.00	"$6,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,809.52"	$0.00	"$1,570.71"	$0.00	$0.00	$0.00	$0.00	"$3,768.50"	"$5,969.30"	"$6,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804202	EAP	Custom 27804202		"Coil 400 Complex Extra Soft, 3mm X 10cm"	BOTH IP/OP	"$8,157.00 "	"$6,036.18"	$0.00	"$6,525.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,287.42"	$0.00	"$1,699.92"	$0.00	$0.00	$0.00	$0.00	"$4,078.50"	"$6,460.34"	"$6,525.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804203	EAP	Custom 27804203		"Coil 400 Complex Extra Soft, 4mm X 4cm"	BOTH IP/OP	"$6,296.00 "	"$4,659.04"	$0.00	"$5,036.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,852.96"	$0.00	"$1,312.09"	$0.00	$0.00	$0.00	$0.00	"$3,148.00"	"$4,986.43"	"$5,036.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804204	EAP	Custom 27804204		"Coil 400 Complex Extra Soft, 4mm X 6cm"	BOTH IP/OP	"$6,916.00 "	"$5,117.84"	$0.00	"$5,532.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,330.85"	$0.00	"$1,441.29"	$0.00	$0.00	$0.00	$0.00	"$3,458.00"	"$5,477.47"	"$5,532.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804205	EAP	Custom 27804205		"Coil 400 Complex Extra Soft, 4mm X 8cm"	BOTH IP/OP	"$7,537.00 "	"$5,577.38"	$0.00	"$6,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,809.52"	$0.00	"$1,570.71"	$0.00	$0.00	$0.00	$0.00	"$3,768.50"	"$5,969.30"	"$6,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804206	EAP	Custom 27804206		"Coil 400 Complex Standard, 7 Mm X 15 Cm"	BOTH IP/OP	"$6,798.00 "	"$5,030.52"	$0.00	"$5,438.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,239.90"	$0.00	"$1,416.70"	$0.00	$0.00	$0.00	$0.00	"$3,399.00"	"$5,384.02"	"$5,438.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804207	EAP	Custom 27804207		"Coil 400 Complex Standard, 7mm X 20cm"	BOTH IP/OP	"$6,946.00 "	"$5,140.04"	$0.00	"$5,556.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,353.98"	$0.00	"$1,447.55"	$0.00	$0.00	$0.00	$0.00	"$3,473.00"	"$5,501.23"	"$5,556.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804208	EAP	Custom 27804208		"Coil 400 Complex Standard, 8 Mm X 15 Cm"	BOTH IP/OP	"$6,798.00 "	"$5,030.52"	$0.00	"$5,438.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,239.90"	$0.00	"$1,416.70"	$0.00	$0.00	$0.00	$0.00	"$3,399.00"	"$5,384.02"	"$5,438.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804209	EAP	Custom 27804209		"Coil 400 Complex Standard, 8mm X 20cm"	BOTH IP/OP	"$6,798.00 "	"$5,030.52"	$0.00	"$5,438.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,239.90"	$0.00	"$1,416.70"	$0.00	$0.00	$0.00	$0.00	"$3,399.00"	"$5,384.02"	"$5,438.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804210	EAP	Custom 27804210		"Coil 400 Complex Standard, 8mm X 30cm"	BOTH IP/OP	"$7,241.00 "	"$5,358.34"	$0.00	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,581.36"	$0.00	"$1,509.02"	$0.00	$0.00	$0.00	$0.00	"$3,620.50"	"$5,734.87"	"$5,792.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804211	EAP	Custom 27804211		"Coil 400 Complex Standard, 9 Mm X 15 Cm"	BOTH IP/OP	"$6,798.00 "	"$5,030.52"	$0.00	"$5,438.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,239.90"	$0.00	"$1,416.70"	$0.00	$0.00	$0.00	$0.00	"$3,399.00"	"$5,384.02"	"$5,438.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804212	EAP	Custom 27804212		"Coil 400 Complex Standard, 9mm X 25cm"	BOTH IP/OP	"$7,094.00 "	"$5,249.56"	$0.00	"$5,675.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,468.06"	$0.00	"$1,478.39"	$0.00	$0.00	$0.00	$0.00	"$3,547.00"	"$5,618.45"	"$5,675.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804213	EAP	Custom 27804213		"Coil 400 Complex Standard, 9mm X 35cm"	BOTH IP/OP	"$7,300.00 "	"$5,402.00"	$0.00	"$5,840.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,626.84"	$0.00	"$1,521.32"	$0.00	$0.00	$0.00	$0.00	"$3,650.00"	"$5,781.60"	"$5,840.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804214	EAP	Custom 27804214		"Coil 400 Complex Standard, 10 Mm X 20 Cm"	BOTH IP/OP	"$6,946.00 "	"$5,140.04"	$0.00	"$5,556.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,353.98"	$0.00	"$1,447.55"	$0.00	$0.00	$0.00	$0.00	"$3,473.00"	"$5,501.23"	"$5,556.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804250	EAP	HCPCS C1751		Catheter Central Venous Pro-fuse Triniflex Od8 Fr Attace	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$265.95	$265.95	$0.00	$0.00	$0.00	$123.18	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$349.58	$349.58	$0.00	$295.50	$468.07	$472.80	$0.00	$0.00	$0.00	$92.49	$0.00	$0.00	$94.09	$0.00	$0.00	$0.00	$0.00	$0.00
27804251	EAP	CPT® C1751		Catheter Powerglide 20 G  8 Cm Full Kit	BOTH IP/OP	$356.00 	$263.44	$0.00	$284.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.00	$281.95	$284.80	$0.00	$0.00	$0.00	$55.71	$0.00	$0.00	$56.68	$0.00	$0.00	$0.00	$0.00	$0.00
27804252	EAP	CPT® C1751		Catheter Powerglide 20 G  10 Cm Full Kit	BOTH IP/OP	$356.00 	$263.44	$0.00	$284.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.00	$281.95	$284.80	$0.00	$0.00	$0.00	$55.71	$0.00	$0.00	$56.68	$0.00	$0.00	$0.00	$0.00	$0.00
27804254	EAP	HCPCS C1713		Screw Bone Mini Long Post 7.5mm 55mm Polyax Mpa Ts	BOTH IP/OP	"$1,550.00 "	"$1,147.00"	$0.00	"$1,240.00"	$697.50	$697.50	$0.00	$0.00	$0.00	$323.06	"$1,150.41"	"$1,150.41"	"$1,194.74"	$0.00	$323.02	$0.00	$916.83	$916.83	$0.00	$775.00	"$1,227.60"	"$1,240.00"	$0.00	$0.00	$0.00	$242.58	$0.00	$0.00	$246.76	$0.00	$0.00	$0.00	$0.00	$0.00
27804260	EAP	HCPCS C1722		Defibrillator Crd 12.7mm 83.1x69.1mm Eblm Pls	BOTH IP/OP	"$53,750.00 "	"$39,775.00"	$0.00	"$43,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,875.00"	"$42,570.00"	"$43,000.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27804261	EAP	HCPCS C1896		Electrode Dfbr 45cm 3 Plr S-icd Coil Conctr Pin	BOTH IP/OP	"$12,500.00 "	"$9,250.00"	$0.00	"$10,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,605.31"	"$4,181.12"	"$4,181.12"	"$9,635.00"	$0.00	"$2,605.00"	$0.00	"$6,162.50"	"$6,162.50"	$0.00	"$6,250.00"	"$9,900.00"	"$10,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804870	EAP	HCPCS C1760		Device Closure .035in 6fr 70cm Valuelink Gwire Insertion	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00	$0.00	$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
27804871	EAP	Custom 27804871		Coil Embolization .02in Complex 11mm 35cm Soft The Penumbra	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,202.90"	$0.00	"$1,406.70"	$0.00	$0.00	$0.00	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804872	EAP	Custom 27804872		Coil Embolization .02in Complex 5mm 13cm Soft The Penumbra	BOTH IP/OP	"$6,108.00 "	"$4,519.92"	$0.00	"$4,886.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,708.05"	$0.00	"$1,272.91"	$0.00	$0.00	$0.00	$0.00	"$3,054.00"	"$4,837.54"	"$4,886.40"	$0.00	"$2,748.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804880	EAP	Custom 27804880		Coil Embolization .02in Complex 6mm 15cm Soft The Penumbra	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,817.50"	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00	"$2,812.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804881	EAP	Custom 27804881		Coil Embolization .02in Complex 7mm 20cm Soft The Penumbra	BOTH IP/OP	"$6,375.00 "	"$4,717.50"	$0.00	"$5,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,913.85"	$0.00	"$1,328.55"	$0.00	$0.00	$0.00	$0.00	"$3,187.50"	"$5,049.00"	"$5,100.00"	$0.00	"$2,868.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804882	EAP	Custom 27804882		Coil Embolization .02in Complex 8mm 20cm Soft The Penumbra	BOTH IP/OP	"$6,375.00 "	"$4,717.50"	$0.00	"$5,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,913.85"	$0.00	"$1,328.55"	$0.00	$0.00	$0.00	$0.00	"$3,187.50"	"$5,049.00"	"$5,100.00"	$0.00	"$2,868.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804883	EAP	Custom 27804883		Coil Embolization .02in Complex 9mm 25cm Soft The Penumbra	BOTH IP/OP	"$6,500.00 "	"$4,810.00"	$0.00	"$5,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,010.20"	$0.00	"$1,354.60"	$0.00	$0.00	$0.00	$0.00	"$3,250.00"	"$5,148.00"	"$5,200.00"	$0.00	"$2,925.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804884	EAP	Custom 27804884		Coil Embolization .02in Standard Complex 11mm 35cm Complex	BOTH IP/OP	"$6,188.00 "	"$4,579.12"	$0.00	"$4,950.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,769.71"	$0.00	"$1,289.58"	$0.00	$0.00	$0.00	$0.00	"$3,094.00"	"$4,900.90"	"$4,950.40"	$0.00	"$2,784.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804885	EAP	Custom 27804885		Coil Embolization .02in Standard Complex 6mm 15cm Complex	BOTH IP/OP	"$5,175.00 "	"$3,829.50"	$0.00	"$4,140.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,840.89"	"$3,840.89"	"$3,988.89"	$0.00	"$1,078.47"	$0.00	$0.00	$0.00	$0.00	"$2,587.50"	"$4,098.60"	"$4,140.00"	$0.00	"$3,363.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27804886	EAP	Custom 27804886		Coil Embolization .02in Standard Complex 7mm 20cm Complex	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,528.45"	$0.00	"$1,224.35"	$0.00	$0.00	$0.00	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805011	EAP	Custom 27805011		20 FR SAFETY PEG KIT PULL	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$63.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805012	EAP	Custom 27805012		24 FR SAFETY PEG KIT PULL	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$71.00	$112.46	$113.60	$0.00	$63.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805013	EAP	Custom 27805013		"18 FR Replacement G-Tube, Right An 18"	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.17	$31.17	$32.37	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$21.00	$33.26	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805014	EAP	Custom 27805014		"20 FR REPLACEMENT G-TUBE, RIGHT-AN 20"	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805015	EAP	Custom 27805015		"22 FR REPLACEMENT G-TUBE, RIGHT-AN"	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805016	EAP	HCPCS C2625		Rx Stent 7x7cm	BOTH IP/OP	$133.00 	$98.42	$0.00	$106.40	$59.85	$59.85	$0.00	$0.00	$0.00	$27.72	$98.71	$98.71	$102.52	$0.00	$27.72	$0.00	$78.67	$78.67	$0.00	$66.50	$105.34	$106.40	$0.00	$0.00	$0.00	$20.81	$0.00	$0.00	$21.17	$0.00	$0.00	$0.00	$0.00	$0.00
27805017	EAP	HCPCS C2625		Rx Stent 7x10cm	BOTH IP/OP	$133.00 	$98.42	$0.00	$106.40	$59.85	$59.85	$0.00	$0.00	$0.00	$27.72	$98.71	$98.71	$102.52	$0.00	$27.72	$0.00	$78.67	$78.67	$0.00	$66.50	$105.34	$106.40	$0.00	$0.00	$0.00	$20.81	$0.00	$0.00	$21.17	$0.00	$0.00	$0.00	$0.00	$0.00
27805018	EAP	HCPCS C2625		Rx Stent 10x5cm	BOTH IP/OP	$133.00 	$98.42	$0.00	$106.40	$59.85	$59.85	$0.00	$0.00	$0.00	$27.72	$98.71	$98.71	$102.52	$0.00	$27.72	$0.00	$78.67	$78.67	$0.00	$66.50	$105.34	$106.40	$0.00	$0.00	$0.00	$20.81	$0.00	$0.00	$21.17	$0.00	$0.00	$0.00	$0.00	$0.00
27805019	EAP	HCPCS C2625		Rx Stent 10x10cm	BOTH IP/OP	$133.00 	$98.42	$0.00	$106.40	$59.85	$59.85	$0.00	$0.00	$0.00	$27.72	$98.71	$98.71	$102.52	$0.00	$27.72	$0.00	$78.67	$78.67	$0.00	$66.50	$105.34	$106.40	$0.00	$0.00	$0.00	$20.81	$0.00	$0.00	$21.17	$0.00	$0.00	$0.00	$0.00	$0.00
27805020	EAP	Custom 27805020		Pill Cam Capsule	BOTH IP/OP	$532.00 	$393.68	$0.00	$425.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$394.85	$394.85	$410.07	$0.00	$110.87	$0.00	$0.00	$0.00	$0.00	$266.00	$421.34	$425.60	$0.00	$239.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805021	EAP	HCPCS L8614		Cochlear  Implant	BOTH IP/OP	"$106,399.00 "	"$78,735.26"	$0.00	"$85,119.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$82,012.35"	$0.00	"$22,173.55"	$0.00	$0.00	$0.00	$0.00	"$53,199.50"	"$84,268.01"	"$85,119.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805022	EAP	HCPCS C1878		Radiesse Voice Material For Vocal Cord Medialization	BOTH IP/OP	$638.00 	$472.12	$0.00	$510.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$473.52	$473.52	$491.77	$0.00	$132.96	$0.00	$0.00	$0.00	$0.00	$319.00	$505.30	$510.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805040	EAP	Custom 27805040		Sensor Monitor Flotrac Adult L60 In Vamp Latex Free	BOTH IP/OP	$961.00 	$711.14	$0.00	$768.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$713.25	$713.25	$740.74	$0.00	$200.27	$0.00	$0.00	$0.00	$0.00	$480.50	$761.11	$768.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805041	EAP	Custom 27805041		Sensor Monitor  Flotrac Adlt L60 In Vamp Bifurcated Pres	BOTH IP/OP	$961.00 	$711.14	$0.00	$768.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$713.25	$713.25	$740.74	$0.00	$200.27	$0.00	$0.00	$0.00	$0.00	$480.50	$761.11	$768.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805044	EAP	Custom 27805044		"Accessory Kit, Slit Suture Sleeve, Ss-1056"	BOTH IP/OP	$72.00 	$53.28	$0.00	$57.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.44	$53.44	$55.50	$0.00	$15.00	$0.00	$0.00	$0.00	$0.00	$36.00	$57.02	$57.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805045	EAP	Custom 27805045		Coil Embl 14cm 6mm Nst Sft Cath Xtd Embl Endhole .035in4	BOTH IP/OP	$320.00 	$236.80	$0.00	$256.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$237.50	$237.50	$246.66	$0.00	$66.69	$0.00	$0.00	$0.00	$0.00	$160.00	$253.44	$256.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805046	EAP	HCPCS C1751		Cath Infus .038in 5fr 100cm 10cm Peri Vlv Crgg-mcnam	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.00	$190.08	$192.00	$0.00	$0.00	$0.00	$37.56	$0.00	$0.00	$38.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805048	EAP	HCPCS C1874		Xience Xpedition Sv Des 2.25 Mm X 8 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805049	EAP	HCPCS C1874		Xience Xpedition Sv Des 2.25 Mm X 12 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805050	EAP	HCPCS C1874		Xience Xpedition Sv Des 2.25 Mm X 15 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805051	EAP	HCPCS C1874		Xience Xpedition Sv Des 2.25 Mm X 18 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805052	EAP	HCPCS C1874		Xience Xpedition Sv Des 2.25 Mm X 23 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805053	EAP	HCPCS C1874		Xience Xpedition Sv Des 2.25 Mm X 28 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805054	EAP	HCPCS C1874		Xience Xpedition Des 2.50 Mm X 8 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805055	EAP	HCPCS C1874		Xience Xpedition Des 2.50 Mm X 12 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805056	EAP	HCPCS C1874		Xience Xpedition Des 2.50 Mm X 15 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805057	EAP	HCPCS C1874		Xience Xpedition Des 2.50 Mm X 18 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805058	EAP	HCPCS C1874		Xience Xpedition Des 2.50 Mm X 23 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805059	EAP	HCPCS C1874		Xience Xpedition Des 2.50 Mm X 28 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805060	EAP	HCPCS C1874		Xience Xpedition Ll Des 2.50 Mm X 33 Mm	BOTH IP/OP	"$6,429.00 "	"$4,757.46"	$0.00	"$5,143.20"	"$2,893.05"	"$2,893.05"	$0.00	$0.00	$0.00	"$1,339.96"	"$4,181.12"	"$4,181.12"	"$4,955.47"	$0.00	"$1,339.80"	$0.00	"$3,169.50"	"$3,169.50"	$0.00	"$3,214.50"	"$5,091.77"	"$5,143.20"	$0.00	$0.00	$0.00	"$1,006.14"	$0.00	$0.00	"$1,023.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805061	EAP	HCPCS C1874		Xience Xpedition Ll Des 2.50 Mm X 38 Mm	BOTH IP/OP	"$6,429.00 "	"$4,757.46"	$0.00	"$5,143.20"	"$2,893.05"	"$2,893.05"	$0.00	$0.00	$0.00	"$1,339.96"	"$4,181.12"	"$4,181.12"	"$4,955.47"	$0.00	"$1,339.80"	$0.00	"$3,169.50"	"$3,169.50"	$0.00	"$3,214.50"	"$5,091.77"	"$5,143.20"	$0.00	$0.00	$0.00	"$1,006.14"	$0.00	$0.00	"$1,023.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805062	EAP	HCPCS C1874		Xience Xpedition Des 2.75 Mm X 8 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805063	EAP	HCPCS C1874		Xience Xpedition Des 2.75 Mm X 12 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805064	EAP	HCPCS C1874		Xience Xpedition Des 2.75 Mm X 15 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805065	EAP	HCPCS C1874		Xience Xpedition Des 2.75 Mm X 18 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805066	EAP	HCPCS C1874		Xience Xpedition Des 2.75 Mm X 23 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805067	EAP	HCPCS C1874		Xience Xpedition Des 2.75 Mm X 28 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805068	EAP	HCPCS C1874		Xience Xpedition Ll Des 2.75 Mm X 33 Mm	BOTH IP/OP	"$6,429.00 "	"$4,757.46"	$0.00	"$5,143.20"	"$2,893.05"	"$2,893.05"	$0.00	$0.00	$0.00	"$1,339.96"	"$4,181.12"	"$4,181.12"	"$4,955.47"	$0.00	"$1,339.80"	$0.00	"$3,169.50"	"$3,169.50"	$0.00	"$3,214.50"	"$5,091.77"	"$5,143.20"	$0.00	$0.00	$0.00	"$1,006.14"	$0.00	$0.00	"$1,023.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805069	EAP	HCPCS C1874		Xience Xpedition Ll Des 2.75 Mm X 38 Mm	BOTH IP/OP	"$6,429.00 "	"$4,757.46"	$0.00	"$5,143.20"	"$2,893.05"	"$2,893.05"	$0.00	$0.00	$0.00	"$1,339.96"	"$4,181.12"	"$4,181.12"	"$4,955.47"	$0.00	"$1,339.80"	$0.00	"$3,169.50"	"$3,169.50"	$0.00	"$3,214.50"	"$5,091.77"	"$5,143.20"	$0.00	$0.00	$0.00	"$1,006.14"	$0.00	$0.00	"$1,023.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805070	EAP	HCPCS C1874		Xience Xpedition Des 3.00 Mm X 8 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805071	EAP	HCPCS C1874		Xience Xpedition Des 3.00 Mm X 12 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805072	EAP	HCPCS C1874		Xience Xpedition Des 3.00 Mm X 15 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805073	EAP	HCPCS C1874		Xience Xpedition Des 3.00 Mm X 18 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805074	EAP	HCPCS C1874		Xience Xpedition Des 3.00 Mm X 23 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805075	EAP	HCPCS C1874		Xience Xpedition Des 3.00 Mm X 28 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805076	EAP	HCPCS C1874		Xience Xpedition Ll Des 3.00 Mm X 33 Mm	BOTH IP/OP	"$6,429.00 "	"$4,757.46"	$0.00	"$5,143.20"	"$2,893.05"	"$2,893.05"	$0.00	$0.00	$0.00	"$1,339.96"	"$4,181.12"	"$4,181.12"	"$4,955.47"	$0.00	"$1,339.80"	$0.00	"$3,169.50"	"$3,169.50"	$0.00	"$3,214.50"	"$5,091.77"	"$5,143.20"	$0.00	$0.00	$0.00	"$1,006.14"	$0.00	$0.00	"$1,023.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805077	EAP	HCPCS C1874		Xience Xpedition Ll Des 3.00 Mm X 38 Mm	BOTH IP/OP	"$6,429.00 "	"$4,757.46"	$0.00	"$5,143.20"	"$2,893.05"	"$2,893.05"	$0.00	$0.00	$0.00	"$1,339.96"	"$4,181.12"	"$4,181.12"	"$4,955.47"	$0.00	"$1,339.80"	$0.00	"$3,169.50"	"$3,169.50"	$0.00	"$3,214.50"	"$5,091.77"	"$5,143.20"	$0.00	$0.00	$0.00	"$1,006.14"	$0.00	$0.00	"$1,023.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805078	EAP	HCPCS C1874		Xience Xpedition Des 3.25 Mm X 8 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805079	EAP	HCPCS C1874		Xience Xpedition Des 3.25 Mm X 12 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805080	EAP	HCPCS C1874		Xience Xpedition Des 3.25 Mm X 15 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805081	EAP	HCPCS C1874		Xience Xpedition Des 3.25 Mm X 18 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805082	EAP	HCPCS C1874		Xience Xpedition Des 3.25 Mm X 23 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805083	EAP	HCPCS C1874		Xience Xpedition Des 3.25 Mm X 28 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805084	EAP	HCPCS C1874		Xience Xpedition Ll Des 3.25 Mm X 33 Mm	BOTH IP/OP	"$6,429.00 "	"$4,757.46"	$0.00	"$5,143.20"	"$2,893.05"	"$2,893.05"	$0.00	$0.00	$0.00	"$1,339.96"	"$4,181.12"	"$4,181.12"	"$4,955.47"	$0.00	"$1,339.80"	$0.00	"$3,169.50"	"$3,169.50"	$0.00	"$3,214.50"	"$5,091.77"	"$5,143.20"	$0.00	$0.00	$0.00	"$1,006.14"	$0.00	$0.00	"$1,023.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805085	EAP	HCPCS C1874		Xience Xpedition Ll Des 3.25 Mm X 38 Mm	BOTH IP/OP	"$6,429.00 "	"$4,757.46"	$0.00	"$5,143.20"	"$2,893.05"	"$2,893.05"	$0.00	$0.00	$0.00	"$1,339.96"	"$4,181.12"	"$4,181.12"	"$4,955.47"	$0.00	"$1,339.80"	$0.00	"$3,169.50"	"$3,169.50"	$0.00	"$3,214.50"	"$5,091.77"	"$5,143.20"	$0.00	$0.00	$0.00	"$1,006.14"	$0.00	$0.00	"$1,023.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805086	EAP	HCPCS C1874		Xience Xpedition Des 3.50 Mm X 8 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805087	EAP	HCPCS C1874		Xience Xpedition Des 3.50 Mm X 12 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805088	EAP	HCPCS C1874		Xience Xpedition Des 3.50 Mm X 15 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805089	EAP	HCPCS C1874		Xience Xpedition Des 3.50 Mm X 18 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805090	EAP	HCPCS C1874		Xience Xpedition Des 3.50 Mm X 23 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	"$2,793.60"	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805091	EAP	HCPCS C1874		Xience Xpedition Des 3.50 Mm X 28 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805092	EAP	HCPCS C1874		Xience Xpedition Ll Des 3.50 Mm X 33 Mm	BOTH IP/OP	"$6,429.00 "	"$4,757.46"	$0.00	"$5,143.20"	"$2,893.05"	"$2,893.05"	$0.00	$0.00	$0.00	"$1,339.96"	"$4,181.12"	"$4,181.12"	"$4,955.47"	$0.00	"$1,339.80"	$0.00	"$3,169.50"	"$3,169.50"	$0.00	"$3,214.50"	"$5,091.77"	"$5,143.20"	$0.00	$0.00	$0.00	"$1,006.14"	$0.00	$0.00	"$1,023.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805093	EAP	HCPCS C1874		Xience Xpedition Ll Des 3.50 Mm X 38 Mm	BOTH IP/OP	"$6,429.00 "	"$4,757.46"	$0.00	"$5,143.20"	"$2,893.05"	"$2,893.05"	$0.00	$0.00	$0.00	"$1,339.96"	"$4,181.12"	"$4,181.12"	"$4,955.47"	$0.00	"$1,339.80"	$0.00	"$3,169.50"	"$3,169.50"	$0.00	"$3,214.50"	"$5,091.77"	"$5,143.20"	$0.00	$0.00	$0.00	"$1,006.14"	$0.00	$0.00	"$1,023.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805094	EAP	HCPCS C1874		Xience Xpedition Des 4.00 Mm X 8 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805095	EAP	HCPCS C1874		Xience Xpedition Des 4.00 Mm X 12 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805096	EAP	HCPCS C1874		Xience Xpedition Des 4.00 Mm X 15 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	"$2,793.60"	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805097	EAP	HCPCS C1874		Xience Xpedition Des 4.00 Mm X 18 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805098	EAP	HCPCS C1874		Xience Xpedition Des 4.00 Mm X 23 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805099	EAP	HCPCS C1874		Xience Xpedition Des 4.00 Mm X 28 Mm	BOTH IP/OP	"$6,208.00 "	"$4,593.92"	$0.00	"$4,966.40"	"$2,793.60"	"$2,793.60"	$0.00	$0.00	$0.00	"$1,293.90"	"$4,181.12"	"$4,181.12"	"$4,785.13"	$0.00	"$1,293.75"	$0.00	"$3,060.54"	"$3,060.54"	$0.00	"$3,104.00"	"$4,916.74"	"$4,966.40"	$0.00	$0.00	$0.00	$971.55	$0.00	$0.00	$988.31	$0.00	$0.00	$0.00	$0.00	$0.00
27805101	EAP	Custom 27805101		Pipeline Embolization Device	BOTH IP/OP	"$41,378.00 "	"$30,619.72"	$0.00	"$33,102.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$31,894.16"	$0.00	"$8,623.18"	$0.00	$0.00	$0.00	$0.00	"$20,689.00"	"$32,771.38"	"$33,102.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805102	EAP	HCPCS C1874		Xience Xpedition Ll Des 4.00 Mm X 33 Mm	BOTH IP/OP	"$6,429.00 "	"$4,757.46"	$0.00	"$5,143.20"	"$2,893.05"	"$2,893.05"	$0.00	$0.00	$0.00	"$1,339.96"	"$4,181.12"	"$4,181.12"	"$4,955.47"	$0.00	"$1,339.80"	$0.00	"$3,169.50"	"$3,169.50"	$0.00	"$3,214.50"	"$5,091.77"	"$5,143.20"	$0.00	$0.00	$0.00	"$1,006.14"	$0.00	$0.00	"$1,023.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805103	EAP	HCPCS C1874		Xience Xpedition Ll Des 4.00 Mm X 38 Mm	BOTH IP/OP	"$6,429.00 "	"$4,757.46"	$0.00	"$5,143.20"	"$2,893.05"	"$2,893.05"	$0.00	$0.00	$0.00	"$1,339.96"	"$4,181.12"	"$4,181.12"	"$4,955.47"	$0.00	"$1,339.80"	$0.00	"$3,169.50"	"$3,169.50"	$0.00	"$3,214.50"	"$5,091.77"	"$5,143.20"	$0.00	$0.00	$0.00	"$1,006.14"	$0.00	$0.00	"$1,023.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805104	EAP	Custom 27805104		Coil Embl 4.1cm 5-3mm Trnd .035in Std Sm Pltn Arterioves	BOTH IP/OP	$264.00 	$195.36	$0.00	$211.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.94	$195.94	$203.49	$0.00	$55.02	$0.00	$0.00	$0.00	$0.00	$132.00	$209.09	$211.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805106	EAP	HCPCS C1876		Se Biliary Stent  6mmx40mmx120cm	BOTH IP/OP	"$4,138.00 "	"$3,062.12"	$0.00	"$3,310.40"	"$1,862.10"	"$1,862.10"	$0.00	$0.00	$0.00	$862.46	"$3,071.22"	"$3,071.22"	"$3,189.57"	$0.00	$862.36	$0.00	"$2,040.03"	"$2,040.03"	$0.00	"$2,069.00"	"$3,277.30"	"$3,310.40"	$0.00	$0.00	$0.00	$647.60	$0.00	$0.00	$658.77	$0.00	$0.00	$0.00	$0.00	$0.00
27805107	EAP	HCPCS C1876		Se Peripheral Stent 7mmx80mmx120cm	BOTH IP/OP	"$5,024.00 "	"$3,717.76"	$0.00	"$4,019.20"	"$2,260.80"	"$2,260.80"	$0.00	$0.00	$0.00	"$1,047.13"	"$3,728.81"	"$3,728.81"	"$3,872.50"	$0.00	"$1,047.00"	$0.00	"$2,476.83"	"$2,476.83"	$0.00	"$2,512.00"	"$3,979.01"	"$4,019.20"	$0.00	$0.00	$0.00	$786.26	$0.00	$0.00	$799.82	$0.00	$0.00	$0.00	$0.00	$0.00
27805108	EAP	Custom 27805108		"Coil 400 Complex Standard, 22 Mm X 60 Cm"	BOTH IP/OP	"$7,685.00 "	"$5,686.90"	$0.00	"$6,148.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,923.60"	$0.00	"$1,601.55"	$0.00	$0.00	$0.00	$0.00	"$3,842.50"	"$6,086.52"	"$6,148.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805112	EAP	HCPCS Q4107		Coil Embolization 7cm 3mm Nester 7.4 Loop Microcoil .018	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.95	$218.95	$227.39	$0.00	$61.48	$0.00	$0.00	$0.00	$0.00	$147.50	$233.64	$236.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805113	EAP	Custom 27805113		Coil Embolization 7cm 4mm Nester 5.6 Loop Microcoil .018	BOTH IP/OP	"$3,403.00 "	"$2,518.22"	$0.00	"$2,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,525.71"	"$2,525.71"	"$2,623.03"	$0.00	$709.19	$0.00	$0.00	$0.00	$0.00	"$1,701.50"	"$2,695.18"	"$2,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805115	EAP	Custom 27805115		"Coil 400 Complex Standard, 24 Mm X 57 Cm"	BOTH IP/OP	"$7,642.00 "	"$5,655.08"	$0.00	"$6,113.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,890.45"	$0.00	"$1,592.59"	$0.00	$0.00	$0.00	$0.00	"$3,821.00"	"$6,052.46"	"$6,113.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805116	EAP	Custom 27805116		"Coil 400 Complex Standard, 28 Mm X 60 Cm"	BOTH IP/OP	"$8,572.00 "	"$6,343.28"	$0.00	"$6,857.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,607.30"	$0.00	"$1,786.40"	$0.00	$0.00	$0.00	$0.00	"$4,286.00"	"$6,789.02"	"$6,857.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805118	EAP	Custom 27805118		Coil Embl 2cm 1mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805119	EAP	Custom 27805119		Coil Embl 3cm 1mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805120	EAP	Custom 27805120		Coil Embl 2cm 1.5mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805121	EAP	Custom 27805121		Coil Embl 3cm 1.5mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805122	EAP	Custom 27805122		Coil Embl 4cm 1.5mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805123	EAP	Custom 27805123		Coil Embl 3cm 2mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805124	EAP	Custom 27805124		Coil Embl 4cm 2mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805125	EAP	Custom 27805125		Coil Embl 6cm 2mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805126	EAP	Custom 27805126		Coil Embl 4cm 2.5mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805127	EAP	Custom 27805127		Coil Embl 4cm 3mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805128	EAP	Custom 27805128		Coil Embl 6cm 3mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805129	EAP	Custom 27805129		Coil Embl 8cm 3mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805130	EAP	Custom 27805130		Coil Embl 10cm 3mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805131	EAP	Custom 27805131		Coil Embl 6cm 4mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,352.00 "	"$3,960.48"	$0.00	"$4,281.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,972.25"	"$3,972.25"	"$4,125.32"	$0.00	"$1,115.36"	$0.00	$0.00	$0.00	$0.00	"$2,676.00"	"$4,238.78"	"$4,281.60"	$0.00	"$2,408.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805132	EAP	Custom 27805132		Coil Embl 8cm 4mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805133	EAP	Custom 27805133		Coil Embl 10cm 5mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805134	EAP	Custom 27805134		Coil Embl 15cm 5mm Trgt Dtch Ult 360d	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	"$2,293.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805135	EAP	Custom CUSTOM		System Embl Dtch Inzone	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.50	$29.30	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805137	EAP	HCPCS C1898		LEAD PCNG BRKWY DLV SYS IMPLTABLE HRT FAIL ACTY	BOTH IP/OP	"$5,010.00 "	"$3,707.40"	$0.00	"$4,008.00"	"$2,254.50"	"$2,254.50"	$0.00	$0.00	$0.00	"$1,044.21"	"$3,718.42"	"$3,718.42"	"$3,861.71"	$0.00	"$1,044.08"	$0.00	"$2,469.93"	"$2,469.93"	$0.00	"$2,505.00"	"$3,967.92"	"$4,008.00"	$0.00	$0.00	$0.00	$784.07	$0.00	$0.00	$797.59	$0.00	$0.00	$0.00	$0.00	$0.00
27805138	EAP	HCPCS C1900		LEAD PCNG 59CM 9FR ECRDL BIPOL ACT FIX 1 COIL RTRCT HLX TIP	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805139	EAP	HCPCS C1777		LEAD PCNG 64CM 9FR ECRDM 1 COIL ACT FIX BIPOL CARDVRT DFBR	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805140	EAP	HCPCS C1898		LEAD PCNG 54CM MYOCRD BIPOL SUTLS INNOMEDICA SIL	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805141	EAP	HCPCS C1898		LEAD PCNG 52CM 3.2MM ECRDM ATR VNTRC PCMKR FLXTND	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805142	EAP	HCPCS C1895		LEAD PCNG 90CM ECRDM DUAL COIL PSV FIX CARDVRT DFBR	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805143	EAP	HCPCS C1898		LEAD PCNG 64CM 9FR 18CM SPC ECRDM IS-1 CONCTR DUAL COIL	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805144	EAP	HCPCS C1898		LEAD PCNG 59CM 9FR 18CM SPC ECRDL BIPOL PSV FIX 2 COIL TN	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805145	EAP	HCPCS C1876		STENT BIL 10MM 8FR 80MM 3.2MM .035IN RAPEX UNCVR GWIRE	BOTH IP/OP	$461.00 	$341.14	$0.00	$368.80	$207.45	$207.45	$0.00	$0.00	$0.00	$96.08	$342.15	$342.15	$355.34	$0.00	$96.07	$0.00	$272.68	$272.68	$0.00	$230.50	$365.11	$368.80	$0.00	$0.00	$0.00	$72.15	$0.00	$0.00	$73.39	$0.00	$0.00	$0.00	$0.00	$0.00
27805146	EAP	HCPCS C1876		STENT BIL 10MM 8FR 60MM .035IN RAPEX UNCVR GWIRE DLV SYS	BOTH IP/OP	$461.00 	$341.14	$0.00	$368.80	$207.45	$207.45	$0.00	$0.00	$0.00	$96.08	$342.15	$342.15	$355.34	$0.00	$96.07	$0.00	$272.68	$272.68	$0.00	$230.50	$365.11	$368.80	$0.00	$0.00	$0.00	$72.15	$0.00	$0.00	$73.39	$0.00	$0.00	$0.00	$0.00	$0.00
27805147	EAP	HCPCS C1876		STENT BIL 8MM 8FR 100MM .035IN RAPEX NCT UNCVR DLV SYS	BOTH IP/OP	$461.00 	$341.14	$0.00	$368.80	$207.45	$207.45	$0.00	$0.00	$0.00	$96.08	$342.15	$342.15	$355.34	$0.00	$96.07	$0.00	$272.68	$272.68	$0.00	$230.50	$365.11	$368.80	$0.00	$0.00	$0.00	$72.15	$0.00	$0.00	$73.39	$0.00	$0.00	$0.00	$0.00	$0.00
27805148	EAP	HCPCS C1777		LEAD PCNG 64CM 9FR ECRDM 1 COIL PSV FIX BIPOL CARDVRT DFBR	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805149	EAP	HCPCS C1898		LEAD PCNG 59CM 9FR 18CM SPC ECRDM 1 COIL PSV FIX BIPOL	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805150	EAP	HCPCS C1777		ENDOTAK RELIANCE PF (Passive Fixation) LEADS	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805151	EAP	HCPCS C1777		ENDOTAK RELIANCE S PF (Passive Fixation) LEADS	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805152	EAP	HCPCS C1898		LEAD PCNG 90CM 18CM SPC ECRDM BIPOL PSV FIX 2 COIL IS-1 DF-1	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805153	EAP	HCPCS C1895		LEAD PCNG ECRDM DUAL COIL ICD PSV FIX CARDVRT DFBR IMPLTABLE	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805154	EAP	HCPCS C1898		LEAD PCNG 64CM 9FR 18CM SPC ECRDL BIPOL PSV FIX 2 COIL TN	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805155	EAP	HCPCS C1875		STENT BIL 8MM 8.5FR  80MM 70MM .035IN RAPEX PRT RMLM COVERED	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$781.54	$781.54	$811.65	$0.00	$219.45	$0.00	$0.00	$0.00	$0.00	$526.50	$833.98	$842.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805156	EAP	HCPCS C1898		LEAD PCNG 59CM 9FR 18CM SPC ECRDM BIPOL PSV FIX 2 COIL IS-1	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805157	EAP	HCPCS C1900		LEAD PCNG 80CM 4.1-2.6FR SPRL LV CORON VNS ACTY	BOTH IP/OP	"$5,911.00 "	"$4,374.14"	$0.00	"$4,728.80"	"$2,659.95"	"$2,659.95"	$0.00	$0.00	$0.00	"$1,232.00"	"$4,181.12"	"$4,181.12"	"$4,556.20"	$0.00	"$1,231.85"	$0.00	"$2,914.12"	"$2,914.12"	$0.00	"$2,955.50"	"$4,681.51"	"$4,728.80"	$0.00	$0.00	$0.00	$925.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805158	EAP	HCPCS C1779		LEAD PCNG 90CM 4.1-2.6FR SPRL LV CORON VNS IMPLTABLE ACTY	BOTH IP/OP	"$5,911.00 "	"$4,374.14"	$0.00	"$4,728.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,556.20"	$0.00	"$1,231.85"	$0.00	$0.00	$0.00	$0.00	"$2,955.50"	"$4,681.51"	"$4,728.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805159	EAP	HCPCS C1777		LEAD PCNG ECRDM 1 COIL ICD CARDVRT DFBR IMPLTABLE ETAK RLNC	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805160	EAP	HCPCS C1900		LEAD PCNG 80CM CORON VNS STRBL BIPOL ACTY STRD ELUT	BOTH IP/OP	"$5,911.00 "	"$4,374.14"	$0.00	"$4,728.80"	"$2,659.95"	"$2,659.95"	$0.00	$0.00	$0.00	"$1,232.00"	"$4,181.12"	"$4,181.12"	"$4,556.20"	$0.00	"$1,231.85"	$0.00	"$2,914.12"	"$2,914.12"	$0.00	"$2,955.50"	"$4,681.51"	"$4,728.80"	$0.00	$0.00	$0.00	$925.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805161	EAP	HCPCS C2625		STENT BIL 7FR 5CM RAPEX NONCORONARY TEMP DLV SYS PLST DISP	BOTH IP/OP	"$5,911.00 "	"$4,374.14"	$0.00	"$4,728.80"	"$2,659.95"	"$2,659.95"	$0.00	$0.00	$0.00	"$1,232.00"	"$4,181.12"	"$4,181.12"	"$4,556.20"	$0.00	"$1,231.85"	$0.00	"$2,914.12"	"$2,914.12"	$0.00	"$2,955.50"	"$4,681.51"	"$4,728.80"	$0.00	$0.00	$0.00	$925.07	$0.00	$0.00	$941.03	$0.00	$0.00	$0.00	$0.00	$0.00
27805162	EAP	HCPCS C1777		LEAD PCNG ECRDM 1 COIL ICD CARDVRT DFBR IMPLTABLE ETAK RLNC	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805163	EAP	HCPCS C1777		Lead Dfbr Etak Rlnc G Act Fix	BOTH IP/OP	"$13,300.00 "	"$9,842.00"	$0.00	"$10,640.00"	"$5,985.00"	"$5,985.00"	$0.00	$0.00	$0.00	"$2,772.05"	"$4,181.12"	"$4,181.12"	"$10,251.64"	$0.00	"$2,771.72"	$0.00	"$6,556.90"	"$6,556.90"	$0.00	"$6,650.00"	"$10,533.60"	"$10,640.00"	$0.00	$0.00	$0.00	"$2,081.45"	$0.00	$0.00	"$2,117.36"	$0.00	$0.00	$0.00	$0.00	$0.00
27805164	EAP	HCPCS C1777		Lead Dfbr Etak Rlnc G Psv Fix	BOTH IP/OP	"$13,300.00 "	"$9,842.00"	$0.00	"$10,640.00"	"$5,985.00"	"$5,985.00"	$0.00	$0.00	$0.00	"$2,772.05"	"$4,181.12"	"$4,181.12"	"$10,251.64"	$0.00	"$2,771.72"	$0.00	"$6,556.90"	"$6,556.90"	$0.00	"$6,650.00"	"$10,533.60"	"$10,640.00"	$0.00	$0.00	$0.00	"$2,081.45"	$0.00	$0.00	"$2,117.36"	$0.00	$0.00	$0.00	$0.00	$0.00
27805165	EAP	HCPCS C1898		LEAD PCNG 90CM 18CM SPC ECRDM DUAL COIL ACT DISTAL TIP ELTRD	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805166	EAP	HCPCS C1785		PCMKR CRD THK8MM 49X43MM ALTRUA 40DR ATR VNTRC IMPLTABLE 2	BOTH IP/OP	"$11,527.00 "	"$8,529.98"	$0.00	"$9,221.60"	"$5,187.15"	"$5,187.15"	$0.00	$0.00	$0.00	"$2,402.51"	"$4,181.12"	"$4,181.12"	"$8,885.01"	$0.00	"$2,402.23"	$0.00	"$5,682.81"	"$5,682.81"	$0.00	"$5,763.50"	"$9,129.38"	"$9,221.60"	$0.00	$0.00	$0.00	"$1,803.98"	$0.00	$0.00	"$1,835.10"	$0.00	$0.00	$0.00	$0.00	$0.00
27805167	EAP	HCPCS C1786		PCMKR CRD 8MM 43X49MM ALTRUA 40 IS-1 CONCTR	BOTH IP/OP	"$11,527.00 "	"$8,529.98"	$0.00	"$9,221.60"	"$5,187.15"	"$5,187.15"	$0.00	$0.00	$0.00	"$2,402.51"	"$4,181.12"	"$4,181.12"	"$8,885.01"	$0.00	"$2,402.23"	$0.00	"$5,682.81"	"$5,682.81"	$0.00	"$5,763.50"	"$9,129.38"	"$9,221.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805168	EAP	HCPCS C1785		PCMKR CRD THK8MM 44X42MM ALTRUA 40DR ATR VNTRC IMPLTABLE 2	BOTH IP/OP	"$11,527.00 "	"$8,529.98"	$0.00	"$9,221.60"	"$5,187.15"	"$5,187.15"	$0.00	$0.00	$0.00	"$2,402.51"	"$4,181.12"	"$4,181.12"	"$8,885.01"	$0.00	"$2,402.23"	$0.00	"$5,682.81"	"$5,682.81"	$0.00	"$5,763.50"	"$9,129.38"	"$9,221.60"	$0.00	$0.00	$0.00	"$1,803.98"	$0.00	$0.00	"$1,835.10"	$0.00	$0.00	$0.00	$0.00	$0.00
27805169	EAP	HCPCS C1786		PCMKR CRD THK8MM 42X42MM ALTRUA 40SR 1 CHMBR RT RSPN	BOTH IP/OP	"$10,049.00 "	"$7,436.26"	$0.00	"$8,039.20"	"$4,522.05"	"$4,522.05"	$0.00	$0.00	$0.00	"$2,094.46"	"$4,181.12"	"$4,181.12"	"$7,745.77"	$0.00	"$2,094.21"	$0.00	"$4,954.16"	"$4,954.16"	$0.00	"$5,024.50"	"$7,958.81"	"$8,039.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805170	EAP	HCPCS C1785		Pcmkr Crd Altura 2 Lead Sys	BOTH IP/OP	"$14,482.00 "	"$10,716.68"	$0.00	"$11,585.60"	"$6,516.90"	"$6,516.90"	$0.00	$0.00	$0.00	"$3,018.41"	"$4,181.12"	"$4,181.12"	"$11,162.73"	$0.00	"$3,018.05"	$0.00	"$7,139.63"	"$7,139.63"	$0.00	"$7,241.00"	"$11,469.74"	"$11,585.60"	$0.00	$0.00	$0.00	"$2,266.43"	$0.00	$0.00	"$2,305.53"	$0.00	$0.00	$0.00	$0.00	$0.00
27805171	EAP	HCPCS C1898		LEAD PCNG 70CM 9FR 18CM SPC ECRDM DUALCOIL XTD-RETRAC DF-1	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805172	EAP	HCPCS C1898		LEAD PCNG 64CM 9FR ECRDM BIPOL ACT FIX DUAL COIL XTD-RETRAC	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805173	EAP	HCPCS C1898		LEAD PCNG 59CM 18CM SPC ECRDM BIPOL ACT FIX XTD-RETRAC 2	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805174	EAP	HCPCS C1898		LEAD PCNG 64CM HLX ECRDM 1 COIL BIPOL ACT FIX XTD-RETRAC	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805175	EAP	HCPCS C1777		ENDOTAK RELIANCE G AF (Active Fixation) LEADS	BOTH IP/OP	"$13,300.00 "	"$9,842.00"	$0.00	"$10,640.00"	"$5,985.00"	"$5,985.00"	$0.00	$0.00	$0.00	"$2,772.05"	"$4,181.12"	"$4,181.12"	"$10,251.64"	$0.00	"$2,771.72"	$0.00	"$6,556.90"	"$6,556.90"	$0.00	"$6,650.00"	"$10,533.60"	"$10,640.00"	$0.00	"$5,985.00"	$0.00	"$2,081.45"	$0.00	$0.00	"$2,117.36"	$0.00	$0.00	$0.00	$0.00	$0.00
27805176	EAP	HCPCS C1777		Lead Dfbr Etak Rlnc G Act Fix	BOTH IP/OP	"$13,300.00 "	"$9,842.00"	$0.00	"$10,640.00"	"$5,985.00"	"$5,985.00"	$0.00	$0.00	$0.00	"$2,772.05"	"$4,181.12"	"$4,181.12"	"$10,251.64"	$0.00	"$2,771.72"	$0.00	"$6,556.90"	"$6,556.90"	$0.00	"$6,650.00"	"$10,533.60"	"$10,640.00"	$0.00	$0.00	$0.00	"$2,081.45"	$0.00	$0.00	"$2,117.36"	$0.00	$0.00	$0.00	$0.00	$0.00
27805177	EAP	HCPCS C1876		STENT TRCHBR 7MM 8MM 30MM SLF XPD ARWY DLV SYS PLFX SIL	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,182.40"	$665.10	$665.10	$0.00	$0.00	$0.00	$308.05	"$1,096.97"	"$1,096.97"	"$1,139.24"	$0.00	$308.02	$0.00	$874.24	$874.24	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$231.31	$0.00	$0.00	$235.30	$0.00	$0.00	$0.00	$0.00	$0.00
27805178	EAP	HCPCS C1882		COGNIS / ACUITY/ ENDOTAK - CARDIAC RESYNCHRONIZATION THERAPY	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27805179	EAP	HCPCS C1898		LEAD PCNG 90CM 9FR 18CM SPC ECRDM DUAL COIL ACT FIX BIPOL	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805180	EAP	HCPCS C1898		LEAD PCNG 64CM 9FR 18CM SPC ECRDL DUAL COIL IMPLTABLE	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805181	EAP	HCPCS C1898		LEAD PCNG 59CM 9FR 18CM SPC ECRDL BIPOL ACT FIX 2 COIL	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805182	EAP	HCPCS C1896		LEAD PCNG ECRDL 1 COIL ACT FIX CARDVRT DFBR IMPLTABLE ETAK	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805183	EAP	HCPCS C1898		LEAD PCNG 45CM 6.7FR 10MM SPC RIGHT AV XTD-RETRAC ACT FIX	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805184	EAP	HCPCS C1777		ENDOTAK RELIANCE AF (Active Fixation) LEADS	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	"$5,053.95"	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805185	EAP	HCPCS C1898		LEAD PCNG 60CM 6.7FR 10MM SPC RIGHT AV ECRDL IS-1 CONCTR	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805186	EAP	HCPCS C1900		Easytrack 2	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	"$1,994.85"	"$1,994.85"	$0.00	$0.00	$0.00	$923.95	"$3,290.17"	"$3,290.17"	"$3,416.96"	$0.00	$923.84	$0.00	"$2,185.47"	"$2,185.47"	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$693.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805187	EAP	HCPCS C1898		Lead Pcng Sm Act Fix Rlnc	BOTH IP/OP	"$11,231.00 "	"$8,310.94"	$0.00	"$8,984.80"	"$5,053.95"	"$5,053.95"	$0.00	$0.00	$0.00	"$2,340.82"	"$4,181.12"	"$4,181.12"	"$8,656.85"	$0.00	"$2,340.54"	$0.00	"$5,536.88"	"$5,536.88"	$0.00	"$5,615.50"	"$8,894.95"	"$8,984.80"	$0.00	$0.00	$0.00	"$1,757.65"	$0.00	$0.00	"$1,787.98"	$0.00	$0.00	$0.00	$0.00	$0.00
27805188	EAP	HCPCS C1887		RAPIDO ADVANCE LEAD DELIVERY SYSTEM	BOTH IP/OP	"$2,941.00 "	"$2,176.34"	$0.00	"$2,352.80"	"$1,323.45"	"$1,323.45"	$0.00	$0.00	$0.00	$612.98	"$2,182.81"	"$2,182.81"	"$2,266.92"	$0.00	$612.90	$0.00	"$1,449.91"	"$1,449.91"	$0.00	"$1,470.50"	"$2,329.27"	"$2,352.80"	$0.00	$0.00	$0.00	$460.27	$0.00	$0.00	$468.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805189	EAP	HCPCS C1900		LEAD PCNG 80CM 5.4FR CORON VNS LV IS 1 BIPOL OTW EZTRK 2	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	"$1,994.85"	"$1,994.85"	$0.00	$0.00	$0.00	$923.95	"$3,290.17"	"$3,290.17"	"$3,416.96"	$0.00	$923.84	$0.00	"$2,185.47"	"$2,185.47"	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$693.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805190	EAP	HCPCS C1898		LEAD PCNG CORON VNS IS 1 EZTRK 2	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	"$1,994.85"	"$1,994.85"	$0.00	$0.00	$0.00	$923.95	"$3,290.17"	"$3,290.17"	"$3,416.96"	$0.00	$923.84	$0.00	"$2,185.47"	"$2,185.47"	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$693.76	$0.00	$0.00	$705.73	$0.00	$0.00	$0.00	$0.00	$0.00
27805191	EAP	HCPCS C1898		LEAD PCNG 100CM 7-5FR 8.5MM .035IN CORON VNS LV IS-1 DUAL	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	"$1,994.85"	"$1,994.85"	$0.00	$0.00	$0.00	$923.95	"$3,290.17"	"$3,290.17"	"$3,416.96"	$0.00	$923.84	$0.00	"$2,185.47"	"$2,185.47"	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$693.76	$0.00	$0.00	$705.73	$0.00	$0.00	$0.00	$0.00	$0.00
27805192	EAP	HCPCS C1898		LEAD PCNG 80CM 8FR J ECRDL RIGHT ARTIAL BIPOL IS-1 LV-1 DUAL	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	"$1,994.85"	"$1,994.85"	$0.00	$0.00	$0.00	$923.95	"$3,290.17"	"$3,290.17"	"$3,416.96"	$0.00	$923.84	$0.00	"$2,185.47"	"$2,185.47"	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$693.76	$0.00	$0.00	$705.73	$0.00	$0.00	$0.00	$0.00	$0.00
27805193	EAP	HCPCS C1898		LEAD PCNG 90CM CORON VNS LV LV-1 DUAL ELTRD CONCTR BIPOL PSV	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	"$1,994.85"	"$1,994.85"	$0.00	$0.00	$0.00	$923.95	"$3,290.17"	"$3,290.17"	"$3,416.96"	$0.00	$923.84	$0.00	"$2,185.47"	"$2,185.47"	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$693.76	$0.00	$0.00	$705.73	$0.00	$0.00	$0.00	$0.00	$0.00
27805194	EAP	HCPCS C1779		LEAD PCNG 35CM MYOCARDIUM VNTRC IS-1 CONCTR SCR FIX UNPLR	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805195	EAP	HCPCS C1898		LEAD PCNG 80CM 8FR CORON VNS BIPOL DUAL ELTRD SPRL FIX IS-1	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	"$1,994.85"	"$1,994.85"	$0.00	$0.00	$0.00	$923.95	"$3,290.17"	"$3,290.17"	"$3,416.96"	$0.00	$923.84	$0.00	"$2,185.47"	"$2,185.47"	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$693.76	$0.00	$0.00	$705.73	$0.00	$0.00	$0.00	$0.00	$0.00
27805196	EAP	HCPCS C1898		LEAD PCNG 90CM CORON VNS LV IS-1 EZTRK 3IS-1 STRD ELUT SIL	BOTH IP/OP	"$4,433.00 "	"$3,280.42"	$0.00	"$3,546.40"	"$1,994.85"	"$1,994.85"	$0.00	$0.00	$0.00	$923.95	"$3,290.17"	"$3,290.17"	"$3,416.96"	$0.00	$923.84	$0.00	"$2,185.47"	"$2,185.47"	$0.00	"$2,216.50"	"$3,510.94"	"$3,546.40"	$0.00	$0.00	$0.00	$693.76	$0.00	$0.00	$705.73	$0.00	$0.00	$0.00	$0.00	$0.00
27805197	EAP	HCPCS C1779		LEAD PCNG 35CM MYOCARDIUM EPICARDIUM RV IS-1 CONCTR OTHR	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805198	EAP	HCPCS C1899		LEAD PCNG 59CM ECRDL 4 ST DUAL COIL IMPLTABLE CARDVRT DFBR	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	$0.00	$0.00	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805199	EAP	HCPCS C1898		LEAD PCNG 64CM ECRDL 4 ST DUAL COIL ACT FIX IMPLTABLE	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805200	EAP	HCPCS C1898		LEAD PCNG 59CM ECRDM 4-ST DUAL COIL ACT DF4 TRM CONCTR	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805201	EAP	HCPCS C1898		LEAD PCNG 64CM ECRDM 4-ST DUAL COIL ACT DF4 TRM CONCTR	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805202	EAP	HCPCS C1898		LEAD PCNG 59CM ECRDM 4-ST DUAL COIL PSV DF4 TRM CONCTR	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805203	EAP	HCPCS C1898		LEAD PCNG 64CM ECRDL 4 ST DUAL COIL ACT FIX IMPLTABLE	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805204	EAP	HCPCS C1898		LEAD PCNG 59CM ECRDL 4 ST DUAL COIL PSV FIX IMPLTABLE	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805205	EAP	HCPCS C1898		LEAD PCNG 64CM ECRDL 4 ST DUAL COIL PSV FIX IMPLTABLE	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805206	EAP	HCPCS C1777		LEAD PCNG 59CM ECRDM 4-ST 1 COIL ACT DF4 TRM CONCTR CARDVRT	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805207	EAP	HCPCS C1777		LEAD PCNG 64CM ECRDL 4 ST 1 COIL PSV FIX IMPLTABLE CARDVRT	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805208	EAP	HCPCS C1777		LEAD PCNG 59CM ECRDL 4 ST 1 COIL PSV FIX IMPLTABLE CARDVRT	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805209	EAP	HCPCS C1777		LEAD PCNG 64CM ECRDL 4 ST 1 COIL PSV FIX IMPLTABLE CARDVRT	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805210	EAP	HCPCS C1900		INVIVE / EASYTRAK or ACUITY / w RV or AV LEAD: CARDIAC RESYN	BOTH IP/OP	"$26,452.00 "	"$19,574.48"	$0.00	"$21,161.60"	"$11,903.40"	"$11,903.40"	$0.00	$0.00	$0.00	"$5,513.26"	"$4,181.12"	"$4,181.12"	"$20,389.20"	$0.00	"$5,512.60"	$0.00	"$13,040.84"	"$13,040.84"	$0.00	"$13,226.00"	"$20,949.98"	"$21,161.60"	$0.00	$0.00	$0.00	"$4,139.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805211	EAP	HCPCS C1900		INVIVE / EASYTRAK or ACUITY / w RV & AV LEAD: CARDIAC RESYNC	BOTH IP/OP	"$26,452.00 "	"$19,574.48"	$0.00	"$21,161.60"	"$11,903.40"	"$11,903.40"	$0.00	$0.00	$0.00	"$5,513.26"	"$4,181.12"	"$4,181.12"	"$20,389.20"	$0.00	"$5,512.60"	$0.00	"$13,040.84"	"$13,040.84"	$0.00	"$13,226.00"	"$20,949.98"	"$21,161.60"	$0.00	$0.00	$0.00	"$4,139.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805212	EAP	HCPCS C1722		INCEPTA LV-1 / EASYTRAK or ACUITY / ENDOTAK w ATRIAL LEAD: C	BOTH IP/OP	"$71,524.00 "	"$52,927.76"	$0.00	"$57,219.20"	"$32,185.80"	"$32,185.80"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$55,130.70"	$0.00	"$14,905.60"	$0.00	"$35,261.33"	"$35,261.33"	$0.00	"$35,762.00"	"$56,647.01"	"$57,219.20"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27805213	EAP	HCPCS C1898		LEAD PCNG 59CM 2.4MM STR ATR VNTRC BIPOL ACT FIX RTRCT HLX	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805214	EAP	HCPCS C1898		LEAD PCNG 45CM ECRDM ATR VNTRC IS-1 CONCTR ACT FIX BIPOL SIL	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805215	EAP	HCPCS C1898		LEAD PCNG ECRDL RIGHT ATR RV IS-1 CONCTR BIPOL XTD-RETRAC	BOTH IP/OP	"$1,463.00 "	"$1,082.62"	$0.00	"$1,170.40"	$658.35	$658.35	$0.00	$0.00	$0.00	$304.93	"$1,085.84"	"$1,085.84"	"$1,127.68"	$0.00	$304.89	$0.00	$865.36	$865.36	$0.00	$731.50	"$1,158.70"	"$1,170.40"	$0.00	$0.00	$0.00	$228.96	$0.00	$0.00	$232.91	$0.00	$0.00	$0.00	$0.00	$0.00
27805216	EAP	HCPCS C1898		LEAD PCNG ECRDM RIGHT ATR LV BIPOL IS-1 SCR FIX SIL INSL FLN	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805217	EAP	HCPCS C1898		LEAD PCNG 52CM 7FR RIGHT ATR VNTRC ECRDM IS-1 CONCTR BIPOL	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805218	EAP	HCPCS C1898		LEAD PCNG 45CM 6FR ECRDL OTHR THAN TRNVNS VDD 1 PASS BIPOL	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805219	EAP	HCPCS C1898		LEAD PCNG 58CM 5FR ECRDM AV BIPOL ACT FIX SCR IN IS-1 FLN2	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805220	EAP	HCPCS C1898		LEAD PCNG 52CM 7FR STR ECRDM RIGHT ATR LV BIPOL IS-1 SCR FIX	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805221	EAP	HCPCS C1779		LEAD PCNG 45CM 7FR THK1.7MM STR ATR VNTRC BIPOL ACT FIX FLN2	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805222	EAP	HCPCS C1898		LEAD PCNG 52CM OTHR THAN TRNVNS VDD 1 PASS IMPLTABLE FLN2	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805223	EAP	HCPCS C1898		LEAD PCNG 45CM 8FR J ECRDM RIGHT ATR BIPOL IS-1 PSV FIX POLY	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805224	EAP	HCPCS C1900		LEAD PCNG 58CM 6FR ECRDM VNTRC BIPOL IS-1 PSV FIX FLN2	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805225	EAP	HCPCS C1779		LEAD PCNG 52CM 9FR RV ECRDM BIPOL IS-1 PSV FIX TRNVNS VDD 1	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805226	EAP	HCPCS C1898		LEAD PCNG RV ECRDM BIPOL PSV FIX IS-1 FLN2 STRX PU	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27805227	EAP	HCPCS C1900		LEAD PCNG 52CM VNTRC ECRDL OTHR THAN TRNVNS VDD 1 PASS BIPOL	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	"$1,025.16"	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00	$0.00	$0.00	$208.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805228	EAP	Custom 27805228		Sensor Flotrac Vamp Adult 60in 152cm Sterile	BOTH IP/OP	$961.00 	$711.14	$0.00	$768.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$713.25	$713.25	$740.74	$0.00	$200.27	$0.00	$0.00	$0.00	$0.00	$480.50	$761.11	$768.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805229	EAP	Custom 27805229		Sensor Monitor  Flotrac Adlt L60 In Vamp Bifurcated Pres	BOTH IP/OP	$961.00 	$711.14	$0.00	$768.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$713.25	$713.25	$740.74	$0.00	$200.27	$0.00	$0.00	$0.00	$0.00	$480.50	$761.11	$768.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805231	EAP	HCPCS C1874		Stent Endoprsth 8mm 5cm 120cm .035in Dlv Sys Tip To Hubl	BOTH IP/OP	"$7,966.00 "	"$5,894.84"	$0.00	"$6,372.80"	"$3,584.70"	"$3,584.70"	$0.00	$0.00	$0.00	"$1,660.31"	"$4,181.12"	"$4,181.12"	"$6,140.19"	$0.00	"$1,660.11"	$0.00	"$3,927.24"	"$3,927.24"	$0.00	"$3,983.00"	"$6,309.07"	"$6,372.80"	$0.00	$0.00	$0.00	"$1,246.68"	$0.00	$0.00	"$1,268.19"	$0.00	$0.00	$0.00	$0.00	$0.00
27805232	EAP	HCPCS C1874		Stent Endoprsth 8mm 10cm 120cm .035in Dlv Sys Tip To Hul	BOTH IP/OP	"$9,148.00 "	"$6,769.52"	$0.00	"$7,318.40"	"$4,116.60"	"$4,116.60"	$0.00	$0.00	$0.00	"$1,906.67"	"$4,181.12"	"$4,181.12"	"$7,051.28"	$0.00	"$1,906.44"	$0.00	"$4,509.96"	"$4,509.96"	$0.00	"$4,574.00"	"$7,245.22"	"$7,318.40"	$0.00	$0.00	$0.00	"$1,431.66"	$0.00	$0.00	"$1,456.36"	$0.00	$0.00	$0.00	$0.00	$0.00
27805233	EAP	HCPCS C1874		Stent Endoprsth 10mm 5cm 120cm .035in Dlv Sys Tip To Hul	BOTH IP/OP	"$7,966.00 "	"$5,894.84"	$0.00	"$6,372.80"	"$3,584.70"	"$3,584.70"	$0.00	$0.00	$0.00	"$1,660.31"	"$4,181.12"	"$4,181.12"	"$6,140.19"	$0.00	"$1,660.11"	$0.00	"$3,927.24"	"$3,927.24"	$0.00	"$3,983.00"	"$6,309.07"	"$6,372.80"	$0.00	$0.00	$0.00	"$1,246.68"	$0.00	$0.00	"$1,268.19"	$0.00	$0.00	$0.00	$0.00	$0.00
27805234	EAP	HCPCS C1874		Stent Endoprsth 10mm 10cm 120cm .035in Dlv Sys Tip To Hb	BOTH IP/OP	"$9,148.00 "	"$6,769.52"	$0.00	"$7,318.40"	"$4,116.60"	"$4,116.60"	$0.00	$0.00	$0.00	"$1,906.67"	"$4,181.12"	"$4,181.12"	"$7,051.28"	$0.00	"$1,906.44"	$0.00	"$4,509.96"	"$4,509.96"	$0.00	"$4,574.00"	"$7,245.22"	"$7,318.40"	$0.00	$0.00	$0.00	"$1,431.66"	$0.00	$0.00	"$1,456.36"	$0.00	$0.00	$0.00	$0.00	$0.00
27805235	EAP	HCPCS C1874		Stent Endoprsth 6mm 7fr 5cm 120cm .035in Hep Bioactive C	BOTH IP/OP	"$7,061.00 "	"$5,225.14"	$0.00	"$5,648.80"	"$3,177.45"	"$3,177.45"	$0.00	$0.00	$0.00	"$1,471.69"	"$4,181.12"	"$4,181.12"	"$5,442.62"	$0.00	"$1,471.51"	$0.00	"$3,481.07"	"$3,481.07"	$0.00	"$3,530.50"	"$5,592.31"	"$5,648.80"	$0.00	"$3,177.45"	$0.00	"$1,105.05"	$0.00	$0.00	"$1,124.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27805236	EAP	HCPCS C1874		Stent Endoprsth 6mm 10cm 120cm .035in Dlv Sys Tip To Hul	BOTH IP/OP	"$9,604.00 "	"$7,106.96"	$0.00	"$7,683.20"	"$4,321.80"	"$4,321.80"	$0.00	$0.00	$0.00	"$2,001.71"	"$4,181.12"	"$4,181.12"	"$7,402.76"	$0.00	"$2,001.47"	$0.00	"$4,734.77"	"$4,734.77"	$0.00	"$4,802.00"	"$7,606.37"	"$7,683.20"	$0.00	$0.00	$0.00	"$1,503.03"	$0.00	$0.00	"$1,528.96"	$0.00	$0.00	$0.00	$0.00	$0.00
27805240	EAP	HCPCS V2790		Graft Crnl 16mm Prokera Amnio Membr Crprs Ring Set	BOTH IP/OP	"$2,646.00 "	"$1,958.04"	$0.00	"$2,116.80"	"$1,190.70"	"$1,190.70"	$0.00	$0.00	$0.00	$551.49	"$1,963.86"	"$1,963.86"	"$2,039.54"	$0.00	$551.43	$0.00	"$1,304.48"	"$1,304.48"	$0.00	"$1,323.00"	"$2,095.63"	"$2,116.80"	$0.00	$0.00	$0.00	$414.10	$0.00	$0.00	$421.24	$0.00	$0.00	$0.00	$0.00	$0.00
27805252	EAP	Custom 27805252		Pipeline  Embolization  Device  2.75 Cm 10mm	BOTH IP/OP	"$38,126.00 "	"$28,213.24"	$0.00	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,387.52"	$0.00	"$7,945.46"	$0.00	$0.00	$0.00	$0.00	"$19,063.00"	"$30,195.79"	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805253	EAP	Custom 27805253		Pipeline  Embolization  Device 2.75 Cm 12mm	BOTH IP/OP	"$38,126.00 "	"$28,213.24"	$0.00	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,387.52"	$0.00	"$7,945.46"	$0.00	$0.00	$0.00	$0.00	"$19,063.00"	"$30,195.79"	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805254	EAP	Custom 27805254		PIPELINE  EMBOLIZATION  DEVICE 2.75CM 16MM	BOTH IP/OP	"$38,126.00 "	"$28,213.24"	$0.00	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,387.52"	$0.00	"$7,945.46"	$0.00	$0.00	$0.00	$0.00	"$19,063.00"	"$30,195.79"	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805255	EAP	Custom 27805255		Pipeline  Embolization  Device 3.00cm 10mm	BOTH IP/OP	"$38,126.00 "	"$28,213.24"	$0.00	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,387.52"	$0.00	"$7,945.46"	$0.00	$0.00	$0.00	$0.00	"$19,063.00"	"$30,195.79"	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805256	EAP	Custom 27805256		Pipeline  Embolization  Device 3.00cm 12mm	BOTH IP/OP	"$38,126.00 "	"$28,213.24"	$0.00	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,387.52"	$0.00	"$7,945.46"	$0.00	$0.00	$0.00	$0.00	"$19,063.00"	"$30,195.79"	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805257	EAP	Custom 27805257		Pipeline  Embolization  Device  3.00cm 16mm	BOTH IP/OP	"$38,126.00 "	"$28,213.24"	$0.00	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,387.52"	$0.00	"$7,945.46"	$0.00	$0.00	$0.00	$0.00	"$19,063.00"	"$30,195.79"	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805258	EAP	Custom 27805258		Pipeline  Embolization  Device  3.50cm 10mm	BOTH IP/OP	"$38,126.00 "	"$28,213.24"	$0.00	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,387.52"	$0.00	"$7,945.46"	$0.00	$0.00	$0.00	$0.00	"$19,063.00"	"$30,195.79"	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805259	EAP	Custom 27805259		PIPELINE  EMBOLIZATION  DEVICE 3.5CM 12MM	BOTH IP/OP	"$38,126.00 "	"$28,213.24"	$0.00	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,387.52"	$0.00	"$7,945.46"	$0.00	$0.00	$0.00	$0.00	"$19,063.00"	"$30,195.79"	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805260	EAP	Custom 27805260		PIPELINE  EMBOLIZATION  DEVICE 3.5CM 16MM	BOTH IP/OP	"$38,126.00 "	"$28,213.24"	$0.00	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,387.52"	$0.00	"$7,945.46"	$0.00	$0.00	$0.00	$0.00	"$19,063.00"	"$30,195.79"	"$30,500.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805265	EAP	HCPCS C1777		Linox Smart Dx 65/17	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805266	EAP	HCPCS C1777		Linox Smart Dx 65/15	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805267	EAP	HCPCS C1777		Lumax 740 Vr-t Dx W/gsm Hm	BOTH IP/OP	"$45,811.00 "	"$33,900.14"	$0.00	"$36,648.80"	"$20,614.95"	"$20,614.95"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$35,311.12"	$0.00	"$9,547.01"	$0.00	"$22,584.82"	"$22,584.82"	$0.00	"$22,905.50"	"$36,282.31"	"$36,648.80"	$0.00	$0.00	$0.00	"$7,169.42"	$0.00	$0.00	"$7,293.11"	$0.00	$0.00	$0.00	$0.00	$0.00
27805268	EAP	HCPCS C1777		Lumax 740 Vr-t Dx System W/gsm Hm	BOTH IP/OP	"$57,560.00 "	"$42,594.40"	$0.00	"$46,048.00"	"$25,902.00"	"$25,902.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$44,367.25"	$0.00	"$11,995.50"	$0.00	"$28,377.08"	"$28,377.08"	$0.00	"$28,780.00"	"$45,587.52"	"$46,048.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27805269	EAP	HCPCS C1781		"Mesh Surg Craniocurve .6mm Occptl Crnm Etch Lbl Antm, 01-9520"	BOTH IP/OP	"$11,822.00 "	"$8,748.28"	$0.00	"$9,457.60"	"$5,319.90"	"$5,319.90"	$0.00	$0.00	$0.00	"$2,464.00"	"$4,181.12"	"$4,181.12"	"$9,112.40"	$0.00	"$2,463.70"	$0.00	"$5,828.25"	"$5,828.25"	$0.00	"$5,911.00"	"$9,363.02"	"$9,457.60"	$0.00	$0.00	$0.00	"$1,850.14"	$0.00	$0.00	"$1,882.06"	$0.00	$0.00	$0.00	$0.00	$0.00
27805270	EAP	Custom 27805270		Target Coils 360 Standard 3mm X 6cm	BOTH IP/OP	"$4,559.00 "	"$3,373.66"	$0.00	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,383.69"	"$3,383.69"	"$3,514.08"	$0.00	$950.10	$0.00	$0.00	$0.00	$0.00	"$2,279.50"	"$3,610.73"	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805271	EAP	Custom 27805271		Target Coils 360 Standard 3mm X 8cm	BOTH IP/OP	"$4,559.00 "	"$3,373.66"	$0.00	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,383.69"	"$3,383.69"	"$3,514.08"	$0.00	$950.10	$0.00	$0.00	$0.00	$0.00	"$2,279.50"	"$3,610.73"	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805272	EAP	Custom 27805272		Target Coils 360 Standard 4mm X 8cm	BOTH IP/OP	"$4,559.00 "	"$3,373.66"	$0.00	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,383.69"	"$3,383.69"	"$3,514.08"	$0.00	$950.10	$0.00	$0.00	$0.00	$0.00	"$2,279.50"	"$3,610.73"	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805273	EAP	Custom 27805273		Target Coils 360 Standard 4mm X 10cm	BOTH IP/OP	"$4,559.00 "	"$3,373.66"	$0.00	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,383.69"	"$3,383.69"	"$3,514.08"	$0.00	$950.10	$0.00	$0.00	$0.00	$0.00	"$2,279.50"	"$3,610.73"	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805274	EAP	Custom 27805274		Target Coils 360 Standard 4mm X 15cm	BOTH IP/OP	"$4,559.00 "	"$3,373.66"	$0.00	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,383.69"	"$3,383.69"	"$3,514.08"	$0.00	$950.10	$0.00	$0.00	$0.00	$0.00	"$2,279.50"	"$3,610.73"	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805275	EAP	Custom 27805275		Target Coils 360 Standard 5mm X 15cm	BOTH IP/OP	"$4,559.00 "	"$3,373.66"	$0.00	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,383.69"	"$3,383.69"	"$3,514.08"	$0.00	$950.10	$0.00	$0.00	$0.00	$0.00	"$2,279.50"	"$3,610.73"	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805276	EAP	Custom 27805276		Target Coils 360 Standard 5mm X 20cm	BOTH IP/OP	"$4,559.00 "	"$3,373.66"	$0.00	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,383.69"	"$3,383.69"	"$3,514.08"	$0.00	$950.10	$0.00	$0.00	$0.00	$0.00	"$2,279.50"	"$3,610.73"	"$3,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805277	EAP	Custom 27805277		Target Coils 360 Standard 6mm X 15cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805278	EAP	Custom 27805278		Target Coils 360 Standard 6mm X 20cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805279	EAP	Custom 27805279		Target Coils 360 Standard 6mm X 30cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805280	EAP	Custom 27805280		Target Coils 360 Standard 7mm X 15cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805281	EAP	Custom 27805281		Target Coils 360 Standard 7mm X 20cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805282	EAP	Custom 27805282		Target Coils 360 Standard 7mm X 30cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805283	EAP	Custom 27805283		Target Coils 360 Standard 8mm X 20cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805284	EAP	Custom 27805284		Target Coils 360 Standard 8mm X 30cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805285	EAP	Custom 27805285		Target Coils 360 Standard 9mm X 20cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805286	EAP	Custom 27805286		Target Coils 360 Standard 9mm X 30cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805287	EAP	Custom 27805287		Target Coils 360 Standard 10mm X 30cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805288	EAP	Custom 27805288		Target Coils 360 Standard 11mm X 30cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805289	EAP	Custom 27805289		Target Coils 360 Standard 12mm X 30cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805290	EAP	Custom 27805290		Target Coils 360 Standard 13mm X 30cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805291	EAP	Custom 27805291		Target Coils 360 Standard 14mm X 30cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805292	EAP	Custom 27805292		Target Coils 360 Standard 15mm X 40cm	BOTH IP/OP	"$5,097.00 "	"$3,771.78"	$0.00	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,782.99"	"$3,782.99"	"$3,928.77"	$0.00	"$1,062.21"	$0.00	$0.00	$0.00	$0.00	"$2,548.50"	"$4,036.82"	"$4,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805293	EAP	Custom 27805293		Target Coils 360 Soft 2mm X 4cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805294	EAP	Custom 27805294		Target Coils 360 Soft 3mm X 6cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805295	EAP	Custom 27805295		Target Coils 360 Soft 3mm X 8cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805296	EAP	Custom 27805296		Target Coils 360 Soft 3mm X 10cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805297	EAP	Custom 27805297		Target Coils 360 Soft 4mm X 6cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805298	EAP	Custom 27805298		Target Coils 360 Soft 4mm X 8cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	"$2,172.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805299	EAP	Custom 27805299		Target Coils 360 Soft 4mm X 10cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805300	EAP	Custom 27805300		Target Coils 360 Soft 4mm X 15cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805301	EAP	Custom 27805301		Target Coils 360 Soft 5mm X 10cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805302	EAP	Custom 27805302		Target Coils 360 Soft 5mm X 15cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805303	EAP	Custom 27805303		Target Coils 360 Soft 5mm X 20cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805304	EAP	Custom 27805304		Target Coils 360 Soft 6mm X 10cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805305	EAP	Custom 27805305		Target Coils 360 Soft 6mm X 15cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	"$2,172.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805306	EAP	Custom 27805306		Target Coils 360 Soft 6mm X 20cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805307	EAP	Custom 27805307		Target Coils 360 Soft 6mm X 30cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805308	EAP	Custom 27805308		Target Coils 360 Soft 7mm X 15cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805309	EAP	Custom 27805309		Target Coils 360 Soft 7mm X 20cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805310	EAP	Custom 27805310		Target Coils 360 Soft 7mm X 30cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805311	EAP	Custom 27805311		Target Coils 360 Soft 8mm X 20cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805312	EAP	Custom 27805312		Target Coils 360 Soft 8mm X 30cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805313	EAP	Custom 27805313		Target Coils 360 Soft 9mm X 20cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805314	EAP	Custom 27805314		Target Coils 360 Soft 9mm X 30cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805315	EAP	Custom 27805315		Target Coils 360 Soft 10mm X 30cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805316	EAP	Custom 27805316		Target Coils 360 Soft 11mm X 30cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805317	EAP	Custom 27805317		Target Coils 360 Soft 12mm X 30cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805318	EAP	Custom 27805318		Target Coils 360 Soft 13mm X 30cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805319	EAP	Custom 27805319		Target Coils 360 Soft 14mm X 30cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805320	EAP	Custom 27805320		Target Coils Helical Ultra 1mm X 1cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805321	EAP	Custom 27805321		Target Coils Helical Ultra 1mm X 2cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805322	EAP	Custom 27805322		Target Coils Helical Ultra 1mm X 3cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805323	EAP	Custom 27805323		Target Coils Helical Ultra 1.5mm X 1cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805324	EAP	Custom 27805324		Target Coils Helical Ultra 1.5mm X 2cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805325	EAP	Custom 27805325		Target Coils Helical Ultra 1.5mm X 3cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805326	EAP	Custom 27805326		Target Coils Helical Ultra 1.5mm X 4cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805327	EAP	Custom 27805327		Target Coils Helical Ultra 2mm X 1cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805328	EAP	Custom 27805328		Target Coils Helical Ultra 2mm X 2cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805329	EAP	Custom 27805329		Target Coils Helical Ultra 2mm X 3cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805330	EAP	Custom 27805330		Target Coils Helical Ultra 2mm X 4cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805331	EAP	Custom 27805331		Target Coils Helical Ultra 2mm X 6cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805332	EAP	Custom 27805332		Target Coils Helical Ultra 2mm X 8cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805333	EAP	Custom 27805333		Target Coils Helical Ultra 2.5mm X 3cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805334	EAP	Custom 27805334		Target Coils Helical Ultra 2.5mm X 4cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805335	EAP	Custom 27805335		Target Coils Helical Ultra 2.5mm X 6cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805336	EAP	Custom 27805336		Target Coils Helical Ultra 3mm X 4cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805337	EAP	Custom 27805337		Target Coils Helical Ultra 3mm X 6cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805338	EAP	Custom 27805338		Target Coils Helical Ultra 3mm X 8cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805339	EAP	Custom 27805339		Target Coils Helical Ultra 3mm X 10cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805340	EAP	Custom 27805340		Target Coils Helical Ultra 4mm X 6cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805341	EAP	Custom 27805341		Target Coils Helical Ultra 4mm X 8cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805342	EAP	Custom 27805342		Target Coils Helical Ultra 4mm X 15cm	BOTH IP/OP	"$3,483.00 "	"$2,577.42"	$0.00	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,585.08"	"$2,585.08"	"$2,684.70"	$0.00	$725.86	$0.00	$0.00	$0.00	$0.00	"$1,741.50"	"$2,758.54"	"$2,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805343	EAP	Custom 27805343		Target Xl Detachable Coils 360 Soft 6 X 20cm	BOTH IP/OP	"$5,903.00 "	"$4,368.22"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.03"	$0.00	"$1,230.19"	$0.00	$0.00	$0.00	$0.00	"$2,951.50"	"$4,675.18"	"$4,722.40"	$0.00	"$2,656.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805344	EAP	Custom 27805344		Target Xl Detachable Coils 360 Soft 7 X 20cm	BOTH IP/OP	"$5,903.00 "	"$4,368.22"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.03"	$0.00	"$1,230.19"	$0.00	$0.00	$0.00	$0.00	"$2,951.50"	"$4,675.18"	"$4,722.40"	$0.00	"$2,656.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805345	EAP	Custom 27805345		Target Xl Detachable Coils 360 Soft 8 X 30cm	BOTH IP/OP	"$5,903.00 "	"$4,368.22"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.03"	$0.00	"$1,230.19"	$0.00	$0.00	$0.00	$0.00	"$2,951.50"	"$4,675.18"	"$4,722.40"	$0.00	"$2,656.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805346	EAP	Custom 27805346		Target Xl Detachable Coils 360 Soft 9 X 30cm	BOTH IP/OP	"$5,903.00 "	"$4,368.22"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.03"	$0.00	"$1,230.19"	$0.00	$0.00	$0.00	$0.00	"$2,951.50"	"$4,675.18"	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805347	EAP	Custom 27805347		Target Xl Detachable Coils 360 Soft 10 X 40cm	BOTH IP/OP	"$5,903.00 "	"$4,368.22"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.03"	$0.00	"$1,230.19"	$0.00	$0.00	$0.00	$0.00	"$2,951.50"	"$4,675.18"	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805348	EAP	Custom 27805348		Target Xl Detachable Coils 360 Soft 12 X 45cm	BOTH IP/OP	"$5,903.00 "	"$4,368.22"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.03"	$0.00	"$1,230.19"	$0.00	$0.00	$0.00	$0.00	"$2,951.50"	"$4,675.18"	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805349	EAP	Custom 27805349		Target Xl Detachable Coils 360 Soft 14 X 50cm	BOTH IP/OP	"$6,441.00 "	"$4,766.34"	$0.00	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,964.72"	$0.00	"$1,342.30"	$0.00	$0.00	$0.00	$0.00	"$3,220.50"	"$5,101.27"	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805350	EAP	Custom 27805350		Target Xl Detachable Coils 360 Soft 16 X 50cm	BOTH IP/OP	"$6,441.00 "	"$4,766.34"	$0.00	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,964.72"	$0.00	"$1,342.30"	$0.00	$0.00	$0.00	$0.00	"$3,220.50"	"$5,101.27"	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805351	EAP	Custom 27805351		Target Xl Detachable Coils 360 Soft 18 X 50cm	BOTH IP/OP	"$6,441.00 "	"$4,766.34"	$0.00	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,220.50"	"$5,101.27"	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805352	EAP	Custom 27805352		Target Xl Detachable Coils 360 Soft 20 X 50cm	BOTH IP/OP	"$6,441.00 "	"$4,766.34"	$0.00	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,220.50"	"$5,101.27"	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805353	EAP	Custom 27805353		Target Xl Detachable Coils 360 Standard  6 X 20cm	BOTH IP/OP	"$5,903.00 "	"$4,368.22"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.03"	$0.00	"$1,230.19"	$0.00	$0.00	$0.00	$0.00	"$2,951.50"	"$4,675.18"	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805354	EAP	Custom 27805354		Target Xl Detachable Coils 360 Standard  7 X 20cm	BOTH IP/OP	"$5,903.00 "	"$4,368.22"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.03"	$0.00	"$1,230.19"	$0.00	$0.00	$0.00	$0.00	"$2,951.50"	"$4,675.18"	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805355	EAP	Custom 27805355		Target Xl Detachable Coils 360 Standard  8 X 30cm	BOTH IP/OP	"$5,903.00 "	"$4,368.22"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.03"	$0.00	"$1,230.19"	$0.00	$0.00	$0.00	$0.00	"$2,951.50"	"$4,675.18"	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805356	EAP	Custom 27805356		Target Xl Detachable Coils 360 Standard  9 X 30cm	BOTH IP/OP	"$5,903.00 "	"$4,368.22"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.03"	$0.00	"$1,230.19"	$0.00	$0.00	$0.00	$0.00	"$2,951.50"	"$4,675.18"	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805357	EAP	Custom 27805357		Target Xl Detachable Coils 360 Standard  10 X 40cm	BOTH IP/OP	"$5,903.00 "	"$4,368.22"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.03"	$0.00	"$1,230.19"	$0.00	$0.00	$0.00	$0.00	"$2,951.50"	"$4,675.18"	"$4,722.40"	$0.00	"$2,656.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805358	EAP	Custom 27805358		Target Xl Detachable Coils 360 Standard  12 X 45cm	BOTH IP/OP	"$5,903.00 "	"$4,368.22"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,951.50"	"$4,675.18"	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805359	EAP	Custom 27805359		Target Xl Detachable Coils 360 Standard  14 X 50cm	BOTH IP/OP	"$6,441.00 "	"$4,766.34"	$0.00	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,964.72"	$0.00	"$1,342.30"	$0.00	$0.00	$0.00	$0.00	"$3,220.50"	"$5,101.27"	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805360	EAP	Custom 27805360		Target Xl Detachable Coils 360 Standard  16 X 50cm	BOTH IP/OP	"$6,441.00 "	"$4,766.34"	$0.00	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,964.72"	$0.00	"$1,342.30"	$0.00	$0.00	$0.00	$0.00	"$3,220.50"	"$5,101.27"	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805361	EAP	Custom 27805361		Target Xl Detachable Coils 360 Standard  18 X 50cm	BOTH IP/OP	"$6,441.00 "	"$4,766.34"	$0.00	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,964.72"	$0.00	"$1,342.30"	$0.00	$0.00	$0.00	$0.00	"$3,220.50"	"$5,101.27"	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805362	EAP	Custom 27805362		Target Xl Detachable Coils 360 Standard  20 X 50cm	BOTH IP/OP	"$6,441.00 "	"$4,766.34"	$0.00	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,964.72"	$0.00	"$1,342.30"	$0.00	$0.00	$0.00	$0.00	"$3,220.50"	"$5,101.27"	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805363	EAP	Custom 27805363		Target Xl Detachable Coils 360 Standard  22 X 50cm	BOTH IP/OP	"$6,441.00 "	"$4,766.34"	$0.00	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,964.72"	$0.00	"$1,342.30"	$0.00	$0.00	$0.00	$0.00	"$3,220.50"	"$5,101.27"	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805364	EAP	Custom 27805364		Target Xl Detachable Coils 360 Standard  24 X 50cm	BOTH IP/OP	"$6,441.00 "	"$4,766.34"	$0.00	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,964.72"	$0.00	"$1,342.30"	$0.00	$0.00	$0.00	$0.00	"$3,220.50"	"$5,101.27"	"$5,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805365	EAP	Custom 27805365		Target Xl Detachable Coils Helical 10 X 40cm	BOTH IP/OP	"$4,290.00 "	"$3,174.60"	$0.00	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,184.04"	"$3,184.04"	"$3,306.73"	$0.00	$894.04	$0.00	$0.00	$0.00	$0.00	"$2,145.00"	"$3,397.68"	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805366	EAP	Custom 27805366		Target Xl Detachable Coils Helical 12 X 50cm	BOTH IP/OP	"$4,290.00 "	"$3,174.60"	$0.00	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,184.04"	"$3,184.04"	"$3,306.73"	$0.00	$894.04	$0.00	$0.00	$0.00	$0.00	"$2,145.00"	"$3,397.68"	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805367	EAP	Custom 27805367		Target Xl Detachable Coils Helical 14 X 50cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805368	EAP	Custom 27805368		Target Xl Detachable Coils Helical 16 X 50cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805369	EAP	Custom 27805369		Target Xl Detachable Coils Helical 18 X 50cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805370	EAP	Custom 27805370		Target Xl Detachable Coils Helical 20 X 50cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805371	EAP	Custom 27805371		Target Xl Detachable Coils Helical 22 X 50cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805372	EAP	Custom 27805372		Target Xl Detachable Coils Helical 24 X 50cm	BOTH IP/OP	"$4,827.00 "	"$3,571.98"	$0.00	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,582.60"	"$3,582.60"	"$3,720.65"	$0.00	"$1,005.95"	$0.00	$0.00	$0.00	$0.00	"$2,413.50"	"$3,822.98"	"$3,861.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805373	EAP	Custom 27805373		Target Xl Detachable Coils Helical 5 X 15cm	BOTH IP/OP	"$4,290.00 "	"$3,174.60"	$0.00	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,184.04"	"$3,184.04"	"$3,306.73"	$0.00	$894.04	$0.00	$0.00	$0.00	$0.00	"$2,145.00"	"$3,397.68"	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805374	EAP	Custom 27805374		Target Xl Detachable Coils Helical 6 X 20cm	BOTH IP/OP	"$4,290.00 "	"$3,174.60"	$0.00	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,184.04"	"$3,184.04"	"$3,306.73"	$0.00	$894.04	$0.00	$0.00	$0.00	$0.00	"$2,145.00"	"$3,397.68"	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805375	EAP	Custom 27805375		Target Xl Detachable Coils Helical 7 X 20cm	BOTH IP/OP	"$4,290.00 "	"$3,174.60"	$0.00	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,184.04"	"$3,184.04"	"$3,306.73"	$0.00	$894.04	$0.00	$0.00	$0.00	$0.00	"$2,145.00"	"$3,397.68"	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805376	EAP	Custom 27805376		Target Xl Detachable Coils Helical 8 X 30cm	BOTH IP/OP	"$4,290.00 "	"$3,174.60"	$0.00	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,184.04"	"$3,184.04"	"$3,306.73"	$0.00	$894.04	$0.00	$0.00	$0.00	$0.00	"$2,145.00"	"$3,397.68"	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805377	EAP	Custom 27805377		Target Xl Detachable Coils Helical 9 X 30cm	BOTH IP/OP	"$4,290.00 "	"$3,174.60"	$0.00	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,184.04"	"$3,184.04"	"$3,306.73"	$0.00	$894.04	$0.00	$0.00	$0.00	$0.00	"$2,145.00"	"$3,397.68"	"$3,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805378	EAP	HCPCS C1781		"Mesh Surg Craniocurve .6mm Left Prtl Sm Crnm Etch Lbl Antm, 01-9521"	BOTH IP/OP	"$13,300.00 "	"$9,842.00"	$0.00	"$10,640.00"	"$5,985.00"	"$5,985.00"	$0.00	$0.00	$0.00	"$2,772.05"	"$4,181.12"	"$4,181.12"	"$10,251.64"	$0.00	"$2,771.72"	$0.00	"$6,556.90"	"$6,556.90"	$0.00	"$6,650.00"	"$10,533.60"	"$10,640.00"	$0.00	$0.00	$0.00	"$2,081.45"	$0.00	$0.00	"$2,117.36"	$0.00	$0.00	$0.00	$0.00	$0.00
27805379	EAP	HCPCS C1781		"Mesh Surg Craniocurve .6mm Right Prtl Sm Crnm Etch Lbl Antm, 01-9522"	BOTH IP/OP	"$13,300.00 "	"$9,842.00"	$0.00	"$10,640.00"	"$5,985.00"	"$5,985.00"	$0.00	$0.00	$0.00	"$2,772.05"	"$4,181.12"	"$4,181.12"	"$10,251.64"	$0.00	"$2,771.72"	$0.00	"$6,556.90"	"$6,556.90"	$0.00	"$6,650.00"	"$10,533.60"	"$10,640.00"	$0.00	$0.00	$0.00	"$2,081.45"	$0.00	$0.00	"$2,117.36"	$0.00	$0.00	$0.00	$0.00	$0.00
27805380	EAP	HCPCS C1781		"Mesh Surg Craniocurve .6mm Left Prtl Lg Crnm Etch Lbl Antm, 01-9523"	BOTH IP/OP	"$14,777.00 "	"$10,934.98"	$0.00	"$11,821.60"	"$6,649.65"	"$6,649.65"	$0.00	$0.00	$0.00	"$3,079.90"	"$4,181.12"	"$4,181.12"	"$11,390.11"	$0.00	"$3,079.53"	$0.00	"$7,285.06"	"$7,285.06"	$0.00	"$7,388.50"	"$11,703.38"	"$11,821.60"	$0.00	$0.00	$0.00	"$2,312.60"	$0.00	$0.00	"$2,352.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805381	EAP	HCPCS C1781		"Mesh Surg Craniocurve .6mm Right Prtl Lg Crnm Etch Lbl Antm, 01-9524"	BOTH IP/OP	"$14,777.00 "	"$10,934.98"	$0.00	"$11,821.60"	"$6,649.65"	"$6,649.65"	$0.00	$0.00	$0.00	"$3,079.90"	"$4,181.12"	"$4,181.12"	"$11,390.11"	$0.00	"$3,079.53"	$0.00	"$7,285.06"	"$7,285.06"	$0.00	"$7,388.50"	"$11,703.38"	"$11,821.60"	$0.00	$0.00	$0.00	"$2,312.60"	$0.00	$0.00	"$2,352.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27805382	EAP	HCPCS C1876		Protege Everflex Stent 6x40x120	BOTH IP/OP	"$3,990.00 "	"$2,952.60"	$0.00	"$3,192.00"	"$1,795.50"	"$1,795.50"	$0.00	$0.00	$0.00	$831.62	"$2,961.38"	"$2,961.38"	"$3,075.49"	$0.00	$831.52	$0.00	"$1,967.07"	"$1,967.07"	$0.00	"$1,995.00"	"$3,160.08"	"$3,192.00"	$0.00	$0.00	$0.00	$624.44	$0.00	$0.00	$635.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805383	EAP	HCPCS C1876		Protege Everflex Stent 6x60x120	BOTH IP/OP	"$3,990.00 "	"$2,952.60"	$0.00	"$3,192.00"	"$1,795.50"	"$1,795.50"	$0.00	$0.00	$0.00	$831.62	"$2,961.38"	"$2,961.38"	"$3,075.49"	$0.00	$831.52	$0.00	"$1,967.07"	"$1,967.07"	$0.00	"$1,995.00"	"$3,160.08"	"$3,192.00"	$0.00	$0.00	$0.00	$624.44	$0.00	$0.00	$635.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805384	EAP	HCPCS C1876		Protege Everflex Stent 6x80x120	BOTH IP/OP	"$3,990.00 "	"$2,952.60"	$0.00	"$3,192.00"	"$1,795.50"	"$1,795.50"	$0.00	$0.00	$0.00	$831.62	"$2,961.38"	"$2,961.38"	"$3,075.49"	$0.00	$831.52	$0.00	"$1,967.07"	"$1,967.07"	$0.00	"$1,995.00"	"$3,160.08"	"$3,192.00"	$0.00	$0.00	$0.00	$624.44	$0.00	$0.00	$635.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805385	EAP	HCPCS C1876		Protege Everflex Stent 8x40x120	BOTH IP/OP	"$3,990.00 "	"$2,952.60"	$0.00	"$3,192.00"	"$1,795.50"	"$1,795.50"	$0.00	$0.00	$0.00	$831.62	"$2,961.38"	"$2,961.38"	"$3,075.49"	$0.00	$831.52	$0.00	"$1,967.07"	"$1,967.07"	$0.00	"$1,995.00"	"$3,160.08"	"$3,192.00"	$0.00	$0.00	$0.00	$624.44	$0.00	$0.00	$635.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805386	EAP	HCPCS C1876		Protege Everflex Stent 8x60x120	BOTH IP/OP	"$3,990.00 "	"$2,952.60"	$0.00	"$3,192.00"	"$1,795.50"	"$1,795.50"	$0.00	$0.00	$0.00	$831.62	"$2,961.38"	"$2,961.38"	"$3,075.49"	$0.00	$831.52	$0.00	"$1,967.07"	"$1,967.07"	$0.00	"$1,995.00"	"$3,160.08"	"$3,192.00"	$0.00	$0.00	$0.00	$624.44	$0.00	$0.00	$635.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805387	EAP	HCPCS C1876		Protege Everflex Stent 8x80x120	BOTH IP/OP	"$3,990.00 "	"$2,952.60"	$0.00	"$3,192.00"	"$1,795.50"	"$1,795.50"	$0.00	$0.00	$0.00	$831.62	"$2,961.38"	"$2,961.38"	"$3,075.49"	$0.00	$831.52	$0.00	"$1,967.07"	"$1,967.07"	$0.00	"$1,995.00"	"$3,160.08"	"$3,192.00"	$0.00	$0.00	$0.00	$624.44	$0.00	$0.00	$635.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805388	EAP	HCPCS C1876		Protege Stent 10x40x120	BOTH IP/OP	"$3,990.00 "	"$2,952.60"	$0.00	"$3,192.00"	"$1,795.50"	"$1,795.50"	$0.00	$0.00	$0.00	$831.62	"$2,961.38"	"$2,961.38"	"$3,075.49"	$0.00	$831.52	$0.00	"$1,967.07"	"$1,967.07"	$0.00	"$1,995.00"	"$3,160.08"	"$3,192.00"	$0.00	$0.00	$0.00	$624.44	$0.00	$0.00	$635.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805389	EAP	HCPCS C1876		Protege Stent 10x60x120	BOTH IP/OP	"$3,990.00 "	"$2,952.60"	$0.00	"$3,192.00"	"$1,795.50"	"$1,795.50"	$0.00	$0.00	$0.00	$831.62	"$2,961.38"	"$2,961.38"	"$3,075.49"	$0.00	$831.52	$0.00	"$1,967.07"	"$1,967.07"	$0.00	"$1,995.00"	"$3,160.08"	"$3,192.00"	$0.00	$0.00	$0.00	$624.44	$0.00	$0.00	$635.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805390	EAP	HCPCS C1876		Protege Stent 12x40x80	BOTH IP/OP	"$3,990.00 "	"$2,952.60"	$0.00	"$3,192.00"	"$1,795.50"	"$1,795.50"	$0.00	$0.00	$0.00	$831.62	"$2,961.38"	"$2,961.38"	"$3,075.49"	$0.00	$831.52	$0.00	"$1,967.07"	"$1,967.07"	$0.00	"$1,995.00"	"$3,160.08"	"$3,192.00"	$0.00	$0.00	$0.00	$624.44	$0.00	$0.00	$635.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805391	EAP	HCPCS C1876		Protege Stent 12x60x80	BOTH IP/OP	"$3,990.00 "	"$2,952.60"	$0.00	"$3,192.00"	"$1,795.50"	"$1,795.50"	$0.00	$0.00	$0.00	$831.62	"$2,961.38"	"$2,961.38"	"$3,075.49"	$0.00	$831.52	$0.00	"$1,967.07"	"$1,967.07"	$0.00	"$1,995.00"	"$3,160.08"	"$3,192.00"	$0.00	$0.00	$0.00	$624.44	$0.00	$0.00	$635.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805392	EAP	HCPCS C1876		Protege Stent 14x40x80	BOTH IP/OP	"$3,990.00 "	"$2,952.60"	$0.00	"$3,192.00"	"$1,795.50"	"$1,795.50"	$0.00	$0.00	$0.00	$831.62	"$2,961.38"	"$2,961.38"	"$3,075.49"	$0.00	$831.52	$0.00	"$1,967.07"	"$1,967.07"	$0.00	"$1,995.00"	"$3,160.08"	"$3,192.00"	$0.00	$0.00	$0.00	$624.44	$0.00	$0.00	$635.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805393	EAP	HCPCS C1876		Protege Stent 14x80x80	BOTH IP/OP	"$3,990.00 "	"$2,952.60"	$0.00	"$3,192.00"	"$1,795.50"	"$1,795.50"	$0.00	$0.00	$0.00	$831.62	"$2,961.38"	"$2,961.38"	"$3,075.49"	$0.00	$831.52	$0.00	"$1,967.07"	"$1,967.07"	$0.00	"$1,995.00"	"$3,160.08"	"$3,192.00"	$0.00	$0.00	$0.00	$624.44	$0.00	$0.00	$635.21	$0.00	$0.00	$0.00	$0.00	$0.00
27805394	EAP	HCPCS C1876		Protege Everflex Stent 6x150x120	BOTH IP/OP	"$5,319.00 "	"$3,936.06"	$0.00	"$4,255.20"	"$2,393.55"	"$2,393.55"	$0.00	$0.00	$0.00	"$1,108.61"	"$3,947.76"	"$3,947.76"	"$4,099.89"	$0.00	"$1,108.48"	$0.00	"$2,622.27"	"$2,622.27"	$0.00	"$2,659.50"	"$4,212.65"	"$4,255.20"	$0.00	$0.00	$0.00	$832.42	$0.00	$0.00	$846.78	$0.00	$0.00	$0.00	$0.00	$0.00
27805395	EAP	HCPCS C1751		Cath Art 8fr 110cm Td Co Sg Hep	BOTH IP/OP	"$1,013.00 "	$749.62	$0.00	$810.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.50	$802.30	$810.40	$0.00	$0.00	$0.00	$158.53	$0.00	$0.00	$161.27	$0.00	$0.00	$0.00	$0.00	$0.00
27805407	EAP	HCPCS C1876		Stent Duodenal Wallflex .035 In L9 Cm L230 Cm Od22-27 Mm	BOTH IP/OP	"$7,537.00 "	"$5,577.38"	$0.00	"$6,029.60"	"$3,391.65"	"$3,391.65"	$0.00	$0.00	$0.00	"$1,570.90"	"$4,181.12"	"$4,181.12"	"$5,809.52"	$0.00	"$1,570.71"	$0.00	"$3,715.74"	"$3,715.74"	$0.00	"$3,768.50"	"$5,969.30"	"$6,029.60"	$0.00	"$3,391.65"	$0.00	"$1,179.54"	$0.00	$0.00	"$1,199.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27805409	EAP	HCPCS L8699		Onyx 18 Kit Avm Us	BOTH IP/OP	"$6,984.00 "	"$5,168.16"	$0.00	"$5,587.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,383.27"	$0.00	"$1,455.47"	$0.00	$0.00	$0.00	$0.00	"$3,492.00"	"$5,531.33"	"$5,587.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805410	EAP	HCPCS L8699		Onyx 34 Kit Avm Us	BOTH IP/OP	"$6,651.00 "	"$4,921.74"	$0.00	"$5,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,126.59"	$0.00	"$1,386.07"	$0.00	$0.00	$0.00	$0.00	"$3,325.50"	"$5,267.59"	"$5,320.80"	$0.00	"$2,992.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805412	EAP	HCPCS C1874		Stent Bil 8mm 8.5fr 60mm Flly Covered Trnshep Wallflex	BOTH IP/OP	"$7,978.00 "	"$5,903.72"	$0.00	"$6,382.40"	"$3,590.10"	"$3,590.10"	$0.00	$0.00	$0.00	"$1,662.81"	"$4,181.12"	"$4,181.12"	"$6,149.44"	$0.00	"$1,662.62"	$0.00	"$3,933.15"	"$3,933.15"	$0.00	"$3,989.00"	"$6,318.58"	"$6,382.40"	$0.00	$0.00	$0.00	"$1,248.56"	$0.00	$0.00	"$1,270.10"	$0.00	$0.00	$0.00	$0.00	$0.00
27805413	EAP	HCPCS C1874		Stent Bil 8mm 8.5fr 80mm Flly Covered Trnshep Wallflex	BOTH IP/OP	"$7,978.00 "	"$5,903.72"	$0.00	"$6,382.40"	"$3,590.10"	"$3,590.10"	$0.00	$0.00	$0.00	"$1,662.81"	"$4,181.12"	"$4,181.12"	"$6,149.44"	$0.00	"$1,662.62"	$0.00	"$3,933.15"	"$3,933.15"	$0.00	"$3,989.00"	"$6,318.58"	"$6,382.40"	$0.00	$0.00	$0.00	"$1,248.56"	$0.00	$0.00	"$1,270.10"	$0.00	$0.00	$0.00	$0.00	$0.00
27805414	EAP	HCPCS C1874		Stent Bil 10mm 8.5fr 40mm Flly Covered Trnshep Wallflex	BOTH IP/OP	"$7,978.00 "	"$5,903.72"	$0.00	"$6,382.40"	"$3,590.10"	"$3,590.10"	$0.00	$0.00	$0.00	"$1,662.81"	"$4,181.12"	"$4,181.12"	"$6,149.44"	$0.00	"$1,662.62"	$0.00	"$3,933.15"	"$3,933.15"	$0.00	"$3,989.00"	"$6,318.58"	"$6,382.40"	$0.00	"$3,590.10"	$0.00	"$1,248.56"	$0.00	$0.00	"$1,270.10"	$0.00	$0.00	$0.00	$0.00	$0.00
27805415	EAP	HCPCS C1876		Stent Bil 10mm 8.5fr 60mm Flly Covered Trnshep Wallflex	BOTH IP/OP	"$7,978.00 "	"$5,903.72"	$0.00	"$6,382.40"	"$3,590.10"	"$3,590.10"	$0.00	$0.00	$0.00	"$1,662.81"	"$4,181.12"	"$4,181.12"	"$6,149.44"	$0.00	"$1,662.62"	$0.00	"$3,933.15"	"$3,933.15"	$0.00	"$3,989.00"	"$6,318.58"	"$6,382.40"	$0.00	$0.00	$0.00	"$1,248.56"	$0.00	$0.00	"$1,270.10"	$0.00	$0.00	$0.00	$0.00	$0.00
27805416	EAP	HCPCS C1876		Stent Bil 10mm 8.5fr 80mm Flly Covered Trnshep Wallflex	BOTH IP/OP	"$7,978.00 "	"$5,903.72"	$0.00	"$6,382.40"	"$3,590.10"	"$3,590.10"	$0.00	$0.00	$0.00	"$1,662.81"	"$4,181.12"	"$4,181.12"	"$6,149.44"	$0.00	"$1,662.62"	$0.00	"$3,933.15"	"$3,933.15"	$0.00	"$3,989.00"	"$6,318.58"	"$6,382.40"	$0.00	$0.00	$0.00	"$1,248.56"	$0.00	$0.00	"$1,270.10"	$0.00	$0.00	$0.00	$0.00	$0.00
27805417	EAP	HCPCS C1876		Stent Bil 10mm 80mm Uncvr Wallflex	BOTH IP/OP	"$5,395.00 "	"$3,992.30"	$0.00	"$4,316.00"	"$2,427.75"	"$2,427.75"	$0.00	$0.00	$0.00	"$1,124.45"	"$4,004.17"	"$4,004.17"	"$4,158.47"	$0.00	"$1,124.32"	$0.00	"$2,659.74"	"$2,659.74"	$0.00	"$2,697.50"	"$4,272.84"	"$4,316.00"	$0.00	$0.00	$0.00	$844.32	$0.00	$0.00	$858.88	$0.00	$0.00	$0.00	$0.00	$0.00
27805418	EAP	HCPCS C1876		Stent Bil 80mm 60mm Uncvr Wallflex	BOTH IP/OP	"$5,395.00 "	"$3,992.30"	$0.00	"$4,316.00"	"$2,427.75"	"$2,427.75"	$0.00	$0.00	$0.00	"$1,124.45"	"$4,004.17"	"$4,004.17"	"$4,158.47"	$0.00	"$1,124.32"	$0.00	"$2,659.74"	"$2,659.74"	$0.00	"$2,697.50"	"$4,272.84"	"$4,316.00"	$0.00	$0.00	$0.00	$844.32	$0.00	$0.00	$858.88	$0.00	$0.00	$0.00	$0.00	$0.00
27805419	EAP	HCPCS C1876		Stent Bil 80mm 80mm Uncvr Wallflex	BOTH IP/OP	"$5,395.00 "	"$3,992.30"	$0.00	"$4,316.00"	"$2,427.75"	"$2,427.75"	$0.00	$0.00	$0.00	"$1,124.45"	"$4,004.17"	"$4,004.17"	"$4,158.47"	$0.00	"$1,124.32"	$0.00	"$2,659.74"	"$2,659.74"	$0.00	"$2,697.50"	"$4,272.84"	"$4,316.00"	$0.00	$0.00	$0.00	$844.32	$0.00	$0.00	$858.88	$0.00	$0.00	$0.00	$0.00	$0.00
27805420	EAP	HCPCS C1876		Stent Bil 80mm 10mm Uncvr Wallflex	BOTH IP/OP	"$5,395.00 "	"$3,992.30"	$0.00	"$4,316.00"	"$2,427.75"	"$2,427.75"	$0.00	$0.00	$0.00	"$1,124.45"	"$4,004.17"	"$4,004.17"	"$4,158.47"	$0.00	"$1,124.32"	$0.00	"$2,659.74"	"$2,659.74"	$0.00	"$2,697.50"	"$4,272.84"	"$4,316.00"	$0.00	$0.00	$0.00	$844.32	$0.00	$0.00	$858.88	$0.00	$0.00	$0.00	$0.00	$0.00
27805421	EAP	HCPCS C1876		Stent Bil 10mm 80mm Uncvr Wallflex	BOTH IP/OP	"$5,395.00 "	"$3,992.30"	$0.00	"$4,316.00"	"$2,427.75"	"$2,427.75"	$0.00	$0.00	$0.00	"$1,124.45"	"$4,004.17"	"$4,004.17"	"$4,158.47"	$0.00	"$1,124.32"	$0.00	"$2,659.74"	"$2,659.74"	$0.00	"$2,697.50"	"$4,272.84"	"$4,316.00"	$0.00	$0.00	$0.00	$844.32	$0.00	$0.00	$858.88	$0.00	$0.00	$0.00	$0.00	$0.00
27805422	EAP	HCPCS C1876		Stent Bil 10mm 10mm Uncvr Wallflex	BOTH IP/OP	"$5,395.00 "	"$3,992.30"	$0.00	"$4,316.00"	"$2,427.75"	"$2,427.75"	$0.00	$0.00	$0.00	"$1,124.45"	"$4,004.17"	"$4,004.17"	"$4,158.47"	$0.00	"$1,124.32"	$0.00	"$2,659.74"	"$2,659.74"	$0.00	"$2,697.50"	"$4,272.84"	"$4,316.00"	$0.00	$0.00	$0.00	$844.32	$0.00	$0.00	$858.88	$0.00	$0.00	$0.00	$0.00	$0.00
27805423	EAP	HCPCS C1876		Stent Bil 10mm 40mm Uncvr Wallflex	BOTH IP/OP	"$5,395.00 "	"$3,992.30"	$0.00	"$4,316.00"	"$2,427.75"	"$2,427.75"	$0.00	$0.00	$0.00	"$1,124.45"	"$4,004.17"	"$4,004.17"	"$4,158.47"	$0.00	"$1,124.32"	$0.00	"$2,659.74"	"$2,659.74"	$0.00	"$2,697.50"	"$4,272.84"	"$4,316.00"	$0.00	"$2,427.75"	$0.00	$844.32	$0.00	$0.00	$858.88	$0.00	$0.00	$0.00	$0.00	$0.00
27805424	EAP	HCPCS C1876		Stent Bil 10mm 60mm Uncvr Wallflex	BOTH IP/OP	"$5,395.00 "	"$3,992.30"	$0.00	"$4,316.00"	"$2,427.75"	"$2,427.75"	$0.00	$0.00	$0.00	"$1,124.45"	"$4,004.17"	"$4,004.17"	"$4,158.47"	$0.00	"$1,124.32"	$0.00	"$2,659.74"	"$2,659.74"	$0.00	"$2,697.50"	"$4,272.84"	"$4,316.00"	$0.00	"$2,427.75"	$0.00	$844.32	$0.00	$0.00	$858.88	$0.00	$0.00	$0.00	$0.00	$0.00
27805431	EAP	Custom 27805431		Pipeline  Embolization  Device  3.00mm X 25mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805432	EAP	Custom 27805432		Bowtie Shape - 10g Mammomark - Biopsy Site Identtfier	BOTH IP/OP	$689.00 	$509.86	$0.00	$551.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$511.38	$511.38	$531.08	$0.00	$143.59	$0.00	$0.00	$0.00	$0.00	$344.50	$545.69	$551.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805437	EAP	 C1817		Amplatzer Septal Occluder 20 Mm	BOTH IP/OP	"$16,714.00 "	"$12,368.36"	$0.00	"$13,371.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,883.15"	$0.00	"$3,483.20"	$0.00	$0.00	$0.00	$0.00	"$8,357.00"	"$13,237.49"	"$13,371.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805438	EAP	 C1817		Amplatzer Septal Occluder 22 Mm	BOTH IP/OP	"$16,714.00 "	"$12,368.36"	$0.00	"$13,371.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,883.15"	$0.00	"$3,483.20"	$0.00	$0.00	$0.00	$0.00	"$8,357.00"	"$13,237.49"	"$13,371.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805439	EAP	HCPCS C1817		Amplatzer Septal Occluder 24 Mm	BOTH IP/OP	"$16,714.00 "	"$12,368.36"	$0.00	"$13,371.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,883.15"	$0.00	"$3,483.20"	$0.00	$0.00	$0.00	$0.00	"$8,357.00"	"$13,237.49"	"$13,371.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805440	EAP	CPT® C1817		Amplatzer Septal Occluder 26 Mm	BOTH IP/OP	"$16,714.00 "	"$12,368.36"	$0.00	"$13,371.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,883.15"	$0.00	"$3,483.20"	$0.00	$0.00	$0.00	$0.00	"$8,357.00"	"$13,237.49"	"$13,371.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805441	EAP	CPT® C1896		Q-trak Electrode	BOTH IP/OP	"$13,779.00 "	"$10,196.46"	$0.00	"$11,023.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,871.89"	"$4,181.12"	"$4,181.12"	"$10,620.85"	$0.00	"$2,871.54"	$0.00	"$6,793.05"	"$6,793.05"	$0.00	"$6,889.50"	"$10,912.97"	"$11,023.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805442	EAP	HCPCS C1781		Occluder Septal 15mm	BOTH IP/OP	"$18,552.00 "	"$13,728.48"	$0.00	"$14,841.60"	"$8,348.40"	"$8,348.40"	$0.00	$0.00	$0.00	"$3,866.70"	"$4,181.12"	"$4,181.12"	"$14,299.88"	$0.00	"$3,866.24"	$0.00	"$9,146.14"	"$9,146.14"	$0.00	"$9,276.00"	"$14,693.18"	"$14,841.60"	$0.00	$0.00	$0.00	"$2,903.39"	$0.00	$0.00	"$2,953.48"	$0.00	$0.00	$0.00	$0.00	$0.00
27805443	EAP	HCPCS C1781		Occluder Septal 20mm	BOTH IP/OP	"$18,552.00 "	"$13,728.48"	$0.00	"$14,841.60"	"$8,348.40"	"$8,348.40"	$0.00	$0.00	$0.00	"$3,866.70"	"$4,181.12"	"$4,181.12"	"$14,299.88"	$0.00	"$3,866.24"	$0.00	"$9,146.14"	"$9,146.14"	$0.00	"$9,276.00"	"$14,693.18"	"$14,841.60"	$0.00	$0.00	$0.00	"$2,903.39"	$0.00	$0.00	"$2,953.48"	$0.00	$0.00	$0.00	$0.00	$0.00
27805444	EAP	HCPCS C1781		Occluder Septal 25mm	BOTH IP/OP	"$18,552.00 "	"$13,728.48"	$0.00	"$14,841.60"	"$8,348.40"	"$8,348.40"	$0.00	$0.00	$0.00	"$3,866.70"	"$4,181.12"	"$4,181.12"	"$14,299.88"	$0.00	"$3,866.24"	$0.00	"$9,146.14"	"$9,146.14"	$0.00	"$9,276.00"	"$14,693.18"	"$14,841.60"	$0.00	"$8,348.40"	$0.00	"$2,903.39"	$0.00	$0.00	"$2,953.48"	$0.00	$0.00	$0.00	$0.00	$0.00
27805445	EAP	HCPCS C1781		Occluder Septal 30mm	BOTH IP/OP	"$18,552.00 "	"$13,728.48"	$0.00	"$14,841.60"	"$8,348.40"	"$8,348.40"	$0.00	$0.00	$0.00	"$3,866.70"	"$4,181.12"	"$4,181.12"	"$14,299.88"	$0.00	"$3,866.24"	$0.00	"$9,146.14"	"$9,146.14"	$0.00	"$9,276.00"	"$14,693.18"	"$14,841.60"	$0.00	$0.00	$0.00	"$2,903.39"	$0.00	$0.00	"$2,953.48"	$0.00	$0.00	$0.00	$0.00	$0.00
27805446	EAP	HCPCS C1781		Occluder Septal 35mm	BOTH IP/OP	"$18,552.00 "	"$13,728.48"	$0.00	"$14,841.60"	"$8,348.40"	"$8,348.40"	$0.00	$0.00	$0.00	"$3,866.70"	"$4,181.12"	"$4,181.12"	"$14,299.88"	$0.00	"$3,866.24"	$0.00	"$9,146.14"	"$9,146.14"	$0.00	"$9,276.00"	"$14,693.18"	"$14,841.60"	$0.00	$0.00	$0.00	"$2,903.39"	$0.00	$0.00	"$2,953.48"	$0.00	$0.00	$0.00	$0.00	$0.00
27805447	EAP	Custom 27805447		Pipeline  Embolization  Device  3.00mm X 30mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805448	EAP	Custom 27805448		Pipeline  Embolization  Device  3.00mm X 35mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805449	EAP	Custom 27805449		Pipeline  Embolization  Device  3.25mm X 25mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805450	EAP	Custom 27805450		Pipeline  Embolization  Device  3.25mm X 30mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805451	EAP	Custom 27805451		Pipeline  Embolization  Device  3.25mm X 35mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805452	EAP	Custom 27805452		Pipeline  Embolization  Device  3.50mm X 25mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805453	EAP	Custom 27805453		Pipeline  Embolization  Device  3.50mm X 30mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805454	EAP	Custom 27805454		Pipeline  Embolization  Device  3.50mm X 35mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805455	EAP	Custom 27805455		Pipeline  Embolization  Device  3.75mm X 25mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805456	EAP	Custom 27805456		Pipeline  Embolization  Device  3.75mm X 30mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805457	EAP	Custom 27805457		Pipeline  Embolization  Device  3.75mm X 35mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805458	EAP	Custom 27805458		Pipeline  Embolization  Device  4.00mm X 25mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805459	EAP	Custom 27805459		Pipeline  Embolization  Device  4.00mm X 30mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805460	EAP	Custom 27805460		Pipeline  Embolization  Device  4.00mm X 35mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805461	EAP	Custom 27805461		Pipeline  Embolization  Device  4.25mm X 25mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805462	EAP	Custom 27805462		Pipeline  Embolization  Device  4.25mm X 30mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805463	EAP	Custom 27805463		Pipeline  Embolization  Device  4.25mm X 35mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805464	EAP	Custom 27805464		Pipeline  Embolization  Device  4.50mm X 25mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805465	EAP	Custom 27805465		Pipeline  Embolization  Device  4.50mm X 30mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805466	EAP	Custom 27805466		Pipeline  Embolization  Device  4.50mm X 35mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805467	EAP	Custom 27805467		Pipeline  Embolization  Device  4.75mm X 25mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805468	EAP	Custom 27805468		Pipeline  Embolization  Device  4.75mm X 30mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805469	EAP	Custom 27805469		Pipeline  Embolization  Device  4.75mm X 35mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805470	EAP	Custom 27805470		Pipeline  Embolization  Device  5.00mm X 25mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805471	EAP	Custom 27805471		Pipeline  Embolization  Device  5.00mm X 30mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805472	EAP	Custom 27805472		Pipeline  Embolization  Device  5.00mm X 35mm	BOTH IP/OP	"$38,029.00 "	"$28,141.46"	$0.00	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$29,312.75"	$0.00	"$7,925.24"	$0.00	$0.00	$0.00	$0.00	"$19,014.50"	"$30,118.97"	"$30,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805473	EAP	Custom 27805473		Pipeline  Embolization  Device  2.50mm X 10mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805474	EAP	Custom 27805474		Pipeline  Embolization  Device  2.50mm X 12mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805475	EAP	Custom 27805475		Pipeline  Embolization  Device  2.50mm X 14mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805476	EAP	Custom 27805476		Pipeline  Embolization  Device  2.50mm X 16mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805477	EAP	Custom 27805477		Pipeline  Embolization  Device  2.50mm X 18mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805478	EAP	Custom 27805478		Pipeline  Embolization  Device  2.50mm X 20mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805479	EAP	Custom 27805479		Pipeline  Embolization  Device  2.75mm X 14mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805480	EAP	Custom 27805480		Pipeline  Embolization  Device  2.75mm X 18mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805481	EAP	Custom 27805481		Pipeline  Embolization  Device  2.75mm X 20mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805482	EAP	Custom 27805482		Pipeline  Embolization  Device  3.00mm X 14mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805483	EAP	Custom 27805483		Pipeline  Embolization  Device  3.00mm X 18mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805484	EAP	Custom 27805484		Pipeline  Embolization  Device  3.00mm X 20mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805485	EAP	Custom 27805485		Pipeline  Embolization  Device  3.25mm X 10mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805486	EAP	Custom 27805486		Pipeline  Embolization  Device  3.25mm X 12mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805487	EAP	Custom 27805487		Pipeline  Embolization  Device  3.25mm X 14mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805488	EAP	Custom 27805488		Pipeline  Embolization  Device  3.25mm X 16mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805489	EAP	Custom 27805489		Pipeline  Embolization  Device  3.25mm X 18mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805490	EAP	Custom 27805490		Pipeline  Embolization  Device  3.25mm X 20mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805491	EAP	Custom 27805491		Pipeline  Embolization  Device  3.50mm X 14mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805492	EAP	Custom 27805492		Pipeline  Embolization  Device  3.50mm X 18mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805493	EAP	Custom 27805493		Pipeline  Embolization  Device  3.50mm X 20mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805494	EAP	Custom 27805494		Pipeline  Embolization  Device  3.75mm X 10mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805495	EAP	Custom 27805495		Pipeline  Embolization  Device  3.75mm X 12mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805496	EAP	Custom 27805496		Pipeline  Embolization  Device  3.75mm X 14mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805497	EAP	Custom 27805497		Pipeline  Embolization  Device  3.75mm X 16mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805498	EAP	Custom 27805498		Pipeline  Embolization  Device  3.75mm X 18mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805499	EAP	Custom 27805499		Pipeline  Embolization  Device  3.75mm X 20mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805500	EAP	Custom 27805500		Pipeline  Embolization  Device  4.00mm X 10mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805501	EAP	Custom 27805501		Pipeline  Embolization  Device  4.00mm X 12mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805502	EAP	Custom 27805502		Pipeline  Embolization  Device  4.00mm X 14mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805503	EAP	Custom 27805503		Pipeline  Embolization  Device  4.00mm X 16mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805504	EAP	Custom 27805504		Pipeline  Embolization  Device  4.00mm X 18mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805505	EAP	Custom 27805505		Pipeline  Embolization  Device  4.00mm X 20mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805506	EAP	Custom 27805506		Pipeline  Embolization  Device  4.25mm X 10mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805507	EAP	Custom 27805507		Pipeline  Embolization  Device  4.25mm X 12mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805508	EAP	Custom 27805508		Pipeline  Embolization  Device  4.25mm X 14mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805509	EAP	Custom 27805509		Pipeline  Embolization  Device  4.25mm X 16mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805510	EAP	Custom 27805510		Pipeline  Embolization  Device  4.25mm X 18mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805511	EAP	Custom 27805511		Pipeline  Embolization  Device  4.25mm X 20mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805512	EAP	Custom 27805512		Pipeline  Embolization  Device  4.50mm X 10mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805513	EAP	Custom 27805513		Pipeline  Embolization  Device  4.50mm X 12mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805514	EAP	Custom 27805514		Pipeline  Embolization  Device  4.50mm X 14mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805515	EAP	Custom 27805515		Pipeline  Embolization  Device  4.50mm X 16mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805516	EAP	Custom 27805516		Pipeline  Embolization  Device  4.50mm X 18mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805517	EAP	Custom 27805517		Pipeline  Embolization  Device  4.50mm X 20mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805518	EAP	Custom 27805518		Pipeline  Embolization  Device  4.75mm X 10mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805519	EAP	Custom 27805519		Pipeline  Embolization  Device  4.75mm X 12mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805520	EAP	Custom 27805520		Pipeline  Embolization  Device  4.75mm X 14mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805521	EAP	Custom 27805521		Pipeline  Embolization  Device  4.75mm X 16mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805522	EAP	Custom 27805522		Pipeline  Embolization  Device  4.75mm X 18mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805523	EAP	Custom 27805523		Pipeline  Embolization  Device  4.75mm X 20mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805524	EAP	Custom 27805524		Pipeline  Embolization  Device  5.00mm X 10mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805525	EAP	Custom 27805525		Pipeline  Embolization  Device  5.00mm X 12mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805526	EAP	Custom 27805526		Pipeline  Embolization  Device  5.00mm X 14mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805527	EAP	Custom 27805527		Pipeline  Embolization  Device  5.00mm X 16mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805528	EAP	Custom 27805528		Pipeline  Embolization  Device  5.00mm X 18mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805529	EAP	Custom 27805529		Pipeline  Embolization  Device  5.00mm X 20mm	BOTH IP/OP	"$35,550.00 "	"$26,307.00"	$0.00	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,401.94"	$0.00	"$7,408.62"	$0.00	$0.00	$0.00	$0.00	"$17,775.00"	"$28,155.60"	"$28,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805530	EAP	HCPCS C1876		Stent Coron 4mm 18mm .014in Rapex Flxb Lp Mtlnk Vsn Cocr	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$322.65	$322.65	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$0.00	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27805531	EAP	HCPCS C1876		Stent Coron 4mm 28mm .014in Rapex Flxb Lp Mtlnk Vsn Cocr	BOTH IP/OP	$717.00 	$530.58	$0.00	$573.60	$322.65	$322.65	$0.00	$0.00	$0.00	$149.44	$532.16	$532.16	$552.66	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$358.50	$567.86	$573.60	$0.00	$0.00	$0.00	$112.21	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00
27805532	EAP	HCPCS C1874		Stent Coron 3.5mm 24mm Drg Eluding Endvr Sprnt Zotarolimus	BOTH IP/OP	"$1,847.00 "	"$1,366.78"	$0.00	"$1,477.60"	$831.15	$831.15	$0.00	$0.00	$0.00	$384.96	"$1,370.84"	"$1,370.84"	"$1,423.67"	$0.00	$384.91	$0.00	"$1,092.50"	"$1,092.50"	$0.00	$923.50	"$1,462.82"	"$1,477.60"	$0.00	$0.00	$0.00	$289.06	$0.00	$0.00	$294.04	$0.00	$0.00	$0.00	$0.00	$0.00
27805533	EAP	HCPCS C1874		Stent Coron 3.5mm 12mm Drg Eluding Endvr Sprnt Zotarolimus	BOTH IP/OP	"$1,847.00 "	"$1,366.78"	$0.00	"$1,477.60"	$831.15	$831.15	$0.00	$0.00	$0.00	$384.96	"$1,370.84"	"$1,370.84"	"$1,423.67"	$0.00	$384.91	$0.00	"$1,092.50"	"$1,092.50"	$0.00	$923.50	"$1,462.82"	"$1,477.60"	$0.00	$0.00	$0.00	$289.06	$0.00	$0.00	$294.04	$0.00	$0.00	$0.00	$0.00	$0.00
27805534	EAP	HCPCS C1874		Stent Coron 3.5mm 18mm Drg Eluding Endvr Sprnt Zotarolimus	BOTH IP/OP	"$1,847.00 "	"$1,366.78"	$0.00	"$1,477.60"	$831.15	$831.15	$0.00	$0.00	$0.00	$384.96	"$1,370.84"	"$1,370.84"	"$1,423.67"	$0.00	$384.91	$0.00	"$1,092.50"	"$1,092.50"	$0.00	$923.50	"$1,462.82"	"$1,477.60"	$0.00	$0.00	$0.00	$289.06	$0.00	$0.00	$294.04	$0.00	$0.00	$0.00	$0.00	$0.00
27805535	EAP	HCPCS C1874		Stent Coron 2.5mm 12mm Drg Eluding Endvr Sprnt Zotarolimus	BOTH IP/OP	"$1,847.00 "	"$1,366.78"	$0.00	"$1,477.60"	$831.15	$831.15	$0.00	$0.00	$0.00	$384.96	"$1,370.84"	"$1,370.84"	"$1,423.67"	$0.00	$384.91	$0.00	"$1,092.50"	"$1,092.50"	$0.00	$923.50	"$1,462.82"	"$1,477.60"	$0.00	$0.00	$0.00	$289.06	$0.00	$0.00	$294.04	$0.00	$0.00	$0.00	$0.00	$0.00
27805536	EAP	Custom 27805536		Coil Target 3d 3mm X 6cm	BOTH IP/OP	"$4,502.00 "	"$3,331.48"	$0.00	"$3,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,341.38"	"$3,341.38"	"$3,470.14"	$0.00	$938.22	$0.00	$0.00	$0.00	$0.00	"$2,251.00"	"$3,565.58"	"$3,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805537	EAP	Custom 27805537		Coil Target 3d 4mm X 8cm	BOTH IP/OP	"$4,502.00 "	"$3,331.48"	$0.00	"$3,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,341.38"	"$3,341.38"	"$3,470.14"	$0.00	$938.22	$0.00	$0.00	$0.00	$0.00	"$2,251.00"	"$3,565.58"	"$3,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805538	EAP	Custom 27805538		Coil Target 3d 5mm X 10cm	BOTH IP/OP	"$4,502.00 "	"$3,331.48"	$0.00	"$3,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,341.38"	"$3,341.38"	"$3,470.14"	$0.00	$938.22	$0.00	$0.00	$0.00	$0.00	"$2,251.00"	"$3,565.58"	"$3,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805539	EAP	Custom 27805539		Coil Target 3d 6mm X 15cm	BOTH IP/OP	"$4,502.00 "	"$3,331.48"	$0.00	"$3,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,341.38"	"$3,341.38"	"$3,470.14"	$0.00	$938.22	$0.00	$0.00	$0.00	$0.00	"$2,251.00"	"$3,565.58"	"$3,601.60"	$0.00	"$2,025.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805540	EAP	Custom 27805540		Coil Target 3d 7mm X 15cm	BOTH IP/OP	"$4,502.00 "	"$3,331.48"	$0.00	"$3,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,341.38"	"$3,341.38"	"$3,470.14"	$0.00	$938.22	$0.00	$0.00	$0.00	$0.00	"$2,251.00"	"$3,565.58"	"$3,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805541	EAP	Custom 27805541		Coil Target 3d 8mm X 25cm	BOTH IP/OP	"$4,502.00 "	"$3,331.48"	$0.00	"$3,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,341.38"	"$3,341.38"	"$3,470.14"	$0.00	$938.22	$0.00	$0.00	$0.00	$0.00	"$2,251.00"	"$3,565.58"	"$3,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805542	EAP	Custom 27805542		Coil Target 3d 10mm X 30cm	BOTH IP/OP	"$4,502.00 "	"$3,331.48"	$0.00	"$3,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,341.38"	"$3,341.38"	"$3,470.14"	$0.00	$938.22	$0.00	$0.00	$0.00	$0.00	"$2,251.00"	"$3,565.58"	"$3,601.60"	$0.00	"$2,025.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805543	EAP	Custom 27805543		Coil Embl 10cm 4mm Trgt Dtch Ult 360d	BOTH IP/OP	"$4,752.00 "	"$3,516.48"	$0.00	"$3,801.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,526.93"	"$3,526.93"	"$3,662.84"	$0.00	$990.32	$0.00	$0.00	$0.00	$0.00	"$2,376.00"	"$3,763.58"	"$3,801.60"	$0.00	"$2,138.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805544	EAP	Custom 27805544		Coil Target 360 Ultra 3.5mm X 8cm	BOTH IP/OP	"$5,401.00 "	"$3,996.74"	$0.00	"$4,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,008.62"	"$4,008.62"	"$4,163.09"	$0.00	"$1,125.57"	$0.00	$0.00	$0.00	$0.00	"$2,700.50"	"$4,277.59"	"$4,320.80"	$0.00	"$2,430.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805545	EAP	Custom 27805545		Coil Target 360 Ultra 4.5mm X 10cm	BOTH IP/OP	"$5,671.00 "	"$4,196.54"	$0.00	"$4,536.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,371.21"	$0.00	"$1,181.84"	$0.00	$0.00	$0.00	$0.00	"$2,835.50"	"$4,491.43"	"$4,536.80"	$0.00	"$2,551.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805546	EAP	Custom 27805546		Coil Target 360 Nano 2mm X 3cm	BOTH IP/OP	"$5,671.00 "	"$4,196.54"	$0.00	"$4,536.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,371.21"	$0.00	"$1,181.84"	$0.00	$0.00	$0.00	$0.00	"$2,835.50"	"$4,491.43"	"$4,536.80"	$0.00	"$2,551.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805547	EAP	Custom 27805547		Coil Target 360 Nano 2mm X 4cm	BOTH IP/OP	"$5,671.00 "	"$4,196.54"	$0.00	"$4,536.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,371.21"	$0.00	"$1,181.84"	$0.00	$0.00	$0.00	$0.00	"$2,835.50"	"$4,491.43"	"$4,536.80"	$0.00	"$2,551.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805548	EAP	Custom 27805548		Coil Target 360 Nano 2.5mm X 4cm	BOTH IP/OP	"$5,401.00 "	"$3,996.74"	$0.00	"$4,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,008.62"	"$4,008.62"	"$4,163.09"	$0.00	"$1,125.57"	$0.00	$0.00	$0.00	$0.00	"$2,700.50"	"$4,277.59"	"$4,320.80"	$0.00	"$2,430.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805549	EAP	Custom 27805549		Coil Target 360 Nano 3mm X 4cm	BOTH IP/OP	"$5,671.00 "	"$4,196.54"	$0.00	"$4,536.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,371.21"	$0.00	"$1,181.84"	$0.00	$0.00	$0.00	$0.00	"$2,835.50"	"$4,491.43"	"$4,536.80"	$0.00	"$2,551.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805550	EAP	Custom 27805550		Coil Target 360 Nano 3mm X 6cm	BOTH IP/OP	"$5,401.00 "	"$3,996.74"	$0.00	"$4,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,008.62"	"$4,008.62"	"$4,163.09"	$0.00	"$1,125.57"	$0.00	$0.00	$0.00	$0.00	"$2,700.50"	"$4,277.59"	"$4,320.80"	$0.00	"$2,430.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805551	EAP	Custom 27805551		Coil Target 360 Nano 3.5mm X 6cm	BOTH IP/OP	"$5,671.00 "	"$4,196.54"	$0.00	"$4,536.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,371.21"	$0.00	"$1,181.84"	$0.00	$0.00	$0.00	$0.00	"$2,835.50"	"$4,491.43"	"$4,536.80"	$0.00	"$2,551.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805552	EAP	Custom 27805552		Sensation Plus 40cc Iab 7.5	BOTH IP/OP	"$3,004.00 "	"$2,222.96"	$0.00	"$2,403.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,229.57"	"$2,229.57"	"$2,315.48"	$0.00	$626.03	$0.00	$0.00	$0.00	$0.00	"$1,502.00"	"$2,379.17"	"$2,403.20"	$0.00	"$1,351.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805553	EAP	Custom 27805553		Sensation Plus 50cc Iab 8.0	BOTH IP/OP	"$3,154.00 "	"$2,333.96"	$0.00	"$2,523.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,340.90"	"$2,340.90"	"$2,431.10"	$0.00	$657.29	$0.00	$0.00	$0.00	$0.00	"$1,577.00"	"$2,497.97"	"$2,523.20"	$0.00	"$1,419.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805554	EAP	HCPCS C1760		Vascade Vascular Closure Device 5fr	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$247.50	$247.50	$0.00	$0.00	$0.00	$114.63	$408.21	$408.21	$423.94	$0.00	$114.62	$0.00	$325.33	$325.33	$0.00	$275.00	$435.60	$440.00	$0.00	$247.50	$0.00	$86.08	$0.00	$0.00	$87.56	$0.00	$0.00	$0.00	$0.00	$0.00
27805555	EAP	HCPCS C1760		Vascade Vascular Closure Device 6/7fr	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$247.50	$247.50	$0.00	$0.00	$0.00	$114.63	$408.21	$408.21	$423.94	$0.00	$114.62	$0.00	$325.33	$325.33	$0.00	$275.00	$435.60	$440.00	$0.00	$247.50	$0.00	$86.08	$0.00	$0.00	$87.56	$0.00	$0.00	$0.00	$0.00	$0.00
27805556	EAP	HCPCS C1876		Stent Bil 9mm 6fr 20mm 80cm .035in 7.5-8.5mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805557	EAP	HCPCS C1876		Stent Bil 9mm 6fr 30mm 80cm .035in 7.5-8.5mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805558	EAP	HCPCS C1876		Stent Bil 9mm 6fr 40mm 80cm .035in Slf Xpd Flxb Lp Tntlm	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805559	EAP	HCPCS C1876		Stent Bil 9mm 6fr 60mm 80cm .35in 7.5-8.5mm Slf Expandable	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805560	EAP	HCPCS C1876		Stent Bil 9mm 6fr 80mm 80cm .035in 7.5-8.5mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805561	EAP	HCPCS C1876		Stent Bil 10mm 6fr 20mm 80cm .035in 8.5-9.5mm Slf Xpd Lp	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805562	EAP	HCPCS C1876		Stent Bil 10mm 6fr 30mm 80cm .035in 8.5-9.5mm Slf Xpd Lp	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805563	EAP	HCPCS C1876		Stent Bil 10mm 6fr 40mm 80cm 8.5-9.5mm .035in Slf Xpd Flxb	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805564	EAP	HCPCS C1876		Stent Bil 10mm 6fr 60mm 80cm .035in 8.5-9.5mm Slf Xpd Dlv	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805565	EAP	HCPCS C1876		Stent Bil 10mm 6fr 80mm 80cm .035in 8.5-9.5mm Slf Xpd Lp	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805566	EAP	HCPCS C1876		Stent Bil 12mm 6fr 20mm 80cm .35in 9.5-11mm Slf Xpd Lp Prcs	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805567	EAP	HCPCS C1876		Stent Bil 12mm 6fr 30mm 80cm .035in 9.5-11mm Slf Xpd Lp Prcs	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805568	EAP	HCPCS C1876		Stent Bil 12mm 6fr 80mm 80cm .035in Otw Slf Xpd Lp Tntlm	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805569	EAP	HCPCS C1876		Stent Bil 14mm 6fr 20mm 80cm .035in 11.5-13mm Slf Xpd Lp	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805570	EAP	HCPCS C1876		Stent Bil 14mm 6fr 30mm 80cm .035in 11.5-13mm Slf Xpd Lp	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805571	EAP	HCPCS C1876		Stent Bil 14mm 6fr 60mm 80cm .035in Slf Xpd Cmpt Flxb Lp	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805572	EAP	HCPCS C1876		Stent Bil 9mm 6fr 20mm 120cm .035in Slf Xpd Flxb Lp Tntlm	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805573	EAP	HCPCS C1876		Stent Bil 9mm 6fr 30mm 120cm Lg Dia Lp Slf Xpd Opn Ltc Dsgn	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805574	EAP	HCPCS C1876		Stent Bil 9mm 6fr 40mm 120cm .035in 7.5-8.5mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805575	EAP	HCPCS C1876		Stent Bil 9mm 6fr 60mm 120cm .035in 7.5-8.5mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805576	EAP	HCPCS C1876		Stent Bil 9mm 6fr 80mm 120cm .035in 7.5-8.5mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805577	EAP	HCPCS C1876		Stent Bil 10mm 6fr 20mm 120cm .035in 8.5-9.5mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805578	EAP	HCPCS C1876		Stent Bil 10mm 6fr 30mm 120cm .018in 8.5-9.5mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805579	EAP	HCPCS C1876		Stent Bil 10mm 6fr 80mm 120cm .035in 8.5-9.5mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805580	EAP	HCPCS C1876		Stent Bil 12mm 6fr 20mm 120cm Lg Dia Lp Slf Xpd Opn Ltc Dsgn	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805581	EAP	HCPCS C1876		Stent Bil 12mm 6fr 30mm 120cm .035in 9.5-11mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805582	EAP	HCPCS C1876		Stent Bil 12mm 6fr 40mm 120cm .035in 9.5-11mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805583	EAP	HCPCS C1876		Stent Bil 12mm 6fr 60mm 120cm Lp Slf Xpd Flxb Radl Strth Gps	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805584	EAP	HCPCS C1876		Stent Bil 12mm 9.5-11fr 80mm 120cm .035in Slf Xpd Flxb Lp	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805585	EAP	HCPCS C1876		Stent Bil 14mm 6fr 20mm 120cm .035in Slf Xpd Cmpt Flxb Lp	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805586	EAP	HCPCS C1876		Stent Bil 14mm 6fr 30mm 120cm .035in 11.5-13mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805587	EAP	HCPCS C1876		Stent Bil 14mm 6fr 40mm 120cm .035in 11.5-13mm Gwire Lum Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805588	EAP	HCPCS C1876		Stent Bil 14mm 6fr 60mm 120cm .035in Slf Xpd Flxb Lp Tntlm	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805589	EAP	HCPCS C1876		Stent Bil 14mm 6fr 80mm 120cm .035in Slf Xpd Flxb Lp Tntlm	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805590	EAP	CPT® C1876		Integrity Rx Coronary Stent System Mm	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$868.50	$868.50	$0.00	$0.00	$0.00	$402.26	"$1,432.45"	"$1,432.45"	"$1,487.64"	$0.00	$402.21	$0.00	"$1,141.60"	"$1,141.60"	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00	$0.00	$0.00	$302.05	$0.00	$0.00	$307.26	$0.00	$0.00	$0.00	$0.00	$0.00
27805591	EAP	HCPCS C1876		Stent Prtg Everflex 6mm 6fr 80cm 20mm .035in Peri Otw Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805592	EAP	HCPCS C1876		Stent Everflex 6mm 6fr 80cm 30mm .035in Peri Otw Slf Xpd	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805593	EAP	HCPCS C1876		Stent Everflex 6mm 6fr 80cm 40mm .035in Peri Slf Xpd Flxb	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805594	EAP	HCPCS C1876		Stent Bil 6mm 6fr 60mm 80cm .035in Slf Xpd Flxb Drblty Sprl	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805595	EAP	HCPCS C1876		Stent Bil 6mm 6fr 80mm 80cm .035in 3 Wv Peak Dsgn Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805596	EAP	HCPCS C1876		Stent Bil 6mm 6fr 100mm 80cm .035in Otw Slf Xpd Flxb Drble	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805597	EAP	HCPCS C1876		Stent Bil 6mm 6fr 120mm 80cm .035in 3 Wv Peak Dsgn Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805598	EAP	HCPCS C1876		Stent Bil 6mm 6fr 150mm 80cm .035in Otw Slf Xpd Flxb Drble	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805599	EAP	HCPCS C1876		Stent Bil 7mm 6fr 20mm 80cm .035in Sprl 3 Wv Peak Dsgn Gwire	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805600	EAP	HCPCS C1876		Stent Everflex Prtg 7mm 6fr 80cm 30mm .035in Peri 3 Wv Peak	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805601	EAP	HCPCS C1876		Stent Everflex 7mm 6fr 80cm 40mm .035in Peri 3 Wv Peak	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805602	EAP	HCPCS C1876		Stent Prtg Everflex 7mm 6fr 80cm 60mm .035in Peri 3 Wv Peak	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805603	EAP	HCPCS C1876		Stent Bil 7mm 6fr 80mm 80cm .035in 3 Wv Peak Introd Shth Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805604	EAP	HCPCS C1876		Stent Bil 7mm 6fr 100mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805605	EAP	HCPCS C1876		Stent Bil 7mm 6fr 120mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805606	EAP	HCPCS C1876		Stent Bil 7mm 6fr 150mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805607	EAP	HCPCS C1876		Stent Bil 8mm 6fr 20mm 80cm .035in 3 Wv Peak Dsgn Otw Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805608	EAP	HCPCS C1876		Stent Prtg Everflex 8mm 6fr 80mm 30cm .035in Peri 3 Wv Peak	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805609	EAP	HCPCS C1876		Stent Everflex 8mm 6fr 80cm 40mm .035in Peri Slf Xpd Flxb	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805610	EAP	HCPCS C1876		Stent Vasc 8mm 6fr 60mm 80cm .035in Slf Xpd Gwire Drblty	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805611	EAP	HCPCS C1876		Stent Prtg Everflex 8mm 6fr 80mm 80cm .035in Peri 3 Wv Peak	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805612	EAP	HCPCS C1876		Stent Bil 8mm 6fr 100mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805613	EAP	HCPCS C1876		Stent Bil 8mm 6fr 120mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805614	EAP	HCPCS C1876		Stent Bil 8mm 6fr 150mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805615	EAP	HCPCS C1876		Stent Everflex 6mm 6fr 120cm 20mm .035in Peri Slf Xpd Flxb	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805616	EAP	HCPCS C1876		Stent Bil 6mm 6fr 30mm 120cm .035in Slf Xpd Flxb Drblty Sprl	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805617	EAP	HCPCS C1876		Stent Everflex 6mm 6fr 120cm 100mm .035in Peri 3 Wv Peak	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805618	EAP	HCPCS C1876		Stent Everflex 6mm 6fr 120cm 120mm .035in Peri 3 Wv Peak	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805619	EAP	HCPCS C1876		Stent Vasc 6mm 6fr 200mm 120cm .035in Slf Expandable Flxb	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805620	EAP	HCPCS C1876		Stent Vasc 7mm 6fr 20mm 120cm .035in 3 Wv Peak Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805621	EAP	HCPCS C1876		Stent Everflex 7mm 6fr 120cm 30mm .035in Peri 3 Wv Peak Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805622	EAP	HCPCS C1876		Stent Vasc 7mm 6fr 40mm 120cm .035in Slf Expandable Flxb	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805623	EAP	HCPCS C1876		Stent Bil 7mm 6fr 60mm 120cm 3 Wv Peak Dsgn Slf Xpd Flxb	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805624	EAP	HCPCS C1876		Stent Vasc 7mm 6fr 80mm 120cm .035in 3 Wv Peak Introd Shth	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805625	EAP	HCPCS C1876		Stent Vasc 7mm 6fr 100mm 120cm .035in 3 Wv Peak Introd Shth	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805626	EAP	HCPCS C1876		Stent Vasc 7mm 6fr 120mm 120cm .035in 3 Wv Peak Introd Shth	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805627	EAP	HCPCS C1876		Stent Bil 7mm 6fr 150mm 120cm .035in 3 Wv Peak Dsgn Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805628	EAP	HCPCS C1876		Stent Vasc 7mm 6fr 200mm 120cm .035in 5.5-6.5mm Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805629	EAP	HCPCS C1876		Stent Prtg Everflex 8mm 6fr 120mm 20cm .035in Peri 3 Wv Peak	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805630	EAP	HCPCS C1876		Stent Bil 8mm 6fr 30mm 120cm .035in Slf Xpd Flxb Drble Sprl	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805631	EAP	HCPCS C1876		Stent Everflex Prtg 8mm 6fr 120cm 100mm .035in Peri 3 Wv	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805632	EAP	HCPCS C1876		Stent Prtg Everflex 8mm 6fr 120cm 120mm .035in Peri Otw Slf	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805633	EAP	HCPCS C1876		Stent Prtg Everflex 8mm 6fr 120cm 150mm .035in Peri 3 Wv	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805634	EAP	HCPCS C1876		Stent Vasc 8mm 6fr 200mm 120cm .035in 6.5-7.5mm Slf Xpd Shth	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	"$1,674.45"	"$1,674.45"	$0.00	$0.00	$0.00	$775.55	"$2,761.73"	"$2,761.73"	"$2,868.15"	$0.00	$775.46	$0.00	"$1,834.45"	"$1,834.45"	$0.00	"$1,860.50"	"$2,947.03"	"$2,976.80"	$0.00	$0.00	$0.00	$582.34	$0.00	$0.00	$592.38	$0.00	$0.00	$0.00	$0.00	$0.00
27805635	EAP	HCPCS C1876		Stent Vasc 10-8mm 40mm Tpr Slf Expandable Erg Hndl Flxb Crtd	BOTH IP/OP	"$6,739.00 "	"$4,986.86"	$0.00	"$5,391.20"	"$3,032.55"	"$3,032.55"	$0.00	$0.00	$0.00	"$1,404.58"	"$4,181.12"	"$4,181.12"	"$5,194.42"	$0.00	"$1,404.41"	$0.00	"$3,322.33"	"$3,322.33"	$0.00	"$3,369.50"	"$5,337.29"	"$5,391.20"	$0.00	"$3,032.55"	$0.00	"$1,054.65"	$0.00	$0.00	"$1,072.85"	$0.00	$0.00	$0.00	$0.00	$0.00
27805636	EAP	HCPCS C1876		Stent Vasc 9-7mm 40mm Tpr Slf Expandable Erg Hndl Flxb Crtd	BOTH IP/OP	"$6,739.00 "	"$4,986.86"	$0.00	"$5,391.20"	"$3,032.55"	"$3,032.55"	$0.00	$0.00	$0.00	"$1,404.58"	"$4,181.12"	"$4,181.12"	"$5,194.42"	$0.00	"$1,404.41"	$0.00	"$3,322.33"	"$3,322.33"	$0.00	"$3,369.50"	"$5,337.29"	"$5,391.20"	$0.00	"$3,032.55"	$0.00	"$1,054.65"	$0.00	$0.00	"$1,072.85"	$0.00	$0.00	$0.00	$0.00	$0.00
27805637	EAP	HCPCS C1876		Stent Vasc 8-6mm 40mm Tpr Slf Expandable Erg Hndl Flxb Crtd	BOTH IP/OP	"$6,739.00 "	"$4,986.86"	$0.00	"$5,391.20"	"$3,032.55"	"$3,032.55"	$0.00	$0.00	$0.00	"$1,404.58"	"$4,181.12"	"$4,181.12"	"$5,194.42"	$0.00	"$1,404.41"	$0.00	"$3,322.33"	"$3,322.33"	$0.00	"$3,369.50"	"$5,337.29"	"$5,391.20"	$0.00	"$3,032.55"	$0.00	"$1,054.65"	$0.00	$0.00	"$1,072.85"	$0.00	$0.00	$0.00	$0.00	$0.00
27805638	EAP	Custom 27805638		Og Cmplx Fill Coil 2x1.5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805639	EAP	Custom 27805639		Og Cmplx Fill Coil 2x2	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805640	EAP	Custom 27805640		Og Cmplx Fill Coil 3x4	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805641	EAP	Custom 27805641		Og Cmplx Fill Coil 3x6	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805642	EAP	Custom 27805642		Og Cmplx Fill Coil 3x8	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805643	EAP	Custom 27805643		Og Tdl Cmplx Fill Coil 4x4	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805644	EAP	Custom 27805644		Og Tdl Cmplx Fill Coil 4x7	BOTH IP/OP	"$4,327.00 "	"$3,201.98"	$0.00	"$3,461.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,211.50"	"$3,211.50"	"$3,335.25"	$0.00	$901.75	$0.00	$0.00	$0.00	$0.00	"$2,163.50"	"$3,426.98"	"$3,461.60"	$0.00	"$1,947.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805645	EAP	Custom 27805645		Og Tdl Cmplx Fill Coil 4x10	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805646	EAP	Custom 27805646		Og Tdl Cmplx Fill Coil 4x12	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805647	EAP	Custom 27805647		Og Tdl Cmplx Fill Coil 5x5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805648	EAP	Custom 27805648		Og Tdl Cmplx Fill Coil 5x10	BOTH IP/OP	"$4,327.00 "	"$3,201.98"	$0.00	"$3,461.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,211.50"	"$3,211.50"	"$3,335.25"	$0.00	$901.75	$0.00	$0.00	$0.00	$0.00	"$2,163.50"	"$3,426.98"	"$3,461.60"	$0.00	"$1,947.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805649	EAP	Custom 27805649		Coil Embolization .012in 5mm 15cm Complex Fill Detachable	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	$0.00	$0.00	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	"$1,682.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805650	EAP	Custom 27805650		Og Tdl Cmplx Fill Coil 6x10	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805651	EAP	Custom 27805651		Og Tdl Cmplx Fill Coil 6x15	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	"$1,854.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805652	EAP	Custom 27805652		Og Tdl Cmplx Fill Coil 6x20	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	"$1,854.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805653	EAP	Custom 27805653		Og Tdl Cmplx Fill Coil 7x15	BOTH IP/OP	"$4,327.00 "	"$3,201.98"	$0.00	"$3,461.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,211.50"	"$3,211.50"	"$3,335.25"	$0.00	$901.75	$0.00	$0.00	$0.00	$0.00	"$2,163.50"	"$3,426.98"	"$3,461.60"	$0.00	"$1,947.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805654	EAP	Custom 27805654		Og Tdl Cmplx Fill Coil 7x21	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	"$1,854.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805655	EAP	Custom 27805655		Og Tdl Cmplx Fill Coil 8x15	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805656	EAP	Custom 27805656		Og Tdl Cmplx Fill Coil 8x24	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805657	EAP	Custom 27805657		Og Tdl Cmplx Fill Coil 9x15	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805658	EAP	Custom 27805658		Og Tdl Cmplx Fill Coil 9x25	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	"$1,854.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805659	EAP	Custom 27805659		Og Tdl Cmplx Fill Coil 10x30	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805660	EAP	Custom 27805660		Og Tdl Cmplx Fill Coil 12x30	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805661	EAP	Custom 27805661		Og Cmplx Fill Coil 3.5x7.5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805662	EAP	Custom 27805662		Og Tdl Cmplx Frame Coil 6x20	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805663	EAP	Custom 27805663		Og Tdl Cmplx Frame Coil 7x25	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805664	EAP	Custom 27805664		Og Tdl Cmplx Frame Coil 8x30	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805665	EAP	Custom 27805665		Og Tdl Cmplx Frame Coil 9x30	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805666	EAP	Custom 27805666		Og Tdl Cmplx Frame Coil 10x30	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805667	EAP	Custom 27805667		Og Tdl Cmplx Frame Coil 12x30	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805668	EAP	Custom 27805668		Og Tdl Cmplx Frame Coil 14x30	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805669	EAP	Custom 27805669		Og Tdl Cmplx Frame Coil 16x30	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805670	EAP	Custom 27805670		Og Tdl Cmplx Frame Coil 18x30	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805671	EAP	Custom 27805671		Og Tdl Cmplx Frame Coil 20x30	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805672	EAP	Custom 27805672		G2 Complex Fill Coil 2x1.5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805673	EAP	Custom 27805673		G2 Complex Fill Coil 2x2	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805674	EAP	Custom 27805674		G2 Complex Fill Coil 3x4	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805675	EAP	Custom 27805675		G2 Complex Fill Coil 3x6	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805676	EAP	Custom 27805676		G2 Complex Fill Coil 3x8	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805677	EAP	Custom 27805677		G2 Tdl Complex Fill Coil 4x7	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805678	EAP	Custom 27805678		G2 Tdl Complex Fill Coil 4x10	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805679	EAP	Custom 27805679		G2 Tdl Complex Fill Coil 4x12	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805680	EAP	Custom 27805680		G2 Tdl Complex Fill Coil 5x10	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805681	EAP	Custom 27805681		G2 Tdl Complex Fill Coil 5x15	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805682	EAP	Custom 27805682		G2 Tdl Complex Fill Coil 6x15	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805683	EAP	Custom 27805683		G2 Tdl Complex Fill Coil 6x20	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805684	EAP	Custom 27805684		G2 Tdl Complex Fill Coil 7x15	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805685	EAP	Custom 27805685		G2 Tdl Complex Fill Coil 7x21	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805686	EAP	Custom 27805686		G2 Tdl Complex Fill Coil 8x15	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805687	EAP	Custom 27805687		G2 Tdl Complex Fill Coil 8x24	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805688	EAP	Custom 27805688		G2 Tdl Complex Fill Coil 9x25	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805689	EAP	Custom 27805689		G2 Tdl Complex Fill Coil 10x30	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805690	EAP	Custom 27805690		G2 Tdl Complex Fill Coil 12x30	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805691	EAP	Custom 27805691		G2 Complex Fill Coil 2.5x5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805692	EAP	Custom 27805692		G2 Complex Fill Coil 2.5x3.5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805693	EAP	Custom 27805693		G2 Complex Fill Coil 3.5x9	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805694	EAP	Custom 27805694		G2 Complex Fill Coil 3.5x7.5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805695	EAP	Custom 27805695		G2 Complex Xtrasoft Coil 2x1.5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805696	EAP	Custom 27805696		G2 Complex Xtrasoft Coil 2x2	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805697	EAP	Custom 27805697		G2 Complex Xtrasoft Coil 3x4	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805698	EAP	Custom 27805698		G2 Complex Xtrasoft Coil 3x6	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805700	EAP	Custom 27805700		G2 Tdl Complex Xtrasoft Coil 4	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805701	EAP	Custom 27805701		G2 Complex Xtrasoft Coil 2.5x5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805702	EAP	Custom 27805702		G2 Complex Xtrasoft Coil 2.5x2	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805703	EAP	Custom 27805703		G2 Complex Xtrasoft Coil 2.5x3	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805704	EAP	Custom 27805704		G2 Complex Xtrasoft Coil 3.5x5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805705	EAP	Custom 27805705		G2 Complex Xtrasoft Coil 3.5x9	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805706	EAP	Custom 27805706		G2 Complex Xtrasoft Coil 3.5x7	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805707	EAP	Custom 27805707		G2 Helical Xtrasoft Coil 2x4	BOTH IP/OP	"$3,148.00 "	"$2,329.52"	$0.00	"$2,518.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.45"	"$2,336.45"	"$2,426.48"	$0.00	$656.04	$0.00	$0.00	$0.00	$0.00	"$1,574.00"	"$2,493.22"	"$2,518.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805708	EAP	Custom 27805708		G2 Helical Xtrasoft Coil 2x6	BOTH IP/OP	"$3,148.00 "	"$2,329.52"	$0.00	"$2,518.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.45"	"$2,336.45"	"$2,426.48"	$0.00	$656.04	$0.00	$0.00	$0.00	$0.00	"$1,574.00"	"$2,493.22"	"$2,518.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805709	EAP	Custom 27805709		G2 Helical Xtrasoft Coil 2x8	BOTH IP/OP	"$3,148.00 "	"$2,329.52"	$0.00	"$2,518.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.45"	"$2,336.45"	"$2,426.48"	$0.00	$656.04	$0.00	$0.00	$0.00	$0.00	"$1,574.00"	"$2,493.22"	"$2,518.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805710	EAP	Custom 27805710		Og Cmplx Xtrasoft Coil 2x1.5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805711	EAP	Custom 27805711		Og Cmplx Xtrasoft Coil 2x2	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	"$1,854.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805712	EAP	Custom 27805712		Og Cmplx Xtrasoft Coil 3x3	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805713	EAP	Custom 27805713		Og Cmplx Xtrasoft Coil 3x4	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	"$1,854.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805714	EAP	Custom 27805714		Og Cmplx Xtrasoft Coil 3x6	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	"$1,854.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805715	EAP	Custom 27805715		Og Cmplx Xtrasoft Coil 3x8	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805716	EAP	Custom 27805716		Og Cmplx Xtrasoft Coil 4x4	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805717	EAP	Custom 27805717		Og Cmplx Xtrasoft Coil 4x6	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	"$1,854.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805718	EAP	Custom 27805718		Og Cmplx Xtrasoft Coil 4x8	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	"$1,854.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805719	EAP	Custom 27805719		Og Cmplx Xtrasoft Coil 4x10	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	"$1,854.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805720	EAP	Custom 27805720		Og Cmplx Xtrasoft Coil 2.5x5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805721	EAP	Custom 27805721		Og Cmplx Xtrasoft Coil 2.5x2.5	BOTH IP/OP	"$4,327.00 "	"$3,201.98"	$0.00	"$3,461.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,211.50"	"$3,211.50"	"$3,335.25"	$0.00	$901.75	$0.00	$0.00	$0.00	$0.00	"$2,163.50"	"$3,426.98"	"$3,461.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805722	EAP	Custom 27805722		Og Cmplx Xtrasoft Coil 2.5x3.5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805723	EAP	Custom 27805723		Og Cmplx Xtrasoft Coil 3.5x5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	"$1,854.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805724	EAP	Custom 27805724		Og Cmplx Xtrasoft Coil 3.5x9	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805725	EAP	Custom 27805725		Og Cmplx Xtrasoft Coil 3.5x7.5	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805726	EAP	Custom 27805726		Og Helical Xtrsoft Coil 2x4	BOTH IP/OP	"$3,148.00 "	"$2,329.52"	$0.00	"$2,518.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.45"	"$2,336.45"	"$2,426.48"	$0.00	$656.04	$0.00	$0.00	$0.00	$0.00	"$1,574.00"	"$2,493.22"	"$2,518.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805727	EAP	Custom 27805727		Og Helical Xtrsoft Coil 2x6	BOTH IP/OP	"$3,148.00 "	"$2,329.52"	$0.00	"$2,518.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.45"	"$2,336.45"	"$2,426.48"	$0.00	$656.04	$0.00	$0.00	$0.00	$0.00	"$1,574.00"	"$2,493.22"	"$2,518.40"	$0.00	"$1,416.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805728	EAP	Custom 27805728		Og Helical Xtrsoft Coil 2x8	BOTH IP/OP	"$3,148.00 "	"$2,329.52"	$0.00	"$2,518.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.45"	"$2,336.45"	"$2,426.48"	$0.00	$656.04	$0.00	$0.00	$0.00	$0.00	"$1,574.00"	"$2,493.22"	"$2,518.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805729	EAP	Custom 27805729		G2 Tdl Complex Xtrasoft Coil 4x8	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805730	EAP	Custom 27805730		G2 Tdl Complex Xtrasoft Coil 4x10	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.61"	"$3,058.61"	"$3,176.47"	$0.00	$858.82	$0.00	$0.00	$0.00	$0.00	"$2,060.50"	"$3,263.83"	"$3,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805731	EAP	Custom 27805731		Kit Prss Monitr 14ga Cdmn Mcsnsr Basic Trndcr Tuo Ndl	BOTH IP/OP	"$2,074.00 "	"$1,534.76"	$0.00	"$1,659.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,539.32"	"$1,539.32"	"$1,598.64"	$0.00	$432.22	$0.00	$0.00	$0.00	$0.00	"$1,037.00"	"$1,642.61"	"$1,659.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805732	EAP	Custom 27805732		Kit Prss Monitr Mcsnsr .7mm Sbdrl Inprench Skl Bolt	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	"$1,654.91"	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805733	EAP	Custom 27805733		Kit Prss Monitr 38cm Cdmn Intrcran Vntrc Trndcr Cath Tnl	BOTH IP/OP	"$2,235.00 "	"$1,653.90"	$0.00	"$1,788.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,658.82"	"$1,658.82"	"$1,722.74"	$0.00	$465.77	$0.00	$0.00	$0.00	$0.00	"$1,117.50"	"$1,770.12"	"$1,788.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805734	EAP	Custom 27805734		Stent Lvis 4.5 23mm	BOTH IP/OP	"$17,913.00 "	"$13,255.62"	$0.00	"$14,330.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,807.34"	$0.00	"$3,733.07"	$0.00	$0.00	$0.00	$0.00	"$8,956.50"	"$14,187.10"	"$14,330.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805735	EAP	Custom 27805735		Device Cmpr Gold Fmstp Pneum Dome Intgr Dgt Mnmtr Adj Belt	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$223.53	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00	$130.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805736	EAP	Custom 27805736		Prtcl Embl 2 Vl Lq Sys Trfl Nbca 1gm	BOTH IP/OP	"$11,437.00 "	"$8,463.38"	$0.00	"$9,149.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,815.64"	$0.00	"$2,383.47"	$0.00	$0.00	$0.00	$0.00	"$5,718.50"	"$9,058.10"	"$9,149.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805737	EAP	Custom 27805737		Prtcl Embl 1 Vl Lq Sys Trfl Nbca 1gm	BOTH IP/OP	"$6,546.00 "	"$4,844.04"	$0.00	"$5,236.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,045.66"	$0.00	"$1,364.19"	$0.00	$0.00	$0.00	$0.00	"$3,273.00"	"$5,184.43"	"$5,236.80"	$0.00	"$2,945.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805738	EAP	HCPCS C1760		Device Clsr 8fr Angsl Vip Vasc Hmst Strl Latex Free Disp	BOTH IP/OP	$723.00 	$535.02	$0.00	$578.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.50	$572.62	$578.40	$0.00	$0.00	$0.00	$113.15	$0.00	$0.00	$115.10	$0.00	$0.00	$0.00	$0.00	$0.00
27805739	EAP	Custom 27805739		Stent 3.5 X 19 Coil Assist Headway 21	BOTH IP/OP	"$16,121.00 "	"$11,929.54"	$0.00	"$12,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,426.07"	$0.00	"$3,359.62"	$0.00	$0.00	$0.00	$0.00	"$8,060.50"	"$12,767.83"	"$12,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805740	EAP	Custom 27805740		Stent 3.5 X 24 Coil Assist  Headway 21	BOTH IP/OP	"$16,121.00 "	"$11,929.54"	$0.00	"$12,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,426.07"	$0.00	"$3,359.62"	$0.00	$0.00	$0.00	$0.00	"$8,060.50"	"$12,767.83"	"$12,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805741	EAP	Custom 27805741		Stent 4.5 X 16 Coil Assist Headway 21	BOTH IP/OP	"$16,121.00 "	"$11,929.54"	$0.00	"$12,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,426.07"	$0.00	"$3,359.62"	$0.00	$0.00	$0.00	$0.00	"$8,060.50"	"$12,767.83"	"$12,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805742	EAP	Custom 27805742		Stent 4.5 X 34 Coil Assist Headway 21	BOTH IP/OP	"$16,121.00 "	"$11,929.54"	$0.00	"$12,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,426.07"	$0.00	"$3,359.62"	$0.00	$0.00	$0.00	$0.00	"$8,060.50"	"$12,767.83"	"$12,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805743	EAP	Custom 27805743		Stent 5.5 X 27 Coil Assist Headway 21	BOTH IP/OP	"$16,121.00 "	"$11,929.54"	$0.00	"$12,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,426.07"	$0.00	"$3,359.62"	$0.00	$0.00	$0.00	$0.00	"$8,060.50"	"$12,767.83"	"$12,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805744	EAP	Custom 27805744		Stent 5.5 X 34 Coil Assist Headway 21	BOTH IP/OP	"$16,121.00 "	"$11,929.54"	$0.00	"$12,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,426.07"	$0.00	"$3,359.62"	$0.00	$0.00	$0.00	$0.00	"$8,060.50"	"$12,767.83"	"$12,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805745	EAP	Custom 27805745		Stent 3.5 X 18 Coil Assist Headway 17	BOTH IP/OP	"$18,980.00 "	"$14,045.20"	$0.00	"$15,184.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,629.78"	$0.00	"$3,955.43"	$0.00	$0.00	$0.00	$0.00	"$9,490.00"	"$15,032.16"	"$15,184.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805746	EAP	Custom 27805746		Stent 3.5 X 23 Coil Assist Headway 17	BOTH IP/OP	"$18,980.00 "	"$14,045.20"	$0.00	"$15,184.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,629.78"	$0.00	"$3,955.43"	$0.00	$0.00	$0.00	$0.00	"$9,490.00"	"$15,032.16"	"$15,184.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805747	EAP	Custom 27805747		Stent 3.5 X 28 Coil Assist Headway 17	BOTH IP/OP	"$18,981.00 "	"$14,045.94"	$0.00	"$15,184.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,630.55"	$0.00	"$3,955.64"	$0.00	$0.00	$0.00	$0.00	"$9,490.50"	"$15,032.95"	"$15,184.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805748	EAP	Custom 27805748		Stent 3.5 X 33 Coil Assist Headway 17	BOTH IP/OP	"$18,981.00 "	"$14,045.94"	$0.00	"$15,184.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,630.55"	$0.00	"$3,955.64"	$0.00	$0.00	$0.00	$0.00	"$9,490.50"	"$15,032.95"	"$15,184.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805750	EAP	HCPCS C1764		System Crd Monitr Rvl Linq Ins	BOTH IP/OP	"$14,592.00 "	"$10,798.08"	$0.00	"$11,673.60"	"$6,566.40"	"$6,566.40"	$0.00	$0.00	$0.00	"$3,041.34"	"$4,181.12"	"$4,181.12"	"$11,247.51"	$0.00	"$3,040.97"	$0.00	"$7,193.86"	"$7,193.86"	$0.00	"$7,296.00"	"$11,556.86"	"$11,673.60"	$0.00	$0.00	$0.00	"$2,283.65"	$0.00	$0.00	"$2,323.05"	$0.00	$0.00	$0.00	$0.00	$0.00
27805751	EAP	HCPCS C1880		Filter Embl Vc Femoral Navalign Dlv Set Strl Disp Pltn Celect	BOTH IP/OP	"$3,032.00 "	"$2,243.68"	$0.00	"$2,425.60"	"$1,364.40"	"$1,364.40"	$0.00	$0.00	$0.00	$631.94	"$2,250.35"	"$2,250.35"	"$2,337.07"	$0.00	$631.87	$0.00	"$1,494.78"	"$1,494.78"	$0.00	"$1,516.00"	"$2,401.34"	"$2,425.60"	$0.00	"$1,364.40"	$0.00	$474.51	$0.00	$0.00	$482.69	$0.00	$0.00	$0.00	$0.00	$0.00
27805752	EAP	HCPCS C1880		Filter Embl Vc Jug Navalign Dlv Set Strl Disp Pltn Celect	BOTH IP/OP	"$3,032.00 "	"$2,243.68"	$0.00	"$2,425.60"	"$1,364.40"	"$1,364.40"	$0.00	$0.00	$0.00	$631.94	"$2,250.35"	"$2,250.35"	"$2,337.07"	$0.00	$631.87	$0.00	"$1,494.78"	"$1,494.78"	$0.00	"$1,516.00"	"$2,401.34"	"$2,425.60"	$0.00	$0.00	$0.00	$474.51	$0.00	$0.00	$482.69	$0.00	$0.00	$0.00	$0.00	$0.00
27805753	EAP	HCPCS C1880		Filter Embl Navalign Dlv Uniset Strl Disp Pltn Celect	BOTH IP/OP	"$3,032.00 "	"$2,243.68"	$0.00	"$2,425.60"	"$1,364.40"	"$1,364.40"	$0.00	$0.00	$0.00	$631.94	"$2,250.35"	"$2,250.35"	"$2,337.07"	$0.00	$631.87	$0.00	"$1,494.78"	"$1,494.78"	$0.00	"$1,516.00"	"$2,401.34"	"$2,425.60"	$0.00	"$1,364.40"	$0.00	$474.51	$0.00	$0.00	$482.69	$0.00	$0.00	$0.00	$0.00	$0.00
27805754	EAP	Custom 27805754		Syr Inflat Dfl Indfltr Embl Coil Trf Dcs 2 Pltn	BOTH IP/OP	$816.00 	$603.84	$0.00	$652.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.64	$605.64	$628.97	$0.00	$170.05	$0.00	$0.00	$0.00	$0.00	$408.00	$646.27	$652.80	$0.00	$367.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805755	EAP	HCPCS C1876		Stent Coron 8mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27805756	EAP	HCPCS C1876		Stent Coron 12mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27805757	EAP	HCPCS C1876		Stent Coron 15mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27805758	EAP	HCPCS C1876		Stent Coron 18mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27805759	EAP	HCPCS C1876		Stent Coron 23mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27805760	EAP	HCPCS C1876		Stent Coron 28mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27805761	EAP	HCPCS C1876		Stent Coron 15mm 2.25mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27805762	EAP	HCPCS C1876		Stent Coron 18mm 2.25mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27805763	EAP	HCPCS C1876		Stent Coron 23mm 2.25mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27805764	EAP	HCPCS C1876		Stent Coron 28mm 2.25mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln	BOTH IP/OP	"$1,791.00 "	"$1,325.34"	$0.00	"$1,432.80"	$805.95	$805.95	$0.00	$0.00	$0.00	$373.29	"$1,329.28"	"$1,329.28"	"$1,380.50"	$0.00	$373.24	$0.00	"$1,059.38"	"$1,059.38"	$0.00	$895.50	"$1,418.47"	"$1,432.80"	$0.00	$0.00	$0.00	$280.29	$0.00	$0.00	$285.13	$0.00	$0.00	$0.00	$0.00	$0.00
27805765	EAP	Custom 27805765		Cath Angio 5fr 8mm 110cm 2 Lum Bln Syr Wdg Prss Strl Latex	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00	$62.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805766	EAP	HCPCS V2790		Amniofix 16mm Disc	BOTH IP/OP	$971.00 	$718.54	$0.00	$776.80	$436.95	$436.95	$0.00	$0.00	$0.00	$202.38	$720.68	$720.68	$748.45	$0.00	$202.36	$0.00	$574.35	$574.35	$0.00	$485.50	$769.03	$776.80	$0.00	$0.00	$0.00	$151.96	$0.00	$0.00	$154.58	$0.00	$0.00	$0.00	$0.00	$0.00
27805767	EAP	HCPCS V2790		Amniofix 2x3cm	BOTH IP/OP	"$2,756.00 "	"$2,039.44"	$0.00	"$2,204.80"	"$1,240.20"	"$1,240.20"	$0.00	$0.00	$0.00	$574.42	"$2,045.50"	"$2,045.50"	"$2,124.32"	$0.00	$574.35	$0.00	"$1,358.71"	"$1,358.71"	$0.00	"$1,378.00"	"$2,182.75"	"$2,204.80"	$0.00	$0.00	$0.00	$431.31	$0.00	$0.00	$438.76	$0.00	$0.00	$0.00	$0.00	$0.00
27805768	EAP	HCPCS V2790		Amniofix 3x3cm	BOTH IP/OP	"$3,662.00 "	"$2,709.88"	$0.00	"$2,929.60"	"$1,647.90"	"$1,647.90"	$0.00	$0.00	$0.00	$763.25	"$2,717.94"	"$2,717.94"	"$2,822.67"	$0.00	$763.16	$0.00	"$1,805.37"	"$1,805.37"	$0.00	"$1,831.00"	"$2,900.30"	"$2,929.60"	$0.00	$0.00	$0.00	$573.10	$0.00	$0.00	$582.99	$0.00	$0.00	$0.00	$0.00	$0.00
27805769	EAP	HCPCS V2790		Amniofix 4x4cm	BOTH IP/OP	"$3,925.00 "	"$2,904.50"	$0.00	"$3,140.00"	"$1,766.25"	"$1,766.25"	$0.00	$0.00	$0.00	$818.07	"$2,913.14"	"$2,913.14"	"$3,025.39"	$0.00	$817.97	$0.00	"$1,935.03"	"$1,935.03"	$0.00	"$1,962.50"	"$3,108.60"	"$3,140.00"	$0.00	$0.00	$0.00	$614.26	$0.00	$0.00	$624.86	$0.00	$0.00	$0.00	$0.00	$0.00
27805770	EAP	HCPCS V2790		Amniofix 4x6cm	BOTH IP/OP	"$5,629.00 "	"$4,165.46"	$0.00	"$4,503.20"	"$2,533.05"	"$2,533.05"	$0.00	$0.00	$0.00	"$1,173.22"	"$4,177.84"	"$4,177.84"	"$4,338.83"	$0.00	"$1,173.08"	$0.00	"$2,775.10"	"$2,775.10"	$0.00	"$2,814.50"	"$4,458.17"	"$4,503.20"	$0.00	$0.00	$0.00	$880.94	$0.00	$0.00	$896.14	$0.00	$0.00	$0.00	$0.00	$0.00
27805771	EAP	HCPCS V2790		Amniofix 2x12cm	BOTH IP/OP	"$2,612.00 "	"$1,932.88"	$0.00	"$2,089.60"	"$1,175.40"	"$1,175.40"	$0.00	$0.00	$0.00	$544.41	"$1,938.63"	"$1,938.63"	"$2,013.33"	$0.00	$544.34	$0.00	"$1,287.72"	"$1,287.72"	$0.00	"$1,306.00"	"$2,068.70"	"$2,089.60"	$0.00	$0.00	$0.00	$408.78	$0.00	$0.00	$415.83	$0.00	$0.00	$0.00	$0.00	$0.00
27805772	EAP	HCPCS V2790		Amniofix 6x16cm	BOTH IP/OP	"$9,005.00 "	"$6,663.70"	$0.00	"$7,204.00"	"$4,052.25"	"$4,052.25"	$0.00	$0.00	$0.00	"$1,876.87"	"$4,181.12"	"$4,181.12"	"$6,941.05"	$0.00	"$1,876.64"	$0.00	"$4,439.47"	"$4,439.47"	$0.00	"$4,502.50"	"$7,131.96"	"$7,204.00"	$0.00	$0.00	$0.00	"$1,409.28"	$0.00	$0.00	"$1,433.60"	$0.00	$0.00	$0.00	$0.00	$0.00
27805773	EAP	HCPCS V2790		Amniofix 9x20cm	BOTH IP/OP	"$21,453.00 "	"$15,875.22"	$0.00	"$17,162.40"	"$9,653.85"	"$9,653.85"	$0.00	$0.00	$0.00	"$4,471.34"	"$4,181.12"	"$4,181.12"	"$16,535.97"	$0.00	"$4,470.81"	$0.00	"$10,576.33"	"$10,576.33"	$0.00	"$10,726.50"	"$16,990.78"	"$17,162.40"	$0.00	$0.00	$0.00	"$3,357.39"	$0.00	$0.00	"$3,415.32"	$0.00	$0.00	$0.00	$0.00	$0.00
27805774	EAP	HCPCS V2790		Amniofix Wrap 2x2 Cm	BOTH IP/OP	"$1,903.00 "	"$1,408.22"	$0.00	"$1,522.40"	$856.35	$856.35	$0.00	$0.00	$0.00	$396.63	"$1,412.41"	"$1,412.41"	"$1,466.83"	$0.00	$396.59	$0.00	"$1,125.62"	"$1,125.62"	$0.00	$951.50	"$1,507.18"	"$1,522.40"	$0.00	$0.00	$0.00	$297.82	$0.00	$0.00	$302.96	$0.00	$0.00	$0.00	$0.00	$0.00
27805775	EAP	HCPCS V2790		Amniofix Wrap 2x4 Cm	BOTH IP/OP	"$3,399.00 "	"$2,515.26"	$0.00	"$2,719.20"	"$1,529.55"	"$1,529.55"	$0.00	$0.00	$0.00	$708.44	"$2,522.74"	"$2,522.74"	"$2,619.95"	$0.00	$708.35	$0.00	"$1,675.71"	"$1,675.71"	$0.00	"$1,699.50"	"$2,692.01"	"$2,719.20"	$0.00	$0.00	$0.00	$531.94	$0.00	$0.00	$541.12	$0.00	$0.00	$0.00	$0.00	$0.00
27805776	EAP	HCPCS V2790		Amniofix Wrap 4x6 Cm	BOTH IP/OP	"$5,772.00 "	"$4,271.28"	$0.00	"$4,617.60"	"$2,597.40"	"$2,597.40"	$0.00	$0.00	$0.00	"$1,203.03"	"$4,181.12"	"$4,181.12"	"$4,449.06"	$0.00	"$1,202.88"	$0.00	"$2,845.60"	"$2,845.60"	$0.00	"$2,886.00"	"$4,571.42"	"$4,617.60"	$0.00	$0.00	$0.00	$903.32	$0.00	$0.00	$918.90	$0.00	$0.00	$0.00	$0.00	$0.00
27805777	EAP	HCPCS C1777		Lead Dfbr 65cm 8fr Optisure Ecrdm Optim 1 Coil Df1is-1	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	$0.00	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27805778	EAP	HCPCS C1777		Lead Dfbr 52cm 8fr Optisure Ecrdm 1 Coil Df4 Conctr True	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	$0.00	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27805779	EAP	HCPCS C1777		Lead Dfbr 58cm 8fr Optisure Ecrdm Optim 1 Coil Df4 Conctr	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	"$4,842.45"	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27805780	EAP	HCPCS C1777		Lead Dfbr 65cm 8fr Optisure Ecrdm 1 Coil Df4 Conctr True	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	"$4,842.45"	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27805781	EAP	HCPCS C1895		Lead Dfbr 65cm 8fr Optisure Ecrdm 2 Coil Df1 Df4 Conctr True	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	"$4,842.45"	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27805782	EAP	HCPCS C1895		Lead Dfbr 52cm 8fr Optisure Ecrdm 2 Coil Df4 Conctr True	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	$0.00	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27805783	EAP	HCPCS C1895		Lead Dfbr 58cm 8fr Optisure Ecrdm 2 Coil Df4 Conctr True	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	"$4,842.45"	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27805784	EAP	HCPCS C1895		Lead Dfbr 65cm 8fr Optisure Ecrdm 2 Coil Df4 220 Dual Shock	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	"$4,842.45"	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27805785	EAP	HCPCS C1895		Lead Dfbr 65cm 8fr Optisure Ecrdm 2 Coil Df4 230 Dual Shock	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	"$4,842.45"	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27805786	EAP	HCPCS C1895		Lead Dfbr 65cm 8fr Optisure Ecrdm 2 Coil Df4 Pass Dual Shock	BOTH IP/OP	"$10,761.00 "	"$7,963.14"	$0.00	"$8,608.80"	"$4,842.45"	"$4,842.45"	$0.00	$0.00	$0.00	"$2,242.86"	"$4,181.12"	"$4,181.12"	"$8,294.58"	$0.00	"$2,242.59"	$0.00	"$5,305.17"	"$5,305.17"	$0.00	"$5,380.50"	"$8,522.71"	"$8,608.80"	$0.00	$0.00	$0.00	"$1,684.10"	$0.00	$0.00	"$1,713.15"	$0.00	$0.00	$0.00	$0.00	$0.00
27805787	EAP	HCPCS C1777		Lead Pcng 64cm 9fr Ecrdm 1 Coil Act Fix Bipol Cardvrt Dfbr	BOTH IP/OP	"$9,175.00 "	"$6,789.50"	$0.00	"$7,340.00"	"$4,128.75"	"$4,128.75"	$0.00	$0.00	$0.00	"$1,912.30"	"$4,181.12"	"$4,181.12"	"$7,072.09"	$0.00	"$1,912.07"	$0.00	"$4,523.28"	"$4,523.28"	$0.00	"$4,587.50"	"$7,266.60"	"$7,340.00"	$0.00	$0.00	$0.00	"$1,435.89"	$0.00	$0.00	"$1,460.66"	$0.00	$0.00	$0.00	$0.00	$0.00
27805788	EAP	HCPCS C1874		Stent Coron 8mm 2.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	"$1,712.70"	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805789	EAP	HCPCS C1874		Stent Coron 12mm 2.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805790	EAP	HCPCS C1874		Stent Coron 15mm 2.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805791	EAP	HCPCS C1874		Stent Coron 18mm 2.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805792	EAP	HCPCS C1874		Stent Coron 23mm 2.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805793	EAP	HCPCS C1874		Stent Coron 28mm 2.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805794	EAP	HCPCS C1874		Stent Coron 8mm 2.5mm .034-.029in 5fr Cocr	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805795	EAP	HCPCS C1874		Stent Coron 12mm 2.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805796	EAP	HCPCS C1874		Stent Coron 15mm 2.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805797	EAP	HCPCS C1874		Stent Coron 18mm 2.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805798	EAP	HCPCS C1874		Stent Coron 23mm 2.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	"$1,712.70"	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805799	EAP	HCPCS C1874		Stent Coron 28mm 2.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	"$1,712.70"	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805800	EAP	HCPCS C1874		Stent Coron 33mm 2.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	"$1,712.70"	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805801	EAP	HCPCS C1874		Stent Coron 38mm 2.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,996.00 "	"$2,957.04"	$0.00	"$3,196.80"	"$1,798.20"	"$1,798.20"	$0.00	$0.00	$0.00	$832.87	"$2,965.83"	"$2,965.83"	"$3,080.12"	$0.00	$832.77	$0.00	"$1,970.03"	"$1,970.03"	$0.00	"$1,998.00"	"$3,164.83"	"$3,196.80"	$0.00	"$1,798.20"	$0.00	$625.37	$0.00	$0.00	$636.16	$0.00	$0.00	$0.00	$0.00	$0.00
27805802	EAP	HCPCS C1874		Stent Coron 8mm 2.75mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805803	EAP	HCPCS C1874		Stent Coron 12mm 2.75mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805804	EAP	HCPCS C1874		Stent Coron 15mm 2.75mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805805	EAP	HCPCS C1874		Stent Coron 18mm 2.75mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805806	EAP	HCPCS C1874		Stent Coron 23mm 2.75mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805807	EAP	HCPCS C1874		Stent Coron 28mm 2.75mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805808	EAP	HCPCS C1874		Stent Coron 33mm 2.75mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805809	EAP	HCPCS C1874		Stent Coron 38mm 2.75mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805810	EAP	HCPCS C1874		Stent Coron 8mm 3mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805811	EAP	HCPCS C1874		Stent Coron 12mm 3mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805812	EAP	HCPCS C1874		Stent Coron 15mm 3mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805813	EAP	HCPCS C1874		Stent Coron 18mm 3mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,996.00 "	"$2,957.04"	$0.00	"$3,196.80"	"$1,798.20"	"$1,798.20"	$0.00	$0.00	$0.00	$832.87	"$2,965.83"	"$2,965.83"	"$3,080.12"	$0.00	$832.77	$0.00	"$1,970.03"	"$1,970.03"	$0.00	"$1,998.00"	"$3,164.83"	"$3,196.80"	$0.00	$0.00	$0.00	$625.37	$0.00	$0.00	$636.16	$0.00	$0.00	$0.00	$0.00	$0.00
27805814	EAP	HCPCS C1874		Stent Coron 23mm 3mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,996.00 "	"$2,957.04"	$0.00	"$3,196.80"	"$1,798.20"	"$1,798.20"	$0.00	$0.00	$0.00	$832.87	"$2,965.83"	"$2,965.83"	"$3,080.12"	$0.00	$832.77	$0.00	"$1,970.03"	"$1,970.03"	$0.00	"$1,998.00"	"$3,164.83"	"$3,196.80"	$0.00	$0.00	$0.00	$625.37	$0.00	$0.00	$636.16	$0.00	$0.00	$0.00	$0.00	$0.00
27805815	EAP	HCPCS C1874		Stent Coron 28mm 3mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805816	EAP	HCPCS C1874		Stent Coron 33mm 3mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805817	EAP	HCPCS C1874		Stent Coron 38mm 3mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,996.00 "	"$2,957.04"	$0.00	"$3,196.80"	"$1,798.20"	"$1,798.20"	$0.00	$0.00	$0.00	$832.87	"$2,965.83"	"$2,965.83"	"$3,080.12"	$0.00	$832.77	$0.00	"$1,970.03"	"$1,970.03"	$0.00	"$1,998.00"	"$3,164.83"	"$3,196.80"	$0.00	$0.00	$0.00	$625.37	$0.00	$0.00	$636.16	$0.00	$0.00	$0.00	$0.00	$0.00
27805818	EAP	HCPCS C1874		Stent Coron 8mm 3.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805819	EAP	HCPCS C1874		Stent Coron 12mm 3.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805820	EAP	HCPCS C1874		Stent Coron 15mm 3.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805821	EAP	HCPCS C1874		Stent Coron 18mm 3.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805822	EAP	HCPCS C1874		Stent Coron 23mm 3.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	"$1,712.70"	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805823	EAP	HCPCS C1874		Stent Coron 28mm 3.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805824	EAP	HCPCS C1874		Stent Coron 33mm 3.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,996.00 "	"$2,957.04"	$0.00	"$3,196.80"	"$1,798.20"	"$1,798.20"	$0.00	$0.00	$0.00	$832.87	"$2,965.83"	"$2,965.83"	"$3,080.12"	$0.00	$832.77	$0.00	"$1,970.03"	"$1,970.03"	$0.00	"$1,998.00"	"$3,164.83"	"$3,196.80"	$0.00	$0.00	$0.00	$625.37	$0.00	$0.00	$636.16	$0.00	$0.00	$0.00	$0.00	$0.00
27805825	EAP	HCPCS C1874		Stent Coron 38mm 3.25mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805826	EAP	HCPCS C1874		Stent Coron 8mm 3.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805827	EAP	HCPCS C1874		Stent Coron 12mm 3.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,996.00 "	"$2,957.04"	$0.00	"$3,196.80"	"$1,798.20"	"$1,798.20"	$0.00	$0.00	$0.00	$832.87	"$2,965.83"	"$2,965.83"	"$3,080.12"	$0.00	$832.77	$0.00	"$1,970.03"	"$1,970.03"	$0.00	"$1,998.00"	"$3,164.83"	"$3,196.80"	$0.00	$0.00	$0.00	$625.37	$0.00	$0.00	$636.16	$0.00	$0.00	$0.00	$0.00	$0.00
27805828	EAP	HCPCS C1874		Stent Coron 15mm 3.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805829	EAP	HCPCS C1874		Stent Coron 18mm 3.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805830	EAP	HCPCS C1874		Stent Coron 23mm 3.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,996.00 "	"$2,957.04"	$0.00	"$3,196.80"	"$1,798.20"	"$1,798.20"	$0.00	$0.00	$0.00	$832.87	"$2,965.83"	"$2,965.83"	"$3,080.12"	$0.00	$832.77	$0.00	"$1,970.03"	"$1,970.03"	$0.00	"$1,998.00"	"$3,164.83"	"$3,196.80"	$0.00	$0.00	$0.00	$625.37	$0.00	$0.00	$636.16	$0.00	$0.00	$0.00	$0.00	$0.00
27805831	EAP	HCPCS C1874		Stent Coron 28mm 3.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805832	EAP	HCPCS C1874		Stent Coron 33mm 3.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,806.00 "	"$2,816.44"	$0.00	"$3,044.80"	"$1,712.70"	"$1,712.70"	$0.00	$0.00	$0.00	$793.27	"$2,824.81"	"$2,824.81"	"$2,933.66"	$0.00	$793.17	$0.00	"$1,876.36"	"$1,876.36"	$0.00	"$1,903.00"	"$3,014.35"	"$3,044.80"	$0.00	$0.00	$0.00	$595.64	$0.00	$0.00	$605.92	$0.00	$0.00	$0.00	$0.00	$0.00
27805833	EAP	HCPCS C1874		Stent Coron 38mm 3.5mm .034-.029in 5fr Everolimus	BOTH IP/OP	"$3,996.00 "	"$2,957.04"	$0.00	"$3,196.80"	"$1,798.20"	"$1,798.20"	$0.00	$0.00	$0.00	$832.87	"$2,965.83"	"$2,965.83"	"$3,080.12"	$0.00	$832.77	$0.00	"$1,970.03"	"$1,970.03"	$0.00	"$1,998.00"	"$3,164.83"	"$3,196.80"	$0.00	$0.00	$0.00	$625.37	$0.00	$0.00	$636.16	$0.00	$0.00	$0.00	$0.00	$0.00
27805834	EAP	HCPCS C1877		Stent Trchbr 15mm 14fr 5cm Introd Slf Xpd Gnt Rsch	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	"$2,362.05"	"$2,362.05"	$0.00	$0.00	$0.00	"$1,094.02"	"$3,895.81"	"$3,895.81"	"$4,045.93"	$0.00	"$1,093.89"	$0.00	"$2,587.76"	"$2,587.76"	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	$0.00	$0.00	$821.47	$0.00	$0.00	$835.64	$0.00	$0.00	$0.00	$0.00	$0.00
27805836	EAP	HCPCS C1877		Stent Trchbr 20mm 16fr 5cm Introd Slf Xpd Gnt Rsch	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	"$2,362.05"	"$2,362.05"	$0.00	$0.00	$0.00	"$1,094.02"	"$3,895.81"	"$3,895.81"	"$4,045.93"	$0.00	"$1,093.89"	$0.00	"$2,587.76"	"$2,587.76"	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	$0.00	$0.00	$821.47	$0.00	$0.00	$835.64	$0.00	$0.00	$0.00	$0.00	$0.00
27805837	EAP	HCPCS C1877		Stent Trchbr 25mm 16fr 5cm Introd Slf Xpd Gnt Rsch	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	"$2,362.05"	"$2,362.05"	$0.00	$0.00	$0.00	"$1,094.02"	"$3,895.81"	"$3,895.81"	"$4,045.93"	$0.00	"$1,093.89"	$0.00	"$2,587.76"	"$2,587.76"	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	"$2,362.05"	$0.00	$821.47	$0.00	$0.00	$835.64	$0.00	$0.00	$0.00	$0.00	$0.00
27805838	EAP	HCPCS C1877		Stent Trchbr 30mm 16fr 5cm Introd Slf Xpd Gnt Rsch	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	"$2,362.05"	"$2,362.05"	$0.00	$0.00	$0.00	"$1,094.02"	"$3,895.81"	"$3,895.81"	"$4,045.93"	$0.00	"$1,093.89"	$0.00	"$2,587.76"	"$2,587.76"	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	$0.00	$0.00	$821.47	$0.00	$0.00	$835.64	$0.00	$0.00	$0.00	$0.00	$0.00
27805839	EAP	HCPCS C1877		Stent Trchbr 35mm 16fr 5cm Introd Slf Xpd Gnt Rsch	BOTH IP/OP	"$5,249.00 "	"$3,884.26"	$0.00	"$4,199.20"	"$2,362.05"	"$2,362.05"	$0.00	$0.00	$0.00	"$1,094.02"	"$3,895.81"	"$3,895.81"	"$4,045.93"	$0.00	"$1,093.89"	$0.00	"$2,587.76"	"$2,587.76"	$0.00	"$2,624.50"	"$4,157.21"	"$4,199.20"	$0.00	$0.00	$0.00	$821.47	$0.00	$0.00	$835.64	$0.00	$0.00	$0.00	$0.00	$0.00
27805841	EAP	HCPCS C1874		Stent Coron 8mm 4mm 2.3-2.7fr Everolimus Elut Pltn	BOTH IP/OP	"$3,412.00 "	"$2,524.88"	$0.00	"$2,729.60"	"$1,535.40"	"$1,535.40"	$0.00	$0.00	$0.00	$711.15	"$2,532.39"	"$2,532.39"	"$2,629.97"	$0.00	$711.06	$0.00	"$1,682.12"	"$1,682.12"	$0.00	"$1,706.00"	"$2,702.30"	"$2,729.60"	$0.00	$0.00	$0.00	$533.98	$0.00	$0.00	$543.19	$0.00	$0.00	$0.00	$0.00	$0.00
27805842	EAP	HCPCS C1874		Stent Coron 12mm 4mm 2.3-2.7fr Everolimus Elut	BOTH IP/OP	"$3,412.00 "	"$2,524.88"	$0.00	"$2,729.60"	"$1,535.40"	"$1,535.40"	$0.00	$0.00	$0.00	$711.15	"$2,532.39"	"$2,532.39"	"$2,629.97"	$0.00	$711.06	$0.00	"$1,682.12"	"$1,682.12"	$0.00	"$1,706.00"	"$2,702.30"	"$2,729.60"	$0.00	$0.00	$0.00	$533.98	$0.00	$0.00	$543.19	$0.00	$0.00	$0.00	$0.00	$0.00
27805843	EAP	HCPCS C1874		Stent Coron 16mm 4mm 2.3-2.7fr Everolimus Elut	BOTH IP/OP	"$3,412.00 "	"$2,524.88"	$0.00	"$2,729.60"	"$1,535.40"	"$1,535.40"	$0.00	$0.00	$0.00	$711.15	"$2,532.39"	"$2,532.39"	"$2,629.97"	$0.00	$711.06	$0.00	"$1,682.12"	"$1,682.12"	$0.00	"$1,706.00"	"$2,702.30"	"$2,729.60"	$0.00	$0.00	$0.00	$533.98	$0.00	$0.00	$543.19	$0.00	$0.00	$0.00	$0.00	$0.00
27805844	EAP	HCPCS C1874		Stent Coron 20mm 4mm 2.3-2.7fr Everolimus Elut	BOTH IP/OP	"$3,412.00 "	"$2,524.88"	$0.00	"$2,729.60"	"$1,535.40"	"$1,535.40"	$0.00	$0.00	$0.00	$711.15	"$2,532.39"	"$2,532.39"	"$2,629.97"	$0.00	$711.06	$0.00	"$1,682.12"	"$1,682.12"	$0.00	"$1,706.00"	"$2,702.30"	"$2,729.60"	$0.00	$0.00	$0.00	$533.98	$0.00	$0.00	$543.19	$0.00	$0.00	$0.00	$0.00	$0.00
27805845	EAP	HCPCS C1874		Stent Coron 24mm 4mm 2.3-2.7fr Everolimus Elut	BOTH IP/OP	"$3,412.00 "	"$2,524.88"	$0.00	"$2,729.60"	"$1,535.40"	"$1,535.40"	$0.00	$0.00	$0.00	$711.15	"$2,532.39"	"$2,532.39"	"$2,629.97"	$0.00	$711.06	$0.00	"$1,682.12"	"$1,682.12"	$0.00	"$1,706.00"	"$2,702.30"	"$2,729.60"	$0.00	$0.00	$0.00	$533.98	$0.00	$0.00	$543.19	$0.00	$0.00	$0.00	$0.00	$0.00
27805846	EAP	HCPCS C1874		Stent Coron 28mm 4mm 2.3-2.7fr Everolimus Elut	BOTH IP/OP	"$3,412.00 "	"$2,524.88"	$0.00	"$2,729.60"	"$1,535.40"	"$1,535.40"	$0.00	$0.00	$0.00	$711.15	"$2,532.39"	"$2,532.39"	"$2,629.97"	$0.00	$711.06	$0.00	"$1,682.12"	"$1,682.12"	$0.00	"$1,706.00"	"$2,702.30"	"$2,729.60"	$0.00	$0.00	$0.00	$533.98	$0.00	$0.00	$543.19	$0.00	$0.00	$0.00	$0.00	$0.00
27805847	EAP	HCPCS C1874		Stent Coron 32mm 4mm 2.3-2.7fr Everolimus Elut	BOTH IP/OP	"$3,412.00 "	"$2,524.88"	$0.00	"$2,729.60"	"$1,535.40"	"$1,535.40"	$0.00	$0.00	$0.00	$711.15	"$2,532.39"	"$2,532.39"	"$2,629.97"	$0.00	$711.06	$0.00	"$1,682.12"	"$1,682.12"	$0.00	"$1,706.00"	"$2,702.30"	"$2,729.60"	$0.00	$0.00	$0.00	$533.98	$0.00	$0.00	$543.19	$0.00	$0.00	$0.00	$0.00	$0.00
27805848	EAP	HCPCS C1874		Stent Coron 38mm 4mm 2.3-2.7fr Everolimus Elut	BOTH IP/OP	"$3,412.00 "	"$2,524.88"	$0.00	"$2,729.60"	"$1,535.40"	"$1,535.40"	$0.00	$0.00	$0.00	$711.15	"$2,532.39"	"$2,532.39"	"$2,629.97"	$0.00	$711.06	$0.00	"$1,682.12"	"$1,682.12"	$0.00	"$1,706.00"	"$2,702.30"	"$2,729.60"	$0.00	$0.00	$0.00	$533.98	$0.00	$0.00	$543.19	$0.00	$0.00	$0.00	$0.00	$0.00
27805850	EAP	HCPCS C1900		Lead Pcng 78cm 5.3fr 5.1fr .014-.018in Lv Qdpl	BOTH IP/OP	"$5,840.00 "	"$4,321.60"	$0.00	"$4,672.00"	"$2,628.00"	"$2,628.00"	$0.00	$0.00	$0.00	"$1,217.20"	"$4,181.12"	"$4,181.12"	"$4,501.47"	$0.00	"$1,217.06"	$0.00	"$2,879.12"	"$2,879.12"	$0.00	"$2,920.00"	"$4,625.28"	"$4,672.00"	$0.00	$0.00	$0.00	$913.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805851	EAP	HCPCS C1900		Lead Pcng Lv Atn Starfix	BOTH IP/OP	"$5,840.00 "	"$4,321.60"	$0.00	"$4,672.00"	"$2,628.00"	"$2,628.00"	$0.00	$0.00	$0.00	"$1,217.20"	"$4,181.12"	"$4,181.12"	"$4,501.47"	$0.00	"$1,217.06"	$0.00	"$2,879.12"	"$2,879.12"	$0.00	"$2,920.00"	"$4,625.28"	"$4,672.00"	$0.00	$0.00	$0.00	$913.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805852	EAP	HCPCS C1900		Lead Pcng 78cm 5.3fr 5.1fr .014-.018in Offst S Lv	BOTH IP/OP	"$5,840.00 "	"$4,321.60"	$0.00	"$4,672.00"	"$2,628.00"	"$2,628.00"	$0.00	$0.00	$0.00	"$1,217.20"	"$4,181.12"	"$4,181.12"	"$4,501.47"	$0.00	"$1,217.06"	$0.00	"$2,879.12"	"$2,879.12"	$0.00	"$2,920.00"	"$4,625.28"	"$4,672.00"	$0.00	$0.00	$0.00	$913.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805853	EAP	HCPCS C1900		Lead Pcng 88cm 5.3fr 5.1fr .014-.018in Offst S Lv	BOTH IP/OP	"$5,840.00 "	"$4,321.60"	$0.00	"$4,672.00"	"$2,628.00"	"$2,628.00"	$0.00	$0.00	$0.00	"$1,217.20"	"$4,181.12"	"$4,181.12"	"$4,501.47"	$0.00	"$1,217.06"	$0.00	"$2,879.12"	"$2,879.12"	$0.00	"$2,920.00"	"$4,625.28"	"$4,672.00"	$0.00	"$2,628.00"	$0.00	$913.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805856	EAP	HCPCS C1874		Stent Coron 16mm 4mm 2.3-2.7fr Everolimus Elut	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	"$15,402.15"	"$15,402.15"	$0.00	$0.00	$0.00	"$7,133.76"	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	"$16,873.91"	"$16,873.91"	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	"$5,356.53"	$0.00	$0.00	"$5,448.94"	$0.00	$0.00	$0.00	$0.00	$0.00
27805860	EAP	HCPCS C1767		Generator Esurg Demipulse Ncp	BOTH IP/OP	"$57,141.00 "	"$42,284.34"	$0.00	"$45,712.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$44,044.28"	$0.00	"$11,908.18"	$0.00	$0.00	$0.00	$0.00	"$28,570.50"	"$45,255.67"	"$45,712.80"	$0.00	"$25,713.45"	$0.00	"$7,751.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805861	EAP	HCPCS C1778		Lead Nrstm 43cm 3mm Perenniaflex Vagus Nrv Sil	BOTH IP/OP	"$17,920.00 "	"$13,260.80"	$0.00	"$14,336.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,812.74"	$0.00	"$3,734.53"	$0.00	$0.00	$0.00	$0.00	"$8,960.00"	"$14,192.64"	"$14,336.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805862	EAP	HCPCS C1876		"Stnt Trchbr 9mm 7fr 59mm 120cm .035"" Cvd Ult Lw Cx"	BOTH IP/OP	"$6,591.00 "	"$4,877.34"	$0.00	"$5,272.80"	"$2,965.95"	"$2,965.95"	$0.00	$0.00	$0.00	"$1,373.73"	"$4,181.12"	"$4,181.12"	"$5,080.34"	$0.00	"$1,373.56"	$0.00	"$3,249.36"	"$3,249.36"	$0.00	"$3,295.50"	"$5,220.07"	"$5,272.80"	$0.00	$0.00	$0.00	"$1,031.49"	$0.00	$0.00	"$1,049.29"	$0.00	$0.00	$0.00	$0.00	$0.00
27805863	EAP	Custom 27805863		Pipeline Embol. Device 3.00mm X 25mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805864	EAP	Custom 27805864		Pipeline Embol. Device 3.00mm X 30mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805865	EAP	Custom 27805865		Pipeline Embol. Device 3.00mm X 35mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805866	EAP	Custom 27805866		Pipeline Embol. Device 3.25mm X 25mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805867	EAP	Custom 27805867		Pipeline Embol. Device 3.25mm X 30mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805868	EAP	Custom 27805868		Pipeline Embol. Device 3.25mm X 35mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805869	EAP	Custom 27805869		Pipeline Embol. Device 3.50mm X 25mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805870	EAP	Custom 27805870		Pipeline Embol. Device 3.50mm X 30mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805871	EAP	Custom 27805871		Pipeline Embol. Device 3.50mm X 35mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805872	EAP	Custom 27805872		Pipeline Embol. Device 3.75mm X 25mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805873	EAP	Custom 27805873		Pipeline Embol. Device 3.75mm X 30mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805874	EAP	Custom 27805874		Pipeline Embol. Device 3.75mm X 35mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805875	EAP	Custom 27805875		Pipeline Embol. Device 4.00mm X 25mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805876	EAP	Custom 27805876		Pipeline Embol. Device 4.00mm X 30mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805877	EAP	Custom 27805877		Pipeline Embol. Device 4.00mm X 35mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805878	EAP	Custom 27805878		Pipeline Embol. Device 4.25mm X 25mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805879	EAP	Custom 27805879		Pipeline Embol. Device 4.25mm X 30mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805880	EAP	Custom 27805880		Pipeline Embol. Device 4.25mm X 35mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805881	EAP	Custom 27805881		Pipeline Embol. Device 4.50mm X 25mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805882	EAP	Custom 27805882		Pipeline Embol. Device 4.50mm X 30mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805883	EAP	Custom 27805883		Pipeline Embol. Device 4.50mm X 35mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805884	EAP	Custom 27805884		Pipeline Embol. Device 4.75mm X 25mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805885	EAP	Custom 27805885		Pipeline Embol. Device 4.75mm X 30mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805886	EAP	Custom 27805886		Pipeline Embol. Device 4.75mm X 35mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805887	EAP	Custom 27805887		Pipeline Embol. Device 5.00mm X 25mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805888	EAP	Custom 27805888		Pipeline Embol. Device 5.00mm X 30mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805889	EAP	Custom 27805889		Pipeline Embol. Device 5.00mm X 35mm	BOTH IP/OP	"$36,219.00 "	"$26,802.06"	$0.00	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,917.61"	$0.00	"$7,548.04"	$0.00	$0.00	$0.00	$0.00	"$18,109.50"	"$28,685.45"	"$28,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805890	EAP	Custom 27805890		Pipeline Embol. Device 2.50mm X 10mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805891	EAP	Custom 27805891		Pipeline Embol. Device 2.50mm X 12mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805892	EAP	Custom 27805892		Pipeline Embol. Device 2.50mm X 14mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805893	EAP	Custom 27805893		Pipeline Embol. Device 2.50mm X 16mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805894	EAP	Custom 27805894		Pipeline Embol. Device 2.50mm X 18mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805895	EAP	Custom 27805895		Pipeline Embol. Device 2.50mm X 20mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805896	EAP	Custom 27805896		Pipeline Embol. Device 2.75mm X 10mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805897	EAP	Custom 27805897		Pipeline Embol. Device 2.75mm X 12mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805898	EAP	Custom 27805898		Pipeline Embol. Device 2.75mm X 14mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805899	EAP	Custom 27805899		Pipeline Embol. Device 2.75mm X 16mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805900	EAP	Custom 27805900		Pipeline Embol. Device 2.75mm X 18mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805901	EAP	Custom 27805901		Pipeline Embol. Device 2.75mm X 20mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805902	EAP	Custom 27805902		Pipeline Embol. Device 3.00mm X 10mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805903	EAP	Custom 27805903		Pipeline Embol. Device 3.00mm X 12mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805904	EAP	Custom 27805904		Pipeline Embol. Device 3.00mm X 14mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805905	EAP	Custom 27805905		Pipeline Embol. Device 3.00mm X 16mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805906	EAP	Custom 27805906		Pipeline Embol. Device 3.00mm X 18mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805907	EAP	Custom 27805907		Pipeline Embol. Device 3.00mm X 20mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805908	EAP	Custom 27805908		Pipeline Embol. Device 3.25mm X 10mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805909	EAP	Custom 27805909		Pipeline Embol. Device 3.25mm X 12mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805910	EAP	Custom 27805910		Pipeline Embol. Device 3.25mm X 14mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805911	EAP	Custom 27805911		Pipeline Embol. Device 3.25mm X 16mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805912	EAP	Custom 27805912		Pipeline Embol. Device 3.25mm X 18mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805913	EAP	Custom 27805913		Pipeline Embol. Device 3.25mm X 20mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805914	EAP	Custom 27805914		Pipeline Embol. Device 3.50mm X 10mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805915	EAP	Custom 27805915		Pipeline Embol. Device 3.50mm X 12mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805916	EAP	Custom 27805916		Pipeline Embol. Device 3.50mm X 14mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805917	EAP	Custom 27805917		Pipeline Embol. Device 3.50mm X 16mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805918	EAP	Custom 27805918		Pipeline Embol. Device 3.50mm X 18mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805919	EAP	Custom 27805919		Pipeline Embol. Device 3.50mm X 20mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805920	EAP	Custom 27805920		Pipeline Embol. Device 3.75mm X 10mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805921	EAP	Custom 27805921		Pipeline Embol. Device 3.75mm X 12mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805922	EAP	Custom 27805922		Pipeline Embol. Device 3.75mm X 14mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805923	EAP	Custom 27805923		Pipeline Embol. Device 3.75mm X 16mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805924	EAP	Custom 27805924		Pipeline Embol. Device 3.75mm X 18mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805925	EAP	Custom 27805925		Pipeline Embol. Device 3.75mm X 20mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805926	EAP	Custom 27805926		Pipeline Embol. Device 4.00mm X 10mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805927	EAP	Custom 27805927		Pipeline Embol. Device 4.00mm X 12mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805928	EAP	Custom 27805928		Pipeline Embol. Device 4.00mm X 14mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805929	EAP	Custom 27805929		Pipeline Embol. Device 4.00mm X 16mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805930	EAP	Custom 27805930		Pipeline Embol. Device 4.00mm X 18mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805931	EAP	Custom 27805931		Pipeline Embol. Device 4.00mm X 20mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805932	EAP	Custom 27805932		Pipeline Embol. Device 4.25mm X 10mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805933	EAP	Custom 27805933		Pipeline Embol. Device 4.25mm X 12mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805934	EAP	Custom 27805934		Pipeline Embol. Device 4.25mm X 14mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805935	EAP	Custom 27805935		Pipeline Embol. Device 4.25mm X 16mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805936	EAP	Custom 27805936		Pipeline Embol. Device 4.25mm X 18mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805937	EAP	Custom 27805937		Pipeline Embol. Device 4.25mm X 20mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805938	EAP	Custom 27805938		Pipeline Embol. Device 4.50mm X 10mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805939	EAP	Custom 27805939		Pipeline Embol. Device 4.50mm X 12mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805940	EAP	Custom 27805940		Pipeline Embol. Device 4.50mm X 14mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805941	EAP	Custom 27805941		Pipeline Embol. Device 4.50mm X 16mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805942	EAP	Custom 27805942		Pipeline Embol. Device 4.50mm X 18mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805943	EAP	Custom 27805943		Pipeline Embol. Device 4.50mm X 20mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805944	EAP	Custom 27805944		Pipeline Embol. Device 4.75mm X 10mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805945	EAP	Custom 27805945		Pipeline Embol. Device 4.75mm X 12mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805946	EAP	Custom 27805946		Pipeline Embol. Device 4.75mm X 14mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805947	EAP	Custom 27805947		Pipeline Embol. Device 4.75mm X 16mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805948	EAP	Custom 27805948		Pipeline Embol. Device 4.75mm X 18mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805949	EAP	Custom 27805949		Pipeline Embol. Device 4.75mm X 20mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805950	EAP	Custom 27805950		Pipeline Embol. Device 5.00mm X 10mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805951	EAP	Custom 27805951		Pipeline Embol. Device 5.00mm X 12mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805952	EAP	Custom 27805952		Pipeline Embol. Device 5.00mm X 14mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805953	EAP	Custom 27805953		Pipeline Embol. Device 5.00mm X 16mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805954	EAP	Custom 27805954		Pipeline Embol. Device 5.00mm X 18mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805955	EAP	Custom 27805955		Pipeline Embol. Device 5.00mm X 20mm	BOTH IP/OP	"$33,856.00 "	"$25,053.44"	$0.00	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,096.20"	$0.00	"$7,055.59"	$0.00	$0.00	$0.00	$0.00	"$16,928.00"	"$26,813.95"	"$27,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805956	EAP	Custom 27805956		"Pipeline Flex, 3.00mm X 25mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805957	EAP	Custom 27805957		"Pipeline Flex, 3.00mm X 30mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805958	EAP	Custom 27805958		"Pipeline Flex, 3.00mm X 35mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805959	EAP	Custom 27805959		"Pipeline Flex, 3.25mm X 25mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805960	EAP	Custom 27805960		"Pipeline Flex, 3.25mm X 30mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805961	EAP	Custom 27805961		"Pipeline Flex, 3.25mm X 35mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805962	EAP	Custom 27805962		"Pipeline Flex, 3.50mm X 25mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805963	EAP	Custom 27805963		"Pipeline Flex, 3.50mm X 30mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805964	EAP	Custom 27805964		"Pipeline Flex, 3.50mm X 35mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805965	EAP	Custom 27805965		"Pipeline Flex, 3.75mm X 25mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805966	EAP	Custom 27805966		"Pipeline Flex, 3.75mm X 30mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805967	EAP	Custom 27805967		"Pipeline Flex, 3.75mm X 35mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805968	EAP	Custom 27805968		"Pipeline Flex, 4.00mm X 25mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805969	EAP	Custom 27805969		"Pipeline Flex, 4.00mm X 30mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805970	EAP	Custom 27805970		"Pipeline Flex, 4.00mm X 35mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805971	EAP	Custom 27805971		"Pipeline Flex, 4.25mm X 25mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805972	EAP	Custom 27805972		"Pipeline Flex, 4.25mm X 30mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805973	EAP	Custom 27805973		"Pipeline Flex, 4.25mm X 35mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805974	EAP	Custom 27805974		"Pipeline Flex, 4.50mm X 25mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805975	EAP	Custom 27805975		"Pipeline Flex, 4.50mm X 30mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805976	EAP	Custom 27805976		"Pipeline Flex, 4.50mm X 35mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805977	EAP	Custom 27805977		"Pipeline Flex, 4.75mm X 25mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805978	EAP	Custom 27805978		"Pipeline Flex, 4.75mm X 30mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805979	EAP	Custom 27805979		"Pipeline Flex, 4.75mm X 35mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805980	EAP	Custom 27805980		"Pipeline Flex, 5.00mm X 25mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805981	EAP	Custom 27805981		"Pipeline Flex, 5.00mm X 30mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805982	EAP	Custom 27805982		"Pipeline Flex, 5.00mm X 35mm"	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805983	EAP	Custom 27805983		"Pipeline Flex, 2.50mm X 10mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805984	EAP	Custom 27805984		"Pipeline Flex, 2.50mm X 12mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805985	EAP	Custom 27805985		"Pipeline Flex, 2.50mm X 14mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805986	EAP	Custom 27805986		"Pipeline Flex, 2.50mm X 16mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805987	EAP	Custom 27805987		"Pipeline Flex, 2.50mm X 18mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805988	EAP	Custom 27805988		"Pipeline Flex, 2.50mm X 20mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805989	EAP	Custom 27805989		"Pipeline Flex, 2.75mm X 10mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805990	EAP	Custom 27805990		"Pipeline Flex, 2.75mm X 12mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805991	EAP	Custom 27805991		"Pipeline Flex, 2.75mm X 14mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805992	EAP	Custom 27805992		"Pipeline Flex, 2.75mm X 16mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805993	EAP	Custom 27805993		"Pipeline Flex, 2.75mm X 18mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805994	EAP	Custom 27805994		"Pipeline Flex, 2.75mm X 20mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805995	EAP	Custom 27805995		"Pipeline Flex, 3.00mm X 10mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805996	EAP	Custom 27805996		"Pipeline Flex, 3.00mm X 12mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805997	EAP	Custom 27805997		"Pipeline Flex, 3.00mm X 14mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805998	EAP	Custom 27805998		"Pipeline Flex, 3.00mm X 16mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27805999	EAP	Custom 27805999		"Pipeline Flex, 3.00mm X 18mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806000	EAP	Custom 27806000		"Pipeline Flex, 3.00mm X 20mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806001	EAP	Custom 27806001		"Pipeline Flex, 3.25mm X 10mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806002	EAP	Custom 27806002		"Pipeline Flex, 3.25mm X 12mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806003	EAP	Custom 27806003		"Pipeline Flex, 3.25mm X 14mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806004	EAP	Custom 27806004		"Pipeline Flex, 3.25mm X 16mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806005	EAP	Custom 27806005		"Pipeline Flex, 3.25mm X 18mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806006	EAP	Custom 27806006		"Pipeline Flex, 3.25mm X 20mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806007	EAP	Custom 27806007		"Pipeline Flex, 3.50mm X 10mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806008	EAP	Custom 27806008		"Pipeline Flex, 3.50mm X 12mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806009	EAP	Custom 27806009		"Pipeline Flex, 3.50mm X 14mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806010	EAP	Custom 27806010		"Pipeline Flex, 3.50mm X 16mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806011	EAP	Custom 27806011		"Pipeline Flex, 3.50mm X 18mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806012	EAP	Custom 27806012		"Pipeline Flex, 3.50mm X 20mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806013	EAP	Custom 27806013		"Pipeline Flex, 3.75mm X 10mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806014	EAP	Custom 27806014		"Pipeline Flex, 3.75mm X 12mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806015	EAP	Custom 27806015		"Pipeline Flex, 3.75mm X 14mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806016	EAP	Custom 27806016		"Pipeline Flex, 3.75mm X 16mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806017	EAP	Custom 27806017		"Pipeline Flex, 3.75mm X 18mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806018	EAP	Custom 27806018		"Pipeline Flex, 3.75mm X 20mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806019	EAP	Custom 27806019		"Pipeline Flex, 4.00mm X 10mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806020	EAP	Custom 27806020		"Pipeline Flex, 4.00mm X 12mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806021	EAP	Custom 27806021		"Pipeline Flex, 4.00mm X 14mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806022	EAP	Custom 27806022		"Pipeline Flex, 4.00mm X 16mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806023	EAP	Custom 27806023		"Pipeline Flex, 4.00mm X 18mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806024	EAP	Custom 27806024		"Pipeline Flex, 4.00mm X 20mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806025	EAP	Custom 27806025		"Pipeline Flex, 4.25mm X 10mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806026	EAP	Custom 27806026		"Pipeline Flex, 4.25mm X 12mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806027	EAP	Custom 27806027		"Pipeline Flex, 4.25mm X 14mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806028	EAP	Custom 27806028		"Pipeline Flex, 4.25mm X 16mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806029	EAP	Custom 27806029		"Pipeline Flex, 4.25mm X 18mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806030	EAP	Custom 27806030		"Pipeline Flex, 4.25mm X 20mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806031	EAP	Custom 27806031		"Pipeline Flex, 4.50mm X 10mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806032	EAP	Custom 27806032		"Pipeline Flex, 4.50mm X 12mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806033	EAP	Custom 27806033		"Pipeline Flex, 4.50mm X 14mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806034	EAP	Custom 27806034		"Pipeline Flex, 4.50mm X 16mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806035	EAP	Custom 27806035		"Pipeline Flex, 4.50mm X 18mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806036	EAP	Custom 27806036		"Pipeline Flex, 4.50mm X 20mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806037	EAP	Custom 27806037		"Pipeline Flex, 4.75mm X 10mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806038	EAP	Custom 27806038		"Pipeline Flex, 4.75mm X 12mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806039	EAP	Custom 27806039		"Pipeline Flex, 4.75mm X 14mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806040	EAP	Custom 27806040		"Pipeline Flex, 4.75mm X 16mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806041	EAP	Custom 27806041		"Pipeline Flex, 4.75mm X 18mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806042	EAP	Custom 27806042		"Pipeline Flex, 4.75mm X 20mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806043	EAP	Custom 27806043		"Pipeline Flex, 5.00mm X 10mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806044	EAP	Custom 27806044		"Pipeline Flex, 5.00mm X 12mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806045	EAP	Custom 27806045		"Pipeline Flex, 5.00mm X 14mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806046	EAP	Custom 27806046		"Pipeline Flex, 5.00mm X 16mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806047	EAP	Custom 27806047		"Pipeline Flex, 5.00mm X 18mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806048	EAP	Custom 27806048		"Pipeline Flex, 5.00mm X 20mm"	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806050	EAP	Custom 27806050		Device Embl  25mm 3mm  Pipeline Flx 55d Nrvsc 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806051	EAP	Custom 27806051		DEVICE EMBL  30MM 3MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806052	EAP	Custom 27806052		DEVICE EMBL  35MM 3MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806053	EAP	Custom 27806053		DEVICE EMBL  25MM 3.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806054	EAP	Custom 27806054		DEVICE EMBL  30MM 3.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806055	EAP	Custom 27806055		DEVICE EMBL  35MM 3.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806056	EAP	Custom 27806056		DEVICE EMBL  25MM 3.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806057	EAP	Custom 27806057		DEVICE EMBL  30MM 3.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806058	EAP	Custom 27806058		DEVICE EMBL  35MM 3.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806059	EAP	Custom 27806059		DEVICE EMBL  25MM 3.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806060	EAP	Custom 27806060		DEVICE EMBL  30MM 3.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806061	EAP	Custom 27806061		DEVICE EMBL  35MM 3.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806062	EAP	Custom 27806062		DEVICE EMBL  25MM 4MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806063	EAP	Custom 27806063		DEVICE EMBL  30MM 4MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806064	EAP	Custom 27806064		DEVICE EMBL  35MM 4MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806065	EAP	Custom 27806065		DEVICE EMBL  25MM 4.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806066	EAP	Custom 27806066		DEVICE EMBL  30MM 4.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806067	EAP	Custom 27806067		DEVICE EMBL  35MM 4.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806068	EAP	Custom 27806068		DEVICE EMBL  30MM 4.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806069	EAP	Custom 27806069		DEVICE EMBL  35MM 4.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806070	EAP	Custom 27806070		DEVICE EMBL  25MM 4.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806071	EAP	Custom 27806071		DEVICE EMBL  30MM 4.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806072	EAP	Custom 27806072		DEVICE EMBL  35MM 4.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806073	EAP	Custom 27806073		DEVICE EMBL  25MM 5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806074	EAP	Custom 27806074		DEVICE EMBL  30MM 5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,279.88"	$0.00	"$7,645.99"	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806075	EAP	Custom 27806075		DEVICE EMBL  35MM 5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$36,689.00 "	"$27,149.86"	$0.00	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,344.50"	"$29,057.69"	"$29,351.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806076	EAP	Custom 27806076		DEVICE EMBL  10MM 2.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806077	EAP	Custom 27806077		DEVICE EMBL  12MM 2.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806078	EAP	Custom 27806078		DEVICE EMBL  16MM 2.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806079	EAP	Custom 27806079		DEVICE EMBL  18MM 2.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806080	EAP	Custom 27806080		DEVICE EMBL  20MM 2.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806081	EAP	Custom 27806081		DEVICE EMBL  10MM 2.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806082	EAP	Custom 27806082		DEVICE EMBL  12MM 2.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806083	EAP	Custom 27806083		DEVICE EMBL  14MM 2.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806084	EAP	Custom 27806084		DEVICE EMBL  16MM 2.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$35,938.00 "	"$26,594.12"	$0.00	"$28,750.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,701.01"	$0.00	"$7,489.48"	$0.00	$0.00	$0.00	$0.00	"$17,969.00"	"$28,462.90"	"$28,750.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806085	EAP	Custom 27806085		DEVICE EMBL  18MM 2.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806086	EAP	Custom 27806086		DEVICE EMBL  20MM 2.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806087	EAP	Custom 27806087		DEVICE EMBL  10MM 3MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806088	EAP	Custom 27806088		DEVICE EMBL  12MM 3MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806089	EAP	Custom 27806089		DEVICE EMBL  14MM 3MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806090	EAP	Custom 27806090		DEVICE EMBL  16MM 3MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806091	EAP	Custom 27806091		DEVICE EMBL  18MM 3MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806092	EAP	Custom 27806092		DEVICE EMBL  20MM 3MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806093	EAP	Custom 27806093		DEVICE EMBL  10MM 3.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806094	EAP	Custom 27806094		DEVICE EMBL  12MM 3.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	"$15,402.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806095	EAP	Custom 27806095		DEVICE EMBL  14MM 3.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806096	EAP	Custom 27806096		DEVICE EMBL  16MM 3.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806097	EAP	Custom 27806097		DEVICE EMBL  18MM 3.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806098	EAP	Custom 27806098		DEVICE EMBL  20MM 3.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806099	EAP	Custom 27806099		DEVICE EMBL  10MM 3.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806100	EAP	Custom 27806100		DEVICE EMBL  12MM 3.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806101	EAP	Custom 27806101		DEVICE EMBL  14MM 3.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806102	EAP	Custom 27806102		DEVICE EMBL  16MM 3.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	"$15,402.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806103	EAP	Custom 27806103		DEVICE EMBL  18MM 3.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806104	EAP	Custom 27806104		DEVICE EMBL  20MM 3.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806105	EAP	Custom 27806105		DEVICE EMBL  10MM 3.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806106	EAP	Custom 27806106		DEVICE EMBL  12MM 3.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806107	EAP	Custom 27806107		DEVICE EMBL  14MM 3.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	"$15,402.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806108	EAP	Custom 27806108		DEVICE EMBL  16MM 3.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	"$15,402.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806109	EAP	Custom 27806109		DEVICE EMBL  18MM 3.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806110	EAP	Custom 27806110		DEVICE EMBL  20MM 3.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806111	EAP	Custom 27806111		DEVICE EMBL  10MM 4MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806112	EAP	Custom 27806112		DEVICE EMBL  12MM 4MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806113	EAP	Custom 27806113		DEVICE EMBL  14MM 4MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806114	EAP	Custom 27806114		DEVICE EMBL  16MM 4MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	"$15,402.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806115	EAP	Custom 27806115		DEVICE EMBL  18MM 4MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806116	EAP	Custom 27806116		DEVICE EMBL  20MM 4MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806117	EAP	Custom 27806117		DEVICE EMBL  10MM 4.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806118	EAP	Custom 27806118		DEVICE EMBL  12MM 4.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806119	EAP	Custom 27806119		DEVICE EMBL  14MM 4.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806120	EAP	Custom 27806120		DEVICE EMBL  16MM 4.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806121	EAP	Custom 27806121		DEVICE EMBL  18MM 4.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806122	EAP	Custom 27806122		DEVICE EMBL  20MM 4.25MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806123	EAP	Custom 27806123		DEVICE EMBL  10MM 4.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806124	EAP	Custom 27806124		DEVICE EMBL  12MM 4.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	"$15,402.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806125	EAP	Custom 27806125		DEVICE EMBL  14MM 4.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,107.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$27,107.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806126	EAP	Custom 27806126		DEVICE EMBL  16MM 4.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806127	EAP	Custom 27806127		DEVICE EMBL  18MM 4.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806128	EAP	Custom 27806128		DEVICE EMBL  20MM 4.5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806129	EAP	Custom 27806129		DEVICE EMBL  10MM 4.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806130	EAP	Custom 27806130		DEVICE EMBL  12MM 4.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$32,603.00 "	"$24,126.22"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$25,130.39"	$0.00	"$6,794.47"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806131	EAP	Custom 27806131		DEVICE EMBL  14MM 4.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806132	EAP	Custom 27806132		DEVICE EMBL  16MM 4.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806133	EAP	Custom 27806133		DEVICE EMBL  18MM 4.75MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806134	EAP	Custom 27806134		DEVICE EMBL  10MM 5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806135	EAP	Custom 27806135		DEVICE EMBL  12MM 5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806136	EAP	Custom 27806136		DEVICE EMBL  14MM 5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806137	EAP	Custom 27806137		DEVICE EMBL  16MM 5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806138	EAP	Custom 27806138		DEVICE EMBL  18MM 5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806139	EAP	Custom 27806139		DEVICE EMBL  20MM 5MM  PIPELINE FLX 55D NRVSC 75%	BOTH IP/OP	"$34,227.00 "	"$25,327.98"	$0.00	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,382.17"	$0.00	"$7,132.91"	$0.00	$0.00	$0.00	$0.00	"$17,113.50"	"$27,107.78"	"$27,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806156	EAP	HCPCS C2625		Stent Uret 10.2fr 28cm Pgtl Curve Lp Radiopq Sdprt	BOTH IP/OP	$281.00 	$207.94	$0.00	$224.80	$126.45	$126.45	$0.00	$0.00	$0.00	$58.57	$208.56	$208.56	$216.59	$0.00	$58.56	$0.00	$166.21	$166.21	$0.00	$140.50	$222.55	$224.80	$0.00	$0.00	$0.00	$43.98	$0.00	$0.00	$44.74	$0.00	$0.00	$0.00	$0.00	$0.00
27806157	EAP	HCPCS C1876		Stent Vasc 4.5mm 6fr 20mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806158	EAP	HCPCS C1876		Stent Vasc 4.5mm 6fr 30mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806159	EAP	HCPCS C1876		Stent Bil 4.5mm 6fr 40mm 120cm Brd Slf Xpd Rapex	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806165	EAP	HCPCS C1769		Coil Embl 8cm 4mm .0125in Axium 1 Hand Op Dtch	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$258.75	$258.75	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$443.21	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$287.50	$455.40	$460.00	$0.00	$0.00	$0.00	$89.99	$0.00	$0.00	$91.54	$0.00	$0.00	$0.00	$0.00	$0.00
27806166	EAP	HCPCS C1880		Coil Embl 30cm 8mm Helipaq 18 Mciol Hlcl Loop Dtch	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$770.80	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00	$450.00	$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
27806167	EAP	HCPCS C1887		Coil Embl 6cm 3mm .0115in Axium 1 Hand Op Dtch	BOTH IP/OP	"$1,668.00 "	"$1,234.32"	$0.00	"$1,334.40"	$750.60	$750.60	$0.00	$0.00	$0.00	$347.65	"$1,237.99"	"$1,237.99"	"$1,285.69"	$0.00	$347.61	$0.00	$986.62	$986.62	$0.00	$834.00	"$1,321.06"	"$1,334.40"	$0.00	$750.60	$0.00	$261.04	$0.00	$0.00	$265.55	$0.00	$0.00	$0.00	$0.00	$0.00
27806168	EAP	HCPCS C1887		Coil Embl 50cm 25mm .0145in Axium 1 Hand Op Dtch	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	"$1,214.01"	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00	$708.75	$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
27806169	EAP	Custom 27806169		System Embolization Nonadhesive Delivery Syringe Lower	BOTH IP/OP	"$5,908.00 "	"$4,371.92"	$0.00	"$4,726.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,553.89"	$0.00	"$1,231.23"	$0.00	$0.00	$0.00	$0.00	"$2,954.00"	"$4,679.14"	"$4,726.40"	$0.00	"$2,658.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806170	EAP	Custom 27806170		Coil Embolization Sphere 10mm 30cm 10 Microcoil Spherical	BOTH IP/OP	"$2,830.00 "	"$2,094.20"	$0.00	"$2,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,100.43"	"$2,100.43"	"$2,181.36"	$0.00	$589.77	$0.00	$0.00	$0.00	$0.00	"$1,415.00"	"$2,241.36"	"$2,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806171	EAP	Custom 27806171		Coil Embolization 9mm 14cm 14 Microcoil 2 Helical Multiple	BOTH IP/OP	"$2,960.00 "	"$2,190.40"	$0.00	"$2,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,196.91"	"$2,196.91"	"$2,281.57"	$0.00	$616.86	$0.00	$0.00	$0.00	$0.00	"$1,480.00"	"$2,344.32"	"$2,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806172	EAP	Custom 27806172		Coil Embl 10cm 2mm Deltapaq 10 Mciol Loop Dtch Sft Rst Dflc	BOTH IP/OP	"$2,294.00 "	"$1,697.56"	$0.00	"$1,835.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,702.61"	"$1,702.61"	"$1,768.22"	$0.00	$478.07	$0.00	$0.00	$0.00	$0.00	"$1,147.00"	"$1,816.85"	"$1,835.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806173	EAP	Custom 27806173		Coil Embolization 4mm 6cm 10 Microcoil Stretch Resistant	BOTH IP/OP	"$2,294.00 "	"$1,697.56"	$0.00	"$1,835.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,702.61"	"$1,702.61"	"$1,768.22"	$0.00	$478.07	$0.00	$0.00	$0.00	$0.00	"$1,147.00"	"$1,816.85"	"$1,835.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806174	EAP	Custom 27806174		Coil Embolization 8mm 30cm 18 Microcoil Helical Loop	BOTH IP/OP	"$1,358.00 "	"$1,004.92"	$0.00	"$1,086.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,007.91"	"$1,007.91"	"$1,046.75"	$0.00	$283.01	$0.00	$0.00	$0.00	$0.00	$679.00	"$1,075.54"	"$1,086.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806175	EAP	Custom 27806175		Coil Embolization Helix 4mm .0125in 8cm 1 Hand Operation	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,404.98"	"$1,404.98"	"$1,459.12"	$0.00	$394.50	$0.00	$0.00	$0.00	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806176	EAP	Custom 27806176		Coil Embolization 3d 3mm .0115in 6cm 1 Hand Operation	BOTH IP/OP	"$2,555.00 "	"$1,890.70"	$0.00	"$2,044.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,896.32"	"$1,896.32"	"$1,969.39"	$0.00	$532.46	$0.00	$0.00	$0.00	$0.00	"$1,277.50"	"$2,023.56"	"$2,044.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806177	EAP	Custom 27806177		Coil Embolization 3d 25mm .0145in 50cm 1 Hand Operation	BOTH IP/OP	"$2,555.00 "	"$1,890.70"	$0.00	"$2,044.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,896.32"	"$1,896.32"	"$1,969.39"	$0.00	$532.46	$0.00	$0.00	$0.00	$0.00	"$1,277.50"	"$2,023.56"	"$2,044.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806178	EAP	HCPCS C1757		System Dlv Angjt Pwr Pls Y Spk Irr 1 Wy Stpck Thrmb Cath	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806179	EAP	HCPCS C1874		Stent Vascular 4.5mm 28mm W/o Distal Tip Enterprise Nitinol	BOTH IP/OP	"$13,910.00 "	"$10,293.40"	$0.00	"$11,128.00"	"$6,259.50"	"$6,259.50"	$0.00	$0.00	$0.00	"$2,899.19"	"$4,181.12"	"$4,181.12"	"$10,721.83"	$0.00	"$2,898.84"	$0.00	"$6,857.63"	"$6,857.63"	$0.00	"$6,955.00"	"$11,016.72"	"$11,128.00"	$0.00	"$6,259.50"	$0.00	"$2,176.92"	$0.00	$0.00	"$2,214.47"	$0.00	$0.00	$0.00	$0.00	$0.00
27806180	EAP	HCPCS C1874		Stent Vascular 4.5mm 37mm W/o Distal Tip Enterprise Nitinol	BOTH IP/OP	"$13,910.00 "	"$10,293.40"	$0.00	"$11,128.00"	"$6,259.50"	"$6,259.50"	$0.00	$0.00	$0.00	"$2,899.19"	"$4,181.12"	"$4,181.12"	"$10,721.83"	$0.00	"$2,898.84"	$0.00	"$6,857.63"	"$6,857.63"	$0.00	"$6,955.00"	"$11,016.72"	"$11,128.00"	$0.00	"$6,259.50"	$0.00	"$2,176.92"	$0.00	$0.00	"$2,214.47"	$0.00	$0.00	$0.00	$0.00	$0.00
27806181	EAP	HCPCS C1769		Guidewire Vascular J .014in 205cm 42cm Soft Tip Steerable	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$517.50	$517.50	$0.00	$0.00	$0.00	$239.69	$853.53	$853.53	$886.42	$0.00	$239.66	$0.00	$680.23	$680.23	$0.00	$575.00	$910.80	$920.00	$0.00	$0.00	$0.00	$179.98	$0.00	$0.00	$183.08	$0.00	$0.00	$0.00	$0.00	$0.00
27806182	EAP	HCPCS C1769		Guidewire Vascular J .014in 205cm 43cm Soft Tip Steerable	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$517.50	$517.50	$0.00	$0.00	$0.00	$239.69	$853.53	$853.53	$886.42	$0.00	$239.66	$0.00	$680.23	$680.23	$0.00	$575.00	$910.80	$920.00	$0.00	$0.00	$0.00	$179.98	$0.00	$0.00	$183.08	$0.00	$0.00	$0.00	$0.00	$0.00
27806183	EAP	HCPCS C1722		Defibrillator Crd .99cm 5.37x7.36cm Dynagen	BOTH IP/OP	"$33,750.00 "	"$24,975.00"	$0.00	"$27,000.00"	"$15,187.50"	"$15,187.50"	$0.00	$0.00	$0.00	"$7,034.34"	"$4,181.12"	"$4,181.12"	"$26,014.50"	$0.00	"$7,033.50"	$0.00	"$16,638.75"	"$16,638.75"	$0.00	"$16,875.00"	"$26,730.00"	"$27,000.00"	$0.00	"$15,187.50"	$0.00	"$5,281.88"	$0.00	$0.00	"$5,373.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27806184	EAP	HCPCS C1788		Catheter Central Venous Pro-fuse Triniflex Od8 Fr Attachable	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$385.40	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00	$225.00	$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
27806185	EAP	Custom 27806185		Xpede Cement And Mixer With Size 2 Multi-tap	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.50	$534.60	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806189	EAP	Custom 27806189		Graft Evas 10cm 12mm Xcldr Cntrlt Leg Stent Xtd	BOTH IP/OP	"$11,275.00 "	"$8,343.50"	$0.00	"$9,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,690.77"	$0.00	"$2,349.71"	$0.00	$0.00	$0.00	$0.00	"$5,637.50"	"$8,929.80"	"$9,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806190	EAP	Custom 27806190		Graft Evas 3.3cm 23mm 19-21mm Aorta	BOTH IP/OP	"$7,938.00 "	"$5,874.12"	$0.00	"$6,350.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,118.61"	$0.00	"$1,654.28"	$0.00	$0.00	$0.00	$0.00	"$3,969.00"	"$6,286.90"	"$6,350.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806195	EAP	HCPCS C1882		Claria Mri Quad Crt-d Device	BOTH IP/OP	"$52,375.00 "	"$38,757.50"	$0.00	"$41,900.00"	"$23,568.75"	"$23,568.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$40,370.65"	$0.00	"$10,914.95"	$0.00	"$25,820.88"	"$25,820.88"	$0.00	"$26,187.50"	"$41,481.00"	"$41,900.00"	$0.00	"$23,568.75"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27806196	EAP	HCPCS C1882		Dfbr Crd 13mm 51x74mm Claria Mri Crt-d Surescan	BOTH IP/OP	"$52,375.00 "	"$38,757.50"	$0.00	"$41,900.00"	"$23,568.75"	"$23,568.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$40,370.65"	$0.00	"$10,914.95"	$0.00	"$25,820.88"	"$25,820.88"	$0.00	"$26,187.50"	"$41,481.00"	"$41,900.00"	$0.00	"$23,568.75"	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27806197	EAP	HCPCS C1882		Dfbr Crd 13mm 51x71mm Surescan Claria Mri	BOTH IP/OP	"$52,375.00 "	"$38,757.50"	$0.00	"$41,900.00"	"$23,568.75"	"$23,568.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$40,370.65"	$0.00	"$10,914.95"	$0.00	"$25,820.88"	"$25,820.88"	$0.00	"$26,187.50"	"$41,481.00"	"$41,900.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27806198	EAP	HCPCS C1882		Dfbr Crd 13mm 51x73mm Claria Mri Crt-d Surescan	BOTH IP/OP	"$52,375.00 "	"$38,757.50"	$0.00	"$41,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$26,187.50"	"$41,481.00"	"$41,900.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27806199	EAP	HCPCS C1882		Claria Mri Crt-d System Mmam	BOTH IP/OP	"$67,375.00 "	"$49,857.50"	$0.00	"$53,900.00"	"$30,318.75"	"$30,318.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$51,932.65"	$0.00	"$14,040.95"	$0.00	"$33,215.88"	"$33,215.88"	$0.00	"$33,687.50"	"$53,361.00"	"$53,900.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27806200	EAP	Custom 27806200		Target Xl Soft 2mm X 3cm -coil	BOTH IP/OP	"$5,904.00 "	"$4,368.96"	$0.00	"$4,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.80"	$0.00	"$1,230.39"	$0.00	$0.00	$0.00	$0.00	"$2,952.00"	"$4,675.97"	"$4,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806201	EAP	Custom 27806201		Target Xl Soft 2mm X 6cm -coil	BOTH IP/OP	"$5,904.00 "	"$4,368.96"	$0.00	"$4,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.80"	$0.00	"$1,230.39"	$0.00	$0.00	$0.00	$0.00	"$2,952.00"	"$4,675.97"	"$4,723.20"	$0.00	"$2,656.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806202	EAP	Custom 27806202		Target Xl Soft 3mm X 6cm -coil	BOTH IP/OP	"$5,904.00 "	"$4,368.96"	$0.00	"$4,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.80"	$0.00	"$1,230.39"	$0.00	$0.00	$0.00	$0.00	"$2,952.00"	"$4,675.97"	"$4,723.20"	$0.00	"$2,656.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806203	EAP	Custom 27806203		Target Xl Soft 3mm X 9cm - Coil	BOTH IP/OP	"$5,904.00 "	"$4,368.96"	$0.00	"$4,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.80"	$0.00	"$1,230.39"	$0.00	$0.00	$0.00	$0.00	"$2,952.00"	"$4,675.97"	"$4,723.20"	$0.00	"$2,656.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806204	EAP	Custom 27806204		Target Xl Soft 4mm X 8cm - Coil	BOTH IP/OP	"$5,904.00 "	"$4,368.96"	$0.00	"$4,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.80"	$0.00	"$1,230.39"	$0.00	$0.00	$0.00	$0.00	"$2,952.00"	"$4,675.97"	"$4,723.20"	$0.00	"$2,656.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806205	EAP	Custom 27806205		Target Xl Soft 4mm X 12cm -coil	BOTH IP/OP	"$5,904.00 "	"$4,368.96"	$0.00	"$4,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.80"	$0.00	"$1,230.39"	$0.00	$0.00	$0.00	$0.00	"$2,952.00"	"$4,675.97"	"$4,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806206	EAP	Custom 27806206		Target Xl Soft 5mm X 10cm Coil	BOTH IP/OP	"$5,904.00 "	"$4,368.96"	$0.00	"$4,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.80"	$0.00	"$1,230.39"	$0.00	$0.00	$0.00	$0.00	"$2,952.00"	"$4,675.97"	"$4,723.20"	$0.00	"$2,656.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806207	EAP	Custom 27806207		Target Xl Soft 5mm X 15cm -coil	BOTH IP/OP	"$5,904.00 "	"$4,368.96"	$0.00	"$4,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.80"	$0.00	"$1,230.39"	$0.00	$0.00	$0.00	$0.00	"$2,952.00"	"$4,675.97"	"$4,723.20"	$0.00	"$2,656.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806208	EAP	Custom 27806208		Dev Emb  25mm 3mm	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806209	EAP	HCPCS C1725		Pleurx Peritoneal Catheter Kit	BOTH IP/OP	"$2,916.00 "	"$2,157.84"	$0.00	"$2,332.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,458.00"	"$2,309.47"	"$2,332.80"	$0.00	$0.00	$0.00	$456.35	$0.00	$0.00	$464.23	$0.00	$0.00	$0.00	$0.00	$0.00
27806210	EAP	HCPCS C1882		Claria Mri Quad Crtd System Mmqm	BOTH IP/OP	"$67,375.00 "	"$49,857.50"	$0.00	"$53,900.00"	"$30,318.75"	"$30,318.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$51,932.65"	$0.00	"$14,040.95"	$0.00	"$33,215.88"	"$33,215.88"	$0.00	"$33,687.50"	"$53,361.00"	"$53,900.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27806211	EAP	HCPCS C1876		Stent Vasc 4.5mm 6fr 60mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806212	EAP	HCPCS C1876		Stent Vasc 4.5mm 6fr 80mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806213	EAP	HCPCS C1876		Stent Vasc 4.5mm 6fr 100mm 120cm Otw Slf	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806214	EAP	HCPCS C1876		Stent Vasc 4.5mm 6fr 120mm 120cm Otw Slf	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806215	EAP	HCPCS C1876		Stent Vasc 5mm 6fr 20mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806216	EAP	HCPCS C1876		Stent Vasc 5mm 6fr 30mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806217	EAP	HCPCS C1876		Stent Vasc 5mm 6fr 40mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806218	EAP	HCPCS C1876		Stent Vasc 5mm 6fr 60mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806219	EAP	HCPCS C1876		Stent Vasc 5mm 6fr 80mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	"$2,418.75"	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806220	EAP	HCPCS C1876		Stent Vasc 5mm 6fr 100mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806221	EAP	HCPCS C1876		Stent Vasc 5mm 6fr 120mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806222	EAP	HCPCS C1876		Stent Vasc 5.5mm 6fr 20mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806223	EAP	HCPCS C1876		Stent Vasc 5.5mm 6fr 30mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806224	EAP	HCPCS C1876		Stent Vasc 5.5mm 6fr 40mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806225	EAP	HCPCS C1876		Stent Vasc 5.5mm 6fr 60mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806227	EAP	HCPCS C1876		Stent Bil 5.5mm 6fr 100mm 120cm Mimetic Dsgn Flxb	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806228	EAP	HCPCS C1876		Stent Bil 5.5mm 6fr 120mm 120cm Mimetic Dsgn Flxb	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806229	EAP	HCPCS C1876		Stent Vasc 6mm 6fr 20mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806230	EAP	HCPCS C1876		Stent Vasc 6mm 6fr 30mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806231	EAP	HCPCS C1876		Stent Vasc 6mm 6fr 40mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806232	EAP	HCPCS C1876		Stent Vasc 6mm 6fr 60mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806233	EAP	HCPCS C1876		Stent Vasc 6mm 6fr 80mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806234	EAP	HCPCS C1876		Stent Vasc 6mm 6fr 100mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806235	EAP	HCPCS C1876		Stent Vasc 6mm 6fr 120mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806236	EAP	HCPCS C1876		Stent Vasc 6mm 6fr 150mm 120cm Peri Supera	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806237	EAP	HCPCS C1876		Stent Vasc 6.5mm 6fr 20mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806238	EAP	HCPCS C1876		Stent Vasc 6.5mm 6fr 30mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806239	EAP	HCPCS C1876		Stent Vasc 6.5mm 6fr 40mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806240	EAP	HCPCS C1876		Stent Vasc 6.5mm 6fr 60mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806241	EAP	HCPCS C1876		Stent Vasc 6.5mm 6fr 120mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806242	EAP	HCPCS C1876		Stent Vasc 6.5mm 6fr 150mm 120cm Otw Slf Expandable	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806243	EAP	HCPCS C1876		Stent Bil 5.5mm 6fr 150mm 120cm Mimetic Dsgn Flxb	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	"$2,244.60"	"$2,244.60"	$0.00	$0.00	$0.00	"$1,039.62"	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	"$2,459.08"	"$2,459.08"	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$780.62	$0.00	$0.00	$794.09	$0.00	$0.00	$0.00	$0.00	$0.00
27806244	EAP	Custom 27806244		STENT VASC 6.5MM 6FR 80MM 120CM OTW SLF EXPANDABLE	BOTH IP/OP	"$4,988.00 "	"$3,691.12"	$0.00	"$3,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,702.09"	"$3,702.09"	"$3,844.75"	$0.00	"$1,039.50"	$0.00	$0.00	$0.00	$0.00	"$2,494.00"	"$3,950.50"	"$3,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806245	EAP	Custom 27806245		Dev Emb  30mm 3mm	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806246	EAP	Custom 27806246		Dev Emb  25mm 3.25	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806247	EAP	Custom 27806247		Dev Emb  35mm 3mm	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806248	EAP	Custom 27806248		Dev Emb  30mm 3.25	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806249	EAP	Custom 27806249		Dev Emb  35mm 3.25	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806250	EAP	Custom 27806250		Dev Emb  25mm 3.5m	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806251	EAP	Custom 27806251		Dev Emb  30mm 3.5m	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806252	EAP	Custom 27806252		Dev Emb 55d 3.5mm	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806253	EAP	Custom 27806253		Dev Emb  25mm 3.75	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806254	EAP	Custom 27806254		Dev Emb  30mm 3.75	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806255	EAP	Custom 27806255		Dev Emb 55d 3.75mm	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806256	EAP	Custom 27806256		Dev Emb  25mm 4mm	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	"$6,290.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806257	EAP	Custom 27806257		Dev Emb  30mm 4mm	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	"$6,290.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806258	EAP	Custom 27806258		Dev Emb 55d 4mm 35	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806259	EAP	Custom 27806259		Dev Emb  25mm 4.25	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806260	EAP	Custom 27806260		Dev Emb  30mm 4.25	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806261	EAP	Custom 27806261		Dev Emb 55d 4.25mm	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806262	EAP	Custom 27806262		Dev Emb  30mm 4.5m	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806263	EAP	Custom 27806263		Dev Emb 55d 4.5mm	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806264	EAP	Custom 27806264		Dev Emb  25mm 4.75	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806265	EAP	Custom 27806265		Dev Emb  30mm 4.75	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806266	EAP	Custom 27806266		Dev Emb 55d 4.75mm	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806267	EAP	Custom 27806267		Dev Emb 55d 5mm 25	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806268	EAP	Custom 27806268		Dev Emb  30mm 5mm	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	"$6,290.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806269	EAP	Custom 27806269		Dev Emb 55d 5mm 33	BOTH IP/OP	"$13,979.00 "	"$10,344.46"	$0.00	"$11,183.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,775.01"	$0.00	"$2,913.22"	$0.00	$0.00	$0.00	$0.00	"$6,989.50"	"$11,071.37"	"$11,183.20"	$0.00	"$6,290.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806270	EAP	Custom 27806270		Dev Emb 55d 2.5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	"$5,868.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806271	EAP	Custom 27806271		Dev Emb  12mm 2.5m	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806272	EAP	Custom 27806272		Dev Emb  16mm 2.5m	BOTH IP/OP	"$32,603.00 "	"$24,126.22"	$0.00	"$26,082.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$25,130.39"	$0.00	"$6,794.47"	$0.00	$0.00	$0.00	$0.00	"$16,301.50"	"$25,821.58"	"$26,082.40"	$0.00	"$14,671.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806273	EAP	Custom 27806273		Dev Emb  18mm 2.5m	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806274	EAP	Custom 27806274		Dev Emb 55d 2.5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806275	EAP	Custom 27806275		Dev Emb  10mm 2.75	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806276	EAP	Custom 27806276		Dev Emb  12mm 2.75	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806277	EAP	Custom 27806277		Dev Emb  14mm 2.75	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806278	EAP	Custom 27806278		Dev Emb 55d 2.75mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806279	EAP	Custom 27806279		Dev Emb  18mm 2.75	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806280	EAP	Custom 27806280		Dev Emb 55d 2.75mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806281	EAP	Custom 27806281		Dev Emb  10mm 3mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806282	EAP	Custom 27806282		Dev Emb  12mm 3mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	"$5,868.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806283	EAP	Custom 27806283		Dev Emb 55d 3mm 14	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806284	EAP	Custom 27806284		Dev Emb  16mm 3mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806285	EAP	Custom 27806285		Dev Emb 55d 3mm 18	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806286	EAP	Custom 27806286		Dev Emb 55d 3mm 20	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806287	EAP	Custom 27806287		Dev Emb  10mm 3.25	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806288	EAP	Custom 27806288		Dev Emb  12mm 3.25	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806289	EAP	Custom 27806289		Dev Emb 55d 3.25mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806290	EAP	Custom 27806290		Dev Emb  16mm 3.25	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806291	EAP	Custom 27806291		Dev Emb 55d 3.25mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806292	EAP	Custom 27806292		Dev Emb 55d 3.25mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806293	EAP	Custom 27806293		Dev Emb  10mm 3.5m	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806294	EAP	Custom 27806294		Dev Emb 55d 3.5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	"$5,868.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806295	EAP	Custom 27806295		Dev Emb 55d 3.5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	"$5,868.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806296	EAP	Custom 27806296		Dev Emb 55d 3.5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806297	EAP	Custom 27806297		Dev Emb 55d 3.5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806298	EAP	Custom 27806298		Dev Emb 55d 3.5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806299	EAP	Custom 27806299		Dev Emb  10mm 3.75	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806300	EAP	Custom 27806300		Dev Emb  12mm 3.75	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	"$5,868.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806301	EAP	Custom 27806301		Dev Emb 55d 3.75mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806302	EAP	Custom 27806302		Dev Emb  16mm 3.75	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	"$5,868.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806303	EAP	Custom 27806303		Dev Emb 55d 3.75mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806304	EAP	Custom 27806304		Dev Emb 55d 3.75mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806305	EAP	Custom 27806305		Dev Emb 55d 4mm 10	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806306	EAP	Custom 27806306		Dev Emb 55d 4mm 12	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806307	EAP	Custom 27806307		Dev Emb 55d 4mm 14	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806308	EAP	Custom 27806308		Dev Emb 55d 4mm 16	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806309	EAP	Custom 27806309		Dev Emb 55d 4mm 18	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806310	EAP	Custom 27806310		Dev Emb 55d 4mm 20	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806311	EAP	Custom 27806311		Dev Emb  10mm 4.25	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806312	EAP	Custom 27806312		Dev Emb 55d 4.25mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806313	EAP	Custom 27806313		Dev Emb 55d 4.25mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806314	EAP	Custom 27806314		Dev Emb 55d 4.25mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	"$5,868.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806315	EAP	Custom 27806315		Dev Emb 55d 4.25mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	"$5,868.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806316	EAP	Custom 27806316		Dev Emb 55d 4.25mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806317	EAP	Custom 27806317		Dev Emb  10mm 4.5m	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806318	EAP	Custom 27806318		Dev Emb 55d 4.5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806319	EAP	Custom 27806319		Dev Emb 55d 4.5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806320	EAP	Custom 27806320		Dev Emb 55d 4.5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806321	EAP	Custom 27806321		Dev Emb 55d 4.5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806322	EAP	Custom 27806322		Dev Emb  10mm 4.75	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806323	EAP	Custom 27806323		Dev Emb 55d 4.75mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806324	EAP	Custom 27806324		Dev Emb 55d 4.75mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806325	EAP	Custom 27806325		Dev Emb 55d 4.75mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	"$5,868.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806326	EAP	Custom 27806326		Dev Emb 55d 4.75mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806327	EAP	Custom 27806327		Dev Emb  10mm 5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806328	EAP	Custom 27806328		Dev Emb  12mm 5mm	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	"$5,868.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806329	EAP	Custom 27806329		Dev Emb 55d 5mm 14	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	"$5,868.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806330	EAP	Custom 27806330		Dev Emb 55d 5mm 16	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806331	EAP	Custom 27806331		Dev Emb 55d 5mm 18	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806332	EAP	Custom 27806332		Dev Emb 55d 5mm 20	BOTH IP/OP	"$13,041.00 "	"$9,650.34"	$0.00	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,052.00"	$0.00	"$2,717.74"	$0.00	$0.00	$0.00	$0.00	"$6,520.50"	"$10,328.47"	"$10,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806333	EAP			Innova 5mm X 20mm X 75cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806334	EAP	HCPCS C1876		Innova 5mm X 40mm X 75cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806335	EAP	HCPCS C1876		Innova 5mm X 60mm X 75cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806336	EAP	HCPCS C1876		Innova 5mm X 80mm X 75cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806337	EAP	HCPCS C1876		Innova 5mm X 100mm X 75cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806338	EAP	HCPCS C1876		Innova 5mm X 120mm X 75cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806339	EAP	HCPCS C1876		Innova 6mm X 20mm X 75cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806340	EAP	HCPCS C1876		Stent Vasc Blue 40mm 6mm Innova Slf Xpd Radiopq	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806341	EAP	HCPCS C1876		Stent Vasc Blue 60mm 6mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806342	EAP	HCPCS C1876		Stent Vasc Blue 80mm 6mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806343	EAP	HCPCS C1876		Stent Vasc Blue 100mm 6mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806344	EAP	HCPCS C1876		Innova 6mm X 120mm X 75cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806345	EAP	HCPCS C1876		Innova 7mm X 20mm X 75cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806346	EAP	HCPCS C1876		Stent Vasc Blue 40mm 7mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806347	EAP	HCPCS C1876		Stent Vasc Blue 60mm 7mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806348	EAP	HCPCS C1876		Stent Vasc Blue 80mm 7mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806349	EAP	HCPCS C1876		Stent Vasc Blue 100mm 7mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806350	EAP	HCPCS C1876		Innova 7mm X 120mm X 75cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806351	EAP	HCPCS C1876		Stent Vasc Blue 20mm 7mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806352	EAP	HCPCS C1876		Stent Vasc Blue 40mm 8mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806353	EAP	HCPCS C1876		Stent Vasc Blue 60mm 8mm Innova Slf Xpd Radiopq	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806354	EAP	HCPCS C1876		Stent Vasc Blue 80mm 8mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806355	EAP	HCPCS C1876		Innova 8mm X 100mm X 75cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806356	EAP	HCPCS C1876		Innova 8mm X 120mm X 75cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806357	EAP	HCPCS C1876		Innova 5mm X 20mm X 130cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806358	EAP	HCPCS C1876		Stent Vasc Blue 40mm 5mm Innova Slf Xpd Radiopq	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806359	EAP	HCPCS C1876		Stent Vasc Blue 60mm 5mm Innova Slf Xpd Radiopq	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806360	EAP	HCPCS C1876		Stent Vasc Blue 80mm 5mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806361	EAP	HCPCS C1876		Stent Vasc Blue 100mm 5mm Innova Slf Xpd Radiopq	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806362	EAP	HCPCS C1876		Stent Vasc Blue 120mm 5mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806363	EAP	HCPCS C1876		Innova 6mm X 20mm X 130cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806364	EAP	HCPCS C1876		Stent Vasc Blue 40mm 6mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806365	EAP	HCPCS C1876		Stent Vasc 60mm 6mm Innova Slf Xpd Radiopq	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806366	EAP	HCPCS C1876		Stent Vasc Blue 80mm 6mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806367	EAP	HCPCS C1876		Stent Vasc 100mm 6mm Innova Slf Xpd Radiopq	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806368	EAP	HCPCS C1876		Stent Vasc Blue 120mm 6mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806369	EAP	HCPCS C1876		Innova 7mm X 20mm X 130cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806370	EAP	HCPCS C1876		Stent Vasc Blue 40mm 7mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806371	EAP	HCPCS C1876		Stent Vasc Blue 60mm 7mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806372	EAP	HCPCS C1876		Stent Vasc Blue 80mm 7mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806373	EAP	HCPCS C1876		Stent Vasc Blue 100mm 7mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806374	EAP	HCPCS C1876		Stent Vasc Blue 120mm 7mm Innova Sprfc Fem Art Slf	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806375	EAP	HCPCS C1876		Innova 8mm X 20mm X 130cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806376	EAP	HCPCS C1876		Innova 8mm X 40mm X 130cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806377	EAP	HCPCS C1876		Innova 8mm X 60mm X 130cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806378	EAP	HCPCS C1876		Innova 8mm X 80mm X 130cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806379	EAP	HCPCS C1876		Innova 8mm X 100mm X 130cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806380	EAP	HCPCS C1876		Innova 8mm X 120mm X 130cm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
27806381	EAP	Custom 27806381		Coil Embl 18d .018in 2mm 2cm Azur Hdrcl Dtch Pltn Ddrgl Peri	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806382	EAP	Custom 27806382		Coil Embl 18d .018in 2mm 4cm Azur Hdrcl Dtch Pltn Ddrgl Peri	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806383	EAP	Custom 27806383		Coil Embl 3mm .018in 2cm Azur Hdrcl 18 Coil Dtch Pltn Ddrgl	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806384	EAP	Custom 27806384		Coil Embl .018in 3mm .021in 5cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806385	EAP	Custom 27806385		Coil Embl .018in 4mm 5cm Azur	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806386	EAP	Custom 27806386		System Embl 5mm .018in 5cm Azur Hdrcl 18 Dtch Pltn Ddrgl	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806387	EAP	HCPCS C1882		"Claria Mri Crt-d System, Mmae"	BOTH IP/OP	"$67,375.00 "	"$49,857.50"	$0.00	"$53,900.00"	"$30,318.75"	"$30,318.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$51,932.65"	$0.00	"$14,040.95"	$0.00	"$33,215.88"	"$33,215.88"	$0.00	"$33,687.50"	"$53,361.00"	"$53,900.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27806388	EAP	HCPCS C1882		"Claria Mri Quad Crtd System, Mmqe"	BOTH IP/OP	"$67,375.00 "	"$49,857.50"	$0.00	"$53,900.00"	"$30,318.75"	"$30,318.75"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$51,932.65"	$0.00	"$14,040.95"	$0.00	"$33,215.88"	"$33,215.88"	$0.00	"$33,687.50"	"$53,361.00"	"$53,900.00"	$0.00	$0.00	$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
27806389	EAP	Custom 27806389		System Embl 5mm .018in 10cm Azur Hdrcl 18 Dtch Pltn Ddrgl	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806390	EAP	Custom 27806390		System Embl 5mm .018in 15cm Azur 18 Dtch Hdrcl Peri	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806391	EAP	Custom 27806391		System Embl 5mm .018in 20cm Azur 18 Dtch Hdrcl Peri	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806392	EAP	Custom 27806392		Coil Embl 4mm .018in 10cm 135cm Azur Dtch Pltn Ddrgl Peri	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806393	EAP	Custom 27806393		Coil Embl .018in 6mm .021in 10cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806394	EAP	Custom 27806394		Coil Embl .018in 8mm .021in 10cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806395	EAP	Custom 27806395		Coil Embl .018in 10mm .021in 10cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806396	EAP	Custom 27806396		Coil Embl 6mm .018in 15cm 135cm Azur 18 Coil Dtch Hdrcl Pltn	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806397	EAP	Custom 27806397		Coil Embl .018in 8mm .021in 15cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806398	EAP	Custom 27806398		Coil Embl .018in 10mm .021in 15cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806399	EAP	Custom 27806399		Coil Embl .018in 12mm .021in 15cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806400	EAP	HCPCS C2617		Set Stent 2 Pigtail Curve 8fr 26cm Radiopq Graduat	BOTH IP/OP	$269.00 	$199.06	$0.00	$215.20	$121.05	$121.05	$0.00	$0.00	$0.00	$56.07	$199.65	$199.65	$207.35	$0.00	$56.06	$0.00	$159.11	$159.11	$0.00	$134.50	$213.05	$215.20	$0.00	$0.00	$0.00	$42.10	$0.00	$0.00	$42.82	$0.00	$0.00	$0.00	$0.00	$0.00
27806401	EAP	HCPCS C1874		Graft Evas 106mm 12mm H&l-b 1-shot Znth Fenestrate	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27806405	EAP	Custom 27806405		Coil Embl 8mm 20cm Azur Hdrcl 18 Coils Dtch	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806406	EAP	Custom 27806406		Coil Embl .018in 12mm .021in 20cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806407	EAP	Custom 27806407		Coil Embl 15mm 20cm Azur Hdrcl 18 Coils Dtch	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806408	EAP	Custom 27806408		Coil Embl 20mm .018in 20cm Strl Azur Hdrcl Dtch Pltn Ddrgl	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806409	EAP	Custom 27806409		Coil Embl 15mm .018in 30cm Strl Azur Hdrcl 18 Coil Dtch Pltn	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806410	EAP	Custom 27806410		Coil Embl 20mm .018in 30cm Strl Azur 18 Coil Dtch Hdrcl Pltn	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806411	EAP	Custom 27806411		Coil Embl .018in 4mm .021-.027in 13cm Strl Azur Cx Dtch Pltn	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806412	EAP	Custom 27806412		Coil Embl .018in 5mm .021-.027in 16cm Azur Cx Dtch Sft Flxb	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806413	EAP	Custom 27806413		Coil Embl .018in 6mm .021-.027in 20cm Azur Cx Dtch Sft Flxb	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806414	EAP	Custom 27806414		Coil Embl .018in 7mm .021-.027in 24cm Azur Cx Dtch Sft Flxb	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806415	EAP	Custom 27806415		Coil Embl .018in 8mm .021-.027in 28cm Azur Cx Hdrcl Dtch Sft	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806416	EAP	Custom 27806416		Coil Embl .018in 9mm .021-.027in 28cm Azur Cx Hdrcl Dtch Sft	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806417	EAP	Custom 27806417		Coil Embl .018in 10mm .021-.027in 32cm Azur Cx Hdrcl Dtch	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806418	EAP	Custom 27806418		Coil Embl .018in 12mm .021-.027in 38cm Azur Cx Hdrcl Dtch	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806419	EAP	Custom 27806419		Coil Embl .018in 14mm .021-.027in 34cm Azur Cx Hdrcl Dtch	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806420	EAP	Custom 27806420		Coil Embl .018in 16mm .021-.027in 39cm Azur Cx Hdrcl Dtch	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806421	EAP	Custom 27806421		Coil Embl .018in 18mm .021-.027in 36cm Azur Cx Hdrcl Dtch	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806422	EAP	Custom 27806422		Coil Embl .018in 20mm .021-.027in 40cm Azur Cx Hdrcl Dtch	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806423	EAP	Custom 27806423		Coil Embl .035in 4mm .038in 5cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806424	EAP	Custom 27806424		Coil Embl 4mm 10cm Azur Dtch Ddrgl Peri 35 Sys	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806425	EAP	Custom 27806425		Coil Embl .035in 6mm .038in 10cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806426	EAP	Custom 27806426		Coil Embl .035in 4mm 15cm Azur Dtch Ddrgl Peri	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806427	EAP	Custom 27806427		Coil Embl .035in 6mm .038in 15cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806428	EAP	Custom 27806428		Coil Embl .035in 8mm .038in 15cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806429	EAP	Custom 27806429		Coil Embl .035in 10mm .038in 15cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806430	EAP	Custom 27806430		Coil Embl 6mm 20cm Azur Dtch Ddrgl Peri 35 Sys	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806431	EAP	Custom 27806431		Coil Embl .035in 8mm .038in 20cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806432	EAP	Custom 27806432		Coil Embl .035in 12mm .038in 20cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806433	EAP	Custom 27806433		Coil Embl .035in 15mm .038in 20cm 135cm Azur Dtch Pltn Ddrgl	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806434	EAP	Custom 27806434		Coil Embl 20mm 20cm Azur Dtch Ddrgl Peri 35 Sys	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806435	EAP	Custom 27806435		Coil Embl 12mm 30cm Azur Dtch Ddrgl Peri 35 Sys	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806436	EAP	Custom 27806436		Coil Embl .035in 4mm 7cm Azur Cx Dtch Sft Sld Cor Flxb Ddrgl	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	"$1,406.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806437	EAP	Custom 27806437		Coil Embl .035in 5mm 11cm Azur Cx Dtch Sft Sld Cor Flxb	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	"$1,406.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806438	EAP	Custom 27806438		Coil Embl .035in 6mm 9cm Azur Cx Dtch Sft Sld Cor Flxb Ddrgl	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806439	EAP	Custom 27806439		Coil Embl .035in 6mm 17cm Azur Cx Dtch Cx Sect Cvrgls Flxb	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	"$1,406.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806440	EAP	Custom 27806440		Coil Embl .035in 8mm 12cm Azur Cx Dtch Sft Sld Cor Flxb	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806441	EAP	Custom 27806441		Coil Embl .035in 8mm 24cm Azur Cx Dtch Sft Sld Cor Flxb	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	"$1,406.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806442	EAP	Custom 27806442		Coil Embl .035in 10mm 19cm Azur Cx Dtch Sft Sld Cor Flxb	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806443	EAP	Custom 27806443		Coil Embl .035in 13mm 24cm Azur Cx Dtch Sft Sld Cor Flxb	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	"$1,406.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806444	EAP	Custom 27806444		Coil Embl .035in 16mm 32cm Azur Cx Dtch Sft Sld Cor Flxb	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806445	EAP	Custom 27806445		Coil Embl .035in 10mm .038in 26cm 150cm Azur Frme Elc Dtch	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	"$1,406.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806446	EAP	Custom 27806446		Coil Embl 8mm 20cm Azur Frm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806447	EAP	Custom 27806447		Coil Embl .018in 10mm .021in 26cm 150cm Azur Frme Elc Dtch	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806448	EAP	Custom 27806448		Coil Embl .018in 14mm 34mm Azur Frme Nonhydrogel Dtch Loop	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806449	EAP	Custom 27806449		Coil Embl .018in 20mm .021in 50cm 150cm Azur Frme Elc Dtch	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806450	EAP	Custom 27806450		Coil Embl Azur Dtch Cntrlr	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$191.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27806451	EAP	HCPCS C1880		"Kit Aln Removal And/or Repositioning, 2in1 Rs"	BOTH IP/OP	"$1,063.00 "	$786.62	$0.00	$850.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$531.50	$841.90	$850.40	$0.00	$0.00	$0.00	$166.36	$0.00	$0.00	$169.23	$0.00	$0.00	$0.00	$0.00	$0.00
27806493	EAP	HCPCS C1874		Graft Evas 91mm 12fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27806494	EAP	HCPCS C1874		Graft Evas 124mm 32mm H&l-b 1-shot Znth 2 Prox	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27806596	EAP	HCPCS C1874		Graft Evas 121mm 12mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27806798	EAP	HCPCS C1874		Graft Evas 76mm 16fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27806899	EAP	HCPCS C1874		Graft Evas 76mm 20fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27807101	EAP	HCPCS C1874		Graft Evas 91mm 16fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27807202	EAP	HCPCS C1874		Graft Evas 91mm 20fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27807303	EAP	HCPCS C1874		Graft Evas 106mm 16fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27807404	EAP	HCPCS C1874		Graft Evas 106mm 20fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27807505	EAP	HCPCS C1874		Graft Evas 121mm 16fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27807606	EAP	HCPCS C1874		Graft Evas 121mm 20fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27807707	EAP	HCPCS C1874		Graft Evas 76mm 12fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27807808	EAP	HCPCS C1874		Graft Evas 76mm 16fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27807909	EAP	HCPCS C1874		Graft Evas 76mm 20fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27808010	EAP	HCPCS C1874		Graft Evas 76mm 24fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27808111	EAP	HCPCS C1874		Graft Evas 91mm 12fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27808212	EAP	HCPCS C1874		Graft Evas 91mm 16fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27808313	EAP	HCPCS C1874		Graft Evas 91mm 20fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27808414	EAP	HCPCS C1874		Graft Evas 91mm 24fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27808515	EAP	HCPCS C1874		Graft Evas 106mm 12fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27808616	EAP	HCPCS C1874		Graft Evas 106mm 16fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27808717	EAP	HCPCS C1874		Graft Evas 106mm 20fr Znth H&l-b 1-shot Vscr Fen	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27808818	EAP	HCPCS C1874		Graft Evas 106mm 24fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27808919	EAP	HCPCS C1874		Graft Evas 121mm 12fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27809020	EAP	HCPCS C1874		Graft Evas 121mm 16fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27809021	EAP	HCPCS C1876		Tent Vasc Strg 10mm 30mm Xact Slf Xpd Cls Cell Fl	BOTH IP/OP	"$4,938.00 "	"$3,654.12"	$0.00	"$3,950.40"	"$2,222.10"	"$2,222.10"	$0.00	$0.00	$0.00	"$1,029.20"	"$3,664.98"	"$3,664.98"	"$3,806.21"	$0.00	"$1,029.08"	$0.00	"$2,434.43"	"$2,434.43"	$0.00	"$2,469.00"	"$3,910.90"	"$3,950.40"	$0.00	"$2,222.10"	$0.00	$772.80	$0.00	$0.00	$786.13	$0.00	$0.00	$0.00	$0.00	$0.00
27809121	EAP	HCPCS C1874		Graft Evas 121mm 20fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27809222	EAP	HCPCS C1874		Graft Evas 121mm 24fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27809323	EAP	HCPCS C1874		Graft Evas 76mm 12fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27809424	EAP	HCPCS C1874		Graft Evas 76mm 20mm 8.1mm 20fr Znth Aaa Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27809525	EAP	HCPCS C1874		Graft Evas 76mm 24fr Znth 1-shot Aaa 2 Brch Vscr	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27809626	EAP	HCPCS C1874		Graft Evas 91mm 12fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27809727	EAP	HCPCS C1874		Graft Evas 91mm 16fr Znth Aaa Fenst Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27809828	EAP	HCPCS C1874		Graft Evas 91mm 20fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27809929	EAP	HCPCS C1874		Graft Evas 91mm 24fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27809930	EAP	HCPCS C1876		Stent Endoth 12mm 8fr 40mm 100cm Flex Recons	BOTH IP/OP	"$2,438.00 "	"$1,804.12"	$0.00	"$1,950.40"	"$1,097.10"	"$1,097.10"	$0.00	$0.00	$0.00	$508.14	"$1,809.48"	"$1,809.48"	"$1,879.21"	$0.00	$508.08	$0.00	"$1,442.08"	"$1,442.08"	$0.00	"$1,219.00"	"$1,930.90"	"$1,950.40"	$0.00	"$1,097.10"	$0.00	$381.55	$0.00	$0.00	$388.13	$0.00	$0.00	$0.00	$0.00	$0.00
27809931	EAP	HCPCS C1788		Set Hmdial 33ml Lf Aqdx Bld Crct Uf-500	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	"$1,734.30"	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00	"$1,012.50"	$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
27810030	EAP	HCPCS C1874		Graft Evas 106mm 12fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27810131	EAP	HCPCS C1874		Graft Evas 106mm 16fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27810232	EAP	HCPCS C1874		Graft Evas 106mm 20fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27810333	EAP	HCPCS C1874		Graft Evas 106mm 24fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27810434	EAP	HCPCS C1874		Graft Evas 121mm 12fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27810535	EAP	HCPCS C1874		Graft Evas 121mm 16fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27810636	EAP	HCPCS C1874		Graft Evas 121mm 20fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27810737	EAP	HCPCS C1874		Graft Evas 121mm 24fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27810838	EAP	HCPCS C1874		Graft Evas 76mm 16fr Znth Aaa Vscr Fen Distal Bfur	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27810939	EAP	HCPCS C1874		Graft Evas 76mm 24mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27811040	EAP	HCPCS C1874		Graft Evas 76mm 26mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27811141	EAP	HCPCS C1874		Graft Evas 76mm 28mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27811242	EAP	HCPCS C1874		Graft Evas 76mm 30mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27811343	EAP	HCPCS C1874		Graft Evas 76mm 32mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27811444	EAP	HCPCS C1874		Graft Evas 91mm 24mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27811545	EAP	HCPCS C1874		Graft Evas 91mm 26mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27811646	EAP	HCPCS C1874		Graft Evas 91mm 28mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27811747	EAP	HCPCS C1874		Graft Evas 91mm 30mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27811848	EAP	HCPCS C1874		Graft Evas 91mm 32mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27811949	EAP	HCPCS C1874		Graft Evas 106mm 24mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27812050	EAP	HCPCS C1874		Graft Evas 106mm 26mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27812151	EAP	HCPCS C1874		Graft Evas 106mm 28mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27812252	EAP	HCPCS C1874		Graft Evas 106mm 30mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27812353	EAP	HCPCS C1874		Graft Evas 106mm 32mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27812454	EAP	HCPCS C1874		Graft Evas 121mm 24mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27812555	EAP	HCPCS C1874		Graft Evas 121mm 26mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27812656	EAP	HCPCS C1874		Graft Evas 121mm 28mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27812757	EAP	HCPCS C1874		Graft Evas 121mm 30mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27812858	EAP	HCPCS C1874		Graft Evas 121mm 32mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27812959	EAP	HCPCS C1874		Graft Evas 84mm 34mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27813060	EAP	HCPCS C1874		Graft Evas 84mm 36mm 8.5mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27813161	EAP	HCPCS C1874		Graft Evas 99mm 34mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27813262	EAP	HCPCS C1874		Graft Evas 99mm 36mm 8.5mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27813363	EAP	HCPCS C1874		Graft Evas 114mm 34mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27813464	EAP	HCPCS C1874		Graft Evas 114mm 36mm 8.5mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27813565	EAP	HCPCS C1874		Graft Evas 129mm 34mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27813666	EAP	HCPCS C1874		Graft Evas 129mm 36mm 8.5mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27813767	EAP	HCPCS C1874		Graft Evas 94mm 24mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27813868	EAP	HCPCS C1874		Graft Evas 94mm 26mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27813969	EAP	HCPCS C1874		Graft Evas 94mm 20fr Znth Aaa Vscr Fen Prox Bfur	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27814070	EAP	HCPCS C1874		Graft Evas 94mm 30mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27814171	EAP	HCPCS C1874		Graft Evas 94mm 32mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27814272	EAP	HCPCS C1874		Graft Evas 109mm 24mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27814373	EAP	HCPCS C1874		Graft Evas 109mm 26mm H&l-b 1-shot Znth 2 Prox	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27814474	EAP	HCPCS C1874		Graft Evas 109mm 28mm H&l-b 1-shot Znth 2 Prox	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27814575	EAP	HCPCS C1874		Graft Evas 109mm 30mm H&l-b 1-shot Znth 2 Prox	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27814676	EAP	HCPCS C1874		Graft Evas 109mm 32mm H&l-b 1-shot Znth 2 Prox	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27814777	EAP	HCPCS C1874		Graft Evas 124mm 24mm 7.7mm 20fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27814878	EAP	HCPCS C1874		Graft Evas 124mm 12fr Znth Aaa Vscr Fen Distal	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27814979	EAP	HCPCS C1874		Graft Evas 124mm 2fr Znth Aaa Fenst Prox Body 28mm	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27815080	EAP	HCPCS C1874		Graft Evas 124mm 30mm H&l-b 1-shot Znth 2 Prox	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27815282	EAP	HCPCS C1874		Graft Evas 107mm 34mm H&l-b 1-shot Znth 2 Prox	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27815383	EAP	HCPCS C1874		Graft Evas 107mm 36mm H&l-b 1-shot Znth 2 Prox	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27815484	EAP	HCPCS C1874		Graft Evas 122mm 34mm 20fr H L-b 1-shot Znth 2	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27815585	EAP	HCPCS C1874		Graft Evas 122mm 36mm 8.5mm 22fr Znth H&l-b 1-shot	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27815686	EAP	HCPCS C1874		Graft Evas 137mm 34mm H&l-b 1-shot Znth 2 Prox	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27815787	EAP	HCPCS C1874		Graft Evas 137mm 36mm Znth H&l-b 1-shot 2 Prox	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	"$21,197.00"	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00	$0.00	$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27815888	EAP	HCPCS C1874		Graft Evas 109mm 20mm 7.7mm 20fr Znth Fenestrate 2	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	"$7,145.32"	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00	$0.00	$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
27815889	EAP	HCPCS C1881		Catheter Intvn Mic 2.7fr L130c	BOTH IP/OP	$818.13 	$605.42	$0.00	$654.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$607.22	$607.22	$630.61	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$409.07	$647.96	$654.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815890	EAP	Custom 27815890		Coil Embol L14cm Loop Od5mm 0.018in Platinum Hydrogel Polyme	BOTH IP/OP	$818.13 	$605.42	$0.00	$654.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$607.22	$607.22	$630.61	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$409.07	$647.96	$654.50	$0.00	$368.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815891	EAP	Custom 27815891		Coil Embol L20cm Od6mm 0.018in Hydrocoil Pushable Azur 18p	BOTH IP/OP	$818.13 	$605.42	$0.00	$654.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$607.22	$607.22	$630.61	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$409.07	$647.96	$654.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815892	EAP	Custom 27815892		Coil Embol L20cm Loop Od8mm 0.018in Platinum Hydrogel Polyme	BOTH IP/OP	$923.33 	$683.26	$0.00	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$685.30	$685.30	$711.70	$0.00	$192.42	$0.00	$0.00	$0.00	$0.00	$461.67	$731.28	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815893	EAP	Custom 27815893		Coil Embol L14cm Loop Od6mm 0.035in Platinum Hydrogel Polyme	BOTH IP/OP	$923.33 	$683.26	$0.00	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$685.30	$685.30	$711.70	$0.00	$192.42	$0.00	$0.00	$0.00	$0.00	$461.67	$731.28	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815894	EAP	Custom 27815894		Coil Embol L20cm Loop Od8mm 0.035in Platinum Hydrogel Polyme	BOTH IP/OP	$923.33 	$683.26	$0.00	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$685.30	$685.30	$711.70	$0.00	$192.42	$0.00	$0.00	$0.00	$0.00	$461.67	$731.28	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815895	EAP	Custom 27815895		Coil Embol L20cm Loop Od10mm 0.035in Platinum Hydrogel Polym	BOTH IP/OP	$923.33 	$683.26	$0.00	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$685.30	$685.30	$711.70	$0.00	$192.42	$0.00	$0.00	$0.00	$0.00	$461.67	$731.28	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815896	EAP	Custom 27815896		Coil Embol L20cm Loop Od15mm 0	BOTH IP/OP	$923.33 	$683.26	$0.00	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$685.30	$685.30	$711.70	$0.00	$192.42	$0.00	$0.00	$0.00	$0.00	$461.67	$731.28	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815897	EAP	Custom 27815897		Coil Embol L20cm Loop Od16mm 0	BOTH IP/OP	$818.13 	$605.42	$0.00	$654.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$607.22	$607.22	$630.61	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$409.07	$647.96	$654.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815898	EAP	Custom 27815898		Coil Embl .018in 10mm 14cm Azur Hdrcl Psh Peri 18 Sys	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.24	$260.24	$270.27	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.32	$277.70	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815899	EAP	Custom 27815899		Coil Embl .018in 2mm 2cm Azur Hdrcl Psh Perm Mech Ocl Ddrgl	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.24	$260.24	$270.27	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.32	$277.70	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815900	EAP	Custom 27815900		Coil Embl .018in 3mm 2cm Azur Hdrcl Psh Loop Pltn Ddrgl Peri	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.98	$346.98	$360.35	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$233.75	$370.26	$374.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815901	EAP	Custom 27815901		Coil Embl .018in 3mm 4cm Azur Hdrcl Psh Perm Mech Ocl Ddrgl	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.24	$260.24	$270.27	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.32	$277.70	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815902	EAP	Custom 27815902		Coil Embl .018in 4mm 2cm Azur Hdrcl Psh Peri 18 Sys	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.98	$346.98	$360.35	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$233.75	$370.26	$374.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815903	EAP	Custom 27815903		Coil Embl .018in 4mm 4cm Azur Hdrcl Psh Peri 18 Sys	BOTH IP/OP	$584.38 	$432.44	$0.00	$467.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$433.73	$433.73	$450.44	$0.00	$121.78	$0.00	$0.00	$0.00	$0.00	$292.19	$462.83	$467.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815904	EAP	Custom 27815904		Coil Embl .018in 4mm 6cm Azur Hdrcl Psh Peri 18 Sys	BOTH IP/OP	$689.58 	$510.29	$0.00	$551.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$511.81	$511.81	$531.53	$0.00	$143.71	$0.00	$0.00	$0.00	$0.00	$344.79	$546.15	$551.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815905	EAP	Custom 27815905		Coil Embl .018in 4mm 6cm Azur Hdrcl Psh Perm Mech Ocl Ddrgl	BOTH IP/OP	$701.25 	$518.93	$0.00	$561.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$520.47	$520.47	$540.52	$0.00	$146.14	$0.00	$0.00	$0.00	$0.00	$350.63	$555.39	$561.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815906	EAP	Custom 27815906		Coil Embl .018in 5mm 10cm Azur Hdrcl Psh Peri 18 Sys	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.98	$346.98	$360.35	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$233.75	$370.26	$374.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815907	EAP	Custom 27815907		Coil Embl .018in 5mm 4cm Azur Hdrcl Psh Peri 18 Sys	BOTH IP/OP	$584.38 	$432.44	$0.00	$467.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$433.73	$433.73	$450.44	$0.00	$121.78	$0.00	$0.00	$0.00	$0.00	$292.19	$462.83	$467.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815908	EAP	Custom 27815908		Coil Embl .018in 5mm 6cm Azur Hdrcl Psh 18 Sys	BOTH IP/OP	$689.58 	$510.29	$0.00	$551.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$511.81	$511.81	$531.53	$0.00	$143.71	$0.00	$0.00	$0.00	$0.00	$344.79	$546.15	$551.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815909	EAP	Custom 27815909		Coil Embl .018in 5mm 6cm Azur Hdrcl Psh Perm Mech Ocl Ddrgl	BOTH IP/OP	$701.25 	$518.93	$0.00	$561.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$520.47	$520.47	$540.52	$0.00	$146.14	$0.00	$0.00	$0.00	$0.00	$350.63	$555.39	$561.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815910	EAP	Custom 27815910		Coil Embl .018in 6mm 10cm Azur Hdrcl Psh Peri 18 Sys	BOTH IP/OP	$818.13 	$605.42	$0.00	$654.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$607.22	$607.22	$630.61	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$409.07	$647.96	$654.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815911	EAP	Custom 27815911		Coil Embl .018in 6mm 14cm Azur Hdrcl Psh Peri 18 Sys	BOTH IP/OP	$584.38 	$432.44	$0.00	$467.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$433.73	$433.73	$450.44	$0.00	$121.78	$0.00	$0.00	$0.00	$0.00	$292.19	$462.83	$467.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815912	EAP	Custom 27815912		Coil Embl .018in 6mm 6cm Azur Hdrcl Psh Peri 18 Sys	BOTH IP/OP	$701.25 	$518.93	$0.00	$561.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$520.47	$520.47	$540.52	$0.00	$146.14	$0.00	$0.00	$0.00	$0.00	$350.63	$555.39	$561.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815913	EAP	Custom 27815913		Coil Embl .018in 8mm 10cm Azur Hdrcl Psh Peri 18 Sys	BOTH IP/OP	$818.13 	$605.42	$0.00	$654.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$607.22	$607.22	$630.61	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$409.07	$647.96	$654.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815914	EAP	Custom 27815914		Coil Embl .018in 8mm 14cm Azur Hdrcl Psh Peri 18 Sys	BOTH IP/OP	$923.33 	$683.26	$0.00	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$685.30	$685.30	$711.70	$0.00	$192.42	$0.00	$0.00	$0.00	$0.00	$461.67	$731.28	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815915	EAP	Custom 27815915		Coil Embl .035in 10mm 14cm Azur Hdrcl Psh Peri 35 Sys	BOTH IP/OP	$923.33 	$683.26	$0.00	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$685.30	$685.30	$711.70	$0.00	$192.42	$0.00	$0.00	$0.00	$0.00	$461.67	$731.28	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815916	EAP	Custom 27815916		Coil Embl .035in 15mm 14cm Azur Hdrcl Psh Loop Pltn Ddrgl	BOTH IP/OP	$572.70 	$423.80	$0.00	$458.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$425.06	$425.06	$441.44	$0.00	$119.35	$0.00	$0.00	$0.00	$0.00	$286.35	$453.58	$458.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815917	EAP	Custom 27815917		Coil Embl .035in 4mm 4cm Azur Hdrcl Psh Peri 35 Sys	BOTH IP/OP	$806.45 	$596.77	$0.00	$645.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$598.55	$598.55	$621.61	$0.00	$168.06	$0.00	$0.00	$0.00	$0.00	$403.23	$638.71	$645.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815918	EAP	Custom 27815918		Coil Embl .035in 5mm 10cm Azur Hdrcl Psh	BOTH IP/OP	$806.45 	$596.77	$0.00	$645.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$598.55	$598.55	$621.61	$0.00	$168.06	$0.00	$0.00	$0.00	$0.00	$403.23	$638.71	$645.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815919	EAP	Custom 27815919		Coil Embl .035in 6mm 10cm Azur Hdrcl Psh	BOTH IP/OP	$806.45 	$596.77	$0.00	$645.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$598.55	$598.55	$621.61	$0.00	$168.06	$0.00	$0.00	$0.00	$0.00	$403.23	$638.71	$645.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815920	EAP	Custom 27815920		Coil Embl .035in 8mm 10cm Azur Hdrcl Psh Peri 35 Sys	BOTH IP/OP	$923.33 	$683.26	$0.00	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$685.30	$685.30	$711.70	$0.00	$192.42	$0.00	$0.00	$0.00	$0.00	$461.67	$731.28	$738.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815922	EAP	Custom 27815922		Coil Embol L20cm Od10mm 0.018in Hydrocoil Pushable Azur 18p	BOTH IP/OP	$775.00 	$573.50	$0.00	$620.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.21	$575.21	$597.37	$0.00	$161.51	$0.00	$0.00	$0.00	$0.00	$387.50	$613.80	$620.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815923	EAP	HCPCS C1874		Stent Endoprsth 29mm 7mm 11mm 7fr Gore Vbhn 135cm	BOTH IP/OP	"$6,725.00 "	"$4,976.50"	$0.00	"$5,380.00"	"$3,026.25"	"$3,026.25"	$0.00	$0.00	$0.00	"$1,401.66"	"$4,181.12"	"$4,181.12"	"$5,183.63"	$0.00	"$1,401.49"	$0.00	"$3,315.43"	"$3,315.43"	$0.00	"$3,362.50"	"$5,326.20"	"$5,380.00"	$0.00	$0.00	$0.00	"$1,052.46"	$0.00	$0.00	"$1,070.62"	$0.00	$0.00	$0.00	$0.00	$0.00
27815924	EAP	HCPCS C1874		Stent Endoprsth 29mm 8mm 11mm 7fr Gore Vbhn 135cm	BOTH IP/OP	"$6,725.00 "	"$4,976.50"	$0.00	"$5,380.00"	"$3,026.25"	"$3,026.25"	$0.00	$0.00	$0.00	"$1,401.66"	"$4,181.12"	"$4,181.12"	"$5,183.63"	$0.00	"$1,401.49"	$0.00	"$3,315.43"	"$3,315.43"	$0.00	"$3,362.50"	"$5,326.20"	"$5,380.00"	$0.00	$0.00	$0.00	"$1,052.46"	$0.00	$0.00	"$1,070.62"	$0.00	$0.00	$0.00	$0.00	$0.00
27815925	EAP	HCPCS C1874		Stent Endoprsth 29mm 11mm 16sq Mm 8fr Gore Vbhn	BOTH IP/OP	"$8,138.00 "	"$6,022.12"	$0.00	"$6,510.40"	"$3,662.10"	"$3,662.10"	$0.00	$0.00	$0.00	"$1,696.16"	"$4,181.12"	"$4,181.12"	"$6,272.77"	$0.00	"$1,695.96"	$0.00	"$4,012.03"	"$4,012.03"	$0.00	"$4,069.00"	"$6,445.30"	"$6,510.40"	$0.00	$0.00	$0.00	"$1,273.60"	$0.00	$0.00	"$1,295.57"	$0.00	$0.00	$0.00	$0.00	$0.00
27815926	EAP	HCPCS C1874		Stent Endoprsth 39mm 7mm 11mm 7fr Gore Vbhn 135cm	BOTH IP/OP	"$8,138.00 "	"$6,022.12"	$0.00	"$6,510.40"	"$3,662.10"	"$3,662.10"	$0.00	$0.00	$0.00	"$1,696.16"	"$4,181.12"	"$4,181.12"	"$6,272.77"	$0.00	"$1,695.96"	$0.00	"$4,012.03"	"$4,012.03"	$0.00	"$4,069.00"	"$6,445.30"	"$6,510.40"	$0.00	$0.00	$0.00	"$1,273.60"	$0.00	$0.00	"$1,295.57"	$0.00	$0.00	$0.00	$0.00	$0.00
27815927	EAP	HCPCS C1874		Stent Endoprsth 39mm 8mm 11mm 7fr Gore Vbhn 135cm	BOTH IP/OP	"$8,138.00 "	"$6,022.12"	$0.00	"$6,510.40"	"$3,662.10"	"$3,662.10"	$0.00	$0.00	$0.00	"$1,696.16"	"$4,181.12"	"$4,181.12"	"$6,272.77"	$0.00	"$1,695.96"	$0.00	"$4,012.03"	"$4,012.03"	$0.00	"$4,069.00"	"$6,445.30"	"$6,510.40"	$0.00	$0.00	$0.00	"$1,273.60"	$0.00	$0.00	"$1,295.57"	$0.00	$0.00	$0.00	$0.00	$0.00
27815928	EAP	HCPCS c1874		Stent Endoprsth 39mm 11mm 16sq Mm 8fr Gore Vbhn	BOTH IP/OP	"$8,138.00 "	"$6,022.12"	$0.00	"$6,510.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,272.77"	$0.00	"$1,695.96"	$0.00	$0.00	$0.00	$0.00	"$4,069.00"	"$6,445.30"	"$6,510.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815929	EAP	HCPCS C1874		Stent Endoprsth 59mm 7mm 11mm 7fr Gore Vbhn 135cm	BOTH IP/OP	"$8,138.00 "	"$6,022.12"	$0.00	"$6,510.40"	"$3,662.10"	"$3,662.10"	$0.00	$0.00	$0.00	"$1,696.16"	"$4,181.12"	"$4,181.12"	"$6,272.77"	$0.00	"$1,695.96"	$0.00	"$4,012.03"	"$4,012.03"	$0.00	"$4,069.00"	"$6,445.30"	"$6,510.40"	$0.00	"$3,662.10"	$0.00	"$1,273.60"	$0.00	$0.00	"$1,295.57"	$0.00	$0.00	$0.00	$0.00	$0.00
27815930	EAP	HCPCS C1874		Stent Endoprsth 59mm 8mm 11mm 7fr Gore Vbhn 135cm	BOTH IP/OP	"$8,138.00 "	"$6,022.12"	$0.00	"$6,510.40"	"$3,662.10"	"$3,662.10"	$0.00	$0.00	$0.00	"$1,696.16"	"$4,181.12"	"$4,181.12"	"$6,272.77"	$0.00	"$1,695.96"	$0.00	"$4,012.03"	"$4,012.03"	$0.00	"$4,069.00"	"$6,445.30"	"$6,510.40"	$0.00	$0.00	$0.00	"$1,273.60"	$0.00	$0.00	"$1,295.57"	$0.00	$0.00	$0.00	$0.00	$0.00
27815931	EAP	HCPCS C1874		Stent Endoprsth 59mm 11mm 16sq Mm 8fr Gore Vbhn	BOTH IP/OP	"$8,138.00 "	"$6,022.12"	$0.00	"$6,510.40"	"$3,662.10"	"$3,662.10"	$0.00	$0.00	$0.00	"$1,696.16"	"$4,181.12"	"$4,181.12"	"$6,272.77"	$0.00	"$1,695.96"	$0.00	"$4,012.03"	"$4,012.03"	$0.00	"$4,069.00"	"$6,445.30"	"$6,510.40"	$0.00	$0.00	$0.00	"$1,273.60"	$0.00	$0.00	"$1,295.57"	$0.00	$0.00	$0.00	$0.00	$0.00
27815932	EAP			Catheter Infus 18fr Trevo Pro Mic Nrvsc	BOTH IP/OP	"$1,269.00 "	$939.06	$0.00	"$1,015.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$941.85	$941.85	$978.15	$0.00	$264.46	$0.00	$0.00	$0.00	$0.00	$634.50	"$1,005.05"	"$1,015.20"	$0.00	$571.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815933	EAP	HCPCS C1874		Stent Eprsth 8mm 7fr 10cm 120cm Vbhn Dlv Sys Hep Sprfc Fem	BOTH IP/OP	"$8,738.00 "	"$6,466.12"	$0.00	"$6,990.40"	"$3,932.10"	"$3,932.10"	$0.00	$0.00	$0.00	"$1,821.22"	"$4,181.12"	"$4,181.12"	"$6,735.25"	$0.00	"$1,821.00"	$0.00	"$4,307.83"	"$4,307.83"	$0.00	"$4,369.00"	"$6,920.50"	"$6,990.40"	$0.00	$0.00	$0.00	"$1,367.50"	$0.00	$0.00	"$1,391.09"	$0.00	$0.00	$0.00	$0.00	$0.00
27815934	EAP			Coil Embolization 4mm 12cm Complex Fill Trufill Dcs Orbit	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	$0.00	$0.00	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	"$1,682.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815935	EAP	HCPCS C1876		Stent Cor .02in 2.5mm 19mm 140cm Tryton Rx Dlv Sys Radopq Sd	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	"$1,002.04"	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00	$0.00	$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
27815936	EAP	HCPCS C1876		Stent Cor .02in 2.5-3mm 19mm 140cm Tryton Rx Dlv Sys Radopq	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	"$1,002.04"	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00	$0.00	$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
27815937	EAP	HCPCS C1876		Stent Cor .02in 2.5-3.5mm 19mm 140cm Tryton Rx Dlv Sys	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	"$1,002.04"	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00	$0.00	$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
27815939	EAP	HCPCS C1876		Stent Cor .02in 3.5-4mm 15mm 140cm Tryton Rx Dlv Sys Radopq	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	"$1,002.04"	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00	$0.00	$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
27815940	EAP	Custom 27815940		Pin Half 5mm 4mm 300mm 50mm Tr	BOTH IP/OP	$256.00 	$189.44	$0.00	$204.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$190.00	$190.00	$197.32	$0.00	$53.35	$0.00	$0.00	$0.00	$0.00	$128.00	$202.75	$204.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815941	EAP	HCPCS C1874		System Cor Stnt 4.5mm 12mm 140cm Rslt Onyx Rx Dlv Sys Radopq	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
27815942	EAP	Custom 27815942		Coil Embl 3d 3mm 6cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	"$2,019.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815943	EAP	Custom 27815943		Coil Embl 3d 3mm 8cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815944	EAP	Custom 27815944		Coil Embl 3d 3mm 10cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815945	EAP	Custom 27815945		Coil Embl 3d 3.5mm 6cm Axium Prm Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	"$2,019.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815946	EAP	Custom 27815946		Coil Embl 3d 3.5mm 8cm Axium Frm Nrvsc V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	"$2,019.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815947	EAP	Custom 27815947		Coil Embl 3d 3.5mm 10cm Axium Frm Nrvsc V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815948	EAP	Custom 27815948		Coil Embl 3d 4mm 6cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815949	EAP	Custom 27815949		Coil Embl 3d 4mm 8cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815950	EAP	Custom 27815950		Coil Embl 3d 4mm 10cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	"$2,019.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815951	EAP	Custom 27815951		Coil Embl 3d 4mm 12cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815952	EAP	Custom 27815952		Coil Embl 3d 4mm 15cm Axium Frm Nrvsc V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815953	EAP	Custom 27815953		Coil Embl 3d 5mm 8cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815954	EAP	Custom 27815954		Coil Embl 3d 5mm 10cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815955	EAP	Custom 27815955		Coil Embl 3d 5mm 15cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	"$2,019.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815956	EAP	Custom 27815956		Coil Embl 3d 5mm 20cm Axium Frm Nrvsc V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815957	EAP	Custom 27815957		Coil Embl 3d 6mm 10cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	"$2,019.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815958	EAP	Custom 27815958		Coil Embl 3d 6mm 15cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	"$2,019.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815959	EAP	Custom 27815959		Coil Embl 3d 6mm 20cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	"$2,019.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815960	EAP	Custom 27815960		Coil Embl 3d 6mm 25cm Axium Frm Nrvsc V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815961	EAP	Custom 27815961		Coil Embl 3d 7mm 12cm Axium Frm Nrvsc V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815962	EAP	Custom 27815962		Coil Embl 3d 7mm 15cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815963	EAP	Custom 27815963		Coil Embl 3d 7mm 20cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	"$2,019.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815964	EAP	Custom 27815964		Coil Embl 3d 7mm 30cm Axium Frm V01	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815965	EAP	Custom 27815965		Coil Embl 3d 8mm 15cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815966	EAP	Custom 27815966		Coil Embl 3d 8mm 20cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	"$2,357.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815967	EAP	Custom 27815967		Coil Embl 3d 8mm 30cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815968	EAP	Custom 27815968		Coil Embl 3d 9mm 20cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	"$2,357.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815969	EAP	Custom 27815969		Coil Embl 3d 9mm 30cm Axium Prm Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815970	EAP	Custom 27815970		Coil Embl 3d 10mm 20cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	"$2,357.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815971	EAP	Custom 27815971		Coil Embl 3d 10mm 30cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815972	EAP	Custom 27815972		Coil Embl 3d 10mm 40cm Axium Frm Nrvsc V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815973	EAP	Custom 27815973		Coil Embl 3d 12mm 30cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815974	EAP	Custom 27815974		Coil Embl 3d 12mm 40cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815975	EAP	Custom 27815975		Coil Embl 3d 12mm 50cm Axium Frm Nrvsc V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815976	EAP	Custom 27815976		Coil Embl 3d 14mm 30cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815977	EAP	Custom 27815977		Coil Embl 3d 14mm 40cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815978	EAP	Custom 27815978		Coil Embl 3d 14mm 50cm Axium Frm Nrvsc V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815979	EAP	Custom 27815979		Coil Embl 3d 16mm 40cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815980	EAP	Custom 27815980		Coil Embl 3d 16mm 50cm Axium Frm Nrvsc V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815981	EAP	Custom 27815981		Coil Embl 3d 18mm 40cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815982	EAP	Custom 27815982		Coil Embl 3d 18mm 50cm Axium Frm Nrvsc V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815983	EAP	Custom 27815983		Coil Embl 3d 20mm 50cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815984	EAP	Custom 27815984		Coil Embl 3d 22mm 50cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815985	EAP	Custom 27815985		Coil Embl 3d 25mm 50cm Axium Frm V01	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	$0.00	$0.00	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815986	EAP	HCPCS C1876		Stent 4.5mm 30mm 5.0mm Neuroform Atlas	BOTH IP/OP	"$18,125.00 "	"$13,412.50"	$0.00	"$14,500.00"	"$8,156.25"	"$8,156.25"	$0.00	$0.00	$0.00	"$3,777.70"	"$4,181.12"	"$4,181.12"	"$13,970.75"	$0.00	"$3,777.25"	$0.00	"$8,935.63"	"$8,935.63"	$0.00	"$9,062.50"	"$14,355.00"	"$14,500.00"	$0.00	"$8,156.25"	$0.00	"$2,836.56"	$0.00	$0.00	"$2,885.50"	$0.00	$0.00	$0.00	$0.00	$0.00
27815987	EAP	HCPCS C1876		Neuroform Atlas 4.5x21mm	BOTH IP/OP	"$17,038.00 "	"$12,608.12"	$0.00	"$13,630.40"	"$7,667.10"	"$7,667.10"	$0.00	$0.00	$0.00	"$3,551.15"	"$4,181.12"	"$4,181.12"	"$13,132.89"	$0.00	"$3,550.72"	$0.00	"$8,399.73"	"$8,399.73"	$0.00	"$8,519.00"	"$13,494.10"	"$13,630.40"	$0.00	"$7,667.10"	$0.00	"$2,666.45"	$0.00	$0.00	"$2,712.45"	$0.00	$0.00	$0.00	$0.00	$0.00
27815988	EAP	HCPCS C1876		Neuroform Atlas 4.0x24mm	BOTH IP/OP	"$17,038.00 "	"$12,608.12"	$0.00	"$13,630.40"	"$7,667.10"	"$7,667.10"	$0.00	$0.00	$0.00	"$3,551.15"	"$4,181.12"	"$4,181.12"	"$13,132.89"	$0.00	"$3,550.72"	$0.00	"$8,399.73"	"$8,399.73"	$0.00	"$8,519.00"	"$13,494.10"	"$13,630.40"	$0.00	"$7,667.10"	$0.00	"$2,666.45"	$0.00	$0.00	"$2,712.45"	$0.00	$0.00	$0.00	$0.00	$0.00
27815989	EAP	HCPCS C1876		Neuroform Atlas 4.0x21mm	BOTH IP/OP	"$17,038.00 "	"$12,608.12"	$0.00	"$13,630.40"	"$7,667.10"	"$7,667.10"	$0.00	$0.00	$0.00	"$3,551.15"	"$4,181.12"	"$4,181.12"	"$13,132.89"	$0.00	"$3,550.72"	$0.00	"$8,399.73"	"$8,399.73"	$0.00	"$8,519.00"	"$13,494.10"	"$13,630.40"	$0.00	"$7,667.10"	$0.00	"$2,666.45"	$0.00	$0.00	"$2,712.45"	$0.00	$0.00	$0.00	$0.00	$0.00
27815990	EAP	HCPCS C1876		Neuroform Atlas 3.0x24mm	BOTH IP/OP	"$17,038.00 "	"$12,608.12"	$0.00	"$13,630.40"	"$7,667.10"	"$7,667.10"	$0.00	$0.00	$0.00	"$3,551.15"	"$4,181.12"	"$4,181.12"	"$13,132.89"	$0.00	"$3,550.72"	$0.00	"$8,399.73"	"$8,399.73"	$0.00	"$8,519.00"	"$13,494.10"	"$13,630.40"	$0.00	"$7,667.10"	$0.00	"$2,666.45"	$0.00	$0.00	"$2,712.45"	$0.00	$0.00	$0.00	$0.00	$0.00
27815991	EAP	HCPCS C1876		Neuroform Atlas 3.0x21mm	BOTH IP/OP	"$17,038.00 "	"$12,608.12"	$0.00	"$13,630.40"	"$7,667.10"	"$7,667.10"	$0.00	$0.00	$0.00	"$3,551.15"	"$4,181.12"	"$4,181.12"	"$13,132.89"	$0.00	"$3,550.72"	$0.00	"$8,399.73"	"$8,399.73"	$0.00	"$8,519.00"	"$13,494.10"	"$13,630.40"	$0.00	"$7,667.10"	$0.00	"$2,666.45"	$0.00	$0.00	"$2,712.45"	$0.00	$0.00	$0.00	$0.00	$0.00
27815992	EAP	HCPCS C1876		Neuroform Atlas 3.0x15mm	BOTH IP/OP	"$17,038.00 "	"$12,608.12"	$0.00	"$13,630.40"	"$7,667.10"	"$7,667.10"	$0.00	$0.00	$0.00	"$3,551.15"	"$4,181.12"	"$4,181.12"	"$13,132.89"	$0.00	"$3,550.72"	$0.00	"$8,399.73"	"$8,399.73"	$0.00	"$8,519.00"	"$13,494.10"	"$13,630.40"	$0.00	"$7,667.10"	$0.00	"$2,666.45"	$0.00	$0.00	"$2,712.45"	$0.00	$0.00	$0.00	$0.00	$0.00
27815993	EAP	HCPCS C1874		Stent Trchbr 16mm 22fr 40mm 61cm Gmtr Otw Flly	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27815994	EAP	HCPCS C1874		Stent Trchbr 12mm 16fr 30mm 62cm Gmtr Otw Flly	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27815995	EAP	HCPCS C1874		Stent Trchbr 14mm 16fr 20mm 63cm Gmtr Otw Flly	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27815996	EAP	HCPCS C1874		Stent Trchbr 14mm 16fr 40mm 61cm Gmtr Otw Flly	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27815997	EAP	HCPCS C1874		Stent Trchbr 20mm 22fr 40mm 61cm Gmtr Otw Flly	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27815998	EAP	HCPCS C1874		Stent Trchbr 20mm 60mm Otw Flly Covered Aero	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27815999	EAP	HCPCS C1874		Stent Trchbr 16mm 60mm Flly Covered Purse Stng Dir	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816000	EAP	HCPCS C1874		Stent Trchbr 14mm 40mm Flly Covered Purse Stng Dir	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816001	EAP	Custom 27816001		Sizer Surg Aerosizer Stent Msr Dev	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816002	EAP	HCPCS C1874		Stent Esph 16fr 18mm 67cm 70mm Full Cover Prox	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816003	EAP	HCPCS C1874		Stent Esph 18mm 22fr 100cm Rem Covered Radiopq	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	"$2,362.50"	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816004	EAP	HCPCS C1874		Stent Esph 22fr 18mm 120cm Rem Covered Alimaxx-e	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816005	EAP	HCPCS C1874		Stent Esph 22mm 22fr 70cm Rem Covered Radiopq	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816006	EAP	HCPCS C1874		Stent Esph 22fr 100cm Sys Alimaxx-e Mtl	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816007	EAP	HCPCS C1874		Stent Esph 22fr 120cm Slf Xpd Alimaxx-e Mtl Disp	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816008	EAP	HCPCS C1874		Stent Esph 12mm 70cm Flly Covered Alimaxx-es	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816009	EAP	HCPCS C1874		Stent Esph 22mm 100cm Pu Cover Antimigration Strut	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816010	EAP	HCPCS C1874		Stent Esph 12mm 16fr 120mm 62cm Gmtr Flly Covered	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816011	EAP	HCPCS C1874		Stent Esph 14mm 70cm Flly Covered Alimaxx-es	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816012	EAP	HCPCS C1874		Stent Esph 14mm 16fr 100mm 64cm Flly Covered Smth	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816013	EAP	HCPCS C1874		Stent Esph 14mm 16fr 62cm 120mm Flly Covered Gmtr	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816014	EAP	HCPCS C1874		Stent Esph 16mm 70cm Gmtr Flly Covered Pu Cover	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816015	EAP	HCPCS C1874		Stent Esph 16mm 16fr 100mm 64cm Flly Covered Smth	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816016	EAP	HCPCS C1874		Stent Esph 16mm 62cm 120mm Flly Covered Gmtr Pu	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816017	EAP	HCPCS C1874		Stent Trchbr 18mm 22fr 56mm Lp Otw Full Cover Flxb	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27816018	EAP	HCPCS C1874		Stent Trchbr 16mm 22fr 56mm Lp Otw Full Cover Flxb	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27816019	EAP	HCPCS C1874		Stent Trchbr 10mm 16fr 20mm 63cm Gmtr Otw Flly	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27816020	EAP	HCPCS C1874		Stent Trchbr 10mm 16fr 40mm 61cm Gmtr Otw Flly	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27816021	EAP	HCPCS C1874		Stent Trchbr 12mm 16fr 20mm 63cm Flly Cover	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27816022	EAP	HCPCS C1874		Stent Trchbr 14mm 16fr 30mm 62cm Gmtr Otw Flly	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27816023	EAP	HCPCS C1874		Stent Trch 20mm 80mm Flly Covered Aero	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816024	EAP	HCPCS C1874		Stent Trchbr 18mm 40mm Flly Covered Dir Vis Sys	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816025	EAP	HCPCS C1874		Stent Trchbr 18mm 60mm Flly Covered Dir Vis Sys	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816026	EAP	HCPCS C1874		Stent Trchbr 18mm 80mm Flly Covered Dir Vsn Dlv	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816027	EAP	HCPCS C1874		Stent Trchbr 16mm 30mm 40mm 39mm Otw Dir Vis Novel	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816028	EAP	HCPCS C1874		Stent Trchbr 16mm 80mm Flly Covered Dir Vsn Dlv	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816029	EAP	HCPCS C1874		Stent Trchbr 12mm 20mm Flly Covered Dir Vsn Dlv	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816030	EAP	HCPCS C1874		Stent Trchbr 12mm 28fr 30mm 40cm Gmtr Lp Full	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816031	EAP	HCPCS C1874		Stent Trchbr 28fr 12mm 40mm 39cm Gmtr Lp Full	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816032	EAP	HCPCS C1874		Stent Trchbr 14mm 20mm Flly Covered Dir Vsn Dlv	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816033	EAP	HCPCS C1874		Stent Trchbr 14mm 30mm Flly Covered Dir Vis Sys	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816034	EAP	HCPCS C1874		Stent Trchbr 20mm 40mm Flly Covered Dir Vis Sys	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816036	EAP	HCPCS C1874		Stent Trchbr 20mm 80mm Flly Covered Dir Vis Sys	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	$0.00	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
27816037	EAP	HCPCS C1874		Stent Esph 19mm 24mm 70mm Flly Covered	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27816038	EAP	Custom 27816038		Holder Tube 100mm Blue Tio Unq Oral Arwy Dsgn Cnv	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$9.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816039	EAP	Custom 27816039		Block Bite Tio 110mm	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816040	EAP	Custom 27816040		Holder Tube 90mm Ylw Tio Unq Oral Arwy Dsgn Cnv	BOTH IP/OP	$20.00 	$14.80	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$10.00	$15.84	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816041	EAP	Custom 27816041		Device Basixcompak 20ml Anlg Lmscnt Dspl Inflat	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$48.18	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816042	EAP	HCPCS C1874		Stent Esph 19mm 24fr 150mm 90cm Otw Flly Covered	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27816043	EAP	HCPCS C1874		Stent Esph 23mm 24fr 70mm 90cm 28mm Otw Flly Cover	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	"$4,432.10"	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00	$0.00	$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
27816050	EAP	HCPCS C1876		System Coron Stent 38mm 4.5mm Mtlnk Ul Xcelon	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816051	EAP	HCPCS C1876		System Coron Stent 18mm 5mm Mtlnk Ul Xcelon Mcgld	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816052	EAP	HCPCS C1876		System Coron Stent 38mm 5mm Mtlnk Ul Xcelon Mcgld	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816053	EAP	HCPCS C1876		System Coron Stent 8mm 2.75mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816054	EAP	HCPCS C1876		System Coron Stent 12mm 2.75mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816055	EAP	HCPCS C1876		System Coron Stent 15mm 2.75mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816056	EAP	HCPCS C1876		System Coron Stent 18mm 2.75mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816057	EAP	HCPCS C1876		System Coron Stent 23mm 2.75mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816058	EAP	HCPCS C1876		System Coron Stent 28mm 2.75mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816059	EAP	HCPCS C1876		System Coron Stent 8mm 3mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816060	EAP	HCPCS C1876		System Coron Stent 12mm 3mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816061	EAP	HCPCS C1876		System Coron Stent 15mm 3mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816062	EAP	HCPCS C1876		System Coron Stent 18mm 3mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816063	EAP	HCPCS C1876		System Coron Stent 23mm 3mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816064	EAP	HCPCS C1876		System Coron Stent 28mm 3mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816065	EAP	HCPCS C1876		System Coron Stent 8mm 3.5mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816066	EAP	HCPCS C1876		System Coron Stent 12mm 3.5mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816067	EAP	HCPCS C1876		System Coron Stent 15mm 3.5mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816068	EAP	HCPCS C1876		System Coron Stent 18mm 3.5mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816069	EAP	HCPCS C1876		System Coron Stent 23mm 3.5mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816070	EAP	HCPCS C1876		System Coron Stent 28mm 3.5mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816071	EAP	HCPCS C1876		System Coron Stent 8mm 4mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816072	EAP	HCPCS C1876		System Coron Stent 12mm 4mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816073	EAP	HCPCS C1876		System Coron Stent 15mm 4mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816074	EAP	HCPCS C1876		System Coron Stent 18mm 4mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816075	EAP	HCPCS C1876		System Coron Stent 23mm 4mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816076	EAP	HCPCS C1876		System Coron Stent 28mm 4mm Mtlnk Mvsn Cocr Otw	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816077	EAP	HCPCS C1874		System Coron Stent 38mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816078	EAP	HCPCS C1874		System Coron Stent 33mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816079	EAP	HCPCS C1874		System Coron Stent 28mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816080	EAP	HCPCS C1874		System Coron Stent 23mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816081	EAP	HCPCS C1874		System Coron Stent 18mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816082	EAP	HCPCS C1874		System Coron Stent 15mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816083	EAP	HCPCS C1874		System Coron Stent 12mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816084	EAP	HCPCS C1874		System Coron Stent 8mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816085	EAP	HCPCS C1874		System Coron Stent 38mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816086	EAP	HCPCS C1874		System Coron Stent 33mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816087	EAP	HCPCS C1874		System Coron Stent 28mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816088	EAP	HCPCS C1874		System Coron Stent 23mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816089	EAP	HCPCS C1874		System Coron Stent 18mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816090	EAP	HCPCS C1874		System Coron Stent 15mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816091	EAP	HCPCS C1874		System Coron Stent 12mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816092	EAP	HCPCS C1874		System Coron Stent 8mm 3.5mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816093	EAP	HCPCS C1874		System Coron Stent 38mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816094	EAP	HCPCS C1874		System Coron Stent 33mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816095	EAP	HCPCS C1874		System Coron Stent 28mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816096	EAP	HCPCS C1874		System Coron Stent 23mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816097	EAP	HCPCS C1874		System Coron Stent 18mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816098	EAP	HCPCS C1874		System Coron Stent 15mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816099	EAP	HCPCS C1874		System Coron Stent 12mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816100	EAP	HCPCS C1874		System Coron Stent 8mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816101	EAP	HCPCS C1874		System Coron Stent 38mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816102	EAP	HCPCS C1874		System Coron Stent 33mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816103	EAP	HCPCS C1874		System Coron Stent 28mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816104	EAP	HCPCS C1874		System Coron Stent 23mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816105	EAP	HCPCS C1874		System Coron Stent 18mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816106	EAP	HCPCS C1874		System Coron Stent 15mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816107	EAP	HCPCS C1874		System Coron Stent 12mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816108	EAP	HCPCS C1874		System Coron Stent 8mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816109	EAP	HCPCS C1874		System Coron Stent 38mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816110	EAP	HCPCS C1874		System Coron Stent 33mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816111	EAP	HCPCS C1874		System Coron Stent 28mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816112	EAP	HCPCS C1874		System Coron Stent 23mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816113	EAP	HCPCS C1874		System Coron Stent 18mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816114	EAP	HCPCS C1874		System Coron Stent 15mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816115	EAP	HCPCS C1874		System Coron Stent 12mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816116	EAP	HCPCS C1874		System Coron Stent 8mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816117	EAP	HCPCS C1874		System Coron Stent 38mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816118	EAP	HCPCS C1874		System Coron Stent 33mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816119	EAP	HCPCS C1874		System Coron Stent 28mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816120	EAP	HCPCS C1874		System Coron Stent 23mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816121	EAP	HCPCS C1874		System Coron Stent 18mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816122	EAP	HCPCS C1874		System Coron Stent 15mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816123	EAP	HCPCS C1874		System Coron Stent 8mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816124	EAP	HCPCS C1874		System Coron Stent 15mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816125	EAP	HCPCS C1874		System Coron Stent 23mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816126	EAP	HCPCS C1874		System Coron Stent 28mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816127	EAP	HCPCS C1874		System Coron Stent 33mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816128	EAP	HCPCS C1874		System Coron Stent 8mm 2.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816129	EAP	HCPCS C1874		System Coron Stent 12mm 2.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816130	EAP	HCPCS C1874		System Coron Stent 15mm 2.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816131	EAP	HCPCS C1874		System Coron Stent 18mm 2.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816132	EAP	HCPCS C1874		System Coron Stent 23mm 2.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816133	EAP	HCPCS C1874		System Coron Stent 28mm 2.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816134	EAP	HCPCS C1874		System Coron Stent 8mm 2.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816135	EAP	HCPCS C1874		System Coron Stent 12mm 2.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816136	EAP	HCPCS C1874		System Coron Stent 15mm 2.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816137	EAP	HCPCS C1874		System Coron Stent 18mm 2.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816138	EAP	HCPCS C1874		System Coron Stent 23mm 2.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816139	EAP	HCPCS C1874		System Coron Stent 28mm 2.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816140	EAP	HCPCS C1874		System Coron Stent 33mm 2.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816141	EAP	HCPCS C1874		System Coron Stent 38mm 2.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816142	EAP	HCPCS C1874		System Coron Stent 8mm 2.75mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816143	EAP	HCPCS C1874		System Coron Stent 12mm 2.75mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816144	EAP	HCPCS C1874		System Coron Stent 15mm 2.75mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816145	EAP	HCPCS C1874		System Coron Stent 18mm 2.75mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816146	EAP	HCPCS C1874		System Coron Stent 23mm 2.75mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816147	EAP	HCPCS C1874		System Coron Stent 28mm 2.75mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816148	EAP	HCPCS C1874		System Coron Stent 33mm 2.75mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816149	EAP	HCPCS C1874		System Coron Stent 38mm 2.75mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816150	EAP	HCPCS C1874		System Coron Stent 8mm 3mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816151	EAP	HCPCS C1874		System Coron Stent 12mm 3mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816152	EAP	HCPCS C1874		System Coron Stent 15mm 3mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816153	EAP	HCPCS C1874		System Coron Stent 18mm 3mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816154	EAP	HCPCS C1874		System Coron Stent 23mm 3mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816155	EAP	HCPCS C1874		System Coron Stent 28mm 3mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816156	EAP	HCPCS C1874		System Coron Stent 33mm 3mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816157	EAP	HCPCS C1874		System Coron Stent 38mm 3mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816158	EAP	HCPCS C1874		System Coron Stent 8mm 3.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816159	EAP	HCPCS C1874		System Coron Stent 12mm 3.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816160	EAP	HCPCS C1874		System Coron Stent 15mm 3.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816161	EAP	HCPCS C1874		System Coron Stent 18mm 3.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816162	EAP	HCPCS C1874		System Coron Stent 23mm 3.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816163	EAP	HCPCS C1874		System Coron Stent 28mm 3.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816164	EAP	HCPCS C1874		System Coron Stent 33mm 3.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816165	EAP	HCPCS C1874		System Coron Stent 38mm 3.25mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816166	EAP	HCPCS C1874		System Coron Stent 8mm 3.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816167	EAP	HCPCS C1874		System Coron Stent 12mm 3.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816168	EAP	HCPCS C1874		System Coron Stent 15mm 3.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816169	EAP	HCPCS C1874		System Coron Stent 18mm 3.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816170	EAP	HCPCS C1874		System Coron Stent 23mm 3.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816171	EAP	HCPCS C1874		System Coron Stent 28mm 3.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816172	EAP	HCPCS C1874		System Coron Stent 33mm 3.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816173	EAP	HCPCS C1874		System Coron Stent 38mm 3.5mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816174	EAP	HCPCS C1874		System Coron Stent 8mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816175	EAP	HCPCS C1874		System Coron Stent 12mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816176	EAP	HCPCS C1874		System Coron Stent 15mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816177	EAP	HCPCS C1874		System Coron Stent 18mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816178	EAP	HCPCS C1874		System Coron Stent 23mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816179	EAP	HCPCS C1874		System Coron Stent 28mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816180	EAP	HCPCS C1874		System Coron Stent 33mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816181	EAP	HCPCS C1874		System Coron Stent 38mm 4mm Xience Alpine	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$0.00	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816182	EAP	HCPCS C1874		System Coron Stent 12mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816183	EAP	HCPCS C1874		System Coron Stent 8mm 2.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816184	EAP	HCPCS C1874		System Coron Stent 12mm 2.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816185	EAP	HCPCS C1874		System Coron Stent 15mm 2.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816186	EAP	HCPCS C1874		System Coron Stent 18mm 2.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816187	EAP			Coil Embolization 360d 5mm 15cm Detachable Soft Target	BOTH IP/OP	"$4,539.00 "	"$3,358.86"	$0.00	"$3,631.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,368.85"	"$3,368.85"	"$3,498.66"	$0.00	$945.93	$0.00	$0.00	$0.00	$0.00	"$2,269.50"	"$3,594.89"	"$3,631.20"	$0.00	"$2,042.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816188	EAP			Coil Embolization Standard Large 22mm 50cm Detachable Smooth	BOTH IP/OP	"$5,904.00 "	"$4,368.96"	$0.00	"$4,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,550.80"	$0.00	"$1,230.39"	$0.00	$0.00	$0.00	$0.00	"$2,952.00"	"$4,675.97"	"$4,723.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816190	EAP			Coil Embl .02in Cmplx 4mm 10cm The Penumbra Coil 400 Xsft	BOTH IP/OP	"$6,900.00 "	"$5,106.00"	$0.00	"$5,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,318.52"	$0.00	"$1,437.96"	$0.00	$0.00	$0.00	$0.00	"$3,450.00"	"$5,464.80"	"$5,520.00"	$0.00	"$3,105.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816191	EAP			Coil Embl .02in Cmplx 4mm 8cm The Penumbra Coil 400 Sft	BOTH IP/OP	"$6,075.00 "	"$4,495.50"	$0.00	"$4,860.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,682.61"	$0.00	"$1,266.03"	$0.00	$0.00	$0.00	$0.00	"$3,037.50"	"$4,811.40"	"$4,860.00"	$0.00	"$2,733.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816192	EAP			Coil Embl Crv 4mm 10cm The Penumbra Coil 400 Xsft	BOTH IP/OP	"$6,513.00 "	"$4,819.62"	$0.00	"$5,210.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,020.22"	$0.00	"$1,357.31"	$0.00	$0.00	$0.00	$0.00	"$3,256.50"	"$5,158.30"	"$5,210.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816193	EAP			Coil Embolization Curve 4mm 8cm Xsoft The Penumbra Coil 400	BOTH IP/OP	"$6,125.00 "	"$4,532.50"	$0.00	"$4,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,721.15"	$0.00	"$1,276.45"	$0.00	$0.00	$0.00	$0.00	"$3,062.50"	"$4,851.00"	"$4,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816194	EAP			Coil Embolization 10cm J Soft Fill Coil 400 Nitinol	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,856.04"	$0.00	"$1,312.92"	$0.00	$0.00	$0.00	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816195	EAP			Coil Embolization 15cm J Coil 400	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,048.74"	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00	"$2,947.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816196	EAP	Custom 27816196		Graft Evas 26mm 22-23mm 3.3cm Aorta	BOTH IP/OP	"$8,135.00 "	"$6,019.90"	$0.00	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,270.46"	$0.00	"$1,695.33"	$0.00	$0.00	$0.00	$0.00	"$4,067.50"	"$6,442.92"	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816197	EAP	Custom 27816197		Graft Evas 28.5mm 24-26mm 3.3cm Aorta	BOTH IP/OP	"$8,135.00 "	"$6,019.90"	$0.00	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,270.46"	$0.00	"$1,695.33"	$0.00	$0.00	$0.00	$0.00	"$4,067.50"	"$6,442.92"	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816198	EAP	Custom 27816198		Graft Evas 32mm 27-29mm 4.5cm Xcldr Stnt Xtd Abrsn Rst	BOTH IP/OP	"$8,135.00 "	"$6,019.90"	$0.00	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,270.46"	$0.00	"$1,695.33"	$0.00	$0.00	$0.00	$0.00	"$4,067.50"	"$6,442.92"	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816199	EAP	Custom 27816199		Graft Evas 36mm 30-32mm 4.5cm Xcldr Sinusoidal Stnt Sl Cuf	BOTH IP/OP	"$8,135.00 "	"$6,019.90"	$0.00	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,270.46"	$0.00	"$1,695.33"	$0.00	$0.00	$0.00	$0.00	"$4,067.50"	"$6,442.92"	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816200	EAP	Custom 27816200		Graft Evas 12mm 10cm Gore Xcldr Cntrlt Lg	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816201	EAP	Custom 27816201		Graft Evas 12mm 12cm Gore Xcldr Cntrlt Lg	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816202	EAP	Custom 27816202		Graft Evas 12mm 14cm Gore Xcldr Cntrlt Lg	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816203	EAP	Custom 27816203		Graft Evas 14.5mm 10cm Gore Xcldr Cntrlt Lg	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816204	EAP	Custom 27816204		Graft Evas 14.5mm 12cm Gore Xcldr Cntrlt Lg	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816205	EAP	Custom 27816205		Graft Evas 14.5mm 12-13.5mm 14cm Gore Xcldr Cntrlt Lg Aaa	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816206	EAP	Custom 27816206		Graft Evas 16mm 13.5-14.5mm 11.5cm Xcldr Stnt Abrsn Rst	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816207	EAP	Custom 27816207		Graft Evas 16mm 13.5-14.5mm 13.5cm Xcldr Stnt Abrsn Rst	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816208	EAP	Custom 27816208		Graft Evas 18mm 14.5-16.5mm 9.5cm Xcldr Stnt Abrsn Rst	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816209	EAP	Custom 27816209		Graft Evas 18mm 14.5-16.5mm 11.5cm Xcldr Stnt Abrsn Rst	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816210	EAP	Custom 27816210		Graft Evas 18mm 14.5-16.5mm 13.5cm Xcldr Stnt Abrsn Rst	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816211	EAP	Custom 27816211		Graft Evas 20mm 16.5-18.5mm 9.5cm Xcldr Stnt Abrsn Rst	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816212	EAP	Custom 27816212		Graft Evas 20mm 16.5-18.5mm 13.5cm Grtx Xcldr Sinusoidal	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816213	EAP	Custom 27816213		Graft Evas 23mm 18.5-21.5mm 12cm Xcldr Stnt Abrsn Rst	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816214	EAP	Custom 27816214		Graft Evas 23mm 18.5-21.5mm 14cm Xcldr Stnt Abrsn Rst	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816215	EAP	Custom 27816215		Graft Evas 27mm 21.5-25mm 10cm Grtx Xcldr Sinusoidal Stnt Sl	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816216	EAP	Custom 27816216		Graft Evas 27mm 21.5-25mm 12cm Xcldr Stnt Abrsn Rst	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816217	EAP	Custom 27816217		Graft Evas 27mm 21.5-25mm 14cm Xcldr Stnt Abrsn Rst	BOTH IP/OP	"$11,558.00 "	"$8,552.92"	$0.00	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,908.91"	$0.00	"$2,408.69"	$0.00	$0.00	$0.00	$0.00	"$5,779.00"	"$9,153.94"	"$9,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816218	EAP	Custom 27816218		Graft Stnt 10mm 7cm Gore Xcldr Xtd Ilc Aaa	BOTH IP/OP	"$8,135.00 "	"$6,019.90"	$0.00	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,270.46"	$0.00	"$1,695.33"	$0.00	$0.00	$0.00	$0.00	"$4,067.50"	"$6,442.92"	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816219	EAP	Custom 27816219		Graft Evas 12mm 7cm Xcldr Stnt Xtd Sl Cuf Ntnl Eptfe Ilc Aaa	BOTH IP/OP	"$8,135.00 "	"$6,019.90"	$0.00	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,270.46"	$0.00	"$1,695.33"	$0.00	$0.00	$0.00	$0.00	"$4,067.50"	"$6,442.92"	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816220	EAP	Custom 27816220		Graft Evas 14.5mm 12-13.5mm 7cm Gore Xcldr Xtd Ilc Art Acpt	BOTH IP/OP	"$8,135.00 "	"$6,019.90"	$0.00	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,270.46"	$0.00	"$1,695.33"	$0.00	$0.00	$0.00	$0.00	"$4,067.50"	"$6,442.92"	"$6,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816221	EAP	Custom 27816221		Graft Evas 23mm 12mm 19-21mm 10-11mm 12cm Gore Xcldr C3 Bond	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816222	EAP	Custom 27816222		Graft Evas 23mm 12mm 19-21mm 10-11mm 14cm Gore Xcldr C3 Bond	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816223	EAP	Custom 27816223		Graft Evas 23mm 12mm 19-21mm 10-11mm 16cm Gore Xcldr C3 Bond	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816224	EAP	Custom 27816224		Graft Evas 23mm 12mm 19-21mm 10-11mm 18cm Gore Xcldr C3 Bond	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816225	EAP	Custom 27816225		Graft Evas 23mm 14.5mm 19-21mm 12-13.5mm 12cm Gore Xcldr C3	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816226	EAP	Custom 27816226		Graft Evas 23mm 14.5mm 19-21mm 12-13.5mm 14cm Gore Xcldr C3	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816227	EAP	Custom 27816227		Graft Evas 23mm 14.5mm 19-21mm 12-13.5mm 16cm Gore Xcldr C3	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816228	EAP	Custom 27816228		Graft Evas 23mm 14.5mm 19-21mm 12-13.5mm 18cm Gore Xcldr C3	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816229	EAP	Custom 27816229		Graft Evas 26mm 12mm 22-23mm 10-11mm 12cm Gore Xcldr C3 Bond	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816230	EAP	Custom 27816230		Graft Evas 26mm 12mm 22-23mm 10-11mm 14cm Gore Xcldr C3 Bond	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816231	EAP	Custom 27816231		Graft Evas 26mm 12mm 22-23mm 10-11mm 16cm Gore Xcldr C3 Bond	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816232	EAP	Custom 27816232		Graft Evas 26mm 12mm 22-23mm 10-11mm 18cm Gore Xcldr C3 Bond	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816233	EAP	Custom 27816233		Graft Evas 26mm 14.5mm 22-23mm 12-13.5mm 12cm Gore Xcldr C3	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816234	EAP	Custom 27816234		Graft Evas 26mm 14.5mm 14cm Gore Xcldr C3 Trnkipsl Lg Aaa	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816235	EAP	Custom 27816235		Graft Evas 26mm 14.5mm 16cm Gore Xcldr C3 Trnkipsl Lg Aaa	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816236	EAP	Custom 27816236		Graft Evas 26mm 14.5mm 22-23mm 12-13.5mm 18cm Gore Xcldr C3	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816237	EAP	Custom 27816237		Graft Evas 28.5mm 12mm 24-26mm 10-11mm 12cm Gore Xcldr C3	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816238	EAP	Custom 27816238		Graft Evas 28.5mm 12mm 24-26mm 10-11mm 14cm Gore Xcldr C3	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816239	EAP	Custom 27816239		Graft Evas 28.5mm 12mm 24-26mm 10-11mm 16cm Gore Xcldr C3	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816240	EAP	Custom 27816240		Graft Evas 28.5mm 12mm 24-26mm 10-11mm 18cm Gore Xcldr C3	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816241	EAP	Custom 27816241		Graft Evas 28.5mm 14.5mm 24-26mm 12-13.5mm 14cm Gore Xcldr C	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816242	EAP	Custom 27816242		Graft Evas 28.5mm 14.5mm 24-26mm 12-13.5mm 16cm Gore Xcldr C	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816243	EAP	Custom 27816243		Graft Evas 28.5mm 14.5mm 24-26mm 12-13.5mm 18cm Gore Xcldr C	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816244	EAP	Custom 27816244		Graft Evas 31mm 14.5mm 13cm Xcldr C3 Stnt Dlv Sys Grtx Ntnl	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816245	EAP	Custom 27816245		Graft Evas 31mm 14.5mm 15cm Xcldr C3 Stnt Dlv Sys Grtx Ntnl	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816246	EAP	Custom 27816246		Graft Evas 31mm 14.5mm 17cm Xcldr C3 Stnt Dlv Sys Grtx Ntnl	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816247	EAP	Custom 27816247		Graft Evas 35mm 14.5mm 30-32mm 12-13.5mm 14cm Strl Gore	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816248	EAP	Custom 27816248		Graft Evas 35mm 14.5mm 16cm Xcldr C3 Stnt Dlv Sys Grtx Ntnl	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816249	EAP	Custom 27816249		Graft Evas 35mm 14.5mm 30-32mm 12-13.5mm 18cm Gore Xcldr C3	BOTH IP/OP	"$28,188.00 "	"$20,859.12"	$0.00	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,727.31"	$0.00	"$5,874.38"	$0.00	$0.00	$0.00	$0.00	"$14,094.00"	"$22,324.90"	"$22,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816250	EAP	HCPCS C1752		Catheter Hmdial 20cm Schn Xl Kink Rst Tip Clip Sh Rem Sty	BOTH IP/OP	$119.00 	$88.06	$0.00	$95.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.32	$88.32	$91.73	$0.00	$24.80	$0.00	$0.00	$0.00	$0.00	$59.50	$94.25	$95.20	$0.00	$53.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816251	EAP	HCPCS C1876		Stent Intrcran T 2.7-3.5mm 8mm Pulserider Arch	BOTH IP/OP	"$31,250.00 "	"$23,125.00"	$0.00	"$25,000.00"	"$14,062.50"	"$14,062.50"	$0.00	$0.00	$0.00	"$6,513.28"	"$4,181.12"	"$4,181.12"	"$24,087.50"	$0.00	"$6,512.50"	$0.00	"$15,406.25"	"$15,406.25"	$0.00	"$15,625.00"	"$24,750.00"	"$25,000.00"	$0.00	$0.00	$0.00	"$4,890.63"	$0.00	$0.00	"$4,975.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27816252	EAP	HCPCS C1876		Stent Intrcran T 3.5-4.5mm 8mm Pulserider Arch	BOTH IP/OP	"$31,250.00 "	"$23,125.00"	$0.00	"$25,000.00"	"$14,062.50"	"$14,062.50"	$0.00	$0.00	$0.00	"$6,513.28"	"$4,181.12"	"$4,181.12"	"$24,087.50"	$0.00	"$6,512.50"	$0.00	"$15,406.25"	"$15,406.25"	$0.00	"$15,625.00"	"$24,750.00"	"$25,000.00"	$0.00	$0.00	$0.00	"$4,890.63"	$0.00	$0.00	"$4,975.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27816253	EAP	HCPCS C1876		Stent Intrcran T 2.7-3.5mm 10mm Pulserider Arch	BOTH IP/OP	"$31,250.00 "	"$23,125.00"	$0.00	"$25,000.00"	"$14,062.50"	"$14,062.50"	$0.00	$0.00	$0.00	"$6,513.28"	"$4,181.12"	"$4,181.12"	"$24,087.50"	$0.00	"$6,512.50"	$0.00	"$15,406.25"	"$15,406.25"	$0.00	"$15,625.00"	"$24,750.00"	"$25,000.00"	$0.00	$0.00	$0.00	"$4,890.63"	$0.00	$0.00	"$4,975.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27816254	EAP	HCPCS C1876		Stent Intrcran Y 2.7-3.5mm 8mm Pulserider Arch	BOTH IP/OP	"$31,250.00 "	"$23,125.00"	$0.00	"$25,000.00"	"$14,062.50"	"$14,062.50"	$0.00	$0.00	$0.00	"$6,513.28"	"$4,181.12"	"$4,181.12"	"$24,087.50"	$0.00	"$6,512.50"	$0.00	"$15,406.25"	"$15,406.25"	$0.00	"$15,625.00"	"$24,750.00"	"$25,000.00"	$0.00	$0.00	$0.00	"$4,890.63"	$0.00	$0.00	"$4,975.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27816255	EAP	HCPCS C1876		Stent Intrcran Y 3.5-4.5mm 8mm Pulserider Arch	BOTH IP/OP	"$31,250.00 "	"$23,125.00"	$0.00	"$25,000.00"	"$14,062.50"	"$14,062.50"	$0.00	$0.00	$0.00	"$6,513.28"	"$4,181.12"	"$4,181.12"	"$24,087.50"	$0.00	"$6,512.50"	$0.00	"$15,406.25"	"$15,406.25"	$0.00	"$15,625.00"	"$24,750.00"	"$25,000.00"	$0.00	$0.00	$0.00	"$4,890.63"	$0.00	$0.00	"$4,975.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27816256	EAP	HCPCS C1876		Stent Intrcran Y 2.7-3.5mm 10mm Pulserider Arch	BOTH IP/OP	"$31,250.00 "	"$23,125.00"	$0.00	"$25,000.00"	"$14,062.50"	"$14,062.50"	$0.00	$0.00	$0.00	"$6,513.28"	"$4,181.12"	"$4,181.12"	"$24,087.50"	$0.00	"$6,512.50"	$0.00	"$15,406.25"	"$15,406.25"	$0.00	"$15,625.00"	"$24,750.00"	"$25,000.00"	$0.00	$0.00	$0.00	"$4,890.63"	$0.00	$0.00	"$4,975.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27816257	EAP	HCPCS C1876		Stent Intrcran Y 3.5-4.5mm 10mm Pulserider Arch	BOTH IP/OP	"$31,250.00 "	"$23,125.00"	$0.00	"$25,000.00"	"$14,062.50"	"$14,062.50"	$0.00	$0.00	$0.00	"$6,513.28"	"$4,181.12"	"$4,181.12"	"$24,087.50"	$0.00	"$6,512.50"	$0.00	"$15,406.25"	"$15,406.25"	$0.00	"$15,625.00"	"$24,750.00"	"$25,000.00"	$0.00	$0.00	$0.00	"$4,890.63"	$0.00	$0.00	"$4,975.00"	$0.00	$0.00	$0.00	$0.00	$0.00
27816259	EAP	HCPCS C1874		System Cor Stnt 4.5mm 15mm 140cm Rslt Onyx Rx Dlv Sys Radopq	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
27816260	EAP	HCPCS C1874		System Cor Stnt 4.5mm 18mm 140cm Rslt Onyx Rx Dlv Sys Radopq	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
27816261	EAP	HCPCS C1874		System Cor Stnt 4.5mm 22mm 140cm Rslt Onyx Rx Dlv Sys Radopq	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
27816262	EAP	HCPCS C1874		System Cor Stnt 4.5mm 26mm 140cm Rslt Onyx Rx Dlv Sys Radopq	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
27816263	EAP	HCPCS C1874		System Cor Stnt 4.5mm 30mm 140cm Rslt Onyx Rx Dlv Sys Radopq	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
27816264	EAP	HCPCS C1874		System Cor Stnt 5mm 12mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
27816265	EAP	HCPCS C1874		System Cor Stnt 5mm 15mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
27816266	EAP	HCPCS C1874		System Cor Stnt 5mm 18mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
27816267	EAP	HCPCS C1874		System Cor Stnt 5mm 22mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
27816268	EAP	HCPCS C1874		System Cor Stnt 5mm 26mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
27816269	EAP	HCPCS C1874		System Cor Stnt 5mm 30mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
27816270	EAP	HCPCS C1757		Catheter Thrmb .044in 140cm Strl Lf Indg Sys Asp Kt Cor	BOTH IP/OP	"$4,850.00 "	"$3,589.00"	$0.00	"$3,880.00"	"$2,182.50"	"$2,182.50"	$0.00	$0.00	$0.00	"$1,010.86"	"$3,599.67"	"$3,599.67"	"$3,738.38"	$0.00	"$1,010.74"	$0.00	"$2,391.05"	"$2,391.05"	$0.00	"$2,425.00"	"$3,841.20"	"$3,880.00"	$0.00	"$2,182.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816279	EAP	HCPCS C1874		Stent Eprsth 8mm 10cm Strl 120cm Vbhn Flxb Slf Xpd Radopq	BOTH IP/OP	"$9,160.00 "	"$6,778.40"	$0.00	"$7,328.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,580.00"	"$7,254.72"	"$7,328.00"	$0.00	$0.00	$0.00	"$1,433.54"	$0.00	$0.00	"$1,458.27"	$0.00	$0.00	$0.00	$0.00	$0.00
27816280	EAP	Custom 27816280		Stent Eprsth 21mm 10cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816281	EAP	Custom 27816281		Stent Eprsth 21-26mm 10cm Strl Gore Tag Cnfrm Flxb Radopq	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816282	EAP	Custom 27816282		Stent Eprsth 26mm 10cm Strl Gore Tag Flxb Radopq Ntnl Fep	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816283	EAP	Custom 27816283		Stent Eprsth 28mm 10cm Strl Gore Tag Flxb Radopq Ntnl Fep	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816284	EAP	Custom 27816284		Stent Eprsth 28mm 15cm Strl Gore Tag Flxb Radopq Ntnl Fep	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816285	EAP	Custom 27816285		Stent Eprsth 26-31mm 10cm Strl Gore Tag Cnfrm Flxb Radopq	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816286	EAP	Custom 27816286		Stent Eprsth 31mm 10cm Strl Gore Tag Flxb Radopq Ntnl Fep	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816287	EAP	Custom 27816287		Stent Eprsth 31mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816288	EAP	Custom 27816288		Stent Eprsth 34mm 10cm Strl Gore Tag Flxb Radopq Ntnl Fep	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816289	EAP	Custom 27816289		Stent Eprsth 34mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816290	EAP	Custom 27816290		Stent Eprsth 34mm 20cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816291	EAP	Custom 27816291		Stent Eprsth 37mm 10cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816292	EAP	Custom 27816292		Stent Eprsth 37mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816293	EAP	Custom 27816293		Stent Eprsth 37mm 20cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816294	EAP	Custom 27816294		Stent Eprsth 40mm 10cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816295	EAP	Custom 27816295		Stent Eprsth 40mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816296	EAP	Custom 27816296		Stent Eprsth 40mm 20cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816297	EAP	Custom 27816297		Stent Eprsth 45mm 10cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816298	EAP	Custom 27816298		Stent Eprsth 45mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816299	EAP	Custom 27816299		Stent Eprsth 45mm 20cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe	BOTH IP/OP	"$41,640.00 "	"$30,813.60"	$0.00	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$32,096.11"	$0.00	"$8,677.78"	$0.00	$0.00	$0.00	$0.00	"$20,820.00"	"$32,978.88"	"$33,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816300	EAP			Plug Ocl 3mm 12x5.3mm Mvp Mech Dtch Full Resheathable Ntnl	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	$0.00	$0.00	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816301	EAP			Plug Ocl 5mm 12x6.5mm Strl Lf Mvp Mech Dtch Full	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	$0.00	$0.00	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	"$1,682.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816302	EAP			Plug Ocl Mic 7mm Strl Lf Mvp Mech Vasc Disp V03	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	$0.00	$0.00	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	"$1,682.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816303	EAP			Plug Ocl 9mm Strl Lf Mvp V03	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	$0.00	$0.00	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	"$1,682.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816304	EAP	Custom 27816304		Graft Evas 10mm 10cm Gore Xcldr Brch Cmpnt Ilc Aaa	BOTH IP/OP	"$27,548.00 "	"$20,385.52"	$0.00	"$22,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,234.00"	$0.00	"$5,741.00"	$0.00	$0.00	$0.00	$0.00	"$13,774.00"	"$21,818.02"	"$22,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816305	EAP	Custom 27816305		Graft Evas 12mm 10cm Gore Xcldr Brch Cmpnt Ilc Aaa	BOTH IP/OP	"$27,548.00 "	"$20,385.52"	$0.00	"$22,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,234.00"	$0.00	"$5,741.00"	$0.00	$0.00	$0.00	$0.00	"$13,774.00"	"$21,818.02"	"$22,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816306	EAP	Custom 27816306		Graft Evas 14.5mm 10cm Gore Xcldr Brch Cmpnt Ilc Aaa	BOTH IP/OP	"$27,548.00 "	"$20,385.52"	$0.00	"$22,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,234.00"	$0.00	"$5,741.00"	$0.00	$0.00	$0.00	$0.00	"$13,774.00"	"$21,818.02"	"$22,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816307	EAP	Custom 27816307		Graft Evas 14.5mm 7cm Gore Xcldr Intnl Cmpnt Ilc Aaa	BOTH IP/OP	"$7,688.00 "	"$5,689.12"	$0.00	"$6,150.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,925.91"	$0.00	"$1,602.18"	$0.00	$0.00	$0.00	$0.00	"$3,844.00"	"$6,088.90"	"$6,150.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816308	EAP	HCPCS C1783		Stent Opth 50um 230um 80um 360um Strl Istent Inj 2 Preld 1	BOTH IP/OP	"$3,688.00 "	"$2,729.12"	$0.00	"$2,950.40"	"$1,659.60"	"$1,659.60"	$0.00	$0.00	$0.00	$768.67	"$2,737.23"	"$2,737.23"	"$2,842.71"	$0.00	$768.58	$0.00	"$1,818.18"	"$1,818.18"	$0.00	"$1,844.00"	"$2,920.90"	"$2,950.40"	$0.00	"$1,659.60"	$0.00	$577.17	$0.00	$0.00	$587.13	$0.00	$0.00	$0.00	$0.00	$0.00
27816309	EAP	HCPCS C1874		Axios Stent And Electrocautery 15x10	BOTH IP/OP	"$11,625.00 "	"$8,602.50"	$0.00	"$9,300.00"	"$5,231.25"	"$5,231.25"	$0.00	$0.00	$0.00	"$2,422.94"	"$4,181.12"	"$4,181.12"	"$8,960.55"	$0.00	"$2,422.65"	$0.00	"$5,731.13"	"$5,731.13"	$0.00	"$5,812.50"	"$9,207.00"	"$9,300.00"	$0.00	"$5,231.25"	$0.00	"$1,819.31"	$0.00	$0.00	"$1,850.70"	$0.00	$0.00	$0.00	$0.00	$0.00
27816310	EAP	HCPCS C1874		Wallflex Biliary Stent	BOTH IP/OP	"$6,738.00 "	"$4,986.12"	$0.00	"$5,390.40"	"$3,032.10"	"$3,032.10"	$0.00	$0.00	$0.00	"$1,404.37"	"$4,181.12"	"$4,181.12"	"$5,193.65"	$0.00	"$1,404.20"	$0.00	"$3,321.83"	"$3,321.83"	$0.00	"$3,369.00"	"$5,336.50"	"$5,390.40"	$0.00	"$3,032.10"	$0.00	"$1,054.50"	$0.00	$0.00	"$1,072.69"	$0.00	$0.00	$0.00	$0.00	$0.00
27816311	EAP	HCPCS C1768		Envelope Tiss 5x5.4cm Cormatrix Cangaroo Sm Sft	BOTH IP/OP	"$12,063.00 "	"$8,926.62"	$0.00	"$9,650.40"	"$5,428.35"	"$5,428.35"	$0.00	$0.00	$0.00	"$2,514.23"	"$4,181.12"	"$4,181.12"	"$9,298.16"	$0.00	"$2,513.93"	$0.00	"$5,947.06"	"$5,947.06"	$0.00	"$6,031.50"	"$9,553.90"	"$9,650.40"	$0.00	$0.00	$0.00	"$1,887.86"	$0.00	$0.00	"$1,920.43"	$0.00	$0.00	$0.00	$0.00	$0.00
27816312	EAP	HCPCS C1768		Envelope Tiss 6.9x6.5cm Cormatrix Cangaroo Med Sft	BOTH IP/OP	"$12,063.00 "	"$8,926.62"	$0.00	"$9,650.40"	"$5,428.35"	"$5,428.35"	$0.00	$0.00	$0.00	"$2,514.23"	"$4,181.12"	"$4,181.12"	"$9,298.16"	$0.00	"$2,513.93"	$0.00	"$5,947.06"	"$5,947.06"	$0.00	"$6,031.50"	"$9,553.90"	"$9,650.40"	$0.00	$0.00	$0.00	"$1,887.86"	$0.00	$0.00	"$1,920.43"	$0.00	$0.00	$0.00	$0.00	$0.00
27816313	EAP	HCPCS C1768		Envelope Tiss 8x6.9cm Cormatrix Cangaroo Lg Sft	BOTH IP/OP	"$12,063.00 "	"$8,926.62"	$0.00	"$9,650.40"	"$5,428.35"	"$5,428.35"	$0.00	$0.00	$0.00	"$2,514.23"	"$4,181.12"	"$4,181.12"	"$9,298.16"	$0.00	"$2,513.93"	$0.00	"$5,947.06"	"$5,947.06"	$0.00	"$6,031.50"	"$9,553.90"	"$9,650.40"	$0.00	$0.00	$0.00	"$1,887.86"	$0.00	$0.00	"$1,920.43"	$0.00	$0.00	$0.00	$0.00	$0.00
27816314	EAP	HCPCS C1768		Envelope Tiss 9.5x6.9cm Cormatrix Cangaroo Xl Sft	BOTH IP/OP	"$12,063.00 "	"$8,926.62"	$0.00	"$9,650.40"	"$5,428.35"	"$5,428.35"	$0.00	$0.00	$0.00	"$2,514.23"	"$4,181.12"	"$4,181.12"	"$9,298.16"	$0.00	"$2,513.93"	$0.00	"$5,947.06"	"$5,947.06"	$0.00	"$6,031.50"	"$9,553.90"	"$9,650.40"	$0.00	$0.00	$0.00	"$1,887.86"	$0.00	$0.00	"$1,920.43"	$0.00	$0.00	$0.00	$0.00	$0.00
27816315	EAP	HCPCS C1768		Envelope Tiss 10.8x8.9cm Cangaroo 2xl Sft Reinf	BOTH IP/OP	"$16,563.00 "	"$12,256.62"	$0.00	"$13,250.40"	"$7,453.35"	"$7,453.35"	$0.00	$0.00	$0.00	"$3,452.14"	"$4,181.12"	"$4,181.12"	"$12,766.76"	$0.00	"$3,451.73"	$0.00	"$8,165.56"	"$8,165.56"	$0.00	"$8,281.50"	"$13,117.90"	"$13,250.40"	$0.00	$0.00	$0.00	"$2,592.11"	$0.00	$0.00	"$2,636.83"	$0.00	$0.00	$0.00	$0.00	$0.00
27816316	EAP	HCPCS C1874		Stent Endoprsth 2.5cm 5mm Hep Ntnl Eptfe Vbhn 120	BOTH IP/OP	"$8,808.00 "	"$6,517.92"	$0.00	"$7,046.40"	"$3,963.60"	"$3,963.60"	$0.00	$0.00	$0.00	"$1,835.81"	"$4,181.12"	"$4,181.12"	"$6,789.21"	$0.00	"$1,835.59"	$0.00	"$4,342.34"	"$4,342.34"	$0.00	"$4,404.00"	"$6,975.94"	"$7,046.40"	$0.00	$0.00	$0.00	"$1,378.45"	$0.00	$0.00	"$1,402.23"	$0.00	$0.00	$0.00	$0.00	$0.00
27816317	EAP	HCPCS C1874		Stent Endoprsth 2.5cm 6mm Hep Ntnl Eptfe Vbhn 120	BOTH IP/OP	"$8,808.00 "	"$6,517.92"	$0.00	"$7,046.40"	"$3,963.60"	"$3,963.60"	$0.00	$0.00	$0.00	"$1,835.81"	"$4,181.12"	"$4,181.12"	"$6,789.21"	$0.00	"$1,835.59"	$0.00	"$4,342.34"	"$4,342.34"	$0.00	"$4,404.00"	"$6,975.94"	"$7,046.40"	$0.00	$0.00	$0.00	"$1,378.45"	$0.00	$0.00	"$1,402.23"	$0.00	$0.00	$0.00	$0.00	$0.00
27816318	EAP	HCPCS C1874		Stent Endoprsth 2.5cm 8mm Hep Ntnl Eptfe Vbhn 120	BOTH IP/OP	"$8,808.00 "	"$6,517.92"	$0.00	"$7,046.40"	"$3,963.60"	"$3,963.60"	$0.00	$0.00	$0.00	"$1,835.81"	"$4,181.12"	"$4,181.12"	"$6,789.21"	$0.00	"$1,835.59"	$0.00	"$4,342.34"	"$4,342.34"	$0.00	"$4,404.00"	"$6,975.94"	"$7,046.40"	$0.00	$0.00	$0.00	"$1,378.45"	$0.00	$0.00	"$1,402.23"	$0.00	$0.00	$0.00	$0.00	$0.00
27816320	EAP	HCPCS C1874		System Coron Stent 8mm 2.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816321	EAP	HCPCS C1874		System Coron Stent 12mm 2.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816322	EAP	HCPCS C1874		System Coron Stent 15mm 2.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816323	EAP	HCPCS C1874		System Coron Stent 17mm 2.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816324	EAP	HCPCS C1874		System Coron Stent 20mm 2.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816325	EAP	HCPCS C1874		System Coron Stent 24mm 2.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816326	EAP	HCPCS C1874		System Coron Stent 28mm 2.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816327	EAP	HCPCS C1874		System Coron Stent 33mm 2.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816328	EAP	HCPCS C1874		System Coron Stent 8mm 2.75mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816329	EAP	HCPCS C1874		System Coron Stent 12mm 2.75mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816330	EAP	HCPCS C1874		System Coron Stent 15mm 2.75mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816331	EAP	HCPCS C1874		System Coron Stent 17mm 2.75mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816332	EAP	HCPCS C1874		System Coron Stent 20mm 2.75mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816333	EAP	HCPCS C1874		Stent Coron 24mm 2.75mm Carbosil 20 55d	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816334	EAP	HCPCS C1874		System Coron Stent 28mm 2.75mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816335	EAP	HCPCS C1874		System Coron Stent 33mm 2.75mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816336	EAP	HCPCS C1874		System Coron Stent 38mm 2.75mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816337	EAP	HCPCS C1874		System Coron Stent 44mm 2.75mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816338	EAP	HCPCS C1874		System Coron Stent 8mm 3mm Elunir Thk90um Carbosil	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816339	EAP	HCPCS C1874		System Coron Stent 12mm 3mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816340	EAP	HCPCS C1874		System Coron Stent 15mm 3mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816341	EAP	HCPCS C1874		System Coron Stent 17mm 3mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816342	EAP	HCPCS C1874		System Coron Stent 20mm 3mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816343	EAP	HCPCS C1874		System Coron Stent 24mm 3mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816344	EAP	HCPCS C1874		System Coron Stent 28mm 3mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816345	EAP	HCPCS C1874		System Coron Stent 33mm 3mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816346	EAP	HCPCS C1874		System Coron Stent 38mm 3mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816347	EAP	HCPCS C1874		System Coron Stent 44mm 3mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816348	EAP	HCPCS C1874		System Coron Stent 8mm 3.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816349	EAP	HCPCS C1874		System Coron Stent 12mm 3.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816350	EAP	HCPCS C1874		System Coron Stent 15mm 3.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816351	EAP	HCPCS C1874		System Coron Stent 17mm 3.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816352	EAP	HCPCS C1874		System Coron Stent 20mm 3.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816353	EAP	HCPCS C1874		System Coron Stent 24mm 3.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816354	EAP	HCPCS C1874		System Coron Stent 28mm 3.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816355	EAP	HCPCS C1874		System Coron Stent 33mm 3.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816356	EAP	HCPCS C1874		System Coron Stent 38mm 3.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816357	EAP	HCPCS C1874		System Coron Stent 44mm 3.5mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816358	EAP	HCPCS C1874		System Coron Stent 8mm 4mm Elunir Thk90um Carbosil	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816359	EAP	HCPCS C1874		System Coron Stent 12mm 4mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816360	EAP	HCPCS C1874		System Coron Stent 15mm 4mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816361	EAP	HCPCS C1874		System Coron Stent 17mm 4mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816362	EAP	HCPCS C1874		System Coron Stent 20mm 4mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816363	EAP	HCPCS C1874		System Coron Stent 24mm 4mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816364	EAP	HCPCS C1874		System Coron Stent 28mm 4mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816365	EAP	HCPCS C1874		System Coron Stent 33mm 4mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816366	EAP	HCPCS C1874		System Coron Stent 38mm 4mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816367	EAP	HCPCS C1874		System Coron Stent 44mm 4mm Elunir Thk90um	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
27816371	EAP	HCPCS C1874		Stent Endoprosthesis Viabahn Heparin Nitinol Eptfe L25 Cm L120 Cm Od6 Mm	BOTH IP/OP	"$15,988.00 "	"$11,831.12"	$0.00	"$12,790.40"	"$7,194.60"	"$7,194.60"	$0.00	$0.00	$0.00	"$3,332.30"	"$4,181.12"	"$4,181.12"	"$12,323.55"	$0.00	"$3,331.90"	$0.00	"$7,882.08"	"$7,882.08"	$0.00	"$7,994.00"	"$12,662.50"	"$12,790.40"	$0.00	"$7,194.60"	$0.00	"$2,502.12"	$0.00	$0.00	"$2,545.29"	$0.00	$0.00	$0.00	$0.00	$0.00
28000001	EAP	CPT® 96522		Refill/maint Implant Pump	BOTH IP/OP	$497.00 	$367.78	$0.00	$397.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.57	$0.00	$0.00	$0.00	$0.00	$248.50	$393.62	$397.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000001	EAP	CPT® 36415		"PHLEBOTOMY,VEN-1OPC"	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.15	$21.50	$34.06	$34.40	$4.35	$0.00	$4.35	$6.73	$3.00	$3.00	$6.85	$3.00	$0.00	$0.00	$0.00	$0.00
30000002	EAP	CPT® 80053		Comp Metabolic Panel	BOTH IP/OP	$472.00 	$349.28	$0.00	$381.60	$21.81	$21.81	$10.56	$10.56	$5.28	$5.28	$16.06	$16.06	$16.68	$10.56	$15.61	$6.86	$279.19	$279.19	$11.09	$29.54	$377.78	$381.60	$15.31	$0.00	$15.31	$16.64	$10.56	$10.56	$11.65	$10.56	$0.00	$0.00	$0.00	$0.00
30000003	EAP	CPT® 81340		"T Cell Receptor (tcr) Beta Gene  Rearrang, Pcr (so)"	BOTH IP/OP	$690.00 	$510.60	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.42	$296.42	$307.82	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000004	EAP	CPT® 84999		Unlisted Chemistry Procedure (so)gene	BOTH IP/OP	$143.00 	$105.82	$0.00	$112.80	$0.00	$0.00	$0.00	$0.00	$25.45	$0.00	$106.13	$106.13	$110.22	$0.00	$29.80	$0.00	$0.00	$0.00	$0.00	$0.00	$111.67	$112.80	$0.00	$92.95	$0.00	$22.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000005	EAP	CPT® 81340		T -cell Antigen  Receptor Beta  (so) Clon	BOTH IP/OP	$690.00 	$510.60	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.42	$296.42	$307.82	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$341.00	$540.14	$545.60	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000006	EAP	CPT® 81342		T -cell Antigen  Receptor Gamma (so) Clon	BOTH IP/OP	$954.00 	$705.96	$0.00	$753.60	$415.93	$415.93	$201.50	$201.50	$100.75	$100.75	$285.90	$285.90	$296.89	$201.50	$192.65	$130.98	$564.29	$564.29	$0.00	$471.00	$746.06	$753.60	$0.00	$332.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000007	EAP	CPT® 84999		Unlisted Chemistry Procedure (so) Clon	BOTH IP/OP	$143.00 	$105.82	$0.00	$112.80	$0.00	$0.00	$0.00	$0.00	$25.45	$0.00	$106.13	$106.13	$110.22	$0.00	$29.80	$0.00	$0.00	$0.00	$0.00	$0.00	$111.67	$112.80	$0.00	$92.95	$0.00	$22.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000008	EAP	CPT® 81381		HLA- B57:01 DETERMINATION-PCR (QUEST)	BOTH IP/OP	$370.00 	$273.80	$0.00	$370.40	$195.23	$195.23	$169.90	$169.90	$84.95	$76.46	$134.19	$134.19	$139.35	$169.90	$46.99	$110.44	$218.86	$218.86	$178.40	$231.50	$366.70	$370.40	$246.36	$0.00	$246.36	$50.07	$169.90	$169.90	$35.05	$169.90	$0.00	$0.00	$0.00	$0.00
30000009	EAP	CPT® 81380		HLA -B HIGH RESOLUTION- PCR (QUEST)	BOTH IP/OP	$573.00 	$424.02	$0.00	$539.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$251.48	$251.48	$261.15	$0.00	$192.65	$0.00	$0.00	$0.00	$0.00	$289.50	$458.57	$463.20	$0.00	$539.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000010	EAP	CPT® 87798		"Ebola -cdc,rt-pcr,evd"	BOTH IP/OP	$114.00 	$84.36	$0.00	$109.60	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$67.43	$67.43	$36.84	$54.82	$108.50	$109.60	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30000018	EAP	CPT® 80346		"Benzodiazpne,ur-eia"	BOTH IP/OP	$374.00 	$276.76	$0.00	$288.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$277.58	$277.58	$288.28	$0.00	$27.32	$0.00	$0.00	$0.00	$0.00	$170.00	$269.28	$272.00	$0.00	$206.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000019	EAP	CPT® 80353		Cocain Metab.ur-eia	BOTH IP/OP	$374.00 	$276.76	$0.00	$288.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$277.58	$277.58	$288.28	$0.00	$14.16	$0.00	$0.00	$0.00	$0.00	$170.00	$269.28	$272.00	$0.00	$203.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000020	EAP	CPT® 83992		"Phencyclidne,ur-eia"	BOTH IP/OP	$374.00 	$276.76	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.32	$22.32	$23.18	$0.00	$21.72	$0.00	$0.00	$0.00	$0.00	$41.08	$269.28	$272.00	$0.00	$159.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000021	EAP	CPT® 80361		"Opiates,ur-eia"	BOTH IP/OP	$495.00 	$366.30	$0.00	$381.55	$0.03	$0.03	$0.00	$0.00	$12.01	$11.94	$367.39	$367.39	$381.55	$0.00	$30.51	$0.00	$292.79	$292.79	$0.00	$225.00	$356.40	$360.00	$270.00	$321.75	$270.00	$32.51	$0.00	$0.00	$22.76	$0.00	$0.00	$0.00	$0.00	$0.00
30000022	EAP	CPT® 80349		"Thc, Ur-eia"	BOTH IP/OP	$374.00 	$276.76	$0.00	$288.28	$0.03	$0.03	$0.00	$0.00	$12.01	$0.00	$277.58	$277.58	$288.28	$0.00	$77.94	$0.00	$0.00	$0.00	$0.00	$170.00	$269.28	$272.00	$0.00	$164.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000023	EAP	CPT® 80345		"Barbiturate,ur-eia"	BOTH IP/OP	$245.00 	$181.30	$0.00	$251.20	$0.03	$0.03	$0.00	$0.00	$12.01	$7.03	$181.84	$181.84	$188.85	$0.00	$16.93	$0.00	$144.92	$144.92	$0.00	$157.00	$248.69	$251.20	$0.00	$159.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000024	EAP	CPT® 80150		Amikacin-random	BOTH IP/OP	$265.00 	$196.10	$0.00	$212.00	$31.13	$31.13	$15.08	$15.08	$7.54	$7.54	$22.89	$22.89	$23.77	$15.08	$22.26	$9.80	$156.75	$156.75	$0.00	$42.12	$209.88	$212.00	$0.00	$172.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000025	EAP	CPT® 80335		Amitriptyline-random	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.02	$69.02	$71.68	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$46.50	$73.66	$74.40	$0.00	$60.45	$0.00	$28.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000026	EAP	CPT® 80159		Clozapine (so)	BOTH IP/OP	$299.00 	$221.26	$9.25	$239.20	$38.17	$38.17	$20.15	$20.15	$10.08	$9.25	$26.24	$26.24	$27.25	$20.15	$23.71	$13.10	$176.86	$176.86	$21.16	$149.50	$236.81	$239.20	$29.22	$194.35	$29.22	$25.26	$20.15	$20.15	$17.68	$20.15	$0.00	$0.00	$0.00	$0.00
30000027	EAP	CPT® 80156		Carbamazpine-random	BOTH IP/OP	$279.00 	$206.46	$7.28	$223.20	$30.07	$30.07	$14.57	$14.57	$7.29	$7.28	$22.11	$22.11	$22.96	$14.57	$21.51	$9.47	$165.03	$165.03	$15.30	$40.68	$220.97	$223.20	$21.13	$181.35	$21.13	$22.92	$14.57	$14.57	$16.05	$14.57	$0.00	$0.00	$0.00	$0.00
30000028	EAP	CPT® 80158		Cyclosporine	BOTH IP/OP	$238.00 	$176.12	$6.57	$190.40	$12.30	$12.30	$18.05	$18.05	$9.03	$9.03	$9.05	$9.05	$9.40	$18.05	$8.81	$11.73	$140.78	$140.78	$18.95	$16.66	$188.50	$190.40	$26.17	$154.70	$26.17	$9.39	$18.05	$18.05	$6.57	$18.05	$0.00	$0.00	$0.00	$0.00
30000029	EAP	CPT® 80335		Desipramine-random	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.03	$92.03	$95.58	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$62.00	$98.21	$99.20	$0.00	$80.60	$0.00	$28.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000030	EAP	CPT® 80162		"Digoxin, Total"	BOTH IP/OP	$281.00 	$207.94	$0.00	$224.80	$27.40	$27.40	$13.28	$13.28	$6.64	$0.00	$20.17	$20.17	$20.94	$0.00	$19.61	$0.00	$0.00	$0.00	$13.94	$37.10	$222.55	$224.80	$19.26	$182.65	$19.26	$20.90	$13.28	$13.28	$14.63	$13.28	$0.00	$0.00	$0.00	$0.00
30000031	EAP	CPT® 80164		"Valproic Acid, Total"	BOTH IP/OP	$319.00 	$236.06	$6.77	$255.20	$23.44	$23.44	$13.54	$13.54	$6.77	$6.77	$17.23	$17.23	$17.90	$13.54	$16.77	$8.80	$188.69	$188.69	$14.22	$31.72	$252.65	$255.20	$19.63	$207.35	$19.63	$17.87	$13.54	$13.54	$12.51	$13.54	$0.00	$0.00	$0.00	$0.00
30000032	EAP	CPT® 80335		Doxepin-random	BOTH IP/OP	$123.00 	$91.02	$0.00	$98.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.29	$91.29	$94.81	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$61.50	$97.42	$98.40	$0.00	$0.00	$0.00	$28.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000033	EAP	CPT® 80168		Ethosuximide-random	BOTH IP/OP	$86.00 	$63.64	$0.00	$68.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.81	$24.81	$25.77	$0.00	$24.14	$0.00	$0.00	$0.00	$0.00	$45.66	$68.11	$68.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000034	EAP	CPT® 80170		Gentamicin-random	BOTH IP/OP	$201.00 	$148.74	$8.19	$160.80	$33.82	$33.82	$16.38	$16.38	$8.19	$8.19	$24.89	$24.89	$25.84	$16.38	$24.21	$10.65	$118.89	$118.89	$17.20	$45.80	$159.19	$160.80	$23.75	$130.65	$23.75	$25.80	$16.38	$16.38	$18.06	$16.38	$0.00	$0.00	$0.00	$0.00
30000035	EAP	CPT® 80173		Haloperidol	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$30.07	$30.07	$15.78	$15.78	$7.89	$7.28	$22.11	$22.11	$22.96	$15.78	$21.51	$10.26	$70.98	$70.98	$0.00	$40.68	$95.04	$96.00	$0.00	$37.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000036	EAP	CPT® 80335		Imipramine-random	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$104.06	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00	$0.00	$0.00	$28.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000037	EAP	CPT® 80176		Lidocaine-random	BOTH IP/OP	$159.00 	$117.66	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.31	$22.31	$23.17	$0.00	$21.69	$0.00	$0.00	$0.00	$0.00	$41.04	$126.72	$128.00	$0.00	$103.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000038	EAP	CPT® 80178		Lithium-random	BOTH IP/OP	$225.00 	$166.50	$3.31	$180.00	$13.65	$13.65	$6.61	$6.61	$3.31	$3.31	$10.04	$10.04	$10.42	$6.61	$9.78	$4.30	$133.09	$133.09	$6.94	$18.48	$178.20	$180.00	$9.58	$146.25	$9.58	$10.42	$6.61	$6.61	$7.29	$6.61	$0.00	$0.00	$0.00	$0.00
30000039	EAP	CPT® 80335		Nortriptyline-random	BOTH IP/OP	$117.00 	$86.58	$0.00	$93.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.84	$86.84	$90.18	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$58.50	$92.66	$93.60	$0.00	$76.05	$0.00	$28.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000040	EAP	CPT® 80184		Phenobarb-random	BOTH IP/OP	$236.00 	$174.64	$6.89	$188.80	$23.02	$23.02	$15.30	$15.30	$7.65	$6.89	$17.39	$17.39	$18.06	$15.30	$16.93	$9.95	$139.59	$139.59	$16.07	$32.02	$186.91	$188.80	$22.19	$149.50	$22.19	$18.04	$15.30	$15.30	$12.62	$15.30	$0.00	$0.00	$0.00	$0.00
30000041	EAP	CPT® 80185		Dilantin-random	BOTH IP/OP	$287.00 	$212.38	$6.63	$229.60	$27.35	$27.35	$13.25	$13.25	$6.63	$6.63	$20.13	$20.13	$20.91	$13.25	$19.58	$8.61	$169.76	$169.76	$13.91	$37.04	$227.30	$229.60	$19.21	$186.55	$19.21	$20.87	$13.25	$13.25	$14.61	$13.25	$0.00	$0.00	$0.00	$0.00
30000042	EAP	CPT® 80186		Phenytoin Free (so)	BOTH IP/OP	$205.00 	$151.70	$6.88	$164.00	$28.41	$28.41	$13.76	$13.76	$6.88	$6.88	$20.90	$20.90	$21.71	$13.76	$20.34	$8.94	$121.26	$121.26	$14.45	$38.46	$162.36	$164.00	$19.95	$133.25	$19.95	$21.67	$13.76	$13.76	$15.17	$13.76	$0.00	$0.00	$0.00	$0.00
30000043	EAP	CPT® 80188		Primidone/myso-rand.	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.20	$25.20	$26.17	$0.00	$24.51	$0.00	$0.00	$0.00	$0.00	$46.36	$148.90	$150.40	$0.00	$122.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000044	EAP	CPT® 80192		Procainamide-random	BOTH IP/OP	$191.00 	$141.34	$0.00	$152.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.44	$25.44	$26.42	$0.00	$24.75	$0.00	$0.00	$0.00	$0.00	$46.82	$151.27	$152.80	$0.00	$124.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000045	EAP	CPT® 80194		Quinidine-random	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.16	$22.16	$23.01	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$40.78	$126.72	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000046	EAP	CPT® 80307		Salicylate-quant	BOTH IP/OP	$388.00 	$287.12	$0.00	$299.07	$0.00	$0.00	$38.57	$38.57	$19.29	$80.87	$287.97	$287.97	$299.07	$38.57	$36.26	$25.07	$229.50	$229.50	$65.25	$176.50	$279.58	$282.40	$90.10	$63.64	$90.10	$76.56	$62.14	$62.14	$53.59	$62.14	$0.00	$0.00	$0.00	$0.00
30000047	EAP	CPT® 80198		Theophylline-random	BOTH IP/OP	$173.00 	$128.02	$0.00	$138.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.49	$21.49	$22.31	$0.00	$20.90	$0.00	$0.00	$0.00	$14.85	$39.54	$137.02	$138.40	$20.50	$112.45	$20.50	$0.00	$14.14	$14.14	$15.58	$14.14	$0.00	$0.00	$0.00	$0.00
30000048	EAP	CPT® 80200		Tobramycin-random	BOTH IP/OP	$263.00 	$194.62	$0.00	$210.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.74	$22.74	$23.62	$0.00	$22.13	$0.00	$0.00	$0.00	$0.00	$41.86	$208.30	$210.40	$0.00	$170.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000049	EAP	CPT® 80201		Topiramate/topamaz	BOTH IP/OP	$94.00 	$69.56	$5.96	$75.20	$24.60	$24.60	$11.92	$11.92	$5.96	$5.96	$18.10	$18.10	$18.79	$11.92	$17.61	$7.75	$55.60	$55.60	$12.52	$33.32	$74.45	$75.20	$17.28	$61.10	$17.28	$18.76	$11.92	$11.92	$13.13	$11.92	$0.00	$0.00	$0.00	$0.00
30000050	EAP	CPT® 80202		Vancomycin-random	BOTH IP/OP	$292.00 	$216.08	$6.77	$233.60	$23.44	$23.44	$13.54	$13.54	$6.77	$6.77	$17.23	$17.23	$17.90	$13.54	$16.77	$8.80	$172.72	$172.72	$14.22	$31.72	$231.26	$233.60	$19.63	$189.80	$19.63	$17.87	$13.54	$13.54	$12.51	$13.54	$0.00	$0.00	$0.00	$0.00
30000051	EAP	CPT® 80299		Methotrexate-random	BOTH IP/OP	$217.00 	$160.58	$0.00	$217.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.06	$161.06	$167.26	$0.00	$17.51	$0.00	$0.00	$0.00	$19.57	$33.64	$172.66	$174.40	$27.03	$217.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30000052	EAP	CPT® 80171		"Gabapentin, Whl Bld/ser/plasma"	BOTH IP/OP	$431.00 	$318.94	$0.00	$346.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.81	$18.81	$19.54	$0.00	$17.00	$0.00	$0.00	$0.00	$0.00	$216.50	$342.94	$346.40	$0.00	$247.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000053	EAP	CPT® 80299		Amiodarone/cordarone	BOTH IP/OP	$217.00 	$160.58	$0.00	$174.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.06	$161.06	$167.26	$0.00	$17.51	$0.00	$0.00	$0.00	$19.57	$33.64	$172.66	$174.40	$27.03	$48.75	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30000054	EAP	CPT® 80175		Lamotrigine (so)	BOTH IP/OP	$431.00 	$318.94	$6.63	$346.40	$27.35	$27.35	$13.25	$13.25	$6.63	$6.63	$18.81	$18.81	$19.54	$13.25	$17.00	$8.61	$254.94	$254.94	$13.91	$216.50	$342.94	$346.40	$19.21	$280.15	$19.21	$18.11	$13.25	$13.25	$12.68	$13.25	$0.00	$0.00	$0.00	$0.00
30000055	EAP	CPT® 80299		Olanzapine/zyprexa	BOTH IP/OP	$217.00 	$160.58	$8.39	$174.40	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$128.36	$128.36	$19.57	$33.64	$172.66	$174.40	$27.03	$141.05	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30000056	EAP	CPT® 82013		Acetylcholinesterase-amnio	BOTH IP/OP	$37.00 	$27.38	$0.00	$31.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.96	$16.96	$17.61	$0.00	$16.51	$0.00	$0.00	$0.00	$0.00	$31.22	$29.30	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000057	EAP	CPT® 82017		"Carnitine, Ester"	BOTH IP/OP	$131.00 	$96.94	$0.00	$131.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.62	$25.62	$26.60	$0.00	$24.92	$0.00	$0.00	$0.00	$0.00	$47.14	$104.54	$105.60	$0.00	$131.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000058	EAP	CPT® 82270		Fecal Occult Blood Test	BOTH IP/OP	$57.00 	$42.18	$0.00	$46.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.88	$4.88	$5.07	$0.00	$4.75	$0.00	$0.00	$0.00	$0.00	$8.98	$45.94	$46.40	$0.00	$37.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000060	EAP	CPT® 82330		"Calcium, Ionized"	BOTH IP/OP	$375.00 	$277.50	$6.84	$273.60	$28.22	$28.22	$13.68	$13.68	$6.84	$6.84	$20.75	$20.75	$21.55	$13.68	$20.18	$8.89	$221.81	$221.81	$14.36	$38.18	$270.86	$273.60	$19.84	$22.57	$19.84	$21.50	$13.68	$13.68	$15.05	$13.68	$0.00	$0.00	$0.00	$0.00
30000062	EAP	CPT® 82948		"Glucose-2hr Pp,wb"	BOTH IP/OP	$251.00 	$185.74	$0.00	$248.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.82	$4.82	$5.00	$0.00	$4.68	$0.00	$0.00	$0.00	$0.00	$8.86	$246.31	$248.80	$0.00	$48.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000063	EAP	CPT® 82948		"Glucose-fbs,wb"	BOTH IP/OP	$251.00 	$185.74	$0.00	$248.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.82	$4.82	$5.00	$0.00	$4.68	$0.00	$0.00	$0.00	$0.00	$8.86	$246.31	$248.80	$0.00	$48.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000064	EAP	CPT® 82948		"Glucose-fbs,wb Micro"	BOTH IP/OP	$251.00 	$185.74	$0.00	$248.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.82	$4.82	$5.00	$0.00	$4.68	$0.00	$0.00	$0.00	$0.00	$8.86	$246.31	$248.80	$0.00	$48.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000065	EAP	CPT® 82948		"Glucose-random,wb"	BOTH IP/OP	$251.00 	$185.74	$0.00	$248.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.82	$4.82	$5.00	$0.00	$4.68	$0.00	$0.00	$0.00	$0.00	$8.86	$246.31	$248.80	$0.00	$48.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000066	EAP	CPT® 82948		"GLU-RANDOM,WB MICRO"	BOTH IP/OP	$251.00 	$185.74	$0.00	$248.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.82	$4.82	$5.00	$0.00	$4.68	$0.00	$0.00	$0.00	$0.00	$8.86	$246.31	$248.80	$0.00	$48.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000067	EAP	CPT® 83020		Newborn Screen	BOTH IP/OP	$204.00 	$150.96	$6.44	$163.20	$20.17	$20.17	$12.87	$12.87	$6.44	$6.44	$14.84	$14.84	$15.41	$12.87	$14.44	$8.37	$120.67	$120.67	$13.51	$27.32	$161.57	$163.20	$18.66	$21.24	$18.66	$15.38	$12.87	$12.87	$10.77	$12.87	$0.00	$0.00	$0.00	$0.00
30000068	EAP	CPT® 83516		T-transglutamin Igg	BOTH IP/OP	$181.00 	$133.94	$5.76	$140.80	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$107.06	$107.06	$12.11	$29.88	$139.39	$140.80	$16.72	$117.65	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30000069	EAP	CPT® 83520		Anti Gm1 Ab Titer	BOTH IP/OP	$477.00 	$352.98	$7.77	$371.20	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$282.15	$282.15	$18.13	$36.18	$367.49	$371.20	$25.04	$204.75	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30000070	EAP	CPT® 83520		Anti Asialo-gm-ab	BOTH IP/OP	$411.00 	$304.14	$7.77	$371.20	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$243.11	$243.11	$18.13	$36.18	$367.49	$371.20	$25.04	$204.75	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30000071	EAP	CPT® 83520		Anti Gq1b Ab Titer	BOTH IP/OP	$477.00 	$352.98	$7.77	$371.20	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$282.15	$282.15	$18.13	$36.18	$367.49	$371.20	$25.04	$204.75	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30000072	EAP	CPT® 83520		Anti Gd 1b Ab Titer	BOTH IP/OP	$411.00 	$304.14	$7.77	$371.20	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$243.11	$243.11	$18.13	$36.18	$367.49	$371.20	$25.04	$204.75	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30000073	EAP	CPT® 83520		Mitochondrial Ab	BOTH IP/OP	$477.00 	$352.98	$7.77	$371.20	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$282.15	$282.15	$18.13	$36.18	$367.49	$371.20	$25.04	$248.30	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30000074	EAP	CPT® 83605		"Lactate, Plasma"	BOTH IP/OP	$258.00 	$190.92	$5.34	$248.80	$22.04	$22.04	$11.57	$11.57	$5.79	$5.34	$16.21	$16.21	$16.84	$11.57	$15.78	$7.52	$152.61	$152.61	$12.15	$29.84	$246.31	$248.80	$16.78	$19.09	$16.78	$16.82	$11.57	$11.57	$11.77	$11.57	$0.00	$0.00	$0.00	$0.00
30000083	EAP	CPT® 84030		"Phenylalanine (pku), Blood"	BOTH IP/OP	$48.00 	$35.52	$0.00	$38.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.36	$8.36	$8.68	$0.00	$8.13	$0.00	$0.00	$0.00	$0.00	$15.38	$38.02	$38.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000084	EAP	CPT® 84066		Prostatic Acid Phosphatase	BOTH IP/OP	$100.00 	$74.00	$4.83	$76.00	$19.93	$19.93	$9.66	$9.66	$4.83	$4.83	$14.66	$14.66	$15.23	$9.66	$14.27	$6.28	$59.15	$59.15	$10.14	$27.00	$75.24	$76.00	$14.01	$15.94	$14.01	$15.20	$9.66	$9.66	$10.64	$9.66	$0.00	$0.00	$0.00	$0.00
30000085	EAP	CPT® 84100		"Phosphorus, Serum"	BOTH IP/OP	$128.00 	$94.72	$2.37	$108.80	$9.79	$9.79	$4.74	$4.74	$2.37	$2.37	$7.21	$7.21	$7.48	$4.74	$7.01	$3.08	$75.71	$75.71	$4.98	$13.26	$107.71	$108.80	$6.87	$72.80	$6.87	$7.47	$4.74	$4.74	$5.23	$4.74	$0.00	$0.00	$0.00	$0.00
30000086	EAP	CPT® 84152		"Psa, Total Screening"	BOTH IP/OP	$237.00 	$175.38	$0.00	$189.60	$37.96	$37.96	$19.31	$19.31	$9.66	$9.20	$27.92	$27.92	$29.00	$19.31	$27.17	$12.55	$140.19	$140.19	$20.28	$51.40	$187.70	$189.60	$26.67	$154.05	$26.67	$0.00	$18.39	$18.39	$20.27	$19.31	$0.00	$0.00	$0.00	$0.00
30000087	EAP	CPT® 84163		Preg Assoc Plasma Protein	BOTH IP/OP	$96.00 	$71.04	$7.07	$75.20	$13.25	$13.25	$15.05	$15.05	$7.53	$7.53	$9.74	$9.74	$10.12	$15.05	$9.48	$9.78	$56.78	$56.78	$15.80	$17.94	$74.45	$75.20	$21.82	$24.83	$21.82	$10.10	$15.05	$15.05	$7.07	$15.05	$0.00	$0.00	$0.00	$0.00
30000089	EAP	CPT® 84702		D-HCG FREE & INTACT	BOTH IP/OP	$419.00 	$310.06	$7.07	$304.80	$13.25	$13.25	$15.05	$15.05	$7.53	$7.53	$9.74	$9.74	$10.12	$15.05	$9.48	$9.78	$247.84	$247.84	$15.80	$17.94	$301.75	$304.80	$21.82	$215.80	$21.82	$10.10	$15.05	$15.05	$7.07	$15.05	$0.00	$0.00	$0.00	$0.00
30000090	EAP	CPT® 85461		Fetal Screen Rhig	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.08	$10.08	$10.47	$0.00	$9.79	$0.00	$0.00	$0.00	$0.00	$18.52	$118.80	$120.00	$0.00	$97.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000091	EAP	CPT® 85557		"Osmotic Fragility,erythrocytes"	BOTH IP/OP	$264.00 	$195.36	$0.00	$264.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.28	$20.28	$21.06	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$37.32	$209.09	$211.20	$0.00	$264.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000092	EAP	CPT® 85660		Donor Hgb S (arc)	BOTH IP/OP	$201.00 	$148.74	$2.75	$146.40	$11.38	$11.38	$5.51	$5.51	$2.76	$2.75	$8.38	$8.38	$8.70	$5.51	$8.15	$3.58	$118.89	$118.89	$5.79	$15.42	$144.94	$146.40	$7.99	$9.09	$7.99	$8.68	$5.51	$5.51	$6.08	$5.51	$0.00	$0.00	$0.00	$0.00
30000093	EAP	CPT® 86003		Epicoccum Purpurascn	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30000095	EAP	CPT® 86022		Platelet Ab Screen (arc)	BOTH IP/OP	$457.00 	$338.18	$0.00	$336.00	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$270.32	$270.32	$0.00	$51.32	$332.64	$336.00	$0.00	$30.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000096	EAP	CPT® 86147		Antiphospholipid Igg	BOTH IP/OP	$581.00 	$429.94	$12.73	$580.80	$52.54	$52.54	$25.45	$25.45	$12.73	$12.73	$38.63	$38.63	$40.11	$25.45	$37.58	$16.54	$343.66	$343.66	$26.72	$71.08	$574.99	$580.80	$36.90	$41.99	$36.90	$40.04	$25.45	$25.45	$28.03	$25.45	$0.00	$0.00	$0.00	$0.00
30000097	EAP	CPT® 86147		Antiphospholipid Igm	BOTH IP/OP	$581.00 	$429.94	$12.73	$580.80	$52.54	$52.54	$25.45	$25.45	$12.73	$12.73	$38.63	$38.63	$40.11	$25.45	$37.58	$16.54	$343.66	$343.66	$26.72	$71.08	$574.99	$580.80	$36.90	$41.99	$36.90	$40.04	$25.45	$25.45	$28.03	$25.45	$0.00	$0.00	$0.00	$0.00
30000098	EAP	CPT® 86235		Antihistone Ab	BOTH IP/OP	$344.00 	$254.56	$8.97	$265.60	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$203.48	$203.48	$18.83	$50.12	$262.94	$265.60	$26.00	$223.60	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30000099	EAP	CPT® 86255		Murine Typhus Igg	BOTH IP/OP	$59.00 	$43.66	$6.03	$47.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$34.90	$34.90	$12.65	$33.68	$46.73	$47.20	$17.47	$38.35	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30000100	EAP	CPT® 86331		Pigeon Serum	BOTH IP/OP	$38.00 	$28.12	$0.00	$33.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.20	$18.20	$18.90	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.50	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000101	EAP	CPT® 86331		T. Candidus	BOTH IP/OP	$38.00 	$28.12	$0.00	$33.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.20	$18.20	$18.90	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.50	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000102	EAP	CPT® 86331		T.vulgaris	BOTH IP/OP	$38.00 	$28.12	$0.00	$33.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.20	$18.20	$18.90	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.50	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000103	EAP	CPT® 86331		S. Viridis	BOTH IP/OP	$38.00 	$28.12	$0.00	$33.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.20	$18.20	$18.90	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.50	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000104	EAP	CPT® 86355		"Cd19,total B %"	BOTH IP/OP	$210.00 	$155.40	$0.00	$174.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$172.66	$174.40	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30000105	EAP	CPT® 86357		"Natural Killer (nk)cells,total"	BOTH IP/OP	$210.00 	$155.40	$0.00	$174.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$172.66	$174.40	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30000106	EAP	CPT® 86357		"Cd56+16,nk%"	BOTH IP/OP	$210.00 	$155.40	$0.00	$174.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$172.66	$174.40	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30000107	EAP	CPT® 86485		Candida Skin Test	BOTH IP/OP	$262.00 	$193.88	$0.00	$211.20	$29.73	$29.73	$24.06	$24.06	$24.19	$54.61	$13.03	$13.03	$13.53	$23.64	$18.61	$15.37	$154.97	$154.97	$23.06	$132.00	$209.09	$211.20	$32.04	$170.30	$32.04	$19.83	$0.00	$0.00	$13.88	$21.96	$0.00	$0.00	$0.00	$0.00
30000108	EAP	CPT® 86603		Adenovirus Ab	BOTH IP/OP	$64.00 	$47.36	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.54	$19.54	$20.29	$0.00	$19.01	$0.00	$0.00	$0.00	$13.51	$35.96	$51.48	$52.00	$18.66	$41.60	$18.66	$0.00	$12.87	$12.87	$14.18	$12.87	$0.00	$0.00	$0.00	$0.00
30000109	EAP	CPT® 86612		Blastomyces Ab	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.59	$19.59	$20.35	$0.00	$19.07	$0.00	$0.00	$0.00	$0.00	$36.06	$79.20	$80.00	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000110	EAP	CPT® 86635		Coccidiodes Ab	BOTH IP/OP	$155.00 	$114.70	$0.00	$112.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.42	$17.42	$18.09	$0.00	$16.95	$0.00	$0.00	$0.00	$0.00	$32.06	$111.67	$112.80	$0.00	$100.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000113	EAP	CPT® 86710		Influenza A Ab	BOTH IP/OP	$134.00 	$99.16	$0.00	$108.00	$27.98	$27.98	$13.55	$13.55	$6.78	$6.78	$20.59	$20.59	$21.38	$13.55	$20.03	$8.81	$79.26	$79.26	$0.00	$37.88	$106.92	$108.00	$0.00	$87.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000114	EAP	CPT® 86710		Influenza B Ab	BOTH IP/OP	$134.00 	$99.16	$0.00	$108.00	$27.98	$27.98	$13.55	$13.55	$6.78	$6.78	$20.59	$20.59	$21.38	$13.55	$20.03	$8.81	$79.26	$79.26	$0.00	$37.88	$106.92	$108.00	$0.00	$87.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000115	EAP	CPT® 86710		Parainfluenza-1 Ab	BOTH IP/OP	$133.00 	$98.42	$0.00	$108.00	$27.98	$27.98	$13.55	$13.55	$6.78	$6.78	$20.59	$20.59	$21.38	$13.55	$20.03	$8.81	$78.67	$78.67	$0.00	$37.88	$106.92	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000116	EAP	CPT® 86710		Parainfluenza-2 Ab	BOTH IP/OP	$133.00 	$98.42	$0.00	$108.00	$27.98	$27.98	$13.55	$13.55	$6.78	$6.78	$20.59	$20.59	$21.38	$13.55	$20.03	$8.81	$78.67	$78.67	$0.00	$37.88	$106.92	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000117	EAP	CPT® 86710		Parainfluenza-3 Ab	BOTH IP/OP	$133.00 	$98.42	$0.00	$108.00	$27.98	$27.98	$13.55	$13.55	$6.78	$6.78	$20.59	$20.59	$21.38	$13.55	$20.03	$8.81	$78.67	$78.67	$0.00	$37.88	$106.92	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000118	EAP	CPT® 86735		Mumps Igm	BOTH IP/OP	$130.00 	$96.20	$6.53	$104.80	$26.93	$26.93	$13.05	$13.05	$6.53	$6.53	$19.82	$19.82	$20.58	$13.05	$19.28	$8.48	$76.90	$76.90	$13.70	$36.46	$103.75	$104.80	$18.92	$84.50	$18.92	$20.54	$13.05	$13.05	$14.38	$13.05	$0.00	$0.00	$0.00	$0.00
30000119	EAP	CPT® 86735		Mumps Igg	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$26.93	$26.93	$13.05	$13.05	$6.53	$6.53	$19.82	$19.82	$20.58	$13.05	$19.28	$8.48	$77.49	$77.49	$13.70	$36.46	$103.75	$104.80	$18.92	$0.00	$18.92	$20.54	$13.05	$13.05	$14.38	$13.05	$0.00	$0.00	$0.00	$0.00
30000120	EAP	CPT® 86744		Micropolyspora Faeni	BOTH IP/OP	$40.00 	$29.60	$0.00	$36.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000121	EAP	CPT® 86756		Rsv Ab	BOTH IP/OP	$186.00 	$137.64	$0.00	$148.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.57	$19.57	$20.33	$0.00	$19.05	$0.00	$0.00	$0.00	$0.00	$36.02	$147.31	$148.80	$0.00	$120.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000124	EAP	CPT® 86850		Antibody Screen (arc)	BOTH IP/OP	$366.00 	$270.84	$4.40	$267.20	$7.89	$7.89	$48.39	$48.39	$48.66	$4.40	$16.59	$16.59	$17.23	$47.69	$17.89	$31.00	$216.49	$216.49	$49.62	$37.22	$264.53	$267.20	$68.93	$237.90	$68.93	$19.06	$9.77	$9.77	$13.35	$47.25	$0.00	$0.00	$0.00	$0.00
30000126	EAP	CPT® 86850		Antibody Screen	BOTH IP/OP	$366.00 	$270.84	$4.40	$267.20	$7.89	$7.89	$48.39	$48.39	$48.66	$4.40	$16.59	$16.59	$17.23	$47.69	$17.89	$31.00	$216.49	$216.49	$49.62	$37.22	$264.53	$267.20	$68.93	$237.90	$68.93	$19.06	$9.77	$9.77	$13.35	$47.25	$0.00	$0.00	$0.00	$0.00
30000128	EAP	CPT® 86860		Rbc Elution (arc)	BOTH IP/OP	$563.00 	$416.62	$0.00	$411.20	$47.04	$47.04	$145.24	$145.24	$146.06	$117.34	$19.75	$19.75	$20.51	$142.96	$7.19	$92.92	$333.01	$333.01	$143.92	$44.66	$407.09	$411.20	$199.96	$336.70	$199.96	$7.66	$0.00	$0.00	$5.36	$137.07	$0.00	$0.00	$0.00	$0.00
30000129	EAP	CPT® 86860		Rbc Elution	BOTH IP/OP	$563.00 	$416.62	$0.00	$411.20	$47.04	$47.04	$145.24	$145.24	$146.06	$117.34	$19.75	$19.75	$20.51	$142.96	$7.19	$92.92	$333.01	$333.01	$143.92	$44.66	$407.09	$411.20	$199.96	$336.70	$199.96	$7.66	$0.00	$0.00	$5.36	$137.07	$0.00	$0.00	$0.00	$0.00
30000130	EAP	CPT® 86870		Antibody Id	BOTH IP/OP	$634.00 	$469.16	$0.00	$463.20	$64.34	$64.34	$283.63	$283.63	$285.22	$132.14	$30.41	$30.41	$31.58	$279.15	$7.19	$181.45	$375.01	$375.01	$284.24	$69.46	$458.57	$463.20	$394.92	$412.10	$394.92	$7.66	$0.00	$0.00	$5.36	$270.71	$0.00	$0.00	$0.00	$0.00
30000131	EAP	CPT® 86870		Antibody Id (arc)	BOTH IP/OP	$634.00 	$469.16	$0.00	$463.20	$64.34	$64.34	$283.63	$283.63	$285.22	$132.14	$30.41	$30.41	$31.58	$279.15	$7.19	$181.45	$375.01	$375.01	$284.24	$69.46	$458.57	$463.20	$394.92	$412.10	$394.92	$7.66	$0.00	$0.00	$5.36	$270.71	$0.00	$0.00	$0.00	$0.00
30000136	EAP	CPT® 86880		Direct Coombs (arc)	BOTH IP/OP	$140.00 	$103.60	$2.70	$112.80	$11.11	$11.11	$54.21	$54.21	$54.51	$2.70	$8.15	$8.15	$8.47	$53.35	$7.93	$34.67	$82.81	$82.81	$33.53	$15.00	$111.67	$112.80	$46.58	$91.00	$46.58	$8.45	$5.39	$5.39	$5.91	$31.93	$0.00	$0.00	$0.00	$0.00
30000146	EAP	CPT® 86900		"Blood Typing, Serologic, Abo (arc)"	BOTH IP/OP	$165.00 	$122.10	$1.49	$150.00	$6.18	$6.18	$109.81	$109.81	$110.43	$1.49	$4.52	$4.52	$4.70	$107.30	$4.41	$69.74	$97.60	$97.60	$109.35	$8.34	$118.80	$120.00	$150.00	$107.25	$150.00	$4.70	$2.99	$2.99	$3.29	$104.14	$0.00	$0.00	$0.00	$0.00
30000149	EAP	CPT® 86901		"Blood Typing, Serologic, Rh (d) (arc)"	BOTH IP/OP	$165.00 	$122.10	$1.49	$120.00	$6.18	$6.18	$32.96	$32.96	$33.15	$1.49	$4.52	$4.52	$4.70	$32.43	$17.04	$21.08	$97.60	$97.60	$33.53	$8.34	$118.80	$120.00	$46.58	$88.40	$46.58	$18.16	$2.99	$2.99	$12.71	$31.93	$0.00	$0.00	$0.00	$0.00
30000153	EAP	CPT® 86902		Blood Type Ag Donor Ea	BOTH IP/OP	$828.00 	$612.72	$2.86	$604.80	$7.89	$7.89	$283.63	$283.63	$285.22	$2.86	$5.60	$5.60	$5.81	$279.15	$5.05	$181.45	$489.76	$489.76	$284.24	$378.00	$598.75	$604.80	$394.92	$494.00	$394.92	$5.38	$6.35	$6.35	$3.77	$270.71	$0.00	$0.00	$0.00	$0.00
30000154	EAP	CPT® 86902		Blood Type Ag Donor Ea (arc)	BOTH IP/OP	$828.00 	$612.72	$2.86	$604.80	$7.89	$7.89	$283.63	$283.63	$285.22	$2.86	$5.60	$5.60	$5.81	$279.15	$5.05	$181.45	$489.76	$489.76	$284.24	$378.00	$598.75	$604.80	$394.92	$538.20	$394.92	$5.38	$6.35	$6.35	$3.77	$270.71	$0.00	$0.00	$0.00	$0.00
30000155	EAP	CPT® 86904		Ag Screen Pt Serum Ea Unit (arc)	BOTH IP/OP	"$2,572.00 "	"$1,903.28"	$0.00	$167.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.44	$14.44	$14.99	$0.00	$14.04	$0.00	$0.00	$0.00	$0.00	$26.56	$115.63	$116.80	$0.00	$167.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000160	EAP	CPT® 86905		Patient Ag Typing (arc)	BOTH IP/OP	$353.00 	$261.22	$1.91	$322.00	$7.89	$7.89	$283.63	$283.63	$285.22	$1.91	$5.80	$5.80	$6.03	$279.15	$5.65	$181.45	$208.80	$208.80	$284.24	$10.68	$255.02	$257.60	$322.00	$229.45	$322.00	$6.02	$3.83	$3.83	$4.21	$270.71	$0.00	$0.00	$0.00	$0.00
30000161	EAP	CPT® 86905		Patient Ag Typing	BOTH IP/OP	$353.00 	$261.22	$1.91	$322.00	$7.89	$7.89	$283.63	$283.63	$285.22	$1.91	$5.80	$5.80	$6.03	$279.15	$5.65	$181.45	$208.80	$208.80	$284.24	$10.68	$255.02	$257.60	$322.00	$229.45	$322.00	$6.02	$3.83	$3.83	$4.21	$270.71	$0.00	$0.00	$0.00	$0.00
30000179	EAP	CPT® 86906		Rh Phenotype (arc)	BOTH IP/OP	$786.00 	$581.64	$0.00	$572.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.76	$11.76	$12.21	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$21.66	$566.28	$572.00	$0.00	$405.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000180	EAP	CPT® 86920		Crossmatch Is Ea Unit	BOTH IP/OP	$314.00 	$232.36	$0.00	$228.80	$51.90	$51.90	$145.24	$145.24	$146.06	$65.45	$27.25	$27.25	$28.30	$142.96	$65.44	$92.92	$185.73	$185.73	$143.92	$62.02	$226.51	$228.80	$199.96	$204.10	$199.96	$44.76	$0.00	$0.00	$45.53	$137.07	$0.00	$0.00	$0.00	$0.00
30000182	EAP	CPT® 86920		COMPATIBILITY EA- MT	BOTH IP/OP	$263.00 	$194.62	$0.00	$228.80	$51.90	$51.90	$145.24	$145.24	$146.06	$54.82	$27.25	$27.25	$28.30	$142.96	$54.81	$92.92	$155.56	$155.56	$143.92	$62.02	$226.51	$228.80	$199.96	$0.00	$199.96	$44.76	$0.00	$0.00	$45.53	$137.07	$0.00	$0.00	$0.00	$0.00
30000185	EAP	CPT® 86921		Crossmatch Incub Ea Unit	BOTH IP/OP	$502.00 	$371.48	$0.00	$365.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.12	$22.12	$22.97	$0.00	$104.62	$0.00	$0.00	$0.00	$143.92	$50.44	$361.94	$365.60	$199.96	$295.75	$199.96	$71.52	$0.00	$0.00	$72.75	$137.07	$0.00	$0.00	$0.00	$0.00
30000187	EAP	CPT® 86921		Platelet Crossmatch (arc)	BOTH IP/OP	$502.00 	$371.48	$0.00	$365.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.12	$22.12	$22.97	$0.00	$104.62	$0.00	$0.00	$0.00	$143.92	$50.44	$361.94	$365.60	$199.96	$295.75	$199.96	$71.52	$0.00	$0.00	$72.75	$137.07	$0.00	$0.00	$0.00	$0.00
30000190	EAP	CPT® 86922		Crossmatch Ahg (arc)	BOTH IP/OP	$528.00 	$390.72	$0.00	$384.00	$55.68	$55.68	$145.24	$145.24	$146.06	$110.05	$24.89	$24.89	$25.84	$142.96	$110.04	$92.92	$312.31	$312.31	$143.92	$56.24	$380.16	$384.00	$199.96	$308.75	$199.96	$75.12	$0.00	$0.00	$76.42	$137.07	$0.00	$0.00	$0.00	$0.00
30000191	EAP	CPT® 86922		Crossmatch Ahg	BOTH IP/OP	$528.00 	$390.72	$0.00	$384.00	$55.68	$55.68	$145.24	$145.24	$146.06	$110.05	$24.89	$24.89	$25.84	$142.96	$110.04	$92.92	$312.31	$312.31	$143.92	$56.24	$380.16	$384.00	$199.96	$343.20	$199.96	$75.12	$0.00	$0.00	$76.42	$137.07	$0.00	$0.00	$0.00	$0.00
30000192	EAP	CPT® 86923		Crossmatch Electronic	BOTH IP/OP	$463.00 	$342.62	$0.00	$336.80	$41.63	$41.63	$145.24	$145.24	$146.06	$96.50	$19.75	$19.75	$20.51	$142.96	$96.49	$92.92	$273.86	$273.86	$143.92	$44.66	$333.43	$336.80	$199.96	$300.95	$199.96	$65.89	$0.00	$0.00	$67.02	$137.07	$0.00	$0.00	$0.00	$0.00
30000195	EAP	CPT® 86940		Hemolysins/agglutinins Auto Ea (arc)	BOTH IP/OP	$139.00 	$102.86	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.45	$12.45	$12.93	$0.00	$12.11	$0.00	$0.00	$0.00	$0.00	$22.92	$120.38	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000196	EAP	CPT® 86941		Hemolysins/agglutinins Incubated (arc)	BOTH IP/OP	$139.00 	$102.86	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.39	$18.39	$19.09	$0.00	$17.89	$0.00	$0.00	$0.00	$0.00	$33.84	$120.38	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000198	EAP	CPT® 86970		Rbc Pretx Chem (arc)	BOTH IP/OP	$810.00 	$599.40	$0.00	$592.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.59	$16.59	$17.23	$0.00	$168.80	$0.00	$0.00	$0.00	$0.00	$37.22	$586.08	$592.00	$0.00	$193.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000199	EAP	CPT® 86971		Rbc Pretx Enz (arc)	BOTH IP/OP	$383.00 	$283.42	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.59	$16.59	$17.23	$0.00	$79.82	$0.00	$0.00	$0.00	$0.00	$37.22	$277.20	$280.00	$0.00	$248.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000200	EAP	CPT® 86972		Rbc Pretx Dens Grad (arc)	BOTH IP/OP	$827.00 	$611.98	$0.00	$710.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.47	$26.47	$27.49	$0.00	$172.35	$0.00	$0.00	$0.00	$0.00	$60.36	$703.30	$710.40	$0.00	$285.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000201	EAP	CPT® 86975		Rbc Pretx Drug (arc)	BOTH IP/OP	$810.00 	$599.40	$0.00	$592.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.12	$22.12	$22.97	$0.00	$168.80	$0.00	$0.00	$0.00	$0.00	$50.44	$586.08	$592.00	$0.00	$215.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000202	EAP	CPT® 86976		"Rbc Dilution Of Serum, Per Aliquot (arc)"	BOTH IP/OP	$264.00 	$195.36	$0.00	$107.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.89	$24.89	$25.84	$0.00	$55.02	$0.00	$0.00	$0.00	$0.00	$56.24	$57.82	$58.40	$0.00	$107.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000203	EAP	CPT® 86977		"Rbc Incubation With Inhibitors, Per Aliquot (arc)"	BOTH IP/OP	$751.00 	$555.74	$0.00	$261.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.12	$22.12	$22.97	$0.00	$156.51	$0.00	$0.00	$0.00	$0.00	$50.44	$157.61	$159.20	$0.00	$261.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000204	EAP	CPT® 86978		Rbc Pretx Ab Id Diff Ea Absorp (arc)	BOTH IP/OP	$640.00 	$473.60	$0.00	$467.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.12	$22.12	$22.97	$0.00	$133.38	$0.00	$0.00	$0.00	$0.00	$50.44	$462.53	$467.20	$0.00	$259.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000205	EAP	CPT® 86985		Aliquot Blood Products Ea	BOTH IP/OP	$376.00 	$278.24	$0.00	$304.00	$38.39	$38.39	$145.24	$145.24	$146.06	$78.37	$16.59	$16.59	$17.23	$142.96	$78.36	$92.92	$222.40	$222.40	$143.92	$37.22	$300.96	$304.00	$199.96	$244.40	$199.96	$0.00	$0.00	$0.00	$60.50	$137.07	$0.00	$0.00	$0.00	$0.00
30000208	EAP	CPT® 87015		Concentration	BOTH IP/OP	$132.00 	$97.68	$3.34	$96.00	$13.78	$13.78	$6.68	$6.68	$3.34	$3.34	$10.14	$10.14	$10.53	$6.68	$9.87	$4.34	$78.08	$78.08	$7.01	$18.66	$95.04	$96.00	$9.69	$11.02	$9.69	$10.52	$6.68	$6.68	$7.36	$6.68	$0.00	$0.00	$0.00	$0.00
30000209	EAP	CPT® 87046		"Stool Cult, Aerobic-campy"	BOTH IP/OP	$143.00 	$105.82	$2.60	$115.20	$19.48	$19.48	$9.44	$9.44	$4.72	$4.72	$14.32	$14.32	$14.87	$9.44	$3.49	$6.14	$84.58	$84.58	$9.91	$26.36	$114.05	$115.20	$13.69	$15.58	$13.69	$3.71	$9.44	$9.44	$2.60	$9.44	$0.00	$0.00	$0.00	$0.00
30000210	EAP	CPT® 87046		"Stool, Cult, Aerobic-yersinnia"	BOTH IP/OP	$143.00 	$105.82	$2.60	$115.20	$19.48	$19.48	$9.44	$9.44	$4.72	$4.72	$14.32	$14.32	$14.87	$9.44	$3.49	$6.14	$84.58	$84.58	$9.91	$26.36	$114.05	$115.20	$13.69	$15.58	$13.69	$3.71	$9.44	$9.44	$2.60	$9.44	$0.00	$0.00	$0.00	$0.00
30000211	EAP	CPT® 87176		"Homogenization, Tissue"	BOTH IP/OP	$101.00 	$74.74	$2.94	$73.60	$12.14	$12.14	$5.88	$5.88	$2.94	$2.94	$8.93	$8.93	$9.28	$5.88	$8.69	$3.82	$59.74	$59.74	$6.17	$16.44	$72.86	$73.60	$8.53	$9.70	$8.53	$9.26	$5.88	$5.88	$6.48	$5.88	$0.00	$0.00	$0.00	$0.00
30000212	EAP	CPT® 87177		Wet Prep	BOTH IP/OP	$112.00 	$82.88	$4.45	$87.20	$18.37	$18.37	$8.90	$8.90	$4.45	$4.45	$13.51	$13.51	$14.03	$8.90	$13.15	$5.79	$66.25	$66.25	$9.35	$24.86	$86.33	$87.20	$12.91	$72.80	$12.91	$14.01	$8.90	$8.90	$9.81	$8.90	$0.00	$0.00	$0.00	$0.00
30000213	EAP	CPT® 87220		Skin Prep: 10% Koh	BOTH IP/OP	$198.00 	$146.52	$2.14	$147.20	$8.82	$8.82	$4.27	$4.27	$2.14	$2.14	$6.48	$6.48	$6.73	$4.27	$6.30	$2.78	$117.12	$117.12	$4.48	$11.92	$145.73	$147.20	$6.19	$128.70	$6.19	$6.71	$4.27	$4.27	$4.70	$4.27	$0.00	$0.00	$0.00	$0.00
30000214	EAP	CPT® 87250		Herpes Viral Culture	BOTH IP/OP	$367.00 	$271.58	$9.78	$296.00	$40.37	$40.37	$19.56	$19.56	$9.78	$9.78	$29.69	$29.69	$30.83	$19.56	$28.89	$12.71	$217.08	$217.08	$20.54	$54.64	$293.04	$296.00	$28.36	$32.27	$28.36	$30.78	$19.56	$19.56	$21.54	$19.56	$0.00	$0.00	$0.00	$0.00
30000215	EAP	CPT® 87497		"Cytomegalovirus, Dna"	BOTH IP/OP	"$1,040.00 "	$769.60	$21.42	$807.20	$88.41	$88.41	$42.84	$42.84	$21.42	$21.42	$65.04	$65.04	$67.54	$42.84	$63.28	$27.85	$615.16	$615.16	$44.98	$119.70	$799.13	$807.20	$62.12	$676.00	$62.12	$67.43	$42.84	$42.84	$47.20	$42.84	$0.00	$0.00	$0.00	$0.00
30000217	EAP	CPT® 87536		Hiv /rna Pcr Quant	BOTH IP/OP	$842.00 	$623.08	$42.55	$653.60	$107.10	$107.10	$85.10	$85.10	$42.55	$42.55	$78.80	$78.80	$81.83	$85.10	$66.37	$55.32	$498.04	$498.04	$89.36	$145.02	$647.06	$653.60	$123.40	$140.42	$123.40	$70.72	$85.10	$85.10	$49.50	$85.10	$0.00	$0.00	$0.00	$0.00
30000218	EAP	CPT® 87536		"Hiv-1 Rna Ultra, Qnt"	BOTH IP/OP	$790.00 	$584.60	$0.00	$653.60	$107.10	$107.10	$85.10	$85.10	$42.55	$42.55	$78.80	$78.80	$81.83	$85.10	$66.37	$55.32	$467.29	$467.29	$89.36	$145.02	$647.06	$653.60	$123.40	$0.00	$123.40	$70.72	$85.10	$85.10	$49.50	$85.10	$0.00	$0.00	$0.00	$0.00
30000220	EAP	CPT® 87798		"Ebv Dna-pcr, Qual"	BOTH IP/OP	$900.00 	$666.00	$17.55	$725.60	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$532.35	$532.35	$36.84	$54.82	$718.34	$725.60	$50.88	$410.80	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30000221	EAP	CPT® 89050		Csf Exam-hematology	BOTH IP/OP	$227.00 	$167.98	$2.36	$171.20	$9.74	$9.74	$4.72	$4.72	$2.36	$2.36	$7.18	$7.18	$7.45	$4.72	$6.99	$3.07	$134.27	$134.27	$4.96	$13.22	$169.49	$171.20	$6.84	$147.55	$6.84	$7.45	$4.72	$4.72	$5.22	$4.72	$0.00	$0.00	$0.00	$0.00
30000222	EAP	CPT® 89050		Fluid Exam-heme	BOTH IP/OP	$227.00 	$167.98	$2.36	$171.20	$9.74	$9.74	$4.72	$4.72	$2.36	$2.36	$7.18	$7.18	$7.45	$4.72	$6.99	$3.07	$134.27	$134.27	$4.96	$13.22	$169.49	$171.20	$6.84	$147.55	$6.84	$7.45	$4.72	$4.72	$5.22	$4.72	$0.00	$0.00	$0.00	$0.00
30000223	EAP	CPT® 89060		Synovial Fluid Crystal Id	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$14.76	$14.76	$7.33	$7.33	$3.67	$3.58	$10.86	$10.86	$11.28	$7.33	$10.56	$4.76	$88.73	$88.73	$7.70	$19.98	$118.80	$120.00	$10.63	$0.00	$10.63	$11.26	$7.33	$7.33	$7.88	$7.33	$0.00	$0.00	$0.00	$0.00
30000225	EAP	CPT® 87081		"Pertussis,state Lab"	BOTH IP/OP	$631.00 	$466.94	$3.31	$463.20	$13.68	$13.68	$6.63	$6.63	$3.32	$3.31	$10.08	$10.08	$10.47	$6.63	$9.79	$4.31	$373.24	$373.24	$6.96	$18.52	$458.57	$463.20	$9.61	$10.94	$9.61	$10.43	$6.63	$6.63	$7.30	$6.63	$0.00	$0.00	$0.00	$0.00
30000228	EAP	CPT® 88275		"Fish,aml, Aml1/eto,translocation8,21,probe"	BOTH IP/OP	$435.00 	$321.90	$23.04	$345.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$257.30	$257.30	$53.75	$112.22	$342.14	$345.60	$74.23	$282.75	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000229	EAP	CPT® 88271		"Fish,aml, Aml1/eto,translocation8,21,100-300 Cells"	BOTH IP/OP	$435.00 	$321.90	$10.71	$345.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$257.30	$257.30	$22.49	$59.86	$342.14	$345.60	$31.06	$282.75	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000230	EAP	CPT® 88275		"Fish,mll,11g23,gene Rearrang,probe"	BOTH IP/OP	$397.00 	$293.78	$23.04	$315.20	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$234.83	$234.83	$53.75	$112.22	$312.05	$315.20	$74.23	$258.05	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000231	EAP	CPT® 88271		"Fish,mll,11g23,gene Rearrang,100-300 Cells"	BOTH IP/OP	$397.00 	$293.78	$10.71	$315.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$234.83	$234.83	$22.49	$59.86	$312.05	$315.20	$31.06	$258.05	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000232	EAP	CPT® 88235		"Sc Anemia,dna Probe,fetus"	BOTH IP/OP	$258.00 	$190.92	$0.00	$261.00	$258.00	$258.00	$150.30	$150.30	$75.15	$0.00	$223.60	$223.60	$232.20	$0.00	$217.53	$0.00	$0.00	$0.00	$157.82	$261.00	$206.71	$208.80	$217.94	$167.70	$217.94	$231.78	$150.30	$150.30	$162.25	$150.30	$0.00	$0.00	$0.00	$0.00
30000234	EAP	HCPCS 88271		"Fish,dup 22q11.2, Probe"	BOTH IP/OP	$330.00 	$244.20	$10.71	$262.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$195.20	$195.20	$22.49	$59.86	$259.78	$262.40	$31.06	$214.50	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000235	EAP	CPT® 88271		"Fish,dup 22q11.2, 100-300 Cells"	BOTH IP/OP	$364.00 	$269.36	$10.71	$289.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$215.31	$215.31	$22.49	$59.86	$286.70	$289.60	$31.06	$236.60	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000236	EAP	CPT® 84432		Thyroglobulin Panel	BOTH IP/OP	$68.00 	$50.32	$8.03	$54.40	$33.16	$33.16	$16.06	$16.06	$8.03	$8.03	$24.39	$24.39	$25.33	$16.06	$23.73	$10.44	$40.22	$40.22	$16.86	$44.88	$53.86	$54.40	$23.29	$44.20	$23.29	$25.28	$16.06	$16.06	$17.70	$16.06	$0.00	$0.00	$0.00	$0.00
30000237	EAP	CPT® 86800		"Thyroglobulin Panel, Antibody"	BOTH IP/OP	$69.00 	$51.06	$7.95	$55.20	$32.84	$32.84	$15.91	$15.91	$7.96	$7.95	$24.15	$24.15	$25.08	$15.91	$23.50	$10.34	$40.81	$40.81	$16.71	$44.44	$54.65	$55.20	$23.07	$44.85	$23.07	$25.04	$15.91	$15.91	$17.53	$15.91	$0.00	$0.00	$0.00	$0.00
30000240	EAP	CPT® 83520		"Vasc Endothelial Gf,elisa"	BOTH IP/OP	$593.00 	$438.82	$7.77	$461.60	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$350.76	$350.76	$18.13	$36.18	$456.98	$461.60	$25.04	$204.75	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30000241	EAP	CPT® 83605		Poct Lactate Venous (meter)	BOTH IP/OP	$239.00 	$176.86	$5.34	$174.40	$22.04	$22.04	$11.57	$11.57	$5.79	$5.34	$16.21	$16.21	$16.84	$11.57	$15.78	$7.52	$141.37	$141.37	$12.15	$29.84	$172.66	$174.40	$16.78	$155.35	$16.78	$16.82	$11.57	$11.57	$11.77	$11.57	$0.00	$0.00	$0.00	$0.00
30000242	EAP	CPT® 84484		Poct Troponin Venous (meter)	BOTH IP/OP	$283.00 	$209.42	$5.61	$228.80	$20.33	$20.33	$12.47	$12.47	$6.24	$5.61	$14.94	$14.94	$15.52	$12.47	$14.54	$8.11	$167.39	$167.39	$13.09	$27.50	$226.51	$228.80	$18.08	$183.95	$18.08	$15.50	$12.47	$12.47	$10.85	$12.47	$0.00	$0.00	$0.00	$0.00
30000251	EAP	CPT® 86828		Hla I/ii Ab Scr Plt Trans (arc)	BOTH IP/OP	$587.00 	$434.38	$0.00	$474.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.46	$57.46	$59.67	$0.00	$122.33	$0.00	$0.00	$0.00	$0.00	$296.50	$469.66	$474.40	$0.00	$381.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000300	EAP	CPT® 80358		Methadone - Urine	BOTH IP/OP	$375.00 	$277.50	$0.00	$289.05	$0.03	$0.03	$0.00	$0.00	$12.01	$10.03	$278.33	$278.33	$289.05	$0.00	$24.12	$0.00	$221.81	$221.81	$0.00	$170.50	$270.07	$272.80	$0.00	$203.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000302	EAP	CPT® 86885		Abid Ea Selected Cell	BOTH IP/OP	$168.00 	$124.32	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.68	$8.68	$9.02	$0.00	$8.44	$0.00	$0.00	$0.00	$143.92	$15.98	$134.64	$136.00	$170.00	$109.20	$170.00	$9.00	$5.72	$5.72	$6.30	$137.07	$0.00	$0.00	$0.00	$0.00
30000411	EAP	CPT® 86927		Ffp Thawing Ea Unit	BOTH IP/OP	$318.00 	$235.32	$0.00	$231.20	$0.00	$0.00	$0.00	$0.00	$0.00	$66.28	$10.66	$10.66	$11.07	$142.96	$66.27	$92.92	$188.10	$188.10	$143.92	$24.80	$228.89	$231.20	$199.96	$206.70	$199.96	$45.23	$0.00	$0.00	$46.01	$137.07	$0.00	$0.00	$0.00	$0.00
30000412	EAP	CPT® 84702		D-hcg Free & Intact	BOTH IP/OP	$214.00 	$158.36	$0.00	$174.40	$13.25	$13.25	$15.05	$15.05	$7.53	$7.53	$9.74	$9.74	$10.12	$15.05	$9.48	$9.78	$126.58	$126.58	$15.80	$17.94	$172.66	$174.40	$21.82	$0.00	$21.82	$10.10	$15.05	$15.05	$7.07	$15.05	$0.00	$0.00	$0.00	$0.00
30000413	EAP	CPT® 86920		"Charge: Xmatch, Saline"	BOTH IP/OP	$263.00 	$194.62	$0.00	$228.80	$51.90	$51.90	$145.24	$145.24	$146.06	$54.82	$27.25	$27.25	$28.30	$142.96	$54.81	$92.92	$155.56	$155.56	$143.92	$62.02	$226.51	$228.80	$199.96	$0.00	$199.96	$44.76	$0.00	$0.00	$45.53	$137.07	$0.00	$0.00	$0.00	$0.00
30000420	EAP	CPT® 36415		Venipuncture	BOTH IP/OP	$43.00 	$31.82	$1.35	$34.40	$23.35	$23.35	$3.00	$3.00	$1.50	$1.35	$3.12	$3.12	$3.24	$3.00	$8.96	$1.95	$25.43	$25.43	$3.15	$21.50	$34.06	$34.40	$4.35	$27.95	$4.35	$6.73	$3.00	$3.00	$6.85	$3.00	$0.00	$0.00	$0.00	$0.00
30000425	EAP	CPT® 86923		Crossmatch - Mass Transfusion	BOTH IP/OP	$314.00 	$232.36	$0.00	$228.80	$41.63	$41.63	$145.24	$145.24	$146.06	$65.45	$19.75	$19.75	$20.51	$142.96	$65.44	$92.92	$185.73	$185.73	$143.92	$44.66	$226.51	$228.80	$199.96	$204.10	$199.96	$44.76	$0.00	$0.00	$45.53	$137.07	$0.00	$0.00	$0.00	$0.00
30000426	EAP	CPT® 86480		Quantiferon-tb Gold	BOTH IP/OP	$315.00 	$233.10	$30.99	$254.40	$127.93	$127.93	$61.98	$61.98	$30.99	$30.99	$94.11	$94.11	$97.73	$61.98	$91.55	$40.29	$186.32	$186.32	$65.08	$173.18	$251.86	$254.40	$89.87	$204.75	$89.87	$97.55	$61.98	$61.98	$68.28	$61.98	$0.00	$0.00	$0.00	$0.00
30000427	EAP	CPT® 86022		Serotonin Release Assay (sra) Unfractionated	BOTH IP/OP	$315.00 	$233.10	$0.00	$232.00	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$186.32	$186.32	$0.00	$51.32	$229.68	$232.00	$0.00	$204.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000428	EAP	CPT® 86022		Serotonin Release Assay (sra) Lmwh	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$171.54	$171.54	$0.00	$51.32	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000429	EAP	CPT® 81599		MATERNI T21™ PLUS	BOTH IP/OP	"$1,153.00 "	$853.22	$0.00	"$1,054.40"	$0.00	$0.00	$0.00	$0.00	$205.23	$240.31	$855.76	$855.76	$888.73	$0.00	$240.29	$0.00	$682.00	$682.00	$0.00	$659.00	"$1,043.86"	"$1,054.40"	$790.80	$0.00	$790.80	$0.00	$0.00	$0.00	$209.83	$0.00	$0.00	$0.00	$0.00	$0.00
30000502	EAP	CPT® 83516		Immunoassay Nonantibody	BOTH IP/OP	$68.00 	$50.32	$0.00	$61.60	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$40.22	$40.22	$12.11	$29.88	$60.98	$61.60	$16.72	$0.00	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30000503	EAP	CPT® 86235		Nuclear Antigen Antibody	BOTH IP/OP	$71.00 	$52.54	$0.00	$69.60	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$42.00	$42.00	$18.83	$50.12	$68.90	$69.60	$26.00	$0.00	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30000504	EAP	CPT® 86003		Allergen Specific Ige	BOTH IP/OP	$32.00 	$23.68	$0.00	$32.00	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$18.93	$18.93	$5.48	$14.60	$31.68	$32.00	$7.57	$0.00	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30000505	EAP	CPT® 86735		Mumps Antibody	BOTH IP/OP	$32.00 	$23.68	$6.53	$32.00	$26.93	$26.93	$13.05	$13.05	$6.53	$6.53	$19.82	$19.82	$20.58	$13.05	$19.28	$8.48	$18.93	$18.93	$13.70	$32.00	$25.34	$25.60	$18.92	$21.53	$18.92	$20.54	$13.05	$13.05	$14.38	$13.05	$0.00	$0.00	$0.00	$0.00
30000506	EAP	CPT® 86644		Cmv Antibody	BOTH IP/OP	$24.00 	$17.76	$0.00	$24.00	$24.00	$24.00	$14.39	$14.39	$7.20	$7.20	$17.67	$17.67	$18.35	$14.39	$17.19	$9.35	$14.20	$14.20	$15.11	$24.00	$19.01	$19.20	$20.87	$0.00	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30000507	EAP	CPT® 86710		Influenza Virus Antibody	BOTH IP/OP	$25.00 	$18.50	$0.00	$25.00	$25.00	$25.00	$13.55	$13.55	$6.78	$6.78	$20.59	$20.59	$21.38	$13.55	$20.03	$8.81	$14.79	$14.79	$0.00	$25.00	$19.80	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000508	EAP	CPT® 84702		Chorionic Gonadotropin Test	BOTH IP/OP	$162.00 	$119.88	$7.07	$117.60	$13.25	$13.25	$15.05	$15.05	$7.53	$7.53	$9.74	$9.74	$10.12	$15.05	$9.48	$9.78	$95.82	$95.82	$15.80	$17.94	$116.42	$117.60	$21.82	$24.83	$21.82	$10.10	$15.05	$15.05	$7.07	$15.05	$0.00	$0.00	$0.00	$0.00
30000509	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$402.00 	$297.48	$8.39	$323.20	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$237.78	$237.78	$19.57	$33.64	$319.97	$323.20	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30000510	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$201.00 	$148.74	$0.00	$160.80	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$118.89	$118.89	$19.57	$33.64	$159.19	$160.80	$27.03	$0.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30000515	EAP	CPT® 86022		Platelet Antibodies	BOTH IP/OP	$347.00 	$256.78	$0.00	$277.60	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$205.25	$205.25	$0.00	$51.32	$274.82	$277.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000519	EAP	CPT® 86003		Allergen Specific Ige	BOTH IP/OP	$378.00 	$279.72	$2.61	$376.80	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$223.59	$223.59	$5.48	$14.60	$373.03	$376.80	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30000521	EAP	CPT® 86235		Nuclear Antigen Antibody	BOTH IP/OP	$144.00 	$106.56	$0.00	$140.80	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$85.18	$85.18	$18.83	$50.12	$139.39	$140.80	$26.00	$0.00	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30000525	EAP	CPT® 82962		Blood Glucose Check	BOTH IP/OP	$58.00 	$42.92	$1.48	$42.40	$4.83	$4.83	$3.28	$3.28	$1.64	$1.48	$3.56	$3.56	$3.69	$3.28	$3.45	$2.13	$34.31	$34.31	$3.44	$6.54	$41.98	$42.40	$4.76	$37.70	$4.76	$3.68	$3.28	$3.28	$2.58	$3.28	$0.00	$0.00	$0.00	$0.00
30000526	EAP	CPT® 86003		Allegen - Mosquito Q	BOTH IP/OP	$96.00 	$71.04	$0.00	$96.00	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$56.78	$56.78	$5.48	$14.60	$95.04	$96.00	$7.57	$0.00	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30000527	EAP	CPT® 83916		"Oligoclonal Bands,csf(so)"	BOTH IP/OP	$56.00 	$41.44	$12.33	$51.00	$41.53	$41.53	$27.39	$27.39	$13.70	$12.33	$30.53	$30.53	$31.71	$27.39	$29.69	$17.80	$33.12	$33.12	$28.76	$51.00	$40.39	$40.80	$39.72	$36.40	$39.72	$31.64	$27.39	$27.39	$22.15	$27.39	$0.00	$0.00	$0.00	$0.00
30000528	EAP	CPT® 84157		"Protein,total And Electrophoresis,csf(so)"	BOTH IP/OP	$103.00 	$76.22	$1.83	$80.80	$7.58	$7.58	$4.00	$4.00	$2.00	$1.83	$5.56	$5.56	$5.78	$4.00	$5.42	$2.60	$60.92	$60.92	$4.20	$10.24	$79.99	$80.80	$5.80	$66.95	$5.80	$5.77	$4.00	$4.00	$4.04	$4.00	$0.00	$0.00	$0.00	$0.00
30000529	EAP	CPT® 84166		"Protein,total And Electrophoresis,qnt,csf(so)"	BOTH IP/OP	$89.00 	$65.86	$8.91	$69.60	$36.80	$36.80	$17.83	$17.83	$8.92	$8.91	$27.08	$27.08	$28.12	$17.83	$26.34	$11.59	$52.64	$52.64	$18.72	$49.84	$68.90	$69.60	$25.85	$57.85	$25.85	$28.07	$17.83	$17.83	$19.65	$17.83	$0.00	$0.00	$0.00	$0.00
30000530	EAP	CPT® 85810		"Viscosity, Serum(so)"	BOTH IP/OP	$76.00 	$56.24	$0.00	$61.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.73	$17.73	$18.41	$0.00	$17.26	$0.00	$0.00	$0.00	$0.00	$32.64	$60.98	$61.60	$0.00	$49.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000570	EAP	CPT® 86341		Ia-2 Islet Cell Ab (so)	BOTH IP/OP	$193.00 	$142.82	$0.00	$154.40	$40.84	$40.84	$23.57	$23.57	$11.79	$10.61	$30.05	$30.05	$31.20	$23.57	$29.24	$15.32	$114.16	$114.16	$24.75	$55.30	$152.86	$154.40	$34.18	$0.00	$34.18	$31.16	$23.57	$23.57	$21.81	$23.57	$0.00	$0.00	$0.00	$0.00
30000571	EAP	CPT® 86355		Lymph Sub 1 B Cells Tot (so)	BOTH IP/OP	$206.00 	$152.44	$0.00	$171.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$169.49	$171.20	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30000572	EAP	CPT® 86357		Lymph Sub 1 Nk Cells Tot (so)	BOTH IP/OP	$196.00 	$145.04	$0.00	$163.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$161.57	$163.20	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30000573	EAP	CPT® 86359		Lymph Sub 1 T Cells Tot (so)	BOTH IP/OP	$210.00 	$155.40	$0.00	$174.40	$48.63	$48.63	$37.73	$37.73	$18.87	$18.86	$35.77	$35.77	$37.14	$37.73	$34.80	$24.52	$124.22	$124.22	$39.62	$65.82	$172.66	$174.40	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30000574	EAP	CPT® 86360		Lymph Sub 1 T Cell Ratio (so)	BOTH IP/OP	$311.00 	$230.14	$0.00	$258.40	$96.99	$96.99	$46.98	$46.98	$23.49	$23.49	$71.34	$71.34	$74.09	$46.98	$69.42	$30.54	$183.96	$183.96	$49.33	$131.30	$255.82	$258.40	$68.12	$0.00	$68.12	$73.96	$46.98	$46.98	$51.77	$46.98	$0.00	$0.00	$0.00	$0.00
30000602	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$55.60	$55.60	$22.49	$59.86	$74.45	$75.20	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000604	EAP	CPT® 86603		Adenovirus Antibody	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.54	$19.54	$20.29	$0.00	$19.01	$0.00	$0.00	$0.00	$13.51	$35.96	$69.70	$70.40	$18.66	$0.00	$18.66	$0.00	$12.87	$12.87	$14.18	$12.87	$0.00	$0.00	$0.00	$0.00
30000605	EAP	CPT® 84182		Protein Western Blot Test	BOTH IP/OP	$513.00 	$379.62	$0.00	$410.40	$37.14	$37.14	$29.21	$29.21	$14.61	$13.14	$27.33	$27.33	$28.38	$29.21	$26.60	$18.99	$303.44	$303.44	$30.67	$50.30	$406.30	$410.40	$42.35	$0.00	$42.35	$28.34	$29.21	$29.21	$19.84	$29.21	$0.00	$0.00	$0.00	$0.00
30000610	EAP	CPT® 86316		Immunoassay Tumor Other	BOTH IP/OP	$217.00 	$160.58	$10.41	$175.20	$42.95	$42.95	$20.81	$20.81	$10.41	$10.41	$31.60	$31.60	$32.81	$20.81	$30.73	$13.53	$128.36	$128.36	$21.85	$58.14	$173.45	$175.20	$30.17	$141.05	$30.17	$32.75	$20.81	$20.81	$22.92	$20.81	$0.00	$0.00	$0.00	$0.00
30000611	EAP	CPT® 88305		Tissue Exam By Pathologist	BOTH IP/OP	$624.00 	$461.76	$31.00	$405.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$162.36	$164.00	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
30000612	EAP	CPT® 88311		Decalcify Tissue	BOTH IP/OP	$103.00 	$76.22	$0.00	$83.20	$34.06	$34.06	$0.00	$0.00	$0.00	$9.89	$6.40	$6.40	$6.64	$0.00	$18.15	$0.00	$60.92	$60.92	$0.00	$12.30	$82.37	$83.20	$0.00	$66.95	$0.00	$19.34	$9.00	$9.00	$13.54	$0.00	$0.00	$0.00	$0.00	$0.00
30000613	EAP	CPT® 88313		Special Stains Group 2	BOTH IP/OP	$146.00 	$108.04	$21.08	$116.00	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$86.36	$86.36	$33.53	$110.70	$114.84	$116.00	$46.58	$94.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
30000614	EAP	CPT® 85097		Bone Marrow Interpretation	BOTH IP/OP	$700.00 	$518.00	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.62	$48.62	$50.49	$0.00	$75.35	$0.00	$0.00	$0.00	$630.05	$213.48	$554.40	$560.00	$700.00	$0.00	$700.00	$80.29	$51.21	$51.21	$56.20	$600.04	$0.00	$0.00	$0.00	$0.00
30000615	EAP	CPT® 82507		Assay Of Citrate	BOTH IP/OP	$192.00 	$142.08	$0.00	$153.60	$0.00	$0.00	$0.00	$0.00	$0.00	$13.90	$42.22	$42.22	$43.85	$27.80	$41.08	$18.07	$113.57	$113.57	$0.00	$77.70	$152.06	$153.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000616	EAP	CPT® 82131		Amino Acids Single Quant	BOTH IP/OP	$68.00 	$50.32	$0.00	$54.40	$34.82	$34.82	$22.98	$22.98	$11.49	$10.34	$25.62	$25.62	$26.60	$22.98	$24.92	$14.94	$40.22	$40.22	$24.13	$47.14	$53.86	$54.40	$33.32	$0.00	$33.32	$26.55	$22.98	$22.98	$18.58	$22.98	$0.00	$0.00	$0.00	$0.00
30000617	EAP	CPT® 86480		Tb Test Cell Immun Measure	BOTH IP/OP	$500.00 	$370.00	$30.99	$482.40	$127.93	$127.93	$61.98	$61.98	$30.99	$30.99	$94.11	$94.11	$97.73	$61.98	$91.55	$40.29	$295.75	$295.75	$65.08	$173.18	$477.58	$482.40	$89.87	$293.15	$89.87	$97.55	$61.98	$61.98	$68.28	$61.98	$0.00	$0.00	$0.00	$0.00
30000618	EAP	CPT® 83516		Immunoassay Nonantibody	BOTH IP/OP	"$2,073.00 "	"$1,534.02"	$5.76	"$1,872.00"	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	"$1,226.18"	"$1,226.18"	$12.11	$29.88	"$1,853.28"	"$1,872.00"	$16.72	$195.65	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30000621	EAP	CPT® 82943		Assay Of Glucagon	BOTH IP/OP	$82.00 	$60.68	$0.00	$65.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.69	$21.69	$22.53	$0.00	$21.11	$0.00	$0.00	$0.00	$0.00	$39.94	$64.94	$65.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000622	EAP	CPT® 82040		Assay Of Serum Albumin	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.04	$5.94	$5.94	$4.95	$4.95	$2.48	$2.48	$4.37	$4.37	$4.54	$4.95	$4.25	$3.22	$5.92	$5.92	$5.20	$8.04	$7.92	$8.00	$7.18	$0.00	$7.18	$4.53	$4.95	$4.95	$3.17	$4.95	$0.00	$0.00	$0.00	$0.00
30000623	EAP	CPT® 84270		Assay Of Sex Hormone Globul	BOTH IP/OP	$35.00 	$25.90	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.87	$33.00	$33.00	$34.27	$21.73	$32.10	$14.12	$20.70	$20.70	$0.00	$35.00	$27.72	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000624	EAP	CPT® 84403		Assay Of Total Testosterone	BOTH IP/OP	$50.00 	$37.00	$0.00	$50.00	$50.00	$50.00	$25.81	$25.81	$12.91	$12.91	$39.21	$39.21	$40.72	$25.81	$38.15	$16.78	$29.58	$29.58	$27.10	$50.00	$39.60	$40.00	$37.42	$0.00	$37.42	$40.65	$25.81	$25.81	$28.45	$25.81	$0.00	$0.00	$0.00	$0.00
30000625	EAP	CPT® 83520		Immunoassay Quant Nos Nonab	BOTH IP/OP	$996.00 	$737.04	$7.77	$899.20	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$589.13	$589.13	$18.13	$36.18	$890.21	$899.20	$25.04	$204.75	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30000626	EAP	CPT® 87906		Genotype Dna Hiv Reverse T	BOTH IP/OP	$159.00 	$117.66	$0.00	$186.66	$90.02	$90.02	$128.73	$128.73	$64.37	$64.36	$63.81	$63.81	$66.27	$128.73	$57.67	$83.67	$94.05	$94.05	$135.17	$96.00	$152.06	$153.60	$186.66	$0.00	$186.66	$61.44	$128.73	$128.73	$43.01	$128.73	$0.00	$0.00	$0.00	$0.00
30000627	EAP	CPT® 87903		Phenotype Dna Hiv W/culture	BOTH IP/OP	$855.00 	$632.70	$0.00	$884.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$513.58	$513.58	$533.34	$0.00	$499.62	$0.00	$0.00	$0.00	$0.00	$884.00	$700.13	$707.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000628	EAP	CPT® 87904		Phenotype Dna Hiv W/clt Add	BOTH IP/OP	$172.00 	$127.28	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.57	$33.57	$34.86	$0.00	$32.66	$0.00	$0.00	$0.00	$0.00	$61.78	$140.98	$142.40	$0.00	$108.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000629	EAP	CPT® 83785		Assay Of Manganese	BOTH IP/OP	$69.00 	$51.06	$0.00	$68.72	$50.77	$50.77	$26.65	$26.65	$13.33	$12.30	$37.34	$37.34	$38.77	$26.65	$36.32	$17.32	$40.81	$40.81	$0.00	$68.72	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000630	EAP	CPT® 82300		Assay Of Cadmium	BOTH IP/OP	$67.00 	$49.58	$0.00	$64.66	$47.78	$47.78	$23.64	$23.64	$11.82	$11.57	$35.14	$35.14	$36.49	$23.64	$34.19	$15.37	$39.63	$39.63	$0.00	$64.66	$53.06	$53.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000631	EAP	CPT® 82570		Assay Of Urine Creatinine	BOTH IP/OP	$77.00 	$56.98	$0.00	$61.60	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$45.55	$45.55	$5.44	$14.46	$60.98	$61.60	$7.51	$0.00	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30000632	EAP	CPT® 83885		Assay Of Nickel	BOTH IP/OP	$69.00 	$51.06	$0.00	$68.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.20	$37.20	$38.63	$0.00	$36.19	$0.00	$0.00	$0.00	$0.00	$68.46	$54.65	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000633	EAP	CPT® 83018		Quantitative Screen Metals	BOTH IP/OP	$114.00 	$84.36	$0.00	$91.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.34	$33.34	$34.62	$0.00	$32.43	$0.00	$0.00	$0.00	$0.00	$61.36	$90.29	$91.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000634	EAP	CPT® 83785		Assay Of Manganese	BOTH IP/OP	$79.00 	$58.46	$0.00	$68.72	$50.77	$50.77	$26.65	$26.65	$13.33	$12.30	$37.34	$37.34	$38.77	$26.65	$36.32	$17.32	$46.73	$46.73	$0.00	$68.72	$62.57	$63.20	$0.00	$51.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000635	EAP	CPT® 82525		Assay Of Copper	BOTH IP/OP	$61.00 	$45.14	$6.21	$49.60	$25.61	$25.61	$12.41	$12.41	$6.21	$6.21	$18.84	$18.84	$19.57	$12.41	$18.33	$8.07	$36.08	$36.08	$13.03	$34.68	$49.10	$49.60	$17.99	$39.65	$17.99	$19.53	$12.41	$12.41	$13.67	$12.41	$0.00	$0.00	$0.00	$0.00
30000636	EAP	CPT® 83520		Immunoassay Quant Nos Nonab	BOTH IP/OP	$974.00 	$720.76	$7.77	$757.60	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$576.12	$576.12	$18.13	$36.18	$750.02	$757.60	$25.04	$204.75	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30000637	EAP	CPT® 80361		Assay Of Dihydrocodeinone	BOTH IP/OP	$257.00 	$190.18	$0.00	$217.60	$0.03	$0.03	$0.00	$0.00	$12.01	$11.94	$190.75	$190.75	$198.10	$0.00	$30.51	$0.00	$152.02	$152.02	$0.00	$136.00	$215.42	$217.60	$163.20	$0.00	$163.20	$32.51	$0.00	$0.00	$22.76	$0.00	$0.00	$0.00	$0.00	$0.00
30000706	EAP	CPT® 81479		Rhd Variant By Snp (arc)	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	"$1,114.12"	$0.00	$0.00	$0.00	$0.00	$204.70	$239.69	$853.53	$853.53	$886.42	$0.00	"$1,045.61"	$0.00	$680.23	$680.23	$0.00	$568.00	$899.71	$908.80	$681.60	$747.50	$681.60	"$1,114.12"	$0.00	$0.00	$779.89	$0.00	$0.00	$0.00	$0.00	$0.00
30000710	EAP	CPT® 81479		Rhce Variant By Snp (arc)	BOTH IP/OP	$994.00 	$735.56	$0.00	"$1,114.12"	$0.00	$0.00	$0.00	$0.00	$176.93	$207.17	$737.75	$737.75	$766.18	$0.00	$994.00	$0.00	$587.95	$587.95	$0.00	$491.00	$777.74	$785.60	$589.20	$646.10	$589.20	"$1,114.12"	$0.00	$0.00	$779.89	$0.00	$0.00	$0.00	$0.00	$0.00
30000715	EAP	CPT® 86355		Cd19 B-cells (flow Cytometry) So	BOTH IP/OP	$81.00 	$59.94	$0.00	$67.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$66.53	$67.20	$54.71	$52.65	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30000716	EAP	CPT® 81403		Xhea Licensed Rbc Panel (arc)	BOTH IP/OP	$831.00 	$614.94	$83.34	$656.80	$264.00	$264.00	$185.20	$185.20	$92.60	$83.34	$616.77	$616.77	$640.53	$185.20	$220.85	$120.38	$491.54	$491.54	$194.46	$410.50	$650.23	$656.80	$268.54	$305.58	$268.54	$235.32	$185.20	$185.20	$164.72	$185.20	$0.00	$0.00	$0.00	$0.00
30000750	EAP	CPT® 85335		Adamts 13 Inhibitor (so)	BOTH IP/OP	$375.00 	$277.50	$0.00	$303.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.55	$19.55	$20.30	$0.00	$19.02	$0.00	$0.00	$0.00	$0.00	$35.98	$300.17	$303.20	$0.00	$228.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000751	EAP	CPT® 87900		Hiv Genotyping	BOTH IP/OP	"$1,201.00 "	$888.74	$0.00	"$1,084.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.86	$167.86	$174.31	$0.00	$163.30	$0.00	$0.00	$0.00	$0.00	$308.90	"$1,073.16"	"$1,084.00"	$0.00	$692.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000753	EAP	CPT® 86830		Hla Ab Id (arc)	BOTH IP/OP	$560.00 	$414.40	$0.00	$452.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.08	$117.08	$121.59	$0.00	$116.70	$0.00	$0.00	$0.00	$0.00	$282.50	$447.48	$452.00	$0.00	$364.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000755	EAP	CPT® 81310		"Npm (exon 12) Mutation,gene Analy(so)"	BOTH IP/OP	$612.00 	$452.88	$0.00	$559.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.03	$257.03	$266.91	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$349.50	$553.61	$559.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000761	EAP	CPT® 81245		"FLT3 ITD and TKD Mutation,Variants(SO)"	BOTH IP/OP	$445.00 	$329.30	$0.00	$407.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.56	$172.56	$179.19	$0.00	$115.59	$0.00	$0.00	$0.00	$0.00	$254.50	$403.13	$407.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000762	EAP	CPT® 81246		CEBPA Mutation(SO)	BOTH IP/OP	$576.00 	$426.24	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.51	$427.51	$443.98	$0.00	$120.04	$0.00	$0.00	$0.00	$0.00	$329.00	$521.14	$526.40	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000764	EAP	CPT® 81450		Myeloproliferative Neoplasm Mut(SO)	BOTH IP/OP	"$1,655.00 "	"$1,224.70"	$0.00	"$1,512.80"	$982.56	$982.56	$759.53	$759.53	$379.77	$0.00	"$1,228.34"	"$1,228.34"	"$1,275.67"	$0.00	$344.90	$0.00	$0.00	$0.00	$0.00	$945.50	"$1,497.67"	"$1,512.80"	$0.00	$0.00	$0.00	$295.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000766	EAP	CPT® 81261		"Lympho Clonal Panel, IGK,PCR(SO)"	BOTH IP/OP	$878.00 	$649.72	$0.00	$802.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.91	$280.91	$291.72	$0.00	$286.64	$0.00	$0.00	$0.00	$0.00	$501.50	$794.38	$802.40	$0.00	$0.00	$0.00	$305.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000767	EAP	CPT® 81264		"Lympho Clonal Panel,TRB PCR(SO)"	BOTH IP/OP	$913.00 	$675.62	$0.00	$834.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.87	$211.87	$220.02	$0.00	$115.59	$0.00	$0.00	$0.00	$0.00	$521.50	$826.06	$834.40	$0.00	$0.00	$0.00	$123.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000768	EAP	CPT® 81340		"Lympho Clonal Panel,TRG PCR(SO)"	BOTH IP/OP	$526.00 	$389.24	$0.00	$480.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.42	$296.42	$307.82	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$300.50	$475.99	$480.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000769	EAP	CPT® 81342		"Lympho Clonal Panel, PCR,Unlisted Proc(SO)"	BOTH IP/OP	$624.00 	$461.76	$0.00	$570.40	$415.93	$415.93	$201.50	$201.50	$100.75	$100.75	$285.90	$285.90	$296.89	$201.50	$192.65	$130.98	$369.10	$369.10	$0.00	$356.50	$564.70	$570.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000770	EAP	CPT® 84999		B-Cell Clonality Panel (IGH)(SO)	BOTH IP/OP	$517.00 	$382.58	$0.00	$440.80	$0.00	$0.00	$0.00	$0.00	$92.03	$0.00	$383.72	$383.72	$398.50	$0.00	$107.74	$0.00	$0.00	$0.00	$0.00	$0.00	$436.39	$440.80	$0.00	$120.90	$0.00	$86.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000771	EAP	CPT® 81261		B-Cell Clonality Panel (IGK)(SO)	BOTH IP/OP	$755.00 	$558.70	$0.00	$755.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.91	$280.91	$291.72	$0.00	$286.64	$0.00	$0.00	$0.00	$0.00	$373.00	$590.83	$596.80	$0.00	$755.00	$0.00	$305.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000772	EAP	CPT® 81264		"B-Cell Clonality Panel,Unlisted Proc(SO)"	BOTH IP/OP	$636.00 	$470.64	$0.00	$636.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.87	$211.87	$220.02	$0.00	$115.59	$0.00	$0.00	$0.00	$0.00	$314.00	$497.38	$502.40	$0.00	$636.00	$0.00	$123.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000773	EAP	CPT® 84999		"MYD88, Mutation Analysis(SO)"	BOTH IP/OP	$970.00 	$717.80	$0.00	$766.40	$0.00	$0.00	$0.00	$0.00	$172.66	$0.00	$719.93	$719.93	$747.68	$0.00	$202.15	$0.00	$0.00	$0.00	$0.00	$0.00	$758.74	$766.40	$0.00	$120.90	$0.00	$149.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000774	EAP	CPT® 81479		"KIT D816, Mutation Analysis(SO)"	BOTH IP/OP	"$1,437.00 "	"$1,063.38"	$0.00	"$1,136.00"	$0.00	$0.00	$0.00	$0.00	$255.79	$299.51	"$1,066.54"	"$1,066.54"	"$1,107.64"	$0.00	"$1,045.61"	$0.00	$849.99	$849.99	$0.00	$710.00	"$1,124.64"	"$1,136.00"	$852.00	$934.05	$852.00	"$1,114.12"	$0.00	$0.00	$779.89	$0.00	$0.00	$0.00	$0.00	$0.00
30000777	EAP	CPT® 88271		"Fish, ALL, TEL/ AML1 Transl,100-300 Cells(SO)"	BOTH IP/OP	$357.00 	$264.18	$0.00	$285.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$211.17	$211.17	$22.49	$59.86	$282.74	$285.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000778	EAP	CPT® 88275		"Chromosome Analysis, Lymph Node,BM(SO)"	BOTH IP/OP	"$1,347.00 "	$996.78	$23.04	"$1,077.60"	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$796.75	$796.75	$53.75	$112.22	"$1,066.82"	"$1,077.60"	$74.23	$426.40	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000779	EAP	CPT® 88237		"ChromAnaly, Lymph Node,20-25 Cells(SO)"	BOTH IP/OP	"$1,567.00 "	"$1,159.58"	$64.69	"$1,388.80"	$182.24	$182.24	$143.75	$143.75	$71.88	$64.69	$134.06	$134.06	$139.21	$143.75	$130.42	$93.44	$926.88	$926.88	$150.94	$246.70	"$1,374.91"	"$1,388.80"	$208.44	$884.00	$208.44	$138.97	$143.75	$143.75	$97.28	$143.75	$0.00	$0.00	$0.00	$0.00
30000780	EAP	CPT® 88264		"Fish, B-Cell Malignancy, IGH, 14q32(SO)"	BOTH IP/OP	$460.00 	$340.40	$0.00	$408.00	$257.29	$257.29	$144.61	$144.61	$72.31	$65.07	$189.26	$189.26	$196.54	$144.61	$184.12	$94.00	$272.09	$272.09	$151.84	$348.28	$403.92	$408.00	$209.68	$0.00	$209.68	$196.18	$144.61	$144.61	$137.33	$144.61	$0.00	$0.00	$0.00	$0.00
30000781	EAP	CPT® 88271		"Fish, B-Cell Malig, IGH, 14q32,100-300 Cells(SO)"	BOTH IP/OP	$398.00 	$294.52	$10.71	$316.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$235.42	$235.42	$22.49	$59.86	$312.84	$316.00	$31.06	$258.70	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000782	EAP	CPT® 88275		ZAP -70(SO)	BOTH IP/OP	$233.00 	$172.42	$23.04	$184.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$137.82	$137.82	$53.75	$112.22	$182.95	$184.80	$74.23	$151.45	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000783	EAP	CPT® 88184		"ZAP -70,Add Marker(SO)"	BOTH IP/OP	$303.00 	$224.22	$0.00	$303.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$179.22	$179.22	$284.24	$133.74	$239.98	$242.40	$303.00	$0.00	$303.00	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
30000784	EAP	CPT® 88185		"CLL Prognostic Panel,First Marker(SO)"	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$76.90	$76.90	$0.00	$71.72	$102.96	$104.00	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000785	EAP	CPT® 88184		"CLL Prognostic Panel,Add Marker(SO)-1"	BOTH IP/OP	$303.00 	$224.22	$0.00	$303.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$179.22	$179.22	$284.24	$133.74	$239.98	$242.40	$303.00	$0.00	$303.00	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
30000786	EAP	CPT® 88185		"CLL Prognostic Panel,Add Marker(SO)-2"	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$76.90	$76.90	$0.00	$71.72	$102.96	$104.00	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000787	EAP	CPT® 88185		"CLL Prognostic Panel,IGH(SO)"	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.40	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$273.86	$273.86	$0.00	$71.72	$366.70	$370.40	$0.00	$131.95	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000788	EAP	CPT® 81263		"CLL Prognostic Panel,Beta-2(SO)"	BOTH IP/OP	$559.00 	$413.66	$0.00	$559.00	$559.00	$559.00	$294.52	$294.52	$147.26	$147.26	$417.86	$417.86	$433.93	$294.52	$115.59	$191.44	$330.65	$330.65	$309.25	$319.50	$506.09	$511.20	$427.05	$0.00	$427.05	$123.17	$294.52	$294.52	$86.22	$294.52	$0.00	$0.00	$0.00	$0.00
30000789	EAP	CPT® 82232		"CLL Prognostic Panel,DNA Probe(SO)-1"	BOTH IP/OP	$327.00 	$241.98	$0.00	$327.20	$33.40	$33.40	$16.18	$16.18	$8.09	$8.09	$24.56	$24.56	$25.51	$16.18	$23.91	$10.52	$193.42	$193.42	$16.99	$45.22	$323.93	$327.20	$23.46	$0.00	$23.46	$25.48	$16.18	$16.18	$17.83	$16.18	$0.00	$0.00	$0.00	$0.00
30000790	EAP	CPT® 88271		"CLL Prognostic Panel,DNA Probe(SO)-2"	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$128.95	$128.95	$22.49	$59.86	$172.66	$174.40	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000791	EAP	CPT® 88271		"CLL Prognostic Panel,DNA Probe(SO)-3"	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$128.95	$128.95	$22.49	$59.86	$172.66	$174.40	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000792	EAP	CPT® 88271		"CLL Prognostic Panel,DNA Probe(SO)-4"	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$128.95	$128.95	$22.49	$59.86	$172.66	$174.40	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000793	EAP	CPT® 88271		"CLL Prognostic Panel,DNA Probe(SO)-5"	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$128.95	$128.95	$22.49	$59.86	$172.66	$174.40	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000794	EAP	CPT® 88271		"CLL Prognostic Panel,100-300 Cells(SO)-1"	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$128.95	$128.95	$22.49	$59.86	$172.66	$174.40	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000795	EAP	CPT® 88275		"CLL Prognostic Panel,100-300 Cells(SO)-2"	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$128.95	$128.95	$53.75	$112.22	$172.66	$174.40	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000796	EAP	CPT® 88275		"CLL Prognostic Panel,100-300 Cells(SO)-3"	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$128.95	$128.95	$53.75	$112.22	$172.66	$174.40	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000797	EAP	CPT® 88275		"CLL Prognostic Panel,100-300 Cells(SO)-4"	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$128.95	$128.95	$53.75	$112.22	$172.66	$174.40	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000798	EAP	CPT® 88275		"CLL Prognostic Panel,100-300 Cells(SO)-5"	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$128.95	$128.95	$53.75	$112.22	$172.66	$174.40	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000799	EAP	CPT® 88275		"CLL Prognostic Panel,BM(SO)"	BOTH IP/OP	$233.00 	$172.42	$0.00	$186.40	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$137.82	$137.82	$53.75	$112.22	$184.54	$186.40	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000800	EAP	CPT® 88237		"CLL Prognostic Panel,20-25 Cells(SO)"	BOTH IP/OP	$382.00 	$282.68	$0.00	$338.40	$182.24	$182.24	$143.75	$143.75	$71.88	$64.69	$134.06	$134.06	$139.21	$143.75	$130.42	$93.44	$225.95	$225.95	$150.94	$246.70	$335.02	$338.40	$208.44	$0.00	$208.44	$138.97	$143.75	$143.75	$97.28	$143.75	$0.00	$0.00	$0.00	$0.00
30000801	EAP	CPT® 88264		"CHROM, CLL/LPD,BM(SO)"	BOTH IP/OP	$592.00 	$438.08	$0.00	$524.80	$257.29	$257.29	$144.61	$144.61	$72.31	$65.07	$189.26	$189.26	$196.54	$144.61	$184.12	$94.00	$350.17	$350.17	$151.84	$348.28	$519.55	$524.80	$209.68	$0.00	$209.68	$196.18	$144.61	$144.61	$137.33	$144.61	$0.00	$0.00	$0.00	$0.00
30000802	EAP	CPT® 88237		"CHROM, CLL/LPD, 20-25 Cells(SO)"	BOTH IP/OP	$592.00 	$438.08	$0.00	$524.80	$182.24	$182.24	$143.75	$143.75	$71.88	$64.69	$134.06	$134.06	$139.21	$143.75	$130.42	$93.44	$350.17	$350.17	$150.94	$246.70	$519.55	$524.80	$208.44	$0.00	$208.44	$138.97	$143.75	$143.75	$97.28	$143.75	$0.00	$0.00	$0.00	$0.00
30000803	EAP	CPT® 88264		"CHROM, CLL/LPD,Interp(SO)"	BOTH IP/OP	$592.00 	$438.08	$0.00	$524.80	$257.29	$257.29	$144.61	$144.61	$72.31	$65.07	$189.26	$189.26	$196.54	$144.61	$184.12	$94.00	$350.17	$350.17	$151.84	$348.28	$519.55	$524.80	$209.68	$0.00	$209.68	$196.18	$144.61	$144.61	$137.33	$144.61	$0.00	$0.00	$0.00	$0.00
30000805	EAP	CPT® 88271		"Fish, ALL, Pre-B,100-300 Cells(SO)"	BOTH IP/OP	"$1,002.00 "	$741.48	$10.71	$801.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$592.68	$592.68	$22.49	$59.86	$793.58	$801.60	$31.06	$380.25	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000806	EAP	CPT® 88275		"Fish, MALT Lymph, rea18q21,DNA Probe(SO)-1"	BOTH IP/OP	$303.00 	$224.22	$0.00	$242.40	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$179.22	$179.22	$53.75	$112.22	$239.98	$242.40	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000807	EAP	CPT® 88271		"Fish, MALT Lymph, rea18q21,DNA Probe(SO)-2"	BOTH IP/OP	$303.00 	$224.22	$0.00	$242.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$179.22	$179.22	$22.49	$59.86	$239.98	$242.40	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000808	EAP	CPT® 88271		"Fish, MALT Lymph, rea18q21100-300 Cells(SO)"	BOTH IP/OP	$303.00 	$224.22	$0.00	$242.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$179.22	$179.22	$22.49	$59.86	$239.98	$242.40	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000809	EAP	CPT® 88275		"Fish, TCL1, 14q32.1,DNA Probe(SO)-1"	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$136.64	$136.64	$53.75	$112.22	$182.95	$184.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000810	EAP	CPT® 88271		"Fish, TCL1, 14q32.1,DNA Probe(SO)-2"	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$136.64	$136.64	$22.49	$59.86	$182.95	$184.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000811	EAP	CPT® 88271		"Fish, TCL1, 14q32.1,100-300 Cells(SO)"	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$136.64	$136.64	$22.49	$59.86	$182.95	$184.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000812	EAP	CPT® 88275		"Fish, T-Cell Receptor Alpha/ Delta,DNA Probe(SO)-1"	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$136.64	$136.64	$53.75	$112.22	$182.95	$184.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000813	EAP	CPT® 88271		"Fish, T-Cell Receptor Alpha/ Delta,DNA Probe(SO)-2"	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$136.64	$136.64	$22.49	$59.86	$182.95	$184.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000814	EAP	CPT® 88271		"Fish, T-Cell Receptor Alpha/ Delta,100-300 Cells(SO)"	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$136.64	$136.64	$22.49	$59.86	$182.95	$184.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000815	EAP	CPT® 88275		"Chrom. Microarray, Hematologic Malig.(SO)"	BOTH IP/OP	"$2,718.00 "	"$2,011.32"	$23.04	"$2,174.40"	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	"$1,607.70"	"$1,607.70"	$53.75	$112.22	"$2,152.66"	"$2,174.40"	$74.23	$426.40	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000816	EAP	CPT® 81406		"Fish, Mult Myel, IGH/ MAFB,DNA Probe(SO)-1"	BOTH IP/OP	$283.00 	$209.42	$0.00	$283.00	$237.60	$237.60	$282.88	$282.88	$141.44	$127.30	$210.04	$210.04	$218.14	$282.88	$283.00	$183.87	$167.39	$167.39	$0.00	$161.50	$255.82	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30000817	EAP	CPT® 88271		"Fish, Mult Myel, IGH/ MAFB,DNA Probe(SO)-2"	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$136.64	$136.64	$22.49	$59.86	$182.95	$184.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000818	EAP	CPT® 88271		"Fish, Mult Myel, IGH/ MAFB,100-300 Cells(SO)"	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$136.64	$136.64	$22.49	$59.86	$182.95	$184.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000819	EAP	CPT® 88275		"Fish, Mult Myel, 1q21,DNA Probe(SO)-1"	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$136.64	$136.64	$53.75	$112.22	$182.95	$184.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000820	EAP	CPT® 88271		"Fish, Mult Myel, 1q21,DNA Probe(SO)-2"	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$136.64	$136.64	$22.49	$59.86	$182.95	$184.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000821	EAP	CPT® 88271		"Fish, Mult Myel, 1q21,100-300 Cells(SO)"	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$136.64	$136.64	$22.49	$59.86	$182.95	$184.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000822	EAP	CPT® 88275		"Fish, Myeloid Neopl, MECOM,DNA Probe(SO)-1"	BOTH IP/OP	$251.00 	$185.74	$0.00	$200.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$148.47	$148.47	$53.75	$112.22	$198.79	$200.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000823	EAP	CPT® 88271		"Fish, Myeloid Neopl, MECOM,DNA Probe(SO)-2"	BOTH IP/OP	$251.00 	$185.74	$0.00	$200.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$148.47	$148.47	$22.49	$59.86	$198.79	$200.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000824	EAP	CPT® 88271		"Fish, Myeloid Neopl, MECOM,DNA Probe(SO)-3"	BOTH IP/OP	$251.00 	$185.74	$0.00	$200.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$148.47	$148.47	$22.49	$59.86	$198.79	$200.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000825	EAP	CPT® 88271		"Fish, Myeloid Neoplasms, MECOM,100-300 Cells(SO)"	BOTH IP/OP	$251.00 	$185.74	$0.00	$200.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$148.47	$148.47	$22.49	$59.86	$198.79	$200.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000826	EAP	CPT® 88275		"Fish, High-Grade LymphPanel,DNA Probe(SO)-1"	BOTH IP/OP	$312.00 	$230.88	$0.00	$249.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$184.55	$184.55	$53.75	$112.22	$247.10	$249.60	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000827	EAP	CPT® 88271		"Fish, High-Grade LymphPanel,DNA Probe(SO)-2"	BOTH IP/OP	$314.00 	$232.36	$10.71	$249.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$185.73	$185.73	$22.49	$59.86	$247.10	$249.60	$31.06	$204.10	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000828	EAP	CPT® 88271		"Fish, High-Grade LymphPanel,DNA Probe(SO)-3"	BOTH IP/OP	$314.00 	$232.36	$10.71	$249.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$185.73	$185.73	$22.49	$59.86	$247.10	$249.60	$31.06	$204.10	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000829	EAP	CPT® 88271		"Fish, High-Grade LymphPanel,DNA Probe(SO)-4"	BOTH IP/OP	$314.00 	$232.36	$10.71	$249.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$185.73	$185.73	$22.49	$59.86	$247.10	$249.60	$31.06	$204.10	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000830	EAP	CPT® 88271		"Fish, High-Grade LymphPanel,DNA Probe(SO)-5"	BOTH IP/OP	$314.00 	$232.36	$10.71	$249.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$185.73	$185.73	$22.49	$59.86	$247.10	$249.60	$31.06	$204.10	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000831	EAP	CPT® 88271		"Fish, High-Grade LymphPanel,DNA Probe(SO)-6"	BOTH IP/OP	$314.00 	$232.36	$10.71	$249.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$185.73	$185.73	$22.49	$59.86	$247.10	$249.60	$31.06	$204.10	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000832	EAP	CPT® 88271		"Fish, High-Grade LymphPanel,100-300 Cells(SO)-1"	BOTH IP/OP	$314.00 	$232.36	$10.71	$249.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$185.73	$185.73	$22.49	$59.86	$247.10	$249.60	$31.06	$204.10	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000833	EAP	CPT® 88275		"Fish, High-Grade LymphPanel,100-300 Cells(SO)-2"	BOTH IP/OP	$314.00 	$232.36	$23.04	$249.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$185.73	$185.73	$53.75	$112.22	$247.10	$249.60	$74.23	$204.10	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000834	EAP	CPT® 88275		"Fish, High-Grade LymphPanel,100-300 Cells(SO)-3"	BOTH IP/OP	$314.00 	$232.36	$23.04	$249.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$185.73	$185.73	$53.75	$112.22	$247.10	$249.60	$74.23	$204.10	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000835	EAP	CPT® 88275		"CLL Prognostic Panel, Comp,First Marker(SO)"	BOTH IP/OP	$130.00 	$96.20	$23.04	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$76.90	$76.90	$53.75	$112.22	$102.17	$103.20	$74.23	$84.50	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000836	EAP	CPT® 88184		"CLL Prognostic Panel, Comp,Add  Marker(SO)-1"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$295.75	$295.75	$284.24	$133.74	$396.00	$400.00	$394.92	$0.00	$394.92	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
30000837	EAP	CPT® 88185		"CLL Prognostic Panel, Comp,Add  Marker(SO)-2"	BOTH IP/OP	$77.00 	$56.98	$0.00	$71.72	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$45.55	$45.55	$0.00	$71.72	$60.98	$61.60	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000838	EAP	CPT® 88185		"CLL Prognostic Panel,Comp,Beta-2(SO)"	BOTH IP/OP	$77.00 	$56.98	$0.00	$71.72	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$45.55	$45.55	$0.00	$71.72	$60.98	$61.60	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000839	EAP	CPT® 82232		"CLL Prognostic Panel, Comp,DNA Probe(SO)-1"	BOTH IP/OP	$194.00 	$143.56	$0.00	$193.60	$33.40	$33.40	$16.18	$16.18	$8.09	$8.09	$24.56	$24.56	$25.51	$16.18	$23.91	$10.52	$114.75	$114.75	$16.99	$45.22	$191.66	$193.60	$23.46	$0.00	$23.46	$25.48	$16.18	$16.18	$17.83	$16.18	$0.00	$0.00	$0.00	$0.00
30000840	EAP	CPT® 88271		"CLL Prognostic Panel, Comp,DNA Probe(SO)-2"	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$76.30	$76.30	$22.49	$59.86	$102.17	$103.20	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000841	EAP	CPT® 88271		"CLL Prognostic Panel, Comp,DNA Probe(SO)-3"	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$76.30	$76.30	$22.49	$59.86	$102.17	$103.20	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000842	EAP	CPT® 88271		"CLL Prognostic Panel, Comp,DNA Probe(SO)-4"	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$76.30	$76.30	$22.49	$59.86	$102.17	$103.20	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000843	EAP	CPT® 88271		"CLL Prognostic Panel, Comp,DNA Probe(SO)-5"	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$76.30	$76.30	$22.49	$59.86	$102.17	$103.20	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000844	EAP	CPT® 88271		"CLL Prognostic Panel, Comp,100-300 Cells(SO)-1"	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$76.30	$76.30	$22.49	$59.86	$102.17	$103.20	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30000845	EAP	CPT® 88275		"CLL Prognostic Panel, Comp,100-300 Cells(SO)-2"	BOTH IP/OP	$129.00 	$95.46	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$76.30	$76.30	$53.75	$112.22	$102.17	$103.20	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000846	EAP	CPT® 88275		"CLL Prognostic Panel, Comp,100-300 Cells(SO)-3"	BOTH IP/OP	$129.00 	$95.46	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$76.30	$76.30	$53.75	$112.22	$102.17	$103.20	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000847	EAP	CPT® 88275		"CLL Prognostic Panel, Comp,100-300 Cells(SO)-4"	BOTH IP/OP	$129.00 	$95.46	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$76.30	$76.30	$53.75	$112.22	$102.17	$103.20	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000848	EAP	CPT® 88275		"CLL Prognostic Panel, Comp,100-300 Cells(SO)-5"	BOTH IP/OP	$129.00 	$95.46	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$76.30	$76.30	$53.75	$112.22	$102.17	$103.20	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000849	EAP	CPT® 88275		"CLL Lymphoma Follow-up Panel,First Marker(SO)"	BOTH IP/OP	$119.00 	$88.06	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$70.39	$70.39	$53.75	$112.22	$94.25	$95.20	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30000850	EAP	CPT® 88184		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-1"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$295.75	$295.75	$284.24	$133.74	$396.00	$400.00	$394.92	$0.00	$394.92	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
30000851	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-2"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000852	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-3"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000853	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-4"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000854	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-5"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000855	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-6"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000856	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-7"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000857	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-8"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000858	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-9"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000859	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-10"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000860	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-11"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000861	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-12"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000862	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-13"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000863	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,Add Marker(SO)-14"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000864	EAP	CPT® 88185		"CLL Lymphoma Follow-up Panel,9-15 Markers(SO)"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30000865	EAP	CPT® 88188		"Cll Lymphoma Follow-up Panel,9-15 Markers(so)"	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.70	$52.70	$54.73	$0.00	$71.00	$0.00	$0.00	$0.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30005065	EAP	CPT® 82948		"Glu-random,wb Micro"	BOTH IP/OP	$251.00 	$185.74	$0.00	$248.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.82	$4.82	$5.00	$0.00	$4.68	$0.00	$0.00	$0.00	$0.00	$8.86	$246.31	$248.80	$0.00	$48.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30040001	EAP	CPT® 86885		Abid Ea Selected Cell (arc)	BOTH IP/OP	$149.00 	$110.26	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.68	$8.68	$9.02	$0.00	$8.44	$0.00	$0.00	$0.00	$143.92	$15.98	$118.80	$120.00	$150.00	$96.85	$150.00	$9.00	$5.72	$5.72	$6.30	$137.07	$0.00	$0.00	$0.00	$0.00
30050138	EAP	CPT® 86880		Direct Coombs	BOTH IP/OP	$140.00 	$103.60	$2.70	$112.80	$11.11	$11.11	$54.21	$54.21	$54.51	$2.70	$8.15	$8.15	$8.47	$53.35	$7.93	$34.67	$82.81	$82.81	$33.53	$15.00	$111.67	$112.80	$46.58	$91.00	$46.58	$8.45	$5.39	$5.39	$5.91	$31.93	$0.00	$0.00	$0.00	$0.00
30050139	EAP	CPT® 86880		"Dct,anti-igg"	BOTH IP/OP	$140.00 	$103.60	$2.70	$112.80	$11.11	$11.11	$54.21	$54.21	$54.51	$2.70	$8.15	$8.15	$8.47	$53.35	$7.93	$34.67	$82.81	$82.81	$33.53	$15.00	$111.67	$112.80	$46.58	$91.00	$46.58	$8.45	$5.39	$5.39	$5.91	$31.93	$0.00	$0.00	$0.00	$0.00
30050140	EAP	CPT® 86880		"Dct,anti-c3d"	BOTH IP/OP	$140.00 	$103.60	$2.70	$112.80	$11.11	$11.11	$54.21	$54.21	$54.51	$2.70	$8.15	$8.15	$8.47	$53.35	$7.93	$34.67	$82.81	$82.81	$33.53	$15.00	$111.67	$112.80	$46.58	$91.00	$46.58	$8.45	$5.39	$5.39	$5.91	$31.93	$0.00	$0.00	$0.00	$0.00
30050141	EAP	CPT® 86886		Antibody Titer	BOTH IP/OP	$146.00 	$108.04	$2.59	$147.00	$9.58	$9.58	$145.24	$145.24	$146.00	$2.59	$7.06	$7.06	$7.33	$142.96	$6.87	$92.92	$86.36	$86.36	$143.92	$13.00	$116.42	$117.60	$147.00	$94.90	$147.00	$7.32	$5.18	$5.18	$5.12	$137.07	$0.00	$0.00	$0.00	$0.00
30050148	EAP	CPT® 86900		"Blood Typing, Serologic, Abo"	BOTH IP/OP	$165.00 	$122.10	$1.49	$150.00	$6.18	$6.18	$109.81	$109.81	$110.43	$1.49	$4.52	$4.52	$4.70	$107.30	$4.41	$69.74	$97.60	$97.60	$109.35	$8.34	$118.80	$120.00	$150.00	$107.25	$150.00	$4.70	$2.99	$2.99	$3.29	$104.14	$0.00	$0.00	$0.00	$0.00
30050149	EAP	CPT® 86901		"Blood Typing, Serologic, Rh (d)"	BOTH IP/OP	$165.00 	$122.10	$1.49	$120.00	$6.18	$6.18	$32.96	$32.96	$33.15	$1.49	$4.52	$4.52	$4.70	$32.43	$17.04	$21.08	$97.60	$97.60	$33.53	$8.34	$118.80	$120.00	$46.58	$88.40	$46.58	$18.16	$2.99	$2.99	$12.71	$31.93	$0.00	$0.00	$0.00	$0.00
30050300	EAP	CPT® 80354		Fentanyl - Urine	BOTH IP/OP	$260.00 	$192.40	$0.00	$200.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.97	$192.97	$200.41	$0.00	$54.18	$0.00	$0.00	$0.00	$0.00	$118.00	$186.91	$188.80	$0.00	$169.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050301	EAP	CPT® 80324		Amphetamine - Urine	BOTH IP/OP	$260.00 	$192.40	$0.00	$200.41	$0.00	$0.00	$0.00	$0.00	$0.00	$9.54	$192.97	$192.97	$200.41	$0.00	$22.96	$0.00	$153.79	$153.79	$0.00	$118.00	$186.91	$188.80	$141.60	$169.00	$141.60	$24.47	$0.00	$0.00	$17.13	$0.00	$0.00	$0.00	$0.00	$0.00
30050302	EAP	CPT® 80307		Methaqualone - Urine	BOTH IP/OP	$241.00 	$178.34	$29.09	$175.20	$115.05	$115.05	$62.14	$62.14	$31.07	$29.09	$79.51	$79.51	$82.57	$62.14	$71.85	$40.39	$142.55	$142.55	$65.25	$109.50	$173.45	$175.20	$90.10	$102.53	$90.10	$76.56	$62.14	$62.14	$53.59	$62.14	$0.00	$0.00	$0.00	$0.00
30050303	EAP	CPT® 80367		Propoxyphene - Urine	BOTH IP/OP	$260.00 	$192.40	$0.00	$200.41	$0.03	$0.03	$0.00	$0.00	$12.01	$11.94	$192.97	$192.97	$200.41	$0.00	$54.18	$0.00	$153.79	$153.79	$0.00	$118.00	$186.91	$188.80	$0.00	$87.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050420	EAP	CPT® 85347		Act	BOTH IP/OP	$103.00 	$76.22	$2.13	$75.20	$8.79	$8.79	$4.28	$4.28	$2.14	$2.13	$6.47	$6.47	$6.72	$4.28	$6.30	$2.78	$60.92	$60.92	$4.49	$11.90	$74.45	$75.20	$6.21	$66.95	$6.21	$6.71	$4.28	$4.28	$4.70	$4.28	$0.00	$0.00	$0.00	$0.00
30050421	EAP	CPT® 83018		Quantitative Screen Metals	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.34	$33.34	$34.62	$0.00	$32.43	$0.00	$0.00	$0.00	$0.00	$61.36	$166.32	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050422	EAP	CPT® 84311		Spectrophotometry	BOTH IP/OP	$210.00 	$155.40	$0.00	$209.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.61	$10.61	$11.02	$0.00	$10.32	$0.00	$0.00	$0.00	$8.51	$19.54	$207.50	$209.60	$11.75	$101.40	$11.75	$11.00	$8.10	$8.10	$7.70	$8.10	$0.00	$0.00	$0.00	$0.00
30050423	EAP	CPT® 83519		Ria Nonantibody	BOTH IP/OP	"$1,284.00 "	$950.16	$8.28	"$1,159.20"	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$759.49	$759.49	$19.32	$37.76	"$1,147.61"	"$1,159.20"	$26.68	$388.05	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30050424	EAP	CPT® 86765		Rubeola Antibody	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$59.15	$59.15	$13.52	$36.00	$79.20	$80.00	$18.68	$0.00	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30050425	EAP	CPT® 86022		Platelet Antibodies	BOTH IP/OP	$112.00 	$82.88	$0.00	$89.60	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$66.25	$66.25	$0.00	$51.32	$88.70	$89.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050426	EAP	CPT® 82480		Assay Serum Cholinesterase	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.97	$11.97	$12.43	$0.00	$11.64	$0.00	$0.00	$0.00	$0.00	$22.02	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050427	EAP	CPT® 82638		Assay Of Dibucaine Number	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.60	$18.60	$19.31	$0.00	$18.09	$0.00	$0.00	$0.00	$0.00	$34.22	$38.81	$39.20	$0.00	$31.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050428	EAP	CPT® 88360		Tumor Immunohistochem/manual	BOTH IP/OP	$911.00 	$674.14	$0.00	$728.80	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$538.86	$538.86	$143.92	$121.34	$721.51	$728.80	$199.96	$0.00	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
30050435	EAP	CPT® 86790		Virus Antibody Nos	BOTH IP/OP	$368.00 	$272.32	$6.44	$268.80	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$217.67	$217.67	$13.52	$36.00	$266.11	$268.80	$18.68	$194.35	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30050436	EAP	CPT® 87380		Hepatitis Delta Ag Eia	BOTH IP/OP	$202.00 	$149.48	$0.00	$161.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.94	$24.94	$25.90	$0.00	$24.26	$0.00	$0.00	$0.00	$0.00	$45.88	$159.98	$161.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050437	EAP	CPT® 87502		Influenza Dna Amp Probe	BOTH IP/OP	$627.00 	$463.98	$0.00	$508.80	$107.10	$107.10	$95.80	$95.80	$47.90	$43.11	$75.96	$75.96	$78.88	$95.80	$68.64	$62.27	$370.87	$370.87	$100.59	$318.00	$503.71	$508.80	$138.91	$0.00	$138.91	$73.14	$95.80	$95.80	$51.20	$95.80	$0.00	$0.00	$0.00	$0.00
30050438	EAP	CPT® 83520		Immunoassay Auant Nos Nonab	BOTH IP/OP	"$2,216.00 "	"$1,639.84"	$7.77	"$2,000.80"	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	"$1,310.76"	"$1,310.76"	$18.13	$36.18	"$1,980.79"	"$2,000.80"	$25.04	$204.75	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30050439	EAP	CPT® 84145		Procalcitonin - Serum	BOTH IP/OP	$205.00 	$151.70	$13.40	$165.60	$55.31	$55.31	$27.22	$27.22	$13.61	$13.40	$28.87	$28.87	$29.98	$27.22	$28.27	$17.69	$121.26	$121.26	$28.58	$103.50	$163.94	$165.60	$39.47	$133.25	$39.47	$30.12	$27.22	$27.22	$21.08	$27.22	$0.00	$0.00	$0.00	$0.00
30050440	EAP	CPT® 85999		"Eosinophil Smear, Urine"	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$0.00	$49.90	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050441	EAP	HCPCS 89055		Fecal Leukocyte Smear	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.57	$3.57	$3.70	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$6.56	$93.46	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050442	EAP	CPT® 87498		"Enterovirus Rna, Qual, Rt-pcr So"	BOTH IP/OP	$114.00 	$84.36	$0.00	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.79	$29.79	$30.93	$0.00	$28.98	$0.00	$0.00	$0.00	$0.00	$54.82	$87.91	$88.80	$0.00	$74.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050443	EAP	CPT® 89055		Fecal Leukocyte Smear	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.57	$3.57	$3.70	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$6.56	$93.46	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050445	EAP	CPT® 81403		"JAK2-EXONS-12,13 SEQ"	BOTH IP/OP	$846.00 	$626.04	$0.00	$773.60	$0.00	$0.00	$185.20	$185.20	$92.60	$176.33	$627.90	$627.90	$652.10	$185.20	$174.05	$120.38	$500.41	$500.41	$194.46	$483.50	$765.86	$773.60	$268.54	$0.00	$268.54	$235.32	$185.20	$185.20	$164.72	$185.20	$0.00	$0.00	$0.00	$0.00
30050446	EAP	CPT® 86021		Proteinase -3 Antibody (so)	BOTH IP/OP	$163.00 	$120.62	$7.53	$120.00	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$96.41	$96.41	$15.80	$42.06	$118.80	$120.00	$21.82	$105.95	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30050447	EAP	CPT® 81261		"B-cell Recep Igh Gene Rearrangement , Pcr (so)"	BOTH IP/OP	$607.00 	$449.18	$0.00	$555.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.91	$280.91	$291.72	$0.00	$286.64	$0.00	$0.00	$0.00	$0.00	$347.00	$549.65	$555.20	$0.00	$0.00	$0.00	$305.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050448	EAP	CPT® 81264		"B-cell Recep Igk Gene Rearrangement , Pcr (so)"	BOTH IP/OP	$607.00 	$449.18	$0.00	$555.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.87	$211.87	$220.02	$0.00	$115.59	$0.00	$0.00	$0.00	$0.00	$347.00	$549.65	$555.20	$0.00	$0.00	$0.00	$123.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050449	EAP	CPT® 88271		MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO)	BOTH IP/OP	"$1,071.00 "	$792.54	$10.71	$851.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$633.50	$633.50	$22.49	$59.86	$842.69	$851.20	$31.06	$380.25	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30050450	EAP	CPT® 88274		Interphase In Situ Hybridization (25-99) Cells (so)	BOTH IP/OP	$537.00 	$397.38	$0.00	$426.40	$0.00	$0.00	$0.00	$0.00	$0.00	$19.07	$52.85	$52.85	$54.89	$42.38	$51.42	$27.55	$317.64	$317.64	$44.50	$97.26	$422.14	$426.40	$61.45	$349.05	$61.45	$54.79	$42.38	$42.38	$38.35	$42.38	$0.00	$0.00	$0.00	$0.00
30050451	EAP	CPT® 81342		"T - Cell Receptor Gamma Gene Rearrangement, Pcr (so)"	BOTH IP/OP	"$1,177.00 "	$870.98	$0.00	$930.40	$415.93	$415.93	$201.50	$201.50	$100.75	$100.75	$285.90	$285.90	$296.89	$201.50	$192.65	$130.98	$696.20	$696.20	$0.00	$581.50	$921.10	$930.40	$0.00	$332.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050452	EAP	CPT® 88271		Molecular Cytogenetics; Dna Probe( Fish) (so)	BOTH IP/OP	$504.00 	$372.96	$10.71	$400.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$298.12	$298.12	$22.49	$59.86	$396.79	$400.80	$31.06	$327.60	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30050454	EAP	CPT® 88271		MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO)	BOTH IP/OP	$559.00 	$413.66	$10.71	$444.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$330.65	$330.65	$22.49	$59.86	$439.56	$444.00	$31.06	$363.35	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30050455	EAP	CPT® 88275		INTERPHASE IN SITU HYBRIDIZATION (100-300) CELLS (SO)	BOTH IP/OP	$280.00 	$207.20	$23.04	$222.40	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$165.62	$165.62	$53.75	$112.22	$220.18	$222.40	$74.23	$182.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30050456	EAP	CPT® 81331		"Prader-willi/angelman Syndrome , Dna Methylation (so)"	BOTH IP/OP	$588.00 	$435.12	$0.00	$537.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$436.41	$436.41	$453.23	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$336.00	$532.22	$537.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050457	EAP	CPT® 88275		Interphase In Situ Hybridization (100-300) Cells (so)	BOTH IP/OP	$253.00 	$187.22	$23.04	$200.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$149.65	$149.65	$53.75	$112.22	$198.79	$200.80	$74.23	$164.45	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30050458	EAP	CPT® 88271		MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO)	BOTH IP/OP	$481.00 	$355.94	$10.71	$382.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$284.51	$284.51	$22.49	$59.86	$378.58	$382.40	$31.06	$312.65	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30050459	EAP	CPT® 88275		INTERPHASE IN SITU HYBRIDIZATION (100-300) CELLS (SO)	BOTH IP/OP	$242.00 	$179.08	$23.04	$192.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$143.14	$143.14	$53.75	$112.22	$190.08	$192.00	$74.23	$157.30	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30050460	EAP	CPT® 88271		Molecular Cytogenetics; Dna Probe( Fish) (so)cml	BOTH IP/OP	$481.00 	$355.94	$10.71	$382.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$284.51	$284.51	$22.49	$59.86	$378.58	$382.40	$31.06	$312.65	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30050461	EAP	CPT® 88275		Interphase In Situ Hybridization (100-300) Cells (so)cml	BOTH IP/OP	$242.00 	$179.08	$23.04	$192.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$143.14	$143.14	$53.75	$112.22	$190.08	$192.00	$74.23	$157.30	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30050462	EAP	CPT® 81315		Pml/rara T(15;17) Quant (pcr) (so)	BOTH IP/OP	$771.00 	$570.54	$0.00	$771.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$294.14	$294.14	$305.46	$0.00	$115.59	$0.00	$0.00	$0.00	$0.00	$381.00	$603.50	$609.60	$0.00	$771.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050463	EAP	CPT® 81210		Braf Mutation Analysis (so)	BOTH IP/OP	"$1,079.00 "	$798.46	$78.93	$852.80	$271.21	$271.21	$175.40	$175.40	$87.70	$78.93	$186.42	$186.42	$193.59	$175.40	$115.59	$114.01	$638.23	$638.23	$184.17	$533.00	$844.27	$852.80	$254.33	$289.41	$254.33	$123.17	$175.40	$175.40	$86.22	$175.40	$0.00	$0.00	$0.00	$0.00
30050464	EAP	CPT® 82172		Apoliprotein (so)	BOTH IP/OP	$57.00 	$42.18	$9.49	$45.60	$32.00	$32.00	$21.09	$21.09	$10.55	$9.49	$23.52	$23.52	$24.43	$21.09	$22.90	$13.71	$33.72	$33.72	$22.14	$43.30	$45.14	$45.60	$30.58	$37.05	$30.58	$24.40	$21.09	$21.09	$17.08	$21.09	$0.00	$0.00	$0.00	$0.00
30050465	EAP	CPT® 86738		"Mycoplasma Pneumoniae Antibody (igg), Ifa, Csf (so)"	BOTH IP/OP	$95.00 	$70.30	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00	$6.62	$20.11	$20.11	$20.89	$13.24	$19.57	$8.61	$56.19	$56.19	$13.90	$37.02	$77.62	$78.40	$19.20	$0.00	$19.20	$20.85	$13.24	$13.24	$14.60	$13.24	$0.00	$0.00	$0.00	$0.00
30050466	EAP	CPT® 81401		Cbfb/myh11 Inv(16) Quant Pcr (so)	BOTH IP/OP	$648.00 	$479.52	$61.65	$512.00	$64.94	$64.94	$137.00	$137.00	$68.50	$61.65	$480.95	$480.95	$499.48	$137.00	$131.58	$89.05	$383.29	$383.29	$143.85	$320.00	$506.88	$512.00	$198.65	$226.05	$198.65	$140.20	$137.00	$137.00	$98.14	$137.00	$0.00	$0.00	$0.00	$0.00
30050467	EAP	CPT® 81404		C-kit Mutation Analysis (so)	BOTH IP/OP	"$2,106.00 "	"$1,558.44"	$123.67	"$1,664.00"	$462.00	$462.00	$274.83	$274.83	$137.42	$123.67	"$1,563.07"	"$1,563.07"	"$1,623.30"	$274.83	$286.64	$178.64	"$1,245.70"	"$1,245.70"	$288.57	"$1,040.00"	"$1,647.36"	"$1,664.00"	$398.50	$453.47	$398.50	$305.42	$274.83	$274.83	$213.79	$274.83	$0.00	$0.00	$0.00	$0.00
30050468	EAP	CPT® 87798		"Bordetella Pertussis/parapertussis Dna, Pcr (so)"	BOTH IP/OP	$470.00 	$347.80	$0.00	$452.80	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$278.01	$278.01	$36.84	$54.82	$448.27	$452.80	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30050469	EAP	CPT® 86255		"Nmda- Receptor Antibody , Csf(mayo)"	BOTH IP/OP	$371.00 	$274.54	$6.03	$371.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$219.45	$219.45	$12.65	$33.68	$367.49	$371.20	$17.47	$167.70	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050470	EAP	CPT® 87661		"Trichomonas Vaginalis Rna, Qualitative, Tma (so)"	BOTH IP/OP	$153.00 	$113.22	$0.00	$122.40	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$27.84	$27.84	$28.91	$35.09	$25.16	$22.81	$90.50	$90.50	$36.84	$76.50	$121.18	$122.40	$50.88	$0.00	$50.88	$26.81	$35.09	$35.09	$18.76	$35.09	$0.00	$0.00	$0.00	$0.00
30050471	EAP	CPT® 86256		Agna-1 (mayo)	BOTH IP/OP	$86.00 	$63.64	$0.00	$86.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$50.87	$50.87	$12.65	$33.68	$85.54	$86.40	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050472	EAP	CPT® 86256		Amphiphysin (mayo)	BOTH IP/OP	$56.00 	$41.44	$0.00	$56.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$33.12	$33.12	$12.65	$33.68	$55.44	$56.00	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050473	EAP	CPT® 86256		Anna-1 (mayo)	BOTH IP/OP	$56.00 	$41.44	$0.00	$56.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$33.12	$33.12	$12.65	$33.68	$55.44	$56.00	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050474	EAP	CPT® 86256		Anna-2 (mayo)	BOTH IP/OP	$56.00 	$41.44	$0.00	$56.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$33.12	$33.12	$12.65	$33.68	$55.44	$56.00	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050475	EAP	CPT® 86256		Anna-3 (mayo)	BOTH IP/OP	$56.00 	$41.44	$0.00	$56.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$33.12	$33.12	$12.65	$33.68	$55.44	$56.00	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050476	EAP	CPT® 86256		Crmp-5-igg	BOTH IP/OP	$56.00 	$41.44	$0.00	$56.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$33.12	$33.12	$12.65	$33.68	$55.44	$56.00	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050477	EAP	CPT® 86256		Pca-1 (mayo)	BOTH IP/OP	$56.00 	$41.44	$0.00	$56.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$33.12	$33.12	$12.65	$33.68	$55.44	$56.00	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050478	EAP	CPT® 86256		Pca-2 (mayo)	BOTH IP/OP	$56.00 	$41.44	$0.00	$56.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$33.12	$33.12	$12.65	$33.68	$55.44	$56.00	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050479	EAP	CPT® 86256		Pca-tr (mayo)	BOTH IP/OP	$56.00 	$41.44	$0.00	$56.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$33.12	$33.12	$12.65	$33.68	$55.44	$56.00	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050481	EAP	CPT® 87912		"Hepatitis B Virus Drug Resistance, Genotype (so)"	BOTH IP/OP	$600.00 	$444.00	$0.00	$484.80	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$373.52	$373.52	$387.88	$257.45	$112.65	$167.34	$354.90	$354.90	$0.00	$303.00	$479.95	$484.80	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050482	EAP	CPT® 81402		"Follicular Lymphoma, Pcr (so)"	BOTH IP/OP	"$1,042.00 "	$771.08	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$773.37	$773.37	$803.17	$0.00	$192.65	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050483	EAP	CPT® 81401		"Mantle Cell Lymphoma, Pcr (so)"	BOTH IP/OP	"$1,163.00 "	$860.62	$61.65	"$1,063.20"	$64.94	$64.94	$137.00	$137.00	$68.50	$61.65	$863.18	$863.18	$896.44	$137.00	$131.58	$89.05	$687.91	$687.91	$143.85	$664.50	"$1,052.57"	"$1,063.20"	$198.65	$226.05	$198.65	$140.20	$137.00	$137.00	$98.14	$137.00	$0.00	$0.00	$0.00	$0.00
30050484	EAP	CPT® 88271		Molecular Cytogenetics: Dna Probe (fish) (so) Nhl	BOTH IP/OP	$514.00 	$380.36	$10.71	$408.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$304.03	$304.03	$22.49	$59.86	$404.71	$408.80	$31.06	$334.10	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30050485	EAP	CPT® 88275		Interphase In Situ Hybridization(100-300) Cells (so) Nhl	BOTH IP/OP	$258.00 	$190.92	$23.04	$204.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$152.61	$152.61	$53.75	$112.22	$202.75	$204.80	$74.23	$167.70	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30050486	EAP	CPT® 88271		Molecular Cytogenetics: Dna Probe (fish) (so) Fol	BOTH IP/OP	$617.00 	$456.58	$10.71	$490.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$364.96	$364.96	$22.49	$59.86	$485.50	$490.40	$31.06	$380.25	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30050487	EAP	CPT® 88275		Interphase In Situ Hybridization(100-300) Cells (so) Fol	BOTH IP/OP	$309.00 	$228.66	$23.04	$245.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$182.77	$182.77	$53.75	$112.22	$243.14	$245.60	$74.23	$200.85	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30050488	EAP	CPT® 83520		Ganglioside Gq1b Antibody (igg)(so)	BOTH IP/OP	$296.00 	$219.04	$7.77	$230.40	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$175.08	$175.08	$18.13	$36.18	$228.10	$230.40	$25.04	$192.40	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30050489	EAP	CPT® 81210		"Melanoma, Braf V600 Mutation (so)"	BOTH IP/OP	"$1,482.00 "	"$1,096.68"	$78.93	"$1,171.20"	$271.21	$271.21	$175.40	$175.40	$87.70	$78.93	$186.42	$186.42	$193.59	$175.40	$115.59	$114.01	$876.60	$876.60	$184.17	$732.00	"$1,159.49"	"$1,171.20"	$254.33	$289.41	$254.33	$123.17	$175.40	$175.40	$86.22	$175.40	$0.00	$0.00	$0.00	$0.00
30050490	EAP	CPT® 81404		"Nras, Mutation Analysis (so)"	BOTH IP/OP	$771.00 	$570.54	$123.67	$609.60	$462.00	$462.00	$274.83	$274.83	$137.42	$123.67	$572.24	$572.24	$594.29	$274.83	$286.64	$178.64	$456.05	$456.05	$288.57	$381.00	$603.50	$609.60	$398.50	$453.47	$398.50	$305.42	$274.83	$274.83	$213.79	$274.83	$0.00	$0.00	$0.00	$0.00
30050491	EAP	CPT® 83520		Interleukin -2 (il-2) (so)	BOTH IP/OP	$284.00 	$210.16	$0.00	$256.80	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$167.99	$167.99	$18.13	$36.18	$254.23	$256.80	$25.04	$0.00	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30050492	EAP	CPT® 86255		Nmo/aqp4-igg Cba (mayo)	BOTH IP/OP	$55.00 	$40.70	$0.00	$55.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$32.53	$32.53	$12.65	$33.68	$54.65	$55.20	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050493	EAP	CPT® 86341		Gad65 Abs (mayo)	BOTH IP/OP	$66.00 	$48.84	$0.00	$55.30	$40.84	$40.84	$23.57	$23.57	$11.79	$10.61	$30.05	$30.05	$31.20	$23.57	$29.24	$15.32	$39.04	$39.04	$24.75	$55.30	$52.27	$52.80	$34.18	$0.00	$34.18	$31.16	$23.57	$23.57	$21.81	$23.57	$0.00	$0.00	$0.00	$0.00
30050495	EAP	CPT® 86255		"Nmo/aqp4-igg Cba, Csf (mayo)"	BOTH IP/OP	$462.00 	$341.88	$6.03	$462.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$273.27	$273.27	$12.65	$33.68	$457.78	$462.40	$17.47	$167.70	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050496	EAP	CPT® 81170		Abl Kinase Domain Mutation In Cml (so)	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	"$1,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$135.00	$342.69	$342.69	$355.87	$300.00	$309.68	$195.00	$680.23	$680.23	$315.00	$568.00	$899.71	$908.80	$435.00	"$1,150.00"	$435.00	$329.97	$300.00	$300.00	$230.98	$300.00	$0.00	$0.00	$0.00	$0.00
30050497	EAP	CPT® 86003		Allergen Specific (mold Group)	BOTH IP/OP	$247.00 	$182.78	$2.61	$199.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$146.10	$146.10	$5.48	$14.60	$197.21	$199.20	$7.57	$64.35	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30050500	EAP	CPT® 80361		Monacetylmorphine-free-6	BOTH IP/OP	$516.00 	$381.84	$0.00	$436.80	$0.03	$0.03	$0.00	$0.00	$12.01	$11.94	$382.98	$382.98	$397.73	$0.00	$30.51	$0.00	$305.21	$305.21	$0.00	$273.00	$432.43	$436.80	$327.60	$269.10	$327.60	$32.51	$0.00	$0.00	$22.76	$0.00	$0.00	$0.00	$0.00	$0.00
30050501	EAP	CPT® 87902		Hepatits C Viral Rna Ns3 Genotype (so)	BOTH IP/OP	"$1,252.00 "	$926.48	$0.00	"$1,035.20"	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$132.42	$132.42	$137.52	$257.45	$128.84	$167.34	$740.56	$740.56	$270.32	$243.70	"$1,024.85"	"$1,035.20"	$373.30	$0.00	$373.30	$137.28	$257.45	$257.45	$96.09	$257.45	$0.00	$0.00	$0.00	$0.00
30050503	EAP	CPT® 88342		Platelet Function Plavix( Clopidogrel)	BOTH IP/OP	$326.00 	$241.24	$11.21	$236.80	$44.35	$44.35	$24.91	$24.91	$12.46	$11.21	$32.62	$32.62	$33.88	$24.91	$31.73	$16.19	$192.83	$192.83	$143.92	$106.46	$234.43	$236.80	$199.96	$211.90	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
30050520	EAP	CPT® 86361		T Cell; Absolute Cd4 Count	BOTH IP/OP	$114.00 	$84.36	$13.39	$92.00	$53.91	$53.91	$26.78	$26.78	$13.39	$13.39	$39.63	$39.63	$41.16	$26.78	$38.56	$17.41	$67.43	$67.43	$28.12	$72.94	$91.08	$92.00	$38.83	$74.10	$38.83	$41.08	$26.78	$26.78	$28.76	$26.78	$0.00	$0.00	$0.00	$0.00
30050521	EAP	CPT® 85004		Automated Differential Wbc Count	BOTH IP/OP	$83.00 	$61.42	$0.00	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.83	$9.83	$10.21	$0.00	$9.57	$0.00	$0.00	$0.00	$0.00	$18.08	$65.74	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30050550	EAP	CPT® 83520		Phospholipase A2 Ab Quant (so)	BOTH IP/OP	$424.00 	$313.76	$7.77	$329.60	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$250.80	$250.80	$18.13	$36.18	$326.30	$329.60	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30050560	EAP	CPT® 86255		Phospholipase A2 Scrn (so)	BOTH IP/OP	$263.00 	$194.62	$6.03	$210.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$155.56	$155.56	$12.65	$33.68	$208.30	$210.40	$17.47	$167.70	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30050561	EAP	CPT® 81162		Brca1&2 Seq & Full Dup/del (so)	BOTH IP/OP	"$3,730.00 "	"$2,760.20"	$912.44	"$3,730.00"	"$3,730.00"	"$3,730.00"	"$1,824.88"	"$1,824.88"	$912.44	$912.44	"$2,585.29"	"$2,585.29"	"$2,684.73"	"$1,824.88"	"$2,336.20"	"$1,186.17"	"$2,206.30"	"$2,206.30"	"$1,916.12"	"$1,842.50"	"$2,918.52"	"$2,948.00"	"$2,646.08"	"$3,011.05"	"$2,646.08"	"$2,489.27"	"$1,824.88"	"$1,824.88"	"$1,742.49"	"$1,824.88"	$0.00	$0.00	$0.00	$0.00
30050562	EAP	HCPCS C9803		Op Specimen Collection For (sars-cov-2) Covid-19	BOTH IP/OP	$57.00 	$42.18	$0.00	$57.00	$30.95	$30.95	$24.06	$24.06	$24.19	$22.38	$42.31	$42.31	$41.31	$23.64	$22.38	$15.37	$33.72	$33.72	$23.06	$28.50	$45.14	$45.60	$32.04	$57.00	$32.04	$8.92	$0.00	$0.00	$9.07	$21.96	$0.00	$0.00	$0.00	$0.00
30100001	EAP	CPT® 80299		Oxycarbazepine So	BOTH IP/OP	$122.00 	$90.28	$8.39	$97.60	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$72.16	$72.16	$19.57	$33.64	$96.62	$97.60	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30100003	EAP	CPT® 80051		"Chem 4, Electrolyte Panel"	BOTH IP/OP	$228.00 	$168.72	$3.51	$184.00	$14.47	$14.47	$7.01	$7.01	$3.51	$3.51	$10.65	$10.65	$11.06	$7.01	$10.36	$4.56	$134.86	$134.86	$7.36	$19.60	$182.16	$184.00	$10.16	$11.57	$10.16	$11.04	$7.01	$7.01	$7.73	$7.01	$0.00	$0.00	$0.00	$0.00
30100005	EAP	CPT® 80053		"Comprehensive Metabolic Panel, Evd"	BOTH IP/OP	$472.00 	$349.28	$0.00	$381.60	$21.81	$21.81	$10.56	$10.56	$5.28	$5.28	$16.06	$16.06	$16.68	$10.56	$15.61	$6.86	$279.19	$279.19	$11.09	$29.54	$377.78	$381.60	$15.31	$0.00	$15.31	$16.64	$10.56	$10.56	$11.65	$10.56	$0.00	$0.00	$0.00	$0.00
30100006	EAP	CPT® 80047		"Basic Metabolic Panel, Evd"	BOTH IP/OP	$370.00 	$273.80	$0.00	$299.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.85	$12.85	$13.35	$0.00	$32.26	$0.00	$0.00	$0.00	$0.00	$187.00	$296.21	$299.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100007	EAP	CPT® 80061		"Chem 3, Lipid Panel"	BOTH IP/OP	$282.00 	$208.68	$6.70	$228.00	$27.64	$27.64	$13.39	$13.39	$6.70	$6.70	$20.35	$20.35	$21.14	$13.39	$19.79	$8.70	$166.80	$166.80	$14.06	$37.44	$225.72	$228.00	$19.42	$22.09	$19.42	$21.09	$13.39	$13.39	$14.76	$13.39	$0.00	$0.00	$0.00	$0.00
30100008	EAP	CPT® 80069		"RENAL FUNCTION PANEL, EVD"	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$17.93	$17.93	$8.68	$8.68	$4.34	$4.34	$13.19	$13.19	$13.69	$8.68	$12.83	$5.64	$136.05	$136.05	$9.11	$24.26	$182.16	$184.00	$12.59	$0.00	$12.59	$13.67	$8.68	$8.68	$9.57	$8.68	$0.00	$0.00	$0.00	$0.00
30100009	EAP	CPT® 80069		Renal Panel	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$17.93	$17.93	$8.68	$8.68	$4.34	$4.34	$13.19	$13.19	$13.69	$8.68	$12.83	$5.64	$136.05	$136.05	$9.11	$24.26	$182.16	$184.00	$12.59	$0.00	$12.59	$13.67	$8.68	$8.68	$9.57	$8.68	$0.00	$0.00	$0.00	$0.00
30100010	EAP	CPT® 83986		"Ph, Misc Fluids"	BOTH IP/OP	$70.00 	$51.80	$0.00	$51.20	$7.39	$7.39	$3.58	$3.58	$1.79	$1.79	$5.43	$5.43	$5.64	$3.58	$5.28	$2.33	$41.41	$41.41	$3.76	$10.00	$50.69	$51.20	$5.19	$5.91	$5.19	$0.00	$3.58	$3.58	$3.94	$3.58	$0.00	$0.00	$0.00	$0.00
30100011	EAP	CPT® 80076		HEPATIC PROFILE	BOTH IP/OP	$333.00 	$246.42	$4.09	$266.40	$16.87	$16.87	$8.17	$8.17	$4.09	$4.09	$12.41	$12.41	$12.88	$8.17	$12.08	$5.31	$196.97	$196.97	$8.58	$22.84	$263.74	$266.40	$11.85	$13.48	$11.85	$12.87	$8.17	$8.17	$9.01	$8.17	$0.00	$0.00	$0.00	$0.00
30100013	EAP	CPT® 80346		Clonazepam/klonopin	BOTH IP/OP	$238.00 	$176.12	$0.00	$201.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.64	$176.64	$183.45	$0.00	$27.32	$0.00	$0.00	$0.00	$0.00	$126.00	$199.58	$201.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100014	EAP	CPT® 80197		Tacrolimus	BOTH IP/OP	$393.00 	$290.82	$0.00	$393.00	$28.35	$28.35	$13.73	$13.73	$6.87	$0.00	$20.84	$20.84	$21.64	$0.00	$20.27	$0.00	$0.00	$0.00	$14.42	$38.34	$311.26	$314.40	$19.91	$393.00	$19.91	$21.59	$13.73	$13.73	$15.11	$13.73	$0.00	$0.00	$0.00	$0.00
30100015	EAP	CPT® 80299		"Digitoxin, Serum"	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$128.95	$128.95	$19.57	$33.64	$172.66	$174.40	$27.03	$0.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30100016	EAP	CPT® 80299		Felbamate-random	BOTH IP/OP	$217.00 	$160.58	$0.00	$174.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.06	$161.06	$167.26	$0.00	$17.51	$0.00	$0.00	$0.00	$19.57	$33.64	$172.66	$174.40	$27.03	$56.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30100017	EAP	CPT® 80299		Bupropion/wellbutrin	BOTH IP/OP	$217.00 	$160.58	$8.39	$174.40	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$128.36	$128.36	$19.57	$33.64	$172.66	$174.40	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30100018	EAP	CPT® 80307		Acetaminophen	BOTH IP/OP	$585.00 	$432.90	$29.09	$425.60	$115.05	$115.05	$62.14	$62.14	$31.07	$29.09	$79.51	$79.51	$82.57	$62.14	$71.85	$40.39	$346.03	$346.03	$65.25	$266.00	$421.34	$425.60	$90.10	$102.53	$90.10	$76.56	$62.14	$62.14	$53.59	$62.14	$0.00	$0.00	$0.00	$0.00
30100019	EAP	CPT® 80076		"Hepatic Function Panel, Evd"	BOTH IP/OP	$333.00 	$246.42	$4.09	$266.40	$16.87	$16.87	$8.17	$8.17	$4.09	$4.09	$12.41	$12.41	$12.88	$8.17	$12.08	$5.31	$196.97	$196.97	$8.58	$22.84	$263.74	$266.40	$11.85	$13.48	$11.85	$12.87	$8.17	$8.17	$9.01	$8.17	$0.00	$0.00	$0.00	$0.00
30100020	EAP	CPT® 82009		ACETOACETATE-QUALITATIVE	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.99	$4.99	$5.18	$0.00	$4.85	$0.00	$0.00	$0.00	$0.00	$9.18	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100021	EAP	CPT® 82010		B-oh Butyric Acid	BOTH IP/OP	$192.00 	$142.08	$4.09	$155.20	$16.87	$16.87	$8.17	$8.17	$4.09	$4.09	$12.41	$12.41	$12.88	$8.17	$12.08	$5.31	$113.57	$113.57	$8.58	$22.84	$153.65	$155.20	$11.85	$13.48	$11.85	$12.87	$8.17	$8.17	$9.01	$8.17	$0.00	$0.00	$0.00	$0.00
30100022	EAP	CPT® 82024		"Acth, Plasma"	BOTH IP/OP	$461.00 	$341.14	$19.31	$372.80	$79.73	$79.73	$38.62	$38.62	$19.31	$19.31	$58.66	$58.66	$60.91	$38.62	$57.06	$25.10	$272.68	$272.68	$40.55	$107.94	$369.07	$372.80	$56.00	$63.72	$56.00	$60.80	$38.62	$38.62	$42.56	$38.62	$0.00	$0.00	$0.00	$0.00
30100023	EAP	CPT® 82040		Albumin (bcg)	BOTH IP/OP	$75.00 	$55.50	$2.48	$60.80	$5.94	$5.94	$4.95	$4.95	$2.48	$2.48	$4.37	$4.37	$4.54	$4.95	$4.25	$3.22	$44.36	$44.36	$5.20	$8.04	$60.19	$60.80	$7.18	$8.17	$7.18	$4.53	$4.95	$4.95	$3.17	$4.95	$0.00	$0.00	$0.00	$0.00
30100024	EAP	CPT® 82042		"Albumin,fluid"	BOTH IP/OP	$128.00 	$94.72	$3.50	$103.20	$10.69	$10.69	$7.78	$7.78	$3.89	$3.50	$7.86	$7.86	$8.16	$7.78	$7.64	$5.06	$75.71	$75.71	$8.17	$14.46	$102.17	$103.20	$11.28	$12.84	$11.28	$8.14	$7.78	$7.78	$5.70	$7.78	$0.00	$0.00	$0.00	$0.00
30100025	EAP	CPT® 82043		"Microalbumin, Ur"	BOTH IP/OP	$222.00 	$164.28	$2.89	$179.20	$11.93	$11.93	$5.78	$5.78	$2.89	$2.89	$8.79	$8.79	$9.13	$5.78	$8.55	$3.76	$131.31	$131.31	$6.07	$16.18	$177.41	$179.20	$8.38	$9.54	$8.38	$9.11	$5.78	$5.78	$6.37	$5.78	$0.00	$0.00	$0.00	$0.00
30100026	EAP	CPT® 83615		"Lactate Dehydrogenase (ldh), Evd"	BOTH IP/OP	$139.00 	$102.86	$0.00	$111.20	$12.46	$12.46	$6.04	$6.04	$3.02	$3.02	$9.16	$9.16	$9.51	$6.04	$7.46	$3.93	$82.22	$82.22	$6.34	$16.88	$110.09	$111.20	$8.76	$0.00	$8.76	$7.94	$6.04	$6.04	$5.56	$6.04	$0.00	$0.00	$0.00	$0.00
30100027	EAP	CPT® 80320		Ethanol	BOTH IP/OP	$399.00 	$295.26	$0.03	$307.55	$0.03	$0.03	$114.43	$114.43	$57.22	$6.63	$296.14	$296.14	$307.55	$114.43	$15.96	$74.38	$236.01	$236.01	$120.15	$181.50	$287.50	$290.40	$217.80	$188.81	$217.80	$17.01	$114.43	$114.43	$11.90	$114.43	$0.00	$0.00	$0.00	$0.00
30100028	EAP	CPT® 82085		"Aldolase, Serum"	BOTH IP/OP	$122.00 	$90.28	$4.86	$97.60	$20.04	$20.04	$9.71	$9.71	$4.86	$4.86	$14.74	$14.74	$15.30	$9.71	$14.33	$6.31	$72.16	$72.16	$10.20	$27.12	$96.62	$97.60	$14.08	$16.02	$14.08	$15.27	$9.71	$9.71	$10.69	$9.71	$0.00	$0.00	$0.00	$0.00
30100029	EAP	CPT® 82088		"Aldosterone, Serum"	BOTH IP/OP	$177.00 	$130.98	$20.38	$141.60	$84.11	$84.11	$40.75	$40.75	$20.38	$20.38	$61.88	$61.88	$64.26	$40.75	$60.21	$26.49	$104.70	$104.70	$42.79	$113.88	$140.18	$141.60	$59.09	$67.24	$59.09	$64.15	$40.75	$40.75	$44.91	$40.75	$0.00	$0.00	$0.00	$0.00
30100030	EAP	CPT® 82088		"Aldosterone, Ur-24hr"	BOTH IP/OP	$177.00 	$130.98	$20.38	$141.60	$84.11	$84.11	$40.75	$40.75	$20.38	$20.38	$61.88	$61.88	$64.26	$40.75	$60.21	$26.49	$104.70	$104.70	$42.79	$113.88	$140.18	$141.60	$59.09	$67.24	$59.09	$64.15	$40.75	$40.75	$44.91	$40.75	$0.00	$0.00	$0.00	$0.00
30100031	EAP	CPT® 82103		Alpha-1-antitrypsin	BOTH IP/OP	$299.00 	$221.26	$6.72	$240.80	$27.75	$27.75	$13.44	$13.44	$6.72	$6.72	$20.39	$20.39	$21.18	$13.44	$19.85	$8.74	$176.86	$176.86	$14.11	$37.54	$238.39	$240.80	$19.49	$22.18	$19.49	$21.15	$13.44	$13.44	$14.80	$13.44	$0.00	$0.00	$0.00	$0.00
30100032	EAP	CPT® 82104		Alpha-1 At Phenotype	BOTH IP/OP	$137.00 	$101.38	$0.00	$137.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.95	$21.95	$22.80	$0.00	$21.36	$0.00	$0.00	$0.00	$0.00	$40.40	$109.30	$110.40	$0.00	$137.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100033	EAP	CPT® 82105		Alpha-fetoprotein	BOTH IP/OP	$258.00 	$190.92	$0.00	$206.40	$34.64	$34.64	$16.77	$16.77	$8.39	$8.39	$25.47	$25.47	$26.45	$16.77	$24.79	$10.90	$152.61	$152.61	$17.61	$46.88	$204.34	$206.40	$24.32	$0.00	$24.32	$26.41	$16.77	$16.77	$18.49	$16.77	$0.00	$0.00	$0.00	$0.00
30100034	EAP	CPT® 82105		"Afp,maternal Serum"	BOTH IP/OP	$239.00 	$176.86	$0.00	$191.20	$34.64	$34.64	$16.77	$16.77	$8.39	$8.39	$25.47	$25.47	$26.45	$16.77	$24.79	$10.90	$141.37	$141.37	$17.61	$46.88	$189.29	$191.20	$24.32	$0.00	$24.32	$26.41	$16.77	$16.77	$18.49	$16.77	$0.00	$0.00	$0.00	$0.00
30100035	EAP	CPT® 82105		Alpha-fetoprotein	BOTH IP/OP	$257.00 	$190.18	$8.39	$206.40	$34.64	$34.64	$16.77	$16.77	$8.39	$8.39	$25.47	$25.47	$26.45	$16.77	$24.79	$10.90	$152.02	$152.02	$17.61	$46.88	$204.34	$206.40	$24.32	$27.67	$24.32	$26.41	$16.77	$16.77	$18.49	$16.77	$0.00	$0.00	$0.00	$0.00
30100036	EAP	CPT® 82106		"Afp, Amniotic Fluid"	BOTH IP/OP	$238.00 	$176.12	$0.00	$191.20	$34.64	$34.64	$17.00	$17.00	$8.50	$0.00	$25.47	$25.47	$26.45	$0.00	$24.79	$0.00	$0.00	$0.00	$17.85	$46.88	$189.29	$191.20	$24.65	$28.05	$24.65	$26.41	$17.00	$17.00	$18.49	$17.00	$0.00	$0.00	$0.00	$0.00
30100037	EAP	CPT® 82108		Aluminum	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$34.80	$34.80	$25.48	$25.48	$12.74	$12.74	$25.59	$25.59	$26.58	$25.48	$24.91	$16.56	$52.05	$52.05	$26.75	$47.10	$69.70	$70.40	$36.95	$42.04	$36.95	$0.00	$25.48	$25.48	$18.58	$25.48	$0.00	$0.00	$0.00	$0.00
30100038	EAP	CPT® 82128		"Metabolic Screen,ur"	BOTH IP/OP	$278.00 	$205.72	$0.00	$222.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.05	$21.05	$21.86	$0.00	$20.48	$0.00	$0.00	$0.00	$0.00	$38.74	$220.18	$222.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100039	EAP	CPT® 82128		"Amino Acid-scn,urine"	BOTH IP/OP	$278.00 	$205.72	$0.00	$278.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.05	$21.05	$21.86	$0.00	$20.48	$0.00	$0.00	$0.00	$0.00	$38.74	$220.18	$222.40	$0.00	$278.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100040	EAP	CPT® 82131		Homocysteine	BOTH IP/OP	$158.00 	$116.92	$10.34	$126.40	$34.82	$34.82	$22.98	$22.98	$11.49	$10.34	$25.62	$25.62	$26.60	$22.98	$24.92	$14.94	$93.46	$93.46	$24.13	$47.14	$125.14	$126.40	$33.32	$37.92	$33.32	$26.55	$22.98	$22.98	$18.58	$22.98	$0.00	$0.00	$0.00	$0.00
30100041	EAP	CPT® 82131		"Cystine, Urine-24hr"	BOTH IP/OP	$165.00 	$122.10	$10.34	$132.00	$34.82	$34.82	$22.98	$22.98	$11.49	$10.34	$25.62	$25.62	$26.60	$22.98	$24.92	$14.94	$97.60	$97.60	$24.13	$47.14	$130.68	$132.00	$33.32	$37.92	$33.32	$26.55	$22.98	$22.98	$18.58	$22.98	$0.00	$0.00	$0.00	$0.00
30100042	EAP	CPT® 82139		"Amino Acids-qnt,plas"	BOTH IP/OP	$490.00 	$362.60	$0.00	$490.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.62	$25.62	$26.60	$0.00	$24.92	$0.00	$0.00	$0.00	$0.00	$47.14	$388.08	$392.00	$0.00	$490.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100043	EAP	CPT® 82139		Amino Acids - Qnt	BOTH IP/OP	$490.00 	$362.60	$0.00	$392.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.62	$25.62	$26.60	$0.00	$24.92	$0.00	$0.00	$0.00	$0.00	$47.14	$388.08	$392.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100044	EAP	CPT® 82140		"Ammonia,blood"	BOTH IP/OP	$317.00 	$234.58	$7.29	$253.60	$20.41	$20.41	$14.57	$14.57	$7.29	$7.29	$15.02	$15.02	$15.60	$14.57	$14.62	$9.47	$187.51	$187.51	$15.30	$27.64	$251.06	$253.60	$21.13	$24.04	$21.13	$15.57	$14.57	$14.57	$10.90	$14.57	$0.00	$0.00	$0.00	$0.00
30100045	EAP	CPT® 83605		"Lactate ( Lactic Acid),evd"	BOTH IP/OP	$258.00 	$190.92	$5.34	$248.80	$22.04	$22.04	$11.57	$11.57	$5.79	$5.34	$16.21	$16.21	$16.84	$11.57	$15.78	$7.52	$152.61	$152.61	$12.15	$29.84	$246.31	$248.80	$16.78	$19.09	$16.78	$16.82	$11.57	$11.57	$11.77	$11.57	$0.00	$0.00	$0.00	$0.00
30100046	EAP	CPT® 82150		"Amylase,serum"	BOTH IP/OP	$301.00 	$222.74	$3.24	$243.20	$13.38	$13.38	$6.48	$6.48	$3.24	$3.24	$9.84	$9.84	$10.22	$6.48	$9.58	$4.21	$178.04	$178.04	$6.80	$18.12	$240.77	$243.20	$9.40	$10.69	$9.40	$10.20	$6.48	$6.48	$7.14	$6.48	$0.00	$0.00	$0.00	$0.00
30100047	EAP	CPT® 82150		"Amylase,fluid"	BOTH IP/OP	$301.00 	$222.74	$3.24	$243.20	$13.38	$13.38	$6.48	$6.48	$3.24	$3.24	$9.84	$9.84	$10.22	$6.48	$9.58	$4.21	$178.04	$178.04	$6.80	$18.12	$240.77	$243.20	$9.40	$10.69	$9.40	$10.20	$6.48	$6.48	$7.14	$6.48	$0.00	$0.00	$0.00	$0.00
30100048	EAP	CPT® 82150		"AMYLASE,URINE"	BOTH IP/OP	$283.00 	$209.42	$3.24	$243.20	$13.38	$13.38	$6.48	$6.48	$3.24	$3.24	$9.84	$9.84	$10.22	$6.48	$9.58	$4.21	$167.39	$167.39	$6.80	$18.12	$240.77	$243.20	$9.40	$10.69	$9.40	$10.20	$6.48	$6.48	$7.14	$6.48	$0.00	$0.00	$0.00	$0.00
30100049	EAP	CPT® 82157		Androstenedione	BOTH IP/OP	$251.00 	$185.74	$0.00	$251.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.45	$44.45	$46.16	$0.00	$43.24	$0.00	$0.00	$0.00	$30.74	$81.80	$200.38	$202.40	$42.46	$251.00	$42.46	$46.07	$29.28	$29.28	$32.25	$29.28	$0.00	$0.00	$0.00	$0.00
30100050	EAP	CPT® 82164		Angio-1 Convert Enz.	BOTH IP/OP	$325.00 	$240.50	$7.30	$237.60	$30.15	$30.15	$14.60	$14.60	$7.30	$7.30	$22.16	$22.16	$23.01	$14.60	$21.56	$9.49	$192.24	$192.24	$15.33	$40.78	$235.22	$237.60	$21.17	$24.09	$21.17	$22.97	$14.60	$14.60	$16.08	$14.60	$0.00	$0.00	$0.00	$0.00
30100051	EAP	CPT® 82164		Angio-1 Conv Enz-csf	BOTH IP/OP	$325.00 	$240.50	$7.30	$237.60	$30.15	$30.15	$14.60	$14.60	$7.30	$7.30	$22.16	$22.16	$23.01	$14.60	$21.56	$9.49	$192.24	$192.24	$15.33	$40.78	$235.22	$237.60	$21.17	$24.09	$21.17	$22.97	$14.60	$14.60	$16.08	$14.60	$0.00	$0.00	$0.00	$0.00
30100052	EAP	CPT® 82175		"Arsenic,urine-24hr"	BOTH IP/OP	$97.00 	$71.78	$0.00	$97.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.49	$28.81	$28.81	$29.92	$18.97	$28.02	$12.33	$57.38	$57.38	$19.92	$53.02	$76.82	$77.60	$27.51	$97.00	$27.51	$0.00	$18.97	$18.97	$20.90	$18.97	$0.00	$0.00	$0.00	$0.00
30100053	EAP	CPT® 82180		"Vitamin C, Serum"	BOTH IP/OP	$155.00 	$114.70	$0.00	$155.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.42	$13.42	$13.93	$0.00	$13.05	$0.00	$0.00	$0.00	$10.38	$24.68	$124.34	$125.60	$14.34	$155.00	$14.34	$13.91	$9.89	$9.89	$9.73	$9.89	$0.00	$0.00	$0.00	$0.00
30100054	EAP	CPT® 80345		Pentobarbital-quant	BOTH IP/OP	$245.00 	$181.30	$0.00	$188.85	$0.03	$0.03	$0.00	$0.00	$12.01	$7.03	$181.84	$181.84	$188.85	$0.00	$16.93	$0.00	$144.92	$144.92	$0.00	$111.50	$176.62	$178.40	$0.00	$159.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100055	EAP	CPT® 82232		Beta-2 Microglobulin	BOTH IP/OP	$219.00 	$162.06	$8.09	$160.80	$33.40	$33.40	$16.18	$16.18	$8.09	$8.09	$24.56	$24.56	$25.51	$16.18	$23.91	$10.52	$129.54	$129.54	$16.99	$45.22	$159.19	$160.80	$23.46	$26.70	$23.46	$25.48	$16.18	$16.18	$17.83	$16.18	$0.00	$0.00	$0.00	$0.00
30100056	EAP	CPT® 82239		"Bile Acids, Serum"	BOTH IP/OP	$261.00 	$193.14	$8.56	$192.80	$35.35	$35.35	$17.12	$17.12	$8.56	$8.56	$26.01	$26.01	$27.01	$17.12	$25.32	$11.13	$154.38	$154.38	$17.98	$47.88	$190.87	$192.80	$24.82	$28.25	$24.82	$26.97	$17.12	$17.12	$18.88	$17.12	$0.00	$0.00	$0.00	$0.00
30100057	EAP	CPT® 82247		"Bilirubin,total"	BOTH IP/OP	$117.00 	$86.58	$2.51	$94.40	$10.35	$10.35	$5.02	$5.02	$2.51	$2.51	$7.62	$7.62	$7.92	$5.02	$7.42	$3.26	$69.21	$69.21	$5.27	$14.04	$93.46	$94.40	$7.28	$8.28	$7.28	$7.91	$5.02	$5.02	$5.54	$5.02	$0.00	$0.00	$0.00	$0.00
30100058	EAP	CPT® 82150		"Amylase, Evd"	BOTH IP/OP	$283.00 	$209.42	$3.24	$243.20	$13.38	$13.38	$6.48	$6.48	$3.24	$3.24	$9.84	$9.84	$10.22	$6.48	$9.58	$4.21	$167.39	$167.39	$6.80	$18.12	$240.77	$243.20	$9.40	$10.69	$9.40	$10.20	$6.48	$6.48	$7.14	$6.48	$0.00	$0.00	$0.00	$0.00
30100059	EAP	CPT® 82247		"BILI, TOTAL-FLUID"	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$10.35	$10.35	$5.02	$5.02	$2.51	$2.51	$7.62	$7.62	$7.92	$5.02	$7.42	$3.26	$69.80	$69.80	$5.27	$14.04	$93.46	$94.40	$7.28	$0.00	$7.28	$7.91	$5.02	$5.02	$5.54	$5.02	$0.00	$0.00	$0.00	$0.00
30100060	EAP	CPT® 82248		"Bilirubin,direct"	BOTH IP/OP	$117.00 	$86.58	$2.51	$94.40	$10.35	$10.35	$5.02	$5.02	$2.51	$2.51	$7.62	$7.62	$7.92	$5.02	$7.42	$3.26	$69.21	$69.21	$5.27	$14.04	$93.46	$94.40	$7.28	$8.28	$7.28	$7.91	$5.02	$5.02	$5.54	$5.02	$0.00	$0.00	$0.00	$0.00
30100061	EAP	CPT® 82248		"Bili, Direct - Fluid"	BOTH IP/OP	$117.00 	$86.58	$2.51	$94.40	$10.35	$10.35	$5.02	$5.02	$2.51	$2.51	$7.62	$7.62	$7.92	$5.02	$7.42	$3.26	$69.21	$69.21	$5.27	$14.04	$93.46	$94.40	$7.28	$8.28	$7.28	$7.91	$5.02	$5.02	$5.54	$5.02	$0.00	$0.00	$0.00	$0.00
30100062	EAP	CPT® 84100		"Phosphorus, Evd"	BOTH IP/OP	$128.00 	$94.72	$2.37	$108.80	$9.79	$9.79	$4.74	$4.74	$2.37	$2.37	$7.21	$7.21	$7.48	$4.74	$7.01	$3.08	$75.71	$75.71	$4.98	$13.26	$107.71	$108.80	$6.87	$7.82	$6.87	$7.47	$4.74	$4.74	$5.23	$4.74	$0.00	$0.00	$0.00	$0.00
30100063	EAP	CPT® 83735		"Magnesium,evd"	BOTH IP/OP	$160.00 	$118.40	$0.00	$136.80	$13.83	$13.83	$6.70	$6.70	$3.35	$3.35	$10.17	$10.17	$10.56	$6.70	$9.89	$4.36	$94.64	$94.64	$7.04	$18.72	$135.43	$136.80	$9.72	$0.00	$9.72	$10.54	$6.70	$6.70	$7.38	$6.70	$0.00	$0.00	$0.00	$0.00
30100064	EAP	CPT® 87536		"Hiv -1 Rna, Quant,rt-pcr (quest)"	BOTH IP/OP	$269.00 	$199.06	$0.00	$222.40	$107.10	$107.10	$85.10	$85.10	$42.55	$42.55	$78.80	$78.80	$81.83	$85.10	$66.37	$55.32	$159.11	$159.11	$89.36	$145.02	$220.18	$222.40	$123.40	$0.00	$123.40	$70.72	$85.10	$85.10	$49.50	$85.10	$0.00	$0.00	$0.00	$0.00
30100065	EAP	CPT® 83519		Pth-realated Protein So	BOTH IP/OP	$434.00 	$321.16	$8.28	$337.60	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$256.71	$256.71	$19.32	$37.76	$334.22	$337.60	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30100066	EAP	CPT® 82270		"OCCULT BLOOD, STOOL"	BOTH IP/OP	$58.00 	$42.92	$0.00	$46.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.88	$4.88	$5.07	$0.00	$4.75	$0.00	$0.00	$0.00	$0.00	$8.98	$45.94	$46.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100067	EAP	CPT® 82271		"Occult Blood, Gastric"	BOTH IP/OP	$57.00 	$42.18	$0.00	$57.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.88	$4.88	$5.07	$0.00	$4.75	$0.00	$0.00	$0.00	$5.59	$8.98	$45.94	$46.40	$7.71	$57.00	$7.71	$0.00	$5.32	$5.32	$3.54	$5.32	$0.00	$0.00	$0.00	$0.00
30100068	EAP	CPT® 82306		"Vitamin D, Serum"	BOTH IP/OP	$279.00 	$206.46	$14.80	$225.60	$61.12	$61.12	$29.60	$29.60	$14.80	$14.80	$44.95	$44.95	$46.68	$29.60	$43.72	$19.24	$165.03	$165.03	$31.08	$82.72	$223.34	$225.60	$42.92	$48.84	$42.92	$46.59	$29.60	$29.60	$32.61	$29.60	$0.00	$0.00	$0.00	$0.00
30100069	EAP	CPT® 82308		"Calcitonin, Serum"	BOTH IP/OP	$138.00 	$102.12	$0.00	$111.20	$55.31	$55.31	$26.79	$26.79	$13.40	$13.40	$40.66	$40.66	$42.23	$26.79	$39.55	$17.41	$81.63	$81.63	$28.13	$74.82	$110.09	$111.20	$38.85	$44.20	$38.85	$0.00	$26.79	$26.79	$29.50	$26.79	$0.00	$0.00	$0.00	$0.00
30100070	EAP	CPT® 82310		Calcium	BOTH IP/OP	$102.00 	$75.48	$2.58	$74.40	$10.67	$10.67	$5.16	$5.16	$2.58	$2.58	$7.83	$7.83	$8.13	$5.16	$7.46	$3.35	$60.33	$60.33	$5.42	$14.40	$73.66	$74.40	$7.48	$8.51	$7.48	$7.94	$5.16	$5.16	$5.56	$5.16	$0.00	$0.00	$0.00	$0.00
30100071	EAP	CPT® 82310		"Calcium,synvl Fluid"	BOTH IP/OP	$102.00 	$75.48	$2.58	$74.40	$10.67	$10.67	$5.16	$5.16	$2.58	$2.58	$7.83	$7.83	$8.13	$5.16	$7.46	$3.35	$60.33	$60.33	$5.42	$14.40	$73.66	$74.40	$7.48	$8.51	$7.48	$7.94	$5.16	$5.16	$5.56	$5.16	$0.00	$0.00	$0.00	$0.00
30100072	EAP	CPT® 82310		"CALCIUM, URINE"	BOTH IP/OP	$90.00 	$66.60	$0.00	$74.40	$10.67	$10.67	$5.16	$5.16	$2.58	$2.58	$7.83	$7.83	$8.13	$5.16	$7.46	$3.35	$53.24	$53.24	$5.42	$14.40	$73.66	$74.40	$7.48	$0.00	$7.48	$7.94	$5.16	$5.16	$5.56	$5.16	$0.00	$0.00	$0.00	$0.00
30100073	EAP	CPT® 82330		"Calcium,ionized,wb"	BOTH IP/OP	$375.00 	$277.50	$6.84	$273.60	$28.22	$28.22	$13.68	$13.68	$6.84	$6.84	$20.75	$20.75	$21.55	$13.68	$20.18	$8.89	$221.81	$221.81	$14.36	$38.18	$270.86	$273.60	$19.84	$22.57	$19.84	$21.50	$13.68	$13.68	$15.05	$13.68	$0.00	$0.00	$0.00	$0.00
30100074	EAP	CPT® 82365		Stone Analysis	BOTH IP/OP	$399.00 	$295.26	$6.45	$291.20	$26.61	$26.61	$12.90	$12.90	$6.45	$6.45	$19.58	$19.58	$20.34	$12.90	$19.05	$8.39	$236.01	$236.01	$13.55	$36.02	$288.29	$291.20	$18.71	$21.29	$18.71	$20.30	$12.90	$12.90	$14.21	$12.90	$0.00	$0.00	$0.00	$0.00
30100075	EAP	CPT® 82374		Co2 Content	BOTH IP/OP	$35.00 	$25.90	$2.44	$28.00	$10.08	$10.08	$4.88	$4.88	$2.44	$2.44	$7.43	$7.43	$7.71	$4.88	$7.22	$3.17	$20.70	$20.70	$5.12	$13.66	$27.72	$28.00	$7.08	$8.05	$7.08	$7.70	$4.88	$4.88	$5.39	$4.88	$0.00	$0.00	$0.00	$0.00
30100076	EAP	CPT® 82378		Cea	BOTH IP/OP	$302.00 	$223.48	$9.48	$244.00	$39.15	$39.15	$18.96	$18.96	$9.48	$9.48	$28.81	$28.81	$29.92	$18.96	$28.02	$12.32	$178.63	$178.63	$19.91	$53.02	$241.56	$244.00	$27.49	$31.28	$27.49	$29.86	$18.96	$18.96	$20.90	$18.96	$0.00	$0.00	$0.00	$0.00
30100077	EAP	CPT® 82379		"Carnitine, Total"	BOTH IP/OP	$157.00 	$116.18	$0.00	$127.20	$34.82	$34.82	$16.87	$16.87	$8.44	$8.43	$25.62	$25.62	$26.60	$16.87	$24.92	$10.97	$92.87	$92.87	$0.00	$47.14	$125.93	$127.20	$0.00	$27.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100078	EAP	CPT® 82379		"Carnitine, Free"	BOTH IP/OP	$157.00 	$116.18	$0.00	$127.20	$34.82	$34.82	$16.87	$16.87	$8.44	$8.43	$25.62	$25.62	$26.60	$16.87	$24.92	$10.97	$92.87	$92.87	$0.00	$47.14	$125.93	$127.20	$0.00	$27.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100079	EAP	CPT® 82380		"Carotene, Serum"	BOTH IP/OP	$120.00 	$88.80	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.01	$14.01	$14.55	$0.00	$13.63	$0.00	$0.00	$0.00	$0.00	$25.78	$95.83	$96.80	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100080	EAP	CPT® 82384		"Catecholamines,plasm"	BOTH IP/OP	$173.00 	$128.02	$12.63	$138.40	$52.11	$52.11	$25.25	$25.25	$12.63	$12.63	$38.34	$38.34	$39.82	$25.25	$37.30	$16.41	$102.33	$102.33	$26.51	$70.56	$137.02	$138.40	$36.61	$41.66	$36.61	$39.74	$25.25	$25.25	$27.82	$25.25	$0.00	$0.00	$0.00	$0.00
30100081	EAP	CPT® 82384		"Catecholam.,ur Frac"	BOTH IP/OP	$173.00 	$128.02	$12.63	$138.40	$52.11	$52.11	$25.25	$25.25	$12.63	$12.63	$38.34	$38.34	$39.82	$25.25	$37.30	$16.41	$102.33	$102.33	$26.51	$70.56	$137.02	$138.40	$36.61	$41.66	$36.61	$39.74	$25.25	$25.25	$27.82	$25.25	$0.00	$0.00	$0.00	$0.00
30100082	EAP	CPT® 82390		"Ceruloplasmin,serum"	BOTH IP/OP	$236.00 	$174.64	$5.37	$188.80	$22.18	$22.18	$10.74	$10.74	$5.37	$5.37	$16.31	$16.31	$16.93	$10.74	$15.87	$6.98	$139.59	$139.59	$11.28	$30.02	$186.91	$188.80	$15.57	$17.72	$15.57	$16.91	$10.74	$10.74	$11.83	$10.74	$0.00	$0.00	$0.00	$0.00
30100083	EAP	CPT® 82415		Chloramphen-peak	BOTH IP/OP	$145.00 	$107.30	$0.00	$134.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.24	$19.24	$19.98	$0.00	$18.71	$0.00	$0.00	$0.00	$0.00	$35.40	$114.84	$116.00	$0.00	$134.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100084	EAP	CPT® 82435		Chloride	BOTH IP/OP	$117.00 	$86.58	$0.00	$93.60	$9.50	$9.50	$4.60	$4.60	$2.30	$2.30	$6.97	$6.97	$7.24	$4.60	$6.79	$2.99	$69.21	$69.21	$0.00	$12.84	$92.66	$93.60	$0.00	$7.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100085	EAP	CPT® 82436		"Chloride, Urine"	BOTH IP/OP	$123.00 	$91.02	$2.59	$98.40	$10.38	$10.38	$5.75	$5.75	$2.88	$2.59	$7.63	$7.63	$7.93	$5.75	$7.42	$3.74	$72.75	$72.75	$6.04	$14.04	$97.42	$98.40	$8.34	$9.49	$8.34	$7.91	$5.75	$5.75	$5.54	$5.75	$0.00	$0.00	$0.00	$0.00
30100086	EAP	CPT® 82438		"Chloride,fluid"	BOTH IP/OP	$105.00 	$77.70	$0.00	$105.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.43	$7.43	$7.71	$0.00	$7.22	$0.00	$0.00	$0.00	$0.00	$13.66	$83.16	$84.00	$0.00	$105.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100087	EAP	CPT® 87798		"Toxoplasma Gondii Dna,qual,pcr So"	BOTH IP/OP	$422.00 	$312.28	$17.55	$340.00	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$249.61	$249.61	$36.84	$54.82	$336.60	$340.00	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30100088	EAP	CPT® 82465		Cholesterol	BOTH IP/OP	$91.00 	$67.34	$2.18	$73.60	$8.98	$8.98	$4.35	$4.35	$2.18	$2.18	$6.61	$6.61	$6.87	$4.35	$6.43	$2.83	$53.83	$53.83	$4.57	$12.16	$72.86	$73.60	$6.31	$7.18	$6.31	$6.85	$4.35	$4.35	$4.79	$4.35	$0.00	$0.00	$0.00	$0.00
30100090	EAP	CPT® 82384		"Catacholamines,frac,ur So"	BOTH IP/OP	$46.00 	$34.04	$12.63	$46.00	$46.00	$46.00	$25.25	$25.25	$12.63	$12.63	$38.34	$38.34	$39.82	$25.25	$37.30	$16.41	$27.21	$27.21	$26.51	$46.00	$36.43	$36.80	$36.61	$41.66	$36.61	$39.74	$25.25	$25.25	$27.82	$25.25	$0.00	$0.00	$0.00	$0.00
30100096	EAP	CPT® 82507		"Citric Acid, Ur-24hr"	BOTH IP/OP	$129.00 	$95.46	$0.00	$129.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.90	$42.22	$42.22	$43.85	$27.80	$41.08	$18.07	$76.30	$76.30	$0.00	$77.70	$102.17	$103.20	$0.00	$129.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100097	EAP	CPT® 82523		Pyridinoline	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$38.57	$38.57	$18.68	$18.68	$9.34	$9.34	$28.38	$28.38	$29.47	$18.68	$27.60	$12.14	$52.05	$52.05	$19.61	$52.22	$69.70	$70.40	$27.09	$0.00	$27.09	$29.41	$18.68	$18.68	$20.59	$18.68	$0.00	$0.00	$0.00	$0.00
30100098	EAP	CPT® 82525		"Copper, Serum"	BOTH IP/OP	$127.00 	$93.98	$6.21	$102.40	$25.61	$25.61	$12.41	$12.41	$6.21	$6.21	$18.84	$18.84	$19.57	$12.41	$18.33	$8.07	$75.12	$75.12	$13.03	$34.68	$101.38	$102.40	$17.99	$20.48	$17.99	$19.53	$12.41	$12.41	$13.67	$12.41	$0.00	$0.00	$0.00	$0.00
30100099	EAP	CPT® 82525		"Copper, Urine-24hr"	BOTH IP/OP	$127.00 	$93.98	$6.21	$102.40	$25.61	$25.61	$12.41	$12.41	$6.21	$6.21	$18.84	$18.84	$19.57	$12.41	$18.33	$8.07	$75.12	$75.12	$13.03	$34.68	$101.38	$102.40	$17.99	$20.48	$17.99	$19.53	$12.41	$12.41	$13.67	$12.41	$0.00	$0.00	$0.00	$0.00
30100100	EAP	CPT® 82530		"Cortisol Free, Ur-24h"	BOTH IP/OP	$302.00 	$223.48	$8.36	$244.00	$34.48	$34.48	$16.71	$16.71	$8.36	$8.36	$25.39	$25.39	$26.36	$16.71	$24.70	$10.86	$178.63	$178.63	$17.55	$46.70	$241.56	$244.00	$24.23	$27.57	$24.23	$26.31	$16.71	$16.71	$18.42	$16.71	$0.00	$0.00	$0.00	$0.00
30100101	EAP	CPT® 82533		"Cortisol,serum"	BOTH IP/OP	$650.00 	$481.00	$8.15	$525.60	$33.66	$33.66	$16.30	$16.30	$8.15	$8.15	$24.76	$24.76	$25.71	$16.30	$24.09	$10.60	$384.48	$384.48	$17.12	$45.56	$520.34	$525.60	$23.64	$26.90	$23.64	$25.67	$16.30	$16.30	$17.97	$16.30	$0.00	$0.00	$0.00	$0.00
30100102	EAP	CPT® 82542		"Thiopurine Methyl Transferase, Qt"	BOTH IP/OP	$791.00 	$585.34	$6.62	$625.60	$37.28	$37.28	$24.09	$24.09	$12.05	$10.84	$9.12	$9.12	$9.47	$24.09	$8.87	$15.66	$467.88	$467.88	$25.29	$16.78	$619.34	$625.60	$34.93	$39.75	$34.93	$9.45	$24.09	$24.09	$6.62	$24.09	$0.00	$0.00	$0.00	$0.00
30100103	EAP	CPT® 82550		"Cpk,total-serum"	BOTH IP/OP	$176.00 	$130.24	$0.00	$151.20	$13.44	$13.44	$6.51	$6.51	$3.26	$3.25	$9.89	$9.89	$10.27	$6.51	$7.46	$4.23	$104.10	$104.10	$6.84	$18.20	$149.69	$151.20	$9.44	$0.00	$9.44	$7.94	$6.51	$6.51	$5.56	$6.51	$0.00	$0.00	$0.00	$0.00
30100104	EAP	CPT® 82656		Pancreatic Elastase-1 So	BOTH IP/OP	$226.00 	$167.24	$5.76	$179.20	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$47.10	$7.49	$133.68	$133.68	$12.11	$29.88	$177.41	$179.20	$16.72	$19.02	$16.72	$35.06	$11.53	$11.53	$35.66	$11.53	$0.00	$0.00	$0.00	$0.00
30100105	EAP	CPT® 82553		Ckmb-meia	BOTH IP/OP	$355.00 	$262.70	$5.77	$258.40	$23.84	$23.84	$11.55	$11.55	$5.78	$5.77	$17.53	$17.53	$18.21	$11.55	$17.05	$7.51	$209.98	$209.98	$12.13	$32.26	$255.82	$258.40	$16.75	$19.06	$16.75	$18.17	$11.55	$11.55	$12.72	$11.55	$0.00	$0.00	$0.00	$0.00
30100106	EAP	CPT® 82565		Creatinine	BOTH IP/OP	$139.00 	$102.86	$2.56	$103.20	$10.59	$10.59	$5.12	$5.12	$2.56	$2.56	$7.78	$7.78	$8.08	$5.12	$7.46	$3.33	$82.22	$82.22	$5.38	$14.32	$102.17	$103.20	$7.42	$8.45	$7.42	$7.94	$5.12	$5.12	$5.56	$5.12	$0.00	$0.00	$0.00	$0.00
30100107	EAP	CPT® 82570		"Creatinine,fluid"	BOTH IP/OP	$122.00 	$90.28	$2.59	$97.60	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$72.16	$72.16	$5.44	$14.46	$96.62	$97.60	$7.51	$8.55	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30100108	EAP	CPT® 82570		"Creat,amniotic Fld"	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$76.30	$76.30	$5.44	$14.46	$102.17	$103.20	$7.51	$0.00	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30100109	EAP	CPT® 82570		"Creatinine, Urine"	BOTH IP/OP	$122.00 	$90.28	$2.59	$97.60	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$72.16	$72.16	$5.44	$14.46	$96.62	$97.60	$7.51	$8.55	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30100110	EAP	CPT® 82108		"Aluminum, 24hr Urine So"	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$34.80	$34.80	$25.48	$25.48	$12.74	$12.74	$25.59	$25.59	$26.58	$25.48	$24.91	$16.56	$40.81	$40.81	$26.75	$47.10	$54.65	$55.20	$36.95	$42.04	$36.95	$0.00	$25.48	$25.48	$18.58	$25.48	$0.00	$0.00	$0.00	$0.00
30100111	EAP	CPT® 82575		Creatinine Clearance	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.34	$14.34	$14.89	$0.00	$13.95	$0.00	$0.00	$0.00	$0.00	$26.40	$196.42	$198.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100112	EAP	CPT® 82595		"Cryoglobulin,serum"	BOTH IP/OP	$88.00 	$65.12	$3.23	$71.20	$13.36	$13.36	$6.47	$6.47	$3.24	$3.23	$9.83	$9.83	$10.21	$6.47	$9.57	$4.21	$52.05	$52.05	$6.79	$18.08	$70.49	$71.20	$9.38	$10.68	$9.38	$10.19	$6.47	$6.47	$7.13	$6.47	$0.00	$0.00	$0.00	$0.00
30100113	EAP	CPT® 82595		"Cryocrit,serum"	BOTH IP/OP	$88.00 	$65.12	$3.23	$71.20	$13.36	$13.36	$6.47	$6.47	$3.24	$3.23	$9.83	$9.83	$10.21	$6.47	$9.57	$4.21	$52.05	$52.05	$6.79	$18.08	$70.49	$71.20	$9.38	$10.68	$9.38	$10.19	$6.47	$6.47	$7.13	$6.47	$0.00	$0.00	$0.00	$0.00
30100114	EAP	CPT® 82600		Cyanide	BOTH IP/OP	$135.00 	$99.90	$0.00	$135.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.46	$29.46	$30.60	$0.00	$28.67	$0.00	$0.00	$0.00	$0.00	$54.22	$107.71	$108.80	$0.00	$135.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100115	EAP	CPT® 82607		"Vitamin B12,serum"	BOTH IP/OP	$398.00 	$294.52	$7.54	$321.60	$31.13	$31.13	$15.08	$15.08	$7.54	$7.54	$22.89	$22.89	$23.77	$15.08	$22.26	$9.80	$235.42	$235.42	$15.83	$42.12	$318.38	$321.60	$21.87	$24.88	$21.87	$23.72	$15.08	$15.08	$16.60	$15.08	$0.00	$0.00	$0.00	$0.00
30100116	EAP	CPT® 82627		"Dhea-so4, Serum"	BOTH IP/OP	$428.00 	$316.72	$11.12	$345.60	$45.91	$45.91	$22.23	$22.23	$11.12	$11.12	$33.76	$33.76	$35.06	$22.23	$32.84	$14.45	$253.16	$253.16	$23.34	$62.14	$342.14	$345.60	$32.23	$36.68	$32.23	$35.00	$22.23	$22.23	$24.50	$22.23	$0.00	$0.00	$0.00	$0.00
30100117	EAP	CPT® 82634		"Deoxycortisol,11-bld"	BOTH IP/OP	$129.00 	$95.46	$0.00	$129.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.45	$44.45	$46.16	$0.00	$43.24	$0.00	$0.00	$0.00	$0.00	$81.80	$102.17	$103.20	$0.00	$129.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100118	EAP	CPT® 80327		Dihydrotestosterone	BOTH IP/OP	$142.00 	$105.08	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.39	$105.39	$109.45	$0.00	$38.14	$0.00	$0.00	$0.00	$0.00	$64.50	$102.17	$103.20	$0.00	$92.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100119	EAP	CPT® 82652		"Vit D,1,25-dihydroxy"	BOTH IP/OP	$355.00 	$262.70	$19.25	$286.40	$79.46	$79.46	$38.50	$38.50	$19.25	$19.25	$58.45	$58.45	$60.70	$38.50	$56.86	$25.03	$209.98	$209.98	$40.43	$107.56	$283.54	$286.40	$55.83	$63.53	$55.83	$60.58	$38.50	$38.50	$42.41	$38.50	$0.00	$0.00	$0.00	$0.00
30100120	EAP	CPT® 82664		"Amylase, Isoenzymes"	BOTH IP/OP	$501.00 	$370.74	$0.00	$404.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.17	$52.17	$54.17	$0.00	$50.75	$0.00	$0.00	$0.00	$64.58	$96.00	$400.75	$404.80	$89.18	$222.00	$89.18	$54.07	$61.50	$61.50	$37.85	$61.50	$0.00	$0.00	$0.00	$0.00
30100121	EAP	CPT® 82668		"Erythropoietin,serum"	BOTH IP/OP	$246.00 	$182.04	$9.40	$198.40	$38.78	$38.78	$18.79	$18.79	$9.40	$9.40	$28.55	$28.55	$29.65	$18.79	$27.76	$12.21	$145.51	$145.51	$19.73	$52.52	$196.42	$198.40	$27.25	$31.00	$27.25	$29.58	$18.79	$18.79	$20.71	$18.79	$0.00	$0.00	$0.00	$0.00
30100122	EAP	CPT® 82670		Estradiol	BOTH IP/OP	$405.00 	$299.70	$13.97	$324.00	$57.66	$57.66	$27.94	$27.94	$13.97	$13.97	$42.43	$42.43	$44.06	$27.94	$41.28	$18.16	$239.56	$239.56	$29.34	$78.08	$320.76	$324.00	$40.51	$46.10	$40.51	$43.98	$27.94	$27.94	$30.79	$27.94	$0.00	$0.00	$0.00	$0.00
30100123	EAP	CPT® 82677		"Estriol(free),serum"	BOTH IP/OP	$139.00 	$102.86	$0.00	$139.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.72	$36.72	$38.13	$0.00	$35.72	$0.00	$0.00	$0.00	$25.39	$67.58	$110.09	$111.20	$35.06	$139.00	$35.06	$38.06	$24.18	$24.18	$26.64	$24.18	$0.00	$0.00	$0.00	$0.00
30100124	EAP	CPT® 82677		"Estriol, Urine-ref"	BOTH IP/OP	$139.00 	$102.86	$0.00	$111.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.72	$36.72	$38.13	$0.00	$35.72	$0.00	$0.00	$0.00	$25.39	$67.58	$110.09	$111.20	$35.06	$0.00	$35.06	$38.06	$24.18	$24.18	$26.64	$24.18	$0.00	$0.00	$0.00	$0.00
30100125	EAP	CPT® 82677		"Estriol, Maternal Serum"	BOTH IP/OP	$139.00 	$102.86	$0.00	$111.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.72	$36.72	$38.13	$0.00	$35.72	$0.00	$0.00	$0.00	$25.39	$67.58	$110.09	$111.20	$35.06	$0.00	$35.06	$38.06	$24.18	$24.18	$26.64	$24.18	$0.00	$0.00	$0.00	$0.00
30100126	EAP	CPT® 82679		"Estrone, Serum"	BOTH IP/OP	$118.00 	$87.32	$12.48	$94.40	$51.51	$51.51	$24.95	$24.95	$12.48	$12.48	$37.91	$37.91	$39.37	$24.95	$36.88	$16.22	$69.80	$69.80	$26.20	$69.76	$93.46	$94.40	$36.18	$41.17	$36.18	$39.29	$24.95	$24.95	$27.50	$24.95	$0.00	$0.00	$0.00	$0.00
30100127	EAP	CPT® 82693		"Ethylene Glycol,bld"	BOTH IP/OP	$364.00 	$269.36	$0.00	$337.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.62	$22.62	$23.49	$0.00	$22.02	$0.00	$0.00	$0.00	$0.00	$41.64	$291.46	$294.40	$0.00	$337.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100128	EAP	CPT® 82705		"Stool Fat, Qual"	BOTH IP/OP	$64.00 	$47.36	$0.00	$52.00	$10.51	$10.51	$5.10	$5.10	$2.55	$2.55	$7.73	$7.73	$8.02	$5.10	$7.52	$3.32	$37.86	$37.86	$0.00	$14.22	$51.48	$52.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100129	EAP	CPT® 82710		"Fecal Fat, Quant"	BOTH IP/OP	$89.00 	$65.86	$8.40	$72.00	$34.69	$34.69	$16.80	$16.80	$8.40	$8.40	$25.51	$25.51	$26.49	$16.80	$24.81	$10.92	$52.64	$52.64	$17.64	$46.94	$71.28	$72.00	$24.36	$27.72	$24.36	$26.44	$16.80	$16.80	$18.51	$16.80	$0.00	$0.00	$0.00	$0.00
30100130	EAP	CPT® 82725		"Fatty Acids,ess-ser"	BOTH IP/OP	$212.00 	$156.88	$0.00	$175.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.22	$20.22	$21.00	$0.00	$19.67	$0.00	$0.00	$0.00	$0.00	$37.20	$166.32	$168.00	$0.00	$175.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100131	EAP	CPT® 82728		"Ferritin,serum"	BOTH IP/OP	$247.00 	$182.78	$6.82	$199.20	$28.14	$28.14	$13.63	$13.63	$6.82	$6.82	$20.69	$20.69	$21.48	$13.63	$20.13	$8.86	$146.10	$146.10	$14.31	$38.06	$197.21	$199.20	$19.76	$22.49	$19.76	$21.45	$13.63	$13.63	$15.01	$13.63	$0.00	$0.00	$0.00	$0.00
30100132	EAP	CPT® 82731		Fetal Fibronectin	BOTH IP/OP	$614.00 	$454.36	$32.21	$496.00	$132.98	$132.98	$64.41	$64.41	$32.21	$32.21	$97.80	$97.80	$101.56	$64.41	$95.14	$41.87	$363.18	$363.18	$67.63	$179.98	$491.04	$496.00	$93.39	$106.28	$93.39	$101.37	$64.41	$64.41	$70.96	$64.41	$0.00	$0.00	$0.00	$0.00
30100133	EAP	CPT® 82746		"Folate,serum"	BOTH IP/OP	$292.00 	$216.08	$7.35	$235.20	$30.36	$30.36	$14.70	$14.70	$7.35	$7.35	$22.33	$22.33	$23.19	$14.70	$21.72	$9.56	$172.72	$172.72	$15.44	$41.08	$232.85	$235.20	$21.32	$24.26	$21.32	$23.15	$14.70	$14.70	$16.20	$14.70	$0.00	$0.00	$0.00	$0.00
30100134	EAP	CPT® 82747		"Folate, Rbc"	BOTH IP/OP	$434.00 	$321.16	$8.66	$350.40	$35.75	$35.75	$17.65	$17.65	$8.83	$8.66	$26.30	$26.30	$27.31	$17.65	$25.59	$11.47	$256.71	$256.71	$18.53	$48.40	$346.90	$350.40	$25.59	$29.12	$25.59	$27.27	$17.65	$17.65	$19.09	$17.65	$0.00	$0.00	$0.00	$0.00
30100135	EAP	CPT® 82775		Galactose-1-put	BOTH IP/OP	$224.00 	$165.76	$0.00	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.98	$31.98	$33.21	$0.00	$31.12	$0.00	$0.00	$0.00	$0.00	$58.86	$177.41	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100136	EAP	CPT® 82775		Galactose-1-phos	BOTH IP/OP	$224.00 	$165.76	$0.00	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.98	$31.98	$33.21	$0.00	$31.12	$0.00	$0.00	$0.00	$0.00	$58.86	$177.41	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100137	EAP	CPT® 82784		"Immunoglob-a,serum"	BOTH IP/OP	$273.00 	$202.02	$4.65	$220.80	$19.19	$19.19	$9.30	$9.30	$4.65	$4.65	$14.12	$14.12	$14.67	$9.30	$13.73	$6.05	$161.48	$161.48	$9.77	$25.98	$218.59	$220.80	$13.49	$15.35	$13.49	$14.63	$9.30	$9.30	$10.24	$9.30	$0.00	$0.00	$0.00	$0.00
30100138	EAP	CPT® 82784		"Immunoglob-g,serum"	BOTH IP/OP	$273.00 	$202.02	$4.65	$220.80	$19.19	$19.19	$9.30	$9.30	$4.65	$4.65	$14.12	$14.12	$14.67	$9.30	$13.73	$6.05	$161.48	$161.48	$9.77	$25.98	$218.59	$220.80	$13.49	$15.35	$13.49	$14.63	$9.30	$9.30	$10.24	$9.30	$0.00	$0.00	$0.00	$0.00
30100139	EAP	CPT® 82784		"Immunoglob-m,serum"	BOTH IP/OP	$273.00 	$202.02	$4.65	$220.80	$19.19	$19.19	$9.30	$9.30	$4.65	$4.65	$14.12	$14.12	$14.67	$9.30	$13.73	$6.05	$161.48	$161.48	$9.77	$25.98	$218.59	$220.80	$13.49	$15.35	$13.49	$14.63	$9.30	$9.30	$10.24	$9.30	$0.00	$0.00	$0.00	$0.00
30100140	EAP	CPT® 82784		"Immuno-igg,csf"	BOTH IP/OP	$165.00 	$122.10	$4.65	$133.60	$19.19	$19.19	$9.30	$9.30	$4.65	$4.65	$14.12	$14.12	$14.67	$9.30	$13.73	$6.05	$97.60	$97.60	$9.77	$25.98	$132.26	$133.60	$13.49	$15.35	$13.49	$14.63	$9.30	$9.30	$10.24	$9.30	$0.00	$0.00	$0.00	$0.00
30100141	EAP	CPT® 82784		"Immunoglob-igd,serum"	BOTH IP/OP	$251.00 	$185.74	$4.65	$202.40	$19.19	$19.19	$9.30	$9.30	$4.65	$4.65	$14.12	$14.12	$14.67	$9.30	$13.73	$6.05	$148.47	$148.47	$9.77	$25.98	$200.38	$202.40	$13.49	$15.35	$13.49	$14.63	$9.30	$9.30	$10.24	$9.30	$0.00	$0.00	$0.00	$0.00
30100142	EAP	CPT® 82785		"Immunoglob-ige,serum"	BOTH IP/OP	$202.00 	$149.48	$8.23	$163.20	$33.98	$33.98	$16.46	$16.46	$8.23	$8.23	$25.01	$25.01	$25.97	$16.46	$24.33	$10.70	$119.48	$119.48	$17.28	$46.02	$161.57	$163.20	$23.87	$27.16	$23.87	$25.92	$16.46	$16.46	$18.15	$16.46	$0.00	$0.00	$0.00	$0.00
30100143	EAP	CPT® 82800		"Ph, Ven."	BOTH IP/OP	$222.00 	$164.28	$4.95	$222.00	$17.48	$17.48	$11.00	$11.00	$5.50	$4.95	$12.86	$12.86	$13.36	$11.00	$12.52	$7.15	$131.31	$131.31	$11.55	$23.66	$159.98	$161.60	$15.95	$222.00	$15.95	$13.34	$11.00	$11.00	$9.34	$11.00	$0.00	$0.00	$0.00	$0.00
30100144	EAP	CPT® 82800		"Ph, Art."	BOTH IP/OP	$222.00 	$164.28	$4.95	$222.00	$17.48	$17.48	$11.00	$11.00	$5.50	$4.95	$12.86	$12.86	$13.36	$11.00	$12.52	$7.15	$131.31	$131.31	$11.55	$23.66	$159.98	$161.60	$15.95	$222.00	$15.95	$13.34	$11.00	$11.00	$9.34	$11.00	$0.00	$0.00	$0.00	$0.00
30100145	EAP	CPT® 82800		"Ph, Cord, Art."	BOTH IP/OP	$201.00 	$148.74	$4.95	$222.00	$17.48	$17.48	$11.00	$11.00	$5.50	$4.95	$12.86	$12.86	$13.36	$11.00	$12.52	$7.15	$118.89	$118.89	$11.55	$23.66	$159.98	$161.60	$15.95	$222.00	$15.95	$13.34	$11.00	$11.00	$9.34	$11.00	$0.00	$0.00	$0.00	$0.00
30100148	EAP	CPT® 82803		Blood Gas-venous	BOTH IP/OP	$510.00 	$377.40	$11.73	$371.20	$39.94	$39.94	$26.07	$26.07	$13.04	$11.73	$29.38	$29.38	$30.51	$26.07	$28.59	$16.95	$301.67	$301.67	$27.37	$54.08	$367.49	$371.20	$37.80	$43.02	$37.80	$30.46	$26.07	$26.07	$21.33	$26.07	$0.00	$0.00	$0.00	$0.00
30100149	EAP	CPT® 82803		Blood Gas-arterial	BOTH IP/OP	$510.00 	$377.40	$11.73	$371.20	$39.94	$39.94	$26.07	$26.07	$13.04	$11.73	$29.38	$29.38	$30.51	$26.07	$28.59	$16.95	$301.67	$301.67	$27.37	$54.08	$367.49	$371.20	$37.80	$43.02	$37.80	$30.46	$26.07	$26.07	$21.33	$26.07	$0.00	$0.00	$0.00	$0.00
30100150	EAP	CPT® 82803		Blood Gas-micro	BOTH IP/OP	$510.00 	$377.40	$11.73	$371.20	$39.94	$39.94	$26.07	$26.07	$13.04	$11.73	$29.38	$29.38	$30.51	$26.07	$28.59	$16.95	$301.67	$301.67	$27.37	$54.08	$367.49	$371.20	$37.80	$43.02	$37.80	$30.46	$26.07	$26.07	$21.33	$26.07	$0.00	$0.00	$0.00	$0.00
30100151	EAP	CPT® 82803		Blood Gas-cord Art.	BOTH IP/OP	$510.00 	$377.40	$11.73	$371.20	$39.94	$39.94	$26.07	$26.07	$13.04	$11.73	$29.38	$29.38	$30.51	$26.07	$28.59	$16.95	$301.67	$301.67	$27.37	$54.08	$367.49	$371.20	$37.80	$43.02	$37.80	$30.46	$26.07	$26.07	$21.33	$26.07	$0.00	$0.00	$0.00	$0.00
30100152	EAP	CPT® 82803		BLOOD GAS-CORD VEN.	BOTH IP/OP	$462.00 	$341.88	$11.73	$371.20	$39.94	$39.94	$26.07	$26.07	$13.04	$11.73	$29.38	$29.38	$30.51	$26.07	$28.59	$16.95	$273.27	$273.27	$27.37	$54.08	$367.49	$371.20	$37.80	$43.02	$37.80	$30.46	$26.07	$26.07	$21.33	$26.07	$0.00	$0.00	$0.00	$0.00
30100153	EAP	CPT® 82172		Apolipoproteina 1 (so)	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$32.00	$32.00	$21.09	$21.09	$10.55	$9.49	$23.52	$23.52	$24.43	$21.09	$22.90	$13.71	$104.10	$104.10	$22.14	$43.30	$139.39	$140.80	$30.58	$0.00	$30.58	$24.40	$21.09	$21.09	$17.08	$21.09	$0.00	$0.00	$0.00	$0.00
30100158	EAP	CPT® 82805		"Bld. Gas+sat. Prof, Art"	BOTH IP/OP	$533.00 	$394.42	$31.27	$388.00	$58.56	$58.56	$78.77	$78.77	$39.39	$35.45	$43.09	$43.09	$44.74	$78.77	$41.93	$51.20	$315.27	$315.27	$82.71	$79.30	$384.12	$388.00	$114.22	$129.97	$114.22	$44.67	$78.77	$78.77	$31.27	$78.77	$0.00	$0.00	$0.00	$0.00
30100159	EAP	CPT® 82805		"Bld. Gas+sat. Prof, Ven"	BOTH IP/OP	$533.00 	$394.42	$31.27	$388.00	$58.56	$58.56	$78.77	$78.77	$39.39	$35.45	$43.09	$43.09	$44.74	$78.77	$41.93	$51.20	$315.27	$315.27	$82.71	$79.30	$384.12	$388.00	$114.22	$129.97	$114.22	$44.67	$78.77	$78.77	$31.27	$78.77	$0.00	$0.00	$0.00	$0.00
30100160	EAP	CPT® 82805		"Bld. Gas+sat. Prof, Mcr"	BOTH IP/OP	$483.00 	$357.42	$31.27	$388.00	$58.56	$58.56	$78.77	$78.77	$39.39	$35.45	$43.09	$43.09	$44.74	$78.77	$41.93	$51.20	$285.69	$285.69	$82.71	$79.30	$384.12	$388.00	$114.22	$129.97	$114.22	$44.67	$78.77	$78.77	$31.27	$78.77	$0.00	$0.00	$0.00	$0.00
30100161	EAP	CPT® 82810		"Saturation Prof, Ven."	BOTH IP/OP	$113.00 	$83.62	$4.40	$113.00	$18.00	$18.00	$9.77	$9.77	$4.89	$4.40	$13.25	$13.25	$13.76	$9.77	$12.89	$6.35	$66.84	$66.84	$10.26	$24.40	$81.58	$82.40	$14.17	$113.00	$14.17	$13.74	$9.77	$9.77	$9.62	$9.77	$0.00	$0.00	$0.00	$0.00
30100162	EAP	CPT® 82810		"Saturation Prof, Art."	BOTH IP/OP	$113.00 	$83.62	$4.40	$113.00	$18.00	$18.00	$9.77	$9.77	$4.89	$4.40	$13.25	$13.25	$13.76	$9.77	$12.89	$6.35	$66.84	$66.84	$10.26	$24.40	$81.58	$82.40	$14.17	$113.00	$14.17	$13.74	$9.77	$9.77	$9.62	$9.77	$0.00	$0.00	$0.00	$0.00
30100163	EAP	CPT® 82810		"Saturation Prof, Micro"	BOTH IP/OP	$103.00 	$76.22	$0.00	$82.40	$18.00	$18.00	$9.77	$9.77	$4.89	$4.40	$13.25	$13.25	$13.76	$9.77	$12.89	$6.35	$60.92	$60.92	$10.26	$24.40	$81.58	$82.40	$14.17	$0.00	$14.17	$13.74	$9.77	$9.77	$9.62	$9.77	$0.00	$0.00	$0.00	$0.00
30100165	EAP	CPT® 82941		"Gastrin,serum"	BOTH IP/OP	$281.00 	$207.94	$0.00	$222.40	$36.41	$36.41	$17.63	$17.63	$8.82	$8.82	$26.78	$26.78	$27.81	$17.63	$26.05	$11.46	$166.21	$166.21	$18.51	$49.28	$220.18	$222.40	$25.56	$29.09	$25.56	$0.00	$17.63	$17.63	$19.43	$17.63	$0.00	$0.00	$0.00	$0.00
30100167	EAP	CPT® 82945		"Glucose,fluid"	BOTH IP/OP	$341.00 	$252.34	$1.97	$248.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$201.70	$201.70	$4.13	$10.96	$246.31	$248.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30100168	EAP	CPT® 82945		"Glucose,csf"	BOTH IP/OP	$341.00 	$252.34	$1.97	$248.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$201.70	$201.70	$4.13	$10.96	$246.31	$248.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30100169	EAP	CPT® 82945		"GLUCOSE,URINE(QUANT)"	BOTH IP/OP	$251.00 	$185.74	$1.97	$248.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$148.47	$148.47	$4.13	$10.96	$246.31	$248.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30100171	EAP	CPT® 82947		Glucose	BOTH IP/OP	$358.00 	$264.92	$1.97	$260.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$211.76	$211.76	$4.13	$10.96	$258.19	$260.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30100173	EAP	CPT® 82947		"Glucose,fasting Bld"	BOTH IP/OP	$358.00 	$264.92	$1.97	$260.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$211.76	$211.76	$4.13	$10.96	$258.19	$260.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30100174	EAP	CPT® 82947		Glucose-wb	BOTH IP/OP	$358.00 	$264.92	$1.97	$260.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$211.76	$211.76	$4.13	$10.96	$258.19	$260.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30100176	EAP	CPT® 82947		"Gtt,oral-1hr Indiv"	BOTH IP/OP	$263.00 	$194.62	$1.97	$260.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$155.56	$155.56	$4.13	$10.96	$258.19	$260.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30100177	EAP	CPT® 82947		"GTT,ORAL-2HR INDIV"	BOTH IP/OP	$263.00 	$194.62	$1.97	$260.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$155.56	$155.56	$4.13	$10.96	$258.19	$260.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30100178	EAP	CPT® 82947		"Poct, Glucose (meter)"	BOTH IP/OP	$92.00 	$68.08	$1.97	$67.20	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$54.42	$54.42	$4.13	$10.96	$66.53	$67.20	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30100180	EAP	HCPCS G0480		Drug Test Definitive 1-7 Classes	BOTH IP/OP	$293.00 	$216.82	$0.00	$234.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.46	$217.46	$225.84	$0.00	$110.57	$0.00	$0.00	$0.00	$120.15	$146.50	$232.06	$234.40	$165.92	$0.00	$165.92	$117.81	$114.43	$114.43	$82.47	$114.43	$0.00	$0.00	$0.00	$0.00
30100181	EAP	HCPCS G0481		Drug Test Definitive 8-14 Classes	BOTH IP/OP	$322.00 	$238.28	$0.00	$257.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.99	$238.99	$248.20	$0.00	$151.29	$0.00	$0.00	$0.00	$0.00	$161.00	$255.02	$257.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100182	EAP	HCPCS G0482		Drug Test Definitive 15-21 Classes	BOTH IP/OP	$354.00 	$261.96	$0.00	$283.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.74	$262.74	$272.86	$0.00	$192.03	$0.00	$0.00	$0.00	$0.00	$177.00	$280.37	$283.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100183	EAP	HCPCS G0483		Drug Test Definitive 22+ Classes	BOTH IP/OP	$389.00 	$287.86	$0.00	$311.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$288.72	$288.72	$299.84	$0.00	$238.59	$0.00	$0.00	$0.00	$0.00	$194.50	$308.09	$311.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100186	EAP	CPT® 82948		"Glu-2hr Pp, Wb-micro"	BOTH IP/OP	$251.00 	$185.74	$0.00	$248.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.82	$4.82	$5.00	$0.00	$4.68	$0.00	$0.00	$0.00	$0.00	$8.86	$246.31	$248.80	$0.00	$75.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100187	EAP	CPT® 82950		"Glucose,bld-2hr Pp"	BOTH IP/OP	$341.00 	$252.34	$2.37	$248.80	$9.79	$9.79	$4.75	$4.75	$2.38	$2.37	$7.21	$7.21	$7.48	$4.75	$7.02	$3.09	$201.70	$201.70	$4.99	$13.28	$246.31	$248.80	$6.89	$7.84	$6.89	$7.48	$4.75	$4.75	$5.24	$4.75	$0.00	$0.00	$0.00	$0.00
30100188	EAP	CPT® 82950		"Glucose, 1hr (75gm)"	BOTH IP/OP	$251.00 	$185.74	$2.37	$248.80	$9.79	$9.79	$4.75	$4.75	$2.38	$2.37	$7.21	$7.21	$7.48	$4.75	$7.02	$3.09	$148.47	$148.47	$4.99	$13.28	$246.31	$248.80	$6.89	$7.84	$6.89	$7.48	$4.75	$4.75	$5.24	$4.75	$0.00	$0.00	$0.00	$0.00
30100189	EAP	CPT® 82950		"GLUCOSE,1HR (50GM)"	BOTH IP/OP	$251.00 	$185.74	$2.37	$248.80	$9.79	$9.79	$4.75	$4.75	$2.38	$2.37	$7.21	$7.21	$7.48	$4.75	$7.02	$3.09	$148.47	$148.47	$4.99	$13.28	$246.31	$248.80	$6.89	$7.84	$6.89	$7.48	$4.75	$4.75	$5.24	$4.75	$0.00	$0.00	$0.00	$0.00
30100192	EAP	CPT® 82951		"Gtt,prenatal(75 Gm)"	BOTH IP/OP	$201.00 	$148.74	$0.00	$160.80	$26.58	$26.58	$12.87	$12.87	$6.44	$6.44	$19.55	$19.55	$20.30	$12.87	$19.02	$8.37	$118.89	$118.89	$13.51	$35.98	$159.19	$160.80	$18.66	$0.00	$18.66	$20.26	$12.87	$12.87	$14.18	$12.87	$0.00	$0.00	$0.00	$0.00
30100193	EAP	CPT® 82951		"Gtt,oral-3hr Gtt"	BOTH IP/OP	$199.00 	$147.26	$6.44	$160.80	$26.58	$26.58	$12.87	$12.87	$6.44	$6.44	$19.55	$19.55	$20.30	$12.87	$19.02	$8.37	$117.71	$117.71	$13.51	$35.98	$159.19	$160.80	$18.66	$21.24	$18.66	$20.26	$12.87	$12.87	$14.18	$12.87	$0.00	$0.00	$0.00	$0.00
30100194	EAP	CPT® 82951		"Gtt,oral-4hr Gtt"	BOTH IP/OP	$201.00 	$148.74	$0.00	$160.80	$26.58	$26.58	$12.87	$12.87	$6.44	$6.44	$19.55	$19.55	$20.30	$12.87	$19.02	$8.37	$118.89	$118.89	$13.51	$35.98	$159.19	$160.80	$18.66	$0.00	$18.66	$20.26	$12.87	$12.87	$14.18	$12.87	$0.00	$0.00	$0.00	$0.00
30100195	EAP	CPT® 82951		"Gtt,oral-5hr Gtt"	BOTH IP/OP	$201.00 	$148.74	$0.00	$160.80	$26.58	$26.58	$12.87	$12.87	$6.44	$6.44	$19.55	$19.55	$20.30	$12.87	$19.02	$8.37	$118.89	$118.89	$13.51	$35.98	$159.19	$160.80	$18.66	$0.00	$18.66	$20.26	$12.87	$12.87	$14.18	$12.87	$0.00	$0.00	$0.00	$0.00
30100196	EAP	CPT® 82951		"Gtt,oral-6hr Gtt"	BOTH IP/OP	$201.00 	$148.74	$0.00	$160.80	$26.58	$26.58	$12.87	$12.87	$6.44	$6.44	$19.55	$19.55	$20.30	$12.87	$19.02	$8.37	$118.89	$118.89	$13.51	$35.98	$159.19	$160.80	$18.66	$0.00	$18.66	$20.26	$12.87	$12.87	$14.18	$12.87	$0.00	$0.00	$0.00	$0.00
30100197	EAP	CPT® 82951		"GTT,PRENATAL(100GM)"	BOTH IP/OP	$199.00 	$147.26	$6.44	$160.80	$26.58	$26.58	$12.87	$12.87	$6.44	$6.44	$19.55	$19.55	$20.30	$12.87	$19.02	$8.37	$117.71	$117.71	$13.51	$35.98	$159.19	$160.80	$18.66	$21.24	$18.66	$20.26	$12.87	$12.87	$14.18	$12.87	$0.00	$0.00	$0.00	$0.00
30100200	EAP	CPT® 82952		3rd Hour-gtt Specimen	BOTH IP/OP	$102.00 	$75.48	$1.96	$82.40	$8.10	$8.10	$3.92	$3.92	$1.96	$1.96	$5.95	$5.95	$6.18	$3.92	$5.80	$2.55	$60.33	$60.33	$4.12	$10.96	$81.58	$82.40	$5.68	$6.47	$5.68	$6.18	$3.92	$3.92	$4.32	$3.92	$0.00	$0.00	$0.00	$0.00
30100201	EAP	CPT® 82952		4th Hour-gtt Specimen	BOTH IP/OP	$103.00 	$76.22	$1.96	$82.40	$8.10	$8.10	$3.92	$3.92	$1.96	$1.96	$5.95	$5.95	$6.18	$3.92	$5.80	$2.55	$60.92	$60.92	$4.12	$10.96	$81.58	$82.40	$5.68	$6.47	$5.68	$6.18	$3.92	$3.92	$4.32	$3.92	$0.00	$0.00	$0.00	$0.00
30100202	EAP	CPT® 82952		5TH HOUR GTT SPECIMEN	BOTH IP/OP	$103.00 	$76.22	$1.96	$82.40	$8.10	$8.10	$3.92	$3.92	$1.96	$1.96	$5.95	$5.95	$6.18	$3.92	$5.80	$2.55	$60.92	$60.92	$4.12	$10.96	$81.58	$82.40	$5.68	$6.47	$5.68	$6.18	$3.92	$3.92	$4.32	$3.92	$0.00	$0.00	$0.00	$0.00
30100203	EAP	CPT® 82955		"G6pd, Rbc Quant"	BOTH IP/OP	$242.00 	$179.08	$4.85	$195.20	$16.08	$16.08	$9.70	$9.70	$4.85	$4.85	$11.86	$11.86	$12.31	$9.70	$11.54	$6.31	$143.14	$143.14	$10.19	$21.82	$193.25	$195.20	$14.07	$16.01	$14.07	$12.30	$9.70	$9.70	$8.61	$9.70	$0.00	$0.00	$0.00	$0.00
30100205	EAP	CPT® 82977		"GGTP,SERUM"	BOTH IP/OP	$162.00 	$119.88	$3.60	$129.60	$14.86	$14.86	$7.20	$7.20	$3.60	$3.60	$10.93	$10.93	$11.35	$7.20	$7.46	$4.68	$95.82	$95.82	$7.56	$20.12	$128.30	$129.60	$10.44	$11.88	$10.44	$7.94	$7.20	$7.20	$5.56	$7.20	$0.00	$0.00	$0.00	$0.00
30100206	EAP	CPT® 83001		"Fsh,serum"	BOTH IP/OP	$480.00 	$355.20	$9.29	$372.00	$38.36	$38.36	$18.58	$18.58	$9.29	$9.29	$28.23	$28.23	$29.31	$18.58	$27.46	$12.08	$283.92	$283.92	$19.51	$51.94	$368.28	$372.00	$26.94	$30.66	$26.94	$29.26	$18.58	$18.58	$20.48	$18.58	$0.00	$0.00	$0.00	$0.00
30100207	EAP	CPT® 83002		"Lh,serum"	BOTH IP/OP	$532.00 	$393.68	$9.26	$412.00	$38.23	$38.23	$18.52	$18.52	$9.26	$9.26	$28.12	$28.12	$29.20	$18.52	$27.36	$12.04	$314.68	$314.68	$19.45	$51.76	$407.88	$412.00	$26.85	$30.56	$26.85	$29.16	$18.52	$18.52	$20.41	$18.52	$0.00	$0.00	$0.00	$0.00
30100208	EAP	CPT® 83003		Growth Hormone	BOTH IP/OP	$133.00 	$98.42	$0.00	$103.20	$29.38	$29.38	$16.67	$16.67	$8.34	$8.33	$21.62	$21.62	$22.45	$16.67	$21.03	$10.84	$78.67	$78.67	$0.00	$39.78	$102.17	$103.20	$0.00	$27.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100209	EAP	CPT® 83010		"Haptoglobin,serum"	BOTH IP/OP	$333.00 	$246.42	$4.11	$268.80	$7.71	$7.71	$12.58	$12.58	$6.29	$6.29	$5.66	$5.66	$5.88	$12.58	$5.51	$8.18	$196.97	$196.97	$13.21	$10.42	$266.11	$268.80	$18.24	$20.76	$18.24	$5.87	$12.58	$12.58	$4.11	$12.58	$0.00	$0.00	$0.00	$0.00
30100211	EAP	CPT® 83020		Hgb Elect - Family	BOTH IP/OP	$218.00 	$161.32	$6.44	$174.40	$20.17	$20.17	$12.87	$12.87	$6.44	$6.44	$14.84	$14.84	$15.41	$12.87	$14.44	$8.37	$128.95	$128.95	$13.51	$27.32	$172.66	$174.40	$18.66	$21.24	$18.66	$15.38	$12.87	$12.87	$10.77	$12.87	$0.00	$0.00	$0.00	$0.00
30100212	EAP	CPT® 83020		Hgb Electrophoresis	BOTH IP/OP	$218.00 	$161.32	$6.44	$174.40	$20.17	$20.17	$12.87	$12.87	$6.44	$6.44	$14.84	$14.84	$15.41	$12.87	$14.44	$8.37	$128.95	$128.95	$13.51	$27.32	$172.66	$174.40	$18.66	$21.24	$18.66	$15.38	$12.87	$12.87	$10.77	$12.87	$0.00	$0.00	$0.00	$0.00
30100213	EAP	CPT® 83020		Citrate Agar Elect.	BOTH IP/OP	$217.00 	$160.58	$0.00	$174.40	$20.17	$20.17	$12.87	$12.87	$6.44	$6.44	$14.84	$14.84	$15.41	$12.87	$14.44	$8.37	$128.36	$128.36	$13.51	$27.32	$172.66	$174.40	$18.66	$0.00	$18.66	$15.38	$12.87	$12.87	$10.77	$12.87	$0.00	$0.00	$0.00	$0.00
30100214	EAP	CPT® 83020		Hgb Elect. Quant	BOTH IP/OP	$217.00 	$160.58	$0.00	$174.40	$20.17	$20.17	$12.87	$12.87	$6.44	$6.44	$14.84	$14.84	$15.41	$12.87	$14.44	$8.37	$128.36	$128.36	$13.51	$27.32	$172.66	$174.40	$18.66	$0.00	$18.66	$15.38	$12.87	$12.87	$10.77	$12.87	$0.00	$0.00	$0.00	$0.00
30100215	EAP	CPT® 83020		HGB ELECT. CORD BLD	BOTH IP/OP	$217.00 	$160.58	$0.00	$174.40	$20.17	$20.17	$12.87	$12.87	$6.44	$6.44	$14.84	$14.84	$15.41	$12.87	$14.44	$8.37	$128.36	$128.36	$13.51	$27.32	$172.66	$174.40	$18.66	$0.00	$18.66	$15.38	$12.87	$12.87	$10.77	$12.87	$0.00	$0.00	$0.00	$0.00
30100216	EAP	CPT® 83021		"Hgb Phenotyping, Family Member"	BOTH IP/OP	$218.00 	$161.32	$6.62	$174.40	$12.41	$12.41	$18.06	$18.06	$9.03	$9.03	$9.12	$9.12	$9.47	$18.06	$8.87	$11.74	$128.95	$128.95	$18.96	$16.78	$172.66	$174.40	$26.19	$29.80	$26.19	$9.45	$18.06	$18.06	$6.62	$18.06	$0.00	$0.00	$0.00	$0.00
30100217	EAP	CPT® 83021		"Hgb A, S, And C Quant, Hplc"	BOTH IP/OP	$217.00 	$160.58	$0.00	$174.40	$12.41	$12.41	$18.06	$18.06	$9.03	$9.03	$9.12	$9.12	$9.47	$18.06	$8.87	$11.74	$128.36	$128.36	$18.96	$16.78	$172.66	$174.40	$26.19	$0.00	$26.19	$9.45	$18.06	$18.06	$6.62	$18.06	$0.00	$0.00	$0.00	$0.00
30100218	EAP	CPT® 83021		"Hgb Phenotyping, Complete"	BOTH IP/OP	$218.00 	$161.32	$6.62	$174.40	$12.41	$12.41	$18.06	$18.06	$9.03	$9.03	$9.12	$9.12	$9.47	$18.06	$8.87	$11.74	$128.95	$128.95	$18.96	$16.78	$172.66	$174.40	$26.19	$29.80	$26.19	$9.45	$18.06	$18.06	$6.62	$18.06	$0.00	$0.00	$0.00	$0.00
30100219	EAP	CPT® 83021		"Fetal Hgb Quant, Hplc"	BOTH IP/OP	$217.00 	$160.58	$0.00	$174.40	$12.41	$12.41	$18.06	$18.06	$9.03	$9.03	$9.12	$9.12	$9.47	$18.06	$8.87	$11.74	$128.36	$128.36	$18.96	$16.78	$172.66	$174.40	$26.19	$0.00	$26.19	$9.45	$18.06	$18.06	$6.62	$18.06	$0.00	$0.00	$0.00	$0.00
30100221	EAP	CPT® 83036		HGB GLUCOSE A1C	BOTH IP/OP	$219.00 	$162.06	$4.86	$175.20	$20.04	$20.04	$9.71	$9.71	$4.86	$4.86	$14.74	$14.74	$15.30	$9.71	$14.33	$6.31	$129.54	$129.54	$10.20	$27.12	$173.45	$175.20	$14.08	$16.02	$14.08	$15.27	$9.71	$9.71	$10.69	$9.71	$0.00	$0.00	$0.00	$0.00
30100222	EAP	CPT® 83051		"Hgb,plasma-quant"	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.10	$11.10	$11.52	$0.00	$10.79	$0.00	$0.00	$0.00	$0.00	$20.42	$130.68	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100223	EAP	CPT® 83060		"Sulfhemoglobin,bld"	BOTH IP/OP	$164.00 	$121.36	$0.00	$131.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.56	$12.56	$13.05	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$23.12	$129.89	$131.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100224	EAP	CPT® 83065		"Hgb Denaturat.,heat"	BOTH IP/OP	$146.00 	$108.04	$0.00	$116.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.46	$10.46	$10.86	$0.00	$10.17	$0.00	$0.00	$0.00	$0.00	$19.24	$115.63	$116.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100225	EAP	CPT® 83068		"Hgb Pp't,isopropanol"	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.86	$12.86	$13.36	$0.00	$12.52	$0.00	$0.00	$0.00	$0.00	$23.66	$139.39	$140.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100226	EAP	CPT® 83069		"Hemoglobin,urine-qnt"	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.99	$5.99	$6.22	$0.00	$5.83	$0.00	$0.00	$0.00	$0.00	$11.02	$69.70	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100227	EAP	CPT® 83070		"Hemosiderin, Urine"	BOTH IP/OP	$58.00 	$42.92	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.21	$7.21	$7.48	$0.00	$7.02	$0.00	$0.00	$0.00	$0.00	$13.28	$46.73	$47.20	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100228	EAP	CPT® 83080		Hexosaminidase-1	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.62	$25.62	$26.60	$0.00	$24.92	$0.00	$0.00	$0.00	$0.00	$47.14	$415.80	$420.00	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100229	EAP	CPT® 83150		Homovanillic Acid-24h	BOTH IP/OP	$94.00 	$69.56	$0.00	$87.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.38	$29.38	$30.51	$0.00	$28.59	$0.00	$0.00	$0.00	$0.00	$54.08	$74.45	$75.20	$0.00	$87.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100230	EAP	CPT® 83491		"Steroids-17oh,24h Ur"	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.59	$26.59	$27.62	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$48.94	$74.45	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100231	EAP	CPT® 83497		"Serotonin,urine-24"	BOTH IP/OP	$154.00 	$113.96	$6.45	$123.20	$26.61	$26.61	$12.90	$12.90	$6.45	$6.45	$19.58	$19.58	$20.34	$12.90	$19.05	$8.39	$91.09	$91.09	$13.55	$36.02	$121.97	$123.20	$18.71	$21.29	$18.71	$20.30	$12.90	$12.90	$14.21	$12.90	$0.00	$0.00	$0.00	$0.00
30100232	EAP	CPT® 83498		"Progesterone,17a-oh"	BOTH IP/OP	$286.00 	$211.64	$13.59	$231.20	$56.07	$56.07	$27.17	$27.17	$13.59	$13.59	$41.25	$41.25	$42.83	$27.17	$40.13	$17.66	$169.17	$169.17	$28.53	$75.90	$228.89	$231.20	$39.40	$44.83	$39.40	$42.76	$27.17	$27.17	$29.93	$27.17	$0.00	$0.00	$0.00	$0.00
30100233	EAP	CPT® 83516		T-transglutaminase Iga	BOTH IP/OP	$181.00 	$133.94	$5.76	$140.80	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$107.06	$107.06	$12.11	$29.88	$139.39	$140.80	$16.72	$19.02	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30100234	EAP	CPT® 83516		Gliadin Ab Igg	BOTH IP/OP	$313.00 	$231.62	$5.76	$243.20	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$185.14	$185.14	$12.11	$29.88	$240.77	$243.20	$16.72	$19.02	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30100235	EAP	CPT® 83516		Gliadin Ab Iga	BOTH IP/OP	$269.00 	$199.06	$0.00	$243.20	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$159.11	$159.11	$12.11	$29.88	$240.77	$243.20	$16.72	$0.00	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30100236	EAP	CPT® 83519		Igf Binding Protein-3	BOTH IP/OP	$260.00 	$192.40	$8.28	$202.40	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$153.79	$153.79	$19.32	$37.76	$200.38	$202.40	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30100237	EAP	CPT® 83519		Gad-65 Autoantibody	BOTH IP/OP	$260.00 	$192.40	$8.28	$202.40	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$153.79	$153.79	$19.32	$37.76	$200.38	$202.40	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30100238	EAP	CPT® 84490		"Trypsin,fecal"	BOTH IP/OP	$119.00 	$88.06	$0.00	$119.00	$15.71	$15.71	$9.93	$9.93	$4.97	$0.00	$11.55	$11.55	$12.00	$0.00	$11.25	$0.00	$0.00	$0.00	$0.00	$21.26	$91.87	$92.80	$0.00	$119.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100239	EAP	CPT® 80155		Caffeine (so)	BOTH IP/OP	$570.00 	$421.80	$0.00	$443.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.07	$20.07	$20.84	$0.00	$18.13	$0.00	$0.00	$0.00	$0.00	$277.00	$438.77	$443.20	$0.00	$380.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100240	EAP	CPT® 83525		"Insulin, Serum"	BOTH IP/OP	$324.00 	$239.76	$5.72	$261.60	$23.60	$23.60	$11.43	$11.43	$5.72	$5.72	$17.36	$17.36	$18.03	$11.43	$16.89	$7.43	$191.65	$191.65	$12.00	$31.96	$258.98	$261.60	$16.57	$18.86	$16.57	$18.00	$11.43	$11.43	$12.60	$11.43	$0.00	$0.00	$0.00	$0.00
30100241	EAP	CPT® 83540		"Iron-total,serum"	BOTH IP/OP	$202.00 	$149.48	$3.24	$160.00	$13.36	$13.36	$6.47	$6.47	$3.24	$3.24	$9.84	$9.84	$10.22	$6.47	$9.58	$4.21	$119.48	$119.48	$6.79	$18.10	$158.40	$160.00	$9.38	$10.68	$9.38	$10.20	$6.47	$6.47	$7.14	$6.47	$0.00	$0.00	$0.00	$0.00
30100242	EAP	CPT® 83540		"Iron, Liver Tissue"	BOTH IP/OP	$186.00 	$137.64	$0.00	$148.80	$13.36	$13.36	$6.47	$6.47	$3.24	$3.24	$9.84	$9.84	$10.22	$6.47	$9.58	$4.21	$110.02	$110.02	$6.79	$18.10	$147.31	$148.80	$9.38	$0.00	$9.38	$10.20	$6.47	$6.47	$7.14	$6.47	$0.00	$0.00	$0.00	$0.00
30100243	EAP	CPT® 83582		"Steroids-17kg,24h Ur"	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.52	$21.52	$22.35	$0.00	$20.94	$0.00	$0.00	$0.00	$0.00	$39.60	$73.66	$74.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100244	EAP	CPT® 83593		"Steroids-17keto,24hr"	BOTH IP/OP	$367.00 	$271.58	$0.00	$367.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.94	$39.94	$41.47	$0.00	$38.86	$0.00	$0.00	$0.00	$0.00	$73.50	$290.66	$293.60	$0.00	$367.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100247	EAP	CPT® 83605		"Lactic Acid, Blood"	BOTH IP/OP	$341.00 	$252.34	$5.34	$248.80	$22.04	$22.04	$11.57	$11.57	$5.79	$5.34	$16.21	$16.21	$16.84	$11.57	$15.78	$7.52	$201.70	$201.70	$12.15	$29.84	$246.31	$248.80	$16.78	$19.09	$16.78	$16.82	$11.57	$11.57	$11.77	$11.57	$0.00	$0.00	$0.00	$0.00
30100248	EAP	CPT® 83605		"Lactic Acid, Csf"	BOTH IP/OP	$341.00 	$252.34	$5.34	$248.80	$22.04	$22.04	$11.57	$11.57	$5.79	$5.34	$16.21	$16.21	$16.84	$11.57	$15.78	$7.52	$201.70	$201.70	$12.15	$29.84	$246.31	$248.80	$16.78	$19.09	$16.78	$16.82	$11.57	$11.57	$11.77	$11.57	$0.00	$0.00	$0.00	$0.00
30100249	EAP	CPT® 83605		"LACTIC ACID, FLUID"	BOTH IP/OP	$258.00 	$190.92	$5.34	$248.80	$22.04	$22.04	$11.57	$11.57	$5.79	$5.34	$16.21	$16.21	$16.84	$11.57	$15.78	$7.52	$152.61	$152.61	$12.15	$29.84	$246.31	$248.80	$16.78	$19.09	$16.78	$16.82	$11.57	$11.57	$11.77	$11.57	$0.00	$0.00	$0.00	$0.00
30100251	EAP	CPT® 83615		"Ldh,total-serum"	BOTH IP/OP	$153.00 	$113.22	$3.02	$111.20	$12.46	$12.46	$6.04	$6.04	$3.02	$3.02	$9.16	$9.16	$9.51	$6.04	$7.46	$3.93	$90.50	$90.50	$6.34	$16.88	$110.09	$111.20	$8.76	$9.97	$8.76	$7.94	$6.04	$6.04	$5.56	$6.04	$0.00	$0.00	$0.00	$0.00
30100252	EAP	CPT® 83615		"Ldh,fluid"	BOTH IP/OP	$153.00 	$113.22	$3.02	$111.20	$12.46	$12.46	$6.04	$6.04	$3.02	$3.02	$9.16	$9.16	$9.51	$6.04	$7.46	$3.93	$90.50	$90.50	$6.34	$16.88	$110.09	$111.20	$8.76	$9.97	$8.76	$7.94	$6.04	$6.04	$5.56	$6.04	$0.00	$0.00	$0.00	$0.00
30100253	EAP	CPT® 83615		"LDH,CSF"	BOTH IP/OP	$139.00 	$102.86	$0.00	$111.20	$12.46	$12.46	$6.04	$6.04	$3.02	$3.02	$9.16	$9.16	$9.51	$6.04	$7.46	$3.93	$82.22	$82.22	$6.34	$16.88	$110.09	$111.20	$8.76	$0.00	$8.76	$7.94	$6.04	$6.04	$5.56	$6.04	$0.00	$0.00	$0.00	$0.00
30100254	EAP	CPT® 83655		"Lead,blood"	BOTH IP/OP	$200.00 	$148.00	$6.05	$160.00	$25.00	$25.00	$12.11	$12.11	$6.06	$6.05	$18.38	$18.38	$19.08	$12.11	$11.75	$7.87	$118.30	$118.30	$12.72	$33.82	$158.40	$160.00	$17.56	$19.98	$17.56	$12.52	$12.11	$12.11	$8.76	$12.11	$0.00	$0.00	$0.00	$0.00
30100255	EAP	CPT® 83655		"Lead,urine-24hr"	BOTH IP/OP	$195.00 	$144.30	$6.05	$156.00	$25.00	$25.00	$12.11	$12.11	$6.06	$6.05	$18.38	$18.38	$19.08	$12.11	$11.75	$7.87	$115.34	$115.34	$12.72	$33.82	$154.44	$156.00	$17.56	$19.98	$17.56	$12.52	$12.11	$12.11	$8.76	$12.11	$0.00	$0.00	$0.00	$0.00
30100256	EAP	CPT® 83661		Fetal Lung Maturity	BOTH IP/OP	$262.00 	$193.88	$0.00	$210.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.37	$33.37	$34.66	$0.00	$32.47	$0.00	$0.00	$0.00	$0.00	$61.42	$208.30	$210.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100258	EAP	CPT® 83690		"LIPASE, SERUM"	BOTH IP/OP	$225.00 	$166.50	$0.00	$200.80	$14.23	$14.23	$6.89	$6.89	$3.45	$3.44	$10.46	$10.46	$10.86	$6.89	$10.17	$4.48	$133.09	$133.09	$7.23	$19.24	$198.79	$200.80	$9.99	$0.00	$9.99	$10.84	$6.89	$6.89	$7.59	$6.89	$0.00	$0.00	$0.00	$0.00
30100259	EAP	CPT® 83698		Plac (lp-pla2) Test	BOTH IP/OP	$453.00 	$335.22	$0.00	$362.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.54	$51.54	$53.52	$0.00	$50.15	$0.00	$0.00	$0.00	$0.00	$94.86	$358.78	$362.40	$0.00	$234.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100260	EAP	CPT® 83718		"CHOL,HDL"	BOTH IP/OP	$118.00 	$87.32	$0.00	$95.20	$16.92	$16.92	$8.19	$8.19	$4.10	$4.10	$12.44	$12.44	$12.92	$8.19	$12.10	$5.32	$69.80	$69.80	$8.60	$22.88	$94.25	$95.20	$11.88	$0.00	$11.88	$12.89	$8.19	$8.19	$9.02	$8.19	$0.00	$0.00	$0.00	$0.00
30100262	EAP	CPT® 83721		"CHOL-LDL, DIRECT"	BOTH IP/OP	$147.00 	$108.78	$0.00	$119.20	$19.69	$19.69	$10.50	$10.50	$5.25	$4.77	$14.49	$14.49	$15.04	$10.50	$14.10	$6.83	$86.95	$86.95	$11.03	$26.66	$118.01	$119.20	$15.23	$0.00	$15.23	$15.03	$10.50	$10.50	$10.52	$10.50	$0.00	$0.00	$0.00	$0.00
30100263	EAP	CPT® 83735		Magnesium	BOTH IP/OP	$188.00 	$139.12	$3.35	$136.80	$13.83	$13.83	$6.70	$6.70	$3.35	$3.35	$10.17	$10.17	$10.56	$6.70	$9.89	$4.36	$111.20	$111.20	$7.04	$18.72	$135.43	$136.80	$9.72	$11.06	$9.72	$10.54	$6.70	$6.70	$7.38	$6.70	$0.00	$0.00	$0.00	$0.00
30100264	EAP	CPT® 83735		"MAGNESIUM, URINE"	BOTH IP/OP	$160.00 	$118.40	$0.00	$136.80	$13.83	$13.83	$6.70	$6.70	$3.35	$3.35	$10.17	$10.17	$10.56	$6.70	$9.89	$4.36	$94.64	$94.64	$7.04	$18.72	$135.43	$136.80	$9.72	$0.00	$9.72	$10.54	$6.70	$6.70	$7.38	$6.70	$0.00	$0.00	$0.00	$0.00
30100266	EAP	CPT® 83825		"Mercury,urine-24hr"	BOTH IP/OP	$84.00 	$62.16	$0.00	$67.20	$33.55	$33.55	$16.26	$16.26	$8.13	$8.13	$24.69	$24.69	$25.64	$16.26	$24.02	$10.57	$49.69	$49.69	$17.07	$45.44	$66.53	$67.20	$23.58	$26.83	$23.58	$0.00	$16.26	$16.26	$17.92	$16.26	$0.00	$0.00	$0.00	$0.00
30100267	EAP	CPT® 83835		"Metaneph.tot,ur"	BOTH IP/OP	$508.00 	$375.92	$8.47	$376.80	$34.98	$34.98	$16.94	$16.94	$8.47	$8.47	$25.73	$25.73	$26.72	$16.94	$25.02	$11.01	$300.48	$300.48	$17.79	$47.34	$373.03	$376.80	$24.56	$27.95	$24.56	$26.66	$16.94	$16.94	$18.66	$16.94	$0.00	$0.00	$0.00	$0.00
30100268	EAP	CPT® 83835		"Metanephrines, Frac, Plasma"	BOTH IP/OP	$544.00 	$402.56	$8.47	$403.20	$34.98	$34.98	$16.94	$16.94	$8.47	$8.47	$25.73	$25.73	$26.72	$16.94	$25.02	$11.01	$321.78	$321.78	$17.79	$47.34	$399.17	$403.20	$24.56	$27.95	$24.56	$26.66	$16.94	$16.94	$18.66	$16.94	$0.00	$0.00	$0.00	$0.00
30100269	EAP	CPT® 83835		"Metanephrines, Urine, Random"	BOTH IP/OP	$504.00 	$372.96	$8.47	$403.20	$34.98	$34.98	$16.94	$16.94	$8.47	$8.47	$25.73	$25.73	$26.72	$16.94	$25.02	$11.01	$298.12	$298.12	$17.79	$47.34	$399.17	$403.20	$24.56	$27.95	$24.56	$26.66	$16.94	$16.94	$18.66	$16.94	$0.00	$0.00	$0.00	$0.00
30100270	EAP	CPT® 83864		Mucopolysaccha	BOTH IP/OP	$388.00 	$287.12	$0.00	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.23	$30.23	$31.40	$0.00	$15.87	$0.00	$0.00	$0.00	$0.00	$55.64	$307.30	$310.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100271	EAP	CPT® 83874		"Myoglobin-qual,urine"	BOTH IP/OP	$182.00 	$134.68	$6.46	$145.60	$26.66	$26.66	$12.92	$12.92	$6.46	$6.46	$19.61	$19.61	$20.37	$12.92	$19.08	$8.40	$107.65	$107.65	$13.57	$36.08	$144.14	$145.60	$18.73	$21.32	$18.73	$20.33	$12.92	$12.92	$14.23	$12.92	$0.00	$0.00	$0.00	$0.00
30100272	EAP	CPT® 83880		B-type Natriurtic Peptide	BOTH IP/OP	$368.00 	$272.32	$17.67	$297.60	$70.07	$70.07	$39.26	$39.26	$19.63	$17.67	$51.54	$51.54	$53.52	$39.26	$50.15	$25.52	$217.67	$217.67	$41.22	$94.86	$294.62	$297.60	$56.93	$64.78	$56.93	$53.43	$39.26	$39.26	$37.40	$39.26	$0.00	$0.00	$0.00	$0.00
30100273	EAP	CPT® 83883		Alpha2-macroglbulin	BOTH IP/OP	$178.00 	$131.72	$0.00	$142.40	$28.06	$28.06	$13.60	$13.60	$6.80	$6.80	$20.64	$20.64	$21.44	$13.60	$20.09	$8.84	$105.29	$105.29	$14.28	$38.00	$140.98	$142.40	$19.72	$0.00	$19.72	$21.40	$13.60	$13.60	$14.98	$13.60	$0.00	$0.00	$0.00	$0.00
30100274	EAP	CPT® 83883		"Albumin-immuno,ser"	BOTH IP/OP	$176.00 	$130.24	$6.80	$142.40	$28.06	$28.06	$13.60	$13.60	$6.80	$6.80	$20.64	$20.64	$21.44	$13.60	$20.09	$8.84	$104.10	$104.10	$14.28	$38.00	$140.98	$142.40	$19.72	$22.44	$19.72	$21.40	$13.60	$13.60	$14.98	$13.60	$0.00	$0.00	$0.00	$0.00
30100275	EAP	CPT® 83883		"Albumin,csf-immuno"	BOTH IP/OP	$176.00 	$130.24	$6.80	$142.40	$28.06	$28.06	$13.60	$13.60	$6.80	$6.80	$20.64	$20.64	$21.44	$13.60	$20.09	$8.84	$104.10	$104.10	$14.28	$38.00	$140.98	$142.40	$19.72	$22.44	$19.72	$21.40	$13.60	$13.60	$14.98	$13.60	$0.00	$0.00	$0.00	$0.00
30100276	EAP	CPT® 83883		"Albumin,urine-immuno"	BOTH IP/OP	$178.00 	$131.72	$0.00	$142.40	$28.06	$28.06	$13.60	$13.60	$6.80	$6.80	$20.64	$20.64	$21.44	$13.60	$20.09	$8.84	$105.29	$105.29	$14.28	$38.00	$140.98	$142.40	$19.72	$0.00	$19.72	$21.40	$13.60	$13.60	$14.98	$13.60	$0.00	$0.00	$0.00	$0.00
30100277	EAP	CPT® 83883		C-1 Esterase Inhib	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$28.06	$28.06	$13.60	$13.60	$6.80	$6.80	$20.64	$20.64	$21.44	$13.60	$20.09	$8.84	$99.37	$99.37	$14.28	$38.00	$133.06	$134.40	$19.72	$0.00	$19.72	$21.40	$13.60	$13.60	$14.98	$13.60	$0.00	$0.00	$0.00	$0.00
30100278	EAP	CPT® 83883		Free Kappa	BOTH IP/OP	$176.00 	$130.24	$6.80	$142.40	$28.06	$28.06	$13.60	$13.60	$6.80	$6.80	$20.64	$20.64	$21.44	$13.60	$20.09	$8.84	$104.10	$104.10	$14.28	$38.00	$140.98	$142.40	$19.72	$22.44	$19.72	$21.40	$13.60	$13.60	$14.98	$13.60	$0.00	$0.00	$0.00	$0.00
30100279	EAP	CPT® 83883		Free Lambda	BOTH IP/OP	$176.00 	$130.24	$6.80	$142.40	$28.06	$28.06	$13.60	$13.60	$6.80	$6.80	$20.64	$20.64	$21.44	$13.60	$20.09	$8.84	$104.10	$104.10	$14.28	$38.00	$140.98	$142.40	$19.72	$22.44	$19.72	$21.40	$13.60	$13.60	$14.98	$13.60	$0.00	$0.00	$0.00	$0.00
30100280	EAP	CPT® 80323		Nicotine	BOTH IP/OP	$422.00 	$312.28	$0.00	$337.60	$0.03	$0.03	$0.00	$0.00	$12.01	$18.43	$313.21	$313.21	$325.28	$0.00	$44.34	$0.00	$249.61	$249.61	$0.00	$211.00	$334.22	$337.60	$253.20	$249.60	$253.20	$47.25	$0.00	$0.00	$33.07	$0.00	$0.00	$0.00	$0.00	$0.00
30100296	EAP	CPT® 83915		5'-nucleotidase	BOTH IP/OP	$63.00 	$46.62	$0.00	$51.20	$23.02	$23.02	$11.15	$11.15	$5.58	$5.58	$16.94	$16.94	$17.59	$11.15	$16.47	$7.25	$37.26	$37.26	$0.00	$31.16	$50.69	$51.20	$0.00	$18.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100297	EAP	CPT® 83921		Methylmalonic Acid	BOTH IP/OP	$241.00 	$178.34	$9.54	$194.40	$33.95	$33.95	$21.21	$21.21	$10.61	$9.54	$25.00	$25.00	$25.96	$21.21	$24.32	$13.79	$142.55	$142.55	$22.27	$46.00	$192.46	$194.40	$30.75	$35.00	$30.75	$25.91	$21.21	$21.21	$18.14	$21.21	$0.00	$0.00	$0.00	$0.00
30100298	EAP	CPT® 83921		Orotic Acid	BOTH IP/OP	$241.00 	$178.34	$9.54	$194.40	$33.95	$33.95	$21.21	$21.21	$10.61	$9.54	$25.00	$25.00	$25.96	$21.21	$24.32	$13.79	$142.55	$142.55	$22.27	$46.00	$192.46	$194.40	$30.75	$35.00	$30.75	$25.91	$21.21	$21.21	$18.14	$21.21	$0.00	$0.00	$0.00	$0.00
30100299	EAP	CPT® 83930		"Osmolality,crystal"	BOTH IP/OP	$230.00 	$170.20	$3.31	$192.80	$13.65	$13.65	$6.61	$6.61	$3.31	$3.31	$10.04	$10.04	$10.42	$6.61	$9.78	$4.30	$136.05	$136.05	$6.94	$18.48	$190.87	$192.80	$9.58	$10.91	$9.58	$10.42	$6.61	$6.61	$7.29	$6.61	$0.00	$0.00	$0.00	$0.00
30100300	EAP	CPT® 83930		Osmolality	BOTH IP/OP	$265.00 	$196.10	$3.31	$192.80	$13.65	$13.65	$6.61	$6.61	$3.31	$3.31	$10.04	$10.04	$10.42	$6.61	$9.78	$4.30	$156.75	$156.75	$6.94	$18.48	$190.87	$192.80	$9.58	$10.91	$9.58	$10.42	$6.61	$6.61	$7.29	$6.61	$0.00	$0.00	$0.00	$0.00
30100301	EAP	CPT® 83935		"Osmolality,fluid"	BOTH IP/OP	$272.00 	$201.28	$3.41	$197.60	$14.07	$14.07	$6.82	$6.82	$3.41	$3.41	$10.35	$10.35	$10.75	$6.82	$10.07	$4.43	$160.89	$160.89	$7.16	$19.04	$195.62	$197.60	$9.89	$11.25	$9.89	$10.73	$6.82	$6.82	$7.51	$6.82	$0.00	$0.00	$0.00	$0.00
30100302	EAP	CPT® 83935		"Osmolality,urine"	BOTH IP/OP	$272.00 	$201.28	$3.41	$197.60	$14.07	$14.07	$6.82	$6.82	$3.41	$3.41	$10.35	$10.35	$10.75	$6.82	$10.07	$4.43	$160.89	$160.89	$7.16	$19.04	$195.62	$197.60	$9.89	$11.25	$9.89	$10.73	$6.82	$6.82	$7.51	$6.82	$0.00	$0.00	$0.00	$0.00
30100303	EAP	CPT® 83945		"Oxalate, Urine-24hr"	BOTH IP/OP	$53.00 	$39.22	$0.00	$42.40	$26.58	$26.58	$14.45	$14.45	$7.23	$6.50	$19.55	$19.55	$20.30	$14.45	$19.02	$9.39	$31.35	$31.35	$0.00	$35.98	$41.98	$42.40	$0.00	$23.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100304	EAP	CPT® 83970		Parathormone Intact	BOTH IP/OP	$502.00 	$371.48	$20.64	$401.60	$85.19	$85.19	$41.28	$41.28	$20.64	$20.64	$62.68	$62.68	$65.09	$41.28	$60.97	$26.83	$296.93	$296.93	$43.34	$115.34	$397.58	$401.60	$59.86	$68.11	$59.86	$64.97	$41.28	$41.28	$45.48	$41.28	$0.00	$0.00	$0.00	$0.00
30100306	EAP	CPT® 83986		"Ph, Stool"	BOTH IP/OP	$86.00 	$63.64	$0.00	$62.40	$7.39	$7.39	$3.58	$3.58	$1.79	$1.79	$5.43	$5.43	$5.64	$3.58	$5.28	$2.33	$50.87	$50.87	$3.76	$10.00	$61.78	$62.40	$5.19	$5.91	$5.19	$0.00	$3.58	$3.58	$3.94	$3.58	$0.00	$0.00	$0.00	$0.00
30100307	EAP	CPT® 84075		Alk Phosphatase	BOTH IP/OP	$110.00 	$81.40	$2.59	$84.00	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.46	$3.37	$65.07	$65.07	$5.44	$14.46	$83.16	$84.00	$7.51	$8.55	$7.51	$7.94	$5.18	$5.18	$5.56	$5.18	$0.00	$0.00	$0.00	$0.00
30100308	EAP	CPT® 84075		"Alk Phos,fluid"	BOTH IP/OP	$110.00 	$81.40	$0.00	$88.00	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.46	$3.37	$65.07	$65.07	$5.44	$14.46	$87.12	$88.00	$7.51	$0.00	$7.51	$7.94	$5.18	$5.18	$5.56	$5.18	$0.00	$0.00	$0.00	$0.00
30100309	EAP	CPT® 84080		Alk Phos Isoenzymes	BOTH IP/OP	$316.00 	$233.84	$7.39	$240.80	$30.52	$30.52	$14.78	$14.78	$7.39	$7.39	$22.45	$22.45	$23.32	$14.78	$21.84	$9.61	$186.91	$186.91	$15.52	$41.32	$238.39	$240.80	$21.43	$24.39	$21.43	$23.27	$14.78	$14.78	$16.29	$14.78	$0.00	$0.00	$0.00	$0.00
30100310	EAP	CPT® 84081		Pg Agglutinin Test	BOTH IP/OP	$194.00 	$143.56	$0.00	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.08	$25.08	$26.05	$0.00	$24.41	$0.00	$0.00	$0.00	$0.00	$46.18	$153.65	$155.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100311	EAP	CPT® 84100		Phosphorus	BOTH IP/OP	$150.00 	$111.00	$2.37	$108.80	$9.79	$9.79	$4.74	$4.74	$2.37	$2.37	$7.21	$7.21	$7.48	$4.74	$7.01	$3.08	$88.73	$88.73	$4.98	$13.26	$107.71	$108.80	$6.87	$7.82	$6.87	$7.47	$4.74	$4.74	$5.23	$4.74	$0.00	$0.00	$0.00	$0.00
30100312	EAP	CPT® 84100		"Phosporus, Serum"	BOTH IP/OP	$128.00 	$94.72	$2.37	$108.80	$9.79	$9.79	$4.74	$4.74	$2.37	$2.37	$7.21	$7.21	$7.48	$4.74	$7.01	$3.08	$75.71	$75.71	$4.98	$13.26	$107.71	$108.80	$6.87	$7.82	$6.87	$7.47	$4.74	$4.74	$5.23	$4.74	$0.00	$0.00	$0.00	$0.00
30100313	EAP	CPT® 84105		"Phosphorus, Urine"	BOTH IP/OP	$164.00 	$121.36	$2.60	$119.20	$10.69	$10.69	$5.78	$5.78	$2.89	$2.60	$7.86	$7.86	$8.16	$5.78	$7.64	$3.76	$97.01	$97.01	$6.07	$14.46	$118.01	$119.20	$8.38	$9.54	$8.38	$8.14	$5.78	$5.78	$5.70	$5.78	$0.00	$0.00	$0.00	$0.00
30100314	EAP	CPT® 84110		Porphobilinogen-24hr	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.83	$12.83	$13.33	$0.00	$12.47	$0.00	$0.00	$0.00	$8.86	$23.60	$59.40	$60.00	$12.24	$0.00	$12.24	$13.29	$8.44	$8.44	$9.30	$8.44	$0.00	$0.00	$0.00	$0.00
30100315	EAP	CPT® 84120		"Porphyrins,ur-quant"	BOTH IP/OP	$109.00 	$80.66	$0.00	$109.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.36	$22.33	$22.33	$23.19	$14.71	$21.74	$9.56	$64.47	$64.47	$0.00	$41.10	$86.33	$87.20	$0.00	$109.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100316	EAP	CPT® 84132		"Potassium, Wb"	BOTH IP/OP	$141.00 	$104.34	$2.30	$112.80	$9.50	$9.50	$4.76	$4.76	$2.38	$2.30	$6.97	$6.97	$7.24	$4.76	$6.79	$3.09	$83.40	$83.40	$5.00	$12.84	$111.67	$112.80	$6.90	$7.85	$6.90	$7.24	$4.76	$4.76	$5.07	$4.76	$0.00	$0.00	$0.00	$0.00
30100317	EAP	CPT® 84132		Potassium	BOTH IP/OP	$141.00 	$104.34	$2.30	$112.80	$9.50	$9.50	$4.76	$4.76	$2.38	$2.30	$6.97	$6.97	$7.24	$4.76	$6.79	$3.09	$83.40	$83.40	$5.00	$12.84	$111.67	$112.80	$6.90	$7.85	$6.90	$7.24	$4.76	$4.76	$5.07	$4.76	$0.00	$0.00	$0.00	$0.00
30100318	EAP	CPT® 84132		"Potassium,plasma"	BOTH IP/OP	$141.00 	$104.34	$2.30	$112.80	$9.50	$9.50	$4.76	$4.76	$2.38	$2.30	$6.97	$6.97	$7.24	$4.76	$6.79	$3.09	$83.40	$83.40	$5.00	$12.84	$111.67	$112.80	$6.90	$7.85	$6.90	$7.24	$4.76	$4.76	$5.07	$4.76	$0.00	$0.00	$0.00	$0.00
30100319	EAP	CPT® 84133		"Potassium,fluid"	BOTH IP/OP	$106.00 	$78.44	$2.16	$84.80	$8.90	$8.90	$4.73	$4.73	$2.37	$2.16	$6.53	$6.53	$6.78	$4.73	$6.35	$3.07	$62.70	$62.70	$4.97	$12.02	$83.95	$84.80	$6.86	$7.80	$6.86	$6.77	$4.73	$4.73	$4.74	$4.73	$0.00	$0.00	$0.00	$0.00
30100320	EAP	CPT® 84133		"Potassium, Urine"	BOTH IP/OP	$106.00 	$78.44	$2.16	$84.80	$8.90	$8.90	$4.73	$4.73	$2.37	$2.16	$6.53	$6.53	$6.78	$4.73	$6.35	$3.07	$62.70	$62.70	$4.97	$12.02	$83.95	$84.80	$6.86	$7.80	$6.86	$6.77	$4.73	$4.73	$4.74	$4.73	$0.00	$0.00	$0.00	$0.00
30100321	EAP	CPT® 84134		Prealbumin	BOTH IP/OP	$282.00 	$208.68	$7.29	$204.80	$30.12	$30.12	$14.59	$14.59	$7.30	$7.29	$22.15	$22.15	$23.00	$14.59	$21.55	$9.48	$166.80	$166.80	$15.32	$40.76	$202.75	$204.80	$21.16	$24.07	$21.16	$22.96	$14.59	$14.59	$16.07	$14.59	$0.00	$0.00	$0.00	$0.00
30100322	EAP	CPT® 84135		"Pregnanediol,ur-24hr"	BOTH IP/OP	$210.00 	$155.40	$0.00	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.06	$29.06	$30.18	$0.00	$43.76	$0.00	$0.00	$0.00	$0.00	$53.46	$177.41	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100323	EAP	CPT® 84138		"Pregnanetriol,ur-24h"	BOTH IP/OP	$209.00 	$154.66	$0.00	$178.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.76	$28.76	$29.86	$0.00	$27.97	$0.00	$0.00	$0.00	$0.00	$52.92	$176.62	$178.40	$0.00	$95.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100324	EAP	CPT® 84144		"Progesterone, Serum"	BOTH IP/OP	$222.00 	$164.28	$10.43	$179.20	$42.06	$42.06	$20.86	$20.86	$10.43	$10.43	$30.93	$30.93	$32.12	$20.86	$30.08	$13.56	$131.31	$131.31	$21.90	$56.92	$177.41	$179.20	$30.25	$34.42	$30.25	$32.05	$20.86	$20.86	$22.44	$20.86	$0.00	$0.00	$0.00	$0.00
30100325	EAP	CPT® 84146		"Prolactin,serum"	BOTH IP/OP	$427.00 	$315.98	$9.69	$341.60	$40.00	$40.00	$19.38	$19.38	$9.69	$9.69	$29.43	$29.43	$30.56	$19.38	$28.63	$12.60	$252.57	$252.57	$20.35	$54.16	$338.18	$341.60	$28.10	$31.98	$28.10	$30.51	$19.38	$19.38	$21.36	$19.38	$0.00	$0.00	$0.00	$0.00
30100326	EAP	CPT® 84153		Prostatic Antigen	BOTH IP/OP	$335.00 	$247.90	$9.20	$268.00	$37.96	$37.96	$18.39	$18.39	$9.20	$9.20	$27.92	$27.92	$29.00	$18.39	$27.17	$11.95	$198.15	$198.15	$19.31	$51.40	$265.32	$268.00	$26.67	$30.34	$26.67	$28.95	$18.39	$18.39	$20.27	$18.39	$0.00	$0.00	$0.00	$0.00
30100327	EAP	CPT® 84155		"Protein,total"	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$7.58	$7.58	$3.67	$3.67	$1.84	$1.83	$5.56	$5.56	$5.78	$3.67	$5.42	$2.39	$78.08	$78.08	$0.00	$10.24	$104.54	$105.60	$0.00	$6.06	$0.00	$5.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100328	EAP	CPT® 84155		"Protein, Csf"	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$7.58	$7.58	$3.67	$3.67	$1.84	$1.83	$5.56	$5.56	$5.78	$3.67	$5.42	$2.39	$78.08	$78.08	$0.00	$10.24	$104.54	$105.60	$0.00	$6.06	$0.00	$5.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100329	EAP	CPT® 84155		"Protein,total"	BOTH IP/OP	$135.00 	$99.90	$0.00	$105.60	$7.58	$7.58	$3.67	$3.67	$1.84	$1.83	$5.56	$5.56	$5.78	$3.67	$5.42	$2.39	$79.85	$79.85	$0.00	$10.24	$104.54	$105.60	$0.00	$6.06	$0.00	$5.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100330	EAP	CPT® 84156		"Protein,ur (quant)"	BOTH IP/OP	$132.00 	$97.68	$1.83	$103.20	$7.58	$7.58	$3.67	$3.67	$1.84	$1.83	$5.56	$5.56	$5.78	$3.67	$5.42	$2.39	$78.08	$78.08	$3.85	$10.24	$102.17	$103.20	$5.32	$6.06	$5.32	$5.77	$3.67	$3.67	$4.04	$3.67	$0.00	$0.00	$0.00	$0.00
30100331	EAP	CPT® 84157		"Protein,fluid"	BOTH IP/OP	$155.00 	$114.70	$1.83	$121.60	$7.58	$7.58	$4.00	$4.00	$2.00	$1.83	$5.56	$5.56	$5.78	$4.00	$5.42	$2.60	$91.68	$91.68	$4.20	$10.24	$120.38	$121.60	$5.80	$6.60	$5.80	$5.77	$4.00	$4.00	$4.04	$4.00	$0.00	$0.00	$0.00	$0.00
30100332	EAP	CPT® 84157		"Protein, Csf"	BOTH IP/OP	$155.00 	$114.70	$1.83	$121.60	$7.58	$7.58	$4.00	$4.00	$2.00	$1.83	$5.56	$5.56	$5.78	$4.00	$5.42	$2.60	$91.68	$91.68	$4.20	$10.24	$120.38	$121.60	$5.80	$6.60	$5.80	$5.77	$4.00	$4.00	$4.04	$4.00	$0.00	$0.00	$0.00	$0.00
30100333	EAP	CPT® 84165		"Protein Elect, Serum"	BOTH IP/OP	$357.00 	$264.18	$5.37	$280.00	$22.18	$22.18	$10.74	$10.74	$5.37	$5.37	$16.31	$16.31	$16.93	$10.74	$15.87	$6.98	$211.17	$211.17	$11.28	$30.02	$277.20	$280.00	$15.57	$17.72	$15.57	$16.91	$10.74	$10.74	$11.83	$10.74	$0.00	$0.00	$0.00	$0.00
30100334	EAP	CPT® 84166		"Protein Electrophoresis, Csf"	BOTH IP/OP	$350.00 	$259.00	$8.91	$280.00	$36.80	$36.80	$17.83	$17.83	$8.92	$8.91	$27.08	$27.08	$28.12	$17.83	$26.34	$11.59	$207.03	$207.03	$18.72	$49.84	$277.20	$280.00	$25.85	$29.42	$25.85	$28.07	$17.83	$17.83	$19.65	$17.83	$0.00	$0.00	$0.00	$0.00
30100335	EAP	CPT® 84166		"Protein Elect, Urine"	BOTH IP/OP	$357.00 	$264.18	$8.91	$280.00	$36.80	$36.80	$17.83	$17.83	$8.92	$8.91	$27.08	$27.08	$28.12	$17.83	$26.34	$11.59	$211.17	$211.17	$18.72	$49.84	$277.20	$280.00	$25.85	$29.42	$25.85	$28.07	$17.83	$17.83	$19.65	$17.83	$0.00	$0.00	$0.00	$0.00
30100336	EAP	CPT® 84202		"Protoporphyrin,rbc"	BOTH IP/OP	$74.00 	$54.76	$0.00	$59.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.79	$21.79	$22.63	$0.00	$21.20	$0.00	$0.00	$0.00	$0.00	$40.10	$58.61	$59.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100337	EAP	CPT® 84207		Vitamine B6; Pyridoxine	BOTH IP/OP	$800.00 	$592.00	$0.00	$640.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.66	$42.66	$44.30	$0.00	$41.51	$0.00	$0.00	$0.00	$0.00	$78.50	$633.60	$640.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100338	EAP	CPT® 84210		"Pyruvic Acid, Blood"	BOTH IP/OP	$118.00 	$87.32	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.48	$16.48	$17.12	$0.00	$16.03	$0.00	$0.00	$0.00	$15.20	$30.34	$93.46	$94.40	$21.00	$118.00	$21.00	$0.00	$14.48	$14.48	$11.96	$14.48	$0.00	$0.00	$0.00	$0.00
30100339	EAP	CPT® 84238		Acetcholn Reptor Ad	BOTH IP/OP	$201.00 	$148.74	$18.28	$162.40	$75.48	$75.48	$36.57	$36.57	$18.29	$18.28	$55.53	$55.53	$57.66	$36.57	$54.01	$23.77	$118.89	$118.89	$38.40	$102.18	$160.78	$162.40	$53.03	$60.34	$53.03	$57.55	$36.57	$36.57	$40.29	$36.57	$0.00	$0.00	$0.00	$0.00
30100340	EAP	CPT® 84244		"Renin, Blood"	BOTH IP/OP	$322.00 	$238.28	$11.00	$260.00	$45.41	$45.41	$21.99	$21.99	$11.00	$11.00	$33.40	$33.40	$34.69	$21.99	$32.50	$14.29	$190.46	$190.46	$23.09	$61.46	$257.40	$260.00	$31.89	$36.28	$31.89	$34.63	$21.99	$21.99	$24.24	$21.99	$0.00	$0.00	$0.00	$0.00
30100341	EAP	CPT® 84295		"Sodium, Wb"	BOTH IP/OP	$220.00 	$162.80	$2.41	$160.00	$9.93	$9.93	$4.81	$4.81	$2.41	$2.41	$7.30	$7.30	$7.58	$4.81	$7.11	$3.13	$130.13	$130.13	$5.05	$13.44	$158.40	$160.00	$6.97	$7.94	$6.97	$7.57	$4.81	$4.81	$5.30	$4.81	$0.00	$0.00	$0.00	$0.00
30100342	EAP	CPT® 84295		Sodium	BOTH IP/OP	$220.00 	$162.80	$2.41	$160.00	$9.93	$9.93	$4.81	$4.81	$2.41	$2.41	$7.30	$7.30	$7.58	$4.81	$7.11	$3.13	$130.13	$130.13	$5.05	$13.44	$158.40	$160.00	$6.97	$7.94	$6.97	$7.57	$4.81	$4.81	$5.30	$4.81	$0.00	$0.00	$0.00	$0.00
30100343	EAP	CPT® 84295		Sodium-direct Ise	BOTH IP/OP	$190.00 	$140.60	$2.41	$160.00	$9.93	$9.93	$4.81	$4.81	$2.41	$2.41	$7.30	$7.30	$7.58	$4.81	$7.11	$3.13	$112.39	$112.39	$5.05	$13.44	$158.40	$160.00	$6.97	$7.94	$6.97	$7.57	$4.81	$4.81	$5.30	$4.81	$0.00	$0.00	$0.00	$0.00
30100344	EAP	CPT® 84300		"Sodium, Urine"	BOTH IP/OP	$144.00 	$106.56	$2.43	$104.80	$7.13	$7.13	$5.06	$5.06	$2.53	$2.43	$5.25	$5.25	$5.45	$5.06	$5.11	$3.29	$85.18	$85.18	$5.31	$9.66	$103.75	$104.80	$7.34	$8.35	$7.34	$5.45	$5.06	$5.06	$3.81	$5.06	$0.00	$0.00	$0.00	$0.00
30100345	EAP	CPT® 84302		"Sodium,fluid"	BOTH IP/OP	$144.00 	$106.56	$0.00	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.25	$5.25	$5.45	$0.00	$5.11	$0.00	$0.00	$0.00	$0.00	$9.66	$103.75	$104.80	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100346	EAP	CPT® 84305		Igf-1(somatomedin C)	BOTH IP/OP	$283.00 	$209.42	$10.63	$220.00	$43.90	$43.90	$21.26	$21.26	$10.63	$10.63	$32.28	$32.28	$33.52	$21.26	$31.41	$13.82	$167.39	$167.39	$22.32	$59.40	$217.80	$220.00	$30.83	$35.08	$30.83	$33.46	$21.26	$21.26	$23.42	$21.26	$0.00	$0.00	$0.00	$0.00
30100347	EAP	CPT® 84375		Oligosaccharide	BOTH IP/OP	$134.00 	$99.16	$0.00	$107.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.76	$29.76	$30.91	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$54.78	$106.13	$107.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100348	EAP	CPT® 84402		"Testosterone, Free"	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$52.59	$52.59	$25.47	$25.47	$12.74	$12.74	$38.67	$38.67	$40.15	$25.47	$37.60	$16.56	$56.19	$56.19	$26.74	$71.14	$75.24	$76.00	$36.93	$0.00	$36.93	$40.06	$25.47	$25.47	$28.04	$25.47	$0.00	$0.00	$0.00	$0.00
30100349	EAP	CPT® 84403		"Testosterone, Total"	BOTH IP/OP	$384.00 	$284.16	$0.00	$307.20	$53.28	$53.28	$25.81	$25.81	$12.91	$12.91	$39.21	$39.21	$40.72	$25.81	$38.15	$16.78	$227.14	$227.14	$27.10	$72.16	$304.13	$307.20	$37.42	$0.00	$37.42	$40.65	$25.81	$25.81	$28.45	$25.81	$0.00	$0.00	$0.00	$0.00
30100350	EAP	CPT® 84403		"Testosterone, Serum"	BOTH IP/OP	$384.00 	$284.16	$12.91	$307.20	$53.28	$53.28	$25.81	$25.81	$12.91	$12.91	$39.21	$39.21	$40.72	$25.81	$38.15	$16.78	$227.14	$227.14	$27.10	$72.16	$304.13	$307.20	$37.42	$42.59	$37.42	$40.65	$25.81	$25.81	$28.45	$25.81	$0.00	$0.00	$0.00	$0.00
30100351	EAP	CPT® 84425		Vitamine B1; Thyamin	BOTH IP/OP	$276.00 	$204.24	$0.00	$220.80	$43.82	$43.82	$21.23	$21.23	$10.62	$10.62	$32.25	$32.25	$33.49	$21.23	$31.36	$13.80	$163.25	$163.25	$22.29	$59.34	$218.59	$220.80	$30.78	$0.00	$30.78	$33.42	$21.23	$21.23	$23.39	$21.23	$0.00	$0.00	$0.00	$0.00
30100352	EAP	CPT® 84430		Thiocyanate-quant	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.76	$8.76	$9.09	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$16.12	$157.61	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100353	EAP	CPT® 84432		"Thyroglobulin, Quant"	BOTH IP/OP	$214.00 	$158.36	$8.03	$171.20	$33.16	$33.16	$16.06	$16.06	$8.03	$8.03	$24.39	$24.39	$25.33	$16.06	$23.73	$10.44	$126.58	$126.58	$16.86	$44.88	$169.49	$171.20	$23.29	$26.50	$23.29	$25.28	$16.06	$16.06	$17.70	$16.06	$0.00	$0.00	$0.00	$0.00
30100354	EAP	CPT® 84436		"Thyroxine,total(t4)"	BOTH IP/OP	$322.00 	$238.28	$3.43	$258.40	$14.18	$14.18	$6.87	$6.87	$3.44	$3.43	$10.43	$10.43	$10.83	$6.87	$10.16	$4.47	$190.46	$190.46	$7.21	$19.22	$255.82	$258.40	$9.96	$11.34	$9.96	$10.83	$6.87	$6.87	$7.58	$6.87	$0.00	$0.00	$0.00	$0.00
30100355	EAP	CPT® 84439		Free Thyroxine	BOTH IP/OP	$215.00 	$159.10	$4.51	$172.00	$18.61	$18.61	$9.02	$9.02	$4.51	$4.51	$13.70	$13.70	$14.22	$9.02	$13.32	$5.86	$127.17	$127.17	$9.47	$25.20	$170.28	$172.00	$13.08	$14.88	$13.08	$14.20	$9.02	$9.02	$9.94	$9.02	$0.00	$0.00	$0.00	$0.00
30100356	EAP	CPT® 84442		Thyroxine Bind.glob.	BOTH IP/OP	$63.00 	$46.62	$0.00	$63.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.67	$17.67	$18.35	$0.00	$17.19	$0.00	$0.00	$0.00	$15.52	$32.52	$49.90	$50.40	$21.43	$63.00	$21.43	$18.31	$14.78	$14.78	$12.82	$14.78	$0.00	$0.00	$0.00	$0.00
30100357	EAP	CPT® 84443		"Tsh,serum-irma"	BOTH IP/OP	$275.00 	$203.50	$8.40	$220.00	$34.69	$34.69	$16.80	$16.80	$8.40	$8.40	$25.51	$25.51	$26.49	$16.80	$24.81	$10.92	$162.66	$162.66	$17.64	$46.94	$217.80	$220.00	$24.36	$27.72	$24.36	$26.44	$16.80	$16.80	$18.51	$16.80	$0.00	$0.00	$0.00	$0.00
30100358	EAP	CPT® 84446		"Vitamin E, Serum"	BOTH IP/OP	$178.00 	$131.72	$7.09	$178.00	$29.28	$29.28	$14.18	$14.18	$7.09	$7.09	$21.53	$21.53	$22.36	$14.18	$20.95	$9.22	$105.29	$105.29	$14.89	$39.62	$140.98	$142.40	$20.56	$178.00	$20.56	$22.32	$14.18	$14.18	$15.62	$14.18	$0.00	$0.00	$0.00	$0.00
30100359	EAP	CPT® 84450		"Sgot(ast),serum"	BOTH IP/OP	$63.00 	$46.62	$2.59	$51.20	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.85	$7.85	$8.15	$5.18	$7.46	$3.37	$37.26	$37.26	$5.44	$14.44	$50.69	$51.20	$7.51	$8.55	$7.51	$7.94	$5.18	$5.18	$5.56	$5.18	$0.00	$0.00	$0.00	$0.00
30100360	EAP	CPT® 84460		Sgpt(alt)-rate	BOTH IP/OP	$63.00 	$46.62	$2.65	$51.20	$10.93	$10.93	$5.30	$5.30	$2.65	$2.65	$8.04	$8.04	$8.35	$5.30	$7.46	$3.45	$37.26	$37.26	$5.57	$14.80	$50.69	$51.20	$7.69	$8.75	$7.69	$7.94	$5.30	$5.30	$5.56	$5.30	$0.00	$0.00	$0.00	$0.00
30100361	EAP	CPT® 84466		Transferrin	BOTH IP/OP	$340.00 	$251.60	$6.38	$274.40	$26.35	$26.35	$12.76	$12.76	$6.38	$6.38	$19.39	$19.39	$20.13	$12.76	$18.87	$8.29	$201.11	$201.11	$13.40	$35.68	$271.66	$274.40	$18.50	$21.05	$18.50	$20.10	$12.76	$12.76	$14.07	$12.76	$0.00	$0.00	$0.00	$0.00
30100362	EAP	CPT® 84478		Triglyceride-serum	BOTH IP/OP	$131.00 	$96.94	$0.00	$120.00	$11.85	$11.85	$5.74	$5.74	$2.87	$2.87	$8.74	$8.74	$9.07	$5.74	$7.46	$3.73	$77.49	$77.49	$6.03	$16.08	$118.80	$120.00	$8.32	$0.00	$8.32	$7.94	$5.74	$5.74	$5.56	$5.74	$0.00	$0.00	$0.00	$0.00
30100363	EAP	CPT® 84478		Triglyceride	BOTH IP/OP	$152.00 	$112.48	$2.87	$120.00	$11.85	$11.85	$5.74	$5.74	$2.87	$2.87	$8.74	$8.74	$9.07	$5.74	$7.46	$3.73	$89.91	$89.91	$6.03	$16.08	$118.80	$120.00	$8.32	$9.47	$8.32	$7.94	$5.74	$5.74	$5.56	$5.74	$0.00	$0.00	$0.00	$0.00
30100364	EAP	CPT® 84478		"Triglyceride,fluid"	BOTH IP/OP	$152.00 	$112.48	$2.87	$120.00	$11.85	$11.85	$5.74	$5.74	$2.87	$2.87	$8.74	$8.74	$9.07	$5.74	$7.46	$3.73	$89.91	$89.91	$6.03	$16.08	$118.80	$120.00	$8.32	$9.47	$8.32	$7.94	$5.74	$5.74	$5.56	$5.74	$0.00	$0.00	$0.00	$0.00
30100365	EAP	CPT® 84478		Triglyceride	BOTH IP/OP	$114.00 	$84.36	$0.00	$104.80	$11.85	$11.85	$5.74	$5.74	$2.87	$2.87	$8.74	$8.74	$9.07	$5.74	$7.46	$3.73	$67.43	$67.43	$6.03	$16.08	$103.75	$104.80	$8.32	$0.00	$8.32	$7.94	$5.74	$5.74	$5.56	$5.74	$0.00	$0.00	$0.00	$0.00
30100366	EAP	CPT® 84480		T3-triiodothyronine	BOTH IP/OP	$302.00 	$223.48	$7.09	$239.20	$26.35	$26.35	$14.18	$14.18	$7.09	$7.09	$19.35	$19.35	$20.10	$14.18	$18.83	$9.22	$178.63	$178.63	$14.89	$35.62	$236.81	$239.20	$20.56	$23.40	$20.56	$20.06	$14.18	$14.18	$14.04	$14.18	$0.00	$0.00	$0.00	$0.00
30100367	EAP	CPT® 84484		Troponin-1	BOTH IP/OP	$416.00 	$307.84	$5.61	$336.00	$20.33	$20.33	$12.47	$12.47	$6.24	$5.61	$14.94	$14.94	$15.52	$12.47	$14.54	$8.11	$246.06	$246.06	$13.09	$27.50	$332.64	$336.00	$18.08	$20.58	$18.08	$15.50	$12.47	$12.47	$10.85	$12.47	$0.00	$0.00	$0.00	$0.00
30100368	EAP	CPT® 84484		Troponin-t	BOTH IP/OP	$416.00 	$307.84	$5.61	$336.00	$20.33	$20.33	$12.47	$12.47	$6.24	$5.61	$14.94	$14.94	$15.52	$12.47	$14.54	$8.11	$246.06	$246.06	$13.09	$27.50	$332.64	$336.00	$18.08	$20.58	$18.08	$15.50	$12.47	$12.47	$10.85	$12.47	$0.00	$0.00	$0.00	$0.00
30100369	EAP	CPT® 84520		Urea Nitrogen	BOTH IP/OP	$147.00 	$108.78	$0.00	$118.40	$8.16	$8.16	$3.95	$3.95	$1.98	$1.98	$5.99	$5.99	$6.22	$3.95	$5.83	$2.57	$86.95	$86.95	$0.00	$11.02	$117.22	$118.40	$0.00	$6.52	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100370	EAP	CPT® 84540		"Urea Nitrogen,fluid"	BOTH IP/OP	$171.00 	$126.54	$2.50	$138.40	$9.79	$9.79	$5.56	$5.56	$2.78	$2.50	$7.21	$7.21	$7.48	$5.56	$7.02	$3.61	$101.15	$101.15	$5.84	$13.28	$137.02	$138.40	$8.06	$9.17	$8.06	$7.48	$5.56	$5.56	$5.24	$5.56	$0.00	$0.00	$0.00	$0.00
30100371	EAP	CPT® 84540		"Urea Nitrogen,urine"	BOTH IP/OP	$171.00 	$126.54	$2.50	$138.40	$9.79	$9.79	$5.56	$5.56	$2.78	$2.50	$7.21	$7.21	$7.48	$5.56	$7.02	$3.61	$101.15	$101.15	$5.84	$13.28	$137.02	$138.40	$8.06	$9.17	$8.06	$7.48	$5.56	$5.56	$5.24	$5.56	$0.00	$0.00	$0.00	$0.00
30100372	EAP	CPT® 84550		Uric Acid - Serum	BOTH IP/OP	$141.00 	$104.34	$2.26	$112.80	$9.32	$9.32	$4.52	$4.52	$2.26	$2.26	$6.85	$6.85	$7.12	$4.52	$6.67	$2.94	$83.40	$83.40	$4.75	$12.62	$111.67	$112.80	$6.55	$7.46	$6.55	$7.10	$4.52	$4.52	$4.97	$4.52	$0.00	$0.00	$0.00	$0.00
30100373	EAP	CPT® 84550		Uric Acid	BOTH IP/OP	$140.00 	$103.60	$2.26	$112.80	$9.32	$9.32	$4.52	$4.52	$2.26	$2.26	$6.85	$6.85	$7.12	$4.52	$6.67	$2.94	$82.81	$82.81	$4.75	$12.62	$111.67	$112.80	$6.55	$7.46	$6.55	$7.10	$4.52	$4.52	$4.97	$4.52	$0.00	$0.00	$0.00	$0.00
30100374	EAP	CPT® 84560		"Uric Acid,syn Fluid"	BOTH IP/OP	$140.00 	$103.60	$2.37	$112.80	$9.79	$9.79	$5.08	$5.08	$2.54	$2.37	$7.21	$7.21	$7.48	$5.08	$7.02	$3.30	$82.81	$82.81	$5.33	$13.28	$111.67	$112.80	$7.37	$8.38	$7.37	$7.48	$5.08	$5.08	$5.24	$5.08	$0.00	$0.00	$0.00	$0.00
30100375	EAP	CPT® 84560		"Uric Acid, Urine"	BOTH IP/OP	$140.00 	$103.60	$2.37	$112.80	$9.79	$9.79	$5.08	$5.08	$2.54	$2.37	$7.21	$7.21	$7.48	$5.08	$7.02	$3.30	$82.81	$82.81	$5.33	$13.28	$111.67	$112.80	$7.37	$8.38	$7.37	$7.48	$5.08	$5.08	$5.24	$5.08	$0.00	$0.00	$0.00	$0.00
30100376	EAP	CPT® 84585		"Vma, Urine-24hr"	BOTH IP/OP	$85.00 	$62.90	$0.00	$85.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.55	$23.55	$24.45	$0.00	$22.90	$0.00	$0.00	$0.00	$0.00	$43.32	$67.32	$68.00	$0.00	$85.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100377	EAP	CPT® 84586		Vasoac Intes Polypep	BOTH IP/OP	$156.00 	$115.44	$0.00	$156.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.67	$53.65	$53.65	$55.72	$35.33	$52.20	$22.96	$92.27	$92.27	$37.10	$98.74	$123.55	$124.80	$51.23	$156.00	$51.23	$0.00	$35.33	$35.33	$38.93	$35.33	$0.00	$0.00	$0.00	$0.00
30100378	EAP	CPT® 84588		Adh Result	BOTH IP/OP	$263.00 	$194.62	$0.00	$263.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.54	$51.54	$53.52	$0.00	$50.15	$0.00	$0.00	$0.00	$0.00	$94.86	$208.30	$210.40	$0.00	$263.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100379	EAP	CPT® 84590		"Vitamin A, Serum"	BOTH IP/OP	$243.00 	$179.82	$0.00	$196.00	$23.94	$23.94	$11.61	$11.61	$5.81	$5.81	$17.61	$17.61	$18.28	$11.61	$17.13	$7.55	$143.73	$143.73	$12.19	$32.40	$194.04	$196.00	$16.83	$19.16	$16.83	$0.00	$11.61	$11.61	$12.77	$11.61	$0.00	$0.00	$0.00	$0.00
30100380	EAP	CPT® 84600		"Volatile, Drug Screen"	BOTH IP/OP	$333.00 	$246.42	$0.00	$333.00	$33.18	$33.18	$17.11	$17.11	$8.56	$8.04	$24.41	$24.41	$25.35	$17.11	$23.74	$11.12	$196.97	$196.97	$0.00	$44.90	$263.74	$266.40	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100381	EAP	CPT® 84620		"D-xylose, Serum"	BOTH IP/OP	$131.00 	$96.94	$0.00	$111.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.98	$17.98	$18.67	$0.00	$17.50	$0.00	$0.00	$0.00	$0.00	$33.10	$110.09	$111.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100382	EAP	CPT® 84620		"D-xylose, Urine"	BOTH IP/OP	$131.00 	$96.94	$0.00	$111.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.98	$17.98	$18.67	$0.00	$17.50	$0.00	$0.00	$0.00	$0.00	$33.10	$110.09	$111.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100383	EAP	CPT® 84630		"Zinc, Serum"	BOTH IP/OP	$81.00 	$59.94	$5.69	$65.60	$23.50	$23.50	$11.39	$11.39	$5.70	$5.69	$17.30	$17.30	$17.96	$11.39	$16.82	$7.40	$47.91	$47.91	$11.96	$31.82	$64.94	$65.60	$16.52	$18.79	$16.52	$17.92	$11.39	$11.39	$12.55	$11.39	$0.00	$0.00	$0.00	$0.00
30100384	EAP	CPT® 84681		"C-peptide, Random"	BOTH IP/OP	$370.00 	$273.80	$10.41	$299.20	$32.82	$32.82	$20.81	$20.81	$10.41	$10.41	$24.13	$24.13	$25.06	$20.81	$23.47	$13.53	$218.86	$218.86	$21.85	$44.40	$296.21	$299.20	$30.17	$34.34	$30.17	$25.01	$20.81	$20.81	$17.50	$20.81	$0.00	$0.00	$0.00	$0.00
30100385	EAP	CPT® 84681		"C-peptide, Fasting"	BOTH IP/OP	$374.00 	$276.76	$0.00	$299.20	$32.82	$32.82	$20.81	$20.81	$10.41	$10.41	$24.13	$24.13	$25.06	$20.81	$23.47	$13.53	$221.22	$221.22	$21.85	$44.40	$296.21	$299.20	$30.17	$0.00	$30.17	$25.01	$20.81	$20.81	$17.50	$20.81	$0.00	$0.00	$0.00	$0.00
30100386	EAP	CPT® 84681		"C-peptide, Stimulat."	BOTH IP/OP	$374.00 	$276.76	$0.00	$299.20	$32.82	$32.82	$20.81	$20.81	$10.41	$10.41	$24.13	$24.13	$25.06	$20.81	$23.47	$13.53	$221.22	$221.22	$21.85	$44.40	$296.21	$299.20	$30.17	$0.00	$30.17	$25.01	$20.81	$20.81	$17.50	$20.81	$0.00	$0.00	$0.00	$0.00
30100387	EAP	CPT® 84702		"*hcg, Serum, Quant"	BOTH IP/OP	$419.00 	$310.06	$7.07	$304.80	$13.25	$13.25	$15.05	$15.05	$7.53	$7.53	$9.74	$9.74	$10.12	$15.05	$9.48	$9.78	$247.84	$247.84	$15.80	$17.94	$301.75	$304.80	$21.82	$24.83	$21.82	$10.10	$15.05	$15.05	$7.07	$15.05	$0.00	$0.00	$0.00	$0.00
30100388	EAP	CPT® 84702		"B-hcg,mat.serum"	BOTH IP/OP	$204.00 	$150.96	$0.00	$166.40	$13.25	$13.25	$15.05	$15.05	$7.53	$7.53	$9.74	$9.74	$10.12	$15.05	$9.48	$9.78	$120.67	$120.67	$15.80	$17.94	$164.74	$166.40	$21.82	$0.00	$21.82	$10.10	$15.05	$15.05	$7.07	$15.05	$0.00	$0.00	$0.00	$0.00
30100389	EAP	CPT® 84702		"Hcg,serum-quant"	BOTH IP/OP	$374.00 	$276.76	$7.07	$304.80	$13.25	$13.25	$15.05	$15.05	$7.53	$7.53	$9.74	$9.74	$10.12	$15.05	$9.48	$9.78	$221.22	$221.22	$15.80	$17.94	$301.75	$304.80	$21.82	$24.83	$21.82	$10.10	$15.05	$15.05	$7.07	$15.05	$0.00	$0.00	$0.00	$0.00
30100390	EAP	CPT® 84703		Pregnancy Test	BOTH IP/OP	$67.00 	$49.58	$0.00	$67.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.74	$9.74	$10.12	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$17.94	$48.31	$48.80	$0.00	$67.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100392	EAP	CPT® 84999		Lysosomal Enz.scrn	BOTH IP/OP	"$2,308.00 "	"$1,707.92"	$0.00	"$1,966.40"	$0.00	$0.00	$0.00	$0.00	$410.82	$0.00	"$1,713.00"	"$1,713.00"	"$1,779.01"	$0.00	$480.99	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,946.74"	"$1,966.40"	$0.00	$120.90	$0.00	$384.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100393	EAP	CPT® 84466		"B-2 Transferrin, Fld"	BOTH IP/OP	$483.00 	$357.42	$6.38	$389.60	$26.35	$26.35	$12.76	$12.76	$6.38	$6.38	$19.39	$19.39	$20.13	$12.76	$18.87	$8.29	$285.69	$285.69	$13.40	$35.68	$385.70	$389.60	$18.50	$21.05	$18.50	$20.10	$12.76	$12.76	$14.07	$12.76	$0.00	$0.00	$0.00	$0.00
30100395	EAP	CPT® 80048		Basic Metabolic Panel	BOTH IP/OP	$383.00 	$283.42	$4.23	$299.20	$17.45	$17.45	$8.46	$8.46	$4.23	$4.23	$12.85	$12.85	$13.35	$8.46	$12.52	$5.50	$226.54	$226.54	$8.88	$23.66	$296.21	$299.20	$12.27	$13.96	$12.27	$13.34	$8.46	$8.46	$9.34	$8.46	$0.00	$0.00	$0.00	$0.00
30100396	EAP	CPT® 88720		"Bilirubin,total-transcutaneous"	BOTH IP/OP	$56.00 	$41.44	$2.51	$45.60	$10.35	$10.35	$5.02	$5.02	$2.51	$2.51	$7.62	$7.62	$7.92	$5.02	$11.67	$3.26	$33.12	$33.12	$5.27	$28.50	$45.14	$45.60	$7.28	$8.28	$7.28	$8.92	$5.02	$5.02	$9.07	$5.02	$0.00	$0.00	$0.00	$0.00
30100401	EAP	CPT® 82274		"Fecal Occult Blood,fit"	BOTH IP/OP	$133.00 	$98.42	$7.95	$107.20	$32.84	$32.84	$15.92	$15.92	$7.96	$7.95	$24.15	$24.15	$25.08	$15.92	$25.48	$10.35	$78.67	$78.67	$16.72	$44.44	$106.13	$107.20	$23.08	$26.27	$23.08	$27.15	$15.92	$15.92	$19.01	$15.92	$0.00	$0.00	$0.00	$0.00
30100403	EAP	CPT® 82306		"25-hydroxyvit D (d2,d3)(so)"	BOTH IP/OP	$86.00 	$63.64	$0.00	$82.72	$61.12	$61.12	$29.60	$29.60	$14.80	$14.80	$44.95	$44.95	$46.68	$29.60	$43.72	$19.24	$50.87	$50.87	$31.08	$82.72	$68.11	$68.80	$42.92	$0.00	$42.92	$46.59	$29.60	$29.60	$32.61	$29.60	$0.00	$0.00	$0.00	$0.00
30100410	EAP	CPT® 82009		Acetoacetate-qualitative	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.99	$4.99	$5.18	$0.00	$4.85	$0.00	$0.00	$0.00	$0.00	$9.18	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100411	EAP	CPT® 82043		Microalbumin	BOTH IP/OP	$223.00 	$165.02	$0.00	$179.20	$11.93	$11.93	$5.78	$5.78	$2.89	$2.89	$8.79	$8.79	$9.13	$5.78	$8.55	$3.76	$131.90	$131.90	$6.07	$16.18	$177.41	$179.20	$8.38	$0.00	$8.38	$9.11	$5.78	$5.78	$6.37	$5.78	$0.00	$0.00	$0.00	$0.00
30100412	EAP	CPT® 82270		"Occult Blood, Stool"	BOTH IP/OP	$57.00 	$42.18	$0.00	$57.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.88	$4.88	$5.07	$0.00	$4.75	$0.00	$0.00	$0.00	$0.00	$8.98	$45.94	$46.40	$0.00	$57.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100413	EAP	CPT® 82465		Cholesterol	BOTH IP/OP	$91.00 	$67.34	$0.00	$73.60	$8.98	$8.98	$4.35	$4.35	$2.18	$2.18	$6.61	$6.61	$6.87	$4.35	$6.43	$2.83	$53.83	$53.83	$4.57	$12.16	$72.86	$73.60	$6.31	$0.00	$6.31	$6.85	$4.35	$4.35	$4.79	$4.35	$0.00	$0.00	$0.00	$0.00
30100414	EAP	CPT® 82550		"Cpk,total-serum"	BOTH IP/OP	$208.00 	$153.92	$3.25	$151.20	$13.44	$13.44	$6.51	$6.51	$3.26	$3.25	$9.89	$9.89	$10.27	$6.51	$7.46	$4.23	$123.03	$123.03	$6.84	$18.20	$149.69	$151.20	$9.44	$10.74	$9.44	$7.94	$6.51	$6.51	$5.56	$6.51	$0.00	$0.00	$0.00	$0.00
30100415	EAP	CPT® 82565		"Poct, Creatinine (meter)"	BOTH IP/OP	$139.00 	$102.86	$2.56	$103.20	$10.59	$10.59	$5.12	$5.12	$2.56	$2.56	$7.78	$7.78	$8.08	$5.12	$7.46	$3.33	$82.22	$82.22	$5.38	$14.32	$102.17	$103.20	$7.42	$8.45	$7.42	$7.94	$5.12	$5.12	$5.56	$5.12	$0.00	$0.00	$0.00	$0.00
30100416	EAP	CPT® 82570		Creatinine Urine	BOTH IP/OP	$122.00 	$90.28	$0.00	$97.60	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$72.16	$72.16	$5.44	$14.46	$96.62	$97.60	$7.51	$0.00	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30100417	EAP	CPT® 82947		"Gtt, Oral-2hr Indiv"	BOTH IP/OP	$263.00 	$194.62	$1.97	$260.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$155.56	$155.56	$4.13	$10.96	$258.19	$260.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30100420	EAP	CPT® 82950		"Glucose, Bld-2hr Pp"	BOTH IP/OP	$251.00 	$185.74	$2.37	$248.80	$9.79	$9.79	$4.75	$4.75	$2.38	$2.37	$7.21	$7.21	$7.48	$4.75	$7.02	$3.09	$148.47	$148.47	$4.99	$13.28	$246.31	$248.80	$6.89	$7.84	$6.89	$7.48	$4.75	$4.75	$5.24	$4.75	$0.00	$0.00	$0.00	$0.00
30100421	EAP	CPT® 83036		Hgb Glycosy A1c-ddcl	BOTH IP/OP	$218.00 	$161.32	$0.00	$175.20	$20.04	$20.04	$9.71	$9.71	$4.86	$4.86	$14.74	$14.74	$15.30	$9.71	$14.33	$6.31	$128.95	$128.95	$10.20	$27.12	$173.45	$175.20	$14.08	$0.00	$14.08	$15.27	$9.71	$9.71	$10.69	$9.71	$0.00	$0.00	$0.00	$0.00
30100422	EAP	CPT® 83690		"Lipase, Serum"	BOTH IP/OP	$248.00 	$183.52	$3.44	$200.80	$14.23	$14.23	$6.89	$6.89	$3.45	$3.44	$10.46	$10.46	$10.86	$6.89	$10.17	$4.48	$146.69	$146.69	$7.23	$19.24	$198.79	$200.80	$9.99	$11.37	$9.99	$10.84	$6.89	$6.89	$7.59	$6.89	$0.00	$0.00	$0.00	$0.00
30100423	EAP	CPT® 83718		"Chol,hdl"	BOTH IP/OP	$118.00 	$87.32	$4.10	$95.20	$16.92	$16.92	$8.19	$8.19	$4.10	$4.10	$12.44	$12.44	$12.92	$8.19	$12.10	$5.32	$69.80	$69.80	$8.60	$22.88	$94.25	$95.20	$11.88	$13.51	$11.88	$12.89	$8.19	$8.19	$9.02	$8.19	$0.00	$0.00	$0.00	$0.00
30100424	EAP	CPT® 83718		"Chol, Hdl"	BOTH IP/OP	$118.00 	$87.32	$0.00	$95.20	$16.92	$16.92	$8.19	$8.19	$4.10	$4.10	$12.44	$12.44	$12.92	$8.19	$12.10	$5.32	$69.80	$69.80	$8.60	$22.88	$94.25	$95.20	$11.88	$0.00	$11.88	$12.89	$8.19	$8.19	$9.02	$8.19	$0.00	$0.00	$0.00	$0.00
30100425	EAP	CPT® 83721		"Chol-ldl, Direct"	BOTH IP/OP	$148.00 	$109.52	$4.77	$119.20	$19.69	$19.69	$10.50	$10.50	$5.25	$4.77	$14.49	$14.49	$15.04	$10.50	$14.10	$6.83	$87.54	$87.54	$11.03	$26.66	$118.01	$119.20	$15.23	$17.33	$15.23	$15.03	$10.50	$10.50	$10.52	$10.50	$0.00	$0.00	$0.00	$0.00
30100426	EAP	CPT® 83721		"Chol-ldl, Direct"	BOTH IP/OP	$147.00 	$108.78	$0.00	$119.20	$19.69	$19.69	$10.50	$10.50	$5.25	$4.77	$14.49	$14.49	$15.04	$10.50	$14.10	$6.83	$86.95	$86.95	$11.03	$26.66	$118.01	$119.20	$15.23	$0.00	$15.23	$15.03	$10.50	$10.50	$10.52	$10.50	$0.00	$0.00	$0.00	$0.00
30100427	EAP	CPT® 83735		"Magneseum, Serum"	BOTH IP/OP	$160.00 	$118.40	$0.00	$136.80	$13.83	$13.83	$6.70	$6.70	$3.35	$3.35	$10.17	$10.17	$10.56	$6.70	$9.89	$4.36	$94.64	$94.64	$7.04	$18.72	$135.43	$136.80	$9.72	$0.00	$9.72	$10.54	$6.70	$6.70	$7.38	$6.70	$0.00	$0.00	$0.00	$0.00
30100430	EAP	CPT® 80048		"Chem 8, Metabolic Panel"	BOTH IP/OP	$383.00 	$283.42	$4.23	$299.20	$17.45	$17.45	$8.46	$8.46	$4.23	$4.23	$12.85	$12.85	$13.35	$8.46	$12.52	$5.50	$226.54	$226.54	$8.88	$23.66	$296.21	$299.20	$12.27	$13.96	$12.27	$13.34	$8.46	$8.46	$9.34	$8.46	$0.00	$0.00	$0.00	$0.00
30100431	EAP	CPT® 82270		Occult Blood	BOTH IP/OP	$58.00 	$42.92	$0.00	$46.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.88	$4.88	$5.07	$0.00	$4.75	$0.00	$0.00	$0.00	$0.00	$8.98	$45.94	$46.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100432	EAP	CPT® 82977		Ggt-serum	BOTH IP/OP	$162.00 	$119.88	$3.60	$129.60	$14.86	$14.86	$7.20	$7.20	$3.60	$3.60	$10.93	$10.93	$11.35	$7.20	$7.46	$4.68	$95.82	$95.82	$7.56	$20.12	$128.30	$129.60	$10.44	$11.88	$10.44	$7.94	$7.20	$7.20	$5.56	$7.20	$0.00	$0.00	$0.00	$0.00
30100434	EAP	CPT® 80069		Renal Panel	BOTH IP/OP	$228.00 	$168.72	$4.34	$184.00	$17.93	$17.93	$8.68	$8.68	$4.34	$4.34	$13.19	$13.19	$13.69	$8.68	$12.83	$5.64	$134.86	$134.86	$9.11	$24.26	$182.16	$184.00	$12.59	$14.32	$12.59	$13.67	$8.68	$8.68	$9.57	$8.68	$0.00	$0.00	$0.00	$0.00
30100435	EAP	CPT® 80076		Hepatic Profile	BOTH IP/OP	$330.00 	$244.20	$4.09	$266.40	$16.87	$16.87	$8.17	$8.17	$4.09	$4.09	$12.41	$12.41	$12.88	$8.17	$12.08	$5.31	$195.20	$195.20	$8.58	$22.84	$263.74	$266.40	$11.85	$13.48	$11.85	$12.87	$8.17	$8.17	$9.01	$8.17	$0.00	$0.00	$0.00	$0.00
30100436	EAP	CPT® 80076		Hepatic Profile	BOTH IP/OP	$333.00 	$246.42	$4.09	$266.40	$16.87	$16.87	$8.17	$8.17	$4.09	$4.09	$12.41	$12.41	$12.88	$8.17	$12.08	$5.31	$196.97	$196.97	$8.58	$22.84	$263.74	$266.40	$11.85	$13.48	$11.85	$12.87	$8.17	$8.17	$9.01	$8.17	$0.00	$0.00	$0.00	$0.00
30100437	EAP	CPT® 82465		"Cholesterol,fluid"	BOTH IP/OP	$91.00 	$67.34	$2.18	$73.60	$8.98	$8.98	$4.35	$4.35	$2.18	$2.18	$6.61	$6.61	$6.87	$4.35	$6.43	$2.83	$53.83	$53.83	$4.57	$12.16	$72.86	$73.60	$6.31	$7.18	$6.31	$6.85	$4.35	$4.35	$4.79	$4.35	$0.00	$0.00	$0.00	$0.00
30100439	EAP	CPT® 82947		"Glucose,fasting Bld"	BOTH IP/OP	$263.00 	$194.62	$1.97	$260.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$155.56	$155.56	$4.13	$10.96	$258.19	$260.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30100441	EAP	CPT® 82950		"Glucose,1hr (50gm)"	BOTH IP/OP	$341.00 	$252.34	$2.37	$248.80	$9.79	$9.79	$4.75	$4.75	$2.38	$2.37	$7.21	$7.21	$7.48	$4.75	$7.02	$3.09	$201.70	$201.70	$4.99	$13.28	$246.31	$248.80	$6.89	$7.84	$6.89	$7.48	$4.75	$4.75	$5.24	$4.75	$0.00	$0.00	$0.00	$0.00
30100442	EAP	CPT® 82977		"Ggtp,serum"	BOTH IP/OP	$160.00 	$118.40	$3.60	$129.60	$14.86	$14.86	$7.20	$7.20	$3.60	$3.60	$10.93	$10.93	$11.35	$7.20	$7.46	$4.68	$94.64	$94.64	$7.56	$20.12	$128.30	$129.60	$10.44	$11.88	$10.44	$7.94	$7.20	$7.20	$5.56	$7.20	$0.00	$0.00	$0.00	$0.00
30100443	EAP	CPT® 83735		"Magnesium, Urine"	BOTH IP/OP	$188.00 	$139.12	$3.35	$136.80	$13.83	$13.83	$6.70	$6.70	$3.35	$3.35	$10.17	$10.17	$10.56	$6.70	$9.89	$4.36	$111.20	$111.20	$7.04	$18.72	$135.43	$136.80	$9.72	$11.06	$9.72	$10.54	$6.70	$6.70	$7.38	$6.70	$0.00	$0.00	$0.00	$0.00
30100444	EAP	CPT® 80375		Thiopurine Metabolites Serum (so)	BOTH IP/OP	$355.00 	$262.70	$0.00	$273.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.48	$263.48	$273.63	$0.00	$21.44	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$193.80	$143.65	$193.80	$22.85	$0.00	$0.00	$15.99	$0.00	$0.00	$0.00	$0.00	$0.00
30100450	EAP	CPT® 82803		Hemodynamics	BOTH IP/OP	$510.00 	$377.40	$11.73	$371.20	$39.94	$39.94	$26.07	$26.07	$13.04	$11.73	$29.38	$29.38	$30.51	$26.07	$28.59	$16.95	$301.67	$301.67	$27.37	$54.08	$367.49	$371.20	$37.80	$43.02	$37.80	$30.46	$26.07	$26.07	$21.33	$26.07	$0.00	$0.00	$0.00	$0.00
30100451	EAP	CPT® 82803		Abg Analysis	BOTH IP/OP	$510.00 	$377.40	$11.73	$371.20	$39.94	$39.94	$26.07	$26.07	$13.04	$11.73	$29.38	$29.38	$30.51	$26.07	$28.59	$16.95	$301.67	$301.67	$27.37	$54.08	$367.49	$371.20	$37.80	$43.02	$37.80	$30.46	$26.07	$26.07	$21.33	$26.07	$0.00	$0.00	$0.00	$0.00
30100455	EAP	CPT® 82040		Albumin (bcg)	BOTH IP/OP	$76.00 	$56.24	$0.00	$60.80	$5.94	$5.94	$4.95	$4.95	$2.48	$2.48	$4.37	$4.37	$4.54	$4.95	$4.25	$3.22	$44.95	$44.95	$5.20	$8.04	$60.19	$60.80	$7.18	$0.00	$7.18	$4.53	$4.95	$4.95	$3.17	$4.95	$0.00	$0.00	$0.00	$0.00
30100456	EAP	CPT® 81381		HLA B5701	BOTH IP/OP	$458.00 	$338.92	$35.05	$370.40	$195.23	$195.23	$169.90	$169.90	$84.95	$76.46	$134.19	$134.19	$139.35	$169.90	$46.99	$110.44	$270.91	$270.91	$178.40	$231.50	$366.70	$370.40	$246.36	$280.34	$246.36	$50.07	$169.90	$169.90	$35.05	$169.90	$0.00	$0.00	$0.00	$0.00
30100475	EAP	CPT® 82172		Apolipoprotein (so)	BOTH IP/OP	$181.00 	$133.94	$0.00	$144.80	$32.00	$32.00	$21.09	$21.09	$10.55	$9.49	$23.52	$23.52	$24.43	$21.09	$22.90	$13.71	$107.06	$107.06	$22.14	$43.30	$143.35	$144.80	$30.58	$0.00	$30.58	$24.40	$21.09	$21.09	$17.08	$21.09	$0.00	$0.00	$0.00	$0.00
30100476	EAP	CPT® 82247		Total Bilirubin (so)	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$10.35	$10.35	$5.02	$5.02	$2.51	$2.51	$7.62	$7.62	$7.92	$5.02	$7.42	$3.26	$52.05	$52.05	$5.27	$14.04	$69.70	$70.40	$7.28	$0.00	$7.28	$7.91	$5.02	$5.02	$5.54	$5.02	$0.00	$0.00	$0.00	$0.00
30100477	EAP	CPT® 82977		Ggt (so)	BOTH IP/OP	$187.00 	$138.38	$3.60	$149.60	$14.86	$14.86	$7.20	$7.20	$3.60	$3.60	$10.93	$10.93	$11.35	$7.20	$7.46	$4.68	$110.61	$110.61	$7.56	$20.12	$148.10	$149.60	$10.44	$11.88	$10.44	$7.94	$7.20	$7.20	$5.56	$7.20	$0.00	$0.00	$0.00	$0.00
30100478	EAP	CPT® 83010		Haptoglobin Quant (so)	BOTH IP/OP	$265.00 	$196.10	$0.00	$212.00	$7.71	$7.71	$12.58	$12.58	$6.29	$6.29	$5.66	$5.66	$5.88	$12.58	$5.51	$8.18	$156.75	$156.75	$13.21	$10.42	$209.88	$212.00	$18.24	$0.00	$18.24	$5.87	$12.58	$12.58	$4.11	$12.58	$0.00	$0.00	$0.00	$0.00
30100479	EAP	CPT® 83883		Nephelometry (so)	BOTH IP/OP	$222.00 	$164.28	$0.00	$177.60	$28.06	$28.06	$13.60	$13.60	$6.80	$6.80	$20.64	$20.64	$21.44	$13.60	$20.09	$8.84	$131.31	$131.31	$14.28	$38.00	$175.82	$177.60	$19.72	$0.00	$19.72	$21.40	$13.60	$13.60	$14.98	$13.60	$0.00	$0.00	$0.00	$0.00
30100480	EAP	CPT® 84460		Alt (s0)	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$10.93	$10.93	$5.30	$5.30	$2.65	$2.65	$8.04	$8.04	$8.35	$5.30	$7.46	$3.45	$53.24	$53.24	$5.57	$14.80	$71.28	$72.00	$7.69	$0.00	$7.69	$7.94	$5.30	$5.30	$5.56	$5.30	$0.00	$0.00	$0.00	$0.00
30100481	EAP	CPT® 88360		Pd-l1 Ihc W/interp (s0)	BOTH IP/OP	$488.00 	$361.12	$58.38	$388.00	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$288.65	$288.65	$143.92	$121.34	$384.12	$388.00	$199.96	$317.20	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
30100482	EAP	CPT® 88341		Lynch Syn Pan Addl Slide (so)	BOTH IP/OP	$566.00 	$418.84	$0.00	$457.60	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$334.79	$334.79	$0.00	$286.00	$453.02	$457.60	$0.00	$367.90	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
30100483	EAP	CPT® 88342		Lynch Syn Pan  1st Slide (so)	BOTH IP/OP	$645.00 	$477.30	$48.82	$520.80	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$381.52	$381.52	$143.92	$106.46	$515.59	$520.80	$199.96	$419.25	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
30100490	EAP	CPT® 80177		Levetiracetam (so)	BOTH IP/OP	$333.00 	$246.42	$6.63	$267.20	$27.35	$27.35	$13.25	$13.25	$6.63	$6.63	$18.81	$18.81	$19.54	$13.25	$17.00	$8.61	$196.97	$196.97	$13.91	$167.00	$264.53	$267.20	$19.21	$21.86	$19.21	$18.11	$13.25	$13.25	$12.68	$13.25	$0.00	$0.00	$0.00	$0.00
30100499	EAP	CPT® 83520		Anti Mag Q	BOTH IP/OP	$68.00 	$50.32	$0.00	$61.60	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$40.22	$40.22	$18.13	$36.18	$60.98	$61.60	$25.04	$0.00	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30100500	EAP	CPT® 80342		"Fluphenazine, Serum"	BOTH IP/OP	$140.00 	$103.60	$0.00	$118.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.91	$103.91	$107.91	$0.00	$23.01	$0.00	$0.00	$0.00	$0.00	$74.00	$117.22	$118.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100501	EAP	CPT® 82438		"Feces, Chloride (so)"	BOTH IP/OP	$96.00 	$71.04	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.43	$7.43	$7.71	$0.00	$7.22	$0.00	$0.00	$0.00	$0.00	$13.66	$76.03	$76.80	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100502	EAP	CPT® 84302		"Feces, Sodium (so)"	BOTH IP/OP	$105.00 	$77.70	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.25	$5.25	$5.45	$0.00	$5.11	$0.00	$0.00	$0.00	$0.00	$9.66	$75.24	$76.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100503	EAP	CPT® 84311		"Feces,electrophoresis (so)"	BOTH IP/OP	$160.00 	$118.40	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.61	$10.61	$11.02	$0.00	$10.32	$0.00	$0.00	$0.00	$8.51	$19.54	$158.40	$160.00	$11.75	$156.00	$11.75	$11.00	$8.10	$8.10	$7.70	$8.10	$0.00	$0.00	$0.00	$0.00
30100505	EAP	CPT® 84311		"Feces, Potassium (so)"	BOTH IP/OP	$198.00 	$146.52	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.61	$10.61	$11.02	$0.00	$10.32	$0.00	$0.00	$0.00	$8.51	$19.54	$158.40	$160.00	$11.75	$156.00	$11.75	$11.00	$8.10	$8.10	$7.70	$8.10	$0.00	$0.00	$0.00	$0.00
30100600	EAP	CPT® 82248		"Bilirubin,direct"	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$10.35	$10.35	$5.02	$5.02	$2.51	$2.51	$7.62	$7.62	$7.92	$5.02	$7.42	$3.26	$69.80	$69.80	$5.27	$14.04	$93.46	$94.40	$7.28	$0.00	$7.28	$7.91	$5.02	$5.02	$5.54	$5.02	$0.00	$0.00	$0.00	$0.00
30100602	EAP	CPT® 80299		Voriconazole Quant Assay (so)	BOTH IP/OP	$204.00 	$150.96	$0.00	$163.20	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$120.67	$120.67	$19.57	$33.64	$161.57	$163.20	$27.03	$0.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30100622	EAP	CPT® 80203		Zonisamide (so)	BOTH IP/OP	$417.00 	$308.58	$0.00	$417.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.81	$18.81	$19.54	$0.00	$17.00	$0.00	$0.00	$0.00	$13.91	$209.50	$331.85	$335.20	$19.21	$417.00	$19.21	$18.11	$13.25	$13.25	$12.68	$13.25	$0.00	$0.00	$0.00	$0.00
30100634	EAP	CPT® 84181		Western Blot Test	BOTH IP/OP	"$1,387.00 "	"$1,026.38"	$0.00	"$1,109.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.86	$25.86	$26.86	$0.00	$25.16	$0.00	$0.00	$0.00	$0.00	$47.60	"$1,098.50"	"$1,109.60"	$0.00	$507.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100635	EAP	CPT® 82530		Cortisol;free	BOTH IP/OP	$200.00 	$148.00	$8.36	$161.60	$34.48	$34.48	$16.71	$16.71	$8.36	$8.36	$25.39	$25.39	$26.36	$16.71	$24.70	$10.86	$118.30	$118.30	$17.55	$46.70	$159.98	$161.60	$24.23	$27.57	$24.23	$26.31	$16.71	$16.71	$18.42	$16.71	$0.00	$0.00	$0.00	$0.00
30100636	EAP	CPT® 82570		Other Source	BOTH IP/OP	$91.00 	$67.34	$2.59	$72.80	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$53.83	$53.83	$5.44	$14.46	$72.07	$72.80	$7.51	$8.55	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30100637	EAP	CPT® 83789		"Quantitative, Each Specimen"	BOTH IP/OP	$142.00 	$105.08	$0.00	$142.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$113.26	$114.40	$0.00	$142.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100643	EAP	CPT® 83789		"Quantitative, Each Specimen"	BOTH IP/OP	$241.00 	$178.34	$0.00	$241.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$191.66	$193.60	$0.00	$241.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100644	EAP	CPT® 83520		"Quantitative, Not Otherwise Specified"	BOTH IP/OP	$103.00 	$76.22	$0.00	$92.80	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$60.92	$60.92	$18.13	$36.18	$91.87	$92.80	$25.04	$0.00	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30100645	EAP	CPT® 84999		Unlisted Chemistry Procedure	BOTH IP/OP	$58.00 	$42.92	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$10.32	$0.00	$43.05	$43.05	$44.71	$0.00	$12.09	$0.00	$0.00	$0.00	$0.00	$0.00	$49.10	$49.60	$0.00	$0.00	$0.00	$9.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100652	EAP	CPT® 82017		Acylcarnities Quant	BOTH IP/OP	$187.00 	$138.38	$0.00	$149.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.62	$25.62	$26.60	$0.00	$24.92	$0.00	$0.00	$0.00	$0.00	$47.14	$148.10	$149.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100653	EAP	CPT® 82139		"Amino Acids,6 Or More Amino Acids,quantitative,each"	BOTH IP/OP	$292.00 	$216.08	$0.00	$233.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.62	$25.62	$26.60	$0.00	$24.92	$0.00	$0.00	$0.00	$0.00	$47.14	$231.26	$233.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100654	EAP	CPT® 82379		"Carnitine(total And Free),quantitative,each Specimen"	BOTH IP/OP	$223.00 	$165.02	$0.00	$180.00	$34.82	$34.82	$16.87	$16.87	$8.44	$8.43	$25.62	$25.62	$26.60	$16.87	$24.92	$10.97	$131.90	$131.90	$0.00	$47.14	$178.20	$180.00	$0.00	$27.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100656	EAP	CPT® 82542		"Quantitative,single Stationary & Mobile Phase, Qt"	BOTH IP/OP	$296.00 	$219.04	$0.00	$236.80	$37.28	$37.28	$24.09	$24.09	$12.05	$10.84	$9.12	$9.12	$9.47	$24.09	$8.87	$15.66	$175.08	$175.08	$25.29	$16.78	$234.43	$236.80	$34.93	$0.00	$34.93	$9.45	$24.09	$24.09	$6.62	$24.09	$0.00	$0.00	$0.00	$0.00
30100660	EAP	CPT® 82962		Poct Glucose Meter	BOTH IP/OP	$92.00 	$68.08	$1.48	$67.20	$4.83	$4.83	$3.28	$3.28	$1.64	$1.48	$3.56	$3.56	$3.69	$3.28	$3.45	$2.13	$54.42	$54.42	$3.44	$6.54	$66.53	$67.20	$4.76	$5.41	$4.76	$3.68	$3.28	$3.28	$2.58	$3.28	$0.00	$0.00	$0.00	$0.00
30100662	EAP	CPT® 84600		Propylene Glycol (nms)	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$33.18	$33.18	$17.11	$17.11	$8.56	$8.04	$24.41	$24.41	$25.35	$17.11	$23.74	$11.12	$143.73	$143.73	$0.00	$44.90	$192.46	$194.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100665	EAP	CPT® 83825		"Mercury,blood(q)"	BOTH IP/OP	$41.00 	$30.34	$0.00	$41.00	$33.55	$33.55	$16.26	$16.26	$8.13	$8.13	$24.69	$24.69	$25.64	$16.26	$24.02	$10.57	$24.25	$24.25	$17.07	$41.00	$32.47	$32.80	$23.58	$0.00	$23.58	$0.00	$16.26	$16.26	$17.92	$16.26	$0.00	$0.00	$0.00	$0.00
30100666	EAP	CPT® 80347		Quantitative Benzo Panel(q)	BOTH IP/OP	$398.00 	$294.52	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.40	$295.40	$306.78	$0.00	$27.32	$0.00	$0.00	$0.00	$0.00	$199.00	$315.22	$318.40	$0.00	$98.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100668	EAP	CPT® 86161		"C1 Inhibitor , Functional  (so)"	BOTH IP/OP	$169.00 	$125.06	$6.00	$136.80	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$99.96	$99.96	$12.60	$33.56	$135.43	$136.80	$17.40	$19.80	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30100669	EAP	CPT® 86774		Tetanus Antitoxoid   (so)	BOTH IP/OP	$83.00 	$61.42	$0.00	$83.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.47	$22.47	$23.34	$0.00	$21.86	$0.00	$0.00	$0.00	$15.54	$41.36	$65.74	$66.40	$21.46	$83.00	$21.46	$23.29	$14.80	$14.80	$16.31	$14.80	$0.00	$0.00	$0.00	$0.00
30100670	EAP	CPT® 86343		Histamine Release -cu  (so)	BOTH IP/OP	$234.00 	$173.16	$0.00	$188.80	$25.71	$25.71	$12.46	$12.46	$6.23	$6.23	$18.93	$18.93	$19.66	$12.46	$18.41	$8.10	$138.41	$138.41	$0.00	$34.82	$186.91	$188.80	$0.00	$20.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100671	EAP	CPT® 83520		Tryptase  (so)	BOTH IP/OP	$217.00 	$160.58	$7.77	$168.80	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$128.36	$128.36	$18.13	$36.18	$167.11	$168.80	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30100672	EAP	CPT® 82106		Alpha- Fetoprotein  Af (so)	BOTH IP/OP	$41.00 	$30.34	$0.00	$41.00	$34.64	$34.64	$17.00	$17.00	$8.50	$0.00	$25.47	$25.47	$26.45	$0.00	$24.79	$0.00	$0.00	$0.00	$17.85	$41.00	$32.47	$32.80	$24.65	$28.05	$24.65	$26.41	$17.00	$17.00	$18.49	$17.00	$0.00	$0.00	$0.00	$0.00
30100673	EAP	CPT® 83033		Fetal Hemoglobin  Af (so)	BOTH IP/OP	$76.00 	$56.24	$0.00	$60.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.05	$9.05	$9.40	$0.00	$8.81	$0.00	$0.00	$0.00	$0.00	$16.66	$60.19	$60.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100674	EAP	CPT® 82664		Acetylcholinesterase  Af (so)	BOTH IP/OP	$156.00 	$115.44	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.17	$52.17	$54.17	$0.00	$50.75	$0.00	$0.00	$0.00	$64.58	$96.00	$133.06	$134.40	$89.18	$0.00	$89.18	$54.07	$61.50	$61.50	$37.85	$61.50	$0.00	$0.00	$0.00	$0.00
30100680	EAP	CPT® 82105		Maternal Serum Afp (so)	BOTH IP/OP	$47.00 	$34.78	$8.39	$46.88	$34.64	$34.64	$16.77	$16.77	$8.39	$8.39	$25.47	$25.47	$26.45	$16.77	$24.79	$10.90	$27.80	$27.80	$17.61	$46.88	$37.22	$37.60	$24.32	$27.67	$24.32	$26.41	$16.77	$16.77	$18.49	$16.77	$0.00	$0.00	$0.00	$0.00
30100681	EAP	CPT® 86160		C1 Esterase Inhibitor  Protein (so)	BOTH IP/OP	$85.00 	$62.90	$6.00	$68.80	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$50.28	$50.28	$12.60	$33.56	$68.11	$68.80	$17.40	$19.80	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30100682	EAP	CPT® 84591		Vitamin B-5( Pantothenic Acid) (so)	BOTH IP/OP	$178.00 	$131.72	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.61	$17.61	$18.28	$0.00	$17.13	$0.00	$0.00	$0.00	$0.00	$32.40	$140.98	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100683	EAP	CPT® 82397		Leptin (so)	BOTH IP/OP	$232.00 	$171.68	$0.00	$209.60	$29.15	$29.15	$14.12	$14.12	$7.06	$7.06	$21.46	$21.46	$22.28	$14.12	$20.87	$9.18	$137.23	$137.23	$14.83	$39.48	$207.50	$209.60	$20.47	$0.00	$20.47	$22.24	$14.12	$14.12	$15.57	$14.12	$0.00	$0.00	$0.00	$0.00
30100684	EAP	CPT® 85415		Plasminogen Activator Inhibitor-a (pai-1) (so)	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.10	$26.10	$27.11	$0.00	$25.40	$0.00	$0.00	$0.00	$0.00	$48.04	$174.24	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100685	EAP	CPT® 83516		"Ribosomal P Antibody , Csf (so)"	BOTH IP/OP	$240.00 	$177.60	$0.00	$216.80	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$141.96	$141.96	$12.11	$29.88	$214.63	$216.80	$16.72	$0.00	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30100686	EAP	CPT® 83516		Serine Protease 3 Antibody (so)arup	BOTH IP/OP	$302.00 	$223.48	$5.76	$272.80	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$178.63	$178.63	$12.11	$29.88	$270.07	$272.80	$16.72	$19.02	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30100687	EAP	CPT® 82610		Cystatin C (so)	BOTH IP/OP	$244.00 	$180.56	$8.33	$196.80	$28.06	$28.06	$18.52	$18.52	$9.26	$8.33	$20.64	$20.64	$21.44	$18.52	$20.09	$12.04	$144.33	$144.33	$19.45	$123.00	$194.83	$196.80	$26.85	$30.56	$26.85	$21.40	$18.52	$18.52	$14.98	$18.52	$0.00	$0.00	$0.00	$0.00
30100688	EAP	CPT® 80180		Mycophenolic Acid (so)	BOTH IP/OP	$169.00 	$125.06	$0.00	$135.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.44	$8.44	$8.77	$0.00	$7.63	$0.00	$0.00	$0.00	$0.00	$84.50	$133.85	$135.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100689	EAP	CPT® 83516		"Saccharmyces Cerevisiae Ab, Igg (arup)"	BOTH IP/OP	$174.00 	$128.76	$0.00	$156.80	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$102.92	$102.92	$12.11	$29.88	$155.23	$156.80	$16.72	$0.00	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30100690	EAP	CPT® 83516		"Laminaribioside Carbohydrate Ab, Igg (arup)"	BOTH IP/OP	$174.00 	$128.76	$0.00	$156.80	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$102.92	$102.92	$12.11	$29.88	$155.23	$156.80	$16.72	$0.00	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30100691	EAP	CPT® 83516		"Mannobioside Carbohydrate Ab, Igg (arup)"	BOTH IP/OP	$174.00 	$128.76	$0.00	$156.80	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$102.92	$102.92	$12.11	$29.88	$155.23	$156.80	$16.72	$0.00	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30100692	EAP	CPT® 86671		"Chitobioside Carbohydrate Ab, Iga (arup)"	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$18.62	$19.33	$0.00	$18.11	$0.00	$0.00	$0.00	$12.86	$34.26	$63.36	$64.00	$17.76	$0.00	$17.76	$19.30	$12.25	$12.25	$13.51	$12.25	$0.00	$0.00	$0.00	$0.00
30100693	EAP	CPT® 83789		Levamisole (so) Nms	BOTH IP/OP	$298.00 	$220.52	$0.00	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$236.02	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100702	EAP	CPT® 84182		Zic4 Ab Protein West Blot (so)	BOTH IP/OP	$441.00 	$326.34	$0.00	$352.80	$37.14	$37.14	$29.21	$29.21	$14.61	$13.14	$27.33	$27.33	$28.38	$29.21	$26.60	$18.99	$260.85	$260.85	$30.67	$50.30	$349.27	$352.80	$42.35	$0.00	$42.35	$28.34	$29.21	$29.21	$19.84	$29.21	$0.00	$0.00	$0.00	$0.00
30100703	EAP	CPT® 83789		Diurectics Screen Urine (so)	BOTH IP/OP	$228.00 	$168.72	$0.00	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$180.58	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100704	EAP	CPT® 82785		Abpa  Ige (so)	BOTH IP/OP	$191.00 	$141.34	$0.00	$152.80	$33.98	$33.98	$16.46	$16.46	$8.23	$8.23	$25.01	$25.01	$25.97	$16.46	$24.33	$10.70	$112.98	$112.98	$17.28	$46.02	$151.27	$152.80	$23.87	$0.00	$23.87	$25.92	$16.46	$16.46	$18.15	$16.46	$0.00	$0.00	$0.00	$0.00
30100705	EAP	CPT® 84146		Macroprolactin (so)	BOTH IP/OP	$322.00 	$238.28	$0.00	$257.60	$40.00	$40.00	$19.38	$19.38	$9.69	$9.69	$29.43	$29.43	$30.56	$19.38	$28.63	$12.60	$190.46	$190.46	$20.35	$54.16	$255.02	$257.60	$28.10	$0.00	$28.10	$30.51	$19.38	$19.38	$21.36	$19.38	$0.00	$0.00	$0.00	$0.00
30100706	EAP	CPT® 82570		Thiosulfate Urine	BOTH IP/OP	$280.00 	$207.20	$2.59	$224.00	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$165.62	$165.62	$5.44	$14.46	$221.76	$224.00	$7.51	$8.55	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30100708	EAP	CPT® 83921		Succinlylacetone Urine (so)	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$33.95	$33.95	$21.21	$21.21	$10.61	$9.54	$25.00	$25.00	$25.96	$21.21	$24.32	$13.79	$147.88	$147.88	$22.27	$46.00	$198.00	$200.00	$30.75	$0.00	$30.75	$25.91	$21.21	$21.21	$18.14	$21.21	$0.00	$0.00	$0.00	$0.00
30100709	EAP	CPT® 83520		Vwf Propeptide (so)	BOTH IP/OP	$365.00 	$270.10	$7.77	$329.60	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$215.90	$215.90	$18.13	$36.18	$326.30	$329.60	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30100710	EAP	CPT® 80061		Nmr Lipoprofile Panel  (so)	BOTH IP/OP	$239.00 	$176.86	$0.00	$228.00	$27.64	$27.64	$13.39	$13.39	$6.70	$6.70	$20.35	$20.35	$21.14	$13.39	$19.79	$8.70	$141.37	$141.37	$14.06	$37.44	$225.72	$228.00	$19.42	$0.00	$19.42	$21.09	$13.39	$13.39	$14.76	$13.39	$0.00	$0.00	$0.00	$0.00
30100711	EAP	CPT® 83704		Nmr Lipoprofile Bld (so)	BOTH IP/OP	$239.00 	$176.86	$0.00	$228.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.91	$47.91	$49.76	$0.00	$46.60	$0.00	$0.00	$0.00	$0.00	$88.16	$225.72	$228.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100712	EAP	CPT® 83520		Factor H Comp (so)	BOTH IP/OP	$365.00 	$270.10	$7.77	$329.60	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$215.90	$215.90	$18.13	$36.18	$326.30	$329.60	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30100714	EAP	CPT® 82542		Thiosulfate Chromotography	BOTH IP/OP	$221.00 	$163.54	$0.00	$176.80	$37.28	$37.28	$24.09	$24.09	$12.05	$10.84	$9.12	$9.12	$9.47	$24.09	$8.87	$15.66	$130.72	$130.72	$25.29	$16.78	$175.03	$176.80	$34.93	$0.00	$34.93	$9.45	$24.09	$24.09	$6.62	$24.09	$0.00	$0.00	$0.00	$0.00
30100715	EAP	CPT® 82656		Pancreatitic Elastase Serum (so)	BOTH IP/OP	$326.00 	$241.24	$0.00	$260.80	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$67.94	$7.49	$192.83	$192.83	$12.11	$29.88	$258.19	$260.80	$16.72	$0.00	$16.72	$51.02	$11.53	$11.53	$51.90	$11.53	$0.00	$0.00	$0.00	$0.00
30100716	EAP	CPT® 80299		Itraconazole (so)	BOTH IP/OP	$203.00 	$150.22	$0.00	$163.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.67	$150.67	$156.47	$0.00	$25.48	$0.00	$0.00	$0.00	$19.57	$33.64	$161.57	$163.20	$27.03	$27.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30100717	EAP	CPT® 80365		"Oxycodone And Metabolite Total, Urine (so)"	BOTH IP/OP	$136.00 	$100.64	$0.00	$188.81	$0.03	$0.03	$114.43	$114.43	$57.22	$11.94	$100.94	$100.94	$104.83	$114.43	$28.34	$74.38	$80.44	$80.44	$120.15	$62.00	$98.21	$99.20	$74.40	$188.81	$74.40	$19.41	$0.00	$0.00	$19.74	$114.43	$0.00	$0.00	$0.00	$0.00
30100718	EAP	CPT® 80361		Hydromorphone Opi 1 Urine (so)	BOTH IP/OP	$484.00 	$358.16	$0.00	$409.60	$0.03	$0.03	$0.00	$0.00	$12.01	$11.94	$359.22	$359.22	$373.07	$0.00	$30.51	$0.00	$286.29	$286.29	$0.00	$256.00	$405.50	$409.60	$307.20	$269.10	$307.20	$32.51	$0.00	$0.00	$22.76	$0.00	$0.00	$0.00	$0.00	$0.00
30100719	EAP	CPT® 83520		Thrombin-antithrom Quant (so)	BOTH IP/OP	$421.00 	$311.54	$7.77	$327.20	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$249.02	$249.02	$18.13	$36.18	$323.93	$327.20	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30100720	EAP	CPT® 84182		Redombx (antirecoverin Ab) (so)	BOTH IP/OP	$441.00 	$326.34	$0.00	$352.80	$37.14	$37.14	$29.21	$29.21	$14.61	$13.14	$27.33	$27.33	$28.38	$29.21	$26.60	$18.99	$260.85	$260.85	$30.67	$50.30	$349.27	$352.80	$42.35	$0.00	$42.35	$28.34	$29.21	$29.21	$19.84	$29.21	$0.00	$0.00	$0.00	$0.00
30100721	EAP	CPT® 80299		Baclofin Quant	BOTH IP/OP	$430.00 	$318.20	$8.39	$344.00	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$254.35	$254.35	$19.57	$33.64	$340.56	$344.00	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30100722	EAP	CPT® 82726		Very Long Fatty Acids (so)	BOTH IP/OP	$411.00 	$304.14	$0.00	$325.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$322.34	$325.60	$0.00	$319.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100723	EAP	CPT® 83051		Hgb Free Plasma (so)	BOTH IP/OP	$181.00 	$133.94	$0.00	$171.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.10	$11.10	$11.52	$0.00	$10.79	$0.00	$0.00	$0.00	$0.00	$20.42	$143.35	$144.80	$0.00	$171.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100724	EAP	CPT® 83789		Levamisole	BOTH IP/OP	$297.00 	$219.78	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$236.02	$238.40	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100725	EAP	CPT® 83520		Interleuk 2 Rec Cd25 (so)	BOTH IP/OP	$424.00 	$313.76	$7.77	$329.60	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$250.80	$250.80	$18.13	$36.18	$326.30	$329.60	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30100726	EAP	CPT® 82542		Cannabinoid Quant (so)	BOTH IP/OP	$221.00 	$163.54	$0.00	$176.80	$37.28	$37.28	$24.09	$24.09	$12.05	$10.84	$9.12	$9.12	$9.47	$24.09	$8.87	$15.66	$130.72	$130.72	$25.29	$16.78	$175.03	$176.80	$34.93	$0.00	$34.93	$9.45	$24.09	$24.09	$6.62	$24.09	$0.00	$0.00	$0.00	$0.00
30100729	EAP	CPT® 82378		Cea Cyst Fluid (so)	BOTH IP/OP	$283.00 	$209.42	$9.48	$228.80	$39.15	$39.15	$18.96	$18.96	$9.48	$9.48	$28.81	$28.81	$29.92	$18.96	$28.02	$12.32	$167.39	$167.39	$19.91	$53.02	$226.51	$228.80	$27.49	$31.28	$27.49	$29.86	$18.96	$18.96	$20.90	$18.96	$0.00	$0.00	$0.00	$0.00
30100730	EAP	CPT® 83520		Paraneo Autoab Quant Ria(so)	BOTH IP/OP	$124.00 	$91.76	$7.77	$96.80	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$73.35	$73.35	$18.13	$36.18	$95.83	$96.80	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30100731	EAP	CPT® 82542		"Cc/ms Spec Anal-ghb, Ql (so)"	BOTH IP/OP	$239.00 	$176.86	$0.00	$191.20	$37.28	$37.28	$24.09	$24.09	$12.05	$10.84	$9.12	$9.12	$9.47	$24.09	$8.87	$15.66	$141.37	$141.37	$25.29	$16.78	$189.29	$191.20	$34.93	$0.00	$34.93	$9.45	$24.09	$24.09	$6.62	$24.09	$0.00	$0.00	$0.00	$0.00
30100732	EAP	CPT® 83880		Cardio Iq Nt Probnp (so)	BOTH IP/OP	$309.00 	$228.66	$17.67	$249.60	$70.07	$70.07	$39.26	$39.26	$19.63	$17.67	$51.54	$51.54	$53.52	$39.26	$50.15	$25.52	$182.77	$182.77	$41.22	$94.86	$247.10	$249.60	$56.93	$64.78	$56.93	$53.43	$39.26	$39.26	$37.40	$39.26	$0.00	$0.00	$0.00	$0.00
30100740	EAP	CPT® 80299		Adalimumab Quant (so)	BOTH IP/OP	$210.00 	$155.40	$8.39	$168.80	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$124.22	$124.22	$19.57	$33.64	$167.11	$168.80	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30100741	EAP	CPT® 82397		Anti Adalimumab Ab (so)	BOTH IP/OP	$286.00 	$211.64	$7.06	$222.40	$29.15	$29.15	$14.12	$14.12	$7.06	$7.06	$21.46	$21.46	$22.28	$14.12	$20.87	$9.18	$169.17	$169.17	$14.83	$39.48	$220.18	$222.40	$20.47	$23.30	$20.47	$22.24	$14.12	$14.12	$15.57	$14.12	$0.00	$0.00	$0.00	$0.00
30100742	EAP	CPT® 80354		Acetyl Fentanyl Qual (so)	BOTH IP/OP	$125.00 	$92.50	$0.00	$105.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$96.35	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$66.00	$104.54	$105.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100750	EAP	CPT® 83088		Histamine 24hr Urine (so)	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.84	$44.84	$46.57	$0.00	$43.62	$0.00	$0.00	$0.00	$0.00	$82.52	$192.46	$194.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100751	EAP	CPT® 80299		Metoprolol Quant (so)	BOTH IP/OP	$211.00 	$156.14	$0.00	$168.80	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$124.81	$124.81	$19.57	$33.64	$167.11	$168.80	$27.03	$0.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30100752	EAP	CPT® 80361		Morphine Glucuronide (so)	BOTH IP/OP	$133.00 	$98.42	$0.00	$112.80	$0.03	$0.03	$0.00	$0.00	$12.01	$11.94	$98.71	$98.71	$102.52	$0.00	$30.51	$0.00	$78.67	$78.67	$0.00	$70.50	$111.67	$112.80	$84.60	$0.00	$84.60	$32.51	$0.00	$0.00	$22.76	$0.00	$0.00	$0.00	$0.00	$0.00
30100755	EAP	CPT® 84182		Recombx Mata Autoab (so)	BOTH IP/OP	$468.00 	$346.32	$0.00	$374.40	$37.14	$37.14	$29.21	$29.21	$14.61	$13.14	$27.33	$27.33	$28.38	$29.21	$26.60	$18.99	$276.82	$276.82	$30.67	$50.30	$370.66	$374.40	$42.35	$0.00	$42.35	$28.34	$29.21	$29.21	$19.84	$29.21	$0.00	$0.00	$0.00	$0.00
30100756	EAP	CPT® 83789		Bile Acids Urine (so)	BOTH IP/OP	$236.00 	$174.64	$0.00	$188.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$186.91	$188.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100757	EAP	CPT® 84311		Fluvoxamine (so)	BOTH IP/OP	$158.00 	$116.92	$0.00	$157.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.61	$10.61	$11.02	$0.00	$10.32	$0.00	$0.00	$0.00	$8.51	$19.54	$156.02	$157.60	$11.75	$156.00	$11.75	$11.00	$8.10	$8.10	$7.70	$8.10	$0.00	$0.00	$0.00	$0.00
30100758	EAP	CPT® 84311		Fungitell Serum (so)	BOTH IP/OP	$158.00 	$116.92	$0.00	$157.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.61	$10.61	$11.02	$0.00	$10.32	$0.00	$0.00	$0.00	$8.51	$19.54	$156.02	$157.60	$11.75	$156.00	$11.75	$11.00	$8.10	$8.10	$7.70	$8.10	$0.00	$0.00	$0.00	$0.00
30100759	EAP	CPT® 83520		Ganglioside Gd1b Ab (so)	BOTH IP/OP	$335.00 	$247.90	$7.77	$260.80	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$198.15	$198.15	$18.13	$36.18	$258.19	$260.80	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30100760	EAP	CPT® 83520		Ganglioside Gm-1 Ab (so)	BOTH IP/OP	$289.00 	$213.86	$0.00	$260.80	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$170.94	$170.94	$18.13	$36.18	$258.19	$260.80	$25.04	$0.00	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30100761	EAP	CPT® 83051		Hemoglobin Free Plasma (so)	BOTH IP/OP	$104.00 	$76.96	$0.00	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.10	$11.10	$11.52	$0.00	$10.79	$0.00	$0.00	$0.00	$0.00	$20.42	$82.37	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100762	EAP	CPT® 83520		Interleukin-6 Ruo	BOTH IP/OP	$228.00 	$168.72	$7.77	$177.60	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$134.86	$134.86	$18.13	$36.18	$175.82	$177.60	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30105004	EAP	CPT® 80053		Comprehensive Metabolic Panel	BOTH IP/OP	$472.00 	$349.28	$0.00	$381.60	$21.81	$21.81	$10.56	$10.56	$5.28	$5.28	$16.06	$16.06	$16.68	$10.56	$15.61	$6.86	$279.19	$279.19	$11.09	$29.54	$377.78	$381.60	$15.31	$0.00	$15.31	$16.64	$10.56	$10.56	$11.65	$10.56	$0.00	$0.00	$0.00	$0.00
30105007	EAP	CPT® 80061		Lipid Panel	BOTH IP/OP	$239.00 	$176.86	$0.00	$228.00	$27.64	$27.64	$13.39	$13.39	$6.70	$6.70	$20.35	$20.35	$21.14	$13.39	$19.79	$8.70	$141.37	$141.37	$14.06	$37.44	$225.72	$228.00	$19.42	$0.00	$19.42	$21.09	$13.39	$13.39	$14.76	$13.39	$0.00	$0.00	$0.00	$0.00
30105047	EAP	CPT® 82150		"Amylase,urine"	BOTH IP/OP	$301.00 	$222.74	$3.24	$243.20	$13.38	$13.38	$6.48	$6.48	$3.24	$3.24	$9.84	$9.84	$10.22	$6.48	$9.58	$4.21	$178.04	$178.04	$6.80	$18.12	$240.77	$243.20	$9.40	$10.69	$9.40	$10.20	$6.48	$6.48	$7.14	$6.48	$0.00	$0.00	$0.00	$0.00
30105057	EAP	CPT® 82247		"Bili, Total-fluid"	BOTH IP/OP	$117.00 	$86.58	$2.51	$94.40	$10.35	$10.35	$5.02	$5.02	$2.51	$2.51	$7.62	$7.62	$7.92	$5.02	$7.42	$3.26	$69.21	$69.21	$5.27	$14.04	$93.46	$94.40	$7.28	$8.28	$7.28	$7.91	$5.02	$5.02	$5.54	$5.02	$0.00	$0.00	$0.00	$0.00
30105071	EAP	CPT® 82310		"Calcium, Urine"	BOTH IP/OP	$102.00 	$75.48	$2.58	$74.40	$10.67	$10.67	$5.16	$5.16	$2.58	$2.58	$7.83	$7.83	$8.13	$5.16	$7.46	$3.35	$60.33	$60.33	$5.42	$14.40	$73.66	$74.40	$7.48	$8.51	$7.48	$7.94	$5.16	$5.16	$5.56	$5.16	$0.00	$0.00	$0.00	$0.00
30105151	EAP	CPT® 82803		Blood Gas-cord Ven.	BOTH IP/OP	$510.00 	$377.40	$11.73	$371.20	$39.94	$39.94	$26.07	$26.07	$13.04	$11.73	$29.38	$29.38	$30.51	$26.07	$28.59	$16.95	$301.67	$301.67	$27.37	$54.08	$367.49	$371.20	$37.80	$43.02	$37.80	$30.46	$26.07	$26.07	$21.33	$26.07	$0.00	$0.00	$0.00	$0.00
30105168	EAP	CPT® 82945		"Glucose,urine(quant)"	BOTH IP/OP	$341.00 	$252.34	$1.97	$248.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$201.70	$201.70	$4.13	$10.96	$246.31	$248.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30105171	EAP	CPT® 82947		"Gtt,oral-2hr Indiv"	BOTH IP/OP	$263.00 	$194.62	$1.97	$260.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$155.56	$155.56	$4.13	$10.96	$258.19	$260.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30105196	EAP	CPT® 82951		"Gtt,prenatal(100gm)"	BOTH IP/OP	$201.00 	$148.74	$0.00	$160.80	$26.58	$26.58	$12.87	$12.87	$6.44	$6.44	$19.55	$19.55	$20.30	$12.87	$19.02	$8.37	$118.89	$118.89	$13.51	$35.98	$159.19	$160.80	$18.66	$0.00	$18.66	$20.26	$12.87	$12.87	$14.18	$12.87	$0.00	$0.00	$0.00	$0.00
30105201	EAP	CPT® 82952		5th Hour Gtt Specimen	BOTH IP/OP	$103.00 	$76.22	$1.96	$82.40	$8.10	$8.10	$3.92	$3.92	$1.96	$1.96	$5.95	$5.95	$6.18	$3.92	$5.80	$2.55	$60.92	$60.92	$4.12	$10.96	$81.58	$82.40	$5.68	$6.47	$5.68	$6.18	$3.92	$3.92	$4.32	$3.92	$0.00	$0.00	$0.00	$0.00
30105214	EAP	CPT® 83020		Hgb Elect. Cord Bld	BOTH IP/OP	$217.00 	$160.58	$0.00	$174.40	$20.17	$20.17	$12.87	$12.87	$6.44	$6.44	$14.84	$14.84	$15.41	$12.87	$14.44	$8.37	$128.36	$128.36	$13.51	$27.32	$172.66	$174.40	$18.66	$0.00	$18.66	$15.38	$12.87	$12.87	$10.77	$12.87	$0.00	$0.00	$0.00	$0.00
30105248	EAP	CPT® 83605		"Lactic Acid, Fluid"	BOTH IP/OP	$341.00 	$252.34	$5.34	$248.80	$22.04	$22.04	$11.57	$11.57	$5.79	$5.34	$16.21	$16.21	$16.84	$11.57	$15.78	$7.52	$201.70	$201.70	$12.15	$29.84	$246.31	$248.80	$16.78	$19.09	$16.78	$16.82	$11.57	$11.57	$11.77	$11.57	$0.00	$0.00	$0.00	$0.00
30105252	EAP	CPT® 83615		"Ldh,csf"	BOTH IP/OP	$153.00 	$113.22	$3.02	$111.20	$12.46	$12.46	$6.04	$6.04	$3.02	$3.02	$9.16	$9.16	$9.51	$6.04	$7.46	$3.93	$90.50	$90.50	$6.34	$16.88	$110.09	$111.20	$8.76	$9.97	$8.76	$7.94	$6.04	$6.04	$5.56	$6.04	$0.00	$0.00	$0.00	$0.00
30105255	EAP	CPT® 83519		Ria Nonantibody	BOTH IP/OP	"$1,127.00 "	$833.98	$8.28	$876.80	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$666.62	$666.62	$19.32	$37.76	$868.03	$876.80	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30105256	EAP	CPT® 84260		Assay Of Serotonin	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.04	$47.04	$48.85	$0.00	$45.76	$0.00	$0.00	$0.00	$0.00	$86.56	$157.61	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30105257	EAP	CPT® 84252		Assay Of Vitamin B-12	BOTH IP/OP	$284.00 	$210.16	$0.00	$284.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.73	$30.73	$31.91	$0.00	$29.89	$0.00	$0.00	$0.00	$0.00	$56.56	$224.93	$227.20	$0.00	$284.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30105258	EAP	CPT® 83018		"Quantitative, Each"	BOTH IP/OP	$182.00 	$134.68	$0.00	$145.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.34	$33.34	$34.62	$0.00	$32.43	$0.00	$0.00	$0.00	$0.00	$61.36	$144.14	$145.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30105261	EAP	CPT® 83519		"Quantitative, By Radioimmunoassay(eg:ria)"	BOTH IP/OP	$743.00 	$549.82	$8.28	$578.40	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$439.48	$439.48	$19.32	$37.76	$572.62	$578.40	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30105262	EAP	CPT® 83519		"Quantitative, By Radioimmunoassay(eg:ria)"	BOTH IP/OP	$716.00 	$529.84	$8.28	$556.80	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$423.51	$423.51	$19.32	$37.76	$551.23	$556.80	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30105263	EAP	CPT® 82378		Cea Pancreatic Cyst Fluid (so)	BOTH IP/OP	$152.00 	$112.48	$0.00	$126.40	$39.15	$39.15	$18.96	$18.96	$9.48	$9.48	$28.81	$28.81	$29.92	$18.96	$28.02	$12.32	$89.91	$89.91	$19.91	$53.02	$125.14	$126.40	$27.49	$0.00	$27.49	$29.86	$18.96	$18.96	$20.90	$18.96	$0.00	$0.00	$0.00	$0.00
30105264	EAP	CPT® 84432		Thyroglobulin (so) Th	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$33.16	$33.16	$16.06	$16.06	$8.03	$8.03	$24.39	$24.39	$25.33	$16.06	$23.73	$10.44	$44.36	$44.36	$16.86	$44.88	$59.40	$60.00	$23.29	$0.00	$23.29	$25.28	$16.06	$16.06	$17.70	$16.06	$0.00	$0.00	$0.00	$0.00
30105265	EAP	CPT® 86800		Thyroglobulin  Antibody (so) Th	BOTH IP/OP	$54.00 	$39.96	$0.00	$44.44	$32.84	$32.84	$15.91	$15.91	$7.96	$7.95	$24.15	$24.15	$25.08	$15.91	$23.50	$10.34	$31.94	$31.94	$16.71	$44.44	$42.77	$43.20	$23.07	$0.00	$23.07	$25.04	$15.91	$15.91	$17.53	$15.91	$0.00	$0.00	$0.00	$0.00
30105268	EAP	CPT® 82108		"Aluminum, 24- Hour Urine (so)"	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$34.80	$34.80	$25.48	$25.48	$12.74	$12.74	$25.59	$25.59	$26.58	$25.48	$24.91	$16.56	$40.81	$40.81	$26.75	$47.10	$54.65	$55.20	$36.95	$0.00	$36.95	$0.00	$25.48	$25.48	$18.58	$25.48	$0.00	$0.00	$0.00	$0.00
30105269	EAP	CPT® 83789		"Ethambutol, Serum (nms)"	BOTH IP/OP	$210.00 	$155.40	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$167.11	$168.80	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30105270	EAP	CPT® 83789		"Pyrazinamide, Serum (nms)"	BOTH IP/OP	$505.00 	$373.70	$0.00	$460.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$401.54	$405.60	$0.00	$460.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30105271	EAP	CPT® 84999		Nephrocheck Acute Kidney Injury	BOTH IP/OP	$301.00 	$222.74	$0.00	$237.60	$0.00	$0.00	$0.00	$0.00	$53.58	$0.00	$223.40	$223.40	$232.01	$0.00	$62.73	$0.00	$0.00	$0.00	$0.00	$0.00	$235.22	$237.60	$0.00	$156.65	$0.00	$46.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30105275	EAP	CPT® 80186		Free Phenytoin	BOTH IP/OP	$157.00 	$116.18	$6.88	$125.60	$28.41	$28.41	$13.76	$13.76	$6.88	$6.88	$20.90	$20.90	$21.71	$13.76	$20.34	$8.94	$92.87	$92.87	$14.45	$38.46	$124.34	$125.60	$19.95	$22.70	$19.95	$21.67	$13.76	$13.76	$15.17	$13.76	$0.00	$0.00	$0.00	$0.00
30150004	EAP	CPT® 80053		"Comp, Metabolic Panel"	BOTH IP/OP	$489.00 	$361.86	$5.28	$381.60	$21.81	$21.81	$10.56	$10.56	$5.28	$5.28	$16.06	$16.06	$16.68	$10.56	$15.61	$6.86	$289.24	$289.24	$11.09	$29.54	$377.78	$381.60	$15.31	$17.42	$15.31	$16.64	$10.56	$10.56	$11.65	$10.56	$0.00	$0.00	$0.00	$0.00
30150007	EAP	CPT® 80061		Lipoprotein Profile	BOTH IP/OP	$239.00 	$176.86	$0.00	$228.00	$27.64	$27.64	$13.39	$13.39	$6.70	$6.70	$20.35	$20.35	$21.14	$13.39	$19.79	$8.70	$141.37	$141.37	$14.06	$37.44	$225.72	$228.00	$19.42	$0.00	$19.42	$21.09	$13.39	$13.39	$14.76	$13.39	$0.00	$0.00	$0.00	$0.00
30150171	EAP	CPT® 82947		Glucose	BOTH IP/OP	$263.00 	$194.62	$1.97	$260.80	$8.10	$8.10	$3.93	$3.93	$1.97	$1.97	$5.96	$5.96	$6.19	$3.93	$5.80	$2.55	$155.56	$155.56	$4.13	$10.96	$258.19	$260.80	$5.70	$6.48	$5.70	$6.18	$3.93	$3.93	$4.32	$3.93	$0.00	$0.00	$0.00	$0.00
30150172	EAP	CPT® 82480		Cholinesterase; Serum	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.97	$11.97	$12.43	$0.00	$11.64	$0.00	$0.00	$0.00	$0.00	$22.02	$30.89	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30150173	EAP	CPT® 82482		Rbc	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.67	$11.67	$12.12	$0.00	$11.36	$0.00	$0.00	$0.00	$0.00	$21.48	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30150174	EAP	CPT® 86255		"Fluor Noninfec Agnt Ab Scr,ea"	BOTH IP/OP	$51.00 	$37.74	$0.00	$51.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$30.17	$30.17	$12.65	$33.68	$50.69	$51.20	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30150176	EAP	CPT® 86628		Candida	BOTH IP/OP	$252.00 	$186.48	$0.00	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.23	$18.23	$18.93	$0.00	$17.73	$0.00	$0.00	$0.00	$0.00	$33.56	$201.17	$203.20	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30150177	EAP	CPT® 83789		"Quantitative, Each Specimen"	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$186.12	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30150178	EAP	CPT® 86235		"Extractable Nuclear Antigen,antibody To, Any Method"	BOTH IP/OP	$130.00 	$96.20	$0.00	$127.20	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$76.90	$76.90	$18.83	$50.12	$125.93	$127.20	$26.00	$0.00	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30150179	EAP	CPT® 87798		"Amplified Probe Technique,each Organism"	BOTH IP/OP	$502.00 	$371.48	$0.00	$484.00	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$296.93	$296.93	$36.84	$54.82	$479.16	$484.00	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30150180	EAP	CPT® 86658		Enterovirus - A	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$30.17	$30.17	$13.68	$36.40	$40.39	$40.80	$18.89	$0.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30150181	EAP	CPT® 86658		Enterovirus - B	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$30.17	$30.17	$13.68	$36.40	$40.39	$40.80	$18.89	$0.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30150182	EAP	CPT® 86750		Plasmodium(malaria)	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$47.52	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30150183	EAP	CPT® 86750		Plasmodium(malaria)	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$47.52	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30150184	EAP	CPT® 83520		"Quantitative, Not Otherwise Specified"	BOTH IP/OP	$638.00 	$472.12	$7.77	$576.00	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$377.38	$377.38	$18.13	$36.18	$570.24	$576.00	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30150185	EAP	CPT® 86635		Coccidioides	BOTH IP/OP	$75.00 	$55.50	$0.00	$75.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.42	$17.42	$18.09	$0.00	$16.95	$0.00	$0.00	$0.00	$0.00	$32.06	$53.86	$54.40	$0.00	$75.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30150193	EAP	CPT® 83519		"Quantitative, By Radioimmunoassay"	BOTH IP/OP	$609.00 	$450.66	$8.28	$549.60	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$360.22	$360.22	$19.32	$37.76	$544.10	$549.60	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30150194	EAP	CPT® 88271		"Molecular Cytogenetics; Dna Probe, Each"	BOTH IP/OP	$307.00 	$227.18	$0.00	$245.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$181.59	$181.59	$22.49	$59.86	$243.14	$245.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30150195	EAP	CPT® 88275		"Interphase Insitu Hybrid, Ana 10-30 Cells"	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$236.60	$236.60	$53.75	$112.22	$316.80	$320.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30150196	EAP	CPT® 86255		"Fluor Noninfect Agent Ab Scr, Ea Ab"	BOTH IP/OP	$85.00 	$62.90	$0.00	$84.80	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$50.28	$50.28	$12.65	$33.68	$83.95	$84.80	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30150197	EAP	CPT® 83625		"Isoenzymes, Separation And Quantitation"	BOTH IP/OP	$48.00 	$35.52	$0.00	$38.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.58	$17.58	$18.25	$0.00	$17.09	$0.00	$0.00	$0.00	$0.00	$32.34	$38.02	$38.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30150202	EAP	CPT® 82379		"Carnitine, Urine (quest 30338)"	BOTH IP/OP	$321.00 	$237.54	$0.00	$259.20	$34.82	$34.82	$16.87	$16.87	$8.44	$8.43	$25.62	$25.62	$26.60	$16.87	$24.92	$10.97	$189.87	$189.87	$0.00	$47.14	$256.61	$259.20	$0.00	$27.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30150203	EAP	CPT® 84143		C17-HYDROXYPREGNENOLONE(QUEST 8352)	BOTH IP/OP	$150.00 	$111.00	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.65	$34.65	$35.99	$0.00	$33.72	$0.00	$0.00	$0.00	$0.00	$63.78	$118.80	$120.00	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30150204	EAP	CPT® 86332		IMMUNE COMPLEX DETECTION BY C1Q BINDING(Q 36735)	BOTH IP/OP	$34.00 	$25.16	$12.19	$40.21	$34.00	$34.00	$24.37	$24.37	$12.19	$12.19	$37.01	$37.01	$38.44	$24.37	$34.00	$15.84	$20.11	$20.11	$25.59	$34.00	$26.93	$27.20	$34.00	$40.21	$34.00	$38.36	$24.37	$24.37	$26.85	$24.37	$0.00	$0.00	$0.00	$0.00
30150205	EAP	CPT® 81229		"CHROMOSOMAL MICROARRAY, PRENATAL (QUEST 90927)"	BOTH IP/OP	"$3,929.00 "	"$2,907.46"	$0.00	"$3,104.80"	$807.84	$807.84	"$1,160.00"	"$1,160.00"	$580.00	$0.00	"$2,916.10"	"$2,916.10"	"$3,028.47"	$0.00	"$2,725.40"	$0.00	$0.00	$0.00	"$1,218.00"	"$1,940.50"	"$3,073.75"	"$3,104.80"	"$1,682.00"	"$1,914.00"	"$1,682.00"	"$2,903.98"	"$1,160.00"	"$1,160.00"	"$2,032.79"	"$1,160.00"	$0.00	$0.00	$0.00	$0.00
30150206	EAP	CPT® 86003		"ALLERGY PANEL,MOLD GROUP (QUEST 7911)"	BOTH IP/OP	$252.00 	$186.48	$2.61	$203.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$149.06	$149.06	$5.48	$14.60	$201.17	$203.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30150207	EAP	CPT® 88271		"FISH,PDGFRB,5q331.(QUEST 90510)DNA PROBE"	BOTH IP/OP	$511.00 	$378.14	$0.00	$408.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$302.26	$302.26	$22.49	$59.86	$404.71	$408.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30150208	EAP	CPT® 88275		"FISH,PDGFRB,5q331.(QUEST 90510)100-300cells"	BOTH IP/OP	$256.00 	$189.44	$0.00	$204.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$151.42	$151.42	$53.75	$112.22	$202.75	$204.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30150209	EAP	CPT® 86235		MYOSITIS ASSESS AUTOAB (Q10185)NUC AG AB	BOTH IP/OP	$429.00 	$317.46	$8.97	$331.20	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$253.75	$253.75	$18.83	$50.12	$327.89	$331.20	$26.00	$29.58	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30150210	EAP	CPT® 83516		MYOSITIS ASSESS AUTOAB (Q10185)Non AB	BOTH IP/OP	"$1,134.00 "	$839.16	$5.76	$882.40	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$670.76	$670.76	$12.11	$29.88	$873.58	$882.40	$16.72	$19.02	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30150211	EAP	CPT® 80356		MONOACETLYMORPNINE MAM (SO)	BOTH IP/OP	$166.00 	$122.84	$0.00	$140.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.21	$123.21	$127.95	$0.00	$34.59	$0.00	$0.00	$0.00	$0.00	$88.00	$139.39	$140.80	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30150212	EAP	CPT® 80377		Hypoglycemic Mass Spec (so)	BOTH IP/OP	$428.00 	$316.72	$0.00	$329.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.66	$317.66	$329.90	$0.00	$89.20	$0.00	$0.00	$0.00	$0.00	$194.50	$308.09	$311.20	$0.00	$278.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30159005	EAP	CPT® 89055		Fecal Leukocyte Smear	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.57	$3.57	$3.70	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$6.56	$93.46	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30159016	EAP	CPT® 82570		Urine Creatinine (so)	BOTH IP/OP	$79.00 	$58.46	$2.59	$63.20	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$46.73	$46.73	$5.44	$14.46	$62.57	$63.20	$7.51	$8.55	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30159017	EAP	CPT® 83918		Organic Acids (so)	BOTH IP/OP	$660.00 	$488.40	$0.00	$533.60	$33.95	$33.95	$23.60	$23.60	$11.80	$10.62	$25.00	$25.00	$25.96	$23.60	$24.32	$15.34	$390.39	$390.39	$24.78	$46.00	$528.26	$533.60	$34.22	$38.94	$34.22	$0.00	$23.60	$23.60	$18.14	$23.60	$0.00	$0.00	$0.00	$0.00
30159018	EAP	CPT® 83018		"Cobalt, Plasma (so)"	BOTH IP/OP	$158.00 	$116.92	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.34	$33.34	$34.62	$0.00	$32.43	$0.00	$0.00	$0.00	$0.00	$61.36	$125.93	$127.20	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30159019	EAP	CPT® 84999		Macroamylase	BOTH IP/OP	$71.00 	$52.54	$0.00	$60.80	$0.00	$0.00	$0.00	$0.00	$12.64	$0.00	$52.70	$52.70	$54.73	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00	$60.19	$60.80	$0.00	$0.00	$0.00	$11.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30159020	EAP	CPT® 81511		Integrated Maternal Serum Screen (so)	BOTH IP/OP	"$1,246.00 "	$922.04	$69.08	$984.80	$462.00	$462.00	$153.50	$153.50	$76.75	$69.08	$924.78	$924.78	$960.42	$153.50	$144.26	$99.78	$737.01	$737.01	$161.18	$615.50	$974.95	$984.80	$222.58	$253.28	$222.58	$153.71	$153.50	$153.50	$107.60	$153.50	$0.00	$0.00	$0.00	$0.00
30159021	EAP	CPT® 84163		Pregnancy Associated Plasma Protein (so)	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$13.25	$13.25	$15.05	$15.05	$7.53	$7.53	$9.74	$9.74	$10.12	$15.05	$9.48	$9.78	$106.47	$106.47	$15.80	$17.94	$142.56	$144.00	$21.82	$0.00	$21.82	$10.10	$15.05	$15.05	$7.07	$15.05	$0.00	$0.00	$0.00	$0.00
30159024	EAP	CPT® 82172		Apolipoprotein (so)	BOTH IP/OP	$155.00 	$114.70	$0.00	$124.00	$32.00	$32.00	$21.09	$21.09	$10.55	$9.49	$23.52	$23.52	$24.43	$21.09	$22.90	$13.71	$91.68	$91.68	$22.14	$43.30	$122.76	$124.00	$30.58	$0.00	$30.58	$24.40	$21.09	$21.09	$17.08	$21.09	$0.00	$0.00	$0.00	$0.00
30159025	EAP	CPT® 82247		"Bilirubin, Total (so)"	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$10.35	$10.35	$5.02	$5.02	$2.51	$2.51	$7.62	$7.62	$7.92	$5.02	$7.42	$3.26	$47.32	$47.32	$5.27	$14.04	$63.36	$64.00	$7.28	$0.00	$7.28	$7.91	$5.02	$5.02	$5.54	$5.02	$0.00	$0.00	$0.00	$0.00
30159026	EAP	CPT® 82977		Gamma - Ggt (so)	BOTH IP/OP	$144.00 	$106.56	$3.60	$115.20	$14.86	$14.86	$7.20	$7.20	$3.60	$3.60	$10.93	$10.93	$11.35	$7.20	$7.46	$4.68	$85.18	$85.18	$7.56	$20.12	$114.05	$115.20	$10.44	$11.88	$10.44	$7.94	$7.20	$7.20	$5.56	$7.20	$0.00	$0.00	$0.00	$0.00
30159027	EAP	CPT® 83010		"Haptoglobin, Quant (so)"	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$7.71	$7.71	$12.58	$12.58	$6.29	$6.29	$5.66	$5.66	$5.88	$12.58	$5.51	$8.18	$73.94	$73.94	$13.21	$10.42	$99.00	$100.00	$18.24	$0.00	$18.24	$5.87	$12.58	$12.58	$4.11	$12.58	$0.00	$0.00	$0.00	$0.00
30159028	EAP	CPT® 83883		"Nephelometry, Each Analyte (so)"	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$28.06	$28.06	$13.60	$13.60	$6.80	$6.80	$20.64	$20.64	$21.44	$13.60	$20.09	$8.84	$85.77	$85.77	$14.28	$38.00	$114.84	$116.00	$19.72	$0.00	$19.72	$21.40	$13.60	$13.60	$14.98	$13.60	$0.00	$0.00	$0.00	$0.00
30159029	EAP	CPT® 84460		Alt (alanine Aminotransferase) (so)	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$10.93	$10.93	$5.30	$5.30	$2.65	$2.65	$8.04	$8.04	$8.35	$5.30	$7.46	$3.45	$47.32	$47.32	$5.57	$14.80	$63.36	$64.00	$7.69	$0.00	$7.69	$7.94	$5.30	$5.30	$5.56	$5.30	$0.00	$0.00	$0.00	$0.00
30159062	EAP	CPT® 84210		"Pyruvate, Csf (so)"	BOTH IP/OP	$254.00 	$187.96	$0.00	$214.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.48	$16.48	$17.12	$0.00	$16.03	$0.00	$0.00	$0.00	$15.20	$30.34	$201.17	$203.20	$21.00	$214.00	$21.00	$0.00	$14.48	$14.48	$11.96	$14.48	$0.00	$0.00	$0.00	$0.00
30159063	EAP	CPT® 86787		"Varicella - Zoster Virus Antibody , Csf (so)"	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$64.47	$64.47	$13.52	$36.00	$86.33	$87.20	$18.68	$0.00	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30159064	EAP	CPT® 80350		"Cannabinoids, Synthetic, 1-3"	BOTH IP/OP	$140.00 	$103.60	$0.00	$118.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.91	$103.91	$107.91	$0.00	$29.18	$0.00	$0.00	$0.00	$0.00	$74.00	$117.22	$118.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30159065	EAP	CPT® 80335		"Clomipramine, Serum (nms), Qt"	BOTH IP/OP	$266.00 	$196.84	$0.00	$212.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.43	$197.43	$205.03	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$133.00	$210.67	$212.80	$0.00	$0.00	$0.00	$28.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30159066	EAP	CPT® 82657		"Alpha - Galactosidase, Leukocytes (mayo)"	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$304.92	$308.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30159067	EAP	CPT® 80307		"Hypoglycemic Agent Screen, Serum (mayo)"	BOTH IP/OP	$397.00 	$293.78	$29.09	$288.80	$115.05	$115.05	$62.14	$62.14	$31.07	$29.09	$79.51	$79.51	$82.57	$62.14	$71.85	$40.39	$234.83	$234.83	$65.25	$180.50	$285.91	$288.80	$90.10	$102.53	$90.10	$76.56	$62.14	$62.14	$53.59	$62.14	$0.00	$0.00	$0.00	$0.00
30159068	EAP	CPT® 80347		Benzodiazepines (so)nms	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.98	$120.98	$125.64	$0.00	$27.32	$0.00	$0.00	$0.00	$0.00	$81.50	$129.10	$130.40	$0.00	$98.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30159069	EAP	CPT® 80320		"Alcohol( Ethanol), (so)nms"	BOTH IP/OP	$46.00 	$34.04	$0.00	$120.15	$0.03	$0.03	$114.43	$114.43	$57.22	$6.63	$34.14	$34.14	$35.46	$114.43	$15.96	$74.38	$27.21	$27.21	$120.15	$24.50	$38.81	$39.20	$29.40	$0.00	$29.40	$17.01	$0.00	$0.00	$11.90	$114.43	$0.00	$0.00	$0.00	$0.00
30159070	EAP	CPT® 80307		"Drug Screen, Qualitative,(so)nms"	BOTH IP/OP	$270.00 	$199.80	$0.00	$228.80	$115.05	$115.05	$62.14	$62.14	$31.07	$29.09	$79.51	$79.51	$82.57	$62.14	$71.85	$40.39	$159.71	$159.71	$65.25	$143.00	$226.51	$228.80	$90.10	$0.00	$90.10	$76.56	$62.14	$62.14	$53.59	$62.14	$0.00	$0.00	$0.00	$0.00
30159071	EAP	CPT® 80307		"Single Drug Class (elisa), (so)nms"	BOTH IP/OP	$204.00 	$150.96	$0.00	$172.80	$115.05	$115.05	$62.14	$62.14	$31.07	$29.09	$79.51	$79.51	$82.57	$62.14	$71.85	$40.39	$120.67	$120.67	$65.25	$108.00	$171.07	$172.80	$90.10	$0.00	$90.10	$76.56	$62.14	$62.14	$53.59	$62.14	$0.00	$0.00	$0.00	$0.00
30159072	EAP	CPT® 83519		Ach Receptor (muscle Binding Abs) Mayo	BOTH IP/OP	$145.00 	$107.30	$8.28	$112.80	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$85.77	$85.77	$19.32	$37.76	$111.67	$112.80	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30159073	EAP	CPT® 83519		Achr Ganglionic Neuronal Abs (mayo)	BOTH IP/OP	$125.00 	$92.50	$0.00	$112.80	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$73.94	$73.94	$19.32	$37.76	$111.67	$112.80	$26.68	$0.00	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30159074	EAP	CPT® 83519		Neuronal Vgkc Autoantibody (mayo)	BOTH IP/OP	$125.00 	$92.50	$0.00	$112.80	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$73.94	$73.94	$19.32	$37.76	$111.67	$112.80	$26.68	$0.00	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30159075	EAP	CPT® 83519		N-type Calcium Channel Abs (mayo)	BOTH IP/OP	$125.00 	$92.50	$0.00	$112.80	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$73.94	$73.94	$19.32	$37.76	$111.67	$112.80	$26.68	$0.00	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30159076	EAP	CPT® 83519		P/q -type Calcium Channel Abs (mayo)	BOTH IP/OP	$125.00 	$92.50	$0.00	$112.80	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$73.94	$73.94	$19.32	$37.76	$111.67	$112.80	$26.68	$0.00	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30159077	EAP	CPT® 83519		Ach Receptor (muscle) Modulating Abs (mayo)	BOTH IP/OP	$125.00 	$92.50	$0.00	$112.80	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$73.94	$73.94	$19.32	$37.76	$111.67	$112.80	$26.68	$0.00	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30159078	EAP	CPT® 83520		Striational (striated Muscle) Abs (mayo)	BOTH IP/OP	$125.00 	$92.50	$0.00	$112.80	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$73.94	$73.94	$18.13	$36.18	$111.67	$112.80	$25.04	$0.00	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30159079	EAP	CPT® 84182		Amphiphysin Western Blot (mayo)	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$37.14	$37.14	$29.21	$29.21	$14.61	$13.14	$27.33	$27.33	$28.38	$29.21	$26.60	$18.99	$37.26	$37.26	$30.67	$50.30	$49.90	$50.40	$42.35	$0.00	$42.35	$28.34	$29.21	$29.21	$19.84	$29.21	$0.00	$0.00	$0.00	$0.00
30159080	EAP	CPT® 84182		Crmp-5-igg Western Blot (mayo)	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$37.14	$37.14	$29.21	$29.21	$14.61	$13.14	$27.33	$27.33	$28.38	$29.21	$26.60	$18.99	$37.26	$37.26	$30.67	$50.30	$49.90	$50.40	$42.35	$0.00	$42.35	$28.34	$29.21	$29.21	$19.84	$29.21	$0.00	$0.00	$0.00	$0.00
30159081	EAP	CPT® 84182		Paraneoplastic Autoantibody Western Blot (mayo)	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$37.14	$37.14	$29.21	$29.21	$14.61	$13.14	$27.33	$27.33	$28.38	$29.21	$26.60	$18.99	$37.26	$37.26	$30.67	$50.30	$49.90	$50.40	$42.35	$0.00	$42.35	$28.34	$29.21	$29.21	$19.84	$29.21	$0.00	$0.00	$0.00	$0.00
30159082	EAP	CPT® 83519		Alpha Subunit (so)	BOTH IP/OP	$216.00 	$159.84	$0.00	$195.20	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$127.76	$127.76	$19.32	$37.76	$193.25	$195.20	$26.68	$0.00	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30159083	EAP	CPT® 80299		"Metformin  Quantitative, Serum (arup)"	BOTH IP/OP	$308.00 	$227.92	$8.39	$246.40	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$182.18	$182.18	$19.57	$33.64	$243.94	$246.40	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30159084	EAP	CPT® 83872		"Mucin Clot, Synovial (so)"	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.90	$8.90	$9.24	$0.00	$14.54	$0.00	$0.00	$0.00	$0.00	$16.38	$47.52	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30159085	EAP	CPT® 82379		"Carnitine, Urine (so)"	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$34.82	$34.82	$16.87	$16.87	$8.44	$8.43	$25.62	$25.62	$26.60	$16.87	$24.92	$10.97	$191.65	$191.65	$0.00	$47.14	$256.61	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30159086	EAP	CPT® 83519		"Musk  Quantitative , Antibody (so)"	BOTH IP/OP	"$1,583.00 "	"$1,171.42"	$8.28	"$1,429.60"	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$936.34	$936.34	$19.32	$37.76	"$1,415.30"	"$1,429.60"	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30159087	EAP	CPT® 82542		"Cannabinoid Metabolite, Urine (nms), Qt"	BOTH IP/OP	$284.00 	$210.16	$0.00	$227.20	$37.28	$37.28	$24.09	$24.09	$12.05	$10.84	$9.12	$9.12	$9.47	$24.09	$8.87	$15.66	$167.99	$167.99	$25.29	$16.78	$224.93	$227.20	$34.93	$0.00	$34.93	$9.45	$24.09	$24.09	$6.62	$24.09	$0.00	$0.00	$0.00	$0.00
30159088	EAP	CPT® 83520		Tsh Receptor Binding Ab Trab (so)	BOTH IP/OP	$270.00 	$199.80	$7.77	$210.40	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$159.71	$159.71	$18.13	$36.18	$208.30	$210.40	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30159089	EAP	CPT® 84143		"Hydroxypregnenolone-17, Lc/ms/ms (so)"	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.65	$34.65	$35.99	$0.00	$33.72	$0.00	$0.00	$0.00	$0.00	$63.78	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30159090	EAP	CPT® 80299		Infliximab Drug Concentration	BOTH IP/OP	$399.00 	$295.26	$8.39	$320.80	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$236.01	$236.01	$19.57	$33.64	$317.59	$320.80	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30159091	EAP	CPT® 82397		Anti-infliximab Ab	BOTH IP/OP	$738.00 	$546.12	$7.06	$574.40	$29.15	$29.15	$14.12	$14.12	$7.06	$7.06	$21.46	$21.46	$22.28	$14.12	$20.87	$9.18	$436.53	$436.53	$14.83	$39.48	$568.66	$574.40	$20.47	$23.30	$20.47	$22.24	$14.12	$14.12	$15.57	$14.12	$0.00	$0.00	$0.00	$0.00
30160020	EAP	CPT® 82172		Apolipoprotein A1 (so)	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$32.00	$32.00	$21.09	$21.09	$10.55	$9.49	$23.52	$23.52	$24.43	$21.09	$22.90	$13.71	$103.51	$103.51	$22.14	$43.30	$138.60	$140.00	$30.58	$0.00	$30.58	$24.40	$21.09	$21.09	$17.08	$21.09	$0.00	$0.00	$0.00	$0.00
30160023	EAP	CPT® 84182		Redombx Car Antirecoverin (so)	BOTH IP/OP	$468.00 	$346.32	$0.00	$374.40	$37.14	$37.14	$29.21	$29.21	$14.61	$13.14	$27.33	$27.33	$28.38	$29.21	$26.60	$18.99	$276.82	$276.82	$30.67	$50.30	$370.66	$374.40	$42.35	$0.00	$42.35	$28.34	$29.21	$29.21	$19.84	$29.21	$0.00	$0.00	$0.00	$0.00
30160024	EAP	CPT® 83520		Prothrom Frag 1.2 (so)	BOTH IP/OP	$367.00 	$271.58	$7.77	$331.20	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$217.08	$217.08	$18.13	$36.18	$327.89	$331.20	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30160025	EAP	CPT® 80369		Baclofin (so)	BOTH IP/OP	$380.00 	$281.20	$0.00	$321.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.04	$282.04	$292.90	$0.00	$26.04	$0.00	$0.00	$0.00	$0.00	$201.00	$318.38	$321.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30160027	EAP	CPT® 82042		"Albumin, Csf (so)"	BOTH IP/OP	$18.00 	$13.32	$3.50	$14.46	$10.69	$10.69	$7.78	$7.78	$3.89	$3.50	$7.86	$7.86	$8.16	$7.78	$7.64	$5.06	$10.65	$10.65	$8.17	$14.46	$14.26	$14.40	$11.28	$12.84	$11.28	$8.14	$7.78	$7.78	$5.70	$7.78	$0.00	$0.00	$0.00	$0.00
30160028	EAP	CPT® 82272		"Occult Blood Guaiac, Fecal"	BOTH IP/OP	$64.00 	$47.36	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.88	$4.88	$5.07	$0.00	$4.75	$0.00	$0.00	$0.00	$0.00	$8.98	$51.48	$52.00	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30160029	EAP	CPT® 80365		"Oxycodone And Metabolite, Quant Serum (so-quest)"	BOTH IP/OP	$333.00 	$246.42	$0.00	$256.68	$0.03	$0.03	$114.43	$114.43	$57.22	$11.94	$247.15	$247.15	$256.68	$114.43	$69.40	$74.38	$196.97	$196.97	$120.15	$151.50	$239.98	$242.40	$181.80	$188.81	$181.80	$47.42	$0.00	$0.00	$48.24	$114.43	$0.00	$0.00	$0.00	$0.00
30160030	EAP	CPT® 82397		"Anti-mullerian Hormone (amh), Male (so)"	BOTH IP/OP	$255.00 	$188.70	$0.00	$230.40	$29.15	$29.15	$14.12	$14.12	$7.06	$7.06	$21.46	$21.46	$22.28	$14.12	$20.87	$9.18	$150.83	$150.83	$14.83	$39.48	$228.10	$230.40	$20.47	$0.00	$20.47	$22.24	$14.12	$14.12	$15.57	$14.12	$0.00	$0.00	$0.00	$0.00
30160031	EAP	CPT® 82397		"Anti-mullerian Hormone (amh), Female (so)"	BOTH IP/OP	$296.00 	$219.04	$7.06	$230.40	$29.15	$29.15	$14.12	$14.12	$7.06	$7.06	$21.46	$21.46	$22.28	$14.12	$20.87	$9.18	$175.08	$175.08	$14.83	$39.48	$228.10	$230.40	$20.47	$23.30	$20.47	$22.24	$14.12	$14.12	$15.57	$14.12	$0.00	$0.00	$0.00	$0.00
30160032	EAP	CPT® 83520		Infliximab Ab - Rd (so)	BOTH IP/OP	$425.00 	$314.50	$7.77	$384.00	$26.72	$26.72	$114.43	$114.43	$57.22	$7.77	$19.67	$19.67	$20.42	$114.43	$19.12	$74.38	$251.39	$251.39	$120.15	$36.18	$380.16	$384.00	$25.04	$188.81	$25.04	$20.37	$17.27	$17.27	$14.26	$114.43	$0.00	$0.00	$0.00	$0.00
30160033	EAP	CPT® 80299		Infliximab Rd (so)	BOTH IP/OP	$423.00 	$313.02	$8.39	$340.00	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$250.20	$250.20	$19.57	$33.64	$336.60	$340.00	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30160034	EAP	CPT® 83520		Infliximab Ab Ibd (so)	BOTH IP/OP	$494.00 	$365.56	$7.77	$384.00	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$292.20	$292.20	$18.13	$36.18	$380.16	$384.00	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30160035	EAP	CPT® 80299		Infliximab Ibd (so)	BOTH IP/OP	$423.00 	$313.02	$8.39	$340.00	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$250.20	$250.20	$19.57	$33.64	$336.60	$340.00	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30160036	EAP	CPT® 80050		Champva General Health Panel	BOTH IP/OP	$836.00 	$618.64	$0.00	$664.00	$70.80	$70.80	$0.00	$0.00	$22.64	$22.10	$44.24	$44.24	$45.94	$0.00	$174.22	$0.00	$494.49	$494.49	$0.00	$91.78	$657.36	$664.00	$0.00	$287.95	$0.00	$129.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30160040	EAP	CPT® 82570		Urine Creatinine Qd (so)	BOTH IP/OP	$27.00 	$19.98	$2.59	$21.60	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$15.97	$15.97	$5.44	$14.46	$21.38	$21.60	$7.51	$8.55	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30160041	EAP	CPT® 84156		Urine Protein Qd (so	BOTH IP/OP	$28.00 	$20.72	$1.83	$21.60	$7.58	$7.58	$3.67	$3.67	$1.84	$1.83	$5.56	$5.56	$5.78	$3.67	$5.42	$2.39	$16.56	$16.56	$3.85	$10.24	$21.38	$21.60	$5.32	$6.06	$5.32	$5.77	$3.67	$3.67	$4.04	$3.67	$0.00	$0.00	$0.00	$0.00
30160042	EAP	CPT® 83001		Follicle Stimulating Hormone (so)	BOTH IP/OP	$56.00 	$41.44	$9.29	$51.94	$38.36	$38.36	$18.58	$18.58	$9.29	$9.29	$28.23	$28.23	$29.31	$18.58	$27.46	$12.08	$33.12	$33.12	$19.51	$51.94	$42.77	$43.20	$26.94	$30.66	$26.94	$29.26	$18.58	$18.58	$20.48	$18.58	$0.00	$0.00	$0.00	$0.00
30160043	EAP	CPT® 83002		Luteinizing Hormone (so)	BOTH IP/OP	$56.00 	$41.44	$9.26	$51.76	$38.23	$38.23	$18.52	$18.52	$9.26	$9.26	$28.12	$28.12	$29.20	$18.52	$27.36	$12.04	$33.12	$33.12	$19.45	$51.76	$42.77	$43.20	$26.85	$30.56	$26.85	$29.16	$18.52	$18.52	$20.41	$18.52	$0.00	$0.00	$0.00	$0.00
30160044	EAP	CPT® 84182		Myositis Specific 11 Ab Protein Western Blot  (so)	BOTH IP/OP	$103.00 	$76.22	$13.14	$82.40	$37.14	$37.14	$29.21	$29.21	$14.61	$13.14	$27.33	$27.33	$28.38	$29.21	$26.60	$18.99	$60.92	$60.92	$30.67	$50.30	$81.58	$82.40	$42.35	$48.20	$42.35	$28.34	$29.21	$29.21	$19.84	$29.21	$0.00	$0.00	$0.00	$0.00
30160050	EAP	CPT® 83520		Interleukin-6 (il-6) (so)	BOTH IP/OP	$257.00 	$190.18	$7.77	$200.00	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$152.02	$152.02	$18.13	$36.18	$198.00	$200.00	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30160055	EAP	CPT® 82140		Stone Risk Profile - Ammonia (so)	BOTH IP/OP	$21.00 	$15.54	$7.29	$24.04	$20.41	$20.41	$14.57	$14.57	$7.29	$7.29	$15.02	$15.02	$15.60	$14.57	$14.62	$9.47	$12.42	$12.42	$15.30	$21.00	$16.63	$16.80	$21.00	$24.04	$21.00	$15.57	$14.57	$14.57	$10.90	$14.57	$0.00	$0.00	$0.00	$0.00
30160056	EAP	CPT® 82340		Stone Risk Profile - Calcium Urine Quant (so)	BOTH IP/OP	$23.00 	$17.02	$0.00	$23.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.16	$9.16	$9.51	$0.00	$8.91	$0.00	$0.00	$0.00	$0.00	$16.86	$16.63	$16.80	$0.00	$23.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30160057	EAP	CPT® 82507		Stone Risk Profile - Citrate (so)	BOTH IP/OP	$21.00 	$15.54	$0.00	$43.85	$0.00	$0.00	$0.00	$0.00	$0.00	$13.90	$42.22	$42.22	$43.85	$27.80	$21.00	$18.07	$12.42	$12.42	$0.00	$21.00	$16.63	$16.80	$0.00	$21.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30160058	EAP	CPT® 82570		Stone Risk Profile - Creatinine (so)	BOTH IP/OP	$21.00 	$15.54	$2.59	$16.80	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$12.42	$12.42	$5.44	$14.46	$16.63	$16.80	$7.51	$8.55	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30160059	EAP	CPT® 83735		Stone Risk Profile - Magnesium (so)	BOTH IP/OP	$23.00 	$17.02	$3.35	$18.72	$13.83	$13.83	$6.70	$6.70	$3.35	$3.35	$10.17	$10.17	$10.56	$6.70	$9.89	$4.36	$13.60	$13.60	$7.04	$18.72	$16.63	$16.80	$9.72	$11.06	$9.72	$10.54	$6.70	$6.70	$7.38	$6.70	$0.00	$0.00	$0.00	$0.00
30160060	EAP	CPT® 83945		Stone Risk Profile - Oxalate (so)	BOTH IP/OP	$21.00 	$15.54	$0.00	$23.84	$21.00	$21.00	$14.45	$14.45	$7.23	$6.50	$19.55	$19.55	$20.30	$14.45	$19.02	$9.39	$12.42	$12.42	$0.00	$21.00	$16.63	$16.80	$0.00	$23.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30160061	EAP	CPT® 83986		Stone Risk Profile - Ph Body Fluid (so)	BOTH IP/OP	$23.00 	$17.02	$0.00	$16.80	$7.39	$7.39	$3.58	$3.58	$1.79	$1.79	$5.43	$5.43	$5.64	$3.58	$5.28	$2.33	$13.60	$13.60	$3.76	$10.00	$16.63	$16.80	$5.19	$5.91	$5.19	$0.00	$3.58	$3.58	$3.94	$3.58	$0.00	$0.00	$0.00	$0.00
30160062	EAP	CPT® 84105		Stone Risk Profile - Phosphate Urine (so)	BOTH IP/OP	$23.00 	$17.02	$2.60	$16.80	$10.69	$10.69	$5.78	$5.78	$2.89	$2.60	$7.86	$7.86	$8.16	$5.78	$7.64	$3.76	$13.60	$13.60	$6.07	$14.46	$16.63	$16.80	$8.38	$9.54	$8.38	$8.14	$5.78	$5.78	$5.70	$5.78	$0.00	$0.00	$0.00	$0.00
30160063	EAP	CPT® 84133		Stone Risk Profile - Potassium Urine (so)	BOTH IP/OP	$21.00 	$15.54	$2.16	$16.80	$8.90	$8.90	$4.73	$4.73	$2.37	$2.16	$6.53	$6.53	$6.78	$4.73	$6.35	$3.07	$12.42	$12.42	$4.97	$12.02	$16.63	$16.80	$6.86	$7.80	$6.86	$6.77	$4.73	$4.73	$4.74	$4.73	$0.00	$0.00	$0.00	$0.00
30160064	EAP	CPT® 84300		Stone Risk Profile - Sodium Urine (so)	BOTH IP/OP	$23.00 	$17.02	$2.43	$16.80	$7.13	$7.13	$5.06	$5.06	$2.53	$2.43	$5.25	$5.25	$5.45	$5.06	$5.11	$3.29	$13.60	$13.60	$5.31	$9.66	$16.63	$16.80	$7.34	$8.35	$7.34	$5.45	$5.06	$5.06	$3.81	$5.06	$0.00	$0.00	$0.00	$0.00
30160065	EAP	CPT® 84392		Stone Risk Profile - Sulfate Urine (so)	BOTH IP/OP	$21.00 	$15.54	$0.00	$21.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.21	$7.21	$7.48	$0.00	$7.02	$0.00	$0.00	$0.00	$0.00	$13.28	$16.63	$16.80	$0.00	$21.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30160066	EAP	CPT® 84560		Stone Risk Profile - Uric Acid (so)	BOTH IP/OP	$21.00 	$15.54	$2.37	$16.80	$9.79	$9.79	$5.08	$5.08	$2.54	$2.37	$7.21	$7.21	$7.48	$5.08	$7.02	$3.30	$12.42	$12.42	$5.33	$13.28	$16.63	$16.80	$7.37	$8.38	$7.37	$7.48	$5.08	$5.08	$5.24	$5.08	$0.00	$0.00	$0.00	$0.00
30160070	EAP	CPT® 84155		"Assay Protein, Serum (so)"	BOTH IP/OP	$21.00 	$15.54	$0.00	$25.60	$7.58	$7.58	$3.67	$3.67	$1.84	$1.83	$5.56	$5.56	$5.78	$3.67	$5.42	$2.39	$12.42	$12.42	$0.00	$10.24	$25.34	$25.60	$0.00	$6.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30160071	EAP	CPT® 84165		Protein Electrophoresis Urine (so)	BOTH IP/OP	$21.00 	$15.54	$0.00	$30.02	$21.00	$21.00	$10.74	$10.74	$5.37	$5.37	$16.31	$16.31	$16.93	$10.74	$15.87	$6.98	$12.42	$12.42	$11.28	$30.02	$25.34	$25.60	$15.57	$17.72	$15.57	$0.00	$10.74	$10.74	$11.83	$10.74	$0.00	$0.00	$0.00	$0.00
30160072	EAP	CPT® 82570		Assay Creatinine Urine (so)	BOTH IP/OP	$32.00 	$23.68	$0.00	$28.00	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$18.93	$18.93	$5.44	$14.46	$27.72	$28.00	$7.51	$8.55	$7.51	$0.00	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30160073	EAP	CPT® 84156		Assay Protein Urine (so)	BOTH IP/OP	$36.00 	$26.64	$0.00	$28.00	$7.58	$7.58	$3.67	$3.67	$1.84	$1.83	$5.56	$5.56	$5.78	$3.67	$5.42	$2.39	$21.29	$21.29	$3.85	$10.24	$27.72	$28.00	$5.32	$6.06	$5.32	$0.00	$3.67	$3.67	$4.04	$3.67	$0.00	$0.00	$0.00	$0.00
30160074	EAP	CPT® 84166		"Protein Electrophoresis, Urine (so)"	BOTH IP/OP	$36.00 	$26.64	$0.00	$36.00	$36.00	$36.00	$17.83	$17.83	$8.92	$8.91	$27.08	$27.08	$28.12	$17.83	$26.34	$11.59	$21.29	$21.29	$18.72	$35.00	$27.72	$28.00	$25.85	$29.42	$25.85	$0.00	$17.83	$17.83	$19.65	$17.83	$0.00	$0.00	$0.00	$0.00
30200001	EAP	CPT® 86000		Proteus Ox-19 Ab	BOTH IP/OP	$320.00 	$236.80	$0.00	$319.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.60	$10.60	$11.01	$0.00	$10.31	$0.00	$0.00	$0.00	$0.00	$19.50	$316.01	$319.20	$0.00	$78.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200002	EAP	CPT® 86000		Typhoid O Antibody	BOTH IP/OP	$320.00 	$236.80	$0.00	$319.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.60	$10.60	$11.01	$0.00	$10.31	$0.00	$0.00	$0.00	$0.00	$19.50	$316.01	$319.20	$0.00	$78.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200003	EAP	CPT® 86000		Typhoid H Antibody	BOTH IP/OP	$320.00 	$236.80	$0.00	$319.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.60	$10.60	$11.01	$0.00	$10.31	$0.00	$0.00	$0.00	$0.00	$19.50	$316.01	$319.20	$0.00	$78.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200004	EAP	CPT® 86003		*alternaria Alternata Ige	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200005	EAP	CPT® 86003		*penicillium Notatum Ige	BOTH IP/OP	$207.00 	$153.18	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$122.44	$122.44	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200006	EAP	CPT® 86003		*kentucky/june Bluegrass Ige	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200007	EAP	CPT® 86003		*mouse Epithelia Ige	BOTH IP/OP	$207.00 	$153.18	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$122.44	$122.44	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200008	EAP	CPT® 86003		*clam Ige	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200009	EAP	CPT® 86003		*walnut (food) Ige	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200010	EAP	CPT® 86003		*scallop Ige	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200011	EAP	CPT® 86003		Ige Allergen Sesame Seed	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200012	EAP	CPT® 86003		Ige Allergen Nettle	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200013	EAP	CPT® 86003		Ige Allergen Sheep Sorrel	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200014	EAP	CPT® 86003		Mk82 Latex-rst	BOTH IP/OP	$207.00 	$153.18	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$122.44	$122.44	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200015	EAP	CPT® 86003		Curvularia Lunato	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200016	EAP	CPT® 86003		Heluminthosporium I.	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200017	EAP	CPT® 86003		"Egg, Chicken"	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200018	EAP	CPT® 86003		"Milk, Cow's"	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200019	EAP	CPT® 86003		Wheat	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200020	EAP	CPT® 86003		Oat	BOTH IP/OP	$207.00 	$153.18	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$122.44	$122.44	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200021	EAP	CPT® 86003		Corn	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200022	EAP	CPT® 86003		Soybean	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200023	EAP	CPT® 86003		Peanut	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200024	EAP	CPT® 86003		Tuna	BOTH IP/OP	$180.00 	$133.20	$2.61	$179.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$106.47	$106.47	$5.48	$14.60	$177.41	$179.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200025	EAP	CPT® 86003		Codfish	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200026	EAP	CPT® 86003		Allergen Specific Ige	BOTH IP/OP	$180.00 	$133.20	$2.61	$179.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$106.47	$106.47	$5.48	$14.60	$177.41	$179.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200027	EAP	CPT® 86003		Shrimp	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200028	EAP	CPT® 86003		Beef	BOTH IP/OP	$180.00 	$133.20	$2.61	$179.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$106.47	$106.47	$5.48	$14.60	$177.41	$179.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200029	EAP	CPT® 86003		Rice	BOTH IP/OP	$180.00 	$133.20	$2.61	$179.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$106.47	$106.47	$5.48	$14.60	$177.41	$179.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200030	EAP	CPT® 86003		White Potato	BOTH IP/OP	$180.00 	$133.20	$2.61	$179.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$106.47	$106.47	$5.48	$14.60	$177.41	$179.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200031	EAP	CPT® 86003		Yellow Onion	BOTH IP/OP	$180.00 	$133.20	$2.61	$179.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$106.47	$106.47	$5.48	$14.60	$177.41	$179.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200032	EAP	CPT® 86003		Honey Bee	BOTH IP/OP	$207.00 	$153.18	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$122.44	$122.44	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200033	EAP	CPT® 86003		White Faced Hornet	BOTH IP/OP	$207.00 	$153.18	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$122.44	$122.44	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200034	EAP	CPT® 86003		Yellow Jacket	BOTH IP/OP	$207.00 	$153.18	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$122.44	$122.44	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200035	EAP	CPT® 86003		Paper Wasp	BOTH IP/OP	$207.00 	$153.18	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$122.44	$122.44	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200036	EAP	CPT® 86003		Yellow Faced Hornet	BOTH IP/OP	$207.00 	$153.18	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$122.44	$122.44	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200037	EAP	CPT® 86003		Short Ragweed	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200038	EAP	CPT® 86003		Yellow Dock	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200039	EAP	CPT® 86003		Lamb's Quarters	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200040	EAP	CPT® 86003		Pigweed	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200041	EAP	CPT® 86003		Marsh Elder	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200042	EAP	CPT® 86003		English Plantain	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200043	EAP	CPT® 86003		Cocklebur	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200044	EAP	CPT® 86003		Bermuda Grass	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200045	EAP	CPT® 86003		Perennial Ryegrass	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200046	EAP	CPT® 86003		Timothy	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200047	EAP	CPT® 86003		Johnson Grass	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200048	EAP	CPT® 86003		Bahia Grass	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200049	EAP	CPT® 86003		White Oak	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200050	EAP	CPT® 86003		Elm	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200051	EAP	CPT® 86003		Black Walnut	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200052	EAP	CPT® 86003		White Ash	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200053	EAP	CPT® 86003		White Pine	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200054	EAP	CPT® 86003		Pecan	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200055	EAP	CPT® 86003		Cottonwood	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200056	EAP	CPT® 86003		Sycamore	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200057	EAP	CPT® 86003		Birch	BOTH IP/OP	$209.00 	$154.66	$0.00	$167.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.48	$14.60	$165.53	$167.20	$7.57	$0.00	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200058	EAP	CPT® 86003		Eucalyptus	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200059	EAP	CPT® 86003		Red Cedar	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200060	EAP	CPT® 86003		Red Maple	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200061	EAP	CPT® 86003		Cat Hair	BOTH IP/OP	$209.00 	$154.66	$0.00	$167.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.48	$14.60	$165.53	$167.20	$7.57	$0.00	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200062	EAP	CPT® 86003		Dog Hair	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200063	EAP	CPT® 86003		Horse Hair	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200064	EAP	CPT® 86003		Feather Mix	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200065	EAP	CPT® 86003		D.pteronyssinus	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200066	EAP	CPT® 86003		D.farinae Mite	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200067	EAP	CPT® 86003		Cockroach	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200068	EAP	CPT® 86003		Pen. Brevicomp	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200069	EAP	CPT® 86003		"Clado, Herbarium"	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200070	EAP	CPT® 86003		Candida Albicans	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200071	EAP	CPT® 86003		Alternaria Tenuis	BOTH IP/OP	$168.00 	$124.32	$2.61	$167.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$99.37	$99.37	$5.48	$14.60	$165.53	$167.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200072	EAP	CPT® 86021		Perinuclear Ab Scrn	BOTH IP/OP	$326.00 	$241.24	$0.00	$260.80	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$192.83	$192.83	$15.80	$42.06	$258.19	$260.80	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30200073	EAP	CPT® 86021		Cytoplasmic Ab Scrn	BOTH IP/OP	$355.00 	$262.70	$7.53	$260.80	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$209.98	$209.98	$15.80	$42.06	$258.19	$260.80	$21.82	$24.83	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30200074	EAP	CPT® 86022		Plt Ab: Hla Class 1	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$248.43	$248.43	$0.00	$51.32	$332.64	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200075	EAP	CPT® 86022		Plt Ab: Gp Iib/iiia	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$248.43	$248.43	$0.00	$51.32	$332.64	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200076	EAP	CPT® 86022		Plt Ab: Gp Ib/ix	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$248.43	$248.43	$0.00	$51.32	$332.64	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200077	EAP	CPT® 86022		Plt Ab: Gp Ia/iib	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$248.43	$248.43	$0.00	$51.32	$332.64	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200078	EAP	CPT® 86022		Plt Ab: Gp Iv	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$248.43	$248.43	$0.00	$51.32	$332.64	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200079	EAP	CPT® 86038		Ana Screen	BOTH IP/OP	$291.00 	$215.34	$6.04	$220.80	$24.95	$24.95	$12.09	$12.09	$6.05	$6.04	$18.36	$18.36	$19.06	$12.09	$17.86	$7.86	$172.13	$172.13	$12.69	$33.78	$218.59	$220.80	$17.53	$19.95	$17.53	$19.03	$12.09	$12.09	$13.32	$12.09	$0.00	$0.00	$0.00	$0.00
30200080	EAP	CPT® 86060		Strep Aso	BOTH IP/OP	$79.00 	$58.46	$3.65	$60.80	$14.44	$14.44	$7.30	$7.30	$3.65	$3.65	$10.62	$10.62	$11.03	$7.30	$10.32	$4.75	$46.73	$46.73	$7.67	$19.54	$60.19	$60.80	$10.59	$12.05	$10.59	$11.00	$7.30	$7.30	$7.70	$7.30	$0.00	$0.00	$0.00	$0.00
30200081	EAP	CPT® 86140		C-reactive Protein	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.86	$7.86	$8.16	$0.00	$7.64	$0.00	$0.00	$0.00	$0.00	$14.46	$186.12	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200082	EAP	CPT® 86141		C-reactive Protein-hs	BOTH IP/OP	$248.00 	$183.52	$6.48	$200.00	$26.72	$26.72	$12.95	$12.95	$6.48	$6.48	$19.67	$19.67	$20.42	$12.95	$19.12	$8.42	$146.69	$146.69	$13.60	$36.18	$198.00	$200.00	$18.78	$21.37	$18.78	$20.37	$12.95	$12.95	$14.26	$12.95	$0.00	$0.00	$0.00	$0.00
30200083	EAP	CPT® 86141		"Crp-hs,micro"	BOTH IP/OP	$250.00 	$185.00	$6.48	$200.00	$26.72	$26.72	$12.95	$12.95	$6.48	$6.48	$19.67	$19.67	$20.42	$12.95	$19.12	$8.42	$147.88	$147.88	$13.60	$36.18	$198.00	$200.00	$18.78	$21.37	$18.78	$20.37	$12.95	$12.95	$14.26	$12.95	$0.00	$0.00	$0.00	$0.00
30200084	EAP	CPT® 86160		Complement-3c	BOTH IP/OP	$337.00 	$249.38	$6.00	$272.00	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$199.34	$199.34	$12.60	$33.56	$269.28	$272.00	$17.40	$19.80	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30200085	EAP	CPT® 86160		Complement-4	BOTH IP/OP	$337.00 	$249.38	$6.00	$272.00	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$199.34	$199.34	$12.60	$33.56	$269.28	$272.00	$17.40	$19.80	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30200086	EAP	CPT® 86160		"Complement-c3,synvl"	BOTH IP/OP	$337.00 	$249.38	$6.00	$272.00	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$199.34	$199.34	$12.60	$33.56	$269.28	$272.00	$17.40	$19.80	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30200087	EAP	CPT® 86160		"Complement-c4,synvl"	BOTH IP/OP	$337.00 	$249.38	$6.00	$272.00	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$199.34	$199.34	$12.60	$33.56	$269.28	$272.00	$17.40	$19.80	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30200088	EAP	CPT® 86162		"Complement Tot,ch50"	BOTH IP/OP	$227.00 	$167.98	$0.00	$227.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.86	$30.86	$32.04	$0.00	$30.02	$0.00	$0.00	$0.00	$21.34	$56.78	$181.37	$183.20	$29.46	$227.00	$29.46	$31.99	$20.32	$20.32	$22.39	$20.32	$0.00	$0.00	$0.00	$0.00
30200089	EAP	CPT® 86162		"Complemnt Tot,ch100"	BOTH IP/OP	$199.00 	$147.26	$0.00	$183.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.86	$30.86	$32.04	$0.00	$30.02	$0.00	$0.00	$0.00	$21.34	$56.78	$181.37	$183.20	$29.46	$0.00	$29.46	$31.99	$20.32	$20.32	$22.39	$20.32	$0.00	$0.00	$0.00	$0.00
30200090	EAP	CPT® 86171		Fungal Serology	BOTH IP/OP	$157.00 	$116.18	$0.00	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.62	$10.62	$11.03	$0.00	$10.32	$0.00	$0.00	$0.00	$0.00	$19.54	$124.34	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200091	EAP	CPT® 86171		Parasitic Serology	BOTH IP/OP	$157.00 	$116.18	$0.00	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.62	$10.62	$11.03	$0.00	$10.32	$0.00	$0.00	$0.00	$0.00	$19.54	$124.34	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200092	EAP	CPT® 86171		Viral Serology	BOTH IP/OP	$157.00 	$116.18	$0.00	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.62	$10.62	$11.03	$0.00	$10.32	$0.00	$0.00	$0.00	$0.00	$19.54	$124.34	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200093	EAP	CPT® 86171		Misc. Serology	BOTH IP/OP	$157.00 	$116.18	$0.00	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.62	$10.62	$11.03	$0.00	$10.32	$0.00	$0.00	$0.00	$0.00	$19.54	$124.34	$125.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200094	EAP	CPT® 86215		Strep Antid-nase B	BOTH IP/OP	$190.00 	$140.60	$6.62	$190.00	$27.35	$27.35	$13.25	$13.25	$6.63	$6.62	$20.12	$20.12	$20.90	$13.25	$19.57	$8.61	$112.39	$112.39	$13.91	$37.02	$144.14	$145.60	$19.21	$190.00	$19.21	$20.85	$13.25	$13.25	$14.60	$13.25	$0.00	$0.00	$0.00	$0.00
30200095	EAP	CPT® 86225		"Ds-dna Ab,crithidia"	BOTH IP/OP	$291.00 	$215.34	$0.00	$242.40	$28.35	$28.35	$13.74	$13.74	$6.87	$6.87	$20.86	$20.86	$21.66	$13.74	$20.30	$8.93	$172.13	$172.13	$14.43	$38.40	$239.98	$242.40	$19.92	$0.00	$19.92	$21.63	$13.74	$13.74	$15.14	$13.74	$0.00	$0.00	$0.00	$0.00
30200096	EAP	CPT® 86225		"Ds-dna Ab,eia"	BOTH IP/OP	$325.00 	$240.50	$6.87	$262.40	$28.35	$28.35	$13.74	$13.74	$6.87	$6.87	$20.86	$20.86	$21.66	$13.74	$20.30	$8.93	$192.24	$192.24	$14.43	$38.40	$259.78	$262.40	$19.92	$22.67	$19.92	$21.63	$13.74	$13.74	$15.14	$13.74	$0.00	$0.00	$0.00	$0.00
30200097	EAP	CPT® 86235		"Jo-1 Ab Screen, Eia"	BOTH IP/OP	$344.00 	$254.56	$8.97	$265.60	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$203.48	$203.48	$18.83	$50.12	$262.94	$265.60	$26.00	$29.58	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30200098	EAP	CPT® 86235		"Scl-70 Ab Screen, Eia"	BOTH IP/OP	$344.00 	$254.56	$8.97	$265.60	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$203.48	$203.48	$18.83	$50.12	$262.94	$265.60	$26.00	$29.58	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30200099	EAP	CPT® 86235		Anticentromere Scrn	BOTH IP/OP	$344.00 	$254.56	$8.97	$265.60	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$203.48	$203.48	$18.83	$50.12	$262.94	$265.60	$26.00	$29.58	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30200100	EAP	CPT® 86235		Smith (sm) Ab Screen	BOTH IP/OP	$325.00 	$240.50	$8.97	$251.20	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$192.24	$192.24	$18.83	$50.12	$248.69	$251.20	$26.00	$29.58	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30200101	EAP	CPT® 86235		Rnp Ab Screen	BOTH IP/OP	$325.00 	$240.50	$8.97	$251.20	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$192.24	$192.24	$18.83	$50.12	$248.69	$251.20	$26.00	$29.58	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30200102	EAP	CPT® 86235		Ssa (ro) Ab Screen	BOTH IP/OP	$325.00 	$240.50	$8.97	$251.20	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$192.24	$192.24	$18.83	$50.12	$248.69	$251.20	$26.00	$29.58	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30200103	EAP	CPT® 86235		Ssb (la) Ab Screen	BOTH IP/OP	$325.00 	$240.50	$8.97	$251.20	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$192.24	$192.24	$18.83	$50.12	$248.69	$251.20	$26.00	$29.58	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30200104	EAP	CPT® 86255		Perinuclear Ab	BOTH IP/OP	$50.00 	$37.00	$0.00	$50.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$29.58	$29.58	$12.65	$33.68	$49.90	$50.40	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200105	EAP	CPT® 86255		Smooth Muscle Ab	BOTH IP/OP	$59.00 	$43.66	$6.03	$47.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$34.90	$34.90	$12.65	$33.68	$46.73	$47.20	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200106	EAP	CPT® 86255		Parietal Cell Ab	BOTH IP/OP	$59.00 	$43.66	$6.03	$47.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$34.90	$34.90	$12.65	$33.68	$46.73	$47.20	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200107	EAP	CPT® 86256		Adrenal Ab Screen	BOTH IP/OP	$88.00 	$65.12	$6.03	$70.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$52.05	$52.05	$12.65	$33.68	$69.70	$70.40	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200108	EAP	CPT® 86256		Basement Mem Ab Scrn	BOTH IP/OP	$88.00 	$65.12	$6.03	$70.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$52.05	$52.05	$12.65	$33.68	$69.70	$70.40	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200109	EAP	CPT® 86256		Rmsf Antibody Igg	BOTH IP/OP	$88.00 	$65.12	$6.03	$70.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$52.05	$52.05	$12.65	$33.68	$69.70	$70.40	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200110	EAP	CPT® 86256		Rmsf Antibody Igm	BOTH IP/OP	$88.00 	$65.12	$6.03	$70.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$52.05	$52.05	$12.65	$33.68	$69.70	$70.40	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200111	EAP	CPT® 86300		Cancer Antigen 15-3	BOTH IP/OP	$143.00 	$105.82	$10.41	$115.20	$42.95	$42.95	$20.81	$20.81	$10.41	$10.41	$31.60	$31.60	$32.81	$20.81	$30.73	$13.53	$84.58	$84.58	$21.85	$58.14	$114.05	$115.20	$30.17	$34.34	$30.17	$32.75	$20.81	$20.81	$22.92	$20.81	$0.00	$0.00	$0.00	$0.00
30200112	EAP	CPT® 86300		Cancer Ag 27-29	BOTH IP/OP	$143.00 	$105.82	$10.41	$115.20	$42.95	$42.95	$20.81	$20.81	$10.41	$10.41	$31.60	$31.60	$32.81	$20.81	$30.73	$13.53	$84.58	$84.58	$21.85	$58.14	$114.05	$115.20	$30.17	$34.34	$30.17	$32.75	$20.81	$20.81	$22.92	$20.81	$0.00	$0.00	$0.00	$0.00
30200113	EAP	CPT® 86301		Carbohydrate Ag 19-9	BOTH IP/OP	$206.00 	$152.44	$10.41	$166.40	$42.95	$42.95	$20.81	$20.81	$10.41	$10.41	$31.60	$31.60	$32.81	$20.81	$30.73	$13.53	$121.85	$121.85	$21.85	$58.14	$164.74	$166.40	$30.17	$34.34	$30.17	$32.75	$20.81	$20.81	$22.92	$20.81	$0.00	$0.00	$0.00	$0.00
30200114	EAP	CPT® 86308		Infect Mono Screen	BOTH IP/OP	$203.00 	$150.22	$2.59	$164.00	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$120.07	$120.07	$5.44	$14.46	$162.36	$164.00	$7.51	$8.55	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30200115	EAP	CPT® 86316		Cancer Antigen 125	BOTH IP/OP	$529.00 	$391.46	$10.41	$426.40	$42.95	$42.95	$20.81	$20.81	$10.41	$10.41	$31.60	$31.60	$32.81	$20.81	$30.73	$13.53	$312.90	$312.90	$21.85	$58.14	$422.14	$426.40	$30.17	$34.34	$30.17	$32.75	$20.81	$20.81	$22.92	$20.81	$0.00	$0.00	$0.00	$0.00
30200116	EAP	CPT® 86317		Diphtheria Ab	BOTH IP/OP	$248.00 	$183.52	$7.49	$180.00	$24.79	$24.79	$14.99	$14.99	$7.50	$7.49	$18.22	$18.22	$18.92	$14.99	$17.72	$9.74	$146.69	$146.69	$15.74	$33.54	$178.20	$180.00	$21.74	$24.73	$21.74	$18.89	$14.99	$14.99	$13.22	$14.99	$0.00	$0.00	$0.00	$0.00
30200117	EAP	CPT® 86317		Dnp Antibody	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$24.79	$24.79	$14.99	$14.99	$7.50	$7.49	$18.22	$18.22	$18.92	$14.99	$17.72	$9.74	$133.09	$133.09	$15.74	$33.54	$178.20	$180.00	$21.74	$0.00	$21.74	$18.89	$14.99	$14.99	$13.22	$14.99	$0.00	$0.00	$0.00	$0.00
30200118	EAP	CPT® 86329		Hypersens Pneumo Scr	BOTH IP/OP	$204.00 	$150.96	$0.00	$164.80	$28.99	$28.99	$14.05	$14.05	$7.03	$0.00	$21.33	$21.33	$22.15	$0.00	$20.75	$0.00	$0.00	$0.00	$14.75	$39.24	$163.15	$164.80	$20.37	$23.18	$20.37	$22.11	$14.05	$14.05	$15.48	$14.05	$0.00	$0.00	$0.00	$0.00
30200119	EAP	CPT® 86332		Immune Complex(c1q)	BOTH IP/OP	$116.00 	$85.84	$12.19	$93.60	$50.32	$50.32	$24.37	$24.37	$12.19	$12.19	$37.01	$37.01	$38.44	$24.37	$36.00	$15.84	$68.61	$68.61	$25.59	$68.10	$92.66	$93.60	$35.34	$40.21	$35.34	$38.36	$24.37	$24.37	$26.85	$24.37	$0.00	$0.00	$0.00	$0.00
30200120	EAP	CPT® 86334		"Immunofixation,ser"	BOTH IP/OP	$439.00 	$324.86	$11.17	$333.60	$46.12	$46.12	$22.34	$22.34	$11.17	$11.17	$33.92	$33.92	$35.23	$22.34	$33.00	$14.52	$259.67	$259.67	$23.46	$62.42	$330.26	$333.60	$32.39	$36.86	$32.39	$35.16	$22.34	$22.34	$24.61	$22.34	$0.00	$0.00	$0.00	$0.00
30200121	EAP	CPT® 86335		"Immunofixation,urine"	BOTH IP/OP	$462.00 	$341.88	$14.67	$351.20	$60.59	$60.59	$29.35	$29.35	$14.68	$14.67	$44.56	$44.56	$46.28	$29.35	$43.34	$19.08	$273.27	$273.27	$30.82	$82.00	$347.69	$351.20	$42.56	$48.43	$42.56	$46.18	$29.35	$29.35	$32.33	$29.35	$0.00	$0.00	$0.00	$0.00
30200122	EAP	CPT® 86336		Inhibin-a	BOTH IP/OP	$77.00 	$56.98	$0.00	$61.60	$26.74	$26.74	$15.59	$15.59	$7.80	$7.79	$19.66	$19.66	$20.41	$15.59	$19.12	$10.13	$45.55	$45.55	$16.37	$36.18	$60.98	$61.60	$22.61	$0.00	$22.61	$20.37	$15.59	$15.59	$14.26	$15.59	$0.00	$0.00	$0.00	$0.00
30200123	EAP	CPT® 86337		Insulin Auto Ab	BOTH IP/OP	$235.00 	$173.90	$0.00	$189.60	$44.19	$44.19	$21.41	$21.41	$10.71	$10.71	$32.52	$32.52	$33.77	$21.41	$31.64	$13.92	$139.00	$139.00	$22.48	$59.84	$187.70	$189.60	$31.04	$35.33	$31.04	$0.00	$21.41	$21.41	$23.60	$21.41	$0.00	$0.00	$0.00	$0.00
30200124	EAP	CPT® 86340		Intrinsic Factor Ab	BOTH IP/OP	$230.00 	$170.20	$7.54	$182.40	$31.13	$31.13	$15.08	$15.08	$7.54	$7.54	$22.89	$22.89	$23.77	$15.08	$22.26	$9.80	$136.05	$136.05	$15.83	$42.12	$180.58	$182.40	$21.87	$24.88	$21.87	$23.72	$15.08	$15.08	$16.60	$15.08	$0.00	$0.00	$0.00	$0.00
30200125	EAP	CPT® 86341		Pancreatic Islet Ab	BOTH IP/OP	$81.00 	$59.94	$10.61	$64.00	$40.84	$40.84	$23.57	$23.57	$11.79	$10.61	$30.05	$30.05	$31.20	$23.57	$29.24	$15.32	$47.91	$47.91	$24.75	$55.30	$63.36	$64.00	$34.18	$38.89	$34.18	$31.16	$23.57	$23.57	$21.81	$23.57	$0.00	$0.00	$0.00	$0.00
30200126	EAP	CPT® 86344		Phagocytic Charge	BOTH IP/OP	$517.00 	$382.58	$0.00	$431.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.13	$12.13	$12.59	$0.00	$11.79	$0.00	$0.00	$0.00	$0.00	$22.32	$413.42	$417.60	$0.00	$431.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200127	EAP	CPT® 86359		"Cd3, Total T%"	BOTH IP/OP	$230.00 	$170.20	$18.86	$185.60	$48.63	$48.63	$37.73	$37.73	$18.87	$18.86	$35.77	$35.77	$37.14	$37.73	$34.80	$24.52	$136.05	$136.05	$39.62	$65.82	$183.74	$185.60	$54.71	$62.25	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30200128	EAP	CPT® 86360		Lymph Subsets:cd4&cd8	BOTH IP/OP	$495.00 	$366.30	$23.49	$400.00	$96.99	$96.99	$46.98	$46.98	$23.49	$23.49	$71.34	$71.34	$74.09	$46.98	$69.42	$30.54	$292.79	$292.79	$49.33	$131.30	$396.00	$400.00	$68.12	$77.52	$68.12	$73.96	$46.98	$46.98	$51.77	$46.98	$0.00	$0.00	$0.00	$0.00
30200129	EAP	CPT® 86376		L-k Microsomal Ab	BOTH IP/OP	$295.00 	$218.30	$7.28	$238.40	$30.04	$30.04	$14.55	$14.55	$7.28	$7.28	$22.10	$22.10	$22.95	$14.55	$21.49	$9.46	$174.49	$174.49	$15.28	$40.66	$236.02	$238.40	$21.10	$24.01	$21.10	$22.90	$14.55	$14.55	$16.03	$14.55	$0.00	$0.00	$0.00	$0.00
30200130	EAP	CPT® 86376		Microsomal Ab	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$30.04	$30.04	$14.55	$14.55	$7.28	$7.28	$22.10	$22.10	$22.95	$14.55	$21.49	$9.46	$186.32	$186.32	$15.28	$40.66	$249.48	$252.00	$21.10	$0.00	$21.10	$22.90	$14.55	$14.55	$16.03	$14.55	$0.00	$0.00	$0.00	$0.00
30200131	EAP	CPT® 86403		Rapid Strep Test	BOTH IP/OP	$204.00 	$150.96	$5.19	$156.80	$21.04	$21.04	$11.54	$11.54	$5.77	$5.19	$15.48	$15.48	$16.07	$11.54	$11.75	$7.50	$120.67	$120.67	$12.12	$28.48	$155.23	$156.80	$16.73	$19.04	$16.73	$12.52	$11.54	$11.54	$8.76	$11.54	$0.00	$0.00	$0.00	$0.00
30200132	EAP	CPT® 86403		Crypto.antigen Scrn	BOTH IP/OP	$204.00 	$150.96	$5.19	$156.80	$21.04	$21.04	$11.54	$11.54	$5.77	$5.19	$15.48	$15.48	$16.07	$11.54	$11.75	$7.50	$120.67	$120.67	$12.12	$28.48	$155.23	$156.80	$16.73	$19.04	$16.73	$12.52	$11.54	$11.54	$8.76	$11.54	$0.00	$0.00	$0.00	$0.00
30200133	EAP	CPT® 86403		"Crypto.ag,csf-qual"	BOTH IP/OP	$204.00 	$150.96	$5.19	$156.80	$21.04	$21.04	$11.54	$11.54	$5.77	$5.19	$15.48	$15.48	$16.07	$11.54	$11.75	$7.50	$120.67	$120.67	$12.12	$28.48	$155.23	$156.80	$16.73	$19.04	$16.73	$12.52	$11.54	$11.54	$8.76	$11.54	$0.00	$0.00	$0.00	$0.00
30200134	EAP	CPT® 86403		"H.flu Ag,urine"	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$21.04	$21.04	$11.54	$11.54	$5.77	$5.19	$15.48	$15.48	$16.07	$11.54	$11.75	$7.50	$115.93	$115.93	$12.12	$28.48	$155.23	$156.80	$16.73	$0.00	$16.73	$12.52	$11.54	$11.54	$8.76	$11.54	$0.00	$0.00	$0.00	$0.00
30200135	EAP	CPT® 86403		"N.mening Ag,urine"	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$21.04	$21.04	$11.54	$11.54	$5.77	$5.19	$15.48	$15.48	$16.07	$11.54	$11.75	$7.50	$115.93	$115.93	$12.12	$28.48	$155.23	$156.80	$16.73	$0.00	$16.73	$12.52	$11.54	$11.54	$8.76	$11.54	$0.00	$0.00	$0.00	$0.00
30200136	EAP	CPT® 86403		"St.pneumo Ag,urine"	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$21.04	$21.04	$11.54	$11.54	$5.77	$5.19	$15.48	$15.48	$16.07	$11.54	$11.75	$7.50	$115.93	$115.93	$12.12	$28.48	$155.23	$156.80	$16.73	$0.00	$16.73	$12.52	$11.54	$11.54	$8.76	$11.54	$0.00	$0.00	$0.00	$0.00
30200137	EAP	CPT® 86403		"Strep-b Ag,urine"	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$21.04	$21.04	$11.54	$11.54	$5.77	$5.19	$15.48	$15.48	$16.07	$11.54	$11.75	$7.50	$115.93	$115.93	$12.12	$28.48	$155.23	$156.80	$16.73	$0.00	$16.73	$12.52	$11.54	$11.54	$8.76	$11.54	$0.00	$0.00	$0.00	$0.00
30200138	EAP	CPT® 86406		"Crypto.ag,csf-quant"	BOTH IP/OP	$244.00 	$180.56	$0.00	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$5.32	$16.15	$16.15	$16.77	$10.64	$15.72	$6.92	$144.33	$144.33	$11.17	$29.74	$187.70	$189.60	$15.43	$189.00	$15.43	$16.75	$10.64	$10.64	$11.72	$10.64	$0.00	$0.00	$0.00	$0.00
30200139	EAP	CPT® 86406		"Crypto.ag,bld-quant"	BOTH IP/OP	$244.00 	$180.56	$0.00	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$5.32	$16.15	$16.15	$16.77	$10.64	$15.72	$6.92	$144.33	$144.33	$11.17	$29.74	$187.70	$189.60	$15.43	$189.00	$15.43	$16.75	$10.64	$10.64	$11.72	$10.64	$0.00	$0.00	$0.00	$0.00
30200140	EAP	CPT® 86431		"Rheumatoid Factor, Bld"	BOTH IP/OP	$183.00 	$135.42	$2.84	$132.80	$11.70	$11.70	$5.67	$5.67	$2.84	$2.84	$8.62	$8.62	$8.95	$5.67	$8.39	$3.69	$108.24	$108.24	$5.95	$15.86	$131.47	$132.80	$8.22	$9.36	$8.22	$8.94	$5.67	$5.67	$6.26	$5.67	$0.00	$0.00	$0.00	$0.00
30200141	EAP	CPT® 86431		"Rheumatoid Factor, Syn Fld"	BOTH IP/OP	$183.00 	$135.42	$2.84	$132.80	$11.70	$11.70	$5.67	$5.67	$2.84	$2.84	$8.62	$8.62	$8.95	$5.67	$8.39	$3.69	$108.24	$108.24	$5.95	$15.86	$131.47	$132.80	$8.22	$9.36	$8.22	$8.94	$5.67	$5.67	$6.26	$5.67	$0.00	$0.00	$0.00	$0.00
30200145	EAP	CPT® 86357		Natural Killer Cellls So	BOTH IP/OP	$85.00 	$62.90	$0.00	$85.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$68.11	$68.80	$54.71	$85.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30200146	EAP	CPT® 86341		Ia-2 Ab (so)	BOTH IP/OP	$193.00 	$142.82	$0.00	$154.40	$40.84	$40.84	$23.57	$23.57	$11.79	$10.61	$30.05	$30.05	$31.20	$23.57	$29.24	$15.32	$114.16	$114.16	$24.75	$55.30	$152.86	$154.40	$34.18	$0.00	$34.18	$31.16	$23.57	$23.57	$21.81	$23.57	$0.00	$0.00	$0.00	$0.00
30200147	EAP	CPT® 86355		Lymph Subset B Cell Tot (so)	BOTH IP/OP	$206.00 	$152.44	$0.00	$171.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$169.49	$171.20	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30200148	EAP	CPT® 86357		Lymph Subset Nk Cell Tot (so)	BOTH IP/OP	$196.00 	$145.04	$0.00	$163.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$161.57	$163.20	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30200149	EAP	CPT® 86580		"PPD, TB SKIN"	BOTH IP/OP	$89.00 	$65.86	$3.89	$72.00	$12.43	$12.43	$24.06	$24.06	$24.19	$3.89	$7.48	$7.48	$7.77	$23.64	$9.56	$15.37	$52.64	$52.64	$23.06	$20.46	$71.28	$72.00	$32.04	$57.85	$32.04	$10.18	$9.36	$9.36	$7.13	$21.96	$0.00	$0.00	$0.00	$0.00
30200150	EAP	CPT® 86780		Fta - Abs	BOTH IP/OP	$215.00 	$159.10	$6.62	$156.80	$27.32	$27.32	$13.24	$13.24	$6.62	$6.62	$19.73	$19.73	$20.49	$13.24	$44.81	$8.61	$127.17	$127.17	$13.90	$98.00	$155.23	$156.80	$19.20	$21.85	$19.20	$30.67	$13.24	$13.24	$31.20	$13.24	$0.00	$0.00	$0.00	$0.00
30200157	EAP	CPT® 86592		Rpr (qual)	BOTH IP/OP	$153.00 	$113.22	$2.14	$111.20	$8.82	$8.82	$4.27	$4.27	$2.14	$2.14	$6.48	$6.48	$6.73	$4.27	$5.46	$2.78	$90.50	$90.50	$4.48	$11.92	$110.09	$111.20	$6.19	$7.05	$6.19	$5.82	$4.27	$4.27	$4.07	$4.27	$0.00	$0.00	$0.00	$0.00
30200158	EAP	CPT® 86592		"Rpr(qual),capillary"	BOTH IP/OP	$139.00 	$102.86	$0.00	$111.20	$8.82	$8.82	$4.27	$4.27	$2.14	$2.14	$6.48	$6.48	$6.73	$4.27	$5.46	$2.78	$82.22	$82.22	$4.48	$11.92	$110.09	$111.20	$6.19	$0.00	$6.19	$5.82	$4.27	$4.27	$4.07	$4.27	$0.00	$0.00	$0.00	$0.00
30200159	EAP	CPT® 86592		"Vdrl,csf"	BOTH IP/OP	$153.00 	$113.22	$2.14	$111.20	$8.82	$8.82	$4.27	$4.27	$2.14	$2.14	$6.48	$6.48	$6.73	$4.27	$5.46	$2.78	$90.50	$90.50	$4.48	$11.92	$110.09	$111.20	$6.19	$7.05	$6.19	$5.82	$4.27	$4.27	$4.07	$4.27	$0.00	$0.00	$0.00	$0.00
30200160	EAP	CPT® 86593		"Vdrl-csf,quant"	BOTH IP/OP	$153.00 	$113.22	$2.20	$111.20	$9.08	$9.08	$4.40	$4.40	$2.20	$2.20	$6.69	$6.69	$6.94	$4.40	$31.89	$2.86	$90.50	$90.50	$4.62	$12.32	$110.09	$111.20	$6.38	$7.26	$6.38	$21.75	$4.40	$4.40	$22.13	$4.40	$0.00	$0.00	$0.00	$0.00
30200161	EAP	CPT® 86593		Rpr (quant)	BOTH IP/OP	$153.00 	$113.22	$2.20	$111.20	$9.08	$9.08	$4.40	$4.40	$2.20	$2.20	$6.69	$6.69	$6.94	$4.40	$31.89	$2.86	$90.50	$90.50	$4.62	$12.32	$110.09	$111.20	$6.38	$7.26	$6.38	$21.75	$4.40	$4.40	$22.13	$4.40	$0.00	$0.00	$0.00	$0.00
30200162	EAP	CPT® 86606		Aspergillus Fumigatus	BOTH IP/OP	$47.00 	$34.78	$7.53	$42.06	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$27.80	$27.80	$15.80	$42.06	$37.22	$37.60	$21.82	$24.83	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30200163	EAP	CPT® 86611		B.henselae Igg	BOTH IP/OP	$80.00 	$59.20	$5.09	$63.20	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$47.32	$47.32	$10.69	$28.44	$62.57	$63.20	$14.76	$16.80	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30200164	EAP	CPT® 86611		B.henselae Igm	BOTH IP/OP	$80.00 	$59.20	$5.09	$63.20	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$47.32	$47.32	$10.69	$28.44	$62.57	$63.20	$14.76	$16.80	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30200165	EAP	CPT® 86611		B.quintana Igg	BOTH IP/OP	$80.00 	$59.20	$5.09	$63.20	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$47.32	$47.32	$10.69	$28.44	$62.57	$63.20	$14.76	$16.80	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30200166	EAP	CPT® 86611		B.quintana Igm	BOTH IP/OP	$80.00 	$59.20	$5.09	$63.20	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$47.32	$47.32	$10.69	$28.44	$62.57	$63.20	$14.76	$16.80	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30200167	EAP	CPT® 86617		Lyme Ab Westernblot	BOTH IP/OP	$103.00 	$76.22	$0.00	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.51	$23.51	$24.42	$0.00	$22.88	$0.00	$0.00	$0.00	$0.00	$43.28	$81.58	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200168	EAP	CPT® 86618		Lyme Ab Total	BOTH IP/OP	$357.00 	$264.18	$8.51	$288.80	$35.16	$35.16	$17.03	$17.03	$8.52	$8.51	$25.86	$25.86	$26.86	$17.03	$25.16	$11.07	$211.17	$211.17	$17.88	$47.60	$285.91	$288.80	$24.69	$28.10	$24.69	$26.81	$17.03	$17.03	$18.76	$17.03	$0.00	$0.00	$0.00	$0.00
30200169	EAP	CPT® 86618		Lyme Ab-igm	BOTH IP/OP	$361.00 	$267.14	$8.51	$288.80	$35.16	$35.16	$17.03	$17.03	$8.52	$8.51	$25.86	$25.86	$26.86	$17.03	$25.16	$11.07	$213.53	$213.53	$17.88	$47.60	$285.91	$288.80	$24.69	$28.10	$24.69	$26.81	$17.03	$17.03	$18.76	$17.03	$0.00	$0.00	$0.00	$0.00
30200170	EAP	CPT® 86622		B. Abortus Igg	BOTH IP/OP	$131.00 	$96.94	$0.00	$131.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.57	$13.57	$14.09	$0.00	$13.19	$0.00	$0.00	$0.00	$9.38	$24.96	$104.54	$105.60	$12.95	$131.00	$12.95	$14.05	$8.93	$8.93	$9.84	$8.93	$0.00	$0.00	$0.00	$0.00
30200171	EAP	CPT® 86622		B. Abortus Igm	BOTH IP/OP	$131.00 	$96.94	$0.00	$131.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.57	$13.57	$14.09	$0.00	$13.19	$0.00	$0.00	$0.00	$9.38	$24.96	$104.54	$105.60	$12.95	$131.00	$12.95	$14.05	$8.93	$8.93	$9.84	$8.93	$0.00	$0.00	$0.00	$0.00
30200172	EAP	CPT® 86631		Chlam Pnuemo Igg	BOTH IP/OP	$135.00 	$99.90	$0.00	$135.00	$24.42	$24.42	$11.82	$11.82	$5.91	$5.91	$17.96	$17.96	$18.65	$11.82	$17.47	$7.68	$79.85	$79.85	$0.00	$33.04	$97.42	$98.40	$0.00	$135.00	$0.00	$18.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200173	EAP	CPT® 86631		Chlam Pnuemo Iga	BOTH IP/OP	$135.00 	$99.90	$0.00	$135.00	$24.42	$24.42	$11.82	$11.82	$5.91	$5.91	$17.96	$17.96	$18.65	$11.82	$17.47	$7.68	$79.85	$79.85	$0.00	$33.04	$97.42	$98.40	$0.00	$135.00	$0.00	$18.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200174	EAP	CPT® 86631		Chlam Trach Igg	BOTH IP/OP	$135.00 	$99.90	$0.00	$135.00	$24.42	$24.42	$11.82	$11.82	$5.91	$5.91	$17.96	$17.96	$18.65	$11.82	$17.47	$7.68	$79.85	$79.85	$0.00	$33.04	$97.42	$98.40	$0.00	$135.00	$0.00	$18.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200175	EAP	CPT® 86631		Chlam Trach Iga	BOTH IP/OP	$135.00 	$99.90	$0.00	$135.00	$24.42	$24.42	$11.82	$11.82	$5.91	$5.91	$17.96	$17.96	$18.65	$11.82	$17.47	$7.68	$79.85	$79.85	$0.00	$33.04	$97.42	$98.40	$0.00	$135.00	$0.00	$18.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200176	EAP	CPT® 86631		Chlam Psittaci Icg	BOTH IP/OP	$135.00 	$99.90	$0.00	$135.00	$24.42	$24.42	$11.82	$11.82	$5.91	$5.91	$17.96	$17.96	$18.65	$11.82	$17.47	$7.68	$79.85	$79.85	$0.00	$33.04	$97.42	$98.40	$0.00	$135.00	$0.00	$18.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200177	EAP	CPT® 86631		Chlam Psittaci Iga	BOTH IP/OP	$135.00 	$99.90	$0.00	$135.00	$24.42	$24.42	$11.82	$11.82	$5.91	$5.91	$17.96	$17.96	$18.65	$11.82	$17.47	$7.68	$79.85	$79.85	$0.00	$33.04	$97.42	$98.40	$0.00	$135.00	$0.00	$18.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200178	EAP	CPT® 86632		Chlam Pnuemo Igm	BOTH IP/OP	$143.00 	$105.82	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.27	$19.27	$20.01	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$35.48	$102.96	$104.00	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200179	EAP	CPT® 86632		Chlam Trach Igm	BOTH IP/OP	$143.00 	$105.82	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.27	$19.27	$20.01	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$35.48	$102.96	$104.00	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200180	EAP	CPT® 86638		"Q Fever Igg, Acute"	BOTH IP/OP	$250.00 	$185.00	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.41	$18.41	$19.12	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$33.88	$200.38	$202.40	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200181	EAP	CPT® 86638		"Q Fever Igg, Conval."	BOTH IP/OP	$250.00 	$185.00	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.41	$18.41	$19.12	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$33.88	$200.38	$202.40	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200182	EAP	CPT® 86644		Cmv Igg	BOTH IP/OP	$209.00 	$154.66	$7.20	$152.00	$24.02	$24.02	$14.39	$14.39	$7.20	$7.20	$17.67	$17.67	$18.35	$14.39	$17.19	$9.35	$123.62	$123.62	$15.11	$32.52	$150.48	$152.00	$20.87	$23.74	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200183	EAP	CPT® 86644		Cmv Igg Ab-eia	BOTH IP/OP	$222.00 	$164.28	$7.20	$161.60	$24.02	$24.02	$14.39	$14.39	$7.20	$7.20	$17.67	$17.67	$18.35	$14.39	$17.19	$9.35	$131.31	$131.31	$15.11	$32.52	$159.98	$161.60	$20.87	$23.74	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200184	EAP	CPT® 86645		Cmv Igm	BOTH IP/OP	$141.00 	$104.34	$8.42	$102.40	$34.77	$34.77	$16.85	$16.85	$8.43	$8.42	$25.58	$25.58	$26.57	$16.85	$24.90	$10.95	$83.40	$83.40	$17.69	$47.08	$101.38	$102.40	$24.43	$27.80	$24.43	$26.53	$16.85	$16.85	$18.57	$16.85	$0.00	$0.00	$0.00	$0.00
30200185	EAP	CPT® 86645		Cmv Igm Ab-eia	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$34.77	$34.77	$16.85	$16.85	$8.43	$8.42	$25.58	$25.58	$26.57	$16.85	$24.90	$10.95	$81.63	$81.63	$17.69	$47.08	$109.30	$110.40	$24.43	$0.00	$24.43	$26.53	$16.85	$16.85	$18.57	$16.85	$0.00	$0.00	$0.00	$0.00
30200186	EAP	CPT® 86651		"Encep, California, Csf, Igg"	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$99.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200187	EAP	CPT® 86651		"Encep, California, Csf, Igm"	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$99.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200188	EAP	CPT® 86651		Calfornia Equine Igm	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$93.46	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200189	EAP	CPT® 86651		Calif. Equine Encephalitis	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$93.46	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200190	EAP	CPT® 86652		"Encep, E. Equine, Csf,igg"	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$99.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200191	EAP	CPT® 86652		"Encep, E. Equine, Csf,igm"	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$99.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200192	EAP	CPT® 86652		Eastern Equine Igm	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$93.46	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200193	EAP	CPT® 86652		Eastern Equine Encephalitis	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$93.46	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200194	EAP	CPT® 86653		"Encep,st. Louis, Csf Igg"	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$99.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200195	EAP	CPT® 86653		"Encep,st. Louis, Csf Igm"	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$99.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200196	EAP	CPT® 86653		St. Louis Equine Igm	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$93.46	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200197	EAP	CPT® 86653		St. Louis Equine Encephalitis	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$93.46	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200198	EAP	CPT® 86654		"Encep, W. Equine, Csf,igg"	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$99.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200199	EAP	CPT® 86654		"Encep, W. Equine, Csf,igm"	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$99.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200200	EAP	CPT® 86654		Western Equine Igm	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$93.46	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200201	EAP	CPT® 86654		Western Equine Encephalitis	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$93.46	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200202	EAP	CPT® 86658		Coxsackie B1 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200203	EAP	CPT® 86658		Coxsackie B2 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200204	EAP	CPT® 86658		Coxsackie B3 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200205	EAP	CPT® 86658		Coxsackie B4 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200206	EAP	CPT® 86658		Coxsackie B5 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200207	EAP	CPT® 86658		Coxsackie B6 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200208	EAP	CPT® 86658		Echovirus 4 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200209	EAP	CPT® 86658		Echovirus 9 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200210	EAP	CPT® 86658		Echovirus 11 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200211	EAP	CPT® 86658		Coxsackie A2 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200212	EAP	CPT® 86658		Coxsackie A4 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200213	EAP	CPT® 86658		Coxsackie A10 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200214	EAP	CPT® 86658		Coxsackie A16 Titer	BOTH IP/OP	$112.00 	$82.88	$6.51	$112.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$66.25	$66.25	$13.68	$36.40	$89.50	$90.40	$18.89	$112.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200215	EAP	CPT® 86664		Ebv Nuclear Ab	BOTH IP/OP	$204.00 	$150.96	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.65	$23.23	$23.23	$24.13	$15.29	$22.61	$9.94	$120.67	$120.67	$16.05	$42.76	$163.15	$164.80	$22.17	$204.00	$22.17	$24.09	$15.29	$15.29	$16.86	$15.29	$0.00	$0.00	$0.00	$0.00
30200216	EAP	CPT® 86665		Ebv Capsid Igg Ab	BOTH IP/OP	$229.00 	$169.46	$0.00	$229.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.07	$27.54	$27.54	$28.60	$18.14	$26.81	$11.79	$135.45	$135.45	$19.05	$50.70	$182.95	$184.80	$26.30	$229.00	$26.30	$28.56	$18.14	$18.14	$19.99	$18.14	$0.00	$0.00	$0.00	$0.00
30200217	EAP	CPT® 86665		Ebv Capsid Igm Ab	BOTH IP/OP	$229.00 	$169.46	$0.00	$229.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.07	$27.54	$27.54	$28.60	$18.14	$26.81	$11.79	$135.45	$135.45	$19.05	$50.70	$182.95	$184.80	$26.30	$229.00	$26.30	$28.56	$18.14	$18.14	$19.99	$18.14	$0.00	$0.00	$0.00	$0.00
30200218	EAP	CPT® 86666		Ehrlichia Igg	BOTH IP/OP	$155.00 	$114.70	$0.00	$155.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.44	$15.44	$16.04	$0.00	$15.04	$0.00	$0.00	$0.00	$0.00	$28.44	$124.34	$125.60	$0.00	$155.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200219	EAP	CPT® 86666		Ehrlichia Igm	BOTH IP/OP	$155.00 	$114.70	$0.00	$155.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.44	$15.44	$16.04	$0.00	$15.04	$0.00	$0.00	$0.00	$0.00	$28.44	$124.34	$125.60	$0.00	$155.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200220	EAP	CPT® 86668		Tularemia Antibody	BOTH IP/OP	$72.00 	$53.28	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.79	$15.79	$16.39	$0.00	$15.36	$0.00	$0.00	$0.00	$0.00	$29.06	$57.02	$57.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200221	EAP	CPT® 86671		S.cerevisiae Igg	BOTH IP/OP	$139.00 	$102.86	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$18.62	$19.33	$0.00	$18.11	$0.00	$0.00	$0.00	$12.86	$34.26	$110.09	$111.20	$17.76	$124.00	$17.76	$19.30	$12.25	$12.25	$13.51	$12.25	$0.00	$0.00	$0.00	$0.00
30200222	EAP	CPT® 86671		S.cerevisiae Iga	BOTH IP/OP	$139.00 	$102.86	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$18.62	$19.33	$0.00	$18.11	$0.00	$0.00	$0.00	$12.86	$34.26	$110.09	$111.20	$17.76	$124.00	$17.76	$19.30	$12.25	$12.25	$13.51	$12.25	$0.00	$0.00	$0.00	$0.00
30200223	EAP	CPT® 86671		Sporothrix Igg	BOTH IP/OP	$139.00 	$102.86	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$18.62	$19.33	$0.00	$18.11	$0.00	$0.00	$0.00	$12.86	$34.26	$110.09	$111.20	$17.76	$124.00	$17.76	$19.30	$12.25	$12.25	$13.51	$12.25	$0.00	$0.00	$0.00	$0.00
30200224	EAP	CPT® 86671		Sporothrix Igm	BOTH IP/OP	$139.00 	$102.86	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$18.62	$19.33	$0.00	$18.11	$0.00	$0.00	$0.00	$12.86	$34.26	$110.09	$111.20	$17.76	$124.00	$17.76	$19.30	$12.25	$12.25	$13.51	$12.25	$0.00	$0.00	$0.00	$0.00
30200225	EAP	CPT® 86671		Sporothrix Iga	BOTH IP/OP	$139.00 	$102.86	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$18.62	$19.33	$0.00	$18.11	$0.00	$0.00	$0.00	$12.86	$34.26	$110.09	$111.20	$17.76	$124.00	$17.76	$19.30	$12.25	$12.25	$13.51	$12.25	$0.00	$0.00	$0.00	$0.00
30200226	EAP	CPT® 86677		H. Pylori Igg	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$29.94	$29.94	$16.85	$16.85	$8.43	$7.58	$22.04	$22.04	$22.89	$16.85	$21.44	$10.95	$122.44	$122.44	$17.69	$40.56	$163.94	$165.60	$24.43	$0.00	$24.43	$22.85	$16.85	$16.85	$15.99	$16.85	$0.00	$0.00	$0.00	$0.00
30200227	EAP	CPT® 86677		H.pylori Iga	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$29.94	$29.94	$16.85	$16.85	$8.43	$7.58	$22.04	$22.04	$22.89	$16.85	$21.44	$10.95	$122.44	$122.44	$17.69	$40.56	$163.94	$165.60	$24.43	$0.00	$24.43	$22.85	$16.85	$16.85	$15.99	$16.85	$0.00	$0.00	$0.00	$0.00
30200228	EAP	CPT® 86677		H.pylori Igg Ab-eia	BOTH IP/OP	$220.00 	$162.80	$7.58	$177.60	$29.94	$29.94	$16.85	$16.85	$8.43	$7.58	$22.04	$22.04	$22.89	$16.85	$21.44	$10.95	$130.13	$130.13	$17.69	$40.56	$175.82	$177.60	$24.43	$27.80	$24.43	$22.85	$16.85	$16.85	$15.99	$16.85	$0.00	$0.00	$0.00	$0.00
30200229	EAP	CPT® 86682		Cysticercus Igg	BOTH IP/OP	$127.00 	$93.98	$6.50	$102.40	$26.85	$26.85	$13.01	$13.01	$6.51	$6.50	$19.75	$19.75	$20.51	$13.01	$19.20	$8.46	$75.12	$75.12	$13.66	$36.34	$101.38	$102.40	$18.86	$21.47	$18.86	$20.46	$13.01	$13.01	$14.32	$13.01	$0.00	$0.00	$0.00	$0.00
30200230	EAP	CPT® 86682		Echinococcus Igg	BOTH IP/OP	$127.00 	$93.98	$6.50	$102.40	$26.85	$26.85	$13.01	$13.01	$6.51	$6.50	$19.75	$19.75	$20.51	$13.01	$19.20	$8.46	$75.12	$75.12	$13.66	$36.34	$101.38	$102.40	$18.86	$21.47	$18.86	$20.46	$13.01	$13.01	$14.32	$13.01	$0.00	$0.00	$0.00	$0.00
30200231	EAP	CPT® 86682		Filaria Ab	BOTH IP/OP	$127.00 	$93.98	$6.50	$102.40	$26.85	$26.85	$13.01	$13.01	$6.51	$6.50	$19.75	$19.75	$20.51	$13.01	$19.20	$8.46	$75.12	$75.12	$13.66	$36.34	$101.38	$102.40	$18.86	$21.47	$18.86	$20.46	$13.01	$13.01	$14.32	$13.01	$0.00	$0.00	$0.00	$0.00
30200232	EAP	CPT® 86682		Strongyloides Igg	BOTH IP/OP	$127.00 	$93.98	$6.50	$102.40	$26.85	$26.85	$13.01	$13.01	$6.51	$6.50	$19.75	$19.75	$20.51	$13.01	$19.20	$8.46	$75.12	$75.12	$13.66	$36.34	$101.38	$102.40	$18.86	$21.47	$18.86	$20.46	$13.01	$13.01	$14.32	$13.01	$0.00	$0.00	$0.00	$0.00
30200233	EAP	CPT® 86682		Schistosoma Igg	BOTH IP/OP	$127.00 	$93.98	$6.50	$102.40	$26.85	$26.85	$13.01	$13.01	$6.51	$6.50	$19.75	$19.75	$20.51	$13.01	$19.20	$8.46	$75.12	$75.12	$13.66	$36.34	$101.38	$102.40	$18.86	$21.47	$18.86	$20.46	$13.01	$13.01	$14.32	$13.01	$0.00	$0.00	$0.00	$0.00
30200235	EAP	CPT® 86689		Hiv-ab Western Blot	BOTH IP/OP	$388.00 	$287.12	$0.00	$320.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.39	$29.39	$30.52	$0.00	$24.81	$0.00	$0.00	$0.00	$0.00	$54.10	$317.59	$320.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200236	EAP	CPT® 86692		Hepatitis Delta Ab	BOTH IP/OP	$196.00 	$145.04	$0.00	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.58	$26.06	$26.06	$27.06	$17.16	$25.35	$11.15	$115.93	$115.93	$18.02	$47.96	$156.82	$158.40	$24.88	$196.00	$24.88	$27.01	$17.16	$17.16	$18.91	$17.16	$0.00	$0.00	$0.00	$0.00
30200237	EAP	CPT® 86694		Hsv 1/2 Igm	BOTH IP/OP	$185.00 	$136.90	$0.00	$185.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.67	$17.67	$18.35	$0.00	$17.19	$0.00	$0.00	$0.00	$15.11	$32.52	$142.56	$144.00	$20.87	$185.00	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200238	EAP	CPT® 86694		Hsv Igm Ab Titer	BOTH IP/OP	$187.00 	$138.38	$0.00	$154.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.67	$17.67	$18.35	$0.00	$17.19	$0.00	$0.00	$0.00	$15.11	$32.52	$152.86	$154.40	$20.87	$0.00	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200239	EAP	CPT® 86694		"Hsv2 Igg/igm Ab,csf"	BOTH IP/OP	$174.00 	$128.76	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.67	$17.67	$18.35	$0.00	$17.19	$0.00	$0.00	$0.00	$15.11	$32.52	$142.56	$144.00	$20.87	$0.00	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200240	EAP	CPT® 86694		"Hsv-2 Igm Ab,csf"	BOTH IP/OP	$174.00 	$128.76	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.67	$17.67	$18.35	$0.00	$17.19	$0.00	$0.00	$0.00	$15.11	$32.52	$142.56	$144.00	$20.87	$0.00	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200241	EAP	CPT® 86694		Hsv Igg	BOTH IP/OP	$174.00 	$128.76	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.67	$17.67	$18.35	$0.00	$17.19	$0.00	$0.00	$0.00	$15.11	$32.52	$142.56	$144.00	$20.87	$0.00	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200244	EAP	CPT® 86695		HSV-I IGG	BOTH IP/OP	$133.00 	$98.42	$6.59	$103.20	$27.22	$27.22	$13.19	$13.19	$6.60	$6.59	$20.02	$20.02	$20.79	$13.19	$19.49	$8.57	$78.67	$78.67	$13.85	$36.86	$102.17	$103.20	$19.13	$21.76	$19.13	$20.76	$13.19	$13.19	$14.54	$13.19	$0.00	$0.00	$0.00	$0.00
30200245	EAP	CPT® 86696		HSV - II IGG	BOTH IP/OP	$145.00 	$107.30	$9.68	$112.80	$39.94	$39.94	$19.35	$19.35	$9.68	$9.68	$29.39	$29.39	$30.52	$19.35	$28.60	$12.58	$85.77	$85.77	$20.32	$54.10	$111.67	$112.80	$28.06	$31.93	$28.06	$30.48	$19.35	$19.35	$21.33	$19.35	$0.00	$0.00	$0.00	$0.00
30200246	EAP	CPT® 86698		Histoplasma Ab (s)	BOTH IP/OP	$74.00 	$54.76	$0.00	$74.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$18.98	$18.98	$19.71	$13.79	$18.46	$8.96	$43.77	$43.77	$14.48	$34.92	$59.40	$60.00	$20.00	$74.00	$20.00	$19.67	$13.79	$13.79	$13.77	$13.79	$0.00	$0.00	$0.00	$0.00
30200247	EAP	CPT® 86703		Hiv-1/2	BOTH IP/OP	$255.00 	$188.70	$0.00	$213.60	$28.30	$28.30	$13.71	$13.71	$6.86	$6.85	$20.82	$20.82	$21.62	$13.71	$17.58	$8.91	$150.83	$150.83	$14.40	$38.34	$211.46	$213.60	$19.88	$0.00	$19.88	$18.73	$13.71	$13.71	$13.11	$13.71	$0.00	$0.00	$0.00	$0.00
30200248	EAP	CPT® 86704		Hbv Core Ab	BOTH IP/OP	$285.00 	$210.90	$6.03	$229.60	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$168.58	$168.58	$12.65	$33.68	$227.30	$229.60	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200249	EAP	CPT® 86705		Hepatitis-b Core M	BOTH IP/OP	$285.00 	$210.90	$5.89	$229.60	$24.31	$24.31	$11.77	$11.77	$5.89	$5.89	$17.87	$17.87	$18.55	$11.77	$17.39	$7.65	$168.58	$168.58	$12.36	$32.88	$227.30	$229.60	$17.07	$19.42	$17.07	$18.53	$11.77	$11.77	$12.97	$11.77	$0.00	$0.00	$0.00	$0.00
30200250	EAP	CPT® 86706		Hbv Surface Ab	BOTH IP/OP	$257.00 	$190.18	$5.37	$207.20	$22.18	$22.18	$10.74	$10.74	$5.37	$5.37	$16.31	$16.31	$16.93	$10.74	$15.87	$6.98	$152.02	$152.02	$11.28	$30.02	$205.13	$207.20	$15.57	$17.72	$15.57	$16.91	$10.74	$10.74	$11.83	$10.74	$0.00	$0.00	$0.00	$0.00
30200251	EAP	CPT® 86707		Hbv E Ab	BOTH IP/OP	$134.00 	$99.16	$5.78	$108.00	$23.89	$23.89	$11.57	$11.57	$5.79	$5.78	$17.57	$17.57	$18.24	$11.57	$17.08	$7.52	$79.26	$79.26	$12.15	$32.32	$106.92	$108.00	$16.78	$19.09	$16.78	$18.20	$11.57	$11.57	$12.74	$11.57	$0.00	$0.00	$0.00	$0.00
30200252	EAP	CPT® 86708		"Hav Ab, Total"	BOTH IP/OP	$291.00 	$215.34	$0.00	$243.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.81	$18.81	$19.54	$0.00	$18.30	$0.00	$0.00	$0.00	$0.00	$34.62	$240.77	$243.20	$0.00	$202.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200253	EAP	CPT® 86709		Hav Igm Ab	BOTH IP/OP	$275.00 	$203.50	$5.63	$221.60	$23.23	$23.23	$11.26	$11.26	$5.63	$5.63	$17.10	$17.10	$17.76	$11.26	$16.63	$7.32	$162.66	$162.66	$11.82	$31.46	$219.38	$221.60	$16.33	$18.58	$16.33	$17.72	$11.26	$11.26	$12.41	$11.26	$0.00	$0.00	$0.00	$0.00
30200254	EAP	CPT® 86713		L. Pneumoph. Ab - Total	BOTH IP/OP	$146.00 	$108.04	$0.00	$146.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.24	$23.24	$24.14	$0.00	$22.62	$0.00	$0.00	$0.00	$0.00	$42.78	$116.42	$117.60	$0.00	$146.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200255	EAP	CPT® 86720		Leptospirosis Ab	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$27.22	$27.22	$16.20	$16.20	$8.10	$7.29	$20.02	$20.02	$20.79	$16.20	$19.49	$10.53	$47.32	$47.32	$17.01	$36.86	$63.36	$64.00	$23.49	$0.00	$23.49	$0.00	$16.20	$16.20	$14.54	$16.20	$0.00	$0.00	$0.00	$0.00
30200256	EAP	CPT® 86631		Lgv Antibody Screen	BOTH IP/OP	$212.00 	$156.88	$0.00	$207.00	$24.42	$24.42	$11.82	$11.82	$5.91	$5.91	$17.96	$17.96	$18.65	$11.82	$17.47	$7.68	$125.40	$125.40	$0.00	$33.04	$152.86	$154.40	$0.00	$207.00	$0.00	$18.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200257	EAP	CPT® 86738		Mycoplasma Igg	BOTH IP/OP	$99.00 	$73.26	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.62	$20.11	$20.11	$20.89	$13.24	$19.57	$8.61	$58.56	$58.56	$13.90	$37.02	$76.03	$76.80	$19.20	$99.00	$19.20	$20.85	$13.24	$13.24	$14.60	$13.24	$0.00	$0.00	$0.00	$0.00
30200258	EAP	CPT® 86738		Mycoplasma Igm	BOTH IP/OP	$99.00 	$73.26	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.62	$20.11	$20.11	$20.89	$13.24	$19.57	$8.61	$58.56	$58.56	$13.90	$37.02	$76.03	$76.80	$19.20	$99.00	$19.20	$20.85	$13.24	$13.24	$14.60	$13.24	$0.00	$0.00	$0.00	$0.00
30200259	EAP	CPT® 86747		Parvovirus Igg	BOTH IP/OP	$124.00 	$91.76	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.83	$22.83	$23.71	$0.00	$22.21	$0.00	$0.00	$0.00	$15.78	$42.00	$99.00	$100.00	$21.79	$124.00	$21.79	$0.00	$15.03	$15.03	$16.56	$15.03	$0.00	$0.00	$0.00	$0.00
30200260	EAP	CPT® 86747		Parvovirus Igm	BOTH IP/OP	$124.00 	$91.76	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.83	$22.83	$23.71	$0.00	$22.21	$0.00	$0.00	$0.00	$15.78	$42.00	$99.00	$100.00	$21.79	$124.00	$21.79	$0.00	$15.03	$15.03	$16.56	$15.03	$0.00	$0.00	$0.00	$0.00
30200261	EAP	CPT® 86753		Ent. Histolytica Ab	BOTH IP/OP	$96.00 	$71.04	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.81	$18.81	$19.54	$0.00	$18.31	$0.00	$0.00	$0.00	$0.00	$34.64	$76.82	$77.60	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200262	EAP	CPT® 86762		Rubella Immune Scrn	BOTH IP/OP	$230.00 	$170.20	$7.20	$185.60	$24.02	$24.02	$14.39	$14.39	$7.20	$7.20	$17.67	$17.67	$18.35	$14.39	$17.19	$9.35	$136.05	$136.05	$15.11	$32.52	$183.74	$185.60	$20.87	$23.74	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200263	EAP	CPT® 86762		Rubella Igg	BOTH IP/OP	$216.00 	$159.84	$7.20	$174.40	$24.02	$24.02	$14.39	$14.39	$7.20	$7.20	$17.67	$17.67	$18.35	$14.39	$17.19	$9.35	$127.76	$127.76	$15.11	$32.52	$172.66	$174.40	$20.87	$23.74	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200264	EAP	CPT® 86762		Rubella Igm	BOTH IP/OP	$216.00 	$159.84	$7.20	$174.40	$24.02	$24.02	$14.39	$14.39	$7.20	$7.20	$17.67	$17.67	$18.35	$14.39	$17.19	$9.35	$127.76	$127.76	$15.11	$32.52	$172.66	$174.40	$20.87	$23.74	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200265	EAP	CPT® 86765		Rubeola (measles) Igm	BOTH IP/OP	$130.00 	$96.20	$6.44	$104.80	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$76.90	$76.90	$13.52	$36.00	$103.75	$104.80	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30200266	EAP	CPT® 86765		Rubeola (measles) Igg	BOTH IP/OP	$130.00 	$96.20	$6.44	$104.80	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$76.90	$76.90	$13.52	$36.00	$103.75	$104.80	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30200267	EAP	CPT® 86777		Toxoplasma Igg	BOTH IP/OP	$248.00 	$183.52	$7.20	$200.80	$24.02	$24.02	$14.39	$14.39	$7.20	$7.20	$17.67	$17.67	$18.35	$14.39	$17.19	$9.35	$146.69	$146.69	$15.11	$32.52	$198.79	$200.80	$20.87	$23.74	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200268	EAP	CPT® 86777		"Toxo Ab-igg,csf"	BOTH IP/OP	$248.00 	$183.52	$7.20	$200.80	$24.02	$24.02	$14.39	$14.39	$7.20	$7.20	$17.67	$17.67	$18.35	$14.39	$17.19	$9.35	$146.69	$146.69	$15.11	$32.52	$198.79	$200.80	$20.87	$23.74	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200269	EAP	CPT® 86777		Toxo Igg Ab-eia	BOTH IP/OP	$216.00 	$159.84	$0.00	$216.00	$24.02	$24.02	$14.39	$14.39	$7.20	$7.20	$17.67	$17.67	$18.35	$14.39	$17.19	$9.35	$127.76	$127.76	$15.11	$32.52	$213.84	$216.00	$20.87	$0.00	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200270	EAP	CPT® 86778		Toxoplasma Igm	BOTH IP/OP	$133.00 	$98.42	$7.20	$107.20	$29.73	$29.73	$14.41	$14.41	$7.21	$7.20	$21.87	$21.87	$22.71	$14.41	$21.27	$9.37	$78.67	$78.67	$15.13	$40.24	$106.13	$107.20	$20.89	$23.78	$20.89	$22.67	$14.41	$14.41	$15.87	$14.41	$0.00	$0.00	$0.00	$0.00
30200271	EAP	CPT® 86778		"Toxo Ab-igm,csf"	BOTH IP/OP	$133.00 	$98.42	$7.20	$107.20	$29.73	$29.73	$14.41	$14.41	$7.21	$7.20	$21.87	$21.87	$22.71	$14.41	$21.27	$9.37	$78.67	$78.67	$15.13	$40.24	$106.13	$107.20	$20.89	$23.78	$20.89	$22.67	$14.41	$14.41	$15.87	$14.41	$0.00	$0.00	$0.00	$0.00
30200272	EAP	CPT® 86780		"Treponemal Igg, Csf"	BOTH IP/OP	$215.00 	$159.10	$6.62	$156.80	$27.32	$27.32	$13.24	$13.24	$6.62	$6.62	$19.73	$19.73	$20.49	$13.24	$44.81	$8.61	$127.17	$127.17	$13.90	$98.00	$155.23	$156.80	$19.20	$21.85	$19.20	$30.67	$13.24	$13.24	$31.20	$13.24	$0.00	$0.00	$0.00	$0.00
30200273	EAP	CPT® 86780		Treponemal-igg-eia	BOTH IP/OP	$215.00 	$159.10	$6.62	$156.80	$27.32	$27.32	$13.24	$13.24	$6.62	$6.62	$19.73	$19.73	$20.49	$13.24	$44.81	$8.61	$127.17	$127.17	$13.90	$98.00	$155.23	$156.80	$19.20	$21.85	$19.20	$30.67	$13.24	$13.24	$31.20	$13.24	$0.00	$0.00	$0.00	$0.00
30200274	EAP	CPT® 86780		Treponemal -igm-eia	BOTH IP/OP	$158.00 	$116.92	$0.00	$144.80	$27.32	$27.32	$13.24	$13.24	$6.62	$6.62	$19.73	$19.73	$20.49	$13.24	$32.93	$8.61	$93.46	$93.46	$13.90	$90.50	$143.35	$144.80	$19.20	$0.00	$19.20	$28.33	$13.24	$13.24	$28.82	$13.24	$0.00	$0.00	$0.00	$0.00
30200275	EAP	CPT® 86787		Varicella Zoster Igm	BOTH IP/OP	$237.00 	$175.38	$6.44	$191.20	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$140.19	$140.19	$13.52	$36.00	$189.29	$191.20	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30200276	EAP	CPT® 86787		Varicella Zoster	BOTH IP/OP	$254.00 	$187.96	$6.44	$205.60	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$150.24	$150.24	$13.52	$36.00	$203.54	$205.60	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30200277	EAP	CPT® 86788		"W. Nile Ab, Igm"	BOTH IP/OP	$352.00 	$260.48	$0.00	$299.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.42	$25.58	$25.58	$26.57	$16.85	$24.90	$10.95	$208.21	$208.21	$0.00	$47.08	$278.78	$281.60	$0.00	$299.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200278	EAP	CPT® 86788		"W. Nile Ab, Igm, Csf"	BOTH IP/OP	$352.00 	$260.48	$0.00	$299.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.42	$25.58	$25.58	$26.57	$16.85	$24.90	$10.95	$208.21	$208.21	$0.00	$47.08	$278.78	$281.60	$0.00	$299.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200279	EAP	CPT® 86789		"W. Nile Ab, Igg"	BOTH IP/OP	$352.00 	$260.48	$0.00	$299.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.67	$17.67	$18.35	$0.00	$17.19	$0.00	$0.00	$0.00	$0.00	$32.52	$278.78	$281.60	$0.00	$299.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200280	EAP	CPT® 86789		"W. Nile Ab, Igg, Csf"	BOTH IP/OP	$352.00 	$260.48	$0.00	$299.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.67	$17.67	$18.35	$0.00	$17.19	$0.00	$0.00	$0.00	$0.00	$32.52	$278.78	$281.60	$0.00	$299.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200281	EAP	CPT® 86790		Htlv I/ii Ab	BOTH IP/OP	$328.00 	$242.72	$6.44	$240.00	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$194.01	$194.01	$13.52	$36.00	$237.60	$240.00	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30200282	EAP	CPT® 86800		"Thyroglob Ab, Quant"	BOTH IP/OP	$336.00 	$248.64	$7.95	$269.60	$32.84	$32.84	$15.91	$15.91	$7.96	$7.95	$24.15	$24.15	$25.08	$15.91	$23.50	$10.34	$198.74	$198.74	$16.71	$44.44	$266.90	$269.60	$23.07	$26.25	$23.07	$25.04	$15.91	$15.91	$17.53	$15.91	$0.00	$0.00	$0.00	$0.00
30200283	EAP	CPT® 86800		Thyroglobulin Ab	BOTH IP/OP	$359.00 	$265.66	$7.95	$287.20	$32.84	$32.84	$15.91	$15.91	$7.96	$7.95	$24.15	$24.15	$25.08	$15.91	$23.50	$10.34	$212.35	$212.35	$16.71	$44.44	$284.33	$287.20	$23.07	$26.25	$23.07	$25.04	$15.91	$15.91	$17.53	$15.91	$0.00	$0.00	$0.00	$0.00
30200284	EAP	CPT® 86803		Hcv Ab (2nd Gen)	BOTH IP/OP	$343.00 	$253.82	$7.13	$276.80	$29.44	$29.44	$14.27	$14.27	$7.14	$7.13	$21.67	$21.67	$22.51	$14.27	$11.75	$9.28	$202.88	$202.88	$14.98	$39.88	$274.03	$276.80	$20.69	$23.55	$20.69	$12.52	$14.27	$14.27	$8.76	$14.27	$0.00	$0.00	$0.00	$0.00
30200285	EAP	CPT® 86812		Hla-b27	BOTH IP/OP	$582.00 	$430.68	$12.90	$470.40	$53.28	$53.28	$25.81	$25.81	$12.91	$12.90	$39.19	$39.19	$40.69	$25.81	$38.13	$16.78	$344.25	$344.25	$27.10	$72.12	$465.70	$470.40	$37.42	$42.59	$37.42	$40.62	$25.81	$25.81	$28.44	$25.81	$0.00	$0.00	$0.00	$0.00
30200286	EAP	CPT® 86922		"Charge: Xmatch, Coombs"	BOTH IP/OP	$187.00 	$138.38	$0.00	$199.96	$55.68	$55.68	$145.24	$145.24	$146.06	$38.98	$24.89	$24.89	$25.84	$142.96	$38.97	$92.92	$110.61	$110.61	$143.92	$56.24	$161.57	$163.20	$199.96	$0.00	$199.96	$31.93	$0.00	$0.00	$32.48	$137.07	$0.00	$0.00	$0.00	$0.00
30200287	EAP	CPT® 86922		"Charge: Xmatch, Coombs"	BOTH IP/OP	$187.00 	$138.38	$0.00	$199.96	$55.68	$55.68	$145.24	$145.24	$146.06	$38.98	$24.89	$24.89	$25.84	$142.96	$38.97	$92.92	$110.61	$110.61	$143.92	$56.24	$161.57	$163.20	$199.96	$0.00	$199.96	$31.93	$0.00	$0.00	$32.48	$137.07	$0.00	$0.00	$0.00	$0.00
30200289	EAP	CPT® 86359		Lymph Subset T Cel Tot (so)	BOTH IP/OP	$210.00 	$155.40	$0.00	$174.40	$48.63	$48.63	$37.73	$37.73	$18.87	$18.86	$35.77	$35.77	$37.14	$37.73	$34.80	$24.52	$124.22	$124.22	$39.62	$65.82	$172.66	$174.40	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30200292	EAP	CPT® 86360		Lymph Subset Abs Ct Ratio (so)	BOTH IP/OP	$310.00 	$229.40	$0.00	$257.60	$96.99	$96.99	$46.98	$46.98	$23.49	$23.49	$71.34	$71.34	$74.09	$46.98	$69.42	$30.54	$183.37	$183.37	$49.33	$131.30	$255.02	$257.60	$68.12	$0.00	$68.12	$73.96	$46.98	$46.98	$51.77	$46.98	$0.00	$0.00	$0.00	$0.00
30200310	EAP	CPT® 86256		Smooth Muscle Ab Titer	BOTH IP/OP	$70.00 	$51.80	$0.00	$70.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$41.41	$41.41	$12.65	$33.68	$69.70	$70.40	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200315	EAP	CPT® 85027		Cbc & Plat	BOTH IP/OP	$202.00 	$149.48	$3.23	$147.20	$13.36	$13.36	$6.47	$6.47	$3.24	$3.23	$9.83	$9.83	$10.21	$6.47	$9.57	$4.21	$119.48	$119.48	$6.79	$18.08	$145.73	$147.20	$9.38	$10.68	$9.38	$10.19	$6.47	$6.47	$7.13	$6.47	$0.00	$0.00	$0.00	$0.00
30200330	EAP	CPT® 86355		Lymphocyte Sub 6  B Cells (so)	BOTH IP/OP	$217.00 	$160.58	$0.00	$180.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$178.99	$180.80	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30200331	EAP	CPT® 86357		Lymphocyte Sub 6 Nk Total (so)	BOTH IP/OP	$211.00 	$156.14	$0.00	$175.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$173.45	$175.20	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30200332	EAP	CPT® 86359		Lymphocyte Sub 6 T Cell Total (so)	BOTH IP/OP	$220.00 	$162.80	$0.00	$183.20	$48.63	$48.63	$37.73	$37.73	$18.87	$18.86	$35.77	$35.77	$37.14	$37.73	$34.80	$24.52	$130.13	$130.13	$39.62	$65.82	$181.37	$183.20	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30200333	EAP	CPT® 86360		Lymphocyte Sub 6 T Cells Abs(so)	BOTH IP/OP	$312.00 	$230.88	$0.00	$259.20	$96.99	$96.99	$46.98	$46.98	$23.49	$23.49	$71.34	$71.34	$74.09	$46.98	$69.42	$30.54	$184.55	$184.55	$49.33	$131.30	$256.61	$259.20	$68.12	$0.00	$68.12	$73.96	$46.98	$46.98	$51.77	$46.98	$0.00	$0.00	$0.00	$0.00
30200334	EAP	CPT® 86356		Lymphocyte Sub 6 Ag (so)	BOTH IP/OP	$190.00 	$140.60	$0.00	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.63	$39.63	$41.16	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200335	EAP	CPT® 86021		Neutraphil Ab Id (so)	BOTH IP/OP	$244.00 	$180.56	$0.00	$195.20	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$144.33	$144.33	$15.80	$42.06	$193.25	$195.20	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30200336	EAP	CPT® 86828		Neutraphil Ab Id Hla I&ii (so)	BOTH IP/OP	$591.00 	$437.34	$0.00	$472.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.46	$57.46	$59.67	$0.00	$123.16	$0.00	$0.00	$0.00	$0.00	$295.50	$468.07	$472.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200337	EAP	CPT® 86658		Echovirus Ab Csf (so)	BOTH IP/OP	$183.00 	$135.42	$6.51	$183.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$108.24	$108.24	$13.68	$36.40	$146.52	$148.00	$18.89	$183.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30200338	EAP	CPT® 83519		Enceph Auto Eval Csf Ria (so)	BOTH IP/OP	$434.00 	$321.16	$8.28	$337.60	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$256.71	$256.71	$19.32	$37.76	$334.22	$337.60	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30200339	EAP	CPT® 86255		Enceph Ab Screen Csf (so)	BOTH IP/OP	$240.00 	$177.60	$6.03	$192.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$141.96	$141.96	$12.65	$33.68	$190.08	$192.00	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200340	EAP	CPT® 86341		Enceph Islet Cell Ab Csf (so)	BOTH IP/OP	$196.00 	$145.04	$10.61	$155.20	$40.84	$40.84	$23.57	$23.57	$11.79	$10.61	$30.05	$30.05	$31.20	$23.57	$29.24	$15.32	$115.93	$115.93	$24.75	$55.30	$153.65	$155.20	$34.18	$38.89	$34.18	$31.16	$23.57	$23.57	$21.81	$23.57	$0.00	$0.00	$0.00	$0.00
30200341	EAP	CPT® 86606		Aspergillus Ab (so)	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$70.98	$70.98	$15.80	$42.06	$95.04	$96.00	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30200342	EAP	CPT® 86612		Blastomyces Ab (so)	BOTH IP/OP	$120.00 	$88.80	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.59	$19.59	$20.35	$0.00	$19.07	$0.00	$0.00	$0.00	$0.00	$36.06	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200343	EAP	CPT® 86305		Human Epididymis Prot 4 (so)	BOTH IP/OP	$330.00 	$244.20	$0.00	$330.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.00	$31.00	$32.19	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$166.50	$263.74	$266.40	$0.00	$330.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200344	EAP	CPT® 86635		Coccidioides Ab (so)	BOTH IP/OP	$180.00 	$133.20	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.42	$17.42	$18.09	$0.00	$16.95	$0.00	$0.00	$0.00	$0.00	$32.06	$129.89	$131.20	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200345	EAP	CPT® 86698		Histoplasma Ab (so)	BOTH IP/OP	$116.00 	$85.84	$0.00	$92.80	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$18.98	$18.98	$19.71	$13.79	$18.46	$8.96	$68.61	$68.61	$14.48	$34.92	$91.87	$92.80	$20.00	$0.00	$20.00	$19.67	$13.79	$13.79	$13.77	$13.79	$0.00	$0.00	$0.00	$0.00
30200346	EAP	CPT® 87449		Fungitell Csf (so)	BOTH IP/OP	$182.00 	$134.68	$0.00	$145.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$144.14	$145.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200347	EAP	CPT® 86790		Chikungunya Ab (so)	BOTH IP/OP	$188.00 	$139.12	$6.44	$137.60	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$111.20	$111.20	$13.52	$36.00	$136.22	$137.60	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30200349	EAP	CPT® 86580		Tb Skin Test	BOTH IP/OP	$75.00 	$55.50	$0.00	$72.00	$12.43	$12.43	$24.06	$24.06	$24.19	$3.89	$7.48	$7.48	$7.77	$23.64	$9.56	$15.37	$44.36	$44.36	$23.06	$20.46	$71.28	$72.00	$32.04	$0.00	$32.04	$10.18	$9.36	$9.36	$7.13	$21.96	$0.00	$0.00	$0.00	$0.00
30200350	EAP	CPT® 86580		Step 2 Ppd #1	BOTH IP/OP	$62.00 	$45.88	$0.00	$60.00	$12.43	$12.43	$24.06	$24.06	$24.19	$3.89	$7.48	$7.48	$7.77	$23.64	$9.56	$15.37	$36.67	$36.67	$23.06	$20.46	$59.40	$60.00	$32.04	$0.00	$32.04	$10.18	$9.36	$9.36	$7.13	$21.96	$0.00	$0.00	$0.00	$0.00
30200370	EAP	CPT® 86701		Focus Hiv-1 Confirmation	BOTH IP/OP	$197.00 	$145.78	$4.44	$158.40	$18.35	$18.35	$8.89	$8.89	$4.45	$4.44	$13.48	$13.48	$14.00	$8.89	$11.39	$5.78	$116.53	$116.53	$9.33	$24.82	$156.82	$158.40	$12.89	$14.67	$12.89	$12.14	$8.89	$8.89	$8.50	$8.89	$0.00	$0.00	$0.00	$0.00
30200371	EAP	CPT® 86702		Focus Hiv-2 Confirmation	BOTH IP/OP	$238.00 	$176.12	$6.76	$192.00	$27.90	$27.90	$13.52	$13.52	$6.76	$6.76	$20.53	$20.53	$21.32	$13.52	$17.33	$8.79	$140.78	$140.78	$14.20	$37.76	$190.08	$192.00	$19.60	$22.31	$19.60	$18.46	$13.52	$13.52	$12.92	$13.52	$0.00	$0.00	$0.00	$0.00
30200372	EAP	CPT® 83516		Aquaporin 4 Recep Ab (so)	BOTH IP/OP	$259.00 	$191.66	$0.00	$233.60	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$153.20	$153.20	$12.11	$29.88	$231.26	$233.60	$16.72	$0.00	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30200373	EAP	CPT® 86003		Abpa Allergen Spec Ige (so)	BOTH IP/OP	$110.00 	$81.40	$2.61	$109.60	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$65.07	$65.07	$5.48	$14.60	$108.50	$109.60	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200374	EAP	CPT® 86606		Aspergillus Ab (so)	BOTH IP/OP	$113.00 	$83.62	$0.00	$90.40	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$66.84	$66.84	$15.80	$42.06	$89.50	$90.40	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30200375	EAP	CPT® 86161		C3 Nephritic Factor (so)	BOTH IP/OP	$231.00 	$170.94	$0.00	$212.80	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$136.64	$136.64	$12.60	$33.56	$210.67	$212.80	$17.40	$0.00	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30200376	EAP	CPT® 86406		Toxo Titr Pregnancy (so)	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$5.32	$16.15	$16.15	$16.77	$10.64	$15.72	$6.92	$89.91	$89.91	$11.17	$29.74	$120.38	$121.60	$15.43	$0.00	$15.43	$16.75	$10.64	$10.64	$11.72	$10.64	$0.00	$0.00	$0.00	$0.00
30200377	EAP	CPT® 86777		Toxoplasma Ab (so)	BOTH IP/OP	$152.00 	$112.48	$0.00	$152.00	$24.02	$24.02	$14.39	$14.39	$7.20	$7.20	$17.67	$17.67	$18.35	$14.39	$17.19	$9.35	$89.91	$89.91	$15.11	$32.52	$150.48	$152.00	$20.87	$0.00	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30200378	EAP	CPT® 86778		Toxoplasma Ab Igm (so)	BOTH IP/OP	$155.00 	$114.70	$0.00	$155.20	$29.73	$29.73	$14.41	$14.41	$7.21	$7.20	$21.87	$21.87	$22.71	$14.41	$21.27	$9.37	$91.68	$91.68	$15.13	$40.24	$153.65	$155.20	$20.89	$0.00	$20.89	$22.67	$14.41	$14.41	$15.87	$14.41	$0.00	$0.00	$0.00	$0.00
30200379	EAP	CPT® 86038		Ana Ifa With Reflex (so)	BOTH IP/OP	$201.00 	$148.74	$0.00	$160.80	$24.95	$24.95	$12.09	$12.09	$6.05	$6.04	$18.36	$18.36	$19.06	$12.09	$17.86	$7.86	$118.89	$118.89	$12.69	$33.78	$159.19	$160.80	$17.53	$0.00	$17.53	$19.03	$12.09	$12.09	$13.32	$12.09	$0.00	$0.00	$0.00	$0.00
30200380	EAP	CPT® 86021		Wbc Ab Id (neutrophil) (so)	BOTH IP/OP	$236.00 	$174.64	$0.00	$188.80	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$139.59	$139.59	$15.80	$42.06	$186.91	$188.80	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30200381	EAP	CPT® 86828		Hla I & Ii Ab Qual (so)	BOTH IP/OP	$593.00 	$438.82	$0.00	$474.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.46	$57.46	$59.67	$0.00	$123.58	$0.00	$0.00	$0.00	$0.00	$296.50	$469.66	$474.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200382	EAP	CPT® 86255		Ampa Recept Fluor Ab Screen (so)	BOTH IP/OP	$429.00 	$317.46	$6.03	$428.80	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$253.75	$253.75	$12.65	$33.68	$424.51	$428.80	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200383	EAP	CPT® 86833		Hla Ii Post Trans Dsa (so)	BOTH IP/OP	$326.00 	$241.24	$0.00	$260.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.37	$167.37	$173.80	$0.00	$67.94	$0.00	$0.00	$0.00	$0.00	$163.00	$258.19	$260.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200384	EAP	CPT® 86832		Hla I Post Trans Dsa (so)	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.25	$184.25	$191.33	$0.00	$67.52	$0.00	$0.00	$0.00	$0.00	$162.00	$256.61	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200385	EAP	CPT® 86829		Hla I/ii Post Trans Dsa (so)	BOTH IP/OP	$245.00 	$181.30	$0.00	$197.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.10	$43.10	$44.76	$0.00	$51.06	$0.00	$0.00	$0.00	$0.00	$122.50	$194.04	$196.00	$0.00	$197.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200386	EAP	CPT® 86671		Crohns Prognostic Fung Ab (so)	BOTH IP/OP	$145.00 	$107.30	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$18.62	$19.33	$0.00	$18.11	$0.00	$0.00	$0.00	$12.86	$34.26	$114.84	$116.00	$17.76	$124.00	$17.76	$19.30	$12.25	$12.25	$13.51	$12.25	$0.00	$0.00	$0.00	$0.00
30200387	EAP	CPT® 83516		Crohns Prognostic Nonab (so)	BOTH IP/OP	$244.00 	$180.56	$0.00	$220.00	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$144.33	$144.33	$12.11	$29.88	$217.80	$220.00	$16.72	$0.00	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30200388	EAP	CPT® 83519		Paraneo Autoab Eval Ria(so)	BOTH IP/OP	$124.00 	$91.76	$8.28	$96.80	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$73.35	$73.35	$19.32	$37.76	$95.83	$96.80	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30200389	EAP	CPT® 86256		Paraneo Autoab Titer Ria(so)	BOTH IP/OP	$80.00 	$59.20	$6.03	$64.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$47.32	$47.32	$12.65	$33.68	$63.36	$64.00	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200390	EAP	CPT® 86255		Nmda Recep Ab Serum	BOTH IP/OP	$184.00 	$136.16	$0.00	$184.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$108.84	$108.84	$12.65	$33.68	$182.16	$184.00	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200400	EAP	CPT® 82963		Beta Glucosidase So	BOTH IP/OP	"$1,282.00 "	$948.68	$0.00	"$1,282.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.62	$32.62	$33.88	$0.00	$31.73	$0.00	$0.00	$0.00	$0.00	$60.02	$925.06	$934.40	$0.00	"$1,282.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200401	EAP	CPT® 87389		Hiv 1/2 Ag/ab 4th Generation So	BOTH IP/OP	$104.00 	$76.96	$12.04	$80.80	$49.71	$49.71	$24.08	$24.08	$12.04	$12.04	$35.48	$35.48	$36.85	$24.08	$32.07	$15.65	$61.52	$61.52	$25.28	$50.50	$79.99	$80.80	$34.92	$39.73	$34.92	$34.17	$24.08	$24.08	$23.92	$24.08	$0.00	$0.00	$0.00	$0.00
30200449	EAP	CPT® 86580		Tb Skin Test	BOTH IP/OP	$75.00 	$55.50	$0.00	$72.00	$12.43	$12.43	$24.06	$24.06	$24.19	$3.89	$7.48	$7.48	$7.77	$23.64	$9.56	$15.37	$44.36	$44.36	$23.06	$20.46	$71.28	$72.00	$32.04	$0.00	$32.04	$10.18	$9.36	$9.36	$7.13	$21.96	$0.00	$0.00	$0.00	$0.00
30200450	EAP	CPT® 86021		Proteinase-3 Antibody	BOTH IP/OP	$206.00 	$152.44	$0.00	$164.80	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$121.85	$121.85	$15.80	$42.06	$163.15	$164.80	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30200451	EAP	CPT® 86021		Myeloperoxidase Antibody	BOTH IP/OP	$200.00 	$148.00	$7.53	$147.20	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$118.30	$118.30	$15.80	$42.06	$145.73	$147.20	$21.82	$24.83	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30200452	EAP	CPT® 86022		"Platelet Igg Ab,indirect"	BOTH IP/OP	$301.00 	$222.74	$0.00	$240.80	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$178.04	$178.04	$0.00	$51.32	$238.39	$240.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200453	EAP	CPT® 86023		Platelet Glycoprot. Ab	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.92	$18.92	$19.65	$0.00	$18.40	$0.00	$0.00	$0.00	$0.00	$34.80	$346.90	$350.40	$0.00	$334.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200454	EAP	CPT® 86200		Cyclic Citurullinate Antibody	BOTH IP/OP	$387.00 	$286.38	$6.48	$312.80	$26.72	$26.72	$12.95	$12.95	$6.48	$6.48	$19.67	$19.67	$20.42	$12.95	$19.12	$8.42	$228.91	$228.91	$13.60	$36.18	$309.67	$312.80	$18.78	$21.37	$18.78	$20.37	$12.95	$12.95	$14.26	$12.95	$0.00	$0.00	$0.00	$0.00
30200455	EAP	CPT® 86256		Parietal Antibody Titer	BOTH IP/OP	$88.00 	$65.12	$6.03	$70.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$52.05	$52.05	$12.65	$33.68	$69.70	$70.40	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30200480	EAP	CPT® 83789		Tpmt Activity	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$546.48	$552.00	$0.00	$460.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200481	EAP	CPT® 86689		Htlv Ab. Western Blot	BOTH IP/OP	$281.00 	$207.94	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.39	$29.39	$30.52	$0.00	$24.81	$0.00	$0.00	$0.00	$0.00	$54.10	$229.68	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200491	EAP	CPT® 86316		"Immunoassay, Tumor Antigen, Quant"	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$42.95	$42.95	$20.81	$20.81	$10.41	$10.41	$31.60	$31.60	$32.81	$20.81	$30.73	$13.53	$186.32	$186.32	$21.85	$58.14	$249.48	$252.00	$30.17	$0.00	$30.17	$32.75	$20.81	$20.81	$22.92	$20.81	$0.00	$0.00	$0.00	$0.00
30200492	EAP	CPT® 86651		Encephal Antibody Calif	BOTH IP/OP	$36.00 	$26.64	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200493	EAP	CPT® 86652		Encephal Antibody East Equ	BOTH IP/OP	$36.00 	$26.64	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200494	EAP	CPT® 86653		Encephal Antibody St Louis	BOTH IP/OP	$36.00 	$26.64	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200495	EAP	CPT® 86654		Encephal Antibody West Equ	BOTH IP/OP	$36.00 	$26.64	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200496	EAP	CPT® 88360		Tumor Immunohistochem/manual	BOTH IP/OP	"$1,842.00 "	"$1,363.08"	$58.38	"$1,473.60"	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	"$1,089.54"	"$1,089.54"	$143.92	$121.34	"$1,458.86"	"$1,473.60"	$199.96	$740.35	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
30200498	EAP	CPT® 82787		"Igg1, 2, 3 Or 4, Each"	BOTH IP/OP	$84.00 	$62.16	$0.00	$67.20	$16.55	$16.55	$8.02	$8.02	$4.01	$4.01	$12.18	$12.18	$12.65	$8.02	$11.84	$5.21	$49.69	$49.69	$8.42	$22.40	$66.53	$67.20	$11.63	$0.00	$11.63	$12.62	$8.02	$8.02	$8.83	$8.02	$0.00	$0.00	$0.00	$0.00
30200499	EAP	CPT® 86343		Leukocyte Histamine Release	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$25.71	$25.71	$12.46	$12.46	$6.23	$6.23	$18.93	$18.93	$19.66	$12.46	$18.41	$8.10	$247.25	$247.25	$0.00	$34.82	$331.06	$334.40	$0.00	$20.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200500	EAP	CPT® 86580		Tb Intradermal Test	BOTH IP/OP	$106.00 	$78.44	$3.89	$102.40	$12.43	$12.43	$24.06	$24.06	$24.19	$3.89	$7.48	$7.48	$7.77	$23.64	$9.56	$15.37	$62.70	$62.70	$23.06	$20.46	$101.38	$102.40	$32.04	$66.95	$32.04	$10.18	$9.36	$9.36	$7.13	$21.96	$0.00	$0.00	$0.00	$0.00
30200501	EAP	CPT® 83789		"Mass Spectrometry Quant,nonspec"	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$99.79	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200503	EAP	CPT® 88189		"Flowcytometry/read, 16 & > Markers"	BOTH IP/OP	$248.00 	$183.52	$0.00	$210.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.07	$184.07	$191.16	$0.00	$115.43	$0.00	$0.00	$0.00	$93.43	$210.82	$196.42	$198.40	$88.72	$0.00	$88.72	$122.99	$88.72	$88.72	$86.09	$88.72	$0.00	$0.00	$0.00	$0.00
30200504	EAP	CPT® 88188		"Flowcytometry/read, 9-15 Markers"	BOTH IP/OP	$278.00 	$205.72	$0.00	$222.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.33	$206.33	$214.28	$0.00	$87.63	$0.00	$0.00	$0.00	$0.00	$161.74	$220.18	$222.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200505	EAP	CPT® 88187		"Flowcytometry/read, 2-8 Markers"	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$138.74	$0.00	$70.22	$0.00	$0.00	$0.00	$50.66	$130.50	$142.56	$144.00	$39.31	$0.00	$39.31	$74.83	$39.31	$39.31	$52.38	$39.31	$0.00	$0.00	$0.00	$0.00
30200506	EAP	CPT® 88368		"Insitu Hybridization, Manual"	BOTH IP/OP	"$1,076.00 "	$796.24	$0.00	$860.80	$178.36	$178.36	$283.63	$283.63	$285.22	$58.22	$151.36	$151.36	$157.18	$279.15	$199.20	$181.45	$636.45	$636.45	$284.24	$207.74	$852.19	$860.80	$394.92	$0.00	$394.92	$212.25	$90.40	$90.40	$148.57	$270.71	$0.00	$0.00	$0.00	$0.00
30200507	EAP	CPT® 86480		"Tb Test,cell Immun Meas By Gamma Interfron"	BOTH IP/OP	$572.00 	$423.28	$30.99	$552.00	$127.93	$127.93	$61.98	$61.98	$30.99	$30.99	$94.11	$94.11	$97.73	$61.98	$91.55	$40.29	$338.34	$338.34	$65.08	$173.18	$546.48	$552.00	$89.87	$102.27	$89.87	$97.55	$61.98	$61.98	$68.28	$61.98	$0.00	$0.00	$0.00	$0.00
30200508	EAP	CPT® 87799		"Jc Virus Pcr, Urine (q)"	BOTH IP/OP	$743.00 	$549.82	$0.00	$679.20	$0.00	$0.00	$0.00	$0.00	$0.00	$21.42	$65.04	$65.04	$67.54	$42.84	$154.84	$27.85	$439.48	$439.48	$0.00	$119.70	$672.41	$679.20	$0.00	$0.00	$0.00	$132.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200509	EAP	CPT® 87799		"Bk Virus Pcr, Urine (q)"	BOTH IP/OP	$635.00 	$469.90	$0.00	$580.80	$0.00	$0.00	$0.00	$0.00	$0.00	$21.42	$65.04	$65.04	$67.54	$42.84	$132.33	$27.85	$375.60	$375.60	$0.00	$119.70	$574.99	$580.80	$0.00	$0.00	$0.00	$113.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200510	EAP	CPT® 83519		Thyrotrpn Bndng Inhib Ab (q)	BOTH IP/OP	$225.00 	$166.50	$0.00	$203.20	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$133.09	$133.09	$19.32	$37.76	$201.17	$203.20	$26.68	$0.00	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30200511	EAP	CPT® 83520		Prothrombin Fragment (e)	BOTH IP/OP	$232.00 	$171.68	$7.77	$180.80	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$137.23	$137.23	$18.13	$36.18	$178.99	$180.80	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30200512	EAP	CPT® 87912		"Heptis B Resist, Geno (q)"	BOTH IP/OP	$606.00 	$448.44	$0.00	$484.80	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$373.52	$373.52	$387.88	$257.45	$112.65	$167.34	$358.45	$358.45	$0.00	$303.00	$479.95	$484.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200600	EAP	CPT® 88184		Flowcytometry/ Tc 1 Marker	BOTH IP/OP	$300.00 	$222.00	$0.00	$300.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$177.45	$177.45	$284.24	$133.74	$237.60	$240.00	$300.00	$0.00	$300.00	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
30200601	EAP	CPT® 88185		Flowcytometry/tc Add-on	BOTH IP/OP	$28.00 	$20.72	$0.00	$50.81	$28.00	$28.00	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$16.56	$16.56	$0.00	$28.00	$22.18	$22.40	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30200602	EAP	CPT® 86813		Hla Typing A B Or C	BOTH IP/OP	$413.00 	$305.62	$0.00	$330.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.05	$88.05	$91.43	$0.00	$85.66	$0.00	$0.00	$0.00	$0.00	$162.04	$327.10	$330.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200603	EAP	CPT® 87252		Virus Inoculation Tissue - Acyclovir	BOTH IP/OP	$496.00 	$367.04	$0.00	$396.80	$45.65	$45.65	$26.07	$26.07	$13.04	$13.04	$33.57	$33.57	$34.86	$26.07	$32.66	$16.95	$293.38	$293.38	$27.37	$61.78	$392.83	$396.80	$37.80	$0.00	$37.80	$34.79	$26.07	$26.07	$24.36	$26.07	$0.00	$0.00	$0.00	$0.00
30200604	EAP	CPT® 87253		Virus Inoculate Tissue Addl - Acyclovir	BOTH IP/OP	$471.00 	$348.54	$0.00	$376.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.73	$24.73	$25.68	$0.00	$24.06	$0.00	$0.00	$0.00	$0.00	$45.52	$373.03	$376.80	$0.00	$249.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200605	EAP	CPT® 85246		Blood Clot Factor Viii Test	BOTH IP/OP	$106.00 	$78.44	$0.00	$84.80	$47.36	$47.36	$22.94	$22.94	$11.47	$11.47	$34.85	$34.85	$36.19	$22.94	$33.89	$14.91	$62.70	$62.70	$24.09	$64.12	$83.95	$84.80	$33.26	$0.00	$33.26	$36.11	$22.94	$22.94	$25.28	$22.94	$0.00	$0.00	$0.00	$0.00
30200606	EAP	CPT® 83033		Fetal Hemoglobin Assay Qual	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.05	$9.05	$9.40	$0.00	$8.81	$0.00	$0.00	$0.00	$0.00	$16.66	$75.24	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200629	EAP	CPT® 80347		Assay Of Benzodiazepines	BOTH IP/OP	$562.00 	$415.88	$0.00	$449.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.12	$417.12	$433.19	$0.00	$27.32	$0.00	$0.00	$0.00	$0.00	$281.00	$445.10	$449.60	$0.00	$152.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200630	EAP	CPT® 88237		Tissue Culture Bone Marrow	BOTH IP/OP	$507.00 	$375.18	$0.00	$449.60	$182.24	$182.24	$143.75	$143.75	$71.88	$64.69	$134.06	$134.06	$139.21	$143.75	$130.42	$93.44	$299.89	$299.89	$150.94	$246.70	$445.10	$449.60	$208.44	$0.00	$208.44	$138.97	$143.75	$143.75	$97.28	$143.75	$0.00	$0.00	$0.00	$0.00
30200631	EAP	CPT® 88264		Chromosome Analysis 20-25	BOTH IP/OP	$624.00 	$461.76	$0.00	$552.80	$257.29	$257.29	$144.61	$144.61	$72.31	$65.07	$189.26	$189.26	$196.54	$144.61	$184.12	$94.00	$369.10	$369.10	$151.84	$348.28	$547.27	$552.80	$209.68	$0.00	$209.68	$196.18	$144.61	$144.61	$137.33	$144.61	$0.00	$0.00	$0.00	$0.00
30200633	EAP	CPT® 88237		Tissue Culture Bone Marrow	BOTH IP/OP	$237.00 	$175.38	$0.00	$246.70	$182.24	$182.24	$143.75	$143.75	$71.88	$64.69	$134.06	$134.06	$139.21	$143.75	$130.42	$93.44	$140.19	$140.19	$150.94	$246.70	$208.30	$210.40	$208.44	$0.00	$208.44	$138.97	$143.75	$143.75	$97.28	$143.75	$0.00	$0.00	$0.00	$0.00
30200634	EAP	CPT® 88262		Chromosome Analysis 15-20	BOTH IP/OP	$199.00 	$147.26	$0.00	$220.00	$199.00	$199.00	$125.49	$125.49	$62.75	$62.32	$189.26	$189.26	$196.54	$125.49	$184.12	$81.57	$117.71	$117.71	$131.76	$220.00	$174.24	$176.00	$181.96	$0.00	$181.96	$196.18	$125.49	$125.49	$137.33	$125.49	$0.00	$0.00	$0.00	$0.00
30200636	EAP	CPT® 86343		Leukocyte Histamine Release	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$25.71	$25.71	$12.46	$12.46	$6.23	$6.23	$18.93	$18.93	$19.66	$12.46	$18.41	$8.10	$30.76	$30.76	$0.00	$34.82	$41.18	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200637	EAP	CPT® 83088		Assay Of Histamine	BOTH IP/OP	$50.00 	$37.00	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.84	$44.84	$46.57	$0.00	$43.62	$0.00	$0.00	$0.00	$0.00	$50.00	$39.60	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200638	EAP	CPT® 86021		Wbc Antibody Identification	BOTH IP/OP	$31.00 	$22.94	$0.00	$31.00	$31.00	$31.00	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$18.34	$18.34	$15.80	$31.00	$24.55	$24.80	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30200639	EAP	CPT® 86376		Microsomal Antibody	BOTH IP/OP	$29.00 	$21.46	$0.00	$29.00	$29.00	$29.00	$14.55	$14.55	$7.28	$7.28	$22.10	$22.10	$22.95	$14.55	$21.49	$9.46	$17.15	$17.15	$15.28	$29.00	$22.97	$23.20	$21.10	$0.00	$21.10	$22.90	$14.55	$14.55	$16.03	$14.55	$0.00	$0.00	$0.00	$0.00
30200640	EAP	CPT® 84443		Assay Thyroid Stim Hormone	BOTH IP/OP	$42.00 	$31.08	$0.00	$42.00	$34.69	$34.69	$16.80	$16.80	$8.40	$8.40	$25.51	$25.51	$26.49	$16.80	$24.81	$10.92	$24.84	$24.84	$17.64	$42.00	$33.26	$33.60	$24.36	$0.00	$24.36	$26.44	$16.80	$16.80	$18.51	$16.80	$0.00	$0.00	$0.00	$0.00
30200641	EAP	CPT® 86800		Thyroglobulin Antibody	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$32.84	$32.84	$15.91	$15.91	$7.96	$7.95	$24.15	$24.15	$25.08	$15.91	$23.50	$10.34	$44.36	$44.36	$16.71	$44.44	$59.40	$60.00	$23.07	$0.00	$23.07	$25.04	$15.91	$15.91	$17.53	$15.91	$0.00	$0.00	$0.00	$0.00
30200649	EAP	CPT® 88321		Microslide Consultation	BOTH IP/OP	$364.00 	$269.36	$0.00	$291.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.27	$82.27	$85.44	$0.00	$69.33	$0.00	$0.00	$0.00	$0.00	$180.64	$288.29	$291.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200650	EAP	CPT® 86343		Leukocyte Histamine Release	BOTH IP/OP	$48.00 	$35.52	$0.00	$38.40	$25.71	$25.71	$12.46	$12.46	$6.23	$6.23	$18.93	$18.93	$19.66	$12.46	$18.41	$8.10	$28.39	$28.39	$0.00	$34.82	$38.02	$38.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200651	EAP	CPT® 83088		Assay Of Histamine	BOTH IP/OP	$49.00 	$36.26	$0.00	$49.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.84	$44.84	$46.57	$0.00	$43.62	$0.00	$0.00	$0.00	$0.00	$49.00	$38.81	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200652	EAP	CPT® 86021		Wbc Antibody Identification	BOTH IP/OP	$29.00 	$21.46	$0.00	$29.00	$29.00	$29.00	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$17.15	$17.15	$15.80	$29.00	$22.97	$23.20	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30200653	EAP	CPT® 86376		Microsomal Antibody	BOTH IP/OP	$27.00 	$19.98	$0.00	$27.00	$27.00	$27.00	$14.55	$14.55	$7.28	$7.28	$22.10	$22.10	$22.95	$14.55	$21.49	$9.46	$15.97	$15.97	$15.28	$27.00	$21.38	$21.60	$21.10	$0.00	$21.10	$22.90	$14.55	$14.55	$16.03	$14.55	$0.00	$0.00	$0.00	$0.00
30200654	EAP	CPT® 84443		Assay Thyroid Stim Hormone	BOTH IP/OP	$39.00 	$28.86	$0.00	$39.00	$34.69	$34.69	$16.80	$16.80	$8.40	$8.40	$25.51	$25.51	$26.49	$16.80	$24.81	$10.92	$23.07	$23.07	$17.64	$39.00	$30.89	$31.20	$24.36	$0.00	$24.36	$26.44	$16.80	$16.80	$18.51	$16.80	$0.00	$0.00	$0.00	$0.00
30200655	EAP	CPT® 86800		Thyroglobulin Antibody	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$32.84	$32.84	$15.91	$15.91	$7.96	$7.95	$24.15	$24.15	$25.08	$15.91	$23.50	$10.34	$40.81	$40.81	$16.71	$44.44	$54.65	$55.20	$23.07	$0.00	$23.07	$25.04	$15.91	$15.91	$17.53	$15.91	$0.00	$0.00	$0.00	$0.00
30200656	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$77.00 	$56.98	$0.00	$61.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$45.55	$45.55	$22.49	$59.86	$60.98	$61.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30200657	EAP	CPT® 88273		Cytogenetics 10-30	BOTH IP/OP	$107.00 	$79.18	$0.00	$89.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.79	$48.79	$50.66	$0.00	$47.46	$0.00	$0.00	$0.00	$0.00	$89.78	$84.74	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200660	EAP	CPT® 88182		Cell Marker Study	BOTH IP/OP	$93.00 	$68.82	$0.00	$93.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.95	$68.95	$71.60	$0.00	$78.66	$0.00	$0.00	$0.00	$0.00	$93.00	$73.66	$74.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200661	EAP	CPT® 86817		Hla Typing Dr/dq	BOTH IP/OP	$743.00 	$549.82	$0.00	$594.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.76	$97.76	$101.52	$0.00	$95.11	$0.00	$0.00	$0.00	$0.00	$179.90	$588.46	$594.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200671	EAP	CPT® 88360		Tumor Immunohistochem/manual	BOTH IP/OP	$310.00 	$229.40	$0.00	$248.00	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$183.37	$183.37	$143.92	$121.34	$245.52	$248.00	$199.96	$0.00	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
30200672	EAP	CPT® 88321		Microslide Consultation	BOTH IP/OP	$84.00 	$62.16	$0.00	$85.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.27	$82.27	$85.44	$0.00	$69.33	$0.00	$0.00	$0.00	$0.00	$84.00	$66.53	$67.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200673	EAP	CPT® 84600		Assay Of Volatiles	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$33.18	$33.18	$17.11	$17.11	$8.56	$8.04	$24.41	$24.41	$25.35	$17.11	$23.74	$11.12	$191.65	$191.65	$0.00	$44.90	$256.61	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200674	EAP	CPT® 84600		Assay Of Volatiles	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$33.18	$33.18	$17.11	$17.11	$8.56	$8.04	$24.41	$24.41	$25.35	$17.11	$23.74	$11.12	$191.65	$191.65	$0.00	$44.90	$256.61	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200675	EAP	CPT® 85210		Blood Clot Factor Ii Test	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.72	$19.72	$20.48	$0.00	$19.18	$0.00	$0.00	$0.00	$0.00	$36.28	$87.91	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200676	EAP	CPT® 85210		Blood Clot Factor Ii Test	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.72	$19.72	$20.48	$0.00	$19.18	$0.00	$0.00	$0.00	$0.00	$36.28	$99.79	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200677	EAP	CPT® 85260		Blood Clot Factor X Test	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.19	$27.19	$28.23	$0.00	$26.46	$0.00	$0.00	$0.00	$0.00	$50.04	$83.16	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200679	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$59.74	$59.74	$22.49	$59.86	$79.99	$80.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30200680	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$117.00 	$86.58	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$69.21	$69.21	$53.75	$112.22	$92.66	$93.60	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30200681	EAP	CPT® 88184		Flowcytometry/ Tc 1 Marker	BOTH IP/OP	$561.00 	$415.14	$30.49	$452.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$331.83	$331.83	$284.24	$133.74	$237.60	$452.00	$300.00	$364.65	$300.00	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
30200682	EAP	CPT® 88185		Flowcytometry/tc Add-on	BOTH IP/OP	$33.00 	$24.42	$0.00	$50.81	$33.00	$33.00	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$19.52	$19.52	$0.00	$33.00	$23.76	$26.40	$0.00	$21.45	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30200683	EAP	CPT® 88184		Flowcytometry/ Tc 1 Marker	BOTH IP/OP	$300.00 	$222.00	$0.00	$300.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$177.45	$177.45	$284.24	$133.74	$237.60	$240.00	$300.00	$0.00	$300.00	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
30200684	EAP	CPT® 88185		Flowcytometry/tc Add-on	BOTH IP/OP	$14.00 	$10.36	$0.00	$50.81	$14.00	$14.00	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$14.00	$0.00	$8.28	$8.28	$0.00	$14.00	$11.09	$11.20	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30200685	EAP	CPT® 88182		Cell Marker Study	BOTH IP/OP	$93.00 	$68.82	$0.00	$93.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.95	$68.95	$71.60	$0.00	$78.66	$0.00	$0.00	$0.00	$0.00	$93.00	$73.66	$74.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200686	EAP	CPT® 85520		Heparin Assay	BOTH IP/OP	$199.00 	$147.26	$0.00	$168.00	$27.03	$27.03	$13.09	$13.09	$6.55	$6.55	$19.87	$19.87	$20.64	$13.09	$19.34	$8.51	$117.71	$117.71	$13.74	$36.58	$166.32	$168.00	$18.98	$0.00	$18.98	$20.61	$13.09	$13.09	$14.43	$13.09	$0.00	$0.00	$0.00	$0.00
30200687	EAP	CPT® 87252		Virus Inoculation Tissue	BOTH IP/OP	$496.00 	$367.04	$0.00	$396.80	$45.65	$45.65	$26.07	$26.07	$13.04	$13.04	$33.57	$33.57	$34.86	$26.07	$32.66	$16.95	$293.38	$293.38	$27.37	$61.78	$392.83	$396.80	$37.80	$0.00	$37.80	$34.79	$26.07	$26.07	$24.36	$26.07	$0.00	$0.00	$0.00	$0.00
30200688	EAP	CPT® 87253		Virus Inoculate Tissue Addl	BOTH IP/OP	$476.00 	$352.24	$0.00	$380.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.73	$24.73	$25.68	$0.00	$24.06	$0.00	$0.00	$0.00	$0.00	$45.52	$376.99	$380.80	$0.00	$249.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200693	EAP	CPT® 87449		Ag Detect Nos Eia Mult	BOTH IP/OP	$317.00 	$234.58	$0.00	$253.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$251.06	$253.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200694	EAP	CPT® 82570		Assay Of Urine Creatinine	BOTH IP/OP	$165.00 	$122.10	$2.59	$132.00	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$97.60	$97.60	$5.44	$14.46	$130.68	$132.00	$7.51	$8.55	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30200695	EAP	CPT® 84378		Sugars Single Quant	BOTH IP/OP	$210.00 	$155.40	$0.00	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.50	$17.50	$18.18	$0.00	$17.02	$0.00	$0.00	$0.00	$0.00	$32.20	$177.41	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200696	EAP	CPT® 80500		Lab Pathology Consultation	BOTH IP/OP	$112.00 	$82.88	$0.00	$89.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.18	$0.00	$0.00	$0.00	$0.00	$43.34	$88.70	$89.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200697	EAP	CPT® 87252		Virus Inoculation Tissue	BOTH IP/OP	$496.00 	$367.04	$0.00	$396.80	$45.65	$45.65	$26.07	$26.07	$13.04	$13.04	$33.57	$33.57	$34.86	$26.07	$32.66	$16.95	$293.38	$293.38	$27.37	$61.78	$392.83	$396.80	$37.80	$0.00	$37.80	$34.79	$26.07	$26.07	$24.36	$26.07	$0.00	$0.00	$0.00	$0.00
30200698	EAP	CPT® 87253		Virus Inoculate Tissue Addl	BOTH IP/OP	$476.00 	$352.24	$0.00	$380.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.73	$24.73	$25.68	$0.00	$24.06	$0.00	$0.00	$0.00	$0.00	$45.52	$376.99	$380.80	$0.00	$249.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200708	EAP	CPT® 88368		Insitu Hybridization Manual	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$178.36	$178.36	$283.63	$283.63	$285.22	$58.22	$151.36	$151.36	$157.18	$279.15	$199.20	$181.45	$296.34	$296.34	$284.24	$207.74	$396.79	$400.80	$394.92	$0.00	$394.92	$212.25	$90.40	$90.40	$148.57	$270.71	$0.00	$0.00	$0.00	$0.00
30200711	EAP	CPT® 80307		"Drug Screen, Any Number Drug Classes"	BOTH IP/OP	$451.00 	$333.74	$29.09	$328.00	$115.05	$115.05	$62.14	$62.14	$31.07	$29.09	$79.51	$79.51	$82.57	$62.14	$71.85	$40.39	$266.77	$266.77	$65.25	$205.00	$324.72	$328.00	$90.10	$102.53	$90.10	$76.56	$62.14	$62.14	$53.59	$62.14	$0.00	$0.00	$0.00	$0.00
30200712	EAP	CPT® 87252		Virus Inoculation Tissue	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$45.65	$45.65	$26.07	$26.07	$13.04	$13.04	$33.57	$33.57	$34.86	$26.07	$32.66	$16.95	$204.07	$204.07	$27.37	$61.78	$273.24	$276.00	$37.80	$0.00	$37.80	$34.79	$26.07	$26.07	$24.36	$26.07	$0.00	$0.00	$0.00	$0.00
30200713	EAP	CPT® 88184		Flowcytometry/ Tc 1 Marker	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$295.75	$295.75	$284.24	$133.74	$396.00	$400.00	$394.92	$0.00	$394.92	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
30200714	EAP	CPT® 88185		Flowcytometry/tc Add-on	BOTH IP/OP	$58.00 	$42.92	$0.00	$58.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$34.31	$34.31	$0.00	$58.00	$45.94	$46.40	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30200719	EAP	CPT® 88360		Tumor Immunohistochem/manual	BOTH IP/OP	$310.00 	$229.40	$0.00	$248.00	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$183.37	$183.37	$143.92	$121.34	$245.52	$248.00	$199.96	$0.00	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
30200720	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$131.00 	$96.94	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$77.49	$77.49	$53.75	$112.22	$103.75	$104.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30200721	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$44.36	$44.36	$22.49	$59.86	$59.40	$60.00	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30200732	EAP	CPT® 87530		Hsv Dna Quant	BOTH IP/OP	$74.00 	$54.76	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.04	$65.04	$67.54	$0.00	$15.42	$0.00	$0.00	$0.00	$0.00	$76.00	$60.19	$60.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200740	EAP	CPT® 87556		M.tuberculo Dna Amp Probe	BOTH IP/OP	$220.00 	$162.80	$0.00	$181.60	$40.50	$40.50	$41.68	$41.68	$20.84	$18.76	$29.79	$29.79	$30.93	$41.68	$45.85	$27.09	$130.13	$130.13	$43.76	$54.82	$179.78	$181.60	$60.44	$0.00	$60.44	$35.53	$41.68	$41.68	$36.14	$41.68	$0.00	$0.00	$0.00	$0.00
30200746	EAP	CPT® 83018		Quantitative Screen Metals	BOTH IP/OP	$61.00 	$45.14	$0.00	$61.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.34	$33.34	$34.62	$0.00	$32.43	$0.00	$0.00	$0.00	$0.00	$61.00	$48.31	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200747	EAP	CPT® 83655		Assay Of Lead	BOTH IP/OP	$46.00 	$34.04	$0.00	$36.80	$25.00	$25.00	$12.11	$12.11	$6.06	$6.05	$18.38	$18.38	$19.08	$12.11	$11.75	$7.87	$27.21	$27.21	$12.72	$33.82	$36.43	$36.80	$17.56	$0.00	$17.56	$12.52	$12.11	$12.11	$8.76	$12.11	$0.00	$0.00	$0.00	$0.00
30200748	EAP	CPT® 83825		Assay Of Mercury	BOTH IP/OP	$41.00 	$30.34	$0.00	$41.00	$33.55	$33.55	$16.26	$16.26	$8.13	$8.13	$24.69	$24.69	$25.64	$16.26	$24.02	$10.57	$24.25	$24.25	$17.07	$41.00	$32.47	$32.80	$23.58	$0.00	$23.58	$0.00	$16.26	$16.26	$17.92	$16.26	$0.00	$0.00	$0.00	$0.00
30200749	EAP	CPT® 84255		Assay Of Selenium	BOTH IP/OP	$55.00 	$40.70	$0.00	$55.00	$52.69	$52.69	$25.53	$25.53	$12.77	$12.77	$38.76	$38.76	$40.25	$25.53	$37.71	$16.59	$32.53	$32.53	$0.00	$55.00	$43.56	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200750	EAP	CPT® 88182		Cell Marker Study	BOTH IP/OP	$87.00 	$64.38	$0.00	$87.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.95	$68.95	$71.60	$0.00	$78.66	$0.00	$0.00	$0.00	$0.00	$87.00	$68.90	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200751	EAP	CPT® 88342		Immunohistochemistry	BOTH IP/OP	$278.00 	$205.72	$0.00	$222.40	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$164.44	$164.44	$143.92	$106.46	$220.18	$222.40	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
30200752	EAP	CPT® 88230		Tissue Culture Lymphocyte	BOTH IP/OP	$186.00 	$137.64	$0.00	$206.00	$186.00	$186.00	$116.49	$116.49	$58.25	$58.25	$176.90	$176.90	$183.71	$116.49	$172.08	$75.72	$110.02	$110.02	$122.31	$206.00	$163.15	$164.80	$168.91	$0.00	$168.91	$183.36	$116.49	$116.49	$128.35	$116.49	$0.00	$0.00	$0.00	$0.00
30200753	EAP	CPT® 88263		Chromosome Analysis 45	BOTH IP/OP	$241.00 	$178.34	$0.00	$267.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.20	$228.20	$236.97	$0.00	$221.99	$0.00	$0.00	$0.00	$0.00	$267.00	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200754	EAP	CPT® 88285		Chromosome Count Additional	BOTH IP/OP	$31.00 	$22.94	$0.00	$34.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.85	$28.85	$29.96	$0.00	$28.07	$0.00	$0.00	$0.00	$0.00	$34.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200756	EAP	CPT® 82441		Test For Chlorohydrocarbons	BOTH IP/OP	$183.00 	$135.42	$0.00	$146.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.11	$9.11	$9.46	$0.00	$8.86	$0.00	$0.00	$0.00	$0.00	$16.76	$144.94	$146.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200757	EAP	CPT® 82570		Assay Of Urine Creatinine	BOTH IP/OP	$83.00 	$61.42	$0.00	$66.40	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$49.09	$49.09	$5.44	$14.46	$65.74	$66.40	$7.51	$0.00	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30200758	EAP	CPT® 84600		Assay Of Volatiles	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$33.18	$33.18	$17.11	$17.11	$8.56	$8.04	$24.41	$24.41	$25.35	$17.11	$23.74	$11.12	$59.15	$59.15	$0.00	$44.90	$79.20	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200759	EAP	CPT® 85576		Blood Platelet Aggregation	BOTH IP/OP	$122.00 	$90.28	$0.00	$120.80	$44.35	$44.35	$24.91	$24.91	$12.46	$11.21	$32.62	$32.62	$33.88	$24.91	$31.73	$16.19	$72.16	$72.16	$26.16	$60.02	$119.59	$120.80	$36.12	$0.00	$36.12	$33.81	$24.91	$24.91	$23.67	$24.91	$0.00	$0.00	$0.00	$0.00
30200760	EAP	CPT® 85049		Automated Platelet Count	BOTH IP/OP	$24.00 	$17.76	$0.00	$19.20	$9.24	$9.24	$4.48	$4.48	$2.24	$2.24	$6.79	$6.79	$7.05	$4.48	$6.62	$2.91	$14.20	$14.20	$4.70	$12.50	$19.01	$19.20	$6.50	$0.00	$6.50	$7.05	$4.48	$4.48	$4.93	$4.48	$0.00	$0.00	$0.00	$0.00
30200776	EAP	CPT® 88184		Flowcytometry/ Tc 1 Marker	BOTH IP/OP	$303.00 	$224.22	$0.00	$303.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$179.22	$179.22	$284.24	$133.74	$239.98	$242.40	$303.00	$0.00	$303.00	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
30200777	EAP	CPT® 88185		Flowcytometry/tc Add-on	BOTH IP/OP	$26.00 	$19.24	$0.00	$50.81	$26.00	$26.00	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.00	$0.00	$15.38	$15.38	$0.00	$26.00	$20.59	$20.80	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30200778	EAP	CPT® 88187		Flowcytometry/read 2-8	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$138.74	$0.00	$70.22	$0.00	$0.00	$0.00	$50.66	$130.50	$142.56	$144.00	$39.31	$0.00	$39.31	$74.83	$39.31	$39.31	$52.38	$39.31	$0.00	$0.00	$0.00	$0.00
30200784	EAP	CPT® 80500		Lab Pathology Consultation	BOTH IP/OP	$53.00 	$39.22	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.18	$0.00	$0.00	$0.00	$0.00	$43.34	$41.98	$42.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200785	EAP	CPT® 82657		Enzyme Cell Activity	BOTH IP/OP	$20.00 	$14.80	$0.00	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$19.80	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200790	EAP	CPT® 86022		Platelet Antibodies	BOTH IP/OP	$184.00 	$136.16	$0.00	$147.20	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$108.84	$108.84	$0.00	$51.32	$145.73	$147.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200791	EAP	CPT® 86022		Platelet Antibodies	BOTH IP/OP	$106.00 	$78.44	$0.00	$84.80	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$62.70	$62.70	$0.00	$51.32	$83.95	$84.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200792	EAP	CPT® 88239		Tissue Culture Tumor	BOTH IP/OP	$276.00 	$204.24	$0.00	$306.00	$276.00	$276.00	$147.52	$147.52	$73.76	$73.76	$224.01	$224.01	$232.62	$147.52	$217.93	$95.89	$163.25	$163.25	$154.90	$306.00	$242.35	$244.80	$213.90	$0.00	$213.90	$232.21	$147.52	$147.52	$162.54	$147.52	$0.00	$0.00	$0.00	$0.00
30200793	EAP	CPT® 88237		Tissue Culture Bone Marrow	BOTH IP/OP	$237.00 	$175.38	$0.00	$246.70	$182.24	$182.24	$143.75	$143.75	$71.88	$64.69	$134.06	$134.06	$139.21	$143.75	$130.42	$93.44	$140.19	$140.19	$150.94	$246.70	$208.30	$210.40	$208.44	$0.00	$208.44	$138.97	$143.75	$143.75	$97.28	$143.75	$0.00	$0.00	$0.00	$0.00
30200804	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$82.00 	$60.68	$0.00	$65.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$48.50	$48.50	$22.49	$59.86	$64.94	$65.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30200805	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$146.00 	$108.04	$0.00	$116.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$86.36	$86.36	$53.75	$112.22	$115.63	$116.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30200806	EAP	CPT® 86780		Treponema Pallidum	BOTH IP/OP	$179.00 	$132.46	$6.62	$130.40	$27.32	$27.32	$13.24	$13.24	$6.62	$6.62	$19.73	$19.73	$20.49	$13.24	$37.30	$8.61	$105.88	$105.88	$13.90	$81.50	$129.10	$130.40	$19.20	$21.85	$19.20	$25.51	$13.24	$13.24	$25.95	$13.24	$0.00	$0.00	$0.00	$0.00
30200818	EAP	CPT® 86003		Allergen Specific Ige	BOTH IP/OP	$362.00 	$267.88	$2.61	$360.80	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$214.12	$214.12	$5.48	$14.60	$357.19	$360.80	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200819	EAP	CPT® 86003		Allergen Specific Ige	BOTH IP/OP	$362.00 	$267.88	$2.61	$360.80	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$214.12	$214.12	$5.48	$14.60	$357.19	$360.80	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200820	EAP	CPT® 86003		Allergen Specific Ige	BOTH IP/OP	$362.00 	$267.88	$2.61	$360.80	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$214.12	$214.12	$5.48	$14.60	$357.19	$360.80	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200827	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$106.00 	$78.44	$0.00	$84.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$62.70	$62.70	$22.49	$59.86	$83.95	$84.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30200828	EAP	CPT® 88272		Cytogenetics 3-5	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$55.28	$55.28	$40.70	$40.70	$20.35	$18.32	$40.65	$40.65	$42.22	$40.70	$39.55	$26.46	$74.53	$74.53	$0.00	$74.82	$99.79	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200830	EAP	CPT® 88237		Tissue Culture Bone Marrow	BOTH IP/OP	$376.00 	$278.24	$0.00	$332.80	$182.24	$182.24	$143.75	$143.75	$71.88	$64.69	$134.06	$134.06	$139.21	$143.75	$130.42	$93.44	$222.40	$222.40	$150.94	$246.70	$329.47	$332.80	$208.44	$0.00	$208.44	$138.97	$143.75	$143.75	$97.28	$143.75	$0.00	$0.00	$0.00	$0.00
30200831	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$202.29	$202.29	$22.49	$59.86	$270.86	$273.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30200832	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$236.60	$236.60	$53.75	$112.22	$316.80	$320.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30200840	EAP	CPT® 88237		Tissue Culture Bone Marrow	BOTH IP/OP	$262.00 	$193.88	$0.00	$246.70	$182.24	$182.24	$143.75	$143.75	$71.88	$64.69	$134.06	$134.06	$139.21	$143.75	$130.42	$93.44	$154.97	$154.97	$150.94	$246.70	$229.68	$232.00	$208.44	$0.00	$208.44	$138.97	$143.75	$143.75	$97.28	$143.75	$0.00	$0.00	$0.00	$0.00
30200841	EAP	CPT® 88262		Chromosome Analysis 15-20	BOTH IP/OP	$219.00 	$162.06	$0.00	$243.00	$219.00	$219.00	$125.49	$125.49	$62.75	$62.32	$189.26	$189.26	$196.54	$125.49	$184.12	$81.57	$129.54	$129.54	$131.76	$243.00	$192.46	$194.40	$181.96	$0.00	$181.96	$196.18	$125.49	$125.49	$137.33	$125.49	$0.00	$0.00	$0.00	$0.00
30200843	EAP	CPT® 87449		Ag Detect Nos Eia Mult	BOTH IP/OP	$250.00 	$185.00	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$200.38	$202.40	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200844	EAP	CPT® 87449		Ag Detect Nos Eia Mult	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$200.38	$202.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200845	EAP	CPT® 88291		Cyto/molecular Report	BOTH IP/OP	$29.00 	$21.46	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.04	$0.00	$0.00	$0.00	$0.00	$29.00	$22.97	$23.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200846	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$107.00 	$79.18	$0.00	$85.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$63.29	$63.29	$22.49	$59.86	$84.74	$85.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30200847	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$136.00 	$100.64	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$80.44	$80.44	$53.75	$112.22	$107.71	$108.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30200848	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$47.32	$47.32	$22.49	$59.86	$63.36	$64.00	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30200849	EAP	CPT® 88272		Cytogenetics 3-5	BOTH IP/OP	$106.00 	$78.44	$0.00	$84.80	$55.28	$55.28	$40.70	$40.70	$20.35	$18.32	$40.65	$40.65	$42.22	$40.70	$39.55	$26.46	$62.70	$62.70	$0.00	$74.82	$83.95	$84.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200856	EAP	CPT® 87186		Microbe Susceptible Mic	BOTH IP/OP	$308.00 	$227.92	$4.32	$246.40	$17.85	$17.85	$8.65	$8.65	$4.33	$4.32	$13.12	$13.12	$13.63	$8.65	$12.77	$5.62	$182.18	$182.18	$9.08	$24.16	$243.94	$246.40	$12.54	$14.27	$12.54	$13.60	$8.65	$8.65	$9.52	$8.65	$0.00	$0.00	$0.00	$0.00
30200863	EAP	CPT® 82136		Amino Acids Quant 2-5	BOTH IP/OP	$338.00 	$250.12	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.62	$25.62	$26.60	$0.00	$24.92	$0.00	$0.00	$0.00	$0.00	$47.14	$267.70	$270.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200864	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$47.32	$47.32	$22.49	$59.86	$63.36	$64.00	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30200865	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$139.00 	$102.86	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$82.22	$82.22	$53.75	$112.22	$110.09	$111.20	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30200867	EAP	CPT® 87385		Histoplasma Capsul Ag Eia	BOTH IP/OP	$215.00 	$159.10	$0.00	$172.00	$24.74	$24.74	$13.25	$13.25	$6.63	$5.99	$18.22	$18.22	$18.92	$13.25	$17.71	$8.61	$127.17	$127.17	$13.91	$33.52	$170.28	$172.00	$19.21	$0.00	$19.21	$18.87	$13.25	$13.25	$13.21	$13.25	$0.00	$0.00	$0.00	$0.00
30200868	EAP	CPT® 87798		Detect Agent Nos Dna Amp	BOTH IP/OP	$386.00 	$285.64	$17.55	$311.20	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$228.32	$228.32	$36.84	$54.82	$308.09	$311.20	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30200869	EAP	CPT® 82175		Assay Of Arsenic	BOTH IP/OP	$34.00 	$25.16	$0.00	$34.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.49	$28.81	$28.81	$29.92	$18.97	$28.02	$12.33	$20.11	$20.11	$19.92	$34.00	$26.93	$27.20	$27.51	$0.00	$27.51	$0.00	$18.97	$18.97	$20.90	$18.97	$0.00	$0.00	$0.00	$0.00
30200895	EAP	CPT® 84481		"T3, Free"	BOTH IP/OP	$150.00 	$111.00	$8.47	$118.40	$34.98	$34.98	$16.94	$16.94	$8.47	$8.47	$25.73	$25.73	$26.72	$16.94	$25.02	$11.01	$88.73	$88.73	$17.79	$47.34	$117.22	$118.40	$24.56	$27.95	$24.56	$26.66	$16.94	$16.94	$18.66	$16.94	$0.00	$0.00	$0.00	$0.00
30200896	EAP	CPT® 84481		Free Assay(ft-3)	BOTH IP/OP	$137.00 	$101.38	$0.00	$125.60	$34.98	$34.98	$16.94	$16.94	$8.47	$8.47	$25.73	$25.73	$26.72	$16.94	$25.02	$11.01	$81.04	$81.04	$17.79	$47.34	$124.34	$125.60	$24.56	$0.00	$24.56	$26.66	$16.94	$16.94	$18.66	$16.94	$0.00	$0.00	$0.00	$0.00
30200898	EAP	CPT® 83789		Mass Spectrometry Quant	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$93.46	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200900	EAP	CPT® 82154		Androstanediol Glucuronide	BOTH IP/OP	$437.00 	$323.38	$0.00	$349.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.78	$43.78	$45.47	$0.00	$42.60	$0.00	$0.00	$0.00	$0.00	$80.58	$346.10	$349.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200908	EAP	CPT® 82010		Acetone Assay	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$16.87	$16.87	$8.17	$8.17	$4.09	$4.09	$12.41	$12.41	$12.88	$8.17	$12.08	$5.31	$168.58	$168.58	$8.58	$22.84	$225.72	$228.00	$11.85	$0.00	$11.85	$12.87	$8.17	$8.17	$9.01	$8.17	$0.00	$0.00	$0.00	$0.00
30200910	EAP	CPT® 82010		Acetone Assay	BOTH IP/OP	$153.00 	$113.22	$0.00	$122.40	$16.87	$16.87	$8.17	$8.17	$4.09	$4.09	$12.41	$12.41	$12.88	$8.17	$12.08	$5.31	$90.50	$90.50	$8.58	$22.84	$121.18	$122.40	$11.85	$0.00	$11.85	$12.87	$8.17	$8.17	$9.01	$8.17	$0.00	$0.00	$0.00	$0.00
30200912	EAP	CPT® 87252		Virus Inoculation Tissue	BOTH IP/OP	$488.00 	$361.12	$0.00	$390.40	$45.65	$45.65	$26.07	$26.07	$13.04	$13.04	$33.57	$33.57	$34.86	$26.07	$32.66	$16.95	$288.65	$288.65	$27.37	$61.78	$386.50	$390.40	$37.80	$0.00	$37.80	$34.79	$26.07	$26.07	$24.36	$26.07	$0.00	$0.00	$0.00	$0.00
30200913	EAP	CPT® 87253		Virus Inoculate Tissue Addl	BOTH IP/OP	$488.00 	$361.12	$0.00	$390.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.73	$24.73	$25.68	$0.00	$24.06	$0.00	$0.00	$0.00	$0.00	$45.52	$386.50	$390.40	$0.00	$249.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200915	EAP	CPT® 82017		Acylcarnities Quant	BOTH IP/OP	$247.00 	$182.78	$0.00	$197.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.62	$25.62	$26.60	$0.00	$24.92	$0.00	$0.00	$0.00	$0.00	$47.14	$195.62	$197.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200919	EAP	CPT® 84311		Spectrophotometry	BOTH IP/OP	$239.00 	$176.86	$0.00	$192.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.61	$10.61	$11.02	$0.00	$10.32	$0.00	$0.00	$0.00	$8.51	$19.54	$190.87	$192.80	$11.75	$156.00	$11.75	$11.00	$8.10	$8.10	$7.70	$8.10	$0.00	$0.00	$0.00	$0.00
30200921	EAP	CPT® 84311		Spectrophotometry	BOTH IP/OP	$239.00 	$176.86	$0.00	$192.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.61	$10.61	$11.02	$0.00	$10.32	$0.00	$0.00	$0.00	$8.51	$19.54	$190.87	$192.80	$11.75	$156.00	$11.75	$11.00	$8.10	$8.10	$7.70	$8.10	$0.00	$0.00	$0.00	$0.00
30200923	EAP	CPT® 87260		Adenovirus Ag If	BOTH IP/OP	$128.00 	$94.72	$0.00	$102.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$101.38	$102.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200925	EAP	CPT® 87798		Detect Agent Nos Dna Amp	BOTH IP/OP	$464.00 	$343.36	$0.00	$447.20	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$274.46	$274.46	$36.84	$54.82	$442.73	$447.20	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30200927	EAP	CPT® 86316		Immunoassay Tumor Other	BOTH IP/OP	$178.00 	$131.72	$0.00	$142.40	$42.95	$42.95	$20.81	$20.81	$10.41	$10.41	$31.60	$31.60	$32.81	$20.81	$30.73	$13.53	$105.29	$105.29	$21.85	$58.14	$140.98	$142.40	$30.17	$0.00	$30.17	$32.75	$20.81	$20.81	$22.92	$20.81	$0.00	$0.00	$0.00	$0.00
30200929	EAP	CPT® 82088		Assay Of Aldosterone	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$84.11	$84.11	$40.75	$40.75	$20.38	$20.38	$61.88	$61.88	$64.26	$40.75	$60.21	$26.49	$175.68	$175.68	$42.79	$113.88	$235.22	$237.60	$59.09	$0.00	$59.09	$64.15	$40.75	$40.75	$44.91	$40.75	$0.00	$0.00	$0.00	$0.00
30200937	EAP	CPT® 82103		Alpha-1-antitrypsin Total	BOTH IP/OP	$137.00 	$101.38	$0.00	$109.60	$27.75	$27.75	$13.44	$13.44	$6.72	$6.72	$20.39	$20.39	$21.18	$13.44	$19.85	$8.74	$81.04	$81.04	$14.11	$37.54	$108.50	$109.60	$19.49	$0.00	$19.49	$21.15	$13.44	$13.44	$14.80	$13.44	$0.00	$0.00	$0.00	$0.00
30200939	EAP	CPT® 86316		Immunoassay Tumor Other	BOTH IP/OP	$177.00 	$130.98	$10.41	$142.40	$42.95	$42.95	$20.81	$20.81	$10.41	$10.41	$31.60	$31.60	$32.81	$20.81	$30.73	$13.53	$104.70	$104.70	$21.85	$58.14	$140.98	$142.40	$30.17	$34.34	$30.17	$32.75	$20.81	$20.81	$22.92	$20.81	$0.00	$0.00	$0.00	$0.00
30200941	EAP	CPT® 86147		Cardiolipin Antibody	BOTH IP/OP	$53.00 	$39.22	$0.00	$66.00	$52.54	$52.54	$25.45	$25.45	$12.73	$12.73	$38.63	$38.63	$40.11	$25.45	$37.58	$16.54	$31.35	$31.35	$26.72	$66.00	$52.27	$52.80	$36.90	$0.00	$36.90	$40.04	$25.45	$25.45	$28.03	$25.45	$0.00	$0.00	$0.00	$0.00
30200943	EAP	CPT® 83520		Immunoassay Quant Nos Nonab	BOTH IP/OP	$293.00 	$216.82	$0.00	$264.80	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$173.31	$173.31	$18.13	$36.18	$262.15	$264.80	$25.04	$0.00	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30200945	EAP	CPT® 86146		Glycoprotein Antibody	BOTH IP/OP	$107.00 	$79.18	$0.00	$107.20	$52.54	$52.54	$25.45	$25.45	$12.73	$12.73	$38.63	$38.63	$40.11	$25.45	$37.58	$16.54	$63.29	$63.29	$26.72	$71.08	$106.13	$107.20	$36.90	$0.00	$36.90	$40.04	$25.45	$25.45	$28.03	$25.45	$0.00	$0.00	$0.00	$0.00
30200946	EAP	CPT® 86147		Cardiolipin Antibody	BOTH IP/OP	$147.00 	$108.78	$12.73	$107.20	$52.54	$52.54	$25.45	$25.45	$12.73	$12.73	$38.63	$38.63	$40.11	$25.45	$37.58	$16.54	$86.95	$86.95	$26.72	$71.08	$106.13	$107.20	$36.90	$41.99	$36.90	$40.04	$25.45	$25.45	$28.03	$25.45	$0.00	$0.00	$0.00	$0.00
30200947	EAP	CPT® 86148		Phospholipid Antibody	BOTH IP/OP	$83.00 	$61.42	$0.00	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.39	$24.39	$25.33	$0.00	$23.73	$0.00	$0.00	$0.00	$0.00	$44.88	$82.37	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200949	EAP	CPT® 85300		"Antithrombin Iii Test,activity"	BOTH IP/OP	$588.00 	$435.12	$5.93	$470.40	$24.47	$24.47	$11.85	$11.85	$5.93	$5.93	$17.99	$17.99	$18.68	$11.85	$17.50	$7.70	$347.80	$347.80	$12.44	$33.10	$465.70	$470.40	$17.18	$19.55	$17.18	$18.65	$11.85	$11.85	$13.06	$11.85	$0.00	$0.00	$0.00	$0.00
30200950	EAP	CPT® 85301		"Antithrombin Iii Test,antigen Assay"	BOTH IP/OP	$588.00 	$435.12	$0.00	$470.40	$0.00	$0.00	$0.00	$0.00	$0.00	$5.40	$16.42	$16.42	$17.05	$10.81	$15.98	$7.03	$347.80	$347.80	$11.35	$30.22	$465.70	$470.40	$15.67	$459.00	$15.67	$17.03	$10.81	$10.81	$11.92	$10.81	$0.00	$0.00	$0.00	$0.00
30200952	EAP	CPT® 82172		Assay Of Apolipoprotein	BOTH IP/OP	$41.00 	$30.34	$0.00	$41.00	$32.00	$32.00	$21.09	$21.09	$10.55	$9.49	$23.52	$23.52	$24.43	$21.09	$22.90	$13.71	$24.25	$24.25	$22.14	$41.00	$32.47	$32.80	$30.58	$0.00	$30.58	$24.40	$21.09	$21.09	$17.08	$21.09	$0.00	$0.00	$0.00	$0.00
30200954	EAP	CPT® 86651		"Antibody Encephalitis, California (la Crosse)"	BOTH IP/OP	$25.00 	$18.50	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$25.00	$19.80	$20.00	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200955	EAP	CPT® 86652		"Antibody Encephalitis, Eastern Equine"	BOTH IP/OP	$25.00 	$18.50	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$25.00	$19.80	$20.00	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200956	EAP	CPT® 86653		"Antibody Encephalitis, St. Louis"	BOTH IP/OP	$25.00 	$18.50	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$25.00	$19.80	$20.00	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200957	EAP	CPT® 86654		"Antibody Encephalitis, Western Equine"	BOTH IP/OP	$25.00 	$18.50	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$25.00	$19.80	$20.00	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200959	EAP	CPT® 82175		Assay Of Arsenic	BOTH IP/OP	$117.00 	$86.58	$0.00	$93.60	$0.00	$0.00	$0.00	$0.00	$0.00	$9.49	$28.81	$28.81	$29.92	$18.97	$28.02	$12.33	$69.21	$69.21	$19.92	$53.02	$92.66	$93.60	$27.51	$0.00	$27.51	$0.00	$18.97	$18.97	$20.90	$18.97	$0.00	$0.00	$0.00	$0.00
30200961	EAP	CPT® 84311		Spectrophotometry	BOTH IP/OP	$286.00 	$211.64	$0.00	$285.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.61	$10.61	$11.02	$0.00	$10.32	$0.00	$0.00	$0.00	$8.51	$19.54	$282.74	$285.60	$11.75	$156.00	$11.75	$11.00	$8.10	$8.10	$7.70	$8.10	$0.00	$0.00	$0.00	$0.00
30200963	EAP	CPT® 86003		Allergen Specific Ige	BOTH IP/OP	$124.00 	$91.76	$2.61	$124.00	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$73.35	$73.35	$5.48	$14.60	$122.76	$124.00	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30200965	EAP	CPT® 87305		Aspergillus Ag Eia	BOTH IP/OP	$139.00 	$102.86	$0.00	$111.20	$24.74	$24.74	$11.98	$11.98	$5.99	$5.99	$18.22	$18.22	$18.92	$11.98	$17.71	$7.79	$82.22	$82.22	$12.58	$33.52	$110.09	$111.20	$17.37	$0.00	$17.37	$18.87	$11.98	$11.98	$13.21	$11.98	$0.00	$0.00	$0.00	$0.00
30200967	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$280.00 	$207.20	$8.39	$224.00	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$165.62	$165.62	$19.57	$33.64	$221.76	$224.00	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30200969	EAP	CPT® 86337		Insulin Antibodies	BOTH IP/OP	$411.00 	$304.14	$0.00	$328.80	$44.19	$44.19	$21.41	$21.41	$10.71	$10.71	$32.52	$32.52	$33.77	$21.41	$31.64	$13.92	$243.11	$243.11	$22.48	$59.84	$325.51	$328.80	$31.04	$35.33	$31.04	$0.00	$21.41	$21.41	$23.60	$21.41	$0.00	$0.00	$0.00	$0.00
30200976	EAP	CPT® 86753		Protozoa Antibody Nos	BOTH IP/OP	$54.00 	$39.96	$0.00	$54.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.81	$18.81	$19.54	$0.00	$18.31	$0.00	$0.00	$0.00	$0.00	$34.64	$43.56	$44.00	$0.00	$54.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200978	EAP	CPT® 87798		Detect Agent Nos Dna Amp	BOTH IP/OP	$526.00 	$389.24	$17.55	$424.00	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$311.13	$311.13	$36.84	$54.82	$419.76	$424.00	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30200980	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$301.00 	$222.74	$8.39	$240.80	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$178.04	$178.04	$19.57	$33.64	$238.39	$240.80	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30200982	EAP	CPT® 87471		Bartonella Dna Amp Probe	BOTH IP/OP	$441.00 	$326.34	$0.00	$441.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.79	$29.79	$30.93	$0.00	$28.98	$0.00	$0.00	$0.00	$0.00	$54.82	$344.52	$348.00	$0.00	$441.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30200997	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$189.00 	$139.86	$0.00	$151.20	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$111.79	$111.79	$19.57	$33.64	$149.69	$151.20	$27.03	$0.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30200999	EAP	CPT® 86146		Glycoprotein Antibody	BOTH IP/OP	$93.00 	$68.82	$0.00	$92.80	$52.54	$52.54	$25.45	$25.45	$12.73	$12.73	$38.63	$38.63	$40.11	$25.45	$37.58	$16.54	$55.01	$55.01	$26.72	$71.08	$91.87	$92.80	$36.90	$0.00	$36.90	$40.04	$25.45	$25.45	$28.03	$25.45	$0.00	$0.00	$0.00	$0.00
30201001	EAP	CPT® 82143		Amniotic Fluid Scan	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.43	$10.43	$10.83	$0.00	$10.16	$0.00	$0.00	$0.00	$0.00	$19.22	$39.60	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201003	EAP	CPT® 87799		Detect Agent Nos Dna Quant	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	"$1,121.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$21.42	$65.04	$65.04	$67.54	$42.84	$234.45	$27.85	$665.44	$665.44	$0.00	$119.70	"$1,018.51"	"$1,028.80"	$0.00	"$1,121.00"	$0.00	$201.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201005	EAP	CPT® 86615		Bordetella Antibody	BOTH IP/OP	$76.00 	$56.24	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$60.98	$61.60	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201007	EAP	CPT® 82523		Collagen Crosslinks	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$38.57	$38.57	$18.68	$18.68	$9.34	$9.34	$28.38	$28.38	$29.47	$18.68	$27.60	$12.14	$106.47	$106.47	$19.61	$52.22	$142.56	$144.00	$27.09	$0.00	$27.09	$29.41	$18.68	$18.68	$20.59	$18.68	$0.00	$0.00	$0.00	$0.00
30201009	EAP	CPT® 83520		Immunoassay Quant Nos Nonab	BOTH IP/OP	$186.00 	$137.64	$0.00	$168.00	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$110.02	$110.02	$18.13	$36.18	$166.32	$168.00	$25.04	$0.00	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30201011	EAP	CPT® 86160		Complement Antigen	BOTH IP/OP	$224.00 	$165.76	$0.00	$206.40	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$132.50	$132.50	$12.60	$33.56	$204.34	$206.40	$17.40	$0.00	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30201013	EAP	CPT® 86329		Immunodiffusion	BOTH IP/OP	$122.00 	$90.28	$0.00	$120.00	$28.99	$28.99	$14.05	$14.05	$7.03	$0.00	$21.33	$21.33	$22.15	$0.00	$20.75	$0.00	$0.00	$0.00	$14.75	$39.24	$118.80	$120.00	$20.37	$0.00	$20.37	$22.11	$14.05	$14.05	$15.48	$14.05	$0.00	$0.00	$0.00	$0.00
30201015	EAP	CPT® 86301		Immunoassay Tumor Ca 19-9	BOTH IP/OP	$91.00 	$67.34	$10.41	$73.60	$42.95	$42.95	$20.81	$20.81	$10.41	$10.41	$31.60	$31.60	$32.81	$20.81	$30.73	$13.53	$53.83	$53.83	$21.85	$58.14	$72.86	$73.60	$30.17	$34.34	$30.17	$32.75	$20.81	$20.81	$22.92	$20.81	$0.00	$0.00	$0.00	$0.00
30201017	EAP	CPT® 86403		Particle Agglutination Test	BOTH IP/OP	$216.00 	$159.84	$0.00	$172.80	$21.04	$21.04	$11.54	$11.54	$5.77	$5.19	$15.48	$15.48	$16.07	$11.54	$11.75	$7.50	$127.76	$127.76	$12.12	$28.48	$171.07	$172.80	$16.73	$0.00	$16.73	$12.52	$11.54	$11.54	$8.76	$11.54	$0.00	$0.00	$0.00	$0.00
30201019	EAP	CPT® 80157		Assay Of Carbamazepine Free	BOTH IP/OP	$155.00 	$114.70	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.13	$20.13	$20.91	$0.00	$14.69	$0.00	$0.00	$0.00	$0.00	$37.04	$122.76	$124.00	$0.00	$91.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201021	EAP	CPT® 82375		Assay Carboxyhb Quant	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.37	$4.37	$4.54	$0.00	$4.25	$0.00	$0.00	$0.00	$0.00	$8.04	$47.52	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201023	EAP	CPT® 83516		Immunoassay Nonantibody	BOTH IP/OP	$172.00 	$127.28	$0.00	$155.20	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$101.74	$101.74	$12.11	$29.88	$153.65	$155.20	$16.72	$0.00	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30201025	EAP	CPT® 86147		Cariolipin Antibody	BOTH IP/OP	$53.00 	$39.22	$0.00	$66.00	$52.54	$52.54	$25.45	$25.45	$12.73	$12.73	$38.63	$38.63	$40.11	$25.45	$37.58	$16.54	$31.35	$31.35	$26.72	$66.00	$52.27	$52.80	$36.90	$0.00	$36.90	$40.04	$25.45	$25.45	$28.03	$25.45	$0.00	$0.00	$0.00	$0.00
30201027	EAP	CPT® 82384		Assay Three Catecholamines	BOTH IP/OP	$86.00 	$63.64	$0.00	$70.56	$52.11	$52.11	$25.25	$25.25	$12.63	$12.63	$38.34	$38.34	$39.82	$25.25	$37.30	$16.41	$50.87	$50.87	$26.51	$70.56	$68.11	$68.80	$36.61	$0.00	$36.61	$39.74	$25.25	$25.25	$27.82	$25.25	$0.00	$0.00	$0.00	$0.00
30201028	EAP	CPT® 82570		Assay Of Urine Creatinine	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$20.11	$20.11	$5.44	$14.46	$26.93	$27.20	$7.51	$0.00	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30201030	EAP	CPT® 88184		Flowcytometry/tc 1 Marker	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$295.75	$295.75	$284.24	$133.74	$396.00	$400.00	$394.92	$0.00	$394.92	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
30201031	EAP	CPT® 88185		Flowcytometry/tc Add-on	BOTH IP/OP	$48.00 	$35.52	$0.00	$50.81	$48.00	$48.00	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$28.39	$28.39	$0.00	$48.00	$38.02	$38.40	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
30201032	EAP	CPT® 88187		Flowcytometry/read 2-8	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$138.74	$0.00	$70.22	$0.00	$0.00	$0.00	$50.66	$130.50	$142.56	$144.00	$39.31	$0.00	$39.31	$74.83	$39.31	$39.31	$52.38	$39.31	$0.00	$0.00	$0.00	$0.00
30201034	EAP	CPT® 82378		Carcinoembryinic Antigen	BOTH IP/OP	$58.00 	$42.92	$0.00	$53.02	$39.15	$39.15	$18.96	$18.96	$9.48	$9.48	$28.81	$28.81	$29.92	$18.96	$28.02	$12.32	$34.31	$34.31	$19.91	$53.02	$47.52	$48.00	$27.49	$0.00	$27.49	$29.86	$18.96	$18.96	$20.90	$18.96	$0.00	$0.00	$0.00	$0.00
30201036	EAP	CPT® 82378		Carcinoembryinic Antigen	BOTH IP/OP	$58.00 	$42.92	$0.00	$53.02	$39.15	$39.15	$18.96	$18.96	$9.48	$9.48	$28.81	$28.81	$29.92	$18.96	$28.02	$12.32	$34.31	$34.31	$19.91	$53.02	$47.52	$48.00	$27.49	$0.00	$27.49	$29.86	$18.96	$18.96	$20.90	$18.96	$0.00	$0.00	$0.00	$0.00
30201038	EAP	CPT® 86631		Chlamydia Antibody	BOTH IP/OP	$87.00 	$64.38	$0.00	$87.00	$24.42	$24.42	$11.82	$11.82	$5.91	$5.91	$17.96	$17.96	$18.65	$11.82	$17.47	$7.68	$51.46	$51.46	$0.00	$33.04	$62.57	$63.20	$0.00	$87.00	$0.00	$18.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201039	EAP	CPT® 86632		Chlamydia Igm Antibody	BOTH IP/OP	$82.00 	$60.68	$0.00	$65.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.27	$19.27	$20.01	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$35.48	$64.94	$65.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201041	EAP	CPT® 82480		Assay Serum Cholinesterase	BOTH IP/OP	$58.00 	$42.92	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.97	$11.97	$12.43	$0.00	$11.64	$0.00	$0.00	$0.00	$0.00	$22.02	$45.94	$46.40	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201043	EAP	CPT® 82495		Assay Of Chromium	BOTH IP/OP	$97.00 	$71.78	$0.00	$77.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.79	$30.79	$31.98	$0.00	$29.97	$0.00	$0.00	$0.00	$0.00	$56.68	$76.82	$77.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201045	EAP	CPT® 86316		Immunoassay Tumor Other	BOTH IP/OP	$293.00 	$216.82	$0.00	$234.40	$42.95	$42.95	$20.81	$20.81	$10.41	$10.41	$31.60	$31.60	$32.81	$20.81	$30.73	$13.53	$173.31	$173.31	$21.85	$58.14	$232.06	$234.40	$30.17	$0.00	$30.17	$32.75	$20.81	$20.81	$22.92	$20.81	$0.00	$0.00	$0.00	$0.00
30201049	EAP	CPT® 86157		Cold Agglutinin Titer	BOTH IP/OP	$24.00 	$17.76	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.24	$12.24	$12.71	$0.00	$11.91	$0.00	$0.00	$0.00	$0.00	$22.54	$19.01	$19.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201051	EAP	CPT® 82523		Collagen Crosslinks	BOTH IP/OP	$99.00 	$73.26	$9.34	$79.20	$38.57	$38.57	$18.68	$18.68	$9.34	$9.34	$28.38	$28.38	$29.47	$18.68	$27.60	$12.14	$58.56	$58.56	$19.61	$52.22	$78.41	$79.20	$27.09	$30.82	$27.09	$29.41	$18.68	$18.68	$20.59	$18.68	$0.00	$0.00	$0.00	$0.00
30201053	EAP	CPT® 86160		Complement Antigen	BOTH IP/OP	$224.00 	$165.76	$0.00	$206.40	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$132.50	$132.50	$12.60	$33.56	$204.34	$206.40	$17.40	$0.00	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30201055	EAP	CPT® 86160		Complement Antigen	BOTH IP/OP	$200.00 	$148.00	$0.00	$184.80	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$118.30	$118.30	$12.60	$33.56	$182.95	$184.80	$17.40	$0.00	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30201057	EAP	CPT® 86160		Complement Antigen	BOTH IP/OP	$230.00 	$170.20	$0.00	$212.00	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$136.05	$136.05	$12.60	$33.56	$209.88	$212.00	$17.40	$0.00	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30201059	EAP	CPT® 86160		Complement Antigen	BOTH IP/OP	$230.00 	$170.20	$0.00	$212.00	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$136.05	$136.05	$12.60	$33.56	$209.88	$212.00	$17.40	$0.00	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30201061	EAP	CPT® 86160		Complement Antigen	BOTH IP/OP	$224.00 	$165.76	$0.00	$206.40	$24.76	$24.76	$12.00	$12.00	$6.00	$6.00	$18.23	$18.23	$18.93	$12.00	$17.73	$7.80	$132.50	$132.50	$12.60	$33.56	$204.34	$206.40	$17.40	$0.00	$17.40	$18.90	$12.00	$12.00	$13.23	$12.00	$0.00	$0.00	$0.00	$0.00
30201063	EAP	CPT® 83519		Ria Nonantibody	BOTH IP/OP	$686.00 	$507.64	$8.28	$533.60	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$405.77	$405.77	$19.32	$37.76	$528.26	$533.60	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30201065	EAP	CPT® 82530		Cortisol Free	BOTH IP/OP	$180.00 	$133.20	$8.36	$145.60	$34.48	$34.48	$16.71	$16.71	$8.36	$8.36	$25.39	$25.39	$26.36	$16.71	$24.70	$10.86	$106.47	$106.47	$17.55	$46.70	$144.14	$145.60	$24.23	$27.57	$24.23	$26.31	$16.71	$16.71	$18.42	$16.71	$0.00	$0.00	$0.00	$0.00
30201067	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$150.00 	$111.00	$8.39	$120.80	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$88.73	$88.73	$19.57	$33.64	$119.59	$120.80	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201069	EAP	CPT® 82552		Assay Of Cpk In Blood	BOTH IP/OP	$61.00 	$45.14	$0.00	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.34	$20.34	$21.12	$0.00	$19.78	$0.00	$0.00	$0.00	$0.00	$37.42	$48.31	$48.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201071	EAP	CPT® 86343		Leukocyte Histamine Release	BOTH IP/OP	$386.00 	$285.64	$0.00	$308.80	$25.71	$25.71	$12.46	$12.46	$6.23	$6.23	$18.93	$18.93	$19.66	$12.46	$18.41	$8.10	$228.32	$228.32	$0.00	$34.82	$305.71	$308.80	$0.00	$20.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201073	EAP	CPT® 84443		Assay Thyroid Stim Hormone	BOTH IP/OP	$146.00 	$108.04	$0.00	$116.80	$34.69	$34.69	$16.80	$16.80	$8.40	$8.40	$25.51	$25.51	$26.49	$16.80	$24.81	$10.92	$86.36	$86.36	$17.64	$46.94	$115.63	$116.80	$24.36	$0.00	$24.36	$26.44	$16.80	$16.80	$18.51	$16.80	$0.00	$0.00	$0.00	$0.00
30201074	EAP	CPT® 86343		Leukocyte Histamine Release	BOTH IP/OP	$204.00 	$150.96	$0.00	$163.20	$25.71	$25.71	$12.46	$12.46	$6.23	$6.23	$18.93	$18.93	$19.66	$12.46	$18.41	$8.10	$120.67	$120.67	$0.00	$34.82	$161.57	$163.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201075	EAP	CPT® 86376		Microsomal Antibody	BOTH IP/OP	$108.00 	$79.92	$0.00	$86.40	$30.04	$30.04	$14.55	$14.55	$7.28	$7.28	$22.10	$22.10	$22.95	$14.55	$21.49	$9.46	$63.88	$63.88	$15.28	$40.66	$85.54	$86.40	$21.10	$0.00	$21.10	$22.90	$14.55	$14.55	$16.03	$14.55	$0.00	$0.00	$0.00	$0.00
30201076	EAP	CPT® 86800		Thyroglobulin Antibody	BOTH IP/OP	$272.00 	$201.28	$0.00	$217.60	$32.84	$32.84	$15.91	$15.91	$7.96	$7.95	$24.15	$24.15	$25.08	$15.91	$23.50	$10.34	$160.89	$160.89	$16.71	$44.44	$215.42	$217.60	$23.07	$0.00	$23.07	$25.04	$15.91	$15.91	$17.53	$15.91	$0.00	$0.00	$0.00	$0.00
30201078	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$227.00 	$167.98	$0.00	$181.60	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$134.27	$134.27	$19.57	$33.64	$179.78	$181.60	$27.03	$0.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201080	EAP	CPT® 86682		Helminth Antibody	BOTH IP/OP	$179.00 	$132.46	$6.50	$144.80	$26.85	$26.85	$13.01	$13.01	$6.51	$6.50	$19.75	$19.75	$20.51	$13.01	$19.20	$8.46	$105.88	$105.88	$13.66	$36.34	$143.35	$144.80	$18.86	$21.47	$18.86	$20.46	$13.01	$13.01	$14.32	$13.01	$0.00	$0.00	$0.00	$0.00
30201082	EAP	CPT® 82135		Assay Aminolevulinic Acid	BOTH IP/OP	$164.00 	$121.36	$0.00	$131.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.00	$25.00	$25.96	$0.00	$24.32	$0.00	$0.00	$0.00	$0.00	$46.00	$129.89	$131.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201084	EAP	CPT® 82135		Assay Aminolevulinic Acid	BOTH IP/OP	$164.00 	$121.36	$0.00	$131.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.00	$25.00	$25.96	$0.00	$24.32	$0.00	$0.00	$0.00	$0.00	$46.00	$129.89	$131.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201086	EAP	CPT® 86790		Virus Antibody Nos	BOTH IP/OP	$267.00 	$197.58	$6.44	$195.20	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$157.93	$157.93	$13.52	$36.00	$193.25	$195.20	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30201088	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$201.00 	$148.74	$0.00	$160.80	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$118.89	$118.89	$19.57	$33.64	$159.19	$160.80	$27.03	$0.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201090	EAP	CPT® 82533		Total Cortisol	BOTH IP/OP	$367.00 	$271.58	$0.00	$293.60	$33.66	$33.66	$16.30	$16.30	$8.15	$8.15	$24.76	$24.76	$25.71	$16.30	$24.09	$10.60	$217.08	$217.08	$17.12	$45.56	$290.66	$293.60	$23.64	$0.00	$23.64	$25.67	$16.30	$16.30	$17.97	$16.30	$0.00	$0.00	$0.00	$0.00
30201092	EAP	CPT® 86648		Diptheria Antibody	BOTH IP/OP	$97.00 	$71.78	$0.00	$77.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.10	$23.10	$23.99	$0.00	$22.47	$0.00	$0.00	$0.00	$0.00	$42.50	$76.82	$77.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201093	EAP	CPT® 86774		Tetanus Antibody	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.47	$22.47	$23.34	$0.00	$21.86	$0.00	$0.00	$0.00	$15.54	$41.36	$68.90	$69.60	$21.46	$0.00	$21.46	$23.29	$14.80	$14.80	$16.31	$14.80	$0.00	$0.00	$0.00	$0.00
30201097	EAP	CPT® 80307		Drug Screen Single	BOTH IP/OP	$35.00 	$25.90	$0.00	$82.57	$35.00	$35.00	$0.00	$0.00	$6.23	$29.09	$79.51	$79.51	$82.57	$0.00	$7.29	$0.00	$20.70	$20.70	$0.00	$37.50	$59.40	$60.00	$75.00	$0.00	$75.00	$76.56	$62.14	$62.14	$53.59	$0.00	$0.00	$0.00	$0.00	$0.00
30201105	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$282.00 	$208.68	$8.39	$225.60	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$166.80	$166.80	$19.57	$33.64	$223.34	$225.60	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201107	EAP	CPT® 82438		Assay Other Fluid Chlorides	BOTH IP/OP	$110.00 	$81.40	$0.00	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.43	$7.43	$7.71	$0.00	$7.22	$0.00	$0.00	$0.00	$0.00	$13.66	$87.12	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201108	EAP	CPT® 84302		Assay Of Sweat Sodium	BOTH IP/OP	$114.00 	$84.36	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.25	$5.25	$5.45	$0.00	$5.11	$0.00	$0.00	$0.00	$0.00	$9.66	$95.04	$96.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201109	EAP	CPT® 84311		Spectrophotometry	BOTH IP/OP	$72.00 	$53.28	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.61	$10.61	$11.02	$0.00	$10.32	$0.00	$0.00	$0.00	$8.51	$19.54	$71.28	$72.00	$11.75	$0.00	$11.75	$11.00	$8.10	$8.10	$7.70	$8.10	$0.00	$0.00	$0.00	$0.00
30201111	EAP	CPT® 86255		Fluorescent Antibody Screen	BOTH IP/OP	$124.00 	$91.76	$6.03	$124.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$73.35	$73.35	$12.65	$33.68	$122.76	$124.00	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201113	EAP	CPT® 87337		Entamoeb Hist Group Ag Eia	BOTH IP/OP	$89.00 	$65.86	$0.00	$71.20	$24.74	$24.74	$11.98	$11.98	$5.99	$5.99	$18.22	$18.22	$18.92	$11.98	$17.71	$7.79	$52.64	$52.64	$12.58	$33.52	$70.49	$71.20	$17.37	$0.00	$17.37	$18.87	$11.98	$11.98	$13.21	$11.98	$0.00	$0.00	$0.00	$0.00
30201115	EAP	CPT® 87798		Detect Agent Nos Dna Amp	BOTH IP/OP	$311.00 	$230.14	$0.00	$300.00	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$183.96	$183.96	$36.84	$54.82	$297.00	$300.00	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30201117	EAP	CPT® 87799		Detect Agent Nos Dna Quant	BOTH IP/OP	$779.00 	$576.46	$0.00	$712.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.42	$65.04	$65.04	$67.54	$42.84	$162.34	$27.85	$460.78	$460.78	$0.00	$119.70	$704.88	$712.00	$0.00	$0.00	$0.00	$139.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201119	EAP	CPT® 84202		Assay Rbc Protoporphyrin	BOTH IP/OP	$24.00 	$17.76	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.79	$21.79	$22.63	$0.00	$21.20	$0.00	$0.00	$0.00	$0.00	$24.00	$19.01	$19.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201121	EAP	CPT® 82672		Assay Of Estrogen	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.29	$25.29	$26.27	$0.00	$24.60	$0.00	$0.00	$0.00	$0.00	$46.54	$103.75	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201129	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$178.00 	$131.72	$0.00	$142.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$105.29	$105.29	$22.49	$59.86	$140.98	$142.40	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30201130	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$139.00	$139.00	$53.75	$112.22	$186.12	$188.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30201133	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$136.05	$136.05	$22.49	$59.86	$182.16	$184.00	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30201134	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$293.00 	$216.82	$0.00	$234.40	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$173.31	$173.31	$53.75	$112.22	$232.06	$234.40	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30201137	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$128.95	$128.95	$22.49	$59.86	$172.66	$174.40	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30201138	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$282.00 	$208.68	$0.00	$225.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$166.80	$166.80	$53.75	$112.22	$223.34	$225.60	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30201147	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$279.00 	$206.46	$8.39	$223.20	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$165.03	$165.03	$19.57	$33.64	$220.97	$223.20	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201151	EAP	CPT® 83789		Mass Spectrometry Quant	BOTH IP/OP	$104.00 	$76.96	$0.00	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$82.37	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201153	EAP	CPT® 86001		Allergen Specific Igg	BOTH IP/OP	$196.00 	$145.04	$0.00	$195.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.92	$7.92	$8.23	$0.00	$7.72	$0.00	$0.00	$0.00	$0.00	$14.60	$193.25	$195.20	$0.00	$149.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201155	EAP	CPT® 82679		Assay Of Estrone	BOTH IP/OP	$35.00 	$25.90	$0.00	$39.37	$35.00	$35.00	$24.95	$24.95	$12.48	$12.48	$37.91	$37.91	$39.37	$24.95	$35.00	$16.22	$20.70	$20.70	$26.20	$35.00	$27.72	$28.00	$35.00	$0.00	$35.00	$39.29	$24.95	$24.95	$27.50	$24.95	$0.00	$0.00	$0.00	$0.00
30201156	EAP	CPT® 82670		Assay Of Estradiol	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.96	$146.96	$152.62	$0.00	$26.26	$0.00	$0.00	$0.00	$29.34	$78.08	$156.82	$158.40	$40.51	$100.00	$40.51	$43.98	$27.94	$27.94	$30.79	$27.94	$0.00	$0.00	$0.00	$0.00
30201157	EAP	CPT® 82677		Assay Of Estriol	BOTH IP/OP	$35.00 	$25.90	$0.00	$38.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.72	$36.72	$38.13	$0.00	$35.00	$0.00	$0.00	$0.00	$25.39	$35.00	$27.72	$28.00	$35.00	$0.00	$35.00	$38.06	$24.18	$24.18	$26.64	$24.18	$0.00	$0.00	$0.00	$0.00
30201159	EAP	CPT® 83883		Assay Nephelometry Not Spec	BOTH IP/OP	$213.00 	$157.62	$0.00	$170.40	$28.06	$28.06	$13.60	$13.60	$6.80	$6.80	$20.64	$20.64	$21.44	$13.60	$20.09	$8.84	$125.99	$125.99	$14.28	$38.00	$168.70	$170.40	$19.72	$0.00	$19.72	$21.40	$13.60	$13.60	$14.98	$13.60	$0.00	$0.00	$0.00	$0.00
30201165	EAP	CPT® 83727		Assay Of Irh Hormone	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.10	$26.10	$27.11	$0.00	$25.40	$0.00	$0.00	$0.00	$0.00	$48.04	$997.92	"$1,008.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201167	EAP	CPT® 87338		Hpylori Stool Eia	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.84	$21.84	$22.68	$0.00	$21.25	$0.00	$0.00	$0.00	$0.00	$40.20	$138.60	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201169	EAP	CPT® 86684		Hemophilus Influenza	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.06	$24.06	$24.98	$0.00	$23.42	$0.00	$0.00	$0.00	$0.00	$44.28	$156.82	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201171	EAP	CPT® 84702		Chorionic Gonadotropin Test	BOTH IP/OP	$162.00 	$119.88	$7.07	$117.60	$13.25	$13.25	$15.05	$15.05	$7.53	$7.53	$9.74	$9.74	$10.12	$15.05	$9.48	$9.78	$95.82	$95.82	$15.80	$17.94	$116.42	$117.60	$21.82	$24.83	$21.82	$10.10	$15.05	$15.05	$7.07	$15.05	$0.00	$0.00	$0.00	$0.00
30201173	EAP	CPT® 82175		Assay Of Arsenic	BOTH IP/OP	$43.00 	$31.82	$0.00	$43.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.49	$28.81	$28.81	$29.92	$18.97	$28.02	$12.33	$25.43	$25.43	$19.92	$43.00	$34.06	$34.40	$27.51	$0.00	$27.51	$0.00	$18.97	$18.97	$20.90	$18.97	$0.00	$0.00	$0.00	$0.00
30201174	EAP	CPT® 83655		Assay Of Lead	BOTH IP/OP	$54.00 	$39.96	$0.00	$43.20	$25.00	$25.00	$12.11	$12.11	$6.06	$6.05	$18.38	$18.38	$19.08	$12.11	$11.75	$7.87	$31.94	$31.94	$12.72	$33.82	$42.77	$43.20	$17.56	$0.00	$17.56	$12.52	$12.11	$12.11	$8.76	$12.11	$0.00	$0.00	$0.00	$0.00
30201175	EAP	CPT® 83825		Assay Of Mercury	BOTH IP/OP	$38.00 	$28.12	$0.00	$38.00	$33.55	$33.55	$16.26	$16.26	$8.13	$8.13	$24.69	$24.69	$25.64	$16.26	$24.02	$10.57	$22.48	$22.48	$17.07	$38.00	$30.10	$30.40	$23.58	$0.00	$23.58	$0.00	$16.26	$16.26	$17.92	$16.26	$0.00	$0.00	$0.00	$0.00
30201177	EAP	CPT® 82175		Assay Of Arsenic	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$0.00	$9.49	$28.81	$28.81	$29.92	$18.97	$28.02	$12.33	$40.81	$40.81	$19.92	$53.02	$54.65	$55.20	$27.51	$0.00	$27.51	$0.00	$18.97	$18.97	$20.90	$18.97	$0.00	$0.00	$0.00	$0.00
30201178	EAP	CPT® 82300		Assay Of Cadmium	BOTH IP/OP	$75.00 	$55.50	$0.00	$64.66	$47.78	$47.78	$23.64	$23.64	$11.82	$11.57	$35.14	$35.14	$36.49	$23.64	$34.19	$15.37	$44.36	$44.36	$0.00	$64.66	$59.40	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201179	EAP	CPT® 82570		Assay Of Urine Creatinine	BOTH IP/OP	$91.00 	$67.34	$0.00	$72.80	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$53.83	$53.83	$5.44	$14.46	$72.07	$72.80	$7.51	$0.00	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30201180	EAP	CPT® 83655		Assay Of Lead	BOTH IP/OP	$76.00 	$56.24	$0.00	$60.80	$25.00	$25.00	$12.11	$12.11	$6.06	$6.05	$18.38	$18.38	$19.08	$12.11	$11.75	$7.87	$44.95	$44.95	$12.72	$33.82	$60.19	$60.80	$17.56	$0.00	$17.56	$12.52	$12.11	$12.11	$8.76	$12.11	$0.00	$0.00	$0.00	$0.00
30201181	EAP	CPT® 83825		Assay Of Mercury	BOTH IP/OP	$62.00 	$45.88	$0.00	$49.60	$33.55	$33.55	$16.26	$16.26	$8.13	$8.13	$24.69	$24.69	$25.64	$16.26	$24.02	$10.57	$36.67	$36.67	$17.07	$45.44	$49.10	$49.60	$23.58	$0.00	$23.58	$0.00	$16.26	$16.26	$17.92	$16.26	$0.00	$0.00	$0.00	$0.00
30201183	EAP	CPT® 86804		Hep C Ab Test Confirm	BOTH IP/OP	$396.00 	$293.04	$0.00	$330.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.51	$23.51	$24.42	$0.00	$22.88	$0.00	$0.00	$0.00	$0.00	$43.28	$327.10	$330.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201185	EAP	CPT® 87299		Antibody Detection Nos If	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$69.70	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201187	EAP	CPT® 86970		Rbc Pretreatment	BOTH IP/OP	$510.00 	$377.40	$0.00	$438.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.59	$16.59	$17.23	$0.00	$106.28	$0.00	$0.00	$0.00	$0.00	$37.22	$434.02	$438.40	$0.00	$193.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201189	EAP	CPT® 87798		Detect Agent Nos Dna Amp	BOTH IP/OP	$436.00 	$322.64	$0.00	$420.00	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$257.89	$257.89	$36.84	$54.82	$415.80	$420.00	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30201191	EAP	CPT® 86698		Histoplasma	BOTH IP/OP	$72.00 	$53.28	$0.00	$57.60	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$18.98	$18.98	$19.71	$13.79	$18.46	$8.96	$42.59	$42.59	$14.48	$34.92	$57.02	$57.60	$20.00	$0.00	$20.00	$19.67	$13.79	$13.79	$13.77	$13.79	$0.00	$0.00	$0.00	$0.00
30201193	EAP	CPT® 86689		Htlv/hiv Confirmatory Test	BOTH IP/OP	$143.00 	$105.82	$0.00	$118.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.39	$29.39	$30.52	$0.00	$24.81	$0.00	$0.00	$0.00	$0.00	$54.10	$117.22	$118.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201195	EAP	CPT® 86702		Hiv-2	BOTH IP/OP	$135.00 	$99.90	$0.00	$112.80	$27.90	$27.90	$13.52	$13.52	$6.76	$6.76	$20.53	$20.53	$21.32	$13.52	$17.33	$8.79	$79.85	$79.85	$14.20	$37.76	$111.67	$112.80	$19.60	$0.00	$19.60	$18.46	$13.52	$13.52	$12.92	$13.52	$0.00	$0.00	$0.00	$0.00
30201202	EAP	CPT® 83090		Assay Of Homocystine	BOTH IP/OP	$231.00 	$170.94	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.62	$25.62	$26.60	$0.00	$24.92	$0.00	$0.00	$0.00	$0.00	$47.14	$182.95	$184.80	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201204	EAP	CPT® 82570		Assay Of Urine Creatinine	BOTH IP/OP	$54.00 	$39.96	$0.00	$43.20	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$31.94	$31.94	$5.44	$14.46	$42.77	$43.20	$7.51	$0.00	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30201205	EAP	CPT® 82150		Assay Of Amylase	BOTH IP/OP	$101.00 	$74.74	$0.00	$87.20	$13.38	$13.38	$6.48	$6.48	$3.24	$3.24	$9.84	$9.84	$10.22	$6.48	$9.58	$4.21	$59.74	$59.74	$6.80	$18.12	$86.33	$87.20	$9.40	$0.00	$9.40	$10.20	$6.48	$6.48	$7.14	$6.48	$0.00	$0.00	$0.00	$0.00
30201207	EAP	CPT® 87529		Hsv Dna Amp Probe	BOTH IP/OP	$188.00 	$139.12	$17.55	$155.20	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$111.20	$111.20	$36.84	$54.82	$153.65	$155.20	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30201209	EAP	CPT® 87530		Hsv Dna Quant	BOTH IP/OP	$248.00 	$183.52	$0.00	$204.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.04	$65.04	$67.54	$0.00	$51.68	$0.00	$0.00	$0.00	$0.00	$119.70	$202.75	$204.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201211	EAP	CPT® 87532		Hhv-6 Dna Amp Probe	BOTH IP/OP	$343.00 	$253.82	$0.00	$343.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.79	$29.79	$30.93	$0.00	$28.98	$0.00	$0.00	$0.00	$0.00	$54.82	$263.74	$266.40	$0.00	$343.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201213	EAP	CPT® 83632		Placental Lactogen	BOTH IP/OP	$484.00 	$358.16	$0.00	$352.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.69	$30.69	$31.87	$0.00	$29.86	$0.00	$0.00	$0.00	$0.00	$56.48	$349.27	$352.80	$0.00	$321.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201220	EAP	CPT® 86331		Immunodiffusion Ouchterlony	BOTH IP/OP	$19.00 	$14.06	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.20	$18.20	$18.90	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$19.00	$15.05	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201221	EAP	CPT® 86606		Aspergillus Antibody	BOTH IP/OP	$27.00 	$19.98	$0.00	$27.00	$27.00	$27.00	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$15.97	$15.97	$15.80	$27.00	$21.38	$21.60	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30201222	EAP	CPT® 86744		Nocardia Antibody	BOTH IP/OP	$24.00 	$17.76	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$24.00	$19.01	$19.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201224	EAP	CPT® 86341		Islet Cell Antibody	BOTH IP/OP	$195.00 	$144.30	$10.61	$154.40	$40.84	$40.84	$23.57	$23.57	$11.79	$10.61	$30.05	$30.05	$31.20	$23.57	$29.24	$15.32	$115.34	$115.34	$24.75	$55.30	$152.86	$154.40	$34.18	$38.89	$34.18	$31.16	$23.57	$23.57	$21.81	$23.57	$0.00	$0.00	$0.00	$0.00
30201226	EAP	CPT® 82784		Assay Iga/igd/igg/igm Each	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$19.19	$19.19	$9.30	$9.30	$4.65	$4.65	$14.12	$14.12	$14.67	$9.30	$13.73	$6.05	$20.11	$20.11	$9.77	$25.98	$26.93	$27.20	$13.49	$0.00	$13.49	$14.63	$9.30	$9.30	$10.24	$9.30	$0.00	$0.00	$0.00	$0.00
30201227	EAP	CPT® 82787		Igg 1 2 3 Or 4 Each	BOTH IP/OP	$28.00 	$20.72	$4.01	$22.40	$16.55	$16.55	$8.02	$8.02	$4.01	$4.01	$12.18	$12.18	$12.65	$8.02	$11.84	$5.21	$16.56	$16.56	$8.42	$22.40	$22.18	$22.40	$11.63	$13.23	$11.63	$12.62	$8.02	$8.02	$8.83	$8.02	$0.00	$0.00	$0.00	$0.00
30201229	EAP	CPT® 86336		Inhibin A	BOTH IP/OP	$128.00 	$94.72	$0.00	$102.40	$26.74	$26.74	$15.59	$15.59	$7.80	$7.79	$19.66	$19.66	$20.41	$15.59	$19.12	$10.13	$75.71	$75.71	$16.37	$36.18	$101.38	$102.40	$22.61	$0.00	$22.61	$20.37	$15.59	$15.59	$14.26	$15.59	$0.00	$0.00	$0.00	$0.00
30201231	EAP	CPT® 83520		Immunoassay Quant Nos Nonab	BOTH IP/OP	$383.00 	$283.42	$7.77	$345.60	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$226.54	$226.54	$18.13	$36.18	$342.14	$345.60	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30201233	EAP	CPT® 83789		Mass Spectrometry Quant	BOTH IP/OP	$116.00 	$85.84	$0.00	$92.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$91.87	$92.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201235	EAP	CPT® 86886		Coombs Test Indirect Titer	BOTH IP/OP	$163.00 	$120.62	$0.00	$163.00	$9.58	$9.58	$145.24	$145.24	$146.06	$2.59	$7.06	$7.06	$7.33	$142.96	$6.87	$92.92	$96.41	$96.41	$143.92	$13.00	$129.10	$130.40	$163.00	$0.00	$163.00	$7.32	$5.18	$5.18	$5.12	$137.07	$0.00	$0.00	$0.00	$0.00
30201236	EAP	CPT® 86900		"Blood Typing, Serologic, Abo"	BOTH IP/OP	$312.00 	$230.88	$1.49	$262.40	$6.18	$6.18	$109.81	$109.81	$110.43	$1.49	$4.52	$4.52	$4.70	$107.30	$4.41	$69.74	$184.55	$184.55	$109.35	$8.34	$259.78	$262.40	$151.93	$159.90	$151.93	$4.70	$2.99	$2.99	$3.29	$104.14	$0.00	$0.00	$0.00	$0.00
30201238	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$209.00 	$154.66	$8.39	$168.00	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$123.62	$123.62	$19.57	$33.64	$166.32	$168.00	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201248	EAP	CPT® 83630		Lactoferrin Fecal (qual)	BOTH IP/OP	$164.00 	$121.36	$0.00	$131.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.81	$29.81	$30.95	$0.00	$15.80	$0.00	$0.00	$0.00	$0.00	$54.84	$129.89	$131.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201250	EAP	CPT® 87278		Legion Pneumophilia Ag If	BOTH IP/OP	$148.00 	$109.52	$0.00	$118.40	$24.74	$24.74	$15.60	$15.60	$7.80	$7.02	$18.22	$18.22	$18.92	$15.60	$17.71	$10.14	$87.54	$87.54	$0.00	$33.52	$117.22	$118.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201252	EAP	CPT® 86717		Leishmania Antibody	BOTH IP/OP	$149.00 	$110.26	$0.00	$120.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.61	$18.61	$19.32	$0.00	$18.10	$0.00	$0.00	$0.00	$0.00	$34.24	$119.59	$120.80	$0.00	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201254	EAP	CPT® 83690		Assay Of Lipase	BOTH IP/OP	$83.00 	$61.42	$3.44	$67.20	$14.23	$14.23	$6.89	$6.89	$3.45	$3.44	$10.46	$10.46	$10.86	$6.89	$10.17	$4.48	$49.09	$49.09	$7.23	$19.24	$66.53	$67.20	$9.99	$11.37	$9.99	$10.84	$6.89	$6.89	$7.59	$6.89	$0.00	$0.00	$0.00	$0.00
30201256	EAP	CPT® 83695		Assay Of Lipoprotein(a)	BOTH IP/OP	$109.00 	$80.66	$6.48	$87.20	$26.72	$26.72	$14.32	$14.32	$7.16	$6.48	$19.67	$19.67	$20.42	$14.32	$19.12	$9.31	$64.47	$64.47	$15.04	$36.18	$86.33	$87.20	$20.76	$23.63	$20.76	$20.37	$14.32	$14.32	$14.26	$14.32	$0.00	$0.00	$0.00	$0.00
30201258	EAP	CPT® 82465		Assay Bld/serum Cholesterol	BOTH IP/OP	$9.00 	$6.66	$0.00	$9.00	$8.98	$8.98	$4.35	$4.35	$2.18	$2.18	$6.61	$6.61	$6.87	$4.35	$6.43	$2.83	$5.32	$5.32	$4.57	$9.00	$7.13	$7.20	$6.31	$0.00	$6.31	$6.85	$4.35	$4.35	$4.79	$4.35	$0.00	$0.00	$0.00	$0.00
30201259	EAP	CPT® 82664		Electrophoretic Test	BOTH IP/OP	$176.00 	$130.24	$0.00	$151.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.17	$52.17	$54.17	$0.00	$50.75	$0.00	$0.00	$0.00	$64.58	$96.00	$149.69	$151.20	$89.18	$0.00	$89.18	$54.07	$61.50	$61.50	$37.85	$61.50	$0.00	$0.00	$0.00	$0.00
30201260	EAP	CPT® 84478		Assay Of Triglycerides	BOTH IP/OP	$16.00 	$11.84	$0.00	$16.08	$11.85	$11.85	$5.74	$5.74	$2.87	$2.87	$8.74	$8.74	$9.07	$5.74	$7.46	$3.73	$9.46	$9.46	$6.03	$16.08	$14.26	$14.40	$8.32	$0.00	$8.32	$7.94	$5.74	$5.74	$5.56	$5.74	$0.00	$0.00	$0.00	$0.00
30201261	EAP	CPT® 84999		Clinical Chemistry Test	BOTH IP/OP	$23.00 	$17.02	$0.00	$19.20	$0.00	$0.00	$0.00	$0.00	$4.09	$0.00	$17.07	$17.07	$17.73	$0.00	$4.79	$0.00	$0.00	$0.00	$0.00	$0.00	$19.01	$19.20	$0.00	$0.00	$0.00	$3.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201263	EAP	CPT® 86609		Bacterium Antibody	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$103.51	$103.51	$0.00	$36.00	$138.60	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201265	EAP	CPT® 86376		Microsomal Antibody	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$30.04	$30.04	$14.55	$14.55	$7.28	$7.28	$22.10	$22.10	$22.95	$14.55	$21.49	$9.46	$121.26	$121.26	$15.28	$40.66	$162.36	$164.00	$21.10	$0.00	$21.10	$22.90	$14.55	$14.55	$16.03	$14.55	$0.00	$0.00	$0.00	$0.00
30201267	EAP	CPT® 83516		Immunoassay Nonantibody	BOTH IP/OP	$107.00 	$79.18	$0.00	$96.80	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$63.29	$63.29	$12.11	$29.88	$95.83	$96.80	$16.72	$0.00	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30201268	EAP	CPT® 83520		Immunoassay Quant Nos Nonab	BOTH IP/OP	$118.00 	$87.32	$0.00	$106.40	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$69.80	$69.80	$18.13	$36.18	$105.34	$106.40	$25.04	$0.00	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30201269	EAP	CPT® 86038		Antinuclear Antibodies	BOTH IP/OP	$72.00 	$53.28	$0.00	$57.60	$24.95	$24.95	$12.09	$12.09	$6.05	$6.04	$18.36	$18.36	$19.06	$12.09	$17.86	$7.86	$42.59	$42.59	$12.69	$33.78	$57.02	$57.60	$17.53	$0.00	$17.53	$19.03	$12.09	$12.09	$13.32	$12.09	$0.00	$0.00	$0.00	$0.00
30201270	EAP	CPT® 84160		Assay Of Protein Any Source	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.86	$7.86	$8.16	$0.00	$7.64	$0.00	$0.00	$0.00	$0.00	$14.46	$102.17	$103.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201271	EAP	CPT® 86235		Nuclear Antigen Antibody	BOTH IP/OP	$76.00 	$56.24	$0.00	$74.40	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$44.95	$44.95	$18.83	$50.12	$73.66	$74.40	$26.00	$0.00	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30201272	EAP	CPT® 86255		Fluorescent Antibody Screen	BOTH IP/OP	$61.00 	$45.14	$0.00	$60.80	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$36.08	$36.08	$12.65	$33.68	$60.19	$60.80	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201273	EAP	CPT® 86376		Microsomal Antibody	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$30.04	$30.04	$14.55	$14.55	$7.28	$7.28	$22.10	$22.10	$22.95	$14.55	$21.49	$9.46	$33.72	$33.72	$15.28	$40.66	$45.14	$45.60	$21.10	$0.00	$21.10	$22.90	$14.55	$14.55	$16.03	$14.55	$0.00	$0.00	$0.00	$0.00
30201274	EAP	CPT® 86431		Rheumatoid Factor Quant	BOTH IP/OP	$97.00 	$71.78	$0.00	$77.60	$11.70	$11.70	$5.67	$5.67	$2.84	$2.84	$8.62	$8.62	$8.95	$5.67	$8.39	$3.69	$57.38	$57.38	$5.95	$15.86	$76.82	$77.60	$8.22	$0.00	$8.22	$8.94	$5.67	$5.67	$6.26	$5.67	$0.00	$0.00	$0.00	$0.00
30201276	EAP	CPT® 86618		Lyme Disease Antibody	BOTH IP/OP	$69.00 	$51.06	$8.51	$56.00	$35.16	$35.16	$17.03	$17.03	$8.52	$8.51	$25.86	$25.86	$26.86	$17.03	$25.16	$11.07	$40.81	$40.81	$17.88	$47.60	$55.44	$56.00	$24.69	$28.10	$24.69	$26.81	$17.03	$17.03	$18.76	$17.03	$0.00	$0.00	$0.00	$0.00
30201278	EAP	CPT® 87476		Lyme Dis Dna Amp Probe	BOTH IP/OP	$387.00 	$286.38	$0.00	$309.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.79	$29.79	$30.93	$0.00	$28.98	$0.00	$0.00	$0.00	$0.00	$54.82	$306.50	$309.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201280	EAP	CPT® 87476		Lyme Dis Dna Amp Probe	BOTH IP/OP	$387.00 	$286.38	$0.00	$309.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.79	$29.79	$30.93	$0.00	$28.98	$0.00	$0.00	$0.00	$0.00	$54.82	$306.50	$309.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201282	EAP	CPT® 86355		B Cells Total Count	BOTH IP/OP	$111.00 	$82.14	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$91.08	$92.00	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30201283	EAP	CPT® 86357		Nk Cells Total Count	BOTH IP/OP	$111.00 	$82.14	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$91.08	$92.00	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30201284	EAP	CPT® 86359		T Cells Total Count	BOTH IP/OP	$111.00 	$82.14	$0.00	$92.00	$48.63	$48.63	$37.73	$37.73	$18.87	$18.86	$35.77	$35.77	$37.14	$37.73	$34.80	$24.52	$65.66	$65.66	$39.62	$65.82	$91.08	$92.00	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30201285	EAP	CPT® 86360		T Cell Absolute Count/ratio	BOTH IP/OP	$152.00 	$112.48	$0.00	$131.30	$96.99	$96.99	$46.98	$46.98	$23.49	$23.49	$71.34	$71.34	$74.09	$46.98	$69.42	$30.54	$89.91	$89.91	$49.33	$131.30	$125.14	$126.40	$68.12	$0.00	$68.12	$73.96	$46.98	$46.98	$51.77	$46.98	$0.00	$0.00	$0.00	$0.00
30201286	EAP	Custom 30201286		Mac Sensitivity	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201287	EAP	CPT® 87190		Microbe Suscept Mycobacteri	BOTH IP/OP	$35.00 	$25.90	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.58	$8.58	$8.91	$0.00	$8.35	$0.00	$0.00	$0.00	$0.00	$15.80	$25.34	$25.60	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201289	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$266.00 	$196.84	$0.00	$212.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$157.34	$157.34	$22.49	$59.86	$210.67	$212.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30201290	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$192.24	$192.24	$53.75	$112.22	$257.40	$260.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30201295	EAP	CPT® 83825		Assay Of Mercury	BOTH IP/OP	$50.00 	$37.00	$0.00	$45.44	$33.55	$33.55	$16.26	$16.26	$8.13	$8.13	$24.69	$24.69	$25.64	$16.26	$24.02	$10.57	$29.58	$29.58	$17.07	$45.44	$39.60	$40.00	$23.58	$0.00	$23.58	$0.00	$16.26	$16.26	$17.92	$16.26	$0.00	$0.00	$0.00	$0.00
30201297	EAP	CPT® 83825		Assay Of Mercury	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$33.55	$33.55	$16.26	$16.26	$8.13	$8.13	$24.69	$24.69	$25.64	$16.26	$24.02	$10.57	$44.36	$44.36	$17.07	$45.44	$59.40	$60.00	$23.58	$0.00	$23.58	$0.00	$16.26	$16.26	$17.92	$16.26	$0.00	$0.00	$0.00	$0.00
30201299	EAP	CPT® 83835		Assay Of Metanephrines	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$34.98	$34.98	$16.94	$16.94	$8.47	$8.47	$25.73	$25.73	$26.72	$16.94	$25.02	$11.01	$136.05	$136.05	$17.79	$47.34	$182.16	$184.00	$24.56	$0.00	$24.56	$26.66	$16.94	$16.94	$18.66	$16.94	$0.00	$0.00	$0.00	$0.00
30201300	EAP	CPT® 82570		Assay Of Urine Creatinine	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$30.76	$30.76	$5.44	$14.46	$41.18	$41.60	$7.51	$0.00	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30201302	EAP	CPT® 83835		Assay Of Metanephrines	BOTH IP/OP	$573.00 	$424.02	$8.47	$458.40	$34.98	$34.98	$16.94	$16.94	$8.47	$8.47	$25.73	$25.73	$26.72	$16.94	$25.02	$11.01	$338.93	$338.93	$17.79	$47.34	$453.82	$458.40	$24.56	$27.95	$24.56	$26.66	$16.94	$16.94	$18.66	$16.94	$0.00	$0.00	$0.00	$0.00
30201304	EAP	CPT® 80358		Assay Of Methadone	BOTH IP/OP	$187.00 	$138.38	$0.00	$158.40	$0.03	$0.03	$0.00	$0.00	$12.01	$10.03	$138.79	$138.79	$144.14	$0.00	$24.12	$0.00	$110.61	$110.61	$0.00	$99.00	$156.82	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201306	EAP	CPT® 82542		Column Chromotography Quant	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$37.28	$37.28	$24.09	$24.09	$12.05	$10.84	$9.12	$9.12	$9.47	$24.09	$8.87	$15.66	$170.35	$170.35	$25.29	$16.78	$228.10	$230.40	$34.93	$0.00	$34.93	$9.45	$24.09	$24.09	$6.62	$24.09	$0.00	$0.00	$0.00	$0.00
30201310	EAP	CPT® 83921		Organic Acid Single Quant	BOTH IP/OP	$289.00 	$213.86	$0.00	$231.20	$33.95	$33.95	$21.21	$21.21	$10.61	$9.54	$25.00	$25.00	$25.96	$21.21	$24.32	$13.79	$170.94	$170.94	$22.27	$46.00	$228.89	$231.20	$30.75	$0.00	$30.75	$25.91	$21.21	$21.21	$18.14	$21.21	$0.00	$0.00	$0.00	$0.00
30201312	EAP	CPT® 83519		Ria Nonantibody	BOTH IP/OP	"$1,254.00 "	$927.96	$8.28	"$1,132.00"	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$741.74	$741.74	$19.32	$37.76	"$1,120.68"	"$1,132.00"	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30201314	EAP	CPT® 87190		Microbe Suscept Mycobacteri	BOTH IP/OP	$41.00 	$30.34	$0.00	$32.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.58	$8.58	$8.91	$0.00	$8.35	$0.00	$0.00	$0.00	$0.00	$15.80	$32.47	$32.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201316	EAP	CPT® 87581		M.pneumon Dna Probe	BOTH IP/OP	$505.00 	$373.70	$0.00	$417.60	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$298.71	$298.71	$0.00	$54.82	$413.42	$417.60	$0.00	$57.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201318	EAP	CPT® 83873		Assay Of Csf Protein	BOTH IP/OP	$54.00 	$39.96	$0.00	$48.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.12	$26.12	$27.13	$0.00	$25.42	$0.00	$0.00	$0.00	$0.00	$48.08	$42.77	$43.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201320	EAP	CPT® 83874		Assay Of Myoglobin	BOTH IP/OP	$54.00 	$39.96	$0.00	$43.20	$26.66	$26.66	$12.92	$12.92	$6.46	$6.46	$19.61	$19.61	$20.37	$12.92	$19.08	$8.40	$31.94	$31.94	$13.57	$36.08	$42.77	$43.20	$18.73	$0.00	$18.73	$20.33	$12.92	$12.92	$14.23	$12.92	$0.00	$0.00	$0.00	$0.00
30201322	EAP	CPT® 86255		Fluorescent Antibody Screen	BOTH IP/OP	$367.00 	$271.58	$6.03	$294.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$217.08	$217.08	$12.65	$33.68	$291.46	$294.40	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201324	EAP	CPT® 80323		Assay Of Nicotine	BOTH IP/OP	$212.00 	$156.88	$0.00	$169.60	$0.03	$0.03	$0.00	$0.00	$12.01	$18.43	$157.35	$157.35	$163.41	$0.00	$44.34	$0.00	$125.40	$125.40	$0.00	$106.00	$167.90	$169.60	$127.20	$137.80	$127.20	$47.25	$0.00	$0.00	$33.07	$0.00	$0.00	$0.00	$0.00	$0.00
30201326	EAP	CPT® 84999		Clinical Chemistry Test	BOTH IP/OP	$124.00 	$91.76	$0.00	$105.60	$0.00	$0.00	$0.00	$0.00	$22.07	$0.00	$92.03	$92.03	$95.58	$0.00	$25.84	$0.00	$0.00	$0.00	$0.00	$0.00	$104.54	$105.60	$0.00	$0.00	$0.00	$20.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201328	EAP	CPT® 83945		Assay Of Oxalate	BOTH IP/OP	$48.00 	$35.52	$0.00	$38.40	$26.58	$26.58	$14.45	$14.45	$7.23	$6.50	$19.55	$19.55	$20.30	$14.45	$19.02	$9.39	$28.39	$28.39	$0.00	$35.98	$38.02	$38.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201330	EAP	CPT® 87279		Parainfluenza Ag If	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$33.26	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201334	EAP	CPT® 86255		Fluorescent Antibody Screen	BOTH IP/OP	$241.00 	$178.34	$0.00	$192.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.65	$33.68	$190.87	$192.80	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201335	EAP	CPT® 86255		Fluorescent Antibody Screen	BOTH IP/OP	$171.00 	$126.54	$0.00	$171.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$101.15	$101.15	$12.65	$33.68	$169.49	$171.20	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201336	EAP	CPT® 86255		Fluorescent Antibody Screen	BOTH IP/OP	$133.00 	$98.42	$0.00	$132.80	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$78.67	$78.67	$12.65	$33.68	$131.47	$132.80	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201338	EAP	CPT® 87799		Detect Agent Nos Dna Quant	BOTH IP/OP	$634.00 	$469.16	$0.00	$634.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.42	$65.04	$65.04	$67.54	$42.84	$132.13	$27.85	$375.01	$375.01	$0.00	$119.70	$495.79	$500.80	$0.00	$634.00	$0.00	$97.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201340	EAP	CPT® 82657		Enzyme Cell Activity	BOTH IP/OP	$228.00 	$168.72	$0.00	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.12	$9.12	$9.47	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$16.78	$180.58	$182.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201342	EAP	CPT® 83992		Assay For Phencyclidine	BOTH IP/OP	$254.00 	$187.96	$0.00	$215.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.32	$22.32	$23.18	$0.00	$21.72	$0.00	$0.00	$0.00	$0.00	$41.08	$213.05	$215.20	$0.00	$159.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201344	EAP	CPT® 82570		Assay Of Urine Creatinine	BOTH IP/OP	$84.00 	$62.16	$0.00	$67.20	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$49.69	$49.69	$5.44	$14.46	$66.53	$67.20	$7.51	$0.00	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30201345	EAP	CPT® 84600		Assay Of Volatiles	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$33.18	$33.18	$17.11	$17.11	$8.56	$8.04	$24.41	$24.41	$25.35	$17.11	$23.74	$11.12	$59.74	$59.74	$0.00	$44.90	$79.99	$80.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201354	EAP	CPT® 84110		Assay Of Porphobilinogen	BOTH IP/OP	$54.00 	$39.96	$0.00	$54.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.83	$12.83	$13.33	$0.00	$12.47	$0.00	$0.00	$0.00	$8.86	$23.60	$42.77	$43.20	$12.24	$54.00	$12.24	$13.29	$8.44	$8.44	$9.30	$8.44	$0.00	$0.00	$0.00	$0.00
30201358	EAP	CPT® 84120		Assay Of Urine Porphyrins	BOTH IP/OP	$55.00 	$40.70	$0.00	$55.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.36	$22.33	$22.33	$23.19	$14.71	$21.74	$9.56	$32.53	$32.53	$0.00	$41.10	$43.56	$44.00	$0.00	$55.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201362	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$414.00 	$306.36	$8.39	$331.20	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$244.88	$244.88	$19.57	$33.64	$327.89	$331.20	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201363	EAP	CPT® 84206		Proinsulin So	BOTH IP/OP	$488.00 	$361.12	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.05	$27.05	$28.09	$0.00	$26.31	$0.00	$0.00	$0.00	$28.02	$49.78	$386.50	$390.40	$38.70	$488.00	$38.70	$28.04	$26.69	$26.69	$19.63	$26.69	$0.00	$0.00	$0.00	$0.00
30201364	EAP	CPT® 84206		Assay Of Proinsulin	BOTH IP/OP	$644.00 	$476.56	$0.00	$515.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.05	$27.05	$28.09	$0.00	$26.31	$0.00	$0.00	$0.00	$28.02	$49.78	$510.05	$515.20	$38.70	$0.00	$38.70	$28.04	$26.69	$26.69	$19.63	$26.69	$0.00	$0.00	$0.00	$0.00
30201368	EAP	CPT® 85303		"Blood Clot Inhibitor Test;protein C,activity"	BOTH IP/OP	$428.00 	$316.72	$0.00	$342.40	$28.56	$28.56	$13.84	$13.84	$6.92	$6.92	$21.00	$21.00	$21.81	$13.84	$20.43	$9.00	$253.16	$253.16	$14.53	$38.64	$338.98	$342.40	$20.07	$0.00	$20.07	$21.77	$13.84	$13.84	$15.24	$13.84	$0.00	$0.00	$0.00	$0.00
30201369	EAP	CPT® 85306		"Blood Clot Inhibitor Test;protein S,free"	BOTH IP/OP	$513.00 	$379.62	$0.00	$410.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.26	$23.26	$24.16	$0.00	$22.64	$0.00	$0.00	$0.00	$0.00	$42.82	$406.30	$410.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201371	EAP	CPT® 85305		"Blood Clot Inhibitor Assay;protein S,total"	BOTH IP/OP	$493.00 	$364.82	$0.00	$394.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.61	$17.61	$18.28	$0.00	$17.13	$0.00	$0.00	$0.00	$0.00	$32.40	$390.46	$394.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201373	EAP	CPT® 84153		Assay Of Psa Total	BOTH IP/OP	$41.00 	$30.34	$0.00	$32.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.47	$0.00	$0.00	$0.00	$0.00	$28.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201374	EAP	CPT® 84154		Assay Of Psa Free	BOTH IP/OP	$42.00 	$31.08	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.92	$27.92	$29.00	$0.00	$27.17	$0.00	$0.00	$0.00	$0.00	$42.00	$33.26	$33.60	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201376	EAP	CPT® 83970		Assay Of Parathormone	BOTH IP/OP	$177.00 	$130.98	$0.00	$141.60	$85.19	$85.19	$41.28	$41.28	$20.64	$20.64	$62.68	$62.68	$65.09	$41.28	$60.97	$26.83	$104.70	$104.70	$43.34	$115.34	$140.18	$141.60	$59.86	$0.00	$59.86	$64.97	$41.28	$41.28	$45.48	$41.28	$0.00	$0.00	$0.00	$0.00
30201378	EAP	CPT® 83519		Ria Nonantibody	BOTH IP/OP	$483.00 	$357.42	$0.00	$436.00	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$285.69	$285.69	$19.32	$37.76	$431.64	$436.00	$26.68	$0.00	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30201380	EAP	CPT® 84220		Assay Of Pyruvate Kinase	BOTH IP/OP	$232.00 	$171.68	$0.00	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.32	$14.32	$14.87	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$26.36	$183.74	$185.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201382	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$255.00 	$188.70	$8.39	$204.00	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$150.83	$150.83	$19.57	$33.64	$201.96	$204.00	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201384	EAP	CPT® 86317		Immunoassay Infectious Agent	BOTH IP/OP	$143.00 	$105.82	$0.00	$114.40	$24.79	$24.79	$14.99	$14.99	$7.50	$7.49	$18.22	$18.22	$18.92	$14.99	$17.72	$9.74	$84.58	$84.58	$15.74	$33.54	$113.26	$114.40	$21.74	$0.00	$21.74	$18.89	$14.99	$14.99	$13.22	$14.99	$0.00	$0.00	$0.00	$0.00
30201386	EAP	CPT® 80195		Assay Of Sirolimus	BOTH IP/OP	$279.00 	$206.46	$0.00	$223.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.84	$20.84	$21.64	$0.00	$20.27	$0.00	$0.00	$0.00	$0.00	$38.34	$220.97	$223.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201388	EAP	CPT® 87299		Antibody Detection Nos If	BOTH IP/OP	$91.00 	$67.34	$0.00	$72.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$72.07	$72.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201390	EAP	CPT® 86003		Allergen Specific Ige	BOTH IP/OP	$96.00 	$71.04	$0.00	$96.00	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$56.78	$56.78	$5.48	$14.60	$95.04	$96.00	$7.57	$0.00	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30201392	EAP	CPT® 86003		Allergen Specific Ige	BOTH IP/OP	$104.00 	$76.96	$2.61	$104.00	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$61.52	$61.52	$5.48	$14.60	$102.96	$104.00	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30201478	EAP	CPT® 82480		Assay Serum Cholinesterase	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.97	$11.97	$12.43	$0.00	$11.64	$0.00	$0.00	$0.00	$0.00	$22.02	$33.26	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201479	EAP	CPT® 82482		Assay Rbc Cholinesterase	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.67	$11.67	$12.12	$0.00	$11.36	$0.00	$0.00	$0.00	$0.00	$21.48	$33.26	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201481	EAP	CPT® 85635		Reptilase Test	BOTH IP/OP	$178.00 	$131.72	$0.00	$178.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.96	$14.96	$15.53	$0.00	$14.54	$0.00	$0.00	$0.00	$0.00	$27.52	$140.98	$142.40	$0.00	$178.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201483	EAP	CPT® 87798		Detect Agent Nos Dna Amp	BOTH IP/OP	$309.00 	$228.66	$0.00	$297.60	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$182.77	$182.77	$36.84	$54.82	$294.62	$297.60	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30201485	EAP	CPT® 84482		T3 Reverse	BOTH IP/OP	$129.00 	$95.46	$0.00	$118.40	$32.52	$32.52	$15.76	$15.76	$7.88	$7.88	$23.93	$23.93	$24.85	$15.76	$23.28	$10.24	$76.30	$76.30	$16.55	$44.04	$117.22	$118.40	$22.85	$0.00	$22.85	$0.00	$15.76	$15.76	$17.36	$15.76	$0.00	$0.00	$0.00	$0.00
30201487	EAP	CPT® 83516		Immunoassay Nonantibody	BOTH IP/OP	$199.00 	$147.26	$5.76	$155.20	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$117.71	$117.71	$12.11	$29.88	$153.65	$155.20	$16.72	$19.02	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30201489	EAP	CPT® 86757		Rickettsia Antibody	BOTH IP/OP	$78.00 	$57.72	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.39	$29.39	$30.52	$0.00	$28.60	$0.00	$0.00	$0.00	$0.00	$54.10	$77.62	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201493	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$171.00 	$126.54	$8.39	$137.60	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$101.15	$101.15	$19.57	$33.64	$136.22	$137.60	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201495	EAP	CPT® 83520		Immunoassay Quant Nos Nonab	BOTH IP/OP	$211.00 	$156.14	$7.77	$164.00	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$124.81	$124.81	$18.13	$36.18	$162.36	$164.00	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30201497	EAP	CPT® 86671		Fungus Antibody	BOTH IP/OP	$99.00 	$73.26	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$18.62	$19.33	$0.00	$18.11	$0.00	$0.00	$0.00	$12.86	$34.26	$79.20	$80.00	$17.76	$99.00	$17.76	$19.30	$12.25	$12.25	$13.51	$12.25	$0.00	$0.00	$0.00	$0.00
30201499	EAP	CPT® 86671		Fungus Antibody	BOTH IP/OP	$47.00 	$34.78	$0.00	$47.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$18.62	$19.33	$0.00	$18.11	$0.00	$0.00	$0.00	$12.86	$34.26	$37.22	$37.60	$17.76	$47.00	$17.76	$19.30	$12.25	$12.25	$13.51	$12.25	$0.00	$0.00	$0.00	$0.00
30201501	EAP	CPT® 86682		Helminth Antibody	BOTH IP/OP	$192.00 	$142.08	$0.00	$153.60	$26.85	$26.85	$13.01	$13.01	$6.51	$6.50	$19.75	$19.75	$20.51	$13.01	$19.20	$8.46	$113.57	$113.57	$13.66	$36.34	$152.06	$153.60	$18.86	$0.00	$18.86	$20.46	$13.01	$13.01	$14.32	$13.01	$0.00	$0.00	$0.00	$0.00
30201503	EAP	CPT® 84255		Assay Of Selenium	BOTH IP/OP	$98.00 	$72.52	$0.00	$78.40	$52.69	$52.69	$25.53	$25.53	$12.77	$12.77	$38.76	$38.76	$40.25	$25.53	$37.71	$16.59	$57.97	$57.97	$0.00	$71.34	$77.62	$78.40	$0.00	$42.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201505	EAP	CPT® 82570		Assay Of Urine Creatinine	BOTH IP/OP	$72.00 	$53.28	$0.00	$57.60	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$42.59	$42.59	$5.44	$14.46	$57.02	$57.60	$7.51	$0.00	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30201506	EAP	CPT® 84255		Assay Of Selenium	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$52.69	$52.69	$25.53	$25.53	$12.77	$12.77	$38.76	$38.76	$40.25	$25.53	$37.71	$16.59	$42.00	$42.00	$0.00	$71.00	$56.23	$56.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201508	EAP	CPT® 84270		Assay Of Sex Hormone Globul	BOTH IP/OP	$42.00 	$31.08	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.87	$33.00	$33.00	$34.27	$21.73	$32.10	$14.12	$24.84	$24.84	$0.00	$42.00	$33.26	$33.60	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201510	EAP	CPT® 86609		Bacterium Antibody	BOTH IP/OP	$24.00 	$17.76	$0.00	$24.00	$24.00	$24.00	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$14.20	$14.20	$0.00	$24.00	$19.01	$19.20	$0.00	$21.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201512	EAP	CPT® 86403		Particle Agglutination Test	BOTH IP/OP	$203.00 	$150.22	$0.00	$162.40	$21.04	$21.04	$11.54	$11.54	$5.77	$5.19	$15.48	$15.48	$16.07	$11.54	$11.75	$7.50	$120.07	$120.07	$12.12	$28.48	$160.78	$162.40	$16.73	$0.00	$16.73	$12.52	$11.54	$11.54	$8.76	$11.54	$0.00	$0.00	$0.00	$0.00
30201514	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$117.12	$117.12	$19.57	$33.64	$156.82	$158.40	$27.03	$0.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201516	EAP	CPT® 87186		Microbe Susceptible Mic	BOTH IP/OP	$323.00 	$239.02	$4.32	$258.40	$17.85	$17.85	$8.65	$8.65	$4.33	$4.32	$13.12	$13.12	$13.63	$8.65	$12.77	$5.62	$191.05	$191.05	$9.08	$24.16	$255.82	$258.40	$12.54	$14.27	$12.54	$13.60	$8.65	$8.65	$9.52	$8.65	$0.00	$0.00	$0.00	$0.00
30201522	EAP	CPT® 86780		Treponema Pallidum	BOTH IP/OP	$93.00 	$68.82	$0.00	$85.60	$27.32	$27.32	$13.24	$13.24	$6.62	$6.62	$19.73	$19.73	$20.49	$13.24	$19.38	$8.61	$55.01	$55.01	$13.90	$53.50	$84.74	$85.60	$19.20	$0.00	$19.20	$16.75	$13.24	$13.24	$17.03	$13.24	$0.00	$0.00	$0.00	$0.00
30201524	EAP	CPT® 84482		T3 Reverse	BOTH IP/OP	$150.00 	$111.00	$0.00	$118.40	$32.52	$32.52	$15.76	$15.76	$7.88	$7.88	$23.93	$23.93	$24.85	$15.76	$23.28	$10.24	$88.73	$88.73	$16.55	$44.04	$117.22	$118.40	$22.85	$26.00	$22.85	$0.00	$15.76	$15.76	$17.36	$15.76	$0.00	$0.00	$0.00	$0.00
30201531	EAP	CPT® 82040		Assay Of Serum Albumin	BOTH IP/OP	$8.00 	$5.92	$0.00	$8.00	$5.94	$5.94	$4.95	$4.95	$2.48	$2.48	$4.37	$4.37	$4.54	$4.95	$4.25	$3.22	$4.73	$4.73	$5.20	$8.00	$6.34	$6.40	$7.18	$0.00	$7.18	$4.53	$4.95	$4.95	$3.17	$4.95	$0.00	$0.00	$0.00	$0.00
30201532	EAP	CPT® 84270		Assay Of Sex Hormone Globul	BOTH IP/OP	$38.00 	$28.12	$0.00	$38.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.87	$33.00	$33.00	$34.27	$21.73	$32.10	$14.12	$22.48	$22.48	$0.00	$38.00	$30.10	$30.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201533	EAP	CPT® 84403		Assay Of Total Testosterone	BOTH IP/OP	$52.00 	$38.48	$0.00	$52.00	$52.00	$52.00	$25.81	$25.81	$12.91	$12.91	$39.21	$39.21	$40.72	$25.81	$38.15	$16.78	$30.76	$30.76	$27.10	$52.00	$41.18	$41.60	$37.42	$0.00	$37.42	$40.65	$25.81	$25.81	$28.45	$25.81	$0.00	$0.00	$0.00	$0.00
30201535	EAP	CPT® 84402		Assay Of Testosterone	BOTH IP/OP	$50.00 	$37.00	$12.74	$50.00	$50.00	$50.00	$25.47	$25.47	$12.74	$12.74	$38.67	$38.67	$40.15	$25.47	$37.60	$16.56	$29.58	$29.58	$26.74	$50.00	$39.60	$40.00	$36.93	$42.03	$36.93	$40.06	$25.47	$25.47	$28.04	$25.47	$0.00	$0.00	$0.00	$0.00
30201536	EAP	CPT® 84403		Assay Of Total Testosterone	BOTH IP/OP	$50.00 	$37.00	$12.91	$50.00	$50.00	$50.00	$25.81	$25.81	$12.91	$12.91	$39.21	$39.21	$40.72	$25.81	$38.15	$16.78	$29.58	$29.58	$27.10	$50.00	$39.60	$40.00	$37.42	$42.59	$37.42	$40.65	$25.81	$25.81	$28.45	$25.81	$0.00	$0.00	$0.00	$0.00
30201538	EAP	CPT® 84402		Assay Of Testosterone	BOTH IP/OP	$50.00 	$37.00	$12.74	$50.00	$50.00	$50.00	$25.47	$25.47	$12.74	$12.74	$38.67	$38.67	$40.15	$25.47	$37.60	$16.56	$29.58	$29.58	$26.74	$50.00	$39.60	$40.00	$36.93	$42.03	$36.93	$40.06	$25.47	$25.47	$28.04	$25.47	$0.00	$0.00	$0.00	$0.00
30201540	EAP	CPT® 86744		Nocardia Antibody	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$73.66	$74.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201542	EAP	CPT® 83018		Quantitative Screen Metals	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.34	$33.34	$34.62	$0.00	$32.43	$0.00	$0.00	$0.00	$0.00	$61.36	$205.13	$207.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201544	EAP	CPT® 82570		Assay Of Urine Creatinine	BOTH IP/OP	$101.00 	$74.74	$0.00	$80.80	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$59.74	$59.74	$5.44	$14.46	$79.99	$80.80	$7.51	$0.00	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30201545	EAP	CPT® 84430		Assay Of Thiocyanate	BOTH IP/OP	$133.00 	$98.42	$0.00	$106.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.76	$8.76	$9.09	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$16.12	$105.34	$106.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201546	EAP	CPT® 84445		Thyroid Stimulating Immunoglobulin So	BOTH IP/OP	$135.00 	$99.90	$9.34	$108.00	$17.48	$17.48	$50.86	$50.86	$25.43	$25.43	$12.85	$12.85	$13.35	$50.86	$12.52	$33.06	$79.85	$79.85	$53.40	$23.66	$106.92	$108.00	$73.75	$83.92	$73.75	$13.34	$50.86	$50.86	$9.34	$50.86	$0.00	$0.00	$0.00	$0.00
30201547	EAP	CPT® 84445		Assay Of Tsi	BOTH IP/OP	$172.00 	$127.28	$0.00	$137.60	$17.48	$17.48	$50.86	$50.86	$25.43	$25.43	$12.85	$12.85	$13.35	$50.86	$12.52	$33.06	$101.74	$101.74	$53.40	$23.66	$136.22	$137.60	$73.75	$0.00	$73.75	$13.34	$50.86	$50.86	$9.34	$50.86	$0.00	$0.00	$0.00	$0.00
30201549	EAP	CPT® 83519		Ria Nonantibody	BOTH IP/OP	$416.00 	$307.84	$8.28	$324.00	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$246.06	$246.06	$19.32	$37.76	$320.76	$324.00	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30201551	EAP	CPT® 86682		Helminth Antibody	BOTH IP/OP	$69.00 	$51.06	$6.50	$56.00	$26.85	$26.85	$13.01	$13.01	$6.51	$6.50	$19.75	$19.75	$20.51	$13.01	$19.20	$8.46	$40.81	$40.81	$13.66	$36.34	$55.44	$56.00	$18.86	$21.47	$18.86	$20.46	$13.01	$13.01	$14.32	$13.01	$0.00	$0.00	$0.00	$0.00
30201553	EAP	CPT® 87798		Detect Agent Nos Dna Amp	BOTH IP/OP	$442.00 	$327.08	$0.00	$426.40	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$261.44	$261.44	$36.84	$54.82	$422.14	$426.40	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30201555	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$242.00 	$179.08	$0.00	$193.60	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$143.14	$143.14	$19.57	$33.64	$191.66	$193.60	$27.03	$0.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201559	EAP	CPT® 86753		Prorozoa Antibody Nos	BOTH IP/OP	$39.00 	$28.86	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.81	$18.81	$19.54	$0.00	$18.31	$0.00	$0.00	$0.00	$0.00	$34.64	$30.89	$31.20	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201561	EAP	CPT® 83520		Immunoassay Quant Nos Nonab	BOTH IP/OP	$211.00 	$156.14	$0.00	$190.40	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$124.81	$124.81	$18.13	$36.18	$188.50	$190.40	$25.04	$0.00	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30201563	EAP	CPT® 87799		Detect Agent Nos Dna Quant	BOTH IP/OP	$968.00 	$716.32	$0.00	$968.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.42	$65.04	$65.04	$67.54	$42.84	$201.73	$27.85	$572.57	$572.57	$0.00	$119.70	$757.15	$764.80	$0.00	$968.00	$0.00	$149.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201565	EAP	CPT® 84425		Assay Of Vitamin B-1	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$43.82	$43.82	$21.23	$21.23	$10.62	$10.62	$32.25	$32.25	$33.49	$21.23	$31.36	$13.80	$60.33	$60.33	$22.29	$59.34	$80.78	$81.60	$30.78	$0.00	$30.78	$33.42	$21.23	$21.23	$23.39	$21.23	$0.00	$0.00	$0.00	$0.00
30201566	EAP	CPT® 84425		Vitamin B1 Plasma (thiamine) So	BOTH IP/OP	$65.00 	$48.10	$10.62	$59.34	$43.82	$43.82	$21.23	$21.23	$10.62	$10.62	$32.25	$32.25	$33.49	$21.23	$31.36	$13.80	$38.45	$38.45	$22.29	$59.34	$51.48	$52.00	$30.78	$35.03	$30.78	$33.42	$21.23	$21.23	$23.39	$21.23	$0.00	$0.00	$0.00	$0.00
30201567	EAP	CPT® 84425		Assay Of Vitamin B-1	BOTH IP/OP	$157.00 	$116.18	$0.00	$125.60	$43.82	$43.82	$21.23	$21.23	$10.62	$10.62	$32.25	$32.25	$33.49	$21.23	$31.36	$13.80	$92.87	$92.87	$22.29	$59.34	$124.34	$125.60	$30.78	$0.00	$30.78	$33.42	$21.23	$21.23	$23.39	$21.23	$0.00	$0.00	$0.00	$0.00
30201569	EAP	CPT® 84597		Assay Of Vitamin K	BOTH IP/OP	$566.00 	$418.84	$0.00	$452.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.81	$20.81	$21.61	$0.00	$20.25	$0.00	$0.00	$0.00	$0.00	$38.30	$448.27	$452.80	$0.00	$356.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201571	EAP	CPT® 84591		Assay Of Nos Vitamin	BOTH IP/OP	$121.00 	$89.54	$0.00	$121.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.61	$17.61	$18.28	$0.00	$17.13	$0.00	$0.00	$0.00	$0.00	$32.40	$95.83	$96.80	$0.00	$121.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201573	EAP	CPT® 84207		Assay Of Vtamin B-6	BOTH IP/OP	$452.00 	$334.48	$0.00	$452.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.66	$42.66	$44.30	$0.00	$41.51	$0.00	$0.00	$0.00	$0.00	$78.50	$357.98	$361.60	$0.00	$452.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201575	EAP	CPT® 82570		Assay Of Urine Creatinine	BOTH IP/OP	$24.00 	$17.76	$0.00	$19.20	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$14.20	$14.20	$5.44	$14.46	$19.01	$19.20	$7.51	$0.00	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30201576	EAP	CPT® 84585		Assay Of Urine Vma	BOTH IP/OP	$30.00 	$22.20	$0.00	$30.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.55	$23.55	$24.45	$0.00	$22.90	$0.00	$0.00	$0.00	$0.00	$30.00	$23.76	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201578	EAP	CPT® 85247		Blood Clot Factor Viii Test	BOTH IP/OP	$323.00 	$239.02	$0.00	$323.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.85	$34.85	$36.19	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$64.12	$236.02	$238.40	$0.00	$323.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201580	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$402.00 	$297.48	$8.39	$323.20	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$237.78	$237.78	$19.57	$33.64	$319.97	$323.20	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201581	EAP	CPT® 86788		West Nile Ab Csf So	BOTH IP/OP	$193.00 	$142.82	$0.00	$193.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.42	$25.58	$25.58	$26.57	$16.85	$24.90	$10.95	$114.16	$114.16	$0.00	$47.08	$139.39	$140.80	$0.00	$193.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201582	EAP	CPT® 86788		West Nile Virus Ag Igm	BOTH IP/OP	$300.00 	$222.00	$0.00	$299.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.42	$25.58	$25.58	$26.57	$16.85	$24.90	$10.95	$177.45	$177.45	$0.00	$47.08	$237.60	$240.00	$0.00	$299.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201583	EAP	CPT® 86789		West Nile Virus Antibody	BOTH IP/OP	$300.00 	$222.00	$0.00	$299.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.67	$17.67	$18.35	$0.00	$17.19	$0.00	$0.00	$0.00	$0.00	$32.52	$237.60	$240.00	$0.00	$299.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201584	EAP	CPT® 86788		West Nile Ab Serum So	BOTH IP/OP	$162.00 	$119.88	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.42	$25.58	$25.58	$26.57	$16.85	$24.90	$10.95	$95.82	$95.82	$0.00	$47.08	$117.22	$118.40	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201585	EAP	CPT® 86788		West Nile Virus Ag Igm	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.42	$25.58	$25.58	$26.57	$16.85	$24.90	$10.95	$70.98	$70.98	$0.00	$47.08	$95.04	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201586	EAP	CPT® 86789		West Nile Virus Antibody	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.67	$17.67	$18.35	$0.00	$17.19	$0.00	$0.00	$0.00	$0.00	$32.52	$95.04	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201588	EAP	CPT® 84311		Spectrophotometry	BOTH IP/OP	$239.00 	$176.86	$0.00	$192.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.61	$10.61	$11.02	$0.00	$10.32	$0.00	$0.00	$0.00	$8.51	$19.54	$190.87	$192.80	$11.75	$156.00	$11.75	$11.00	$8.10	$8.10	$7.70	$8.10	$0.00	$0.00	$0.00	$0.00
30201590	EAP	CPT® 82570		Assay Of Urine Creatinine	BOTH IP/OP	$68.00 	$50.32	$2.59	$54.40	$10.69	$10.69	$5.18	$5.18	$2.59	$2.59	$7.86	$7.86	$8.16	$5.18	$7.64	$3.37	$40.22	$40.22	$5.44	$14.46	$53.86	$54.40	$7.51	$8.55	$7.51	$8.14	$5.18	$5.18	$5.70	$5.18	$0.00	$0.00	$0.00	$0.00
30201591	EAP	CPT® 83497		Assay Of 5-hiaa	BOTH IP/OP	$147.00 	$108.78	$6.45	$117.60	$26.61	$26.61	$12.90	$12.90	$6.45	$6.45	$19.58	$19.58	$20.34	$12.90	$19.05	$8.39	$86.95	$86.95	$13.55	$36.02	$116.42	$117.60	$18.71	$21.29	$18.71	$20.30	$12.90	$12.90	$14.21	$12.90	$0.00	$0.00	$0.00	$0.00
30201593	EAP	CPT® 83516		Immunoassay Nonantibody	BOTH IP/OP	$288.00 	$213.12	$5.76	$224.00	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$170.35	$170.35	$12.11	$29.88	$221.76	$224.00	$16.72	$19.02	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30201601	EAP	CPT® 88360		Tumor Immunohistochem/manual	BOTH IP/OP	$310.00 	$229.40	$0.00	$248.00	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$183.37	$183.37	$143.92	$121.34	$245.52	$248.00	$199.96	$0.00	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
30201612	EAP	CPT® 88381		Microdissection Manual	BOTH IP/OP	$29.00 	$21.46	$0.00	$210.18	$29.00	$29.00	$0.00	$0.00	$0.00	$70.38	$161.51	$161.51	$167.72	$0.00	$29.00	$0.00	$17.15	$17.15	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$210.18	$156.67	$156.67	$147.12	$0.00	$0.00	$0.00	$0.00	$0.00
30201614	EAP	CPT® 83516		Immunoassay Nonantibody	BOTH IP/OP	$272.00 	$201.28	$5.76	$212.00	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$160.89	$160.89	$12.11	$29.88	$209.88	$212.00	$16.72	$19.02	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30201616	EAP	CPT® 83516		Immunoassay Nonantibody	BOTH IP/OP	$408.00 	$301.92	$5.76	$368.00	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$241.33	$241.33	$12.11	$29.88	$364.32	$368.00	$16.72	$19.02	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30201618	EAP	CPT® 87538		Hiv-2 Dna Amp Probe	BOTH IP/OP	$521.00 	$385.54	$17.55	$404.80	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$108.58	$22.81	$308.17	$308.17	$36.84	$54.82	$400.75	$404.80	$50.88	$57.90	$50.88	$79.19	$35.09	$35.09	$80.56	$35.09	$0.00	$0.00	$0.00	$0.00
30201620	EAP	CPT® 84432		Assay Of Thyroglobulin	BOTH IP/OP	$213.00 	$157.62	$8.03	$170.40	$33.16	$33.16	$16.06	$16.06	$8.03	$8.03	$24.39	$24.39	$25.33	$16.06	$23.73	$10.44	$125.99	$125.99	$16.86	$44.88	$168.70	$170.40	$23.29	$26.50	$23.29	$25.28	$16.06	$16.06	$17.70	$16.06	$0.00	$0.00	$0.00	$0.00
30201628	EAP	CPT® 86317		Immunoassay Infectious Agent	BOTH IP/OP	$36.00 	$26.64	$7.49	$33.00	$24.79	$24.79	$14.99	$14.99	$7.50	$7.49	$18.22	$18.22	$18.92	$14.99	$17.72	$9.74	$21.29	$21.29	$15.74	$33.00	$26.14	$26.40	$21.74	$24.73	$21.74	$18.89	$14.99	$14.99	$13.22	$14.99	$0.00	$0.00	$0.00	$0.00
30201630	EAP	CPT® 86382		Neutralization Test Viral	BOTH IP/OP	$46.00 	$34.04	$0.00	$46.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.68	$25.68	$26.67	$0.00	$24.98	$0.00	$0.00	$0.00	$0.00	$46.00	$36.43	$36.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201632	EAP	CPT® 83088		Assay Of Histamine	BOTH IP/OP	$76.00 	$56.24	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.84	$44.84	$46.57	$0.00	$43.62	$0.00	$0.00	$0.00	$0.00	$76.00	$60.19	$60.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201634	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$69.00 	$51.06	$0.00	$59.86	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$40.81	$40.81	$22.49	$59.86	$54.65	$55.20	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30201635	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$137.00 	$101.38	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$81.04	$81.04	$53.75	$112.22	$108.50	$109.60	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30201638	EAP	CPT® 88272		Cytogenetics 3-5	BOTH IP/OP	$508.00 	$375.92	$0.00	$406.40	$55.28	$55.28	$40.70	$40.70	$20.35	$18.32	$40.65	$40.65	$42.22	$40.70	$39.55	$26.46	$300.48	$300.48	$0.00	$74.82	$402.34	$406.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201640	EAP	CPT® 86787		Varicella-zoster Antibody	BOTH IP/OP	$183.00 	$135.42	$6.44	$148.00	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$108.24	$108.24	$13.52	$36.00	$146.52	$148.00	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30201642	EAP	CPT® 88360		Tumor Immunohistoche/manual	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$175.68	$175.68	$143.92	$121.34	$235.22	$237.60	$199.96	$0.00	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
30201650	EAP	CPT® 86694		Herpes Simplex Test	BOTH IP/OP	$145.00 	$107.30	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.67	$17.67	$18.35	$0.00	$17.19	$0.00	$0.00	$0.00	$15.11	$32.52	$118.80	$120.00	$20.87	$0.00	$20.87	$18.31	$14.39	$14.39	$12.82	$14.39	$0.00	$0.00	$0.00	$0.00
30201652	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$62.00 	$45.88	$0.00	$59.86	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$36.67	$36.67	$22.49	$59.86	$49.10	$49.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30201653	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$151.00 	$111.74	$0.00	$120.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$89.32	$89.32	$53.75	$112.22	$119.59	$120.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30201656	EAP	CPT® 86382		Neutralization Test Viral	BOTH IP/OP	$47.00 	$34.78	$0.00	$47.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.68	$25.68	$26.67	$0.00	$24.98	$0.00	$0.00	$0.00	$0.00	$47.00	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201658	EAP	CPT® 86317		Immunoassay Infectious Agent	BOTH IP/OP	$33.00 	$24.42	$0.00	$33.00	$24.79	$24.79	$14.99	$14.99	$7.50	$7.49	$18.22	$18.22	$18.92	$14.99	$17.72	$9.74	$19.52	$19.52	$15.74	$33.00	$26.14	$26.40	$21.74	$0.00	$21.74	$18.89	$14.99	$14.99	$13.22	$14.99	$0.00	$0.00	$0.00	$0.00
30201660	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$77.00 	$56.98	$0.00	$61.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$45.55	$45.55	$22.49	$59.86	$60.98	$61.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30201661	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$117.00 	$86.58	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$69.21	$69.21	$53.75	$112.22	$92.66	$93.60	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30201664	EAP	CPT® 83516		Immunoassay Nonantibody	BOTH IP/OP	$256.00 	$189.44	$0.00	$231.20	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$151.42	$151.42	$12.11	$29.88	$228.89	$231.20	$16.72	$0.00	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30201665	EAP	CPT® 82784		Assay Iga/igd/igg/igm Each	BOTH IP/OP	$28.00 	$20.72	$0.00	$25.98	$19.19	$19.19	$9.30	$9.30	$4.65	$4.65	$14.12	$14.12	$14.67	$9.30	$13.73	$6.05	$16.56	$16.56	$9.77	$25.98	$22.18	$22.40	$13.49	$0.00	$13.49	$14.63	$9.30	$9.30	$10.24	$9.30	$0.00	$0.00	$0.00	$0.00
30201667	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$50.28	$50.28	$22.49	$59.86	$67.32	$68.00	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30201668	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$139.00 	$102.86	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$82.22	$82.22	$53.75	$112.22	$110.09	$111.20	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30201671	EAP	CPT® 86817		Hla Typing Dr/dq	BOTH IP/OP	"$1,108.00 "	$819.92	$0.00	$886.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.76	$97.76	$101.52	$0.00	$95.11	$0.00	$0.00	$0.00	$0.00	$179.90	$877.54	$886.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201672	EAP	CPT® 86813		Hla Typing A B Or C	BOTH IP/OP	"$1,254.00 "	$927.96	$0.00	"$1,005.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.05	$88.05	$91.43	$0.00	$85.66	$0.00	$0.00	$0.00	$0.00	$162.04	$993.17	"$1,003.20"	$0.00	"$1,005.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201673	EAP	CPT® 86808		Cytotoxic Antibody Screening	BOTH IP/OP	$349.00 	$258.26	$0.00	$279.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.06	$45.06	$46.80	$0.00	$43.84	$0.00	$0.00	$0.00	$0.00	$82.94	$276.41	$279.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201687	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$60.33	$60.33	$22.49	$59.86	$80.78	$81.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30201688	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$104.10	$104.10	$53.75	$112.22	$139.39	$140.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30201691	EAP	CPT® 86255		Fluorescent Antibody Screen	BOTH IP/OP	$659.00 	$487.66	$6.03	$528.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$389.80	$389.80	$12.65	$33.68	$522.72	$528.00	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201693	EAP	CPT® 83519		Ria Nonantibody	BOTH IP/OP	"$1,170.00 "	$865.80	$8.28	"$1,056.00"	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$692.06	$692.06	$19.32	$37.76	"$1,045.44"	"$1,056.00"	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30201706	EAP	CPT® 83520		Immunoassay Quant Nos Nonab	BOTH IP/OP	$182.00 	$134.68	$0.00	$164.00	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$107.65	$107.65	$18.13	$36.18	$162.36	$164.00	$25.04	$0.00	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30201707	EAP	CPT® 86021		Wbc Antibody Identification	BOTH IP/OP	$92.00 	$68.08	$0.00	$73.60	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$54.42	$54.42	$15.80	$42.06	$72.86	$73.60	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30201708	EAP	CPT® 86255		Fluorescent Antibody Screen	BOTH IP/OP	$83.00 	$61.42	$0.00	$83.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$49.09	$49.09	$12.65	$33.68	$82.37	$83.20	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201709	EAP	CPT® 86609		Bacterium Antibody	BOTH IP/OP	$84.00 	$62.16	$0.00	$67.20	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$49.69	$49.69	$0.00	$36.00	$66.53	$67.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201710	EAP	CPT® 86671		Fungus Antibody	BOTH IP/OP	$83.00 	$61.42	$0.00	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$18.62	$19.33	$0.00	$18.11	$0.00	$0.00	$0.00	$12.86	$34.26	$65.74	$66.40	$17.76	$0.00	$17.76	$19.30	$12.25	$12.25	$13.51	$12.25	$0.00	$0.00	$0.00	$0.00
30201711	EAP	CPT® 86689		Hiv-2 Wb	BOTH IP/OP	$213.00 	$157.62	$0.00	$213.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.39	$29.39	$30.52	$0.00	$24.81	$0.00	$0.00	$0.00	$0.00	$54.10	$163.94	$165.60	$0.00	$213.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201712	EAP	CPT® 86038		Antinuclear Antibodies	BOTH IP/OP	$24.00 	$17.76	$0.00	$24.00	$24.00	$24.00	$12.09	$12.09	$6.05	$6.04	$18.36	$18.36	$19.06	$12.09	$17.86	$7.86	$14.20	$14.20	$12.69	$24.00	$19.01	$19.20	$17.53	$0.00	$17.53	$19.03	$12.09	$12.09	$13.32	$12.09	$0.00	$0.00	$0.00	$0.00
30201713	EAP	CPT® 86376		Microsomal Antibody	BOTH IP/OP	$49.00 	$36.26	$0.00	$40.66	$30.04	$30.04	$14.55	$14.55	$7.28	$7.28	$22.10	$22.10	$22.95	$14.55	$21.49	$9.46	$28.98	$28.98	$15.28	$40.66	$38.81	$39.20	$21.10	$0.00	$21.10	$22.90	$14.55	$14.55	$16.03	$14.55	$0.00	$0.00	$0.00	$0.00
30201714	EAP	CPT® 86658		Enterovirus Antibody	BOTH IP/OP	$27.00 	$19.98	$0.00	$27.00	$26.90	$26.90	$13.03	$13.03	$6.52	$6.51	$19.79	$19.79	$20.55	$13.03	$19.25	$8.47	$15.97	$15.97	$13.68	$27.00	$21.38	$21.60	$18.89	$0.00	$18.89	$20.51	$13.03	$13.03	$14.36	$13.03	$0.00	$0.00	$0.00	$0.00
30201715	EAP	CPT® 86652		"Antibody Encephalitis, Eastern Equine"	BOTH IP/OP	$19.00 	$14.06	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$25.00	$19.80	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201718	EAP	CPT® 86765		Rubeola Antibody	BOTH IP/OP	$31.00 	$22.94	$0.00	$31.00	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$18.34	$18.34	$13.52	$31.00	$24.55	$24.80	$18.68	$0.00	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30201719	EAP	CPT® 86653		Encephalitis Antibody	BOTH IP/OP	$19.00 	$14.06	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$25.00	$19.80	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201720	EAP	CPT® 86787		Varicella-zoster Antibody	BOTH IP/OP	$29.00 	$21.46	$0.00	$29.00	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$17.15	$17.15	$13.52	$29.00	$22.97	$23.20	$18.68	$0.00	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30201721	EAP	CPT® 86654		Encephalitis Antibody	BOTH IP/OP	$19.00 	$14.06	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$25.00	$19.80	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201722	EAP	CPT® 86645		Cmv Antibody Igm	BOTH IP/OP	$35.00 	$25.90	$0.00	$35.00	$34.77	$34.77	$16.85	$16.85	$8.43	$8.42	$25.58	$25.58	$26.57	$16.85	$24.90	$10.95	$20.70	$20.70	$17.69	$35.00	$27.72	$28.00	$24.43	$0.00	$24.43	$26.53	$16.85	$16.85	$18.57	$16.85	$0.00	$0.00	$0.00	$0.00
30201724	EAP	CPT® 86403		Particle Agglutination Test	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$21.04	$21.04	$11.54	$11.54	$5.77	$5.19	$15.48	$15.48	$16.07	$11.54	$11.75	$7.50	$53.24	$53.24	$12.12	$28.48	$71.28	$72.00	$16.73	$0.00	$16.73	$12.52	$11.54	$11.54	$8.76	$11.54	$0.00	$0.00	$0.00	$0.00
30201725	EAP	CPT® 86406		Particle Agglutination Test	BOTH IP/OP	$136.00 	$100.64	$0.00	$108.80	$0.00	$0.00	$0.00	$0.00	$0.00	$5.32	$16.15	$16.15	$16.77	$10.64	$15.72	$6.92	$80.44	$80.44	$11.17	$29.74	$107.71	$108.80	$15.43	$0.00	$15.43	$16.75	$10.64	$10.64	$11.72	$10.64	$0.00	$0.00	$0.00	$0.00
30201726	EAP	CPT® 86403		Particle Agglutination Test	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$21.04	$21.04	$11.54	$11.54	$5.77	$5.19	$15.48	$15.48	$16.07	$11.54	$11.75	$7.50	$58.56	$58.56	$12.12	$28.48	$78.41	$79.20	$16.73	$0.00	$16.73	$12.52	$11.54	$11.54	$8.76	$11.54	$0.00	$0.00	$0.00	$0.00
30201727	EAP	CPT® 88342		Immunohistochemistry	BOTH IP/OP	$275.00 	$203.50	$48.82	$222.40	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$162.66	$162.66	$143.92	$106.46	$220.18	$222.40	$199.96	$178.75	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
30201728	EAP	CPT® 88360		Tumor Immunohistochem/manual	BOTH IP/OP	$638.00 	$472.12	$0.00	$510.40	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$377.38	$377.38	$143.92	$121.34	$505.30	$510.40	$199.96	$0.00	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
30201729	EAP	CPT® 86256		Fluorescent Antibody Titer	BOTH IP/OP	$131.00 	$96.94	$6.03	$104.80	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$77.49	$77.49	$12.65	$33.68	$103.75	$104.80	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201730	EAP	CPT® 88368		Insitu Hybridization Manual	BOTH IP/OP	$454.00 	$335.96	$0.00	$394.92	$178.36	$178.36	$283.63	$283.63	$285.22	$58.22	$151.36	$151.36	$157.18	$279.15	$199.20	$181.45	$268.54	$268.54	$284.24	$207.74	$359.57	$363.20	$394.92	$0.00	$394.92	$212.25	$90.40	$90.40	$148.57	$270.71	$0.00	$0.00	$0.00	$0.00
30201731	EAP	CPT® 88342		Immunohistochemistry	BOTH IP/OP	$556.00 	$411.44	$0.00	$444.80	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$328.87	$328.87	$143.92	$106.46	$440.35	$444.80	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
30201735	EAP	CPT® 86022		Nait Platelet Ab (so)	BOTH IP/OP	$361.00 	$267.14	$0.00	$288.80	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$213.53	$213.53	$0.00	$51.32	$285.91	$288.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201736	EAP	CPT® 86255		Fluorescent Antibody Screen	BOTH IP/OP	$27.00 	$19.98	$0.00	$33.68	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$15.97	$15.97	$12.65	$33.68	$26.93	$27.20	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201737	EAP	CPT® 86727		Lymph Choriomeningitis Ab	BOTH IP/OP	$19.00 	$14.06	$0.00	$20.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.54	$19.54	$20.29	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$19.00	$15.05	$15.20	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201738	EAP	CPT® 84181		Western Blot Test	BOTH IP/OP	$316.00 	$233.84	$0.00	$252.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.86	$25.86	$26.86	$0.00	$25.16	$0.00	$0.00	$0.00	$0.00	$47.60	$250.27	$252.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201750	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$337.00 	$249.38	$8.39	$269.60	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$199.34	$199.34	$19.57	$33.64	$266.90	$269.60	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201754	EAP	CPT® 82985		Glycated Protein	BOTH IP/OP	$148.00 	$109.52	$7.54	$119.20	$31.13	$31.13	$16.76	$16.76	$8.38	$7.54	$22.89	$22.89	$23.77	$16.76	$22.26	$10.89	$87.54	$87.54	$17.60	$42.12	$118.01	$119.20	$24.30	$27.65	$24.30	$23.72	$16.76	$16.76	$16.60	$16.76	$0.00	$0.00	$0.00	$0.00
30201758	EAP	CPT® 83519		Ria Nonantibody	BOTH IP/OP	$82.00 	$60.68	$0.00	$74.40	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$48.50	$48.50	$19.32	$37.76	$73.66	$74.40	$26.68	$0.00	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30201759	EAP	CPT® 86255		Fluorescent Antibody Screen	BOTH IP/OP	$35.00 	$25.90	$0.00	$35.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$20.70	$20.70	$12.65	$33.68	$34.85	$35.20	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201760	EAP	CPT® 86256		Fluorescent Antibody Titer	BOTH IP/OP	$35.00 	$25.90	$0.00	$35.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$20.70	$20.70	$12.65	$33.68	$34.85	$35.20	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201761	EAP	CPT® 86003		Allergen Specific Ige	BOTH IP/OP	$104.00 	$76.96	$2.61	$104.00	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$61.52	$61.52	$5.48	$14.60	$102.96	$104.00	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30201762	EAP	CPT® 83519		Ria Nonantibody	BOTH IP/OP	$359.00 	$265.66	$8.28	$279.20	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$212.35	$212.35	$19.32	$37.76	$276.41	$279.20	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30201766	EAP	CPT® 87186		Microbe Susceptible Mic	BOTH IP/OP	$271.00 	$200.54	$4.32	$216.80	$17.85	$17.85	$8.65	$8.65	$4.33	$4.32	$13.12	$13.12	$13.63	$8.65	$12.77	$5.62	$160.30	$160.30	$9.08	$24.16	$214.63	$216.80	$12.54	$14.27	$12.54	$13.60	$8.65	$8.65	$9.52	$8.65	$0.00	$0.00	$0.00	$0.00
30201767	EAP	CPT® 83520		Immunoassay Quant Nos Nonab	BOTH IP/OP	$504.00 	$372.96	$7.77	$392.00	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$298.12	$298.12	$18.13	$36.18	$388.08	$392.00	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30201768	EAP	CPT® 82107		Alpha-fetoprotein 13	BOTH IP/OP	$276.00 	$204.24	$0.00	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.80	$97.80	$101.56	$0.00	$95.14	$0.00	$0.00	$0.00	$0.00	$179.98	$218.59	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201769	EAP	CPT® 87496		Cytomeg Dna Amp Probe	BOTH IP/OP	$212.00 	$156.88	$0.00	$212.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$125.40	$125.40	$36.84	$54.82	$163.15	$164.80	$50.88	$212.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30201770	EAP	CPT® 82374		Assay Blood Carbon Dioxide	BOTH IP/OP	$91.00 	$67.34	$0.00	$72.80	$10.08	$10.08	$4.88	$4.88	$2.44	$2.44	$7.43	$7.43	$7.71	$4.88	$7.22	$3.17	$53.83	$53.83	$5.12	$13.66	$72.07	$72.80	$7.08	$0.00	$7.08	$7.70	$4.88	$4.88	$5.39	$4.88	$0.00	$0.00	$0.00	$0.00
30201771	EAP	CPT® 86255		Fluorescent Antibody Screen	BOTH IP/OP	$55.00 	$40.70	$0.00	$55.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$32.53	$32.53	$12.65	$33.68	$54.65	$55.20	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201772	EAP	CPT® 86256		Fluorescent Antibody Titer	BOTH IP/OP	$55.00 	$40.70	$0.00	$55.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$32.53	$32.53	$12.65	$33.68	$54.65	$55.20	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201773	EAP	CPT® 82310		Assay Of Calcium	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.80	$10.67	$10.67	$5.16	$5.16	$2.58	$2.58	$7.83	$7.83	$8.13	$5.16	$7.46	$3.35	$20.70	$20.70	$5.42	$14.40	$28.51	$28.80	$7.48	$0.00	$7.48	$7.94	$5.16	$5.16	$5.56	$5.16	$0.00	$0.00	$0.00	$0.00
30201774	EAP	CPT® 83970		Assay Of Parathormone	BOTH IP/OP	$71.00 	$52.54	$0.00	$71.00	$71.00	$71.00	$41.28	$41.28	$20.64	$20.64	$62.68	$62.68	$65.09	$41.28	$60.97	$26.83	$42.00	$42.00	$43.34	$71.00	$56.23	$56.80	$59.86	$0.00	$59.86	$64.97	$41.28	$41.28	$45.48	$41.28	$0.00	$0.00	$0.00	$0.00
30201786	EAP	CPT® 84146		Assay Of Prolactin	BOTH IP/OP	$73.00 	$54.02	$0.00	$58.40	$40.00	$40.00	$19.38	$19.38	$9.69	$9.69	$29.43	$29.43	$30.56	$19.38	$28.63	$12.60	$43.18	$43.18	$20.35	$54.16	$57.82	$58.40	$28.10	$0.00	$28.10	$30.51	$19.38	$19.38	$21.36	$19.38	$0.00	$0.00	$0.00	$0.00
30201789	EAP	CPT® 83520		Immunoassay Quant Nos Nonab	BOTH IP/OP	$346.00 	$256.04	$7.77	$312.00	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$204.66	$204.66	$18.13	$36.18	$308.88	$312.00	$25.04	$28.50	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30201790	EAP	CPT® 87798		Detect Agent Nos Dna Amp	BOTH IP/OP	$262.00 	$193.88	$0.00	$252.80	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$154.97	$154.97	$36.84	$54.82	$250.27	$252.80	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30201793	EAP	CPT® 86698		Histoplasma	BOTH IP/OP	$26.00 	$19.24	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$18.98	$18.98	$19.71	$13.79	$18.46	$8.96	$15.38	$15.38	$14.48	$26.00	$20.59	$20.80	$20.00	$0.00	$20.00	$19.67	$13.79	$13.79	$13.77	$13.79	$0.00	$0.00	$0.00	$0.00
30201797	EAP	CPT® 86611		Bartonella Antibody	BOTH IP/OP	$78.00 	$57.72	$0.00	$78.40	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$46.14	$46.14	$10.69	$28.44	$77.62	$78.40	$14.76	$0.00	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30201798	EAP	CPT® 86768		Salmonella Antibody	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.79	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$36.86	$37.22	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201801	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$212.00 	$156.88	$0.00	$169.60	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$125.40	$125.40	$19.57	$33.64	$167.90	$169.60	$27.03	$0.00	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201802	EAP	CPT® 87798		Detect Agent Nos Dna Amp	BOTH IP/OP	$438.00 	$324.12	$17.55	$352.80	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$259.08	$259.08	$36.84	$54.82	$349.27	$352.80	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30201816	EAP	CPT® 83519		Ria Nonantibody	BOTH IP/OP	$496.00 	$367.04	$0.00	$448.00	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$293.38	$293.38	$19.32	$37.76	$443.52	$448.00	$26.68	$0.00	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30201817	EAP	CPT® 80299		Quantitative Assay Drug	BOTH IP/OP	$369.00 	$273.06	$8.39	$296.00	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$218.26	$218.26	$19.57	$33.64	$293.04	$296.00	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30201818	EAP	CPT® 87906		Genotype Dna Hiv Reverse T	BOTH IP/OP	$679.00 	$502.46	$0.00	$654.40	$90.02	$90.02	$128.73	$128.73	$64.37	$64.36	$63.81	$63.81	$66.27	$128.73	$57.67	$83.67	$401.63	$401.63	$135.17	$409.00	$647.86	$654.40	$186.66	$0.00	$186.66	$61.44	$128.73	$128.73	$43.01	$128.73	$0.00	$0.00	$0.00	$0.00
30201819	EAP	CPT® 86727		Lymph Choriomeningitis Ab	BOTH IP/OP	$96.00 	$71.04	$0.00	$76.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.54	$19.54	$20.29	$0.00	$19.01	$0.00	$0.00	$0.00	$0.00	$35.96	$76.03	$76.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201820	EAP	CPT® 87906		Genotype Dna Hiv Reverse T	BOTH IP/OP	"$1,376.00 "	"$1,018.24"	$43.01	"$1,326.40"	$90.02	$90.02	$128.73	$128.73	$64.37	$64.36	$63.81	$63.81	$66.27	$128.73	$57.67	$83.67	$813.90	$813.90	$135.17	$829.00	"$1,313.14"	"$1,326.40"	$186.66	$212.40	$186.66	$61.44	$128.73	$128.73	$43.01	$128.73	$0.00	$0.00	$0.00	$0.00
30201821	EAP	CPT® 88365		Ebv Ish W/interp (so)	BOTH IP/OP	$574.00 	$424.76	$0.00	$459.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.18	$102.18	$106.11	$0.00	$103.59	$0.00	$0.00	$0.00	$143.92	$156.90	$454.61	$459.20	$199.96	$0.00	$199.96	$110.38	$137.95	$137.95	$77.27	$137.07	$0.00	$0.00	$0.00	$0.00
30201822	EAP	CPT® 88365		Ebv Ish W/o Interp (so)	BOTH IP/OP	$574.00 	$424.76	$0.00	$459.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.18	$102.18	$106.11	$0.00	$103.59	$0.00	$0.00	$0.00	$143.92	$156.90	$454.61	$459.20	$199.96	$0.00	$199.96	$110.38	$137.95	$137.95	$77.27	$137.07	$0.00	$0.00	$0.00	$0.00
30201823	EAP	CPT® 88275		Fish Burkitt Nhl T(8;14)(so)	BOTH IP/OP	$620.00 	$458.80	$0.00	$496.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$366.73	$366.73	$53.75	$112.22	$491.04	$496.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30201824	EAP	CPT® 88271		Fish Burkitt Dna Probe (so)	BOTH IP/OP	$404.00 	$298.96	$0.00	$323.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$238.97	$238.97	$22.49	$59.86	$319.97	$323.20	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30201825	EAP	CPT® 87902		Hcv Rna Genotype 1 Ns5b (so)	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$992.80	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$132.42	$132.42	$137.52	$257.45	$128.84	$167.34	$709.80	$709.80	$270.32	$243.70	$982.87	$992.80	$373.30	$0.00	$373.30	$137.28	$257.45	$257.45	$96.09	$257.45	$0.00	$0.00	$0.00	$0.00
30201834	EAP	CPT® 82656		Pancreatic Elastase Fecal	BOTH IP/OP	$273.00 	$202.02	$0.00	$218.40	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$56.89	$7.49	$161.48	$161.48	$12.11	$29.88	$216.22	$218.40	$16.72	$0.00	$16.72	$42.72	$11.53	$11.53	$43.46	$11.53	$0.00	$0.00	$0.00	$0.00
30201835	EAP	CPT® 87798		Detect Agent Nos Dna Amp	BOTH IP/OP	$252.00 	$186.48	$0.00	$243.20	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$149.06	$149.06	$36.84	$54.82	$240.77	$243.20	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30201836	EAP	CPT® 86356		Mononuclear Cell Antigen	BOTH IP/OP	$146.00 	$108.04	$0.00	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.63	$39.63	$41.16	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$76.00	$120.38	$121.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201837	EAP	CPT® 86355		Cells Total Count	BOTH IP/OP	$49.00 	$36.26	$0.00	$49.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$49.00	$38.81	$39.20	$49.00	$49.00	$49.00	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30201838	EAP	CPT® 86359		Cells Total Count	BOTH IP/OP	$49.00 	$36.26	$18.86	$62.25	$48.63	$48.63	$37.73	$37.73	$18.87	$18.86	$35.77	$35.77	$37.14	$37.73	$34.80	$24.52	$28.98	$28.98	$39.62	$49.00	$38.81	$39.20	$49.00	$62.25	$49.00	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30201839	EAP	CPT® 88365		Institu Hybridization (fish)	BOTH IP/OP	$262.00 	$193.88	$0.00	$208.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.18	$102.18	$106.11	$0.00	$103.59	$0.00	$0.00	$0.00	$143.92	$156.90	$205.92	$208.00	$199.96	$170.30	$199.96	$110.38	$137.95	$137.95	$77.27	$137.07	$0.00	$0.00	$0.00	$0.00
30201840	EAP	CPT® 86808		Cytotoxic Antibody Screening	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.06	$45.06	$46.80	$0.00	$43.84	$0.00	$0.00	$0.00	$0.00	$82.94	$257.40	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201841	EAP	CPT® 86816		Hla Typing Dr/dq	BOTH IP/OP	$344.00 	$254.56	$0.00	$275.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.30	$42.30	$43.92	$0.00	$41.15	$0.00	$0.00	$0.00	$0.00	$77.84	$272.45	$275.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201842	EAP	CPT® 86255		Fluorescent Antibody Screen	BOTH IP/OP	$25.00 	$18.50	$6.03	$25.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$14.79	$14.79	$12.65	$25.00	$19.80	$20.00	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201843	EAP	CPT® 86256		Fluorescent Antibody Titer	BOTH IP/OP	$25.00 	$18.50	$6.03	$25.00	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$14.79	$14.79	$12.65	$25.00	$19.80	$20.00	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201844	EAP	CPT® 86003		Allergen Specific Ige	BOTH IP/OP	$407.00 	$301.18	$2.61	$328.80	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$240.74	$240.74	$5.48	$14.60	$325.51	$328.80	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30201845	EAP	CPT® 86317		"Immunoassay For Infectious Agent,ab,quant"	BOTH IP/OP	$31.00 	$22.94	$0.00	$31.00	$24.79	$24.79	$14.99	$14.99	$7.50	$7.49	$18.22	$18.22	$18.92	$14.99	$17.72	$9.74	$18.34	$18.34	$15.74	$31.00	$24.55	$24.80	$21.74	$0.00	$21.74	$18.89	$14.99	$14.99	$13.22	$14.99	$0.00	$0.00	$0.00	$0.00
30201846	EAP	CPT® 86001		Allergen Specific Igg Quant	BOTH IP/OP	$140.00 	$103.60	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.92	$7.92	$8.23	$0.00	$7.72	$0.00	$0.00	$0.00	$0.00	$14.60	$138.60	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201847	EAP	CPT® 86003		Allergen Specific Ige	BOTH IP/OP	$140.00 	$103.60	$2.61	$140.00	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$82.81	$82.81	$5.48	$14.60	$138.60	$140.00	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30201848	EAP	CPT® 86147		Anti-cardiolipin Igg	BOTH IP/OP	$581.00 	$429.94	$12.73	$580.80	$52.54	$52.54	$25.45	$25.45	$12.73	$12.73	$38.63	$38.63	$40.11	$25.45	$37.58	$16.54	$343.66	$343.66	$26.72	$71.08	$574.99	$580.80	$36.90	$41.99	$36.90	$40.04	$25.45	$25.45	$28.03	$25.45	$0.00	$0.00	$0.00	$0.00
30201849	EAP	CPT® 86147		Anti-cardiolipin Igm	BOTH IP/OP	$581.00 	$429.94	$12.73	$580.80	$52.54	$52.54	$25.45	$25.45	$12.73	$12.73	$38.63	$38.63	$40.11	$25.45	$37.58	$16.54	$343.66	$343.66	$26.72	$71.08	$574.99	$580.80	$36.90	$41.99	$36.90	$40.04	$25.45	$25.45	$28.03	$25.45	$0.00	$0.00	$0.00	$0.00
30201850	EAP	CPT® 86757		Rmsf Igm Titer	BOTH IP/OP	$131.00 	$96.94	$0.00	$131.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.39	$29.39	$30.52	$0.00	$28.60	$0.00	$0.00	$0.00	$0.00	$54.10	$129.89	$131.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201856	EAP	CPT® 81342		T-CELL  REARRANGEMENT- PCR  (RQD)	BOTH IP/OP	$667.00 	$493.58	$0.00	$609.60	$415.93	$415.93	$201.50	$201.50	$100.75	$100.75	$285.90	$285.90	$296.89	$201.50	$192.65	$130.98	$394.53	$394.53	$0.00	$381.00	$603.50	$609.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201865	EAP	Custom 30201865		Bcr/abl T(9;22) Fish (gen)	BOTH IP/OP	$663.00 	$490.62	$0.00	$606.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$492.08	$492.08	$511.04	$0.00	$138.17	$0.00	$0.00	$0.00	$0.00	$379.00	$600.34	$606.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201869	EAP	CPT® 81275		KRAS Gene Mutation Detection (RQD)	BOTH IP/OP	$952.00 	$704.48	$86.96	$752.00	$298.80	$298.80	$193.25	$193.25	$96.63	$86.96	$205.38	$205.38	$213.28	$193.25	$220.85	$125.61	$563.11	$563.11	$202.91	$470.00	$744.48	$752.00	$280.21	$318.86	$280.21	$235.32	$193.25	$193.25	$164.72	$193.25	$0.00	$0.00	$0.00	$0.00
30201879	EAP	CPT® 87906		"Integrase, Quest"	BOTH IP/OP	$793.00 	$586.82	$0.00	$764.80	$90.02	$90.02	$128.73	$128.73	$64.37	$64.36	$63.81	$63.81	$66.27	$128.73	$57.67	$83.67	$469.06	$469.06	$135.17	$478.00	$757.15	$764.80	$186.66	$0.00	$186.66	$61.44	$128.73	$128.73	$43.01	$128.73	$0.00	$0.00	$0.00	$0.00
30201900	EAP	CPT® 87999		"Trofile, Dna Monogram -quest"	BOTH IP/OP	"$3,182.00 "	"$2,354.68"	$0.00	"$2,545.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,361.68"	"$2,361.68"	"$2,452.69"	$0.00	$663.13	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,520.14"	"$2,545.60"	$0.00	$390.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201914	EAP	CPT® 81342		T-CELL  REARRANGEMENT-PCR QD	BOTH IP/OP	$667.00 	$493.58	$0.00	$609.60	$415.93	$415.93	$201.50	$201.50	$100.75	$100.75	$285.90	$285.90	$296.89	$201.50	$192.65	$130.98	$394.53	$394.53	$0.00	$381.00	$603.50	$609.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201926	EAP	CPT® 81275		KRAS Gene Mutation Detect(RQD)	BOTH IP/OP	$823.00 	$609.02	$0.00	$752.00	$298.80	$298.80	$193.25	$193.25	$96.63	$86.96	$205.38	$205.38	$213.28	$193.25	$220.85	$125.61	$486.80	$486.80	$202.91	$470.00	$744.48	$752.00	$280.21	$0.00	$280.21	$235.32	$193.25	$193.25	$164.72	$193.25	$0.00	$0.00	$0.00	$0.00
30201933	EAP	CPT® 81270		Jak2 V617f Mutation Quant (so)	BOTH IP/OP	$981.00 	$725.94	$45.83	$775.20	$189.21	$189.21	$91.66	$91.66	$45.83	$45.83	$130.06	$130.06	$135.06	$91.66	$84.58	$59.58	$580.26	$580.26	$96.24	$484.50	$767.45	$775.20	$132.91	$151.24	$132.91	$90.12	$91.66	$91.66	$63.08	$91.66	$0.00	$0.00	$0.00	$0.00
30201934	EAP	CPT® 87906		"INTEGRASE, QUEST"	BOTH IP/OP	$649.00 	$480.26	$0.00	$625.60	$90.02	$90.02	$128.73	$128.73	$64.37	$64.36	$63.81	$63.81	$66.27	$128.73	$57.67	$83.67	$383.88	$383.88	$135.17	$391.00	$619.34	$625.60	$186.66	$0.00	$186.66	$61.44	$128.73	$128.73	$43.01	$128.73	$0.00	$0.00	$0.00	$0.00
30201936	EAP	CPT® 81402		MPL ANAL Mutation Anal (RQD)	BOTH IP/OP	"$1,430.00 "	"$1,058.20"	$0.00	"$1,307.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,061.35"	"$1,061.35"	"$1,102.24"	$0.00	$192.65	$0.00	$0.00	$0.00	$0.00	$817.00	"$1,294.13"	"$1,307.20"	$0.00	"$1,242.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201955	EAP	CPT® 87999		"TROFILE, DNA Monogram -Quest"	BOTH IP/OP	"$3,030.00 "	"$2,242.20"	$0.00	"$2,424.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,248.87"	"$2,248.87"	"$2,335.52"	$0.00	$631.45	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,399.76"	"$2,424.00"	$0.00	$390.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201958	EAP	CPT® 86703		Focus Hiv 1/2 Ab Scrn	BOTH IP/OP	$265.00 	$196.10	$6.85	$213.60	$28.30	$28.30	$18.29	$18.29	$9.15	$6.85	$20.82	$20.82	$21.62	$18.29	$17.58	$11.89	$156.75	$156.75	$19.20	$38.34	$211.46	$213.60	$19.88	$30.18	$19.88	$18.73	$18.29	$18.29	$13.11	$18.29	$0.00	$0.00	$0.00	$0.00
30201959	EAP	CPT® 86689		Focus Hiv Wb	BOTH IP/OP	$388.00 	$287.12	$0.00	$320.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.39	$29.39	$30.52	$0.00	$24.81	$0.00	$0.00	$0.00	$0.00	$54.10	$317.59	$320.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201960	EAP	CPT® 86360		Focus Lymphocyte Subsets	BOTH IP/OP	$495.00 	$366.30	$23.49	$400.00	$96.99	$96.99	$46.98	$46.98	$23.49	$23.49	$71.34	$71.34	$74.09	$46.98	$69.42	$30.54	$292.79	$292.79	$49.33	$131.30	$396.00	$400.00	$68.12	$77.52	$68.12	$73.96	$46.98	$46.98	$51.77	$46.98	$0.00	$0.00	$0.00	$0.00
30201961	EAP	CPT® 86317		Strep Pneumoniae Igg Ab Panel (so)	BOTH IP/OP	$308.00 	$227.92	$7.49	$224.00	$24.79	$24.79	$14.99	$14.99	$7.50	$7.49	$18.22	$18.22	$18.92	$14.99	$17.72	$9.74	$182.18	$182.18	$15.74	$33.54	$221.76	$224.00	$21.74	$24.73	$21.74	$18.89	$14.99	$14.99	$13.22	$14.99	$0.00	$0.00	$0.00	$0.00
30201962	EAP	Custom 30201962		Fragile X Southern Blot (so)	BOTH IP/OP	$208.00 	$153.92	$0.00	$166.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.38	$154.38	$160.33	$0.00	$43.35	$0.00	$0.00	$0.00	$0.00	$104.00	$164.74	$166.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201965	EAP	CPT® 81291		Mthfr  Mutation Analysis (so)	BOTH IP/OP	$331.00 	$244.94	$29.40	$261.60	$90.10	$90.10	$65.34	$65.34	$32.67	$29.40	$61.93	$61.93	$64.31	$65.34	$46.99	$42.47	$195.79	$195.79	$68.61	$163.50	$258.98	$261.60	$94.74	$107.81	$94.74	$50.07	$65.34	$65.34	$35.05	$65.34	$0.00	$0.00	$0.00	$0.00
30201966	EAP	CPT® 81241		FACTOR V LEIDEN MUTATION	BOTH IP/OP	$331.00 	$244.94	$33.02	$261.60	$126.14	$126.14	$73.37	$73.37	$36.69	$33.02	$86.70	$86.70	$90.04	$73.37	$46.99	$47.69	$195.79	$195.79	$77.04	$163.50	$258.98	$261.60	$106.39	$121.06	$106.39	$50.07	$73.37	$73.37	$35.05	$73.37	$0.00	$0.00	$0.00	$0.00
30201967	EAP	CPT® 81240		FACTOR II (PT) GENE MUTATION	BOTH IP/OP	$331.00 	$244.94	$29.56	$261.60	$101.59	$101.59	$65.69	$65.69	$32.85	$29.56	$69.82	$69.82	$72.50	$65.69	$46.99	$42.70	$195.79	$195.79	$68.97	$163.50	$258.98	$261.60	$95.25	$108.39	$95.25	$50.07	$65.69	$65.69	$35.05	$65.69	$0.00	$0.00	$0.00	$0.00
30201968	EAP	CPT® 81220		CYSTIC FIB 97 MUTATION RQD	BOTH IP/OP	"$1,038.00 "	$768.12	$250.47	"$1,201.65"	$789.36	$789.36	$556.60	$556.60	$278.30	$250.47	$770.40	$770.40	$800.09	$556.60	"$1,038.00"	$361.79	$613.98	$613.98	$584.43	$512.50	$811.80	$820.00	$807.07	$918.39	$807.07	"$1,201.65"	$556.60	$556.60	$841.15	$556.60	$0.00	$0.00	$0.00	$0.00
30201974	EAP	CPT® 81406		MEN2 (RET) DNA SEQ(ATHENA)	BOTH IP/OP	"$5,489.00 "	"$4,061.86"	$0.00	"$5,017.60"	$237.60	$237.60	$282.88	$282.88	$141.44	$127.30	"$4,073.94"	"$4,073.94"	"$4,230.92"	$282.88	$610.87	$183.87	"$3,246.74"	"$3,246.74"	$0.00	"$3,136.00"	"$4,967.42"	"$5,017.60"	$0.00	$466.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201975	EAP	CPT® 81401		Huntington's Dna (so)	BOTH IP/OP	"$1,288.00 "	$953.12	$61.65	"$1,017.60"	$64.94	$64.94	$137.00	$137.00	$68.50	$61.65	$955.95	$955.95	$992.79	$137.00	$131.58	$89.05	$761.85	$761.85	$143.85	$636.00	"$1,007.42"	"$1,017.60"	$198.65	$226.05	$198.65	$140.20	$137.00	$137.00	$98.14	$137.00	$0.00	$0.00	$0.00	$0.00
30201977	EAP	CPT® 81256		HERED HEMOCHROM DNA ANAL RQD	BOTH IP/OP	$575.00 	$425.50	$0.00	$575.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.74	$92.74	$96.30	$0.00	$46.99	$0.00	$0.00	$0.00	$68.63	$284.00	$449.86	$454.40	$94.77	$575.00	$94.77	$50.07	$65.36	$65.36	$35.05	$65.36	$0.00	$0.00	$0.00	$0.00
30201980	EAP	CPT® 86003		Allergen Specific Ige (so)	BOTH IP/OP	$40.00 	$29.60	$2.61	$32.00	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$23.66	$23.66	$5.48	$14.60	$31.68	$32.00	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30201983	EAP	CPT® 86003		Allergen Specific (food) Ige (so)	BOTH IP/OP	$40.00 	$29.60	$2.61	$32.00	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$23.66	$23.66	$5.48	$14.60	$31.68	$32.00	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30201984	EAP	CPT® 86003		Allergen Specific (enviro) Ige (so)	BOTH IP/OP	$40.00 	$29.60	$2.61	$32.00	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$23.66	$23.66	$5.48	$14.60	$31.68	$32.00	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30201985	EAP	CPT® 80074		Acute Hepatitis Panel	BOTH IP/OP	$890.00 	$658.60	$0.00	$712.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.32	$72.32	$75.10	$0.00	$70.35	$0.00	$0.00	$0.00	$0.00	$133.08	$704.88	$712.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201986	EAP	CPT® 86790		"Hantavirus Antibody (igg, Igm) (so)"	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$165.62	$165.62	$13.52	$36.00	$221.76	$224.00	$18.68	$0.00	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30201987	EAP	CPT® 86332		Immune Complex Detection By C1q Binding (so)	BOTH IP/OP	$34.00 	$25.16	$0.00	$38.44	$34.00	$34.00	$24.37	$24.37	$12.19	$12.19	$37.01	$37.01	$38.44	$24.37	$34.00	$15.84	$20.11	$20.11	$25.59	$34.00	$26.93	$27.20	$34.00	$0.00	$34.00	$38.36	$24.37	$24.37	$26.85	$24.37	$0.00	$0.00	$0.00	$0.00
30201988	EAP	CPT® 86255		Ampa -receptor Antibody (so) Mayo	BOTH IP/OP	$379.00 	$280.46	$6.03	$379.20	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$224.18	$224.18	$12.65	$33.68	$375.41	$379.20	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201989	EAP	CPT® 86255		"Nmda -receptor Antibody, Serum (mml)"	BOTH IP/OP	$358.00 	$264.92	$6.03	$358.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$211.76	$211.76	$12.65	$33.68	$354.82	$358.40	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30201990	EAP	CPT® 86790		"Chikungunya Antibodies (igg, Igm) (so)"	BOTH IP/OP	$380.00 	$281.20	$6.44	$304.00	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$224.77	$224.77	$13.52	$36.00	$300.96	$304.00	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30201991	EAP	CPT® 86790		"Chikungunya Antibodies (igg, Titration) (so)"	BOTH IP/OP	$380.00 	$281.20	$6.44	$304.00	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$224.77	$224.77	$13.52	$36.00	$300.96	$304.00	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30201992	EAP	CPT® 86790		Chikungunya Antibodies (igm Titration) (so)	BOTH IP/OP	$380.00 	$281.20	$6.44	$304.00	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$224.77	$224.77	$13.52	$36.00	$300.96	$304.00	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30201993	EAP	CPT® 86357		Natural Killer Cells (so)	BOTH IP/OP	$83.00 	$61.42	$0.00	$68.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$68.11	$68.80	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30201994	EAP	CPT® 83516		Myositis Antibody Panel (mml)	BOTH IP/OP	$707.00 	$523.18	$5.76	$638.40	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$418.19	$418.19	$12.11	$29.88	$632.02	$638.40	$16.72	$19.02	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30201995	EAP	CPT® 82017		"Acylcarnitine,plasma(so)"	BOTH IP/OP	$117.00 	$86.58	$0.00	$117.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.62	$25.62	$26.60	$0.00	$24.92	$0.00	$0.00	$0.00	$0.00	$47.14	$93.46	$94.40	$0.00	$117.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201996	EAP	CPT® 87305		"Aspergillus Antigen, Eia, Serum(so)"	BOTH IP/OP	$114.00 	$84.36	$5.99	$92.00	$24.74	$24.74	$11.98	$11.98	$5.99	$5.99	$18.22	$18.22	$18.92	$11.98	$17.71	$7.79	$67.43	$67.43	$12.58	$33.52	$91.08	$92.00	$17.37	$19.77	$17.37	$18.87	$11.98	$11.98	$13.21	$11.98	$0.00	$0.00	$0.00	$0.00
30201997	EAP	CPT® 87254		"Viral Respiratory,rapid Culture With Reflex(so)"	BOTH IP/OP	$425.00 	$314.50	$0.00	$342.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$7.22	$0.00	$0.00	$0.00	$0.00	$54.64	$338.98	$342.40	$0.00	$250.00	$0.00	$7.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30201998	EAP	CPT® 82397		Anti-mullerian Hormone Assessr™(so)	BOTH IP/OP	$296.00 	$219.04	$7.06	$230.40	$29.15	$29.15	$14.12	$14.12	$7.06	$7.06	$21.46	$21.46	$22.28	$14.12	$20.87	$9.18	$175.08	$175.08	$14.83	$39.48	$228.10	$230.40	$20.47	$23.30	$20.47	$22.24	$14.12	$14.12	$15.57	$14.12	$0.00	$0.00	$0.00	$0.00
30201999	EAP	CPT® 87906		Hiv-1 Integrase Genotype(so)	BOTH IP/OP	$225.00 	$166.50	$43.01	$212.40	$90.02	$90.02	$128.73	$128.73	$64.37	$64.36	$63.81	$63.81	$66.27	$128.73	$57.67	$83.67	$133.09	$133.09	$135.17	$113.50	$179.78	$181.60	$186.66	$212.40	$186.66	$61.44	$128.73	$128.73	$43.01	$128.73	$0.00	$0.00	$0.00	$0.00
30202000	EAP	CPT® 87798		"Hpv 8 Dna,qual(so)"	BOTH IP/OP	$418.00 	$309.32	$17.55	$336.80	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$247.25	$247.25	$36.84	$54.82	$333.43	$336.80	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30202001	EAP	CPT® 86316		"Chromgranin A,ecl"	BOTH IP/OP	$221.00 	$163.54	$10.41	$178.40	$42.95	$42.95	$20.81	$20.81	$10.41	$10.41	$31.60	$31.60	$32.81	$20.81	$30.73	$13.53	$130.72	$130.72	$21.85	$58.14	$176.62	$178.40	$30.17	$34.34	$30.17	$32.75	$20.81	$20.81	$22.92	$20.81	$0.00	$0.00	$0.00	$0.00
30202002	EAP	CPT® 83516		Euromyelitis Optica(so)	BOTH IP/OP	"$1,413.00 "	"$1,045.62"	$5.76	"$1,099.20"	$22.04	$22.04	$11.53	$11.53	$5.77	$5.76	$16.23	$16.23	$16.86	$11.53	$15.80	$7.49	$835.79	$835.79	$12.11	$29.88	"$1,088.21"	"$1,099.20"	$16.72	$19.02	$16.72	$16.84	$11.53	$11.53	$11.79	$11.53	$0.00	$0.00	$0.00	$0.00
30202003	EAP	CPT® 86336		Inhibin A(so)	BOTH IP/OP	$89.00 	$65.86	$7.79	$72.00	$26.74	$26.74	$15.59	$15.59	$7.80	$7.79	$19.66	$19.66	$20.41	$15.59	$19.12	$10.13	$52.64	$52.64	$16.37	$36.18	$71.28	$72.00	$22.61	$25.72	$22.61	$20.37	$15.59	$15.59	$14.26	$15.59	$0.00	$0.00	$0.00	$0.00
30202004	EAP	CPT® 82397		Inhibin B(so)	BOTH IP/OP	$427.00 	$315.98	$7.06	$332.00	$29.15	$29.15	$14.12	$14.12	$7.06	$7.06	$21.46	$21.46	$22.28	$14.12	$20.87	$9.18	$252.57	$252.57	$14.83	$39.48	$328.68	$332.00	$20.47	$23.30	$20.47	$22.24	$14.12	$14.12	$15.57	$14.12	$0.00	$0.00	$0.00	$0.00
30202005	EAP	CPT® 88271		"Fish, Myeloma Chrom Cep 9,11,15 Dna Probe (so)"	BOTH IP/OP	$638.00 	$472.12	$10.71	$510.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$377.38	$377.38	$22.49	$59.86	$505.30	$510.40	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30202006	EAP	CPT® 88275		"Fish, Myeloma Chrom Cep 9,11,15 Hybridization(so)"	BOTH IP/OP	$354.00 	$261.96	$0.00	$283.20	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$209.39	$209.39	$53.75	$112.22	$280.37	$283.20	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30202007	EAP	CPT® 88271		"Fish, Myeloma 17p-,rea14q32 (so) Dna Probe (so)"	BOTH IP/OP	"$4,290.00 "	"$3,174.60"	$10.71	"$3,408.80"	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	"$2,537.54"	"$2,537.54"	$22.49	$59.86	"$3,374.71"	"$3,408.80"	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30202008	EAP	CPT® 88275		"Fish, Myeloma 17p-,rea14q32(so) Hybridization(so)"	BOTH IP/OP	$601.00 	$444.74	$23.04	$477.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$355.49	$355.49	$53.75	$112.22	$472.82	$477.60	$74.23	$84.46	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30202009	EAP	CPT® 88271		"Fish, Myeloma Igh Panel(so) Dna Probe (so)"	BOTH IP/OP	"$2,092.00 "	"$1,548.08"	$10.71	"$1,662.40"	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	"$1,237.42"	"$1,237.42"	$22.49	$59.86	"$1,645.78"	"$1,662.40"	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
30202010	EAP	CPT® 88275		"Fish, Myeloma Igh Panel(so) Hybridization(so)"	BOTH IP/OP	"$1,046.00 "	$774.04	$23.04	$831.20	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$618.71	$618.71	$53.75	$112.22	$822.89	$831.20	$74.23	$84.46	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
30202011	EAP	CPT® 81596		"Liver Fibrosis, Fibro Test-actitest Panel (so)"	BOTH IP/OP	"$1,021.00 "	$755.54	$32.49	$807.20	$108.64	$108.64	$72.19	$72.19	$36.10	$32.49	$75.08	$75.08	$77.97	$72.19	$67.84	$46.92	$603.92	$603.92	$75.80	$504.50	$799.13	$807.20	$104.68	$119.11	$104.68	$72.29	$72.19	$72.19	$50.60	$72.19	$0.00	$0.00	$0.00	$0.00
30202012	EAP	CPT® 87535		"Hiv-1, Rna Qualitative Tma(so)"	BOTH IP/OP	$347.00 	$256.78	$17.55	$269.60	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$205.25	$205.25	$36.84	$54.82	$266.90	$269.60	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30202013	EAP	CPT® 87140		"Viral Id, Respiratory(so)"	BOTH IP/OP	$349.00 	$258.26	$0.00	$349.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.47	$8.47	$8.79	$0.00	$8.23	$0.00	$0.00	$0.00	$0.00	$15.58	$276.41	$279.20	$0.00	$349.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30202015	EAP	CPT® 81420		Qnatal  Advanced(so)	BOTH IP/OP	"$2,554.00 "	"$1,889.96"	$341.57	"$2,018.40"	"$1,207.35"	"$1,207.35"	$759.05	$759.05	$379.53	$341.57	"$1,895.58"	"$1,895.58"	"$1,968.62"	$759.05	$754.02	$493.38	"$1,510.69"	"$1,510.69"	$797.00	"$1,261.50"	"$1,998.22"	"$2,018.40"	"$1,100.62"	"$1,252.43"	"$1,100.62"	$803.42	$759.05	$759.05	$562.40	$759.05	$0.00	$0.00	$0.00	$0.00
30202016	EAP	CPT® 83835		"Metanephrines,frac,ur(so)"	BOTH IP/OP	$81.00 	$59.94	$8.47	$60.00	$34.98	$34.98	$16.94	$16.94	$8.47	$8.47	$25.73	$25.73	$26.72	$16.94	$25.02	$11.01	$47.91	$47.91	$17.79	$47.34	$59.40	$60.00	$24.56	$27.95	$24.56	$26.66	$16.94	$16.94	$18.66	$16.94	$0.00	$0.00	$0.00	$0.00
30202017	EAP	CPT® 87305		"Aspergillus Antigen,eia(so)"	BOTH IP/OP	$103.00 	$76.22	$5.99	$83.20	$24.74	$24.74	$11.98	$11.98	$5.99	$5.99	$18.22	$18.22	$18.92	$11.98	$17.71	$7.79	$60.92	$60.92	$12.58	$33.52	$82.37	$83.20	$17.37	$19.77	$17.37	$18.87	$11.98	$11.98	$13.21	$11.98	$0.00	$0.00	$0.00	$0.00
30202018	EAP	CPT® 86701		Hiv-1 Confirmation	BOTH IP/OP	$197.00 	$145.78	$4.44	$158.40	$18.35	$18.35	$8.89	$8.89	$4.45	$4.44	$13.48	$13.48	$14.00	$8.89	$11.39	$5.78	$116.53	$116.53	$9.33	$24.82	$156.82	$158.40	$12.89	$14.67	$12.89	$12.14	$8.89	$8.89	$8.50	$8.89	$0.00	$0.00	$0.00	$0.00
30202019	EAP	CPT® 86702		Hiv-2 Confirmation	BOTH IP/OP	$238.00 	$176.12	$6.76	$192.00	$27.90	$27.90	$13.52	$13.52	$6.76	$6.76	$20.53	$20.53	$21.32	$13.52	$17.33	$8.79	$140.78	$140.78	$14.20	$37.76	$190.08	$192.00	$19.60	$22.31	$19.60	$18.46	$13.52	$13.52	$12.92	$13.52	$0.00	$0.00	$0.00	$0.00
30202020	EAP	CPT® 86666		Anaplasma Phaggocytopilium Ab (so)	BOTH IP/OP	$398.00 	$294.52	$0.00	$396.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.44	$15.44	$16.04	$0.00	$15.04	$0.00	$0.00	$0.00	$0.00	$28.44	$392.04	$396.00	$0.00	$241.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30202021	EAP	CPT® 87798		"Pneumocysttis Jirovecii, Qual Rt Pcr (so)"	BOTH IP/OP	$448.00 	$331.52	$17.55	$361.60	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$264.99	$264.99	$36.84	$54.82	$357.98	$361.60	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30202022	EAP	CPT® 86790		Chikungunya Ab Reflex To Titer (so)	BOTH IP/OP	$219.00 	$162.06	$6.44	$160.00	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$129.54	$129.54	$13.52	$36.00	$158.40	$160.00	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30202024	EAP	CPT® 81255		Tay-sachs Disease Mutation Anal (so)	BOTH IP/OP	$304.00 	$224.96	$0.00	$277.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.63	$225.63	$234.32	$0.00	$115.59	$0.00	$0.00	$0.00	$0.00	$173.50	$274.82	$277.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30202025	EAP	CPT® 86738		Mycoplasma Pneumoniae Ab Cf Csf (so)	BOTH IP/OP	$117.00 	$86.58	$0.00	$96.80	$0.00	$0.00	$0.00	$0.00	$0.00	$6.62	$20.11	$20.11	$20.89	$13.24	$19.57	$8.61	$69.21	$69.21	$13.90	$37.02	$95.83	$96.80	$19.20	$0.00	$19.20	$20.85	$13.24	$13.24	$14.60	$13.24	$0.00	$0.00	$0.00	$0.00
30202026	EAP	CPT® 87902		Hepatitis C Viral Rna Ns3 Genotype(so)	BOTH IP/OP	$339.00 	$250.86	$96.09	$424.79	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$132.42	$132.42	$137.52	$257.45	$128.84	$167.34	$200.52	$200.52	$270.32	$243.70	$260.57	$263.20	$329.00	$424.79	$329.00	$137.28	$257.45	$257.45	$96.09	$257.45	$0.00	$0.00	$0.00	$0.00
30202027	EAP	CPT® 87902		"Hepatitis C Viral Rna, (so)"	BOTH IP/OP	$671.00 	$496.54	$96.09	$520.80	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$132.42	$132.42	$137.52	$257.45	$128.84	$167.34	$396.90	$396.90	$270.32	$243.70	$515.59	$520.80	$373.30	$424.79	$373.30	$137.28	$257.45	$257.45	$96.09	$257.45	$0.00	$0.00	$0.00	$0.00
30250310	EAP	CPT® 86256		Mitochondrial Ab Titer	BOTH IP/OP	$70.00 	$51.80	$0.00	$70.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$41.41	$41.41	$12.65	$33.68	$69.70	$70.40	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30250311	EAP	CPT® 83519		Alp Sub Pit Glycoprotein Horm	BOTH IP/OP	$850.00 	$629.00	$8.28	$767.20	$27.88	$27.88	$18.40	$18.40	$9.20	$8.28	$20.52	$20.52	$21.31	$18.40	$19.96	$11.96	$502.78	$502.78	$19.32	$37.76	$759.53	$767.20	$26.68	$30.36	$26.68	$21.27	$18.40	$18.40	$14.89	$18.40	$0.00	$0.00	$0.00	$0.00
30250312	EAP	CPT® 87624		mRNA	BOTH IP/OP	$101.00 	$74.74	$15.99	$78.40	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$27.77	$27.77	$28.84	$35.09	$21.44	$22.81	$59.74	$59.74	$36.84	$49.00	$77.62	$78.40	$50.88	$57.90	$50.88	$22.85	$35.09	$35.09	$15.99	$35.09	$0.00	$0.00	$0.00	$0.00
30250313	EAP	CPT® 86021		C-anca Titer	BOTH IP/OP	$34.00 	$25.16	$0.00	$34.00	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$20.11	$20.11	$15.80	$34.00	$26.93	$27.20	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30250314	EAP	CPT® 86021		P-anca Titer	BOTH IP/OP	$34.00 	$25.16	$0.00	$34.00	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$20.11	$20.11	$15.80	$34.00	$26.93	$27.20	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30250315	EAP	CPT® 86021		Atypical P-anca Titer	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$47.32	$47.32	$15.80	$42.06	$63.36	$64.00	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30250316	EAP	CPT® 86638		Q Fever Igg Phase I Titer	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.41	$18.41	$19.12	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$33.88	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30250317	EAP	CPT® 86638		Q Fever Igg Phase Ii Titer	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.41	$18.41	$19.12	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$33.88	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30250318	EAP	CPT® 86638		Q Fever Igm Phase I Titer	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.41	$18.41	$19.12	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$33.88	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30250320	EAP	CPT® 86611		B.henselae Igg Titer	BOTH IP/OP	$50.00 	$37.00	$0.00	$50.40	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$29.58	$29.58	$10.69	$28.44	$49.90	$50.40	$14.76	$0.00	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30250321	EAP	CPT® 86611		B.henselae Igm Titer	BOTH IP/OP	$50.00 	$37.00	$0.00	$50.40	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$29.58	$29.58	$10.69	$28.44	$49.90	$50.40	$14.76	$0.00	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30250322	EAP	CPT® 86611		B.quintana Igg Titer	BOTH IP/OP	$50.00 	$37.00	$0.00	$50.40	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$29.58	$29.58	$10.69	$28.44	$49.90	$50.40	$14.76	$0.00	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30250323	EAP	CPT® 86611		B.quintana Igm Titer	BOTH IP/OP	$50.00 	$37.00	$0.00	$50.40	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$29.58	$29.58	$10.69	$28.44	$49.90	$50.40	$14.76	$0.00	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30250325	EAP	CPT® 86003		Allergen Specific Ige Tilapia (so)	BOTH IP/OP	$200.00 	$148.00	$2.61	$199.20	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$118.30	$118.30	$5.48	$14.60	$197.21	$199.20	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30250326	EAP	CPT® 86003		Allergen Specific Ige Trout (so)	BOTH IP/OP	$136.00 	$100.64	$2.61	$136.00	$10.77	$10.77	$5.22	$5.22	$2.61	$2.61	$7.92	$7.92	$8.23	$5.22	$7.72	$3.39	$80.44	$80.44	$5.48	$14.60	$134.64	$136.00	$7.57	$8.61	$7.57	$8.22	$5.22	$5.22	$5.76	$5.22	$0.00	$0.00	$0.00	$0.00
30250327	EAP	CPT® 86790		Hepatitis A  Igg	BOTH IP/OP	$328.00 	$242.72	$6.44	$240.00	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$194.01	$194.01	$13.52	$36.00	$237.60	$240.00	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30250328	EAP	CPT® 87389		Hiv-1 Ag With Hiv-1/2 Ab	BOTH IP/OP	$306.00 	$226.44	$12.04	$237.60	$49.71	$49.71	$24.08	$24.08	$12.04	$12.04	$35.48	$35.48	$36.85	$24.08	$32.07	$15.65	$181.00	$181.00	$25.28	$148.50	$235.22	$237.60	$34.92	$39.73	$34.92	$34.17	$24.08	$24.08	$23.92	$24.08	$0.00	$0.00	$0.00	$0.00
30250329	EAP	CPT® 86255		"Ds-dna An, Crithidia Titer"	BOTH IP/OP	$150.00 	$111.00	$0.00	$150.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$88.73	$88.73	$12.65	$33.68	$148.90	$150.40	$17.47	$0.00	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30250340	EAP	CPT® 86361		Absolute Cd4 Count	BOTH IP/OP	$117.00 	$86.58	$0.00	$97.60	$53.91	$53.91	$26.78	$26.78	$13.39	$13.39	$39.63	$39.63	$41.16	$26.78	$38.56	$17.41	$69.21	$69.21	$28.12	$72.94	$96.62	$97.60	$38.83	$0.00	$38.83	$41.08	$26.78	$26.78	$28.76	$26.78	$0.00	$0.00	$0.00	$0.00
30250342	EAP	CPT® 86038		Ana Ifa W/reflex (so)	BOTH IP/OP	$219.00 	$162.06	$6.04	$166.40	$24.95	$24.95	$12.09	$12.09	$6.05	$6.04	$18.36	$18.36	$19.06	$12.09	$17.86	$7.86	$129.54	$129.54	$12.69	$33.78	$164.74	$166.40	$17.53	$19.95	$17.53	$19.03	$12.09	$12.09	$13.32	$12.09	$0.00	$0.00	$0.00	$0.00
30250380	EAP	CPT® 86790		Chikungunya Igg Titer(so)	BOTH IP/OP	$210.00 	$155.40	$6.44	$153.60	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$124.22	$124.22	$13.52	$36.00	$152.06	$153.60	$18.68	$21.25	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30250381	EAP	CPT® 86790		Chikungunya Igm Titer(so)	BOTH IP/OP	$192.00 	$142.08	$0.00	$153.60	$26.58	$26.58	$12.88	$12.88	$6.44	$6.44	$19.56	$19.56	$20.31	$12.88	$19.03	$8.37	$113.57	$113.57	$13.52	$36.00	$152.06	$153.60	$18.68	$0.00	$18.68	$20.27	$12.88	$12.88	$14.19	$12.88	$0.00	$0.00	$0.00	$0.00
30250382	EAP	CPT® 86039		"Ana Screen Ifa, W/titer And Pattern"	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.95	$16.95	$17.60	$0.00	$16.50	$0.00	$0.00	$0.00	$0.00	$31.20	$112.46	$113.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30250383	EAP	CPT® 86713		"Legionella Pneumophila Ab (igg), Ifa (so)"	BOTH IP/OP	$104.00 	$76.96	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.24	$23.24	$24.14	$0.00	$22.62	$0.00	$0.00	$0.00	$0.00	$42.78	$83.16	$84.00	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30250384	EAP	CPT® 86255		Copeptin (so)	BOTH IP/OP	$43.00 	$31.82	$6.03	$34.40	$24.87	$24.87	$12.05	$12.05	$6.03	$6.03	$18.30	$18.30	$19.01	$12.05	$17.81	$7.83	$25.43	$25.43	$12.65	$33.68	$34.06	$34.40	$17.47	$19.88	$17.47	$18.97	$12.05	$12.05	$13.28	$12.05	$0.00	$0.00	$0.00	$0.00
30250390	EAP	CPT® 86695		Hsv 1 Igg (so)	BOTH IP/OP	$59.00 	$43.66	$6.59	$45.60	$27.22	$27.22	$13.19	$13.19	$6.60	$6.59	$20.02	$20.02	$20.79	$13.19	$19.49	$8.57	$34.90	$34.90	$13.85	$36.86	$45.14	$45.60	$19.13	$21.76	$19.13	$20.76	$13.19	$13.19	$14.54	$13.19	$0.00	$0.00	$0.00	$0.00
30250391	EAP	CPT® 86696		Hsv 2 Igg (so)	BOTH IP/OP	$59.00 	$43.66	$9.68	$54.10	$39.94	$39.94	$19.35	$19.35	$9.68	$9.68	$29.39	$29.39	$30.52	$19.35	$28.60	$12.58	$34.90	$34.90	$20.32	$54.10	$45.14	$45.60	$28.06	$31.93	$28.06	$30.48	$19.35	$19.35	$21.33	$19.35	$0.00	$0.00	$0.00	$0.00
30250392	EAP	CPT® 86696		Hsv 2 Igg Inhibition (so)	BOTH IP/OP	$400.00 	$296.00	$9.68	$310.40	$39.94	$39.94	$19.35	$19.35	$9.68	$9.68	$29.39	$29.39	$30.52	$19.35	$28.60	$12.58	$236.60	$236.60	$20.32	$54.10	$307.30	$310.40	$28.06	$31.93	$28.06	$30.48	$19.35	$19.35	$21.33	$19.35	$0.00	$0.00	$0.00	$0.00
30250395	EAP	CPT® 86235		Myositis Specific 11 Ab Nuclear Ag (so)	BOTH IP/OP	$107.00 	$79.18	$8.97	$82.40	$37.01	$37.01	$17.93	$17.93	$8.97	$8.97	$27.23	$27.23	$28.27	$17.93	$26.49	$11.65	$63.29	$63.29	$18.83	$50.12	$81.58	$82.40	$26.00	$29.58	$26.00	$28.23	$17.93	$17.93	$19.76	$17.93	$0.00	$0.00	$0.00	$0.00
30250396	EAP	CPT® 88365		KAPPA/LAMBDA ISH	BOTH IP/OP	$251.00 	$185.74	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.18	$102.18	$106.11	$0.00	$103.59	$0.00	$0.00	$0.00	$143.92	$156.90	$198.00	$200.00	$199.96	$163.15	$199.96	$110.38	$137.95	$137.95	$77.27	$137.07	$0.00	$0.00	$0.00	$0.00
30250397	EAP	CPT® 88366		KAPPA/LAMBDA ISH	BOTH IP/OP	$251.00 	$185.74	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.94	$155.94	$161.94	$0.00	$52.31	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$163.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30250400	EAP	CPT® 86328		Ia Infectious Ag Ab Sars-cov2 Covid 19	BOTH IP/OP	$151.00 	$111.74	$0.00	$120.00	$119.41	$119.41	$0.00	$0.00	$22.62	$57.41	$0.00	$0.00	$0.00	$0.00	$57.41	$0.00	$89.32	$89.32	$47.49	$75.00	$118.80	$120.00	$65.58	$74.71	$65.58	$23.48	$45.23	$45.23	$23.88	$45.23	$0.00	$0.00	$0.00	$0.00
30250401	EAP	CPT® 86769		Sars-cov-2 Covid-19 Antibody	BOTH IP/OP	$55.00 	$40.70	$0.00	$59.15	$0.00	$0.00	$0.00	$0.00	$0.00	$57.41	$0.00	$0.00	$0.00	$0.00	$55.00	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00	$59.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500001	EAP	CPT® 85002		"Bleeding Time, Temp"	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.83	$6.83	$7.10	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$12.58	$86.33	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500002	EAP	CPT® 85007		Misc. Smear	BOTH IP/OP	$102.00 	$75.48	$1.72	$80.80	$7.08	$7.08	$3.80	$3.80	$1.90	$1.72	$5.22	$5.22	$5.42	$3.80	$5.08	$2.47	$60.33	$60.33	$3.99	$9.62	$79.99	$80.80	$5.51	$6.27	$5.51	$5.41	$3.80	$3.80	$3.79	$3.80	$0.00	$0.00	$0.00	$0.00
30500003	EAP	CPT® 85576		Bld Plat Agg - Teg	BOTH IP/OP	$442.00 	$327.08	$11.21	$321.60	$44.35	$44.35	$24.91	$24.91	$12.46	$11.21	$32.62	$32.62	$33.88	$24.91	$31.73	$16.19	$261.44	$261.44	$26.16	$60.02	$318.38	$321.60	$36.12	$41.10	$36.12	$33.81	$24.91	$24.91	$23.67	$24.91	$0.00	$0.00	$0.00	$0.00
30500004	EAP	CPT® 85384		Fibrinogen Act - Teg	BOTH IP/OP	$207.00 	$153.18	$4.37	$150.40	$17.53	$17.53	$9.72	$9.72	$4.86	$4.37	$12.90	$12.90	$13.39	$9.72	$12.55	$6.32	$122.44	$122.44	$10.21	$23.74	$148.90	$150.40	$14.09	$16.04	$14.09	$13.37	$9.72	$9.72	$9.36	$9.72	$0.00	$0.00	$0.00	$0.00
30500005	EAP	CPT® 85008		Rbc Morphology Exam	BOTH IP/OP	$83.00 	$61.42	$0.00	$66.40	$7.08	$7.08	$3.43	$3.43	$1.72	$1.72	$5.22	$5.22	$5.42	$3.43	$5.08	$2.23	$49.09	$49.09	$3.60	$9.62	$65.74	$66.40	$4.97	$0.00	$4.97	$5.41	$3.43	$3.43	$3.79	$3.43	$0.00	$0.00	$0.00	$0.00
30500006	EAP	CPT® 85008		"Rbc, Schistocyte Cnt"	BOTH IP/OP	$91.00 	$67.34	$1.72	$66.40	$7.08	$7.08	$3.43	$3.43	$1.72	$1.72	$5.22	$5.22	$5.42	$3.43	$5.08	$2.23	$53.83	$53.83	$3.60	$9.62	$65.74	$66.40	$4.97	$5.66	$4.97	$5.41	$3.43	$3.43	$3.79	$3.43	$0.00	$0.00	$0.00	$0.00
30500007	EAP	CPT® 85013		Hematocrit Count	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.60	$3.60	$3.74	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$6.62	$40.39	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500008	EAP	CPT® 85013		"Hematocrit, Fld - Spun"	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.60	$3.60	$3.74	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$6.62	$40.39	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500009	EAP	CPT® 85347		"Coag Time, Activated-teg"	BOTH IP/OP	$293.00 	$216.82	$2.13	$212.80	$8.79	$8.79	$4.28	$4.28	$2.14	$2.13	$6.47	$6.47	$6.72	$4.28	$6.30	$2.78	$173.31	$173.31	$4.49	$11.90	$210.67	$212.80	$6.21	$7.06	$6.21	$6.71	$4.28	$4.28	$4.70	$4.28	$0.00	$0.00	$0.00	$0.00
30500010	EAP	CPT® 85013		"Hematocrit, Spun Cap"	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.60	$3.60	$3.74	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$6.62	$40.39	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500011	EAP	CPT® 85013		"Hematocrit,csf-spun"	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.60	$3.60	$3.74	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$6.62	$40.39	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500012	EAP	CPT® 85014		Hematocrit	BOTH IP/OP	$58.00 	$42.92	$0.00	$46.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.60	$3.60	$3.74	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$6.62	$45.94	$46.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500013	EAP	CPT® 85390		Fibrinolysins Scrn -teg	BOTH IP/OP	$134.00 	$99.16	$0.00	$134.00	$10.69	$10.69	$15.48	$15.48	$7.74	$6.97	$7.84	$7.84	$8.14	$15.48	$7.63	$10.06	$79.26	$79.26	$0.00	$14.44	$96.62	$97.60	$0.00	$134.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500015	EAP	CPT® 85018		"Hemoglobin, Micro(meter)"	BOTH IP/OP	$51.00 	$37.74	$1.18	$40.80	$4.88	$4.88	$2.37	$2.37	$1.19	$1.18	$3.60	$3.60	$3.74	$2.37	$3.50	$1.54	$30.17	$30.17	$2.49	$6.62	$40.39	$40.80	$3.44	$3.91	$3.44	$3.73	$2.37	$2.37	$2.61	$2.37	$0.00	$0.00	$0.00	$0.00
30500016	EAP	CPT® 86022		Platelet Antibody Screen Indirect (so)	BOTH IP/OP	$362.00 	$267.88	$0.00	$289.60	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$214.12	$214.12	$0.00	$51.32	$286.70	$289.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500017	EAP	CPT® 85018		Hgb & Hct	BOTH IP/OP	$51.00 	$37.74	$1.18	$40.80	$4.88	$4.88	$2.37	$2.37	$1.19	$1.18	$3.60	$3.60	$3.74	$2.37	$3.50	$1.54	$30.17	$30.17	$2.49	$6.62	$40.39	$40.80	$3.44	$3.91	$3.44	$3.73	$2.37	$2.37	$2.61	$2.37	$0.00	$0.00	$0.00	$0.00
30500018	EAP	CPT® 85018		"Hgb, Venous (meter)"	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$4.88	$4.88	$2.37	$2.37	$1.19	$1.18	$3.60	$3.60	$3.74	$2.37	$3.50	$1.54	$30.17	$30.17	$2.49	$6.62	$40.39	$40.80	$3.44	$0.00	$3.44	$3.73	$2.37	$2.37	$2.61	$2.37	$0.00	$0.00	$0.00	$0.00
30500021	EAP	CPT® 85025		"CBC, PLAT & DIFF"	BOTH IP/OP	$212.00 	$156.88	$3.88	$177.60	$16.05	$16.05	$7.77	$7.77	$3.89	$3.88	$9.97	$9.97	$10.36	$7.77	$11.48	$5.05	$125.40	$125.40	$8.16	$21.72	$175.82	$177.60	$11.27	$12.82	$11.27	$12.23	$7.77	$7.77	$8.56	$7.77	$0.00	$0.00	$0.00	$0.00
30500022	EAP	CPT® 85027		CBC & PLAT	BOTH IP/OP	$175.00 	$129.50	$3.23	$147.20	$13.36	$13.36	$6.47	$6.47	$3.24	$3.23	$9.83	$9.83	$10.21	$6.47	$9.57	$4.21	$103.51	$103.51	$6.79	$18.08	$145.73	$147.20	$9.38	$10.68	$9.38	$10.19	$6.47	$6.47	$7.13	$6.47	$0.00	$0.00	$0.00	$0.00
30500024	EAP	CPT® 85046		"Reticulocytes, Automated"	BOTH IP/OP	$154.00 	$113.96	$2.79	$112.00	$11.48	$11.48	$5.57	$5.57	$2.79	$2.79	$8.48	$8.48	$8.80	$5.57	$8.24	$3.62	$91.09	$91.09	$5.85	$15.60	$110.88	$112.00	$8.08	$9.19	$8.08	$8.78	$5.57	$5.57	$6.15	$5.57	$0.00	$0.00	$0.00	$0.00
30500026	EAP	CPT® 85048		"EOSINOPHIL COUNT, WB"	BOTH IP/OP	$68.00 	$50.32	$0.00	$59.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.86	$3.86	$4.01	$0.00	$3.76	$0.00	$0.00	$0.00	$0.00	$7.10	$58.61	$59.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500027	EAP	CPT® 85049		Platelet Count (wb)	BOTH IP/OP	$127.00 	$93.98	$2.24	$93.60	$9.24	$9.24	$4.48	$4.48	$2.24	$2.24	$6.79	$6.79	$7.05	$4.48	$6.62	$2.91	$75.12	$75.12	$4.70	$12.50	$92.66	$93.60	$6.50	$7.39	$6.50	$7.05	$4.48	$4.48	$4.93	$4.48	$0.00	$0.00	$0.00	$0.00
30500028	EAP	CPT® 85097		Bone Marrow Exam	BOTH IP/OP	$773.00 	$572.02	$0.00	$781.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.62	$48.62	$50.49	$0.00	$75.35	$0.00	$0.00	$0.00	$630.05	$213.48	$618.55	$624.80	$781.00	$502.45	$781.00	$80.29	$51.21	$51.21	$56.20	$600.04	$0.00	$0.00	$0.00	$0.00
30500029	EAP	CPT® 85210		Factor  Ii Assay	BOTH IP/OP	$424.00 	$313.76	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.72	$19.72	$20.48	$0.00	$19.18	$0.00	$0.00	$0.00	$0.00	$36.28	$309.67	$312.80	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500030	EAP	CPT® 85220		Factor   V Assay	BOTH IP/OP	$568.00 	$420.32	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.82	$26.80	$26.80	$27.83	$17.65	$26.07	$11.47	$335.97	$335.97	$0.00	$49.32	$415.01	$419.20	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500031	EAP	CPT® 85230		Factor Vii Assay	BOTH IP/OP	$584.00 	$432.16	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.19	$27.19	$28.23	$0.00	$26.46	$0.00	$0.00	$0.00	$18.80	$50.04	$426.10	$430.40	$25.96	$584.00	$25.96	$28.19	$17.90	$17.90	$19.74	$17.90	$0.00	$0.00	$0.00	$0.00
30500032	EAP	CPT® 85240		Factor Viii Assay	BOTH IP/OP	$584.00 	$432.16	$8.95	$430.40	$36.96	$36.96	$17.90	$17.90	$8.95	$8.95	$27.19	$27.19	$28.23	$17.90	$26.46	$11.64	$345.44	$345.44	$18.80	$50.04	$426.10	$430.40	$25.96	$29.54	$25.96	$28.19	$17.90	$17.90	$19.74	$17.90	$0.00	$0.00	$0.00	$0.00
30500033	EAP	CPT® 85245		Vw Factor Activity	BOTH IP/OP	$680.00 	$503.20	$0.00	$544.00	$47.36	$47.36	$22.94	$22.94	$11.47	$11.47	$34.85	$34.85	$36.19	$22.94	$33.89	$14.91	$402.22	$402.22	$24.09	$64.12	$538.56	$544.00	$33.26	$0.00	$33.26	$36.11	$22.94	$22.94	$25.28	$22.94	$0.00	$0.00	$0.00	$0.00
30500034	EAP	CPT® 85245		Ristocetin Cofactor	BOTH IP/OP	$738.00 	$546.12	$11.47	$544.00	$47.36	$47.36	$22.94	$22.94	$11.47	$11.47	$34.85	$34.85	$36.19	$22.94	$33.89	$14.91	$436.53	$436.53	$24.09	$64.12	$538.56	$544.00	$33.26	$37.85	$33.26	$36.11	$22.94	$22.94	$25.28	$22.94	$0.00	$0.00	$0.00	$0.00
30500035	EAP	CPT® 85246		Von Willebrand Ag	BOTH IP/OP	$738.00 	$546.12	$11.47	$544.00	$47.36	$47.36	$22.94	$22.94	$11.47	$11.47	$34.85	$34.85	$36.19	$22.94	$33.89	$14.91	$436.53	$436.53	$24.09	$64.12	$538.56	$544.00	$33.26	$37.85	$33.26	$36.11	$22.94	$22.94	$25.28	$22.94	$0.00	$0.00	$0.00	$0.00
30500036	EAP	CPT® 85250		Factor  Ix Assay	BOTH IP/OP	$613.00 	$453.62	$0.00	$613.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.90	$28.90	$30.01	$0.00	$28.12	$0.00	$0.00	$0.00	$19.99	$53.20	$447.48	$452.00	$27.61	$613.00	$27.61	$29.96	$19.04	$19.04	$20.97	$19.04	$0.00	$0.00	$0.00	$0.00
30500037	EAP	CPT® 85260		Factor   X Assay	BOTH IP/OP	$584.00 	$432.16	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.19	$27.19	$28.23	$0.00	$26.46	$0.00	$0.00	$0.00	$0.00	$50.04	$426.10	$430.40	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500038	EAP	CPT® 85270		Factor  Xi Assay	BOTH IP/OP	$584.00 	$432.16	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.19	$27.19	$28.23	$0.00	$26.46	$0.00	$0.00	$0.00	$0.00	$50.04	$426.10	$430.40	$0.00	$584.00	$0.00	$28.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500039	EAP	CPT® 85280		Factor Xii Assay	BOTH IP/OP	$621.00 	$459.54	$0.00	$621.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.38	$29.38	$30.51	$0.00	$28.59	$0.00	$0.00	$0.00	$0.00	$54.08	$453.02	$457.60	$0.00	$621.00	$0.00	$30.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500040	EAP	CPT® 85291		Factor Xiii Screen	BOTH IP/OP	$680.00 	$503.20	$0.00	$501.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$13.50	$14.02	$0.00	$13.14	$0.00	$0.00	$0.00	$0.00	$24.84	$496.58	$501.60	$0.00	$370.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500041	EAP	CPT® 85300		Protein S Activity	BOTH IP/OP	$493.00 	$364.82	$5.93	$386.40	$24.47	$24.47	$11.85	$11.85	$5.93	$5.93	$17.99	$17.99	$18.68	$11.85	$17.50	$7.70	$291.61	$291.61	$12.44	$33.10	$382.54	$386.40	$17.18	$19.55	$17.18	$18.65	$11.85	$11.85	$13.06	$11.85	$0.00	$0.00	$0.00	$0.00
30500042	EAP	CPT® 85300		Factor At-iii Assay	BOTH IP/OP	$493.00 	$364.82	$5.93	$386.40	$24.47	$24.47	$11.85	$11.85	$5.93	$5.93	$17.99	$17.99	$18.68	$11.85	$17.50	$7.70	$291.61	$291.61	$12.44	$33.10	$382.54	$386.40	$17.18	$19.55	$17.18	$18.65	$11.85	$11.85	$13.06	$11.85	$0.00	$0.00	$0.00	$0.00
30500043	EAP	CPT® 85301		At-iii Antigen	BOTH IP/OP	$971.00 	$718.54	$0.00	$784.80	$0.00	$0.00	$0.00	$0.00	$0.00	$5.40	$16.42	$16.42	$17.05	$10.81	$15.98	$7.03	$574.35	$574.35	$11.35	$30.22	$776.95	$784.80	$15.67	$459.00	$15.67	$17.03	$10.81	$10.81	$11.92	$10.81	$0.00	$0.00	$0.00	$0.00
30500044	EAP	CPT® 85303		Protein C Activity	BOTH IP/OP	$466.00 	$344.84	$6.92	$364.80	$28.56	$28.56	$13.84	$13.84	$6.92	$6.92	$21.00	$21.00	$21.81	$13.84	$20.43	$9.00	$275.64	$275.64	$14.53	$38.64	$361.15	$364.80	$20.07	$22.84	$20.07	$21.77	$13.84	$13.84	$15.24	$13.84	$0.00	$0.00	$0.00	$0.00
30500045	EAP	CPT® 85307		Act Prot-c Resist (fv-leiden)	BOTH IP/OP	$264.00 	$195.36	$7.66	$207.20	$31.63	$31.63	$15.32	$15.32	$7.66	$7.66	$23.26	$23.26	$24.16	$15.32	$22.64	$9.96	$156.16	$156.16	$16.09	$42.82	$205.13	$207.20	$22.21	$25.28	$22.21	$24.12	$15.32	$15.32	$16.88	$15.32	$0.00	$0.00	$0.00	$0.00
30500046	EAP	CPT® 85379		D-dimer	BOTH IP/OP	$335.00 	$247.90	$5.09	$270.40	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$198.15	$198.15	$10.69	$28.44	$267.70	$270.40	$14.76	$16.80	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30500047	EAP	CPT® 85384		Fibrinogen Quant.	BOTH IP/OP	$299.00 	$221.26	$4.37	$217.60	$17.53	$17.53	$9.72	$9.72	$4.86	$4.37	$12.90	$12.90	$13.39	$9.72	$12.55	$6.32	$176.86	$176.86	$10.21	$23.74	$215.42	$217.60	$14.09	$16.04	$14.09	$13.37	$9.72	$9.72	$9.36	$9.72	$0.00	$0.00	$0.00	$0.00
30500048	EAP	CPT® 85410		Alpha-2-antiplasmin	BOTH IP/OP	$183.00 	$135.42	$0.00	$146.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.71	$11.71	$12.16	$0.00	$11.38	$0.00	$0.00	$0.00	$0.00	$21.54	$144.94	$146.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500049	EAP	CPT® 85420		Plasminogen Activ.	BOTH IP/OP	$145.00 	$107.30	$0.00	$145.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.93	$9.93	$10.31	$0.00	$9.66	$0.00	$0.00	$0.00	$0.00	$18.26	$115.63	$116.80	$0.00	$145.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500050	EAP	CPT® 85441		Heinz Body Direct	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.39	$6.39	$6.63	$0.00	$6.22	$0.00	$0.00	$0.00	$0.00	$11.76	$45.14	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500051	EAP	CPT® 85445		Heinz Body Induced	BOTH IP/OP	$83.00 	$61.42	$0.00	$82.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.35	$10.35	$10.75	$0.00	$10.07	$0.00	$0.00	$0.00	$0.00	$19.04	$65.74	$66.40	$0.00	$82.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500052	EAP	CPT® 85460		K-b Hgb Fetal Screen **	BOTH IP/OP	$51.00 	$37.74	$2.66	$40.80	$4.99	$4.99	$7.73	$7.73	$3.87	$3.87	$3.67	$3.67	$3.81	$7.73	$3.57	$5.02	$30.17	$30.17	$8.12	$6.76	$40.39	$40.80	$11.21	$12.75	$11.21	$3.80	$7.73	$7.73	$2.66	$7.73	$0.00	$0.00	$0.00	$0.00
30500053	EAP	CPT® 85475		"Hemolysis,acid-ham's"	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.91	$7.91	$8.22	$0.00	$7.70	$0.00	$0.00	$0.00	$0.00	$14.56	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500054	EAP	CPT® 85475		"Hemolysis, Sucrose"	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.91	$7.91	$8.22	$0.00	$7.70	$0.00	$0.00	$0.00	$0.00	$14.56	$46.73	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500055	EAP	CPT® 85520		Heparin Assay	BOTH IP/OP	$400.00 	$296.00	$6.55	$323.20	$27.03	$27.03	$13.09	$13.09	$6.55	$6.55	$19.87	$19.87	$20.64	$13.09	$19.34	$8.51	$236.60	$236.60	$13.74	$36.58	$319.97	$323.20	$18.98	$21.60	$18.98	$20.61	$13.09	$13.09	$14.43	$13.09	$0.00	$0.00	$0.00	$0.00
30500056	EAP	CPT® 85536		Iron Stores-bm	BOTH IP/OP	$186.00 	$137.64	$0.00	$148.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.83	$9.83	$10.21	$0.00	$9.57	$0.00	$0.00	$0.00	$0.00	$18.08	$147.31	$148.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500057	EAP	CPT® 85540		Wbc Lap Stain	BOTH IP/OP	$154.00 	$113.96	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.17	$9.17	$9.53	$0.00	$8.93	$0.00	$0.00	$0.00	$0.00	$16.88	$133.06	$134.40	$0.00	$87.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500058	EAP	CPT® 85549		Lysozyme	BOTH IP/OP	$180.00 	$133.20	$9.37	$145.60	$38.70	$38.70	$18.75	$18.75	$9.38	$9.37	$28.49	$28.49	$29.58	$18.75	$27.71	$12.19	$106.47	$106.47	$19.69	$52.42	$144.14	$145.60	$27.19	$30.94	$27.19	$29.53	$18.75	$18.75	$20.67	$18.75	$0.00	$0.00	$0.00	$0.00
30500059	EAP	CPT® 85576		"Plt Agg, Thrombin"	BOTH IP/OP	$465.00 	$344.10	$11.21	$461.60	$44.35	$44.35	$24.91	$24.91	$12.46	$11.21	$32.62	$32.62	$33.88	$24.91	$31.73	$16.19	$275.05	$275.05	$26.16	$60.02	$456.98	$461.60	$36.12	$41.10	$36.12	$33.81	$24.91	$24.91	$23.67	$24.91	$0.00	$0.00	$0.00	$0.00
30500060	EAP	CPT® 85576		"Plt Agg, Adp"	BOTH IP/OP	$465.00 	$344.10	$11.21	$461.60	$44.35	$44.35	$24.91	$24.91	$12.46	$11.21	$32.62	$32.62	$33.88	$24.91	$31.73	$16.19	$275.05	$275.05	$26.16	$60.02	$456.98	$461.60	$36.12	$41.10	$36.12	$33.81	$24.91	$24.91	$23.67	$24.91	$0.00	$0.00	$0.00	$0.00
30500061	EAP	CPT® 85576		"Plt Agg, Collagen"	BOTH IP/OP	$465.00 	$344.10	$11.21	$461.60	$44.35	$44.35	$24.91	$24.91	$12.46	$11.21	$32.62	$32.62	$33.88	$24.91	$31.73	$16.19	$275.05	$275.05	$26.16	$60.02	$456.98	$461.60	$36.12	$41.10	$36.12	$33.81	$24.91	$24.91	$23.67	$24.91	$0.00	$0.00	$0.00	$0.00
30500062	EAP	CPT® 85576		"Plt Agg, Ristocetin"	BOTH IP/OP	$465.00 	$344.10	$11.21	$461.60	$44.35	$44.35	$24.91	$24.91	$12.46	$11.21	$32.62	$32.62	$33.88	$24.91	$31.73	$16.19	$275.05	$275.05	$26.16	$60.02	$456.98	$461.60	$36.12	$41.10	$36.12	$33.81	$24.91	$24.91	$23.67	$24.91	$0.00	$0.00	$0.00	$0.00
30500063	EAP	CPT® 85576		"Plt Agg, Aracdnc Acid"	BOTH IP/OP	$465.00 	$344.10	$11.21	$461.60	$44.35	$44.35	$24.91	$24.91	$12.46	$11.21	$32.62	$32.62	$33.88	$24.91	$31.73	$16.19	$275.05	$275.05	$26.16	$60.02	$456.98	$461.60	$36.12	$41.10	$36.12	$33.81	$24.91	$24.91	$23.67	$24.91	$0.00	$0.00	$0.00	$0.00
30500064	EAP	CPT® 85576		Pfa-collagen/epi	BOTH IP/OP	$676.00 	$500.24	$11.21	$492.00	$44.35	$44.35	$24.91	$24.91	$12.46	$11.21	$32.62	$32.62	$33.88	$24.91	$31.73	$16.19	$399.85	$399.85	$26.16	$60.02	$487.08	$492.00	$36.12	$41.10	$36.12	$33.81	$24.91	$24.91	$23.67	$24.91	$0.00	$0.00	$0.00	$0.00
30500065	EAP	CPT® 85576		Pfa-collagen/adp	BOTH IP/OP	$676.00 	$500.24	$11.21	$492.00	$44.35	$44.35	$24.91	$24.91	$12.46	$11.21	$32.62	$32.62	$33.88	$24.91	$31.73	$16.19	$399.85	$399.85	$26.16	$60.02	$487.08	$492.00	$36.12	$41.10	$36.12	$33.81	$24.91	$24.91	$23.67	$24.91	$0.00	$0.00	$0.00	$0.00
30500066	EAP	CPT® 86022		Platelet Agg-heprin	BOTH IP/OP	$536.00 	$396.64	$0.00	$394.40	$37.91	$37.91	$18.37	$18.37	$9.19	$9.18	$27.89	$27.89	$28.97	$18.37	$27.12	$11.94	$317.04	$317.04	$0.00	$51.32	$390.46	$394.40	$0.00	$30.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500067	EAP	CPT® 85597		Plat Neutralization	BOTH IP/OP	$420.00 	$310.80	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.30	$27.30	$28.35	$0.00	$26.57	$0.00	$0.00	$0.00	$0.00	$50.24	$412.63	$416.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500068	EAP	CPT® 85610		Pt(prothrombin Time)	BOTH IP/OP	$159.00 	$117.66	$1.97	$116.80	$8.10	$8.10	$4.29	$4.29	$2.15	$1.97	$5.97	$5.97	$6.20	$4.29	$5.81	$2.79	$94.05	$94.05	$4.50	$10.98	$115.63	$116.80	$6.22	$7.08	$6.22	$6.19	$4.29	$4.29	$4.33	$4.29	$0.00	$0.00	$0.00	$0.00
30500069	EAP	CPT® 85610		"Pt,coumadin Therapy"	BOTH IP/OP	$159.00 	$117.66	$1.97	$116.80	$8.10	$8.10	$4.29	$4.29	$2.15	$1.97	$5.97	$5.97	$6.20	$4.29	$5.81	$2.79	$94.05	$94.05	$4.50	$10.98	$115.63	$116.80	$6.22	$7.08	$6.22	$6.19	$4.29	$4.29	$4.33	$4.29	$0.00	$0.00	$0.00	$0.00
30500070	EAP	CPT® 85610		"Pt, Coumatrak"	BOTH IP/OP	$146.00 	$108.04	$1.97	$116.80	$8.10	$8.10	$4.29	$4.29	$2.15	$1.97	$5.97	$5.97	$6.20	$4.29	$5.81	$2.79	$86.36	$86.36	$4.50	$10.98	$115.63	$116.80	$6.22	$7.08	$6.22	$6.19	$4.29	$4.29	$4.33	$4.29	$0.00	$0.00	$0.00	$0.00
30500071	EAP	CPT® 85611		Pt+normal Plasma	BOTH IP/OP	$145.00 	$107.30	$0.00	$145.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.98	$5.98	$6.21	$0.00	$5.83	$0.00	$0.00	$0.00	$0.00	$11.02	$105.34	$106.40	$0.00	$145.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500072	EAP	CPT® 85611		"Pt, Hepzyme-treated"	BOTH IP/OP	$133.00 	$98.42	$0.00	$106.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.98	$5.98	$6.21	$0.00	$5.83	$0.00	$0.00	$0.00	$0.00	$11.02	$105.34	$106.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500073	EAP	CPT® 85613		Dilute Russell's Viper Venom	BOTH IP/OP	$302.00 	$223.48	$4.79	$220.00	$19.77	$19.77	$9.58	$9.58	$4.79	$4.79	$14.53	$14.53	$15.09	$9.58	$14.13	$6.23	$178.63	$178.63	$10.06	$26.74	$217.80	$220.00	$13.89	$15.81	$13.89	$15.06	$9.58	$9.58	$10.54	$9.58	$0.00	$0.00	$0.00	$0.00
30500074	EAP	CPT® 85651		Sed Rate Westergren	BOTH IP/OP	$99.00 	$73.26	$0.00	$98.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.39	$5.39	$5.59	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$9.92	$97.42	$98.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500075	EAP	CPT® 85660		DONOR HGB S-ARC	BOTH IP/OP	$166.00 	$122.84	$0.00	$146.40	$11.38	$11.38	$5.51	$5.51	$2.76	$2.75	$8.38	$8.38	$8.70	$5.51	$8.15	$3.58	$98.19	$98.19	$5.79	$15.42	$144.94	$146.40	$7.99	$0.00	$7.99	$8.68	$5.51	$5.51	$6.08	$5.51	$0.00	$0.00	$0.00	$0.00
30500076	EAP	CPT® 85660		Donor Hgb S-gmh	BOTH IP/OP	$166.00 	$122.84	$0.00	$146.40	$11.38	$11.38	$5.51	$5.51	$2.76	$2.75	$8.38	$8.38	$8.70	$5.51	$8.15	$3.58	$98.19	$98.19	$5.79	$15.42	$144.94	$146.40	$7.99	$0.00	$7.99	$8.68	$5.51	$5.51	$6.08	$5.51	$0.00	$0.00	$0.00	$0.00
30500077	EAP	CPT® 85660		Sickledex	BOTH IP/OP	$201.00 	$148.74	$2.75	$146.40	$11.38	$11.38	$5.51	$5.51	$2.76	$2.75	$8.38	$8.38	$8.70	$5.51	$8.15	$3.58	$118.89	$118.89	$5.79	$15.42	$144.94	$146.40	$7.99	$9.09	$7.99	$8.68	$5.51	$5.51	$6.08	$5.51	$0.00	$0.00	$0.00	$0.00
30500078	EAP	CPT® 85670		Thrombin Time	BOTH IP/OP	$145.00 	$107.30	$2.88	$145.00	$11.91	$11.91	$5.77	$5.77	$2.89	$2.88	$8.78	$8.78	$9.12	$5.77	$8.53	$3.75	$85.77	$85.77	$6.06	$16.14	$104.54	$105.60	$8.37	$145.00	$8.37	$9.08	$5.77	$5.77	$6.36	$5.77	$0.00	$0.00	$0.00	$0.00
30500079	EAP	CPT® 85730		"Appt, Hepzyme-treated"	BOTH IP/OP	$216.00 	$159.84	$3.00	$156.80	$12.41	$12.41	$6.01	$6.01	$3.01	$3.00	$9.11	$9.11	$9.46	$6.01	$8.86	$3.91	$127.76	$127.76	$6.31	$16.76	$155.23	$156.80	$8.71	$9.92	$8.71	$9.44	$6.01	$6.01	$6.61	$6.01	$0.00	$0.00	$0.00	$0.00
30500080	EAP	CPT® 85730		Aptt	BOTH IP/OP	$216.00 	$159.84	$3.00	$156.80	$12.41	$12.41	$6.01	$6.01	$3.01	$3.00	$9.11	$9.11	$9.46	$6.01	$8.86	$3.91	$127.76	$127.76	$6.31	$16.76	$155.23	$156.80	$8.71	$9.92	$8.71	$9.44	$6.01	$6.01	$6.61	$6.01	$0.00	$0.00	$0.00	$0.00
30500082	EAP	CPT® 85730		Aptt Heparin Therapy	BOTH IP/OP	$187.00 	$138.38	$3.00	$156.80	$12.41	$12.41	$6.01	$6.01	$3.01	$3.00	$9.11	$9.11	$9.46	$6.01	$8.86	$3.91	$110.61	$110.61	$6.31	$16.76	$155.23	$156.80	$8.71	$9.92	$8.71	$9.44	$6.01	$6.01	$6.61	$6.01	$0.00	$0.00	$0.00	$0.00
30500083	EAP	CPT® 85730		Ptt-saline	BOTH IP/OP	$187.00 	$138.38	$3.00	$156.80	$12.41	$12.41	$6.01	$6.01	$3.01	$3.00	$9.11	$9.11	$9.46	$6.01	$8.86	$3.91	$110.61	$110.61	$6.31	$16.76	$155.23	$156.80	$8.71	$9.92	$8.71	$9.44	$6.01	$6.01	$6.61	$6.01	$0.00	$0.00	$0.00	$0.00
30500084	EAP	CPT® 85732		Aptt + Apc	BOTH IP/OP	$225.00 	$166.50	$0.00	$164.00	$13.36	$13.36	$6.47	$6.47	$3.24	$3.23	$9.83	$9.83	$10.21	$6.47	$9.57	$4.21	$133.09	$133.09	$0.00	$18.08	$162.36	$164.00	$0.00	$10.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500085	EAP	CPT® 85732		Factor Def Scrn-coag	BOTH IP/OP	$225.00 	$166.50	$0.00	$164.00	$13.36	$13.36	$6.47	$6.47	$3.24	$3.23	$9.83	$9.83	$10.21	$6.47	$9.57	$4.21	$133.09	$133.09	$0.00	$18.08	$162.36	$164.00	$0.00	$10.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500086	EAP	CPT® 85732		Factor Inhib Screen	BOTH IP/OP	$196.00 	$145.04	$0.00	$164.00	$13.36	$13.36	$6.47	$6.47	$3.24	$3.23	$9.83	$9.83	$10.21	$6.47	$9.57	$4.21	$115.93	$115.93	$0.00	$18.08	$162.36	$164.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500087	EAP	CPT® 85810		"Viscosity, Serum"	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.73	$17.73	$18.41	$0.00	$17.26	$0.00	$0.00	$0.00	$0.00	$32.64	$192.46	$194.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500088	EAP	CPT® 86078		Transfusion Reaction	BOTH IP/OP	$470.00 	$347.80	$0.00	$376.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.69	$48.69	$50.57	$0.00	$52.87	$0.00	$0.00	$0.00	$0.00	$103.62	$372.24	$376.00	$0.00	$305.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500090	EAP	CPT® 85048		"Eosinophil Count, Wb"	BOTH IP/OP	$68.00 	$50.32	$0.00	$59.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.86	$3.86	$4.01	$0.00	$3.76	$0.00	$0.00	$0.00	$0.00	$7.10	$58.61	$59.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500091	EAP	CPT® 85652		"Sed Rate, Capillary Photometry"	BOTH IP/OP	$105.00 	$77.70	$1.35	$84.80	$5.57	$5.57	$2.70	$2.70	$1.35	$1.35	$4.10	$4.10	$4.26	$2.70	$3.98	$1.76	$62.11	$62.11	$2.84	$7.54	$83.95	$84.80	$3.92	$4.46	$3.92	$4.24	$2.70	$2.70	$2.97	$2.70	$0.00	$0.00	$0.00	$0.00
30500092	EAP	CPT® 85415		Plasminogen Act Inhib (so)	BOTH IP/OP	$268.00 	$198.32	$0.00	$254.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.10	$26.10	$27.11	$0.00	$25.40	$0.00	$0.00	$0.00	$0.00	$48.04	$212.26	$214.40	$0.00	$254.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500102	EAP	CPT® 85008		Rbc Morphology Exam	BOTH IP/OP	$91.00 	$67.34	$1.72	$66.40	$7.08	$7.08	$3.43	$3.43	$1.72	$1.72	$5.22	$5.22	$5.42	$3.43	$5.08	$2.23	$53.83	$53.83	$3.60	$9.62	$65.74	$66.40	$4.97	$5.66	$4.97	$5.41	$3.43	$3.43	$3.79	$3.43	$0.00	$0.00	$0.00	$0.00
30500103	EAP	CPT® 85013		"Hematocrit, Spun Cap"	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.60	$3.60	$3.74	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$6.62	$40.39	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500104	EAP	CPT® 85018		Hgb & Hct	BOTH IP/OP	$51.00 	$37.74	$1.18	$40.80	$4.88	$4.88	$2.37	$2.37	$1.19	$1.18	$3.60	$3.60	$3.74	$2.37	$3.50	$1.54	$30.17	$30.17	$2.49	$6.62	$40.39	$40.80	$3.44	$3.91	$3.44	$3.73	$2.37	$2.37	$2.61	$2.37	$0.00	$0.00	$0.00	$0.00
30500105	EAP	CPT® 85025		"Cbc, Plat & Diff"	BOTH IP/OP	$244.00 	$180.56	$3.88	$177.60	$16.05	$16.05	$7.77	$7.77	$3.89	$3.88	$9.97	$9.97	$10.36	$7.77	$11.48	$5.05	$144.33	$144.33	$8.16	$21.72	$175.82	$177.60	$11.27	$12.82	$11.27	$12.23	$7.77	$7.77	$8.56	$7.77	$0.00	$0.00	$0.00	$0.00
30500106	EAP	CPT® 85027		Cbc & Plat	BOTH IP/OP	$175.00 	$129.50	$3.23	$147.20	$13.36	$13.36	$6.47	$6.47	$3.24	$3.23	$9.83	$9.83	$10.21	$6.47	$9.57	$4.21	$103.51	$103.51	$6.79	$18.08	$145.73	$147.20	$9.38	$10.68	$9.38	$10.19	$6.47	$6.47	$7.13	$6.47	$0.00	$0.00	$0.00	$0.00
30500108	EAP	CPT® 85008		Rbc Morphology	BOTH IP/OP	$91.00 	$67.34	$1.72	$66.40	$7.08	$7.08	$3.43	$3.43	$1.72	$1.72	$5.22	$5.22	$5.42	$3.43	$5.08	$2.23	$53.83	$53.83	$3.60	$9.62	$65.74	$66.40	$4.97	$5.66	$4.97	$5.41	$3.43	$3.43	$3.79	$3.43	$0.00	$0.00	$0.00	$0.00
30500109	EAP	CPT® 85013		"Hematocrit, Spun"	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.60	$3.60	$3.74	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$6.62	$40.39	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500110	EAP	CPT® 85660		Sickledex	BOTH IP/OP	$166.00 	$122.84	$0.00	$146.40	$11.38	$11.38	$5.51	$5.51	$2.76	$2.75	$8.38	$8.38	$8.70	$5.51	$8.15	$3.58	$98.19	$98.19	$5.79	$15.42	$144.94	$146.40	$7.99	$0.00	$7.99	$8.68	$5.51	$5.51	$6.08	$5.51	$0.00	$0.00	$0.00	$0.00
30500112	EAP	CPT® 85025		"Cbc, Plat & Diff, Idp"	BOTH IP/OP	$244.00 	$180.56	$3.88	$177.60	$16.05	$16.05	$7.77	$7.77	$3.89	$3.88	$9.97	$9.97	$10.36	$7.77	$11.48	$5.05	$144.33	$144.33	$8.16	$21.72	$175.82	$177.60	$11.27	$12.82	$11.27	$12.23	$7.77	$7.77	$8.56	$7.77	$0.00	$0.00	$0.00	$0.00
30500113	EAP	CPT® 86146		Beta-2 Glycoprotein Antibodies	BOTH IP/OP	$327.00 	$241.98	$12.73	$240.00	$52.54	$52.54	$25.45	$25.45	$12.73	$12.73	$38.63	$38.63	$40.11	$25.45	$37.58	$16.54	$193.42	$193.42	$26.72	$71.08	$237.60	$240.00	$36.90	$41.99	$36.90	$40.04	$25.45	$25.45	$28.03	$25.45	$0.00	$0.00	$0.00	$0.00
30500114	EAP	CPT® 85397		Von Willebran Protease Act Q	BOTH IP/OP	$471.00 	$348.54	$13.89	$380.80	$47.36	$47.36	$30.86	$30.86	$15.43	$13.89	$34.85	$34.85	$36.19	$30.86	$31.50	$20.06	$278.60	$278.60	$32.40	$238.00	$376.99	$380.80	$44.75	$50.92	$44.75	$33.56	$30.86	$30.86	$23.49	$30.86	$0.00	$0.00	$0.00	$0.00
30500115	EAP	CPT® 85730		Silica Clotting Time	BOTH IP/OP	$187.00 	$138.38	$3.00	$156.80	$12.41	$12.41	$6.01	$6.01	$3.01	$3.00	$9.11	$9.11	$9.46	$6.01	$8.86	$3.91	$110.61	$110.61	$6.31	$16.76	$155.23	$156.80	$8.71	$9.92	$8.71	$9.44	$6.01	$6.01	$6.61	$6.01	$0.00	$0.00	$0.00	$0.00
30500117	EAP	CPT® 83520		Thrombin Anti Thrmbon Complex (e)	BOTH IP/OP	$286.00 	$211.64	$0.00	$258.40	$26.72	$26.72	$17.27	$17.27	$8.64	$7.77	$19.67	$19.67	$20.42	$17.27	$19.12	$11.23	$169.17	$169.17	$18.13	$36.18	$255.82	$258.40	$25.04	$0.00	$25.04	$20.37	$17.27	$17.27	$14.26	$17.27	$0.00	$0.00	$0.00	$0.00
30500118	EAP	HCPCS 85999		"Eosinophil Smear, Urine"	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$0.00	$49.90	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500119	EAP	CPT® 85999		"Esoinophil Smear, Urine"	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$0.00	$49.90	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500121	EAP	CPT® 85362		Fibrin Monomer (so)	BOTH IP/OP	$320.00 	$236.80	$3.44	$232.80	$14.23	$14.23	$6.89	$6.89	$3.45	$3.44	$10.46	$10.46	$10.86	$6.89	$10.17	$4.48	$189.28	$189.28	$7.23	$19.24	$230.47	$232.80	$9.99	$11.37	$9.99	$10.84	$6.89	$6.89	$7.59	$6.89	$0.00	$0.00	$0.00	$0.00
30500122	EAP	CPT® 85307		Activated Protein C Resistance (so)	BOTH IP/OP	$125.00 	$92.50	$7.66	$97.60	$31.63	$31.63	$15.32	$15.32	$7.66	$7.66	$23.26	$23.26	$24.16	$15.32	$22.64	$9.96	$73.94	$73.94	$16.09	$42.82	$96.62	$97.60	$22.21	$25.28	$22.21	$24.12	$15.32	$15.32	$16.88	$15.32	$0.00	$0.00	$0.00	$0.00
30500123	EAP	CPT® 86355		Lymphocyte Subset Bal - B Cells Total (so)	BOTH IP/OP	$113.00 	$83.62	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.77	$35.77	$37.14	$0.00	$34.80	$0.00	$0.00	$0.00	$39.62	$65.82	$93.46	$94.40	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30500124	EAP	CPT® 86359		Lymphocyte Subset Bal - T Cells Total (so)	BOTH IP/OP	$113.00 	$83.62	$0.00	$94.40	$48.63	$48.63	$37.73	$37.73	$18.87	$18.86	$35.77	$35.77	$37.14	$37.73	$34.80	$24.52	$66.84	$66.84	$39.62	$65.82	$93.46	$94.40	$54.71	$0.00	$54.71	$37.08	$37.73	$37.73	$25.95	$37.73	$0.00	$0.00	$0.00	$0.00
30500125	EAP	CPT® 86360		Lymphocyte Subset Bal - Absolute Cd4/cd8 With Ratio (so)	BOTH IP/OP	$113.00 	$83.62	$0.00	$118.00	$96.99	$96.99	$46.98	$46.98	$23.49	$23.49	$71.34	$71.34	$74.09	$46.98	$69.42	$30.54	$66.84	$66.84	$49.33	$118.00	$93.46	$94.40	$68.12	$0.00	$68.12	$73.96	$46.98	$46.98	$51.77	$46.98	$0.00	$0.00	$0.00	$0.00
30500126	EAP	CPT® 85460		Hemoglobin Fetal Stain Family Member	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$4.99	$4.99	$7.73	$7.73	$3.87	$3.87	$3.67	$3.67	$3.81	$7.73	$3.57	$5.02	$30.17	$30.17	$8.12	$6.76	$40.39	$40.80	$11.21	$0.00	$11.21	$3.80	$7.73	$7.73	$2.66	$7.73	$0.00	$0.00	$0.00	$0.00
30500130	EAP	CPT® 80299		Apixaban Quantitative Assay	BOTH IP/OP	$155.00 	$114.70	$8.39	$124.80	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$91.68	$91.68	$19.57	$33.64	$123.55	$124.80	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30500131	EAP	CPT® 80299		Rivaroxaban Quantitative Assay	BOTH IP/OP	$155.00 	$114.70	$8.39	$124.80	$28.04	$28.04	$18.64	$18.64	$9.32	$8.39	$18.28	$18.28	$18.99	$18.64	$17.79	$12.12	$91.68	$91.68	$19.57	$33.64	$123.55	$124.80	$27.03	$30.76	$27.03	$18.95	$18.64	$18.64	$13.27	$18.64	$0.00	$0.00	$0.00	$0.00
30600001	EAP	CPT® 87040		Blood Cult. Routine	BOTH IP/OP	$476.00 	$352.24	$5.16	$346.40	$21.30	$21.30	$10.32	$10.32	$5.16	$5.16	$15.67	$15.67	$16.28	$10.32	$15.25	$6.71	$281.55	$281.55	$10.84	$28.84	$342.94	$346.40	$14.96	$17.03	$14.96	$16.24	$10.32	$10.32	$11.37	$10.32	$0.00	$0.00	$0.00	$0.00
30600002	EAP	CPT® 87045		Stool Culture	BOTH IP/OP	$206.00 	$152.44	$4.72	$166.40	$19.48	$19.48	$9.44	$9.44	$4.72	$4.72	$14.32	$14.32	$14.87	$9.44	$42.93	$6.14	$121.85	$121.85	$9.91	$26.36	$164.74	$166.40	$13.69	$15.58	$13.69	$32.55	$9.44	$9.44	$33.11	$9.44	$0.00	$0.00	$0.00	$0.00
30600003	EAP	CPT® 87070		Bone Marrow Culture	BOTH IP/OP	$371.00 	$274.54	$4.31	$277.60	$17.79	$17.79	$8.62	$8.62	$4.31	$4.31	$13.07	$13.07	$13.58	$8.62	$12.73	$5.60	$219.45	$219.45	$9.05	$24.06	$274.82	$277.60	$12.50	$14.22	$12.50	$13.56	$8.62	$8.62	$9.49	$8.62	$0.00	$0.00	$0.00	$0.00
30600004	EAP	CPT® 87070		Csf Culture	BOTH IP/OP	$371.00 	$274.54	$4.31	$277.60	$17.79	$17.79	$8.62	$8.62	$4.31	$4.31	$13.07	$13.07	$13.58	$8.62	$12.73	$5.60	$219.45	$219.45	$9.05	$24.06	$274.82	$277.60	$12.50	$14.22	$12.50	$13.56	$8.62	$8.62	$9.49	$8.62	$0.00	$0.00	$0.00	$0.00
30600005	EAP	CPT® 87070		Exudate Culture	BOTH IP/OP	$371.00 	$274.54	$4.31	$277.60	$17.79	$17.79	$8.62	$8.62	$4.31	$4.31	$13.07	$13.07	$13.58	$8.62	$12.73	$5.60	$219.45	$219.45	$9.05	$24.06	$274.82	$277.60	$12.50	$14.22	$12.50	$13.56	$8.62	$8.62	$9.49	$8.62	$0.00	$0.00	$0.00	$0.00
30600006	EAP	CPT® 87070		Fluid/tissue Cult.	BOTH IP/OP	$371.00 	$274.54	$4.31	$277.60	$17.79	$17.79	$8.62	$8.62	$4.31	$4.31	$13.07	$13.07	$13.58	$8.62	$12.73	$5.60	$219.45	$219.45	$9.05	$24.06	$274.82	$277.60	$12.50	$14.22	$12.50	$13.56	$8.62	$8.62	$9.49	$8.62	$0.00	$0.00	$0.00	$0.00
30600007	EAP	CPT® 87070		Genital Culture	BOTH IP/OP	$371.00 	$274.54	$4.31	$277.60	$17.79	$17.79	$8.62	$8.62	$4.31	$4.31	$13.07	$13.07	$13.58	$8.62	$12.73	$5.60	$219.45	$219.45	$9.05	$24.06	$274.82	$277.60	$12.50	$14.22	$12.50	$13.56	$8.62	$8.62	$9.49	$8.62	$0.00	$0.00	$0.00	$0.00
30600008	EAP	CPT® 87070		"Misc Cult,referral"	BOTH IP/OP	$338.00 	$250.12	$4.31	$252.80	$17.79	$17.79	$8.62	$8.62	$4.31	$4.31	$13.07	$13.07	$13.58	$8.62	$12.73	$5.60	$199.93	$199.93	$9.05	$24.06	$250.27	$252.80	$12.50	$14.22	$12.50	$13.56	$8.62	$8.62	$9.49	$8.62	$0.00	$0.00	$0.00	$0.00
30600009	EAP	CPT® 87070		Misc. Culture	BOTH IP/OP	$371.00 	$274.54	$4.31	$277.60	$17.79	$17.79	$8.62	$8.62	$4.31	$4.31	$13.07	$13.07	$13.58	$8.62	$12.73	$5.60	$219.45	$219.45	$9.05	$24.06	$274.82	$277.60	$12.50	$14.22	$12.50	$13.56	$8.62	$8.62	$9.49	$8.62	$0.00	$0.00	$0.00	$0.00
30600010	EAP	CPT® 87070		SPUTUM CULTURE	BOTH IP/OP	$371.00 	$274.54	$4.31	$277.60	$17.79	$17.79	$8.62	$8.62	$4.31	$4.31	$13.07	$13.07	$13.58	$8.62	$12.73	$5.60	$219.45	$219.45	$9.05	$24.06	$274.82	$277.60	$12.50	$14.22	$12.50	$13.56	$8.62	$8.62	$9.49	$8.62	$0.00	$0.00	$0.00	$0.00
30600011	EAP	CPT® 87081		Throat Culture	BOTH IP/OP	$305.00 	$225.70	$3.31	$224.00	$13.68	$13.68	$6.63	$6.63	$3.32	$3.31	$10.08	$10.08	$10.47	$6.63	$9.79	$4.31	$180.41	$180.41	$6.96	$18.52	$221.76	$224.00	$9.61	$10.94	$9.61	$10.43	$6.63	$6.63	$7.30	$6.63	$0.00	$0.00	$0.00	$0.00
30600012	EAP	CPT® 87075		Anaerobe Culture	BOTH IP/OP	$318.00 	$235.32	$4.73	$231.20	$19.54	$19.54	$9.47	$9.47	$4.74	$4.73	$14.36	$14.36	$14.91	$9.47	$13.98	$6.16	$188.10	$188.10	$9.94	$26.44	$228.89	$231.20	$13.73	$15.63	$13.73	$14.89	$9.47	$9.47	$10.42	$9.47	$0.00	$0.00	$0.00	$0.00
30600013	EAP	CPT® 87899		"Malaria Rapid Antigen Test,evd"	BOTH IP/OP	$359.00 	$265.66	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$320.76	$324.00	$0.00	$246.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600014	EAP	CPT® 87076		CULTURE I.D.-AEROBE BIOCHEM	BOTH IP/OP	$229.00 	$169.46	$0.00	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.27	$12.27	$12.74	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$22.58	$187.70	$189.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600015	EAP	CPT® 87801		"Ebola- Amplified Probe Technique, Evd"	BOTH IP/OP	$475.00 	$351.50	$0.00	$457.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.13	$90.13	$93.59	$0.00	$57.96	$0.00	$0.00	$0.00	$0.00	$109.64	$453.02	$457.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600016	EAP	CPT® 87081		"Gc Cult,vag/cervix"	BOTH IP/OP	$305.00 	$225.70	$3.31	$224.00	$13.68	$13.68	$6.63	$6.63	$3.32	$3.31	$10.08	$10.08	$10.47	$6.63	$9.79	$4.31	$180.41	$180.41	$6.96	$18.52	$221.76	$224.00	$9.61	$10.94	$9.61	$10.43	$6.63	$6.63	$7.30	$6.63	$0.00	$0.00	$0.00	$0.00
30600017	EAP	CPT® 87081		"Gc Cult,urethral"	BOTH IP/OP	$305.00 	$225.70	$3.31	$224.00	$13.68	$13.68	$6.63	$6.63	$3.32	$3.31	$10.08	$10.08	$10.47	$6.63	$9.79	$4.31	$180.41	$180.41	$6.96	$18.52	$221.76	$224.00	$9.61	$10.94	$9.61	$10.43	$6.63	$6.63	$7.30	$6.63	$0.00	$0.00	$0.00	$0.00
30600018	EAP	CPT® 87081		"Gc Cult,anal"	BOTH IP/OP	$305.00 	$225.70	$3.31	$224.00	$13.68	$13.68	$6.63	$6.63	$3.32	$3.31	$10.08	$10.08	$10.47	$6.63	$9.79	$4.31	$180.41	$180.41	$6.96	$18.52	$221.76	$224.00	$9.61	$10.94	$9.61	$10.43	$6.63	$6.63	$7.30	$6.63	$0.00	$0.00	$0.00	$0.00
30600019	EAP	CPT® 87081		"Gc Cult,throat"	BOTH IP/OP	$305.00 	$225.70	$3.31	$224.00	$13.68	$13.68	$6.63	$6.63	$3.32	$3.31	$10.08	$10.08	$10.47	$6.63	$9.79	$4.31	$180.41	$180.41	$6.96	$18.52	$221.76	$224.00	$9.61	$10.94	$9.61	$10.43	$6.63	$6.63	$7.30	$6.63	$0.00	$0.00	$0.00	$0.00
30600020	EAP	CPT® 87081		Gc Culture Eye	BOTH IP/OP	$305.00 	$225.70	$3.31	$224.00	$13.68	$13.68	$6.63	$6.63	$3.32	$3.31	$10.08	$10.08	$10.47	$6.63	$9.79	$4.31	$180.41	$180.41	$6.96	$18.52	$221.76	$224.00	$9.61	$10.94	$9.61	$10.43	$6.63	$6.63	$7.30	$6.63	$0.00	$0.00	$0.00	$0.00
30600021	EAP	CPT® 87086		Urine Culture	BOTH IP/OP	$299.00 	$221.26	$4.04	$241.60	$16.66	$16.66	$8.07	$8.07	$4.04	$4.04	$12.26	$12.26	$12.73	$8.07	$11.93	$5.25	$176.86	$176.86	$8.47	$22.56	$239.18	$241.60	$11.70	$13.32	$11.70	$12.71	$8.07	$8.07	$8.90	$8.07	$0.00	$0.00	$0.00	$0.00
30600022	EAP	CPT® 87088		Urine Culture-presump. Id	BOTH IP/OP	$302.00 	$223.48	$0.00	$241.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.29	$12.29	$12.77	$0.00	$11.96	$0.00	$0.00	$0.00	$0.00	$22.62	$239.18	$241.60	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600023	EAP	CPT® 87101		Fungus Cult. Derm.	BOTH IP/OP	$218.00 	$161.32	$3.85	$159.20	$15.89	$15.89	$7.71	$7.71	$3.86	$3.85	$11.71	$11.71	$12.16	$7.71	$11.38	$5.01	$128.95	$128.95	$8.10	$21.54	$157.61	$159.20	$11.18	$12.72	$11.18	$12.13	$7.71	$7.71	$8.49	$7.71	$0.00	$0.00	$0.00	$0.00
30600024	EAP	CPT® 87102		"Fungus Culture,misc."	BOTH IP/OP	$231.00 	$170.94	$4.20	$168.80	$17.34	$17.34	$8.41	$8.41	$4.21	$4.20	$12.75	$12.75	$13.24	$8.41	$12.42	$5.47	$136.64	$136.64	$8.83	$23.48	$167.11	$168.80	$12.19	$13.88	$12.19	$13.24	$8.41	$8.41	$9.26	$8.41	$0.00	$0.00	$0.00	$0.00
30600025	EAP	CPT® 87103		Fungus Cult. Blood	BOTH IP/OP	$251.00 	$185.74	$0.00	$251.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.70	$13.70	$14.22	$0.00	$13.32	$0.00	$0.00	$0.00	$0.00	$25.20	$181.37	$183.20	$0.00	$251.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600026	EAP	CPT® 87106		Culture I.d.-yeast Biochem	BOTH IP/OP	$261.00 	$193.14	$0.00	$208.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.67	$15.67	$16.28	$0.00	$15.25	$0.00	$0.00	$0.00	$0.00	$28.84	$206.71	$208.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600027	EAP	CPT® 87107		Culture I.d.- Mold Biochem	BOTH IP/OP	$261.00 	$193.14	$0.00	$246.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.67	$15.67	$16.28	$0.00	$15.25	$0.00	$0.00	$0.00	$0.00	$28.84	$206.71	$208.80	$0.00	$246.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600028	EAP	CPT® 87110		"Chlam Cult,referral"	BOTH IP/OP	$141.00 	$104.34	$0.00	$141.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.74	$29.74	$30.89	$0.00	$28.94	$0.00	$0.00	$0.00	$0.00	$54.74	$101.38	$102.40	$0.00	$141.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600029	EAP	CPT® 87116		Afb Culture-misc	BOTH IP/OP	$270.00 	$199.80	$5.40	$199.20	$15.02	$15.02	$10.80	$10.80	$5.40	$5.40	$11.02	$11.02	$11.45	$10.80	$56.27	$7.02	$159.71	$159.71	$11.34	$20.28	$197.21	$199.20	$15.66	$17.82	$15.66	$38.97	$10.80	$10.80	$39.64	$10.80	$0.00	$0.00	$0.00	$0.00
30600030	EAP	CPT® 87116		"Afb Culture, Blood"	BOTH IP/OP	$270.00 	$199.80	$5.40	$199.20	$15.02	$15.02	$10.80	$10.80	$5.40	$5.40	$11.02	$11.02	$11.45	$10.80	$56.27	$7.02	$159.71	$159.71	$11.34	$20.28	$197.21	$199.20	$15.66	$17.82	$15.66	$38.97	$10.80	$10.80	$39.64	$10.80	$0.00	$0.00	$0.00	$0.00
30600031	EAP	CPT® 87147		Culture I.d.-immunologic	BOTH IP/OP	$105.00 	$77.70	$0.00	$105.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.77	$6.77	$7.03	$0.00	$6.59	$0.00	$0.00	$0.00	$0.00	$12.46	$83.16	$84.00	$0.00	$105.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600032	EAP	CPT® 87149		Culture I.d.-probe Biochem	BOTH IP/OP	$468.00 	$346.32	$10.03	$378.40	$40.71	$40.71	$20.05	$20.05	$10.03	$10.03	$29.94	$29.94	$31.09	$20.05	$29.14	$13.03	$276.82	$276.82	$21.05	$55.10	$374.62	$378.40	$29.07	$33.08	$29.07	$31.05	$20.05	$20.05	$21.73	$20.05	$0.00	$0.00	$0.00	$0.00
30600033	EAP	CPT® 87172		Pinworm Exam	BOTH IP/OP	$134.00 	$99.16	$0.00	$134.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.48	$6.48	$6.73	$0.00	$6.30	$0.00	$0.00	$0.00	$0.00	$11.92	$106.92	$108.00	$0.00	$134.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600034	EAP	CPT® 87177		"Ova & Parasites, Urn"	BOTH IP/OP	$251.00 	$185.74	$4.45	$195.20	$18.37	$18.37	$8.90	$8.90	$4.45	$4.45	$13.51	$13.51	$14.03	$8.90	$13.15	$5.79	$148.47	$148.47	$9.35	$24.86	$193.25	$195.20	$12.91	$14.69	$12.91	$14.01	$8.90	$8.90	$9.81	$8.90	$0.00	$0.00	$0.00	$0.00
30600035	EAP	CPT® 87177		"O&p,ethylacetate"	BOTH IP/OP	$229.00 	$169.46	$4.45	$178.40	$18.37	$18.37	$8.90	$8.90	$4.45	$4.45	$13.51	$13.51	$14.03	$8.90	$13.15	$5.79	$135.45	$135.45	$9.35	$24.86	$176.62	$178.40	$12.91	$14.69	$12.91	$14.01	$8.90	$8.90	$9.81	$8.90	$0.00	$0.00	$0.00	$0.00
30600036	EAP	CPT® 87186		Sens.special Panel	BOTH IP/OP	$235.00 	$173.90	$4.32	$171.20	$17.85	$17.85	$8.65	$8.65	$4.33	$4.32	$13.12	$13.12	$13.63	$8.65	$12.77	$5.62	$139.00	$139.00	$9.08	$24.16	$169.49	$171.20	$12.54	$14.27	$12.54	$13.60	$8.65	$8.65	$9.52	$8.65	$0.00	$0.00	$0.00	$0.00
30600037	EAP	CPT® 87186		Sens.gram Pos Cocci	BOTH IP/OP	$214.00 	$158.36	$0.00	$171.20	$17.85	$17.85	$8.65	$8.65	$4.33	$4.32	$13.12	$13.12	$13.63	$8.65	$12.77	$5.62	$126.58	$126.58	$9.08	$24.16	$169.49	$171.20	$12.54	$0.00	$12.54	$13.60	$8.65	$8.65	$9.52	$8.65	$0.00	$0.00	$0.00	$0.00
30600038	EAP	CPT® 87205		Gram Stain	BOTH IP/OP	$61.00 	$45.14	$0.00	$50.40	$4.83	$4.83	$4.27	$4.27	$2.14	$2.14	$3.57	$3.57	$3.70	$4.27	$3.47	$2.78	$36.08	$36.08	$4.48	$6.56	$49.90	$50.40	$6.19	$0.00	$6.19	$3.69	$4.27	$4.27	$2.58	$4.27	$0.00	$0.00	$0.00	$0.00
30600039	EAP	CPT® 87502		Influenza Virus -a/b  Amplified Probe	BOTH IP/OP	$272.00 	$201.28	$43.11	$220.00	$107.10	$107.10	$95.80	$95.80	$47.90	$43.11	$75.96	$75.96	$78.88	$95.80	$68.64	$62.27	$160.89	$160.89	$100.59	$137.50	$217.80	$220.00	$138.91	$158.07	$138.91	$73.14	$95.80	$95.80	$51.20	$95.80	$0.00	$0.00	$0.00	$0.00
30600040	EAP	CPT® 87150		Group B Strep - Amplified Probe	BOTH IP/OP	$384.00 	$284.16	$0.00	$307.20	$40.50	$40.50	$35.09	$35.09	$17.55	$0.00	$29.22	$29.22	$30.35	$0.00	$80.03	$0.00	$0.00	$0.00	$0.00	$192.00	$304.13	$307.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600041	EAP	CPT® 87503		Influenza Virus (h1n1) (amplified Probe)	BOTH IP/OP	$271.00 	$200.54	$0.00	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.39	$11.39	$11.83	$0.00	$10.29	$0.00	$0.00	$0.00	$0.00	$137.50	$217.80	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600042	EAP	CPT® 87206		PAS/KOH PREP	BOTH IP/OP	$158.00 	$116.92	$2.70	$123.20	$11.11	$11.11	$5.39	$5.39	$2.70	$2.70	$8.15	$8.15	$8.47	$5.39	$7.93	$3.50	$93.46	$93.46	$5.66	$15.00	$121.97	$123.20	$7.82	$8.89	$7.82	$8.45	$5.39	$5.39	$5.91	$5.39	$0.00	$0.00	$0.00	$0.00
30600044	EAP	CPT® 87328		Cryptosporidium Scrn.	BOTH IP/OP	$195.00 	$144.30	$6.22	$154.40	$24.74	$24.74	$13.82	$13.82	$6.91	$6.22	$18.22	$18.22	$18.92	$13.82	$17.71	$8.98	$115.34	$115.34	$14.51	$33.52	$152.86	$154.40	$20.04	$22.80	$20.04	$18.87	$13.82	$13.82	$13.21	$13.82	$0.00	$0.00	$0.00	$0.00
30600045	EAP	CPT® 87207		Malaria/parasite Smr	BOTH IP/OP	$229.00 	$169.46	$3.00	$178.40	$12.38	$12.38	$5.99	$5.99	$3.00	$3.00	$9.10	$9.10	$9.45	$5.99	$8.84	$3.89	$135.45	$135.45	$6.29	$16.74	$176.62	$178.40	$8.69	$9.88	$8.69	$9.42	$5.99	$5.99	$6.59	$5.99	$0.00	$0.00	$0.00	$0.00
30600046	EAP	CPT® 87207		Rbc Inclusion Body	BOTH IP/OP	$216.00 	$159.84	$0.00	$178.40	$12.38	$12.38	$5.99	$5.99	$3.00	$3.00	$9.10	$9.10	$9.45	$5.99	$8.84	$3.89	$127.76	$127.76	$6.29	$16.74	$176.62	$178.40	$8.69	$0.00	$8.69	$9.42	$5.99	$5.99	$6.59	$5.99	$0.00	$0.00	$0.00	$0.00
30600047	EAP	CPT® 87209		Microsporidium	BOTH IP/OP	$391.00 	$289.34	$8.99	$304.80	$37.12	$37.12	$17.98	$17.98	$8.99	$8.99	$27.29	$27.29	$28.34	$17.98	$26.54	$11.69	$231.28	$231.28	$18.88	$50.22	$301.75	$304.80	$26.07	$29.67	$26.07	$28.28	$17.98	$17.98	$19.80	$17.98	$0.00	$0.00	$0.00	$0.00
30600048	EAP	CPT® 87209		"O&p,pva/trichrome"	BOTH IP/OP	$367.00 	$271.58	$8.99	$285.60	$37.12	$37.12	$17.98	$17.98	$8.99	$8.99	$27.29	$27.29	$28.34	$17.98	$26.54	$11.69	$217.08	$217.08	$18.88	$50.22	$282.74	$285.60	$26.07	$29.67	$26.07	$28.28	$17.98	$17.98	$19.80	$17.98	$0.00	$0.00	$0.00	$0.00
30600049	EAP	CPT® 87799		Eb Virus Dna Quant Pcr (so)	BOTH IP/OP	$796.00 	$589.04	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.42	$65.04	$65.04	$67.54	$42.84	$165.89	$27.85	$470.83	$470.83	$0.00	$119.70	$622.51	$628.80	$0.00	$796.00	$0.00	$123.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600050	EAP	CPT® 87252		Cmv Culture Inoc Tissue (so)	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$45.65	$45.65	$26.07	$26.07	$13.04	$13.04	$33.57	$33.57	$34.86	$26.07	$32.66	$16.95	$230.69	$230.69	$27.37	$61.78	$308.88	$312.00	$37.80	$0.00	$37.80	$34.79	$26.07	$26.07	$24.36	$26.07	$0.00	$0.00	$0.00	$0.00
30600051	EAP	CPT® 87254		Cmv Culture Inoc Shell (so)	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$7.22	$0.00	$0.00	$0.00	$0.00	$54.64	$190.08	$192.00	$0.00	$0.00	$0.00	$7.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600052	EAP	CPT® 87210		"O & P DIRECT, SMEAR"	BOTH IP/OP	$216.00 	$159.84	$2.62	$168.00	$8.82	$8.82	$5.82	$5.82	$2.91	$2.62	$6.48	$6.48	$6.73	$5.82	$6.30	$3.78	$127.76	$127.76	$6.11	$11.92	$166.32	$168.00	$8.44	$9.60	$8.44	$6.71	$5.82	$5.82	$4.70	$5.82	$0.00	$0.00	$0.00	$0.00
30600053	EAP	CPT® 87220		Koh Level	BOTH IP/OP	$198.00 	$146.52	$2.14	$147.20	$8.82	$8.82	$4.27	$4.27	$2.14	$2.14	$6.48	$6.48	$6.73	$4.27	$6.30	$2.78	$117.12	$117.12	$4.48	$11.92	$145.73	$147.20	$6.19	$7.05	$6.19	$6.71	$4.27	$4.27	$4.70	$4.27	$0.00	$0.00	$0.00	$0.00
30600055	EAP	CPT® 87252		"Viral Cult,referral"	BOTH IP/OP	$238.00 	$176.12	$13.04	$192.00	$45.65	$45.65	$26.07	$26.07	$13.04	$13.04	$33.57	$33.57	$34.86	$26.07	$32.66	$16.95	$140.78	$140.78	$27.37	$61.78	$190.08	$192.00	$37.80	$43.02	$37.80	$34.79	$26.07	$26.07	$24.36	$26.07	$0.00	$0.00	$0.00	$0.00
30600056	EAP	CPT® 87320		Chlamydia Screen	BOTH IP/OP	$718.00 	$531.32	$0.00	$574.40	$24.74	$24.74	$15.00	$15.00	$7.50	$6.75	$18.22	$18.22	$18.92	$15.00	$17.71	$9.75	$424.70	$424.70	$0.00	$33.52	$568.66	$574.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600057	EAP	CPT® 87324		"C.diff. Assay,stool"	BOTH IP/OP	$195.00 	$144.30	$5.99	$154.40	$24.74	$24.74	$11.98	$11.98	$5.99	$5.99	$18.22	$18.22	$18.92	$11.98	$17.71	$7.79	$115.34	$115.34	$12.58	$33.52	$152.86	$154.40	$17.37	$19.77	$17.37	$18.87	$11.98	$11.98	$13.21	$11.98	$0.00	$0.00	$0.00	$0.00
30600059	EAP	CPT® 87329		Eia Giardia Screen	BOTH IP/OP	$195.00 	$144.30	$5.99	$154.40	$24.74	$24.74	$11.98	$11.98	$5.99	$5.99	$18.22	$18.22	$18.92	$11.98	$17.71	$7.79	$115.34	$115.34	$12.58	$33.52	$152.86	$154.40	$17.37	$19.77	$17.37	$18.87	$11.98	$11.98	$13.21	$11.98	$0.00	$0.00	$0.00	$0.00
30600060	EAP	CPT® 87337		H.pylori Ag -stool	BOTH IP/OP	$334.00 	$247.16	$5.99	$264.00	$24.74	$24.74	$11.98	$11.98	$5.99	$5.99	$18.22	$18.22	$18.92	$11.98	$17.71	$7.79	$197.56	$197.56	$12.58	$33.52	$261.36	$264.00	$17.37	$19.77	$17.37	$18.87	$11.98	$11.98	$13.21	$11.98	$0.00	$0.00	$0.00	$0.00
30600061	EAP	CPT® 87340		Hbv Surface Ag	BOTH IP/OP	$255.00 	$188.70	$5.17	$205.60	$21.33	$21.33	$10.33	$10.33	$5.17	$5.17	$15.68	$15.68	$16.29	$10.33	$15.26	$6.71	$150.83	$150.83	$10.85	$28.86	$203.54	$205.60	$14.98	$17.04	$14.98	$16.26	$10.33	$10.33	$11.38	$10.33	$0.00	$0.00	$0.00	$0.00
30600062	EAP	CPT® 87340		Hbv Surf Ag-ob	BOTH IP/OP	$246.00 	$182.04	$5.17	$205.60	$21.33	$21.33	$10.33	$10.33	$5.17	$5.17	$15.68	$15.68	$16.29	$10.33	$15.26	$6.71	$145.51	$145.51	$10.85	$28.86	$203.54	$205.60	$14.98	$17.04	$14.98	$16.26	$10.33	$10.33	$11.38	$10.33	$0.00	$0.00	$0.00	$0.00
30600063	EAP	CPT® 87350		Hbv E Ag	BOTH IP/OP	$87.00 	$64.38	$5.76	$70.40	$23.79	$23.79	$11.53	$11.53	$5.77	$5.76	$17.50	$17.50	$18.18	$11.53	$17.02	$7.49	$51.46	$51.46	$12.11	$32.20	$69.70	$70.40	$16.72	$19.02	$16.72	$18.14	$11.53	$11.53	$12.70	$11.53	$0.00	$0.00	$0.00	$0.00
30600064	EAP	CPT® 87385		Histoplasma Ag	BOTH IP/OP	$318.00 	$235.32	$5.99	$251.20	$24.74	$24.74	$13.25	$13.25	$6.63	$5.99	$18.22	$18.22	$18.92	$13.25	$17.71	$8.61	$188.10	$188.10	$13.91	$33.52	$248.69	$251.20	$19.21	$21.86	$19.21	$18.87	$13.25	$13.25	$13.21	$13.25	$0.00	$0.00	$0.00	$0.00
30600065	EAP	CPT® 87390		Hiv-ag-p24	BOTH IP/OP	$225.00 	$166.50	$0.00	$186.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.79	$26.79	$27.82	$0.00	$22.62	$0.00	$0.00	$0.00	$0.00	$49.30	$184.54	$186.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600066	EAP	CPT® 87425		"Rotavirus Ag, Stool"	BOTH IP/OP	$223.00 	$165.02	$0.00	$223.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$178.20	$180.00	$0.00	$223.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600068	EAP	CPT® 87430		STREP A AG-THROAT	BOTH IP/OP	$162.00 	$119.88	$0.00	$129.60	$24.74	$24.74	$16.81	$16.81	$8.41	$7.56	$18.22	$18.22	$18.92	$16.81	$17.71	$10.93	$95.82	$95.82	$17.65	$33.52	$128.30	$129.60	$24.37	$0.00	$24.37	$18.87	$16.81	$16.81	$13.21	$16.81	$0.00	$0.00	$0.00	$0.00
30600070	EAP	CPT® 87450		"L. Pneumo-1 Ag, Urine"	BOTH IP/OP	$271.00 	$200.54	$7.02	$271.00	$24.74	$24.74	$15.60	$15.60	$7.80	$7.02	$18.22	$18.22	$18.92	$15.60	$17.71	$10.14	$160.30	$160.30	$10.07	$26.78	$217.01	$219.20	$13.91	$271.00	$13.91	$15.08	$9.59	$9.59	$10.56	$9.59	$0.00	$0.00	$0.00	$0.00
30600071	EAP	CPT® 87491		Chlamydia Detection	BOTH IP/OP	$374.00 	$276.76	$17.55	$272.00	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$221.22	$221.22	$36.84	$54.82	$269.28	$272.00	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30600072	EAP	CPT® 87496		Cmv Dna-pcr Fluids	BOTH IP/OP	$905.00 	$669.70	$0.00	$905.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$535.31	$535.31	$36.84	$54.82	$695.38	$702.40	$50.88	$905.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30600073	EAP	CPT® 87516		Hbv Dna-pcr	BOTH IP/OP	$319.00 	$236.06	$0.00	$264.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.79	$29.79	$30.93	$0.00	$28.98	$0.00	$0.00	$0.00	$0.00	$54.82	$261.36	$264.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600074	EAP	CPT® 87177		Coccidia Smear	BOTH IP/OP	$229.00 	$169.46	$4.45	$178.40	$18.37	$18.37	$8.90	$8.90	$4.45	$4.45	$13.51	$13.51	$14.03	$8.90	$13.15	$5.79	$135.45	$135.45	$9.35	$24.86	$176.62	$178.40	$12.91	$14.69	$12.91	$14.01	$8.90	$8.90	$9.81	$8.90	$0.00	$0.00	$0.00	$0.00
30600075	EAP	CPT® 87521		Hcv Rna-pcr	BOTH IP/OP	$706.00 	$522.44	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.79	$29.79	$30.93	$0.00	$28.98	$0.00	$0.00	$0.00	$0.00	$54.82	$578.16	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600076	EAP	CPT® 87522		"Hcv Rna-pcr, Quant"	BOTH IP/OP	"$1,023.00 "	$757.02	$21.42	$794.40	$88.41	$88.41	$42.84	$42.84	$21.42	$21.42	$65.04	$65.04	$67.54	$42.84	$63.28	$27.85	$605.10	$605.10	$44.98	$119.70	$786.46	$794.40	$62.12	$70.69	$62.12	$67.43	$42.84	$42.84	$47.20	$42.84	$0.00	$0.00	$0.00	$0.00
30600077	EAP	CPT® 87529		Hsv Dna-pcr	BOTH IP/OP	$901.00 	$666.74	$17.55	$700.00	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$532.94	$532.94	$36.84	$54.82	$693.00	$700.00	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30600078	EAP	CPT® 87535		Hiv-1 Dna-pcr	BOTH IP/OP	$675.00 	$499.50	$17.55	$524.00	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$399.26	$399.26	$36.84	$54.82	$518.76	$524.00	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30600079	EAP	CPT® 87536		"Hiv-1 Rna B Dna, Quant"	BOTH IP/OP	$742.00 	$549.08	$0.00	$613.60	$107.10	$107.10	$85.10	$85.10	$42.55	$42.55	$78.80	$78.80	$81.83	$85.10	$66.37	$55.32	$438.89	$438.89	$89.36	$145.02	$607.46	$613.60	$123.40	$0.00	$123.40	$70.72	$85.10	$85.10	$49.50	$85.10	$0.00	$0.00	$0.00	$0.00
30600080	EAP	CPT® 87556		Direct M. Tb Test	BOTH IP/OP	$317.00 	$234.58	$18.76	$246.40	$40.50	$40.50	$41.68	$41.68	$20.84	$18.76	$29.79	$29.79	$30.93	$41.68	$66.06	$27.09	$187.51	$187.51	$43.76	$54.82	$243.94	$246.40	$60.44	$68.77	$60.44	$48.20	$41.68	$41.68	$49.03	$41.68	$0.00	$0.00	$0.00	$0.00
30600081	EAP	CPT® 87591		Gc Detection	BOTH IP/OP	$374.00 	$276.76	$17.55	$272.00	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$25.16	$22.81	$221.22	$221.22	$36.84	$54.82	$269.28	$272.00	$50.88	$57.90	$50.88	$26.81	$35.09	$35.09	$18.76	$35.09	$0.00	$0.00	$0.00	$0.00
30600082	EAP	CPT® 87798		"Enterovirus Pcr, Csf"	BOTH IP/OP	$807.00 	$597.18	$17.55	$777.60	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$477.34	$477.34	$36.84	$54.82	$769.82	$777.60	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30600083	EAP	CPT® 87798		Thyroid Perox Ab; Tpo	BOTH IP/OP	$964.00 	$713.36	$17.55	$777.60	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$570.21	$570.21	$36.84	$54.82	$769.82	$777.60	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30600084	EAP	CPT® 87798		"Jcv Dna-pcr,csf"	BOTH IP/OP	$900.00 	$666.00	$17.55	$725.60	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$532.35	$532.35	$36.84	$54.82	$718.34	$725.60	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30600085	EAP	CPT® 87798		"Vzv Dna-pcr,csf"	BOTH IP/OP	$900.00 	$666.00	$17.55	$725.60	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$532.35	$532.35	$36.84	$54.82	$718.34	$725.60	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30600086	EAP	CPT® 87804		Influenza-a Ag	BOTH IP/OP	$359.00 	$265.66	$7.45	$290.40	$24.74	$24.74	$16.55	$16.55	$8.28	$7.45	$18.22	$18.22	$18.92	$16.55	$17.71	$10.76	$212.35	$212.35	$17.38	$33.52	$287.50	$290.40	$24.00	$27.31	$24.00	$18.87	$16.55	$16.55	$13.21	$16.55	$0.00	$0.00	$0.00	$0.00
30600087	EAP	CPT® 87804		Influenza-b Ag	BOTH IP/OP	$359.00 	$265.66	$7.45	$290.40	$24.74	$24.74	$16.55	$16.55	$8.28	$7.45	$18.22	$18.22	$18.92	$16.55	$17.71	$10.76	$212.35	$212.35	$17.38	$33.52	$287.50	$290.40	$24.00	$27.31	$24.00	$18.87	$16.55	$16.55	$13.21	$16.55	$0.00	$0.00	$0.00	$0.00
30600088	EAP	CPT® 87807		Rsv Assay	BOTH IP/OP	$656.00 	$485.44	$0.00	$510.40	$24.74	$24.74	$13.10	$13.10	$6.55	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$13.76	$33.52	$505.30	$510.40	$19.00	$219.00	$19.00	$18.87	$13.10	$13.10	$13.21	$13.10	$0.00	$0.00	$0.00	$0.00
30600089	EAP	CPT® 87901		Hiv Genotyping	BOTH IP/OP	"$1,830.00 "	"$1,354.20"	$96.09	"$1,420.80"	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$132.42	$132.42	$137.52	$257.45	$128.84	$167.34	"$1,082.45"	"$1,082.45"	$270.32	$243.70	"$1,406.59"	"$1,420.80"	$373.30	$424.79	$373.30	$137.28	$257.45	$257.45	$96.09	$257.45	$0.00	$0.00	$0.00	$0.00
30600090	EAP	CPT® 87902		Hcv Genotyping	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$96.09	"$1,537.60"	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$132.42	$132.42	$137.52	$257.45	$128.84	$167.34	"$1,171.17"	"$1,171.17"	$270.32	$243.70	"$1,522.22"	"$1,537.60"	$373.30	$424.79	$373.30	$137.28	$257.45	$257.45	$96.09	$257.45	$0.00	$0.00	$0.00	$0.00
30600094	EAP	CPT® 86757		Richettsia Antibody Igm	BOTH IP/OP	$48.00 	$35.52	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.39	$29.39	$30.52	$0.00	$28.60	$0.00	$0.00	$0.00	$0.00	$48.00	$38.02	$38.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600095	EAP	CPT® 87798		"Parvovirus B19 Pcr, Qual"	BOTH IP/OP	$311.00 	$230.14	$17.55	$250.40	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$183.96	$183.96	$36.84	$54.82	$247.90	$250.40	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30600096	EAP	CPT® 87517		"Hbv Dna-pcr,quant"	BOTH IP/OP	$355.00 	$262.70	$21.42	$276.00	$88.41	$88.41	$42.84	$42.84	$21.42	$21.42	$65.04	$65.04	$67.54	$42.84	$63.28	$27.85	$209.98	$209.98	$44.98	$119.70	$273.24	$276.00	$62.12	$70.69	$62.12	$67.43	$42.84	$42.84	$47.20	$42.84	$0.00	$0.00	$0.00	$0.00
30600100	EAP	CPT® 87046		"E.coli O157, Culture(so)"	BOTH IP/OP	$63.00 	$46.62	$2.60	$51.20	$19.48	$19.48	$9.44	$9.44	$4.72	$4.72	$14.32	$14.32	$14.87	$9.44	$3.49	$6.14	$37.26	$37.26	$9.91	$26.36	$50.69	$51.20	$13.69	$15.58	$13.69	$3.71	$9.44	$9.44	$2.60	$9.44	$0.00	$0.00	$0.00	$0.00
30600105	EAP	CPT® 87497		"Cmv,dna,pcr, Quant"	BOTH IP/OP	$659.00 	$487.66	$0.00	$544.80	$88.41	$88.41	$42.84	$42.84	$21.42	$21.42	$65.04	$65.04	$67.54	$42.84	$63.28	$27.85	$389.80	$389.80	$44.98	$119.70	$539.35	$544.80	$62.12	$0.00	$62.12	$67.43	$42.84	$42.84	$47.20	$42.84	$0.00	$0.00	$0.00	$0.00
30600106	EAP	CPT® 87252		Cmv Inoc Tissue (so)	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$45.65	$45.65	$26.07	$26.07	$13.04	$13.04	$33.57	$33.57	$34.86	$26.07	$32.66	$16.95	$230.69	$230.69	$27.37	$61.78	$308.88	$312.00	$37.80	$0.00	$37.80	$34.79	$26.07	$26.07	$24.36	$26.07	$0.00	$0.00	$0.00	$0.00
30600107	EAP	CPT® 87254		Cmv Inoc Shell Via (so)	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$30.83	$0.00	$7.22	$0.00	$0.00	$0.00	$0.00	$54.64	$190.08	$192.00	$0.00	$0.00	$0.00	$7.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600108	EAP	CPT® 87902		Hep C Dna Geno Quant (so)	BOTH IP/OP	"$1,193.00 "	$882.82	$0.00	$986.40	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$132.42	$132.42	$137.52	$257.45	$128.84	$167.34	$705.66	$705.66	$270.32	$243.70	$976.54	$986.40	$373.30	$0.00	$373.30	$137.28	$257.45	$257.45	$96.09	$257.45	$0.00	$0.00	$0.00	$0.00
30600109	EAP	CPT® 87799		Ebv Dna Detect Nos (so)	BOTH IP/OP	$688.00 	$509.12	$0.00	$628.80	$0.00	$0.00	$0.00	$0.00	$0.00	$21.42	$65.04	$65.04	$67.54	$42.84	$143.38	$27.85	$406.95	$406.95	$0.00	$119.70	$622.51	$628.80	$0.00	$0.00	$0.00	$123.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600200	EAP	CPT® 87205		Gram Stain	BOTH IP/OP	$65.00 	$48.10	$2.14	$50.40	$4.83	$4.83	$4.27	$4.27	$2.14	$2.14	$3.57	$3.57	$3.70	$4.27	$3.47	$2.78	$38.45	$38.45	$4.48	$6.56	$49.90	$50.40	$6.19	$7.05	$6.19	$3.69	$4.27	$4.27	$2.58	$4.27	$0.00	$0.00	$0.00	$0.00
30600201	EAP	CPT® 87205		Sezary Cell Prep	BOTH IP/OP	$61.00 	$45.14	$0.00	$50.40	$4.83	$4.83	$4.27	$4.27	$2.14	$2.14	$3.57	$3.57	$3.70	$4.27	$3.47	$2.78	$36.08	$36.08	$4.48	$6.56	$49.90	$50.40	$6.19	$0.00	$6.19	$3.69	$4.27	$4.27	$2.58	$4.27	$0.00	$0.00	$0.00	$0.00
30600202	EAP	CPT® 87206		Pas/koh Prep	BOTH IP/OP	$158.00 	$116.92	$2.70	$123.20	$11.11	$11.11	$5.39	$5.39	$2.70	$2.70	$8.15	$8.15	$8.47	$5.39	$7.93	$3.50	$93.46	$93.46	$5.66	$15.00	$121.97	$123.20	$7.82	$8.89	$7.82	$8.45	$5.39	$5.39	$5.91	$5.39	$0.00	$0.00	$0.00	$0.00
30600203	EAP	CPT® 87206		Afb Stain	BOTH IP/OP	$158.00 	$116.92	$2.70	$123.20	$11.11	$11.11	$5.39	$5.39	$2.70	$2.70	$8.15	$8.15	$8.47	$5.39	$7.93	$3.50	$93.46	$93.46	$5.66	$15.00	$121.97	$123.20	$7.82	$8.89	$7.82	$8.45	$5.39	$5.39	$5.91	$5.39	$0.00	$0.00	$0.00	$0.00
30600204	EAP	CPT® 87210		"O & P Direct, Smear"	BOTH IP/OP	$210.00 	$155.40	$2.62	$168.00	$8.82	$8.82	$5.82	$5.82	$2.91	$2.62	$6.48	$6.48	$6.73	$5.82	$6.30	$3.78	$124.22	$124.22	$6.11	$11.92	$166.32	$168.00	$8.44	$9.60	$8.44	$6.71	$5.82	$5.82	$4.70	$5.82	$0.00	$0.00	$0.00	$0.00
30600205	EAP	CPT® 87210		India Ink Prep	BOTH IP/OP	$216.00 	$159.84	$2.62	$168.00	$8.82	$8.82	$5.82	$5.82	$2.91	$2.62	$6.48	$6.48	$6.73	$5.82	$6.30	$3.78	$127.76	$127.76	$6.11	$11.92	$166.32	$168.00	$8.44	$9.60	$8.44	$6.71	$5.82	$5.82	$4.70	$5.82	$0.00	$0.00	$0.00	$0.00
30600206	EAP	CPT® 87210		Vaginal Wet Prep	BOTH IP/OP	$216.00 	$159.84	$2.62	$168.00	$8.82	$8.82	$5.82	$5.82	$2.91	$2.62	$6.48	$6.48	$6.73	$5.82	$6.30	$3.78	$127.76	$127.76	$6.11	$11.92	$166.32	$168.00	$8.44	$9.60	$8.44	$6.71	$5.82	$5.82	$4.70	$5.82	$0.00	$0.00	$0.00	$0.00
30600207	EAP	CPT® 87430		Strep A Ag-throat	BOTH IP/OP	$169.00 	$125.06	$7.56	$129.60	$24.74	$24.74	$16.81	$16.81	$8.41	$7.56	$18.22	$18.22	$18.92	$16.81	$17.71	$10.93	$99.96	$99.96	$17.65	$33.52	$128.30	$129.60	$24.37	$27.74	$24.37	$18.87	$16.81	$16.81	$13.21	$16.81	$0.00	$0.00	$0.00	$0.00
30600208	EAP	CPT® 87205		Gram Stain For Gc	BOTH IP/OP	$65.00 	$48.10	$2.14	$50.40	$4.83	$4.83	$4.27	$4.27	$2.14	$2.14	$3.57	$3.57	$3.70	$4.27	$3.47	$2.78	$38.45	$38.45	$4.48	$6.56	$49.90	$50.40	$6.19	$7.05	$6.19	$3.69	$4.27	$4.27	$2.58	$4.27	$0.00	$0.00	$0.00	$0.00
30600209	EAP	CPT® 87206		Koh Prep	BOTH IP/OP	$158.00 	$116.92	$2.70	$123.20	$11.11	$11.11	$5.39	$5.39	$2.70	$2.70	$8.15	$8.15	$8.47	$5.39	$7.93	$3.50	$93.46	$93.46	$5.66	$15.00	$121.97	$123.20	$7.82	$8.89	$7.82	$8.45	$5.39	$5.39	$5.91	$5.39	$0.00	$0.00	$0.00	$0.00
30600210	EAP	CPT® 87210		Vaginal Wet Prep	BOTH IP/OP	$216.00 	$159.84	$2.62	$168.00	$8.82	$8.82	$5.82	$5.82	$2.91	$2.62	$6.48	$6.48	$6.73	$5.82	$6.30	$3.78	$127.76	$127.76	$6.11	$11.92	$166.32	$168.00	$8.44	$9.60	$8.44	$6.71	$5.82	$5.82	$4.70	$5.82	$0.00	$0.00	$0.00	$0.00
30600211	EAP	CPT® 87430		Rapid Strep	BOTH IP/OP	$162.00 	$119.88	$0.00	$129.60	$24.74	$24.74	$16.81	$16.81	$8.41	$7.56	$18.22	$18.22	$18.92	$16.81	$17.71	$10.93	$95.82	$95.82	$17.65	$33.52	$128.30	$129.60	$24.37	$0.00	$24.37	$18.87	$16.81	$16.81	$13.21	$16.81	$0.00	$0.00	$0.00	$0.00
30600212	EAP	CPT® 87205		Gram Stain	BOTH IP/OP	$61.00 	$45.14	$0.00	$50.40	$4.83	$4.83	$4.27	$4.27	$2.14	$2.14	$3.57	$3.57	$3.70	$4.27	$3.47	$2.78	$36.08	$36.08	$4.48	$6.56	$49.90	$50.40	$6.19	$0.00	$6.19	$3.69	$4.27	$4.27	$2.58	$4.27	$0.00	$0.00	$0.00	$0.00
30600213	EAP	CPT® 87188		Microbe Suscept Macrobroth	BOTH IP/OP	$41.00 	$30.34	$0.00	$32.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.08	$10.08	$10.47	$0.00	$9.80	$0.00	$0.00	$0.00	$0.00	$18.54	$32.47	$32.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600215	EAP	CPT® 87290		Varicella Zoster Ag If	BOTH IP/OP	$66.00 	$48.84	$0.00	$52.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$52.27	$52.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600216	EAP	CPT® 87299		Antibody Detection Nos If	BOTH IP/OP	$83.00 	$61.42	$0.00	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$65.74	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600218	EAP	CPT® 87015		Pneumocycstis Carni Dfa-concen	BOTH IP/OP	$91.00 	$67.34	$0.00	$72.80	$13.78	$13.78	$6.68	$6.68	$3.34	$3.34	$10.14	$10.14	$10.53	$6.68	$9.87	$4.34	$53.83	$53.83	$7.01	$18.66	$72.07	$72.80	$9.69	$0.00	$9.69	$10.52	$6.68	$6.68	$7.36	$6.68	$0.00	$0.00	$0.00	$0.00
30600219	EAP	CPT® 87281		Pneumocycstis Carni Dfa-id (q)	BOTH IP/OP	$110.00 	$81.40	$0.00	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.22	$18.22	$18.92	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$33.52	$87.12	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600220	EAP	CPT® 87799		"Toxoplasma Gondii Dna , Quant Pcr (so)"	BOTH IP/OP	$846.00 	$626.04	$0.00	$773.60	$0.00	$0.00	$0.00	$0.00	$0.00	$21.42	$65.04	$65.04	$67.54	$42.84	$176.31	$27.85	$500.41	$500.41	$0.00	$119.70	$765.86	$773.60	$0.00	$0.00	$0.00	$151.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600221	EAP	CPT® 87798		Bordetella Pertussis/parapertussis Qual/pcr(so)	BOTH IP/OP	$547.00 	$404.78	$17.55	$440.80	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$323.55	$323.55	$36.84	$54.82	$436.39	$440.80	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30600222	EAP	CPT® 87912		Hepatitis B Virus Drug Resistance Genotype Bcp/precore (so)	BOTH IP/OP	$590.00 	$436.60	$0.00	$472.00	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$373.52	$373.52	$387.88	$257.45	$112.65	$167.34	$348.99	$348.99	$0.00	$295.00	$467.28	$472.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600223	EAP	CPT® 87902		"Hepatitis C Viral Genotype , Lipa (so)"	BOTH IP/OP	$339.00 	$250.86	$0.00	$350.00	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$132.42	$132.42	$137.52	$257.45	$128.84	$167.34	$200.52	$200.52	$270.32	$243.70	$277.20	$280.00	$350.00	$0.00	$350.00	$137.28	$257.45	$257.45	$96.09	$257.45	$0.00	$0.00	$0.00	$0.00
30600224	EAP	CPT® 87661		"Trichomonas Vaginalis Rna, Qual"	BOTH IP/OP	$253.00 	$187.22	$17.55	$196.80	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$27.84	$27.84	$28.91	$35.09	$25.16	$22.81	$149.65	$149.65	$36.84	$123.00	$194.83	$196.80	$50.88	$57.90	$50.88	$26.81	$35.09	$35.09	$18.76	$35.09	$0.00	$0.00	$0.00	$0.00
30600225	EAP	CPT® 87493		"Clostridium Difficile Toxin, Gene ,pcr"	BOTH IP/OP	$288.00 	$213.12	$17.55	$209.60	$40.50	$40.50	$37.27	$37.27	$18.64	$17.55	$29.22	$29.22	$30.35	$37.27	$60.02	$24.23	$170.35	$170.35	$39.13	$131.00	$207.50	$209.60	$54.04	$61.50	$54.04	$41.00	$37.27	$37.27	$41.71	$37.27	$0.00	$0.00	$0.00	$0.00
30600227	EAP	CPT® 87632		Respiratory Pcr Panel Iv (so)	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$309.59	$309.59	$321.49	$0.00	$127.33	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00	$655.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30600228	EAP	CPT® 87530		Herpes Sim Pcr Quant (so)	BOTH IP/OP	$331.00 	$244.94	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.04	$65.04	$67.54	$0.00	$68.98	$0.00	$0.00	$0.00	$0.00	$119.70	$270.86	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30630620	EAP	CPT® 87798		Jc Polyoma Quant Amp (so)	BOTH IP/OP	$326.00 	$241.24	$0.00	$314.40	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$192.83	$192.83	$36.84	$54.82	$311.26	$314.40	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30630621	EAP	CPT® 87799		Jc Polyoma Quant Pcr (so)	BOTH IP/OP	$589.00 	$435.86	$0.00	$589.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.42	$65.04	$65.04	$67.54	$42.84	$122.75	$27.85	$348.39	$348.39	$0.00	$119.70	$460.94	$465.60	$0.00	$589.00	$0.00	$91.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30630622	EAP	CPT® 87798		Aspergillus Dna Qual Pcr (so)	BOTH IP/OP	$326.00 	$241.24	$0.00	$314.40	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$192.83	$192.83	$36.84	$54.82	$311.26	$314.40	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30630623	EAP	CPT® 87081		Brucella Screen (so)	BOTH IP/OP	$143.00 	$105.82	$0.00	$114.40	$13.68	$13.68	$6.63	$6.63	$3.32	$3.31	$10.08	$10.08	$10.47	$6.63	$9.79	$4.31	$84.58	$84.58	$6.96	$18.52	$113.26	$114.40	$9.61	$0.00	$9.61	$10.43	$6.63	$6.63	$7.30	$6.63	$0.00	$0.00	$0.00	$0.00
30630624	EAP	CPT® 87799		Herpes Virus 8 Dna Pcr (so)	BOTH IP/OP	$509.00 	$376.66	$0.00	$465.60	$0.00	$0.00	$0.00	$0.00	$0.00	$21.42	$65.04	$65.04	$67.54	$42.84	$106.08	$27.85	$301.07	$301.07	$0.00	$119.70	$460.94	$465.60	$0.00	$0.00	$0.00	$91.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30650009	EAP	CPT® 87070		Sputum Culture	BOTH IP/OP	$371.00 	$274.54	$4.31	$277.60	$17.79	$17.79	$8.62	$8.62	$4.31	$4.31	$13.07	$13.07	$13.58	$8.62	$12.73	$5.60	$219.45	$219.45	$9.05	$24.06	$274.82	$277.60	$12.50	$14.22	$12.50	$13.56	$8.62	$8.62	$9.49	$8.62	$0.00	$0.00	$0.00	$0.00
30650014	EAP	CPT® 87077		Culture I.d.-aerobe Biochem	BOTH IP/OP	$261.00 	$193.14	$4.04	$189.60	$16.68	$16.68	$8.08	$8.08	$4.04	$4.04	$12.27	$12.27	$12.74	$8.08	$11.94	$5.25	$154.38	$154.38	$8.48	$22.58	$187.70	$189.60	$11.72	$13.33	$11.72	$12.72	$8.08	$8.08	$8.90	$8.08	$0.00	$0.00	$0.00	$0.00
30650094	EAP	CPT® 86757		Richettsia Antibody Igg	BOTH IP/OP	$48.00 	$35.52	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.39	$29.39	$30.52	$0.00	$28.60	$0.00	$0.00	$0.00	$0.00	$48.00	$38.02	$38.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30650206	EAP	CPT® 87210		Trichomonas Prep	BOTH IP/OP	$204.00 	$150.96	$2.62	$168.00	$8.82	$8.82	$5.82	$5.82	$2.91	$2.62	$6.48	$6.48	$6.73	$5.82	$6.30	$3.78	$120.67	$120.67	$6.11	$11.92	$166.32	$168.00	$8.44	$9.60	$8.44	$6.71	$5.82	$5.82	$4.70	$5.82	$0.00	$0.00	$0.00	$0.00
30650311	EAP	CPT® 87530		Hsv Dna Quant	BOTH IP/OP	$445.00 	$329.30	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.04	$65.04	$67.54	$0.00	$92.74	$0.00	$0.00	$0.00	$0.00	$119.70	$364.32	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30650312	EAP	CPT® 87798		"T.pallidum Pcr Ql,csf Q"	BOTH IP/OP	$401.00 	$296.74	$17.55	$323.20	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$237.19	$237.19	$36.84	$54.82	$319.97	$323.20	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30650313	EAP	CPT® 87624		Papillomavirus Human	BOTH IP/OP	$90.00 	$66.60	$0.00	$74.40	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$27.77	$27.77	$28.84	$35.09	$21.44	$22.81	$53.24	$53.24	$36.84	$46.50	$73.66	$74.40	$50.88	$0.00	$50.88	$22.85	$35.09	$35.09	$15.99	$35.09	$0.00	$0.00	$0.00	$0.00
30650315	EAP	CPT® 87798		Ehrlichia Chaff Pcr (so)	BOTH IP/OP	$373.00 	$276.02	$0.00	$359.20	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$220.63	$220.63	$36.84	$54.82	$355.61	$359.20	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30650316	EAP	CPT® 87529		Hsv Pcr Qual Amino (so)	BOTH IP/OP	$340.00 	$251.60	$0.00	$280.80	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$201.11	$201.11	$36.84	$54.82	$277.99	$280.80	$50.88	$0.00	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30650317	EAP	CPT® 87900		Hcv Ns3/4 Pheno (so)	BOTH IP/OP	"$1,201.00 "	$888.74	$0.00	"$1,084.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.86	$167.86	$174.31	$0.00	$163.30	$0.00	$0.00	$0.00	$0.00	$308.90	"$1,073.16"	"$1,084.00"	$0.00	"$1,066.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30650318	EAP	CPT® 87902		Hcv Ns3/4 Geno (so)	BOTH IP/OP	"$1,193.00 "	$882.82	$0.00	$986.40	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$132.42	$132.42	$137.52	$257.45	$128.84	$167.34	$705.66	$705.66	$270.32	$243.70	$976.54	$986.40	$373.30	$0.00	$373.30	$137.28	$257.45	$257.45	$96.09	$257.45	$0.00	$0.00	$0.00	$0.00
30650319	EAP	CPT® 87798		Jc Poly Qual Pcr (so)	BOTH IP/OP	$445.00 	$329.30	$17.55	$359.20	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$263.22	$263.22	$36.84	$54.82	$355.61	$359.20	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30650320	EAP	CPT® 87906		Hiv Coreceptor Tropism Ultra (so)	BOTH IP/OP	$973.00 	$720.02	$0.00	$937.60	$90.02	$90.02	$128.73	$128.73	$64.37	$64.36	$63.81	$63.81	$66.27	$128.73	$57.67	$83.67	$575.53	$575.53	$135.17	$586.00	$928.22	$937.60	$186.66	$0.00	$186.66	$61.44	$128.73	$128.73	$43.01	$128.73	$0.00	$0.00	$0.00	$0.00
30650321	EAP	CPT® 87902		Hcv Rna Ns5a Drug (so)	BOTH IP/OP	"$1,270.00 "	$939.80	$96.09	$986.40	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$132.42	$132.42	$137.52	$257.45	$128.84	$167.34	$751.21	$751.21	$270.32	$243.70	$976.54	$986.40	$373.30	$424.79	$373.30	$137.28	$257.45	$257.45	$96.09	$257.45	$0.00	$0.00	$0.00	$0.00
30650322	EAP	CPT® 87902		Hcv Rna Ns5b Resist (so)	BOTH IP/OP	"$1,193.00 "	$882.82	$0.00	$986.40	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$132.42	$132.42	$137.52	$257.45	$128.84	$167.34	$705.66	$705.66	$270.32	$243.70	$976.54	$986.40	$373.30	$0.00	$373.30	$137.28	$257.45	$257.45	$96.09	$257.45	$0.00	$0.00	$0.00	$0.00
30650323	EAP	CPT® 87632		Resp Virus Pcr Iv (6-11) (so)	BOTH IP/OP	"$3,561.00 "	"$2,635.14"	$0.00	"$2,848.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$309.59	$309.59	$321.49	$0.00	$127.33	$0.00	$0.00	$0.00	$0.00	"$1,780.50"	"$2,820.31"	"$2,848.80"	$0.00	$655.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30650324	EAP	CPT® 87530		Hsv Dna Pcr Quant (so)	BOTH IP/OP	$327.00 	$241.98	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.04	$65.04	$67.54	$0.00	$68.15	$0.00	$0.00	$0.00	$0.00	$119.70	$267.70	$270.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30650325	EAP	CPT® 87902		Hcv Ns5a Drug Resist (so)	BOTH IP/OP	$747.00 	$552.78	$0.00	$617.60	$180.02	$180.02	$257.45	$257.45	$128.73	$128.72	$132.42	$132.42	$137.52	$257.45	$128.84	$167.34	$441.85	$441.85	$270.32	$243.70	$611.42	$617.60	$373.30	$0.00	$373.30	$137.28	$257.45	$257.45	$96.09	$257.45	$0.00	$0.00	$0.00	$0.00
30650326	EAP	CPT® 87625		Hpv Genotyping	BOTH IP/OP	$245.00 	$181.30	$0.00	$245.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.77	$27.77	$28.84	$0.00	$21.44	$0.00	$0.00	$0.00	$0.00	$123.50	$195.62	$197.60	$0.00	$245.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30650330	EAP	CPT® 87015		Cyclospora & Isospora Concentration (so)	BOTH IP/OP	$77.00 	$56.98	$3.34	$56.00	$13.78	$13.78	$6.68	$6.68	$3.34	$3.34	$10.14	$10.14	$10.53	$6.68	$9.87	$4.34	$45.55	$45.55	$7.01	$18.66	$55.44	$56.00	$9.69	$11.02	$9.69	$10.52	$6.68	$6.68	$7.36	$6.68	$0.00	$0.00	$0.00	$0.00
30650331	EAP	CPT® 87207		Cyclospora & Isospora Stain (so)	BOTH IP/OP	$72.00 	$53.28	$3.00	$56.00	$12.38	$12.38	$5.99	$5.99	$3.00	$3.00	$9.10	$9.10	$9.45	$5.99	$8.84	$3.89	$42.59	$42.59	$6.29	$16.74	$55.44	$56.00	$8.69	$9.88	$8.69	$9.42	$5.99	$5.99	$6.59	$5.99	$0.00	$0.00	$0.00	$0.00
30650340	EAP	CPT® 87635		Covid-19 Lab Test Non-cdc	BOTH IP/OP	$242.00 	$179.08	$48.75	$406.40	$131.41	$131.41	$75.00	$75.00	$75.00	$111.88	$186.11	$186.11	$193.28	$75.00	$111.88	$48.75	$143.14	$143.14	$105.00	$254.00	$402.34	$406.40	$74.40	$123.75	$74.40	$79.50	$51.31	$51.31	$80.87	$100.00	$0.00	$0.00	$0.00	$0.00
30650341	EAP	CPT® 87635		Sars-cov-2 Covid-19 Amp Prb (so)	BOTH IP/OP	$174.00 	$128.76	$0.00	$193.28	$94.48	$94.48	$0.00	$0.00	$25.66	$111.88	$186.11	$186.11	$193.28	$0.00	$111.88	$0.00	$102.92	$102.92	$53.88	$86.50	$137.02	$138.40	$74.40	$56.89	$74.40	$27.07	$51.31	$51.31	$27.54	$51.31	$0.00	$0.00	$0.00	$0.00
30650350	EAP	CPT® 87633		Respiratory Virus Panel 12-25 Targets	BOTH IP/OP	"$1,033.00 "	$764.42	$0.00	$834.40	$363.98	$363.98	$416.78	$416.78	$208.39	$208.39	$535.13	$535.13	$555.71	$416.78	$227.79	$270.91	$611.02	$611.02	$0.00	$521.50	$826.06	$834.40	$0.00	$687.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30650351	EAP	CPT® 87798		Bordetella Pertussis	BOTH IP/OP	$87.00 	$64.38	$17.55	$70.40	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$51.46	$51.46	$36.84	$54.82	$69.70	$70.40	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30650352	EAP	CPT® 87486		Chlamydophila/chlamydia Pneumoniae	BOTH IP/OP	$97.00 	$71.78	$0.00	$70.40	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$57.38	$57.38	$0.00	$54.82	$69.70	$70.40	$0.00	$57.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30650353	EAP	CPT® 87581		Mycoplasma Pneumoniae	BOTH IP/OP	$91.00 	$67.34	$0.00	$70.40	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$53.83	$53.83	$0.00	$54.82	$69.70	$70.40	$0.00	$57.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30650354	EAP	CPT® 87798		Bordetella Parapertussis	BOTH IP/OP	$87.00 	$64.38	$17.55	$70.40	$40.50	$40.50	$35.09	$35.09	$17.55	$17.55	$29.79	$29.79	$30.93	$35.09	$28.98	$22.81	$51.46	$51.46	$36.84	$54.82	$69.70	$70.40	$50.88	$57.90	$50.88	$30.88	$35.09	$35.09	$21.62	$35.09	$0.00	$0.00	$0.00	$0.00
30700001	EAP	CPT® 81000		"PH, URINE-DIPSTICK"	BOTH IP/OP	$103.00 	$76.22	$1.81	$88.00	$6.55	$6.55	$4.02	$4.02	$2.01	$1.81	$4.82	$4.82	$5.00	$4.02	$4.68	$2.61	$60.92	$60.92	$4.22	$8.86	$87.12	$88.00	$5.83	$6.63	$5.83	$4.99	$4.02	$4.02	$3.49	$4.02	$0.00	$0.00	$0.00	$0.00
30700002	EAP	CPT® 85025		"Cbc, Plat, Wbcdiff, Evd"	BOTH IP/OP	$212.00 	$156.88	$3.88	$177.60	$16.05	$16.05	$7.77	$7.77	$3.89	$3.88	$9.97	$9.97	$10.36	$7.77	$11.48	$5.05	$125.40	$125.40	$8.16	$21.72	$175.82	$177.60	$11.27	$12.82	$11.27	$12.23	$7.77	$7.77	$8.56	$7.77	$0.00	$0.00	$0.00	$0.00
30700004	EAP	CPT® 81002		Urine Dip Stick	BOTH IP/OP	$103.00 	$76.22	$0.00	$103.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.89	$3.89	$4.04	$0.00	$3.77	$0.00	$0.00	$0.00	$0.00	$7.14	$75.24	$76.00	$0.00	$103.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30700007	EAP	CPT® 81001		Urinalysis Complete	BOTH IP/OP	$192.00 	$142.08	$1.58	$164.00	$6.55	$6.55	$3.17	$3.17	$1.59	$1.58	$4.82	$4.82	$5.00	$3.17	$4.68	$2.06	$113.57	$113.57	$3.33	$8.86	$162.36	$164.00	$4.60	$5.23	$4.60	$4.99	$3.17	$3.17	$3.49	$3.17	$0.00	$0.00	$0.00	$0.00
30700019	EAP	CPT® 81003		Urinalysis	BOTH IP/OP	$157.00 	$116.18	$0.00	$134.40	$4.65	$4.65	$2.25	$2.25	$1.13	$1.12	$3.41	$3.41	$3.54	$2.25	$3.33	$1.46	$92.87	$92.87	$2.36	$6.28	$133.06	$134.40	$3.26	$0.00	$3.26	$3.55	$2.25	$2.25	$2.48	$2.25	$0.00	$0.00	$0.00	$0.00
30700027	EAP	CPT® 81005		"Ph, Urine(quant)"	BOTH IP/OP	$108.00 	$79.92	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$3.29	$3.41	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$6.06	$91.08	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30700035	EAP	CPT® 81015		Urinalysis-micro Only	BOTH IP/OP	$180.00 	$133.20	$0.00	$153.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.61	$4.61	$4.78	$0.00	$4.48	$0.00	$0.00	$0.00	$0.00	$8.48	$152.06	$153.60	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30700041	EAP	CPT® 81025		PREGNANCY TEST-URINE	BOTH IP/OP	$33.00 	$24.42	$0.00	$28.00	$13.04	$13.04	$8.61	$8.61	$4.31	$3.87	$9.61	$9.61	$9.98	$8.61	$9.36	$5.60	$19.52	$19.52	$9.04	$17.68	$27.72	$28.00	$12.48	$0.00	$12.48	$9.97	$8.61	$8.61	$6.98	$8.61	$0.00	$0.00	$0.00	$0.00
30700042	EAP	CPT® 81050		"Urine, Timed Collect"	BOTH IP/OP	$129.00 	$95.46	$1.64	$95.20	$6.20	$6.20	$3.64	$3.64	$1.82	$1.64	$4.54	$4.54	$4.72	$3.64	$4.43	$2.37	$76.30	$76.30	$3.82	$8.38	$94.25	$95.20	$5.28	$6.01	$5.28	$4.72	$3.64	$3.64	$3.30	$3.64	$0.00	$0.00	$0.00	$0.00
30700050	EAP	CPT® 81003		Urinalysis-biochem	BOTH IP/OP	$157.00 	$116.18	$0.00	$134.40	$4.65	$4.65	$2.25	$2.25	$1.13	$1.12	$3.41	$3.41	$3.54	$2.25	$3.33	$1.46	$92.87	$92.87	$2.36	$6.28	$133.06	$134.40	$3.26	$0.00	$3.26	$3.55	$2.25	$2.25	$2.48	$2.25	$0.00	$0.00	$0.00	$0.00
30700080	EAP	CPT® 81000		"Ph, Urine-dipstick"	BOTH IP/OP	$119.00 	$88.06	$1.81	$88.00	$6.55	$6.55	$4.02	$4.02	$2.01	$1.81	$4.82	$4.82	$5.00	$4.02	$4.68	$2.61	$70.39	$70.39	$4.22	$8.86	$87.12	$88.00	$5.83	$6.63	$5.83	$4.99	$4.02	$4.02	$3.49	$4.02	$0.00	$0.00	$0.00	$0.00
30700081	EAP	CPT® 81001		Urinalysis With Microscopy	BOTH IP/OP	$222.00 	$164.28	$1.58	$164.00	$6.55	$6.55	$3.17	$3.17	$1.59	$1.58	$4.82	$4.82	$5.00	$3.17	$4.68	$2.06	$131.31	$131.31	$3.33	$8.86	$162.36	$164.00	$4.60	$5.23	$4.60	$4.99	$3.17	$3.17	$3.49	$3.17	$0.00	$0.00	$0.00	$0.00
30700082	EAP	CPT® 81003		Urinalysis	BOTH IP/OP	$182.00 	$134.68	$1.12	$134.40	$4.65	$4.65	$2.25	$2.25	$1.13	$1.12	$3.41	$3.41	$3.54	$2.25	$3.33	$1.46	$107.65	$107.65	$2.36	$6.28	$133.06	$134.40	$3.26	$3.71	$3.26	$3.55	$2.25	$2.25	$2.48	$2.25	$0.00	$0.00	$0.00	$0.00
30700083	EAP	CPT® 81003		"Urinalysis, Top"	BOTH IP/OP	$182.00 	$134.68	$1.12	$134.40	$4.65	$4.65	$2.25	$2.25	$1.13	$1.12	$3.41	$3.41	$3.54	$2.25	$3.33	$1.46	$107.65	$107.65	$2.36	$6.28	$133.06	$134.40	$3.26	$3.71	$3.26	$3.55	$2.25	$2.25	$2.48	$2.25	$0.00	$0.00	$0.00	$0.00
30700084	EAP	CPT® 81025		Pregnancy Test-urine	BOTH IP/OP	$38.00 	$28.12	$3.87	$28.00	$13.04	$13.04	$8.61	$8.61	$4.31	$3.87	$9.61	$9.61	$9.98	$8.61	$9.36	$5.60	$22.48	$22.48	$9.04	$17.68	$27.72	$28.00	$12.48	$14.21	$12.48	$9.97	$8.61	$8.61	$6.98	$8.61	$0.00	$0.00	$0.00	$0.00
30700085	EAP	CPT® 81025		"Preg Test,urine"	BOTH IP/OP	$38.00 	$28.12	$3.87	$28.00	$13.04	$13.04	$8.61	$8.61	$4.31	$3.87	$9.61	$9.61	$9.98	$8.61	$9.36	$5.60	$22.48	$22.48	$9.04	$17.68	$27.72	$28.00	$12.48	$14.21	$12.48	$9.97	$8.61	$8.61	$6.98	$8.61	$0.00	$0.00	$0.00	$0.00
30700086	EAP	CPT® 81050		"Urine, Timed Collect"	BOTH IP/OP	$117.00 	$86.58	$1.64	$100.00	$6.20	$6.20	$3.64	$3.64	$1.82	$1.64	$4.54	$4.54	$4.72	$3.64	$4.43	$2.37	$69.21	$69.21	$3.82	$8.38	$99.00	$100.00	$5.28	$6.01	$5.28	$4.72	$3.64	$3.64	$3.30	$3.64	$0.00	$0.00	$0.00	$0.00
30700090	EAP	CPT® 81000		"Urobilinogen, Qualitativ"	BOTH IP/OP	$103.00 	$76.22	$1.81	$88.00	$6.55	$6.55	$4.02	$4.02	$2.01	$1.81	$4.82	$4.82	$5.00	$4.02	$4.68	$2.61	$60.92	$60.92	$4.22	$8.86	$87.12	$88.00	$5.83	$6.63	$5.83	$4.99	$4.02	$4.02	$3.49	$4.02	$0.00	$0.00	$0.00	$0.00
30700091	EAP	CPT® 81001		Urinalysis Comp	BOTH IP/OP	$192.00 	$142.08	$1.58	$164.00	$6.55	$6.55	$3.17	$3.17	$1.59	$1.58	$4.82	$4.82	$5.00	$3.17	$4.68	$2.06	$113.57	$113.57	$3.33	$8.86	$162.36	$164.00	$4.60	$5.23	$4.60	$4.99	$3.17	$3.17	$3.49	$3.17	$0.00	$0.00	$0.00	$0.00
30700092	EAP	CPT® 81003		Urinalysis-biochem	BOTH IP/OP	$157.00 	$116.18	$0.00	$134.40	$4.65	$4.65	$2.25	$2.25	$1.13	$1.12	$3.41	$3.41	$3.54	$2.25	$3.33	$1.46	$92.87	$92.87	$2.36	$6.28	$133.06	$134.40	$3.26	$0.00	$3.26	$3.55	$2.25	$2.25	$2.48	$2.25	$0.00	$0.00	$0.00	$0.00
30700093	EAP	CPT® 81025		Urine Pregnancy Test	BOTH IP/OP	$33.00 	$24.42	$0.00	$28.00	$13.04	$13.04	$8.61	$8.61	$4.31	$3.87	$9.61	$9.61	$9.98	$8.61	$9.36	$5.60	$19.52	$19.52	$9.04	$17.68	$27.72	$28.00	$12.48	$0.00	$12.48	$9.97	$8.61	$8.61	$6.98	$8.61	$0.00	$0.00	$0.00	$0.00
30700094	EAP	CPT® 81000		"Sugar, Clinitest"	BOTH IP/OP	$103.00 	$76.22	$1.81	$88.00	$6.55	$6.55	$4.02	$4.02	$2.01	$1.81	$4.82	$4.82	$5.00	$4.02	$4.68	$2.61	$60.92	$60.92	$4.22	$8.86	$87.12	$88.00	$5.83	$6.63	$5.83	$4.99	$4.02	$4.02	$3.49	$4.02	$0.00	$0.00	$0.00	$0.00
30700095	EAP	CPT® 81000		"Bile, Urine"	BOTH IP/OP	$103.00 	$76.22	$1.81	$88.00	$6.55	$6.55	$4.02	$4.02	$2.01	$1.81	$4.82	$4.82	$5.00	$4.02	$4.68	$2.61	$60.92	$60.92	$4.22	$8.86	$87.12	$88.00	$5.83	$6.63	$5.83	$4.99	$4.02	$4.02	$3.49	$4.02	$0.00	$0.00	$0.00	$0.00
30700096	EAP	CPT® 81000		Specific Gravity	BOTH IP/OP	$119.00 	$88.06	$1.81	$88.00	$6.55	$6.55	$4.02	$4.02	$2.01	$1.81	$4.82	$4.82	$5.00	$4.02	$4.68	$2.61	$70.39	$70.39	$4.22	$8.86	$87.12	$88.00	$5.83	$6.63	$5.83	$4.99	$4.02	$4.02	$3.49	$4.02	$0.00	$0.00	$0.00	$0.00
30700097	EAP	CPT® 81000		"Urobilinogen, Qualitativ"	BOTH IP/OP	$103.00 	$76.22	$1.81	$88.00	$6.55	$6.55	$4.02	$4.02	$2.01	$1.81	$4.82	$4.82	$5.00	$4.02	$4.68	$2.61	$60.92	$60.92	$4.22	$8.86	$87.12	$88.00	$5.83	$6.63	$5.83	$4.99	$4.02	$4.02	$3.49	$4.02	$0.00	$0.00	$0.00	$0.00
30700120	EAP	CPT® 81025		Urine Pregnancy Test	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.87	$0.00	$0.00	$0.00	$8.61	$9.36	$5.60	$19.52	$19.52	$9.04	$17.68	$27.72	$28.00	$12.48	$0.00	$12.48	$9.97	$8.61	$8.61	$6.98	$8.61	$0.00	$0.00	$0.00	$0.00
30750027	EAP	CPT® 81005		"Clinitest, Stool"	BOTH IP/OP	$124.00 	$91.76	$0.00	$114.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$3.29	$3.41	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$6.06	$91.08	$92.00	$0.00	$114.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30750028	EAP	CPT® 81005		"Spec.gravity,refrac"	BOTH IP/OP	$108.00 	$79.92	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$3.29	$3.41	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$6.06	$91.08	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30750029	EAP	CPT® 81005		"Clinitest,urine"	BOTH IP/OP	$108.00 	$79.92	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$3.29	$3.41	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$6.06	$91.08	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30750030	EAP	CPT® 81005		"Protein, Ur-qual"	BOTH IP/OP	$108.00 	$79.92	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$3.29	$3.41	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$6.06	$91.08	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30750031	EAP	CPT® 81005		"Glucose, Ur-qual"	BOTH IP/OP	$108.00 	$79.92	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$3.29	$3.41	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$6.06	$91.08	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30750032	EAP	CPT® 81005		"Ketones,ur"	BOTH IP/OP	$108.00 	$79.92	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$3.29	$3.41	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$6.06	$91.08	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30750033	EAP	CPT® 81005		"Urobilinogen,ur-ql"	BOTH IP/OP	$108.00 	$79.92	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$3.29	$3.41	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$6.06	$91.08	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30750034	EAP	CPT® 81005		"Glucose, Ur-qual"	BOTH IP/OP	$108.00 	$79.92	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$3.29	$3.41	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$6.06	$91.08	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30750035	EAP	CPT® 81005		"Protein, Ur-qual"	BOTH IP/OP	$108.00 	$79.92	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$3.29	$3.41	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$6.06	$91.08	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30750036	EAP	CPT® 81005		"Glucose, Ur-qual"	BOTH IP/OP	$108.00 	$79.92	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$3.29	$3.41	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$6.06	$91.08	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30750037	EAP	CPT® 81005		"Ketones,ur"	BOTH IP/OP	$108.00 	$79.92	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$3.29	$3.41	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$6.06	$91.08	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30750080	EAP	CPT® 81000		"Ph, Urine-dipstick"	BOTH IP/OP	$103.00 	$76.22	$1.81	$88.00	$6.55	$6.55	$4.02	$4.02	$2.01	$1.81	$4.82	$4.82	$5.00	$4.02	$4.68	$2.61	$60.92	$60.92	$4.22	$8.86	$87.12	$88.00	$5.83	$6.63	$5.83	$4.99	$4.02	$4.02	$3.49	$4.02	$0.00	$0.00	$0.00	$0.00
30900004	EAP	CPT® 89060		"Crystals,fluid"	BOTH IP/OP	$165.00 	$122.10	$3.58	$120.00	$14.76	$14.76	$7.33	$7.33	$3.67	$3.58	$10.86	$10.86	$11.28	$7.33	$10.56	$4.76	$97.60	$97.60	$7.70	$19.98	$118.80	$120.00	$10.63	$107.25	$10.63	$11.26	$7.33	$7.33	$7.88	$7.33	$0.00	$0.00	$0.00	$0.00
30900005	EAP	CPT® 89190		Nasal Smear For Eos	BOTH IP/OP	$129.00 	$95.46	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.21	$7.21	$7.48	$0.00	$7.02	$0.00	$0.00	$0.00	$0.00	$13.28	$99.79	$100.80	$0.00	$83.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30900006	EAP	CPT® 89320		Semen Examination	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.76	$8.76	$9.09	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$16.12	$59.40	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30900009	EAP	CPT® 81511		Mss Sequential Screen-2 (so)	BOTH IP/OP	$504.00 	$372.96	$69.08	$462.00	$462.00	$462.00	$153.50	$153.50	$76.75	$69.08	$374.07	$374.07	$388.48	$153.50	$144.26	$99.78	$298.12	$298.12	$161.18	$249.00	$394.42	$398.40	$222.58	$253.28	$222.58	$153.71	$153.50	$153.50	$107.60	$153.50	$0.00	$0.00	$0.00	$0.00
30900011	EAP	CPT® 84163		Pregnancy Associated Plasma Protein (so)	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$13.25	$13.25	$15.05	$15.05	$7.53	$7.53	$9.74	$9.74	$10.12	$15.05	$9.48	$9.78	$106.47	$106.47	$15.80	$17.94	$142.56	$144.00	$21.82	$0.00	$21.82	$10.10	$15.05	$15.05	$7.07	$15.05	$0.00	$0.00	$0.00	$0.00
30900012	EAP	CPT® 84702		"Hcg,quantitative"	BOTH IP/OP	$31.00 	$22.94	$0.00	$25.60	$13.25	$13.25	$15.05	$15.05	$7.53	$7.53	$9.74	$9.74	$10.12	$15.05	$9.48	$9.78	$18.34	$18.34	$15.80	$17.94	$25.34	$25.60	$21.82	$0.00	$21.82	$10.10	$15.05	$15.05	$7.07	$15.05	$0.00	$0.00	$0.00	$0.00
30900013	EAP	CPT® 86021		C-anca Titer (so)	BOTH IP/OP	$34.00 	$25.16	$0.00	$34.00	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$20.11	$20.11	$15.80	$34.00	$26.93	$27.20	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30900014	EAP	CPT® 86021		P-anca Titer (so)	BOTH IP/OP	$34.00 	$25.16	$0.00	$34.00	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$20.11	$20.11	$15.80	$34.00	$26.93	$27.20	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30900015	EAP	CPT® 86021		Atypical P-anca Titer (so)	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$31.07	$31.07	$15.05	$15.05	$7.53	$7.53	$22.86	$22.86	$23.74	$15.05	$22.24	$9.78	$47.32	$47.32	$15.80	$42.06	$63.36	$64.00	$21.82	$0.00	$21.82	$23.70	$15.05	$15.05	$16.59	$15.05	$0.00	$0.00	$0.00	$0.00
30900020	EAP	CPT® 86638		Q Fever Igg Phase I Titer (so)	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.41	$18.41	$19.12	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$33.88	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30900021	EAP	CPT® 86638		Q Fever Igg Phase Ii Titer (so)	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.41	$18.41	$19.12	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$33.88	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30900022	EAP	CPT® 86638		Q Fever Igg Phase I Titer (so)	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.41	$18.41	$19.12	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$33.88	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30900023	EAP	CPT® 86638		Q Fever Igg Phase Ii (so)	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.41	$18.41	$19.12	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$33.88	$34.06	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30900024	EAP	CPT® 86611		B.henselae Igg Titer (so)	BOTH IP/OP	$64.00 	$47.36	$5.09	$50.40	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$37.86	$37.86	$10.69	$28.44	$49.90	$50.40	$14.76	$16.80	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30900025	EAP	CPT® 86611		B.henselae Igm Titer (so)	BOTH IP/OP	$64.00 	$47.36	$5.09	$50.40	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$37.86	$37.86	$10.69	$28.44	$49.90	$50.40	$14.76	$16.80	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30900026	EAP	CPT® 86611		B.quintana Igg Titer (so)	BOTH IP/OP	$64.00 	$47.36	$5.09	$50.40	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$37.86	$37.86	$10.69	$28.44	$49.90	$50.40	$14.76	$16.80	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
30900027	EAP	CPT® 86611		B.quintana Igm Titer (so)	BOTH IP/OP	$50.00 	$37.00	$0.00	$50.40	$21.01	$21.01	$10.18	$10.18	$5.09	$5.09	$15.44	$15.44	$16.04	$10.18	$15.04	$6.62	$29.58	$29.58	$10.69	$28.44	$49.90	$50.40	$14.76	$0.00	$14.76	$16.02	$10.18	$10.18	$11.21	$10.18	$0.00	$0.00	$0.00	$0.00
31000001	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$384.00 	$284.16	$0.00	$307.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$227.14	$227.14	$22.49	$59.86	$304.13	$307.20	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000002	EAP	CPT® 88305		Level Iv Surgical Path Exam	BOTH IP/OP	$771.00 	$570.54	$0.00	$616.80	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$456.05	$456.05	$49.62	$140.98	$610.63	$616.80	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31000004	EAP	CPT® 88331		Path Consult Inraop 1 Bloc	BOTH IP/OP	$160.00 	$118.40	$0.00	$160.00	$148.63	$148.63	$145.24	$145.24	$146.06	$44.60	$30.54	$30.54	$31.72	$142.96	$87.82	$92.92	$94.64	$94.64	$143.92	$57.46	$126.72	$128.00	$160.00	$0.00	$160.00	$93.58	$34.94	$34.94	$65.50	$137.07	$0.00	$0.00	$0.00	$0.00
31000006	EAP	CPT® 81314		PDGFRA MUTATION ANALYSIS (QUEST)	BOTH IP/OP	"$1,002.00 "	$741.48	$0.00	"$1,002.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.69	$342.69	$355.87	$0.00	$309.68	$0.00	$0.00	$0.00	$0.00	$495.00	$784.08	$792.00	$0.00	"$1,002.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000007	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$447.00 	$330.78	$0.00	$357.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$264.40	$264.40	$53.75	$112.22	$354.02	$357.60	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31000010	EAP	CPT® 88120		"Cytopath In Situ Hybridization,urinary Tract Spec W/mors"	BOTH IP/OP	$930.00 	$688.20	$0.00	$930.00	$930.00	$930.00	$145.24	$145.24	$146.06	$0.00	$422.54	$422.54	$438.79	$0.00	$324.87	$0.00	$0.00	$0.00	$0.00	$465.00	$736.56	$744.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000011	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$62.00 	$45.88	$0.00	$59.86	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$36.67	$36.67	$22.49	$59.86	$49.10	$49.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000013	EAP	CPT® 88230		Tissue Culture For Non-neoplastic Disorders;lymphocyte	BOTH IP/OP	$347.00 	$256.78	$0.00	$325.54	$240.48	$240.48	$116.49	$116.49	$58.25	$58.25	$176.90	$176.90	$183.71	$116.49	$172.08	$75.72	$205.25	$205.25	$122.31	$325.54	$304.13	$307.20	$168.91	$0.00	$168.91	$183.36	$116.49	$116.49	$128.35	$116.49	$0.00	$0.00	$0.00	$0.00
31000015	EAP	CPT® 88271		Cytogenetics Dna Probe	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$169.76	$169.76	$22.49	$59.86	$227.30	$229.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000016	EAP	CPT® 88275		Cytogenetics 100-300	BOTH IP/OP	$349.00 	$258.26	$0.00	$279.20	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$206.43	$206.43	$53.75	$112.22	$276.41	$279.20	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31000018	EAP	CPT® 88360		Er/pr Her2 W/reflex To Her2 Fish (so)	BOTH IP/OP	$731.00 	$540.94	$58.38	$581.60	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$432.39	$432.39	$143.92	$121.34	$575.78	$581.60	$199.96	$475.15	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31000019	EAP	CPT® 88368		"Fish, Her-2/neu (so)"	BOTH IP/OP	$741.00 	$548.34	$58.22	$589.60	$178.36	$178.36	$283.63	$283.63	$285.22	$58.22	$151.36	$151.36	$157.18	$279.15	$199.20	$181.45	$438.30	$438.30	$284.24	$207.74	$583.70	$589.60	$394.92	$481.65	$394.92	$212.25	$90.40	$90.40	$148.57	$270.71	$0.00	$0.00	$0.00	$0.00
31000020	EAP	CPT® 88271		Molecular Cytogenetics: Dna Probe (fish) (so) Pdgfrb	BOTH IP/OP	$511.00 	$378.14	$0.00	$408.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$302.26	$302.26	$22.49	$59.86	$404.71	$408.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000021	EAP	CPT® 88275		Interphase In Situ Hybridization(100-300) Cells (so) Pdgfrb	BOTH IP/OP	$256.00 	$189.44	$0.00	$204.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$151.42	$151.42	$53.75	$112.22	$202.75	$204.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31000022	EAP	CPT® 88342		"Lynch Syndrome Tumor Panel, Ihc  (so)"	BOTH IP/OP	$700.00 	$518.00	$48.82	$565.60	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$414.05	$414.05	$143.92	$106.46	$559.94	$565.60	$199.96	$455.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31000025	EAP	CPT® 88368		"Fish, Mdm2 Gene Amphlification (arup)"	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$178.36	$178.36	$283.63	$283.63	$285.22	$58.22	$151.36	$151.36	$157.18	$279.15	$199.20	$181.45	$783.74	$783.74	$284.24	$207.74	"$1,049.40"	"$1,060.00"	$394.92	$0.00	$394.92	$212.25	$90.40	$90.40	$148.57	$270.71	$0.00	$0.00	$0.00	$0.00
31000026	EAP	CPT® 88271		Molecular Cytogenetics: Dna Probe (fish) (so) Mn	BOTH IP/OP	$300.00 	$222.00	$10.71	$238.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$177.45	$177.45	$22.49	$59.86	$236.02	$238.40	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000027	EAP	CPT® 88275		Interphase In Situ Hybridization(100-300) Cells (so) Mn	BOTH IP/OP	$128.00 	$94.72	$23.04	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$75.71	$75.71	$53.75	$112.22	$100.58	$101.60	$74.23	$84.46	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31000028	EAP	CPT® 88271		"Fish, Hes/leukemia, 4q12 Rea(fip1l-pdgfra"	BOTH IP/OP	$665.00 	$492.10	$10.71	$532.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$393.35	$393.35	$22.49	$59.86	$526.68	$532.00	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000029	EAP	CPT® 88275		Interphase In Situ Hybridization(100-300) Cells (so) Hes	BOTH IP/OP	$221.00 	$163.54	$0.00	$176.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$130.72	$130.72	$53.75	$112.22	$175.03	$176.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31000030	EAP	CPT® 88271		Molecular Cytogenetics: Dna Probe (fish) (so) Fg	BOTH IP/OP	$499.00 	$369.26	$0.00	$399.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$295.16	$295.16	$22.49	$59.86	$395.21	$399.20	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000031	EAP	CPT® 88275		Interphase In Situ Hybridization(100-300) Cells (so) Fg	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$146.69	$146.69	$53.75	$112.22	$196.42	$198.40	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31000032	EAP	CPT® 88271		Molecular Cytogenetics: Dna Probe (fish) (so) Ne	BOTH IP/OP	$714.00 	$528.36	$10.71	$571.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$422.33	$422.33	$22.49	$59.86	$565.49	$571.20	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000033	EAP	CPT® 88275		Interphase In Situ Hybridization(100-300) Cells (so) Ne	BOTH IP/OP	$142.00 	$105.08	$0.00	$113.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$83.99	$83.99	$53.75	$112.22	$112.46	$113.60	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31000034	EAP	CPT® 88271		Molecular Cytogenetics: Dna Probe (fish) (so) Eto	BOTH IP/OP	$563.00 	$416.62	$0.00	$450.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$333.01	$333.01	$22.49	$59.86	$445.90	$450.40	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000035	EAP	CPT® 88275		Interphase In Situ Hybridization(100-300) Cells (so) Eto	BOTH IP/OP	$282.00 	$208.68	$0.00	$225.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$166.80	$166.80	$53.75	$112.22	$223.34	$225.60	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31000036	EAP	CPT® 88271		Molecular Cytogenetics: Dna Probe (fish) (so) Mll	BOTH IP/OP	$511.00 	$378.14	$0.00	$408.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$302.26	$302.26	$22.49	$59.86	$404.71	$408.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000037	EAP	CPT® 88275		Interphase In Situ Hybridization(100-300) Cells (so) Mll	BOTH IP/OP	$256.00 	$189.44	$0.00	$204.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$151.42	$151.42	$53.75	$112.22	$202.75	$204.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31000038	EAP	CPT® 88184		Flow Cytometry; First Marker (so) Pcn	BOTH IP/OP	$303.00 	$224.22	$0.00	$303.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$179.22	$179.22	$284.24	$133.74	$239.98	$242.40	$303.00	$0.00	$303.00	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
31000039	EAP	CPT® 88185		Flow Cytometry;each Add Marker (so) Pcn	BOTH IP/OP	$233.00 	$172.42	$0.00	$186.40	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$137.82	$137.82	$0.00	$71.72	$184.54	$186.40	$0.00	$131.95	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
31000042	EAP	CPT® 81200		Canavan Disease Mutation Analysis (so)	BOTH IP/OP	$568.00 	$420.32	$0.00	$519.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.57	$421.57	$437.81	$0.00	$115.59	$0.00	$0.00	$0.00	$0.00	$324.50	$514.01	$519.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000043	EAP	CPT® 88235		Tissue Culture For  Am-fld Or Cv-cells (so) Sc	BOTH IP/OP	$236.00 	$174.64	$0.00	$261.00	$236.00	$236.00	$150.30	$150.30	$75.15	$0.00	$223.60	$223.60	$232.20	$0.00	$217.53	$0.00	$0.00	$0.00	$157.82	$261.00	$206.71	$208.80	$217.94	$0.00	$217.94	$231.78	$150.30	$150.30	$162.25	$150.30	$0.00	$0.00	$0.00	$0.00
31000045	EAP	CPT® 88271		Molecular Cytogenetics: Dna Probe (fish) (so) Dup	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$207.03	$207.03	$22.49	$59.86	$277.20	$280.00	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000046	EAP	CPT® 88275		Interphase In Situ Hybridization(100-300) Cells (so) Dup	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$207.03	$207.03	$53.75	$112.22	$277.20	$280.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31000051	EAP	CPT® 88271		Molecular Cytogenetics: Dna Probe (fish) (so) Mm	BOTH IP/OP	$499.00 	$369.26	$0.00	$399.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$295.16	$295.16	$22.49	$59.86	$395.21	$399.20	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000052	EAP	CPT® 88275		Interphase In Situ Hybridization(100-300) Cells (so) Mm	BOTH IP/OP	$248.00 	$183.52	$0.00	$198.40	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$146.69	$146.69	$53.75	$112.22	$196.42	$198.40	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31000055	EAP	CPT® 81401		"Eml4 Alk Gene Fusion, Pcr (so)"	BOTH IP/OP	"$1,030.00 "	$762.20	$0.00	$941.60	$64.94	$64.94	$137.00	$137.00	$68.50	$61.65	$764.47	$764.47	$793.92	$137.00	$131.58	$89.05	$609.25	$609.25	$143.85	$588.50	$932.18	$941.60	$198.65	$0.00	$198.65	$140.20	$137.00	$137.00	$98.14	$137.00	$0.00	$0.00	$0.00	$0.00
31000060	EAP	CPT® 88271		Molecular Cytogenetics: Dna Probe (fish) (so)rara	BOTH IP/OP	$751.00 	$555.74	$10.71	$600.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$444.22	$444.22	$22.49	$59.86	$594.79	$600.80	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000061	EAP	CPT® 88275		Interphase In Situ Hybridization(100-300) Cells (so) Rara	BOTH IP/OP	$374.00 	$276.76	$0.00	$299.20	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$221.22	$221.22	$53.75	$112.22	$296.21	$299.20	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31000062	EAP	CPT® 88271		Molecular Cytogenetics: Dna Probe (fish) (so) Ros1	BOTH IP/OP	$687.00 	$508.38	$10.71	$545.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$406.36	$406.36	$22.49	$59.86	$540.14	$545.60	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000063	EAP	CPT® 88274		Interphase In Situ Hybridization (25-99 Cells (so) Ros1	BOTH IP/OP	$344.00 	$254.56	$0.00	$344.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.07	$52.85	$52.85	$54.89	$42.38	$51.42	$27.55	$203.48	$203.48	$44.50	$97.26	$270.86	$273.60	$61.45	$344.00	$61.45	$54.79	$42.38	$42.38	$38.35	$42.38	$0.00	$0.00	$0.00	$0.00
31000066	EAP	CPT® 88274		Fanconi Anemia Tissue Cx (so)	BOTH IP/OP	$384.00 	$284.16	$0.00	$307.20	$0.00	$0.00	$0.00	$0.00	$0.00	$19.07	$52.85	$52.85	$54.89	$42.38	$51.42	$27.55	$227.14	$227.14	$44.50	$97.26	$304.13	$307.20	$61.45	$0.00	$61.45	$54.79	$42.38	$42.38	$38.35	$42.38	$0.00	$0.00	$0.00	$0.00
31000067	EAP	CPT® 88271		Fanconi Anemia Chrom Anal (so)	BOTH IP/OP	$241.00 	$178.34	$0.00	$192.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$142.55	$142.55	$22.49	$59.86	$190.87	$192.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000068	EAP	CPT® 88271		Fish Sry/x Centromere Dna (so)	BOTH IP/OP	$241.00 	$178.34	$0.00	$192.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$142.55	$142.55	$22.49	$59.86	$190.87	$192.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000069	EAP	CPT® 88273		Fish Sry/x Centromere Ish (so)	BOTH IP/OP	$392.00 	$290.08	$0.00	$313.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.79	$48.79	$50.66	$0.00	$47.46	$0.00	$0.00	$0.00	$0.00	$89.78	$310.46	$313.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000070	EAP	CPT® 88291		Fish Sry/x Centro Interp (so)	BOTH IP/OP	$222.00 	$164.28	$0.00	$177.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.77	$164.77	$171.12	$0.00	$29.83	$0.00	$0.00	$0.00	$0.00	$53.96	$175.82	$177.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000071	EAP	CPT® 88274		Fish Conception Prod Ish (so)	BOTH IP/OP	$387.00 	$286.38	$0.00	$387.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.07	$52.85	$52.85	$54.89	$42.38	$51.42	$27.55	$228.91	$228.91	$44.50	$97.26	$304.13	$307.20	$61.45	$387.00	$61.45	$54.79	$42.38	$42.38	$38.35	$42.38	$0.00	$0.00	$0.00	$0.00
31000072	EAP	CPT® 88271		Fish Conception Prod Dna (so)	BOTH IP/OP	$243.00 	$179.82	$10.71	$192.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$143.73	$143.73	$22.49	$59.86	$190.87	$192.80	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31000099	EAP	CPT® 81275		COLORECTAL CAN. MUT. PANEL KRA SO	BOTH IP/OP	"$1,636.00 "	"$1,210.64"	$86.96	"$1,292.80"	$298.80	$298.80	$193.25	$193.25	$96.63	$86.96	$205.38	$205.38	$213.28	$193.25	$220.85	$125.61	$967.69	$967.69	$202.91	$808.00	"$1,279.87"	"$1,292.80"	$280.21	$318.86	$280.21	$235.32	$193.25	$193.25	$164.72	$193.25	$0.00	$0.00	$0.00	$0.00
31000100	EAP	CPT® 81210		COLORECTAL CAN. MUT. PANEL BRA SO	BOTH IP/OP	"$1,636.00 "	"$1,210.64"	$78.93	"$1,292.80"	$271.21	$271.21	$175.40	$175.40	$87.70	$78.93	$186.42	$186.42	$193.59	$175.40	$115.59	$114.01	$967.69	$967.69	$184.17	$808.00	"$1,279.87"	"$1,292.80"	$254.33	$289.41	$254.33	$123.17	$175.40	$175.40	$86.22	$175.40	$0.00	$0.00	$0.00	$0.00
31000101	EAP	CPT® 88304		Seminal Vesicle	BOTH IP/OP	$299.00 	$221.26	$0.00	$239.20	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$176.86	$176.86	$49.62	$108.12	$236.81	$239.20	$68.93	$0.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31000102	EAP	CPT® 81382		Hla Ii Typing 1 (so)	BOTH IP/OP	$935.00 	$691.90	$0.00	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.48	$175.48	$182.23	$0.00	$192.65	$0.00	$0.00	$0.00	$0.00	$472.00	$747.65	$755.20	$0.00	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000103	EAP	CPT® 81379		Hla I Typing Comp (so)	BOTH IP/OP	"$2,608.00 "	"$1,929.92"	$0.00	"$2,107.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$475.84	$475.84	$494.14	$0.00	$192.65	$0.00	$0.00	$0.00	$0.00	"$1,317.00"	"$2,086.13"	"$2,107.20"	$0.00	"$1,087.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000118	EAP	CPT® 81331		Congen Hyoptonia Ube3a (so)	BOTH IP/OP	$519.00 	$384.06	$0.00	$474.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$385.20	$385.20	$400.05	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$296.50	$469.66	$474.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000119	EAP	CPT® 81400		Congen Hypotonia L1 (so)	BOTH IP/OP	$744.00 	$550.56	$0.00	$680.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$552.20	$552.20	$573.48	$0.00	$115.59	$0.00	$0.00	$0.00	$0.00	$425.00	$673.20	$680.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000120	EAP	CPT® 81404		Congen Hypotonia L5 (so)	BOTH IP/OP	"$1,519.00 "	"$1,124.06"	$0.00	"$1,388.80"	$462.00	$462.00	$274.83	$274.83	$137.42	$123.67	"$1,127.40"	"$1,127.40"	"$1,170.85"	$274.83	$286.64	$178.64	$898.49	$898.49	$288.57	$868.00	"$1,374.91"	"$1,388.80"	$398.50	$0.00	$398.50	$305.42	$274.83	$274.83	$213.79	$274.83	$0.00	$0.00	$0.00	$0.00
31000121	EAP	CPT® 88365		Insitu Hybrid Fish (so)	BOTH IP/OP	$579.00 	$428.46	$0.00	$463.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.18	$102.18	$106.11	$0.00	$103.59	$0.00	$0.00	$0.00	$143.92	$156.90	$458.57	$463.20	$199.96	$0.00	$199.96	$110.38	$137.95	$137.95	$77.27	$137.07	$0.00	$0.00	$0.00	$0.00
31000122	EAP	CPT® 88381		Mgmt Microdissection Pcr (so)	BOTH IP/OP	$506.00 	$374.44	$0.00	$404.80	$185.41	$185.41	$0.00	$0.00	$0.00	$70.38	$161.51	$161.51	$167.72	$0.00	$197.25	$0.00	$299.30	$299.30	$0.00	$253.00	$400.75	$404.80	$0.00	$328.90	$0.00	$210.18	$156.67	$156.67	$147.12	$0.00	$0.00	$0.00	$0.00	$0.00
31000123	EAP	CPT® 81287		Mgmt Gene Analysis (so)	BOTH IP/OP	$591.00 	$437.34	$0.00	$591.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$438.64	$438.64	$455.54	$0.00	$123.16	$0.00	$0.00	$0.00	$0.00	$292.00	$462.53	$467.20	$0.00	$591.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000124	EAP	CPT® 81479		Calr Mutation Analysis (so)	BOTH IP/OP	$954.00 	$705.96	$0.00	"$1,114.12"	$0.00	$0.00	$0.00	$0.00	$169.81	$198.84	$708.06	$708.06	$735.34	$0.00	$954.00	$0.00	$564.29	$564.29	$0.00	$471.00	$746.06	$753.60	$565.20	$620.10	$565.20	"$1,114.12"	$0.00	$0.00	$779.89	$0.00	$0.00	$0.00	$0.00	$0.00
31000126	EAP	CPT® 81406		CADASIL	BOTH IP/OP	"$4,379.00 "	"$3,240.46"	$0.00	"$3,460.80"	$237.60	$237.60	$282.88	$282.88	$141.44	$127.30	"$3,250.09"	"$3,250.09"	"$3,375.33"	$282.88	$610.87	$183.87	"$2,590.18"	"$2,590.18"	$0.00	"$2,163.00"	"$3,426.19"	"$3,460.80"	$0.00	$466.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000135	EAP	CPT® 81218		Aml Prognostic Cebpa (so)	BOTH IP/OP	$529.00 	$391.46	$0.00	$529.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.69	$342.69	$355.87	$0.00	$309.68	$0.00	$0.00	$0.00	$0.00	$261.50	$414.22	$418.40	$0.00	$529.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000136	EAP	CPT® 81245		Aml Prognostic Flt3 (so)	BOTH IP/OP	$381.00 	$281.94	$0.00	$381.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.56	$172.56	$179.19	$0.00	$115.59	$0.00	$0.00	$0.00	$0.00	$188.00	$297.79	$300.80	$0.00	$381.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000137	EAP	CPT® 81246		Aml Prognostic Flt3 Anal (so)	BOTH IP/OP	$275.00 	$203.50	$0.00	$275.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.11	$204.11	$211.97	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$136.00	$215.42	$217.60	$0.00	$275.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000138	EAP	CPT® 81310		Aml Prognostic Npm1 (so)	BOTH IP/OP	$708.00 	$523.92	$0.00	$708.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.03	$257.03	$266.91	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$349.50	$553.61	$559.20	$0.00	$708.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000139	EAP	CPT® 81450		Myeloid Neo Mutation (so)	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$2,148.00"	$982.56	$982.56	$759.53	$759.53	$379.77	$0.00	"$1,744.17"	"$1,744.17"	"$1,811.38"	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,342.50"	"$2,126.52"	"$2,148.00"	$0.00	$0.00	$0.00	$420.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000145	EAP	CPT® 81275		"KRAS GENE ANALYSIS; VARIANTS IN EXON 2 (EG, CODONS 12 & 13)"	BOTH IP/OP	$463.00 	$342.62	$86.96	$365.60	$298.80	$298.80	$193.25	$193.25	$96.63	$86.96	$205.38	$205.38	$213.28	$193.25	$220.85	$125.61	$273.86	$273.86	$202.91	$228.50	$361.94	$365.60	$280.21	$318.86	$280.21	$235.32	$193.25	$193.25	$164.72	$193.25	$0.00	$0.00	$0.00	$0.00
31000146	EAP	CPT® 81276		"KRAS GENE ANALYSIS; ADD'L VARIANT(S) (EG, CODON 61, CODON 146)"	BOTH IP/OP	$463.00 	$342.62	$0.00	$463.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.08	$205.08	$212.97	$0.00	$185.31	$0.00	$0.00	$0.00	$0.00	$228.50	$361.94	$365.60	$0.00	$463.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000147	EAP	CPT® 81210		Thyroseq - Braf Analysis (so)	BOTH IP/OP	$305.00 	$225.70	$78.93	$289.41	$271.21	$271.21	$175.40	$175.40	$87.70	$78.93	$186.42	$186.42	$193.59	$175.40	$115.59	$114.01	$180.41	$180.41	$184.17	$150.50	$238.39	$240.80	$254.33	$289.41	$254.33	$123.17	$175.40	$175.40	$86.22	$175.40	$0.00	$0.00	$0.00	$0.00
31000148	EAP	CPT® 81275		Thyroseq - Kras Analysis (so)	BOTH IP/OP	$335.00 	$247.90	$86.96	$318.86	$298.80	$298.80	$193.25	$193.25	$96.63	$86.96	$205.38	$205.38	$213.28	$193.25	$220.85	$125.61	$198.15	$198.15	$202.91	$165.50	$262.15	$264.80	$280.21	$318.86	$280.21	$235.32	$193.25	$193.25	$164.72	$193.25	$0.00	$0.00	$0.00	$0.00
31000149	EAP	CPT® 81322		Thyroseq - Pten Analysis (so)	BOTH IP/OP	$91.00 	$67.34	$21.40	$123.17	$88.36	$88.36	$46.60	$46.60	$23.30	$21.40	$60.74	$60.74	$63.07	$46.60	$91.00	$30.29	$53.83	$53.83	$48.93	$45.00	$71.28	$72.00	$67.57	$76.89	$67.57	$123.17	$46.60	$46.60	$86.22	$46.60	$0.00	$0.00	$0.00	$0.00
31000150	EAP	CPT® 81401		Thryoseq - Mopath Level 2 (so)	BOTH IP/OP	$238.00 	$176.12	$61.65	$226.05	$64.94	$64.94	$137.00	$137.00	$68.50	$61.65	$176.64	$176.64	$183.45	$137.00	$131.58	$89.05	$140.78	$140.78	$143.85	$117.50	$186.12	$188.00	$198.65	$226.05	$198.65	$140.20	$137.00	$137.00	$98.14	$137.00	$0.00	$0.00	$0.00	$0.00
31000151	EAP	CPT® 81403		Thryoseq - Mopath Level 4 (so)	BOTH IP/OP	$322.00 	$238.28	$83.34	$305.58	$264.00	$264.00	$185.20	$185.20	$92.60	$83.34	$238.99	$238.99	$248.20	$185.20	$220.85	$120.38	$190.46	$190.46	$194.46	$159.00	$251.86	$254.40	$268.54	$305.58	$268.54	$235.32	$185.20	$185.20	$164.72	$185.20	$0.00	$0.00	$0.00	$0.00
31000152	EAP	CPT® 81404		Thryoseq - Mopath Level 5 (so)	BOTH IP/OP	$477.00 	$352.98	$123.67	$462.00	$462.00	$462.00	$274.83	$274.83	$137.42	$123.67	$354.03	$354.03	$367.67	$274.83	$286.64	$178.64	$282.15	$282.15	$288.57	$235.50	$373.03	$376.80	$398.50	$453.47	$398.50	$305.42	$274.83	$274.83	$213.79	$274.83	$0.00	$0.00	$0.00	$0.00
31000153	EAP	CPT® 81405		Thryoseq - Mopath Level 6 (so)	BOTH IP/OP	$523.00 	$387.02	$135.61	$497.23	$462.00	$462.00	$301.35	$301.35	$150.68	$135.61	$388.17	$388.17	$403.13	$301.35	$422.91	$195.88	$309.35	$309.35	$316.42	$258.50	$409.46	$413.60	$436.96	$497.23	$436.96	$450.62	$301.35	$301.35	$315.43	$301.35	$0.00	$0.00	$0.00	$0.00
31000154	EAP	CPT® 81479		Thryoseq - Unlisted Mopath (so)	BOTH IP/OP	$2.00 	$1.48	$0.00	"$1,114.12"	$0.00	$0.00	$0.00	$0.00	$0.36	$0.42	$1.48	$1.48	$1.54	$0.00	$2.00	$0.00	$1.18	$1.18	$0.00	$1.00	$1.58	$1.60	$1.20	$1.30	$1.20	"$1,114.12"	$0.00	$0.00	$779.89	$0.00	$0.00	$0.00	$0.00	$0.00
31000155	EAP	CPT® 81219		JAK2 R/X CALR (SO)	BOTH IP/OP	$436.00 	$322.64	$0.00	$394.40	$251.06	$251.06	$121.63	$121.63	$60.82	$60.81	$172.31	$172.31	$178.93	$121.63	$155.70	$79.06	$257.89	$257.89	$0.00	$246.50	$390.46	$394.40	$0.00	$200.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000156	EAP	CPT® 81270		Jak2 V617f (so)	BOTH IP/OP	$436.00 	$322.64	$45.83	$394.40	$189.21	$189.21	$91.66	$91.66	$45.83	$45.83	$130.06	$130.06	$135.06	$91.66	$84.58	$59.58	$257.89	$257.89	$96.24	$246.50	$390.46	$394.40	$132.91	$151.24	$132.91	$90.12	$91.66	$91.66	$63.08	$91.66	$0.00	$0.00	$0.00	$0.00
31000157	EAP	CPT® 81479		JAK2 R/X-CSF3R (SO)	BOTH IP/OP	$436.00 	$322.64	$0.00	"$1,114.12"	$0.00	$0.00	$0.00	$0.00	$77.61	$90.87	$323.60	$323.60	$336.07	$0.00	$436.00	$0.00	$257.89	$257.89	$0.00	$246.50	$390.46	$394.40	$295.80	$283.40	$295.80	"$1,114.12"	$0.00	$0.00	$779.89	$0.00	$0.00	$0.00	$0.00	$0.00
31000158	EAP	CPT® 81402		JAK2 R/X-MPL (SO)	BOTH IP/OP	$436.00 	$322.64	$0.00	$394.40	$0.00	$0.00	$185.20	$185.20	$92.60	$90.87	$323.60	$323.60	$336.07	$185.20	$174.05	$120.38	$257.89	$257.89	$0.00	$246.50	$390.46	$394.40	$0.00	$305.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000159	EAP	CPT® 81403		JAK2 R/X-EXON12 (SO)	BOTH IP/OP	$431.00 	$318.94	$0.00	$394.40	$264.00	$264.00	$185.20	$185.20	$92.60	$83.34	$319.89	$319.89	$332.21	$185.20	$220.85	$120.38	$254.94	$254.94	$194.46	$246.50	$390.46	$394.40	$268.54	$0.00	$268.54	$235.32	$185.20	$185.20	$164.72	$185.20	$0.00	$0.00	$0.00	$0.00
31000160	EAP	CPT® 81311		Nras Gene Analysis Variants Exon 2&3 (so)	BOTH IP/OP	$463.00 	$342.62	$0.00	$463.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.62	$307.62	$319.45	$0.00	$277.98	$0.00	$0.00	$0.00	$0.00	$228.50	$361.94	$365.60	$0.00	$463.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000161	EAP	CPT® 81403		Hras Gene Analysis (so)	BOTH IP/OP	$463.00 	$342.62	$83.34	$365.60	$264.00	$264.00	$185.20	$185.20	$92.60	$83.34	$343.64	$343.64	$356.88	$185.20	$220.85	$120.38	$273.86	$273.86	$194.46	$228.50	$361.94	$365.60	$268.54	$305.58	$268.54	$235.32	$185.20	$185.20	$164.72	$185.20	$0.00	$0.00	$0.00	$0.00
31000162	EAP	CPT® 81450		"Leukovantage, Myloproliferative Neoplasm (so)"	BOTH IP/OP	"$4,269.00 "	"$3,159.06"	$0.00	"$3,373.60"	$982.56	$982.56	$759.53	$759.53	$379.77	$0.00	"$3,168.45"	"$3,168.45"	"$3,290.55"	$0.00	$889.66	$0.00	$0.00	$0.00	$0.00	"$2,108.50"	"$3,339.86"	"$3,373.60"	$0.00	"$1,253.22"	$0.00	$659.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000163	EAP	CPT® 81450		Leukovantage Acute Myeloid Leukemia (so)	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,556.00"	$982.56	$982.56	$759.53	$759.53	$379.77	$0.00	"$3,339.90"	"$3,339.90"	"$3,468.60"	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,222.50"	"$3,520.44"	"$3,556.00"	$0.00	"$1,253.22"	$0.00	$695.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000164	EAP	CPT® 81450		Leukovantage Myelodysplastic Syndrome (so)	BOTH IP/OP	"$4,425.00 "	"$3,274.50"	$0.00	"$3,496.80"	$982.56	$982.56	$759.53	$759.53	$379.77	$0.00	"$3,284.24"	"$3,284.24"	"$3,410.79"	$0.00	$922.17	$0.00	$0.00	$0.00	$0.00	"$2,185.50"	"$3,461.83"	"$3,496.80"	$0.00	"$1,253.22"	$0.00	$684.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000165	EAP	CPT® 81270		Jak2 V617f Mutation Analysis (so)	BOTH IP/OP	$520.00 	$384.80	$0.00	$416.00	$189.21	$189.21	$91.66	$91.66	$45.83	$45.83	$130.06	$130.06	$135.06	$91.66	$84.58	$59.58	$307.58	$307.58	$96.24	$260.00	$411.84	$416.00	$132.91	$0.00	$132.91	$90.12	$91.66	$91.66	$63.08	$91.66	$0.00	$0.00	$0.00	$0.00
31000170	EAP	CPT® 88360		"Pd-l1 Lung (pembrolizumab), Ihc (so)"	BOTH IP/OP	$855.00 	$632.70	$58.38	$680.00	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$505.73	$505.73	$143.92	$121.34	$673.20	$680.00	$199.96	$555.75	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31000171	EAP	CPT® 88360		"Pd-l1 Lung (nivolumab), Ihc (so)"	BOTH IP/OP	$855.00 	$632.70	$58.38	$680.00	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$505.73	$505.73	$143.92	$121.34	$673.20	$680.00	$199.96	$555.75	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31000172	EAP	CPT® 88360		"Pd-l1 Lung (atezolizumab), Ihc (so)"	BOTH IP/OP	$855.00 	$632.70	$58.38	$680.00	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$505.73	$505.73	$143.92	$121.34	$673.20	$680.00	$199.96	$555.75	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31000173	EAP	CPT® 88360		"Pd-l1 Bladder (atezolizumab), Ihc (so)"	BOTH IP/OP	$855.00 	$632.70	$58.38	$680.00	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$505.73	$505.73	$143.92	$121.34	$673.20	$680.00	$199.96	$555.75	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31000174	EAP	CPT® 88360		"Pd-l1 Non-lung (pembrolizumab), Ihc (so)"	BOTH IP/OP	$944.00 	$698.56	$58.38	$750.40	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$558.38	$558.38	$143.92	$121.34	$742.90	$750.40	$199.96	$613.60	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31000175	EAP	CPT® 88184		"Pd-l1 Monocyte Expression, Sle Flare, 1st Marker (so)"	BOTH IP/OP	$323.00 	$239.02	$30.49	$325.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$191.05	$191.05	$284.24	$133.74	$257.40	$260.00	$325.00	$209.95	$325.00	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
31000176	EAP	CPT® 88185		"Pd-l1 Monocyte Expression, Sle Flare, Addl Marker (so)"	BOTH IP/OP	$323.00 	$239.02	$0.00	$260.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$191.05	$191.05	$0.00	$71.72	$257.40	$260.00	$0.00	$131.95	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
31000180	EAP	HCPCS 0225U		Nfct Ds Dna&rna 21 Targets Sars-cov-2 Amp Probe	BOTH IP/OP	$466.00 	$344.84	$0.00	$370.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.87	$345.87	$359.19	$0.00	$97.11	$0.00	$0.00	$0.00	$0.00	$231.50	$366.70	$370.40	$0.00	$369.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000185	EAP	CPT® 81225		CYP2C19 GENOTYPE	BOTH IP/OP	$744.00 	$550.56	$0.00	$744.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$303.47	$303.47	$315.14	$0.00	$286.64	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00	$744.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100001	EAP	CPT® 88289		Add High Reso	BOTH IP/OP	$460.00 	$340.40	$0.00	$408.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.29	$52.29	$54.30	$0.00	$50.86	$0.00	$0.00	$0.00	$0.00	$96.22	$403.92	$408.00	$0.00	$314.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100002	EAP	CPT® 88283		Addition Band Charge	BOTH IP/OP	$455.00 	$336.70	$0.00	$403.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.14	$54.14	$56.22	$0.00	$94.82	$0.00	$0.00	$0.00	$0.00	$99.64	$399.17	$403.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100003	EAP	CPT® 88285		Addition Cell Charge	BOTH IP/OP	$244.00 	$180.56	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.85	$28.85	$29.96	$0.00	$28.07	$0.00	$0.00	$0.00	$0.00	$53.08	$213.84	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100004	EAP	CPT® 88280		Addition Karyo Charge	BOTH IP/OP	$297.00 	$219.78	$0.00	$240.00	$51.80	$51.80	$33.47	$33.47	$16.74	$0.00	$38.11	$38.11	$39.57	$0.00	$37.08	$0.00	$0.00	$0.00	$35.14	$70.14	$237.60	$240.00	$48.53	$55.23	$48.53	$39.50	$33.47	$33.47	$27.65	$33.47	$0.00	$0.00	$0.00	$0.00
31100005	EAP	CPT® 88267		Ca - 15 Cells Charge	BOTH IP/OP	"$2,037.00 "	"$1,507.38"	$0.00	"$1,646.40"	$371.10	$371.10	$188.57	$188.57	$94.29	$0.00	$272.97	$272.97	$283.47	$0.00	$265.55	$0.00	$0.00	$0.00	$198.00	$502.34	"$1,629.94"	"$1,646.40"	$273.43	$311.14	$273.43	$282.94	$188.57	$188.57	$198.06	$188.57	$0.00	$0.00	$0.00	$0.00
31100006	EAP	CPT® 88248		Ca - Fragile X Charge	BOTH IP/OP	"$2,617.00 "	"$1,936.58"	$0.00	"$2,114.40"	$357.46	$357.46	$173.17	$173.17	$86.59	$86.59	$262.95	$262.95	$273.07	$173.17	$255.81	$112.56	"$1,547.96"	"$1,547.96"	$0.00	$483.92	"$2,093.26"	"$2,114.40"	$0.00	$285.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100007	EAP	CPT® 88264		Cell Analysis Chrg	BOTH IP/OP	"$1,265.00 "	$936.10	$0.00	"$1,120.80"	$257.29	$257.29	$144.61	$144.61	$72.31	$65.07	$189.26	$189.26	$196.54	$144.61	$184.12	$94.00	$748.25	$748.25	$151.84	$348.28	"$1,109.59"	"$1,120.80"	$209.68	$0.00	$209.68	$196.18	$144.61	$144.61	$137.33	$144.61	$0.00	$0.00	$0.00	$0.00
31100008	EAP	CPT® 88262		Cell Cnt/karyo Typ	BOTH IP/OP	"$1,886.00 "	"$1,395.64"	$62.32	"$1,524.00"	$257.29	$257.29	$125.49	$125.49	$62.75	$62.32	$189.26	$189.26	$196.54	$125.49	$184.12	$81.57	"$1,115.57"	"$1,115.57"	$131.76	$348.28	"$1,508.76"	"$1,524.00"	$181.96	$207.06	$181.96	$196.18	$125.49	$125.49	$137.33	$125.49	$0.00	$0.00	$0.00	$0.00
31100009	EAP	CPT® 88164		"Cytology, Female Gen"	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.04	$16.04	$16.65	$0.00	$15.60	$0.00	$0.00	$0.00	$0.00	$29.52	$50.69	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100010	EAP	CPT® 88142		"Cytology, Gyn Lbp"	BOTH IP/OP	$288.00 	$213.12	$10.13	$232.80	$41.82	$41.82	$20.26	$20.26	$10.13	$10.13	$30.76	$30.76	$31.95	$20.26	$29.94	$13.17	$170.35	$170.35	$21.27	$56.62	$230.47	$232.80	$29.38	$33.43	$29.38	$31.90	$20.26	$20.26	$22.33	$20.26	$0.00	$0.00	$0.00	$0.00
31100011	EAP	CPT® 88104		"Cytology,pulmonary"	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$113.52	$113.52	$32.96	$32.96	$33.15	$32.11	$34.86	$34.86	$36.20	$32.43	$50.14	$21.08	$208.80	$208.80	$33.53	$60.16	$279.58	$282.40	$46.58	$0.00	$46.58	$53.42	$40.34	$40.34	$37.40	$31.93	$0.00	$0.00	$0.00	$0.00
31100017	EAP	CPT® 88172		Cytopathology Eval Of Fina	BOTH IP/OP	$176.00 	$130.24	$19.45	$178.00	$87.57	$87.57	$145.24	$145.24	$146.06	$25.95	$23.45	$23.45	$24.35	$142.96	$66.47	$92.92	$104.10	$104.10	$143.92	$44.44	$140.98	$142.40	$178.00	$114.40	$178.00	$70.82	$19.45	$19.45	$49.57	$137.07	$0.00	$0.00	$0.00	$0.00
31100018	EAP	CPT® 88184		Cytoplasmic Charge	BOTH IP/OP	$421.00 	$311.54	$30.49	$394.92	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$249.02	$249.02	$284.24	$133.74	$335.81	$339.20	$394.92	$273.65	$394.92	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
31100019	EAP	CPT® 88172		Fine Needle Aspiration	BOTH IP/OP	$176.00 	$130.24	$19.45	$178.00	$87.57	$87.57	$145.24	$145.24	$146.06	$25.95	$23.45	$23.45	$24.35	$142.96	$66.47	$92.92	$104.10	$104.10	$143.92	$44.44	$140.98	$142.40	$178.00	$114.40	$178.00	$70.82	$19.45	$19.45	$49.57	$137.07	$0.00	$0.00	$0.00	$0.00
31100020	EAP	CPT® 88185		Flow Cytometry - Addt'l Marker	BOTH IP/OP	$169.00 	$125.06	$0.00	$135.20	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$99.96	$99.96	$0.00	$71.72	$133.85	$135.20	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
31100021	EAP	CPT® 88188		"Flow Cytometry, Interp."	BOTH IP/OP	$305.00 	$225.70	$0.00	$244.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$226.37	$226.37	$235.09	$0.00	$87.63	$0.00	$0.00	$0.00	$0.00	$161.74	$241.56	$244.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100022	EAP	CPT® 88161		"Fna-breast,cyto"	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$100.00	$100.00	$24.06	$24.06	$24.19	$30.33	$30.67	$30.67	$31.85	$23.64	$40.98	$15.37	$122.44	$122.44	$23.06	$66.78	$163.94	$165.60	$32.04	$0.00	$32.04	$43.67	$43.22	$43.22	$30.57	$21.96	$0.00	$0.00	$0.00	$0.00
31100023	EAP	CPT® 88104		"Fna-cell Blk,,misc"	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$113.52	$113.52	$32.96	$32.96	$33.15	$32.11	$34.86	$34.86	$36.20	$32.43	$50.14	$21.08	$208.80	$208.80	$33.53	$60.16	$279.58	$282.40	$46.58	$0.00	$46.58	$53.42	$40.34	$40.34	$37.40	$31.93	$0.00	$0.00	$0.00	$0.00
31100024	EAP	CPT® 88104		"Fna-cell Blk,breast"	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$113.52	$113.52	$32.96	$32.96	$33.15	$32.11	$34.86	$34.86	$36.20	$32.43	$50.14	$21.08	$208.80	$208.80	$33.53	$60.16	$279.58	$282.40	$46.58	$0.00	$46.58	$53.42	$40.34	$40.34	$37.40	$31.93	$0.00	$0.00	$0.00	$0.00
31100025	EAP	CPT® 88161		"Fna-misc,cyto"	BOTH IP/OP	$205.00 	$151.70	$15.37	$165.60	$100.00	$100.00	$24.06	$24.06	$24.19	$30.33	$30.67	$30.67	$31.85	$23.64	$40.98	$15.37	$121.26	$121.26	$23.06	$66.78	$163.94	$165.60	$32.04	$133.25	$32.04	$43.67	$43.22	$43.22	$30.57	$21.96	$0.00	$0.00	$0.00	$0.00
31100026	EAP	CPT® 88104		"Fna-pulmonary,cyto"	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$113.52	$113.52	$32.96	$32.96	$33.15	$32.11	$34.86	$34.86	$36.20	$32.43	$50.14	$21.08	$208.80	$208.80	$33.53	$60.16	$279.58	$282.40	$46.58	$0.00	$46.58	$53.42	$40.34	$40.34	$37.40	$31.93	$0.00	$0.00	$0.00	$0.00
31100027	EAP	CPT® 88184		Hairy Cell Leukemia	BOTH IP/OP	$424.00 	$313.76	$0.00	$394.92	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$250.80	$250.80	$284.24	$133.74	$335.81	$339.20	$394.92	$0.00	$394.92	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
31100029	EAP	CPT® 88280		Karyo Typing Charge	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$51.80	$51.80	$33.47	$33.47	$16.74	$0.00	$38.11	$38.11	$39.57	$0.00	$37.08	$0.00	$0.00	$0.00	$35.14	$70.14	$237.60	$240.00	$48.53	$0.00	$48.53	$39.50	$33.47	$33.47	$27.65	$33.47	$0.00	$0.00	$0.00	$0.00
31100030	EAP	CPT® 88184		Lymphoma Prof-basic	BOTH IP/OP	$424.00 	$313.76	$0.00	$394.92	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$250.80	$250.80	$284.24	$133.74	$335.81	$339.20	$394.92	$0.00	$394.92	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
31100031	EAP	CPT® 88184		Nuclear Charge	BOTH IP/OP	$424.00 	$313.76	$0.00	$394.92	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$250.80	$250.80	$284.24	$133.74	$335.81	$339.20	$394.92	$0.00	$394.92	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
31100032	EAP	CPT® 88142		Pap Smear	BOTH IP/OP	$291.00 	$215.34	$0.00	$232.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.27	$56.62	$230.47	$232.80	$29.38	$0.00	$29.38	$31.90	$20.26	$20.26	$22.33	$20.26	$0.00	$0.00	$0.00	$0.00
31100033	EAP	CPT® 88130		Sex Chromatin:buccal	BOTH IP/OP	$166.00 	$122.84	$0.00	$132.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.85	$22.85	$23.73	$0.00	$22.23	$0.00	$0.00	$0.00	$0.00	$42.04	$131.47	$132.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100034	EAP	CPT® 88235		"Tis Cult, Amino Charg"	BOTH IP/OP	"$2,229.00 "	"$1,649.46"	$0.00	"$1,801.60"	$304.00	$304.00	$150.30	$150.30	$75.15	$0.00	$223.60	$223.60	$232.20	$0.00	$217.53	$0.00	$0.00	$0.00	$157.82	$411.48	"$1,783.58"	"$1,801.60"	$217.94	$248.00	$217.94	$231.78	$150.30	$150.30	$162.25	$150.30	$0.00	$0.00	$0.00	$0.00
31100035	EAP	CPT® 88230		"Tis Cult, Lymph Charge"	BOTH IP/OP	"$1,765.00 "	"$1,306.10"	$58.25	"$1,426.40"	$240.48	$240.48	$116.49	$116.49	$58.25	$58.25	$176.90	$176.90	$183.71	$116.49	$172.08	$75.72	"$1,044.00"	"$1,044.00"	$122.31	$325.54	"$1,412.14"	"$1,426.40"	$168.91	$192.21	$168.91	$183.36	$116.49	$116.49	$128.35	$116.49	$0.00	$0.00	$0.00	$0.00
31100036	EAP	CPT® 88239		"Tis Cult, Other Charge"	BOTH IP/OP	"$2,232.00 "	"$1,651.68"	$73.76	"$1,804.00"	$304.52	$304.52	$147.52	$147.52	$73.76	$73.76	$224.01	$224.01	$232.62	$147.52	$217.93	$95.89	"$1,320.23"	"$1,320.23"	$154.90	$412.24	"$1,785.96"	"$1,804.00"	$213.90	$243.41	$213.90	$232.21	$147.52	$147.52	$162.54	$147.52	$0.00	$0.00	$0.00	$0.00
31100037	EAP	CPT® 88237		"Tissue Culture, Chrg"	BOTH IP/OP	$655.00 	$484.70	$0.00	$580.80	$182.24	$182.24	$143.75	$143.75	$71.88	$64.69	$134.06	$134.06	$139.21	$143.75	$130.42	$93.44	$387.43	$387.43	$150.94	$246.70	$574.99	$580.80	$208.44	$0.00	$208.44	$138.97	$143.75	$143.75	$97.28	$143.75	$0.00	$0.00	$0.00	$0.00
31100038	EAP	CPT® 88184		Plasma Cell Neo Flow Tc/marker 1 (so)	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$295.75	$295.75	$284.24	$133.74	$396.00	$400.00	$394.92	$0.00	$394.92	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
31100039	EAP	CPT® 88185		Plasma Cell Neo Flow Tc/add On (so)	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$53.24	$53.24	$0.00	$71.72	$71.28	$72.00	$0.00	$0.00	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
31100040	EAP	CPT® 88187		Plasma Cell Neo Flow Read 2 - 8(so)	BOTH IP/OP	$90.00 	$66.60	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$69.37	$0.00	$70.22	$0.00	$0.00	$0.00	$50.66	$90.00	$71.28	$72.00	$39.31	$0.00	$39.31	$74.83	$39.31	$39.31	$52.38	$39.31	$0.00	$0.00	$0.00	$0.00
31100042	EAP	CPT® 88271		Fish Aml M3 Rara Dna (so)	BOTH IP/OP	$407.00 	$301.18	$0.00	$325.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$240.74	$240.74	$22.49	$59.86	$322.34	$325.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31100043	EAP	CPT® 88275		Fish Aml M3 Rara 100-300 (so)	BOTH IP/OP	$615.00 	$455.10	$0.00	$492.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$363.77	$363.77	$53.75	$112.22	$487.08	$492.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31100044	EAP	CPT® 88364		"Fish, Oligoden 1p/19q (so)"	BOTH IP/OP	$566.00 	$418.84	$0.00	$452.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.50	$101.50	$105.41	$0.00	$97.04	$0.00	$0.00	$0.00	$0.00	$283.00	$448.27	$452.80	$0.00	$0.00	$0.00	$103.40	$104.09	$104.09	$72.38	$0.00	$0.00	$0.00	$0.00	$0.00
31100046	EAP	CPT® 88299		Fshd Cytogenetic Study (so)	BOTH IP/OP	"$2,331.00 "	"$1,724.94"	$0.00	"$1,864.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,730.07"	"$1,730.07"	"$1,796.73"	$0.00	$485.78	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,846.15"	"$1,864.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100047	EAP	CPT® 88275		Fish Hes 4qrea 100-300 (so)	BOTH IP/OP	$389.00 	$287.86	$0.00	$311.20	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$230.09	$230.09	$53.75	$112.22	$308.09	$311.20	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31100048	EAP	CPT® 88271		Fish Hes 4qrea Leuk Dna (so)	BOTH IP/OP	$389.00 	$287.86	$0.00	$311.20	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$230.09	$230.09	$22.49	$59.86	$308.09	$311.20	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31100049	EAP	CPT® 88271		Fish Fgfr1 8p11-12 Dna(so)	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$133.09	$133.09	$22.49	$59.86	$178.20	$180.00	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31100050	EAP	CPT® 88275		Fish Fgfr1 8p11-12 Dna(so)	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$133.09	$133.09	$53.75	$112.22	$178.20	$180.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31100051	EAP	CPT® 88271		Fish Neonatal Screen Dna (so)	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$74.53	$74.53	$22.49	$59.86	$99.79	$100.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31100052	EAP	CPT® 88275		Fish Neonatal Screen (so)	BOTH IP/OP	$126.00 	$93.24	$0.00	$112.22	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$74.53	$74.53	$53.75	$112.22	$99.79	$100.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31100053	EAP	CPT® 88275		Fish Fgfr1 8p11-12 100-300 (so)	BOTH IP/OP	$615.00 	$455.10	$0.00	$492.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$363.77	$363.77	$53.75	$112.22	$487.08	$492.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31100095	EAP	CPT® 88143		Cytopatah C/v Thin Layer Redo	BOTH IP/OP	$109.00 	$80.66	$0.00	$109.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.76	$30.76	$31.95	$0.00	$29.94	$0.00	$0.00	$0.00	$0.00	$56.62	$87.12	$88.00	$0.00	$109.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100096	EAP	CPT® 88173		Cytopath Eval Fna Report	BOTH IP/OP	$405.00 	$299.70	$31.00	$327.20	$234.59	$234.59	$48.39	$48.39	$48.66	$70.06	$66.81	$66.81	$69.38	$47.69	$107.58	$31.00	$239.56	$239.56	$49.62	$137.06	$323.93	$327.20	$68.93	$263.25	$68.93	$114.63	$83.20	$83.20	$80.24	$47.25	$0.00	$0.00	$0.00	$0.00
31100097	EAP	CPT® 88174		Cytopath C/v Auto In Fluid	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.44	$32.44	$33.69	$0.00	$31.56	$0.00	$0.00	$0.00	$0.00	$59.70	$74.45	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100098	EAP	CPT® 88175		Cytopath C/v Auto Fluid Redo	BOTH IP/OP	$116.00 	$85.84	$0.00	$92.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.19	$40.19	$41.73	$0.00	$39.09	$0.00	$0.00	$0.00	$0.00	$73.96	$91.87	$92.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100110	EAP	Custom 31100110		"Fish, B-cell Cll Panel (so)"	BOTH IP/OP	$369.00 	$273.06	$0.00	$293.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$273.87	$273.87	$284.43	$0.00	$76.90	$0.00	$0.00	$0.00	$0.00	$183.50	$290.66	$293.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100111	EAP	CPT® 88271		Molecular Cytogen; Dna Probe  (so)	BOTH IP/OP	$369.00 	$273.06	$10.71	$293.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$218.26	$218.26	$22.49	$59.86	$290.66	$293.60	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31100112	EAP	CPT® 88275		Interphase In Situ Hybird (so)	BOTH IP/OP	$369.00 	$273.06	$23.04	$293.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$218.26	$218.26	$53.75	$112.22	$290.66	$293.60	$74.23	$84.46	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31100113	EAP	Custom 31100113		"Fish, Locus -specific Probe (x1) (so)"	BOTH IP/OP	$367.00 	$271.58	$0.00	$293.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.39	$272.39	$282.88	$0.00	$76.48	$0.00	$0.00	$0.00	$0.00	$183.50	$290.66	$293.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100114	EAP	CPT® 88271		Molecular Cytogentics; Dna Probe (so)	BOTH IP/OP	$367.00 	$271.58	$0.00	$293.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$217.08	$217.08	$22.49	$59.86	$290.66	$293.60	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31100115	EAP	Custom 31100115		Chromosome Analysis Hem Malig (so)	BOTH IP/OP	$340.00 	$251.60	$0.00	$274.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.35	$252.35	$262.07	$0.00	$70.86	$0.00	$0.00	$0.00	$0.00	$171.50	$271.66	$274.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100116	EAP	CPT® 88237		Tissue Culture For Neoplastic Disorder (so)	BOTH IP/OP	$340.00 	$251.60	$64.69	$274.40	$182.24	$182.24	$143.75	$143.75	$71.88	$64.69	$134.06	$134.06	$139.21	$143.75	$130.42	$93.44	$201.11	$201.11	$150.94	$246.70	$271.66	$274.40	$208.44	$237.19	$208.44	$138.97	$143.75	$143.75	$97.28	$143.75	$0.00	$0.00	$0.00	$0.00
31100117	EAP	CPT® 88264		Chromosome Analysis  20-25 Cells (so)	BOTH IP/OP	$366.00 	$270.84	$65.07	$348.28	$257.29	$257.29	$144.61	$144.61	$72.31	$65.07	$189.26	$189.26	$196.54	$144.61	$184.12	$94.00	$216.49	$216.49	$151.84	$348.28	$293.04	$296.00	$209.68	$238.61	$209.68	$196.18	$144.61	$144.61	$137.33	$144.61	$0.00	$0.00	$0.00	$0.00
31100118	EAP	CPT® 88120		"Bladder Cancer,fish (so)"	BOTH IP/OP	$488.00 	$361.12	$0.00	$488.00	$488.00	$488.00	$145.24	$145.24	$146.06	$0.00	$422.54	$422.54	$438.79	$0.00	$324.87	$0.00	$0.00	$0.00	$0.00	$246.50	$390.46	$394.40	$0.00	$317.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100119	EAP	Custom 31100119		"Fish, Prenatal Screen (so)"	BOTH IP/OP	$369.00 	$273.06	$0.00	$293.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$273.87	$273.87	$284.43	$0.00	$76.90	$0.00	$0.00	$0.00	$0.00	$183.50	$290.66	$293.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100120	EAP	CPT® 88271		Molecular Cytogen; Dna Probe (so)	BOTH IP/OP	$369.00 	$273.06	$10.71	$293.60	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$218.26	$218.26	$22.49	$59.86	$290.66	$293.60	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31100121	EAP	CPT® 88275		Interphase Insitu Hybird  (so)	BOTH IP/OP	$369.00 	$273.06	$23.04	$293.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$218.26	$218.26	$53.75	$112.22	$290.66	$293.60	$74.23	$84.46	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31100122	EAP	CPT® 88275		Interphase In Situ Hybirdization (so)	BOTH IP/OP	$367.00 	$271.58	$0.00	$293.60	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$217.08	$217.08	$53.75	$112.22	$290.66	$293.60	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31100123	EAP	CPT® 88271		Molecular Cytogenetics;dna Probe (fish) (so)	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$192.24	$192.24	$22.49	$59.86	$257.40	$260.00	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31100124	EAP	CPT® 88275		Interphase In Situ Hybirdization (so)	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$192.24	$192.24	$53.75	$112.22	$257.40	$260.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31100126	EAP	CPT® 88184		"Pnh Flow Cytometry, 1st Mrk (so)"	BOTH IP/OP	$93.00 	$68.82	$30.49	$284.24	$92.98	$92.98	$283.63	$283.63	$93.00	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$55.01	$55.01	$284.24	$94.00	$74.45	$75.20	$94.00	$60.45	$94.00	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
31100127	EAP	CPT® 88185		"Pnh Flow Cytometry, Ea Addl Mrk (so)"	BOTH IP/OP	$93.00 	$68.82	$0.00	$75.20	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$55.01	$55.01	$0.00	$71.72	$74.45	$75.20	$0.00	$60.45	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
31100130	EAP	CPT® 88184		Flow Cytometry; First Marker (so)	BOTH IP/OP	$303.00 	$224.22	$0.00	$303.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$179.22	$179.22	$284.24	$133.74	$239.98	$242.40	$303.00	$0.00	$303.00	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
31100132	EAP	CPT® 88185		Flow Cytometry;16 Or More Markers (so)	BOTH IP/OP	$133.00 	$98.42	$0.00	$107.20	$56.76	$56.76	$0.00	$0.00	$0.00	$11.19	$48.93	$48.93	$50.81	$0.00	$26.63	$0.00	$78.67	$78.67	$0.00	$71.72	$106.13	$107.20	$0.00	$86.45	$0.00	$28.37	$22.33	$22.33	$19.86	$0.00	$0.00	$0.00	$0.00	$0.00
31100133	EAP	Custom 31100133		Fish  Aml M3-pml/rara Trans 15 17 (so)	BOTH IP/OP	$345.00 	$255.30	$0.00	$274.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$0.00	$0.00	$0.00	$171.50	$271.66	$274.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100134	EAP	CPT® 88271		Molecular Cytogen Dna Probe (so)	BOTH IP/OP	$345.00 	$255.30	$10.71	$274.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$204.07	$204.07	$22.49	$59.86	$271.66	$274.40	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31100135	EAP	CPT® 88275		Interphase In Situ Hybrid (so)	BOTH IP/OP	$343.00 	$253.82	$0.00	$274.40	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$202.88	$202.88	$53.75	$112.22	$271.66	$274.40	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31100136	EAP	Custom 31100136		Cll - Lymphoma Diagnostic Panel (so)	BOTH IP/OP	$93.00 	$68.82	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.02	$69.02	$71.68	$0.00	$19.38	$0.00	$0.00	$0.00	$0.00	$47.00	$74.45	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100137	EAP	CPT® 88184		Flow Cytometry; First Marker (so)	BOTH IP/OP	$303.00 	$224.22	$0.00	$303.00	$92.98	$92.98	$283.63	$283.63	$285.22	$30.49	$82.40	$82.40	$85.57	$279.15	$54.16	$181.45	$179.22	$179.22	$284.24	$133.74	$239.98	$242.40	$303.00	$0.00	$303.00	$57.71	$68.07	$68.07	$40.40	$270.71	$0.00	$0.00	$0.00	$0.00
31100141	EAP	CPT® 88112		Enriched Prep Surepath	BOTH IP/OP	$545.00 	$403.30	$30.81	$440.80	$103.78	$103.78	$48.39	$48.39	$48.66	$30.81	$47.03	$47.03	$48.84	$47.69	$124.75	$31.00	$322.37	$322.37	$49.62	$116.38	$436.39	$440.80	$68.93	$354.25	$68.93	$132.92	$39.62	$39.62	$93.05	$47.25	$0.00	$0.00	$0.00	$0.00
31100142	EAP	CPT® 80356		6-mam Opiates (so)	BOTH IP/OP	$166.00 	$122.84	$0.00	$140.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.21	$123.21	$127.95	$0.00	$34.59	$0.00	$0.00	$0.00	$0.00	$88.00	$139.39	$140.80	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31150011	EAP	CPT® 88104		"Cytology, Urinary"	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$113.52	$113.52	$32.96	$32.96	$33.15	$32.11	$34.86	$34.86	$36.20	$32.43	$50.14	$21.08	$208.80	$208.80	$33.53	$60.16	$279.58	$282.40	$46.58	$0.00	$46.58	$53.42	$40.34	$40.34	$37.40	$31.93	$0.00	$0.00	$0.00	$0.00
31150012	EAP	CPT® 88104		"Cytology,fluid"	BOTH IP/OP	$349.00 	$258.26	$21.08	$282.40	$113.52	$113.52	$32.96	$32.96	$33.15	$32.11	$34.86	$34.86	$36.20	$32.43	$50.14	$21.08	$206.43	$206.43	$33.53	$60.16	$279.58	$282.40	$46.58	$226.85	$46.58	$53.42	$40.34	$40.34	$37.40	$31.93	$0.00	$0.00	$0.00	$0.00
31150013	EAP	CPT® 88104		"Cytology,breast"	BOTH IP/OP	$349.00 	$258.26	$21.08	$282.40	$113.52	$113.52	$32.96	$32.96	$33.15	$32.11	$34.86	$34.86	$36.20	$32.43	$50.14	$21.08	$206.43	$206.43	$33.53	$60.16	$279.58	$282.40	$46.58	$226.85	$46.58	$53.42	$40.34	$40.34	$37.40	$31.93	$0.00	$0.00	$0.00	$0.00
31150014	EAP	CPT® 88104		"Cytology,cns"	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$113.52	$113.52	$32.96	$32.96	$33.15	$32.11	$34.86	$34.86	$36.20	$32.43	$50.14	$21.08	$208.80	$208.80	$33.53	$60.16	$279.58	$282.40	$46.58	$0.00	$46.58	$53.42	$40.34	$40.34	$37.40	$31.93	$0.00	$0.00	$0.00	$0.00
31150015	EAP	CPT® 88104		"Cytology,misc"	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$113.52	$113.52	$32.96	$32.96	$33.15	$32.11	$34.86	$34.86	$36.20	$32.43	$50.14	$21.08	$208.80	$208.80	$33.53	$60.16	$279.58	$282.40	$46.58	$0.00	$46.58	$53.42	$40.34	$40.34	$37.40	$31.93	$0.00	$0.00	$0.00	$0.00
31200001	EAP	CPT® 88300		Tooth	BOTH IP/OP	$291.00 	$215.34	$7.30	$230.40	$24.87	$24.87	$24.06	$24.06	$24.19	$7.30	$19.71	$19.71	$20.47	$23.64	$16.80	$15.37	$172.13	$172.13	$23.06	$38.76	$228.10	$230.40	$32.04	$189.15	$32.04	$17.90	$11.16	$11.16	$12.53	$21.96	$0.00	$0.00	$0.00	$0.00
31200002	EAP	CPT® 88300		Foreign Body	BOTH IP/OP	$291.00 	$215.34	$7.30	$230.40	$24.87	$24.87	$24.06	$24.06	$24.19	$7.30	$19.71	$19.71	$20.47	$23.64	$16.80	$15.37	$172.13	$172.13	$23.06	$38.76	$228.10	$230.40	$32.04	$189.15	$32.04	$17.90	$11.16	$11.16	$12.53	$21.96	$0.00	$0.00	$0.00	$0.00
31200003	EAP	CPT® 88300		"Cataract,os /od"	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.06	$38.76	$228.10	$230.40	$32.04	$0.00	$32.04	$17.90	$11.16	$11.16	$12.53	$21.96	$0.00	$0.00	$0.00	$0.00
31200004	EAP	CPT® 88300		Intrauterine Device	BOTH IP/OP	$291.00 	$215.34	$7.30	$230.40	$24.87	$24.87	$24.06	$24.06	$24.19	$7.30	$19.71	$19.71	$20.47	$23.64	$16.80	$15.37	$172.13	$172.13	$23.06	$38.76	$228.10	$230.40	$32.04	$189.15	$32.04	$17.90	$11.16	$11.16	$12.53	$21.96	$0.00	$0.00	$0.00	$0.00
31200005	EAP	CPT® 88302		"Appendix,incidential"	BOTH IP/OP	$393.00 	$290.82	$14.11	$311.20	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$232.46	$232.46	$23.06	$87.44	$308.09	$311.20	$32.04	$255.45	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200006	EAP	CPT® 88302		"Foreskin, Newborn"	BOTH IP/OP	$389.00 	$287.86	$0.00	$311.20	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$230.09	$230.09	$23.06	$87.44	$308.09	$311.20	$32.04	$0.00	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200007	EAP	CPT® 88302		"Testis,castration"	BOTH IP/OP	$393.00 	$290.82	$14.11	$311.20	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$232.46	$232.46	$23.06	$87.44	$308.09	$311.20	$32.04	$255.45	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200008	EAP	CPT® 88302		Nerve	BOTH IP/OP	$389.00 	$287.86	$0.00	$311.20	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$230.09	$230.09	$23.06	$87.44	$308.09	$311.20	$32.04	$0.00	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200009	EAP	CPT® 88302		Skin Plastic Repair	BOTH IP/OP	$393.00 	$290.82	$14.11	$311.20	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$232.46	$232.46	$23.06	$87.44	$308.09	$311.20	$32.04	$255.45	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200010	EAP	CPT® 88302		"Amput,digit-traumat."	BOTH IP/OP	$393.00 	$290.82	$14.11	$311.20	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$232.46	$232.46	$23.06	$87.44	$308.09	$311.20	$32.04	$255.45	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200011	EAP	CPT® 88302		Hernia Sac	BOTH IP/OP	$393.00 	$290.82	$14.11	$311.20	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$232.46	$232.46	$23.06	$87.44	$308.09	$311.20	$32.04	$255.45	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200012	EAP	CPT® 88302		Hydrocele	BOTH IP/OP	$393.00 	$290.82	$14.11	$311.20	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$232.46	$232.46	$23.06	$87.44	$308.09	$311.20	$32.04	$255.45	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200013	EAP	CPT® 88302		"Vas Deferens, Steril."	BOTH IP/OP	$393.00 	$290.82	$14.11	$311.20	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$232.46	$232.46	$23.06	$87.44	$308.09	$311.20	$32.04	$255.45	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200014	EAP	CPT® 88302		Vaginal Mucosa	BOTH IP/OP	$393.00 	$290.82	$14.11	$311.20	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$232.46	$232.46	$23.06	$87.44	$308.09	$311.20	$32.04	$255.45	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200015	EAP	CPT® 88304		Nasal Polyp	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200016	EAP	CPT® 88304		Colostomy Stoma	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200017	EAP	CPT® 88304		"Foreskin,non-newborn"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200018	EAP	CPT® 88304		"Bone/frag,non-pathologic"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200019	EAP	CPT® 88304		Cartilage Shavings	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200020	EAP	CPT® 88304		Carpal Tunnel Tissue	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200021	EAP	CPT® 88304		Dupuytren's Contrac.	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200022	EAP	CPT® 88304		"Femoral Head,n-fract"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200023	EAP	CPT® 88304		"Cyst,misc"	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$292.79	$292.79	$49.62	$108.12	$392.04	$396.00	$68.93	$0.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200024	EAP	CPT® 88304		"Cyst,synovial"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200025	EAP	CPT® 88304		"Cyst,ganglion"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200026	EAP	CPT® 88304		Fissure / Fistula	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200027	EAP	CPT® 88304		Intervertebral Disc	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200028	EAP	CPT® 88304		"Joint, Loose Body"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200029	EAP	CPT® 88304		Tendon Sheath	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$292.79	$292.79	$49.62	$108.12	$392.04	$396.00	$68.93	$0.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200030	EAP	CPT® 88304		"Cyst,dental"	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$292.79	$292.79	$49.62	$108.12	$392.04	$396.00	$68.93	$0.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200031	EAP	CPT® 88304		"Neuroma,traumatic"	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$292.79	$292.79	$49.62	$108.12	$392.04	$396.00	$68.93	$0.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200032	EAP	CPT® 88304		"Skin Biopsy,punch"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200033	EAP	CPT® 88304		"Skin Excision,debrid"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200034	EAP	CPT® 88304		"Cyst,pilonidal"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200035	EAP	CPT® 88304		"Soft Tissue,debrid"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200036	EAP	CPT® 88304		"Soft Tissue,lipoma"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200037	EAP	CPT® 88304		Aneurysm	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200038	EAP	CPT® 88304		"Vein, Varicosity"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200039	EAP	CPT® 88304		Embolis/thrombus	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200040	EAP	CPT® 88304		Hematoma	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200041	EAP	CPT® 88304		Hemorrhoids	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200042	EAP	CPT® 88304		"Artery/vein, Plaque"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200043	EAP	CPT® 88304		Cholesteatoma	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200044	EAP	CPT® 88304		Conjunctiva Biopsy	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$292.79	$292.79	$49.62	$108.12	$392.04	$396.00	$68.93	$0.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200045	EAP	CPT® 88304		Cornea	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200046	EAP	CPT® 88304		Salivary Mucocele	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$292.79	$292.79	$49.62	$108.12	$392.04	$396.00	$68.93	$0.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200047	EAP	CPT® 88304		Tonsil/adenoids	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200048	EAP	CPT® 88304		Gall Blad./bile Duct	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200049	EAP	CPT® 88304		Spermatocele	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200050	EAP	CPT® 88304		Varicocele	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$292.79	$292.79	$49.62	$108.12	$392.04	$396.00	$68.93	$0.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200051	EAP	CPT® 88304		Vas Deferens	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200052	EAP	CPT® 88304		"Cyst,bartholin"	BOTH IP/OP	$500.00 	$370.00	$18.49	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$295.75	$295.75	$49.62	$108.12	$392.04	$396.00	$68.93	$325.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200053	EAP	CPT® 88304		"Cyst,hydat-morgagni"	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$292.79	$292.79	$49.62	$108.12	$392.04	$396.00	$68.93	$0.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200054	EAP	CPT® 88305		"Breast Bx,core Img"	BOTH IP/OP	$617.00 	$456.58	$0.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$364.96	$364.96	$49.62	$140.98	$488.66	$493.60	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200055	EAP	CPT® 88305		Bronchus Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200056	EAP	CPT® 88305		"Trachea, Biopsy"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200057	EAP	CPT® 88305		"Larynx, Biopsy"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200058	EAP	CPT® 88305		Nasopharynx	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200059	EAP	CPT® 88305		Nasal Mucosa Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200060	EAP	CPT® 88305		Stomach Polyp	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200061	EAP	CPT® 88305		Duodenum Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200062	EAP	CPT® 88305		Colorectal Polyp	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200063	EAP	CPT® 88305		Peritoneum Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200064	EAP	CPT® 88305		Ur Bladder Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200065	EAP	CPT® 88305		Prostate Chips	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200066	EAP	CPT® 88305		Cell Block	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200067	EAP	CPT® 88305		"Femoral Head, Fract."	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200068	EAP	CPT® 88305		Synovium	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200069	EAP	CPT® 88305		Meninges Resection	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200070	EAP	CPT® 88305		"Skin Biopsy,shave"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200071	EAP	CPT® 88305		"Skin Excision,other"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200072	EAP	CPT® 88305		"Soft Tissue,other"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200073	EAP	CPT® 88305		Breast Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200074	EAP	CPT® 88305		"Breast,reduction"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200075	EAP	CPT® 88305		Artery/vein Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200076	EAP	CPT® 88305		Lymph Node Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200077	EAP	CPT® 88305		Bone Marrow Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200078	EAP	CPT® 88305		Spleen	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200079	EAP	CPT® 88305		"Amput,extrm-traumat."	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200080	EAP	CPT® 88305		Joint Resection	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200081	EAP	CPT® 88305		Muscle Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200082	EAP	CPT® 88305		"Amput,digit-nontraum"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200083	EAP	CPT® 88305		Heart Valve	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200084	EAP	CPT® 88305		"Lip, Wedge Biopsy"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200085	EAP	CPT® 88305		Tongue Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200086	EAP	CPT® 88305		Tonsil Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200087	EAP	CPT® 88305		Oral/gingiva Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200088	EAP	CPT® 88305		Salivary Gland Bx	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200089	EAP	CPT® 88305		Parathyroid Gland	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200090	EAP	CPT® 88305		Pituitary Tumor	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200091	EAP	CPT® 88305		Nerve Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200092	EAP	CPT® 88305		Pleural Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200093	EAP	CPT® 88305		Pericardium Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200094	EAP	CPT® 88305		Thyroglossal Duct	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200095	EAP	CPT® 88305		Esophagus Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200096	EAP	CPT® 88305		Stomach Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200097	EAP	CPT® 88305		Sm.intestine Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200098	EAP	CPT® 88305		Colon Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200099	EAP	CPT® 88305		Omentum Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200100	EAP	CPT® 88305		Kidney Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200101	EAP	CPT® 88305		Ureter Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200102	EAP	CPT® 88305		Urethra Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200103	EAP	CPT® 88305		Prostate Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200104	EAP	CPT® 88305		Endocervical Scrape	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200105	EAP	CPT® 88305		Endometrial Scrape	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200106	EAP	CPT® 88305		Cervical Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200107	EAP	CPT® 88305		"Vagina, Biopsy"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200108	EAP	CPT® 88305		Vulva / Labia Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200109	EAP	CPT® 88305		Ovary	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200110	EAP	CPT® 88305		Endometrial Polyp	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200111	EAP	CPT® 88305		"Uterus, Prolapse"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200112	EAP	CPT® 88305		Fallopian Tube Biopsy	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200113	EAP	CPT® 88305		"Fallop. Tube,ectopic"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200114	EAP	CPT® 88305		"Ovary,wedge Biopsy"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200115	EAP	CPT® 88305		"POC, SPONTANEOUS"	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200116	EAP	CPT® 88305		"Placenta, N-3rd Trim."	BOTH IP/OP	$624.00 	$461.76	$31.00	$493.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$369.10	$369.10	$49.62	$140.98	$488.66	$493.60	$68.93	$405.60	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200117	EAP	CPT® 88307		Stomach Resection	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200118	EAP	CPT® 88307		"Colon, Seg Resection"	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200119	EAP	CPT® 88307		"Pancreas, Biopsy"	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200120	EAP	CPT® 88307		Liver Resection	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200121	EAP	CPT® 88307		Ureter Resection	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200122	EAP	CPT® 88307		Testis Biopsy	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200123	EAP	CPT® 88307		Prostate Resection	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200124	EAP	CPT® 88307		Bone Biopsy	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200125	EAP	CPT® 88307		"Tumor,dental"	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200126	EAP	CPT® 88307		"Meninges,tumor"	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200127	EAP	CPT® 88307		"Breast,simple Mast."	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200128	EAP	CPT® 88307		Lymph Node Resectn	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200129	EAP	CPT® 88307		Liver Biopsy	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200130	EAP	CPT® 88307		"Amput,extrm-non Traum"	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200131	EAP	CPT® 88307		"Bone/frag,pathologic"	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200132	EAP	CPT® 88307		"Mediastinum,mass"	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200133	EAP	CPT® 88307		"Soft Tissue,bx/excis"	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200134	EAP	CPT® 88307		"Eye, Enucleation"	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200135	EAP	CPT® 88307		Thyroid Resection	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200136	EAP	CPT® 88307		Adrenal Resection	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200137	EAP	CPT® 88307		Brain Biopsy	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200138	EAP	CPT® 88307		"Lung, Wedge Biopsy"	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200139	EAP	CPT® 88307		Myocardium Biopsy	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200140	EAP	CPT® 88307		Thymus Tumor	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200141	EAP	CPT® 88307		Small Intes. Resectn	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200142	EAP	CPT® 88307		Nephrectomy	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200143	EAP	CPT® 88307		Testis Resection	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200144	EAP	CPT® 88307		Uterus	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200145	EAP	CPT® 88307		Cervical Cone	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200146	EAP	CPT® 88307		"Placenta, Third Trim."	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200147	EAP	CPT® 88307		"Ovary,tumor"	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200148	EAP	CPT® 88309		Small Intes. Tumor	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200149	EAP	CPT® 88309		"Colon, Seg Resec,tumor"	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200150	EAP	CPT® 88309		Ur Bladder Resection	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200151	EAP	CPT® 88309		"Testis Resect,tumor"	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200152	EAP	CPT® 88309		Bone Resection	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200153	EAP	CPT® 88309		"Soft Tissue,tumor"	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200154	EAP	CPT® 88309		"Breast,mast.w/nodes"	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200155	EAP	CPT® 88309		"Larynx, Resectn/node"	BOTH IP/OP	"$1,051.00 "	$777.74	$0.00	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$621.67	$621.67	$630.05	$328.48	$832.39	$840.80	$875.37	$0.00	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200156	EAP	CPT® 88309		"Tongue, Resectn,tumor"	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200157	EAP	CPT® 88309		"Tonsil Resectn,tumor"	BOTH IP/OP	"$1,051.00 "	$777.74	$0.00	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$621.67	$621.67	$630.05	$328.48	$832.39	$840.80	$875.37	$0.00	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200158	EAP	CPT® 88309		Lung Resection	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200159	EAP	CPT® 88309		Esophagus Resection	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200160	EAP	CPT® 88309		"Colon, Total Resectn"	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200161	EAP	CPT® 88309		Pancreas	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200162	EAP	CPT® 88309		"Prostate,resectn Rad"	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200163	EAP	CPT® 88309		"Uterus, Tumor"	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200164	EAP	CPT® 88309		"Fetus, W/dissection"	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200165	EAP	CPT® 88309		Vulva  Resection	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200166	EAP	CPT® 88312		STAIN GRP I - ACID FAST BACT	BOTH IP/OP	$419.00 	$310.06	$31.00	$332.00	$150.27	$150.27	$48.39	$48.39	$48.66	$45.90	$75.24	$75.24	$78.14	$47.69	$50.97	$31.00	$247.84	$247.84	$49.62	$128.88	$328.68	$332.00	$68.93	$256.10	$68.93	$54.31	$79.24	$79.24	$38.01	$47.25	$0.00	$0.00	$0.00	$0.00
31200167	EAP	CPT® 88312		STAIN GRP I - BIELSCHOWSKY	BOTH IP/OP	$415.00 	$307.10	$31.00	$332.00	$150.27	$150.27	$48.39	$48.39	$48.66	$45.90	$75.24	$75.24	$78.14	$47.69	$50.97	$31.00	$245.47	$245.47	$49.62	$128.88	$328.68	$332.00	$68.93	$256.10	$68.93	$54.31	$79.24	$79.24	$38.01	$47.25	$0.00	$0.00	$0.00	$0.00
31200168	EAP	CPT® 88312		STAIN GRP I - C E VIOLET	BOTH IP/OP	$415.00 	$307.10	$31.00	$332.00	$150.27	$150.27	$48.39	$48.39	$48.66	$45.90	$75.24	$75.24	$78.14	$47.69	$50.97	$31.00	$245.47	$245.47	$49.62	$128.88	$328.68	$332.00	$68.93	$256.10	$68.93	$54.31	$79.24	$79.24	$38.01	$47.25	$0.00	$0.00	$0.00	$0.00
31200169	EAP	CPT® 88312		STAIN GRP I - FITE STAIN	BOTH IP/OP	$419.00 	$310.06	$31.00	$332.00	$150.27	$150.27	$48.39	$48.39	$48.66	$45.90	$75.24	$75.24	$78.14	$47.69	$50.97	$31.00	$247.84	$247.84	$49.62	$128.88	$328.68	$332.00	$68.93	$256.10	$68.93	$54.31	$79.24	$79.24	$38.01	$47.25	$0.00	$0.00	$0.00	$0.00
31200170	EAP	CPT® 88312		STAIN GRP I - GRAM STAIN	BOTH IP/OP	$419.00 	$310.06	$31.00	$332.00	$150.27	$150.27	$48.39	$48.39	$48.66	$45.90	$75.24	$75.24	$78.14	$47.69	$50.97	$31.00	$247.84	$247.84	$49.62	$128.88	$328.68	$332.00	$68.93	$256.10	$68.93	$54.31	$79.24	$79.24	$38.01	$47.25	$0.00	$0.00	$0.00	$0.00
31200171	EAP	CPT® 88312		STAIN GRP I - GR METH SILVER	BOTH IP/OP	$419.00 	$310.06	$31.00	$332.00	$150.27	$150.27	$48.39	$48.39	$48.66	$45.90	$75.24	$75.24	$78.14	$47.69	$50.97	$31.00	$247.84	$247.84	$49.62	$128.88	$328.68	$332.00	$68.93	$256.10	$68.93	$54.31	$79.24	$79.24	$38.01	$47.25	$0.00	$0.00	$0.00	$0.00
31200172	EAP	CPT® 88312		SPECAL STAIN GROUP I	BOTH IP/OP	$415.00 	$307.10	$31.00	$332.00	$150.27	$150.27	$48.39	$48.39	$48.66	$45.90	$75.24	$75.24	$78.14	$47.69	$50.97	$31.00	$245.47	$245.47	$49.62	$128.88	$328.68	$332.00	$68.93	$256.10	$68.93	$54.31	$79.24	$79.24	$38.01	$47.25	$0.00	$0.00	$0.00	$0.00
31200173	EAP	CPT® 88312		STAIN GRP I - RETICUL STAIN	BOTH IP/OP	$419.00 	$310.06	$31.00	$332.00	$150.27	$150.27	$48.39	$48.39	$48.66	$45.90	$75.24	$75.24	$78.14	$47.69	$50.97	$31.00	$247.84	$247.84	$49.62	$128.88	$328.68	$332.00	$68.93	$256.10	$68.93	$54.31	$79.24	$79.24	$38.01	$47.25	$0.00	$0.00	$0.00	$0.00
31200174	EAP	CPT® 88312		STAIN GRP I - STEINER-SPIRO	BOTH IP/OP	$415.00 	$307.10	$31.00	$332.00	$150.27	$150.27	$48.39	$48.39	$48.66	$45.90	$75.24	$75.24	$78.14	$47.69	$50.97	$31.00	$245.47	$245.47	$49.62	$128.88	$328.68	$332.00	$68.93	$256.10	$68.93	$54.31	$79.24	$79.24	$38.01	$47.25	$0.00	$0.00	$0.00	$0.00
31200175	EAP	CPT® 88313		STAIN GRP II - ALCIAN BLUE	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$214.71	$214.71	$33.53	$110.70	$287.50	$290.40	$46.58	$0.00	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200176	EAP	CPT® 88313		STAIN GRP II - COLLO IRON	BOTH IP/OP	$366.00 	$270.84	$21.08	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$216.49	$216.49	$33.53	$110.70	$287.50	$290.40	$46.58	$237.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200177	EAP	CPT® 88313		STAIN GRP II - COLLO IRON W HY	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$214.71	$214.71	$33.53	$110.70	$287.50	$290.40	$46.58	$0.00	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200178	EAP	CPT® 88313		STAIN GRP II - DIFF QUCK	BOTH IP/OP	$366.00 	$270.84	$21.08	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$216.49	$216.49	$33.53	$110.70	$287.50	$290.40	$46.58	$237.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200179	EAP	CPT® 88313		STAIN GRP II - CONGO RED	BOTH IP/OP	$366.00 	$270.84	$21.08	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$216.49	$216.49	$33.53	$110.70	$287.50	$290.40	$46.58	$237.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200180	EAP	CPT® 88313		STAIN GRP II - CRYSTAL VIOLET	BOTH IP/OP	$366.00 	$270.84	$21.08	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$216.49	$216.49	$33.53	$110.70	$287.50	$290.40	$46.58	$237.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200181	EAP	CPT® 88313		STAIN GRP II - ELASTIC	BOTH IP/OP	$366.00 	$270.84	$21.08	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$216.49	$216.49	$33.53	$110.70	$287.50	$290.40	$46.58	$237.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200182	EAP	CPT® 88313		STAIN GRP II - GIEMSA	BOTH IP/OP	$366.00 	$270.84	$21.08	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$216.49	$216.49	$33.53	$110.70	$287.50	$290.40	$46.58	$237.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200183	EAP	CPT® 88313		STAIN GRP II - IRON	BOTH IP/OP	$366.00 	$270.84	$21.08	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$216.49	$216.49	$33.53	$110.70	$287.50	$290.40	$46.58	$237.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200184	EAP	CPT® 88313		STAIN GRP II - LUXOL BLUE	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$214.71	$214.71	$33.53	$110.70	$287.50	$290.40	$46.58	$0.00	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200185	EAP	CPT® 88313		STAIN GRP II - MASSON TRI	BOTH IP/OP	$366.00 	$270.84	$21.08	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$216.49	$216.49	$33.53	$110.70	$287.50	$290.40	$46.58	$237.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200186	EAP	CPT® 88313		STAIN GRP II - MUCICARMINE	BOTH IP/OP	$366.00 	$270.84	$21.08	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$216.49	$216.49	$33.53	$110.70	$287.50	$290.40	$46.58	$237.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200187	EAP	CPT® 88313		STAIN GRP II - OIL RED O	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$214.71	$214.71	$33.53	$110.70	$287.50	$290.40	$46.58	$0.00	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200188	EAP	CPT® 88313		STAIN GRP II - PAS	BOTH IP/OP	$366.00 	$270.84	$21.08	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$216.49	$216.49	$33.53	$110.70	$287.50	$290.40	$46.58	$237.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200189	EAP	CPT® 88313		STAIN GRP II - PAS ALC BLUE	BOTH IP/OP	$366.00 	$270.84	$21.08	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$216.49	$216.49	$33.53	$110.70	$287.50	$290.40	$46.58	$237.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200190	EAP	CPT® 88313		STAIN GRP II - PAS W / WO DIAD	BOTH IP/OP	$366.00 	$270.84	$21.08	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$216.49	$216.49	$33.53	$110.70	$287.50	$290.40	$46.58	$237.90	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200191	EAP	CPT® 88313		STAIN GRP II - SUDAN BLK B	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$214.71	$214.71	$33.53	$110.70	$287.50	$290.40	$46.58	$0.00	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200192	EAP	CPT® 88313		STAIN GRP II - TOLU BLUE	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$214.71	$214.71	$33.53	$110.70	$287.50	$290.40	$46.58	$0.00	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200193	EAP	CPT® 88313		Stain Grp Ii - Sudan Black	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$214.71	$214.71	$33.53	$110.70	$287.50	$290.40	$46.58	$0.00	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200194	EAP	CPT® 88313		Stain Grp Ii - Nasd Cl-ac-est	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$214.71	$214.71	$33.53	$110.70	$287.50	$290.40	$46.58	$0.00	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200195	EAP	CPT® 88313		Stain Grp Ii - Nafl Inhi Nasd	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$214.71	$214.71	$33.53	$110.70	$287.50	$290.40	$46.58	$0.00	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200196	EAP	CPT® 88313		Stain Grp Ii - Pas	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$214.71	$214.71	$33.53	$110.70	$287.50	$290.40	$46.58	$0.00	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200197	EAP	CPT® 88313		Stain Grp Ii - Naphth Ester	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$214.71	$214.71	$33.53	$110.70	$287.50	$290.40	$46.58	$0.00	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200198	EAP	CPT® 88313		Stain Grp Ii - T Resist Ap	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$214.71	$214.71	$33.53	$110.70	$287.50	$290.40	$46.58	$0.00	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200199	EAP	CPT® 88313		Stain Grp Ii - Fontana Masson	BOTH IP/OP	$518.00 	$383.32	$21.08	$410.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$306.40	$306.40	$33.53	$110.70	$406.30	$410.40	$46.58	$316.55	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200200	EAP	CPT® 88313		Stain Grp Ii - Bile Stain	BOTH IP/OP	$513.00 	$379.62	$21.08	$410.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$303.44	$303.44	$33.53	$110.70	$406.30	$410.40	$46.58	$316.55	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200201	EAP	CPT® 88313		Stain Grp Ii - Calcium Stain	BOTH IP/OP	$518.00 	$383.32	$21.08	$410.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$306.40	$306.40	$33.53	$110.70	$406.30	$410.40	$46.58	$316.55	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200202	EAP	CPT® 88313		Stain Grp Ii - Melanin (bleach)	BOTH IP/OP	$513.00 	$379.62	$21.08	$410.40	$106.50	$106.50	$32.96	$32.96	$33.15	$33.25	$63.07	$63.07	$65.49	$32.43	$52.76	$21.08	$303.44	$303.44	$33.53	$110.70	$406.30	$410.40	$46.58	$316.55	$46.58	$56.22	$64.47	$64.47	$39.35	$31.93	$0.00	$0.00	$0.00	$0.00
31200203	EAP	CPT® 88342		A-1 Antitrypsin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200204	EAP	CPT® 88342		"Actin,muscle Spec."	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200205	EAP	CPT® 88342		Alpha-fetoprotein	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200206	EAP	CPT® 88342		B72.3-breast	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200207	EAP	CPT® 88342		Ca 125-ovarian Ca	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200208	EAP	CPT® 88342		Ca-19-9-carbohydrat	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200209	EAP	CPT® 88342		Calcitonin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200210	EAP	CPT® 88342		Cea-p	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200211	EAP	CPT® 88342		Chromogranin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200212	EAP	CPT® 88342		Cytokeratin-ae1/ae3	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200213	EAP	CPT® 88342		Cytokeratin-cam5.2	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200214	EAP	CPT® 88342		Cytomegalovirus	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200215	EAP	CPT® 88342		Desmin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200216	EAP	CPT® 88342		Ema	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200217	EAP	CPT® 88342		Factor Viii	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200219	EAP	CPT® 88342		*stain: Oncoprotein (bcl2)	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200220	EAP	CPT® 88342		*stain: Cd30/ber H2 (ki-1)	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200221	EAP	CPT® 88342		*stain: B-1 Glyco	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200222	EAP	CPT® 88342		*stain: Calponin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200223	EAP	CPT® 88342		*stain: Calretinin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200224	EAP	CPT® 88342		*stain: A-1 Antichymotryps	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200225	EAP	CPT® 88342		*stain: Cytokeratin 20	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200226	EAP	CPT® 88342		*stain: Cd10	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200227	EAP	CPT® 88342		*stain: Cd138	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200228	EAP	CPT® 88342		*stain: Cd23	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200229	EAP	CPT® 88342		*stain: Cd3	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200230	EAP	CPT® 88342		*stain: Cd31	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200231	EAP	CPT® 88342		*stain: Cd34	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200232	EAP	CPT® 88342		*stain: Cd43	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200233	EAP	CPT® 88342		*stain: Cd5	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200234	EAP	CPT® 88342		*stain: Cd79	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200235	EAP	CPT® 88360		*stain: Ki-67 (mib-1)	BOTH IP/OP	$642.00 	$475.08	$58.38	$492.80	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$379.74	$379.74	$143.92	$121.34	$487.87	$492.80	$199.96	$417.30	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31200236	EAP	CPT® 88342		*stain: Cytokeratin 7	BOTH IP/OP	$544.00 	$402.56	$48.82	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$321.78	$321.78	$143.92	$106.46	$434.81	$439.20	$199.96	$353.60	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200237	EAP	CPT® 88342		*stain: Hepatocyte	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200238	EAP	CPT® 88342		*stain: Hi Mol Wt Keratin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200239	EAP	CPT® 88342		*stain: Inhibin Alpha	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200240	EAP	CPT® 88342		*stain: Myeloperoxidase	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200241	EAP	CPT® 88342		*stain: P16	BOTH IP/OP	$544.00 	$402.56	$48.82	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$321.78	$321.78	$143.92	$106.46	$434.81	$439.20	$199.96	$353.60	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200242	EAP	CPT® 88342		*stain: P53	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200243	EAP	CPT® 88342		*stain: Tdt	BOTH IP/OP	$544.00 	$402.56	$48.82	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$321.78	$321.78	$143.92	$106.46	$434.81	$439.20	$199.96	$353.60	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200244	EAP	CPT® 88342		*stain: Ttf-1	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200245	EAP	CPT® 88342		*stain: Villin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200246	EAP	CPT® 88342		Immunoperoxidase	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200247	EAP	CPT® 88360		Estrogen Receptor	BOTH IP/OP	$620.00 	$458.80	$58.38	$492.80	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$366.73	$366.73	$143.92	$121.34	$487.87	$492.80	$199.96	$403.00	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31200248	EAP	CPT® 88360		Progesterone Recep.	BOTH IP/OP	$620.00 	$458.80	$58.38	$492.80	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$366.73	$366.73	$143.92	$121.34	$487.87	$492.80	$199.96	$403.00	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31200249	EAP	CPT® 88342		Glial Fibrillary Ap	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200250	EAP	CPT® 88342		Glucagon	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200251	EAP	CPT® 88342		Hepatitis B Core	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200252	EAP	CPT® 88342		Hepatitis B Surface	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200253	EAP	CPT® 88342		Herpes Simplex Prob	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200254	EAP	CPT® 88342		Human Chorionic Gon	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200255	EAP	CPT® 88342		Human Growth Hormon	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200256	EAP	CPT® 88342		Insulin	BOTH IP/OP	$544.00 	$402.56	$48.82	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$321.78	$321.78	$143.92	$106.46	$434.81	$439.20	$199.96	$353.60	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200257	EAP	CPT® 88342		Kappa	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200258	EAP	CPT® 88342		L-26 B Cell Marker	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200259	EAP	CPT® 88342		Lambda	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200260	EAP	CPT® 88342		Leu M1	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200261	EAP	CPT® 88342		Leukocyte Common Ag	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200262	EAP	CPT® 88342		Leuteinizing Hormon	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200263	EAP	CPT® 88342		Macrophage-ham-56	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200264	EAP	CPT® 88342		Melanoma-hmb-45	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200265	EAP	CPT® 88342		Neuron Spec Enolase	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200266	EAP	CPT® 88342		Placental Alk Phos	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200267	EAP	CPT® 88342		Placental Lactogen	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200268	EAP	CPT® 88342		Prolactin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200269	EAP	CPT® 88342		Prostate Acid Phos	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200270	EAP	CPT® 88342		Prostate Spec Ag	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200271	EAP	CPT® 88342		S-100 Neural Ag	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200272	EAP	CPT® 88342		Serotonin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200273	EAP	CPT® 88342		Synatophysin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200274	EAP	CPT® 88342		Thyroglobulin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200275	EAP	CPT® 88342		Uchl-1	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200276	EAP	CPT® 88342		Vimentin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200277	EAP	CPT® 88342		Em:kappa	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200278	EAP	CPT® 88342		Em:lambda	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200279	EAP	CPT® 88346		Em:igg	BOTH IP/OP	$764.00 	$565.36	$0.00	$648.00	$144.30	$144.30	$283.63	$283.63	$285.22	$50.44	$59.58	$59.58	$61.87	$279.15	$83.33	$181.45	$451.91	$451.91	$284.24	$112.24	$641.52	$648.00	$394.92	$0.00	$394.92	$88.79	$90.76	$90.76	$62.15	$270.71	$0.00	$0.00	$0.00	$0.00
31200280	EAP	CPT® 88346		Em:iga	BOTH IP/OP	$764.00 	$565.36	$0.00	$648.00	$144.30	$144.30	$283.63	$283.63	$285.22	$50.44	$59.58	$59.58	$61.87	$279.15	$83.33	$181.45	$451.91	$451.91	$284.24	$112.24	$641.52	$648.00	$394.92	$0.00	$394.92	$88.79	$90.76	$90.76	$62.15	$270.71	$0.00	$0.00	$0.00	$0.00
31200281	EAP	CPT® 88346		Em:igm	BOTH IP/OP	$764.00 	$565.36	$0.00	$648.00	$144.30	$144.30	$283.63	$283.63	$285.22	$50.44	$59.58	$59.58	$61.87	$279.15	$83.33	$181.45	$451.91	$451.91	$284.24	$112.24	$641.52	$648.00	$394.92	$0.00	$394.92	$88.79	$90.76	$90.76	$62.15	$270.71	$0.00	$0.00	$0.00	$0.00
31200282	EAP	CPT® 88346		Em:c3	BOTH IP/OP	$764.00 	$565.36	$0.00	$648.00	$144.30	$144.30	$283.63	$283.63	$285.22	$50.44	$59.58	$59.58	$61.87	$279.15	$83.33	$181.45	$451.91	$451.91	$284.24	$112.24	$641.52	$648.00	$394.92	$0.00	$394.92	$88.79	$90.76	$90.76	$62.15	$270.71	$0.00	$0.00	$0.00	$0.00
31200283	EAP	CPT® 88346		Em:c4	BOTH IP/OP	$764.00 	$565.36	$0.00	$648.00	$144.30	$144.30	$283.63	$283.63	$285.22	$50.44	$59.58	$59.58	$61.87	$279.15	$83.33	$181.45	$451.91	$451.91	$284.24	$112.24	$641.52	$648.00	$394.92	$0.00	$394.92	$88.79	$90.76	$90.76	$62.15	$270.71	$0.00	$0.00	$0.00	$0.00
31200284	EAP	CPT® 88346		Em:c1q	BOTH IP/OP	$764.00 	$565.36	$0.00	$648.00	$144.30	$144.30	$283.63	$283.63	$285.22	$50.44	$59.58	$59.58	$61.87	$279.15	$83.33	$181.45	$451.91	$451.91	$284.24	$112.24	$641.52	$648.00	$394.92	$0.00	$394.92	$88.79	$90.76	$90.76	$62.15	$270.71	$0.00	$0.00	$0.00	$0.00
31200285	EAP	CPT® 88346		Em:fibrogen	BOTH IP/OP	$764.00 	$565.36	$0.00	$648.00	$144.30	$144.30	$283.63	$283.63	$285.22	$50.44	$59.58	$59.58	$61.87	$279.15	$83.33	$181.45	$451.91	$451.91	$284.24	$112.24	$641.52	$648.00	$394.92	$0.00	$394.92	$88.79	$90.76	$90.76	$62.15	$270.71	$0.00	$0.00	$0.00	$0.00
31200286	EAP	CPT® 88346		"Immunof,dir Charge"	BOTH IP/OP	$794.00 	$587.56	$50.44	$604.00	$144.30	$144.30	$283.63	$283.63	$285.22	$50.44	$59.58	$59.58	$61.87	$279.15	$83.33	$181.45	$469.65	$469.65	$284.24	$112.24	$597.96	$604.00	$394.92	$510.25	$394.92	$88.79	$90.76	$90.76	$62.15	$270.71	$0.00	$0.00	$0.00	$0.00
31200287	EAP	CPT® 88346		"Immunof, Ind Charge"	BOTH IP/OP	$537.00 	$397.38	$50.44	$408.80	$144.30	$144.30	$283.63	$283.63	$285.22	$50.44	$59.58	$59.58	$61.87	$279.15	$83.33	$181.45	$317.64	$317.64	$284.24	$112.24	$404.71	$408.80	$394.92	$349.05	$394.92	$88.79	$90.76	$90.76	$62.15	$270.71	$0.00	$0.00	$0.00	$0.00
31200288	EAP	CPT® 88360		*stain: Her2neu	BOTH IP/OP	$642.00 	$475.08	$58.38	$492.80	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$379.74	$379.74	$143.92	$121.34	$487.87	$492.80	$199.96	$417.30	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31200290	EAP	CPT® 88342		*stain: Ber Ep4	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200291	EAP	CPT® 88342		*stain: Cd117 (c-kit)	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200292	EAP	CPT® 88342		*stain: Cdx2	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200293	EAP	CPT® 88342		*stain: Cea (monoclonal)	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200294	EAP	CPT® 88342		*stain: Cyclin D1	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200295	EAP	CPT® 88342		*stain: Cytokeratin 19	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200296	EAP	CPT® 88342		*stain: Cytokeratin 5	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200297	EAP	CPT® 88342		*stain: Cytokeratin 5/6	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200298	EAP	CPT® 88342		*stain: Cytokeratin 6	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200299	EAP	CPT® 88342		*stain: E-cadherin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200300	EAP	CPT® 88342		*stain: Egfr	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200301	EAP	CPT® 88342		*stain: Galectin-3	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200302	EAP	CPT® 88342		*stain: Gcdfp-15	BOTH IP/OP	$544.00 	$402.56	$48.82	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$321.78	$321.78	$143.92	$106.46	$434.81	$439.20	$199.96	$353.60	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200303	EAP	CPT® 88342		*stain: Hbme-1	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200304	EAP	CPT® 88342		*stain: Helicobacter Pylori	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200305	EAP	CPT® 88342		*stain: Hhv-8 (human Herpes-8)	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200306	EAP	CPT® 88342		*stain: Melan A (mart-1)	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200307	EAP	CPT® 88342		*stain: P10	BOTH IP/OP	$544.00 	$402.56	$48.82	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$321.78	$321.78	$143.92	$106.46	$434.81	$439.20	$199.96	$353.60	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200308	EAP	CPT® 88342		*stain: P63	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200309	EAP	CPT® 88342		*stain: Treponema	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200310	EAP	CPT® 88342		*stain: Wt-1	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200311	EAP	CPT® 88342		*stain:pin Cocktail(p63=p504s)	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200312	EAP	CPT® 88342		*stain:sma(smooth Muscle Actin	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200313	EAP	CPT® 88342		Stain: Cd56	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200314	EAP	CPT® 88342		Stain: Cd99	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200315	EAP	CPT® 88342		Stain: Glypican-3	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200316	EAP	CPT® 88342		Stain: Moc-1	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200317	EAP	CPT® 88342		Immunohisto Chemistry	BOTH IP/OP	$278.00 	$205.72	$0.00	$222.40	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$164.44	$164.44	$143.92	$106.46	$220.18	$222.40	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200320	EAP	CPT® 88342		Ihc Marker (stain Only) (so)	BOTH IP/OP	$333.00 	$246.42	$0.00	$266.40	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$196.97	$196.97	$143.92	$106.46	$263.74	$266.40	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200321	EAP	CPT® 88361		Inscape  Er/pr/her Quant-ihc  (so)	BOTH IP/OP	$736.00 	$544.64	$0.00	$588.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.90	$96.90	$100.62	$0.00	$143.65	$0.00	$0.00	$0.00	$0.00	$212.60	$582.91	$588.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31200322	EAP	CPT® 88361		Inscape Er/pr Quant -ihc  (so)	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.90	$96.90	$100.62	$0.00	$143.65	$0.00	$0.00	$0.00	$0.00	$212.60	$403.92	$408.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31200323	EAP	CPT® 88342		Ercc1  Ihc With Interp (so)	BOTH IP/OP	$278.00 	$205.72	$0.00	$222.40	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$164.44	$164.44	$143.92	$106.46	$220.18	$222.40	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200330	EAP	CPT® 88305		Accessort Digit  Diagnostic	BOTH IP/OP	$367.00 	$271.58	$0.00	$293.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$217.08	$217.08	$49.62	$140.98	$290.66	$293.60	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200331	EAP	CPT® 88305		Acromioclavicular Joint	BOTH IP/OP	$367.00 	$271.58	$0.00	$293.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$217.08	$217.08	$49.62	$140.98	$290.66	$293.60	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200332	EAP	CPT® 88304		Adhesions  Pelvic	BOTH IP/OP	$371.00 	$274.54	$18.49	$293.60	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$219.45	$219.45	$49.62	$108.12	$290.66	$293.60	$68.93	$241.15	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200333	EAP	CPT® 88304		Adipose Tissue (fat/fatty Tissue)	BOTH IP/OP	$367.00 	$271.58	$0.00	$293.60	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$217.08	$217.08	$49.62	$108.12	$290.66	$293.60	$68.93	$0.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200334	EAP	CPT® 88305		Ampulla Of Vater	BOTH IP/OP	$371.00 	$274.54	$31.00	$293.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$219.45	$219.45	$49.62	$140.98	$290.66	$293.60	$68.93	$241.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200335	EAP	CPT® 88307		Amputation-extremity  Non-traumatic	BOTH IP/OP	$371.00 	$274.54	$116.80	$371.00	$371.00	$371.00	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$219.45	$219.45	$284.24	$240.00	$290.66	$293.60	$367.00	$241.15	$367.00	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200336	EAP	CPT® 88307		Arachnoid Mater-tumor Resection	BOTH IP/OP	$367.00 	$271.58	$0.00	$367.00	$367.00	$367.00	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$217.08	$217.08	$284.24	$240.00	$290.66	$293.60	$367.00	$0.00	$367.00	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200337	EAP	CPT® 88305		Arteriovenous Malformation (avm)	BOTH IP/OP	$474.00 	$350.76	$31.00	$375.20	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$280.37	$280.37	$49.62	$140.98	$371.45	$375.20	$68.93	$308.10	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200338	EAP	CPT® 88307		Arteriovenous Malformation (avm)  Complex	BOTH IP/OP	$474.00 	$350.76	$116.80	$406.48	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$280.37	$280.37	$284.24	$240.00	$371.45	$375.20	$394.92	$308.10	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200339	EAP	CPT® 88307		Axillary Tail/axilla - Lymph Nodes Resection	BOTH IP/OP	$474.00 	$350.76	$116.80	$406.48	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$280.37	$280.37	$284.24	$240.00	$371.45	$375.20	$394.92	$308.10	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200340	EAP	CPT® 88305		Bone Marrow Particle Clot	BOTH IP/OP	$474.00 	$350.76	$31.00	$375.20	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$280.37	$280.37	$49.62	$140.98	$371.45	$375.20	$68.93	$308.10	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200341	EAP	CPT® 88305		Breast Excision Of Discrete Lesion	BOTH IP/OP	$474.00 	$350.76	$31.00	$375.20	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$280.37	$280.37	$49.62	$140.98	$371.45	$375.20	$68.93	$308.10	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200342	EAP	CPT® 88305		Breast Needle Core Tissue Biopsy	BOTH IP/OP	$474.00 	$350.76	$31.00	$375.20	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$280.37	$280.37	$49.62	$140.98	$371.45	$375.20	$68.93	$308.10	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200343	EAP	CPT® 88305		Breast  Incisional Biopsy	BOTH IP/OP	$474.00 	$350.76	$31.00	$375.20	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$280.37	$280.37	$49.62	$140.98	$371.45	$375.20	$68.93	$308.10	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200344	EAP	CPT® 88307		Breast  Quadrantectomy/partial Mastectomy/segmentectomy	BOTH IP/OP	$474.00 	$350.76	$116.80	$406.48	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$280.37	$280.37	$284.24	$240.00	$371.45	$375.20	$394.92	$308.10	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200345	EAP	CPT® 88307		Cervix Amputation Without Uterus	BOTH IP/OP	$474.00 	$350.76	$116.80	$406.48	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$280.37	$280.37	$284.24	$240.00	$371.45	$375.20	$394.92	$308.10	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200346	EAP	CPT® 88305		"Colon ""donut"""	BOTH IP/OP	$474.00 	$350.76	$31.00	$375.20	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$280.37	$280.37	$49.62	$140.98	$371.45	$375.20	$68.93	$308.10	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200347	EAP	CPT® 88304		Colon Donut	BOTH IP/OP	$474.00 	$350.76	$18.49	$375.20	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$280.37	$280.37	$49.62	$108.12	$371.45	$375.20	$68.93	$308.10	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200348	EAP	CPT® 88307		Cyst - Bone	BOTH IP/OP	$469.00 	$347.06	$0.00	$406.48	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$277.41	$277.41	$284.24	$240.00	$371.45	$375.20	$394.92	$0.00	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200349	EAP	CPT® 88305		Cyst - Cervix	BOTH IP/OP	$469.00 	$347.06	$0.00	$375.20	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$277.41	$277.41	$49.62	$140.98	$371.45	$375.20	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200350	EAP	CPT® 88307		Cyst - Dermoid Of Soft Tissue/ovary (eg Teratoma)	BOTH IP/OP	$474.00 	$350.76	$116.80	$406.48	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$280.37	$280.37	$284.24	$240.00	$371.45	$375.20	$394.92	$308.10	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200351	EAP	CPT® 88304		Cyst - Dermoid Skin	BOTH IP/OP	$469.00 	$347.06	$18.49	$375.20	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$277.41	$277.41	$49.62	$108.12	$371.45	$375.20	$68.93	$304.85	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200352	EAP	CPT® 88304		Cyst - Epidermoid	BOTH IP/OP	$591.00 	$437.34	$18.49	$468.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$349.58	$349.58	$49.62	$108.12	$463.32	$468.00	$68.93	$384.15	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200353	EAP	CPT® 88305		Cyst - Ovarian  Non-neoplastic	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200354	EAP	CPT® 88307		Cyst  Nos  Neoplastic	BOTH IP/OP	$591.00 	$437.34	$116.80	$468.00	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$349.58	$349.58	$284.24	$240.00	$463.32	$468.00	$394.92	$384.15	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200355	EAP	CPT® 88305		Cyst  Nos  Nonneoplastic	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200356	EAP	CPT® 88302		Cystocele	BOTH IP/OP	$585.00 	$432.90	$14.11	$468.00	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$346.03	$346.03	$23.06	$87.44	$463.32	$468.00	$32.04	$291.20	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200357	EAP	CPT® 88309		Diaphragm - Resection For Tumor	BOTH IP/OP	$585.00 	$432.90	$0.00	$638.19	$585.00	$585.00	$638.19	$638.19	$585.00	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$346.03	$346.03	$630.05	$328.48	$463.32	$468.00	$585.00	$0.00	$585.00	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200358	EAP	CPT® 88307		Diaphragm - Resection Other Than For Tumor	BOTH IP/OP	$585.00 	$432.90	$0.00	$468.00	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$346.03	$346.03	$284.24	$240.00	$463.32	$468.00	$394.92	$0.00	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200359	EAP	CPT® 88307		Dura Mater - Tumor Resection	BOTH IP/OP	$591.00 	$437.34	$116.80	$468.00	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$349.58	$349.58	$284.24	$240.00	$463.32	$468.00	$394.92	$384.15	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200360	EAP	CPT® 88305		Endometrial Polyp	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200361	EAP	CPT® 88309		Endoscopic Mucosal Resection (emr)	BOTH IP/OP	$591.00 	$437.34	$164.53	$638.19	$591.00	$591.00	$638.19	$638.19	$591.00	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$349.58	$349.58	$630.05	$328.48	$463.32	$468.00	$585.00	$384.15	$585.00	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200362	EAP	CPT® 88305		Epiglottis Biopsy/simple Excision	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200363	EAP	CPT® 88305		Esophageal Polyp	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200364	EAP	CPT® 88304		Fat/fatty Tissue Nos	BOTH IP/OP	$585.00 	$432.90	$0.00	$468.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$346.03	$346.03	$49.62	$108.12	$463.32	$468.00	$68.93	$0.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200365	EAP	CPT® 88305		Gastric Polyp	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200366	EAP	CPT® 88305		Mucosa Biopsy - Gingiva	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200367	EAP	CPT® 88305		Mucosa Biopsy - Nasal	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200368	EAP	CPT® 88305		Mucosa Biopsy - Nos	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200369	EAP	CPT® 88304		Nasal Septum	BOTH IP/OP	$591.00 	$437.34	$18.49	$468.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$349.58	$349.58	$49.62	$108.12	$463.32	$468.00	$68.93	$384.15	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200370	EAP	CPT® 88307		Omentum Resection	BOTH IP/OP	$591.00 	$437.34	$116.80	$468.00	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$349.58	$349.58	$284.24	$240.00	$463.32	$468.00	$394.92	$384.15	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200371	EAP	CPT® 88309		Omentum Resection - For Tumor	BOTH IP/OP	$591.00 	$437.34	$164.53	$638.19	$591.00	$591.00	$638.19	$638.19	$591.00	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$349.58	$349.58	$630.05	$328.48	$463.32	$468.00	$585.00	$384.15	$585.00	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200372	EAP	CPT® 88305		Oral Cyst	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200373	EAP	CPT® 88305		Panniculus	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200374	EAP	CPT® 88305		Penis Biopsy	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200375	EAP	CPT® 88309		Penis Resection For Tumor	BOTH IP/OP	$591.00 	$437.34	$164.53	$638.19	$591.00	$591.00	$638.19	$638.19	$591.00	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$349.58	$349.58	$630.05	$328.48	$463.32	$468.00	$585.00	$384.15	$585.00	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200376	EAP	CPT® 88305		Pericardiium Biopsy Or Tissue	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200377	EAP	CPT® 88309		Pericardium Resection - For Tumor	BOTH IP/OP	$585.00 	$432.90	$0.00	$638.19	$585.00	$585.00	$638.19	$638.19	$585.00	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$346.03	$346.03	$630.05	$328.48	$463.32	$468.00	$585.00	$0.00	$585.00	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200378	EAP	CPT® 88309		Peritoneum Resection - For Tumor	BOTH IP/OP	$591.00 	$437.34	$164.53	$638.19	$591.00	$591.00	$638.19	$638.19	$591.00	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$349.58	$349.58	$630.05	$328.48	$463.32	$468.00	$585.00	$384.15	$585.00	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200379	EAP	CPT® 88305		Pia Mater - Other Than Tumor Resection	BOTH IP/OP	$585.00 	$432.90	$0.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$346.03	$346.03	$49.62	$140.98	$463.32	$468.00	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200380	EAP	CPT® 88307		Pia Mater - Tumor Resection	BOTH IP/OP	$585.00 	$432.90	$0.00	$468.00	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$346.03	$346.03	$284.24	$240.00	$463.32	$468.00	$394.92	$0.00	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200381	EAP	CPT® 88307		Pleura Resection	BOTH IP/OP	$591.00 	$437.34	$116.80	$468.00	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$349.58	$349.58	$284.24	$240.00	$463.32	$468.00	$394.92	$384.15	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200382	EAP	CPT® 88305		Retroperitoneal Biopsy	BOTH IP/OP	$585.00 	$432.90	$0.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$346.03	$346.03	$49.62	$140.98	$463.32	$468.00	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200383	EAP	CPT® 88304		Scar - Soft Tissue	BOTH IP/OP	$591.00 	$437.34	$18.49	$468.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$349.58	$349.58	$49.62	$108.12	$463.32	$468.00	$68.93	$384.15	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200384	EAP	CPT® 88305		Skin  Wart (eg  Verruca Vulgaris)	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200385	EAP	CPT® 88305		Spinal Cord Biopsy	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200386	EAP	CPT® 88307		Spinal Cord Tumor Excision	BOTH IP/OP	$591.00 	$437.34	$116.80	$468.00	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$349.58	$349.58	$284.24	$240.00	$463.32	$468.00	$394.92	$384.15	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200387	EAP	CPT® 88304		Stoma (any Site)	BOTH IP/OP	$591.00 	$437.34	$18.49	$468.00	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$349.58	$349.58	$49.62	$108.12	$463.32	$468.00	$68.93	$384.15	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200388	EAP	CPT® 88305		Stomach Polyp	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200389	EAP	CPT® 88302		Supernumerary Digit	BOTH IP/OP	$591.00 	$437.34	$14.11	$468.00	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$349.58	$349.58	$23.06	$87.44	$463.32	$468.00	$32.04	$291.20	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200390	EAP	CPT® 88305		Supernumerary Digit Diagnostic	BOTH IP/OP	$585.00 	$432.90	$0.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$346.03	$346.03	$49.62	$140.98	$463.32	$468.00	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200391	EAP	CPT® 88307		Surgical Margin  Complicated Exam	BOTH IP/OP	$591.00 	$437.34	$116.80	$468.00	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$349.58	$349.58	$284.24	$240.00	$463.32	$468.00	$394.92	$384.15	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200392	EAP	CPT® 88302		Thymus  Incidential	BOTH IP/OP	$591.00 	$437.34	$14.11	$468.00	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$349.58	$349.58	$23.06	$87.44	$463.32	$468.00	$32.04	$291.20	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200393	EAP	CPT® 88302		Uvula - Incidental	BOTH IP/OP	$585.00 	$432.90	$14.11	$468.00	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$346.03	$346.03	$23.06	$87.44	$463.32	$468.00	$32.04	$291.20	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200394	EAP	CPT® 88305		Vocal Cord Biopsy	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200395	EAP	CPT® 88307		Vocal Cord Resection	BOTH IP/OP	$591.00 	$437.34	$116.80	$468.00	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$349.58	$349.58	$284.24	$240.00	$463.32	$468.00	$394.92	$384.15	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200396	EAP	CPT® 88307		Bone Cyst	BOTH IP/OP	$591.00 	$437.34	$116.80	$468.00	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$349.58	$349.58	$284.24	$240.00	$463.32	$468.00	$394.92	$384.15	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200397	EAP	CPT® 88305		Breast Biopsy  Without Margin Exam	BOTH IP/OP	$591.00 	$437.34	$31.00	$468.00	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$349.58	$349.58	$49.62	$140.98	$463.32	$468.00	$68.93	$384.15	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200398	EAP	CPT® 88307		Cyst - Ovarian  Neoplastic	BOTH IP/OP	$591.00 	$437.34	$116.80	$468.00	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$349.58	$349.58	$284.24	$240.00	$463.32	$468.00	$394.92	$384.15	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200399	EAP	CPT® 88305		Cyst - Sinsus	BOTH IP/OP	$737.00 	$545.38	$0.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$435.94	$435.94	$49.62	$140.98	$583.70	$589.60	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200400	EAP	CPT® 88305		Diaphragm Biopsy Or Tissue	BOTH IP/OP	$737.00 	$545.38	$0.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$435.94	$435.94	$49.62	$140.98	$583.70	$589.60	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200401	EAP	CPT® 88304		Diverticulum - Bladder/urethra	BOTH IP/OP	$745.00 	$551.30	$18.49	$589.60	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$440.67	$440.67	$49.62	$108.12	$583.70	$589.60	$68.93	$429.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200402	EAP	CPT® 88305		Dura Mater	BOTH IP/OP	$745.00 	$551.30	$31.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$440.67	$440.67	$49.62	$140.98	$583.70	$589.60	$68.93	$484.25	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200403	EAP	CPT® 88302		Enterocele	BOTH IP/OP	$737.00 	$545.38	$14.11	$589.60	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$435.94	$435.94	$23.06	$87.44	$583.70	$589.60	$32.04	$291.20	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200404	EAP	CPT® 88305		Ethmoid Tissue	BOTH IP/OP	$737.00 	$545.38	$0.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$435.94	$435.94	$49.62	$140.98	$583.70	$589.60	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200405	EAP	CPT® 88305		Fat Pad  Biopsy	BOTH IP/OP	$745.00 	$551.30	$31.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$440.67	$440.67	$49.62	$140.98	$583.70	$589.60	$68.93	$484.25	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200406	EAP	CPT® 88305		Leep Biopsy	BOTH IP/OP	$745.00 	$551.30	$31.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$440.67	$440.67	$49.62	$140.98	$583.70	$589.60	$68.93	$484.25	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200407	EAP	CPT® 88304		Ligament	BOTH IP/OP	$745.00 	$551.30	$18.49	$589.60	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$440.67	$440.67	$49.62	$108.12	$583.70	$589.60	$68.93	$484.25	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200408	EAP	CPT® 88307		Lymph Node For Lymphoma Workup	BOTH IP/OP	$745.00 	$551.30	$116.80	$589.60	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$440.67	$440.67	$284.24	$240.00	$583.70	$589.60	$394.92	$484.25	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200409	EAP	CPT® 88304		Meningematoma/meninghematoma	BOTH IP/OP	$737.00 	$545.38	$18.49	$589.60	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$435.94	$435.94	$49.62	$108.12	$583.70	$589.60	$68.93	$429.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200410	EAP	CPT® 88305		Mucosa Biopsy - Oral	BOTH IP/OP	$745.00 	$551.30	$31.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$440.67	$440.67	$49.62	$140.98	$583.70	$589.60	$68.93	$484.25	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200411	EAP	CPT® 88304		Nail  Nail Bed Or Scrapping For Fungus	BOTH IP/OP	$745.00 	$551.30	$18.49	$589.60	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$440.67	$440.67	$49.62	$108.12	$583.70	$589.60	$68.93	$429.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200412	EAP	CPT® 88307		Nerve Tumor	BOTH IP/OP	$745.00 	$551.30	$116.80	$589.60	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$440.67	$440.67	$284.24	$240.00	$583.70	$589.60	$394.92	$484.25	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200413	EAP	CPT® 88305		Neurofibroma/neuroma	BOTH IP/OP	$737.00 	$545.38	$0.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$435.94	$435.94	$49.62	$140.98	$583.70	$589.60	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200414	EAP	CPT® 88305		Osteochondroma (exostosis)	BOTH IP/OP	$737.00 	$545.38	$0.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$435.94	$435.94	$49.62	$140.98	$583.70	$589.60	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200415	EAP	CPT® 88307		Pericardium Resection	BOTH IP/OP	$737.00 	$545.38	$0.00	$589.60	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$435.94	$435.94	$284.24	$240.00	$583.70	$589.60	$394.92	$0.00	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200416	EAP	CPT® 88307		Peritoneum Resection	BOTH IP/OP	$737.00 	$545.38	$0.00	$589.60	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$435.94	$435.94	$284.24	$240.00	$583.70	$589.60	$394.92	$0.00	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200417	EAP	CPT® 88309		Pleura Resection - For Tumor	BOTH IP/OP	$745.00 	$551.30	$164.53	$737.00	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$440.67	$440.67	$630.05	$328.48	$583.70	$589.60	$737.00	$484.25	$737.00	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200418	EAP	CPT® 88307		Retroperitoneal Mass	BOTH IP/OP	$737.00 	$545.38	$0.00	$589.60	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$435.94	$435.94	$284.24	$240.00	$583.70	$589.60	$394.92	$0.00	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200419	EAP	CPT® 88305		Rib  Marrow Squeeze	BOTH IP/OP	$737.00 	$545.38	$0.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$435.94	$435.94	$49.62	$140.98	$583.70	$589.60	$68.93	$0.00	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200420	EAP	CPT® 88305		Scar - Keloid	BOTH IP/OP	$745.00 	$551.30	$31.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$440.67	$440.67	$49.62	$140.98	$583.70	$589.60	$68.93	$484.25	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200421	EAP	CPT® 88304		Scar - Skin (simple/cicatrix)	BOTH IP/OP	$745.00 	$551.30	$18.49	$589.60	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$440.67	$440.67	$49.62	$108.12	$583.70	$589.60	$68.93	$429.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200422	EAP	CPT® 88305		Scar - Skin (tumor Excision/re-excision	BOTH IP/OP	$745.00 	$551.30	$31.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$440.67	$440.67	$49.62	$140.98	$583.70	$589.60	$68.93	$484.25	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200423	EAP	CPT® 88302		Sinus Contents	BOTH IP/OP	"$1,012.00 "	$748.88	$14.11	$800.80	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$598.60	$598.60	$23.06	$87.44	$792.79	$800.80	$32.04	$291.20	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200424	EAP	CPT® 88305		Sinus Mucosa Stripping	BOTH IP/OP	"$1,001.00 "	$740.74	$31.00	$800.80	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$592.09	$592.09	$49.62	$140.98	$792.79	$800.80	$68.93	$521.30	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200425	EAP	CPT® 88305		Surgical Margin  Uncomplicated Exam	BOTH IP/OP	"$1,012.00 "	$748.88	$31.00	$800.80	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$598.60	$598.60	$49.62	$140.98	$792.79	$800.80	$68.93	$657.80	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200426	EAP	CPT® 88305		Thyroid Biopsy	BOTH IP/OP	"$1,012.00 "	$748.88	$31.00	$800.80	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$598.60	$598.60	$49.62	$140.98	$792.79	$800.80	$68.93	$521.30	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200427	EAP	CPT® 88304		Turbinates (nasal Conchae)	BOTH IP/OP	"$1,012.00 "	$748.88	$18.49	$800.80	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$598.60	$598.60	$49.62	$108.12	$792.79	$800.80	$68.93	$429.00	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200428	EAP	CPT® 88302		Uvula Simple Excision	BOTH IP/OP	"$1,012.00 "	$748.88	$14.11	$800.80	$47.04	$47.04	$24.06	$24.06	$24.19	$14.11	$43.98	$43.98	$45.67	$23.64	$41.19	$15.37	$598.60	$598.60	$23.06	$87.44	$792.79	$800.80	$32.04	$291.20	$32.04	$43.89	$24.13	$24.13	$30.72	$21.96	$0.00	$0.00	$0.00	$0.00
31200429	EAP	CPT® 88305		Vein Biopsy/segment	BOTH IP/OP	"$1,012.00 "	$748.88	$31.00	$800.80	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$598.60	$598.60	$49.62	$140.98	$792.79	$800.80	$68.93	$521.30	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200450	EAP	CPT® 88342		"P40 Protein, Ihc"	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200455	EAP	CPT® 88309		"Teratoma , Extensive Resection"	BOTH IP/OP	"$1,001.00 "	$740.74	$0.00	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$592.09	$592.09	$630.05	$328.48	$792.79	$800.80	$875.37	$0.00	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200456	EAP	CPT® 88342		"Napsin-a,ihc"	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200457	EAP	CPT® 88304		"Appendix, Non-incidental"	BOTH IP/OP	$474.00 	$350.76	$18.49	$375.20	$62.70	$62.70	$48.39	$48.39	$48.66	$18.49	$53.11	$53.11	$55.16	$47.69	$35.46	$31.00	$280.37	$280.37	$49.62	$108.12	$371.45	$375.20	$68.93	$308.10	$68.93	$37.78	$29.89	$29.89	$26.45	$47.25	$0.00	$0.00	$0.00	$0.00
31200458	EAP	CPT® 88307		Sentinel Lymph Node(s)	BOTH IP/OP	$745.00 	$551.30	$116.80	$589.60	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$440.67	$440.67	$284.24	$240.00	$583.70	$589.60	$394.92	$484.25	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200459	EAP	CPT® 88305		Needle Core Biopsy	BOTH IP/OP	$745.00 	$551.30	$31.00	$589.60	$104.86	$104.86	$48.39	$48.39	$48.66	$31.63	$70.10	$70.10	$72.79	$47.69	$77.40	$31.00	$440.67	$440.67	$49.62	$140.98	$583.70	$589.60	$68.93	$484.25	$68.93	$82.47	$32.05	$32.05	$57.73	$47.25	$0.00	$0.00	$0.00	$0.00
31200460	EAP	CPT® 88300		"Tissue, Gross Only"	BOTH IP/OP	$266.00 	$196.84	$7.30	$210.40	$24.87	$24.87	$24.06	$24.06	$24.19	$7.30	$19.71	$19.71	$20.47	$23.64	$16.80	$15.37	$157.34	$157.34	$23.06	$38.76	$208.30	$210.40	$32.04	$172.90	$32.04	$17.90	$11.16	$11.16	$12.53	$21.96	$0.00	$0.00	$0.00	$0.00
31200461	EAP	CPT® 88329		Intra-operative Pathology Consult	BOTH IP/OP	$298.00 	$220.52	$0.00	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.74	$34.74	$36.07	$0.00	$43.31	$0.00	$0.00	$0.00	$0.00	$101.94	$236.02	$238.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31200462	EAP	CPT® 88331		First Tissue Block W Fs (single Spec)	BOTH IP/OP	$581.00 	$429.94	$30.54	$426.40	$148.63	$148.63	$145.24	$145.24	$146.06	$44.60	$30.54	$30.54	$31.72	$142.96	$87.82	$92.92	$343.66	$343.66	$143.92	$57.46	$422.14	$426.40	$199.96	$377.65	$199.96	$93.58	$34.94	$34.94	$65.50	$137.07	$0.00	$0.00	$0.00	$0.00
31200463	EAP	CPT® 88332		Each Add Tissue Block W Frozen Section(s)	BOTH IP/OP	$280.00 	$207.20	$0.00	$205.60	$80.52	$80.52	$0.00	$0.00	$0.00	$24.49	$10.90	$10.90	$11.32	$0.00	$44.09	$0.00	$165.62	$165.62	$0.00	$20.46	$203.54	$205.60	$0.00	$182.00	$0.00	$46.98	$23.05	$23.05	$32.88	$0.00	$0.00	$0.00	$0.00	$0.00
31200464	EAP	CPT® 88360		ER/PR QUANTITIATIVE IHC	BOTH IP/OP	"$1,001.00 "	$740.74	$58.38	$796.00	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$592.09	$592.09	$143.92	$121.34	$788.04	$796.00	$199.96	$650.65	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31200466	EAP	CPT® 88342		"Human Herpesvirus , Type 8(hhv-8)"	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$301.67	$301.67	$143.92	$106.46	$403.92	$408.00	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200467	EAP	CPT® 88342		"Neuron Specific Enolase (nse), Ihc"	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200468	EAP	CPT® 88342		"Cd20, L26, Ihc"	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200469	EAP	CPT® 88307		Salivary Gland	BOTH IP/OP	$774.00 	$572.76	$0.00	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$457.82	$457.82	$284.24	$240.00	$613.01	$619.20	$394.92	$0.00	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200470	EAP	CPT® 88307		"Urinary Bladder, Tur"	BOTH IP/OP	$782.00 	$578.68	$116.80	$619.20	$406.48	$406.48	$283.63	$283.63	$285.22	$123.09	$135.39	$135.39	$140.59	$279.15	$156.60	$181.45	$462.55	$462.55	$284.24	$240.00	$613.01	$619.20	$394.92	$508.30	$394.92	$166.86	$194.49	$194.49	$116.80	$270.71	$0.00	$0.00	$0.00	$0.00
31200471	EAP	CPT® 88333		Intraoperative Cytologic Examination (touch Prep) Initial Site	BOTH IP/OP	$654.00 	$483.96	$0.00	$641.78	$143.77	$143.77	$638.19	$638.19	$641.78	$41.03	$32.82	$32.82	$34.08	$628.87	$88.68	$408.76	$386.84	$386.84	$0.00	$57.46	$475.20	$480.00	$0.00	$425.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31200472	EAP	CPT® 88334		Intraoperative Cytologic Examination (touch Prep) Add Site	BOTH IP/OP	$280.00 	$207.20	$0.00	$205.60	$0.00	$0.00	$0.00	$0.00	$0.00	$25.62	$20.02	$20.02	$20.79	$0.00	$46.34	$0.00	$165.62	$165.62	$0.00	$34.52	$203.54	$205.60	$0.00	$182.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31200473	EAP	CPT® 88341		Ihc Stain - Additional	BOTH IP/OP	$766.00 	$566.84	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$453.09	$453.09	$0.00	$386.50	$612.22	$618.40	$0.00	$497.90	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200474	EAP	CPT® 88341		*stain: Melan A (mart-1)	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200475	EAP	CPT® 88341		*stain: P10	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200476	EAP	CPT® 88341		*stain: P63	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200477	EAP	CPT® 88341		*stain: Treponema	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200478	EAP	CPT® 88341		*stain: Wt-1	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200479	EAP	CPT® 88341		*stain: Pin Cocktail(p63=p504s)	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200480	EAP	CPT® 88341		*stain: Sma(smooth Muscle Actin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200481	EAP	CPT® 88341		Stain: Cd56	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200482	EAP	CPT® 88341		Stain: Cd99	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200483	EAP	CPT® 88341		Stain: Glypican-3	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200484	EAP	CPT® 88341		Stain: Moc-1	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200485	EAP	CPT® 88341		Immunohisto Chemistry	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200486	EAP	CPT® 88341		Ihc Marker (stain Only) (so)	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200487	EAP	CPT® 88341		Ercc1 Ihc With Interp (so)	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200488	EAP	CPT® 88341		"P40 Protein, Ihc"	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200489	EAP	CPT® 88341		"Napsin-a,ihc"	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200490	EAP	CPT® 88341		"Neuron Specific Enolase (nse), Ihc"	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200491	EAP	CPT® 88341		"Cd20, L26, Ihc"	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200492	EAP	CPT® 88341		Placental Lactogen	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200493	EAP	CPT® 88341		Prolactin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200494	EAP	CPT® 88341		Prostate Acid Phos	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200495	EAP	CPT® 88341		Prostate Spec Ag	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200496	EAP	CPT® 88341		S-100 Neural Ag	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200497	EAP	CPT® 88341		Serotonin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200498	EAP	CPT® 88341		Synatophysin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200499	EAP	CPT® 88341		Thyroglobulin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200500	EAP	CPT® 88341		Uchl-1	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200501	EAP	CPT® 88341		Vimentin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200502	EAP	CPT® 88341		Em:kappa	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200503	EAP	CPT® 88341		Em:lambda	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200504	EAP	CPT® 88341		*stain: Ber Ep4	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200505	EAP	CPT® 88341		*stain: Cd117 (c-kit)	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200506	EAP	CPT® 88341		*stain: Cdx2	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200507	EAP	CPT® 88341		*stain: Cdx2	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200508	EAP	CPT® 88341		*stain: Cea (monoclonal)	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200509	EAP	CPT® 88341		*stain: Cyclin D1	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200510	EAP	CPT® 88341		*stain: Cyclin D1	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200511	EAP	CPT® 88341		*stain: Cytokeratin 19	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200512	EAP	CPT® 88341		*stain: Cytokeratin 5	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200513	EAP	CPT® 88341		*stain: Cytokeratin 5/6	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200514	EAP	CPT® 88341		*stain: Cytokeratin 6	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200515	EAP	CPT® 88341		*stain: E-cadherin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200516	EAP	CPT® 88341		*stain: Egfr	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200517	EAP	CPT® 88341		*stain: Galectin-3	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200518	EAP	CPT® 88341		*stain: Gcdfp-15	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200519	EAP	CPT® 88341		*stain: Hbme-1	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200520	EAP	CPT® 88341		*stain: Helicobacter Pylori	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200521	EAP	CPT® 88341		*stain: Hhv-8 (human Herpes-8)	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200522	EAP	CPT® 88341		*stain: Cd79	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200523	EAP	CPT® 88341		*stain: Cytokeratin 7	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200524	EAP	CPT® 88341		*stain: Hepatocyte	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200525	EAP	CPT® 88341		*stain: Hi Mol Wt Keratin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200526	EAP	CPT® 88341		*stain: Inhibin Alpha	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200527	EAP	CPT® 88341		*stain: Myeloperoxidase	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200528	EAP	CPT® 88341		*stain: P16	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200529	EAP	CPT® 88341		*stain: P53	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200530	EAP	CPT® 88341		*stain: Tdt	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200531	EAP	CPT® 88341		*stain: Ttf-1	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200532	EAP	CPT® 88341		*stain: Villin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200533	EAP	CPT® 88341		Immunoperoxidase	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200534	EAP	CPT® 88341		Glial Fibrillary Ap	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200535	EAP	CPT® 88341		Glucagon	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200536	EAP	CPT® 88341		Hepatitis B Core	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200537	EAP	CPT® 88341		Hepatitis B Surface	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200538	EAP	CPT® 88341		Herpes Simplex Prob	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200539	EAP	CPT® 88341		Human Chorionic Gon	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200540	EAP	CPT® 88341		Human Growth Hormon	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200541	EAP	CPT® 88341		Insulin	BOTH IP/OP	$766.00 	$566.84	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$453.09	$453.09	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200542	EAP	CPT® 88341		Kappa	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200543	EAP	CPT® 88341		L-26 B Cell Marker	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200544	EAP	CPT® 88341		Lambda	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200545	EAP	CPT® 88341		Leu M1	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200546	EAP	CPT® 88341		Leukocyte Common Ag	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200547	EAP	CPT® 88341		Leuteinizing Hormon	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200548	EAP	CPT® 88341		Macrophage-ham-56	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200549	EAP	CPT® 88341		Melanoma-hmb-45	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200550	EAP	CPT® 88341		Neuron Spec Enolase	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200551	EAP	CPT® 88341		Placental Alk Phos	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200552	EAP	CPT® 88341		A-1 Antitrypsin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200553	EAP	CPT® 88341		"Actin,muscle Spec."	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200554	EAP	CPT® 88341		Alpha-fetoprotein	BOTH IP/OP	$586.00 	$433.64	$0.00	$468.80	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$346.62	$346.62	$0.00	$293.00	$464.11	$468.80	$0.00	$0.00	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200555	EAP	CPT® 88341		B72.3-breast	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200556	EAP	CPT® 88341		Ca 125-ovarian Ca	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200557	EAP	CPT® 88341		Ca-19-9-carbohydrat	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200558	EAP	CPT® 88341		Calcitonin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200559	EAP	CPT® 88341		Cea-p	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200560	EAP	CPT® 88341		Chromogranin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200561	EAP	CPT® 88341		Cytokeratin-ae1/ae3	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200562	EAP	CPT® 88341		Cytokeratin-cam5.2	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200563	EAP	CPT® 88341		Cytomegalovirus	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200564	EAP	CPT® 88341		Desmin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200565	EAP	CPT® 88341		Ema	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200566	EAP	CPT® 88341		Factor Viii	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200567	EAP	CPT® 88341		*stain:oncoprotein (bcl2)	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200568	EAP	CPT® 88341		*stain: Cd30/ber H2 (ki-1)	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200569	EAP	CPT® 88341		*stain: B-1 Glyco	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200570	EAP	CPT® 88341		*stain: Calponin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200571	EAP	CPT® 88341		*stain: Calretinin	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200572	EAP	CPT® 88341		*stain: A-1 Antichymotryps	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200573	EAP	CPT® 88341		*stain: Cytokeratin 20	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200574	EAP	CPT® 88341		*stain: Cd10	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200575	EAP	CPT® 88341		*stain: Cd138	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200576	EAP	CPT® 88341		*stain: Cd23	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200577	EAP	CPT® 88341		*stain: Cd3	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200578	EAP	CPT® 88341		*stain: Cd31	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200579	EAP	CPT® 88341		*stain: Cd34	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200580	EAP	CPT® 88341		*stain: Cd43	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200581	EAP	CPT® 88341		*stain: Cd5	BOTH IP/OP	$773.00 	$572.02	$0.00	$618.40	$138.92	$138.92	$0.00	$0.00	$0.00	$42.49	$70.50	$70.50	$73.21	$0.00	$67.41	$0.00	$457.23	$457.23	$0.00	$386.50	$612.22	$618.40	$0.00	$389.35	$0.00	$71.83	$64.47	$64.47	$50.28	$0.00	$0.00	$0.00	$0.00	$0.00
31200582	EAP	CPT® 88342		Stain:cd45(lca)	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$324.73	$324.73	$143.92	$106.46	$434.81	$439.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200583	EAP	CPT® 88342		Stain:cd15	BOTH IP/OP	$369.00 	$273.06	$0.00	$295.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$218.26	$218.26	$143.92	$106.46	$292.25	$295.20	$199.96	$0.00	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31200584	EAP	CPT® 88360		Er/pr Paraffin (so)	BOTH IP/OP	$526.00 	$389.24	$58.38	$418.40	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$311.13	$311.13	$143.92	$121.34	$414.22	$418.40	$199.96	$341.90	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31200585	EAP	CPT® 88360		Her2 Ihc W/interpret (so)	BOTH IP/OP	$430.00 	$318.20	$58.38	$341.60	$214.05	$214.05	$145.24	$145.24	$146.06	$58.38	$68.33	$68.33	$70.96	$142.96	$114.71	$92.92	$254.35	$254.35	$143.92	$121.34	$338.18	$341.60	$199.96	$279.50	$199.96	$122.23	$83.20	$83.20	$85.56	$137.07	$0.00	$0.00	$0.00	$0.00
31200586	EAP	CPT® 88309		Surg Path Fetus And Placenta	BOTH IP/OP	"$1,062.00 "	$785.88	$164.53	$875.37	$623.22	$623.22	$638.19	$638.19	$641.78	$186.99	$185.59	$185.59	$192.73	$628.87	$220.59	$408.76	$628.17	$628.17	$630.05	$328.48	$832.39	$840.80	$875.37	$690.30	$875.37	$235.05	$274.45	$274.45	$164.53	$600.04	$0.00	$0.00	$0.00	$0.00
31200600	EAP	CPT® 88342		Ihc Stain - First	BOTH IP/OP	$544.00 	$402.56	$48.82	$439.20	$163.26	$163.26	$145.24	$145.24	$146.06	$48.82	$59.96	$59.96	$62.26	$142.96	$84.08	$92.92	$321.78	$321.78	$143.92	$106.46	$434.81	$439.20	$199.96	$353.60	$199.96	$89.59	$70.23	$70.23	$62.72	$137.07	$0.00	$0.00	$0.00	$0.00
31900001	EAP	CPT® 88348		Em Processing Only	BOTH IP/OP	"$3,624.00 "	"$2,681.76"	$0.00	"$3,072.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$572.71	$572.71	$594.73	$0.00	$328.30	$0.00	$0.00	$0.00	$0.00	$906.38	"$3,042.07"	"$3,072.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31900002	EAP	CPT® 88348		Em: Non Kidney	BOTH IP/OP	"$3,624.00 "	"$2,681.76"	$0.00	"$3,072.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$572.71	$572.71	$594.73	$0.00	$328.30	$0.00	$0.00	$0.00	$0.00	$906.38	"$3,042.07"	"$3,072.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31900003	EAP	CPT® 88348		Em:kidney	BOTH IP/OP	"$3,624.00 "	"$2,681.76"	$0.00	"$3,072.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$572.71	$572.71	$594.73	$0.00	$328.30	$0.00	$0.00	$0.00	$0.00	$906.38	"$3,042.07"	"$3,072.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31900004	EAP	CPT® 81229		Chromosomal Microarray  Postnatal (so)	BOTH IP/OP	"$1,401.00 "	"$1,036.74"	$0.00	"$2,903.98"	$807.84	$807.84	"$1,160.00"	"$1,160.00"	$580.00	$0.00	"$1,039.82"	"$1,039.82"	"$1,079.89"	$0.00	"$1,401.00"	$0.00	$0.00	$0.00	"$1,218.00"	$692.00	"$1,096.13"	"$1,107.20"	"$1,384.00"	"$1,914.00"	"$1,384.00"	"$2,903.98"	"$1,160.00"	"$1,160.00"	"$2,032.79"	"$1,160.00"	$0.00	$0.00	$0.00	$0.00
31900005	EAP	CPT® 81263		Cll-igvh Mutation Status  (so)	BOTH IP/OP	"$1,310.00 "	$969.40	$86.22	"$1,035.20"	$607.94	$607.94	$294.52	$294.52	$147.26	$147.26	$417.86	$417.86	$433.93	$294.52	$115.59	$191.44	$774.87	$774.87	$309.25	$647.00	"$1,024.85"	"$1,035.20"	$427.05	$485.96	$427.05	$123.17	$294.52	$294.52	$86.22	$294.52	$0.00	$0.00	$0.00	$0.00
31900007	EAP	CPT® 81301		Microsatelite Instability (msi) (so)	BOTH IP/OP	"$1,565.00 "	"$1,158.10"	$0.00	"$1,236.80"	$597.70	$597.70	$348.56	$348.56	$174.28	$0.00	$410.84	$410.84	$426.64	$0.00	$220.85	$0.00	$0.00	$0.00	$0.00	$773.00	"$1,224.43"	"$1,236.80"	$0.00	$575.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31900009	EAP	CPT® 81206		P210 Bcr-abl1 (so)	BOTH IP/OP	$630.00 	$466.20	$81.98	$497.60	$338.45	$338.45	$163.96	$163.96	$81.98	$81.98	$232.64	$232.64	$241.59	$163.96	$115.59	$106.57	$372.65	$372.65	$172.16	$311.00	$492.62	$497.60	$237.74	$270.53	$237.74	$123.17	$163.96	$163.96	$86.22	$163.96	$0.00	$0.00	$0.00	$0.00
31900011	EAP	CPT® 81235		Egfr Mutation Analysis  (so)	BOTH IP/OP	"$1,354.00 "	"$1,001.96"	$0.00	"$1,354.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$146.06	$343.21	$343.21	$356.41	$324.58	$115.59	$210.98	$800.89	$800.89	$340.81	$669.00	"$1,059.70"	"$1,070.40"	$470.64	"$1,354.00"	$470.64	$123.17	$324.58	$324.58	$86.22	$324.58	$0.00	$0.00	$0.00	$0.00
31900013	EAP	Custom 31900013		Bcr-abl1 Gene Rear Quant Pcr (so)	BOTH IP/OP	$630.00 	$466.20	$0.00	$497.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$467.59	$467.59	$485.60	$0.00	$131.29	$0.00	$0.00	$0.00	$0.00	$311.00	$492.62	$497.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31900014	EAP	CPT® 81207		P190 Bcr-abl1 (so)	BOTH IP/OP	$556.00 	$411.44	$72.42	$439.20	$298.98	$298.98	$144.84	$144.84	$72.42	$72.42	$205.49	$205.49	$213.40	$144.84	$115.59	$94.15	$328.87	$328.87	$152.08	$274.50	$434.81	$439.20	$210.02	$238.99	$210.02	$123.17	$144.84	$144.84	$86.22	$144.84	$0.00	$0.00	$0.00	$0.00
31900015	EAP	CPT® 88271		"Fish Dna Probe, Each (so)"	BOTH IP/OP	$555.00 	$410.70	$0.00	$444.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$328.28	$328.28	$22.49	$59.86	$439.56	$444.00	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31900016	EAP	CPT® 88275		Interphase In Situ Hybridization (so)	BOTH IP/OP	$555.00 	$410.70	$0.00	$444.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$328.28	$328.28	$53.75	$112.22	$439.56	$444.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31900017	EAP	CPT® 88271		"Fish Dna Probe, Each (so)"	BOTH IP/OP	$555.00 	$410.70	$0.00	$444.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$328.28	$328.28	$22.49	$59.86	$439.56	$444.00	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31900018	EAP	CPT® 88275		Interphase In Situ Hybridization (so)	BOTH IP/OP	$555.00 	$410.70	$0.00	$444.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$328.28	$328.28	$53.75	$112.22	$439.56	$444.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31900019	EAP	CPT® 88271		"Fish Dna Probe, Each (so)"	BOTH IP/OP	$411.00 	$304.14	$0.00	$328.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$243.11	$243.11	$22.49	$59.86	$325.51	$328.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31900020	EAP	CPT® 88275		Interphase In Situ Hybridization (so)	BOTH IP/OP	$411.00 	$304.14	$0.00	$328.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$243.11	$243.11	$53.75	$112.22	$325.51	$328.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31900021	EAP	CPT® 88271		"Fish Dna Probe, Each (so)"	BOTH IP/OP	$411.00 	$304.14	$0.00	$328.80	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$243.11	$243.11	$22.49	$59.86	$325.51	$328.80	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31900022	EAP	CPT® 88275		Interphase In Situ Hybridization (so)	BOTH IP/OP	$411.00 	$304.14	$0.00	$328.80	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$243.11	$243.11	$53.75	$112.22	$325.51	$328.80	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31900023	EAP	CPT® 88271		"Fish Dna Probe, Each (so)"	BOTH IP/OP	"$1,105.00 "	$817.70	$10.71	$878.40	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$653.61	$653.61	$22.49	$59.86	$869.62	$878.40	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31900024	EAP	CPT® 88275		Interphase In Situ Hybridization (so)	BOTH IP/OP	"$1,105.00 "	$817.70	$23.04	$878.40	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$653.61	$653.61	$53.75	$112.22	$869.62	$878.40	$74.23	$84.46	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31900025	EAP	CPT® 88271		"Fish, Dna Probe Each (so)"	BOTH IP/OP	$555.00 	$410.70	$0.00	$444.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$328.28	$328.28	$22.49	$59.86	$439.56	$444.00	$31.06	$0.00	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31900026	EAP	CPT® 88275		Interphase In Situ Hybridization (so)	BOTH IP/OP	$555.00 	$410.70	$0.00	$444.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$328.28	$328.28	$53.75	$112.22	$439.56	$444.00	$74.23	$0.00	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31900027	EAP	CPT® 88271		"Fish, Dna Probe Each (so)"	BOTH IP/OP	$690.00 	$510.60	$10.71	$552.00	$44.22	$44.22	$21.42	$21.42	$10.71	$10.71	$32.52	$32.52	$33.77	$21.42	$31.65	$13.92	$408.14	$408.14	$22.49	$59.86	$546.48	$552.00	$31.06	$35.34	$31.06	$33.72	$21.42	$21.42	$23.60	$21.42	$0.00	$0.00	$0.00	$0.00
31900028	EAP	CPT® 88275		Interphase In Situ Hybridization (so)	BOTH IP/OP	$690.00 	$510.60	$23.04	$552.00	$82.90	$82.90	$51.19	$51.19	$25.60	$23.04	$60.99	$60.99	$63.33	$51.19	$59.33	$33.27	$408.14	$408.14	$53.75	$112.22	$546.48	$552.00	$74.23	$84.46	$74.23	$63.21	$51.19	$51.19	$44.25	$51.19	$0.00	$0.00	$0.00	$0.00
31900030	EAP	CPT® 81404		Pancreatitis Press (so)	BOTH IP/OP	"$1,757.00 "	"$1,300.18"	$123.67	"$1,388.80"	$462.00	$462.00	$274.83	$274.83	$137.42	$123.67	"$1,304.05"	"$1,304.05"	"$1,354.30"	$274.83	$286.64	$178.64	"$1,039.27"	"$1,039.27"	$288.57	$868.00	"$1,374.91"	"$1,388.80"	$398.50	$453.47	$398.50	$305.42	$274.83	$274.83	$213.79	$274.83	$0.00	$0.00	$0.00	$0.00
31900031	EAP	CPT® 81404		Pancreatitis Spink-1 (so)	BOTH IP/OP	"$1,757.00 "	"$1,300.18"	$123.67	"$1,388.80"	$462.00	$462.00	$274.83	$274.83	$137.42	$123.67	"$1,304.05"	"$1,304.05"	"$1,354.30"	$274.83	$286.64	$178.64	"$1,039.27"	"$1,039.27"	$288.57	$868.00	"$1,374.91"	"$1,388.80"	$398.50	$453.47	$398.50	$305.42	$274.83	$274.83	$213.79	$274.83	$0.00	$0.00	$0.00	$0.00
31900032	EAP	CPT® 81479		Pancreatitis Ctrc (so)	BOTH IP/OP	$906.00 	$670.44	$0.00	"$1,114.12"	$0.00	$0.00	$0.00	$0.00	$161.27	$188.83	$672.43	$672.43	$698.34	$0.00	$906.00	$0.00	$535.90	$535.90	$0.00	$447.50	$708.84	$716.00	$537.00	$588.90	$537.00	"$1,114.12"	$0.00	$0.00	$779.89	$0.00	$0.00	$0.00	$0.00	$0.00
32000001	EAP	CPT® 77085		"Dual-energy X-ray Absorptiometry(dxa),bone Density Study"	BOTH IP/OP	$668.00 	$494.32	$0.00	$534.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.50	$102.50	$106.44	$0.00	$139.21	$0.00	$0.00	$0.00	$0.00	$160.32	$529.06	$534.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000003	EAP	CPT® 70015		Cisternography	BOTH IP/OP	"$1,032.00 "	$763.68	$0.00	$825.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.20	$200.20	$207.90	$0.00	$215.07	$0.00	$0.00	$0.00	$0.00	$247.68	$817.34	$825.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000005	EAP	CPT® 70100		MANDIBLE 1-3 VIEW RDG	BOTH IP/OP	$259.00 	$191.66	$0.00	$259.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.98	$52.31	$52.31	$54.32	$77.54	$53.98	$50.40	$153.20	$153.20	$0.00	$62.88	$207.50	$209.60	$0.00	$259.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000007	EAP	CPT® 70110		MANDIBLE COMPL 4+ VIEW RDG	BOTH IP/OP	$303.00 	$224.22	$0.00	$244.80	$86.25	$86.25	$106.02	$106.02	$106.62	$0.00	$65.61	$65.61	$68.14	$0.00	$63.15	$0.00	$0.00	$0.00	$112.41	$73.44	$242.35	$244.80	$156.18	$169.61	$156.18	$36.22	$29.89	$29.89	$48.72	$107.06	$0.00	$0.00	$0.00	$0.00
32000013	EAP	CPT® 70160		NASAL BONES COMPL 3+VIEW RDG	BOTH IP/OP	$455.00 	$336.70	$0.00	$455.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.83	$56.86	$56.86	$59.04	$77.54	$94.82	$50.40	$269.13	$269.13	$0.00	$110.40	$364.32	$368.00	$0.00	$455.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000020	EAP	CPT® 70250		SKULL 1-3VIEW W/WO STEREO RDG	BOTH IP/OP	$799.00 	$591.26	$25.57	$645.60	$82.24	$82.24	$106.02	$106.02	$106.62	$166.53	$59.27	$59.27	$61.55	$104.44	$166.51	$67.89	$472.61	$472.61	$112.41	$193.68	$639.14	$645.60	$156.18	$169.61	$156.18	$35.86	$25.57	$25.57	$128.47	$107.06	$0.00	$0.00	$0.00	$0.00
32000022	EAP	CPT® 70300		Periapical X-ray	BOTH IP/OP	$307.00 	$227.18	$0.00	$296.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.47	$21.47	$22.29	$0.00	$63.98	$0.00	$0.00	$0.00	$0.00	$89.04	$293.83	$296.80	$0.00	$235.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000023	EAP	CPT® 70320		X-ray Complete	BOTH IP/OP	$430.00 	$318.20	$0.00	$416.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.04	$89.04	$92.47	$0.00	$89.61	$0.00	$0.00	$0.00	$0.00	$124.80	$411.84	$416.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000024	EAP	CPT® 70355		X-ray Panorex	BOTH IP/OP	$572.00 	$423.28	$8.64	$416.00	$47.57	$47.57	$78.77	$78.77	$79.21	$119.22	$31.14	$31.14	$32.34	$77.54	$119.20	$50.40	$338.34	$338.34	$80.04	$124.80	$411.84	$416.00	$111.21	$137.87	$111.21	$31.96	$8.64	$8.64	$82.78	$76.23	$0.00	$0.00	$0.00	$0.00
32000026	EAP	CPT® 70328		TMJ UNILAT OPEN & CLOSED RDG	BOTH IP/OP	$252.00 	$186.48	$0.00	$201.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.51	$50.51	$52.46	$0.00	$52.52	$0.00	$0.00	$0.00	$0.00	$60.48	$199.58	$201.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000028	EAP	CPT® 70330		TMJ BILAT OPEN & CLOSED RDG	BOTH IP/OP	$660.00 	$488.40	$0.00	$533.60	$109.64	$109.64	$78.77	$78.77	$79.21	$137.56	$85.43	$85.43	$88.71	$77.54	$137.54	$50.40	$390.39	$390.39	$0.00	$160.08	$528.26	$533.60	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000031	EAP	CPT® 70360		NECK SOFT TISSUE RDG	BOTH IP/OP	$746.00 	$552.04	$21.61	$544.80	$63.70	$63.70	$78.77	$78.77	$79.21	$155.49	$45.06	$45.06	$46.80	$77.54	$155.47	$50.40	$441.26	$441.26	$80.04	$163.44	$539.35	$544.80	$111.21	$137.87	$111.21	$24.86	$21.61	$21.61	$108.42	$76.23	$0.00	$0.00	$0.00	$0.00
32000033	EAP	CPT® 70370		Pharyn/larynx Fluo &/magn Rdg	BOTH IP/OP	"$1,216.00 "	$899.84	$0.00	"$1,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.21	$143.21	$148.72	$0.00	$253.41	$0.00	$0.00	$0.00	$0.00	$326.40	"$1,077.12"	"$1,088.00"	$0.00	$814.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000035	EAP	CPT® 70390		SIALOGRAPHY S&I RDG	BOTH IP/OP	"$2,072.00 "	"$1,533.28"	$0.00	"$1,853.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.01	$197.01	$204.58	$0.00	$431.80	$0.00	$0.00	$0.00	$0.00	$556.08	"$1,835.06"	"$1,853.60"	$0.00	$707.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000051	EAP	CPT® 71046		Employee Health 2 View Chest	BOTH IP/OP	$653.00 	$483.22	$0.00	$532.00	$69.46	$69.46	$78.77	$78.77	$79.21	$136.10	$49.06	$49.06	$50.94	$77.54	$136.09	$50.40	$386.25	$386.25	$80.04	$159.60	$526.68	$532.00	$111.21	$0.00	$111.21	$29.30	$21.97	$21.97	$105.87	$76.23	$0.00	$0.00	$0.00	$0.00
32000058	EAP	CPT® 71110		RIBS BILAT X-RAY 3VIEW RDG	BOTH IP/OP	$750.00 	$555.00	$28.45	$579.20	$85.46	$85.46	$106.02	$106.02	$106.62	$156.32	$67.28	$67.28	$69.87	$104.44	$156.30	$67.89	$443.63	$443.63	$112.41	$173.76	$573.41	$579.20	$156.18	$169.61	$156.18	$43.70	$28.45	$28.45	$115.26	$107.06	$0.00	$0.00	$0.00	$0.00
32000060	EAP	CPT® 71111		RIBS BILAT X-RAY 4+VIEW RDG	BOTH IP/OP	"$1,290.00 "	$954.60	$35.30	$996.80	$109.64	$109.64	$106.02	$106.02	$106.62	$268.87	$88.90	$88.90	$92.32	$104.44	$268.84	$67.89	$763.04	$763.04	$112.41	$299.04	$986.83	$996.80	$156.18	$169.61	$156.18	$50.44	$35.30	$35.30	$198.36	$107.06	$0.00	$0.00	$0.00	$0.00
32000062	EAP	CPT® 71120		STERNUM X-RAY 2+VIEW RDG	BOTH IP/OP	$508.00 	$375.92	$22.69	$410.40	$66.92	$66.92	$78.77	$78.77	$79.21	$105.88	$55.63	$55.63	$57.77	$77.54	$105.87	$50.40	$300.48	$300.48	$80.04	$123.12	$406.30	$410.40	$111.21	$137.87	$111.21	$34.82	$22.69	$22.69	$81.67	$76.23	$0.00	$0.00	$0.00	$0.00
32000064	EAP	CPT® 71130		STERNOCLAVICU JNTS 3+VIEW RDG	BOTH IP/OP	$371.00 	$274.54	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.71	$64.71	$67.20	$0.00	$77.32	$0.00	$0.00	$0.00	$0.00	$90.00	$297.00	$300.00	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000065	EAP	CPT® 73020		SHOULDER 1 VIEW RDG	BOTH IP/OP	"$1,417.00 "	"$1,048.58"	$13.69	"$1,036.00"	$52.40	$52.40	$78.77	$78.77	$79.21	$295.34	$38.71	$38.71	$40.20	$77.54	$295.30	$50.40	$838.16	$838.16	$80.04	$310.80	"$1,025.64"	"$1,036.00"	$111.21	$137.87	$111.21	$25.94	$13.69	$13.69	$206.16	$76.23	$0.00	$0.00	$0.00	$0.00
32000071	EAP	CPT® 72020		CERVICAL SPINE 1 VIEW RDG	BOTH IP/OP	"$1,075.00 "	$795.50	$16.21	$793.60	$50.00	$50.00	$78.77	$78.77	$79.21	$224.06	$38.71	$38.71	$40.20	$77.54	$224.03	$50.40	$635.86	$635.86	$80.04	$238.08	$785.66	$793.60	$111.21	$137.87	$111.21	$23.80	$16.21	$16.21	$157.93	$76.23	$0.00	$0.00	$0.00	$0.00
32000073	EAP	CPT® 72020		LUMBAR SPINE 1 VIEW RDG	BOTH IP/OP	"$1,075.00 "	$795.50	$16.21	$793.60	$50.00	$50.00	$78.77	$78.77	$79.21	$224.06	$38.71	$38.71	$40.20	$77.54	$224.03	$50.40	$635.86	$635.86	$80.04	$238.08	$785.66	$793.60	$111.21	$137.87	$111.21	$23.80	$16.21	$16.21	$157.93	$76.23	$0.00	$0.00	$0.00	$0.00
32000075	EAP	CPT® 72020		THORACIC SPINE 1 VIEW RDG	BOTH IP/OP	"$1,075.00 "	$795.50	$16.21	$793.60	$50.00	$50.00	$78.77	$78.77	$79.21	$224.06	$38.71	$38.71	$40.20	$77.54	$224.03	$50.40	$635.86	$635.86	$80.04	$238.08	$785.66	$793.60	$111.21	$137.87	$111.21	$23.80	$16.21	$16.21	$157.93	$76.23	$0.00	$0.00	$0.00	$0.00
32000078	EAP	CPT® 72040		Rad Exam Spine 2 Or 3 Views	BOTH IP/OP	"$1,040.00 "	$769.60	$27.01	$768.00	$74.98	$74.98	$78.77	$78.77	$79.21	$216.76	$62.89	$62.89	$65.31	$77.54	$216.74	$50.40	$615.16	$615.16	$80.04	$230.40	$760.32	$768.00	$111.21	$137.87	$111.21	$34.09	$27.01	$27.01	$152.83	$76.23	$0.00	$0.00	$0.00	$0.00
32000080	EAP	CPT® 72050		CERVICAL SPINE 4+VIEW RDG	BOTH IP/OP	"$1,826.00 "	"$1,351.24"	$37.10	"$1,348.00"	$103.20	$103.20	$106.02	$106.02	$106.62	$380.58	$89.81	$89.81	$93.27	$104.44	$380.54	$67.89	"$1,080.08"	"$1,080.08"	$112.41	$404.40	"$1,334.52"	"$1,348.00"	$156.18	$169.61	$156.18	$49.72	$37.10	$37.10	$268.25	$107.06	$0.00	$0.00	$0.00	$0.00
32000081	EAP	CPT® 72052		CERVICAL SPINE COMPLETE W/ FLEX/EXT RDG	BOTH IP/OP	"$1,837.00 "	"$1,359.38"	$44.66	"$1,356.80"	$127.38	$127.38	$106.02	$106.02	$106.62	$382.88	$115.22	$115.22	$119.65	$104.44	$382.83	$67.89	"$1,086.59"	"$1,086.59"	$112.41	$407.04	"$1,343.23"	"$1,356.80"	$156.18	$169.61	$156.18	$61.14	$44.66	$44.66	$270.00	$107.06	$0.00	$0.00	$0.00	$0.00
32000084	EAP	CPT® 72070		THORACIC SPINE 2 VIEW RDG	BOTH IP/OP	"$1,158.00 "	$856.92	$21.61	$848.00	$77.40	$77.40	$106.02	$106.02	$106.62	$241.36	$55.63	$55.63	$57.77	$104.44	$241.33	$67.89	$684.96	$684.96	$112.41	$254.40	$839.52	$848.00	$156.18	$169.61	$156.18	$35.88	$21.61	$21.61	$168.75	$107.06	$0.00	$0.00	$0.00	$0.00
32000088	EAP	CPT® 72080		THORACOLUMBAR 2VIEW RDG	BOTH IP/OP	"$1,173.00 "	$868.02	$23.41	$858.40	$69.33	$69.33	$78.77	$78.77	$79.21	$244.48	$59.27	$59.27	$61.55	$77.54	$244.45	$50.40	$693.83	$693.83	$80.04	$257.52	$849.82	$858.40	$111.21	$137.87	$111.21	$36.61	$23.41	$23.41	$170.82	$76.23	$0.00	$0.00	$0.00	$0.00
32000092	EAP	CPT® 72100		LUMBOSACRAL SPINE 2-3VIEW RDG	BOTH IP/OP	"$1,018.00 "	$753.32	$27.01	$791.20	$79.81	$79.81	$106.02	$106.02	$106.62	$212.18	$67.44	$67.44	$70.04	$104.44	$212.15	$67.89	$602.15	$602.15	$112.41	$237.36	$783.29	$791.20	$156.18	$169.61	$156.18	$36.61	$27.01	$27.01	$157.45	$107.06	$0.00	$0.00	$0.00	$0.00
32000095	EAP	CPT® 72110		LUMBOSACRAL SPINE 4+VIEW RDG	BOTH IP/OP	"$1,784.00 "	"$1,320.16"	$35.66	"$1,386.40"	$111.25	$111.25	$106.02	$106.02	$106.62	$371.83	$94.35	$94.35	$97.98	$104.44	$371.79	$67.89	"$1,055.24"	"$1,055.24"	$112.41	$415.92	"$1,372.54"	"$1,386.40"	$156.18	$169.61	$156.18	$50.44	$35.66	$35.66	$275.89	$107.06	$0.00	$0.00	$0.00	$0.00
32000097	EAP	CPT® 72114		Lumbosac Com + Bending 6 Views	BOTH IP/OP	"$1,524.00 "	"$1,127.76"	$44.66	"$1,184.00"	$141.08	$141.08	$106.02	$106.02	$106.62	$317.64	$127.92	$127.92	$132.84	$104.44	$317.60	$67.89	$901.45	$901.45	$112.41	$355.20	"$1,172.16"	"$1,184.00"	$156.18	$169.61	$156.18	$63.63	$44.66	$44.66	$235.62	$107.06	$0.00	$0.00	$0.00	$0.00
32000099	EAP	CPT® 72120		Lumbosac Bending 2 Or 3 Views	BOTH IP/OP	$763.00 	$564.62	$0.00	$681.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.62	$91.62	$95.15	$0.00	$159.01	$0.00	$0.00	$0.00	$0.00	$204.48	$674.78	$681.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000109	EAP	CPT® 72170		PELVIS X-RAY 1-2 VIEW RDG	BOTH IP/OP	$796.00 	$589.04	$19.81	$579.20	$72.57	$72.57	$106.02	$106.02	$106.62	$165.91	$42.34	$42.34	$43.97	$104.44	$165.89	$67.89	$470.83	$470.83	$112.41	$173.76	$573.41	$579.20	$156.18	$169.61	$156.18	$28.43	$19.81	$19.81	$115.26	$107.06	$0.00	$0.00	$0.00	$0.00
32000111	EAP	CPT® 72190		PELVIS X-RAY COMPL 3+VIEW RDG	BOTH IP/OP	$805.00 	$595.70	$28.09	$585.60	$86.28	$86.28	$106.02	$106.02	$106.62	$167.78	$70.16	$70.16	$72.86	$104.44	$167.76	$67.89	$476.16	$476.16	$112.41	$175.68	$579.74	$585.60	$156.18	$169.61	$156.18	$36.26	$28.09	$28.09	$116.53	$107.06	$0.00	$0.00	$0.00	$0.00
32000117	EAP	CPT® 72200		Sacroiliac Jnt 1-2 View Rdg	BOTH IP/OP	$300.00 	$222.00	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.61	$49.61	$51.52	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$90.00	$297.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000119	EAP	CPT® 72202		SACROILIAC JNT 3+VIEW RDG	BOTH IP/OP	$317.00 	$234.58	$26.65	$256.00	$74.98	$74.98	$106.02	$106.02	$106.62	$66.07	$61.97	$61.97	$64.36	$104.44	$66.06	$67.89	$187.51	$187.51	$112.41	$76.80	$253.44	$256.00	$156.18	$169.61	$156.18	$33.41	$26.65	$26.65	$50.94	$107.06	$0.00	$0.00	$0.00	$0.00
32000122	EAP	CPT® 72220		SACRUM&COCCYX 2+VIEW RDG	BOTH IP/OP	$655.00 	$484.70	$22.69	$488.00	$63.70	$63.70	$78.77	$78.77	$79.21	$136.52	$51.11	$51.11	$53.07	$77.54	$136.50	$50.40	$387.43	$387.43	$80.04	$146.40	$483.12	$488.00	$111.21	$137.87	$111.21	$30.55	$22.69	$22.69	$97.11	$76.23	$0.00	$0.00	$0.00	$0.00
32000123	EAP	CPT® 72240		MYELOGRAPHY CERVICAL S&I RDG	BOTH IP/OP	"$1,372.00 "	"$1,015.28"	$0.00	"$1,372.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.28	$278.28	$288.99	$0.00	$285.92	$0.00	$0.00	$0.00	$0.00	$332.64	"$1,097.71"	"$1,108.80"	$0.00	"$1,372.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000124	EAP	CPT® 72255		MYELOGRAPHY THORACIC S&I RDG	BOTH IP/OP	"$1,317.00 "	$974.58	$0.00	"$1,317.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.00	$247.00	$256.50	$0.00	$274.46	$0.00	$0.00	$0.00	$0.00	$319.20	"$1,053.36"	"$1,064.00"	$0.00	"$1,317.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000125	EAP	CPT® 72265		MYELOGRAPHY LUMBAR S&I RDG	BOTH IP/OP	"$1,372.00 "	"$1,015.28"	$0.00	"$1,372.00"	$210.41	$210.41	$696.71	$696.71	$700.64	$0.00	$260.59	$260.59	$270.62	$0.00	$285.92	$0.00	$0.00	$0.00	$0.00	$332.64	"$1,097.71"	"$1,108.80"	$0.00	"$1,372.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000126	EAP	CPT® 72270		MYELOGRAPHY COMPLETE S&I RDG	BOTH IP/OP	"$1,265.00 "	$936.10	$0.00	"$1,265.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$401.35	$401.35	$416.78	$0.00	$263.63	$0.00	$0.00	$0.00	$693.78	$306.72	"$1,012.18"	"$1,022.40"	$963.92	"$1,265.00"	$963.92	$298.54	$75.28	$75.28	$203.46	$660.75	$0.00	$0.00	$0.00	$0.00
32000127	EAP	CPT® 72285		Diskography Cervicl/thorac Spn	BOTH IP/OP	"$3,367.00 "	"$2,491.58"	$0.00	"$2,693.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.81	$300.81	$312.38	$0.00	$701.68	$0.00	$0.00	$0.00	$0.00	$808.08	"$2,666.66"	"$2,693.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000128	EAP	CPT® 72295		Diskography Lumbar Spn	BOTH IP/OP	"$3,838.00 "	"$2,840.12"	$0.00	"$3,070.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.41	$290.41	$301.58	$0.00	$799.84	$0.00	$0.00	$0.00	$0.00	$921.12	"$3,039.70"	"$3,070.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000129	EAP	CPT® 73000		Clavicle Complete Rdg	BOTH IP/OP	$754.00 	$557.96	$23.05	$672.00	$62.88	$62.88	$78.77	$78.77	$79.21	$157.15	$46.88	$46.88	$48.69	$77.54	$157.13	$50.40	$445.99	$445.99	$80.04	$201.60	$665.28	$672.00	$111.21	$137.87	$111.21	$27.72	$23.05	$23.05	$133.73	$76.23	$0.00	$0.00	$0.00	$0.00
32000131	EAP	CPT® 73000		CLAVICLE COMPLETE LT RDG	BOTH IP/OP	$922.00 	$682.28	$23.05	$672.00	$62.88	$62.88	$78.77	$78.77	$79.21	$192.17	$46.88	$46.88	$48.69	$77.54	$192.14	$50.40	$545.36	$545.36	$80.04	$201.60	$665.28	$672.00	$111.21	$137.87	$111.21	$27.72	$23.05	$23.05	$133.73	$76.23	$0.00	$0.00	$0.00	$0.00
32000133	EAP	CPT® 73000		CLAVICLE COMPLETE RT RDG	BOTH IP/OP	$922.00 	$682.28	$23.05	$672.00	$62.88	$62.88	$78.77	$78.77	$79.21	$192.17	$46.88	$46.88	$48.69	$77.54	$192.14	$50.40	$545.36	$545.36	$80.04	$201.60	$665.28	$672.00	$111.21	$137.87	$111.21	$27.72	$23.05	$23.05	$133.73	$76.23	$0.00	$0.00	$0.00	$0.00
32000135	EAP	CPT® 73000		CLAVICLES COMPLETE BILAT RDG	BOTH IP/OP	"$1,513.00 "	"$1,119.62"	$23.05	"$1,348.80"	$62.88	$62.88	$78.77	$78.77	$79.21	$315.35	$46.88	$46.88	$48.69	$77.54	$315.31	$50.40	$894.94	$894.94	$80.04	$404.64	"$1,335.31"	"$1,348.80"	$111.21	$137.87	$111.21	$27.72	$23.05	$23.05	$268.41	$76.23	$0.00	$0.00	$0.00	$0.00
32000137	EAP	CPT® 73010		Scapula Complete Rdg	BOTH IP/OP	$648.00 	$479.52	$18.73	$520.00	$68.53	$68.53	$106.02	$106.02	$106.62	$135.06	$47.79	$47.79	$49.63	$104.44	$135.04	$67.89	$383.29	$383.29	$112.41	$156.00	$514.80	$520.00	$156.18	$169.61	$156.18	$28.43	$18.73	$18.73	$103.48	$107.06	$0.00	$0.00	$0.00	$0.00
32000139	EAP	CPT® 73010		SCAPULA COMPLETE LT RDG	BOTH IP/OP	$711.00 	$526.14	$18.73	$520.00	$68.53	$68.53	$106.02	$106.02	$106.62	$148.19	$47.79	$47.79	$49.63	$104.44	$148.17	$67.89	$420.56	$420.56	$112.41	$156.00	$514.80	$520.00	$156.18	$169.61	$156.18	$28.43	$18.73	$18.73	$103.48	$107.06	$0.00	$0.00	$0.00	$0.00
32000141	EAP	CPT® 73010		SCAPULA COMPLETE RT RDG	BOTH IP/OP	$711.00 	$526.14	$18.73	$520.00	$68.53	$68.53	$106.02	$106.02	$106.62	$148.19	$47.79	$47.79	$49.63	$104.44	$148.17	$67.89	$420.56	$420.56	$112.41	$156.00	$514.80	$520.00	$156.18	$169.61	$156.18	$28.43	$18.73	$18.73	$103.48	$107.06	$0.00	$0.00	$0.00	$0.00
32000143	EAP	CPT® 73010		SCAPULAS COMPLETE BILAT RDG	BOTH IP/OP	"$1,291.00 "	$955.34	$18.73	"$1,036.00"	$68.53	$68.53	$106.02	$106.02	$106.62	$269.08	$47.79	$47.79	$49.63	$104.44	$269.04	$67.89	$763.63	$763.63	$112.41	$310.80	"$1,025.64"	"$1,036.00"	$156.18	$169.61	$156.18	$28.43	$18.73	$18.73	$206.16	$107.06	$0.00	$0.00	$0.00	$0.00
32000153	EAP	CPT® 73030		Shoulder 2+views Rdg	BOTH IP/OP	"$1,291.00 "	$955.34	$23.77	"$1,036.00"	$66.11	$66.11	$78.77	$78.77	$79.21	$269.08	$50.19	$50.19	$52.12	$77.54	$269.04	$50.40	$763.63	$763.63	$80.04	$310.80	"$1,025.64"	"$1,036.00"	$111.21	$137.87	$111.21	$30.90	$23.77	$23.77	$206.16	$76.23	$0.00	$0.00	$0.00	$0.00
32000154	EAP	CPT® 73030		Shoulder Compl 2+view Exr	BOTH IP/OP	"$1,291.00 "	$955.34	$23.77	"$1,036.00"	$66.11	$66.11	$78.77	$78.77	$79.21	$269.08	$50.19	$50.19	$52.12	$77.54	$269.04	$50.40	$763.63	$763.63	$80.04	$310.80	"$1,025.64"	"$1,036.00"	$111.21	$137.87	$111.21	$30.90	$23.77	$23.77	$206.16	$76.23	$0.00	$0.00	$0.00	$0.00
32000156	EAP	CPT® 73030		SHOULDER COMPL 2+VIEWS LT RDG	BOTH IP/OP	"$1,417.00 "	"$1,048.58"	$23.77	"$1,036.00"	$66.11	$66.11	$78.77	$78.77	$79.21	$295.34	$50.19	$50.19	$52.12	$77.54	$295.30	$50.40	$838.16	$838.16	$80.04	$310.80	"$1,025.64"	"$1,036.00"	$111.21	$137.87	$111.21	$30.90	$23.77	$23.77	$206.16	$76.23	$0.00	$0.00	$0.00	$0.00
32000158	EAP	CPT® 73030		SHOULDER COMPL 2+VIEWS RT RDG	BOTH IP/OP	"$1,417.00 "	"$1,048.58"	$23.77	"$1,036.00"	$66.11	$66.11	$78.77	$78.77	$79.21	$295.34	$50.19	$50.19	$52.12	$77.54	$295.30	$50.40	$838.16	$838.16	$80.04	$310.80	"$1,025.64"	"$1,036.00"	$111.21	$137.87	$111.21	$30.90	$23.77	$23.77	$206.16	$76.23	$0.00	$0.00	$0.00	$0.00
32000161	EAP	CPT® 73030		SHOULDERS 2+VIEW ECH BILAT RDG	BOTH IP/OP	"$1,430.00 "	"$1,058.20"	$23.77	"$1,045.60"	$66.11	$66.11	$78.77	$78.77	$79.21	$298.05	$50.19	$50.19	$52.12	$77.54	$298.01	$50.40	$845.85	$845.85	$80.04	$313.68	"$1,035.14"	"$1,045.60"	$111.21	$137.87	$111.21	$30.90	$23.77	$23.77	$208.07	$76.23	$0.00	$0.00	$0.00	$0.00
32000163	EAP	CPT® 73040		SHOULDER ARTHROGRAPHY RT RDG	BOTH IP/OP	"$1,335.00 "	$987.90	$94.00	$976.00	$227.33	$227.33	$358.61	$358.61	$360.63	$278.25	$195.02	$195.02	$202.52	$352.81	$278.21	$229.33	$789.65	$789.65	$387.01	$292.80	$966.24	$976.00	$537.70	$584.68	$537.70	$107.06	$94.00	$94.00	$194.22	$368.58	$0.00	$0.00	$0.00	$0.00
32000164	EAP	CPT® 73040		SHOULDER ARTHROGRAPHY LT RDG	BOTH IP/OP	"$1,335.00 "	$987.90	$94.00	$976.00	$227.33	$227.33	$358.61	$358.61	$360.63	$278.25	$195.02	$195.02	$202.52	$352.81	$278.21	$229.33	$789.65	$789.65	$387.01	$292.80	$966.24	$976.00	$537.70	$584.68	$537.70	$107.06	$94.00	$94.00	$194.22	$368.58	$0.00	$0.00	$0.00	$0.00
32000165	EAP	CPT® 73040		Shoulder Arthrograph Bi Rdg	BOTH IP/OP	"$2,432.00 "	"$1,799.68"	$94.00	"$1,952.00"	$227.33	$227.33	$358.61	$358.61	$360.63	$506.89	$195.02	$195.02	$202.52	$352.81	$506.83	$229.33	"$1,438.53"	"$1,438.53"	$387.01	$585.60	"$1,932.48"	"$1,952.00"	$537.70	$584.68	$537.70	$107.06	$94.00	$94.00	$388.45	$368.58	$0.00	$0.00	$0.00	$0.00
32000167	EAP	CPT® 73050		ACROMICLAVICULAR JNTS BI DRG	BOTH IP/OP	$864.00 	$639.36	$0.00	$864.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.97	$61.97	$64.36	$0.00	$180.06	$0.00	$0.00	$0.00	$0.00	$209.52	$691.42	$698.40	$0.00	$864.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000169	EAP	CPT® 73060		HUMERI 2+VIEW EACH BILAT RDG	BOTH IP/OP	"$2,462.00 "	"$1,821.88"	$23.05	"$1,792.00"	$66.11	$66.11	$78.77	$78.77	$79.21	$513.14	$50.19	$50.19	$52.12	$77.54	$513.08	$50.40	"$1,456.27"	"$1,456.27"	$80.04	$537.60	"$1,774.08"	"$1,792.00"	$111.21	$137.87	$111.21	$30.55	$23.05	$23.05	$356.61	$76.23	$0.00	$0.00	$0.00	$0.00
32000171	EAP	CPT® 73060		Humerus 2+view Rdg	BOTH IP/OP	"$1,122.00 "	$830.28	$23.05	$897.60	$66.11	$66.11	$78.77	$78.77	$79.21	$233.85	$50.19	$50.19	$52.12	$77.54	$233.82	$50.40	$663.66	$663.66	$80.04	$269.28	$888.62	$897.60	$111.21	$137.87	$111.21	$30.55	$23.05	$23.05	$178.62	$76.23	$0.00	$0.00	$0.00	$0.00
32000173	EAP	CPT® 73060		HUMERUS 2+VIEW LT RDG	BOTH IP/OP	"$1,233.00 "	$912.42	$23.05	$897.60	$66.11	$66.11	$78.77	$78.77	$79.21	$256.99	$50.19	$50.19	$52.12	$77.54	$256.96	$50.40	$729.32	$729.32	$80.04	$269.28	$888.62	$897.60	$111.21	$137.87	$111.21	$30.55	$23.05	$23.05	$178.62	$76.23	$0.00	$0.00	$0.00	$0.00
32000175	EAP	CPT® 73060		HUMERUS 2+VIEW RT RDG	BOTH IP/OP	"$1,233.00 "	$912.42	$23.05	$897.60	$66.11	$66.11	$78.77	$78.77	$79.21	$256.99	$50.19	$50.19	$52.12	$77.54	$256.96	$50.40	$729.32	$729.32	$80.04	$269.28	$888.62	$897.60	$111.21	$137.87	$111.21	$30.55	$23.05	$23.05	$178.62	$76.23	$0.00	$0.00	$0.00	$0.00
32000177	EAP	CPT® 73070		Elbow 2 View Rdg	BOTH IP/OP	$647.00 	$478.78	$20.17	$581.60	$62.09	$62.09	$78.77	$78.77	$79.21	$134.85	$46.88	$46.88	$48.69	$77.54	$134.83	$50.40	$382.70	$382.70	$80.04	$174.48	$575.78	$581.60	$111.21	$137.87	$111.21	$27.38	$20.17	$20.17	$115.74	$76.23	$0.00	$0.00	$0.00	$0.00
32000179	EAP	CPT® 73070		ELBOW 2 VIEW LT RDG	BOTH IP/OP	$798.00 	$590.52	$20.17	$581.60	$62.09	$62.09	$78.77	$78.77	$79.21	$166.32	$46.88	$46.88	$48.69	$77.54	$166.30	$50.40	$472.02	$472.02	$80.04	$174.48	$575.78	$581.60	$111.21	$137.87	$111.21	$27.38	$20.17	$20.17	$115.74	$76.23	$0.00	$0.00	$0.00	$0.00
32000181	EAP	CPT® 73070		ELBOW 2 VIEW RT RDG	BOTH IP/OP	$798.00 	$590.52	$20.17	$581.60	$62.09	$62.09	$78.77	$78.77	$79.21	$166.32	$46.88	$46.88	$48.69	$77.54	$166.30	$50.40	$472.02	$472.02	$80.04	$174.48	$575.78	$581.60	$111.21	$137.87	$111.21	$27.38	$20.17	$20.17	$115.74	$76.23	$0.00	$0.00	$0.00	$0.00
32000183	EAP	CPT® 73070		ELBOWS 2 VIEW EACH BILAT RDG	BOTH IP/OP	"$1,598.00 "	"$1,182.52"	$20.17	"$1,164.80"	$62.09	$62.09	$78.77	$78.77	$79.21	$333.06	$46.88	$46.88	$48.69	$77.54	$333.02	$50.40	$945.22	$945.22	$80.04	$349.44	"$1,153.15"	"$1,164.80"	$111.21	$137.87	$111.21	$27.38	$20.17	$20.17	$231.80	$76.23	$0.00	$0.00	$0.00	$0.00
32000185	EAP	CPT® 73080		Elbow 3+view Nwr	BOTH IP/OP	$689.00 	$509.86	$22.33	$619.20	$70.96	$70.96	$78.77	$78.77	$79.21	$143.60	$62.89	$62.89	$65.31	$77.54	$143.59	$50.40	$407.54	$407.54	$80.04	$185.76	$613.01	$619.20	$111.21	$137.87	$111.21	$30.55	$22.33	$22.33	$123.22	$76.23	$0.00	$0.00	$0.00	$0.00
32000186	EAP	CPT® 73080		Elbow Compl 3+view Rdg	BOTH IP/OP	$689.00 	$509.86	$22.33	$619.20	$70.96	$70.96	$78.77	$78.77	$79.21	$143.60	$62.89	$62.89	$65.31	$77.54	$143.59	$50.40	$407.54	$407.54	$80.04	$185.76	$613.01	$619.20	$111.21	$137.87	$111.21	$30.55	$22.33	$22.33	$123.22	$76.23	$0.00	$0.00	$0.00	$0.00
32000188	EAP	CPT® 73080		ELBOW COMPL 3+VIEW LT RDG	BOTH IP/OP	$850.00 	$629.00	$22.33	$619.20	$70.96	$70.96	$78.77	$78.77	$79.21	$177.16	$62.89	$62.89	$65.31	$77.54	$177.14	$50.40	$502.78	$502.78	$80.04	$185.76	$613.01	$619.20	$111.21	$137.87	$111.21	$30.55	$22.33	$22.33	$123.22	$76.23	$0.00	$0.00	$0.00	$0.00
32000190	EAP	CPT® 73080		ELBOW COMPL 3+VIEW RT RDG	BOTH IP/OP	$850.00 	$629.00	$22.33	$619.20	$70.96	$70.96	$78.77	$78.77	$79.21	$177.16	$62.89	$62.89	$65.31	$77.54	$177.14	$50.40	$502.78	$502.78	$80.04	$185.76	$613.01	$619.20	$111.21	$137.87	$111.21	$30.55	$22.33	$22.33	$123.22	$76.23	$0.00	$0.00	$0.00	$0.00
32000192	EAP	CPT® 73080		ELBOWS 3+VIEW EACH BILAT RDG	BOTH IP/OP	"$1,376.00 "	"$1,018.24"	$22.33	"$1,236.00"	$70.96	$70.96	$78.77	$78.77	$79.21	$286.79	$62.89	$62.89	$65.31	$77.54	$286.76	$50.40	$813.90	$813.90	$80.04	$370.80	"$1,223.64"	"$1,236.00"	$111.21	$137.87	$111.21	$30.55	$22.33	$22.33	$245.96	$76.23	$0.00	$0.00	$0.00	$0.00
32000195	EAP	CPT® 73085		ELBOW ARTHROGRAPHY RT RDG	BOTH IP/OP	"$2,432.00 "	"$1,799.68"	$0.00	"$2,184.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.52	$170.52	$177.08	$0.00	$506.83	$0.00	$0.00	$0.00	$0.00	$655.44	"$2,162.95"	"$2,184.80"	$0.00	$827.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000196	EAP	CPT® 73085		ELBOW ARTHROGRAPHY LT RDG	BOTH IP/OP	"$2,432.00 "	"$1,799.68"	$0.00	"$2,184.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.52	$170.52	$177.08	$0.00	$506.83	$0.00	$0.00	$0.00	$0.00	$655.44	"$2,162.95"	"$2,184.80"	$0.00	$827.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000197	EAP	CPT® 73085		Elbow Arthrography Bilat Rdg	BOTH IP/OP	"$4,867.00 "	"$3,601.58"	$0.00	"$4,372.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.52	$170.52	$177.08	$0.00	"$1,014.28"	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$4,329.07"	"$4,372.80"	$0.00	"$1,654.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000198	EAP	CPT® 73090		FOREARM X-RAY 2 VIEW RDG	BOTH IP/OP	$739.00 	$546.86	$20.53	$624.80	$58.87	$58.87	$78.77	$78.77	$79.21	$154.03	$46.88	$46.88	$48.69	$77.54	$154.01	$50.40	$437.12	$437.12	$80.04	$187.44	$618.55	$624.80	$111.21	$137.87	$111.21	$27.72	$20.53	$20.53	$124.34	$76.23	$0.00	$0.00	$0.00	$0.00
32000200	EAP	CPT® 73090		FOREARM X-RAY 2 VIEW LT RDG	BOTH IP/OP	$859.00 	$635.66	$20.53	$624.80	$58.87	$58.87	$78.77	$78.77	$79.21	$179.04	$46.88	$46.88	$48.69	$77.54	$179.02	$50.40	$508.10	$508.10	$80.04	$187.44	$618.55	$624.80	$111.21	$137.87	$111.21	$27.72	$20.53	$20.53	$124.34	$76.23	$0.00	$0.00	$0.00	$0.00
32000202	EAP	CPT® 73090		FOREARM X-RAY 2 VIEW RT RDG	BOTH IP/OP	$859.00 	$635.66	$20.53	$624.80	$58.87	$58.87	$78.77	$78.77	$79.21	$179.04	$46.88	$46.88	$48.69	$77.54	$179.02	$50.40	$508.10	$508.10	$80.04	$187.44	$618.55	$624.80	$111.21	$137.87	$111.21	$27.72	$20.53	$20.53	$124.34	$76.23	$0.00	$0.00	$0.00	$0.00
32000205	EAP	CPT® 73090		FOREARMS 2 VIEW EACH BILAT RDG	BOTH IP/OP	"$1,721.00 "	"$1,273.54"	$20.53	"$1,252.00"	$58.87	$58.87	$78.77	$78.77	$79.21	$358.70	$46.88	$46.88	$48.69	$77.54	$358.66	$50.40	"$1,017.97"	"$1,017.97"	$80.04	$375.60	"$1,239.48"	"$1,252.00"	$111.21	$137.87	$111.21	$27.72	$20.53	$20.53	$249.15	$76.23	$0.00	$0.00	$0.00	$0.00
32000206	EAP	CPT® 73092		Upp Ext Infant 2+view Rdg	BOTH IP/OP	$495.00 	$366.30	$0.00	$667.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.68	$48.68	$50.55	$0.00	$103.16	$0.00	$0.00	$0.00	$0.00	$125.52	$414.22	$418.40	$0.00	$667.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000207	EAP	CPT® 73092		UPP EXT INFANT 2+VIEW BI RDG	BOTH IP/OP	$984.00 	$728.16	$0.00	"$1,266.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.68	$48.68	$50.55	$0.00	$205.07	$0.00	$0.00	$0.00	$0.00	$249.60	$823.68	$832.00	$0.00	"$1,266.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000210	EAP	CPT® 73092		UPP EXT INFANT 2+VIEW LT RDG	BOTH IP/OP	$575.00 	$425.50	$0.00	$667.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.68	$48.68	$50.55	$0.00	$119.83	$0.00	$0.00	$0.00	$0.00	$125.52	$414.22	$418.40	$0.00	$667.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000212	EAP	CPT® 73092		UPP EXT INFANT 2+VIEW RT RDG	BOTH IP/OP	$575.00 	$425.50	$0.00	$667.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.68	$48.68	$50.55	$0.00	$119.83	$0.00	$0.00	$0.00	$0.00	$125.52	$414.22	$418.40	$0.00	$667.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000214	EAP	CPT® 73100		Wrist 2 View  Rdg	BOTH IP/OP	$628.00 	$464.72	$24.49	$528.00	$66.11	$66.11	$78.77	$78.77	$79.21	$130.89	$48.68	$48.68	$50.55	$77.54	$130.88	$50.40	$371.46	$371.46	$80.04	$158.40	$522.72	$528.00	$111.21	$137.87	$111.21	$27.37	$24.49	$24.49	$105.07	$76.23	$0.00	$0.00	$0.00	$0.00
32000216	EAP	CPT® 73100		WRIST 2 VIEW  LT RDG	BOTH IP/OP	$725.00 	$536.50	$24.49	$528.00	$66.11	$66.11	$78.77	$78.77	$79.21	$151.11	$48.68	$48.68	$50.55	$77.54	$151.09	$50.40	$428.84	$428.84	$80.04	$158.40	$522.72	$528.00	$111.21	$137.87	$111.21	$27.37	$24.49	$24.49	$105.07	$76.23	$0.00	$0.00	$0.00	$0.00
32000218	EAP	CPT® 73100		WRIST 2 VIEW  RT RDG	BOTH IP/OP	$725.00 	$536.50	$24.49	$528.00	$66.11	$66.11	$78.77	$78.77	$79.21	$151.11	$48.68	$48.68	$50.55	$77.54	$151.09	$50.40	$428.84	$428.84	$80.04	$158.40	$522.72	$528.00	$111.21	$137.87	$111.21	$27.37	$24.49	$24.49	$105.07	$76.23	$0.00	$0.00	$0.00	$0.00
32000220	EAP	CPT® 73100		WRISTS 2 VIEW  BILAT RDG	BOTH IP/OP	"$1,252.00 "	$926.48	$24.49	"$1,053.60"	$66.11	$66.11	$78.77	$78.77	$79.21	$260.95	$48.68	$48.68	$50.55	$77.54	$260.92	$50.40	$740.56	$740.56	$80.04	$316.08	"$1,043.06"	"$1,053.60"	$111.21	$137.87	$111.21	$27.37	$24.49	$24.49	$209.67	$76.23	$0.00	$0.00	$0.00	$0.00
32000223	EAP	CPT® 73110		WRIST 3+VIEW RDG	BOTH IP/OP	$675.00 	$499.50	$28.79	$568.00	$80.63	$80.63	$78.77	$78.77	$79.21	$140.69	$61.39	$61.39	$63.75	$77.54	$140.67	$50.40	$399.26	$399.26	$80.04	$170.40	$562.32	$568.00	$111.21	$137.87	$111.21	$28.79	$30.25	$30.25	$113.03	$76.23	$0.00	$0.00	$0.00	$0.00
32000225	EAP	CPT® 73110		WRIST 3+VIEW LT RDG	BOTH IP/OP	$780.00 	$577.20	$28.79	$568.00	$80.63	$80.63	$78.77	$78.77	$79.21	$162.57	$61.39	$61.39	$63.75	$77.54	$162.55	$50.40	$461.37	$461.37	$80.04	$170.40	$562.32	$568.00	$111.21	$137.87	$111.21	$28.79	$30.25	$30.25	$113.03	$76.23	$0.00	$0.00	$0.00	$0.00
32000227	EAP	CPT® 73110		WRIST 3+VIEW RT RDG	BOTH IP/OP	$780.00 	$577.20	$28.79	$568.00	$80.63	$80.63	$78.77	$78.77	$79.21	$162.57	$61.39	$61.39	$63.75	$77.54	$162.55	$50.40	$461.37	$461.37	$80.04	$170.40	$562.32	$568.00	$111.21	$137.87	$111.21	$28.79	$30.25	$30.25	$113.03	$76.23	$0.00	$0.00	$0.00	$0.00
32000229	EAP	CPT® 73110		WRISTS 3+VIEW EACH BILAT RDG	BOTH IP/OP	"$1,561.00 "	"$1,155.14"	$28.79	"$1,136.80"	$80.63	$80.63	$78.77	$78.77	$79.21	$325.35	$61.39	$61.39	$63.75	$77.54	$325.31	$50.40	$923.33	$923.33	$80.04	$341.04	"$1,125.43"	"$1,136.80"	$111.21	$137.87	$111.21	$28.79	$30.25	$30.25	$226.22	$76.23	$0.00	$0.00	$0.00	$0.00
32000231	EAP	CPT® 73115		Wrist Arthrography Bilat Rdg	BOTH IP/OP	"$4,442.00 "	"$3,287.08"	$0.00	"$3,736.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.57	$183.57	$190.63	$0.00	$925.71	$0.00	$0.00	$0.00	$0.00	"$1,121.04"	"$3,699.43"	"$3,736.80"	$0.00	"$1,848.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000232	EAP	CPT® 73115		WRIST ARTHROGRAPHY RT/LT RDG	BOTH IP/OP	"$2,563.00 "	"$1,896.62"	$0.00	"$1,866.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.57	$183.57	$190.63	$0.00	$534.13	$0.00	$0.00	$0.00	$0.00	$559.92	"$1,847.74"	"$1,866.40"	$0.00	$924.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000233	EAP	CPT® 73120		Hand 2 View Rdg	BOTH IP/OP	$646.00 	$478.04	$21.97	$545.60	$59.66	$59.66	$106.02	$106.02	$106.62	$134.64	$45.96	$45.96	$47.73	$104.44	$134.63	$67.89	$382.11	$382.11	$112.41	$163.68	$540.14	$545.60	$156.18	$169.61	$156.18	$27.37	$21.97	$21.97	$108.57	$107.06	$0.00	$0.00	$0.00	$0.00
32000235	EAP	CPT® 73120		HAND 2 VIEW LT RDG	BOTH IP/OP	$743.00 	$549.82	$21.97	$545.60	$59.66	$59.66	$106.02	$106.02	$106.62	$154.86	$45.96	$45.96	$47.73	$104.44	$154.84	$67.89	$439.48	$439.48	$112.41	$163.68	$540.14	$545.60	$156.18	$169.61	$156.18	$27.37	$21.97	$21.97	$108.57	$107.06	$0.00	$0.00	$0.00	$0.00
32000237	EAP	CPT® 73120		HAND 2 VIEW RT RDG	BOTH IP/OP	$743.00 	$549.82	$21.97	$545.60	$59.66	$59.66	$106.02	$106.02	$106.62	$154.86	$45.96	$45.96	$47.73	$104.44	$154.84	$67.89	$439.48	$439.48	$112.41	$163.68	$540.14	$545.60	$156.18	$169.61	$156.18	$27.37	$21.97	$21.97	$108.57	$107.06	$0.00	$0.00	$0.00	$0.00
32000239	EAP	CPT® 73130		HAND 3+VIEW RDG	BOTH IP/OP	$698.00 	$516.52	$26.29	$589.60	$70.14	$70.14	$78.77	$78.77	$79.21	$145.48	$54.14	$54.14	$56.22	$77.54	$145.46	$50.40	$412.87	$412.87	$80.04	$176.88	$583.70	$589.60	$111.21	$137.87	$111.21	$28.79	$26.29	$26.29	$117.33	$76.23	$0.00	$0.00	$0.00	$0.00
32000241	EAP	CPT® 73130		HAND 3+VIEW LT RDG	BOTH IP/OP	$802.00 	$593.48	$26.29	$589.60	$70.14	$70.14	$78.77	$78.77	$79.21	$167.16	$54.14	$54.14	$56.22	$77.54	$167.14	$50.40	$474.38	$474.38	$80.04	$176.88	$583.70	$589.60	$111.21	$137.87	$111.21	$28.79	$26.29	$26.29	$117.33	$76.23	$0.00	$0.00	$0.00	$0.00
32000243	EAP	CPT® 73130		HAND 3+VIEW RT RDG	BOTH IP/OP	$802.00 	$593.48	$26.29	$589.60	$70.14	$70.14	$78.77	$78.77	$79.21	$167.16	$54.14	$54.14	$56.22	$77.54	$167.14	$50.40	$474.38	$474.38	$80.04	$176.88	$583.70	$589.60	$111.21	$137.87	$111.21	$28.79	$26.29	$26.29	$117.33	$76.23	$0.00	$0.00	$0.00	$0.00
32000244	EAP	CPT® 73120		HANDS 2 VIEW EACH BILAT RDG	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$21.97	"$1,091.20"	$59.66	$59.66	$106.02	$106.02	$106.62	$309.51	$45.96	$45.96	$47.73	$104.44	$309.47	$67.89	$878.38	$878.38	$112.41	$327.36	"$1,080.29"	"$1,091.20"	$156.18	$169.61	$156.18	$27.37	$21.97	$21.97	$217.15	$107.06	$0.00	$0.00	$0.00	$0.00
32000246	EAP	CPT® 73130		HANDS 3+VIEW EACH BILAT RDG	BOTH IP/OP	"$1,609.00 "	"$1,190.66"	$26.29	"$1,182.40"	$70.14	$70.14	$78.77	$78.77	$79.21	$335.36	$54.14	$54.14	$56.22	$77.54	$335.32	$50.40	$951.72	$951.72	$80.04	$354.72	"$1,170.58"	"$1,182.40"	$111.21	$137.87	$111.21	$28.79	$26.29	$26.29	$235.30	$76.23	$0.00	$0.00	$0.00	$0.00
32000248	EAP	CPT® 73140		Finger  3 Views	BOTH IP/OP	$609.00 	$450.66	$23.09	$551.20	$71.76	$71.76	$78.77	$78.77	$79.21	$126.93	$53.24	$53.24	$55.29	$77.54	$126.92	$50.40	$360.22	$360.22	$80.04	$165.36	$545.69	$551.20	$111.21	$137.87	$111.21	$23.09	$28.81	$28.81	$109.69	$76.23	$0.00	$0.00	$0.00	$0.00
32000249	EAP	CPT® 73140		Finger X-ray	BOTH IP/OP	$609.00 	$450.66	$23.09	$551.20	$71.76	$71.76	$78.77	$78.77	$79.21	$126.93	$53.24	$53.24	$55.29	$77.54	$126.92	$50.40	$360.22	$360.22	$80.04	$165.36	$545.69	$551.20	$111.21	$137.87	$111.21	$23.09	$28.81	$28.81	$109.69	$76.23	$0.00	$0.00	$0.00	$0.00
32000250	EAP	CPT® 73140		FINGER(S) 2+VIEW RDG	BOTH IP/OP	$609.00 	$450.66	$23.09	$551.20	$71.76	$71.76	$78.77	$78.77	$79.21	$126.93	$53.24	$53.24	$55.29	$77.54	$126.92	$50.40	$360.22	$360.22	$80.04	$165.36	$545.69	$551.20	$111.21	$137.87	$111.21	$23.09	$28.81	$28.81	$109.69	$76.23	$0.00	$0.00	$0.00	$0.00
32000252	EAP	CPT® 73140		FINGER(S) 2+VIEW EACH BILAT RD	BOTH IP/OP	"$1,218.00 "	$901.32	$23.09	"$1,102.40"	$71.76	$71.76	$78.77	$78.77	$79.21	$253.86	$53.24	$53.24	$55.29	$77.54	$253.83	$50.40	$720.45	$720.45	$80.04	$330.72	"$1,091.38"	"$1,102.40"	$111.21	$137.87	$111.21	$23.09	$28.81	$28.81	$219.38	$76.23	$0.00	$0.00	$0.00	$0.00
32000254	EAP	CPT® 73140		FINGER(S) 2+VIEW LT RDG	BOTH IP/OP	$718.00 	$531.32	$23.09	$551.20	$71.76	$71.76	$78.77	$78.77	$79.21	$149.65	$53.24	$53.24	$55.29	$77.54	$149.63	$50.40	$424.70	$424.70	$80.04	$165.36	$545.69	$551.20	$111.21	$137.87	$111.21	$23.09	$28.81	$28.81	$109.69	$76.23	$0.00	$0.00	$0.00	$0.00
32000256	EAP	CPT® 73140		FINGER(S) 2+VIEW RT RDG	BOTH IP/OP	$718.00 	$531.32	$23.09	$551.20	$71.76	$71.76	$78.77	$78.77	$79.21	$149.65	$53.24	$53.24	$55.29	$77.54	$149.63	$50.40	$424.70	$424.70	$80.04	$165.36	$545.69	$551.20	$111.21	$137.87	$111.21	$23.09	$28.81	$28.81	$109.69	$76.23	$0.00	$0.00	$0.00	$0.00
32000258	EAP	CPT® 36299		Inject Vascular Unlstd Proc	BOTH IP/OP	"$4,131.00 "	"$3,056.94"	$0.00	"$2,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$861.00	$0.00	$0.00	$0.00	$0.00	$860.90	$0.00	"$2,443.49"	"$2,443.49"	$0.00	"$2,255.00"	"$2,754.58"	"$2,782.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000285	EAP	CPT® 73525		HIP ARTHROGRAPHY RT RDG	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,275.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.72	$168.72	$175.21	$0.00	$265.71	$0.00	$0.00	$0.00	$387.01	$283.44	$935.35	$944.80	$537.70	"$1,275.00"	$537.70	$107.06	$94.73	$94.73	$188.02	$368.58	$0.00	$0.00	$0.00	$0.00
32000286	EAP	CPT® 73525		HIP ARTHROGRAPHY LT RDG	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,275.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.72	$168.72	$175.21	$0.00	$265.71	$0.00	$0.00	$0.00	$387.01	$283.44	$935.35	$944.80	$537.70	"$1,275.00"	$537.70	$107.06	$94.73	$94.73	$188.02	$368.58	$0.00	$0.00	$0.00	$0.00
32000287	EAP	CPT® 73525		Hips Arthrography Bilat Rdg	BOTH IP/OP	"$1,891.00 "	"$1,399.34"	$0.00	"$1,888.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.72	$168.72	$175.21	$0.00	$394.08	$0.00	$0.00	$0.00	$387.01	$566.64	"$1,869.91"	"$1,888.80"	$537.70	$0.00	$537.70	$107.06	$94.73	$94.73	$375.87	$368.58	$0.00	$0.00	$0.00	$0.00
32000303	EAP	CPT® 73560		KNEE 1-2 VIEW RDG	BOTH IP/OP	$694.00 	$513.56	$25.21	$612.80	$70.14	$70.14	$78.77	$78.77	$79.21	$144.65	$47.79	$47.79	$49.63	$77.54	$144.63	$50.40	$410.50	$410.50	$80.04	$183.84	$606.67	$612.80	$111.21	$137.87	$111.21	$28.43	$25.21	$25.21	$121.95	$76.23	$0.00	$0.00	$0.00	$0.00
32000305	EAP	CPT® 73560		KNEE 1-2 VIEW LT RDG	BOTH IP/OP	$835.00 	$617.90	$25.21	$612.80	$70.14	$70.14	$78.77	$78.77	$79.21	$174.03	$47.79	$47.79	$49.63	$77.54	$174.01	$50.40	$493.90	$493.90	$80.04	$183.84	$606.67	$612.80	$111.21	$137.87	$111.21	$28.43	$25.21	$25.21	$121.95	$76.23	$0.00	$0.00	$0.00	$0.00
32000307	EAP	CPT® 73560		KNEE 1-2 VIEW RT RDG	BOTH IP/OP	$835.00 	$617.90	$25.21	$612.80	$70.14	$70.14	$78.77	$78.77	$79.21	$174.03	$47.79	$47.79	$49.63	$77.54	$174.01	$50.40	$493.90	$493.90	$80.04	$183.84	$606.67	$612.80	$111.21	$137.87	$111.21	$28.43	$25.21	$25.21	$121.95	$76.23	$0.00	$0.00	$0.00	$0.00
32000309	EAP	CPT® 73560		KNEES 1-2 VIEW EACH BILAT RDG	BOTH IP/OP	"$1,666.00 "	"$1,232.84"	$25.21	"$1,222.40"	$70.14	$70.14	$78.77	$78.77	$79.21	$347.24	$47.79	$47.79	$49.63	$77.54	$347.19	$50.40	$985.44	$985.44	$80.04	$366.72	"$1,210.18"	"$1,222.40"	$111.21	$137.87	$111.21	$28.43	$25.21	$25.21	$243.26	$76.23	$0.00	$0.00	$0.00	$0.00
32000311	EAP	CPT® 73562		Knee 3 View Rdg	BOTH IP/OP	$749.00 	$554.26	$29.89	$660.80	$81.42	$81.42	$78.77	$78.77	$79.21	$156.11	$60.18	$60.18	$62.50	$77.54	$156.09	$50.40	$443.03	$443.03	$80.04	$198.24	$654.19	$660.80	$111.21	$137.87	$111.21	$31.26	$29.89	$29.89	$131.50	$76.23	$0.00	$0.00	$0.00	$0.00
32000313	EAP	CPT® 73562		KNEE 3 VIEW LT RDG	BOTH IP/OP	$901.00 	$666.74	$29.89	$660.80	$81.42	$81.42	$78.77	$78.77	$79.21	$187.79	$60.18	$60.18	$62.50	$77.54	$187.77	$50.40	$532.94	$532.94	$80.04	$198.24	$654.19	$660.80	$111.21	$137.87	$111.21	$31.26	$29.89	$29.89	$131.50	$76.23	$0.00	$0.00	$0.00	$0.00
32000315	EAP	CPT® 73562		KNEE 3 VIEW RT RDG	BOTH IP/OP	$901.00 	$666.74	$29.89	$660.80	$81.42	$81.42	$78.77	$78.77	$79.21	$187.79	$60.18	$60.18	$62.50	$77.54	$187.77	$50.40	$532.94	$532.94	$80.04	$198.24	$654.19	$660.80	$111.21	$137.87	$111.21	$31.26	$29.89	$29.89	$131.50	$76.23	$0.00	$0.00	$0.00	$0.00
32000317	EAP	CPT® 73562		KNEES 3 VIEW EACH BILAT RDG	BOTH IP/OP	"$1,495.00 "	"$1,106.30"	$29.89	"$1,319.20"	$81.42	$81.42	$78.77	$78.77	$79.21	$311.60	$60.18	$60.18	$62.50	$77.54	$311.56	$50.40	$884.29	$884.29	$80.04	$395.76	"$1,306.01"	"$1,319.20"	$111.21	$137.87	$111.21	$31.26	$29.89	$29.89	$262.52	$76.23	$0.00	$0.00	$0.00	$0.00
32000319	EAP	CPT® 73564		KNEE 4+VIEW EXR	BOTH IP/OP	$699.00 	$517.26	$32.78	$616.80	$90.29	$90.29	$106.02	$106.02	$106.62	$145.69	$69.25	$69.25	$71.92	$104.44	$145.67	$67.89	$413.46	$413.46	$112.41	$185.04	$610.63	$616.80	$156.18	$169.61	$156.18	$34.81	$32.78	$32.78	$122.74	$107.06	$0.00	$0.00	$0.00	$0.00
32000320	EAP	CPT® 73564		KNEE 4+VIEW LT RDG	BOTH IP/OP	$841.00 	$622.34	$32.78	$616.80	$90.29	$90.29	$106.02	$106.02	$106.62	$175.29	$69.25	$69.25	$71.92	$104.44	$175.26	$67.89	$497.45	$497.45	$112.41	$185.04	$610.63	$616.80	$156.18	$169.61	$156.18	$34.81	$32.78	$32.78	$122.74	$107.06	$0.00	$0.00	$0.00	$0.00
32000322	EAP	CPT® 73564		KNEE 4+VIEW RT RDG	BOTH IP/OP	$841.00 	$622.34	$32.78	$616.80	$90.29	$90.29	$106.02	$106.02	$106.62	$175.29	$69.25	$69.25	$71.92	$104.44	$175.26	$67.89	$497.45	$497.45	$112.41	$185.04	$610.63	$616.80	$156.18	$169.61	$156.18	$34.81	$32.78	$32.78	$122.74	$107.06	$0.00	$0.00	$0.00	$0.00
32000324	EAP	CPT® 73564		KNEES 4+VIEW BILAT RDG	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$32.78	"$1,231.20"	$90.29	$90.29	$106.02	$106.02	$106.62	$290.75	$69.25	$69.25	$71.92	$104.44	$290.72	$67.89	$825.14	$825.14	$112.41	$369.36	"$1,218.89"	"$1,231.20"	$156.18	$169.61	$156.18	$34.81	$32.78	$32.78	$245.01	$107.06	$0.00	$0.00	$0.00	$0.00
32000327	EAP	CPT® 73565		KNEES BOTH STANDING AP RDG	BOTH IP/OP	$826.00 	$611.24	$0.00	$728.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.41	$51.41	$53.38	$0.00	$172.14	$0.00	$0.00	$0.00	$0.00	$218.64	$721.51	$728.80	$0.00	$577.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000329	EAP	CPT® 73580		KNEE ARTHROGRAPHY RT RDG	BOTH IP/OP	"$2,466.00 "	"$1,824.84"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.38	$227.38	$236.12	$0.00	$513.91	$0.00	$0.00	$0.00	$0.00	$652.80	"$2,154.24"	"$2,176.00"	$0.00	"$1,044.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000330	EAP	CPT® 73580		KNEE ARTHROGRAPHY LT RDG	BOTH IP/OP	"$2,466.00 "	"$1,824.84"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.38	$227.38	$236.12	$0.00	$513.91	$0.00	$0.00	$0.00	$0.00	$652.80	"$2,154.24"	"$2,176.00"	$0.00	"$1,044.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000331	EAP	CPT® 73580		Knees Arthrography Bilat Rdg	BOTH IP/OP	"$2,466.00 "	"$1,824.84"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.38	$227.38	$236.12	$0.00	$513.91	$0.00	$0.00	$0.00	$0.00	$652.80	"$2,154.24"	"$2,176.00"	$0.00	"$2,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000332	EAP	CPT® 73590		TIBIA&FIBULA 2 VIEW RDG	BOTH IP/OP	$879.00 	$650.46	$22.69	$639.20	$65.31	$65.31	$78.77	$78.77	$79.21	$183.21	$45.06	$45.06	$46.80	$77.54	$183.18	$50.40	$519.93	$519.93	$80.04	$191.76	$632.81	$639.20	$111.21	$137.87	$111.21	$28.43	$22.69	$22.69	$127.20	$76.23	$0.00	$0.00	$0.00	$0.00
32000334	EAP	CPT® 73590		TIBIA&FIBULA 2 VIEW LT RDG	BOTH IP/OP	$879.00 	$650.46	$22.69	$639.20	$65.31	$65.31	$78.77	$78.77	$79.21	$183.21	$45.06	$45.06	$46.80	$77.54	$183.18	$50.40	$519.93	$519.93	$80.04	$191.76	$632.81	$639.20	$111.21	$137.87	$111.21	$28.43	$22.69	$22.69	$127.20	$76.23	$0.00	$0.00	$0.00	$0.00
32000336	EAP	CPT® 73590		TIBIA&FIBULA 2 VIEW RT RDG	BOTH IP/OP	$879.00 	$650.46	$22.69	$639.20	$65.31	$65.31	$78.77	$78.77	$79.21	$183.21	$45.06	$45.06	$46.80	$77.54	$183.18	$50.40	$519.93	$519.93	$80.04	$191.76	$632.81	$639.20	$111.21	$137.87	$111.21	$28.43	$22.69	$22.69	$127.20	$76.23	$0.00	$0.00	$0.00	$0.00
32000338	EAP	CPT® 73590		TIBIA&FIBULA 2VW ECH BILAT RDG	BOTH IP/OP	$790.00 	$584.60	$22.69	$639.20	$65.31	$65.31	$78.77	$78.77	$79.21	$164.66	$45.06	$45.06	$46.80	$77.54	$164.64	$50.40	$467.29	$467.29	$80.04	$191.76	$632.81	$639.20	$111.21	$137.87	$111.21	$28.43	$22.69	$22.69	$127.20	$76.23	$0.00	$0.00	$0.00	$0.00
32000339	EAP	CPT® 73592		Low Ext Infant 2+view Rdg	BOTH IP/OP	$372.00 	$275.28	$0.00	$300.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.68	$48.68	$50.55	$0.00	$77.52	$0.00	$0.00	$0.00	$0.00	$90.24	$297.79	$300.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000340	EAP	CPT® 73592		LOW EXT INFANT 2+VIEW BI RDG	BOTH IP/OP	$372.00 	$275.28	$0.00	$744.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.68	$48.68	$50.55	$0.00	$77.52	$0.00	$0.00	$0.00	$0.00	$90.24	$297.79	$300.80	$0.00	$744.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000343	EAP	CPT® 73592		LOW EXT INFANT 2+VIEW LT RDG	BOTH IP/OP	$372.00 	$275.28	$0.00	$300.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.68	$48.68	$50.55	$0.00	$77.52	$0.00	$0.00	$0.00	$0.00	$90.24	$297.79	$300.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000345	EAP	CPT® 73592		LOW EXT INFANT 2+VIEW RT RDG	BOTH IP/OP	$372.00 	$275.28	$0.00	$300.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.68	$48.68	$50.55	$0.00	$77.52	$0.00	$0.00	$0.00	$0.00	$90.24	$297.79	$300.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000347	EAP	CPT® 73600		Ankle 2 View Rdg	BOTH IP/OP	$734.00 	$543.16	$23.41	$713.60	$67.72	$67.72	$78.77	$78.77	$79.21	$152.98	$45.96	$45.96	$47.73	$77.54	$152.97	$50.40	$434.16	$434.16	$80.04	$214.08	$706.46	$713.60	$111.21	$137.87	$111.21	$27.37	$23.41	$23.41	$142.01	$76.23	$0.00	$0.00	$0.00	$0.00
32000349	EAP	CPT® 73600		ANKLE 2 VIEW LT RDG	BOTH IP/OP	$980.00 	$725.20	$23.41	$713.60	$67.72	$67.72	$78.77	$78.77	$79.21	$204.26	$45.96	$45.96	$47.73	$77.54	$204.23	$50.40	$579.67	$579.67	$80.04	$214.08	$706.46	$713.60	$111.21	$137.87	$111.21	$27.37	$23.41	$23.41	$142.01	$76.23	$0.00	$0.00	$0.00	$0.00
32000351	EAP	CPT® 73600		ANKLE 2 VIEW RT RDG	BOTH IP/OP	$980.00 	$725.20	$23.41	$713.60	$67.72	$67.72	$78.77	$78.77	$79.21	$204.26	$45.96	$45.96	$47.73	$77.54	$204.23	$50.40	$579.67	$579.67	$80.04	$214.08	$706.46	$713.60	$111.21	$137.87	$111.21	$27.37	$23.41	$23.41	$142.01	$76.23	$0.00	$0.00	$0.00	$0.00
32000353	EAP	CPT® 73600		ANKLES 2 VIEW EACH BILAT RDG	BOTH IP/OP	"$1,958.00 "	"$1,448.92"	$23.41	"$1,425.60"	$67.72	$67.72	$78.77	$78.77	$79.21	$408.10	$45.96	$45.96	$47.73	$77.54	$408.05	$50.40	"$1,158.16"	"$1,158.16"	$80.04	$427.68	"$1,411.34"	"$1,425.60"	$111.21	$137.87	$111.21	$27.37	$23.41	$23.41	$283.69	$76.23	$0.00	$0.00	$0.00	$0.00
32000357	EAP	CPT® 73610		ANKLE 3+VIEW LT RDG	BOTH IP/OP	"$1,060.00 "	$784.40	$26.29	$772.00	$71.76	$71.76	$78.77	$78.77	$79.21	$220.93	$54.14	$54.14	$56.22	$77.54	$220.90	$50.40	$626.99	$626.99	$80.04	$231.60	$764.28	$772.00	$111.21	$137.87	$111.21	$28.79	$26.29	$26.29	$153.63	$76.23	$0.00	$0.00	$0.00	$0.00
32000359	EAP	CPT® 73610		ANKLE 3+VIEW RT RDG	BOTH IP/OP	"$1,060.00 "	$784.40	$26.29	$772.00	$71.76	$71.76	$78.77	$78.77	$79.21	$220.93	$54.14	$54.14	$56.22	$77.54	$220.90	$50.40	$626.99	$626.99	$80.04	$231.60	$764.28	$772.00	$111.21	$137.87	$111.21	$28.79	$26.29	$26.29	$153.63	$76.23	$0.00	$0.00	$0.00	$0.00
32000362	EAP	CPT® 73615		ANKLE ARTHROGRAPHY LT RDG	BOTH IP/OP	"$2,593.00 "	"$1,918.82"	$0.00	"$2,522.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.98	$175.98	$182.75	$0.00	$540.38	$0.00	$0.00	$0.00	$0.00	$756.72	"$2,497.18"	"$2,522.40"	$0.00	$861.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000363	EAP	CPT® 73615		ANKLE ARTHROGRAPHY RT RDG	BOTH IP/OP	"$2,593.00 "	"$1,918.82"	$0.00	"$2,522.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.98	$175.98	$182.75	$0.00	$540.38	$0.00	$0.00	$0.00	$0.00	$756.72	"$2,497.18"	"$2,522.40"	$0.00	$861.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000364	EAP	CPT® 73610		ANKLES 3+VIEW EACH BILAT RDG	BOTH IP/OP	"$2,115.00 "	"$1,565.10"	$26.29	"$1,540.00"	$71.76	$71.76	$78.77	$78.77	$79.21	$440.82	$54.14	$54.14	$56.22	$77.54	$440.77	$50.40	"$1,251.02"	"$1,251.02"	$80.04	$462.00	"$1,524.60"	"$1,540.00"	$111.21	$137.87	$111.21	$28.79	$26.29	$26.29	$306.46	$76.23	$0.00	$0.00	$0.00	$0.00
32000366	EAP	CPT® 73615		Ankles Arthrography Bilat Rdg	BOTH IP/OP	"$5,189.00 "	"$3,839.86"	$0.00	"$5,047.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.98	$175.98	$182.75	$0.00	"$1,081.39"	$0.00	$0.00	$0.00	$0.00	"$1,514.16"	"$4,996.73"	"$5,047.20"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000367	EAP	CPT® 73620		FEET 2 VIEW EACH BILAT RDG	BOTH IP/OP	"$1,600.00 "	"$1,184.00"	$20.17	"$1,168.80"	$58.87	$58.87	$78.77	$78.77	$79.21	$333.48	$44.15	$44.15	$45.85	$77.54	$333.44	$50.40	$946.40	$946.40	$80.04	$350.64	"$1,157.11"	"$1,168.80"	$111.21	$137.87	$111.21	$27.37	$20.17	$20.17	$232.59	$76.23	$0.00	$0.00	$0.00	$0.00
32000369	EAP	CPT® 73620		FOOT 2 VIEW LT RDG	BOTH IP/OP	$801.00 	$592.74	$20.17	$585.60	$58.87	$58.87	$78.77	$78.77	$79.21	$166.95	$44.15	$44.15	$45.85	$77.54	$166.93	$50.40	$473.79	$473.79	$80.04	$175.68	$579.74	$585.60	$111.21	$137.87	$111.21	$27.37	$20.17	$20.17	$116.53	$76.23	$0.00	$0.00	$0.00	$0.00
32000371	EAP	CPT® 73620		FOOT 2 VIEW RT RDG	BOTH IP/OP	$801.00 	$592.74	$20.17	$585.60	$58.87	$58.87	$78.77	$78.77	$79.21	$166.95	$44.15	$44.15	$45.85	$77.54	$166.93	$50.40	$473.79	$473.79	$80.04	$175.68	$579.74	$585.60	$111.21	$137.87	$111.21	$27.37	$20.17	$20.17	$116.53	$76.23	$0.00	$0.00	$0.00	$0.00
32000373	EAP	CPT® 73620		Foot 2 Views Rdg	BOTH IP/OP	$669.00 	$495.06	$20.17	$585.60	$58.87	$58.87	$78.77	$78.77	$79.21	$139.44	$44.15	$44.15	$45.85	$77.54	$139.42	$50.40	$395.71	$395.71	$80.04	$175.68	$579.74	$585.60	$111.21	$137.87	$111.21	$27.37	$20.17	$20.17	$116.53	$76.23	$0.00	$0.00	$0.00	$0.00
32000375	EAP	CPT® 73630		FEET 3+VIEW EACH BILAT RDG	BOTH IP/OP	"$1,730.00 "	"$1,280.20"	$24.49	"$1,264.00"	$66.11	$66.11	$78.77	$78.77	$79.21	$360.58	$53.24	$53.24	$55.29	$77.54	$360.53	$50.40	"$1,023.30"	"$1,023.30"	$80.04	$379.20	"$1,251.36"	"$1,264.00"	$111.21	$137.87	$111.21	$28.79	$24.49	$24.49	$251.54	$76.23	$0.00	$0.00	$0.00	$0.00
32000377	EAP	CPT® 73630		FOOT 3+VIEW RDG	BOTH IP/OP	$863.00 	$638.62	$24.49	$630.40	$66.11	$66.11	$78.77	$78.77	$79.21	$179.87	$53.24	$53.24	$55.29	$77.54	$179.85	$50.40	$510.46	$510.46	$80.04	$189.12	$624.10	$630.40	$111.21	$137.87	$111.21	$28.79	$24.49	$24.49	$125.45	$76.23	$0.00	$0.00	$0.00	$0.00
32000379	EAP	CPT® 73630		FOOT 3+VIEW LT RDG	BOTH IP/OP	$863.00 	$638.62	$24.49	$630.40	$66.11	$66.11	$78.77	$78.77	$79.21	$179.87	$53.24	$53.24	$55.29	$77.54	$179.85	$50.40	$510.46	$510.46	$80.04	$189.12	$624.10	$630.40	$111.21	$137.87	$111.21	$28.79	$24.49	$24.49	$125.45	$76.23	$0.00	$0.00	$0.00	$0.00
32000381	EAP	CPT® 73630		FOOT 3+VIEW RT RDG	BOTH IP/OP	$720.00 	$532.80	$24.49	$630.40	$66.11	$66.11	$78.77	$78.77	$79.21	$150.07	$53.24	$53.24	$55.29	$77.54	$150.05	$50.40	$425.88	$425.88	$80.04	$189.12	$624.10	$630.40	$111.21	$137.87	$111.21	$28.79	$24.49	$24.49	$125.45	$76.23	$0.00	$0.00	$0.00	$0.00
32000383	EAP	CPT® 73650		CALCANEI 2+VIEW EACH BILAT RDG	BOTH IP/OP	"$1,538.00 "	"$1,138.12"	$20.17	"$1,166.40"	$61.27	$61.27	$78.77	$78.77	$79.21	$320.56	$45.06	$45.06	$46.80	$77.54	$320.52	$50.40	$909.73	$909.73	$80.04	$349.92	"$1,154.74"	"$1,166.40"	$111.21	$137.87	$111.21	$26.66	$20.17	$20.17	$232.11	$76.23	$0.00	$0.00	$0.00	$0.00
32000385	EAP	CPT® 73650		CALCANEUS 2+VIEW RDG	BOTH IP/OP	$638.00 	$472.12	$20.17	$584.00	$61.27	$61.27	$78.77	$78.77	$79.21	$132.98	$45.06	$45.06	$46.80	$77.54	$132.96	$50.40	$377.38	$377.38	$80.04	$175.20	$578.16	$584.00	$111.21	$137.87	$111.21	$26.66	$20.17	$20.17	$116.22	$76.23	$0.00	$0.00	$0.00	$0.00
32000387	EAP	CPT® 73650		CALCANEUS 2+VIEW LT RDG	BOTH IP/OP	$770.00 	$569.80	$20.17	$584.00	$61.27	$61.27	$78.77	$78.77	$79.21	$160.49	$45.06	$45.06	$46.80	$77.54	$160.47	$50.40	$455.46	$455.46	$80.04	$175.20	$578.16	$584.00	$111.21	$137.87	$111.21	$26.66	$20.17	$20.17	$116.22	$76.23	$0.00	$0.00	$0.00	$0.00
32000389	EAP	CPT® 73650		CALCANEUS 2+VIEW RT RDG	BOTH IP/OP	$770.00 	$569.80	$20.17	$584.00	$61.27	$61.27	$78.77	$78.77	$79.21	$160.49	$45.06	$45.06	$46.80	$77.54	$160.47	$50.40	$455.46	$455.46	$80.04	$175.20	$578.16	$584.00	$111.21	$137.87	$111.21	$26.66	$20.17	$20.17	$116.22	$76.23	$0.00	$0.00	$0.00	$0.00
32000391	EAP	CPT® 73660		Toe X-ray	BOTH IP/OP	$863.00 	$638.62	$21.61	$690.40	$63.70	$63.70	$78.77	$78.77	$79.21	$179.87	$50.51	$50.51	$52.46	$77.54	$179.85	$50.40	$510.46	$510.46	$80.04	$207.12	$683.50	$690.40	$111.21	$137.87	$111.21	$23.09	$21.61	$21.61	$137.39	$76.23	$0.00	$0.00	$0.00	$0.00
32000392	EAP	CPT® 73660		TOE(S) 2+VIEW EACH BILAT RDG	BOTH IP/OP	"$1,733.00 "	"$1,282.42"	$21.61	"$1,386.40"	$63.70	$63.70	$78.77	$78.77	$79.21	$361.20	$50.51	$50.51	$52.46	$77.54	$361.16	$50.40	"$1,025.07"	"$1,025.07"	$80.04	$415.92	"$1,372.54"	"$1,386.40"	$111.21	$137.87	$111.21	$23.09	$21.61	$21.61	$275.89	$76.23	$0.00	$0.00	$0.00	$0.00
32000394	EAP	CPT® 73660		TOE(S) X-RAY 2+VIEW RDG	BOTH IP/OP	$863.00 	$638.62	$21.61	$690.40	$63.70	$63.70	$78.77	$78.77	$79.21	$179.87	$50.51	$50.51	$52.46	$77.54	$179.85	$50.40	$510.46	$510.46	$80.04	$207.12	$683.50	$690.40	$111.21	$137.87	$111.21	$23.09	$21.61	$21.61	$137.39	$76.23	$0.00	$0.00	$0.00	$0.00
32000396	EAP	CPT® 73660		TOE(S) X-RAY 2+VIEW LT RDG	BOTH IP/OP	$878.00 	$649.72	$21.61	$690.40	$63.70	$63.70	$78.77	$78.77	$79.21	$183.00	$50.51	$50.51	$52.46	$77.54	$182.98	$50.40	$519.34	$519.34	$80.04	$207.12	$683.50	$690.40	$111.21	$137.87	$111.21	$23.09	$21.61	$21.61	$137.39	$76.23	$0.00	$0.00	$0.00	$0.00
32000398	EAP	CPT® 73660		TOE(S) X-RAY 2+VIEW RT RDG	BOTH IP/OP	$878.00 	$649.72	$21.61	$690.40	$63.70	$63.70	$78.77	$78.77	$79.21	$183.00	$50.51	$50.51	$52.46	$77.54	$182.98	$50.40	$519.34	$519.34	$80.04	$207.12	$683.50	$690.40	$111.21	$137.87	$111.21	$23.09	$21.61	$21.61	$137.39	$76.23	$0.00	$0.00	$0.00	$0.00
32000412	EAP	CPT® 74018		"KUB-KIDNEY,URETER,BLADDER RDG"	BOTH IP/OP	$797.00 	$589.78	$20.17	$581.60	$62.20	$62.20	$78.77	$78.77	$79.21	$166.11	$45.51	$45.51	$47.26	$77.54	$166.09	$50.40	$471.43	$471.43	$80.04	$174.48	$575.78	$581.60	$111.21	$137.87	$111.21	$26.25	$20.17	$20.17	$115.74	$76.23	$0.00	$0.00	$0.00	$0.00
32000417	EAP	CPT® 74019		ABDOMEN AP OBLIQ&CONE RDG	BOTH IP/OP	$704.00 	$520.96	$24.49	$578.40	$75.90	$75.90	$106.02	$106.02	$106.62	$146.73	$54.42	$54.42	$56.52	$104.44	$146.71	$67.89	$416.42	$416.42	$112.41	$173.52	$572.62	$578.40	$156.18	$169.61	$156.18	$32.02	$24.49	$24.49	$115.10	$107.06	$0.00	$0.00	$0.00	$0.00
32000419	EAP	CPT® 74019		ABDOMEN W/DECUB&/ERECT RDG	BOTH IP/OP	$813.00 	$601.62	$24.49	$593.60	$75.90	$75.90	$106.02	$106.02	$106.62	$169.45	$54.42	$54.42	$56.52	$104.44	$169.43	$67.89	$480.89	$480.89	$112.41	$178.08	$587.66	$593.60	$156.18	$169.61	$156.18	$32.02	$24.49	$24.49	$118.13	$107.06	$0.00	$0.00	$0.00	$0.00
32000421	EAP	CPT® 74022		Xr 2 Vw Abd W/ Single View Chest	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$872.00	$101.59	$101.59	$106.02	$106.02	$106.62	$249.07	$79.08	$79.08	$82.12	$104.44	$249.04	$67.89	$706.84	$706.84	$112.41	$261.60	$863.28	$872.00	$156.18	$169.61	$156.18	$44.36	$32.78	$32.78	$0.00	$107.06	$0.00	$0.00	$0.00	$0.00
32000430	EAP	CPT® 74210		Xr Pharynx/cerv Esoph Single Contrast	BOTH IP/OP	$630.00 	$466.20	$0.00	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.45	$142.45	$147.93	$0.00	$131.29	$0.00	$0.00	$0.00	$0.00	$159.60	$526.68	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000432	EAP	CPT® 74220		Xr Esophagus Single Contrast	BOTH IP/OP	"$1,176.00 "	$870.24	$66.99	$950.40	$200.75	$200.75	$173.95	$173.95	$174.93	$245.11	$156.06	$156.06	$162.06	$171.13	$245.08	$111.23	$695.60	$695.60	$202.33	$285.12	$940.90	$950.40	$281.11	$286.19	$281.11	$68.55	$66.99	$66.99	$189.13	$192.70	$0.00	$0.00	$0.00	$0.00
32000434	EAP	CPT® 74230		Xr Swallow Function Single Contrast	BOTH IP/OP	$978.00 	$723.72	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$153.16	$153.16	$159.05	$0.00	$203.82	$0.00	$0.00	$0.00	$0.00	$237.12	$782.50	$790.40	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000435	EAP	CPT® 74230		Barium Swallow	BOTH IP/OP	$988.00 	$731.12	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$153.16	$153.16	$159.05	$0.00	$205.90	$0.00	$0.00	$0.00	$0.00	$237.12	$782.50	$790.40	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000436	EAP	CPT® 74235		ESOPHAGEAL FB REMOVAL  S&I SPV	BOTH IP/OP	"$1,329.00 "	$983.46	$0.00	"$5,322.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$298.34	$298.34	$309.82	$0.00	$276.96	$0.00	$0.00	$0.00	$0.00	$322.08	"$1,062.86"	"$1,073.60"	$0.00	"$5,322.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000437	EAP	CPT® 74235		FB REMOVAL ESOPHAGEAL S&I EXR	BOTH IP/OP	"$1,342.00 "	$993.08	$0.00	"$5,322.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$298.34	$298.34	$309.82	$0.00	$279.67	$0.00	$0.00	$0.00	$0.00	$322.08	"$1,062.86"	"$1,073.60"	$0.00	"$5,322.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000439	EAP	CPT® 74235		Rem. F.b. Esoph Xray Super/int	BOTH IP/OP	"$1,329.00 "	$983.46	$0.00	"$5,322.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$298.34	$298.34	$309.82	$0.00	$276.96	$0.00	$0.00	$0.00	$0.00	$322.08	"$1,062.86"	"$1,073.60"	$0.00	"$5,322.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000441	EAP	CPT® 74240		UGI W/O KUB RDG	BOTH IP/OP	"$1,446.00 "	"$1,070.04"	$80.68	"$1,088.80"	$256.37	$256.37	$173.95	$173.95	$174.93	$301.38	$177.54	$177.54	$184.37	$171.13	$301.35	$111.23	$855.31	$855.31	$202.33	$326.64	"$1,077.91"	"$1,088.80"	$281.11	$286.19	$281.11	$90.47	$80.68	$80.68	$216.67	$192.70	$0.00	$0.00	$0.00	$0.00
32000448	EAP	CPT® 74246		UGI W/ AIR CON W/O KUB RDG	BOTH IP/OP	"$1,369.00 "	"$1,013.06"	$94.36	"$1,031.20"	$288.60	$288.60	$173.95	$173.95	$174.93	$285.33	$216.23	$216.23	$224.54	$171.13	$285.30	$111.23	$809.76	$809.76	$202.33	$309.36	"$1,020.89"	"$1,031.20"	$281.11	$286.19	$281.11	$97.60	$94.36	$94.36	$205.21	$192.70	$0.00	$0.00	$0.00	$0.00
32000449	EAP	CPT® 74246		Ugi W/air Contrast	BOTH IP/OP	"$1,369.00 "	"$1,013.06"	$94.36	"$1,031.20"	$288.60	$288.60	$173.95	$173.95	$174.93	$285.33	$216.23	$216.23	$224.54	$171.13	$285.30	$111.23	$809.76	$809.76	$202.33	$309.36	"$1,020.89"	"$1,031.20"	$281.11	$286.19	$281.11	$97.60	$94.36	$94.36	$205.21	$192.70	$0.00	$0.00	$0.00	$0.00
32000457	EAP	CPT® 74250		Xr Small Bowel Single Contrast	BOTH IP/OP	$656.00 	$485.44	$0.00	$490.40	$236.20	$236.20	$173.95	$173.95	$174.93	$0.00	$190.37	$190.37	$197.69	$0.00	$136.71	$0.00	$0.00	$0.00	$0.00	$147.12	$485.50	$490.40	$0.00	$286.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000462	EAP	CPT® 74270		Xr Colon Single Contrast	BOTH IP/OP	"$1,428.00 "	"$1,056.72"	$100.09	"$1,386.40"	$332.96	$332.96	$173.95	$173.95	$174.93	$297.63	$270.52	$270.52	$280.93	$171.13	$297.60	$111.23	$844.66	$844.66	$202.33	$415.92	"$1,372.54"	"$1,386.40"	$281.11	$286.19	$281.11	$100.09	$103.37	$103.37	$275.89	$192.70	$0.00	$0.00	$0.00	$0.00
32000463	EAP	CPT® 74270		Be (barium Enema) Routi	BOTH IP/OP	"$1,716.00 "	"$1,269.84"	$100.09	"$1,386.40"	$332.96	$332.96	$173.95	$173.95	$174.93	$357.66	$270.52	$270.52	$280.93	$171.13	$357.61	$111.23	"$1,015.01"	"$1,015.01"	$202.33	$415.92	"$1,372.54"	"$1,386.40"	$281.11	$286.19	$281.11	$100.09	$103.37	$103.37	$275.89	$192.70	$0.00	$0.00	$0.00	$0.00
32000465	EAP	CPT® 74280		Xr Colon Double Contrast	BOTH IP/OP	"$2,694.00 "	"$1,993.56"	$0.00	"$2,176.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$561.50	$370.04	$370.04	$384.27	$171.13	$561.43	$111.23	"$1,593.50"	"$1,593.50"	$202.33	$653.04	"$2,155.03"	"$2,176.80"	$281.11	"$1,860.00"	$281.11	$134.85	$160.64	$160.64	$433.18	$192.70	$0.00	$0.00	$0.00	$0.00
32000467	EAP	CPT® 74283		THERAPEUTIC ENEMA CON/AIR RDG	BOTH IP/OP	"$1,218.00 "	$901.32	$0.00	"$1,182.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.43	$256.43	$266.30	$0.00	$253.83	$0.00	$0.00	$0.00	$0.00	$354.72	"$1,170.58"	"$1,182.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000468	EAP	CPT® 74290		Cholecystography W/dye Rdg	BOTH IP/OP	"$1,066.00 "	$788.84	$0.00	"$1,035.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.00	$119.00	$123.57	$0.00	$222.15	$0.00	$0.00	$0.00	$0.00	$310.56	"$1,024.85"	"$1,035.20"	$0.00	$722.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000470	EAP	CPT® 74300		CHOLANGIO INTRAOPERATIVE RDG	BOTH IP/OP	"$1,122.00 "	$830.28	$0.00	"$1,122.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.82	$88.82	$92.23	$0.00	$233.82	$0.00	$0.00	$0.00	$0.00	$269.28	$888.62	$897.60	$0.00	"$1,122.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000471	EAP	CPT® 74300		Xray Bile Ducts/pancreas	BOTH IP/OP	"$1,122.00 "	$830.28	$0.00	$897.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.82	$88.82	$92.23	$0.00	$233.82	$0.00	$0.00	$0.00	$0.00	$269.28	$888.62	$897.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000477	EAP	CPT® 74328		Radiological;biliary Ductal	BOTH IP/OP	$934.00 	$691.16	$0.00	$934.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$344.53	$344.53	$357.78	$0.00	$194.65	$0.00	$0.00	$0.00	$0.00	$224.16	$739.73	$747.20	$0.00	$934.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000478	EAP	CPT® 74329		Radiological;pancreatic Ductal	BOTH IP/OP	$934.00 	$691.16	$0.00	$934.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.01	$174.01	$180.71	$0.00	$194.65	$0.00	$0.00	$0.00	$0.00	$224.16	$739.73	$747.20	$0.00	$934.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000479	EAP	CPT® 74330		Radiological;biliary & Pancrea	BOTH IP/OP	$934.00 	$691.16	$0.00	$934.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$344.53	$344.53	$357.78	$0.00	$194.65	$0.00	$0.00	$0.00	$0.00	$224.16	$739.73	$747.20	$0.00	$934.00	$0.00	$163.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000481	EAP	CPT® 74340		INTRO OF LONG GI TUBE S&I RDG	BOTH IP/OP	$456.00 	$337.44	$0.00	"$1,377.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.63	$286.63	$297.66	$0.00	$95.03	$0.00	$0.00	$0.00	$0.00	$110.64	$365.11	$368.80	$0.00	"$1,377.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000482	EAP	CPT® 74340		X-ray Guide For Gi Tube	BOTH IP/OP	$461.00 	$341.14	$0.00	"$1,377.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.63	$286.63	$297.66	$0.00	$96.07	$0.00	$0.00	$0.00	$0.00	$110.64	$365.11	$368.80	$0.00	"$1,377.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000484	EAP	CPT® 74355		Pl Enteroclysis Tube Perc Spv	BOTH IP/OP	$844.00 	$624.56	$0.00	$675.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.63	$286.63	$297.66	$0.00	$175.89	$0.00	$0.00	$0.00	$0.00	$202.56	$668.45	$675.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000485	EAP	CPT® 74360		Eso-dil Intralu Dil Stric Xray	BOTH IP/OP	$976.00 	$722.24	$0.00	$976.00	$268.62	$268.62	$0.00	$0.00	$0.00	$203.42	$344.53	$344.53	$357.78	$0.00	$203.40	$0.00	$577.30	$577.30	$0.00	$234.24	$772.99	$780.80	$0.00	$976.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000486	EAP	CPT® 74360		INTRALUMINAL DILAT STRICTU SPV	BOTH IP/OP	$976.00 	$722.24	$0.00	$780.80	$268.62	$268.62	$0.00	$0.00	$0.00	$203.42	$344.53	$344.53	$357.78	$0.00	$203.40	$0.00	$577.30	$577.30	$0.00	$234.24	$772.99	$780.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000487	EAP	CPT® 74363		BILIARY STRICTURE SPV	BOTH IP/OP	"$2,534.00 "	"$1,875.16"	$0.00	"$2,027.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.82	$218.82	$227.23	$0.00	$528.09	$0.00	$0.00	$0.00	$0.00	$608.16	"$2,006.93"	"$2,027.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000488	EAP	CPT® 74400		Urography Hypertensive	BOTH IP/OP	$888.00 	$657.12	$0.00	$710.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.81	$208.81	$216.84	$0.00	$185.06	$0.00	$0.00	$0.00	$0.00	$213.12	$703.30	$710.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000490	EAP	CPT® 74400		Urography W/wo Kub/tomog Rdg	BOTH IP/OP	$888.00 	$657.12	$0.00	$710.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.81	$208.81	$216.84	$0.00	$185.06	$0.00	$0.00	$0.00	$0.00	$213.12	$703.30	$710.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000493	EAP	CPT® 74410		Urography Drip Infusion Rdg	BOTH IP/OP	$868.00 	$642.32	$0.00	$694.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.40	$222.40	$230.96	$0.00	$180.89	$0.00	$0.00	$0.00	$0.00	$208.32	$687.46	$694.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000495	EAP	CPT® 74415		Urography With Nephro Exr	BOTH IP/OP	$868.00 	$642.32	$0.00	$694.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.92	$264.92	$275.11	$0.00	$180.89	$0.00	$0.00	$0.00	$0.00	$208.32	$687.46	$694.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000496	EAP	CPT® 74420		Retrograde Urography	BOTH IP/OP	$888.00 	$657.12	$0.00	$710.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.63	$286.63	$297.66	$0.00	$185.06	$0.00	$0.00	$0.00	$0.00	$213.12	$703.30	$710.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000497	EAP	CPT® 74420		Urogra Retro W/wo Kub Rdg	BOTH IP/OP	$888.00 	$657.12	$0.00	$710.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.63	$286.63	$297.66	$0.00	$185.06	$0.00	$0.00	$0.00	$0.00	$213.12	$703.30	$710.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000500	EAP	CPT® 74425		Nephrostogram	BOTH IP/OP	"$1,039.00 "	$768.86	$67.58	"$1,021.42"	"$1,021.42"	"$1,021.42"	$358.61	$358.61	$360.63	$216.55	$142.79	$142.79	$148.28	$352.81	$216.53	$229.33	$614.57	$614.57	$387.01	$249.36	$822.89	$831.20	$537.70	$584.68	$537.70	$67.58	$106.25	$106.25	$165.41	$368.58	$0.00	$0.00	$0.00	$0.00
32000501	EAP	CPT® 74425		Loopogram/pouchogram	BOTH IP/OP	"$1,039.00 "	$768.86	$0.00	"$1,021.42"	"$1,021.42"	"$1,021.42"	$358.61	$358.61	$360.63	$216.55	$142.79	$142.79	$148.28	$352.81	$216.53	$229.33	$614.57	$614.57	$387.01	$249.36	$822.89	$831.20	$537.70	$0.00	$537.70	$67.58	$106.25	$106.25	$165.41	$368.58	$0.00	$0.00	$0.00	$0.00
32000502	EAP	CPT® 74425		UROGRAPHY ANTEGRADE EXR	BOTH IP/OP	"$1,039.00 "	$768.86	$67.58	"$1,021.42"	"$1,021.42"	"$1,021.42"	$358.61	$358.61	$360.63	$216.55	$142.79	$142.79	$148.28	$352.81	$216.53	$229.33	$614.57	$614.57	$387.01	$249.36	$822.89	$831.20	$537.70	$584.68	$537.70	$67.58	$106.25	$106.25	$165.41	$368.58	$0.00	$0.00	$0.00	$0.00
32000503	EAP	CPT® 74430		CYSTOGRAPHY 3+VIEW S&I RDG	BOTH IP/OP	"$1,235.00 "	$913.90	$0.00	$997.60	$0.00	$0.00	$0.00	$0.00	$0.00	$257.40	$152.43	$152.43	$158.30	$352.81	$257.37	$229.33	$730.50	$730.50	$387.01	$299.28	$987.62	$997.60	$537.70	$764.00	$537.70	$56.52	$24.49	$24.49	$198.52	$368.58	$0.00	$0.00	$0.00	$0.00
32000504	EAP	CPT® 74430		Contrast Xray Bladder	BOTH IP/OP	"$1,247.00 "	$922.78	$0.00	$997.60	$0.00	$0.00	$0.00	$0.00	$0.00	$259.91	$152.43	$152.43	$158.30	$352.81	$259.87	$229.33	$737.60	$737.60	$387.01	$299.28	$987.62	$997.60	$537.70	$764.00	$537.70	$56.52	$24.49	$24.49	$198.52	$368.58	$0.00	$0.00	$0.00	$0.00
32000505	EAP	CPT® 74440		Vasography Vesicu'graphy Spv	BOTH IP/OP	"$1,078.00 "	$797.72	$0.00	$862.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.69	$159.69	$165.83	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$258.72	$853.78	$862.40	$0.00	$385.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000506	EAP	CPT® 74445		CORPORA CAVERNO'GRAM S&I SPV	BOTH IP/OP	"$1,078.00 "	$797.72	$0.00	$862.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.12	$123.12	$127.85	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$258.72	$853.78	$862.40	$0.00	$323.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000508	EAP	CPT® 74450		Retro Urethrocystography	BOTH IP/OP	"$2,861.00 "	"$2,117.14"	$0.00	"$2,105.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$596.30	$159.33	$159.33	$165.46	$220.56	$596.23	$143.36	"$1,692.28"	"$1,692.28"	$233.72	$631.68	"$2,084.54"	"$2,105.60"	$324.73	$915.00	$324.73	$72.23	$0.00	$0.00	$419.01	$222.60	$0.00	$0.00	$0.00	$0.00
32000509	EAP	CPT® 74450		RETROGRADE URETHROGRAM RDG	BOTH IP/OP	"$2,861.00 "	"$2,117.14"	$0.00	"$2,105.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$596.30	$159.33	$159.33	$165.46	$220.56	$596.23	$143.36	"$1,692.28"	"$1,692.28"	$233.72	$631.68	"$2,084.54"	"$2,105.60"	$324.73	$915.00	$324.73	$72.23	$0.00	$0.00	$419.01	$222.60	$0.00	$0.00	$0.00	$0.00
32000511	EAP	CPT® 74455		URETHROCYSTOGRAPHY VOID RDG	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$456.66	$0.00	$0.00	$0.00	$220.56	$456.60	$143.36	"$1,295.98"	"$1,295.98"	$233.72	$483.60	"$1,595.88"	"$1,612.00"	$324.73	$0.00	$324.73	$76.86	$82.12	$82.12	$320.79	$222.60	$0.00	$0.00	$0.00	$0.00
32000514	EAP	CPT® 74485		NEPHRSTOMY/URETERAL DILAT SPV	BOTH IP/OP	"$2,682.00 "	"$1,984.68"	$0.00	"$2,145.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.19	$224.19	$232.82	$0.00	$558.93	$0.00	$0.00	$0.00	$0.00	$643.68	"$2,124.14"	"$2,145.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000516	EAP	CPT® 74740		HYSTEROSALPINGOGRAPHY RDG	BOTH IP/OP	$957.00 	$708.18	$68.95	$699.20	$170.10	$170.10	$224.08	$224.08	$225.34	$199.46	$144.10	$144.10	$149.64	$220.56	$199.44	$143.36	$566.07	$566.07	$233.72	$209.76	$692.21	$699.20	$324.73	$370.58	$324.73	$68.95	$72.03	$72.03	$139.14	$222.60	$0.00	$0.00	$0.00	$0.00
32000517	EAP	CPT® 74742		TRANSCERVIC CATH FALLOPIAN SPV	BOTH IP/OP	$623.00 	$461.02	$0.00	$498.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.65	$149.65	$155.40	$0.00	$129.83	$0.00	$0.00	$0.00	$0.00	$149.52	$493.42	$498.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000547	EAP	CPT® 75726		ANGIO MESENTERIC SPV	BOTH IP/OP	"$8,089.00 "	"$5,985.86"	$87.16	"$8,156.48"	$340.22	$340.22	"$4,643.92"	"$4,643.92"	"$4,670.08"	"$1,685.95"	$560.51	$560.51	$582.07	"$4,572.02"	"$1,685.75"	"$2,971.81"	"$4,784.64"	"$4,784.64"	"$4,609.70"	"$1,961.04"	"$6,471.43"	"$6,536.80"	"$6,404.56"	"$8,156.48"	"$6,404.56"	$535.99	$87.16	$87.16	"$1,300.82"	"$4,390.19"	$0.00	$0.00	$0.00	$0.00
32000548	EAP	CPT® 75726		ANGIO HEPATIC SPV	BOTH IP/OP	"$8,089.00 "	"$5,985.86"	$87.16	"$8,156.48"	$340.22	$340.22	"$4,643.92"	"$4,643.92"	"$4,670.08"	"$1,685.95"	$560.51	$560.51	$582.07	"$4,572.02"	"$1,685.75"	"$2,971.81"	"$4,784.64"	"$4,784.64"	"$4,609.70"	"$1,961.04"	"$6,471.43"	"$6,536.80"	"$6,404.56"	"$8,156.48"	"$6,404.56"	$535.99	$87.16	$87.16	"$1,300.82"	"$4,390.19"	$0.00	$0.00	$0.00	$0.00
32000555	EAP	CPT® 75746		ANGIO PULMONARY NONSELE SPV	BOTH IP/OP	"$2,391.00 "	"$1,769.34"	$0.00	"$2,787.76"	$349.06	$349.06	"$2,787.76"	"$2,787.76"	"$2,391.00"	$498.34	$545.99	$545.99	$566.99	"$2,742.67"	$498.28	"$1,782.74"	"$1,414.28"	"$1,414.28"	$0.00	$717.36	"$2,367.29"	"$2,391.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000556	EAP	CPT® 75756		"Artery Xray, Chest"	BOTH IP/OP	"$3,613.00 "	"$2,673.62"	$0.00	"$3,613.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$577.75	$577.75	$599.97	$0.00	$752.95	$0.00	$0.00	$0.00	$0.00	$875.76	"$2,890.01"	"$2,919.20"	$0.00	"$3,613.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000560	EAP	CPT® 75809		Shuntogram Rdg	BOTH IP/OP	$853.00 	$631.22	$53.15	$689.60	$224.93	$224.93	$106.02	$106.02	$106.62	$177.79	$156.21	$156.21	$162.22	$104.44	$177.77	$67.89	$504.55	$504.55	$112.41	$206.88	$682.70	$689.60	$156.18	$169.61	$156.18	$53.15	$68.43	$68.43	$137.23	$107.06	$0.00	$0.00	$0.00	$0.00
32000561	EAP	CPT® 75810		SPLENOPORTOGRAPHY SPV	BOTH IP/OP	"$11,121.00 "	"$8,229.54"	$0.00	"$8,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,375.38"	"$1,375.38"	"$1,428.28"	$0.00	"$2,317.62"	$0.00	$0.00	$0.00	$0.00	"$2,669.04"	"$8,807.83"	"$8,896.80"	$0.00	"$7,093.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000562	EAP	CPT® 75820		EXTREMITY UNI VENOGRAM SPV	BOTH IP/OP	"$1,483.00 "	"$1,097.42"	$71.50	"$2,361.12"	$262.84	$262.84	"$1,369.42"	"$1,369.42"	"$1,377.13"	$309.09	$205.08	$205.08	$212.97	"$1,347.67"	$309.06	$875.99	$877.19	$877.19	$632.36	$359.52	"$1,186.42"	"$1,198.40"	$878.58	"$2,361.12"	$878.58	$71.50	$74.20	$74.20	$238.48	$602.25	$0.00	$0.00	$0.00	$0.00
32000563	EAP	CPT® 75822		EXTREMITY BI VENOGRAM SPV	BOTH IP/OP	"$1,616.00 "	"$1,195.84"	$75.28	"$2,361.12"	$312.02	$312.02	"$1,369.42"	"$1,369.42"	"$1,377.13"	$336.81	$227.43	$227.43	$236.17	"$1,347.67"	$336.77	$875.99	$955.86	$955.86	"$1,635.92"	$378.48	"$1,248.98"	"$1,261.60"	"$1,577.00"	"$2,361.12"	"$1,577.00"	$109.07	$75.28	$75.28	$251.06	"$1,558.02"	$0.00	$0.00	$0.00	$0.00
32000564	EAP	CPT® 75825		INFERIOR VENO CAVAGRAM SPV	BOTH IP/OP	"$8,524.00 "	"$6,307.76"	$0.00	"$6,748.00"	$308.83	$308.83	"$2,787.76"	"$2,787.76"	"$2,803.47"	"$1,776.61"	$506.96	$506.96	$526.46	"$2,742.67"	"$1,776.40"	"$1,782.74"	"$5,041.95"	"$5,041.95"	$0.00	"$2,024.40"	"$6,680.52"	"$6,748.00"	$0.00	"$4,727.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000565	EAP	CPT® 75827		SUPERIOR VENO CAVAGRAM SPV	BOTH IP/OP	"$2,543.00 "	"$1,881.82"	$0.00	"$2,543.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$508.79	$508.79	$528.36	$0.00	$529.96	$0.00	$0.00	$0.00	$0.00	$603.84	"$1,992.67"	"$2,012.80"	$0.00	"$2,543.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000566	EAP	CPT® 75831		RENAL VENOGRAPH UNI SELEC SPV	BOTH IP/OP	"$7,721.00 "	"$5,713.54"	$0.00	"$6,239.20"	$319.28	$319.28	"$2,787.76"	"$2,787.76"	"$2,803.47"	"$1,609.25"	$514.24	$514.24	$534.02	"$2,742.67"	"$1,609.06"	"$1,782.74"	"$4,566.97"	"$4,566.97"	$0.00	"$1,871.76"	"$6,176.81"	"$6,239.20"	$0.00	"$4,727.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000567	EAP	CPT® 75833		RENAL VENOGRAM BI SELECT SPV	BOTH IP/OP	"$8,009.00 "	"$5,926.66"	$0.00	"$7,649.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$546.89	$546.89	$567.93	$0.00	"$1,669.08"	$0.00	$0.00	$0.00	$0.00	"$1,922.16"	"$6,343.13"	"$6,407.20"	$0.00	"$7,649.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000568	EAP	CPT® 75840		ADRENAL VENO UNILAT SEL SPV	BOTH IP/OP	"$5,361.00 "	"$3,967.14"	$0.00	"$5,361.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$510.59	$510.59	$530.23	$0.00	"$1,117.23"	$0.00	$0.00	$0.00	$0.00	"$1,299.60"	"$4,288.68"	"$4,332.00"	$0.00	"$5,361.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000569	EAP	CPT® 75842		ADRENAL VENOGRPHY BI SELCT SPV	BOTH IP/OP	"$5,630.00 "	"$4,166.20"	$0.00	"$4,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$548.70	$548.70	$569.81	$0.00	"$1,173.29"	$0.00	$0.00	$0.00	$0.00	"$1,351.20"	"$4,458.96"	"$4,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000570	EAP	CPT® 75860		SINUS/JUGULAR VENOGRAM SPN	BOTH IP/OP	"$3,267.00 "	"$2,417.58"	$0.00	"$4,727.44"	$327.33	$327.33	"$2,787.76"	"$2,787.76"	"$2,803.47"	$680.92	$524.20	$524.20	$544.36	"$2,742.67"	$680.84	"$1,782.74"	"$1,932.43"	"$1,932.43"	$0.00	$792.00	"$2,613.60"	"$2,640.00"	$0.00	"$4,727.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000571	EAP	CPT® 75870		SUPER SAGG SINUS VENOGRAM SPN	BOTH IP/OP	"$2,716.00 "	"$2,009.84"	$0.00	"$2,172.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$522.39	$522.39	$542.48	$0.00	$566.01	$0.00	$0.00	$0.00	$0.00	$651.84	"$2,151.07"	"$2,172.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000572	EAP	CPT® 75872		EPIDURAL VENOGRAM SPN	BOTH IP/OP	"$1,855.00 "	"$1,372.70"	$0.00	"$1,855.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$574.13	$574.13	$596.21	$0.00	$386.58	$0.00	$0.00	$0.00	$0.00	$445.20	"$1,469.16"	"$1,484.00"	$0.00	"$1,855.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000573	EAP	CPT® 75880		ORBITAL VENOGRAM SPN	BOTH IP/OP	"$1,855.00 "	"$1,372.70"	$0.00	"$1,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.42	$211.42	$219.55	$0.00	$386.58	$0.00	$0.00	$0.00	$0.00	$445.20	"$1,469.16"	"$1,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000574	EAP	CPT® 75885		TRANS-HEP PORT W/HEMODYNAM SPV	BOTH IP/OP	"$7,625.00 "	"$5,642.50"	$0.00	"$7,625.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$516.04	$516.04	$535.89	$0.00	"$1,589.05"	$0.00	$0.00	$0.00	$0.00	"$1,848.48"	"$6,099.98"	"$6,161.60"	$0.00	"$7,625.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000575	EAP	CPT® 75887		TRANS-HEP PORT W/O HEMODYN SPV	BOTH IP/OP	"$4,003.00 "	"$2,962.22"	$0.00	"$4,003.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$521.49	$521.49	$541.54	$0.00	$834.23	$0.00	$0.00	$0.00	$0.00	$970.32	"$3,202.06"	"$3,234.40"	$0.00	"$4,003.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000576	EAP	CPT® 75889		HEPATIC WEDGE VENO W/EVAL SPV	BOTH IP/OP	"$7,625.00 "	"$5,642.50"	$0.00	"$7,625.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$515.13	$515.13	$534.95	$0.00	"$1,589.05"	$0.00	$0.00	$0.00	$0.00	"$1,848.48"	"$6,099.98"	"$6,161.60"	$0.00	"$7,625.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000577	EAP	CPT® 75891		HEPATIC WEDG VENO W/O EVAL SPV	BOTH IP/OP	"$8,009.00 "	"$5,926.66"	$0.00	"$6,407.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$515.13	$515.13	$534.95	$0.00	"$1,669.08"	$0.00	$0.00	$0.00	$0.00	"$1,922.16"	"$6,343.13"	"$6,407.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000578	EAP	CPT® 75893		VENOUS SAMPLING W/WO ANGI SPV	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$514.24	$514.24	$534.02	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$1,200.00"	"$3,960.00"	"$4,000.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000579	EAP	CPT® 75894		Transcath Embolization	BOTH IP/OP	"$11,713.00 "	"$8,667.62"	$0.00	"$12,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,635.61"	"$2,635.61"	"$2,736.98"	$0.00	"$2,440.99"	$0.00	$0.00	$0.00	$0.00	"$2,561.04"	"$8,451.43"	"$8,536.80"	$0.00	"$12,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000580	EAP	CPT® 75894		"Transcath Embolization, S&i"	BOTH IP/OP	"$10,671.00 "	"$7,896.54"	$0.00	"$12,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,635.61"	"$2,635.61"	"$2,736.98"	$0.00	"$2,223.84"	$0.00	$0.00	$0.00	$0.00	"$2,561.04"	"$8,451.43"	"$8,536.80"	$0.00	"$12,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000585	EAP	CPT® 75901		Remove Cva Device Obstruct	BOTH IP/OP	$585.00 	$432.90	$0.00	$585.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.60	$361.60	$375.51	$0.00	$121.91	$0.00	$0.00	$0.00	$0.00	$141.84	$468.07	$472.80	$0.00	$585.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000592	EAP	CPT® 75956		Endovasc Thor Ao Repr	BOTH IP/OP	"$2,118.00 "	"$1,567.32"	$0.00	"$1,694.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.98"	"$1,571.98"	"$1,632.55"	$0.00	$441.39	$0.00	$0.00	$0.00	$0.00	$508.32	"$1,677.46"	"$1,694.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000593	EAP	CPT® 75957		Endovasc Thor Aor Repr	BOTH IP/OP	"$2,287.00 "	"$1,692.38"	$0.00	"$1,829.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,697.41"	"$1,697.41"	"$1,762.82"	$0.00	$476.61	$0.00	$0.00	$0.00	$0.00	$548.88	"$1,811.30"	"$1,829.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000594	EAP	CPT® 75958		Place Prox Ext Thor Ao	BOTH IP/OP	"$1,761.00 "	"$1,303.14"	$0.00	"$1,408.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,307.01"	"$1,307.01"	"$1,357.38"	$0.00	$366.99	$0.00	$0.00	$0.00	$0.00	$422.64	"$1,394.71"	"$1,408.80"	$0.00	"$1,235.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000595	EAP	CPT® 75959		Place Dist Ext Thor Ao	BOTH IP/OP	"$1,693.00 "	"$1,252.82"	$0.00	"$1,354.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,256.54"	"$1,256.54"	"$1,304.96"	$0.00	$352.82	$0.00	$0.00	$0.00	$0.00	$406.32	"$1,340.86"	"$1,354.40"	$0.00	"$1,083.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000607	EAP	CPT® 75984		CHNG DRN TUBE CATH W DYE SPV	BOTH IP/OP	"$2,247.00 "	"$1,662.78"	$0.00	"$1,816.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.56	$191.56	$198.93	$0.00	$468.27	$0.00	$0.00	$0.00	$0.00	$544.80	"$1,797.84"	"$1,816.00"	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000608	EAP	CPT® 75989		Us Drain Percut S&i	BOTH IP/OP	"$3,905.00 "	"$2,889.70"	$0.00	"$3,124.00"	$726.00	$726.00	$0.00	$0.00	$0.00	$813.90	$785.72	$785.72	$815.94	$0.00	$813.80	$0.00	"$2,309.81"	"$2,309.81"	$0.00	$937.20	"$3,092.76"	"$3,124.00"	$0.00	"$2,241.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000609	EAP	CPT® 75989		Drain Of Abscess Perc S&i	BOTH IP/OP	"$4,282.00 "	"$3,168.68"	$0.00	"$3,124.00"	$726.00	$726.00	$0.00	$0.00	$0.00	$892.48	$785.72	$785.72	$815.94	$0.00	$892.37	$0.00	"$2,532.80"	"$2,532.80"	$0.00	$937.20	"$3,092.76"	"$3,124.00"	$0.00	"$2,241.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000612	EAP	CPT® 76000		Fluoro Modified Barium Swallow	BOTH IP/OP	"$1,426.00 "	"$1,055.24"	$26.65	"$1,152.00"	$108.06	$108.06	$224.08	$224.08	$225.34	$297.21	$216.68	$216.68	$225.02	$220.56	$297.18	$143.36	$843.48	$843.48	$233.72	$345.60	"$1,140.48"	"$1,152.00"	$324.73	$370.58	$324.73	$58.43	$26.65	$26.65	$229.25	$222.60	$0.00	$0.00	$0.00	$0.00
32000613	EAP	CPT® 76000		FLUOROSCOPY MAX 1 HOUR RDG	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.72	$345.60	"$1,140.48"	"$1,152.00"	$324.73	$0.00	$324.73	$58.43	$26.65	$26.65	$229.25	$222.60	$0.00	$0.00	$0.00	$0.00
32000614	EAP	CPT® 76000		Fluoro Time Up To 1 Hr	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.72	$345.60	"$1,140.48"	"$1,152.00"	$324.73	$0.00	$324.73	$58.43	$26.65	$26.65	$229.25	$222.60	$0.00	$0.00	$0.00	$0.00
32000615	EAP	CPT® 76000		Prosthetic Valve Cine Fluoro	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.72	$345.60	"$1,140.48"	"$1,152.00"	$324.73	$0.00	$324.73	$58.43	$26.65	$26.65	$229.25	$222.60	$0.00	$0.00	$0.00	$0.00
32000619	EAP	CPT® 76010		NOSE TO RECTUM FBODY CHILD RDG	BOTH IP/OP	$370.00 	$273.80	$0.00	$296.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.96	$45.96	$47.73	$0.00	$77.11	$0.00	$0.00	$0.00	$0.00	$88.80	$293.04	$296.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000621	EAP	CPT® 76080		ABSCESS/FISTULA/SINUS S&I BCT	BOTH IP/OP	$865.00 	$640.10	$0.00	$865.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.90	$88.90	$92.32	$0.00	$180.27	$0.00	$0.00	$0.00	$0.00	$209.76	$692.21	$699.20	$0.00	$865.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000624	EAP	CPT® 76098		RAD EXAM SURGICAL SPECMEN BIC	BOTH IP/OP	"$1,550.00 "	"$1,147.00"	$27.37	"$1,127.20"	$37.91	$37.91	$470.55	$470.55	$473.20	$323.06	$28.74	$28.74	$29.84	$462.81	$323.02	$300.83	$916.83	$916.83	$483.00	$338.16	"$1,115.93"	"$1,127.20"	$671.06	$798.44	$671.06	$220.51	$27.37	$27.37	$224.31	$460.00	$0.00	$0.00	$0.00	$0.00
32000625	EAP	CPT® 76098		Rad Exam Surgical Specmen Cbc	BOTH IP/OP	"$1,409.00 "	"$1,042.66"	$27.37	"$1,127.20"	$37.91	$37.91	$470.55	$470.55	$473.20	$293.67	$28.74	$28.74	$29.84	$462.81	$293.64	$300.83	$833.42	$833.42	$483.00	$338.16	"$1,115.93"	"$1,127.20"	$671.06	$798.44	$671.06	$220.51	$27.37	$27.37	$224.31	$460.00	$0.00	$0.00	$0.00	$0.00
32000733	EAP	CPT® 77001		FLUORO GUIDE CV ACCESS DEV SPV	BOTH IP/OP	"$1,059.00 "	$783.66	$0.00	"$1,059.00"	$191.88	$191.88	$0.00	$0.00	$0.00	$220.72	$211.68	$211.68	$219.82	$0.00	$220.70	$0.00	$626.40	$626.40	$0.00	$256.80	$847.44	$856.00	$0.00	"$1,059.00"	$0.00	$79.65	$78.52	$78.52	$170.34	$0.00	$0.00	$0.00	$0.00	$0.00
32000734	EAP	CPT® 77002		Fluoro Guide Needle Place Rdg	BOTH IP/OP	$717.00 	$530.58	$0.00	"$1,513.00"	$212.04	$212.04	$0.00	$0.00	$0.00	$149.44	$109.62	$109.62	$113.83	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$173.76	$573.41	$579.20	$0.00	"$1,513.00"	$0.00	$71.68	$81.40	$81.40	$115.26	$0.00	$0.00	$0.00	$0.00	$0.00
32000735	EAP	CPT® 77002		FLUORO GUIDED BX/ASPIRAT  SPN	BOTH IP/OP	$724.00 	$535.76	$0.00	$579.20	$0.00	$0.00	$0.00	$0.00	$0.00	$149.44	$0.00	$0.00	$0.00	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$173.76	$573.41	$579.20	$0.00	$0.00	$0.00	$71.68	$81.40	$81.40	$115.26	$0.00	$0.00	$0.00	$0.00	$0.00
32000736	EAP	CPT® 77002		Fluoro Guidance For Needle Pla	BOTH IP/OP	$724.00 	$535.76	$0.00	$579.20	$0.00	$0.00	$0.00	$0.00	$0.00	$149.44	$0.00	$0.00	$0.00	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$173.76	$573.41	$579.20	$0.00	$0.00	$0.00	$71.68	$81.40	$81.40	$115.26	$0.00	$0.00	$0.00	$0.00	$0.00
32000738	EAP	CPT® 77003		Fluoroscopy For Spine Procedur	BOTH IP/OP	$924.00 	$683.76	$0.00	$863.00	$214.45	$214.45	$0.00	$0.00	$0.00	$192.58	$76.94	$76.94	$79.90	$0.00	$192.56	$0.00	$546.55	$546.55	$0.00	$223.92	$738.94	$746.40	$0.00	$863.00	$0.00	$69.40	$72.03	$72.03	$148.53	$0.00	$0.00	$0.00	$0.00	$0.00
32000739	EAP	CPT® 77003		FLOURO GUIDE FOR SPINE RDG	BOTH IP/OP	$924.00 	$683.76	$0.00	$863.00	$214.45	$214.45	$0.00	$0.00	$0.00	$192.58	$76.94	$76.94	$79.90	$0.00	$192.56	$0.00	$546.55	$546.55	$0.00	$223.92	$738.94	$746.40	$0.00	$863.00	$0.00	$69.40	$72.03	$72.03	$148.53	$0.00	$0.00	$0.00	$0.00	$0.00
32000740	EAP	CPT® 77003		Fluoroguide For Spine Inject	BOTH IP/OP	$924.00 	$683.76	$0.00	$863.00	$214.45	$214.45	$0.00	$0.00	$0.00	$192.58	$76.94	$76.94	$79.90	$0.00	$192.56	$0.00	$546.55	$546.55	$0.00	$223.92	$738.94	$746.40	$0.00	$863.00	$0.00	$69.40	$72.03	$72.03	$148.53	$0.00	$0.00	$0.00	$0.00	$0.00
32000751	EAP	CPT® 77053		Galactogram Single Duct Bic	BOTH IP/OP	"$1,073.00 "	$794.02	$0.00	"$1,063.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$144.79	$144.79	$150.36	$0.00	$223.61	$0.00	$0.00	$0.00	$0.00	$318.96	"$1,052.57"	"$1,063.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000752	EAP	CPT® 77054		Galactogram Multi Duct Bic	BOTH IP/OP	"$1,248.00 "	$923.52	$0.00	"$1,236.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.37	$199.37	$207.04	$0.00	$260.08	$0.00	$0.00	$0.00	$0.00	$371.04	"$1,224.43"	"$1,236.80"	$0.00	"$1,231.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000764	EAP	CPT® 77072		BONE AGE STUDIES X-RAY RDG	BOTH IP/OP	$510.00 	$377.40	$15.85	$412.00	$52.40	$52.40	$106.02	$106.02	$106.62	$106.30	$34.16	$34.16	$35.48	$104.44	$106.28	$67.89	$301.67	$301.67	$112.41	$123.60	$407.88	$412.00	$156.18	$169.61	$156.18	$21.36	$15.85	$15.85	$81.99	$107.06	$0.00	$0.00	$0.00	$0.00
32000766	EAP	CPT® 77073		BONE LENGTH STUDIES RDG	BOTH IP/OP	$629.00 	$465.46	$30.61	$508.00	$81.44	$81.44	$106.02	$106.02	$106.62	$131.10	$59.12	$59.12	$61.40	$104.44	$131.08	$67.89	$372.05	$372.05	$112.41	$152.40	$502.92	$508.00	$156.18	$169.61	$156.18	$40.42	$30.61	$30.61	$101.09	$107.06	$0.00	$0.00	$0.00	$0.00
32000768	EAP	CPT® 77074		BONE SURVEY OSSEOUS LIMIT RDG	BOTH IP/OP	$430.00 	$318.20	$0.00	$430.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$113.40	$113.40	$117.76	$0.00	$89.61	$0.00	$0.00	$0.00	$0.00	$103.68	$342.14	$345.60	$0.00	$430.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000770	EAP	CPT® 77075		BONE SURVEY OSSEOUS COMPL RDG	BOTH IP/OP	$453.00 	$335.22	$67.89	$364.00	$198.32	$198.32	$106.02	$106.02	$106.62	$94.42	$179.33	$179.33	$186.22	$104.44	$94.41	$67.89	$267.95	$267.95	$112.41	$109.20	$360.36	$364.00	$156.18	$169.61	$156.18	$85.39	$68.07	$68.07	$72.44	$107.06	$0.00	$0.00	$0.00	$0.00
32000772	EAP	CPT® 77076		BONE SURVEY OSSEOUS INFANT RDG	BOTH IP/OP	$290.00 	$214.60	$0.00	$290.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.33	$145.33	$150.92	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$69.84	$230.47	$232.80	$0.00	$290.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000773	EAP	CPT® 77080		Bone Density Scan Axial	BOTH IP/OP	$866.00 	$640.84	$29.89	$700.00	$93.51	$93.51	$106.02	$106.02	$106.62	$180.50	$152.48	$152.48	$158.35	$104.44	$180.47	$67.89	$512.24	$512.24	$112.41	$210.00	$693.00	$700.00	$156.18	$169.61	$156.18	$108.31	$29.89	$29.89	$139.30	$107.06	$0.00	$0.00	$0.00	$0.00
32000774	EAP	CPT® 77081		BONE DENSISTY SCAN PERIPH NUC	BOTH IP/OP	$162.00 	$119.88	$22.33	$137.87	$63.70	$63.70	$78.77	$78.77	$79.21	$33.76	$48.21	$48.21	$50.07	$77.54	$33.76	$50.40	$95.82	$95.82	$80.04	$39.36	$129.89	$131.20	$111.21	$137.87	$111.21	$38.50	$22.33	$22.33	$26.11	$76.23	$0.00	$0.00	$0.00	$0.00
32000784	EAP	CPT® 75860		Sinus/jugular Venogram Nir	BOTH IP/OP	"$3,145.00 "	"$2,327.30"	$0.00	"$4,727.44"	$327.33	$327.33	"$2,787.76"	"$2,787.76"	"$2,803.47"	$655.50	$524.20	$524.20	$544.36	"$2,742.67"	$655.42	"$1,782.74"	"$1,860.27"	"$1,860.27"	$0.00	$792.00	"$2,613.60"	"$2,640.00"	$0.00	"$4,727.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000785	EAP	CPT® 75870		Super Sagg Sinus Venogram Nir	BOTH IP/OP	"$2,716.00 "	"$2,009.84"	$0.00	"$2,172.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$522.39	$522.39	$542.48	$0.00	$566.01	$0.00	$0.00	$0.00	$0.00	$651.84	"$2,151.07"	"$2,172.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000786	EAP	CPT® 75872		Epidural Venogram Nir	BOTH IP/OP	"$1,855.00 "	"$1,372.70"	$0.00	"$1,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$574.13	$574.13	$596.21	$0.00	$386.58	$0.00	$0.00	$0.00	$0.00	$445.20	"$1,469.16"	"$1,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000787	EAP	CPT® 75894		Transcath Embolization Nir	BOTH IP/OP	"$10,671.00 "	"$7,896.54"	$0.00	"$12,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,635.61"	"$2,635.61"	"$2,736.98"	$0.00	"$2,223.84"	$0.00	$0.00	$0.00	$0.00	"$2,561.04"	"$8,451.43"	"$8,536.80"	$0.00	"$12,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000790	EAP	CPT® 76000		Fluoroscopy Max 1 Hour Nir	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$241.15	$0.00	$0.00	$0.00	$220.56	$241.12	$143.36	$684.37	$684.37	$233.72	$345.60	"$1,140.48"	"$1,152.00"	$324.73	$0.00	$324.73	$58.43	$26.65	$26.65	$229.25	$222.60	$0.00	$0.00	$0.00	$0.00
32000796	EAP	CPT® 74263		"Ct Colonography, Screen"	BOTH IP/OP	"$1,621.00 "	"$1,199.54"	$0.00	"$1,404.90"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.82	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$389.04	"$1,283.83"	"$1,296.80"	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000797	EAP	CPT® 74261		"Ct Colonography, W/o Dye"	BOTH IP/OP	"$1,621.00 "	"$1,199.54"	$0.00	"$1,404.90"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.82	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$389.04	"$1,283.83"	"$1,296.80"	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000798	EAP	CPT® 74262		"Ct Colonography, W/dye"	BOTH IP/OP	"$1,621.00 "	"$1,199.54"	$0.00	"$1,404.90"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.82	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$389.04	"$1,283.83"	"$1,296.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000800	EAP	CPT® 76000		Fluoroscopy 1st Hour	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.72	$345.60	"$1,140.48"	"$1,152.00"	$324.73	$0.00	$324.73	$58.43	$26.65	$26.65	$229.25	$222.60	$0.00	$0.00	$0.00	$0.00
32000801	EAP	CPT® 72072		Throacic Spine 4 View Rdg	BOTH IP/OP	"$1,196.00 "	$885.04	$0.00	"$1,031.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.28	$67.28	$69.87	$0.00	$249.25	$0.00	$0.00	$0.00	$0.00	$287.04	$947.23	$956.80	$0.00	"$1,031.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000802	EAP	CPT® 77071		Manual Appl Stress Pfrmd Phys/qhp Joint Films	BOTH IP/OP	$433.00 	$320.42	$26.91	$349.60	$110.48	$110.48	$78.77	$78.77	$79.21	$90.25	$321.37	$321.37	$333.76	$77.54	$90.24	$50.40	$256.12	$256.12	$80.04	$104.88	$346.10	$349.60	$111.21	$137.87	$111.21	$26.91	$54.05	$54.05	$69.57	$76.23	$0.00	$0.00	$0.00	$0.00
32000810	EAP	CPT® 74190		"Peritoneogram, Radiological Supervision And Interpretation"	BOTH IP/OP	$911.00 	$674.14	$0.00	$728.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.79	$142.79	$148.28	$0.00	$189.85	$0.00	$0.00	$0.00	$0.00	$218.64	$721.51	$728.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000812	EAP	CPT® 74450		"Urethrocystography, Retrograde, Radiological Supervision"	BOTH IP/OP	"$2,150.00 "	"$1,591.00"	$0.00	"$2,105.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$448.11	$159.33	$159.33	$165.46	$220.56	$448.06	$143.36	"$1,271.73"	"$1,271.73"	$233.72	$631.68	"$2,084.54"	"$2,105.60"	$324.73	$915.00	$324.73	$72.23	$0.00	$0.00	$419.01	$222.60	$0.00	$0.00	$0.00	$0.00
32000813	EAP	CPT® 74455		"Urethrocystography, Voiding, Radiological Supervision"	BOTH IP/OP	"$2,191.00 "	"$1,621.34"	$76.86	"$1,612.00"	$186.23	$186.23	$224.08	$224.08	$225.34	$456.66	$181.73	$181.73	$188.72	$220.56	$456.60	$143.36	"$1,295.98"	"$1,295.98"	$233.72	$483.60	"$1,595.88"	"$1,612.00"	$324.73	$370.58	$324.73	$76.86	$82.12	$82.12	$320.79	$222.60	$0.00	$0.00	$0.00	$0.00
32000814	EAP	CPT® 74470		"Radiologic Examination, Renal Cyst Study"	BOTH IP/OP	$927.00 	$685.98	$0.00	$908.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.54	$136.54	$141.79	$0.00	$193.19	$0.00	$0.00	$0.00	$0.00	$272.40	$898.92	$908.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000815	EAP	CPT® 75733		"Adrenal, Bilateral"	BOTH IP/OP	"$4,426.00 "	"$3,275.24"	$0.00	"$4,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$647.63	$647.63	$672.54	$0.00	$922.38	$0.00	$0.00	$0.00	$0.00	"$1,073.04"	"$3,541.03"	"$3,576.80"	$0.00	"$4,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000820	EAP	CPT® 75809		Shuntogram For Investigation	BOTH IP/OP	$862.00 	$637.88	$53.15	$689.60	$224.93	$224.93	$106.02	$106.02	$106.62	$179.66	$156.21	$156.21	$162.22	$104.44	$179.64	$67.89	$509.87	$509.87	$112.41	$206.88	$682.70	$689.60	$156.18	$169.61	$156.18	$53.15	$68.43	$68.43	$137.23	$107.06	$0.00	$0.00	$0.00	$0.00
32000821	EAP	CPT® 75902		Mechanical Removal Of Intraluminal (intracatheter) Frome	BOTH IP/OP	"$1,027.00 "	$759.98	$0.00	$821.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.80	$192.80	$200.21	$0.00	$214.03	$0.00	$0.00	$0.00	$0.00	$246.48	$813.38	$821.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000822	EAP	CPT® 75970		"Transcatheter Biopsy, Radiological Supervision And Interpretation"	BOTH IP/OP	"$3,027.00 "	"$2,239.98"	$0.00	"$3,027.00"	"$1,022.08"	"$1,022.08"	$0.00	$0.00	$0.00	$0.00	"$1,259.39"	"$1,259.39"	"$1,307.83"	$0.00	$630.83	$0.00	$0.00	$0.00	$0.00	$733.92	"$2,421.94"	"$2,446.40"	$0.00	"$3,027.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000823	EAP	CPT® 75984		Change Of Percutaneous Tube Or Drainage Catheter With Contrast	BOTH IP/OP	"$2,247.00 "	"$1,662.78"	$0.00	"$1,816.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.56	$191.56	$198.93	$0.00	$468.27	$0.00	$0.00	$0.00	$0.00	$544.80	"$1,797.84"	"$1,816.00"	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000824	EAP	CPT® 75989		Radiological Guidance For Percutaneous Drainage	BOTH IP/OP	"$4,282.00 "	"$3,168.68"	$0.00	"$3,124.00"	$726.00	$726.00	$0.00	$0.00	$0.00	$892.48	$785.72	$785.72	$815.94	$0.00	$892.37	$0.00	"$2,532.80"	"$2,532.80"	$0.00	$937.20	"$3,092.76"	"$3,124.00"	$0.00	"$2,241.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000825	EAP	CPT® 76080		"Abscess, Fistula, Sinus Tract Study"	BOTH IP/OP	$865.00 	$640.10	$0.00	$865.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.90	$88.90	$92.32	$0.00	$180.27	$0.00	$0.00	$0.00	$0.00	$209.76	$692.21	$699.20	$0.00	$865.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000826	EAP	CPT® 76940		"Ultrasound Guidance For, And Monitoring Of, Parenchymaln"	BOTH IP/OP	"$1,128.00 "	$834.72	$0.00	"$1,443.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.95	$184.95	$192.07	$0.00	$235.08	$0.00	$0.00	$0.00	$0.00	$273.36	$902.09	$911.20	$0.00	"$1,443.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000828	EAP	CPT® 0075T		"Intravascular Stent, Perc, Initial Vessel"	BOTH IP/OP	"$14,320.00 "	"$10,596.80"	$0.00	"$10,875.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,984.29"	$0.00	$0.00	$0.00	$0.00	"$6,797.00"	"$10,766.45"	"$10,875.20"	$0.00	"$9,308.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000829	EAP	CPT® 0076T		"Intravascular Stent, Perc, Ea Add'l Vessel"	BOTH IP/OP	"$11,316.00 "	"$8,373.84"	$0.00	"$10,362.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,722.37"	$0.00	"$2,358.25"	$0.00	$0.00	$0.00	$0.00	"$6,476.50"	"$10,258.78"	"$10,362.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000840	EAP	CPT® 76496		Fluroscopy Procedure	BOTH IP/OP	$528.00 	$390.72	$0.00	$473.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.43	$210.43	$218.53	$0.00	$110.04	$0.00	$0.00	$0.00	$0.00	$125.76	$415.01	$419.20	$0.00	$473.00	$0.00	$82.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000843	EAP	CPT® 49422		Removal Of Tunneled Intraperitoneal Catheter	BOTH IP/OP	"$3,643.00 "	"$2,695.82"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$759.20	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,704.68"	"$2,732.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000854	EAP	CPT® 72081		Xr T-l Spine Incl Skull 1 View	BOTH IP/OP	$424.00 	$313.76	$28.45	$310.40	$88.70	$88.70	$78.77	$78.77	$79.21	$88.37	$63.38	$63.38	$65.82	$77.54	$88.36	$50.40	$250.80	$250.80	$80.04	$93.12	$307.30	$310.40	$111.21	$137.87	$111.21	$37.03	$28.45	$28.45	$61.77	$76.23	$0.00	$0.00	$0.00	$0.00
32000855	EAP	CPT® 72083		Xr T-l Spine 4 Or 5 Views	BOTH IP/OP	"$1,228.00 "	$908.72	$0.00	"$1,182.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.05	$125.05	$129.86	$0.00	$255.92	$0.00	$0.00	$0.00	$0.00	$294.72	$972.58	$982.40	$0.00	"$1,182.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000856	EAP	CPT® 72084		Xr T-l Spine Incl Skll 6+ View	BOTH IP/OP	"$1,228.00 "	$908.72	$0.00	$982.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.07	$150.07	$155.84	$0.00	$255.92	$0.00	$0.00	$0.00	$0.00	$294.72	$972.58	$982.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000857	EAP	CPT® 73501		Xr Hip Unilat W/pelvis 1 View	BOTH IP/OP	$378.00 	$279.72	$22.33	$280.00	$67.72	$67.72	$78.77	$78.77	$79.21	$78.78	$50.89	$50.89	$52.84	$77.54	$78.78	$50.40	$223.59	$223.59	$80.04	$84.00	$277.20	$280.00	$111.21	$137.87	$111.21	$28.22	$22.33	$22.33	$55.72	$76.23	$0.00	$0.00	$0.00	$0.00
32000858	EAP	CPT® 73502		Xr Hip Unilat W/pelvis 2-3 Vw	BOTH IP/OP	$378.00 	$279.72	$34.22	$280.00	$94.33	$94.33	$78.77	$78.77	$79.21	$78.78	$75.00	$75.00	$77.89	$77.54	$78.78	$50.40	$223.59	$223.59	$80.04	$84.00	$277.20	$280.00	$111.21	$137.87	$111.21	$39.45	$34.22	$34.22	$55.72	$76.23	$0.00	$0.00	$0.00	$0.00
32000859	EAP	CPT® 73503		Xr Hip Unilat W/pelvis 4+ Vw	BOTH IP/OP	$627.00 	$463.98	$42.50	$464.80	$117.72	$117.72	$106.02	$106.02	$106.62	$130.68	$92.89	$92.89	$96.47	$104.44	$130.67	$67.89	$370.87	$370.87	$112.41	$139.44	$460.15	$464.80	$156.18	$169.61	$156.18	$49.31	$42.50	$42.50	$92.50	$107.06	$0.00	$0.00	$0.00	$0.00
32000860	EAP	CPT® 73521		Xr Hip Bilat W/pelvis 2 Views	BOTH IP/OP	$627.00 	$463.98	$28.81	$464.80	$90.29	$90.29	$106.02	$106.02	$106.62	$130.68	$70.54	$70.54	$73.26	$104.44	$130.67	$67.89	$370.87	$370.87	$112.41	$139.44	$460.15	$464.80	$156.18	$169.61	$156.18	$37.75	$28.81	$28.81	$92.50	$107.06	$0.00	$0.00	$0.00	$0.00
32000861	EAP	CPT® 73522		Xr Hip Bilat W/pelvis 3-4 View	BOTH IP/OP	$627.00 	$463.98	$37.46	$464.80	$111.25	$111.25	$106.02	$106.02	$106.62	$130.68	$83.92	$83.92	$87.15	$104.44	$130.67	$67.89	$370.87	$370.87	$112.41	$139.44	$460.15	$464.80	$156.18	$169.61	$156.18	$46.58	$37.46	$37.46	$92.50	$107.06	$0.00	$0.00	$0.00	$0.00
32000862	EAP	CPT® 73523		Xr Hip Bilat W/pelvis 5+ Views	BOTH IP/OP	"$1,194.00 "	$883.56	$0.00	$884.80	$128.99	$128.99	$106.02	$106.02	$106.62	$248.86	$100.92	$100.92	$104.80	$104.44	$248.83	$67.89	$706.25	$706.25	$0.00	$265.44	$875.95	$884.80	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000863	EAP	CPT® 73551		Xr Femur 1 View	BOTH IP/OP	$361.00 	$267.14	$0.00	$465.00	$63.70	$63.70	$78.77	$78.77	$79.21	$0.00	$48.20	$48.20	$50.06	$0.00	$75.23	$0.00	$0.00	$0.00	$80.04	$79.44	$262.15	$264.80	$111.21	$465.00	$111.21	$26.17	$20.89	$20.89	$52.70	$76.23	$0.00	$0.00	$0.00	$0.00
32000864	EAP	CPT® 73552		Xr Femur Min 2 Views	BOTH IP/OP	$361.00 	$267.14	$25.57	$264.80	$74.18	$74.18	$78.77	$78.77	$79.21	$75.24	$57.14	$57.14	$59.34	$77.54	$75.23	$50.40	$213.53	$213.53	$80.04	$79.44	$262.15	$264.80	$111.21	$137.87	$111.21	$30.93	$25.57	$25.57	$52.70	$76.23	$0.00	$0.00	$0.00	$0.00
32000865	EAP	CPT® 76499		Radiographic Procedure	BOTH IP/OP	$150.00 	$111.00	$0.00	$137.87	$0.00	$0.00	$78.77	$78.77	$79.21	$31.26	$111.33	$111.33	$115.62	$77.54	$31.26	$50.40	$88.73	$88.73	$0.00	$35.76	$118.01	$119.20	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000866	EAP	CPT® 77077		Joint Survey Single View	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.21	$66.21	$68.75	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$66.00	$217.80	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000867	EAP	CPT® 76000		Fluoro Additional Hour	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.72	$345.60	"$1,140.48"	"$1,152.00"	$324.73	$0.00	$324.73	$58.43	$26.65	$26.65	$229.25	$222.60	$0.00	$0.00	$0.00	$0.00
32000868	EAP	CPT® 75807		Lymph Vessel X-ray Trunk	BOTH IP/OP	"$3,673.00 "	"$2,718.02"	$0.00	"$3,673.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$624.83	$624.83	$648.86	$0.00	$765.45	$0.00	$0.00	$0.00	$0.00	$890.40	"$2,938.32"	"$2,968.00"	$0.00	"$3,673.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000869	EAP	CPT® 74248		Xr Small Bowel Follow-through Add On	BOTH IP/OP	"$2,246.00 "	"$1,662.04"	$0.00	"$1,680.00"	$187.57	$187.57	$0.00	$0.00	$0.00	$468.12	$110.26	$110.26	$114.50	$0.00	$468.07	$0.00	"$1,328.51"	"$1,328.51"	$0.00	$504.00	"$1,663.20"	"$1,680.00"	$0.00	"$1,656.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32000870	EAP	CPT® 72275		Epidurography	BOTH IP/OP	"$1,334.00 "	$987.16	$0.00	"$1,067.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$275.33	$0.00	$0.00	$0.00	$0.00	$275.30	$0.00	$781.37	$781.37	$0.00	$320.16	"$1,056.53"	"$1,067.20"	$0.00	$0.00	$0.00	$107.42	$92.56	$92.56	$212.37	$0.00	$0.00	$0.00	$0.00	$0.00
32200006	EAP	CPT® 73040		Shoulder Arthrography Rdg	BOTH IP/OP	"$1,216.00 "	$899.84	$94.00	$976.00	$227.33	$227.33	$358.61	$358.61	$360.63	$253.44	$902.52	$902.52	$937.29	$352.81	$253.41	$229.33	$719.26	$719.26	$387.01	$292.80	$966.24	$976.00	$537.70	$584.68	$537.70	$107.06	$94.00	$94.00	$194.22	$368.58	$0.00	$0.00	$0.00	$0.00
32300001	EAP	CPT® 75605		THORACIC ARCH ANGIO SPN	BOTH IP/OP	"$5,612.00 "	"$4,152.88"	$0.00	"$18,212.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,165.23"	"$4,165.23"	"$4,325.73"	$0.00	"$1,169.54"	$0.00	$0.00	$0.00	$0.00	"$1,360.56"	"$4,489.85"	"$4,535.20"	$0.00	"$18,212.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32300002	EAP	CPT® 75625		AORTOGRAM ABD CATHETER SPV	BOTH IP/OP	"$5,567.00 "	"$4,119.58"	$69.51	"$4,727.44"	$312.87	$312.87	"$2,787.76"	"$2,787.76"	"$2,803.47"	"$1,160.30"	"$4,131.83"	"$4,131.83"	"$4,291.04"	"$2,742.67"	"$1,160.16"	"$1,782.74"	"$3,292.88"	"$3,292.88"	"$2,779.42"	"$1,349.52"	"$4,453.42"	"$4,498.40"	"$3,861.64"	"$4,727.44"	"$3,861.64"	$536.35	$69.51	$69.51	$895.18	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
32300003	EAP	CPT® 75630		Aortography Bilat Lower	BOTH IP/OP	"$6,875.00 "	"$5,087.50"	$0.00	"$6,658.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,299.25"	$0.00	"$1,432.75"	$0.00	$0.00	$0.00	$0.00	"$1,666.56"	"$5,499.65"	"$5,555.20"	$0.00	"$6,658.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32300013	EAP	CPT® 75705		ANGIO SPINAL SELECTIVE SPN	BOTH IP/OP	"$9,855.00 "	"$7,292.70"	$0.00	"$9,989.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$7,596.23"	$0.00	"$2,053.78"	$0.00	$0.00	$0.00	$0.00	"$2,389.20"	"$7,884.36"	"$7,964.00"	$0.00	"$9,989.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32300014	EAP	CPT® 75710		ANGIO EXTREMITY UNILAT SPV	BOTH IP/OP	"$8,204.00 "	"$6,070.96"	$78.52	"$6,323.64"	$369.31	$369.31	"$2,787.76"	"$2,787.76"	"$2,803.47"	"$1,709.92"	"$4,181.12"	"$4,181.12"	"$6,323.64"	"$2,742.67"	"$1,709.71"	"$1,782.74"	"$4,852.67"	"$4,852.67"	"$2,779.42"	"$1,813.92"	"$5,985.94"	"$6,046.40"	"$3,861.64"	"$4,727.44"	"$3,861.64"	$536.72	$78.52	$78.52	"$1,203.23"	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
32300015	EAP	CPT® 75716		ANGIO EXTREMITY BILAT SPV	BOTH IP/OP	"$8,615.00 "	"$6,375.10"	$80.32	"$6,640.44"	$424.93	$424.93	"$2,787.76"	"$2,787.76"	"$2,803.47"	"$1,795.58"	"$4,181.12"	"$4,181.12"	"$6,640.44"	"$2,742.67"	"$1,795.37"	"$1,782.74"	"$5,095.77"	"$5,095.77"	"$2,779.42"	"$1,904.64"	"$6,285.31"	"$6,348.80"	"$3,861.64"	"$4,727.44"	"$3,861.64"	$544.44	$80.32	$80.32	"$1,263.41"	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
32300018	EAP	CPT® 75726		Angio Visceral	BOTH IP/OP	"$8,089.00 "	"$5,985.86"	$87.16	"$8,156.48"	$340.22	$340.22	"$4,643.92"	"$4,643.92"	"$4,670.08"	"$1,685.95"	"$4,181.12"	"$4,181.12"	"$6,235.00"	"$4,572.02"	"$1,685.75"	"$2,971.81"	"$4,784.64"	"$4,784.64"	"$4,609.70"	"$1,961.04"	"$6,471.43"	"$6,536.80"	"$6,404.56"	"$8,156.48"	"$6,404.56"	$535.99	$87.16	$87.16	"$1,300.82"	"$4,390.19"	$0.00	$0.00	$0.00	$0.00
32300019	EAP	CPT® 75731		ANGIO ADRENAL UNILAT SPV	BOTH IP/OP	"$4,162.00 "	"$3,079.88"	$0.00	"$4,162.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,089.04"	"$3,089.04"	"$3,208.07"	$0.00	$867.36	$0.00	$0.00	$0.00	$0.00	"$1,008.96"	"$3,329.57"	"$3,363.20"	$0.00	"$4,162.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32300021	EAP	CPT® 75736		ANGIO PELVIC SELECTIVE SPV	BOTH IP/OP	"$8,804.00 "	"$6,514.96"	$0.00	"$8,156.48"	$364.43	$364.43	"$4,643.92"	"$4,643.92"	"$4,670.08"	$0.00	"$4,181.12"	"$4,181.12"	"$6,786.12"	$0.00	"$1,834.75"	$0.00	$0.00	$0.00	"$4,609.70"	"$1,920.96"	"$6,339.17"	"$6,403.20"	"$6,404.56"	"$8,156.48"	"$6,404.56"	$535.99	$97.61	$97.61	"$1,274.24"	"$4,390.19"	$0.00	$0.00	$0.00	$0.00
32300022	EAP	CPT® 75741		ANGIO PULMONARY UNILAT SPV	BOTH IP/OP	"$5,405.00 "	"$3,999.70"	$0.00	"$4,727.44"	$343.41	$343.41	"$2,787.76"	"$2,787.76"	"$2,803.47"	$0.00	"$4,011.59"	"$4,011.59"	"$4,166.17"	$0.00	"$1,126.40"	$0.00	$0.00	$0.00	$0.00	"$1,310.40"	"$4,324.32"	"$4,368.00"	$0.00	"$4,727.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32300023	EAP	CPT® 75743		ANGIO PULMONARY BILATERAL SPV	BOTH IP/OP	"$5,466.00 "	"$4,044.84"	$0.00	"$5,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,056.87"	"$4,056.87"	"$4,213.19"	$0.00	"$1,139.11"	$0.00	$0.00	$0.00	$0.00	"$1,325.04"	"$4,372.63"	"$4,416.80"	$0.00	"$5,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32300024	EAP	CPT® 75774		ANGIO SELECTIVE ADD'L VESS SPV	BOTH IP/OP	"$3,796.00 "	"$2,809.04"	$0.00	"$3,884.00"	$196.71	$196.71	$0.00	$0.00	$0.00	$791.18	"$2,817.39"	"$2,817.39"	"$2,925.96"	$0.00	$791.09	$0.00	"$2,245.33"	"$2,245.33"	$0.00	$920.16	"$3,036.53"	"$3,067.20"	$0.00	"$3,884.00"	$0.00	$497.07	$59.79	$59.79	$610.37	$0.00	$0.00	$0.00	$0.00	$0.00
32300026	EAP	CPT® 75898		ANGIO W/EXIST CATH FU STDY SPV	BOTH IP/OP	"$2,784.00 "	"$2,060.16"	$0.00	"$2,219.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,066.28"	"$2,066.28"	"$2,145.91"	$0.00	$580.19	$0.00	$0.00	$0.00	$0.00	$607.44	"$2,004.55"	"$2,024.80"	$0.00	"$2,219.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32300066	EAP	CPT® 75705		Angio Spinal Selective Nir	BOTH IP/OP	"$9,955.00 "	"$7,366.70"	$0.00	"$9,989.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$7,673.31"	$0.00	"$2,074.62"	$0.00	$0.00	$0.00	$0.00	"$2,389.20"	"$7,884.36"	"$7,964.00"	$0.00	"$9,989.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32300071	EAP	CPT® 75716		Inject: Illiac Angio	BOTH IP/OP	"$7,936.00 "	"$5,872.64"	$0.00	"$6,348.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,795.58"	$0.00	$0.00	$0.00	"$2,742.67"	"$1,795.37"	"$1,782.74"	"$5,095.77"	"$5,095.77"	"$2,779.42"	"$1,904.64"	"$6,285.31"	"$6,348.80"	"$3,861.64"	$0.00	"$3,861.64"	$544.44	$80.32	$80.32	"$1,263.41"	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
32300072	EAP	CPT® 37197		"Transcatheter Retrieval,percutaneous Of Intravas Fb Inci"	BOTH IP/OP	"$34,751.00 "	"$25,715.74"	$0.00	"$26,786.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$26,786.07"	$0.00	"$7,242.11"	$0.00	$0.00	$0.00	"$2,779.42"	"$2,858.00"	"$26,126.50"	"$26,390.40"	"$3,861.64"	"$3,725.00"	"$3,861.64"	$0.00	$315.16	$315.16	"$5,251.69"	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
32400001	EAP	CPT® 71045		Chest X-ray	BOTH IP/OP	$623.00 	$461.02	$16.57	$508.00	$45.30	$45.30	$78.77	$78.77	$79.21	$129.85	$26.80	$26.80	$27.83	$77.54	$129.83	$50.40	$368.50	$368.50	$80.04	$152.40	$502.92	$508.00	$111.21	$137.87	$111.21	$19.10	$16.57	$16.57	$101.09	$76.23	$0.00	$0.00	$0.00	$0.00
32400002	EAP	CPT® 71045		CHEST X-RAY 1 VIEW RDG	BOTH IP/OP	$697.00 	$515.78	$16.57	$508.00	$45.30	$45.30	$78.77	$78.77	$79.21	$145.27	$26.80	$26.80	$27.83	$77.54	$145.25	$50.40	$412.28	$412.28	$80.04	$152.40	$502.92	$508.00	$111.21	$137.87	$111.21	$19.10	$16.57	$16.57	$101.09	$76.23	$0.00	$0.00	$0.00	$0.00
32400003	EAP	CPT® 71045		Line Placement-chest	BOTH IP/OP	$623.00 	$461.02	$16.57	$508.00	$45.30	$45.30	$78.77	$78.77	$79.21	$129.85	$26.80	$26.80	$27.83	$77.54	$129.83	$50.40	$368.50	$368.50	$80.04	$152.40	$502.92	$508.00	$111.21	$137.87	$111.21	$19.10	$16.57	$16.57	$101.09	$76.23	$0.00	$0.00	$0.00	$0.00
32400006	EAP	CPT® 71046		CHEST 2 VIEW(PA & LATERAL) RDG	BOTH IP/OP	$730.00 	$540.20	$21.97	$532.00	$69.46	$69.46	$78.77	$78.77	$79.21	$152.15	$49.06	$49.06	$50.94	$77.54	$152.13	$50.40	$431.80	$431.80	$80.04	$159.60	$526.68	$532.00	$111.21	$137.87	$111.21	$29.30	$21.97	$21.97	$105.87	$76.23	$0.00	$0.00	$0.00	$0.00
32400008	EAP	CPT® 71047		CHEST 2VIEW W/APICAL LORDO RDG	BOTH IP/OP	$752.00 	$556.48	$27.73	$548.00	$88.81	$88.81	$78.77	$78.77	$79.21	$156.74	$62.44	$62.44	$64.84	$77.54	$156.72	$50.40	$444.81	$444.81	$80.04	$164.40	$542.52	$548.00	$111.21	$137.87	$111.21	$37.47	$27.73	$27.73	$109.05	$76.23	$0.00	$0.00	$0.00	$0.00
32400010	EAP	CPT® 71048		CHEST X-RAY 4+VIEW RDG	BOTH IP/OP	$809.00 	$598.66	$28.81	$589.60	$95.25	$95.25	$106.02	$106.02	$106.62	$168.62	$64.20	$64.20	$66.67	$104.44	$168.60	$67.89	$478.52	$478.52	$112.41	$176.88	$583.70	$589.60	$156.18	$169.61	$156.18	$40.18	$28.81	$28.81	$117.33	$107.06	$0.00	$0.00	$0.00	$0.00
32400012	EAP	CPT® 71046		CHEST X-RAY 3VW DECUBITUS RDG	BOTH IP/OP	$771.00 	$570.54	$21.97	$561.60	$69.46	$69.46	$78.77	$78.77	$79.21	$160.70	$49.06	$49.06	$50.94	$77.54	$160.68	$50.40	$456.05	$456.05	$80.04	$168.48	$555.98	$561.60	$111.21	$137.87	$111.21	$29.30	$21.97	$21.97	$111.76	$76.23	$0.00	$0.00	$0.00	$0.00
33100001	EAP	CPT® 96411		Iv Chemo Push-ea Addtl Med	BOTH IP/OP	$478.00 	$353.72	$38.61	$385.45	$183.66	$183.66	$60.38	$60.38	$60.72	$99.63	$354.77	$354.77	$368.44	$59.39	$99.62	$38.61	$282.74	$282.74	$60.65	$178.50	$282.74	$285.60	$84.26	$385.45	$84.26	$55.87	$59.80	$59.80	$56.83	$57.76	$0.00	$0.00	$0.00	$0.00
33100002	EAP	CPT® 96409		Iv Chemo Push-1st Med Initl1vs	BOTH IP/OP	$830.00 	$614.20	$97.03	$639.76	$326.62	$326.62	$199.22	$199.22	$200.34	$172.99	$616.03	$616.03	$639.76	$195.04	$172.97	$126.78	$490.95	$490.95	$184.28	$310.00	$491.04	$496.00	$256.03	$616.20	$256.03	$97.03	$109.86	$109.86	$98.70	$175.50	$0.00	$0.00	$0.00	$0.00
33100004	EAP	CPT® 96411		Iv Chemo Push1st Med Dur Infus	BOTH IP/OP	$478.00 	$353.72	$38.61	$385.45	$183.66	$183.66	$60.38	$60.38	$60.72	$99.63	$354.77	$354.77	$368.44	$59.39	$99.62	$38.61	$282.74	$282.74	$60.65	$178.50	$282.74	$285.60	$84.26	$385.45	$84.26	$55.87	$59.80	$59.80	$56.83	$57.76	$0.00	$0.00	$0.00	$0.00
33100006	EAP	CPT® 96411		Iv Chemo Push-1 Med Dur Infus	BOTH IP/OP	$357.00 	$264.18	$38.61	$385.45	$183.66	$183.66	$60.38	$60.38	$60.72	$74.41	$264.97	$264.97	$275.18	$59.39	$74.40	$38.61	$211.17	$211.17	$60.65	$178.50	$282.74	$285.60	$84.26	$385.45	$84.26	$55.87	$59.80	$59.80	$56.83	$57.76	$0.00	$0.00	$0.00	$0.00
33100007	EAP	CPT® 96401		Inject Chemo-im/sq Non Hormona	BOTH IP/OP	$496.00 	$367.04	$38.61	$382.32	$219.15	$219.15	$60.38	$60.38	$60.72	$103.38	$368.13	$368.13	$382.32	$59.39	$103.37	$38.61	$293.38	$293.38	$60.65	$185.00	$293.04	$296.00	$84.26	$322.40	$84.26	$57.91	$79.97	$79.97	$58.90	$57.76	$0.00	$0.00	$0.00	$0.00
33100008	EAP	CPT® 96402		Inject Chemo-im/sq Hormonal	BOTH IP/OP	$619.00 	$458.06	$32.07	$477.13	$95.99	$95.99	$60.38	$60.38	$60.72	$129.02	$459.42	$459.42	$477.13	$59.39	$129.00	$38.61	$366.14	$366.14	$60.65	$231.00	$365.90	$369.60	$84.26	$428.35	$84.26	$72.30	$32.07	$32.07	$73.55	$57.76	$0.00	$0.00	$0.00	$0.00
33300001	EAP	CPT® 77280		Simulation-simple	BOTH IP/OP	"$1,882.00 "	"$1,392.68"	$79.04	"$1,126.40"	$626.37	$626.37	$123.57	$123.57	$124.26	$392.26	$371.97	$371.97	$386.27	$121.59	$392.21	$79.04	"$1,113.20"	"$1,113.20"	$126.96	$337.92	"$1,115.14"	"$1,126.40"	$176.40	$211.67	$176.40	$220.35	$244.20	$244.20	$224.15	$120.92	$0.00	$0.00	$0.00	$0.00
33300002	EAP	CPT® 77285		Simulation-intermediat	BOTH IP/OP	"$2,531.00 "	"$1,872.94"	$210.99	"$1,515.20"	$998.00	$998.00	$329.78	$329.78	$331.64	$527.52	$661.39	$661.39	$686.83	$324.60	$527.46	$210.99	"$1,497.09"	"$1,497.09"	$336.15	$454.56	"$1,500.05"	"$1,515.20"	$467.03	$569.27	$467.03	$296.41	$414.20	$414.20	$301.52	$320.14	$0.00	$0.00	$0.00	$0.00
33300003	EAP	CPT® 77290		Simulation-complex	BOTH IP/OP	"$3,403.00 "	"$2,518.22"	$210.99	"$2,036.80"	"$1,180.16"	"$1,180.16"	$329.78	$329.78	$331.64	$709.27	"$1,034.52"	"$1,034.52"	"$1,074.31"	$324.60	$709.19	$210.99	"$2,012.87"	"$2,012.87"	$336.15	$611.04	"$2,016.43"	"$2,036.80"	$467.03	$569.27	$467.03	$398.45	$422.12	$422.12	$405.32	$320.14	$0.00	$0.00	$0.00	$0.00
33300004	EAP	CPT® 77295		3d Radiotherapy Plan W/ Vol Histo	BOTH IP/OP	"$12,364.00 "	"$9,149.36"	$265.08	"$7,400.80"	"$1,122.08"	"$1,122.08"	"$1,229.74"	"$1,229.74"	"$1,236.66"	"$2,576.97"	"$1,140.85"	"$1,140.85"	"$1,184.73"	"$1,209.70"	"$2,576.66"	$786.30	"$7,313.31"	"$7,313.31"	"$1,249.00"	"$2,220.24"	"$7,326.79"	"$7,400.80"	"$1,735.32"	"$2,127.56"	"$1,735.32"	"$1,447.78"	$265.08	$265.08	"$1,472.76"	"$1,189.52"	$0.00	$0.00	$0.00	$0.00
33300007	EAP	CPT® 77300		Central Axis Calculation	BOTH IP/OP	$916.00 	$677.84	$34.22	$548.00	$152.35	$152.35	$123.57	$123.57	$124.26	$190.92	$100.51	$100.51	$104.37	$121.59	$190.89	$79.04	$541.81	$541.81	$126.96	$164.40	$542.52	$548.00	$176.40	$211.67	$176.40	$107.20	$34.22	$34.22	$109.05	$120.92	$0.00	$0.00	$0.00	$0.00
33300008	EAP	CPT® 77301		Imrt	BOTH IP/OP	"$7,048.00 "	"$5,215.52"	$786.30	"$4,564.49"	"$4,469.34"	"$4,469.34"	"$1,229.74"	"$1,229.74"	"$1,236.66"	"$1,468.98"	"$4,395.44"	"$4,395.44"	"$4,564.49"	"$1,209.70"	"$1,468.80"	$786.30	"$4,168.89"	"$4,168.89"	"$1,249.00"	"$1,265.52"	"$4,176.22"	"$4,218.40"	"$1,735.32"	"$2,127.56"	"$1,735.32"	$825.22	"$1,513.43"	"$1,513.43"	$839.46	"$1,189.52"	$0.00	$0.00	$0.00	$0.00
33300012	EAP	CPT® 77321		Telether Plan Special	BOTH IP/OP	"$1,950.00 "	"$1,443.00"	$44.30	"$1,167.20"	$212.81	$212.81	$329.78	$329.78	$331.64	$406.43	$187.24	$187.24	$194.44	$324.60	$406.38	$210.99	"$1,153.43"	"$1,153.43"	$336.15	$350.16	"$1,155.53"	"$1,167.20"	$467.03	$569.27	$467.03	$228.33	$44.30	$44.30	$232.27	$320.14	$0.00	$0.00	$0.00	$0.00
33300014	EAP	CPT® 77331		Tld/microdosimetry	BOTH IP/OP	$889.00 	$657.86	$0.00	$879.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.88	$46.88	$48.69	$0.00	$185.27	$0.00	$0.00	$0.00	$0.00	$159.60	$526.68	$532.00	$0.00	$879.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33300015	EAP	CPT® 77332		Block Simple	BOTH IP/OP	"$1,023.00 "	$757.02	$23.77	$612.00	$153.96	$153.96	$123.57	$123.57	$124.26	$213.22	$126.87	$126.87	$131.75	$121.59	$213.19	$79.04	$605.10	$605.10	$126.96	$183.60	$605.88	$612.00	$176.40	$211.67	$176.40	$119.72	$23.77	$23.77	$121.79	$120.92	$0.00	$0.00	$0.00	$0.00
33300016	EAP	CPT® 77332		Bolus Simple	BOTH IP/OP	$765.00 	$566.10	$23.77	$612.00	$153.96	$153.96	$123.57	$123.57	$124.26	$159.45	$126.87	$126.87	$131.75	$121.59	$159.43	$79.04	$452.50	$452.50	$126.96	$183.60	$605.88	$612.00	$176.40	$211.67	$176.40	$119.72	$23.77	$23.77	$121.79	$120.92	$0.00	$0.00	$0.00	$0.00
33300017	EAP	CPT® 77333		Block Intermed	BOTH IP/OP	"$1,426.00 "	"$1,055.24"	$0.00	$844.80	$0.00	$0.00	$0.00	$0.00	$0.00	$220.10	$0.00	$0.00	$0.00	$121.59	$220.07	$79.04	$624.62	$624.62	$0.00	$253.44	$836.35	$844.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33300018	EAP	CPT® 77333		Bolus Inter.	BOTH IP/OP	"$1,056.00 "	$781.44	$0.00	$844.80	$220.86	$220.86	$123.57	$123.57	$124.26	$220.10	$67.24	$67.24	$69.82	$121.59	$220.07	$79.04	$624.62	$624.62	$0.00	$253.44	$836.35	$844.80	$0.00	$211.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33300019	EAP	CPT® 77334		Device Complex	BOTH IP/OP	"$1,488.00 "	"$1,101.12"	$67.35	$890.40	$299.06	$299.06	$329.78	$329.78	$331.64	$310.14	$240.51	$240.51	$249.76	$324.60	$310.10	$210.99	$880.15	$880.15	$336.15	$267.12	$881.50	$890.40	$467.03	$569.27	$467.03	$174.18	$67.35	$67.35	$177.19	$320.14	$0.00	$0.00	$0.00	$0.00
33300020	EAP	CPT® 77334		Compensator Filter	BOTH IP/OP	"$1,113.00 "	$823.62	$67.35	$890.40	$299.06	$299.06	$329.78	$329.78	$331.64	$231.98	$240.51	$240.51	$249.76	$324.60	$231.95	$210.99	$658.34	$658.34	$336.15	$267.12	$881.50	$890.40	$467.03	$569.27	$467.03	$174.18	$67.35	$67.35	$177.19	$320.14	$0.00	$0.00	$0.00	$0.00
33300021	EAP	CPT® 77334		Positioning Mold	BOTH IP/OP	"$1,113.00 "	$823.62	$67.35	$890.40	$299.06	$299.06	$329.78	$329.78	$331.64	$231.98	$240.51	$240.51	$249.76	$324.60	$231.95	$210.99	$658.34	$658.34	$336.15	$267.12	$881.50	$890.40	$467.03	$569.27	$467.03	$174.18	$67.35	$67.35	$177.19	$320.14	$0.00	$0.00	$0.00	$0.00
33300022	EAP	CPT® 77336		Continuing Physics/wk	BOTH IP/OP	$962.00 	$711.88	$79.04	$576.00	$181.47	$181.47	$123.57	$123.57	$124.26	$200.50	$155.36	$155.36	$161.33	$121.59	$200.48	$79.04	$569.02	$569.02	$126.96	$172.80	$570.24	$576.00	$176.40	$211.67	$176.40	$112.68	$81.03	$81.03	$114.62	$120.92	$0.00	$0.00	$0.00	$0.00
33300023	EAP	CPT® 77370		Spec Medical Physics Consult	BOTH IP/OP	"$1,142.00 "	$845.08	$79.04	$684.00	$279.07	$279.07	$123.57	$123.57	$124.26	$238.02	$293.91	$293.91	$305.22	$121.59	$237.99	$79.04	$675.49	$675.49	$126.96	$205.20	$677.16	$684.00	$176.40	$211.67	$176.40	$133.81	$126.41	$126.41	$136.12	$120.92	$0.00	$0.00	$0.00	$0.00
33300024	EAP	CPT® 77401		"Rad Delivery, Superf &/or Orthovolt, Per Day"	BOTH IP/OP	$899.00 	$665.26	$0.00	$719.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.93	$79.93	$83.01	$0.00	$187.35	$0.00	$0.00	$0.00	$0.00	$215.76	$712.01	$719.20	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33300026	EAP	CPT® 77306		Telether Plan Simple	BOTH IP/OP	"$1,192.00 "	$882.08	$0.00	"$2,906.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.75	$182.75	$189.78	$0.00	$248.41	$0.00	$0.00	$0.00	$336.15	$214.08	$706.46	$713.60	$467.03	"$2,906.00"	$467.03	$139.60	$76.36	$76.36	$142.01	$320.14	$0.00	$0.00	$0.00	$0.00
33300028	EAP	CPT® 77307		Telether Plan Complex	BOTH IP/OP	"$1,998.00 "	"$1,478.52"	$138.30	"$1,196.00"	$660.98	$660.98	$329.78	$329.78	$331.64	$416.43	$335.12	$335.12	$348.01	$324.60	$416.38	$210.99	"$1,181.82"	"$1,181.82"	$336.15	$358.80	"$1,184.04"	"$1,196.00"	$467.03	$569.27	$467.03	$233.97	$138.30	$138.30	$238.00	$320.14	$0.00	$0.00	$0.00	$0.00
33300030	EAP	CPT® 77318		Brachyther Plan Complex	BOTH IP/OP	"$2,101.00 "	"$1,554.74"	$0.00	"$2,101.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$504.45	$504.45	$523.85	$0.00	$437.85	$0.00	$0.00	$0.00	$0.00	$377.28	"$1,245.02"	"$1,257.60"	$0.00	"$2,101.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33300031	EAP	CPT® 77407		"Rad Tx Del >= 1 Mev, Intermed"	BOTH IP/OP	"$1,214.00 "	$898.36	$0.00	$971.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$531.75	$531.75	$552.20	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$291.36	$961.49	$971.20	$0.00	$804.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33300033	EAP	CPT® 77412		"Rad Tx Del >= 1 Mev, Complex"	BOTH IP/OP	"$1,771.00 "	"$1,310.54"	$0.00	"$1,060.00"	$615.91	$615.91	$235.40	$235.40	$236.72	$369.12	$515.25	$515.25	$535.06	$231.63	$369.08	$150.56	"$1,047.55"	"$1,047.55"	$237.05	$318.00	"$1,049.40"	"$1,060.00"	$329.36	$417.25	$329.36	$207.36	$0.00	$0.00	$210.94	$225.77	$0.00	$0.00	$0.00	$0.00
33300035	EAP	CPT® 77385		Imrt Tx Delivery Simple	BOTH IP/OP	"$4,467.00 "	"$3,305.58"	$0.00	"$3,443.16"	$783.58	$783.58	$528.37	$528.37	$531.35	$931.03	"$3,315.41"	"$3,315.41"	"$3,443.16"	$519.99	$930.92	$337.99	"$2,642.23"	"$2,642.23"	$540.41	$802.08	"$2,646.86"	"$2,673.60"	$750.83	$908.47	$750.83	$523.02	$0.00	$0.00	$532.05	$514.68	$0.00	$0.00	$0.00	$0.00
33300037	EAP	CPT® 77386		Imrt Tx Delivery Complex	BOTH IP/OP	"$4,467.00 "	"$3,305.58"	$0.00	"$3,443.16"	$786.03	$786.03	$528.37	$528.37	$531.35	$931.03	"$3,315.41"	"$3,315.41"	"$3,443.16"	$519.99	$930.92	$337.99	"$2,642.23"	"$2,642.23"	$540.41	$802.08	"$2,646.86"	"$2,673.60"	$750.83	$908.47	$750.83	$523.02	$0.00	$0.00	$532.05	$514.68	$0.00	$0.00	$0.00	$0.00
33300040	EAP	CPT® 77387		Guidance For Radiation Tx Dlvr	BOTH IP/OP	"$1,005.00 "	$743.70	$0.00	"$3,306.00"	$146.70	$146.70	$0.00	$0.00	$0.00	$209.47	$95.28	$95.28	$98.95	$0.00	$209.44	$0.00	$594.46	$594.46	$0.00	$180.48	$595.58	$601.60	$0.00	"$3,306.00"	$0.00	$117.69	$0.00	$0.00	$119.72	$0.00	$0.00	$0.00	$0.00	$0.00
33300047	EAP	CPT® 77417		Port Image(s)	BOTH IP/OP	$631.00 	$466.94	$0.00	$796.00	$25.00	$25.00	$0.00	$0.00	$0.00	$131.52	$40.22	$40.22	$41.76	$0.00	$131.50	$0.00	$373.24	$373.24	$0.00	$113.28	$373.82	$377.60	$0.00	$796.00	$0.00	$73.87	$11.52	$11.52	$75.14	$0.00	$0.00	$0.00	$0.00	$0.00
33300049	EAP	CPT® 77402		"Rad Tx Del >= 1 Mev, Simple"	BOTH IP/OP	"$1,202.00 "	$889.48	$0.00	"$1,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$339.51	$339.51	$352.57	$0.00	$250.50	$0.00	$0.00	$0.00	$123.07	$215.76	$712.01	$719.20	$170.99	"$1,136.00"	$170.99	$140.69	$0.00	$0.00	$143.12	$117.21	$0.00	$0.00	$0.00	$0.00
33300050	EAP	CPT® 77470		Special Treatment	BOTH IP/OP	"$6,620.00 "	"$4,898.80"	$25.93	"$3,962.40"	$329.68	$329.68	$528.37	$528.37	$531.35	"$1,379.77"	$379.95	$379.95	$394.57	$519.99	"$1,379.61"	$337.99	"$3,915.73"	"$3,915.73"	$540.41	"$1,188.72"	"$3,922.78"	"$3,962.40"	$750.83	$908.47	$750.83	$775.14	$25.93	$25.93	$788.52	$514.68	$0.00	$0.00	$0.00	$0.00
33300052	EAP	CPT® 77763		Intracavitary Complex	BOTH IP/OP	"$2,833.00 "	"$2,096.42"	$0.00	"$2,266.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$617.13	$617.13	$640.86	$0.00	$590.40	$0.00	$0.00	$0.00	$0.00	$679.92	"$2,243.74"	"$2,266.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33300053	EAP	CPT® 77338		Imrt Treatment Device	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$172.15	"$1,160.81"	"$1,160.81"	"$1,160.81"	$329.78	$329.78	$331.64	$306.38	$646.24	$646.24	$671.09	$324.60	$306.35	$210.99	$869.51	$869.51	$336.15	$264.00	$871.20	$880.00	$467.03	$569.27	$467.03	$172.15	$264.36	$264.36	$175.12	$320.14	$0.00	$0.00	$0.00	$0.00
33300055	EAP	CPT® 77372		Cranial Only X 1	BOTH IP/OP	"$10,692.00 "	"$7,912.08"	"$1,067.19"	"$12,204.45"	"$2,454.91"	"$2,454.91"	"$7,573.86"	"$7,573.86"	"$7,616.52"	"$2,228.48"	"$2,033.64"	"$2,033.64"	"$2,111.85"	"$7,449.57"	"$2,228.21"	"$4,842.22"	"$6,324.32"	"$6,324.32"	"$7,965.75"	"$1,920.00"	"$6,336.00"	"$6,400.00"	"$8,000.00"	"$12,204.45"	"$8,000.00"	"$1,252.00"	"$1,067.19"	"$1,067.19"	"$1,273.60"	"$7,586.43"	$0.00	$0.00	$0.00	$0.00
33300057	EAP	CPT® 77373		Robt Lin-radsurg Fract 1-5	BOTH IP/OP	"$7,072.00 "	"$5,233.28"	$828.04	"$4,232.80"	"$3,115.99"	"$3,115.99"	"$1,688.97"	"$1,688.97"	"$1,698.48"	"$1,473.98"	"$3,765.33"	"$3,765.33"	"$3,910.15"	"$1,661.65"	"$1,473.80"	"$1,080.07"	"$4,183.09"	"$4,183.09"	"$1,773.65"	"$1,269.84"	"$4,190.47"	"$4,232.80"	"$2,464.25"	"$2,804.83"	"$2,464.25"	$828.04	"$1,228.18"	"$1,228.18"	$842.33	"$1,689.19"	$0.00	$0.00	$0.00	$0.00
33300067	EAP	CPT® 77014		Cbct Infusion Radioactive Mat	BOTH IP/OP	"$1,462.00 "	"$1,081.88"	$0.00	"$2,159.00"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$304.72	$785.72	$785.72	$815.94	$0.00	$304.68	$0.00	$864.77	$864.77	$0.00	$262.56	$866.45	$875.20	$0.00	"$2,159.00"	$0.00	$171.21	$78.16	$78.16	$174.16	$0.00	$0.00	$0.00	$0.00	$0.00
33300073	EAP	CPT® 57156		Ins Vag Brachytx Device	BOTH IP/OP	"$1,386.00 "	"$1,025.64"	$0.00	"$1,386.00"	"$1,386.00"	"$1,386.00"	$274.65	$274.65	$276.20	$288.88	"$1,028.69"	"$1,028.69"	"$1,068.33"	$269.78	$288.84	$175.35	"$1,386.00"	"$1,386.00"	$0.00	"$1,138.00"	$901.30	$910.40	$0.00	"$1,386.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33300088	EAP	CPT® 77293		Resp Motion Mgmt Sim	BOTH IP/OP	"$1,270.00 "	$939.80	$0.00	"$1,270.00"	"$1,066.51"	"$1,066.51"	$0.00	$0.00	$0.00	$264.70	$823.32	$823.32	$854.98	$0.00	$264.67	$0.00	$751.21	$751.21	$0.00	$228.00	$752.40	$760.00	$0.00	"$1,270.00"	$0.00	$148.68	$350.81	$350.81	$151.24	$0.00	$0.00	$0.00	$0.00	$0.00
33500001	EAP	CPT® 96450		Iv Chemo Into Cns W/spinal Pun	BOTH IP/OP	"$1,346.00 "	$996.04	$0.00	"$1,037.50"	$535.21	$535.21	$310.51	$310.51	$312.26	$280.54	$999.00	$999.00	"$1,037.50"	$297.83	$280.51	$193.59	$796.16	$796.16	$0.00	$502.50	$795.96	$804.00	$0.00	$815.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33500002	EAP	CPT® 96413		"Chemo Tx Admn Iv Nfs Tq Up 1 Hr, Sng Or 1st Sbst/drug"	BOTH IP/OP	"$1,213.00 "	$897.62	$141.79	$934.98	$405.93	$405.93	$310.51	$310.51	$312.26	$252.82	$900.29	$900.29	$934.98	$297.83	$252.79	$193.59	$717.49	$717.49	$310.51	$453.00	$717.55	$724.80	$431.41	$832.65	$431.41	$141.79	$142.28	$142.28	$144.24	$295.72	$0.00	$0.00	$0.00	$0.00
33500003	EAP	CPT® 96416		Iv Chemo Inf Prolonged Gtr8hrs	BOTH IP/OP	"$1,346.00 "	$996.04	$142.28	"$1,037.50"	$410.10	$410.10	$310.51	$310.51	$312.26	$280.54	$999.00	$999.00	"$1,037.50"	$297.83	$280.51	$193.59	$796.16	$796.16	$310.51	$502.50	$795.96	$804.00	$431.41	$808.60	$431.41	$157.28	$142.28	$142.28	$160.00	$295.72	$0.00	$0.00	$0.00	$0.00
33500004	EAP	CPT® 96415		Iv Chemo Inf Med Ea Addtl Hr	BOTH IP/OP	$337.00 	$249.38	$30.63	$259.76	$83.48	$83.48	$60.38	$60.38	$60.72	$70.24	$250.12	$250.12	$259.76	$59.39	$70.23	$38.61	$199.34	$199.34	$60.65	$126.00	$199.58	$201.60	$84.26	$219.05	$84.26	$39.44	$30.63	$30.63	$40.12	$57.76	$0.00	$0.00	$0.00	$0.00
33500005	EAP	CPT® 96417		Iv Chemo Inf Ea New Med 16-90	BOTH IP/OP	$529.00 	$391.46	$38.61	$442.00	$192.01	$192.01	$60.38	$60.38	$60.72	$110.26	$392.62	$392.62	$407.75	$59.39	$110.24	$38.61	$312.90	$312.90	$60.65	$197.50	$312.84	$316.00	$84.26	$442.00	$84.26	$61.82	$69.16	$69.16	$62.88	$57.76	$0.00	$0.00	$0.00	$0.00
33500007	EAP	CPT® 96416		Iv Chem Inf Prolong Gtr 8hr Pu	BOTH IP/OP	"$1,346.00 "	$996.04	$142.28	"$1,037.50"	$410.10	$410.10	$310.51	$310.51	$312.26	$280.54	$999.00	$999.00	"$1,037.50"	$297.83	$280.51	$193.59	$796.16	$796.16	$310.51	$502.50	$795.96	$804.00	$431.41	$808.60	$431.41	$157.28	$142.28	$142.28	$160.00	$295.72	$0.00	$0.00	$0.00	$0.00
34000004	EAP	CPT® 79440		Nuclearrx Intra-articular Nuc	BOTH IP/OP	"$1,139.00 "	$842.86	$0.00	$911.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.33	$149.33	$155.08	$0.00	$237.37	$0.00	$0.00	$0.00	$0.00	$273.36	$902.09	$911.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34000005	EAP	CPT® 78265		Nm Gastric Emptying Img Std	BOTH IP/OP	$832.00 	$615.68	$0.00	$948.99	$832.00	$832.00	$367.10	$367.10	$369.17	$0.00	$913.84	$913.84	$948.99	$0.00	$173.39	$0.00	$0.00	$0.00	$0.00	$199.68	$658.94	$665.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100005	EAP	CPT® 78018		THYROID CA/METS IMAGE WHOL NUC	BOTH IP/OP	"$1,629.00 "	"$1,205.46"	$250.40	"$1,316.00"	$738.46	$738.46	$476.55	$476.55	$479.24	$339.52	$662.46	$662.46	$687.94	$469.05	$339.48	$304.88	$963.55	$963.55	$456.86	$394.80	"$1,302.84"	"$1,316.00"	$634.74	$800.61	$634.74	$250.40	$280.57	$280.57	$261.88	$435.10	$0.00	$0.00	$0.00	$0.00
34100006	EAP	CPT® 78020		Thyroid Carcinoma Metatases Up	BOTH IP/OP	"$1,082.00 "	$800.68	$0.00	$874.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.33	$149.33	$155.08	$0.00	$225.49	$0.00	$0.00	$0.00	$0.00	$262.32	$865.66	$874.40	$0.00	$776.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100007	EAP	CPT® 78070		PARATHYROID SCAN NUC	BOTH IP/OP	"$1,933.00 "	"$1,430.42"	$107.84	"$1,562.40"	$707.81	$707.81	$367.10	$367.10	$369.17	$402.89	$321.33	$321.33	$333.69	$361.44	$402.84	$234.94	"$1,143.37"	"$1,143.37"	$354.53	$468.72	"$1,546.78"	"$1,562.40"	$492.57	$616.81	$492.57	$107.84	$265.80	$265.80	$310.92	$337.65	$0.00	$0.00	$0.00	$0.00
34100008	EAP	CPT® 78075		ADRENAL SCAN CORTX&/MEDU NUC	BOTH IP/OP	"$12,239.00 "	"$9,056.86"	$0.00	"$9,890.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$908.41	$908.41	$943.35	$0.00	"$2,550.61"	$0.00	$0.00	$0.00	$0.00	"$2,967.12"	"$9,791.50"	"$9,890.40"	$0.00	"$2,581.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100009	EAP	CPT® 78102		BONE MARROW LIMITED NUC	BOTH IP/OP	"$1,469.00 "	"$1,087.06"	$0.00	"$1,463.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$325.73	$325.73	$338.26	$0.00	$306.14	$0.00	$0.00	$0.00	$0.00	$352.56	"$1,163.45"	"$1,175.20"	$0.00	"$1,463.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100010	EAP	CPT® 78104		BONE MARROW WHOLE BODY NUC	BOTH IP/OP	"$1,469.00 "	"$1,087.06"	$0.00	"$1,175.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.48	$507.48	$527.00	$0.00	$306.14	$0.00	$0.00	$0.00	$0.00	$352.56	"$1,163.45"	"$1,175.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100011	EAP	CPT® 78140		RBC LABELED SEQ LIVER NUC	BOTH IP/OP	"$1,312.00 "	$970.88	$0.00	"$1,049.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$288.89	$288.89	$300.00	$0.00	$273.42	$0.00	$0.00	$0.00	$0.00	$314.88	"$1,039.10"	"$1,049.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100012	EAP	CPT® 78185		SPLEEN SCAN W/ W/O FLOW NUC	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.17	$408.17	$423.87	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$338.40	"$1,116.72"	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100013	EAP	CPT® 78195		LYMPHOSCINTIGRAPHY NUC	BOTH IP/OP	"$1,629.00 "	"$1,205.46"	$211.12	"$1,316.00"	$840.05	$840.05	$476.55	$476.55	$479.24	$339.52	$667.18	$667.18	$692.84	$469.05	$339.48	$304.88	$963.55	$963.55	$456.86	$394.80	"$1,302.84"	"$1,316.00"	$634.74	$800.61	$634.74	$211.12	$306.14	$306.14	$261.88	$435.10	$0.00	$0.00	$0.00	$0.00
34100015	EAP	CPT® 78215		Liver & Spleen Imaging Static	BOTH IP/OP	"$1,454.00 "	"$1,075.96"	$0.00	"$1,175.20"	$457.93	$457.93	$367.10	$367.10	$369.17	$303.05	$390.75	$390.75	$405.78	$361.44	$303.01	$234.94	$860.04	$860.04	$0.00	$352.56	"$1,163.45"	"$1,175.20"	$0.00	$616.81	$0.00	$136.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100016	EAP	CPT® 78216		LIVER/SPLEEN W/VASCU FLOW NUC	BOTH IP/OP	"$1,469.00 "	"$1,087.06"	$0.00	"$1,175.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.22	$271.22	$281.65	$0.00	$306.14	$0.00	$0.00	$0.00	$0.00	$352.56	"$1,163.45"	"$1,175.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100019	EAP	CPT® 78262		GI REFLUX NUC	BOTH IP/OP	"$2,128.00 "	"$1,574.72"	$0.00	"$1,702.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.19	$500.19	$519.43	$0.00	$443.48	$0.00	$0.00	$0.00	$0.00	$510.72	"$1,685.38"	"$1,702.40"	$0.00	$744.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100020	EAP	CPT® 78264		GASTRIC EMPTYING NUC	BOTH IP/OP	"$3,115.00 "	"$2,305.10"	$196.51	"$2,295.20"	$793.29	$793.29	$367.10	$367.10	$369.17	$649.24	$574.62	$574.62	$596.72	$361.44	$649.17	$234.94	"$1,842.52"	"$1,842.52"	$354.53	$688.56	"$2,272.25"	"$2,295.20"	$492.57	$616.81	$492.57	$196.51	$303.26	$303.26	$456.74	$337.65	$0.00	$0.00	$0.00	$0.00
34100021	EAP	CPT® 78278		ACUTE GI BLEEDING IMAGING NUC	BOTH IP/OP	"$2,498.00 "	"$1,848.52"	$0.00	"$2,101.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$685.78	$685.78	$712.15	$0.00	$520.58	$0.00	$0.00	$0.00	$0.00	$552.24	"$1,822.39"	"$1,840.80"	$0.00	"$2,101.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100022	EAP	CPT® 78290		BOWEL IMAGING MECKLES SCAN NUC	BOTH IP/OP	"$2,402.00 "	"$1,777.48"	$0.00	"$1,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$638.22	$638.22	$662.76	$0.00	$500.58	$0.00	$0.00	$0.00	$0.00	$531.12	"$1,752.70"	"$1,770.40"	$0.00	"$1,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100023	EAP	CPT® 78291		SHUNT PATENCY LEVEEN/DENV  NUC	BOTH IP/OP	"$2,255.00 "	"$1,668.70"	$0.00	"$1,804.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.47	$478.47	$496.88	$0.00	$469.94	$0.00	$0.00	$0.00	$0.00	$541.20	"$1,785.96"	"$1,804.00"	$0.00	"$1,418.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100024	EAP	CPT® 78300		BONE IMAGING LIMITED NUC	BOTH IP/OP	"$1,481.00 "	"$1,095.94"	$0.00	"$1,481.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$336.30	$336.30	$349.24	$0.00	$308.64	$0.00	$0.00	$0.00	$0.00	$359.04	"$1,184.83"	"$1,196.80"	$0.00	"$1,481.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100025	EAP	CPT® 78306		Nm Bone Imaging Whole Body	BOTH IP/OP	"$2,737.00 "	"$2,025.38"	$205.40	"$2,212.00"	$592.52	$592.52	$367.10	$367.10	$369.17	$570.46	$502.02	$502.02	$521.33	$361.44	$570.39	$234.94	"$1,618.94"	"$1,618.94"	$354.53	$663.60	"$2,189.88"	"$2,212.00"	$492.57	$616.81	$492.57	$205.40	$266.89	$266.89	$440.19	$337.65	$0.00	$0.00	$0.00	$0.00
34100026	EAP	CPT® 78315		Nm Bone Imaging 3 Phase Study	BOTH IP/OP	"$2,737.00 "	"$2,025.38"	$0.00	"$2,737.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$683.05	$683.05	$709.32	$0.00	$570.39	$0.00	$0.00	$0.00	$354.53	$663.60	"$2,189.88"	"$2,212.00"	$492.57	"$2,737.00"	$492.57	$232.73	$305.42	$305.42	$440.19	$337.65	$0.00	$0.00	$0.00	$0.00
34100028	EAP	CPT® 78445		Ceretec Vascular Flow Imaging	BOTH IP/OP	"$1,584.00 "	"$1,172.16"	$0.00	"$1,267.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.22	$342.22	$355.38	$0.00	$330.11	$0.00	$0.00	$0.00	$0.00	$380.16	"$1,254.53"	"$1,267.20"	$0.00	$938.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100029	EAP	CPT® 78453		Cardiac Scan Thallium (planar)	BOTH IP/OP	"$5,102.00 "	"$3,775.48"	$0.00	"$4,661.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$568.46	$568.46	$590.33	$0.00	"$1,063.26"	$0.00	$0.00	$0.00	$0.00	"$1,398.48"	"$4,614.98"	"$4,661.60"	$0.00	"$1,984.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100030	EAP	CPT® 78451		CARDIAC PERFUSION SINGLE NUC	BOTH IP/OP	"$6,945.00 "	"$5,139.30"	$167.51	"$5,612.00"	$799.71	$799.71	"$1,272.60"	"$1,272.60"	"$1,279.77"	"$1,447.51"	$634.33	$634.33	$658.72	"$1,251.64"	"$1,447.34"	$813.57	"$4,107.97"	"$4,107.97"	"$1,232.99"	"$1,683.60"	"$5,555.88"	"$5,612.00"	"$1,713.08"	"$2,106.29"	"$1,713.08"	$167.51	$278.41	$278.41	"$1,116.79"	"$1,174.28"	$0.00	$0.00	$0.00	$0.00
34100031	EAP	CPT® 78452		Cardiac Scan	BOTH IP/OP	"$9,411.00 "	"$6,964.14"	$286.29	"$7,604.80"	"$1,110.89"	"$1,110.89"	"$1,272.60"	"$1,272.60"	"$1,279.77"	"$1,961.49"	$928.32	$928.32	$964.03	"$1,251.64"	"$1,961.25"	$813.57	"$5,566.61"	"$5,566.61"	"$1,232.99"	"$2,281.44"	"$7,528.75"	"$7,604.80"	"$1,713.08"	"$2,106.29"	"$1,713.08"	$286.29	$403.03	$403.03	"$1,513.36"	"$1,174.28"	$0.00	$0.00	$0.00	$0.00
34100032	EAP	CPT® 78472		CARDIAC SCAN GATED NUC	BOTH IP/OP	"$3,623.00 "	"$2,681.02"	$185.13	"$2,928.00"	$538.53	$538.53	$367.10	$367.10	$369.17	$755.12	$519.79	$519.79	$539.78	$361.44	$755.03	$234.94	"$2,143.00"	"$2,143.00"	$354.53	$878.40	"$2,898.72"	"$2,928.00"	$492.57	$616.81	$492.57	$259.91	$185.13	$185.13	$582.67	$337.65	$0.00	$0.00	$0.00	$0.00
34100034	EAP	CPT® 78580		Pulm (lung) Perfusion Imag	BOTH IP/OP	"$2,905.00 "	"$2,149.70"	$167.63	"$2,329.60"	$563.53	$563.53	$367.10	$367.10	$369.17	$605.47	$418.26	$418.26	$434.34	$361.44	$605.40	$234.94	"$1,718.31"	"$1,718.31"	$354.53	$698.88	"$2,306.30"	"$2,329.60"	$492.57	$616.81	$492.57	$167.63	$206.74	$206.74	$463.59	$337.65	$0.00	$0.00	$0.00	$0.00
34100038	EAP	CPT® 78606		BRAIN SCAN W/VASCULAR FLO NUC	BOTH IP/OP	"$2,511.00 "	"$1,858.14"	$0.00	"$2,511.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$660.09	$660.09	$685.48	$0.00	$523.29	$0.00	$0.00	$0.00	$0.00	$547.92	"$1,808.14"	"$1,826.40"	$0.00	"$2,511.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100040	EAP	CPT® 78630		CISTERNOGRAPHY NUC	BOTH IP/OP	"$1,521.00 "	"$1,125.54"	$0.00	"$1,216.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$700.89	$700.89	$727.84	$0.00	$316.98	$0.00	$0.00	$0.00	$0.00	$365.04	"$1,204.63"	"$1,216.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100041	EAP	CPT® 78701		Kidney Imag W/vascul Flo Nuc	BOTH IP/OP	"$4,099.00 "	"$3,033.26"	$0.00	"$3,279.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$443.66	$443.66	$460.73	$0.00	$854.23	$0.00	$0.00	$0.00	$0.00	$983.76	"$3,246.41"	"$3,279.20"	$0.00	"$1,845.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100042	EAP	CPT® 78707		Kid.img.mor.w/vas.singlew/o Ph	BOTH IP/OP	"$3,679.00 "	"$2,722.46"	$191.97	"$2,755.20"	$548.20	$548.20	$476.55	$476.55	$479.24	$766.80	$466.46	$466.46	$484.40	$469.05	$766.70	$304.88	"$2,176.13"	"$2,176.13"	$456.86	$826.56	"$2,727.65"	"$2,755.20"	$634.74	$800.61	$634.74	$218.15	$191.97	$191.97	$548.28	$435.10	$0.00	$0.00	$0.00	$0.00
34100043	EAP	CPT® 78708		Kid.img.mor.w/vas.singlew/phar	BOTH IP/OP	"$3,968.00 "	"$2,936.32"	$122.10	"$2,972.00"	$413.58	$413.58	$476.55	$476.55	$479.24	$827.03	$324.90	$324.90	$337.39	$469.05	$826.93	$304.88	"$2,347.07"	"$2,347.07"	$456.86	$891.60	"$2,942.28"	"$2,972.00"	$634.74	$800.61	$634.74	$228.29	$122.10	$122.10	$591.43	$435.10	$0.00	$0.00	$0.00	$0.00
34100044	EAP	CPT® 78709		Kid.img.mor.w/vas.multi W&w/o	BOTH IP/OP	"$3,969.00 "	"$2,937.06"	$0.00	"$2,972.80"	$859.37	$859.37	$476.55	$476.55	$479.24	$827.24	$686.09	$686.09	$712.48	$469.05	$827.14	$304.88	"$2,347.66"	"$2,347.66"	$0.00	$891.84	"$2,943.07"	"$2,972.80"	$0.00	$800.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100045	EAP	CPT® 78740		Voiding Cystogram Nuc	BOTH IP/OP	"$3,569.00 "	"$2,641.06"	$0.00	"$2,855.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$428.28	$428.28	$444.75	$0.00	$743.78	$0.00	$0.00	$0.00	$0.00	$856.56	"$2,826.65"	"$2,855.20"	$0.00	"$1,695.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100046	EAP	CPT® 78800		Nm Rp Loclzj Tum Plnr 1 Area Single Day Imaging	BOTH IP/OP	"$1,356.00 "	"$1,003.44"	$162.68	"$1,096.00"	$453.92	$453.92	$367.10	$367.10	$369.17	$282.62	$367.43	$367.43	$381.56	$361.44	$282.59	$234.94	$802.07	$802.07	$354.53	$328.80	"$1,085.04"	"$1,096.00"	$492.57	$616.81	$492.57	$162.68	$233.75	$233.75	$218.10	$337.65	$0.00	$0.00	$0.00	$0.00
34100047	EAP	CPT® 78801		Nm Rp Loclzj Tum Plnr 2+ Areas Or 2+ Days	BOTH IP/OP	"$1,295.00 "	$958.30	$0.00	"$1,036.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.02	$502.02	$521.33	$0.00	$269.88	$0.00	$0.00	$0.00	$0.00	$310.80	"$1,025.64"	"$1,036.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100048	EAP	CPT® 78802		TUMOR SINGLE DAY	BOTH IP/OP	"$1,371.00 "	"$1,014.54"	$0.00	"$1,371.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$680.45	$680.45	$706.62	$0.00	$285.72	$0.00	$0.00	$0.00	$0.00	$332.40	"$1,096.92"	"$1,108.00"	$0.00	"$1,371.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100049	EAP	CPT® 78803		NM TUMOR LOCALALIZATION SPECT	BOTH IP/OP	"$4,783.00 "	"$3,539.42"	$0.00	"$3,864.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$731.39	$731.39	$759.52	$0.00	$996.78	$0.00	$0.00	$0.00	"$1,232.99"	"$1,159.44"	"$3,826.15"	"$3,864.80"	"$1,713.08"	"$2,266.00"	"$1,713.08"	$0.00	$346.84	$346.84	$769.10	"$1,174.28"	$0.00	$0.00	$0.00	$0.00
34100057	EAP	CPT® 78451		Myocardial Ejection Fraction	BOTH IP/OP	"$6,142.00 "	"$4,545.08"	$167.51	"$5,612.00"	$799.71	$799.71	"$1,272.60"	"$1,272.60"	"$1,279.77"	"$1,280.15"	$634.33	$634.33	$658.72	"$1,251.64"	"$1,279.99"	$813.57	"$3,632.99"	"$3,632.99"	"$1,232.99"	"$1,683.60"	"$5,555.88"	"$5,612.00"	"$1,713.08"	"$2,106.29"	"$1,713.08"	$167.51	$278.41	$278.41	"$1,116.79"	"$1,174.28"	$0.00	$0.00	$0.00	$0.00
34100060	EAP	CPT® 78804		TUMOR IMAGING WHOLE BODY NUC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,253.14"	"$1,253.14"	"$1,301.34"	$0.00	$521.00	$0.00	$0.00	$0.00	"$1,232.99"	$606.00	"$1,999.80"	"$2,020.00"	"$1,713.08"	"$2,500.00"	"$1,713.08"	$395.16	$629.22	$629.22	$401.98	"$1,174.28"	$0.00	$0.00	$0.00	$0.00
34100062	EAP	CPT® 78226		Hepatobiliary Imag W Glbldr	BOTH IP/OP	"$2,589.00 "	"$1,915.86"	$234.94	"$2,092.00"	$780.38	$780.38	$367.10	$367.10	$369.17	$539.61	$738.89	$738.89	$767.31	$361.44	$539.55	$234.94	"$1,531.39"	"$1,531.39"	$354.53	$627.60	"$2,071.08"	"$2,092.00"	$492.57	$616.81	$492.57	$315.27	$300.74	$300.74	$416.31	$337.65	$0.00	$0.00	$0.00	$0.00
34100063	EAP	CPT® 78227		Hepatobil Imag Pharma W Glbldr	BOTH IP/OP	"$2,615.00 "	"$1,935.10"	$0.00	"$2,092.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,026.06"	"$1,026.06"	"$1,065.53"	$0.00	$544.97	$0.00	$0.00	$0.00	$0.00	$627.60	"$2,071.08"	"$2,092.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100064	EAP	CPT® 78579		Pulmonary Ventilation Imaging	BOTH IP/OP	"$1,086.00 "	$803.64	$0.00	"$1,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$381.40	$381.40	$396.07	$0.00	$226.32	$0.00	$0.00	$0.00	$0.00	$261.36	$862.49	$871.20	$0.00	"$1,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100065	EAP	CPT® 78582		Pulmon Vent Imag W Perfus	BOTH IP/OP	"$1,696.00 "	"$1,255.04"	$270.64	"$1,360.00"	$789.25	$789.25	$476.55	$476.55	$479.24	$353.49	$684.86	$684.86	$711.20	$469.05	$353.45	$304.88	"$1,003.18"	"$1,003.18"	$456.86	$408.00	"$1,346.40"	"$1,360.00"	$634.74	$800.61	$634.74	$308.89	$289.94	$289.94	$270.64	$435.10	$0.00	$0.00	$0.00	$0.00
34100066	EAP	CPT® 78598		Quant Diff Pulm Perfu + Vent	BOTH IP/OP	"$1,700.00 "	"$1,258.00"	$0.00	"$1,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$662.58	$662.58	$688.07	$0.00	$354.28	$0.00	$0.00	$0.00	$0.00	$408.00	"$1,346.40"	"$1,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100067	EAP	CPT® 78597		Quant Diff Pulm Perfusion	BOTH IP/OP	"$1,086.00 "	$803.64	$0.00	"$1,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.86	$408.86	$424.58	$0.00	$226.32	$0.00	$0.00	$0.00	$0.00	$261.36	$862.49	$871.20	$0.00	"$1,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100070	EAP	CPT® 78645		Shunt Evaluation	BOTH IP/OP	$922.00 	$682.28	$0.00	$737.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$652.41	$652.41	$677.51	$0.00	$192.14	$0.00	$0.00	$0.00	$0.00	$221.28	$730.22	$737.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100072	EAP	CPT® 78012		Thyroid Uptake Sing/multi Inc Supres Disch	BOTH IP/OP	"$4,484.00 "	"$3,318.16"	$0.00	"$3,716.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.90	$185.90	$193.05	$0.00	$934.47	$0.00	$0.00	$0.00	$0.00	"$1,114.80"	"$3,678.84"	"$3,716.00"	$0.00	"$1,275.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100073	EAP	CPT® 78013		Thyroid Imaging	BOTH IP/OP	"$2,280.00 "	"$1,687.20"	$0.00	"$1,842.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$484.05	$484.05	$502.66	$0.00	$475.15	$0.00	$0.00	$0.00	$0.00	$552.72	"$1,823.98"	"$1,842.40"	$0.00	"$1,243.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100074	EAP	CPT® 78014		Thyroid Imaging W/multi Determ Inc Suprs/dc	BOTH IP/OP	"$5,018.00 "	"$3,713.32"	$222.22	"$4,055.20"	$569.98	$569.98	$367.10	$367.10	$369.17	"$1,045.88"	$550.89	$550.89	$572.08	$361.44	"$1,045.75"	$234.94	"$2,968.15"	"$2,968.15"	$354.53	"$1,216.56"	"$4,014.65"	"$4,055.20"	$492.57	$616.81	$492.57	$232.84	$222.22	$222.22	$806.98	$337.65	$0.00	$0.00	$0.00	$0.00
34100075	EAP	CPT® 78071		Parathyrd Planar W/wo Subtrj	BOTH IP/OP	"$1,132.00 "	$837.68	$0.00	$938.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.59	$768.59	$798.15	$0.00	$235.91	$0.00	$0.00	$0.00	$0.00	$281.52	$929.02	$938.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34100076	EAP	CPT® 78072		Parathyrd Planar W/spect&ct	BOTH IP/OP	"$3,095.00 "	"$2,290.30"	$74.44	"$2,500.80"	$726.00	$726.00	$476.55	$476.55	$479.24	$645.08	$785.72	$785.72	$815.94	$469.05	$645.00	$304.88	"$1,830.69"	"$1,830.69"	$456.86	$750.24	"$2,475.79"	"$2,500.80"	$634.74	$800.61	$634.74	$74.44	$381.06	$381.06	$497.66	$435.10	$0.00	$0.00	$0.00	$0.00
34100077	EAP	CPT® 78831		Nm Rp Loclzj Tum Spect 2 Area/1 Day Or 1 Area/2+ Day	BOTH IP/OP	"$2,001.00 "	"$1,480.74"	$0.00	"$1,616.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,480.71"	"$1,480.71"	"$1,537.66"	$0.00	$417.01	$0.00	$0.00	$0.00	$0.00	$485.04	"$1,600.63"	"$1,616.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34200013	EAP	CPT® 79005		INIT HYPERTHYROID THERAPY NUC	BOTH IP/OP	"$2,958.00 "	"$2,188.92"	$51.14	"$2,390.40"	$314.37	$314.37	$246.41	$246.41	$247.80	$616.52	$155.69	$155.69	$161.68	$239.24	$616.45	$155.51	"$1,749.66"	"$1,749.66"	$238.10	$717.12	"$2,366.50"	"$2,390.40"	$330.81	$396.31	$330.81	$196.86	$51.14	$51.14	$475.69	$226.76	$0.00	$0.00	$0.00	$0.00
34200014	EAP	CPT® 77316		Brachyther Plan Simple	BOTH IP/OP	$904.00 	$668.96	$145.35	$730.40	$431.30	$431.30	$329.78	$329.78	$331.64	$188.42	$285.20	$285.20	$296.17	$324.60	$188.39	$210.99	$534.72	$534.72	$336.15	$219.12	$723.10	$730.40	$467.03	$569.27	$467.03	$177.21	$146.23	$146.23	$145.35	$320.14	$0.00	$0.00	$0.00	$0.00
34200015	EAP	CPT® 77317		Brachyther Plan Inter	BOTH IP/OP	"$1,196.00 "	$885.04	$191.61	$966.40	$561.87	$561.87	$329.78	$329.78	$331.64	$249.28	$371.63	$371.63	$385.93	$324.60	$249.25	$210.99	$707.43	$707.43	$336.15	$289.92	$956.74	$966.40	$467.03	$569.27	$467.03	$231.84	$191.61	$191.61	$192.31	$320.14	$0.00	$0.00	$0.00	$0.00
34200016	EAP	CPT® 79445		Nuclear Rx Intra-arterial	BOTH IP/OP	"$1,324.00 "	$979.76	$0.00	"$1,059.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.82	$262.82	$272.93	$0.00	$275.92	$0.00	$0.00	$0.00	$0.00	$317.76	"$1,048.61"	"$1,059.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34200017	EAP	CPT® 77770		Hdr Brachytx 1 Channel	BOTH IP/OP	"$4,521.00 "	"$3,345.54"	$236.63	"$3,653.60"	$733.58	$733.58	$690.83	$690.83	$694.72	$942.29	$554.68	$554.68	$576.02	$679.00	$942.18	$441.35	"$2,674.17"	"$2,674.17"	$742.70	"$1,096.08"	"$3,617.06"	"$3,653.60"	"$1,031.88"	"$1,145.32"	"$1,031.88"	$308.15	$236.63	$236.63	$727.07	$707.33	$0.00	$0.00	$0.00	$0.00
34200018	EAP	CPT® 77771		Hdr Brachytx 2-12 Channel	BOTH IP/OP	"$5,523.00 "	"$4,087.02"	$405.91	"$4,463.20"	"$1,366.38"	"$1,366.38"	$690.83	$690.83	$694.72	"$1,151.13"	"$1,010.25"	"$1,010.25"	"$1,049.10"	$679.00	"$1,150.99"	$441.35	"$3,266.85"	"$3,266.85"	$742.70	"$1,338.96"	"$4,418.57"	"$4,463.20"	"$1,031.88"	"$1,145.32"	"$1,031.88"	$573.41	$405.91	$405.91	$888.18	$707.33	$0.00	$0.00	$0.00	$0.00
34200019	EAP	CPT® 77772		Hdr Brachytx Over 12 Chan	BOTH IP/OP	"$6,877.00 "	"$5,088.98"	$0.00	"$6,877.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,594.37"	"$1,594.37"	"$1,655.69"	$0.00	"$1,433.17"	$0.00	$0.00	$0.00	$0.00	"$1,667.04"	"$5,501.23"	"$5,556.80"	$0.00	"$6,877.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34300001	EAP	HCPCS A9500		Tc-99m Sestambi/cardiolite Nu	BOTH IP/OP	$516.00 	$381.84	$0.00	$412.80	$0.00	$0.00	$0.00	$0.00	$0.00	$107.55	$0.00	$0.00	$0.00	$0.00	$107.53	$0.00	$305.21	$305.21	$0.00	$258.00	$408.67	$412.80	$0.00	$335.40	$0.00	$106.29	$0.00	$0.00	$82.15	$0.00	$0.00	$0.00	$0.00	$0.00
34300002	EAP	HCPCS A9502		Tetrofosmin Myoview Nuc	BOTH IP/OP	$812.00 	$600.88	$0.00	$649.60	$0.00	$0.00	$0.00	$0.00	$0.00	$155.45	$0.00	$0.00	$0.00	$0.00	$131.76	$0.00	$480.30	$480.30	$0.00	$406.00	$643.10	$649.60	$0.00	$527.80	$0.00	$125.46	$0.00	$0.00	$129.27	$0.00	$0.00	$0.00	$0.00	$0.00
34300003	EAP	HCPCS A9503		99mtc Mdp Nuc	BOTH IP/OP	$312.00 	$230.88	$0.00	$249.60	$0.00	$0.00	$0.00	$0.00	$0.00	$65.03	$0.00	$0.00	$0.00	$0.00	$65.02	$0.00	$184.55	$184.55	$0.00	$156.00	$247.10	$249.60	$0.00	$202.80	$0.00	$48.83	$0.00	$0.00	$49.67	$0.00	$0.00	$0.00	$0.00	$0.00
34300004	EAP	HCPCS A9505		Ti-201 Thallous Chloride Nuc	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$65.50	$103.75	$104.80	$0.00	$85.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34300005	EAP	HCPCS A9516		I-123 Iodine Capsule Nuc	BOTH IP/OP	"$2,008.00 "	"$1,485.92"	$0.00	"$1,606.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$418.52	$0.00	$0.00	$0.00	$0.00	$418.47	$0.00	"$1,187.73"	"$1,187.73"	$0.00	"$1,004.00"	"$1,590.34"	"$1,606.40"	$0.00	"$1,305.20"	$0.00	$314.25	$0.00	$0.00	$319.67	$0.00	$0.00	$0.00	$0.00	$0.00
34300006	EAP	HCPCS A9521		99mtc Ceretec-labld - Wbc	BOTH IP/OP	"$1,888.00 "	"$1,397.12"	$0.00	"$1,510.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.46	$0.00	$0.00	$0.00	$0.00	$944.00	"$1,495.30"	"$1,510.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34300007	EAP	HCPCS A9537		99mtc Hepat-biliary-unprep Nu	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.82	$0.00	$0.00	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00	$217.75	$0.00	$52.00	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
34300008	EAP	HCPCS A9539		99mtc Dtpa	BOTH IP/OP	$409.00 	$302.66	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.24	$0.00	$0.00	$0.00	$0.00	$167.50	$265.32	$268.00	$0.00	$265.85	$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
34300009	EAP	HCPCS A9540		99mtc Maauc	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.58	$0.00	$0.00	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$276.25	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
34300010	EAP	HCPCS A9541		Tc-99m S Colloid Nuc	BOTH IP/OP	$523.00 	$387.02	$0.00	$339.95	$0.00	$0.00	$0.00	$0.00	$0.00	$109.01	$0.00	$0.00	$0.00	$0.00	$108.99	$0.00	$309.35	$309.35	$0.00	$167.50	$265.32	$268.00	$0.00	$339.95	$0.00	$48.79	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
34300011	EAP	HCPCS A9521		99mtc Ceretec-bd	BOTH IP/OP	"$4,651.00 "	"$3,441.74"	$0.00	"$3,023.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$969.27	$0.00	$0.00	$0.00	$0.00	$404.50	$640.73	$647.20	$0.00	"$3,023.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34300016	EAP	HCPCS A9582		"I123-mibg,10 Mci"	BOTH IP/OP	"$10,753.00 "	"$7,957.22"	$0.00	"$8,288.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,288.41"	$0.00	"$2,240.93"	$0.00	$0.00	$0.00	$0.00	"$4,475.50"	"$7,089.19"	"$7,160.80"	$0.00	"$6,989.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34300020	EAP	HCPCS A9572		Indium In-111 Pentetreotide	BOTH IP/OP	"$12,489.00 "	"$9,241.86"	$0.00	"$8,117.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,602.71"	$0.00	$0.00	$0.00	$0.00	"$2,152.00"	"$3,408.77"	"$3,443.20"	$0.00	"$8,117.85"	$0.00	$673.58	$0.00	$0.00	$685.20	$0.00	$0.00	$0.00	$0.00	$0.00
34300021	EAP	HCPCS A9512		Technetiumtc-99m Pertechnetate	BOTH IP/OP	$227.00 	$167.98	$0.00	$181.60	$0.00	$0.00	$0.00	$0.00	$0.00	$47.31	$0.00	$0.00	$0.00	$0.00	$47.31	$0.00	$134.27	$134.27	$0.00	$113.50	$179.78	$181.60	$0.00	$147.55	$0.00	$35.53	$0.00	$0.00	$36.14	$0.00	$0.00	$0.00	$0.00	$0.00
34300024	EAP	CPT® A9520		"Lymphoseek, Diag, Up To 0.5mci"	BOTH IP/OP	"$1,571.00 "	"$1,162.54"	$0.00	"$1,021.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$327.44	$0.00	$0.00	$0.00	$0.00	$327.40	$0.00	$929.25	$929.25	$0.00	$414.00	$655.78	$662.40	$0.00	"$1,021.15"	$0.00	$129.58	$0.00	$0.00	$131.82	$0.00	$0.00	$0.00	$0.00	$0.00
34300025	EAP	HCPCS A9580		"Sodium Fluoride F-18, Diagnostic"	BOTH IP/OP	$312.00 	$230.88	$0.00	$249.60	$0.00	$0.00	$0.00	$0.00	$0.00	$65.03	$0.00	$0.00	$0.00	$0.00	$65.02	$0.00	$184.55	$184.55	$0.00	$156.00	$247.10	$249.60	$0.00	$202.80	$0.00	$48.83	$0.00	$0.00	$49.67	$0.00	$0.00	$0.00	$0.00	$0.00
34300026	EAP	HCPCS A9587		"Gallium Ga-68, Dotatate, Diagnostic"	BOTH IP/OP	"$8,000.00 "	"$5,920.00"	$0.00	"$6,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,166.40"	$0.00	"$1,667.20"	$0.00	$0.00	$0.00	$0.00	"$4,000.00"	"$6,336.00"	"$6,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34300027	EAP	HCPCS A9588		"Fluciclovine F-18, Diagnostic"	BOTH IP/OP	"$11,015.00 "	"$8,151.10"	$0.00	"$8,812.00"	"$5,981.15"	"$5,981.15"	$0.00	$0.00	$0.00	"$2,295.80"	"$4,181.12"	"$4,181.12"	"$8,490.36"	$0.00	"$2,295.53"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,507.50"	"$8,723.88"	"$8,812.00"	$0.00	"$7,159.75"	$0.00	"$1,723.85"	$0.00	$0.00	"$1,753.59"	$0.00	$0.00	$0.00	$0.00	$0.00
34300028	EAP	HCPCS A9584		"Iodine 1-123 Ioflupane, Diagnostic"	BOTH IP/OP	"$6,000.00 "	"$4,440.00"	$0.00	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,250.40"	$0.00	$0.00	$0.00	$0.00	"$3,000.00"	"$4,752.00"	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34300029	EAP	HCPCS A9587		"Gallium Ga-68, Dotatate, Diagnostic, 0.1 Millicurie"	BOTH IP/OP	$167.00 	$123.58	$0.00	$133.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.95	$123.95	$128.72	$0.00	$34.80	$0.00	$0.00	$0.00	$0.00	$83.50	$132.26	$133.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34400001	EAP	HCPCS A9527		"Iodine I-125, Sodium Iodide, Per Millicurie"	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$39.97	$39.97	$40.37	$43.14	$153.64	$153.64	$159.56	$26.73	$43.14	$17.37	$122.44	$122.44	$32.83	$103.50	$163.94	$165.60	$45.34	$134.55	$45.34	$32.40	$0.00	$0.00	$32.95	$31.27	$0.00	$0.00	$0.00	$0.00
35000001	EAP	CPT® 73200		Upp Ext Ct W/o Dye Bilat Ect	BOTH IP/OP	"$7,981.00 "	"$5,905.94"	$67.89	"$6,436.80"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	"$1,663.44"	$785.72	$785.72	$815.94	$104.44	"$1,663.24"	$67.89	"$1,106.00"	"$1,106.00"	$112.41	"$1,608.00"	"$6,372.43"	"$6,436.80"	$156.18	$540.00	$156.18	"$1,259.20"	$130.02	$130.02	"$1,280.92"	$107.06	$0.00	$0.00	$0.00	$0.00
35000002	EAP	CPT® 73201		Upp Ext Ct W/dye Bilat Ect	BOTH IP/OP	"$8,891.00 "	"$6,579.34"	$166.40	"$7,170.40"	"$1,404.90"	"$1,404.90"	$358.61	$358.61	$360.63	"$1,853.11"	$785.72	$785.72	$815.94	$352.81	"$1,852.88"	$229.33	"$1,106.00"	"$1,106.00"	$387.01	$774.00	"$7,098.70"	"$7,170.40"	$537.70	$540.00	$537.70	"$1,402.71"	$166.40	$166.40	"$1,426.91"	$368.58	$0.00	$0.00	$0.00	$0.00
35000003	EAP	CPT® 73202		Upp Ext Ct W&wo Dye Bilat Ect	BOTH IP/OP	"$9,863.00 "	"$7,298.62"	$0.00	"$7,954.40"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,055.45"	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$923.00	"$7,874.86"	"$7,954.40"	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000005	EAP	CPT® 73700		LOW EXT CT W/O DYE RT ECT	BOTH IP/OP	"$3,488.00 "	"$2,581.12"	$0.00	"$2,790.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$787.01	$0.00	$0.00	$0.00	$104.44	$786.92	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$2,762.50"	"$2,790.40"	$156.18	$0.00	$156.18	$545.87	$105.89	$105.89	$555.29	$107.06	$0.00	$0.00	$0.00	$0.00
35000006	EAP	CPT® 73701		LOW EXT CT W/DYE RT ECT	BOTH IP/OP	"$4,789.00 "	"$3,543.86"	$0.00	"$3,831.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,080.68"	$0.00	$0.00	$0.00	$171.13	"$1,080.55"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,149.36"	"$3,792.89"	"$3,831.20"	$281.11	$0.00	$281.11	$749.48	$137.23	$137.23	$762.41	$192.70	$0.00	$0.00	$0.00	$0.00
35000007	EAP	CPT® 73702		LOW EXT CT W&WO DYE LT ECT	BOTH IP/OP	"$6,038.00 "	"$4,468.12"	$0.00	"$4,461.60"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,258.32"	$0.00	"$1,106.00"	"$1,106.00"	$202.33	$923.00	"$4,416.98"	"$4,461.60"	$281.11	$540.00	$281.11	$872.80	$174.32	$174.32	$887.86	$192.70	$0.00	$0.00	$0.00	$0.00
35000009	EAP	CPT® 75635		ABD AORTA&ILLIOFEMORAL CTA ECT	BOTH IP/OP	"$6,653.00 "	"$4,923.22"	$111.23	"$4,927.20"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,386.65"	$785.72	$785.72	$815.94	$171.13	"$1,386.49"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$4,877.93"	"$4,927.20"	$281.11	$540.00	$281.11	$963.88	$329.20	$329.20	$980.51	$192.70	$0.00	$0.00	$0.00	$0.00
35000010	EAP	CPT® 76376		3drendering W/o Postprocess	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,626.40"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$458.54	$785.72	$785.72	$815.94	$0.00	$458.48	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$487.92	"$1,610.14"	"$1,626.40"	$0.00	$540.00	$0.00	$318.16	$13.33	$13.33	$323.65	$0.00	$0.00	$0.00	$0.00	$0.00
35000011	EAP	CPT® 76377		3d Rendering W/postprocess	BOTH IP/OP	"$4,133.00 "	"$3,058.42"	$0.00	"$3,056.00"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$861.42	$785.72	$785.72	$815.94	$0.00	$861.32	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$916.80	"$3,025.44"	"$3,056.00"	$0.00	$540.00	$0.00	$597.83	$32.41	$32.41	$608.14	$0.00	$0.00	$0.00	$0.00	$0.00
35000013	EAP	CPT® 77011		CT GUIDED STEREOTAT LOC NCT	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,404.90"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.49	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$414.00	"$1,366.20"	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000014	EAP	CPT® 77012		CT GUIDANCE NEEDLE PLC BCT	BOTH IP/OP	"$2,365.00 "	"$1,750.10"	$0.00	"$1,911.20"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$492.93	$785.72	$785.72	$815.94	$0.00	$492.87	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$573.36	"$1,892.09"	"$1,911.20"	$0.00	$540.00	$0.00	$373.88	$77.80	$77.80	$380.33	$0.00	$0.00	$0.00	$0.00	$0.00
35000015	EAP	CPT® 77013		"Ct, Visceral Tissue Ablation"	BOTH IP/OP	"$2,734.00 "	"$2,023.16"	$0.00	"$2,209.60"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$569.83	$0.00	$0.00	$0.00	$0.00	$569.77	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$662.88	"$2,187.50"	"$2,209.60"	$0.00	$540.00	$0.00	$432.25	$0.00	$0.00	$439.71	$0.00	$0.00	$0.00	$0.00	$0.00
35000104	EAP	CPT® 73206		Upp Ext Cta W&wo Dye Rt Ect	BOTH IP/OP	"$3,509.00 "	"$2,596.66"	$111.23	"$2,829.60"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	$731.36	$785.72	$785.72	$815.94	$171.13	$731.28	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$2,801.30"	"$2,829.60"	$281.11	$540.00	$281.11	$553.54	$241.31	$241.31	$563.09	$192.70	$0.00	$0.00	$0.00	$0.00
35000108	EAP	CPT® 20982		Ablation Bone Tumor Perc W/img	BOTH IP/OP	"$13,275.00 "	"$9,823.50"	$0.00	"$9,956.00"	"$2,321.55"	"$2,321.55"	"$6,099.77"	"$6,099.77"	"$6,134.13"	"$2,766.84"	$0.00	$0.00	$0.00	"$6,004.45"	"$2,766.51"	"$3,902.89"	"$4,877.00"	"$4,877.00"	$0.00	"$5,452.00"	"$9,856.44"	"$9,956.00"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000202	EAP	CPT® 73201		Upp Ext Ct W/dye Lt/rt Ect	BOTH IP/OP	"$4,446.00 "	"$3,290.04"	$166.40	"$3,585.60"	"$1,404.90"	"$1,404.90"	$358.61	$358.61	$360.63	$926.66	$785.72	$785.72	$815.94	$352.81	$926.55	$229.33	"$1,106.00"	"$1,106.00"	$387.01	$774.00	"$3,549.74"	"$3,585.60"	$537.70	$540.00	$537.70	$701.43	$166.40	$166.40	$713.53	$368.58	$0.00	$0.00	$0.00	$0.00
35000303	EAP	CPT® 73202		Upp Ext Ct W&wo Dye Lt/rt Ect	BOTH IP/OP	"$4,933.00 "	"$3,650.42"	$0.00	"$3,978.40"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,028.04"	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$923.00	"$3,938.62"	"$3,978.40"	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000305	EAP	CPT® 75571		Ct Hrt W/o Dye W/ca Test	BOTH IP/OP	$125.00 	$92.50	$19.72	$540.00	$125.00	$125.00	$78.77	$78.77	$79.21	$84.41	$125.00	$125.00	$125.00	$77.54	$84.40	$50.40	$405.00	$405.00	$80.04	$30.24	$99.79	$100.80	$111.21	$540.00	$111.21	$19.72	$76.72	$76.72	$20.06	$76.23	$0.00	$0.00	$0.00	$0.00
35000306	EAP	CPT® 75572		Ct Hrt W/3d Image	BOTH IP/OP	"$1,534.00 "	"$1,135.16"	$0.00	"$1,404.90"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.69	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$372.00	"$1,227.60"	"$1,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000307	EAP	CPT® 75573		"Ct Hrt W/3d Image, Congen"	BOTH IP/OP	"$1,268.00 "	$938.32	$0.00	"$1,268.00"	"$1,268.00"	"$1,268.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.25	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$307.44	"$1,014.55"	"$1,024.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000308	EAP	CPT® 75574		Ct Angio Hrt W/3d Image	BOTH IP/OP	"$2,297.00 "	"$1,699.78"	$111.23	"$1,701.60"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	$478.75	$785.72	$785.72	$815.94	$171.13	$478.69	$111.23	"$1,106.00"	"$1,106.00"	$202.33	$510.48	"$1,684.58"	"$1,701.60"	$281.11	$540.00	$281.11	$332.88	$244.20	$244.20	$338.62	$192.70	$0.00	$0.00	$0.00	$0.00
35000309	EAP	CPT® 75571		Ct Heart W/o Dye;qual Calc Oct	BOTH IP/OP	$125.00 	$92.50	$19.72	$540.00	$125.00	$125.00	$78.77	$78.77	$79.21	$26.05	$125.00	$125.00	$125.00	$77.54	$26.05	$50.40	$125.00	$125.00	$80.04	$30.24	$99.79	$100.80	$111.21	$540.00	$111.21	$19.72	$76.72	$76.72	$20.06	$76.23	$0.00	$0.00	$0.00	$0.00
35000311	EAP	CPT® 73700		Low Ext Ct W/o Dye Bilat Ect	BOTH IP/OP	"$6,983.00 "	"$5,167.42"	$67.89	"$5,586.40"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	"$1,455.43"	$785.72	$785.72	$815.94	$104.44	"$1,455.26"	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$5,530.54"	"$5,586.40"	$156.18	$540.00	$156.18	"$1,092.84"	$105.89	$105.89	"$1,111.69"	$107.06	$0.00	$0.00	$0.00	$0.00
35000312	EAP	CPT® 73701		Low Ext Ct W/dye Bilat Ect	BOTH IP/OP	"$9,578.00 "	"$7,087.72"	$111.23	"$7,662.40"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,996.29"	$785.72	$785.72	$815.94	$171.13	"$1,996.06"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$2,298.72"	"$7,585.78"	"$7,662.40"	$281.11	$540.00	$281.11	"$1,498.96"	$137.23	$137.23	"$1,524.82"	$192.70	$0.00	$0.00	$0.00	$0.00
35000313	EAP	CPT® 73702		Low Ext Ct W&wo Dye Bilat Ect	BOTH IP/OP	"$11,163.00 "	"$8,260.62"	$0.00	"$8,930.40"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,326.37"	$0.00	"$1,106.00"	"$1,106.00"	$202.33	$923.00	"$8,841.10"	"$8,930.40"	$281.11	$540.00	$281.11	"$1,747.01"	$174.32	$174.32	"$1,777.15"	$192.70	$0.00	$0.00	$0.00	$0.00
35000314	EAP	CPT® 73706		Low Ext Cta W&wo Dye Bilat Ect	BOTH IP/OP	"$12,088.00 "	"$8,945.12"	$111.23	"$9,670.40"	$726.00	$726.00	$173.95	$173.95	$174.93	"$2,519.44"	$785.72	$785.72	$815.94	$171.13	"$2,519.14"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$9,573.70"	"$9,670.40"	$281.11	$540.00	$281.11	"$1,891.77"	$264.37	$264.37	"$1,924.41"	$192.70	$0.00	$0.00	$0.00	$0.00
35000315	EAP	CPT® 73206		Upp Ext Cta W&wo Dye Bilat Ect	BOTH IP/OP	"$7,023.00 "	"$5,197.02"	$111.23	"$5,664.00"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,463.77"	$785.72	$785.72	$815.94	$171.13	"$1,463.59"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$5,607.36"	"$5,664.00"	$281.11	$540.00	$281.11	"$1,108.02"	$241.31	$241.31	"$1,127.14"	$192.70	$0.00	$0.00	$0.00	$0.00
35000352	EAP	CPT® 74176		"Ct, Abd And Pelvis W/o Contrast"	BOTH IP/OP	"$7,437.00 "	"$5,503.38"	$113.81	"$5,508.00"	"$1,404.90"	"$1,404.90"	$224.08	$224.08	$225.34	"$1,550.06"	$785.72	$785.72	$815.94	$220.56	"$1,549.87"	$143.36	"$1,106.00"	"$1,106.00"	$233.72	"$1,652.40"	"$5,452.92"	"$5,508.00"	$324.73	$540.00	$324.73	"$1,077.50"	$113.81	$113.81	"$1,096.09"	$222.60	$0.00	$0.00	$0.00	$0.00
35000353	EAP	CPT® 74177		"Ct, Abd And Pelvis W/contrast"	BOTH IP/OP	"$10,201.00 "	"$7,548.74"	$229.33	"$7,555.20"	"$1,404.90"	"$1,404.90"	$358.61	$358.61	$360.63	"$2,126.14"	$785.72	$785.72	$815.94	$352.81	"$2,125.89"	$229.33	"$1,106.00"	"$1,106.00"	$387.01	"$2,266.56"	"$7,479.65"	"$7,555.20"	$537.70	$540.00	$537.70	"$1,477.99"	$238.43	$238.43	"$1,503.48"	$368.58	$0.00	$0.00	$0.00	$0.00
35000354	EAP	CPT® 37220		Iliac Revasc	BOTH IP/OP	"$11,190.00 "	"$8,280.60"	$0.00	"$8,497.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,332.00"	$0.00	$0.00	$0.00	$0.00	"$4,975.00"	"$8,412.62"	"$8,497.60"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000355	EAP	CPT® 37221		Iliac Revasc W/stent	BOTH IP/OP	"$32,950.00 "	"$24,383.00"	$0.00	"$25,023.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,866.78"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$24,772.97"	"$25,023.20"	$0.00	"$5,164.00"	$0.00	"$4,457.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000356	EAP	CPT® 37222		Iliac Revasc Add-on	BOTH IP/OP	"$27,325.00 "	"$20,220.50"	$0.00	"$25,023.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,694.53"	$0.00	$0.00	$0.00	$0.00	"$15,639.50"	"$24,772.97"	"$25,023.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000357	EAP	CPT® 37223		Iliac Revasc W/stent Add-on	BOTH IP/OP	"$32,950.00 "	"$24,383.00"	$0.00	"$25,023.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,866.78"	$0.00	$0.00	$0.00	$0.00	"$15,639.50"	"$24,772.97"	"$25,023.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000358	EAP	CPT® 37224		Fem/popl Revas W/tla	BOTH IP/OP	"$21,928.00 "	"$16,226.72"	$0.00	"$17,203.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,569.80"	$0.00	$0.00	$0.00	"$4,968.47"	"$4,975.00"	"$17,031.17"	"$17,203.20"	"$6,903.03"	"$4,334.00"	"$6,903.03"	"$3,623.42"	$466.92	$466.92	"$3,423.44"	"$4,731.88"	$0.00	$0.00	$0.00	$0.00
35000359	EAP	CPT® 37225		Fem/popl Revas W/ather	BOTH IP/OP	"$46,544.00 "	"$34,442.56"	$0.00	"$36,515.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,699.77"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$36,150.05"	"$36,515.20"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000360	EAP	CPT® 37226		Fem/popl Revasc W/stent	BOTH IP/OP	"$46,544.00 "	"$34,442.56"	$0.00	"$36,515.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,699.77"	$0.00	$0.00	$0.00	"$9,937.60"	"$6,105.00"	"$36,150.05"	"$36,515.20"	"$13,806.97"	"$5,164.00"	"$13,806.97"	"$7,751.33"	$545.88	$545.88	"$7,266.52"	"$9,464.38"	$0.00	$0.00	$0.00	$0.00
35000361	EAP	CPT® 37227		Fem/popl Revasc Stnt & Ather	BOTH IP/OP	"$80,612.00 "	"$59,652.88"	$0.00	"$63,242.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,799.54"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$62,609.98"	"$63,242.40"	$0.00	"$5,343.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000362	EAP	CPT® 37228		Tib/per Revasc W/tla	BOTH IP/OP	"$21,928.00 "	"$16,226.72"	$0.00	"$17,203.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,569.80"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$17,031.17"	"$17,203.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000363	EAP	CPT® 37229		Tib/per Revasc W/ather	BOTH IP/OP	"$41,457.00 "	"$30,678.18"	$0.00	"$36,515.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,639.64"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$36,150.05"	"$36,515.20"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000364	EAP	CPT® 37230		Tib/per Revasc W/stent	BOTH IP/OP	"$46,544.00 "	"$34,442.56"	$0.00	"$36,515.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,699.77"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$36,150.05"	"$36,515.20"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000365	EAP	CPT® 37231		Tib/per Revasc Stent & Ather	BOTH IP/OP	"$62,684.00 "	"$46,386.16"	$0.00	"$49,177.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$13,063.35"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$48,685.82"	"$49,177.60"	$0.00	"$5,343.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000366	EAP	CPT® 37232		Tib/per Revasc Add-on	BOTH IP/OP	"$19,531.00 "	"$14,452.94"	$0.00	"$17,203.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,070.26"	$0.00	$0.00	$0.00	$0.00	"$10,752.00"	"$17,031.17"	"$17,203.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000367	EAP	CPT® 37233		Tibper Revasc W/ather Add-on	BOTH IP/OP	"$41,457.00 "	"$30,678.18"	$0.00	"$36,515.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,639.64"	$0.00	$0.00	$0.00	$0.00	"$22,822.00"	"$36,150.05"	"$36,515.20"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000368	EAP	CPT® 37234		Revsc Opn/prq Tib/pero Stent	BOTH IP/OP	"$19,531.00 "	"$14,452.94"	$0.00	"$17,203.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,070.26"	$0.00	$0.00	$0.00	$0.00	"$10,752.00"	"$17,031.17"	"$17,203.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000369	EAP	CPT® 37235		Tib/per Revasc Stnt & Ather	BOTH IP/OP	"$19,531.00 "	"$14,452.94"	$0.00	"$17,203.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,070.26"	$0.00	$0.00	$0.00	$0.00	"$10,752.00"	"$17,031.17"	"$17,203.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35000381	EAP	CPT® 74178		"Ct, Abd And Pelvis W&w/o Contrast"	BOTH IP/OP	"$11,888.00 "	"$8,797.12"	$229.33	"$8,804.80"	"$1,404.90"	"$1,404.90"	$358.61	$358.61	$360.63	"$2,477.76"	$785.72	$785.72	$815.94	$352.81	"$2,477.46"	$229.33	"$1,106.00"	"$1,106.00"	$387.01	"$2,641.44"	"$8,716.75"	"$8,804.80"	$537.70	$540.00	$537.70	"$1,722.44"	$270.49	$270.49	"$1,752.16"	$368.58	$0.00	$0.00	$0.00	$0.00
35100001	EAP	CPT® 70450		HEAD/BRAIN CT W/O DYE ECT	BOTH IP/OP	"$4,085.00 "	"$3,022.90"	$67.89	"$2,971.20"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$851.42	$785.72	$785.72	$815.94	$104.44	$851.31	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$2,941.49"	"$2,971.20"	$156.18	$540.00	$156.18	$581.24	$73.47	$73.47	$591.27	$107.06	$0.00	$0.00	$0.00	$0.00
35100002	EAP	CPT® 70460		HEAD/BRAIN CT W/ DYE ECT	BOTH IP/OP	"$5,603.00 "	"$4,146.22"	$107.69	"$4,075.20"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,167.81"	$785.72	$785.72	$815.94	$171.13	"$1,167.67"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	$774.00	"$4,034.45"	"$4,075.20"	$281.11	$540.00	$281.11	$797.21	$107.69	$107.69	$810.96	$192.70	$0.00	$0.00	$0.00	$0.00
35100003	EAP	CPT® 70470		HEAD/BRAIN CT W&WO DYE ECT	BOTH IP/OP	"$6,525.00 "	"$4,828.50"	$0.00	"$4,746.40"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	$0.00	$785.72	$785.72	$815.94	$0.00	"$1,359.81"	$0.00	"$1,106.00"	"$1,106.00"	$202.33	$923.00	"$4,698.94"	"$4,746.40"	$281.11	$540.00	$281.11	$928.51	$128.94	$128.94	$944.53	$192.70	$0.00	$0.00	$0.00	$0.00
35100004	EAP	CPT® 70480		ORBIT/SELLA/EAR W/O DYE ECT	BOTH IP/OP	"$4,725.00 "	"$3,496.50"	$67.89	"$3,489.60"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$984.81	$785.72	$785.72	$815.94	$104.44	$984.69	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$3,454.70"	"$3,489.60"	$156.18	$540.00	$156.18	$682.65	$137.95	$137.95	$694.43	$107.06	$0.00	$0.00	$0.00	$0.00
35100005	EAP	CPT® 70481		ORBIT/SELLA/EAR W/DYE ECT	BOTH IP/OP	"$6,480.00 "	"$4,795.20"	$111.23	"$4,785.60"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,350.59"	$785.72	$785.72	$815.94	$171.13	"$1,350.43"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	$774.00	"$4,737.74"	"$4,785.60"	$281.11	$540.00	$281.11	$936.18	$168.92	$168.92	$952.33	$192.70	$0.00	$0.00	$0.00	$0.00
35100006	EAP	CPT® 70482		ORB/SELLA/EAR W&WO DYE ECT	BOTH IP/OP	"$7,547.00 "	"$5,584.78"	$0.00	"$5,573.60"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,572.98"	$785.72	$785.72	$815.94	$171.13	"$1,572.79"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	$923.00	"$5,517.86"	"$5,573.60"	$281.11	$540.00	$281.11	$0.00	$186.57	$186.57	"$1,109.15"	$192.70	$0.00	$0.00	$0.00	$0.00
35100007	EAP	CPT® 70486		MAXILLOFAC CT W/O DYE ECT	BOTH IP/OP	"$4,725.00 "	"$3,496.50"	$67.89	"$3,489.60"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$984.81	$785.72	$785.72	$815.94	$104.44	$984.69	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$3,454.70"	"$3,489.60"	$156.18	$540.00	$156.18	$682.65	$97.25	$97.25	$694.43	$107.06	$0.00	$0.00	$0.00	$0.00
35100008	EAP	CPT® 70487		MAXILLOFAC CT W/DYE ECT	BOTH IP/OP	"$6,480.00 "	"$4,795.20"	$111.23	"$4,785.60"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,350.59"	$785.72	$785.72	$815.94	$171.13	"$1,350.43"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	$774.00	"$4,737.74"	"$4,785.60"	$281.11	$540.00	$281.11	$936.18	$111.65	$111.65	$952.33	$192.70	$0.00	$0.00	$0.00	$0.00
35100009	EAP	CPT® 70488		MAXILLOFAC CT W&WO DYE ECT	BOTH IP/OP	"$7,547.00 "	"$5,584.78"	$0.00	"$5,573.60"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	$0.00	$785.72	$785.72	$815.94	$0.00	"$1,572.79"	$0.00	"$1,106.00"	"$1,106.00"	$202.33	$923.00	"$5,517.86"	"$5,573.60"	$281.11	$540.00	$281.11	"$1,090.34"	$141.55	$141.55	"$1,109.15"	$192.70	$0.00	$0.00	$0.00	$0.00
35100010	EAP	CPT® 70490		SOFT TISS NECK CT W/O DYE ECT	BOTH IP/OP	"$3,955.00 "	"$2,926.70"	$67.89	"$2,877.60"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$824.32	$785.72	$785.72	$815.94	$104.44	$824.22	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$2,848.82"	"$2,877.60"	$156.18	$540.00	$156.18	$562.93	$101.21	$101.21	$572.64	$107.06	$0.00	$0.00	$0.00	$0.00
35100011	EAP	CPT® 70491		SOFT TISS NECK CT W/DYE ECT	BOTH IP/OP	"$5,424.00 "	"$4,013.76"	$111.23	"$3,946.40"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,130.50"	$785.72	$785.72	$815.94	$171.13	"$1,130.36"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	$774.00	"$3,906.94"	"$3,946.40"	$281.11	$540.00	$281.11	$772.01	$134.70	$134.70	$785.33	$192.70	$0.00	$0.00	$0.00	$0.00
35100012	EAP	CPT® 70492		SOFT TISS NECK CT W&WO DYE ECT	BOTH IP/OP	"$6,319.00 "	"$4,676.06"	$111.23	"$4,597.60"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,317.04"	$785.72	$785.72	$815.94	$171.13	"$1,316.88"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	$923.00	"$4,551.62"	"$4,597.60"	$281.11	$540.00	$281.11	$899.41	$164.96	$164.96	$914.92	$192.70	$0.00	$0.00	$0.00	$0.00
35100013	EAP	CPT® 70496		HEAD CTA W & W/O DYE ECT	BOTH IP/OP	"$6,849.00 "	"$5,068.26"	$111.23	"$4,983.20"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,427.50"	$785.72	$785.72	$815.94	$171.13	"$1,427.33"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$4,933.37"	"$4,983.20"	$281.11	$540.00	$281.11	$974.84	$211.42	$211.42	$991.66	$192.70	$0.00	$0.00	$0.00	$0.00
35100014	EAP	CPT® 70498		NECK CTA W & W/O DYE ECT	BOTH IP/OP	"$6,849.00 "	"$5,068.26"	$111.23	"$4,983.20"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,427.50"	$785.72	$785.72	$815.94	$171.13	"$1,427.33"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$4,933.37"	"$4,983.20"	$281.11	$540.00	$281.11	$974.84	$211.06	$211.06	$991.66	$192.70	$0.00	$0.00	$0.00	$0.00
35100015	EAP	CPT® 0042T		"BRAIN PERFUSION W/CONT CT, ECT"	BOTH IP/OP	"$6,102.00 "	"$4,515.48"	$0.00	"$4,438.40"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	"$1,271.81"	$785.72	$785.72	$815.94	$0.00	"$1,271.66"	$0.00	"$1,106.00"	"$1,106.00"	$0.00	"$2,774.00"	"$4,394.02"	"$4,438.40"	$0.00	$540.00	$0.00	$868.26	$0.00	$0.00	$883.24	$0.00	$0.00	$0.00	$0.00	$0.00
35200001	EAP	CPT® 71250		THORAX CT W/O DYE BCT	BOTH IP/OP	"$3,675.00 "	"$2,719.50"	$67.89	"$2,723.20"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$765.96	$785.72	$785.72	$815.94	$104.44	$765.87	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$816.96	"$2,695.97"	"$2,723.20"	$156.18	$540.00	$156.18	$532.73	$101.21	$101.21	$541.92	$107.06	$0.00	$0.00	$0.00	$0.00
35200002	EAP	CPT® 71260		THORAX CT W/DYE BCT	BOTH IP/OP	"$5,044.00 "	"$3,732.56"	$111.23	"$3,737.60"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,051.30"	$785.72	$785.72	$815.94	$171.13	"$1,051.17"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,121.28"	"$3,700.22"	"$3,737.60"	$281.11	$540.00	$281.11	$731.17	$135.06	$135.06	$743.78	$192.70	$0.00	$0.00	$0.00	$0.00
35200003	EAP	CPT® 71270		THORAX CT W&WO DYE BCT	BOTH IP/OP	"$5,874.00 "	"$4,346.76"	$0.00	"$4,352.80"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,224.29"	$785.72	$785.72	$815.94	$171.13	"$1,224.14"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,305.84"	"$4,309.27"	"$4,352.80"	$281.11	$540.00	$281.11	$0.00	$164.96	$164.96	$866.21	$192.70	$0.00	$0.00	$0.00	$0.00
35200004	EAP	CPT® 71275		THORAX CTA W&WO DYE BCT	BOTH IP/OP	"$6,367.00 "	"$4,711.58"	$111.23	"$4,718.40"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,327.04"	$785.72	$785.72	$815.94	$171.13	"$1,326.88"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,415.52"	"$4,671.22"	"$4,718.40"	$281.11	$540.00	$281.11	$923.04	$214.30	$214.30	$938.96	$192.70	$0.00	$0.00	$0.00	$0.00
35200005	EAP	CPT® 72125		CERVICAL SPINE CT W/O DYE ECT	BOTH IP/OP	"$7,128.00 "	"$5,274.72"	$67.89	"$5,184.00"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	"$1,485.65"	$785.72	$785.72	$815.94	$104.44	"$1,485.48"	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$5,132.16"	"$5,184.00"	$156.18	$540.00	$156.18	"$1,014.12"	$106.61	$106.61	"$1,031.62"	$107.06	$0.00	$0.00	$0.00	$0.00
35200006	EAP	CPT® 72126		CERVICAL SPINE CT W/DYE ECT	BOTH IP/OP	"$9,771.00 "	"$7,230.54"	$0.00	"$7,106.40"	"$1,404.90"	"$1,404.90"	$358.61	$358.61	$360.63	"$2,036.52"	$785.72	$785.72	$815.94	$352.81	"$2,036.28"	$229.33	"$1,106.00"	"$1,106.00"	$387.01	$774.00	"$7,035.34"	"$7,106.40"	$537.70	$540.00	$537.70	$0.00	$135.78	$135.78	"$1,414.17"	$368.58	$0.00	$0.00	$0.00	$0.00
35200007	EAP	CPT® 72127		CERVICAL SPINE CT W&WO DYE ECT	BOTH IP/OP	"$10,974.00 "	"$8,120.76"	$0.00	"$7,980.80"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,286.98"	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$923.00	"$7,900.99"	"$7,980.80"	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35200008	EAP	CPT® 72128		THORACIC SPINE CT W/O DYE ECT	BOTH IP/OP	"$4,233.00 "	"$3,132.42"	$67.89	"$3,420.80"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$882.26	$785.72	$785.72	$815.94	$104.44	$882.16	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$3,386.59"	"$3,420.80"	$156.18	$540.00	$156.18	$669.19	$106.61	$106.61	$680.74	$107.06	$0.00	$0.00	$0.00	$0.00
35200009	EAP	CPT® 72129		THORACIC SPINE CT W/DYE ECT	BOTH IP/OP	"$5,804.00 "	"$4,294.96"	$0.00	"$4,690.40"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,209.55"	$0.00	"$1,106.00"	"$1,106.00"	$202.33	$774.00	"$4,643.50"	"$4,690.40"	$281.11	$540.00	$281.11	$917.56	$137.23	$137.23	$933.39	$192.70	$0.00	$0.00	$0.00	$0.00
35200010	EAP	CPT® 72130		THORACIC SPINE CT W&WO DYE ECT	BOTH IP/OP	"$6,518.00 "	"$4,823.32"	$0.00	"$5,267.20"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,358.35"	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$923.00	"$5,214.53"	"$5,267.20"	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35200011	EAP	CPT® 72131		LUMBAR SPINE CT W/O DYE ECT	BOTH IP/OP	"$3,544.00 "	"$2,622.56"	$67.89	"$2,864.00"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$738.66	$785.72	$785.72	$815.94	$104.44	$738.57	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$2,835.36"	"$2,864.00"	$156.18	$540.00	$156.18	$560.27	$105.89	$105.89	$569.94	$107.06	$0.00	$0.00	$0.00	$0.00
35200012	EAP	CPT® 72132		LUMBAR SPINE CT W/DYE ECT	BOTH IP/OP	"$4,861.00 "	"$3,597.14"	$0.00	"$3,928.00"	"$1,404.90"	"$1,404.90"	$358.61	$358.61	$360.63	"$1,013.15"	$785.72	$785.72	$815.94	$352.81	"$1,013.03"	$229.33	"$1,106.00"	"$1,106.00"	$0.00	$774.00	"$3,888.72"	"$3,928.00"	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35200013	EAP	CPT® 72133		LUMBAR SPINE CT W&WO DYE ECT	BOTH IP/OP	"$5,459.00 "	"$4,039.66"	$0.00	"$4,411.20"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,137.66"	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$923.00	"$4,367.09"	"$4,411.20"	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35200014	EAP	CPT® 72191		PELVIS CTA W&WO DYE BCT	BOTH IP/OP	"$6,137.00 "	"$4,541.38"	$0.00	"$4,959.20"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,279.10"	$785.72	$785.72	$815.94	$171.13	"$1,278.95"	$111.23	"$1,106.00"	"$1,106.00"	$0.00	"$1,048.00"	"$4,909.61"	"$4,959.20"	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35200015	EAP	CPT® 72192		ORTHO PELVIS CT W/O DYE BCT	BOTH IP/OP	"$4,157.00 "	"$3,076.18"	$67.89	"$3,111.20"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$866.42	$785.72	$785.72	$815.94	$104.44	$866.32	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$3,080.09"	"$3,111.20"	$156.18	$540.00	$156.18	$608.63	$91.84	$91.84	$619.13	$107.06	$0.00	$0.00	$0.00	$0.00
35200016	EAP	CPT® 72192		PELVIS CT W/O DYE BCT	BOTH IP/OP	"$3,889.00 "	"$2,877.86"	$0.00	"$3,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$866.42	$0.00	$0.00	$0.00	$104.44	$866.32	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$3,080.09"	"$3,111.20"	$156.18	$0.00	$156.18	$608.63	$91.84	$91.84	$619.13	$107.06	$0.00	$0.00	$0.00	$0.00
35200017	EAP	CPT® 72193		PELVIS CT W/DYE BCT	BOTH IP/OP	"$5,705.00 "	"$4,221.70"	$111.23	"$4,269.60"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,189.06"	$785.72	$785.72	$815.94	$171.13	"$1,188.92"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	$774.00	"$4,226.90"	"$4,269.60"	$281.11	$540.00	$281.11	$835.24	$186.21	$186.21	$849.65	$192.70	$0.00	$0.00	$0.00	$0.00
35200018	EAP	CPT® 72194		PELVIS CT W&WO DYE BCT	BOTH IP/OP	"$6,641.00 "	"$4,914.34"	$0.00	"$4,970.40"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	"$1,384.15"	$0.00	$0.00	$0.00	$171.13	"$1,383.98"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	$923.00	"$4,920.70"	"$4,970.40"	$281.11	$540.00	$281.11	$972.33	$213.58	$213.58	$989.11	$192.70	$0.00	$0.00	$0.00	$0.00
35200019	EAP	CPT® 73200		Upp Ext Ct W/o Dye Bilat Bct	BOTH IP/OP	"$7,981.00 "	"$5,905.94"	$67.89	"$6,436.80"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	"$1,663.44"	$785.72	$785.72	$815.94	$104.44	"$1,663.24"	$67.89	"$1,106.00"	"$1,106.00"	$112.41	"$1,608.00"	"$6,372.43"	"$6,436.80"	$156.18	$540.00	$156.18	"$1,259.20"	$130.02	$130.02	"$1,280.92"	$107.06	$0.00	$0.00	$0.00	$0.00
35200020	EAP	CPT® 73200		UPP EXT CT W/O DYE LT BCT	BOTH IP/OP	"$4,400.00 "	"$3,256.00"	$67.89	"$3,217.60"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$917.07	$785.72	$785.72	$815.94	$104.44	$916.96	$67.89	"$1,106.00"	"$1,106.00"	$112.41	"$1,608.00"	"$3,185.42"	"$3,217.60"	$156.18	$540.00	$156.18	$629.44	$130.02	$130.02	$640.30	$107.06	$0.00	$0.00	$0.00	$0.00
35200021	EAP	CPT® 73200		UPP EXT CT W/O DYE RT BCT	BOTH IP/OP	"$4,022.00 "	"$2,976.28"	$0.00	"$3,217.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$917.07	$0.00	$0.00	$0.00	$104.44	$916.96	$67.89	"$1,106.00"	"$1,106.00"	$112.41	"$1,608.00"	"$3,185.42"	"$3,217.60"	$156.18	$0.00	$156.18	$629.44	$130.02	$130.02	$640.30	$107.06	$0.00	$0.00	$0.00	$0.00
35200022	EAP	CPT® 73201		Upp Ext Ct W/dye Bilat Bct	BOTH IP/OP	"$8,891.00 "	"$6,579.34"	$166.40	"$7,170.40"	"$1,404.90"	"$1,404.90"	$358.61	$358.61	$360.63	"$1,853.11"	$785.72	$785.72	$815.94	$352.81	"$1,852.88"	$229.33	"$1,106.00"	"$1,106.00"	$387.01	$774.00	"$7,098.70"	"$7,170.40"	$537.70	$540.00	$537.70	"$1,402.71"	$166.40	$166.40	"$1,426.91"	$368.58	$0.00	$0.00	$0.00	$0.00
35200023	EAP	CPT® 73201		Upp Ext Ct W/dye Lt	BOTH IP/OP	"$4,904.00 "	"$3,628.96"	$166.40	"$3,585.60"	"$1,404.90"	"$1,404.90"	$358.61	$358.61	$360.63	"$1,022.12"	$785.72	$785.72	$815.94	$352.81	"$1,021.99"	$229.33	"$1,106.00"	"$1,106.00"	$387.01	$774.00	"$3,549.74"	"$3,585.60"	$537.70	$540.00	$537.70	$701.43	$166.40	$166.40	$713.53	$368.58	$0.00	$0.00	$0.00	$0.00
35200024	EAP	CPT® 73201		UPP EXT CT W/DYE RT BCT	BOTH IP/OP	"$4,482.00 "	"$3,316.68"	$0.00	"$3,585.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,022.12"	$0.00	$0.00	$0.00	$352.81	"$1,021.99"	$229.33	"$1,106.00"	"$1,106.00"	$387.01	$774.00	"$3,549.74"	"$3,585.60"	$537.70	$0.00	$537.70	$701.43	$166.40	$166.40	$713.53	$368.58	$0.00	$0.00	$0.00	$0.00
35200025	EAP	CPT® 73202		Upp Ext Ct W&wo Dye Bilat Bct	BOTH IP/OP	"$9,863.00 "	"$7,298.62"	$0.00	"$7,954.40"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,055.45"	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$923.00	"$7,874.86"	"$7,954.40"	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35200026	EAP	CPT® 73202		UPP EXT CT W&WO DYE LT BCT	BOTH IP/OP	"$4,933.00 "	"$3,650.42"	$0.00	"$3,978.40"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,028.04"	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$923.00	"$3,938.62"	"$3,978.40"	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35200027	EAP	CPT® 73202		UPP EXT CT W&WO DYE RT BCT	BOTH IP/OP	"$5,441.00 "	"$4,026.34"	$0.00	"$3,978.40"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.90"	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$923.00	"$3,938.62"	"$3,978.40"	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35200028	EAP	CPT® 73206		UPP EXT CTA W&WO DYE BILAT BCT	BOTH IP/OP	"$7,023.00 "	"$5,197.02"	$111.23	"$5,664.00"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,463.77"	$785.72	$785.72	$815.94	$171.13	"$1,463.59"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$5,607.36"	"$5,664.00"	$281.11	$540.00	$281.11	"$1,108.02"	$241.31	$241.31	"$1,127.14"	$192.70	$0.00	$0.00	$0.00	$0.00
35200029	EAP	CPT® 73206		UPP EXT CTA W&WO DYE LT BCT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$111.23	"$2,829.60"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	$806.60	$785.72	$785.72	$815.94	$171.13	$806.51	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$2,801.30"	"$2,829.60"	$281.11	$540.00	$281.11	$553.54	$241.31	$241.31	$563.09	$192.70	$0.00	$0.00	$0.00	$0.00
35200030	EAP	CPT® 73206		UPP EXT CTA W&WO DYE RT BCT	BOTH IP/OP	"$3,537.00 "	"$2,617.38"	$0.00	"$2,829.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$806.60	$0.00	$0.00	$0.00	$171.13	$806.51	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$2,801.30"	"$2,829.60"	$281.11	$0.00	$281.11	$553.54	$241.31	$241.31	$563.09	$192.70	$0.00	$0.00	$0.00	$0.00
35200031	EAP	CPT® 73700		Low Ext Ct W/o Dye Bilat Bct	BOTH IP/OP	"$6,983.00 "	"$5,167.42"	$67.89	"$5,586.40"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	"$1,455.43"	$785.72	$785.72	$815.94	$104.44	"$1,455.26"	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$5,530.54"	"$5,586.40"	$156.18	$540.00	$156.18	"$1,092.84"	$105.89	$105.89	"$1,111.69"	$107.06	$0.00	$0.00	$0.00	$0.00
35200032	EAP	CPT® 73700		LOW EXT CT W/O DYE LT BCT	BOTH IP/OP	"$3,776.00 "	"$2,794.24"	$67.89	"$2,790.40"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$787.01	$785.72	$785.72	$815.94	$104.44	$786.92	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$2,762.50"	"$2,790.40"	$156.18	$540.00	$156.18	$545.87	$105.89	$105.89	$555.29	$107.06	$0.00	$0.00	$0.00	$0.00
35200033	EAP	CPT® 73700		LOW EXT CT W/O DYE RT BCT	BOTH IP/OP	"$3,488.00 "	"$2,581.12"	$0.00	"$2,790.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$787.01	$0.00	$0.00	$0.00	$104.44	$786.92	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$2,762.50"	"$2,790.40"	$156.18	$0.00	$156.18	$545.87	$105.89	$105.89	$555.29	$107.06	$0.00	$0.00	$0.00	$0.00
35200034	EAP	CPT® 73701		Low Ext Ct W/dye Bilat Bct	BOTH IP/OP	"$9,578.00 "	"$7,087.72"	$111.23	"$7,662.40"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,996.29"	$785.72	$785.72	$815.94	$171.13	"$1,996.06"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$2,298.72"	"$7,585.78"	"$7,662.40"	$281.11	$540.00	$281.11	"$1,498.96"	$137.23	$137.23	"$1,524.82"	$192.70	$0.00	$0.00	$0.00	$0.00
35200035	EAP	CPT® 73701		LOW EXT CT W/DYE LT BCT	BOTH IP/OP	"$5,185.00 "	"$3,836.90"	$111.23	"$3,831.20"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,080.68"	$785.72	$785.72	$815.94	$171.13	"$1,080.55"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,149.36"	"$3,792.89"	"$3,831.20"	$281.11	$540.00	$281.11	$749.48	$137.23	$137.23	$762.41	$192.70	$0.00	$0.00	$0.00	$0.00
35200036	EAP	CPT® 73701		LOW EXT CT W/DYE RT BCT	BOTH IP/OP	"$4,789.00 "	"$3,543.86"	$0.00	"$3,831.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,080.68"	$0.00	$0.00	$0.00	$171.13	"$1,080.55"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,149.36"	"$3,792.89"	"$3,831.20"	$281.11	$0.00	$281.11	$749.48	$137.23	$137.23	$762.41	$192.70	$0.00	$0.00	$0.00	$0.00
35200037	EAP	CPT® 73702		Low Ext Ct W&wo Dye Bilat Bct	BOTH IP/OP	"$11,163.00 "	"$8,260.62"	$0.00	"$8,930.40"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,326.37"	$0.00	"$1,106.00"	"$1,106.00"	$202.33	$923.00	"$8,841.10"	"$8,930.40"	$281.11	$540.00	$281.11	"$1,747.01"	$174.32	$174.32	"$1,777.15"	$192.70	$0.00	$0.00	$0.00	$0.00
35200038	EAP	CPT® 73702		LOW EXT CT W&WO DYE LT BCT	BOTH IP/OP	"$5,577.00 "	"$4,126.98"	$0.00	"$4,461.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.33	$923.00	"$4,416.98"	"$4,461.60"	$281.11	$0.00	$281.11	$872.80	$174.32	$174.32	$887.86	$192.70	$0.00	$0.00	$0.00	$0.00
35200039	EAP	CPT® 73702		LOW EXT CT W&WO DYE RT BCT	BOTH IP/OP	"$6,038.00 "	"$4,468.12"	$0.00	"$4,461.60"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,258.32"	$0.00	"$1,106.00"	"$1,106.00"	$202.33	$923.00	"$4,416.98"	"$4,461.60"	$281.11	$540.00	$281.11	$872.80	$174.32	$174.32	$887.86	$192.70	$0.00	$0.00	$0.00	$0.00
35200040	EAP	CPT® 73706		Low Ext Cta W&wo Dye Bilat Bct	BOTH IP/OP	"$12,088.00 "	"$8,945.12"	$0.00	"$9,670.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,045.07"	$0.00	$0.00	$0.00	$171.13	"$2,044.82"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$9,573.70"	"$9,670.40"	$281.11	$0.00	$281.11	"$1,891.77"	$264.37	$264.37	"$1,924.41"	$192.70	$0.00	$0.00	$0.00	$0.00
35200041	EAP	CPT® 73706		LOW EXT CTA W&WO DYE LT BCT	BOTH IP/OP	"$6,541.00 "	"$4,840.34"	$111.23	"$4,833.60"	$726.00	$726.00	$173.95	$173.95	$174.93	"$1,363.31"	$785.72	$785.72	$815.94	$171.13	"$1,363.14"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$4,785.26"	"$4,833.60"	$281.11	$540.00	$281.11	$945.57	$264.37	$264.37	$961.89	$192.70	$0.00	$0.00	$0.00	$0.00
35200042	EAP	CPT® 73706		LOW EXT CTA W&WO DYE RT BCT	BOTH IP/OP	"$6,042.00 "	"$4,471.08"	$0.00	"$4,833.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,363.31"	$0.00	$0.00	$0.00	$171.13	"$1,363.14"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$4,785.26"	"$4,833.60"	$281.11	$0.00	$281.11	$945.57	$264.37	$264.37	$961.89	$192.70	$0.00	$0.00	$0.00	$0.00
35200043	EAP	CPT® 74150		ABDOMEN CT W/O DYE BCT	BOTH IP/OP	"$3,994.00 "	"$2,955.56"	$67.89	"$2,958.40"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$832.45	$785.72	$785.72	$815.94	$104.44	$832.35	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$2,928.82"	"$2,958.40"	$156.18	$540.00	$156.18	$578.74	$90.40	$90.40	$588.72	$107.06	$0.00	$0.00	$0.00	$0.00
35200044	EAP	CPT® 74150		ABDOMEN CT W/O DYE LIMITED BCT	BOTH IP/OP	"$3,661.00 "	"$2,709.14"	$67.89	"$2,958.40"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$763.04	$785.72	$785.72	$815.94	$104.44	$762.95	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$2,928.82"	"$2,958.40"	$156.18	$540.00	$156.18	$578.74	$90.40	$90.40	$588.72	$107.06	$0.00	$0.00	$0.00	$0.00
35200045	EAP	CPT® 74150		"Stone Protocol, Bct"	BOTH IP/OP	"$3,661.00 "	"$2,709.14"	$67.89	"$2,958.40"	"$1,404.90"	"$1,404.90"	$106.02	$106.02	$106.62	$763.04	$785.72	$785.72	$815.94	$104.44	$762.95	$67.89	"$1,106.00"	"$1,106.00"	$112.41	$566.00	"$2,928.82"	"$2,958.40"	$156.18	$540.00	$156.18	$578.74	$90.40	$90.40	$588.72	$107.06	$0.00	$0.00	$0.00	$0.00
35200046	EAP	CPT® 74160		ABDOMEN CT W/DYE BCT	BOTH IP/OP	"$5,483.00 "	"$4,057.42"	$111.23	"$4,060.80"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,142.79"	$785.72	$785.72	$815.94	$171.13	"$1,142.66"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	$774.00	"$4,020.19"	"$4,060.80"	$281.11	$540.00	$281.11	$794.39	$185.49	$185.49	$808.10	$192.70	$0.00	$0.00	$0.00	$0.00
35200047	EAP	CPT® 74160		ABDOMEN CT W/DYE LIMITED BCT	BOTH IP/OP	"$5,025.00 "	"$3,718.50"	$111.23	"$4,060.80"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,047.34"	$785.72	$785.72	$815.94	$171.13	"$1,047.21"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	$774.00	"$4,020.19"	"$4,060.80"	$281.11	$540.00	$281.11	$794.39	$185.49	$185.49	$808.10	$192.70	$0.00	$0.00	$0.00	$0.00
35200048	EAP	CPT® 74170		ABDOMEN CT W&WO DYE BCT	BOTH IP/OP	"$6,385.00 "	"$4,724.90"	$111.23	"$4,728.80"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,330.79"	$785.72	$785.72	$815.94	$171.13	"$1,330.63"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	$923.00	"$4,681.51"	"$4,728.80"	$281.11	$540.00	$281.11	$925.07	$211.06	$211.06	$941.03	$192.70	$0.00	$0.00	$0.00	$0.00
35200049	EAP	CPT® 74175		ABDOMEN CTA W&WO DYE BCT	BOTH IP/OP	"$6,919.00 "	"$5,120.06"	$111.23	"$5,124.80"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,442.09"	$785.72	$785.72	$815.94	$171.13	"$1,441.92"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$5,073.55"	"$5,124.80"	$281.11	$540.00	$281.11	"$1,002.54"	$235.19	$235.19	"$1,019.84"	$192.70	$0.00	$0.00	$0.00	$0.00
35200058	EAP	CPT® 75635		Abd Aorta&illiofemor Cta Bct	BOTH IP/OP	"$6,097.00 "	"$4,511.78"	$111.23	"$4,927.20"	"$1,404.90"	"$1,404.90"	$173.95	$173.95	$174.93	"$1,270.77"	$785.72	$785.72	$815.94	$171.13	"$1,270.61"	$111.23	"$1,106.00"	"$1,106.00"	$202.33	"$1,048.00"	"$4,877.93"	"$4,927.20"	$281.11	$540.00	$281.11	$963.88	$329.20	$329.20	$980.51	$192.70	$0.00	$0.00	$0.00	$0.00
35200059	EAP	CPT® 76380		FOLLOW UP STUDY CT LIMITED BCT	BOTH IP/OP	"$1,494.00 "	"$1,105.56"	$0.00	"$1,404.90"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.35	$0.00	"$1,106.00"	"$1,106.00"	$0.00	$358.56	"$1,183.25"	"$1,195.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35200060	EAP	CPT® 74174		"Cta, Abdomen And Pelvis, W Dye"	BOTH IP/OP	"$8,464.00 "	"$6,263.36"	$229.33	"$6,268.80"	"$1,404.90"	"$1,404.90"	$358.61	$358.61	$360.63	"$1,764.11"	$785.72	$785.72	$815.94	$352.81	"$1,763.90"	$229.33	"$1,106.00"	"$1,106.00"	$387.01	"$1,880.64"	"$6,206.11"	"$6,268.80"	$537.70	$540.00	$537.70	"$1,226.33"	$298.94	$298.94	"$1,247.49"	$368.58	$0.00	$0.00	$0.00	$0.00
35200063	EAP	HCPCS G0297		Low Dose Ct Scan For Lung	BOTH IP/OP	$632.00 	$467.68	$50.40	$632.00	$632.00	$632.00	$106.02	$106.02	$106.62	$131.72	$632.00	$632.00	$632.00	$77.54	$131.71	$50.40	$632.00	$632.00	$80.04	$313.50	$496.58	$501.60	$111.21	$540.00	$111.21	$98.13	$189.09	$189.09	$99.82	$76.23	$0.00	$0.00	$0.00	$0.00
36000003	EAP	CPT® 58611		Ligate Oviduct(s) Add-on	BOTH IP/OP	$499.00 	$369.26	$0.00	$475.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.99	$0.00	$0.00	$0.00	$0.00	$475.00	$376.20	$380.00	$0.00	$324.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000027	EAP	CPT® 19499		Breast Surgery Procedure Cbc	BOTH IP/OP	"$6,169.00 "	"$4,565.06"	$0.00	"$4,899.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,285.62"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,850.21"	"$4,899.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000028	EAP	Custom 36000028		L&d Level 1 1st 30 Min	BOTH IP/OP	"$1,771.00 "	"$1,310.54"	$0.00	"$1,243.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$369.08	$0.00	$0.00	$0.00	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00	"$1,243.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000029	EAP	Custom 36000029		L&d Level 2 1st 30 Min	BOTH IP/OP	"$2,152.00 "	"$1,592.48"	$0.00	"$1,510.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$448.48	$0.00	$0.00	$0.00	$0.00	$893.00	"$1,414.51"	"$1,428.80"	$0.00	"$1,510.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000038	EAP	Custom 36000038		L&d Level 3 1st 30 Min	BOTH IP/OP	"$2,404.00 "	"$1,778.96"	$0.00	"$1,687.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.99	$0.00	$0.00	$0.00	$0.00	$998.00	"$1,580.83"	"$1,596.80"	$0.00	"$1,687.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000039	EAP	Custom 36000039		L&d Level 4 1st 30 Min	BOTH IP/OP	"$2,657.00 "	"$1,966.18"	$0.00	"$1,865.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$553.72	$0.00	$0.00	$0.00	$0.00	"$1,103.00"	"$1,747.15"	"$1,764.80"	$0.00	"$1,865.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000040	EAP	Custom 36000040		L&d Level 5 1st 30 Min	BOTH IP/OP	"$1,957.00 "	"$1,448.18"	$0.00	"$1,932.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.84	$0.00	$0.00	$0.00	$0.00	"$1,208.00"	"$1,913.47"	"$1,932.80"	$0.00	"$1,374.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000042	EAP	Custom 36000042		L&d Level 6 1st 30 Min	BOTH IP/OP	"$3,163.00 "	"$2,340.62"	$0.00	"$2,220.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$659.17	$0.00	$0.00	$0.00	$0.00	"$1,313.00"	"$2,079.79"	"$2,100.80"	$0.00	"$2,220.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000043	EAP	Custom 36000043		L&d Level 1 Add 15 Min	BOTH IP/OP	$797.00 	$589.78	$0.00	$559.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.09	$0.00	$0.00	$0.00	$0.00	$331.00	$524.30	$529.60	$0.00	$559.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000044	EAP	Custom 36000044		L&d Level 2 Add 15 Min	BOTH IP/OP	$969.00 	$717.06	$0.00	$680.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.94	$0.00	$0.00	$0.00	$0.00	$402.00	$636.77	$643.20	$0.00	$680.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000045	EAP	Custom 36000045		L&d Level 3 Add 15 Min	BOTH IP/OP	"$1,081.00 "	$799.94	$0.00	$759.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.28	$0.00	$0.00	$0.00	$0.00	$448.50	$710.42	$717.60	$0.00	$759.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000046	EAP	Custom 36000046		L&d Level 4 Add 15 Min	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$839.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$496.00	$785.66	$793.60	$0.00	$839.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000047	EAP	Custom 36000047		L&d Level 5 Add 15 Min	BOTH IP/OP	$881.00 	$651.94	$0.00	$870.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.60	$0.00	$0.00	$0.00	$0.00	$544.00	$861.70	$870.40	$0.00	$618.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000048	EAP	Custom 36000048		L&d Level 6 Add 15 Min	BOTH IP/OP	"$1,422.00 "	"$1,052.28"	$0.00	$998.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.34	$0.00	$0.00	$0.00	$0.00	$590.50	$935.35	$944.80	$0.00	$998.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000110	EAP	Custom 36000110		Perfusionist	BOTH IP/OP	"$3,589.00 "	"$2,655.86"	$0.00	"$2,871.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$747.95	$0.00	$0.00	$0.00	$0.00	"$1,794.50"	"$2,842.49"	"$2,871.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000116	EAP	CPT® 36680		Placement Of A Needle For Intraosseous Infusion	BOTH IP/OP	$684.00 	$506.16	$0.00	$684.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.55	$0.00	$0.00	$0.00	$0.00	$582.00	$460.94	$465.60	$0.00	$684.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000117	EAP	Custom 36000117		Level 1 1st 30 Min	BOTH IP/OP	"$11,028.00 "	"$8,160.72"	$0.00	"$7,741.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,298.24"	$0.00	$0.00	$0.00	$0.00	"$4,578.50"	"$7,252.34"	"$7,325.60"	$0.00	"$7,741.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000118	EAP	Custom 36000118		Level 2 1st 30 Min	BOTH IP/OP	"$13,392.00 "	"$9,910.08"	$0.00	"$9,400.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,790.89"	$0.00	$0.00	$0.00	$0.00	"$5,560.00"	"$8,807.04"	"$8,896.00"	$0.00	"$9,400.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000119	EAP	Custom 36000119		Level 3 1st 30 Min	BOTH IP/OP	"$14,968.00 "	"$11,076.32"	$0.00	"$10,507.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,119.33"	$0.00	$0.00	$0.00	$0.00	"$6,214.00"	"$9,842.98"	"$9,942.40"	$0.00	"$10,507.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000120	EAP	Custom 36000120		Level 4 1st 30 Min	BOTH IP/OP	"$16,545.00 "	"$12,243.30"	$0.00	"$11,614.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,447.98"	$0.00	$0.00	$0.00	$0.00	"$6,869.00"	"$10,880.50"	"$10,990.40"	$0.00	"$11,614.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000121	EAP	Custom 36000121		Level 5 1st 30 Min	BOTH IP/OP	"$18,117.00 "	"$13,406.58"	$0.00	"$12,717.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,775.58"	$0.00	$0.00	$0.00	$0.00	"$7,521.50"	"$11,914.06"	"$12,034.40"	$0.00	"$12,717.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000122	EAP	Custom 36000122		Level 6 1st 30 Min	BOTH IP/OP	"$19,694.00 "	"$14,573.56"	$0.00	"$13,825.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,104.23"	$0.00	$0.00	$0.00	$0.00	"$8,176.00"	"$12,950.78"	"$13,081.60"	$0.00	"$13,825.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000123	EAP	Custom 36000123		Level 1 Add 15 Min	BOTH IP/OP	"$4,964.00 "	"$3,673.36"	$0.00	"$3,484.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,034.50"	$0.00	$0.00	$0.00	$0.00	"$2,061.00"	"$3,264.62"	"$3,297.60"	$0.00	"$3,484.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000124	EAP	Custom 36000124		Level 2 Add 15 Min	BOTH IP/OP	"$6,030.00 "	"$4,462.20"	$0.00	"$4,232.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,256.65"	$0.00	$0.00	$0.00	$0.00	"$2,503.50"	"$3,965.54"	"$4,005.60"	$0.00	"$4,232.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000125	EAP	Custom 36000125		Level 3 Add 15 Min	BOTH IP/OP	"$6,740.00 "	"$4,987.60"	$0.00	"$4,731.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,404.62"	$0.00	$0.00	$0.00	$0.00	"$2,798.00"	"$4,432.03"	"$4,476.80"	$0.00	"$4,731.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000126	EAP	Custom 36000126		Level 4 Add 15 Min	BOTH IP/OP	"$7,445.00 "	"$5,509.30"	$0.00	"$5,226.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,551.54"	$0.00	$0.00	$0.00	$0.00	"$3,091.00"	"$4,896.14"	"$4,945.60"	$0.00	"$5,226.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000127	EAP	Custom 36000127		Level 5 Add 15 Min	BOTH IP/OP	"$7,979.00 "	"$5,904.46"	$0.00	"$5,601.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,662.82"	$0.00	$0.00	$0.00	$0.00	"$3,312.50"	"$5,247.00"	"$5,300.00"	$0.00	"$5,601.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36000128	EAP	Custom 36000128		Level 6 Add 15 Min	BOTH IP/OP	"$8,864.00 "	"$6,559.36"	$0.00	"$6,222.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,847.26"	$0.00	$0.00	$0.00	$0.00	"$3,680.00"	"$5,829.12"	"$5,888.00"	$0.00	"$6,222.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100001	EAP	CPT® 10021		Fna Bx W/o Img Gdn 1st Les	BOTH IP/OP	"$1,308.00 "	$967.92	$0.00	"$1,521.00"	"$1,308.00"	"$1,308.00"	$336.60	$336.60	$338.49	$272.62	$0.00	$0.00	$0.00	$331.46	$272.59	$215.45	$113.00	$113.00	$320.45	"$1,317.00"	"$1,043.06"	"$1,053.60"	$445.22	"$1,521.00"	$445.22	$93.38	$57.69	$57.69	$209.67	$305.19	$0.00	$0.00	$0.00	$0.00
36100002	EAP	CPT® 69100		Biopsy Of External Ear	BOTH IP/OP	"$2,056.00 "	"$1,521.44"	$0.00	"$2,074.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$428.47	$0.00	$0.00	$0.00	$0.00	"$2,074.00"	"$1,642.61"	"$1,659.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100003	EAP	CPT® 22510		Percut Vertebroplasty Thor	BOTH IP/OP	"$7,794.00 "	"$5,767.56"	$0.00	"$6,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,624.27"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$6,172.85"	"$6,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100005	EAP	CPT® 22511		Percut Vertebroplasty Lumb	BOTH IP/OP	"$7,794.00 "	"$5,767.56"	$0.00	"$6,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,624.27"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$6,172.85"	"$6,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100006	EAP	CPT® 22512		Percut Vertebroplasty Add'l	BOTH IP/OP	"$7,794.00 "	"$5,767.56"	$0.00	"$6,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,624.27"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$6,172.85"	"$6,235.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100007	EAP	CPT® 22513		"Percut Kyphoplasty, Thor"	BOTH IP/OP	"$21,530.00 "	"$15,932.20"	$0.00	"$17,397.60"	"$2,984.10"	"$2,984.10"	"$6,099.77"	"$6,099.77"	"$6,134.13"	"$4,487.39"	$0.00	$0.00	$0.00	"$6,004.45"	"$4,486.85"	"$3,902.89"	"$4,877.00"	"$4,877.00"	$0.00	"$6,105.00"	"$17,223.62"	"$17,397.60"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100008	EAP	CPT® 10040		Acne Surgery	BOTH IP/OP	$568.00 	$420.32	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.37	$0.00	$0.00	$0.00	$0.00	$562.00	$445.10	$449.60	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100009	EAP	CPT® 10060		Drainage Abscess Simple/single	BOTH IP/OP	"$1,334.00 "	$987.16	$74.65	"$1,334.00"	"$1,334.00"	"$1,334.00"	$174.88	$174.88	$175.86	$278.04	"$1,257.08"	"$1,257.08"	"$1,305.43"	$172.08	$278.01	$111.85	$113.00	$113.00	$175.24	"$1,320.00"	"$1,045.44"	"$1,056.00"	$243.48	"$1,216.00"	$243.48	$74.65	$103.45	$103.45	$210.14	$166.90	$0.00	$0.00	$0.00	$0.00
36100010	EAP	CPT® 99291		Hypothermia (critical Care) 1st 30-74 Min	BOTH IP/OP	"$4,975.00 "	"$3,681.50"	$0.00	"$4,975.00"	"$4,975.00"	"$4,975.00"	$725.39	$725.39	$729.47	"$1,036.91"	"$3,261.45"	"$3,261.45"	$0.00	$663.88	"$1,036.79"	$431.52	"$4,975.00"	"$4,975.00"	$668.62	"$2,157.50"	"$3,417.48"	"$3,452.00"	$928.96	"$4,850.95"	$928.96	$182.90	$226.49	$226.49	$686.95	$636.78	$0.00	$0.00	$0.00	$0.00
36100012	EAP	CPT® 99292		Hypothermia (critical Care) Addl 30 Min	BOTH IP/OP	"$1,110.00 "	$821.40	$0.00	"$2,821.00"	"$1,110.00"	"$1,110.00"	$0.00	$0.00	$0.00	$231.35	"$1,110.00"	"$1,110.00"	$0.00	$0.00	$231.32	$0.00	"$1,110.00"	"$1,110.00"	$0.00	$592.50	$938.52	$948.00	$0.00	"$2,821.00"	$0.00	$0.00	$113.96	$113.96	$188.65	$0.00	$0.00	$0.00	$0.00	$0.00
36100013	EAP	CPT® 22514		"Percut Kyphoplasty, Lumb"	BOTH IP/OP	"$21,530.00 "	"$15,932.20"	$0.00	"$17,397.60"	"$2,984.10"	"$2,984.10"	"$6,099.77"	"$6,099.77"	"$6,134.13"	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,486.85"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$17,223.62"	"$17,397.60"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100014	EAP	CPT® 22515		"Percut Kyphoplasty, Add-on"	BOTH IP/OP	"$21,530.00 "	"$15,932.20"	$0.00	"$17,397.60"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	"$4,487.39"	$0.00	$0.00	$0.00	$0.00	"$4,486.85"	$0.00	"$4,877.00"	"$4,877.00"	$0.00	"$10,873.50"	"$17,223.62"	"$17,397.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100016	EAP	CPT® 62302		Myelography Via Lumbar Injection;cervical;including S&i	BOTH IP/OP	$764.00 	$565.36	$0.00	$611.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.22	$0.00	$0.00	$0.00	$0.00	$382.00	$605.09	$611.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100017	EAP	CPT® 62303		Myelography Via Lumbar Injection;thoracic;including S&i	BOTH IP/OP	$804.00 	$594.96	$0.00	$804.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.55	$0.00	$0.00	$0.00	$0.00	$382.00	$605.09	$611.20	$0.00	$804.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100018	EAP	CPT® 62304		Myelography Via Lumbar Injection;lumbosacral;including S&i	BOTH IP/OP	"$1,729.00 "	"$1,279.46"	$0.00	"$1,729.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$360.32	$0.00	$0.00	$0.00	$0.00	$821.50	"$1,301.26"	"$1,314.40"	$0.00	"$1,729.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100019	EAP	CPT® 62305		Myelography Via Lumbar Injection' 2or More Regions;including S&i	BOTH IP/OP	"$3,914.00 "	"$2,896.36"	$0.00	"$2,976.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$815.68	$0.00	$0.00	$0.00	$0.00	"$1,860.00"	"$2,946.24"	"$2,976.00"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100020	EAP	CPT® 10061		Drainage Abscess Complex/multiple	BOTH IP/OP	"$1,394.00 "	"$1,031.56"	$0.00	"$1,394.00"	"$1,394.00"	"$1,394.00"	$336.60	$336.60	$338.49	$290.54	"$1,257.08"	"$1,257.08"	"$1,305.43"	$331.46	$290.51	$215.45	"$1,394.00"	"$1,394.00"	$320.45	"$1,380.00"	"$1,092.96"	"$1,104.00"	$445.22	"$1,394.00"	$445.22	$0.00	$187.80	$187.80	$219.70	$305.19	$0.00	$0.00	$0.00	$0.00
36100022	EAP	CPT® 20604		Drain /inject-finger/toe With Us Guidance	BOTH IP/OP	$935.00 	$691.90	$0.00	$936.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.31	$194.85	$162.70	$113.00	$113.00	$262.54	$936.00	$741.31	$748.80	$364.76	$935.00	$364.76	$69.40	$47.60	$47.60	$149.01	$250.04	$0.00	$0.00	$0.00	$0.00
36100023	EAP	CPT® 20606		Drain/inject-wrist Elbow Ankle With Us Guidance	BOTH IP/OP	$935.00 	$691.90	$0.00	$936.00	$935.00	$935.00	$618.38	$618.38	$621.87	$194.88	$0.00	$0.00	$0.00	$608.20	$194.85	$395.33	$113.00	$113.00	$626.89	$936.00	$741.31	$748.80	$870.98	$935.00	$870.98	$76.82	$54.81	$54.81	$149.01	$597.04	$0.00	$0.00	$0.00	$0.00
36100024	EAP	CPT® 20611		Drain/inject-shoulder Hip Knee With Us Guidance	BOTH IP/OP	"$2,198.00 "	"$1,626.52"	$0.00	"$2,200.00"	"$2,198.00"	"$2,198.00"	$254.43	$254.43	$255.86	$458.12	$0.00	$0.00	$0.00	$250.31	$458.06	$162.70	$113.00	$113.00	$262.54	"$2,200.00"	"$1,742.40"	"$1,760.00"	$364.76	"$1,750.00"	$364.76	$88.61	$62.38	$62.38	$350.24	$250.04	$0.00	$0.00	$0.00	$0.00
36100025	EAP	CPT® 20983		Ablation Therapy Bone Tumor(s) Perq	BOTH IP/OP	"$6,719.00 "	"$4,972.06"	$0.00	"$5,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,400.24"	$0.00	$0.00	$0.00	$0.00	"$5,452.00"	"$4,988.81"	"$5,039.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100026	EAP	CPT® 64566		Percutaneous Tibial Nerve Stimulation	BOTH IP/OP	$617.00 	$456.58	$0.00	$617.00	$617.00	$617.00	$254.43	$254.43	$255.86	$128.60	$0.00	$0.00	$0.00	$250.31	$128.58	$162.70	$617.00	$617.00	$262.54	$617.00	$488.66	$493.60	$364.76	$617.00	$364.76	$122.82	$32.45	$32.45	$98.23	$250.04	$0.00	$0.00	$0.00	$0.00
36100027	EAP	CPT® 46607		Anoscopy Hra W/biopsy	BOTH IP/OP	"$3,451.00 "	"$2,553.74"	$0.00	"$3,451.00"	"$2,321.55"	"$2,321.55"	"$1,009.84"	"$1,009.84"	"$1,015.53"	$719.27	$0.00	$0.00	$0.00	$993.84	$719.19	$646.00	"$3,451.00"	"$3,451.00"	"$1,007.17"	"$2,255.00"	"$2,641.32"	"$2,668.00"	"$1,399.33"	"$1,898.00"	"$1,399.33"	$0.00	$131.60	$131.60	$530.93	$959.21	$0.00	$0.00	$0.00	$0.00
36100028	EAP	CPT® 10080		Drainage Of Pilonidal Cyst	BOTH IP/OP	$712.00 	$526.88	$0.00	"$1,524.00"	$712.00	$712.00	$606.01	$606.01	$609.42	$0.00	$712.00	$712.00	$712.00	$0.00	$148.38	$0.00	$0.00	$0.00	$0.00	$705.00	$558.36	$564.00	$0.00	"$1,524.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100030	EAP	CPT® 10120		Remove Foreign Body Sq Simple	BOTH IP/OP	$768.00 	$568.32	$0.00	"$1,750.00"	$768.00	$768.00	$336.60	$336.60	$338.49	$160.07	$768.00	$768.00	$768.00	$331.46	$160.05	$215.45	$113.00	$113.00	$0.00	$760.00	$601.92	$608.00	$0.00	"$1,750.00"	$0.00	$85.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100034	EAP	CPT® 10121		"Removal Of Fb, Sc Tissue Compl"	BOTH IP/OP	"$7,169.00 "	"$5,305.06"	$0.00	"$5,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,494.02"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$5,619.24"	"$5,676.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100035	EAP	CPT® 10140		Drainage Of Hematoma/fluid	BOTH IP/OP	"$6,515.00 "	"$4,821.10"	$0.00	"$5,158.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,357.73"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,106.82"	"$5,158.40"	$0.00	"$2,500.00"	$0.00	$89.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100036	EAP	CPT® 52204		Cystoscopy W/diopsy (s)	BOTH IP/OP	"$13,064.00 "	"$9,667.36"	$0.00	"$10,482.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,722.54"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$10,377.58"	"$10,482.40"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100037	EAP	CPT® 52354		Cystouretero W/diopsy	BOTH IP/OP	"$6,056.00 "	"$4,481.44"	$0.00	"$4,859.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,262.07"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$4,810.61"	"$4,859.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100041	EAP	CPT® 10160		Aspiration Abscess Hematoma Bulla/cyst	BOTH IP/OP	$645.00 	$477.30	$0.00	$645.00	$645.00	$645.00	$336.60	$336.60	$338.49	$134.43	$0.00	$0.00	$0.00	$331.46	$134.42	$215.45	$113.00	$113.00	$320.45	$638.00	$505.30	$510.40	$445.22	$645.00	$445.22	$78.53	$97.69	$97.69	$101.57	$305.19	$0.00	$0.00	$0.00	$0.00
36100042	EAP	CPT® 31600		"Tracheostomy, Planned"	BOTH IP/OP	"$4,986.00 "	"$3,689.64"	$0.00	"$3,903.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,039.08"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,864.17"	"$3,903.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100044	EAP	CPT® 36473		Endoven Abltj Incmptnt Vein Mchnchem 1st Vein	BOTH IP/OP	"$8,848.00 "	"$6,547.52"	$0.00	"$5,627.20"	"$2,984.10"	"$2,984.10"	"$2,787.76"	"$2,787.76"	"$2,803.47"	"$1,844.14"	$0.00	$0.00	$0.00	"$2,742.67"	"$1,843.92"	"$1,782.74"	$113.00	$113.00	"$2,779.42"	"$2,858.00"	"$5,570.93"	"$5,627.20"	"$3,861.64"	"$3,725.00"	"$3,861.64"	"$1,443.33"	$186.78	$186.78	"$1,119.81"	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
36100045	EAP	CPT® 36474		Endoven Abltj Incmptnt Vein Mchn Sbsq Veins-add On	BOTH IP/OP	"$2,213.00 "	"$1,637.62"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$461.19	$0.00	$0.00	$0.00	$0.00	$879.50	"$1,393.13"	"$1,407.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100046	EAP	CPT® 64611		Chemodenerv Parotid/subm Salivary Glands Bilateral	BOTH IP/OP	$469.00 	$347.06	$0.00	$472.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.74	$0.00	$0.00	$0.00	$262.54	$472.00	$373.82	$377.60	$364.76	$469.00	$364.76	$94.40	$108.82	$108.82	$75.14	$250.04	$0.00	$0.00	$0.00	$0.00
36100049	EAP	CPT® 10180		I&d Complex Post Op Wound Inf	BOTH IP/OP	"$6,264.00 "	"$4,635.36"	$0.00	"$4,959.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,305.42"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,909.61"	"$4,959.20"	$0.00	"$3,250.00"	$0.00	$130.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100050	EAP	CPT® 52315		Cystoscopy And Treatment	BOTH IP/OP	"$8,062.00 "	"$5,965.88"	$0.00	"$6,514.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,680.12"	$0.00	$0.00	$0.00	"$1,776.76"	"$2,327.00"	"$6,449.26"	"$6,514.40"	"$2,468.57"	"$3,250.00"	"$2,468.57"	$535.80	$285.23	$285.23	"$1,296.37"	"$1,692.15"	$0.00	$0.00	$0.00	$0.00
36100051	EAP	CPT® 11000		Debridement Of Skin	BOTH IP/OP	"$3,090.00 "	"$2,286.60"	$0.00	"$2,350.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$643.96	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,326.90"	"$2,350.40"	$0.00	"$1,443.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100057	EAP	CPT® 11001		"Debride, Each Add 10% Of Body"	BOTH IP/OP	"$1,665.00 "	"$1,232.10"	$0.00	"$1,671.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.99	$0.00	$0.00	$0.00	$0.00	"$1,671.00"	"$1,323.43"	"$1,336.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100058	EAP	CPT® 97597		Debridement First 20 Sq Cm Or Less	BOTH IP/OP	$740.00 	$547.60	$0.00	$848.25	$740.00	$740.00	$174.88	$174.88	$175.86	$154.23	$0.00	$0.00	$0.00	$172.08	$154.22	$111.85	$437.71	$437.71	$175.24	$674.00	$533.81	$539.20	$243.48	$848.25	$243.48	$48.15	$37.87	$37.87	$107.30	$166.90	$0.00	$0.00	$0.00	$0.00
36100060	EAP	CPT® 49418		Insertion Of Tunneled Intraperitoneal Catheter	BOTH IP/OP	"$8,783.00 "	"$6,499.42"	$0.00	"$6,587.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,830.38"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$6,521.33"	"$6,587.20"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100061	EAP	CPT® 97598		Debridement Open Wound Ea Addl 20 Sq Cm	BOTH IP/OP	$561.00 	$415.14	$0.00	$448.80	$0.00	$0.00	$0.00	$0.00	$0.00	$128.39	$0.00	$0.00	$0.00	$0.00	$128.37	$0.00	$364.36	$364.36	$0.00	$280.50	$444.31	$448.80	$0.00	$0.00	$0.00	$61.13	$26.68	$26.68	$89.31	$0.00	$0.00	$0.00	$0.00	$0.00
36100063	EAP	CPT® 11042		"Debridement Skin,and Subcutane"	BOTH IP/OP	"$2,172.00 "	"$1,607.28"	$63.09	"$2,172.00"	"$2,172.00"	"$2,172.00"	$336.60	$336.60	$338.49	$452.70	"$1,541.95"	"$1,541.95"	"$1,601.25"	$331.46	$452.64	$215.45	"$2,172.00"	"$2,172.00"	$320.45	"$2,065.00"	"$1,635.48"	"$1,652.00"	$445.22	"$1,750.00"	$445.22	$70.00	$63.09	$63.09	$328.75	$305.19	$0.00	$0.00	$0.00	$0.00
36100065	EAP	CPT® 11043		Debridement Skin/sq/muscle	BOTH IP/OP	"$4,347.00 "	"$3,216.78"	$161.16	"$3,306.40"	"$2,753.10"	"$2,753.10"	$510.03	$510.03	$512.91	$906.02	"$1,541.95"	"$1,541.95"	"$1,601.25"	$502.38	$905.91	$326.54	"$2,836.00"	"$2,836.00"	$498.48	"$2,327.00"	"$3,273.34"	"$3,306.40"	$692.57	"$1,750.00"	$692.57	$168.42	$161.16	$161.16	$657.97	$474.74	$0.00	$0.00	$0.00	$0.00
36100067	EAP	CPT® 11044		"Debridement, Bone"	BOTH IP/OP	"$5,344.00 "	"$3,954.56"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.69"	$0.00	$0.00	$0.00	"$1,376.63"	"$2,327.00"	"$4,023.36"	"$4,064.00"	"$1,912.65"	"$2,150.00"	"$1,912.65"	$0.00	$236.52	$236.52	$808.74	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100070	EAP	CPT® 11055		"Pare Wart/callus/hyperkaratotic Lesion, Single"	BOTH IP/OP	$365.00 	$270.10	$0.00	$624.00	$365.00	$365.00	$174.88	$174.88	$175.86	$76.08	$0.00	$0.00	$0.00	$172.08	$76.07	$111.85	$113.00	$113.00	$175.24	$365.00	$289.08	$292.00	$243.48	$624.00	$243.48	$21.20	$16.59	$16.59	$58.11	$166.90	$0.00	$0.00	$0.00	$0.00
36100073	EAP	CPT® 11056		"Pare Wart/callus, 2-4 Lesions"	BOTH IP/OP	$365.00 	$270.10	$0.00	$814.00	$365.00	$365.00	$174.88	$174.88	$175.86	$76.08	$0.00	$0.00	$0.00	$172.08	$76.07	$111.85	$113.00	$113.00	$175.24	$365.00	$289.08	$292.00	$243.48	$814.00	$243.48	$28.23	$24.16	$24.16	$58.11	$166.90	$0.00	$0.00	$0.00	$0.00
36100074	EAP	CPT® 11057		"Pare Wart/callus, >4 Lesions"	BOTH IP/OP	$927.00 	$685.98	$0.00	$927.00	$927.00	$927.00	$174.88	$174.88	$175.86	$193.21	$0.00	$0.00	$0.00	$172.08	$193.19	$111.85	$113.00	$113.00	$175.24	$926.00	$733.39	$740.80	$243.48	$927.00	$243.48	$31.34	$30.66	$30.66	$147.42	$166.90	$0.00	$0.00	$0.00	$0.00
36100078	EAP	CPT® 11200		Removal Of Skin Tags (1-15)	BOTH IP/OP	$712.00 	$526.88	$55.43	$712.00	$712.00	$712.00	$174.88	$174.88	$175.86	$148.40	$712.00	$712.00	$712.00	$172.08	$148.38	$111.85	$113.00	$113.00	$175.24	$711.00	$563.11	$568.80	$243.48	$614.00	$243.48	$55.43	$75.69	$75.69	$113.19	$166.90	$0.00	$0.00	$0.00	$0.00
36100081	EAP	CPT® 11201		Removal Of Skin Tags;ea Add 10	BOTH IP/OP	"$1,016.00 "	$751.84	$0.00	"$1,016.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.73	$0.00	$0.00	$0.00	$0.00	"$1,015.00"	$803.88	$812.00	$0.00	"$1,016.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100082	EAP	CPT® 11300		Shave Les Trunk Arm Leg <0.5cm	BOTH IP/OP	$365.00 	$270.10	$0.00	$365.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.07	$0.00	$0.00	$0.00	$0.00	$365.00	$289.08	$292.00	$0.00	$266.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100083	EAP	CPT® 11301		Shave Trunk Arm Leg 0.6-1.0cm	BOTH IP/OP	$365.00 	$270.10	$0.00	$365.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.07	$0.00	$0.00	$0.00	$0.00	$365.00	$289.08	$292.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100084	EAP	CPT® 11302		Shave Trunk Arm Leg 1.1-2.0cm	BOTH IP/OP	$752.00 	$556.48	$0.00	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.72	$0.00	$0.00	$0.00	$0.00	$752.00	$595.58	$601.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100085	EAP	CPT® 11303		Shave Trunk Arm Leg >2.0cm	BOTH IP/OP	"$1,136.00 "	$840.64	$0.00	"$1,136.00"	$616.85	$616.85	$336.60	$336.60	$338.49	$236.77	"$1,136.00"	"$1,136.00"	"$1,136.00"	$331.46	$236.74	$215.45	$113.00	$113.00	$0.00	"$1,135.00"	$898.92	$908.00	$0.00	"$1,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100086	EAP	CPT® 11305		Shave Skin Lesion 0.5 Cm/<	BOTH IP/OP	$752.00 	$556.48	$0.00	$752.00	$408.34	$408.34	$174.88	$174.88	$175.86	$156.74	$0.00	$0.00	$0.00	$172.08	$156.72	$111.85	$113.00	$113.00	$0.00	$752.00	$595.58	$601.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100088	EAP	CPT® 11306		Shave Scalp/neck/hnd/ft 0.6-1.	BOTH IP/OP	$752.00 	$556.48	$0.00	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.72	$0.00	$0.00	$0.00	$0.00	$752.00	$595.58	$601.60	$0.00	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100089	EAP	CPT® 11307		Shave Scalp/neck/hnd/ft 1.1-2.	BOTH IP/OP	$670.00 	$495.80	$0.00	$670.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.63	$0.00	$0.00	$0.00	$0.00	$670.00	$530.64	$536.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100090	EAP	CPT® 11308		Shave Scalp/neck/hnd/feet >2.0	BOTH IP/OP	$721.00 	$533.54	$0.00	$721.00	$391.50	$391.50	$336.60	$336.60	$338.49	$150.27	$0.00	$0.00	$0.00	$331.46	$150.26	$215.45	$113.00	$113.00	$320.45	$720.00	$570.24	$576.00	$445.22	$721.00	$445.22	$100.61	$76.09	$76.09	$114.62	$305.19	$0.00	$0.00	$0.00	$0.00
36100091	EAP	CPT® 11310		Shaving Fac Ear Nos Lip <.5cm	BOTH IP/OP	$720.00 	$532.80	$0.00	$720.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.05	$0.00	$0.00	$0.00	$0.00	$720.00	$570.24	$576.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100092	EAP	CPT® 27570		Manipulation Knee Joint Under General Anes	BOTH IP/OP	"$4,221.00 "	"$3,123.54"	$0.00	"$3,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.66	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,343.03"	"$3,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100094	EAP	CPT® 11311		Shav Fac/ear/eye/nos/lip 0.6-1	BOTH IP/OP	$752.00 	$556.48	$0.00	$752.00	$408.34	$408.34	$174.88	$174.88	$175.86	$156.74	$0.00	$0.00	$0.00	$172.08	$156.72	$111.85	$113.00	$113.00	$0.00	$752.00	$595.58	$601.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100096	EAP	CPT® 11312		Shav Fac/ear/eye/nos/lip 1.1-2	BOTH IP/OP	$752.00 	$556.48	$0.00	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.72	$0.00	$0.00	$0.00	$0.00	$752.00	$595.58	$601.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100098	EAP	CPT® 11313		Shav Face/ear/eye/nose/lip >2.	BOTH IP/OP	"$1,483.00 "	"$1,097.42"	$0.00	"$1,483.00"	$805.27	$805.27	$336.60	$336.60	$338.49	$309.09	$0.00	$0.00	$0.00	$331.46	$309.06	$215.45	$113.00	$113.00	$0.00	"$1,483.00"	"$1,174.54"	"$1,186.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100099	EAP	CPT® 11400		Exc Benign Lesion T/a/l  0.5 Cm/<	BOTH IP/OP	"$2,074.00 "	"$1,534.76"	$0.00	"$2,071.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$432.22	$0.00	$0.00	$0.00	$0.00	"$2,071.00"	"$1,640.23"	"$1,656.80"	$0.00	"$1,866.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100100	EAP	CPT® 64999		Quadratus Lumborum-anes	BOTH IP/OP	"$4,470.00 "	"$3,307.80"	$0.00	"$3,550.40"	"$2,321.55"	"$2,321.55"	$254.43	$254.43	$255.86	$0.00	$0.00	$0.00	$0.00	$0.00	$931.55	$0.00	$0.00	$0.00	$262.54	"$2,255.00"	"$3,514.90"	"$3,550.40"	$364.76	"$2,607.00"	$364.76	$694.55	$0.00	$0.00	$706.53	$250.04	$0.00	$0.00	$0.00	$0.00
36100101	EAP	CPT® 11401		Exc Benign Lesion  T/a/l 0.6-1.0 Cm	BOTH IP/OP	"$2,327.00 "	"$1,721.98"	$0.00	"$2,321.55"	"$2,321.55"	"$2,321.55"	$336.60	$336.60	$338.49	$485.00	"$1,257.08"	"$1,257.08"	"$1,305.43"	$331.46	$484.95	$215.45	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$1,840.61"	"$1,859.20"	$0.00	"$2,150.00"	$0.00	$105.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100103	EAP	CPT® 11402		Exc Benign Lesion  T/a/l 1.1-2.0 Cm	BOTH IP/OP	"$2,327.00 "	"$1,721.98"	$117.87	"$2,321.55"	"$2,321.55"	"$2,321.55"	$606.01	$606.01	$609.42	$485.00	"$1,257.08"	"$1,257.08"	"$1,305.43"	$596.11	$484.95	$387.47	"$1,871.00"	"$1,871.00"	$611.80	"$2,255.00"	"$1,840.61"	"$1,859.20"	$850.02	"$2,150.00"	$850.02	$121.81	$117.87	$117.87	$369.98	$582.67	$0.00	$0.00	$0.00	$0.00
36100105	EAP	CPT® 11403		Exc Benign Lesion  T/a/l 2.1-3.0 Cm	BOTH IP/OP	"$6,030.00 "	"$4,462.20"	$142.90	"$4,817.60"	"$2,321.55"	"$2,321.55"	$606.01	$606.01	$609.42	"$1,256.80"	"$1,257.08"	"$1,257.08"	"$1,305.43"	$596.11	"$1,256.65"	$387.47	"$1,871.00"	"$1,871.00"	$611.80	"$2,255.00"	"$4,769.42"	"$4,817.60"	$850.02	"$2,150.00"	$850.02	$142.90	$152.47	$152.47	$958.70	$582.67	$0.00	$0.00	$0.00	$0.00
36100107	EAP	CPT® 11404		Exc Benign Lesion T/a/l 3.1-4.0 Cm	BOTH IP/OP	"$10,505.00 "	"$7,773.70"	$0.00	"$8,393.60"	"$2,321.55"	"$2,321.55"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$2,189.50"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	"$2,189.24"	$876.52	"$1,871.00"	"$1,871.00"	"$1,376.63"	"$2,255.00"	"$8,309.66"	"$8,393.60"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$0.00	$167.97	$167.97	"$1,670.33"	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100109	EAP	CPT® 11406		"Exc, Benign,>4.0 Cm, T/a/l"	BOTH IP/OP	"$11,772.00 "	"$8,711.28"	$197.38	"$9,405.60"	"$2,753.10"	"$2,753.10"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$2,453.58"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,348.50"	"$2,453.28"	$876.52	"$2,836.00"	"$2,836.00"	"$1,376.63"	"$2,327.00"	"$9,311.54"	"$9,405.60"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$197.38	$255.57	$255.57	"$1,871.71"	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100110	EAP	CPT® 64505		N Block Spenopalatine Gangl	BOTH IP/OP	"$2,665.00 "	"$1,972.10"	$0.00	"$2,321.55"	"$2,321.55"	"$2,321.55"	$254.43	$254.43	$255.86	$555.45	$0.00	$0.00	$0.00	$250.31	$555.39	$162.70	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$2,036.23"	"$2,056.80"	$0.00	"$1,199.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100111	EAP	CPT® 11420		Exc Benign Scalp Genit Hand Ft	BOTH IP/OP	"$6,030.00 "	"$4,462.20"	$0.00	"$4,817.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,256.80"	$0.00	$0.00	$0.00	"$1,348.50"	"$1,256.65"	$876.52	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$4,769.42"	"$4,817.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100112	EAP	CPT® 30140		Resect Inferior Turbinate Submucous Bilateral	BOTH IP/OP	"$5,043.00 "	"$3,731.82"	$0.00	"$4,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,050.96"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,994.06"	"$4,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100115	EAP	CPT® 11421		Exc Benign Scalp Genit Hnd Ft	BOTH IP/OP	"$6,030.00 "	"$4,462.20"	$0.00	"$4,817.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,256.80"	$0.00	$0.00	$0.00	$596.11	"$1,256.65"	$387.47	"$1,871.00"	"$1,871.00"	$611.80	"$2,255.00"	"$4,769.42"	"$4,817.60"	$850.02	"$2,150.00"	$850.02	$111.86	$112.83	$112.83	$958.70	$582.67	$0.00	$0.00	$0.00	$0.00
36100118	EAP	CPT® 11422		Exc Ben Scal Gent Hd Ft Neck	BOTH IP/OP	"$5,541.00 "	"$4,100.34"	$127.73	"$4,427.20"	"$2,321.55"	"$2,321.55"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$1,154.88"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	"$1,154.74"	$876.52	"$1,871.00"	"$1,871.00"	"$1,376.63"	"$2,255.00"	"$4,382.93"	"$4,427.20"	"$1,912.65"	"$2,150.00"	"$1,912.65"	$127.73	$139.85	$139.85	$881.01	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100120	EAP	CPT® 11423		Exc Beng Scp Gent Hd Ft Nk	BOTH IP/OP	"$6,030.00 "	"$4,462.20"	$0.00	"$4,817.60"	"$2,321.55"	"$2,321.55"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$1,256.80"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	"$1,256.65"	$876.52	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$4,769.42"	"$4,817.60"	$0.00	"$2,500.00"	$0.00	$156.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100121	EAP	CPT® 31295		Sinus Endo W/balloon Dil	BOTH IP/OP	"$6,390.00 "	"$4,728.60"	$0.00	"$5,112.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,331.68"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$5,060.88"	"$5,112.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100122	EAP	CPT® 11424		"Exc Beng Sc, Genit Hd Ft Neck"	BOTH IP/OP	"$4,851.00 "	"$3,589.74"	$0.00	"$3,876.00"	"$2,753.10"	"$2,753.10"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$1,011.07"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,348.50"	"$1,010.95"	$876.52	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$3,837.24"	"$3,876.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100123	EAP	CPT® 31513		Injection Into Vocal Cord	BOTH IP/OP	"$6,225.00 "	"$4,606.50"	$0.00	"$5,208.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,297.29"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$5,156.71"	"$5,208.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100124	EAP	CPT® 11426		"Exc,benign,>4.0 Cm,sclp/h/f"	BOTH IP/OP	"$6,408.00 "	"$4,741.92"	$0.00	"$5,120.00"	"$2,753.10"	"$2,753.10"	"$2,309.02"	"$2,309.02"	"$2,322.02"	"$1,335.59"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,271.46"	"$1,335.43"	"$1,476.45"	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$5,068.80"	"$5,120.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100126	EAP	CPT® 11440		Exc Benign Face Ear Nose Muc	BOTH IP/OP	"$1,776.00 "	"$1,314.24"	$0.00	"$1,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$370.12	$0.00	$0.00	$0.00	$611.80	"$1,774.00"	"$1,405.01"	"$1,419.20"	$850.02	"$1,776.00"	$850.02	$101.18	$105.96	$105.96	$282.42	$582.67	$0.00	$0.00	$0.00	$0.00
36100130	EAP	CPT® 11441		Exc Benign Face Ear Nose Muc	BOTH IP/OP	"$3,293.00 "	"$2,436.82"	$0.00	"$2,631.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$686.26	$0.00	$0.00	$0.00	$611.80	"$2,255.00"	"$2,604.89"	"$2,631.20"	$850.02	"$2,150.00"	$850.02	$0.00	$134.44	$134.44	$523.61	$582.67	$0.00	$0.00	$0.00	$0.00
36100132	EAP	CPT® 11442		"Exc, Beng Fc, Er,nos,muc 1.1-2"	BOTH IP/OP	"$3,246.00 "	"$2,402.04"	$139.44	"$2,593.60"	"$2,321.55"	"$2,321.55"	$606.01	$606.01	$609.42	$676.55	"$1,257.08"	"$1,257.08"	"$1,305.43"	$596.11	$676.47	$387.47	"$1,871.00"	"$1,871.00"	$611.80	"$2,255.00"	"$2,567.66"	"$2,593.60"	$850.02	"$2,150.00"	$850.02	$139.44	$149.22	$149.22	$516.13	$582.67	$0.00	$0.00	$0.00	$0.00
36100135	EAP	CPT® 11443		Exc Benign Lesion  F/e/e/n/l/m 2.1-3.0cm	BOTH IP/OP	"$6,030.00 "	"$4,462.20"	$0.00	"$4,817.60"	"$2,321.55"	"$2,321.55"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$1,256.80"	$0.00	$0.00	$0.00	"$1,348.50"	"$1,256.65"	$876.52	"$1,871.00"	"$1,871.00"	"$1,376.63"	"$2,255.00"	"$4,769.42"	"$4,817.60"	"$1,912.65"	"$2,150.00"	"$1,912.65"	$177.41	$183.11	$183.11	$958.70	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100138	EAP	CPT® 11444		Exc Benign Lesion  F/e/e/n/l/m 3.1-4.0cm	BOTH IP/OP	"$2,484.00 "	"$1,838.16"	$0.00	"$2,321.55"	"$2,321.55"	"$2,321.55"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$517.73	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	$517.67	$876.52	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$1,964.95"	"$1,984.80"	$0.00	"$2,150.00"	$0.00	$220.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100141	EAP	CPT® 11446		"Exc Benign,>4.0 Cm,f/e/mem"	BOTH IP/OP	"$15,310.00 "	"$11,329.40"	$0.00	"$12,232.80"	"$2,753.10"	"$2,753.10"	"$2,309.02"	"$2,309.02"	"$2,322.02"	"$3,190.99"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,271.46"	"$3,190.60"	"$1,476.45"	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$12,110.47"	"$12,232.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100142	EAP	CPT® 11601		"Exc.malig,tr/a/l,0.6-1.0cm"	BOTH IP/OP	"$2,235.00 "	"$1,653.90"	$0.00	"$2,235.00"	"$2,235.00"	"$2,235.00"	$606.01	$606.01	$609.42	$465.83	$0.00	$0.00	$0.00	$596.11	$465.77	$387.47	"$1,871.00"	"$1,871.00"	$0.00	"$2,232.00"	"$1,767.74"	"$1,785.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100143	EAP	CPT® 11602		"Exc.malig,tr/a/l,1.1-2.0cm"	BOTH IP/OP	"$2,327.00 "	"$1,721.98"	$0.00	"$2,321.55"	"$2,321.55"	"$2,321.55"	$336.60	$336.60	$338.49	$485.00	$0.00	$0.00	$0.00	$331.46	$484.95	$215.45	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$1,840.61"	"$1,859.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100144	EAP	CPT® 11603		"Exc.malig Tr/a/l,2.1-3.0cm"	BOTH IP/OP	"$5,176.00 "	"$3,830.24"	$0.00	"$4,135.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,078.68"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,093.85"	"$4,135.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100145	EAP	CPT® 11604		Exc Malign Tr Arm Leg 3.1-4.0	BOTH IP/OP	"$5,176.00 "	"$3,830.24"	$0.00	"$4,135.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,078.68"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,093.85"	"$4,135.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100146	EAP	CPT® 11606		"Exc Malig>4.0 Cm,trnk/a/l"	BOTH IP/OP	"$10,505.00 "	"$7,773.70"	$0.00	"$8,393.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.24"	$0.00	$0.00	$0.00	"$1,376.63"	"$2,327.00"	"$8,309.66"	"$8,393.60"	"$1,912.65"	"$1,976.00"	"$1,912.65"	$252.57	$329.86	$329.86	"$1,670.33"	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100147	EAP	CPT® 11621		"Exc Malign Scap Gent Hd,ft Nk"	BOTH IP/OP	"$3,293.00 "	"$2,436.82"	$0.00	"$2,631.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$686.26	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,604.89"	"$2,631.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100148	EAP	CPT® 11622		Exc Malignant Lesion  S/n/h/f/g 1.1-2.0 Cm	BOTH IP/OP	"$6,030.00 "	"$4,462.20"	$0.00	"$4,817.60"	"$2,321.55"	"$2,321.55"	$606.01	$606.01	$609.42	"$1,256.80"	$0.00	$0.00	$0.00	$596.11	"$1,256.65"	$387.47	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$4,769.42"	"$4,817.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100150	EAP	CPT® 11623		Exc Malignant Lesion  S/n/h/f/g 2.1-3.0 Cm	BOTH IP/OP	"$11,307.00 "	"$8,367.18"	$0.00	"$9,045.60"	"$2,321.55"	"$2,321.55"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,356.38"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$8,955.14"	"$9,045.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100152	EAP	CPT® 11624		Exc Malign Scp Gent Hd Ft Nk	BOTH IP/OP	"$10,091.00 "	"$7,467.34"	$0.00	"$8,072.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,102.96"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$7,992.07"	"$8,072.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100153	EAP	CPT® 11626		"Excis Malig,>4.0 Cm,scp/h/ft"	BOTH IP/OP	"$13,133.00 "	"$9,718.42"	$0.00	"$10,506.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,736.92"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$10,401.34"	"$10,506.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100154	EAP	CPT® 11640		Exc Malignant Lesion  F/e/e/n/l 0.5 Cm/<	BOTH IP/OP	"$3,168.00 "	"$2,344.32"	$0.00	"$2,531.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$659.38	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,505.89"	"$2,531.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100156	EAP	CPT® 11641		Exc Malignant Lesion  F/e/e/n/l 0.6-1.0 Cm	BOTH IP/OP	"$3,044.00 "	"$2,252.56"	$0.00	"$2,435.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$634.37	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,410.85"	"$2,435.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100159	EAP	CPT® 11642		Exc Malignant Lesion  F/e/e/n/l 1.1-2.0 Cm	BOTH IP/OP	"$6,030.00 "	"$4,462.20"	$0.00	"$4,817.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,256.65"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,769.42"	"$4,817.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100161	EAP	CPT® 11643		Exc Malign Fc Ear Nose Mus Mem	BOTH IP/OP	"$5,789.00 "	"$4,283.86"	$0.00	"$4,631.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.43"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,584.89"	"$4,631.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100162	EAP	CPT® 11644		Exc Malign Fc Ear Nose Muc Mem	BOTH IP/OP	"$10,091.00 "	"$7,467.34"	$0.00	"$8,072.80"	"$2,753.10"	"$2,753.10"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$2,103.22"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,348.50"	"$2,102.96"	$876.52	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$7,992.07"	"$8,072.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100163	EAP	CPT® 11646		"Exc,malig,>4.0 Cm,f/e/mem"	BOTH IP/OP	"$13,656.00 "	"$10,105.44"	$0.00	"$10,924.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,845.91"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$10,815.55"	"$10,924.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100165	EAP	CPT® 11719		Trim Of Nondystrophic Nail(s) Any	BOTH IP/OP	$285.00 	$210.90	$0.00	$288.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.39	$0.00	$0.00	$0.00	$0.00	$288.00	$228.10	$230.40	$0.00	$285.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100166	EAP	CPT® 11720		Debridement Nail Any Method 1-5	BOTH IP/OP	$199.00 	$147.26	$0.00	$201.00	$199.00	$199.00	$54.21	$54.21	$54.51	$41.48	$0.00	$0.00	$0.00	$53.35	$41.47	$34.67	$113.00	$113.00	$55.17	$201.00	$159.19	$160.80	$76.65	$199.00	$76.65	$25.44	$15.15	$15.15	$32.00	$52.54	$0.00	$0.00	$0.00	$0.00
36100169	EAP	CPT® 11721		Debridement Nail Any Method 6/>	BOTH IP/OP	$199.00 	$147.26	$0.00	$298.00	$199.00	$199.00	$54.21	$54.21	$54.51	$41.48	$0.00	$0.00	$0.00	$53.35	$41.47	$34.67	$113.00	$113.00	$55.17	$201.00	$159.19	$160.80	$76.65	$298.00	$76.65	$39.87	$25.97	$25.97	$32.00	$52.54	$0.00	$0.00	$0.00	$0.00
36100173	EAP	CPT® 11730		Avulsion Nail Plate Partial/complete Simple 1st	BOTH IP/OP	$427.00 	$315.98	$56.62	$431.00	$427.00	$427.00	$174.88	$174.88	$175.86	$89.00	$427.00	$427.00	$427.00	$172.08	$88.99	$111.85	$113.00	$113.00	$175.24	$431.00	$341.35	$344.80	$243.48	$427.00	$243.48	$63.22	$56.62	$56.62	$68.62	$166.90	$0.00	$0.00	$0.00	$0.00
36100176	EAP	CPT® 11732		Avulsion Nail Plate Partial/complete Simple Ea Addl	BOTH IP/OP	$207.00 	$153.18	$0.00	$209.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.14	$0.00	$0.00	$0.00	$0.00	$209.00	$165.53	$167.20	$0.00	$207.00	$0.00	$31.24	$18.03	$18.03	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
36100178	EAP	CPT® 11740		Evacuation Subungual Hematoma	BOTH IP/OP	$248.00 	$183.52	$0.00	$377.00	$248.00	$248.00	$109.81	$109.81	$110.43	$51.69	$0.00	$0.00	$0.00	$107.30	$51.68	$69.74	$113.00	$113.00	$0.00	$250.00	$198.00	$200.00	$0.00	$377.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100180	EAP	CPT® 11750		Excision Nail Matrix Permanent Removal	BOTH IP/OP	"$1,397.00 "	"$1,033.78"	$0.00	"$2,150.00"	"$1,397.00"	"$1,397.00"	$336.60	$336.60	$338.49	$291.17	"$1,257.08"	"$1,257.08"	"$1,305.43"	$331.46	$291.13	$215.45	"$1,397.00"	"$1,397.00"	$0.00	"$1,410.00"	"$1,116.72"	"$1,128.00"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100183	EAP	CPT® 11765		Wedge Excision Skin Nail Fold	BOTH IP/OP	$554.00 	$409.96	$0.00	$559.00	$554.00	$554.00	$336.60	$336.60	$338.49	$0.00	$554.00	$554.00	$554.00	$0.00	$115.45	$0.00	$0.00	$0.00	$320.45	$559.00	$442.73	$447.20	$445.22	$554.00	$445.22	$52.25	$95.17	$95.17	$88.99	$305.19	$0.00	$0.00	$0.00	$0.00
36100186	EAP	CPT® 11900		Intralesional Inj Up To 7 Les	BOTH IP/OP	$338.00 	$250.12	$0.00	$521.00	$338.00	$338.00	$174.88	$174.88	$175.86	$70.45	$0.00	$0.00	$0.00	$172.08	$70.44	$111.85	$113.00	$113.00	$175.24	$341.00	$270.07	$272.80	$243.48	$521.00	$243.48	$36.36	$31.37	$31.37	$54.29	$166.90	$0.00	$0.00	$0.00	$0.00
36100188	EAP	CPT® 11901		Injection Intralesional >7 Lesions	BOTH IP/OP	$276.00 	$204.24	$0.00	$279.00	$276.00	$276.00	$174.88	$174.88	$175.86	$57.53	$0.00	$0.00	$0.00	$172.08	$57.52	$111.85	$113.00	$113.00	$175.24	$279.00	$220.97	$223.20	$243.48	$276.00	$243.48	$51.85	$49.03	$49.03	$44.42	$166.90	$0.00	$0.00	$0.00	$0.00
36100190	EAP	CPT® 11952		Saline Injection < 10.0cc	BOTH IP/OP	$556.00 	$411.44	$0.00	$562.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$115.87	$0.00	$0.00	$0.00	$0.00	$562.00	$445.10	$449.60	$0.00	$556.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100191	EAP	CPT® 11954		Saline Injection > 10.0cc	BOTH IP/OP	$562.00 	$415.88	$0.00	$562.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.12	$0.00	$0.00	$0.00	$0.00	$562.00	$445.10	$449.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100192	EAP	CPT® 11960		Insert Tissue Expander(s)	BOTH IP/OP	"$5,416.00 "	"$4,007.84"	$0.00	"$4,332.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,128.69"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,289.47"	"$4,332.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100193	EAP	CPT® 11981		"Insert,implant Contraceptive"	BOTH IP/OP	$286.00 	$211.64	$0.00	"$1,750.00"	$286.00	$286.00	$109.81	$109.81	$110.43	$59.61	$0.00	$0.00	$0.00	$107.30	$59.60	$69.74	$113.00	$113.00	$109.35	$285.00	$225.72	$228.00	$151.93	"$1,750.00"	$151.93	$112.89	$67.06	$67.06	$45.37	$104.14	$0.00	$0.00	$0.00	$0.00
36100196	EAP	CPT® 12001		"Lac Repair, S,n,h,f <2.5cm"	BOTH IP/OP	$704.00 	$520.96	$0.00	$704.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$704.00	$557.57	$563.20	$243.48	$0.00	$243.48	$116.22	$46.87	$46.87	$112.08	$166.90	$0.00	$0.00	$0.00	$0.00
36100197	EAP	CPT® 12001		Lac Repr Sclp Nck Hnd Ft <2.6c	BOTH IP/OP	$704.00 	$520.96	$0.00	$704.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$704.00	$557.57	$563.20	$243.48	$0.00	$243.48	$116.22	$46.87	$46.87	$112.08	$166.90	$0.00	$0.00	$0.00	$0.00
36100198	EAP	CPT® 12001		Lac Repr Sclp Nck Hnd Ft<2.6cm	BOTH IP/OP	$704.00 	$520.96	$0.00	$704.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$704.00	$557.57	$563.20	$243.48	$0.00	$243.48	$116.22	$46.87	$46.87	$112.08	$166.90	$0.00	$0.00	$0.00	$0.00
36100199	EAP	CPT® 12002		"Lac Repair, S,n,h,f 2.6-7.5cm"	BOTH IP/OP	$879.00 	$650.46	$0.00	$879.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$879.00	$696.17	$703.20	$243.48	$0.00	$243.48	$127.88	$62.38	$62.38	$139.94	$166.90	$0.00	$0.00	$0.00	$0.00
36100200	EAP	CPT® 12002		Lac Repr Fce Ear Lp 2.6-5.0	BOTH IP/OP	$867.00 	$641.58	$62.38	"$1,134.00"	$470.78	$470.78	$174.88	$174.88	$175.86	$180.70	$867.00	$867.00	$867.00	$172.08	$180.68	$111.85	$113.00	$113.00	$175.24	$879.00	$696.17	$703.20	$243.48	"$1,134.00"	$243.48	$127.88	$62.38	$62.38	$139.94	$166.90	$0.00	$0.00	$0.00	$0.00
36100201	EAP	CPT® 12002		Lac Repr Sclp Nck Hnd Ft 2.6-7	BOTH IP/OP	$938.00 	$694.12	$62.38	"$1,134.00"	$509.33	$509.33	$174.88	$174.88	$175.86	$195.50	$938.00	$938.00	$938.00	$172.08	$195.48	$111.85	$113.00	$113.00	$175.24	$879.00	$696.17	$703.20	$243.48	"$1,134.00"	$243.48	$127.88	$62.38	$62.38	$139.94	$166.90	$0.00	$0.00	$0.00	$0.00
36100202	EAP	CPT® 12004		Rep Sc/nk/ax/gen/tk 7.6-12.5	BOTH IP/OP	$970.00 	$717.80	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$970.00	$768.24	$776.00	$243.48	$0.00	$243.48	$152.49	$77.52	$77.52	$154.42	$166.90	$0.00	$0.00	$0.00	$0.00
36100203	EAP	CPT® 12011		Lac Repr Fce Ear Eye Lp <2.6cm	BOTH IP/OP	$729.00 	$539.46	$0.00	$729.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$729.00	$577.37	$583.20	$243.48	$0.00	$243.48	$123.67	$58.77	$58.77	$116.06	$166.90	$0.00	$0.00	$0.00	$0.00
36100206	EAP	CPT® 20552		Bilat Inject Trigger Point 1-2 Musc	BOTH IP/OP	$961.00 	$711.14	$0.00	"$1,750.00"	$961.00	$961.00	$254.43	$254.43	$255.86	$200.30	$0.00	$0.00	$0.00	$250.31	$200.27	$162.70	$961.00	$961.00	$262.54	$962.00	$761.90	$769.60	$364.76	"$1,750.00"	$364.76	$66.56	$40.02	$40.02	$153.15	$250.04	$0.00	$0.00	$0.00	$0.00
36100207	EAP	CPT® 12013		Lac Repr Fce Ear Eye Lp 2.6-5.	BOTH IP/OP	$894.00 	$661.56	$0.00	$894.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$894.00	$708.05	$715.20	$243.48	$0.00	$243.48	$140.24	$62.02	$62.02	$142.32	$166.90	$0.00	$0.00	$0.00	$0.00
36100208	EAP	CPT® 16036		Escharotomy Each Addl Incision	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,260.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.58	$0.00	$0.00	$0.00	$0.00	"$1,198.00"	$948.82	$958.40	$0.00	"$1,260.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100209	EAP	CPT® 16035		Escharotomy First Incision	BOTH IP/OP	$770.00 	$569.80	$0.00	$770.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.47	$0.00	$0.00	$0.00	$0.00	$732.00	$579.74	$585.60	$0.00	$770.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100211	EAP	CPT® 12014		Rp Si Fa Ear Nos Lip 5.1cm-7.5	BOTH IP/OP	$970.00 	$717.80	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$970.00	$768.24	$776.00	$243.48	$0.00	$243.48	$166.21	$79.33	$79.33	$154.42	$166.90	$0.00	$0.00	$0.00	$0.00
36100214	EAP	CPT® 12015		Smpl Rpr Sprfsl Face 7.6-12.5c	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$215.72	$0.00	$0.00	$0.00	$172.08	$215.69	$111.85	$113.00	$113.00	$0.00	$970.00	$768.24	$776.00	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100215	EAP	CPT® 12016		Smpl Rpr Sprfsl Face 12.6-20cm	BOTH IP/OP	$957.00 	$708.18	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.44	$0.00	$0.00	$0.00	$0.00	$970.00	$768.24	$776.00	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100216	EAP	CPT® 12017		Smpl Rpr Sprfsl Face 20.1-30.0	BOTH IP/OP	"$1,559.00 "	"$1,153.66"	$0.00	"$1,580.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.90	$0.00	$0.00	$0.00	$0.00	"$1,580.00"	"$1,251.36"	"$1,264.00"	$0.00	"$1,134.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100217	EAP	CPT® 12020		Wound Dehiscence Simple Closur	BOTH IP/OP	"$2,965.00 "	"$2,194.10"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$617.91	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,200.18"	"$2,222.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100219	EAP	CPT® 12021		Packing Of Wound Dehisience	BOTH IP/OP	"$3,923.00 "	"$2,903.02"	$117.17	"$2,940.80"	"$2,321.55"	"$2,321.55"	$336.60	$336.60	$338.49	$817.65	"$1,257.08"	"$1,257.08"	"$1,305.43"	$331.46	$817.55	$215.45	"$1,871.00"	"$1,871.00"	$320.45	"$2,255.00"	"$2,911.39"	"$2,940.80"	$445.22	"$1,750.00"	$445.22	$117.17	$144.54	$144.54	$585.22	$305.19	$0.00	$0.00	$0.00	$0.00
36100221	EAP	CPT® 12031		Int Rep Sclp Trnk Extrm <2.5cm	BOTH IP/OP	$970.00 	$717.80	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.45	$970.00	$768.24	$776.00	$445.22	$0.00	$445.22	$141.63	$157.16	$157.16	$154.42	$305.19	$0.00	$0.00	$0.00	$0.00
36100222	EAP	CPT® 12032		Int Rep Sclp Trk Ext 2.6-7.5cm	BOTH IP/OP	$970.00 	$717.80	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.45	$970.00	$768.24	$776.00	$445.22	$0.00	$445.22	$161.36	$196.82	$196.82	$154.42	$305.19	$0.00	$0.00	$0.00	$0.00
36100223	EAP	CPT® 12034		Int Rep Sclp Trk Ext7.6-12.5cm	BOTH IP/OP	$465.00 	$344.10	$0.00	$465.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$465.00	$368.28	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100224	EAP	CPT® 12041		Int Repr N-hf/genit <2.6cm	BOTH IP/OP	$970.00 	$717.80	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.45	$970.00	$768.24	$776.00	$445.22	$0.00	$445.22	$157.82	$152.13	$152.13	$154.42	$305.19	$0.00	$0.00	$0.00	$0.00
36100225	EAP	CPT® 12042		Int Repr Nck Hnd Ft 2.6-7.5 Cm	BOTH IP/OP	$465.00 	$344.10	$0.00	$465.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$465.00	$368.28	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100226	EAP	CPT® 12044		Int Repr Nck Hnd Ft 7.6-12.5cm	BOTH IP/OP	$948.00 	$701.52	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$948.00	$750.82	$758.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100227	EAP	CPT® 12051		Int Repr Fce Ear Eye Lp<2.5cm	BOTH IP/OP	$970.00 	$717.80	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.45	$970.00	$768.24	$776.00	$445.22	$0.00	$445.22	$0.00	$174.83	$174.83	$154.42	$305.19	$0.00	$0.00	$0.00	$0.00
36100228	EAP	CPT® 12052		Int Repr F/e/l/mm 2.6-5.0cm	BOTH IP/OP	$970.00 	$717.80	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.45	$970.00	$768.24	$776.00	$445.22	$0.00	$445.22	$183.25	$206.92	$206.92	$154.42	$305.19	$0.00	$0.00	$0.00	$0.00
36100229	EAP	CPT® 12053		Int Wnd Repr Face/mm 5.1-7.5cm	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,610.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.45	"$1,610.00"	"$1,275.12"	"$1,288.00"	$445.22	$0.00	$445.22	$204.98	$223.51	$223.51	$256.31	$305.19	$0.00	$0.00	$0.00	$0.00
36100230	EAP	CPT® 12054		Int Rep Fce Ear Lp 7.6-12.5 Cm	BOTH IP/OP	$957.00 	$708.18	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.46	$0.00	$0.00	$0.00	$331.46	$199.44	$215.45	$957.00	$957.00	$0.00	$970.00	$768.24	$776.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100231	EAP	CPT® 12055		Rep Int Fce Ear Lp 12.6-20.0cm	BOTH IP/OP	$957.00 	$708.18	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.44	$0.00	$0.00	$0.00	$0.00	$970.00	$768.24	$776.00	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100232	EAP	CPT® 12056		Rep Int Fce Ear Lp 20.1-30.0cm	BOTH IP/OP	"$1,559.00 "	"$1,153.66"	$0.00	"$1,580.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.90	$0.00	$0.00	$0.00	$0.00	"$1,580.00"	"$1,251.36"	"$1,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100233	EAP	CPT® 12057		Lac Rep Inter Over 30.0cm	BOTH IP/OP	"$4,870.00 "	"$3,603.80"	$0.00	"$3,948.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,014.91"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,908.52"	"$3,948.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100234	EAP	CPT® 13100		"Repr Complex,1.1 To 2.5 Cm"	BOTH IP/OP	"$2,495.00 "	"$1,846.30"	$0.00	"$2,327.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$519.96	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$1,851.70"	"$1,870.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100235	EAP	CPT® 13101		Repr Complex Trk 2.6-7.5cm	BOTH IP/OP	"$2,602.00 "	"$1,925.48"	$0.00	"$2,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$542.32	$0.00	$0.00	$0.00	$502.38	$542.26	$326.54	"$2,602.00"	"$2,602.00"	$0.00	"$2,438.00"	"$1,930.90"	"$1,950.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100236	EAP	CPT® 13120		Repr Comp Scalp Arms Lgs 1.1	BOTH IP/OP	"$1,319.00 "	$976.06	$0.00	"$1,427.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$274.88	$0.00	$0.00	$0.00	$0.00	"$1,337.00"	"$1,058.90"	"$1,069.60"	$0.00	"$1,427.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100237	EAP	CPT® 13121		Repr Comp Scalp Arms Lgs 2.5-7	BOTH IP/OP	"$1,442.00 "	"$1,067.08"	$0.00	"$1,442.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$498.48	"$1,442.00"	"$1,142.06"	"$1,153.60"	$692.57	$0.00	$692.57	$0.00	$270.39	$270.39	$229.57	$474.74	$0.00	$0.00	$0.00	$0.00
36100238	EAP	CPT® 13131		"Repr Complex Mouth Neck Hds,ft"	BOTH IP/OP	"$1,337.00 "	$989.38	$0.00	"$1,337.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,337.00"	"$1,058.90"	"$1,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100239	EAP	CPT® 13132		"Repr Comp Mouth,neck,hds,ft2.6"	BOTH IP/OP	"$1,337.00 "	$989.38	$0.00	"$1,337.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$498.48	"$1,337.00"	"$1,058.90"	"$1,069.60"	$692.57	$0.00	$692.57	$0.00	$317.62	$317.62	$212.85	$474.74	$0.00	$0.00	$0.00	$0.00
36100241	EAP	CPT® 13151		Repr Comp Eye Nose Ears Lips	BOTH IP/OP	"$2,307.00 "	"$1,707.18"	$0.00	"$2,338.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$480.78	$0.00	$0.00	$0.00	$0.00	"$2,338.00"	"$1,851.70"	"$1,870.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100242	EAP	CPT® 13151		Rpr Complx Eyelid Etc.1.1-2.5c	BOTH IP/OP	"$2,307.00 "	"$1,707.18"	$0.00	"$2,338.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$480.78	$0.00	$0.00	$0.00	$0.00	"$2,338.00"	"$1,851.70"	"$1,870.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100243	EAP	CPT® 13152		"Repr Comp Eyel, Nose,ears Lips"	BOTH IP/OP	"$2,533.00 "	"$1,874.42"	$0.00	"$2,533.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$521.00	$0.00	$0.00	$0.00	$0.00	"$2,533.00"	"$2,006.14"	"$2,026.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100244	EAP	CPT® 14000		"Tiss Tran,trnk,<10 Sq Cm"	BOTH IP/OP	"$8,323.00 "	"$6,159.02"	$0.00	"$6,658.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,734.51"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$6,591.82"	"$6,658.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100245	EAP	CPT® 14020		"Tiss Trans,s/a/l/<10 Sq Cm"	BOTH IP/OP	"$8,323.00 "	"$6,159.02"	$0.00	"$6,658.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,734.51"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$6,591.82"	"$6,658.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100246	EAP	CPT® 14040		Tiss Xfr Head Mouth Chk Hnd <1	BOTH IP/OP	"$8,323.00 "	"$6,159.02"	$0.00	"$6,658.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,734.51"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$6,591.82"	"$6,658.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100247	EAP	CPT® 14060		Tiss Trans E/n/e/l <10 Sq Cm	BOTH IP/OP	"$9,690.00 "	"$7,170.60"	$0.00	"$7,752.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,019.40"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$7,674.48"	"$7,752.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100248	EAP	CPT® 15788		Chem Peel Face Epidermal	BOTH IP/OP	$529.00 	$391.46	$0.00	$529.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$110.24	$0.00	$0.00	$0.00	$0.00	$496.00	$392.83	$396.80	$0.00	$529.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100249	EAP	CPT® 15820		Blepharoplasty Lower Eyelid	BOTH IP/OP	"$14,915.00 "	"$11,037.10"	$0.00	"$12,091.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,108.29"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$11,970.29"	"$12,091.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100250	EAP	CPT® 15822		Blepharoplasty Upper Eyelid	BOTH IP/OP	"$14,915.00 "	"$11,037.10"	$0.00	"$12,091.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,108.29"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$11,970.29"	"$12,091.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100251	EAP	CPT® 16000		Init Trmnt Burn 1st Degree	BOTH IP/OP	"$1,690.00 "	"$1,250.60"	$0.00	"$1,690.00"	$917.67	$917.67	$174.88	$174.88	$175.86	$352.24	$0.00	$0.00	$0.00	$172.08	$352.20	$111.85	$113.00	$113.00	$175.24	"$1,607.00"	"$1,272.74"	"$1,285.60"	$243.48	"$1,690.00"	$243.48	$0.00	$47.96	$47.96	$255.83	$166.90	$0.00	$0.00	$0.00	$0.00
36100252	EAP	CPT® 16000		Init. Treatment 1st Degree Bur	BOTH IP/OP	"$1,607.00 "	"$1,189.18"	$0.00	"$1,607.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	"$1,607.00"	"$1,272.74"	"$1,285.60"	$243.48	$0.00	$243.48	$0.00	$47.96	$47.96	$255.83	$166.90	$0.00	$0.00	$0.00	$0.00
36100253	EAP	CPT® 16000		"Inital Treatment, 1% Burn"	BOTH IP/OP	"$1,690.00 "	"$1,250.60"	$0.00	"$1,690.00"	$917.67	$917.67	$174.88	$174.88	$175.86	$352.24	$0.00	$0.00	$0.00	$172.08	$352.20	$111.85	$113.00	$113.00	$175.24	"$1,607.00"	"$1,272.74"	"$1,285.60"	$243.48	"$1,690.00"	$243.48	$0.00	$47.96	$47.96	$255.83	$166.90	$0.00	$0.00	$0.00	$0.00
36100254	EAP	CPT® 16020		PART THICK BURN DRESS/DEBRD;SM	BOTH IP/OP	"$1,690.00 "	"$1,250.60"	$0.00	"$1,690.00"	"$1,690.00"	"$1,690.00"	$174.88	$174.88	$175.86	$352.24	$0.00	$0.00	$0.00	$172.08	$352.20	$111.85	"$1,690.00"	"$1,690.00"	$175.24	"$1,607.00"	"$1,272.74"	"$1,285.60"	$243.48	"$1,690.00"	$243.48	$54.62	$56.23	$56.23	$255.83	$166.90	$0.00	$0.00	$0.00	$0.00
36100255	EAP	CPT® 16025		Part Thick Burn Dress/debrd;md (tbsa 5%-10%)	BOTH IP/OP	"$3,421.00 "	"$2,531.54"	$107.09	"$2,836.00"	"$2,753.10"	"$2,753.10"	$174.88	$174.88	$175.86	$713.02	"$1,541.95"	"$1,541.95"	"$1,601.25"	$172.08	$712.94	$111.85	"$2,836.00"	"$2,836.00"	$175.24	"$2,255.00"	"$2,575.58"	"$2,601.60"	$243.48	"$1,750.00"	$243.48	$107.09	$114.64	$114.64	$517.72	$166.90	$0.00	$0.00	$0.00	$0.00
36100256	EAP	CPT® 16030		Part Thick Burn Dress/debrd;lg (tbsa >10%)	BOTH IP/OP	"$4,574.00 "	"$3,384.76"	$134.39	"$3,478.40"	"$2,753.10"	"$2,753.10"	$336.60	$336.60	$338.49	$953.34	"$1,541.95"	"$1,541.95"	"$1,601.25"	$331.46	$953.22	$215.45	"$2,836.00"	"$2,836.00"	$320.45	"$2,255.00"	"$3,443.62"	"$3,478.40"	$445.22	"$1,305.00"	$445.22	$134.39	$138.43	$138.43	$692.20	$305.19	$0.00	$0.00	$0.00	$0.00
36100257	EAP	CPT® 17000		"Dest, Premalignant Lesion 1st"	BOTH IP/OP	$389.00 	$287.86	$48.44	$389.00	$389.00	$389.00	$174.88	$174.88	$175.86	$81.08	$389.00	$389.00	$389.00	$172.08	$81.07	$111.85	$113.00	$113.00	$175.24	$389.00	$308.09	$311.20	$243.48	$389.00	$243.48	$48.44	$55.15	$55.15	$61.93	$166.90	$0.00	$0.00	$0.00	$0.00
36100258	EAP	CPT® 17000		"Destruc Lesion Benign, 1st"	BOTH IP/OP	$389.00 	$287.86	$0.00	$389.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.08	$0.00	$0.00	$0.00	$172.08	$81.07	$111.85	$113.00	$113.00	$175.24	$389.00	$308.09	$311.20	$243.48	$0.00	$243.48	$48.44	$55.15	$55.15	$61.93	$166.90	$0.00	$0.00	$0.00	$0.00
36100259	EAP	CPT® 17003		"Dest, Premalignant Lesion 2-14"	BOTH IP/OP	$389.00 	$287.86	$0.00	$389.00	$389.00	$389.00	$0.00	$0.00	$0.00	$81.08	$0.00	$0.00	$0.00	$0.00	$81.07	$0.00	$230.09	$230.09	$0.00	$389.00	$308.09	$311.20	$0.00	$389.00	$0.00	$12.73	$2.16	$2.16	$61.93	$0.00	$0.00	$0.00	$0.00	$0.00
36100260	EAP	CPT® 17004		"Les Dest, Benign Premal > 15"	BOTH IP/OP	$807.00 	$597.18	$0.00	$807.00	$807.00	$807.00	$336.60	$336.60	$338.49	$168.20	$0.00	$0.00	$0.00	$331.46	$168.18	$215.45	$807.00	$807.00	$0.00	$806.00	$638.35	$644.80	$0.00	$807.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100261	EAP	CPT® 17004		Lesion Destr Benign >15	BOTH IP/OP	$806.00 	$596.44	$0.00	$806.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.99	$0.00	$0.00	$0.00	$331.46	$167.97	$215.45	$806.00	$806.00	$0.00	$806.00	$638.35	$644.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100262	EAP	CPT® 17110		"Dest Flat Warts Mollu,milla"	BOTH IP/OP	$365.00 	$270.10	$0.00	"$1,750.00"	$365.00	$365.00	$174.88	$174.88	$175.86	$76.08	$0.00	$0.00	$0.00	$172.08	$76.07	$111.85	$113.00	$113.00	$175.24	$365.00	$289.08	$292.00	$243.48	"$1,750.00"	$243.48	$49.09	$68.84	$68.84	$58.11	$166.90	$0.00	$0.00	$0.00	$0.00
36100263	EAP	CPT® 17110		"Dest Flat Warts, Up To 14 Les"	BOTH IP/OP	$365.00 	$270.10	$0.00	$365.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$365.00	$289.08	$292.00	$243.48	$0.00	$243.48	$49.09	$68.84	$68.84	$58.11	$166.90	$0.00	$0.00	$0.00	$0.00
36100264	EAP	CPT® 17110		Destr Flat Wart Mollu Milia <1	BOTH IP/OP	$365.00 	$270.10	$0.00	$365.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$365.00	$289.08	$292.00	$243.48	$0.00	$243.48	$49.09	$68.84	$68.84	$58.11	$166.90	$0.00	$0.00	$0.00	$0.00
36100266	EAP	CPT® 17111		"Dest. Flat Warts, >15 Lesions"	BOTH IP/OP	$807.00 	$597.18	$0.00	$807.00	$807.00	$807.00	$174.88	$174.88	$175.86	$0.00	$0.00	$0.00	$0.00	$0.00	$168.18	$0.00	$0.00	$0.00	$175.24	$806.00	$638.35	$644.80	$243.48	$807.00	$243.48	$66.36	$84.34	$84.34	$128.32	$166.90	$0.00	$0.00	$0.00	$0.00
36100268	EAP	CPT® 17250		"Cauterization, Medical"	BOTH IP/OP	$752.00 	$556.48	$0.00	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$752.00	$595.58	$601.60	$243.48	$0.00	$243.48	$37.05	$38.57	$38.57	$119.72	$166.90	$0.00	$0.00	$0.00	$0.00
36100269	EAP	CPT® 17250		Chemical Cautery Tissue	BOTH IP/OP	$753.00 	$557.22	$0.00	"$1,305.00"	$753.00	$753.00	$174.88	$174.88	$175.86	$156.94	$0.00	$0.00	$0.00	$172.08	$156.93	$111.85	$113.00	$113.00	$175.24	$752.00	$595.58	$601.60	$243.48	"$1,305.00"	$243.48	$37.05	$38.57	$38.57	$119.72	$166.90	$0.00	$0.00	$0.00	$0.00
36100270	EAP	CPT® 36569		Mid Line Insertion	BOTH IP/OP	"$6,447.00 "	"$4,770.78"	$98.45	"$4,343.20"	"$2,321.55"	"$2,321.55"	"$1,369.42"	"$1,369.42"	"$1,377.13"	"$1,343.72"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,347.67"	"$1,343.55"	$875.99	"$1,871.00"	"$1,871.00"	"$1,635.92"	"$2,255.00"	"$4,299.77"	"$4,343.20"	"$2,272.90"	"$4,190.55"	"$2,272.90"	$346.84	$98.45	$98.45	$864.30	"$1,558.02"	$0.00	$0.00	$0.00	$0.00
36100272	EAP	CPT® 17260		Lesion Dstr Malig Trnk Arm <.5	BOTH IP/OP	$670.00 	$495.80	$0.00	$670.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.63	$0.00	$0.00	$0.00	$0.00	$670.00	$530.64	$536.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100273	EAP	CPT® 17261		Les Dstr Malig Trnk Arm 0.6-1.	BOTH IP/OP	$753.00 	$557.22	$0.00	$753.00	$753.00	$753.00	$174.88	$174.88	$175.86	$156.94	$0.00	$0.00	$0.00	$172.08	$156.93	$111.85	$113.00	$113.00	$175.24	$752.00	$595.58	$601.60	$243.48	$753.00	$243.48	$94.09	$89.76	$89.76	$119.72	$166.90	$0.00	$0.00	$0.00	$0.00
36100274	EAP	CPT® 17262		Les Dstr Malig Trnk Arm 1.1-2.	BOTH IP/OP	$753.00 	$557.22	$0.00	$753.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.93	$0.00	$0.00	$0.00	$0.00	$752.00	$595.58	$601.60	$0.00	$753.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100275	EAP	CPT® 17263		Les Dstr Malig Trnk Arm 2.1-3.	BOTH IP/OP	$646.00 	$478.04	$0.00	$646.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.63	$0.00	$0.00	$0.00	$0.00	$645.00	$510.84	$516.00	$0.00	$646.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100276	EAP	CPT® 17264		Les Dstr Malig Trnk Arm 3.1-4.	BOTH IP/OP	$645.00 	$477.30	$0.00	$645.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.42	$0.00	$0.00	$0.00	$0.00	$645.00	$510.84	$516.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100277	EAP	CPT® 17266		Les Dstr Malig Trnk Arm >4.0	BOTH IP/OP	"$1,428.00 "	"$1,056.72"	$0.00	"$1,428.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$297.60	$0.00	$0.00	$0.00	$0.00	"$1,428.00"	"$1,130.98"	"$1,142.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100278	EAP	CPT® 17271		Les Dstr Malig Sclp Nck 0.6-1.	BOTH IP/OP	$946.00 	$700.04	$0.00	$946.00	$946.00	$946.00	$174.88	$174.88	$175.86	$197.17	$0.00	$0.00	$0.00	$172.08	$197.15	$111.85	$113.00	$113.00	$175.24	$945.00	$748.44	$756.00	$243.48	$946.00	$243.48	$115.27	$108.87	$108.87	$150.44	$166.90	$0.00	$0.00	$0.00	$0.00
36100279	EAP	CPT® 17272		Les Dstr Malig Sclp Nck 1.1-2.	BOTH IP/OP	$646.00 	$478.04	$0.00	$646.00	$646.00	$646.00	$174.88	$174.88	$175.86	$134.64	$0.00	$0.00	$0.00	$172.08	$134.63	$111.85	$113.00	$113.00	$175.24	$645.00	$510.84	$516.00	$243.48	$646.00	$243.48	$136.47	$126.90	$126.90	$102.68	$166.90	$0.00	$0.00	$0.00	$0.00
36100280	EAP	CPT® 17273		Les Dstr Malig Sclp Nck 2.1-3.	BOTH IP/OP	$974.00 	$720.76	$0.00	$974.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$974.00	$771.41	$779.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100281	EAP	CPT® 17274		Les Dstr Malig Sclp Nck 3.1-4.	BOTH IP/OP	"$1,430.00 "	"$1,058.20"	$0.00	"$1,430.00"	"$1,430.00"	"$1,430.00"	$336.60	$336.60	$338.49	$298.05	$0.00	$0.00	$0.00	$331.46	$298.01	$215.45	"$1,430.00"	"$1,430.00"	$320.45	"$1,428.00"	"$1,130.98"	"$1,142.40"	$445.22	"$1,430.00"	$445.22	$192.94	$175.94	$175.94	$227.34	$305.19	$0.00	$0.00	$0.00	$0.00
36100282	EAP	CPT® 17280		Lesion Dstr Malig Face Ear <.5	BOTH IP/OP	$646.00 	$478.04	$0.00	$646.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.63	$0.00	$0.00	$0.00	$0.00	$645.00	$510.84	$516.00	$0.00	$646.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100283	EAP	CPT® 17281		Les Dstr Malig Face Ear 0.6-1.	BOTH IP/OP	"$1,726.00 "	"$1,277.24"	$0.00	"$1,726.00"	"$1,726.00"	"$1,726.00"	$336.60	$336.60	$338.49	$359.74	$0.00	$0.00	$0.00	$331.46	$359.70	$215.45	$113.00	$113.00	$0.00	"$1,724.00"	"$1,365.41"	"$1,379.20"	$0.00	"$1,726.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100284	EAP	CPT® 17282		Les Dstr Malig Face Ear 1.1-2.	BOTH IP/OP	$974.00 	$720.76	$0.00	$974.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$974.00	$771.41	$779.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100285	EAP	CPT® 19000		"Punc Asp Cyst, Breast"	BOTH IP/OP	"$1,141.00 "	$844.34	$0.00	"$1,141.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.80	"$1,141.00"	$903.67	$912.80	$850.02	$0.00	$850.02	$59.58	$45.43	$45.43	$181.65	$582.67	$0.00	$0.00	$0.00	$0.00
36100288	EAP	CPT® 19000		Puncture Aspiration Of Breast	BOTH IP/OP	"$1,141.00 "	$844.34	$0.00	"$1,141.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.80	"$1,141.00"	$903.67	$912.80	$850.02	$0.00	$850.02	$59.58	$45.43	$45.43	$181.65	$582.67	$0.00	$0.00	$0.00	$0.00
36100289	EAP	CPT® 19001		Each Additiona Cyst-breast	BOTH IP/OP	$921.00 	$681.54	$0.00	"$1,141.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.94	$0.00	$0.00	$0.00	$0.00	"$1,141.00"	$903.67	$912.80	$0.00	$909.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100297	EAP	CPT® 19000		Punc Aspiration Cyst Of Breast	BOTH IP/OP	"$1,141.00 "	$844.34	$0.00	"$1,141.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.80	"$1,141.00"	$903.67	$912.80	$850.02	$0.00	$850.02	$59.58	$45.43	$45.43	$181.65	$582.67	$0.00	$0.00	$0.00	$0.00
36100298	EAP	CPT® 19000		PUNCT ASPIR CYST BREAST BIC	BOTH IP/OP	"$1,130.00 "	$836.20	$45.43	"$1,141.00"	"$1,130.00"	"$1,130.00"	$606.01	$606.01	$609.42	$235.52	"$1,130.00"	"$1,130.00"	"$1,130.00"	$596.11	$235.49	$387.47	"$1,130.00"	"$1,130.00"	$611.80	"$1,141.00"	$903.67	$912.80	$850.02	"$1,130.00"	$850.02	$59.58	$45.43	$45.43	$181.65	$582.67	$0.00	$0.00	$0.00	$0.00
36100299	EAP	CPT® 54065		Destruction Penis Lesion(s)	BOTH IP/OP	"$7,192.00 "	"$5,322.08"	$0.00	"$5,812.00"	"$2,321.55"	"$2,321.55"	"$1,667.97"	"$1,667.97"	"$1,677.37"	$0.00	"$1,257.08"	"$1,257.08"	"$1,305.43"	$0.00	"$1,498.81"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,753.88"	"$5,812.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100300	EAP	CPT® 19001		Punc Aspir Ea Add'l Cyst Breas	BOTH IP/OP	$921.00 	$681.54	$0.00	"$1,141.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.94	$0.00	$0.00	$0.00	$0.00	"$1,141.00"	$903.67	$912.80	$0.00	$909.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100301	EAP	CPT® 19001		PUNCT ASPIR EA ADDT CYST BIC	BOTH IP/OP	"$1,130.00 "	$836.20	$0.00	"$1,141.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.49	$0.00	$0.00	$0.00	$0.00	"$1,141.00"	$903.67	$912.80	$0.00	$909.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100303	EAP	CPT® 19020		Incision Of Breast Lesion Rt	BOTH IP/OP	"$7,031.00 "	"$5,202.94"	$0.00	"$5,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,465.44"	$0.00	$0.00	$0.00	"$1,348.50"	"$1,465.26"	$876.52	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$5,624.78"	"$5,681.60"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100304	EAP	CPT® 19030		GALACTOGRAM INJECTION BIC	BOTH IP/OP	$764.00 	$565.36	$0.00	$946.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.22	$0.00	$0.00	$0.00	$0.00	$946.00	$749.23	$756.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100306	EAP	CPT® 19100		Breast Bx Needle W/0 Imaging	BOTH IP/OP	"$1,927.00 "	"$1,425.98"	$0.00	"$1,946.00"	"$1,927.00"	"$1,927.00"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$401.63	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	$401.59	$876.52	"$1,871.00"	"$1,871.00"	$0.00	"$1,946.00"	"$1,541.23"	"$1,556.80"	$0.00	"$1,927.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100307	EAP	CPT® 19100		"Breast Bx, Needle"	BOTH IP/OP	"$1,571.00 "	"$1,162.54"	$0.00	"$1,946.00"	"$1,571.00"	"$1,571.00"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$327.44	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	$327.40	$876.52	"$1,571.00"	"$1,571.00"	$0.00	"$1,946.00"	"$1,541.23"	"$1,556.80"	$0.00	"$1,927.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100318	EAP	CPT® 19296		Place Po Breast Cath For Rad	BOTH IP/OP	"$17,549.00 "	"$12,986.26"	$0.00	"$17,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,657.21"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$17,214.91"	"$17,388.80"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100319	EAP	CPT® 19297		Br Cath For Rad Concur W/pt Ma	BOTH IP/OP	"$17,549.00 "	"$12,986.26"	$0.00	"$17,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,657.21"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$17,214.91"	"$17,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100320	EAP	CPT® 19357		Breast Reconst Tiss Expander	BOTH IP/OP	"$11,975.00 "	"$8,861.50"	$0.00	"$11,825.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,495.59"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$11,707.34"	"$11,825.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100321	EAP	CPT® 19499		Duct Lav Aspiration	BOTH IP/OP	"$6,124.00 "	"$4,531.76"	$0.00	"$4,899.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,276.24"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,850.21"	"$4,899.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100322	EAP	CPT® 20103		"Explore Wound, Extremity"	BOTH IP/OP	"$3,502.00 "	"$2,591.48"	$0.00	"$2,801.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.80	"$2,255.00"	"$2,773.58"	"$2,801.60"	$850.02	$0.00	$850.02	$323.52	$360.85	$360.85	$557.52	$582.67	$0.00	$0.00	$0.00	$0.00
36100323	EAP	CPT® 20206		BX MUSCLE NEEDLE PERCUT BCT	BOTH IP/OP	"$1,504.00 "	"$1,112.96"	$60.21	"$1,504.00"	"$1,504.00"	"$1,504.00"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$313.47	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	$313.43	$876.52	"$1,504.00"	"$1,504.00"	"$1,376.63"	"$1,500.00"	"$1,188.00"	"$1,200.00"	"$1,500.00"	"$1,504.00"	"$1,500.00"	$104.27	$60.21	$60.21	$238.80	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100324	EAP	CPT® 20206		Bx Muscle Needle Us	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$60.21	"$1,504.00"	"$1,500.00"	"$1,500.00"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$312.64	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	$312.60	$876.52	"$1,500.00"	"$1,500.00"	"$1,376.63"	"$1,500.00"	"$1,188.00"	"$1,200.00"	"$1,500.00"	"$1,504.00"	"$1,500.00"	$104.27	$60.21	$60.21	$238.80	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100325	EAP	CPT® 20220		Biopsy Bone Trcar/needl Sprfcl	BOTH IP/OP	"$2,013.00 "	"$1,489.62"	$0.00	"$2,013.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,013.00"	"$1,594.30"	"$1,610.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100326	EAP	CPT® 20220		BX BONE TROCAR/NDLE SUPF BCT	BOTH IP/OP	"$2,018.00 "	"$1,493.32"	$0.00	"$2,150.00"	"$2,018.00"	"$2,018.00"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$420.60	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	$420.55	$876.52	"$1,871.00"	"$1,871.00"	$0.00	"$2,013.00"	"$1,594.30"	"$1,610.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100327	EAP	CPT® 20225		Biopsy Bone Trocar/needle Deep	BOTH IP/OP	"$3,050.00 "	"$2,257.00"	$0.00	"$2,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,376.63"	"$2,327.00"	"$2,415.60"	"$2,440.00"	"$1,912.65"	$0.00	"$1,912.65"	$126.60	$137.03	$137.03	$485.56	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100328	EAP	CPT® 20225		BX BONE TROCAR/NDLE DEEP BCT	BOTH IP/OP	"$3,057.00 "	"$2,262.18"	$126.60	"$2,836.00"	"$2,753.10"	"$2,753.10"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$637.16	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,348.50"	$637.08	$876.52	"$2,836.00"	"$2,836.00"	"$1,376.63"	"$2,327.00"	"$2,415.60"	"$2,440.00"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$126.60	$137.03	$137.03	$485.56	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100329	EAP	CPT® 20501		Inject Sinus Tract Diagnostic	BOTH IP/OP	"$1,226.00 "	$907.24	$0.00	"$1,238.00"	"$1,226.00"	"$1,226.00"	$0.00	$0.00	$0.00	$255.53	$0.00	$0.00	$0.00	$0.00	$255.50	$0.00	$725.18	$725.18	$0.00	"$1,238.00"	$980.50	$990.40	$0.00	"$1,068.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100330	EAP	CPT® 20520		Remove Foreign Body (simple)	BOTH IP/OP	"$1,594.00 "	"$1,179.56"	$0.00	"$1,594.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$332.19	$0.00	$0.00	$0.00	$0.00	"$1,550.00"	"$1,227.60"	"$1,240.00"	$0.00	"$1,594.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100331	EAP	CPT® 20525		Remove Foreign Body (compl.)	BOTH IP/OP	"$2,653.00 "	"$1,963.22"	$0.00	"$2,741.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$552.89	$0.00	$0.00	$0.00	$0.00	"$2,741.00"	"$2,170.87"	"$2,192.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100332	EAP	CPT® 20526		Carpal Tunnel Injection	BOTH IP/OP	$903.00 	$668.22	$0.00	$904.00	$903.00	$903.00	$254.43	$254.43	$255.86	$188.21	$0.00	$0.00	$0.00	$250.31	$188.19	$162.70	$903.00	$903.00	$262.54	$904.00	$715.97	$723.20	$364.76	$903.00	$364.76	$141.48	$59.49	$59.49	$143.92	$250.04	$0.00	$0.00	$0.00	$0.00
36100333	EAP	CPT® 20550		Inject Tendon Sheath Ligament	BOTH IP/OP	$719.00 	$532.06	$40.75	$720.00	$719.00	$719.00	$254.43	$254.43	$255.86	$149.86	$719.00	$719.00	$719.00	$250.31	$149.84	$162.70	$719.00	$719.00	$262.54	$720.00	$570.24	$576.00	$364.76	$719.00	$364.76	$70.34	$40.75	$40.75	$114.62	$250.04	$0.00	$0.00	$0.00	$0.00
36100336	EAP	CPT® 20551		Inj Tendon Origin/insertion	BOTH IP/OP	$903.00 	$668.22	$0.00	$904.00	$903.00	$903.00	$254.43	$254.43	$255.86	$188.21	$0.00	$0.00	$0.00	$250.31	$188.19	$162.70	$903.00	$903.00	$262.54	$904.00	$715.97	$723.20	$364.76	$903.00	$364.76	$66.56	$41.47	$41.47	$143.92	$250.04	$0.00	$0.00	$0.00	$0.00
36100337	EAP	CPT® 20552		Inject Trigger Point 1-2 Musc	BOTH IP/OP	$640.00 	$473.60	$0.00	"$1,750.00"	$640.00	$640.00	$254.43	$254.43	$255.86	$133.39	$0.00	$0.00	$0.00	$250.31	$133.38	$162.70	$640.00	$640.00	$262.54	$641.00	$507.67	$512.80	$364.76	"$1,750.00"	$364.76	$66.56	$40.02	$40.02	$102.05	$250.04	$0.00	$0.00	$0.00	$0.00
36100338	EAP	CPT® 20553		Trigger Point Injections: Three Or More Muscles	BOTH IP/OP	$903.00 	$668.22	$0.00	"$1,750.00"	$903.00	$903.00	$254.43	$254.43	$255.86	$188.21	$0.00	$0.00	$0.00	$250.31	$188.19	$162.70	$903.00	$903.00	$262.54	$904.00	$715.97	$723.20	$364.76	"$1,750.00"	$364.76	$66.56	$45.07	$45.07	$143.92	$250.04	$0.00	$0.00	$0.00	$0.00
36100339	EAP	CPT® 20600		Drain/inject-finger/toe Wo Us Guidance	BOTH IP/OP	$935.00 	$691.90	$37.50	$936.00	$935.00	$935.00	$254.43	$254.43	$255.86	$194.88	$935.00	$935.00	$935.00	$250.31	$194.85	$162.70	$935.00	$935.00	$262.54	$936.00	$741.31	$748.80	$364.76	$935.00	$364.76	$54.79	$37.50	$37.50	$149.01	$250.04	$0.00	$0.00	$0.00	$0.00
36100340	EAP	CPT® 50561		Kindey Endoscopy & Treatment	BOTH IP/OP	"$6,215.00 "	"$4,599.10"	$0.00	"$4,972.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,295.21"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,922.28"	"$4,972.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100345	EAP	CPT® 20605		Drain/inject-wrist Elbow Ankle Wo Us Guidance	BOTH IP/OP	$935.00 	$691.90	$0.00	"$1,288.00"	$935.00	$935.00	$254.43	$254.43	$255.86	$194.88	$0.00	$0.00	$0.00	$250.31	$194.85	$162.70	$935.00	$935.00	$262.54	$936.00	$741.31	$748.80	$364.76	"$1,288.00"	$364.76	$60.50	$38.94	$38.94	$149.01	$250.04	$0.00	$0.00	$0.00	$0.00
36100348	EAP	CPT® 20610		Drain/inject-shoulder Hip Knee Wo Us Guidance	BOTH IP/OP	"$2,198.00 "	"$1,626.52"	$47.59	"$2,200.00"	"$2,198.00"	"$2,198.00"	$254.43	$254.43	$255.86	$458.12	"$1,257.08"	"$1,257.08"	"$1,305.43"	$250.31	$458.06	$162.70	"$1,871.00"	"$1,871.00"	$262.54	"$2,200.00"	"$1,742.40"	"$1,760.00"	$364.76	"$1,750.00"	$364.76	$70.76	$47.59	$47.59	$350.24	$250.04	$0.00	$0.00	$0.00	$0.00
36100349	EAP	CPT® 41009		Drainage Of Mouth Lesion	BOTH IP/OP	"$6,979.00 "	"$5,164.46"	$0.00	"$6,556.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,454.42"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,490.44"	"$6,556.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100354	EAP	CPT® 20612		"Aspiration/inj.,gangion Cyst"	BOTH IP/OP	"$1,050.00 "	$777.00	$0.00	"$1,051.00"	"$1,050.00"	"$1,050.00"	$254.43	$254.43	$255.86	$0.00	$0.00	$0.00	$0.00	$250.31	$218.82	$162.70	"$1,050.00"	"$1,050.00"	$262.54	"$1,051.00"	$832.39	$840.80	$364.76	"$1,050.00"	$364.76	$54.88	$42.90	$42.90	$167.32	$250.04	$0.00	$0.00	$0.00	$0.00
36100355	EAP	CPT® 20670		Arch Bar Removal	BOTH IP/OP	"$6,755.00 "	"$4,998.70"	$0.00	"$5,404.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,498.16"	$0.00	$0.00	$0.00	"$1,348.50"	"$1,497.98"	$876.52	"$1,871.00"	"$1,871.00"	"$1,376.63"	"$2,255.00"	"$5,349.96"	"$5,404.00"	"$1,912.65"	$0.00	"$1,912.65"	$166.32	$150.66	$150.66	"$1,075.40"	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100356	EAP	CPT® 20670		Removal Implant; Superficial	BOTH IP/OP	"$7,188.00 "	"$5,319.12"	$150.66	"$5,404.00"	"$2,321.55"	"$2,321.55"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$1,498.16"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	"$1,497.98"	$876.52	"$1,871.00"	"$1,871.00"	"$1,376.63"	"$2,255.00"	"$5,349.96"	"$5,404.00"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$166.32	$150.66	$150.66	"$1,075.40"	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100357	EAP	CPT® 21025		"Sequestrectomy, Mandible"	BOTH IP/OP	"$12,260.00 "	"$9,072.40"	$0.00	"$9,808.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,554.98"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$9,709.92"	"$9,808.00"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100358	EAP	CPT® 21026		"Sequestrectomy, Maxilla"	BOTH IP/OP	"$8,448.00 "	"$6,251.52"	$0.00	"$6,758.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,760.56"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$6,690.82"	"$6,758.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100359	EAP	CPT® 21031		Excision Of Torus Mandibularis	BOTH IP/OP	"$3,080.00 "	"$2,279.20"	$0.00	"$3,080.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$641.87	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,439.36"	"$2,464.00"	$0.00	"$3,080.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100360	EAP	CPT® 21032		Excision Of Maxillary Torus	BOTH IP/OP	"$4,910.00 "	"$3,633.40"	$0.00	"$4,877.00"	"$2,321.55"	"$2,321.55"	"$2,664.14"	"$2,664.14"	"$2,679.15"	"$1,023.37"	$0.00	$0.00	$0.00	"$2,622.61"	"$1,023.24"	"$1,704.70"	"$4,877.00"	"$4,877.00"	$0.00	"$2,327.00"	"$3,888.72"	"$3,928.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100361	EAP	CPT® 21208		"Osteoplasty, Facial Bones"	BOTH IP/OP	"$7,747.00 "	"$5,732.78"	$0.00	"$6,197.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.47"	$0.00	$0.00	$0.00	$0.00	"$4,975.00"	"$6,135.62"	"$6,197.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100362	EAP	CPT® 21320		Closed Nasal Bone W/stabiliza	BOTH IP/OP	"$4,482.00 "	"$3,316.68"	$0.00	"$3,585.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$934.05	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,549.74"	"$3,585.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100364	EAP	CPT® 21440		Reduce Alveolar Ridge Fracture	BOTH IP/OP	"$2,518.00 "	"$1,863.32"	$0.00	"$2,518.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$524.75	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,014.06"	"$2,034.40"	$0.00	"$2,518.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100365	EAP	CPT® 21453		Reduce Mandibular Interdental	BOTH IP/OP	"$7,522.00 "	"$5,566.28"	$0.00	"$7,020.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,567.58"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$6,950.59"	"$7,020.80"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100366	EAP	CPT® 21480		"Reduce Tmj Disloca, Ix Or Sub"	BOTH IP/OP	$257.00 	$190.18	$0.00	$257.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.56	$0.00	$0.00	$0.00	$0.00	$257.00	$203.54	$205.60	$0.00	$257.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100368	EAP	CPT® 21550		Biopsy Neck	BOTH IP/OP	"$4,410.00 "	"$3,263.40"	$0.00	"$3,519.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$919.04	$0.00	$0.00	$0.00	"$1,376.63"	"$2,255.00"	"$3,484.01"	"$3,519.20"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$132.10	$161.13	$161.13	$700.32	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100369	EAP	CPT® 21550		"Biopsy, Neck/thorax"	BOTH IP/OP	"$4,399.00 "	"$3,255.26"	$0.00	"$3,519.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$916.75	$0.00	$0.00	$0.00	"$1,376.63"	"$2,255.00"	"$3,484.01"	"$3,519.20"	"$1,912.65"	$0.00	"$1,912.65"	$132.10	$161.13	$161.13	$700.32	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100376	EAP	CPT® 23350		Injection Shoulder Arthrograph	BOTH IP/OP	"$1,471.00 "	"$1,088.54"	$0.00	"$1,486.00"	"$1,471.00"	"$1,471.00"	$0.00	$0.00	$0.00	$306.59	$0.00	$0.00	$0.00	$0.00	$306.56	$0.00	$870.10	$870.10	$0.00	"$1,486.00"	"$1,176.91"	"$1,188.80"	$0.00	$952.00	$0.00	$202.19	$53.01	$53.01	$236.57	$0.00	$0.00	$0.00	$0.00	$0.00
36100379	EAP	CPT® 24220		Injection Elbow Arthrography	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$2,200.00"	"$1,742.40"	"$1,760.00"	$0.00	"$1,049.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100380	EAP	CPT® 25246		Injection Wrist Arthrography	BOTH IP/OP	"$1,633.00 "	"$1,208.42"	$0.00	"$1,487.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.32	$0.00	$0.00	$0.00	$0.00	"$1,487.00"	"$1,177.70"	"$1,189.60"	$0.00	"$1,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100382	EAP	CPT® 26010		"I&d Finger Abscess, Simple"	BOTH IP/OP	"$1,407.00 "	"$1,041.18"	$0.00	"$1,407.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$293.25	$0.00	$0.00	$0.00	$172.08	$293.22	$111.85	$113.00	$113.00	$0.00	"$1,407.00"	"$1,114.34"	"$1,125.60"	$0.00	"$1,216.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100383	EAP	CPT® 26011		Abscess Finger Complicated	BOTH IP/OP	"$4,878.00 "	"$3,609.72"	$0.00	"$3,901.60"	"$2,321.55"	"$2,321.55"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$1,016.70"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	"$1,016.58"	$876.52	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$3,862.58"	"$3,901.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100384	EAP	CPT® 26035		"Decompression Fingers, Hand"	BOTH IP/OP	"$3,306.00 "	"$2,446.44"	$0.00	"$2,809.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.97	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,781.50"	"$2,809.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100386	EAP	CPT® 27093		Injection  Hip Arthro W/o Anes	BOTH IP/OP	"$1,657.00 "	"$1,226.18"	$0.00	"$1,674.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.32	$0.00	$0.00	$0.00	$0.00	"$1,674.00"	"$1,325.81"	"$1,339.20"	$0.00	"$1,140.00"	$0.00	$243.74	$72.12	$72.12	$266.50	$0.00	$0.00	$0.00	$0.00	$0.00
36100388	EAP	CPT® 27095		Injection Hip Arthro W Anes	BOTH IP/OP	"$2,101.00 "	"$1,554.74"	$0.00	"$2,101.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$437.85	$0.00	$0.00	$0.00	$0.00	"$2,101.00"	"$1,663.99"	"$1,680.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100389	EAP	CPT® 27096		Sacroiliac Jt Inj With Arthrography	BOTH IP/OP	"$2,110.00 "	"$1,561.40"	$0.00	"$2,131.00"	"$2,110.00"	"$2,110.00"	$618.38	$618.38	$621.87	$439.78	$0.00	$0.00	$0.00	$608.20	$439.72	$395.33	$113.00	$113.00	$0.00	"$2,131.00"	"$1,687.75"	"$1,704.80"	$86.18	"$2,110.00"	$86.18	$398.44	$86.18	$86.18	$339.26	$0.00	$0.00	$0.00	$0.00	$0.00
36100391	EAP	CPT® 27630		"Excision, Les Ankle/lower Leg"	BOTH IP/OP	"$7,251.00 "	"$5,365.74"	$0.00	"$5,800.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,511.11"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$5,742.79"	"$5,800.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100392	EAP	CPT® 27648		Injection Ankle Arthrography	BOTH IP/OP	"$1,873.00 "	"$1,386.02"	$0.00	"$1,892.00"	"$1,873.00"	"$1,873.00"	$0.00	$0.00	$0.00	$390.38	$0.00	$0.00	$0.00	$0.00	$390.33	$0.00	"$1,107.88"	"$1,107.88"	$0.00	"$1,892.00"	"$1,498.46"	"$1,513.60"	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100393	EAP	CPT® 28080		"Excision,les. Interdigital Leg"	BOTH IP/OP	"$4,873.00 "	"$3,606.02"	$0.00	"$4,127.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,015.53"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,085.93"	"$4,127.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100394	EAP	CPT® 28090		"Excision, Cyst Foot"	BOTH IP/OP	"$4,873.00 "	"$3,606.02"	$0.00	"$4,127.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,015.53"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,085.93"	"$4,127.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100395	EAP	CPT® 28092		"Excision, Lesion, Toe(s) Each"	BOTH IP/OP	"$4,873.00 "	"$3,606.02"	$0.00	"$4,127.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,015.53"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,085.93"	"$4,127.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100396	EAP	CPT® 28190		"Removal Fb, Foot Sc"	BOTH IP/OP	"$1,304.00 "	$964.96	$0.00	"$1,304.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.80	"$1,304.00"	"$1,032.77"	"$1,043.20"	$850.02	$0.00	$850.02	$173.39	$138.80	$138.80	$207.60	$582.67	$0.00	$0.00	$0.00	$0.00
36100397	EAP	CPT® 28192		"Removal Fb, Foot Deep"	BOTH IP/OP	"$5,468.00 "	"$4,046.32"	$0.00	"$4,374.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,139.53"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,330.66"	"$4,374.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100398	EAP	CPT® 28193		"Removal Fb, Foot, Complicated"	BOTH IP/OP	"$5,468.00 "	"$4,046.32"	$0.00	"$4,374.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,139.53"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$4,330.66"	"$4,374.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100399	EAP	CPT® 29130		"Splinting, Finger"	BOTH IP/OP	$859.00 	$635.66	$0.00	$859.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$859.00	$680.33	$687.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100402	EAP	CPT® 29260		"Splint Application, Wrist"	BOTH IP/OP	"$1,018.00 "	$753.32	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.53	"$1,018.00"	$806.26	$814.40	$46.58	$0.00	$46.58	$44.15	$20.20	$20.20	$162.07	$31.93	$0.00	$0.00	$0.00	$0.00
36100403	EAP	CPT® 29515		Splint Application Ankle	BOTH IP/OP	$888.00 	$657.12	$0.00	$888.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.13	$888.00	$703.30	$710.40	$186.36	$0.00	$186.36	$80.51	$51.19	$51.19	$141.37	$127.75	$0.00	$0.00	$0.00	$0.00
36100404	EAP	CPT® 29515		"Splint Application, Ankle"	BOTH IP/OP	$794.00 	$587.56	$0.00	$943.00	$431.14	$431.14	$137.58	$137.58	$138.36	$165.49	$0.00	$0.00	$0.00	$135.31	$165.47	$87.95	$113.00	$113.00	$134.13	$888.00	$703.30	$710.40	$186.36	$943.00	$186.36	$80.51	$51.19	$51.19	$141.37	$127.75	$0.00	$0.00	$0.00	$0.00
36100405	EAP	CPT® 29530		"Wrapping, Knee"	BOTH IP/OP	$681.00 	$503.94	$0.00	$762.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.92	$0.00	$0.00	$0.00	$0.00	$762.00	$603.50	$609.60	$0.00	$341.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100406	EAP	CPT® 29540		Strapping Of Ankle And/or Ft	BOTH IP/OP	$345.00 	$255.30	$0.00	$345.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.00	$273.24	$276.00	$0.00	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100407	EAP	CPT® 29540		"Wrapping, Ankle"	BOTH IP/OP	$366.00 	$270.84	$0.00	$345.00	$198.74	$198.74	$137.58	$137.58	$138.36	$76.28	$0.00	$0.00	$0.00	$135.31	$76.27	$87.95	$113.00	$113.00	$0.00	$345.00	$273.24	$276.00	$0.00	$237.90	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100408	EAP	CPT® 29550		"Splinting, Toes"	BOTH IP/OP	$751.00 	$555.74	$0.00	$707.00	$407.79	$407.79	$54.21	$54.21	$54.51	$156.53	$0.00	$0.00	$0.00	$53.35	$156.51	$34.67	$113.00	$113.00	$0.00	$707.00	$559.94	$565.60	$0.00	$281.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100409	EAP	CPT® 29580		Unna Boot	BOTH IP/OP	$828.00 	$612.72	$0.00	$780.00	$449.60	$449.60	$137.58	$137.58	$138.36	$172.58	$0.00	$0.00	$0.00	$135.31	$172.56	$87.95	$113.00	$113.00	$134.13	$780.00	$617.76	$624.00	$186.36	$538.20	$186.36	$54.52	$28.49	$28.49	$124.18	$127.75	$0.00	$0.00	$0.00	$0.00
36100411	EAP	CPT® 30100		"Biopsy, Intranasal"	BOTH IP/OP	"$1,837.00 "	"$1,359.38"	$0.00	"$1,837.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.83	$0.00	$0.00	$0.00	"$1,353.31"	"$1,833.00"	"$1,451.74"	"$1,466.40"	"$1,833.00"	"$1,837.00"	"$1,833.00"	$68.81	$68.85	$68.85	$291.81	"$1,288.86"	$0.00	$0.00	$0.00	$0.00
36100412	EAP	CPT® 30300		Remove Fb Intranasal	BOTH IP/OP	$272.00 	$201.28	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.68	$0.00	$0.00	$0.00	$0.00	$272.00	$215.42	$217.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100414	EAP	CPT® 30901		Control Nasal Hemorr Ant Simpl	BOTH IP/OP	$348.00 	$257.52	$0.00	$348.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.00	$275.62	$278.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100416	EAP	CPT® 30903		Control Nasal Hemorr Ant Compl	BOTH IP/OP	$358.00 	$264.92	$0.00	$358.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$358.00	$283.54	$286.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100418	EAP	CPT® 30905		Control Nasal Hemorr Post Init	BOTH IP/OP	$518.00 	$383.32	$0.00	$518.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.95	$0.00	$0.00	$0.00	$0.00	$518.00	$410.26	$414.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100420	EAP	CPT® 31000		Maxillary Sinus Irrigation	BOTH IP/OP	$605.00 	$447.70	$0.00	$605.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.08	$0.00	$0.00	$0.00	$0.00	$605.00	$479.16	$484.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100422	EAP	CPT® 31231		Nasal Endoscopy Dx Uni/bilat	BOTH IP/OP	$887.00 	$656.38	$65.62	$887.00	$887.00	$887.00	$160.31	$160.31	$161.21	$184.87	$887.00	$887.00	$887.00	$157.55	$184.85	$102.41	$113.00	$113.00	$157.01	$822.00	$651.02	$657.60	$218.14	$887.00	$218.14	$98.38	$65.62	$65.62	$130.86	$149.53	$0.00	$0.00	$0.00	$0.00
36100423	EAP	CPT® 31500		Endotracheal Intubation	BOTH IP/OP	"$2,893.00 "	"$2,140.82"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,147.18"	"$2,147.18"	"$2,229.92"	$0.00	$602.90	$0.00	$0.00	$0.00	$204.24	"$2,255.00"	"$2,103.55"	"$2,124.80"	$283.76	"$1,750.00"	$283.76	$0.00	$149.30	$149.30	$422.84	$194.51	$0.00	$0.00	$0.00	$0.00
36100428	EAP	CPT® 31502		Et/trach Change	BOTH IP/OP	"$1,571.00 "	"$1,162.54"	$36.42	"$1,571.00"	"$1,571.00"	"$1,571.00"	$206.03	$206.03	$207.19	$327.44	"$1,166.00"	"$1,166.00"	"$1,210.93"	$202.80	$327.40	$131.82	"$1,571.00"	"$1,571.00"	$204.24	"$1,442.00"	"$1,142.06"	"$1,153.60"	$283.76	"$1,571.00"	$283.76	$63.79	$36.42	$36.42	$229.57	$194.51	$0.00	$0.00	$0.00	$0.00
36100429	EAP	CPT® 31502		Trach Set Change	BOTH IP/OP	"$1,379.00 "	"$1,020.46"	$0.00	"$1,571.00"	"$1,379.00"	"$1,379.00"	$206.03	$206.03	$207.19	$287.42	$0.00	$0.00	$0.00	$202.80	$287.38	$131.82	"$1,379.00"	"$1,379.00"	$204.24	"$1,442.00"	"$1,142.06"	"$1,153.60"	$283.76	"$1,571.00"	$283.76	$63.79	$36.42	$36.42	$229.57	$194.51	$0.00	$0.00	$0.00	$0.00
36100430	EAP	CPT® 31502		Tracheotomy Tube Change	BOTH IP/OP	"$1,442.00 "	"$1,067.08"	$0.00	"$1,442.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.24	"$1,442.00"	"$1,142.06"	"$1,153.60"	$283.76	$0.00	$283.76	$63.79	$36.42	$36.42	$229.57	$194.51	$0.00	$0.00	$0.00	$0.00
36100432	EAP	CPT® 31505		"Laryngoscopy, Indirect, Dx"	BOTH IP/OP	$372.00 	$275.28	$0.00	$648.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.21	$0.00	$0.00	$0.00	$0.00	$648.00	$513.22	$518.40	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100434	EAP	CPT® 31510		"Laryngoscopy, Indir, W Bx"	BOTH IP/OP	"$4,546.00 "	"$3,364.04"	$0.00	"$3,804.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$947.39	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,765.96"	"$3,804.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100435	EAP	CPT® 31528		Laryngoscopy And Dilation	BOTH IP/OP	"$9,657.00 "	"$7,146.18"	$0.00	"$8,080.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,012.52"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$7,999.99"	"$8,080.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100437	EAP	CPT® 31575		"Laryngoscopy, Fiberoptic, Dx"	BOTH IP/OP	$745.00 	$551.30	$0.00	"$1,750.00"	$745.00	$745.00	$160.31	$160.31	$161.21	$155.28	$0.00	$0.00	$0.00	$157.55	$155.26	$102.41	$113.00	$113.00	$157.01	$684.00	$541.73	$547.20	$218.14	"$1,750.00"	$218.14	$103.39	$68.49	$68.49	$108.89	$149.53	$0.00	$0.00	$0.00	$0.00
36100438	EAP	CPT® 31605		Tracheostomy-crico	BOTH IP/OP	"$1,598.00 "	"$1,182.52"	$0.00	"$1,598.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$333.02	$0.00	$0.00	$0.00	$0.00	"$1,598.00"	"$1,265.62"	"$1,278.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100442	EAP	CPT® 31612		Trach Punc Percut  Aspir	BOTH IP/OP	"$10,209.00 "	"$7,554.66"	$0.00	"$7,991.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,127.56"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$7,911.29"	"$7,991.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100444	EAP	CPT® 31615		Tracheobronchoscopy	BOTH IP/OP	"$3,046.00 "	"$2,254.04"	$0.00	"$2,384.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$634.86	$0.00	$0.00	$0.00	$433.55	$634.79	$281.81	"$1,871.00"	"$1,871.00"	$443.02	"$2,255.00"	"$2,360.16"	"$2,384.00"	$615.51	"$1,718.00"	$615.51	$0.00	$118.25	$118.25	$474.42	$421.92	$0.00	$0.00	$0.00	$0.00
36100446	EAP	CPT® 31622		Bronchoscopy W Or W/o Washing	BOTH IP/OP	"$4,212.00 "	"$3,116.88"	$0.00	"$2,996.80"	"$2,753.10"	"$2,753.10"	"$1,456.99"	"$1,456.99"	"$1,465.20"	$877.89	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,434.17"	$877.78	$932.21	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$2,966.83"	"$2,996.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100448	EAP	CPT® 31623		Bronchoscopy W/brushing	BOTH IP/OP	"$3,942.00 "	"$2,917.08"	$137.76	"$2,836.00"	"$2,753.10"	"$2,753.10"	"$1,456.99"	"$1,456.99"	"$1,465.20"	$821.61	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,434.17"	$821.51	$932.21	"$2,836.00"	"$2,836.00"	"$1,434.81"	"$2,327.00"	"$2,458.37"	"$2,483.20"	"$1,993.48"	"$2,500.00"	"$1,993.48"	$224.43	$137.76	$137.76	$494.16	"$1,366.49"	$0.00	$0.00	$0.00	$0.00
36100449	EAP	CPT® 31624		Bronchoscopy W/bal	BOTH IP/OP	"$3,942.00 "	"$2,917.08"	$139.56	"$3,085.60"	"$2,753.10"	"$2,753.10"	"$1,456.99"	"$1,456.99"	"$1,465.20"	$821.61	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,434.17"	$821.51	$932.21	"$2,836.00"	"$2,836.00"	"$1,434.81"	"$2,327.00"	"$3,054.74"	"$3,085.60"	"$1,993.48"	"$2,500.00"	"$1,993.48"	$217.26	$139.56	$139.56	$614.03	"$1,366.49"	$0.00	$0.00	$0.00	$0.00
36100450	EAP	CPT® 31625		BRONCH DX /ENDOBRONCHIAL BX  SINGLE/MULTIPLE LOBE	BOTH IP/OP	"$3,942.00 "	"$2,917.08"	$162.28	"$3,085.60"	"$2,753.10"	"$2,753.10"	"$1,456.99"	"$1,456.99"	"$1,465.20"	$821.61	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,434.17"	$821.51	$932.21	"$2,836.00"	"$2,836.00"	"$1,434.81"	"$2,327.00"	"$3,054.74"	"$3,085.60"	"$1,993.48"	"$2,500.00"	"$1,993.48"	$246.87	$162.28	$162.28	$614.03	"$1,366.49"	$0.00	$0.00	$0.00	$0.00
36100452	EAP	CPT® 31628		Transbronch Bx W&w/o Fluo	BOTH IP/OP	"$3,582.00 "	"$2,650.68"	$182.48	"$3,505.00"	"$2,753.10"	"$2,753.10"	"$3,016.56"	"$3,016.56"	"$3,033.56"	$746.58	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,969.20"	$746.49	"$1,929.98"	"$2,836.00"	"$2,836.00"	"$2,945.54"	"$2,327.00"	"$2,775.96"	"$2,804.00"	"$3,505.00"	"$2,500.00"	"$3,505.00"	$278.79	$182.48	$182.48	$558.00	"$2,805.28"	$0.00	$0.00	$0.00	$0.00
36100453	EAP	CPT® 31629		Bron W/trans Needl Aspir	BOTH IP/OP	"$4,091.00 "	"$3,027.34"	$193.66	"$4,003.00"	"$2,753.10"	"$2,753.10"	"$3,016.56"	"$3,016.56"	"$3,033.56"	$852.67	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,969.20"	$852.56	"$1,929.98"	"$2,836.00"	"$2,836.00"	"$2,945.54"	"$2,327.00"	"$3,170.38"	"$3,202.40"	"$4,003.00"	"$3,725.00"	"$4,003.00"	$211.89	$193.66	$193.66	$637.28	"$2,805.28"	$0.00	$0.00	$0.00	$0.00
36100454	EAP	CPT® 31630		Bronchoscopy Dilate/fx Repr	BOTH IP/OP	"$10,854.00 "	"$8,031.96"	$0.00	"$8,496.00"	"$2,753.10"	"$2,753.10"	"$3,016.56"	"$3,016.56"	"$3,033.56"	"$2,262.24"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,969.20"	"$2,261.97"	"$1,929.98"	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$8,411.04"	"$8,496.00"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100455	EAP	CPT® 31631		Tracheal Broncial W&w/o Stent	BOTH IP/OP	"$9,733.00 "	"$7,202.42"	$0.00	"$7,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,028.36"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$7,708.54"	"$7,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100456	EAP	CPT® 31635		"Bronch Tx, Fb Removal"	BOTH IP/OP	"$10,854.00 "	"$8,031.96"	$0.00	"$8,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,261.97"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$8,411.04"	"$8,496.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100457	EAP	CPT® 31635		Bronchoscopy W/fb Removal	BOTH IP/OP	"$10,854.00 "	"$8,031.96"	$0.00	"$8,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,261.97"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$8,411.04"	"$8,496.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100458	EAP	CPT® 31640		Bronchoscopy W/ Tumor	BOTH IP/OP	"$12,526.00 "	"$9,269.24"	$260.01	"$9,804.80"	"$2,753.10"	"$2,753.10"	"$3,016.56"	"$3,016.56"	"$3,033.56"	"$2,610.73"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,969.20"	"$2,610.42"	"$1,929.98"	"$2,836.00"	"$2,836.00"	"$2,945.54"	"$2,327.00"	"$9,706.75"	"$9,804.80"	"$4,092.44"	"$3,725.00"	"$4,092.44"	$319.32	$260.01	$260.01	"$1,951.16"	"$2,805.28"	$0.00	$0.00	$0.00	$0.00
36100459	EAP	CPT® 31643		Bronchoscopy Intracav Rad Addl	BOTH IP/OP	"$10,051.00 "	"$7,437.74"	$0.00	"$7,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,094.63"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$7,789.32"	"$7,868.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100460	EAP	CPT® 31645		Bron W/aspir Trachbron Int	BOTH IP/OP	"$11,900.00 "	"$8,806.00"	$0.00	"$9,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,434.81"	"$2,255.00"	"$9,424.80"	"$9,520.00"	"$1,993.48"	$0.00	"$1,993.48"	$199.84	$152.54	$152.54	"$1,894.48"	"$1,366.49"	$0.00	$0.00	$0.00	$0.00
36100461	EAP	CPT® 31645		"Bronchoscopy, Clear Airways"	BOTH IP/OP	"$12,162.00 "	"$8,999.88"	$152.54	"$9,520.00"	"$2,753.10"	"$2,753.10"	"$1,456.99"	"$1,456.99"	"$1,465.20"	"$2,534.86"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,434.17"	"$2,534.56"	$932.21	"$1,871.00"	"$1,871.00"	"$1,434.81"	"$2,255.00"	"$9,424.80"	"$9,520.00"	"$1,993.48"	"$2,500.00"	"$1,993.48"	$199.84	$152.54	$152.54	"$1,894.48"	"$1,366.49"	$0.00	$0.00	$0.00	$0.00
36100462	EAP	CPT® 31646		Bron W/asp Trachbron Sub	BOTH IP/OP	"$11,900.00 "	"$8,806.00"	$0.00	"$9,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,479.96"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$9,424.80"	"$9,520.00"	$0.00	"$1,370.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100463	EAP	CPT® 31646		"Bronchoscopy, Reclear Airway"	BOTH IP/OP	"$12,162.00 "	"$8,999.88"	$0.00	"$9,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,534.56"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$9,424.80"	"$9,520.00"	$0.00	"$1,370.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100464	EAP	CPT® 31720		Cath Aspir Nasotracbronch	BOTH IP/OP	$250.00 	$185.00	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.00	$198.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100467	EAP	CPT® 31720		Nasotreacheal Suction	BOTH IP/OP	$256.00 	$189.44	$0.00	$680.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.35	$0.00	$0.00	$0.00	$0.00	$250.00	$198.00	$200.00	$0.00	$680.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100468	EAP	CPT® 31720		Suctioning Nasotracheal	BOTH IP/OP	$250.00 	$185.00	$0.00	$680.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$250.00	$198.00	$200.00	$0.00	$680.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100469	EAP	CPT® 31899		Bronchi Medication Injection	BOTH IP/OP	"$4,452.00 "	"$3,294.48"	$0.00	"$4,297.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.80	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,254.62"	"$4,297.60"	$0.00	$343.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100470	EAP	CPT® 32400		Biopsy Pleura Perc Needle	BOTH IP/OP	"$4,094.00 "	"$3,029.56"	$0.00	"$3,275.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,376.63"	"$2,255.00"	"$3,242.45"	"$3,275.20"	"$1,912.65"	$0.00	"$1,912.65"	$123.21	$89.44	$89.44	$651.76	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100471	EAP	CPT® 32400		Pleural Biopsy	BOTH IP/OP	"$4,104.00 "	"$3,036.96"	$0.00	"$3,275.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$855.27	$0.00	$0.00	$0.00	"$1,376.63"	"$2,255.00"	"$3,242.45"	"$3,275.20"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$123.21	$89.44	$89.44	$651.76	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100472	EAP	CPT® 32405		BX LUNG/MEDIAST PERCUT NDL BCT	BOTH IP/OP	"$2,601.00 "	"$1,924.74"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,376.63"	"$2,255.00"	"$2,059.99"	"$2,080.80"	"$1,912.65"	$0.00	"$1,912.65"	$151.70	$93.40	$93.40	$414.08	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100473	EAP	CPT® 32405		Bx Lung/mediastinum Us	BOTH IP/OP	"$2,601.00 "	"$1,924.74"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,376.63"	"$2,255.00"	"$2,059.99"	"$2,080.80"	"$1,912.65"	$0.00	"$1,912.65"	$151.70	$93.40	$93.40	$414.08	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100474	EAP	CPT® 32405		Lung/mediastinum Bx	BOTH IP/OP	"$2,601.00 "	"$1,924.74"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,376.63"	"$2,255.00"	"$2,059.99"	"$2,080.80"	"$1,912.65"	$0.00	"$1,912.65"	$151.70	$93.40	$93.40	$414.08	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100480	EAP	CPT® 32550		Insert Indwelling Cath	BOTH IP/OP	"$20,731.00 "	"$15,340.94"	$0.00	"$15,694.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,320.34"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$15,537.46"	"$15,694.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100481	EAP	CPT® 32550		Insert/indwelling Tun Pleural	BOTH IP/OP	"$16,257.00 "	"$12,030.18"	$0.00	"$15,694.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,387.96"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$15,537.46"	"$15,694.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100482	EAP	CPT® 32551		Chest Tube Insertion	BOTH IP/OP	"$2,893.00 "	"$2,140.82"	$0.00	"$2,272.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$602.97	$0.00	$0.00	$0.00	"$1,347.67"	$602.90	$875.99	"$1,871.00"	"$1,871.00"	"$1,635.92"	"$2,255.00"	"$1,971.29"	"$1,991.20"	"$2,272.90"	"$2,150.00"	"$2,272.90"	$0.00	$164.42	$164.42	$396.25	"$1,558.02"	$0.00	$0.00	$0.00	$0.00
36100485	EAP	CPT® 32560		Chemical Pleurodesis	BOTH IP/OP	"$2,169.00 "	"$1,605.06"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.02	$0.00	$0.00	$0.00	$0.00	"$2,053.00"	"$1,625.98"	"$1,642.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100486	EAP	CPT® 32999		Removal Of Pleural Catheter	BOTH IP/OP	"$1,359.00 "	"$1,005.66"	$0.00	"$1,373.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.22	$0.00	$0.00	$0.00	$632.36	"$1,373.00"	"$1,087.42"	"$1,098.40"	$878.58	"$1,359.00"	$878.58	$214.87	$0.00	$0.00	$218.58	$602.25	$0.00	$0.00	$0.00	$0.00
36100488	EAP	CPT® 33206		Insrt New/repl Pcmkr/ld-atrial	BOTH IP/OP	"$30,541.00 "	"$22,600.34"	$0.00	"$24,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,780.81"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$24,188.47"	"$24,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100489	EAP	CPT® 33207		Insrt New/repl Pcmkr/ld-vent	BOTH IP/OP	"$31,143.00 "	"$23,045.82"	$0.00	"$24,432.80"	"$5,693.10"	"$5,693.10"	"$10,125.82"	"$10,125.82"	"$10,182.87"	"$6,490.98"	"$2,192.53"	"$2,192.53"	"$2,276.86"	"$9,967.71"	"$6,490.20"	"$6,479.01"	"$4,877.00"	"$4,877.00"	$0.00	"$6,105.00"	"$24,188.47"	"$24,432.80"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100490	EAP	CPT® 33208		Insrt New/repl Pcmkr/ld- A / V	BOTH IP/OP	"$13,386.00 "	"$9,905.64"	$545.42	"$13,127.00"	"$5,693.10"	"$5,693.10"	"$10,125.82"	"$10,125.82"	"$10,182.87"	"$2,789.98"	"$2,571.13"	"$2,571.13"	"$2,670.02"	"$9,967.71"	"$2,789.64"	"$6,479.01"	"$4,877.00"	"$4,877.00"	"$10,282.07"	"$6,105.00"	"$10,396.58"	"$10,501.60"	"$13,127.00"	"$5,343.00"	"$13,127.00"	$611.79	$545.42	$545.42	"$2,089.82"	"$9,792.45"	$0.00	$0.00	$0.00	$0.00
36100491	EAP	CPT® 33210		Temp Pacemaker Wire	BOTH IP/OP	"$25,023.00 "	"$18,517.02"	$0.00	"$19,631.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,214.79"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$19,434.89"	"$19,631.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100492	EAP	CPT® 33212		Insrt Pcmkr W Exist Sngl Ld	BOTH IP/OP	"$19,776.00 "	"$14,634.24"	$0.00	"$15,515.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,121.32"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$15,360.05"	"$15,515.20"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100493	EAP	CPT® 33213		Insrt Pcmkr W Exist Dual Lds	BOTH IP/OP	"$22,852.00 "	"$16,910.48"	$0.00	"$17,928.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,762.36"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$17,748.72"	"$17,928.00"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100494	EAP	CPT® 33214		Upgrade Pacemaker System	BOTH IP/OP	"$11,993.00 "	"$8,874.82"	$0.00	"$10,563.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,499.34"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$10,457.57"	"$10,563.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100495	EAP	CPT® 33215		Reposition Icd Lead	BOTH IP/OP	"$14,372.00 "	"$10,635.28"	$0.00	"$11,275.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,995.12"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$11,162.45"	"$11,275.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100496	EAP	CPT® 33216		Insrt Sngl Icd Lead Transveno	BOTH IP/OP	"$15,719.00 "	"$11,632.06"	$0.00	"$12,332.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,275.84"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$12,208.68"	"$12,332.00"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100497	EAP	CPT® 33217		Insrt Dual Icd Lead Transveno	BOTH IP/OP	"$30,222.00 "	"$22,364.28"	$0.00	"$23,710.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,298.26"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$23,473.30"	"$23,710.40"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100498	EAP	CPT® 33218		Repair Sngl Lead Pcmkr / Icd	BOTH IP/OP	"$26,919.00 "	"$19,920.06"	$0.00	"$23,710.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,609.92"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$23,473.30"	"$23,710.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100499	EAP	CPT® 33220		Repair Dual Leads Pcmkr / Icd	BOTH IP/OP	"$14,001.00 "	"$10,360.74"	$0.00	"$12,332.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,917.81"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$12,208.68"	"$12,332.00"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100500	EAP	CPT® 33223		Relocation Skin  Pkt Cardiovert-defib	BOTH IP/OP	"$6,168.00 "	"$4,564.32"	$0.00	"$4,839.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,285.41"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,790.81"	"$4,839.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100501	EAP	CPT® 33224		Insert Lead To Prev Pcmkr / Icd	BOTH IP/OP	"$13,464.00 "	"$9,963.36"	$0.00	"$10,563.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,805.90"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$10,457.57"	"$10,563.20"	$0.00	"$5,343.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100502	EAP	CPT® 33225		L Ventr Pacing Lead Add +pock	BOTH IP/OP	"$50,601.00 "	"$37,444.74"	$0.00	"$39,698.40"	"$3,735.90"	"$3,735.90"	$0.00	$0.00	$0.00	"$9,417.94"	$0.00	$0.00	$0.00	$0.00	"$10,545.25"	$0.00	"$4,877.00"	"$4,877.00"	$0.00	"$24,811.50"	"$39,301.42"	"$39,698.40"	$0.00	"$5,343.00"	$0.00	$418.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100503	EAP	CPT® 33226		Reposition Lv Pcmkr Lead	BOTH IP/OP	"$7,930.00 "	"$5,868.20"	$0.00	"$6,344.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,280.56"	"$6,344.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100504	EAP	CPT® 33233		Remove Pcmkr Only	BOTH IP/OP	"$12,134.00 "	"$8,979.16"	$0.00	"$10,687.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,528.73"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$10,580.33"	"$10,687.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100505	EAP	CPT® 33234		Remove Pcmkr Electrode	BOTH IP/OP	"$7,315.00 "	"$5,413.10"	$0.00	"$5,739.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,524.45"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,681.81"	"$5,739.20"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100506	EAP	CPT® 33241		Remove Icd Generator Only	BOTH IP/OP	"$6,919.00 "	"$5,120.06"	$0.00	"$5,428.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.92"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,373.72"	"$5,428.00"	$0.00	"$3,725.00"	$0.00	$240.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100507	EAP	CPT® 33244		Transvenous Removal Icd Lead	BOTH IP/OP	"$11,879.00 "	"$8,790.46"	$0.00	"$9,319.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,475.58"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$9,226.01"	"$9,319.20"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100508	EAP	CPT® 33249		Insrt/repl Sgl/dual Icd Ld/gen	BOTH IP/OP	"$40,394.00 "	"$29,891.56"	$959.62	"$39,613.00"	"$5,693.10"	"$5,693.10"	"$31,988.05"	"$31,988.05"	"$32,168.25"	"$8,419.12"	"$4,181.12"	"$4,181.12"	"$31,135.70"	"$31,473.45"	"$8,418.11"	"$20,457.74"	"$4,877.00"	"$4,877.00"	"$32,377.52"	"$6,105.00"	"$31,373.50"	"$31,690.40"	"$39,613.00"	"$5,410.00"	"$39,613.00"	"$1,016.82"	$959.62	$959.62	"$6,306.39"	"$30,835.73"	$0.00	$0.00	$0.00	$0.00
36100518	EAP	CPT® 33968		Remove Intra-aortic Balloon	BOTH IP/OP	"$1,998.00 "	"$1,478.52"	$0.00	"$1,998.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$416.38	$0.00	$0.00	$0.00	$0.00	"$1,959.00"	"$1,551.53"	"$1,567.20"	$0.00	"$1,998.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100519	EAP	CPT® 34201		Emb. Or Thromb; Femoropop	BOTH IP/OP	"$13,033.00 "	"$9,644.42"	$0.00	"$10,426.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,716.08"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$10,322.14"	"$10,426.40"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100520	EAP	CPT® 34203		Emb. Or Thromb;popliteal-tibio	BOTH IP/OP	"$13,033.00 "	"$9,644.42"	$0.00	"$10,426.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,716.08"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$10,322.14"	"$10,426.40"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100535	EAP	CPT® 35286		Repair Blood Vessel With Graft Other Than Vein Lower Exteremity	BOTH IP/OP	"$13,185.00 "	"$9,756.90"	$0.00	"$10,548.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,747.75"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$10,442.52"	"$10,548.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100536	EAP	CPT® 35355		"Thromb., Iliofemoral"	BOTH IP/OP	"$6,828.00 "	"$5,052.72"	$0.00	"$5,462.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,422.96"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,407.78"	"$5,462.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100537	EAP	CPT® 35371		"Thromb., Common Femoral"	BOTH IP/OP	"$5,569.00 "	"$4,121.06"	$0.00	"$4,455.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,160.58"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,410.65"	"$4,455.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100538	EAP	CPT® 35372		"Thromb., Deep Femoral"	BOTH IP/OP	"$6,697.00 "	"$4,955.78"	$0.00	"$5,357.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,395.65"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,304.02"	"$5,357.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100556	EAP	CPT® 36002		Pseudoaneurysm Inject/treat	BOTH IP/OP	"$2,313.00 "	"$1,711.62"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,831.90"	"$1,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100557	EAP	CPT® 36005		Injection Contrast Venography	BOTH IP/OP	"$3,362.00 "	"$2,487.88"	$0.00	"$2,552.80"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	$700.72	$0.00	$0.00	$0.00	$0.00	$700.64	$0.00	"$1,988.62"	"$1,988.62"	$0.00	"$2,255.00"	"$2,527.27"	"$2,552.80"	$0.00	$837.00	$0.00	$315.51	$49.76	$49.76	$508.01	$0.00	$0.00	$0.00	$0.00	$0.00
36100558	EAP	CPT® 36010		"Intro Cath, Sup/inf Vena Cava"	BOTH IP/OP	"$7,585.00 "	"$5,612.90"	$0.00	"$5,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.90"	$0.00	$0.00	$0.00	$0.00	"$1,580.71"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,255.00"	"$5,702.40"	"$5,760.00"	$0.00	"$1,750.00"	$0.00	$0.00	$115.03	$115.03	"$1,146.24"	$0.00	$0.00	$0.00	$0.00	$0.00
36100559	EAP	CPT® 36011		Select Cath Venous 1st Order	BOTH IP/OP	"$2,771.00 "	"$2,050.54"	$0.00	"$2,630.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$577.48	$0.00	$0.00	$0.00	$0.00	"$2,630.00"	"$2,082.96"	"$2,104.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100560	EAP	CPT® 36012		Select Cath Venous 2nd Order	BOTH IP/OP	"$16,258.00 "	"$12,030.92"	$0.00	"$12,346.40"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	"$3,388.57"	$0.00	$0.00	$0.00	$0.00	"$3,388.17"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,255.00"	"$12,222.94"	"$12,346.40"	$0.00	"$1,750.00"	$0.00	$197.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100561	EAP	CPT® 36013		Intro Cath Rt Heart/main Pulm	BOTH IP/OP	"$12,826.00 "	"$9,491.24"	$0.00	"$11,745.60"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	"$2,673.26"	$0.00	$0.00	$0.00	$0.00	"$2,672.94"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,255.00"	"$11,628.14"	"$11,745.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100562	EAP	CPT® 36014		Select Cath Lt/rt Pulm Artery	BOTH IP/OP	"$14,945.00 "	"$11,059.30"	$0.00	"$11,349.60"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,114.54"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$11,236.10"	"$11,349.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100563	EAP	CPT® 36015		Select Cath Segmental Pulm Art	BOTH IP/OP	"$2,294.00 "	"$1,697.56"	$0.00	"$2,178.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.07	$0.00	$0.00	$0.00	$0.00	"$2,178.00"	"$1,724.98"	"$1,742.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100565	EAP	CPT® 36140		Intro Needle Extremity Artery	BOTH IP/OP	"$5,160.00 "	"$3,818.40"	$0.00	"$3,918.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,075.34"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,879.22"	"$3,918.40"	$0.00	"$1,206.00"	$0.00	$113.12	$93.75	$93.75	$779.76	$0.00	$0.00	$0.00	$0.00	$0.00
36100567	EAP	CPT® 36160		Intro Needle Aortic/translumba	BOTH IP/OP	"$7,974.00 "	"$5,900.76"	$0.00	"$7,302.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,661.78"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$7,229.38"	"$7,302.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100568	EAP	CPT® 36200		Intro Catheter Aorta	BOTH IP/OP	"$8,501.00 "	"$6,290.74"	$0.00	"$6,456.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,771.61"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,391.44"	"$6,456.00"	$0.00	"$1,750.00"	$0.00	$0.00	$146.39	$146.39	"$1,284.74"	$0.00	$0.00	$0.00	$0.00	$0.00
36100569	EAP	CPT® 36215		Selct Art 1st Ord Thor/brach	BOTH IP/OP	"$3,917.00 "	"$2,898.58"	$0.00	"$2,753.10"	"$2,753.10"	"$2,753.10"	$0.00	$0.00	$0.00	$816.40	$0.00	$0.00	$0.00	$0.00	$816.30	$0.00	"$2,316.91"	"$2,316.91"	$0.00	"$2,255.00"	"$2,612.02"	"$2,638.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100570	EAP	CPT® 36216		Selct Art 2nd Ord Thor/brach	BOTH IP/OP	"$3,917.00 "	"$2,898.58"	$0.00	"$2,638.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$816.30	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,612.02"	"$2,638.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100571	EAP	CPT® 36217		Selct Art 3rd Ord Thor/brach	BOTH IP/OP	"$3,917.00 "	"$2,898.58"	$0.00	"$2,638.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$816.30	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,612.02"	"$2,638.40"	$0.00	"$1,750.00"	$0.00	$342.41	$343.25	$343.25	$525.04	$0.00	$0.00	$0.00	$0.00	$0.00
36100572	EAP	CPT® 36218		Selct Art Add'l 2nd/3rd Th/br	BOTH IP/OP	"$1,886.00 "	"$1,395.64"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.04	$0.00	$0.00	$0.00	$0.00	"$1,588.00"	"$1,257.70"	"$1,270.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100573	EAP	Custom 36100573		Selct Art 1st Ord Abd/pelv	BOTH IP/OP	"$3,581.00 "	"$2,649.94"	$0.00	"$3,279.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$746.28	$0.00	$0.00	$0.00	$0.00	"$2,049.50"	"$3,246.41"	"$3,279.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100574	EAP	CPT® 36245		Selct Art 1st Ord Abd/pelv/le	BOTH IP/OP	"$3,917.00 "	"$2,898.58"	$0.00	"$2,753.10"	"$2,753.10"	"$2,753.10"	$0.00	$0.00	$0.00	$816.40	"$1,826.79"	"$1,826.79"	"$1,897.05"	$0.00	$816.30	$0.00	"$2,316.91"	"$2,316.91"	$0.00	"$2,255.00"	"$2,612.02"	"$2,638.40"	$0.00	"$1,750.00"	$0.00	$264.78	$248.44	$248.44	$525.04	$0.00	$0.00	$0.00	$0.00	$0.00
36100575	EAP	CPT® 36246		Selct Art 2nd Ord Abd/pelv/le	BOTH IP/OP	"$4,056.00 "	"$3,001.44"	$0.00	"$2,753.10"	"$2,753.10"	"$2,753.10"	$0.00	$0.00	$0.00	$845.37	"$1,826.79"	"$1,826.79"	"$1,897.05"	$0.00	$845.27	$0.00	"$2,399.12"	"$2,399.12"	$0.00	"$2,255.00"	"$2,704.68"	"$2,732.00"	$0.00	"$1,750.00"	$0.00	$288.99	$265.02	$265.02	$543.67	$0.00	$0.00	$0.00	$0.00	$0.00
36100576	EAP	CPT® 36247		Selct Art 3rd Ord Abd/pelv/le	BOTH IP/OP	"$4,335.00 "	"$3,207.90"	$0.00	"$2,920.00"	"$2,753.10"	"$2,753.10"	$0.00	$0.00	$0.00	$903.52	$0.00	$0.00	$0.00	$0.00	$903.41	$0.00	"$2,564.15"	"$2,564.15"	$0.00	"$2,255.00"	"$2,890.80"	"$2,920.00"	$0.00	"$1,750.00"	$0.00	$341.72	$315.51	$315.51	$581.08	$0.00	$0.00	$0.00	$0.00	$0.00
36100577	EAP	CPT® 36248		"Selct Art, Addt'l, Abd/pelv/le"	BOTH IP/OP	"$4,056.00 "	"$3,001.44"	$0.00	"$2,753.10"	"$2,753.10"	"$2,753.10"	$0.00	$0.00	$0.00	$845.37	$0.00	$0.00	$0.00	$0.00	$845.27	$0.00	"$2,399.12"	"$2,399.12"	$0.00	"$2,255.00"	"$2,704.68"	"$2,732.00"	$0.00	"$1,750.00"	$0.00	$56.19	$50.85	$50.85	$543.67	$0.00	$0.00	$0.00	$0.00	$0.00
36100582	EAP	CPT® 36406		"Phelb, Micro-10bopc"	BOTH IP/OP	$89.00 	$65.86	$0.00	$111.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$111.00	$87.91	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100583	EAP	CPT® 36406		"Phelb,micro-ward 12 Midnight"	BOTH IP/OP	$89.00 	$65.86	$0.00	$111.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$111.00	$87.91	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100584	EAP	CPT® 36406		"Phleb,cap-ward 12n"	BOTH IP/OP	$89.00 	$65.86	$0.00	$111.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$111.00	$87.91	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100585	EAP	CPT® 36406		"Phleb,cap-ward 6pm"	BOTH IP/OP	$89.00 	$65.86	$0.00	$111.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$111.00	$87.91	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100586	EAP	CPT® 36406		"Phleb,cap-ward 7am"	BOTH IP/OP	$89.00 	$65.86	$0.00	$111.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$111.00	$87.91	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100587	EAP	CPT® 36406		"Phleb,nursery 1pm"	BOTH IP/OP	$89.00 	$65.86	$0.00	$111.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$111.00	$87.91	$88.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100592	EAP	CPT® 36468		"Injection(s), Spider Vein"	BOTH IP/OP	$447.00 	$330.78	$0.00	$447.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.15	$0.00	$0.00	$0.00	$0.00	$355.00	$281.16	$284.00	$0.00	$447.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100594	EAP	CPT® 36470		Injection Therapy Of Vein	BOTH IP/OP	$717.00 	$530.58	$0.00	$717.00	$717.00	$717.00	$336.60	$336.60	$338.49	$0.00	$0.00	$0.00	$0.00	$0.00	$149.42	$0.00	$0.00	$0.00	$0.00	$570.00	$451.44	$456.00	$0.00	$717.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100596	EAP	CPT® 36475		"Endovenous Rf, 1st Vein"	BOTH IP/OP	"$14,476.00 "	"$10,712.24"	$0.00	"$11,508.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,016.80"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$11,393.71"	"$11,508.80"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100597	EAP	CPT® 36476		"Endovenous Rf, Vein Add On"	BOTH IP/OP	"$14,476.00 "	"$10,712.24"	$0.00	"$11,508.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,016.80"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$11,393.71"	"$11,508.80"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100598	EAP	CPT® 36478		"Endovenous Laser, 1st Vein"	BOTH IP/OP	"$14,476.00 "	"$10,712.24"	$0.00	"$11,508.80"	"$2,984.10"	"$2,984.10"	"$2,787.76"	"$2,787.76"	"$2,803.47"	$0.00	"$4,607.43"	"$4,607.43"	"$4,784.64"	$0.00	"$3,016.80"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$11,393.71"	"$11,508.80"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100599	EAP	CPT® 36479		Endovenous Laser Vein Add-on	BOTH IP/OP	"$14,476.00 "	"$10,712.24"	$0.00	"$11,508.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,016.80"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$11,393.71"	"$11,508.80"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100600	EAP	CPT® 36481		Percut Portal Vein Cath	BOTH IP/OP	"$6,954.00 "	"$5,145.96"	$0.00	"$5,528.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,449.21"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,473.51"	"$5,528.80"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100601	EAP	CPT® 36500		Venous Cath Selct Org Bld Samp	BOTH IP/OP	"$3,040.00 "	"$2,249.60"	$0.00	"$2,285.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$633.54	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,262.74"	"$2,285.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100602	EAP	CPT® 36555		INS NON-TUN CVC <5 SPV	BOTH IP/OP	"$6,197.00 "	"$4,585.78"	$0.00	"$4,175.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,291.45"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,133.45"	"$4,175.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100603	EAP	CPT® 36556		Central Line Placement	BOTH IP/OP	"$6,532.00 "	"$4,833.68"	$0.00	"$4,400.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,361.27"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,356.79"	"$4,400.80"	$0.00	"$2,500.00"	$0.00	$311.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100607	EAP	CPT® 36557		INS TUN CVC W/O PORT <5 SPV	BOTH IP/OP	"$7,565.00 "	"$5,598.10"	$0.00	"$6,928.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,576.55"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$6,858.72"	"$6,928.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100608	EAP	CPT® 36558		INS TUN CVC W/O PORT >5 SPV	BOTH IP/OP	"$11,867.00 "	"$8,781.58"	$0.00	"$7,994.40"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,473.38"	$0.00	$0.00	$0.00	"$2,742.67"	"$2,473.08"	"$1,782.74"	"$2,836.00"	"$2,836.00"	"$2,779.42"	"$2,327.00"	"$7,914.46"	"$7,994.40"	"$3,861.64"	"$3,725.00"	"$3,861.64"	$693.87	$272.22	$272.22	"$1,590.89"	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
36100609	EAP	CPT® 36560		INS TUN CVC W/PORT <5 SPV	BOTH IP/OP	"$16,153.00 "	"$11,953.22"	$0.00	"$14,792.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,366.29"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$14,644.08"	"$14,792.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100610	EAP	CPT® 36561		INS TUN CVC W/PORT >5 SPV	BOTH IP/OP	"$23,715.00 "	"$17,549.10"	$351.16	"$15,976.00"	"$2,984.10"	"$2,984.10"	"$2,787.76"	"$2,787.76"	"$2,803.47"	"$4,942.80"	"$1,826.79"	"$1,826.79"	"$1,897.05"	"$2,742.67"	"$4,942.21"	"$1,782.74"	"$3,856.00"	"$3,856.00"	"$2,779.42"	"$2,858.00"	"$15,816.24"	"$15,976.00"	"$3,861.64"	"$3,725.00"	"$3,861.64"	"$1,322.94"	$351.16	$351.16	"$3,179.22"	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
36100611	EAP	CPT® 36563		INS TUN CVC W/PUMP SPV	BOTH IP/OP	"$34,457.00 "	"$25,498.18"	$0.00	"$31,554.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,180.84"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$31,238.86"	"$31,554.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100612	EAP	CPT® 36565		Insert Tunneled Cv Cath	BOTH IP/OP	"$22,459.00 "	"$16,619.66"	$0.00	"$15,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,680.46"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$14,979.10"	"$15,130.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100613	EAP	CPT® 36566		Insert Tunneled Cv Cath W/port	BOTH IP/OP	"$9,620.00 "	"$7,118.80"	$0.00	"$8,809.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,004.81"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$8,721.50"	"$8,809.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100614	EAP	CPT® 36568		INS PERH CVC W/O PORT <5 SPV	BOTH IP/OP	"$7,208.00 "	"$5,333.92"	$0.00	"$5,115.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,064.05"	"$5,115.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100615	EAP	CPT® 36568		Insert/picc Catheter Discontin	BOTH IP/OP	"$7,208.00 "	"$5,333.92"	$0.00	"$5,115.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,064.05"	"$5,115.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100616	EAP	CPT® 36568		Insertion Of Picc Catheter	BOTH IP/OP	"$7,593.00 "	"$5,618.82"	$0.00	"$5,115.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,582.38"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,064.05"	"$5,115.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100618	EAP	CPT® 36569		Cvc/picc Line Place Exchange	BOTH IP/OP	"$6,120.00 "	"$4,528.80"	$0.00	"$4,343.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,635.92"	"$2,255.00"	"$4,299.77"	"$4,343.20"	"$2,272.90"	$0.00	"$2,272.90"	$346.84	$98.45	$98.45	$864.30	"$1,558.02"	$0.00	$0.00	$0.00	$0.00
36100619	EAP	CPT® 36569		Insert Picc Wo Port/pump >5	BOTH IP/OP	"$4,743.00 "	"$3,509.82"	$98.45	"$4,343.20"	"$2,321.55"	"$2,321.55"	"$1,369.42"	"$1,369.42"	"$1,377.13"	$988.56	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,347.67"	$988.44	$875.99	"$1,871.00"	"$1,871.00"	"$1,635.92"	"$2,255.00"	"$4,299.77"	"$4,343.20"	"$2,272.90"	"$2,500.00"	"$2,272.90"	$346.84	$98.45	$98.45	$864.30	"$1,558.02"	$0.00	$0.00	$0.00	$0.00
36100620	EAP	CPT® 36570		Ins Perh Cvc W/port <5spv	BOTH IP/OP	"$14,840.00 "	"$10,981.60"	$0.00	"$13,589.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,092.66"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$13,453.70"	"$13,589.60"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100621	EAP	CPT® 36571		INS PERH CVC W/ PORT >5 SPV	BOTH IP/OP	"$10,048.00 "	"$7,435.52"	$325.53	"$7,630.40"	"$2,984.10"	"$2,984.10"	"$2,787.76"	"$2,787.76"	"$2,803.47"	"$2,094.25"	"$1,826.79"	"$1,826.79"	"$1,897.05"	"$2,742.67"	"$2,094.00"	"$1,782.74"	"$3,856.00"	"$3,856.00"	"$2,779.42"	"$2,858.00"	"$7,554.10"	"$7,630.40"	"$3,861.64"	"$3,725.00"	"$3,861.64"	"$1,542.56"	$325.53	$325.53	"$1,518.45"	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
36100622	EAP	CPT® 36575		Repair Cv Cath Wo Port/pump	BOTH IP/OP	"$4,589.00 "	"$3,395.86"	$0.00	"$4,202.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$956.35	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,160.38"	"$4,202.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100623	EAP	CPT® 36575		REPAIR TUN/N-TUN CVC WO PT SPV	BOTH IP/OP	"$4,589.00 "	"$3,395.86"	$0.00	"$4,202.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$956.35	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,160.38"	"$4,202.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100624	EAP	CPT® 36576		REPAIR CVC W/PORT/PUMP SPV	BOTH IP/OP	"$4,589.00 "	"$3,395.86"	$0.00	"$4,202.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$956.35	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,160.38"	"$4,202.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100626	EAP	CPT® 36578		Replce Cat Cvc W/port/pump Spv	BOTH IP/OP	"$12,764.00 "	"$9,445.36"	$0.00	"$11,688.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.02"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$11,571.91"	"$11,688.80"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100627	EAP	CPT® 36580		Replace Cv Cath Non-tun Wo Por	BOTH IP/OP	"$6,828.00 "	"$5,052.72"	$0.00	"$6,252.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,422.96"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,190.27"	"$6,252.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100628	EAP	CPT® 36580		REPLCE NON-TUN CVC WO PORT SPV	BOTH IP/OP	"$8,234.00 "	"$6,093.16"	$0.00	"$6,252.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,715.97"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,190.27"	"$6,252.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100629	EAP	CPT® 36581		REPLCE TUN CVC W/O PORT SPV	BOTH IP/OP	"$5,567.00 "	"$4,119.58"	$191.10	"$4,228.00"	"$2,753.10"	"$2,753.10"	"$2,787.76"	"$2,787.76"	"$2,803.47"	"$1,160.30"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,742.67"	"$1,160.16"	"$1,782.74"	"$2,836.00"	"$2,836.00"	"$2,779.42"	"$2,327.00"	"$4,185.72"	"$4,228.00"	"$3,861.64"	"$3,725.00"	"$3,861.64"	$638.75	$191.10	$191.10	$841.37	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
36100630	EAP	CPT® 36582		REPLCE TUN CVC W/ PORT SPV	BOTH IP/OP	"$22,026.00 "	"$16,299.24"	$0.00	"$16,727.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,590.22"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$16,559.93"	"$16,727.20"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100631	EAP	CPT® 36583		Replce Tun Cvc W/pump Spv	BOTH IP/OP	"$34,457.00 "	"$25,498.18"	$0.00	"$31,554.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,180.84"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$31,238.86"	"$31,554.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100632	EAP	CPT® 36584		Replace Picc Wo Port/pump	BOTH IP/OP	"$8,528.00 "	"$6,310.72"	$0.00	"$7,809.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,777.24"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$7,731.50"	"$7,809.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100633	EAP	CPT® 36584		Replacement Of A Picc Catheter	BOTH IP/OP	"$9,762.00 "	"$7,223.88"	$0.00	"$7,809.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$7,731.50"	"$7,809.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100634	EAP	CPT® 36584		REPLCE COMP PICC W/O PORT SPV	BOTH IP/OP	"$10,284.00 "	"$7,610.16"	$0.00	"$7,809.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,143.19"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$7,731.50"	"$7,809.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100635	EAP	CPT® 36585		REPLCE COMP PICC W/PORT SPV	BOTH IP/OP	"$17,895.00 "	"$13,242.30"	$283.37	"$13,589.60"	"$2,984.10"	"$2,984.10"	"$2,787.76"	"$2,787.76"	"$2,803.47"	"$3,729.77"	"$1,826.79"	"$1,826.79"	"$1,897.05"	"$2,742.67"	"$3,729.32"	"$1,782.74"	"$3,856.00"	"$3,856.00"	"$2,779.42"	"$2,858.00"	"$13,453.70"	"$13,589.60"	"$3,861.64"	"$3,725.00"	"$3,861.64"	"$1,518.02"	$283.37	$283.37	"$2,704.33"	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
36100636	EAP	CPT® 36589		REMOVAL TUN CVC W/O PORT SPV	BOTH IP/OP	"$4,906.00 "	"$3,630.44"	$143.13	"$3,725.60"	"$2,321.55"	"$2,321.55"	$526.39	$526.39	$529.35	"$1,022.53"	"$1,257.08"	"$1,257.08"	"$1,305.43"	$519.10	"$1,022.41"	$337.41	"$1,871.00"	"$1,871.00"	$632.36	"$2,255.00"	"$3,688.34"	"$3,725.60"	$878.58	"$2,150.00"	$878.58	$171.53	$143.13	$143.13	$741.39	$602.25	$0.00	$0.00	$0.00	$0.00
36100637	EAP	CPT® 36589		Removal Venous Access Device	BOTH IP/OP	"$4,657.00 "	"$3,446.18"	$0.00	"$3,725.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.36	"$2,255.00"	"$3,688.34"	"$3,725.60"	$878.58	$0.00	$878.58	$171.53	$143.13	$143.13	$741.39	$602.25	$0.00	$0.00	$0.00	$0.00
36100638	EAP	CPT® 36590		REMOVAL TUN CVC W/PORT SPV	BOTH IP/OP	"$4,906.00 "	"$3,630.44"	$198.64	"$3,725.60"	"$2,321.55"	"$2,321.55"	"$1,369.42"	"$1,369.42"	"$1,377.13"	"$1,022.53"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,347.67"	"$1,022.41"	$875.99	"$1,871.00"	"$1,871.00"	$632.36	"$2,255.00"	"$3,688.34"	"$3,725.60"	$878.58	"$2,500.00"	$878.58	$371.18	$198.64	$198.64	$741.39	$602.25	$0.00	$0.00	$0.00	$0.00
36100639	EAP	CPT® 36590		Remove Cv Cath	BOTH IP/OP	"$4,068.00 "	"$3,010.32"	$198.64	"$3,725.60"	"$2,321.55"	"$2,321.55"	"$1,369.42"	"$1,369.42"	"$1,377.13"	$847.87	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,347.67"	$847.77	$875.99	"$1,871.00"	"$1,871.00"	$632.36	"$2,255.00"	"$3,688.34"	"$3,725.60"	$878.58	"$2,500.00"	$878.58	$371.18	$198.64	$198.64	$741.39	$602.25	$0.00	$0.00	$0.00	$0.00
36100640	EAP	CPT® 36591		Blood Draw Central Line	BOTH IP/OP	$311.00 	$230.14	$0.00	$527.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.81	$0.00	$0.00	$0.00	$109.35	$262.00	$207.50	$209.60	$151.93	$527.00	$151.93	$0.00	$25.21	$25.21	$41.71	$104.14	$0.00	$0.00	$0.00	$0.00
36100641	EAP	CPT® 36593		Declot Vasc Cath By Thrombolyt	BOTH IP/OP	"$2,030.00 "	"$1,502.20"	$0.00	"$1,624.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.51	"$1,624.00"	"$1,286.21"	"$1,299.20"	$431.41	$0.00	$431.41	$30.97	$32.05	$32.05	$258.54	$295.72	$0.00	$0.00	$0.00	$0.00
36100642	EAP	CPT® 36593		Declot Vascular Access Device	BOTH IP/OP	"$2,043.00 "	"$1,511.82"	$0.00	"$2,043.00"	"$2,043.00"	"$2,043.00"	$310.51	$310.51	$312.26	$425.81	$0.00	$0.00	$0.00	$297.83	$425.76	$193.59	$113.00	$113.00	$310.51	"$1,624.00"	"$1,286.21"	"$1,299.20"	$431.41	"$1,289.00"	$431.41	$30.97	$32.05	$32.05	$258.54	$295.72	$0.00	$0.00	$0.00	$0.00
36100645	EAP	CPT® 36595		MECH REMOVAL OBSTR CVC SPV	BOTH IP/OP	"$16,371.00 "	"$12,114.54"	$0.00	"$12,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,411.72"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$12,308.47"	"$12,432.80"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100646	EAP	CPT® 36596		MECH REMOVAL CATH OBST CVC SPV	BOTH IP/OP	"$5,648.00 "	"$4,179.52"	$0.00	"$5,172.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,177.04"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,120.28"	"$5,172.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100647	EAP	CPT® 36597		REPOSIT CVC W/ FLUORO GUID SPV	BOTH IP/OP	"$8,057.00 "	"$5,962.18"	$0.00	"$6,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,679.08"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,057.22"	"$6,118.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100648	EAP	CPT® 36598		"Inj W/fluro, Eval Cv Device"	BOTH IP/OP	"$1,173.00 "	$868.02	$0.00	"$1,173.00"	"$1,173.00"	"$1,173.00"	$199.22	$199.22	$200.34	$244.48	$0.00	$0.00	$0.00	$195.04	$244.45	$126.78	"$1,173.00"	"$1,173.00"	$184.28	"$1,100.00"	$871.20	$880.00	$256.03	$803.00	$256.03	$126.13	$38.59	$38.59	$175.12	$175.50	$0.00	$0.00	$0.00	$0.00
36100649	EAP	CPT® 36600		Arterial Puncture	BOTH IP/OP	$302.00 	$223.48	$16.23	$404.00	$302.00	$302.00	$109.81	$109.81	$110.43	$62.94	$224.14	$224.14	$232.78	$107.30	$62.94	$69.74	$113.00	$113.00	$109.35	$284.00	$224.93	$227.20	$151.93	$404.00	$151.93	$24.37	$16.23	$16.23	$45.21	$104.14	$0.00	$0.00	$0.00	$0.00
36100650	EAP	CPT® 20610		Bilateral Drain/inject-shoulder Hip Knee Wo Us Guidance	BOTH IP/OP	"$4,395.00 "	"$3,252.30"	$47.59	"$3,520.00"	"$2,321.55"	"$2,321.55"	$254.43	$254.43	$255.86	$916.03	"$1,257.08"	"$1,257.08"	"$1,305.43"	$250.31	$915.92	$162.70	"$1,871.00"	"$1,871.00"	$262.54	"$2,255.00"	"$3,484.80"	"$3,520.00"	$364.76	"$1,750.00"	$364.76	$70.76	$47.59	$47.59	$700.48	$250.04	$0.00	$0.00	$0.00	$0.00
36100652	EAP	CPT® 36620		Arterial Line Insert	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,750.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$328.27	$0.00	$0.00	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	"$1,339.00"	"$1,060.49"	"$1,071.20"	$0.00	"$1,750.00"	$0.00	$59.97	$46.17	$46.17	$213.17	$0.00	$0.00	$0.00	$0.00	$0.00
36100655	EAP	CPT® 36860		Cannula Declot W/o Balloon	BOTH IP/OP	"$9,536.00 "	"$7,056.64"	$0.00	"$8,732.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,987.30"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$8,645.47"	"$8,732.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100657	EAP	CPT® 37182		Insert Hepatic Shunt (tips)	BOTH IP/OP	"$15,415.00 "	"$11,407.10"	$0.00	"$11,706.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,212.49"	$0.00	$0.00	$0.00	$0.00	"$7,316.50"	"$11,589.34"	"$11,706.40"	$0.00	"$10,019.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100658	EAP	CPT® 37183		Remove Hepatic Shunt (tips)	BOTH IP/OP	"$61,100.00 "	"$45,214.00"	$0.00	"$46,400.80"	"$5,965.05"	"$5,965.05"	"$4,826.66"	"$4,826.66"	"$4,853.85"	$0.00	$0.00	$0.00	$0.00	$0.00	"$12,733.24"	$0.00	$0.00	$0.00	$0.00	"$4,975.00"	"$45,936.79"	"$46,400.80"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100659	EAP	CPT® 37184		Prim Art Mech Thrombectomy	BOTH IP/OP	"$39,064.00 "	"$28,907.36"	$0.00	"$29,665.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,140.94"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$29,368.94"	"$29,665.60"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100660	EAP	CPT® 37185		Prim Art M-thrombect Add-on	BOTH IP/OP	"$36,020.00 "	"$26,654.80"	$0.00	"$31,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,506.57"	$0.00	$0.00	$0.00	$0.00	"$19,570.00"	"$30,998.88"	"$31,312.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100661	EAP	CPT® 37186		Sec Art Thrombect Add-on	BOTH IP/OP	"$31,656.00 "	"$23,425.44"	$0.00	"$28,988.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,597.11"	$0.00	$0.00	$0.00	$0.00	"$18,118.00"	"$28,698.91"	"$28,988.80"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100662	EAP	CPT® 37187		Venous Mech Thrombectomy	BOTH IP/OP	"$19,167.00 "	"$14,183.58"	$0.00	"$15,488.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,994.40"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$15,333.91"	"$15,488.80"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100663	EAP	CPT® 37188		Venous M-thrombectomy Add-on	BOTH IP/OP	"$15,850.00 "	"$11,729.00"	$0.00	"$12,808.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,303.14"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$12,679.92"	"$12,808.00"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100664	EAP	CPT® 37195		"Thrombolytic Therapy, Stroke"	BOTH IP/OP	"$14,728.00 "	"$10,898.72"	$0.00	"$11,184.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,069.32"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$11,072.95"	"$11,184.80"	$0.00	"$1,408.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100665	EAP	CPT® 37200		Transcatheter Biopsy	BOTH IP/OP	"$17,005.00 "	"$12,583.70"	$0.00	"$13,571.20"	"$3,735.90"	"$3,735.90"	"$4,643.92"	"$4,643.92"	"$4,670.08"	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,543.84"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$13,435.49"	"$13,571.20"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100681	EAP	CPT® 37215		"Transcath Stent, Cca W/eps"	BOTH IP/OP	"$18,633.00 "	"$13,788.42"	$0.00	"$14,150.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,883.12"	$0.00	$0.00	$0.00	"$1,114.70"	"$8,844.00"	"$14,008.90"	"$14,150.40"	"$1,046.93"	"$12,111.45"	"$1,046.93"	"$1,065.02"	"$1,046.93"	"$1,046.93"	"$2,815.93"	"$1,046.93"	$0.00	$0.00	$0.00	$0.00
36100682	EAP	CPT® 37216		"Transcath Stent, Cca W/o Eps"	BOTH IP/OP	"$21,388.00 "	"$15,827.12"	$0.00	"$16,242.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,457.26"	$0.00	$0.00	$0.00	$0.00	"$10,151.50"	"$16,079.98"	"$16,242.40"	$0.00	"$7,557.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100685	EAP	CPT® 37609		Temporal Artery Biopsy	BOTH IP/OP	"$10,925.00 "	"$8,084.50"	$214.12	"$8,571.20"	"$2,753.10"	"$2,753.10"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$2,277.04"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,348.50"	"$2,276.77"	$876.52	"$2,836.00"	"$2,836.00"	"$1,376.63"	"$2,327.00"	"$8,485.49"	"$8,571.20"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$242.02	$214.12	$214.12	"$1,705.67"	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100687	EAP	CPT® 37765		Phleb Veins-extrem-up To 20	BOTH IP/OP	"$17,595.00 "	"$13,020.30"	$0.00	"$14,218.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,666.80"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$14,076.22"	"$14,218.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100688	EAP	CPT® 37766		Phleb Veins-extrem-20+	BOTH IP/OP	"$17,362.00 "	"$12,847.88"	$0.00	"$14,029.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,618.24"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$13,889.30"	"$14,029.60"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100689	EAP	CPT® 37799		Vascular Surgery Procedure	BOTH IP/OP	"$11,080.00 "	"$8,199.20"	$0.00	"$8,953.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,309.07"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$8,864.06"	"$8,953.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100690	EAP	CPT® 38200		Splenoportography Inj	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	"$1,250.00"	$990.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100691	EAP	CPT® 38220		Diagnostic Bone Marrow; Aspiration(s)	BOTH IP/OP	"$1,504.00 "	"$1,112.96"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$313.43	$0.00	$0.00	$0.00	$0.00	"$1,500.00"	"$1,188.00"	"$1,200.00"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100692	EAP	CPT® 38220		Diagnostic Bone Marrow; Aspiration(s)	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,500.00"	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100693	EAP	CPT® 38221		Diagnostic Bone Marrow; Biopsy(ies)	BOTH IP/OP	"$1,527.00 "	"$1,129.98"	$0.00	"$2,150.00"	"$1,527.00"	"$1,527.00"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$318.26	$0.00	$0.00	$0.00	"$1,348.50"	$318.23	$876.52	"$1,527.00"	"$1,527.00"	"$1,376.63"	"$1,523.00"	"$1,206.22"	"$1,218.40"	"$1,523.00"	"$2,150.00"	"$1,523.00"	$245.12	$72.12	$72.12	$242.46	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100694	EAP	CPT® 38500		Biopsy Lymph Nodes Sprfcl Open	BOTH IP/OP	"$4,110.00 "	"$3,041.40"	$0.00	"$3,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$856.52	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,255.12"	"$3,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100695	EAP	CPT® 38505		BX LYMPH NODE(S) NDL BCT	BOTH IP/OP	"$1,805.00 "	"$1,335.70"	$72.83	"$2,500.00"	"$1,805.00"	"$1,805.00"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$376.21	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	$376.16	$876.52	"$1,805.00"	"$1,805.00"	"$1,376.63"	"$1,801.00"	"$1,426.39"	"$1,440.80"	"$1,801.00"	"$2,500.00"	"$1,801.00"	$115.87	$72.83	$72.83	$286.72	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100696	EAP	CPT® 38525		"Bx, Open Deep Ax Node"	BOTH IP/OP	"$5,701.00 "	"$4,218.74"	$0.00	"$4,560.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,188.09"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,515.19"	"$4,560.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100697	EAP	CPT® 38790		Inj Lymphangiography	BOTH IP/OP	"$4,411.00 "	"$3,264.14"	$0.00	"$3,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$919.25	$0.00	$0.00	$0.00	$0.00	"$2,200.00"	"$3,484.80"	"$3,520.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100698	EAP	CPT® 38792		Identify Sentinel Node	BOTH IP/OP	$485.00 	$358.90	$0.00	$485.00	$485.00	$485.00	$367.10	$367.10	$369.17	$101.09	$0.00	$0.00	$0.00	$361.44	$101.07	$234.94	$485.00	$485.00	$0.00	$484.00	$383.33	$387.20	$0.00	$485.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100699	EAP	CPT® 40490		Biopsy Of Lip	BOTH IP/OP	$578.00 	$427.72	$0.00	$578.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.46	$0.00	$0.00	$0.00	$0.00	$577.00	$456.98	$461.60	$0.00	$578.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100701	EAP	CPT® 40800		"I&d, Intra-oral, Simple"	BOTH IP/OP	$698.00 	$516.52	$0.00	$705.00	$379.01	$379.01	$606.01	$606.01	$609.42	$145.48	$0.00	$0.00	$0.00	$596.11	$145.46	$387.47	$113.00	$113.00	$611.80	$705.00	$558.36	$564.00	$705.00	$698.00	$705.00	$87.87	$128.30	$128.30	$112.24	$582.67	$0.00	$0.00	$0.00	$0.00
36100702	EAP	CPT® 40801		"I&d Intra-oral, Complex"	BOTH IP/OP	"$1,566.00 "	"$1,158.84"	$0.00	"$1,582.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$326.35	$0.00	$0.00	$0.00	$0.00	"$1,582.00"	"$1,252.94"	"$1,265.60"	$0.00	"$1,566.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100703	EAP	CPT® 40808		Biopsy Vestibule Of Mouth	BOTH IP/OP	$874.00 	$646.76	$0.00	$874.00	$874.00	$874.00	$440.43	$440.43	$442.92	$182.16	$0.00	$0.00	$0.00	$433.55	$182.14	$281.81	$113.00	$113.00	$443.02	$872.00	$690.62	$697.60	$615.51	$874.00	$615.51	$81.68	$89.03	$89.03	$138.82	$421.92	$0.00	$0.00	$0.00	$0.00
36100704	EAP	CPT® 36593		Declot Vascular Access Device	BOTH IP/OP	"$2,030.00 "	"$1,502.20"	$0.00	"$1,624.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.51	"$1,624.00"	"$1,286.21"	"$1,299.20"	$431.41	$0.00	$431.41	$30.97	$32.05	$32.05	$258.54	$295.72	$0.00	$0.00	$0.00	$0.00
36100705	EAP	CPT® 40812		Exc/les/mouth W/simple Repair	BOTH IP/OP	"$6,659.00 "	"$4,927.66"	$0.00	"$5,380.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,387.74"	$0.00	$0.00	$0.00	"$1,353.31"	"$2,255.00"	"$5,326.99"	"$5,380.80"	"$1,880.24"	"$2,500.00"	"$1,880.24"	$161.83	$196.45	$196.45	"$1,070.78"	"$1,288.86"	$0.00	$0.00	$0.00	$0.00
36100706	EAP	CPT® 40814		Exc/les/mouth W/complex Repair	BOTH IP/OP	"$5,169.00 "	"$3,825.06"	$0.00	"$4,176.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,077.22"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,135.03"	"$4,176.80"	$0.00	"$3,359.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100707	EAP	CPT® 40819		Exc Frenum Libial Buccal	BOTH IP/OP	"$2,245.00 "	"$1,661.30"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$467.86	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,087.71"	"$2,108.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100708	EAP	CPT® 40820		Dest/les Vestibule Mouth	BOTH IP/OP	"$5,179.00 "	"$3,832.46"	$0.00	"$4,864.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,079.30"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,816.15"	"$4,864.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100709	EAP	CPT® 41015		I&d Extraoral Sublingual	BOTH IP/OP	$945.00 	$699.30	$0.00	$955.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.94	$0.00	$0.00	$0.00	$0.00	$955.00	$756.36	$764.00	$0.00	$945.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100710	EAP	CPT® 41016		"I&d,floor Of Mouth-submental"	BOTH IP/OP	"$5,296.00 "	"$3,919.04"	$0.00	"$4,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,103.69"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,439.16"	"$4,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100711	EAP	CPT® 41017		"I&d,floor/mouth-submandibular"	BOTH IP/OP	"$2,620.00 "	"$1,938.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$546.01	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,095.63"	"$2,116.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100712	EAP	CPT® 41018		"I&d,floor Of Mouth-masticator"	BOTH IP/OP	"$2,215.00 "	"$1,639.10"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$461.61	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,856.45"	"$1,875.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100713	EAP	CPT® 41100		Biopsy Anterior 2/3 Of Tongue	BOTH IP/OP	$991.00 	$733.34	$108.86	$991.00	$991.00	$991.00	$440.43	$440.43	$442.92	$206.55	$991.00	$991.00	$991.00	$433.55	$206.52	$281.81	$991.00	$991.00	$443.02	$989.00	$783.29	$791.20	$615.51	$991.00	$615.51	$116.06	$108.86	$108.86	$157.45	$421.92	$0.00	$0.00	$0.00	$0.00
36100715	EAP	CPT® 41105		Biopsy Posterior 1/3 Tongue	BOTH IP/OP	"$2,240.00 "	"$1,657.60"	$0.00	"$2,664.14"	"$2,240.00"	"$2,240.00"	"$2,664.14"	"$2,664.14"	"$2,240.00"	$466.87	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,622.61"	$466.82	"$1,704.70"	"$2,240.00"	"$2,240.00"	$0.00	"$2,235.00"	"$1,770.12"	"$1,788.00"	$0.00	"$2,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100717	EAP	CPT® 41108		"Biopsy, Floor Of Mouth"	BOTH IP/OP	"$1,504.00 "	"$1,112.96"	$90.18	"$1,504.00"	"$1,504.00"	"$1,504.00"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$313.47	"$1,504.00"	"$1,504.00"	"$1,504.00"	"$1,348.50"	$313.43	$876.52	"$1,504.00"	"$1,504.00"	"$1,376.63"	"$1,500.00"	"$1,188.00"	"$1,200.00"	"$1,500.00"	"$1,504.00"	"$1,500.00"	$90.18	$90.83	$90.83	$238.80	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100718	EAP	CPT® 41116		Exc Lesion Floor Of Mouth	BOTH IP/OP	"$4,520.00 "	"$3,344.80"	$0.00	"$3,607.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$941.97	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,571.13"	"$3,607.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100719	EAP	CPT® 41822		Excision Of Fibrous Tuberosity	BOTH IP/OP	"$4,451.00 "	"$3,293.74"	$0.00	"$3,594.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.59	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,558.46"	"$3,594.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100720	EAP	CPT® 41823		Excision Of Osseoustuberosity	BOTH IP/OP	"$4,910.00 "	"$3,633.40"	$0.00	"$3,928.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,023.24"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,888.72"	"$3,928.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100721	EAP	CPT® 41826		Exc W/simple Repair Dentoalveo	BOTH IP/OP	"$3,486.00 "	"$2,579.64"	$0.00	"$2,788.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$726.48	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,760.91"	"$2,788.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100722	EAP	CPT® 41850		"Destruct Lesion, Dentoalveolar"	BOTH IP/OP	"$5,372.00 "	"$3,975.28"	$0.00	"$4,297.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,119.52"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,254.62"	"$4,297.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100723	EAP	CPT® 41874		"Alveoloplasty, Each Quadrant"	BOTH IP/OP	"$3,051.00 "	"$2,257.74"	$0.00	"$3,080.00"	"$2,321.55"	"$2,321.55"	"$2,664.14"	"$2,664.14"	"$2,679.15"	$635.90	$0.00	$0.00	$0.00	"$2,622.61"	$635.83	"$1,704.70"	"$3,051.00"	"$3,051.00"	"$2,626.99"	"$3,080.00"	"$2,439.36"	"$2,464.00"	"$3,080.00"	"$2,500.00"	"$3,080.00"	$0.00	$259.89	$259.89	$490.34	"$2,501.89"	$0.00	$0.00	$0.00	$0.00
36100724	EAP	CPT® 41899		Completely Bony	BOTH IP/OP	"$1,862.00 "	"$1,377.88"	$0.00	"$1,880.00"	"$1,862.00"	"$1,862.00"	$206.03	$206.03	$207.19	$388.09	$0.00	$0.00	$0.00	$202.80	$388.04	$131.82	"$1,862.00"	"$1,862.00"	$204.24	"$1,880.00"	"$1,488.96"	"$1,504.00"	$283.76	"$1,750.00"	$283.76	$294.22	$0.00	$0.00	$299.30	$194.51	$0.00	$0.00	$0.00	$0.00
36100725	EAP	CPT® 42100		"Biopsy Palate, Uvula"	BOTH IP/OP	"$1,837.00 "	"$1,359.38"	$0.00	"$1,837.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.83	$0.00	$0.00	$0.00	$0.00	"$1,833.00"	"$1,451.74"	"$1,466.40"	$0.00	"$1,837.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100727	EAP	CPT® 42104		"Exc Palate, Uvula,w/o Closure"	BOTH IP/OP	"$3,431.00 "	"$2,538.94"	$0.00	"$2,772.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$715.02	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,745.07"	"$2,772.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100728	EAP	CPT® 42140		Uvulectomy	BOTH IP/OP	"$3,002.00 "	"$2,221.48"	$0.00	"$2,401.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.62	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,377.58"	"$2,401.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100729	EAP	CPT® 42160		"Dest Lesion, Palate Or Uvula"	BOTH IP/OP	"$7,516.00 "	"$5,561.84"	$0.00	"$6,005.60"	"$2,321.55"	"$2,321.55"	"$2,664.14"	"$2,664.14"	"$2,679.15"	"$1,566.52"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$2,622.61"	"$1,566.33"	"$1,704.70"	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$5,945.54"	"$6,005.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100730	EAP	CPT® 42400		"Biopsy Of Salivary Gland,needl"	BOTH IP/OP	"$4,676.00 "	"$3,460.24"	$0.00	"$3,736.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$974.48	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,698.64"	"$3,736.00"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100732	EAP	CPT® 42700		I&d Peritonsillar Abscess	BOTH IP/OP	$436.00 	$322.64	$70.05	$440.00	$436.00	$436.00	$206.03	$206.03	$207.19	$90.87	$436.00	$436.00	$436.00	$202.80	$90.86	$131.82	$436.00	$436.00	$204.24	$440.00	$348.48	$352.00	$283.76	$436.00	$283.76	$122.16	$139.13	$139.13	$70.05	$194.51	$0.00	$0.00	$0.00	$0.00
36100733	EAP	CPT® 42405		Biopsy Of Salivary Gland	BOTH IP/OP	"$9,563.00 "	"$7,076.62"	$0.00	"$7,640.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,992.93"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$7,564.39"	"$7,640.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100734	EAP	CPT® 42800		"Biopsy, Oropharynx"	BOTH IP/OP	"$5,168.00 "	"$3,824.32"	$0.00	"$4,877.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,077.14"	$0.00	$0.00	$0.00	"$1,296.54"	"$1,077.01"	$842.75	"$4,877.00"	"$4,877.00"	$0.00	"$2,255.00"	"$4,093.06"	"$4,134.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100735	EAP	CPT® 42804		"Biopsy, Nasopharynx"	BOTH IP/OP	"$3,142.00 "	"$2,325.08"	$0.00	"$2,513.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$654.79	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,488.46"	"$2,513.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100738	EAP	CPT® 43246		G-tube Insertion	BOTH IP/OP	"$5,939.00 "	"$4,394.86"	$0.00	"$4,568.80"	"$2,753.10"	"$2,753.10"	"$1,581.72"	"$1,581.72"	"$1,590.63"	"$1,237.84"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,557.45"	"$1,237.69"	"$1,012.34"	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$4,523.11"	"$4,568.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100740	EAP	CPT® 43450		Dil Eso/unguide Bougie 1>1 Pas	BOTH IP/OP	"$2,096.00 "	"$1,551.04"	$0.00	"$2,096.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$436.81	$0.00	$0.00	$0.00	$0.00	"$2,096.00"	"$1,660.03"	"$1,676.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100742	EAP	CPT® 43752		Naso Gastric Tube Place	BOTH IP/OP	"$2,134.00 "	"$1,579.16"	$42.55	"$2,134.00"	"$2,134.00"	"$2,134.00"	$264.30	$264.30	$265.79	$444.78	"$1,257.08"	"$1,257.08"	"$1,305.43"	$258.98	$444.73	$168.34	$113.00	$113.00	$364.66	"$2,052.00"	"$1,625.18"	"$1,641.60"	$506.64	"$1,750.00"	$506.64	$321.14	$42.55	$42.55	$326.68	$347.29	$0.00	$0.00	$0.00	$0.00
36100747	EAP	CPT® 43761		Reposition Gastrostomy Tube	BOTH IP/OP	"$5,739.00 "	"$4,246.86"	$0.00	"$4,415.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,196.01"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,371.05"	"$4,415.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100748	EAP	CPT® 44015		Jejunostomy Intra-op Ent Alime	BOTH IP/OP	"$6,352.00 "	"$4,700.48"	$0.00	"$5,253.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,323.76"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,201.06"	"$5,253.60"	$0.00	"$1,114.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100749	EAP	CPT® 44373		Peg Conversion To Pej	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$845.06	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,211.56"	"$3,244.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100751	EAP	CPT® 44500		Intro Of Long Gi Tube	BOTH IP/OP	"$1,291.00 "	$955.34	$0.00	"$1,304.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.04	$0.00	$0.00	$0.00	$0.00	"$1,304.00"	"$1,032.77"	"$1,043.20"	$0.00	"$1,291.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100754	EAP	CPT® 45000		Drain Pelvic Abscess Us	BOTH IP/OP	"$6,884.00 "	"$5,094.16"	$0.00	"$5,507.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,434.63"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,452.13"	"$5,507.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100757	EAP	CPT® 46040		Perirectal Abscess	BOTH IP/OP	"$2,951.00 "	"$2,183.74"	$0.00	"$2,858.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$614.99	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$2,360.95"	"$2,384.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100758	EAP	CPT® 46600		"Anoscopy, Diagnostic, Inc Spec Collect"	BOTH IP/OP	$561.00 	$415.14	$0.00	$561.00	$561.00	$561.00	$109.81	$109.81	$110.43	$116.93	$0.00	$0.00	$0.00	$107.30	$116.91	$69.74	$113.00	$113.00	$109.35	$542.00	$429.26	$433.60	$151.93	$235.00	$151.93	$37.41	$42.17	$42.17	$86.29	$104.14	$0.00	$0.00	$0.00	$0.00
36100759	EAP	CPT® 46606		Anoscopy And Biopsy	BOTH IP/OP	"$2,211.00 "	"$1,636.14"	$52.76	"$2,211.00"	"$2,211.00"	"$2,211.00"	"$1,009.84"	"$1,009.84"	"$1,015.53"	$460.83	"$1,257.08"	"$1,257.08"	"$1,305.43"	$993.84	$460.77	$646.00	"$2,211.00"	"$2,211.00"	"$1,007.17"	"$2,137.00"	"$1,692.50"	"$1,709.60"	"$1,399.33"	"$2,211.00"	"$1,399.33"	$52.76	$78.23	$78.23	$340.21	$959.21	$0.00	$0.00	$0.00	$0.00
36100760	EAP	CPT® 46900		Destr Condyloma Anal - Chemic	BOTH IP/OP	$945.00 	$699.30	$0.00	$955.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.94	$0.00	$0.00	$0.00	$0.00	$955.00	$756.36	$764.00	$0.00	$945.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100763	EAP	CPT® 46916		Anal Cryo Surgery	BOTH IP/OP	$429.00 	$317.46	$0.00	$433.00	$429.00	$429.00	$174.88	$174.88	$175.86	$89.41	$0.00	$0.00	$0.00	$172.08	$89.40	$111.85	$113.00	$113.00	$175.24	$433.00	$342.94	$346.40	$243.48	$429.00	$243.48	$138.83	$146.36	$146.36	$68.93	$166.90	$0.00	$0.00	$0.00	$0.00
36100764	EAP	CPT® 47000		"Liver Biopsy, Needle, Percut"	BOTH IP/OP	"$2,078.00 "	"$1,537.72"	$92.31	"$2,078.00"	"$2,078.00"	"$2,078.00"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$433.11	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	$433.06	$876.52	"$1,871.00"	"$1,871.00"	"$1,376.63"	"$2,073.00"	"$1,641.82"	"$1,658.40"	"$1,912.65"	"$2,078.00"	"$1,912.65"	$233.09	$92.31	$92.31	$330.02	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100769	EAP	CPT® 47001		BX LIVER ADDTL PROC PERCUT BCT	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$566.92	$0.00	$0.00	$0.00	$0.00	$566.85	$0.00	"$1,608.88"	"$1,608.88"	$0.00	"$2,255.00"	"$2,148.70"	"$2,170.40"	$0.00	$989.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100770	EAP	CPT® 47015		Exploratory Laparotomy	BOTH IP/OP	"$4,765.00 "	"$3,526.10"	$0.00	"$3,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$993.03	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,811.90"	"$3,850.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100771	EAP	CPT® 47380		"Ablation, Open Liver Tumor, Rf"	BOTH IP/OP	"$6,657.00 "	"$4,926.18"	$0.00	"$5,325.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,387.32"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,272.34"	"$5,325.60"	$0.00	"$3,965.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100773	EAP	CPT® 47382		"Ablation, Liver Tumor; Rf"	BOTH IP/OP	"$8,888.00 "	"$6,577.12"	$0.00	"$7,182.40"	"$3,735.90"	"$3,735.90"	"$4,927.54"	"$4,927.54"	"$4,955.30"	"$1,852.48"	$0.00	$0.00	$0.00	"$4,850.03"	"$1,852.26"	"$3,152.52"	"$4,877.00"	"$4,877.00"	"$4,847.92"	"$5,452.00"	"$7,110.58"	"$7,182.40"	"$6,735.53"	"$4,334.00"	"$6,735.53"	$637.15	$774.64	$774.64	"$1,429.30"	"$4,617.06"	$0.00	$0.00	$0.00	$0.00
36100774	EAP	CPT® 47490		DRAIN CHOLECYSTOSTOMY S&I BCT	BOTH IP/OP	"$5,844.00 "	"$4,324.56"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,217.89"	$0.00	$0.00	$0.00	"$3,118.48"	"$2,255.00"	"$4,675.18"	"$4,722.40"	"$4,332.71"	"$3,250.00"	"$4,332.71"	$444.58	$345.72	$345.72	$939.76	"$2,969.98"	$0.00	$0.00	$0.00	$0.00
36100781	EAP	CPT® 47555		DILAT BIL STRICT W/O STENT SPV	BOTH IP/OP	"$4,136.00 "	"$3,060.64"	$0.00	"$3,308.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.94	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$3,275.71"	"$3,308.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100783	EAP	CPT® 47556		Biliary Dil Strict W/stent	BOTH IP/OP	"$8,728.00 "	"$6,458.72"	$0.00	"$6,982.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,818.92"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$6,912.58"	"$6,982.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100786	EAP	CPT® 48000		PANCREATITIS PLACE DRAIN BCT	BOTH IP/OP	"$9,260.00 "	"$6,852.40"	$0.00	"$7,408.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,929.78"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$7,333.92"	"$7,408.00"	$0.00	"$5,889.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100787	EAP	CPT® 48102		BX PANCREAS PERCUT NDL BCT	BOTH IP/OP	"$2,114.00 "	"$1,564.36"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$440.56	$0.00	$0.00	$0.00	$0.00	"$2,114.00"	"$1,674.29"	"$1,691.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100800	EAP	CPT® 37211		Thrombolytic Art Therapy W/s/i Any Meth Init Day	BOTH IP/OP	"$25,698.00 "	"$19,016.52"	$0.00	"$19,515.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,355.46"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$19,320.05"	"$19,515.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100802	EAP	CPT® 37212		Thrombolytic Venous Therapy  W S/i Any Meth Init Day	BOTH IP/OP	"$25,698.00 "	"$19,016.52"	$0.00	"$19,515.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,355.46"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$19,320.05"	"$19,515.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100804	EAP	CPT® 49180		Ablation Abd Standard Bct	BOTH IP/OP	"$2,922.00 "	"$2,162.28"	$0.00	"$2,337.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$649.66	$0.00	$0.00	$0.00	"$1,348.50"	$649.58	$876.52	"$1,871.00"	"$1,871.00"	"$1,376.63"	"$2,255.00"	"$2,314.22"	"$2,337.60"	"$1,912.65"	$0.00	"$1,912.65"	$203.88	$87.64	$87.64	$465.18	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100805	EAP	CPT® 49180		Bx Abd/retroper Mass Us	BOTH IP/OP	"$2,922.00 "	"$2,162.28"	$0.00	"$2,337.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,376.63"	"$2,255.00"	"$2,314.22"	"$2,337.60"	"$1,912.65"	$0.00	"$1,912.65"	$203.88	$87.64	$87.64	$465.18	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100806	EAP	CPT® 49180		Bx Retroperitone Mass Perc Bct	BOTH IP/OP	"$3,117.00 "	"$2,306.58"	$87.64	"$2,500.00"	"$2,321.55"	"$2,321.55"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$649.66	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	$649.58	$876.52	"$1,871.00"	"$1,871.00"	"$1,376.63"	"$2,255.00"	"$2,314.22"	"$2,337.60"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$203.88	$87.64	$87.64	$465.18	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100807	EAP	CPT® 49419		Insert. Of Intrperitoneal Cath	BOTH IP/OP	"$11,483.00 "	"$8,497.42"	$0.00	"$10,746.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,393.06"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$10,638.94"	"$10,746.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100808	EAP	CPT® 49421		Peritoneal Dialysis Cat.placem	BOTH IP/OP	"$11,842.00 "	"$8,763.08"	$0.00	"$11,082.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,467.87"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$10,971.58"	"$11,082.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100809	EAP	CPT® 49423		CATHETER EXCH RAD GUIDE BCT	BOTH IP/OP	"$3,484.00 "	"$2,578.16"	$0.00	"$3,606.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$726.07	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$3,228.19"	"$3,260.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100810	EAP	CPT® 37213		Throm Art/ven Therapy  W S/i  Inc F/u Cath Subsq Day	BOTH IP/OP	"$43,713.00 "	"$32,347.62"	$0.00	"$33,196.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,109.79"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$32,864.83"	"$33,196.80"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100811	EAP	CPT® 49424		Inj Dye Via Previous Drn Bct	BOTH IP/OP	"$3,484.00 "	"$2,578.16"	$0.00	"$3,260.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$726.07	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,228.19"	"$3,260.80"	$0.00	$840.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100812	EAP	CPT® 49427		"Injection, Abdominal Shunt"	BOTH IP/OP	$373.00 	$276.02	$0.00	$436.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.73	$0.00	$0.00	$0.00	$0.00	$436.00	$345.31	$348.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100813	EAP	CPT® 49440		Gastrostomy Tube Place S&i Spv	BOTH IP/OP	"$5,144.00 "	"$3,806.56"	$0.00	"$3,957.60"	"$2,753.10"	"$2,753.10"	"$1,581.72"	"$1,581.72"	"$1,590.63"	"$1,072.14"	$0.00	$0.00	$0.00	"$1,557.45"	"$1,072.01"	"$1,012.34"	"$1,871.00"	"$1,871.00"	"$1,561.98"	"$2,255.00"	"$3,918.02"	"$3,957.60"	"$2,170.16"	"$2,500.00"	"$2,170.16"	$774.21	$213.84	$213.84	$787.56	"$1,487.60"	$0.00	$0.00	$0.00	$0.00
36100814	EAP	CPT® 49446		G Tube Check	BOTH IP/OP	"$6,735.00 "	"$4,983.90"	$0.00	"$5,181.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,403.57"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,129.78"	"$5,181.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100815	EAP	CPT® 49450		Replace G/c Tube Perc	BOTH IP/OP	"$3,451.00 "	"$2,553.74"	$0.00	"$2,655.20"	"$2,321.55"	"$2,321.55"	$787.99	$787.99	$792.43	$719.27	$0.00	$0.00	$0.00	$775.94	$719.19	$504.36	"$1,871.00"	"$1,871.00"	$788.23	"$2,255.00"	"$2,628.65"	"$2,655.20"	"$1,095.14"	"$2,150.00"	"$1,095.14"	$685.21	$68.88	$68.88	$528.38	$750.70	$0.00	$0.00	$0.00	$0.00
36100816	EAP	CPT® 49452		Replace G-j Tube Perc	BOTH IP/OP	"$3,451.00 "	"$2,553.74"	$0.00	"$2,655.20"	"$2,321.55"	"$2,321.55"	$787.99	$787.99	$792.43	$719.27	$0.00	$0.00	$0.00	$775.94	$719.19	$504.36	"$1,871.00"	"$1,871.00"	$788.23	"$2,255.00"	"$2,628.65"	"$2,655.20"	"$1,095.14"	"$2,150.00"	"$1,095.14"	$885.13	$144.98	$144.98	$528.38	$750.70	$0.00	$0.00	$0.00	$0.00
36100818	EAP	CPT® 50200		BX RENAL PERCUT TROCAR/NDL BCT	BOTH IP/OP	"$2,343.00 "	"$1,733.82"	$133.42	"$2,500.00"	"$2,321.55"	"$2,321.55"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$488.34	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	$488.28	$876.52	"$1,871.00"	"$1,871.00"	"$1,376.63"	"$2,255.00"	"$1,850.90"	"$1,869.60"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$161.61	$133.42	$133.42	$372.05	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100819	EAP	CPT® 50200		Percutaneous Kidney Biopsy	BOTH IP/OP	"$2,337.00 "	"$1,729.38"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$487.09	$0.00	$0.00	$0.00	"$1,348.50"	$487.03	$876.52	"$1,871.00"	"$1,871.00"	"$1,376.63"	"$2,255.00"	"$1,850.90"	"$1,869.60"	"$1,912.65"	$0.00	"$1,912.65"	$161.61	$133.42	$133.42	$372.05	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36100821	EAP	CPT® 50382		"Change Urter Stent, Percut"	BOTH IP/OP	"$7,354.00 "	"$5,441.96"	$0.00	"$5,888.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,532.57"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$5,829.12"	"$5,888.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100822	EAP	CPT® 50384		"Remove Urter Stent, Percut"	BOTH IP/OP	"$6,508.00 "	"$4,815.92"	$0.00	"$5,258.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,356.27"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,205.82"	"$5,258.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100823	EAP	CPT® 50387		Change Ext/int Ureter Stent	BOTH IP/OP	"$2,713.00 "	"$2,007.62"	$0.00	"$2,713.00"	"$2,321.55"	"$2,321.55"	"$1,743.67"	"$1,743.67"	"$1,753.49"	$565.46	$0.00	$0.00	$0.00	"$1,718.44"	$565.39	"$1,116.98"	"$2,713.00"	"$2,713.00"	"$1,776.76"	"$2,255.00"	"$2,170.08"	"$2,192.00"	"$2,468.57"	"$2,500.00"	"$2,468.57"	$790.32	$87.64	$87.64	$436.21	"$1,692.15"	$0.00	$0.00	$0.00	$0.00
36100824	EAP	CPT® 50389		Remove Renal Tube With Fluro	BOTH IP/OP	$987.00 	$730.38	$0.00	$997.00	$987.00	$987.00	$560.26	$560.26	$563.41	$205.72	$0.00	$0.00	$0.00	$550.87	$205.69	$358.07	$987.00	$987.00	$558.17	$997.00	$789.62	$797.60	$775.50	$987.00	$775.50	$541.78	$55.90	$55.90	$158.72	$531.59	$0.00	$0.00	$0.00	$0.00
36100825	EAP	CPT® 50390		Aspir/inject Renal Cyst/pelvis	BOTH IP/OP	"$4,429.00 "	"$3,277.46"	$0.00	"$3,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$923.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,334.32"	"$3,368.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100831	EAP	CPT® 50592		"Ablation, Renal Tumor, Rf"	BOTH IP/OP	"$16,043.00 "	"$11,871.82"	$0.00	"$12,200.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,343.36"	$0.00	$0.00	$0.00	"$4,847.92"	"$5,452.00"	"$12,078.79"	"$12,200.80"	"$6,735.53"	"$4,334.00"	"$6,735.53"	"$6,100.60"	$357.73	$357.73	"$2,427.96"	"$4,617.06"	$0.00	$0.00	$0.00	$0.00
36100832	EAP	CPT® 50684		Injection For Ureter Xray	BOTH IP/OP	$774.00 	$572.76	$0.00	$619.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.30	$0.00	$0.00	$0.00	$0.00	$387.00	$613.01	$619.20	$0.00	$327.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100833	EAP	CPT® 50688		Change Of Ureter Tube/stent	BOTH IP/OP	"$2,286.00 "	"$1,691.64"	$0.00	"$2,286.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$476.40	$0.00	$0.00	$0.00	$0.00	"$2,173.00"	"$1,721.02"	"$1,738.40"	$0.00	"$2,286.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100834	EAP	CPT® 50690		Inject For Ureter X-ray	BOTH IP/OP	$829.00 	$613.46	$0.00	$829.00	$829.00	$829.00	$0.00	$0.00	$0.00	$172.78	$829.00	$829.00	$829.00	$0.00	$172.76	$0.00	$490.35	$490.35	$0.00	$394.00	$624.10	$630.40	$0.00	$829.00	$0.00	$298.44	$72.83	$72.83	$125.45	$0.00	$0.00	$0.00	$0.00	$0.00
36100835	EAP	CPT® 51080		DRN PERIVESIC/PREVESIC ABS BCT	BOTH IP/OP	"$3,734.00 "	"$2,763.16"	$0.00	"$2,987.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$778.17	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,957.33"	"$2,987.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100836	EAP	CPT® 51100		Drain Bladder By Needle	BOTH IP/OP	$647.00 	$478.78	$0.00	$647.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.83	$0.00	$0.00	$0.00	$0.00	$647.00	$512.42	$517.60	$0.00	$647.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100839	EAP	CPT® 51102		Bladder Tap-suprapub W Cath In	BOTH IP/OP	"$5,564.00 "	"$4,117.36"	$0.00	"$4,451.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,159.54"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,406.69"	"$4,451.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100840	EAP	CPT® 51102		Drain Bl W/cath Insertion	BOTH IP/OP	"$5,564.00 "	"$4,117.36"	$0.00	"$4,451.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,159.54"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,406.69"	"$4,451.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100841	EAP	CPT® 51102		Drainage Of Bladder	BOTH IP/OP	"$5,564.00 "	"$4,117.36"	$0.00	"$4,451.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,159.54"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,406.69"	"$4,451.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100842	EAP	CPT® 51600		Inject Cystography/voiding	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,275.00"	$692.33	$692.33	$0.00	$0.00	$0.00	$265.74	"$1,257.08"	"$1,257.08"	"$1,275.00"	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.00	"$1,009.01"	"$1,019.20"	$0.00	"$1,275.00"	$0.00	$280.11	$46.16	$46.16	$202.82	$0.00	$0.00	$0.00	$0.00	$0.00
36100844	EAP	CPT® 51610		Inject Cystography/void Retro	BOTH IP/OP	"$2,406.00 "	"$1,780.44"	$0.00	"$1,923.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$501.41	$0.00	$0.00	$0.00	$0.00	"$1,202.00"	"$1,903.97"	"$1,923.20"	$0.00	"$1,022.00"	$0.00	$301.43	$66.70	$66.70	$382.72	$0.00	$0.00	$0.00	$0.00	$0.00
36100846	EAP	CPT® 51700		Bladder Irrigation &/or Instil	BOTH IP/OP	$504.00 	$372.96	$0.00	$504.00	$504.00	$504.00	$259.14	$259.14	$260.60	$105.05	$0.00	$0.00	$0.00	$255.07	$105.03	$165.80	$113.00	$113.00	$0.00	$504.00	$399.17	$403.20	$0.00	$504.00	$0.00	$100.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100848	EAP	CPT® 51701		Insert Straight Cath In & Out	BOTH IP/OP	$865.00 	$640.10	$0.00	$865.00	$865.00	$865.00	$109.81	$109.81	$110.43	$180.29	$0.00	$0.00	$0.00	$107.30	$180.27	$69.74	$113.00	$113.00	$109.35	$864.00	$684.29	$691.20	$151.93	$548.00	$151.93	$57.62	$27.40	$27.40	$137.55	$104.14	$0.00	$0.00	$0.00	$0.00
36100849	EAP	CPT® 51702		Cath Insert Indwelling	BOTH IP/OP	"$1,070.00 "	$791.80	$0.00	"$1,070.00"	"$1,070.00"	"$1,070.00"	$109.81	$109.81	$110.43	$223.01	$0.00	$0.00	$0.00	$107.30	$222.99	$69.74	$113.00	$113.00	$109.35	"$1,069.00"	$846.65	$855.20	$151.93	"$1,070.00"	$151.93	$91.18	$26.68	$26.68	$170.18	$104.14	$0.00	$0.00	$0.00	$0.00
36100850	EAP	CPT® 51702		Insert Foley Cath	BOTH IP/OP	"$1,069.00 "	$791.06	$0.00	"$1,069.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$223.01	$0.00	$0.00	$0.00	$107.30	$222.99	$69.74	$113.00	$113.00	$109.35	"$1,069.00"	$846.65	$855.20	$151.93	$0.00	$151.93	$91.18	$26.68	$26.68	$170.18	$104.14	$0.00	$0.00	$0.00	$0.00
36100851	EAP	CPT® 51703		Insert Complicated Cath	BOTH IP/OP	"$1,809.00 "	"$1,338.66"	$0.00	"$1,809.00"	"$1,809.00"	"$1,809.00"	$135.96	$135.96	$136.73	$0.00	$0.00	$0.00	$0.00	$0.00	$377.00	$0.00	$0.00	$0.00	$138.76	"$1,808.00"	"$1,431.94"	"$1,446.40"	$192.78	$899.00	$192.78	$170.19	$80.41	$80.41	$287.83	$132.15	$0.00	$0.00	$0.00	$0.00
36100852	EAP	CPT® 51705		Change Cysto Tube Simple	BOTH IP/OP	$626.00 	$463.24	$0.00	$626.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.46	$0.00	$0.00	$0.00	$235.59	$625.00	$495.00	$500.00	$327.32	$626.00	$327.32	$86.33	$54.08	$54.08	$99.50	$224.37	$0.00	$0.00	$0.00	$0.00
36100853	EAP	CPT® 51710		Change Cysto Tube Complicated	BOTH IP/OP	"$3,957.00 "	"$2,928.18"	$0.00	"$3,163.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$824.64	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,131.57"	"$3,163.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100854	EAP	CPT® 51720		Instill Bladder Anticancer Age	BOTH IP/OP	"$1,029.00 "	$761.46	$0.00	"$1,029.00"	"$1,029.00"	"$1,029.00"	$259.14	$259.14	$260.60	$214.47	$0.00	$0.00	$0.00	$255.07	$214.44	$165.80	"$1,029.00"	"$1,029.00"	$235.59	"$1,028.00"	$814.18	$822.40	$327.32	"$1,029.00"	$327.32	$147.65	$45.44	$45.44	$163.66	$224.37	$0.00	$0.00	$0.00	$0.00
36100855	EAP	CPT® 51726		Cystometrogram	BOTH IP/OP	"$1,648.00 "	"$1,219.52"	$0.00	"$1,649.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.44	$0.00	$0.00	$0.00	$0.00	"$1,648.00"	"$1,305.22"	"$1,318.40"	$0.00	"$1,649.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100858	EAP	CPT® 51798		Residual Urine By Ultrasound	BOTH IP/OP	$205.00 	$151.70	$0.00	$207.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$55.17	$207.00	$163.94	$165.60	$76.65	$205.00	$76.65	$19.99	$10.44	$10.44	$32.95	$52.54	$0.00	$0.00	$0.00	$0.00
36100860	EAP	CPT® 52000		Cystourethroscopy	BOTH IP/OP	"$3,069.00 "	"$2,271.06"	$84.02	"$2,480.00"	"$2,321.55"	"$2,321.55"	$560.26	$560.26	$563.41	$639.66	"$1,257.08"	"$1,257.08"	"$1,305.43"	$550.87	$639.58	$358.07	"$1,871.00"	"$1,871.00"	$558.17	"$2,255.00"	"$2,455.20"	"$2,480.00"	$775.50	"$2,150.00"	$775.50	$152.62	$84.02	$84.02	$493.52	$531.59	$0.00	$0.00	$0.00	$0.00
36100861	EAP	CPT® 52005		Cystourethro W Ureteral Cath	BOTH IP/OP	"$5,902.00 "	"$4,367.48"	$0.00	"$4,769.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,229.98"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,721.90"	"$4,769.60"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100862	EAP	CPT® 52281		Perc Dilate Ureter W Balloon	BOTH IP/OP	"$6,114.00 "	"$4,524.36"	$0.00	"$4,940.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,274.31"	$0.00	$0.00	$0.00	"$1,718.44"	"$1,274.16"	"$1,116.98"	"$2,836.00"	"$2,836.00"	"$1,776.76"	"$2,327.00"	"$4,891.39"	"$4,940.80"	"$2,468.57"	"$2,500.00"	"$2,468.57"	$208.00	$157.57	$157.57	$983.22	"$1,692.15"	$0.00	$0.00	$0.00	$0.00
36100863	EAP	CPT® 52310		Cysto W Stent Removal	BOTH IP/OP	"$5,725.00 "	"$4,236.50"	$156.86	"$4,626.40"	"$2,753.10"	"$2,753.10"	"$1,743.67"	"$1,743.67"	"$1,753.49"	"$1,193.23"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,718.44"	"$1,193.09"	"$1,116.98"	"$2,836.00"	"$2,836.00"	"$1,776.76"	"$2,327.00"	"$4,580.14"	"$4,626.40"	"$2,468.57"	"$2,500.00"	"$2,468.57"	$409.12	$156.86	$156.86	$920.65	"$1,692.15"	$0.00	$0.00	$0.00	$0.00
36100864	EAP	CPT® 52332		Cysto W Ureter Stent Plcmnt	BOTH IP/OP	"$10,798.00 "	"$7,990.52"	$0.00	"$8,725.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,250.30"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$8,638.34"	"$8,725.60"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100865	EAP	CPT® 53600		Dilate Urethra Strict Male Ini	BOTH IP/OP	$687.00 	$508.38	$0.00	$694.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.17	$0.00	$0.00	$0.00	$235.59	$694.00	$549.65	$555.20	$327.32	$687.00	$327.32	$0.00	$65.99	$65.99	$110.48	$224.37	$0.00	$0.00	$0.00	$0.00
36100866	EAP	CPT® 53601		Dilate Stricture Male Subseq	BOTH IP/OP	$314.00 	$232.36	$0.00	$317.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.44	$0.00	$0.00	$0.00	$0.00	$317.00	$251.06	$253.60	$0.00	$314.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100867	EAP	CPT® 53620		Dilate Strict Male Filiform Ix	BOTH IP/OP	"$4,447.00 "	"$3,290.78"	$0.00	"$3,557.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$926.75	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,522.02"	"$3,557.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100868	EAP	CPT® 53621		Dilate Strict Male Filiform Su	BOTH IP/OP	$804.00 	$594.96	$0.00	$804.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.55	$0.00	$0.00	$0.00	$0.00	$804.00	$636.77	$643.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100869	EAP	CPT® 53660		Dilate Urethra Strict Female I	BOTH IP/OP	$286.00 	$211.64	$0.00	$286.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.60	$0.00	$0.00	$0.00	$0.00	$286.00	$226.51	$228.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100870	EAP	CPT® 53661		Dilate Urethra Strict Female S	BOTH IP/OP	$286.00 	$211.64	$0.00	$286.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.60	$0.00	$0.00	$0.00	$0.00	$286.00	$226.51	$228.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100871	EAP	CPT® 54001		Dorsal Slit  Exc Newborn	BOTH IP/OP	"$6,461.00 "	"$4,781.14"	$0.00	"$5,162.40"	"$2,753.10"	"$2,753.10"	"$1,743.67"	"$1,743.67"	"$1,753.49"	"$1,346.63"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,718.44"	"$1,346.47"	"$1,116.98"	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$5,110.78"	"$5,162.40"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100872	EAP	CPT® 54015		"Incise And Drain Penis, Deep"	BOTH IP/OP	"$4,851.00 "	"$3,589.74"	$0.00	"$3,880.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,010.95"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$3,841.99"	"$3,880.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100873	EAP	CPT® 54050		"Les, Dest, Chem Penis, Simple"	BOTH IP/OP	$755.00 	$558.70	$0.00	$763.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.34	$0.00	$0.00	$0.00	$320.45	$763.00	$604.30	$610.40	$445.22	$755.00	$445.22	$92.54	$107.78	$107.78	$121.47	$305.19	$0.00	$0.00	$0.00	$0.00
36100875	EAP	CPT® 54056		Cryosurg Penis Lesion(s) Simpl	BOTH IP/OP	$304.00 	$224.96	$0.00	$307.00	$165.07	$165.07	$174.88	$174.88	$175.86	$63.36	$0.00	$0.00	$0.00	$172.08	$63.35	$111.85	$113.00	$113.00	$175.24	$307.00	$243.14	$245.60	$243.48	$304.00	$243.48	$104.42	$112.46	$112.46	$48.87	$166.90	$0.00	$0.00	$0.00	$0.00
36100876	EAP	CPT® 54100		Biopsy Of Penis	BOTH IP/OP	"$6,079.00 "	"$4,498.46"	$0.00	"$4,912.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,266.86"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,862.88"	"$4,912.00"	$0.00	"$2,456.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100877	EAP	CPT® 54150		Circumcision	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$2,681.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$474.53	$0.00	$0.00	$0.00	$0.00	"$2,079.00"	"$1,646.57"	"$1,663.20"	$0.00	"$2,681.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100878	EAP	CPT® 54200		Treatment Of Penis Lesion	BOTH IP/OP	$590.00 	$436.60	$0.00	$672.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.96	$0.00	$0.00	$0.00	$0.00	$672.00	$532.22	$537.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100879	EAP	CPT® 54230		Inject Corpora Cavernosography	BOTH IP/OP	"$1,666.00 "	"$1,232.84"	$0.00	"$1,897.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$347.19	$0.00	$0.00	$0.00	$0.00	"$1,897.00"	"$1,502.42"	"$1,517.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100880	EAP	CPT® 54450		Paraphimosis Reduction	BOTH IP/OP	$618.00 	$457.32	$0.00	$624.00	$618.00	$618.00	$259.14	$259.14	$260.60	$0.00	$618.00	$618.00	$618.00	$0.00	$128.79	$0.00	$0.00	$0.00	$235.59	$624.00	$494.21	$499.20	$327.32	$618.00	$327.32	$70.76	$59.86	$59.86	$99.34	$224.37	$0.00	$0.00	$0.00	$0.00
36100881	EAP	CPT® 54700		"Incise And Drain, Testes"	BOTH IP/OP	"$3,277.00 "	"$2,424.98"	$0.00	"$2,621.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$682.93	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,595.38"	"$2,621.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100882	EAP	CPT® 54860		Removal Of Epididymis	BOTH IP/OP	"$7,853.00 "	"$5,811.22"	$0.00	"$6,282.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,636.57"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$6,219.58"	"$6,282.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100883	EAP	CPT® 55000		Aspiration Of Hydrocele	BOTH IP/OP	$988.00 	$731.12	$0.00	$998.00	$536.48	$536.48	$606.01	$606.01	$609.42	$0.00	$0.00	$0.00	$0.00	$0.00	$205.90	$0.00	$0.00	$0.00	$611.80	$998.00	$790.42	$798.40	$850.02	$988.00	$850.02	$92.61	$87.97	$87.97	$158.88	$582.67	$0.00	$0.00	$0.00	$0.00
36100884	EAP	CPT® 55250		Removal Of Sperm Duct(s)	BOTH IP/OP	"$2,475.00 "	"$1,831.50"	$0.00	"$2,475.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$515.79	$0.00	$0.00	$0.00	"$1,776.76"	"$2,327.00"	"$1,980.00"	"$2,000.00"	"$2,468.57"	"$2,475.00"	"$2,468.57"	$321.77	$236.13	$236.13	$398.00	"$1,692.15"	$0.00	$0.00	$0.00	$0.00
36100885	EAP	CPT® 55700		Biopsy Prostate Needle/punch	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$135.95	"$3,595.20"	"$2,753.10"	"$2,753.10"	"$1,743.67"	"$1,743.67"	"$1,753.49"	$938.95	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,718.44"	$938.84	"$1,116.98"	"$2,836.00"	"$2,836.00"	"$1,776.76"	"$2,327.00"	"$3,559.25"	"$3,595.20"	"$2,468.57"	"$2,500.00"	"$2,468.57"	$147.73	$135.95	$135.95	$715.44	"$1,692.15"	$0.00	$0.00	$0.00	$0.00
36100887	EAP	CPT® 56405		I And D Vulva Perineal Absces	BOTH IP/OP	$291.00 	$215.34	$0.00	"$1,750.00"	$291.00	$291.00	$274.65	$274.65	$276.20	$60.65	$291.00	$291.00	$291.00	$269.78	$60.64	$175.35	$291.00	$291.00	$0.00	$294.00	$232.85	$235.20	$0.00	"$1,750.00"	$0.00	$107.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100898	EAP	CPT® 56420		Bartholin Gland Abscess	BOTH IP/OP	$665.00 	$492.10	$0.00	"$1,224.00"	$665.00	$665.00	$165.90	$165.90	$166.84	$138.60	$0.00	$0.00	$0.00	$163.24	$138.59	$106.10	$665.00	$665.00	$166.54	$672.00	$532.22	$537.60	$231.38	"$1,224.00"	$231.38	$106.60	$107.06	$107.06	$106.98	$158.61	$0.00	$0.00	$0.00	$0.00
36100902	EAP	CPT® 37214		Cess Therapy Cath Removalw/ Vess Close	BOTH IP/OP	"$8,844.00 "	"$6,544.56"	$0.00	"$7,075.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$7,004.45"	"$7,075.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100903	EAP	CPT® 56501		"Cryosurgery, Vulvar"	BOTH IP/OP	"$6,455.00 "	"$4,776.70"	$0.00	"$5,216.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,345.22"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,163.84"	"$5,216.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100904	EAP	CPT® 56501		Destroy Lesion(s) Vulva Simple	BOTH IP/OP	"$6,455.00 "	"$4,776.70"	$0.00	"$5,216.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,345.22"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,163.84"	"$5,216.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100906	EAP	CPT® 56515		Destroy Lesion(s) Vulva Extens	BOTH IP/OP	"$4,384.00 "	"$3,244.16"	$0.00	"$3,542.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$913.63	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$3,506.98"	"$3,542.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100909	EAP	CPT® 56605		"Vulvar Biopsy, One Lesion"	BOTH IP/OP	$641.00 	$474.34	$63.10	$641.00	$641.00	$641.00	$617.38	$617.38	$620.86	$133.60	$641.00	$641.00	$641.00	$607.07	$133.58	$394.60	$641.00	$641.00	$640.34	$586.00	$464.11	$468.80	$586.00	$641.00	$586.00	$84.36	$63.10	$63.10	$93.29	$609.84	$0.00	$0.00	$0.00	$0.00
36100914	EAP	CPT® 56606		"Vulvar Bx, Each Addl Lesion"	BOTH IP/OP	$557.00 	$412.18	$0.00	$557.00	$557.00	$557.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.08	$0.00	$0.00	$0.00	$0.00	$556.00	$440.35	$444.80	$0.00	$557.00	$0.00	$53.12	$31.01	$31.01	$88.52	$0.00	$0.00	$0.00	$0.00	$0.00
36100920	EAP	CPT® 56820		"Colposcopy, Vulva"	BOTH IP/OP	$501.00 	$370.74	$0.00	$502.00	$501.00	$501.00	$165.90	$165.90	$166.84	$104.42	$0.00	$0.00	$0.00	$163.24	$104.41	$106.10	$113.00	$113.00	$166.54	$502.00	$397.58	$401.60	$231.38	$501.00	$231.38	$116.33	$89.05	$89.05	$79.92	$158.61	$0.00	$0.00	$0.00	$0.00
36100921	EAP	CPT® 56821		"Colposcopy, Vulva + Vulva Bx"	BOTH IP/OP	"$1,623.00 "	"$1,201.02"	$0.00	"$1,627.00"	"$1,623.00"	"$1,623.00"	$274.65	$274.65	$276.20	$338.27	$0.00	$0.00	$0.00	$269.78	$338.23	$175.35	"$1,623.00"	"$1,623.00"	$271.52	"$1,627.00"	"$1,288.58"	"$1,301.60"	$377.23	"$1,623.00"	$377.23	$150.61	$118.98	$118.98	$259.02	$258.59	$0.00	$0.00	$0.00	$0.00
36100923	EAP	CPT® 57020		Colpocentesis	BOTH IP/OP	"$3,281.00 "	"$2,427.94"	$0.00	"$4,294.21"	"$2,753.10"	"$2,753.10"	"$4,294.21"	"$4,294.21"	"$3,281.00"	$683.84	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$4,226.19"	$683.76	"$2,747.02"	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$2,605.68"	"$2,632.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100925	EAP	CPT® 57061		Destroy Vaginal Lesion(s) Simp	BOTH IP/OP	"$4,198.00 "	"$3,106.52"	$0.00	"$4,198.00"	"$2,321.55"	"$2,321.55"	"$2,555.04"	"$2,555.04"	"$2,569.43"	$874.97	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$2,514.14"	$874.86	"$1,634.19"	"$4,198.00"	"$4,198.00"	$0.00	"$2,327.00"	"$3,358.08"	"$3,392.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100926	EAP	CPT® 57065		Destroy Vaginal Lesion(s) Exte	BOTH IP/OP	"$4,256.00 "	"$3,149.44"	$0.00	"$3,404.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.95	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,370.75"	"$3,404.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100929	EAP	CPT® 57100		Vaginal Biopsy Simple	BOTH IP/OP	"$3,448.00 "	"$2,551.52"	$68.51	"$3,440.00"	"$2,321.55"	"$2,321.55"	$617.38	$617.38	$620.86	$718.65	"$1,257.08"	"$1,257.08"	"$1,305.43"	$607.07	$718.56	$394.60	"$1,871.00"	"$1,871.00"	$640.34	"$3,440.00"	"$2,724.48"	"$2,752.00"	$889.66	"$2,150.00"	$889.66	$71.96	$68.51	$68.51	$547.65	$609.84	$0.00	$0.00	$0.00	$0.00
36100930	EAP	CPT® 27096		Bil Sacroiliac Jt Inj With Arthrography	BOTH IP/OP	"$3,165.00 "	"$2,342.10"	$0.00	"$2,557.60"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	$659.67	$0.00	$0.00	$0.00	$0.00	$659.59	$0.00	$113.00	$113.00	$0.00	"$2,255.00"	"$2,532.02"	"$2,557.60"	$86.18	"$1,750.00"	$86.18	$398.44	$86.18	$86.18	$508.96	$0.00	$0.00	$0.00	$0.00	$0.00
36100933	EAP	CPT® 57150		Vaginal Irrigation	BOTH IP/OP	$472.00 	$349.28	$0.00	$477.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.36	$0.00	$0.00	$0.00	$0.00	$477.00	$377.78	$381.60	$0.00	$472.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100934	EAP	CPT® 57155		Insertion Of T&o	BOTH IP/OP	"$4,229.00 "	"$3,129.46"	$0.00	"$2,327.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.32	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$1,980.00"	"$2,000.00"	$0.00	"$2,150.00"	$0.00	$410.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100935	EAP	CPT® 57160		Pessary Insertion	BOTH IP/OP	$335.00 	$247.90	$0.00	$338.00	$181.91	$181.91	$165.90	$165.90	$166.84	$69.82	$0.00	$0.00	$0.00	$163.24	$69.81	$106.10	$113.00	$113.00	$166.54	$338.00	$267.70	$270.40	$231.38	$335.00	$231.38	$60.59	$48.68	$48.68	$53.81	$158.61	$0.00	$0.00	$0.00	$0.00
36100936	EAP	CPT® 57170		Diaphragm  Cervical Cap Fittin	BOTH IP/OP	$500.00 	$370.00	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$500.00	$396.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100938	EAP	CPT® 57170		Diaphragm Fitting	BOTH IP/OP	$500.00 	$370.00	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$500.00	$396.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100939	EAP	CPT® 57210		Colpoperineorrhaphy	BOTH IP/OP	"$10,423.00 "	"$7,713.02"	$0.00	"$8,338.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,172.15"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$8,255.02"	"$8,338.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100940	EAP	CPT® 57420		Colposcopy Of Vagina	BOTH IP/OP	"$1,237.00 "	$915.38	$0.00	"$1,240.00"	"$1,237.00"	"$1,237.00"	$274.65	$274.65	$276.20	$257.82	$0.00	$0.00	$0.00	$269.78	$257.79	$175.35	"$1,237.00"	"$1,237.00"	$271.52	"$1,240.00"	$982.08	$992.00	$377.23	"$1,237.00"	$377.23	$121.31	$94.46	$94.46	$197.41	$258.59	$0.00	$0.00	$0.00	$0.00
36100941	EAP	CPT® 57420		"Colposcopy, Vagina With Cervix"	BOTH IP/OP	"$1,237.00 "	$915.38	$0.00	"$1,240.00"	"$1,237.00"	"$1,237.00"	$274.65	$274.65	$276.20	$257.82	$0.00	$0.00	$0.00	$269.78	$257.79	$175.35	"$1,237.00"	"$1,237.00"	$271.52	"$1,240.00"	$982.08	$992.00	$377.23	"$1,237.00"	$377.23	$121.31	$94.46	$94.46	$197.41	$258.59	$0.00	$0.00	$0.00	$0.00
36100942	EAP	CPT® 57421		Colposcopy Bx Of Vagina+cervix	BOTH IP/OP	"$1,039.00 "	$768.86	$0.00	"$1,042.00"	"$1,039.00"	"$1,039.00"	$617.38	$617.38	$620.86	$216.55	$0.00	$0.00	$0.00	$607.07	$216.53	$394.60	"$1,039.00"	"$1,039.00"	$640.34	"$1,042.00"	$825.26	$833.60	$889.66	"$1,039.00"	$889.66	$158.06	$128.00	$128.00	$165.89	$609.84	$0.00	$0.00	$0.00	$0.00
36100943	EAP	CPT® 57421		COLPOSCOPY OF VAGINA W/BX	BOTH IP/OP	"$1,039.00 "	$768.86	$0.00	"$1,042.00"	"$1,039.00"	"$1,039.00"	$617.38	$617.38	$620.86	$216.55	$0.00	$0.00	$0.00	$607.07	$216.53	$394.60	"$1,039.00"	"$1,039.00"	$640.34	"$1,042.00"	$825.26	$833.60	$889.66	"$1,039.00"	$889.66	$158.06	$128.00	$128.00	$165.89	$609.84	$0.00	$0.00	$0.00	$0.00
36100944	EAP	CPT® 57421		"COLPOSCOPY, VAGINA W/ BX"	BOTH IP/OP	"$1,039.00 "	$768.86	$0.00	"$1,042.00"	"$1,039.00"	"$1,039.00"	$617.38	$617.38	$620.86	$216.55	$0.00	$0.00	$0.00	$607.07	$216.53	$394.60	"$1,039.00"	"$1,039.00"	$640.34	"$1,042.00"	$825.26	$833.60	$889.66	"$1,039.00"	$889.66	$158.06	$128.00	$128.00	$165.89	$609.84	$0.00	$0.00	$0.00	$0.00
36100945	EAP	CPT® 57452		Colposcopy Without Biopsy	BOTH IP/OP	$556.00 	$411.44	$77.33	$557.00	$556.00	$556.00	$165.90	$165.90	$166.84	$115.88	$556.00	$556.00	$556.00	$163.24	$115.87	$106.10	$556.00	$556.00	$166.54	$557.00	$441.14	$445.60	$231.38	$556.00	$231.38	$77.33	$95.18	$95.18	$88.67	$158.61	$0.00	$0.00	$0.00	$0.00
36100951	EAP	CPT® 57454		Colposcopy W/bx & Ecc	BOTH IP/OP	"$1,185.00 "	$876.90	$99.94	"$1,188.00"	"$1,185.00"	"$1,185.00"	$274.65	$274.65	$276.20	$246.98	"$1,185.00"	"$1,185.00"	"$1,185.00"	$269.78	$246.95	$175.35	"$1,185.00"	"$1,185.00"	$271.52	"$1,188.00"	$940.90	$950.40	$377.23	"$1,185.00"	$377.23	$99.94	$140.25	$140.25	$189.13	$258.59	$0.00	$0.00	$0.00	$0.00
36100956	EAP	CPT® 57455		Colposcopy + Cx Bx	BOTH IP/OP	"$1,218.00 "	$901.32	$115.02	"$1,221.00"	"$1,218.00"	"$1,218.00"	$274.65	$274.65	$276.20	$253.86	"$1,218.00"	"$1,218.00"	"$1,218.00"	$269.78	$253.83	$175.35	"$1,218.00"	"$1,218.00"	$271.52	"$1,221.00"	$967.03	$976.80	$377.23	"$1,218.00"	$377.23	$145.54	$115.02	$115.02	$194.38	$258.59	$0.00	$0.00	$0.00	$0.00
36100960	EAP	CPT® 57456		Colposcopy + Ecc	BOTH IP/OP	"$1,218.00 "	$901.32	$106.36	"$1,221.00"	"$1,218.00"	"$1,218.00"	$274.65	$274.65	$276.20	$253.86	"$1,218.00"	"$1,218.00"	"$1,218.00"	$269.78	$253.83	$175.35	"$1,218.00"	"$1,218.00"	$271.52	"$1,221.00"	$967.03	$976.80	$377.23	"$1,218.00"	$377.23	$137.69	$106.36	$106.36	$194.38	$258.59	$0.00	$0.00	$0.00	$0.00
36100961	EAP	CPT® 57460		Colposcopy W/leep Bx	BOTH IP/OP	"$4,730.00 "	"$3,500.20"	$168.01	"$4,730.00"	"$2,753.10"	"$2,753.10"	"$2,555.04"	"$2,555.04"	"$2,569.43"	$985.85	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,514.14"	$985.73	"$1,634.19"	"$4,730.00"	"$4,730.00"	"$2,505.44"	"$2,255.00"	"$3,756.46"	"$3,794.40"	"$3,480.98"	"$3,250.00"	"$3,480.98"	$178.42	$168.01	$168.01	$755.09	"$2,386.14"	$0.00	$0.00	$0.00	$0.00
36100963	EAP	CPT® 57461		Colposcopy W/leep Cone	BOTH IP/OP	"$8,498.00 "	"$6,288.52"	$194.34	"$6,816.80"	"$2,984.10"	"$2,984.10"	"$2,555.04"	"$2,555.04"	"$2,569.43"	"$1,771.20"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$2,514.14"	"$1,770.98"	"$1,634.19"	"$2,836.00"	"$2,836.00"	"$2,505.44"	"$2,255.00"	"$6,748.63"	"$6,816.80"	"$3,480.98"	"$3,250.00"	"$3,480.98"	$325.94	$194.34	$194.34	"$1,356.54"	"$2,386.14"	$0.00	$0.00	$0.00	$0.00
36100964	EAP	CPT® 57500		Cervical Biopsy	BOTH IP/OP	"$3,362.00 "	"$2,487.88"	$71.26	"$2,683.20"	"$2,321.55"	"$2,321.55"	$617.38	$617.38	$620.86	$700.72	"$1,257.08"	"$1,257.08"	"$1,305.43"	$607.07	$700.64	$394.60	"$1,871.00"	"$1,871.00"	$640.34	"$2,255.00"	"$2,656.37"	"$2,683.20"	$889.66	"$2,150.00"	$889.66	$71.26	$78.23	$78.23	$533.96	$609.84	$0.00	$0.00	$0.00	$0.00
36100967	EAP	CPT® 57511		"Cryosurgery, Cervix"	BOTH IP/OP	$785.00 	$580.90	$0.00	$793.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.59	$0.00	$0.00	$0.00	$0.00	$793.00	$628.06	$634.40	$0.00	$785.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100968	EAP	CPT® 57522		Leep + Ecc + Cone	BOTH IP/OP	"$8,652.00 "	"$6,402.48"	$255.93	"$6,991.20"	"$2,753.10"	"$2,753.10"	"$2,555.04"	"$2,555.04"	"$2,569.43"	"$1,803.29"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,514.14"	"$1,803.08"	"$1,634.19"	"$2,836.00"	"$2,836.00"	"$2,505.44"	"$2,327.00"	"$6,921.29"	"$6,991.20"	"$3,480.98"	"$3,250.00"	"$3,480.98"	$255.93	$259.91	$259.91	"$1,391.25"	"$2,386.14"	$0.00	$0.00	$0.00	$0.00
36100969	EAP	CPT® 57720		Revision Of Cervix	BOTH IP/OP	"$6,223.00 "	"$4,605.02"	$0.00	"$5,028.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,296.87"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,978.51"	"$5,028.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100970	EAP	CPT® 58100		Endometrial Biopsy	BOTH IP/OP	$343.00 	$253.82	$55.08	$652.00	$343.00	$343.00	$165.90	$165.90	$166.84	$71.49	$343.00	$343.00	$343.00	$163.24	$71.48	$106.10	$113.00	$113.00	$166.54	$346.00	$274.03	$276.80	$231.38	$652.00	$231.38	$59.72	$67.07	$67.07	$55.08	$158.61	$0.00	$0.00	$0.00	$0.00
36100971	EAP	CPT® 0237T		"Atherectomy, Branchiocephalic Artery"	BOTH IP/OP	"$12,918.00 "	"$9,559.32"	$0.00	"$10,334.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,692.11"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$10,231.06"	"$10,334.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100972	EAP	CPT® 0236T		"Atherectomy, Aorta"	BOTH IP/OP	"$24,595.00 "	"$18,200.30"	$0.00	"$19,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,125.60"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$19,479.24"	"$19,676.00"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100973	EAP	CPT® 0234T		"Atherectomy, Renal Artery"	BOTH IP/OP	"$24,595.00 "	"$18,200.30"	$0.00	"$19,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,125.60"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$19,479.24"	"$19,676.00"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100974	EAP	CPT® 58110		Endometrial Bx In Conj W/colp	BOTH IP/OP	$238.00 	$176.12	$0.00	$238.00	$238.00	$238.00	$0.00	$0.00	$0.00	$49.61	$0.00	$0.00	$0.00	$0.00	$49.60	$0.00	$140.78	$140.78	$0.00	$120.00	$190.08	$192.00	$0.00	$238.00	$0.00	$50.14	$42.91	$42.91	$38.21	$0.00	$0.00	$0.00	$0.00	$0.00
36100975	EAP	CPT® 0238T		"Atherectomy, Lilac Artery"	BOTH IP/OP	"$18,351.00 "	"$13,579.74"	$0.00	"$14,680.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,824.35"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$14,533.99"	"$14,680.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100978	EAP	CPT® 58300		Insertion Iud	BOTH IP/OP	$676.00 	$500.24	$0.00	"$1,381.00"	$676.00	$676.00	$0.00	$0.00	$51.66	$140.90	$0.00	$0.00	$0.00	$0.00	$140.88	$0.00	$113.00	$113.00	$0.00	$675.00	$534.60	$540.00	$405.00	"$1,381.00"	$405.00	$69.90	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
36100980	EAP	CPT® 37197		Retrieve Fb Percut Intravascul W/ S And I	BOTH IP/OP	"$28,818.00 "	"$21,325.32"	$0.00	"$26,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,005.67"	$0.00	$0.00	$0.00	"$2,779.42"	"$2,858.00"	"$26,126.50"	"$26,390.40"	"$3,861.64"	"$3,725.00"	"$3,861.64"	$0.00	$315.16	$315.16	"$5,251.69"	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
36100981	EAP	CPT® 36221		Non Sel Cath Plac Aort W Angio  Inc S/i	BOTH IP/OP	"$67,249.00 "	"$49,764.26"	$0.00	"$45,304.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$14,014.69"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$44,850.96"	"$45,304.00"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100982	EAP	CPT® 36222		Sel Cath Plac Ext Carotid Angio W S&i	BOTH IP/OP	"$19,446.00 "	"$14,390.04"	$0.00	"$13,100.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,053.03"	$0.00	$0.00	$0.00	"$2,742.67"	"$4,052.55"	"$1,782.74"	"$4,877.00"	"$4,877.00"	$0.00	"$2,858.00"	"$12,969.79"	"$13,100.80"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100983	EAP	CPT® 58301		"Iud, Removal"	BOTH IP/OP	$281.00 	$207.94	$0.00	"$1,279.00"	$281.00	$281.00	$274.65	$274.65	$276.20	$58.57	$0.00	$0.00	$0.00	$269.78	$58.56	$175.35	$281.00	$281.00	$271.52	$280.00	$221.76	$224.00	$280.00	"$1,279.00"	$280.00	$81.66	$70.31	$70.31	$44.58	$258.59	$0.00	$0.00	$0.00	$0.00
36100984	EAP	CPT® 36223		Sel Cath Plac Common/inom Intracranial Carotid	BOTH IP/OP	"$18,704.00 "	"$13,840.96"	$330.96	"$12,600.00"	"$2,753.10"	"$2,753.10"	"$4,643.92"	"$4,643.92"	"$4,670.08"	"$3,898.38"	"$2,192.53"	"$2,192.53"	"$2,276.86"	"$4,572.02"	"$3,897.91"	"$2,971.81"	"$4,877.00"	"$4,877.00"	"$4,609.70"	"$2,858.00"	"$12,474.00"	"$12,600.00"	"$6,404.56"	"$3,725.00"	"$6,404.56"	"$1,513.65"	$330.96	$330.96	"$2,507.40"	"$4,390.19"	$0.00	$0.00	$0.00	$0.00
36100985	EAP	CPT® 36224		Sel Cath Plac Internalcarotid Intracranial Carotid	BOTH IP/OP	"$21,402.00 "	"$15,837.48"	$376.00	"$14,417.60"	"$2,984.10"	"$2,984.10"	"$4,643.92"	"$4,643.92"	"$4,670.08"	"$4,460.71"	"$2,192.53"	"$2,192.53"	"$2,276.86"	"$4,572.02"	"$4,460.18"	"$2,971.81"	"$4,877.00"	"$4,877.00"	"$4,609.70"	"$4,975.00"	"$14,273.42"	"$14,417.60"	"$6,404.56"	"$4,334.00"	"$6,404.56"	"$1,644.17"	$376.00	$376.00	"$2,869.10"	"$4,390.19"	$0.00	$0.00	$0.00	$0.00
36100986	EAP	CPT® 36225		"Sel Cath Plac Sub Clav,/innom Uni W/angio And S/i"	BOTH IP/OP	"$18,704.00 "	"$13,840.96"	$0.00	"$12,600.00"	"$2,753.10"	"$2,753.10"	"$2,787.76"	"$2,787.76"	"$2,803.47"	"$3,898.38"	"$1,826.79"	"$1,826.79"	"$1,897.05"	"$2,742.67"	"$3,897.91"	"$1,782.74"	"$4,877.00"	"$4,877.00"	$0.00	"$2,858.00"	"$12,474.00"	"$12,600.00"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100987	EAP	CPT® 36226		"Sel Cath Plac Sub Clav,/vert  W/angio And S/i"	BOTH IP/OP	"$60,254.00 "	"$44,587.96"	$370.60	"$40,591.20"	"$2,984.10"	"$2,984.10"	"$4,643.92"	"$4,643.92"	"$4,670.08"	"$9,417.94"	"$2,192.53"	"$2,192.53"	"$2,276.86"	"$4,572.02"	"$12,556.93"	"$2,971.81"	"$4,877.00"	"$4,877.00"	"$4,609.70"	"$4,975.00"	"$40,185.29"	"$40,591.20"	"$6,404.56"	"$4,334.00"	"$6,404.56"	"$1,676.21"	$370.60	$370.60	"$8,077.65"	"$4,390.19"	$0.00	$0.00	$0.00	$0.00
36100988	EAP	CPT® 36227		Sel Cath Plac Ext Carotid Angio W S&i	BOTH IP/OP	"$18,704.00 "	"$13,840.96"	$0.00	"$12,600.00"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	"$3,898.38"	$0.00	$0.00	$0.00	$0.00	"$3,897.91"	$0.00	"$4,877.00"	"$4,877.00"	$0.00	"$7,875.00"	"$12,474.00"	"$12,600.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100989	EAP	CPT® 58340		Inject Hysterosalpingography	BOTH IP/OP	"$1,109.00 "	$820.66	$0.00	"$1,233.00"	"$1,109.00"	"$1,109.00"	$0.00	$0.00	$0.00	$231.14	$0.00	$0.00	$0.00	$0.00	$231.12	$0.00	$655.97	$655.97	$0.00	"$1,055.00"	$835.56	$844.00	$0.00	"$1,233.00"	$0.00	$214.45	$59.48	$59.48	$167.96	$0.00	$0.00	$0.00	$0.00	$0.00
36100990	EAP	CPT® 58345		Transcervical Intro Of Cathete	BOTH IP/OP	"$6,236.00 "	"$4,614.64"	$0.00	"$4,988.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,299.58"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,938.91"	"$4,988.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100991	EAP	CPT® 58558		"Hysteroscopy, Biopsy"	BOTH IP/OP	"$5,957.00 "	"$4,408.18"	$0.00	"$4,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,241.44"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,486.68"	"$4,532.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36100993	EAP	CPT® 59000		Amniocentesis Us	BOTH IP/OP	"$1,106.00 "	$818.44	$83.99	"$1,117.00"	"$1,106.00"	"$1,106.00"	$617.38	$617.38	$620.86	$230.52	"$1,106.00"	"$1,106.00"	"$1,106.00"	$607.07	$230.49	$394.60	$654.20	$654.20	$640.34	"$1,117.00"	$884.66	$893.60	$889.66	"$1,106.00"	$889.66	$95.25	$83.99	$83.99	$177.83	$609.84	$0.00	$0.00	$0.00	$0.00
36100999	EAP	CPT® 59200		Insert Cervical Dilator	BOTH IP/OP	$760.00 	$562.40	$0.00	$768.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.38	$0.00	$0.00	$0.00	$0.00	$768.00	$608.26	$614.40	$0.00	$760.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101000	EAP	CPT® 59300		Episitomy/vaginal Repair	BOTH IP/OP	"$6,453.00 "	"$4,775.22"	$0.00	"$7,432.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,916.86"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$7,358.47"	"$7,432.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101001	EAP	CPT® 59414		Delivery Of Placenta	BOTH IP/OP	"$6,078.00 "	"$4,497.72"	$0.00	"$4,877.00"	"$3,300.35"	"$3,300.35"	"$2,555.04"	"$2,555.04"	"$2,569.43"	"$1,266.81"	$0.00	$0.00	$0.00	"$2,514.14"	"$1,266.66"	"$1,634.19"	"$4,877.00"	"$4,877.00"	$0.00	"$2,255.00"	"$4,813.78"	"$4,862.40"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101002	EAP	CPT® 59525		Remove Uterus After Cesarean	BOTH IP/OP	"$7,130.00 "	"$5,276.20"	$0.00	"$7,040.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,485.89"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,970.39"	"$7,040.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101003	EAP	CPT® 59812		Trtmt Of Spontaneous Abortion	BOTH IP/OP	"$3,629.00 "	"$2,685.46"	$267.54	"$3,666.00"	"$3,629.00"	"$3,629.00"	"$2,555.04"	"$2,555.04"	"$2,569.43"	$756.37	"$2,571.13"	"$2,571.13"	"$2,670.02"	"$2,514.14"	$756.28	"$1,634.19"	"$3,629.00"	"$3,629.00"	"$2,505.44"	"$3,666.00"	"$2,903.47"	"$2,932.80"	"$3,480.98"	"$3,250.00"	"$3,480.98"	$267.54	$316.83	$316.83	$583.63	"$2,386.14"	$0.00	$0.00	$0.00	$0.00
36101004	EAP	CPT® 59820		Trmt Of Missed Abort.-1st Trim	BOTH IP/OP	"$3,769.00 "	"$2,789.06"	$0.00	"$3,807.00"	"$3,769.00"	"$3,769.00"	"$2,555.04"	"$2,555.04"	"$2,569.43"	$785.55	"$2,571.13"	"$2,571.13"	"$2,670.02"	"$2,514.14"	$785.46	"$1,634.19"	"$3,769.00"	"$3,769.00"	$0.00	"$3,807.00"	"$3,015.14"	"$3,045.60"	$0.00	"$3,250.00"	$0.00	$302.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101005	EAP	CPT® 59840		Ind/abortion/dilation&curettag	BOTH IP/OP	"$3,706.00 "	"$2,742.44"	$0.00	"$3,743.00"	"$3,706.00"	"$3,706.00"	"$2,555.04"	"$2,555.04"	"$2,569.43"	$772.42	"$2,571.13"	"$2,571.13"	"$2,670.02"	"$2,514.14"	$772.33	"$1,634.19"	"$3,706.00"	"$3,706.00"	$0.00	"$3,743.00"	"$2,964.46"	"$2,994.40"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101007	EAP	CPT® 59855		Abortion By Vag. Sup. Insert	BOTH IP/OP	"$1,807.00 "	"$1,337.18"	$0.00	"$1,825.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$376.58	$0.00	$0.00	$0.00	$0.00	"$1,825.00"	"$1,445.40"	"$1,460.00"	$0.00	"$1,186.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101008	EAP	CPT® 59855		Induced Abortion After 16 Wks	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,825.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.33	$0.00	$0.00	$0.00	$0.00	"$1,825.00"	"$1,445.40"	"$1,460.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101009	EAP	CPT® 59871		Removal Ceralage Suture	BOTH IP/OP	"$3,549.00 "	"$2,626.26"	$0.00	"$3,585.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$739.61	$0.00	$0.00	$0.00	$0.00	"$3,585.00"	"$2,839.32"	"$2,868.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101010	EAP	CPT® 59871		Remove Cerclage Suture	BOTH IP/OP	"$3,549.00 "	"$2,626.26"	$0.00	"$3,585.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$739.61	$0.00	$0.00	$0.00	$0.00	"$3,585.00"	"$2,839.32"	"$2,868.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101011	EAP	CPT® 60100		BX THYROID PERC NEEDLE BCT	BOTH IP/OP	$760.00 	$562.40	$81.14	"$2,150.00"	$760.00	$760.00	$606.01	$606.01	$609.42	$158.40	$760.00	$760.00	$760.00	$596.11	$158.38	$387.47	$760.00	$760.00	$611.80	$760.00	$601.92	$608.00	$760.00	"$2,150.00"	$760.00	$93.18	$81.14	$81.14	$120.99	$582.67	$0.00	$0.00	$0.00	$0.00
36101012	EAP	CPT® 60100		Bx Thyroid Us	BOTH IP/OP	$762.00 	$563.88	$81.14	"$2,150.00"	$762.00	$762.00	$606.01	$606.01	$609.42	$158.82	$762.00	$762.00	$762.00	$596.11	$158.80	$387.47	$762.00	$762.00	$611.80	$760.00	$601.92	$608.00	$760.00	"$2,150.00"	$760.00	$93.18	$81.14	$81.14	$120.99	$582.67	$0.00	$0.00	$0.00	$0.00
36101013	EAP	CPT® 60100		Thyroid Biopsy Perc Needle	BOTH IP/OP	$760.00 	$562.40	$0.00	$760.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.40	$0.00	$0.00	$0.00	$596.11	$158.38	$387.47	$760.00	$760.00	$611.80	$760.00	$601.92	$608.00	$760.00	$0.00	$760.00	$93.18	$81.14	$81.14	$120.99	$582.67	$0.00	$0.00	$0.00	$0.00
36101015	EAP	CPT® 61070		PUNCT SHUNT TUBE/RESERVO BCT	BOTH IP/OP	"$2,212.00 "	"$1,636.88"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$460.98	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,798.63"	"$1,816.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101016	EAP	CPT® 61624		EMBOLIZA INTRACRAN/SP CORD SPN	BOTH IP/OP	"$12,218.00 "	"$9,041.32"	$0.00	"$13,594.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,546.23"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$8,942.47"	"$9,032.80"	$0.00	"$13,594.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101019	EAP	CPT® 61626		Embolization Extracranial	BOTH IP/OP	"$27,904.00 "	"$20,648.96"	$0.00	"$20,629.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,815.19"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$20,423.30"	"$20,629.60"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101020	EAP	CPT® 61630		Intracranial Angioplasty	BOTH IP/OP	"$20,055.00 "	"$14,840.70"	$0.00	"$14,826.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,179.46"	$0.00	$0.00	$0.00	"$1,522.96"	"$9,266.50"	"$14,678.14"	"$14,826.40"	"$1,424.57"	"$8,895.25"	"$1,424.57"	"$2,900.41"	"$1,424.57"	"$1,424.57"	"$2,950.45"	"$1,424.57"	$0.00	$0.00	$0.00	$0.00
36101021	EAP	CPT® 61635		Intracran Angioplasty W/stent	BOTH IP/OP	"$31,953.00 "	"$23,645.22"	$0.00	"$23,623.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,659.01"	$0.00	$0.00	$0.00	"$1,621.20"	"$14,764.50"	"$23,386.97"	"$23,623.20"	"$1,514.43"	"$11,306.10"	"$1,514.43"	"$1,268.01"	"$1,514.43"	"$1,514.43"	"$4,701.02"	"$1,514.43"	$0.00	$0.00	$0.00	$0.00
36101022	EAP	CPT® 61640		"Dilate Ic Vasospasm, Init"	BOTH IP/OP	"$30,077.00 "	"$22,256.98"	$0.00	"$22,236.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,268.05"	$0.00	$0.00	$0.00	$0.00	"$13,897.50"	"$22,013.64"	"$22,236.00"	$0.00	"$6,088.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101023	EAP	CPT® 61642		Dilate Ic Vasospasm Add-on	BOTH IP/OP	"$26,318.00 "	"$19,475.32"	$0.00	"$19,456.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,484.67"	$0.00	$0.00	$0.00	$0.00	"$12,160.50"	"$19,262.23"	"$19,456.80"	$0.00	"$5,218.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101024	EAP	CPT® 61710		Emblz Carotid Cavern Fistula	BOTH IP/OP	"$13,680.00 "	"$10,123.20"	$0.00	"$11,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,850.91"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$11,122.85"	"$11,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101025	EAP	CPT® 62268		SPINAL CORD CYST PERC ASPI BCT	BOTH IP/OP	"$3,101.00 "	"$2,294.74"	$0.00	"$2,475.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$646.25	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,450.45"	"$2,475.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101026	EAP	CPT® 62269		BX SPINAL CORD PERC NEEDLE BCT	BOTH IP/OP	"$3,394.00 "	"$2,511.56"	$0.00	"$2,708.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$707.31	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,681.71"	"$2,708.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101027	EAP	CPT® 62270		Dx Lumbar Puncture W/o Imaging	BOTH IP/OP	$835.00 	$617.90	$64.55	"$2,150.00"	$835.00	$835.00	$618.38	$618.38	$621.87	$174.03	$835.00	$835.00	$835.00	$608.20	$174.01	$395.33	$835.00	$835.00	$626.89	$635.00	$502.92	$508.00	$635.00	"$2,150.00"	$635.00	$120.04	$64.55	$64.55	$101.09	$597.04	$0.00	$0.00	$0.00	$0.00
36101032	EAP	CPT® 62272		Therapeutic Lumbar Puncture W/o Imaging	BOTH IP/OP	$923.00 	$683.02	$0.00	$923.00	$923.00	$923.00	$618.38	$618.38	$621.87	$192.38	$923.00	$923.00	$923.00	$608.20	$192.35	$395.33	$923.00	$923.00	$0.00	$877.00	$694.58	$701.60	$0.00	$923.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101033	EAP	CPT® 55876		Placement Of Prostate Fiducial Markers	BOTH IP/OP	"$3,543.00 "	"$2,621.82"	$0.00	"$2,827.20"	"$2,321.55"	"$2,321.55"	"$1,229.74"	"$1,229.74"	"$1,236.66"	$738.45	$0.00	$0.00	$0.00	"$1,209.70"	$738.36	$786.30	"$1,871.00"	"$1,871.00"	"$1,249.00"	"$2,255.00"	"$2,798.93"	"$2,827.20"	"$1,735.32"	"$2,459.00"	"$1,735.32"	$138.46	$104.92	$104.92	$562.61	"$1,189.52"	$0.00	$0.00	$0.00	$0.00
36101039	EAP	CPT® 62273		Injection Epidural Blood Patch	BOTH IP/OP	"$1,679.00 "	"$1,242.46"	$0.00	"$1,679.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$349.90	$0.00	$0.00	$0.00	$626.89	"$1,596.00"	"$1,264.03"	"$1,276.80"	$870.98	"$1,679.00"	$870.98	$123.36	$117.56	$117.56	$254.08	$597.04	$0.00	$0.00	$0.00	$0.00
36101040	EAP	CPT® 62280		Inject Subarachnoid Neurolytic	BOTH IP/OP	"$1,845.00 "	"$1,365.30"	$0.00	"$1,845.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$384.50	$0.00	$0.00	$0.00	$0.00	"$1,845.00"	"$1,461.24"	"$1,476.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101041	EAP	CPT® 62282		Epidur Lumbar Sacral Neurolyti	BOTH IP/OP	"$1,751.00 "	"$1,295.74"	$0.00	"$1,751.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$364.91	$0.00	$0.00	$0.00	$0.00	"$1,751.00"	"$1,386.79"	"$1,400.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101042	EAP	CPT® 62284		Injection Myelo/ct Spinal	BOTH IP/OP	"$1,572.00 "	"$1,163.28"	$0.00	"$1,572.00"	"$1,572.00"	"$1,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$327.60	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$1,183.25"	"$1,195.20"	$0.00	"$1,572.00"	$0.00	$158.11	$90.14	$90.14	$237.84	$0.00	$0.00	$0.00	$0.00	$0.00
36101043	EAP	CPT® 62287		Aspir Perc Diskectomy	BOTH IP/OP	"$6,339.00 "	"$4,690.86"	$0.00	"$6,105.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,321.05"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$5,020.49"	"$5,071.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101044	EAP	CPT® 62290		Inject Diskography Ea Lev Lumb	BOTH IP/OP	"$2,963.00 "	"$2,192.62"	$0.00	"$2,370.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$617.49	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,346.70"	"$2,370.40"	$0.00	"$1,606.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101045	EAP	CPT® 62291		Inject Diskography Ea Lev Cerv	BOTH IP/OP	"$2,594.00 "	"$1,919.56"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$540.59	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,054.45"	"$2,075.20"	$0.00	"$1,664.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101048	EAP	CPT® 63650		Implant Neuroelectrodes	BOTH IP/OP	"$16,380.00 "	"$12,121.20"	$0.00	"$13,104.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,413.59"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$12,972.96"	"$13,104.00"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101049	EAP	CPT® 64408		Inj Anes/strd Cranial/vagus Nerve	BOTH IP/OP	"$1,831.00 "	"$1,354.94"	$0.00	"$2,005.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$381.58	$0.00	$0.00	$0.00	$0.00	"$2,005.00"	"$1,587.96"	"$1,604.00"	$0.00	"$1,019.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101051	EAP	CPT® 64425		Inj Anes/strd Ilioinguinal/iliohypogastric Nerve	BOTH IP/OP	"$3,566.00 "	"$2,638.84"	$0.00	"$2,752.80"	"$2,321.55"	"$2,321.55"	$618.38	$618.38	$621.87	$743.24	"$1,257.08"	"$1,257.08"	"$1,305.43"	$608.20	$743.15	$395.33	"$1,871.00"	"$1,871.00"	$626.89	"$2,255.00"	"$2,725.27"	"$2,752.80"	$870.98	"$2,150.00"	$870.98	$0.00	$57.69	$57.69	$547.81	$597.04	$0.00	$0.00	$0.00	$0.00
36101052	EAP	CPT® 64450		Inj Anes/strd Other Peripheral Nerve	BOTH IP/OP	"$2,850.00 "	"$2,109.00"	$44.35	"$2,321.55"	"$2,321.55"	"$2,321.55"	$618.38	$618.38	$621.87	$594.01	"$1,257.08"	"$1,257.08"	"$1,305.43"	$608.20	$593.94	$395.33	"$1,871.00"	"$1,871.00"	$626.89	"$2,255.00"	"$2,178.00"	"$2,200.00"	$870.98	"$2,150.00"	$870.98	$85.27	$44.35	$44.35	$437.80	$597.04	$0.00	$0.00	$0.00	$0.00
36101059	EAP	CPT® 64483		Inject Anest Txforamen L/s Sng	BOTH IP/OP	"$1,767.00 "	"$1,307.58"	$115.74	"$1,767.00"	"$1,767.00"	"$1,767.00"	$801.66	$801.66	$806.18	$368.29	"$1,257.08"	"$1,257.08"	"$1,305.43"	$788.26	$368.24	$512.37	"$1,767.00"	"$1,767.00"	$814.44	"$1,705.00"	"$1,350.36"	"$1,364.00"	"$1,131.55"	"$1,767.00"	"$1,131.55"	$197.93	$115.74	$115.74	$271.44	$775.65	$0.00	$0.00	$0.00	$0.00
36101061	EAP	CPT® 64484		Transfor Inj Lum/sac Addt Spn	BOTH IP/OP	"$1,767.00 "	"$1,307.58"	$0.00	"$1,767.00"	"$1,767.00"	"$1,767.00"	$0.00	$0.00	$0.00	$368.29	"$1,257.08"	"$1,257.08"	"$1,305.43"	$0.00	$368.24	$0.00	"$1,045.18"	"$1,045.18"	$0.00	"$1,705.00"	"$1,350.36"	"$1,364.00"	$0.00	"$1,750.00"	$0.00	$183.06	$54.09	$54.09	$271.44	$0.00	$0.00	$0.00	$0.00	$0.00
36101062	EAP	CPT® 64520		Inject Anest Lumbar Thoracic	BOTH IP/OP	"$5,436.00 "	"$4,022.64"	$0.00	"$4,196.00"	"$2,321.55"	"$2,321.55"	$801.66	$801.66	$806.18	"$1,133.00"	"$1,257.08"	"$1,257.08"	"$1,305.43"	$788.26	"$1,132.86"	$512.37	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$4,154.04"	"$4,196.00"	$0.00	"$2,150.00"	$0.00	$125.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101064	EAP	CPT® 64530		"N Block Inj, Celiac Pelus"	BOTH IP/OP	"$8,849.00 "	"$6,548.26"	$0.00	"$6,830.40"	"$2,321.55"	"$2,321.55"	$801.66	$801.66	$806.18	"$1,844.35"	"$1,257.08"	"$1,257.08"	"$1,305.43"	$788.26	"$1,844.13"	$512.37	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$6,762.10"	"$6,830.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101065	EAP	CPT® 64612		Chemodenerve Mus Inv Fac Nerve	BOTH IP/OP	$728.00 	$538.72	$0.00	"$1,199.00"	$728.00	$728.00	$254.43	$254.43	$255.86	$151.73	$0.00	$0.00	$0.00	$250.31	$151.72	$162.70	$728.00	$728.00	$262.54	$732.00	$579.74	$585.60	$364.76	"$1,199.00"	$364.76	$151.15	$120.74	$120.74	$116.53	$250.04	$0.00	$0.00	$0.00	$0.00
36101070	EAP	CPT® 64640		Destr Peripheral Nerve	BOTH IP/OP	"$2,501.00 "	"$1,850.74"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$814.44	"$2,255.00"	"$1,980.79"	"$2,000.80"	"$1,131.55"	$0.00	"$1,131.55"	$198.96	$121.87	$121.87	$398.16	$775.65	$0.00	$0.00	$0.00	$0.00
36101072	EAP	CPT® 64680		Destr Neurolyitc Celiac Plexus	BOTH IP/OP	"$4,672.00 "	"$3,457.28"	$0.00	"$3,737.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$973.64	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,700.22"	"$3,737.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101075	EAP	CPT® 65205		"Fb Removal, Eye"	BOTH IP/OP	$378.00 	$279.72	$0.00	$382.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$78.78	$0.00	$0.00	$0.00	$0.00	$382.00	$302.54	$305.60	$0.00	$378.00	$0.00	$132.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101076	EAP	CPT® 65205		Remove Fb Eye Conj Superficial	BOTH IP/OP	$313.00 	$231.62	$0.00	$382.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.23	$0.00	$0.00	$0.00	$0.00	$382.00	$302.54	$305.60	$0.00	$378.00	$0.00	$132.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101077	EAP	CPT® 65222		Remove Fb Eye Corneal W/sl	BOTH IP/OP	$800.00 	$592.00	$0.00	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.74	$0.00	$0.00	$0.00	$107.30	$166.72	$69.74	$113.00	$113.00	$0.00	$808.00	$639.94	$646.40	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101078	EAP	CPT® 65270		Repair Laceration Conjunctiva	BOTH IP/OP	"$4,186.00 "	"$3,097.64"	$0.00	"$3,380.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$872.36	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,346.99"	"$3,380.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101079	EAP	CPT® 65275		Rpr Lacer Cornea Non-perfor	BOTH IP/OP	"$8,972.00 "	"$6,639.28"	$0.00	"$7,247.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,869.76"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$7,174.73"	"$7,247.20"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101080	EAP	CPT® 65286		Cornea Sclera Wound Tissue Glu	BOTH IP/OP	"$3,275.00 "	"$2,423.50"	$0.00	"$2,817.36"	"$2,753.10"	"$2,753.10"	"$2,022.30"	"$2,022.30"	"$2,033.69"	$682.59	$0.00	$0.00	$0.00	"$1,992.71"	$682.51	"$1,295.26"	"$1,871.00"	"$1,871.00"	"$2,027.80"	"$2,255.00"	"$2,619.14"	"$2,645.60"	"$2,817.36"	"$2,500.00"	"$2,817.36"	$433.21	$506.49	$506.49	$526.47	"$1,931.24"	$0.00	$0.00	$0.00	$0.00
36101081	EAP	CPT® 65290		Repair Wound Extraocular Muscl	BOTH IP/OP	"$4,425.00 "	"$3,274.50"	$0.00	"$4,326.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$922.17	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,283.14"	"$4,326.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101082	EAP	CPT® 65400		Excise Lesn Cornea Not Pterygm	BOTH IP/OP	"$5,997.00 "	"$4,437.78"	$0.00	"$4,844.00"	"$2,321.55"	"$2,321.55"	$788.63	$788.63	$793.07	"$1,249.92"	"$1,257.08"	"$1,257.08"	"$1,305.43"	$775.88	"$1,249.77"	$504.32	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$4,795.56"	"$4,844.00"	$0.00	"$2,150.00"	$0.00	$484.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101083	EAP	CPT® 65410		Biopsy Of Cornea	BOTH IP/OP	"$3,307.00 "	"$2,447.18"	$0.00	"$2,645.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$563.93	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,619.14"	"$2,645.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101084	EAP	CPT® 65420		Excise Pterygium W/o Graft	BOTH IP/OP	"$2,706.00 "	"$2,002.44"	$0.00	"$2,645.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$563.93	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,619.14"	"$2,645.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101085	EAP	CPT® 65430		Scraping Cornea Diagnostic	BOTH IP/OP	$525.00 	$388.50	$0.00	$530.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.45	$0.00	$0.00	$0.00	$0.00	$530.00	$419.76	$424.00	$0.00	$525.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101086	EAP	CPT® 65772		Relax Cornea Incision Astigmat	BOTH IP/OP	"$4,930.00 "	"$3,648.20"	$0.00	"$4,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,027.41"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$4,771.80"	"$4,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101087	EAP	CPT® 65800		Paracentesis Ant Chamb Eye Wdx	BOTH IP/OP	"$4,717.00 "	"$3,490.58"	$0.00	"$3,773.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$973.76	$0.00	$0.00	$0.00	"$1,992.71"	$973.64	"$1,295.26"	"$1,871.00"	"$1,871.00"	"$2,027.80"	"$2,255.00"	"$3,735.86"	"$3,773.60"	"$2,817.36"	"$1,750.00"	"$2,817.36"	$0.00	$93.03	$93.03	$750.95	"$1,931.24"	$0.00	$0.00	$0.00	$0.00
36101089	EAP	CPT® 65815		Eye Paracentesis Ant Blood Rem	BOTH IP/OP	"$7,374.00 "	"$5,456.76"	$0.00	"$7,208.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,536.74"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$7,136.71"	"$7,208.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101090	EAP	CPT® 65855		Trabeculoplasty By Laser	BOTH IP/OP	"$2,930.00 "	"$2,168.20"	$211.62	"$2,753.10"	"$2,753.10"	"$2,753.10"	$490.09	$490.09	$492.86	$610.69	"$2,571.13"	"$2,571.13"	"$2,670.02"	$482.91	$610.61	$313.89	"$1,871.00"	"$1,871.00"	$508.42	"$2,255.00"	"$2,344.32"	"$2,368.00"	$706.38	"$2,150.00"	$706.38	$354.58	$211.62	$211.62	$471.23	$484.21	$0.00	$0.00	$0.00	$0.00
36101091	EAP	CPT® 65860		Incise Inner Eye Adhesions	BOTH IP/OP	"$1,369.00 "	"$1,013.06"	$0.00	"$1,475.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$285.30	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$1,168.20"	"$1,180.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101092	EAP	CPT® 66250		Repair Operative Wound Ant Eye	BOTH IP/OP	"$3,567.00 "	"$2,639.58"	$0.00	"$2,853.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$743.36	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,825.06"	"$2,853.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101093	EAP	CPT® 66710		Destruction Ciliary Body	BOTH IP/OP	"$4,407.00 "	"$3,261.18"	$399.78	"$3,561.60"	"$2,753.10"	"$2,753.10"	"$1,948.73"	"$1,948.73"	"$1,959.70"	$918.53	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,919.09"	$918.42	"$1,247.41"	"$2,836.00"	"$2,836.00"	"$1,940.89"	"$2,327.00"	"$3,525.98"	"$3,561.60"	"$2,696.60"	"$3,250.00"	"$2,696.60"	$412.49	$399.78	$399.78	$708.76	"$1,848.46"	$0.00	$0.00	$0.00	$0.00
36101094	EAP	CPT® 66710		Transscleral Cyclophotocoagula	BOTH IP/OP	"$4,407.00 "	"$3,261.18"	$399.78	"$3,561.60"	"$2,753.10"	"$2,753.10"	"$1,948.73"	"$1,948.73"	"$1,959.70"	$918.53	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,919.09"	$918.42	"$1,247.41"	"$2,836.00"	"$2,836.00"	"$1,940.89"	"$2,327.00"	"$3,525.98"	"$3,561.60"	"$2,696.60"	"$3,250.00"	"$2,696.60"	$412.49	$399.78	$399.78	$708.76	"$1,848.46"	$0.00	$0.00	$0.00	$0.00
36101095	EAP	CPT® 66720		Destroy Ciliary Body Cryother	BOTH IP/OP	"$2,644.00 "	"$1,956.56"	$0.00	"$2,327.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$551.01	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,156.62"	"$2,178.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101096	EAP	CPT® 66761		Iridotomy Laser Surgery	BOTH IP/OP	"$7,642.00 "	"$5,655.08"	$0.00	"$6,175.20"	"$2,321.55"	"$2,321.55"	$490.09	$490.09	$492.86	"$1,592.78"	$0.00	$0.00	$0.00	$482.91	"$1,592.59"	$313.89	"$1,871.00"	"$1,871.00"	$508.42	"$2,255.00"	"$6,113.45"	"$6,175.20"	$706.38	"$2,150.00"	$706.38	$315.03	$240.80	$240.80	"$1,228.86"	$484.21	$0.00	$0.00	$0.00	$0.00
36101097	EAP	CPT® 66762		Iridoplasty Photocoagulation	BOTH IP/OP	"$1,046.00 "	$774.04	$0.00	"$1,057.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.99	$0.00	$0.00	$0.00	$508.42	"$1,057.00"	$837.14	$845.60	$706.38	"$1,046.00"	$706.38	$348.17	$432.93	$432.93	$168.27	$484.21	$0.00	$0.00	$0.00	$0.00
36101098	EAP	CPT® 66821		Yag Laser Capsulotomy	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$188.16	"$2,146.00"	"$2,125.00"	"$2,125.00"	$490.09	$490.09	$492.86	$442.90	"$1,541.95"	"$1,541.95"	"$1,601.25"	$482.91	$442.85	$313.89	"$2,125.00"	"$2,125.00"	$508.42	"$2,146.00"	"$1,699.63"	"$1,716.80"	$706.38	"$2,125.00"	$706.38	$188.16	$317.54	$317.54	$341.64	$484.21	$0.00	$0.00	$0.00	$0.00
36101099	EAP	CPT® 67015		Posterior Sclerotomy	BOTH IP/OP	"$15,938.00 "	"$11,794.12"	$0.00	"$12,750.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,321.48"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$12,622.90"	"$12,750.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101100	EAP	CPT® 67025		Inject Vitreous Pars Pla/limbl	BOTH IP/OP	"$8,619.00 "	"$6,378.06"	$643.81	"$6,964.80"	"$2,321.55"	"$2,321.55"	"$2,022.30"	"$2,022.30"	"$2,033.69"	"$1,796.42"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,992.71"	"$1,796.20"	"$1,295.26"	"$1,871.00"	"$1,871.00"	"$2,027.80"	"$2,255.00"	"$6,895.15"	"$6,964.80"	"$2,817.36"	"$3,250.00"	"$2,817.36"	$651.56	$643.81	$643.81	"$1,386.00"	"$1,931.24"	$0.00	$0.00	$0.00	$0.00
36101101	EAP	CPT® 67028		Injection Intravitreal Drug	BOTH IP/OP	"$2,178.00 "	"$1,611.72"	$100.58	"$2,200.00"	"$2,178.00"	"$2,178.00"	$310.51	$310.51	$312.26	$453.95	"$1,257.08"	"$1,257.08"	"$1,305.43"	$297.83	$453.90	$193.59	"$1,871.00"	"$1,871.00"	$310.51	"$2,200.00"	"$1,742.40"	"$1,760.00"	$431.41	"$1,750.00"	$431.41	$307.74	$100.58	$100.58	$350.24	$295.72	$0.00	$0.00	$0.00	$0.00
36101102	EAP	CPT® 67031		"Sever Vitreous, Laser"	BOTH IP/OP	"$2,310.00 "	"$1,709.40"	$0.00	"$2,310.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$481.40	$0.00	$0.00	$0.00	$0.00	"$2,310.00"	"$1,829.52"	"$1,848.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101103	EAP	CPT® 67101		Retinal Detach Rpr Cryo/diath	BOTH IP/OP	"$7,769.00 "	"$5,749.06"	$0.00	"$6,277.60"	"$3,735.90"	"$3,735.90"	"$2,022.30"	"$2,022.30"	"$2,033.69"	$0.00	"$2,192.53"	"$2,192.53"	"$2,276.86"	$0.00	"$1,619.06"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,214.82"	"$6,277.60"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101104	EAP	CPT® 67105		Repair Retinal Detach Laser	BOTH IP/OP	"$1,373.00 "	"$1,016.02"	$0.00	"$1,387.00"	"$1,373.00"	"$1,373.00"	$490.09	$490.09	$492.86	$286.17	"$1,373.00"	"$1,373.00"	"$1,373.00"	$482.91	$286.13	$313.89	"$1,373.00"	"$1,373.00"	$0.00	"$1,387.00"	"$1,098.50"	"$1,109.60"	$0.00	"$1,373.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101105	EAP	CPT® 67141		Cryotherapy Retinal Tear	BOTH IP/OP	"$1,917.00 "	"$1,418.58"	$0.00	"$1,917.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$399.50	$0.00	$0.00	$0.00	$0.00	"$1,917.00"	"$1,518.26"	"$1,533.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101106	EAP	CPT® 67145		Photocoagulation Retinal Tear	BOTH IP/OP	"$1,043.00 "	$771.82	$0.00	"$1,054.00"	"$1,043.00"	"$1,043.00"	$490.09	$490.09	$492.86	$217.39	$0.00	$0.00	$0.00	$482.91	$217.36	$313.89	"$1,043.00"	"$1,043.00"	$508.42	"$1,054.00"	$834.77	$843.20	$706.38	"$1,043.00"	$706.38	$412.94	$506.47	$506.47	$167.80	$484.21	$0.00	$0.00	$0.00	$0.00
36101107	EAP	CPT® 67208		Destroy Lesion Retina Cryo/dia	BOTH IP/OP	"$4,906.00 "	"$3,630.44"	$0.00	"$3,964.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,022.41"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,925.15"	"$3,964.80"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101108	EAP	CPT® 67210		Destroy Lesion Retina Photocoa	BOTH IP/OP	"$1,009.00 "	$746.66	$0.00	"$1,019.00"	"$1,009.00"	"$1,009.00"	$490.09	$490.09	$492.86	$210.30	$0.00	$0.00	$0.00	$482.91	$210.28	$313.89	"$1,009.00"	"$1,009.00"	$0.00	"$1,019.00"	$807.05	$815.20	$0.00	"$1,009.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101109	EAP	CPT® 67220		Destr Choroid Lesion Phoptocoa	BOTH IP/OP	"$1,514.00 "	"$1,120.36"	$0.00	"$1,514.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.52	$0.00	$0.00	$0.00	$0.00	"$1,514.00"	"$1,199.09"	"$1,211.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101110	EAP	CPT® 67227		Destroy Retinopathy Cryo/diath	BOTH IP/OP	"$4,468.00 "	"$3,306.32"	$0.00	"$3,574.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$931.13	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,538.66"	"$3,574.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101111	EAP	CPT® 67228		Destroy Retinopathy Photocoag	BOTH IP/OP	"$7,387.00 "	"$5,466.38"	$311.48	"$5,969.60"	"$2,321.55"	"$2,321.55"	$490.09	$490.09	$492.86	"$1,539.64"	"$1,257.08"	"$1,257.08"	"$1,305.43"	$482.91	"$1,539.45"	$313.89	"$1,871.00"	"$1,871.00"	$508.42	"$2,255.00"	"$5,909.90"	"$5,969.60"	$706.38	"$2,150.00"	$706.38	$821.55	$311.48	$311.48	"$1,187.95"	$484.21	$0.00	$0.00	$0.00	$0.00
36101112	EAP	CPT® 67335		Place Adjust Suture Strabismus	BOTH IP/OP	"$6,484.00 "	"$4,798.16"	$0.00	"$5,187.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,351.27"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$5,135.33"	"$5,187.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101113	EAP	CPT® 67345		Chemodenerv Extraocular Muscle	BOTH IP/OP	$846.00 	$626.04	$0.00	$851.00	$846.00	$846.00	$254.74	$254.74	$256.18	$176.33	$0.00	$0.00	$0.00	$250.42	$176.31	$162.77	$846.00	$846.00	$0.00	$851.00	$673.99	$680.80	$0.00	$846.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101114	EAP	CPT® 67415		Fna Orbital Contents	BOTH IP/OP	"$11,904.00 "	"$8,808.96"	$0.00	"$9,523.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,480.79"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$9,427.97"	"$9,523.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101115	EAP	CPT® 67500		Inject Medication Retrobulbar	BOTH IP/OP	$703.00 	$520.22	$0.00	$703.00	$381.73	$381.73	$254.74	$254.74	$256.18	$146.52	$0.00	$0.00	$0.00	$250.42	$146.51	$162.77	$113.00	$113.00	$271.28	$639.00	$506.09	$511.20	$376.91	$703.00	$376.91	$179.43	$62.75	$62.75	$101.73	$258.37	$0.00	$0.00	$0.00	$0.00
36101116	EAP	CPT® 67505		Inject Alcohol Retrobulbar	BOTH IP/OP	$843.00 	$623.82	$0.00	$843.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.68	$0.00	$0.00	$0.00	$0.00	$843.00	$667.66	$674.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101117	EAP	CPT® 67515		Inject Medication Tenon's Caps	BOTH IP/OP	"$2,002.00 "	"$1,481.48"	$0.00	"$1,871.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$417.27	$0.00	$0.00	$0.00	$250.42	$417.22	$162.77	"$1,871.00"	"$1,871.00"	$271.28	"$1,820.00"	"$1,441.44"	"$1,456.00"	$376.91	"$1,750.00"	$376.91	$137.37	$60.20	$60.20	$289.74	$258.37	$0.00	$0.00	$0.00	$0.00
36101118	EAP	CPT® 67700		Blepharotomy Eyelid	BOTH IP/OP	"$1,339.00 "	$990.86	$0.00	"$1,339.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$279.08	$0.00	$0.00	$0.00	$250.42	$279.05	$162.77	"$1,339.00"	"$1,339.00"	$0.00	"$1,339.00"	"$1,060.49"	"$1,071.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101119	EAP	CPT® 67710		Severing Of Tarsorrhaphy	BOTH IP/OP	"$2,216.00 "	"$1,639.84"	$0.00	"$2,216.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$461.81	$0.00	$0.00	$0.00	$0.00	"$2,216.00"	"$1,755.07"	"$1,772.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101120	EAP	CPT® 67715		Canthotomy	BOTH IP/OP	"$9,511.00 "	"$7,038.14"	$0.00	"$7,636.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,982.09"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$7,560.43"	"$7,636.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101121	EAP	CPT® 67800		Excise Chalazion Single	BOTH IP/OP	"$1,334.00 "	$987.16	$0.00	"$1,339.00"	"$1,334.00"	"$1,334.00"	$254.74	$254.74	$256.18	$0.00	$0.00	$0.00	$0.00	$0.00	$278.01	$0.00	$0.00	$0.00	$271.28	"$1,339.00"	"$1,060.49"	"$1,071.20"	$376.91	"$1,334.00"	$376.91	$174.52	$104.90	$104.90	$213.17	$258.37	$0.00	$0.00	$0.00	$0.00
36101122	EAP	CPT® 67801		Excise Chalazion Multiple	BOTH IP/OP	"$2,208.00 "	"$1,633.92"	$0.00	"$2,216.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$460.15	$0.00	$0.00	$0.00	$0.00	"$2,216.00"	"$1,755.07"	"$1,772.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101123	EAP	CPT® 67805		"Excise Chalazion,mult,diff Lid"	BOTH IP/OP	"$1,668.00 "	"$1,234.32"	$0.00	"$1,674.00"	"$1,668.00"	"$1,668.00"	$254.74	$254.74	$256.18	$347.65	$0.00	$0.00	$0.00	$250.42	$347.61	$162.77	"$1,668.00"	"$1,668.00"	$0.00	"$1,674.00"	"$1,325.81"	"$1,339.20"	$0.00	"$1,668.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101124	EAP	CPT® 67810		Biopsy Of Eyelid	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	"$1,154.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$271.28	"$1,154.00"	$913.97	$923.20	$376.91	"$1,150.00"	$376.91	$152.92	$72.11	$72.11	$183.72	$258.37	$0.00	$0.00	$0.00	$0.00
36101125	EAP	CPT® 67825		Correct Trichiasis Electrosurg	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	"$1,154.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	"$1,154.00"	$913.97	$923.20	$0.00	"$1,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101126	EAP	CPT® 67840		Excise Lesion Eyelid Smpl Clos	BOTH IP/OP	"$2,572.00 "	"$1,903.28"	$160.78	"$2,572.00"	"$2,572.00"	"$2,572.00"	$788.63	$788.63	$793.07	$536.07	"$1,257.08"	"$1,257.08"	"$1,305.43"	$775.88	$536.00	$504.32	"$1,871.00"	"$1,871.00"	$809.34	"$2,255.00"	"$2,044.15"	"$2,064.80"	"$1,124.47"	"$2,150.00"	"$1,124.47"	$209.29	$160.78	$160.78	$410.90	$770.80	$0.00	$0.00	$0.00	$0.00
36101127	EAP	CPT® 67875		Temporary Tarsorraphy	BOTH IP/OP	"$3,736.00 "	"$2,764.64"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$778.68	$0.00	$0.00	$0.00	$775.88	$778.58	$504.32	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$2,970.00"	"$3,000.00"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101128	EAP	CPT® 67880		Construct Intemar Adhes Etc.	BOTH IP/OP	"$7,543.00 "	"$5,581.82"	$0.00	"$6,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.96"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$5,995.44"	"$6,056.00"	$0.00	"$3,250.00"	$0.00	$389.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101129	EAP	CPT® 67909		Reduce Ptosis Overcorrection	BOTH IP/OP	"$9,164.00 "	"$6,781.36"	$0.00	"$7,331.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.78"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$7,257.89"	"$7,331.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101130	EAP	CPT® 67914		Repair Ectropion By Suture	BOTH IP/OP	"$5,265.00 "	"$3,896.10"	$0.00	"$4,227.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,097.23"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,184.93"	"$4,227.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101131	EAP	CPT® 67916		"Rpr Ectropion, Blephar Tarsal"	BOTH IP/OP	"$9,164.00 "	"$6,781.36"	$0.00	"$7,331.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.78"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$7,257.89"	"$7,331.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101132	EAP	CPT® 67921		Repair Entropion By Suture	BOTH IP/OP	"$5,284.00 "	"$3,910.16"	$0.00	"$4,227.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,101.19"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,184.93"	"$4,227.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101133	EAP	CPT® 67923		"Rpr Entropion, Blephar Tarsal"	BOTH IP/OP	"$9,164.00 "	"$6,781.36"	$0.00	"$7,331.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.78"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$7,257.89"	"$7,331.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101134	EAP	CPT® 67924		"Rpr Entropion, Blephar Extnsv"	BOTH IP/OP	"$9,164.00 "	"$6,781.36"	$0.00	"$7,331.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.78"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$7,257.89"	"$7,331.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101135	EAP	CPT® 67930		Suture Wound Eyelid Partial Th	BOTH IP/OP	"$5,476.00 "	"$4,052.24"	$0.00	"$4,396.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,141.20"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,352.83"	"$4,396.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101136	EAP	CPT® 67935		Suture Wound Eyelid Full Thick	BOTH IP/OP	"$10,632.00 "	"$7,867.68"	$0.00	"$8,536.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,215.71"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$8,451.43"	"$8,536.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101138	EAP	CPT® 67938		Remove Foreign Body Eyelid	BOTH IP/OP	"$1,204.00 "	$890.96	$0.00	"$1,208.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.91	$0.00	$0.00	$0.00	$0.00	"$1,208.00"	$956.74	$966.40	$0.00	"$1,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101139	EAP	CPT® 67950		Canthoplasty	BOTH IP/OP	"$9,333.00 "	"$6,906.42"	$0.00	"$7,541.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,945.00"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$7,466.18"	"$7,541.60"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101140	EAP	CPT® 68020		I & D Conjunctiva Cyst	BOTH IP/OP	"$3,391.00 "	"$2,509.34"	$0.00	"$2,712.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$706.68	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,685.67"	"$2,712.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101141	EAP	CPT® 68100		Biopsy Of Conjunctiva	BOTH IP/OP	"$2,389.00 "	"$1,767.86"	$0.00	"$2,389.00"	"$2,321.55"	"$2,321.55"	"$1,948.73"	"$1,948.73"	"$1,959.70"	$497.93	$0.00	$0.00	$0.00	"$1,919.09"	$497.87	"$1,247.41"	"$2,389.00"	"$2,389.00"	$0.00	"$2,255.00"	"$1,877.83"	"$1,896.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101142	EAP	CPT® 68110		Excise Lesion Conjunctiva <1 C	BOTH IP/OP	"$4,701.00 "	"$3,478.74"	$0.00	"$3,732.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$979.81	$0.00	$0.00	$0.00	"$1,919.09"	$979.69	"$1,247.41"	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$3,694.68"	"$3,732.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101143	EAP	CPT® 68110		Incision Conjunctival Lesion	BOTH IP/OP	"$4,701.00 "	"$3,478.74"	$0.00	"$3,732.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$979.81	$0.00	$0.00	$0.00	"$1,919.09"	$979.69	"$1,247.41"	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$3,694.68"	"$3,732.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101144	EAP	CPT® 68115		Excise Lesion Conjunctiva >1 C	BOTH IP/OP	"$5,304.00 "	"$3,924.96"	$0.00	"$4,243.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,114.03"	$0.00	$0.00	$0.00	"$1,919.09"	"$1,113.90"	"$1,247.41"	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$4,200.77"	"$4,243.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101145	EAP	CPT® 68200		Injection Subconjunctiva	BOTH IP/OP	$264.00 	$195.36	$0.00	$264.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.02	$0.00	$0.00	$0.00	$0.00	$262.00	$207.50	$209.60	$0.00	$264.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101146	EAP	CPT® 68400		I & D Lacrimal Gland	BOTH IP/OP	$850.00 	$629.00	$0.00	$850.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.14	$0.00	$0.00	$0.00	$0.00	$850.00	$673.20	$680.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101147	EAP	CPT® 68420		I & D Lacrimal Sac	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$631.24	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,398.97"	"$2,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101148	EAP	CPT® 68440		Snip Incision Lacrimal Punctum	BOTH IP/OP	$661.00 	$489.14	$0.00	$661.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.75	$0.00	$0.00	$0.00	$0.00	$661.00	$523.51	$528.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101149	EAP	CPT® 68510		Biopsy Of Lacrimal Gland	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$631.24	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,398.97"	"$2,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101150	EAP	CPT® 68705		Correct Everted Punctum Cauter	BOTH IP/OP	$661.00 	$489.14	$0.00	$661.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.75	$0.00	$0.00	$0.00	$0.00	$661.00	$523.51	$528.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101151	EAP	CPT® 68760		Close Lacri Punct Laser Ligate	BOTH IP/OP	$623.00 	$461.02	$0.00	$623.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.83	$0.00	$0.00	$0.00	$0.00	$623.00	$493.42	$498.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101152	EAP	CPT® 68761		Close Tear Duct Opening	BOTH IP/OP	$584.00 	$432.16	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.71	$0.00	$0.00	$0.00	$0.00	$579.00	$458.57	$463.20	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101153	EAP	CPT® 68770		Closure Lacrimal Fistula	BOTH IP/OP	"$5,253.00 "	"$3,887.22"	$0.00	"$4,202.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,094.73"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$4,160.38"	"$4,202.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101154	EAP	CPT® 68801		Dilate Lacrimal Punctum	BOTH IP/OP	$523.00 	$387.02	$0.00	$523.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.99	$0.00	$0.00	$0.00	$0.00	$519.00	$411.05	$415.20	$0.00	$523.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101155	EAP	CPT® 68810		Probe Nasolacrimal Duct	BOTH IP/OP	$670.00 	$495.80	$0.00	$670.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.63	$0.00	$0.00	$0.00	$0.00	$670.00	$530.64	$536.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101156	EAP	CPT® 68815		Probe Nasolacrimal Duct W Tube	BOTH IP/OP	"$5,253.00 "	"$3,887.22"	$0.00	"$4,202.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,094.73"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,160.38"	"$4,202.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101157	EAP	CPT® 68840		Probe Lacrimal Canaliculi	BOTH IP/OP	$670.00 	$495.80	$0.00	$670.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.63	$0.00	$0.00	$0.00	$0.00	$670.00	$530.64	$536.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101158	EAP	CPT® 69105		Biopsy External Ear Canal	BOTH IP/OP	"$3,660.00 "	"$2,708.40"	$0.00	"$3,660.00"	"$1,987.38"	"$1,987.38"	"$1,317.34"	"$1,317.34"	"$1,324.76"	$762.84	$0.00	$0.00	$0.00	"$1,296.54"	$762.74	$842.75	"$3,660.00"	"$3,660.00"	"$1,353.31"	"$2,255.00"	"$2,924.06"	"$2,953.60"	"$1,880.24"	"$2,500.00"	"$1,880.24"	$69.63	$64.16	$64.16	$587.77	"$1,288.86"	$0.00	$0.00	$0.00	$0.00
36101160	EAP	CPT® 69145		Excision Aural Mass	BOTH IP/OP	"$14,091.00 "	"$10,427.34"	$0.00	"$11,372.00"	"$2,753.10"	"$2,753.10"	"$2,309.02"	"$2,309.02"	"$2,322.02"	"$2,936.92"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,271.46"	"$2,936.56"	"$1,476.45"	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$11,258.28"	"$11,372.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101162	EAP	CPT® 69200		Remove Fb Ear W/o Anes	BOTH IP/OP	$408.00 	$301.92	$0.00	$564.00	$221.54	$221.54	$109.81	$109.81	$110.43	$85.04	$0.00	$0.00	$0.00	$107.30	$85.03	$69.74	$113.00	$113.00	$109.35	$412.00	$326.30	$329.60	$151.93	$564.00	$151.93	$58.58	$48.67	$48.67	$65.59	$104.14	$0.00	$0.00	$0.00	$0.00
36101165	EAP	CPT® 69220		"Debridement,ear Wash Placement"	BOTH IP/OP	$326.00 	$241.24	$0.00	$329.00	$177.02	$177.02	$174.88	$174.88	$175.86	$0.00	$0.00	$0.00	$0.00	$0.00	$67.94	$0.00	$0.00	$0.00	$175.24	$329.00	$260.57	$263.20	$243.48	$326.00	$243.48	$62.84	$52.64	$52.64	$52.38	$166.90	$0.00	$0.00	$0.00	$0.00
36101171	EAP	CPT® 69420		"Myringotomy W Aspir, E Tube In"	BOTH IP/OP	"$1,533.00 "	"$1,134.42"	$96.31	"$1,547.00"	"$1,533.00"	"$1,533.00"	$206.03	$206.03	$207.19	$319.52	"$1,533.00"	"$1,533.00"	"$1,533.00"	$202.80	$319.48	$131.82	"$1,533.00"	"$1,533.00"	$204.24	"$1,547.00"	"$1,225.22"	"$1,237.60"	$283.76	"$1,533.00"	$283.76	$96.31	$122.18	$122.18	$246.28	$194.51	$0.00	$0.00	$0.00	$0.00
36101173	EAP	CPT® 69424		Remove Ventilating Tube W Anes	BOTH IP/OP	"$10,633.00 "	"$7,868.42"	$0.00	"$8,506.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,215.92"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$8,421.34"	"$8,506.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101176	EAP	CPT® 69433		Tympanostomy Local Anes	BOTH IP/OP	"$1,455.00 "	"$1,076.70"	$116.53	"$1,470.00"	"$1,455.00"	"$1,455.00"	$440.43	$440.43	$442.92	$303.26	"$1,257.08"	"$1,257.08"	"$1,305.43"	$433.55	$303.22	$281.81	"$1,455.00"	"$1,455.00"	$443.02	"$1,470.00"	"$1,164.24"	"$1,176.00"	$615.51	"$1,455.00"	$615.51	$116.53	$134.08	$134.08	$234.02	$421.92	$0.00	$0.00	$0.00	$0.00
36101177	EAP	CPT® 69540		Excision Of Aural Polyp	BOTH IP/OP	"$2,303.00 "	"$1,704.22"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$479.95	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,823.98"	"$1,842.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101179	EAP	CPT® 69610		Tympanic Membrane Repair	BOTH IP/OP	"$3,245.00 "	"$2,401.30"	$0.00	"$2,596.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$676.26	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,570.04"	"$2,596.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101181	EAP	CPT® 92977		Thrombolytic By Iv For Ami	BOTH IP/OP	"$3,599.00 "	"$2,663.26"	$0.00	"$3,381.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$750.03	$0.00	$0.00	$0.00	$0.00	"$2,113.50"	"$3,347.78"	"$3,381.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101183	EAP	CPT® 92978		Ivus Initial Vessel	BOTH IP/OP	"$8,205.00 "	"$6,071.70"	$0.00	"$5,967.20"	"$4,455.32"	"$4,455.32"	$0.00	$0.00	$0.00	"$1,710.13"	$0.00	$0.00	$0.00	$0.00	"$1,709.92"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,729.50"	"$5,907.53"	"$5,967.20"	$0.00	"$1,750.00"	$0.00	$273.18	$0.00	$0.00	"$1,187.47"	$0.00	$0.00	$0.00	$0.00	$0.00
36101184	EAP	CPT® 92979		Ivus - Addit Vessel	BOTH IP/OP	"$8,818.00 "	"$6,525.32"	$0.00	"$6,796.91"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,796.91"	$0.00	"$1,837.67"	$0.00	$0.00	$0.00	$0.00	"$3,729.50"	"$5,907.53"	"$5,967.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101185	EAP	CPT® 27096		Inject Si Joint Arthrgrphy&/anes/steroid W/image	BOTH IP/OP	"$2,110.00 "	"$1,561.40"	$0.00	"$2,131.00"	"$2,110.00"	"$2,110.00"	$618.38	$618.38	$621.87	$439.78	$0.00	$0.00	$0.00	$608.20	$439.72	$395.33	$113.00	$113.00	$626.89	"$2,131.00"	"$1,687.75"	"$1,704.80"	$86.18	"$2,110.00"	$86.18	$398.44	$86.18	$86.18	$339.26	$597.04	$0.00	$0.00	$0.00	$0.00
36101186	EAP	CPT® 27096		Bil Inject Si Joint Arthrgrphy&/anes/steroid W/image	BOTH IP/OP	"$3,165.00 "	"$2,342.10"	$0.00	"$2,557.60"	"$2,321.55"	"$2,321.55"	$618.38	$618.38	$621.87	$659.67	$0.00	$0.00	$0.00	$608.20	$659.59	$395.33	$113.00	$113.00	$626.89	"$2,255.00"	"$2,532.02"	"$2,557.60"	$86.18	"$2,150.00"	$86.18	$398.44	$86.18	$86.18	$508.96	$597.04	$0.00	$0.00	$0.00	$0.00
36101187	EAP	HCPCS G0269		Closure Device Placement	BOTH IP/OP	"$2,840.00 "	"$2,101.60"	$0.00	"$2,276.00"	"$1,542.12"	"$1,542.12"	$0.00	$0.00	$0.00	$591.93	$0.00	$0.00	$0.00	$0.00	$591.86	$0.00	"$1,679.86"	"$1,679.86"	$0.00	"$1,422.50"	"$2,253.24"	"$2,276.00"	$0.00	"$1,750.00"	$0.00	$445.24	$0.00	$0.00	$452.92	$0.00	$0.00	$0.00	$0.00	$0.00
36101192	EAP	CPT® 41899		Partially Bony	BOTH IP/OP	"$1,862.00 "	"$1,377.88"	$0.00	"$1,880.00"	"$1,862.00"	"$1,862.00"	$206.03	$206.03	$207.19	$388.09	$0.00	$0.00	$0.00	$202.80	$388.04	$131.82	"$1,862.00"	"$1,862.00"	$204.24	"$1,880.00"	"$1,488.96"	"$1,504.00"	$283.76	"$1,750.00"	$283.76	$294.22	$0.00	$0.00	$299.30	$194.51	$0.00	$0.00	$0.00	$0.00
36101193	EAP	CPT® 41899		Soft Tissue	BOTH IP/OP	"$1,862.00 "	"$1,377.88"	$0.00	"$1,880.00"	"$1,862.00"	"$1,862.00"	$206.03	$206.03	$207.19	$388.09	$0.00	$0.00	$0.00	$202.80	$388.04	$131.82	"$1,862.00"	"$1,862.00"	$204.24	"$1,880.00"	"$1,488.96"	"$1,504.00"	$283.76	"$1,750.00"	$283.76	$294.22	$0.00	$0.00	$299.30	$194.51	$0.00	$0.00	$0.00	$0.00
36101198	EAP	CPT® 62320		Njx Interlaminar Crv/thrc	BOTH IP/OP	"$1,385.00 "	"$1,024.90"	$0.00	"$1,385.00"	"$1,385.00"	"$1,385.00"	$618.38	$618.38	$621.87	$288.67	$0.00	$0.00	$0.00	$608.20	$288.63	$395.33	"$1,385.00"	"$1,385.00"	$0.00	"$1,316.00"	"$1,042.27"	"$1,052.80"	$0.00	"$1,385.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101202	EAP	CPT® 15792		Tca Peel	BOTH IP/OP	"$1,056.00 "	$781.44	$0.00	"$1,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.07	$0.00	$0.00	$0.00	$0.00	$990.00	$784.08	$792.00	$0.00	"$1,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101204	EAP	CPT® 17000		"Destruc Lesion Benign, 1st"	BOTH IP/OP	$389.00 	$287.86	$0.00	$389.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$389.00	$308.09	$311.20	$243.48	$0.00	$243.48	$48.44	$55.15	$55.15	$61.93	$166.90	$0.00	$0.00	$0.00	$0.00
36101208	EAP	CPT® 36600		Arterial Puncture	BOTH IP/OP	$227.00 	$167.98	$0.00	$404.00	$227.00	$227.00	$109.81	$109.81	$110.43	$47.31	$0.00	$0.00	$0.00	$107.30	$47.31	$69.74	$113.00	$113.00	$109.35	$284.00	$224.93	$227.20	$151.93	$404.00	$151.93	$24.37	$16.23	$16.23	$45.21	$104.14	$0.00	$0.00	$0.00	$0.00
36101209	EAP	CPT® 46611		Hr Anoscopy W/ Bx	BOTH IP/OP	"$2,999.00 "	"$2,219.26"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$624.99	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,295.22"	"$2,318.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101210	EAP	CPT® 46614		Hr Ano/w Control Of Bleeding	BOTH IP/OP	"$1,516.00 "	"$1,121.84"	$0.00	"$1,516.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.93	$0.00	$0.00	$0.00	$0.00	"$1,516.00"	"$1,200.67"	"$1,212.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101211	EAP	CPT® 46615		Hr Ano W/ablation Of Tumor	BOTH IP/OP	"$6,197.00 "	"$4,585.78"	$0.00	"$4,791.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,291.45"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,743.29"	"$4,791.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101212	EAP	CPT® 51727		Cystometrogram W/urethral Pres	BOTH IP/OP	$790.00 	$584.60	$0.00	$790.00	$790.00	$790.00	$560.26	$560.26	$563.41	$164.66	$0.00	$0.00	$0.00	$550.87	$164.64	$358.07	$113.00	$113.00	$0.00	$790.00	$625.68	$632.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101213	EAP	CPT® 51728		Cystometrogram W/voiding Press	BOTH IP/OP	$791.00 	$585.34	$0.00	$791.00	$791.00	$791.00	$560.26	$560.26	$563.41	$164.86	$0.00	$0.00	$0.00	$550.87	$164.84	$358.07	$113.00	$113.00	$0.00	$790.00	$625.68	$632.00	$0.00	$791.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101214	EAP	CPT® 51729		Cystometrogram W/vp&up	BOTH IP/OP	$791.00 	$585.34	$0.00	$791.00	$791.00	$791.00	$560.26	$560.26	$563.41	$164.86	$0.00	$0.00	$0.00	$550.87	$164.84	$358.07	$113.00	$113.00	$558.17	$790.00	$625.68	$632.00	$775.50	$791.00	$775.50	$235.63	$252.48	$252.48	$125.77	$531.59	$0.00	$0.00	$0.00	$0.00
36101216	EAP	CPT® 49429		Removal Of Peritoneal-venous Shunt	BOTH IP/OP	"$9,158.00 "	"$6,776.92"	$0.00	"$8,570.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,908.53"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$8,484.70"	"$8,570.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101217	EAP	CPT® 21040		Excision Benign Tumor/cyst Mandible Encl & Curt	BOTH IP/OP	"$4,993.00 "	"$3,694.82"	$0.00	"$3,994.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,040.54"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,954.46"	"$3,994.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101219	EAP	CPT® 57800		Insert Smit Sleeve	BOTH IP/OP	"$5,262.00 "	"$3,893.88"	$0.00	"$4,209.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,096.60"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,167.50"	"$4,209.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101225	EAP	CPT® 64415		Inj Anes/strd Brachial Plexus	BOTH IP/OP	"$2,280.00 "	"$1,687.20"	$0.00	"$2,280.00"	"$2,280.00"	"$2,280.00"	$801.66	$801.66	$806.18	$475.21	"$1,257.08"	"$1,257.08"	"$1,305.43"	$788.26	$475.15	$512.37	"$1,871.00"	"$1,871.00"	$814.44	"$1,890.00"	"$1,496.88"	"$1,512.00"	"$1,131.55"	$0.00	"$1,131.55"	$107.25	$66.00	$66.00	$300.89	$775.65	$0.00	$0.00	$0.00	$0.00
36101226	EAP	CPT® 64417		Inj Anes/strd Axillary Nerve	BOTH IP/OP	"$1,969.00 "	"$1,457.06"	$0.00	"$1,969.00"	"$1,969.00"	"$1,969.00"	$801.66	$801.66	$806.18	$410.39	"$1,257.08"	"$1,257.08"	"$1,305.43"	$788.26	$410.34	$512.37	"$1,871.00"	"$1,871.00"	$814.44	"$1,890.00"	"$1,496.88"	"$1,512.00"	"$1,131.55"	$0.00	"$1,131.55"	$106.55	$63.11	$63.11	$300.89	$775.65	$0.00	$0.00	$0.00	$0.00
36101227	EAP	CPT® 64420		Inj Anes/strd Intercostal Nerve 1st Level	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,959.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.26	$0.00	$0.00	$0.00	$626.89	"$1,890.00"	"$1,496.88"	"$1,512.00"	$870.98	"$1,959.00"	$870.98	$95.79	$62.02	$62.02	$300.89	$597.04	$0.00	$0.00	$0.00	$0.00
36101228	EAP	CPT® 64421		Inj Anes/strd Intercostal Nerve Addl Level	BOTH IP/OP	"$3,789.00 "	"$2,803.86"	$0.00	"$2,924.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$789.63	$0.00	$0.00	$0.00	$814.44	"$2,255.00"	"$2,895.55"	"$2,924.80"	"$1,131.55"	"$2,150.00"	"$1,131.55"	$124.25	$26.33	$26.33	$582.04	$775.65	$0.00	$0.00	$0.00	$0.00
36101229	EAP	CPT® 64445		Inj Anes/strd Sciatic Nerve	BOTH IP/OP	"$3,789.00 "	"$2,803.86"	$0.00	"$2,924.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$789.72	$0.00	$0.00	$0.00	$608.20	$789.63	$395.33	"$1,871.00"	"$1,871.00"	$626.89	"$2,255.00"	"$2,895.55"	"$2,924.80"	$870.98	"$2,150.00"	$870.98	$117.68	$55.89	$55.89	$582.04	$597.04	$0.00	$0.00	$0.00	$0.00
36101230	EAP	CPT® 64447		Inj Anes/strd Femoral Nerve	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,890.00"	"$1,294.51"	"$1,294.51"	$618.38	$618.38	$621.87	$496.89	$0.00	$0.00	$0.00	$608.20	$496.83	$395.33	"$1,871.00"	"$1,871.00"	$626.89	"$1,890.00"	"$1,496.88"	"$1,512.00"	$870.98	$0.00	$870.98	$74.36	$55.18	$55.18	$300.89	$597.04	$0.00	$0.00	$0.00	$0.00
36101231	EAP	CPT® 64490		Bilat_inj Paravert F Jnt C/t 1 Lev	BOTH IP/OP	"$5,684.00 "	"$4,206.16"	$0.00	"$4,387.20"	"$2,321.55"	"$2,321.55"	$801.66	$801.66	$806.18	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,184.55"	$0.00	$0.00	$0.00	$814.44	"$2,255.00"	"$4,343.33"	"$4,387.20"	"$1,131.55"	"$2,150.00"	"$1,131.55"	$122.58	$109.61	$109.61	$873.05	$775.65	$0.00	$0.00	$0.00	$0.00
36101232	EAP	CPT® 64491		Bilat_inj Paravert F Jnt C/t 2 Lev	BOTH IP/OP	"$2,740.00 "	"$2,027.60"	$0.00	"$2,321.55"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$571.02	$0.00	$0.00	$0.00	$0.00	"$1,322.00"	"$2,094.05"	"$2,115.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101233	EAP	CPT® 64492		Bilat_inj Paravert F Jnt C/t 3 Lev	BOTH IP/OP	"$2,441.00 "	"$1,806.34"	$0.00	"$2,321.55"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$508.70	$0.00	$0.00	$0.00	$0.00	"$1,177.50"	"$1,865.16"	"$1,884.00"	$0.00	"$1,741.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101234	EAP	CPT® 64493		Bilat_inj Paravert F Jnt L/s 1 Lev	BOTH IP/OP	"$5,684.00 "	"$4,206.16"	$0.00	"$4,387.20"	"$2,321.55"	"$2,321.55"	$801.66	$801.66	$806.18	"$1,184.69"	$0.00	$0.00	$0.00	$788.26	"$1,184.55"	$512.37	"$1,871.00"	"$1,871.00"	$814.44	"$2,255.00"	"$4,343.33"	"$4,387.20"	"$1,131.55"	"$2,150.00"	"$1,131.55"	$111.04	$93.03	$93.03	$873.05	$775.65	$0.00	$0.00	$0.00	$0.00
36101235	EAP	CPT® 64494		Bilat_inj Paravert F Jnt L/s 2 Lev	BOTH IP/OP	"$2,583.00 "	"$1,911.42"	$0.00	"$2,321.55"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	$538.36	$0.00	$0.00	$0.00	$0.00	$538.30	$0.00	"$1,527.84"	"$1,527.84"	$0.00	"$1,246.00"	"$1,973.66"	"$1,993.60"	$0.00	"$1,750.00"	$0.00	$54.06	$53.73	$53.73	$396.73	$0.00	$0.00	$0.00	$0.00	$0.00
36101236	EAP	CPT® 64495		Bilat_inj Paravert F Jnt L/s 3 Lev	BOTH IP/OP	"$2,478.00 "	"$1,833.72"	$0.00	"$2,321.55"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	$516.48	$0.00	$0.00	$0.00	$0.00	$516.42	$0.00	"$1,465.74"	"$1,465.74"	$0.00	"$1,195.50"	"$1,893.67"	"$1,912.80"	$0.00	"$1,750.00"	$0.00	$0.00	$54.45	$54.45	$380.65	$0.00	$0.00	$0.00	$0.00	$0.00
36101252	EAP	CPT® 19126		Excision Addl Breast Lesion	BOTH IP/OP	$508.00 	$375.92	$0.00	$508.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.87	$0.00	$0.00	$0.00	$0.00	$508.00	$402.34	$406.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101253	EAP	CPT® 57520		Conization Of Cervix	BOTH IP/OP	"$2,862.00 "	"$2,117.88"	$0.00	"$2,327.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$596.44	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,266.70"	"$2,289.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101264	EAP	CPT® 69210		Removal Impacted Cerumen Instrument Unilat	BOTH IP/OP	$408.00 	$301.92	$0.00	$564.00	$408.00	$408.00	$54.21	$54.21	$54.51	$85.04	$0.00	$0.00	$0.00	$53.35	$85.03	$34.67	$113.00	$113.00	$55.17	$412.00	$326.30	$329.60	$76.65	$564.00	$76.65	$47.34	$34.61	$34.61	$65.59	$52.54	$0.00	$0.00	$0.00	$0.00
36101266	EAP	CPT® 36569		Picc W/o Port	BOTH IP/OP	"$4,743.00 "	"$3,509.82"	$98.45	"$4,343.20"	"$2,321.55"	"$2,321.55"	"$1,369.42"	"$1,369.42"	"$1,377.13"	$988.56	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,347.67"	$988.44	$875.99	"$1,871.00"	"$1,871.00"	"$1,635.92"	"$2,255.00"	"$4,299.77"	"$4,343.20"	"$2,272.90"	"$2,500.00"	"$2,272.90"	$346.84	$98.45	$98.45	$864.30	"$1,558.02"	$0.00	$0.00	$0.00	$0.00
36101267	EAP	CPT® 67820		Revised Eye Lashes	BOTH IP/OP	$316.00 	$233.84	$0.00	$317.00	$171.59	$171.59	$109.81	$109.81	$110.43	$65.86	$0.00	$0.00	$0.00	$107.30	$65.85	$69.74	$113.00	$113.00	$109.35	$317.00	$251.06	$253.60	$151.93	$316.00	$151.93	$67.50	$28.84	$28.84	$50.47	$104.14	$0.00	$0.00	$0.00	$0.00
36101270	EAP	CPT® 19000		Drain Breast Cyst	BOTH IP/OP	$921.00 	$681.54	$45.43	"$1,141.00"	$921.00	$921.00	$606.01	$606.01	$609.42	$191.96	$921.00	$921.00	$921.00	$596.11	$191.94	$387.47	$921.00	$921.00	$611.80	"$1,141.00"	$903.67	$912.80	$850.02	"$1,130.00"	$850.02	$59.58	$45.43	$45.43	$181.65	$582.67	$0.00	$0.00	$0.00	$0.00
36101273	EAP	CPT® 21925		Bx Soft Tissue Back/flank	BOTH IP/OP	"$5,368.00 "	"$3,972.32"	$0.00	"$4,294.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,118.69"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,251.46"	"$4,294.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101274	EAP	CPT® 31535		Laryngoscopy W/biopsy	BOTH IP/OP	"$9,759.00 "	"$7,221.66"	$0.00	"$7,168.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,033.78"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$7,096.32"	"$7,168.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101275	EAP	CPT® 31577		"Removal Foreign Body, Larynx"	BOTH IP/OP	"$1,746.00 "	"$1,292.04"	$0.00	"$1,826.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$363.87	$0.00	$0.00	$0.00	$0.00	"$1,826.00"	"$1,446.19"	"$1,460.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101280	EAP	CPT® 44370		"Small Bowel Endoscop/stent,spv"	BOTH IP/OP	"$7,753.00 "	"$5,737.22"	$0.00	"$6,202.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,615.73"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$6,140.38"	"$6,202.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101281	EAP	CPT® 49411		Ins Mark Abd/pel For Rt Perq	BOTH IP/OP	"$2,721.00 "	"$2,013.54"	$0.00	"$2,546.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$567.06	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,520.94"	"$2,546.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101284	EAP	CPT® 54161		Circum 28 Days Or Older	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,426.40"	"$2,753.10"	"$2,753.10"	"$1,743.67"	"$1,743.67"	"$1,753.49"	$888.72	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,718.44"	$888.62	"$1,116.98"	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$3,392.14"	"$3,426.40"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101285	EAP	CPT® 58999		Female Genital System Procedur	BOTH IP/OP	$263.00 	$194.62	$0.00	$263.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.81	$0.00	$0.00	$0.00	$0.00	$250.00	$198.00	$200.00	$0.00	$263.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101286	EAP	CPT® 59412		Antepartum Manipulation	BOTH IP/OP	"$4,901.00 "	"$3,626.74"	$0.00	"$3,920.80"	"$2,661.24"	"$2,661.24"	"$2,555.04"	"$2,555.04"	"$2,569.43"	"$1,021.49"	$0.00	$0.00	$0.00	"$2,514.14"	"$1,021.37"	"$1,634.19"	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$3,881.59"	"$3,920.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101287	EAP	CPT® 59870		Evacuate Mole Of Uterus	BOTH IP/OP	"$4,868.00 "	"$3,602.32"	$0.00	"$3,933.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,014.49"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$3,894.26"	"$3,933.60"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101288	EAP	CPT® 60300		Aspir/inj Thyroid Cyst	BOTH IP/OP	"$1,745.00 "	"$1,291.30"	$0.00	"$1,745.00"	"$1,745.00"	"$1,745.00"	$606.01	$606.01	$609.42	$363.70	$0.00	$0.00	$0.00	$596.11	$363.66	$387.47	$113.00	$113.00	$611.80	"$1,741.00"	"$1,378.87"	"$1,392.80"	$850.02	"$1,745.00"	$850.02	$86.36	$51.21	$51.21	$277.17	$582.67	$0.00	$0.00	$0.00	$0.00
36101290	EAP	CPT® 61623		Endovasc Tempry Vesel Ocl Nir	BOTH IP/OP	"$17,372.00 "	"$12,855.28"	$0.00	"$12,843.20"	"$4,778.55"	"$4,778.55"	"$9,781.76"	"$9,781.76"	"$9,836.87"	"$3,620.76"	$0.00	$0.00	$0.00	"$9,625.35"	"$3,620.32"	"$6,256.48"	"$4,877.00"	"$4,877.00"	$0.00	"$6,105.00"	"$12,714.77"	"$12,843.20"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101292	EAP	CPT® 61641		Dilate Ic Vasospasm Add-on	BOTH IP/OP	"$13,302.00 "	"$9,843.48"	$0.00	"$9,834.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,772.14"	$0.00	$0.00	$0.00	$0.00	"$6,146.50"	"$9,736.06"	"$9,834.40"	$0.00	"$3,992.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101295	EAP	CPT® 65210		Remove Foreign Body From Eye	BOTH IP/OP	$605.00 	$447.70	$0.00	$611.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$611.00	$483.91	$488.80	$0.00	$605.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101296	EAP	CPT® 69200		Removal Fb Ear W/o Anesth	BOTH IP/OP	$412.00 	$304.88	$0.00	$412.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.04	$0.00	$0.00	$0.00	$107.30	$85.03	$69.74	$113.00	$113.00	$109.35	$412.00	$326.30	$329.60	$151.93	$0.00	$151.93	$58.58	$48.67	$48.67	$65.59	$104.14	$0.00	$0.00	$0.00	$0.00
36101298	EAP	CPT® 74220		"Contrast X-ray, Esophagus,spv"	BOTH IP/OP	"$1,126.00 "	$833.24	$0.00	$950.40	$200.75	$200.75	$173.95	$173.95	$174.93	$234.69	$0.00	$0.00	$0.00	$171.13	$234.66	$111.23	$666.03	$666.03	$202.33	$285.12	$940.90	$950.40	$281.11	$611.65	$281.11	$68.55	$66.99	$66.99	$189.13	$192.70	$0.00	$0.00	$0.00	$0.00
36101302	EAP	CPT® 92953		Temp Transcut Pacing	BOTH IP/OP	"$2,499.00 "	"$1,849.26"	$0.00	"$1,999.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$520.79	$0.00	$0.00	$0.00	$0.00	"$1,249.50"	"$1,979.21"	"$1,999.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101310	EAP	CPT® 31641		Bronchoscopy Treat Blockage	BOTH IP/OP	"$9,910.00 "	"$7,333.40"	$265.77	"$7,757.60"	"$2,753.10"	"$2,753.10"	"$3,016.56"	"$3,016.56"	"$3,033.56"	"$2,065.49"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,969.20"	"$2,065.24"	"$1,929.98"	"$2,836.00"	"$2,836.00"	"$2,945.54"	"$2,327.00"	"$7,680.02"	"$7,757.60"	"$4,092.44"	"$3,725.00"	"$4,092.44"	$324.15	$265.77	$265.77	"$1,543.76"	"$2,805.28"	$0.00	$0.00	$0.00	$0.00
36101311	EAP	CPT® 64416		Inj Anes/strd Brachial Plexus By Cont Infusion	BOTH IP/OP	"$4,307.00 "	"$3,187.18"	$0.00	"$3,445.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,411.14"	"$3,445.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101312	EAP	CPT® 64446		Inj Anes/strd Sicatic Nerve By Cont Infusion	BOTH IP/OP	"$4,292.00 "	"$3,176.08"	$0.00	"$3,759.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$894.45	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,721.61"	"$3,759.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101313	EAP	CPT® 64448		Inj Anes/strd Femoral Nerve By Cont Infusion	BOTH IP/OP	"$3,481.00 "	"$2,575.94"	$0.00	"$3,048.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$725.44	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,018.31"	"$3,048.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101314	EAP	CPT® 64449		Inj Anes/strd Lumbar Plexus By Cont Infusion	BOTH IP/OP	"$3,355.00 "	"$2,482.70"	$0.00	"$2,938.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$699.18	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,909.02"	"$2,938.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101315	EAP	CPT® 64486		Tap Block Unil By Injection	BOTH IP/OP	"$1,767.00 "	"$1,307.58"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$368.24	$0.00	$0.00	$0.00	$0.00	$852.50	"$1,350.36"	"$1,364.00"	$0.00	"$1,750.00"	$0.00	$119.70	$58.43	$58.43	$271.44	$0.00	$0.00	$0.00	$0.00	$0.00
36101316	EAP	CPT® 64487		Tap Block Uni By Infusion	BOTH IP/OP	"$1,557.00 "	"$1,152.18"	$0.00	"$1,364.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.48	$0.00	$0.00	$0.00	$0.00	$852.50	"$1,350.36"	"$1,364.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101317	EAP	CPT® 64488		Tap Block Bi Injection	BOTH IP/OP	"$1,767.00 "	"$1,307.58"	$0.00	"$1,767.00"	"$1,767.00"	"$1,767.00"	$0.00	$0.00	$0.00	$368.29	$0.00	$0.00	$0.00	$0.00	$368.24	$0.00	"$1,045.18"	"$1,045.18"	$0.00	$852.50	"$1,350.36"	"$1,364.00"	$0.00	"$1,750.00"	$0.00	$147.17	$72.14	$72.14	$271.44	$0.00	$0.00	$0.00	$0.00	$0.00
36101318	EAP	CPT® 64489		Tap Block Bi By Infusion	BOTH IP/OP	"$1,557.00 "	"$1,152.18"	$0.00	"$1,364.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.48	$0.00	$0.00	$0.00	$0.00	$852.50	"$1,350.36"	"$1,364.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101350	EAP	CPT® 31525		"Dx Laryngoscopy, Except Nb"	BOTH IP/OP	"$6,130.00 "	"$4,536.20"	$0.00	"$5,129.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,277.49"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,078.30"	"$5,129.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101351	EAP	CPT® 49451		"Replace Duod/jej Tube Perc,spv"	BOTH IP/OP	"$2,862.00 "	"$2,117.88"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$596.44	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,179.58"	"$2,201.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101355	EAP	CPT® 69000		Drain External Ear Lesion	BOTH IP/OP	$694.00 	$513.56	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$144.63	$0.00	$0.00	$0.00	$0.00	$700.00	$554.40	$560.00	$0.00	$694.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101370	EAP	CPT® 92511		Nasopharyngoscopy W/endoscope	BOTH IP/OP	$606.00 	$448.44	$0.00	$612.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.29	$0.00	$0.00	$0.00	$157.01	$612.00	$484.70	$489.60	$218.14	$393.90	$218.14	$64.35	$38.94	$38.94	$97.43	$149.53	$0.00	$0.00	$0.00	$0.00
36101371	EAP	CPT® 77002		Fluoro Guidance For Needle Pla	BOTH IP/OP	$724.00 	$535.76	$0.00	$579.20	$0.00	$0.00	$0.00	$0.00	$0.00	$149.44	$0.00	$0.00	$0.00	$0.00	$149.42	$0.00	$424.11	$424.11	$0.00	$173.76	$573.41	$579.20	$0.00	$0.00	$0.00	$71.68	$81.40	$81.40	$115.26	$0.00	$0.00	$0.00	$0.00	$0.00
36101375	EAP	CPT® 12021		Wound Dehiscence With Packing	BOTH IP/OP	"$3,676.00 "	"$2,720.24"	$0.00	"$2,940.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.45	"$2,255.00"	"$2,911.39"	"$2,940.80"	$445.22	$0.00	$445.22	$117.17	$144.54	$144.54	$585.22	$305.19	$0.00	$0.00	$0.00	$0.00
36101390	EAP	CPT® 49180		Ablation Abd Standa	BOTH IP/OP	"$2,498.00 "	"$1,848.52"	$87.64	"$2,500.00"	"$2,321.55"	"$2,321.55"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$520.65	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	$520.58	$876.52	"$1,871.00"	"$1,871.00"	"$1,376.63"	"$2,255.00"	"$2,314.22"	"$2,337.60"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$203.88	$87.64	$87.64	$465.18	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36101396	EAP	CPT® 32555		Aspirate Pleura W/ Imaging	BOTH IP/OP	"$3,461.00 "	"$2,561.14"	$0.00	"$2,768.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.36	"$2,255.00"	"$2,741.11"	"$2,768.80"	$878.58	$0.00	$878.58	$626.46	$116.13	$116.13	$550.99	$602.25	$0.00	$0.00	$0.00	$0.00
36101398	EAP	CPT® 31647		Bronchial Valve Init Insert	BOTH IP/OP	"$5,148.00 "	"$3,809.52"	$0.00	"$4,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,096.39"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,077.22"	"$4,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101399	EAP	CPT® 31648		Bronchial Valve Addl Insert	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,858.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$631.24	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$2,398.97"	"$2,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101400	EAP	CPT® 31649		Bronchial Valve Remov Init	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	"$1,500.00"	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101401	EAP	CPT® 31651		Bronchial Valve Remov Addl	BOTH IP/OP	$947.00 	$700.78	$0.00	$757.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.35	$0.00	$0.00	$0.00	$0.00	$473.50	$750.02	$757.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101402	EAP	CPT® 32556		Insert Cath Pleura W/o Image	BOTH IP/OP	"$3,737.00 "	"$2,765.38"	$0.00	"$2,828.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$778.79	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,800.51"	"$2,828.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101403	EAP	CPT® 32557		Insert Cath Pleura W/ Image	BOTH IP/OP	"$2,776.00 "	"$2,054.24"	$0.00	"$2,753.10"	"$2,753.10"	"$2,753.10"	"$1,369.42"	"$1,369.42"	"$1,377.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$578.52	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,080.58"	"$2,101.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101404	EAP	CPT® 31626		Navigation Bronchoscopy W/markers	BOTH IP/OP	"$5,560.00 "	"$4,114.40"	$0.00	"$5,671.09"	"$2,984.10"	"$2,984.10"	"$5,671.09"	"$5,671.09"	"$5,560.00"	"$1,158.84"	$0.00	$0.00	$0.00	"$5,580.65"	"$1,158.70"	"$3,627.42"	"$3,856.00"	"$3,856.00"	"$5,456.35"	"$2,858.00"	"$4,192.06"	"$4,234.40"	"$5,293.00"	"$3,725.00"	"$5,293.00"	$317.84	$205.55	$205.55	$842.65	"$5,196.52"	$0.00	$0.00	$0.00	$0.00
36101405	EAP	CPT® 61650		Endovasc Intracran Adm Rx 1st	BOTH IP/OP	"$10,002.00 "	"$7,401.48"	$0.00	"$7,394.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,084.42"	$0.00	$0.00	$0.00	$0.00	"$4,621.50"	"$7,320.46"	"$7,394.40"	$0.00	"$6,501.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101406	EAP	CPT® 61651		Endovasc Intracran Adm Rx Add	BOTH IP/OP	"$9,649.00 "	"$7,140.26"	$0.00	"$7,133.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,010.85"	$0.00	$0.00	$0.00	$0.00	"$4,458.50"	"$7,062.26"	"$7,133.60"	$0.00	"$6,271.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101407	EAP	CPT® 37252		Us Vascular Non-coronary Init	BOTH IP/OP	"$15,412.00 "	"$11,404.88"	$0.00	"$12,091.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,211.86"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$11,970.29"	"$12,091.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101408	EAP	CPT® 37253		Us Vascular Non-coron Add Ea	BOTH IP/OP	"$11,429.00 "	"$8,457.46"	$0.00	"$8,966.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,381.80"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$8,876.74"	"$8,966.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101409	EAP	CPT® 47532		Xr Cholangiogram Transhepatic	BOTH IP/OP	"$3,224.00 "	"$2,385.76"	$0.00	"$3,224.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$671.88	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$2,579.54"	"$2,605.60"	$0.00	"$3,224.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101410	EAP	CPT® 47531		Xr Cholangiogram Thru Cath	BOTH IP/OP	"$3,224.00 "	"$2,385.76"	$0.00	"$3,257.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$671.88	$0.00	$0.00	$0.00	"$3,118.48"	"$2,255.00"	"$2,579.54"	"$2,605.60"	"$3,257.00"	"$1,750.00"	"$3,257.00"	$360.21	$73.56	$73.56	$518.51	"$2,969.98"	$0.00	$0.00	$0.00	$0.00
36101411	EAP	CPT® 47533		Pl Bil Drn Cath Perc Ext Rad	BOTH IP/OP	"$5,443.00 "	"$4,027.82"	$0.00	"$4,354.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,134.32"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,310.86"	"$4,354.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101412	EAP	CPT® 47534		Pl Bil Drn Cath Perc Int/ext R	BOTH IP/OP	"$6,143.00 "	"$4,545.82"	$0.00	"$4,964.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.20"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,914.36"	"$4,964.00"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101413	EAP	CPT® 47535		Conv Ext Bil Drn Cath To Int/e	BOTH IP/OP	"$5,443.00 "	"$4,027.82"	$0.00	"$4,354.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,134.32"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,310.86"	"$4,354.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101414	EAP	CPT® 47536		Exch Bil Drn Cath Perc Rad	BOTH IP/OP	"$6,143.00 "	"$4,545.82"	$0.00	"$6,143.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.35"	$0.00	$0.00	$0.00	"$3,051.04"	"$1,280.20"	"$1,983.18"	"$6,143.00"	"$6,143.00"	"$3,118.48"	"$2,255.00"	"$4,914.36"	"$4,964.00"	"$4,332.71"	"$3,725.00"	"$4,332.71"	$789.54	$138.48	$138.48	$987.84	"$2,969.98"	$0.00	$0.00	$0.00	$0.00
36101415	EAP	CPT® 47537		Rmvl Bil Drn Cath Perc Fluor G	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	"$1,207.00"	"$1,195.00"	"$1,195.00"	$787.99	$787.99	$792.43	$249.07	$0.00	$0.00	$0.00	$775.94	$249.04	$504.36	"$1,195.00"	"$1,195.00"	$788.23	"$1,207.00"	$955.94	$965.60	"$1,095.14"	"$1,195.00"	"$1,095.14"	$390.05	$100.61	$100.61	$192.15	$750.70	$0.00	$0.00	$0.00	$0.00
36101416	EAP	CPT® 47538		PLMT STENT BILE DUCT PERC RAD EXIS ACCS	BOTH IP/OP	"$10,193.00 "	"$7,542.82"	$0.00	"$8,236.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,124.22"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$8,154.43"	"$8,236.80"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101417	EAP	CPT® 47539		PLMT STENT BILE DUCT PERC RAD NEW ACCS W/O CATH	BOTH IP/OP	"$10,193.00 "	"$7,542.82"	$0.00	"$8,236.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,124.22"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$8,154.43"	"$8,236.80"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101418	EAP	CPT® 47540		PLMT STENT BILE DUCT PERC RAD NEW ACCS W/ CATH	BOTH IP/OP	"$10,296.00 "	"$7,619.04"	$0.00	"$8,236.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,145.69"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$8,154.43"	"$8,236.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101419	EAP	CPT® 47541		Place Access Biliary Sm Bowel	BOTH IP/OP	"$5,443.00 "	"$4,027.82"	$0.00	"$4,354.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,134.32"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,310.86"	"$4,354.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101420	EAP	CPT® 47542		Dilation Biliary Duct/ampulla	BOTH IP/OP	"$5,389.00 "	"$3,987.86"	$0.00	"$4,354.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,123.07"	$0.00	$0.00	$0.00	$0.00	"$2,721.50"	"$4,310.86"	"$4,354.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101421	EAP	CPT® 47543		Endolumin Bx Biliary Tree Perq	BOTH IP/OP	"$5,389.00 "	"$3,987.86"	$0.00	"$4,354.40"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	"$1,123.20"	$0.00	$0.00	$0.00	$0.00	"$1,123.07"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,721.50"	"$4,310.86"	"$4,354.40"	$0.00	"$1,750.00"	$0.00	"$1,282.63"	$151.83	$151.83	$866.53	$0.00	$0.00	$0.00	$0.00	$0.00
36101422	EAP	CPT® 47544		Extract Stone Duct Biliary	BOTH IP/OP	"$2,246.00 "	"$1,662.04"	$0.00	"$2,246.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.07	$0.00	$0.00	$0.00	$0.00	"$2,246.00"	"$1,778.83"	"$1,796.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101423	EAP	CPT® 49185		Sclerotx Fluid Collection Perq	BOTH IP/OP	"$2,939.00 "	"$2,174.86"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$612.49	$0.00	$0.00	$0.00	$0.00	"$1,377.50"	"$2,181.96"	"$2,204.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101424	EAP	CPT® 50432		Ins Cath Drain Renal Pelvis	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$6,538.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,362.68"	$0.00	$0.00	$0.00	"$1,718.44"	"$1,362.52"	"$1,116.98"	"$6,538.00"	"$6,538.00"	"$1,776.76"	"$2,255.00"	"$4,922.28"	"$4,972.00"	"$2,468.57"	"$3,250.00"	"$2,468.57"	$817.36	$214.93	$214.93	$989.43	"$1,692.15"	$0.00	$0.00	$0.00	$0.00
36101425	EAP	CPT® 50693		PLMT URETERAL STENT PRQ NEPH/URETEROGRAM PRE-EXIST	BOTH IP/OP	"$5,609.00 "	"$4,150.66"	$0.00	"$4,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,168.92"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,442.33"	"$4,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101426	EAP	CPT® 50694		PLMT URETERAL STENT PRQ NEPH/URETEROGRAM NEW ACCES	BOTH IP/OP	"$5,609.00 "	"$4,150.66"	$0.00	"$4,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,168.92"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,442.33"	"$4,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101427	EAP	CPT® 50695		PLMT URETERAL STENT PRQ NEP/URT NEW ACCES SEP CATH	BOTH IP/OP	"$5,609.00 "	"$4,150.66"	$0.00	"$4,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,168.92"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,442.33"	"$4,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101428	EAP	CPT® 50430		Inj Antegrade Neph/uret Comp	BOTH IP/OP	"$1,379.00 "	"$1,020.46"	$0.00	"$1,379.00"	"$1,379.00"	"$1,379.00"	$560.26	$560.26	$563.41	$287.42	$0.00	$0.00	$0.00	$550.87	$287.38	$358.07	"$1,379.00"	"$1,379.00"	$558.17	"$1,311.00"	"$1,038.31"	"$1,048.80"	$775.50	"$1,379.00"	$775.50	$503.90	$160.83	$160.83	$208.71	$531.59	$0.00	$0.00	$0.00	$0.00
36101429	EAP	CPT® 50431		Inj Antegrade Neph/uret Comp	BOTH IP/OP	"$1,379.00 "	"$1,020.46"	$0.00	"$1,379.00"	"$1,379.00"	"$1,379.00"	$560.26	$560.26	$563.41	$287.42	$0.00	$0.00	$0.00	$550.87	$287.38	$358.07	"$1,379.00"	"$1,379.00"	$558.17	"$1,311.00"	"$1,038.31"	"$1,048.80"	$775.50	"$1,379.00"	$775.50	$156.69	$67.79	$67.79	$208.71	$531.59	$0.00	$0.00	$0.00	$0.00
36101430	EAP	CPT® 50433		Place Nephroureteral Cath Prq	BOTH IP/OP	"$3,960.00 "	"$2,930.40"	$0.00	"$3,960.00"	"$2,753.10"	"$2,753.10"	"$2,994.12"	"$2,994.12"	"$3,010.98"	$825.36	$0.00	$0.00	$0.00	"$2,948.43"	$825.26	"$1,916.48"	"$3,960.00"	"$3,960.00"	$0.00	"$2,255.00"	"$2,981.88"	"$3,012.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101431	EAP	CPT® 50434		Convert Nephrostomy Cath	BOTH IP/OP	"$2,023.00 "	"$1,497.02"	$0.00	"$2,023.00"	"$2,023.00"	"$2,023.00"	"$1,743.67"	"$1,743.67"	"$1,753.49"	$421.64	$0.00	$0.00	$0.00	"$1,718.44"	$421.59	"$1,116.98"	"$2,023.00"	"$2,023.00"	"$1,776.76"	"$1,923.00"	"$1,523.02"	"$1,538.40"	"$1,923.00"	"$2,023.00"	"$1,923.00"	$870.58	$200.50	$200.50	$306.14	"$1,692.15"	$0.00	$0.00	$0.00	$0.00
36101432	EAP	CPT® 50435		Chg Tube Nephro/pyelo	BOTH IP/OP	"$2,275.00 "	"$1,683.50"	$0.00	"$2,275.00"	"$2,275.00"	"$2,275.00"	"$1,743.67"	"$1,743.67"	"$1,753.49"	$474.17	$0.00	$0.00	$0.00	"$1,718.44"	$474.11	"$1,116.98"	"$2,275.00"	"$2,275.00"	"$1,776.76"	"$2,163.00"	"$1,713.10"	"$1,730.40"	"$2,163.00"	"$2,150.00"	"$2,163.00"	$457.01	$103.85	$103.85	$344.35	"$1,692.15"	$0.00	$0.00	$0.00	$0.00
36101433	EAP	CPT® 50606		Endoluminal Bx Ureter Renal	BOTH IP/OP	"$5,609.00 "	"$4,150.66"	$0.00	"$4,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,168.92"	$0.00	$0.00	$0.00	$0.00	"$2,804.50"	"$4,442.33"	"$4,487.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101437	EAP	CPT® 50705		Ureteral Embolization/occusion	BOTH IP/OP	"$5,609.00 "	"$4,150.66"	$0.00	"$4,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,168.92"	$0.00	$0.00	$0.00	$0.00	"$2,804.50"	"$4,442.33"	"$4,487.20"	$0.00	$656.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101438	EAP	CPT® 50706		Ball Dilat Ureteral Stricture	BOTH IP/OP	"$5,900.00 "	"$4,366.00"	$0.00	"$4,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,229.56"	$0.00	$0.00	$0.00	$0.00	"$2,804.50"	"$4,442.33"	"$4,487.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101439	EAP	CPT® 61645		Perq Arterial Translum Thromec	BOTH IP/OP	"$25,070.00 "	"$18,551.80"	$0.00	"$24,443.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,224.59"	$0.00	$0.00	$0.00	$0.00	"$11,584.00"	"$18,349.06"	"$18,534.40"	$0.00	"$24,443.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101440	EAP	CPT® 62321		Inj Of Sub Spinal Canal Upper/mid Back; W/image	BOTH IP/OP	"$1,385.00 "	"$1,024.90"	$0.00	"$1,385.00"	"$1,385.00"	"$1,385.00"	$618.38	$618.38	$621.87	$288.67	$0.00	$0.00	$0.00	$608.20	$288.63	$395.33	"$1,385.00"	"$1,385.00"	$626.89	"$1,316.00"	"$1,042.27"	"$1,052.80"	$870.98	"$1,385.00"	$870.98	$240.25	$111.42	$111.42	$209.51	$597.04	$0.00	$0.00	$0.00	$0.00
36101441	EAP	CPT® 62323		Inj Of Sub Spinal Canal Lower Back/sacrum; W/image	BOTH IP/OP	"$1,385.00 "	"$1,024.90"	$0.00	"$2,150.00"	"$1,385.00"	"$1,385.00"	$618.38	$618.38	$621.87	$288.67	$0.00	$0.00	$0.00	$608.20	$288.63	$395.33	"$1,385.00"	"$1,385.00"	$626.89	"$1,316.00"	"$1,042.27"	"$1,052.80"	$870.98	"$2,150.00"	$870.98	$235.81	$103.13	$103.13	$209.51	$597.04	$0.00	$0.00	$0.00	$0.00
36101445	EAP	CPT® 31573		Laryngoscopy Flexible Therapeutic Injection Uni	BOTH IP/OP	"$3,859.00 "	"$2,855.66"	$0.00	"$3,859.00"	"$2,753.10"	"$2,753.10"	"$1,456.99"	"$1,456.99"	"$1,465.20"	$804.31	$0.00	$0.00	$0.00	"$1,434.17"	$804.22	$932.21	"$3,859.00"	"$3,859.00"	$0.00	"$2,255.00"	"$2,806.06"	"$2,834.40"	$0.00	"$2,239.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101501	EAP	CPT® 30020		Drainage Of Nose Lesion	BOTH IP/OP	"$2,343.00 "	"$1,733.82"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$488.28	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,855.66"	"$1,874.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101502	EAP	CPT® 31654		Bronchoscopy Rigid/flex Ebus Interven Peri Lesion	BOTH IP/OP	"$22,686.00 "	"$16,787.64"	$0.00	"$18,332.00"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	"$4,728.33"	$0.00	$0.00	$0.00	$0.00	"$4,727.76"	$0.00	"$2,836.00"	"$2,836.00"	$0.00	"$11,457.50"	"$18,148.68"	"$18,332.00"	$0.00	"$1,750.00"	$0.00	$139.20	$69.97	$69.97	"$3,648.07"	$0.00	$0.00	$0.00	$0.00	$0.00
36101503	EAP	CPT® 31652		Bronchoscopy Rigid/flex Ebus Sampling 1 Or 2 Node	BOTH IP/OP	"$5,306.00 "	"$3,926.44"	$0.00	"$5,306.00"	"$2,753.10"	"$2,753.10"	"$3,016.56"	"$3,016.56"	"$3,033.56"	"$1,105.90"	$0.00	$0.00	$0.00	"$2,969.20"	"$1,105.77"	"$1,929.98"	"$5,306.00"	"$5,306.00"	"$2,945.54"	"$2,255.00"	"$4,245.12"	"$4,288.00"	"$4,092.44"	"$3,250.00"	"$4,092.44"	$874.40	$230.08	$230.08	$853.31	"$2,805.28"	$0.00	$0.00	$0.00	$0.00
36101504	EAP	CPT® 31653		Bronchoscopy Rigid/flex Ebus Sampling 3/> Node	BOTH IP/OP	"$4,682.00 "	"$3,464.68"	$0.00	"$4,682.00"	"$2,753.10"	"$2,753.10"	"$3,016.56"	"$3,016.56"	"$3,033.56"	$975.85	$0.00	$0.00	$0.00	"$2,969.20"	$975.73	"$1,929.98"	"$4,682.00"	"$4,682.00"	"$2,945.54"	"$2,255.00"	"$3,745.37"	"$3,783.20"	"$4,092.44"	"$3,250.00"	"$4,092.44"	$929.42	$255.33	$255.33	$752.86	"$2,805.28"	$0.00	$0.00	$0.00	$0.00
36101520	EAP	CPT® 42330		Removal Of Salivary Stone	BOTH IP/OP	"$6,425.00 "	"$4,754.50"	$0.00	"$5,133.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,338.97"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,082.26"	"$5,133.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101961	EAP	CPT® 57460		Colposcopy W/leep Bx	BOTH IP/OP	"$4,743.00 "	"$3,509.82"	$0.00	"$4,743.00"	"$2,753.10"	"$2,753.10"	"$2,555.04"	"$2,555.04"	"$2,569.43"	$988.56	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,514.14"	$988.44	"$1,634.19"	"$4,743.00"	"$4,743.00"	"$2,505.44"	"$2,255.00"	"$3,756.46"	"$3,794.40"	"$3,480.98"	$0.00	"$3,480.98"	$178.42	$168.01	$168.01	$755.09	"$2,386.14"	$0.00	$0.00	$0.00	$0.00
36101970	EAP	CPT® 58100		Endometrial Biopsy	BOTH IP/OP	$346.00 	$256.04	$0.00	$346.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.49	$0.00	$0.00	$0.00	$163.24	$71.48	$106.10	$113.00	$113.00	$166.54	$346.00	$274.03	$276.80	$231.38	$0.00	$231.38	$59.72	$67.07	$67.07	$55.08	$158.61	$0.00	$0.00	$0.00	$0.00
36101985	EAP	CPT® 46999		Anus Surgery Procedure	BOTH IP/OP	"$1,251.00 "	$925.74	$0.00	"$1,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$260.74	$0.00	$0.00	$0.00	$760.65	$260.71	$494.42	"$1,251.00"	"$1,251.00"	$0.00	"$1,264.00"	"$1,001.09"	"$1,011.20"	$0.00	"$1,251.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101987	EAP	CPT® 57456		Colposcopy + Ecc	BOTH IP/OP	"$1,218.00 "	$901.32	$106.36	"$1,221.00"	"$1,218.00"	"$1,218.00"	$274.65	$274.65	$276.20	$253.86	"$1,218.00"	"$1,218.00"	"$1,218.00"	$269.78	$253.83	$175.35	"$1,218.00"	"$1,218.00"	$271.52	"$1,221.00"	$967.03	$976.80	$377.23	"$1,218.00"	$377.23	$137.69	$106.36	$106.36	$194.38	$258.59	$0.00	$0.00	$0.00	$0.00
36101989	EAP	CPT® 23931		Drainage Of Arm Bursa	BOTH IP/OP	"$7,496.00 "	"$5,547.04"	$0.00	"$5,832.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,562.17"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$5,773.68"	"$5,832.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101990	EAP	CPT® 91111		Esophageal Capsule Endoscopy	BOTH IP/OP	"$3,592.00 "	"$2,658.08"	$0.00	"$2,627.20"	"$1,950.46"	"$1,950.46"	$787.99	$787.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$748.57	$0.00	$0.00	$0.00	$788.23	"$1,642.00"	"$2,600.93"	"$2,627.20"	"$1,095.14"	"$2,500.00"	"$1,095.14"	$513.95	$828.40	$828.40	$522.81	$750.70	$0.00	$0.00	$0.00	$0.00
36101991	EAP	CPT® 91110		Gi Tract Capsule Endoscopy	BOTH IP/OP	"$4,034.00 "	"$2,985.16"	$0.00	"$2,958.40"	"$2,190.46"	"$2,190.46"	$787.99	$787.99	$792.43	$840.79	$0.00	$0.00	$0.00	$775.94	$840.69	$504.36	"$2,386.11"	"$2,386.11"	$788.23	"$1,849.00"	"$2,928.82"	"$2,958.40"	"$1,095.14"	"$2,500.00"	"$1,095.14"	$923.73	$745.92	$745.92	$588.72	$750.70	$0.00	$0.00	$0.00	$0.00
36101992	EAP	CPT® 56405		"I & D, Vulva, Perineum"	BOTH IP/OP	$294.00 	$217.56	$0.00	"$1,750.00"	$294.00	$294.00	$274.65	$274.65	$276.20	$61.28	$294.00	$294.00	$294.00	$269.78	$61.27	$175.35	$294.00	$294.00	$0.00	$294.00	$232.85	$235.20	$0.00	"$1,750.00"	$0.00	$107.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36101994	EAP	CPT® 64425		Inject Anest Ilioin	BOTH IP/OP	"$3,143.00 "	"$2,325.82"	$0.00	"$2,752.80"	"$2,321.55"	"$2,321.55"	$618.38	$618.38	$621.87	$655.08	"$1,257.08"	"$1,257.08"	"$1,305.43"	$608.20	$655.00	$395.33	"$1,871.00"	"$1,871.00"	$626.89	"$2,255.00"	"$2,725.27"	"$2,752.80"	$870.98	"$2,150.00"	$870.98	$0.00	$57.69	$57.69	$547.81	$597.04	$0.00	$0.00	$0.00	$0.00
36101995	EAP	CPT® 41899		Rem Imp Tooth W Mucoper Fip	BOTH IP/OP	"$1,862.00 "	"$1,377.88"	$0.00	"$1,880.00"	"$1,862.00"	"$1,862.00"	$206.03	$206.03	$207.19	$388.09	$0.00	$0.00	$0.00	$202.80	$388.04	$131.82	"$1,862.00"	"$1,862.00"	$204.24	"$1,880.00"	"$1,488.96"	"$1,504.00"	$283.76	"$1,750.00"	$283.76	$294.22	$0.00	$0.00	$299.30	$194.51	$0.00	$0.00	$0.00	$0.00
36101997	EAP	CPT® 12001		Repair Superficial Wound(s)	BOTH IP/OP	$704.00 	$520.96	$0.00	$704.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	$704.00	$557.57	$563.20	$243.48	$0.00	$243.48	$116.22	$46.87	$46.87	$112.08	$166.90	$0.00	$0.00	$0.00	$0.00
36101998	EAP	CPT® 36228		Sel Cath Plc Intracrn Brnch Ic/vert Art W/angio	BOTH IP/OP	"$73,169.00 "	"$54,145.06"	$0.00	"$49,292.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$15,248.42"	$0.00	$0.00	$0.00	$0.00	"$30,807.50"	"$48,799.08"	"$49,292.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102010	EAP	CPT® 29580		Unna Booth	BOTH IP/OP	$780.00 	$577.20	$0.00	$780.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.13	$780.00	$617.76	$624.00	$186.36	$0.00	$186.36	$54.52	$28.49	$28.49	$124.18	$127.75	$0.00	$0.00	$0.00	$0.00
36102050	EAP	CPT® 26010		Abscess Finger Simple	BOTH IP/OP	"$1,407.00 "	"$1,041.18"	$0.00	"$1,407.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$293.25	$0.00	$0.00	$0.00	$172.08	$293.22	$111.85	$113.00	$113.00	$0.00	"$1,407.00"	"$1,114.34"	"$1,125.60"	$0.00	"$1,216.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102062	EAP	CPT® 29130		Application Of Finger Splint	BOTH IP/OP	$859.00 	$635.66	$0.00	$859.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$859.00	$680.33	$687.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102063	EAP	CPT® 38505		Bx Lymph Node Ndl Bic	BOTH IP/OP	"$1,805.00 "	"$1,335.70"	$72.83	"$2,500.00"	"$1,805.00"	"$1,805.00"	"$1,370.21"	"$1,370.21"	"$1,377.93"	$376.21	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	$376.16	$876.52	"$1,805.00"	"$1,805.00"	"$1,376.63"	"$1,801.00"	"$1,426.39"	"$1,440.80"	"$1,801.00"	"$2,500.00"	"$1,801.00"	$115.87	$72.83	$72.83	$286.72	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36102064	EAP	CPT® 45005		Drainage Of Rectal Abscess Ult	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,172.25"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,455.00"	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102066	EAP	CPT® 49060		Drain Open Retrop Abscess Ult	BOTH IP/OP	"$5,398.00 "	"$3,994.52"	$0.00	"$4,318.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,124.94"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,275.22"	"$4,318.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102068	EAP	CPT® 52341		Cysto W/ureter Stricture Tx	BOTH IP/OP	"$9,570.00 "	"$7,081.80"	$0.00	"$7,679.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,994.39"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$7,602.41"	"$7,679.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102082	EAP	CPT® 57505		Ecc Cervical Scrape	BOTH IP/OP	"$2,043.00 "	"$1,511.82"	$0.00	"$2,064.00"	"$2,043.00"	"$2,043.00"	$617.38	$617.38	$620.86	$425.81	$0.00	$0.00	$0.00	$607.07	$425.76	$394.60	"$1,871.00"	"$1,871.00"	$640.34	"$2,064.00"	"$1,634.69"	"$1,651.20"	$889.66	"$2,043.00"	$889.66	$86.47	$104.52	$104.52	$328.59	$609.84	$0.00	$0.00	$0.00	$0.00
36102090	EAP	CPT® 49421		Perm Peritoneal Cath Insert	BOTH IP/OP	"$11,842.00 "	"$8,763.08"	$0.00	"$11,082.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,467.87"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$10,971.58"	"$11,082.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102091	EAP	CPT® 49402		Techoff Cath. Removal	BOTH IP/OP	"$5,016.00 "	"$3,711.84"	$0.00	"$4,694.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,045.33"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,647.46"	"$4,694.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102095	EAP	CPT® 19120		"Excision Of Cyst,fibro Adrenoma"	BOTH IP/OP	"$5,508.00 "	"$4,075.92"	$0.00	"$4,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,147.87"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,352.04"	"$4,396.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102100	EAP	CPT® 64400		"Inj Anes/strd Trigeminal Nerve, Each Branch"	BOTH IP/OP	"$1,227.00 "	$907.98	$0.00	"$1,227.00"	"$1,227.00"	"$1,227.00"	$254.43	$254.43	$255.86	$255.74	$0.00	$0.00	$0.00	$250.31	$255.71	$162.70	"$1,227.00"	"$1,227.00"	$0.00	"$1,184.00"	$937.73	$947.20	$0.00	"$1,227.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102101	EAP	CPT® 64455		N Block Inj Plantar Digit	BOTH IP/OP	"$1,081.00 "	$799.94	$0.00	"$1,081.00"	"$1,081.00"	"$1,081.00"	$254.43	$254.43	$255.86	$225.31	$0.00	$0.00	$0.00	$250.31	$225.28	$162.70	$113.00	$113.00	$262.54	"$1,043.00"	$826.06	$834.40	$364.76	"$1,081.00"	$364.76	$46.42	$36.07	$36.07	$166.05	$250.04	$0.00	$0.00	$0.00	$0.00
36102150	EAP	CPT® 19101		"Breast Biopsy, Open, Incisional"	BOTH IP/OP	"$3,347.00 "	"$2,476.78"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$697.51	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,677.75"	"$2,704.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102151	EAP	CPT® 19125		Excision Breast Lesion	BOTH IP/OP	"$3,037.00 "	"$2,247.38"	$0.00	"$3,037.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.91	$0.00	$0.00	$0.00	$0.00	"$2,825.00"	"$2,237.40"	"$2,260.00"	$0.00	"$3,037.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102152	EAP	CPT® 66020		Injection Treatment Of Eye	BOTH IP/OP	"$4,930.00 "	"$3,648.20"	$0.00	"$4,249.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,027.41"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,207.10"	"$4,249.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102153	EAP	CPT® 68530		Clearance Of Tear Duct	BOTH IP/OP	$579.00 	$428.46	$0.00	$579.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.66	$0.00	$0.00	$0.00	$0.00	$579.00	$458.57	$463.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102155	EAP	CPT® 11600		Exc Tr-emt Mlg+marg 0.5<cm	BOTH IP/OP	"$3,699.00 "	"$2,737.26"	$0.00	"$2,955.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$770.87	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,925.65"	"$2,955.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102156	EAP	CPT® 64530		"INJECTION, ANESTHETIC AGENT,CELIAC"	BOTH IP/OP	"$7,798.00 "	"$5,770.52"	$0.00	"$6,830.40"	"$2,321.55"	"$2,321.55"	$801.66	$801.66	$806.18	"$1,625.30"	"$1,257.08"	"$1,257.08"	"$1,305.43"	$788.26	"$1,625.10"	$512.37	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$6,762.10"	"$6,830.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102157	EAP	CPT® 77012		Ct Quidance For Needle Placement	BOTH IP/OP	"$2,039.00 "	"$1,508.86"	$0.00	"$2,968.55"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$424.98	$0.00	$0.00	$0.00	$0.00	$424.93	$0.00	"$1,206.07"	"$1,206.07"	$0.00	$489.36	"$1,614.89"	"$1,631.20"	$0.00	"$2,968.55"	$0.00	$312.12	$77.80	$77.80	$324.61	$0.00	$0.00	$0.00	$0.00	$0.00
36102161	EAP	CPT® 19120		Excision Of Cyst Or Other Benign/malignant  Tumor 1 Or S	BOTH IP/OP	"$5,495.00 "	"$4,066.30"	$0.00	"$4,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,352.04"	"$4,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102172	EAP	CPT® 20500		"Sinogram, Therapeutic"	BOTH IP/OP	"$1,414.00 "	"$1,046.36"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$294.68	$0.00	$0.00	$0.00	$0.00	"$1,414.00"	"$1,119.89"	"$1,131.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102183	EAP	CPT® 32561		"Fibrinolysis Via Chest Tube/catheter, Initial"	BOTH IP/OP	"$2,157.00 "	"$1,596.18"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.52	$0.00	$0.00	$0.00	$0.00	"$2,041.00"	"$1,616.47"	"$1,632.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102184	EAP	CPT® 32562		"Fibrinolysis Via Chest Tube/cath Catheter, Subseq"	BOTH IP/OP	"$1,691.00 "	"$1,251.34"	$0.00	"$2,041.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.40	$0.00	$0.00	$0.00	$0.00	"$2,041.00"	"$1,616.47"	"$1,632.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102185	EAP	CPT® 32998		Percutaneous Rfa Lung Tumor(s)	BOTH IP/OP	"$12,852.00 "	"$9,510.48"	$0.00	"$10,385.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,678.36"	$0.00	$0.00	$0.00	$0.00	"$5,452.00"	"$10,281.74"	"$10,385.60"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102189	EAP	CPT® 35226		Repair Of Blood  Vessel Direct Lower  Extremity	BOTH IP/OP	"$2,111.00 "	"$1,562.14"	$0.00	"$2,111.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$439.93	$0.00	$0.00	$0.00	$0.00	"$1,812.00"	"$1,435.10"	"$1,449.60"	$0.00	"$2,111.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102190	EAP	CPT® 35256		"Lower Extremity, Vein Graft"	BOTH IP/OP	"$7,768.00 "	"$5,748.32"	$0.00	"$6,214.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,618.85"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,152.26"	"$6,214.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102193	EAP	CPT® 35556		"Bypass Graft, With Vein; Femoral-popliteal"	BOTH IP/OP	"$12,248.00 "	"$9,063.52"	$0.00	"$11,216.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,552.48"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$11,103.84"	"$11,216.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102194	EAP	CPT® 35565		"Bypass Graft, With Vein; Iliofemoral"	BOTH IP/OP	"$12,365.00 "	"$9,150.10"	$0.00	"$11,323.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,576.87"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$11,209.97"	"$11,323.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102195	EAP	CPT® 36002		Pseudoaneurysm Tx Injection (thrombin)	BOTH IP/OP	"$2,437.00 "	"$1,803.38"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.87	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,831.90"	"$1,850.40"	$0.00	"$1,131.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102196	EAP	CPT® 36100		"Introduction Of Needle Or Intracatheter, Carotid Or Vertebral Artery"	BOTH IP/OP	"$2,260.00 "	"$1,672.40"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$470.98	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,048.90"	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102197	EAP	CPT® 36471		"Injection Of Sclerosing Solution; Multiple Veins, Same Leg"	BOTH IP/OP	$786.00 	$581.64	$0.00	$786.00	$786.00	$786.00	$336.60	$336.60	$338.49	$163.82	$0.00	$0.00	$0.00	$331.46	$163.80	$215.45	$113.00	$113.00	$0.00	$625.00	$495.00	$500.00	$0.00	$786.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102198	EAP	CPT® 36620		"Arterial Catheterization Or Cannulation For Sampling, Mn"	BOTH IP/OP	"$1,480.00 "	"$1,095.20"	$0.00	"$1,339.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,339.00"	"$1,060.49"	"$1,071.20"	$0.00	$0.00	$0.00	$59.97	$46.17	$46.17	$213.17	$0.00	$0.00	$0.00	$0.00	$0.00
36102200	EAP	CPT® 38505		"Lymph Nodes, Sup., Percut"	BOTH IP/OP	"$1,801.00 "	"$1,332.74"	$0.00	"$1,801.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,376.63"	"$1,801.00"	"$1,426.39"	"$1,440.80"	"$1,801.00"	$0.00	"$1,801.00"	$115.87	$72.83	$72.83	$286.72	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36102202	EAP	CPT® 43752		Naso/oro Gastric Tube Placement	BOTH IP/OP	"$2,134.00 "	"$1,579.16"	$42.55	"$2,134.00"	"$2,134.00"	"$2,134.00"	$264.30	$264.30	$265.79	$444.78	"$1,257.08"	"$1,257.08"	"$1,305.43"	$258.98	$444.73	$168.34	$113.00	$113.00	$364.66	"$2,052.00"	"$1,625.18"	"$1,641.60"	$506.64	"$1,750.00"	$506.64	$321.14	$42.55	$42.55	$326.68	$347.29	$0.00	$0.00	$0.00	$0.00
36102205	EAP	CPT® 47380		"Open Rfa, Liver Tumor(s) Using U/s Guidance"	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,325.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,272.34"	"$5,325.60"	$0.00	"$3,965.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102208	EAP	CPT® 47490		Perc. Cholecystostomy	BOTH IP/OP	"$5,844.00 "	"$4,324.56"	$0.00	"$4,722.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,217.89"	$0.00	$0.00	$0.00	"$3,118.48"	"$2,255.00"	"$4,675.18"	"$4,722.40"	"$4,332.71"	"$3,250.00"	"$4,332.71"	$444.58	$345.72	$345.72	$939.76	"$2,969.98"	$0.00	$0.00	$0.00	$0.00
36102209	EAP	CPT® 47552		"Cholangioscopy, Perc., W/ Or W/o Brushing Or Washing"	BOTH IP/OP	"$5,467.00 "	"$4,045.58"	$0.00	"$4,373.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,139.32"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,329.86"	"$4,373.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102210	EAP	CPT® 47553		"Cholangioscopy, Perc., With Biopsy"	BOTH IP/OP	"$5,467.00 "	"$4,045.58"	$0.00	"$4,373.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,139.32"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,329.86"	"$4,373.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102211	EAP	CPT® 47554		"Cholangioscopy, Perc., With Calculus/calculi Removal"	BOTH IP/OP	"$5,467.00 "	"$4,045.58"	$0.00	"$4,373.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,139.32"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,329.86"	"$4,373.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102212	EAP	CPT® 48102		"Pancreas, Percutaneous"	BOTH IP/OP	"$2,114.00 "	"$1,564.36"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$440.56	$0.00	$0.00	$0.00	$0.00	"$2,114.00"	"$1,674.29"	"$1,691.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102215	EAP	CPT® 49180		"Abdomen/retrop., Percutaneous"	BOTH IP/OP	"$2,922.00 "	"$2,162.28"	$0.00	"$2,337.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$649.66	$0.00	$0.00	$0.00	"$1,348.50"	$649.58	$876.52	"$1,871.00"	"$1,871.00"	"$1,376.63"	"$2,255.00"	"$2,314.22"	"$2,337.60"	"$1,912.65"	$0.00	"$1,912.65"	$203.88	$87.64	$87.64	$465.18	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36102216	EAP	CPT® 49400		Peritoneogram (air And/or Contrast)	BOTH IP/OP	"$2,781.00 "	"$2,057.94"	$0.00	"$2,602.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$579.56	$0.00	$0.00	$0.00	$0.00	"$1,626.50"	"$2,576.38"	"$2,602.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102217	EAP	CPT® 49423		Change Of Abscess Drain (inc. Injection)	BOTH IP/OP	"$4,348.00 "	"$3,217.52"	$0.00	"$3,606.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$906.12	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$3,228.19"	"$3,260.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102218	EAP	CPT® 49424		Abscessogram (tube Check)	BOTH IP/OP	"$4,348.00 "	"$3,217.52"	$0.00	"$3,260.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$906.12	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,228.19"	"$3,260.80"	$0.00	$840.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102219	EAP	CPT® 49441		J-tube Placement Under Fluoro Guidance	BOTH IP/OP	"$4,644.00 "	"$3,436.56"	$0.00	"$3,840.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$967.81	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,802.39"	"$3,840.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102220	EAP	CPT® 49442		Duodenostomy Tube Placement Under Fluoro Guidance	BOTH IP/OP	"$8,330.00 "	"$6,164.20"	$0.00	"$6,889.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,735.97"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,820.70"	"$6,889.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102222	EAP	CPT® 49465		"Contrast Injection For G-, J-, G-j, C Tube Radiological Evaluation"	BOTH IP/OP	$485.00 	$358.90	$0.00	$485.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.09	$0.00	$0.00	$0.00	$220.56	$101.07	$143.36	$113.00	$113.00	$233.72	$455.00	$360.36	$364.00	$324.73	$485.00	$324.73	$150.79	$32.10	$32.10	$72.44	$222.60	$0.00	$0.00	$0.00	$0.00
36102224	EAP	CPT® 50250		"Open Cryo, Renal Tumor(s) Includes Us Guidance"	BOTH IP/OP	"$5,535.00 "	"$4,095.90"	$0.00	"$4,417.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,153.49"	$0.00	$0.00	$0.00	$0.00	"$2,761.00"	"$4,373.42"	"$4,417.60"	$0.00	"$3,597.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102225	EAP	CPT® 50385		"Exchange, Transuretheral Approach Includes Imaging"	BOTH IP/OP	"$5,669.00 "	"$4,195.06"	$0.00	"$4,538.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,181.42"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,493.02"	"$4,538.40"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102226	EAP	CPT® 50386		"Removal, Transuretheral Approach Includes Imaging"	BOTH IP/OP	"$1,755.00 "	"$1,298.70"	$0.00	"$1,755.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$365.74	$0.00	$0.00	$0.00	$0.00	"$1,740.00"	"$1,378.08"	"$1,392.00"	$0.00	"$1,755.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102229	EAP	CPT® 50592		"Percutaneous Rfa, Renal Tumor(s)"	BOTH IP/OP	"$15,251.00 "	"$11,285.74"	$0.00	"$12,200.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,178.31"	$0.00	$0.00	$0.00	"$4,847.92"	"$5,452.00"	"$12,078.79"	"$12,200.80"	"$6,735.53"	"$4,334.00"	"$6,735.53"	"$6,100.60"	$357.73	$357.73	"$2,427.96"	"$4,617.06"	$0.00	$0.00	$0.00	$0.00
36102230	EAP	CPT® 50593		"Percutaneous Cryoablation, Renal Tumor(s)"	BOTH IP/OP	"$11,130.00 "	"$8,236.20"	$0.00	"$10,581.00"	"$5,965.05"	"$5,965.05"	"$8,673.73"	"$8,673.73"	"$8,722.60"	"$2,319.77"	$0.00	$0.00	$0.00	"$8,537.28"	"$2,319.49"	"$5,549.23"	"$9,641.00"	"$9,641.00"	"$8,437.84"	"$5,452.00"	"$8,380.15"	"$8,464.80"	"$10,581.00"	"$4,334.00"	"$10,581.00"	"$4,167.31"	$479.98	$479.98	"$1,684.50"	"$8,036.03"	$0.00	$0.00	$0.00	$0.00
36102231	EAP	CPT® 51101		Aspirate Bladder (diagnostic) By Trocar/catheter	BOTH IP/OP	$950.00 	$703.00	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.98	$0.00	$0.00	$0.00	$0.00	$950.00	$752.40	$760.00	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102232	EAP	CPT® 51610		"Urethrocystogram, Retrograde"	BOTH IP/OP	"$2,406.00 "	"$1,780.44"	$0.00	"$1,923.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$501.41	$0.00	$0.00	$0.00	$0.00	"$1,202.00"	"$1,903.97"	"$1,923.20"	$0.00	"$1,022.00"	$0.00	$301.43	$66.70	$66.70	$382.72	$0.00	$0.00	$0.00	$0.00	$0.00
36102233	EAP	CPT® 51705		Change Bladder Tube	BOTH IP/OP	$626.00 	$463.24	$0.00	$626.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.46	$0.00	$0.00	$0.00	$235.59	$625.00	$495.00	$500.00	$327.32	$626.00	$327.32	$86.33	$54.08	$54.08	$99.50	$224.37	$0.00	$0.00	$0.00	$0.00
36102235	EAP	CPT® 55700		"Biopsy, Prostate"	BOTH IP/OP	"$4,494.00 "	"$3,325.56"	$0.00	"$3,595.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$938.95	$0.00	$0.00	$0.00	"$1,718.44"	$938.84	"$1,116.98"	"$2,836.00"	"$2,836.00"	"$1,776.76"	"$2,327.00"	"$3,559.25"	"$3,595.20"	"$2,468.57"	$0.00	"$2,468.57"	$147.73	$135.95	$135.95	$715.44	"$1,692.15"	$0.00	$0.00	$0.00	$0.00
36102238	EAP	CPT® 61070		puncture of shunt tubling injectio	BOTH IP/OP	"$2,457.00 "	"$1,818.18"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$512.04	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,798.63"	"$1,816.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102239	EAP	CPT® 62269		"Biopsy, Spinal Cord"	BOTH IP/OP	"$3,386.00 "	"$2,505.64"	$0.00	"$2,708.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$705.64	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,681.71"	"$2,708.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102241	EAP	CPT® 62281		Injection Cervical Or Thoracic Epidural	BOTH IP/OP	"$1,751.00 "	"$1,295.74"	$0.00	"$1,751.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$364.91	$0.00	$0.00	$0.00	$0.00	"$1,751.00"	"$1,386.79"	"$1,400.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102244	EAP	CPT® 64479		Injection Cervical/Thoracic sngl LEVel	BOTH IP/OP	"$3,510.00 "	"$2,597.40"	$0.00	"$2,709.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$731.48	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,682.50"	"$2,709.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102245	EAP	CPT® 64480		"Injection Cervical/thoracic, Each Additional Level"	BOTH IP/OP	"$1,576.00 "	"$1,166.24"	$0.00	"$1,726.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.44	$0.00	$0.00	$0.00	$0.00	"$1,726.00"	"$1,366.99"	"$1,380.80"	$0.00	"$1,523.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102249	EAP	CPT® 36593		Declotting Vasc Device	BOTH IP/OP	"$2,030.00 "	"$1,502.20"	$0.00	"$1,624.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.51	"$1,624.00"	"$1,286.21"	"$1,299.20"	$431.41	$0.00	$431.41	$30.97	$32.05	$32.05	$258.54	$295.72	$0.00	$0.00	$0.00	$0.00
36102255	EAP	CPT® 49460		"Mechanical Removal Obstructive Material G-, J-, G-j, C O"	BOTH IP/OP	"$3,566.00 "	"$2,638.84"	$0.00	"$2,743.20"	"$2,321.55"	"$2,321.55"	$787.99	$787.99	$792.43	$743.24	$0.00	$0.00	$0.00	$775.94	$743.15	$504.36	"$1,871.00"	"$1,871.00"	$788.23	"$2,255.00"	"$2,715.77"	"$2,743.20"	"$1,095.14"	"$2,150.00"	"$1,095.14"	$727.94	$50.85	$50.85	$545.90	$750.70	$0.00	$0.00	$0.00	$0.00
36102260	EAP	CPT® 66030		Injection Eye Treatment(medication)	BOTH IP/OP	"$4,930.00 "	"$3,648.20"	$0.00	"$4,249.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,027.41"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,207.10"	"$4,249.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102262	EAP	CPT® 59830		"Treatment Of Septic Abortion, Completed"	BOTH IP/OP	"$3,807.00 "	"$2,817.18"	$0.00	"$3,045.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$793.38	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,015.14"	"$3,045.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102280	EAP	CPT® 41825		Exc. Of Gum Lesion	BOTH IP/OP	"$3,942.00 "	"$2,917.08"	$0.00	"$3,942.00"	"$2,321.55"	"$2,321.55"	"$2,664.14"	"$2,664.14"	"$2,679.15"	$821.61	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$2,622.61"	$821.51	"$1,704.70"	"$3,942.00"	"$3,942.00"	$0.00	"$2,255.00"	"$3,151.37"	"$3,183.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102281	EAP	CPT® 41899		Simple Tooth Extraction	BOTH IP/OP	"$1,862.00 "	"$1,377.88"	$0.00	"$1,880.00"	"$1,862.00"	"$1,862.00"	$206.03	$206.03	$207.19	$388.09	$0.00	$0.00	$0.00	$202.80	$388.04	$131.82	"$1,862.00"	"$1,862.00"	$204.24	"$1,880.00"	"$1,488.96"	"$1,504.00"	$283.76	"$1,750.00"	$283.76	$294.22	$0.00	$0.00	$299.30	$194.51	$0.00	$0.00	$0.00	$0.00
36102284	EAP	CPT® 51728		Cystometrogram W/vp	BOTH IP/OP	$621.00 	$459.54	$0.00	$791.00	$621.00	$621.00	$560.26	$560.26	$563.41	$129.43	$0.00	$0.00	$0.00	$550.87	$129.42	$358.07	$113.00	$113.00	$0.00	$790.00	$625.68	$632.00	$0.00	$791.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102285	EAP	CPT® 36002		Thrombin Injection For Percutaneours Pseudoaneurysm	BOTH IP/OP	"$2,021.00 "	"$1,495.54"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.18	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,831.90"	"$1,850.40"	$0.00	"$1,131.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102290	EAP	CPT® 41899		Comp Bony W/surg.comp	BOTH IP/OP	"$1,862.00 "	"$1,377.88"	$0.00	"$1,880.00"	"$1,862.00"	"$1,862.00"	$206.03	$206.03	$207.19	$388.09	$0.00	$0.00	$0.00	$202.80	$388.04	$131.82	"$1,862.00"	"$1,862.00"	$204.24	"$1,880.00"	"$1,488.96"	"$1,504.00"	$283.76	"$1,750.00"	$283.76	$294.22	$0.00	$0.00	$299.30	$194.51	$0.00	$0.00	$0.00	$0.00
36102310	EAP	CPT® 37191		Ins Endovas Vena Cava Filter	BOTH IP/OP	"$25,113.00 "	"$18,583.62"	$0.00	"$19,071.20"	"$2,984.10"	"$2,984.10"	"$4,643.92"	"$4,643.92"	"$4,670.08"	"$5,234.18"	$0.00	$0.00	$0.00	"$4,572.02"	"$5,233.55"	"$2,971.81"	"$4,877.00"	"$4,877.00"	$0.00	"$2,858.00"	"$18,880.49"	"$19,071.20"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102311	EAP	CPT® 37192		Reposition Endov Vena Cava Fil	BOTH IP/OP	"$17,233.00 "	"$12,752.42"	$0.00	"$13,087.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,591.36"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$12,956.33"	"$13,087.20"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102312	EAP	CPT® 37193		Replace Endovas Vena Cava Fil	BOTH IP/OP	"$17,233.00 "	"$12,752.42"	$0.00	"$13,087.20"	"$2,984.10"	"$2,984.10"	"$2,787.76"	"$2,787.76"	"$2,803.47"	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,591.36"	$0.00	$0.00	$0.00	"$2,779.42"	"$2,858.00"	"$12,956.33"	"$13,087.20"	"$3,861.64"	"$3,725.00"	"$3,861.64"	$0.00	$365.30	$365.30	"$2,604.35"	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
36102313	EAP	CPT® 36251		Sel Cath Plmt Renal 1st Ord Uni	BOTH IP/OP	"$15,451.00 "	"$11,433.74"	$0.00	"$10,408.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,219.99"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$10,304.71"	"$10,408.80"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102314	EAP	CPT® 36252		Sel Cath Plmt Renal 1st Ord Bil	BOTH IP/OP	"$15,451.00 "	"$11,433.74"	$0.00	"$10,408.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,219.99"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$10,304.71"	"$10,408.80"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102315	EAP	CPT® 36253		Sprsel Cath Pl Rena 1st Ord Uni	BOTH IP/OP	"$15,451.00 "	"$11,433.74"	$0.00	"$10,408.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,219.99"	$0.00	$0.00	$0.00	"$4,609.70"	"$2,858.00"	"$10,304.71"	"$10,408.80"	"$6,404.56"	"$3,725.00"	"$6,404.56"	"$2,156.13"	$373.25	$373.25	"$2,071.35"	"$4,390.19"	$0.00	$0.00	$0.00	$0.00
36102316	EAP	CPT® 36254		Sprsel Cath Pl Rena 1st Ord Bil	BOTH IP/OP	"$11,366.00 "	"$8,410.84"	$0.00	"$10,408.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,368.67"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$10,304.71"	"$10,408.80"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102317	EAP	CPT® 37619		Ligate Inferior Vena Cava	BOTH IP/OP	"$14,820.00 "	"$10,966.80"	$0.00	"$12,626.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,088.49"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$12,500.14"	"$12,626.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102318	EAP	CPT® 64633		Dstr Cerv/thor Paravet Sngl	BOTH IP/OP	"$1,742.00 "	"$1,289.08"	$0.00	"$1,751.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$363.03	$0.00	$0.00	$0.00	$0.00	"$1,751.00"	"$1,386.79"	"$1,400.80"	$0.00	"$1,742.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102319	EAP	CPT® 64634		Dstr Cerv/thor Paravet Ea Addl	BOTH IP/OP	$577.00 	$426.98	$0.00	$577.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.25	$0.00	$0.00	$0.00	$0.00	$290.00	$459.36	$464.00	$0.00	$577.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102320	EAP	CPT® 64635		Unilateral Dstr Lumb/sac Paravet; Sngl	BOTH IP/OP	"$2,835.00 "	"$2,097.90"	$0.00	"$2,835.00"	"$2,321.55"	"$2,321.55"	"$1,709.97"	"$1,709.97"	"$1,719.60"	$590.88	$0.00	$0.00	$0.00	"$1,681.44"	$590.81	"$1,092.94"	"$2,835.00"	"$2,835.00"	"$1,724.40"	"$2,255.00"	"$2,257.20"	"$2,280.00"	"$2,395.83"	"$2,835.00"	"$2,395.83"	$425.03	$229.68	$229.68	$453.72	"$1,642.29"	$0.00	$0.00	$0.00	$0.00
36102321	EAP	CPT® 64636		Unilateral Dstr Lumb/sac Paravet; Ea Addl	BOTH IP/OP	"$1,653.00 "	"$1,223.22"	$0.00	"$1,653.00"	"$1,653.00"	"$1,653.00"	$0.00	$0.00	$0.00	$344.53	$0.00	$0.00	$0.00	$0.00	$344.49	$0.00	$977.75	$977.75	$0.00	$831.00	"$1,316.30"	"$1,329.60"	$0.00	"$1,653.00"	$0.00	$178.62	$62.03	$62.03	$264.59	$0.00	$0.00	$0.00	$0.00	$0.00
36102322	EAP	CPT® 36222		Ir Sel Cath Plac Ext Carotid Angio W/s&i	BOTH IP/OP	"$32,310.00 "	"$23,909.40"	$0.00	"$22,929.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,094.16"	$0.00	$0.00	$0.00	"$2,742.67"	"$7,093.31"	"$1,782.74"	"$4,877.00"	"$4,877.00"	$0.00	"$2,858.00"	"$22,700.30"	"$22,929.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102323	EAP	CPT® 36223		Ir Sel Cath Plac Common Inom Intracranial Carotid	BOTH IP/OP	"$31,070.00 "	"$22,991.80"	$0.00	"$22,049.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,821.75"	$0.00	$0.00	$0.00	"$4,572.02"	"$6,820.93"	"$2,971.81"	"$4,877.00"	"$4,877.00"	"$4,609.70"	"$2,858.00"	"$21,829.10"	"$22,049.60"	"$6,404.56"	$0.00	"$6,404.56"	"$1,513.65"	$330.96	$330.96	"$4,387.87"	"$4,390.19"	$0.00	$0.00	$0.00	$0.00
36102324	EAP	CPT® 36224		Ir Sel Cath Plac Internal Carotid Intracranial Carotid	BOTH IP/OP	"$37,454.00 "	"$27,715.96"	$376.00	"$25,232.00"	"$2,984.10"	"$2,984.10"	"$4,643.92"	"$4,643.92"	"$4,670.08"	"$7,806.35"	"$2,192.53"	"$2,192.53"	"$2,276.86"	"$4,572.02"	"$7,805.41"	"$2,971.81"	"$4,877.00"	"$4,877.00"	"$4,609.70"	"$4,975.00"	"$24,979.68"	"$25,232.00"	"$6,404.56"	"$4,334.00"	"$6,404.56"	"$1,644.17"	$376.00	$376.00	"$5,021.17"	"$4,390.19"	$0.00	$0.00	$0.00	$0.00
36102325	EAP	CPT® 36225		"Ir Sel Cath Plac Sub Clav, Innom, Bilat W/angio  S&i"	BOTH IP/OP	"$31,070.00 "	"$22,991.80"	$0.00	"$22,049.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,821.75"	$0.00	$0.00	$0.00	"$2,742.67"	"$6,820.93"	"$1,782.74"	"$4,877.00"	"$4,877.00"	$0.00	"$2,858.00"	"$21,829.10"	"$22,049.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102326	EAP	CPT® 36226		"Ir Sel Cath Plac Sub Calv, Vert W/angio S&i"	BOTH IP/OP	"$57,197.00 "	"$42,325.78"	$0.00	"$40,591.20"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	$0.00	$0.00	$0.00	"$4,572.02"	"$12,556.93"	"$2,971.81"	"$4,877.00"	"$4,877.00"	"$4,609.70"	"$4,975.00"	"$40,185.29"	"$40,591.20"	"$6,404.56"	$0.00	"$6,404.56"	"$1,676.21"	$370.60	$370.60	"$8,077.65"	"$4,390.19"	$0.00	$0.00	$0.00	$0.00
36102327	EAP	CPT® 36227		Ir Sel Cath Plac Ext Carotid W/angio S&i	BOTH IP/OP	"$31,070.00 "	"$22,991.80"	$0.00	"$22,049.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,821.75"	$0.00	$0.00	$0.00	$0.00	"$6,820.93"	$0.00	"$4,877.00"	"$4,877.00"	$0.00	"$13,781.00"	"$21,829.10"	"$22,049.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102328	EAP	CPT® 36228		Ir Sel Cath Plac Intra Internal Carotid Or Vert W/angio S&i	BOTH IP/OP	"$53,827.00 "	"$39,831.98"	$0.00	"$49,292.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,217.55"	$0.00	$0.00	$0.00	$0.00	"$30,807.50"	"$48,799.08"	"$49,292.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102329	EAP	CPT® 10035		Placement Of Soft Tissue Localization Device; 1st	BOTH IP/OP	"$1,630.00 "	"$1,206.20"	$0.00	"$1,630.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$339.69	$0.00	$0.00	$0.00	$0.00	$820.50	"$1,299.67"	"$1,312.80"	$0.00	"$1,630.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102330	EAP	CPT® 11045		Excl Debride- Subq > 20sq Cm	BOTH IP/OP	"$2,528.00 "	"$1,870.72"	$0.00	"$1,922.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.84	$0.00	$0.00	$0.00	$0.00	"$1,201.50"	"$1,903.18"	"$1,922.40"	$0.00	"$1,267.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102331	EAP	CPT® 11046		Excl Debride- Muscle > 20sq Cm	BOTH IP/OP	"$2,528.00 "	"$1,870.72"	$0.00	"$1,922.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.84	$0.00	$0.00	$0.00	$0.00	"$1,201.50"	"$1,903.18"	"$1,922.40"	$0.00	"$1,417.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102332	EAP	CPT® 11047		Excl Debride-bone > 20 Sq Cm	BOTH IP/OP	"$6,167.00 "	"$4,563.58"	$0.00	"$4,950.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,285.20"	$0.00	$0.00	$0.00	$0.00	"$3,094.00"	"$4,900.90"	"$4,950.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102333	EAP	CPT® 11755		Biopsy Of Nail Unit	BOTH IP/OP	$978.00 	$723.72	$0.00	$987.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$203.82	$0.00	$0.00	$0.00	$0.00	$987.00	$781.70	$789.60	$0.00	$978.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102334	EAP	CPT® 15004		"Site Prep-100 Sq Cm (hands, Feet)"	BOTH IP/OP	"$2,328.00 "	"$1,722.72"	$0.00	"$2,327.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$485.16	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$1,843.78"	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102341	EAP	CPT® 29581		Apply Multlay Comprs Lwr Leg	BOTH IP/OP	$478.00 	$353.72	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.00	$378.58	$382.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102342	EAP	CPT® 97602		REM/DEBRIDE DEVITALIZED TISSUE W/O ANES	BOTH IP/OP	$386.00 	$285.64	$0.00	$281.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.44	$0.00	$0.00	$0.00	$0.00	$176.00	$278.78	$281.60	$0.00	$200.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102343	EAP	CPT® 10036		Placement Of Soft Tissue Localization Device; Each	BOTH IP/OP	"$1,630.00 "	"$1,206.20"	$0.00	"$1,630.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$339.69	$0.00	$0.00	$0.00	$0.00	$820.50	"$1,299.67"	"$1,312.80"	$0.00	"$1,630.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102344	EAP	CPT® 41110		Exc. Of Tongue Lesion W/o  Closure	BOTH IP/OP	"$3,523.00 "	"$2,607.02"	$0.00	"$2,818.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,790.22"	"$2,818.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102345	EAP	CPT® 41820		Exc. Gum Each Quad(gingivectomy)	BOTH IP/OP	"$2,596.00 "	"$1,921.04"	$0.00	"$2,596.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.01	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,821.60"	"$1,840.00"	$0.00	"$2,596.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102346	EAP	CPT® 30580		"Repair Upper Jaw Fistula,"	BOTH IP/OP	"$9,049.00 "	"$6,696.26"	$0.00	"$7,239.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,885.81"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$7,166.81"	"$7,239.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102347	EAP	CPT® 26605		Treat Metacarpal Fx	BOTH IP/OP	$647.00 	$478.78	$0.00	$647.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$647.00	$512.42	$517.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102360	EAP	CPT® 55100		Drainage Of Scrotum Abcess	BOTH IP/OP	"$2,572.00 "	"$1,903.28"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$536.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,057.62"	"$2,078.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102362	EAP	CPT® 19081		Breast Bx W/ Plce Local Dev And Imaging Of Spec 1st Lese	BOTH IP/OP	"$6,618.00 "	"$4,897.32"	$0.00	"$5,348.00"	"$2,753.10"	"$2,753.10"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$1,379.36"	$0.00	$0.00	$0.00	"$1,348.50"	"$1,379.19"	$876.52	"$3,856.00"	"$3,856.00"	"$1,376.63"	"$2,255.00"	"$5,294.52"	"$5,348.00"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$649.79	$173.82	$173.82	"$1,064.25"	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36102363	EAP	CPT® 19082		Breast Bx W/ Plce Local Dev And Imaging Of Spec Ea Add'e	BOTH IP/OP	"$4,964.00 "	"$3,673.36"	$0.00	"$4,011.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,034.50"	$0.00	$0.00	$0.00	$0.00	"$2,507.00"	"$3,971.09"	"$4,011.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102364	EAP	CPT® 19083		Breast Bx W/ Plce Local Dev And Imaging Of Spec 1st Lese	BOTH IP/OP	"$7,720.00 "	"$5,712.80"	$0.00	"$6,238.40"	"$2,753.10"	"$2,753.10"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$1,609.04"	$0.00	$0.00	$0.00	"$1,348.50"	"$1,608.85"	$876.52	"$3,856.00"	"$3,856.00"	"$1,376.63"	"$2,255.00"	"$6,176.02"	"$6,238.40"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$645.55	$164.44	$164.44	"$1,241.44"	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36102365	EAP	CPT® 19084		Breast Bx W/ Plce Local Dev And Imaging Of Spec Ea Add'e	BOTH IP/OP	"$5,433.00 "	"$4,020.42"	$0.00	"$4,390.40"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	"$1,132.37"	$0.00	$0.00	$0.00	$0.00	"$1,132.24"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,744.00"	"$4,346.50"	"$4,390.40"	$0.00	"$1,750.00"	$0.00	$518.83	$81.14	$81.14	$873.69	$0.00	$0.00	$0.00	$0.00	$0.00
36102366	EAP	CPT® 19085		Breast Bx W/ Plce Local Dev And Imaging Of Spec 1st Lese	BOTH IP/OP	"$7,925.00 "	"$5,864.50"	$0.00	"$6,404.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,651.57"	$0.00	$0.00	$0.00	"$1,376.63"	"$2,255.00"	"$6,339.96"	"$6,404.00"	"$1,912.65"	"$2,500.00"	"$1,912.65"	$0.00	$190.41	$190.41	"$1,274.40"	"$1,311.08"	$0.00	$0.00	$0.00	$0.00
36102367	EAP	CPT® 19086		Breast Bx W/ Plce Local Dev And Imaging Of Spec Ea Add'l Lesion Inc Mri Guide	BOTH IP/OP	"$4,847.00 "	"$3,586.78"	$0.00	"$4,802.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,010.11"	$0.00	$0.00	$0.00	$0.00	"$3,001.50"	"$4,754.38"	"$4,802.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102368	EAP	CPT® 19281		Plce Breast Local Dev Percut 1st Lesion Inc Mammo Guide	BOTH IP/OP	"$2,033.00 "	"$1,504.42"	$0.00	"$2,033.00"	"$2,033.00"	"$2,033.00"	$606.01	$606.01	$609.42	$423.73	$0.00	$0.00	$0.00	$596.11	$423.68	$387.47	"$1,871.00"	"$1,871.00"	$611.80	"$2,028.00"	"$1,606.18"	"$1,622.40"	$850.02	"$1,602.00"	$850.02	$234.02	$104.58	$104.58	$322.86	$582.67	$0.00	$0.00	$0.00	$0.00
36102369	EAP	CPT® 19282		Plce Breast Local Dev Percut Ea Add'l Lesion Inc Mammo Guide	BOTH IP/OP	"$1,526.00 "	"$1,129.24"	$0.00	"$1,217.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$318.02	$0.00	$0.00	$0.00	$0.00	$761.00	"$1,205.42"	"$1,217.60"	$0.00	$922.00	$0.00	$162.73	$52.65	$52.65	$242.30	$0.00	$0.00	$0.00	$0.00	$0.00
36102370	EAP	CPT® 19283		Plce Breast Local Dev Percut 1st Lesion Inc Stereo Guide	BOTH IP/OP	"$3,496.00 "	"$2,587.04"	$0.00	"$2,796.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$728.57	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,768.83"	"$2,796.80"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102371	EAP	CPT® 19284		Plce Breast Local Dev Percut Ea Add'l Lesion Inc Stereo Guide	BOTH IP/OP	"$2,623.00 "	"$1,941.02"	$0.00	"$2,098.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$546.63	$0.00	$0.00	$0.00	$0.00	"$1,311.50"	"$2,077.42"	"$2,098.40"	$0.00	$992.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102372	EAP	CPT® 19285		Plce Breast Local Dev Percut 1st Lesion Inc Ultrsnd Guide	BOTH IP/OP	"$1,641.00 "	"$1,214.34"	$0.00	"$1,750.00"	"$1,641.00"	"$1,641.00"	$606.01	$606.01	$609.42	$342.03	$0.00	$0.00	$0.00	$596.11	$341.98	$387.47	"$1,641.00"	"$1,641.00"	$611.80	"$1,637.00"	"$1,296.50"	"$1,309.60"	$850.02	"$1,750.00"	$850.02	$450.73	$89.79	$89.79	$260.61	$582.67	$0.00	$0.00	$0.00	$0.00
36102373	EAP	CPT® 19286		Plce Breast Local Dev Percut Ea Add'l Lesion Inc Ultrsnd Guide	BOTH IP/OP	"$1,231.00 "	$910.94	$0.00	$992.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.57	$0.00	$0.00	$0.00	$0.00	$256.54	$0.00	$728.14	$728.14	$0.00	$614.00	$972.58	$982.40	$0.00	$992.00	$0.00	$434.23	$45.44	$45.44	$195.50	$0.00	$0.00	$0.00	$0.00	$0.00
36102374	EAP	CPT® 19287		Plce Breast Local Dev Percut 1st Lesion Inc Stereo Guide	BOTH IP/OP	"$5,193.00 "	"$3,842.82"	$0.00	"$4,154.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,082.22"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,112.86"	"$4,154.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102375	EAP	CPT® 19288		Plce Breast Local Dev Percut Ea Add'l Lesion Inc Mri Guide	BOTH IP/OP	"$3,894.00 "	"$2,881.56"	$0.00	"$3,115.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$811.51	$0.00	$0.00	$0.00	$0.00	"$1,947.00"	"$3,084.05"	"$3,115.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36102376	EAP	CPT® 10030		Perq Image-guided Catheter Fluid Collection	BOTH IP/OP	"$1,213.00 "	$897.62	$0.00	"$1,221.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$252.82	$0.00	$0.00	$0.00	$596.11	$252.79	$387.47	$113.00	$113.00	$611.80	"$1,221.00"	$967.03	$976.80	$850.02	"$1,213.00"	$850.02	$754.70	$143.53	$143.53	$194.38	$582.67	$0.00	$0.00	$0.00	$0.00
36102380	EAP	CPT® 67028		Injection Intravitreal Drug-both Eyes	BOTH IP/OP	"$3,267.00 "	"$2,417.58"	$100.58	"$2,640.00"	"$2,321.55"	"$2,321.55"	$310.51	$310.51	$312.26	$680.92	"$1,257.08"	"$1,257.08"	"$1,305.43"	$297.83	$680.84	$193.59	"$1,871.00"	"$1,871.00"	$310.51	"$2,255.00"	"$2,613.60"	"$2,640.00"	$431.41	"$1,750.00"	$431.41	$307.74	$100.58	$100.58	$525.36	$295.72	$0.00	$0.00	$0.00	$0.00
36103335	EAP	CPT® 57135		Remove Vagina Lesion	BOTH IP/OP	"$3,669.00 "	"$2,715.06"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$764.62	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,935.15"	"$2,964.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103340	EAP	CPT® 64642		Chemodenerv 1 Extermity 1-4	BOTH IP/OP	"$3,119.00 "	"$2,308.06"	$0.00	"$2,508.80"	"$2,321.55"	"$2,321.55"	$618.38	$618.38	$621.87	$650.08	$0.00	$0.00	$0.00	$608.20	$650.00	$395.33	$113.00	$113.00	$626.89	"$2,255.00"	"$2,483.71"	"$2,508.80"	$870.98	"$2,150.00"	$870.98	$134.17	$111.39	$111.39	$499.25	$597.04	$0.00	$0.00	$0.00	$0.00
36103341	EAP	CPT® 64643		Chemodenerv 1 Exterm  1-4 Ea	BOTH IP/OP	"$2,339.00 "	"$1,730.86"	$0.00	"$2,321.55"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	$487.51	$0.00	$0.00	$0.00	$0.00	$487.45	$0.00	"$1,383.52"	"$1,383.52"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00	$967.00	$0.00	$88.23	$74.27	$74.27	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
36103342	EAP	CPT® 64644		Chemodenerv 1 Exterm --5/>mus	BOTH IP/OP	"$3,701.00 "	"$2,738.74"	$0.00	"$2,976.80"	"$2,321.55"	"$2,321.55"	$618.38	$618.38	$621.87	$771.38	$0.00	$0.00	$0.00	$608.20	$771.29	$395.33	$113.00	$113.00	$626.89	"$2,255.00"	"$2,947.03"	"$2,976.80"	$870.98	"$2,150.00"	$870.98	$153.25	$121.48	$121.48	$592.38	$597.04	$0.00	$0.00	$0.00	$0.00
36103343	EAP	CPT® 64645		Chemodenerv 1 Exterm --5/> Ea	BOTH IP/OP	"$2,775.00 "	"$2,053.50"	$0.00	"$2,321.55"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	$578.38	$0.00	$0.00	$0.00	$0.00	$578.31	$0.00	"$1,641.41"	"$1,641.41"	$0.00	"$1,395.00"	"$2,209.68"	"$2,232.00"	$0.00	$967.00	$0.00	$107.96	$85.44	$85.44	$444.17	$0.00	$0.00	$0.00	$0.00	$0.00
36103344	EAP	CPT® 64646		Chemodenerv Trunk Musc 1-5	BOTH IP/OP	"$3,119.00 "	"$2,308.06"	$0.00	"$2,508.80"	"$2,321.55"	"$2,321.55"	$618.38	$618.38	$621.87	$650.08	$0.00	$0.00	$0.00	$608.20	$650.00	$395.33	$113.00	$113.00	$626.89	"$2,255.00"	"$2,483.71"	"$2,508.80"	$870.98	"$2,150.00"	$870.98	$144.35	$119.68	$119.68	$499.25	$597.04	$0.00	$0.00	$0.00	$0.00
36103345	EAP	CPT® 64647		Chemodenerv Trunk Musc 6/>	BOTH IP/OP	"$3,721.00 "	"$2,753.54"	$0.00	"$2,976.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$775.46	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,947.03"	"$2,976.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103352	EAP	CPT® 37239		Open/peq Place Stent Ea Add	BOTH IP/OP	"$20,475.00 "	"$15,151.50"	$0.00	"$16,063.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,266.99"	$0.00	$0.00	$0.00	$0.00	"$10,039.50"	"$15,902.57"	"$16,063.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103353	EAP	CPT® 37238		Open/pero Place Stent Same	BOTH IP/OP	"$45,270.00 "	"$33,499.80"	$0.00	"$35,516.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,434.27"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$35,160.84"	"$35,516.00"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103354	EAP	CPT® 37236		Open/perq Place Stent 1st	BOTH IP/OP	"$45,270.00 "	"$33,499.80"	$0.00	"$35,516.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,434.27"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$35,160.84"	"$35,516.00"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103355	EAP	CPT® 37237		Open/perq Place Stent Ea Add	BOTH IP/OP	"$18,237.00 "	"$13,495.38"	$0.00	"$16,063.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,800.59"	$0.00	$0.00	$0.00	$0.00	"$10,039.50"	"$15,902.57"	"$16,063.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103358	EAP	CPT® 37242		Vasc Embolize/occlude Artery	BOTH IP/OP	"$21,962.00 "	"$16,251.88"	$0.00	"$17,229.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,576.88"	$0.00	$0.00	$0.00	"$9,937.60"	"$6,105.00"	"$17,057.30"	"$17,229.60"	"$13,806.97"	"$5,164.00"	"$13,806.97"	"$7,460.11"	$499.45	$499.45	"$3,428.69"	"$9,464.38"	$0.00	$0.00	$0.00	$0.00
36103359	EAP	CPT® 37244		Vasc Embolize/occlude Bleed	BOTH IP/OP	"$21,962.00 "	"$16,251.88"	$0.00	"$17,229.60"	"$2,984.10"	"$2,984.10"	"$9,781.76"	"$9,781.76"	"$9,836.87"	"$4,577.43"	$0.00	$0.00	$0.00	"$9,625.35"	"$4,576.88"	"$6,256.48"	"$4,877.00"	"$4,877.00"	$0.00	"$6,105.00"	"$17,057.30"	"$17,229.60"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103361	EAP	CPT® 37241		Vasc Embolize/occlude Venous	BOTH IP/OP	"$21,962.00 "	"$16,251.88"	$0.00	"$17,229.60"	"$2,984.10"	"$2,984.10"	"$9,781.76"	"$9,781.76"	"$9,836.87"	"$4,577.43"	$0.00	$0.00	$0.00	"$9,625.35"	"$4,576.88"	"$6,256.48"	"$4,877.00"	"$4,877.00"	$0.00	"$6,105.00"	"$17,057.30"	"$17,229.60"	$0.00	"$14,275.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103374	EAP	CPT® 64616		Chemodenerv  Musc Neck Dyston	BOTH IP/OP	$632.00 	$467.68	$0.00	$635.00	$632.00	$632.00	$254.43	$254.43	$255.86	$0.00	$0.00	$0.00	$0.00	$0.00	$131.71	$0.00	$0.00	$0.00	$262.54	$635.00	$502.92	$508.00	$364.76	$632.00	$364.76	$117.83	$113.17	$113.17	$101.09	$250.04	$0.00	$0.00	$0.00	$0.00
36103376	EAP	CPT® 37243		Vasc Embolize/occlude Organ	BOTH IP/OP	"$23,963.00 "	"$17,732.62"	$0.00	"$18,800.00"	"$2,984.10"	"$2,984.10"	"$9,781.76"	"$9,781.76"	"$9,836.87"	"$4,994.49"	$0.00	$0.00	$0.00	"$9,625.35"	"$4,993.89"	"$6,256.48"	"$4,877.00"	"$4,877.00"	"$9,937.60"	"$6,105.00"	"$18,612.00"	"$18,800.00"	"$13,806.97"	"$5,164.00"	"$13,806.97"	"$7,751.33"	$587.86	$587.86	"$3,741.20"	"$9,464.38"	$0.00	$0.00	$0.00	$0.00
36103378	EAP	CPT® 34841		"Endovas Rp Vis A Dep Viscl Aort End, S/i,angio One"	BOTH IP/OP	"$19,007.00 "	"$14,065.18"	$0.00	"$15,205.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,961.06"	$0.00	$0.00	$0.00	$0.00	"$9,503.50"	"$15,053.54"	"$15,205.60"	$0.00	"$3,949.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103379	EAP	CPT® 34842		Endovas Rp Vis A Dep Viscl Aort End S/i Angio Two	BOTH IP/OP	"$20,567.00 "	"$15,219.58"	$0.00	"$16,453.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,286.16"	$0.00	$0.00	$0.00	$0.00	"$10,283.50"	"$16,289.06"	"$16,453.60"	$0.00	"$3,949.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103380	EAP	CPT® 34843		Endovas Rp Vis A Dep Viscl Aort End S/i Angio Three	BOTH IP/OP	"$22,120.00 "	"$16,368.80"	$0.00	"$17,696.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,609.81"	$0.00	$0.00	$0.00	$0.00	"$11,060.00"	"$17,519.04"	"$17,696.00"	$0.00	"$3,949.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103381	EAP	CPT® 34844		Endovas Rp Vis A Dep Viscl Aort End S/i Angio Four Or >	BOTH IP/OP	"$23,672.00 "	"$17,517.28"	$0.00	"$18,937.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,933.24"	$0.00	$0.00	$0.00	$0.00	"$11,836.00"	"$18,748.22"	"$18,937.60"	$0.00	"$3,949.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103382	EAP	CPT® 34845		Endovas Rp Vis A Dep Viscl Aort End W/ Unibdy Or Mod Infrenl End  S/i Angio One	BOTH IP/OP	"$23,049.00 "	"$17,056.26"	$0.00	"$18,439.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,803.41"	$0.00	$0.00	$0.00	$0.00	"$11,524.50"	"$18,254.81"	"$18,439.20"	$0.00	"$3,949.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103383	EAP	CPT® 34846		Endovas Rp Vis A Dep Viscl Aort End W/ Unibdy Or Mod Infrenl End  S/i Angio Two	BOTH IP/OP	"$24,602.00 "	"$18,205.48"	$0.00	"$19,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,127.06"	$0.00	$0.00	$0.00	$0.00	"$12,301.00"	"$19,484.78"	"$19,681.60"	$0.00	"$3,949.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103384	EAP	CPT® 34847		Endovas Rp Vis A Dep Viscl Aort End W/ Unibdy Or Mod Infrenl End  S/i Angio Three	BOTH IP/OP	"$26,154.00 "	"$19,353.96"	$0.00	"$20,923.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,450.49"	$0.00	$0.00	$0.00	$0.00	"$13,077.00"	"$20,713.97"	"$20,923.20"	$0.00	"$3,949.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103385	EAP	CPT® 34848		Endovas Rp Vis A Dep Viscl Aort End W/ Unibdy Or Mod Infrenl End  S/i Angio Four Or >	BOTH IP/OP	"$27,705.00 "	"$20,501.70"	$0.00	"$22,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,773.72"	$0.00	$0.00	$0.00	$0.00	"$13,852.50"	"$21,942.36"	"$22,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103388	EAP	CPT® 20694		"Removal, Under Anesthesia, Of External Fix System"	BOTH IP/OP	"$5,413.00 "	"$4,005.62"	$0.00	"$4,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,128.07"	$0.00	$0.00	$0.00	"$1,359.37"	"$2,255.00"	"$4,028.90"	"$4,069.60"	"$1,888.67"	"$3,250.00"	"$1,888.67"	$337.82	$350.34	$350.34	$809.85	"$1,294.64"	$0.00	$0.00	$0.00	$0.00
36103390	EAP	CPT® 64617		"Chemodenervation Of Muscle(s); Larynx, Unilateral, Percd"	BOTH IP/OP	$850.00 	$629.00	$0.00	$855.00	$850.00	$850.00	$254.43	$254.43	$255.86	$177.16	$0.00	$0.00	$0.00	$250.31	$177.14	$162.70	$113.00	$113.00	$0.00	$855.00	$677.16	$684.00	$0.00	$722.00	$0.00	$183.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103391	EAP	CPT® 66183		"Insertion Of Anterior Segment Aqueous Drainage Device, H"	BOTH IP/OP	"$6,247.00 "	"$4,622.78"	$0.00	"$5,384.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,301.87"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$5,330.95"	"$5,384.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103392	EAP	CPT® 49406		"Img-gde Fluid Collect Drain / Cath (eg, Abcss, Hema, Seu"	BOTH IP/OP	"$6,571.00 "	"$4,862.54"	$0.00	"$6,571.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,369.56"	$0.00	$0.00	$0.00	"$1,348.50"	"$1,369.40"	$876.52	"$6,571.00"	"$6,571.00"	$0.00	"$2,255.00"	"$4,878.72"	"$4,928.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103394	EAP	CPT® 52356		"Cysto, W/ Ureter And/or Pyelo; W/ Litho Inc Inst Of Ind "	BOTH IP/OP	"$8,403.00 "	"$6,218.22"	$0.00	"$6,790.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,751.19"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$6,722.50"	"$6,790.40"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103395	EAP	CPT® 49405		"Img-gde Fluid Collect Drain / Cath (eg, Abcss, Hema, Seu"	BOTH IP/OP	"$6,571.00 "	"$4,862.54"	$0.00	"$6,571.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,369.56"	$0.00	$0.00	$0.00	"$1,348.50"	"$1,369.40"	$876.52	"$6,571.00"	"$6,571.00"	$0.00	"$2,255.00"	"$4,878.72"	"$4,928.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103396	EAP	CPT® 23333		Removal Foreign Body Shoulder Deep Sub Fac/intra Musc	BOTH IP/OP	"$2,755.00 "	"$2,038.70"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$574.14	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,121.77"	"$2,143.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103397	EAP	CPT® 31633		Tranbronchial Needle Aspiration Biospy Ea Addtl  Lobe	BOTH IP/OP	"$2,726.00 "	"$2,017.24"	$0.00	"$2,726.00"	"$2,726.00"	"$2,726.00"	$0.00	$0.00	$0.00	$568.17	$0.00	$0.00	$0.00	$0.00	$568.10	$0.00	"$2,726.00"	"$2,726.00"	$0.00	"$1,333.50"	"$2,112.26"	"$2,133.60"	$0.00	"$1,750.00"	$0.00	$86.74	$65.64	$65.64	$424.59	$0.00	$0.00	$0.00	$0.00	$0.00
36103398	EAP	CPT® 31627		"Bronch With Computer-assisted, Image-guided Navigation"	BOTH IP/OP	"$3,577.00 "	"$2,646.98"	$0.00	"$2,800.00"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	$745.54	$0.00	$0.00	$0.00	$0.00	$745.45	$0.00	"$2,115.80"	"$2,115.80"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	"$1,750.00"	$0.00	$879.48	$100.26	$100.26	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
36103399	EAP	HCPCS 64650		Chemodenerv Eccrine Glands	BOTH IP/OP	$527.00 	$389.98	$0.00	$530.00	$527.00	$527.00	$254.43	$254.43	$255.86	$109.84	$0.00	$0.00	$0.00	$250.31	$109.83	$162.70	$527.00	$527.00	$0.00	$530.00	$419.76	$424.00	$0.00	$527.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103400	EAP	HCPCS 64653		"Chemodenerv Eccrine Other Scalp,face,neck"	BOTH IP/OP	$561.00 	$415.14	$0.00	$561.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.91	$0.00	$0.00	$0.00	$0.00	$561.00	$444.31	$448.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103401	EAP	HCPCS 46221		Ligation Of Hemorrhoid(s)	BOTH IP/OP	"$2,229.00 "	"$1,649.46"	$0.00	"$2,252.00"	"$2,229.00"	"$2,229.00"	$772.82	$772.82	$777.17	$464.58	$0.00	$0.00	$0.00	$760.65	$464.52	$494.42	"$1,871.00"	"$1,871.00"	$766.13	"$2,252.00"	"$1,783.58"	"$1,801.60"	"$1,064.43"	"$2,150.00"	"$1,064.43"	$119.76	$198.96	$198.96	$358.52	$729.64	$0.00	$0.00	$0.00	$0.00
36103402	EAP	CPT® 64450		Adductor Canal	BOTH IP/OP	"$2,850.00 "	"$2,109.00"	$44.35	"$2,321.55"	"$2,321.55"	"$2,321.55"	$618.38	$618.38	$621.87	$594.01	"$1,257.08"	"$1,257.08"	"$1,305.43"	$608.20	$593.94	$395.33	"$1,871.00"	"$1,871.00"	$626.89	"$2,255.00"	"$2,178.00"	"$2,200.00"	$870.98	"$2,150.00"	$870.98	$85.27	$44.35	$44.35	$437.80	$597.04	$0.00	$0.00	$0.00	$0.00
36103404	EAP	CPT® 24200		Removal Of Arm Foreign Body	BOTH IP/OP	"$4,943.00 "	"$3,657.82"	$0.00	"$3,845.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,030.12"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,807.14"	"$3,845.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103405	EAP	CPT® 49425		Insert Abdomen - Venous Drain	BOTH IP/OP	"$24,132.00 "	"$17,857.68"	$0.00	"$18,098.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,029.11"	$0.00	$0.00	$0.00	$0.00	"$11,311.50"	"$17,917.42"	"$18,098.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103406	EAP	CPT® 54220		Treatment Of Penis Lesion	BOTH IP/OP	"$1,092.00 "	$808.08	$139.18	"$1,103.00"	"$1,092.00"	"$1,092.00"	$259.14	$259.14	$260.60	$227.60	"$1,092.00"	"$1,092.00"	"$1,092.00"	$255.07	$227.57	$165.80	"$1,092.00"	"$1,092.00"	$235.59	"$1,103.00"	$873.58	$882.40	$327.32	"$1,009.00"	$327.32	$151.42	$139.18	$139.18	$175.60	$224.37	$0.00	$0.00	$0.00	$0.00
36103407	EAP	CPT® 17106		Destruction Of Skin Lesions	BOTH IP/OP	"$1,627.00 "	"$1,203.98"	$0.00	"$1,627.00"	"$1,627.00"	"$1,627.00"	$336.60	$336.60	$338.49	$339.11	$0.00	$0.00	$0.00	$331.46	$339.07	$215.45	"$1,627.00"	"$1,627.00"	$320.45	"$1,625.00"	"$1,287.00"	"$1,300.00"	$445.22	"$1,627.00"	$445.22	$0.00	$282.61	$282.61	$258.70	$305.19	$0.00	$0.00	$0.00	$0.00
36103410	EAP	CPT® 54205		Injection For Peyronie Disease; W/surg Exp Plaque	BOTH IP/OP	"$9,133.00 "	"$6,758.42"	$0.00	"$8,318.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,903.32"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$8,235.22"	"$8,318.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36103411	EAP	CPT® 55874		Tprnl Plmt Biodegradable Matrl Periprostatic	BOTH IP/OP	"$6,075.00 "	"$4,495.50"	$0.00	"$5,452.00"	"$2,321.55"	"$2,321.55"	"$4,296.49"	"$4,296.49"	"$4,320.70"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,266.03"	$0.00	$0.00	$0.00	$0.00	"$5,452.00"	"$4,799.52"	"$4,848.00"	$0.00	"$3,948.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191374	EAP	CPT® 64615		"Destroy Mucles Facial, Trigeminal, Cervical, Spinal "	BOTH IP/OP	$533.00 	$394.42	$0.00	$830.00	$533.00	$533.00	$254.43	$254.43	$255.86	$111.09	$0.00	$0.00	$0.00	$250.31	$111.08	$162.70	$113.00	$113.00	$262.54	$536.00	$424.51	$428.80	$364.76	$830.00	$364.76	$136.28	$127.95	$127.95	$85.33	$250.04	$0.00	$0.00	$0.00	$0.00
36191375	EAP	CPT® 58145		Myomectomy Vag Method	BOTH IP/OP	"$5,267.00 "	"$3,897.58"	$0.00	"$4,007.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,097.64"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$3,967.13"	"$4,007.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191376	EAP	CPT® 11982		Remove Drug Implant Contraceptive	BOTH IP/OP	$501.00 	$370.74	$0.00	"$1,750.00"	$501.00	$501.00	$264.30	$264.30	$265.79	$104.42	$0.00	$0.00	$0.00	$258.98	$104.41	$168.34	$113.00	$113.00	$364.66	$500.00	$396.00	$400.00	$500.00	"$1,750.00"	$500.00	$128.55	$78.96	$78.96	$79.60	$347.29	$0.00	$0.00	$0.00	$0.00
36191377	EAP	CPT® 11983		Remove With Reinsertion Of Drug Implant	BOTH IP/OP	$502.00 	$371.48	$0.00	$502.00	$502.00	$502.00	$264.30	$264.30	$265.79	$104.63	$0.00	$0.00	$0.00	$258.98	$104.62	$168.34	$113.00	$113.00	$364.66	$501.00	$396.79	$400.80	$501.00	$502.00	$501.00	$207.60	$108.53	$108.53	$79.76	$347.29	$0.00	$0.00	$0.00	$0.00
36191378	EAP	CPT® 64435		Inj Anes/strd Paracervical Nerve	BOTH IP/OP	"$1,923.00 "	"$1,423.02"	$0.00	"$1,923.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$400.75	$0.00	$0.00	$0.00	$0.00	"$1,855.00"	"$1,469.16"	"$1,484.00"	$0.00	"$1,923.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191379	EAP	CPT® 65800		Anterior Chamber Tap	BOTH IP/OP	"$10,501.00 "	"$7,770.74"	$0.00	"$8,400.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,167.62"	$0.00	$0.00	$0.00	"$1,992.71"	"$2,167.36"	"$1,295.26"	"$1,871.00"	"$1,871.00"	"$2,027.80"	"$2,255.00"	"$8,316.79"	"$8,400.80"	"$2,817.36"	$0.00	"$2,817.36"	$0.00	$93.03	$93.03	"$1,671.76"	"$1,931.24"	$0.00	$0.00	$0.00	$0.00
36191381	EAP	CPT® 31632		Transbronchial Bx W/addl Lobe	BOTH IP/OP	"$2,153.00 "	"$1,593.22"	$0.00	"$2,153.00"	"$2,153.00"	"$2,153.00"	$0.00	$0.00	$0.00	$448.74	$0.00	$0.00	$0.00	$0.00	$448.69	$0.00	"$2,153.00"	"$2,153.00"	$0.00	"$1,053.50"	"$1,668.74"	"$1,685.60"	$0.00	"$1,750.00"	$0.00	$70.82	$51.57	$51.57	$335.43	$0.00	$0.00	$0.00	$0.00	$0.00
36191382	EAP	CPT® 31633		Transbronchial Needle Bx W/addl Lobe	BOTH IP/OP	"$2,667.00 "	"$1,973.58"	$0.00	"$2,667.00"	"$2,667.00"	"$2,667.00"	$0.00	$0.00	$0.00	$555.87	$0.00	$0.00	$0.00	$0.00	$555.80	$0.00	"$2,667.00"	"$2,667.00"	$0.00	"$1,333.50"	"$2,112.26"	"$2,133.60"	$0.00	"$1,750.00"	$0.00	$86.74	$65.64	$65.64	$424.59	$0.00	$0.00	$0.00	$0.00	$0.00
36191383	EAP	CPT® 20950		Compartment Pressure Measurement	BOTH IP/OP	$664.00 	$491.36	$0.00	$664.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.38	$0.00	$0.00	$0.00	$0.00	$664.00	$525.89	$531.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191384	EAP	CPT® 23405		"Tenotomy, Shoulder Area; Single Tendon"	BOTH IP/OP	"$5,610.00 "	"$4,151.40"	$0.00	"$4,560.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,169.12"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,514.40"	"$4,560.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191385	EAP	CPT® 59151		Treat Ectopic Pregnancy	BOTH IP/OP	"$13,348.00 "	"$9,877.52"	$0.00	"$10,678.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,781.72"	$0.00	$0.00	$0.00	$0.00	"$5,452.00"	"$10,571.62"	"$10,678.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191386	EAP	CPT® 24357		"Tenotomy, Elbow, Lateral Or Media; Percutaneous"	BOTH IP/OP	"$2,899.00 "	"$2,145.26"	$0.00	"$2,858.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$604.15	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$2,372.04"	"$2,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191387	EAP	CPT® 26055		Tendon Sheath Incision	BOTH IP/OP	"$2,440.00 "	"$1,805.60"	$0.00	"$2,440.00"	"$2,440.00"	"$2,440.00"	"$1,356.40"	"$1,356.40"	"$1,364.04"	$0.00	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,334.46"	$508.50	$867.40	"$2,440.00"	"$2,440.00"	$0.00	"$2,327.00"	"$1,931.69"	"$1,951.20"	$0.00	"$2,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191389	EAP	CPT® 64491		Inj Paravert F Jnt C/t 2 Lev	BOTH IP/OP	"$1,819.00 "	"$1,346.06"	$0.00	"$1,819.00"	"$1,819.00"	"$1,819.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$379.08	$0.00	$0.00	$0.00	$0.00	$877.50	"$1,389.96"	"$1,404.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191391	EAP	CPT® 27000		"Tenotomy, Adductor Of Hip, Percutaneous"	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,575.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.23	$0.00	$0.00	$0.00	$0.00	"$1,575.00"	"$1,247.40"	"$1,260.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191392	EAP	CPT® 27005		"Tenotomy, Hip Flexor(s), Open"	BOTH IP/OP	"$1,961.00 "	"$1,451.14"	$0.00	"$1,961.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.67	$0.00	$0.00	$0.00	$0.00	"$1,961.00"	"$1,553.11"	"$1,568.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191393	EAP	CPT® 27006		"Tenotomy, Abductors And/or Extensor(s) Of Hip,open"	BOTH IP/OP	"$2,650.00 "	"$1,961.00"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$552.26	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,098.80"	"$2,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191394	EAP	CPT® 27306		"Tenotomy, Percutaneous, Or Hamstring, Single Tendon"	BOTH IP/OP	"$5,757.00 "	"$4,260.18"	$0.00	"$4,605.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,199.76"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,559.54"	"$4,605.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191395	EAP	CPT® 27307		"Tenotomy, Percutaneous, Adductor Or Hamstring; Multiple Tendons"	BOTH IP/OP	"$8,511.00 "	"$6,298.14"	$0.00	"$6,808.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,773.69"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$6,740.71"	"$6,808.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191396	EAP	CPT® 27605		"Tenotomy, Percutaneous, Achilles Tendon ; Local Anesthesia"	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$309.51	$0.00	$0.00	$0.00	"$1,334.46"	$309.47	$867.40	"$1,485.00"	"$1,485.00"	"$1,359.37"	"$1,500.00"	"$1,188.00"	"$1,200.00"	"$1,500.00"	"$1,485.00"	"$1,500.00"	$0.00	$192.52	$192.52	$238.80	"$1,294.64"	$0.00	$0.00	$0.00	$0.00
36191397	EAP	CPT® 28008		"Fasciotomy, Foot And/or Toe"	BOTH IP/OP	"$2,912.00 "	"$2,154.88"	$0.00	"$2,858.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$606.86	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$2,441.74"	"$2,466.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191398	EAP	CPT® 28899		"Unlisted Procedure, Foot Or Toes"	BOTH IP/OP	"$2,668.00 "	"$1,974.32"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,098.01"	"$2,119.20"	$0.00	$587.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191399	EAP	CPT® 64430		Inj Anes/strd Pudendal Nerve	BOTH IP/OP	$995.00 	$736.30	$0.00	$995.00	$995.00	$995.00	$801.66	$801.66	$806.18	$207.38	$995.00	$995.00	$995.00	$788.26	$207.36	$512.37	$995.00	$995.00	$0.00	$960.00	$760.32	$768.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191400	EAP	CPT® 12037		Intmd Wnd Repair S/tr/ext	BOTH IP/OP	"$2,035.00 "	"$1,505.90"	$0.00	"$2,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.09	$0.00	$0.00	$0.00	$0.00	"$1,907.00"	"$1,510.34"	"$1,525.60"	$0.00	"$2,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191401	EAP	CPT® 26070		"Arthrotomy W/expl,drain,rmvl Of Loose/fb Carpometacarpal Jnt"	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	"$1,500.00"	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191402	EAP	CPT® 26075		"Arthrotomy W/expl,drain,rmvl Of Loose/fb Metacarpophalangeal Jnt Ea"	BOTH IP/OP	"$2,700.00 "	"$1,998.00"	$0.00	"$2,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.68	$0.00	$0.00	$0.00	$0.00	"$2,700.00"	"$2,138.40"	"$2,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191403	EAP	CPT® 26080		"Arthrotomy W/expl,drain,rmvl Of Loose/fb Interphalangeal Jnt Ea"	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,575.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$536.63	$0.00	$0.00	$0.00	$0.00	"$2,575.00"	"$2,039.40"	"$2,060.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191404	EAP	Custom 26320		Removal Of Implant From Finger Or Hand	BOTH IP/OP	"$1,581.00 "	"$1,169.94"	$0.00	"$1,581.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$329.48	$0.00	$0.00	$0.00	$0.00	"$1,581.00"	"$1,252.15"	"$1,264.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191405	EAP	CPT® 26641		"Closed Treatment Of Carpometacarpal Dislocation,thumb,w/manipulation"	BOTH IP/OP	"$1,104.00 "	$816.96	$0.00	"$1,233.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.07	$0.00	$0.00	$0.00	$0.00	"$1,104.00"	$874.37	$883.20	$0.00	"$1,233.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191406	EAP	CPT® 26607		"Clsd Tx Of Metacarpal Fx, W/ Manip,w/external Fix Ea Bone"	BOTH IP/OP	"$3,176.00 "	"$2,350.24"	$0.00	"$2,699.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$661.88	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,672.21"	"$2,699.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191407	EAP	CPT® 26645		"Clsd Tx Of Carpometacarpal Fx Disloc, Thumb  W/manip"	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,593.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	"$1,593.00"	"$1,261.66"	"$1,274.40"	$0.00	"$1,593.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191408	EAP	CPT® 26650		Perc Skel Fix Of Carpometacarpal Fx Disloc Thumb W/ Manip	BOTH IP/OP	"$5,811.00 "	"$4,300.14"	$0.00	"$4,938.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,211.01"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,889.02"	"$4,938.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191409	EAP	CPT® 26670		"Clsd Tx Of Carpometacarpal Disloc Not Thumb, W/manip Ea Jnt,w/o Anest"	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,099.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	"$1,099.00"	$870.41	$879.20	$0.00	"$1,099.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191410	EAP	CPT® 26700		"Clsd Tx Of Metacarpophalangeal Disloc Single W/manip, W/o Anest"	BOTH IP/OP	$735.00 	$543.90	$0.00	$735.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$735.00	$582.12	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191450	EAP	CPT® 69209		Remove Cerumen Impacted Irrig/lavage Unilat	BOTH IP/OP	$274.00 	$202.76	$0.00	$276.00	$274.00	$274.00	$54.21	$54.21	$54.51	$57.11	$0.00	$0.00	$0.00	$53.35	$57.10	$34.67	$113.00	$113.00	$55.17	$276.00	$218.59	$220.80	$76.65	$263.00	$76.65	$12.24	$14.41	$14.41	$43.94	$52.54	$0.00	$0.00	$0.00	$0.00
36191451	EAP	CPT® 66761		Iridotomy Laser Surgery-both Eyes	BOTH IP/OP	"$11,463.00 "	"$8,482.62"	$0.00	"$9,263.20"	"$2,321.55"	"$2,321.55"	$490.09	$490.09	$492.86	"$2,389.18"	$0.00	$0.00	$0.00	$482.91	"$2,388.89"	$313.89	"$1,871.00"	"$1,871.00"	$508.42	"$2,255.00"	"$9,170.57"	"$9,263.20"	$706.38	"$2,150.00"	$706.38	$315.03	$240.80	$240.80	"$1,843.38"	$484.21	$0.00	$0.00	$0.00	$0.00
36191452	EAP	CPT® 64405		Inj Anes/strd Greater Occipital Nerve	BOTH IP/OP	"$3,313.00 "	"$2,451.62"	$0.00	"$2,557.60"	"$2,321.55"	"$2,321.55"	$254.43	$254.43	$255.86	$690.51	$0.00	$0.00	$0.00	$250.31	$690.43	$162.70	"$1,871.00"	"$1,871.00"	$262.54	"$2,255.00"	"$2,532.02"	"$2,557.60"	$364.76	"$1,199.00"	$364.76	$102.34	$55.88	$55.88	$508.96	$250.04	$0.00	$0.00	$0.00	$0.00
36191453	EAP	CPT® 64510		Inject Stellate Ganglion	BOTH IP/OP	"$1,767.00 "	"$1,307.58"	$0.00	"$1,767.00"	"$1,767.00"	"$1,767.00"	$801.66	$801.66	$806.18	$368.29	"$1,257.08"	"$1,257.08"	"$1,305.43"	$788.26	$368.24	$512.37	"$1,767.00"	"$1,767.00"	$0.00	"$1,705.00"	"$1,350.36"	"$1,364.00"	$0.00	"$1,767.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191454	EAP	CPT® 64620		Destroy Intercostal Neurolytic	BOTH IP/OP	"$6,513.00 "	"$4,819.62"	$176.30	"$5,238.40"	"$2,321.55"	"$2,321.55"	$801.66	$801.66	$806.18	"$1,357.47"	"$1,257.08"	"$1,257.08"	"$1,305.43"	$788.26	"$1,357.31"	$512.37	"$1,871.00"	"$1,871.00"	$814.44	"$2,255.00"	"$5,186.02"	"$5,238.40"	"$1,131.55"	"$3,250.00"	"$1,131.55"	$176.30	$181.36	$181.36	"$1,042.44"	$775.65	$0.00	$0.00	$0.00	$0.00
36191455	EAP	CPT® 64494		Inj Paravert F Jnt L/s 2 Lev	BOTH IP/OP	"$1,721.00 "	"$1,273.54"	$0.00	"$1,721.00"	"$1,721.00"	"$1,721.00"	$0.00	$0.00	$0.00	$358.70	$0.00	$0.00	$0.00	$0.00	$358.66	$0.00	"$1,017.97"	"$1,017.97"	$0.00	$830.50	"$1,315.51"	"$1,328.80"	$0.00	"$1,721.00"	$0.00	$54.06	$53.73	$53.73	$264.43	$0.00	$0.00	$0.00	$0.00	$0.00
36191456	EAP	CPT® 64495		Inj Paravert F Jnt L/s 3 Lev	BOTH IP/OP	"$1,652.00 "	"$1,222.48"	$0.00	"$1,652.00"	"$1,652.00"	"$1,652.00"	$0.00	$0.00	$0.00	$344.32	$0.00	$0.00	$0.00	$0.00	$344.28	$0.00	$977.16	$977.16	$0.00	$797.00	"$1,262.45"	"$1,275.20"	$0.00	"$1,652.00"	$0.00	$0.00	$54.45	$54.45	$253.76	$0.00	$0.00	$0.00	$0.00	$0.00
36191457	EAP	CPT® 64492		Inj Paravert F Jnt C/t 3 Lev	BOTH IP/OP	"$1,627.00 "	"$1,203.98"	$0.00	"$1,627.00"	"$1,627.00"	"$1,627.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$339.07	$0.00	$0.00	$0.00	$0.00	$785.00	"$1,243.44"	"$1,256.00"	$0.00	$871.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191458	EAP	CPT® 64493		Inj Paravert F Jnt L/s 1 Lev	BOTH IP/OP	"$3,789.00 "	"$2,803.86"	$0.00	"$2,924.80"	"$2,321.55"	"$2,321.55"	$801.66	$801.66	$806.18	$789.72	$0.00	$0.00	$0.00	$788.26	$789.63	$512.37	"$1,871.00"	"$1,871.00"	$814.44	"$2,255.00"	"$2,895.55"	"$2,924.80"	"$1,131.55"	"$2,150.00"	"$1,131.55"	$111.04	$93.03	$93.03	$582.04	$775.65	$0.00	$0.00	$0.00	$0.00
36191459	EAP	CPT® 64490		Inj Paravert F Jnt C/t 1 Lev	BOTH IP/OP	"$3,789.00 "	"$2,803.86"	$0.00	"$2,924.80"	"$2,321.55"	"$2,321.55"	$801.66	$801.66	$806.18	$0.00	$0.00	$0.00	$0.00	$0.00	$789.63	$0.00	$0.00	$0.00	$814.44	"$2,255.00"	"$2,895.55"	"$2,924.80"	"$1,131.55"	"$2,150.00"	"$1,131.55"	$122.58	$109.61	$109.61	$582.04	$775.65	$0.00	$0.00	$0.00	$0.00
36191460	EAP	CPT® 64517		Nblock Inj Hypogas Plxs	BOTH IP/OP	"$3,493.00 "	"$2,584.82"	$0.00	"$2,836.00"	"$2,753.10"	"$2,753.10"	$801.66	$801.66	$806.18	$728.03	"$1,541.95"	"$1,541.95"	"$1,601.25"	$788.26	$727.94	$512.37	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$2,669.04"	"$2,696.00"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191461	EAP	CPT® 64418		Inj Anes/strd Suprascapular	BOTH IP/OP	"$3,173.00 "	"$2,348.02"	$0.00	"$2,449.60"	"$2,321.55"	"$2,321.55"	$618.38	$618.38	$621.87	$661.33	$0.00	$0.00	$0.00	$608.20	$661.25	$395.33	"$1,871.00"	"$1,871.00"	$626.89	"$2,255.00"	"$2,425.10"	"$2,449.60"	$870.98	"$2,150.00"	$870.98	$104.21	$59.14	$59.14	$487.47	$597.04	$0.00	$0.00	$0.00	$0.00
36191462	EAP	CPT® 38222		Bone Marrow Biopsy(ies) & Aspiration(s)	BOTH IP/OP	"$2,325.00 "	"$1,720.50"	$0.00	"$2,325.71"	"$2,321.55"	"$2,321.55"	"$2,309.02"	"$2,309.02"	"$2,322.02"	$484.59	$0.00	$0.00	$0.00	"$2,271.46"	$484.53	"$1,476.45"	"$1,871.00"	"$1,871.00"	"$2,325.71"	"$2,000.00"	"$1,584.00"	"$1,600.00"	"$2,000.00"	"$1,511.25"	"$2,000.00"	$164.87	$80.78	$80.78	$318.40	"$2,214.96"	$0.00	$0.00	$0.00	$0.00
36191464	EAP	CPT® 65855		"Argon Trabeculoplasty, Both Eyes"	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$211.62	"$3,552.80"	"$2,753.10"	"$2,753.10"	$490.09	$490.09	$492.86	$858.92	"$2,571.13"	"$2,571.13"	"$2,670.02"	$482.91	$858.82	$313.89	"$1,871.00"	"$1,871.00"	$508.42	"$2,255.00"	"$3,517.27"	"$3,552.80"	$706.38	"$2,150.00"	$706.38	$354.58	$211.62	$211.62	$707.01	$484.21	$0.00	$0.00	$0.00	$0.00
36191465	EAP	CPT® 67040		"Pan Retinal Photocoagulation, Both Eyes"	BOTH IP/OP	"$15,964.00 "	"$11,813.36"	$0.00	"$12,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,326.90"	$0.00	$0.00	$0.00	$0.00	"$4,975.00"	"$12,771.00"	"$12,900.00"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191466	EAP	CPT® 66821		"Yag Capsulotomy, Both Eyes"	BOTH IP/OP	"$3,181.00 "	"$2,353.94"	$188.16	"$2,836.00"	"$2,753.10"	"$2,753.10"	$490.09	$490.09	$492.86	$663.00	"$1,541.95"	"$1,541.95"	"$1,601.25"	$482.91	$662.92	$313.89	"$2,836.00"	"$2,836.00"	$508.42	"$2,327.00"	"$2,544.70"	"$2,570.40"	$706.38	"$2,150.00"	$706.38	$188.16	$317.54	$317.54	$511.51	$484.21	$0.00	$0.00	$0.00	$0.00
36191467	EAP	CPT® 65865		"Argon Laser Gonioplasty, One Eye"	BOTH IP/OP	"$4,345.00 "	"$3,215.30"	$0.00	"$3,511.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$905.50	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,476.09"	"$3,511.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191468	EAP	CPT® 46230		"Excision Of Multiple External Papillae Or Tags, Anus"	BOTH IP/OP	"$4,962.00 "	"$3,671.88"	$0.00	"$3,969.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,034.08"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,929.90"	"$3,969.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191469	EAP	CPT® 31574		Laryngoscopy W/ Inj Augmentation Unilateral	BOTH IP/OP	"$3,605.00 "	"$2,667.70"	$0.00	"$3,605.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$751.37	$0.00	$0.00	$0.00	"$1,434.17"	$751.28	$932.21	"$3,605.00"	"$3,605.00"	$0.00	"$2,255.00"	"$2,621.52"	"$2,648.00"	$0.00	"$2,239.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191470	EAP	CPT® 31574		Laryngoscopy W/ Inj Augmentation Bilateral	BOTH IP/OP	"$4,748.00 "	"$3,513.52"	$0.00	"$4,748.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$989.60	$0.00	$0.00	$0.00	"$1,434.17"	$989.48	$932.21	"$4,748.00"	"$4,748.00"	$0.00	"$2,255.00"	"$3,933.07"	"$3,972.80"	$0.00	"$2,239.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191471	EAP	CPT® 62355		Remove Spinal Canal Catheter	BOTH IP/OP	"$7,880.00 "	"$5,831.20"	$0.00	"$6,304.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,642.19"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$6,240.96"	"$6,304.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191472	EAP	CPT® 64561		Implant Neuroelectrodes Sacral Nerve	BOTH IP/OP	"$11,177.00 "	"$8,270.98"	$0.00	"$8,627.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,329.29"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$8,540.93"	"$8,627.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191473	EAP	CPT® 64461		Pvb Thoracic Single Inj Site	BOTH IP/OP	"$4,312.00 "	"$3,190.88"	$0.00	"$3,328.80"	"$2,321.55"	"$2,321.55"	$618.38	$618.38	$621.87	$0.00	$0.00	$0.00	$0.00	$0.00	$898.62	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,295.51"	"$3,328.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191474	EAP	CPT® 64462		Pvb Thoracic 2nd+ Inj Site	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,189.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$521.00	$0.00	$0.00	$0.00	$0.00	"$1,368.50"	"$2,167.70"	"$2,189.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191475	EAP	CPT® 55920		Place Needles Pelvic For Rt	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,084.00"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$7,920.79"	"$8,000.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191476	EAP	CPT® 36660		Insertion Catheter Artery	BOTH IP/OP	$212.00 	$156.88	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$180.00	$142.56	$144.00	$0.00	$137.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191477	EAP	CPT® 46910		Destruction Anal Lesion(s)	BOTH IP/OP	"$5,868.00 "	"$4,342.32"	$138.42	"$4,877.00"	"$2,753.10"	"$2,753.10"	"$1,667.97"	"$1,667.97"	"$1,677.37"	"$1,223.04"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,644.04"	"$1,222.89"	"$1,068.62"	"$4,877.00"	"$4,877.00"	"$1,553.51"	"$2,255.00"	"$4,694.18"	"$4,741.60"	"$2,158.40"	"$2,500.00"	"$2,158.40"	$144.75	$138.42	$138.42	$943.58	"$1,479.54"	$0.00	$0.00	$0.00	$0.00
36191478	EAP	CPT® 66500		Iridotomy By Stab Incision; Except Transfixion	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,295.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$833.60	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,262.25"	"$3,295.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191479	EAP	CPT® 65435		Curette/treat Cornea	BOTH IP/OP	"$2,421.00 "	"$1,791.54"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$504.54	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,935.65"	"$1,955.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191480	EAP	CPT® 65810		Paracentesis Ant Cham W/ Rmvl Vitreous W/wo Air Inj	BOTH IP/OP	"$6,052.00 "	"$4,478.48"	$0.00	"$4,888.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,261.24"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,839.12"	"$4,888.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191481	EAP	CPT® 27369		Njx Px Cntrst Kne Arthg Cntrst Enhncd Ct/mri Kne	BOTH IP/OP	"$1,323.00 "	$979.02	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.71	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00	$563.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191482	EAP	CPT® 33285		Insertion Subq Cardiac Rhythm Monitor W/prgrmg	BOTH IP/OP	"$12,848.00 "	"$9,507.52"	$0.00	"$16,063.45"	"$2,321.55"	"$2,321.55"	"$7,945.15"	"$7,945.15"	"$7,989.91"	"$2,677.84"	$0.00	$0.00	$0.00	"$7,813.60"	"$2,677.52"	"$5,078.84"	"$4,877.00"	"$4,877.00"	"$7,664.31"	"$6,105.00"	"$9,979.20"	"$10,080.00"	"$10,648.54"	"$16,063.45"	"$10,648.54"	"$4,971.59"	$92.65	$92.65	"$2,005.92"	"$7,299.34"	$0.00	$0.00	$0.00	$0.00
36191483	EAP	CPT® 33286		Removal Subcutaneous Cardiac Rhythm Monitor	BOTH IP/OP	"$13,427.00 "	"$9,935.98"	$91.21	"$10,533.60"	"$2,321.55"	"$2,321.55"	$606.01	$606.01	$609.42	"$2,798.52"	"$1,257.08"	"$1,257.08"	"$1,305.43"	$596.11	"$2,798.19"	$387.47	"$2,836.00"	"$2,836.00"	$611.80	"$2,255.00"	"$10,428.26"	"$10,533.60"	$850.02	"$2,065.05"	$850.02	$130.54	$91.21	$91.21	"$2,096.19"	$582.67	$0.00	$0.00	$0.00	$0.00
36191484	EAP	CPT® 10005		Fna Bx W/ Us Guide 1st Lesion	BOTH IP/OP	"$1,535.00 "	"$1,135.90"	$0.00	"$1,824.55"	"$1,535.00"	"$1,535.00"	$606.01	$606.01	$609.42	$319.93	$0.00	$0.00	$0.00	$596.11	$319.89	$387.47	"$1,535.00"	"$1,535.00"	$611.80	"$1,546.00"	"$1,224.43"	"$1,236.80"	$850.02	"$1,824.55"	$850.02	$42.95	$74.65	$74.65	$246.12	$582.67	$0.00	$0.00	$0.00	$0.00
36191485	EAP	CPT® 10006		Fna Bx W/ Us Guide Ea Addtl	BOTH IP/OP	$524.00 	$387.76	$0.00	$422.40	$0.00	$0.00	$0.00	$0.00	$0.00	$109.21	$0.00	$0.00	$0.00	$0.00	$109.20	$0.00	$309.95	$309.95	$0.00	$264.00	$418.18	$422.40	$0.00	$340.60	$0.00	$58.60	$51.21	$51.21	$84.06	$0.00	$0.00	$0.00	$0.00	$0.00
36191486	EAP	CPT® 10007		Fna Bx W/ Fluoro Guide 1st Lesion	BOTH IP/OP	"$1,535.00 "	"$1,135.90"	$0.00	"$1,546.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.89	$0.00	$0.00	$0.00	$0.00	"$1,546.00"	"$1,224.43"	"$1,236.80"	$0.00	$997.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191487	EAP	CPT® 10008		Fna Bx W/ Fluoro Guide Ea Addtl	BOTH IP/OP	$524.00 	$387.76	$0.00	$422.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.20	$0.00	$0.00	$0.00	$0.00	$264.00	$418.18	$422.40	$0.00	$340.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191488	EAP	CPT® 10009		Fna Bx W/ Ct Guide 1st Lesion	BOTH IP/OP	"$1,535.00 "	"$1,135.90"	$0.00	"$1,546.00"	"$1,535.00"	"$1,535.00"	$606.01	$606.01	$609.42	$319.93	$0.00	$0.00	$0.00	$596.11	$319.89	$387.47	"$1,535.00"	"$1,535.00"	$611.80	"$1,546.00"	"$1,224.43"	"$1,236.80"	$850.02	$997.75	$850.02	$451.42	$118.28	$118.28	$246.12	$582.67	$0.00	$0.00	$0.00	$0.00
36191489	EAP	CPT® 10010		Fna Bx W/ Ct Guide Ea Addtl	BOTH IP/OP	$524.00 	$387.76	$0.00	$422.40	$0.00	$0.00	$0.00	$0.00	$0.00	$109.21	$0.00	$0.00	$0.00	$0.00	$109.20	$0.00	$309.95	$309.95	$0.00	$264.00	$418.18	$422.40	$0.00	$340.60	$0.00	$272.43	$85.83	$85.83	$84.06	$0.00	$0.00	$0.00	$0.00	$0.00
36191490	EAP	CPT® 10011		Fna Bx W/ Mr Guide 1st Lesion	BOTH IP/OP	"$1,535.00 "	"$1,135.90"	$0.00	"$1,546.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.89	$0.00	$0.00	$0.00	$0.00	"$1,546.00"	"$1,224.43"	"$1,236.80"	$0.00	$997.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191491	EAP	CPT® 10012		Fna Bx W/ Mr Guide Ea Addtl	BOTH IP/OP	$524.00 	$387.76	$0.00	$422.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.20	$0.00	$0.00	$0.00	$0.00	$264.00	$418.18	$422.40	$0.00	$340.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191492	EAP	CPT® 11102		Tangential (shave) Bx Skin; 1st Lesion	BOTH IP/OP	$313.00 	$231.62	$0.00	$557.05	$313.00	$313.00	$174.88	$174.88	$175.86	$65.24	$0.00	$0.00	$0.00	$172.08	$65.23	$111.85	$113.00	$113.00	$175.24	$313.00	$247.90	$250.40	$243.48	$557.05	$243.48	$95.62	$40.38	$40.38	$49.83	$166.90	$0.00	$0.00	$0.00	$0.00
36191493	EAP	CPT® 11104		Punch Bx Skin; 1st Lesion	BOTH IP/OP	$313.00 	$231.62	$0.00	$557.05	$313.00	$313.00	$336.60	$336.60	$313.00	$65.24	$0.00	$0.00	$0.00	$331.46	$65.23	$215.45	$113.00	$113.00	$175.24	$313.00	$247.90	$250.40	$243.48	$557.05	$243.48	$120.20	$50.48	$50.48	$49.83	$166.90	$0.00	$0.00	$0.00	$0.00
36191494	EAP	CPT® 11106		Incisional (wedge) Bx Skin; 1st Lesion	BOTH IP/OP	$375.00 	$277.50	$0.00	$510.03	$375.00	$375.00	$510.03	$510.03	$375.00	$78.16	$0.00	$0.00	$0.00	$502.38	$78.15	$326.54	$375.00	$375.00	$320.45	$375.00	$297.00	$300.00	$375.00	$243.75	$375.00	$145.49	$60.94	$60.94	$59.70	$305.19	$0.00	$0.00	$0.00	$0.00
36191495	EAP	CPT® 11103		Tangential (shave) Bx Skin; Ea Addtl	BOTH IP/OP	$300.00 	$222.00	$0.00	$300.00	$300.00	$300.00	$0.00	$0.00	$0.00	$62.53	$0.00	$0.00	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$195.00	$0.00	$51.58	$23.44	$23.44	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
36191496	EAP	CPT® 11105		Punch Bx Skin; Ea Addtl	BOTH IP/OP	$300.00 	$222.00	$0.00	$300.00	$300.00	$300.00	$0.00	$0.00	$0.00	$62.53	$0.00	$0.00	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$195.00	$0.00	$59.11	$27.40	$27.40	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
36191497	EAP	CPT® 11107		Incisional (wedge) Bx Skin; Ea Addtl	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00	$195.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191498	EAP	CPT® 43762		Perq Replacement Gtube Not Req Rev Gastro Tract	BOTH IP/OP	"$1,668.00 "	"$1,234.32"	$0.00	"$1,604.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$347.61	$0.00	$0.00	$0.00	$0.00	"$1,604.00"	"$1,270.37"	"$1,283.20"	$0.00	$727.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191499	EAP	CPT® 43763		Perq Replacement Gtube Requiring Rev Gastro Tract	BOTH IP/OP	"$1,668.00 "	"$1,234.32"	$0.00	"$1,604.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$347.61	$0.00	$0.00	$0.00	$0.00	"$1,604.00"	"$1,270.37"	"$1,283.20"	$0.00	$632.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191500	EAP	CPT® 50436		Perq Dilation Xst Trc Endourologic Px W/img	BOTH IP/OP	"$9,134.00 "	"$6,759.16"	$0.00	"$7,307.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,903.53"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$7,234.13"	"$7,307.20"	$0.00	"$4,672.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191501	EAP	CPT® 50437		Perq Dilation Xst Trc New Access Renal Coltj Sys	BOTH IP/OP	"$9,134.00 "	"$6,759.16"	$0.00	"$7,307.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,903.53"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$7,234.13"	"$7,307.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191502	EAP	CPT® 65436		Curettage/treatment Cornea	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$4,399.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,355.21"	"$4,399.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191503	EAP	CPT® 10004		Fna Bx W/o Img Gdn Ea Addl	BOTH IP/OP	$524.00 	$387.76	$0.00	$524.00	$524.00	$524.00	$0.00	$0.00	$0.00	$109.21	$0.00	$0.00	$0.00	$0.00	$109.20	$0.00	$309.95	$309.95	$0.00	$264.00	$418.18	$422.40	$0.00	$340.60	$0.00	$51.12	$45.07	$45.07	$84.06	$0.00	$0.00	$0.00	$0.00	$0.00
36191504	EAP	CPT® 27369		Ct/mr Contrast Enhanced Arthrg Knee Inj Px Bilateral	BOTH IP/OP	"$1,984.00 "	"$1,468.16"	$0.00	"$1,508.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.47	$0.00	$0.00	$0.00	$0.00	$943.00	"$1,493.71"	"$1,508.80"	$0.00	$563.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191505	EAP	CPT® 64635		Bilateral Destr Lumb/sac Facet Jnt; Single	BOTH IP/OP	"$4,252.00 "	"$3,146.48"	$0.00	"$4,252.00"	"$2,321.55"	"$2,321.55"	"$1,709.97"	"$1,709.97"	"$1,719.60"	$886.22	$0.00	$0.00	$0.00	"$1,681.44"	$886.12	"$1,092.94"	"$4,252.00"	"$4,252.00"	"$1,724.40"	"$2,255.00"	"$3,385.80"	"$3,420.00"	"$2,395.83"	"$3,250.00"	"$2,395.83"	$425.03	$229.68	$229.68	$680.58	"$1,642.29"	$0.00	$0.00	$0.00	$0.00
36191507	EAP	CPT® 69209		Remove Impacted Ear Wax Irrig/lavage Bil	BOTH IP/OP	$410.00 	$303.40	$0.00	$414.00	$410.00	$410.00	$54.21	$54.21	$54.51	$85.45	$0.00	$0.00	$0.00	$53.35	$85.44	$34.67	$113.00	$113.00	$55.17	$414.00	$327.89	$331.20	$76.65	$263.00	$76.65	$12.24	$14.41	$14.41	$65.91	$52.54	$0.00	$0.00	$0.00	$0.00
36191508	EAP	CPT® 36573		Ins Picc W/ Imaging 5 Yr+	BOTH IP/OP	"$5,719.00 "	"$4,232.06"	$0.00	"$5,719.00"	"$2,321.55"	"$2,321.55"	"$1,369.42"	"$1,369.42"	"$1,377.13"	"$1,191.98"	$0.00	$0.00	$0.00	"$1,347.67"	"$1,191.84"	$875.99	"$5,719.00"	"$5,719.00"	"$1,635.92"	"$2,255.00"	"$4,299.77"	"$4,343.20"	"$2,272.90"	"$3,717.35"	"$2,272.90"	$849.64	$88.35	$88.35	$864.30	"$1,558.02"	$0.00	$0.00	$0.00	$0.00
36191509	EAP	CPT® 27266		Clsd Tx Post Hip Arthroplasty Disloc	BOTH IP/OP	"$4,283.00 "	"$3,169.42"	$0.00	"$3,460.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$892.58	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,426.19"	"$3,460.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191510	EAP	CPT® 15793		Chemical Peel (tca) Nonfacial	BOTH IP/OP	"$1,268.00 "	$938.32	$0.00	"$1,268.00"	$688.52	$688.52	$336.60	$336.60	$338.49	$264.28	$0.00	$0.00	$0.00	$331.46	$264.25	$215.45	$113.00	$113.00	$320.45	"$1,188.00"	$940.90	$950.40	$445.22	"$1,268.00"	$445.22	$185.92	$362.58	$362.58	$189.13	$305.19	$0.00	$0.00	$0.00	$0.00
36191511	EAP	CPT® 46922		Simple Excision Of Anal Lesion(s)	BOTH IP/OP	"$7,021.00 "	"$5,195.54"	$0.00	"$5,673.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,463.18"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,616.86"	"$5,673.60"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191512	EAP	CPT® 20526		Bilateral Carpal Tunnel Inj	BOTH IP/OP	"$1,355.00 "	"$1,002.70"	$0.00	"$1,356.00"	"$1,355.00"	"$1,355.00"	$254.43	$254.43	$255.86	$282.42	$0.00	$0.00	$0.00	$250.31	$282.38	$162.70	"$1,355.00"	"$1,355.00"	$262.54	"$1,356.00"	"$1,073.95"	"$1,084.80"	$364.76	"$1,355.00"	$364.76	$212.21	$59.49	$59.49	$215.88	$250.04	$0.00	$0.00	$0.00	$0.00
36191513	EAP	CPT® 64483		Bil Inject Txforamen Epi L/s Sngl	BOTH IP/OP	"$2,651.00 "	"$1,961.74"	$115.74	"$2,321.55"	"$2,321.55"	"$2,321.55"	$801.66	$801.66	$806.18	$552.53	"$1,257.08"	"$1,257.08"	"$1,305.43"	$788.26	$552.47	$512.37	"$1,871.00"	"$1,871.00"	$814.44	"$2,255.00"	"$2,025.94"	"$2,046.40"	"$1,131.55"	"$2,150.00"	"$1,131.55"	$197.93	$115.74	$115.74	$407.23	$775.65	$0.00	$0.00	$0.00	$0.00
36191514	EAP	CPT® 67110		Repair Retinal Detachment Inj Px	BOTH IP/OP	"$7,476.00 "	"$5,532.24"	$0.00	"$6,041.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,558.00"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,981.18"	"$6,041.60"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191515	EAP	CPT® 11450		Removal Sweat Gland Lesion	BOTH IP/OP	"$8,560.00 "	"$6,334.40"	$0.00	"$6,839.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,783.90"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$6,770.81"	"$6,839.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191516	EAP	CPT® 69210		Bil Removal Impacted Cerumen Instrument	BOTH IP/OP	$613.00 	$453.62	$0.00	$618.00	$613.00	$613.00	$54.21	$54.21	$54.51	$127.76	$0.00	$0.00	$0.00	$53.35	$127.75	$34.67	$113.00	$113.00	$55.17	$618.00	$489.46	$494.40	$76.65	$564.00	$76.65	$47.34	$34.61	$34.61	$98.39	$52.54	$0.00	$0.00	$0.00	$0.00
36191517	EAP	CPT® 45100		Biopsy Of Rectum	BOTH IP/OP	"$5,621.00 "	"$4,159.54"	$0.00	"$4,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,171.42"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,442.33"	"$4,487.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191518	EAP	CPT® 11462		Excision Hidradenitis Inguinal Simple/interm	BOTH IP/OP	"$7,409.00 "	"$5,482.66"	$0.00	"$5,920.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,544.04"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$5,860.80"	"$5,920.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191519	EAP	CPT® 20611		Bilateral Drain/inject-shoulder Hip Knee With Us Guidance	BOTH IP/OP	"$4,395.00 "	"$3,252.30"	$0.00	"$3,520.00"	"$2,321.55"	"$2,321.55"	$254.43	$254.43	$255.86	$916.03	$0.00	$0.00	$0.00	$250.31	$915.92	$162.70	$113.00	$113.00	$262.54	"$2,255.00"	"$3,484.80"	"$3,520.00"	$364.76	"$1,750.00"	$364.76	$88.61	$62.38	$62.38	$700.48	$250.04	$0.00	$0.00	$0.00	$0.00
36191520	EAP	CPT® 55899		Genital Surgery Procedure Unlisted	BOTH IP/OP	"$5,214.00 "	"$3,858.36"	$0.00	"$4,171.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,086.60"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,129.49"	"$4,171.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191521	EAP	CPT® 53020		Incision Of Urethra	BOTH IP/OP	"$6,761.00 "	"$5,003.14"	$0.00	"$5,424.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,408.99"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,370.55"	"$5,424.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191522	EAP	CPT® 31636		Bronchoscopy Initial Bronch Stent	BOTH IP/OP	"$9,005.00 "	"$6,663.70"	$0.00	"$7,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,876.64"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$7,131.96"	"$7,204.00"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191523	EAP	CPT® 31637		Bronchoscopy Addl Bronch Stent	BOTH IP/OP	"$4,558.00 "	"$3,372.92"	$0.00	"$3,646.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$949.89	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,609.94"	"$3,646.40"	$0.00	$360.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191524	EAP	CPT® 31638		Bronchoscopy Stent Revision Incl Dilation	BOTH IP/OP	"$8,711.00 "	"$6,446.14"	$0.00	"$6,968.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,815.37"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$6,899.11"	"$6,968.80"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191525	EAP	CPT® 64788		Remove Nf Or Nl; Cutaneous Nerve	BOTH IP/OP	"$7,647.00 "	"$5,658.78"	$0.00	"$6,117.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.63"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$6,056.42"	"$6,117.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191526	EAP	CPT® 64999		Unlisted Neuro Px	BOTH IP/OP	"$5,528.00 "	"$4,090.72"	$0.00	"$4,390.40"	"$2,321.55"	"$2,321.55"	$254.43	$254.43	$255.86	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,152.04"	$0.00	$0.00	$0.00	$262.54	"$2,255.00"	"$4,346.50"	"$4,390.40"	$364.76	"$2,607.00"	$364.76	$858.87	$0.00	$0.00	$873.69	$250.04	$0.00	$0.00	$0.00	$0.00
36191527	EAP	CPT® 49999		Unlisted Abdominal Px	BOTH IP/OP	"$8,000.00 "	"$5,920.00"	$0.00	"$6,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,667.20"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,336.00"	"$6,400.00"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191528	EAP	CPT® 67911		Bil Correction Of Lid Retraction	BOTH IP/OP	"$6,479.00 "	"$4,794.46"	$0.00	"$5,202.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,350.22"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$5,150.38"	"$5,202.40"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191529	EAP	CPT® 38794		Access Thoracic Lymph Duct	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$2,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$2,000.00"	"$1,584.00"	"$1,600.00"	$0.00	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191530	EAP	CPT® 67025		Bil Inj Substitute Pars Plana/limbl W/wo Asp Spx	BOTH IP/OP	"$13,059.00 "	"$9,663.66"	$0.00	"$10,447.20"	"$2,321.55"	"$2,321.55"	"$2,022.30"	"$2,022.30"	"$2,033.69"	"$2,721.82"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,992.71"	"$2,721.50"	"$1,295.26"	"$1,871.00"	"$1,871.00"	"$2,027.80"	"$2,255.00"	"$10,342.73"	"$10,447.20"	"$2,817.36"	$0.00	"$2,817.36"	$651.56	$643.81	$643.81	"$2,078.99"	"$1,931.24"	$0.00	$0.00	$0.00	$0.00
36191531	EAP	CPT® 67505		Bil Retrobulbar Injection Alcohol	BOTH IP/OP	"$1,265.00 "	$936.10	$0.00	"$1,265.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.63	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$1,001.88"	"$1,012.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191532	EAP	CPT® 68200		Bil Subconjunctival Injection	BOTH IP/OP	$393.00 	$290.82	$0.00	$393.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.90	$0.00	$0.00	$0.00	$0.00	$393.00	$311.26	$314.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191533	EAP	CPT® 67515		Bil Injection Medication/other Subst Tenon Capsule	BOTH IP/OP	"$2,730.00 "	"$2,020.20"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$569.00	$0.00	$0.00	$0.00	$250.42	$568.93	$162.77	"$1,871.00"	"$1,871.00"	$271.28	"$2,255.00"	"$2,162.16"	"$2,184.00"	$376.91	$0.00	$376.91	$137.37	$60.20	$60.20	$434.62	$258.37	$0.00	$0.00	$0.00	$0.00
36191534	EAP	CPT® 36831		Thrmbc Opn Arven Fstl W/o Revj Dial Grf	BOTH IP/OP	"$14,743.00 "	"$10,909.82"	$0.00	"$11,794.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,072.44"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$11,676.46"	"$11,794.40"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191535	EAP	CPT® 33016		Pericardiocentesis W/imaging	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,385.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.72	$0.00	$0.00	$0.00	$0.00	"$1,385.00"	"$1,096.92"	"$1,108.00"	$0.00	$906.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191536	EAP	CPT® 33017		Perq Prcrd Drg 6yr+ W/o Congenital Car Anomaly	BOTH IP/OP	$405.00 	$299.70	$0.00	$321.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$201.00	$318.38	$321.60	$0.00	$263.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191537	EAP	CPT® 33018		Perq Prcrd Drg 0-5yr/any Age W/cgen Car Anomaly	BOTH IP/OP	$405.00 	$299.70	$0.00	$321.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$201.00	$318.38	$321.60	$0.00	$263.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191540	EAP	CPT® 62328		Dx Lumbar Puncture W/fl Or Ct Guidance	BOTH IP/OP	"$1,571.00 "	"$1,162.54"	$0.00	"$1,571.00"	"$1,571.00"	"$1,571.00"	$618.38	$618.38	$621.87	$327.44	$0.00	$0.00	$0.00	$608.20	$327.40	$395.33	"$1,571.00"	"$1,571.00"	$626.89	"$1,493.00"	"$1,182.46"	"$1,194.40"	$870.98	"$1,021.15"	$870.98	$252.51	$93.39	$93.39	$237.69	$597.04	$0.00	$0.00	$0.00	$0.00
36191541	EAP	CPT® 62329		Therapeutic Lumbar Puncture W/fl Or Ct Guidance	BOTH IP/OP	"$1,571.00 "	"$1,162.54"	$0.00	"$1,493.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$327.40	$0.00	$0.00	$0.00	$0.00	"$1,493.00"	"$1,182.46"	"$1,194.40"	$0.00	"$1,021.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191550	EAP	CPT® 64451		Injection Aa&/strd Nerves Nrvtg Si Joint W/img	BOTH IP/OP	"$1,547.00 "	"$1,144.78"	$0.00	"$1,547.00"	"$1,547.00"	"$1,547.00"	$618.38	$618.38	$621.87	$0.00	$0.00	$0.00	$0.00	$0.00	$322.39	$0.00	$0.00	$0.00	$626.89	"$1,493.00"	"$1,182.46"	"$1,194.40"	$870.98	"$1,005.55"	$870.98	$204.40	$82.58	$82.58	$237.69	$597.04	$0.00	$0.00	$0.00	$0.00
36191551	EAP	CPT® 64454		Injection Aa&/strd Genicular Nrv Branches W/img	BOTH IP/OP	"$1,547.00 "	"$1,144.78"	$0.00	"$1,797.25"	"$1,547.00"	"$1,547.00"	$618.38	$618.38	$621.87	$322.43	$0.00	$0.00	$0.00	$608.20	$322.39	$395.33	"$1,547.00"	"$1,547.00"	$626.89	"$1,493.00"	"$1,182.46"	"$1,194.40"	$870.98	"$1,797.25"	$870.98	$206.45	$85.10	$85.10	$237.69	$597.04	$0.00	$0.00	$0.00	$0.00
36191552	EAP	CPT® 64624		Destruction Neurolytic Agt Genicular Nerve W/img	BOTH IP/OP	"$4,084.00 "	"$3,022.16"	$0.00	"$4,940.00"	"$2,321.55"	"$2,321.55"	"$1,709.97"	"$1,709.97"	"$1,719.60"	$851.21	$0.00	$0.00	$0.00	"$1,681.44"	$851.11	"$1,092.94"	"$1,871.00"	"$1,871.00"	"$1,724.40"	"$2,255.00"	"$3,251.95"	"$3,284.80"	"$2,395.83"	"$4,940.00"	"$2,395.83"	$0.00	$152.52	$152.52	$653.68	"$1,642.29"	$0.00	$0.00	$0.00	$0.00
36191553	EAP	CPT® 64625		Radiofrequency Abltj Nrv Nrvtg Si Jt W/img Gdn	BOTH IP/OP	"$4,084.00 "	"$3,022.16"	$0.00	"$4,084.00"	"$3,735.90"	"$3,735.90"	"$1,709.97"	"$1,709.97"	"$1,719.60"	$851.21	$0.00	$0.00	$0.00	"$1,681.44"	$851.11	"$1,092.94"	"$4,084.00"	"$4,084.00"	"$1,724.40"	"$2,255.00"	"$3,251.95"	"$3,284.80"	"$2,395.83"	"$2,654.60"	"$2,395.83"	$0.00	$201.56	$201.56	$653.68	"$1,642.29"	$0.00	$0.00	$0.00	$0.00
36191555	EAP	CPT® 64405		Bil Greater Occipital Nerve Inj	BOTH IP/OP	"$4,971.00 "	"$3,678.54"	$0.00	"$3,836.80"	"$2,321.55"	"$2,321.55"	$254.43	$254.43	$255.86	"$1,036.08"	$0.00	$0.00	$0.00	$250.31	"$1,035.96"	$162.70	"$1,871.00"	"$1,871.00"	$262.54	"$2,255.00"	"$3,798.43"	"$3,836.80"	$364.76	"$1,199.00"	$364.76	$102.34	$55.88	$55.88	$763.52	$250.04	$0.00	$0.00	$0.00	$0.00
36191556	EAP	CPT® 52224		Cystourethroscopy W/ Fulguration <.5cm Lesn	BOTH IP/OP	"$3,924.00 "	"$2,903.76"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$817.86	$0.00	$0.00	$0.00	"$2,948.43"	$817.76	"$1,916.48"	"$2,836.00"	"$2,836.00"	"$1,776.76"	"$2,327.00"	"$3,139.49"	"$3,171.20"	"$2,468.57"	"$3,250.00"	"$2,468.57"	$272.85	$212.40	$212.40	$631.07	"$1,692.15"	$0.00	$0.00	$0.00	$0.00
36191560	EAP	CPT® 41008		Submandibular Abscess	BOTH IP/OP	"$4,919.00 "	"$3,640.06"	$0.00	"$3,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,025.12"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,935.45"	"$3,975.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191561	EAP	CPT® 42000		"I&d Abscess Plate, Uvula"	BOTH IP/OP	$283.00 	$209.42	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$58.98	$0.00	$0.00	$0.00	$202.80	$58.98	$131.82	$283.00	$283.00	$204.24	$286.00	$226.51	$228.80	$283.76	"$1,750.00"	$283.76	$95.00	$107.41	$107.41	$45.53	$194.51	$0.00	$0.00	$0.00	$0.00
36191562	EAP	CPT® 46050		I & D Perianal Abcess	BOTH IP/OP	"$3,991.00 "	"$2,953.34"	$0.00	"$3,224.80"	"$2,321.55"	"$2,321.55"	$772.82	$772.82	$777.17	$831.82	"$1,257.08"	"$1,257.08"	"$1,305.43"	$760.65	$831.72	$494.42	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$3,192.55"	"$3,224.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191563	EAP	CPT® 31233		"Nasal/sinus Endoscopy, Dx"	BOTH IP/OP	$661.00 	$489.14	$0.00	$661.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.75	$0.00	$0.00	$0.00	$0.00	$661.00	$523.51	$528.80	$0.00	$661.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191564	EAP	CPT® 45385		Colonoscopy W/lesion Removal	BOTH IP/OP	"$3,182.00 "	"$2,354.68"	$0.00	"$2,836.00"	"$2,753.10"	"$2,753.10"	"$1,009.84"	"$1,009.84"	"$1,015.53"	$0.00	"$1,541.95"	"$1,541.95"	"$1,601.25"	$993.84	$663.13	$646.00	"$2,836.00"	"$2,836.00"	"$1,007.17"	"$2,327.00"	"$2,314.22"	"$2,337.60"	"$1,399.33"	"$2,500.00"	"$1,399.33"	$450.95	$265.02	$265.02	$465.18	$959.21	$0.00	$0.00	$0.00	$0.00
36191565	EAP	CPT® 43235		"Upper Gi Endoscopy, Diagnostic"	BOTH IP/OP	"$4,485.00 "	"$3,318.90"	$0.00	"$3,289.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$775.94	$934.67	$504.36	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$3,256.70"	"$3,289.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191566	EAP	CPT® 31515		Laryngoscopy For Aspiration	BOTH IP/OP	"$7,668.00 "	"$5,674.32"	$0.00	"$5,632.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,598.01"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,575.68"	"$5,632.00"	$0.00	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191567	EAP	CPT® 45305		Proctosigmoidoscopy W/bx Single/multiple	BOTH IP/OP	"$5,063.00 "	"$3,746.62"	$0.00	"$4,091.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,055.13"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,050.29"	"$4,091.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191568	EAP	CPT® 45300		Proctosigmoidoscopy Dx	BOTH IP/OP	"$2,337.00 "	"$1,729.38"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$487.03	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,869.91"	"$1,888.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191569	EAP	CPT® 96373		Iintra-arterial Injection	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191570	EAP	CPT® 24201		REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP	BOTH IP/OP	"$9,504.00 "	"$7,032.96"	$0.00	"$7,603.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,325.71"	"$2,327.00"	"$7,527.17"	"$7,603.20"	"$3,231.26"	$0.00	"$3,231.26"	$360.96	$376.65	$376.65	"$1,513.04"	"$2,214.96"	$0.00	$0.00	$0.00	$0.00
36191571	EAP	CPT® 42809		REMOVE PHARYNX FOREIGN BODY	BOTH IP/OP	$500.00 	$370.00	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.00	$396.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191573	EAP	CPT® 43247		Egd Flexible Foreign Body Removal	BOTH IP/OP	"$4,228.00 "	"$3,128.72"	$0.00	"$3,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.12	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,376.30"	"$3,410.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191585	EAP	CPT® 26740		Clsd Tx Artclr Fx Mtcrphlngl/iphal Jt W/o Manip	BOTH IP/OP	$795.00 	$588.30	$0.00	$795.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.68	$0.00	$0.00	$0.00	$0.00	$795.00	$629.64	$636.00	$0.00	$795.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36191586	EAP	CPT® 10081		I&d Pilonidal Cyst Complex	BOTH IP/OP	"$3,502.00 "	"$2,591.48"	$0.00	"$2,772.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$729.82	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,745.07"	"$2,772.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000023	EAP	Custom 37000023		Level 1 1st 30 Min	BOTH IP/OP	"$1,003.00 "	$742.22	$0.00	$852.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$744.43	$744.43	$773.11	$0.00	$209.03	$0.00	$0.00	$0.00	$0.00	$533.00	$844.27	$852.80	$0.00	$703.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000024	EAP	Custom 37000024		Level 2 1st 30 Min	BOTH IP/OP	"$1,766.00 "	"$1,306.84"	$0.00	"$1,361.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,310.73"	"$1,310.73"	"$1,361.23"	$0.00	$368.03	$0.00	$0.00	$0.00	$0.00	$736.50	"$1,166.62"	"$1,178.40"	$0.00	"$1,239.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000025	EAP	Custom 37000025		Level 3 1st 30 Min	BOTH IP/OP	"$2,608.00 "	"$1,929.92"	$0.00	"$2,010.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,935.66"	"$1,935.66"	"$2,010.25"	$0.00	$543.51	$0.00	$0.00	$0.00	$0.00	"$1,087.50"	"$1,722.60"	"$1,740.00"	$0.00	"$1,831.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000026	EAP	Custom 37000026		Level 4 1st 30 Min	BOTH IP/OP	"$3,052.00 "	"$2,258.48"	$0.00	"$2,352.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.19"	"$2,265.19"	"$2,352.48"	$0.00	$636.04	$0.00	$0.00	$0.00	$0.00	"$1,272.50"	"$2,015.64"	"$2,036.00"	$0.00	"$2,142.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000027	EAP	Custom 37000027		Level 5 1st 30 Min	BOTH IP/OP	"$3,572.00 "	"$2,643.28"	$0.00	"$2,753.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,651.14"	"$2,651.14"	"$2,753.30"	$0.00	$744.40	$0.00	$0.00	$0.00	$0.00	"$1,489.50"	"$2,359.37"	"$2,383.20"	$0.00	"$2,507.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000028	EAP	Custom 37000028		Level 1 Add 15 Min	BOTH IP/OP	$408.00 	$301.92	$0.00	$347.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.82	$302.82	$314.49	$0.00	$85.03	$0.00	$0.00	$0.00	$0.00	$217.00	$343.73	$347.20	$0.00	$286.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000029	EAP	Custom 37000029		Level 2 Add 15 Min	BOTH IP/OP	$667.00 	$493.58	$0.00	$514.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$495.05	$495.05	$514.12	$0.00	$139.00	$0.00	$0.00	$0.00	$0.00	$278.00	$440.35	$444.80	$0.00	$468.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000030	EAP	Custom 37000030		Level 3 Add 15 Min	BOTH IP/OP	"$1,085.00 "	$802.90	$0.00	$836.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$805.29	$805.29	$836.32	$0.00	$226.11	$0.00	$0.00	$0.00	$0.00	$426.50	$675.58	$682.40	$0.00	$761.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000031	EAP	Custom 37000031		Level 4 Add 15 Min	BOTH IP/OP	"$1,203.00 "	$890.22	$0.00	$927.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$892.87	$892.87	$927.27	$0.00	$250.71	$0.00	$0.00	$0.00	$0.00	$502.00	$795.17	$803.20	$0.00	$844.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000032	EAP	Custom 37000032		Level 5 Add 15 Min	BOTH IP/OP	"$1,376.00 "	"$1,018.24"	$0.00	"$1,060.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,021.27"	"$1,021.27"	"$1,060.62"	$0.00	$286.76	$0.00	$0.00	$0.00	$0.00	$573.50	$908.42	$917.60	$0.00	$965.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000033	EAP	CPT® 99151		Mod Sed Same Phys/qhp Initial 15 Mins; <5 Yrs	BOTH IP/OP	$504.00 	$372.96	$0.00	$388.48	$273.67	$273.67	$0.00	$0.00	$0.00	$105.05	$374.07	$374.07	$388.48	$0.00	$105.03	$0.00	$298.12	$298.12	$0.00	$210.00	$332.64	$336.00	$0.00	$327.60	$0.00	$74.17	$24.16	$24.16	$66.86	$0.00	$0.00	$0.00	$0.00	$0.00
37000034	EAP	CPT® 99152		Mod Sed Same Phys/qhp Initial 15 Mins 5/> Yrs	BOTH IP/OP	$504.00 	$372.96	$0.00	$753.35	$273.67	$273.67	$0.00	$0.00	$0.00	$105.05	$374.07	$374.07	$388.48	$0.00	$105.03	$0.00	$298.12	$298.12	$0.00	$210.00	$332.64	$336.00	$0.00	$753.35	$0.00	$49.33	$12.62	$12.62	$66.86	$0.00	$0.00	$0.00	$0.00	$0.00
37000035	EAP	CPT® 99153		Mod Sed Same Phys/qhp Each Addl 15 Mins	BOTH IP/OP	$138.00 	$102.12	$0.00	$375.70	$74.93	$74.93	$0.00	$0.00	$0.00	$28.76	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$81.63	$81.63	$0.00	$57.50	$91.08	$92.00	$0.00	$375.70	$0.00	$10.55	$10.80	$10.80	$18.31	$0.00	$0.00	$0.00	$0.00	$0.00
37000036	EAP	CPT® 99155		Mod Sed Other Phys/qhp Initial 15 Mins; <5 Yrs	BOTH IP/OP	$504.00 	$372.96	$0.00	$388.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.07	$374.07	$388.48	$0.00	$105.03	$0.00	$0.00	$0.00	$0.00	$210.00	$332.64	$336.00	$0.00	$327.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000037	EAP	CPT® 99156		Mod Sed Other Phys/qhp Initial 15 Mins 5/> Yrs	BOTH IP/OP	$504.00 	$372.96	$0.00	$388.48	$273.67	$273.67	$0.00	$0.00	$0.00	$105.05	$374.07	$374.07	$388.48	$0.00	$105.03	$0.00	$298.12	$298.12	$0.00	$210.00	$332.64	$336.00	$0.00	$327.60	$0.00	$73.17	$80.07	$80.07	$66.86	$0.00	$0.00	$0.00	$0.00	$0.00
37000038	EAP	CPT® 99157		Mod Sed Other Phys/qhp Each Addl 15 Mins	BOTH IP/OP	$138.00 	$102.12	$0.00	$106.37	$74.93	$74.93	$0.00	$0.00	$0.00	$28.76	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$81.63	$81.63	$0.00	$57.50	$91.08	$92.00	$0.00	$89.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000123	EAP	Custom 37000123		Epidural Fee	BOTH IP/OP	"$2,316.00 "	"$1,713.84"	$0.00	"$1,785.17"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.94"	"$1,718.94"	"$1,785.17"	$0.00	$482.65	$0.00	$0.00	$0.00	$0.00	$966.00	"$1,530.14"	"$1,545.60"	$0.00	"$1,625.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37000124	EAP			Ea Add’l 60-90 Min	BOTH IP/OP	$520.00 	$384.80	$0.00	$400.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$385.94	$385.94	$400.82	$0.00	$108.37	$0.00	$0.00	$0.00	$0.00	$217.00	$343.73	$347.20	$0.00	$365.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37825171	EAP	CPT® 36430		"Transfusion, Blood"	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.18	"$2,255.00"	"$2,009.30"	"$2,029.60"	$540.71	$0.00	$540.71	$38.59	$35.66	$35.66	$403.89	$370.65	$0.00	$0.00	$0.00	$0.00
39000001	EAP	HCPCS P9010		Whole Blood Unit	BOTH IP/OP	"$2,098.00 "	"$1,552.52"	$0.00	"$1,617.14"	"$1,139.21"	"$1,139.21"	$151.64	$151.64	$153.17	$437.28	"$1,557.14"	"$1,557.14"	"$1,617.14"	$150.14	$437.22	$97.59	"$1,240.97"	"$1,240.97"	$133.56	$956.00	"$1,514.30"	"$1,529.60"	$184.44	"$1,363.70"	$184.44	$299.23	$0.00	$0.00	$304.39	$127.20	$0.00	$0.00	$0.00	$0.00
39000002	EAP	HCPCS P9012		Pooled Cryo	BOTH IP/OP	$904.00 	$668.96	$0.00	$696.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$670.95	$670.95	$696.80	$0.00	$188.39	$0.00	$0.00	$0.00	$0.00	$412.00	$652.61	$659.20	$0.00	$587.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39000003	EAP	HCPCS P9016		Rbc Leukored Unit	BOTH IP/OP	"$1,327.00 "	$981.98	$0.00	"$1,022.85"	$720.56	$720.56	$190.47	$190.47	$192.39	$276.58	$984.90	$984.90	"$1,022.85"	$188.51	$276.55	$122.53	$784.92	$784.92	$197.77	$604.50	$957.53	$967.20	$273.11	"$1,013.35"	$273.11	$189.21	$0.00	$0.00	$192.47	$188.35	$0.00	$0.00	$0.00	$0.00
39000004	EAP	HCPCS P9017		Fresh Frozen Plasma Unit	BOTH IP/OP	$629.00 	$465.46	$0.00	$484.83	$0.00	$0.00	$0.00	$0.00	$84.40	$131.10	$466.84	$466.84	$484.83	$82.66	$131.08	$53.73	$372.05	$372.05	$0.00	$286.50	$453.82	$458.40	$0.00	$408.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39000012	EAP	HCPCS P9035		Platelet Pheresis Leukored Unit	BOTH IP/OP	"$4,769.00 "	"$3,529.06"	$0.00	"$3,675.95"	"$2,589.57"	"$2,589.57"	$491.94	$491.94	$496.91	$993.98	"$3,539.55"	"$3,539.55"	"$3,675.95"	$486.80	$993.86	$316.42	"$2,820.86"	"$2,820.86"	$0.00	"$2,173.00"	"$3,442.03"	"$3,476.80"	$0.00	"$3,099.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39000013	EAP	HCPCS P9037		Platelet Pheresis Leukored Irr Unit	BOTH IP/OP	"$5,621.00 "	"$4,159.54"	$0.00	"$4,332.67"	"$3,052.20"	"$3,052.20"	$624.02	$624.02	$630.32	"$1,171.56"	"$4,171.91"	"$4,171.91"	"$4,332.67"	$617.33	"$1,171.42"	$401.26	"$3,094.73"	"$3,094.73"	$666.42	"$2,561.00"	"$4,056.62"	"$4,097.60"	$920.30	"$3,653.65"	$920.30	$801.59	$0.00	$0.00	$815.42	$634.69	$0.00	$0.00	$0.00	$0.00
39000016	EAP	HCPCS P9040		Rbc Leukored Irr Unit	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,755.11"	"$1,236.41"	"$1,236.41"	$263.37	$263.37	$266.03	$474.58	"$1,689.99"	"$1,689.99"	"$1,755.11"	$260.55	$474.53	$169.36	"$1,346.85"	"$1,346.85"	$275.90	"$1,037.50"	"$1,643.40"	"$1,660.00"	$381.00	"$1,480.05"	$381.00	$324.74	$0.00	$0.00	$330.34	$262.76	$0.00	$0.00	$0.00	$0.00
39000017	EAP	HCPCS P9044		Ffp-cryo Poor Plasma	BOTH IP/OP	$337.00 	$249.38	$0.00	$259.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.12	$250.12	$259.76	$0.00	$70.23	$0.00	$0.00	$0.00	$0.00	$153.50	$243.14	$245.60	$0.00	$219.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39000021	EAP	HCPCS P9054		Blood Leukored Deglyc Washed Unit	BOTH IP/OP	"$2,064.00 "	"$1,527.36"	$0.00	"$1,651.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,531.90"	"$1,531.90"	"$1,590.93"	$0.00	$430.14	$0.00	$0.00	$0.00	$0.00	"$1,032.00"	"$1,634.69"	"$1,651.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39000024	EAP	HCPCS P9057		Blood Leukored Deglyc Washed Irr Unit	BOTH IP/OP	"$2,718.00 "	"$2,011.32"	$0.00	"$2,174.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,017.30"	"$2,017.30"	"$2,095.03"	$0.00	$566.43	$0.00	$0.00	$0.00	$0.00	"$1,359.00"	"$2,152.66"	"$2,174.40"	$0.00	"$1,753.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39000026	EAP	HCPCS P9059		Ffp-frozen 24 Hour	BOTH IP/OP	$776.00 	$574.24	$0.00	$598.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.95	$575.95	$598.14	$0.00	$161.72	$0.00	$0.00	$0.00	$0.00	$353.50	$559.94	$565.60	$0.00	$413.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39000040	EAP	HCPCS P9016		Rbc-wbc Reduced	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	"$1,013.35"	$656.49	$656.49	$190.47	$190.47	$192.39	$251.99	$897.32	$897.32	$931.90	$188.51	$251.96	$122.53	$715.12	$715.12	$197.77	$604.50	$957.53	$967.20	$273.11	"$1,013.35"	$273.11	$189.21	$0.00	$0.00	$192.47	$188.35	$0.00	$0.00	$0.00	$0.00
39000052	EAP	CPT® 86891		Non Cardiac Cell Saver	BOTH IP/OP	"$1,970.00 "	"$1,457.80"	$0.00	"$1,576.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.55	$0.00	$0.00	$0.00	$0.00	$234.84	"$1,560.24"	"$1,576.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39000060	EAP	HCPCS P9011		Rbc Leukored Aliquot	BOTH IP/OP	$396.00 	$293.04	$0.00	$381.55	$215.03	$215.03	$149.18	$149.18	$150.69	$82.54	$293.91	$293.91	$305.24	$147.58	$82.53	$95.93	$234.23	$234.23	$141.20	$180.50	$285.91	$288.80	$195.00	$381.55	$195.00	$56.50	$0.00	$0.00	$57.47	$134.48	$0.00	$0.00	$0.00	$0.00
39000061	EAP	HCPCS P9011		Rbc Leukored Irr Aliquot	BOTH IP/OP	$396.00 	$293.04	$0.00	$381.55	$215.03	$215.03	$149.18	$149.18	$150.69	$82.54	$293.91	$293.91	$305.24	$147.58	$82.53	$95.93	$234.23	$234.23	$141.20	$180.50	$285.91	$288.80	$195.00	$381.55	$195.00	$56.50	$0.00	$0.00	$57.47	$134.48	$0.00	$0.00	$0.00	$0.00
39000062	EAP	HCPCS P9011		"Platelet Pheresis, Lr Aliquot"	BOTH IP/OP	$800.00 	$592.00	$0.00	$616.64	$434.40	$434.40	$149.18	$149.18	$150.69	$166.74	$593.76	$593.76	$616.64	$147.58	$166.72	$95.93	$473.20	$473.20	$141.20	$364.50	$577.37	$583.20	$195.00	$381.55	$195.00	$114.09	$0.00	$0.00	$116.06	$134.48	$0.00	$0.00	$0.00	$0.00
39000063	EAP	HCPCS P9011		Platelet Pheresis Lr Irr Aliquot	BOTH IP/OP	$882.00 	$652.68	$0.00	$679.85	$478.93	$478.93	$149.18	$149.18	$150.69	$183.83	$654.62	$654.62	$679.85	$147.58	$183.81	$95.93	$521.70	$521.70	$141.20	$402.00	$636.77	$643.20	$195.00	$381.55	$195.00	$125.83	$0.00	$0.00	$128.00	$134.48	$0.00	$0.00	$0.00	$0.00
39000064	EAP	HCPCS P9012		Single Cryo	BOTH IP/OP	$396.00 	$293.04	$0.00	$587.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$293.91	$293.91	$305.24	$0.00	$82.53	$0.00	$0.00	$0.00	$0.00	$180.50	$285.91	$288.80	$0.00	$587.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39000065	EAP	HCPCS P9011		Thawed Ffp Aliquot	BOTH IP/OP	$396.00 	$293.04	$0.00	$381.55	$215.03	$215.03	$149.18	$149.18	$150.69	$82.54	$293.91	$293.91	$305.24	$147.58	$82.53	$95.93	$234.23	$234.23	$141.20	$180.50	$285.91	$288.80	$195.00	$381.55	$195.00	$56.50	$0.00	$0.00	$57.47	$134.48	$0.00	$0.00	$0.00	$0.00
39100001	EAP	CPT® 36430		"TRANSFUSION, BLOOD"	BOTH IP/OP	"$3,057.00 "	"$2,262.18"	$35.66	"$2,356.34"	"$2,321.55"	"$2,321.55"	$386.53	$386.53	$388.71	$637.16	"$2,268.91"	"$2,268.91"	"$2,356.34"	$380.55	$637.08	$247.36	"$1,871.00"	"$1,871.00"	$389.18	"$2,255.00"	"$2,009.30"	"$2,029.60"	$540.71	"$1,750.00"	$540.71	$38.59	$35.66	$35.66	$403.89	$370.65	$0.00	$0.00	$0.00	$0.00
39100005	EAP	CPT® 36430		"Transfusion, Blood Or Bld Comp"	BOTH IP/OP	"$2,537.00 "	"$1,877.38"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.18	"$2,255.00"	"$2,009.30"	"$2,029.60"	$540.71	$0.00	$540.71	$38.59	$35.66	$35.66	$403.89	$370.65	$0.00	$0.00	$0.00	$0.00
40000002	EAP	CPT® 76376		3d Rendering W/o Postproce Nir	BOTH IP/OP	"$3,154.00 "	"$2,333.96"	$0.00	"$3,091.20"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$657.37	"$2,340.90"	"$2,340.90"	"$2,431.10"	$0.00	$657.29	$0.00	"$1,865.59"	"$1,865.59"	$0.00	$927.36	"$3,060.29"	"$3,091.20"	$0.00	"$2,200.00"	$0.00	$140.81	$13.33	$13.33	$615.15	$0.00	$0.00	$0.00	$0.00	$0.00
40000003	EAP	CPT® 76377		3d Rendering W/postprocess Nir	BOTH IP/OP	"$3,154.00 "	"$2,333.96"	$0.00	"$3,306.00"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$657.37	"$2,340.90"	"$2,340.90"	"$2,431.10"	$0.00	$657.29	$0.00	"$1,865.59"	"$1,865.59"	$0.00	$927.36	"$3,060.29"	"$3,091.20"	$0.00	"$3,306.00"	$0.00	$186.77	$32.41	$32.41	$615.15	$0.00	$0.00	$0.00	$0.00	$0.00
40100003	EAP	CPT® 77061		Dx Digital Breast Tomosynthesis; Unilateral	BOTH IP/OP	$156.00 	$115.44	$0.00	$310.17	$156.00	$156.00	$25.21	$25.21	$55.28	$32.51	$298.68	$298.68	$310.17	$25.21	$32.51	$16.39	$92.27	$92.27	$26.75	$36.00	$118.80	$120.00	$90.00	$156.00	$90.00	$23.48	$0.00	$0.00	$23.88	$25.21	$0.00	$0.00	$0.00	$0.00
40100008	EAP	CPT® 77062		Dx Digital Breast Tomosynthesis; Bilateral	BOTH IP/OP	$275.00 	$203.50	$0.00	$275.00	$275.00	$275.00	$25.21	$25.21	$55.28	$48.56	$234.47	$234.47	$243.49	$25.21	$48.56	$16.39	$137.82	$137.82	$26.75	$36.00	$118.80	$120.00	$90.00	$275.00	$90.00	$23.48	$0.00	$0.00	$23.88	$25.21	$0.00	$0.00	$0.00	$0.00
40100012	EAP	CPT® 77065		Dx Mammo Incl Cad Uni	BOTH IP/OP	$337.00 	$249.38	$54.13	$776.00	$303.12	$303.12	$94.36	$94.36	$111.20	$70.24	$236.28	$236.28	$245.37	$94.36	$70.23	$61.33	$199.34	$199.34	$100.65	$81.60	$269.28	$272.00	$94.36	$776.00	$94.36	$130.40	$94.36	$94.36	$54.13	$94.36	$0.00	$0.00	$0.00	$0.00
40100013	EAP	CPT® 77066		Dx Mammo Incl Cad Bi	BOTH IP/OP	$416.00 	$307.84	$66.86	"$1,039.00"	$384.54	$384.54	$120.30	$120.30	$140.79	$86.70	$302.23	$302.23	$313.86	$120.30	$86.69	$78.20	$246.06	$246.06	$128.54	$100.80	$332.64	$336.00	$120.30	"$1,039.00"	$120.30	$163.40	$120.30	$120.30	$66.86	$120.30	$0.00	$0.00	$0.00	$0.00
40200001	EAP	CPT® 76506		Ultrasound Cranial	BOTH IP/OP	$621.00 	$459.54	$0.00	$496.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.65	$205.65	$213.56	$0.00	$129.42	$0.00	$0.00	$0.00	$0.00	$149.04	$491.83	$496.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200002	EAP	CPT® 76641		"Ultrasound, Breast,unilateal,complete"	BOTH IP/OP	"$1,344.00 "	$994.56	$0.00	$981.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.16	$179.16	$186.05	$0.00	$280.09	$0.00	$0.00	$0.00	$0.00	$294.48	$971.78	$981.60	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200003	EAP	CPT® 76506		Us Cranial Complete	BOTH IP/OP	$615.00 	$455.10	$0.00	$496.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.65	$205.65	$213.56	$0.00	$128.17	$0.00	$0.00	$0.00	$0.00	$149.04	$491.83	$496.80	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200005	EAP	CPT® 76512		"Ophth Us, B W/non-quant A"	BOTH IP/OP	$759.00 	$561.66	$21.61	$613.60	$211.15	$211.15	$106.02	$106.02	$106.62	$158.19	$104.58	$104.58	$108.60	$104.44	$158.18	$67.89	$448.95	$448.95	$112.41	$184.08	$607.46	$613.60	$156.18	$183.00	$156.18	$93.72	$21.61	$21.61	$122.11	$107.06	$0.00	$0.00	$0.00	$0.00
40200006	EAP	CPT® 76514		"Echo Exam Of Eye, Thickness"	BOTH IP/OP	$287.00 	$212.38	$3.96	$224.00	$34.66	$34.66	$24.06	$24.06	$24.19	$59.82	$8.91	$8.91	$9.26	$23.64	$59.81	$15.37	$169.76	$169.76	$23.06	$67.20	$221.76	$224.00	$32.04	$183.00	$32.04	$11.96	$3.96	$3.96	$44.58	$21.96	$0.00	$0.00	$0.00	$0.00
40200007	EAP	CPT® 76519		Ultrasonography	BOTH IP/OP	$759.00 	$561.66	$0.00	$613.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.71	$108.71	$112.89	$0.00	$158.18	$0.00	$0.00	$0.00	$112.41	$184.08	$607.46	$613.60	$156.18	$183.00	$156.18	$76.68	$36.02	$36.02	$122.11	$107.06	$0.00	$0.00	$0.00	$0.00
40200008	EAP	CPT® 76642		"Ultrasound, Breast,unilateal,limited"	BOTH IP/OP	"$1,265.00 "	$936.10	$50.40	$924.00	$202.36	$202.36	$78.77	$78.77	$79.21	$263.66	$137.30	$137.30	$142.58	$77.54	$263.63	$50.40	$748.25	$748.25	$80.04	$277.20	$914.76	$924.00	$111.21	$183.00	$111.21	$85.51	$54.39	$54.39	$183.88	$76.23	$0.00	$0.00	$0.00	$0.00
40200009	EAP	CPT® 76536		Soft Tiss/head&neck W/realtime	BOTH IP/OP	"$1,100.00 "	$814.00	$67.89	$888.80	$266.85	$266.85	$106.02	$106.02	$106.62	$229.27	$204.76	$204.76	$212.63	$104.44	$229.24	$67.89	$650.65	$650.65	$112.41	$266.64	$879.91	$888.80	$156.18	$183.00	$156.18	$82.37	$88.96	$88.96	$176.87	$107.06	$0.00	$0.00	$0.00	$0.00
40200011	EAP	CPT® 76536		Us Thyroid	BOTH IP/OP	"$1,100.00 "	$814.00	$67.89	$888.80	$266.85	$266.85	$106.02	$106.02	$106.62	$229.27	$204.76	$204.76	$212.63	$104.44	$229.24	$67.89	$650.65	$650.65	$112.41	$266.64	$879.91	$888.80	$156.18	$183.00	$156.18	$82.37	$88.96	$88.96	$176.87	$107.06	$0.00	$0.00	$0.00	$0.00
40200012	EAP	CPT® 76604		"Ultrasound Exam, Chest"	BOTH IP/OP	"$1,206.00 "	$892.44	$50.78	$880.80	$202.36	$202.36	$106.02	$106.02	$106.62	$251.36	$145.00	$145.00	$150.57	$104.44	$251.33	$67.89	$713.35	$713.35	$112.41	$264.24	$871.99	$880.80	$156.18	$183.00	$156.18	$77.40	$50.78	$50.78	$175.28	$107.06	$0.00	$0.00	$0.00	$0.00
40200014	EAP	CPT® 76604		"Us Chest, Rt W/image"	BOTH IP/OP	"$1,206.00 "	$892.44	$50.78	$880.80	$202.36	$202.36	$106.02	$106.02	$106.62	$251.36	$145.00	$145.00	$150.57	$104.44	$251.33	$67.89	$713.35	$713.35	$112.41	$264.24	$871.99	$880.80	$156.18	$183.00	$156.18	$77.40	$50.78	$50.78	$175.28	$107.06	$0.00	$0.00	$0.00	$0.00
40200018	EAP	CPT® 76700		"Us Abd, Rt W/image"	BOTH IP/OP	"$1,489.00 "	"$1,101.86"	$67.89	"$1,188.80"	$280.53	$280.53	$106.02	$106.02	$106.62	$310.34	$236.95	$236.95	$246.07	$104.44	$310.31	$67.89	$880.74	$880.74	$112.41	$356.64	"$1,176.91"	"$1,188.80"	$156.18	$183.00	$156.18	$115.39	$83.20	$83.20	$236.57	$107.06	$0.00	$0.00	$0.00	$0.00
40200020	EAP	CPT® 76705		Bladder Ultrasound	BOTH IP/OP	"$1,412.00 "	"$1,044.88"	$62.67	"$1,129.60"	$209.59	$209.59	$106.02	$106.02	$106.62	$294.30	$182.05	$182.05	$189.05	$104.44	$294.26	$67.89	$835.20	$835.20	$112.41	$338.88	"$1,118.30"	"$1,129.60"	$156.18	$183.00	$156.18	$83.78	$62.67	$62.67	$224.79	$107.06	$0.00	$0.00	$0.00	$0.00
40200021	EAP	CPT® 76705		"Us Abdominal, Ltd"	BOTH IP/OP	"$1,415.00 "	"$1,047.10"	$62.67	"$1,129.60"	$209.59	$209.59	$106.02	$106.02	$106.62	$294.92	$182.05	$182.05	$189.05	$104.44	$294.89	$67.89	$836.97	$836.97	$112.41	$338.88	"$1,118.30"	"$1,129.60"	$156.18	$183.00	$156.18	$83.78	$62.67	$62.67	$224.79	$107.06	$0.00	$0.00	$0.00	$0.00
40200022	EAP	CPT® 76641		Ultrasound Breast Rt Complete	BOTH IP/OP	"$1,168.00 "	$864.32	$0.00	$981.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.16	$179.16	$186.05	$0.00	$243.41	$0.00	$0.00	$0.00	$0.00	$294.48	$971.78	$981.60	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200023	EAP	CPT® 76770		"Us Retroperit, Rt W/image; Complete"	BOTH IP/OP	"$1,417.00 "	"$1,048.58"	$67.89	"$1,144.80"	$259.59	$259.59	$106.02	$106.02	$106.62	$295.34	$231.49	$231.49	$240.40	$104.44	$295.30	$67.89	$838.16	$838.16	$112.41	$343.44	"$1,133.35"	"$1,144.80"	$156.18	$183.00	$156.18	$112.23	$77.44	$77.44	$227.82	$107.06	$0.00	$0.00	$0.00	$0.00
40200025	EAP	CPT® 76775		"Us Retroper, Rt W/image Ltd"	BOTH IP/OP	"$1,302.00 "	$963.48	$30.25	"$1,052.00"	$133.82	$133.82	$106.02	$106.02	$106.62	$271.37	$202.02	$202.02	$209.79	$104.44	$271.34	$67.89	$770.13	$770.13	$112.41	$315.60	"$1,041.48"	"$1,052.00"	$156.18	$183.00	$156.18	$83.43	$30.25	$30.25	$209.35	$107.06	$0.00	$0.00	$0.00	$0.00
40200027	EAP	CPT® 76800		Us Spine	BOTH IP/OP	"$1,019.00 "	$754.06	$0.00	$815.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.28	$170.28	$176.83	$0.00	$212.36	$0.00	$0.00	$0.00	$0.00	$244.56	$807.05	$815.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200028	EAP	CPT® 76642		Ultrasound Breast Rt Limited	BOTH IP/OP	"$1,082.00 "	$800.68	$50.40	$790.40	$202.36	$202.36	$78.77	$78.77	$79.21	$225.52	$137.30	$137.30	$142.58	$77.54	$225.49	$50.40	$640.00	$640.00	$80.04	$237.12	$782.50	$790.40	$111.21	$183.00	$111.21	$85.51	$54.39	$54.39	$157.29	$76.23	$0.00	$0.00	$0.00	$0.00
40200029	EAP	CPT® 76641		Ultrasound Breast Rt Complete	BOTH IP/OP	"$1,168.00 "	$864.32	$0.00	$981.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.16	$179.16	$186.05	$0.00	$243.41	$0.00	$0.00	$0.00	$0.00	$294.48	$971.78	$981.60	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200030	EAP	CPT® 76642		Ultrasound Breast Rt Limited	BOTH IP/OP	$941.00 	$696.34	$50.40	$790.40	$202.36	$202.36	$78.77	$78.77	$79.21	$196.13	$137.30	$137.30	$142.58	$77.54	$196.10	$50.40	$556.60	$556.60	$80.04	$237.12	$782.50	$790.40	$111.21	$183.00	$111.21	$85.51	$54.39	$54.39	$157.29	$76.23	$0.00	$0.00	$0.00	$0.00
40200031	EAP	CPT® 76941		Cordocentesis Us Guidance	BOTH IP/OP	$813.00 	$601.62	$0.00	$812.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.76	$147.76	$153.45	$0.00	$169.43	$0.00	$0.00	$0.00	$0.00	$243.60	$803.88	$812.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200034	EAP	CPT® 76801		"Ob Us <14 Wks, Single Fetus"	BOTH IP/OP	$554.00 	$409.96	$67.89	$444.00	$283.77	$283.77	$106.02	$106.02	$106.62	$115.47	$201.38	$201.38	$209.12	$104.44	$115.45	$67.89	$327.69	$327.69	$112.41	$133.20	$439.56	$444.00	$156.18	$183.00	$156.18	$90.90	$73.47	$73.47	$88.36	$107.06	$0.00	$0.00	$0.00	$0.00
40200035	EAP	CPT® 76885		Us Infant Hips Dynamic	BOTH IP/OP	"$1,786.00 "	"$1,321.64"	$0.00	"$1,785.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.37	$244.37	$253.77	$0.00	$372.20	$0.00	$0.00	$0.00	$0.00	$535.68	"$1,767.74"	"$1,785.60"	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200036	EAP	CPT® 76870		Us Scrotum	BOTH IP/OP	"$1,540.00 "	"$1,139.60"	$67.89	"$1,244.80"	$156.39	$156.39	$106.02	$106.02	$106.62	$320.97	$215.32	$215.32	$223.60	$104.44	$320.94	$67.89	$910.91	$910.91	$112.41	$373.44	"$1,232.35"	"$1,244.80"	$156.18	$183.00	$156.18	$90.49	$74.20	$74.20	$247.72	$107.06	$0.00	$0.00	$0.00	$0.00
40200037	EAP	CPT® 76872		"Ultrasound,transrectal"	BOTH IP/OP	$615.00 	$455.10	$67.89	$496.80	$217.64	$217.64	$106.02	$106.02	$106.62	$128.18	$263.43	$263.43	$273.56	$104.44	$128.17	$67.89	$363.77	$363.77	$112.41	$149.04	$491.83	$496.80	$156.18	$183.00	$156.18	$93.31	$125.34	$125.34	$98.86	$107.06	$0.00	$0.00	$0.00	$0.00
40200038	EAP	CPT® 76881		"US EXTREMITY, NON-VASC RT W/IM COM"	BOTH IP/OP	"$1,000.00 "	$740.00	$46.82	$808.00	$270.86	$270.86	$106.02	$106.02	$106.62	$208.43	$215.36	$215.36	$223.65	$104.44	$208.40	$67.89	$591.50	$591.50	$112.41	$242.40	$799.92	$808.00	$156.18	$183.00	$156.18	$109.54	$46.82	$46.82	$160.79	$107.06	$0.00	$0.00	$0.00	$0.00
40200039	EAP	CPT® 76805		Ob Us >/= 14 Wks Sngl Fetus	BOTH IP/OP	$679.00 	$502.46	$67.89	$544.80	$327.31	$327.31	$106.02	$106.02	$106.62	$141.52	$239.50	$239.50	$248.71	$104.44	$141.50	$67.89	$401.63	$401.63	$112.41	$163.44	$539.35	$544.80	$156.18	$183.00	$156.18	$130.22	$91.48	$91.48	$108.42	$107.06	$0.00	$0.00	$0.00	$0.00
40200040	EAP	CPT® 76886		Us Infant Hips Static	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,724.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.09	$172.09	$178.71	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$517.44	"$1,707.55"	"$1,724.80"	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200042	EAP	CPT® 76937		Us Guidance For Vascular Acess	BOTH IP/OP	"$1,573.00 "	"$1,164.02"	$0.00	"$1,211.20"	$71.76	$71.76	$0.00	$0.00	$0.00	$327.85	$51.04	$51.04	$53.01	$0.00	$327.81	$0.00	$930.43	$930.43	$0.00	$363.36	"$1,199.09"	"$1,211.20"	$0.00	$183.00	$0.00	$33.32	$22.33	$22.33	$241.03	$0.00	$0.00	$0.00	$0.00	$0.00
40200043	EAP	CPT® 76940		Ult Guide For Mon. Par.tis.abl	BOTH IP/OP	$912.00 	$674.88	$0.00	$911.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.95	$184.95	$192.07	$0.00	$190.06	$0.00	$0.00	$0.00	$0.00	$273.36	$902.09	$911.20	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200044	EAP	CPT® 76810		Ob Us >/= 14 Wks Additional Fetus	BOTH IP/OP	$666.00 	$492.84	$0.00	$533.60	$214.45	$214.45	$0.00	$0.00	$0.00	$138.81	$129.92	$129.92	$134.91	$0.00	$138.79	$0.00	$393.94	$393.94	$0.00	$160.08	$528.26	$533.60	$0.00	$183.00	$0.00	$258.70	$42.86	$42.86	$106.19	$0.00	$0.00	$0.00	$0.00	$0.00
40200045	EAP	CPT® 76942		NEEDLE PLACEMENT US GUIDE BIC	BOTH IP/OP	"$1,083.00 "	$801.42	$0.00	$875.20	$137.83	$137.83	$0.00	$0.00	$0.00	$225.72	$375.04	$375.04	$389.47	$0.00	$225.70	$0.00	$640.59	$640.59	$0.00	$262.56	$866.45	$875.20	$0.00	$183.00	$0.00	$92.25	$25.93	$25.93	$174.16	$0.00	$0.00	$0.00	$0.00	$0.00
40200047	EAP	CPT® 76946		Echo Guide Amniocentesis	BOTH IP/OP	$770.00 	$569.80	$0.00	$601.60	$75.00	$75.00	$0.00	$0.00	$0.00	$160.49	$64.66	$64.66	$67.14	$0.00	$160.47	$0.00	$455.46	$455.46	$0.00	$180.48	$595.58	$601.60	$0.00	$183.00	$0.00	$77.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200048	EAP	CPT® 76810		Ob Us >/= 14 Wks Additional Fetus	BOTH IP/OP	$667.00 	$493.58	$0.00	$533.60	$214.45	$214.45	$0.00	$0.00	$0.00	$139.02	$129.92	$129.92	$134.91	$0.00	$139.00	$0.00	$394.53	$394.53	$0.00	$160.08	$528.26	$533.60	$0.00	$183.00	$0.00	$258.70	$42.86	$42.86	$106.19	$0.00	$0.00	$0.00	$0.00	$0.00
40200049	EAP	CPT® 76998		Us Guidance Intraoperative	BOTH IP/OP	$864.00 	$639.36	$0.00	$691.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.63	$286.63	$297.66	$0.00	$180.06	$0.00	$0.00	$0.00	$0.00	$207.36	$684.29	$691.20	$0.00	$183.00	$0.00	$135.22	$0.00	$0.00	$137.55	$0.00	$0.00	$0.00	$0.00	$0.00
40200052	EAP	CPT® 76811		Us Preg Uterus 1st Gest	BOTH IP/OP	"$1,414.00 "	"$1,046.36"	$83.92	"$1,133.60"	$422.48	$422.48	$224.08	$224.08	$225.34	$294.71	$279.03	$279.03	$289.76	$220.56	$294.68	$143.36	$836.38	$836.38	$233.72	$340.08	"$1,122.26"	"$1,133.60"	$324.73	$183.00	$324.73	$237.77	$83.92	$83.92	$225.59	$222.60	$0.00	$0.00	$0.00	$0.00
40200054	EAP	CPT® 76813		"Ob Us Nuchal Meas, 1 Gest"	BOTH IP/OP	$927.00 	$685.98	$63.03	$743.20	$281.37	$281.37	$106.02	$106.02	$106.62	$193.21	$174.75	$174.75	$181.47	$104.44	$193.19	$67.89	$548.32	$548.32	$112.41	$222.96	$735.77	$743.20	$156.18	$183.00	$156.18	$118.66	$63.03	$63.03	$147.90	$107.06	$0.00	$0.00	$0.00	$0.00
40200055	EAP	CPT® 76814		"Ob Us Nuchal Meas, Add-on"	BOTH IP/OP	$555.00 	$410.70	$0.00	$444.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.72	$86.72	$90.05	$0.00	$115.66	$0.00	$0.00	$0.00	$0.00	$133.20	$439.56	$444.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200056	EAP	CPT® 76815		"Ob Us, Limited, Fetus(s)"	BOTH IP/OP	$554.00 	$409.96	$52.22	$444.00	$195.10	$195.10	$106.02	$106.02	$106.62	$115.47	$144.86	$144.86	$150.43	$104.44	$115.45	$67.89	$327.69	$327.69	$112.41	$133.20	$439.56	$444.00	$156.18	$183.00	$156.18	$87.30	$52.22	$52.22	$88.36	$107.06	$0.00	$0.00	$0.00	$0.00
40200062	EAP	CPT® 76816		Us Preg Uterus F/u	BOTH IP/OP	$554.00 	$409.96	$67.89	$444.00	$266.85	$266.85	$106.02	$106.02	$106.62	$115.47	$171.46	$171.46	$178.06	$104.44	$115.45	$67.89	$327.69	$327.69	$112.41	$133.20	$439.56	$444.00	$156.18	$183.00	$156.18	$71.66	$71.67	$71.67	$88.36	$107.06	$0.00	$0.00	$0.00	$0.00
40200064	EAP	CPT® 76817		Transvaginal U/s Pregnant	BOTH IP/OP	$593.00 	$438.82	$59.07	$475.20	$224.11	$224.11	$106.02	$106.02	$106.62	$123.60	$158.78	$158.78	$164.88	$104.44	$123.58	$67.89	$350.76	$350.76	$112.41	$142.56	$470.45	$475.20	$156.18	$183.00	$156.18	$94.59	$59.07	$59.07	$94.56	$107.06	$0.00	$0.00	$0.00	$0.00
40200065	EAP	CPT® 76882		"Ultrasound, Extremity, Nonvascular, Limited"	BOTH IP/OP	$649.00 	$480.26	$0.00	$795.60	$82.24	$82.24	$106.02	$106.02	$106.62	$10.15	$25.36	$25.36	$26.33	$104.44	$135.25	$67.89	$0.00	$0.00	$112.41	$157.44	$519.55	$524.80	$156.18	$795.60	$156.18	$28.65	$33.14	$33.14	$0.00	$107.06	$0.00	$0.00	$0.00	$0.00
40200067	EAP	CPT® 76818		Biophysical Profile W/nst	BOTH IP/OP	"$1,430.00 "	"$1,058.20"	$66.63	"$1,055.20"	$284.62	$284.62	$106.02	$106.02	$106.62	$298.05	$170.84	$170.84	$177.41	$104.44	$298.01	$67.89	$845.85	$845.85	$112.41	$316.56	"$1,044.65"	"$1,055.20"	$156.18	$183.00	$156.18	$101.11	$66.63	$66.63	$209.98	$107.06	$0.00	$0.00	$0.00	$0.00
40200069	EAP	CPT® 76819		Biophysical Profile W/o Nst	BOTH IP/OP	"$1,063.00 "	$786.62	$48.98	$784.80	$208.01	$208.01	$106.02	$106.02	$106.62	$221.56	$137.27	$137.27	$142.55	$104.44	$221.53	$67.89	$628.76	$628.76	$112.41	$235.44	$776.95	$784.80	$156.18	$183.00	$156.18	$96.45	$48.98	$48.98	$156.18	$107.06	$0.00	$0.00	$0.00	$0.00
40200071	EAP	CPT® 76820		Fetal Dopp Velocimetry Umb Art	BOTH IP/OP	"$1,583.00 "	"$1,171.42"	$21.97	"$1,168.00"	$111.28	$111.28	$106.02	$106.02	$106.62	$329.94	$73.41	$73.41	$76.24	$104.44	$329.90	$67.89	$936.34	$936.34	$112.41	$350.40	"$1,156.32"	"$1,168.00"	$156.18	$183.00	$156.18	$92.68	$21.97	$21.97	$232.43	$107.06	$0.00	$0.00	$0.00	$0.00
40200072	EAP	CPT® 76821		Fetal Dopp Velocimetry Mid Cer	BOTH IP/OP	"$1,583.00 "	"$1,171.42"	$56.55	"$1,168.00"	$214.47	$214.47	$106.02	$106.02	$106.62	$329.94	$156.00	$156.00	$162.00	$104.44	$329.90	$67.89	$936.34	$936.34	$112.41	$350.40	"$1,156.32"	"$1,168.00"	$156.18	$183.00	$156.18	$102.99	$56.55	$56.55	$232.43	$107.06	$0.00	$0.00	$0.00	$0.00
40200073	EAP	CPT® 76825		Fetal Echo (2d)	BOTH IP/OP	"$2,946.00 "	"$2,180.04"	$153.19	"$2,142.40"	$639.28	$639.28	$470.55	$470.55	$473.20	$614.02	$311.37	$311.37	$323.34	$462.81	$613.95	$300.83	"$1,742.56"	"$1,742.56"	$483.00	$642.72	"$2,120.98"	"$2,142.40"	$671.06	$183.00	$671.06	$153.19	$193.77	$193.77	$426.34	$460.00	$0.00	$0.00	$0.00	$0.00
40200074	EAP	CPT® 76826		"Fetal Echo, F/u, Repeat"	BOTH IP/OP	"$1,629.00 "	"$1,205.46"	$0.00	"$1,303.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.35	$184.35	$191.44	$0.00	$339.48	$0.00	$0.00	$0.00	$0.00	$390.96	"$1,290.17"	"$1,303.20"	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200075	EAP	CPT® 76827		Fetal Doppler Echo	BOTH IP/OP	"$2,946.00 "	"$2,180.04"	$0.00	"$2,142.40"	$174.13	$174.13	$106.02	$106.02	$106.62	$614.02	$107.91	$107.91	$112.06	$104.44	$613.95	$67.89	"$1,742.56"	"$1,742.56"	$112.41	$642.72	"$2,120.98"	"$2,142.40"	$156.18	$183.00	$156.18	$0.00	$45.38	$45.38	$426.34	$107.06	$0.00	$0.00	$0.00	$0.00
40200077	EAP	CPT® 76828		"Fetal Dopp Echo,repeat"	BOTH IP/OP	"$1,148.00 "	$849.52	$0.00	$918.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.18	$63.18	$65.61	$0.00	$239.24	$0.00	$0.00	$0.00	$0.00	$275.52	$909.22	$918.40	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200078	EAP	CPT® 76812		Ob Us Detailed Addl Fetus	BOTH IP/OP	$289.00 	$213.86	$0.00	$545.35	$289.00	$289.00	$0.00	$0.00	$0.00	$60.23	$0.00	$0.00	$0.00	$0.00	$60.23	$0.00	$170.94	$170.94	$0.00	$65.28	$215.42	$217.60	$0.00	$545.35	$0.00	$139.72	$111.65	$111.65	$43.30	$0.00	$0.00	$0.00	$0.00	$0.00
40200079	EAP	CPT® 76830		US TRANSVAGINAL	BOTH IP/OP	"$1,612.00 "	"$1,192.88"	$67.89	"$1,302.40"	$280.55	$280.55	$106.02	$106.02	$106.62	$335.98	$211.68	$211.68	$219.82	$104.44	$335.94	$67.89	$953.50	$953.50	$112.41	$390.72	"$1,289.38"	"$1,302.40"	$156.18	$183.00	$156.18	$92.96	$89.68	$89.68	$259.18	$107.06	$0.00	$0.00	$0.00	$0.00
40200083	EAP	CPT® 76831		Us Hysterosono W/wo Doppler	BOTH IP/OP	"$2,535.00 "	"$1,875.90"	$84.28	"$2,048.80"	$274.90	$274.90	$224.08	$224.08	$225.34	$528.36	$209.87	$209.87	$217.94	$220.56	$528.29	$143.36	"$1,499.45"	"$1,499.45"	$233.72	$614.64	"$2,028.31"	"$2,048.80"	$324.73	$183.00	$324.73	$94.72	$84.28	$84.28	$407.71	$222.60	$0.00	$0.00	$0.00	$0.00
40200085	EAP	CPT® 76856		Us Pelvis(non-ob)comp W/rt Img	BOTH IP/OP	"$1,593.00 "	"$1,178.82"	$67.89	"$1,287.20"	$253.12	$253.12	$106.02	$106.02	$106.62	$332.02	$212.59	$212.59	$220.76	$104.44	$331.98	$67.89	$942.26	$942.26	$112.41	$386.16	"$1,274.33"	"$1,287.20"	$156.18	$183.00	$156.18	$92.96	$76.36	$76.36	$256.15	$107.06	$0.00	$0.00	$0.00	$0.00
40200087	EAP	CPT® 76857		Us Pelvis Ltd/fu Non-ob	BOTH IP/OP	"$1,018.00 "	$753.32	$24.13	$822.40	$110.46	$110.46	$106.02	$106.02	$106.62	$212.18	$200.51	$200.51	$208.22	$104.44	$212.15	$67.89	$602.15	$602.15	$112.41	$246.72	$814.18	$822.40	$156.18	$183.00	$156.18	$59.67	$24.13	$24.13	$163.66	$107.06	$0.00	$0.00	$0.00	$0.00
40200092	EAP	CPT® 76516		Echo Exam Of Eye	BOTH IP/OP	$249.00 	$184.26	$25.57	$194.40	$178.94	$178.94	$106.02	$106.02	$106.62	$51.90	$97.82	$97.82	$101.58	$104.44	$51.89	$67.89	$147.28	$147.28	$112.41	$58.32	$192.46	$194.40	$156.18	$183.00	$156.18	$76.68	$25.57	$25.57	$38.69	$107.06	$0.00	$0.00	$0.00	$0.00
40200097	EAP	CPT® 76510		Opth Us B & Quant A	BOTH IP/OP	$636.00 	$470.64	$0.00	$508.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.59	$168.59	$175.08	$0.00	$132.54	$0.00	$0.00	$0.00	$0.00	$152.64	$503.71	$508.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200125	EAP	CPT® 76802		Us Preg Uterus Ea Addl Gest	BOTH IP/OP	$487.00 	$360.38	$0.00	$390.40	$148.34	$148.34	$0.00	$0.00	$0.00	$101.50	$80.66	$80.66	$83.76	$0.00	$101.49	$0.00	$288.06	$288.06	$0.00	$117.12	$386.50	$390.40	$0.00	$183.00	$0.00	$70.91	$21.97	$21.97	$77.69	$0.00	$0.00	$0.00	$0.00	$0.00
40200126	EAP	CPT® 93990		Duplex Scan Of Hemodialysis Access	BOTH IP/OP	"$1,058.00 "	$782.92	$67.89	$839.80	$300.62	$300.62	$106.02	$106.02	$106.62	$220.51	$450.12	$450.12	$467.43	$104.44	$220.49	$67.89	$625.81	$625.81	$112.41	$502.00	$795.17	$803.20	$156.18	$839.80	$156.18	$112.81	$132.54	$132.54	$159.84	$107.06	$0.00	$0.00	$0.00	$0.00
40200127	EAP	CPT® 76529		Ophthalmic Ultrasonic Foreign Body Localization	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.85	$95.85	$99.53	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$52.80	$174.24	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200128	EAP	CPT® 76932		"Us Guidance Endomyocardial Biopsy, Imaging S & I"	BOTH IP/OP	$454.00 	$335.96	$0.00	$363.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.61	$0.00	$0.00	$0.00	$0.00	$108.96	$359.57	$363.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40200132	EAP	CPT® 76706		Us Abdl Aorta Screen Aaa	BOTH IP/OP	$380.00 	$281.20	$60.34	$303.20	$214.45	$214.45	$106.02	$106.02	$106.62	$79.20	$166.71	$166.71	$173.12	$104.44	$79.19	$67.89	$224.77	$224.77	$112.41	$90.96	$300.17	$303.20	$156.18	$183.00	$156.18	$90.50	$87.52	$87.52	$60.34	$107.06	$0.00	$0.00	$0.00	$0.00
40200133	EAP	CPT® 76516		Quantitative A-scan Us Both Eyes	BOTH IP/OP	$374.00 	$276.76	$25.57	$292.00	$178.94	$178.94	$106.02	$106.02	$106.62	$77.95	$97.82	$97.82	$101.58	$104.44	$77.94	$67.89	$221.22	$221.22	$112.41	$87.60	$289.08	$292.00	$156.18	$183.00	$156.18	$76.68	$25.57	$25.57	$58.11	$107.06	$0.00	$0.00	$0.00	$0.00
40200134	EAP	CPT® 76513		B-scan Us High Resolution One Eye	BOTH IP/OP	$539.00 	$398.86	$64.47	$435.20	$216.82	$216.82	$106.02	$106.02	$106.62	$112.34	$125.46	$125.46	$130.28	$104.44	$112.33	$67.89	$318.82	$318.82	$112.41	$130.56	$430.85	$435.20	$156.18	$183.00	$156.18	$93.36	$64.47	$64.47	$86.60	$107.06	$0.00	$0.00	$0.00	$0.00
40200135	EAP	CPT® 76513		"B-scan Us, High Resolution Both Eyes"	BOTH IP/OP	$808.00 	$597.92	$64.47	$652.80	$216.82	$216.82	$106.02	$106.02	$106.62	$168.41	$125.46	$125.46	$130.28	$104.44	$168.39	$67.89	$477.93	$477.93	$112.41	$195.84	$646.27	$652.80	$156.18	$183.00	$156.18	$93.36	$64.47	$64.47	$129.91	$107.06	$0.00	$0.00	$0.00	$0.00
40300003	EAP	CPT® 77063		"Scr Digital Breast Tomosynthesis, Bil"	BOTH IP/OP	$149.00 	$110.26	$16.39	$209.00	$126.56	$126.56	$25.21	$25.21	$46.99	$31.06	$64.15	$64.15	$66.61	$25.21	$31.05	$16.39	$88.13	$88.13	$26.75	$36.00	$118.80	$120.00	$25.21	$209.00	$25.21	$53.24	$25.21	$25.21	$23.88	$25.21	$0.00	$0.00	$0.00	$0.00
40300004	EAP	CPT® 77063		"Scr Digital Breast Tomosynthesis, Uni"	BOTH IP/OP	$149.00 	$110.26	$16.39	$209.00	$126.56	$126.56	$25.21	$25.21	$46.99	$31.06	$64.15	$64.15	$66.61	$25.21	$31.05	$16.39	$88.13	$88.13	$26.75	$36.00	$118.80	$120.00	$25.21	$209.00	$25.21	$53.24	$25.21	$25.21	$23.88	$25.21	$0.00	$0.00	$0.00	$0.00
40300010	EAP	CPT® 77067		Scr Mammo Bi Incl Cad	BOTH IP/OP	$366.00 	$270.84	$58.90	$549.00	$310.36	$310.36	$99.77	$99.77	$113.86	$76.28	$249.62	$249.62	$259.22	$99.77	$76.27	$64.85	$216.49	$216.49	$106.31	$88.80	$293.04	$296.00	$99.77	$549.00	$99.77	$132.75	$99.77	$99.77	$58.90	$99.77	$0.00	$0.00	$0.00	$0.00
40300011	EAP	CPT® 77067		Scr Mammo Unilateral Incl Cad	BOTH IP/OP	$366.00 	$270.84	$58.90	$549.00	$310.36	$310.36	$99.77	$99.77	$113.86	$76.28	$249.62	$249.62	$259.22	$99.77	$76.27	$64.85	$216.49	$216.49	$106.31	$88.80	$293.04	$296.00	$99.77	$549.00	$99.77	$132.75	$99.77	$99.77	$58.90	$99.77	$0.00	$0.00	$0.00	$0.00
40400005	EAP	CPT® 78814		PET IMG RESTG THYROID CA PET	BOTH IP/OP	"$10,583.00 "	"$7,831.42"	$0.00	"$8,466.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,153.99"	"$2,153.99"	"$2,236.83"	$0.00	"$2,205.50"	$0.00	"$3,731.00"	"$3,731.00"	$0.00	"$2,539.92"	"$8,381.74"	"$8,466.40"	$0.00	"$2,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40400008	EAP	CPT® 78815		Pet/ct Skull Base Mid-thigh	BOTH IP/OP	"$10,477.00 "	"$7,752.98"	$0.00	"$8,466.40"	"$3,960.00"	"$3,960.00"	"$1,441.32"	"$1,441.32"	"$1,449.43"	"$2,183.67"	"$2,380.34"	"$2,380.34"	"$2,471.89"	"$1,418.79"	"$2,183.41"	$922.21	"$3,731.00"	"$3,731.00"	"$1,379.58"	"$2,539.92"	"$8,381.74"	"$8,466.40"	"$1,916.75"	"$2,400.00"	"$1,916.75"	"$2,380.22"	$0.00	$0.00	"$1,684.81"	"$1,313.89"	$0.00	$0.00	$0.00	$0.00
40400055	EAP	CPT® 78816		Pet/ct Whole Body	BOTH IP/OP	"$10,477.00 "	"$7,752.98"	$0.00	"$8,466.40"	"$3,960.00"	"$3,960.00"	"$1,441.32"	"$1,441.32"	"$1,449.43"	"$2,183.67"	"$2,441.96"	"$2,441.96"	"$2,535.88"	"$1,418.79"	"$2,183.41"	$922.21	"$3,731.00"	"$3,731.00"	"$1,379.58"	"$2,539.92"	"$8,381.74"	"$8,466.40"	"$1,916.75"	"$2,400.00"	"$1,916.75"	"$1,656.24"	$0.00	$0.00	"$1,684.81"	"$1,313.89"	$0.00	$0.00	$0.00	$0.00
40400056	EAP	CPT® 78608		"Brain Imaging, Positron Emission Tomo (pet); Metabolic Eval"	BOTH IP/OP	"$6,836.00 "	"$5,058.64"	$0.00	"$5,524.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$594.83	$594.83	$617.71	$0.00	"$1,424.62"	$0.00	"$3,731.00"	"$3,731.00"	"$1,379.58"	"$1,657.20"	"$5,468.76"	"$5,524.00"	"$1,916.75"	"$2,400.00"	"$1,916.75"	"$1,080.63"	$0.00	$0.00	"$1,099.28"	"$1,313.89"	$0.00	$0.00	$0.00	$0.00
40400057	EAP	CPT® 78459		"Myocardial Imaging, Positron Emission Tomography (pet), Metabolic Eval"	BOTH IP/OP	"$5,940.00 "	"$4,395.60"	$0.00	"$4,800.00"	"$3,960.00"	"$3,960.00"	"$1,272.60"	"$1,272.60"	"$1,279.77"	"$1,238.04"	$479.75	$479.75	$498.20	"$1,251.64"	"$1,237.90"	$813.57	"$3,731.00"	"$3,731.00"	"$1,232.99"	"$1,440.00"	"$4,752.00"	"$4,800.00"	"$1,713.08"	"$2,400.00"	"$1,713.08"	$939.00	$0.00	$0.00	$955.20	"$1,174.28"	$0.00	$0.00	$0.00	$0.00
40400058	EAP	CPT® 78429		Pet/ct Cardiac Metabolic Eval	BOTH IP/OP	"$5,940.00 "	"$4,395.60"	$0.00	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,578.55"	$0.00	"$1,237.90"	$0.00	"$3,731.00"	"$3,731.00"	"$1,379.58"	"$1,440.00"	"$4,752.00"	"$4,800.00"	"$1,916.75"	"$2,400.00"	"$1,916.75"	$939.00	$0.00	$0.00	$955.20	"$1,313.89"	$0.00	$0.00	$0.00	$0.00
41000001	EAP	CPT® 94002		Ventilation Assist/mgt Initial	BOTH IP/OP	"$6,841.00 "	"$5,062.34"	$77.15	"$5,273.04"	"$3,714.66"	"$3,714.66"	$474.42	$474.42	$477.09	"$1,425.84"	"$4,181.12"	"$4,181.12"	"$5,273.04"	$465.08	"$1,425.66"	$302.30	"$4,046.45"	"$4,046.45"	$465.90	"$3,120.00"	"$4,942.08"	"$4,992.00"	$647.30	"$4,446.65"	$647.30	$77.15	$94.86	$94.86	$993.41	$443.71	$0.00	$0.00	$0.00	$0.00
41000009	EAP	CPT® 94003		"Mech Vent, Ea Subseq Day"	BOTH IP/OP	"$6,231.00 "	"$4,610.94"	$0.00	"$4,802.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,802.85"	$0.00	"$1,298.54"	$0.00	$0.00	$0.00	$465.90	"$2,842.00"	"$4,501.73"	"$4,547.20"	$647.30	"$4,050.15"	$647.30	$56.62	$68.52	$68.52	$904.89	$443.71	$0.00	$0.00	$0.00	$0.00
41000017	EAP	CPT® 94640		Aerosal Rx Sub Admin (o2)	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000020	EAP	Custom 94640		Aerosol Continuous Subsequent	BOTH IP/OP	$494.00 	$365.56	$18.01	$380.78	$268.24	$268.24	$183.05	$183.05	$184.08	$102.96	$366.65	$366.65	$380.78	$180.07	$102.95	$117.04	$292.20	$292.20	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000021	EAP	CPT® 94640		Aerosol Treatment Initial	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000022	EAP	CPT® 94640		Aersol Treatment Subsequent	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000027	EAP	CPT® 94640		Delivery Assist	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000028	EAP	CPT® 94640		High Humidity Aerosol Initial	BOTH IP/OP	$414.00 	$306.36	$18.01	$377.00	$224.80	$224.80	$183.05	$183.05	$184.08	$86.29	$307.27	$307.27	$319.11	$180.07	$86.28	$117.04	$244.88	$244.88	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000029	EAP	CPT® 94640		High Humidity Aerosol Subseq	BOTH IP/OP	$414.00 	$306.36	$18.01	$377.00	$224.80	$224.80	$183.05	$183.05	$184.08	$86.29	$307.27	$307.27	$319.11	$180.07	$86.28	$117.04	$244.88	$244.88	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000031	EAP	CPT® 94640		Incentive Spirometer Subsequen	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000034	EAP	CPT® 94640		Init Inhala Trtmnt Airway Obs	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000040	EAP	CPT® 94640		"Mdi, Initial Rx"	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000041	EAP	CPT® 94640		"Mdi, Subsequent Rx"	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000042	EAP	CPT® 94640		Micro Neb Subsequent	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000043	EAP	CPT® 94640		"Micro Neb, Setup"	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000045	EAP	CPT® 94640		Neo Micro Subsquent	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000050	EAP	CPT® 94640		Sputum Induction Initial	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000055	EAP	CPT® 94644		"Micro Nebulizer, Cont; Initial"	BOTH IP/OP	$983.00 	$727.42	$0.00	$945.75	$533.77	$533.77	$109.81	$109.81	$0.00	$204.88	$729.58	$729.58	$757.70	$107.30	$204.86	$69.74	$581.44	$581.44	$0.00	$491.50	$778.54	$786.40	$0.00	$945.75	$0.00	$0.00	$54.39	$54.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41000059	EAP	CPT® 94645		Repeat Neb Treatment	BOTH IP/OP	$524.00 	$387.76	$0.00	$403.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$388.91	$388.91	$403.90	$0.00	$109.20	$0.00	$0.00	$0.00	$0.00	$211.00	$334.22	$337.60	$0.00	$340.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41000062	EAP	CPT® 94660		Sleep Apnea/bipap	BOTH IP/OP	"$2,079.00 "	"$1,538.46"	$39.31	"$1,602.49"	"$1,128.90"	"$1,128.90"	$183.05	$183.05	$184.08	$433.32	"$1,543.03"	"$1,543.03"	"$1,602.49"	$180.07	$433.26	$117.04	"$1,229.73"	"$1,229.73"	$184.50	"$1,000.50"	"$1,584.79"	"$1,600.80"	$256.34	"$1,558.70"	$256.34	$52.24	$39.31	$39.31	$318.56	$175.71	$0.00	$0.00	$0.00	$0.00
41000063	EAP	CPT® 94660		Neo Cpap	BOTH IP/OP	"$2,079.00 "	"$1,538.46"	$39.31	"$1,602.49"	"$1,128.90"	"$1,128.90"	$183.05	$183.05	$184.08	$433.32	"$1,543.03"	"$1,543.03"	"$1,602.49"	$180.07	$433.26	$117.04	"$1,229.73"	"$1,229.73"	$184.50	"$1,000.50"	"$1,584.79"	"$1,600.80"	$256.34	"$1,558.70"	$256.34	$52.24	$39.31	$39.31	$318.56	$175.71	$0.00	$0.00	$0.00	$0.00
41000064	EAP	CPT® 94660		Cpap Prescription	BOTH IP/OP	"$2,001.00 "	"$1,480.74"	$39.31	"$1,600.80"	"$1,086.54"	"$1,086.54"	$183.05	$183.05	$184.08	$417.06	"$1,485.14"	"$1,485.14"	"$1,542.37"	$180.07	$417.01	$117.04	"$1,183.59"	"$1,183.59"	$184.50	"$1,000.50"	"$1,584.79"	"$1,600.80"	$256.34	"$1,558.70"	$256.34	$52.24	$39.31	$39.31	$318.56	$175.71	$0.00	$0.00	$0.00	$0.00
41000065	EAP	CPT® 94664		Patient Assessment/education	BOTH IP/OP	$290.00 	$214.60	$16.93	$223.53	$157.47	$157.47	$183.05	$183.05	$184.08	$60.44	$215.24	$215.24	$223.53	$180.07	$60.44	$117.04	$171.54	$171.54	$184.50	$110.00	$174.24	$176.00	$220.00	$188.50	$220.00	$18.91	$16.93	$16.93	$35.02	$175.71	$0.00	$0.00	$0.00	$0.00
41000067	EAP	CPT® 94667		"Chest Pt, Inital Rx"	BOTH IP/OP	$501.00 	$370.74	$0.00	$511.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$386.17	$0.00	$104.41	$0.00	$0.00	$0.00	$109.35	$232.50	$368.28	$372.00	$151.93	$511.55	$151.93	$0.00	$25.21	$25.21	$74.03	$104.14	$0.00	$0.00	$0.00	$0.00
41000069	EAP	CPT® 94667		Cpt/vest	BOTH IP/OP	$501.00 	$370.74	$0.00	$511.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$386.17	$0.00	$104.41	$0.00	$0.00	$0.00	$109.35	$232.50	$368.28	$372.00	$151.93	$511.55	$151.93	$0.00	$25.21	$25.21	$74.03	$104.14	$0.00	$0.00	$0.00	$0.00
41000070	EAP	CPT® 94667		Initial Chest Therapy	BOTH IP/OP	$465.00 	$344.10	$0.00	$511.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$358.42	$0.00	$96.91	$0.00	$0.00	$0.00	$109.35	$232.50	$368.28	$372.00	$151.93	$511.55	$151.93	$0.00	$25.21	$25.21	$74.03	$104.14	$0.00	$0.00	$0.00	$0.00
41000072	EAP	CPT® 94667		Pep/acpella Therapy	BOTH IP/OP	$465.00 	$344.10	$0.00	$511.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$358.42	$0.00	$96.91	$0.00	$0.00	$0.00	$109.35	$232.50	$368.28	$372.00	$151.93	$511.55	$151.93	$0.00	$25.21	$25.21	$74.03	$104.14	$0.00	$0.00	$0.00	$0.00
41000073	EAP	CPT® 94667		Sipap Setup	BOTH IP/OP	$501.00 	$370.74	$0.00	$511.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$386.17	$0.00	$104.41	$0.00	$0.00	$0.00	$109.35	$232.50	$368.28	$372.00	$151.93	$511.55	$151.93	$0.00	$25.21	$25.21	$74.03	$104.14	$0.00	$0.00	$0.00	$0.00
41000074	EAP	CPT® 94668		"Chest Pt, Subsequent Rx"	BOTH IP/OP	$373.00 	$276.02	$0.00	$399.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.84	$276.84	$287.51	$0.00	$77.73	$0.00	$0.00	$0.00	$0.00	$141.50	$224.14	$226.40	$0.00	$399.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41000076	EAP	CPT® 94668		Cpt/vest Sub	BOTH IP/OP	$283.00 	$209.42	$0.00	$399.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.04	$210.04	$218.14	$0.00	$58.98	$0.00	$0.00	$0.00	$0.00	$141.50	$224.14	$226.40	$0.00	$399.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41000077	EAP	CPT® 94668		Sipap Ea Shift	BOTH IP/OP	$373.00 	$276.02	$0.00	$399.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.84	$276.84	$287.51	$0.00	$77.73	$0.00	$0.00	$0.00	$0.00	$141.50	$224.14	$226.40	$0.00	$399.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41000078	EAP	CPT® 94668		Subsequent Chest Therapy	BOTH IP/OP	$373.00 	$276.02	$0.00	$399.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.84	$276.84	$287.51	$0.00	$77.73	$0.00	$0.00	$0.00	$0.00	$141.50	$224.14	$226.40	$0.00	$399.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41000080	EAP	CPT® 94003		"Mech Vent, Ea Subseq Day"	BOTH IP/OP	"$5,771.00 "	"$4,270.54"	$0.00	"$4,547.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,448.29"	$0.00	"$1,202.68"	$0.00	$0.00	$0.00	$465.90	"$2,842.00"	"$4,501.73"	"$4,547.20"	$647.30	"$4,050.15"	$647.30	$56.62	$68.52	$68.52	$904.89	$443.71	$0.00	$0.00	$0.00	$0.00
41000081	EAP	CPT® 94664		Asthma Teaching-nebulizer &mdi	BOTH IP/OP	$290.00 	$214.60	$16.93	$223.53	$157.47	$157.47	$183.05	$183.05	$184.08	$60.44	$215.24	$215.24	$223.53	$180.07	$60.44	$117.04	$171.54	$171.54	$184.50	$110.00	$174.24	$176.00	$220.00	$188.50	$220.00	$18.91	$16.93	$16.93	$35.02	$175.71	$0.00	$0.00	$0.00	$0.00
41000090	EAP	CPT® 94003		"Mech Vent, Ea Subseq Day"	BOTH IP/OP	"$5,771.00 "	"$4,270.54"	$0.00	"$4,547.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,448.29"	$0.00	"$1,202.68"	$0.00	$0.00	$0.00	$465.90	"$2,842.00"	"$4,501.73"	"$4,547.20"	$647.30	"$4,050.15"	$647.30	$56.62	$68.52	$68.52	$904.89	$443.71	$0.00	$0.00	$0.00	$0.00
41000110	EAP	CPT® 94002		Spec Vent Initial	BOTH IP/OP	"$6,841.00 "	"$5,062.34"	$77.15	"$5,273.04"	"$3,714.66"	"$3,714.66"	$474.42	$474.42	$477.09	"$1,425.84"	"$4,181.12"	"$4,181.12"	"$5,273.04"	$465.08	"$1,425.66"	$302.30	"$4,046.45"	"$4,046.45"	$465.90	"$3,120.00"	"$4,942.08"	"$4,992.00"	$647.30	"$4,446.65"	$647.30	$77.15	$94.86	$94.86	$993.41	$443.71	$0.00	$0.00	$0.00	$0.00
41000111	EAP	CPT® 94002		Neo Mech Vent Initial	BOTH IP/OP	"$6,841.00 "	"$5,062.34"	$77.15	"$5,273.04"	"$3,714.66"	"$3,714.66"	$474.42	$474.42	$477.09	"$1,425.84"	"$4,181.12"	"$4,181.12"	"$5,273.04"	$465.08	"$1,425.66"	$302.30	"$4,046.45"	"$4,046.45"	$465.90	"$3,120.00"	"$4,942.08"	"$4,992.00"	$647.30	"$4,446.65"	$647.30	$77.15	$94.86	$94.86	$993.41	$443.71	$0.00	$0.00	$0.00	$0.00
41000112	EAP	CPT® 94002		Mech Vent Initial	BOTH IP/OP	"$6,841.00 "	"$5,062.34"	$77.15	"$5,273.04"	"$3,714.66"	"$3,714.66"	$474.42	$474.42	$477.09	"$1,425.84"	"$4,181.12"	"$4,181.12"	"$5,273.04"	$465.08	"$1,425.66"	$302.30	"$4,046.45"	"$4,046.45"	$465.90	"$3,120.00"	"$4,942.08"	"$4,992.00"	$647.30	"$4,446.65"	$647.30	$77.15	$94.86	$94.86	$993.41	$443.71	$0.00	$0.00	$0.00	$0.00
41000119	EAP	CPT® 94003		"Spec Vent, Ea Subseq Day"	BOTH IP/OP	"$6,231.00 "	"$4,610.94"	$0.00	"$4,802.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,802.85"	$0.00	"$1,298.54"	$0.00	$0.00	$0.00	$465.90	"$2,842.00"	"$4,501.73"	"$4,547.20"	$647.30	"$4,050.15"	$647.30	$56.62	$68.52	$68.52	$904.89	$443.71	$0.00	$0.00	$0.00	$0.00
41000120	EAP	CPT® 94003		Neo Mech Vent Subseq	BOTH IP/OP	"$6,231.00 "	"$4,610.94"	$0.00	"$4,802.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,802.85"	$0.00	"$1,298.54"	$0.00	$0.00	$0.00	$465.90	"$2,842.00"	"$4,501.73"	"$4,547.20"	$647.30	"$4,050.15"	$647.30	$56.62	$68.52	$68.52	$904.89	$443.71	$0.00	$0.00	$0.00	$0.00
41000121	EAP	CPT® 94640		"Neo Micro Neb, Setup"	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000150	EAP	CPT® 94640		Sputum Induction Subseq	BOTH IP/OP	$535.00 	$395.90	$18.01	$412.38	$290.51	$290.51	$183.05	$183.05	$184.08	$111.51	$397.08	$397.08	$412.38	$180.07	$111.49	$117.04	$316.45	$316.45	$184.50	$207.00	$327.89	$331.20	$256.34	$377.00	$256.34	$19.30	$18.01	$18.01	$65.91	$175.71	$0.00	$0.00	$0.00	$0.00
41000190	EAP	CPT® 94003		Neo Ventilation Subseq	BOTH IP/OP	"$6,231.00 "	"$4,610.94"	$0.00	"$4,802.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,802.85"	$0.00	"$1,298.54"	$0.00	$0.00	$0.00	$465.90	"$2,842.00"	"$4,501.73"	"$4,547.20"	$647.30	"$4,050.15"	$647.30	$56.62	$68.52	$68.52	$904.89	$443.71	$0.00	$0.00	$0.00	$0.00
41000191	EAP	CPT® 94669		Chest Vest  Mechanical Oscillat	BOTH IP/OP	"$1,866.00 "	"$1,380.84"	$0.00	"$1,492.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.95"	"$1,384.95"	"$1,438.31"	$0.00	$388.87	$0.00	$0.00	$0.00	$0.00	$933.00	"$1,477.87"	"$1,492.80"	$0.00	$563.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41200001	EAP	CPT® 94642		Aerosol Inhal. Of Pentamidine	BOTH IP/OP	$353.00 	$261.22	$0.00	$272.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.00	$262.00	$272.09	$0.00	$73.57	$0.00	$0.00	$0.00	$184.50	$142.00	$224.93	$227.20	$256.34	$229.45	$256.34	$31.57	$0.00	$0.00	$45.21	$175.71	$0.00	$0.00	$0.00	$0.00
42000002	EAP	CPT® 92526		Pediatric Feeding	BOTH IP/OP	$792.00 	$586.08	$0.00	$582.40	$430.06	$430.06	$86.29	$86.29	$87.06	$165.07	$444.74	$444.74	$461.84	$84.61	$165.05	$55.00	$468.47	$468.47	$88.84	$364.00	$576.58	$582.40	$122.68	$133.74	$122.68	$113.93	$84.61	$84.61	$0.00	$84.61	$0.00	$0.00	$0.00	$0.00
42000006	EAP	CPT® 97012		"Traction, Mechanical"	BOTH IP/OP	$206.00 	$152.44	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$42.93	$0.00	$0.00	$0.00	$0.00	$103.00	$163.15	$164.80	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000007	EAP	CPT® 97014		Electrical Stim Unsupervised	BOTH IP/OP	$291.00 	$215.34	$0.00	$461.84	$27.09	$27.09	$13.21	$13.21	$14.03	$60.65	$444.74	$444.74	$461.84	$13.17	$60.64	$8.56	$172.13	$172.13	$13.83	$150.50	$238.39	$240.80	$180.60	$19.04	$180.60	$14.50	$0.00	$0.00	$0.00	$13.17	$0.00	$0.00	$0.00	$0.00
42000009	EAP	CPT® 97018		Paraffin Bath	BOTH IP/OP	$278.00 	$205.72	$0.00	$461.84	$18.66	$18.66	$5.89	$5.89	$11.16	$57.94	$444.74	$444.74	$461.84	$5.63	$57.94	$3.66	$164.44	$164.44	$5.91	$126.50	$200.38	$202.40	$8.16	$8.99	$8.16	$10.67	$5.63	$5.63	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00
42000010	EAP	CPT® 97022		Whirlpool	BOTH IP/OP	$328.00 	$242.72	$0.00	$461.84	$40.34	$40.34	$18.09	$18.09	$23.78	$68.36	$444.74	$444.74	$461.84	$16.98	$68.36	$11.04	$194.01	$194.01	$17.83	$150.00	$237.60	$240.00	$24.62	$26.94	$24.62	$14.51	$16.98	$16.98	$0.00	$16.98	$0.00	$0.00	$0.00	$0.00
42000011	EAP	CPT® 97032		Elec Stim Cons Atten Ea 15 Min	BOTH IP/OP	$301.00 	$222.74	$0.00	$461.84	$32.52	$32.52	$14.96	$14.96	$19.43	$62.74	$444.74	$444.74	$461.84	$14.41	$62.73	$9.37	$178.04	$178.04	$15.13	$150.50	$238.39	$240.80	$20.89	$22.74	$20.89	$16.22	$14.41	$14.41	$0.00	$14.41	$0.00	$0.00	$0.00	$0.00
42000012	EAP	CPT® 97035		Ultrasound Ea 15 Min	BOTH IP/OP	$162.00 	$119.88	$0.00	$461.84	$21.67	$21.67	$14.61	$14.61	$12.94	$33.76	$444.74	$444.74	$461.84	$13.93	$33.76	$9.05	$95.82	$95.82	$14.63	$82.00	$129.89	$131.20	$20.20	$22.74	$20.20	$11.96	$13.93	$13.93	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00
42000013	EAP	CPT® 97036		Hubbard Tank Ea 15 Min	BOTH IP/OP	$200.00 	$148.00	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000015	EAP	CPT® 97110		Exercise Each 15 Minutes	BOTH IP/OP	$351.00 	$259.74	$0.00	$461.84	$55.39	$55.39	$30.26	$30.26	$32.74	$73.16	$444.74	$444.74	$461.84	$29.58	$73.15	$19.23	$207.62	$207.62	$31.06	$159.50	$252.65	$255.20	$42.89	$46.51	$42.89	$22.45	$29.58	$29.58	$0.00	$29.58	$0.00	$0.00	$0.00	$0.00
42000016	EAP	CPT® 97112		Neuro-musc Re-ed Ea 15 Min	BOTH IP/OP	$332.00 	$245.68	$0.00	$461.84	$57.82	$57.82	$35.14	$35.14	$33.84	$69.20	$444.74	$444.74	$461.84	$33.96	$69.19	$22.07	$196.38	$196.38	$35.66	$151.00	$239.18	$241.60	$49.24	$53.38	$49.24	$23.53	$33.96	$33.96	$0.00	$33.96	$0.00	$0.00	$0.00	$0.00
42000017	EAP	CPT® 97116		Gait Training Ea 15 Min	BOTH IP/OP	$332.00 	$245.68	$0.00	$461.84	$48.15	$48.15	$30.26	$30.26	$28.80	$69.20	$444.74	$444.74	$461.84	$29.26	$69.19	$19.02	$196.38	$196.38	$30.72	$151.00	$239.18	$241.60	$42.43	$46.51	$42.43	$21.09	$29.26	$29.26	$0.00	$29.26	$0.00	$0.00	$0.00	$0.00
42000018	EAP	CPT® 97139		Tilt Table - Each 15 Min	BOTH IP/OP	$198.00 	$146.52	$0.00	$461.84	$39.36	$39.36	$0.00	$0.00	$13.61	$41.27	$444.74	$444.74	$461.84	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$90.00	$142.56	$144.00	$108.00	$191.00	$108.00	$28.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000019	EAP	CPT® 97140		Joint Mobilization Ea 15 Min	BOTH IP/OP	$468.00 	$346.32	$0.00	$461.84	$51.16	$51.16	$27.82	$27.82	$30.24	$97.54	$444.74	$444.74	$461.84	$27.26	$97.53	$17.72	$276.82	$276.82	$28.62	$219.50	$347.69	$351.20	$39.53	$42.82	$39.53	$25.71	$27.26	$27.26	$0.00	$27.26	$0.00	$0.00	$0.00	$0.00
42000020	EAP	CPT® 97150		Group Activity/exercise	BOTH IP/OP	$143.00 	$105.82	$0.00	$461.84	$29.49	$29.49	$18.10	$18.10	$17.62	$29.80	$444.74	$444.74	$461.84	$17.78	$29.80	$11.56	$84.58	$84.58	$18.67	$71.50	$113.26	$114.40	$25.78	$28.02	$25.78	$18.34	$17.78	$17.78	$0.00	$17.78	$0.00	$0.00	$0.00	$0.00
42000021	EAP	CPT® 97530		Functional Activities Ea 15 Mi	BOTH IP/OP	$331.00 	$244.94	$0.00	$461.84	$59.61	$59.61	$39.32	$39.32	$35.29	$68.99	$444.74	$444.74	$461.84	$37.56	$68.98	$24.41	$195.79	$195.79	$39.44	$150.50	$238.39	$240.80	$54.46	$58.66	$54.46	$21.84	$37.56	$37.56	$0.00	$37.56	$0.00	$0.00	$0.00	$0.00
42000023	EAP	CPT® 97542		W/c Management Training Ea 15m	BOTH IP/OP	$290.00 	$214.60	$0.00	$461.84	$52.38	$52.38	$32.70	$32.70	$30.95	$60.44	$444.74	$444.74	$461.84	$31.95	$60.44	$20.77	$171.54	$171.54	$33.55	$132.00	$209.09	$211.20	$46.33	$50.21	$46.33	$15.60	$31.95	$31.95	$0.00	$31.95	$0.00	$0.00	$0.00	$0.00
42000026	EAP	CPT® 97760		Orthotic Fit/train Init Ea 15	BOTH IP/OP	$344.00 	$254.56	$0.00	$461.84	$186.79	$186.79	$50.11	$50.11	$38.52	$71.70	$444.74	$444.74	$461.84	$46.79	$71.69	$30.41	$203.48	$203.48	$49.13	$156.50	$247.90	$250.40	$67.85	$76.61	$67.85	$48.98	$46.79	$46.79	$0.00	$46.79	$0.00	$0.00	$0.00	$0.00
42000027	EAP	CPT® 97761		Prosthetic Training Ea 15 Min	BOTH IP/OP	$164.00 	$121.36	$0.00	$461.84	$89.05	$89.05	$42.45	$42.45	$33.46	$0.00	$444.74	$444.74	$461.84	$0.00	$34.18	$0.00	$0.00	$0.00	$42.05	$74.50	$118.01	$119.20	$58.07	$66.05	$58.07	$23.32	$40.05	$40.05	$0.00	$40.05	$0.00	$0.00	$0.00	$0.00
42000028	EAP	CPT® 97763		Orthotics/prosth Mgmt &/trainj Sbsq Enctr 15 Min	BOTH IP/OP	$344.00 	$254.56	$0.00	$461.84	$186.79	$186.79	$54.99	$54.99	$0.00	$71.70	$444.74	$444.74	$461.84	$49.92	$71.69	$32.45	$203.48	$203.48	$52.42	$156.50	$247.90	$250.40	$72.38	$84.00	$72.38	$46.64	$49.92	$49.92	$0.00	$49.92	$0.00	$0.00	$0.00	$0.00
42000034	EAP	CPT® 97545		Work Hardening-pt	BOTH IP/OP	$207.00 	$153.18	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$43.14	$0.00	$0.00	$0.00	$0.00	$103.50	$163.94	$165.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000045	EAP	CPT® 97139		Scar Management Ea 15 Min	BOTH IP/OP	$198.00 	$146.52	$0.00	$461.84	$39.36	$39.36	$0.00	$0.00	$13.61	$41.27	$444.74	$444.74	$461.84	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$90.00	$142.56	$144.00	$108.00	$191.00	$108.00	$28.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000050	EAP	CPT® 97546		Work Hardening Add-on	BOTH IP/OP	$102.00 	$75.48	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$51.00	$80.78	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000060	EAP	CPT® 29581		Apply Multlay Comprs Lwr Leg-lt	BOTH IP/OP	$478.00 	$353.72	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.00	$378.58	$382.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000068	EAP	CPT® 29584		Apply Multlay Comprs  Arm/hand-lt	BOTH IP/OP	$427.00 	$315.98	$0.00	$508.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$88.99	$0.00	$0.00	$0.00	$0.00	$478.00	$378.58	$382.40	$0.00	$508.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000088	EAP	CPT® 97022		FLUIDIOTHERAPY-GP	BOTH IP/OP	$328.00 	$242.72	$0.00	$461.84	$40.34	$40.34	$18.09	$18.09	$23.78	$68.36	$444.74	$444.74	$461.84	$16.98	$68.36	$11.04	$194.01	$194.01	$17.83	$150.00	$237.60	$240.00	$24.62	$26.94	$24.62	$14.51	$16.98	$16.98	$0.00	$16.98	$0.00	$0.00	$0.00	$0.00
42000090	EAP	CPT® 29581		Apply Multlay Comprs Lwr Leg-rt	BOTH IP/OP	$478.00 	$353.72	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.00	$378.58	$382.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000093	EAP	CPT® 29584		Apply Multlay Comprs Arm/hand-rt	BOTH IP/OP	$427.00 	$315.98	$0.00	$508.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$88.99	$0.00	$0.00	$0.00	$0.00	$478.00	$378.58	$382.40	$0.00	$508.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000100	EAP	HCPCS G8978		Mobility Current Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000101	EAP	HCPCS G8979		Mobility Goal Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000102	EAP	HCPCS G8980		Mobility D/c Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000103	EAP	HCPCS G8981		Body Pos Current Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000104	EAP	HCPCS G8982		Body Pos Goal Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000105	EAP	HCPCS G8983		Body Pos D/c Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000106	EAP	HCPCS G8984		Carry Current Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000107	EAP	HCPCS G8985		Carry Goal Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000108	EAP	HCPCS G8986		Carry D/c  Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000109	EAP	HCPCS G8987		Self-care Current Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000110	EAP	HCPCS G8988		Self-care Goal Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000111	EAP	HCPCS G8989		Self-care D/c Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000112	EAP	HCPCS G8990		Other Pt/ot Current Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000113	EAP	HCPCS G8991		Other Pt/ot Goal Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000114	EAP	HCPCS G8992		Other Pt/ot D/c Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000115	EAP	HCPCS G8993		Sub Pt/ot Current Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000116	EAP	HCPCS G8994		Sub Pt/ot Goal Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000117	EAP	HCPCS G8995		Sub Pt/ot D/c Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000125	EAP	CPT® 97597		Debridement First 20 Sq Cm Or Less	BOTH IP/OP	$740.00 	$547.60	$0.00	"$1,305.00"	$740.00	$740.00	$174.88	$174.88	$175.86	$154.23	$444.74	$444.74	$461.84	$172.08	$154.22	$111.85	$437.71	$437.71	$175.24	$674.00	$533.81	$539.20	$243.48	"$1,305.00"	$243.48	$48.15	$37.87	$37.87	$0.00	$166.90	$0.00	$0.00	$0.00	$0.00
42000126	EAP	CPT® 97610		Pt Low Frequency Non Contrast/thermal Per Day	BOTH IP/OP	$514.00 	$380.36	$0.00	$506.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$107.12	$0.00	$0.00	$0.00	$0.00	$257.00	$407.09	$411.20	$0.00	$506.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000226	EAP	CPT® 97598		Debridement Open Wound Ea Addl 20 Sq Cm	BOTH IP/OP	$616.00 	$455.84	$0.00	$924.00	$616.00	$616.00	$0.00	$0.00	$0.00	$128.39	$444.74	$444.74	$461.84	$0.00	$128.37	$0.00	$364.36	$364.36	$0.00	$280.50	$444.31	$448.80	$0.00	$924.00	$0.00	$61.13	$26.68	$26.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000227	EAP	CPT® 97014		Pt Electric Stim Ther Unsupervised Wound	BOTH IP/OP	$291.00 	$215.34	$0.00	$461.84	$27.09	$27.09	$0.00	$0.00	$13.56	$60.65	$444.74	$444.74	$461.84	$0.00	$60.64	$0.00	$172.13	$172.13	$0.00	$150.50	$238.39	$240.80	$180.60	$181.00	$180.60	$14.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000228	EAP	CPT® 97014		Pt Electric Stim Ther Unsupervised Non-wound	BOTH IP/OP	$301.00 	$222.74	$0.00	$461.84	$27.09	$27.09	$13.21	$13.21	$14.03	$62.74	$444.74	$444.74	$461.84	$13.17	$62.73	$8.56	$178.04	$178.04	$13.83	$150.50	$238.39	$240.80	$180.60	$19.04	$180.60	$14.50	$0.00	$0.00	$0.00	$13.17	$0.00	$0.00	$0.00	$0.00
42400010	EAP	CPT® 97161		Pt Eval Low Complex	BOTH IP/OP	$726.00 	$537.24	$0.00	$528.00	$138.52	$138.52	$101.63	$101.63	$0.00	$151.32	$444.74	$444.74	$461.84	$82.44	$151.30	$53.59	$429.43	$429.43	$86.56	$330.00	$522.72	$528.00	$119.54	$158.58	$119.54	$77.58	$82.44	$82.44	$0.00	$82.44	$0.00	$0.00	$0.00	$0.00
42400011	EAP	CPT® 97162		Pt Eval Mod Complex	BOTH IP/OP	$743.00 	$549.82	$0.00	$540.00	$138.52	$138.52	$101.63	$101.63	$0.00	$154.86	$444.74	$444.74	$461.84	$82.44	$154.84	$53.59	$439.48	$439.48	$86.56	$337.50	$534.60	$540.00	$119.54	$158.58	$119.54	$77.58	$82.44	$82.44	$0.00	$82.44	$0.00	$0.00	$0.00	$0.00
42400012	EAP	CPT® 97163		Pt Eval High Complex	BOTH IP/OP	$759.00 	$561.66	$0.00	$552.00	$138.52	$138.52	$101.63	$101.63	$0.00	$158.19	$444.74	$444.74	$461.84	$82.44	$158.18	$53.59	$448.95	$448.95	$86.56	$345.00	$546.48	$552.00	$119.54	$158.58	$119.54	$77.58	$82.44	$82.44	$0.00	$82.44	$0.00	$0.00	$0.00	$0.00
42400013	EAP	CPT® 97164		Pt Re-eval	BOTH IP/OP	$528.00 	$390.72	$0.00	$461.84	$93.38	$93.38	$69.58	$69.58	$0.00	$110.05	$444.74	$444.74	$461.84	$56.39	$110.04	$36.65	$312.31	$312.31	$59.21	$240.00	$380.16	$384.00	$81.77	$109.95	$81.77	$52.74	$56.39	$56.39	$0.00	$56.39	$0.00	$0.00	$0.00	$0.00
43000002	EAP	CPT® 92526		Dysphagia Treatment	BOTH IP/OP	$728.00 	$538.72	$0.00	$582.40	$395.30	$395.30	$86.29	$86.29	$87.06	$151.73	$444.74	$444.74	$461.84	$84.61	$151.72	$55.00	$430.61	$430.61	$88.84	$364.00	$576.58	$582.40	$122.68	$133.74	$122.68	$113.93	$84.61	$84.61	$0.00	$84.61	$0.00	$0.00	$0.00	$0.00
43000005	EAP	CPT® 95851		Range Of Motion Measurement	BOTH IP/OP	$36.00 	$26.64	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000008	EAP	CPT® 97014		Electrical Stim Unsupervised	BOTH IP/OP	$291.00 	$215.34	$0.00	$461.84	$27.09	$27.09	$13.21	$13.21	$14.03	$60.65	$444.74	$444.74	$461.84	$13.17	$60.64	$8.56	$172.13	$172.13	$13.83	$150.50	$238.39	$240.80	$180.60	$19.04	$180.60	$14.50	$0.00	$0.00	$0.00	$13.17	$0.00	$0.00	$0.00	$0.00
43000010	EAP	CPT® 97018		Paraffin Bath	BOTH IP/OP	$278.00 	$205.72	$0.00	$461.84	$18.66	$18.66	$5.89	$5.89	$11.16	$57.94	$444.74	$444.74	$461.84	$5.63	$57.94	$3.66	$164.44	$164.44	$5.91	$126.50	$200.38	$202.40	$8.16	$8.99	$8.16	$10.67	$5.63	$5.63	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00
43000011	EAP	CPT® 97022		Whirlpool	BOTH IP/OP	$328.00 	$242.72	$0.00	$461.84	$40.34	$40.34	$18.09	$18.09	$23.78	$68.36	$444.74	$444.74	$461.84	$16.98	$68.36	$11.04	$194.01	$194.01	$17.83	$150.00	$237.60	$240.00	$24.62	$26.94	$24.62	$14.51	$16.98	$16.98	$0.00	$16.98	$0.00	$0.00	$0.00	$0.00
43000012	EAP	CPT® 97032		Elec Stim Cons Atten Ea 15 Min	BOTH IP/OP	$301.00 	$222.74	$0.00	$461.84	$32.52	$32.52	$14.96	$14.96	$19.43	$62.74	$444.74	$444.74	$461.84	$14.41	$62.73	$9.37	$178.04	$178.04	$15.13	$150.50	$238.39	$240.80	$20.89	$22.74	$20.89	$16.22	$14.41	$14.41	$0.00	$14.41	$0.00	$0.00	$0.00	$0.00
43000013	EAP	CPT® 97035		Ultrasound Heat Ea 15 Min	BOTH IP/OP	$162.00 	$119.88	$0.00	$461.84	$21.67	$21.67	$14.61	$14.61	$12.94	$33.76	$444.74	$444.74	$461.84	$13.93	$33.76	$9.05	$95.82	$95.82	$14.63	$82.00	$129.89	$131.20	$20.20	$22.74	$20.20	$11.96	$13.93	$13.93	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00
43000014	EAP	CPT® 97022		Fluidiotherapy	BOTH IP/OP	$328.00 	$242.72	$0.00	$461.84	$40.34	$40.34	$18.09	$18.09	$23.78	$68.36	$444.74	$444.74	$461.84	$16.98	$68.36	$11.04	$194.01	$194.01	$17.83	$150.00	$237.60	$240.00	$24.62	$26.94	$24.62	$14.51	$16.98	$16.98	$0.00	$16.98	$0.00	$0.00	$0.00	$0.00
43000015	EAP	CPT® 97110		Therapeutic Exercise Ea 15min	BOTH IP/OP	$351.00 	$259.74	$0.00	$461.84	$55.39	$55.39	$30.26	$30.26	$32.74	$73.16	$444.74	$444.74	$461.84	$29.58	$73.15	$19.23	$207.62	$207.62	$31.06	$159.50	$252.65	$255.20	$42.89	$46.51	$42.89	$22.45	$29.58	$29.58	$0.00	$29.58	$0.00	$0.00	$0.00	$0.00
43000016	EAP	CPT® 97112		Neuromuscular Re-ed Ea. 15 Min	BOTH IP/OP	$332.00 	$245.68	$0.00	$461.84	$57.82	$57.82	$35.14	$35.14	$33.84	$69.20	$444.74	$444.74	$461.84	$33.96	$69.19	$22.07	$196.38	$196.38	$35.66	$151.00	$239.18	$241.60	$49.24	$53.38	$49.24	$23.53	$33.96	$33.96	$0.00	$33.96	$0.00	$0.00	$0.00	$0.00
43000018	EAP	CPT® 97139		Scar Management Ea 15 Min	BOTH IP/OP	$198.00 	$146.52	$0.00	$461.84	$39.36	$39.36	$0.00	$0.00	$13.61	$41.27	$444.74	$444.74	$461.84	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$90.00	$142.56	$144.00	$108.00	$124.15	$108.00	$28.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000019	EAP	CPT® 97140		Joint Mobilization Ea 15 Min	BOTH IP/OP	$468.00 	$346.32	$0.00	$461.84	$51.16	$51.16	$27.82	$27.82	$30.24	$97.54	$444.74	$444.74	$461.84	$27.26	$97.53	$17.72	$276.82	$276.82	$28.62	$219.50	$347.69	$351.20	$39.53	$42.82	$39.53	$25.71	$27.26	$27.26	$0.00	$27.26	$0.00	$0.00	$0.00	$0.00
43000020	EAP	CPT® 97150		Group Activity/exercise	BOTH IP/OP	$143.00 	$105.82	$0.00	$461.84	$29.49	$29.49	$18.10	$18.10	$17.62	$29.80	$444.74	$444.74	$461.84	$17.78	$29.80	$11.56	$84.58	$84.58	$18.67	$71.50	$113.26	$114.40	$25.78	$0.00	$25.78	$18.34	$17.78	$17.78	$0.00	$17.78	$0.00	$0.00	$0.00	$0.00
43000021	EAP	CPT® 97530		Activ.to Increase Func.ea 15mi	BOTH IP/OP	$331.00 	$244.94	$0.00	$461.84	$59.61	$59.61	$39.32	$39.32	$35.29	$68.99	$444.74	$444.74	$461.84	$37.56	$68.98	$24.41	$195.79	$195.79	$39.44	$150.50	$238.39	$240.80	$54.46	$58.66	$54.46	$21.84	$37.56	$37.56	$0.00	$37.56	$0.00	$0.00	$0.00	$0.00
43000023	EAP	CPT® 97533		Sensory Integrat Tech Ea 15min	BOTH IP/OP	$191.00 	$141.34	$0.00	$461.84	$49.98	$49.98	$60.56	$60.56	$29.51	$0.00	$444.74	$444.74	$461.84	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$87.00	$137.81	$139.20	$0.00	$100.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000024	EAP	CPT® 97535		Adl Training Each 15 Mins	BOTH IP/OP	$278.00 	$205.72	$0.00	$461.84	$59.61	$59.61	$33.74	$33.74	$35.29	$57.94	$444.74	$444.74	$461.84	$32.79	$57.94	$21.31	$164.44	$164.44	$34.43	$126.50	$200.38	$202.40	$47.55	$51.79	$47.55	$23.39	$32.79	$32.79	$0.00	$32.79	$0.00	$0.00	$0.00	$0.00
43000028	EAP	CPT® 97760		"Splint/ort-fab,fit/tra/q 15min"	BOTH IP/OP	$344.00 	$254.56	$0.00	$461.84	$186.79	$186.79	$50.11	$50.11	$38.52	$71.70	$444.74	$444.74	$461.84	$46.79	$71.69	$30.41	$203.48	$203.48	$49.13	$156.50	$247.90	$250.40	$67.85	$76.61	$67.85	$48.98	$46.79	$46.79	$0.00	$46.79	$0.00	$0.00	$0.00	$0.00
43000029	EAP	CPT® 97761		Prosth/training Ea 15 Min	BOTH IP/OP	$164.00 	$121.36	$0.00	$461.84	$89.05	$89.05	$42.45	$42.45	$33.46	$0.00	$444.74	$444.74	$461.84	$0.00	$34.18	$0.00	$0.00	$0.00	$42.05	$74.50	$118.01	$119.20	$58.07	$66.05	$58.07	$23.32	$40.05	$40.05	$0.00	$40.05	$0.00	$0.00	$0.00	$0.00
43000030	EAP	CPT® 97763		Orthotics/prosth Mgmt &/trainj Sbsq Enctr 15 Min	BOTH IP/OP	$344.00 	$254.56	$0.00	$461.84	$186.79	$186.79	$54.99	$54.99	$0.00	$71.70	$444.74	$444.74	$461.84	$49.92	$71.69	$32.45	$203.48	$203.48	$52.42	$156.50	$247.90	$250.40	$72.38	$84.00	$72.38	$46.64	$49.92	$49.92	$0.00	$49.92	$0.00	$0.00	$0.00	$0.00
43000044	EAP	CPT® 97545		Work Hardening-ot	BOTH IP/OP	$207.00 	$153.18	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$43.14	$0.00	$0.00	$0.00	$0.00	$103.50	$163.94	$165.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000051	EAP	CPT® 97598		"WOUND CARE,EACH ADDITIONAL 20 SQ CEMENT &PULSED LAVAGE)"	BOTH IP/OP	$616.00 	$455.84	$0.00	$616.00	$616.00	$616.00	$0.00	$0.00	$0.00	$128.39	$444.74	$444.74	$461.84	$0.00	$128.37	$0.00	$364.36	$364.36	$0.00	$280.50	$444.31	$448.80	$0.00	$600.60	$0.00	$61.13	$26.68	$26.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000060	EAP	CPT® 97546		Work Hardening Add-on-ot	BOTH IP/OP	$102.00 	$75.48	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$51.00	$80.78	$81.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000062	EAP	CPT® 29581		Apply Multlay Comprs Lwr Leg-lt	BOTH IP/OP	$478.00 	$353.72	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.00	$378.58	$382.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000065	EAP	CPT® 29584		Apply Multlay Comprs  Arm/hand-lt	BOTH IP/OP	$508.00 	$375.92	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$105.87	$0.00	$0.00	$0.00	$0.00	$478.00	$378.58	$382.40	$0.00	$330.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000070	EAP	CPT® 29581		Apply Multlay Comprs Lwr Leg-rt	BOTH IP/OP	$478.00 	$353.72	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.00	$378.58	$382.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000080	EAP	CPT® 97129		Occ Ther Ivntj Cog Funcj Cntct 1st 15 Minutes	BOTH IP/OP	$379.00 	$280.46	$0.00	$461.84	$41.10	$41.10	$24.17	$24.17	$18.64	$78.99	$444.74	$444.74	$461.84	$24.17	$78.98	$15.71	$224.18	$224.18	$0.00	$172.50	$273.24	$276.00	$24.17	$246.35	$24.17	$23.23	$24.17	$24.17	$0.00	$24.17	$0.00	$0.00	$0.00	$0.00
43000081	EAP	CPT® 97130		Occ Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes	BOTH IP/OP	$379.00 	$280.46	$0.00	$461.84	$39.28	$39.28	$23.44	$23.44	$17.80	$78.99	$444.74	$444.74	$461.84	$23.44	$78.98	$15.24	$224.18	$224.18	$0.00	$172.50	$273.24	$276.00	$23.44	$197.60	$23.44	$22.20	$23.44	$23.44	$0.00	$23.44	$0.00	$0.00	$0.00	$0.00
43000093	EAP	CPT® 29584		Apply Multlay Comprs  Arm/hand-rt	BOTH IP/OP	$508.00 	$375.92	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$105.87	$0.00	$0.00	$0.00	$0.00	$478.00	$378.58	$382.40	$0.00	$330.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000100	EAP	HCPCS G8978		Mobility Current Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000101	EAP	HCPCS G8979		Mobility Goal Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000102	EAP	HCPCS G8980		Mobility D/c Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000103	EAP	HCPCS G8981		Body Pos Current Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000104	EAP	HCPCS G8982		Body Pos Goal Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000106	EAP	HCPCS G8984		Carry Current Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000107	EAP	HCPCS G8985		Carry Goal Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000108	EAP	HCPCS G8986		Carry D/c  Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000109	EAP	HCPCS G8987		Self-care Current Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000110	EAP	HCPCS G8988		Self-care Goal Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000111	EAP	HCPCS G8989		Self-care D/c Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000112	EAP	HCPCS G8990		Other Pt/ot Current Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000113	EAP	HCPCS G8991		Other Pt/ot Goal Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000114	EAP	HCPCS G8992		Other Pt/ot D/c Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000115	EAP	HCPCS G8993		Sub Pt/ot Current Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000116	EAP	HCPCS G8994		Sub Pt/ot Goal Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000117	EAP	HCPCS G8995		Sub Pt/ot D/c Status	BOTH IP/OP	$0.01 	$0.01	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000118	EAP	CPT® 97014		Ot Electric Stim Ther Unsupervised Wound	BOTH IP/OP	$291.00 	$215.34	$0.00	$461.84	$27.09	$27.09	$0.00	$0.00	$13.56	$60.65	$444.74	$444.74	$461.84	$0.00	$60.64	$0.00	$172.13	$172.13	$0.00	$150.50	$238.39	$240.80	$180.60	$117.65	$180.60	$14.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43000119	EAP	CPT® 97014		Ot Electric Stim Ther Unsupervised Non-wound	BOTH IP/OP	$301.00 	$222.74	$0.00	$461.84	$27.09	$27.09	$13.21	$13.21	$14.03	$62.74	$444.74	$444.74	$461.84	$13.17	$62.73	$8.56	$178.04	$178.04	$13.83	$150.50	$238.39	$240.80	$180.60	$19.04	$180.60	$14.50	$0.00	$0.00	$0.00	$13.17	$0.00	$0.00	$0.00	$0.00
43400001	EAP	CPT® 92610		Nicu/ped/swallowing Evaluation	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$643.46	$643.46	$74.65	$74.65	$56.49	$246.98	$444.74	$444.74	$461.84	$74.65	$246.95	$48.52	$700.93	$700.93	$77.89	$592.50	$938.52	$948.00	$74.65	$837.20	$74.65	$42.12	$74.65	$74.65	$0.00	$74.65	$0.00	$0.00	$0.00	$0.00
43400060	EAP	CPT® 97165		Ot Eval Low Complex	BOTH IP/OP	$726.00 	$537.24	$0.00	$528.00	$157.79	$157.79	$98.49	$98.49	$0.00	$151.32	$444.74	$444.74	$461.84	$87.25	$151.30	$56.71	$429.43	$429.43	$91.61	$330.00	$522.72	$528.00	$126.51	$158.58	$126.51	$75.19	$87.25	$87.25	$0.00	$87.25	$0.00	$0.00	$0.00	$0.00
43400061	EAP	CPT® 97166		Ot Eval Mod Complex	BOTH IP/OP	$743.00 	$549.82	$0.00	$540.00	$157.79	$157.79	$98.49	$98.49	$0.00	$154.86	$444.74	$444.74	$461.84	$86.93	$154.84	$56.50	$439.48	$439.48	$91.28	$337.50	$534.60	$540.00	$126.05	$158.58	$126.05	$75.19	$86.93	$86.93	$0.00	$86.93	$0.00	$0.00	$0.00	$0.00
43400062	EAP	CPT® 97167		Ot Eval High Complex	BOTH IP/OP	$759.00 	$561.66	$0.00	$552.00	$157.79	$157.79	$98.49	$98.49	$0.00	$158.19	$444.74	$444.74	$461.84	$86.93	$158.18	$56.50	$448.95	$448.95	$91.28	$345.00	$546.48	$552.00	$126.05	$158.58	$126.05	$75.19	$86.93	$86.93	$0.00	$86.93	$0.00	$0.00	$0.00	$0.00
43400063	EAP	CPT® 97168		Ot Re-eval	BOTH IP/OP	$528.00 	$390.72	$0.00	$528.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$110.04	$0.00	$0.00	$0.00	$62.92	$240.00	$380.16	$384.00	$86.88	$528.00	$86.88	$49.67	$59.92	$59.92	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00
44000001	EAP	CPT® 92507		Individual Speech Therapy	BOTH IP/OP	$629.00 	$465.46	$44.25	$461.84	$148.00	$148.00	$77.93	$77.93	$80.21	$131.10	$444.74	$444.74	$461.84	$77.07	$131.08	$50.10	$372.05	$372.05	$80.92	$286.00	$453.02	$457.60	$111.75	$120.54	$111.75	$44.25	$77.07	$77.07	$91.06	$77.07	$0.00	$0.00	$0.00	$0.00
44000004	EAP	CPT® 92526		Treatmet Of Swallow & Oral Fun	BOTH IP/OP	$792.00 	$586.08	$55.00	$582.40	$430.06	$430.06	$86.29	$86.29	$87.06	$165.07	$444.74	$444.74	$461.84	$84.61	$165.05	$55.00	$468.47	$468.47	$88.84	$364.00	$576.58	$582.40	$122.68	$133.74	$122.68	$113.93	$84.61	$84.61	$115.90	$84.61	$0.00	$0.00	$0.00	$0.00
44000007	EAP	CPT® 92609		Ther Ser/speech-generating Dev	BOTH IP/OP	$509.00 	$376.66	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$106.08	$0.00	$0.00	$0.00	$0.00	$254.50	$403.13	$407.20	$0.00	$375.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44000044	EAP	CPT® 92524		Behavioral And Qualitative Analysis Of Voice And Resonae	BOTH IP/OP	$920.00 	$680.80	$56.95	$676.80	$166.61	$166.61	$111.62	$111.62	$91.21	$191.75	$444.74	$444.74	$461.84	$87.62	$191.73	$56.95	$544.18	$544.18	$92.00	$423.00	$670.03	$676.80	$127.05	$172.90	$127.05	$91.88	$87.62	$87.62	$134.68	$87.62	$0.00	$0.00	$0.00	$0.00
44000050	EAP	CPT® 97129		Speech Ther Ivntj Cog Funcj Cntct 1st 15 Minutes	BOTH IP/OP	$379.00 	$280.46	$0.00	$461.84	$41.10	$41.10	$24.17	$24.17	$18.64	$78.99	$444.74	$444.74	$461.84	$24.17	$78.98	$15.71	$224.18	$224.18	$0.00	$172.50	$273.24	$276.00	$24.17	$246.35	$24.17	$23.23	$24.17	$24.17	$54.92	$24.17	$0.00	$0.00	$0.00	$0.00
44000051	EAP	CPT® 97130		Speech Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes	BOTH IP/OP	$379.00 	$280.46	$0.00	$461.84	$39.28	$39.28	$23.44	$23.44	$17.80	$78.99	$444.74	$444.74	$461.84	$23.44	$78.98	$15.24	$224.18	$224.18	$0.00	$172.50	$273.24	$276.00	$23.44	$197.60	$23.44	$22.20	$23.44	$23.44	$54.92	$23.44	$0.00	$0.00	$0.00	$0.00
44300005	EAP	CPT® 92508		Group Speech Ther Each 15min	BOTH IP/OP	$188.00 	$139.12	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44400003	EAP	CPT® 92597		Evaluation For Voice Prosthesi	BOTH IP/OP	"$1,176.00 "	$870.24	$46.40	$865.60	$638.57	$638.57	$72.36	$72.36	$72.95	$245.11	$444.74	$444.74	$461.84	$71.39	$245.08	$46.40	$695.60	$695.60	$74.96	$541.00	$856.94	$865.60	$103.52	$113.15	$103.52	$169.33	$71.39	$71.39	$172.25	$71.39	$0.00	$0.00	$0.00	$0.00
44400005	EAP	CPT® 92607		Eval Speech Device First Hour	BOTH IP/OP	$553.00 	$409.22	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$115.25	$0.00	$0.00	$0.00	$0.00	$276.50	$437.98	$442.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44400007	EAP	CPT® 92608		Eval/speech Dvc (add'l 30 Min)	BOTH IP/OP	$200.00 	$148.00	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44400009	EAP	CPT® 92610		Eval.of Swallow & Oral Func.	BOTH IP/OP	"$1,288.00 "	$953.12	$42.12	$948.00	$699.38	$699.38	$74.65	$74.65	$56.49	$268.45	$444.74	$444.74	$461.84	$74.65	$268.42	$48.52	$761.85	$761.85	$77.89	$592.50	$938.52	$948.00	$74.65	$837.20	$74.65	$42.12	$74.65	$74.65	$188.65	$74.65	$0.00	$0.00	$0.00	$0.00
44400012	EAP	CPT® 92611		Motion Fluo Eval Of Swallowing	BOTH IP/OP	"$1,288.00 "	$953.12	$45.81	$948.00	$699.38	$699.38	$94.46	$94.46	$74.78	$268.45	$444.74	$444.74	$461.84	$94.46	$268.42	$61.40	$761.85	$761.85	$93.79	$592.50	$938.52	$948.00	$94.46	$837.20	$94.46	$45.81	$94.46	$94.46	$188.65	$94.46	$0.00	$0.00	$0.00	$0.00
44400014	EAP	CPT® 92612		Flex Fib Endo Eval/swallowing	BOTH IP/OP	"$2,142.00 "	"$1,585.08"	$0.00	"$1,576.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$446.39	$0.00	$0.00	$0.00	$0.00	$985.00	"$1,560.24"	"$1,576.00"	$0.00	"$1,392.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44400017	EAP	CPT® 96105		Assessment Of Aphasia	BOTH IP/OP	$607.00 	$449.18	$0.00	$485.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$126.50	$0.00	$0.00	$0.00	$0.00	$303.50	$480.74	$485.60	$0.00	$253.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44400020	EAP	CPT® 92540		Basic Vestibular Exam	BOTH IP/OP	$911.00 	$674.14	$0.00	$702.20	$494.67	$494.67	$135.96	$135.96	$136.73	$189.88	$676.14	$676.14	$702.20	$133.75	$189.85	$86.94	$538.86	$538.86	$0.00	$419.00	$663.70	$670.40	$0.00	$513.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44400030	EAP	CPT® 92570		Acoustic Immittance Testing	BOTH IP/OP	$273.00 	$202.02	$0.00	$461.84	$148.24	$148.24	$135.96	$135.96	$136.73	$56.90	$444.74	$444.74	$461.84	$133.75	$56.89	$86.94	$161.48	$161.48	$0.00	$138.00	$218.59	$220.80	$0.00	$177.45	$0.00	$23.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44400031	EAP	CPT® 92550		Tympanometry And Reflex Thresh	BOTH IP/OP	$156.00 	$115.44	$15.45	$461.84	$84.71	$84.71	$135.96	$135.96	$136.73	$32.51	$444.74	$444.74	$461.84	$133.75	$32.51	$86.94	$92.27	$92.27	$138.76	$79.00	$125.14	$126.40	$158.00	$101.40	$158.00	$15.45	$22.71	$22.71	$25.15	$132.15	$0.00	$0.00	$0.00	$0.00
44400033	EAP	CPT® 92618		Ex For Non-speech Dev Rx Add	BOTH IP/OP	$150.00 	$111.00	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44400034	EAP	CPT® 92522		"Eval Of Only Speech Snd Prod (motor Speech, Artic, Etc)"	BOTH IP/OP	$772.00 	$571.28	$58.20	$568.00	$172.58	$172.58	$114.03	$114.03	$93.49	$160.90	$444.74	$444.74	$461.84	$89.54	$160.88	$58.20	$456.64	$456.64	$94.02	$355.00	$562.32	$568.00	$129.83	$175.01	$129.83	$88.23	$89.54	$89.54	$113.03	$89.54	$0.00	$0.00	$0.00	$0.00
44400035	EAP	CPT® 92521		"Evaluation Of Speech Fluency (eg, Stuttering, Clutterin)"	BOTH IP/OP	$811.00 	$600.14	$0.00	$596.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$169.01	$0.00	$0.00	$0.00	$114.94	$373.00	$590.83	$596.80	$158.73	$596.00	$158.73	$108.68	$109.47	$109.47	$118.76	$109.47	$0.00	$0.00	$0.00	$0.00
44400036	EAP	CPT® 92523		"Eval Of Speech, Language & Cognition-communication"	BOTH IP/OP	"$1,188.00 "	$879.12	$122.04	$874.40	$368.39	$368.39	$234.49	$234.49	$190.53	$247.61	$444.74	$444.74	$461.84	$187.76	$247.58	$122.04	$702.70	$702.70	$197.15	$546.50	$865.66	$874.40	$272.25	$358.96	$272.25	$183.27	$187.76	$187.76	$174.01	$187.76	$0.00	$0.00	$0.00	$0.00
44400056	EAP	CPT® 92523		"EVAL OF SPEECH, LANGUAGE & COGNITION-COMM"	BOTH IP/OP	"$1,188.00 "	$879.12	$122.04	$874.40	$368.39	$368.39	$234.49	$234.49	$190.53	$247.61	$444.74	$444.74	$461.84	$187.76	$247.58	$122.04	$702.70	$702.70	$197.15	$546.50	$865.66	$874.40	$272.25	$358.96	$272.25	$183.27	$187.76	$187.76	$174.01	$187.76	$0.00	$0.00	$0.00	$0.00
45000003	EAP	CPT® 52310		Cystoscopy And Treatament	BOTH IP/OP	"$5,725.00 "	"$4,236.50"	$156.86	"$4,626.40"	"$2,753.10"	"$2,753.10"	"$1,743.67"	"$1,743.67"	"$1,753.49"	"$1,193.23"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,718.44"	"$1,193.09"	"$1,116.98"	"$2,836.00"	"$2,836.00"	"$1,776.76"	"$2,327.00"	"$4,580.14"	"$4,626.40"	"$2,468.57"	"$2,500.00"	"$2,468.57"	$409.12	$156.86	$156.86	$920.65	"$1,692.15"	$0.00	$0.00	$0.00	$0.00
45000005	EAP	CPT® 45300		Proctosigmidoscopy Dx	BOTH IP/OP	"$2,361.00 "	"$1,747.14"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$492.03	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,869.91"	"$1,888.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000006	EAP	CPT® 24675		Closed Tratment Of Proximal Ulna/w Manipulation	BOTH IP/OP	"$1,594.00 "	"$1,179.56"	$0.00	"$1,594.00"	"$1,594.00"	"$1,594.00"	"$1,356.40"	"$1,356.40"	"$1,364.04"	$332.23	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,334.46"	$332.19	$867.40	"$1,594.00"	"$1,594.00"	$0.00	"$1,550.00"	"$1,227.60"	"$1,240.00"	$0.00	"$1,594.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000009	EAP	CPT® 29126		Applyfore Arm Splint	BOTH IP/OP	$732.00 	$541.68	$0.00	$689.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.55	$0.00	$0.00	$0.00	$0.00	$689.00	$545.69	$551.20	$0.00	$524.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000018	EAP	CPT® 11760		Repair Of Nail Bed	BOTH IP/OP	$752.00 	$556.48	$0.00	$759.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.74	$0.00	$0.00	$0.00	$502.38	$156.72	$326.54	$113.00	$113.00	$0.00	$759.00	$601.13	$607.20	$0.00	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000020	EAP	CPT® 12001		Lac Repr Sclp Nck Hnd Ft <2.6c	BOTH IP/OP	$751.00 	$555.74	$46.87	$751.00	$751.00	$751.00	$174.88	$174.88	$175.86	$156.53	$751.00	$751.00	$751.00	$172.08	$156.51	$111.85	$113.00	$113.00	$175.24	$704.00	$557.57	$563.20	$243.48	$751.00	$243.48	$116.22	$46.87	$46.87	$112.08	$166.90	$0.00	$0.00	$0.00	$0.00
45000021	EAP	CPT® 27550		"Treat Knee Dislocation,w/o Anesthesia"	BOTH IP/OP	$902.00 	$667.48	$0.00	$902.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.98	$0.00	$0.00	$0.00	$0.00	$857.00	$678.74	$685.60	$0.00	$902.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000022	EAP	CPT® 12002		Lac Repr Sclp Nck Hnd Ft 2.6-7	BOTH IP/OP	$938.00 	$694.12	$62.38	"$1,134.00"	$509.33	$509.33	$174.88	$174.88	$175.86	$195.50	$938.00	$938.00	$938.00	$172.08	$195.48	$111.85	$113.00	$113.00	$175.24	$879.00	$696.17	$703.20	$243.48	"$1,134.00"	$243.48	$127.88	$62.38	$62.38	$139.94	$166.90	$0.00	$0.00	$0.00	$0.00
45000023	EAP	CPT® 12004		Rep Sc/nk/ax/gen/tk 7.6-12.5cm	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,134.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$175.24	$970.00	$768.24	$776.00	$243.48	"$1,134.00"	$243.48	$152.49	$77.52	$77.52	$154.42	$166.90	$0.00	$0.00	$0.00	$0.00
45000025	EAP	CPT® 12005		Rep Sc/nk/ax/gen/ 12.6-20.0 Cm	BOTH IP/OP	$970.00 	$717.80	$0.00	"$1,134.00"	$970.00	$970.00	$336.60	$336.60	$338.49	$202.17	$970.00	$970.00	$970.00	$331.46	$202.15	$215.45	$970.00	$970.00	$0.00	$909.00	$719.93	$727.20	$0.00	"$1,134.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000027	EAP	CPT® 12006		Rep Sc/nk/ax/gen/ 20.1-30.0 Cm	BOTH IP/OP	$465.00 	$344.10	$0.00	$465.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$436.00	$345.31	$348.80	$0.00	$465.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000029	EAP	CPT® 12007		Rep Sc/nk/ax/gen/tk > 30.0 Cm	BOTH IP/OP	$970.00 	$717.80	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.15	$0.00	$0.00	$0.00	$0.00	$909.00	$719.93	$727.20	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000030	EAP	CPT® 12011		Lac Rep.fac/ear/lid/nose<2.5cm	BOTH IP/OP	$778.00 	$575.72	$58.77	$891.00	$422.45	$422.45	$174.88	$174.88	$175.86	$162.15	$778.00	$778.00	$778.00	$172.08	$162.14	$111.85	$113.00	$113.00	$175.24	$729.00	$577.37	$583.20	$243.48	$891.00	$243.48	$123.67	$58.77	$58.77	$116.06	$166.90	$0.00	$0.00	$0.00	$0.00
45000031	EAP	CPT® 12013		Lac Repr Fce Ear Eye Lp 2.6-5.	BOTH IP/OP	$954.00 	$705.96	$62.02	$954.00	$518.02	$518.02	$174.88	$174.88	$175.86	$198.84	$954.00	$954.00	$954.00	$172.08	$198.81	$111.85	$113.00	$113.00	$175.24	$894.00	$708.05	$715.20	$243.48	$954.00	$243.48	$140.24	$62.02	$62.02	$142.32	$166.90	$0.00	$0.00	$0.00	$0.00
45000032	EAP	CPT® 12014		Lac Repr Fce Ear Eye Lp 5.1-7.	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$215.72	$0.00	$0.00	$0.00	$172.08	$215.69	$111.85	$113.00	$113.00	$175.24	$970.00	$768.24	$776.00	$243.48	"$1,035.00"	$243.48	$166.21	$79.33	$79.33	$154.42	$166.90	$0.00	$0.00	$0.00	$0.00
45000034	EAP	CPT® 12015		Lac Rep Fce Ear Eye Lp 7.6-12.	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$215.72	$0.00	$0.00	$0.00	$172.08	$215.69	$111.85	$113.00	$113.00	$0.00	$970.00	$768.24	$776.00	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000035	EAP	CPT® 27510		"Treatment Of Thigh Fracture,w Manipulation"	BOTH IP/OP	"$1,589.00 "	"$1,175.86"	$0.00	"$1,589.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.15	$0.00	$0.00	$0.00	$0.00	"$1,589.00"	"$1,258.49"	"$1,271.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000036	EAP	CPT® 12016		Lac Rep Fce Ear Eye Lp12.6-20.	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	$970.00	$768.24	$776.00	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000038	EAP	CPT® 12017		Rp Si Fa Ear Nos Lip 20.1-30.0	BOTH IP/OP	"$1,686.00 "	"$1,247.64"	$0.00	"$1,580.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$351.36	$0.00	$0.00	$0.00	$0.00	"$1,580.00"	"$1,251.36"	"$1,264.00"	$0.00	"$1,134.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000041	EAP	CPT® 12031		Int Rep Sclp Trnk Extrm <2.5cm	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$215.72	$0.00	$0.00	$0.00	$331.46	$215.69	$215.45	$113.00	$113.00	$320.45	$970.00	$768.24	$776.00	$445.22	"$1,035.00"	$445.22	$141.63	$157.16	$157.16	$154.42	$305.19	$0.00	$0.00	$0.00	$0.00
45000042	EAP	CPT® 12032		Int Rep Sclp Trk Ext 2.6-7.5cm	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,257.00"	"$1,035.00"	"$1,035.00"	$336.60	$336.60	$338.49	$215.72	$0.00	$0.00	$0.00	$331.46	$215.69	$215.45	$113.00	$113.00	$320.45	$970.00	$768.24	$776.00	$445.22	"$1,257.00"	$445.22	$161.36	$196.82	$196.82	$154.42	$305.19	$0.00	$0.00	$0.00	$0.00
45000043	EAP	CPT® 12034		Int Rep Sclp Trk Ext7.6-12.5cm	BOTH IP/OP	$496.00 	$367.04	$0.00	$496.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.38	$0.00	$0.00	$0.00	$331.46	$103.37	$215.45	$496.00	$496.00	$0.00	$465.00	$368.28	$372.00	$0.00	$496.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000044	EAP	CPT® 12035		Int Rep Sclp Trk Extrm12.6-20.	BOTH IP/OP	$970.00 	$717.80	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.15	$0.00	$0.00	$0.00	$0.00	$909.00	$719.93	$727.20	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000045	EAP	CPT® 28455		Treatment Of Tarsal Bone Fracture	BOTH IP/OP	"$6,532.00 "	"$4,833.68"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,361.27"	$0.00	$0.00	$0.00	$0.00	"$1,500.00"	"$1,188.00"	"$1,200.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000046	EAP	CPT® 12036		Int Rep S/tr/ext/20.1-30.0cm	BOTH IP/OP	$894.00 	$661.56	$0.00	$894.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.31	$0.00	$0.00	$0.00	$0.00	$838.00	$663.70	$670.40	$0.00	$894.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000047	EAP	CPT® 56440		Marsupialization Of Bartholin Cyst	BOTH IP/OP	"$7,879.00 "	"$5,830.46"	$0.00	"$6,303.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,641.98"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$6,240.17"	"$6,303.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000048	EAP	CPT® 12037		Intmd Wnd Repair S/tr/ext	BOTH IP/OP	"$1,882.00 "	"$1,392.68"	$0.00	"$2,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$392.21	$0.00	$0.00	$0.00	$0.00	"$1,907.00"	"$1,510.34"	"$1,525.60"	$0.00	"$2,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000049	EAP	CPT® 12041		Int Repr N-hf/genit <2.6cm	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.46	$215.69	$0.00	$113.00	$113.00	$320.45	$970.00	$768.24	$776.00	$445.22	"$1,035.00"	$445.22	$157.82	$152.13	$152.13	$154.42	$305.19	$0.00	$0.00	$0.00	$0.00
45000051	EAP	CPT® 12042		Int Repr Nck Hnd Ft 2.6-7.5 Cm	BOTH IP/OP	$615.00 	$455.10	$0.00	$615.00	$615.00	$615.00	$336.60	$336.60	$338.49	$128.18	$615.00	$615.00	$615.00	$331.46	$128.17	$215.45	$113.00	$113.00	$0.00	$465.00	$368.28	$372.00	$0.00	$615.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000052	EAP	CPT® 12044		Int Repr Nck Hnd Ft 7.6-12.5cm	BOTH IP/OP	"$1,012.00 "	$748.88	$0.00	"$1,012.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.90	$0.00	$0.00	$0.00	$0.00	$948.00	$750.82	$758.40	$0.00	"$1,012.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000053	EAP	CPT® 12045		Int Rep Nck Hnd Ft 12.6-20.0cm	BOTH IP/OP	"$2,196.00 "	"$1,625.04"	$0.00	"$2,058.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$457.65	$0.00	$0.00	$0.00	$0.00	"$2,058.00"	"$1,629.94"	"$1,646.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000054	EAP	CPT® 12046		Int Rep Nck Hnd Ft 20.1-30.0cm	BOTH IP/OP	"$1,314.00 "	$972.36	$0.00	"$1,332.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$273.84	$0.00	$0.00	$0.00	$0.00	"$1,332.00"	"$1,054.94"	"$1,065.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000055	EAP	CPT® 12051		Int Repr Fce Ear Eye Lp<2.5cm	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,035.00"	"$1,035.00"	"$1,035.00"	$336.60	$336.60	$338.49	$215.72	$0.00	$0.00	$0.00	$331.46	$215.69	$215.45	$113.00	$113.00	$320.45	$970.00	$768.24	$776.00	$445.22	"$1,035.00"	$445.22	$0.00	$174.83	$174.83	$154.42	$305.19	$0.00	$0.00	$0.00	$0.00
45000056	EAP	CPT® 12052		Int Repr F/e/l/mm 2.6-5.0cm	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,035.00"	"$1,035.00"	"$1,035.00"	$336.60	$336.60	$338.49	$215.72	$0.00	$0.00	$0.00	$331.46	$215.69	$215.45	$113.00	$113.00	$320.45	$970.00	$768.24	$776.00	$445.22	"$1,035.00"	$445.22	$183.25	$206.92	$206.92	$154.42	$305.19	$0.00	$0.00	$0.00	$0.00
45000057	EAP	CPT® 12053		Int Wnd Repr Face/mm 5.1-7.5cm	BOTH IP/OP	"$1,718.00 "	"$1,271.32"	$0.00	"$1,718.00"	"$1,718.00"	"$1,718.00"	$336.60	$336.60	$338.49	$0.00	$0.00	$0.00	$0.00	$0.00	$358.03	$0.00	$0.00	$0.00	$320.45	"$1,610.00"	"$1,275.12"	"$1,288.00"	$445.22	"$1,134.00"	$445.22	$204.98	$223.51	$223.51	$256.31	$305.19	$0.00	$0.00	$0.00	$0.00
45000058	EAP	CPT® 12054		Int Rep Fce Ear Lp 7.6-12.5 Cm	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$215.72	$0.00	$0.00	$0.00	$331.46	$215.69	$215.45	"$1,035.00"	"$1,035.00"	$0.00	$970.00	$768.24	$776.00	$0.00	$957.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000059	EAP	CPT® 12055		Rep Int Fce Ear Lp 12.6-20.0cm	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	$970.00	$768.24	$776.00	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000060	EAP	CPT® 16000		Init Trmnt Burn 1st Degree	BOTH IP/OP	"$1,690.00 "	"$1,250.60"	$0.00	"$1,690.00"	$917.67	$917.67	$174.88	$174.88	$175.86	$352.24	$0.00	$0.00	$0.00	$172.08	$352.20	$111.85	$113.00	$113.00	$175.24	"$1,607.00"	"$1,272.74"	"$1,285.60"	$243.48	"$1,690.00"	$243.48	$0.00	$47.96	$47.96	$255.83	$166.90	$0.00	$0.00	$0.00	$0.00
45000061	EAP	CPT® 16020		Part Thick Burn Dress/debrd;sm (tbsa<5%)	BOTH IP/OP	"$1,607.00 "	"$1,189.18"	$0.00	"$1,607.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	"$1,607.00"	"$1,272.74"	"$1,285.60"	$243.48	$0.00	$243.48	$54.62	$56.23	$56.23	$255.83	$166.90	$0.00	$0.00	$0.00	$0.00
45000062	EAP	CPT® 16030		Part Thick Burn Dress/debrd;lg (tbsa >10%)	BOTH IP/OP	"$4,348.00 "	"$3,217.52"	$0.00	"$3,478.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.45	"$2,255.00"	"$3,443.62"	"$3,478.40"	$445.22	$0.00	$445.22	$134.39	$138.43	$138.43	$692.20	$305.19	$0.00	$0.00	$0.00	$0.00
45000063	EAP	CPT® 19020		Incision Of Breast Lesion	BOTH IP/OP	"$7,031.00 "	"$5,202.94"	$0.00	"$5,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,465.44"	$0.00	$0.00	$0.00	"$1,348.50"	"$1,465.26"	$876.52	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$5,624.78"	"$5,681.60"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000067	EAP	CPT® 24565		Treat Humerus Fracture	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,550.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	"$1,550.00"	"$1,227.60"	"$1,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000069	EAP	CPT® 25535		Clsd Fracture Ulna W Manip	BOTH IP/OP	$662.00 	$489.88	$0.00	"$1,233.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.96	$0.00	$0.00	$0.00	$0.00	$625.00	$495.00	$500.00	$0.00	"$1,233.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000070	EAP	CPT® 25600		Treat Fracture Radius/ulna	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,233.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.62	$260.50	$128.45	$113.00	$113.00	$0.00	"$1,180.00"	$934.56	$944.00	$0.00	"$1,233.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000071	EAP	CPT® 26010		"I&d Finger Abscess, Simple"	BOTH IP/OP	"$1,407.00 "	"$1,041.18"	$0.00	"$1,407.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,407.00"	"$1,114.34"	"$1,125.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000072	EAP	CPT® 27760		Clsd Tx Medial Malleolus Fx	BOTH IP/OP	$680.00 	$503.20	$0.00	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.71	$0.00	$0.00	$0.00	$0.00	$720.00	$570.24	$576.00	$0.00	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000073	EAP	CPT® 27780		Clsd Fracture Fibula W/o Manip	BOTH IP/OP	"$1,057.00 "	$782.18	$0.00	"$1,119.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.28	$0.00	$0.00	$0.00	$0.00	"$1,119.00"	$886.25	$895.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000075	EAP	CPT® 27786		Clsd Tx Distal Fibular Fx	BOTH IP/OP	"$1,204.00 "	$890.96	$0.00	"$1,153.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.91	$0.00	$0.00	$0.00	$0.00	"$1,153.00"	$913.18	$922.40	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000077	EAP	CPT® 28400		Clsd Fracture Heel W/o Manip	BOTH IP/OP	$811.00 	$600.14	$0.00	$811.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.01	$0.00	$0.00	$0.00	$0.00	$811.00	$642.31	$648.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000078	EAP	CPT® 28430		Treatment Of Ankle Fracture	BOTH IP/OP	$820.00 	$606.80	$0.00	$820.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.89	$0.00	$0.00	$0.00	$0.00	$811.00	$642.31	$648.80	$0.00	$820.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000079	EAP	CPT® 28515		Clsd Fracture Toe W Manip	BOTH IP/OP	$547.00 	$404.78	$0.00	$547.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$113.99	$0.00	$0.00	$0.00	$0.00	$541.00	$428.47	$432.80	$0.00	$547.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000080	EAP	CPT® 28540		Treat Foot Dislocation	BOTH IP/OP	$398.00 	$294.52	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.94	$0.00	$0.00	$0.00	$0.00	$398.00	$315.22	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000081	EAP	CPT® 28630		Closed Tx Metatarsophal Jt Dis	BOTH IP/OP	$547.00 	$404.78	$0.00	$547.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$113.99	$0.00	$0.00	$0.00	$0.00	$541.00	$428.47	$432.80	$0.00	$547.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000082	EAP	CPT® 29105		App'l Long Arm Splint	BOTH IP/OP	$859.00 	$635.66	$0.00	$859.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.13	$859.00	$680.33	$687.20	$186.36	$0.00	$186.36	$94.27	$43.63	$43.63	$136.75	$127.75	$0.00	$0.00	$0.00	$0.00
45000083	EAP	CPT® 29240		Strapping Of Shoulder	BOTH IP/OP	$727.00 	$537.98	$0.00	$813.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.51	$0.00	$0.00	$0.00	$0.00	$813.00	$643.90	$650.40	$0.00	$302.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000084	EAP	CPT® 29240		Apply Shoulder Immobilizer	BOTH IP/OP	$727.00 	$537.98	$0.00	$813.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.51	$0.00	$0.00	$0.00	$0.00	$813.00	$643.90	$650.40	$0.00	$302.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000087	EAP	CPT® 36600		Arterial Puncture	BOTH IP/OP	$300.00 	$222.00	$0.00	$284.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.35	$284.00	$224.93	$227.20	$151.93	$0.00	$151.93	$24.37	$16.23	$16.23	$45.21	$104.14	$0.00	$0.00	$0.00	$0.00
45000088	EAP	CPT® 41250		Repair Tongue Laceration	BOTH IP/OP	$794.00 	$587.56	$0.00	$802.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.47	$0.00	$0.00	$0.00	$0.00	$802.00	$635.18	$641.60	$0.00	$794.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000089	EAP	CPT® 41800		Drainage Of Gum Lesion	BOTH IP/OP	$634.00 	$469.16	$69.74	$640.00	$634.00	$634.00	$109.81	$109.81	$110.43	$132.14	$634.00	$634.00	$634.00	$107.30	$132.13	$69.74	$634.00	$634.00	$109.35	$640.00	$506.88	$512.00	$151.93	$634.00	$151.93	$87.50	$157.47	$157.47	$101.89	$104.14	$0.00	$0.00	$0.00	$0.00
45000090	EAP	CPT® 42700		I&d Peritonsillar Abscess	BOTH IP/OP	$436.00 	$322.64	$70.05	$440.00	$436.00	$436.00	$206.03	$206.03	$207.19	$90.87	$436.00	$436.00	$436.00	$202.80	$90.86	$131.82	$436.00	$436.00	$204.24	$440.00	$348.48	$352.00	$283.76	$436.00	$283.76	$122.16	$139.13	$139.13	$70.05	$194.51	$0.00	$0.00	$0.00	$0.00
45000093	EAP	CPT® 46050		I & D Perianal Abcess	BOTH IP/OP	"$4,031.00 "	"$2,982.94"	$0.00	"$3,224.80"	"$2,321.55"	"$2,321.55"	$772.82	$772.82	$777.17	$840.16	"$1,257.08"	"$1,257.08"	"$1,305.43"	$760.65	$840.06	$494.42	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$3,192.55"	"$3,224.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000094	EAP	CPT® 56420		I & D Bartholin Abscess	BOTH IP/OP	$665.00 	$492.10	$0.00	"$1,224.00"	$665.00	$665.00	$165.90	$165.90	$166.84	$138.60	$0.00	$0.00	$0.00	$163.24	$138.59	$106.10	$665.00	$665.00	$166.54	$672.00	$532.22	$537.60	$231.38	"$1,224.00"	$231.38	$106.60	$107.06	$107.06	$106.98	$158.61	$0.00	$0.00	$0.00	$0.00
45000096	EAP	CPT® 69000		Drain External Ear Lesion	BOTH IP/OP	$694.00 	$513.56	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$144.63	$0.00	$0.00	$0.00	$0.00	$700.00	$554.40	$560.00	$0.00	$694.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000112	EAP	CPT® 12056		Rep Int Fce Ear Lp 20.1-30.0cm	BOTH IP/OP	"$1,559.00 "	"$1,153.66"	$0.00	"$1,580.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.90	$0.00	$0.00	$0.00	$0.00	"$1,580.00"	"$1,251.36"	"$1,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000113	EAP	CPT® 13120		Cmplx Rpr Sclp Arm Lgs 1.1-2.5	BOTH IP/OP	"$1,427.00 "	"$1,055.98"	$0.00	"$1,427.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$297.39	$0.00	$0.00	$0.00	$0.00	"$1,337.00"	"$1,058.90"	"$1,069.60"	$0.00	"$1,427.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000114	EAP	CPT® 13121		Repr Comp Scalp Arms Lgs 2.5-7	BOTH IP/OP	"$1,539.00 "	"$1,138.86"	$0.00	"$1,539.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.73	$0.00	$0.00	$0.00	$498.48	"$1,442.00"	"$1,142.06"	"$1,153.60"	$692.57	"$1,539.00"	$692.57	$0.00	$270.39	$270.39	$229.57	$474.74	$0.00	$0.00	$0.00	$0.00
45000115	EAP	CPT® 13122		Cmplx Rpr Sclp Arm Lgs Ea Add	BOTH IP/OP	"$1,378.00 "	"$1,019.72"	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.18	$0.00	$0.00	$0.00	$0.00	"$1,291.00"	"$1,022.47"	"$1,032.80"	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000116	EAP	CPT® 13131		"Repr Complex Mouth Neck Hds,ft"	BOTH IP/OP	"$1,427.00 "	"$1,055.98"	$0.00	"$1,427.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$297.39	$0.00	$0.00	$0.00	$0.00	"$1,337.00"	"$1,058.90"	"$1,069.60"	$0.00	"$1,427.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000117	EAP	CPT® 13132		"Repr Comp Mouth,neck,hds,ft2.6"	BOTH IP/OP	"$1,427.00 "	"$1,055.98"	$0.00	"$1,427.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$297.39	$0.00	$0.00	$0.00	$498.48	"$1,337.00"	"$1,058.90"	"$1,069.60"	$692.57	"$1,427.00"	$692.57	$0.00	$317.62	$317.62	$212.85	$474.74	$0.00	$0.00	$0.00	$0.00
45000118	EAP	CPT® 13133		Repair Wound/lesion Add-on	BOTH IP/OP	"$1,336.00 "	$988.64	$0.00	"$1,336.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.42	$0.00	$0.00	$0.00	$0.00	"$1,252.00"	$991.58	"$1,001.60"	$0.00	"$1,336.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000120	EAP	CPT® 13151		Cmplx Rpr Eye Nose Ear 1.1-2.5	BOTH IP/OP	"$2,495.00 "	"$1,846.30"	$0.00	"$2,338.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$519.96	$0.00	$0.00	$0.00	$0.00	"$2,338.00"	"$1,851.70"	"$1,870.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000121	EAP	CPT® 13152		"Repr Comp Eyel, Nose,ears Lips"	BOTH IP/OP	"$2,703.00 "	"$2,000.22"	$0.00	"$2,533.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$563.31	$0.00	$0.00	$0.00	$0.00	"$2,533.00"	"$2,006.14"	"$2,026.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000122	EAP	CPT® 13153		Cmplx Rpr Eye Nose Ear Add-on	BOTH IP/OP	"$1,378.00 "	"$1,019.72"	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.18	$0.00	$0.00	$0.00	$0.00	"$1,291.00"	"$1,022.47"	"$1,032.80"	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000123	EAP	CPT® 13160		Second Closr Surg Wound; Comp	BOTH IP/OP	"$10,207.00 "	"$7,553.18"	$0.00	"$8,274.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,127.14"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$8,191.66"	"$8,274.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000124	EAP	CPT® 16025		Part Thick Burn Dress/debrd;md (tbsa 5%-10%)	BOTH IP/OP	"$3,252.00 "	"$2,406.48"	$0.00	"$2,601.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.24	"$2,255.00"	"$2,575.58"	"$2,601.60"	$243.48	$0.00	$243.48	$107.09	$114.64	$114.64	$517.72	$166.90	$0.00	$0.00	$0.00	$0.00
45000125	EAP	CPT® 26675		Treat Hand Dislocation	BOTH IP/OP	"$3,905.00 "	"$2,889.70"	$0.00	"$3,318.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$813.80	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,285.22"	"$3,318.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000126	EAP	CPT® 19000		Punc Aspiration Cyst Of Breast	BOTH IP/OP	"$1,141.00 "	$844.34	$0.00	"$1,141.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.80	"$1,141.00"	$903.67	$912.80	$850.02	$0.00	$850.02	$59.58	$45.43	$45.43	$181.65	$582.67	$0.00	$0.00	$0.00	$0.00
45000128	EAP	CPT® 20102		"Explore Wound, Abdomen"	BOTH IP/OP	"$4,018.00 "	"$2,973.32"	$0.00	"$3,214.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$837.35	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,182.26"	"$3,214.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000129	EAP	CPT® 20103		"Explore Wound, Extremity"	BOTH IP/OP	"$3,502.00 "	"$2,591.48"	$0.00	"$2,801.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$729.82	$0.00	$0.00	$0.00	$611.80	"$2,255.00"	"$2,773.58"	"$2,801.60"	$850.02	"$2,500.00"	$850.02	$323.52	$360.85	$360.85	$557.52	$582.67	$0.00	$0.00	$0.00	$0.00
45000133	EAP	CPT® 20612		"Aspiration/inj.,gangion Cyst"	BOTH IP/OP	"$1,051.00 "	$777.74	$0.00	"$1,051.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.54	"$1,051.00"	$832.39	$840.80	$364.76	$0.00	$364.76	$54.88	$42.90	$42.90	$167.32	$250.04	$0.00	$0.00	$0.00	$0.00
45000134	EAP	CPT® 20822		"Replantation Digit, Complete"	BOTH IP/OP	"$9,548.00 "	"$7,065.52"	$0.00	"$7,638.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,989.80"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$7,562.02"	"$7,638.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000135	EAP	CPT® 21110		Interdental Fixation	BOTH IP/OP	"$1,478.00 "	"$1,093.72"	$0.00	"$1,478.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.02	$0.00	$0.00	$0.00	$0.00	"$1,389.00"	"$1,100.09"	"$1,111.20"	$0.00	"$1,478.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000136	EAP	CPT® 21310		Nasal Bone Fx Wo Manip	BOTH IP/OP	$506.00 	$374.44	$0.00	$506.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.45	$0.00	$0.00	$0.00	$0.00	$506.00	$400.75	$404.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000138	EAP	CPT® 21315		Treatment Of Nose Fracture	BOTH IP/OP	"$4,285.00 "	"$3,170.90"	$0.00	"$3,462.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$892.99	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,427.78"	"$3,462.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000140	EAP	CPT® 21421		Maxillary Fracture	BOTH IP/OP	"$9,532.00 "	"$7,053.68"	$0.00	"$7,702.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,986.47"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$7,625.38"	"$7,702.40"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000141	EAP	CPT® 21450		Mandibular Fx Wo Manip	BOTH IP/OP	$810.00 	$599.40	$0.00	$818.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.80	$0.00	$0.00	$0.00	$0.00	$818.00	$647.86	$654.40	$0.00	$810.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000142	EAP	CPT® 21480		Reset Dislocated Jaw	BOTH IP/OP	$254.00 	$187.96	$0.00	$257.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.93	$0.00	$0.00	$0.00	$0.00	$257.00	$203.54	$205.60	$0.00	$257.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000148	EAP	CPT® 23500		Clavicular Fx Wo Manip	BOTH IP/OP	"$1,101.00 "	$814.74	$0.00	"$1,101.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.45	$0.00	$0.00	$0.00	$0.00	"$1,037.00"	$821.30	$829.60	$0.00	"$1,101.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000150	EAP	CPT® 23540		Acromioclavicular Disloca	BOTH IP/OP	$815.00 	$603.10	$0.00	$815.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.85	$0.00	$0.00	$0.00	$0.00	$815.00	$645.48	$652.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000154	EAP	CPT® 23605		CLSD TXT PROXIMAL HUMERUS W/MANIPU	BOTH IP/OP	"$6,187.00 "	"$4,578.38"	$0.00	"$4,813.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,289.37"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,765.46"	"$4,813.60"	$0.00	"$3,250.00"	$0.00	$410.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000156	EAP	CPT® 23615		Treat Humerus Fracture	BOTH IP/OP	"$36,769.00 "	"$27,209.06"	$0.00	"$28,604.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,662.66"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$28,318.75"	"$28,604.80"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000158	EAP	CPT® 23650		Shoulder Disloca W Manip	BOTH IP/OP	"$1,131.00 "	$836.94	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.70	$0.00	$0.00	$0.00	$216.27	"$1,100.00"	$871.20	$880.00	$300.48	"$1,378.00"	$300.48	$251.06	$301.31	$301.31	$175.12	$205.98	$0.00	$0.00	$0.00	$0.00
45000160	EAP	CPT® 23655		Shoulder Disloca W Humeral	BOTH IP/OP	"$5,598.00 "	"$4,142.52"	$0.00	"$4,355.20"	"$2,321.55"	"$2,321.55"	"$1,356.40"	"$1,356.40"	"$1,364.04"	$0.00	"$1,257.08"	"$1,257.08"	"$1,305.43"	$0.00	"$1,166.62"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,311.65"	"$4,355.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000162	EAP	CPT® 23675		Shoulder Disloca W Neck Fx	BOTH IP/OP	"$1,594.00 "	"$1,179.56"	$0.00	"$1,550.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$332.19	$0.00	$0.00	$0.00	$0.00	"$1,550.00"	"$1,227.60"	"$1,240.00"	$0.00	"$1,489.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000163	EAP	CPT® 24201		Removal Of Arm Foreign Body	BOTH IP/OP	"$9,773.00 "	"$7,232.02"	$0.00	"$7,603.20"	"$2,753.10"	"$2,753.10"	"$2,309.02"	"$2,309.02"	"$2,322.02"	$0.00	"$1,541.95"	"$1,541.95"	"$1,601.25"	$0.00	"$2,036.69"	$0.00	$0.00	$0.00	"$2,325.71"	"$2,327.00"	"$7,527.17"	"$7,603.20"	"$3,231.26"	"$2,500.00"	"$3,231.26"	$360.96	$376.65	$376.65	"$1,513.04"	"$2,214.96"	$0.00	$0.00	$0.00	$0.00
45000164	EAP	CPT® 24341		Repair Tendon/muscle Upper Arm	BOTH IP/OP	"$17,367.00 "	"$12,851.58"	$0.00	"$14,352.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,619.28"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$14,209.27"	"$14,352.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000165	EAP	CPT® 24500		Clsd Txt Humeral Shaft Fx W/out Manip	BOTH IP/OP	$712.00 	$526.88	$0.00	$712.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.00	$563.90	$569.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000167	EAP	CPT® 24500		Apply Humeral Splint	BOTH IP/OP	$712.00 	$526.88	$0.00	$712.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.00	$563.90	$569.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000168	EAP	CPT® 24505		Clsd Txt Humeral Shaft W/manipulation	BOTH IP/OP	"$1,594.00 "	"$1,179.56"	$0.00	"$1,594.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$332.19	$0.00	$0.00	$0.00	$0.00	"$1,550.00"	"$1,227.60"	"$1,240.00"	$0.00	"$1,594.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000174	EAP	CPT® 24577		Treat Humerus Fracture	BOTH IP/OP	"$2,383.00 "	"$1,763.42"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$496.62	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,949.90"	"$1,969.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000175	EAP	CPT® 24600		Elbow Disloca Wo Anes	BOTH IP/OP	$879.00 	$650.46	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.18	$0.00	$0.00	$0.00	$0.00	$855.00	$677.16	$684.00	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000176	EAP	CPT® 24605		Treat Elbow Dislocation	BOTH IP/OP	"$9,171.00 "	"$6,786.54"	$0.00	"$7,134.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,911.24"	$0.00	$0.00	$0.00	"$1,359.37"	"$2,327.00"	"$7,063.06"	"$7,134.40"	"$1,888.67"	"$2,500.00"	"$1,888.67"	$330.49	$491.61	$491.61	"$1,419.75"	"$1,294.64"	$0.00	$0.00	$0.00	$0.00
45000177	EAP	CPT® 24620		Treat Elbow Fracture	BOTH IP/OP	"$8,190.00 "	"$6,060.60"	$0.00	"$6,371.20"	"$2,753.10"	"$2,753.10"	"$1,356.40"	"$1,356.40"	"$1,364.04"	$0.00	"$1,541.95"	"$1,541.95"	"$1,601.25"	$0.00	"$1,706.80"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$6,307.49"	"$6,371.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000179	EAP	CPT® 24650		Radial Hd/neck Fx Wo Manip	BOTH IP/OP	"$1,128.00 "	$834.72	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.08	$0.00	$0.00	$0.00	$0.00	"$1,097.00"	$868.82	$877.60	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000181	EAP	CPT® 24655		CLSD TXT RADIAL HD/NECK FX W/OUT M	BOTH IP/OP	"$2,532.00 "	"$1,873.68"	$0.00	"$2,321.55"	"$2,321.55"	"$2,321.55"	"$1,356.40"	"$1,356.40"	"$1,364.04"	$527.73	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,334.46"	$527.67	$867.40	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$1,949.90"	"$1,969.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000184	EAP	CPT® 25500		Radial Shaft Fx Wo Manip	BOTH IP/OP	"$1,047.00 "	$774.78	$0.00	"$1,061.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.19	$0.00	$0.00	$0.00	$0.00	"$1,061.00"	$840.31	$848.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000186	EAP	CPT® 25505		CLSD TXT RADIAL SHAFT FX W/MANIPUL	BOTH IP/OP	"$2,452.00 "	"$1,814.48"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$511.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,833.48"	"$1,852.00"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000189	EAP	CPT® 25520		Treat Fracture Of Radius	BOTH IP/OP	"$2,483.00 "	"$1,837.42"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.46	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,857.24"	"$1,876.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000190	EAP	CPT® 25530		Ulnar Shaft Fx Wo Manip	BOTH IP/OP	"$1,274.00 "	$942.76	$0.00	"$1,233.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$265.50	$0.00	$0.00	$0.00	$0.00	"$1,203.00"	$952.78	$962.40	$0.00	"$1,233.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000192	EAP	CPT® 25560		Radial/ulner Fx Wo Manip	BOTH IP/OP	$891.00 	$659.34	$0.00	$903.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.68	$0.00	$0.00	$0.00	$0.00	$903.00	$715.18	$722.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000194	EAP	CPT® 25565		Treat Fracture Radius & Ulna	BOTH IP/OP	"$2,483.00 "	"$1,837.42"	$373.32	"$2,483.00"	"$2,483.00"	"$2,483.00"	"$1,356.40"	"$1,356.40"	"$1,364.04"	$517.52	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,334.46"	$517.46	$867.40	"$2,483.00"	"$2,483.00"	"$1,359.37"	"$2,327.00"	"$1,857.24"	"$1,876.00"	"$1,888.67"	"$1,750.00"	"$1,888.67"	$473.67	$482.25	$482.25	$373.32	"$1,294.64"	$0.00	$0.00	$0.00	$0.00
45000196	EAP	CPT® 25605		Treat Fracture Radius/ulna	BOTH IP/OP	"$2,483.00 "	"$1,837.42"	$373.32	"$2,483.00"	"$2,483.00"	"$2,483.00"	"$1,356.40"	"$1,356.40"	"$1,364.04"	$517.52	"$1,826.79"	"$1,826.79"	"$1,897.05"	"$1,334.46"	$517.46	$867.40	"$2,483.00"	"$2,483.00"	"$1,359.37"	"$2,345.00"	"$1,857.24"	"$1,876.00"	"$1,888.67"	"$2,150.00"	"$1,888.67"	$469.11	$530.90	$530.90	$373.32	"$1,294.64"	$0.00	$0.00	$0.00	$0.00
45000200	EAP	CPT® 25635		Treat Wrist Bone Fracture	BOTH IP/OP	"$2,483.00 "	"$1,837.42"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.46	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,857.24"	"$1,876.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000203	EAP	CPT® 25650		Treat Wrist Bone Fracture	BOTH IP/OP	$992.00 	$734.08	$0.00	$992.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.73	$0.00	$0.00	$0.00	$0.00	$937.00	$742.10	$749.60	$0.00	$992.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000205	EAP	CPT® 25675		Treat Wrist Dislocation	BOTH IP/OP	$509.00 	$376.66	$0.00	$509.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.08	$0.00	$0.00	$0.00	$0.00	$487.00	$385.70	$389.60	$0.00	$509.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000206	EAP	CPT® 25680		Trans-scapoperilunar Fx Disloc	BOTH IP/OP	"$1,085.00 "	$802.90	$0.00	"$1,099.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$226.11	$0.00	$0.00	$0.00	$0.00	"$1,099.00"	$870.41	$879.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000207	EAP	CPT® 25690		Treat Wrist Dislocation	BOTH IP/OP	"$8,034.00 "	"$5,945.16"	$0.00	"$6,068.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,674.29"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,008.11"	"$6,068.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000209	EAP	CPT® 26410		Repair Hand Tendon	BOTH IP/OP	"$3,718.00 "	"$2,751.32"	$0.00	"$2,973.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$774.83	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$2,943.86"	"$2,973.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000210	EAP	CPT® 26418		Repair Finger Tendon	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,651.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$951.35	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$3,614.69"	"$3,651.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000211	EAP	CPT® 26600		"Metacarpal Fx, Single,wo Manip"	BOTH IP/OP	"$1,078.00 "	$797.72	$0.00	"$1,078.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	"$1,078.00"	$853.78	$862.40	$0.00	"$1,078.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000213	EAP	CPT® 26605		Treat Metacarpal Fracture	BOTH IP/OP	$647.00 	$478.78	$0.00	$647.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.83	$0.00	$0.00	$0.00	$0.00	$647.00	$512.42	$517.60	$0.00	$647.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000215	EAP	CPT® 26641		Treat Thumb Disolcation	BOTH IP/OP	"$1,104.00 "	$816.96	$0.00	"$1,104.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,104.00"	$874.37	$883.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000216	EAP	CPT® 26645		Treat Thumb Fracture	BOTH IP/OP	"$1,593.00 "	"$1,178.82"	$0.00	"$1,593.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.98	$0.00	$0.00	$0.00	$0.00	"$1,593.00"	"$1,261.66"	"$1,274.40"	$0.00	"$1,593.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000217	EAP	CPT® 26670		Treat Hand Dislocation	BOTH IP/OP	"$1,099.00 "	$813.26	$0.00	"$1,099.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.03	$0.00	$0.00	$0.00	$0.00	"$1,099.00"	$870.41	$879.20	$0.00	"$1,099.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000218	EAP	CPT® 26700		"Metacarpophlangeal Disloc,sing"	BOTH IP/OP	$735.00 	$543.90	$0.00	$735.00	$399.11	$399.11	$200.72	$200.72	$201.85	$153.19	$0.00	$0.00	$0.00	$197.62	$153.17	$128.45	$113.00	$113.00	$0.00	$735.00	$582.12	$588.00	$0.00	$735.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000219	EAP	CPT® 26705		Treat Knuckle Dislocation	BOTH IP/OP	"$1,593.00 "	"$1,178.82"	$0.00	"$1,593.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.98	$0.00	$0.00	$0.00	$0.00	"$1,593.00"	"$1,261.66"	"$1,274.40"	$0.00	"$1,489.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000220	EAP	CPT® 26720		"Phalangeal Shaft Fx, Wo Manip"	BOTH IP/OP	$678.00 	$501.72	$0.00	$678.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.30	$0.00	$0.00	$0.00	$0.00	$678.00	$536.98	$542.40	$0.00	$678.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000223	EAP	CPT® 26725		Closd Fracture Finger W Manip	BOTH IP/OP	"$1,116.00 "	$825.84	$0.00	"$1,116.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.57	$0.00	$0.00	$0.00	$0.00	"$1,116.00"	$883.87	$892.80	$0.00	"$1,116.00"	$0.00	$234.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000224	EAP	CPT® 26746		"Treat Finger Fracture, Each"	BOTH IP/OP	"$7,420.00 "	"$5,490.80"	$0.00	"$5,934.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,546.33"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$5,875.06"	"$5,934.40"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000227	EAP	CPT® 26755		"Treat Finger Fracture, Each"	BOTH IP/OP	$649.00 	$480.26	$0.00	$649.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$135.25	$0.00	$0.00	$0.00	$0.00	$649.00	$514.01	$519.20	$0.00	$649.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000229	EAP	CPT® 26756		"Pin Finger Fracture, Each"	BOTH IP/OP	"$6,983.00 "	"$5,167.42"	$0.00	"$5,934.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.26"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$5,875.06"	"$5,934.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000230	EAP	CPT® 26765		"Treat Finger Fracture, Each"	BOTH IP/OP	"$7,322.00 "	"$5,418.28"	$0.00	"$5,856.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,525.90"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$5,797.44"	"$5,856.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000231	EAP	CPT® 26770		Interphalan Jt Disloca W Manip	BOTH IP/OP	$650.00 	$481.00	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$135.46	$0.00	$0.00	$0.00	$0.00	$650.00	$514.80	$520.00	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000233	EAP	CPT® 26775		Treat Finger Dislocation	BOTH IP/OP	"$4,733.00 "	"$3,502.42"	$0.00	"$4,022.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$986.36	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,982.18"	"$4,022.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000235	EAP	CPT® 26785		Dislocation Of Finger	BOTH IP/OP	"$16,294.00 "	"$12,057.56"	$0.00	"$13,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,395.67"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$12,901.68"	"$13,032.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000236	EAP	CPT® 26951		Amputation Of Finger/thumb	BOTH IP/OP	"$7,787.00 "	"$5,762.38"	$0.00	"$5,690.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,622.81"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$5,633.50"	"$5,690.40"	$0.00	"$2,500.00"	$0.00	$412.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000238	EAP	CPT® 27230		Femoral Fx Neck Wo Manip	BOTH IP/OP	$612.00 	$452.88	$0.00	$612.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.54	$0.00	$0.00	$0.00	$0.00	$612.00	$484.70	$489.60	$0.00	$505.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000239	EAP	CPT® 27232		Treat Thigh Fracture	BOTH IP/OP	"$3,641.00 "	"$2,694.34"	$0.00	"$2,912.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.78	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,883.67"	"$2,912.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000240	EAP	CPT® 27246		Trochanteric Fx Wo Manip	BOTH IP/OP	$612.00 	$452.88	$0.00	$612.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.54	$0.00	$0.00	$0.00	$0.00	$612.00	$484.70	$489.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000241	EAP	CPT® 27250		Hip Disloca Wo Anes	BOTH IP/OP	$572.00 	$423.28	$0.00	$578.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.20	$0.00	$0.00	$0.00	$0.00	$578.00	$457.78	$462.40	$0.00	$572.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000244	EAP	CPT® 27256		Treat Hip Dislocation	BOTH IP/OP	$941.00 	$696.34	$0.00	$941.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.10	$0.00	$0.00	$0.00	$0.00	$568.00	$449.86	$454.40	$0.00	$941.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000245	EAP	CPT® 69020		Er Drain Absc Ext Auditory Can	BOTH IP/OP	$600.00 	$444.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$600.00	$475.20	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000246	EAP	CPT® 27500		Femoral Shaft Fx Wo Manip	BOTH IP/OP	"$1,560.00 "	"$1,154.40"	$0.00	"$1,560.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$325.10	$0.00	$0.00	$0.00	$0.00	"$1,560.00"	"$1,235.52"	"$1,248.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000248	EAP	CPT® 27508		"Femoral Fx,distal End,wo Manip"	BOTH IP/OP	"$1,091.00 "	$807.34	$0.00	"$1,091.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.36	$0.00	$0.00	$0.00	$0.00	"$1,091.00"	$864.07	$872.80	$0.00	"$1,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000250	EAP	CPT® 27520		Patellar Fx Wo Manip	BOTH IP/OP	"$1,494.00 "	"$1,105.56"	$0.00	"$1,494.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.35	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$1,183.25"	"$1,195.20"	$0.00	$505.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000252	EAP	CPT® 27530		Tibial Fx Wo Manip	BOTH IP/OP	"$1,494.00 "	"$1,105.56"	$0.00	"$1,494.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.35	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$1,183.25"	"$1,195.20"	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000254	EAP	CPT® 27535		Treat Knee Fracture	BOTH IP/OP	"$5,367.00 "	"$3,971.58"	$0.00	"$4,293.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,118.48"	$0.00	$0.00	$0.00	$0.00	"$2,683.50"	"$4,250.66"	"$4,293.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000255	EAP	CPT® 27560		Treat Kneecap Dislocation	BOTH IP/OP	"$1,047.00 "	$774.78	$0.00	"$1,047.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.19	$0.00	$0.00	$0.00	$0.00	$995.00	$788.04	$796.00	$0.00	"$1,047.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000259	EAP	CPT® 27750		Tibial Shaft Fx Wo Manip	BOTH IP/OP	"$1,070.00 "	$791.80	$0.00	"$1,133.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.99	$0.00	$0.00	$0.00	$0.00	"$1,133.00"	$897.34	$906.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000261	EAP	CPT® 27752		Treatment Of Tibia Fracture	BOTH IP/OP	"$7,594.00 "	"$5,619.56"	$0.00	"$5,820.00"	"$2,321.55"	"$2,321.55"	"$1,356.40"	"$1,356.40"	"$1,364.04"	"$1,582.78"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,334.46"	"$1,582.59"	$867.40	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$5,761.80"	"$5,820.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000264	EAP	CPT® 27762		Treatment Of Ankle Fracture	BOTH IP/OP	"$7,594.00 "	"$5,619.56"	$0.00	"$5,820.00"	"$2,321.55"	"$2,321.55"	"$1,356.40"	"$1,356.40"	"$1,364.04"	$0.00	"$1,257.08"	"$1,257.08"	"$1,305.43"	$0.00	"$1,582.59"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,761.80"	"$5,820.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000267	EAP	CPT® 27788		Treatment Of Ankle Fracture	BOTH IP/OP	"$1,028.00 "	$760.72	$0.00	$941.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.24	$0.00	$0.00	$0.00	$0.00	$275.00	$217.80	$220.00	$0.00	$941.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000269	EAP	CPT® 29125		App'l Short Arm Splint	BOTH IP/OP	$952.00 	$704.48	$0.00	$952.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.35	$952.00	$753.98	$761.60	$151.93	$0.00	$151.93	$72.40	$40.73	$40.73	$151.56	$104.14	$0.00	$0.00	$0.00	$0.00
45000270	EAP	CPT® 27808		Clsd Frac Bimall Ankle Wo Mani	BOTH IP/OP	"$1,135.00 "	$839.90	$0.00	"$1,135.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.53	$0.00	$0.00	$0.00	$0.00	"$1,087.00"	$860.90	$869.60	$0.00	"$1,135.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000272	EAP	CPT® 27810		Closed Tx Bimal Ankle Fx W/man	BOTH IP/OP	"$2,348.00 "	"$1,737.52"	$0.00	"$2,249.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$489.38	$0.00	$0.00	$0.00	"$1,334.46"	$489.32	$867.40	"$1,871.00"	"$1,871.00"	$0.00	"$2,249.00"	"$1,781.21"	"$1,799.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000273	EAP	CPT® 27816		Clsd Fx Trimall Ankle Wo Mani	BOTH IP/OP	$902.00 	$667.48	$0.00	$955.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.98	$0.00	$0.00	$0.00	$0.00	$955.00	$756.36	$764.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000275	EAP	CPT® 27818		Trimalleolar Ankle Fx With Man	BOTH IP/OP	"$2,348.00 "	"$1,737.52"	$358.04	"$2,321.55"	"$2,321.55"	"$2,321.55"	"$1,356.40"	"$1,356.40"	"$1,364.04"	$489.38	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,334.46"	$489.32	$867.40	"$1,871.00"	"$1,871.00"	"$1,359.37"	"$2,249.00"	"$1,781.21"	"$1,799.20"	"$1,888.67"	"$2,150.00"	"$1,888.67"	$492.83	$451.99	$451.99	$358.04	"$1,294.64"	$0.00	$0.00	$0.00	$0.00
45000277	EAP	CPT® 27825		Treat Lower Leg Fracture	BOTH IP/OP	"$7,594.00 "	"$5,619.56"	$0.00	"$5,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,582.59"	$0.00	$0.00	$0.00	"$1,359.37"	"$2,327.00"	"$5,761.80"	"$5,820.00"	"$1,888.67"	"$2,500.00"	"$1,888.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000278	EAP	CPT® 27840		Ankle Disloca Wo Anes	BOTH IP/OP	"$2,348.00 "	"$1,737.52"	$0.00	"$2,249.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.32	$0.00	$0.00	$0.00	$0.00	"$2,249.00"	"$1,781.21"	"$1,799.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000283	EAP	CPT® 28470		Clsd Tx Metatar Fx Wo Manip Ea	BOTH IP/OP	$981.00 	$725.94	$0.00	$981.00	$981.00	$981.00	$200.72	$200.72	$201.85	$0.00	$0.00	$0.00	$0.00	$197.62	$204.44	$128.45	$113.00	$113.00	$216.27	$981.00	$776.95	$784.80	$300.48	$981.00	$300.48	$214.80	$210.83	$210.83	$0.00	$205.98	$0.00	$0.00	$0.00	$0.00
45000285	EAP	CPT® 28475		Clsd Tx Metatar Fx W/manip	BOTH IP/OP	$419.00 	$310.06	$0.00	$419.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.32	$0.00	$0.00	$0.00	$0.00	$415.00	$328.68	$332.00	$0.00	$419.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000286	EAP	CPT® 28490		"Clsd Tx Fx Grt Toe,phal/phalan"	BOTH IP/OP	$898.00 	$664.52	$0.00	$898.00	$898.00	$898.00	$200.72	$200.72	$201.85	$0.00	$0.00	$0.00	$0.00	$0.00	$187.14	$0.00	$0.00	$0.00	$0.00	$898.00	$711.22	$718.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000289	EAP	CPT® 28510		Clsd Fx Toe W/o Manipulation	BOTH IP/OP	$991.00 	$733.34	$0.00	$991.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.52	$0.00	$0.00	$0.00	$0.00	$981.00	$776.95	$784.80	$0.00	$991.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000291	EAP	CPT® 28600		Treat Foot Dislocation	BOTH IP/OP	$832.00 	$615.68	$0.00	$832.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.39	$0.00	$0.00	$0.00	$0.00	$832.00	$658.94	$665.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000292	EAP	CPT® 28660		Treat Toe Dislocation	BOTH IP/OP	$232.00 	$171.68	$0.00	$232.00	$232.00	$232.00	$200.72	$200.72	$201.85	$48.35	$0.00	$0.00	$0.00	$197.62	$48.35	$128.45	$113.00	$113.00	$0.00	$230.00	$182.16	$184.00	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000296	EAP	CPT® 29130		App'l Finger Splint	BOTH IP/OP	$859.00 	$635.66	$0.00	$859.00	$466.44	$466.44	$109.81	$109.81	$110.43	$0.00	$0.00	$0.00	$0.00	$0.00	$179.02	$0.00	$0.00	$0.00	$0.00	$859.00	$680.33	$687.20	$0.00	$859.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000298	EAP	CPT® 29200		Apply Clavicle Strap	BOTH IP/OP	$579.00 	$428.46	$0.00	$559.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.66	$0.00	$0.00	$0.00	$0.00	$545.00	$431.64	$436.00	$0.00	$559.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000299	EAP	CPT® 29280		Strapping Hand Or Finger	BOTH IP/OP	$511.00 	$378.14	$0.00	$481.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.49	$0.00	$0.00	$0.00	$0.00	$481.00	$380.95	$384.80	$0.00	$477.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000300	EAP	CPT® 29345		Apply Long Leg Cast	BOTH IP/OP	$705.00 	$521.70	$0.00	$838.00	$705.00	$705.00	$234.93	$234.93	$236.25	$146.94	$0.00	$0.00	$0.00	$231.14	$146.92	$150.24	$113.00	$113.00	$0.00	$789.00	$624.89	$631.20	$0.00	$838.00	$0.00	$170.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000301	EAP	CPT® 29358		Long Leg Application	BOTH IP/OP	"$1,062.00 "	$785.88	$0.00	"$1,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.32	$0.00	$0.00	$0.00	$0.00	"$1,188.00"	$940.90	$950.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000302	EAP	CPT® 29515		Apply Short Leg Splint	BOTH IP/OP	$888.00 	$657.12	$0.00	$888.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.13	$888.00	$703.30	$710.40	$186.36	$0.00	$186.36	$80.51	$51.19	$51.19	$141.37	$127.75	$0.00	$0.00	$0.00	$0.00
45000304	EAP	CPT® 29505		App'l Long Leg Splint	BOTH IP/OP	"$1,535.00 "	"$1,135.90"	$0.00	"$1,535.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.13	"$1,535.00"	"$1,215.72"	"$1,228.00"	$186.36	$0.00	$186.36	$94.49	$52.27	$52.27	$244.37	$127.75	$0.00	$0.00	$0.00	$0.00
45000310	EAP	CPT® 29530		Apply Knee Immobilizer	BOTH IP/OP	$809.00 	$598.66	$0.00	$762.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.60	$0.00	$0.00	$0.00	$0.00	$762.00	$603.50	$609.60	$0.00	$341.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000313	EAP	CPT® 29580		Strapping; Unna Boot	BOTH IP/OP	$780.00 	$577.20	$0.00	$780.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.13	$780.00	$617.76	$624.00	$186.36	$0.00	$186.36	$54.52	$28.49	$28.49	$124.18	$127.75	$0.00	$0.00	$0.00	$0.00
45000315	EAP	CPT® 30300		"Remove Fb, Intranasal"	BOTH IP/OP	$269.00 	$199.06	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.06	$0.00	$0.00	$0.00	$0.00	$272.00	$215.42	$217.60	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000317	EAP	CPT® 30901		Control Nasal Hemorr Ant Simpl	BOTH IP/OP	$345.00 	$255.30	$0.00	$348.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.90	$0.00	$0.00	$0.00	$0.00	$348.00	$275.62	$278.40	$0.00	$345.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000319	EAP	CPT® 30903		Control Nasal Hemorr Ant Compl	BOTH IP/OP	$354.00 	$261.96	$0.00	$358.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.77	$0.00	$0.00	$0.00	$0.00	$358.00	$283.54	$286.40	$0.00	$354.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000320	EAP	CPT® 30905		Control Nasal Hemorr Post Init	BOTH IP/OP	$518.00 	$383.32	$0.00	$518.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.95	$0.00	$0.00	$0.00	$0.00	$518.00	$410.26	$414.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000322	EAP	CPT® 31233		"Nasal/sinus Endoscopy, Dx"	BOTH IP/OP	$661.00 	$489.14	$0.00	$661.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$661.00	$523.51	$528.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000323	EAP	CPT® 31500		Endotracheal Intubation	BOTH IP/OP	"$2,656.00 "	"$1,965.44"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.24	"$2,255.00"	"$2,103.55"	"$2,124.80"	$283.76	$0.00	$283.76	$0.00	$149.30	$149.30	$422.84	$194.51	$0.00	$0.00	$0.00	$0.00
45000326	EAP	CPT® 31515		Laryngoscopy For Aspiration	BOTH IP/OP	"$6,731.00 "	"$4,980.94"	$0.00	"$5,632.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,402.74"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,575.68"	"$5,632.00"	$0.00	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000327	EAP	CPT® 31525		"Dx Laryngoscopy, Except Nb"	BOTH IP/OP	"$6,130.00 "	"$4,536.20"	$0.00	"$5,129.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,277.49"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,078.30"	"$5,129.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000328	EAP	CPT® 31575		"Laryngoscopy, Fiberoptic, Dx"	BOTH IP/OP	$684.00 	$506.16	$0.00	$684.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.01	$684.00	$541.73	$547.20	$218.14	$0.00	$218.14	$103.39	$68.49	$68.49	$108.89	$149.53	$0.00	$0.00	$0.00	$0.00
45000330	EAP	CPT® 31605		"Tracheostomy, Cricothyroid"	BOTH IP/OP	"$1,598.00 "	"$1,182.52"	$0.00	"$1,598.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$333.02	$0.00	$0.00	$0.00	$0.00	"$1,598.00"	"$1,265.62"	"$1,278.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000332	EAP	CPT® 31720		Nasotreacheal Suction	BOTH IP/OP	$250.00 	$185.00	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.00	$198.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000333	EAP	CPT® 32160		Thoracotomy W/cardiac Massage	BOTH IP/OP	"$5,460.00 "	"$4,040.40"	$0.00	"$4,133.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,137.86"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,092.26"	"$4,133.60"	$0.00	"$2,964.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000337	EAP	CPT® 35206		Repair Blood Vessel Lesion	BOTH IP/OP	"$8,232.00 "	"$6,091.68"	$0.00	"$6,525.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,715.55"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,460.34"	"$6,525.60"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000347	EAP	CPT® 36589		Removal Venous Access Device	BOTH IP/OP	"$4,657.00 "	"$3,446.18"	$0.00	"$3,725.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.36	"$2,255.00"	"$3,688.34"	"$3,725.60"	$878.58	$0.00	$878.58	$171.53	$143.13	$143.13	$741.39	$602.25	$0.00	$0.00	$0.00	$0.00
45000348	EAP	CPT® 36593		Declot Vascular Access Device	BOTH IP/OP	"$1,299.00 "	$961.26	$0.00	"$1,624.00"	"$1,299.00"	"$1,299.00"	$310.51	$310.51	$312.26	$270.74	$0.00	$0.00	$0.00	$297.83	$270.71	$193.59	$113.00	$113.00	$310.51	"$1,624.00"	"$1,286.21"	"$1,299.20"	$431.41	"$1,289.00"	$431.41	$30.97	$32.05	$32.05	$258.54	$295.72	$0.00	$0.00	$0.00	$0.00
45000352	EAP	CPT® 40800		I & D Of Abscess Of Mouth	BOTH IP/OP	$705.00 	$521.70	$0.00	$705.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.80	$705.00	$558.36	$564.00	$705.00	$0.00	$705.00	$87.87	$128.30	$128.30	$112.24	$582.67	$0.00	$0.00	$0.00	$0.00
45000353	EAP	CPT® 40801		Drainage Of Mouth Lesion	BOTH IP/OP	"$1,582.00 "	"$1,170.68"	$0.00	"$1,582.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,582.00"	"$1,252.94"	"$1,265.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000355	EAP	CPT® 41008		Submandibular Abscess	BOTH IP/OP	"$4,969.00 "	"$3,677.06"	$0.00	"$3,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,935.45"	"$3,975.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000356	EAP	CPT® 41252		Repair Tongue Laceration 2.6cm	BOTH IP/OP	"$2,783.00 "	"$2,059.42"	$0.00	"$2,327.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$579.98	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,226.31"	"$2,248.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000357	EAP	CPT® 42000		"I&d Abscess Plate, Uvula"	BOTH IP/OP	$283.00 	$209.42	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$58.98	$0.00	$0.00	$0.00	$202.80	$58.98	$131.82	$283.00	$283.00	$204.24	$286.00	$226.51	$228.80	$283.76	"$1,750.00"	$283.76	$95.00	$107.41	$107.41	$45.53	$194.51	$0.00	$0.00	$0.00	$0.00
45000358	EAP	CPT® 42809		Remove Fb Pharynx	BOTH IP/OP	$495.00 	$366.30	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.16	$0.00	$0.00	$0.00	$0.00	$500.00	$396.00	$400.00	$0.00	$495.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000359	EAP	CPT® 43247		Ugi Endo-rem Of Foreign Body	BOTH IP/OP	"$4,263.00 "	"$3,154.62"	$0.00	"$3,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,376.30"	"$3,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000360	EAP	CPT® 43752		N/g Tube Placement	BOTH IP/OP	"$2,134.00 "	"$1,579.16"	$42.55	"$2,134.00"	"$2,134.00"	"$2,134.00"	$264.30	$264.30	$265.79	$444.78	"$1,257.08"	"$1,257.08"	"$1,305.43"	$258.98	$444.73	$168.34	$113.00	$113.00	$364.66	"$2,052.00"	"$1,625.18"	"$1,641.60"	$506.64	"$1,750.00"	$506.64	$321.14	$42.55	$42.55	$326.68	$347.29	$0.00	$0.00	$0.00	$0.00
45000361	EAP	CPT® 44500		Intro Of Long Gi Tube	BOTH IP/OP	"$1,291.00 "	$955.34	$0.00	"$1,304.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.04	$0.00	$0.00	$0.00	$0.00	"$1,304.00"	"$1,032.77"	"$1,043.20"	$0.00	"$1,291.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000362	EAP	CPT® 45300		Proctosigmoidoscopy	BOTH IP/OP	"$2,361.00 "	"$1,747.14"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$492.03	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,869.91"	"$1,888.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000363	EAP	CPT® 45305		Proctosigmoidoscopy W/bx	BOTH IP/OP	"$5,114.00 "	"$3,784.36"	$0.00	"$4,091.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,065.76"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,050.29"	"$4,091.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000364	EAP	CPT® 45385		Lesion Removal Colonoscopy	BOTH IP/OP	"$2,922.00 "	"$2,162.28"	$0.00	"$2,836.00"	"$2,753.10"	"$2,753.10"	"$1,009.84"	"$1,009.84"	"$1,015.53"	$0.00	"$1,541.95"	"$1,541.95"	"$1,601.25"	$993.84	$608.94	$646.00	"$2,836.00"	"$2,836.00"	"$1,007.17"	"$2,327.00"	"$2,314.22"	"$2,337.60"	"$1,399.33"	"$2,500.00"	"$1,399.33"	$450.95	$265.02	$265.02	$465.18	$959.21	$0.00	$0.00	$0.00	$0.00
45000366	EAP	CPT® 46040		Incision Of Rectal Abscess	BOTH IP/OP	"$2,951.00 "	"$2,183.74"	$0.00	"$2,858.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$614.99	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$2,360.95"	"$2,384.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000367	EAP	CPT® 46083		Incise External Hemorrhoid	BOTH IP/OP	"$1,099.00 "	$813.26	$0.00	"$1,110.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.03	$0.00	$0.00	$0.00	$0.00	"$1,110.00"	$879.12	$888.00	$0.00	"$1,099.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000371	EAP	CPT® 51701		"Urinary Cath, Straight"	BOTH IP/OP	$865.00 	$640.10	$0.00	$865.00	$865.00	$865.00	$109.81	$109.81	$110.43	$180.29	$0.00	$0.00	$0.00	$107.30	$180.27	$69.74	$113.00	$113.00	$109.35	$864.00	$684.29	$691.20	$151.93	$548.00	$151.93	$57.62	$27.40	$27.40	$137.55	$104.14	$0.00	$0.00	$0.00	$0.00
45000372	EAP	CPT® 51701		Insert Straight Cath	BOTH IP/OP	$865.00 	$640.10	$0.00	$865.00	$865.00	$865.00	$109.81	$109.81	$110.43	$180.29	$0.00	$0.00	$0.00	$107.30	$180.27	$69.74	$113.00	$113.00	$109.35	$864.00	$684.29	$691.20	$151.93	$548.00	$151.93	$57.62	$27.40	$27.40	$137.55	$104.14	$0.00	$0.00	$0.00	$0.00
45000374	EAP	CPT® 51702		Cath Insert Indwelling	BOTH IP/OP	"$1,070.00 "	$791.80	$0.00	"$1,070.00"	"$1,070.00"	"$1,070.00"	$109.81	$109.81	$110.43	$223.01	$0.00	$0.00	$0.00	$107.30	$222.99	$69.74	$113.00	$113.00	$109.35	"$1,069.00"	$846.65	$855.20	$151.93	"$1,070.00"	$151.93	$91.18	$26.68	$26.68	$170.18	$104.14	$0.00	$0.00	$0.00	$0.00
45000375	EAP	CPT® 51703		"Insert Bladder Cath, Complex"	BOTH IP/OP	"$1,809.00 "	"$1,338.66"	$0.00	"$1,809.00"	"$1,809.00"	"$1,809.00"	$135.96	$135.96	$136.73	$0.00	$0.00	$0.00	$0.00	$0.00	$377.00	$0.00	$0.00	$0.00	$138.76	"$1,808.00"	"$1,431.94"	"$1,446.40"	$192.78	$899.00	$192.78	$170.19	$80.41	$80.41	$287.83	$132.15	$0.00	$0.00	$0.00	$0.00
45000376	EAP	CPT® 51705		Cystostomy Tube	BOTH IP/OP	$626.00 	$463.24	$0.00	$626.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.46	$0.00	$0.00	$0.00	$235.59	$625.00	$495.00	$500.00	$327.32	$626.00	$327.32	$86.33	$54.08	$54.08	$99.50	$224.37	$0.00	$0.00	$0.00	$0.00
45000377	EAP	CPT® 52000		Cystoscopy	BOTH IP/OP	"$3,069.00 "	"$2,271.06"	$84.02	"$2,480.00"	"$2,321.55"	"$2,321.55"	$560.26	$560.26	$563.41	$639.66	"$1,257.08"	"$1,257.08"	"$1,305.43"	$550.87	$639.58	$358.07	"$1,871.00"	"$1,871.00"	$558.17	"$2,255.00"	"$2,455.20"	"$2,480.00"	$775.50	"$2,150.00"	$775.50	$152.62	$84.02	$84.02	$493.52	$531.59	$0.00	$0.00	$0.00	$0.00
45000378	EAP	CPT® 54220		Treatment Of Penis Lesion	BOTH IP/OP	"$1,092.00 "	$808.08	$139.18	"$1,103.00"	"$1,092.00"	"$1,092.00"	$259.14	$259.14	$260.60	$227.60	"$1,092.00"	"$1,092.00"	"$1,092.00"	$255.07	$227.57	$165.80	"$1,092.00"	"$1,092.00"	$235.59	"$1,103.00"	$873.58	$882.40	$327.32	"$1,009.00"	$327.32	$151.42	$139.18	$139.18	$175.60	$224.37	$0.00	$0.00	$0.00	$0.00
45000380	EAP	CPT® 54700		I & D Scrotum	BOTH IP/OP	"$3,277.00 "	"$2,424.98"	$0.00	"$2,621.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$682.93	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,595.38"	"$2,621.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000381	EAP	CPT® 55100		Drainage Of Scrotum Abscess	BOTH IP/OP	"$2,572.00 "	"$1,903.28"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$536.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,057.62"	"$2,078.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000383	EAP	CPT® 56405		I & D Of Vulva/perineum	BOTH IP/OP	$291.00 	$215.34	$0.00	"$1,750.00"	$291.00	$291.00	$274.65	$274.65	$276.20	$60.65	$291.00	$291.00	$291.00	$269.78	$60.64	$175.35	$291.00	$291.00	$0.00	$294.00	$232.85	$235.20	$0.00	"$1,750.00"	$0.00	$107.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000384	EAP	CPT® 57180		Vag. Exam With Packing	BOTH IP/OP	$382.00 	$282.68	$0.00	$382.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.61	$0.00	$0.00	$0.00	$0.00	$382.00	$302.54	$305.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000385	EAP	CPT® 57415		Remove Vaginal Fb W/anesthesia	BOTH IP/OP	"$8,477.00 "	"$6,272.98"	$0.00	"$6,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,766.61"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$6,732.00"	"$6,800.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000391	EAP	CPT® 62273		Injection Epidural Blood Patch	BOTH IP/OP	"$1,679.00 "	"$1,242.46"	$0.00	"$1,679.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$349.90	$0.00	$0.00	$0.00	$626.89	"$1,596.00"	"$1,264.03"	"$1,276.80"	$870.98	"$1,679.00"	$870.98	$123.36	$117.56	$117.56	$254.08	$597.04	$0.00	$0.00	$0.00	$0.00
45000394	EAP	CPT® 64450		Inject Anest Peripheral Nerve	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$594.01	$0.00	$0.00	$0.00	$608.20	$593.94	$395.33	"$1,871.00"	"$1,871.00"	$626.89	"$2,255.00"	"$2,178.00"	"$2,200.00"	$870.98	$0.00	$870.98	$85.27	$44.35	$44.35	$437.80	$597.04	$0.00	$0.00	$0.00	$0.00
45000395	EAP	CPT® 65205		Remove Fb Eye Conj Superficial	BOTH IP/OP	$378.00 	$279.72	$0.00	$382.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$78.78	$0.00	$0.00	$0.00	$0.00	$382.00	$302.54	$305.60	$0.00	$378.00	$0.00	$132.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000398	EAP	CPT® 65220		Eye Exam W/o Slit Lamp	BOTH IP/OP	"$1,563.00 "	"$1,156.62"	$0.00	"$1,578.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$325.73	$0.00	$0.00	$0.00	$0.00	"$1,578.00"	"$1,249.78"	"$1,262.40"	$0.00	"$1,029.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000399	EAP	CPT® 65222		Eye Exam Slit Lamp	BOTH IP/OP	$800.00 	$592.00	$0.00	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.74	$0.00	$0.00	$0.00	$107.30	$166.72	$69.74	$113.00	$113.00	$0.00	$808.00	$639.94	$646.40	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000400	EAP	CPT® 65800		Paracentesis Ant Chamb Eye Wdx	BOTH IP/OP	"$4,672.00 "	"$3,457.28"	$0.00	"$3,773.60"	"$2,321.55"	"$2,321.55"	"$2,022.30"	"$2,022.30"	"$2,033.69"	$973.76	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,992.71"	$973.64	"$1,295.26"	"$1,871.00"	"$1,871.00"	"$2,027.80"	"$2,255.00"	"$3,735.86"	"$3,773.60"	"$2,817.36"	"$1,750.00"	"$2,817.36"	$0.00	$93.03	$93.03	$750.95	"$1,931.24"	$0.00	$0.00	$0.00	$0.00
45000402	EAP	CPT® 66999		Irrigation Eye	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$2,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$412.63	$0.00	$0.00	$0.00	$0.00	"$2,000.00"	"$1,584.00"	"$1,600.00"	$0.00	"$1,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000403	EAP	CPT® 67228		Destroy Retinopathy Photocoag	BOTH IP/OP	"$7,462.00 "	"$5,521.88"	$311.48	"$5,969.60"	"$2,321.55"	"$2,321.55"	$490.09	$490.09	$492.86	"$1,555.27"	"$1,257.08"	"$1,257.08"	"$1,305.43"	$482.91	"$1,555.08"	$313.89	"$1,871.00"	"$1,871.00"	$508.42	"$2,255.00"	"$5,909.90"	"$5,969.60"	$706.38	"$2,150.00"	$706.38	$821.55	$311.48	$311.48	"$1,187.95"	$484.21	$0.00	$0.00	$0.00	$0.00
45000404	EAP	CPT® 67700		Drainage Of Eyelid Abscess	BOTH IP/OP	"$1,334.00 "	$987.16	$0.00	"$1,339.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$278.04	$0.00	$0.00	$0.00	$250.42	$278.01	$162.77	"$1,334.00"	"$1,334.00"	$0.00	"$1,339.00"	"$1,060.49"	"$1,071.20"	$0.00	"$1,339.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000405	EAP	CPT® 67715		Incision Of Eye Lid Fold	BOTH IP/OP	"$9,511.00 "	"$7,038.14"	$0.00	"$7,636.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,982.09"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$7,560.43"	"$7,636.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000406	EAP	CPT® 67840		Excise Lesion Eyelid Smpl Clos	BOTH IP/OP	"$2,581.00 "	"$1,909.94"	$160.78	"$2,581.00"	"$2,581.00"	"$2,581.00"	$788.63	$788.63	$793.07	$537.94	"$1,257.08"	"$1,257.08"	"$1,305.43"	$775.88	$537.88	$504.32	"$1,871.00"	"$1,871.00"	$809.34	"$2,255.00"	"$2,044.15"	"$2,064.80"	"$1,124.47"	"$2,150.00"	"$1,124.47"	$209.29	$160.78	$160.78	$410.90	$770.80	$0.00	$0.00	$0.00	$0.00
45000407	EAP	CPT® 69005		Drain External Ear Lesion	BOTH IP/OP	"$9,524.00 "	"$7,047.76"	$0.00	"$7,619.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,984.80"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$7,543.01"	"$7,619.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000409	EAP	CPT® 69200		Removal Fb Ear	BOTH IP/OP	$412.00 	$304.88	$0.00	$412.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.04	$0.00	$0.00	$0.00	$107.30	$85.03	$69.74	$113.00	$113.00	$109.35	$412.00	$326.30	$329.60	$151.93	$0.00	$151.93	$58.58	$48.67	$48.67	$65.59	$104.14	$0.00	$0.00	$0.00	$0.00
45000412	EAP	CPT® 90945		Peritoneal Dialysis	BOTH IP/OP	"$1,724.00 "	"$1,275.76"	$0.00	"$1,379.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.28	$0.00	$0.00	$0.00	$0.00	$862.00	"$1,365.41"	"$1,379.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000413	EAP	CPT® 92511		Nasopharyngoscopy W/endoscope	BOTH IP/OP	$606.00 	$448.44	$0.00	$612.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.29	$0.00	$0.00	$0.00	$157.01	$612.00	$484.70	$489.60	$218.14	$393.90	$218.14	$64.35	$38.94	$38.94	$97.43	$149.53	$0.00	$0.00	$0.00	$0.00
45000426	EAP	CPT® 96373		Inject-intra-arterial Only	BOTH IP/OP	$266.00 	$196.84	$0.00	"$1,062.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.43	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	"$1,062.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000443	EAP	CPT® 99281		Minimal Care	BOTH IP/OP	$564.00 	$417.36	$0.00	$564.00	$564.00	$564.00	$70.64	$70.64	$71.04	$67.13	$444.74	$444.74	$461.84	$69.58	$117.54	$45.23	$564.00	$564.00	$0.00	$195.00	$308.88	$312.00	$0.00	$0.00	$0.00	$19.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000445	EAP	CPT® 99281		Acute Visit Level 1	BOTH IP/OP	$564.00 	$417.36	$0.00	$564.00	$564.00	$564.00	$70.64	$70.64	$71.04	$67.13	$444.74	$444.74	$461.84	$69.58	$117.54	$45.23	$564.00	$564.00	$0.00	$195.00	$308.88	$312.00	$0.00	$564.00	$0.00	$19.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000447	EAP	CPT® 99282		Limited Care	BOTH IP/OP	"$1,060.00 "	$784.40	$0.00	"$1,060.00"	"$1,060.00"	"$1,060.00"	$127.92	$127.92	$128.64	$220.93	$592.99	$592.99	$615.79	$126.12	$220.90	$81.98	"$1,049.00"	"$1,049.00"	$128.34	$420.50	$666.07	$672.80	$178.31	$0.00	$178.31	$30.21	$44.36	$44.36	$133.89	$122.22	$0.00	$0.00	$0.00	$0.00
45000449	EAP	CPT® 99282		Acute Visit Level 2	BOTH IP/OP	"$1,060.00 "	$784.40	$30.21	"$1,060.00"	"$1,060.00"	"$1,060.00"	$127.92	$127.92	$128.64	$220.93	$592.99	$592.99	$615.79	$126.12	$220.90	$81.98	"$1,049.00"	"$1,049.00"	$128.34	$420.50	$666.07	$672.80	$178.31	$992.00	$178.31	$30.21	$44.36	$44.36	$133.89	$122.22	$0.00	$0.00	$0.00	$0.00
45000451	EAP	CPT® 99283		Moderate Care	BOTH IP/OP	"$1,580.00 "	"$1,169.20"	$0.00	"$1,580.00"	"$1,404.90"	"$1,404.90"	$225.37	$225.37	$226.64	$329.31	$741.24	$741.24	$769.75	$221.97	$329.27	$144.28	"$1,580.00"	"$1,580.00"	$224.00	$691.00	"$1,094.54"	"$1,105.60"	$311.21	$0.00	$311.21	$61.31	$66.37	$66.37	$220.01	$213.33	$0.00	$0.00	$0.00	$0.00
45000453	EAP	CPT® 99283		Acute Visit Level 3	BOTH IP/OP	"$1,295.00 "	$958.30	$61.31	"$1,295.00"	"$1,295.00"	"$1,295.00"	$225.37	$225.37	$226.64	$269.91	$741.24	$741.24	$769.75	$221.97	$269.88	$144.28	"$1,295.00"	"$1,295.00"	$224.00	$691.00	"$1,094.54"	"$1,105.60"	$311.21	"$1,274.00"	$311.21	$61.31	$66.37	$66.37	$220.01	$213.33	$0.00	$0.00	$0.00	$0.00
45000455	EAP	CPT® 99284		Extended Care	BOTH IP/OP	"$3,050.00 "	"$2,257.00"	$0.00	"$3,050.00"	"$2,566.20"	"$2,566.20"	$354.25	$354.25	$356.25	$635.70	"$2,890.83"	"$2,890.83"	"$3,002.01"	$348.62	$635.62	$226.60	"$3,050.00"	"$3,050.00"	$352.82	"$1,080.50"	"$1,711.51"	"$1,728.80"	$490.20	$0.00	$490.20	$94.21	$121.91	$121.91	$344.03	$336.02	$0.00	$0.00	$0.00	$0.00
45000457	EAP	CPT® 99284		Acute Visit Level 4	BOTH IP/OP	"$3,050.00 "	"$2,257.00"	$94.21	"$3,050.00"	"$2,566.20"	"$2,566.20"	$354.25	$354.25	$356.25	$635.70	"$2,890.83"	"$2,890.83"	"$3,002.01"	$348.62	$635.62	$226.60	"$3,050.00"	"$3,050.00"	$352.82	"$1,080.50"	"$1,711.51"	"$1,728.80"	$490.20	"$2,164.00"	$490.20	$94.21	$121.91	$121.91	$344.03	$336.02	$0.00	$0.00	$0.00	$0.00
45000459	EAP	CPT® 99285		Comprehensive Care	BOTH IP/OP	"$3,503.00 "	"$2,592.22"	$0.00	"$3,503.00"	"$3,503.00"	"$3,503.00"	$508.49	$508.49	$511.35	$730.11	"$3,261.45"	"$3,261.45"	"$3,386.89"	$500.41	$730.03	$325.27	"$3,503.00"	"$3,503.00"	$505.99	"$1,530.00"	"$2,423.52"	"$2,448.00"	$703.01	$0.00	$703.01	$148.14	$177.09	$177.09	$487.15	$481.90	$0.00	$0.00	$0.00	$0.00
45000461	EAP	CPT® 99285		Acute Visit Level 5	BOTH IP/OP	"$2,866.00 "	"$2,120.84"	$148.14	"$2,932.00"	"$2,866.00"	"$2,866.00"	$508.49	$508.49	$511.35	$597.35	"$2,866.00"	"$2,866.00"	"$2,866.00"	$500.41	$597.27	$325.27	"$2,866.00"	"$2,866.00"	$505.99	"$1,530.00"	"$2,423.52"	"$2,448.00"	$703.01	"$2,932.00"	$703.01	$148.14	$177.09	$177.09	$487.15	$481.90	$0.00	$0.00	$0.00	$0.00
45000462	EAP	CPT® 99291		Critical Care 1st Hr	BOTH IP/OP	"$4,975.00 "	"$3,681.50"	$182.90	"$4,975.00"	"$4,975.00"	"$4,975.00"	$725.39	$725.39	$729.47	"$1,036.91"	"$3,261.45"	"$3,261.45"	"$3,386.89"	$663.88	"$1,036.79"	$431.52	"$4,975.00"	"$4,975.00"	$668.62	"$2,157.50"	"$3,417.48"	"$3,452.00"	$928.96	"$4,850.95"	$928.96	$182.90	$226.49	$226.49	$686.95	$636.78	$0.00	$0.00	$0.00	$0.00
45000464	EAP	CPT® 99292		Critical Care Add'l 0.5 Hr	BOTH IP/OP	"$1,359.00 "	"$1,005.66"	$0.00	"$2,821.00"	"$1,359.00"	"$1,359.00"	$0.00	$0.00	$0.00	$283.25	"$1,359.00"	"$1,359.00"	"$1,359.00"	$0.00	$283.22	$0.00	"$1,359.00"	"$1,359.00"	$0.00	$592.50	$938.52	$948.00	$0.00	"$2,821.00"	$0.00	$0.00	$113.96	$113.96	$188.65	$0.00	$0.00	$0.00	$0.00	$0.00
45000468	EAP	CPT® 99465		Newborn Resuscitation	BOTH IP/OP	"$1,530.00 "	"$1,132.20"	$0.00	"$1,224.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$318.85	$0.00	$0.00	$0.00	$0.00	$765.00	"$1,211.76"	"$1,224.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000471	EAP	Custom 45000471		Strapping	BOTH IP/OP	$68.00 	$50.32	$0.00	$54.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.17	$0.00	$0.00	$0.00	$0.00	$34.00	$53.86	$54.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000473	EAP	CPT® 29131		Application Finger Splint Dynamic	BOTH IP/OP	$517.00 	$382.58	$0.00	$517.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.76	$0.00	$0.00	$0.00	$53.35	$107.74	$34.67	$113.00	$113.00	$0.00	$487.00	$385.70	$389.60	$0.00	$517.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000476	EAP	CPT® 40830		Repair Mouth Laceration	BOTH IP/OP	"$1,099.00 "	$813.26	$0.00	"$1,110.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.03	$0.00	$0.00	$0.00	$0.00	"$1,110.00"	$879.12	$888.00	$0.00	"$1,099.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000477	EAP	CPT® 26775		Treat Finger Dislocation	BOTH IP/OP	"$5,029.00 "	"$3,721.46"	$0.00	"$4,022.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,048.04"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,982.18"	"$4,022.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000479	EAP	CPT® 28665		Txt Toe Dislocation W/anesth	BOTH IP/OP	"$4,530.00 "	"$3,352.20"	$0.00	"$3,585.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.05	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,549.74"	"$3,585.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000480	EAP	CPT® 27784		Treatment Of Fibula Fracture	BOTH IP/OP	"$16,355.00 "	"$12,102.70"	$0.00	"$12,534.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,408.38"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$12,409.06"	"$12,534.40"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000481	EAP	CPT® 43235		"Upper Gi Endoscopy, Diagnosis"	BOTH IP/OP	"$4,485.00 "	"$3,318.90"	$0.00	"$3,289.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$775.94	$934.67	$504.36	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$3,256.70"	"$3,289.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000491	EAP	CPT® 12020		Wound Dehiscence Simple Closur	BOTH IP/OP	"$2,965.00 "	"$2,194.10"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$617.91	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,200.18"	"$2,222.40"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000492	EAP	CPT® 26011		Abscess Finger Complicated	BOTH IP/OP	"$4,878.00 "	"$3,609.72"	$0.00	"$3,901.60"	"$2,321.55"	"$2,321.55"	"$1,370.21"	"$1,370.21"	"$1,377.93"	"$1,016.70"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,348.50"	"$1,016.58"	$876.52	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$3,862.58"	"$3,901.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000493	EAP	CPT® 29260		"Splint Application, Wrist"	BOTH IP/OP	"$1,081.00 "	$799.94	$0.00	"$1,018.00"	$586.98	$586.98	$54.21	$54.21	$54.51	$225.31	$0.00	$0.00	$0.00	$53.35	$225.28	$34.67	$113.00	$113.00	$33.53	"$1,018.00"	$806.26	$814.40	$46.58	$389.00	$46.58	$44.15	$20.20	$20.20	$162.07	$31.93	$0.00	$0.00	$0.00	$0.00
45000494	EAP	CPT® 53600		Dilate Urethra Strict Male Ini	BOTH IP/OP	$687.00 	$508.38	$0.00	$694.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.17	$0.00	$0.00	$0.00	$235.59	$694.00	$549.65	$555.20	$327.32	$687.00	$327.32	$0.00	$65.99	$65.99	$110.48	$224.37	$0.00	$0.00	$0.00	$0.00
45000495	EAP	CPT® 54001		Dorsal Slit Except Newborn	BOTH IP/OP	"$6,453.00 "	"$4,775.22"	$0.00	"$5,162.40"	"$2,753.10"	"$2,753.10"	"$1,743.67"	"$1,743.67"	"$1,753.49"	"$1,344.97"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,718.44"	"$1,344.81"	"$1,116.98"	"$2,836.00"	"$2,836.00"	$0.00	"$2,327.00"	"$5,110.78"	"$5,162.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000496	EAP	CPT® 58301		Removal Iud	BOTH IP/OP	$281.00 	$207.94	$0.00	"$1,279.00"	$281.00	$281.00	$274.65	$274.65	$276.20	$58.57	$0.00	$0.00	$0.00	$269.78	$58.56	$175.35	$281.00	$281.00	$271.52	$280.00	$221.76	$224.00	$280.00	"$1,279.00"	$280.00	$81.66	$70.31	$70.31	$44.58	$258.59	$0.00	$0.00	$0.00	$0.00
45000498	EAP	CPT® 27781		Clsd Fracture Fibular	BOTH IP/OP	"$6,322.00 "	"$4,678.28"	$0.00	"$5,057.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,007.02"	"$5,057.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000499	EAP	CPT® 69000		Drain External Ear Lesion	BOTH IP/OP	$700.00 	$518.00	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.88	$0.00	$0.00	$0.00	$0.00	$700.00	$554.40	$560.00	$0.00	$694.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000501	EAP	CPT® 28190		Removal Of Foot Foreign Body	BOTH IP/OP	"$1,318.00 "	$975.32	$0.00	"$1,318.00"	"$1,318.00"	"$1,318.00"	$606.01	$606.01	$609.42	$0.00	"$1,257.08"	"$1,257.08"	"$1,305.43"	$0.00	$274.67	$0.00	$0.00	$0.00	$611.80	"$1,304.00"	"$1,032.77"	"$1,043.20"	$850.02	"$1,318.00"	$850.02	$173.39	$138.80	$138.80	$207.60	$582.67	$0.00	$0.00	$0.00	$0.00
45000502	EAP	CPT® 49451		Replace Duod/jej Tube Perc	BOTH IP/OP	"$2,862.00 "	"$2,117.88"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$596.44	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,179.58"	"$2,201.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000505	EAP	CPT® 25260		Repair Forearm Tendon/muscle	BOTH IP/OP	"$6,859.00 "	"$5,075.66"	$0.00	"$5,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.42"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$5,432.33"	"$5,487.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000506	EAP	CPT® 42960		Control Throat Bleeding	BOTH IP/OP	"$5,082.00 "	"$3,760.68"	$0.00	"$4,065.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,059.09"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,024.94"	"$4,065.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000508	EAP	CPT® 25270		Repair Forearm Tendon/muscle	BOTH IP/OP	"$5,401.00 "	"$3,996.74"	$0.00	"$4,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.57"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$4,862.09"	"$4,911.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000512	EAP	CPT® 36425		Vein Access Cutdown > 1 Yr	BOTH IP/OP	$399.00 	$295.26	$0.00	$499.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.15	$0.00	$0.00	$0.00	$0.00	$499.00	$395.21	$399.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000520	EAP	Custom 45000520		Screened To Clinic	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.01	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000525	EAP	CPT® 64420		Intercostal Nerve Block	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,959.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.26	$0.00	$0.00	$0.00	$626.89	"$1,890.00"	"$1,496.88"	"$1,512.00"	$870.98	"$1,959.00"	$870.98	$95.79	$62.02	$62.02	$300.89	$597.04	$0.00	$0.00	$0.00	$0.00
45000526	EAP	CPT® 64421		Intercostal Nerve Block/multi	BOTH IP/OP	"$3,789.00 "	"$2,803.86"	$0.00	"$2,924.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$789.63	$0.00	$0.00	$0.00	$814.44	"$2,255.00"	"$2,895.55"	"$2,924.80"	"$1,131.55"	"$2,150.00"	"$1,131.55"	$124.25	$26.33	$26.33	$582.04	$775.65	$0.00	$0.00	$0.00	$0.00
45000529	EAP	CPT® 64400		Trigeminal Nerve Block	BOTH IP/OP	"$1,227.00 "	$907.98	$0.00	"$1,227.00"	"$1,227.00"	"$1,227.00"	$254.43	$254.43	$255.86	$255.74	$0.00	$0.00	$0.00	$250.31	$255.71	$162.70	"$1,227.00"	"$1,227.00"	$0.00	"$1,184.00"	$937.73	$947.20	$0.00	"$1,227.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000535	EAP	CPT® 36569		Insert Picc Cath	BOTH IP/OP	"$4,743.00 "	"$3,509.82"	$98.45	"$4,343.20"	"$2,321.55"	"$2,321.55"	"$1,369.42"	"$1,369.42"	"$1,377.13"	$988.56	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$1,347.67"	$988.44	$875.99	"$1,871.00"	"$1,871.00"	"$1,635.92"	"$2,255.00"	"$4,299.77"	"$4,343.20"	"$2,272.90"	"$2,500.00"	"$2,272.90"	$346.84	$98.45	$98.45	$864.30	"$1,558.02"	$0.00	$0.00	$0.00	$0.00
45000536	EAP	CPT® 54235		Penile Injection	BOTH IP/OP	$898.00 	$664.52	$0.00	"$1,128.00"	$487.61	$487.61	$259.14	$259.14	$260.60	$187.17	$0.00	$0.00	$0.00	$255.07	$187.14	$165.80	$113.00	$113.00	$235.59	$907.00	$718.34	$725.60	$327.32	"$1,128.00"	$327.32	$70.35	$75.71	$75.71	$144.39	$224.37	$0.00	$0.00	$0.00	$0.00
45000537	EAP	CPT® 46320		Rem. Of Hemorrhoid Clot	BOTH IP/OP	"$6,695.00 "	"$4,954.30"	$0.00	"$5,356.00"	"$2,321.55"	"$2,321.55"	"$1,009.84"	"$1,009.84"	"$1,015.53"	"$1,395.41"	$0.00	$0.00	$0.00	$993.84	"$1,395.24"	$646.00	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$5,302.44"	"$5,356.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000538	EAP	CPT® 26735		Open Tx Of Phalangeal Shaft Fx	BOTH IP/OP	"$8,714.00 "	"$6,448.36"	$0.00	"$6,969.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,816.00"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$6,899.90"	"$6,969.60"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000541	EAP	CPT® 23665		Treat Dislocation /fx	BOTH IP/OP	"$1,745.00 "	"$1,291.30"	$0.00	"$1,745.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$363.66	$0.00	$0.00	$0.00	$0.00	"$1,697.00"	"$1,344.02"	"$1,357.60"	$0.00	"$1,745.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000542	EAP	CPT® 40654		Repair Lip/complex	BOTH IP/OP	"$1,515.00 "	"$1,121.10"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.73	$0.00	$0.00	$0.00	$0.00	"$1,426.00"	"$1,129.39"	"$1,140.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000543	EAP	CPT® 31530		Laryngoscopy W/fb Rem	BOTH IP/OP	"$7,908.00 "	"$5,851.92"	$0.00	"$5,808.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,648.03"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$5,750.71"	"$5,808.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000544	EAP	CPT® 28435		Treatment Of Ankle Fx	BOTH IP/OP	"$1,516.00 "	"$1,121.84"	$0.00	"$1,516.00"	"$1,516.00"	"$1,516.00"	"$1,356.40"	"$1,356.40"	"$1,364.04"	$0.00	"$1,516.00"	"$1,516.00"	"$1,516.00"	$0.00	$315.93	$0.00	$0.00	$0.00	$0.00	"$1,500.00"	"$1,188.00"	"$1,200.00"	$0.00	"$1,516.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000545	EAP	CPT® 23625		Treat Humerus Fx	BOTH IP/OP	"$7,014.00 "	"$5,190.36"	$0.00	"$5,456.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,461.72"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$5,402.23"	"$5,456.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000546	EAP	CPT® 23545		Treat Clavicle Dislocation	BOTH IP/OP	"$1,245.00 "	$921.30	$0.00	"$1,245.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	"$1,245.00"	$986.04	$996.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000550	EAP	CPT® 52332		Cysto W Ureter Stent Plcmnt	BOTH IP/OP	"$10,798.00 "	"$7,990.52"	$0.00	"$8,725.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,250.30"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$8,638.34"	"$8,725.60"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000560	EAP	CPT® 24535		Treat Humerus Fx	BOTH IP/OP	"$1,745.00 "	"$1,291.30"	$0.00	"$1,745.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$363.66	$0.00	$0.00	$0.00	$0.00	"$1,697.00"	"$1,344.02"	"$1,357.60"	$0.00	"$1,745.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000561	EAP	CPT® 24640		Treat Elbow Dis/nursemaid	BOTH IP/OP	$615.00 	$455.10	$0.00	$615.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$128.17	$0.00	$0.00	$0.00	$0.00	$499.00	$395.21	$399.20	$0.00	$615.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000562	EAP	CPT® 28405		Treat Heel Fx	BOTH IP/OP	"$5,013.00 "	"$3,709.62"	$0.00	"$3,968.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,044.71"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,928.32"	"$3,968.00"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000563	EAP	CPT® 40831		Repair Mouth Lacerations	BOTH IP/OP	"$2,115.00 "	"$1,565.10"	$0.00	"$2,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$440.77	$0.00	$0.00	$0.00	$0.00	"$2,136.00"	"$1,691.71"	"$1,708.80"	$0.00	"$2,115.00"	$0.00	$170.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000564	EAP	CPT® 23675		Treat Dislocation/fracture	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,550.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	"$1,550.00"	"$1,227.60"	"$1,240.00"	$0.00	"$1,489.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000565	EAP	CPT® 20101		Exploration Of Penetrating Wound (chest)	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,086.92"	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000571	EAP	CPT® 90792		Psych Diag Eval W/med Srvcs	BOTH IP/OP	$482.00 	$356.68	$0.00	$457.60	$261.73	$261.73	$130.30	$130.30	$131.03	$100.46	$0.00	$0.00	$0.00	$128.07	$0.00	$83.25	$285.10	$285.10	$131.75	$286.00	$453.02	$457.60	$183.04	$374.40	$183.04	$117.89	$142.86	$142.86	$91.06	$125.47	$0.00	$0.00	$0.00	$0.00
45000572	EAP	CPT® 90863		Pharma Mgmt Inc Prescpt/med Review W Psytx (add-on)	BOTH IP/OP	$331.00 	$244.94	$0.00	$264.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.98	$0.00	$0.00	$0.00	$0.00	$165.50	$262.15	$264.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000574	EAP	CPT® 32555		Aspirate Pleura W/ Imaging	BOTH IP/OP	"$3,461.00 "	"$2,561.14"	$0.00	"$2,768.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.36	"$2,255.00"	"$2,741.11"	"$2,768.80"	$878.58	$0.00	$878.58	$626.46	$116.13	$116.13	$550.99	$602.25	$0.00	$0.00	$0.00	$0.00
45000575	EAP	CPT® 27781		Treatment Fibula Fracture	BOTH IP/OP	"$6,599.00 "	"$4,883.26"	$0.00	"$5,057.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,375.23"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,007.02"	"$5,057.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000576	EAP	CPT® 45900		Reduction Of Rectal Prolapse	BOTH IP/OP	"$1,534.00 "	"$1,135.16"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.69	$0.00	$0.00	$0.00	$0.00	"$1,534.00"	"$1,214.93"	"$1,227.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000580	EAP	Custom 45000580		I & D Complex Post Op Wound Inf	BOTH IP/OP	"$6,628.00 "	"$4,904.72"	$0.00	"$6,522.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,381.28"	$0.00	$0.00	$0.00	$0.00	"$4,076.50"	"$6,457.18"	"$6,522.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000581	EAP	CPT® 21451		Treata Lower Jaw Fracture	BOTH IP/OP	"$5,346.00 "	"$3,956.04"	$0.00	"$4,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,114.11"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$4,276.80"	"$4,320.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000584	EAP	Custom 45000584		I & D Floor Mouth Sub Mandibular	BOTH IP/OP	"$1,227.00 "	$907.98	$0.00	"$1,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$255.71	$0.00	$0.00	$0.00	$0.00	$720.50	"$1,141.27"	"$1,152.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000585	EAP	CPT® 13102		"Repair,complex,trunk,each Additional 5cm Or Less"	BOTH IP/OP	"$3,100.00 "	"$2,294.00"	$0.00	"$2,512.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$646.04	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,487.67"	"$2,512.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000589	EAP	CPT® 41016		"I&d Mouth Floor Les, Abcess,cyst, Hemat"	BOTH IP/OP	"$5,296.00 "	"$3,919.04"	$0.00	"$4,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,103.69"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,439.16"	"$4,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000590	EAP	CPT® 27265		Treat Hip Dislocation	BOTH IP/OP	$891.00 	$659.34	$0.00	$891.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.68	$0.00	$0.00	$0.00	$0.00	$891.00	$705.67	$712.80	$0.00	$681.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000592	EAP	CPT® 41016		"I&d,floor Of Mouth-submental"	BOTH IP/OP	"$5,549.00 "	"$4,106.26"	$0.00	"$4,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,156.41"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,439.16"	"$4,484.00"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000593	EAP	CPT® 21320		Closed Tx Nose Fx W/stabj	BOTH IP/OP	"$4,437.00 "	"$3,283.38"	$0.00	"$3,585.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.67	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,549.74"	"$3,585.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000594	EAP	CPT® 21453		Reduce Mandibular Interdental	BOTH IP/OP	"$8,688.00 "	"$6,429.12"	$0.00	"$7,020.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,810.58"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$6,950.59"	"$7,020.80"	$0.00	"$5,647.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000595	EAP	CPT® 11012		Deb Skin Bone At Fx Site	BOTH IP/OP	"$8,257.00 "	"$6,110.18"	$0.00	"$6,280.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,720.76"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$6,217.20"	"$6,280.00"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000598	EAP	CPT® 25624		Closed Treatment Of Carpal Scaphoid Fracture With Manipulation	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$2,295.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$2,295.00"	"$1,817.64"	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000599	EAP	CPT® 28825		"Amputation Toe, Interphalangeal Joint"	BOTH IP/OP	"$5,435.00 "	"$4,021.90"	$0.00	"$4,302.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,132.65"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,259.38"	"$4,302.40"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000600	EAP	CPT® 28495		Closed Fracture Treatment Of Great Toe Or Phalanx	BOTH IP/OP	$588.00 	$435.12	$0.00	$588.00	$588.00	$588.00	$200.72	$200.72	$201.85	$122.55	$0.00	$0.00	$0.00	$197.62	$122.54	$128.45	$113.00	$113.00	$0.00	$582.00	$460.94	$465.60	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000606	EAP	CPT® 28505		"Open Tx, Internal Fixation Grt Toe Fx"	BOTH IP/OP	"$6,418.00 "	"$4,749.32"	$0.00	"$5,134.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,337.51"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$5,083.06"	"$5,134.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000607	EAP	CPT® 40652		Repair Lip	BOTH IP/OP	"$2,180.00 "	"$1,613.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$454.31	$0.00	$0.00	$0.00	$0.00	"$2,051.00"	"$1,624.39"	"$1,640.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000608	EAP	CPT® 26952		Amputation Of Finger/thumb	BOTH IP/OP	"$6,468.00 "	"$4,786.32"	$0.00	"$4,726.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,347.93"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$4,679.14"	"$4,726.40"	$0.00	"$4,204.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000609	EAP	CPT® 51102		Drain Bl W/cath Insertion	BOTH IP/OP	"$5,564.00 "	"$4,117.36"	$0.00	"$4,451.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,159.54"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,406.69"	"$4,451.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000610	EAP	CPT® 57200		Repair Of Vagina	BOTH IP/OP	"$5,461.00 "	"$4,041.14"	$0.00	"$4,368.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,138.07"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,325.11"	"$4,368.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000611	EAP	CPT® 27532		Tx Fx Tibial Prox W/ Or W/o Manip W/tract Closed	BOTH IP/OP	"$5,978.00 "	"$4,423.72"	$0.00	"$4,782.40"	"$2,321.55"	"$2,321.55"	"$2,757.87"	"$2,757.87"	"$2,773.41"	$0.00	"$1,257.08"	"$1,257.08"	"$1,305.43"	$0.00	"$1,245.82"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,734.58"	"$4,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000612	EAP	Custom 45000612		Level 3 Partial Trauma Activation W/o Prenotificat	BOTH IP/OP	"$7,507.00 "	"$5,555.18"	$0.00	"$5,367.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,564.46"	$0.00	$0.00	$0.00	$0.00	"$2,345.00"	"$3,714.48"	"$3,752.00"	$0.00	"$5,367.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000613	EAP	CPT® 41007		Drainage Of Mouth Lesion	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,348.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$521.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,325.31"	"$2,348.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000620	EAP	CPT® 20650		Insert And Remove Bone Pin	BOTH IP/OP	"$6,356.00 "	"$4,703.44"	$0.00	"$5,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,324.59"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$5,033.95"	"$5,084.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45000634	EAP	CPT® 61107		Twist Drill Hole Implt Ventricular Cath/device	BOTH IP/OP	"$4,189.00 "	"$3,099.86"	$0.00	"$3,096.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$872.99	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,065.83"	"$3,096.80"	$0.00	"$2,722.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000001	EAP	CPT® 94010		Spiro Lung Vol/pf	BOTH IP/OP	$685.00 	$506.90	$27.37	$528.00	$371.96	$371.96	$135.96	$135.96	$136.73	$142.77	$508.41	$508.41	$528.00	$133.75	$142.75	$86.94	$405.18	$405.18	$138.76	$266.00	$421.34	$425.60	$192.78	$445.25	$192.78	$28.79	$27.37	$27.37	$84.69	$132.15	$0.00	$0.00	$0.00	$0.00
46000006	EAP	CPT® 94060		Bronchospasm Eval Pre And Post	BOTH IP/OP	$784.00 	$580.16	$46.82	$709.15	$425.71	$425.71	$257.73	$257.73	$259.18	$163.41	$581.88	$581.88	$604.31	$253.45	$163.39	$164.75	$463.74	$463.74	$253.05	$304.50	$482.33	$487.20	$351.58	$709.15	$351.58	$55.45	$46.82	$46.82	$96.95	$241.00	$0.00	$0.00	$0.00	$0.00
46000007	EAP	CPT® 94060		Spirometry Pre & Post	BOTH IP/OP	$784.00 	$580.16	$46.82	$709.15	$425.71	$425.71	$257.73	$257.73	$259.18	$163.41	$581.88	$581.88	$604.31	$253.45	$163.39	$164.75	$463.74	$463.74	$253.05	$304.50	$482.33	$487.20	$351.58	$709.15	$351.58	$55.45	$46.82	$46.82	$96.95	$241.00	$0.00	$0.00	$0.00	$0.00
46000010	EAP	CPT® 94070		Bronchoprovocation	BOTH IP/OP	"$1,441.00 "	"$1,066.34"	$0.00	"$1,119.20"	$782.46	$782.46	$257.73	$257.73	$259.18	$300.34	"$1,069.51"	"$1,069.51"	"$1,110.72"	$253.45	$300.30	$164.75	$852.35	$852.35	$0.00	$699.50	"$1,108.01"	"$1,119.20"	$0.00	$936.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000012	EAP	CPT® 94150		Peak Flow Determination	BOTH IP/OP	$267.00 	$197.58	$0.00	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.17	$198.17	$205.80	$0.00	$55.64	$0.00	$0.00	$0.00	$0.00	$133.50	$211.46	$213.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000015	EAP	CPT® 94200		Max Volume Ventilation (mvv)	BOTH IP/OP	$109.00 	$80.66	$0.00	$88.00	$59.19	$59.19	$54.21	$54.21	$54.51	$22.72	$80.90	$80.90	$84.02	$53.35	$22.72	$34.67	$64.47	$64.47	$0.00	$55.00	$87.12	$88.00	$0.00	$70.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000019	EAP	CPT® 94250		Expired Gas Analysis	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000027	EAP	CPT® 94375		"Maxflw-vol Curves, I+r"	BOTH IP/OP	$266.00 	$196.84	$24.49	$268.00	$144.44	$144.44	$257.73	$257.73	$259.18	$55.44	$197.43	$197.43	$205.03	$253.45	$55.43	$164.75	$157.34	$157.34	$253.05	$134.00	$212.26	$214.40	$268.00	$172.90	$268.00	$35.48	$24.49	$24.49	$42.67	$241.00	$0.00	$0.00	$0.00	$0.00
46000028	EAP	CPT® 94400		Breathing Response To Co2	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.50	$217.80	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000029	EAP	CPT® 94400		Co2 Response Curve	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.50	$217.80	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000030	EAP	CPT® 94450		Hypoxic Response Curve	BOTH IP/OP	$219.00 	$162.06	$0.00	$175.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.54	$162.54	$168.81	$0.00	$45.64	$0.00	$0.00	$0.00	$0.00	$109.50	$173.45	$175.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000031	EAP	CPT® 94618		Six Minute Walk(pulm Stress Simple)	BOTH IP/OP	$311.00 	$230.14	$10.80	$411.45	$168.87	$168.87	$109.81	$109.81	$110.43	$64.82	$230.82	$230.82	$239.72	$107.30	$64.81	$69.74	$183.96	$183.96	$109.35	$157.00	$248.69	$251.20	$151.93	$411.45	$151.93	$33.08	$10.80	$10.80	$49.99	$104.14	$0.00	$0.00	$0.00	$0.00
46000033	EAP	CPT® 94680		02 Anal	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$115.62	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000035	EAP	CPT® 94681		Et/co2 Oxygen Uptake	BOTH IP/OP	"$1,529.00 "	"$1,131.46"	$43.22	"$1,178.55"	$830.25	$830.25	$257.73	$257.73	$259.18	$318.68	"$1,134.82"	"$1,134.82"	"$1,178.55"	$253.45	$318.64	$164.75	$904.40	$904.40	$253.05	$695.00	"$1,100.88"	"$1,112.00"	$351.58	$993.85	$351.58	$66.54	$43.22	$43.22	$221.29	$241.00	$0.00	$0.00	$0.00	$0.00
46000037	EAP	CPT® 94681		Met Cart V02	BOTH IP/OP	"$1,529.00 "	"$1,131.46"	$43.22	"$1,178.55"	$830.25	$830.25	$257.73	$257.73	$259.18	$318.68	"$1,134.82"	"$1,134.82"	"$1,178.55"	$253.45	$318.64	$164.75	$904.40	$904.40	$253.05	$695.00	"$1,100.88"	"$1,112.00"	$351.58	$993.85	$351.58	$66.54	$43.22	$43.22	$221.29	$241.00	$0.00	$0.00	$0.00	$0.00
46000039	EAP	CPT® 94681		O2 Uptake Incl Co2 Output	BOTH IP/OP	$279.00 	$206.46	$43.22	$993.85	$151.50	$151.50	$257.73	$257.73	$259.18	$58.15	$207.07	$207.07	$215.05	$253.45	$58.14	$164.75	$165.03	$165.03	$253.05	$139.50	$220.97	$223.20	$279.00	$993.85	$279.00	$66.54	$43.22	$43.22	$44.42	$241.00	$0.00	$0.00	$0.00	$0.00
46000042	EAP	CPT® 94750		Pulmonary Compliance	BOTH IP/OP	"$1,179.00 "	$872.46	$0.00	$943.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.76	$589.50	$933.77	$943.20	$192.78	$0.00	$192.78	$36.60	$78.16	$78.16	$187.70	$132.15	$0.00	$0.00	$0.00	$0.00
46000044	EAP	CPT® 94760		Neo Pulse Oximetry Single	BOTH IP/OP	$440.00 	$325.60	$0.00	$354.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$326.57	$326.57	$339.15	$0.00	$91.70	$0.00	$0.00	$0.00	$0.00	$221.50	$350.86	$354.40	$0.00	$286.00	$0.00	$10.16	$2.52	$2.52	$70.53	$0.00	$0.00	$0.00	$0.00	$0.00
46000046	EAP	CPT® 94760		Pulse Oximetry	BOTH IP/OP	$440.00 	$325.60	$0.00	$354.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$326.57	$326.57	$339.15	$0.00	$91.70	$0.00	$0.00	$0.00	$0.00	$221.50	$350.86	$354.40	$0.00	$286.00	$0.00	$10.16	$2.52	$2.52	$70.53	$0.00	$0.00	$0.00	$0.00	$0.00
46000049	EAP	CPT® 94761		Adult Pulse Ox Multiple	BOTH IP/OP	$576.00 	$426.24	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.51	$427.51	$443.98	$0.00	$120.04	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00	$253.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000050	EAP	CPT® 94761		Neo Pulse Ox Multiple	BOTH IP/OP	$576.00 	$426.24	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.51	$427.51	$443.98	$0.00	$120.04	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00	$253.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000051	EAP	CPT® 94761		"Oximetry, Multiple"	BOTH IP/OP	$576.00 	$426.24	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.51	$427.51	$443.98	$0.00	$120.04	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00	$253.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000055	EAP	CPT® 94762		Oximetry Continuous	BOTH IP/OP	$759.00 	$561.66	$25.94	$611.20	$412.14	$412.14	$135.96	$135.96	$136.73	$158.19	$563.33	$563.33	$585.04	$133.75	$158.18	$86.94	$448.95	$448.95	$138.76	$382.00	$605.09	$611.20	$192.78	$410.80	$192.78	$25.94	$26.65	$26.65	$121.63	$132.15	$0.00	$0.00	$0.00	$0.00
46000056	EAP	CPT® 94762		Pulse Ox-overnight	BOTH IP/OP	$674.00 	$498.76	$25.94	$543.20	$365.98	$365.98	$135.96	$135.96	$136.73	$140.48	$500.24	$500.24	$519.52	$133.75	$140.46	$86.94	$398.67	$398.67	$138.76	$339.50	$537.77	$543.20	$192.78	$410.80	$192.78	$25.94	$26.65	$26.65	$108.10	$132.15	$0.00	$0.00	$0.00	$0.00
46000059	EAP	CPT® 94770		Transcut Co2 Monitor	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000060	EAP	CPT® 94799		Breathing Exercise	BOTH IP/OP	"$1,459.00 "	"$1,079.66"	$0.00	"$1,124.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,082.87"	"$1,082.87"	"$1,124.60"	$0.00	$304.06	$0.00	$0.00	$0.00	$0.00	$663.50	"$1,050.98"	"$1,061.60"	$0.00	$865.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000061	EAP	CPT® 94799		Mini Bal Lavage	BOTH IP/OP	"$1,459.00 "	"$1,079.66"	$0.00	"$1,124.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,082.87"	"$1,082.87"	"$1,124.60"	$0.00	$304.06	$0.00	$0.00	$0.00	$0.00	$663.50	"$1,050.98"	"$1,061.60"	$0.00	$865.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000066	EAP	CPT® 94610		Surfactant Administration	BOTH IP/OP	$397.00 	$293.78	$0.00	$317.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$294.65	$294.65	$306.01	$0.00	$82.73	$0.00	$0.00	$0.00	$0.00	$198.50	$314.42	$317.60	$0.00	$258.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000070	EAP	CPT® 94681		Met Cart Vco2	BOTH IP/OP	"$1,529.00 "	"$1,131.46"	$43.22	"$1,178.55"	$830.25	$830.25	$257.73	$257.73	$259.18	$318.68	"$1,134.82"	"$1,134.82"	"$1,178.55"	$253.45	$318.64	$164.75	$904.40	$904.40	$253.05	$695.00	"$1,100.88"	"$1,112.00"	$351.58	$993.85	$351.58	$66.54	$43.22	$43.22	$221.29	$241.00	$0.00	$0.00	$0.00	$0.00
46000071	EAP	CPT® 94726		Plethysmo Lung Vol / Air Resist	BOTH IP/OP	$314.00 	$232.36	$40.44	$758.55	$170.50	$170.50	$257.73	$257.73	$259.18	$65.45	$233.05	$233.05	$242.03	$253.45	$65.44	$164.75	$185.73	$185.73	$253.05	$127.00	$201.17	$203.20	$254.00	$758.55	$254.00	$51.52	$41.78	$41.78	$40.44	$241.00	$0.00	$0.00	$0.00	$0.00
46000072	EAP	CPT® 94728		Pul Func Oscillometry	BOTH IP/OP	$254.00 	$187.96	$0.00	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.52	$188.52	$195.78	$0.00	$52.93	$0.00	$0.00	$0.00	$0.00	$127.00	$201.17	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000075	EAP	CPT® 94726		Pulm Func Test Plethysmogr	BOTH IP/OP	"$1,167.00 "	$863.58	$40.44	$899.52	$633.68	$633.68	$257.73	$257.73	$259.18	$243.23	$866.15	$866.15	$899.52	$253.45	$243.20	$164.75	$690.28	$690.28	$253.05	$127.00	$201.17	$203.20	$254.00	$758.55	$254.00	$51.52	$41.78	$41.78	$40.44	$241.00	$0.00	$0.00	$0.00	$0.00
46000076	EAP	CPT® 94727		Pulm Func Test By Gas	BOTH IP/OP	$331.00 	$244.94	$0.00	$255.13	$179.73	$179.73	$135.96	$135.96	$136.73	$68.99	$245.67	$245.67	$255.13	$133.75	$68.98	$86.94	$195.79	$195.79	$138.76	$127.00	$201.17	$203.20	$192.78	$215.15	$192.78	$0.00	$31.69	$31.69	$40.44	$132.15	$0.00	$0.00	$0.00	$0.00
46000077	EAP	CPT® 94728		Pulm Func Test Oscillometry	BOTH IP/OP	$254.00 	$187.96	$0.00	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.52	$188.52	$195.78	$0.00	$52.93	$0.00	$0.00	$0.00	$0.00	$127.00	$201.17	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000078	EAP	CPT® 94729		C02/membrane Diffuse Capac	BOTH IP/OP	$379.00 	$280.46	$0.00	$629.85	$205.80	$205.80	$0.00	$0.00	$0.00	$78.99	$281.29	$281.29	$292.13	$0.00	$78.98	$0.00	$224.18	$224.18	$0.00	$153.50	$243.14	$245.60	$0.00	$629.85	$0.00	$51.25	$47.90	$47.90	$48.87	$0.00	$0.00	$0.00	$0.00	$0.00
46000082	EAP	CPT® 32554		Aspirate Pleura W/o Imaging	BOTH IP/OP	"$2,630.00 "	"$1,946.20"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$548.16	"$1,951.99"	"$1,951.99"	"$2,027.20"	$519.10	$548.09	$337.41	"$1,871.00"	"$1,871.00"	$632.36	"$2,255.00"	"$1,971.29"	"$1,991.20"	$878.58	"$2,150.00"	$878.58	$543.38	$93.40	$93.40	$396.25	$602.25	$0.00	$0.00	$0.00	$0.00
46000083	EAP	CPT® 32555		Aspirate Pleura W/ Imaging	BOTH IP/OP	"$3,657.00 "	"$2,706.18"	$116.13	"$2,818.82"	"$2,321.55"	"$2,321.55"	$526.39	$526.39	$529.35	$762.21	"$2,714.23"	"$2,714.23"	"$2,818.82"	$519.10	$762.12	$337.41	"$1,871.00"	"$1,871.00"	$632.36	"$2,255.00"	"$2,741.11"	"$2,768.80"	$878.58	"$2,150.00"	$878.58	$626.46	$116.13	$116.13	$550.99	$602.25	$0.00	$0.00	$0.00	$0.00
46000084	EAP	CPT® 31647		Bronchial Valve Init Insert	BOTH IP/OP	"$5,261.00 "	"$3,893.14"	$0.00	"$4,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,904.71"	"$3,904.71"	"$4,055.18"	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$4,077.22"	"$4,118.40"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000085	EAP	CPT® 31648		Bronchial Valve Addl Insert	BOTH IP/OP	"$2,999.00 "	"$2,219.26"	$0.00	"$2,999.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,225.86"	"$2,225.86"	"$2,311.63"	$0.00	$631.24	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$2,398.97"	"$2,423.20"	$0.00	"$2,999.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000086	EAP	CPT® 31649		Bronchial Valve Remov Init	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,102.17"	"$1,102.17"	"$1,144.64"	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	"$1,500.00"	"$1,188.00"	"$1,200.00"	$0.00	"$1,485.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000087	EAP	CPT® 31651		Bronchial Valve Remov Addl	BOTH IP/OP	$947.00 	$700.78	$0.00	$757.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$702.86	$702.86	$729.95	$0.00	$197.35	$0.00	$0.00	$0.00	$0.00	$473.50	$750.02	$757.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000088	EAP	CPT® 32556		Insert Cath Pleura W/o Image	BOTH IP/OP	"$2,930.00 "	"$2,168.20"	$0.00	"$2,828.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,174.65"	"$2,174.65"	"$2,258.44"	$0.00	$610.61	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,800.51"	"$2,828.80"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000089	EAP	CPT® 32557		Insert Cath Pleura W/ Image	BOTH IP/OP	"$2,627.00 "	"$1,943.98"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,080.58"	"$2,101.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000090	EAP	CPT® 94452		High Altitude Simulation Testing(hast)	BOTH IP/OP	$447.00 	$330.78	$0.00	$357.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.76	$331.76	$344.55	$0.00	$93.15	$0.00	$0.00	$0.00	$0.00	$223.50	$354.02	$357.60	$0.00	$213.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46000091	EAP	CPT® 94453		High Altitude Simulation Testing(hast) O2 Titration	BOTH IP/OP	$500.00 	$370.00	$53.67	$400.00	$271.50	$271.50	$109.81	$109.81	$110.43	$104.21	$371.10	$371.10	$385.40	$107.30	$104.20	$69.74	$295.75	$295.75	$109.35	$250.00	$396.00	$400.00	$151.93	$325.00	$151.93	$74.05	$53.67	$53.67	$79.60	$104.14	$0.00	$0.00	$0.00	$0.00
47000001	EAP	CPT® 92551		"Ipv Scr, 2 Ears, Pure Tone,air"	BOTH IP/OP	$30.00 	$22.20	$0.00	$97.50	$16.29	$16.29	$0.00	$0.00	$11.81	$6.25	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$18.00	$97.50	$18.00	$9.01	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
47000006	EAP	CPT® 92592		"Hearing Aid Check, Monaural"	BOTH IP/OP	$146.00 	$108.04	$0.00	$117.60	$79.28	$79.28	$0.00	$0.00	$22.24	$30.43	$108.36	$108.36	$112.54	$0.00	$30.43	$0.00	$86.36	$86.36	$0.00	$73.50	$116.42	$117.60	$88.20	$33.80	$88.20	$23.01	$0.00	$0.00	$23.40	$0.00	$0.00	$0.00	$0.00	$0.00
47000007	EAP	CPT® 92593		"Hearing Aid Check, Binaural"	BOTH IP/OP	$288.00 	$213.12	$0.00	$232.80	$156.38	$156.38	$0.00	$0.00	$37.15	$60.03	$213.75	$213.75	$221.99	$0.00	$60.02	$0.00	$170.35	$170.35	$0.00	$145.50	$230.47	$232.80	$174.60	$187.20	$174.60	$45.54	$0.00	$0.00	$46.33	$0.00	$0.00	$0.00	$0.00	$0.00
47000022	EAP	CPT® 95992		Canalith Repositioning Proc	BOTH IP/OP	$102.00 	$75.48	$0.00	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$21.26	$75.70	$75.70	$78.62	$38.95	$21.26	$25.32	$60.33	$60.33	$40.49	$51.50	$81.58	$82.40	$38.95	$66.30	$38.95	$16.12	$38.95	$38.95	$16.40	$38.95	$0.00	$0.00	$0.00	$0.00
47000023	EAP	CPT® 92626		Eval Aud Funcj Cand/po Surg Implt Dev 1st Hr	BOTH IP/OP	$508.00 	$375.92	$0.00	$406.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$377.04	$377.04	$391.57	$0.00	$105.87	$0.00	$0.00	$0.00	$0.00	$254.00	$402.34	$406.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47000024	EAP	CPT® 92591		Hearing Aid Examination & Selection Binaural	BOTH IP/OP	$345.00 	$255.30	$0.00	$278.40	$187.34	$187.34	$0.00	$0.00	$72.56	$71.91	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$174.00	$275.62	$278.40	$208.80	$216.45	$208.80	$54.46	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
47000025	EAP			Electroacous Eval Hearing Aid Binaural	BOTH IP/OP	$224.00 	$165.76	$0.00	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.25	$166.25	$172.66	$0.00	$46.68	$0.00	$0.00	$0.00	$0.00	$112.00	$177.41	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100001	EAP	CPT® 92511		"Nasal Pharyngoscopy, Simple"	BOTH IP/OP	$606.00 	$448.44	$0.00	$612.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.77	$449.77	$467.10	$0.00	$126.29	$0.00	$0.00	$0.00	$157.01	$612.00	$484.70	$489.60	$218.14	$393.90	$218.14	$64.35	$38.94	$38.94	$97.43	$149.53	$0.00	$0.00	$0.00	$0.00
47100002	EAP	CPT® 92541		Spontaneous Nystagmus Test	BOTH IP/OP	$647.00 	$478.78	$4.32	$523.20	$351.32	$351.32	$109.81	$109.81	$110.43	$134.85	$480.20	$480.20	$498.71	$107.30	$134.83	$69.74	$382.70	$382.70	$109.35	$327.00	$517.97	$523.20	$151.93	$212.55	$151.93	$36.09	$4.32	$4.32	$104.12	$104.14	$0.00	$0.00	$0.00	$0.00
47100003	EAP	CPT® 92542		POSITIONAL NYSTAGMUS TEST	BOTH IP/OP	$899.00 	$665.26	$0.00	$726.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$667.24	$667.24	$692.95	$0.00	$187.35	$0.00	$0.00	$0.00	$0.00	$454.00	$719.14	$726.40	$0.00	$212.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100005	EAP	CPT® 92544		Optokinetic Nystagmus Test	BOTH IP/OP	$654.00 	$483.96	$0.00	$523.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$485.40	$485.40	$504.10	$0.00	$136.29	$0.00	$0.00	$0.00	$0.00	$327.00	$517.97	$523.20	$0.00	$302.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100006	EAP	CPT® 92545		Oscillating Tracking Test	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$426.77	$426.77	$443.21	$0.00	$119.83	$0.00	$0.00	$0.00	$0.00	$287.50	$455.40	$460.00	$0.00	$302.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100007	EAP	CPT® 92551		Hearing Screening	BOTH IP/OP	$164.00 	$121.36	$0.00	$132.00	$89.05	$89.05	$0.00	$0.00	$11.81	$34.18	$121.72	$121.72	$126.41	$0.00	$34.18	$0.00	$97.01	$97.01	$0.00	$82.50	$130.68	$132.00	$99.00	$97.50	$99.00	$9.01	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
47100011	EAP	CPT® 92552		Air Conduction (both)	BOTH IP/OP	$276.00 	$204.24	$17.48	$220.80	$149.87	$149.87	$109.81	$109.81	$110.43	$57.53	$204.85	$204.85	$212.74	$107.30	$57.52	$69.74	$163.25	$163.25	$109.35	$138.00	$218.59	$220.80	$151.93	$98.15	$151.93	$17.48	$32.05	$32.05	$43.94	$104.14	$0.00	$0.00	$0.00	$0.00
47100012	EAP	CPT® 92552		Air Conduction (one)	BOTH IP/OP	$276.00 	$204.24	$17.48	$220.80	$149.87	$149.87	$109.81	$109.81	$110.43	$57.53	$204.85	$204.85	$212.74	$107.30	$57.52	$69.74	$163.25	$163.25	$109.35	$138.00	$218.59	$220.80	$151.93	$98.15	$151.93	$17.48	$32.05	$32.05	$43.94	$104.14	$0.00	$0.00	$0.00	$0.00
47100013	EAP	CPT® 92552		Audiometry	BOTH IP/OP	$273.00 	$202.02	$17.48	$220.80	$148.24	$148.24	$109.81	$109.81	$110.43	$56.90	$202.62	$202.62	$210.43	$107.30	$56.89	$69.74	$161.48	$161.48	$109.35	$138.00	$218.59	$220.80	$151.93	$98.15	$151.93	$17.48	$32.05	$32.05	$43.94	$104.14	$0.00	$0.00	$0.00	$0.00
47100014	EAP	CPT® 92552		Audiometry - Air Only	BOTH IP/OP	$273.00 	$202.02	$17.48	$220.80	$148.24	$148.24	$109.81	$109.81	$110.43	$56.90	$202.62	$202.62	$210.43	$107.30	$56.89	$69.74	$161.48	$161.48	$109.35	$138.00	$218.59	$220.80	$151.93	$98.15	$151.93	$17.48	$32.05	$32.05	$43.94	$104.14	$0.00	$0.00	$0.00	$0.00
47100015	EAP	CPT® 92552		Audiometry-air Conduction	BOTH IP/OP	$276.00 	$204.24	$17.48	$220.80	$149.87	$149.87	$109.81	$109.81	$110.43	$57.53	$204.85	$204.85	$212.74	$107.30	$57.52	$69.74	$163.25	$163.25	$109.35	$138.00	$218.59	$220.80	$151.93	$98.15	$151.93	$17.48	$32.05	$32.05	$43.94	$104.14	$0.00	$0.00	$0.00	$0.00
47100017	EAP	CPT® 92553		Air & Bone Conduction (both)	BOTH IP/OP	$622.00 	$460.28	$0.00	$497.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$128.37	$0.00	$0.00	$0.00	$138.76	$311.00	$492.62	$497.60	$192.78	$0.00	$192.78	$25.68	$38.90	$38.90	$99.02	$132.15	$0.00	$0.00	$0.00	$0.00
47100018	EAP	CPT® 92592		Air And Bone Conduction (one)	BOTH IP/OP	$295.00 	$218.30	$0.00	$238.40	$160.19	$160.19	$0.00	$0.00	$22.24	$61.49	$218.95	$218.95	$227.39	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$149.00	$236.02	$238.40	$178.80	$33.80	$178.80	$46.64	$0.00	$0.00	$47.44	$0.00	$0.00	$0.00	$0.00	$0.00
47100019	EAP	CPT® 92553		Audiometry - Air And Bone	BOTH IP/OP	$616.00 	$455.84	$0.00	$497.60	$334.49	$334.49	$135.96	$135.96	$136.73	$0.00	$457.20	$457.20	$474.81	$0.00	$128.37	$0.00	$0.00	$0.00	$138.76	$311.00	$492.62	$497.60	$192.78	$284.70	$192.78	$25.68	$38.90	$38.90	$99.02	$132.15	$0.00	$0.00	$0.00	$0.00
47100020	EAP	CPT® 92555		Speech Audiometry Threshold	BOTH IP/OP	$218.00 	$161.32	$14.98	$176.00	$118.37	$118.37	$32.96	$32.96	$33.15	$45.44	$161.80	$161.80	$168.03	$32.43	$45.43	$21.08	$128.95	$128.95	$33.53	$110.00	$174.24	$176.00	$46.58	$126.10	$46.58	$14.98	$24.13	$24.13	$35.02	$31.93	$0.00	$0.00	$0.00	$0.00
47100023	EAP	CPT® 92556		"Speech Audiometry, Complete"	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$123.33	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100026	EAP	CPT® 92557		Audiometric Battery	BOTH IP/OP	$736.00 	$544.64	$33.54	$594.40	$399.65	$399.65	$135.96	$135.96	$136.73	$153.40	$546.26	$546.26	$567.31	$133.75	$153.38	$86.94	$435.34	$435.34	$138.76	$371.50	$588.46	$594.40	$192.78	$478.40	$192.78	$47.03	$33.54	$33.54	$118.29	$132.15	$0.00	$0.00	$0.00	$0.00
47100028	EAP	CPT® 92557		Compre Audiometric Battery	BOTH IP/OP	$743.00 	$549.82	$0.00	$594.40	$0.00	$0.00	$0.00	$0.00	$0.00	$153.40	$0.00	$0.00	$0.00	$133.75	$153.38	$86.94	$435.34	$435.34	$138.76	$371.50	$588.46	$594.40	$192.78	$0.00	$192.78	$47.03	$33.54	$33.54	$118.29	$132.15	$0.00	$0.00	$0.00	$0.00
47100029	EAP	CPT® 92562		Loudness Balance Test	BOTH IP/OP	$227.00 	$167.98	$0.00	$181.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.48	$168.48	$174.97	$0.00	$47.31	$0.00	$0.00	$0.00	$0.00	$113.50	$179.78	$181.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100032	EAP	CPT® 92565		"Stenger Test, Pure Tone"	BOTH IP/OP	$278.00 	$205.72	$0.00	$224.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.33	$206.33	$214.28	$0.00	$57.94	$0.00	$0.00	$0.00	$0.00	$140.50	$222.55	$224.80	$0.00	$180.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100033	EAP	CPT® 92567		Tympanometry	BOTH IP/OP	$158.00 	$116.92	$11.18	$168.35	$85.79	$85.79	$32.96	$32.96	$33.15	$32.93	$117.27	$117.27	$121.79	$32.43	$32.93	$21.08	$93.46	$93.46	$33.53	$80.00	$126.72	$128.00	$46.58	$168.35	$46.58	$20.66	$11.18	$11.18	$25.47	$31.93	$0.00	$0.00	$0.00	$0.00
47100034	EAP	CPT® 92567		"Tympanometry, Binaural"	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.93	$0.00	$0.00	$0.00	$32.43	$32.93	$21.08	$93.46	$93.46	$33.53	$80.00	$126.72	$128.00	$46.58	$0.00	$46.58	$20.66	$11.18	$11.18	$25.47	$31.93	$0.00	$0.00	$0.00	$0.00
47100036	EAP	CPT® 92568		Acoustic Reflex Testing	BOTH IP/OP	$276.00 	$204.24	$0.00	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.85	$204.85	$212.74	$0.00	$57.52	$0.00	$0.00	$0.00	$0.00	$138.00	$218.59	$220.80	$0.00	$163.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100038	EAP	CPT® 92568		Acoustic Reflex Testing (bt)	BOTH IP/OP	$276.00 	$204.24	$0.00	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.85	$204.85	$212.74	$0.00	$57.52	$0.00	$0.00	$0.00	$0.00	$138.00	$218.59	$220.80	$0.00	$163.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100040	EAP	CPT® 92568		Acoustic Reflex(one)	BOTH IP/OP	$276.00 	$204.24	$0.00	$220.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.85	$204.85	$212.74	$0.00	$57.52	$0.00	$0.00	$0.00	$0.00	$138.00	$218.59	$220.80	$0.00	$163.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100044	EAP	CPT® 92570		"Acoustic Reflex Testing, Both"	BOTH IP/OP	$273.00 	$202.02	$0.00	$220.80	$148.24	$148.24	$135.96	$135.96	$136.73	$56.90	$202.62	$202.62	$210.43	$133.75	$56.89	$86.94	$161.48	$161.48	$0.00	$138.00	$218.59	$220.80	$0.00	$177.45	$0.00	$23.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100045	EAP	CPT® 92570		"Acoustic Reflex Testing, One"	BOTH IP/OP	$276.00 	$204.24	$0.00	$220.80	$149.87	$149.87	$135.96	$135.96	$136.73	$57.53	$204.85	$204.85	$212.74	$133.75	$57.52	$86.94	$163.25	$163.25	$0.00	$138.00	$218.59	$220.80	$0.00	$177.45	$0.00	$23.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100049	EAP	CPT® 92577		"Stenger Test, Speech"	BOTH IP/OP	$495.00 	$366.30	$14.05	$500.00	$268.79	$268.79	$475.36	$475.36	$478.04	$103.17	$367.39	$367.39	$381.55	$467.50	$103.16	$303.87	$292.79	$292.79	$487.04	$250.00	$396.00	$400.00	$500.00	$321.75	$500.00	$28.15	$14.05	$14.05	$79.60	$463.84	$0.00	$0.00	$0.00	$0.00
47100052	EAP	CPT® 92579		Visual Reinforcement Audiometr	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.18	$244.18	$253.59	$0.00	$68.56	$0.00	$0.00	$0.00	$0.00	$164.50	$260.57	$263.20	$0.00	$204.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100053	EAP	CPT® 92582		Conditioning Play Audiometry	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.27	$307.27	$319.11	$0.00	$86.28	$0.00	$0.00	$0.00	$0.00	$207.00	$327.89	$331.20	$0.00	$195.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100057	EAP	CPT® 92585		Auditory Brainstern Response	BOTH IP/OP	$727.00 	$537.98	$0.00	$581.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$363.50	$575.78	$581.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100059	EAP	CPT® 92585		"Auditory Evok Potent, Compre"	BOTH IP/OP	$727.00 	$537.98	$0.00	$581.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$363.50	$575.78	$581.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100061	EAP	CPT® 92587		Evoke Otoacoustic Emission Ltd	BOTH IP/OP	$431.00 	$318.94	$0.00	$410.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.89	$319.89	$332.21	$0.00	$89.82	$0.00	$0.00	$0.00	$0.00	$217.00	$343.73	$347.20	$0.00	$410.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100064	EAP	CPT® 92588		Evoke Otoacoustic Dx/compre	BOTH IP/OP	$442.00 	$327.08	$0.00	$356.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.05	$328.05	$340.69	$0.00	$92.11	$0.00	$0.00	$0.00	$0.00	$222.50	$352.44	$356.00	$0.00	$287.30	$0.00	$40.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100066	EAP	CPT® 92567		"Tympanometry, Monoaural"	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.35	$0.00	$0.00	$0.00	$32.43	$33.34	$21.08	$94.64	$94.64	$33.53	$80.00	$126.72	$128.00	$46.58	$0.00	$46.58	$20.66	$11.18	$11.18	$25.47	$31.93	$0.00	$0.00	$0.00	$0.00
47100067	EAP	CPT® 92590		Hearing Aid Eval 75 Min	BOTH IP/OP	$288.00 	$213.12	$0.00	$232.80	$156.38	$156.38	$0.00	$0.00	$56.60	$60.03	$213.75	$213.75	$221.99	$0.00	$60.02	$0.00	$170.35	$170.35	$0.00	$145.50	$230.47	$232.80	$174.60	$46.80	$174.60	$45.54	$0.00	$0.00	$46.33	$0.00	$0.00	$0.00	$0.00	$0.00
47100072	EAP	CPT® 92594		Electroacoustic Eval Monaural	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$85.79	$85.79	$0.00	$0.00	$21.19	$0.00	$117.27	$117.27	$121.79	$0.00	$32.93	$0.00	$0.00	$0.00	$0.00	$79.00	$125.14	$126.40	$0.00	$33.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100073	EAP	CPT® 92596		Ear Protector Attenuation Meas	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.84	$181.84	$188.85	$0.00	$51.06	$0.00	$0.00	$0.00	$0.00	$122.50	$194.04	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100086	EAP	CPT® 92551		"Hearing Test, Diagnostic"	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$89.60	$89.60	$0.00	$0.00	$11.81	$34.39	$122.46	$122.46	$127.18	$0.00	$34.39	$0.00	$97.60	$97.60	$0.00	$82.50	$130.68	$132.00	$99.00	$97.50	$99.00	$9.01	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
47100088	EAP	CPT® 95885		Ncs/emg <=4 Limb	BOTH IP/OP	$240.00 	$177.60	$0.00	$366.60	$130.32	$130.32	$0.00	$0.00	$0.00	$50.02	$178.13	$178.13	$184.99	$0.00	$50.02	$0.00	$141.96	$141.96	$0.00	$118.00	$186.91	$188.80	$0.00	$366.60	$0.00	$53.47	$44.66	$44.66	$37.57	$0.00	$0.00	$0.00	$0.00	$0.00
47100089	EAP	CPT® 95886		Ncs/emg 5+limb	BOTH IP/OP	$240.00 	$177.60	$0.00	$464.10	$130.32	$130.32	$0.00	$0.00	$0.00	$50.02	$178.13	$178.13	$184.99	$0.00	$50.02	$0.00	$141.96	$141.96	$0.00	$118.00	$186.91	$188.80	$0.00	$464.10	$0.00	$83.61	$51.87	$51.87	$37.57	$0.00	$0.00	$0.00	$0.00	$0.00
47100098	EAP	CPT® 95887		Muscl Test W/n Test Non-extr	BOTH IP/OP	$127.00 	$93.98	$0.00	$100.00	$68.96	$68.96	$0.00	$0.00	$0.00	$26.47	$94.26	$94.26	$97.89	$0.00	$26.47	$0.00	$75.12	$75.12	$0.00	$62.50	$99.00	$100.00	$0.00	$82.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100099	EAP	CPT® 95938		Somatosensory Testing	BOTH IP/OP	$556.00 	$411.44	$0.00	"$4,513.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$412.66	$412.66	$428.56	$0.00	$115.87	$0.00	$0.00	$0.00	$0.00	$287.50	$455.40	$460.00	$0.00	"$4,513.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100110	EAP	CPT® 92547		Vertical Electrodes	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$84.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100132	EAP	CPT® 92537		"Caloric Vstblar Test W/rec,bilat"	BOTH IP/OP	"$1,168.00 "	$864.32	$10.08	$944.00	$634.22	$634.22	$135.96	$135.96	$136.73	$243.44	$866.89	$866.89	$900.29	$133.75	$243.41	$86.94	$690.87	$690.87	$138.76	$590.00	$934.56	$944.00	$192.78	$555.75	$192.78	$38.69	$10.08	$10.08	$187.86	$132.15	$0.00	$0.00	$0.00	$0.00
47100133	EAP	CPT® 92538		"Caloric Vstblar Test W/rec,bilat;monothermal"	BOTH IP/OP	"$1,168.00 "	$864.32	$6.48	$944.00	$634.22	$634.22	$135.96	$135.96	$136.73	$243.44	$866.89	$866.89	$900.29	$133.75	$243.41	$86.94	$690.87	$690.87	$138.76	$590.00	$934.56	$944.00	$192.78	$561.60	$192.78	$19.67	$6.48	$6.48	$187.86	$132.15	$0.00	$0.00	$0.00	$0.00
47100134	EAP	CPT® 92567		"Tympanometry, Monaural"	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.35	$0.00	$0.00	$0.00	$32.43	$33.34	$21.08	$94.64	$94.64	$33.53	$80.00	$126.72	$128.00	$46.58	$0.00	$46.58	$20.66	$11.18	$11.18	$25.47	$31.93	$0.00	$0.00	$0.00	$0.00
47100135	EAP	CPT® 92602		Reprogram Cochlear Implt <7	BOTH IP/OP	$676.00 	$500.24	$0.00	$540.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$501.73	$501.73	$521.06	$0.00	$140.88	$0.00	$0.00	$0.00	$0.00	$338.00	$535.39	$540.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100137	EAP			Gll Fitting Visit	BOTH IP/OP	$215.00 	$159.10	$0.00	$172.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.57	$159.57	$165.72	$0.00	$44.81	$0.00	$0.00	$0.00	$0.00	$107.50	$170.28	$172.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47100138	EAP			Gll Visit - Post 4th Visit	BOTH IP/OP	$25.00 	$18.50	$0.00	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.56	$18.56	$19.27	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$12.50	$19.80	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47200002	EAP	CPT® 92603		Cochlear Implt Exam 7 > Yrs	BOTH IP/OP	$267.00 	$197.58	$42.98	$216.00	$144.98	$144.98	$135.96	$135.96	$136.73	$55.65	$198.17	$198.17	$205.80	$133.75	$55.64	$86.94	$157.93	$157.93	$138.76	$135.00	$213.84	$216.00	$192.78	$173.55	$192.78	$88.28	$125.50	$125.50	$42.98	$132.15	$0.00	$0.00	$0.00	$0.00
47200003	EAP	CPT® 92604		Reprogram Codhlear Implt 7 > Yrs	BOTH IP/OP	$631.00 	$466.94	$0.00	$509.60	$342.63	$342.63	$135.96	$135.96	$136.73	$131.52	$468.33	$468.33	$486.37	$133.75	$131.50	$86.94	$373.24	$373.24	$0.00	$318.50	$504.50	$509.60	$0.00	$410.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47200010	EAP	HCPCS C1887		Maxc Catheter Reperfusion 4max	BOTH IP/OP	"$4,108.00 "	"$3,039.92"	$0.00	"$3,286.40"	"$2,230.64"	"$2,230.64"	$0.00	$0.00	$0.00	$856.21	"$3,048.96"	"$3,048.96"	"$3,166.45"	$0.00	$856.11	$0.00	"$2,429.88"	"$2,429.88"	$0.00	"$2,054.00"	"$3,253.54"	"$3,286.40"	$0.00	$0.00	$0.00	$642.90	$0.00	$0.00	$653.99	$0.00	$0.00	$0.00	$0.00	$0.00
47200011	EAP	HCPCS C1757		Psc041 Catheter Thrmb 141cm 4.1fr .041in Reperfusion	BOTH IP/OP	"$3,813.00 "	"$2,821.62"	$0.00	"$3,050.40"	"$2,070.46"	"$2,070.46"	$0.00	$0.00	$0.00	$794.72	"$2,830.01"	"$2,830.01"	"$2,939.06"	$0.00	$794.63	$0.00	"$2,255.39"	"$2,255.39"	$0.00	"$1,906.50"	"$3,019.90"	"$3,050.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47900001	EAP	CPT® 92586		Hearing Screening (aabr)	BOTH IP/OP	$439.00 	$324.86	$0.00	$351.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.50	$347.69	$351.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47900003	EAP	CPT® 92587		Hearing Screening (oae)	BOTH IP/OP	$431.00 	$318.94	$0.00	$410.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.89	$319.89	$332.21	$0.00	$89.82	$0.00	$0.00	$0.00	$0.00	$217.00	$343.73	$347.20	$0.00	$410.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000001	EAP	CPT® 33967		Perc Insertion Intraaortic Bal	BOTH IP/OP	"$5,482.00 "	"$4,056.68"	$0.00	"$5,343.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,068.74"	"$4,068.74"	"$4,225.53"	$0.00	"$1,142.45"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,873.67"	"$3,912.80"	$0.00	"$5,343.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000002	EAP	CPT® 92950		Cardio Res - Cpr	BOTH IP/OP	"$2,336.00 "	"$1,728.64"	$0.00	"$1,800.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,733.78"	"$1,733.78"	"$1,800.59"	$0.00	$486.82	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000003	EAP	CPT® 92953		Temp Transcut Pacing	BOTH IP/OP	"$2,474.00 "	"$1,830.76"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,836.20"	"$1,836.20"	"$1,906.96"	$0.00	$515.58	$0.00	$0.00	$0.00	$0.00	"$1,249.50"	"$1,979.21"	"$1,999.20"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000004	EAP	CPT® 92960		Cardioversion	BOTH IP/OP	"$2,742.00 "	"$2,029.08"	$112.51	"$2,150.00"	"$1,488.91"	"$1,488.91"	$547.07	$547.07	$550.15	$571.50	"$2,035.11"	"$2,035.11"	"$2,113.53"	$538.55	$571.43	$350.05	"$1,621.89"	"$1,621.89"	$538.04	"$1,082.50"	"$1,714.68"	"$1,732.00"	$747.53	"$2,150.00"	$747.53	$154.62	$112.51	$112.51	$344.67	$512.42	$0.00	$0.00	$0.00	$0.00
48000005	EAP	CPT® 92971		Circulatory Assist - External	BOTH IP/OP	"$1,227.00 "	$907.98	$0.00	$981.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$910.68	$910.68	$945.77	$0.00	$255.71	$0.00	$0.00	$0.00	$0.00	$613.50	$971.78	$981.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000011	EAP	CPT® 92986		"Perc Balloon Vplasty, Aortic"	BOTH IP/OP	"$20,704.00 "	"$15,320.96"	$0.00	"$16,563.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$15,958.64"	$0.00	"$4,314.71"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$16,397.57"	"$16,563.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000012	EAP	CPT® 92987		"Perc Balloon Vplasty, Mitral"	BOTH IP/OP	"$20,704.00 "	"$15,320.96"	$0.00	"$16,563.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$15,958.64"	$0.00	"$4,314.71"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$16,397.57"	"$16,563.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000013	EAP	CPT® 92990		"Perc Balloon Vplasty, Pulm"	BOTH IP/OP	"$20,704.00 "	"$15,320.96"	$0.00	"$16,563.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$15,958.64"	$0.00	"$4,314.71"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$16,397.57"	"$16,563.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000014	EAP	CPT® 93282		Single Lead Icd Programming / Evaluation In Person	BOTH IP/OP	$328.00 	$242.72	$23.14	$252.82	$140.08	$140.08	$36.26	$36.26	$36.47	$68.36	$243.44	$243.44	$252.82	$35.61	$68.36	$23.14	$194.01	$194.01	$36.36	$132.00	$209.09	$211.20	$50.51	$213.20	$50.51	$68.00	$30.97	$30.97	$42.03	$34.63	$0.00	$0.00	$0.00	$0.00
48000015	EAP	CPT® 93283		Dual Lead Icd Program/ Eval In Person	BOTH IP/OP	$328.00 	$242.72	$23.14	$252.82	$180.76	$180.76	$36.26	$36.26	$36.47	$68.36	$243.44	$243.44	$252.82	$35.61	$68.36	$23.14	$194.01	$194.01	$36.36	$132.00	$209.09	$211.20	$50.51	$213.20	$50.51	$82.80	$33.86	$33.86	$42.03	$34.63	$0.00	$0.00	$0.00	$0.00
48000016	EAP	CPT® 93285		Sq-cardiac Rhythm Monitor / Loop Recorder  Program / Eval In Person	BOTH IP/OP	$204.00 	$150.96	$23.14	$157.24	$93.14	$93.14	$36.26	$36.26	$36.47	$42.52	$151.41	$151.41	$157.24	$35.61	$42.51	$23.14	$120.67	$120.67	$36.36	$82.00	$129.89	$131.20	$50.51	$132.60	$50.51	$45.96	$27.73	$27.73	$26.11	$34.63	$0.00	$0.00	$0.00	$0.00
48000017	EAP	CPT® 93289		Pacemaker Interrog / Eval In Person	BOTH IP/OP	$328.00 	$242.72	$23.14	$252.82	$145.54	$145.54	$36.26	$36.26	$36.47	$68.36	$243.44	$243.44	$252.82	$35.61	$68.36	$23.14	$194.01	$194.01	$36.36	$132.00	$209.09	$211.20	$50.51	$146.25	$50.51	$63.29	$28.81	$28.81	$42.03	$34.63	$0.00	$0.00	$0.00	$0.00
48000019	EAP	CPT® 93307		2d Echo	BOTH IP/OP	"$3,555.00 "	"$2,630.70"	$0.00	"$2,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$316.71	$316.71	$328.89	$0.00	$740.86	$0.00	$0.00	$0.00	$0.00	"$1,810.50"	"$2,867.83"	"$2,896.80"	$0.00	"$1,316.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000020	EAP	CPT® 93312		Transesophageal Echo	BOTH IP/OP	"$4,858.00 "	"$3,594.92"	$138.31	"$3,482.40"	$544.66	$544.66	$470.55	$470.55	$473.20	"$1,012.53"	$522.69	$522.69	$542.80	$462.81	"$1,012.41"	$300.83	"$2,873.51"	"$2,873.51"	$483.00	"$2,176.50"	"$3,447.58"	"$3,482.40"	$671.06	"$2,526.55"	$671.06	$268.29	$138.31	$138.31	$693.00	$460.00	$0.00	$0.00	$0.00	$0.00
48000021	EAP	CPT® 93320		Echo Doppler Complete	BOTH IP/OP	"$2,768.00 "	"$2,048.32"	$0.00	"$1,984.00"	$119.72	$119.72	$0.00	$0.00	$0.00	$576.92	$143.29	$143.29	$148.80	$0.00	$576.85	$0.00	"$1,637.27"	"$1,637.27"	$0.00	"$1,240.00"	"$1,964.16"	"$1,984.00"	$0.00	"$1,976.65"	$0.00	$90.75	$35.66	$35.66	$394.82	$0.00	$0.00	$0.00	$0.00	$0.00
48000022	EAP	CPT® 93325		Color Flow Mapping	BOTH IP/OP	"$1,693.00 "	"$1,252.82"	$0.00	"$1,976.65"	$56.34	$56.34	$0.00	$0.00	$0.00	$352.86	$122.81	$122.81	$127.54	$0.00	$352.82	$0.00	"$1,001.41"	"$1,001.41"	$0.00	$834.50	"$1,321.85"	"$1,335.20"	$0.00	"$1,976.65"	$0.00	$116.25	$21.97	$21.97	$265.70	$0.00	$0.00	$0.00	$0.00	$0.00
48000023	EAP	CPT® 93350		Transthoracic Echo	BOTH IP/OP	"$3,694.00 "	"$2,733.56"	$0.00	"$2,955.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$781.18	$0.00	$0.00	$0.00	$462.81	$781.08	$300.83	"$2,216.94"	"$2,216.94"	$483.00	"$1,847.00"	"$2,925.65"	"$2,955.20"	$671.06	$0.00	$671.06	$118.63	$120.30	$120.30	$588.08	$460.00	$0.00	$0.00	$0.00	$0.00
48000024	EAP	CPT® 93503		Insertion Swan Ganz	BOTH IP/OP	"$8,527.00 "	"$6,309.98"	$0.00	"$6,890.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,572.61"	$0.00	"$1,777.03"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,821.50"	"$6,890.40"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000025	EAP	CPT® 93580		Perc Closure Atrial Septal Def	BOTH IP/OP	"$19,473.00 "	"$14,410.02"	$0.00	"$15,009.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$15,009.79"	$0.00	"$4,058.17"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$14,770.01"	"$14,919.20"	$0.00	"$5,343.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000026	EAP	CPT® 33222		Relocation Skin  Pkt For Pacemaker	BOTH IP/OP	"$27,668.00 "	"$20,474.32"	$0.00	"$21,706.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,766.01"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$21,489.34"	"$21,706.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000027	EAP	CPT® 93640		Ep Eval Icd Leads Init Implant	BOTH IP/OP	"$5,142.00 "	"$3,805.08"	$0.00	"$4,113.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,816.39"	"$3,816.39"	"$3,963.45"	$0.00	"$1,071.59"	$0.00	$0.00	$0.00	$0.00	"$2,571.00"	"$4,072.46"	"$4,113.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000028	EAP	CPT® 93641		Test Icd Gen Initial Implant	BOTH IP/OP	"$5,361.00 "	"$3,967.14"	$0.00	"$5,361.00"	"$5,361.00"	"$5,361.00"	$0.00	$0.00	$0.00	"$1,117.37"	"$3,978.93"	"$3,978.93"	"$4,132.26"	$0.00	"$1,117.23"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,478.50"	"$3,925.94"	"$3,965.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000029	EAP	CPT® 93642		Ep Eval Icd Gen & Programming	BOTH IP/OP	"$5,562.00 "	"$4,115.88"	$0.00	"$5,562.00"	"$5,562.00"	"$5,562.00"	"$1,084.66"	"$1,084.66"	"$1,090.77"	$0.00	"$4,128.12"	"$4,128.12"	"$4,287.19"	$0.00	"$1,159.12"	$0.00	$0.00	$0.00	$990.46	"$2,571.00"	"$4,072.46"	"$4,113.60"	"$1,376.12"	"$2,500.00"	"$1,376.12"	$590.04	$83.20	$83.20	$818.61	$943.30	$0.00	$0.00	$0.00	$0.00
48000030	EAP	CPT® 93660		Tilt Table Evaluation	BOTH IP/OP	"$1,423.00 "	"$1,053.02"	$0.00	"$1,423.00"	$772.69	$772.69	$475.36	$475.36	$0.00	$296.59	"$1,056.15"	"$1,056.15"	"$1,096.85"	$467.50	$296.55	$303.87	$841.70	$841.70	$0.00	$718.50	"$1,138.10"	"$1,149.60"	$0.00	"$1,423.00"	$0.00	$173.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000040	EAP	CPT® 93788		Ambulatory Bp Analysis	BOTH IP/OP	$212.00 	$156.88	$0.00	$169.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.35	$157.35	$163.41	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$106.00	$167.90	$169.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000045	EAP	CPT® 93458		Lt Heart Cath Including V Gram	BOTH IP/OP	"$22,078.00 "	"$16,337.72"	$786.98	"$14,473.60"	"$10,292.10"	"$10,292.10"	"$2,823.89"	"$2,823.89"	"$2,839.80"	"$4,601.61"	"$5,345.48"	"$5,345.48"	"$5,773.12"	"$2,778.48"	"$4,601.06"	"$1,806.01"	"$13,059.14"	"$13,059.14"	"$2,858.33"	"$2,858.00"	"$14,328.86"	"$14,473.60"	"$3,971.26"	"$4,334.00"	"$3,971.26"	"$1,000.10"	$786.98	$786.98	"$2,880.25"	"$2,722.22"	$0.00	$0.00	$0.00	$0.00
48000046	EAP	CPT® 93459		Lhc W/ V Gram And Grafts	BOTH IP/OP	"$22,078.00 "	"$16,337.72"	$842.80	"$14,473.60"	"$10,292.10"	"$10,292.10"	"$2,823.89"	"$2,823.89"	"$2,839.80"	"$4,601.61"	"$5,345.48"	"$5,345.48"	"$5,773.12"	"$2,778.48"	"$4,601.06"	"$1,806.01"	"$13,059.14"	"$13,059.14"	"$2,858.33"	"$2,858.00"	"$14,328.86"	"$14,473.60"	"$3,971.26"	"$4,334.00"	"$3,971.26"	"$1,104.45"	$842.80	$842.80	"$2,880.25"	"$2,722.22"	$0.00	$0.00	$0.00	$0.00
48000047	EAP	CPT® 93460		R&lhc W/v Gram	BOTH IP/OP	"$22,078.00 "	"$16,337.72"	$0.00	"$14,473.60"	"$10,292.10"	"$10,292.10"	"$2,823.89"	"$2,823.89"	"$2,839.80"	"$4,601.61"	"$5,345.48"	"$5,345.48"	"$5,773.12"	"$2,778.48"	"$4,601.06"	"$1,806.01"	"$13,059.14"	"$13,059.14"	$0.00	"$2,858.00"	"$14,328.86"	"$14,473.60"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000048	EAP	CPT® 93461		R&lhc W/v Gram And Grafts	BOTH IP/OP	"$22,078.00 "	"$16,337.72"	$0.00	"$14,473.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,601.06"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$14,328.86"	"$14,473.60"	$0.00	"$4,334.00"	$0.00	"$1,354.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000050	EAP	CPT® 33235		Removal Pacemaker Electrodes	BOTH IP/OP	"$9,098.00 "	"$6,732.52"	$0.00	"$8,013.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$7,012.74"	$0.00	"$1,896.02"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$7,933.46"	"$8,013.60"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000053	EAP	CPT® 94621		Pulm Exer Stress Test; Complex	BOTH IP/OP	"$1,097.00 "	$811.78	$0.00	$877.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$814.19	$814.19	$845.57	$0.00	$228.61	$0.00	$0.00	$0.00	$0.00	$548.50	$868.82	$877.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000054	EAP	Custom 48000054		Cpet Patient Interface Kit	BOTH IP/OP	$424.00 	$313.76	$0.00	$339.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$314.69	$314.69	$326.82	$0.00	$88.36	$0.00	$0.00	$0.00	$0.00	$212.00	$335.81	$339.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000055	EAP	Custom 48000055		Analyze/ind/term Tachycardia	BOTH IP/OP	$238.00 	$176.12	$0.00	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.64	$176.64	$183.45	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$127.00	$201.17	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000057	EAP	CPT® 92920		Prq Cardiac Angioplast 1 Art	BOTH IP/OP	"$17,577.00 "	"$13,006.98"	$0.00	"$13,631.20"	"$9,544.31"	"$9,544.31"	"$4,826.66"	"$4,826.66"	"$4,853.85"	"$3,663.49"	"$4,181.12"	"$4,181.12"	"$13,548.35"	"$4,750.73"	"$3,663.05"	"$3,087.98"	"$10,396.80"	"$10,396.80"	$0.00	"$4,975.00"	"$13,494.89"	"$13,631.20"	$0.00	"$3,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000058	EAP	CPT® 92921		Prq Cardiac Angio Addl Art	BOTH IP/OP	"$28,094.00 "	"$20,789.56"	$0.00	"$21,786.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,654.86"	$0.00	"$5,854.79"	$0.00	$0.00	$0.00	$0.00	"$13,616.50"	"$21,568.54"	"$21,786.40"	$0.00	"$6,409.00"	$0.00	"$4,261.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000059	EAP	CPT® 92928		Prq Card Stent W/angio 1 Vsl	BOTH IP/OP	"$32,293.00 "	"$23,896.82"	$0.00	"$25,043.20"	"$17,535.10"	"$17,535.10"	"$9,781.76"	"$9,781.76"	"$9,836.87"	"$6,730.67"	"$4,181.12"	"$4,181.12"	"$24,891.44"	"$9,625.35"	"$6,729.86"	"$6,256.48"	"$19,101.31"	"$19,101.31"	$0.00	"$6,105.00"	"$24,792.77"	"$25,043.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000060	EAP	CPT® 92929		Prq Card Stent W/angio Addl	BOTH IP/OP	"$44,709.00 "	"$33,084.66"	$0.00	"$34,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$34,461.70"	$0.00	"$9,317.36"	$0.00	$0.00	$0.00	$0.00	"$21,670.00"	"$34,325.28"	"$34,672.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000061	EAP	CPT® 92937		Prq Revasc Byp Graft 1 Vsl	BOTH IP/OP	"$14,275.00 "	"$10,563.50"	$0.00	"$11,070.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,003.17"	$0.00	"$2,974.91"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$10,959.70"	"$11,070.40"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000062	EAP	CPT® 92938		Prq Revasc Byp Graft Addl	BOTH IP/OP	"$12,738.00 "	"$9,426.12"	$0.00	"$9,878.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$9,818.45"	$0.00	"$2,654.60"	$0.00	$0.00	$0.00	$0.00	"$6,174.00"	"$9,779.62"	"$9,878.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000063	EAP	CPT® 92941		Prq Card Revasc Mi 1 Vsl	BOTH IP/OP	"$39,045.00 "	"$28,893.30"	$0.00	"$30,279.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$30,095.89"	$0.00	"$8,136.98"	$0.00	$0.00	$0.00	$0.00	"$18,924.50"	"$29,976.41"	"$30,279.20"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000064	EAP	CPT® 92943		Prq Card Revasc Chronic 1vsl	BOTH IP/OP	"$29,217.00 "	"$21,620.58"	$0.00	"$22,657.60"	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,089.55"	"$4,181.12"	"$4,181.12"	"$22,520.46"	"$15,396.06"	"$6,088.82"	"$10,007.44"	"$17,281.86"	"$17,281.86"	$0.00	"$6,105.00"	"$22,431.02"	"$22,657.60"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000065	EAP	CPT® 92944		Prq Card Revasc Chronic Addl	BOTH IP/OP	"$20,209.00 "	"$14,954.66"	$0.00	"$15,672.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$15,577.10"	$0.00	"$4,211.56"	$0.00	$0.00	$0.00	$0.00	"$9,795.00"	"$15,515.28"	"$15,672.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000066	EAP	CPT® 33223		Relocation Skin  Pkt Cardiovert-defib	BOTH IP/OP	"$5,494.00 "	"$4,065.56"	$0.00	"$4,839.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,144.95"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$4,790.81"	"$4,839.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000067	EAP	CPT® 93261		S-icd Interrog / Eval In Person	BOTH IP/OP	$208.00 	$153.92	$23.14	$167.05	$132.26	$132.26	$36.26	$36.26	$36.47	$43.35	$154.38	$154.38	$160.33	$35.61	$43.35	$23.14	$123.03	$123.03	$36.36	$83.50	$132.26	$133.60	$50.51	$167.05	$50.51	$58.66	$29.17	$29.17	$26.59	$34.63	$0.00	$0.00	$0.00	$0.00
48000070	EAP	CPT® 92933		Prq Trluml Coronary Angio/athe	BOTH IP/OP	"$20,912.00 "	"$15,474.88"	$0.00	"$16,216.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$16,118.97"	$0.00	"$4,358.06"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$16,054.63"	"$16,216.80"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000071	EAP	CPT® 33999		Insertion Of Impella Device - Rp	BOTH IP/OP	"$13,372.00 "	"$9,895.28"	$0.00	"$10,805.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,307.14"	$0.00	"$2,786.72"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$10,697.54"	"$10,805.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000072	EAP	CPT® 93621		Comp Ep Exam W/lt Atrial Pacing/record	BOTH IP/OP	"$12,625.00 "	"$9,342.50"	$0.00	"$8,856.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,307.47"	$0.00	$0.00	$0.00	$0.00	"$2,307.20"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,535.50"	"$8,768.23"	"$8,856.80"	$0.00	$0.00	$0.00	"$1,732.61"	$0.00	$0.00	"$1,762.50"	$0.00	$0.00	$0.00	$0.00	$0.00
48000110	EAP	CPT® 93297		Icm Interrog / Eval Remote Up To 30 Days	BOTH IP/OP	$333.00 	$246.42	$0.00	$212.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.00	$210.67	$212.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48000111	EAP	CPT® 93298		S-icd/loop Recorder Interrog / Eval Remote Up To 30 Days	BOTH IP/OP	$204.00 	$150.96	$23.14	$212.80	$59.48	$59.48	$36.26	$36.26	$36.47	$42.52	$151.41	$151.41	$157.24	$35.61	$42.51	$23.14	$120.67	$120.67	$36.36	$133.00	$210.67	$212.80	$28.13	$132.60	$28.13	$28.19	$28.13	$28.13	$42.35	$34.63	$0.00	$0.00	$0.00	$0.00
48100001	EAP	CPT® 33240		Insrt Icd Pulse Gen W Sngl Lead	BOTH IP/OP	"$29,623.00 "	"$21,921.02"	$0.00	"$29,050.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,173.43"	$0.00	$0.00	$0.00	"$22,779.64"	"$6,105.00"	"$23,007.60"	"$23,240.00"	"$29,050.00"	"$5,410.00"	"$29,050.00"	$517.77	$381.75	$381.75	"$4,624.76"	"$21,694.90"	$0.00	$0.00	$0.00	$0.00
48100003	EAP	CPT® 33249		Insrt/repl Sgl/dual Icd Ld/gen	BOTH IP/OP	"$39,613.00 "	"$29,313.62"	$0.00	"$39,613.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$32,377.52"	"$6,105.00"	"$31,373.50"	"$31,690.40"	"$39,613.00"	$0.00	"$39,613.00"	"$1,016.82"	$959.62	$959.62	"$6,306.39"	"$30,835.73"	$0.00	$0.00	$0.00	$0.00
48100004	EAP	CPT® 92973		Perc Coronary Thrombectomy	BOTH IP/OP	"$9,050.00 "	"$6,697.00"	$0.00	"$6,975.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,975.74"	$0.00	"$1,886.02"	$0.00	$0.00	$0.00	$0.00	"$4,336.50"	"$6,869.02"	"$6,938.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100006	EAP	CPT® 93505		Endomyocardial Biopsy	BOTH IP/OP	"$3,290.00 "	"$2,434.60"	$0.00	"$3,290.00"	"$3,290.00"	"$3,290.00"	"$2,787.76"	"$2,787.76"	"$2,803.47"	$685.72	"$2,441.84"	"$2,441.84"	"$2,535.93"	"$2,742.67"	$685.64	"$1,782.74"	"$1,946.04"	"$1,946.04"	$0.00	"$2,255.00"	"$2,631.82"	"$2,658.40"	$0.00	"$3,250.00"	$0.00	$339.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100020	EAP	CPT® 93561		Therm Dilu Stdy Cardoutput Se	BOTH IP/OP	$261.00 	$193.14	$0.00	$246.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.27	$0.00	$0.00	$0.00	$0.00	$246.00	$194.83	$196.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100021	EAP	CPT® 93562		Measure Card Output	BOTH IP/OP	$88.00 	$65.12	$0.00	$83.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.30	$0.00	$0.00	$0.00	$0.00	$83.00	$65.74	$66.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100022	EAP	CPT® 93571		Intravasc Cornary Flow Measure	BOTH IP/OP	"$5,647.00 "	"$4,178.78"	$0.00	"$4,352.71"	"$3,066.32"	"$3,066.32"	$0.00	$0.00	$0.00	"$1,176.98"	"$4,181.12"	"$4,181.12"	"$4,352.71"	$0.00	"$1,176.83"	$0.00	"$3,340.20"	"$3,340.20"	$0.00	"$2,704.00"	"$4,283.14"	"$4,326.40"	$0.00	"$1,750.00"	$0.00	$261.34	$0.00	$0.00	$860.95	$0.00	$0.00	$0.00	$0.00	$0.00
48100023	EAP	CPT® 93572		Intravasc Cor. Flow Addit Vess	BOTH IP/OP	"$5,581.00 "	"$4,129.94"	$0.00	"$4,301.83"	"$3,030.48"	"$3,030.48"	$0.00	$0.00	$0.00	"$1,163.22"	"$4,142.22"	"$4,142.22"	"$4,301.83"	$0.00	"$1,163.08"	$0.00	"$3,301.16"	"$3,301.16"	$0.00	"$2,672.00"	"$4,232.45"	"$4,275.20"	$0.00	"$1,750.00"	$0.00	$239.81	$0.00	$0.00	$850.76	$0.00	$0.00	$0.00	$0.00	$0.00
48100026	EAP	CPT® 33270		Insert Subcutaneous Aicd	BOTH IP/OP	"$129,402.00 "	"$95,757.48"	$574.64	"$101,520.00"	"$2,984.10"	"$2,984.10"	"$31,988.05"	"$31,988.05"	"$32,168.25"	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$99,743.06"	"$31,473.45"	"$26,967.38"	"$20,457.74"	"$4,877.00"	"$4,877.00"	"$32,377.52"	"$6,105.00"	"$100,504.80"	"$101,520.00"	"$44,984.24"	"$5,410.00"	"$44,984.24"	$574.64	$592.28	$592.28	"$8,138.89"	"$30,835.73"	$0.00	$0.00	$0.00	$0.00
48100029	EAP	CPT® 93462		Left Heart Cath By Transeptal Puncture	BOTH IP/OP	"$12,155.00 "	"$8,994.70"	$0.00	"$7,968.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,533.10"	$0.00	$0.00	$0.00	$0.00	"$4,980.00"	"$7,888.32"	"$7,968.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100030	EAP	CPT® 93451		Right Heart Cath	BOTH IP/OP	"$22,078.00 "	"$16,337.72"	$0.00	"$14,473.60"	"$10,292.10"	"$10,292.10"	"$2,823.89"	"$2,823.89"	"$2,839.80"	$0.00	"$5,345.48"	"$5,345.48"	"$5,773.12"	$0.00	"$4,601.06"	$0.00	$0.00	$0.00	"$2,858.33"	"$2,858.00"	"$14,328.86"	"$14,473.60"	"$3,971.26"	"$4,334.00"	"$3,971.26"	$725.02	$725.39	$725.39	"$2,880.25"	"$2,722.22"	$0.00	$0.00	$0.00	$0.00
48100031	EAP	CPT® 93452		Lhc W/v Gram	BOTH IP/OP	"$22,078.00 "	"$16,337.72"	$0.00	"$14,473.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,601.06"	$0.00	$0.00	$0.00	"$2,858.33"	"$2,858.00"	"$14,328.86"	"$14,473.60"	"$3,971.26"	"$4,334.00"	"$3,971.26"	$803.53	$686.49	$686.49	"$2,880.25"	"$2,722.22"	$0.00	$0.00	$0.00	$0.00
48100032	EAP	CPT® 93453		R/lhc W/v Gram (s&i)	BOTH IP/OP	"$22,078.00 "	"$16,337.72"	$0.00	"$14,473.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,601.06"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$14,328.86"	"$14,473.60"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100033	EAP	CPT® 93454		Coronary Angio W/o Lhc	BOTH IP/OP	"$22,078.00 "	"$16,337.72"	$685.77	"$14,473.60"	"$10,292.10"	"$10,292.10"	"$2,823.89"	"$2,823.89"	"$2,839.80"	"$4,601.61"	"$5,345.48"	"$5,345.48"	"$5,773.12"	"$2,778.48"	"$4,601.06"	"$1,806.01"	"$13,059.14"	"$13,059.14"	"$2,858.33"	"$2,255.00"	"$14,328.86"	"$14,473.60"	"$3,971.26"	"$4,334.00"	"$3,971.26"	$828.78	$685.77	$685.77	"$2,880.25"	"$2,722.22"	$0.00	$0.00	$0.00	$0.00
48100034	EAP	CPT® 93455		Coronary Angio W/o Lhc W/graft Inj	BOTH IP/OP	"$22,078.00 "	"$16,337.72"	$0.00	"$14,473.60"	"$10,292.10"	"$10,292.10"	"$2,823.89"	"$2,823.89"	"$2,839.80"	"$4,601.61"	"$5,345.48"	"$5,345.48"	"$5,773.12"	"$2,778.48"	"$4,601.06"	"$1,806.01"	"$13,059.14"	"$13,059.14"	$0.00	"$2,255.00"	"$14,328.86"	"$14,473.60"	$0.00	"$4,334.00"	$0.00	$967.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100035	EAP	CPT® 93456		Rhc/coronary Angio W/o Lhc	BOTH IP/OP	"$22,078.00 "	"$16,337.72"	$0.00	"$14,473.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,601.06"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$14,328.86"	"$14,473.60"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100036	EAP	CPT® 93457		Rhc/coronary Angio W/o Lhc W/graft Inj	BOTH IP/OP	"$22,078.00 "	"$16,337.72"	$0.00	"$14,473.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,601.06"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$14,328.86"	"$14,473.60"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100037	EAP	CPT® 33991		Insert Vad Art&vein Access	BOTH IP/OP	"$31,345.00 "	"$23,195.30"	$0.00	"$27,608.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$24,160.73"	$0.00	"$6,532.30"	$0.00	$0.00	$0.00	$0.00	"$17,255.50"	"$27,332.71"	"$27,608.80"	$0.00	"$13,874.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100040	EAP	CPT® 93567		Inj. Supravalvular Aortography	BOTH IP/OP	$185.00 	$136.90	$0.00	$185.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.55	$0.00	$0.00	$0.00	$0.00	$88.50	$140.18	$141.60	$0.00	$185.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100042	EAP	HCPCS G0278		Iliac/fem Angio W/cardiac Cath	BOTH IP/OP	"$2,706.00 "	"$2,002.44"	$0.00	"$2,186.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,008.39"	"$2,008.39"	"$2,085.78"	$0.00	$563.93	$0.00	$0.00	$0.00	$0.00	"$1,366.50"	"$2,164.54"	"$2,186.40"	$0.00	"$1,758.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100050	EAP	CPT® 33227		Remove/repl Pcmkr W Sngl Ld	BOTH IP/OP	"$39,256.00 "	"$29,049.44"	$0.00	"$31,404.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,431.39"	$0.00	$0.00	$0.00	"$7,813.60"	"$7,430.50"	"$5,078.84"	"$4,877.00"	"$4,877.00"	$0.00	"$6,105.00"	"$31,090.75"	"$31,404.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100051	EAP	CPT® 33229		Remove/replac Pcmkr W Dual Ld	BOTH IP/OP	"$43,902.00 "	"$32,487.48"	$0.00	"$34,442.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$33,839.66"	$0.00	"$9,149.18"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$34,097.98"	"$34,442.40"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100052	EAP	CPT® 33229		Remove/replac Pcmkr W Multi Ld	BOTH IP/OP	"$43,053.00 "	"$31,859.22"	$0.00	"$34,442.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$34,097.98"	"$34,442.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100053	EAP	CPT® 33230		Insrt Icd W Exist Dual Lds	BOTH IP/OP	"$77,559.00 "	"$57,393.66"	$0.00	"$68,313.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$59,782.48"	$0.00	"$16,163.30"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$67,630.46"	"$68,313.60"	$0.00	"$5,410.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100054	EAP	CPT® 33231		Insrt Icd W Exist Multi Lds	BOTH IP/OP	"$77,559.00 "	"$57,393.66"	$0.00	"$68,313.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$59,782.48"	$0.00	"$16,163.30"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$67,630.46"	"$68,313.60"	$0.00	"$5,410.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100055	EAP	CPT® 33262		Remove/repl Icd W Sngl Ld	BOTH IP/OP	"$87,076.00 "	"$64,436.24"	$351.54	"$68,313.60"	"$2,984.10"	"$2,984.10"	"$22,456.40"	"$22,456.40"	"$22,582.91"	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$67,118.18"	"$22,082.15"	"$18,146.64"	"$14,353.40"	"$4,877.00"	"$4,877.00"	"$22,779.64"	"$6,105.00"	"$67,630.46"	"$68,313.60"	"$31,649.28"	"$5,410.00"	"$31,649.28"	$351.54	$390.40	$390.40	"$8,138.89"	"$21,694.90"	$0.00	$0.00	$0.00	$0.00
48100056	EAP	CPT® 33263		Remove/repl Icd W Dual Lds	BOTH IP/OP	"$87,076.00 "	"$64,436.24"	$0.00	"$68,313.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$67,118.18"	$0.00	"$18,146.64"	$0.00	$0.00	$0.00	"$22,779.64"	"$6,105.00"	"$67,630.46"	"$68,313.60"	"$31,649.28"	"$5,410.00"	"$31,649.28"	$365.37	$405.90	$405.90	"$8,138.89"	"$21,694.90"	$0.00	$0.00	$0.00	$0.00
48100057	EAP	CPT® 33264		Remove/repl Icd W Multi Lds	BOTH IP/OP	"$87,076.00 "	"$64,436.24"	$0.00	"$68,313.60"	"$2,984.10"	"$2,984.10"	"$31,988.05"	"$31,988.05"	"$32,168.25"	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$67,118.18"	"$31,473.45"	"$18,146.64"	"$20,457.74"	"$4,877.00"	"$4,877.00"	"$32,377.52"	"$6,105.00"	"$67,630.46"	"$68,313.60"	"$44,984.24"	"$5,410.00"	"$44,984.24"	$0.00	$424.28	$424.28	"$8,138.89"	"$30,835.73"	$0.00	$0.00	$0.00	$0.00
48100058	EAP	CPT® 33221		Insrt Pcmkr Gen Only Exist Multi	BOTH IP/OP	"$39,104.00 "	"$28,936.96"	$0.00	"$34,442.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$30,141.36"	$0.00	"$8,149.27"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$34,097.98"	"$34,442.40"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100059	EAP	CPT® 33228		Remv & Replc Pm Gen Dual Lead	BOTH IP/OP	"$42,575.00 "	"$31,505.50"	$0.00	"$33,401.60"	"$2,984.10"	"$2,984.10"	"$10,125.82"	"$10,125.82"	"$10,182.87"	"$8,873.69"	"$4,181.12"	"$4,181.12"	"$32,816.81"	"$9,967.71"	"$8,872.63"	"$6,479.01"	"$4,877.00"	"$4,877.00"	"$10,282.07"	"$6,105.00"	"$33,067.58"	"$33,401.60"	"$14,285.57"	"$5,164.00"	"$14,285.57"	$0.00	$370.57	$370.57	"$6,646.92"	"$9,792.45"	$0.00	$0.00	$0.00	$0.00
48100060	EAP	CPT® 93600		Bundle Of Hils Recording	BOTH IP/OP	"$5,320.00 "	"$3,936.80"	$0.00	"$4,256.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,948.50"	"$3,948.50"	"$4,100.66"	$0.00	"$1,108.69"	$0.00	$0.00	$0.00	$0.00	"$2,660.00"	"$4,213.44"	"$4,256.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100061	EAP	CPT® 93602		Intra-atrial Recording	BOTH IP/OP	"$6,000.00 "	"$4,440.00"	$0.00	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,624.80"	$0.00	"$1,250.40"	$0.00	$0.00	$0.00	$0.00	"$3,000.00"	"$4,752.00"	"$4,800.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100062	EAP	CPT® 93603		Right Ventricular Recording	BOTH IP/OP	"$9,546.00 "	"$7,064.04"	$0.00	"$7,636.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$7,358.06"	$0.00	"$1,989.39"	$0.00	$0.00	$0.00	$0.00	"$4,773.00"	"$7,560.43"	"$7,636.80"	$0.00	"$1,329.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100063	EAP	CPT® 93610		Intra-atrial Pacing	BOTH IP/OP	"$6,000.00 "	"$4,440.00"	$0.00	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,624.80"	$0.00	"$1,250.40"	$0.00	$0.00	$0.00	$0.00	"$3,000.00"	"$4,752.00"	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100064	EAP	CPT® 93612		Intra-ventricular Pacing	BOTH IP/OP	"$6,000.00 "	"$4,440.00"	$0.00	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,624.80"	$0.00	"$1,250.40"	$0.00	$0.00	$0.00	$0.00	"$3,000.00"	"$4,752.00"	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100065	EAP	CPT® 93618		Induction Of Arrythmia By Electrial Pacing	BOTH IP/OP	"$4,835.00 "	"$3,577.90"	$0.00	"$3,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,588.54"	"$3,588.54"	"$3,726.82"	$0.00	"$1,007.61"	$0.00	$0.00	$0.00	$0.00	"$2,417.50"	"$3,829.32"	"$3,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100066	EAP	CPT® 93624		Follow-up Ep Study W/pacing & Recording	BOTH IP/OP	"$10,198.00 "	"$7,546.52"	$0.00	"$8,158.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$7,860.62"	$0.00	"$2,125.26"	$0.00	$0.00	$0.00	$0.00	"$5,099.00"	"$8,076.82"	"$8,158.40"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100067	EAP	CPT® 93619		Complete Eps W/oinduction Of Arrhythmia	BOTH IP/OP	"$14,885.00 "	"$11,014.90"	$0.00	"$11,473.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,473.36"	$0.00	"$3,102.03"	$0.00	$0.00	$0.00	$0.00	"$6,999.50"	"$11,087.21"	"$11,199.20"	$0.00	"$9,675.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100068	EAP	CPT® 93620		Complete Eps With Induction Arrhythmia	BOTH IP/OP	"$16,933.00 "	"$12,530.42"	$0.00	"$13,051.96"	"$5,693.10"	"$5,693.10"	"$5,919.35"	"$5,919.35"	"$5,952.70"	"$3,529.26"	"$4,181.12"	"$4,181.12"	"$13,051.96"	"$5,825.74"	"$3,528.84"	"$3,786.73"	"$10,015.87"	"$10,015.87"	"$5,903.01"	"$7,962.50"	"$12,612.60"	"$12,740.00"	"$8,201.44"	"$4,334.00"	"$8,201.44"	"$1,092.52"	$0.00	$0.00	"$2,535.26"	"$5,621.91"	$0.00	$0.00	$0.00	$0.00
48100069	EAP	CPT® 93621		Left Atrial Or Coronary Sinus Pacing & Recording	BOTH IP/OP	"$13,424.00 "	"$9,933.76"	$0.00	"$10,347.22"	"$5,693.10"	"$5,693.10"	$0.00	$0.00	$0.00	"$2,797.90"	"$4,181.12"	"$4,181.12"	"$10,347.22"	$0.00	"$2,797.56"	$0.00	"$7,940.30"	"$7,940.30"	$0.00	"$6,312.50"	"$9,999.00"	"$10,100.00"	$0.00	"$1,750.00"	$0.00	"$1,975.81"	$0.00	$0.00	"$2,009.90"	$0.00	$0.00	$0.00	$0.00	$0.00
48100070	EAP	CPT® 93622		Left Ventricular Pacing & Recording	BOTH IP/OP	"$12,767.00 "	"$9,447.58"	$0.00	"$9,840.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$9,840.80"	$0.00	"$2,660.64"	$0.00	$0.00	$0.00	$0.00	"$6,003.50"	"$9,509.54"	"$9,605.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100071	EAP	CPT® 93609		Catheter Mapping Of Tachycardia	BOTH IP/OP	"$7,163.00 "	"$5,300.62"	$0.00	"$5,730.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,521.24"	$0.00	"$1,492.77"	$0.00	$0.00	$0.00	$0.00	"$3,581.50"	"$5,673.10"	"$5,730.40"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100072	EAP	CPT® 93613		Electrophys Map 3d	BOTH IP/OP	"$13,202.00 "	"$9,769.48"	$0.00	"$10,176.10"	"$7,168.69"	"$7,168.69"	$0.00	$0.00	$0.00	"$2,751.63"	"$4,181.12"	"$4,181.12"	"$10,176.10"	$0.00	"$2,751.30"	$0.00	"$7,808.98"	"$7,808.98"	$0.00	"$6,001.00"	"$9,505.58"	"$9,601.60"	$0.00	"$1,750.00"	$0.00	$373.18	$311.12	$311.12	"$1,910.72"	$0.00	$0.00	$0.00	$0.00	$0.00
48100073	EAP	CPT® 93623		Program Stimulation And Pacing After Drug Infusion	BOTH IP/OP	"$7,519.00 "	"$5,564.06"	$0.00	"$5,795.65"	"$4,082.82"	"$4,082.82"	$0.00	$0.00	$0.00	"$1,567.15"	"$4,181.12"	"$4,181.12"	"$5,795.65"	$0.00	"$1,566.96"	$0.00	"$4,447.49"	"$4,447.49"	$0.00	"$3,535.50"	"$5,600.23"	"$5,656.80"	$0.00	"$1,750.00"	$0.00	$223.88	$0.00	$0.00	"$1,125.70"	$0.00	$0.00	$0.00	$0.00	$0.00
48100074	EAP	CPT® 93650		Av Node Ablation	BOTH IP/OP	"$11,950.00 "	"$8,843.00"	$0.00	"$9,560.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$9,211.06"	$0.00	"$2,490.38"	$0.00	$0.00	$0.00	$0.00	"$5,975.00"	"$9,464.40"	"$9,560.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100077	EAP	CPT® 93662		Intracardiac Echocardiography	BOTH IP/OP	"$5,649.00 "	"$4,180.26"	$0.00	"$4,354.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,354.25"	$0.00	"$1,177.25"	$0.00	$0.00	$0.00	$0.00	"$2,531.00"	"$4,009.10"	"$4,049.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100078	EAP	CPT® 93631		Heart Pacing Mapping	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	"$3,915.66"	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100079	EAP	CPT® 37197		Trans Cath Retrval Fb Inc S/i	BOTH IP/OP	"$28,818.00 "	"$21,325.32"	$0.00	"$26,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$22,212.91"	$0.00	"$6,005.67"	$0.00	$0.00	$0.00	"$2,779.42"	"$2,858.00"	"$26,126.50"	"$26,390.40"	"$3,861.64"	"$3,725.00"	"$3,861.64"	$0.00	$315.16	$315.16	"$5,251.69"	"$2,647.07"	$0.00	$0.00	$0.00	$0.00
48100080	EAP	CPT® 93653		"Comp Ep Eval Inc Arrhyth Ind Ventric Pac, His Rec,  Cath Ablat"	BOTH IP/OP	"$40,706.00 "	"$30,122.44"	$777.53	"$31,376.18"	"$5,693.10"	"$5,693.10"	"$20,897.13"	"$20,897.13"	"$21,014.85"	"$8,484.15"	"$4,181.12"	"$4,181.12"	"$31,376.18"	"$20,571.92"	"$8,483.13"	"$13,371.75"	"$24,077.60"	"$24,077.60"	"$20,495.33"	"$18,817.50"	"$29,806.92"	"$30,108.00"	"$28,475.53"	"$5,343.00"	"$28,475.53"	$777.53	$875.69	$875.69	"$5,991.49"	"$19,519.36"	$0.00	$0.00	$0.00	$0.00
48100081	EAP	CPT® 93654		"Comp Ep Eval Inc Arrhyth Ind Ventric Pac, His Rec,  Cath Ablat W/tx Ve"	BOTH IP/OP	"$40,706.00 "	"$30,122.44"	$0.00	"$31,376.18"	"$5,693.10"	"$5,693.10"	"$20,897.13"	"$20,897.13"	"$21,014.85"	$0.00	"$4,181.12"	"$4,181.12"	"$31,376.18"	$0.00	"$8,483.13"	$0.00	$0.00	$0.00	"$20,495.33"	"$18,817.50"	"$29,806.92"	"$30,108.00"	"$28,475.53"	"$15,317.90"	"$28,475.53"	$0.00	"$1,172.76"	"$1,172.76"	"$5,991.49"	"$19,519.36"	$0.00	$0.00	$0.00	$0.00
48100082	EAP	CPT® 93655		Ablatae Arrhythmia - Add On	BOTH IP/OP	"$37,635.00 "	"$27,849.90"	$0.00	"$30,108.00"	"$2,321.55"	"$2,321.55"	$0.00	$0.00	$0.00	"$7,844.07"	"$4,181.12"	"$4,181.12"	"$29,009.06"	$0.00	"$7,843.13"	$0.00	"$22,261.10"	"$22,261.10"	$0.00	"$18,817.50"	"$29,806.92"	"$30,108.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100083	EAP	CPT® 93656		"Comp Ep Eval Inc  Trans Sept Cath, Insert Elect Cath, Induct Arrhyth,"	BOTH IP/OP	"$40,706.00 "	"$30,122.44"	$0.00	"$31,376.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$31,376.18"	$0.00	"$8,483.13"	$0.00	$0.00	$0.00	$0.00	"$18,817.50"	"$29,806.92"	"$30,108.00"	$0.00	"$5,343.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100084	EAP	CPT® 93657		Tx L/r Atrial Fib Addl	BOTH IP/OP	"$40,706.00 "	"$30,122.44"	$0.00	"$31,376.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$31,376.18"	$0.00	"$8,483.13"	$0.00	$0.00	$0.00	$0.00	"$18,817.50"	"$29,806.92"	"$30,108.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100085	EAP	CPT® 93530		Rt Hearat Cath Congenital	BOTH IP/OP	"$20,015.00 "	"$14,811.10"	$0.00	"$16,012.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,419.75"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$15,851.88"	"$16,012.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100086	EAP	CPT® 93463		MED ADMIN & HEMODYNAMIC MEASURMENT (W/NITRIC OXIDE)	BOTH IP/OP	"$3,396.00 "	"$2,513.04"	$0.00	"$3,396.00"	"$1,844.03"	"$1,844.03"	$0.00	$0.00	$0.00	$0.00	"$3,396.00"	"$3,396.00"	"$3,396.00"	$0.00	$707.73	$0.00	$0.00	$0.00	$0.00	"$1,602.50"	"$2,538.36"	"$2,564.00"	$0.00	$640.00	$0.00	$101.49	$101.70	$101.70	$510.24	$0.00	$0.00	$0.00	$0.00	$0.00
48100090	EAP	CPT® 93581		Percut Trans Cath Close Congent Ventric Sept Defect W/ T	BOTH IP/OP	"$16,546.00 "	"$12,244.04"	$0.00	"$15,408.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,753.66"	$0.00	"$3,448.19"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$15,253.92"	"$15,408.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100091	EAP	CPT® 93582		Percut Trans Cath Close Patent Duct Arteriosus	BOTH IP/OP	"$18,778.00 "	"$13,895.72"	$0.00	"$17,486.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$14,474.08"	$0.00	"$3,913.34"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$17,311.54"	"$17,486.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100092	EAP	CPT® 93583		Percut Trans Cath Septal Reduct Therpy (alcohol Sept Ab	BOTH IP/OP	"$27,795.00 "	"$20,568.30"	$0.00	"$25,883.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,424.39"	$0.00	"$5,792.48"	$0.00	$0.00	$0.00	$0.00	"$16,177.00"	"$25,624.37"	"$25,883.20"	$0.00	"$11,982.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100095	EAP	CPT® 93566		Inject R Ventr/atrial Angio	BOTH IP/OP	"$3,057.00 "	"$2,262.18"	$0.00	"$2,931.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$637.08	$0.00	$0.00	$0.00	$0.00	"$1,832.00"	"$2,901.89"	"$2,931.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100096	EAP	CPT® 93568		Inject Pulm Art Hrt Cath	BOTH IP/OP	"$2,738.00 "	"$2,026.12"	$0.00	"$2,624.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$570.60	$0.00	$0.00	$0.00	$0.00	"$1,640.50"	"$2,598.55"	"$2,624.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100097	EAP	CPT® 92998		Pulmonary Artery Pta Add'l Vessel	BOTH IP/OP	"$13,019.00 "	"$9,634.06"	$0.00	"$10,415.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,035.05"	$0.00	"$2,713.16"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$10,311.05"	"$10,415.20"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100098	EAP	CPT® 92924		Coronary Atherectomy	BOTH IP/OP	"$25,780.00 "	"$19,077.20"	$0.00	"$19,871.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,871.22"	$0.00	"$5,372.55"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$19,269.36"	"$19,464.00"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100099	EAP	CPT® 92925		Atherectomy Add'l Vessel	BOTH IP/OP	"$22,259.00 "	"$16,471.66"	$0.00	"$19,464.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$17,157.24"	$0.00	"$4,638.78"	$0.00	$0.00	$0.00	$0.00	"$12,165.00"	"$19,269.36"	"$19,464.00"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100100	EAP	CPT® 93568		Inj. Proc During Cath Pulmonary Angiography	BOTH IP/OP	"$3,441.00 "	"$2,546.34"	$0.00	"$2,624.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$717.10	$0.00	$0.00	$0.00	$0.00	"$1,640.50"	"$2,598.55"	"$2,624.80"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100101	EAP	CPT® 93566		Inject Pro. During Cath/rv/ra./s&i	BOTH IP/OP	"$3,057.00 "	"$2,262.18"	$0.00	"$2,931.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$637.08	$0.00	$0.00	$0.00	$0.00	"$1,832.00"	"$2,901.89"	"$2,931.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100102	EAP	CPT® 93565		Inj. Pro During Cath/lv/la/s&i	BOTH IP/OP	"$2,659.00 "	"$1,967.66"	$0.00	"$2,148.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$554.14	$0.00	$0.00	$0.00	$0.00	"$1,343.00"	"$2,127.31"	"$2,148.80"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100103	EAP	CPT® 33990		Insertion Of Impella Device - Cp	BOTH IP/OP	"$35,191.00 "	"$26,041.34"	$0.00	"$27,608.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$27,125.22"	$0.00	"$7,333.80"	$0.00	$0.00	$0.00	$0.00	"$17,255.50"	"$27,332.71"	"$27,608.80"	$0.00	"$13,224.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100104	EAP	CPT® 33992		Removal Of Impella	BOTH IP/OP	"$12,888.00 "	"$9,537.12"	$0.00	"$10,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$9,934.07"	$0.00	"$2,685.86"	$0.00	$0.00	$0.00	$0.00	"$6,319.50"	"$10,010.09"	"$10,111.20"	$0.00	"$5,678.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100105	EAP	CPT® 33993		Respositioning Of Impella	BOTH IP/OP	"$17,220.00 "	"$12,742.80"	$0.00	"$15,167.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,273.18"	$0.00	"$3,588.65"	$0.00	$0.00	$0.00	$0.00	"$9,479.50"	"$15,015.53"	"$15,167.20"	$0.00	"$3,223.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100106	EAP	CPT® 34812		Open Of Femoral Artery	BOTH IP/OP	"$8,696.00 "	"$6,435.04"	$0.00	"$6,956.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,702.88"	$0.00	"$1,812.25"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,887.23"	"$6,956.80"	$0.00	"$3,227.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100107	EAP	HCPCS 93531		R & L Heart Cath Congenital	BOTH IP/OP	"$29,098.00 "	"$21,532.52"	$0.00	"$23,278.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,425.60"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$23,045.62"	"$23,278.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100108	EAP	HCPCS 93563		Inject Congenital Card Cath	BOTH IP/OP	"$3,180.00 "	"$2,353.20"	$0.00	"$3,048.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$662.71	$0.00	$0.00	$0.00	$0.00	"$1,905.50"	"$3,018.31"	"$3,048.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100109	EAP	CPT® 33947		Ecmo/ecls Initiation Artery	BOTH IP/OP	"$4,152.00 "	"$3,072.48"	$0.00	"$12,587.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,081.61"	"$3,081.61"	"$3,200.36"	$0.00	$865.28	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,620.23"	"$3,656.80"	$0.00	"$12,587.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100110	EAP	CPT® 33947		Ecmo/ecls Insj Prph Cannula	BOTH IP/OP	"$6,244.00 "	"$4,620.56"	$0.00	"$12,587.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,812.88"	$0.00	"$1,301.25"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,445.00"	"$5,500.00"	$0.00	"$12,587.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100111	EAP	CPT® 36901		Intro Cath Dialysis Circuit	BOTH IP/OP	"$3,666.00 "	"$2,712.84"	$0.00	"$2,825.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,720.91"	"$2,720.91"	"$2,825.75"	$0.00	$763.99	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,444.90"	"$2,469.60"	$0.00	"$2,150.00"	$0.00	$550.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100112	EAP	CPT® 36902		Intro Cath Dialysis Circuit; W Angio	BOTH IP/OP	"$18,144.00 "	"$13,426.56"	$0.00	"$13,985.40"	"$5,693.10"	"$5,693.10"	"$4,826.66"	"$4,826.66"	"$4,853.85"	"$3,781.66"	"$4,181.12"	"$4,181.12"	"$13,985.40"	"$4,750.73"	"$3,781.21"	"$3,087.98"	"$4,877.00"	"$4,877.00"	$0.00	"$4,975.00"	"$12,100.97"	"$12,223.20"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100113	EAP	CPT® 36903		Intro Cath Dialysis Circuit; W Trans Intra Stent	BOTH IP/OP	"$36,671.00 "	"$27,136.54"	$0.00	"$28,266.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,266.01"	$0.00	"$7,642.24"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$24,457.75"	"$24,704.80"	$0.00	"$5,343.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100114	EAP	CPT® 36904		Thrmbc/nfs Dialysis Circuit	BOTH IP/OP	"$18,144.00 "	"$13,426.56"	$0.00	"$13,985.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,985.40"	$0.00	"$3,781.21"	$0.00	$0.00	$0.00	$0.00	"$4,975.00"	"$12,100.97"	"$12,223.20"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100115	EAP	CPT® 36905		Thrmbc/nfs Dialysis Circuit; W Angio	BOTH IP/OP	"$36,671.00 "	"$27,136.54"	$0.00	"$28,266.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$28,266.01"	$0.00	"$7,642.24"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$24,457.75"	"$24,704.80"	$0.00	"$5,343.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100116	EAP	CPT® 36906		Thrmbc/nfs Dialysis Circuit; W Trans Intra Stent	BOTH IP/OP	"$55,585.00 "	"$41,132.90"	$0.00	"$42,844.92"	"$5,693.10"	"$5,693.10"	"$15,640.07"	"$15,640.07"	"$15,728.18"	"$9,417.94"	"$4,181.12"	"$4,181.12"	"$42,844.92"	"$15,396.06"	"$11,583.91"	"$10,007.44"	"$4,877.00"	"$4,877.00"	$0.00	"$6,105.00"	"$37,071.14"	"$37,445.60"	$0.00	"$5,410.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100117	EAP	CPT® 36907		Balo Angiop Ctr Dialysis Seg	BOTH IP/OP	"$3,666.00 "	"$2,712.84"	$0.00	"$2,825.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,720.91"	"$2,720.91"	"$2,825.75"	$0.00	$763.99	$0.00	$0.00	$0.00	$0.00	"$1,543.50"	"$2,444.90"	"$2,469.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100118	EAP	CPT® 37246		Trluml Balo Angiop 1st Art	BOTH IP/OP	"$15,477.00 "	"$11,452.98"	$0.00	"$12,142.40"	"$5,693.10"	"$5,693.10"	"$4,826.66"	"$4,826.66"	"$4,853.85"	"$3,225.79"	"$4,181.12"	"$4,181.12"	"$11,929.67"	"$4,750.73"	"$3,225.41"	"$3,087.98"	"$4,877.00"	"$4,877.00"	$0.00	"$4,975.00"	"$12,020.98"	"$12,142.40"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100119	EAP	CPT® 37247		Trluml Balo Angiop Addl Art	BOTH IP/OP	"$7,740.00 "	"$5,727.60"	$0.00	"$6,072.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,965.99"	$0.00	"$1,613.02"	$0.00	$0.00	$0.00	$0.00	"$3,795.00"	"$6,011.28"	"$6,072.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100120	EAP	CPT® 37248		Trluml Balo Angiop 1st Vein	BOTH IP/OP	"$15,477.00 "	"$11,452.98"	$0.00	"$12,142.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,929.67"	$0.00	"$3,225.41"	$0.00	$0.00	$0.00	$0.00	"$4,975.00"	"$12,020.98"	"$12,142.40"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100121	EAP	CPT® 37249		Trluml Balo Angiop Addl Vein	BOTH IP/OP	"$7,740.00 "	"$5,727.60"	$0.00	"$6,072.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,965.99"	$0.00	"$1,613.02"	$0.00	$0.00	$0.00	$0.00	"$3,795.00"	"$6,011.28"	"$6,072.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100122	EAP	CPT® 36908		Tcat Plmt Iv Stent Ctr Dialysis Seg W/img S&i	BOTH IP/OP	"$3,261.00 "	"$2,413.14"	$0.00	"$2,513.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,420.31"	"$2,420.31"	"$2,513.58"	$0.00	$679.59	$0.00	$0.00	$0.00	$0.00	"$1,373.00"	"$2,174.83"	"$2,196.80"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100123	EAP	CPT® 36909		Dialyis Circuit Vasc Emboli Occls Evasc Img S&i	BOTH IP/OP	"$3,261.00 "	"$2,413.14"	$0.00	"$2,196.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$679.59	$0.00	$0.00	$0.00	$0.00	"$1,373.00"	"$2,174.83"	"$2,196.80"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100124	EAP	CPT® 62321		Njx Dx/ther Sbst Intrlmnr Crv/thrc W/img Gdn	BOTH IP/OP	"$1,385.00 "	"$1,024.90"	$0.00	"$1,385.00"	"$1,385.00"	"$1,385.00"	$618.38	$618.38	$621.87	$288.67	"$1,027.95"	"$1,027.95"	"$1,067.56"	$608.20	$288.63	$395.33	"$1,385.00"	"$1,385.00"	$626.89	"$1,316.00"	"$1,042.27"	"$1,052.80"	$870.98	$0.00	$870.98	$240.25	$111.42	$111.42	$209.51	$597.04	$0.00	$0.00	$0.00	$0.00
48100125	EAP	CPT® 62323		Njx Dx/ther Sbst Intrlmnr Lmbr/sac W/img Gdn	BOTH IP/OP	"$1,385.00 "	"$1,024.90"	$103.13	"$2,150.00"	"$1,385.00"	"$1,385.00"	$618.38	$618.38	$621.87	$288.67	"$1,027.95"	"$1,027.95"	"$1,067.56"	$608.20	$288.63	$395.33	"$1,385.00"	"$1,385.00"	$626.89	"$1,316.00"	"$1,042.27"	"$1,052.80"	$870.98	"$2,150.00"	$870.98	$235.81	$103.13	$103.13	$209.51	$597.04	$0.00	$0.00	$0.00	$0.00
48100126	EAP	HCPCS C9600		Perc Drug-eluting Cor Stent; Single Vessel	BOTH IP/OP	"$30,247.00 "	"$22,382.78"	$0.00	"$23,314.39"	"$16,424.12"	"$16,424.12"	"$9,781.76"	"$9,781.76"	"$9,836.87"	"$6,304.23"	"$4,181.12"	"$4,181.12"	"$23,314.39"	"$9,625.35"	"$6,303.47"	"$6,256.48"	"$17,891.10"	"$17,891.10"	"$9,937.60"	"$11,676.00"	"$18,494.78"	"$18,681.60"	"$13,806.97"	"$5,164.00"	"$13,806.97"	"$3,654.59"	$0.00	$0.00	"$3,717.64"	"$9,464.38"	$0.00	$0.00	$0.00	$0.00
48100127	EAP	HCPCS C9601		Perc Drug-eluting Cor Stent; Ea Addl Branch	BOTH IP/OP	"$25,675.00 "	"$18,999.50"	$0.00	"$19,790.29"	"$13,941.53"	"$13,941.53"	$0.00	$0.00	$0.00	"$5,351.31"	"$4,181.12"	"$4,181.12"	"$19,790.29"	$0.00	"$5,350.67"	$0.00	"$15,186.76"	"$15,186.76"	$0.00	"$9,911.00"	"$15,699.02"	"$15,857.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100128	EAP	HCPCS C9602		Perc Drug-eluting Cor Stent & Atherect; Singl Vess	BOTH IP/OP	"$25,675.00 "	"$18,999.50"	$0.00	"$19,790.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,790.29"	$0.00	"$5,350.67"	$0.00	$0.00	$0.00	$0.00	"$9,911.00"	"$15,699.02"	"$15,857.60"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100129	EAP	HCPCS C9603		Perc Drug-eluting Cor Stent & Atherect; Ea Addl Br	BOTH IP/OP	"$28,009.00 "	"$20,726.66"	$0.00	"$21,589.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,589.34"	$0.00	"$5,837.08"	$0.00	$0.00	$0.00	$0.00	"$10,812.00"	"$17,126.21"	"$17,299.20"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100130	EAP	HCPCS C9604		Perc Drug-eluting Cor Revasc Of Or Thro Cabg;sing	BOTH IP/OP	"$26,434.00 "	"$19,561.16"	$0.00	"$20,375.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$20,375.33"	$0.00	"$5,508.85"	$0.00	$0.00	$0.00	$0.00	"$10,204.00"	"$16,163.14"	"$16,326.40"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100131	EAP	HCPCS C9605		Perc Drug-eluting Cor Revasc Of Or Thr Cabg; Ea Ad	BOTH IP/OP	"$25,675.00 "	"$18,999.50"	$0.00	"$19,790.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$19,790.29"	$0.00	"$5,350.67"	$0.00	$0.00	$0.00	$0.00	"$9,911.00"	"$15,699.02"	"$15,857.60"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100132	EAP	HCPCS C9606		Perc Drug-eluting Cor W/ Ami;single Ves	BOTH IP/OP	"$28,038.00 "	"$20,748.12"	$0.00	"$21,611.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$21,611.69"	$0.00	"$5,843.12"	$0.00	$0.00	$0.00	$0.00	"$10,823.00"	"$17,143.63"	"$17,316.80"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100133	EAP	HCPCS C9607		Perc Drug-eluting Cor Revasc Cto;single Vess	BOTH IP/OP	"$25,675.00 "	"$18,999.50"	$0.00	"$19,790.29"	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,351.31"	"$4,181.12"	"$4,181.12"	"$19,790.29"	"$15,396.06"	"$5,350.67"	"$10,007.44"	"$15,186.76"	"$15,186.76"	$0.00	"$9,911.00"	"$15,699.02"	"$15,857.60"	$0.00	"$5,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100134	EAP	HCPCS C9608		Perc Drug-eluting Cor Revasc Cto; Ea Addl Vessel	BOTH IP/OP	"$26,553.00 "	"$19,649.22"	$0.00	"$20,467.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$20,467.05"	$0.00	"$5,533.65"	$0.00	$0.00	$0.00	$0.00	"$10,250.00"	"$16,236.00"	"$16,400.00"	$0.00	"$1,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100136	EAP	CPT® 33272		Removal Sq Implant Defib Electrode	BOTH IP/OP	"$10,938.00 "	"$8,094.12"	$0.00	"$8,750.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,070.45"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$8,662.90"	"$8,750.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48100140	EAP	CPT® 33274		Transcath Insj/rpl Perm Leadless Pm Rv W/img	BOTH IP/OP	"$43,271.00 "	"$32,020.54"	$0.00	"$33,947.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$33,353.29"	$0.00	"$9,017.68"	$0.00	$0.00	$0.00	$0.00	"$6,105.00"	"$33,607.73"	"$33,947.20"	$0.00	"$28,126.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48200001	EAP	CPT® 93017		STRESS ECHO	BOTH IP/OP	"$3,621.00 "	"$2,679.54"	$0.00	"$2,896.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$747.20	$0.00	$0.00	$0.00	$253.45	$747.11	$164.75	"$2,120.53"	"$2,120.53"	$253.05	"$1,810.50"	"$2,867.83"	"$2,896.80"	$351.58	$0.00	$351.58	$64.64	$34.22	$34.22	$576.46	$241.00	$0.00	$0.00	$0.00	$0.00
48200002	EAP	CPT® 93017		Cardiac Stress Test	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$34.22	"$2,896.80"	$86.88	$86.88	$257.73	$257.73	$259.18	$747.20	"$2,660.79"	"$2,660.79"	"$2,763.32"	$253.45	$747.11	$164.75	"$2,120.53"	"$2,120.53"	$253.05	"$1,810.50"	"$2,867.83"	"$2,896.80"	$351.58	"$2,330.25"	$351.58	$64.64	$34.22	$34.22	$576.46	$241.00	$0.00	$0.00	$0.00	$0.00
48300001	EAP	CPT® 93306		"Tte, Complete"	BOTH IP/OP	"$4,414.00 "	"$3,266.36"	$136.14	"$3,402.31"	$504.77	$504.77	$470.55	$470.55	$473.20	$919.99	"$3,276.07"	"$3,276.07"	"$3,402.31"	$462.81	$919.88	$300.83	"$2,610.88"	"$2,610.88"	$483.00	"$1,977.50"	"$3,132.36"	"$3,164.00"	$671.06	"$2,869.10"	$671.06	$254.50	$136.14	$136.14	$629.64	$460.00	$0.00	$0.00	$0.00	$0.00
48300003	EAP	CPT® 93308		Tte. Limited	BOTH IP/OP	"$2,613.00 "	"$1,933.62"	$74.20	"$1,976.65"	$276.25	$276.25	$224.08	$224.08	$225.34	$544.61	$205.76	$205.76	$213.68	$220.56	$544.55	$143.36	"$1,545.59"	"$1,545.59"	$233.72	"$1,171.00"	"$1,854.86"	"$1,873.60"	$324.73	"$1,976.65"	$324.73	$108.83	$74.20	$74.20	$372.85	$222.60	$0.00	$0.00	$0.00	$0.00
48300004	EAP	CPT® 93350		Echo W/stress Test	BOTH IP/OP	"$3,748.00 "	"$2,773.52"	$118.63	"$2,955.20"	$532.14	$532.14	$470.55	$470.55	$473.20	$781.18	$328.30	$328.30	$340.92	$462.81	$781.08	$300.83	"$2,216.94"	"$2,216.94"	$483.00	"$1,847.00"	"$2,925.65"	"$2,955.20"	$671.06	"$2,436.20"	$671.06	$118.63	$120.30	$120.30	$588.08	$460.00	$0.00	$0.00	$0.00	$0.00
48300005	EAP	CPT® 93303		Transthoracic Echo For Congenital Anomalies	BOTH IP/OP	"$2,416.00 "	"$1,787.84"	$0.00	"$1,968.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.07	$372.07	$386.38	$0.00	$503.49	$0.00	$0.00	$0.00	$0.00	"$1,230.50"	"$1,949.11"	"$1,968.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48300006	EAP	CPT® 93304		Transthoracic Echo Follow-up Limited Study	BOTH IP/OP	"$1,512.00 "	"$1,118.88"	$0.00	"$1,232.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.35	$239.35	$248.55	$0.00	$315.10	$0.00	$0.00	$0.00	$0.00	$770.00	"$1,219.68"	"$1,232.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48300007	EAP	HCPCS C8924		Tte 2d W Or W/o Fol W/contrast; Follow-up Or Ltd	BOTH IP/OP	"$2,899.00 "	"$2,145.26"	$0.00	"$2,234.55"	"$1,574.16"	"$1,574.16"	$358.61	$358.61	$360.63	$604.22	"$2,151.64"	"$2,151.64"	"$2,234.55"	$352.81	$604.15	$229.33	"$1,714.76"	"$1,714.76"	$387.01	"$1,298.50"	"$2,056.82"	"$2,077.60"	$537.70	"$1,508.00"	$537.70	$406.43	$0.00	$0.00	$413.44	$368.58	$0.00	$0.00	$0.00	$0.00
48300008	EAP	HCPCS C8929		Tte 2d W Or W/o Fol W/contrast; Doppler	BOTH IP/OP	"$4,697.00 "	"$3,475.78"	$0.00	"$3,620.45"	"$2,550.47"	"$2,550.47"	$696.71	$696.71	$700.64	$978.97	"$3,486.11"	"$3,486.11"	"$3,620.45"	$685.44	$978.85	$445.54	"$2,778.28"	"$2,778.28"	$693.78	"$2,104.50"	"$3,333.53"	"$3,367.20"	$963.92	"$2,898.35"	$963.92	$658.71	$0.00	$0.00	$670.07	$660.75	$0.00	$0.00	$0.00	$0.00
48300009	EAP	CPT® 93321		Doppler Echo Exam Heart (add-on)	BOTH IP/OP	$670.00 	$495.80	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.89	$65.89	$68.43	$0.00	$139.63	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00	$435.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
49000001	EAP	CPT® 59821		Trmt Of Missed Abort.-2nd Trim	BOTH IP/OP	"$3,666.00 "	"$2,712.84"	$0.00	"$3,666.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$763.99	$0.00	$0.00	$0.00	$0.00	"$3,666.00"	"$2,903.47"	"$2,932.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000003	EAP	CPT® 19499		"Duct Lav Ea Brst, Sing Duct"	BOTH IP/OP	"$6,124.00 "	"$4,531.76"	$0.00	"$4,899.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,276.24"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,850.21"	"$4,899.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000004	EAP	CPT® 23500		Shoulder-clavicular	BOTH IP/OP	"$1,037.00 "	$767.38	$0.00	"$1,101.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.11	$0.00	$0.00	$0.00	$0.00	"$1,037.00"	$821.30	$829.60	$0.00	"$1,101.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000005	EAP	CPT® 23540		Treat Clavicle Dislocation	BOTH IP/OP	$815.00 	$603.10	$0.00	$815.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.85	$0.00	$0.00	$0.00	$0.00	$815.00	$645.48	$652.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000006	EAP	CPT® 23620		Humerus-proximal	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,069.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	"$1,069.00"	$846.65	$855.20	$0.00	$797.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000007	EAP	CPT® 23675		Humerus-neck	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,550.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	"$1,550.00"	"$1,227.60"	"$1,240.00"	$0.00	"$1,489.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000008	EAP	CPT® 24500		Humerus-shaft	BOTH IP/OP	$689.00 	$509.86	$0.00	$712.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.59	$0.00	$0.00	$0.00	$0.00	$712.00	$563.90	$569.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000009	EAP	CPT® 24530		Humerus-condyle-supra	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	"$1,069.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	"$1,069.00"	$846.65	$855.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000010	EAP	CPT® 24560		Humerus-distal Closed	BOTH IP/OP	$978.00 	$723.72	$0.00	"$1,010.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$203.82	$0.00	$0.00	$0.00	$0.00	"$1,010.00"	$799.92	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000011	EAP	CPT® 24576		Humerus-condyle-medial	BOTH IP/OP	"$1,053.00 "	$779.22	$0.00	"$1,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.45	$0.00	$0.00	$0.00	$0.00	"$1,088.00"	$861.70	$870.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000012	EAP	CPT® 24650		Elbow-radial Head	BOTH IP/OP	"$1,062.00 "	$785.88	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.32	$0.00	$0.00	$0.00	$0.00	"$1,097.00"	$868.82	$877.60	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000013	EAP	CPT® 24670		Elbow-olecranon	BOTH IP/OP	$978.00 	$723.72	$0.00	"$1,010.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$203.82	$0.00	$0.00	$0.00	$0.00	"$1,010.00"	$799.92	$808.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000014	EAP	CPT® 25530		Forearm-ulnar Shaft	BOTH IP/OP	"$1,203.00 "	$890.22	$0.00	"$1,203.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,203.00"	$952.78	$962.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000015	EAP	CPT® 25560		Forearm-both Bones	BOTH IP/OP	$891.00 	$659.34	$0.00	$903.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.68	$0.00	$0.00	$0.00	$0.00	$903.00	$715.18	$722.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000016	EAP	CPT® 25600		Wrist-colles	BOTH IP/OP	"$1,165.00 "	$862.10	$0.00	"$1,233.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.62	$242.79	$128.45	$113.00	$113.00	$0.00	"$1,180.00"	$934.56	$944.00	$0.00	"$1,233.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000017	EAP	CPT® 25622		Wrist-scaphoid	BOTH IP/OP	"$1,077.00 "	$796.98	$0.00	"$1,091.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.45	$0.00	$0.00	$0.00	$0.00	"$1,091.00"	$864.07	$872.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000018	EAP	CPT® 25630		Wrist-capitate	BOTH IP/OP	"$1,223.00 "	$905.02	$0.00	"$1,223.00"	"$1,223.00"	"$1,223.00"	$200.72	$200.72	$201.85	$254.90	$0.00	$0.00	$0.00	$197.62	$254.87	$128.45	$113.00	$113.00	$216.27	"$1,155.00"	$914.76	$924.00	$300.48	"$1,223.00"	$300.48	$266.34	$293.00	$293.00	$183.88	$205.98	$0.00	$0.00	$0.00	$0.00
51000019	EAP	CPT® 26600		Hand-metacarpal Bone	BOTH IP/OP	"$1,078.00 "	$797.72	$0.00	"$1,078.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.53	$0.00	$0.00	$0.00	$0.00	"$1,078.00"	$853.78	$862.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000020	EAP	CPT® 26750		Hand-phallax	BOTH IP/OP	$974.00 	$720.76	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	"$1,035.00"	$819.72	$828.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000021	EAP	CPT® 27750		Tibia-proximal	BOTH IP/OP	"$1,070.00 "	$791.80	$0.00	"$1,133.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.99	$0.00	$0.00	$0.00	$0.00	"$1,133.00"	$897.34	$906.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000022	EAP	CPT® 27760		Ankle-medical Malleolus	BOTH IP/OP	$752.00 	$556.48	$0.00	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.72	$0.00	$0.00	$0.00	$0.00	$720.00	$570.24	$576.00	$0.00	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000023	EAP	CPT® 27780		Tiba-distal	BOTH IP/OP	"$1,057.00 "	$782.18	$0.00	"$1,119.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.28	$0.00	$0.00	$0.00	$0.00	"$1,119.00"	$886.25	$895.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000024	EAP	CPT® 27786		Ankle-lateral Malleolus	BOTH IP/OP	"$1,204.00 "	$890.96	$0.00	"$1,153.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.91	$0.00	$0.00	$0.00	$0.00	"$1,153.00"	$913.18	$922.40	$0.00	"$1,035.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000025	EAP	CPT® 27808		Treatment Of Ankle Fracture	BOTH IP/OP	"$1,087.00 "	$804.38	$0.00	"$1,087.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,087.00"	$860.90	$869.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000026	EAP	CPT® 28470		Foot-metatarsal	BOTH IP/OP	$981.00 	$725.94	$0.00	$981.00	$981.00	$981.00	$200.72	$200.72	$201.85	$0.00	$0.00	$0.00	$0.00	$197.62	$204.44	$128.45	$113.00	$113.00	$216.27	$981.00	$776.95	$784.80	$300.48	$0.00	$300.48	$214.80	$210.83	$210.83	$156.18	$205.98	$0.00	$0.00	$0.00	$0.00
51000027	EAP	CPT® 28510		Treatment Of Toe Fracture	BOTH IP/OP	$981.00 	$725.94	$0.00	$991.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.44	$0.00	$0.00	$0.00	$0.00	$981.00	$776.95	$784.80	$0.00	$991.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000028	EAP	CPT® 29105		Long Arm Splint	BOTH IP/OP	$859.00 	$635.66	$0.00	$859.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.13	$859.00	$680.33	$687.20	$186.36	$0.00	$186.36	$94.27	$43.63	$43.63	$136.75	$127.75	$0.00	$0.00	$0.00	$0.00
51000029	EAP	CPT® 29125		"Splint, Short Arm"	BOTH IP/OP	$952.00 	$704.48	$0.00	$952.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.35	$952.00	$753.98	$761.60	$151.93	$0.00	$151.93	$72.40	$40.73	$40.73	$151.56	$104.14	$0.00	$0.00	$0.00	$0.00
51000030	EAP	CPT® 29130		"Splint, Finger"	BOTH IP/OP	$859.00 	$635.66	$0.00	$859.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$859.00	$680.33	$687.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000031	EAP	CPT® 29505		Long Leg Splint	BOTH IP/OP	"$1,372.00 "	"$1,015.28"	$0.00	"$1,535.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$285.92	$0.00	$0.00	$0.00	$134.13	"$1,535.00"	"$1,215.72"	"$1,228.00"	$186.36	$940.00	$186.36	$94.49	$52.27	$52.27	$244.37	$127.75	$0.00	$0.00	$0.00	$0.00
51000032	EAP	CPT® 29515		"Splint, Short Leg"	BOTH IP/OP	$943.00 	$697.82	$0.00	$943.00	$512.05	$512.05	$137.58	$137.58	$138.36	$196.54	$0.00	$0.00	$0.00	$135.31	$196.52	$87.95	$113.00	$113.00	$134.13	$888.00	$703.30	$710.40	$186.36	$943.00	$186.36	$80.51	$51.19	$51.19	$141.37	$127.75	$0.00	$0.00	$0.00	$0.00
51000036	EAP	CPT® 51702		Cath Insert Indwelling	BOTH IP/OP	"$1,069.00 "	$791.06	$0.00	"$1,069.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$223.01	$0.00	$0.00	$0.00	$107.30	$222.99	$69.74	$113.00	$113.00	$109.35	"$1,069.00"	$846.65	$855.20	$151.93	$0.00	$151.93	$91.18	$26.68	$26.68	$170.18	$104.14	$0.00	$0.00	$0.00	$0.00
51000038	EAP	CPT® 59070		Amnio Infusion (adb)	BOTH IP/OP	$439.00 	$324.86	$0.00	$443.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.49	$0.00	$0.00	$0.00	$0.00	$443.00	$350.86	$354.40	$0.00	$439.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000039	EAP	CPT® 59899		Maternity Care Procedure	BOTH IP/OP	$183.00 	$135.42	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.14	$0.00	$0.00	$0.00	$0.00	$183.00	$144.94	$146.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000041	EAP	CPT® 92002		"Ophalmol Exam, Inter, Np"	BOTH IP/OP	$313.00 	$231.62	$0.00	$323.29	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$65.23	$73.97	$185.14	$185.14	$116.27	$122.50	$194.04	$196.00	$161.54	$313.00	$161.54	$60.73	$48.33	$48.33	$39.00	$110.73	$0.00	$0.00	$0.00	$0.00
51000042	EAP	CPT® 92004		"Opthalmol Exam, Compre, Np"	BOTH IP/OP	$411.00 	$304.14	$0.00	$329.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$85.65	$73.97	$243.11	$243.11	$116.27	$202.00	$319.97	$323.20	$161.54	$329.00	$161.54	$101.46	$99.90	$99.90	$64.32	$110.73	$0.00	$0.00	$0.00	$0.00
51000043	EAP	CPT® 92012		"Opthalmol Exam, Inter, Ep"	BOTH IP/OP	$313.00 	$231.62	$0.00	$323.29	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$65.23	$73.97	$185.14	$185.14	$116.27	$111.00	$175.82	$177.60	$161.54	$313.00	$161.54	$51.64	$53.01	$53.01	$35.34	$110.73	$0.00	$0.00	$0.00	$0.00
51000044	EAP	CPT® 92014		"Opthalmol Exam, Compre, Ep"	BOTH IP/OP	$380.00 	$281.20	$0.00	$380.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$79.19	$73.97	$224.77	$224.77	$116.27	$187.00	$296.21	$299.20	$161.54	$380.00	$161.54	$74.47	$80.42	$80.42	$59.54	$110.73	$0.00	$0.00	$0.00	$0.00
51000046	EAP	CPT® 92020		Gonioscopy Exam	BOTH IP/OP	$272.00 	$201.28	$0.00	$323.29	$0.00	$0.00	$109.81	$109.81	$110.43	$67.13	$311.31	$311.31	$323.29	$107.30	$56.68	$69.74	$160.89	$160.89	$109.35	$134.00	$212.26	$214.40	$151.93	$294.00	$151.93	$33.89	$21.28	$21.28	$42.67	$104.14	$0.00	$0.00	$0.00	$0.00
51000050	EAP	CPT® 96372		Inject-im/sq Only	BOTH IP/OP	$260.00 	$192.40	$0.00	$200.41	$141.18	$141.18	$60.38	$60.38	$60.72	$54.19	$192.97	$192.97	$200.41	$59.39	$0.00	$38.61	$153.79	$153.79	$60.65	$111.50	$176.62	$178.40	$84.26	$169.00	$84.26	$20.00	$14.42	$14.42	$35.50	$57.76	$0.00	$0.00	$0.00	$0.00
51000057	EAP	CPT® 99201		Visit Level 1 - Np	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.27	$164.50	$260.57	$263.20	$27.04	$0.00	$27.04	$108.52	$0.00	$0.00	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000058	EAP	CPT® 99202		Visit Level 2 - Np	BOTH IP/OP	$384.00 	$284.16	$0.00	$384.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$227.14	$227.14	$116.27	$189.00	$299.38	$302.40	$51.57	$384.00	$51.57	$108.52	$0.00	$0.00	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000059	EAP	CPT® 99203		Visit Level 3 - Np	BOTH IP/OP	$449.00 	$332.26	$0.00	$449.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$265.58	$265.58	$116.27	$221.00	$350.06	$353.60	$77.17	$449.00	$77.17	$108.52	$0.00	$0.00	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000060	EAP	CPT® 99204		Visit Level 4 - Np	BOTH IP/OP	$579.00 	$428.46	$0.00	$579.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$342.48	$342.48	$116.27	$284.50	$450.65	$455.20	$131.98	$579.00	$131.98	$108.52	$0.00	$0.00	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000061	EAP	CPT® 99205		Visit Level 5-np	BOTH IP/OP	$697.00 	$515.78	$0.00	$697.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$412.28	$412.28	$116.27	$343.00	$543.31	$548.80	$172.37	$697.00	$172.37	$108.52	$0.00	$0.00	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000062	EAP	CPT® 99211		Visit Level 1 - Ep	BOTH IP/OP	$325.00 	$240.50	$0.00	$325.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$192.24	$192.24	$116.27	$145.00	$229.68	$232.00	$9.38	$325.00	$9.38	$108.52	$0.00	$0.00	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000063	EAP	CPT® 99212		Visit Level 2-ep	BOTH IP/OP	$348.00 	$257.52	$0.00	$348.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$205.84	$205.84	$116.27	$156.50	$247.90	$250.40	$26.32	$348.00	$26.32	$108.52	$0.00	$0.00	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000064	EAP	CPT® 99213		Visit Level 3-ep	BOTH IP/OP	$434.00 	$321.16	$0.00	$434.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$256.71	$256.71	$116.27	$199.50	$316.01	$319.20	$52.29	$434.00	$52.29	$108.52	$0.00	$0.00	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000065	EAP	CPT® 99214		Visit Level 4-ep	BOTH IP/OP	$526.00 	$389.24	$0.00	$526.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$311.13	$311.13	$116.27	$245.50	$388.87	$392.80	$80.42	$526.00	$80.42	$108.52	$0.00	$0.00	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000066	EAP	CPT® 99215		Visit Level 5-ep	BOTH IP/OP	$576.00 	$426.24	$0.00	$576.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$340.70	$340.70	$116.27	$270.50	$428.47	$432.80	$113.60	$576.00	$113.60	$108.52	$0.00	$0.00	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000086	EAP	HCPCS G0127		Trim Of Dystrophic Nail(s)	BOTH IP/OP	$121.00 	$89.54	$0.00	$122.00	$65.70	$65.70	$54.21	$54.21	$54.51	$25.22	$0.00	$0.00	$0.00	$53.35	$25.22	$34.67	$113.00	$113.00	$55.17	$122.00	$96.62	$97.60	$76.65	$121.00	$76.65	$19.09	$7.94	$7.94	$19.42	$52.54	$0.00	$0.00	$0.00	$0.00
51000087	EAP	HCPCS G0402		New Medicare Phys Exam	BOTH IP/OP	$375.00 	$277.50	$0.00	$323.29	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$78.15	$73.97	$221.81	$221.81	$116.27	$184.50	$292.25	$295.20	$161.54	$243.75	$161.54	$57.75	$129.11	$129.11	$58.74	$110.73	$0.00	$0.00	$0.00	$0.00
51000090	EAP	Custom 51000090		Annual Health Screen	BOTH IP/OP	$168.00 	$124.32	$0.00	$323.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.31	$311.31	$323.29	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000157	EAP	CPT® 99201		Visit Level Bccp 1 - Np	BOTH IP/OP	$329.00 	$243.46	$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.27	$164.50	$260.57	$263.20	$27.04	$0.00	$27.04	$108.52	$27.04	$27.04	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000158	EAP	CPT® 99202		Visit Level Bccp 2 - Np	BOTH IP/OP	$384.00 	$284.16	$0.00	$384.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$227.14	$227.14	$116.27	$189.00	$299.38	$302.40	$51.57	$384.00	$51.57	$108.52	$51.57	$51.57	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000159	EAP	CPT® 99203		Visit Level Bccp 3 - Np	BOTH IP/OP	$449.00 	$332.26	$0.00	$449.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$265.58	$265.58	$116.27	$221.00	$350.06	$353.60	$77.17	$449.00	$77.17	$108.52	$77.17	$77.17	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000161	EAP	CPT® 99205		Visit Level Bccp 5-np	BOTH IP/OP	$697.00 	$515.78	$0.00	$697.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$412.28	$412.28	$116.27	$343.00	$543.31	$548.80	$172.37	$697.00	$172.37	$108.52	$172.37	$172.37	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000162	EAP	CPT® 99211		Visit Level Bccp 1 - Ep	BOTH IP/OP	$325.00 	$240.50	$0.00	$323.29	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$192.24	$192.24	$116.27	$145.00	$229.68	$232.00	$9.38	$0.00	$9.38	$108.52	$9.38	$9.38	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000163	EAP	CPT® 99212		Visit Level Bccp 2 - Ep	BOTH IP/OP	$340.00 	$251.60	$0.00	$348.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$201.11	$201.11	$116.27	$156.50	$247.90	$250.40	$26.32	$348.00	$26.32	$108.52	$26.32	$26.32	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000164	EAP	CPT® 99213		Visit Level Bccp 3 - Ep	BOTH IP/OP	$434.00 	$321.16	$0.00	$434.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$256.71	$256.71	$116.27	$199.50	$316.01	$319.20	$52.29	$434.00	$52.29	$108.52	$52.29	$52.29	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000166	EAP	CPT® 99215		Visit Level Bccp 5-ep	BOTH IP/OP	$576.00 	$426.24	$0.00	$576.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$340.70	$340.70	$116.27	$270.50	$428.47	$432.80	$113.60	$576.00	$113.60	$108.52	$113.60	$113.60	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000190	EAP	CPT® 92133		Cmptr Ophth Img Optic Nerve	BOTH IP/OP	$342.00 	$253.08	$0.00	$342.00	$0.00	$0.00	$54.21	$54.21	$54.51	$67.13	$311.31	$311.31	$323.29	$53.35	$71.27	$34.67	$202.29	$202.29	$55.17	$168.00	$266.11	$268.80	$76.65	$342.00	$76.65	$42.26	$15.13	$15.13	$53.49	$52.54	$0.00	$0.00	$0.00	$0.00
51000191	EAP	CPT® 92134		Cptr Ophth Dx Img Post Segmt	BOTH IP/OP	$342.00 	$253.08	$0.00	$342.00	$0.00	$0.00	$54.21	$54.21	$54.51	$67.13	$311.31	$311.31	$323.29	$53.35	$71.27	$34.67	$202.29	$202.29	$55.17	$168.00	$266.11	$268.80	$76.65	$342.00	$76.65	$42.26	$15.49	$15.49	$53.49	$52.54	$0.00	$0.00	$0.00	$0.00
51000211	EAP	CPT® 99497		Advance Care Planning First 30 Mins	BOTH IP/OP	$173.00 	$128.02	$0.00	$323.29	$0.00	$0.00	$72.87	$72.87	$73.28	$67.13	$311.31	$311.31	$323.29	$71.76	$36.05	$46.64	$102.33	$102.33	$78.77	$85.00	$134.64	$136.00	$109.44	$173.00	$109.44	$26.61	$80.42	$80.42	$27.06	$75.02	$0.00	$0.00	$0.00	$0.00
51000212	EAP	CPT® 99498		Advance Care Planning Ea Addl 30 Mins (add-on)	BOTH IP/OP	$158.00 	$116.92	$0.00	$323.29	$0.00	$0.00	$0.00	$0.00	$0.00	$67.13	$311.31	$311.31	$323.29	$0.00	$32.93	$0.00	$93.46	$93.46	$0.00	$77.50	$122.76	$124.00	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000260	EAP	CPT® 99204		Visit Level Bccp 4 - Np	BOTH IP/OP	$579.00 	$428.46	$0.00	$579.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$342.48	$342.48	$116.27	$284.50	$450.65	$455.20	$131.98	$579.00	$131.98	$108.52	$131.98	$131.98	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000265	EAP	CPT® 99214		Visit Level Bccp 4-ep	BOTH IP/OP	$526.00 	$389.24	$0.00	$526.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$0.00	$73.97	$311.13	$311.13	$116.27	$245.50	$388.87	$392.80	$80.42	$526.00	$80.42	$108.52	$80.42	$80.42	$99.16	$110.73	$0.00	$0.00	$0.00	$0.00
51000313	EAP	CPT® 99495		DISCHARGE PHONE CALL AND F/U APPT WITHIN 14  DAYS	BOTH IP/OP	$285.00 	$210.90	$0.00	$323.29	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$59.39	$73.97	$168.58	$168.58	$116.27	$140.00	$221.76	$224.00	$161.54	$0.00	$161.54	$43.82	$125.50	$125.50	$44.58	$110.73	$0.00	$0.00	$0.00	$0.00
51000314	EAP	CPT® 99496		DISCHARGE PHONE CALL AND F/U APPT WITHIN 7  DAYS	BOTH IP/OP	$417.00 	$308.58	$0.00	$328.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$86.90	$73.97	$246.66	$246.66	$116.27	$205.00	$324.72	$328.00	$161.54	$0.00	$161.54	$64.17	$165.53	$165.53	$65.27	$110.73	$0.00	$0.00	$0.00	$0.00
51000315	EAP	CPT® 99205		Isolation Evaluation - Np	BOTH IP/OP	"$1,700.00 "	"$1,258.00"	$0.00	"$1,360.00"	$0.00	$0.00	$172.37	$172.37	$185.53	$67.13	$311.31	$311.31	$323.29	$172.37	$0.00	$112.04	"$1,005.55"	"$1,005.55"	$181.26	$850.00	"$1,346.40"	"$1,360.00"	$172.37	$697.00	$172.37	$108.52	$172.37	$172.37	$99.16	$172.37	$0.00	$0.00	$0.00	$0.00
51000316	EAP	CPT® 99215		Isolation Evaluation - Ep	BOTH IP/OP	"$1,320.00 "	$976.80	$0.00	"$1,056.00"	$0.00	$0.00	$113.60	$113.60	$147.16	$67.13	$311.31	$311.31	$323.29	$113.60	$0.00	$73.84	$780.78	$780.78	$118.93	$660.00	"$1,045.44"	"$1,056.00"	$113.60	$576.00	$113.60	$108.52	$113.60	$113.60	$99.16	$113.60	$0.00	$0.00	$0.00	$0.00
51000320	EAP	CPT® 97605		Neg Press Wd Tx - 50 Sq Cm Or Less	BOTH IP/OP	$317.00 	$234.58	$0.00	$246.40	$172.13	$172.13	$174.88	$174.88	$175.86	$66.07	$0.00	$0.00	$0.00	$172.08	$66.06	$111.85	$187.51	$187.51	$175.24	$154.00	$243.94	$246.40	$243.48	$206.05	$243.48	$33.92	$26.69	$26.69	$49.03	$166.90	$0.00	$0.00	$0.00	$0.00
51000321	EAP	CPT® 97606		Neg Press Wd Tx-> Than 50 Sq Cm	BOTH IP/OP	$524.00 	$387.76	$0.00	$407.20	$0.00	$0.00	$0.00	$0.00	$0.00	$109.21	$0.00	$0.00	$0.00	$331.46	$109.20	$215.45	$309.95	$309.95	$0.00	$254.50	$403.13	$407.20	$0.00	$340.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000322	EAP	CPT® G0438		"Annual Wellness Visit, Initial Visit"	BOTH IP/OP	$409.00 	$302.66	$0.00	$409.00	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$85.24	$73.97	$241.92	$241.92	$116.27	$201.00	$318.38	$321.60	$172.69	$409.00	$172.69	$62.91	$172.69	$172.69	$64.00	$110.73	$0.00	$0.00	$0.00	$0.00
51000323	EAP	CPT® G0439		"Annual Wellness Visit, Subseq Visit"	BOTH IP/OP	$291.00 	$215.34	$0.00	$323.29	$0.00	$0.00	$115.71	$115.71	$116.36	$67.13	$311.31	$311.31	$323.29	$113.80	$60.64	$73.97	$172.13	$172.13	$116.27	$143.00	$226.51	$228.80	$117.16	$291.00	$117.16	$44.76	$117.16	$117.16	$45.53	$110.73	$0.00	$0.00	$0.00	$0.00
51000324	EAP	CPT® 99487		Complex Chronic Care Mgmt - 1st Hr Per Month	BOTH IP/OP	$175.00 	$129.50	$0.00	$323.29	$0.00	$0.00	$130.30	$130.30	$131.03	$67.13	$311.31	$311.31	$323.29	$128.07	$36.47	$83.25	$103.51	$103.51	$78.77	$86.00	$136.22	$137.60	$109.44	$175.00	$109.44	$26.92	$53.37	$53.37	$27.38	$75.02	$0.00	$0.00	$0.00	$0.00
51000325	EAP	CPT® 99490		Chronic Care Mgmt - 20 Min. Per Month	BOTH IP/OP	$175.00 	$129.50	$0.00	$323.29	$0.00	$0.00	$72.87	$72.87	$73.28	$67.13	$311.31	$311.31	$323.29	$71.76	$36.47	$46.64	$103.51	$103.51	$78.77	$86.00	$136.22	$137.60	$109.44	$175.00	$109.44	$26.92	$32.82	$32.82	$27.38	$75.02	$0.00	$0.00	$0.00	$0.00
51000326	EAP	CPT® 99489		Complex Chronic Care Mgmt – Ea Addl 30 Min Per Month	BOTH IP/OP	$87.00 	$64.38	$0.00	$323.29	$0.00	$0.00	$0.00	$0.00	$0.00	$67.13	$311.31	$311.31	$323.29	$0.00	$18.13	$0.00	$51.46	$51.46	$0.00	$43.00	$68.11	$68.80	$0.00	$87.00	$0.00	$13.46	$26.33	$26.33	$13.69	$0.00	$0.00	$0.00	$0.00	$0.00
51000327	EAP	CPT® 92230		Eye Exam With Photos	BOTH IP/OP	$712.00 	$526.88	$0.00	$712.00	$0.00	$0.00	$475.36	$475.36	$478.04	$67.13	$311.31	$311.31	$323.29	$467.50	$148.38	$303.87	$421.15	$421.15	$0.00	$350.00	$554.40	$560.00	$0.00	$712.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51000328	EAP	CPT® 92326		Replacement Of Contact Lens	BOTH IP/OP	$150.00 	$111.00	$0.00	$323.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.31	$311.31	$323.29	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51100021	EAP	CPT® 64640		Destr Peripheral Nerve	BOTH IP/OP	"$2,488.00 "	"$1,841.12"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$518.56	$0.00	$0.00	$0.00	$788.26	$518.50	$512.37	"$1,871.00"	"$1,871.00"	$814.44	"$2,255.00"	"$1,980.79"	"$2,000.80"	"$1,131.55"	"$2,150.00"	"$1,131.55"	$198.96	$121.87	$121.87	$398.16	$775.65	$0.00	$0.00	$0.00	$0.00
61000001	EAP	CPT® 70336		Mri Tmj Mri	BOTH IP/OP	"$4,123.00 "	"$3,051.02"	$143.36	"$3,332.00"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	$859.34	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	$859.23	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$3,298.68"	"$3,332.00"	$324.73	$800.00	$324.73	$651.82	$236.99	$236.99	$663.07	$222.60	$0.00	$0.00	$0.00	$0.00
61000002	EAP	CPT® 70540		Mri:orbit/face/neckw/o Contr.	BOTH IP/OP	"$5,561.00 "	"$4,115.14"	$143.36	"$4,229.60"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	"$1,159.05"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	"$1,158.91"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$4,187.30"	"$4,229.60"	$324.73	$800.00	$324.73	$827.42	$195.93	$195.93	$841.69	$222.60	$0.00	$0.00	$0.00	$0.00
61000003	EAP	CPT® 70542		Mri Orbit/face/neck/w/dye Mri	BOTH IP/OP	"$5,964.00 "	"$4,413.36"	$229.33	"$4,536.00"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,243.05"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,242.90"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,162.00"	"$4,490.64"	"$4,536.00"	$537.70	$800.00	$537.70	$887.36	$230.87	$230.87	$902.66	$368.58	$0.00	$0.00	$0.00	$0.00
61000004	EAP	CPT® 70543		Mri Orb/face/neck W&wo Dye Mri	BOTH IP/OP	"$8,010.00 "	"$5,927.40"	$229.33	"$6,092.00"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,669.48"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,669.28"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$6,031.08"	"$6,092.00"	$537.70	$800.00	$537.70	"$1,191.75"	$285.62	$285.62	"$1,212.31"	$368.58	$0.00	$0.00	$0.00	$0.00
61000005	EAP	CPT® 70544		Mra Head W/o Dye	BOTH IP/OP	"$5,561.00 "	"$4,115.14"	$143.36	"$4,229.60"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	"$1,159.05"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	"$1,158.91"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$4,187.30"	"$4,229.60"	$324.73	$800.00	$324.73	$827.42	$187.29	$187.29	$841.69	$222.60	$0.00	$0.00	$0.00	$0.00
61000006	EAP	CPT® 70545		Mra Head W/ Dye	BOTH IP/OP	"$5,964.00 "	"$4,413.36"	$198.45	"$4,536.00"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,243.05"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,242.90"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,162.00"	"$4,490.64"	"$4,536.00"	$537.70	$800.00	$537.70	$887.36	$198.45	$198.45	$902.66	$368.58	$0.00	$0.00	$0.00	$0.00
61000007	EAP	CPT® 70546		Mra Head W & W/o Dye	BOTH IP/OP	"$8,010.00 "	"$5,927.40"	$229.33	"$6,092.00"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,669.48"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,669.28"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$6,031.08"	"$6,092.00"	$537.70	$800.00	$537.70	"$1,191.75"	$300.74	$300.74	"$1,212.31"	$368.58	$0.00	$0.00	$0.00	$0.00
61000008	EAP	CPT® 70547		Mra Neck W/o Dye	BOTH IP/OP	"$5,561.00 "	"$4,115.14"	$143.36	"$4,229.60"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	"$1,159.05"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	"$1,158.91"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$4,187.30"	"$4,229.60"	$324.73	$800.00	$324.73	$827.42	$188.01	$188.01	$841.69	$222.60	$0.00	$0.00	$0.00	$0.00
61000009	EAP	CPT® 70548		Mra Neck W/ Dye	BOTH IP/OP	"$6,193.00 "	"$4,582.82"	$202.06	"$4,710.40"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,290.78"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,290.62"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,162.00"	"$4,663.30"	"$4,710.40"	$537.70	$800.00	$537.70	$921.47	$202.06	$202.06	$937.37	$368.58	$0.00	$0.00	$0.00	$0.00
61000010	EAP	CPT® 70549		Mra Neck W&wo Dye	BOTH IP/OP	"$8,010.00 "	"$5,927.40"	$229.33	"$6,092.00"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,669.48"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,669.28"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$6,031.08"	"$6,092.00"	$537.70	$800.00	$537.70	"$1,191.75"	$302.90	$302.90	"$1,212.31"	$368.58	$0.00	$0.00	$0.00	$0.00
61000011	EAP	CPT® 71550		Mri Chest W/o Dye	BOTH IP/OP	"$4,941.00 "	"$3,656.34"	$0.00	"$3,992.80"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,029.70"	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$1,043.00"	"$3,952.87"	"$3,992.80"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000012	EAP	CPT® 71551		Mri Chest W/dye	BOTH IP/OP	"$3,511.00 "	"$2,598.14"	$0.00	"$2,836.80"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$731.69	$0.00	"$1,758.00"	"$1,758.00"	$693.78	"$1,162.00"	"$2,808.43"	"$2,836.80"	$963.92	$800.00	$963.92	$554.95	$355.13	$355.13	$564.52	$660.75	$0.00	$0.00	$0.00	$0.00
61000013	EAP	CPT® 71552		Mri Chest W&wo Dye	BOTH IP/OP	"$6,183.00 "	"$4,575.42"	$229.33	"$4,996.00"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,288.69"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,288.54"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$4,946.04"	"$4,996.00"	$537.70	$800.00	$537.70	$977.34	$446.61	$446.61	$994.20	$368.58	$0.00	$0.00	$0.00	$0.00
61000014	EAP	CPT® 71555		Mra Chest W&wo Dye	BOTH IP/OP	"$5,145.00 "	"$3,807.30"	$0.00	"$4,157.60"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	$0.00	"$1,171.15"	"$1,171.15"	"$1,216.20"	$0.00	"$1,072.22"	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$1,247.28"	"$4,116.02"	"$4,157.60"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000015	EAP	CPT® 72159		Mra Spinal Canal W/wo Dye	BOTH IP/OP	"$8,413.00 "	"$6,225.62"	$0.00	"$6,798.40"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,753.27"	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$2,039.52"	"$6,730.42"	"$6,798.40"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000016	EAP	CPT® 72198		Mra  Pelvis W/wo Dye	BOTH IP/OP	"$6,417.00 "	"$4,748.58"	$0.00	"$5,131.20"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,337.30"	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$1,539.36"	"$5,079.89"	"$5,131.20"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000017	EAP	CPT® 73218		Mri Upp Ext Nt Jt Wo Dye B Mri	BOTH IP/OP	"$10,051.00 "	"$7,437.74"	$143.36	"$8,040.80"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	"$2,094.88"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	"$2,094.63"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$7,960.39"	"$8,040.80"	$324.73	$800.00	$324.73	"$1,572.98"	$288.50	$288.50	"$1,600.12"	$222.60	$0.00	$0.00	$0.00	$0.00
61000018	EAP	CPT® 73218		Mri Upp Ext Nt Jt Wo Dye L Mri	BOTH IP/OP	"$5,026.00 "	"$3,719.24"	$0.00	"$4,020.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,037.12"	$0.00	$0.00	$0.00	$220.56	"$1,037.00"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$3,980.59"	"$4,020.80"	$324.73	$0.00	$324.73	$786.57	$288.50	$288.50	$800.14	$222.60	$0.00	$0.00	$0.00	$0.00
61000019	EAP	CPT® 73218		Mri Upp Ext Nt Jt Wo Dye R Mri	BOTH IP/OP	"$4,976.00 "	"$3,682.24"	$143.36	"$4,020.80"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	"$1,037.12"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	"$1,037.00"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$3,980.59"	"$4,020.80"	$324.73	$800.00	$324.73	$786.57	$288.50	$288.50	$800.14	$222.60	$0.00	$0.00	$0.00	$0.00
61000020	EAP	CPT® 73219		Mri Upp Ext Not Jt W/dye B Mri	BOTH IP/OP	"$10,778.00 "	"$7,975.72"	$0.00	"$8,622.40"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$2,246.40"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$2,246.14"	$229.33	"$1,758.00"	"$1,758.00"	$0.00	"$1,162.00"	"$8,536.18"	"$8,622.40"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000021	EAP	CPT® 73219		Mri Upp Ext Not Jt W/dye L Mri	BOTH IP/OP	"$5,393.00 "	"$3,990.82"	$0.00	"$4,314.40"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,124.04"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,123.90"	$229.33	"$1,758.00"	"$1,758.00"	$0.00	"$1,162.00"	"$4,271.26"	"$4,314.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000022	EAP	CPT® 73219		Mri Upp Ext Not Jt W/dye R Mri	BOTH IP/OP	"$5,339.00 "	"$3,950.86"	$0.00	"$4,314.40"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,112.78"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,112.65"	$229.33	"$1,758.00"	"$1,758.00"	$0.00	"$1,162.00"	"$4,271.26"	"$4,314.40"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000023	EAP	CPT® 73220		Mri Upp Ext Nt Jt W&wo Bi Mri	BOTH IP/OP	"$13,949.00 "	"$10,322.26"	$229.33	"$11,159.20"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$2,907.32"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$2,906.97"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$11,047.61"	"$11,159.20"	$537.70	$800.00	$537.70	"$2,183.02"	$376.02	$376.02	"$2,220.68"	$368.58	$0.00	$0.00	$0.00	$0.00
61000024	EAP	CPT® 73220		Mri Upp Ext Nt Jt W&wo Lt Mri	BOTH IP/OP	"$6,906.00 "	"$5,110.44"	$229.33	"$5,580.80"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,439.38"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,439.21"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$5,524.99"	"$5,580.80"	$537.70	$800.00	$537.70	"$1,091.74"	$376.02	$376.02	"$1,110.58"	$368.58	$0.00	$0.00	$0.00	$0.00
61000025	EAP	CPT® 73220		Mri Upp Ext Nt Jt W&wo Rt Mri	BOTH IP/OP	"$6,976.00 "	"$5,162.24"	$0.00	"$5,580.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,439.38"	$0.00	$0.00	$0.00	$352.81	"$1,439.21"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$5,524.99"	"$5,580.80"	$537.70	$0.00	$537.70	"$1,091.74"	$376.02	$376.02	"$1,110.58"	$368.58	$0.00	$0.00	$0.00	$0.00
61000026	EAP	CPT® 73221		Mri Upp Ext Jnt W/o Dye Bi Mri	BOTH IP/OP	"$10,051.00 "	"$7,437.74"	$143.36	"$8,040.80"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	"$2,094.88"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	"$2,094.63"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$7,960.39"	"$8,040.80"	$324.73	$800.00	$324.73	"$1,572.98"	$162.80	$162.80	"$1,600.12"	$222.60	$0.00	$0.00	$0.00	$0.00
61000027	EAP	CPT® 73221		Mri Upp Ext Jnt W/o Dye Lt Mri	BOTH IP/OP	"$5,026.00 "	"$3,719.24"	$0.00	"$4,020.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,037.12"	$0.00	$0.00	$0.00	$220.56	"$1,037.00"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$3,980.59"	"$4,020.80"	$324.73	$0.00	$324.73	$786.57	$162.80	$162.80	$800.14	$222.60	$0.00	$0.00	$0.00	$0.00
61000028	EAP	CPT® 73221		Mri Upp Ext Jnt W/o Dye Rt Mri	BOTH IP/OP	"$4,976.00 "	"$3,682.24"	$143.36	"$4,020.80"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	"$1,037.12"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	"$1,037.00"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$3,980.59"	"$4,020.80"	$324.73	$800.00	$324.73	$786.57	$162.80	$162.80	$800.14	$222.60	$0.00	$0.00	$0.00	$0.00
61000030	EAP	CPT® 73222		Mri Upp Ext Jnt W/dye Bi Mri	BOTH IP/OP	"$11,196.00 "	"$8,285.04"	$287.06	"$8,956.80"	"$2,060.10"	"$2,060.10"	$696.71	$696.71	$700.64	"$2,333.53"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$685.44	"$2,333.25"	$445.54	"$1,758.00"	"$1,758.00"	$693.78	"$1,162.00"	"$8,867.23"	"$8,956.80"	$963.92	$800.00	$963.92	"$1,752.17"	$287.06	$287.06	"$1,782.40"	$660.75	$0.00	$0.00	$0.00	$0.00
61000031	EAP	CPT® 73222		Mri Upp Ext Jnt W/dye Lt Mri	BOTH IP/OP	"$5,541.00 "	"$4,100.34"	$287.06	"$4,477.60"	"$2,060.10"	"$2,060.10"	$696.71	$696.71	$700.64	"$1,154.88"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$685.44	"$1,154.74"	$445.54	"$1,758.00"	"$1,758.00"	$693.78	"$1,162.00"	"$4,432.82"	"$4,477.60"	$963.92	$800.00	$963.92	$875.93	$287.06	$287.06	$891.04	$660.75	$0.00	$0.00	$0.00	$0.00
61000032	EAP	CPT® 73222		Mri Upp Ext Jnt W/dye Rt Mri	BOTH IP/OP	"$5,541.00 "	"$4,100.34"	$287.06	"$4,477.60"	"$2,060.10"	"$2,060.10"	$696.71	$696.71	$700.64	"$1,154.88"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$685.44	"$1,154.74"	$445.54	"$1,758.00"	"$1,758.00"	$693.78	"$1,162.00"	"$4,432.82"	"$4,477.60"	$963.92	$800.00	$963.92	$875.93	$287.06	$287.06	$891.04	$660.75	$0.00	$0.00	$0.00	$0.00
61000033	EAP	CPT® 73223		Mri Upp Ext Jnt W&wo Dye B Mri	BOTH IP/OP	"$13,949.00 "	"$10,322.26"	$0.00	"$11,159.20"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	"$2,907.32"	$0.00	$0.00	$0.00	$352.81	"$2,906.97"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$11,047.61"	"$11,159.20"	$537.70	$800.00	$537.70	"$2,183.02"	$348.65	$348.65	"$2,220.68"	$368.58	$0.00	$0.00	$0.00	$0.00
61000034	EAP	CPT® 73223		Mri Uppr Ext Jnt W&wo Dye Lt	BOTH IP/OP	"$6,976.00 "	"$5,162.24"	$0.00	"$5,580.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,439.38"	$0.00	$0.00	$0.00	$352.81	"$1,439.21"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$5,524.99"	"$5,580.80"	$537.70	$0.00	$537.70	"$1,091.74"	$348.65	$348.65	"$1,110.58"	$368.58	$0.00	$0.00	$0.00	$0.00
61000035	EAP	CPT® 73223		Mri Uppr Ext Jnt W&wo Dye Rt	BOTH IP/OP	"$6,906.00 "	"$5,110.44"	$0.00	"$5,580.80"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	"$1,439.38"	$0.00	$0.00	$0.00	$352.81	"$1,439.21"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$5,524.99"	"$5,580.80"	$537.70	$800.00	$537.70	"$1,091.74"	$348.65	$348.65	"$1,110.58"	$368.58	$0.00	$0.00	$0.00	$0.00
61000036	EAP	CPT® 73225		Mra Upp Ext W/wo Dye Bilat	BOTH IP/OP	"$27,844.00 "	"$20,604.56"	$0.00	"$22,275.20"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,802.69"	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$6,682.56"	"$22,052.45"	"$22,275.20"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000037	EAP	CPT® 73225		Mra Upp Ext W/wo Dye Lt	BOTH IP/OP	"$13,918.00 "	"$10,299.32"	$0.00	"$11,134.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,340.32"	"$11,023.06"	"$11,134.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000038	EAP	CPT® 73225		Mra Upp Ext W/wo Dye Rt	BOTH IP/OP	"$13,918.00 "	"$10,299.32"	$0.00	"$11,134.40"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,900.51"	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$3,340.32"	"$11,023.06"	"$11,134.40"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000040	EAP	CPT® 73718		Mri Low Ext Nt Jt Wo Dye B Mri	BOTH IP/OP	"$11,745.00 "	"$8,691.30"	$143.36	"$9,396.00"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	"$2,447.95"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	"$2,447.66"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$9,302.04"	"$9,396.00"	$324.73	$800.00	$324.73	"$1,838.09"	$192.33	$192.33	"$1,869.80"	$222.60	$0.00	$0.00	$0.00	$0.00
61000041	EAP	CPT® 73718		Mri Low Ext Nt Jt Wo Dye L Mri	BOTH IP/OP	"$4,151.00 "	"$3,071.74"	$0.00	"$3,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$889.14	$0.00	$0.00	$0.00	$220.56	$889.03	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$3,287.59"	"$3,320.80"	$324.73	$0.00	$324.73	$649.63	$192.33	$192.33	$660.84	$222.60	$0.00	$0.00	$0.00	$0.00
61000042	EAP	CPT® 73718		Mri Low Ext Nt Jt Wo Dye R Mri	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$143.36	"$3,320.80"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	$889.14	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	$889.03	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$3,287.59"	"$3,320.80"	$324.73	$800.00	$324.73	$649.63	$192.33	$192.33	$660.84	$222.60	$0.00	$0.00	$0.00	$0.00
61000043	EAP	CPT® 73719		Mri Low Ext Nt Jt W/dye B Mri	BOTH IP/OP	"$9,248.00 "	"$6,843.52"	$0.00	"$7,398.40"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,927.28"	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$1,162.00"	"$7,324.42"	"$7,398.40"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000044	EAP	CPT® 73719		Mri Low Ext Nt Jt W/dye L Mri	BOTH IP/OP	"$4,759.00 "	"$3,521.66"	$0.00	"$3,704.80"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$991.78	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$1,162.00"	"$3,667.75"	"$3,704.80"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000045	EAP	CPT® 73719		Mri Low Ext Nt Jt W/dye R Mri	BOTH IP/OP	"$4,759.00 "	"$3,521.66"	$0.00	"$3,704.80"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$991.78	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$1,162.00"	"$3,667.75"	"$3,704.80"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000046	EAP	CPT® 73720		Mri Low Ext Not Jnt W&wo B Mri	BOTH IP/OP	"$11,957.00 "	"$8,848.18"	$229.33	"$9,565.60"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$2,492.14"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$2,491.84"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$9,469.94"	"$9,565.60"	$537.70	$800.00	$537.70	"$1,871.27"	$286.34	$286.34	"$1,903.55"	$368.58	$0.00	$0.00	$0.00	$0.00
61000047	EAP	CPT® 73720		Mri Low Ext Not Jnt W&wo L Mri	BOTH IP/OP	"$6,146.00 "	"$4,548.04"	$229.33	"$4,784.80"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,280.98"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,280.83"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$4,736.95"	"$4,784.80"	$537.70	$800.00	$537.70	$936.03	$286.34	$286.34	$952.18	$368.58	$0.00	$0.00	$0.00	$0.00
61000048	EAP	CPT® 73720		Mri Low Ext Not Jnt W&wo R Mri	BOTH IP/OP	"$5,981.00 "	"$4,425.94"	$0.00	"$4,784.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.98"	$0.00	$0.00	$0.00	$352.81	"$1,280.83"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$4,736.95"	"$4,784.80"	$537.70	$0.00	$537.70	$936.03	$286.34	$286.34	$952.18	$368.58	$0.00	$0.00	$0.00	$0.00
61000050	EAP	CPT® 73721		Mri Low Ext Jnt W/o Dye Bi Mri	BOTH IP/OP	"$8,531.00 "	"$6,312.94"	$143.36	"$6,641.60"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	"$1,778.07"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	"$1,777.86"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,992.48"	"$6,575.18"	"$6,641.60"	$324.73	$800.00	$324.73	"$1,299.26"	$162.80	$162.80	"$1,321.68"	$222.60	$0.00	$0.00	$0.00	$0.00
61000051	EAP	CPT® 73721		Mri Low Ext Jnt W/o Dye Lt Mri	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$143.36	"$3,320.80"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	$889.14	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	$889.03	$143.36	"$1,758.00"	"$1,758.00"	$233.72	$996.24	"$3,287.59"	"$3,320.80"	$324.73	$800.00	$324.73	$649.63	$162.80	$162.80	$660.84	$222.60	$0.00	$0.00	$0.00	$0.00
61000052	EAP	CPT® 73721		Mri Low Ext Jnt W/o Dye Rt Mri	BOTH IP/OP	"$4,151.00 "	"$3,071.74"	$0.00	"$3,320.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$889.14	$0.00	$0.00	$0.00	$220.56	$889.03	$143.36	"$1,758.00"	"$1,758.00"	$233.72	$996.24	"$3,287.59"	"$3,320.80"	$324.73	$0.00	$324.73	$649.63	$162.80	$162.80	$660.84	$222.60	$0.00	$0.00	$0.00	$0.00
61000053	EAP	CPT® 73722		Mri Low Ext Jnt W/dye Bi Mri	BOTH IP/OP	"$8,903.00 "	"$6,588.22"	$0.00	"$7,122.40"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,855.39"	$0.00	"$1,758.00"	"$1,758.00"	$693.78	"$1,162.00"	"$7,051.18"	"$7,122.40"	$963.92	$800.00	$963.92	"$1,393.32"	$287.78	$287.78	"$1,417.36"	$660.75	$0.00	$0.00	$0.00	$0.00
61000054	EAP	CPT® 73722		Mri Low Ext Jnt W/dye Lt Mri	BOTH IP/OP	"$4,578.00 "	"$3,387.72"	$0.00	"$3,564.00"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$954.06	$0.00	"$1,758.00"	"$1,758.00"	$693.78	"$1,162.00"	"$3,528.36"	"$3,564.00"	$963.92	$800.00	$963.92	$697.21	$287.78	$287.78	$709.24	$660.75	$0.00	$0.00	$0.00	$0.00
61000055	EAP	CPT® 73722		Mri Low Ext Jnt W/dye Rt Mri	BOTH IP/OP	"$4,578.00 "	"$3,387.72"	$0.00	"$3,564.00"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$954.06	$0.00	"$1,758.00"	"$1,758.00"	$693.78	"$1,162.00"	"$3,528.36"	"$3,564.00"	$963.92	$800.00	$963.92	$697.21	$287.78	$287.78	$709.24	$660.75	$0.00	$0.00	$0.00	$0.00
61000056	EAP	CPT® 73723		Mri Low Ext Jnt W&wo Dye B Mri	BOTH IP/OP	"$12,288.00 "	"$9,093.12"	$229.33	"$9,565.60"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$2,561.13"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$2,560.82"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$9,469.94"	"$9,565.60"	$537.70	$800.00	$537.70	"$1,871.27"	$347.93	$347.93	"$1,903.55"	$368.58	$0.00	$0.00	$0.00	$0.00
61000057	EAP	CPT® 73723		Mri Low Ext Jnt W&wo Dye L Mri	BOTH IP/OP	"$6,146.00 "	"$4,548.04"	$229.33	"$4,784.80"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,280.98"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,280.83"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$4,736.95"	"$4,784.80"	$537.70	$800.00	$537.70	$936.03	$347.93	$347.93	$952.18	$368.58	$0.00	$0.00	$0.00	$0.00
61000058	EAP	CPT® 73723		Mri Low Ext Jnt W&wo Dye R Mri	BOTH IP/OP	"$5,981.00 "	"$4,425.94"	$0.00	"$4,784.80"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.98"	$0.00	$0.00	$0.00	$352.81	"$1,280.83"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$4,736.95"	"$4,784.80"	$537.70	$0.00	$537.70	$936.03	$347.93	$347.93	$952.18	$368.58	$0.00	$0.00	$0.00	$0.00
61000059	EAP	CPT® 74181		Mri Abdomen W/o Dye	BOTH IP/OP	"$5,552.00 "	"$4,108.48"	$143.36	"$4,474.40"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	"$1,157.18"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	"$1,157.04"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$4,429.66"	"$4,474.40"	$324.73	$800.00	$324.73	$875.30	$153.43	$153.43	$890.41	$222.60	$0.00	$0.00	$0.00	$0.00
61000060	EAP	CPT® 74182		Mri Abdomen W/ Dye	BOTH IP/OP	"$5,491.00 "	"$4,063.34"	$229.33	"$4,425.60"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,144.46"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,144.32"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,162.00"	"$4,381.34"	"$4,425.60"	$537.70	$800.00	$537.70	$865.76	$267.97	$267.97	$880.69	$368.58	$0.00	$0.00	$0.00	$0.00
61000062	EAP	CPT® 74183		Mri Abdomen W&wo Dye	BOTH IP/OP	"$6,073.00 "	"$4,494.02"	$229.33	"$4,894.40"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,265.77"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,265.61"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$4,845.46"	"$4,894.40"	$537.70	$800.00	$537.70	$957.47	$284.90	$284.90	$973.99	$368.58	$0.00	$0.00	$0.00	$0.00
61000063	EAP	CPT® 74185		Mra Abdomen Wo Cont	BOTH IP/OP	"$3,369.00 "	"$2,493.06"	$0.00	"$2,715.20"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$702.10	$0.00	"$1,758.00"	"$1,758.00"	$0.00	$814.56	"$2,688.05"	"$2,715.20"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000064	EAP	CPT® 75557		Mri Card Morph W/o Cont	BOTH IP/OP	"$3,922.00 "	"$2,902.28"	$0.00	"$3,169.60"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	$817.44	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	$817.34	$143.36	"$1,758.00"	"$1,758.00"	$0.00	$950.88	"$3,137.90"	"$3,169.60"	$0.00	$800.00	$0.00	$620.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000065	EAP	CPT® 75559		Mri Card Morph W/o W/stress	BOTH IP/OP	"$3,112.00 "	"$2,302.88"	$0.00	"$2,489.60"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$648.54	$0.00	"$1,758.00"	"$1,758.00"	$0.00	$746.88	"$2,464.70"	"$2,489.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000066	EAP	CPT® 75561		Mri Card Morph W&w/o	BOTH IP/OP	"$4,708.00 "	"$3,483.92"	$229.33	"$3,804.80"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	$981.26	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	$981.15	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,141.44"	"$3,766.75"	"$3,804.80"	$537.70	$800.00	$537.70	$744.31	$295.70	$295.70	$757.16	$368.58	$0.00	$0.00	$0.00	$0.00
61000067	EAP	CPT® 75563		Mri Card Morph W&w/o W/stress	BOTH IP/OP	"$5,552.00 "	"$4,108.48"	$0.00	"$4,441.60"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,157.04"	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$1,332.48"	"$4,397.18"	"$4,441.60"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000068	EAP	CPT® 76390		Mri Spectroscopy	BOTH IP/OP	"$4,990.00 "	"$3,692.60"	$0.00	"$3,689.60"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	"$1,040.04"	$0.00	$0.00	$0.00	$77.54	"$1,039.92"	$50.40	"$1,758.00"	"$1,758.00"	$0.00	"$1,106.88"	"$3,652.70"	"$3,689.60"	"$2,767.20"	$800.00	"$2,767.20"	$721.78	$0.00	$0.00	$734.23	$0.00	$0.00	$0.00	$0.00	$0.00
61000069	EAP	HCPCS C8900		Mra Abdomen W Dye	BOTH IP/OP	"$4,319.00 "	"$3,196.06"	$0.00	"$3,480.80"	$0.00	$0.00	$0.00	$0.00	$360.63	$900.19	$0.00	$0.00	$0.00	$352.81	$900.08	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$2,175.50"	"$3,445.99"	"$3,480.80"	$537.70	$800.00	$537.70	$680.93	$0.00	$0.00	$692.68	$368.58	$0.00	$0.00	$0.00	$0.00
61000070	EAP	HCPCS C8901		Mra Abdomen W/o Dye	BOTH IP/OP	"$2,291.00 "	"$1,695.34"	$0.00	"$1,846.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$477.44	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$1,154.00"	"$1,827.94"	"$1,846.40"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000071	EAP	HCPCS C8909		Mra Chest W Dye	BOTH IP/OP	"$4,649.00 "	"$3,440.26"	$0.00	"$3,756.80"	"$2,524.41"	"$2,524.41"	$358.61	$358.61	$360.63	$968.97	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	$968.85	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$2,348.00"	"$3,719.23"	"$3,756.80"	$537.70	$800.00	$537.70	$0.00	$0.00	$0.00	$747.60	$368.58	$0.00	$0.00	$0.00	$0.00
61000072	EAP	HCPCS C8910		Mra Chest W/o Dye	BOTH IP/OP	"$5,409.00 "	"$4,002.66"	$0.00	"$4,371.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,127.24"	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$2,732.00"	"$4,327.49"	"$4,371.20"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000073	EAP	HCPCS C8914		Mra Low Ext W&wo Dye Bi Mri	BOTH IP/OP	"$4,133.00 "	"$3,058.42"	$0.00	"$3,306.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.32	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$2,066.50"	"$3,273.34"	"$3,306.40"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000074	EAP	HCPCS C8914		Mra Low Ext W&wo Dye Lt	BOTH IP/OP	"$2,898.00 "	"$2,144.52"	$0.00	"$2,318.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.94	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$1,449.00"	"$2,295.22"	"$2,318.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000075	EAP	HCPCS C8914		Mra Low Ext W/wo Dye Rt	BOTH IP/OP	"$2,898.00 "	"$2,144.52"	$0.00	"$2,318.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.94	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$1,449.00"	"$2,295.22"	"$2,318.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000077	EAP	HCPCS C8903		"Mri W/cont, Brst, Uni, Mri"	BOTH IP/OP	"$1,389.00 "	"$1,027.86"	$0.00	"$1,389.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.47	$0.00	"$1,389.00"	"$1,389.00"	$0.00	$868.00	"$1,374.91"	"$1,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000081	EAP	HCPCS C8905		"Mri W/ofol W/con,brst,uni,mri"	BOTH IP/OP	"$1,753.00 "	"$1,297.22"	$0.00	"$1,753.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$365.33	$0.00	"$1,753.00"	"$1,753.00"	$0.00	"$1,095.50"	"$1,735.27"	"$1,752.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000082	EAP	HCPCS C8906		"Mri W/con, Brst, Bi,mri"	BOTH IP/OP	"$1,389.00 "	"$1,027.86"	$0.00	"$1,389.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.47	$0.00	"$1,389.00"	"$1,389.00"	$0.00	$868.00	"$1,374.91"	"$1,388.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000087	EAP	HCPCS C8908		"Mri W/ofol W/con, Brst, Bi,mri"	BOTH IP/OP	"$4,339.00 "	"$3,210.86"	$0.00	"$3,506.40"	"$1,122.00"	"$1,122.00"	$358.61	$358.61	$360.63	$904.36	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	$904.25	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$2,191.50"	"$3,471.34"	"$3,506.40"	$537.70	$800.00	$537.70	$685.94	$0.00	$0.00	$697.77	$368.58	$0.00	$0.00	$0.00	$0.00
61000090	EAP	CPT® 72220		Cervical Spine Flex Ext Nir	BOTH IP/OP	$488.00 	$361.12	$22.69	$768.00	$63.70	$63.70	$78.77	$78.77	$79.21	$101.71	$488.00	$488.00	$488.00	$77.54	$101.70	$50.40	$488.00	$488.00	$80.04	$146.40	$483.12	$488.00	$111.21	$768.00	$111.21	$95.47	$22.69	$22.69	$97.11	$76.23	$0.00	$0.00	$0.00	$0.00
61000098	EAP	CPT® 76376		3d Rendering W/o Postproce Mri	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,659.00"	"$1,404.90"	"$1,404.90"	$0.00	$0.00	$0.00	$345.78	"$1,171.15"	"$1,171.15"	"$1,216.20"	$0.00	$345.74	$0.00	"$1,659.00"	"$1,659.00"	$0.00	$487.92	"$1,610.14"	"$1,626.40"	$0.00	$800.00	$0.00	$318.16	$13.33	$13.33	$323.65	$0.00	$0.00	$0.00	$0.00	$0.00
61000099	EAP	CPT® 76377		3d Rendering W/postprocess Mri	BOTH IP/OP	"$2,033.00 "	"$1,504.42"	$0.00	"$1,758.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$458.54	$0.00	$0.00	$0.00	$0.00	$458.48	$0.00	"$1,758.00"	"$1,758.00"	$0.00	$487.92	"$1,610.14"	"$1,626.40"	$0.00	$0.00	$0.00	$318.16	$32.41	$32.41	$323.65	$0.00	$0.00	$0.00	$0.00	$0.00
61000110	EAP	CPT® 77021		"Mri Guide Needle Place, Cbc"	BOTH IP/OP	"$3,150.00 "	"$2,331.00"	$0.00	"$2,520.00"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$656.46	$0.00	"$1,758.00"	"$1,758.00"	$0.00	$756.00	"$2,494.80"	"$2,520.00"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000116	EAP	HCPCS C8932		"Mra, W/o Dye, Spinal Canal"	BOTH IP/OP	"$4,243.00 "	"$3,139.82"	$0.00	"$3,394.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$884.24	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$2,121.50"	"$3,360.46"	"$3,394.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000117	EAP	HCPCS C8933		"Mra, W/o&w/dye, Spinal Canal"	BOTH IP/OP	"$3,605.00 "	"$2,667.70"	$0.00	"$2,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$751.28	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$1,802.50"	"$2,855.16"	"$2,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000118	EAP	HCPCS C8934		"Mra, W/dye, Upper Extremity"	BOTH IP/OP	"$4,210.00 "	"$3,115.40"	$0.00	"$3,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$877.36	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$2,105.00"	"$3,334.32"	"$3,368.00"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000119	EAP	HCPCS C8935		"Mra, W/odye, Upper Extremity"	BOTH IP/OP	"$4,210.00 "	"$3,115.40"	$0.00	"$3,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$877.36	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$2,105.00"	"$3,334.32"	"$3,368.00"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000120	EAP	HCPCS C8936		"Mra, W/o&w/dye, Upper Extremity"	BOTH IP/OP	"$4,210.00 "	"$3,115.40"	$0.00	"$3,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$877.36	$0.00	"$1,758.00"	"$1,758.00"	$0.00	"$2,105.00"	"$3,334.32"	"$3,368.00"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000121	EAP	CPT® 73725		Mri Ang Lwr Ext W Or W/o Dye	BOTH IP/OP	"$3,816.00 "	"$2,823.84"	$0.00	"$3,052.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$795.25	$0.00	"$1,758.00"	"$1,758.00"	$0.00	$915.84	"$3,022.27"	"$3,052.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000122	EAP	CPT® 77021		Mri Guidance For Needle Placement	BOTH IP/OP	"$3,150.00 "	"$2,331.00"	$0.00	"$2,520.00"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$656.46	$0.00	"$1,758.00"	"$1,758.00"	$0.00	$756.00	"$2,494.80"	"$2,520.00"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000124	EAP	CPT® 77048		Mri Breast W And/or Wo Cont Incl Cad Uni	BOTH IP/OP	$491.00 	$363.34	$0.00	$491.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.32	$0.00	$491.00	$491.00	$0.00	$117.84	$388.87	$392.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000125	EAP	CPT® 77049		Mri Breast W And/or Wo Cont Incl Cad Bil	BOTH IP/OP	$491.00 	$363.34	$0.00	$800.00	$491.00	$491.00	$285.62	$285.62	$335.44	$102.34	$491.00	$491.00	$491.00	$285.62	$102.32	$185.65	$491.00	$491.00	$0.00	$117.84	$388.87	$392.80	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61000126	EAP	CPT® 77047		Mri Breast Without Contrast Material Bilateral	BOTH IP/OP	"$2,874.00 "	"$2,126.76"	$143.36	"$2,299.20"	"$1,122.00"	"$1,122.00"	$224.08	$224.08	$225.34	$599.01	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	$598.94	$143.36	"$1,758.00"	"$1,758.00"	$233.72	$689.76	"$2,276.21"	"$2,299.20"	$324.73	$800.00	$324.73	$449.78	$173.24	$173.24	$457.54	$222.60	$0.00	$0.00	$0.00	$0.00
61000127	EAP	CPT® 77046		MRI BREAST WO CONTRAST UNI	BOTH IP/OP	$554.00 	$409.96	$0.00	$554.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$115.45	$0.00	$554.00	$554.00	$0.00	$132.96	$438.77	$443.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61100001	EAP	CPT® 70551		Mri Brain W/o Dye	BOTH IP/OP	"$5,561.00 "	"$4,115.14"	$143.36	"$4,229.60"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	"$1,159.05"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	"$1,158.91"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$4,187.30"	"$4,229.60"	$324.73	$800.00	$324.73	$827.42	$150.19	$150.19	$841.69	$222.60	$0.00	$0.00	$0.00	$0.00
61100003	EAP	CPT® 70552		Mri Brain W/dye	BOTH IP/OP	"$6,193.00 "	"$4,582.82"	$0.00	"$4,710.40"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	"$1,290.78"	$0.00	$0.00	$0.00	$352.81	"$1,290.62"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,162.00"	"$4,663.30"	"$4,710.40"	$537.70	$800.00	$537.70	$921.47	$221.87	$221.87	$937.37	$368.58	$0.00	$0.00	$0.00	$0.00
61100005	EAP	CPT® 70553		Mri Brain W&wo Dye	BOTH IP/OP	"$8,010.00 "	"$5,927.40"	$229.33	"$6,092.00"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,669.48"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,669.28"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$6,031.08"	"$6,092.00"	$537.70	$800.00	$537.70	"$1,191.75"	$252.84	$252.84	"$1,212.31"	$368.58	$0.00	$0.00	$0.00	$0.00
61200001	EAP	CPT® 72141		Mri Cervical Spine W/o Dye	BOTH IP/OP	"$5,640.00 "	"$4,173.60"	$143.36	"$4,255.20"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	"$1,175.52"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	"$1,175.38"	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$4,212.65"	"$4,255.20"	$324.73	$800.00	$324.73	$832.42	$144.07	$144.07	$846.78	$222.60	$0.00	$0.00	$0.00	$0.00
61200004	EAP	CPT® 72142		Mri Cervical Spine W Contrast	BOTH IP/OP	"$6,282.00 "	"$4,648.68"	$0.00	"$4,739.20"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	"$1,309.33"	$0.00	$0.00	$0.00	$352.81	"$1,309.17"	$229.33	"$1,758.00"	"$1,758.00"	$0.00	"$1,162.00"	"$4,691.81"	"$4,739.20"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61200005	EAP	CPT® 72146		Mri Thoracic Spine W/o Dye	BOTH IP/OP	"$4,510.00 "	"$3,337.40"	$143.36	"$3,460.00"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	$940.00	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	$939.88	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,038.00"	"$3,425.40"	"$3,460.00"	$324.73	$800.00	$324.73	$676.86	$144.07	$144.07	$688.54	$222.60	$0.00	$0.00	$0.00	$0.00
61200006	EAP	CPT® 72147		Mri Thoracic Spine W/dye	BOTH IP/OP	"$5,023.00 "	"$3,717.02"	$0.00	"$3,853.60"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.79"	$0.00	"$1,758.00"	"$1,758.00"	$387.01	"$1,162.00"	"$3,815.06"	"$3,853.60"	$537.70	$800.00	$537.70	$753.86	$226.55	$226.55	$766.87	$368.58	$0.00	$0.00	$0.00	$0.00
61200007	EAP	CPT® 72148		Mri Lumbar Spine W/o Dye	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$143.36	"$3,445.60"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	$888.72	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	$888.62	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$3,411.14"	"$3,445.60"	$324.73	$800.00	$324.73	$674.05	$144.43	$144.43	$685.67	$222.60	$0.00	$0.00	$0.00	$0.00
61200008	EAP	CPT® 72149		Mri Lumbar Spine W/ Dye	BOTH IP/OP	"$4,587.00 "	"$3,394.38"	$0.00	"$3,706.40"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.93	$0.00	"$1,758.00"	"$1,758.00"	$387.01	"$1,162.00"	"$3,669.34"	"$3,706.40"	$537.70	$800.00	$537.70	$725.06	$223.67	$223.67	$737.57	$368.58	$0.00	$0.00	$0.00	$0.00
61200009	EAP	CPT® 72156		Mri Cervical Spine W&wo Dye	BOTH IP/OP	"$8,124.00 "	"$6,011.76"	$229.33	"$6,129.60"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,693.24"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,693.04"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$6,068.30"	"$6,129.60"	$537.70	$800.00	$537.70	"$1,199.10"	$255.72	$255.72	"$1,219.79"	$368.58	$0.00	$0.00	$0.00	$0.00
61200010	EAP	CPT® 72157		Mri Thoracic Spine W&wo Dye	BOTH IP/OP	"$6,499.00 "	"$4,809.26"	$229.33	"$4,985.60"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,354.55"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,354.39"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,495.68"	"$4,935.74"	"$4,985.60"	$537.70	$800.00	$537.70	$975.31	$256.44	$256.44	$992.13	$368.58	$0.00	$0.00	$0.00	$0.00
61200011	EAP	CPT® 72158		Mri Lumbar Spine W&wo Dye	BOTH IP/OP	"$6,144.00 "	"$4,546.56"	$229.33	"$4,964.80"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,280.56"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,280.41"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$4,915.15"	"$4,964.80"	$537.70	$800.00	$537.70	$971.24	$255.00	$255.00	$988.00	$368.58	$0.00	$0.00	$0.00	$0.00
61200012	EAP	CPT® 72195		Mri Pelvis W/o Dye	BOTH IP/OP	"$4,089.00 "	"$3,025.86"	$143.36	"$3,269.60"	"$2,060.10"	"$2,060.10"	$224.08	$224.08	$225.34	$852.25	"$1,171.15"	"$1,171.15"	"$1,216.20"	$220.56	$852.15	$143.36	"$1,758.00"	"$1,758.00"	$233.72	"$1,043.00"	"$3,236.90"	"$3,269.60"	$324.73	$800.00	$324.73	$639.62	$194.85	$194.85	$650.65	$222.60	$0.00	$0.00	$0.00	$0.00
61200013	EAP	CPT® 72196		Mri Pelvis W/ Dye	BOTH IP/OP	"$4,633.00 "	"$3,428.42"	$226.19	"$3,704.80"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	$965.63	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	$965.52	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,162.00"	"$3,667.75"	"$3,704.80"	$537.70	$800.00	$537.70	$724.75	$226.19	$226.19	$737.26	$368.58	$0.00	$0.00	$0.00	$0.00
61200014	EAP	CPT® 72197		Mri Pelvis W&wo Dye	BOTH IP/OP	"$5,028.00 "	"$3,720.72"	$229.33	"$4,020.00"	"$2,060.10"	"$2,060.10"	$358.61	$358.61	$360.63	"$1,047.96"	"$1,171.15"	"$1,171.15"	"$1,216.20"	$352.81	"$1,047.84"	$229.33	"$1,758.00"	"$1,758.00"	$387.01	"$1,608.00"	"$3,979.80"	"$4,020.00"	$537.70	$800.00	$537.70	$786.41	$284.18	$284.18	$799.98	$368.58	$0.00	$0.00	$0.00	$0.00
61400000	EAP	CPT® 75565		Mr Cardiac Mri For Velocity Flow Mapping	BOTH IP/OP	"$2,506.00 "	"$1,854.44"	$0.00	"$2,060.10"	"$2,060.10"	"$2,060.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$522.25	$0.00	"$1,758.00"	"$1,758.00"	$0.00	$601.44	"$1,984.75"	"$2,004.80"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61800010	EAP	HCPCS C8902		"Mra W/o Fol W/cont, Abd, Cbc"	BOTH IP/OP	"$1,744.00 "	"$1,290.56"	$0.00	"$1,744.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$363.45	$0.00	"$1,744.00"	"$1,744.00"	$0.00	$872.00	"$1,381.25"	"$1,395.20"	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62200001	EAP	Custom 62200001		Intro Aortic Balloons	BOTH IP/OP	"$5,547.00 "	"$4,104.78"	$0.00	"$4,437.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,155.99"	$0.00	$0.00	$0.00	$0.00	"$2,773.50"	"$4,393.22"	"$4,437.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62300002	EAP	HCPCS A6234		Hydrocolloid Dsg 16 Sq In Or Less	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00	$27.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62300003	EAP	HCPCS A6235		Hydrocolloid Dsg more than 16sq in	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.30	$0.00	$0.00	$0.00	$0.00	$65.50	$103.75	$104.80	$0.00	$85.15	$0.00	$20.50	$0.00	$0.00	$20.86	$0.00	$0.00	$0.00	$0.00	$0.00
62300006	EAP	HCPCS A6196		Alginate Dressing <= 16 Sq In	BOTH IP/OP	$44.00 	$32.56	$0.00	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$0.00	$28.60	$0.00	$6.89	$0.00	$0.00	$7.00	$0.00	$0.00	$0.00	$0.00	$0.00
62400002	EAP	Custom 62400002		Trevo Retriever-ide#g100056	BOTH IP/OP	"$4,937.00 "	"$3,653.38"	$0.00	"$3,949.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,028.87"	$0.00	$0.00	$0.00	$0.00	"$2,468.50"	"$3,910.10"	"$3,949.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62400003	EAP	Custom 62400003		Trevo 18 Microcatheter-ide#g100056	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.47	$0.00	$0.00	$0.00	$0.00	$99.50	$157.61	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600011	EAP	CPT® 90670		PNEUMONIA VACCINE PREVNAR	BOTH IP/OP	$30.00 	$22.20	$4.38	$252.18	$13.50	$13.50	$7.80	$7.80	$230.14	$6.25	$22.27	$22.27	$23.12	$7.80	$30.00	$5.07	$17.75	$17.75	$4.38	$15.00	$23.76	$24.00	$4.38	$13.50	$4.38	$252.18	$7.80	$7.80	$240.12	$7.80	$0.00	$0.00	$0.00	$0.00
63600012	EAP	CPT® 90732		PNEUMONIA VACCINE PNEUMOVAX	BOTH IP/OP	$30.00 	$22.20	$4.38	$134.20	$13.50	$13.50	$7.80	$7.80	$119.92	$9.40	$22.27	$22.27	$23.12	$7.80	$30.00	$5.07	$17.75	$17.75	$4.38	$15.00	$23.76	$24.00	$4.38	$13.50	$4.38	$134.20	$7.80	$7.80	$127.78	$7.80	$0.00	$0.00	$0.00	$0.00
63600022	EAP	CPT® 90651		GARDASIL-9 VACCINE	BOTH IP/OP	$493.00 	$364.82	$0.00	$394.40	$221.85	$221.85	$0.00	$0.00	$229.60	$102.75	$365.90	$365.90	$380.00	$0.00	$297.98	$0.00	$291.61	$291.61	$0.00	$246.50	$390.46	$394.40	$295.80	$221.85	$295.80	$267.82	$0.00	$0.00	$255.01	$0.00	$0.00	$0.00	$0.00	$0.00
63600025	EAP	HCPCS J2182		Rx Eap Nucala Charge	BOTH IP/OP	$80.00 	$59.20	$0.00	"$5,945.60"	$36.00	$36.00	$28.69	$28.69	$28.69	$16.67	$59.38	$59.38	$61.66	$28.29	$33.24	$18.39	$47.32	$47.32	$31.21	"$3,716.00"	"$5,886.14"	"$5,945.60"	$43.09	$36.00	$43.09	$34.42	$0.00	$0.00	$32.77	$29.72	$0.00	$0.00	$0.00	$0.00
63600101	EAP	HCPCS A9562		Rad-99mtc Mag 3(ren)-pr	BOTH IP/OP	$784.00 	$580.16	$0.00	$509.60	$0.00	$0.00	$0.00	$0.00	$0.00	$163.41	$0.00	$0.00	$0.00	$0.00	$163.39	$0.00	$463.74	$463.74	$0.00	$175.00	$277.20	$280.00	$0.00	$509.60	$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
63600104	EAP	HCPCS J7197		Anti-thrombin Iii	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600112	EAP	HCPCS J0881		Darbepoetin Alfa 1	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$7.20	$7.20	$3.09	$3.09	$3.09	$3.60	$11.88	$11.88	$12.33	$3.15	$3.71	$2.05	$9.46	$9.46	$4.04	$8.00	$12.67	$12.80	$5.59	$7.20	$5.59	$4.49	$0.00	$0.00	$4.27	$3.79	$0.00	$0.00	$0.00	$0.00
63600116	EAP	HCPCS J7189		Factor 7a Novoseven	BOTH IP/OP	$5.00 	$3.70	$0.00	$4.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.71	$3.71	$3.85	$0.00	$1.04	$0.00	$0.00	$0.00	$0.00	$2.50	$3.96	$4.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600119	EAP	HCPCS A9552		Fdg Unit Dose (supp	BOTH IP/OP	"$1,722.00 "	"$1,274.28"	$0.00	"$1,377.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$358.91	$0.00	$0.00	$0.00	$0.00	$358.86	$0.00	"$1,018.56"	"$1,018.56"	$0.00	$861.00	"$1,363.82"	"$1,377.60"	$0.00	"$1,119.30"	$0.00	$227.28	$0.00	$0.00	$274.14	$0.00	$0.00	$0.00	$0.00	$0.00
63600120	EAP	HCPCS A9556		Ga-67 Gallium Citra	BOTH IP/OP	$169.00 	$125.06	$0.00	$109.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.22	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00	$109.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600122	EAP	HCPCS A9517		"I131 Therapy, 1mci"	BOTH IP/OP	$350.00 	$259.00	$0.00	$269.78	$190.05	$190.05	$20.12	$20.12	$20.12	$72.95	$259.77	$259.77	$269.78	$20.12	$72.94	$13.08	$207.03	$207.03	$21.80	$30.00	$47.52	$48.00	$30.10	$227.50	$30.10	$9.39	$0.00	$0.00	$9.55	$20.69	$0.00	$0.00	$0.00	$0.00
63600133	EAP	HCPCS J1885		Ketorolac 15mg Inj	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$15.30	$15.30	$0.00	$0.00	$0.00	$0.32	$25.23	$25.23	$26.21	$0.00	$0.57	$0.00	$20.11	$20.11	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
63600134	EAP	HCPCS J1885		Ketorolac 30mg	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$15.30	$15.30	$0.00	$0.00	$0.00	$0.32	$25.23	$25.23	$26.21	$0.00	$0.57	$0.00	$20.11	$20.11	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
63600138	EAP	HCPCS J0561		Penicillin G Benzathine Inj	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$13.50	$13.50	$15.04	$15.04	$15.04	$6.25	$22.27	$22.27	$23.12	$14.95	$17.57	$9.72	$17.75	$17.75	$14.51	$15.00	$23.76	$24.00	$20.04	$13.50	$20.04	$16.17	$0.00	$0.00	$15.39	$13.82	$0.00	$0.00	$0.00	$0.00
63600146	EAP	HCPCS Q9967		Locm 300-349mg/ml I	BOTH IP/OP	$2.00 	$1.48	$0.00	$1.60	$0.90	$0.90	$0.00	$0.00	$0.00	$0.42	$1.48	$1.48	$0.00	$0.00	$0.14	$0.00	$1.18	$1.18	$0.00	$1.00	$1.58	$1.60	$0.00	$0.00	$0.00	$0.13	$0.00	$0.00	$0.32	$0.00	$0.00	$0.00	$0.00	$0.00
63600170	EAP	HCPCS J0561		Penicillin G Benz L	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$71.10	$71.10	$15.04	$15.04	$15.04	$32.93	$117.27	$117.27	$121.79	$14.95	$17.57	$9.72	$93.46	$93.46	$14.51	$79.00	$125.14	$126.40	$20.04	$71.10	$20.04	$16.17	$0.00	$0.00	$15.39	$13.82	$0.00	$0.00	$0.00	$0.00
63600174	EAP	HCPCS J0561		Penicillin G Benz L	BOTH IP/OP	$159.00 	$117.66	$0.00	$127.20	$71.55	$71.55	$15.04	$15.04	$15.04	$33.14	$118.01	$118.01	$122.56	$14.95	$17.57	$9.72	$94.05	$94.05	$14.51	$79.50	$125.93	$127.20	$20.04	$0.00	$20.04	$16.17	$0.00	$0.00	$15.39	$13.82	$0.00	$0.00	$0.00	$0.00
63600182	EAP	HCPCS J2820		Sargramostim 50mcg	BOTH IP/OP	$174.00 	$128.76	$0.00	$139.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.14	$129.14	$134.12	$0.00	$58.18	$0.00	$0.00	$0.00	$0.00	$87.00	$137.81	$139.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600209	EAP	HCPCS A9551		Tc-99m Dmsa Nuc	BOTH IP/OP	"$1,886.00 "	"$1,395.64"	$0.00	"$1,225.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.04	$0.00	$0.00	$0.00	$0.00	$307.50	$487.08	$492.00	$0.00	"$1,225.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600210	EAP	HCPCS A9600		Sr-89 Therapy Radio	BOTH IP/OP	"$3,784.00 "	"$2,800.16"	$0.00	"$3,027.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,808.48"	"$2,808.48"	"$2,916.71"	$0.00	$788.59	$0.00	$0.00	$0.00	$0.00	"$1,892.00"	"$2,996.93"	"$3,027.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600211	EAP	HCPCS A9604		Sm 153 Lexidronam 5	BOTH IP/OP	"$48,815.00 "	"$36,123.10"	$0.00	"$37,626.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$37,626.60"	$0.00	"$10,173.05"	$0.00	$0.00	$0.00	$0.00	"$6,754.50"	"$10,699.13"	"$10,807.20"	$0.00	"$31,729.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600212	EAP	HCPCS A9548		In 111pentetate Dtp	BOTH IP/OP	"$7,022.00 "	"$5,196.28"	$0.00	"$4,564.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,463.38"	$0.00	$0.00	$0.00	$0.00	"$1,547.00"	"$2,450.45"	"$2,475.20"	$0.00	"$4,564.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600324	EAP	CPT® 90632		HEP A VACCINE	BOTH IP/OP	$72.00 	$53.28	$0.00	$72.00	$32.40	$32.40	$0.00	$0.00	$0.00	$56.67	$53.44	$53.44	$55.50	$0.00	$72.00	$0.00	$42.59	$42.59	$0.00	$36.00	$57.02	$57.60	$0.00	$32.40	$0.00	$70.39	$0.00	$0.00	$67.03	$0.00	$0.00	$0.00	$0.00	$0.00
63600325	EAP	CPT® 90633		HEPA VACCINE PED/ADOL 2 DOSE IM	BOTH IP/OP	$72.00 	$53.28	$0.00	$57.60	$32.40	$32.40	$0.00	$0.00	$0.00	$9.40	$53.44	$53.44	$55.50	$0.00	$15.00	$0.00	$42.59	$42.59	$0.00	$36.00	$57.02	$57.60	$0.00	$32.40	$0.00	$11.27	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$0.00
63600326	EAP	CPT® 90636		HEP A/B TWINRX VACCINE	BOTH IP/OP	$98.00 	$72.52	$0.00	$122.20	$44.10	$44.10	$0.00	$0.00	$0.00	$107.88	$72.74	$72.74	$75.54	$0.00	$98.00	$0.00	$57.97	$57.97	$0.00	$49.00	$77.62	$78.40	$0.00	$44.10	$0.00	$122.20	$0.00	$0.00	$116.36	$0.00	$0.00	$0.00	$0.00	$0.00
63600327	EAP	CPT® 90647		PEDVAXHIB VACCINE	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$17.10	$17.10	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00	$17.10	$0.00	$5.95	$0.00	$0.00	$6.05	$0.00	$0.00	$0.00	$0.00	$0.00
63600335	EAP	CPT® 90675		RABIES VACCINE	BOTH IP/OP	"$1,011.00 "	$748.14	$0.00	$808.80	$454.95	$454.95	$341.95	$341.95	$341.95	$174.76	$750.36	$750.36	$779.28	$327.53	$384.85	$212.90	$598.01	$598.01	$312.47	$505.50	$800.71	$808.80	$431.50	$0.00	$431.50	$326.44	$0.00	$0.00	$310.83	$294.72	$0.00	$0.00	$0.00	$0.00
63600336	EAP	CPT® 90680		ROTAVIRUS 3 DOSE VACCINE	BOTH IP/OP	$108.00 	$79.92	$0.00	$86.40	$48.60	$48.60	$0.00	$0.00	$0.00	$22.51	$80.16	$80.16	$83.25	$0.00	$22.51	$0.00	$63.88	$63.88	$0.00	$54.00	$85.54	$86.40	$0.00	$48.60	$0.00	$16.90	$0.00	$0.00	$17.19	$0.00	$0.00	$0.00	$0.00	$0.00
63600337	EAP	CPT® 90698		PENTACEL VACCINE	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.49	$96.49	$100.20	$0.00	$27.09	$0.00	$0.00	$0.00	$0.00	$65.00	$102.96	$104.00	$0.00	$84.50	$0.00	$20.35	$0.00	$0.00	$20.70	$0.00	$0.00	$0.00	$0.00	$0.00
63600338	EAP	CPT® 90700		DTAP VACCINE	BOTH IP/OP	$38.00 	$28.12	$0.00	$30.40	$17.10	$17.10	$0.00	$0.00	$0.00	$7.92	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$22.48	$22.48	$0.00	$19.00	$30.10	$30.40	$0.00	$17.10	$0.00	$5.95	$0.00	$0.00	$6.05	$0.00	$0.00	$0.00	$0.00	$0.00
63600344	EAP	CPT® 90707		MMR VACCINE	BOTH IP/OP	$83.00 	$61.42	$0.00	$92.45	$37.35	$37.35	$0.00	$0.00	$0.00	$11.75	$61.60	$61.60	$63.98	$0.00	$83.00	$0.00	$49.09	$49.09	$0.00	$41.50	$65.74	$66.40	$0.00	$37.35	$0.00	$92.45	$0.00	$0.00	$88.03	$0.00	$0.00	$0.00	$0.00	$0.00
63600346	EAP	CPT® 90710		MMRV VACCINE	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$8.55	$8.55	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$3.96	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$8.55	$0.00	$2.97	$0.00	$0.00	$3.02	$0.00	$0.00	$0.00	$0.00	$0.00
63600348	EAP	CPT® 90713		POLIO VACCINE	BOTH IP/OP	$32.00 	$23.68	$0.00	$32.00	$14.40	$14.40	$0.00	$0.00	$0.00	$9.40	$23.75	$23.75	$24.67	$0.00	$32.00	$0.00	$18.93	$18.93	$0.00	$16.00	$25.34	$25.60	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600349	EAP	CPT® 90714		TENIVAC VACCINE	BOTH IP/OP	$30.00 	$22.20	$0.00	$30.00	$13.50	$13.50	$0.00	$0.00	$0.00	$11.75	$22.27	$22.27	$23.12	$0.00	$30.00	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00	$13.50	$0.00	$29.50	$0.00	$0.00	$28.09	$0.00	$0.00	$0.00	$0.00	$0.00
63600350	EAP	CPT® 90715		TDAP VACCINE	BOTH IP/OP	$54.00 	$39.96	$0.00	$43.20	$24.30	$24.30	$0.00	$0.00	$0.00	$11.25	$40.08	$40.08	$41.62	$0.00	$42.06	$0.00	$31.94	$31.94	$0.00	$27.00	$42.77	$43.20	$0.00	$24.30	$0.00	$39.53	$0.00	$0.00	$37.64	$0.00	$0.00	$0.00	$0.00	$0.00
63600351	EAP	CPT® 90716		VARICELLA VACCINE	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$186.30	$186.30	$0.00	$0.00	$136.66	$9.40	$307.27	$307.27	$319.11	$0.00	$177.40	$0.00	$244.88	$244.88	$0.00	$207.00	$327.89	$331.20	$248.40	$186.30	$248.40	$159.48	$0.00	$0.00	$151.85	$0.00	$0.00	$0.00	$0.00	$0.00
63600355	EAP	CPT® 90723		DTAP HEPB VACCINE	BOTH IP/OP	$108.00 	$79.92	$0.00	$86.40	$48.60	$48.60	$0.00	$0.00	$79.00	$22.51	$80.16	$80.16	$83.25	$0.00	$22.51	$0.00	$63.88	$63.88	$0.00	$54.00	$85.54	$86.40	$64.80	$48.60	$64.80	$16.90	$0.00	$0.00	$17.19	$0.00	$0.00	$0.00	$0.00	$0.00
63600360	EAP	CPT® 90746		HEP B VACCINE ADULT 3 DOSE	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$103.50	$103.50	$59.80	$59.80	$69.65	$70.16	$170.71	$170.71	$177.28	$59.80	$81.84	$38.87	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$138.00	$103.50	$138.00	$78.80	$59.80	$59.80	$75.03	$59.80	$0.00	$0.00	$0.00	$0.00
63600374	EAP	HCPCS J0561		Penicillin G Benz La 1.2 Mu	BOTH IP/OP	$159.00 	$117.66	$0.00	$127.20	$71.55	$71.55	$15.04	$15.04	$15.04	$33.14	$118.01	$118.01	$122.56	$14.95	$17.57	$9.72	$94.05	$94.05	$14.51	$79.50	$125.93	$127.20	$20.04	$71.55	$20.04	$16.17	$0.00	$0.00	$15.39	$13.82	$0.00	$0.00	$0.00	$0.00
63600380	EAP	HCPCS J0131		"Acetaminophen, Iv 1000mg/100 Ml"	BOTH IP/OP	$58.00 	$42.92	$0.00	$46.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.05	$43.05	$44.71	$0.00	$12.09	$0.00	$0.00	$0.00	$0.00	$29.00	$45.94	$46.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600381	EAP	HCPCS J0461		"Atropine 0.4mg/ml,20 Ml"	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$95.58	$0.00	$0.09	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00	$0.00	$0.00	$0.09	$0.00	$0.00	$0.09	$0.00	$0.00	$0.00	$0.00	$0.00
63600382	EAP	HCPCS J0690		"Cefazolin Sodium, 1 Gm Vial"	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$7.20	$7.20	$0.00	$0.00	$0.00	$0.69	$11.88	$11.88	$12.33	$0.00	$0.88	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.96	$0.00	$0.00	$0.92	$0.00	$0.00	$0.00	$0.00	$0.00
63600383	EAP	HCPCS S0077		"Clindamycin Phosphate, 300 Mg"	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$17.55	$17.55	$0.00	$0.00	$1.35	$3.54	$28.95	$28.95	$30.06	$0.00	$1.66	$0.00	$23.07	$23.07	$0.00	$19.50	$30.89	$31.20	$23.40	$0.00	$23.40	$1.65	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$0.00
63600384	EAP	HCPCS J1100		"Dexamethasone,4mg/ml 5ml"	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$7.20	$7.20	$0.00	$0.00	$0.00	$0.11	$11.88	$11.88	$12.33	$0.00	$0.14	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$7.20	$0.00	$0.14	$0.00	$0.00	$0.13	$0.00	$0.00	$0.00	$0.00	$0.00
63600385	EAP	HCPCS J1200		Diphenhydramine  Hci  Up To 50 Mg	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$7.20	$7.20	$0.00	$0.00	$0.00	$0.86	$11.88	$11.88	$12.33	$0.00	$1.16	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$1.06	$0.00	$0.00	$1.01	$0.00	$0.00	$0.00	$0.00	$0.00
63600386	EAP	HCPCS J0171		"Epinephrine1 Mg/1 Ml, 30 Ml"	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60	$12.15	$12.15	$0.00	$0.00	$0.00	$5.63	$20.04	$20.04	$20.81	$0.00	$0.87	$0.00	$15.97	$15.97	$0.00	$13.50	$21.38	$21.60	$0.00	$0.00	$0.00	$0.96	$0.00	$0.00	$0.92	$0.00	$0.00	$0.00	$0.00	$0.00
63600387	EAP	HCPCS J1940		"Furosemide, Up To 20 Mg"	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$7.20	$7.20	$0.00	$0.00	$0.00	$0.25	$11.88	$11.88	$12.33	$0.00	$0.56	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
63600388	EAP	HCPCS J1644		"Heparin Sodium, Per 1000 Units/ml, 10 Ml"	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$7.20	$7.20	$0.00	$0.00	$0.00	$0.24	$11.88	$11.88	$12.33	$0.00	$0.29	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
63600389	EAP	HCPCS J0360		"Hydralazine  Hci, Up To 20 Mg"	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$21.15	$21.15	$0.00	$0.00	$0.00	$5.77	$34.88	$34.88	$36.23	$0.00	$6.11	$0.00	$27.80	$27.80	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$4.41	$0.00	$0.00	$4.20	$0.00	$0.00	$0.00	$0.00	$0.00
63600390	EAP	HCPCS J1720		"Hydrocortisone Sod Succ Up, To 100"	BOTH IP/OP	$19.00 	$14.06	$0.00	$17.40	$8.55	$8.55	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$17.40	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$15.33	$0.00	$0.00	$14.60	$0.00	$0.00	$0.00	$0.00	$0.00
63600391	EAP	HCPCS J1885		Ketorolac 60mg/2ml	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$7.20	$7.20	$0.00	$0.00	$0.00	$0.32	$11.88	$11.88	$12.33	$0.00	$0.57	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
63600392	EAP	HCPCS J2405		"Ondansetron Hci, Per 1mg"	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$7.20	$7.20	$0.00	$0.00	$0.00	$0.25	$11.88	$11.88	$12.33	$0.00	$0.11	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.11	$0.00	$0.00	$0.10	$0.00	$0.00	$0.00	$0.00	$0.00
63600393	EAP	HCPCS J2590		"Oxytocin, Up To 10 Units"	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$7.20	$7.20	$0.00	$0.00	$0.00	$1.47	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$2.50	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$0.00
63600394	EAP	HCPCS J2370		"Phenylephrine 10mg/ml, 1ml"	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$21.15	$21.15	$0.00	$0.00	$0.00	$0.96	$34.88	$34.88	$36.23	$0.00	$4.14	$0.00	$27.80	$27.80	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$4.31	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00
63600395	EAP	HCPCS J0330		"Succinylcholine Chloride, Up To 20 Mg/ml,10 Ml"	BOTH IP/OP	$33.00 	$24.42	$0.00	$26.40	$14.85	$14.85	$0.00	$0.00	$0.00	$6.88	$24.49	$24.49	$25.44	$0.00	$6.88	$0.00	$19.52	$19.52	$0.00	$16.50	$26.14	$26.40	$0.00	$0.00	$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
63600396	EAP	HCPCS J3370		Vancomycin 1gm Vial	BOTH IP/OP	$24.00 	$17.76	$0.00	$19.20	$10.80	$10.80	$0.00	$0.00	$0.00	$3.62	$17.81	$17.81	$18.50	$0.00	$3.34	$0.00	$14.20	$14.20	$0.00	$12.00	$19.01	$19.20	$0.00	$10.80	$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
63600402	EAP	HCPCS J2791		"Njx, Rho(d) Immune Globulin (human), (rhophylac)"	BOTH IP/OP	$534.00 	$395.16	$0.00	$427.20	$240.30	$240.30	$0.00	$0.00	$0.00	$111.30	$396.33	$396.33	$411.61	$0.00	$5.52	$0.00	$315.86	$315.86	$0.00	$267.00	$422.93	$427.20	$0.00	$240.30	$0.00	$0.00	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
63600404	EAP	HCPCS J7194		Factor 9	BOTH IP/OP	$2.00 	$1.48	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.48	$1.48	$1.54	$0.00	$0.42	$0.00	$0.00	$0.00	$0.00	$1.00	$1.58	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600405	EAP	HCPCS J2790		Rh Immune Globulin- 300 Mcg	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$58.95	$58.95	$0.00	$0.00	$0.00	$101.36	$97.23	$97.23	$100.97	$0.00	$88.76	$0.00	$77.49	$77.49	$0.00	$65.50	$103.75	$104.80	$0.00	$58.95	$0.00	$87.71	$0.00	$0.00	$83.52	$0.00	$0.00	$0.00	$0.00	$0.00
63600460	EAP	HCPCS J7189		Novoseven F7 1.0	BOTH IP/OP	"$5,380.00 "	"$3,981.20"	$0.00	"$4,304.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,993.04"	"$3,993.04"	"$4,146.90"	$0.00	"$1,121.19"	$0.00	$0.00	$0.00	$0.00	"$2,690.00"	"$4,260.96"	"$4,304.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600461	EAP	HCPCS J7189		Novoseven F7 2.0	BOTH IP/OP	"$10,222.00 "	"$7,564.28"	$0.00	"$8,177.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,586.77"	"$7,586.77"	"$7,879.12"	$0.00	"$2,130.26"	$0.00	$0.00	$0.00	$0.00	"$5,111.00"	"$8,095.82"	"$8,177.60"	$0.00	"$4,599.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63600462	EAP	CPT® 90734		MENVEO VACCINE	BOTH IP/OP	$410.00 	$303.40	$0.00	$328.00	$184.50	$184.50	$0.00	$0.00	$129.14	$9.40	$304.30	$304.30	$316.03	$0.00	$158.35	$0.00	$242.52	$242.52	$0.00	$205.00	$324.72	$328.00	$246.00	$184.50	$246.00	$143.71	$0.00	$0.00	$136.84	$0.00	$0.00	$0.00	$0.00	$0.00
63600467	EAP	CPT® 90620		MENINGITIS VACCINE	BOTH IP/OP	$569.62 	$421.52	$0.00	$455.70	$256.33	$256.33	$0.00	$0.00	$171.96	$118.72	$422.77	$422.77	$439.06	$0.00	$225.31	$0.00	$336.93	$336.93	$0.00	$284.81	$451.14	$455.70	$341.77	$256.33	$341.77	$200.63	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
63600526	EAP	HCPCS C9250		Kit Tiss Clsr 4ml Artiss Frzn Slnt	BOTH IP/OP	$811.00 	$600.14	$0.00	$648.80	$364.95	$364.95	$156.84	$156.84	$156.84	$169.03	$601.92	$601.92	$625.12	$156.84	$169.01	$101.95	$479.71	$479.71	$173.09	$405.50	$642.31	$648.80	$239.03	$0.00	$239.03	$126.92	$0.00	$0.00	$129.11	$164.85	$0.00	$0.00	$0.00	$0.00
63600527	EAP	HCPCS C9250		Kit Tiss Clsr 10ml Artiss Frzn Slnt	BOTH IP/OP	"$1,814.00 "	"$1,342.36"	$0.00	"$1,451.20"	$816.30	$816.30	$156.84	$156.84	$156.84	$378.08	"$1,346.35"	"$1,346.35"	"$1,398.23"	$156.84	$378.04	$101.95	$894.30	$894.30	$173.09	$907.00	"$1,436.69"	"$1,451.20"	$239.03	$0.00	$239.03	$283.89	$0.00	$0.00	$288.79	$164.85	$0.00	$0.00	$0.00	$0.00
63600528	EAP	HCPCS C9250		Kit Tiss Clsr 2ml Artiss Frzn Slnt	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$156.84	$156.84	$156.84	$99.00	$352.55	$352.55	$366.13	$156.84	$98.99	$101.95	$280.96	$280.96	$173.09	$237.50	$376.20	$380.00	$239.03	$0.00	$239.03	$74.34	$0.00	$0.00	$75.62	$164.85	$0.00	$0.00	$0.00	$0.00
63603027	EAP	HCPCS J1610		Glucagon 1 Mg	BOTH IP/OP	$415.00 	$307.10	$0.00	$332.00	$186.75	$186.75	$166.77	$166.77	$166.77	$88.07	$308.01	$308.01	$319.88	$171.74	$201.79	$111.63	$245.47	$245.47	$209.24	$207.50	$328.68	$332.00	$288.94	$0.00	$288.94	$255.63	$0.00	$0.00	$243.41	$199.13	$0.00	$0.00	$0.00	$0.00
63603176	EAP	HCPCS J2792		"Rho(d) Immune Globulin H, Sd  Winrho"	BOTH IP/OP	$215.00 	$159.10	$0.00	"$1,185.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.57	$159.57	$165.72	$0.00	$36.91	$0.00	$0.00	$0.00	$0.00	$741.00	"$1,173.74"	"$1,185.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63603287	EAP	CPT® 90634		HEPA VACCINE PED/ADOL-3 DOSE-IM	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$26.21	$0.00	$7.09	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63603296	EAP	CPT® 90696		DTAP IPV VACCINE	BOTH IP/OP	$185.00 	$136.90	$0.00	$148.00	$83.25	$83.25	$0.00	$0.00	$0.00	$38.56	$137.31	$137.31	$142.60	$0.00	$38.55	$0.00	$109.43	$109.43	$0.00	$92.50	$146.52	$148.00	$0.00	$83.25	$0.00	$28.95	$0.00	$0.00	$29.45	$0.00	$0.00	$0.00	$0.00	$0.00
63603300	EAP	CPT® 90747		HEP B VACCINE IMMUNOSUPRESSED	BOTH IP/OP	$100.00 	$74.00	$0.00	$157.59	$45.00	$45.00	$26.00	$26.00	$140.76	$140.32	$74.22	$74.22	$77.08	$26.00	$100.00	$16.90	$59.15	$59.15	$0.00	$50.00	$79.20	$80.00	$60.00	$45.00	$60.00	$157.59	$26.00	$26.00	$150.05	$26.00	$0.00	$0.00	$0.00	$0.00
63603301	EAP	CPT® 90744		HEP B VACCINE PED/ADULT 3 DOSE	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$45.00	$45.00	$26.00	$26.00	$28.21	$20.84	$74.22	$74.22	$77.08	$26.00	$20.84	$16.90	$59.15	$59.15	$0.00	$50.00	$79.20	$80.00	$60.00	$45.00	$60.00	$15.65	$26.00	$26.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00
63604091	EAP	HCPCS C9250		Kit Tiss Clsr Frzn Slnt Artiss 4ml	BOTH IP/OP	$836.00 	$618.64	$0.00	$668.80	$376.20	$376.20	$156.84	$156.84	$156.84	$174.24	$620.48	$620.48	$644.39	$156.84	$174.22	$101.95	$494.49	$494.49	$173.09	$418.00	$662.11	$668.80	$239.03	$376.20	$239.03	$130.83	$0.00	$0.00	$133.09	$164.85	$0.00	$0.00	$0.00	$0.00
63604093	EAP	CPT® 90648		HIBERIX VACCINE	BOTH IP/OP	$87.19 	$64.52	$0.00	$69.75	$39.24	$39.24	$0.00	$0.00	$0.00	$18.17	$64.71	$64.71	$67.21	$0.00	$18.17	$0.00	$51.57	$51.57	$0.00	$43.60	$69.05	$69.75	$0.00	$39.24	$0.00	$13.65	$0.00	$0.00	$13.88	$0.00	$0.00	$0.00	$0.00	$0.00
63690324	EAP	HCPCS J1050		Depo Provera Inject 1mg	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$22.50	$22.50	$0.00	$0.00	$0.00	$10.42	$37.11	$37.11	$38.54	$0.00	$0.67	$0.00	$29.58	$29.58	$0.00	$25.00	$39.60	$40.00	$0.00	$22.50	$0.00	$0.66	$0.00	$0.00	$0.63	$0.00	$0.00	$0.00	$0.00	$0.00
63690325	EAP	HCPCS J0696		Ceftriaxone Per 250 Mg	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$15.75	$15.75	$0.00	$0.00	$0.00	$1.41	$25.98	$25.98	$26.98	$0.00	$0.59	$0.00	$20.70	$20.70	$0.00	$17.50	$27.72	$28.00	$0.00	$15.75	$0.00	$0.71	$0.00	$0.00	$0.67	$0.00	$0.00	$0.00	$0.00	$0.00
63690332	EAP	HCPCS J0694		Cefoxitin 1gm Vial	BOTH IP/OP	$25.00 	$18.50	$0.00	$20.00	$11.25	$11.25	$0.00	$0.00	$0.00	$8.06	$18.56	$18.56	$19.27	$0.00	$5.42	$0.00	$14.79	$14.79	$0.00	$12.50	$19.80	$20.00	$0.00	$0.00	$0.00	$6.22	$0.00	$0.00	$5.92	$0.00	$0.00	$0.00	$0.00	$0.00
63690333	EAP	HCPCS J1200		Diphenhydramine 50 Mg/ml	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$7.20	$7.20	$0.00	$0.00	$0.00	$0.86	$11.88	$11.88	$12.33	$0.00	$1.16	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$1.06	$0.00	$0.00	$1.01	$0.00	$0.00	$0.00	$0.00	$0.00
63690334	EAP	HCPCS J0360		Hydralazine 20mg/1ml	BOTH IP/OP	$47.00 	$34.78	$0.00	$37.60	$21.15	$21.15	$0.00	$0.00	$0.00	$5.77	$34.88	$34.88	$36.23	$0.00	$6.11	$0.00	$27.80	$27.80	$0.00	$23.50	$37.22	$37.60	$0.00	$0.00	$0.00	$4.41	$0.00	$0.00	$4.20	$0.00	$0.00	$0.00	$0.00	$0.00
63690335	EAP	HCPCS J1720		Hydrocortisone Sod Succ 100mg Vial	BOTH IP/OP	$19.00 	$14.06	$0.00	$17.40	$8.55	$8.55	$0.00	$0.00	$0.00	$3.96	$14.10	$14.10	$14.65	$0.00	$17.40	$0.00	$11.24	$11.24	$0.00	$9.50	$15.05	$15.20	$0.00	$0.00	$0.00	$15.33	$0.00	$0.00	$14.60	$0.00	$0.00	$0.00	$0.00	$0.00
63690336	EAP	HCPCS J1885		Ketorolac 60 Mg/2ml	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$7.20	$7.20	$0.00	$0.00	$0.00	$0.32	$11.88	$11.88	$12.33	$0.00	$0.57	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
63690337	EAP	HCPCS J2590		Oxytocin 10unit/1ml	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$7.20	$7.20	$0.00	$0.00	$0.00	$1.47	$11.88	$11.88	$12.33	$0.00	$3.33	$0.00	$9.46	$9.46	$0.00	$8.00	$12.67	$12.80	$0.00	$0.00	$0.00	$2.50	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$0.00
63690341	EAP	CPT® 90656		Flu Vaccine Pf > 18 Yrs 2018-2019	BOTH IP/OP	$25.00 	$18.50	$0.00	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.56	$18.56	$19.27	$0.00	$5.21	$0.00	$0.00	$0.00	$3.65	$12.50	$19.80	$20.00	$3.65	$11.25	$3.65	$3.91	$6.50	$6.50	$3.98	$6.50	$0.00	$0.00	$0.00	$0.00
63690342	EAP	CPT® 90685		Flu Vaccine Pf 6-35 Months 2018-2019	BOTH IP/OP	$25.00 	$18.50	$3.65	$25.00	$11.25	$11.25	$6.50	$6.50	$21.13	$5.21	$18.56	$18.56	$19.27	$6.50	$25.00	$4.23	$14.79	$14.79	$3.65	$12.50	$19.80	$20.00	$3.65	$11.25	$3.65	$3.91	$6.50	$6.50	$3.98	$6.50	$0.00	$0.00	$0.00	$0.00
63690347	EAP	CPT® 90688		Flu Iiv4 Vaccine Splt 0.5ml Im (2018-2019)	BOTH IP/OP	$25.00 	$18.50	$0.00	$23.39	$11.25	$11.25	$6.50	$6.50	$19.17	$0.00	$18.56	$18.56	$19.27	$0.00	$23.39	$0.00	$0.00	$0.00	$3.65	$12.50	$19.80	$20.00	$3.65	$11.25	$3.65	$0.00	$6.50	$6.50	$19.96	$6.50	$0.00	$0.00	$0.00	$0.00
63690350	EAP	CPT® 90685		Flu Vaccine Pf 6m - 35m 2019-2020	BOTH IP/OP	$25.00 	$18.50	$3.65	$25.00	$11.25	$11.25	$6.50	$6.50	$21.13	$5.21	$18.56	$18.56	$19.27	$6.50	$25.00	$4.23	$14.79	$14.79	$3.65	$12.50	$19.80	$20.00	$3.65	$11.25	$3.65	$3.91	$6.50	$6.50	$3.98	$6.50	$0.00	$0.00	$0.00	$0.00
63690351	EAP	CPT® 90686		Flu Vaccine Pf 3 & Up 2019-2020	BOTH IP/OP	$25.00 	$18.50	$3.65	$24.12	$11.25	$11.25	$6.50	$6.50	$6.50	$5.21	$18.56	$18.56	$19.27	$6.50	$24.12	$4.23	$14.79	$14.79	$3.65	$12.50	$19.80	$20.00	$3.65	$11.25	$3.65	$22.36	$6.50	$6.50	$21.29	$6.50	$0.00	$0.00	$0.00	$0.00
63690355	EAP	CPT® 90674		2020-2021 FLU VACCINE	BOTH IP/OP	$25.00 	$18.50	$3.65	$33.05	$11.25	$11.25	$6.50	$6.50	$6.50	$5.21	$18.56	$18.56	$19.27	$6.50	$25.00	$4.23	$14.79	$14.79	$3.65	$12.50	$19.80	$20.00	$3.65	$11.25	$3.65	$33.05	$6.50	$6.50	$31.47	$6.50	$0.00	$0.00	$0.00	$0.00
63690358	EAP	CPT® 90686		2020-2021 FLU VACCINE	BOTH IP/OP	$25.00 	$18.50	$3.65	$24.12	$11.25	$11.25	$6.50	$6.50	$6.50	$5.21	$18.56	$18.56	$19.27	$6.50	$24.12	$4.23	$14.79	$14.79	$3.65	$12.50	$19.80	$20.00	$3.65	$11.25	$3.65	$22.36	$6.50	$6.50	$21.29	$6.50	$0.00	$0.00	$0.00	$0.00
63690360	EAP	CPT® 90681		ROTAVIRUS 2 DOSE VACCINE	BOTH IP/OP	$108.00 	$79.92	$0.00	$119.46	$48.60	$48.60	$0.00	$0.00	$119.46	$22.51	$80.16	$80.16	$83.25	$0.00	$22.51	$0.00	$63.88	$63.88	$0.00	$54.00	$85.54	$86.40	$64.80	$48.60	$64.80	$0.00	$0.00	$0.00	$17.19	$0.00	$0.00	$0.00	$0.00	$0.00
63690370	EAP	CPT® 90648		ACTHIB VACCINE	BOTH IP/OP	$71.00 	$52.54	$0.00	$56.80	$31.95	$31.95	$0.00	$0.00	$0.00	$14.80	$52.70	$52.70	$54.73	$0.00	$14.80	$0.00	$42.00	$42.00	$0.00	$35.50	$56.23	$56.80	$0.00	$31.95	$0.00	$11.11	$0.00	$0.00	$11.30	$0.00	$0.00	$0.00	$0.00	$0.00
68000010	EAP	Custom 68000010		Level 2 Partial Trauma Activation W/o Prenotificat	BOTH IP/OP	"$14,957.00 "	"$11,068.18"	$0.00	"$10,694.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,117.04"	$0.00	$0.00	$0.00	$0.00	"$6,181.50"	"$9,791.50"	"$9,890.40"	$0.00	"$10,694.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68000065	EAP	Custom 68000065		Level 1 Full Trauma Activation W/o Prenotification	BOTH IP/OP	"$27,981.00 "	"$20,705.94"	$0.00	"$20,006.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,831.24"	$0.00	$0.00	$0.00	$0.00	"$11,563.50"	"$18,316.58"	"$18,501.60"	$0.00	"$20,006.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68100003	EAP	Custom 68100003		Level 1 Full Trauma Activation	BOTH IP/OP	"$27,981.00 "	"$20,705.94"	$0.00	"$20,006.35"	"$5,630.00"	"$5,630.00"	$0.00	$0.00	$0.00	$0.00	"$4,447.44"	"$4,447.44"	"$4,618.49"	$0.00	"$5,831.24"	$0.00	"$5,671.00"	"$5,671.00"	$0.00	"$11,563.50"	"$18,316.58"	"$18,501.60"	$0.00	"$20,006.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68100004	EAP	Custom 68100004		Level 2 Partial Trauma Activation	BOTH IP/OP	"$14,957.00 "	"$11,068.18"	$0.00	"$10,694.45"	"$5,630.00"	"$5,630.00"	$0.00	$0.00	$0.00	$0.00	"$4,447.44"	"$4,447.44"	"$4,618.49"	$0.00	"$3,117.04"	$0.00	"$5,671.00"	"$5,671.00"	$0.00	"$6,181.50"	"$9,791.50"	"$9,890.40"	$0.00	"$10,694.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68100005	EAP	Custom 68100005		Level 3 Partial Trauma Activation	BOTH IP/OP	"$7,507.00 "	"$5,555.18"	$0.00	"$5,671.00"	"$5,630.00"	"$5,630.00"	$0.00	$0.00	$0.00	$0.00	"$4,447.44"	"$4,447.44"	"$4,618.49"	$0.00	"$1,564.46"	$0.00	"$5,671.00"	"$5,671.00"	$0.00	"$3,102.00"	"$4,913.57"	"$4,963.20"	$0.00	"$5,367.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70000001	EAP	CPT® 29035		"Apply Body Cast, Shldr To Hips"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,578.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	"$1,578.00"	"$1,249.78"	"$1,262.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70000002	EAP	CPT® 29040		Apply Body Cast Risser/minerva	BOTH IP/OP	"$1,062.00 "	$785.88	$0.00	"$1,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.32	$0.00	$0.00	$0.00	$0.00	"$1,188.00"	$940.90	$950.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70000003	EAP	CPT® 29065		Apply Long Arm Cast	BOTH IP/OP	"$1,466.00 "	"$1,084.84"	$0.00	"$1,750.00"	$796.04	$796.04	$234.93	$234.93	$236.25	$305.55	$0.00	$0.00	$0.00	$231.14	$305.51	$150.24	$113.00	$113.00	$230.50	"$1,380.00"	"$1,092.96"	"$1,104.00"	$320.24	"$1,750.00"	$320.24	$126.54	$70.29	$70.29	$219.70	$219.52	$0.00	$0.00	$0.00	$0.00
70000004	EAP	CPT® 29075		Apply Short Arm Cast	BOTH IP/OP	$943.00 	$697.82	$0.00	"$1,750.00"	$512.05	$512.05	$234.93	$234.93	$236.25	$196.54	$0.00	$0.00	$0.00	$231.14	$196.52	$150.24	$113.00	$113.00	$230.50	$888.00	$703.30	$710.40	$320.24	"$1,750.00"	$320.24	$110.88	$63.44	$63.44	$141.37	$219.52	$0.00	$0.00	$0.00	$0.00
70000005	EAP	CPT® 29105		Apply Long Arm Splint	BOTH IP/OP	$912.00 	$674.88	$0.00	$859.00	$495.22	$495.22	$137.58	$137.58	$138.36	$190.08	$0.00	$0.00	$0.00	$135.31	$190.06	$87.95	$113.00	$113.00	$134.13	$859.00	$680.33	$687.20	$186.36	$840.00	$186.36	$94.27	$43.63	$43.63	$136.75	$127.75	$0.00	$0.00	$0.00	$0.00
70000006	EAP	CPT® 29125		Apply Short Arm Splint Static	BOTH IP/OP	"$1,011.00 "	$748.14	$0.00	"$1,011.00"	$548.97	$548.97	$109.81	$109.81	$110.43	$210.72	$0.00	$0.00	$0.00	$107.30	$210.69	$69.74	$113.00	$113.00	$109.35	$952.00	$753.98	$761.60	$151.93	"$1,011.00"	$151.93	$72.40	$40.73	$40.73	$151.56	$104.14	$0.00	$0.00	$0.00	$0.00
70000007	EAP	CPT® 29305		"Apply Hip Spica Cast, One Leg"	BOTH IP/OP	$612.00 	$452.88	$0.00	$685.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.54	$0.00	$0.00	$0.00	$0.00	$685.00	$542.52	$548.00	$0.00	$608.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70000008	EAP	CPT® 29325		Apply Hip Spica Cast Both Legs	BOTH IP/OP	"$1,104.00 "	$816.96	$0.00	"$1,235.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.07	$0.00	$0.00	$0.00	$0.00	"$1,235.00"	$978.12	$988.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70000009	EAP	CPT® 29345		Apply Long Leg Cast	BOTH IP/OP	$838.00 	$620.12	$0.00	$838.00	$838.00	$838.00	$234.93	$234.93	$236.25	$174.66	$0.00	$0.00	$0.00	$231.14	$174.64	$150.24	$113.00	$113.00	$0.00	$789.00	$624.89	$631.20	$0.00	$838.00	$0.00	$170.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70000010	EAP	CPT® 29358		Apply Long Leg Cast Brace	BOTH IP/OP	"$1,062.00 "	$785.88	$0.00	"$1,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.32	$0.00	$0.00	$0.00	$0.00	"$1,188.00"	$940.90	$950.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70000011	EAP	CPT® 29365		Apply Cylinder Cast	BOTH IP/OP	"$1,312.00 "	$970.88	$0.00	"$1,235.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$273.45	$0.00	$0.00	$0.00	$231.14	$273.42	$150.24	$113.00	$113.00	$230.50	"$1,235.00"	$978.12	$988.00	$320.24	$604.00	$320.24	$144.43	$90.11	$90.11	$196.61	$219.52	$0.00	$0.00	$0.00	$0.00
70000012	EAP	CPT® 29405		Apply Short Leg Cast	BOTH IP/OP	$943.00 	$697.82	$0.00	"$1,366.00"	$512.05	$512.05	$234.93	$234.93	$236.25	$196.54	$0.00	$0.00	$0.00	$231.14	$196.52	$150.24	$113.00	$113.00	$230.50	$888.00	$703.30	$710.40	$320.24	"$1,366.00"	$320.24	$118.65	$60.92	$60.92	$141.37	$219.52	$0.00	$0.00	$0.00	$0.00
70000013	EAP	CPT® 29425		Apply Short Leg Cast Walking	BOTH IP/OP	"$1,403.00 "	"$1,038.22"	$0.00	"$1,321.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$292.39	$0.00	$0.00	$0.00	$230.50	"$1,321.00"	"$1,046.23"	"$1,056.80"	$320.24	$805.00	$320.24	$123.49	$57.32	$57.32	$210.30	$219.52	$0.00	$0.00	$0.00	$0.00
70000014	EAP	CPT® 29435		Apply Short Leg Cast Ptb	BOTH IP/OP	$794.00 	$587.56	$0.00	$888.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.47	$0.00	$0.00	$0.00	$0.00	$888.00	$703.30	$710.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70000015	EAP	CPT® 29445		"Long Leg Cast, Rigid"	BOTH IP/OP	"$1,935.00 "	"$1,431.90"	$0.00	"$1,822.00"	"$1,050.71"	"$1,050.71"	$234.93	$234.93	$236.25	$403.30	$0.00	$0.00	$0.00	$231.14	$403.25	$150.24	$113.00	$113.00	$230.50	"$1,822.00"	"$1,443.02"	"$1,457.60"	$320.24	"$1,750.00"	$320.24	$206.12	$106.00	$106.00	$290.06	$219.52	$0.00	$0.00	$0.00	$0.00
70000016	EAP	CPT® 29505		Apply Long Leg Splint	BOTH IP/OP	"$1,630.00 "	"$1,206.20"	$0.00	"$1,535.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$339.69	$0.00	$0.00	$0.00	$134.13	"$1,535.00"	"$1,215.72"	"$1,228.00"	$186.36	$940.00	$186.36	$94.49	$52.27	$52.27	$244.37	$127.75	$0.00	$0.00	$0.00	$0.00
70000017	EAP	CPT® 29515		Apply Short Leg Splint	BOTH IP/OP	$943.00 	$697.82	$0.00	$943.00	$512.05	$512.05	$137.58	$137.58	$138.36	$196.54	$0.00	$0.00	$0.00	$135.31	$196.52	$87.95	$113.00	$113.00	$134.13	$888.00	$703.30	$710.40	$186.36	$943.00	$186.36	$80.51	$51.19	$51.19	$141.37	$127.75	$0.00	$0.00	$0.00	$0.00
70000018	EAP	CPT® 29705		Removal Full Arm/leg Cast	BOTH IP/OP	$943.00 	$697.82	$0.00	$943.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.52	$0.00	$0.00	$0.00	$230.50	$888.00	$703.30	$710.40	$320.24	$943.00	$320.24	$51.73	$47.23	$47.23	$141.37	$219.52	$0.00	$0.00	$0.00	$0.00
70000019	EAP	CPT® 29730		Windowing Of Cast	BOTH IP/OP	$612.00 	$452.88	$0.00	$685.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.54	$0.00	$0.00	$0.00	$0.00	$685.00	$542.52	$548.00	$0.00	$322.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70000200	EAP	HCPCS C1725		Catheter Angio 100cm 4fr Sfvu Pgtl Curve Brd Strl	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00	$0.00	$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
70000217	EAP	HCPCS C1725		Catheter Angio Cbr 2 Curve 5fr 65cm Vscr Radiopq	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00	$0.00	$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
70000219	EAP	HCPCS C1757		Catheter Thrmb 135cm 5fr Unfs Flw-thru Hub Infus	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70000220	EAP	HCPCS C1757		Catheter Thrmb 135cm 5fr Unfs Flw-thru Hub Infus	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70000224	EAP	HCPCS C1725		Catheter Angio Ang Brnstn Curve 5fr 100cm 10cm	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00	$0.00	$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
70000225	EAP	HCPCS C1725		Catheter Angio Sos O2 Curve 5fr 80cm Vscr Radiopq	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$95.03	$95.03	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$134.89	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00	$113.75	$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
70000226	EAP	HCPCS C1725		Catheter Angio Cbr 2 Curve 4fr 65cm Vscr Radiopq	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00	$0.00	$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
70000584	EAP	HCPCS C1876		Stent Endoprsth Trchbr 90mm 16mm 9fr Mtl Wlstnt	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	"$1,734.30"	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00	$0.00	$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
70000587	EAP	HCPCS C1769		Guidewire Vasc 260cm .035in Flxb Flpy Tip Fltwr	BOTH IP/OP	"$2,653.00 "	"$1,963.22"	$0.00	"$2,122.40"	"$1,440.58"	"$1,440.58"	$0.00	$0.00	$0.00	$552.95	"$1,969.06"	"$1,969.06"	"$2,044.93"	$0.00	$552.89	$0.00	"$1,569.25"	"$1,569.25"	$0.00	"$1,326.50"	"$2,101.18"	"$2,122.40"	$0.00	$0.00	$0.00	$415.19	$0.00	$0.00	$422.36	$0.00	$0.00	$0.00	$0.00	$0.00
70000602	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Intmd Tip Radiopq X	BOTH IP/OP	"$1,075.00 "	$795.50	$0.00	$860.00	$583.73	$583.73	$0.00	$0.00	$0.00	$224.06	$797.87	$797.87	$828.61	$0.00	$224.03	$0.00	$635.86	$635.86	$0.00	$537.50	$851.40	$860.00	$0.00	$0.00	$0.00	$168.24	$0.00	$0.00	$171.14	$0.00	$0.00	$0.00	$0.00	$0.00
70000603	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Flpy Intmd Tip Radiopq	BOTH IP/OP	"$1,075.00 "	$795.50	$0.00	$860.00	$583.73	$583.73	$0.00	$0.00	$0.00	$224.06	$797.87	$797.87	$828.61	$0.00	$224.03	$0.00	$635.86	$635.86	$0.00	$537.50	$851.40	$860.00	$0.00	$0.00	$0.00	$168.24	$0.00	$0.00	$171.14	$0.00	$0.00	$0.00	$0.00	$0.00
70000626	EAP	HCPCS C1769		Guidewire Vasc 145cm .035in Flxb Flpy Tip Fltwr	BOTH IP/OP	$331.00 	$244.94	$0.00	$264.80	$179.73	$179.73	$0.00	$0.00	$0.00	$68.99	$245.67	$245.67	$255.13	$0.00	$68.98	$0.00	$195.79	$195.79	$0.00	$165.50	$262.15	$264.80	$0.00	$215.15	$0.00	$51.80	$0.00	$0.00	$52.70	$0.00	$0.00	$0.00	$0.00	$0.00
70000720	EAP	HCPCS C1769		Guidewire Vasc 260cm .035in Fix Core Flx Tp Hvdty	BOTH IP/OP	$74.00 	$54.76	$0.00	$59.20	$0.00	$0.00	$0.00	$0.00	$0.00	$15.42	$0.00	$0.00	$0.00	$0.00	$15.42	$0.00	$43.77	$43.77	$0.00	$37.00	$58.61	$59.20	$0.00	$0.00	$0.00	$11.58	$0.00	$0.00	$11.78	$0.00	$0.00	$0.00	$0.00	$0.00
70000762	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Trnb Ad Bcn Jb1 Curve Ss	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.50	$49.90	$50.40	$0.00	$0.00	$0.00	$9.86	$0.00	$0.00	$10.03	$0.00	$0.00	$0.00	$0.00	$0.00
70000764	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Trnb Ad Bcn Sim2 Curve Ss	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.50	$247.90	$250.40	$0.00	$0.00	$0.00	$48.98	$0.00	$0.00	$49.83	$0.00	$0.00	$0.00	$0.00	$0.00
70000820	EAP	HCPCS C1773		Set Rtrvl 80cm 6.3fr 11fr Gnth Tlp Coons Vc 3w	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$339.38	$339.38	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$481.75	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00	$0.00	$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
70000823	EAP	HCPCS C1769		Guidewire Vasc 60cm .018in Flpy Sftp Ang Tpr 7cm	BOTH IP/OP	$98.00 	$72.52	$0.00	$76.00	$53.21	$53.21	$0.00	$0.00	$0.00	$19.80	$72.74	$72.74	$75.54	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00	$63.70	$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
70000977	EAP	HCPCS C1887		Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr Ar2	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$50.50	$50.50	$0.00	$0.00	$0.00	$19.38	$69.02	$69.02	$71.68	$0.00	$19.38	$0.00	$55.01	$55.01	$0.00	$46.50	$73.66	$74.40	$0.00	$0.00	$0.00	$14.55	$0.00	$0.00	$14.81	$0.00	$0.00	$0.00	$0.00	$0.00
70000983	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Shr Nx Act Mp1 Curve Peri	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70000997	EAP	HCPCS C1887		Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr Jr4st	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$50.50	$50.50	$0.00	$0.00	$0.00	$19.38	$69.02	$69.02	$71.68	$0.00	$19.38	$0.00	$55.01	$55.01	$0.00	$46.50	$73.66	$74.40	$0.00	$0.00	$0.00	$14.55	$0.00	$0.00	$14.81	$0.00	$0.00	$0.00	$0.00	$0.00
70000998	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Ar1 Curve Coron	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001000	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Std Jl3.5 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001001	EAP	HCPCS C1887		Catheter Guid 7fr Shr Nx Bal Std Jr3.5 Curve Coron	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001003	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Std Jl5 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001005	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Std Jr5 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001006	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Mp1 Curve Peri	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001013	EAP	HCPCS C1887		Catheter Guid 7fr Shr Nx Bal Std Jr4 Curve Coron	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001014	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Ima Curve Peri	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001028	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Shr Nx Bal Ar1 Curve Coron	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001029	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Shr Nx Bal Std Jl4 Curve	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$64.07	$64.07	$0.00	$0.00	$0.00	$24.59	$87.58	$87.58	$90.95	$0.00	$24.59	$0.00	$69.80	$69.80	$0.00	$59.00	$93.46	$94.40	$0.00	$0.00	$0.00	$18.47	$0.00	$0.00	$18.79	$0.00	$0.00	$0.00	$0.00	$0.00
70001030	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Shr Nx Bal Std Jr4 Curve	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$64.07	$64.07	$0.00	$0.00	$0.00	$24.59	$87.58	$87.58	$90.95	$0.00	$24.59	$0.00	$69.80	$69.80	$0.00	$59.00	$93.46	$94.40	$0.00	$0.00	$0.00	$18.47	$0.00	$0.00	$18.79	$0.00	$0.00	$0.00	$0.00	$0.00
70001041	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Std Jl4 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001043	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Std Jr4 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001045	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Shr Nx Bal Al1 Curve Coron	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$64.07	$64.07	$0.00	$0.00	$0.00	$24.59	$87.58	$87.58	$90.95	$0.00	$24.59	$0.00	$69.80	$69.80	$0.00	$59.00	$93.46	$94.40	$0.00	$0.00	$0.00	$18.47	$0.00	$0.00	$18.79	$0.00	$0.00	$0.00	$0.00	$0.00
70001047	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Al1 Curve Coron	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001048	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Shr Nx Bal Std Jl4 Curve	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$64.07	$64.07	$0.00	$0.00	$0.00	$24.59	$87.58	$87.58	$90.95	$0.00	$24.59	$0.00	$69.80	$69.80	$0.00	$59.00	$93.46	$94.40	$0.00	$76.70	$0.00	$18.47	$0.00	$0.00	$18.79	$0.00	$0.00	$0.00	$0.00	$0.00
70001049	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Shr Nx Bal Std Jr4 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$105.95	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001050	EAP	HCPCS C1887		Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr Xb3	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$50.50	$50.50	$0.00	$0.00	$0.00	$19.38	$69.02	$69.02	$71.68	$0.00	$19.38	$0.00	$55.01	$55.01	$0.00	$46.50	$73.66	$74.40	$0.00	$0.00	$0.00	$14.55	$0.00	$0.00	$14.81	$0.00	$0.00	$0.00	$0.00	$0.00
70001051	EAP	HCPCS C1887		Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr Xb3.5	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$50.50	$50.50	$0.00	$0.00	$0.00	$19.38	$69.02	$69.02	$71.68	$0.00	$19.38	$0.00	$55.01	$55.01	$0.00	$46.50	$73.66	$74.40	$0.00	$0.00	$0.00	$14.55	$0.00	$0.00	$14.81	$0.00	$0.00	$0.00	$0.00	$0.00
70001053	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Shr Nx Bal Std Jl3.5 Curve	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$24.59	$0.00	$0.00	$0.00	$0.00	$24.59	$0.00	$69.80	$69.80	$0.00	$59.00	$93.46	$94.40	$0.00	$0.00	$0.00	$18.47	$0.00	$0.00	$18.79	$0.00	$0.00	$0.00	$0.00	$0.00
70001054	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Shr Nx Bal Al2 Curve Coron	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001055	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Shr Nx Bal Std Jr3.5 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001056	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Shr Nx Bal Al.75 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001057	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Al.75 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
70001234	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Sft Rbn Tip Kink Rst	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
70001408	EAP	HCPCS C1757		Snare Vasc 120cm 9-15mm 6fr Ensnr Std 3 Prefrm	BOTH IP/OP	$828.00 	$612.72	$0.00	$662.40	$449.60	$449.60	$0.00	$0.00	$0.00	$172.58	$614.54	$614.54	$638.22	$0.00	$172.56	$0.00	$489.76	$489.76	$0.00	$414.00	$655.78	$662.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70001510	EAP	HCPCS L0625		Support Orthopedic Universal Binder Velcro Closure Yellow	BOTH IP/OP	$538.00 	$398.12	$0.00	$430.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$399.30	$399.30	$414.69	$0.00	$112.12	$0.00	$0.00	$0.00	$0.00	$269.00	$426.10	$430.40	$0.00	$349.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000014	EAP	Custom 71000014		PHASE II RECOVERY < 6HRS	BOTH IP/OP	"$2,822.00 "	"$2,088.28"	$0.00	"$2,175.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,094.49"	"$2,094.49"	"$2,175.20"	$0.00	$588.10	$0.00	$0.00	$0.00	$0.00	"$1,245.50"	"$1,972.87"	"$1,992.80"	$0.00	"$1,980.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000033	EAP	Custom 71000033		Phase Ii Recovery > 6hrs	BOTH IP/OP	"$4,229.00 "	"$3,129.46"	$0.00	"$3,259.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,138.76"	"$3,138.76"	"$3,259.71"	$0.00	$881.32	$0.00	$0.00	$0.00	$0.00	"$1,866.50"	"$2,956.54"	"$2,986.40"	$0.00	"$2,968.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000040	EAP	Custom 71000040		Level 1 1st 30 Min	BOTH IP/OP	"$2,001.00 "	"$1,480.74"	$0.00	"$1,542.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,485.14"	"$1,485.14"	"$1,542.37"	$0.00	$417.01	$0.00	$0.00	$0.00	$0.00	$883.00	"$1,398.67"	"$1,412.80"	$0.00	"$1,404.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000041	EAP	Custom 71000041		Level 2 1st 30 Min	BOTH IP/OP	"$2,403.00 "	"$1,778.22"	$0.00	"$1,852.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,783.51"	"$1,783.51"	"$1,852.23"	$0.00	$500.79	$0.00	$0.00	$0.00	$0.00	"$1,060.50"	"$1,679.83"	"$1,696.80"	$0.00	"$1,686.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000042	EAP	Custom 71000042		Level 3 1st 30 Min	BOTH IP/OP	"$3,201.00 "	"$2,368.74"	$0.00	"$2,467.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,375.78"	"$2,375.78"	"$2,467.33"	$0.00	$667.09	$0.00	$0.00	$0.00	$0.00	"$1,412.50"	"$2,237.40"	"$2,260.00"	$0.00	"$2,247.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000043	EAP	Custom 71000043		Level 4 1st 30 Min	BOTH IP/OP	"$3,467.00 "	"$2,565.58"	$0.00	"$2,672.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,573.21"	"$2,573.21"	"$2,672.36"	$0.00	$722.52	$0.00	$0.00	$0.00	$0.00	"$1,530.00"	"$2,423.52"	"$2,448.00"	$0.00	"$2,433.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000044	EAP	Custom 71000044		Level 5 1st 30 Min	BOTH IP/OP	"$4,801.00 "	"$3,552.74"	$0.00	"$3,700.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,563.30"	"$3,563.30"	"$3,700.61"	$0.00	"$1,000.53"	$0.00	$0.00	$0.00	$0.00	"$2,118.50"	"$3,355.70"	"$3,389.60"	$0.00	"$3,370.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000045	EAP	Custom 71000045		Level 1 Add 15 Min	BOTH IP/OP	"$1,049.00 "	$776.26	$0.00	$808.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$778.57	$778.57	$808.57	$0.00	$218.61	$0.00	$0.00	$0.00	$0.00	$462.50	$732.60	$740.00	$0.00	$736.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000046	EAP	Custom 71000046		Level 2 Add 15 Min	BOTH IP/OP	"$1,261.00 "	$933.14	$0.00	$971.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$935.91	$935.91	$971.98	$0.00	$262.79	$0.00	$0.00	$0.00	$0.00	$556.50	$881.50	$890.40	$0.00	$884.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000047	EAP	Custom 71000047		Level 3 Add 15 Min	BOTH IP/OP	"$1,678.00 "	"$1,241.72"	$0.00	"$1,293.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,245.41"	"$1,245.41"	"$1,293.40"	$0.00	$349.70	$0.00	$0.00	$0.00	$0.00	$740.50	"$1,172.95"	"$1,184.80"	$0.00	"$1,177.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000048	EAP	Custom 71000048		Level 4 Add 15 Min	BOTH IP/OP	"$1,823.00 "	"$1,349.02"	$0.00	"$1,405.17"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,353.03"	"$1,353.03"	"$1,405.17"	$0.00	$379.91	$0.00	$0.00	$0.00	$0.00	$804.50	"$1,274.33"	"$1,287.20"	$0.00	"$1,279.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000049	EAP	Custom 71000049		Level 5 Add 15 Min	BOTH IP/OP	"$2,521.00 "	"$1,865.54"	$0.00	"$1,943.19"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,871.09"	"$1,871.09"	"$1,943.19"	$0.00	$525.38	$0.00	$0.00	$0.00	$0.00	"$1,112.50"	"$1,762.20"	"$1,780.00"	$0.00	"$1,769.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000050	EAP			Gi Procedure Recovery	BOTH IP/OP	$636.00 	$470.64	$0.00	$490.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$472.04	$472.04	$490.23	$0.00	$132.54	$0.00	$0.00	$0.00	$0.00	$280.50	$444.31	$448.80	$0.00	$445.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000051	EAP			Cardiology Recovery	BOTH IP/OP	$636.00 	$470.64	$0.00	$490.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$472.04	$472.04	$490.23	$0.00	$132.54	$0.00	$0.00	$0.00	$0.00	$280.50	$444.31	$448.80	$0.00	$445.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000133	EAP	Custom 71000133		Phase Ii Recovery > 6hrs	BOTH IP/OP	"$3,435.00 "	"$2,541.90"	$0.00	"$3,080.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,549.46"	"$2,549.46"	"$2,647.70"	$0.00	$715.85	$0.00	$0.00	$0.00	$0.00	"$1,925.50"	"$3,049.99"	"$3,080.80"	$0.00	"$2,410.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71000134	EAP			Ir Recovery	BOTH IP/OP	$636.00 	$470.64	$0.00	$490.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$472.04	$472.04	$490.23	$0.00	$132.54	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00	$445.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71900020	EAP	Custom 71900020		Extended Recovery 1st 30 Mins	BOTH IP/OP	"$1,308.00 "	$967.92	$0.00	"$1,172.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$970.80	$970.80	"$1,008.21"	$0.00	$272.59	$0.00	$0.00	$0.00	$0.00	$733.00	"$1,161.07"	"$1,172.80"	$0.00	$917.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71900021	EAP	Custom 71900021		Extended Recovery Ea Addtl 15 Mins	BOTH IP/OP	$739.00 	$546.86	$0.00	$662.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$548.49	$548.49	$569.62	$0.00	$154.01	$0.00	$0.00	$0.00	$0.00	$414.00	$655.78	$662.40	$0.00	$518.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72000001	EAP	CPT® 59030		Fetal Scalp Blood	BOTH IP/OP	"$1,104.00 "	$816.96	$0.00	"$1,115.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.07	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	$883.08	$892.00	$0.00	"$1,104.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72000006	EAP	CPT® 59612		Vaginal Delivery After Prior Cesarean Delivery	BOTH IP/OP	"$8,307.00 "	"$6,147.18"	$0.00	"$6,645.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,731.18"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,579.14"	"$6,645.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72200001	EAP	CPT® 59409		Vaginal Delivery Only Complica	BOTH IP/OP	"$6,614.00 "	"$4,894.36"	$0.00	"$4,877.00"	"$2,321.55"	"$2,321.55"	"$2,555.04"	"$2,555.04"	"$2,569.43"	"$1,378.52"	$0.00	$0.00	$0.00	"$2,514.14"	"$1,378.36"	"$1,634.19"	"$4,877.00"	"$4,877.00"	$0.00	"$2,255.00"	"$4,210.27"	"$4,252.80"	$0.00	"$3,250.00"	$0.00	$892.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72200002	EAP	CPT® 59409		Vaginal Delivery Only Uncompl.	BOTH IP/OP	"$6,435.00 "	"$4,761.90"	$0.00	"$4,877.00"	"$2,321.55"	"$2,321.55"	"$2,555.04"	"$2,555.04"	"$2,569.43"	"$1,341.21"	$0.00	$0.00	$0.00	"$2,514.14"	"$1,341.05"	"$1,634.19"	"$4,877.00"	"$4,877.00"	$0.00	"$2,255.00"	"$3,374.71"	"$3,408.80"	$0.00	"$3,250.00"	$0.00	$892.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73000001	EAP	CPT® 93005		Ekg	BOTH IP/OP	$606.00 	$448.44	$8.64	$467.10	$18.80	$18.80	$54.21	$54.21	$54.51	$126.31	$449.77	$449.77	$467.10	$53.35	$126.29	$34.67	$358.45	$358.45	$55.17	$245.00	$388.08	$392.00	$76.65	$394.55	$76.65	$17.51	$8.64	$8.64	$78.01	$52.54	$0.00	$0.00	$0.00	$0.00
73000007	EAP	CPT® 93041		"Rhythm Ecg, Tracing"	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.31	$42.31	$43.94	$0.00	$11.88	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73000010	EAP	CPT® 93041		Ekg Rhythm Strip 3 Lead	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.31	$42.31	$43.94	$0.00	$11.88	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73000011	EAP	CPT® 93017		Cardiac Stress Test	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$34.22	"$2,896.80"	$86.88	$86.88	$257.73	$257.73	$259.18	$747.20	"$2,660.79"	"$2,660.79"	"$2,763.32"	$253.45	$747.11	$164.75	"$2,120.53"	"$2,120.53"	$253.05	"$1,810.50"	"$2,867.83"	"$2,896.80"	$351.58	"$2,330.25"	$351.58	$64.64	$34.22	$34.22	$576.46	$241.00	$0.00	$0.00	$0.00	$0.00
73100001	EAP	CPT® 93225		"Ecg Monitoring, Continuous"	BOTH IP/OP	"$1,032.00 "	$763.68	$25.93	$820.80	$58.71	$58.71	$109.81	$109.81	$110.43	$215.09	$765.95	$765.95	$795.47	$107.30	$215.07	$69.74	$610.43	$610.43	$109.35	$513.00	$812.59	$820.80	$151.93	$594.75	$151.93	$47.49	$25.93	$25.93	$163.34	$104.14	$0.00	$0.00	$0.00	$0.00
73100002	EAP	CPT® 93226		Ecg Monitoring Analysis&report	BOTH IP/OP	"$1,644.00 "	"$1,216.56"	$0.00	"$1,315.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,220.18"	"$1,220.18"	"$1,267.20"	$0.00	$342.61	$0.00	$0.00	$0.00	$0.00	$822.00	"$1,302.05"	"$1,315.20"	$0.00	$752.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73100003	EAP	CPT® 93270		Cardiac Event Recording	BOTH IP/OP	$709.00 	$524.66	$9.00	$572.80	$20.35	$20.35	$36.26	$36.26	$36.47	$147.77	$526.22	$526.22	$546.50	$35.61	$147.76	$23.14	$419.37	$419.37	$36.36	$358.00	$567.07	$572.80	$50.51	$206.05	$50.51	$47.49	$9.00	$9.00	$113.99	$34.63	$0.00	$0.00	$0.00	$0.00
73100004	EAP	CPT® 93271		Cardiac Event Analysis	BOTH IP/OP	$716.00 	$529.84	$0.00	$572.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$531.42	$531.42	$551.89	$0.00	$149.21	$0.00	$0.00	$0.00	$0.00	$358.00	$567.07	$572.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73100005	EAP	CPT® 0296T		Ext Ecg > 48hr To 21 Day Rcrd W/conect Intl Rcrd	BOTH IP/OP	$681.00 	$503.94	$0.00	$656.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$656.00	$519.55	$524.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000001	EAP	CPT® 95812		Eeg Up To 1 Hour	BOTH IP/OP	$835.00 	$617.90	$0.00	$643.62	$453.41	$453.41	$257.73	$257.73	$259.18	$174.03	$619.74	$619.74	$643.62	$253.45	$174.01	$164.75	$493.90	$493.90	$0.00	$312.50	$495.00	$500.00	$0.00	$542.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000002	EAP	CPT® 95813		Eeg Extended Monitoring 61-119 Minutes	BOTH IP/OP	"$1,873.00 "	"$1,386.02"	$0.00	"$1,443.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,390.14"	"$1,390.14"	"$1,443.71"	$0.00	$390.33	$0.00	$0.00	$0.00	$0.00	$854.50	"$1,353.53"	"$1,367.20"	$0.00	"$1,217.45"	$0.00	$183.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000003	EAP	CPT® 95816		"Eeg, Awake And Drowsy"	BOTH IP/OP	"$1,050.00 "	$777.00	$124.97	"$1,109.55"	$570.15	$570.15	$257.73	$257.73	$259.18	$218.85	$779.31	$779.31	$809.34	$253.45	$218.82	$164.75	$621.08	$621.08	$253.05	$392.50	$621.72	$628.00	$351.58	"$1,109.55"	$351.58	$128.39	$311.91	$311.91	$124.97	$241.00	$0.00	$0.00	$0.00	$0.00
74000004	EAP	CPT® 95819		"Eeg, W/awake & Asleep Record"	BOTH IP/OP	"$1,794.00 "	"$1,327.56"	$110.11	"$1,382.82"	$974.14	$974.14	$257.73	$257.73	$259.18	$373.91	"$1,331.51"	"$1,331.51"	"$1,382.82"	$253.45	$373.87	$164.75	"$1,061.15"	"$1,061.15"	$253.05	$818.50	"$1,296.50"	"$1,309.60"	$351.58	"$1,208.35"	$351.58	$110.11	$381.06	$381.06	$260.61	$241.00	$0.00	$0.00	$0.00	$0.00
74000005	EAP	CPT® 95822		"Eeg, Sleep Only"	BOTH IP/OP	"$1,752.00 "	"$1,296.48"	$0.00	"$1,565.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,300.33"	"$1,300.33"	"$1,350.44"	$0.00	$365.12	$0.00	$0.00	$0.00	$0.00	$655.50	"$1,038.31"	"$1,048.80"	$0.00	"$1,565.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000009	EAP	CPT® 92585		Ssep Ue	BOTH IP/OP	"$1,264.00 "	$935.36	$0.00	"$1,011.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.00	"$1,001.09"	"$1,011.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000011	EAP	CPT® 95930		Vep	BOTH IP/OP	"$1,158.00 "	$856.92	$0.00	$957.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$859.47	$859.47	$892.59	$0.00	$241.33	$0.00	$0.00	$0.00	$0.00	$598.50	$948.02	$957.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000012	EAP	CPT® 95938		Ssep 4 Ext	BOTH IP/OP	$768.00 	$568.32	$0.00	"$4,513.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$570.01	$570.01	$591.97	$0.00	$160.05	$0.00	$0.00	$0.00	$0.00	$287.50	$455.40	$460.00	$0.00	"$4,513.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000013	EAP	CPT® 95929		Cmep Lower Limbs	BOTH IP/OP	$981.00 	$725.94	$0.00	$811.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$728.10	$728.10	$756.15	$0.00	$204.44	$0.00	$0.00	$0.00	$0.00	$507.00	$803.09	$811.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000014	EAP	CPT® 95939		Cmep Upper Limbs	BOTH IP/OP	"$1,351.00 "	$999.74	$0.00	"$1,041.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,002.71"	"$1,002.71"	"$1,041.35"	$0.00	$281.55	$0.00	$0.00	$0.00	$0.00	$505.50	$800.71	$808.80	$0.00	$878.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000015	EAP	CPT® 95940		Intraoperative Monitoring Neuro In Or Ea 15 Min	BOTH IP/OP	"$4,241.00 "	"$3,138.34"	$0.00	"$3,268.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,147.67"	"$3,147.67"	"$3,268.96"	$0.00	$883.82	$0.00	$0.00	$0.00	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00	"$2,756.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000017	EAP	CPT® 95961		Functional Cortical Mapping By Intra Operative Stimulation Initial Hr	BOTH IP/OP	$905.00 	$669.70	$0.00	$771.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$671.69	$671.69	$697.57	$0.00	$188.60	$0.00	$0.00	$0.00	$0.00	$482.00	$763.49	$771.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000018	EAP	CPT® 95962		Functional Monitor By Stimulation Ea Add'l Hour	BOTH IP/OP	$661.00 	$489.14	$0.00	$563.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$490.59	$490.59	$509.50	$0.00	$137.75	$0.00	$0.00	$0.00	$0.00	$352.00	$557.57	$563.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000019	EAP	CPT® 92585		Baer Auditory Evoked Potentials For Evoked Response Ans Or Testing Cns	BOTH IP/OP	$967.00 	$715.58	$0.00	$773.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.50	$765.86	$773.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000020	EAP	CPT® 95958		Eeg Monitoring/function Test	BOTH IP/OP	"$1,943.00 "	"$1,437.82"	$0.00	"$1,607.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,442.09"	"$1,442.09"	"$1,497.66"	$0.00	$404.92	$0.00	$0.00	$0.00	$0.00	"$1,004.50"	"$1,591.13"	"$1,607.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000021	EAP	CPT® 95958		Eeg Hemisphere Function (wada)	BOTH IP/OP	"$1,943.00 "	"$1,437.82"	$0.00	"$1,607.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,442.09"	"$1,442.09"	"$1,497.66"	$0.00	$404.92	$0.00	$0.00	$0.00	$0.00	"$1,004.50"	"$1,591.13"	"$1,607.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000030	EAP	CPT® 95941		Ionm Remote/nearby/>1 Patient In Or Per Hour	BOTH IP/OP	"$3,680.00 "	"$2,723.20"	$0.00	"$2,836.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,731.30"	"$2,731.30"	"$2,836.54"	$0.00	$766.91	$0.00	$0.00	$0.00	$0.00	"$1,679.00"	"$2,659.54"	"$2,686.40"	$0.00	$576.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000050	EAP	CPT® 95700		EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS	BOTH IP/OP	"$4,241.00 "	"$3,138.34"	$0.00	"$3,268.96"	"$2,302.86"	"$2,302.86"	$257.73	$257.73	$259.18	$883.93	"$3,147.67"	"$3,147.67"	"$3,268.96"	$253.45	$883.82	$164.75	"$2,508.55"	"$2,508.55"	$253.05	"$1,935.00"	"$3,065.04"	"$3,096.00"	$351.58	"$2,756.65"	$351.58	$605.66	$0.00	$0.00	$616.10	$241.00	$0.00	$0.00	$0.00	$0.00
74000052	EAP	CPT® 95706		Eeg W/o Video (ceribell) 2-12 Hr Intermittent Mntr	BOTH IP/OP	"$4,241.00 "	"$3,138.34"	$0.00	"$3,268.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,147.67"	"$3,147.67"	"$3,268.96"	$0.00	$883.82	$0.00	$0.00	$0.00	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00	"$1,589.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000054	EAP	CPT® 95708		Eeg W/o Vid By Tech Ea Incr 12-26hr Unmonitored	BOTH IP/OP	"$6,903.00 "	"$5,108.22"	$0.00	"$5,320.83"	"$3,748.33"	"$3,748.33"	$475.36	$475.36	$478.04	"$1,438.76"	"$4,181.12"	"$4,181.12"	"$5,320.83"	$467.50	"$1,438.59"	$303.87	"$3,094.73"	"$3,094.73"	$487.04	"$3,150.00"	"$4,989.60"	"$5,040.00"	$676.67	"$4,486.95"	$676.67	$985.95	$0.00	$0.00	"$1,002.96"	$463.84	$0.00	$0.00	$0.00	$0.00
74000055	EAP	CPT® 95709		Eeg W/o Video (ceribell) Ea Incr 12-26 Hr Intmt Mntr	BOTH IP/OP	"$10,349.00 "	"$7,658.26"	$0.00	"$7,977.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$7,977.01"	$0.00	"$2,156.73"	$0.00	$0.00	$0.00	$0.00	"$4,722.50"	"$7,480.44"	"$7,556.00"	$0.00	"$4,548.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000057	EAP	CPT® 95711		Veeg By Tech 2-12 Hours Unmonitored	BOTH IP/OP	"$4,241.00 "	"$3,138.34"	$0.00	"$3,268.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,147.67"	"$3,147.67"	"$3,268.96"	$0.00	$883.82	$0.00	$0.00	$0.00	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00	$568.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74000058	EAP	CPT® 95712		Veeg By Tech 2-12 Hr Intermittent Monitoring	BOTH IP/OP	"$4,241.00 "	"$3,138.34"	$0.00	"$3,268.96"	"$2,302.86"	"$2,302.86"	$257.73	$257.73	$259.18	$883.93	"$3,147.67"	"$3,147.67"	"$3,268.96"	$253.45	$883.82	$164.75	"$2,508.55"	"$2,508.55"	$253.05	"$1,935.00"	"$3,065.04"	"$3,096.00"	$351.58	"$2,756.65"	$351.58	$0.00	$0.00	$0.00	$616.10	$241.00	$0.00	$0.00	$0.00	$0.00
74000060	EAP	CPT® 95714		Veeg By Tech Ea Incr 12-26 Hr Unmonitored	BOTH IP/OP	"$6,903.00 "	"$5,108.22"	$0.00	"$5,320.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,320.83"	$0.00	"$1,438.59"	$0.00	$0.00	$0.00	$487.04	"$3,150.00"	"$4,989.60"	"$5,040.00"	$676.67	"$4,486.95"	$676.67	$985.95	$0.00	$0.00	"$1,002.96"	$463.84	$0.00	$0.00	$0.00	$0.00
74000061	EAP	CPT® 95715		Veeg By Tech Ea Incr 12-26 Hr Intermittent Mntr	BOTH IP/OP	"$10,349.00 "	"$7,658.26"	$0.00	"$7,977.01"	"$5,619.51"	"$5,619.51"	$475.36	$475.36	$478.04	"$2,156.99"	"$4,181.12"	"$4,181.12"	"$7,977.01"	$467.50	"$2,156.73"	$303.87	"$3,094.73"	"$3,094.73"	$487.04	"$4,722.50"	"$7,480.44"	"$7,556.00"	$676.67	"$6,726.85"	$676.67	$0.00	$0.00	$0.00	"$1,503.64"	$463.84	$0.00	$0.00	$0.00	$0.00
74000065	EAP	CPT® 95955		Eeg During (carotid) Surgery	BOTH IP/OP	"$1,096.00 "	$811.04	$0.00	$844.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$813.45	$813.45	$844.80	$0.00	$228.41	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00	$584.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000001	EAP	CPT® 31622		Bronchoscopy	BOTH IP/OP	"$4,121.00 "	"$3,049.54"	$0.00	"$2,996.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,966.83"	"$2,996.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000029	EAP	CPT® 43260		Ercp-w/wo Biopsy	BOTH IP/OP	"$6,432.00 "	"$4,759.68"	$0.00	"$5,145.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,328.97"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$5,094.14"	"$5,145.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000046	EAP	CPT® 44360		Sb Endoscop Excluding Ileum Dx	BOTH IP/OP	"$3,384.00 "	"$2,504.16"	$0.00	"$2,729.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$705.23	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,702.30"	"$2,729.60"	$0.00	"$1,879.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000047	EAP	CPT® 44361		Sb Endo-bx Single Multiple	BOTH IP/OP	"$2,728.00 "	"$2,018.72"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$568.52	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$1,980.79"	"$2,000.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000050	EAP	CPT® 44366		Sb Endo-ctrl Of Bleed Any Meth	BOTH IP/OP	"$3,030.00 "	"$2,242.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$631.45	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,199.38"	"$2,221.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000051	EAP	CPT® 44369		"Sb Endo-ablat Of Tum,les Other"	BOTH IP/OP	"$3,030.00 "	"$2,242.20"	$256.01	"$2,836.00"	"$2,753.10"	"$2,753.10"	"$1,581.72"	"$1,581.72"	"$1,590.63"	$631.53	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,557.45"	$631.45	"$1,012.34"	"$2,836.00"	"$2,836.00"	"$1,561.98"	"$2,327.00"	"$2,199.38"	"$2,221.60"	"$2,170.16"	"$2,500.00"	"$2,170.16"	$328.65	$256.01	$256.01	$442.10	"$1,487.60"	$0.00	$0.00	$0.00	$0.00
75000076	EAP	CPT® 45334		"Sigmoid, Flex W Control Bleedi"	BOTH IP/OP	"$3,337.00 "	"$2,469.38"	$0.00	"$2,669.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$695.43	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,642.90"	"$2,669.60"	$0.00	"$1,893.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000089	EAP	CPT® 46600		"Anoscopy, Diagnostic, Inc Spec Collect"	BOTH IP/OP	$542.00 	$401.08	$0.00	$542.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.35	$542.00	$429.26	$433.60	$151.93	$0.00	$151.93	$37.41	$42.17	$42.17	$86.29	$104.14	$0.00	$0.00	$0.00	$0.00
75000091	EAP	CPT® 46606		Anoscopy With Biopsy	BOTH IP/OP	"$2,137.00 "	"$1,581.38"	$0.00	"$2,211.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$460.83	$0.00	$0.00	$0.00	$993.84	$460.77	$646.00	"$2,211.00"	"$2,211.00"	"$1,007.17"	"$2,137.00"	"$1,692.50"	"$1,709.60"	"$1,399.33"	$0.00	"$1,399.33"	$52.76	$78.23	$78.23	$340.21	$959.21	$0.00	$0.00	$0.00	$0.00
75000100	EAP	HCPCS G0121		Colon Ca Scrn Not Hi Rsk Ind	BOTH IP/OP	"$4,021.00 "	"$2,975.54"	$0.00	"$3,216.80"	"$2,753.10"	"$2,753.10"	$772.82	$772.82	$777.17	$0.00	"$1,541.95"	"$1,541.95"	"$1,601.25"	$760.65	$837.98	$494.42	"$2,836.00"	"$2,836.00"	$766.13	"$2,327.00"	"$3,184.63"	"$3,216.80"	"$1,064.43"	"$2,091.00"	"$1,064.43"	$629.29	$193.26	$193.26	$640.14	$729.64	$0.00	$0.00	$0.00	$0.00
75000101	EAP	CPT® 45391		"Colonoscopy, Endoscopic Ultrasound Examination"	BOTH IP/OP	"$3,045.00 "	"$2,253.30"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$634.58	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,214.43"	"$2,236.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000102	EAP	CPT® 45341		Sigmoidscopy W/ultrasound	BOTH IP/OP	"$4,341.00 "	"$3,212.34"	$0.00	"$3,188.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$904.66	$0.00	$0.00	$0.00	$766.13	"$2,255.00"	"$3,156.91"	"$3,188.80"	"$1,064.43"	"$2,500.00"	"$1,064.43"	$219.13	$128.72	$128.72	$634.57	$729.64	$0.00	$0.00	$0.00	$0.00
75000110	EAP	CPT® 45335		Sigmoidoscopy W/submuc Inj	BOTH IP/OP	"$2,361.00 "	"$1,747.14"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$492.03	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,869.91"	"$1,888.80"	$0.00	"$1,239.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000120	EAP	CPT® 43238		Upper Gi Endoscopy W/us Fn Bx	BOTH IP/OP	"$2,842.00 "	"$2,103.08"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$592.27	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$2,063.16"	"$2,084.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000125	EAP	CPT® 43242		Upper Gi Endoscopy W/us Fn Bx	BOTH IP/OP	"$5,337.00 "	"$3,949.38"	$0.00	"$3,914.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,112.23"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,875.26"	"$3,914.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000127	EAP	CPT® 43242		Transendoscopic Us W/ Fn Bx	BOTH IP/OP	"$4,893.00 "	"$3,620.82"	$0.00	"$3,914.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,019.70"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,875.26"	"$3,914.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000128	EAP	CPT® 45327		Proctosigmoidoscopy W/stent	BOTH IP/OP	"$11,233.00 "	"$8,312.42"	$0.00	"$8,986.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,340.96"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$8,896.54"	"$8,986.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000130	EAP	CPT® 45335		Sigmoidoscopy W/submuc Inj	BOTH IP/OP	"$2,361.00 "	"$1,747.14"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$492.03	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,869.91"	"$1,888.80"	$0.00	"$1,239.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000132	EAP	CPT® 45340		Sig W/balloon Dilation	BOTH IP/OP	"$5,946.00 "	"$4,400.04"	$0.00	"$4,756.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,239.15"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,709.23"	"$4,756.80"	$0.00	"$1,893.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000136	EAP	CPT® 91034		"Esoph, Gastroesoph Reflux Test W/rec, Anlys,rpt "	BOTH IP/OP	"$2,483.00 "	"$1,837.42"	$0.00	"$2,483.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.46	$0.00	$0.00	$0.00	$0.00	"$1,552.00"	"$2,458.37"	"$2,483.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000137	EAP	CPT® 91038		"Esoph Gastro Reflux Test, Prolonged 1-24 Hrs."	BOTH IP/OP	"$2,693.00 "	"$1,992.82"	$0.00	"$1,978.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$561.22	$0.00	$0.00	$0.00	$0.00	"$1,236.50"	"$1,958.62"	"$1,978.40"	$0.00	"$1,684.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000138	EAP	CPT® 91010		Esophageal Motility Study W/ Interp & Report	BOTH IP/OP	"$3,327.00 "	"$2,461.98"	$0.00	"$2,444.00"	"$2,321.55"	"$2,321.55"	$475.36	$475.36	$478.04	$693.43	$0.00	$0.00	$0.00	$467.50	$693.35	$303.87	"$1,967.92"	"$1,967.92"	$487.04	"$1,527.50"	"$2,419.56"	"$2,444.00"	$676.67	"$1,750.00"	$676.67	$111.47	$137.22	$137.22	$486.36	$463.84	$0.00	$0.00	$0.00	$0.00
75000139	EAP	CPT® 91037		"Esoph  Gastroesoph Reflux Test Funct W/rec, Anlys,rpt  "	BOTH IP/OP	"$2,254.00 "	"$1,667.96"	$0.00	"$1,656.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$469.73	$0.00	$0.00	$0.00	$0.00	"$1,035.00"	"$1,639.44"	"$1,656.00"	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000140	EAP	CPT® 91120		Rectal Sensation Tone & Comply Balloon Distention	BOTH IP/OP	"$1,373.00 "	"$1,016.02"	$0.00	"$1,008.80"	$745.54	$745.54	$257.73	$257.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.13	$0.00	$0.00	$0.00	$138.76	$630.50	$998.71	"$1,008.80"	$192.78	$440.00	$192.78	$462.13	$445.89	$445.89	$200.75	$132.15	$0.00	$0.00	$0.00	$0.00
75000141	EAP	CPT® 91122		Anorectal Manometry	BOTH IP/OP	"$1,373.00 "	"$1,016.02"	$0.00	"$1,373.00"	$745.54	$745.54	$259.14	$259.14	$260.60	$286.17	$0.00	$0.00	$0.00	$255.07	$286.13	$165.80	$812.13	$812.13	$235.59	$630.50	$998.71	"$1,008.80"	$327.32	"$1,373.00"	$327.32	$125.40	$164.96	$164.96	$200.75	$224.37	$0.00	$0.00	$0.00	$0.00
75000142	EAP	CPT® 51784		"Emg Anal Or Urethral Sphincter, Other Than Needle"	BOTH IP/OP	$210.00 	$155.40	$0.00	$212.00	$114.03	$114.03	$135.96	$135.96	$136.73	$43.77	$0.00	$0.00	$0.00	$133.75	$43.76	$86.94	$113.00	$113.00	$138.76	$212.00	$167.90	$169.60	$192.78	$210.00	$192.78	$94.94	$29.53	$29.53	$33.75	$132.15	$0.00	$0.00	$0.00	$0.00
75000146	EAP	CPT® 91022		Duodenal Motility Study	BOTH IP/OP	"$1,128.00 "	$834.72	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.08	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000147	EAP	CPT® 91117		Colon Motility 6hrs Or >inc Provoc Test W/ Interp& Repot	BOTH IP/OP	$865.00 	$640.10	$0.00	$692.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.27	$0.00	$0.00	$0.00	$0.00	$432.50	$685.08	$692.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000182	EAP	CPT® 46601		Diagnostic Anoscopy	BOTH IP/OP	$637.00 	$471.38	$0.00	$637.00	$637.00	$637.00	$109.81	$109.81	$110.43	$132.77	$0.00	$0.00	$0.00	$107.30	$132.75	$69.74	$637.00	$637.00	$109.35	$560.00	$443.52	$448.00	$151.93	$292.00	$151.93	$87.64	$97.71	$97.71	$89.15	$104.14	$0.00	$0.00	$0.00	$0.00
75000200	EAP	Custom 75000200		Colonscopy Dx	BOTH IP/OP	"$3,855.00 "	"$2,852.70"	$0.00	"$2,832.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$803.38	$0.00	$0.00	$0.00	$0.00	"$1,770.00"	"$2,803.68"	"$2,832.00"	$0.00	"$2,756.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000201	EAP	Custom 75000201		Colonscopy Thera 1 Intervention	BOTH IP/OP	"$4,243.00 "	"$3,139.82"	$0.00	"$3,116.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$884.24	$0.00	$0.00	$0.00	$0.00	"$1,948.00"	"$3,085.63"	"$3,116.80"	$0.00	"$3,033.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000202	EAP	Custom 75000202		Colonscopy Thera 2 Intervention	BOTH IP/OP	"$4,665.00 "	"$3,452.10"	$0.00	"$3,427.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.19	$0.00	$0.00	$0.00	$0.00	"$2,142.00"	"$3,392.93"	"$3,427.20"	$0.00	"$3,335.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000203	EAP	Custom 75000203		Colonscopy Thera 3 Intervention	BOTH IP/OP	"$5,132.00 "	"$3,797.68"	$0.00	"$3,770.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,069.51"	$0.00	$0.00	$0.00	$0.00	"$2,356.50"	"$3,732.70"	"$3,770.40"	$0.00	"$3,669.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000204	EAP	Custom 75000204		Egd Dx	BOTH IP/OP	"$3,286.00 "	"$2,431.64"	$0.00	"$2,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$684.80	$0.00	$0.00	$0.00	$0.00	"$1,506.50"	"$2,386.30"	"$2,410.40"	$0.00	"$2,349.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000205	EAP	Custom 75000205		Egd Thera 1 Intervention	BOTH IP/OP	"$3,615.00 "	"$2,675.10"	$0.00	"$2,651.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$753.37	$0.00	$0.00	$0.00	$0.00	"$1,657.00"	"$2,624.69"	"$2,651.20"	$0.00	"$2,585.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000206	EAP	Custom 75000206		Egd Thera 2 Intervention	BOTH IP/OP	"$3,977.00 "	"$2,942.98"	$0.00	"$2,916.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$828.81	$0.00	$0.00	$0.00	$0.00	"$1,822.50"	"$2,886.84"	"$2,916.00"	$0.00	"$2,843.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000207	EAP	Custom 75000207		Egd Thera 3 Intervention	BOTH IP/OP	"$4,374.00 "	"$3,236.76"	$0.00	"$3,208.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$911.54	$0.00	$0.00	$0.00	$0.00	"$2,005.00"	"$3,175.92"	"$3,208.00"	$0.00	"$3,127.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000208	EAP	Custom 75000208		Ercp Dx	BOTH IP/OP	"$6,193.00 "	"$4,582.82"	$0.00	"$4,549.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,290.62"	$0.00	$0.00	$0.00	$0.00	"$2,843.50"	"$4,504.10"	"$4,549.60"	$0.00	"$4,427.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000209	EAP	Custom 75000209		Ercp Thera 1 Intervention	BOTH IP/OP	"$6,810.00 "	"$5,039.40"	$0.00	"$5,003.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,419.20"	$0.00	$0.00	$0.00	$0.00	"$3,127.00"	"$4,953.17"	"$5,003.20"	$0.00	"$4,869.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000210	EAP	Custom 75000210		Ercp Thera 2 Intervention	BOTH IP/OP	"$7,493.00 "	"$5,544.82"	$0.00	"$5,504.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,561.54"	$0.00	$0.00	$0.00	$0.00	"$3,440.50"	"$5,449.75"	"$5,504.80"	$0.00	"$5,357.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000211	EAP	Custom 75000211		Ercp Thera 3 Intervention	BOTH IP/OP	"$8,242.00 "	"$6,099.08"	$0.00	"$6,054.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,717.63"	$0.00	$0.00	$0.00	$0.00	"$3,784.00"	"$5,993.86"	"$6,054.40"	$0.00	"$5,357.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000212	EAP	Custom 75000212		Sigmoidoscopy Dx	BOTH IP/OP	"$3,919.00 "	"$2,900.06"	$0.00	"$2,879.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$816.72	$0.00	$0.00	$0.00	$0.00	"$1,799.50"	"$2,850.41"	"$2,879.20"	$0.00	"$2,802.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000213	EAP	Custom 75000213		Sigmoidoscopy Thera 1 Intervention	BOTH IP/OP	"$4,311.00 "	"$3,190.14"	$0.00	"$3,167.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$898.41	$0.00	$0.00	$0.00	$0.00	"$1,979.50"	"$3,135.53"	"$3,167.20"	$0.00	"$3,082.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000214	EAP	Custom 75000214		Sigmoidoscopy Thera 2 Intervention	BOTH IP/OP	"$4,741.00 "	"$3,508.34"	$0.00	"$3,483.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$988.02	$0.00	$0.00	$0.00	$0.00	"$2,177.00"	"$3,448.37"	"$3,483.20"	$0.00	"$3,389.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000215	EAP	Custom 75000215		Sigmoidoscopy Thera 3 Intervention	BOTH IP/OP	"$5,217.00 "	"$3,860.58"	$0.00	"$3,832.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,087.22"	$0.00	$0.00	$0.00	$0.00	"$2,395.50"	"$3,794.47"	"$3,832.80"	$0.00	"$3,730.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000216	EAP	Custom 75000216		Colonscopy Via Stoma Dx	BOTH IP/OP	"$3,081.00 "	"$2,279.94"	$0.00	"$2,263.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$642.08	$0.00	$0.00	$0.00	$0.00	"$1,414.50"	"$2,240.57"	"$2,263.20"	$0.00	"$2,202.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000217	EAP	Custom 75000217		Colonscopy Via Stoma 1 Intervention	BOTH IP/OP	"$3,389.00 "	"$2,507.86"	$0.00	"$2,489.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$706.27	$0.00	$0.00	$0.00	$0.00	"$1,556.00"	"$2,464.70"	"$2,489.60"	$0.00	"$2,423.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000218	EAP	Custom 75000218		Colonscopy Via Stoma 2 Intervention	BOTH IP/OP	"$3,727.00 "	"$2,757.98"	$0.00	"$2,738.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$776.71	$0.00	$0.00	$0.00	$0.00	"$1,711.50"	"$2,711.02"	"$2,738.40"	$0.00	"$2,665.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000219	EAP	Custom 75000219		Colonscopy Via Stoma 3 Intervention	BOTH IP/OP	"$4,101.00 "	"$3,034.74"	$0.00	"$3,012.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$854.65	$0.00	$0.00	$0.00	$0.00	"$1,882.50"	"$2,981.88"	"$3,012.00"	$0.00	"$2,932.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000220	EAP	CPT® 91112		Gi Wireless Capsule Measure	BOTH IP/OP	"$3,844.00 "	"$2,844.56"	$0.00	"$3,075.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$801.09	$0.00	$0.00	$0.00	$0.00	"$1,922.00"	"$3,044.45"	"$3,075.20"	$0.00	"$2,092.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000221	EAP	HCPCS 91299		Patency Pill Placement	BOTH IP/OP	"$1,081.00 "	$799.94	$0.00	$864.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.28	$0.00	$0.00	$0.00	$0.00	$540.50	$856.15	$864.80	$0.00	$317.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000222	EAP			Egd Transoral Biopsy Single/multi-ip Bedside	BOTH IP/OP	"$3,388.00 "	"$2,507.12"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$706.06	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00	"$2,202.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100002	EAP	CPT® 36511		Leukopheresis	BOTH IP/OP	"$6,450.00 "	"$4,773.00"	$0.00	"$5,905.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,344.18"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,846.54"	"$5,905.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100003	EAP	CPT® 36512		THERAPEUTIC APHERESIS RED BLOOD CELLS	BOTH IP/OP	"$8,063.00 "	"$5,966.62"	$0.00	"$6,123.20"	"$2,753.10"	"$2,753.10"	"$1,328.28"	"$1,328.28"	"$1,335.77"	"$1,680.53"	$0.00	$0.00	$0.00	"$1,306.48"	"$1,680.33"	$849.21	"$4,877.00"	"$4,877.00"	"$1,327.51"	"$2,255.00"	"$6,061.97"	"$6,123.20"	"$1,844.40"	"$2,500.00"	"$1,844.40"	$88.77	$112.51	$112.51	"$1,218.52"	"$1,264.30"	$0.00	$0.00	$0.00	$0.00
76100004	EAP	CPT® 36513		Plateletpheresis	BOTH IP/OP	"$8,063.00 "	"$5,966.62"	$0.00	"$6,123.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,680.33"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,061.97"	"$6,123.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100005	EAP	CPT® 36514		Plasmapheresis	BOTH IP/OP	"$7,805.00 "	"$5,775.70"	$0.00	"$7,146.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,626.56"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$7,074.94"	"$7,146.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100006	EAP	CPT® 51700		Bladder Irrig/instill Simple	BOTH IP/OP	$504.00 	$372.96	$0.00	$504.00	$504.00	$504.00	$259.14	$259.14	$260.60	$105.05	$0.00	$0.00	$0.00	$255.07	$105.03	$165.80	$113.00	$113.00	$0.00	$504.00	$399.17	$403.20	$0.00	$504.00	$0.00	$100.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100007	EAP	CPT® 51700		Badder Irrig/instill Simple	BOTH IP/OP	$504.00 	$372.96	$0.00	$504.00	$504.00	$504.00	$259.14	$259.14	$260.60	$105.05	$0.00	$0.00	$0.00	$255.07	$105.03	$165.80	$113.00	$113.00	$0.00	$504.00	$399.17	$403.20	$0.00	$504.00	$0.00	$100.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100009	EAP	CPT® 92136		Iol Calculations (ophthalmic Biometry)	BOTH IP/OP	$416.00 	$307.84	$0.00	$336.00	$225.89	$225.89	$109.81	$109.81	$110.43	$86.70	$0.00	$0.00	$0.00	$107.30	$86.69	$69.74	$246.06	$246.06	$109.35	$210.00	$332.64	$336.00	$151.93	$270.40	$151.93	$90.57	$31.69	$31.69	$66.86	$104.14	$0.00	$0.00	$0.00	$0.00
76100011	EAP	CPT® 51701		Insert Straight Cath	BOTH IP/OP	$865.00 	$640.10	$0.00	$865.00	$865.00	$865.00	$109.81	$109.81	$110.43	$180.29	$0.00	$0.00	$0.00	$107.30	$180.27	$69.74	$113.00	$113.00	$109.35	$864.00	$684.29	$691.20	$151.93	$548.00	$151.93	$57.62	$27.40	$27.40	$137.55	$104.14	$0.00	$0.00	$0.00	$0.00
76100013	EAP	CPT® 51703		"Urinary Cath, Indwelling"	BOTH IP/OP	"$1,809.00 "	"$1,338.66"	$0.00	"$1,809.00"	"$1,809.00"	"$1,809.00"	$135.96	$135.96	$136.73	$0.00	$0.00	$0.00	$0.00	$0.00	$377.00	$0.00	$0.00	$0.00	$138.76	"$1,808.00"	"$1,431.94"	"$1,446.40"	$192.78	$899.00	$192.78	$170.19	$80.41	$80.41	$287.83	$132.15	$0.00	$0.00	$0.00	$0.00
76100014	EAP	CPT® 51702		Cath Insert Indwelling	BOTH IP/OP	"$1,069.00 "	$791.06	$0.00	"$1,069.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.35	"$1,069.00"	$846.65	$855.20	$151.93	$0.00	$151.93	$91.18	$26.68	$26.68	$170.18	$104.14	$0.00	$0.00	$0.00	$0.00
76100016	EAP	CPT® 51703		Cath Insertion Complicated	BOTH IP/OP	"$1,808.00 "	"$1,337.92"	$0.00	"$1,808.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.76	"$1,808.00"	"$1,431.94"	"$1,446.40"	$192.78	$0.00	$192.78	$170.19	$80.41	$80.41	$287.83	$132.15	$0.00	$0.00	$0.00	$0.00
76100017	EAP	CPT® 51703		"Insert Bladder Cath, Complex"	BOTH IP/OP	"$1,808.00 "	"$1,337.92"	$0.00	"$1,808.00"	"$1,808.00"	"$1,808.00"	$135.96	$135.96	$136.73	$0.00	$0.00	$0.00	$0.00	$0.00	$376.79	$0.00	$0.00	$0.00	$138.76	"$1,808.00"	"$1,431.94"	"$1,446.40"	$192.78	$899.00	$192.78	$170.19	$80.41	$80.41	$287.83	$132.15	$0.00	$0.00	$0.00	$0.00
76100020	EAP	CPT® 51701		Bladder Irrig/instill Simple	BOTH IP/OP	$864.00 	$639.36	$0.00	$864.00	$864.00	$864.00	$109.81	$109.81	$110.43	$180.08	$0.00	$0.00	$0.00	$107.30	$180.06	$69.74	$113.00	$113.00	$109.35	$864.00	$684.29	$691.20	$151.93	$548.00	$151.93	$57.62	$27.40	$27.40	$137.55	$104.14	$0.00	$0.00	$0.00	$0.00
76100028	EAP	CPT® 40810		Exc. Lesion Mucosa&sub W/o Repair	BOTH IP/OP	"$5,204.00 "	"$3,850.96"	$0.00	"$4,877.00"	"$2,321.55"	"$2,321.55"	"$2,664.14"	"$2,664.14"	"$2,679.15"	"$1,084.64"	$0.00	$0.00	$0.00	"$2,622.61"	"$1,084.51"	"$1,704.70"	"$4,877.00"	"$4,877.00"	"$2,626.99"	"$2,255.00"	"$4,163.54"	"$4,205.60"	"$3,649.85"	"$2,500.00"	"$3,649.85"	$822.72	$127.59	$127.59	$836.91	"$2,501.89"	$0.00	$0.00	$0.00	$0.00
76100029	EAP	CPT® 40804		"Rem Embedded Fb, Mouth Simple"	BOTH IP/OP	$800.00 	$592.00	$0.00	$939.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.72	$0.00	$0.00	$0.00	$0.00	$939.00	$743.69	$751.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100030	EAP	CPT® 54520		Orchiectomy Simple	BOTH IP/OP	"$4,759.00 "	"$3,521.66"	$0.00	"$3,845.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$991.78	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$3,807.14"	"$3,845.60"	$0.00	"$3,725.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100031	EAP	CPT® 54535		Orchiectomy Radical/tumor	BOTH IP/OP	"$7,279.00 "	"$5,386.46"	$0.00	"$5,823.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,516.94"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,764.97"	"$5,823.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100032	EAP	CPT® 40799		Lip Surgery Procedure	BOTH IP/OP	$244.00 	$180.56	$0.00	$244.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.85	$0.00	$0.00	$0.00	$0.00	$230.00	$182.16	$184.00	$0.00	$244.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100034	EAP	CPT® 53040		Drainage Of Urethra Abscess	BOTH IP/OP	"$6,748.00 "	"$4,993.52"	$0.00	"$5,414.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,406.28"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$5,360.26"	"$5,414.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100035	EAP	CPT® 42106		Exc. Lesion Mouth Roof(palate)	BOTH IP/OP	"$2,709.00 "	"$2,004.66"	$0.00	"$2,255.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$564.56	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,145.53"	"$2,167.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100040	EAP	CPT® 21497		Indental Wiring	BOTH IP/OP	"$4,596.00 "	"$3,401.04"	$0.00	"$3,713.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$957.81	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,676.46"	"$3,713.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100041	EAP	CPT® 41800		Drainage Of Gum Lesion	BOTH IP/OP	$640.00 	$473.60	$0.00	$640.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.35	$640.00	$506.88	$512.00	$151.93	$0.00	$151.93	$87.50	$157.47	$157.47	$101.89	$104.14	$0.00	$0.00	$0.00	$0.00
76100042	EAP	CPT® 29799		Casting/strapping Procedure	BOTH IP/OP	$198.00 	$146.52	$0.00	$198.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.00	$156.82	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100043	EAP	CPT® 31820		Closure Of Windpipe Lesion	BOTH IP/OP	"$6,588.00 "	"$4,875.12"	$0.00	"$6,360.00"	"$2,321.55"	"$2,321.55"	"$2,664.14"	"$2,664.14"	"$2,679.15"	"$1,373.10"	"$1,257.08"	"$1,257.08"	"$1,305.43"	"$2,622.61"	"$1,372.94"	"$1,704.70"	"$1,871.00"	"$1,871.00"	$0.00	"$2,255.00"	"$6,296.40"	"$6,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100044	EAP	CPT® 40650		Lip Repair	BOTH IP/OP	"$1,705.00 "	"$1,261.70"	$0.00	"$1,705.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$355.32	$0.00	$0.00	$0.00	$0.00	"$1,604.00"	"$1,270.37"	"$1,283.20"	$0.00	"$1,705.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100045	EAP	CPT® 41000		Drainage Of Mouth Lesion	BOTH IP/OP	"$3,430.00 "	"$2,538.20"	$98.48	"$2,772.00"	"$2,321.55"	"$2,321.55"	$440.43	$440.43	$442.92	$714.90	"$1,257.08"	"$1,257.08"	"$1,305.43"	$433.55	$714.81	$281.81	"$1,871.00"	"$1,871.00"	$443.02	"$2,255.00"	"$2,744.28"	"$2,772.00"	$615.51	"$2,150.00"	$615.51	$98.48	$112.82	$112.82	$551.63	$421.92	$0.00	$0.00	$0.00	$0.00
76100046	EAP	CPT® 36511		Leukopheresis	BOTH IP/OP	"$7,776.00 "	"$5,754.24"	$0.00	"$5,905.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,620.52"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$5,846.54"	"$5,905.60"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100047	EAP	CPT® 36513		Plateletpheresis	BOTH IP/OP	"$8,063.00 "	"$5,966.62"	$0.00	"$6,123.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,680.33"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$6,061.97"	"$6,123.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100048	EAP	CPT® 36514		Plasmapheresis	BOTH IP/OP	"$9,881.00 "	"$7,311.94"	$0.00	"$7,146.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,059.20"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$7,074.94"	"$7,146.40"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100055	EAP	CPT® 65778		Cover Eye W/ Membrane	BOTH IP/OP	"$3,166.00 "	"$2,342.84"	$0.00	"$2,557.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$659.79	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,532.02"	"$2,557.60"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100060	EAP	CPT® 54235		Penile Injection	BOTH IP/OP	$898.00 	$664.52	$0.00	"$1,128.00"	$487.61	$487.61	$259.14	$259.14	$260.60	$187.17	$0.00	$0.00	$0.00	$255.07	$187.14	$165.80	$113.00	$113.00	$235.59	$907.00	$718.34	$725.60	$327.32	"$1,128.00"	$327.32	$70.35	$75.71	$75.71	$144.39	$224.37	$0.00	$0.00	$0.00	$0.00
76100061	EAP	CPT® 20240		Bone Bx Exc.	BOTH IP/OP	"$2,386.00 "	"$1,765.64"	$0.00	"$2,386.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$497.24	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$1,884.96"	"$1,904.00"	$0.00	"$2,386.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100062	EAP	CPT® 21337		Treat Nasa Septal Fx	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$2,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$474.53	$0.00	$0.00	$0.00	$0.00	"$2,300.00"	"$1,821.60"	"$1,840.00"	$0.00	"$2,277.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100063	EAP	CPT® 31579		Direct Laryngoscopy	BOTH IP/OP	"$1,660.00 "	"$1,228.40"	$0.00	"$1,660.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.94	$0.00	$0.00	$0.00	$0.00	"$1,524.00"	"$1,207.01"	"$1,219.20"	$0.00	"$1,660.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100064	EAP	CPT® 31237		Nasal/sinus Endoscopy	BOTH IP/OP	"$7,080.00 "	"$5,239.20"	$163.68	"$5,246.40"	"$2,753.10"	"$2,753.10"	"$1,456.99"	"$1,456.99"	"$1,465.20"	"$1,475.65"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$1,434.17"	"$1,475.47"	$932.21	"$2,836.00"	"$2,836.00"	"$1,434.81"	"$2,327.00"	"$5,193.94"	"$5,246.40"	"$1,993.48"	"$2,500.00"	"$1,993.48"	$226.31	$163.68	$163.68	"$1,044.03"	"$1,366.49"	$0.00	$0.00	$0.00	$0.00
76100070	EAP	CPT® 20615		Treatment Of Bone Cyst	BOTH IP/OP	$919.00 	$680.06	$0.00	$919.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.52	$0.00	$0.00	$0.00	$0.00	$919.00	$727.85	$735.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100071	EAP	CPT® 41830		Removal Of Gum Tissue	BOTH IP/OP	"$3,478.00 "	"$2,573.72"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$724.82	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,780.71"	"$2,808.80"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100072	EAP	CPT® 31237		Nasal/sinus Endoscopy	BOTH IP/OP	"$6,558.00 "	"$4,852.92"	$0.00	"$5,246.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,434.81"	"$2,327.00"	"$5,193.94"	"$5,246.40"	"$1,993.48"	$0.00	"$1,993.48"	$226.31	$163.68	$163.68	"$1,044.03"	"$1,366.49"	$0.00	$0.00	$0.00	$0.00
76100073	EAP	CPT® 42310		Drainage Of Salivary Gland	BOTH IP/OP	"$1,573.00 "	"$1,164.02"	$0.00	"$1,573.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$327.81	$0.00	$0.00	$0.00	$0.00	"$1,571.00"	"$1,244.23"	"$1,256.80"	$0.00	"$1,573.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100076	EAP	CPT® 53852		Prostatic Rf Thermotx (tuna)	BOTH IP/OP	"$15,721.00 "	"$11,633.54"	$0.00	"$12,576.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,276.26"	$0.00	$0.00	$0.00	$0.00	"$3,902.00"	"$12,451.03"	"$12,576.80"	$0.00	"$4,334.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100077	EAP	CPT® 53850		Prostatic Microwave Thermotx (tumt)	BOTH IP/OP	"$15,721.00 "	"$11,633.54"	$0.00	"$12,576.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,276.26"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$12,451.03"	"$12,576.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100078	EAP	CPT® 31571		Laryngoscopy W/vc Inj+scope	BOTH IP/OP	"$12,143.00 "	"$8,985.82"	$0.00	"$8,919.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,530.60"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$8,830.01"	"$8,919.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100086	EAP	CPT® 36512		Therapetic Phlebotomy	BOTH IP/OP	"$8,063.00 "	"$5,966.62"	$0.00	"$6,123.20"	"$2,753.10"	"$2,753.10"	"$1,328.28"	"$1,328.28"	"$1,335.77"	"$1,680.53"	$0.00	$0.00	$0.00	"$1,306.48"	"$1,680.33"	$849.21	"$4,877.00"	"$4,877.00"	"$1,327.51"	"$2,255.00"	"$6,061.97"	"$6,123.20"	"$1,844.40"	"$2,500.00"	"$1,844.40"	$88.77	$112.51	$112.51	"$1,218.52"	"$1,264.30"	$0.00	$0.00	$0.00	$0.00
76100087	EAP	CPT® 21299		Cranio/maxillofacial Proc.	BOTH IP/OP	$272.00 	$201.28	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.68	$0.00	$0.00	$0.00	$0.00	$272.00	$215.42	$217.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100088	EAP	CPT® 20527		Inj Dupuytren Cord W Enzyme	BOTH IP/OP	$514.00 	$380.36	$0.00	$514.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.12	$0.00	$0.00	$0.00	$0.00	$514.00	$407.09	$411.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100089	EAP	CPT® 20615		Nasal Surgery Proc	BOTH IP/OP	$919.00 	$680.06	$0.00	$919.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.52	$0.00	$0.00	$0.00	$0.00	$919.00	$727.85	$735.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100090	EAP	CPT® 15271		Skin Sub Graft Trnk/arm/leg 25	BOTH IP/OP	"$2,131.00 "	"$1,576.94"	$0.00	"$2,131.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.10	$0.00	$0.00	$0.00	$0.00	"$1,997.00"	"$1,581.62"	"$1,597.60"	$0.00	"$2,131.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100091	EAP	CPT® 15272		Skin Sub Graft T/a/l Addl 25	BOTH IP/OP	$622.00 	$460.28	$0.00	$622.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.62	$0.00	$0.00	$0.00	$0.00	$291.50	$461.74	$466.40	$0.00	$622.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100092	EAP	CPT® 15273		Skin Sub Grft T/a/lg Child 100	BOTH IP/OP	"$3,292.00 "	"$2,436.08"	$0.00	"$2,858.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$686.05	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$2,607.26"	"$2,633.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100093	EAP	CPT® 15274		Skin Sub Grft T/a/lg Ch Addl 100	BOTH IP/OP	"$1,578.00 "	"$1,167.72"	$0.00	"$1,262.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.86	$0.00	$0.00	$0.00	$0.00	$789.00	"$1,249.78"	"$1,262.40"	$0.00	$744.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100094	EAP	CPT® 15275		Skin Sub Grft Face/nk/hf/g 25	BOTH IP/OP	"$2,179.00 "	"$1,612.46"	$0.00	"$2,179.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$454.10	$0.00	$0.00	$0.00	$0.00	"$2,179.00"	"$1,725.77"	"$1,743.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100095	EAP	CPT® 15276		Skin Sub Grft F/n/hf/g Addl 25	BOTH IP/OP	$583.00 	$431.42	$0.00	$466.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.50	$0.00	$0.00	$0.00	$0.00	$291.50	$461.74	$466.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100096	EAP	CPT® 15277		Skin Sub Grft F/n/hf/g Child 100	BOTH IP/OP	"$2,570.00 "	"$1,901.80"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$535.59	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$1,907.14"	"$1,926.40"	$0.00	"$2,500.00"	$0.00	$283.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100097	EAP	CPT® 15278		Skin Sub Grft F/n/hf/g Ch Add 100	BOTH IP/OP	"$1,684.00 "	"$1,246.16"	$0.00	"$1,684.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$350.95	$0.00	$0.00	$0.00	$0.00	$789.00	"$1,249.78"	"$1,262.40"	$0.00	"$1,684.00"	$0.00	$81.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100098	EAP	CPT® 29581		Apply Multlay Comprs Lwr Leg	BOTH IP/OP	$453.00 	$335.22	$0.00	$478.00	$245.98	$245.98	$137.58	$137.58	$138.36	$94.42	$0.00	$0.00	$0.00	$135.31	$94.41	$87.95	$113.00	$113.00	$0.00	$478.00	$378.58	$382.40	$0.00	$458.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100102	EAP	CPT® 29584		Apply Multlay Comprs  Arm/hand	BOTH IP/OP	$427.00 	$315.98	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.99	$0.00	$0.00	$0.00	$0.00	$478.00	$378.58	$382.40	$0.00	$330.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100103	EAP	CPT® 46220		Exc. Anal Ext. Tag/papilla	BOTH IP/OP	"$4,310.00 "	"$3,189.40"	$0.00	"$3,483.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$898.20	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$3,448.37"	"$3,483.20"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100104	EAP	CPT® 17999		Skin Tissue Procedure	BOTH IP/OP	$252.00 	$186.48	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.52	$0.00	$0.00	$0.00	$0.00	$250.00	$198.00	$200.00	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100105	EAP	CPT® 31570		Laryngoscope W/vc Inj	BOTH IP/OP	"$8,010.00 "	"$5,927.40"	$235.43	"$5,883.20"	"$2,753.10"	"$2,753.10"	"$3,016.56"	"$3,016.56"	"$3,033.56"	"$1,669.48"	"$1,541.95"	"$1,541.95"	"$1,601.25"	"$2,969.20"	"$1,669.28"	"$1,929.98"	"$2,836.00"	"$2,836.00"	"$2,945.54"	"$2,327.00"	"$5,824.37"	"$5,883.20"	"$4,092.44"	"$2,500.00"	"$4,092.44"	$296.20	$235.43	$235.43	"$1,170.76"	"$2,805.28"	$0.00	$0.00	$0.00	$0.00
76100106	EAP	CPT® 41899		Bx Of Gum Mass	BOTH IP/OP	"$1,862.00 "	"$1,377.88"	$0.00	"$1,880.00"	"$1,862.00"	"$1,862.00"	$206.03	$206.03	$207.19	$388.09	$0.00	$0.00	$0.00	$202.80	$388.04	$131.82	"$1,862.00"	"$1,862.00"	$204.24	"$1,880.00"	"$1,488.96"	"$1,504.00"	$283.76	"$1,750.00"	$283.76	$294.22	$0.00	$0.00	$299.30	$194.51	$0.00	$0.00	$0.00	$0.00
76100107	EAP	CPT® 40899		Vestibule Of Mouth (unlisted)	BOTH IP/OP	$262.00 	$193.88	$0.00	$308.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.60	$0.00	$0.00	$0.00	$0.00	$308.00	$243.94	$246.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100110	EAP	CPT® 49082		Abdom Paracentesis W/o Imag	BOTH IP/OP	"$1,861.00 "	"$1,377.14"	$0.00	"$1,861.00"	"$1,861.00"	"$1,861.00"	$787.99	$787.99	$792.43	$387.88	$0.00	$0.00	$0.00	$775.94	$387.83	$504.36	"$1,861.00"	"$1,861.00"	$788.23	"$1,769.00"	"$1,401.05"	"$1,415.20"	"$1,095.14"	"$1,706.00"	"$1,095.14"	$0.00	$77.15	$77.15	$281.62	$750.70	$0.00	$0.00	$0.00	$0.00
76100112	EAP	CPT® 49083		Abdom Paracentesis W Imag	BOTH IP/OP	"$1,861.00 "	"$1,377.14"	$0.00	"$2,150.00"	"$1,861.00"	"$1,861.00"	$787.99	$787.99	$792.43	$387.88	$0.00	$0.00	$0.00	$775.94	$387.83	$504.36	"$1,861.00"	"$1,861.00"	$788.23	"$1,769.00"	"$1,401.05"	"$1,415.20"	"$1,095.14"	"$2,150.00"	"$1,095.14"	$296.18	$112.15	$112.15	$281.62	$750.70	$0.00	$0.00	$0.00	$0.00
76100113	EAP	CPT® 49084		Peritoneal Lavage W Imag	BOTH IP/OP	"$1,861.00 "	"$1,377.14"	$0.00	"$1,861.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$387.83	$0.00	$0.00	$0.00	$0.00	"$1,769.00"	"$1,401.05"	"$1,415.20"	$0.00	"$1,861.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100114	EAP	CPT® 20680		Removal Of Support Implant	BOTH IP/OP	"$5,413.00 "	"$4,005.62"	$0.00	"$4,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,128.07"	$0.00	$0.00	$0.00	"$2,325.71"	"$2,858.00"	"$4,028.90"	"$4,069.60"	"$3,231.26"	"$3,250.00"	"$3,231.26"	$0.00	$437.25	$437.25	$809.85	"$2,214.96"	$0.00	$0.00	$0.00	$0.00
76100115	EAP	CPT® 25605		Treat Fracture Radius Ulna	BOTH IP/OP	"$2,345.00 "	"$1,735.30"	$0.00	"$2,345.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,359.37"	"$2,345.00"	"$1,857.24"	"$1,876.00"	"$1,888.67"	$0.00	"$1,888.67"	$469.11	$530.90	$530.90	$373.32	"$1,294.64"	$0.00	$0.00	$0.00	$0.00
76100116	EAP	CPT® 27825		Treat Lower Leg Fracture	BOTH IP/OP	"$6,872.00 "	"$5,085.28"	$0.00	"$5,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.12"	$0.00	$0.00	$0.00	"$1,359.37"	"$2,327.00"	"$5,761.80"	"$5,820.00"	"$1,888.67"	"$2,500.00"	"$1,888.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100117	EAP	CPT® 41899		Alveoplasty W/extractions	BOTH IP/OP	"$2,369.00 "	"$1,753.06"	$0.00	"$2,369.00"	"$2,321.55"	"$2,321.55"	$206.03	$206.03	$207.19	$493.76	$0.00	$0.00	$0.00	$202.80	$493.70	$131.82	"$2,369.00"	"$2,369.00"	$204.24	"$2,327.00"	"$1,893.67"	"$1,912.80"	$283.76	"$1,750.00"	$283.76	$374.19	$0.00	$0.00	$380.65	$194.51	$0.00	$0.00	$0.00	$0.00
76100118	EAP	CPT® 26705		Treat Knuckle Dislocation	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,593.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	"$1,593.00"	"$1,261.66"	"$1,274.40"	$0.00	"$1,489.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100119	EAP	CPT® 51784		Anal/urinary Muscle Study	BOTH IP/OP	$210.00 	$155.40	$0.00	$212.00	$114.03	$114.03	$135.96	$135.96	$136.73	$43.77	$0.00	$0.00	$0.00	$133.75	$43.76	$86.94	$113.00	$113.00	$138.76	$212.00	$167.90	$169.60	$192.78	$210.00	$192.78	$94.94	$29.53	$29.53	$33.75	$132.15	$0.00	$0.00	$0.00	$0.00
76100120	EAP	CPT® 26951		Amputation Of Finger Thumb	BOTH IP/OP	"$7,787.00 "	"$5,762.38"	$0.00	"$5,690.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,622.81"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$5,633.50"	"$5,690.40"	$0.00	"$2,500.00"	$0.00	$412.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100121	EAP	CPT® 26705		Treat Knuckle Dislocation	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,593.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	"$1,593.00"	"$1,261.66"	"$1,274.40"	$0.00	"$1,489.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100122	EAP	CPT® 62273		Injection Epidural Blood Patch	BOTH IP/OP	"$1,679.00 "	"$1,242.46"	$0.00	"$1,679.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$349.90	$0.00	$0.00	$0.00	$626.89	"$1,596.00"	"$1,264.03"	"$1,276.80"	$870.98	"$1,679.00"	$870.98	$123.36	$117.56	$117.56	$254.08	$597.04	$0.00	$0.00	$0.00	$0.00
76100123	EAP	CPT® 67904		Blepharoptosis	BOTH IP/OP	"$5,049.00 "	"$3,736.26"	$0.00	"$4,053.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,052.21"	$0.00	$0.00	$0.00	$0.00	"$3,606.00"	"$4,013.06"	"$4,053.60"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100124	EAP	CPT® 11760		Repair Nail Bed	BOTH IP/OP	$759.00 	$561.66	$0.00	$759.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.19	$0.00	$0.00	$0.00	$502.38	$158.18	$326.54	$113.00	$113.00	$0.00	$759.00	$601.13	$607.20	$0.00	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100125	EAP	CPT® 17270		Destruction Malignant Lesion 0.5cm Or Less	BOTH IP/OP	$477.00 	$352.98	$0.00	$477.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.41	$0.00	$0.00	$0.00	$0.00	$477.00	$377.78	$381.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100126	EAP	CPT® 41599		Tongue/mouth Unlisted Proc.	BOTH IP/OP	$271.00 	$200.54	$0.00	$271.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.48	$0.00	$0.00	$0.00	$0.00	$271.00	$214.63	$216.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100129	EAP	CPT® 28405		Treat Heel Fx	BOTH IP/OP	"$4,960.00 "	"$3,670.40"	$0.00	"$3,968.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.66"	$0.00	$0.00	$0.00	$0.00	"$2,327.00"	"$3,928.32"	"$3,968.00"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100130	EAP	CPT® 31576		"Laryngoscopy, Fiberoptic W/bx"	BOTH IP/OP	"$7,908.00 "	"$5,851.92"	$0.00	"$5,808.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,648.03"	$0.00	$0.00	$0.00	"$1,434.81"	"$2,327.00"	"$5,750.71"	"$5,808.80"	"$1,993.48"	"$2,500.00"	"$1,993.48"	$149.37	$121.86	$121.86	"$1,155.95"	"$1,366.49"	$0.00	$0.00	$0.00	$0.00
76100131	EAP	CPT® 42999		Throat Proc. ( Phary/ Aden/tons)	BOTH IP/OP	$206.00 	$152.44	$0.00	$225.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.93	$0.00	$0.00	$0.00	$0.00	$225.00	$178.20	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100132	EAP	CPT® 59150		Treat Ectopic Pregnancy	BOTH IP/OP	"$21,864.00 "	"$16,179.36"	$0.00	"$17,491.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,556.46"	$0.00	$0.00	$0.00	$0.00	"$5,452.00"	"$17,316.29"	"$17,491.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100133	EAP	CPT® 24999		Upper Arm/elbow Surg	BOTH IP/OP	$483.00 	$357.42	$0.00	$483.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$0.00	$0.00	$0.00	$0.00	$483.00	$382.54	$386.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100134	EAP	CPT® 52001		Cysto Rem Of Clots	BOTH IP/OP	"$5,099.00 "	"$3,773.26"	$0.00	"$4,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,062.63"	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$4,078.80"	"$4,120.00"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100135	EAP	CPT® 92025		Topography	BOTH IP/OP	$288.00 	$213.12	$0.00	$232.80	$156.38	$156.38	$54.21	$54.21	$54.51	$60.03	$0.00	$0.00	$0.00	$53.35	$60.02	$34.67	$170.35	$170.35	$55.17	$145.50	$230.47	$232.80	$76.65	$150.15	$76.65	$45.54	$17.29	$17.29	$46.33	$52.54	$0.00	$0.00	$0.00	$0.00
76100136	EAP	CPT® 59001		Amniocentesis Therapeutic	BOTH IP/OP	"$2,089.00 "	"$1,545.86"	$0.00	"$2,089.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$435.35	$0.00	$0.00	$0.00	$0.00	"$2,089.00"	"$1,654.49"	"$1,671.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100138	EAP	CPT® 25111		Removal Of Ganglion Cyst	BOTH IP/OP	"$4,220.00 "	"$3,122.80"	$0.00	"$3,376.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.45	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$3,342.24"	"$3,376.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100139	EAP	CPT® 92025		Corneal Topography	BOTH IP/OP	$291.00 	$215.34	$0.00	$232.80	$0.00	$0.00	$0.00	$0.00	$0.00	$60.03	$0.00	$0.00	$0.00	$53.35	$60.02	$34.67	$170.35	$170.35	$55.17	$145.50	$230.47	$232.80	$76.65	$0.00	$76.65	$45.54	$17.29	$17.29	$46.33	$52.54	$0.00	$0.00	$0.00	$0.00
76100140	EAP	CPT® 27509		Treatment Of Thigh Fracture	BOTH IP/OP	"$16,329.00 "	"$12,083.46"	$0.00	"$13,063.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,402.96"	$0.00	$0.00	$0.00	$0.00	"$2,858.00"	"$12,932.57"	"$13,063.20"	$0.00	"$3,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76100141	EAP	CPT® 92504		Ear Microscopy Examination	BOTH IP/OP	$89.00 	$65.86	$0.00	$72.00	$48.33	$48.33	$0.00	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$18.55	$0.00	$52.64	$52.64	$0.00	$45.00	$71.28	$72.00	$0.00	$57.85	$0.00	$25.24	$9.74	$9.74	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00
76200002	EAP	HCPCS G0378		Observation Room	BOTH IP/OP	$141.00 	$104.34	$0.00	$150.00	$141.00	$141.00	$0.00	$0.00	$0.00	$29.39	$104.65	$104.65	$108.68	$0.00	$29.38	$0.00	$83.40	$83.40	$0.00	$80.60	$98.21	$99.20	$0.00	$150.00	$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
76200028	EAP	HCPCS G0378		Obs. Rm. Ecc	BOTH IP/OP	$141.00 	$104.34	$0.00	$150.00	$141.00	$141.00	$0.00	$0.00	$0.00	$29.39	$104.65	$104.65	$108.68	$0.00	$29.38	$0.00	$83.40	$83.40	$0.00	$80.60	$98.21	$99.20	$0.00	$150.00	$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
76200077	EAP	HCPCS G0378		Observation Room Carveout	BOTH IP/OP	$141.00 	$104.34	$0.00	$150.00	$141.00	$141.00	$0.00	$0.00	$0.00	$29.39	$104.65	$104.65	$108.68	$0.00	$29.38	$0.00	$83.40	$83.40	$0.00	$80.60	$98.21	$99.20	$0.00	$150.00	$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
77000001	EAP	HCPCS G0101		Pelvic/breast Exam	BOTH IP/OP	$282.00 	$208.68	$29.20	$217.37	$153.13	$153.13	$72.87	$72.87	$73.28	$58.78	$209.30	$209.30	$217.37	$71.76	$58.77	$46.64	$166.80	$166.80	$78.77	$132.00	$209.09	$211.20	$109.44	$183.30	$109.44	$41.32	$29.20	$29.20	$42.03	$75.02	$0.00	$0.00	$0.00	$0.00
77100006	EAP	CPT® 90471		Immunization Admin 1st	BOTH IP/OP	$62.00 	$45.88	$9.08	$75.40	$33.67	$33.67	$60.38	$60.38	$60.72	$12.92	$46.02	$46.02	$47.79	$59.39	$12.92	$38.61	$36.67	$36.67	$60.65	$29.00	$45.94	$46.40	$58.00	$75.40	$58.00	$9.08	$14.42	$14.42	$9.23	$57.76	$0.00	$0.00	$0.00	$0.00
77100007	EAP	CPT® 90471		Administration Pneumo Vaccine	BOTH IP/OP	$62.00 	$45.88	$9.08	$75.40	$33.67	$33.67	$38.97	$38.97	$39.19	$12.92	$46.02	$46.02	$47.79	$38.34	$12.92	$24.92	$36.67	$36.67	$38.22	$29.00	$45.94	$46.40	$58.00	$75.40	$58.00	$9.08	$14.42	$14.42	$9.23	$36.40	$0.00	$0.00	$0.00	$0.00
77100011	EAP	CPT® 90472		Immunization Each Additional	BOTH IP/OP	$62.00 	$45.88	$0.00	$75.40	$33.67	$33.67	$0.00	$0.00	$0.00	$12.92	$46.02	$46.02	$47.79	$0.00	$12.92	$0.00	$36.67	$36.67	$0.00	$29.00	$45.94	$46.40	$0.00	$75.40	$0.00	$9.08	$12.98	$12.98	$9.23	$0.00	$0.00	$0.00	$0.00	$0.00
77100018	EAP	HCPCS 90471		Administration Flu Vaccine	BOTH IP/OP	$62.00 	$45.88	$9.08	$75.40	$33.67	$33.67	$38.97	$38.97	$39.19	$12.92	$46.02	$46.02	$47.79	$38.34	$12.92	$24.92	$36.67	$36.67	$38.22	$29.00	$45.94	$46.40	$58.00	$75.40	$58.00	$9.08	$14.42	$14.42	$9.23	$36.40	$0.00	$0.00	$0.00	$0.00
77100035	EAP	CPT® 90471		Immunization Admin. (ped)	BOTH IP/OP	$62.00 	$45.88	$9.08	$75.40	$33.67	$33.67	$60.38	$60.38	$60.72	$12.92	$46.02	$46.02	$47.79	$59.39	$12.92	$38.61	$36.67	$36.67	$60.65	$29.00	$45.94	$46.40	$58.00	$75.40	$58.00	$9.08	$14.42	$14.42	$9.23	$57.76	$0.00	$0.00	$0.00	$0.00
77100040	EAP	CPT® 90471		Administration Of Hepatitis B Vaccine	BOTH IP/OP	$62.00 	$45.88	$9.08	$75.40	$33.67	$33.67	$38.97	$38.97	$39.19	$12.92	$46.02	$46.02	$47.79	$38.34	$12.92	$24.92	$36.67	$36.67	$38.22	$29.00	$45.94	$46.40	$58.00	$75.40	$58.00	$9.08	$14.42	$14.42	$9.23	$36.40	$0.00	$0.00	$0.00	$0.00
77100044	EAP	CPT® 90471		R-immunization Administration-24	BOTH IP/OP	$66.00 	$48.84	$9.08	$75.40	$35.84	$35.84	$60.38	$60.38	$60.72	$13.76	$48.99	$48.99	$50.87	$59.39	$13.75	$38.61	$39.04	$39.04	$60.65	$29.00	$45.94	$46.40	$58.00	$75.40	$58.00	$9.08	$14.42	$14.42	$9.23	$57.76	$0.00	$0.00	$0.00	$0.00
78000010	EAP	HCPCS Q3014		Telehealth Facility Fee	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$35.30	$35.30	$0.00	$0.00	$26.81	$20.52	$0.00	$0.00	$0.00	$0.00	$20.52	$27.02	$38.45	$38.45	$0.00	$32.50	$51.48	$52.00	$39.00	$31.14	$39.00	$22.96	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$0.00
80000611	EAP	HCPCS C1769		Guidewire Vasc 150cm .035in Fix Core Flxb 3mm Rad	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$250.51	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00	$0.00	$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
80000635	EAP	HCPCS C1894		Sheath Introd 10cm 6fr Pncl Peri Snpon Dilat Lock	BOTH IP/OP	$219.00 	$162.06	$0.00	$175.20	$118.92	$118.92	$0.00	$0.00	$0.00	$45.65	$162.54	$162.54	$168.81	$0.00	$45.64	$0.00	$129.54	$129.54	$0.00	$109.50	$173.45	$175.20	$0.00	$142.35	$0.00	$34.27	$0.00	$0.00	$34.86	$0.00	$0.00	$0.00	$0.00	$0.00
80002673	EAP	HCPCS C1729		Catheter Xtrn Drn 80cm Strl Edm Cls Tip Ba Imprg Sil Lmbr	BOTH IP/OP	$566.00 	$418.84	$0.00	$452.80	$307.34	$307.34	$0.00	$0.00	$0.00	$0.00	$420.09	$420.09	$436.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.00	$448.27	$452.80	$0.00	$367.90	$0.00	$88.58	$0.00	$0.00	$90.11	$0.00	$0.00	$0.00	$0.00	$0.00
80003182	EAP	HCPCS C1751		Catheter Art Ln 110cm 7fr Std Fem Vn 4 Lum S Tip	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.50	$114.84	$116.00	$0.00	$0.00	$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
80003186	EAP	HCPCS C1887		Catheter Guid Blue Ylw 100cm 7fr Crds Vsbr Jl4st	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$50.50	$50.50	$0.00	$0.00	$0.00	$19.38	$69.02	$69.02	$71.68	$0.00	$19.38	$0.00	$55.01	$55.01	$0.00	$46.50	$73.66	$74.40	$0.00	$0.00	$0.00	$14.55	$0.00	$0.00	$14.81	$0.00	$0.00	$0.00	$0.00	$0.00
80003206	EAP	HCPCS C1725		Catheter Pa 110cm 7fr 10mm Arw 1 Lum Bln Wdg Prss	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$91.22	$91.22	$0.00	$0.00	$0.00	$35.02	$124.69	$124.69	$129.49	$0.00	$35.01	$0.00	$99.37	$99.37	$0.00	$84.00	$133.06	$134.40	$0.00	$109.20	$0.00	$26.29	$0.00	$0.00	$26.75	$0.00	$0.00	$0.00	$0.00	$0.00
80003226	EAP	HCPCS C1884		System Embl Prtc 300cm .014in 110um 3.2fr Crtd	BOTH IP/OP	"$4,188.00 "	"$3,099.12"	$0.00	"$3,350.40"	"$2,274.08"	"$2,274.08"	$0.00	$0.00	$0.00	$872.88	"$3,108.33"	"$3,108.33"	"$3,228.11"	$0.00	$872.78	$0.00	"$2,477.20"	"$2,477.20"	$0.00	"$2,094.00"	"$3,316.90"	"$3,350.40"	$0.00	$0.00	$0.00	$655.42	$0.00	$0.00	$666.73	$0.00	$0.00	$0.00	$0.00	$0.00
80003239	EAP	HCPCS C1757		Catheter Thrmb 140cm 6fr .07in Xprt Ap Aspirat	BOTH IP/OP	"$1,238.00 "	$916.12	$0.00	$990.40	$672.23	$672.23	$0.00	$0.00	$0.00	$258.03	$918.84	$918.84	$954.25	$0.00	$258.00	$0.00	$732.28	$732.28	$0.00	$619.00	$980.50	$990.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80006190	EAP	HCPCS C1769		Guidewire Vasc 145cm .035in Fix Core Flpy Flx Tp	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$26.61	$26.61	$0.00	$0.00	$0.00	$10.21	$36.37	$36.37	$37.77	$0.00	$10.21	$0.00	$28.98	$28.98	$0.00	$24.50	$38.81	$39.20	$0.00	$0.00	$0.00	$7.67	$0.00	$0.00	$7.80	$0.00	$0.00	$0.00	$0.00	$0.00
80006520	EAP	HCPCS C1876		System Coron Stent 8mm 3.5mm Mtlnk Vsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80006521	EAP	HCPCS C1876		System Coron Stent 8mm 4mm Mtlnk Vsn Cocr Rapex Lp	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80006522	EAP	HCPCS C1876		System Coron Stent 12mm 3mm Mtlnk Vsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80006523	EAP	HCPCS C1874		System Coron Stent 12mm 3.5mm Mtlnk Vsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80006524	EAP	HCPCS C1876		System Coron Stent 12mm 4mm Mtlnk Vsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80006526	EAP	HCPCS C1876		System Coron Stent 15mm 3.5mm Mtlnk Vsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80006531	EAP	HCPCS C1876		System Coron Stent 23mm 3mm Mtlnk Vsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80006535	EAP	HCPCS C1874		System Coron Stent 28mm 3.5mm Mtlnk Vsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80006536	EAP	HCPCS C1876		System Coron Stent 28mm 4mm Mtlnk Vsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80006635	EAP	HCPCS C1769		Guidewire Vasc 145cm .038in Atrm Flpy Flx Tp Xstif	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$35.30	$35.30	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$50.10	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$32.50	$51.48	$52.00	$0.00	$0.00	$0.00	$10.17	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$0.00
80006680	EAP	HCPCS C1894		Sheath Introd 10cm 7fr Pncl Peri Ss Hydphi Ptfe	BOTH IP/OP	$219.00 	$162.06	$0.00	$175.20	$118.92	$118.92	$0.00	$0.00	$0.00	$45.65	$162.54	$162.54	$168.81	$0.00	$45.64	$0.00	$129.54	$129.54	$0.00	$109.50	$173.45	$175.20	$0.00	$0.00	$0.00	$34.27	$0.00	$0.00	$34.86	$0.00	$0.00	$0.00	$0.00	$0.00
80006701	EAP	HCPCS C1773		Kit Snr 120cm 15mm 6fr Agn Ntnl Cath Preform Loop	BOTH IP/OP	$800.00 	$592.00	$0.00	$640.00	$434.40	$434.40	$0.00	$0.00	$0.00	$166.74	$593.76	$593.76	$616.64	$0.00	$166.72	$0.00	$473.20	$473.20	$0.00	$400.00	$633.60	$640.00	$0.00	$0.00	$0.00	$125.20	$0.00	$0.00	$127.36	$0.00	$0.00	$0.00	$0.00	$0.00
80008328	EAP	HCPCS C1876		System Coron Stent 8mm 2.5mm Mtlnk Mvsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80008330	EAP	HCPCS C1876		System Coron Stent 15mm 2.5mm Mtlnk Mvsn Cocr	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80008333	EAP	HCPCS C1876		System Coron Stent 28mm 2.5mm Mtlnk Mvsn Cocr	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80008338	EAP	HCPCS A6198		Dressing Brn 16x16in Strl Lf Actct Anbctrl Fst Act Brr Cntrl	BOTH IP/OP	$156.00 	$115.44	$0.00	$148.00	$84.71	$84.71	$0.00	$0.00	$0.00	$0.00	$115.78	$115.78	$120.24	$0.00	$32.51	$0.00	$0.00	$0.00	$0.00	$92.50	$146.52	$148.00	$0.00	$101.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80008439	EAP	HCPCS C1894		Sheath Guid 45cm 6fr Pn Dstn Hs Curve Ss Nyl	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$111.32	$111.32	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$158.01	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00	$0.00	$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
80008456	EAP	HCPCS C1894		Introd Shth 6fr 4cm Radiopq Lg Bore Stpck Pinch	BOTH IP/OP	$213.00 	$157.62	$0.00	$170.40	$115.66	$115.66	$0.00	$0.00	$0.00	$44.39	$158.09	$158.09	$164.18	$0.00	$44.39	$0.00	$125.99	$125.99	$0.00	$106.50	$168.70	$170.40	$0.00	$0.00	$0.00	$33.33	$0.00	$0.00	$33.91	$0.00	$0.00	$0.00	$0.00	$0.00
80008503	EAP	HCPCS C1725		Catheter Angiographic Chuang C Curve 5fr 80cm Torcon Nb	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$34.21	$34.21	$0.00	$0.00	$0.00	$13.13	$46.76	$46.76	$48.56	$0.00	$13.13	$0.00	$37.26	$37.26	$0.00	$31.50	$49.90	$50.40	$0.00	$40.95	$0.00	$9.86	$0.00	$0.00	$10.03	$0.00	$0.00	$0.00	$0.00	$0.00
80008556	EAP	HCPCS C1894		Introd Shth 10fr 2.5cm 25cm Dilat Kink Rst Pncl	BOTH IP/OP	$499.00 	$369.26	$0.00	$399.20	$270.96	$270.96	$0.00	$0.00	$0.00	$104.00	$370.36	$370.36	$384.63	$0.00	$103.99	$0.00	$295.16	$295.16	$0.00	$249.50	$395.21	$399.20	$0.00	$0.00	$0.00	$78.09	$0.00	$0.00	$79.44	$0.00	$0.00	$0.00	$0.00	$0.00
80008561	EAP	HCPCS C1894		Sheath Introd 25cm 5fr Pncl Peri Ss Hydphi Ptfe	BOTH IP/OP	$499.00 	$369.26	$0.00	$399.20	$270.96	$270.96	$0.00	$0.00	$0.00	$104.00	$370.36	$370.36	$384.63	$0.00	$103.99	$0.00	$295.16	$295.16	$0.00	$249.50	$395.21	$399.20	$0.00	$0.00	$0.00	$78.09	$0.00	$0.00	$79.44	$0.00	$0.00	$0.00	$0.00	$0.00
80008562	EAP	HCPCS C1757		Catheter Thrmb 135cm 5fr Unfs Flw-thru Hub Infus	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$276.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80008565	EAP	HCPCS C1894		Sheath Introd 25cm 6fr Pncl Peri Ss Hydphi Ptfe	BOTH IP/OP	$499.00 	$369.26	$0.00	$399.20	$270.96	$270.96	$0.00	$0.00	$0.00	$104.00	$370.36	$370.36	$384.63	$0.00	$103.99	$0.00	$295.16	$295.16	$0.00	$249.50	$395.21	$399.20	$0.00	$0.00	$0.00	$78.09	$0.00	$0.00	$79.44	$0.00	$0.00	$0.00	$0.00	$0.00
80008566	EAP	HCPCS C1894		Introd Shth 8fr 2.5cm 25cm Dilat Mini Gwire Kink	BOTH IP/OP	$499.00 	$369.26	$0.00	$399.20	$270.96	$270.96	$0.00	$0.00	$0.00	$104.00	$370.36	$370.36	$384.63	$0.00	$103.99	$0.00	$295.16	$295.16	$0.00	$249.50	$395.21	$399.20	$0.00	$0.00	$0.00	$78.09	$0.00	$0.00	$79.44	$0.00	$0.00	$0.00	$0.00	$0.00
80008570	EAP	HCPCS C1894		Sheath Introd 25cm 7fr Pncl Peri Ss Hydphi Ptfe	BOTH IP/OP	$499.00 	$369.26	$0.00	$399.20	$270.96	$270.96	$0.00	$0.00	$0.00	$104.00	$370.36	$370.36	$384.63	$0.00	$103.99	$0.00	$295.16	$295.16	$0.00	$249.50	$395.21	$399.20	$0.00	$0.00	$0.00	$78.09	$0.00	$0.00	$79.44	$0.00	$0.00	$0.00	$0.00	$0.00
80008625	EAP	HCPCS C1894		Sheath Introd 10cm 10fr Pncl Peri Ss Hydphi Ptfe	BOTH IP/OP	$219.00 	$162.06	$0.00	$175.20	$118.92	$118.92	$0.00	$0.00	$0.00	$45.65	$162.54	$162.54	$168.81	$0.00	$45.64	$0.00	$129.54	$129.54	$0.00	$109.50	$173.45	$175.20	$0.00	$0.00	$0.00	$34.27	$0.00	$0.00	$34.86	$0.00	$0.00	$0.00	$0.00	$0.00
80008715	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Lcb Curve Coron	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80008870	EAP	HCPCS C1887		Catheter Guid Blue Ylw 100cm 7fr Crds Vsbr Mpa1	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00	$0.00	$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
80008873	EAP	HCPCS C1887		Catheter Guid Blue Ylw 100cm 7fr Crds Vsbr Jr3.5	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$50.50	$50.50	$0.00	$0.00	$0.00	$19.38	$69.02	$69.02	$71.68	$0.00	$19.38	$0.00	$55.01	$55.01	$0.00	$46.50	$73.66	$74.40	$0.00	$0.00	$0.00	$14.55	$0.00	$0.00	$14.81	$0.00	$0.00	$0.00	$0.00	$0.00
80008874	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Ima Curve Peri	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80008930	EAP	HCPCS C1760		Device Clsr 70cm 6fr Angsl Vip .035in Vasc Clgn	BOTH IP/OP	"$1,600.00 "	"$1,184.00"	$0.00	"$6,400.00"	$868.80	$868.80	$0.00	$0.00	$0.00	$333.48	"$1,187.52"	"$1,187.52"	"$1,233.28"	$0.00	$333.44	$0.00	$946.40	$946.40	$0.00	"$4,000.00"	"$6,336.00"	"$6,400.00"	$0.00	"$1,040.00"	$0.00	"$1,252.00"	$0.00	$0.00	"$1,273.60"	$0.00	$0.00	$0.00	$0.00	$0.00
80009063	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Gldcath Radifocus Ang	BOTH IP/OP	$607.00 	$449.18	$0.00	$485.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$303.50	$480.74	$485.60	$0.00	$0.00	$0.00	$95.00	$0.00	$0.00	$96.63	$0.00	$0.00	$0.00	$0.00	$0.00
80009071	EAP	HCPCS C1725		Catheter Angio 65cm 5fr Gldcath Radifocus C2 Curve	BOTH IP/OP	$607.00 	$449.18	$0.00	$485.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$303.50	$480.74	$485.60	$0.00	$0.00	$0.00	$95.00	$0.00	$0.00	$96.63	$0.00	$0.00	$0.00	$0.00	$0.00
80009072	EAP	HCPCS C1769		Guidewire Vasc Std Ang .035in 260cm 3cm Gldwr Gld Tch Flxb	BOTH IP/OP	$555.00 	$410.70	$0.00	$444.00	$301.37	$301.37	$0.00	$0.00	$0.00	$115.68	$411.92	$411.92	$427.79	$0.00	$115.66	$0.00	$328.28	$328.28	$0.00	$277.50	$439.56	$444.00	$0.00	$360.75	$0.00	$86.86	$0.00	$0.00	$88.36	$0.00	$0.00	$0.00	$0.00	$0.00
80009076	EAP	HCPCS C1769		Guidewire Vasc 150cm .035in Radiopq Std Shft Flxb	BOTH IP/OP	$402.00 	$297.48	$0.00	$309.86	$218.29	$218.29	$0.00	$0.00	$0.00	$75.66	$298.36	$298.36	$309.86	$0.00	$75.65	$0.00	$214.71	$214.71	$0.00	$181.50	$287.50	$290.40	$0.00	$261.30	$0.00	$56.81	$0.00	$0.00	$57.79	$0.00	$0.00	$0.00	$0.00	$0.00
80009079	EAP	HCPCS C1894		Sheath Introd 10cm 5fr Pncl Peri Ss Hydphi Ptfe	BOTH IP/OP	$219.00 	$162.06	$0.00	$175.20	$118.92	$118.92	$0.00	$0.00	$0.00	$45.65	$162.54	$162.54	$168.81	$0.00	$45.64	$0.00	$129.54	$129.54	$0.00	$109.50	$173.45	$175.20	$0.00	$142.35	$0.00	$34.27	$0.00	$0.00	$34.86	$0.00	$0.00	$0.00	$0.00	$0.00
80009081	EAP	HCPCS C1894		Sheath Introd 10cm 8fr Pncl Peri Ss Hydphi Ptfe	BOTH IP/OP	$219.00 	$162.06	$0.00	$175.20	$118.92	$118.92	$0.00	$0.00	$0.00	$45.65	$162.54	$162.54	$168.81	$0.00	$45.64	$0.00	$129.54	$129.54	$0.00	$109.50	$173.45	$175.20	$0.00	$142.35	$0.00	$34.27	$0.00	$0.00	$34.86	$0.00	$0.00	$0.00	$0.00	$0.00
80009082	EAP	HCPCS C1894		Sheath Introd 10cm 9fr Pncl Peri Ss Hydphi Ptfe	BOTH IP/OP	$272.00 	$201.28	$0.00	$209.66	$147.70	$147.70	$0.00	$0.00	$0.00	$45.65	$201.88	$201.88	$209.66	$0.00	$45.64	$0.00	$129.54	$129.54	$0.00	$109.50	$173.45	$175.20	$0.00	$176.80	$0.00	$34.27	$0.00	$0.00	$34.86	$0.00	$0.00	$0.00	$0.00	$0.00
80009106	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Sft Rbn Tip Kink Rst	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80009617	EAP	HCPCS B4087		Tube Jjnstm 12fr 2-3ml Strl Lf Mc Slk Med Port Radopq Strp	BOTH IP/OP	$337.00 	$249.38	$0.00	$269.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.12	$250.12	$259.76	$0.00	$70.23	$0.00	$0.00	$0.00	$0.00	$168.50	$266.90	$269.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80009798	EAP	HCPCS C1760		Device Clsr 5-7fr Cardiva Ctlst Ii Fem Art Prtmn	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	"$2,890.50"	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00	$0.00	$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
80009995	EAP	HCPCS C1894		Sheath Guid 45cm 6fr Pn Dstn Str Ss Nyl Hydphi	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$112.40	$112.40	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$159.56	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00	$0.00	$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
80010072	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Shr Nx Bal Al1 Curve Coron	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$64.07	$64.07	$0.00	$0.00	$0.00	$24.59	$87.58	$87.58	$90.95	$0.00	$24.59	$0.00	$69.80	$69.80	$0.00	$59.00	$93.46	$94.40	$0.00	$0.00	$0.00	$18.47	$0.00	$0.00	$18.79	$0.00	$0.00	$0.00	$0.00	$0.00
80010120	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Core To Tip Radiopq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80010121	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Core To Tip Radiopq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80010122	EAP	HCPCS C1769		Extension Gwire 145cm .014in Doc	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
80010594	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Prfm Pgtl Curve Peri	BOTH IP/OP	$226.00 	$167.24	$0.00	$180.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$113.00	$178.99	$180.80	$0.00	$0.00	$0.00	$35.37	$0.00	$0.00	$35.98	$0.00	$0.00	$0.00	$0.00	$0.00
80010631	EAP	HCPCS C1874		Stent Trchbr 5mm 6fr 22mm 120cm Cover Cath Introd	BOTH IP/OP	"$6,288.00 "	"$4,653.12"	$0.00	"$5,030.40"	"$2,829.60"	"$2,829.60"	$0.00	$0.00	$0.00	"$1,310.58"	"$4,181.12"	"$4,181.12"	"$4,846.79"	$0.00	"$1,310.42"	$0.00	"$3,099.98"	"$3,099.98"	$0.00	"$3,144.00"	"$4,980.10"	"$5,030.40"	$0.00	$0.00	$0.00	$984.07	$0.00	$0.00	"$1,001.05"	$0.00	$0.00	$0.00	$0.00	$0.00
80010639	EAP	HCPCS C1876		System Coron Stent 13mm 4.5mm Mtlnk Ul Xcelon	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80016126	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Lnchr Ebu3 Curve Coron Nyl	BOTH IP/OP	$120.00 	$88.80	$0.00	$130.40	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$81.50	$129.10	$130.40	$0.00	$78.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80016128	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Lnchr Ebu4 Curve Coron Nyl	BOTH IP/OP	$113.00 	$83.62	$0.00	$90.40	$61.36	$61.36	$0.00	$0.00	$0.00	$23.55	$83.87	$83.87	$87.10	$0.00	$23.55	$0.00	$66.84	$66.84	$0.00	$56.50	$89.50	$90.40	$0.00	$0.00	$0.00	$17.68	$0.00	$0.00	$17.99	$0.00	$0.00	$0.00	$0.00	$0.00
80016129	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Ebu3 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80016130	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Ebu3.5 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80016131	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Shr Nx Bal Ebu4 Curve	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80016135	EAP	HCPCS C1757		Catheter Thrmb 145cm 7fr .080in Xprt Ap Aspirat	BOTH IP/OP	"$1,238.00 "	$916.12	$0.00	$990.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$619.00	$980.50	$990.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80016142	EAP	HCPCS C1753		Catheter Us 150cm 3.3-2.9fr 20mm Ee Pltn 20mhz	BOTH IP/OP	"$1,813.00 "	"$1,341.62"	$0.00	"$1,450.40"	$984.46	$984.46	$0.00	$0.00	$0.00	$377.87	"$1,345.61"	"$1,345.61"	"$1,397.46"	$0.00	$377.83	$0.00	"$1,072.39"	"$1,072.39"	$0.00	$906.50	"$1,435.90"	"$1,450.40"	$0.00	$0.00	$0.00	$283.73	$0.00	$0.00	$288.63	$0.00	$0.00	$0.00	$0.00	$0.00
80016144	EAP	HCPCS C1773		Kit Snr Agn 90d Mic 175cm 2.3-3fr 2mm Cath Loop	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,120.00"	$760.20	$760.20	$0.00	$0.00	$0.00	$291.80	"$1,039.08"	"$1,039.08"	"$1,079.12"	$0.00	$291.76	$0.00	$828.10	$828.10	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00	$0.00	$0.00	$219.10	$0.00	$0.00	$222.88	$0.00	$0.00	$0.00	$0.00	$0.00
80017153	EAP	HCPCS C1752		Catheter Sct Kt 2 Lum Coil Xtd Lgth	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80017258	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 12mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80017262	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 15mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80017266	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 20mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80017278	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 25mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80017284	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 25mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80017293	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 12mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80017362	EAP	Custom 80017362		Envelope Abs 2.7x2.5in Tyrx Polyarylate	BOTH IP/OP	"$1,738.00 "	"$1,286.12"	$0.00	"$1,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,289.94"	"$1,289.94"	"$1,339.65"	$0.00	$362.20	$0.00	$0.00	$0.00	$0.00	$869.00	"$1,376.50"	"$1,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80017977	EAP	Custom 80017977		Envelope Abs 3.3x2.9in Anbctrl Tyrx Polyarylate	BOTH IP/OP	"$2,238.00 "	"$1,656.12"	$0.00	"$1,790.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,661.04"	"$1,661.04"	"$1,725.05"	$0.00	$466.40	$0.00	$0.00	$0.00	$0.00	"$1,119.00"	"$1,772.50"	"$1,790.40"	$0.00	"$1,454.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80018159	EAP	HCPCS C1894		Tray Cath Lf A Neos 2 Tier Dsgn Fn Tip Fcp Ins Deph Fr Mgln	BOTH IP/OP	$127.00 	$93.98	$0.00	$101.60	$68.96	$68.96	$0.00	$0.00	$0.00	$26.47	$94.26	$94.26	$97.89	$0.00	$26.47	$0.00	$75.12	$75.12	$0.00	$63.50	$100.58	$101.60	$0.00	$82.55	$0.00	$19.88	$0.00	$0.00	$20.22	$0.00	$0.00	$0.00	$0.00	$0.00
80018208	EAP	HCPCS C1752		Set Catheter .035in 24cm 70cm Sidehole Removable S	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00	$243.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80018623	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 145cm 12mm Otw 2 Lum Ult	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018626	EAP	HCPCS C1725		Catheter Baldilat 2mm 145cm 12mm Otw 2 Lum Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018627	EAP	HCPCS C1725		Catheter Baldilat 2mm 145cm 15mm Otw 2 Lum Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018653	EAP			Dressing Foam 20x8in Gentle Adherence Polyurethane Foam Pad	BOTH IP/OP	$167.00 	$123.58	$0.00	$133.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.95	$123.95	$128.72	$0.00	$34.80	$0.00	$0.00	$0.00	$0.00	$83.50	$132.26	$133.60	$0.00	$108.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80018673	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 20mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018676	EAP	HCPCS C1725		Catheter Baldilat 3mm 12mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018677	EAP	HCPCS C1725		Catheter Baldilat 3mm 15mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018678	EAP	HCPCS C1725		Catheter Baldilat 3mm 20mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018679	EAP	HCPCS C1725		Catheter Baldilat 3mm 25mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018680	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 12mm Coron Rapex Radiopq	BOTH IP/OP	$488.00 	$361.12	$0.00	$390.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.00	$386.50	$390.40	$0.00	$0.00	$0.00	$76.37	$0.00	$0.00	$77.69	$0.00	$0.00	$0.00	$0.00	$0.00
80018683	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 8mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018684	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 12mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018685	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 15mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018686	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 20mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018689	EAP	HCPCS C1725		Catheter Baldilat 3.75mm 15mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018690	EAP	HCPCS C1725		Catheter Baldilat 3.75mm 20mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018691	EAP	HCPCS C1725		Catheter Baldilat 4mm 8mm Coron Rapex Radiopq Smth	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018692	EAP	HCPCS C1725		Catheter Baldilat 4mm 12mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018693	EAP	HCPCS C1725		Catheter Baldilat 4mm 15mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018694	EAP	HCPCS C1725		Catheter Baldilat 4mm 20mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80018696	EAP	HCPCS C1725		Catheter Baldilat 5mm 12mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80074158	EAP	HCPCS C1898		Lead Pacing 10mm Space Small Str 6.2fr 2mm 52cm 20	BOTH IP/OP	"$1,013.00 "	$749.62	$0.00	$810.40	$455.85	$455.85	$0.00	$0.00	$0.00	$211.13	$751.85	$751.85	$780.82	$0.00	$211.11	$0.00	$599.19	$599.19	$0.00	$506.50	$802.30	$810.40	$0.00	$455.85	$0.00	$158.53	$0.00	$0.00	$161.27	$0.00	$0.00	$0.00	$0.00	$0.00
80074159	EAP	HCPCS C1898		Lead Pacing 10mm Space Small Str 6.2fr 2mm 58cm 20	BOTH IP/OP	"$1,013.00 "	$749.62	$0.00	$810.40	$455.85	$455.85	$0.00	$0.00	$0.00	$211.13	$751.85	$751.85	$780.82	$0.00	$211.11	$0.00	$599.19	$599.19	$0.00	$506.50	$802.30	$810.40	$0.00	$455.85	$0.00	$158.53	$0.00	$0.00	$161.27	$0.00	$0.00	$0.00	$0.00	$0.00
80078368	EAP	HCPCS C1884		System Embl Prtc 320cm Crtd Lwr Xtrmt Cptr Wire	BOTH IP/OP	"$3,488.00 "	"$2,581.12"	$0.00	"$2,790.40"	"$1,893.98"	"$1,893.98"	$0.00	$0.00	$0.00	$726.99	"$2,588.79"	"$2,588.79"	"$2,688.55"	$0.00	$726.90	$0.00	"$2,063.15"	"$2,063.15"	$0.00	"$1,744.00"	"$2,762.50"	"$2,790.40"	$0.00	$0.00	$0.00	$545.87	$0.00	$0.00	$555.29	$0.00	$0.00	$0.00	$0.00	$0.00
80078369	EAP	HCPCS C1884		System Embl Prtc 320cm Crtd Lwr Xtrmt Cptr Wire	BOTH IP/OP	"$4,170.00 "	"$3,085.80"	$0.00	"$3,214.24"	"$2,264.31"	"$2,264.31"	$0.00	$0.00	$0.00	$869.13	"$3,094.97"	"$3,094.97"	"$3,214.24"	$0.00	$869.03	$0.00	"$2,466.56"	"$2,466.56"	$0.00	"$1,744.00"	"$2,762.50"	"$2,790.40"	$0.00	"$2,710.50"	$0.00	$545.87	$0.00	$0.00	$555.29	$0.00	$0.00	$0.00	$0.00	$0.00
80078384	EAP	HCPCS C1769		Guidewire Vasc 260cm .035in Radiopq Flxb Core To	BOTH IP/OP	$623.00 	$461.02	$0.00	$498.40	$338.29	$338.29	$0.00	$0.00	$0.00	$129.85	$462.39	$462.39	$480.21	$0.00	$129.83	$0.00	$368.50	$368.50	$0.00	$311.50	$493.42	$498.40	$0.00	$404.95	$0.00	$97.50	$0.00	$0.00	$99.18	$0.00	$0.00	$0.00	$0.00	$0.00
80079016	EAP	HCPCS C1894		Sheath Guid 80cm 6fr 2.2mm Flxr Sh Aq Radiopq Stf	BOTH IP/OP	$378.00 	$279.72	$0.00	$302.40	$205.25	$205.25	$0.00	$0.00	$0.00	$78.78	$280.55	$280.55	$291.36	$0.00	$78.78	$0.00	$223.59	$223.59	$0.00	$189.00	$299.38	$302.40	$0.00	$245.70	$0.00	$59.16	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$0.00
80079147	EAP	HCPCS C1760		Device Clsr 6fr Prgld Prcls Vasc Suture Mediate	BOTH IP/OP	$650.00 	$481.00	$0.00	$520.00	$292.50	$292.50	$0.00	$0.00	$0.00	$135.48	$482.43	$482.43	$501.02	$0.00	$135.46	$0.00	$384.48	$384.48	$0.00	$325.00	$514.80	$520.00	$0.00	$292.50	$0.00	$101.73	$0.00	$0.00	$103.48	$0.00	$0.00	$0.00	$0.00	$0.00
80079222	EAP	HCPCS C1894		Introducer Sheath Short 7fr 21ga 4cm Orange Hub Tubing	BOTH IP/OP	$48.00 	$35.52	$0.00	$37.00	$26.06	$26.06	$0.00	$0.00	$0.00	$8.96	$35.63	$35.63	$37.00	$0.00	$8.96	$0.00	$25.43	$25.43	$0.00	$21.50	$34.06	$34.40	$0.00	$31.20	$0.00	$6.73	$0.00	$0.00	$6.85	$0.00	$0.00	$0.00	$0.00	$0.00
80079510	EAP	HCPCS C1769		Guidewire Vasc 180cm .016in Str Tip Strbl	BOTH IP/OP	$744.00 	$550.56	$0.00	$595.20	$403.99	$403.99	$0.00	$0.00	$0.00	$155.07	$552.20	$552.20	$573.48	$0.00	$155.05	$0.00	$440.08	$440.08	$0.00	$372.00	$589.25	$595.20	$0.00	$483.60	$0.00	$116.44	$0.00	$0.00	$118.44	$0.00	$0.00	$0.00	$0.00	$0.00
80079568	EAP	Custom 80079568		Coil Embl 15cm 4mm Intlk Fbr Idc 18 Coil 2d Std	BOTH IP/OP	$943.00 	$697.82	$0.00	$754.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$699.89	$699.89	$726.86	$0.00	$196.52	$0.00	$0.00	$0.00	$0.00	$471.50	$746.86	$754.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80079570	EAP	Custom 80079570		Coil Embl 15cm 5mm Intlk Fbr Idc 18 Coil 2d Std	BOTH IP/OP	$943.00 	$697.82	$0.00	$754.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$699.89	$699.89	$726.86	$0.00	$196.52	$0.00	$0.00	$0.00	$0.00	$471.50	$746.86	$754.40	$0.00	$424.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80097224	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Imprs Sim2 Curve Crbrl Ss	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
80097225	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Crds Tmp Vert Curve Crbrl	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.50	$29.30	$29.60	$0.00	$0.00	$0.00	$5.79	$0.00	$0.00	$5.89	$0.00	$0.00	$0.00	$0.00	$0.00
80097341	EAP	Custom C1751		Axium Coil Detacher	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$73.31	$73.31	$0.00	$0.00	$0.00	$28.14	$100.20	$100.20	$104.06	$0.00	$28.13	$0.00	$79.85	$79.85	$0.00	$67.50	$106.92	$108.00	$0.00	$87.75	$0.00	$21.13	$0.00	$0.00	$21.49	$0.00	$0.00	$0.00	$0.00	$0.00
80097344	EAP	HCPCS C1769		Guidewire Vascular Taper .018in 300cm 8cm Radiopq Str Tip	BOTH IP/OP	$197.00 	$145.78	$0.00	$157.60	$106.97	$106.97	$0.00	$0.00	$0.00	$41.06	$146.21	$146.21	$151.85	$0.00	$41.05	$0.00	$116.53	$116.53	$0.00	$98.50	$156.02	$157.60	$0.00	$128.05	$0.00	$30.83	$0.00	$0.00	$31.36	$0.00	$0.00	$0.00	$0.00	$0.00
80097387	EAP	HCPCS C1876		System Cor Stnt 2.25mm 12mm Intgr Microtrac Rx 1 Strn Intgr	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$787.50	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
80097412	EAP	HCPCS C1876		System Cor Stnt 3mm 9mm Intgr Microtrac Rx 1 Strn Intgr Tip	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$787.50	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
80097421	EAP	HCPCS C1876		System Cor Stnt 4mm 12mm Intgr Microtrac Rx 1 Strn Intgr Tip	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$787.50	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
80097435	EAP	HCPCS C1757		System Thrmb 135cm 4fr 2mm Angjt Ult Cx-strm	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	"$2,436.98"	"$2,436.98"	$0.00	$0.00	$0.00	$935.41	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	"$2,654.65"	"$2,654.65"	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	"$2,917.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80097440	EAP	Custom 80097440		Pad Thrp Lg Arcticgel	BOTH IP/OP	"$4,960.00 "	"$3,670.40"	$0.00	"$3,968.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,681.31"	"$3,681.31"	"$3,823.17"	$0.00	"$1,033.66"	$0.00	$0.00	$0.00	$0.00	"$2,480.00"	"$3,928.32"	"$3,968.00"	$0.00	"$3,224.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80097469	EAP	HCPCS C1725		Catheter Baldilat 2mm 12mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80097470	EAP	HCPCS C1725		Catheter Baldilat 2mm 15mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80097471	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 12mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80097472	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 15mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80097473	EAP	HCPCS C1725		Catheter Baldilat 3mm 12mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80097474	EAP	HCPCS C1725		Catheter Baldilat 3mm 15mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80097475	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 12mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80097476	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 15mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80097477	EAP	Custom 80097477		Catheter Baldilat 4mm 15mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80100003	EAP	Custom 80100003		Hemodialysis-acute-i/p	BOTH IP/OP	"$3,300.00 "	"$2,442.00"	$0.00	"$2,145.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$687.72	$0.00	$0.00	$0.00	$0.00	"$1,194.00"	"$1,891.30"	"$1,910.40"	$0.00	"$2,145.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80100234	EAP	HCPCS C1894		Sheath Guid 70cm 6fr 2.2mm Flxr Chk-flo Str Tip Hi	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
80100235	EAP	HCPCS C1894		Sheath Guid 70cm 6fr 2.2mm Flxr Chk-flo Curve	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
80100236	EAP	HCPCS C1894		Introd Shth 8.8fr 7fr 110cm Gw Radiopq Band Hi Flx	BOTH IP/OP	$503.00 	$372.22	$0.00	$402.40	$273.13	$273.13	$0.00	$0.00	$0.00	$104.84	$373.33	$373.33	$387.71	$0.00	$104.83	$0.00	$297.52	$297.52	$0.00	$251.50	$398.38	$402.40	$0.00	$0.00	$0.00	$78.72	$0.00	$0.00	$80.08	$0.00	$0.00	$0.00	$0.00	$0.00
80100237	EAP	HCPCS C1894		Sheath Guid 70cm 7fr 2.5mm Flxr Introd / Flxr Guid	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00	$146.25	$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
80100239	EAP	HCPCS C1894		Sheath Guid 70cm 8fr 2.9mm Flxr Chk-flo Curve	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
80100242	EAP	HCPCS C1894		Sheath Guid 45cm 6fr .087in Flxr Chk-flo Anl0	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80100243	EAP	HCPCS C1894		Sheath Guid 45cm 6fr 2.2mm Flxr Chk-flo Multpur	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$122.20	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80100244	EAP	HCPCS C1894		Sheath Guid 45cm 6fr 2.2in Flxr Chk-flo Anl2 Curve	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80100245	EAP	HCPCS C1894		Sheath Guid 45cm 7fr .1in Flxr Chk-flo Anl0 Curve	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$122.20	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80100246	EAP	HCPCS C1894		Sheath Guid 45cm 7fr 2.5mm Flxr Chk-flo Anl3 Curve	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$122.20	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80100247	EAP	HCPCS C1894		Sheath Guid .018/.038in Anl0 Curve 8fr .113in 45cm Radiopq	BOTH IP/OP	$203.00 	$150.22	$0.00	$156.47	$110.23	$110.23	$0.00	$0.00	$0.00	$0.00	$150.67	$150.67	$156.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00	$131.95	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80100254	EAP	HCPCS C1769		Guidewire Vasc 180cm .035in Flx Tp Fix Core Exch	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$23.35	$23.35	$0.00	$0.00	$0.00	$8.96	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$25.43	$25.43	$0.00	$21.50	$34.06	$34.40	$0.00	$0.00	$0.00	$6.73	$0.00	$0.00	$6.85	$0.00	$0.00	$0.00	$0.00	$0.00
80100273	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Trnb Ad Bcn Kmp Curve Ss	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.50	$49.90	$50.40	$0.00	$0.00	$0.00	$9.86	$0.00	$0.00	$10.03	$0.00	$0.00	$0.00	$0.00	$0.00
80100275	EAP	HCPCS C1725		Catheter Angio 65cm 5fr Trnb Ad Bcn Kmp Curve Ss	BOTH IP/OP	$325.00 	$240.50	$0.00	$250.51	$176.48	$176.48	$0.00	$0.00	$0.00	$65.24	$241.22	$241.22	$250.51	$0.00	$65.23	$0.00	$185.14	$185.14	$0.00	$156.50	$247.90	$250.40	$0.00	$211.25	$0.00	$48.98	$0.00	$0.00	$49.83	$0.00	$0.00	$0.00	$0.00	$0.00
80100322	EAP	HCPCS C1876		Stent Bil 5mm 19mm 150cm Prmnt Bln Xpd Cath	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80100329	EAP	HCPCS C1876		Stent Bil 6mm 17mm 135cm 20mm Otw Radiopq Nc Bln	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80100330	EAP	HCPCS C1876		Stent Bil 6mm 37mm 135cm 40mm Radiopq Otw Nc Bln	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80100331	EAP	HCPCS C1876		Stent Bil 7mm 17mm 135cm 20mm Otw Radiopq Nc Bln	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80100332	EAP	HCPCS C1876		Stent Bil 7mm 37mm 135cm 40mm Otw Radiopq Nc Bln	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80100333	EAP	HCPCS C1876		Stent Bil 8mm 17mm 135cm 20mm Otw Radiopq Nc Bln	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80100334	EAP	HCPCS C1876		Stent Bil 8mm 37mm 135cm 40mm Otw Prmnt Bln Xpd	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80100335	EAP	HCPCS C1876		Stent Bil 9mm 25mm 135cm 30mm Otw Radiopq Nc Bln	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80100336	EAP	HCPCS C1876		Stent Bil 9mm 57mm 135cm 60mm Otw Radiopq Nc Bln	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80100337	EAP	HCPCS C1725		Catheter Baldilat 4mm 135cm 20mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100340	EAP	HCPCS C1725		Catheter Baldilat 5mm 135cm 40mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100343	EAP	HCPCS C1725		Catheter Baldilat 6mm 135cm 80mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$276.25	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100350	EAP	HCPCS C1725		Catheter Baldilat 2mm 144cm 40mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100353	EAP	HCPCS C1725		Catheter Baldilat 4mm 143cm 20mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100355	EAP	HCPCS C1725		Catheter Baldilat 2mm 150cm 100mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100356	EAP	HCPCS C1725		Catheter Baldilat 2mm 150cm 120mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100357	EAP	HCPCS C1725		Catheter Baldilat 2mm 150cm 150mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100358	EAP	HCPCS C1725		Catheter Baldilat 2mm 150cm 80mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100359	EAP	HCPCS C1725		Catheter Baldilat 3mm 150cm 100mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100361	EAP	HCPCS C1725		Catheter Baldilat 3mm 150cm 150mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100362	EAP	HCPCS C1725		Catheter Baldilat 3mm 150cm 80mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100363	EAP	HCPCS C1725		Catheter Baldilat 4mm 150cm 150mm Otw Infl Port Lp	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100364	EAP	HCPCS C1725		Catheter Baldilat 4mm 150cm 80mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100366	EAP	HCPCS C1725		Catheter Baldilat 4mm 135cm 200mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100371	EAP	HCPCS C1725		Catheter Baldilat 5mm 135cm 200mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100374	EAP	HCPCS C1725		Catheter Baldilat 6mm 135cm 200mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100377	EAP	HCPCS C1725		Catheter Baldilat 8mm 75cm 100mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100381	EAP	HCPCS C1726		Catheter Baldilat 2mm 150cm 150mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$276.25	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100382	EAP	HCPCS C1726		Catheter Baldilat 2mm 150cm 220mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$276.25	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100383	EAP	HCPCS C1726		Catheter Baldilat 3mm 150cm 100mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100385	EAP	HCPCS C1725		Catheter Baldilat 3mm 150cm 220mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100386	EAP	HCPCS C1726		Catheter Baldilat 4mm 150cm 100mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100392	EAP	HCPCS C1876		Stent Bil 10mm 37mm 75cm 40mm Otw Radiopq Nc Bln	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80100413	EAP	HCPCS C1725		Catheter Baldilat 4mm 135cm 40mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100416	EAP	HCPCS C1725		Catheter Baldilat 6mm 20mm 135cm Otw Tpr Tip Lp	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$276.25	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100418	EAP	HCPCS C1725		Catheter Baldilat 6mm 135cm 40mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100420	EAP	HCPCS C1725		Catheter Baldilat 6mm 135cm 60mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100425	EAP	HCPCS C1725		Catheter Baldilat 7mm 135cm 60mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100428	EAP	HCPCS C1725		Catheter Baldilat 8mm 135cm 20mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100430	EAP	HCPCS C1725		Catheter Baldilat 8mm 135cm 40mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100432	EAP	HCPCS C1725		Catheter Baldilat 8mm 135cm 40mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100433	EAP	HCPCS C1725		Catheter Baldilat 4mm 75cm 20mm Hi-prs Nybax	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.40	$233.49	$233.49	$0.00	$0.00	$0.00	$91.29	$319.15	$319.15	$331.44	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$279.50	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100434	EAP	HCPCS C1725		Catheter Baldilat 4mm 135cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100435	EAP	HCPCS C1726		Catheter Baldilat 4mm 75cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100436	EAP	HCPCS C1725		Catheter Baldilat 4mm 135cm 120mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100437	EAP	HCPCS C1725		Catheter Baldilat 5mm 75cm 20mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100438	EAP	HCPCS C1725		Catheter Baldilat 5mm 135cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100439	EAP	HCPCS C1725		Catheter Baldilat 5mm 75cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100440	EAP	HCPCS C1725		Catheter Baldilat 5mm 135cm 100mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100441	EAP	HCPCS C1725		Catheter Baldilat 5mm 135cm 150mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100443	EAP	HCPCS C1725		Catheter Baldilat 6mm 75cm 20mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100444	EAP	HCPCS C1725		Catheter Baldilat 6mm 135cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100445	EAP	HCPCS C1725		Catheter Baldilat 6mm 75cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100446	EAP	HCPCS C1725		Catheter Baldilat 6mm 135cm 100mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100447	EAP	HCPCS C1725		Catheter Baldilat 6mm 135cm 150mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100448	EAP	HCPCS C1725		Catheter Baldilat 7mm 75cm 20mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100449	EAP	HCPCS C1725		Catheter Baldilat 7mm 135cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100450	EAP	HCPCS C1725		Catheter Baldilat 7mm 75cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$284.70	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100451	EAP	HCPCS C1725		Catheter Baldilat 8mm 75cm 20mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100453	EAP	HCPCS C1725		Catheter Baldilat 8mm 75cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100454	EAP	HCPCS C1725		Catheter Baldilat 8mm 75cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100456	EAP	HCPCS C1725		Catheter Baldilat 10mm 75cm 20mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$284.70	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80100470	EAP	HCPCS C1757		SET THROMBECTOMY 6FR 3MM 120CM 15MM OTW CONTRAST INJEC PORT	BOTH IP/OP	"$4,225.00 "	"$3,126.50"	$0.00	"$3,380.00"	"$2,294.18"	"$2,294.18"	$0.00	$0.00	$0.00	$880.60	"$3,135.80"	"$3,135.80"	"$3,256.63"	$0.00	$880.49	$0.00	"$2,499.09"	"$2,499.09"	$0.00	"$2,112.50"	"$3,346.20"	"$3,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80100527	EAP	HCPCS C1768		Graft Vascular Gore Heparin Propaten Ptfe Standard Wall	BOTH IP/OP	"$3,148.00 "	"$2,329.52"	$0.00	"$2,518.40"	"$1,416.60"	"$1,416.60"	$0.00	$0.00	$0.00	$656.12	"$2,336.45"	"$2,336.45"	"$2,426.48"	$0.00	$656.04	$0.00	"$1,551.96"	"$1,551.96"	$0.00	"$1,574.00"	"$2,493.22"	"$2,518.40"	$0.00	$0.00	$0.00	$492.66	$0.00	$0.00	$501.16	$0.00	$0.00	$0.00	$0.00	$0.00
80100552	EAP	HCPCS C1894		Set Introd 30cm 14fr 4.6mm Chk-flo 41cm Acpt .038	BOTH IP/OP	$318.00 	$235.32	$0.00	$254.40	$172.67	$172.67	$0.00	$0.00	$0.00	$66.28	$236.02	$236.02	$245.11	$0.00	$66.27	$0.00	$188.10	$188.10	$0.00	$159.00	$251.86	$254.40	$0.00	$0.00	$0.00	$49.77	$0.00	$0.00	$50.63	$0.00	$0.00	$0.00	$0.00	$0.00
80100555	EAP	HCPCS C1726		CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
80100582	EAP	HCPCS C1769		GUIDEWIRE VASCULAR ANGLED .035IN 260CM 25CM GLIDEW	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$244.35	$244.35	$0.00	$0.00	$0.00	$93.79	$333.99	$333.99	$346.86	$0.00	$93.78	$0.00	$266.18	$266.18	$0.00	$225.00	$356.40	$360.00	$0.00	$292.50	$0.00	$70.43	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$0.00
80100584	EAP	HCPCS C1887		Catheter Angiographic Angle 4fr .041in 100cm 15cm 2 Braid	BOTH IP/OP	$121.00 	$89.54	$0.00	$96.80	$65.70	$65.70	$0.00	$0.00	$0.00	$25.22	$89.81	$89.81	$93.27	$0.00	$25.22	$0.00	$71.57	$71.57	$0.00	$60.50	$95.83	$96.80	$0.00	$78.65	$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
80100610	EAP	HCPCS C1726		Catheter Baldilat 2.5mm 150cm 120mm Otw Ult Lp	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100611	EAP	HCPCS C1726		Catheter Baldilat 2.5mm 150cm 220mm Otw Ult Lp	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80100614	EAP	HCPCS C1725		Catheter Baldilat 4mm 150cm 220mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$276.25	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80200001	EAP	Custom 80200001		Peritoneal Dialysis-inpat	BOTH IP/OP	"$1,724.00 "	"$1,275.76"	$0.00	"$1,120.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.28	$0.00	$0.00	$0.00	$0.00	$458.50	$726.26	$733.60	$0.00	"$1,120.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80200005	EAP	HCPCS C1751		Catheter Cen Ven .032in 9.3fr 38cm 75cm 3 Infus Lumen Extn	BOTH IP/OP	"$1,955.00 "	"$1,446.70"	$0.00	"$1,564.00"	"$1,061.57"	"$1,061.57"	$0.00	$0.00	$0.00	$407.47	"$1,451.00"	"$1,451.00"	"$1,506.91"	$0.00	$407.42	$0.00	"$1,156.38"	"$1,156.38"	$0.00	$977.50	"$1,548.36"	"$1,564.00"	$0.00	"$1,270.75"	$0.00	$305.96	$0.00	$0.00	$311.24	$0.00	$0.00	$0.00	$0.00	$0.00
80200008	EAP	HCPCS C1769		Guidewire Vasc 180cm .014in Atrm X Flpy Tip	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00	$130.00	$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
80200010	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Optitorque Jacky Radl 3.5	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.00	$69.70	$70.40	$0.00	$0.00	$0.00	$13.77	$0.00	$0.00	$14.01	$0.00	$0.00	$0.00	$0.00	$0.00
80200013	EAP	HCPCS C1894		Set Acces 10cm 5fr 21ga Mpnch Slht .018in Ss	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$54.30	$54.30	$0.00	$0.00	$0.00	$20.84	$74.22	$74.22	$77.08	$0.00	$20.84	$0.00	$59.15	$59.15	$0.00	$50.00	$79.20	$80.00	$0.00	$65.00	$0.00	$15.65	$0.00	$0.00	$15.92	$0.00	$0.00	$0.00	$0.00	$0.00
80200098	EAP	HCPCS C1769		Guidewire Vasc 260cm .018in Flpy Tip Radiopq Shrt	BOTH IP/OP	$203.00 	$150.22	$0.00	$162.40	$110.23	$110.23	$0.00	$0.00	$0.00	$42.31	$150.67	$150.67	$156.47	$0.00	$42.31	$0.00	$120.07	$120.07	$0.00	$101.50	$160.78	$162.40	$0.00	$131.95	$0.00	$31.77	$0.00	$0.00	$32.32	$0.00	$0.00	$0.00	$0.00	$0.00
80200103	EAP	HCPCS C1887		Catheter Intvn 6fr 5.1fr .056in 150cm 25cm Rapex	BOTH IP/OP	"$1,183.00 "	$875.42	$0.00	$946.40	$642.37	$642.37	$0.00	$0.00	$0.00	$246.57	$878.02	$878.02	$911.86	$0.00	$246.54	$0.00	$699.74	$699.74	$0.00	$591.50	$936.94	$946.40	$0.00	$768.95	$0.00	$185.14	$0.00	$0.00	$188.33	$0.00	$0.00	$0.00	$0.00	$0.00
80200104	EAP	HCPCS C1725		Catheter Guid 100cm 7fr Lnchr Ebu3.75 Curve Coron	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$105.95	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80200105	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Optitorque Radl Tig 4.5	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$47.78	$47.78	$0.00	$0.00	$0.00	$18.34	$65.31	$65.31	$67.83	$0.00	$18.34	$0.00	$52.05	$52.05	$0.00	$44.00	$69.70	$70.40	$0.00	$57.20	$0.00	$13.77	$0.00	$0.00	$14.01	$0.00	$0.00	$0.00	$0.00	$0.00
80200129	EAP	HCPCS C1725		Catheter Baldilat 9mm 75cm 60mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80200207	EAP	HCPCS C1725		Catheter Baldilat 8mm 135cm 100mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80200262	EAP	HCPCS C1753		Catheter Us .018in 3.4fr 135cm Intvasc Exch Vsn Pv	BOTH IP/OP	"$1,688.00 "	"$1,249.12"	$0.00	"$1,350.40"	$916.58	$916.58	$0.00	$0.00	$0.00	$351.82	"$1,252.83"	"$1,252.83"	"$1,301.11"	$0.00	$351.78	$0.00	$998.45	$998.45	$0.00	$844.00	"$1,336.90"	"$1,350.40"	$0.00	$0.00	$0.00	$264.17	$0.00	$0.00	$268.73	$0.00	$0.00	$0.00	$0.00	$0.00
80202089	EAP	Custom 80202089		SET TUBING 2.6MR 2 WAY COMMUNICATION IRRIGATION PUMP	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$96.35	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00	$81.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80202090	EAP	HCPCS C1733		Catheter Ep 110cm 7fr Safire Tx 2-5-2mm Spc 1mm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	"$1,153.88"	"$1,153.88"	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	"$1,381.25"	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80202091	EAP	HCPCS C1733		Safire Tx Catheter 8mm Large Curl	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$814.50	$814.50	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$975.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80202094	EAP	HCPCS C1733		Catheter Ep 115cm 7fr Safire Comfortgrip 2-5-2mm	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	"$1,056.25"	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
80202112	EAP	HCPCS C1893		Introd Shth 8.5fr 180cm 63cm Hmsts Vlv Sdprt Dilat	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$197.11	$197.11	$0.00	$0.00	$0.00	$75.66	$269.42	$269.42	$279.80	$0.00	$75.65	$0.00	$214.71	$214.71	$0.00	$181.50	$287.50	$290.40	$0.00	$0.00	$0.00	$56.81	$0.00	$0.00	$57.79	$0.00	$0.00	$0.00	$0.00	$0.00
80202116	EAP	HCPCS C1894		Introd Shth 8fr 50cm 12cm 2 Distal Gwire Hmsts Vlv	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$15.20	$15.20	$0.00	$0.00	$0.00	$5.84	$20.78	$20.78	$21.58	$0.00	$5.84	$0.00	$16.56	$16.56	$0.00	$14.00	$22.18	$22.40	$0.00	$18.20	$0.00	$4.38	$0.00	$0.00	$4.46	$0.00	$0.00	$0.00	$0.00	$0.00
80202118	EAP	HCPCS C1894		Introd Shth 6fr 50cm 12cm 2 Distal Gwire Hmsts Vlv	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$15.20	$15.20	$0.00	$0.00	$0.00	$5.84	$20.78	$20.78	$21.58	$0.00	$5.84	$0.00	$16.56	$16.56	$0.00	$14.00	$22.18	$22.40	$0.00	$18.20	$0.00	$4.38	$0.00	$0.00	$4.46	$0.00	$0.00	$0.00	$0.00	$0.00
80202121	EAP	HCPCS C1893		Introd Shth 8fr 60cm Fstcth Strl Latex Free Disp	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$169.96	$169.96	$0.00	$0.00	$0.00	$65.24	$232.31	$232.31	$241.26	$0.00	$65.23	$0.00	$185.14	$185.14	$0.00	$156.50	$247.90	$250.40	$0.00	$0.00	$0.00	$48.98	$0.00	$0.00	$49.83	$0.00	$0.00	$0.00	$0.00	$0.00
80202130	EAP	HCPCS C1766		Introd Cath 40cm 8.5fr 17ga Epicardium Rspn Agilis	BOTH IP/OP	"$2,638.00 "	"$1,952.12"	$0.00	"$2,110.40"	"$1,432.43"	"$1,432.43"	$0.00	$0.00	$0.00	$549.83	"$1,957.92"	"$1,957.92"	"$2,033.37"	$0.00	$549.76	$0.00	"$1,560.38"	"$1,560.38"	$0.00	"$1,319.00"	"$2,089.30"	"$2,110.40"	$0.00	$0.00	$0.00	$412.85	$0.00	$0.00	$419.97	$0.00	$0.00	$0.00	$0.00	$0.00
80202131	EAP	HCPCS C1730		Catheter Ep 120cm 5fr Rspn 5mm Spc Crnnd Curve	BOTH IP/OP	$213.00 	$157.62	$0.00	$170.40	$115.66	$115.66	$0.00	$0.00	$0.00	$44.39	$158.09	$158.09	$164.18	$0.00	$44.39	$0.00	$125.99	$125.99	$0.00	$106.50	$168.70	$170.40	$0.00	$138.45	$0.00	$33.33	$0.00	$0.00	$33.91	$0.00	$0.00	$0.00	$0.00	$0.00
80202133	EAP	HCPCS C1730		Catheter Ep 120cm 5fr Rspn 5mm Spc Jsphsn Curve	BOTH IP/OP	$213.00 	$157.62	$0.00	$170.40	$115.66	$115.66	$0.00	$0.00	$0.00	$44.39	$158.09	$158.09	$164.18	$0.00	$44.39	$0.00	$125.99	$125.99	$0.00	$106.50	$168.70	$170.40	$0.00	$138.45	$0.00	$33.33	$0.00	$0.00	$33.91	$0.00	$0.00	$0.00	$0.00	$0.00
80202150	EAP	HCPCS C1731		Catheter Ep 95cm 7fr Lvwr 2-10-2mm Spc Sup Lg Curl	BOTH IP/OP	"$1,938.00 "	"$1,434.12"	$0.00	"$1,550.40"	"$1,052.33"	"$1,052.33"	$0.00	$0.00	$0.00	$403.93	"$1,438.38"	"$1,438.38"	"$1,493.81"	$0.00	$403.88	$0.00	"$1,146.33"	"$1,146.33"	$0.00	$969.00	"$1,534.90"	"$1,550.40"	$0.00	"$1,259.70"	$0.00	$303.30	$0.00	$0.00	$308.53	$0.00	$0.00	$0.00	$0.00	$0.00
80202158	EAP			Kit Eltrd Ns Lf Ensite Navx Srfc Disp	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	"$1,734.30"	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00	"$1,462.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80202163	EAP	HCPCS C1898		Lead Packing Tendril Sts Steroid Silicone Helix L46cm Od6fr	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00	$506.25	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
80202164	EAP	HCPCS C1898		Lead Pacing Tendril Sts Optim Steroid L52 Cm Od6 Fr Endocard Is-1 Bipolar Con	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00	$506.25	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
80202165	EAP	HCPCS C1898		Lead Pacing Tendril Sts Steroid Silicone Helix L58 Od6 Fr Endocard	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$867.15	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00	$506.25	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
80202189	EAP	HCPCS C1751		Kit Cath .032in 8.5fr 18ga 16cm Lf 2.5in Blu Flxtp Arwg+ard	BOTH IP/OP	$349.00 	$258.26	$0.00	$279.20	$189.51	$189.51	$0.00	$0.00	$0.00	$72.74	$259.03	$259.03	$269.01	$0.00	$72.73	$0.00	$206.43	$206.43	$0.00	$174.50	$276.41	$279.20	$0.00	$226.85	$0.00	$54.62	$0.00	$0.00	$55.56	$0.00	$0.00	$0.00	$0.00	$0.00
80202203	EAP	HCPCS C1729		Tray Catheterization 16fr 2 Conctr Temperature Sense	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$37.47	$37.47	$0.00	$0.00	$0.00	$14.38	$51.21	$51.21	$53.19	$0.00	$14.38	$0.00	$40.81	$40.81	$0.00	$34.50	$54.65	$55.20	$0.00	$44.85	$0.00	$10.80	$0.00	$0.00	$10.98	$0.00	$0.00	$0.00	$0.00	$0.00
80202219	EAP	HCPCS C1726		Catheter Blndil 11 Atm 8mm 180cm 4cm Hrcn Rx Loprfl Radopq	BOTH IP/OP	$603.00 	$446.22	$0.00	$482.40	$327.43	$327.43	$0.00	$0.00	$0.00	$125.68	$447.55	$447.55	$464.79	$0.00	$125.67	$0.00	$356.67	$356.67	$0.00	$301.50	$477.58	$482.40	$0.00	$391.95	$0.00	$94.37	$0.00	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00
80202586	EAP			Coil Embolization .02in Complex 14mm 40cm Soft The Penumbra	BOTH IP/OP	"$6,188.00 "	"$4,579.12"	$0.00	"$4,950.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,769.71"	$0.00	"$1,289.58"	$0.00	$0.00	$0.00	$0.00	"$3,094.00"	"$4,900.90"	"$4,950.40"	$0.00	"$2,784.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80202609	EAP			Coil Embl .02in Cmplx 5mm 9cm The Penumbra Coil 400 Sft	BOTH IP/OP	"$5,490.00 "	"$4,062.60"	$0.00	"$4,392.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,074.68"	"$4,074.68"	"$4,231.69"	$0.00	"$1,144.12"	$0.00	$0.00	$0.00	$0.00	"$2,745.00"	"$4,348.08"	"$4,392.00"	$0.00	"$2,470.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80202611	EAP			Coil Embolization .02in Standard Complex 10mm 30cm Complex	BOTH IP/OP	"$5,513.00 "	"$4,079.62"	$0.00	"$4,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,091.75"	"$4,091.75"	"$4,249.42"	$0.00	"$1,148.91"	$0.00	$0.00	$0.00	$0.00	"$2,756.50"	"$4,366.30"	"$4,410.40"	$0.00	"$2,480.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80202615	EAP			Coil Embolization .02in Standard Complex 12mm 35cm Complex	BOTH IP/OP	"$5,570.00 "	"$4,121.80"	$0.00	"$4,456.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,134.05"	"$4,134.05"	"$4,293.36"	$0.00	"$1,160.79"	$0.00	$0.00	$0.00	$0.00	"$2,785.00"	"$4,411.44"	"$4,456.00"	$0.00	"$2,506.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80202624	EAP			Coil Embl .02in Cmplx 7mm 15cm The Penumbra Coil 400 Sft	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,174.88"	"$4,174.88"	"$4,335.75"	$0.00	"$1,172.25"	$0.00	$0.00	$0.00	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00	"$2,531.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80202641	EAP			Coil Embolization .02in Complex 10mm 30cm Soft The Penumbra	BOTH IP/OP	"$5,963.00 "	"$4,412.62"	$0.00	"$4,770.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,596.28"	$0.00	"$1,242.69"	$0.00	$0.00	$0.00	$0.00	"$2,981.50"	"$4,722.70"	"$4,770.40"	$0.00	"$2,683.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80202926	EAP	HCPCS C1887		Set Interventional .038in 10fr 40cm 62.5cm Catheter Cannu	BOTH IP/OP	"$1,131.00 "	$836.94	$0.00	$904.80	$614.13	$614.13	$0.00	$0.00	$0.00	$235.73	$839.43	$839.43	$871.77	$0.00	$235.70	$0.00	$668.99	$668.99	$0.00	$565.50	$895.75	$904.80	$0.00	$735.15	$0.00	$177.00	$0.00	$0.00	$180.06	$0.00	$0.00	$0.00	$0.00	$0.00
80202933	EAP	HCPCS C1894		Introd Cath 80cm 10fr 3.4mm Chk-flo Flxr Lg Vlv	BOTH IP/OP	$265.00 	$196.10	$0.00	$212.00	$143.90	$143.90	$0.00	$0.00	$0.00	$55.23	$196.68	$196.68	$204.26	$0.00	$55.23	$0.00	$156.75	$156.75	$0.00	$132.50	$209.88	$212.00	$0.00	$172.25	$0.00	$41.47	$0.00	$0.00	$42.19	$0.00	$0.00	$0.00	$0.00	$0.00
80202945	EAP	HCPCS C1894		Sheath Guid 45cm 7fr 2.5mm Flxr Chk-flo Anl2 Curve	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80202946	EAP	HCPCS C1894		Sheath Guid 90cm 6fr 2.2mm Flxr Chk-flo Anl1 Curve	BOTH IP/OP	$378.00 	$279.72	$0.00	$302.40	$205.25	$205.25	$0.00	$0.00	$0.00	$78.78	$280.55	$280.55	$291.36	$0.00	$78.78	$0.00	$223.59	$223.59	$0.00	$189.00	$299.38	$302.40	$0.00	$245.70	$0.00	$59.16	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$0.00
80202963	EAP	HCPCS C1894		Sheath Guid 45cm 8fr 2.9mm Flxr Chk-flo Anl1 Curve	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80203000	EAP	HCPCS C1751		Kit Catheter 8.5fr 16cm 3 Lumen Expand Chloraprep Safety	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$412.50	$653.40	$660.00	$0.00	$536.25	$0.00	$129.11	$0.00	$0.00	$131.34	$0.00	$0.00	$0.00	$0.00	$0.00
80206800	EAP			Kit Ndl Gd 21ga 96in Strt Us	BOTH IP/OP	$54.00 	$39.96	$0.00	$43.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.08	$40.08	$41.62	$0.00	$11.25	$0.00	$0.00	$0.00	$0.00	$27.00	$42.77	$43.20	$0.00	$35.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80206851	EAP	Custom 27220128		Dressing Gel 144x10in Effective Protection Knit Roll	BOTH IP/OP	$118.00 	$87.32	$0.00	$94.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.58	$87.58	$90.95	$0.00	$24.59	$0.00	$0.00	$0.00	$0.00	$59.00	$93.46	$94.40	$0.00	$76.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80206898	EAP	HCPCS C1725		Catheter Baldilat 5mm 135cm 120mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206901	EAP	HCPCS C1725		Catheter Baldilat 6mm 135cm 120mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206904	EAP	HCPCS C1725		Catheter Baldilat 7mm 135cm 120mm Hi-prs Nybax	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.40	$233.49	$233.49	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$331.44	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$219.00	$346.90	$350.40	$0.00	$279.50	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206906	EAP	HCPCS C1725		Catheter Baldilat 8mm 135cm 120mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206908	EAP	HCPCS C1725		Catheter Baldilat 3mm 135cm 150mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206910	EAP	HCPCS C1725		Catheter Baldilat 4mm 135cm 150mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206916	EAP	HCPCS C1725		Catheter Baldilat 8mm 135cm 150mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206930	EAP	HCPCS C1725		Catheter Baldilat 3mm 135cm 200mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206935	EAP	HCPCS C1725		Catheter Baldilat 7mm 135cm 200mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206937	EAP	HCPCS C1725		Catheter Baldilat 8mm 135cm 200mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206941	EAP	HCPCS C1726		Catheter Baldilat 3mm 75cm 20mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206949	EAP	HCPCS C1725		Catheter Baldilat 9mm 135cm 20mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206952	EAP	HCPCS C1725		CAT BALD LP 5.8FR 10MM 135CM 20MM HIGH PRE	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$284.70	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206954	EAP	HCPCS C1725		CAT BALD LP 5.8FR 12MM 135CM 20MM HIGH PRES	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206956	EAP	HCPCS C1725		Catheter Baldilat 12mm 75cm 20mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206984	EAP	HCPCS C1725		Catheter Baldilat 3mm 135cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206986	EAP	HCPCS C1725		Catheter Baldilat 3mm 75cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206988	EAP	HCPCS C1725		Catheter Baldilat 9mm 135cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206990	EAP	HCPCS C1725		Catheter Baldilat 10mm 135cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206992	EAP	HCPCS C1725		Catheter Baldilat 12mm 135cm 40mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206997	EAP	HCPCS C1753		CATHETER BALDILAT LP 5.3FR 4MM 135CM 60MM HIGH PRESSURE	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80206999	EAP	HCPCS C1725		CATHETER BALDILAT LP 5.3FR 4MM 75CM 60MM HIGH PRESSURE	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$284.70	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207000	EAP	HCPCS C1725		Catheter Baldilat 5mm 135cm 60mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$284.70	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207002	EAP	HCPCS C1725		Catheter Baldilat 5mm 75cm 60mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207003	EAP	HCPCS C1725		CAT BALD LP 5.3FR 6MM 135CM 60MM HIGH PRES	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207005	EAP	HCPCS C1725		CAT BALD .035IN 6MM 75CM 60MM HIGH PRES LP	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$284.70	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207009	EAP	HCPCS C1725		Catheter Baldilat 8mm 135cm 60mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207011	EAP	HCPCS C1725		CAT BALD .035IN 8MM 75CM 60MM HIGH PRE LP	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207012	EAP	HCPCS C1725		CAT BALD LP 5.8FR 9MM 135CM 60MM HIGH PRES	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207014	EAP	HCPCS C1725		Catheter Baldilat 10mm 135cm 60mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207016	EAP	HCPCS C1725		"MUSTANG 7FR 12.0MM X 60MM, 135CM"	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207018	EAP	HCPCS C1725		CAT BALD LP 5.8FR 12MM 75CM 60MM HIGH PRES	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207019	EAP	HCPCS C1725		Catheter Baldilat 3mm 135cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207021	EAP	HCPCS C1725		Catheter Baldilat 3mm 75cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207022	EAP	HCPCS C1725		Catheter Baldilat 4mm 135cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207024	EAP	HCPCS C1725		Catheter Baldilat 4mm 75cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207025	EAP	HCPCS C1725		Catheter Balloon Dilatation Mustang Nybax L135cm L80mm Od5.3fr	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$284.70	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207027	EAP	HCPCS C1725		Catheter Baldilat 5mm 75cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207028	EAP	HCPCS C1725		Catheter Baldilat 6mm 135cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207030	EAP	HCPCS C1725		Catheter Baldilat 6mm 75cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207031	EAP	HCPCS C1725		Catheter Baldilat 7mm 135cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207033	EAP	HCPCS C1725		Catheter Baldilat 7mm 75cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207039	EAP	HCPCS C1725		Catheter Baldilat 10mm 135cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207041	EAP	HCPCS C1725		Catheter Baldilat 10mm 75cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207044	EAP	HCPCS C1725		Catheter Baldilat 12mm 75cm 80mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207045	EAP	HCPCS C1725		Catheter Baldilat 3mm 135cm 100mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207048	EAP	HCPCS C1725		Catheter Baldilat 4mm 135cm 100mm Hi-prs Nybax	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207050	EAP	HCPCS C1725		Catheter Blndil 4mm 75cm 100mm Mustang	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207054	EAP	HCPCS C1725		CAT BALD LP 5.3FR 7MM 135CM 100MM HIGH PRES	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80207066	EAP	HCPCS C1725		Catheter Baldilat 4mm 30mm 135cm Otw Tpr Tip Lp	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207067	EAP	Custom 80207067		STERLING OTW 4MM X 60MM X 135CM	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80207074	EAP	HCPCS C1725		Catheter Baldilat 5mm 135cm 30mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207075	EAP	HCPCS C1725		Catheter Baldilat 5mm 135cm 60mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207077	EAP	HCPCS C1725		STERLING OTW 5MM X 100MM X 135CM	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207083	EAP	HCPCS C1725		Catheter Baldilat 6mm 135cm 30mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207084	EAP	HCPCS C1725		STERLING OTW 6MM X 100MM X 135CM	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207089	EAP	HCPCS C1725		Catheter Baldilat 7mm 135cm 30mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207090	EAP	HCPCS C1725		Catheter Baldilat 7mm 135cm 80mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207091	EAP	HCPCS C1725		Catheter Baldilat 7mm 135cm 100mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207096	EAP	HCPCS C1725		Catheter Baldilat 8mm 135cm 30mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207101	EAP	HCPCS C1725		Catheter Baldilat 9mm 135cm 20mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207102	EAP	HCPCS C1725		Catheter Baldilat 9mm 135cm 30mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207103	EAP	HCPCS C1725		Catheter Baldilat 9mm 135cm 60mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207104	EAP	HCPCS C1725		Catheter Baldilat 9mm 135cm 80mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207111	EAP	HCPCS C1725		Catheter Baldilat 10mm 135cm 30mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207113	EAP	HCPCS C1725		Catheter Baldilat 10mm 135cm 60mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207114	EAP	HCPCS C1725		Catheter Baldilat 10mm 135cm 80mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207119	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 150cm 80mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207125	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 150cm 80mm Otw Infl Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207145	EAP	HCPCS C1725		CAT BALD 14 ATM ULT LP 6FR 2.5MM 143CM 20MM	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207168	EAP	HCPCS C1753		Catheter Baldilat 2mm 150cm 60mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207169	EAP	HCPCS C1753		Catheter Baldilat 2.5mm 150cm 60mm Otw Ult Lp	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207170	EAP	HCPCS C1753		Catheter Baldilat 3mm 150cm 60mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207171	EAP	HCPCS C1753		Catheter Baldilat 3.5mm 150cm 60mm Otw Ult Lp	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$276.25	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207172	EAP	HCPCS C1753		Catheter Baldilat 4mm 150cm 60mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207173	EAP	HCPCS C1753		Catheter Baldilat 2mm 150cm 80mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207174	EAP	HCPCS C1753		Catheter Baldilat 2.5mm 150cm 80mm Otw Ult Lp	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207177	EAP	HCPCS C1753		Catheter Baldilat 4mm 150cm 80mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207178	EAP	HCPCS C1725		CAT BALD ULT LP TAP 6FR 2.5MM 150CM 100MM OTW	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207190	EAP	HCPCS C1753		Catheter Baldilat 3.5mm 150cm 120mm Otw Ult Lp	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207191	EAP	HCPCS C1753		Catheter Baldilat 2.5mm 150cm 150mm Otw Ult Lp	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207192	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 150cm 150mm Otw Ult Lp	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207193	EAP	HCPCS C1753		Catheter Baldilat 4mm 150cm 150mm Otw Ult Lp Nybax	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207199	EAP	HCPCS C1725		COYOTE 3.5MM X 220MM X 150CM	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80207206	EAP	HCPCS C1725		Catheter Baldilat 14mm 75cm 60mm Peri Lv Scrch Rst	BOTH IP/OP	$513.00 	$379.62	$0.00	$410.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.50	$406.30	$410.40	$0.00	$0.00	$0.00	$80.28	$0.00	$0.00	$81.67	$0.00	$0.00	$0.00	$0.00	$0.00
80207210	EAP	HCPCS C1725		Catheter Baldilat 16mm 75cm 60mm Peri Lv Scrch Rst	BOTH IP/OP	$513.00 	$379.62	$0.00	$410.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.50	$406.30	$410.40	$0.00	$0.00	$0.00	$80.28	$0.00	$0.00	$81.67	$0.00	$0.00	$0.00	$0.00	$0.00
80207214	EAP	HCPCS C1725		Catheter Baldilat 18mm 75cm 60mm Peri Lv Scrch Rst	BOTH IP/OP	$513.00 	$379.62	$0.00	$410.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.50	$406.30	$410.40	$0.00	$0.00	$0.00	$80.28	$0.00	$0.00	$81.67	$0.00	$0.00	$0.00	$0.00	$0.00
80207556	EAP	HCPCS C1725		Catheter Baldilat 8mm 135cm 20mm Otw Inflat Port	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00	$0.00	$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
80207580	EAP	HCPCS C1876		Stent Bil 7mm 27mm 135cm 30mm Otw Radiopq Bln Xpd	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80207581	EAP	HCPCS C1876		Stent Bil 8mm 27mm 135cm 30mm Otw Radiopq Nc Bln	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80207585	EAP	HCPCS C1876		Stent Bil 7mm 57mm 135cm 60mm Otw Radiopq Nc Bln	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80207586	EAP	HCPCS C1876		Stent Bil 8mm 57mm 135cm 60mm Otw Radiopq Nc Bln	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80207662	EAP	HCPCS C1876		STENT ENDO 100CM 14MM 40MM 75CM UNCONSTRAIN FLEX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	"$1,734.30"	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00	$0.00	$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
80207663	EAP	HCPCS C1876		Stent Endoprsth Trchbr 60mm 14mm 9fr Mtl Wlstnt	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	"$1,734.30"	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00	$0.00	$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
80207665	EAP	HCPCS C1876		Stent Endoprsth Trchbr Vns 40mm 16mm Elgiloy	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	"$1,734.30"	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00	$0.00	$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
80207666	EAP	HCPCS C1876		Stent Endoprsth Trchbr 60mm 16mm 9fr Mtl Wlstnt	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	"$1,734.30"	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00	$0.00	$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
80207668	EAP	HCPCS C1876		Stent Endoprsth Trchbr 60mm 18mm 9fr Mtl Wlstnt	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	"$1,734.30"	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00	$0.00	$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
80207678	EAP	HCPCS C1876		Stent Endoprsth Trchbr 90mm 14mm 9fr Mtl Wlstnt	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	"$1,734.30"	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00	$0.00	$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
80207773	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Imgr2 Bern Curve Crbrl	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$0.00	$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
80207912	EAP	HCPCS C1726		Device Athrcm 165cm .018in Truepath .017in Peri	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$2,128.56"	"$2,128.56"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	"$3,021.54"	$0.00	$816.93	$0.00	"$2,318.68"	"$2,318.68"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00	"$2,548.00"	$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
80207913	EAP	HCPCS C1769		Wire Cath Extn Truepath Chrnc Tot Ocl Dev	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$114.03	$114.03	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$161.87	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00	$0.00	$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
80207925	EAP	HCPCS C1769		GUI VAS ST STR .035IN 260CM FLEXIBLE TIP	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$54.30	$54.30	$0.00	$0.00	$0.00	$20.84	$74.22	$74.22	$77.08	$0.00	$20.84	$0.00	$59.15	$59.15	$0.00	$50.00	$79.20	$80.00	$0.00	$65.00	$0.00	$15.65	$0.00	$0.00	$15.92	$0.00	$0.00	$0.00	$0.00	$0.00
80207926	EAP	HCPCS C1769		Guidewire Vasc 260cm .038in Flpy Tip Fltwr Coil	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$54.30	$54.30	$0.00	$0.00	$0.00	$20.84	$74.22	$74.22	$77.08	$0.00	$20.84	$0.00	$59.15	$59.15	$0.00	$50.00	$79.20	$80.00	$0.00	$0.00	$0.00	$15.65	$0.00	$0.00	$15.92	$0.00	$0.00	$0.00	$0.00	$0.00
80207935	EAP	HCPCS C1769		Guidewire Vasc 260cm .035in Flpy Tip Fltwr Coil 3	BOTH IP/OP	$104.00 	$76.96	$0.00	$83.20	$56.47	$56.47	$0.00	$0.00	$0.00	$21.68	$77.19	$77.19	$80.16	$0.00	$21.67	$0.00	$61.52	$61.52	$0.00	$52.00	$82.37	$83.20	$0.00	$67.60	$0.00	$16.28	$0.00	$0.00	$16.56	$0.00	$0.00	$0.00	$0.00	$0.00
80207943	EAP	HCPCS C1769		Guidewire Vasc 260cm .018in Flpy Tip Radiopq Lng	BOTH IP/OP	$203.00 	$150.22	$0.00	$162.40	$110.23	$110.23	$0.00	$0.00	$0.00	$42.31	$150.67	$150.67	$156.47	$0.00	$42.31	$0.00	$120.07	$120.07	$0.00	$101.50	$160.78	$162.40	$0.00	$131.95	$0.00	$31.77	$0.00	$0.00	$32.32	$0.00	$0.00	$0.00	$0.00	$0.00
80207946	EAP	HCPCS C1769		Guidewire Vasc 260cm .025in Flpy Tip Radiopq Shrt	BOTH IP/OP	$202.00 	$149.48	$0.00	$161.60	$109.69	$109.69	$0.00	$0.00	$0.00	$42.10	$149.92	$149.92	$155.70	$0.00	$42.10	$0.00	$119.48	$119.48	$0.00	$101.00	$159.98	$161.60	$0.00	$131.30	$0.00	$31.61	$0.00	$0.00	$32.16	$0.00	$0.00	$0.00	$0.00	$0.00
80207949	EAP	HCPCS C1769		GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 300CM 8CM ROBUST	BOTH IP/OP	$319.00 	$236.06	$0.00	$255.20	$173.22	$173.22	$0.00	$0.00	$0.00	$66.49	$236.76	$236.76	$245.89	$0.00	$66.48	$0.00	$188.69	$188.69	$0.00	$159.50	$252.65	$255.20	$0.00	$0.00	$0.00	$49.92	$0.00	$0.00	$50.78	$0.00	$0.00	$0.00	$0.00	$0.00
80208087	EAP	HCPCS C1887		Mcth Infus 150cm 3-2.8fr .027in Rngd Hfl Hydphi	BOTH IP/OP	$721.00 	$533.54	$0.00	$576.80	$391.50	$391.50	$0.00	$0.00	$0.00	$150.27	$535.13	$535.13	$555.75	$0.00	$150.26	$0.00	$426.47	$426.47	$0.00	$360.50	$571.03	$576.80	$0.00	$0.00	$0.00	$112.84	$0.00	$0.00	$114.78	$0.00	$0.00	$0.00	$0.00	$0.00
80208096	EAP	HCPCS C1887		Mcth Infus 130cm 3-2.4fr Rngd Stc 18 90d Peri Hdr	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$572.87	$572.87	$0.00	$0.00	$0.00	$219.89	$783.02	$783.02	$813.19	$0.00	$219.86	$0.00	$624.03	$624.03	$0.00	$527.50	$835.56	$844.00	$0.00	$0.00	$0.00	$165.11	$0.00	$0.00	$167.96	$0.00	$0.00	$0.00	$0.00	$0.00
80208101	EAP	HCPCS C1769		Guidewire Vasc 180cm .016in Strbl Microfabricate	BOTH IP/OP	$744.00 	$550.56	$0.00	$595.20	$403.99	$403.99	$0.00	$0.00	$0.00	$155.07	$552.20	$552.20	$573.48	$0.00	$155.05	$0.00	$440.08	$440.08	$0.00	$372.00	$589.25	$595.20	$0.00	$0.00	$0.00	$116.44	$0.00	$0.00	$118.44	$0.00	$0.00	$0.00	$0.00	$0.00
80215246	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Optitorque Radl Tig 4	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$47.78	$47.78	$0.00	$0.00	$0.00	$18.34	$65.31	$65.31	$67.83	$0.00	$18.34	$0.00	$52.05	$52.05	$0.00	$44.00	$69.70	$70.40	$0.00	$57.20	$0.00	$13.77	$0.00	$0.00	$14.01	$0.00	$0.00	$0.00	$0.00	$0.00
80284625	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Lnchr Ebu3.75 Curve Coron	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80298657	EAP	HCPCS C1894		Set Introd 25 5/8in 6fr 8fr S Arwflx Perc 3w Stpck	BOTH IP/OP	$257.00 	$190.18	$0.00	$205.60	$139.55	$139.55	$0.00	$0.00	$0.00	$53.57	$190.75	$190.75	$198.10	$0.00	$53.56	$0.00	$152.02	$152.02	$0.00	$128.50	$203.54	$205.60	$0.00	$0.00	$0.00	$40.22	$0.00	$0.00	$40.91	$0.00	$0.00	$0.00	$0.00	$0.00
80307573	EAP	HCPCS C1729		Tray Surg 14fr 18ga 29cm 5cm 19 Sideport Catheter Echogenic	BOTH IP/OP	$450.00 	$333.00	$0.00	$490.95	$244.35	$244.35	$0.00	$0.00	$0.00	$172.99	$333.99	$333.99	$346.86	$0.00	$172.97	$0.00	$490.95	$490.95	$0.00	$208.50	$330.26	$333.60	$0.00	$292.50	$0.00	$65.26	$0.00	$0.00	$66.39	$0.00	$0.00	$0.00	$0.00	$0.00
80307582	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Core To Tip Radiopq	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00	$0.00	$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
80307684	EAP	HCPCS C1766		Introd Shth 8.5fr Strbl Cath Agilis Nxt 22.4mm	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	"$1,086.00"	"$1,086.00"	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	"$1,541.60"	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00	$0.00	$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
80307685	EAP	HCPCS C1766		Introd Shth 8.5fr 71cm 50mm Gwire Strbl Radiopq	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	"$1,086.00"	"$1,086.00"	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	"$1,541.60"	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00	$0.00	$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
80307691	EAP	HCPCS C1730		Catheter Ep 115cm 5fr Lvwr Crnnd-2 5mm Spc 1mm	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00	$0.00	$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
80307719	EAP	HCPCS C1894		Sheath Guid 55cm 6fr 2.2mm Flxr Chk-flo Str	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00	$0.00	$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
80307720	EAP	HCPCS C1894		Sheath Guid 55cm 6fr 2.2mm Flxr Hi-flx Chk-flo	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00	$0.00	$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
80307775	EAP	Custom 80307775		Coil Embolization 360d 5mm 10cm Detachable Soft Target	BOTH IP/OP	"$4,755.00 "	"$3,518.70"	$0.00	"$3,804.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,529.16"	"$3,529.16"	"$3,665.15"	$0.00	$990.94	$0.00	$0.00	$0.00	$0.00	"$2,377.50"	"$3,765.96"	"$3,804.00"	$0.00	"$2,139.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80307945	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 20mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307951	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 20mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307953	EAP	HCPCS C1725		Catheter Baldilat 4mm 8mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307954	EAP	HCPCS C1725		Catheter Baldilat 4mm 12mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307956	EAP	HCPCS C1725		Catheter Baldilat 2mm 8mm Coron Rapex Radiopq Smth	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307957	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 8mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307959	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 15mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307960	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 20mm Coron Rapex Radiopq	BOTH IP/OP	$175.00 	$129.50	$0.00	$200.00	$95.03	$95.03	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$134.89	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$125.00	$198.00	$200.00	$0.00	$113.75	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307961	EAP	HCPCS C1725		Catheter Baldilat 2.75mm 8mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307962	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 8mm Coron Rapex Radiopq	BOTH IP/OP	$213.00 	$157.62	$0.00	$200.00	$115.66	$115.66	$0.00	$0.00	$0.00	$44.39	$158.09	$158.09	$164.18	$0.00	$44.39	$0.00	$125.99	$125.99	$0.00	$125.00	$198.00	$200.00	$0.00	$138.45	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307963	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 20mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307964	EAP	HCPCS C1725		Catheter Baldilat 3.75mm 8mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307965	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 8mm Coron Rapex Radiopq	BOTH IP/OP	$213.00 	$157.62	$0.00	$200.00	$115.66	$115.66	$0.00	$0.00	$0.00	$44.39	$158.09	$158.09	$164.18	$0.00	$44.39	$0.00	$125.99	$125.99	$0.00	$125.00	$198.00	$200.00	$0.00	$138.45	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307966	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 15mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80307967	EAP	HCPCS C1725		Catheter Baldilat 5mm 15mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80308041	EAP	HCPCS C1724		Catheter Athrcm 135cm 7fr 2.1mm Navitus Jetstream	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80308043	EAP	HCPCS C1724		Catheter Athrcm Jetstream Navitus Rot	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80308065	EAP	HCPCS C1724		Catheter Athrcm 120cm 7fr 2.4/3.4mm Jetstream	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80308067	EAP	HCPCS C1894		Introducer Sheath 6fr 25cm 2.5cm Dilat Kink Resistant	BOTH IP/OP	$43.00 	$31.82	$0.00	$33.60	$23.35	$23.35	$0.00	$0.00	$0.00	$8.96	$31.91	$31.91	$33.14	$0.00	$8.96	$0.00	$25.43	$25.43	$0.00	$21.00	$33.26	$33.60	$0.00	$27.95	$0.00	$6.57	$0.00	$0.00	$6.69	$0.00	$0.00	$0.00	$0.00	$0.00
80308097	EAP	HCPCS C1725		Kit Cath Ins 8fr Sns Plus Stlk Fo Bln Iab Dev 50cc	BOTH IP/OP	"$2,614.00 "	"$1,934.36"	$0.00	"$2,091.20"	"$1,419.40"	"$1,419.40"	$0.00	$0.00	$0.00	$544.82	"$1,940.11"	"$1,940.11"	"$2,014.87"	$0.00	$544.76	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,307.00"	"$2,070.29"	"$2,091.20"	$0.00	$0.00	$0.00	$409.09	$0.00	$0.00	$416.15	$0.00	$0.00	$0.00	$0.00	$0.00
80308098	EAP	HCPCS C1725		Catheter Iab 6in 7.5fr 16mm Sns Plus .025in 2 Stlk	BOTH IP/OP	"$2,725.00 "	"$2,016.50"	$0.00	"$2,180.00"	"$1,479.68"	"$1,479.68"	$0.00	$0.00	$0.00	$567.96	"$2,022.50"	"$2,022.50"	"$2,100.43"	$0.00	$567.89	$0.00	"$1,611.84"	"$1,611.84"	$0.00	"$1,362.50"	"$2,158.20"	"$2,180.00"	$0.00	$0.00	$0.00	$426.46	$0.00	$0.00	$433.82	$0.00	$0.00	$0.00	$0.00	$0.00
80308211	EAP	HCPCS C1894		Kit Introd 10cm 6fr 21ga Glidesheath Slndr .021in	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$74.93	$74.93	$0.00	$0.00	$0.00	$28.76	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$81.63	$81.63	$0.00	$69.00	$109.30	$110.40	$0.00	$89.70	$0.00	$21.60	$0.00	$0.00	$21.97	$0.00	$0.00	$0.00	$0.00	$0.00
80308259	EAP	HCPCS C1817		Occluder Cardio 4mm 22mm 32-36mm Spt 2 Disc Slf	BOTH IP/OP	"$15,163.00 "	"$11,220.62"	$0.00	"$12,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,687.64"	$0.00	"$3,159.97"	$0.00	$0.00	$0.00	$0.00	"$7,581.50"	"$12,009.10"	"$12,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80308260	EAP	HCPCS C1817		Occluder Cardio 4mm 24mm 34-38mm Spt 2 Disc Slf	BOTH IP/OP	"$15,163.00 "	"$11,220.62"	$0.00	"$12,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$11,687.64"	$0.00	"$3,159.97"	$0.00	$0.00	$0.00	$0.00	"$7,581.50"	"$12,009.10"	"$12,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80308262	EAP	Custom 80308262		Catheter Dlv Sys 45d 10fr 80cm Lfric Radiopq Tip	BOTH IP/OP	"$1,630.00 "	"$1,206.20"	$0.00	"$1,304.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,209.79"	"$1,209.79"	"$1,256.40"	$0.00	$339.69	$0.00	$0.00	$0.00	$0.00	$815.00	"$1,290.96"	"$1,304.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80308264	EAP	Custom 80308264		Balloon Sz 70cm 40mm Amplzr 3 Lum Radiopq Sft	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$512.12	$512.12	$531.85	$0.00	$143.80	$0.00	$0.00	$0.00	$0.00	$345.00	$546.48	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80308265	EAP	HCPCS C1759		Catheter Us Cnsl Viewflexxice Viewmate	BOTH IP/OP	"$7,000.00 "	"$5,180.00"	$0.00	"$5,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,395.60"	$0.00	"$1,458.80"	$0.00	$0.00	$0.00	$0.00	"$3,500.00"	"$5,544.00"	"$5,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80308295	EAP	HCPCS C1753		Catheter Us 20mhz Shrt Tpr 5fr 2.9fr 150cm 24cm	BOTH IP/OP	"$1,813.00 "	"$1,341.62"	$0.00	"$1,450.40"	$984.46	$984.46	$0.00	$0.00	$0.00	$377.87	"$1,345.61"	"$1,345.61"	"$1,397.46"	$0.00	$377.83	$0.00	"$1,072.39"	"$1,072.39"	$0.00	$906.50	"$1,435.90"	"$1,450.40"	$0.00	$0.00	$0.00	$283.73	$0.00	$0.00	$288.63	$0.00	$0.00	$0.00	$0.00	$0.00
80308611	EAP	HCPCS C1760		Device Clsr 5fr Vascade Fem Art	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$404.67	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00	$236.25	$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
80308612	EAP	HCPCS C1760		System Cmpr 6/7fr Vascade Vasc Clgn Babsr	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$404.67	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00	$0.00	$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
80308880	EAP	HCPCS C1887		Catheter Sprt 150cm 1.5fr .026-.039in Qkcrs 15mm	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$233.49	$233.49	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$331.44	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$215.00	$340.56	$344.00	$0.00	$0.00	$0.00	$67.30	$0.00	$0.00	$68.46	$0.00	$0.00	$0.00	$0.00	$0.00
80308883	EAP	Custom 80308883		QUICK CROSS 4F .018IN X 150CM	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.15	$319.15	$331.44	$0.00	$89.61	$0.00	$0.00	$0.00	$0.00	$215.00	$340.56	$344.00	$0.00	$279.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80308885	EAP	HCPCS C1887		CATHETER GUID .035IN 4.8-3.7FR 90CM LOW CROSSING P	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$226.97	$226.97	$0.00	$0.00	$0.00	$87.12	$310.24	$310.24	$322.19	$0.00	$87.11	$0.00	$247.25	$247.25	$0.00	$209.00	$331.06	$334.40	$0.00	$271.70	$0.00	$65.42	$0.00	$0.00	$66.55	$0.00	$0.00	$0.00	$0.00	$0.00
80308887	EAP	HCPCS C1887		Catheter Sprt 150cm 3.1fr .05-.063in Qkcrs 50mm	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$226.97	$226.97	$0.00	$0.00	$0.00	$87.12	$310.24	$310.24	$322.19	$0.00	$87.11	$0.00	$247.25	$247.25	$0.00	$209.00	$331.06	$334.40	$0.00	$0.00	$0.00	$65.42	$0.00	$0.00	$66.55	$0.00	$0.00	$0.00	$0.00	$0.00
80308888	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Core To Tip Radiopq	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$162.90	$162.90	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
80308889	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Core To Tip Radiopq	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$162.90	$162.90	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
80308892	EAP	HCPCS C1729		Kit Pressure Monitr 38cm Transducer Catheter Tunneling	BOTH IP/OP	"$2,146.00 "	"$1,588.04"	$0.00	"$1,654.14"	"$1,165.28"	"$1,165.28"	$0.00	$0.00	$0.00	$447.28	"$1,592.76"	"$1,592.76"	"$1,654.14"	$0.00	$447.23	$0.00	"$1,269.36"	"$1,269.36"	$0.00	"$1,014.00"	"$1,606.18"	"$1,622.40"	$0.00	"$1,394.90"	$0.00	$317.38	$0.00	$0.00	$322.86	$0.00	$0.00	$0.00	$0.00	$0.00
80308949	EAP	HCPCS C1724		System Athrcm 135cm 1.25mm Rtbl Rtl+ Dmd Precnct	BOTH IP/OP	"$3,092.00 "	"$2,288.08"	$0.00	"$2,473.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,294.88"	"$2,294.88"	"$2,383.31"	$0.00	$644.37	$0.00	$0.00	$0.00	$0.00	"$1,546.00"	"$2,448.86"	"$2,473.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80308950	EAP	HCPCS C1724		System Athrcm 135cm 1.5mm Rtbl Rtl+ Dmd Precnct	BOTH IP/OP	"$2,988.00 "	"$2,211.12"	$0.00	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,217.69"	"$2,217.69"	"$2,303.15"	$0.00	$622.70	$0.00	$0.00	$0.00	$0.00	"$1,494.00"	"$2,366.50"	"$2,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80308951	EAP	HCPCS C1724		System Athrcm 135cm 1.75mm Rtbl Rtl+ Dmd Precnct	BOTH IP/OP	"$3,092.00 "	"$2,288.08"	$0.00	"$2,473.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,294.88"	"$2,294.88"	"$2,383.31"	$0.00	$644.37	$0.00	$0.00	$0.00	$0.00	"$1,546.00"	"$2,448.86"	"$2,473.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80308954	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Atrm X Flpy Tip	BOTH IP/OP	$213.00 	$157.62	$0.00	$170.40	$115.66	$115.66	$0.00	$0.00	$0.00	$44.39	$158.09	$158.09	$164.18	$0.00	$44.39	$0.00	$125.99	$125.99	$0.00	$106.50	$168.70	$170.40	$0.00	$0.00	$0.00	$33.33	$0.00	$0.00	$33.91	$0.00	$0.00	$0.00	$0.00	$0.00
80308956	EAP	HCPCS C1887		Catheter Guid 150cm 1.8-2.6fr Finecross Mg Coron	BOTH IP/OP	"$1,063.00 "	$786.62	$0.00	$850.40	$577.21	$577.21	$0.00	$0.00	$0.00	$221.56	$788.96	$788.96	$819.36	$0.00	$221.53	$0.00	$628.76	$628.76	$0.00	$531.50	$841.90	$850.40	$0.00	$690.95	$0.00	$166.36	$0.00	$0.00	$169.23	$0.00	$0.00	$0.00	$0.00	$0.00
80308957	EAP	HCPCS C1769		Guidewire Vasc 330cm .014in Sprg Tip X Sprt Stf	BOTH IP/OP	"$2,070.00 "	"$1,531.80"	$0.00	"$1,656.00"	"$1,124.01"	"$1,124.01"	$0.00	$0.00	$0.00	$431.44	"$1,536.35"	"$1,536.35"	"$1,595.56"	$0.00	$431.39	$0.00	"$1,224.41"	"$1,224.41"	$0.00	"$1,035.00"	"$1,639.44"	"$1,656.00"	$0.00	$0.00	$0.00	$323.96	$0.00	$0.00	$329.54	$0.00	$0.00	$0.00	$0.00	$0.00
80308958	EAP	HCPCS C1769		Guidewire Vasc 330cm .014in Flpy Flxb Sprg Tip 2.2	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$224.80	$224.80	$0.00	$0.00	$0.00	$86.29	$307.27	$307.27	$319.11	$0.00	$86.28	$0.00	$244.88	$244.88	$0.00	$207.00	$327.89	$331.20	$0.00	$0.00	$0.00	$64.79	$0.00	$0.00	$65.91	$0.00	$0.00	$0.00	$0.00	$0.00
80308964	EAP	HCPCS C1769		Guidewire Vasc 180cm .035in Flxb Core To Tip	BOTH IP/OP	$496.00 	$367.04	$0.00	$396.80	$269.33	$269.33	$0.00	$0.00	$0.00	$103.38	$368.13	$368.13	$382.32	$0.00	$103.37	$0.00	$293.38	$293.38	$0.00	$248.00	$392.83	$396.80	$0.00	$0.00	$0.00	$77.62	$0.00	$0.00	$78.96	$0.00	$0.00	$0.00	$0.00	$0.00
80308966	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Kink Rst Radiopq Strbl	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80308967	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Core To Tip Radiopq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80308968	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Core To Tip Radiopq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80308971	EAP	HCPCS C1730		Catheter Ep 65cm 6fr Rspn 5-5-5mm Spc Csl Curve Mp	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$475.13	$475.13	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$674.45	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00	$0.00	$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
80308973	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Core To Tip Radiopq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$122.20	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80309134	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 145cm 6mm Otw 2 Lum Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309137	EAP	HCPCS C1725		Catheter Baldilat 2mm 145cm 20mm Otw 2 Lum Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309140	EAP	HCPCS C1725		Catheter Baldilat 1.2mm 12mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309141	EAP	HCPCS C1725		Catheter Baldilat 1.2mm 15mm Coron Rapex Ult Lp	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.50	$247.90	$250.40	$0.00	$0.00	$0.00	$48.98	$0.00	$0.00	$49.83	$0.00	$0.00	$0.00	$0.00	$0.00
80309142	EAP	HCPCS C1725		Catheter Baldilat 1.2mm 20mm Coron Rapex Ult Lp	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.50	$247.90	$250.40	$0.00	$0.00	$0.00	$48.98	$0.00	$0.00	$49.83	$0.00	$0.00	$0.00	$0.00	$0.00
80309152	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 12mm Coron Rapex Ult Lp	BOTH IP/OP	$175.00 	$129.50	$0.00	$200.00	$95.03	$95.03	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$134.89	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$125.00	$198.00	$200.00	$0.00	$113.75	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309153	EAP	HCPCS C1725		Catheter Baldilat 2.25mm 15mm Coron Rapex Ult Lp	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.50	$247.90	$250.40	$0.00	$0.00	$0.00	$48.98	$0.00	$0.00	$49.83	$0.00	$0.00	$0.00	$0.00	$0.00
80309166	EAP	HCPCS C1725		Catheter Baldilat 3mm 6mm Coron Rapex Ult Lp	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$169.96	$169.96	$0.00	$0.00	$0.00	$65.24	$232.31	$232.31	$241.26	$0.00	$65.23	$0.00	$185.14	$185.14	$0.00	$156.50	$247.90	$250.40	$0.00	$0.00	$0.00	$48.98	$0.00	$0.00	$49.83	$0.00	$0.00	$0.00	$0.00	$0.00
80309172	EAP	HCPCS C1725		Catheter Baldilat 3.25mm 20mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309175	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 6mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309176	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 30mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309185	EAP	HCPCS C1725		Catheter Baldilat 4mm 20mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309186	EAP	HCPCS C1725		Catheter Baldilat 4mm 25mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309187	EAP	HCPCS C1725		Catheter Baldilat 4mm 30mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309188	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 6mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309192	EAP	HCPCS C1725		Catheter Baldilat 1.5mm 20mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309193	EAP	HCPCS C1725		Catheter Baldilat 2mm 15mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309197	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 20mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309198	EAP	HCPCS C1725		Catheter Baldilat 5mm 20mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309200	EAP	HCPCS C1876		System Coron Stent 12mm 2.75mm Mtlnk Vsn Cocr	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80309201	EAP	HCPCS C1876		System Coron Stent 15mm 2.75mm Mtlnk Vsn Cocr	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80309203	EAP	HCPCS C1876		System Coron Stent 23mm 2.75mm Mtlnk Vsn Cocr	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80309206	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Core To Tip Radiopq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80309208	EAP	Custom 80309208		Catheter Pcng Eltrd Bipol Distal Tip Bln Flw Ast	BOTH IP/OP	"$1,950.00 "	"$1,443.00"	$0.00	"$1,560.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,447.29"	"$1,447.29"	"$1,503.06"	$0.00	$406.38	$0.00	$0.00	$0.00	$0.00	$975.00	"$1,544.40"	"$1,560.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80309257	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Lnchr Std Jr5 Curve Coron	BOTH IP/OP	$113.00 	$83.62	$0.00	$90.40	$61.36	$61.36	$0.00	$0.00	$0.00	$23.55	$83.87	$83.87	$87.10	$0.00	$23.55	$0.00	$66.84	$66.84	$0.00	$56.50	$89.50	$90.40	$0.00	$0.00	$0.00	$17.68	$0.00	$0.00	$17.99	$0.00	$0.00	$0.00	$0.00	$0.00
80309258	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Lnchr Lcb Curve Coron Nyl	BOTH IP/OP	$113.00 	$83.62	$0.00	$90.40	$61.36	$61.36	$0.00	$0.00	$0.00	$23.55	$83.87	$83.87	$87.10	$0.00	$23.55	$0.00	$66.84	$66.84	$0.00	$56.50	$89.50	$90.40	$0.00	$0.00	$0.00	$17.68	$0.00	$0.00	$17.99	$0.00	$0.00	$0.00	$0.00	$0.00
80309261	EAP	HCPCS C1887		Catheter Guid 100cm 7fr Lnchr Al1 Curve Coron Peri	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80309262	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Lnchr Radl Curve Peri Nyl	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80309263	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Lnchr Lara Curve Coron Nyl	BOTH IP/OP	$113.00 	$83.62	$0.00	$90.40	$61.36	$61.36	$0.00	$0.00	$0.00	$23.55	$83.87	$83.87	$87.10	$0.00	$23.55	$0.00	$66.84	$66.84	$0.00	$56.50	$89.50	$90.40	$0.00	$0.00	$0.00	$17.68	$0.00	$0.00	$17.99	$0.00	$0.00	$0.00	$0.00	$0.00
80309264	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Lnchr 30d Mac3 Curve Coron	BOTH IP/OP	$113.00 	$83.62	$0.00	$90.40	$61.36	$61.36	$0.00	$0.00	$0.00	$23.55	$83.87	$83.87	$87.10	$0.00	$23.55	$0.00	$66.84	$66.84	$0.00	$56.50	$89.50	$90.40	$0.00	$0.00	$0.00	$17.68	$0.00	$0.00	$17.99	$0.00	$0.00	$0.00	$0.00	$0.00
80309265	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Lnchr Std Ima Curve Coron	BOTH IP/OP	$113.00 	$83.62	$0.00	$90.40	$61.36	$61.36	$0.00	$0.00	$0.00	$23.55	$83.87	$83.87	$87.10	$0.00	$23.55	$0.00	$66.84	$66.84	$0.00	$56.50	$89.50	$90.40	$0.00	$0.00	$0.00	$17.68	$0.00	$0.00	$17.99	$0.00	$0.00	$0.00	$0.00	$0.00
80309266	EAP	HCPCS C1725		Catheter Angio 125cm 5fr Stsr Jr4 Curve Peri Pebax	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00	$0.00	$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
80309276	EAP	HCPCS C1769		"GUIDEWIRE HI-TORQUE COMM ES .014"" 300CM"	BOTH IP/OP	$988.00 	$731.12	$0.00	$790.40	$536.48	$536.48	$0.00	$0.00	$0.00	$205.92	$733.29	$733.29	$761.55	$0.00	$205.90	$0.00	$584.40	$584.40	$0.00	$494.00	$782.50	$790.40	$0.00	$642.20	$0.00	$154.62	$0.00	$0.00	$157.29	$0.00	$0.00	$0.00	$0.00	$0.00
80309278	EAP	HCPCS C1725		Catheter Baldilat 6mm 150cm 200mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80309279	EAP	HCPCS C1725		Catheter Angio 110cm 6fr Langston 145d Pgtl Curve	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00	$0.00	$0.00	$8.92	$0.00	$0.00	$9.07	$0.00	$0.00	$0.00	$0.00	$0.00
80309287	EAP	HCPCS C1725		Catheter Baldilat 3mm 8mm Coron Rapex Radiopq Smth	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309335	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 15mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309338	EAP	HCPCS C1725		Catheter Baldilat 4.5mm 12mm Coron Rapex Radiopq	BOTH IP/OP	$213.00 	$157.62	$0.00	$200.00	$115.66	$115.66	$0.00	$0.00	$0.00	$44.39	$158.09	$158.09	$164.18	$0.00	$44.39	$0.00	$125.99	$125.99	$0.00	$125.00	$198.00	$200.00	$0.00	$138.45	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309343	EAP	HCPCS C1880		Filter Embl 49mm 65cm Vc Radiopq Preld Flsh Sdprt	BOTH IP/OP	"$2,313.00 "	"$1,711.62"	$0.00	"$1,850.40"	"$1,040.85"	"$1,040.85"	$0.00	$0.00	$0.00	$482.09	"$1,716.71"	"$1,716.71"	"$1,782.86"	$0.00	$482.03	$0.00	"$1,368.14"	"$1,368.14"	$0.00	"$1,156.50"	"$1,831.90"	"$1,850.40"	$0.00	$0.00	$0.00	$361.98	$0.00	$0.00	$368.23	$0.00	$0.00	$0.00	$0.00	$0.00
80309345	EAP	HCPCS C1880		Filter Embl Navalign Dlv Uniset Strl Disp Pltn	BOTH IP/OP	"$2,313.00 "	"$1,711.62"	$0.00	"$1,850.40"	"$1,040.85"	"$1,040.85"	$0.00	$0.00	$0.00	$482.09	"$1,716.71"	"$1,716.71"	"$1,782.86"	$0.00	$482.03	$0.00	"$1,368.14"	"$1,368.14"	$0.00	"$1,156.50"	"$1,831.90"	"$1,850.40"	$0.00	$0.00	$0.00	$361.98	$0.00	$0.00	$368.23	$0.00	$0.00	$0.00	$0.00	$0.00
80309346	EAP	HCPCS C1725		Catheter Baldilat 2mm 12mm Coron Rapex Radiopq	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80309407	EAP	HCPCS C1876		System Coron Stent 8mm 2mm Mtlnk Mvsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80309409	EAP	HCPCS C1876		System Coron Stent 15mm 2mm Mtlnk Mvsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80309410	EAP	HCPCS C1876		System Coron Stent 18mm 2mm Mtlnk Mvsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80309411	EAP	HCPCS C1876		System Coron Stent 23mm 2mm Mtlnk Mvsn Cocr Rapex	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80309438	EAP	HCPCS C1900		Lead Pcng Lv Atn Starfix	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	"$3,179.55"	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00	"$1,856.25"	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80309448	EAP	HCPCS C1725		Catheter Pa 110cm 5fr 8mm Arw 1 Lum Bln Wdg Prss	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$162.90	$162.90	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
80309457	EAP	Custom 80309457		System Drg Dlv Ekosonic Mach 4 Microsonic Tx Zn	BOTH IP/OP	"$6,738.00 "	"$4,986.12"	$0.00	"$5,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,193.65"	$0.00	"$1,404.20"	$0.00	$0.00	$0.00	$0.00	"$3,369.00"	"$5,336.50"	"$5,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80309459	EAP	Custom 80309459		Device Thrmb 135cm 5.4fr Ekosonic Mach 4 Evas	BOTH IP/OP	"$6,738.00 "	"$4,986.12"	$0.00	"$5,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,193.65"	$0.00	"$1,404.20"	$0.00	$0.00	$0.00	$0.00	"$3,369.00"	"$5,336.50"	"$5,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80309461	EAP	Custom 80309461		Device Drg Dlv Ekosonic Mach 4 Infus Cath Us Core	BOTH IP/OP	"$6,738.00 "	"$4,986.12"	$0.00	"$5,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,193.65"	$0.00	"$1,404.20"	$0.00	$0.00	$0.00	$0.00	"$3,369.00"	"$5,336.50"	"$5,390.40"	$0.00	"$4,379.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80309462	EAP	Custom 80309462		Device Drg Dlv Ekosonic Mach 4 Infus Cath Us Core	BOTH IP/OP	"$6,738.00 "	"$4,986.12"	$0.00	"$5,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,193.65"	$0.00	"$1,404.20"	$0.00	$0.00	$0.00	$0.00	"$3,369.00"	"$5,336.50"	"$5,390.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80309492	EAP	HCPCS A6212		Dressing 6x3.5in Anmc Wtprf Flxb N Linr Strp Ionic	BOTH IP/OP	$45.00 	$33.30	$0.00	$51.20	$24.44	$24.44	$0.00	$0.00	$0.00	$9.38	$33.40	$33.40	$34.69	$0.00	$9.38	$0.00	$26.62	$26.62	$0.00	$32.00	$50.69	$51.20	$0.00	$29.25	$0.00	$10.02	$0.00	$0.00	$10.19	$0.00	$0.00	$0.00	$0.00	$0.00
80309550	EAP	Custom 80309550		Set Vntrc Ast 17.4x13.8in Impella Cp 9.3in 10-40c	BOTH IP/OP	"$62,500.00 "	"$46,250.00"	$0.00	"$50,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$48,175.00"	$0.00	"$13,025.00"	$0.00	$0.00	$0.00	$0.00	"$31,250.00"	"$49,500.00"	"$50,000.00"	$0.00	"$40,625.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80309582	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Sft Rbn Tip Kink Rst	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80309672	EAP	HCPCS C1757		Catheter Thrmb 10mm Flowtriever Strl Latex Free	BOTH IP/OP	"$11,625.00 "	"$8,602.50"	$0.00	"$9,300.00"	"$6,312.38"	"$6,312.38"	$0.00	$0.00	$0.00	"$2,422.94"	"$4,181.12"	"$4,181.12"	"$8,960.55"	$0.00	"$2,422.65"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,812.50"	"$9,207.00"	"$9,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80309673	EAP	HCPCS C1757		Catheter Thrmb 14mm Flowtriever Strl Latex Free	BOTH IP/OP	"$11,625.00 "	"$8,602.50"	$0.00	"$9,300.00"	"$6,312.38"	"$6,312.38"	$0.00	$0.00	$0.00	"$2,422.94"	"$4,181.12"	"$4,181.12"	"$8,960.55"	$0.00	"$2,422.65"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,812.50"	"$9,207.00"	"$9,300.00"	$0.00	"$7,556.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80309674	EAP	HCPCS C1757		Catheter Thrmb 18mm Flowtriever Strl Latex Free	BOTH IP/OP	"$11,625.00 "	"$8,602.50"	$0.00	"$9,300.00"	"$6,312.38"	"$6,312.38"	$0.00	$0.00	$0.00	"$2,422.94"	"$4,181.12"	"$4,181.12"	"$8,960.55"	$0.00	"$2,422.65"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$5,812.50"	"$9,207.00"	"$9,300.00"	$0.00	"$7,556.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80309675	EAP	HCPCS C1757		Catheter Guid 6.7mm Flowtriever 1 Ins Aspirate	BOTH IP/OP	"$6,875.00 "	"$5,087.50"	$0.00	"$5,500.00"	"$3,733.13"	"$3,733.13"	$0.00	$0.00	$0.00	"$1,432.92"	"$4,181.12"	"$4,181.12"	"$5,299.25"	$0.00	"$1,432.75"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,437.50"	"$5,445.00"	"$5,500.00"	$0.00	"$4,468.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80309676	EAP	Custom 80309676		FT RETRACTION ASPIRATOR DEVICE SE	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80309726	EAP	HCPCS C1887		Catheter Vasc 135cm 2.6-2.9fr 1.6fr Turnpike Ml Lr	BOTH IP/OP	"$1,313.00 "	$971.62	$0.00	"$1,050.40"	$712.96	$712.96	$0.00	$0.00	$0.00	$273.66	$974.51	$974.51	"$1,012.06"	$0.00	$273.63	$0.00	$776.64	$776.64	$0.00	$656.50	"$1,039.90"	"$1,050.40"	$0.00	$853.45	$0.00	$205.48	$0.00	$0.00	$209.03	$0.00	$0.00	$0.00	$0.00	$0.00
80309727	EAP	HCPCS C1887		Catheter Vasc 150cm 2.6-3.1fr 1.6fr Turnpike Ml Lr	BOTH IP/OP	"$1,488.00 "	"$1,101.12"	$0.00	"$1,190.40"	$807.98	$807.98	$0.00	$0.00	$0.00	$310.14	"$1,104.39"	"$1,104.39"	"$1,146.95"	$0.00	$310.10	$0.00	$880.15	$880.15	$0.00	$744.00	"$1,178.50"	"$1,190.40"	$0.00	$0.00	$0.00	$232.87	$0.00	$0.00	$236.89	$0.00	$0.00	$0.00	$0.00	$0.00
80309751	EAP	HCPCS C1874		System Coron Stent 12mm 4mm Promus Prmr Mnrl	BOTH IP/OP	"$4,250.00 "	"$3,145.00"	$0.00	"$3,400.00"	"$1,912.50"	"$1,912.50"	$0.00	$0.00	$0.00	$885.81	"$3,154.35"	"$3,154.35"	"$3,275.90"	$0.00	$885.70	$0.00	"$2,095.25"	"$2,095.25"	$0.00	"$2,125.00"	"$3,366.00"	"$3,400.00"	$0.00	$0.00	$0.00	$665.13	$0.00	$0.00	$676.60	$0.00	$0.00	$0.00	$0.00	$0.00
80309753	EAP	HCPCS C1874		System Coron Stent 20mm 4mm Promus Prmr Mnrl	BOTH IP/OP	"$4,250.00 "	"$3,145.00"	$0.00	"$3,400.00"	"$1,912.50"	"$1,912.50"	$0.00	$0.00	$0.00	$885.81	"$3,154.35"	"$3,154.35"	"$3,275.90"	$0.00	$885.70	$0.00	"$2,095.25"	"$2,095.25"	$0.00	"$2,125.00"	"$3,366.00"	"$3,400.00"	$0.00	$0.00	$0.00	$665.13	$0.00	$0.00	$676.60	$0.00	$0.00	$0.00	$0.00	$0.00
80309754	EAP	HCPCS C1874		System Coron Stent 24mm 4mm Promus Prmr Mnrl	BOTH IP/OP	"$4,250.00 "	"$3,145.00"	$0.00	"$3,400.00"	"$1,912.50"	"$1,912.50"	$0.00	$0.00	$0.00	$885.81	"$3,154.35"	"$3,154.35"	"$3,275.90"	$0.00	$885.70	$0.00	"$2,095.25"	"$2,095.25"	$0.00	"$2,125.00"	"$3,366.00"	"$3,400.00"	$0.00	$0.00	$0.00	$665.13	$0.00	$0.00	$676.60	$0.00	$0.00	$0.00	$0.00	$0.00
80310083	EAP	HCPCS C1884		System Embl Prtc 190cm .014in 110um Crtd Gwire	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$2,029.73"	"$2,029.73"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$2,211.03"	"$2,211.03"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
80310085	EAP	HCPCS C1894		Introd Shth Ped 5fr 21ga 40cm 7cm Gry Hub Dilat	BOTH IP/OP	$103.00 	$76.22	$0.00	$82.40	$55.93	$55.93	$0.00	$0.00	$0.00	$21.47	$76.45	$76.45	$79.39	$0.00	$21.47	$0.00	$60.92	$60.92	$0.00	$51.50	$81.58	$82.40	$0.00	$0.00	$0.00	$16.12	$0.00	$0.00	$16.40	$0.00	$0.00	$0.00	$0.00	$0.00
80310086	EAP	HCPCS C1894		Introd Shth Ped 6fr 21ga 40cm 7cm Grn Hub Dilat	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$55.39	$55.39	$0.00	$0.00	$0.00	$21.26	$75.70	$75.70	$78.62	$0.00	$21.26	$0.00	$60.33	$60.33	$0.00	$51.00	$80.78	$81.60	$0.00	$66.30	$0.00	$15.96	$0.00	$0.00	$16.24	$0.00	$0.00	$0.00	$0.00	$0.00
80310399	EAP	HCPCS C1876		Stent Vasc Epic Nitinol L60mm L120cm Od9mm Iliac	BOTH IP/OP	"$1,463.00 "	"$1,082.62"	$0.00	"$1,170.40"	$658.35	$658.35	$0.00	$0.00	$0.00	$304.93	"$1,085.84"	"$1,085.84"	"$1,127.68"	$0.00	$304.89	$0.00	$865.36	$865.36	$0.00	$731.50	"$1,158.70"	"$1,170.40"	$0.00	$658.35	$0.00	$228.96	$0.00	$0.00	$232.91	$0.00	$0.00	$0.00	$0.00	$0.00
80310402	EAP	HCPCS C1876		Stent Vasc 9mm 80mm 159cm 120cm Slf Xpd Ilc Art Ep	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$0.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80310534	EAP	HCPCS C1769		Guidewire Vasc 260cm .035in Flxb Sprg Coil Tip Std	BOTH IP/OP	$251.00 	$185.74	$0.00	$200.80	$136.29	$136.29	$0.00	$0.00	$0.00	$52.31	$186.29	$186.29	$193.47	$0.00	$52.31	$0.00	$148.47	$148.47	$0.00	$125.50	$198.79	$200.80	$0.00	$0.00	$0.00	$39.28	$0.00	$0.00	$39.96	$0.00	$0.00	$0.00	$0.00	$0.00
80310535	EAP	HCPCS C1769		Guidewire Vasc 180cm .035in Flxb Sprg Coil Tip Std	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$70.59	$70.59	$0.00	$0.00	$0.00	$27.10	$96.49	$96.49	$100.20	$0.00	$27.09	$0.00	$76.90	$76.90	$0.00	$65.00	$102.96	$104.00	$0.00	$0.00	$0.00	$20.35	$0.00	$0.00	$20.70	$0.00	$0.00	$0.00	$0.00	$0.00
80310536	EAP	HCPCS C1769		Guidewire Vasc 260cm .035in Flxb Sprg Coil Tip Std	BOTH IP/OP	"$1,045.00 "	$773.30	$0.00	$836.00	$567.44	$567.44	$0.00	$0.00	$0.00	$217.80	$775.60	$775.60	$805.49	$0.00	$217.78	$0.00	$618.12	$618.12	$0.00	$522.50	$827.64	$836.00	$0.00	$679.25	$0.00	$163.54	$0.00	$0.00	$166.36	$0.00	$0.00	$0.00	$0.00	$0.00
80310824	EAP	HCPCS C1733		Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc F-j Curve	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$2,239.88"	"$2,239.88"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	"$3,179.55"	$0.00	$859.65	$0.00	"$2,439.94"	"$2,439.94"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00	"$2,681.25"	$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
80315167	EAP	HCPCS C1894		Sheath Introd 28cm 9.8mm 26fr Gore Dryseal Hydphi	BOTH IP/OP	$863.00 	$638.62	$0.00	$690.40	$468.61	$468.61	$0.00	$0.00	$0.00	$179.87	$640.52	$640.52	$665.20	$0.00	$179.85	$0.00	$510.46	$510.46	$0.00	$431.50	$683.50	$690.40	$0.00	$560.95	$0.00	$135.06	$0.00	$0.00	$137.39	$0.00	$0.00	$0.00	$0.00	$0.00
80315263	EAP	HCPCS C1725		CATR BALD 14 ATM LP TAER 7FR 5MM 150CM 150MM	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80315264	EAP	HCPCS C1725		Catheter Baldilat 5mm 150cm 200mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80315265	EAP	HCPCS C1725		Catheter Baldilat 6mm 150cm 150mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80315266	EAP	HCPCS C1725		Catheter Baldilat 6mm 150cm 220mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80315267	EAP	HCPCS C1725		Catheter Baldilat 7mm 150cm 120mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80315268	EAP	HCPCS C1725		Catheter Baldilat 7mm 150cm 150mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80316943	EAP	HCPCS C1757		Set Thrmb 145cm 3-4fr 1.5mm Angjt Ult Solent Dista	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,715.00"	"$2,715.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	"$3,854.00"	$0.00	"$1,042.00"	$0.00	"$2,957.50"	"$2,957.50"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80317120	EAP	HCPCS C1760		Device Clsr 6fr Strcls Se Vasc Ntnl Clip Strl Disp	BOTH IP/OP	$788.00 	$583.12	$0.00	$630.40	$354.60	$354.60	$0.00	$0.00	$0.00	$164.24	$584.85	$584.85	$607.39	$0.00	$164.22	$0.00	$466.10	$466.10	$0.00	$394.00	$624.10	$630.40	$0.00	$0.00	$0.00	$123.32	$0.00	$0.00	$125.45	$0.00	$0.00	$0.00	$0.00	$0.00
80318107	EAP	HCPCS C1894		Introd Cath 90cm 6fr Chk-flo Flxr Raabe	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80318555	EAP	HCPCS C1725		Catheter Guid 135cm 3.2fr Stingray Lp Hydphi Strl	BOTH IP/OP	"$4,738.00 "	"$3,506.12"	$0.00	"$3,790.40"	"$2,572.73"	"$2,572.73"	$0.00	$0.00	$0.00	$987.52	"$3,516.54"	"$3,516.54"	"$3,652.05"	$0.00	$987.40	$0.00	"$2,802.53"	"$2,802.53"	$0.00	"$2,369.00"	"$3,752.50"	"$3,790.40"	$0.00	$0.00	$0.00	$741.50	$0.00	$0.00	$754.29	$0.00	$0.00	$0.00	$0.00	$0.00
80318556	EAP	HCPCS C1769		Guidewire Vasc 185cm .014in 20cm Stingray Hydphi	BOTH IP/OP	"$1,228.00 "	$908.72	$0.00	$982.40	$666.80	$666.80	$0.00	$0.00	$0.00	$255.95	$911.42	$911.42	$946.54	$0.00	$255.92	$0.00	$726.36	$726.36	$0.00	$614.00	$972.58	$982.40	$0.00	$0.00	$0.00	$192.18	$0.00	$0.00	$195.50	$0.00	$0.00	$0.00	$0.00	$0.00
80318557	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in 20cm Stingray Hydphi	BOTH IP/OP	"$1,228.00 "	$908.72	$0.00	$982.40	$666.80	$666.80	$0.00	$0.00	$0.00	$255.95	$911.42	$911.42	$946.54	$0.00	$255.92	$0.00	$726.36	$726.36	$0.00	$614.00	$972.58	$982.40	$0.00	$0.00	$0.00	$192.18	$0.00	$0.00	$195.50	$0.00	$0.00	$0.00	$0.00	$0.00
80318677	EAP	HCPCS C1764		System Crd Monitr Rvl Linq Mycarelink Ins Loop	BOTH IP/OP	"$11,613.00 "	"$8,593.62"	$0.00	"$9,290.40"	"$5,225.85"	"$5,225.85"	$0.00	$0.00	$0.00	"$2,420.44"	"$4,181.12"	"$4,181.12"	"$8,951.30"	$0.00	"$2,420.15"	$0.00	"$5,725.21"	"$5,725.21"	$0.00	"$5,806.50"	"$9,197.50"	"$9,290.40"	$0.00	"$5,225.85"	$0.00	"$1,817.43"	$0.00	$0.00	"$1,848.79"	$0.00	$0.00	$0.00	$0.00	$0.00
80320653	EAP	HCPCS C1894		Kit Introd 10cm 7fr 21ga Glidesheath Slndr .021in	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$74.93	$74.93	$0.00	$0.00	$0.00	$28.76	$102.42	$102.42	$106.37	$0.00	$28.76	$0.00	$81.63	$81.63	$0.00	$69.00	$109.30	$110.40	$0.00	$0.00	$0.00	$21.60	$0.00	$0.00	$21.97	$0.00	$0.00	$0.00	$0.00	$0.00
80320723	EAP	HCPCS C1769		Guidewire Vasc 80cm .035in Flxb Core To Tip	BOTH IP/OP	$73.00 	$54.02	$0.00	$58.40	$39.64	$39.64	$0.00	$0.00	$0.00	$15.22	$54.18	$54.18	$56.27	$0.00	$15.21	$0.00	$43.18	$43.18	$0.00	$36.50	$57.82	$58.40	$0.00	$0.00	$0.00	$11.42	$0.00	$0.00	$11.62	$0.00	$0.00	$0.00	$0.00	$0.00
80320735	EAP	HCPCS C1725		CHOCOLATE PTCA BALLOON CATHETER 2.0X10 MM 5F	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320736	EAP	HCPCS C1725		CHOCOLATE PTCA BALLOON CATHETER 2.0X15 MM 5F	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320737	EAP	HCPCS C1725		CHOCOLATE PTCA BALLOON CATHETER 2.0X20 MM 5F	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320738	EAP	HCPCS C1725		CHOCOLATE PTCA BALLOON CATHETER 2.5X10 MM 5F	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320739	EAP	HCPCS C1725		CHOCOLATE PTCA BALLOON CATHETER 2.5X15 MM 5F	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320740	EAP	HCPCS C1725		CHOCOLATE PTCA BALLOON CATHETER 2.5X20 MM 5F	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320741	EAP	HCPCS C1725		CHOCOLATE PTCA BALLOON CATHETER 3.0X10 MM 6F	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320742	EAP	HCPCS C1725		Catheter Baldilat 3mm 140cm 15mm Rapex Ntnl Latex	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320743	EAP	HCPCS C1725		CHOCOLATE PTCA BALLOON CATHETER 3.0X20 MM 6F	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320744	EAP	HCPCS C1725		CHOCOLATE PTCA BALLOON CATHETER 3.5X10 MM 6F	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320745	EAP	HCPCS C1725		CHOCOLATE PTCA BALLOON CATHETER 3.5X15 MM 6F	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320746	EAP	HCPCS C1725		CHOCOLATE PTCA BALLOON CATHETER 3.5X20 MM 6F	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	"$1,218.75"	$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320748	EAP	HCPCS C1887		CATHETER GUID EBU3.75 CURVE 8FR .09IN 90CM LEFT	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80320749	EAP	HCPCS C1887		CATHETER GUID JR4 CURVE 8FR .088IN 90CM CORON SHR	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80320750	EAP	HCPCS C1887		CATHETER GUID JL4 CURVE 8FR 90CM CORON SHR NX BAL	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80320781	EAP			Dressing 8x8in Anbctrl Latex Hydrofera Foam Blue	BOTH IP/OP	$33.00 	$24.42	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.49	$24.49	$25.44	$0.00	$6.88	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00	$21.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80320787	EAP	HCPCS C1729		Set Drain .038in 18fr L 40cm 32 Side Port Luer Lock Lock	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$152.04	$152.04	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$215.82	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00	$182.00	$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
80320793	EAP	HCPCS C1894		Introducer Sheath 9fr 25cm 2.5cm Dilat Kink Resistant	BOTH IP/OP	$429.00 	$317.46	$0.00	$339.20	$232.95	$232.95	$0.00	$0.00	$0.00	$89.41	$318.40	$318.40	$330.67	$0.00	$89.40	$0.00	$253.75	$253.75	$0.00	$212.00	$335.81	$339.20	$0.00	$278.85	$0.00	$66.36	$0.00	$0.00	$67.50	$0.00	$0.00	$0.00	$0.00	$0.00
80320799	EAP	HCPCS C1896		Electrode Dfbr 45cm Trplr Eblm S-icd 11.5fr Sbq	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	"$7,708.00"	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80320811	EAP	HCPCS C1769		Guidewire Vasc 300cm .035in Core To Tip Radiopq	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
80320812	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Crds Infnt Jl3.5 Curve	BOTH IP/OP	$97.00 	$71.78	$0.00	$77.60	$52.67	$52.67	$0.00	$0.00	$0.00	$20.22	$71.99	$71.99	$74.77	$0.00	$20.21	$0.00	$57.38	$57.38	$0.00	$48.50	$76.82	$77.60	$0.00	$63.05	$0.00	$15.18	$0.00	$0.00	$15.44	$0.00	$0.00	$0.00	$0.00	$0.00
80320813	EAP	HCPCS C1887		CATHETER ANGIO JL 4 CRV 5FR .047IN 100CM INFNT THRLMN RADOPQ	BOTH IP/OP	$97.00 	$71.78	$0.00	$77.60	$52.67	$52.67	$0.00	$0.00	$0.00	$20.22	$71.99	$71.99	$74.77	$0.00	$20.21	$0.00	$57.38	$57.38	$0.00	$48.50	$76.82	$77.60	$0.00	$63.05	$0.00	$15.18	$0.00	$0.00	$15.44	$0.00	$0.00	$0.00	$0.00	$0.00
80320814	EAP	HCPCS C1725		Catheter Angio 100cm 5fr Crds Infnt Jr4 Curve	BOTH IP/OP	$97.00 	$71.78	$0.00	$77.60	$52.67	$52.67	$0.00	$0.00	$0.00	$20.22	$71.99	$71.99	$74.77	$0.00	$20.21	$0.00	$57.38	$57.38	$0.00	$48.50	$76.82	$77.60	$0.00	$63.05	$0.00	$15.18	$0.00	$0.00	$15.44	$0.00	$0.00	$0.00	$0.00	$0.00
80320817	EAP	HCPCS C1894		SET INTROD 6FR 8FR 17.75IN 3 W	BOTH IP/OP	$249.00 	$184.26	$0.00	$199.20	$135.21	$135.21	$0.00	$0.00	$0.00	$51.90	$184.81	$184.81	$191.93	$0.00	$51.89	$0.00	$147.28	$147.28	$0.00	$124.50	$197.21	$199.20	$0.00	$0.00	$0.00	$38.97	$0.00	$0.00	$39.64	$0.00	$0.00	$0.00	$0.00	$0.00
80320820	EAP	HCPCS C1893		Introd Shth 10fr 67cm 63cm Gwire Hmsts Vlv Sh	BOTH IP/OP	$638.00 	$472.12	$0.00	$510.40	$346.43	$346.43	$0.00	$0.00	$0.00	$132.98	$473.52	$473.52	$491.77	$0.00	$132.96	$0.00	$377.38	$377.38	$0.00	$319.00	$505.30	$510.40	$0.00	$0.00	$0.00	$99.85	$0.00	$0.00	$101.57	$0.00	$0.00	$0.00	$0.00	$0.00
80320821	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Sft Rbn Tip Kink Rst	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$0.00	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80320844	EAP	HCPCS C1876		System Coron Stent 28mm 5mm Mtlnk Ul Xcelon Mcgld	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$0.00	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80320846	EAP	HCPCS C1725		Catheter Baldilat 2mm 150cm 220mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80320847	EAP	HCPCS C1725		Catheter Baldilat 2mm 150cm 40mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80320848	EAP	HCPCS C1725		Catheter Baldilat 3mm 150cm 220mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80320849	EAP	HCPCS C1725		Catheter Baldilat 3mm 150cm 40mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80320850	EAP	HCPCS C1725		Catheter Baldilat 4mm 150cm 220mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80320851	EAP	HCPCS C1725		Catheter Baldilat 7mm 150cm 200mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80320852	EAP	HCPCS C1725		Catheter Baldilat 7mm 150cm 220mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80320854	EAP	HCPCS C1757		Catheter Thrmb 135cm 4fr Unfs Flw-thru Hub Infus	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$237.83	$237.83	$0.00	$0.00	$0.00	$91.29	$325.08	$325.08	$337.61	$0.00	$91.28	$0.00	$259.08	$259.08	$0.00	$219.00	$346.90	$350.40	$0.00	$284.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80320860	EAP	HCPCS C1725		Catheter Baldilat 26mm 100cm 4cm Flxb Distal Tip	BOTH IP/OP	"$1,712.00 "	"$1,266.88"	$0.00	"$1,369.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$856.00	"$1,355.90"	"$1,369.60"	$0.00	$0.00	$0.00	$267.93	$0.00	$0.00	$272.55	$0.00	$0.00	$0.00	$0.00	$0.00
80320864	EAP	HCPCS C1876		System Coron Stent 13mm 5mm Mtlnk Ul Xcelon Mcgld	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$915.71	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00	$534.60	$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
80320865	EAP	Custom 80320865		Balloon Sz 70cm 27mm Amplzr 3 Lum Sft Distal Tip	BOTH IP/OP	$775.00 	$573.50	$0.00	$652.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.21	$575.21	$597.37	$0.00	$161.51	$0.00	$0.00	$0.00	$0.00	$407.50	$645.48	$652.00	$0.00	$503.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80320866	EAP	HCPCS C1887		Catheter Guid 90cm 6fr Lnchr Ima Curve Peri Nyl Lg	BOTH IP/OP	$120.00 	$88.80	$0.00	$130.40	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$81.50	$129.10	$130.40	$0.00	$78.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80320868	EAP	HCPCS C1887		Catheter Guid 100cm 5fr Lnchr Ebu5 Curve Coron Nyl	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00	$78.00	$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
80320869	EAP	HCPCS C1887		Catheter Guid 100cm 6fr Lnchr Ebu3.5 Curve Peri	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80320870	EAP	HCPCS C1769		CATHETER GUID EXTRA BACKUP 4.5 LEFT CURVE 6FR .071	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00	$78.00	$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
80321053	EAP	HCPCS C2617		Zimmon Pancreatic Stent 7fr 12cm	BOTH IP/OP	$178.00 	$131.72	$0.00	$142.40	$80.10	$80.10	$0.00	$0.00	$0.00	$37.10	$132.11	$132.11	$137.20	$0.00	$37.10	$0.00	$105.29	$105.29	$0.00	$89.00	$140.98	$142.40	$0.00	$80.10	$0.00	$27.86	$0.00	$0.00	$28.34	$0.00	$0.00	$0.00	$0.00	$0.00
80321087	EAP	HCPCS C1757		"INDIGO CATHETER 8, XTORQ TIP 115CM"	BOTH IP/OP	"$7,225.00 "	"$5,346.50"	$0.00	"$5,780.00"	"$3,923.18"	"$3,923.18"	$0.00	$0.00	$0.00	"$1,505.87"	"$4,181.12"	"$4,181.12"	"$5,569.03"	$0.00	"$1,505.69"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,612.50"	"$5,722.20"	"$5,780.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80321088	EAP	Custom 80321088		INDIGO SEPARATOR 8	BOTH IP/OP	"$4,700.00 "	"$3,478.00"	$0.00	"$3,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,488.34"	"$3,488.34"	"$3,622.76"	$0.00	$979.48	$0.00	$0.00	$0.00	$0.00	"$2,350.00"	"$3,722.40"	"$3,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80321095	EAP	HCPCS C1773		Kit Snr Agn 90d 200cm 2.3-3fr 7mm Mcth Loop Coil	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	$0.00	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
80321110	EAP	HCPCS C1769		Guidewire Vasc 175cm .014in Radiopq Prox Conctr	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$814.50	$814.50	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$975.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80321111	EAP	Custom 80321111		Kit Cath 135cm 2.7fr Img 1 Syr Rapex Tip Radiopq	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.63"	"$1,391.63"	"$1,445.25"	$0.00	$390.75	$0.00	$0.00	$0.00	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80321115	EAP	HCPCS C1887		Catheter Intvn 5fr .056in .046in 150cm 25cm Rapex	BOTH IP/OP	"$1,023.00 "	$757.02	$0.00	$818.40	$555.49	$555.49	$0.00	$0.00	$0.00	$213.22	$759.27	$759.27	$788.53	$0.00	$213.19	$0.00	$605.10	$605.10	$0.00	$511.50	$810.22	$818.40	$0.00	$664.95	$0.00	$160.10	$0.00	$0.00	$162.86	$0.00	$0.00	$0.00	$0.00	$0.00
80321116	EAP	HCPCS C1887		CATHETER INTVN 7FR .078IN .062IN 150CM 25CM RAPEX	BOTH IP/OP	"$1,023.00 "	$757.02	$0.00	$818.40	$555.49	$555.49	$0.00	$0.00	$0.00	$213.22	$759.27	$759.27	$788.53	$0.00	$213.19	$0.00	$605.10	$605.10	$0.00	$511.50	$810.22	$818.40	$0.00	$664.95	$0.00	$160.10	$0.00	$0.00	$162.86	$0.00	$0.00	$0.00	$0.00	$0.00
80321117	EAP	HCPCS C1887		Catheter Intvn 8fr .088in .071in 150cm 25cm Rapex	BOTH IP/OP	"$1,023.00 "	$757.02	$0.00	$818.40	$555.49	$555.49	$0.00	$0.00	$0.00	$213.22	$759.27	$759.27	$788.53	$0.00	$213.19	$0.00	$605.10	$605.10	$0.00	$511.50	$810.22	$818.40	$0.00	$0.00	$0.00	$160.10	$0.00	$0.00	$162.86	$0.00	$0.00	$0.00	$0.00	$0.00
80321162	EAP	HCPCS C1887		SHEATH GUID 65CM 8FR PN DSTN .038IN STR HYDPHI	BOTH IP/OP	$224.00 	$165.76	$0.00	$179.20	$121.63	$121.63	$0.00	$0.00	$0.00	$46.69	$166.25	$166.25	$172.66	$0.00	$46.68	$0.00	$132.50	$132.50	$0.00	$112.00	$177.41	$179.20	$0.00	$145.60	$0.00	$35.06	$0.00	$0.00	$35.66	$0.00	$0.00	$0.00	$0.00	$0.00
80321939	EAP	HCPCS C1773		SEPARATOR THRMB INDG 6 LATEX FREE	BOTH IP/OP	"$2,700.00 "	"$1,998.00"	$0.00	"$2,160.00"	"$1,466.10"	"$1,466.10"	$0.00	$0.00	$0.00	$562.75	"$2,003.94"	"$2,003.94"	"$2,081.16"	$0.00	$562.68	$0.00	"$1,597.05"	"$1,597.05"	$0.00	"$1,350.00"	"$2,138.40"	"$2,160.00"	$0.00	$0.00	$0.00	$422.55	$0.00	$0.00	$429.84	$0.00	$0.00	$0.00	$0.00	$0.00
80321943	EAP	HCPCS C1757		CATHETER THRMB 6FR INDG ASPIRAT LATEX FREE	BOTH IP/OP	"$4,725.00 "	"$3,496.50"	$0.00	"$3,780.00"	"$2,565.68"	"$2,565.68"	$0.00	$0.00	$0.00	$984.81	"$3,506.90"	"$3,506.90"	"$3,642.03"	$0.00	$984.69	$0.00	"$2,794.84"	"$2,794.84"	$0.00	"$2,362.50"	"$3,742.20"	"$3,780.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80321958	EAP			Coloplast Fistula Wound Mgr.-small 14021	BOTH IP/OP	$29.00 	$21.46	$0.00	$23.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.52	$21.52	$22.35	$0.00	$6.04	$0.00	$0.00	$0.00	$0.00	$14.50	$22.97	$23.20	$0.00	$18.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80321959	EAP			System 156-228mm Ost Midi Ctf 2 Spout Drain Port	BOTH IP/OP	$127.00 	$93.98	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.26	$94.26	$97.89	$0.00	$26.47	$0.00	$0.00	$0.00	$0.00	$63.50	$100.58	$101.60	$0.00	$82.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80321960	EAP			Coloplast Fistula Wound Mgr.-large 14041	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.49	$96.49	$100.20	$0.00	$27.09	$0.00	$0.00	$0.00	$0.00	$65.00	$102.96	$104.00	$0.00	$84.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80322020	EAP	HCPCS C1753		CATHETER ULTRASOUND .035IN 8.5FR 90CM 100CM OTW RADIOPQ	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,357.50"	"$1,357.50"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	"$1,927.00"	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00	"$1,625.00"	$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
80322156	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 30mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80322157	EAP	HCPCS C1725		Catheter Baldilat 2mm 25mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80322159	EAP	HCPCS C1725		CATHETER BALDILAT ULTRA LP 5FR 1.5MM 12MM 2 LUMEN	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80322160	EAP	HCPCS C1874		Catheter Baldilat 1.5mm 8mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80322163	EAP	HCPCS C1725		Catheter Baldilat 3mm 25mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80322164	EAP	HCPCS C1725		Catheter Baldilat 3mm 20mm Coron Rapex Ult Lp	BOTH IP/OP	$175.00 	$129.50	$0.00	$200.00	$95.03	$95.03	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$134.89	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$125.00	$198.00	$200.00	$0.00	$113.75	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80322165	EAP	HCPCS C1725		Catheter Baldilat 3mm 8mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$0.00	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80322166	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 25mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80322167	EAP	HCPCS C1725		Trek Coronary Dilatation Catheter 2.50 Mm X 8 Mm / Rapid-exchange	BOTH IP/OP	$213.00 	$157.62	$0.00	$170.40	$115.66	$115.66	$0.00	$0.00	$0.00	$44.39	$158.09	$158.09	$164.18	$0.00	$44.39	$0.00	$125.99	$125.99	$0.00	$106.50	$168.70	$170.40	$0.00	$138.45	$0.00	$33.33	$0.00	$0.00	$33.91	$0.00	$0.00	$0.00	$0.00	$0.00
80322168	EAP	HCPCS C1725		Catheter Baldilat 2mm 20mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80322169	EAP	HCPCS C1725		Catheter Baldilat 2mm 8mm Coron Rapex Ult Lp	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80322170	EAP	HCPCS C1725		CATHETER BALDILAT ULTRA LP 5FR 1.5MM 15MM 2 LUMEN	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80322173	EAP	HCPCS C1769		Guidewire Vasc 190cm .014in Jointless Sprg Coil	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$122.20	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80322174	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Core To Tip Radiopq	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$122.20	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80322178	EAP	HCPCS C1769		Guidewire Vasc 300cm .014in Jointless Sprg Coil	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$122.20	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80322247	EAP	HCPCS A6213		Dressing 6x6in Adh Hydrofera Foam Blue	BOTH IP/OP	$336.00 	$248.64	$0.00	$268.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.38	$249.38	$258.99	$0.00	$70.02	$0.00	$0.00	$0.00	$0.00	$168.00	$266.11	$268.80	$0.00	$218.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80322311	EAP	HCPCS C1769		GUIDEWIRE VASC 180CM ASAHI PTCA SION BLUE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
80322312	EAP	HCPCS C1769		GUIDEWIRE VASC 180CM .014IN STR 3CM SION ASAHI SS	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$243.75	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
80322313	EAP	HCPCS C1769		GUIDEWIRE VASC 300CM .014IN 3 RADIOPQ SEG STR 3CM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
80322314	EAP	HCPCS C1769		GUIDEWIRE VASC RG3	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$312.23	$312.23	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$443.21	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$287.50	$455.40	$460.00	$0.00	$373.75	$0.00	$89.99	$0.00	$0.00	$91.54	$0.00	$0.00	$0.00	$0.00	$0.00
80322339	EAP	HCPCS C1887		CATHETER GUID AL1 CURVE 8FR 90CM CORON SH LNCHR	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80322340	EAP	HCPCS C1887		CATHETER GUID 3DRC CURVE 8FR 90CM CORON LNCHR	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$105.95	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80322342	EAP	HCPCS C1887		CATHETER GUID AL1.5 CURVE 8FR .09IN 90CM CORON	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80322343	EAP	HCPCS C1887		CATHETER GUID AL1.5 CURVE 8FR 90CM CORON SH LNCHR	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80322347	EAP	HCPCS C1887		CATHETER GUID XB3.5 CURVE 8FR 90CM CORON SH LNCHR	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$105.95	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80322349	EAP	HCPCS C1887		CATHETER GUID XB4 CURVE 8FR 90CM CORON SH LNCHR	BOTH IP/OP	$163.00 	$120.62	$0.00	$130.40	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$96.41	$96.41	$0.00	$81.50	$129.10	$130.40	$0.00	$0.00	$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80322411	EAP	Custom 80322411		OMNI FLUSH (VCF) 5FR 100CM	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80322620	EAP	HCPCS C1750		Kit Cath 61cm Palindrome Prcs Smtr Tip 44cm Chrnc	BOTH IP/OP	"$1,445.00 "	"$1,069.30"	$0.00	"$1,156.00"	$784.64	$784.64	$0.00	$0.00	$0.00	$301.17	"$1,072.48"	"$1,072.48"	"$1,113.81"	$0.00	$301.14	$0.00	$854.72	$854.72	$0.00	$722.50	"$1,144.44"	"$1,156.00"	$0.00	$939.25	$0.00	$226.14	$0.00	$0.00	$230.04	$0.00	$0.00	$0.00	$0.00	$0.00
80322779	EAP	Custom 80322779		Set Ndl 15ga 45mm Strl Lf Ezio Ez-cnct Wrst Band Std Ll Cath	BOTH IP/OP	$340.00 	$251.60	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.35	$252.35	$262.07	$0.00	$70.86	$0.00	$0.00	$0.00	$0.00	$170.00	$269.28	$272.00	$0.00	$221.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80323591	EAP			Stabilit First Fracture Kit With Powercurve	BOTH IP/OP	"$7,000.00 "	"$5,180.00"	$0.00	"$5,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,395.60"	$0.00	"$1,458.80"	$0.00	$0.00	$0.00	$0.00	"$3,500.00"	"$5,544.00"	"$5,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80323627	EAP	HCPCS C1874		Stent Vascular  Zilver Ptx 125cm 80mm 100mm Od6 Fr	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	"$2,436.98"	"$2,436.98"	$0.00	$0.00	$0.00	$935.41	"$3,330.99"	"$3,330.99"	"$3,459.35"	$0.00	$935.30	$0.00	"$2,654.65"	"$2,654.65"	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	"$2,917.20"	$0.00	$702.37	$0.00	$0.00	$714.49	$0.00	$0.00	$0.00	$0.00	$0.00
80323828	EAP	HCPCS C1769		GUIDEWIRE VASC 190CM .014IN STRBL RADIOPQ KINK RST	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$122.20	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80323833	EAP	Custom 80323833		IMPELLA RP US HDE PUMP SET	BOTH IP/OP	"$62,500.00 "	"$46,250.00"	$0.00	"$50,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$48,175.00"	$0.00	"$13,025.00"	$0.00	$0.00	$0.00	$0.00	"$31,250.00"	"$49,500.00"	"$50,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80324729	EAP	Custom 80324729		TURNPIKE CATHETER LP 135CM	BOTH IP/OP	"$1,313.00 "	$971.62	$0.00	"$1,050.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$974.51	$974.51	"$1,012.06"	$0.00	$273.63	$0.00	$0.00	$0.00	$0.00	$656.50	"$1,039.90"	"$1,050.40"	$0.00	$853.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80324730	EAP	Custom 80324730		TURNPIKE CATHETER LP 150CM	BOTH IP/OP	"$1,488.00 "	"$1,101.12"	$0.00	"$1,190.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,104.39"	"$1,104.39"	"$1,146.95"	$0.00	$310.10	$0.00	$0.00	$0.00	$0.00	$744.00	"$1,178.50"	"$1,190.40"	$0.00	$967.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80324863	EAP	HCPCS C1874		Stent Endoprsth Sprfc Fem Art Ilium 10cm 7mm 7fr	BOTH IP/OP	"$8,950.00 "	"$6,623.00"	$0.00	"$7,160.00"	"$4,027.50"	"$4,027.50"	$0.00	$0.00	$0.00	"$1,865.40"	"$4,181.12"	"$4,181.12"	"$6,898.66"	$0.00	"$1,865.18"	$0.00	"$4,412.35"	"$4,412.35"	$0.00	"$4,475.00"	"$7,088.40"	"$7,160.00"	$0.00	$0.00	$0.00	"$1,400.68"	$0.00	$0.00	"$1,424.84"	$0.00	$0.00	$0.00	$0.00	$0.00
80324866	EAP	HCPCS C1892		Introd Shth 9fr 13cm Optiseal	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$70.59	$70.59	$0.00	$0.00	$0.00	$27.10	$96.49	$96.49	$100.20	$0.00	$27.09	$0.00	$76.90	$76.90	$0.00	$65.00	$102.96	$104.00	$0.00	$0.00	$0.00	$20.35	$0.00	$0.00	$20.70	$0.00	$0.00	$0.00	$0.00	$0.00
80325074	EAP	HCPCS C1773		Snare Vasc 47in .71-1.18in .055in .074in Ensnr	BOTH IP/OP	$828.00 	$612.72	$0.00	$662.40	$449.60	$449.60	$0.00	$0.00	$0.00	$172.58	$614.54	$614.54	$638.22	$0.00	$172.56	$0.00	$489.76	$489.76	$0.00	$414.00	$655.78	$662.40	$0.00	$0.00	$0.00	$129.58	$0.00	$0.00	$131.82	$0.00	$0.00	$0.00	$0.00	$0.00
80325086	EAP	HCPCS C1817		Occluder Cardio 25mm Spt Sft Wire Frm Flrscp Img	BOTH IP/OP	"$19,778.00 "	"$14,635.72"	$0.00	"$15,822.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$15,244.88"	$0.00	"$4,121.74"	$0.00	$0.00	$0.00	$0.00	"$9,889.00"	"$15,664.18"	"$15,822.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80325087	EAP	HCPCS C1817		Occluder Cardio 30mm Spt Sft Wire Frm Flrscp Img	BOTH IP/OP	"$19,778.00 "	"$14,635.72"	$0.00	"$15,822.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$15,244.88"	$0.00	"$4,121.74"	$0.00	$0.00	$0.00	$0.00	"$9,889.00"	"$15,664.18"	"$15,822.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80325319	EAP			Spinestar Ablation Instr 17.5 Cm L15 Mm L10 Mm Od11 Ga Therm	BOTH IP/OP	"$7,250.00 "	"$5,365.00"	$0.00	"$5,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,588.30"	$0.00	"$1,510.90"	$0.00	$0.00	$0.00	$0.00	"$3,625.00"	"$5,742.00"	"$5,800.00"	$0.00	"$4,712.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80325443	EAP	HCPCS C1887		Sheath Guid 65cm 6fr .109in .087in Pn Dstn Str Ss	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$173.43	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00	$0.00	$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
80325494	EAP	HCPCS C1725		Catheter Angio 125cm 6fr Crds St+ Jr4 Curve Coron	BOTH IP/OP	$84.00 	$62.16	$0.00	$67.20	$45.61	$45.61	$0.00	$0.00	$0.00	$17.51	$62.34	$62.34	$64.75	$0.00	$17.51	$0.00	$49.69	$49.69	$0.00	$42.00	$66.53	$67.20	$0.00	$54.60	$0.00	$13.15	$0.00	$0.00	$13.37	$0.00	$0.00	$0.00	$0.00	$0.00
80325495	EAP	HCPCS C1725		Catheter Angio 125cm 6fr Crds St+ Jl4 Curve Coron	BOTH IP/OP	$84.00 	$62.16	$0.00	$67.20	$45.61	$45.61	$0.00	$0.00	$0.00	$17.51	$62.34	$62.34	$64.75	$0.00	$17.51	$0.00	$49.69	$49.69	$0.00	$42.00	$66.53	$67.20	$0.00	$54.60	$0.00	$13.15	$0.00	$0.00	$13.37	$0.00	$0.00	$0.00	$0.00	$0.00
80325526	EAP	HCPCS C1876		INNOVA 5MM X 60MM X 75CM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80325555	EAP	HCPCS C1876		STENT VASC BLUE 40MM 6MM INNOVA SPRFC FEM ART SLF	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80325566	EAP	HCPCS C1876		INNOVA 8MM X 20MM X 130CM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80325567	EAP	HCPCS C1876		INNOVA 8MM X 40MM X 130CM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80325568	EAP	HCPCS C1876		INNOVA 8MM X 60MM X 130CM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80325569	EAP	HCPCS C1876		INNOVA 8MM X 80MM X 130CM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80325650	EAP	HCPCS C1757		SYSTEM THRMB ZELANTEDVT	BOTH IP/OP	"$7,313.00 "	"$5,411.62"	$0.00	"$5,850.40"	"$3,970.96"	"$3,970.96"	$0.00	$0.00	$0.00	"$1,524.21"	"$4,181.12"	"$4,181.12"	"$5,636.86"	$0.00	"$1,524.03"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,656.50"	"$5,791.90"	"$5,850.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80325671	EAP	HCPCS C1874		STENT VASC 60MM 6MM GORE TIGRIS CBAS NTNL FLPLMR	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
80325673	EAP	HCPCS C1874		STENT VASC 100MM 6MM GORE TIGRIS CBAS NTNL FLPLMR	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
80325675	EAP	HCPCS C1874		STENT VASC 60MM 7MM GORE TIGRIS CBAS NTNL FLPLMR	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
80325676	EAP	HCPCS C1874		STENT VASC 100MM 7MM GORE TIGRIS CBAS NTNL FLPLMR	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$779.09	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	"$1,842.83"	"$1,842.83"	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	$0.00	$0.00	$585.00	$0.00	$0.00	$595.09	$0.00	$0.00	$0.00	$0.00	$0.00
80326084	EAP	HCPCS C1887		CATHETER ANGIO RADIALTIGER CURVE 6FR 4MM 110CM	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$47.78	$47.78	$0.00	$0.00	$0.00	$18.34	$65.31	$65.31	$67.83	$0.00	$18.34	$0.00	$52.05	$52.05	$0.00	$44.00	$69.70	$70.40	$0.00	$57.20	$0.00	$13.77	$0.00	$0.00	$14.01	$0.00	$0.00	$0.00	$0.00	$0.00
80326288	EAP	HCPCS C1769		Guidewire Vasc 325cm .012in Viperwire Adv Coron	BOTH IP/OP	$488.00 	$361.12	$0.00	$390.40	$264.98	$264.98	$0.00	$0.00	$0.00	$101.71	$362.19	$362.19	$376.15	$0.00	$101.70	$0.00	$288.65	$288.65	$0.00	$244.00	$386.50	$390.40	$0.00	$317.20	$0.00	$76.37	$0.00	$0.00	$77.69	$0.00	$0.00	$0.00	$0.00	$0.00
80326302	EAP	HCPCS C1724		CATHETER ATHRCM 145CM STLTH 360 1.25MM ORBTL CLS	BOTH IP/OP	"$9,488.00 "	"$7,021.12"	$0.00	"$7,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$7,313.35"	$0.00	"$1,977.30"	$0.00	$0.00	$0.00	$0.00	"$4,744.00"	"$7,514.50"	"$7,590.40"	$0.00	"$6,167.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80326668	EAP	HCPCS C1722		Generator Pcmkr 83.1x69.1mm Eblm S-icd 12.7mm 59.5	BOTH IP/OP	"$42,500.00 "	"$31,450.00"	$0.00	"$34,000.00"	"$19,125.00"	"$19,125.00"	$0.00	$0.00	$0.00	"$8,858.06"	"$4,181.12"	"$4,181.12"	"$32,759.00"	$0.00	"$8,857.00"	$0.00	"$20,952.50"	"$20,952.50"	$0.00	"$21,250.00"	"$33,660.00"	"$34,000.00"	$0.00	"$19,125.00"	$0.00	"$6,651.25"	$0.00	$0.00	"$6,766.00"	$0.00	$0.00	$0.00	$0.00	$0.00
80332586	EAP	HCPCS C1751		Catheter Angel	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	"$3,054.38"	"$3,054.38"	$0.00	$0.00	$0.00	"$1,172.39"	"$4,174.88"	"$4,174.88"	"$4,335.75"	$0.00	"$1,172.25"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00	"$3,656.25"	$0.00	$880.31	$0.00	$0.00	$895.50	$0.00	$0.00	$0.00	$0.00	$0.00
80332596	EAP	HCPCS C1757		Retriever Escp 3mm 20mm Trevo Xp Provue	BOTH IP/OP	"$13,118.00 "	"$9,707.32"	$0.00	"$10,494.40"	"$7,123.07"	"$7,123.07"	$0.00	$0.00	$0.00	"$2,734.12"	"$4,181.12"	"$4,181.12"	"$10,111.35"	$0.00	"$2,733.79"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$6,559.00"	"$10,389.46"	"$10,494.40"	$0.00	"$8,526.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80333053	EAP	HCPCS C1769		GUIDEWIRE VASC 185CM STRL LF VERRATA + PRSS DISP	BOTH IP/OP	"$1,688.00 "	"$1,249.12"	$0.00	"$1,350.40"	$916.58	$916.58	$0.00	$0.00	$0.00	$351.82	"$1,252.83"	"$1,252.83"	"$1,301.11"	$0.00	$351.78	$0.00	$998.45	$998.45	$0.00	$844.00	"$1,336.90"	"$1,350.40"	$0.00	"$1,097.20"	$0.00	$264.17	$0.00	$0.00	$268.73	$0.00	$0.00	$0.00	$0.00	$0.00
80338397	EAP	HCPCS C1769		Guidewire Vasc 180cm .035in Flx Tp Ang 25cm 5cm	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00	$260.00	$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
80339398	EAP	HCPCS C1874		Stent Eprsth .035in 9mm 13mm 8	BOTH IP/OP	"$6,725.00 "	"$4,976.50"	$0.00	"$5,380.00"	"$3,026.25"	"$3,026.25"	$0.00	$0.00	$0.00	"$1,401.66"	"$4,181.12"	"$4,181.12"	"$5,183.63"	$0.00	"$1,401.49"	$0.00	"$3,315.43"	"$3,315.43"	$0.00	"$3,362.50"	"$5,326.20"	"$5,380.00"	$0.00	"$3,026.25"	$0.00	"$1,052.46"	$0.00	$0.00	"$1,070.62"	$0.00	$0.00	$0.00	$0.00	$0.00
80339402	EAP	HCPCS C1874		Stent Endoprsth 29mm 11mm 16sq Mm 8fr Gore Vbhn	BOTH IP/OP	"$8,548.00 "	"$6,325.52"	$0.00	"$6,838.40"	"$3,846.60"	"$3,846.60"	$0.00	$0.00	$0.00	"$1,781.62"	"$4,181.12"	"$4,181.12"	"$6,588.80"	$0.00	"$1,781.40"	$0.00	"$4,214.16"	"$4,214.16"	$0.00	"$4,274.00"	"$6,770.02"	"$6,838.40"	$0.00	$0.00	$0.00	"$1,337.76"	$0.00	$0.00	"$1,360.84"	$0.00	$0.00	$0.00	$0.00	$0.00
80339410	EAP	HCPCS C1874		Stent Endoprsth 39mm 7mm 11mm 7fr Gore Vbhn 135cm	BOTH IP/OP	"$8,548.00 "	"$6,325.52"	$0.00	"$6,838.40"	"$3,846.60"	"$3,846.60"	$0.00	$0.00	$0.00	"$1,781.62"	"$4,181.12"	"$4,181.12"	"$6,588.80"	$0.00	"$1,781.40"	$0.00	"$4,214.16"	"$4,214.16"	$0.00	"$4,274.00"	"$6,770.02"	"$6,838.40"	$0.00	$0.00	$0.00	"$1,337.76"	$0.00	$0.00	"$1,360.84"	$0.00	$0.00	$0.00	$0.00	$0.00
80339412	EAP	HCPCS C1874		Stent Endoprsth 39mm 8mm 11mm 7fr Gore Vbhn 135cm	BOTH IP/OP	"$8,548.00 "	"$6,325.52"	$0.00	"$6,838.40"	"$3,846.60"	"$3,846.60"	$0.00	$0.00	$0.00	"$1,781.62"	"$4,181.12"	"$4,181.12"	"$6,588.80"	$0.00	"$1,781.40"	$0.00	"$4,214.16"	"$4,214.16"	$0.00	"$4,274.00"	"$6,770.02"	"$6,838.40"	$0.00	$0.00	$0.00	"$1,337.76"	$0.00	$0.00	"$1,360.84"	$0.00	$0.00	$0.00	$0.00	$0.00
80339426	EAP	HCPCS C1874		Stent Endoprsth 59mm 7mm 11mm 7fr Gore Vbhn 135cm	BOTH IP/OP	"$8,548.00 "	"$6,325.52"	$0.00	"$6,838.40"	"$3,846.60"	"$3,846.60"	$0.00	$0.00	$0.00	"$1,781.62"	"$4,181.12"	"$4,181.12"	"$6,588.80"	$0.00	"$1,781.40"	$0.00	"$4,214.16"	"$4,214.16"	$0.00	"$4,274.00"	"$6,770.02"	"$6,838.40"	$0.00	$0.00	$0.00	"$1,337.76"	$0.00	$0.00	"$1,360.84"	$0.00	$0.00	$0.00	$0.00	$0.00
80339428	EAP	HCPCS C1874		Stent Endoprsth 59mm 8mm 11mm 7fr Gore Vbhn 135cm	BOTH IP/OP	"$8,138.00 "	"$6,022.12"	$0.00	"$6,510.40"	"$3,662.10"	"$3,662.10"	$0.00	$0.00	$0.00	"$1,696.16"	"$4,181.12"	"$4,181.12"	"$6,272.77"	$0.00	"$1,695.96"	$0.00	"$4,012.03"	"$4,012.03"	$0.00	"$4,069.00"	"$6,445.30"	"$6,510.40"	$0.00	$0.00	$0.00	"$1,273.60"	$0.00	$0.00	"$1,295.57"	$0.00	$0.00	$0.00	$0.00	$0.00
80339456	EAP	HCPCS C1887		Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr 3drc	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$50.50	$50.50	$0.00	$0.00	$0.00	$19.38	$69.02	$69.02	$71.68	$0.00	$19.38	$0.00	$55.01	$55.01	$0.00	$46.50	$73.66	$74.40	$0.00	$60.45	$0.00	$14.55	$0.00	$0.00	$14.81	$0.00	$0.00	$0.00	$0.00	$0.00
80339903	EAP			Catheter Angio Tpr Loprfl Rc2 Crv 5fr 65cm Strl Trnb Ad	BOTH IP/OP	$313.00 	$231.62	$0.00	$250.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.31	$232.31	$241.26	$0.00	$65.23	$0.00	$0.00	$0.00	$0.00	$156.50	$247.90	$250.40	$0.00	$203.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80340523	EAP	HCPCS C1894		Sheath Guid 90cm 2.5fr Chk-flo Flxr Raabe	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$102.08	$102.08	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$144.91	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00	$122.20	$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
80341173	EAP	HCPCS C1769		Guidewire Vasc 260cm .035in Radiopq Flpy Flx Tp	BOTH IP/OP	$551.00 	$407.74	$0.00	$440.80	$299.19	$299.19	$0.00	$0.00	$0.00	$114.84	$408.95	$408.95	$424.71	$0.00	$114.83	$0.00	$325.92	$325.92	$0.00	$275.50	$436.39	$440.80	$0.00	$0.00	$0.00	$86.23	$0.00	$0.00	$87.72	$0.00	$0.00	$0.00	$0.00	$0.00
80341288	EAP	HCPCS C1769		Guidewire Vasc Ang Shrt Tpr .018in 60cm 7cm Cp Mdrl Dist Tip	BOTH IP/OP	$106.00 	$78.44	$0.00	$84.80	$57.56	$57.56	$0.00	$0.00	$0.00	$22.09	$78.67	$78.67	$81.70	$0.00	$22.09	$0.00	$62.70	$62.70	$0.00	$53.00	$83.95	$84.80	$0.00	$68.90	$0.00	$16.59	$0.00	$0.00	$16.88	$0.00	$0.00	$0.00	$0.00	$0.00
80341936	EAP	HCPCS C1769		Guidewire Vasc 15cm Strg 2 Crv Tpr .035in 180cm 7cm Lndrqs	BOTH IP/OP	$753.00 	$557.22	$0.00	$602.40	$408.88	$408.88	$0.00	$0.00	$0.00	$156.94	$558.88	$558.88	$580.41	$0.00	$156.93	$0.00	$445.40	$445.40	$0.00	$376.50	$596.38	$602.40	$0.00	$489.45	$0.00	$117.84	$0.00	$0.00	$119.88	$0.00	$0.00	$0.00	$0.00	$0.00
80349650	EAP			KIT MCTRDCR .018IN TPR 5FR 40CM 7CM VSI SMTH NDL GW REG DIL	BOTH IP/OP	$474.00 	$350.76	$0.00	$379.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$351.80	$351.80	$365.36	$0.00	$98.78	$0.00	$0.00	$0.00	$0.00	$237.00	$375.41	$379.20	$0.00	$308.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80359050	EAP	HCPCS C1753		Catheter Us Kodama	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$162.90	$162.90	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00	$195.00	$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
80359064	EAP	HCPCS A6198		Dressing Brn 48x4in Strl Lf Actct Flx 3 Anmc Brr 1 Lyr Knit	BOTH IP/OP	$179.00 	$132.46	$0.00	$168.80	$97.20	$97.20	$0.00	$0.00	$0.00	$0.00	$132.85	$132.85	$137.97	$0.00	$37.30	$0.00	$0.00	$0.00	$0.00	$105.50	$167.11	$168.80	$0.00	$116.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80370959	EAP	HCPCS C1874		System Coron Stent 24mm 2.75mm Cbr Pzf Polyzene-f	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80370960	EAP	HCPCS C1874		System Coron Stent 30mm 2.75mm Cbr Pzf Polyzene-f	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80370964	EAP	HCPCS C1874		System Cor Stnt 3mm 18mm Cbr Pzf Rx Dlv Sys Polyzene-f Cocr	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80370965	EAP	HCPCS C1874		System Coron Stent 24mm 3mm Cbr Pzf Polyzene-f	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80370966	EAP	HCPCS C1874		System Coron Stent 30mm 3mm Cbr Pzf Cocr Hydphi	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$0.00	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80370969	EAP	HCPCS C1876		System Coronary Stent Cobra Pzf Polyzene-f L15mm	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80370970	EAP	HCPCS C1876		System Cor Stnt 3.5mm 18mm Cbr Pzf Rx Dlv Sys Polyzene-f	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80370972	EAP	HCPCS C1876		System Coronary Stent Cobra L30mm Id3.5mm Rapid Exchange	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80370976	EAP	HCPCS C1876		System Coronary Stent Cobra L18mm Id4mm Rapid Exchange	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80370978	EAP	HCPCS C1876		System Coronary Stent Cobra L30 Mm Id4 Mm Rapid Exchange	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	"$1,637.95"	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00	$956.25	$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
80371591	EAP	HCPCS C1874		STENT EPRSTH 8MM 7FR 10CM 120CM VBHN DLV SYS HEP SPRFC FEM	BOTH IP/OP	"$8,738.00 "	"$6,466.12"	$0.00	"$6,990.40"	"$3,932.10"	"$3,932.10"	$0.00	$0.00	$0.00	"$1,821.22"	"$4,181.12"	"$4,181.12"	"$6,735.25"	$0.00	"$1,821.00"	$0.00	"$4,307.83"	"$4,307.83"	$0.00	"$4,369.00"	"$6,920.50"	"$6,990.40"	$0.00	"$3,369.60"	$0.00	"$1,367.50"	$0.00	$0.00	"$1,391.09"	$0.00	$0.00	$0.00	$0.00	$0.00
80379042	EAP	HCPCS C1752		Kit Cath 13fr 20cm Strl Pwr-trialysis 3 Lum Shrt Term Dlys	BOTH IP/OP	$596.00 	$441.04	$0.00	$476.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$442.35	$442.35	$459.40	$0.00	$124.21	$0.00	$0.00	$0.00	$0.00	$298.00	$472.03	$476.80	$0.00	$387.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80379099	EAP	HCPCS C2621		Percepta Quad Crtp Mri Surescan	BOTH IP/OP	"$16,500.00 "	"$12,210.00"	$0.00	"$13,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$12,718.20"	$0.00	"$3,438.60"	$0.00	$0.00	$0.00	$0.00	"$8,250.00"	"$13,068.00"	"$13,200.00"	$0.00	"$7,425.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80379103	EAP	HCPCS C1729		Catheter Primafit Sage	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60	$14.66	$14.66	$0.00	$0.00	$0.00	$5.63	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$15.97	$15.97	$0.00	$13.50	$21.38	$21.60	$0.00	$17.55	$0.00	$4.23	$0.00	$0.00	$4.30	$0.00	$0.00	$0.00	$0.00	$0.00
80379488	EAP	HCPCS C1726		Rigiflex Ii Single Use Achalasia Balloon Dilator	BOTH IP/OP	"$1,690.00 "	"$1,250.60"	$0.00	"$1,352.00"	$917.67	$917.67	$0.00	$0.00	$0.00	$352.24	"$1,254.32"	"$1,254.32"	"$1,302.65"	$0.00	$352.20	$0.00	$999.64	$999.64	$0.00	$845.00	"$1,338.48"	"$1,352.00"	$0.00	"$1,098.50"	$0.00	$264.49	$0.00	$0.00	$269.05	$0.00	$0.00	$0.00	$0.00	$0.00
80379641	EAP	HCPCS C1786		SYSTEM DLV 3.2V 120MAH 6.7MM 25.9MM MICRA SURESCAN HBRD	BOTH IP/OP	"$26,875.00 "	"$19,887.50"	$0.00	"$21,500.00"	"$12,093.75"	"$12,093.75"	$0.00	$0.00	$0.00	"$5,601.42"	"$4,181.12"	"$4,181.12"	"$20,715.25"	$0.00	"$5,600.75"	$0.00	"$13,249.38"	"$13,249.38"	$0.00	"$13,437.50"	"$21,285.00"	"$21,500.00"	$0.00	"$12,093.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80379642	EAP	HCPCS C1894		INTRODUCER SHTH 23FR 55.7CM 69.9CM MICRA STPCK RADOPQ DIL	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$814.50	$814.50	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	"$1,156.20"	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00	$975.00	$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
80379742	EAP	Custom 80379742		Set Hmdial 27x22x9cm 165ml Strl Lf Prismaflex Hmfltr Bg	BOTH IP/OP	$426.00 	$315.24	$0.00	$328.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$316.18	$316.18	$328.36	$0.00	$88.78	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00	$276.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80379801	EAP	HCPCS C2623		CATHETER BLNDIL 7MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
80379803	EAP	HCPCS C2623		CATHETER BLNDIL 8MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN	BOTH IP/OP	"$4,250.00 "	"$3,145.00"	$0.00	"$3,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,154.35"	"$3,154.35"	"$3,275.90"	$0.00	$885.70	$0.00	$0.00	$0.00	$0.00	"$2,125.00"	"$3,366.00"	"$3,400.00"	$0.00	"$2,762.50"	$0.00	$665.13	$0.00	$0.00	$676.60	$0.00	$0.00	$0.00	$0.00	$0.00
80379806	EAP	HCPCS C2623		CATHETER BLNDIL 10MM 75CM 40MM LUTONIX DRG COAT ACPT .035IN	BOTH IP/OP	"$4,250.00 "	"$3,145.00"	$0.00	"$3,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,125.00"	"$3,366.00"	"$3,400.00"	$0.00	$0.00	$0.00	$665.13	$0.00	$0.00	$676.60	$0.00	$0.00	$0.00	$0.00	$0.00
80390076	EAP	HCPCS C2623		Catheter Baldilat 4mm 130cm 100mm Pcltxl Latex	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
80390081	EAP	HCPCS C2623		Catheter Baldilat 4mm 130cm 60mm Pcltxl Latex Free	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
80390085	EAP	HCPCS C2623		Catheter Baldilat 5mm 130cm 100mm Pcltxl Latex	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	$0.00	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
80390093	EAP	HCPCS C2623		Catheter Baldilat 5mm 130cm 60mm Pcltxl Latex Free	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	"$2,697.80"	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00	"$2,275.00"	$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
80390101	EAP	HCPCS C2623		Catheter Blndil 5f 6mm 130cm 150mm Lutonix	BOTH IP/OP	"$4,250.00 "	"$3,145.00"	$0.00	"$3,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,154.35"	"$3,154.35"	"$3,275.90"	$0.00	$885.70	$0.00	$0.00	$0.00	$0.00	"$2,125.00"	"$3,366.00"	"$3,400.00"	$0.00	$0.00	$0.00	$665.13	$0.00	$0.00	$676.60	$0.00	$0.00	$0.00	$0.00	$0.00
80397351	EAP	HCPCS C1898		Lead Pacing Capsure Sense Steroid Eluting L52 Cm Atrium Right Vent	BOTH IP/OP	"$1,013.00 "	$749.62	$0.00	$810.40	$455.85	$455.85	$0.00	$0.00	$0.00	$211.13	$751.85	$751.85	$780.82	$0.00	$211.11	$0.00	$599.19	$599.19	$0.00	$506.50	$802.30	$810.40	$0.00	$455.85	$0.00	$158.53	$0.00	$0.00	$161.27	$0.00	$0.00	$0.00	$0.00	$0.00
80397520	EAP	HCPCS C1887		Catheter Gd 9fr 7.2fr 45cm Atn Cmnd Surevalve Lh	BOTH IP/OP	$588.00 	$435.12	$0.00	$470.40	$319.28	$319.28	$0.00	$0.00	$0.00	$122.55	$436.41	$436.41	$453.23	$0.00	$122.54	$0.00	$347.80	$347.80	$0.00	$294.00	$465.70	$470.40	$0.00	$0.00	$0.00	$92.02	$0.00	$0.00	$93.61	$0.00	$0.00	$0.00	$0.00	$0.00
80397527	EAP	HCPCS C1887		Catheter Gd .035in Mp Rt Crv 9fr 7.2fr 45cm Atn Cmnd	BOTH IP/OP	$588.00 	$435.12	$0.00	$470.40	$319.28	$319.28	$0.00	$0.00	$0.00	$122.55	$436.41	$436.41	$453.23	$0.00	$122.54	$0.00	$347.80	$347.80	$0.00	$294.00	$465.70	$470.40	$0.00	$0.00	$0.00	$92.02	$0.00	$0.00	$93.61	$0.00	$0.00	$0.00	$0.00	$0.00
80397542	EAP	HCPCS C1777		Lead Pacing Sprint Quattro Secure L58 Cm 1 Coil Defib	BOTH IP/OP	"$7,875.00 "	"$5,827.50"	$0.00	"$6,300.00"	"$3,543.75"	"$3,543.75"	$0.00	$0.00	$0.00	"$1,641.35"	"$4,181.12"	"$4,181.12"	"$6,070.05"	$0.00	"$1,641.15"	$0.00	"$3,882.38"	"$3,882.38"	$0.00	"$3,937.50"	"$6,237.00"	"$6,300.00"	$0.00	"$3,543.75"	$0.00	"$1,232.44"	$0.00	$0.00	"$1,253.70"	$0.00	$0.00	$0.00	$0.00	$0.00
80397543	EAP	HCPCS C1777		Lead Pacing Sprint Quattro Secure Steroid Eluting Silicone Helix L65	BOTH IP/OP	"$7,875.00 "	"$5,827.50"	$0.00	"$6,300.00"	"$3,543.75"	"$3,543.75"	$0.00	$0.00	$0.00	"$1,641.35"	"$4,181.12"	"$4,181.12"	"$6,070.05"	$0.00	"$1,641.15"	$0.00	"$3,882.38"	"$3,882.38"	$0.00	"$3,937.50"	"$6,237.00"	"$6,300.00"	$0.00	"$3,543.75"	$0.00	"$1,232.44"	$0.00	$0.00	"$1,253.70"	$0.00	$0.00	$0.00	$0.00	$0.00
80398493	EAP	HCPCS C1769		GUIDEWIRE VASC 300CM .014IN RADIOPQ KINK RST STR 3	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$101.81	$101.81	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$144.53	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00	$0.00	$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
80398507	EAP	HCPCS C1769		GUIDEWIRE VASC 300CM .014IN STR 3CM HTORQ WHSPR LS	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$101.81	$101.81	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$144.53	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00	$0.00	$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
80398619	EAP	HCPCS C1874		System Coron Stent 38mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398620	EAP	HCPCS C1874		System Coron Stent 33mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398621	EAP	HCPCS C1874		System Coron Stent 28mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398622	EAP	HCPCS C1874		System Coron Stent 23mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398629	EAP	HCPCS C1874		System Coron Stent 18mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$2,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$787.50	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398631	EAP	HCPCS C1874		System Coron Stent 15mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398632	EAP	HCPCS C1874		System Coron Stent 12mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398634	EAP	HCPCS C1874		System Coron Stent 8mm 4mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398635	EAP	HCPCS C1874		System Coron Stent 38mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398636	EAP	HCPCS C1874		System Coron Stent 33mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398638	EAP	HCPCS C1874		System Coron Stent 28mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398639	EAP	HCPCS C1874		System Coron Stent 23mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398640	EAP	HCPCS C1874		System Coron Stent 18mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398647	EAP	HCPCS C1874		System Coron Stent 15mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398650	EAP	HCPCS C1874		System Coron Stent 12mm 3.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398655	EAP	HCPCS C1874		System Coron Stent 8mm 3.5mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398661	EAP	HCPCS C1874		System Coron Stent 38mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398666	EAP	HCPCS C1874		System Coron Stent 33mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398672	EAP	HCPCS C1874		System Coron Stent 28mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398673	EAP	HCPCS C1874		System Coron Stent 23mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398679	EAP	HCPCS C1874		System Coron Stent 18mm 3.25mm Xience Srr	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$2,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$787.50	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398680	EAP	HCPCS C1874		System Coron Stent 15mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398682	EAP	HCPCS C1874		System Coron Stent 12mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398683	EAP	HCPCS C1874		System Coron Stent 8mm 3.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398684	EAP	HCPCS C1874		System Coron Stent 38mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398685	EAP	HCPCS C1874		System Coron Stent 33mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398686	EAP	HCPCS C1874		System Coron Stent 28mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398687	EAP	HCPCS C1874		System Coron Stent 23mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398688	EAP	HCPCS C1874		System Coron Stent 18mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398689	EAP	HCPCS C1874		System Coron Stent 15mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398690	EAP	HCPCS C1874		System Coron Stent 12mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398691	EAP	HCPCS C1874		System Coron Stent 8mm 3mm Xience Srr Everolimus	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398692	EAP	HCPCS C1874		System Coron Stent 38mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398693	EAP	HCPCS C1874		System Coron Stent 33mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398699	EAP	HCPCS C1874		System Coron Stent 28mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398700	EAP	HCPCS C1874		System Coron Stent 23mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398701	EAP	HCPCS C1874		System Coron Stent 18mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398702	EAP	HCPCS C1874		System Coron Stent 15mm 2.75mm Xience Srr	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$2,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$787.50	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398703	EAP	HCPCS C1874		System Coron Stent 12mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398704	EAP	HCPCS C1874		System Coron Stent 8mm 2.75mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398705	EAP	HCPCS C1874		System Coron Stent 38mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398706	EAP	HCPCS C1874		System Coron Stent 33mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398707	EAP	HCPCS C1874		System Coron Stent 28mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398708	EAP	HCPCS C1874		System Coron Stent 23mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398709	EAP	HCPCS C1874		System Coron Stent 18mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398710	EAP	HCPCS C1874		System Coron Stent 15mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398770	EAP	HCPCS C1874		System Coron Stent 12mm 2.5mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398771	EAP	HCPCS C1874		System Coron Stent 8mm 2.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398772	EAP	HCPCS C1874		System Coron Stent 12mm 2.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398773	EAP	HCPCS C1874		System Coron Stent 15mm 2.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398774	EAP	HCPCS C1874		System Coron Stent 18mm 2.25mm Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398775	EAP	HCPCS C1874		System Coron Stent 23mm 2.25mm Xience Srr	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$2,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$787.50	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398776	EAP	HCPCS C1874		System Coron Stent 28mm 2.25mm Xience Srr	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$2,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$787.50	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398777	EAP	HCPCS C1874		Stent Coron 33mm 2.25mm Everolimus Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398778	EAP	HCPCS C1874		Stent Coron 38mm 2.25mm Everolimus Xience Srr	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	"$2,312.40"	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	"$1,350.00"	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398779	EAP	HCPCS C1874		System Coron Stent 8mm 2.5mm Xience Srr Everolimus	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$2,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	"$1,348.90"	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00	$787.50	$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
80398790	EAP	HCPCS C1769		GUIDEWIRE VASC 300CM .014IN RADIOPQ CORE TO TIP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00	$0.00	$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
80399090	EAP			Advance Capsule Endoscopy Delivery Device	BOTH IP/OP	$413.00 	$305.62	$0.00	$330.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.53	$306.53	$318.34	$0.00	$86.07	$0.00	$0.00	$0.00	$0.00	$206.50	$327.10	$330.40	$0.00	$268.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80399207	EAP	HCPCS C1887		Catheter Infus 10d 3.5fr 135cm Otw 2 Lum Brd Trq	BOTH IP/OP	"$1,068.00 "	$790.32	$0.00	$854.40	$579.92	$579.92	$0.00	$0.00	$0.00	$222.60	$792.67	$792.67	$823.21	$0.00	$222.57	$0.00	$631.72	$631.72	$0.00	$534.00	$845.86	$854.40	$0.00	$0.00	$0.00	$167.14	$0.00	$0.00	$170.03	$0.00	$0.00	$0.00	$0.00	$0.00
80399275	EAP	HCPCS C1887		CATHETER INTVN 5.1FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	"$1,056.25"	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
80399276	EAP	HCPCS C1887		CATHETER INTVN 5.7FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	"$1,056.25"	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
80399277	EAP	HCPCS C1887		CATHETER INTVN 6.5FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	"$1,056.25"	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
80405583	EAP	HCPCS C1757		CATHETER THRMB .044IN 140CM STRL LF INDG SYS ASP KT COR	BOTH IP/OP	"$4,850.00 "	"$3,589.00"	$0.00	"$3,880.00"	"$2,182.50"	"$2,182.50"	$0.00	$0.00	$0.00	"$1,010.86"	"$3,599.67"	"$3,599.67"	"$3,738.38"	$0.00	"$1,010.74"	$0.00	"$2,391.05"	"$2,391.05"	$0.00	"$2,425.00"	"$3,841.20"	"$3,880.00"	$0.00	"$2,182.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80405584	EAP	Custom 80405584		SEPARATOR THRMB STRL LF INDG SYS 4 DISP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	"$1,695.76"	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80405589	EAP	HCPCS C1874		SYSTEM COR STNT 2MM 8MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	"$1,541.25"	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
80405590	EAP	HCPCS C1874		SYSTEM COR STNT 2MM 12MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	"$1,541.25"	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
80405591	EAP	HCPCS C1874		SYSTEM COR STNT 2MM 15MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
80405592	EAP	HCPCS C1874		SYSTEM COR STNT 2MM 18MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	"$1,541.25"	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
80405593	EAP	HCPCS C1874		SYSTEM COR STNT 2MM 22MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
80405594	EAP	HCPCS C1874		SYSTEM COR STNT 2MM 26MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	"$1,541.25"	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
80405595	EAP	HCPCS C1874		SYSTEM COR STNT 2MM 30MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	"$2,639.99"	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00	$0.00	$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
80406242	EAP	Custom 80406242		PLUG OCL 3MM 12X5.3MM MVP MECH DTCH FULL RESHEATHABLE NTNL	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	$0.00	$0.00	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	"$1,682.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80406243	EAP	Custom 80406243		PLUG OCL 5MM 12X6.5MM STRL LF MVP MECH DTCH FULL	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	$0.00	$0.00	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	"$1,682.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80406244	EAP	Custom 80406244		PLUG OCL MIC 7MM STRL LF MVP MECH VASC DISP V03	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	"$1,682.10"	"$1,682.10"	$0.00	$0.00	$0.00	$0.00	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	$0.00	$0.00	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	"$1,682.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80406245	EAP	Custom 80406245		PLUG OCL 9MM STRL LF MVP V03	BOTH IP/OP	"$3,738.00 "	"$2,766.12"	$0.00	"$2,990.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,774.34"	"$2,774.34"	"$2,881.25"	$0.00	$779.00	$0.00	$0.00	$0.00	$0.00	"$1,869.00"	"$2,960.50"	"$2,990.40"	$0.00	"$1,682.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80406248	EAP	HCPCS C1769		GUIDEWIRE VASC .014IN 180CM STRL LF CNFNZ PRO 12 DISP	BOTH IP/OP	$333.00 	$246.42	$0.00	$266.40	$180.82	$180.82	$0.00	$0.00	$0.00	$69.41	$247.15	$247.15	$256.68	$0.00	$69.40	$0.00	$196.97	$196.97	$0.00	$166.50	$263.74	$266.40	$0.00	$216.45	$0.00	$52.11	$0.00	$0.00	$53.01	$0.00	$0.00	$0.00	$0.00	$0.00
80406249	EAP	HCPCS C1769		GUIDEWIRE VASC .014IN 300CM STRL LF FIELDER FC DISP	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$107.51	$107.51	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$152.62	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00	$0.00	$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80406250	EAP	HCPCS C1769		GUIDEWIRE VASC .014IN 180CM STRL LF FIELDER FC DISP	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$107.51	$107.51	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$152.62	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00	$128.70	$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80406251	EAP	HCPCS C1769		GUIDEWIRE VASC .014IN 300CM STRL LF GRAND SLAM DISP	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$156.38	$156.38	$0.00	$0.00	$0.00	$60.03	$213.75	$213.75	$221.99	$0.00	$60.02	$0.00	$170.35	$170.35	$0.00	$144.00	$228.10	$230.40	$0.00	$0.00	$0.00	$45.07	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$0.00
80406252	EAP	HCPCS C1769		GUIDEWIRE VASC .014IN 180CM STRL LF MRCLBRS 6 DISP	BOTH IP/OP	$333.00 	$246.42	$0.00	$266.40	$180.82	$180.82	$0.00	$0.00	$0.00	$69.41	$247.15	$247.15	$256.68	$0.00	$69.40	$0.00	$196.97	$196.97	$0.00	$166.50	$263.74	$266.40	$0.00	$216.45	$0.00	$52.11	$0.00	$0.00	$53.01	$0.00	$0.00	$0.00	$0.00	$0.00
80406253	EAP	HCPCS C1769		GUIDEWIRE VASC .014IN 300CM STRL LF MRCLBRS 6 DISP	BOTH IP/OP	$333.00 	$246.42	$0.00	$266.40	$180.82	$180.82	$0.00	$0.00	$0.00	$69.41	$247.15	$247.15	$256.68	$0.00	$69.40	$0.00	$196.97	$196.97	$0.00	$166.50	$263.74	$266.40	$0.00	$216.45	$0.00	$52.11	$0.00	$0.00	$53.01	$0.00	$0.00	$0.00	$0.00	$0.00
80406254	EAP	HCPCS C1769		GUIDEWIRE VASC .014IN 300CM STRL LF MRCLBRS 3 DISP	BOTH IP/OP	$333.00 	$246.42	$0.00	$266.40	$180.82	$180.82	$0.00	$0.00	$0.00	$69.41	$247.15	$247.15	$256.68	$0.00	$69.40	$0.00	$196.97	$196.97	$0.00	$166.50	$263.74	$266.40	$0.00	$216.45	$0.00	$52.11	$0.00	$0.00	$53.01	$0.00	$0.00	$0.00	$0.00	$0.00
80406255	EAP	HCPCS C1769		GUIDEWIRE VASC .014IN 180CM STRL LF P-H2O DISP	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$107.51	$107.51	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$152.62	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00	$128.70	$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80406256	EAP	HCPCS C1769		GUIDEWIRE VASC .014IN 300CM STRL LF P-H2O DISP	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00	$0.00	$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80406275	EAP	HCPCS C1894		Vascular Vein Kit	BOTH IP/OP	$353.00 	$261.22	$0.00	$282.40	$191.68	$191.68	$0.00	$0.00	$0.00	$73.57	$262.00	$262.00	$272.09	$0.00	$73.57	$0.00	$208.80	$208.80	$0.00	$176.50	$279.58	$282.40	$0.00	$229.45	$0.00	$55.24	$0.00	$0.00	$56.20	$0.00	$0.00	$0.00	$0.00	$0.00
80406279	EAP	HCPCS C1785		Pacemaker Assurity Mri 6mm X 50mm X 47mm 10.44 Cc 2 Chmbr  Is-1 Con	BOTH IP/OP	"$12,225.00 "	"$9,046.50"	$0.00	"$9,780.00"	"$5,501.25"	"$5,501.25"	$0.00	$0.00	$0.00	"$2,548.00"	"$4,181.12"	"$4,181.12"	"$9,423.03"	$0.00	"$2,547.69"	$0.00	"$6,026.93"	"$6,026.93"	$0.00	"$6,112.50"	"$9,682.20"	"$9,780.00"	$0.00	"$5,501.25"	$0.00	"$1,913.21"	$0.00	$0.00	"$1,946.22"	$0.00	$0.00	$0.00	$0.00	$0.00
80406478	EAP			Dressing Gel Strl Lf Isrb Abs Tube Nadh Cdxmr Iod 10gm	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$18.00	$28.51	$28.80	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80406479	EAP			Dressing Gel Strl Iodoflex 3 In 1 Mode Abs Pd Nadh Cdxmr Iod	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$23.12	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80406513	EAP			Marker Endoscopic Spot Ex Tattoo Prefill Perm Syringe	BOTH IP/OP	$950.00 	$703.00	$0.00	$760.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$705.09	$705.09	$732.26	$0.00	$197.98	$0.00	$0.00	$0.00	$0.00	$475.00	$752.40	$760.00	$0.00	$617.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80406525	EAP	HCPCS C1894		"Kit Triple Lumen Cvc,  Agb+ 7 French, Pressure Rated, 20cm"	BOTH IP/OP	$366.00 	$270.84	$0.00	$288.00	$198.74	$198.74	$0.00	$0.00	$0.00	$76.28	$271.65	$271.65	$282.11	$0.00	$76.27	$0.00	$216.49	$216.49	$0.00	$180.00	$285.12	$288.00	$0.00	$237.90	$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
80411625	EAP	HCPCS C1725		Catheter Baldilat 2mm 150cm 20mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411627	EAP	HCPCS C1725		Catheter Baldilat 2mm 150cm 30mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411630	EAP	HCPCS C1725		Catheter Baldilat 2mm 150cm 60mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411635	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 150cm 30mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411637	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 150cm 40mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411639	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 150cm 60mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411641	EAP	HCPCS C1725		Catheter Baldilat 2.5mm 150cm 220mm Otw Inflat	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$276.25	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411645	EAP	HCPCS C1725		Catheter Baldilat 3mm 150cm 30mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411648	EAP	HCPCS C1725		Catheter Baldilat 3mm 150cm 60mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411651	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 150cm 20mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411653	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 150cm 30mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411655	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 150cm 40mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411657	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 150cm 60mm Otw Inflat Port	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411659	EAP	HCPCS C1725		Catheter Baldilat 3.5mm 150cm 220mm Otw Inflat	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411662	EAP	HCPCS C1725		Catheter Baldilat 5mm 150cm 120mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411666	EAP	HCPCS C1725		Catheter Baldilat 5mm 150cm 220mm Peri Otw Tpr Tip	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80411668	EAP	HCPCS C1725		Catheter Baldilat 6mm 120mm 150cm Otw Tpr Tip Lp	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$327.59	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00	$0.00	$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
80412733	EAP	HCPCS C2630		Catheter Ablation Tacticath 2-2-2 Mm Space Damato Type	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$5,202.90"	$0.00	"$1,406.70"	$0.00	$0.00	$0.00	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00	"$4,387.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80416033	EAP	HCPCS C1895		"Lead Defibrillator Reliance 4-front, Dual Coil 59cm"	BOTH IP/OP	"$6,500.00 "	"$4,810.00"	$0.00	"$5,200.00"	"$2,925.00"	"$2,925.00"	$0.00	$0.00	$0.00	"$1,354.76"	"$4,181.12"	"$4,181.12"	"$5,010.20"	$0.00	"$1,354.60"	$0.00	"$3,204.50"	"$3,204.50"	$0.00	"$3,250.00"	"$5,148.00"	"$5,200.00"	$0.00	"$2,925.00"	$0.00	"$1,017.25"	$0.00	$0.00	"$1,034.80"	$0.00	$0.00	$0.00	$0.00	$0.00
80416166	EAP	HCPCS C1722		Dfbr Crd .99cm 5.37x7.79cm Momentum Heartlogic	BOTH IP/OP	"$22,643.00 "	"$16,755.82"	$0.00	"$18,114.40"	"$10,189.35"	"$10,189.35"	$0.00	$0.00	$0.00	"$4,719.37"	"$4,181.12"	"$4,181.12"	"$17,453.22"	$0.00	"$4,718.80"	$0.00	"$11,163.00"	"$11,163.00"	$0.00	"$11,321.50"	"$17,933.26"	"$18,114.40"	$0.00	$0.00	$0.00	"$3,543.63"	$0.00	$0.00	"$3,604.77"	$0.00	$0.00	$0.00	$0.00	$0.00
80416179	EAP	HCPCS C1721		Resonate El Aicd Dual Chamber 5.37cm 7.68cm 0.99cm	BOTH IP/OP	"$28,250.00 "	"$20,905.00"	$0.00	"$22,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,888.01"	"$4,181.12"	"$4,181.12"	"$21,775.10"	$0.00	"$5,887.30"	$0.00	"$13,927.25"	"$13,927.25"	$0.00	"$14,125.00"	"$22,374.00"	"$22,600.00"	$0.00	"$12,712.50"	$0.00	"$4,421.13"	$0.00	$0.00	"$4,497.40"	$0.00	$0.00	$0.00	$0.00	$0.00
80416197	EAP	HCPCS C1786		Pacemaker Crd .75cm 4.45x4.81cm Acld Pacesafe Ltd	BOTH IP/OP	"$6,680.00 "	"$4,943.20"	$0.00	"$5,344.00"	"$3,006.00"	"$3,006.00"	$0.00	$0.00	$0.00	"$1,392.28"	"$4,181.12"	"$4,181.12"	"$5,148.94"	$0.00	"$1,392.11"	$0.00	"$3,293.24"	"$3,293.24"	$0.00	"$3,340.00"	"$5,290.56"	"$5,344.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80416198	EAP	HCPCS C1785		Pacemaker Crd .75cm 4.45x5.02cm Acld Pacesafe Ltd	BOTH IP/OP	"$7,625.00 "	"$5,642.50"	$0.00	"$6,100.00"	"$3,431.25"	"$3,431.25"	$0.00	$0.00	$0.00	"$1,589.24"	"$4,181.12"	"$4,181.12"	"$5,877.35"	$0.00	"$1,589.05"	$0.00	"$3,759.13"	"$3,759.13"	$0.00	"$3,812.50"	"$6,039.00"	"$6,100.00"	$0.00	$0.00	$0.00	"$1,193.31"	$0.00	$0.00	"$1,213.90"	$0.00	$0.00	$0.00	$0.00	$0.00
80435214	EAP	HCPCS C1887		Kit Catheter Gd 9fr 80cm Strl Lf Mrc Bln Sil With Axs Catalyst	BOTH IP/OP	"$7,979.00 "	"$5,904.46"	$0.00	"$6,383.20"	"$4,332.60"	"$4,332.60"	$0.00	$0.00	$0.00	"$1,663.02"	"$4,181.12"	"$4,181.12"	"$6,150.21"	$0.00	"$1,662.82"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,989.50"	"$6,319.37"	"$6,383.20"	$0.00	$0.00	$0.00	"$1,248.71"	$0.00	$0.00	"$1,270.26"	$0.00	$0.00	$0.00	$0.00	$0.00
80435215	EAP	HCPCS C1887		Kit Catheter Gd 9fr 95cm Strl Lf Mrc Bln Sil With Axs Catalyst	BOTH IP/OP	"$7,979.00 "	"$5,904.46"	$0.00	"$6,383.20"	"$4,332.60"	"$4,332.60"	$0.00	$0.00	$0.00	"$1,663.02"	"$4,181.12"	"$4,181.12"	"$6,150.21"	$0.00	"$1,662.82"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,989.50"	"$6,319.37"	"$6,383.20"	$0.00	$0.00	$0.00	"$1,248.71"	$0.00	$0.00	"$1,270.26"	$0.00	$0.00	$0.00	$0.00	$0.00
80436768	EAP	HCPCS C1817		Plug Cardio 11mm 6mm 4fr Amplzr .038in Lp Ntnl	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,762.73"	"$1,762.73"	"$1,830.65"	$0.00	$494.95	$0.00	$0.00	$0.00	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00	"$1,068.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80436769	EAP	HCPCS C1817		Plug Cardio 13.5mm 8mm 4fr Amplzr .038in Lp Ntnl	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,762.73"	"$1,762.73"	"$1,830.65"	$0.00	$494.95	$0.00	$0.00	$0.00	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00	"$1,068.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80436770	EAP	HCPCS C1769		Kit Trevo 3x20 Packaged With Synchro2 Std Custom Grady	BOTH IP/OP	"$14,432.00 "	"$10,679.68"	$0.00	"$11,545.60"	"$7,836.58"	"$7,836.58"	$0.00	$0.00	$0.00	"$3,007.99"	"$4,181.12"	"$4,181.12"	"$11,124.19"	$0.00	"$3,007.63"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,216.00"	"$11,430.14"	"$11,545.60"	$0.00	$0.00	$0.00	"$2,258.61"	$0.00	$0.00	"$2,297.57"	$0.00	$0.00	$0.00	$0.00	$0.00
80436771	EAP	HCPCS C1769		Kit Trevo 4x20 Packaged With Synchro2 Std Custom Grady	BOTH IP/OP	"$14,432.00 "	"$10,679.68"	$0.00	"$11,545.60"	"$7,836.58"	"$7,836.58"	$0.00	$0.00	$0.00	"$3,007.99"	"$4,181.12"	"$4,181.12"	"$11,124.19"	$0.00	"$3,007.63"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,216.00"	"$11,430.14"	"$11,545.60"	$0.00	$0.00	$0.00	"$2,258.61"	$0.00	$0.00	"$2,297.57"	$0.00	$0.00	$0.00	$0.00	$0.00
80436772	EAP	HCPCS C1769		Kit Trevo 4x30 Packaged With Synchro2 Std Custom Grady	BOTH IP/OP	"$14,432.00 "	"$10,679.68"	$0.00	"$11,545.60"	"$7,836.58"	"$7,836.58"	$0.00	$0.00	$0.00	"$3,007.99"	"$4,181.12"	"$4,181.12"	"$11,124.19"	$0.00	"$3,007.63"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,216.00"	"$11,430.14"	"$11,545.60"	$0.00	$0.00	$0.00	"$2,258.61"	$0.00	$0.00	"$2,297.57"	$0.00	$0.00	$0.00	$0.00	$0.00
80436773	EAP	HCPCS C1769		Kit Trevo 6x25 Packaged With Synchro2 Std Custom Grady	BOTH IP/OP	"$14,432.00 "	"$10,679.68"	$0.00	"$11,545.60"	"$7,836.58"	"$7,836.58"	$0.00	$0.00	$0.00	"$3,007.99"	"$4,181.12"	"$4,181.12"	"$11,124.19"	$0.00	"$3,007.63"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$7,216.00"	"$11,430.14"	"$11,545.60"	$0.00	$0.00	$0.00	"$2,258.61"	$0.00	$0.00	"$2,297.57"	$0.00	$0.00	$0.00	$0.00	$0.00
80436775	EAP	HCPCS C1884		Kit Intvn Enroute Neuroprotection Transcarotid	BOTH IP/OP	"$8,875.00 "	"$6,567.50"	$0.00	"$7,100.00"	"$4,819.13"	"$4,819.13"	$0.00	$0.00	$0.00	"$1,849.77"	"$4,181.12"	"$4,181.12"	"$6,840.85"	$0.00	"$1,849.55"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$4,437.50"	"$7,029.00"	"$7,100.00"	$0.00	$0.00	$0.00	"$1,388.94"	$0.00	$0.00	"$1,412.90"	$0.00	$0.00	$0.00	$0.00	$0.00
80436776	EAP	HCPCS C1894		Kit Mctrdcr 21ga 7cm Ndl	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$2,375.63"	"$2,375.63"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	"$3,372.25"	$0.00	$911.75	$0.00	"$2,587.81"	"$2,587.81"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00	$0.00	$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
80436777	EAP	HCPCS C1769		Guidewire Vasc 5cm .014in 95cm 15cm Enroute Radopq Ptfe	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	"$1,289.63"	"$1,289.63"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	"$1,830.65"	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00	$0.00	$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
80436779	EAP	HCPCS C1729		Tray Cath 14fr 60in 350ml Ltx Bdx Lbr Adv Urmtr Drn Tube	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.50	$40.39	$40.80	$0.00	$0.00	$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
80436780	EAP	HCPCS C1729		Tray Cath 16fr 60in 350ml Strl Ltx Lbrcth Urmtr Drn Tube	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.50	$40.39	$40.80	$0.00	$0.00	$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
80436781	EAP	HCPCS C1729		Tray Cath 18fr 60in 350ml Ltx Bdx Lbr Adv Urmtr Drn Tube	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.50	$40.39	$40.80	$0.00	$0.00	$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
80436783	EAP	HCPCS C1757		Catheter Asp .074in 125cm Strl Lf Axs Vecta 74 Lum Disp	BOTH IP/OP	"$7,375.00 "	"$5,457.50"	$0.00	"$5,900.00"	"$4,004.63"	"$4,004.63"	$0.00	$0.00	$0.00	"$1,537.13"	"$4,181.12"	"$4,181.12"	"$5,684.65"	$0.00	"$1,536.95"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,687.50"	"$5,841.00"	"$5,900.00"	$0.00	"$4,793.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80436784	EAP	HCPCS C1757		Catheter Asp .074in 132cm Strl Lf Axs Vecta 74 Lum Disp	BOTH IP/OP	"$7,375.00 "	"$5,457.50"	$0.00	"$5,900.00"	"$4,004.63"	"$4,004.63"	$0.00	$0.00	$0.00	"$1,537.13"	"$4,181.12"	"$4,181.12"	"$5,684.65"	$0.00	"$1,536.95"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,687.50"	"$5,841.00"	"$5,900.00"	$0.00	"$4,793.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80436791	EAP	HCPCS C1894		Kit Intro .021in 80cm 6fr 21ga 25cm Strl 1.5in Glidesheath	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00	$78.00	$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
80436798	EAP	HCPCS C1894		Sheath Intro 8.2mm 22fr 33cm Gore Dryseal Flx Hdrph	BOTH IP/OP	"$1,585.00 "	"$1,172.90"	$0.00	"$1,268.00"	$860.66	$860.66	$0.00	$0.00	$0.00	$330.35	"$1,176.39"	"$1,176.39"	"$1,221.72"	$0.00	$330.31	$0.00	$937.53	$937.53	$0.00	$792.50	"$1,255.32"	"$1,268.00"	$0.00	"$1,030.25"	$0.00	$248.05	$0.00	$0.00	$252.33	$0.00	$0.00	$0.00	$0.00	$0.00
80436802	EAP	HCPCS C1894		Sheath Introducer Gore Dryseal Flex Hydro L33 Cm Od9.5 Mm Id26 Fr	BOTH IP/OP	"$1,585.00 "	"$1,172.90"	$0.00	"$1,268.00"	$860.66	$860.66	$0.00	$0.00	$0.00	$330.35	"$1,176.39"	"$1,176.39"	"$1,221.72"	$0.00	$330.31	$0.00	$937.53	$937.53	$0.00	$792.50	"$1,255.32"	"$1,268.00"	$0.00	"$1,030.25"	$0.00	$248.05	$0.00	$0.00	$252.33	$0.00	$0.00	$0.00	$0.00	$0.00
80436934	EAP	HCPCS C1876		Stent Eprsth 14mm 90mm 100mm Vici Vns Stnt Cath Ntnl Acpt	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	"$4,046.70"	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00	"$2,362.50"	$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80438566	EAP	HCPCS C1760		Device Clsr 18fr Manta Vasc	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	$0.00	$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
80438567	EAP	HCPCS C1760		Device Clsr 14fr Manta Vasc	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	"$2,408.75"	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00	"$1,406.25"	$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
80438594	EAP	HCPCS C1894		Kit Intro .018in Mic 5fr 21ga 3fr 45cm Strl 15cm	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$135.75	$135.75	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$192.70	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00	$162.50	$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
80438603	EAP	Custom 80438603		Sheath Gd Strg 6fr 119cm Strl Lf R2p Destination Slndr Disp	BOTH IP/OP	$754.00 	$557.96	$0.00	$603.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$377.00	$597.17	$603.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80438604	EAP	HCPCS C1887		Catheter Intvn 45d .014in Mic 2.1-2.5fr .017in .021in 150cm	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.00	$958.32	$968.00	$0.00	$0.00	$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
80438605	EAP	HCPCS C1887		Catheter Intvn 90d Mic 2.4fr .017in .018in 130cm 40cm	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.00	$958.32	$968.00	$0.00	$0.00	$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
80438606	EAP	HCPCS C1887		Catheter Intvn 90d .014in Mic 2.1-2.5fr .017in .021in 150cm	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.00	$958.32	$968.00	$0.00	$0.00	$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
80438607	EAP	HCPCS C1887		Catheter Intvn 120d Mic 2.4-3.2fr .017-.018in 130cm 80cm	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.00	$958.32	$968.00	$0.00	$0.00	$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
80438608	EAP	HCPCS C1887		Catheter Intvn 120d .014in Mic 2.1-2.5fr .017in .021in 150cm	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.00	$958.32	$968.00	$0.00	$0.00	$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
80438609	EAP	HCPCS C1887		Catheter Intvn 90d Mic 2.4fr .017in .018in 130cm 80cm	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.00	$958.32	$968.00	$0.00	$0.00	$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
80438610	EAP	HCPCS C1887		Catheter Intvn 45d .014in Mic 2.1-2.5fr .017in .021in 130cm	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.00	$958.32	$968.00	$0.00	$0.00	$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
80438611	EAP	HCPCS C1887		Catheter Intvn 120d Mic 3.2-2.4fr .018-.017in 150cm 80cm	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.00	$958.32	$968.00	$0.00	$0.00	$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
80438621	EAP			Bronchoscope Glidescope	BOTH IP/OP	$369.00 	$273.06	$0.00	$284.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$273.87	$273.87	$284.43	$0.00	$76.90	$0.00	$0.00	$0.00	$0.00	$18.50	$29.30	$29.60	$0.00	$239.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80463074	EAP	HCPCS C1887		Catheter Gd Mp1 Crv 6fr 100cm Strl Lf Lnchr Lg Lum Radopq	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$92.50	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00	$78.00	$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
80467372	EAP	HCPCS C1769		Guidewire Vasc 220cm .007-.012in Distal Tip	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00	$0.00	$0.00	$223.01	$0.00	$0.00	$226.86	$0.00	$0.00	$0.00	$0.00	$0.00
80467373	EAP	HCPCS C1769		Guidewire Vasc 220cm .007-.012in Distal Tip	BOTH IP/OP	"$1,495.00 "	"$1,106.30"	$0.00	"$1,196.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$747.50	"$1,184.04"	"$1,196.00"	$0.00	$0.00	$0.00	$233.97	$0.00	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00
80467374	EAP	HCPCS C1769		Guidewire Vasc 220cm .008-.012in Hbrd Radiopq Str	BOTH IP/OP	"$1,426.00 "	"$1,055.24"	$0.00	"$1,140.00"	$774.32	$774.32	$0.00	$0.00	$0.00	$297.21	"$1,058.38"	"$1,058.38"	"$1,099.16"	$0.00	$297.18	$0.00	$843.48	$843.48	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00	$926.90	$0.00	$223.01	$0.00	$0.00	$226.86	$0.00	$0.00	$0.00	$0.00	$0.00
80467375	EAP	HCPCS C1769		Guidewire Vasc 220cm .008-.012in Distal Tip	BOTH IP/OP	"$1,495.00 "	"$1,106.30"	$0.00	"$1,196.00"	$811.79	$811.79	$0.00	$0.00	$0.00	$311.60	"$1,109.59"	"$1,109.59"	"$1,152.35"	$0.00	$311.56	$0.00	$884.29	$884.29	$0.00	$747.50	"$1,184.04"	"$1,196.00"	$0.00	$971.75	$0.00	$233.97	$0.00	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00
80467376	EAP	HCPCS C1769		Guidewire Vasc 200cm .012-.014in Hbrd Radiopq Str	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	$828.00	$562.01	$562.01	$0.00	$0.00	$0.00	$215.72	$768.18	$768.18	$797.78	$0.00	$215.69	$0.00	$612.20	$612.20	$0.00	$517.50	$819.72	$828.00	$0.00	$672.75	$0.00	$161.98	$0.00	$0.00	$164.77	$0.00	$0.00	$0.00	$0.00	$0.00
80467377	EAP	HCPCS C1769		Guidewire Vasc 2 Ang .012-.014	BOTH IP/OP	"$1,093.00 "	$808.82	$0.00	$874.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$546.50	$865.66	$874.40	$0.00	$0.00	$0.00	$171.05	$0.00	$0.00	$174.01	$0.00	$0.00	$0.00	$0.00	$0.00
80467378	EAP	HCPCS C1769		Guidewire Vasc 310cm .010in Radiopq Atrm Tip Str	BOTH IP/OP	"$1,598.00 "	"$1,182.52"	$0.00	"$1,278.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$799.00	"$1,265.62"	"$1,278.40"	$0.00	$0.00	$0.00	$250.09	$0.00	$0.00	$254.40	$0.00	$0.00	$0.00	$0.00	$0.00
80467379	EAP	HCPCS C1769		Guidewire Vasc 310cm .012in Radiopq Atrm Tip Str	BOTH IP/OP	"$1,598.00 "	"$1,182.52"	$0.00	"$1,278.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$799.00	"$1,265.62"	"$1,278.40"	$0.00	$0.00	$0.00	$250.09	$0.00	$0.00	$254.40	$0.00	$0.00	$0.00	$0.00	$0.00
80467381	EAP	HCPCS C1894		Introducer Sheath 088 80 Cm	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$597.30	$597.30	$0.00	$0.00	$0.00	$0.00	$816.42	$816.42	$847.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$550.00	$871.20	$880.00	$0.00	$715.00	$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
80467382	EAP	HCPCS C1894		Introducer Sheath 088 90 Cm	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$597.30	$597.30	$0.00	$0.00	$0.00	$229.27	$816.42	$816.42	$847.88	$0.00	$229.24	$0.00	$650.65	$650.65	$0.00	$550.00	$871.20	$880.00	$0.00	$715.00	$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
80467383	EAP	HCPCS C1894		Introducer Sheath 088 100 Cm	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$550.00	$871.20	$880.00	$0.00	$0.00	$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
80467384	EAP	HCPCS C1769		Guidewire Vasc 180cm .035in Std Tip Radiopq Strbl	BOTH IP/OP	$155.00 	$114.70	$0.00	$140.00	$84.17	$84.17	$0.00	$0.00	$0.00	$32.31	$115.04	$115.04	$119.47	$0.00	$32.30	$0.00	$91.68	$91.68	$0.00	$87.50	$138.60	$140.00	$0.00	$100.75	$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
80467385	EAP	HCPCS C1769		Guidewire Vasc 300cm .035in Std Tip Radiopq Strbl	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00	$0.00	$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
80467387	EAP	HCPCS C1751		Kit Cath 6fr 60cm Prln 2 Lum Basic Gwire Mini Scpl	BOTH IP/OP	$438.00 	$324.12	$0.00	$350.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$346.90	$350.40	$0.00	$0.00	$0.00	$68.55	$0.00	$0.00	$69.73	$0.00	$0.00	$0.00	$0.00	$0.00
80467396	EAP	HCPCS C2628		Catheter Blnocc Thk.9mm 3cm 7mm 1.1in 6- Mm 2fr	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80467397	EAP	HCPCS C2628		Catheter Blnocc Thk.9mm 3cm 7mm 1.1in 6- Mm 2fr	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80467398	EAP	HCPCS C2628		Catheter Blnocc Thk.9mm 3cm 7mm 1.1in 6- Mm 2fr	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80467399	EAP	HCPCS C2628		Catheter Blnocc Thk.9mm 3cm 7mm 1.1in 6- Mm 2fr	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80467400	EAP	HCPCS C2628		Catheter Blnocc Thk.9mm 3cm 3mm 1.1in 6- Mm 2fr	BOTH IP/OP	"$5,238.00 "	"$3,876.12"	$0.00	"$4,190.40"	"$2,844.23"	"$2,844.23"	$0.00	$0.00	$0.00	"$1,091.73"	"$3,887.64"	"$3,887.64"	"$4,037.45"	$0.00	"$1,091.60"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,619.00"	"$4,148.50"	"$4,190.40"	$0.00	"$3,404.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80469324	EAP	HCPCS C1895		Lead Dfbr 64cm 7.3fr Rlnc 4-frn Rv Mp35n Irox Strd	BOTH IP/OP	"$6,500.00 "	"$4,810.00"	$0.00	"$5,200.00"	"$2,925.00"	"$2,925.00"	$0.00	$0.00	$0.00	"$1,354.76"	"$4,181.12"	"$4,181.12"	"$5,010.20"	$0.00	"$1,354.60"	$0.00	"$3,204.50"	"$3,204.50"	$0.00	"$3,250.00"	"$5,148.00"	"$5,200.00"	$0.00	"$2,925.00"	$0.00	"$1,017.25"	$0.00	$0.00	"$1,034.80"	$0.00	$0.00	$0.00	$0.00	$0.00
80469325	EAP	HCPCS C1777		Lead Dfbr 64cm 7.3fr Rlnc 4-frn Rv Mp35n Irox Strd 1 Coil	BOTH IP/OP	"$6,500.00 "	"$4,810.00"	$0.00	"$5,200.00"	"$2,925.00"	"$2,925.00"	$0.00	$0.00	$0.00	"$1,354.76"	"$4,181.12"	"$4,181.12"	"$5,010.20"	$0.00	"$1,354.60"	$0.00	"$3,204.50"	"$3,204.50"	$0.00	"$3,250.00"	"$5,148.00"	"$5,200.00"	$0.00	"$2,925.00"	$0.00	"$1,017.25"	$0.00	$0.00	"$1,034.80"	$0.00	$0.00	$0.00	$0.00	$0.00
80469326	EAP	HCPCS C1895		Lead Dfbr 59cm 7.3fr Rlnc 4-frn Rv Mp35n Irox Strd 2 Coil	BOTH IP/OP	"$6,500.00 "	"$4,810.00"	$0.00	"$5,200.00"	"$2,925.00"	"$2,925.00"	$0.00	$0.00	$0.00	"$1,354.76"	"$4,181.12"	"$4,181.12"	"$5,010.20"	$0.00	"$1,354.60"	$0.00	"$3,204.50"	"$3,204.50"	$0.00	"$3,250.00"	"$5,148.00"	"$5,200.00"	$0.00	"$2,925.00"	$0.00	"$1,017.25"	$0.00	$0.00	"$1,034.80"	$0.00	$0.00	$0.00	$0.00	$0.00
80472492	EAP	HCPCS C1887		Catheter Dlv Sys 45d Mic .025in 135cm Lntrn Hflo	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	"$1,252.55"	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00	"$1,056.25"	$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
80472499	EAP			Coil Embl Std .02in 3mm 20cm Penumbra Coil 400 Ruby Cmplx Lg	BOTH IP/OP	"$2,475.00 "	"$1,831.50"	$0.00	"$1,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,836.95"	"$1,836.95"	"$1,907.73"	$0.00	$515.79	$0.00	$0.00	$0.00	$0.00	"$1,237.50"	"$1,960.20"	"$1,980.00"	$0.00	"$1,113.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80472510	EAP			Coil Embl Std .02in 7mm 25cm Penumbra Coil 400 Ruby Cmplx Lg	BOTH IP/OP	"$2,475.00 "	"$1,831.50"	$0.00	"$1,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,836.95"	"$1,836.95"	"$1,907.73"	$0.00	$515.79	$0.00	$0.00	$0.00	$0.00	"$1,237.50"	"$1,960.20"	"$1,980.00"	$0.00	"$1,113.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80472512	EAP			COIL EMBL STD .02IN 8MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG	BOTH IP/OP	"$2,475.00 "	"$1,831.50"	$0.00	"$1,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,836.95"	"$1,836.95"	"$1,907.73"	$0.00	$515.79	$0.00	$0.00	$0.00	$0.00	"$1,237.50"	"$1,960.20"	"$1,980.00"	$0.00	"$1,113.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80472530	EAP			Coil Embl .02in 2mm 4cm Penumbra Coil 400 Ruby Cmplx Lg	BOTH IP/OP	"$1,975.00 "	"$1,461.50"	$0.00	"$1,580.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,465.85"	"$1,465.85"	"$1,522.33"	$0.00	$411.59	$0.00	$0.00	$0.00	$0.00	$987.50	"$1,564.20"	"$1,580.00"	$0.00	$888.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80472552	EAP			Coil Embl J-sft 30cm Strl Lf Pod Pk	BOTH IP/OP	"$3,225.00 "	"$2,386.50"	$0.00	"$2,580.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,393.60"	"$2,393.60"	"$2,485.83"	$0.00	$672.09	$0.00	$0.00	$0.00	$0.00	"$1,612.50"	"$2,554.20"	"$2,580.00"	$0.00	"$1,451.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80472555	EAP			COIL EMBL J-SFT 60CM STRL LF POD PK	BOTH IP/OP	"$3,225.00 "	"$2,386.50"	$0.00	"$2,580.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,393.60"	"$2,393.60"	"$2,485.83"	$0.00	$672.09	$0.00	$0.00	$0.00	$0.00	"$1,612.50"	"$2,554.20"	"$2,580.00"	$0.00	"$1,451.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80472556	EAP			Handle Inst Ruby Dtch Coil	BOTH IP/OP	$595.00 	$440.30	$0.00	$476.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$441.61	$441.61	$458.63	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$297.50	$471.24	$476.00	$0.00	$267.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80488974	EAP	HCPCS C1882		Cobalt Hf Quad Crt-d Mri Surescan	BOTH IP/OP	"$44,750.00 "	"$33,115.00"	$0.00	"$35,800.00"	"$20,137.50"	"$20,137.50"	$0.00	$0.00	$0.00	"$9,327.02"	"$4,181.12"	"$4,181.12"	"$34,493.30"	$0.00	"$9,325.90"	$0.00	"$22,061.75"	"$22,061.75"	$0.00	"$22,375.00"	"$35,442.00"	"$35,800.00"	$0.00	"$20,137.50"	$0.00	$0.00	$0.00	$0.00	"$7,124.20"	$0.00	$0.00	$0.00	$0.00	$0.00
82000002	EAP	CPT® G0257		Emergency Dialysis	BOTH IP/OP	"$3,267.00 "	"$2,417.58"	$0.00	"$2,123.55"	"$1,773.98"	"$1,773.98"	$637.82	$637.82	$641.42	$680.92	$0.00	$0.00	$0.00	$627.13	$680.84	$407.64	"$1,932.43"	"$1,932.43"	$641.91	"$1,194.00"	"$1,891.30"	"$1,910.40"	$891.85	"$2,123.55"	$891.85	$373.72	$0.00	$0.00	$380.17	$611.34	$0.00	$0.00	$0.00	$0.00
83100001	EAP	CPT® 90947		Intpatient Dialysis Crrt	BOTH IP/OP	"$3,267.00 "	"$2,417.58"	$0.00	"$2,123.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$680.84	$0.00	$0.00	$0.00	$0.00	"$1,194.00"	"$1,891.30"	"$1,910.40"	$0.00	"$2,123.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
83100005	EAP	CPT® 90945		Peritoneal Dialysis Op	BOTH IP/OP	"$1,724.00 "	"$1,275.76"	$0.00	"$1,379.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.28	$0.00	$0.00	$0.00	$0.00	$862.00	"$1,365.41"	"$1,379.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000011	EAP	CPT® 90882		Brief Evaluation Management	BOTH IP/OP	$62.00 	$45.88	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.02	$46.02	$47.79	$0.00	$12.92	$0.00	$0.00	$0.00	$0.00	$31.00	$49.10	$49.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000012	EAP	CPT® 90885		Psych Eval Of Records	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$308.32	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000013	EAP	CPT® 90887		Consultation With Family	BOTH IP/OP	$242.00 	$179.08	$0.00	$192.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.61	$179.61	$186.53	$0.00	$50.43	$0.00	$0.00	$0.00	$0.00	$120.00	$190.08	$192.00	$0.00	$157.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000014	EAP	CPT® 90889		Preparation Of Reports	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.13	$178.13	$184.99	$0.00	$50.02	$0.00	$0.00	$0.00	$0.00	$120.00	$190.08	$192.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000017	EAP	HCPCS H0004		Group Outpatient Services	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$11.40	$0.00	$11.40	$2.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000020	EAP	HCPCS H0004		Group Outpatient Services	BOTH IP/OP	$19.00 	$14.06	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$3.38	$24.42	$14.10	$14.10	$14.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$51.00	$12.35	$51.00	$13.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000022	EAP	HCPCS H0004		Group Outpatient Services	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$15.13	$24.42	$63.09	$63.09	$65.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$51.00	$0.00	$51.00	$13.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000023	EAP	HCPCS H0020		Methadone Administration	BOTH IP/OP	$131.00 	$96.94	$0.00	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.23	$97.23	$100.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.50	$103.75	$104.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000024	EAP	HCPCS H0031		Mh Assessment By A Non-physician	BOTH IP/OP	$168.00 	$124.32	$0.00	$133.60	$0.00	$0.00	$0.00	$0.00	$29.90	$27.68	$124.69	$124.69	$129.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$132.26	$133.60	$100.20	$109.20	$100.20	$26.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000026	EAP	HCPCS H0032		Service Plan Development	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$15.13	$27.68	$63.09	$63.09	$65.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$51.00	$55.25	$51.00	$13.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000027	EAP	HCPCS H0038		Peer Support	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$4.98	$1.80	$20.78	$20.78	$21.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$16.80	$18.20	$16.80	$4.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000028	EAP	HCPCS H0039		Assertive Community Treatment	BOTH IP/OP	$93.00 	$68.82	$0.00	$74.40	$0.00	$0.00	$0.00	$0.00	$16.55	$28.95	$69.02	$69.02	$71.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.50	$73.66	$74.40	$55.80	$60.45	$55.80	$14.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000030	EAP	HCPCS H2010		Medication Administ Comp	BOTH IP/OP	$86.00 	$63.64	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$15.31	$28.99	$63.83	$63.83	$66.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$51.00	$55.90	$51.00	$13.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000035	EAP	HCPCS H2014		Group Skills Train/devl 15 Min	BOTH IP/OP	$15.00 	$11.10	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$2.67	$16.80	$11.13	$11.13	$11.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$9.00	$11.05	$9.00	$2.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000045	EAP	HCPCS H2011		Crisis Intervention	BOTH IP/OP	$137.00 	$101.38	$0.00	$108.80	$0.00	$0.00	$0.00	$0.00	$24.39	$28.15	$101.68	$101.68	$105.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.00	$107.71	$108.80	$81.60	$89.05	$81.60	$21.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000048	EAP	HCPCS H2017		Psychosocial Rehabilitation	BOTH IP/OP	$28.00 	$20.72	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$4.98	$0.00	$20.78	$20.78	$21.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.00	$22.18	$22.40	$16.80	$18.20	$16.80	$4.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000049	EAP	HCPCS H2014		Grp/fam Skill Train W/pat15min	BOTH IP/OP	$17.00 	$12.58	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$3.03	$16.80	$12.62	$12.62	$13.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$10.20	$0.00	$10.20	$2.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000051	EAP	HCPCS H2014		Group Skills Training 15mins	BOTH IP/OP	$17.00 	$12.58	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$3.03	$16.80	$12.62	$12.62	$13.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$10.20	$0.00	$10.20	$2.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000052	EAP	HCPCS H2014		Family Training W/pat 15mins	BOTH IP/OP	$72.00 	$53.28	$0.00	$57.60	$0.00	$0.00	$0.00	$0.00	$12.82	$16.80	$53.44	$53.44	$55.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.00	$57.02	$57.60	$43.20	$0.00	$43.20	$11.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000053	EAP	HCPCS H2014		Family Training W/o Pat 15mins	BOTH IP/OP	$72.00 	$53.28	$0.00	$57.60	$0.00	$0.00	$0.00	$0.00	$12.82	$16.80	$53.44	$53.44	$55.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.00	$57.02	$57.60	$43.20	$0.00	$43.20	$11.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000054	EAP	HCPCS T1001		Nursing Assessment	BOTH IP/OP	$99.00 	$73.26	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$17.62	$0.00	$73.48	$73.48	$76.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.00	$77.62	$78.40	$58.80	$64.35	$58.80	$15.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000055	EAP	HCPCS T1001		Nursing Assessment	BOTH IP/OP	$98.00 	$72.52	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.00	$77.62	$78.40	$58.80	$0.00	$58.80	$15.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000056	EAP	HCPCS T1002		Rn Services 15mins	BOTH IP/OP	$99.00 	$73.26	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$17.62	$0.00	$73.48	$73.48	$76.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.00	$77.62	$78.40	$58.80	$64.35	$58.80	$15.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000057	EAP	HCPCS T1003		Lpn Services 15mins	BOTH IP/OP	$75.00 	$55.50	$0.00	$59.20	$0.00	$0.00	$0.00	$0.00	$13.35	$0.00	$55.67	$55.67	$57.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.00	$58.61	$59.20	$44.40	$48.75	$44.40	$11.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000058	EAP	HCPCS T2038		Community Transitional Planning	BOTH IP/OP	$70.00 	$51.80	$0.00	$55.20	$0.00	$0.00	$0.00	$0.00	$12.46	$0.00	$51.95	$51.95	$53.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.50	$54.65	$55.20	$41.40	$45.50	$41.40	$10.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000060	EAP	HCPCS H0004		Multi-group Family Couns 15min	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$11.40	$0.00	$11.40	$2.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000067	EAP	CPT® 90791		Psych Dx Eval (no Med Service)	BOTH IP/OP	$576.00 	$426.24	$0.00	$457.60	$312.77	$312.77	$130.30	$130.30	$131.03	$120.05	$427.51	$427.51	$443.98	$128.07	$0.00	$83.25	$340.70	$340.70	$131.75	$286.00	$453.02	$457.60	$183.04	$374.40	$183.04	$143.47	$127.71	$127.71	$91.06	$125.47	$0.00	$0.00	$0.00	$0.00
90000068	EAP	CPT® 90792		Psych Dx Eval (with Med Service)	BOTH IP/OP	$576.00 	$426.24	$0.00	$457.60	$312.77	$312.77	$130.30	$130.30	$131.03	$120.05	$427.51	$427.51	$443.98	$128.07	$0.00	$83.25	$340.70	$340.70	$131.75	$286.00	$453.02	$457.60	$183.04	$374.40	$183.04	$117.89	$142.86	$142.86	$91.06	$125.47	$0.00	$0.00	$0.00	$0.00
90000069	EAP	CPT® 90785		Interactive Complexity	BOTH IP/OP	$321.00 	$237.54	$0.00	$255.20	$174.30	$174.30	$0.00	$0.00	$0.00	$66.90	$238.25	$238.25	$247.43	$0.00	$0.00	$0.00	$189.87	$189.87	$0.00	$159.50	$252.65	$255.20	$0.00	$208.65	$0.00	$49.92	$14.07	$14.07	$50.78	$0.00	$0.00	$0.00	$0.00	$0.00
90000070	EAP	HCPCS T1016		Case Management	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$33.40	$33.40	$34.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$27.00	$29.25	$27.00	$7.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000071	EAP	HCPCS T1016		"Case Management - Practitioner Level 5,"	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$33.40	$33.40	$34.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$27.00	$0.00	$27.00	$7.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000072	EAP	HCPCS T1016		"Case Management - Practitioner Level 4,"	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$33.40	$33.40	$34.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$27.00	$0.00	$27.00	$7.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000073	EAP	HCPCS T1016		"Case Management - Practitioner Level 5,"	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$33.40	$33.40	$34.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$27.00	$0.00	$27.00	$7.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000074	EAP	HCPCS T1016		"CASE MANAGEMENT-PRACTITIONER LEVEL 4, COLLATERAL CONTACT"	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$33.40	$33.40	$34.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$27.00	$0.00	$27.00	$7.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000075	EAP	HCPCS T1016		"Case Management-practitioner Level 5, Collateral Contact"	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$27.00	$0.00	$27.00	$7.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000076	EAP	HCPCS T1016		"CASE MANAGEMENT-PRACTITIONER LEVEL 4,COLLATERAL CONTACT"	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$33.40	$33.40	$34.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$27.00	$0.00	$27.00	$7.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000077	EAP	HCPCS T1016		"CASE MANAGEMENT-PREACTITIONER LEVEL 5,OUT-COLLATERAL"	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$27.00	$0.00	$27.00	$7.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000078	EAP	HCPCS H0025		Peer Support Whole Health & Wellness	BOTH IP/OP	$34.00 	$25.16	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$6.05	$0.00	$25.23	$25.23	$26.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$20.40	$22.10	$20.40	$5.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90000080	EAP	CPT® G0447		Behavior Counsel Obesity 15m	BOTH IP/OP	$101.00 	$74.74	$15.65	$100.00	$54.84	$54.84	$72.87	$72.87	$73.28	$21.05	$74.96	$74.96	$77.85	$71.76	$21.05	$46.64	$59.74	$59.74	$78.77	$50.00	$79.20	$80.00	$100.00	$65.65	$100.00	$15.65	$24.16	$24.16	$15.92	$75.02	$0.00	$0.00	$0.00	$0.00
90000081	EAP	HCPCS G0444		"Annual Depression Screening, 15 Minutes"	BOTH IP/OP	$71.00 	$52.54	$0.00	$56.00	$38.55	$38.55	$25.59	$25.59	$25.74	$14.80	$52.70	$52.70	$54.73	$25.14	$14.80	$16.34	$42.00	$42.00	$27.40	$35.00	$55.44	$56.00	$38.07	$0.00	$38.07	$10.96	$9.74	$9.74	$11.14	$26.10	$0.00	$0.00	$0.00	$0.00
91400004	EAP	CPT® 90832		Individual Psychotherapy 30 Mins	BOTH IP/OP	$541.00 	$400.34	$0.00	$429.60	$293.76	$293.76	$130.30	$130.30	$131.03	$112.76	$401.53	$401.53	$417.00	$128.07	$0.00	$83.25	$320.00	$320.00	$131.75	$268.50	$425.30	$429.60	$183.04	$351.65	$183.04	$59.54	$63.85	$63.85	$85.49	$125.47	$0.00	$0.00	$0.00	$0.00
91400006	EAP	CPT® 90837		Individual Psychotherapy 60 Min	BOTH IP/OP	$658.00 	$486.92	$0.00	$522.40	$357.29	$357.29	$130.30	$130.30	$131.03	$137.14	$488.37	$488.37	$507.19	$128.07	$0.00	$83.25	$389.21	$389.21	$131.75	$326.50	$517.18	$522.40	$183.04	$427.70	$183.04	$124.37	$127.35	$127.35	$103.96	$125.47	$0.00	$0.00	$0.00	$0.00
91400024	EAP	CPT® 90834		Individual Psychotherapy 45 Min	BOTH IP/OP	$541.00 	$400.34	$0.00	$429.60	$293.76	$293.76	$130.30	$130.30	$131.03	$112.76	$401.53	$401.53	$417.00	$128.07	$0.00	$83.25	$320.00	$320.00	$131.75	$268.50	$425.30	$429.60	$183.04	$351.65	$183.04	$84.04	$85.14	$85.14	$85.49	$125.47	$0.00	$0.00	$0.00	$0.00
91400061	EAP	CPT® 90833		Psychotherapy W/pat W/e&m Srvcs 30 Min (add-on)	BOTH IP/OP	$382.00 	$282.68	$0.00	$303.20	$0.00	$0.00	$0.00	$0.00	$0.00	$69.65	$283.52	$283.52	$294.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.50	$300.17	$303.20	$0.00	$248.30	$0.00	$39.40	$66.38	$66.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91400062	EAP	CPT® 90836		INDIVIDUAL COUNSELING 45 MIN ADD ON	BOTH IP/OP	$541.00 	$400.34	$0.00	$429.60	$293.76	$293.76	$0.00	$0.00	$0.00	$112.76	$401.53	$401.53	$417.00	$0.00	$0.00	$0.00	$320.00	$320.00	$0.00	$268.50	$425.30	$429.60	$0.00	$351.65	$0.00	$84.04	$84.05	$84.05	$85.49	$0.00	$0.00	$0.00	$0.00	$0.00
91400063	EAP	CPT® 90838		"Psychotherapy, 60min W/pat And Or Fam W  E/m(add-on)"	BOTH IP/OP	$658.00 	$486.92	$0.00	$522.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$488.37	$488.37	$507.19	$0.00	$137.13	$0.00	$0.00	$0.00	$0.00	$326.50	$517.18	$522.40	$0.00	$427.70	$0.00	$102.19	$110.39	$110.39	$103.96	$0.00	$0.00	$0.00	$0.00	$0.00
91400071	EAP	CPT® 90839		Psychotherapy For Crisis First 60 Minutes	BOTH IP/OP	$682.00 	$504.68	$0.00	$541.60	$0.00	$0.00	$0.00	$0.00	$0.00	$142.15	$506.18	$506.18	$525.69	$128.07	$0.00	$83.25	$403.40	$403.40	$131.75	$338.50	$536.18	$541.60	$183.04	$443.30	$183.04	$105.95	$133.12	$133.12	$107.78	$125.47	$0.00	$0.00	$0.00	$0.00
91400072	EAP	CPT® 90840		PSYCHOTHERAPY ADDITIONAL 30  MINUTES	BOTH IP/OP	$218.00 	$161.32	$0.00	$172.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.80	$161.80	$168.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.00	$171.07	$172.80	$0.00	$141.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91500001	EAP	CPT® 90853		Psy Group Therapy	BOTH IP/OP	$247.00 	$182.78	$0.00	$197.60	$134.12	$134.12	$72.87	$72.87	$73.28	$51.48	$183.32	$183.32	$190.39	$71.76	$0.00	$46.64	$146.10	$146.10	$78.77	$123.50	$195.62	$197.60	$109.44	$160.55	$109.44	$34.39	$25.25	$25.25	$39.32	$75.02	$0.00	$0.00	$0.00	$0.00
91500006	EAP	HCPCS H2014		Group Skills Training 15mins	BOTH IP/OP	$17.00 	$12.58	$0.00	$16.80	$0.00	$0.00	$0.00	$0.00	$3.03	$16.80	$12.62	$12.62	$13.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.50	$13.46	$13.60	$10.20	$0.00	$10.20	$2.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91600001	EAP	CPT® 90846		Family Psychotherapy W/o Patient Present 50 Min	BOTH IP/OP	"$1,054.00 "	$779.96	$0.00	$836.80	$572.32	$572.32	$130.30	$130.30	$131.03	$219.68	$782.28	$782.28	$812.42	$128.07	$0.00	$83.25	$623.44	$623.44	$131.75	$523.00	$828.43	$836.80	$183.04	$685.10	$183.04	$163.70	$102.82	$102.82	$166.52	$125.47	$0.00	$0.00	$0.00	$0.00
91600009	EAP	CPT® 90847		Psy Family Therapy W Pt	BOTH IP/OP	"$1,054.00 "	$779.96	$0.00	$836.80	$572.32	$572.32	$130.30	$130.30	$131.03	$219.68	$782.28	$782.28	$812.42	$128.07	$0.00	$83.25	$623.44	$623.44	$131.75	$523.00	$828.43	$836.80	$183.04	$685.10	$183.04	$105.59	$106.79	$106.79	$166.52	$125.47	$0.00	$0.00	$0.00	$0.00
91600010	EAP	CPT® 90849		Multiple Family Group Therapy	BOTH IP/OP	$258.00 	$190.92	$0.00	$206.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.49	$191.49	$198.87	$0.00	$53.77	$0.00	$0.00	$0.00	$0.00	$129.00	$204.34	$206.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91600012	EAP	HCPCS H2014		Group Outpatient Services	BOTH IP/OP	$72.00 	$53.28	$0.00	$57.60	$0.00	$0.00	$0.00	$0.00	$12.82	$16.80	$53.44	$53.44	$55.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.00	$57.02	$57.60	$43.20	$0.00	$43.20	$11.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91600013	EAP	HCPCS H2014		Group Outpatient Services	BOTH IP/OP	$72.00 	$53.28	$0.00	$57.60	$0.00	$0.00	$0.00	$0.00	$12.82	$16.80	$53.44	$53.44	$55.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.00	$57.02	$57.60	$43.20	$0.00	$43.20	$11.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800005	EAP	CPT® 96110		"NICU/PED/DEVELOP.TESTING,LIMI"	BOTH IP/OP	$192.00 	$142.08	$0.00	$153.60	$0.00	$0.00	$0.00	$0.00	$10.07	$0.00	$142.50	$142.50	$147.99	$0.00	$40.01	$0.00	$0.00	$0.00	$0.00	$96.00	$152.06	$153.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800013	EAP	CPT® 96125		Cognitive Testing	BOTH IP/OP	$702.00 	$519.48	$0.00	$561.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$146.30	$0.00	$0.00	$0.00	$0.00	$351.00	$555.98	$561.60	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800017	EAP	CPT® 96125		Cognitive Testing_52	BOTH IP/OP	$353.00 	$261.22	$0.00	$461.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.74	$444.74	$461.84	$0.00	$73.57	$0.00	$0.00	$0.00	$0.00	$176.50	$279.58	$282.40	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800019	EAP	CPT® 96130		Psychological Tst Eval Svc Phys/qhp First Hour	BOTH IP/OP	$568.00 	$420.32	$0.00	$451.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.57	$421.57	$437.81	$0.00	$118.37	$0.00	$0.00	$0.00	$138.76	$282.00	$446.69	$451.20	$192.78	$369.20	$192.78	$112.86	$111.11	$111.11	$89.79	$132.15	$0.00	$0.00	$0.00	$0.00
91800020	EAP	CPT® 96131		Psychological Tst Eval Svc Phys/qhp Ea Addl Hour	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800021	EAP	CPT® 96112		Developmental Tst Admin Phys/qhp 1st Hour	BOTH IP/OP	$699.00 	$517.26	$0.00	$559.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$518.80	$518.80	$538.79	$0.00	$145.67	$0.00	$0.00	$0.00	$0.00	$349.50	$553.61	$559.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800022	EAP	CPT® 96113		Developmental Tst Admin Phys/qhp Ea Addl 30 Min	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800023	EAP	CPT® 96116		Neurobehavioral Status Xm Phys/qhp 1st Hour	BOTH IP/OP	$609.00 	$450.66	$86.57	$484.00	$330.69	$330.69	$253.61	$253.61	$255.04	$126.93	$452.00	$452.00	$469.42	$249.66	$126.92	$162.28	$360.22	$360.22	$239.36	$302.50	$479.16	$484.00	$332.56	$395.85	$332.56	$101.28	$86.57	$86.57	$96.32	$227.96	$0.00	$0.00	$0.00	$0.00
91800024	EAP	CPT® 96121		Neurobehavioral Status Xm Phys/qhp Ea Addl Hour	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$231.24	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800025	EAP	CPT® 96132		Neuropsychol Tst Eval Phys/qhp 1st Hour	BOTH IP/OP	$329.00 	$243.46	$52.06	$261.60	$178.65	$178.65	$253.61	$253.61	$255.04	$68.57	$244.18	$244.18	$253.59	$249.66	$68.56	$162.28	$194.60	$194.60	$138.76	$163.50	$258.98	$261.60	$192.78	$213.85	$192.78	$126.78	$109.67	$109.67	$52.06	$132.15	$0.00	$0.00	$0.00	$0.00
91800026	EAP	CPT® 96133		Neuropsychol Tst Eval Physl/qph Ea Addl Hr	BOTH IP/OP	$165.00 	$122.10	$0.00	$131.20	$89.60	$89.60	$0.00	$0.00	$0.00	$34.39	$122.46	$122.46	$127.18	$0.00	$34.39	$0.00	$97.60	$97.60	$0.00	$82.00	$129.89	$131.20	$0.00	$107.25	$0.00	$79.70	$84.42	$84.42	$26.11	$0.00	$0.00	$0.00	$0.00	$0.00
91800027	EAP	CPT® 96138		Psycl/nrpsycl Tst Tech 2+ Tst 1st 30 Min	BOTH IP/OP	$41.00 	$30.34	$6.53	$253.61	$22.26	$22.26	$253.61	$253.61	$41.00	$8.55	$30.43	$30.43	$31.60	$249.66	$8.54	$162.28	$24.25	$24.25	$23.06	$20.50	$32.47	$32.80	$32.04	$26.65	$32.04	$36.79	$38.54	$38.54	$6.53	$21.96	$0.00	$0.00	$0.00	$0.00
91800028	EAP	CPT® 96139		Psycl/nrpsyc Tst Tech 2+ Tst Ea Addl 30 Min	BOTH IP/OP	$20.00 	$14.80	$0.00	$38.54	$10.86	$10.86	$0.00	$0.00	$0.00	$4.17	$14.84	$14.84	$15.42	$0.00	$4.17	$0.00	$11.83	$11.83	$0.00	$10.00	$15.84	$16.00	$0.00	$13.00	$0.00	$36.79	$38.54	$38.54	$3.18	$0.00	$0.00	$0.00	$0.00	$0.00
91800029	EAP	CPT® 96136		Psycl/nrpsycl Tst Phy/qhp Tst 1st 30 Min	BOTH IP/OP	$55.00 	$40.70	$8.76	$109.81	$29.87	$29.87	$109.81	$109.81	$55.00	$11.46	$40.82	$40.82	$42.39	$107.30	$11.46	$69.74	$32.53	$32.53	$23.06	$27.50	$43.56	$44.00	$32.04	$35.75	$32.04	$45.41	$25.25	$25.25	$8.76	$21.96	$0.00	$0.00	$0.00	$0.00
91800030	EAP	CPT® 96137		Psycl/nrpsycl Tst Phy/qhp Tst Addl 30 Min	BOTH IP/OP	$21.00 	$15.54	$0.00	$41.97	$11.40	$11.40	$0.00	$0.00	$0.00	$4.38	$15.59	$15.59	$16.19	$0.00	$4.38	$0.00	$12.42	$12.42	$0.00	$10.50	$16.63	$16.80	$0.00	$13.65	$0.00	$41.97	$19.84	$19.84	$3.34	$0.00	$0.00	$0.00	$0.00	$0.00
91800031	EAP	CPT® 96156		Health Behavior Assessment/re-assessment	BOTH IP/OP	$189.00 	$139.86	$29.93	$150.40	$102.63	$102.63	$72.87	$72.87	$73.28	$39.39	$140.28	$140.28	$145.68	$71.76	$39.39	$46.64	$111.79	$111.79	$78.77	$94.00	$148.90	$150.40	$109.44	$122.85	$109.44	$94.62	$90.55	$90.55	$29.93	$75.02	$0.00	$0.00	$0.00	$0.00
91800032	EAP	CPT® 96158		Health Behavior Ivntj Indiv F2f 1st 30 Min	BOTH IP/OP	$189.00 	$139.86	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$140.28	$140.28	$145.68	$0.00	$39.39	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00	$122.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800033	EAP	CPT® 96159		Health Behavior Ivntj Indiv F2f Ea Addl 15 Min	BOTH IP/OP	$94.00 	$69.56	$0.00	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.00	$74.45	$75.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800034	EAP	CPT® 96164		Health Behavior Ivntj Group F2f 1st 30 Min	BOTH IP/OP	$107.00 	$79.18	$0.00	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.50	$84.74	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800035	EAP	CPT® 96165		Health Behavior Ivntj Group F2f Ea Addl 15 Min	BOTH IP/OP	$107.00 	$79.18	$0.00	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.50	$84.74	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800036	EAP	CPT® 96167		Health Behavior Invtj Fam W/pt F2f 1st 30 Min	BOTH IP/OP	$107.00 	$79.18	$0.00	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.50	$84.74	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91800037	EAP	CPT® 96168		Health Behavior Ivntj Fam W/pt F2f Ea Add 15 Min	BOTH IP/OP	$107.00 	$79.18	$0.00	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.50	$84.74	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000001	EAP	CPT® 51725		"Cystometrogram, Simple"	BOTH IP/OP	"$1,683.00 "	"$1,245.42"	$0.00	"$1,683.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$350.74	$0.00	$0.00	$0.00	$235.59	"$1,682.00"	"$1,332.14"	"$1,345.60"	$327.32	"$1,683.00"	$327.32	$92.84	$139.03	$139.03	$267.77	$224.37	$0.00	$0.00	$0.00	$0.00
92000002	EAP	CPT® 51726		"Cystometrogram, Complex"	BOTH IP/OP	"$1,649.00 "	"$1,220.26"	$0.00	"$1,649.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.65	$0.00	$0.00	$0.00	$0.00	"$1,648.00"	"$1,305.22"	"$1,318.40"	$0.00	"$1,649.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000003	EAP	CPT® 51736		Uroflowmetry Simple	BOTH IP/OP	$293.00 	$216.82	$0.00	$293.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.46	$217.46	$225.84	$0.00	$61.06	$0.00	$0.00	$0.00	$0.00	$293.00	$232.06	$234.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000004	EAP	CPT® 51741		"Uroflowmetry, Complex"	BOTH IP/OP	$277.00 	$204.98	$5.76	$280.00	$150.41	$150.41	$135.96	$135.96	$136.73	$57.73	$205.59	$205.59	$213.51	$133.75	$57.73	$86.94	$113.00	$113.00	$138.76	$280.00	$221.76	$224.00	$192.78	$277.00	$192.78	$64.97	$5.76	$5.76	$44.58	$132.15	$0.00	$0.00	$0.00	$0.00
92000007	EAP	CPT® 51797		Intra-abdominal Pressure Test	BOTH IP/OP	$460.00 	$340.40	$0.00	$465.00	$460.00	$460.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$354.57	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$465.00	$368.28	$372.00	$0.00	$460.00	$0.00	$97.70	$124.26	$124.26	$74.03	$0.00	$0.00	$0.00	$0.00	$0.00
92000009	EAP	CPT® 59020		Fetal Contraction Stress Test	BOTH IP/OP	"$2,603.00 "	"$1,926.22"	$0.00	"$2,255.00"	"$1,413.43"	"$1,413.43"	$165.90	$165.90	$166.84	$0.00	"$1,931.95"	"$1,931.95"	"$2,006.39"	$0.00	$542.47	$0.00	$0.00	$0.00	$0.00	"$2,255.00"	"$2,082.17"	"$2,103.20"	$0.00	"$1,579.00"	$0.00	$65.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000010	EAP	CPT® 59025		Fetal Non Stress Test	BOTH IP/OP	$427.00 	$315.98	$19.09	"$1,750.00"	$231.86	$231.86	$165.90	$165.90	$166.84	$89.00	$316.92	$316.92	$329.13	$163.24	$88.99	$106.10	$252.57	$252.57	$166.54	$431.00	$341.35	$344.80	$231.38	"$1,750.00"	$231.38	$40.51	$19.09	$19.09	$68.62	$158.61	$0.00	$0.00	$0.00	$0.00
92000011	EAP	CPT® 92081		Vision Screen	BOTH IP/OP	$267.00 	$197.58	$17.65	$215.20	$144.98	$144.98	$54.21	$54.21	$54.51	$55.65	$198.17	$198.17	$205.80	$53.35	$55.64	$34.67	$157.93	$157.93	$55.17	$134.50	$213.05	$215.20	$76.65	$76.05	$76.65	$46.21	$17.65	$17.65	$42.82	$52.54	$0.00	$0.00	$0.00	$0.00
92000012	EAP	CPT® 92081		"Vision Test, Routine"	BOTH IP/OP	$269.00 	$199.06	$0.00	$215.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.17	$134.50	$213.05	$215.20	$76.65	$0.00	$76.65	$46.21	$17.65	$17.65	$42.82	$52.54	$0.00	$0.00	$0.00	$0.00
92000013	EAP	CPT® 92081		Visual Exam Limited-lt	BOTH IP/OP	$269.00 	$199.06	$17.65	$215.20	$146.07	$146.07	$54.21	$54.21	$54.51	$56.07	$199.65	$199.65	$207.35	$53.35	$56.06	$34.67	$159.11	$159.11	$55.17	$134.50	$213.05	$215.20	$76.65	$76.05	$76.65	$46.21	$17.65	$17.65	$42.82	$52.54	$0.00	$0.00	$0.00	$0.00
92000014	EAP	CPT® 92081		Visual Field Exam Unilat/bilat	BOTH IP/OP	$529.00 	$391.46	$17.65	$427.20	$287.25	$287.25	$54.21	$54.21	$54.51	$110.26	$392.62	$392.62	$407.75	$53.35	$110.24	$34.67	$312.90	$312.90	$55.17	$267.00	$422.93	$427.20	$76.65	$76.05	$76.65	$46.21	$17.65	$17.65	$85.01	$52.54	$0.00	$0.00	$0.00	$0.00
92000016	EAP	CPT® 92081		Visual Field Exam Limited-lt	BOTH IP/OP	$269.00 	$199.06	$17.65	$215.20	$146.07	$146.07	$54.21	$54.21	$54.51	$56.07	$199.65	$199.65	$207.35	$53.35	$56.06	$34.67	$159.11	$159.11	$55.17	$134.50	$213.05	$215.20	$76.65	$76.05	$76.65	$46.21	$17.65	$17.65	$42.82	$52.54	$0.00	$0.00	$0.00	$0.00
92000017	EAP	CPT® 92081		Visual Field Exam Limited-rt	BOTH IP/OP	$269.00 	$199.06	$17.65	$215.20	$146.07	$146.07	$54.21	$54.21	$54.51	$56.07	$199.65	$199.65	$207.35	$53.35	$56.06	$34.67	$159.11	$159.11	$55.17	$134.50	$213.05	$215.20	$76.65	$76.05	$76.65	$46.21	$17.65	$17.65	$42.82	$52.54	$0.00	$0.00	$0.00	$0.00
92000020	EAP	CPT® 92082		Visual Field Exam Uni/bil Intermed	BOTH IP/OP	$570.00 	$421.80	$0.00	$460.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$423.05	$423.05	$439.36	$0.00	$118.79	$0.00	$0.00	$0.00	$0.00	$287.50	$455.40	$460.00	$0.00	$82.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000028	EAP	CPT® 92083		Visual Field Exam Uni/bil Extended	BOTH IP/OP	$578.00 	$427.72	$36.02	$466.40	$313.85	$313.85	$109.81	$109.81	$110.43	$120.47	$428.99	$428.99	$445.52	$107.30	$120.46	$69.74	$341.89	$341.89	$109.35	$291.50	$461.74	$466.40	$151.93	$300.95	$151.93	$56.79	$36.02	$36.02	$92.81	$104.14	$0.00	$0.00	$0.00	$0.00
92000032	EAP	CPT® 92235		Flourescein Angioscopy W Photo	BOTH IP/OP	$959.00 	$709.66	$61.59	$768.00	$520.74	$520.74	$257.73	$257.73	$259.18	$199.88	$711.77	$711.77	$739.20	$253.45	$199.86	$164.75	$567.25	$567.25	$253.05	$480.00	$760.32	$768.00	$351.58	$188.50	$351.58	$100.45	$61.59	$61.59	$152.83	$241.00	$0.00	$0.00	$0.00	$0.00
92000033	EAP	CPT® 92235		Flourescein Photo W Photo Both	BOTH IP/OP	$960.00 	$710.40	$61.59	$768.00	$521.28	$521.28	$257.73	$257.73	$259.18	$200.09	$712.51	$712.51	$739.97	$253.45	$200.06	$164.75	$567.84	$567.84	$253.05	$480.00	$760.32	$768.00	$351.58	$188.50	$351.58	$100.45	$61.59	$61.59	$152.83	$241.00	$0.00	$0.00	$0.00	$0.00
92000035	EAP	CPT® 92250		Ophthalmoscopy W/ Fundus Photo	BOTH IP/OP	$407.00 	$301.18	$23.77	$326.40	$221.00	$221.00	$109.81	$109.81	$110.43	$84.83	$302.08	$302.08	$313.72	$107.30	$84.82	$69.74	$240.74	$240.74	$109.35	$204.00	$323.14	$326.40	$151.93	$211.90	$151.93	$59.03	$23.77	$23.77	$64.95	$104.14	$0.00	$0.00	$0.00	$0.00
92000036	EAP	CPT® 92285		Slit Lamp Photography	BOTH IP/OP	$159.00 	$117.66	$0.00	$128.80	$86.34	$86.34	$54.21	$54.21	$54.51	$33.14	$118.01	$118.01	$122.56	$53.35	$33.14	$34.67	$94.05	$94.05	$0.00	$80.50	$127.51	$128.80	$0.00	$82.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000037	EAP	CPT® 95810		Polysomnography	BOTH IP/OP	"$5,967.00 "	"$4,415.58"	$495.59	"$4,821.60"	"$1,604.30"	"$1,604.30"	$895.94	$895.94	$900.99	"$1,243.67"	"$3,372.63"	"$3,372.63"	"$3,502.34"	$881.57	"$1,243.52"	$573.02	"$3,094.73"	"$3,094.73"	$911.62	"$3,013.50"	"$4,773.38"	"$4,821.60"	"$1,266.58"	"$3,878.55"	"$1,266.58"	$594.31	$495.59	$495.59	$959.50	$868.21	$0.00	$0.00	$0.00	$0.00
92000038	EAP	CPT® 95811		Polysomnography W/cpap	BOTH IP/OP	"$7,160.00 "	"$5,298.40"	$518.64	"$5,785.60"	"$1,685.49"	"$1,685.49"	$895.94	$895.94	$900.99	"$1,492.32"	"$2,890.83"	"$2,890.83"	"$3,002.01"	$881.57	"$1,492.14"	$573.02	"$3,094.73"	"$3,094.73"	$911.62	"$3,616.00"	"$5,727.74"	"$5,785.60"	"$1,266.58"	"$5,541.90"	"$1,266.58"	$618.03	$518.64	$518.64	"$1,151.33"	$868.21	$0.00	$0.00	$0.00	$0.00
92000039	EAP	CPT® 95857		Tensilon Test	BOTH IP/OP	$257.00 	$190.18	$0.00	$205.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$190.75	$190.75	$198.10	$0.00	$53.56	$0.00	$0.00	$0.00	$0.00	$128.50	$203.54	$205.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000041	EAP	CPT® 95970		Analyze Neurostim No Prog	BOTH IP/OP	$345.00 	$255.30	$0.00	$294.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.06	$256.06	$265.93	$0.00	$71.90	$0.00	$0.00	$0.00	$0.00	$184.00	$291.46	$294.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000050	EAP	CPT® 95972		"Complex Programming, Up To 1 Hr"	BOTH IP/OP	$443.00 	$327.82	$0.00	$377.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.79	$328.79	$341.46	$0.00	$92.32	$0.00	$0.00	$0.00	$0.00	$236.00	$373.82	$377.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000054	EAP	CPT® 51728		Cystometrogram W/vp	BOTH IP/OP	$790.00 	$584.60	$0.00	$791.00	$790.00	$790.00	$560.26	$560.26	$563.41	$164.66	$586.34	$586.34	$608.93	$550.87	$164.64	$358.07	$113.00	$113.00	$0.00	$790.00	$625.68	$632.00	$0.00	$791.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000055	EAP	CPT® 95873		Guide Nerv Destr Elec Stim	BOTH IP/OP	$168.00 	$124.32	$0.00	$132.00	$91.22	$91.22	$0.00	$0.00	$0.00	$35.02	$124.69	$124.69	$129.49	$0.00	$35.01	$0.00	$99.37	$99.37	$0.00	$82.50	$130.68	$132.00	$0.00	$109.20	$0.00	$27.56	$57.63	$57.63	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
92000056	EAP	CPT® 95874		Guide Nerv Destr Needle Emg	BOTH IP/OP	$197.00 	$145.78	$0.00	$155.20	$106.97	$106.97	$0.00	$0.00	$0.00	$41.06	$146.21	$146.21	$151.85	$0.00	$41.05	$0.00	$116.53	$116.53	$0.00	$97.00	$153.65	$155.20	$0.00	$152.75	$0.00	$27.93	$60.15	$60.15	$30.88	$0.00	$0.00	$0.00	$0.00	$0.00
92000057	EAP	CPT® 95971		Analyze Neurostim Simple	BOTH IP/OP	$375.00 	$277.50	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$289.05	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000058	EAP	CPT® 91200		Liver Elastography	BOTH IP/OP	$305.00 	$225.70	$23.41	$242.40	$165.62	$165.62	$135.96	$135.96	$136.73	$63.57	$226.37	$226.37	$235.09	$133.75	$63.56	$86.94	$180.41	$180.41	$138.76	$151.50	$239.98	$242.40	$192.78	$198.25	$192.78	$34.27	$23.41	$23.41	$48.24	$132.15	$0.00	$0.00	$0.00	$0.00
92000059	EAP	CPT® 92132		Cmptr Ophthalmic Dx Img Ant Segmt W/i&r Uni/bi	BOTH IP/OP	$210.00 	$155.40	$15.13	$168.00	$114.03	$114.03	$54.21	$54.21	$54.51	$43.77	$155.86	$155.86	$161.87	$53.35	$43.76	$34.67	$124.22	$124.22	$55.17	$105.00	$166.32	$168.00	$76.65	$104.65	$76.65	$34.49	$15.13	$15.13	$33.43	$52.54	$0.00	$0.00	$0.00	$0.00
92000060	EAP	CPT® 92240		Icg Angiography - One Eye	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$697.67	$697.67	$724.55	$0.00	$195.90	$0.00	$0.00	$0.00	$0.00	$470.00	$744.48	$752.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000061	EAP	CPT® 92240		Icg Angiography - Both Eyes	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	"$1,086.83"	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000062	EAP	CPT® 92060		Sensormotor Xm W/mlt Meas Ocular Devij W/i&r Spx	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$154.16	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00	$84.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000065	EAP	CPT® 92283		Color Vision Examination	BOTH IP/OP	$198.00 	$146.52	$0.00	$160.00	$107.51	$107.51	$54.21	$54.21	$54.51	$41.27	$146.96	$146.96	$152.62	$53.35	$41.26	$34.67	$117.12	$117.12	$0.00	$100.00	$158.40	$160.00	$0.00	$76.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000066	EAP	CPT® 95976		Elec Alys Implt Smpl Cn Npgt Prgrmg	BOTH IP/OP	$554.00 	$409.96	$0.00	$472.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$411.18	$411.18	$427.02	$0.00	$115.45	$0.00	$0.00	$0.00	$0.00	$295.00	$467.28	$472.00	$0.00	$104.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000067	EAP	CPT® 95977		Elec Alys Implt Cplx Cn Npgt Prgrmg	BOTH IP/OP	$554.00 	$409.96	$0.00	$472.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$411.18	$411.18	$427.02	$0.00	$115.45	$0.00	$0.00	$0.00	$0.00	$295.00	$467.28	$472.00	$0.00	$330.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000068	EAP	CPT® 0509T		Electroretinography (erg) W/i&r Pattern (perg)	BOTH IP/OP	$327.00 	$241.98	$0.00	$261.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.70	$242.70	$252.05	$0.00	$68.15	$0.00	$0.00	$0.00	$0.00	$163.50	$258.98	$261.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000069	EAP	CPT® 92273		"Electroretinography (erg), W/i&r; Full Field"	BOTH IP/OP	$606.00 	$448.44	$0.00	$606.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.77	$449.77	$467.10	$0.00	$126.29	$0.00	$0.00	$0.00	$0.00	$606.00	$479.95	$484.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000070	EAP	CPT® 92274		"Electroretinography (erg), W/i&r; Multifocal (mferg)"	BOTH IP/OP	$327.00 	$241.98	$0.00	$261.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.70	$242.70	$252.05	$0.00	$68.15	$0.00	$0.00	$0.00	$0.00	$163.50	$258.98	$261.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000071	EAP	CPT® 95249		Cont Gluc Mntr Pt Prov Eqp	BOTH IP/OP	$155.00 	$114.70	$0.00	$155.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$115.04	$115.04	$119.47	$0.00	$32.30	$0.00	$0.00	$0.00	$0.00	$155.00	$122.76	$124.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000072	EAP	CPT® 95250		Cont Gluc Mntr Phys/qhp Prov Eqp	BOTH IP/OP	$302.00 	$223.48	$0.00	$240.00	$163.99	$163.99	$115.71	$115.71	$116.36	$62.94	$224.14	$224.14	$232.78	$113.80	$62.94	$73.97	$178.63	$178.63	$0.00	$150.00	$237.60	$240.00	$0.00	$157.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000073	EAP	HCPCS G0399		HOME SLEEP STUDY	BOTH IP/OP	$772.00 	$571.28	$0.00	$624.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$572.98	$572.98	$595.06	$0.00	$160.88	$0.00	$0.00	$0.00	$0.00	$390.00	$617.76	$624.00	$0.00	$501.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000074	EAP	CPT® 92201		Ophthalmoscopy Ext Retinal Drawing Uni Or Bil	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000075	EAP	CPT® 92202		Ophthalmoscopy Ext Optic Nerve Drawing Uni Or Bil	BOTH IP/OP	$175.00 	$129.50	$15.15	$140.00	$95.03	$95.03	$54.21	$54.21	$54.51	$36.47	$129.89	$129.89	$134.89	$53.35	$36.47	$34.67	$103.51	$103.51	$55.17	$87.50	$138.60	$140.00	$76.65	$109.85	$76.65	$15.37	$15.15	$15.15	$27.86	$52.54	$0.00	$0.00	$0.00	$0.00
92000080	EAP	CPT® 95800		Slp Stdy Unattended W/hrt Rate/o2 Sat/resp/slp Time	BOTH IP/OP	$772.00 	$571.28	$0.00	$624.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$572.98	$572.98	$595.06	$0.00	$160.88	$0.00	$0.00	$0.00	$0.00	$390.00	$617.76	$624.00	$0.00	$501.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000081	EAP	CPT® 95801		Slp Stdy Unatnd W/min Hrt Rate/o2 Sat/resp Analysis	BOTH IP/OP	$644.00 	$476.56	$0.00	$520.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$477.98	$477.98	$496.40	$0.00	$134.21	$0.00	$0.00	$0.00	$0.00	$325.00	$514.80	$520.00	$0.00	$418.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92000085	EAP	CPT® 99453		Rem Mntr Physiol Param 1st Set Up Pt Educaj Eqp	BOTH IP/OP	$277.00 	$204.98	$0.00	$221.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.27	$138.50	$219.38	$221.60	$161.54	$0.00	$161.54	$43.35	$18.73	$18.73	$44.10	$110.73	$0.00	$0.00	$0.00	$0.00
92000086	EAP	CPT® 99454		Rem Mntr Physiol Param 1st Dev Supply Ea 30 D	BOTH IP/OP	$87.00 	$64.38	$0.00	$69.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.36	$43.50	$68.90	$69.60	$50.51	$0.00	$50.51	$13.62	$62.31	$62.31	$13.85	$34.63	$0.00	$0.00	$0.00	$0.00
92100001	EAP	CPT® 93279		Single Lead Pacemaker Program / Eval In Person	BOTH IP/OP	$204.00 	$150.96	$23.14	$157.24	$111.12	$111.12	$36.26	$36.26	$36.47	$42.52	$151.41	$151.41	$157.24	$35.61	$42.51	$23.14	$120.67	$120.67	$36.36	$82.00	$129.89	$131.20	$50.51	$132.60	$50.51	$53.20	$28.81	$28.81	$26.11	$34.63	$0.00	$0.00	$0.00	$0.00
92100002	EAP	CPT® 93280		Dual Lead Pacemaker Program / Eval In Person	BOTH IP/OP	$204.00 	$150.96	$23.14	$157.24	$129.12	$129.12	$36.26	$36.26	$36.47	$42.52	$151.41	$151.41	$157.24	$35.61	$42.51	$23.14	$120.67	$120.67	$36.36	$82.00	$129.89	$131.20	$50.51	$132.60	$50.51	$62.94	$33.50	$33.50	$26.11	$34.63	$0.00	$0.00	$0.00	$0.00
92100003	EAP	CPT® 93288		Pacemaker Sngl/dual/multi Interrog / Eval In Person	BOTH IP/OP	$204.00 	$150.96	$0.00	$157.24	$82.95	$82.95	$36.26	$36.26	$36.47	$42.52	$151.41	$151.41	$157.24	$35.61	$42.51	$23.14	$120.67	$120.67	$0.00	$82.00	$129.89	$131.20	$0.00	$132.60	$0.00	$41.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100005	EAP	CPT® 93880		US DUPLEX CA	BOTH IP/OP	"$3,057.00 "	"$2,262.18"	$143.36	"$2,268.80"	$448.48	$448.48	$224.08	$224.08	$225.34	$637.16	$541.69	$541.69	$562.53	$220.56	$637.08	$143.36	"$1,808.22"	"$1,808.22"	$233.72	"$1,418.00"	"$2,246.11"	"$2,268.80"	$324.73	"$1,823.90"	$324.73	$179.50	$162.44	$162.44	$451.49	$222.60	$0.00	$0.00	$0.00	$0.00
92100007	EAP	CPT® 93882		US DUPLEX CA	BOTH IP/OP	"$2,599.00 "	"$1,923.26"	$67.89	"$1,928.80"	$285.70	$285.70	$106.02	$106.02	$106.62	$541.70	$356.80	$356.80	$370.53	$104.44	$541.63	$67.89	"$1,537.31"	"$1,537.31"	$112.41	"$1,205.50"	"$1,909.51"	"$1,928.80"	$156.18	"$1,063.40"	$156.18	$119.45	$105.17	$105.17	$383.83	$107.06	$0.00	$0.00	$0.00	$0.00
92100009	EAP	CPT® 93886		Us Transcran Intracran Complete	BOTH IP/OP	"$2,429.00 "	"$1,797.46"	$143.36	"$2,381.60"	$597.96	$597.96	$224.08	$224.08	$225.34	$506.26	$624.57	$624.57	$648.59	$220.56	$506.20	$143.36	"$1,436.75"	"$1,436.75"	$233.72	"$1,346.50"	"$2,132.86"	"$2,154.40"	$324.73	"$2,381.60"	$324.73	$214.18	$228.71	$228.71	$428.73	$222.60	$0.00	$0.00	$0.00	$0.00
92100011	EAP	CPT® 93888		Us Transcran Intracran Limited	BOTH IP/OP	"$2,429.00 "	"$1,797.46"	$0.00	"$2,154.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$425.90	$425.90	$442.28	$0.00	$506.20	$0.00	$0.00	$0.00	$0.00	"$1,346.50"	"$2,132.86"	"$2,154.40"	$0.00	"$1,541.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100013	EAP	Custom 92100013		Ankle/brachial Indices (abi)	BOTH IP/OP	$768.00 	$568.32	$0.00	$614.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$570.01	$570.01	$591.97	$0.00	$160.05	$0.00	$0.00	$0.00	$0.00	$384.00	$608.26	$614.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100014	EAP	CPT® 93922		Abi -non-inv Doppler Test	BOTH IP/OP	"$1,074.00 "	$794.76	$0.00	$868.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.29	$269.29	$279.64	$0.00	$223.82	$0.00	$0.00	$0.00	$0.00	$542.50	$859.32	$868.00	$0.00	$705.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100015	EAP	CPT® 93923		Ext Arterial Pvr Study	BOTH IP/OP	"$1,355.00 "	"$1,002.70"	$86.94	"$1,095.20"	$305.26	$305.26	$135.96	$135.96	$136.73	$282.42	$406.72	$406.72	$422.37	$133.75	$282.38	$86.94	$801.48	$801.48	$138.76	$684.50	"$1,084.25"	"$1,095.20"	$192.78	"$1,033.50"	$192.78	$115.78	$112.01	$112.01	$217.94	$132.15	$0.00	$0.00	$0.00	$0.00
92100017	EAP	CPT® 93925		Us Low Ext Arteries Comp	BOTH IP/OP	"$2,478.00 "	"$1,833.72"	$143.36	"$1,860.00"	$573.70	$573.70	$224.08	$224.08	$225.34	$516.48	$695.99	$695.99	$722.76	$220.56	$516.42	$143.36	"$1,465.74"	"$1,465.74"	$233.72	"$1,162.50"	"$1,841.40"	"$1,860.00"	$324.73	"$1,288.95"	$324.73	$179.51	$218.26	$218.26	$370.14	$222.60	$0.00	$0.00	$0.00	$0.00
92100018	EAP	CPT® 93926		Low Ext Arteries Ltd	BOTH IP/OP	"$1,346.00 "	$996.04	$67.89	"$1,063.40"	$299.80	$299.80	$106.02	$106.02	$106.62	$280.54	$441.03	$441.03	$458.00	$104.44	$280.51	$67.89	$796.16	$796.16	$112.41	$631.50	"$1,000.30"	"$1,010.40"	$156.18	"$1,063.40"	$156.18	$120.13	$127.86	$127.86	$201.07	$107.06	$0.00	$0.00	$0.00	$0.00
92100020	EAP	CPT® 93930		Upper Ext Arteries Comp	BOTH IP/OP	"$2,291.00 "	"$1,695.34"	$143.36	"$1,720.00"	$461.02	$461.02	$224.08	$224.08	$225.34	$477.50	$548.65	$548.65	$569.75	$220.56	$477.44	$143.36	"$1,355.13"	"$1,355.13"	$233.72	"$1,075.00"	"$1,702.80"	"$1,720.00"	$324.73	"$1,188.20"	$324.73	$183.19	$168.92	$168.92	$342.28	$222.60	$0.00	$0.00	$0.00	$0.00
92100022	EAP	CPT® 93931		Upper Ext Arteries Ltd	BOTH IP/OP	"$1,346.00 "	$996.04	$67.89	"$1,063.40"	$284.91	$284.91	$106.02	$106.02	$106.62	$280.54	$367.39	$367.39	$381.52	$104.44	$280.51	$67.89	$796.16	$796.16	$112.41	$631.50	"$1,000.30"	"$1,010.40"	$156.18	"$1,063.40"	$156.18	$121.65	$105.89	$105.89	$201.07	$107.06	$0.00	$0.00	$0.00	$0.00
92100025	EAP	CPT® 93970		Us Ext Veins Doppler Comp	BOTH IP/OP	"$2,823.00 "	"$2,089.02"	$143.36	"$2,133.60"	$436.74	$436.74	$224.08	$224.08	$225.34	$588.38	$544.52	$544.52	$565.47	$220.56	$588.31	$143.36	"$1,669.80"	"$1,669.80"	$233.72	"$1,333.50"	"$2,112.26"	"$2,133.60"	$324.73	"$1,638.65"	$324.73	$199.35	$163.16	$163.16	$424.59	$222.60	$0.00	$0.00	$0.00	$0.00
92100026	EAP	CPT® 93970		Periph.vas. Bil. W/mapping	BOTH IP/OP	"$2,667.00 "	"$1,973.58"	$0.00	"$2,133.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$588.38	$0.00	$0.00	$0.00	$220.56	$588.31	$143.36	"$1,669.80"	"$1,669.80"	$233.72	"$1,333.50"	"$2,112.26"	"$2,133.60"	$324.73	$0.00	$324.73	$199.35	$163.16	$163.16	$424.59	$222.60	$0.00	$0.00	$0.00	$0.00
92100028	EAP	CPT® 93971		Us Ext Veins Doppler Ltd	BOTH IP/OP	"$2,071.00 "	"$1,532.54"	$67.89	"$1,564.80"	$266.11	$266.11	$106.02	$106.02	$106.62	$431.65	$360.55	$360.55	$374.41	$104.44	$431.60	$67.89	"$1,225.00"	"$1,225.00"	$112.41	$978.00	"$1,549.15"	"$1,564.80"	$156.18	"$1,346.15"	$156.18	$132.53	$101.21	$101.21	$311.40	$107.06	$0.00	$0.00	$0.00	$0.00
92100029	EAP	CPT® 93971		Periph.vas. Uni. & Ext Non-vas	BOTH IP/OP	"$1,604.00 "	"$1,186.96"	$67.89	"$1,564.80"	$266.11	$266.11	$106.02	$106.02	$106.62	$334.31	$360.55	$360.55	$374.41	$104.44	$334.27	$67.89	$948.77	$948.77	$112.41	$978.00	"$1,549.15"	"$1,564.80"	$156.18	"$1,346.15"	$156.18	$132.53	$101.21	$101.21	$311.40	$107.06	$0.00	$0.00	$0.00	$0.00
92100030	EAP	CPT® 93971		Periph.vas. Uni. W/mapping	BOTH IP/OP	"$1,604.00 "	"$1,186.96"	$67.89	"$1,564.80"	$266.11	$266.11	$106.02	$106.02	$106.62	$334.31	$360.55	$360.55	$374.41	$104.44	$334.27	$67.89	$948.77	$948.77	$112.41	$978.00	"$1,549.15"	"$1,564.80"	$156.18	"$1,346.15"	$156.18	$132.53	$101.21	$101.21	$311.40	$107.06	$0.00	$0.00	$0.00	$0.00
92100032	EAP	CPT® 93975		Abd/retroper Doppler Comp Us	BOTH IP/OP	"$3,461.00 "	"$2,561.14"	$143.36	"$2,660.80"	$621.46	$621.46	$224.08	$224.08	$225.34	$721.36	$711.04	$711.04	$738.39	$220.56	$721.27	$143.36	"$2,047.18"	"$2,047.18"	$233.72	"$1,663.00"	"$2,634.19"	"$2,660.80"	$324.73	"$2,249.65"	$324.73	$268.31	$223.31	$223.31	$529.50	$222.60	$0.00	$0.00	$0.00	$0.00
92100033	EAP	CPT® 93976		Abd/retroper Doppler Ltd Us	BOTH IP/OP	"$1,882.00 "	"$1,392.68"	$67.89	"$1,447.20"	$334.96	$334.96	$106.02	$106.02	$106.62	$392.26	$390.03	$390.03	$405.03	$104.44	$392.21	$67.89	"$1,113.20"	"$1,113.20"	$112.41	$904.50	"$1,432.73"	"$1,447.20"	$156.18	"$1,223.30"	$156.18	$179.32	$126.42	$126.42	$287.99	$107.06	$0.00	$0.00	$0.00	$0.00
92100034	EAP	Custom 92100034		Sngl Lead Pm Program Eval	BOTH IP/OP	$204.00 	$150.96	$0.00	$163.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.41	$151.41	$157.24	$0.00	$42.51	$0.00	$0.00	$0.00	$0.00	$102.00	$161.57	$163.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100035	EAP	Custom 92100035		Sngl Lead Icd Program Eval	BOTH IP/OP	$262.00 	$193.88	$0.00	$211.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.46	$194.46	$201.95	$0.00	$54.60	$0.00	$0.00	$0.00	$0.00	$132.00	$209.09	$211.20	$0.00	$170.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100036	EAP	CPT® 93286		Pacemaker Sngl/dual/multi  Peri-procedure Eval In Person	BOTH IP/OP	$234.00 	$173.16	$0.00	$180.37	$60.27	$60.27	$0.00	$0.00	$0.00	$48.77	$173.67	$173.67	$180.37	$0.00	$48.77	$0.00	$138.41	$138.41	$0.00	$94.00	$148.90	$150.40	$0.00	$92.95	$0.00	$29.42	$25.21	$25.21	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
92100037	EAP	CPT® 93287		Icd Sngl/dual/multi Peri-procedure Eval In Person	BOTH IP/OP	$311.00 	$230.14	$0.00	$239.72	$81.39	$81.39	$0.00	$0.00	$0.00	$64.82	$230.82	$230.82	$239.72	$0.00	$64.81	$0.00	$183.96	$183.96	$0.00	$125.00	$198.00	$200.00	$0.00	$97.50	$0.00	$34.26	$25.21	$25.21	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
92100038	EAP	CPT® 93296		Pacemaker/icd Interrog / Eval Remote Up To 90 Days	BOTH IP/OP	$253.00 	$187.22	$0.00	$195.01	$57.92	$57.92	$36.26	$36.26	$36.47	$52.73	$187.78	$187.78	$195.01	$35.61	$52.73	$23.14	$149.65	$149.65	$36.36	$102.00	$161.57	$163.20	$50.51	$189.80	$50.51	$0.00	$25.93	$25.93	$32.48	$34.63	$0.00	$0.00	$0.00	$0.00
92100039	EAP	Custom 92100039		Mult Lead Pm Program Eval	BOTH IP/OP	$163.00 	$120.62	$0.00	$131.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$0.00	$0.00	$0.00	$82.00	$129.89	$131.20	$0.00	$105.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100040	EAP	CPT® 93284		Multi-lead Icd  Program / Eval In Person	BOTH IP/OP	$328.00 	$242.72	$23.14	$252.82	$200.32	$200.32	$36.26	$36.26	$36.47	$68.36	$243.44	$243.44	$252.82	$35.61	$68.36	$23.14	$194.01	$194.01	$36.36	$132.00	$209.09	$211.20	$50.51	$213.20	$50.51	$96.97	$36.38	$36.38	$42.03	$34.63	$0.00	$0.00	$0.00	$0.00
92100041	EAP	CPT® 93291		Interrog / Eval Scrms Or Loop Recorder In Clinic	BOTH IP/OP	$203.00 	$150.22	$15.37	$163.20	$81.39	$81.39	$24.06	$24.06	$24.19	$42.31	$150.67	$150.67	$156.47	$23.64	$42.31	$15.37	$120.07	$120.07	$23.06	$102.00	$161.57	$163.20	$32.04	$131.95	$32.04	$39.45	$24.85	$24.85	$32.48	$21.96	$0.00	$0.00	$0.00	$0.00
92100043	EAP	Custom 92100043		Icd Interrogation	BOTH IP/OP	$262.00 	$193.88	$0.00	$211.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.46	$194.46	$201.95	$0.00	$54.60	$0.00	$0.00	$0.00	$0.00	$132.00	$209.09	$211.20	$0.00	$170.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100044	EAP	Custom 92100044		Dual Lead Pm Program Eval	BOTH IP/OP	$204.00 	$150.96	$0.00	$163.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.41	$151.41	$157.24	$0.00	$42.51	$0.00	$0.00	$0.00	$0.00	$102.00	$161.57	$163.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100045	EAP	Custom 92100045		Dual Lead Icd Program Eval	BOTH IP/OP	$264.00 	$195.36	$0.00	$211.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.94	$195.94	$203.49	$0.00	$55.02	$0.00	$0.00	$0.00	$0.00	$132.00	$209.09	$211.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100050	EAP	CPT® 93978		Aorta Duplex	BOTH IP/OP	"$1,539.00 "	"$1,138.86"	$143.36	"$1,348.00"	$422.69	$422.69	$224.08	$224.08	$225.34	$320.77	$510.54	$510.54	$530.17	$220.56	$320.73	$143.36	$910.32	$910.32	$233.72	$842.50	"$1,334.52"	"$1,348.00"	$324.73	"$1,233.70"	$324.73	$187.25	$151.27	$151.27	$268.25	$222.60	$0.00	$0.00	$0.00	$0.00
92100052	EAP	CPT® 93880		Carotid Duplex	BOTH IP/OP	"$2,558.00 "	"$1,892.92"	$143.36	"$2,268.80"	$448.48	$448.48	$224.08	$224.08	$225.34	$533.15	$541.69	$541.69	$562.53	$220.56	$533.09	$143.36	"$1,513.06"	"$1,513.06"	$233.72	"$1,418.00"	"$2,246.11"	"$2,268.80"	$324.73	"$1,823.90"	$324.73	$179.50	$162.44	$162.44	$451.49	$222.60	$0.00	$0.00	$0.00	$0.00
92100063	EAP	CPT® 93978		Vascular Study Ult	BOTH IP/OP	"$1,753.00 "	"$1,297.22"	$143.36	"$1,348.00"	$422.69	$422.69	$224.08	$224.08	$225.34	$365.37	$510.54	$510.54	$530.17	$220.56	$365.33	$143.36	"$1,036.90"	"$1,036.90"	$233.72	$842.50	"$1,334.52"	"$1,348.00"	$324.73	"$1,233.70"	$324.73	$187.25	$151.27	$151.27	$268.25	$222.60	$0.00	$0.00	$0.00	$0.00
92100065	EAP	CPT® 93979		Vascular Study Limited Ult	BOTH IP/OP	$965.00 	$714.10	$0.00	$845.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.68	$354.68	$368.32	$0.00	$201.11	$0.00	$0.00	$0.00	$0.00	$528.50	$837.14	$845.60	$0.00	$440.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100072	EAP	CPT® 93281		Multi-lead Pacemaker Program / Eval In Person	BOTH IP/OP	$204.00 	$150.96	$23.14	$157.24	$151.80	$151.80	$36.26	$36.26	$36.47	$42.52	$151.41	$151.41	$157.24	$35.61	$42.51	$23.14	$120.67	$120.67	$36.36	$82.00	$129.89	$131.20	$50.51	$132.60	$50.51	$73.61	$34.22	$34.22	$26.11	$34.63	$0.00	$0.00	$0.00	$0.00
92100080	EAP	CPT® 93886		Transcran Doppler Comp Us	BOTH IP/OP	"$2,903.00 "	"$2,148.22"	$143.36	"$2,381.60"	$597.96	$597.96	$224.08	$224.08	$225.34	$605.06	$624.57	$624.57	$648.59	$220.56	$604.99	$143.36	"$1,717.12"	"$1,717.12"	$233.72	"$1,346.50"	"$2,132.86"	"$2,154.40"	$324.73	"$2,381.60"	$324.73	$214.18	$228.71	$228.71	$428.73	$222.60	$0.00	$0.00	$0.00	$0.00
92100081	EAP	CPT® 93888		Transcran Doppler Ltd Us	BOTH IP/OP	"$2,903.00 "	"$2,148.22"	$0.00	"$2,154.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$425.90	$425.90	$442.28	$0.00	$604.99	$0.00	$0.00	$0.00	$0.00	"$1,346.50"	"$2,132.86"	"$2,154.40"	$0.00	"$1,541.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100082	EAP	CPT® 93890		Tcd. Vasoreactivity Study	BOTH IP/OP	"$1,989.00 "	"$1,471.86"	$0.00	"$1,476.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.52	$526.52	$546.77	$0.00	$414.51	$0.00	$0.00	$0.00	$0.00	$922.50	"$1,461.24"	"$1,476.00"	$0.00	"$1,292.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100083	EAP	CPT® 93892		Tcd. Emboli Detct W/o Inj	BOTH IP/OP	$967.00 	$715.58	$0.00	$717.60	$0.00	$0.00	$0.00	$0.00	$106.62	$201.55	$571.93	$571.93	$593.92	$104.44	$201.52	$67.89	$571.98	$571.98	$112.41	$448.50	$710.42	$717.60	$156.18	$628.55	$156.18	$256.10	$255.72	$255.72	$142.80	$107.06	$0.00	$0.00	$0.00	$0.00
92100084	EAP	CPT® 93893		Tcd. Emboli Detect W/inj	BOTH IP/OP	$967.00 	$715.58	$0.00	$717.60	$378.79	$378.79	$106.02	$106.02	$106.62	$201.55	$569.21	$569.21	$591.11	$104.44	$201.52	$67.89	$571.98	$571.98	$112.41	$448.50	$710.42	$717.60	$156.18	$628.55	$156.18	$0.00	$302.18	$302.18	$142.80	$107.06	$0.00	$0.00	$0.00	$0.00
92100086	EAP	CPT® 93922		Abi -non-inv Doppler Test	BOTH IP/OP	"$1,085.00 "	$802.90	$0.00	$868.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.29	$269.29	$279.64	$0.00	$226.11	$0.00	$0.00	$0.00	$0.00	$542.50	$859.32	$868.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100088	EAP	CPT® 93922		Limited Bilateral Pvr Exam	BOTH IP/OP	"$1,085.00 "	$802.90	$0.00	$868.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.29	$269.29	$279.64	$0.00	$226.11	$0.00	$0.00	$0.00	$0.00	$542.50	$859.32	$868.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100089	EAP	CPT® 93980		Penile Vascular Study	BOTH IP/OP	"$1,392.00 "	"$1,030.08"	$0.00	"$1,219.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.01	$295.01	$306.35	$0.00	$290.09	$0.00	$0.00	$0.00	$0.00	$762.00	"$1,207.01"	"$1,219.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100090	EAP	CPT® 93924		Vas Lab Pvr Lower Ext With Exercise	BOTH IP/OP	"$1,188.00 "	$879.12	$127.08	$960.00	$380.40	$380.40	$257.73	$257.73	$259.18	$247.61	$506.06	$506.06	$525.53	$253.45	$247.58	$164.75	$702.70	$702.70	$138.76	$600.00	$950.40	$960.00	$192.78	$772.20	$192.78	$127.08	$141.19	$141.19	$191.04	$132.15	$0.00	$0.00	$0.00	$0.00
92100091	EAP	CPT® 93985		Vessel Mapping For Hd Access Bilateral	BOTH IP/OP	$580.00 	$429.20	$88.67	"$1,133.60"	$580.00	$580.00	$224.08	$224.08	$225.34	$120.89	$430.48	$430.48	$447.06	$220.56	$120.87	$143.36	$343.07	$343.07	$233.72	$278.50	$441.14	$445.60	$324.73	"$1,133.60"	$324.73	$256.89	$231.59	$231.59	$88.67	$222.60	$0.00	$0.00	$0.00	$0.00
92100092	EAP	CPT® 93986		Vessel Mapping For Hd Access Unilateral	BOTH IP/OP	$279.00 	$206.46	$42.67	$279.00	$279.00	$279.00	$106.02	$106.02	$106.62	$58.15	$207.07	$207.07	$215.05	$104.44	$58.14	$67.89	$165.03	$165.03	$112.41	$134.00	$212.26	$214.40	$156.18	$181.35	$156.18	$130.33	$131.82	$131.82	$42.67	$107.06	$0.00	$0.00	$0.00	$0.00
92200001	EAP	CPT® 95860		Electromyogram - 1 Extermity	BOTH IP/OP	$440.00 	$325.60	$0.00	$345.60	$0.00	$0.00	$0.00	$0.00	$0.00	$91.71	$326.57	$326.57	$339.15	$107.30	$91.70	$69.74	$260.26	$260.26	$109.35	$216.00	$342.14	$345.60	$151.93	$286.00	$151.93	$70.97	$68.79	$68.79	$68.77	$104.14	$0.00	$0.00	$0.00	$0.00
92200002	EAP	CPT® 95861		Electromyorgam - 2 Extermities	BOTH IP/OP	$421.00 	$311.54	$0.00	$336.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.47	$312.47	$324.51	$0.00	$87.74	$0.00	$0.00	$0.00	$0.00	$210.50	$333.43	$336.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92200003	EAP	CPT® 95869		Emg Limited (thoracic Psp)	BOTH IP/OP	$186.00 	$137.64	$0.00	$146.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.05	$138.05	$143.37	$0.00	$38.76	$0.00	$0.00	$0.00	$0.00	$91.50	$144.94	$146.40	$0.00	$120.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92200004	EAP	CPT® 95870		Emg Limited Ext	BOTH IP/OP	$317.00 	$234.58	$0.00	$248.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.28	$235.28	$244.34	$0.00	$66.06	$0.00	$0.00	$0.00	$0.00	$155.50	$246.31	$248.80	$0.00	$206.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92200010	EAP	CPT® 95937		Rns	BOTH IP/OP	$192.00 	$142.08	$27.86	$175.00	$104.26	$104.26	$135.96	$135.96	$136.73	$40.02	$142.50	$142.50	$147.99	$133.75	$40.01	$86.94	$113.57	$113.57	$138.76	$87.50	$138.60	$140.00	$175.00	$124.80	$175.00	$50.14	$60.15	$60.15	$27.86	$132.15	$0.00	$0.00	$0.00	$0.00
92200011	EAP	CPT® 95907		Nvr Cndj Tst 1-2 Studies	BOTH IP/OP	$706.00 	$522.44	$0.00	$544.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$523.99	$523.99	$544.18	$0.00	$147.13	$0.00	$0.00	$0.00	$138.76	$339.50	$537.77	$543.20	$192.78	$458.90	$192.78	$90.38	$42.14	$42.14	$108.10	$132.15	$0.00	$0.00	$0.00	$0.00
92200012	EAP	CPT® 95908		Nrv Cndj Tst 3-4 Studies	BOTH IP/OP	"$1,040.00 "	$769.60	$54.75	"$1,702.35"	$564.72	$564.72	$257.73	$257.73	$259.18	$216.76	$771.89	$771.89	$801.63	$253.45	$216.74	$164.75	$615.16	$615.16	$253.05	$500.50	$792.79	$800.80	$351.58	"$1,702.35"	$351.58	$111.50	$54.75	$54.75	$159.36	$241.00	$0.00	$0.00	$0.00	$0.00
92200013	EAP	CPT® 95909		Nrv Cndj Tst 5-6 Studies	BOTH IP/OP	"$1,374.00 "	"$1,016.76"	$65.55	"$2,553.20"	$746.08	$746.08	$257.73	$257.73	$259.18	$286.38	"$1,019.78"	"$1,019.78"	"$1,059.08"	$253.45	$286.34	$164.75	$812.72	$812.72	$253.05	$661.00	"$1,047.02"	"$1,057.60"	$351.58	"$2,553.20"	$351.58	$133.60	$65.55	$65.55	$210.46	$241.00	$0.00	$0.00	$0.00	$0.00
92200014	EAP	CPT® 95910		Nrv Cndj Test 7-8 Studies	BOTH IP/OP	"$1,711.00 "	"$1,266.14"	$84.28	"$3,403.40"	$929.07	$929.07	$257.73	$257.73	$259.18	$356.62	"$1,269.90"	"$1,269.90"	"$1,318.84"	$253.45	$356.57	$164.75	"$1,012.06"	"$1,012.06"	$253.05	$823.00	"$1,303.63"	"$1,316.80"	$351.58	"$3,403.40"	$351.58	$175.83	$84.28	$84.28	$262.04	$241.00	$0.00	$0.00	$0.00	$0.00
92200015	EAP	CPT® 95911		Nrv Cndj Test 9-10 Studies	BOTH IP/OP	"$2,045.00 "	"$1,513.30"	$96.53	"$4,253.60"	"$1,110.44"	"$1,110.44"	$475.36	$475.36	$478.04	$426.23	"$1,517.80"	"$1,517.80"	"$1,576.29"	$467.50	$426.18	$303.87	"$1,209.62"	"$1,209.62"	$487.04	$984.00	"$1,558.66"	"$1,574.40"	$676.67	"$4,253.60"	$676.67	$212.84	$96.53	$96.53	$313.31	$463.84	$0.00	$0.00	$0.00	$0.00
92200016	EAP	CPT® 95912		Nvr Cndj Tst 11-12 Studies	BOTH IP/OP	"$2,380.00 "	"$1,761.20"	$104.09	"$1,834.50"	"$1,292.34"	"$1,292.34"	$475.36	$475.36	$478.04	$496.05	"$1,766.44"	"$1,766.44"	"$1,834.50"	$467.50	$495.99	$303.87	"$1,407.77"	"$1,407.77"	$487.04	"$1,145.00"	"$1,813.68"	"$1,832.00"	$676.67	"$1,547.00"	$676.67	$249.19	$104.09	$104.09	$364.57	$463.84	$0.00	$0.00	$0.00	$0.00
92200017	EAP	CPT® 95913		Nrv Cndj Tst 13- Or More Studies	BOTH IP/OP	"$2,715.00 "	"$2,009.10"	$115.61	"$3,462.55"	"$1,474.25"	"$1,474.25"	$475.36	$475.36	$478.04	$565.87	"$2,015.07"	"$2,015.07"	"$2,092.72"	$467.50	$565.81	$303.87	"$1,605.92"	"$1,605.92"	$487.04	"$1,306.00"	"$2,068.70"	"$2,089.60"	$676.67	"$3,462.55"	$676.67	$288.80	$115.61	$115.61	$415.83	$463.84	$0.00	$0.00	$0.00	$0.00
92200018	EAP	CPT® 95872		Needle Emg W/1 Fiber Electrode Quan Meas Jitter	BOTH IP/OP	$647.00 	$478.78	$0.00	$508.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$480.20	$480.20	$498.71	$0.00	$134.83	$0.00	$0.00	$0.00	$138.76	$318.00	$503.71	$508.80	$192.78	$370.50	$192.78	$101.87	$47.18	$47.18	$101.25	$132.15	$0.00	$0.00	$0.00	$0.00
92200040	EAP	CPT® 95933		Orbicularis Oculi Reflex	BOTH IP/OP	$461.00 	$341.14	$0.00	$355.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.15	$342.15	$355.34	$0.00	$96.07	$0.00	$0.00	$0.00	$55.17	$210.50	$333.43	$336.80	$76.65	$167.70	$76.65	$65.19	$51.50	$51.50	$67.02	$52.54	$0.00	$0.00	$0.00	$0.00
92200041	EAP	CPT® 95925		Short-latency Somatosens Ep Std Upr Limbs	BOTH IP/OP	"$1,372.00 "	"$1,015.28"	$0.00	"$1,097.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,018.30"	"$1,018.30"	"$1,057.54"	$0.00	$285.92	$0.00	$0.00	$0.00	$0.00	$686.00	"$1,086.62"	"$1,097.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92200042	EAP	CPT® 95926		Short-latency Somatosens Ep Std Lwr Limbs	BOTH IP/OP	"$1,372.00 "	"$1,015.28"	$0.00	"$1,097.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,018.30"	"$1,018.30"	"$1,057.54"	$0.00	$285.92	$0.00	$0.00	$0.00	$0.00	$686.00	"$1,086.62"	"$1,097.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92200043	EAP	CPT® 95867		Emg Cranial Nerve Unilateral	BOTH IP/OP	$625.00 	$462.50	$0.00	$491.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$481.75	$0.00	$130.25	$0.00	$0.00	$0.00	$138.76	$307.00	$486.29	$491.20	$192.78	$375.70	$192.78	$68.25	$65.91	$65.91	$97.75	$132.15	$0.00	$0.00	$0.00	$0.00
92200044	EAP	CPT® 95868		Emg Cranial Nerve Bilateral	BOTH IP/OP	$836.00 	$618.64	$0.00	$668.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$620.48	$620.48	$644.39	$0.00	$174.22	$0.00	$0.00	$0.00	$0.00	$418.00	$662.11	$668.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92400001	EAP	CPT® 95004		"Perc. Allergy Test, Immed. Rea"	BOTH IP/OP	$999.00 	$739.26	$0.00	$900.99	$542.46	$542.46	$895.94	$895.94	$900.99	$208.22	$741.46	$741.46	$770.03	$881.57	$208.19	$573.02	$590.91	$590.91	$0.00	$504.50	$799.13	$807.20	$0.00	$45.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92400002	EAP	CPT® 95004		"Allergy Testing, Extracts"	BOTH IP/OP	$941.00 	$696.34	$0.00	$900.99	$510.96	$510.96	$895.94	$895.94	$900.99	$196.13	$698.41	$698.41	$725.32	$881.57	$196.10	$573.02	$556.60	$556.60	$0.00	$475.00	$752.40	$760.00	$0.00	$45.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92400011	EAP	CPT® 95028		Intradermal Test #	BOTH IP/OP	$163.00 	$120.62	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.98	$120.98	$125.64	$0.00	$33.97	$0.00	$0.00	$0.00	$33.53	$82.50	$130.68	$132.00	$46.58	$105.95	$46.58	$8.93	$12.97	$12.97	$26.27	$31.93	$0.00	$0.00	$0.00	$0.00
92400012	EAP	CPT® 95044		Patch Tests - Each	BOTH IP/OP	$904.00 	$668.96	$5.40	$913.00	$490.87	$490.87	$895.94	$895.94	$900.99	$188.42	$670.95	$670.95	$696.80	$881.57	$188.39	$573.02	$534.72	$534.72	$911.62	$456.50	$723.10	$730.40	$913.00	$587.60	$913.00	$7.85	$5.40	$5.40	$145.35	$868.21	$0.00	$0.00	$0.00	$0.00
92400030	EAP	CPT® 95180		Rapid Desensitization	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$285.75	$285.75	$296.76	$0.00	$80.23	$0.00	$0.00	$0.00	$0.00	$192.50	$304.92	$308.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92400034	EAP	CPT® 95076		Ingest Challenge Ini 120 Min	BOTH IP/OP	$695.00 	$514.30	$0.00	$561.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$515.83	$515.83	$535.71	$0.00	$144.84	$0.00	$0.00	$0.00	$0.00	$351.00	$555.98	$561.60	$0.00	$451.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92900002	EAP	CPT® 93293		"Transtelephonic Rhythm Strip Pm Eval / Sngl, Dual, Multi-lead"	BOTH IP/OP	$264.00 	$195.36	$0.00	$211.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.94	$195.94	$203.49	$0.00	$55.02	$0.00	$0.00	$0.00	$0.00	$132.00	$209.09	$211.20	$0.00	$138.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94000002	EAP	CPT® 95115		Allergy Injection	BOTH IP/OP	$40.00 	$29.60	$0.00	$39.19	$21.72	$21.72	$38.97	$38.97	$39.19	$8.34	$29.69	$29.69	$30.83	$38.34	$8.34	$24.92	$23.66	$23.66	$0.00	$20.00	$31.68	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94000003	EAP	CPT® 95117		"Allergy Injections, 2 Or More"	BOTH IP/OP	$67.00 	$49.58	$0.00	$51.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.73	$49.73	$51.64	$0.00	$13.96	$0.00	$0.00	$0.00	$0.00	$31.50	$49.90	$50.40	$0.00	$36.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94000005	EAP	CPT® 96900		"Actinotherapy, Uvl"	BOTH IP/OP	$215.00 	$159.10	$0.00	$172.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.81	$0.00	$0.00	$0.00	$32.43	$44.81	$21.08	$127.17	$127.17	$0.00	$107.50	$170.28	$172.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94000006	EAP	CPT® 96910		"Photochemotherapy,uvb"	BOTH IP/OP	$126.00 	$93.24	$20.22	$118.14	$68.42	$68.42	$54.21	$54.21	$54.51	$26.26	$93.52	$93.52	$97.12	$53.35	$26.26	$34.67	$74.53	$74.53	$55.17	$63.50	$100.58	$101.60	$76.65	$80.60	$76.65	$22.14	$118.14	$118.14	$20.22	$52.54	$0.00	$0.00	$0.00	$0.00
94000007	EAP	CPT® 96912		"Photochemotherapy, Puva"	BOTH IP/OP	$204.00 	$150.96	$0.00	$164.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.41	$151.41	$157.24	$0.00	$42.51	$0.00	$0.00	$0.00	$0.00	$103.00	$163.15	$164.80	$0.00	$78.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94000021	EAP	CPT® 99195		Phlebotomy	BOTH IP/OP	$189.00 	$139.86	$17.15	$151.93	$102.63	$102.63	$109.81	$109.81	$110.43	$39.39	$140.28	$140.28	$145.68	$107.30	$39.39	$69.74	$111.79	$111.79	$109.35	$94.00	$148.90	$150.40	$151.93	$122.85	$151.93	$17.15	$102.65	$102.65	$29.93	$104.14	$0.00	$0.00	$0.00	$0.00
94000022	EAP	CPT® 99195		Therapeutic Phlebotomy	BOTH IP/OP	$189.00 	$139.86	$17.15	$151.93	$102.63	$102.63	$109.81	$109.81	$110.43	$39.39	$140.28	$140.28	$145.68	$107.30	$39.39	$69.74	$111.79	$111.79	$109.35	$94.00	$148.90	$150.40	$151.93	$122.85	$151.93	$17.15	$102.65	$102.65	$29.93	$104.14	$0.00	$0.00	$0.00	$0.00
94000031	EAP	CPT® 95907		Nerve conductionstudies 1-2 studie	BOTH IP/OP	$706.00 	$522.44	$0.00	$544.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$523.99	$523.99	$544.18	$0.00	$147.13	$0.00	$0.00	$0.00	$138.76	$339.50	$537.77	$543.20	$192.78	$458.90	$192.78	$90.38	$42.14	$42.14	$108.10	$132.15	$0.00	$0.00	$0.00	$0.00
94200001	EAP	CPT® 97802		"Mnt - Individual, Initial Per 15 Min"	BOTH IP/OP	$98.00 	$72.52	$15.18	$127.40	$53.21	$53.21	$34.61	$34.61	$33.05	$20.43	$72.74	$72.74	$75.54	$34.61	$20.42	$22.50	$57.97	$57.97	$29.55	$48.50	$76.82	$77.60	$34.61	$127.40	$34.61	$15.18	$34.61	$34.61	$15.44	$34.61	$0.00	$0.00	$0.00	$0.00
94200002	EAP	CPT® 97803		"Mnt - Individual, Follow-up Per 15 Min"	BOTH IP/OP	$85.00 	$62.90	$13.15	$67.20	$46.16	$46.16	$29.21	$29.21	$28.17	$17.72	$63.09	$63.09	$65.52	$29.21	$17.71	$18.99	$50.28	$50.28	$25.06	$42.00	$66.53	$67.20	$29.21	$58.50	$29.21	$13.15	$29.21	$29.21	$13.37	$29.21	$0.00	$0.00	$0.00	$0.00
94200003	EAP	CPT® 97804		"Mnt - Group, Initial Or Follow-up Per 30 Min"	BOTH IP/OP	$46.00 	$34.04	$7.20	$55.25	$24.98	$24.98	$16.23	$16.23	$15.66	$9.59	$34.14	$34.14	$35.46	$16.23	$9.59	$10.55	$27.21	$27.21	$13.82	$23.00	$36.43	$36.80	$16.23	$55.25	$16.23	$7.20	$16.23	$16.23	$7.32	$16.23	$0.00	$0.00	$0.00	$0.00
94200004	EAP	HCPCS G0108		"Dsmt - Individual, Initial Or Follow-up Per 30 Min"	BOTH IP/OP	$155.00 	$114.70	$24.10	$123.20	$84.17	$84.17	$56.97	$56.97	$55.96	$32.31	$115.04	$115.04	$119.47	$56.97	$32.30	$37.03	$91.68	$91.68	$57.08	$77.00	$121.97	$123.20	$56.97	$114.40	$56.97	$24.10	$56.97	$56.97	$24.52	$56.97	$0.00	$0.00	$0.00	$0.00
94200005	EAP	HCPCS G0109		"Dsmt - Group, Initial Or Follow-up Per 30 Min"	BOTH IP/OP	$118.00 	$87.32	$10.31	$93.60	$64.07	$64.07	$15.86	$15.86	$15.66	$24.59	$87.58	$87.58	$90.95	$15.86	$24.59	$10.31	$69.80	$69.80	$15.50	$58.50	$92.66	$93.60	$15.86	$76.70	$15.86	$18.31	$15.86	$15.86	$18.63	$15.86	$0.00	$0.00	$0.00	$0.00
94200012	EAP	HCPCS G0270		Mnt - Individual (beyond Initial 3hrs Or Beyond 2hrs In Subq Yrs) - Per 15 Min	BOTH IP/OP	$108.00 	$79.92	$0.00	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.16	$80.16	$83.25	$0.00	$22.51	$0.00	$0.00	$0.00	$25.06	$53.50	$84.74	$85.60	$29.21	$65.00	$29.21	$16.75	$29.21	$29.21	$17.03	$29.21	$0.00	$0.00	$0.00	$0.00
94200013	EAP	HCPCS G0271		Mnt - Group (beyond Initial 3hrs Or Beyond 2hrs In Sebq Yrs) - Per 30 Min	BOTH IP/OP	$59.00 	$43.66	$0.00	$47.20	$0.00	$0.00	$0.00	$0.00	$0.00	$12.30	$43.79	$43.79	$45.48	$16.23	$12.30	$10.55	$34.90	$34.90	$13.82	$29.50	$46.73	$47.20	$16.23	$38.35	$16.23	$9.23	$16.23	$16.23	$0.00	$16.23	$0.00	$0.00	$0.00	$0.00
94200014	EAP	CPT® 99412		Childbirth Education Class	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$19.01	$19.01	$0.00	$0.00	$12.84	$7.29	$25.98	$25.98	$26.98	$0.00	$7.29	$0.00	$20.70	$20.70	$0.00	$17.50	$27.72	$28.00	$21.00	$22.75	$21.00	$5.48	$0.00	$0.00	$5.57	$0.00	$0.00	$0.00	$0.00	$0.00
94200015	EAP	CPT® 99078		Centering Preg Group Session	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.00	$68.42	$68.42	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$97.12	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$62.50	$99.00	$100.00	$0.00	$81.90	$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
94300001	EAP	CPT® 93797		Cardiac Rehab - Regular	BOTH IP/OP	$143.00 	$105.82	$0.00	$114.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.13	$106.13	$110.22	$0.00	$29.80	$0.00	$0.00	$0.00	$0.00	$71.50	$113.26	$114.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94600011	EAP	Custom 94600011		Kinair Iii W/o Scale	BOTH IP/OP	$178.00 	$131.72	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.11	$132.11	$137.20	$0.00	$37.10	$0.00	$0.00	$0.00	$0.00	$89.00	$140.98	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99900120	EAP	HCPCS G1004		"Cdsm National Decision Support Company, Medicare Auc Program"	BOTH IP/OP	$0.01 	$0.01	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.00	$0.00	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99900132	EAP	Custom 99900132		"Trauma Protocol, Ect"	BOTH IP/OP	"$27,445.00 "	"$20,309.30"	$0.00	"$20,223.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,719.54"	$0.00	$0.00	$0.00	$0.00	"$12,639.50"	"$20,020.97"	"$20,223.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99900529	EAP	Custom 99900529		"Head/neck Cta W&w/o Dye,nct"	BOTH IP/OP	"$13,698.00 "	"$10,136.52"	$0.00	"$9,966.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,854.66"	$0.00	"$1,106.00"	"$1,106.00"	$0.00	"$6,229.00"	"$9,866.74"	"$9,966.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0159T	EAP	CPT® 0159T		Computer Aided Breast Mri	BOTH IP/OP	$118.00 	$87.32	$0.00	$93.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C9803	EAP	HCPCS C9803		Hopd Covid-19 Spec Collect	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.06	$28.50	$45.14	$45.60	$32.04	$0.00	$32.04	$8.92	$0.00	$0.00	$9.07	$21.96	$0.00	$0.00	$0.00	$0.00
CMPR7501	EAP			Colonoscopy Procedure	BOTH IP/OP	"$1,413.00 "	"$1,045.62"	$0.00	"$1,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$294.47	$0.00	$0.00	$0.00	$0.00	$706.50	"$1,119.10"	"$1,130.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CMPR7502	EAP			Sigmoidoscopy Procedure	BOTH IP/OP	$761.00 	$563.14	$0.00	$608.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.59	$0.00	$0.00	$0.00	$0.00	$380.50	$602.71	$608.80	$0.00	$494.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CMPR7504	EAP			Dilation Of Esophagus Procedure	BOTH IP/OP	"$3,267.00 "	"$2,417.58"	$0.00	"$2,613.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$680.84	$0.00	$0.00	$0.00	$0.00	"$1,633.50"	"$2,587.46"	"$2,613.60"	$0.00	"$2,123.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CMPR7505	EAP			Endoscopic Cannulation Procedure	BOTH IP/OP	$445.00 	$329.30	$0.00	$356.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.74	$0.00	$0.00	$0.00	$0.00	$222.50	$352.44	$356.00	$0.00	$289.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G0008	EAP	HCPCS G0008		ADMIN INFLUENZA VIRUS VAC	BOTH IP/OP	$73.00 	$54.02	$0.00	$73.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.82	$0.00	$0.00	$73.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G0009	EAP	HCPCS G0009		ADMIN PNEUMOCOCCAL VACCINE	BOTH IP/OP	$73.00 	$54.02	$0.00	$57.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G0010	EAP	HCPCS G0010		ADMIN HEPATITIS B VACCINE	BOTH IP/OP	$73.00 	$54.02	$0.00	$57.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G0105	EAP	HCPCS G0105		COLORECTAL SCRN; HI RISK IND	BOTH IP/OP	"$1,187.00 "	$878.38	$0.00	"$1,187.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,187.00"	$940.10	$949.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G0121	EAP	HCPCS G0121		COLON CA SCRN NOT HI RSK IND	BOTH IP/OP	$985.00 	$728.90	$0.00	"$1,189.00"	$985.00	$985.00	$772.82	$772.82	$777.17	$0.00	$985.00	$985.00	$985.00	$760.65	$205.27	$494.42	$985.00	$985.00	$766.13	"$1,189.00"	$941.69	$951.20	"$1,064.43"	$0.00	"$1,064.43"	$186.08	$193.26	$193.26	$189.29	$729.64	$0.00	$0.00	$0.00	$0.00
G0297	EAP	HCPCS G0297		Ldct for lung ca screen	BOTH IP/OP	$662.00 	$489.88	$0.00	$529.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.04	$331.00	$524.30	$529.60	$111.21	$0.00	$111.21	$103.60	$189.09	$189.09	$105.39	$76.23	$0.00	$0.00	$0.00	$0.00
G0438	EAP	HCPCS G0438		FIRST ANNUAL WELLNESS VISIT	BOTH IP/OP	$468.00 	$346.32	$0.00	$483.20	$0.00	$0.00	$172.69	$172.69	$168.58	$67.13	$311.31	$311.31	$323.29	$172.69	$97.53	$112.25	$276.82	$276.82	$184.17	$302.00	$478.37	$483.20	$172.69	$468.00	$172.69	$0.00	$172.69	$172.69	$96.16	$172.69	$0.00	$0.00	$0.00	$0.00
G0447	EAP	HCPCS G0447		"Face-to-face Behavioral Counseling For Obesity, 15 Minus"	BOTH IP/OP	$74.00 	$54.76	$14.55	$93.00	$40.18	$40.18	$72.87	$72.87	$73.28	$15.42	$54.92	$54.92	$57.04	$71.76	$15.42	$46.64	$43.77	$43.77	$78.77	$46.50	$73.66	$74.40	$93.00	$48.10	$93.00	$14.55	$24.16	$24.16	$14.81	$75.02	$0.00	$0.00	$0.00	$0.00
G2012	EAP	HCPCS G2012		PR BRIEF CHECK IN BY MD/QHP BY TELEPHONE	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$13.34	$0.00	$13.34	$8.14	$13.34	$13.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101	ERX	HCPCS 25000001	00904-6719-60	ACETAMINOPHEN 325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101	ERX	HCPCS 25000001	00904-6773-61	ACETAMINOPHEN 325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101	ERX	HCPCS 25000001	49348-0973-10	ACETAMINOPHEN 325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101	ERX	HCPCS 25000001	50580-0600-02	ACETAMINOPHEN 325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101	ERX	HCPCS 25000001	57896-0102-10	ACETAMINOPHEN 325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101	ERX	HCPCS 25000001	63739-0440-01	ACETAMINOPHEN 325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101	ERX	HCPCS 25000001	69618-0010-01	ACETAMINOPHEN 325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102	ERX	HCPCS 25000001	00904-6730-61	ACETAMINOPHEN 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102	ERX	HCPCS 25000001	49348-0042-14	ACETAMINOPHEN 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102	ERX	HCPCS 25000001	50580-0412-01	ACETAMINOPHEN 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102	ERX	HCPCS 25000001	50580-0412-02	ACETAMINOPHEN 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102	ERX	HCPCS 25000001	57896-0204-01	ACETAMINOPHEN 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103	ERX	HCPCS 25000001	45802-0732-00	ACETAMINOPHEN 120 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103	ERX	HCPCS 25000001	45802-0732-30	ACETAMINOPHEN 120 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104	ERX	HCPCS 25000001		ACETAMINOPHEN 325 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$64.95		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
104	ERX	HCPCS 25000001	51672-2116-02	ACETAMINOPHEN 325 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$64.95		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
105	ERX	HCPCS 25000001	45802-0730-00	ACETAMINOPHEN 650 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$64.95		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
105	ERX	HCPCS 25000001	45802-0730-30	ACETAMINOPHEN 650 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$64.95		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
105	ERX	HCPCS 25000001	45802-0730-32	ACETAMINOPHEN 650 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$64.95		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
113	ERX	HCPCS 63700001	00527-1050-01	ACETAZOLAMIDE 250 MG PO TABS	BOTH IP/OP	$12.08 	$8.94	$0.00	$8.77		$0.00	$0.00	$0.00	$2.15	$0.00	$0.00	$0.00	$0.00	$0.00	$2.52	$0.00	$0.00	$0.00	$0.00	$5.48	$8.68	$8.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
113	ERX	HCPCS 63700001	51672-4023-01	ACETAZOLAMIDE 250 MG PO TABS	BOTH IP/OP	$12.08 	$8.94	$0.00	$8.77		$0.00	$0.00	$0.00	$2.15	$0.00	$0.00	$0.00	$0.00	$0.00	$2.52	$0.00	$0.00	$0.00	$0.00	$5.48	$8.68	$8.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
114	ERX	HCPCS J1120	00143-9503-01	ACETAZOLAMIDE SODIUM 500 MG IJ SOLR	BOTH IP/OP	$101.81 	$75.34	$0.00	$78.48	$45.81	$45.81	$0.00	$0.00	$0.00	$41.60	$75.56	$75.56	$78.48	$0.00	$23.66	$0.00	$60.22	$60.22	$0.00	$46.16	$73.12	$73.86	$0.00		$0.00	$16.61	$0.00	$0.00	$15.82	$0.00	$0.00	$0.00	$0.00	$0.00
114	ERX	HCPCS J1120	39822-0190-01	ACETAZOLAMIDE SODIUM 500 MG IJ SOLR	BOTH IP/OP	$101.81 	$75.34	$0.00	$78.48	$45.81	$45.81	$0.00	$0.00	$0.00	$41.60	$75.56	$75.56	$78.48	$0.00	$23.66	$0.00	$60.22	$60.22	$0.00	$46.16	$73.12	$73.86	$0.00		$0.00	$16.61	$0.00	$0.00	$15.82	$0.00	$0.00	$0.00	$0.00	$0.00
114	ERX	HCPCS J1120	39822-0190-07	ACETAZOLAMIDE SODIUM 500 MG IJ SOLR	BOTH IP/OP	$101.81 	$75.34	$0.00	$78.48	$45.81	$45.81	$0.00	$0.00	$0.00	$41.60	$75.56	$75.56	$78.48	$0.00	$23.66	$0.00	$60.22	$60.22	$0.00	$46.16	$73.12	$73.86	$0.00		$0.00	$16.61	$0.00	$0.00	$15.82	$0.00	$0.00	$0.00	$0.00	$0.00
114	ERX	HCPCS J1120	67457-0853-50	ACETAZOLAMIDE SODIUM 500 MG IJ SOLR	BOTH IP/OP	$101.81 	$75.34	$0.00	$78.48	$45.81	$45.81	$0.00	$0.00	$0.00	$41.60	$75.56	$75.56	$78.48	$0.00	$23.66	$0.00	$60.22	$60.22	$0.00	$46.16	$73.12	$73.86	$0.00		$0.00	$16.61	$0.00	$0.00	$15.82	$0.00	$0.00	$0.00	$0.00	$0.00
123	ERX	HCPCS J7608	00409-3308-03	ACETYLCYSTEINE 20 % IN SOLN	BOTH IP/OP	$47.03 	$34.80	$0.00	$36.25	$21.16	$21.16	$0.00	$0.00	$5.74	$9.80	$34.91	$34.91	$36.25	$0.00	$9.80	$0.00	$27.82	$27.82	$0.00	$21.33	$33.78	$34.12	$0.00		$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123	ERX	HCPCS J7608	00517-7604-01	ACETYLCYSTEINE 20 % IN SOLN	BOTH IP/OP	$47.03 	$34.80	$0.00	$36.25	$21.16	$21.16	$0.00	$0.00	$5.74	$9.80	$34.91	$34.91	$36.25	$0.00	$9.80	$0.00	$27.82	$27.82	$0.00	$21.33	$33.78	$34.12	$0.00		$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123	ERX	HCPCS J7608	00517-7604-25	ACETYLCYSTEINE 20 % IN SOLN	BOTH IP/OP	$47.03 	$34.80	$0.00	$36.25	$21.16	$21.16	$0.00	$0.00	$5.74	$9.80	$34.91	$34.91	$36.25	$0.00	$9.80	$0.00	$27.82	$27.82	$0.00	$21.33	$33.78	$34.12	$0.00		$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123	ERX	HCPCS J7608	63323-0690-30	ACETYLCYSTEINE 20 % IN SOLN	BOTH IP/OP	$47.03 	$34.80	$0.00	$36.25	$21.16	$21.16	$0.00	$0.00	$5.74	$9.80	$34.91	$34.91	$36.25	$0.00	$9.80	$0.00	$27.82	$27.82	$0.00	$21.33	$33.78	$34.12	$0.00		$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123	ERX	HCPCS J7608	63323-0694-04	ACETYLCYSTEINE 20 % IN SOLN	BOTH IP/OP	$47.03 	$34.80	$0.00	$36.25	$21.16	$21.16	$0.00	$0.00	$5.74	$9.80	$34.91	$34.91	$36.25	$0.00	$9.80	$0.00	$27.82	$27.82	$0.00	$21.33	$33.78	$34.12	$0.00		$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123	ERX	HCPCS J7608	99999-6005-92	ACETYLCYSTEINE 20 % IN SOLN	BOTH IP/OP	$47.03 	$34.80	$0.00	$36.25	$21.16	$21.16	$0.00	$0.00	$5.74	$9.80	$34.91	$34.91	$36.25	$0.00	$9.80	$0.00	$27.82	$27.82	$0.00	$21.33	$33.78	$34.12	$0.00		$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
250	ERX	HCPCS 25000001	00378-6990-31	ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
250	ERX	HCPCS 25000001	00487-9501-01	ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
250	ERX	HCPCS 25000001	00487-9501-03	ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
250	ERX	HCPCS 25000001	00487-9501-25	ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
250	ERX	HCPCS 25000001	00591-3797-83	ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
250	ERX	HCPCS 25000001	76204-0200-01	ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
252	ERX	HCPCS 25000001	99999-6010-97	ALBUTEROL SULFATE 2 MG/5ML PO SYRP	BOTH IP/OP	$21.37 	$15.81	$0.00	$57.12		$0.00	$0.00	$0.00	$0.00	$0.00	$15.86	$15.86	$16.47	$0.00	$4.45	$0.00	$0.00	$0.00	$0.00	$35.70	$15.35	$57.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
252	ERX	HCPCS 25000001	99999-6004-59	ALBUTEROL SULFATE 2 MG/5ML PO SYRP	BOTH IP/OP	$21.37 	$15.81	$0.00	$57.12		$0.00	$0.00	$0.00	$0.00	$0.00	$15.86	$15.86	$16.47	$0.00	$4.45	$0.00	$0.00	$0.00	$0.00	$35.70	$56.55	$57.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
252	ERX	HCPCS 25000001	00472-0825-16	ALBUTEROL SULFATE 2 MG/5ML PO SYRP	BOTH IP/OP	$21.37 	$15.81	$0.00	$85.23		$0.00	$0.00	$0.00	$0.00	$0.00	$15.86	$15.86	$16.47	$0.00	$4.45	$0.00	$0.00	$0.00	$0.00	$35.70	$85.23	$57.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
253	ERX	HCPCS 63700001	51079-0657-20	ALBUTEROL SULFATE 2 MG PO TABS	BOTH IP/OP	$29.54 	$21.86	$0.00	$21.43		$0.00	$0.00	$0.00	$5.26	$0.00	$0.00	$0.00	$0.00	$0.00	$6.16	$0.00	$0.00	$0.00	$0.00	$13.40	$21.22	$21.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
253	ERX	HCPCS 63700001	68084-0949-95	ALBUTEROL SULFATE 2 MG PO TABS	BOTH IP/OP	$29.54 	$21.86	$0.00	$21.43		$0.00	$0.00	$0.00	$5.26	$0.00	$0.00	$0.00	$0.00	$0.00	$6.16	$0.00	$0.00	$0.00	$0.00	$13.40	$21.22	$21.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
254	ERX	HCPCS 63700001	00378-0572-01	ALBUTEROL SULFATE 4 MG PO TABS	BOTH IP/OP	$26.79 	$19.82	$0.00	$21.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.40	$21.22	$21.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
254	ERX	HCPCS 63700001	53489-0177-01	ALBUTEROL SULFATE 4 MG PO TABS	BOTH IP/OP	$26.79 	$19.82	$0.00	$21.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.40	$21.22	$21.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
254	ERX	HCPCS 63700001	69543-0291-10	ALBUTEROL SULFATE 4 MG PO TABS	BOTH IP/OP	$26.79 	$19.82	$0.00	$21.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.40	$21.22	$21.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310	ERX	HCPCS 63700001	00904-6571-61	ALLOPURINOL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310	ERX	HCPCS 63700001	16714-0041-10	ALLOPURINOL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310	ERX	HCPCS 63700001	16714-0041-12	ALLOPURINOL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310	ERX	HCPCS 63700001	51079-0205-20	ALLOPURINOL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310	ERX	HCPCS 63700001	62584-0988-01	ALLOPURINOL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310	ERX	HCPCS 63700001	62584-0988-11	ALLOPURINOL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310	ERX	HCPCS 63700001	63739-0410-10	ALLOPURINOL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311	ERX	HCPCS 63700001	00591-5544-01	ALLOPURINOL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311	ERX	HCPCS 63700001	00904-6572-61	ALLOPURINOL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311	ERX	HCPCS 63700001	50268-0064-11	ALLOPURINOL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311	ERX	HCPCS 63700001	50268-0064-15	ALLOPURINOL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311	ERX	HCPCS 63700001	51079-0206-01	ALLOPURINOL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311	ERX	HCPCS 63700001	51079-0206-20	ALLOPURINOL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311	ERX	HCPCS 63700001	62584-0713-01	ALLOPURINOL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
324	ERX	HCPCS 25000001	00228-2027-10	ALPRAZOLAM 0.25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
324	ERX	HCPCS 25000001	59762-3719-01	ALPRAZOLAM 0.25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
326	ERX	HCPCS 25000001	00904-5860-61	ALPRAZOLAM 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
345	ERX	HCPCS 25000001	00395-0049-96	ALUM AMMONIUM POWD	BOTH IP/OP	$34.70 	$25.68	$0.00	$26.75		$0.00	$0.00	$0.00	$0.00	$0.00	$25.75	$25.75	$26.75	$0.00	$7.23	$0.00	$0.00	$0.00	$0.00	$15.39	$24.38	$24.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
346	ERX	HCPCS 25000001	49452-0370-01	ALUM POTASSIUM POWD	BOTH IP/OP	$384.30 	$284.38	$0.00	$304.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.58	$304.37	$24.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
346	ERX	HCPCS 25000001	51927-1692-00	ALUM POTASSIUM POWD	BOTH IP/OP	$6.00 	$4.44	$0.00	$24.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.58	$4.75	$24.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
353	ERX	HCPCS 63700001	99999-6009-93	ALUMINUM HYDROXIDE GEL 320 MG/5ML PO SUSP	BOTH IP/OP	$12.07 	$8.93	$0.00	$8.80		$0.00	$0.00	$0.00	$2.15	$0.00	$0.00	$0.00	$0.00	$0.00	$2.52	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
353	ERX	HCPCS 63700001	00536-0091-85	ALUMINUM HYDROXIDE GEL 320 MG/5ML PO SUSP	BOTH IP/OP	$12.07 	$8.93	$0.00	$18.51		$0.00	$0.00	$0.00	$2.15	$0.00	$0.00	$0.00	$0.00	$0.00	$2.52	$0.00	$0.00	$0.00	$0.00	$5.50	$18.51	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364	ERX	HCPCS 63700001	00904-6630-61	AMANTADINE HCL 100 MG PO CAPS	BOTH IP/OP	$8.13 	$6.02	$0.00	$5.90		$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$0.00	$1.69	$0.00	$0.00	$0.00	$0.00	$3.69	$5.84	$5.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364	ERX	HCPCS 63700001	42543-0493-01	AMANTADINE HCL 100 MG PO CAPS	BOTH IP/OP	$8.13 	$6.02	$0.00	$5.90		$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$0.00	$1.69	$0.00	$0.00	$0.00	$0.00	$3.69	$5.84	$5.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364	ERX	HCPCS 63700001	62332-0246-31	AMANTADINE HCL 100 MG PO CAPS	BOTH IP/OP	$8.13 	$6.02	$0.00	$5.90		$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$0.00	$1.69	$0.00	$0.00	$0.00	$0.00	$3.69	$5.84	$5.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365	ERX	HCPCS 63700001	00121-0646-16	AMANTADINE HCL 50 MG/5ML PO SYRP	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365	ERX	HCPCS 63700001	50383-0807-16	AMANTADINE HCL 50 MG/5ML PO SYRP	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365	ERX	HCPCS 63700001	60432-0093-16	AMANTADINE HCL 50 MG/5ML PO SYRP	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365	ERX	HCPCS 63700001	99999-6008-86	AMANTADINE HCL 50 MG/5ML PO SYRP	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
391	ERX	HCPCS 63700001	00574-0292-01	AMILORIDE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
391	ERX	HCPCS 63700001	49884-0117-01	AMILORIDE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
391	ERX	HCPCS 63700001	50268-0071-15	AMILORIDE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
403	ERX	HCPCS 25000001	00409-4346-16	AMINOCAPROIC ACID 250 MG/ML IV SOLN	BOTH IP/OP	$36.63 	$27.11	$0.00	$28.23		$0.00	$0.00	$0.00	$0.00	$0.00	$27.19	$27.19	$28.23	$0.00	$7.63	$0.00	$0.00	$0.00	$0.00	$16.34	$25.88	$26.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
403	ERX	HCPCS 25000001	00409-4346-73	AMINOCAPROIC ACID 250 MG/ML IV SOLN	BOTH IP/OP	$36.63 	$27.11	$0.00	$28.23		$0.00	$0.00	$0.00	$0.00	$0.00	$27.19	$27.19	$28.23	$0.00	$7.63	$0.00	$0.00	$0.00	$0.00	$16.34	$25.88	$26.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
403	ERX	HCPCS 25000001	00517-9120-25	AMINOCAPROIC ACID 250 MG/ML IV SOLN	BOTH IP/OP	$36.63 	$27.11	$0.00	$28.23		$0.00	$0.00	$0.00	$0.00	$0.00	$27.19	$27.19	$28.23	$0.00	$7.63	$0.00	$0.00	$0.00	$0.00	$16.34	$25.88	$26.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
407	ERX	HCPCS J0280	00409-5921-01	AMINOPHYLLINE 25 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.51	$16.33	$16.33	$16.96	$0.00	$10.07	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
407	ERX	HCPCS J0280	00409-5922-01	AMINOPHYLLINE 25 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.51	$16.33	$16.33	$16.96	$0.00	$10.07	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
407	ERX	HCPCS J0280	00409-5922-16	AMINOPHYLLINE 25 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.51	$16.33	$16.33	$16.96	$0.00	$10.07	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
432	ERX	HCPCS 63700001	16714-0446-01	AMITRIPTYLINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
432	ERX	HCPCS 63700001	51079-0131-01	AMITRIPTYLINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
432	ERX	HCPCS 63700001	51079-0131-20	AMITRIPTYLINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
435	ERX	HCPCS 63700001	16714-0447-01	AMITRIPTYLINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
435	ERX	HCPCS 63700001	51079-0107-20	AMITRIPTYLINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
436	ERX	HCPCS 63700001	51079-0133-01	AMITRIPTYLINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
436	ERX	HCPCS 63700001	51079-0133-20	AMITRIPTYLINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
437	ERX	HCPCS 63700001	16714-0449-01	AMITRIPTYLINE HCL 75 MG PO TABS	BOTH IP/OP	$7.61 	$5.63	$0.00	$5.52		$0.00	$0.00	$0.00	$1.35	$0.00	$0.00	$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$3.45	$5.46	$5.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
449	ERX	HCPCS 63700001	00591-5714-01	AMOXAPINE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
450	ERX	HCPCS 63700001	00781-2020-01	AMOXICILLIN 250 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
450	ERX	HCPCS 63700001	00781-2020-05	AMOXICILLIN 250 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
450	ERX	HCPCS 63700001	16714-0298-02	AMOXICILLIN 250 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
451	ERX	HCPCS 63700001	00781-2613-05	AMOXICILLIN 500 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
451	ERX	HCPCS 63700001	16714-0299-03	AMOXICILLIN 500 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
451	ERX	HCPCS 63700001	16714-0299-04	AMOXICILLIN 500 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
451	ERX	HCPCS 63700001	65862-0017-05	AMOXICILLIN 500 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
452	ERX	HCPCS 63700001	00093-2268-01	AMOXICILLIN 250 MG PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
453	ERX	HCPCS 25000001	00143-9888-80	AMOXICILLIN 125 MG/5ML PO SUSR	BOTH IP/OP	$11.86 	$8.78	$0.00	$9.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.93	$9.39	$9.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
453	ERX	HCPCS 25000001	00781-6039-58	AMOXICILLIN 125 MG/5ML PO SUSR	BOTH IP/OP	$11.86 	$8.78	$0.00	$9.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.93	$9.39	$9.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
454	ERX	HCPCS 63700001	00093-4155-79	AMOXICILLIN 250 MG/5ML PO SUSR	BOTH IP/OP	$29.54 	$21.86	$0.00	$21.43		$0.00	$0.00	$0.00	$5.26	$0.00	$0.00	$0.00	$0.00	$0.00	$6.16	$0.00	$0.00	$0.00	$0.00	$13.40	$15.90	$21.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
454	ERX	HCPCS 63700001	00781-6041-58	AMOXICILLIN 250 MG/5ML PO SUSR	BOTH IP/OP	$29.54 	$21.86	$0.00	$21.43		$0.00	$0.00	$0.00	$5.26	$0.00	$0.00	$0.00	$0.00	$0.00	$6.16	$0.00	$0.00	$0.00	$0.00	$13.40	$15.90	$21.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
454	ERX	HCPCS 63700001	00093-4155-80	AMOXICILLIN 250 MG/5ML PO SUSR	BOTH IP/OP	$29.54 	$21.86	$0.00	$21.43		$0.00	$0.00	$0.00	$5.26	$0.00	$0.00	$0.00	$0.00	$0.00	$6.16	$0.00	$0.00	$0.00	$0.00	$13.40	$21.22	$21.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
454	ERX	HCPCS 63700001	00143-9889-15	AMOXICILLIN 250 MG/5ML PO SUSR	BOTH IP/OP	$29.54 	$21.86	$0.00	$21.43		$0.00	$0.00	$0.00	$5.26	$0.00	$0.00	$0.00	$0.00	$0.00	$6.16	$0.00	$0.00	$0.00	$0.00	$13.40	$21.22	$21.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
454	ERX	HCPCS 63700001	00781-6041-55	AMOXICILLIN 250 MG/5ML PO SUSR	BOTH IP/OP	$29.54 	$21.86	$0.00	$21.43		$0.00	$0.00	$0.00	$5.26	$0.00	$0.00	$0.00	$0.00	$0.00	$6.16	$0.00	$0.00	$0.00	$0.00	$13.40	$21.22	$21.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
464	ERX	HCPCS J0285	39822-1055-05	AMPHOTERICIN B 50 MG IV SOLR	BOTH IP/OP	$189.57 	$140.28	$0.00	$146.12		$0.00	$0.00	$0.00	$0.00	$0.00	$140.70	$140.70	$146.12	$0.00	$50.11	$0.00	$0.00	$0.00	$0.00	$83.13	$131.67	$133.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
466	ERX	HCPCS 63700001	00781-2145-01	AMPICILLIN 500 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
469	ERX	HCPCS J0290	00781-3404-85	AMPICILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$36.19 	$26.78	$0.00	$27.90	$16.29	$16.29	$0.00	$0.00	$0.00	$5.22	$26.86	$26.86	$27.90	$0.00	$1.90	$0.00	$21.41	$21.41	$0.00	$16.41	$25.99	$26.26	$0.00		$0.00	$2.30	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$0.00
469	ERX	HCPCS J0290	00781-3404-95	AMPICILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$36.19 	$26.78	$0.00	$27.90	$16.29	$16.29	$0.00	$0.00	$0.00	$5.22	$26.86	$26.86	$27.90	$0.00	$1.90	$0.00	$21.41	$21.41	$0.00	$16.41	$25.99	$26.26	$0.00		$0.00	$2.30	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$0.00
469	ERX	HCPCS J0290	00781-9404-95	AMPICILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$36.19 	$26.78	$0.00	$27.90	$16.29	$16.29	$0.00	$0.00	$0.00	$5.22	$26.86	$26.86	$27.90	$0.00	$1.90	$0.00	$21.41	$21.41	$0.00	$16.41	$25.99	$26.26	$0.00		$0.00	$2.30	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$0.00
469	ERX	HCPCS J0290	25021-0136-10	AMPICILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$36.19 	$26.78	$0.00	$27.90	$16.29	$16.29	$0.00	$0.00	$0.00	$5.22	$26.86	$26.86	$27.90	$0.00	$1.90	$0.00	$21.41	$21.41	$0.00	$16.41	$25.99	$26.26	$0.00		$0.00	$2.30	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$0.00
469	ERX	HCPCS J0290	44567-0102-10	AMPICILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$36.19 	$26.78	$0.00	$27.90	$16.29	$16.29	$0.00	$0.00	$0.00	$5.22	$26.86	$26.86	$27.90	$0.00	$1.90	$0.00	$21.41	$21.41	$0.00	$16.41	$25.99	$26.26	$0.00		$0.00	$2.30	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$0.00
469	ERX	HCPCS J0290	55150-0113-10	AMPICILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$36.19 	$26.78	$0.00	$27.90	$16.29	$16.29	$0.00	$0.00	$0.00	$5.22	$26.86	$26.86	$27.90	$0.00	$1.90	$0.00	$21.41	$21.41	$0.00	$16.41	$25.99	$26.26	$0.00		$0.00	$2.30	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$0.00
469	ERX	HCPCS J0290	67457-0351-01	AMPICILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$36.19 	$26.78	$0.00	$27.90	$16.29	$16.29	$0.00	$0.00	$0.00	$5.22	$26.86	$26.86	$27.90	$0.00	$1.90	$0.00	$21.41	$21.41	$0.00	$16.41	$25.99	$26.26	$0.00		$0.00	$2.30	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$0.00
469	ERX	HCPCS J0290	67457-0351-10	AMPICILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$36.19 	$26.78	$0.00	$27.90	$16.29	$16.29	$0.00	$0.00	$0.00	$5.22	$26.86	$26.86	$27.90	$0.00	$1.90	$0.00	$21.41	$21.41	$0.00	$16.41	$25.99	$26.26	$0.00		$0.00	$2.30	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$0.00
471	ERX	HCPCS 25000001	00781-3400-78	AMPICILLIN SODIUM 125 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
471	ERX	HCPCS 25000001	00781-3400-95	AMPICILLIN SODIUM 125 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
472	ERX	HCPCS J0290	00781-3408-95	AMPICILLIN SODIUM 2 G IJ SOLR	BOTH IP/OP	$70.20 	$51.95	$0.00	$54.11	$31.59	$31.59	$0.00	$0.00	$0.00	$10.43	$52.10	$52.10	$54.11	$0.00	$3.79	$0.00	$41.52	$41.52	$0.00	$31.84	$50.43	$50.94	$0.00		$0.00	$4.61	$0.00	$0.00	$4.39	$0.00	$0.00	$0.00	$0.00	$0.00
472	ERX	HCPCS J0290	00781-9408-95	AMPICILLIN SODIUM 2 G IJ SOLR	BOTH IP/OP	$70.20 	$51.95	$0.00	$54.11	$31.59	$31.59	$0.00	$0.00	$0.00	$10.43	$52.10	$52.10	$54.11	$0.00	$3.79	$0.00	$41.52	$41.52	$0.00	$31.84	$50.43	$50.94	$0.00		$0.00	$4.61	$0.00	$0.00	$4.39	$0.00	$0.00	$0.00	$0.00	$0.00
472	ERX	HCPCS J0290	25021-0137-20	AMPICILLIN SODIUM 2 G IJ SOLR	BOTH IP/OP	$70.20 	$51.95	$0.00	$54.11	$31.59	$31.59	$0.00	$0.00	$0.00	$10.43	$52.10	$52.10	$54.11	$0.00	$3.79	$0.00	$41.52	$41.52	$0.00	$31.84	$50.43	$50.94	$0.00		$0.00	$4.61	$0.00	$0.00	$4.39	$0.00	$0.00	$0.00	$0.00	$0.00
472	ERX	HCPCS J0290	44567-0103-10	AMPICILLIN SODIUM 2 G IJ SOLR	BOTH IP/OP	$70.20 	$51.95	$0.00	$54.11	$31.59	$31.59	$0.00	$0.00	$0.00	$10.43	$52.10	$52.10	$54.11	$0.00	$3.79	$0.00	$41.52	$41.52	$0.00	$31.84	$50.43	$50.94	$0.00		$0.00	$4.61	$0.00	$0.00	$4.39	$0.00	$0.00	$0.00	$0.00	$0.00
472	ERX	HCPCS J0290	55150-0114-20	AMPICILLIN SODIUM 2 G IJ SOLR	BOTH IP/OP	$70.20 	$51.95	$0.00	$54.11	$31.59	$31.59	$0.00	$0.00	$0.00	$10.43	$52.10	$52.10	$54.11	$0.00	$3.79	$0.00	$41.52	$41.52	$0.00	$31.84	$50.43	$50.94	$0.00		$0.00	$4.61	$0.00	$0.00	$4.39	$0.00	$0.00	$0.00	$0.00	$0.00
474	ERX	HCPCS J0290	00781-3407-78	AMPICILLIN SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.61	$16.33	$16.33	$16.96	$0.00	$0.95	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.15	$0.00	$0.00	$1.10	$0.00	$0.00	$0.00	$0.00	$0.00
474	ERX	HCPCS J0290	00781-3407-95	AMPICILLIN SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.61	$16.33	$16.33	$16.96	$0.00	$0.95	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.15	$0.00	$0.00	$1.10	$0.00	$0.00	$0.00	$0.00	$0.00
474	ERX	HCPCS J0290	00781-9407-78	AMPICILLIN SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.61	$16.33	$16.33	$16.96	$0.00	$0.95	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.15	$0.00	$0.00	$1.10	$0.00	$0.00	$0.00	$0.00	$0.00
474	ERX	HCPCS J0290	00781-9407-95	AMPICILLIN SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.61	$16.33	$16.33	$16.96	$0.00	$0.95	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.15	$0.00	$0.00	$1.10	$0.00	$0.00	$0.00	$0.00	$0.00
474	ERX	HCPCS J0290	44567-0101-10	AMPICILLIN SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.61	$16.33	$16.33	$16.96	$0.00	$0.95	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.15	$0.00	$0.00	$1.10	$0.00	$0.00	$0.00	$0.00	$0.00
474	ERX	HCPCS J0290	55150-0112-10	AMPICILLIN SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.61	$16.33	$16.33	$16.96	$0.00	$0.95	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.15	$0.00	$0.00	$1.10	$0.00	$0.00	$0.00	$0.00	$0.00
612	ERX	HCPCS 63700001	72140-0452-31	AQUAPHOR EX OINT	BOTH IP/OP	$24.31 	$17.99	$0.00	$123.20		$0.00	$0.00	$0.00	$4.33	$0.00	$0.00	$0.00	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$77.00	$16.55	$123.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
612	ERX	HCPCS 63700001	72140-0031-47	AQUAPHOR EX OINT	BOTH IP/OP	$24.31 	$17.99	$0.00	$123.20		$0.00	$0.00	$0.00	$4.33	$0.00	$0.00	$0.00	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$77.00	$121.97	$123.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
654	ERX	HCPCS 25000001	67457-0118-50	ASCORBIC ACID 500 MG/ML IJ SOLN	BOTH IP/OP	$364.90 	$270.03	$0.00	$281.26		$0.00	$0.00	$0.00	$0.00	$0.00	$270.83	$270.83	$281.26	$0.00	$76.05	$0.00	$0.00	$0.00	$0.00	$165.62	$262.33	$264.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
680	ERX	HCPCS 25000001	00536-1008-36	ASPIRIN 81 MG PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
680	ERX	HCPCS 25000001	00904-4040-73	ASPIRIN 81 MG PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
680	ERX	HCPCS 25000001	00904-6794-80	ASPIRIN 81 MG PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
680	ERX	HCPCS 25000001	63739-0434-01	ASPIRIN 81 MG PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
680	ERX	HCPCS 25000001	66553-0002-01	ASPIRIN 81 MG PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
681	ERX	HCPCS 25000001	66553-0001-01	ASPIRIN 325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
693	ERX	HCPCS 25000001	00574-7034-12	ASPIRIN 300 MG RECTAL SUPP	BOTH IP/OP	$6.11 	$4.52	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.53	$4.53	$4.71	$0.00	$1.27	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
716	ERX	HCPCS 63700001	00781-1507-01	ATENOLOL 100 MG PO TABS	BOTH IP/OP	$6.26 	$4.63	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
716	ERX	HCPCS 63700001	51079-0685-01	ATENOLOL 100 MG PO TABS	BOTH IP/OP	$6.26 	$4.63	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
716	ERX	HCPCS 63700001	51079-0685-20	ATENOLOL 100 MG PO TABS	BOTH IP/OP	$6.26 	$4.63	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
716	ERX	HCPCS 63700001	68382-0024-01	ATENOLOL 100 MG PO TABS	BOTH IP/OP	$6.26 	$4.63	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
717	ERX	HCPCS 63700001	00093-0787-01	ATENOLOL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
717	ERX	HCPCS 63700001	00781-1078-01	ATENOLOL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
717	ERX	HCPCS 63700001	51079-0759-01	ATENOLOL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
717	ERX	HCPCS 63700001	51079-0759-20	ATENOLOL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
718	ERX	HCPCS 63700001	00781-1506-01	ATENOLOL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
718	ERX	HCPCS 63700001	51079-0684-20	ATENOLOL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
718	ERX	HCPCS 63700001	68382-0023-01	ATENOLOL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
731	ERX	HCPCS J0461	00517-0401-25	ATROPINE SULFATE 0.4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$1.79	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.88	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$0.00
731	ERX	HCPCS J0461	99999-6008-06	ATROPINE SULFATE 0.4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$1.79	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.88	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$0.00
734	ERX	HCPCS J0461	00517-1010-25	ATROPINE SULFATE 1 MG/ML IJ SOLN	BOTH IP/OP	$63.16 	$46.74	$0.00	$48.68	$28.42	$28.42	$0.00	$0.00	$0.00	$13.16	$46.88	$46.88	$48.68	$0.00	$8.93	$0.00	$37.36	$37.36	$0.00	$27.55	$43.63	$44.07	$0.00		$0.00	$9.40	$0.00	$0.00	$8.95	$0.00	$0.00	$0.00	$0.00	$0.00
735	ERX	HCPCS 25000001	24208-0825-55	ATROPINE SULFATE 1 % OP OINT	BOTH IP/OP	$81.11 	$60.02	$0.00	$62.52		$0.00	$0.00	$0.00	$0.00	$0.00	$60.20	$60.20	$62.52	$0.00	$16.90	$0.00	$0.00	$0.00	$0.00	$36.77	$58.24	$58.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
736	ERX	HCPCS 25000001	17478-0215-02	ATROPINE SULFATE 1 % OP SOLN	BOTH IP/OP	$184.74 	$136.71	$0.00	$142.40		$0.00	$0.00	$0.00	$0.00	$0.00	$137.11	$137.11	$142.40	$0.00	$38.50	$0.00	$0.00	$0.00	$0.00	$78.05	$123.63	$124.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
736	ERX	HCPCS 25000001	00065-0303-55	ATROPINE SULFATE 1 % OP SOLN	BOTH IP/OP	$184.74 	$136.71	$0.00	$145.65		$0.00	$0.00	$0.00	$0.00	$0.00	$137.11	$137.11	$142.40	$0.00	$38.50	$0.00	$0.00	$0.00	$0.00	$78.05	$145.65	$124.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
736	ERX	HCPCS 25000001	17478-0215-05	ATROPINE SULFATE 1 % OP SOLN	BOTH IP/OP	$184.74 	$136.71	$0.00	$145.65		$0.00	$0.00	$0.00	$0.00	$0.00	$137.11	$137.11	$142.40	$0.00	$38.50	$0.00	$0.00	$0.00	$0.00	$78.05	$145.65	$124.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
850	ERX	HCPCS 25000001	45802-0060-70	BACITRACIN 500 UNIT/GM EX OINT	BOTH IP/OP	$14.52 	$10.74	$0.00	$11.19		$0.00	$0.00	$0.00	$0.00	$0.00	$10.78	$10.78	$11.19	$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$6.59	$10.43	$10.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
850	ERX	HCPCS 25000001	00713-0280-31	BACITRACIN 500 UNIT/GM EX OINT	BOTH IP/OP	$14.52 	$10.74	$0.00	$11.19		$0.00	$0.00	$0.00	$0.00	$0.00	$10.78	$10.78	$11.19	$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$6.59	$10.43	$10.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
851	ERX	HCPCS 25000001	00009-0233-01	BACITRACIN 50000 UNITS IM SOLR	BOTH IP/OP	$41.04 	$30.37	$0.00	$32.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
851	ERX	HCPCS 25000001	00009-0233-03	BACITRACIN 50000 UNITS IM SOLR	BOTH IP/OP	$41.04 	$30.37	$0.00	$32.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
851	ERX	HCPCS 25000001	63323-0329-31	BACITRACIN 50000 UNITS IM SOLR	BOTH IP/OP	$41.04 	$30.37	$0.00	$32.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
851	ERX	HCPCS 25000001	70594-0026-01	BACITRACIN 50000 UNITS IM SOLR	BOTH IP/OP	$41.04 	$30.37	$0.00	$32.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
851	ERX	HCPCS 25000001	70594-0026-02	BACITRACIN 50000 UNITS IM SOLR	BOTH IP/OP	$41.04 	$30.37	$0.00	$32.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
852	ERX	HCPCS 25000001	00574-4022-35	BACITRACIN 500 UNIT/GM OP OINT	BOTH IP/OP	$361.25 	$267.33	$0.00	$289.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.63	$286.11	$289.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
854	ERX	HCPCS 25000001	45802-0143-03	BACITRACIN-NEOMYCIN-POLYMYXIN 400-5-5000 EX OINT	BOTH IP/OP	$25.82 	$19.11	$0.00	$19.90		$0.00	$0.00	$0.00	$0.00	$0.00	$19.16	$19.16	$19.90	$0.00	$5.38	$0.00	$0.00	$0.00	$0.00	$11.71	$18.54	$18.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
856	ERX	HCPCS 25000001	24208-0555-55	BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OP OINT	BOTH IP/OP	$110.60 	$81.84	$0.00	$85.25		$0.00	$0.00	$0.00	$0.00	$0.00	$82.09	$82.09	$85.25	$0.00	$23.05	$0.00	$0.00	$0.00	$0.00	$50.14	$79.42	$80.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
860	ERX	HCPCS 63700001	00904-6475-61	BACLOFEN 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
860	ERX	HCPCS 63700001	16714-0071-04	BACLOFEN 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
860	ERX	HCPCS 63700001	63739-0479-10	BACLOFEN 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
860	ERX	HCPCS 63700001	68084-0855-01	BACLOFEN 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
987	ERX	HCPCS 25000001	54162-0100-01	BENZOIN COMPOUND EX TINC	BOTH IP/OP	$41.74 	$30.89	$0.00	$32.17		$0.00	$0.00	$0.00	$0.00	$0.00	$30.98	$30.98	$32.17	$0.00	$8.70	$0.00	$0.00	$0.00	$0.00	$18.02	$11.09	$28.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
987	ERX	HCPCS 25000001	54162-0100-02	BENZOIN COMPOUND EX TINC	BOTH IP/OP	$41.74 	$30.89	$0.00	$32.17		$0.00	$0.00	$0.00	$0.00	$0.00	$30.98	$30.98	$32.17	$0.00	$8.70	$0.00	$0.00	$0.00	$0.00	$18.02	$16.06	$28.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
987	ERX	HCPCS 25000001	54162-0100-04	BENZOIN COMPOUND EX TINC	BOTH IP/OP	$41.74 	$30.89	$0.00	$32.17		$0.00	$0.00	$0.00	$0.00	$0.00	$30.98	$30.98	$32.17	$0.00	$8.70	$0.00	$0.00	$0.00	$0.00	$18.02	$28.42	$28.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
987	ERX	HCPCS 25000001	00395-0243-92	BENZOIN COMPOUND EX TINC	BOTH IP/OP	$41.74 	$30.89	$0.00	$32.17		$0.00	$0.00	$0.00	$0.00	$0.00	$30.98	$30.98	$32.17	$0.00	$8.70	$0.00	$0.00	$0.00	$0.00	$18.02	$28.54	$28.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
988	ERX	HCPCS 63700001	00904-6564-60	BENZONATATE 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
988	ERX	HCPCS 63700001	00904-6564-61	BENZONATATE 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
988	ERX	HCPCS 63700001	42291-0164-01	BENZONATATE 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
988	ERX	HCPCS 63700001	42291-0164-50	BENZONATATE 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
988	ERX	HCPCS 63700001	60687-0346-01	BENZONATATE 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
988	ERX	HCPCS 63700001	60687-0346-11	BENZONATATE 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
988	ERX	HCPCS 63700001	63739-0029-10	BENZONATATE 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
988	ERX	HCPCS 63700001	67877-0573-01	BENZONATATE 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
988	ERX	HCPCS 63700001	68382-0247-01	BENZONATATE 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
989	ERX	HCPCS 25000001	00536-1056-56	BENZOYL PEROXIDE 10 % EX GEL	BOTH IP/OP	$29.03 	$21.48	$0.00	$22.38		$0.00	$0.00	$0.00	$0.00	$0.00	$21.55	$21.55	$22.38	$0.00	$6.05	$0.00	$0.00	$0.00	$0.00	$13.17	$20.85	$21.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
991	ERX	HCPCS 25000001	00536-1055-56	BENZOYL PEROXIDE 5 % EX GEL	BOTH IP/OP	$23.87 	$17.66	$0.00	$18.40		$0.00	$0.00	$0.00	$0.00	$0.00	$17.72	$17.72	$18.40	$0.00	$4.97	$0.00	$0.00	$0.00	$0.00	$10.83	$17.15	$17.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
998	ERX	HCPCS 63700001	00603-2437-21	BENZTROPINE MESYLATE 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
998	ERX	HCPCS 63700001	60687-0356-01	BENZTROPINE MESYLATE 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
998	ERX	HCPCS 63700001	60687-0356-11	BENZTROPINE MESYLATE 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
998	ERX	HCPCS 63700001	69315-0136-01	BENZTROPINE MESYLATE 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
999	ERX	HCPCS 63700001	00603-2438-21	BENZTROPINE MESYLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
999	ERX	HCPCS 63700001	10135-0607-01	BENZTROPINE MESYLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
999	ERX	HCPCS 63700001	60687-0368-01	BENZTROPINE MESYLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
999	ERX	HCPCS 63700001	60687-0368-11	BENZTROPINE MESYLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
999	ERX	HCPCS 63700001	76385-0104-01	BENZTROPINE MESYLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1000	ERX	HCPCS 63700001	00603-2439-21	BENZTROPINE MESYLATE 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1000	ERX	HCPCS 63700001	69315-0138-01	BENZTROPINE MESYLATE 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1029	ERX	HCPCS 63700001	00168-0056-15	BETAMETHASONE DIPROPIONATE 0.05 % EX OINT	BOTH IP/OP	$213.36 	$157.89	$0.00	$154.94		$0.00	$0.00	$0.00	$37.98	$0.00	$0.00	$0.00	$0.00	$0.00	$44.46	$0.00	$0.00	$0.00	$0.00	$96.84	$153.39	$154.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1029	ERX	HCPCS 63700001	00472-0381-15	BETAMETHASONE DIPROPIONATE 0.05 % EX OINT	BOTH IP/OP	$213.36 	$157.89	$0.00	$154.94		$0.00	$0.00	$0.00	$37.98	$0.00	$0.00	$0.00	$0.00	$0.00	$44.46	$0.00	$0.00	$0.00	$0.00	$96.84	$153.39	$154.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1044	ERX	HCPCS 63700001	00832-0512-01	BETHANECHOL CHLORIDE 25 MG PO TABS	BOTH IP/OP	$8.98 	$6.65	$0.00	$6.51		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.07	$6.45	$6.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1044	ERX	HCPCS 63700001	00832-0512-89	BETHANECHOL CHLORIDE 25 MG PO TABS	BOTH IP/OP	$8.98 	$6.65	$0.00	$6.51		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.07	$6.45	$6.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1044	ERX	HCPCS 63700001	65162-0573-10	BETHANECHOL CHLORIDE 25 MG PO TABS	BOTH IP/OP	$8.98 	$6.65	$0.00	$6.51		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.07	$6.45	$6.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1079	ERX	HCPCS 63700001	00904-6407-61	BISACODYL 5 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1079	ERX	HCPCS 63700001	00904-7927-60	BISACODYL 5 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1079	ERX	HCPCS 63700001	49483-0003-01	BISACODYL 5 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1080	ERX	HCPCS 63700001	00574-7050-12	BISACODYL 10 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1080	ERX	HCPCS 63700001	00574-7050-50	BISACODYL 10 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1080	ERX	HCPCS 63700001	57896-0443-05	BISACODYL 10 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1080	ERX	HCPCS 63700001	57896-0444-05	BISACODYL 10 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1080	ERX	HCPCS 63700001	68784-0102-12	BISACODYL 10 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1080	ERX	HCPCS 63700001	81421-0021-01	BISACODYL 10 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1090	ERX	HCPCS 25000001	37000-0032-01	BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1259	ERX	HCPCS 25000001	46017-0018-16	CAFFEINE 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1259	ERX	HCPCS 25000001	70677-0021-01	CAFFEINE 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1262	ERX	HCPCS 25000001	00517-2502-10	CAFFEINE-SODIUM BENZOATE 125-125 MG/ML IJ SOLN	BOTH IP/OP	$58.05 	$42.96	$0.00	$46.53		$0.00	$0.00	$0.00	$0.00	$0.00	$44.81	$44.81	$46.53	$0.00	$12.10	$0.00	$0.00	$0.00	$0.00	$23.98	$37.98	$38.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1306	ERX	HCPCS 25000001	00409-1631-10	CALCIUM CHLORIDE 10 % IV SOLN	BOTH IP/OP	$89.52 	$66.24	$0.00	$69.00		$0.00	$0.00	$0.00	$0.00	$0.00	$66.44	$66.44	$69.00	$0.00	$18.66	$0.00	$0.00	$0.00	$0.00	$40.59	$64.29	$64.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1306	ERX	HCPCS 25000001	00409-4928-34	CALCIUM CHLORIDE 10 % IV SOLN	BOTH IP/OP	$89.52 	$66.24	$0.00	$69.00		$0.00	$0.00	$0.00	$0.00	$0.00	$66.44	$66.44	$69.00	$0.00	$18.66	$0.00	$0.00	$0.00	$0.00	$40.59	$64.29	$64.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1306	ERX	HCPCS 25000001	00517-2710-25	CALCIUM CHLORIDE 10 % IV SOLN	BOTH IP/OP	$89.52 	$66.24	$0.00	$69.00		$0.00	$0.00	$0.00	$0.00	$0.00	$66.44	$66.44	$69.00	$0.00	$18.66	$0.00	$0.00	$0.00	$0.00	$40.59	$64.29	$64.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1306	ERX	HCPCS 25000001	00517-6710-01	CALCIUM CHLORIDE 10 % IV SOLN	BOTH IP/OP	$89.52 	$66.24	$0.00	$69.00		$0.00	$0.00	$0.00	$0.00	$0.00	$66.44	$66.44	$69.00	$0.00	$18.66	$0.00	$0.00	$0.00	$0.00	$40.59	$64.29	$64.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1306	ERX	HCPCS 25000001	00517-6710-10	CALCIUM CHLORIDE 10 % IV SOLN	BOTH IP/OP	$89.52 	$66.24	$0.00	$69.00		$0.00	$0.00	$0.00	$0.00	$0.00	$66.44	$66.44	$69.00	$0.00	$18.66	$0.00	$0.00	$0.00	$0.00	$40.59	$64.29	$64.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1306	ERX	HCPCS 25000001	76329-3304-01	CALCIUM CHLORIDE 10 % IV SOLN	BOTH IP/OP	$89.52 	$66.24	$0.00	$69.00		$0.00	$0.00	$0.00	$0.00	$0.00	$66.44	$66.44	$69.00	$0.00	$18.66	$0.00	$0.00	$0.00	$0.00	$40.59	$64.29	$64.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1308	ERX	HCPCS 63700001	00904-5062-60	CALCIUM CITRATE 950 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1312	ERX	HCPCS J0610	63323-0360-19	CALCIUM GLUCONATE 10 % IV SOLN	BOTH IP/OP	$32.00 	$23.68	$0.00	$25.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.00	$25.34	$25.60	$0.00		$0.00	$4.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1350	ERX	HCPCS 63700001	00536-2525-25	CAPSAICIN 0.025 % EX CREA	BOTH IP/OP	$41.74 	$30.89	$0.00	$30.28		$0.00	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00	$8.70	$0.00	$0.00	$0.00	$0.00	$18.93	$29.98	$30.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1355	ERX	HCPCS 63700001	00904-3854-61	CARBAMAZEPINE 100 MG PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1356	ERX	HCPCS 25000001	99999-6004-61	CARBAMAZEPINE 100 MG/5ML PO SUSP	BOTH IP/OP	$107.00 	$79.18	$0.00	$82.48		$0.00	$0.00	$0.00	$0.00	$0.00	$79.42	$79.42	$82.48	$0.00	$22.30	$0.00	$0.00	$0.00	$0.00	$48.51	$76.84	$77.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1356	ERX	HCPCS 25000001	00078-0508-83	CARBAMAZEPINE 100 MG/5ML PO SUSP	BOTH IP/OP	$107.00 	$79.18	$0.00	$472.86		$0.00	$0.00	$0.00	$0.00	$0.00	$79.42	$79.42	$82.48	$0.00	$22.30	$0.00	$0.00	$0.00	$0.00	$48.51	$472.86	$77.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1356	ERX	HCPCS 25000001	60432-0129-16	CARBAMAZEPINE 100 MG/5ML PO SUSP	BOTH IP/OP	$107.00 	$79.18	$0.00	$472.86		$0.00	$0.00	$0.00	$0.00	$0.00	$79.42	$79.42	$82.48	$0.00	$22.30	$0.00	$0.00	$0.00	$0.00	$48.51	$472.86	$77.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1357	ERX	HCPCS 63700001	00904-6172-61	CARBAMAZEPINE 200 MG PO TABS	BOTH IP/OP	$6.08 	$4.50	$0.00	$4.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.04	$4.82	$4.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1357	ERX	HCPCS 63700001	51079-0385-20	CARBAMAZEPINE 200 MG PO TABS	BOTH IP/OP	$6.08 	$4.50	$0.00	$4.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.04	$4.82	$4.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1395	ERX	HCPCS 63700001	42543-0700-01	CARISOPRODOL 350 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1445	ERX	HCPCS J0690	00143-9262-25	CEFAZOLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1445	ERX	HCPCS J0690	00143-9924-90	CEFAZOLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1445	ERX	HCPCS J0690	00781-3451-96	CEFAZOLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1445	ERX	HCPCS J0690	25021-0101-10	CEFAZOLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1445	ERX	HCPCS J0690	44567-0707-25	CEFAZOLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1445	ERX	HCPCS J0690	60505-6142-05	CEFAZOLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1445	ERX	HCPCS J0690	63323-0237-10	CEFAZOLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1446	ERX	HCPCS J0690	00143-9261-01	CEFAZOLIN SODIUM 10 G IJ SOLR	BOTH IP/OP	$60.34 	$44.65	$0.00	$46.51	$27.15	$27.15	$0.00	$0.00	$0.00	$13.87	$44.78	$44.78	$46.51	$0.00	$17.53	$0.00	$35.69	$35.69	$0.00	$27.36	$43.34	$43.78	$0.00		$0.00	$19.27	$0.00	$0.00	$18.35	$0.00	$0.00	$0.00	$0.00	$0.00
1446	ERX	HCPCS J0690	00143-9261-10	CEFAZOLIN SODIUM 10 G IJ SOLR	BOTH IP/OP	$60.34 	$44.65	$0.00	$46.51	$27.15	$27.15	$0.00	$0.00	$0.00	$13.87	$44.78	$44.78	$46.51	$0.00	$17.53	$0.00	$35.69	$35.69	$0.00	$27.36	$43.34	$43.78	$0.00		$0.00	$19.27	$0.00	$0.00	$18.35	$0.00	$0.00	$0.00	$0.00	$0.00
1446	ERX	HCPCS J0690	00143-9983-03	CEFAZOLIN SODIUM 10 G IJ SOLR	BOTH IP/OP	$60.34 	$44.65	$0.00	$46.51	$27.15	$27.15	$0.00	$0.00	$0.00	$13.87	$44.78	$44.78	$46.51	$0.00	$17.53	$0.00	$35.69	$35.69	$0.00	$27.36	$43.34	$43.78	$0.00		$0.00	$19.27	$0.00	$0.00	$18.35	$0.00	$0.00	$0.00	$0.00	$0.00
1446	ERX	HCPCS J0690	00781-3452-95	CEFAZOLIN SODIUM 10 G IJ SOLR	BOTH IP/OP	$60.34 	$44.65	$0.00	$46.51	$27.15	$27.15	$0.00	$0.00	$0.00	$13.87	$44.78	$44.78	$46.51	$0.00	$17.53	$0.00	$35.69	$35.69	$0.00	$27.36	$43.34	$43.78	$0.00		$0.00	$19.27	$0.00	$0.00	$18.35	$0.00	$0.00	$0.00	$0.00	$0.00
1446	ERX	HCPCS J0690	25021-0102-99	CEFAZOLIN SODIUM 10 G IJ SOLR	BOTH IP/OP	$60.34 	$44.65	$0.00	$46.51	$27.15	$27.15	$0.00	$0.00	$0.00	$13.87	$44.78	$44.78	$46.51	$0.00	$17.53	$0.00	$35.69	$35.69	$0.00	$27.36	$43.34	$43.78	$0.00		$0.00	$19.27	$0.00	$0.00	$18.35	$0.00	$0.00	$0.00	$0.00	$0.00
1446	ERX	HCPCS J0690	44567-0708-10	CEFAZOLIN SODIUM 10 G IJ SOLR	BOTH IP/OP	$60.34 	$44.65	$0.00	$46.51	$27.15	$27.15	$0.00	$0.00	$0.00	$13.87	$44.78	$44.78	$46.51	$0.00	$17.53	$0.00	$35.69	$35.69	$0.00	$27.36	$43.34	$43.78	$0.00		$0.00	$19.27	$0.00	$0.00	$18.35	$0.00	$0.00	$0.00	$0.00	$0.00
1446	ERX	HCPCS J0690	63323-0238-61	CEFAZOLIN SODIUM 10 G IJ SOLR	BOTH IP/OP	$60.34 	$44.65	$0.00	$46.51	$27.15	$27.15	$0.00	$0.00	$0.00	$13.87	$44.78	$44.78	$46.51	$0.00	$17.53	$0.00	$35.69	$35.69	$0.00	$27.36	$43.34	$43.78	$0.00		$0.00	$19.27	$0.00	$0.00	$18.35	$0.00	$0.00	$0.00	$0.00	$0.00
1448	ERX	HCPCS J0690	00143-9923-90	CEFAZOLIN SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.69	$16.33	$16.33	$16.96	$0.00	$0.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.96	$0.00	$0.00	$0.92	$0.00	$0.00	$0.00	$0.00	$0.00
1448	ERX	HCPCS J0690	00781-3450-95	CEFAZOLIN SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.69	$16.33	$16.33	$16.96	$0.00	$0.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.96	$0.00	$0.00	$0.92	$0.00	$0.00	$0.00	$0.00	$0.00
1448	ERX	HCPCS J0690	25021-0100-10	CEFAZOLIN SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.69	$16.33	$16.33	$16.96	$0.00	$0.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.96	$0.00	$0.00	$0.92	$0.00	$0.00	$0.00	$0.00	$0.00
1448	ERX	HCPCS J0690	63323-0236-10	CEFAZOLIN SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.69	$16.33	$16.33	$16.96	$0.00	$0.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.96	$0.00	$0.00	$0.92	$0.00	$0.00	$0.00	$0.00	$0.00
1465	ERX	HCPCS J0697	00143-9979-22	CEFUROXIME SODIUM 750 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$2.37	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1465	ERX	HCPCS J0697	25021-0118-10	CEFUROXIME SODIUM 750 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$2.37	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1622	ERX	HCPCS 25000001	00555-0033-02	CHLORDIAZEPOXIDE HCL 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1622	ERX	HCPCS 25000001	51079-0375-01	CHLORDIAZEPOXIDE HCL 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1622	ERX	HCPCS 25000001	51079-0375-20	CHLORDIAZEPOXIDE HCL 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1623	ERX	HCPCS 25000001	51079-0141-01	CHLORDIAZEPOXIDE HCL 25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1623	ERX	HCPCS 25000001	51079-0141-20	CHLORDIAZEPOXIDE HCL 25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1624	ERX	HCPCS 25000001	00555-0158-02	CHLORDIAZEPOXIDE HCL 5 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1624	ERX	HCPCS 25000001	51079-0374-01	CHLORDIAZEPOXIDE HCL 5 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1624	ERX	HCPCS 25000001	51079-0374-20	CHLORDIAZEPOXIDE HCL 5 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1637	ERX	HCPCS 63700001	64980-0177-50	CHLOROQUINE PHOSPHATE 250 MG PO TABS	BOTH IP/OP	$38.53 	$28.51	$0.00	$27.95		$0.00	$0.00	$0.00	$6.86	$0.00	$0.00	$0.00	$0.00	$0.00	$8.03	$0.00	$0.00	$0.00	$0.00	$17.47	$27.67	$27.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1645	ERX	HCPCS 63700001	00904-0012-59	CHLORPHENIRAMINE MALEATE 4 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1645	ERX	HCPCS 63700001	10135-0133-01	CHLORPHENIRAMINE MALEATE 4 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1649	ERX	HCPCS J3230	00641-1397-31	CHLORPROMAZINE HCL 25 MG/ML IJ SOLN	BOTH IP/OP	$133.82 	$99.03	$0.00	$103.15	$60.22	$60.22	$0.00	$0.00	$0.00	$9.35	$99.32	$99.32	$103.15	$0.00	$38.62	$0.00	$79.15	$79.15	$0.00	$60.67	$96.10	$97.07	$0.00		$0.00	$37.08	$0.00	$0.00	$35.31	$0.00	$0.00	$0.00	$0.00	$0.00
1649	ERX	HCPCS J3230	00641-1397-35	CHLORPROMAZINE HCL 25 MG/ML IJ SOLN	BOTH IP/OP	$133.82 	$99.03	$0.00	$103.15	$60.22	$60.22	$0.00	$0.00	$0.00	$9.35	$99.32	$99.32	$103.15	$0.00	$38.62	$0.00	$79.15	$79.15	$0.00	$60.67	$96.10	$97.07	$0.00		$0.00	$37.08	$0.00	$0.00	$35.31	$0.00	$0.00	$0.00	$0.00	$0.00
1653	ERX	HCPCS Q0161	00781-5913-01	CHLORPROMAZINE HCL 10 MG PO TABS	BOTH IP/OP	$25.20 	$18.65	$0.00	$20.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.60	$19.96	$20.16	$0.00		$0.00	$3.94	$0.00	$0.00	$4.01	$0.00	$0.00	$0.00	$0.00	$0.00
1653	ERX	HCPCS Q0161	00832-0300-00	CHLORPROMAZINE HCL 10 MG PO TABS	BOTH IP/OP	$25.20 	$18.65	$0.00	$20.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.60	$19.96	$20.16	$0.00		$0.00	$3.94	$0.00	$0.00	$4.01	$0.00	$0.00	$0.00	$0.00	$0.00
1653	ERX	HCPCS Q0161	51079-0518-01	CHLORPROMAZINE HCL 10 MG PO TABS	BOTH IP/OP	$25.20 	$18.65	$0.00	$20.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.60	$19.96	$20.16	$0.00		$0.00	$3.94	$0.00	$0.00	$4.01	$0.00	$0.00	$0.00	$0.00	$0.00
1653	ERX	HCPCS Q0161	51079-0518-20	CHLORPROMAZINE HCL 10 MG PO TABS	BOTH IP/OP	$25.20 	$18.65	$0.00	$20.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.60	$19.96	$20.16	$0.00		$0.00	$3.94	$0.00	$0.00	$4.01	$0.00	$0.00	$0.00	$0.00	$0.00
1654	ERX	HCPCS Q0161	00832-0303-00	CHLORPROMAZINE HCL 100 MG PO TABS	BOTH IP/OP	$77.83 	$57.59	$0.00	$62.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.92	$61.64	$62.26	$0.00		$0.00	$12.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1654	ERX	HCPCS Q0161	51079-0516-01	CHLORPROMAZINE HCL 100 MG PO TABS	BOTH IP/OP	$77.83 	$57.59	$0.00	$62.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.92	$61.64	$62.26	$0.00		$0.00	$12.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1654	ERX	HCPCS Q0161	51079-0516-20	CHLORPROMAZINE HCL 100 MG PO TABS	BOTH IP/OP	$77.83 	$57.59	$0.00	$62.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.92	$61.64	$62.26	$0.00		$0.00	$12.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1655	ERX	HCPCS Q0161	00781-5917-01	CHLORPROMAZINE HCL 200 MG PO TABS	BOTH IP/OP	$92.82 	$68.69	$0.00	$74.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.41	$73.51	$74.26	$0.00		$0.00	$14.53	$0.00	$0.00	$14.78	$0.00	$0.00	$0.00	$0.00	$0.00
1655	ERX	HCPCS Q0161	00832-0304-00	CHLORPROMAZINE HCL 200 MG PO TABS	BOTH IP/OP	$92.82 	$68.69	$0.00	$74.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.41	$73.51	$74.26	$0.00		$0.00	$14.53	$0.00	$0.00	$14.78	$0.00	$0.00	$0.00	$0.00	$0.00
1655	ERX	HCPCS Q0161	51079-0517-01	CHLORPROMAZINE HCL 200 MG PO TABS	BOTH IP/OP	$92.82 	$68.69	$0.00	$74.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.41	$73.51	$74.26	$0.00		$0.00	$14.53	$0.00	$0.00	$14.78	$0.00	$0.00	$0.00	$0.00	$0.00
1655	ERX	HCPCS Q0161	51079-0517-20	CHLORPROMAZINE HCL 200 MG PO TABS	BOTH IP/OP	$92.82 	$68.69	$0.00	$74.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.41	$73.51	$74.26	$0.00		$0.00	$14.53	$0.00	$0.00	$14.78	$0.00	$0.00	$0.00	$0.00	$0.00
1656	ERX	HCPCS Q0161	00781-5914-01	CHLORPROMAZINE HCL 25 MG PO TABS	BOTH IP/OP	$36.34 	$26.89	$0.00	$29.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.17	$28.78	$29.07	$0.00		$0.00	$5.69	$0.00	$0.00	$5.79	$0.00	$0.00	$0.00	$0.00	$0.00
1656	ERX	HCPCS Q0161	00832-0301-00	CHLORPROMAZINE HCL 25 MG PO TABS	BOTH IP/OP	$36.34 	$26.89	$0.00	$29.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.17	$28.78	$29.07	$0.00		$0.00	$5.69	$0.00	$0.00	$5.79	$0.00	$0.00	$0.00	$0.00	$0.00
1656	ERX	HCPCS Q0161	51079-0519-01	CHLORPROMAZINE HCL 25 MG PO TABS	BOTH IP/OP	$36.34 	$26.89	$0.00	$29.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.17	$28.78	$29.07	$0.00		$0.00	$5.69	$0.00	$0.00	$5.79	$0.00	$0.00	$0.00	$0.00	$0.00
1656	ERX	HCPCS Q0161	51079-0519-20	CHLORPROMAZINE HCL 25 MG PO TABS	BOTH IP/OP	$36.34 	$26.89	$0.00	$29.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.17	$28.78	$29.07	$0.00		$0.00	$5.69	$0.00	$0.00	$5.79	$0.00	$0.00	$0.00	$0.00	$0.00
1657	ERX	HCPCS Q0161	00781-5915-01	CHLORPROMAZINE HCL 50 MG PO TABS	BOTH IP/OP	$43.48 	$32.18	$0.00	$33.51	$19.57	$19.57	$0.00	$0.00	$0.00	$9.06	$32.27	$32.27	$33.51	$0.00	$9.06	$0.00	$25.72	$25.72	$0.00	$19.72	$31.23	$31.54	$0.00		$0.00	$6.17	$0.00	$0.00	$6.28	$0.00	$0.00	$0.00	$0.00	$0.00
1657	ERX	HCPCS Q0161	00832-0302-00	CHLORPROMAZINE HCL 50 MG PO TABS	BOTH IP/OP	$43.48 	$32.18	$0.00	$33.51	$19.57	$19.57	$0.00	$0.00	$0.00	$9.06	$32.27	$32.27	$33.51	$0.00	$9.06	$0.00	$25.72	$25.72	$0.00	$19.72	$31.23	$31.54	$0.00		$0.00	$6.17	$0.00	$0.00	$6.28	$0.00	$0.00	$0.00	$0.00	$0.00
1657	ERX	HCPCS Q0161	00832-0302-89	CHLORPROMAZINE HCL 50 MG PO TABS	BOTH IP/OP	$43.48 	$32.18	$0.00	$33.51	$19.57	$19.57	$0.00	$0.00	$0.00	$9.06	$32.27	$32.27	$33.51	$0.00	$9.06	$0.00	$25.72	$25.72	$0.00	$19.72	$31.23	$31.54	$0.00		$0.00	$6.17	$0.00	$0.00	$6.28	$0.00	$0.00	$0.00	$0.00	$0.00
1657	ERX	HCPCS Q0161	51079-0130-01	CHLORPROMAZINE HCL 50 MG PO TABS	BOTH IP/OP	$43.48 	$32.18	$0.00	$33.51	$19.57	$19.57	$0.00	$0.00	$0.00	$9.06	$32.27	$32.27	$33.51	$0.00	$9.06	$0.00	$25.72	$25.72	$0.00	$19.72	$31.23	$31.54	$0.00		$0.00	$6.17	$0.00	$0.00	$6.28	$0.00	$0.00	$0.00	$0.00	$0.00
1657	ERX	HCPCS Q0161	51079-0130-20	CHLORPROMAZINE HCL 50 MG PO TABS	BOTH IP/OP	$43.48 	$32.18	$0.00	$33.51	$19.57	$19.57	$0.00	$0.00	$0.00	$9.06	$32.27	$32.27	$33.51	$0.00	$9.06	$0.00	$25.72	$25.72	$0.00	$19.72	$31.23	$31.54	$0.00		$0.00	$6.17	$0.00	$0.00	$6.28	$0.00	$0.00	$0.00	$0.00	$0.00
1661	ERX	HCPCS 63700001	00378-0222-01	CHLORTHALIDONE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1661	ERX	HCPCS 63700001	16714-0800-01	CHLORTHALIDONE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1661	ERX	HCPCS 63700001	43598-0719-01	CHLORTHALIDONE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1661	ERX	HCPCS 63700001	57664-0648-88	CHLORTHALIDONE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1661	ERX	HCPCS 63700001	68382-0970-01	CHLORTHALIDONE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1662	ERX	HCPCS 63700001	00378-0213-01	CHLORTHALIDONE 50 MG PO TABS	BOTH IP/OP	$6.24 	$4.62	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1662	ERX	HCPCS 63700001	57664-0649-88	CHLORTHALIDONE 50 MG PO TABS	BOTH IP/OP	$6.24 	$4.62	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1662	ERX	HCPCS 63700001	64980-0304-01	CHLORTHALIDONE 50 MG PO TABS	BOTH IP/OP	$6.24 	$4.62	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1662	ERX	HCPCS 63700001	66689-0346-99	CHLORTHALIDONE 50 MG PO TABS	BOTH IP/OP	$6.24 	$4.62	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1664	ERX	HCPCS 63700001	00591-2520-01	CHLORZOXAZONE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1676	ERX	HCPCS J0725	55566-1501-01	CHORIONIC GONADOTROPIN 10000 UNITS IM SOLR	BOTH IP/OP	$75.45 	$55.83	$0.00	$58.16		$0.00	$0.00	$0.00	$0.00	$0.00	$56.00	$56.00	$58.16	$0.00	$26.57	$0.00	$0.00	$0.00	$0.00	$32.90	$52.11	$52.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1683	ERX	HCPCS 63700001	00904-4314-60	CHROMIUM 200 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.75	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1740	ERX	HCPCS 63700001	00904-5959-61	CLINDAMYCIN HCL 150 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1740	ERX	HCPCS 63700001	63739-0059-10	CLINDAMYCIN HCL 150 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1742	ERX	HCPCS 25000001	00168-0201-30	CLINDAMYCIN PHOSPHATE 1 % EX SOLN	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1742	ERX	HCPCS 25000001	45802-0562-01	CLINDAMYCIN PHOSPHATE 1 % EX SOLN	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1753	ERX	HCPCS 63700001	49884-0701-55	CLOMIPHENE CITRATE 50 MG PO TABS	BOTH IP/OP	$29.00 	$21.46	$0.00	$21.04		$0.00	$0.00	$0.00	$5.16	$0.00	$0.00	$0.00	$0.00	$0.00	$6.04	$0.00	$0.00	$0.00	$0.00	$13.15	$20.83	$21.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1754	ERX	HCPCS 63700001	00406-8807-01	CLOMIPRAMINE HCL 50 MG PO CAPS	BOTH IP/OP	$47.11 	$34.86	$0.00	$34.18		$0.00	$0.00	$0.00	$8.39	$0.00	$0.00	$0.00	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.36	$33.83	$34.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1754	ERX	HCPCS 63700001	00781-2037-01	CLOMIPRAMINE HCL 50 MG PO CAPS	BOTH IP/OP	$47.11 	$34.86	$0.00	$34.18		$0.00	$0.00	$0.00	$8.39	$0.00	$0.00	$0.00	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.36	$33.83	$34.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1754	ERX	HCPCS 63700001	51672-4012-06	CLOMIPRAMINE HCL 50 MG PO CAPS	BOTH IP/OP	$47.11 	$34.86	$0.00	$34.18		$0.00	$0.00	$0.00	$8.39	$0.00	$0.00	$0.00	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.36	$33.83	$34.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1755	ERX	HCPCS 25000001	00597-0006-01	CLONIDINE HCL 0.1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1755	ERX	HCPCS 25000001	29300-0135-01	CLONIDINE HCL 0.1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1755	ERX	HCPCS 25000001	51079-0299-01	CLONIDINE HCL 0.1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1755	ERX	HCPCS 25000001	51079-0299-20	CLONIDINE HCL 0.1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1755	ERX	HCPCS 25000001	62332-0054-91	CLONIDINE HCL 0.1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1755	ERX	HCPCS 25000001	63739-0060-10	CLONIDINE HCL 0.1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1756	ERX	HCPCS 25000001	29300-0136-01	CLONIDINE HCL 0.2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1756	ERX	HCPCS 25000001	51079-0300-01	CLONIDINE HCL 0.2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1756	ERX	HCPCS 25000001	51079-0300-20	CLONIDINE HCL 0.2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1756	ERX	HCPCS 25000001	62332-0055-31	CLONIDINE HCL 0.2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1767	ERX	HCPCS 25000001	00904-7822-31	CLOTRIMAZOLE 1 % EX CREA	BOTH IP/OP	$35.96 	$26.61	$0.00	$27.72		$0.00	$0.00	$0.00	$0.00	$0.00	$26.69	$26.69	$27.72	$0.00	$7.49	$0.00	$0.00	$0.00	$0.00	$16.31	$25.83	$26.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1767	ERX	HCPCS 25000001	45802-0434-11	CLOTRIMAZOLE 1 % EX CREA	BOTH IP/OP	$35.96 	$26.61	$0.00	$27.72		$0.00	$0.00	$0.00	$0.00	$0.00	$26.69	$26.69	$27.72	$0.00	$7.49	$0.00	$0.00	$0.00	$0.00	$16.31	$25.83	$26.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1768	ERX	HCPCS 25000001	51672-1260-03	CLOTRIMAZOLE 1 % EX SOLN	BOTH IP/OP	$259.32 	$191.90	$0.00	$199.88		$0.00	$0.00	$0.00	$0.00	$0.00	$192.47	$192.47	$199.88	$0.00	$54.04	$0.00	$0.00	$0.00	$0.00	$117.70	$186.44	$188.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1768	ERX	HCPCS 25000001	70954-0036-20	CLOTRIMAZOLE 1 % EX SOLN	BOTH IP/OP	$259.32 	$191.90	$0.00	$199.88		$0.00	$0.00	$0.00	$0.00	$0.00	$192.47	$192.47	$199.88	$0.00	$54.04	$0.00	$0.00	$0.00	$0.00	$117.70	$186.44	$188.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1770	ERX	HCPCS 25000001	00395-1949-88	CLOVE OIL OIL	BOTH IP/OP	$27.20 	$20.13	$0.00	$20.97		$0.00	$0.00	$0.00	$0.00	$0.00	$20.19	$20.19	$20.97	$0.00	$5.67	$0.00	$0.00	$0.00	$0.00	$11.86	$18.79	$18.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1802	ERX	HCPCS 25000001	00054-0244-24	CODEINE SULFATE 30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1821	ERX	HCPCS 63700001	00254-2008-01	COLCHICINE 0.6 MG PO TABS	BOTH IP/OP	$28.23 	$20.89	$0.00	$20.48		$0.00	$0.00	$0.00	$5.02	$0.00	$0.00	$0.00	$0.00	$0.00	$5.88	$0.00	$0.00	$0.00	$0.00	$12.80	$20.28	$20.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1821	ERX	HCPCS 63700001	64764-0119-01	COLCHICINE 0.6 MG PO TABS	BOTH IP/OP	$28.23 	$20.89	$0.00	$20.48		$0.00	$0.00	$0.00	$5.02	$0.00	$0.00	$0.00	$0.00	$0.00	$5.88	$0.00	$0.00	$0.00	$0.00	$12.80	$20.28	$20.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1821	ERX	HCPCS 63700001	65162-0710-09	COLCHICINE 0.6 MG PO TABS	BOTH IP/OP	$28.23 	$20.89	$0.00	$20.48		$0.00	$0.00	$0.00	$5.02	$0.00	$0.00	$0.00	$0.00	$0.00	$5.88	$0.00	$0.00	$0.00	$0.00	$12.80	$20.28	$20.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1821	ERX	HCPCS 63700001	66993-0165-02	COLCHICINE 0.6 MG PO TABS	BOTH IP/OP	$28.23 	$20.89	$0.00	$20.48		$0.00	$0.00	$0.00	$5.02	$0.00	$0.00	$0.00	$0.00	$0.00	$5.88	$0.00	$0.00	$0.00	$0.00	$12.80	$20.28	$20.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1985	ERX	HCPCS 25000001	00409-4092-01	CUPRIC CHLORIDE 0.4 MG/ML IV SOLN	BOTH IP/OP	$98.36 	$72.79	$0.00	$75.82		$0.00	$0.00	$0.00	$0.00	$0.00	$73.00	$73.00	$75.82	$0.00	$20.50	$0.00	$0.00	$0.00	$0.00	$41.04	$65.01	$65.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2007	ERX	HCPCS J3420	00143-9621-01	CYANOCOBALAMIN 1000 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.31	$16.33	$16.33	$16.96	$0.00	$2.49	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.60	$0.00	$0.00	$2.47	$0.00	$0.00	$0.00	$0.00	$0.00
2007	ERX	HCPCS J3420	00143-9621-25	CYANOCOBALAMIN 1000 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.31	$16.33	$16.33	$16.96	$0.00	$2.49	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.60	$0.00	$0.00	$2.47	$0.00	$0.00	$0.00	$0.00	$0.00
2007	ERX	HCPCS J3420	00517-0031-25	CYANOCOBALAMIN 1000 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.31	$16.33	$16.33	$16.96	$0.00	$2.49	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.60	$0.00	$0.00	$2.47	$0.00	$0.00	$0.00	$0.00	$0.00
2007	ERX	HCPCS J3420	63323-0044-00	CYANOCOBALAMIN 1000 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.31	$16.33	$16.33	$16.96	$0.00	$2.49	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.60	$0.00	$0.00	$2.47	$0.00	$0.00	$0.00	$0.00	$0.00
2007	ERX	HCPCS J3420	63323-0044-01	CYANOCOBALAMIN 1000 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.31	$16.33	$16.33	$16.96	$0.00	$2.49	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.60	$0.00	$0.00	$2.47	$0.00	$0.00	$0.00	$0.00	$0.00
2007	ERX	HCPCS J3420	70069-0005-10	CYANOCOBALAMIN 1000 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.31	$16.33	$16.33	$16.96	$0.00	$2.49	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.60	$0.00	$0.00	$2.47	$0.00	$0.00	$0.00	$0.00	$0.00
2017	ERX	HCPCS 63700001	52817-0332-10	CYCLOBENZAPRINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2017	ERX	HCPCS 63700001	52817-0332-50	CYCLOBENZAPRINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2017	ERX	HCPCS 63700001	63739-0531-10	CYCLOBENZAPRINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2017	ERX	HCPCS 63700001	69097-0846-07	CYCLOBENZAPRINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2025	ERX	HCPCS 25000001	17478-0100-02	CYCLOPENTOLATE HCL 1 % OP SOLN	BOTH IP/OP	$206.33 	$152.68	$0.00	$174.96		$0.00	$0.00	$0.00	$0.00	$0.00	$168.46	$168.46	$174.96	$0.00	$43.00	$0.00	$0.00	$0.00	$0.00	$66.97	$50.56	$107.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2025	ERX	HCPCS 25000001	24208-0735-01	CYCLOPENTOLATE HCL 1 % OP SOLN	BOTH IP/OP	$206.33 	$152.68	$0.00	$174.96		$0.00	$0.00	$0.00	$0.00	$0.00	$168.46	$168.46	$174.96	$0.00	$43.00	$0.00	$0.00	$0.00	$0.00	$66.97	$50.56	$107.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2025	ERX	HCPCS 25000001	61314-0396-01	CYCLOPENTOLATE HCL 1 % OP SOLN	BOTH IP/OP	$206.33 	$152.68	$0.00	$174.96		$0.00	$0.00	$0.00	$0.00	$0.00	$168.46	$168.46	$174.96	$0.00	$43.00	$0.00	$0.00	$0.00	$0.00	$66.97	$50.56	$107.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2025	ERX	HCPCS 25000001	17478-0100-12	CYCLOPENTOLATE HCL 1 % OP SOLN	BOTH IP/OP	$206.33 	$152.68	$0.00	$174.96		$0.00	$0.00	$0.00	$0.00	$0.00	$168.46	$168.46	$174.96	$0.00	$43.00	$0.00	$0.00	$0.00	$0.00	$66.97	$106.07	$107.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2025	ERX	HCPCS 25000001	24208-0735-06	CYCLOPENTOLATE HCL 1 % OP SOLN	BOTH IP/OP	$206.33 	$152.68	$0.00	$174.96		$0.00	$0.00	$0.00	$0.00	$0.00	$168.46	$168.46	$174.96	$0.00	$43.00	$0.00	$0.00	$0.00	$0.00	$66.97	$106.07	$107.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2025	ERX	HCPCS 25000001	61314-0396-03	CYCLOPENTOLATE HCL 1 % OP SOLN	BOTH IP/OP	$206.33 	$152.68	$0.00	$174.96		$0.00	$0.00	$0.00	$0.00	$0.00	$168.46	$168.46	$174.96	$0.00	$43.00	$0.00	$0.00	$0.00	$0.00	$66.97	$106.07	$107.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2025	ERX	HCPCS 25000001	00065-0396-05	CYCLOPENTOLATE HCL 1 % OP SOLN	BOTH IP/OP	$206.33 	$152.68	$0.00	$174.96		$0.00	$0.00	$0.00	$0.00	$0.00	$168.46	$168.46	$174.96	$0.00	$43.00	$0.00	$0.00	$0.00	$0.00	$66.97	$148.34	$107.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2033	ERX	HCPCS 63700001	51991-0838-01	CYPROHEPTADINE HCL 4 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2091	ERX	HCPCS J9130	00703-5075-01	DACARBAZINE 200 MG IV SOLR	BOTH IP/OP	$137.97 	$102.10	$0.00	$110.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.99	$109.27	$110.38	$0.00		$0.00	$9.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2091	ERX	HCPCS J9130	61703-0327-22	DACARBAZINE 200 MG IV SOLR	BOTH IP/OP	$137.97 	$102.10	$0.00	$110.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.99	$109.27	$110.38	$0.00		$0.00	$9.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2091	ERX	HCPCS J9130	63323-0128-20	DACARBAZINE 200 MG IV SOLR	BOTH IP/OP	$137.97 	$102.10	$0.00	$110.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.99	$109.27	$110.38	$0.00		$0.00	$9.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2120	ERX	HCPCS 25000001	00527-1369-01	DANAZOL 200 MG PO CAPS	BOTH IP/OP	$38.00 	$28.12	$0.00	$29.29		$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$17.24	$27.30	$27.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2120	ERX	HCPCS 25000001	00527-1369-06	DANAZOL 200 MG PO CAPS	BOTH IP/OP	$38.00 	$28.12	$0.00	$29.29		$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$17.24	$27.30	$27.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2120	ERX	HCPCS 25000001	00555-0635-02	DANAZOL 200 MG PO CAPS	BOTH IP/OP	$38.00 	$28.12	$0.00	$29.29		$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$17.24	$27.30	$27.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2120	ERX	HCPCS 25000001	00555-0635-09	DANAZOL 200 MG PO CAPS	BOTH IP/OP	$38.00 	$28.12	$0.00	$29.29		$0.00	$0.00	$0.00	$0.00	$0.00	$28.20	$28.20	$29.29	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$17.24	$27.30	$27.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2131	ERX	HCPCS 63700001	47781-0334-31	DAPSONE 100 MG PO TABS	BOTH IP/OP	$11.32 	$8.38	$0.00	$8.21		$0.00	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$0.00	$2.36	$0.00	$0.00	$0.00	$0.00	$5.13	$8.13	$8.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2131	ERX	HCPCS 63700001	69543-0151-30	DAPSONE 100 MG PO TABS	BOTH IP/OP	$11.32 	$8.38	$0.00	$8.21		$0.00	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$0.00	$2.36	$0.00	$0.00	$0.00	$0.00	$5.13	$8.13	$8.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2131	ERX	HCPCS 63700001	70954-0136-10	DAPSONE 100 MG PO TABS	BOTH IP/OP	$11.32 	$8.38	$0.00	$8.21		$0.00	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$0.00	$2.36	$0.00	$0.00	$0.00	$0.00	$5.13	$8.13	$8.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2131	ERX	HCPCS 63700001	70954-0136-20	DAPSONE 100 MG PO TABS	BOTH IP/OP	$11.32 	$8.38	$0.00	$8.21		$0.00	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$0.00	$2.36	$0.00	$0.00	$0.00	$0.00	$5.13	$8.13	$8.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2132	ERX	HCPCS 63700001	47781-0333-31	DAPSONE 25 MG PO TABS	BOTH IP/OP	$11.48 	$8.50	$0.00	$8.33		$0.00	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00	$2.39	$0.00	$0.00	$0.00	$0.00	$5.21	$8.24	$8.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2132	ERX	HCPCS 63700001	49938-0102-30	DAPSONE 25 MG PO TABS	BOTH IP/OP	$11.48 	$8.50	$0.00	$8.33		$0.00	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00	$2.39	$0.00	$0.00	$0.00	$0.00	$5.21	$8.24	$8.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2132	ERX	HCPCS 63700001	70954-0135-20	DAPSONE 25 MG PO TABS	BOTH IP/OP	$11.48 	$8.50	$0.00	$8.33		$0.00	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00	$2.39	$0.00	$0.00	$0.00	$0.00	$5.21	$8.24	$8.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2286	ERX	HCPCS 63700001	50742-0113-01	DESIPRAMINE HCL 25 MG PO TABS	BOTH IP/OP	$6.93 	$5.13	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.47	$5.49	$5.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2286	ERX	HCPCS 63700001	69238-1055-01	DESIPRAMINE HCL 25 MG PO TABS	BOTH IP/OP	$6.93 	$5.13	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.47	$5.49	$5.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2287	ERX	HCPCS 63700001	45963-0343-02	DESIPRAMINE HCL 50 MG PO TABS	BOTH IP/OP	$11.23 	$8.31	$0.00	$8.14		$0.00	$0.00	$0.00	$2.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.34	$0.00	$0.00	$0.00	$0.00	$5.09	$8.06	$8.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2287	ERX	HCPCS 63700001	50742-0114-01	DESIPRAMINE HCL 50 MG PO TABS	BOTH IP/OP	$11.23 	$8.31	$0.00	$8.14		$0.00	$0.00	$0.00	$2.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.34	$0.00	$0.00	$0.00	$0.00	$5.09	$8.06	$8.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2291	ERX	HCPCS 25000001	45802-0422-37	DESONIDE 0.05 % EX CREA	BOTH IP/OP	$299.81 	$221.86	$0.00	$231.09		$0.00	$0.00	$0.00	$0.00	$0.00	$222.52	$222.52	$231.09	$0.00	$62.48	$0.00	$0.00	$0.00	$0.00	$136.08	$215.55	$217.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2291	ERX	HCPCS 25000001	51672-1280-03	DESONIDE 0.05 % EX CREA	BOTH IP/OP	$299.81 	$221.86	$0.00	$231.09		$0.00	$0.00	$0.00	$0.00	$0.00	$222.52	$222.52	$231.09	$0.00	$62.48	$0.00	$0.00	$0.00	$0.00	$136.08	$215.55	$217.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2319	ERX	HCPCS J8540	54879-0003-08	DEXAMETHASONE 0.5 MG/5ML PO ELIX	BOTH IP/OP	$200.83 	$148.61	$0.00	$159.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.38	$159.06	$130.20	$0.00		$0.00	$31.43	$0.00	$0.00	$25.91	$0.00	$0.00	$0.00	$0.00	$0.00
2319	ERX	HCPCS J8540	60432-0466-08	DEXAMETHASONE 0.5 MG/5ML PO ELIX	BOTH IP/OP	$200.83 	$148.61	$0.00	$159.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.38	$159.06	$130.20	$0.00		$0.00	$31.43	$0.00	$0.00	$25.91	$0.00	$0.00	$0.00	$0.00	$0.00
2322	ERX	HCPCS J8540	00054-4179-25	DEXAMETHASONE 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$2.70	$2.70	$0.00	$0.00	$0.00	$0.14	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
2322	ERX	HCPCS J8540	00054-8179-25	DEXAMETHASONE 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$2.70	$2.70	$0.00	$0.00	$0.00	$0.14	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
2327	ERX	HCPCS 25000001	00054-4184-25	DEXAMETHASONE 4 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2327	ERX	HCPCS 25000001	00054-8175-25	DEXAMETHASONE 4 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2332	ERX	HCPCS J1100	00641-6145-25	DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.42	$16.33	$16.33	$16.96	$0.00	$0.55	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.56	$0.00	$0.00	$0.54	$0.00	$0.00	$0.00	$0.00	$0.00
2332	ERX	HCPCS J1100	55150-0237-01	DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.42	$16.33	$16.33	$16.96	$0.00	$0.55	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.56	$0.00	$0.00	$0.54	$0.00	$0.00	$0.00	$0.00	$0.00
2332	ERX	HCPCS J1100	63323-0165-01	DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.42	$16.33	$16.33	$16.96	$0.00	$0.55	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.56	$0.00	$0.00	$0.54	$0.00	$0.00	$0.00	$0.00	$0.00
2332	ERX	HCPCS J1100	63323-0165-02	DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.42	$16.33	$16.33	$16.96	$0.00	$0.55	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.56	$0.00	$0.00	$0.54	$0.00	$0.00	$0.00	$0.00	$0.00
2332	ERX	HCPCS J1100	67457-0423-12	DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.42	$16.33	$16.33	$16.96	$0.00	$0.55	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.56	$0.00	$0.00	$0.54	$0.00	$0.00	$0.00	$0.00	$0.00
2335	ERX	HCPCS 25000001	24208-0720-02	DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OP SOLN	BOTH IP/OP	$224.44 	$166.09	$0.00	$173.00		$0.00	$0.00	$0.00	$0.00	$0.00	$166.58	$166.58	$173.00	$0.00	$46.77	$0.00	$0.00	$0.00	$0.00	$101.88	$161.37	$163.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2354	ERX	HCPCS 63700001	00406-8958-01	DEXTROAMPHETAMINE SULFATE 5 MG PO TABS	BOTH IP/OP	$12.16 	$9.00	$0.00	$8.82		$0.00	$0.00	$0.00	$2.16	$0.00	$0.00	$0.00	$0.00	$0.00	$2.53	$0.00	$0.00	$0.00	$0.00	$5.51	$8.73	$8.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2354	ERX	HCPCS 63700001	00555-0952-02	DEXTROAMPHETAMINE SULFATE 5 MG PO TABS	BOTH IP/OP	$12.16 	$9.00	$0.00	$8.82		$0.00	$0.00	$0.00	$2.16	$0.00	$0.00	$0.00	$0.00	$0.00	$2.53	$0.00	$0.00	$0.00	$0.00	$5.51	$8.73	$8.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2354	ERX	HCPCS 63700001	13107-0035-01	DEXTROAMPHETAMINE SULFATE 5 MG PO TABS	BOTH IP/OP	$12.16 	$9.00	$0.00	$8.82		$0.00	$0.00	$0.00	$2.16	$0.00	$0.00	$0.00	$0.00	$0.00	$2.53	$0.00	$0.00	$0.00	$0.00	$5.51	$8.73	$8.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2357	ERX	HCPCS 25000001	00264-7520-20	DEXTROSE 10 % IV SOLN	BOTH IP/OP	$33.52 	$24.80	$0.00	$25.84		$0.00	$0.00	$0.00	$0.00	$0.00	$24.88	$24.88	$25.84	$0.00	$6.99	$0.00	$0.00	$0.00	$0.00	$15.20	$17.42	$24.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2357	ERX	HCPCS 25000001	00338-0023-02	DEXTROSE 10 % IV SOLN	BOTH IP/OP	$33.52 	$24.80	$0.00	$25.84		$0.00	$0.00	$0.00	$0.00	$0.00	$24.88	$24.88	$25.84	$0.00	$6.99	$0.00	$0.00	$0.00	$0.00	$15.20	$17.42	$24.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2357	ERX	HCPCS 25000001	00264-7520-10	DEXTROSE 10 % IV SOLN	BOTH IP/OP	$33.52 	$24.80	$0.00	$25.84		$0.00	$0.00	$0.00	$0.00	$0.00	$24.88	$24.88	$25.84	$0.00	$6.99	$0.00	$0.00	$0.00	$0.00	$15.20	$18.06	$24.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2357	ERX	HCPCS 25000001	00338-0023-03	DEXTROSE 10 % IV SOLN	BOTH IP/OP	$33.52 	$24.80	$0.00	$25.84		$0.00	$0.00	$0.00	$0.00	$0.00	$24.88	$24.88	$25.84	$0.00	$6.99	$0.00	$0.00	$0.00	$0.00	$15.20	$18.06	$24.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2357	ERX	HCPCS 25000001	00409-7930-03	DEXTROSE 10 % IV SOLN	BOTH IP/OP	$33.52 	$24.80	$0.00	$25.84		$0.00	$0.00	$0.00	$0.00	$0.00	$24.88	$24.88	$25.84	$0.00	$6.99	$0.00	$0.00	$0.00	$0.00	$15.20	$18.06	$24.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2357	ERX	HCPCS 25000001	00338-0023-04	DEXTROSE 10 % IV SOLN	BOTH IP/OP	$33.52 	$24.80	$0.00	$25.84		$0.00	$0.00	$0.00	$0.00	$0.00	$24.88	$24.88	$25.84	$0.00	$6.99	$0.00	$0.00	$0.00	$0.00	$15.20	$24.08	$24.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2357	ERX	HCPCS 25000001	00409-7930-09	DEXTROSE 10 % IV SOLN	BOTH IP/OP	$33.52 	$24.80	$0.00	$25.84		$0.00	$0.00	$0.00	$0.00	$0.00	$24.88	$24.88	$25.84	$0.00	$6.99	$0.00	$0.00	$0.00	$0.00	$15.20	$24.08	$24.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2359	ERX	HCPCS 25000001	00990-7935-19	DEXTROSE 20 % IV SOLN	BOTH IP/OP	$53.20 	$39.37	$0.00	$42.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2361	ERX	HCPCS 25000001	00409-1775-10	DEXTROSE 250 MG/ML IV SOLN	BOTH IP/OP	$53.13 	$39.32	$0.00	$40.95		$0.00	$0.00	$0.00	$0.00	$0.00	$39.43	$39.43	$40.95	$0.00	$11.07	$0.00	$0.00	$0.00	$0.00	$20.87	$33.05	$33.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00264-7510-20	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00338-0017-02	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00264-1510-31	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00338-0017-11	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00338-0017-31	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00338-0017-41	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00338-0551-11	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00264-7510-10	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00338-0017-03	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	63323-0624-75	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00338-0017-04	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00338-0017-18	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00338-0017-38	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00338-0017-48	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2364	ERX	HCPCS J7060	00338-0551-18	DEXTROSE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.24	$9.90	$9.90	$0.00	$0.00	$0.00	$1.28	$16.33	$16.33	$16.96	$0.00	$2.04	$0.00	$13.01	$13.01	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$4.28	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$0.00
2365	ERX	HCPCS 25000001	00409-6648-02	DEXTROSE 50 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2365	ERX	HCPCS 25000001	00409-6648-16	DEXTROSE 50 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2365	ERX	HCPCS 25000001	00409-7517-16	DEXTROSE 50 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2365	ERX	HCPCS 25000001	00409-7936-19	DEXTROSE 50 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2365	ERX	HCPCS 25000001	69374-0953-50	DEXTROSE 50 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2365	ERX	HCPCS 25000001	76329-3301-01	DEXTROSE 50 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2365	ERX	HCPCS 25000001	99999-6007-48	DEXTROSE 50 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2367	ERX	HCPCS 25000001	00264-7387-50	DEXTROSE 70 % IV SOLN	BOTH IP/OP	$75.42 	$55.81	$0.00	$58.13		$0.00	$0.00	$0.00	$0.00	$0.00	$55.98	$55.98	$58.13	$0.00	$15.72	$0.00	$0.00	$0.00	$0.00	$34.20	$54.17	$54.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2367	ERX	HCPCS 25000001	00338-0719-06	DEXTROSE 70 % IV SOLN	BOTH IP/OP	$75.42 	$55.81	$0.00	$58.13		$0.00	$0.00	$0.00	$0.00	$0.00	$55.98	$55.98	$58.13	$0.00	$15.72	$0.00	$0.00	$0.00	$0.00	$34.20	$54.17	$54.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2401	ERX	HCPCS J3360	00409-1273-32	DIAZEPAM 5 MG/ML IJ SOLN	BOTH IP/OP	$34.97 	$25.88	$0.00	$26.95		$0.00	$0.00	$0.00	$0.00	$0.00	$25.95	$25.95	$26.95	$0.00	$6.80	$0.00	$0.00	$0.00	$0.00	$15.59	$24.69	$24.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2401	ERX	HCPCS J3360	69339-0136-02	DIAZEPAM 5 MG/ML IJ SOLN	BOTH IP/OP	$34.97 	$25.88	$0.00	$26.95		$0.00	$0.00	$0.00	$0.00	$0.00	$25.95	$25.95	$26.95	$0.00	$6.80	$0.00	$0.00	$0.00	$0.00	$15.59	$24.69	$24.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2401	ERX	HCPCS J3360	69339-0136-32	DIAZEPAM 5 MG/ML IJ SOLN	BOTH IP/OP	$34.97 	$25.88	$0.00	$26.95		$0.00	$0.00	$0.00	$0.00	$0.00	$25.95	$25.95	$26.95	$0.00	$6.80	$0.00	$0.00	$0.00	$0.00	$15.59	$24.69	$24.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2405	ERX	HCPCS 25000001	00172-3926-60	DIAZEPAM 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2405	ERX	HCPCS 25000001	00904-5880-61	DIAZEPAM 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2405	ERX	HCPCS 25000001	51079-0285-20	DIAZEPAM 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2405	ERX	HCPCS 25000001	63739-0073-10	DIAZEPAM 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2412	ERX	HCPCS 25000001	55741-0402-02	DIBUCAINE 1 % EX OINT	BOTH IP/OP	$83.21 	$61.58	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.06	$65.90	$24.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2412	ERX	HCPCS 25000001	00536-1211-95	DIBUCAINE 1 % EX OINT	BOTH IP/OP	$30.12 	$22.29	$0.00	$24.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2412	ERX	HCPCS 25000001	54162-0011-01	DIBUCAINE 1 % EX OINT	BOTH IP/OP	$30.12 	$22.29	$0.00	$24.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2414	ERX	HCPCS 63700001	00093-3123-01	DICLOXACILLIN SODIUM 250 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2414	ERX	HCPCS 63700001	00781-2248-01	DICLOXACILLIN SODIUM 250 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2418	ERX	HCPCS 63700001	00378-1610-01	DICYCLOMINE HCL 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2418	ERX	HCPCS 63700001	00378-1610-05	DICYCLOMINE HCL 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2418	ERX	HCPCS 63700001	00527-0586-01	DICYCLOMINE HCL 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2418	ERX	HCPCS 63700001	00591-0794-01	DICYCLOMINE HCL 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2420	ERX	HCPCS J0500	00378-1620-01	DICYCLOMINE HCL 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$59.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$59.65	$0.00	$0.00	$0.00	$0.00	$0.00
2420	ERX	HCPCS J0500	00527-1282-01	DICYCLOMINE HCL 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$59.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$59.65	$0.00	$0.00	$0.00	$0.00	$0.00
2420	ERX	HCPCS J0500	00591-0795-01	DICYCLOMINE HCL 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$59.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$59.65	$0.00	$0.00	$0.00	$0.00	$0.00
2420	ERX	HCPCS J0500	51079-0119-20	DICYCLOMINE HCL 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$59.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$59.65	$0.00	$0.00	$0.00	$0.00	$0.00
2442	ERX	HCPCS J1160	00641-1410-31	DIGOXIN 0.25 MG/ML IJ SOLN	BOTH IP/OP	$27.66 	$20.47	$0.00	$21.32		$0.00	$0.00	$0.00	$0.00	$0.00	$20.53	$20.53	$21.32	$0.00	$16.94	$0.00	$0.00	$0.00	$0.00	$12.54	$19.86	$20.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2442	ERX	HCPCS J1160	00641-1410-35	DIGOXIN 0.25 MG/ML IJ SOLN	BOTH IP/OP	$27.66 	$20.47	$0.00	$21.32		$0.00	$0.00	$0.00	$0.00	$0.00	$20.53	$20.53	$21.32	$0.00	$16.94	$0.00	$0.00	$0.00	$0.00	$12.54	$19.86	$20.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2442	ERX	HCPCS J1160	00641-6184-01	DIGOXIN 0.25 MG/ML IJ SOLN	BOTH IP/OP	$27.66 	$20.47	$0.00	$21.32		$0.00	$0.00	$0.00	$0.00	$0.00	$20.53	$20.53	$21.32	$0.00	$16.94	$0.00	$0.00	$0.00	$0.00	$12.54	$19.86	$20.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2442	ERX	HCPCS J1160	00641-6184-25	DIGOXIN 0.25 MG/ML IJ SOLN	BOTH IP/OP	$27.66 	$20.47	$0.00	$21.32		$0.00	$0.00	$0.00	$0.00	$0.00	$20.53	$20.53	$21.32	$0.00	$16.94	$0.00	$0.00	$0.00	$0.00	$12.54	$19.86	$20.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2442	ERX	HCPCS J1160	00781-3059-72	DIGOXIN 0.25 MG/ML IJ SOLN	BOTH IP/OP	$27.66 	$20.47	$0.00	$21.32		$0.00	$0.00	$0.00	$0.00	$0.00	$20.53	$20.53	$21.32	$0.00	$16.94	$0.00	$0.00	$0.00	$0.00	$12.54	$19.86	$20.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2442	ERX	HCPCS J1160	00781-3059-95	DIGOXIN 0.25 MG/ML IJ SOLN	BOTH IP/OP	$27.66 	$20.47	$0.00	$21.32		$0.00	$0.00	$0.00	$0.00	$0.00	$20.53	$20.53	$21.32	$0.00	$16.94	$0.00	$0.00	$0.00	$0.00	$12.54	$19.86	$20.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2444	ERX	HCPCS 63700001	00143-1240-01	DIGOXIN 0.125 MG PO TABS	BOTH IP/OP	$8.83 	$6.53	$0.00	$6.41		$0.00	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$0.00	$1.84	$0.00	$0.00	$0.00	$0.00	$4.01	$6.34	$6.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2444	ERX	HCPCS 63700001	16714-0590-01	DIGOXIN 0.125 MG PO TABS	BOTH IP/OP	$8.83 	$6.53	$0.00	$6.41		$0.00	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$0.00	$1.84	$0.00	$0.00	$0.00	$0.00	$4.01	$6.34	$6.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2445	ERX	HCPCS 63700001	00527-1325-01	DIGOXIN 0.25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2445	ERX	HCPCS 63700001	00904-5922-61	DIGOXIN 0.25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2445	ERX	HCPCS 63700001	16714-0591-01	DIGOXIN 0.25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2474	ERX	HCPCS 63700001	00093-0321-01	DILTIAZEM HCL 120 MG PO TABS	BOTH IP/OP	$12.09 	$8.95	$0.00	$8.77		$0.00	$0.00	$0.00	$2.15	$0.00	$0.00	$0.00	$0.00	$0.00	$2.52	$0.00	$0.00	$0.00	$0.00	$5.48	$8.68	$8.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2475	ERX	HCPCS 63700001	00093-0318-01	DILTIAZEM HCL 30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2475	ERX	HCPCS 63700001	63739-0079-10	DILTIAZEM HCL 30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2475	ERX	HCPCS 63700001	68682-0006-10	DILTIAZEM HCL 30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2476	ERX	HCPCS 63700001	00378-0045-05	DILTIAZEM HCL 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2476	ERX	HCPCS 63700001	51079-0746-20	DILTIAZEM HCL 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2476	ERX	HCPCS 63700001	63739-0080-10	DILTIAZEM HCL 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2476	ERX	HCPCS 63700001	68682-0007-10	DILTIAZEM HCL 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2477	ERX	HCPCS 63700001	00093-0320-01	DILTIAZEM HCL 90 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2508	ERX	HCPCS J1200	00641-0376-21	DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.86	$16.33	$16.33	$16.96	$0.00	$1.16	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.06	$0.00	$0.00	$1.01	$0.00	$0.00	$0.00	$0.00	$0.00
2508	ERX	HCPCS J1200	00641-0376-25	DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.86	$16.33	$16.33	$16.96	$0.00	$1.16	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.06	$0.00	$0.00	$1.01	$0.00	$0.00	$0.00	$0.00	$0.00
2508	ERX	HCPCS J1200	63323-0664-01	DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.86	$16.33	$16.33	$16.96	$0.00	$1.16	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.06	$0.00	$0.00	$1.01	$0.00	$0.00	$0.00	$0.00	$0.00
2509	ERX	HCPCS J3490	00904-5306-61	DIPHENHYDRAMINE HCL 25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$3.26	$3.26	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
2510	ERX	HCPCS Q0163	00904-2056-61	DIPHENHYDRAMINE HCL 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$3.26	$3.26	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
2511	ERX	HCPCS Q0163	00121-0489-00	DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX	BOTH IP/OP	$9.01 	$6.67	$0.00	$6.94	$4.05	$4.05	$0.00	$0.00	$0.00	$1.88	$6.69	$6.69	$6.94	$0.00	$1.88	$0.00	$5.33	$5.33	$0.00	$4.09	$6.47	$6.54	$0.00		$0.00	$1.28	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$0.00
2511	ERX	HCPCS Q0163	00121-0489-05	DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX	BOTH IP/OP	$9.01 	$6.67	$0.00	$6.94	$4.05	$4.05	$0.00	$0.00	$0.00	$1.88	$6.69	$6.69	$6.94	$0.00	$1.88	$0.00	$5.33	$5.33	$0.00	$4.09	$6.47	$6.54	$0.00		$0.00	$1.28	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$0.00
2515	ERX	HCPCS 63700001	99999-6009-38	DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5ML PO LIQD	BOTH IP/OP	$9.00 	$6.66	$0.00	$8.80		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2516	ERX	HCPCS 63700001	00378-0415-01	DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2516	ERX	HCPCS 63700001	59762-1061-01	DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2528	ERX	HCPCS 63700001	64980-0133-01	DIPYRIDAMOLE 25 MG PO TABS	BOTH IP/OP	$11.91 	$8.81	$0.00	$8.64		$0.00	$0.00	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$0.00	$2.48	$0.00	$0.00	$0.00	$0.00	$5.40	$8.55	$8.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2537	ERX	HCPCS 63700001	00025-2732-31	DISOPYRAMIDE PHOSPHATE ER 100 MG PO CP12	BOTH IP/OP	$21.08 	$15.60	$0.00	$14.63		$0.00	$0.00	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$0.00	$4.39	$0.00	$0.00	$0.00	$0.00	$9.15	$14.49	$14.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2551	ERX	HCPCS 63700001	00074-6212-13	DIVALPROEX SODIUM 125 MG PO TBEC	BOTH IP/OP	$8.93 	$6.61	$0.00	$6.48		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$4.05	$6.42	$6.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2551	ERX	HCPCS 63700001	00832-7122-11	DIVALPROEX SODIUM 125 MG PO TBEC	BOTH IP/OP	$8.93 	$6.61	$0.00	$6.48		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$4.05	$6.42	$6.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2552	ERX	HCPCS 63700001	00832-7123-15	DIVALPROEX SODIUM 250 MG PO TBEC	BOTH IP/OP	$9.08 	$6.72	$0.00	$6.58		$0.00	$0.00	$0.00	$1.62	$0.00	$0.00	$0.00	$0.00	$0.00	$1.89	$0.00	$0.00	$0.00	$0.00	$4.12	$6.52	$6.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2552	ERX	HCPCS 63700001	68084-0776-01	DIVALPROEX SODIUM 250 MG PO TBEC	BOTH IP/OP	$9.08 	$6.72	$0.00	$6.58		$0.00	$0.00	$0.00	$1.62	$0.00	$0.00	$0.00	$0.00	$0.00	$1.89	$0.00	$0.00	$0.00	$0.00	$4.12	$6.52	$6.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2553	ERX	HCPCS 63700001	00832-7124-01	DIVALPROEX SODIUM 500 MG PO TBEC	BOTH IP/OP	$13.47 	$9.97	$0.00	$9.88		$0.00	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$6.18	$9.78	$9.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2553	ERX	HCPCS 63700001	00832-7124-11	DIVALPROEX SODIUM 500 MG PO TBEC	BOTH IP/OP	$13.47 	$9.97	$0.00	$9.88		$0.00	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$6.18	$9.78	$9.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2553	ERX	HCPCS 63700001	62756-0798-13	DIVALPROEX SODIUM 500 MG PO TBEC	BOTH IP/OP	$13.47 	$9.97	$0.00	$9.88		$0.00	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$6.18	$9.78	$9.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2553	ERX	HCPCS 63700001	62756-0798-88	DIVALPROEX SODIUM 500 MG PO TBEC	BOTH IP/OP	$13.47 	$9.97	$0.00	$9.88		$0.00	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$6.18	$9.78	$9.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2553	ERX	HCPCS 63700001	68084-0782-61	DIVALPROEX SODIUM 500 MG PO TBEC	BOTH IP/OP	$13.47 	$9.97	$0.00	$9.88		$0.00	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$6.18	$9.78	$9.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2565	ERX	HCPCS 63700001	00904-6459-59	DOCUSATE CALCIUM 240 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2565	ERX	HCPCS 63700001	49348-0280-10	DOCUSATE CALCIUM 240 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2566	ERX	HCPCS 63700001	00904-6455-61	DOCUSATE SODIUM 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2566	ERX	HCPCS 63700001	00904-6457-60	DOCUSATE SODIUM 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2566	ERX	HCPCS 63700001	00904-6457-80	DOCUSATE SODIUM 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2566	ERX	HCPCS 63700001	69618-0044-10	DOCUSATE SODIUM 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2569	ERX	HCPCS 63700001	50383-0771-10	DOCUSATE SODIUM 150 MG/15ML PO LIQD	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2569	ERX	HCPCS 63700001	50383-0771-11	DOCUSATE SODIUM 150 MG/15ML PO LIQD	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2569	ERX	HCPCS 63700001	50383-0771-16	DOCUSATE SODIUM 150 MG/15ML PO LIQD	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2595	ERX	HCPCS J1265	00409-9104-20	DOPAMINE HCL 40 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2595	ERX	HCPCS J1265	00409-5820-01	DOPAMINE HCL 40 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2607	ERX	HCPCS 25000001	00641-6018-06	DOXAPRAM HCL 20 MG/ML IV SOLN	BOTH IP/OP	$221.60 	$163.98	$0.00	$170.81		$0.00	$0.00	$0.00	$0.00	$0.00	$164.47	$164.47	$170.81	$0.00	$46.18	$0.00	$0.00	$0.00	$0.00	$91.51	$144.95	$146.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2608	ERX	HCPCS 63700001	00378-1049-01	DOXEPIN HCL 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2608	ERX	HCPCS 63700001	51079-0436-01	DOXEPIN HCL 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2608	ERX	HCPCS 63700001	51079-0436-20	DOXEPIN HCL 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2609	ERX	HCPCS 63700001	51079-0651-01	DOXEPIN HCL 100 MG PO CAPS	BOTH IP/OP	$8.37 	$6.19	$0.00	$6.07		$0.00	$0.00	$0.00	$1.49	$0.00	$0.00	$0.00	$0.00	$0.00	$1.74	$0.00	$0.00	$0.00	$0.00	$3.80	$6.01	$6.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2609	ERX	HCPCS 63700001	51079-0651-20	DOXEPIN HCL 100 MG PO CAPS	BOTH IP/OP	$8.37 	$6.19	$0.00	$6.07		$0.00	$0.00	$0.00	$1.49	$0.00	$0.00	$0.00	$0.00	$0.00	$1.74	$0.00	$0.00	$0.00	$0.00	$3.80	$6.01	$6.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2610	ERX	HCPCS 63700001	49884-0222-01	DOXEPIN HCL 150 MG PO CAPS	BOTH IP/OP	$13.95 	$10.32	$0.00	$10.12		$0.00	$0.00	$0.00	$2.48	$0.00	$0.00	$0.00	$0.00	$0.00	$2.91	$0.00	$0.00	$0.00	$0.00	$6.33	$10.02	$10.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2611	ERX	HCPCS 63700001	51079-0437-01	DOXEPIN HCL 25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2611	ERX	HCPCS 63700001	51079-0437-20	DOXEPIN HCL 25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2612	ERX	HCPCS 63700001	51079-0438-01	DOXEPIN HCL 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2612	ERX	HCPCS 63700001	51079-0438-20	DOXEPIN HCL 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2613	ERX	HCPCS 63700001	00378-5375-01	DOXEPIN HCL 75 MG PO CAPS	BOTH IP/OP	$7.59 	$5.62	$0.00	$5.50		$0.00	$0.00	$0.00	$1.35	$0.00	$0.00	$0.00	$0.00	$0.00	$1.58	$0.00	$0.00	$0.00	$0.00	$3.44	$5.45	$5.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2614	ERX	HCPCS 63700001	54838-0512-40	DOXEPIN HCL 10 MG/ML PO CONC	BOTH IP/OP	$246.93 	$182.73	$0.00	$125.89		$0.00	$0.00	$0.00	$43.95	$0.00	$0.00	$0.00	$0.00	$0.00	$51.46	$0.00	$0.00	$0.00	$0.00	$78.68	$65.86	$125.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2614	ERX	HCPCS 63700001	60432-0651-04	DOXEPIN HCL 10 MG/ML PO CONC	BOTH IP/OP	$246.93 	$182.73	$0.00	$125.89		$0.00	$0.00	$0.00	$43.95	$0.00	$0.00	$0.00	$0.00	$0.00	$51.46	$0.00	$0.00	$0.00	$0.00	$78.68	$124.63	$125.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2616	ERX	HCPCS J9000	00069-3034-20	DOXORUBICIN HCL 2 MG/ML IV SOLN	BOTH IP/OP	$564.48 	$417.72	$0.00	$435.10	$254.02	$254.02	$0.00	$0.00	$0.00	$89.07	$418.96	$418.96	$435.10	$0.00	$50.95	$0.00	$333.89	$333.89	$0.00	$256.20	$405.82	$409.92	$0.00		$0.00	$67.45	$0.00	$0.00	$64.22	$0.00	$0.00	$0.00	$0.00	$0.00
2616	ERX	HCPCS J9000	00069-4034-01	DOXORUBICIN HCL 2 MG/ML IV SOLN	BOTH IP/OP	$564.48 	$417.72	$0.00	$435.10	$254.02	$254.02	$0.00	$0.00	$0.00	$89.07	$418.96	$418.96	$435.10	$0.00	$50.95	$0.00	$333.89	$333.89	$0.00	$256.20	$405.82	$409.92	$0.00		$0.00	$67.45	$0.00	$0.00	$64.22	$0.00	$0.00	$0.00	$0.00	$0.00
2616	ERX	HCPCS J9000	00143-9546-01	DOXORUBICIN HCL 2 MG/ML IV SOLN	BOTH IP/OP	$564.48 	$417.72	$0.00	$435.10	$254.02	$254.02	$0.00	$0.00	$0.00	$89.07	$418.96	$418.96	$435.10	$0.00	$50.95	$0.00	$333.89	$333.89	$0.00	$256.20	$405.82	$409.92	$0.00		$0.00	$67.45	$0.00	$0.00	$64.22	$0.00	$0.00	$0.00	$0.00	$0.00
2616	ERX	HCPCS J9000	45963-0733-60	DOXORUBICIN HCL 2 MG/ML IV SOLN	BOTH IP/OP	$564.48 	$417.72	$0.00	$435.10	$254.02	$254.02	$0.00	$0.00	$0.00	$89.07	$418.96	$418.96	$435.10	$0.00	$50.95	$0.00	$333.89	$333.89	$0.00	$256.20	$405.82	$409.92	$0.00		$0.00	$67.45	$0.00	$0.00	$64.22	$0.00	$0.00	$0.00	$0.00	$0.00
2616	ERX	HCPCS J9000	70860-0208-51	DOXORUBICIN HCL 2 MG/ML IV SOLN	BOTH IP/OP	$564.48 	$417.72	$0.00	$435.10	$254.02	$254.02	$0.00	$0.00	$0.00	$89.07	$418.96	$418.96	$435.10	$0.00	$50.95	$0.00	$333.89	$333.89	$0.00	$256.20	$405.82	$409.92	$0.00		$0.00	$67.45	$0.00	$0.00	$64.22	$0.00	$0.00	$0.00	$0.00	$0.00
2622	ERX	HCPCS 25000001	63323-0130-11	DOXYCYCLINE HYCLATE 100 MG IV SOLR	BOTH IP/OP	$97.28 	$71.99	$0.00	$74.98		$0.00	$0.00	$0.00	$0.00	$0.00	$72.20	$72.20	$74.98	$0.00	$20.27	$0.00	$0.00	$0.00	$0.00	$44.10	$69.85	$70.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2622	ERX	HCPCS 25000001	63323-0130-13	DOXYCYCLINE HYCLATE 100 MG IV SOLR	BOTH IP/OP	$97.28 	$71.99	$0.00	$74.98		$0.00	$0.00	$0.00	$0.00	$0.00	$72.20	$72.20	$74.98	$0.00	$20.27	$0.00	$0.00	$0.00	$0.00	$44.10	$69.85	$70.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2622	ERX	HCPCS 25000001	68382-0910-01	DOXYCYCLINE HYCLATE 100 MG IV SOLR	BOTH IP/OP	$97.28 	$71.99	$0.00	$74.98		$0.00	$0.00	$0.00	$0.00	$0.00	$72.20	$72.20	$74.98	$0.00	$20.27	$0.00	$0.00	$0.00	$0.00	$44.10	$69.85	$70.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2622	ERX	HCPCS 25000001	68382-0910-10	DOXYCYCLINE HYCLATE 100 MG IV SOLR	BOTH IP/OP	$97.28 	$71.99	$0.00	$74.98		$0.00	$0.00	$0.00	$0.00	$0.00	$72.20	$72.20	$74.98	$0.00	$20.27	$0.00	$0.00	$0.00	$0.00	$44.10	$69.85	$70.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2654	ERX	HCPCS J1790	00517-9702-01	DROPERIDOL 2.5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.87	$16.33	$16.33	$16.96	$0.00	$9.64	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$5.16	$0.00	$0.00	$0.00	$0.00	$0.00
2654	ERX	HCPCS J1790	00517-9702-25	DROPERIDOL 2.5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.87	$16.33	$16.33	$16.96	$0.00	$9.64	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$5.16	$0.00	$0.00	$0.00	$0.00	$0.00
2805	ERX	HCPCS 25000001	00536-7415-51	ENEMA 7-19 GM/133ML RECTAL ENEM	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2887	ERX	HCPCS 25000001	45802-0038-46	ERYTHROMYCIN 2 % EX SOLN	BOTH IP/OP	$192.93 	$142.77	$0.00	$148.71		$0.00	$0.00	$0.00	$0.00	$0.00	$143.19	$143.19	$148.71	$0.00	$40.21	$0.00	$0.00	$0.00	$0.00	$83.37	$132.06	$133.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2887	ERX	HCPCS 25000001	60432-0671-60	ERYTHROMYCIN 2 % EX SOLN	BOTH IP/OP	$192.93 	$142.77	$0.00	$148.71		$0.00	$0.00	$0.00	$0.00	$0.00	$143.19	$143.19	$148.71	$0.00	$40.21	$0.00	$0.00	$0.00	$0.00	$83.37	$132.06	$133.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2888	ERX	HCPCS 25000001	00574-4024-11	ERYTHROMYCIN 5 MG/GM OP OINT	BOTH IP/OP	$146.70 	$108.56	$0.00	$113.08		$0.00	$0.00	$0.00	$0.00	$0.00	$108.88	$108.88	$113.08	$0.00	$30.57	$0.00	$0.00	$0.00	$0.00	$36.11	$57.19	$57.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2888	ERX	HCPCS 25000001	00574-4024-50	ERYTHROMYCIN 5 MG/GM OP OINT	BOTH IP/OP	$146.70 	$108.56	$0.00	$113.08		$0.00	$0.00	$0.00	$0.00	$0.00	$108.88	$108.88	$113.08	$0.00	$30.57	$0.00	$0.00	$0.00	$0.00	$36.11	$57.19	$57.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2888	ERX	HCPCS 25000001	17478-0070-31	ERYTHROMYCIN 5 MG/GM OP OINT	BOTH IP/OP	$146.70 	$108.56	$0.00	$113.08		$0.00	$0.00	$0.00	$0.00	$0.00	$108.88	$108.88	$113.08	$0.00	$30.57	$0.00	$0.00	$0.00	$0.00	$36.11	$57.19	$57.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2888	ERX	HCPCS 25000001	24208-0910-19	ERYTHROMYCIN 5 MG/GM OP OINT	BOTH IP/OP	$146.70 	$108.56	$0.00	$113.08		$0.00	$0.00	$0.00	$0.00	$0.00	$108.88	$108.88	$113.08	$0.00	$30.57	$0.00	$0.00	$0.00	$0.00	$36.11	$57.19	$57.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2888	ERX	HCPCS 25000001	00574-4024-35	ERYTHROMYCIN 5 MG/GM OP OINT	BOTH IP/OP	$146.70 	$108.56	$0.00	$113.08		$0.00	$0.00	$0.00	$0.00	$0.00	$108.88	$108.88	$113.08	$0.00	$30.57	$0.00	$0.00	$0.00	$0.00	$36.11	$105.35	$57.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2888	ERX	HCPCS 25000001	17478-0070-35	ERYTHROMYCIN 5 MG/GM OP OINT	BOTH IP/OP	$146.70 	$108.56	$0.00	$113.08		$0.00	$0.00	$0.00	$0.00	$0.00	$108.88	$108.88	$113.08	$0.00	$30.57	$0.00	$0.00	$0.00	$0.00	$36.11	$105.35	$57.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2888	ERX	HCPCS 25000001	24208-0910-55	ERYTHROMYCIN 5 MG/GM OP OINT	BOTH IP/OP	$146.70 	$108.56	$0.00	$113.08		$0.00	$0.00	$0.00	$0.00	$0.00	$108.88	$108.88	$113.08	$0.00	$30.57	$0.00	$0.00	$0.00	$0.00	$36.11	$105.35	$57.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2899	ERX	HCPCS 63700001	24338-0132-13	ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR	BOTH IP/OP	"$1,318.38 "	$975.60	$0.00	$957.18		$0.00	$0.00	$0.00	$234.67	$0.00	$0.00	$0.00	$0.00	$0.00	$274.75	$0.00	$0.00	$0.00	$0.00	$598.24	$947.61	$957.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2899	ERX	HCPCS 63700001	24338-0134-02	ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR	BOTH IP/OP	"$1,318.38 "	$975.60	$0.00	$957.18		$0.00	$0.00	$0.00	$234.67	$0.00	$0.00	$0.00	$0.00	$0.00	$274.75	$0.00	$0.00	$0.00	$0.00	$598.24	$947.61	$957.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2899	ERX	HCPCS 63700001	62559-0630-01	ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR	BOTH IP/OP	"$1,318.38 "	$975.60	$0.00	$957.18		$0.00	$0.00	$0.00	$234.67	$0.00	$0.00	$0.00	$0.00	$0.00	$274.75	$0.00	$0.00	$0.00	$0.00	$598.24	$947.61	$957.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2899	ERX	HCPCS 63700001	69238-1503-01	ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR	BOTH IP/OP	"$1,318.38 "	$975.60	$0.00	$957.18		$0.00	$0.00	$0.00	$234.67	$0.00	$0.00	$0.00	$0.00	$0.00	$274.75	$0.00	$0.00	$0.00	$0.00	$598.24	$947.61	$957.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2903	ERX	HCPCS J1364	00409-6476-44	ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR	BOTH IP/OP	$344.04 	$254.59	$0.00	$265.19		$0.00	$0.00	$0.00	$0.00	$0.00	$255.35	$255.35	$265.19	$0.00	$91.35	$0.00	$0.00	$0.00	$0.00	$153.84	$243.68	$246.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2903	ERX	HCPCS J1364	00409-6482-01	ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR	BOTH IP/OP	$344.04 	$254.59	$0.00	$265.19		$0.00	$0.00	$0.00	$0.00	$0.00	$255.35	$255.35	$265.19	$0.00	$91.35	$0.00	$0.00	$0.00	$0.00	$153.84	$243.68	$246.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2931	ERX	HCPCS J1380	00574-0870-05	ESTRADIOL VALERATE 20 MG/ML IM OIL	BOTH IP/OP	$47.03 	$34.80	$0.00	$36.25	$21.16	$21.16	$0.00	$0.00	$0.00	$9.80	$34.91	$34.91	$36.25	$0.00	$9.80	$0.00	$27.82	$27.82	$0.00	$21.33	$33.79	$34.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2931	ERX	HCPCS J1380	42023-0111-01	ESTRADIOL VALERATE 20 MG/ML IM OIL	BOTH IP/OP	$47.03 	$34.80	$0.00	$36.25	$21.16	$21.16	$0.00	$0.00	$0.00	$9.80	$34.91	$34.91	$36.25	$0.00	$9.80	$0.00	$27.82	$27.82	$0.00	$21.33	$33.79	$34.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2938	ERX	HCPCS 63700001	00046-1104-81	ESTROGENS CONJUGATED 1.25 MG PO TABS	BOTH IP/OP	$32.11 	$23.76	$0.00	$21.54		$0.00	$0.00	$0.00	$5.72	$0.00	$0.00	$0.00	$0.00	$0.00	$6.69	$0.00	$0.00	$0.00	$0.00	$13.47	$21.33	$21.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3000	ERX	HCPCS 25000001	10119-0002-52	EYE WASH OP SOLN	BOTH IP/OP	$11.87 	$8.78	$0.00	$9.15		$0.00	$0.00	$0.00	$0.00	$0.00	$8.81	$8.81	$9.15	$0.00	$2.47	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3059	ERX	HCPCS 63700001	48783-0112-08	FERRIC SUBSULFATE PASTE	BOTH IP/OP	$62.85 	$46.51	$0.00	$45.60		$0.00	$0.00	$0.00	$11.19	$0.00	$0.00	$0.00	$0.00	$0.00	$13.10	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3069	ERX	HCPCS 63700001	99999-6004-65	FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$1.96	$0.00	$0.00	$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3069	ERX	HCPCS 63700001	99999-6010-60	FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$1.96	$0.00	$0.00	$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3069	ERX	HCPCS 63700001	50383-0778-16	FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX	BOTH IP/OP	$11.00 	$8.14	$0.00	$51.25		$0.00	$0.00	$0.00	$1.96	$0.00	$0.00	$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$51.25	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3069	ERX	HCPCS 63700001	54838-0001-80	FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX	BOTH IP/OP	$11.00 	$8.14	$0.00	$51.25		$0.00	$0.00	$0.00	$1.96	$0.00	$0.00	$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$51.25	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3074	ERX	HCPCS 63700001	00904-7590-60	FERROUS SULFATE 325 (65 FE) MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3074	ERX	HCPCS 63700001	00904-7591-60	FERROUS SULFATE 325 (65 FE) MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3074	ERX	HCPCS 63700001	00904-7591-61	FERROUS SULFATE 325 (65 FE) MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3128	ERX	HCPCS 25000001	00132-0202-20	FLEET PEDIATRIC 3.5-9.5 GM/66ML RECTAL ENEM	BOTH IP/OP	$9.13 	$6.76	$0.00	$7.04		$0.00	$0.00	$0.00	$0.00	$0.00	$6.78	$6.78	$7.04	$0.00	$1.90	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3177	ERX	HCPCS J9200	00143-9270-01	FLOXURIDINE 0.5 G IJ SOLR	BOTH IP/OP	$479.81 	$355.06	$0.00	$369.84		$0.00	$0.00	$0.00	$0.00	$0.00	$356.11	$356.11	$369.84	$0.00	$99.99	$0.00	$0.00	$0.00	$0.00	$217.77	$344.95	$348.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3177	ERX	HCPCS J9200	63323-0145-07	FLOXURIDINE 0.5 G IJ SOLR	BOTH IP/OP	$479.81 	$355.06	$0.00	$369.84		$0.00	$0.00	$0.00	$0.00	$0.00	$356.11	$356.11	$369.84	$0.00	$99.99	$0.00	$0.00	$0.00	$0.00	$217.77	$344.95	$348.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3184	ERX	HCPCS 25000001	00168-0060-15	FLUOCINOLONE ACETONIDE 0.025 % EX CREA	BOTH IP/OP	$130.34 	$96.45	$0.00	$100.47		$0.00	$0.00	$0.00	$0.00	$0.00	$96.74	$96.74	$100.47	$0.00	$27.16	$0.00	$0.00	$0.00	$0.00	$59.09	$93.60	$94.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3184	ERX	HCPCS 25000001	52565-0020-15	FLUOCINOLONE ACETONIDE 0.025 % EX CREA	BOTH IP/OP	$130.34 	$96.45	$0.00	$100.47		$0.00	$0.00	$0.00	$0.00	$0.00	$96.74	$96.74	$100.47	$0.00	$27.16	$0.00	$0.00	$0.00	$0.00	$59.09	$93.60	$94.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3185	ERX	HCPCS 25000001	00168-0064-15	FLUOCINOLONE ACETONIDE 0.025 % EX OINT	BOTH IP/OP	$130.34 	$96.45	$0.00	$100.47		$0.00	$0.00	$0.00	$0.00	$0.00	$96.74	$96.74	$100.47	$0.00	$27.16	$0.00	$0.00	$0.00	$0.00	$59.09	$93.60	$94.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3185	ERX	HCPCS 25000001	00713-0224-15	FLUOCINOLONE ACETONIDE 0.025 % EX OINT	BOTH IP/OP	$130.34 	$96.45	$0.00	$100.47		$0.00	$0.00	$0.00	$0.00	$0.00	$96.74	$96.74	$100.47	$0.00	$27.16	$0.00	$0.00	$0.00	$0.00	$59.09	$93.60	$94.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3186	ERX	HCPCS 25000001	00168-0059-60	FLUOCINOLONE ACETONIDE 0.01 % EX SOLN	BOTH IP/OP	$154.71 	$114.49	$0.00	$439.20		$0.00	$0.00	$0.00	$0.00	$0.00	$114.83	$114.83	$119.25	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3186	ERX	HCPCS 25000001	51672-1365-04	FLUOCINOLONE ACETONIDE 0.01 % EX SOLN	BOTH IP/OP	$154.71 	$114.49	$0.00	$439.20		$0.00	$0.00	$0.00	$0.00	$0.00	$114.83	$114.83	$119.25	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3186	ERX	HCPCS 25000001	52565-0012-59	FLUOCINOLONE ACETONIDE 0.01 % EX SOLN	BOTH IP/OP	$154.71 	$114.49	$0.00	$439.20		$0.00	$0.00	$0.00	$0.00	$0.00	$114.83	$114.83	$119.25	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3187	ERX	HCPCS 25000001	00093-0262-15	FLUOCINONIDE 0.05 % EX CREA	BOTH IP/OP	$175.85 	$130.13	$0.00	$135.55		$0.00	$0.00	$0.00	$0.00	$0.00	$130.52	$130.52	$135.55	$0.00	$36.65	$0.00	$0.00	$0.00	$0.00	$79.73	$126.28	$127.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3187	ERX	HCPCS 25000001	51672-1253-01	FLUOCINONIDE 0.05 % EX CREA	BOTH IP/OP	$175.85 	$130.13	$0.00	$135.55		$0.00	$0.00	$0.00	$0.00	$0.00	$130.52	$130.52	$135.55	$0.00	$36.65	$0.00	$0.00	$0.00	$0.00	$79.73	$126.28	$127.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3187	ERX	HCPCS 25000001	51672-1386-01	FLUOCINONIDE 0.05 % EX CREA	BOTH IP/OP	$175.85 	$130.13	$0.00	$135.55		$0.00	$0.00	$0.00	$0.00	$0.00	$130.52	$130.52	$135.55	$0.00	$36.65	$0.00	$0.00	$0.00	$0.00	$79.73	$126.28	$127.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3187	ERX	HCPCS 25000001	00093-0262-30	FLUOCINONIDE 0.05 % EX CREA	BOTH IP/OP	$175.85 	$130.13	$0.00	$227.30		$0.00	$0.00	$0.00	$0.00	$0.00	$130.52	$130.52	$135.55	$0.00	$36.65	$0.00	$0.00	$0.00	$0.00	$79.73	$227.30	$127.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3187	ERX	HCPCS 25000001	51672-1253-02	FLUOCINONIDE 0.05 % EX CREA	BOTH IP/OP	$175.85 	$130.13	$0.00	$227.30		$0.00	$0.00	$0.00	$0.00	$0.00	$130.52	$130.52	$135.55	$0.00	$36.65	$0.00	$0.00	$0.00	$0.00	$79.73	$227.30	$127.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3187	ERX	HCPCS 25000001	51672-1386-02	FLUOCINONIDE 0.05 % EX CREA	BOTH IP/OP	$175.85 	$130.13	$0.00	$227.30		$0.00	$0.00	$0.00	$0.00	$0.00	$130.52	$130.52	$135.55	$0.00	$36.65	$0.00	$0.00	$0.00	$0.00	$79.73	$227.30	$127.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3188	ERX	HCPCS 25000001	51672-1279-01	FLUOCINONIDE 0.05 % EX GEL	BOTH IP/OP	$695.55 	$514.71	$0.00	$536.13		$0.00	$0.00	$0.00	$0.00	$0.00	$516.24	$516.24	$536.13	$0.00	$144.95	$0.00	$0.00	$0.00	$0.00	$315.62	$499.93	$504.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3188	ERX	HCPCS 25000001	51672-1279-02	FLUOCINONIDE 0.05 % EX GEL	BOTH IP/OP	$695.55 	$514.71	$0.00	$536.13		$0.00	$0.00	$0.00	$0.00	$0.00	$516.24	$516.24	$536.13	$0.00	$144.95	$0.00	$0.00	$0.00	$0.00	$315.62	$499.93	$504.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3188	ERX	HCPCS 25000001	00168-0135-60	FLUOCINONIDE 0.05 % EX GEL	BOTH IP/OP	$695.55 	$514.71	$0.00	$536.13		$0.00	$0.00	$0.00	$0.00	$0.00	$516.24	$516.24	$536.13	$0.00	$144.95	$0.00	$0.00	$0.00	$0.00	$315.62	$499.93	$504.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3188	ERX	HCPCS 25000001	51672-1279-03	FLUOCINONIDE 0.05 % EX GEL	BOTH IP/OP	$695.55 	$514.71	$0.00	$536.13		$0.00	$0.00	$0.00	$0.00	$0.00	$516.24	$516.24	$536.13	$0.00	$144.95	$0.00	$0.00	$0.00	$0.00	$315.62	$499.93	$504.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3189	ERX	HCPCS 25000001	00093-0264-15	FLUOCINONIDE 0.05 % EX OINT	BOTH IP/OP	$245.52 	$181.68	$0.00	$189.25		$0.00	$0.00	$0.00	$0.00	$0.00	$182.22	$182.22	$189.25	$0.00	$51.17	$0.00	$0.00	$0.00	$0.00	$111.44	$176.52	$178.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3189	ERX	HCPCS 25000001	16714-0502-01	FLUOCINONIDE 0.05 % EX OINT	BOTH IP/OP	$245.52 	$181.68	$0.00	$189.25		$0.00	$0.00	$0.00	$0.00	$0.00	$182.22	$182.22	$189.25	$0.00	$51.17	$0.00	$0.00	$0.00	$0.00	$111.44	$176.52	$178.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3189	ERX	HCPCS 25000001	51672-1264-01	FLUOCINONIDE 0.05 % EX OINT	BOTH IP/OP	$245.52 	$181.68	$0.00	$189.25		$0.00	$0.00	$0.00	$0.00	$0.00	$182.22	$182.22	$189.25	$0.00	$51.17	$0.00	$0.00	$0.00	$0.00	$111.44	$176.52	$178.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3190	ERX	HCPCS 25000001	00168-0134-60	FLUOCINONIDE 0.05 % EX SOLN	BOTH IP/OP	$337.29 	$249.59	$0.00	$259.98		$0.00	$0.00	$0.00	$0.00	$0.00	$250.34	$250.34	$259.98	$0.00	$70.29	$0.00	$0.00	$0.00	$0.00	$153.09	$242.49	$244.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3215	ERX	HCPCS J2680	00143-9529-01	FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN	BOTH IP/OP	$77.92 	$57.66	$0.00	$60.06	$35.06	$35.06	$0.00	$0.00	$0.00	$4.27	$57.83	$57.83	$60.06	$0.00	$12.10	$0.00	$46.09	$46.09	$0.00	$35.34	$55.97	$56.54	$0.00		$0.00	$11.73	$0.00	$0.00	$11.17	$0.00	$0.00	$0.00	$0.00	$0.00
3215	ERX	HCPCS J2680	42023-0129-01	FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN	BOTH IP/OP	$77.92 	$57.66	$0.00	$60.06	$35.06	$35.06	$0.00	$0.00	$0.00	$4.27	$57.83	$57.83	$60.06	$0.00	$12.10	$0.00	$46.09	$46.09	$0.00	$35.34	$55.97	$56.54	$0.00		$0.00	$11.73	$0.00	$0.00	$11.17	$0.00	$0.00	$0.00	$0.00	$0.00
3215	ERX	HCPCS J2680	55150-0267-05	FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN	BOTH IP/OP	$77.92 	$57.66	$0.00	$60.06	$35.06	$35.06	$0.00	$0.00	$0.00	$4.27	$57.83	$57.83	$60.06	$0.00	$12.10	$0.00	$46.09	$46.09	$0.00	$35.34	$55.97	$56.54	$0.00		$0.00	$11.73	$0.00	$0.00	$11.17	$0.00	$0.00	$0.00	$0.00	$0.00
3215	ERX	HCPCS J2680	63323-0272-05	FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN	BOTH IP/OP	$77.92 	$57.66	$0.00	$60.06	$35.06	$35.06	$0.00	$0.00	$0.00	$4.27	$57.83	$57.83	$60.06	$0.00	$12.10	$0.00	$46.09	$46.09	$0.00	$35.34	$55.97	$56.54	$0.00		$0.00	$11.73	$0.00	$0.00	$11.17	$0.00	$0.00	$0.00	$0.00	$0.00
3216	ERX	HCPCS 25000001	63323-0281-10	FLUPHENAZINE HCL 2.5 MG/ML IJ SOLN	BOTH IP/OP	$673.01 	$498.03	$0.00	$518.76		$0.00	$0.00	$0.00	$0.00	$0.00	$499.51	$499.51	$518.76	$0.00	$140.26	$0.00	$0.00	$0.00	$0.00	$290.84	$460.69	$465.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3218	ERX	HCPCS 63700001	00527-1788-01	FLUPHENAZINE HCL 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3219	ERX	HCPCS 63700001	00527-1791-01	FLUPHENAZINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3220	ERX	HCPCS 63700001	00527-1789-01	FLUPHENAZINE HCL 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3221	ERX	HCPCS 63700001	00527-1790-01	FLUPHENAZINE HCL 5 MG PO TABS	BOTH IP/OP	$38.55 	$28.53	$0.00	$27.97		$0.00	$0.00	$0.00	$6.86	$0.00	$0.00	$0.00	$0.00	$0.00	$8.03	$0.00	$0.00	$0.00	$0.00	$17.48	$27.69	$27.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3232	ERX	HCPCS 25000001	63323-0184-10	FOLIC ACID 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3232	ERX	HCPCS 25000001	99999-6005-63	FOLIC ACID 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3233	ERX	HCPCS 63700001	62584-0897-01	FOLIC ACID 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3233	ERX	HCPCS 63700001	62584-0897-11	FOLIC ACID 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3233	ERX	HCPCS 63700001	63739-0537-10	FOLIC ACID 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3233	ERX	HCPCS 63700001	65162-0361-10	FOLIC ACID 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3233	ERX	HCPCS 63700001	65162-0361-11	FOLIC ACID 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3264	ERX	HCPCS 25000001	00264-9341-55	FREAMINE III 10 % IV SOLN	BOTH IP/OP	$164.05 	$121.40	$0.00	$126.45		$0.00	$0.00	$0.00	$0.00	$0.00	$121.76	$121.76	$126.45	$0.00	$34.19	$0.00	$0.00	$0.00	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	00409-6102-02	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	00409-6102-04	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	00409-6102-10	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	00409-6102-18	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	00409-6102-25	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	00409-6102-26	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	00409-6102-27	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	00409-6102-35	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	00409-6102-36	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	00409-6102-37	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	23155-0473-32	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	23155-0473-42	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	23155-0473-44	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	36000-0282-25	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	36000-0283-25	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	36000-0284-25	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	63323-0280-01	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	63323-0280-02	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	63323-0280-03	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	63323-0280-04	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3291	ERX	HCPCS J1940	63323-0280-10	FUROSEMIDE 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$50.88	$9.90	$9.90	$0.00	$0.00	$0.00	$0.25	$48.99	$48.99	$50.88	$0.00	$0.56	$0.00	$39.03	$39.03	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.69	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
3292	ERX	HCPCS 25000001	00054-3294-46	FUROSEMIDE 10 MG/ML PO SOLN	BOTH IP/OP	$43.50 	$32.19	$0.00	$56.45		$0.00	$0.00	$0.00	$0.00	$0.00	$32.29	$32.29	$33.53	$0.00	$9.07	$0.00	$0.00	$0.00	$0.00	$35.28	$31.24	$56.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3292	ERX	HCPCS 25000001	60432-0613-60	FUROSEMIDE 10 MG/ML PO SOLN	BOTH IP/OP	$43.50 	$32.19	$0.00	$56.45		$0.00	$0.00	$0.00	$0.00	$0.00	$32.29	$32.29	$33.53	$0.00	$9.07	$0.00	$0.00	$0.00	$0.00	$35.28	$31.24	$56.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3292	ERX	HCPCS 25000001	99999-6004-66	FUROSEMIDE 10 MG/ML PO SOLN	BOTH IP/OP	$43.50 	$32.19	$0.00	$56.45		$0.00	$0.00	$0.00	$0.00	$0.00	$32.29	$32.29	$33.53	$0.00	$9.07	$0.00	$0.00	$0.00	$0.00	$35.28	$31.24	$56.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3292	ERX	HCPCS 25000001	00054-3294-50	FUROSEMIDE 10 MG/ML PO SOLN	BOTH IP/OP	$43.50 	$32.19	$0.00	$56.45		$0.00	$0.00	$0.00	$0.00	$0.00	$32.29	$32.29	$33.53	$0.00	$9.07	$0.00	$0.00	$0.00	$0.00	$35.28	$55.88	$56.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3294	ERX	HCPCS 63700001	00054-8297-25	FUROSEMIDE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3294	ERX	HCPCS 63700001	00378-0208-01	FUROSEMIDE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3294	ERX	HCPCS 63700001	51079-0072-20	FUROSEMIDE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3295	ERX	HCPCS 63700001	00054-8299-25	FUROSEMIDE 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3295	ERX	HCPCS 63700001	00378-0216-01	FUROSEMIDE 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3295	ERX	HCPCS 63700001	00781-1966-10	FUROSEMIDE 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3295	ERX	HCPCS 63700001	51079-0073-01	FUROSEMIDE 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3295	ERX	HCPCS 63700001	51079-0073-20	FUROSEMIDE 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3296	ERX	HCPCS 63700001	00054-4301-25	FUROSEMIDE 80 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3296	ERX	HCPCS 63700001	00054-8301-25	FUROSEMIDE 80 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3296	ERX	HCPCS 63700001	51079-0527-01	FUROSEMIDE 80 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3296	ERX	HCPCS 63700001	51079-0527-20	FUROSEMIDE 80 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3378	ERX	HCPCS 63700001	16714-0101-05	GEMFIBROZIL 600 MG PO TABS	BOTH IP/OP	$9.24 	$6.84	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.62	$7.32	$7.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3378	ERX	HCPCS 63700001	60687-0224-01	GEMFIBROZIL 600 MG PO TABS	BOTH IP/OP	$9.24 	$6.84	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.62	$7.32	$7.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3423	ERX	HCPCS 25000001	45802-0056-35	GENTAMICIN SULFATE 0.1 % EX CREA	BOTH IP/OP	$342.70 	$253.60	$0.00	$264.15		$0.00	$0.00	$0.00	$0.00	$0.00	$254.35	$254.35	$264.15	$0.00	$71.42	$0.00	$0.00	$0.00	$0.00	$155.55	$246.39	$248.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3423	ERX	HCPCS 25000001	45802-0056-11	GENTAMICIN SULFATE 0.1 % EX CREA	BOTH IP/OP	$342.70 	$253.60	$0.00	$264.15		$0.00	$0.00	$0.00	$0.00	$0.00	$254.35	$254.35	$264.15	$0.00	$71.42	$0.00	$0.00	$0.00	$0.00	$155.55	$246.39	$248.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3424	ERX	HCPCS 25000001	45802-0046-35	GENTAMICIN SULFATE 0.1 % EX OINT	BOTH IP/OP	$342.70 	$253.60	$0.00	$264.15		$0.00	$0.00	$0.00	$0.00	$0.00	$254.35	$254.35	$264.15	$0.00	$71.42	$0.00	$0.00	$0.00	$0.00	$155.55	$246.39	$248.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3424	ERX	HCPCS 25000001	45802-0046-11	GENTAMICIN SULFATE 0.1 % EX OINT	BOTH IP/OP	$342.70 	$253.60	$0.00	$264.15		$0.00	$0.00	$0.00	$0.00	$0.00	$254.35	$254.35	$264.15	$0.00	$71.42	$0.00	$0.00	$0.00	$0.00	$155.55	$246.39	$248.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3424	ERX	HCPCS 25000001	52565-0090-30	GENTAMICIN SULFATE 0.1 % EX OINT	BOTH IP/OP	$342.70 	$253.60	$0.00	$264.15		$0.00	$0.00	$0.00	$0.00	$0.00	$254.35	$254.35	$264.15	$0.00	$71.42	$0.00	$0.00	$0.00	$0.00	$155.55	$246.39	$248.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3425	ERX	HCPCS J1580	63323-0173-02	GENTAMICIN SULFATE 10 MG/ML (NICU) IM INJ	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.22	$10.64	$10.64	$0.00	$0.00	$0.00	$1.02	$17.55	$17.55	$18.22	$0.00	$1.97	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.31	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$0.00
3426	ERX	HCPCS J1580	00409-1207-03	GENTAMICIN SULFATE 40 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.02	$16.33	$16.33	$16.96	$0.00	$1.97	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.31	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$0.00
3426	ERX	HCPCS J1580	00409-1207-25	GENTAMICIN SULFATE 40 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.02	$16.33	$16.33	$16.96	$0.00	$1.97	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.31	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$0.00
3426	ERX	HCPCS J1580	63323-0010-02	GENTAMICIN SULFATE 40 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.02	$16.33	$16.33	$16.96	$0.00	$1.97	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.31	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$0.00
3426	ERX	HCPCS J1580	63323-0010-20	GENTAMICIN SULFATE 40 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.02	$16.33	$16.33	$16.96	$0.00	$1.97	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.31	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$0.00
3427	ERX	HCPCS 63700001	17478-0284-35	GENTAMICIN SULFATE 0.3 % OP OINT	BOTH IP/OP	$150.36 	$111.27	$0.00	$99.24		$0.00	$0.00	$0.00	$26.76	$0.00	$0.00	$0.00	$0.00	$0.00	$31.34	$0.00	$0.00	$0.00	$0.00	$62.03	$98.25	$99.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3428	ERX	HCPCS 25000001	17478-0283-10	GENTAMICIN SULFATE 0.3 % OP SOLN	BOTH IP/OP	$83.77 	$61.99	$0.00	$64.57		$0.00	$0.00	$0.00	$0.00	$0.00	$62.17	$62.17	$64.57	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$37.98	$60.15	$60.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3428	ERX	HCPCS 25000001	24208-0580-60	GENTAMICIN SULFATE 0.3 % OP SOLN	BOTH IP/OP	$83.77 	$61.99	$0.00	$64.57		$0.00	$0.00	$0.00	$0.00	$0.00	$62.17	$62.17	$64.57	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$37.98	$60.15	$60.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3428	ERX	HCPCS 25000001	60758-0188-05	GENTAMICIN SULFATE 0.3 % OP SOLN	BOTH IP/OP	$83.77 	$61.99	$0.00	$64.57		$0.00	$0.00	$0.00	$0.00	$0.00	$62.17	$62.17	$64.57	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$37.98	$60.15	$60.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3428	ERX	HCPCS 25000001	61314-0633-05	GENTAMICIN SULFATE 0.3 % OP SOLN	BOTH IP/OP	$83.77 	$61.99	$0.00	$64.57		$0.00	$0.00	$0.00	$0.00	$0.00	$62.17	$62.17	$64.57	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$37.98	$60.15	$60.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3430	ERX	HCPCS 25000001	00395-1003-92	GENTIAN VIOLET 1 % EX SOLN	BOTH IP/OP	$34.86 	$25.80	$0.00	$26.87		$0.00	$0.00	$0.00	$0.00	$0.00	$25.87	$25.87	$26.87	$0.00	$7.26	$0.00	$0.00	$0.00	$0.00	$15.25	$24.16	$24.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3489	ERX	HCPCS 63700001	00093-8344-01	GLYBURIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3489	ERX	HCPCS 63700001	63739-0119-10	GLYBURIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3497	ERX	HCPCS 25000001	00143-9587-25	GLYCOPYRROLATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$35.44 	$26.23	$0.00	$27.32		$0.00	$0.00	$0.00	$0.00	$0.00	$26.30	$26.30	$27.32	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.07	$25.45	$25.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3497	ERX	HCPCS 25000001	00143-9682-01	GLYCOPYRROLATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$35.44 	$26.23	$0.00	$27.32		$0.00	$0.00	$0.00	$0.00	$0.00	$26.30	$26.30	$27.32	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.07	$25.45	$25.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3497	ERX	HCPCS 25000001	00143-9682-25	GLYCOPYRROLATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$35.44 	$26.23	$0.00	$27.32		$0.00	$0.00	$0.00	$0.00	$0.00	$26.30	$26.30	$27.32	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.07	$25.45	$25.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3497	ERX	HCPCS 25000001	00517-4601-25	GLYCOPYRROLATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$35.44 	$26.23	$0.00	$27.32		$0.00	$0.00	$0.00	$0.00	$0.00	$26.30	$26.30	$27.32	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.07	$25.45	$25.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3497	ERX	HCPCS 25000001	00781-3825-71	GLYCOPYRROLATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$35.44 	$26.23	$0.00	$27.32		$0.00	$0.00	$0.00	$0.00	$0.00	$26.30	$26.30	$27.32	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.07	$25.45	$25.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3497	ERX	HCPCS 25000001	00781-3825-96	GLYCOPYRROLATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$35.44 	$26.23	$0.00	$27.32		$0.00	$0.00	$0.00	$0.00	$0.00	$26.30	$26.30	$27.32	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.07	$25.45	$25.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3497	ERX	HCPCS 25000001	66794-0202-42	GLYCOPYRROLATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$35.44 	$26.23	$0.00	$27.32		$0.00	$0.00	$0.00	$0.00	$0.00	$26.30	$26.30	$27.32	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.07	$25.45	$25.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3497	ERX	HCPCS 25000001	70069-0011-25	GLYCOPYRROLATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$35.44 	$26.23	$0.00	$27.32		$0.00	$0.00	$0.00	$0.00	$0.00	$26.30	$26.30	$27.32	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.07	$25.45	$25.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3497	ERX	HCPCS 25000001	70121-1394-05	GLYCOPYRROLATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$35.44 	$26.23	$0.00	$27.32		$0.00	$0.00	$0.00	$0.00	$0.00	$26.30	$26.30	$27.32	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.07	$25.45	$25.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3578	ERX	HCPCS 25000001	00378-0351-01	HALOPERIDOL 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3578	ERX	HCPCS 25000001	00781-1391-01	HALOPERIDOL 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3578	ERX	HCPCS 25000001	51079-0733-01	HALOPERIDOL 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3578	ERX	HCPCS 25000001	51079-0733-20	HALOPERIDOL 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3579	ERX	HCPCS 25000001	51079-0734-20	HALOPERIDOL 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3580	ERX	HCPCS 63700001	51079-0431-20	HALOPERIDOL 10 MG PO TABS	BOTH IP/OP	$6.82 	$5.05	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.41	$5.40	$5.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3580	ERX	HCPCS 63700001	68382-0080-01	HALOPERIDOL 10 MG PO TABS	BOTH IP/OP	$6.82 	$5.05	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.41	$5.40	$5.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3581	ERX	HCPCS 63700001	00378-0214-01	HALOPERIDOL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3582	ERX	HCPCS 63700001	00378-0335-01	HALOPERIDOL 20 MG PO TABS	BOTH IP/OP	$15.17 	$11.23	$0.00	$11.01		$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$6.88	$10.90	$11.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3582	ERX	HCPCS 63700001	00781-1398-01	HALOPERIDOL 20 MG PO TABS	BOTH IP/OP	$15.17 	$11.23	$0.00	$11.01		$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$6.88	$10.90	$11.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3582	ERX	HCPCS 63700001	68382-0081-01	HALOPERIDOL 20 MG PO TABS	BOTH IP/OP	$15.17 	$11.23	$0.00	$11.01		$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$6.88	$10.90	$11.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3583	ERX	HCPCS 63700001	00378-0327-01	HALOPERIDOL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3583	ERX	HCPCS 63700001	00781-1396-01	HALOPERIDOL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3583	ERX	HCPCS 63700001	51079-0736-20	HALOPERIDOL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3583	ERX	HCPCS 63700001	68382-0079-01	HALOPERIDOL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3584	ERX	HCPCS J1630	00143-9501-25	HALOPERIDOL LACTATE 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.80	$16.33	$16.33	$16.96	$0.00	$1.71	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.42	$0.00	$0.00	$1.35	$0.00	$0.00	$0.00	$0.00	$0.00
3584	ERX	HCPCS J1630	25021-0806-01	HALOPERIDOL LACTATE 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.80	$16.33	$16.33	$16.96	$0.00	$1.71	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.42	$0.00	$0.00	$1.35	$0.00	$0.00	$0.00	$0.00	$0.00
3584	ERX	HCPCS J1630	63323-0474-00	HALOPERIDOL LACTATE 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.80	$16.33	$16.33	$16.96	$0.00	$1.71	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.42	$0.00	$0.00	$1.35	$0.00	$0.00	$0.00	$0.00	$0.00
3584	ERX	HCPCS J1630	63323-0474-01	HALOPERIDOL LACTATE 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.80	$16.33	$16.33	$16.96	$0.00	$1.71	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.42	$0.00	$0.00	$1.35	$0.00	$0.00	$0.00	$0.00	$0.00
3584	ERX	HCPCS J1630	67457-0426-00	HALOPERIDOL LACTATE 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.80	$16.33	$16.33	$16.96	$0.00	$1.71	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.42	$0.00	$0.00	$1.35	$0.00	$0.00	$0.00	$0.00	$0.00
3584	ERX	HCPCS J1630	67457-0426-12	HALOPERIDOL LACTATE 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.80	$16.33	$16.33	$16.96	$0.00	$1.71	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.42	$0.00	$0.00	$1.35	$0.00	$0.00	$0.00	$0.00	$0.00
3585	ERX	HCPCS 25000001	00121-0581-04	HALOPERIDOL LACTATE 2 MG/ML PO CONC	BOTH IP/OP	$9.50 	$7.03	$0.00	$7.32		$0.00	$0.00	$0.00	$0.00	$0.00	$7.05	$7.05	$7.32	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$4.31	$6.82	$6.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3585	ERX	HCPCS 25000001	00121-0581-05	HALOPERIDOL LACTATE 2 MG/ML PO CONC	BOTH IP/OP	$9.50 	$7.03	$0.00	$7.32		$0.00	$0.00	$0.00	$0.00	$0.00	$7.05	$7.05	$7.32	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$4.31	$6.82	$6.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3585	ERX	HCPCS 25000001	99999-6007-06	HALOPERIDOL LACTATE 2 MG/ML PO CONC	BOTH IP/OP	$9.50 	$7.03	$0.00	$7.32		$0.00	$0.00	$0.00	$0.00	$0.00	$7.05	$7.05	$7.32	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$4.31	$6.82	$6.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3697	ERX	HCPCS J0360	63323-0614-00	HYDRALAZINE HCL 20 MG/ML IJ SOLN	BOTH IP/OP	$65.77 	$48.67	$0.00	$55.51	$32.40	$32.40	$0.00	$0.00	$0.00	$5.77	$53.45	$53.45	$55.51	$0.00	$6.11	$0.00	$38.90	$38.90	$0.00	$29.83	$47.24	$47.72	$0.00		$0.00	$4.41	$0.00	$0.00	$4.20	$0.00	$0.00	$0.00	$0.00	$0.00
3697	ERX	HCPCS J0360	63323-0614-01	HYDRALAZINE HCL 20 MG/ML IJ SOLN	BOTH IP/OP	$65.77 	$48.67	$0.00	$55.51	$32.40	$32.40	$0.00	$0.00	$0.00	$5.77	$53.45	$53.45	$55.51	$0.00	$6.11	$0.00	$38.90	$38.90	$0.00	$29.83	$47.24	$47.72	$0.00		$0.00	$4.41	$0.00	$0.00	$4.20	$0.00	$0.00	$0.00	$0.00	$0.00
3697	ERX	HCPCS J0360	63323-0614-55	HYDRALAZINE HCL 20 MG/ML IJ SOLN	BOTH IP/OP	$65.77 	$48.67	$0.00	$55.51	$32.40	$32.40	$0.00	$0.00	$0.00	$5.77	$53.45	$53.45	$55.51	$0.00	$6.11	$0.00	$38.90	$38.90	$0.00	$29.83	$47.24	$47.72	$0.00		$0.00	$4.41	$0.00	$0.00	$4.20	$0.00	$0.00	$0.00	$0.00	$0.00
3697	ERX	HCPCS J0360	67457-0291-01	HYDRALAZINE HCL 20 MG/ML IJ SOLN	BOTH IP/OP	$65.77 	$48.67	$0.00	$55.51	$32.40	$32.40	$0.00	$0.00	$0.00	$5.77	$53.45	$53.45	$55.51	$0.00	$6.11	$0.00	$38.90	$38.90	$0.00	$29.83	$47.24	$47.72	$0.00		$0.00	$4.41	$0.00	$0.00	$4.20	$0.00	$0.00	$0.00	$0.00	$0.00
3698	ERX	HCPCS 63700001	00904-6440-61	HYDRALAZINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3698	ERX	HCPCS 63700001	50111-0398-01	HYDRALAZINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3698	ERX	HCPCS 63700001	51079-0074-01	HYDRALAZINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3698	ERX	HCPCS 63700001	51079-0074-20	HYDRALAZINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3698	ERX	HCPCS 63700001	68084-0447-01	HYDRALAZINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3699	ERX	HCPCS 63700001	00904-6443-61	HYDRALAZINE HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3699	ERX	HCPCS 63700001	31722-0522-01	HYDRALAZINE HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3699	ERX	HCPCS 63700001	50111-0397-01	HYDRALAZINE HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3700	ERX	HCPCS 63700001	00904-6441-61	HYDRALAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3700	ERX	HCPCS 63700001	50111-0327-01	HYDRALAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3700	ERX	HCPCS 63700001	51079-0075-01	HYDRALAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3700	ERX	HCPCS 63700001	51079-0075-20	HYDRALAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3700	ERX	HCPCS 63700001	62584-0733-01	HYDRALAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3700	ERX	HCPCS 63700001	62584-0733-11	HYDRALAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3700	ERX	HCPCS 63700001	63739-0126-10	HYDRALAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3700	ERX	HCPCS 63700001	63739-0327-10	HYDRALAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3701	ERX	HCPCS 63700001	00904-6442-61	HYDRALAZINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3701	ERX	HCPCS 63700001	50111-0328-01	HYDRALAZINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3701	ERX	HCPCS 63700001	51079-0076-01	HYDRALAZINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3701	ERX	HCPCS 63700001	62584-0734-01	HYDRALAZINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3701	ERX	HCPCS 63700001	62584-0734-11	HYDRALAZINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3701	ERX	HCPCS 63700001	63739-0328-10	HYDRALAZINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3701	ERX	HCPCS 63700001	76282-0311-01	HYDRALAZINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3720	ERX	HCPCS 63700001	16729-0183-01	HYDROCHLOROTHIAZIDE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3720	ERX	HCPCS 63700001	16729-0183-17	HYDROCHLOROTHIAZIDE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3720	ERX	HCPCS 63700001	29300-0128-10	HYDROCHLOROTHIAZIDE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3720	ERX	HCPCS 63700001	63739-0128-10	HYDROCHLOROTHIAZIDE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3721	ERX	HCPCS 63700001	16729-0184-01	HYDROCHLOROTHIAZIDE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3721	ERX	HCPCS 63700001	43547-0398-10	HYDROCHLOROTHIAZIDE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3726	ERX	HCPCS 63700001	45802-0438-03	HYDROCORTISONE 1 % EX CREA	BOTH IP/OP	$30.18 	$22.33	$0.00	$8.80		$0.00	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00	$6.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3726	ERX	HCPCS 63700001	00168-0015-31	HYDROCORTISONE 1 % EX CREA	BOTH IP/OP	$30.18 	$22.33	$0.00	$8.80		$0.00	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00	$6.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3726	ERX	HCPCS 63700001	00168-0154-31	HYDROCORTISONE 1 % EX CREA	BOTH IP/OP	$30.18 	$22.33	$0.00	$8.80		$0.00	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00	$6.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3726	ERX	HCPCS 63700001	51672-2069-02	HYDROCORTISONE 1 % EX CREA	BOTH IP/OP	$30.18 	$22.33	$0.00	$8.80		$0.00	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00	$6.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3727	ERX	HCPCS 63700001	45802-0004-03	HYDROCORTISONE 2.5 % EX CREA	BOTH IP/OP	$46.14 	$34.14	$0.00	$33.47		$0.00	$0.00	$0.00	$8.21	$0.00	$0.00	$0.00	$0.00	$0.00	$9.62	$0.00	$0.00	$0.00	$0.00	$20.92	$33.14	$33.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3727	ERX	HCPCS 63700001	00168-0080-31	HYDROCORTISONE 2.5 % EX CREA	BOTH IP/OP	$46.14 	$34.14	$0.00	$33.47		$0.00	$0.00	$0.00	$8.21	$0.00	$0.00	$0.00	$0.00	$0.00	$9.62	$0.00	$0.00	$0.00	$0.00	$20.92	$33.14	$33.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3727	ERX	HCPCS 63700001	00472-0337-30	HYDROCORTISONE 2.5 % EX CREA	BOTH IP/OP	$46.14 	$34.14	$0.00	$33.47		$0.00	$0.00	$0.00	$8.21	$0.00	$0.00	$0.00	$0.00	$0.00	$9.62	$0.00	$0.00	$0.00	$0.00	$20.92	$33.14	$33.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3728	ERX	HCPCS 63700001	00394-0859-32	HYDROCORTISONE 1 % EX LOTN	BOTH IP/OP	$27.71 	$20.51	$0.00	$20.10		$0.00	$0.00	$0.00	$4.93	$0.00	$0.00	$0.00	$0.00	$0.00	$5.77	$0.00	$0.00	$0.00	$0.00	$12.57	$19.90	$20.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3731	ERX	HCPCS 63700001	00472-0345-56	HYDROCORTISONE 1 % EX OINT	BOTH IP/OP	$14.55 	$10.77	$0.00	$10.56		$0.00	$0.00	$0.00	$2.59	$0.00	$0.00	$0.00	$0.00	$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$6.60	$10.45	$10.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3731	ERX	HCPCS 63700001	45802-0276-03	HYDROCORTISONE 1 % EX OINT	BOTH IP/OP	$14.55 	$10.77	$0.00	$10.56		$0.00	$0.00	$0.00	$2.59	$0.00	$0.00	$0.00	$0.00	$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$6.60	$10.45	$10.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3731	ERX	HCPCS 63700001	00168-0020-16	HYDROCORTISONE 1 % EX OINT	BOTH IP/OP	$14.55 	$10.77	$0.00	$147.26		$0.00	$0.00	$0.00	$2.59	$0.00	$0.00	$0.00	$0.00	$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$6.60	$147.26	$10.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3732	ERX	HCPCS 63700001	45802-0014-02	HYDROCORTISONE 2.5 % EX OINT	BOTH IP/OP	$46.09 	$34.11	$0.00	$33.44		$0.00	$0.00	$0.00	$8.20	$0.00	$0.00	$0.00	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3732	ERX	HCPCS 63700001	00168-0146-30	HYDROCORTISONE 2.5 % EX OINT	BOTH IP/OP	$46.09 	$34.11	$0.00	$33.44		$0.00	$0.00	$0.00	$8.20	$0.00	$0.00	$0.00	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3733	ERX	HCPCS 63700001	59762-0074-01	HYDROCORTISONE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3734	ERX	HCPCS 63700001	00009-0044-01	HYDROCORTISONE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3734	ERX	HCPCS 63700001	42543-0142-01	HYDROCORTISONE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3734	ERX	HCPCS 63700001	59762-0075-01	HYDROCORTISONE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3734	ERX	HCPCS 63700001	72789-0062-01	HYDROCORTISONE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3738	ERX	HCPCS 25000001	00574-7090-12	HYDROCORTISONE ACETATE 25 MG RECTAL SUPP	BOTH IP/OP	$254.19 	$188.10	$0.00	$195.93		$0.00	$0.00	$0.00	$0.00	$0.00	$188.66	$188.66	$195.93	$0.00	$52.97	$0.00	$0.00	$0.00	$0.00	$99.10	$156.97	$158.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3738	ERX	HCPCS 25000001	00713-0503-12	HYDROCORTISONE ACETATE 25 MG RECTAL SUPP	BOTH IP/OP	$254.19 	$188.10	$0.00	$195.93		$0.00	$0.00	$0.00	$0.00	$0.00	$188.66	$188.66	$195.93	$0.00	$52.97	$0.00	$0.00	$0.00	$0.00	$99.10	$156.97	$158.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3738	ERX	HCPCS 25000001	00713-0503-24	HYDROCORTISONE ACETATE 25 MG RECTAL SUPP	BOTH IP/OP	$254.19 	$188.10	$0.00	$195.93		$0.00	$0.00	$0.00	$0.00	$0.00	$188.66	$188.66	$195.93	$0.00	$52.97	$0.00	$0.00	$0.00	$0.00	$99.10	$156.97	$158.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3738	ERX	HCPCS 25000001	16477-0201-24	HYDROCORTISONE ACETATE 25 MG RECTAL SUPP	BOTH IP/OP	$254.19 	$188.10	$0.00	$195.93		$0.00	$0.00	$0.00	$0.00	$0.00	$188.66	$188.66	$195.93	$0.00	$52.97	$0.00	$0.00	$0.00	$0.00	$99.10	$156.97	$158.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3738	ERX	HCPCS 25000001	65649-0411-12	HYDROCORTISONE ACETATE 25 MG RECTAL SUPP	BOTH IP/OP	$254.19 	$188.10	$0.00	$195.93		$0.00	$0.00	$0.00	$0.00	$0.00	$188.66	$188.66	$195.93	$0.00	$52.97	$0.00	$0.00	$0.00	$0.00	$99.10	$156.97	$158.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3738	ERX	HCPCS 25000001	65649-0411-24	HYDROCORTISONE ACETATE 25 MG RECTAL SUPP	BOTH IP/OP	$254.19 	$188.10	$0.00	$195.93		$0.00	$0.00	$0.00	$0.00	$0.00	$188.66	$188.66	$195.93	$0.00	$52.97	$0.00	$0.00	$0.00	$0.00	$99.10	$156.97	$158.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3747	ERX	HCPCS 25000001	51672-2010-02	HYDROCORTISONE-ALOE 0.5 % EX CREA	BOTH IP/OP	$23.09 	$17.09	$0.00	$17.80		$0.00	$0.00	$0.00	$0.00	$0.00	$17.14	$17.14	$17.80	$0.00	$4.81	$0.00	$0.00	$0.00	$0.00	$10.47	$16.58	$16.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3757	ERX	HCPCS J1170	00409-1283-03	HYDROMORPHONE HCL 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3757	ERX	HCPCS J1170	00409-1283-31	HYDROMORPHONE HCL 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3757	ERX	HCPCS J1170	00409-2552-01	HYDROMORPHONE HCL 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3757	ERX	HCPCS J1170	76045-0009-01	HYDROMORPHONE HCL 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3757	ERX	HCPCS J1170	76045-0009-10	HYDROMORPHONE HCL 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3757	ERX	HCPCS J1170	76045-0009-11	HYDROMORPHONE HCL 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3757	ERX	HCPCS J1170	99999-6010-70	HYDROMORPHONE HCL 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3758	ERX	HCPCS J1170	00409-1312-30	HYDROMORPHONE HCL 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3758	ERX	HCPCS J1170	00409-3365-01	HYDROMORPHONE HCL 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3758	ERX	HCPCS J1170	00409-3365-11	HYDROMORPHONE HCL 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3758	ERX	HCPCS J1170	00641-0121-25	HYDROMORPHONE HCL 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3758	ERX	HCPCS J1170	00641-6151-01	HYDROMORPHONE HCL 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3758	ERX	HCPCS J1170	00641-6151-25	HYDROMORPHONE HCL 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
3760	ERX	HCPCS 25000001	42858-0301-25	HYDROMORPHONE HCL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3760	ERX	HCPCS 25000001	68084-0423-01	HYDROMORPHONE HCL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3760	ERX	HCPCS 25000001	68084-0423-11	HYDROMORPHONE HCL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3761	ERX	HCPCS 25000001	00054-0264-24	HYDROMORPHONE HCL 4 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3761	ERX	HCPCS 25000001	42858-0302-25	HYDROMORPHONE HCL 4 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3770	ERX	HCPCS J3410	00517-5602-25	HYDROXYZINE HCL 50 MG/ML IM SOLN	BOTH IP/OP	$86.30 	$63.86	$0.00	$69.18		$0.00	$0.00	$0.00	$0.00	$0.00	$66.61	$66.61	$69.18	$0.00	$21.22	$0.00	$0.00	$0.00	$0.00	$37.12	$58.79	$59.38	$0.00		$0.00	$16.50	$0.00	$0.00	$15.71	$0.00	$0.00	$0.00	$0.00	$0.00
3771	ERX	HCPCS 63700001	99999-6010-58	HYDROXYZINE HCL 10 MG/5ML PO SYRP	BOTH IP/OP	$42.24 	$31.26	$0.00	$30.65		$0.00	$0.00	$0.00	$7.52	$0.00	$0.00	$0.00	$0.00	$0.00	$8.80	$0.00	$0.00	$0.00	$0.00	$19.16	$15.17	$30.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3771	ERX	HCPCS 63700001	60432-0150-04	HYDROXYZINE HCL 10 MG/5ML PO SYRP	BOTH IP/OP	$42.24 	$31.26	$0.00	$30.65		$0.00	$0.00	$0.00	$7.52	$0.00	$0.00	$0.00	$0.00	$0.00	$8.80	$0.00	$0.00	$0.00	$0.00	$19.16	$30.34	$30.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3771	ERX	HCPCS 63700001	99999-6004-67	HYDROXYZINE HCL 10 MG/5ML PO SYRP	BOTH IP/OP	$42.24 	$31.26	$0.00	$30.65		$0.00	$0.00	$0.00	$7.52	$0.00	$0.00	$0.00	$0.00	$0.00	$8.80	$0.00	$0.00	$0.00	$0.00	$19.16	$30.34	$30.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3771	ERX	HCPCS 63700001	60432-0150-16	HYDROXYZINE HCL 10 MG/5ML PO SYRP	BOTH IP/OP	$42.24 	$31.26	$0.00	$110.14		$0.00	$0.00	$0.00	$7.52	$0.00	$0.00	$0.00	$0.00	$0.00	$8.80	$0.00	$0.00	$0.00	$0.00	$19.16	$110.14	$30.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3772	ERX	HCPCS 63700001	16714-0081-10	HYDROXYZINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3772	ERX	HCPCS 63700001	68084-0253-01	HYDROXYZINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3772	ERX	HCPCS 63700001	68084-0253-11	HYDROXYZINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3774	ERX	HCPCS 63700001	16714-0082-10	HYDROXYZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3774	ERX	HCPCS 63700001	63739-0486-10	HYDROXYZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3774	ERX	HCPCS 63700001	68084-0254-01	HYDROXYZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3778	ERX	HCPCS Q0177	00185-0615-01	HYDROXYZINE PAMOATE 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
3778	ERX	HCPCS Q0177	00185-0615-05	HYDROXYZINE PAMOATE 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
3778	ERX	HCPCS Q0177	51079-0078-20	HYDROXYZINE PAMOATE 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
3781	ERX	HCPCS 25000001	39328-0048-16	HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX	BOTH IP/OP	$57.32 	$42.42	$0.00	$44.18		$0.00	$0.00	$0.00	$0.00	$0.00	$42.54	$42.54	$44.18	$0.00	$11.95	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3781	ERX	HCPCS 25000001	54838-0511-80	HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX	BOTH IP/OP	$57.32 	$42.42	$0.00	$44.18		$0.00	$0.00	$0.00	$0.00	$0.00	$42.54	$42.54	$44.18	$0.00	$11.95	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3781	ERX	HCPCS 25000001	58657-0427-16	HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX	BOTH IP/OP	$57.32 	$42.42	$0.00	$44.18		$0.00	$0.00	$0.00	$0.00	$0.00	$42.54	$42.54	$44.18	$0.00	$11.95	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3781	ERX	HCPCS 25000001	99999-6008-10	HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX	BOTH IP/OP	$57.32 	$42.42	$0.00	$44.18		$0.00	$0.00	$0.00	$0.00	$0.00	$42.54	$42.54	$44.18	$0.00	$11.95	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3783	ERX	HCPCS 63700001	42192-0340-01	HYOSCYAMINE SULFATE 0.125 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3841	ERX	HCPCS 25000001	00904-7914-59	IBUPROFEN 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3841	ERX	HCPCS 25000001	00904-7914-61	IBUPROFEN 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3841	ERX	HCPCS 25000001	63739-0134-01	IBUPROFEN 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3843	ERX	HCPCS 25000001	00904-5853-60	IBUPROFEN 400 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3843	ERX	HCPCS 25000001	00904-5853-61	IBUPROFEN 400 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3843	ERX	HCPCS 25000001	49483-0602-01	IBUPROFEN 400 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3843	ERX	HCPCS 25000001	60687-0446-01	IBUPROFEN 400 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3843	ERX	HCPCS 25000001	63739-0672-01	IBUPROFEN 400 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3843	ERX	HCPCS 25000001	63739-0672-10	IBUPROFEN 400 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3844	ERX	HCPCS 25000001	00904-5854-61	IBUPROFEN 600 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3844	ERX	HCPCS 25000001	11788-0009-05	IBUPROFEN 600 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3844	ERX	HCPCS 25000001	63739-0684-01	IBUPROFEN 600 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3844	ERX	HCPCS 25000001	63739-0684-10	IBUPROFEN 600 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3845	ERX	HCPCS 25000001	49483-0604-50	IBUPROFEN 800 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3845	ERX	HCPCS 25000001	63739-0691-01	IBUPROFEN 800 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3845	ERX	HCPCS 25000001	63739-0691-10	IBUPROFEN 800 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3860	ERX	HCPCS 63700001	00781-1762-01	IMIPRAMINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3860	ERX	HCPCS 63700001	49884-0054-01	IMIPRAMINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3860	ERX	HCPCS 63700001	53489-0330-01	IMIPRAMINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3861	ERX	HCPCS 63700001	00781-1764-01	IMIPRAMINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3861	ERX	HCPCS 63700001	00781-1764-13	IMIPRAMINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3862	ERX	HCPCS 63700001	00781-1766-01	IMIPRAMINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3862	ERX	HCPCS 63700001	00781-1766-13	IMIPRAMINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3862	ERX	HCPCS 63700001	49884-0056-01	IMIPRAMINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3879	ERX	HCPCS 63700001	00378-0080-01	INDAPAMIDE 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3897	ERX	HCPCS 63700001	31722-0542-01	INDOMETHACIN 25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3897	ERX	HCPCS 63700001	50268-0430-11	INDOMETHACIN 25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3897	ERX	HCPCS 63700001	50268-0430-15	INDOMETHACIN 25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3897	ERX	HCPCS 63700001	68462-0406-01	INDOMETHACIN 25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3900	ERX	HCPCS 25000001	69344-0101-01	INDOMETHACIN 25 MG/5ML PO SUSP	BOTH IP/OP	$191.60 	$141.78	$0.00	$147.69		$0.00	$0.00	$0.00	$0.00	$0.00	$142.21	$142.21	$147.69	$0.00	$39.93	$0.00	$0.00	$0.00	$0.00	$86.87	$137.59	$138.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3900	ERX	HCPCS 25000001	99999-6012-44	INDOMETHACIN 25 MG/5ML PO SUSP	BOTH IP/OP	$191.60 	$141.78	$0.00	$147.69		$0.00	$0.00	$0.00	$0.00	$0.00	$142.21	$142.21	$147.69	$0.00	$39.93	$0.00	$0.00	$0.00	$0.00	$86.87	$137.59	$138.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3901	ERX	HCPCS 63700001	69344-0102-33	INDOMETHACIN 50 MG RECTAL SUPP	BOTH IP/OP	$594.12 	$439.65	$0.00	$475.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$297.06	$470.54	$475.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3961	ERX	HCPCS 25000001	48433-0230-15	IODINE STRONG 5 % SOLN	BOTH IP/OP	$133.16 	$98.54	$0.00	$102.64		$0.00	$0.00	$0.00	$0.00	$0.00	$98.83	$98.83	$102.64	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$60.37	$95.63	$96.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3961	ERX	HCPCS 25000001	00395-2775-16	IODINE STRONG 5 % SOLN	BOTH IP/OP	$133.16 	$98.54	$0.00	$201.79		$0.00	$0.00	$0.00	$0.00	$0.00	$98.83	$98.83	$102.64	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$60.37	$201.79	$96.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3990	ERX	HCPCS J1750	00023-6082-01	IRON DEXTRAN 50 MG/ML IJ SOLN	BOTH IP/OP	$33.31 	$24.65	$0.00	$26.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.13	$16.66	$26.38	$26.65	$20.89		$20.89	$16.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3990	ERX	HCPCS J1750	00023-6082-10	IRON DEXTRAN 50 MG/ML IJ SOLN	BOTH IP/OP	$33.31 	$24.65	$0.00	$26.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.13	$16.66	$26.38	$26.65	$20.89		$20.89	$16.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4008	ERX	HCPCS 25000001	10019-0360-40	ISOFLURANE IN SOLN	BOTH IP/OP	$111.17 	$82.27	$0.00	$85.69		$0.00	$0.00	$0.00	$0.00	$0.00	$82.51	$82.51	$85.69	$0.00	$23.17	$0.00	$0.00	$0.00	$0.00	$50.40	$79.83	$80.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4008	ERX	HCPCS 25000001	66794-0017-10	ISOFLURANE IN SOLN	BOTH IP/OP	$111.17 	$82.27	$0.00	$85.69		$0.00	$0.00	$0.00	$0.00	$0.00	$82.51	$82.51	$85.69	$0.00	$23.17	$0.00	$0.00	$0.00	$0.00	$50.40	$79.83	$80.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4008	ERX	HCPCS 25000001	66794-0017-25	ISOFLURANE IN SOLN	BOTH IP/OP	$111.17 	$82.27	$0.00	$103.95		$0.00	$0.00	$0.00	$0.00	$0.00	$82.51	$82.51	$85.69	$0.00	$23.17	$0.00	$0.00	$0.00	$0.00	$50.40	$103.95	$80.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4024	ERX	HCPCS 25000001	00781-3056-70	ISONIAZID 100 MG/ML IJ SOLN	BOTH IP/OP	$354.88 	$262.61	$0.00	$273.54		$0.00	$0.00	$0.00	$0.00	$0.00	$263.39	$263.39	$273.54	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$161.07	$255.13	$257.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4025	ERX	HCPCS 63700001	99999-6004-68	ISONIAZID 50 MG/5ML PO SYRP	BOTH IP/OP	$69.39 	$51.35	$0.00	$50.34		$0.00	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00	$14.46	$0.00	$0.00	$0.00	$0.00	$31.47	$49.84	$50.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4025	ERX	HCPCS 63700001	46287-0009-01	ISONIAZID 50 MG/5ML PO SYRP	BOTH IP/OP	$69.39 	$51.35	$0.00	$857.73		$0.00	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00	$14.46	$0.00	$0.00	$0.00	$0.00	$31.47	$857.73	$50.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4026	ERX	HCPCS 63700001	00555-0066-02	ISONIAZID 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4027	ERX	HCPCS 63700001	00555-0071-01	ISONIAZID 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4027	ERX	HCPCS 63700001	00555-0071-02	ISONIAZID 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4027	ERX	HCPCS 63700001	51079-0083-01	ISONIAZID 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4027	ERX	HCPCS 63700001	51079-0083-20	ISONIAZID 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4030	ERX	HCPCS 25000001	00574-0067-16	ISOPROPYL ALCOHOL 70 % SOLN	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4030	ERX	HCPCS 25000001	49348-0030-38	ISOPROPYL ALCOHOL 70 % SOLN	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4034	ERX	HCPCS 25000001	00187-4330-01	ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN	BOTH IP/OP	"$2,250.90 "	"$1,665.67"	$0.00	"$1,800.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.45"	"$1,782.71"	"$1,800.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4034	ERX	HCPCS 25000001	00187-4330-05	ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN	BOTH IP/OP	"$2,250.90 "	"$1,665.67"	$0.00	"$1,800.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.45"	"$1,782.71"	"$1,800.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4034	ERX	HCPCS 25000001	00548-9501-00	ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN	BOTH IP/OP	"$2,250.90 "	"$1,665.67"	$0.00	"$1,800.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.45"	"$1,782.71"	"$1,800.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4034	ERX	HCPCS 25000001	00548-9502-00	ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN	BOTH IP/OP	"$2,250.90 "	"$1,665.67"	$0.00	"$1,800.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.45"	"$1,782.71"	"$1,800.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4034	ERX	HCPCS 25000001	14789-0015-05	ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN	BOTH IP/OP	"$2,250.90 "	"$1,665.67"	$0.00	"$1,800.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.45"	"$1,782.71"	"$1,800.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4034	ERX	HCPCS 25000001	14789-0015-07	ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN	BOTH IP/OP	"$2,250.90 "	"$1,665.67"	$0.00	"$1,800.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.45"	"$1,782.71"	"$1,800.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4034	ERX	HCPCS 25000001	70121-1604-01	ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN	BOTH IP/OP	"$2,250.90 "	"$1,665.67"	$0.00	"$1,800.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.45"	"$1,782.71"	"$1,800.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4034	ERX	HCPCS 25000001	70121-1604-07	ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN	BOTH IP/OP	"$2,250.90 "	"$1,665.67"	$0.00	"$1,800.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.45"	"$1,782.71"	"$1,800.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4034	ERX	HCPCS 25000001	70121-1605-01	ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN	BOTH IP/OP	"$2,250.90 "	"$1,665.67"	$0.00	"$1,800.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.45"	"$1,782.71"	"$1,800.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4034	ERX	HCPCS 25000001	70121-1605-07	ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN	BOTH IP/OP	"$2,250.90 "	"$1,665.67"	$0.00	"$1,800.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.45"	"$1,782.71"	"$1,800.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4064	ERX	HCPCS 63700001	00143-1771-01	ISOSORBIDE DINITRATE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4064	ERX	HCPCS 63700001	00781-1556-01	ISOSORBIDE DINITRATE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4064	ERX	HCPCS 63700001	00904-6619-61	ISOSORBIDE DINITRATE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4064	ERX	HCPCS 63700001	50268-0448-15	ISOSORBIDE DINITRATE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4064	ERX	HCPCS 63700001	63739-0569-10	ISOSORBIDE DINITRATE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4064	ERX	HCPCS 63700001	68084-0082-01	ISOSORBIDE DINITRATE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4065	ERX	HCPCS 63700001	00781-1695-01	ISOSORBIDE DINITRATE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4065	ERX	HCPCS 63700001	00904-6620-61	ISOSORBIDE DINITRATE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4065	ERX	HCPCS 63700001	63739-0367-10	ISOSORBIDE DINITRATE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4065	ERX	HCPCS 63700001	68084-0083-01	ISOSORBIDE DINITRATE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4068	ERX	HCPCS 63700001	00143-1769-01	ISOSORBIDE DINITRATE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4068	ERX	HCPCS 63700001	00781-1635-01	ISOSORBIDE DINITRATE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4201	ERX	HCPCS 25000001	99999-6005-50	KAYEXALATE PO POWD	BOTH IP/OP	$28.50 	$21.09	$0.00	$22.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4236	ERX	HCPCS J3490	42023-0113-10	KETAMINE HCL 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
4236	ERX	HCPCS J3490	67457-0181-20	KETAMINE HCL 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
4237	ERX	HCPCS 25000001	00143-9509-10	KETAMINE HCL 100 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4238	ERX	HCPCS J3490	00143-9508-10	KETAMINE HCL 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
4238	ERX	HCPCS J3490	00409-2053-10	KETAMINE HCL 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
4238	ERX	HCPCS J3490	42023-0114-10	KETAMINE HCL 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
4238	ERX	HCPCS J3490	67457-0001-00	KETAMINE HCL 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
4238	ERX	HCPCS J3490	67457-0001-10	KETAMINE HCL 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
4318	ERX	HCPCS J7120	00264-7750-00	LACTATED RINGERS IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$1.13	$18.66	$18.66	$19.38	$0.00	$2.95	$0.00	$14.87	$14.87	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.77	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00
4318	ERX	HCPCS J7120	00338-0117-04	LACTATED RINGERS IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$1.13	$18.66	$18.66	$19.38	$0.00	$2.95	$0.00	$14.87	$14.87	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.77	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00
4318	ERX	HCPCS J7120	00990-7953-09	LACTATED RINGERS IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$1.13	$18.66	$18.66	$19.38	$0.00	$2.95	$0.00	$14.87	$14.87	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.77	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00
4318	ERX	HCPCS J7120	00264-7750-20	LACTATED RINGERS IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$1.13	$18.66	$18.66	$19.38	$0.00	$2.95	$0.00	$14.87	$14.87	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.77	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00
4318	ERX	HCPCS J7120	00338-0117-03	LACTATED RINGERS IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.56	$11.31	$11.31	$0.00	$0.00	$0.00	$1.13	$18.66	$18.66	$19.38	$0.00	$2.95	$0.00	$14.87	$14.87	$0.00	$11.00	$19.56	$17.60	$0.00		$0.00	$2.77	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00
4318	ERX	HCPCS J7120	00409-7953-03	LACTATED RINGERS IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.56	$11.31	$11.31	$0.00	$0.00	$0.00	$1.13	$18.66	$18.66	$19.38	$0.00	$2.95	$0.00	$14.87	$14.87	$0.00	$11.00	$19.56	$17.60	$0.00		$0.00	$2.77	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00
4323	ERX	HCPCS 63700001	08290-2367-12	LACTINEX PO PACK	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4393	ERX	HCPCS J0640	00143-9552-01	LEUCOVORIN CALCIUM 350 MG IJ SOLR	BOTH IP/OP	$120.44 	$89.13	$0.00	$92.84	$54.20	$54.20	$0.00	$0.00	$0.00	$7.32	$89.39	$89.39	$92.84	$0.00	$30.08	$0.00	$71.24	$71.24	$0.00	$54.60	$86.49	$87.36	$0.00		$0.00	$27.39	$0.00	$0.00	$26.08	$0.00	$0.00	$0.00	$0.00	$0.00
4393	ERX	HCPCS J0640	00703-5145-01	LEUCOVORIN CALCIUM 350 MG IJ SOLR	BOTH IP/OP	$120.44 	$89.13	$0.00	$92.84	$54.20	$54.20	$0.00	$0.00	$0.00	$7.32	$89.39	$89.39	$92.84	$0.00	$30.08	$0.00	$71.24	$71.24	$0.00	$54.60	$86.49	$87.36	$0.00		$0.00	$27.39	$0.00	$0.00	$26.08	$0.00	$0.00	$0.00	$0.00	$0.00
4393	ERX	HCPCS J0640	67457-0530-35	LEUCOVORIN CALCIUM 350 MG IJ SOLR	BOTH IP/OP	$120.44 	$89.13	$0.00	$92.84	$54.20	$54.20	$0.00	$0.00	$0.00	$7.32	$89.39	$89.39	$92.84	$0.00	$30.08	$0.00	$71.24	$71.24	$0.00	$54.60	$86.49	$87.36	$0.00		$0.00	$27.39	$0.00	$0.00	$26.08	$0.00	$0.00	$0.00	$0.00	$0.00
4394	ERX	HCPCS J0640	00143-9555-01	LEUCOVORIN CALCIUM 50 MG IJ SOLR	BOTH IP/OP	$50.28 	$37.21	$0.00	$38.76	$22.63	$22.63	$0.00	$0.00	$0.00	$1.05	$37.32	$37.32	$38.76	$0.00	$4.30	$0.00	$29.74	$29.74	$0.00	$22.80	$36.12	$36.48	$0.00		$0.00	$3.91	$0.00	$0.00	$3.73	$0.00	$0.00	$0.00	$0.00	$0.00
4394	ERX	HCPCS J0640	25021-0813-10	LEUCOVORIN CALCIUM 50 MG IJ SOLR	BOTH IP/OP	$50.28 	$37.21	$0.00	$38.76	$22.63	$22.63	$0.00	$0.00	$0.00	$1.05	$37.32	$37.32	$38.76	$0.00	$4.30	$0.00	$29.74	$29.74	$0.00	$22.80	$36.12	$36.48	$0.00		$0.00	$3.91	$0.00	$0.00	$3.73	$0.00	$0.00	$0.00	$0.00	$0.00
4397	ERX	HCPCS 63700001	51079-0582-01	LEUCOVORIN CALCIUM 25 MG PO TABS	BOTH IP/OP	$57.36 	$42.45	$0.00	$41.62		$0.00	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00	$11.95	$0.00	$0.00	$0.00	$0.00	$26.01	$41.20	$41.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4397	ERX	HCPCS 63700001	51079-0582-05	LEUCOVORIN CALCIUM 25 MG PO TABS	BOTH IP/OP	$57.36 	$42.45	$0.00	$41.62		$0.00	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00	$11.95	$0.00	$0.00	$0.00	$0.00	$26.01	$41.20	$41.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4397	ERX	HCPCS 63700001	60687-0227-94	LEUCOVORIN CALCIUM 25 MG PO TABS	BOTH IP/OP	$57.36 	$42.45	$0.00	$41.62		$0.00	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00	$11.95	$0.00	$0.00	$0.00	$0.00	$26.01	$41.20	$41.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4398	ERX	HCPCS 63700001	00054-8496-19	LEUCOVORIN CALCIUM 5 MG PO TABS	BOTH IP/OP	$13.62 	$10.08	$0.00	$9.88		$0.00	$0.00	$0.00	$2.42	$0.00	$0.00	$0.00	$0.00	$0.00	$2.84	$0.00	$0.00	$0.00	$0.00	$6.18	$9.78	$9.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4398	ERX	HCPCS 63700001	00555-0484-01	LEUCOVORIN CALCIUM 5 MG PO TABS	BOTH IP/OP	$13.62 	$10.08	$0.00	$9.88		$0.00	$0.00	$0.00	$2.42	$0.00	$0.00	$0.00	$0.00	$0.00	$2.84	$0.00	$0.00	$0.00	$0.00	$6.18	$9.78	$9.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4398	ERX	HCPCS 63700001	51079-0581-01	LEUCOVORIN CALCIUM 5 MG PO TABS	BOTH IP/OP	$13.62 	$10.08	$0.00	$9.88		$0.00	$0.00	$0.00	$2.42	$0.00	$0.00	$0.00	$0.00	$0.00	$2.84	$0.00	$0.00	$0.00	$0.00	$6.18	$9.78	$9.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4398	ERX	HCPCS 63700001	51079-0581-06	LEUCOVORIN CALCIUM 5 MG PO TABS	BOTH IP/OP	$13.62 	$10.08	$0.00	$9.88		$0.00	$0.00	$0.00	$2.42	$0.00	$0.00	$0.00	$0.00	$0.00	$2.84	$0.00	$0.00	$0.00	$0.00	$6.18	$9.78	$9.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4420	ERX	HCPCS 63700001	00378-1800-77	LEVOTHYROXINE SODIUM 25 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4420	ERX	HCPCS 63700001	00781-5180-92	LEVOTHYROXINE SODIUM 25 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4420	ERX	HCPCS 63700001	51079-0444-20	LEVOTHYROXINE SODIUM 25 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4421	ERX	HCPCS 63700001	00378-1803-77	LEVOTHYROXINE SODIUM 50 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4421	ERX	HCPCS 63700001	00781-5181-92	LEVOTHYROXINE SODIUM 50 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4421	ERX	HCPCS 63700001	51079-0440-20	LEVOTHYROXINE SODIUM 50 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4422	ERX	HCPCS 63700001	00378-1805-77	LEVOTHYROXINE SODIUM 75 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4422	ERX	HCPCS 63700001	00781-5182-92	LEVOTHYROXINE SODIUM 75 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4422	ERX	HCPCS 63700001	51079-0441-20	LEVOTHYROXINE SODIUM 75 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4423	ERX	HCPCS 63700001	00781-5184-92	LEVOTHYROXINE SODIUM 100 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4423	ERX	HCPCS 63700001	51079-0442-20	LEVOTHYROXINE SODIUM 100 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4424	ERX	HCPCS 63700001	00781-5186-92	LEVOTHYROXINE SODIUM 125 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4424	ERX	HCPCS 63700001	51079-0443-20	LEVOTHYROXINE SODIUM 125 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4425	ERX	HCPCS 63700001	00378-1815-77	LEVOTHYROXINE SODIUM 150 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4425	ERX	HCPCS 63700001	00781-5187-92	LEVOTHYROXINE SODIUM 150 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4426	ERX	HCPCS 63700001	00781-5189-92	LEVOTHYROXINE SODIUM 200 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4450	ERX	HCPCS 25000001	00054-3505-47	LIDOCAINE HCL 4 % EX SOLN	BOTH IP/OP	$185.28 	$137.11	$0.00	$142.81		$0.00	$0.00	$0.00	$0.00	$0.00	$137.51	$137.51	$142.81	$0.00	$38.61	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4451	ERX	HCPCS 25000001	00409-4275-01	LIDOCAINE HCL 0.5 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4451	ERX	HCPCS 25000001	63323-0484-57	LIDOCAINE HCL 0.5 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4452	ERX	HCPCS 25000001	00409-4276-01	LIDOCAINE HCL 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4452	ERX	HCPCS 25000001	00409-4276-16	LIDOCAINE HCL 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4452	ERX	HCPCS 25000001	55150-0252-20	LIDOCAINE HCL 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4452	ERX	HCPCS 25000001	63323-0485-27	LIDOCAINE HCL 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4454	ERX	HCPCS 25000001	00409-4277-01	LIDOCAINE HCL 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4454	ERX	HCPCS 25000001	00409-4277-16	LIDOCAINE HCL 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4454	ERX	HCPCS 25000001	55150-0254-10	LIDOCAINE HCL 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4454	ERX	HCPCS 25000001	55150-0255-20	LIDOCAINE HCL 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4454	ERX	HCPCS 25000001	63323-0202-02	LIDOCAINE HCL 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4454	ERX	HCPCS 25000001	63323-0486-17	LIDOCAINE HCL 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4454	ERX	HCPCS 25000001	63323-0486-27	LIDOCAINE HCL 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4498	ERX	HCPCS 25000001	60432-0834-60	LINDANE 1 % EX SHAM	BOTH IP/OP	$459.85 	$340.29	$0.00	$354.45		$0.00	$0.00	$0.00	$0.00	$0.00	$341.30	$341.30	$354.45	$0.00	$95.83	$0.00	$0.00	$0.00	$0.00	$208.72	$330.60	$333.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4504	ERX	HCPCS 63700001	59762-1207-01	LIOTHYRONINE SODIUM 25 MCG PO TABS	BOTH IP/OP	$13.24 	$9.80	$0.00	$9.19		$0.00	$0.00	$0.00	$2.36	$0.00	$0.00	$0.00	$0.00	$0.00	$2.76	$0.00	$0.00	$0.00	$0.00	$5.75	$9.10	$9.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4504	ERX	HCPCS 63700001	60793-0116-01	LIOTHYRONINE SODIUM 25 MCG PO TABS	BOTH IP/OP	$13.24 	$9.80	$0.00	$9.19		$0.00	$0.00	$0.00	$2.36	$0.00	$0.00	$0.00	$0.00	$0.00	$2.76	$0.00	$0.00	$0.00	$0.00	$5.75	$9.10	$9.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4526	ERX	HCPCS 63700001	00904-6799-61	LISINOPRIL 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4526	ERX	HCPCS 63700001	43547-0354-10	LISINOPRIL 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4526	ERX	HCPCS 63700001	60687-0333-01	LISINOPRIL 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4526	ERX	HCPCS 63700001	63739-0350-10	LISINOPRIL 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4529	ERX	HCPCS 63700001	00054-2527-25	LITHIUM CARBONATE 300 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4529	ERX	HCPCS 63700001	00054-8527-25	LITHIUM CARBONATE 300 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4560	ERX	HCPCS 63700001	00093-0311-01	LOPERAMIDE HCL 2 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4560	ERX	HCPCS 63700001	51079-0690-01	LOPERAMIDE HCL 2 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4560	ERX	HCPCS 63700001	51079-0690-20	LOPERAMIDE HCL 2 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4560	ERX	HCPCS 63700001	60687-0229-01	LOPERAMIDE HCL 2 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4571	ERX	HCPCS 25000001	00054-3532-44	LORAZEPAM 2 MG/ML PO CONC	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4571	ERX	HCPCS 25000001	00121-0770-01	LORAZEPAM 2 MG/ML PO CONC	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4571	ERX	HCPCS 25000001	50383-0705-30	LORAZEPAM 2 MG/ML PO CONC	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4571	ERX	HCPCS 25000001	99999-6007-84	LORAZEPAM 2 MG/ML PO CONC	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4572	ERX	HCPCS 25000001	69315-0904-01	LORAZEPAM 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4573	ERX	HCPCS 25000001	00591-0241-01	LORAZEPAM 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4573	ERX	HCPCS 25000001	00904-6008-60	LORAZEPAM 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4573	ERX	HCPCS 25000001	00904-6008-61	LORAZEPAM 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4573	ERX	HCPCS 25000001	69315-0905-01	LORAZEPAM 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4574	ERX	HCPCS 25000001	00591-0242-01	LORAZEPAM 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4574	ERX	HCPCS 25000001	00591-0242-05	LORAZEPAM 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4574	ERX	HCPCS 25000001	00904-6009-61	LORAZEPAM 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4574	ERX	HCPCS 25000001	60687-0367-01	LORAZEPAM 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4574	ERX	HCPCS 25000001	60687-0367-11	LORAZEPAM 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4599	ERX	HCPCS 63700001	00527-1395-01	LOXAPINE SUCCINATE 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4600	ERX	HCPCS 63700001	00591-0371-01	LOXAPINE SUCCINATE 25 MG PO CAPS	BOTH IP/OP	$7.32 	$5.42	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.66	$5.80	$5.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4602	ERX	HCPCS 63700001	00378-7050-01	LOXAPINE SUCCINATE 50 MG PO CAPS	BOTH IP/OP	$10.78 	$7.98	$0.00	$7.82		$0.00	$0.00	$0.00	$1.92	$0.00	$0.00	$0.00	$0.00	$0.00	$2.25	$0.00	$0.00	$0.00	$0.00	$4.89	$7.75	$7.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4602	ERX	HCPCS 63700001	00591-0372-01	LOXAPINE SUCCINATE 50 MG PO CAPS	BOTH IP/OP	$10.78 	$7.98	$0.00	$7.82		$0.00	$0.00	$0.00	$1.92	$0.00	$0.00	$0.00	$0.00	$0.00	$2.25	$0.00	$0.00	$0.00	$0.00	$4.89	$7.75	$7.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4711	ERX	HCPCS 63700001	00869-0686-38	MAGNESIUM CITRATE 58 MG/ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4711	ERX	HCPCS 63700001	00904-6787-44	MAGNESIUM CITRATE 58 MG/ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4711	ERX	HCPCS 63700001	49348-0504-49	MAGNESIUM CITRATE 58 MG/ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4711	ERX	HCPCS 63700001	49348-0696-49	MAGNESIUM CITRATE 58 MG/ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4711	ERX	HCPCS 63700001	70677-0051-01	MAGNESIUM CITRATE 58 MG/ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4711	ERX	HCPCS 63700001	70677-0053-01	MAGNESIUM CITRATE 58 MG/ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4715	ERX	HCPCS 63700001	59016-0420-17	MAGNESIUM LACTATE 84 MG (7MEQ) PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4720	ERX	HCPCS J3475	51754-1000-04	MAGNESIUM SULFATE 50 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.12	$16.33	$16.33	$16.96	$0.00	$1.77	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.48	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00
4720	ERX	HCPCS J3475	63323-0064-03	MAGNESIUM SULFATE 50 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.12	$16.33	$16.33	$16.96	$0.00	$1.77	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.48	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00
4720	ERX	HCPCS J3475	63323-0064-11	MAGNESIUM SULFATE 50 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.12	$16.33	$16.33	$16.96	$0.00	$1.77	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.48	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00
4720	ERX	HCPCS J3475	63323-0642-20	MAGNESIUM SULFATE 50 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.12	$16.33	$16.33	$16.96	$0.00	$1.77	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.48	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00
4720	ERX	HCPCS J3475	63323-0642-50	MAGNESIUM SULFATE 50 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.12	$16.33	$16.33	$16.96	$0.00	$1.77	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.48	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00
4744	ERX	HCPCS 25000001	00409-4091-01	MANGANESE CHLORIDE 0.1 MG/ML IV SOLN	BOTH IP/OP	$115.65 	$85.58	$0.00	$89.14		$0.00	$0.00	$0.00	$0.00	$0.00	$85.84	$85.84	$89.14	$0.00	$24.10	$0.00	$0.00	$0.00	$0.00	$48.23	$76.40	$77.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4749	ERX	HCPCS 25000001	00264-7578-10	MANNITOL 20 % IV SOLN	BOTH IP/OP	$108.57 	$80.34	$0.00	$83.69		$0.00	$0.00	$0.00	$0.00	$0.00	$80.58	$80.58	$83.69	$0.00	$22.63	$0.00	$0.00	$0.00	$0.00	$45.94	$72.77	$73.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4749	ERX	HCPCS 25000001	00338-0357-02	MANNITOL 20 % IV SOLN	BOTH IP/OP	$108.57 	$80.34	$0.00	$83.69		$0.00	$0.00	$0.00	$0.00	$0.00	$80.58	$80.58	$83.69	$0.00	$22.63	$0.00	$0.00	$0.00	$0.00	$45.94	$72.77	$73.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4749	ERX	HCPCS 25000001	00338-0357-03	MANNITOL 20 % IV SOLN	BOTH IP/OP	$108.57 	$80.34	$0.00	$83.69		$0.00	$0.00	$0.00	$0.00	$0.00	$80.58	$80.58	$83.69	$0.00	$22.63	$0.00	$0.00	$0.00	$0.00	$45.94	$72.77	$73.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4750	ERX	HCPCS J2150	00409-4031-01	MANNITOL 25 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$2.96	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4750	ERX	HCPCS J2150	63323-0024-25	MANNITOL 25 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$2.96	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4759	ERX	HCPCS 63700001	00378-0060-01	MAPROTILINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4760	ERX	HCPCS 63700001	00378-0087-01	MAPROTILINE HCL 50 MG PO TABS	BOTH IP/OP	$6.50 	$4.81	$0.00	$5.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.25	$5.15	$5.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4822	ERX	HCPCS 63700001	00536-1018-01	MECLIZINE HCL 25 MG PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4854	ERX	HCPCS 63700001	00555-0779-02	MEDROXYPROGESTERONE ACETATE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4855	ERX	HCPCS 63700001	00555-0872-02	MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4856	ERX	HCPCS 63700001	00555-0873-02	MEDROXYPROGESTERONE ACETATE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4871	ERX	HCPCS 63700001	00904-3571-61	MEGESTROL ACETATE 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4871	ERX	HCPCS 63700001	49884-0290-01	MEGESTROL ACETATE 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4871	ERX	HCPCS 63700001	63739-0165-10	MEGESTROL ACETATE 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4903	ERX	HCPCS J2175	00409-1176-03	MEPERIDINE HCL 25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.67	$16.33	$16.33	$16.96	$0.00	$7.61	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.55	$0.00	$0.00	$5.28	$0.00	$0.00	$0.00	$0.00	$0.00
4903	ERX	HCPCS J2175	00409-1176-30	MEPERIDINE HCL 25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.67	$16.33	$16.33	$16.96	$0.00	$7.61	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.55	$0.00	$0.00	$5.28	$0.00	$0.00	$0.00	$0.00	$0.00
4903	ERX	HCPCS J2175	00641-6052-25	MEPERIDINE HCL 25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.67	$16.33	$16.33	$16.96	$0.00	$7.61	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.55	$0.00	$0.00	$5.28	$0.00	$0.00	$0.00	$0.00	$0.00
4904	ERX	HCPCS J2175	00641-6053-25	MEPERIDINE HCL 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.67	$16.33	$16.33	$16.96	$0.00	$7.61	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.55	$0.00	$0.00	$5.28	$0.00	$0.00	$0.00	$0.00	$0.00
4905	ERX	HCPCS J2175	00409-1179-03	MEPERIDINE HCL 75 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.67	$16.33	$16.33	$16.96	$0.00	$7.61	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.55	$0.00	$0.00	$5.28	$0.00	$0.00	$0.00	$0.00	$0.00
4905	ERX	HCPCS J2175	00409-1179-30	MEPERIDINE HCL 75 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.67	$16.33	$16.33	$16.96	$0.00	$7.61	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.55	$0.00	$0.00	$5.28	$0.00	$0.00	$0.00	$0.00	$0.00
4914	ERX	HCPCS J0670	00409-1038-50	MEPIVACAINE HCL 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.24	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4915	ERX	HCPCS J0670	00409-2047-50	MEPIVACAINE HCL 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4952	ERX	HCPCS 63700001	00054-3555-63	METHADONE HCL 5 MG/5ML PO SOLN	BOTH IP/OP	$39.60 	$29.30	$0.00	$28.73		$0.00	$0.00	$0.00	$7.05	$0.00	$0.00	$0.00	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$17.96	$28.44	$28.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4952	ERX	HCPCS 63700001	66689-0711-16	METHADONE HCL 5 MG/5ML PO SOLN	BOTH IP/OP	$39.60 	$29.30	$0.00	$28.73		$0.00	$0.00	$0.00	$7.05	$0.00	$0.00	$0.00	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$17.96	$28.44	$28.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4952	ERX	HCPCS 63700001	99999-6011-43	METHADONE HCL 5 MG/5ML PO SOLN	BOTH IP/OP	$39.60 	$29.30	$0.00	$28.73		$0.00	$0.00	$0.00	$7.05	$0.00	$0.00	$0.00	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$17.96	$28.44	$28.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4953	ERX	HCPCS 63700001	00054-8554-24	METHADONE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4953	ERX	HCPCS 63700001	00406-5771-62	METHADONE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4954	ERX	HCPCS 63700001	00054-4570-25	METHADONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4954	ERX	HCPCS 63700001	00054-8553-24	METHADONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4954	ERX	HCPCS 63700001	00406-5755-23	METHADONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4954	ERX	HCPCS 63700001	00406-5755-62	METHADONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4962	ERX	HCPCS 63700001	00574-0791-01	METHAZOLAMIDE 50 MG PO TABS	BOTH IP/OP	$29.12 	$21.55	$0.00	$23.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.56	$23.06	$23.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4962	ERX	HCPCS 63700001	00781-1071-01	METHAZOLAMIDE 50 MG PO TABS	BOTH IP/OP	$29.12 	$21.55	$0.00	$23.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.56	$23.06	$23.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4962	ERX	HCPCS 63700001	62559-0241-01	METHAZOLAMIDE 50 MG PO TABS	BOTH IP/OP	$29.12 	$21.55	$0.00	$23.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.56	$23.06	$23.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4966	ERX	HCPCS 63700001	13925-0107-01	METHENAMINE MANDELATE 1 G PO TABS	BOTH IP/OP	$9.94 	$7.36	$0.00	$7.21		$0.00	$0.00	$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$0.00	$2.07	$0.00	$0.00	$0.00	$0.00	$4.51	$7.14	$7.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4971	ERX	HCPCS 63700001	76385-0123-50	METHOCARBAMOL 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4972	ERX	HCPCS 63700001	31722-0534-01	METHOCARBAMOL 750 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4973	ERX	HCPCS J8610	00054-4550-25	METHOTREXATE 2.5 MG PO TABS	BOTH IP/OP	$78.44 	$58.05	$0.00	$60.46	$35.30	$35.30	$0.00	$0.00	$0.00	$16.35	$58.22	$58.22	$60.46	$0.00	$16.35	$0.00	$46.40	$46.40	$0.00	$35.57	$56.34	$56.91	$0.00		$0.00	$11.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4973	ERX	HCPCS J8610	00054-8550-25	METHOTREXATE 2.5 MG PO TABS	BOTH IP/OP	$78.44 	$58.05	$0.00	$60.46	$35.30	$35.30	$0.00	$0.00	$0.00	$16.35	$58.22	$58.22	$60.46	$0.00	$16.35	$0.00	$46.40	$46.40	$0.00	$35.57	$56.34	$56.91	$0.00		$0.00	$11.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4973	ERX	HCPCS J8610	00378-0014-01	METHOTREXATE 2.5 MG PO TABS	BOTH IP/OP	$78.44 	$58.05	$0.00	$60.46	$35.30	$35.30	$0.00	$0.00	$0.00	$16.35	$58.22	$58.22	$60.46	$0.00	$16.35	$0.00	$46.40	$46.40	$0.00	$35.57	$56.34	$56.91	$0.00		$0.00	$11.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4973	ERX	HCPCS J8610	00555-0572-02	METHOTREXATE 2.5 MG PO TABS	BOTH IP/OP	$78.44 	$58.05	$0.00	$60.46	$35.30	$35.30	$0.00	$0.00	$0.00	$16.35	$58.22	$58.22	$60.46	$0.00	$16.35	$0.00	$46.40	$46.40	$0.00	$35.57	$56.34	$56.91	$0.00		$0.00	$11.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4973	ERX	HCPCS J8610	51079-0670-01	METHOTREXATE 2.5 MG PO TABS	BOTH IP/OP	$78.44 	$58.05	$0.00	$60.46	$35.30	$35.30	$0.00	$0.00	$0.00	$16.35	$58.22	$58.22	$60.46	$0.00	$16.35	$0.00	$46.40	$46.40	$0.00	$35.57	$56.34	$56.91	$0.00		$0.00	$11.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4973	ERX	HCPCS J8610	51079-0670-05	METHOTREXATE 2.5 MG PO TABS	BOTH IP/OP	$78.44 	$58.05	$0.00	$60.46	$35.30	$35.30	$0.00	$0.00	$0.00	$16.35	$58.22	$58.22	$60.46	$0.00	$16.35	$0.00	$46.40	$46.40	$0.00	$35.57	$56.34	$56.91	$0.00		$0.00	$11.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4986	ERX	HCPCS 63700001	00406-1144-01	METHYLPHENIDATE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4986	ERX	HCPCS 63700001	10702-0101-01	METHYLPHENIDATE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4986	ERX	HCPCS 63700001	65580-0530-01	METHYLPHENIDATE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4988	ERX	HCPCS 63700001	00406-1142-01	METHYLPHENIDATE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4988	ERX	HCPCS 63700001	00781-5748-01	METHYLPHENIDATE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4988	ERX	HCPCS 63700001	16714-0821-01	METHYLPHENIDATE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4991	ERX	HCPCS J7509	00781-5022-07	METHYLPREDNISOLONE 4 MG PO TBPK	BOTH IP/OP	$115.92 	$85.78	$0.00	$89.35	$52.16	$52.16	$0.00	$0.00	$0.00	$24.16	$86.04	$86.04	$89.35	$0.00	$24.16	$0.00	$68.57	$68.57	$0.00	$52.56	$83.25	$84.09	$0.00		$0.00	$16.45	$0.00	$0.00	$16.73	$0.00	$0.00	$0.00	$0.00	$0.00
4992	ERX	HCPCS J7509	00009-0073-01	METHYLPREDNISOLONE 16 MG PO TABS	BOTH IP/OP	$14.46 	$10.70	$0.00	$11.15	$6.51	$6.51	$0.00	$0.00	$0.00	$3.01	$10.73	$10.73	$11.15	$0.00	$3.01	$0.00	$8.55	$8.55	$0.00	$6.46	$10.23	$10.34	$0.00		$0.00	$2.02	$0.00	$0.00	$2.06	$0.00	$0.00	$0.00	$0.00	$0.00
4992	ERX	HCPCS J7509	59746-0003-14	METHYLPREDNISOLONE 16 MG PO TABS	BOTH IP/OP	$14.46 	$10.70	$0.00	$11.15	$6.51	$6.51	$0.00	$0.00	$0.00	$3.01	$10.73	$10.73	$11.15	$0.00	$3.01	$0.00	$8.55	$8.55	$0.00	$6.46	$10.23	$10.34	$0.00		$0.00	$2.02	$0.00	$0.00	$2.06	$0.00	$0.00	$0.00	$0.00	$0.00
4992	ERX	HCPCS J7509	59762-0050-01	METHYLPREDNISOLONE 16 MG PO TABS	BOTH IP/OP	$14.46 	$10.70	$0.00	$11.15	$6.51	$6.51	$0.00	$0.00	$0.00	$3.01	$10.73	$10.73	$11.15	$0.00	$3.01	$0.00	$8.55	$8.55	$0.00	$6.46	$10.23	$10.34	$0.00		$0.00	$2.02	$0.00	$0.00	$2.06	$0.00	$0.00	$0.00	$0.00	$0.00
4993	ERX	HCPCS J7509	00781-5022-01	METHYLPREDNISOLONE 4 MG PO TABS	BOTH IP/OP	$6.92 	$5.12	$0.00	$5.33	$3.11	$3.11	$0.00	$0.00	$0.00	$1.44	$5.14	$5.14	$5.33	$0.00	$1.44	$0.00	$4.09	$4.09	$0.00	$3.14	$4.97	$5.02	$0.00		$0.00	$0.98	$0.00	$0.00	$1.00	$0.00	$0.00	$0.00	$0.00	$0.00
4993	ERX	HCPCS J7509	59746-0001-06	METHYLPREDNISOLONE 4 MG PO TABS	BOTH IP/OP	$6.92 	$5.12	$0.00	$5.33	$3.11	$3.11	$0.00	$0.00	$0.00	$1.44	$5.14	$5.14	$5.33	$0.00	$1.44	$0.00	$4.09	$4.09	$0.00	$3.14	$4.97	$5.02	$0.00		$0.00	$0.98	$0.00	$0.00	$1.00	$0.00	$0.00	$0.00	$0.00	$0.00
4993	ERX	HCPCS J7509	68084-0149-01	METHYLPREDNISOLONE 4 MG PO TABS	BOTH IP/OP	$6.92 	$5.12	$0.00	$5.33	$3.11	$3.11	$0.00	$0.00	$0.00	$1.44	$5.14	$5.14	$5.33	$0.00	$1.44	$0.00	$4.09	$4.09	$0.00	$3.14	$4.97	$5.02	$0.00		$0.00	$0.98	$0.00	$0.00	$1.00	$0.00	$0.00	$0.00	$0.00	$0.00
4993	ERX	HCPCS J7509	68084-0149-11	METHYLPREDNISOLONE 4 MG PO TABS	BOTH IP/OP	$6.92 	$5.12	$0.00	$5.33	$3.11	$3.11	$0.00	$0.00	$0.00	$1.44	$5.14	$5.14	$5.33	$0.00	$1.44	$0.00	$4.09	$4.09	$0.00	$3.14	$4.97	$5.02	$0.00		$0.00	$0.98	$0.00	$0.00	$1.00	$0.00	$0.00	$0.00	$0.00	$0.00
4995	ERX	HCPCS J1030	00009-3073-01	METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP	BOTH IP/OP	$26.70 	$19.76	$0.00	$20.58	$12.02	$12.02	$0.00	$0.00	$0.00	$4.86	$19.82	$19.82	$20.58	$0.00	$6.61	$0.00	$15.79	$15.79	$0.00	$12.05	$19.09	$19.28	$0.00		$0.00	$7.39	$0.00	$0.00	$7.04	$0.00	$0.00	$0.00	$0.00	$0.00
4995	ERX	HCPCS J1030	00009-3073-03	METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP	BOTH IP/OP	$26.70 	$19.76	$0.00	$20.58	$12.02	$12.02	$0.00	$0.00	$0.00	$4.86	$19.82	$19.82	$20.58	$0.00	$6.61	$0.00	$15.79	$15.79	$0.00	$12.05	$19.09	$19.28	$0.00		$0.00	$7.39	$0.00	$0.00	$7.04	$0.00	$0.00	$0.00	$0.00	$0.00
5002	ERX	HCPCS J2765	00409-3414-01	METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$1.32	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$1.34	$0.00	$0.00	$0.00	$0.00	$0.00
5002	ERX	HCPCS J2765	00409-3414-18	METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$1.32	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$1.34	$0.00	$0.00	$0.00	$0.00	$0.00
5002	ERX	HCPCS J2765	00703-4502-04	METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$1.32	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$1.34	$0.00	$0.00	$0.00	$0.00	$0.00
5005	ERX	HCPCS 25000001	00093-2203-01	METOCLOPRAMIDE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005	ERX	HCPCS 25000001	00093-2203-05	METOCLOPRAMIDE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005	ERX	HCPCS 25000001	51079-0888-20	METOCLOPRAMIDE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005	ERX	HCPCS 25000001	63739-0293-10	METOCLOPRAMIDE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005	ERX	HCPCS 25000001	68084-0676-01	METOCLOPRAMIDE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005	ERX	HCPCS 25000001	68084-0676-11	METOCLOPRAMIDE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5009	ERX	HCPCS 63700001	51079-0801-01	METOPROLOL TARTRATE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5009	ERX	HCPCS 63700001	51079-0801-20	METOPROLOL TARTRATE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5009	ERX	HCPCS 63700001	57664-0477-52	METOPROLOL TARTRATE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5009	ERX	HCPCS 63700001	62584-0266-01	METOPROLOL TARTRATE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5009	ERX	HCPCS 63700001	62584-0266-11	METOPROLOL TARTRATE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5009	ERX	HCPCS 63700001	65862-0063-01	METOPROLOL TARTRATE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5015	ERX	HCPCS 63700001	00904-1453-61	METRONIDAZOLE 250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5015	ERX	HCPCS 63700001	50111-0333-01	METRONIDAZOLE 250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5015	ERX	HCPCS 63700001	50111-0333-02	METRONIDAZOLE 250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5016	ERX	HCPCS 63700001	29300-0227-01	METRONIDAZOLE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5016	ERX	HCPCS 63700001	29300-0227-05	METRONIDAZOLE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5016	ERX	HCPCS 63700001	29300-0227-46	METRONIDAZOLE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5016	ERX	HCPCS 63700001	50111-0334-01	METRONIDAZOLE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5016	ERX	HCPCS 63700001	50268-0535-11	METRONIDAZOLE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5016	ERX	HCPCS 63700001	50268-0535-15	METRONIDAZOLE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5016	ERX	HCPCS 63700001	60687-0550-01	METRONIDAZOLE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5018	ERX	HCPCS 25000001	00338-1055-48	METRONIDAZOLE IN NACL 5-0.79 MG/ML-% IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5018	ERX	HCPCS 25000001	00409-7811-24	METRONIDAZOLE IN NACL 5-0.79 MG/ML-% IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5018	ERX	HCPCS 25000001	00409-7811-37	METRONIDAZOLE IN NACL 5-0.79 MG/ML-% IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5039	ERX	HCPCS 63700001	00472-0735-56	MICONAZOLE NITRATE 2 % EX CREA	BOTH IP/OP	$22.13 	$16.38	$0.00	$16.06		$0.00	$0.00	$0.00	$3.94	$0.00	$0.00	$0.00	$0.00	$0.00	$4.61	$0.00	$0.00	$0.00	$0.00	$10.04	$15.90	$16.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5039	ERX	HCPCS 63700001	49348-0689-72	MICONAZOLE NITRATE 2 % EX CREA	BOTH IP/OP	$22.13 	$16.38	$0.00	$16.06		$0.00	$0.00	$0.00	$3.94	$0.00	$0.00	$0.00	$0.00	$0.00	$4.61	$0.00	$0.00	$0.00	$0.00	$10.04	$15.90	$16.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5039	ERX	HCPCS 63700001	51672-2001-02	MICONAZOLE NITRATE 2 % EX CREA	BOTH IP/OP	$22.13 	$16.38	$0.00	$16.06		$0.00	$0.00	$0.00	$3.94	$0.00	$0.00	$0.00	$0.00	$0.00	$4.61	$0.00	$0.00	$0.00	$0.00	$10.04	$15.90	$16.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5086	ERX	HCPCS 25000001	00869-0831-43	MINERAL OIL PO OIL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5086	ERX	HCPCS 25000001	00869-4206-10	MINERAL OIL PO OIL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5086	ERX	HCPCS 25000001	48433-0202-30	MINERAL OIL PO OIL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5086	ERX	HCPCS 25000001	54162-0190-16	MINERAL OIL PO OIL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5086	ERX	HCPCS 25000001	99999-6007-83	MINERAL OIL PO OIL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5110	ERX	HCPCS 63700001	00591-5695-50	MINOCYCLINE HCL 100 MG PO CAPS	BOTH IP/OP	$14.24 	$10.54	$0.00	$10.33		$0.00	$0.00	$0.00	$2.53	$0.00	$0.00	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$0.00	$0.00	$6.46	$10.22	$10.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5110	ERX	HCPCS 63700001	65862-0211-50	MINOCYCLINE HCL 100 MG PO CAPS	BOTH IP/OP	$14.24 	$10.54	$0.00	$10.33		$0.00	$0.00	$0.00	$2.53	$0.00	$0.00	$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$0.00	$0.00	$6.46	$10.22	$10.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5111	ERX	HCPCS 63700001	00591-5694-01	MINOCYCLINE HCL 50 MG PO CAPS	BOTH IP/OP	$7.12 	$5.27	$0.00	$5.17		$0.00	$0.00	$0.00	$1.27	$0.00	$0.00	$0.00	$0.00	$0.00	$1.48	$0.00	$0.00	$0.00	$0.00	$3.23	$5.12	$5.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5111	ERX	HCPCS 63700001	63304-0694-01	MINOCYCLINE HCL 50 MG PO CAPS	BOTH IP/OP	$7.12 	$5.27	$0.00	$5.17		$0.00	$0.00	$0.00	$1.27	$0.00	$0.00	$0.00	$0.00	$0.00	$1.48	$0.00	$0.00	$0.00	$0.00	$3.23	$5.12	$5.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5111	ERX	HCPCS 63700001	65862-0209-01	MINOCYCLINE HCL 50 MG PO CAPS	BOTH IP/OP	$7.12 	$5.27	$0.00	$5.17		$0.00	$0.00	$0.00	$1.27	$0.00	$0.00	$0.00	$0.00	$0.00	$1.48	$0.00	$0.00	$0.00	$0.00	$3.23	$5.12	$5.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5114	ERX	HCPCS 63700001	68084-0205-01	MINOXIDIL 10 MG PO TABS	BOTH IP/OP	$8.89 	$6.58	$0.00	$6.45		$0.00	$0.00	$0.00	$1.58	$0.00	$0.00	$0.00	$0.00	$0.00	$1.85	$0.00	$0.00	$0.00	$0.00	$4.03	$6.38	$6.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5114	ERX	HCPCS 63700001	68084-0205-11	MINOXIDIL 10 MG PO TABS	BOTH IP/OP	$8.89 	$6.58	$0.00	$6.45		$0.00	$0.00	$0.00	$1.58	$0.00	$0.00	$0.00	$0.00	$0.00	$1.85	$0.00	$0.00	$0.00	$0.00	$4.03	$6.38	$6.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5115	ERX	HCPCS 63700001	00591-5642-01	MINOXIDIL 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5115	ERX	HCPCS 63700001	49884-0256-01	MINOXIDIL 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5115	ERX	HCPCS 63700001	68084-0204-01	MINOXIDIL 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5115	ERX	HCPCS 63700001	68084-0204-11	MINOXIDIL 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5170	ERX	HCPCS J2270	76045-0004-10	MORPHINE SULFATE 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.39	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00
5172	ERX	HCPCS J2270	76045-0005-10	MORPHINE SULFATE 4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.42	$0.00	$0.00		$0.00	$2.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5176	ERX	HCPCS 25000001	00054-0237-63	MORPHINE SULFATE 10 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5176	ERX	HCPCS 25000001	66689-0032-50	MORPHINE SULFATE 10 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5176	ERX	HCPCS 25000001	68094-0001-62	MORPHINE SULFATE 10 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5176	ERX	HCPCS 25000001	99999-6007-18	MORPHINE SULFATE 10 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5178	ERX	HCPCS 25000001	00054-0235-24	MORPHINE SULFATE 15 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5178	ERX	HCPCS 25000001	00054-0235-25	MORPHINE SULFATE 15 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5179	ERX	HCPCS 25000001	00054-0236-25	MORPHINE SULFATE 30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5180	ERX	HCPCS 25000001	00574-7112-12	MORPHINE SULFATE 10 MG RECTAL SUPP	BOTH IP/OP	$26.19 	$19.38	$0.00	$20.19		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$11.88	$18.81	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5330	ERX	HCPCS 63700001	51079-0812-20	NADOLOL 20 MG PO TABS	BOTH IP/OP	$19.53 	$14.45	$0.00	$14.17		$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$8.86	$14.03	$14.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5330	ERX	HCPCS 63700001	69238-1123-09	NADOLOL 20 MG PO TABS	BOTH IP/OP	$19.53 	$14.45	$0.00	$14.17		$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$8.86	$14.03	$14.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5331	ERX	HCPCS 63700001	51079-0813-01	NADOLOL 40 MG PO TABS	BOTH IP/OP	$30.30 	$22.42	$0.00	$21.98		$0.00	$0.00	$0.00	$5.39	$0.00	$0.00	$0.00	$0.00	$0.00	$6.31	$0.00	$0.00	$0.00	$0.00	$13.74	$21.76	$21.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5331	ERX	HCPCS 63700001	51079-0813-20	NADOLOL 40 MG PO TABS	BOTH IP/OP	$30.30 	$22.42	$0.00	$21.98		$0.00	$0.00	$0.00	$5.39	$0.00	$0.00	$0.00	$0.00	$0.00	$6.31	$0.00	$0.00	$0.00	$0.00	$13.74	$21.76	$21.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5331	ERX	HCPCS 63700001	59762-0811-01	NADOLOL 40 MG PO TABS	BOTH IP/OP	$30.30 	$22.42	$0.00	$21.98		$0.00	$0.00	$0.00	$5.39	$0.00	$0.00	$0.00	$0.00	$0.00	$6.31	$0.00	$0.00	$0.00	$0.00	$13.74	$21.76	$21.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5331	ERX	HCPCS 63700001	69097-0868-07	NADOLOL 40 MG PO TABS	BOTH IP/OP	$30.30 	$22.42	$0.00	$21.98		$0.00	$0.00	$0.00	$5.39	$0.00	$0.00	$0.00	$0.00	$0.00	$6.31	$0.00	$0.00	$0.00	$0.00	$13.74	$21.76	$21.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5331	ERX	HCPCS 63700001	69238-1124-09	NADOLOL 40 MG PO TABS	BOTH IP/OP	$30.30 	$22.42	$0.00	$21.98		$0.00	$0.00	$0.00	$5.39	$0.00	$0.00	$0.00	$0.00	$0.00	$6.31	$0.00	$0.00	$0.00	$0.00	$13.74	$21.76	$21.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5332	ERX	HCPCS 63700001	69097-0869-07	NADOLOL 80 MG PO TABS	BOTH IP/OP	$31.39 	$23.23	$0.00	$22.78		$0.00	$0.00	$0.00	$5.59	$0.00	$0.00	$0.00	$0.00	$0.00	$6.54	$0.00	$0.00	$0.00	$0.00	$14.24	$22.55	$22.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5332	ERX	HCPCS 63700001	69238-1125-09	NADOLOL 80 MG PO TABS	BOTH IP/OP	$31.39 	$23.23	$0.00	$22.78		$0.00	$0.00	$0.00	$5.59	$0.00	$0.00	$0.00	$0.00	$0.00	$6.54	$0.00	$0.00	$0.00	$0.00	$14.24	$22.55	$22.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5333	ERX	HCPCS 25000001	00781-3124-85	NAFCILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$60.76 	$44.96	$0.00	$46.83		$0.00	$0.00	$0.00	$0.00	$0.00	$45.10	$45.10	$46.83	$0.00	$12.66	$0.00	$0.00	$0.00	$0.00	$27.55	$43.64	$44.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5333	ERX	HCPCS 25000001	00781-3124-95	NAFCILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$60.76 	$44.96	$0.00	$46.83		$0.00	$0.00	$0.00	$0.00	$0.00	$45.10	$45.10	$46.83	$0.00	$12.66	$0.00	$0.00	$0.00	$0.00	$27.55	$43.64	$44.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5333	ERX	HCPCS 25000001	25021-0139-10	NAFCILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$60.76 	$44.96	$0.00	$46.83		$0.00	$0.00	$0.00	$0.00	$0.00	$45.10	$45.10	$46.83	$0.00	$12.66	$0.00	$0.00	$0.00	$0.00	$27.55	$43.64	$44.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5333	ERX	HCPCS 25000001	44567-0221-10	NAFCILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$60.76 	$44.96	$0.00	$46.83		$0.00	$0.00	$0.00	$0.00	$0.00	$45.10	$45.10	$46.83	$0.00	$12.66	$0.00	$0.00	$0.00	$0.00	$27.55	$43.64	$44.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5333	ERX	HCPCS 25000001	55150-0122-15	NAFCILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$60.76 	$44.96	$0.00	$46.83		$0.00	$0.00	$0.00	$0.00	$0.00	$45.10	$45.10	$46.83	$0.00	$12.66	$0.00	$0.00	$0.00	$0.00	$27.55	$43.64	$44.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5333	ERX	HCPCS 25000001	63323-0327-10	NAFCILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$60.76 	$44.96	$0.00	$46.83		$0.00	$0.00	$0.00	$0.00	$0.00	$45.10	$45.10	$46.83	$0.00	$12.66	$0.00	$0.00	$0.00	$0.00	$27.55	$43.64	$44.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5333	ERX	HCPCS 25000001	70860-0116-26	NAFCILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$60.76 	$44.96	$0.00	$46.83		$0.00	$0.00	$0.00	$0.00	$0.00	$45.10	$45.10	$46.83	$0.00	$12.66	$0.00	$0.00	$0.00	$0.00	$27.55	$43.64	$44.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5333	ERX	HCPCS 25000001	70860-0116-41	NAFCILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$60.76 	$44.96	$0.00	$46.83		$0.00	$0.00	$0.00	$0.00	$0.00	$45.10	$45.10	$46.83	$0.00	$12.66	$0.00	$0.00	$0.00	$0.00	$27.55	$43.64	$44.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5335	ERX	HCPCS 25000001	25021-0140-10	NAFCILLIN SODIUM 2 G IJ SOLR	BOTH IP/OP	$109.15 	$80.77	$0.00	$84.13		$0.00	$0.00	$0.00	$0.00	$0.00	$81.01	$81.01	$84.13	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$49.49	$78.38	$79.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5335	ERX	HCPCS 25000001	44567-0222-10	NAFCILLIN SODIUM 2 G IJ SOLR	BOTH IP/OP	$109.15 	$80.77	$0.00	$84.13		$0.00	$0.00	$0.00	$0.00	$0.00	$81.01	$81.01	$84.13	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$49.49	$78.38	$79.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5335	ERX	HCPCS 25000001	55150-0123-15	NAFCILLIN SODIUM 2 G IJ SOLR	BOTH IP/OP	$109.15 	$80.77	$0.00	$84.13		$0.00	$0.00	$0.00	$0.00	$0.00	$81.01	$81.01	$84.13	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$49.49	$78.38	$79.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5335	ERX	HCPCS 25000001	55150-0123-16	NAFCILLIN SODIUM 2 G IJ SOLR	BOTH IP/OP	$109.15 	$80.77	$0.00	$84.13		$0.00	$0.00	$0.00	$0.00	$0.00	$81.01	$81.01	$84.13	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$49.49	$78.38	$79.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5335	ERX	HCPCS 25000001	63323-0328-20	NAFCILLIN SODIUM 2 G IJ SOLR	BOTH IP/OP	$109.15 	$80.77	$0.00	$84.13		$0.00	$0.00	$0.00	$0.00	$0.00	$81.01	$81.01	$84.13	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$49.49	$78.38	$79.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5335	ERX	HCPCS 25000001	70860-0117-26	NAFCILLIN SODIUM 2 G IJ SOLR	BOTH IP/OP	$109.15 	$80.77	$0.00	$84.13		$0.00	$0.00	$0.00	$0.00	$0.00	$81.01	$81.01	$84.13	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$49.49	$78.38	$79.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5335	ERX	HCPCS 25000001	70860-0117-41	NAFCILLIN SODIUM 2 G IJ SOLR	BOTH IP/OP	$109.15 	$80.77	$0.00	$84.13		$0.00	$0.00	$0.00	$0.00	$0.00	$81.01	$81.01	$84.13	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$49.49	$78.38	$79.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5339	ERX	HCPCS J2300	00409-1463-01	NALBUPHINE HCL 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$1.22	$16.33	$16.33	$16.96	$0.00	$3.35	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.70	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
5339	ERX	HCPCS J2300	00409-1463-49	NALBUPHINE HCL 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$1.22	$16.33	$16.33	$16.96	$0.00	$3.35	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.70	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
5339	ERX	HCPCS J2300	00409-1464-01	NALBUPHINE HCL 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$1.22	$16.33	$16.33	$16.96	$0.00	$3.35	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.70	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
5339	ERX	HCPCS J2300	99999-6005-73	NALBUPHINE HCL 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$1.22	$16.33	$16.33	$16.96	$0.00	$3.35	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.70	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
5340	ERX	HCPCS J2300	00409-1465-01	NALBUPHINE HCL 20 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$1.22	$16.33	$16.33	$16.96	$0.00	$3.35	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.70	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
5340	ERX	HCPCS J2300	00409-1467-01	NALBUPHINE HCL 20 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$1.22	$16.33	$16.33	$16.96	$0.00	$3.35	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.70	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
5373	ERX	HCPCS J2310	00409-1215-01	NALOXONE HCL 0.4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.37	$16.33	$16.33	$16.96	$0.00	$12.85	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$15.60	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
5373	ERX	HCPCS J2310	00409-1215-21	NALOXONE HCL 0.4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.37	$16.33	$16.33	$16.96	$0.00	$12.85	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$15.60	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
5373	ERX	HCPCS J2310	00641-6132-25	NALOXONE HCL 0.4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.37	$16.33	$16.33	$16.96	$0.00	$12.85	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$15.60	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
5373	ERX	HCPCS J2310	67457-0292-00	NALOXONE HCL 0.4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.37	$16.33	$16.33	$16.96	$0.00	$12.85	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$15.60	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
5373	ERX	HCPCS J2310	67457-0292-02	NALOXONE HCL 0.4 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.37	$16.33	$16.33	$16.96	$0.00	$12.85	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$15.60	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
5384	ERX	HCPCS 25000001	00065-0085-15	NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN	BOTH IP/OP	$62.85 	$46.51	$0.00	$48.44		$0.00	$0.00	$0.00	$0.00	$0.00	$46.65	$46.65	$48.44	$0.00	$13.10	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5384	ERX	HCPCS 25000001	12547-0493-78	NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN	BOTH IP/OP	$62.85 	$46.51	$0.00	$48.44		$0.00	$0.00	$0.00	$0.00	$0.00	$46.65	$46.65	$48.44	$0.00	$13.10	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5384	ERX	HCPCS 25000001	69968-0063-01	NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN	BOTH IP/OP	$62.85 	$46.51	$0.00	$48.44		$0.00	$0.00	$0.00	$0.00	$0.00	$46.65	$46.65	$48.44	$0.00	$13.10	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5391	ERX	HCPCS 63700001	50268-0594-15	NAPROXEN 250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5391	ERX	HCPCS 63700001	51079-0793-01	NAPROXEN 250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5391	ERX	HCPCS 63700001	51079-0793-20	NAPROXEN 250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5391	ERX	HCPCS 63700001	65162-0188-10	NAPROXEN 250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5392	ERX	HCPCS 63700001	65162-0189-50	NAPROXEN 375 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5392	ERX	HCPCS 63700001	76282-0341-01	NAPROXEN 375 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5393	ERX	HCPCS 63700001	51079-0795-01	NAPROXEN 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5393	ERX	HCPCS 63700001	51079-0795-20	NAPROXEN 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5393	ERX	HCPCS 63700001	60687-0491-01	NAPROXEN 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5393	ERX	HCPCS 63700001	60687-0491-11	NAPROXEN 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5393	ERX	HCPCS 63700001	63739-0403-10	NAPROXEN 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5393	ERX	HCPCS 63700001	68462-0190-01	NAPROXEN 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5472	ERX	HCPCS 63700001	00093-1177-01	NEOMYCIN SULFATE 500 MG PO TABS	BOTH IP/OP	$8.28 	$6.13	$0.00	$6.01		$0.00	$0.00	$0.00	$1.47	$0.00	$0.00	$0.00	$0.00	$0.00	$1.73	$0.00	$0.00	$0.00	$0.00	$3.76	$5.95	$6.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5472	ERX	HCPCS 63700001	39822-0310-05	NEOMYCIN SULFATE 500 MG PO TABS	BOTH IP/OP	$8.28 	$6.13	$0.00	$6.01		$0.00	$0.00	$0.00	$1.47	$0.00	$0.00	$0.00	$0.00	$0.00	$1.73	$0.00	$0.00	$0.00	$0.00	$3.76	$5.95	$6.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5472	ERX	HCPCS 63700001	50383-0565-10	NEOMYCIN SULFATE 500 MG PO TABS	BOTH IP/OP	$8.28 	$6.13	$0.00	$6.01		$0.00	$0.00	$0.00	$1.47	$0.00	$0.00	$0.00	$0.00	$0.00	$1.73	$0.00	$0.00	$0.00	$0.00	$3.76	$5.95	$6.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5472	ERX	HCPCS 63700001	51079-0015-01	NEOMYCIN SULFATE 500 MG PO TABS	BOTH IP/OP	$8.28 	$6.13	$0.00	$6.01		$0.00	$0.00	$0.00	$1.47	$0.00	$0.00	$0.00	$0.00	$0.00	$1.73	$0.00	$0.00	$0.00	$0.00	$3.76	$5.95	$6.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5472	ERX	HCPCS 63700001	51079-0015-20	NEOMYCIN SULFATE 500 MG PO TABS	BOTH IP/OP	$8.28 	$6.13	$0.00	$6.01		$0.00	$0.00	$0.00	$1.47	$0.00	$0.00	$0.00	$0.00	$0.00	$1.73	$0.00	$0.00	$0.00	$0.00	$3.76	$5.95	$6.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5474	ERX	HCPCS 25000001	24208-0790-62	NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75-10000-.025 OP SOLN	BOTH IP/OP	$212.58 	$157.31	$0.00	$163.86		$0.00	$0.00	$0.00	$0.00	$0.00	$157.78	$157.78	$163.86	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$96.49	$152.83	$154.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5539	ERX	HCPCS 63700001	54629-0071-01	NIACIN 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542	ERX	HCPCS 63700001	00536-4078-10	NIACIN 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5558	ERX	HCPCS 63700001	00228-2497-10	NIFEDIPINE 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5558	ERX	HCPCS 63700001	43386-0440-24	NIFEDIPINE 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5558	ERX	HCPCS 63700001	69315-0211-01	NIFEDIPINE 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5559	ERX	HCPCS 63700001	00228-2530-10	NIFEDIPINE 20 MG PO CAPS	BOTH IP/OP	$9.65 	$7.14	$0.00	$7.01		$0.00	$0.00	$0.00	$1.72	$0.00	$0.00	$0.00	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$4.38	$6.94	$7.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5559	ERX	HCPCS 63700001	23155-0195-01	NIFEDIPINE 20 MG PO CAPS	BOTH IP/OP	$9.65 	$7.14	$0.00	$7.01		$0.00	$0.00	$0.00	$1.72	$0.00	$0.00	$0.00	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$4.38	$6.94	$7.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5595	ERX	HCPCS 63700001	47781-0307-01	NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS	BOTH IP/OP	$9.52 	$7.04	$0.00	$6.91		$0.00	$0.00	$0.00	$1.69	$0.00	$0.00	$0.00	$0.00	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$4.32	$6.84	$6.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5599	ERX	HCPCS 25000001	00517-4810-25	NITROGLYCERIN 5 MG/ML IV SOLN	BOTH IP/OP	$71.74 	$53.09	$0.00	$55.30		$0.00	$0.00	$0.00	$0.00	$0.00	$53.25	$53.25	$55.30	$0.00	$14.95	$0.00	$0.00	$0.00	$0.00	$32.53	$51.53	$52.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5603	ERX	HCPCS 25000001	00071-0417-24	NITROGLYCERIN 0.3 MG SL SUBL	BOTH IP/OP	$261.64 	$193.61	$0.00	$201.67		$0.00	$0.00	$0.00	$0.00	$0.00	$194.19	$194.19	$201.67	$0.00	$54.53	$0.00	$0.00	$0.00	$0.00	$113.25	$179.38	$181.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5603	ERX	HCPCS 25000001	59762-4921-01	NITROGLYCERIN 0.3 MG SL SUBL	BOTH IP/OP	$261.64 	$193.61	$0.00	$201.67		$0.00	$0.00	$0.00	$0.00	$0.00	$194.19	$194.19	$201.67	$0.00	$54.53	$0.00	$0.00	$0.00	$0.00	$113.25	$179.38	$181.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5604	ERX	HCPCS 25000001	00071-0418-13	NITROGLYCERIN 0.4 MG SL SUBL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5604	ERX	HCPCS 25000001	43598-0436-11	NITROGLYCERIN 0.4 MG SL SUBL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5604	ERX	HCPCS 25000001	43598-0436-35	NITROGLYCERIN 0.4 MG SL SUBL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5604	ERX	HCPCS 25000001	59762-3304-03	NITROGLYCERIN 0.4 MG SL SUBL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5604	ERX	HCPCS 25000001	68462-0639-45	NITROGLYCERIN 0.4 MG SL SUBL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5605	ERX	HCPCS 25000001	00071-0419-24	NITROGLYCERIN 0.6 MG SL SUBL	BOTH IP/OP	$261.64 	$193.61	$0.00	$201.67		$0.00	$0.00	$0.00	$0.00	$0.00	$194.19	$194.19	$201.67	$0.00	$54.53	$0.00	$0.00	$0.00	$0.00	$113.25	$179.38	$181.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5605	ERX	HCPCS 25000001	59762-0489-01	NITROGLYCERIN 0.6 MG SL SUBL	BOTH IP/OP	$261.64 	$193.61	$0.00	$201.67		$0.00	$0.00	$0.00	$0.00	$0.00	$194.19	$194.19	$201.67	$0.00	$54.53	$0.00	$0.00	$0.00	$0.00	$113.25	$179.38	$181.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5606	ERX	HCPCS 25000001	00281-0326-08	NITROGLYCERIN 2 % TD OINT	BOTH IP/OP	$11.55 	$8.55	$0.00	$8.90		$0.00	$0.00	$0.00	$0.00	$0.00	$8.57	$8.57	$8.90	$0.00	$2.41	$0.00	$0.00	$0.00	$0.00	$5.24	$8.29	$8.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5674	ERX	HCPCS 63700001	50268-0603-15	NORTRIPTYLINE HCL 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5674	ERX	HCPCS 63700001	60687-0281-01	NORTRIPTYLINE HCL 10 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5675	ERX	HCPCS 63700001	51672-4002-01	NORTRIPTYLINE HCL 25 MG PO CAPS	BOTH IP/OP	$6.15 	$4.55	$0.00	$4.80		$0.00	$0.00	$0.00	$1.09	$0.00	$0.00	$0.00	$0.00	$0.00	$1.28	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5677	ERX	HCPCS 63700001	00093-0813-01	NORTRIPTYLINE HCL 75 MG PO CAPS	BOTH IP/OP	$17.68 	$13.08	$0.00	$12.82		$0.00	$0.00	$0.00	$3.15	$0.00	$0.00	$0.00	$0.00	$0.00	$3.68	$0.00	$0.00	$0.00	$0.00	$8.02	$12.70	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5677	ERX	HCPCS 63700001	51672-4004-01	NORTRIPTYLINE HCL 75 MG PO CAPS	BOTH IP/OP	$17.68 	$13.08	$0.00	$12.82		$0.00	$0.00	$0.00	$3.15	$0.00	$0.00	$0.00	$0.00	$0.00	$3.68	$0.00	$0.00	$0.00	$0.00	$8.02	$12.70	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5749	ERX	HCPCS 25000001	00168-0054-15	NYSTATIN 100000 UNIT/GM EX CREA	BOTH IP/OP	$101.68 	$75.24	$0.00	$78.37		$0.00	$0.00	$0.00	$0.00	$0.00	$75.47	$75.47	$78.37	$0.00	$21.19	$0.00	$0.00	$0.00	$0.00	$46.10	$73.01	$73.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5749	ERX	HCPCS 25000001	45802-0059-35	NYSTATIN 100000 UNIT/GM EX CREA	BOTH IP/OP	$101.68 	$75.24	$0.00	$78.37		$0.00	$0.00	$0.00	$0.00	$0.00	$75.47	$75.47	$78.37	$0.00	$21.19	$0.00	$0.00	$0.00	$0.00	$46.10	$73.01	$73.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5749	ERX	HCPCS 25000001	51672-1289-01	NYSTATIN 100000 UNIT/GM EX CREA	BOTH IP/OP	$101.68 	$75.24	$0.00	$78.37		$0.00	$0.00	$0.00	$0.00	$0.00	$75.47	$75.47	$78.37	$0.00	$21.19	$0.00	$0.00	$0.00	$0.00	$46.10	$73.01	$73.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5749	ERX	HCPCS 25000001	00168-0054-30	NYSTATIN 100000 UNIT/GM EX CREA	BOTH IP/OP	$101.68 	$75.24	$0.00	$78.37		$0.00	$0.00	$0.00	$0.00	$0.00	$75.47	$75.47	$78.37	$0.00	$21.19	$0.00	$0.00	$0.00	$0.00	$46.10	$73.01	$73.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5749	ERX	HCPCS 25000001	45802-0059-11	NYSTATIN 100000 UNIT/GM EX CREA	BOTH IP/OP	$101.68 	$75.24	$0.00	$78.37		$0.00	$0.00	$0.00	$0.00	$0.00	$75.47	$75.47	$78.37	$0.00	$21.19	$0.00	$0.00	$0.00	$0.00	$46.10	$73.01	$73.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5749	ERX	HCPCS 25000001	51672-1289-02	NYSTATIN 100000 UNIT/GM EX CREA	BOTH IP/OP	$101.68 	$75.24	$0.00	$78.37		$0.00	$0.00	$0.00	$0.00	$0.00	$75.47	$75.47	$78.37	$0.00	$21.19	$0.00	$0.00	$0.00	$0.00	$46.10	$73.01	$73.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5750	ERX	HCPCS 25000001	00168-0007-15	NYSTATIN 100000 UNIT/GM EX OINT	BOTH IP/OP	$97.28 	$71.99	$0.00	$74.98		$0.00	$0.00	$0.00	$0.00	$0.00	$72.20	$72.20	$74.98	$0.00	$20.27	$0.00	$0.00	$0.00	$0.00	$44.10	$69.85	$70.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5750	ERX	HCPCS 25000001	45802-0048-35	NYSTATIN 100000 UNIT/GM EX OINT	BOTH IP/OP	$97.28 	$71.99	$0.00	$74.98		$0.00	$0.00	$0.00	$0.00	$0.00	$72.20	$72.20	$74.98	$0.00	$20.27	$0.00	$0.00	$0.00	$0.00	$44.10	$69.85	$70.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5750	ERX	HCPCS 25000001	00168-0007-30	NYSTATIN 100000 UNIT/GM EX OINT	BOTH IP/OP	$97.28 	$71.99	$0.00	$74.98		$0.00	$0.00	$0.00	$0.00	$0.00	$72.20	$72.20	$74.98	$0.00	$20.27	$0.00	$0.00	$0.00	$0.00	$44.10	$69.85	$70.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5750	ERX	HCPCS 25000001	00472-0166-30	NYSTATIN 100000 UNIT/GM EX OINT	BOTH IP/OP	$97.28 	$71.99	$0.00	$74.98		$0.00	$0.00	$0.00	$0.00	$0.00	$72.20	$72.20	$74.98	$0.00	$20.27	$0.00	$0.00	$0.00	$0.00	$44.10	$69.85	$70.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5750	ERX	HCPCS 25000001	45802-0048-11	NYSTATIN 100000 UNIT/GM EX OINT	BOTH IP/OP	$97.28 	$71.99	$0.00	$74.98		$0.00	$0.00	$0.00	$0.00	$0.00	$72.20	$72.20	$74.98	$0.00	$20.27	$0.00	$0.00	$0.00	$0.00	$44.10	$69.85	$70.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5751	ERX	HCPCS 25000001	50383-0587-16	NYSTATIN 100000 UNIT/ML MT SUSP	BOTH IP/OP	$353.45 	$261.55	$0.00	$282.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.73	$279.93	$282.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5751	ERX	HCPCS 25000001	51672-4117-09	NYSTATIN 100000 UNIT/ML MT SUSP	BOTH IP/OP	$353.45 	$261.55	$0.00	$282.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.73	$279.93	$282.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5751	ERX	HCPCS 25000001	60432-0537-16	NYSTATIN 100000 UNIT/ML MT SUSP	BOTH IP/OP	$353.45 	$261.55	$0.00	$282.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.73	$279.93	$282.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5751	ERX	HCPCS 25000001	50383-0587-66	NYSTATIN 100000 UNIT/ML MT SUSP	BOTH IP/OP	$64.30 	$47.58	$0.00	$282.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.73	$50.93	$282.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5751	ERX	HCPCS 25000001	51672-4117-04	NYSTATIN 100000 UNIT/ML MT SUSP	BOTH IP/OP	$64.30 	$47.58	$0.00	$282.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.73	$50.93	$282.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5751	ERX	HCPCS 25000001	60432-0537-60	NYSTATIN 100000 UNIT/ML MT SUSP	BOTH IP/OP	$64.30 	$47.58	$0.00	$282.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.73	$50.93	$282.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5755	ERX	HCPCS 25000001	51672-1272-01	NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX OINT	BOTH IP/OP	$376.14 	$278.34	$0.00	$289.93		$0.00	$0.00	$0.00	$0.00	$0.00	$279.17	$279.17	$289.93	$0.00	$78.39	$0.00	$0.00	$0.00	$0.00	$170.72	$270.42	$273.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5851	ERX	HCPCS 25000001	99999-6006-21	ORA-PLUS PO LIQD	BOTH IP/OP	$21.12 	$15.63	$0.00	$16.28		$0.00	$0.00	$0.00	$0.00	$0.00	$15.68	$15.68	$16.28	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$9.58	$15.17	$15.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5851	ERX	HCPCS 25000001	00574-0303-16	ORA-PLUS PO LIQD	BOTH IP/OP	$21.12 	$15.63	$0.00	$61.63		$0.00	$0.00	$0.00	$0.00	$0.00	$15.68	$15.68	$16.28	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$9.58	$61.63	$15.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5852	ERX	HCPCS 25000001	00574-0304-16	ORA-SWEET PO SYRP	BOTH IP/OP	$85.82 	$63.51	$0.00	$66.15		$0.00	$0.00	$0.00	$0.00	$0.00	$63.70	$63.70	$66.15	$0.00	$17.88	$0.00	$0.00	$0.00	$0.00	$38.91	$61.63	$62.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5853	ERX	HCPCS 25000001	00574-0302-16	ORA-SWEET SF PO SYRP	BOTH IP/OP	$85.82 	$63.51	$0.00	$66.15		$0.00	$0.00	$0.00	$0.00	$0.00	$63.70	$63.70	$66.15	$0.00	$17.88	$0.00	$0.00	$0.00	$0.00	$38.91	$61.63	$62.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5924	ERX	HCPCS J2700	25021-0146-10	OXACILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$28.29 	$20.93	$0.00	$21.81		$0.00	$0.00	$0.00	$0.00	$0.00	$21.00	$21.00	$21.81	$0.00	$3.01	$0.00	$0.00	$0.00	$0.00	$12.83	$20.31	$20.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5924	ERX	HCPCS J2700	55150-0127-15	OXACILLIN SODIUM 1 G IJ SOLR	BOTH IP/OP	$28.29 	$20.93	$0.00	$21.81		$0.00	$0.00	$0.00	$0.00	$0.00	$21.00	$21.00	$21.81	$0.00	$3.01	$0.00	$0.00	$0.00	$0.00	$12.83	$20.31	$20.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5938	ERX	HCPCS 63700001	00603-4975-21	OXYBUTYNIN CHLORIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5938	ERX	HCPCS 63700001	00832-0038-00	OXYBUTYNIN CHLORIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5938	ERX	HCPCS 63700001	00832-0038-01	OXYBUTYNIN CHLORIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5938	ERX	HCPCS 63700001	00832-0038-50	OXYBUTYNIN CHLORIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5938	ERX	HCPCS 63700001	00904-2821-61	OXYBUTYNIN CHLORIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5938	ERX	HCPCS 63700001	50111-0456-01	OXYBUTYNIN CHLORIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5938	ERX	HCPCS 63700001	68084-0400-01	OXYBUTYNIN CHLORIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5940	ERX	HCPCS 25000001	00054-0551-25	OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5940	ERX	HCPCS 25000001	00406-0512-01	OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5940	ERX	HCPCS 25000001	00406-0512-05	OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5940	ERX	HCPCS 25000001	00406-0512-23	OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5940	ERX	HCPCS 25000001	00406-0512-62	OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5940	ERX	HCPCS 25000001	00904-6437-61	OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5940	ERX	HCPCS 25000001	13107-0044-01	OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5940	ERX	HCPCS 25000001	68084-0355-01	OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5940	ERX	HCPCS 25000001	68084-0355-11	OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5940	ERX	HCPCS 25000001	99999-6006-78	OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5943	ERX	HCPCS 25000001	00904-6761-30	OXYMETAZOLINE HCL 0.05 % NA SOLN	BOTH IP/OP	$16.72 	$12.37	$0.00	$12.89		$0.00	$0.00	$0.00	$0.00	$0.00	$12.41	$12.41	$12.89	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5944	ERX	HCPCS J2590	42023-0116-02	OXYTOCIN 10 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5944	ERX	HCPCS J2590	42023-0116-25	OXYTOCIN 10 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5944	ERX	HCPCS J2590	63323-0012-03	OXYTOCIN 10 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5944	ERX	HCPCS J2590	63323-0012-10	OXYTOCIN 10 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5944	ERX	HCPCS J2590	63323-0012-11	OXYTOCIN 10 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5944	ERX	HCPCS J2590	63323-0012-12	OXYTOCIN 10 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5955	ERX	HCPCS 63700001	00904-1883-61	OYSTER CALCIUM 500 (1250 CA CARB) MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5955	ERX	HCPCS 63700001	00904-1883-72	OYSTER CALCIUM 500 (1250 CA CARB) MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5955	ERX	HCPCS 63700001	51645-0827-99	OYSTER CALCIUM 500 (1250 CA CARB) MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6013	ERX	HCPCS 25000001	00409-4646-01	PANCURONIUM BROMIDE 1 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6030	ERX	HCPCS J2440	00517-4002-25	PAPAVERINE HCL 30 MG/ML IJ SOLN	BOTH IP/OP	$95.91 	$70.97	$0.00	$73.93	$43.16	$43.16	$0.00	$0.00	$0.00	$19.99	$71.18	$71.18	$73.93	$0.00	$19.99	$0.00	$56.73	$56.73	$0.00	$43.49	$68.88	$69.58	$0.00		$0.00	$13.61	$0.00	$0.00	$13.85	$0.00	$0.00	$0.00	$0.00	$0.00
6040	ERX	HCPCS J7300	51285-0204-01	PARAGARD INTRAUTERINE COPPER IU IUD	BOTH IP/OP	"$2,541.15 "	"$1,880.45"	$0.00	"$1,958.72"	"$1,143.52"	"$1,143.52"	$0.00	$0.00	$849.12	$750.43	"$1,886.04"	"$1,886.04"	"$1,958.72"	$0.00	"$1,100.98"	$0.00	"$1,252.79"	"$1,252.79"	$0.00	"$1,087.94"	"$1,723.29"	"$1,740.70"	"$1,305.52"		"$1,305.52"	"$1,039.29"	$0.00	$0.00	$989.58	$0.00	$0.00	$0.00	$0.00	$0.00
6040	ERX	HCPCS J7300	59365-5128-01	PARAGARD INTRAUTERINE COPPER IU IUD	BOTH IP/OP	"$2,541.15 "	"$1,880.45"	$0.00	"$1,958.72"	"$1,143.52"	"$1,143.52"	$0.00	$0.00	$849.12	$750.43	"$1,886.04"	"$1,886.04"	"$1,958.72"	$0.00	"$1,100.98"	$0.00	"$1,252.79"	"$1,252.79"	$0.00	"$1,087.94"	"$1,723.29"	"$1,740.70"	"$1,305.52"		"$1,305.52"	"$1,039.29"	$0.00	$0.00	$989.58	$0.00	$0.00	$0.00	$0.00	$0.00
6085	ERX	HCPCS J2540	00049-0530-22	PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.08	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6085	ERX	HCPCS J2540	00049-0530-28	PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.08	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6085	ERX	HCPCS J2540	70860-0127-51	PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.08	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6086	ERX	HCPCS J2540	00049-0520-83	PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR	BOTH IP/OP	$63.97 	$47.34	$0.00	$49.31		$0.00	$0.00	$0.00	$0.00	$0.00	$47.48	$47.48	$49.31	$0.00	$8.65	$0.00	$0.00	$0.00	$0.00	$28.87	$45.72	$46.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6087	ERX	HCPCS 25000001	00781-6153-94	PENICILLIN G SODIUM 5000000 UNITS IJ SOLR	BOTH IP/OP	$28.97 	$21.44	$0.00	$22.33		$0.00	$0.00	$0.00	$0.00	$0.00	$21.50	$21.50	$22.33	$0.00	$6.04	$0.00	$0.00	$0.00	$0.00	$13.14	$20.81	$21.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6087	ERX	HCPCS 25000001	00781-6153-95	PENICILLIN G SODIUM 5000000 UNITS IJ SOLR	BOTH IP/OP	$28.97 	$21.44	$0.00	$22.33		$0.00	$0.00	$0.00	$0.00	$0.00	$21.50	$21.50	$22.33	$0.00	$6.04	$0.00	$0.00	$0.00	$0.00	$13.14	$20.81	$21.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6090	ERX	HCPCS 63700001	00093-4125-73	PENICILLIN V POTASSIUM 125 MG/5ML PO SOLR	BOTH IP/OP	$38.13 	$28.22	$0.00	$27.66		$0.00	$0.00	$0.00	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$7.95	$0.00	$0.00	$0.00	$0.00	$17.29	$27.39	$27.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6090	ERX	HCPCS 63700001	00093-4125-74	PENICILLIN V POTASSIUM 125 MG/5ML PO SOLR	BOTH IP/OP	$38.13 	$28.22	$0.00	$40.33		$0.00	$0.00	$0.00	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$7.95	$0.00	$0.00	$0.00	$0.00	$17.29	$40.33	$27.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6091	ERX	HCPCS 25000001	00093-4127-73	PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR	BOTH IP/OP	$42.74 	$31.63	$0.00	$32.94		$0.00	$0.00	$0.00	$0.00	$0.00	$31.72	$31.72	$32.94	$0.00	$8.91	$0.00	$0.00	$0.00	$0.00	$19.38	$30.70	$31.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6091	ERX	HCPCS 25000001	00093-4127-74	PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR	BOTH IP/OP	$42.74 	$31.63	$0.00	$44.54		$0.00	$0.00	$0.00	$0.00	$0.00	$31.72	$31.72	$32.94	$0.00	$8.91	$0.00	$0.00	$0.00	$0.00	$19.38	$44.54	$31.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6092	ERX	HCPCS 63700001	00093-1172-10	PENICILLIN V POTASSIUM 250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6092	ERX	HCPCS 63700001	16714-0234-01	PENICILLIN V POTASSIUM 250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6092	ERX	HCPCS 63700001	57237-0040-01	PENICILLIN V POTASSIUM 250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6093	ERX	HCPCS 63700001	16714-0235-01	PENICILLIN V POTASSIUM 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6097	ERX	HCPCS J2515	25021-0676-20	PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN	BOTH IP/OP	"$3,796.80 "	"$2,809.63"	$0.00	"$2,926.57"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,817.98"	"$2,817.98"	"$2,926.57"	$0.00	$620.66	$0.00	$0.00	$0.00	$0.00	"$1,722.00"	"$2,727.65"	"$2,755.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6097	ERX	HCPCS J2515	76478-0501-20	PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN	BOTH IP/OP	"$3,796.80 "	"$2,809.63"	$0.00	"$2,926.57"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,817.98"	"$2,817.98"	"$2,926.57"	$0.00	$620.66	$0.00	$0.00	$0.00	$0.00	"$1,722.00"	"$2,727.65"	"$2,755.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6116	ERX	HCPCS 25000001	00395-2015-91	PEPPERMINT OIL OIL	BOTH IP/OP	$98.78 	$73.10	$0.00	$76.14		$0.00	$0.00	$0.00	$0.00	$0.00	$73.31	$73.31	$76.14	$0.00	$20.59	$0.00	$0.00	$0.00	$0.00	$43.05	$68.19	$68.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6157	ERX	HCPCS Q0175	00781-1046-13	PERPHENAZINE 2 MG PO TABS	BOTH IP/OP	$8.24 	$6.10	$0.00	$5.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.72	$0.00	$0.00	$0.00	$0.00	$3.74	$5.92	$5.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6157	ERX	HCPCS Q0175	52536-0162-01	PERPHENAZINE 2 MG PO TABS	BOTH IP/OP	$8.24 	$6.10	$0.00	$5.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.72	$0.00	$0.00	$0.00	$0.00	$3.74	$5.92	$5.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6158	ERX	HCPCS Q0175	00603-5061-21	PERPHENAZINE 4 MG PO TABS	BOTH IP/OP	$11.26 	$8.33	$0.00	$8.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.35	$0.00	$0.00	$0.00	$0.00	$5.11	$8.09	$8.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6158	ERX	HCPCS Q0175	00781-1047-01	PERPHENAZINE 4 MG PO TABS	BOTH IP/OP	$11.26 	$8.33	$0.00	$8.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.35	$0.00	$0.00	$0.00	$0.00	$5.11	$8.09	$8.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6158	ERX	HCPCS Q0175	00781-1047-13	PERPHENAZINE 4 MG PO TABS	BOTH IP/OP	$11.26 	$8.33	$0.00	$8.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.35	$0.00	$0.00	$0.00	$0.00	$5.11	$8.09	$8.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6158	ERX	HCPCS Q0175	00781-8047-01	PERPHENAZINE 4 MG PO TABS	BOTH IP/OP	$11.26 	$8.33	$0.00	$8.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.35	$0.00	$0.00	$0.00	$0.00	$5.11	$8.09	$8.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6159	ERX	HCPCS Q0175	00378-5352-01	PERPHENAZINE 8 MG PO TABS	BOTH IP/OP	$13.67 	$10.12	$0.00	$9.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.85	$0.00	$0.00	$0.00	$0.00	$6.20	$9.82	$9.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6159	ERX	HCPCS Q0175	00603-5062-21	PERPHENAZINE 8 MG PO TABS	BOTH IP/OP	$13.67 	$10.12	$0.00	$9.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.85	$0.00	$0.00	$0.00	$0.00	$6.20	$9.82	$9.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6159	ERX	HCPCS Q0175	00781-1048-13	PERPHENAZINE 8 MG PO TABS	BOTH IP/OP	$13.67 	$10.12	$0.00	$9.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.85	$0.00	$0.00	$0.00	$0.00	$6.20	$9.82	$9.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6159	ERX	HCPCS Q0175	00781-8048-01	PERPHENAZINE 8 MG PO TABS	BOTH IP/OP	$13.67 	$10.12	$0.00	$9.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.85	$0.00	$0.00	$0.00	$0.00	$6.20	$9.82	$9.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6159	ERX	HCPCS Q0175	68084-0607-01	PERPHENAZINE 8 MG PO TABS	BOTH IP/OP	$13.67 	$10.12	$0.00	$9.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.85	$0.00	$0.00	$0.00	$0.00	$6.20	$9.82	$9.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6193	ERX	HCPCS 63700001	10135-0620-01	PHENAZOPYRIDINE HCL 100 MG PO TABS	BOTH IP/OP	$6.67 	$4.94	$0.00	$4.84		$0.00	$0.00	$0.00	$1.19	$0.00	$0.00	$0.00	$0.00	$0.00	$1.39	$0.00	$0.00	$0.00	$0.00	$3.03	$4.79	$4.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6193	ERX	HCPCS 63700001	42937-0701-10	PHENAZOPYRIDINE HCL 100 MG PO TABS	BOTH IP/OP	$6.67 	$4.94	$0.00	$4.84		$0.00	$0.00	$0.00	$1.19	$0.00	$0.00	$0.00	$0.00	$0.00	$1.39	$0.00	$0.00	$0.00	$0.00	$3.03	$4.79	$4.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6193	ERX	HCPCS 63700001	51293-0801-01	PHENAZOPYRIDINE HCL 100 MG PO TABS	BOTH IP/OP	$6.67 	$4.94	$0.00	$4.84		$0.00	$0.00	$0.00	$1.19	$0.00	$0.00	$0.00	$0.00	$0.00	$1.39	$0.00	$0.00	$0.00	$0.00	$3.03	$4.79	$4.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6212	ERX	HCPCS 63700001	00603-1508-58	PHENOBARBITAL 20 MG/5ML PO ELIX	BOTH IP/OP	$6.23 	$4.61	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6212	ERX	HCPCS 63700001	13517-0107-16	PHENOBARBITAL 20 MG/5ML PO ELIX	BOTH IP/OP	$6.23 	$4.61	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6212	ERX	HCPCS 63700001	99999-6006-84	PHENOBARBITAL 20 MG/5ML PO ELIX	BOTH IP/OP	$6.23 	$4.61	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6217	ERX	HCPCS 63700001	00904-6575-61	PHENOBARBITAL 32.4 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6220	ERX	HCPCS 63700001	00603-5168-21	PHENOBARBITAL 97.2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6220	ERX	HCPCS 63700001	13517-0113-01	PHENOBARBITAL 97.2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6221	ERX	HCPCS J2560	00641-0477-21	PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN	BOTH IP/OP	$199.57 	$147.68	$0.00	$153.83		$0.00	$0.00	$0.00	$0.00	$0.00	$148.12	$148.12	$153.83	$0.00	$47.25	$0.00	$0.00	$0.00	$0.00	$90.59	$143.49	$144.94	$0.00		$0.00	$49.81	$0.00	$0.00	$47.43	$0.00	$0.00	$0.00	$0.00	$0.00
6221	ERX	HCPCS J2560	00641-0477-25	PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN	BOTH IP/OP	$199.57 	$147.68	$0.00	$153.83		$0.00	$0.00	$0.00	$0.00	$0.00	$148.12	$148.12	$153.83	$0.00	$47.25	$0.00	$0.00	$0.00	$0.00	$90.59	$143.49	$144.94	$0.00		$0.00	$49.81	$0.00	$0.00	$47.43	$0.00	$0.00	$0.00	$0.00	$0.00
6224	ERX	HCPCS J2560	00641-0476-25	PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN	BOTH IP/OP	$111.08 	$82.20	$0.00	$85.62		$0.00	$0.00	$0.00	$0.00	$0.00	$82.44	$82.44	$85.62	$0.00	$47.25	$0.00	$0.00	$0.00	$0.00	$50.36	$79.77	$80.58	$0.00		$0.00	$49.81	$0.00	$0.00	$47.43	$0.00	$0.00	$0.00	$0.00	$0.00
6227	ERX	HCPCS 25000001	49452-5220-02	PHENOL EX LIQD	BOTH IP/OP	"$1,370.11 "	"$1,013.88"	$0.00	"$1,056.08"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,016.90"	"$1,016.90"	"$1,056.08"	$0.00	$285.53	$0.00	$0.00	$0.00	$0.00	$634.80	"$1,005.52"	"$1,015.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6243	ERX	HCPCS 25000001	00225-0800-47	PHENYLEPHRINE HCL 0.25 % NA SOLN	BOTH IP/OP	$15.91 	$11.77	$0.00	$12.26		$0.00	$0.00	$0.00	$0.00	$0.00	$11.81	$11.81	$12.26	$0.00	$3.32	$0.00	$0.00	$0.00	$0.00	$7.22	$11.43	$11.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6244	ERX	HCPCS 25000001	00225-0805-47	PHENYLEPHRINE HCL 0.5 % NA SOLN	BOTH IP/OP	$15.91 	$11.77	$0.00	$12.26		$0.00	$0.00	$0.00	$0.00	$0.00	$11.81	$11.81	$12.26	$0.00	$3.32	$0.00	$0.00	$0.00	$0.00	$7.22	$11.43	$11.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6246	ERX	HCPCS 25000001	17478-0201-02	PHENYLEPHRINE HCL 2.5 % OP SOLN	BOTH IP/OP	$362.88 	$268.53	$0.00	$279.71		$0.00	$0.00	$0.00	$0.00	$0.00	$269.33	$269.33	$279.71	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$171.57	$112.63	$274.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6246	ERX	HCPCS 25000001	17478-0201-15	PHENYLEPHRINE HCL 2.5 % OP SOLN	BOTH IP/OP	$362.88 	$268.53	$0.00	$279.71		$0.00	$0.00	$0.00	$0.00	$0.00	$269.33	$269.33	$279.71	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$171.57	$271.76	$274.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6246	ERX	HCPCS 25000001	42702-0102-15	PHENYLEPHRINE HCL 2.5 % OP SOLN	BOTH IP/OP	$362.88 	$268.53	$0.00	$279.71		$0.00	$0.00	$0.00	$0.00	$0.00	$269.33	$269.33	$279.71	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$171.57	$271.76	$274.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6255	ERX	HCPCS 63700001	99999-6010-65	PHENYTOIN 125 MG/5ML PO SUSP	BOTH IP/OP	$82.72 	$61.21	$0.00	$110.54		$0.00	$0.00	$0.00	$14.72	$0.00	$0.00	$0.00	$0.00	$0.00	$17.24	$0.00	$0.00	$0.00	$0.00	$69.09	$59.42	$110.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6255	ERX	HCPCS 63700001	99999-6004-70	PHENYTOIN 125 MG/5ML PO SUSP	BOTH IP/OP	$82.72 	$61.21	$0.00	$110.54		$0.00	$0.00	$0.00	$14.72	$0.00	$0.00	$0.00	$0.00	$0.00	$17.24	$0.00	$0.00	$0.00	$0.00	$69.09	$109.44	$110.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6255	ERX	HCPCS 63700001	00071-2214-20	PHENYTOIN 125 MG/5ML PO SUSP	BOTH IP/OP	$82.72 	$61.21	$0.00	$427.28		$0.00	$0.00	$0.00	$14.72	$0.00	$0.00	$0.00	$0.00	$0.00	$17.24	$0.00	$0.00	$0.00	$0.00	$69.09	$427.28	$110.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6255	ERX	HCPCS 63700001	59762-0531-02	PHENYTOIN 125 MG/5ML PO SUSP	BOTH IP/OP	$82.72 	$61.21	$0.00	$427.28		$0.00	$0.00	$0.00	$14.72	$0.00	$0.00	$0.00	$0.00	$0.00	$17.24	$0.00	$0.00	$0.00	$0.00	$69.09	$427.28	$110.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6256	ERX	HCPCS J1165	00641-0493-25	PHENYTOIN SODIUM 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.05	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6256	ERX	HCPCS J1165	00641-2555-41	PHENYTOIN SODIUM 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.05	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6256	ERX	HCPCS J1165	00641-2555-45	PHENYTOIN SODIUM 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.05	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6256	ERX	HCPCS J1165	00641-6138-25	PHENYTOIN SODIUM 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.05	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6256	ERX	HCPCS J1165	00641-6139-25	PHENYTOIN SODIUM 50 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.05	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6257	ERX	HCPCS 63700001	00071-0369-40	PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6257	ERX	HCPCS 63700001	00904-6187-61	PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6257	ERX	HCPCS 63700001	51079-0905-20	PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6257	ERX	HCPCS 63700001	51672-4111-01	PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6257	ERX	HCPCS 63700001	51672-4111-03	PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6257	ERX	HCPCS 63700001	68084-0376-01	PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6270	ERX	HCPCS 25000001	17478-0510-02	PHYSOSTIGMINE SALICYLATE 1 MG/ML IJ SOLN	BOTH IP/OP	$181.32 	$134.18	$0.00	$139.76		$0.00	$0.00	$0.00	$0.00	$0.00	$134.58	$134.58	$139.76	$0.00	$37.79	$0.00	$0.00	$0.00	$0.00	$82.21	$130.21	$131.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6279	ERX	HCPCS 25000001	00998-0203-15	PILOCARPINE HCL 1 % OP SOLN	BOTH IP/OP	$342.03 	$253.10	$0.00	$263.64		$0.00	$0.00	$0.00	$0.00	$0.00	$253.85	$253.85	$263.64	$0.00	$71.28	$0.00	$0.00	$0.00	$0.00	$155.24	$245.90	$248.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6279	ERX	HCPCS 25000001	61314-0203-15	PILOCARPINE HCL 1 % OP SOLN	BOTH IP/OP	$342.03 	$253.10	$0.00	$263.64		$0.00	$0.00	$0.00	$0.00	$0.00	$253.85	$253.85	$263.64	$0.00	$71.28	$0.00	$0.00	$0.00	$0.00	$155.24	$245.90	$248.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6279	ERX	HCPCS 25000001	70069-0181-01	PILOCARPINE HCL 1 % OP SOLN	BOTH IP/OP	$342.03 	$253.10	$0.00	$263.64		$0.00	$0.00	$0.00	$0.00	$0.00	$253.85	$253.85	$263.64	$0.00	$71.28	$0.00	$0.00	$0.00	$0.00	$155.24	$245.90	$248.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280	ERX	HCPCS 25000001	00998-0204-15	PILOCARPINE HCL 2 % OP SOLN	BOTH IP/OP	$338.74 	$250.67	$0.00	$261.10		$0.00	$0.00	$0.00	$0.00	$0.00	$251.41	$251.41	$261.10	$0.00	$70.59	$0.00	$0.00	$0.00	$0.00	$153.75	$243.53	$245.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280	ERX	HCPCS 25000001	17478-0224-12	PILOCARPINE HCL 2 % OP SOLN	BOTH IP/OP	$338.74 	$250.67	$0.00	$261.10		$0.00	$0.00	$0.00	$0.00	$0.00	$251.41	$251.41	$261.10	$0.00	$70.59	$0.00	$0.00	$0.00	$0.00	$153.75	$243.53	$245.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280	ERX	HCPCS 25000001	61314-0204-15	PILOCARPINE HCL 2 % OP SOLN	BOTH IP/OP	$338.74 	$250.67	$0.00	$261.10		$0.00	$0.00	$0.00	$0.00	$0.00	$251.41	$251.41	$261.10	$0.00	$70.59	$0.00	$0.00	$0.00	$0.00	$153.75	$243.53	$245.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6282	ERX	HCPCS 25000001	00998-0206-15	PILOCARPINE HCL 4 % OP SOLN	BOTH IP/OP	$355.12 	$262.79	$0.00	$273.73		$0.00	$0.00	$0.00	$0.00	$0.00	$263.57	$263.57	$273.73	$0.00	$74.01	$0.00	$0.00	$0.00	$0.00	$161.18	$255.31	$257.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6282	ERX	HCPCS 25000001	61314-0206-15	PILOCARPINE HCL 4 % OP SOLN	BOTH IP/OP	$355.12 	$262.79	$0.00	$273.73		$0.00	$0.00	$0.00	$0.00	$0.00	$263.57	$263.57	$273.73	$0.00	$74.01	$0.00	$0.00	$0.00	$0.00	$161.18	$255.31	$257.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6296	ERX	HCPCS 63700001	00378-0127-01	PINDOLOL 10 MG PO TABS	BOTH IP/OP	$7.54 	$5.58	$0.00	$5.47		$0.00	$0.00	$0.00	$1.34	$0.00	$0.00	$0.00	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$3.42	$5.42	$5.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6296	ERX	HCPCS 63700001	57664-0656-88	PINDOLOL 10 MG PO TABS	BOTH IP/OP	$7.54 	$5.58	$0.00	$5.47		$0.00	$0.00	$0.00	$1.34	$0.00	$0.00	$0.00	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$3.42	$5.42	$5.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6297	ERX	HCPCS 63700001	00378-0052-01	PINDOLOL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6297	ERX	HCPCS 63700001	57664-0655-88	PINDOLOL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6331	ERX	HCPCS 25000001	00338-0221-04	PLASMA-LYTE A IV SOLN	BOTH IP/OP	$67.04 	$49.61	$0.00	$51.67		$0.00	$0.00	$0.00	$0.00	$0.00	$49.76	$49.76	$51.67	$0.00	$13.97	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6393	ERX	HCPCS 25000001	55150-0234-10	POLYMYXIN B SULFATE 500000 UNITS IJ SOLR	BOTH IP/OP	$51.30 	$37.96	$0.00	$41.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.65	$40.63	$41.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6393	ERX	HCPCS 25000001	63323-0367-01	POLYMYXIN B SULFATE 500000 UNITS IJ SOLR	BOTH IP/OP	$51.30 	$37.96	$0.00	$41.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.65	$40.63	$41.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6393	ERX	HCPCS 25000001	63323-0367-11	POLYMYXIN B SULFATE 500000 UNITS IJ SOLR	BOTH IP/OP	$51.30 	$37.96	$0.00	$41.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.65	$40.63	$41.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6393	ERX	HCPCS 25000001	70860-0103-10	POLYMYXIN B SULFATE 500000 UNITS IJ SOLR	BOTH IP/OP	$51.30 	$37.96	$0.00	$41.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.65	$40.63	$41.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6393	ERX	HCPCS 25000001	70860-0103-41	POLYMYXIN B SULFATE 500000 UNITS IJ SOLR	BOTH IP/OP	$51.30 	$37.96	$0.00	$41.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.65	$40.63	$41.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6420	ERX	HCPCS 25000001	00409-8183-01	POTASSIUM ACETATE 2 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6429	ERX	HCPCS J3480	00264-1940-20	KCL 2 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$1.69	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.65	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$0.00
6429	ERX	HCPCS J3480	00409-6651-06	KCL 2 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$1.69	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.65	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$0.00
6429	ERX	HCPCS J3480	63323-0965-03	KCL 2 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$1.69	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.65	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$0.00
6429	ERX	HCPCS J3480	63323-0965-10	KCL 2 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$1.69	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.65	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$0.00
6429	ERX	HCPCS J3480	63323-0965-20	KCL 2 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$1.69	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.65	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$0.00
6458	ERX	HCPCS 25000001	49348-0622-37	POVIDONE-IODINE 10 % EX SOLN	BOTH IP/OP	$26.82 	$19.85	$0.00	$20.67		$0.00	$0.00	$0.00	$0.00	$0.00	$19.91	$19.91	$20.67	$0.00	$5.59	$0.00	$0.00	$0.00	$0.00	$12.16	$19.26	$19.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6462	ERX	HCPCS J2730	60977-0141-01	PRALIDOXIME CHLORIDE 1 G IV SOLR	BOTH IP/OP	$100.40 	$74.30	$0.00	$77.39		$0.00	$0.00	$0.00	$0.00	$0.00	$74.52	$74.52	$77.39	$0.00	$20.92	$0.00	$0.00	$0.00	$0.00	$45.52	$72.10	$72.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6462	ERX	HCPCS J2730	60977-0141-27	PRALIDOXIME CHLORIDE 1 G IV SOLR	BOTH IP/OP	$100.40 	$74.30	$0.00	$77.39		$0.00	$0.00	$0.00	$0.00	$0.00	$74.52	$74.52	$77.39	$0.00	$20.92	$0.00	$0.00	$0.00	$0.00	$45.52	$72.10	$72.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6468	ERX	HCPCS 63700001	00378-1101-01	PRAZOSIN HCL 1 MG PO CAPS	BOTH IP/OP	$7.60 	$5.62	$0.00	$5.51		$0.00	$0.00	$0.00	$1.35	$0.00	$0.00	$0.00	$0.00	$0.00	$1.58	$0.00	$0.00	$0.00	$0.00	$3.45	$5.46	$5.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6468	ERX	HCPCS 63700001	51079-0630-20	PRAZOSIN HCL 1 MG PO CAPS	BOTH IP/OP	$7.60 	$5.62	$0.00	$5.51		$0.00	$0.00	$0.00	$1.35	$0.00	$0.00	$0.00	$0.00	$0.00	$1.58	$0.00	$0.00	$0.00	$0.00	$3.45	$5.46	$5.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6469	ERX	HCPCS 63700001	00093-4068-01	PRAZOSIN HCL 2 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6469	ERX	HCPCS 63700001	00378-2302-01	PRAZOSIN HCL 2 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6469	ERX	HCPCS 63700001	51079-0631-20	PRAZOSIN HCL 2 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6469	ERX	HCPCS 63700001	59762-5320-01	PRAZOSIN HCL 2 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6470	ERX	HCPCS 63700001	00093-4069-01	PRAZOSIN HCL 5 MG PO CAPS	BOTH IP/OP	$18.06 	$13.36	$0.00	$13.10		$0.00	$0.00	$0.00	$3.21	$0.00	$0.00	$0.00	$0.00	$0.00	$3.76	$0.00	$0.00	$0.00	$0.00	$8.19	$12.97	$13.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6470	ERX	HCPCS 63700001	51079-0632-20	PRAZOSIN HCL 5 MG PO CAPS	BOTH IP/OP	$18.06 	$13.36	$0.00	$13.10		$0.00	$0.00	$0.00	$3.21	$0.00	$0.00	$0.00	$0.00	$0.00	$3.76	$0.00	$0.00	$0.00	$0.00	$8.19	$12.97	$13.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6470	ERX	HCPCS 63700001	70954-0021-10	PRAZOSIN HCL 5 MG PO CAPS	BOTH IP/OP	$18.06 	$13.36	$0.00	$13.10		$0.00	$0.00	$0.00	$3.21	$0.00	$0.00	$0.00	$0.00	$0.00	$3.76	$0.00	$0.00	$0.00	$0.00	$8.19	$12.97	$13.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6487	ERX	HCPCS 25000001	60758-0119-10	PREDNISOLONE ACETATE 1 % OP SUSP	BOTH IP/OP	$354.82 	$262.57	$0.00	$273.50		$0.00	$0.00	$0.00	$0.00	$0.00	$263.35	$263.35	$273.50	$0.00	$73.94	$0.00	$0.00	$0.00	$0.00	$161.04	$255.09	$257.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6487	ERX	HCPCS 25000001	61314-0637-10	PREDNISOLONE ACETATE 1 % OP SUSP	BOTH IP/OP	$354.82 	$262.57	$0.00	$273.50		$0.00	$0.00	$0.00	$0.00	$0.00	$263.35	$263.35	$273.50	$0.00	$73.94	$0.00	$0.00	$0.00	$0.00	$161.04	$255.09	$257.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6487	ERX	HCPCS 25000001	11980-0180-05	PREDNISOLONE ACETATE 1 % OP SUSP	BOTH IP/OP	$354.82 	$262.57	$0.00	$442.81		$0.00	$0.00	$0.00	$0.00	$0.00	$263.35	$263.35	$273.50	$0.00	$73.94	$0.00	$0.00	$0.00	$0.00	$161.04	$442.81	$257.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6487	ERX	HCPCS 25000001	60758-0119-05	PREDNISOLONE ACETATE 1 % OP SUSP	BOTH IP/OP	$354.82 	$262.57	$0.00	$442.81		$0.00	$0.00	$0.00	$0.00	$0.00	$263.35	$263.35	$273.50	$0.00	$73.94	$0.00	$0.00	$0.00	$0.00	$161.04	$442.81	$257.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6487	ERX	HCPCS 25000001	61314-0637-05	PREDNISOLONE ACETATE 1 % OP SUSP	BOTH IP/OP	$354.82 	$262.57	$0.00	$442.81		$0.00	$0.00	$0.00	$0.00	$0.00	$263.35	$263.35	$273.50	$0.00	$73.94	$0.00	$0.00	$0.00	$0.00	$161.04	$442.81	$257.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6493	ERX	HCPCS 25000001	00054-4741-25	PREDNISONE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6493	ERX	HCPCS 25000001	00054-8739-25	PREDNISONE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6493	ERX	HCPCS 25000001	59746-0171-06	PREDNISONE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6494	ERX	HCPCS 25000001	00054-0017-20	PREDNISONE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6494	ERX	HCPCS 25000001	00054-0017-29	PREDNISONE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6494	ERX	HCPCS 25000001	00603-5338-21	PREDNISONE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6494	ERX	HCPCS 25000001	00603-5338-28	PREDNISONE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6494	ERX	HCPCS 25000001	00603-5338-32	PREDNISONE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6494	ERX	HCPCS 25000001	59746-0173-06	PREDNISONE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6494	ERX	HCPCS 25000001	60687-0134-01	PREDNISONE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6494	ERX	HCPCS 25000001	63739-0519-10	PREDNISONE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6496	ERX	HCPCS 25000001	00054-0018-20	PREDNISONE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6496	ERX	HCPCS 25000001	59746-0175-06	PREDNISONE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6497	ERX	HCPCS 25000001	00054-8724-25	PREDNISONE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6497	ERX	HCPCS 25000001	00603-5337-21	PREDNISONE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6497	ERX	HCPCS 25000001	59746-0172-06	PREDNISONE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6497	ERX	HCPCS 25000001	60687-0122-01	PREDNISONE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6497	ERX	HCPCS 25000001	60687-0122-11	PREDNISONE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6497	ERX	HCPCS 25000001	63739-0518-10	PREDNISONE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6498	ERX	HCPCS 25000001	00054-0019-20	PREDNISONE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6498	ERX	HCPCS 25000001	00054-0019-25	PREDNISONE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6541	ERX	HCPCS 63700001	00024-1596-01	PRIMAQUINE PHOSPHATE 26.3 MG PO TABS	BOTH IP/OP	$8.10 	$5.99	$0.00	$6.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.05	$6.42	$6.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6541	ERX	HCPCS 63700001	76385-0102-01	PRIMAQUINE PHOSPHATE 26.3 MG PO TABS	BOTH IP/OP	$8.10 	$5.99	$0.00	$6.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.05	$6.42	$6.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6544	ERX	HCPCS 63700001	00591-5321-01	PRIMIDONE 250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6544	ERX	HCPCS 63700001	68084-0203-01	PRIMIDONE 250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6561	ERX	HCPCS 63700001	00378-0156-01	PROBENECID 500 MG PO TABS	BOTH IP/OP	$8.24 	$6.10	$0.00	$5.98		$0.00	$0.00	$0.00	$1.47	$0.00	$0.00	$0.00	$0.00	$0.00	$1.72	$0.00	$0.00	$0.00	$0.00	$3.74	$5.92	$5.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6561	ERX	HCPCS 63700001	00591-5347-01	PROBENECID 500 MG PO TABS	BOTH IP/OP	$8.24 	$6.10	$0.00	$5.98		$0.00	$0.00	$0.00	$1.47	$0.00	$0.00	$0.00	$0.00	$0.00	$1.72	$0.00	$0.00	$0.00	$0.00	$3.74	$5.92	$5.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6562	ERX	HCPCS J2690	14789-0901-10	PROCAINAMIDE HCL 100 MG/ML IJ SOLN	BOTH IP/OP	$458.97 	$339.64	$0.00	$367.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.49	$363.50	$367.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6582	ERX	HCPCS S0183	59746-0115-06	PROCHLORPERAZINE MALEATE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$3.60		$3.60	$0.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6583	ERX	HCPCS S0183	00378-5105-01	PROCHLORPERAZINE MALEATE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$3.60		$3.60	$0.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6583	ERX	HCPCS S0183	59746-0113-06	PROCHLORPERAZINE MALEATE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$3.60		$3.60	$0.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6597	ERX	HCPCS J2675	00591-3128-79	PROGESTERONE 50 MG/ML IM OIL	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.66	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6618	ERX	HCPCS J2550	00641-0928-21	PROMETHAZINE HCL 25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.93	$16.33	$16.33	$16.96	$0.00	$2.78	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.42	$0.00	$0.00	$2.30	$0.00	$0.00	$0.00	$0.00	$0.00
6618	ERX	HCPCS J2550	00641-0928-25	PROMETHAZINE HCL 25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.93	$16.33	$16.33	$16.96	$0.00	$2.78	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.42	$0.00	$0.00	$2.30	$0.00	$0.00	$0.00	$0.00	$0.00
6618	ERX	HCPCS J2550	00641-0955-25	PROMETHAZINE HCL 25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.93	$16.33	$16.33	$16.96	$0.00	$2.78	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.42	$0.00	$0.00	$2.30	$0.00	$0.00	$0.00	$0.00	$0.00
6618	ERX	HCPCS J2550	00641-1495-31	PROMETHAZINE HCL 25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.93	$16.33	$16.33	$16.96	$0.00	$2.78	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.42	$0.00	$0.00	$2.30	$0.00	$0.00	$0.00	$0.00	$0.00
6618	ERX	HCPCS J2550	00641-1495-35	PROMETHAZINE HCL 25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.93	$16.33	$16.33	$16.96	$0.00	$2.78	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.42	$0.00	$0.00	$2.30	$0.00	$0.00	$0.00	$0.00	$0.00
6618	ERX	HCPCS J2550	00641-6084-25	PROMETHAZINE HCL 25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.93	$16.33	$16.33	$16.96	$0.00	$2.78	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.42	$0.00	$0.00	$2.30	$0.00	$0.00	$0.00	$0.00	$0.00
6618	ERX	HCPCS J2550	39822-5525-03	PROMETHAZINE HCL 25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.93	$16.33	$16.33	$16.96	$0.00	$2.78	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.42	$0.00	$0.00	$2.30	$0.00	$0.00	$0.00	$0.00	$0.00
6622	ERX	HCPCS Q0169	00904-6461-61	PROMETHAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$2.70	$2.70	$0.00	$0.00	$0.00	$1.25	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
6622	ERX	HCPCS Q0169	10702-0003-01	PROMETHAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$2.70	$2.70	$0.00	$0.00	$0.00	$1.25	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
6622	ERX	HCPCS Q0169	68084-0155-01	PROMETHAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$2.70	$2.70	$0.00	$0.00	$0.00	$1.25	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
6643	ERX	HCPCS 63700001	00054-4721-25	PROPANTHELINE BROMIDE 15 MG PO TABS	BOTH IP/OP	$11.40 	$8.44	$0.00	$9.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.70	$9.03	$9.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6644	ERX	HCPCS 25000001	24208-0730-06	PROPARACAINE HCL 0.5 % OP SOLN	BOTH IP/OP	$169.36 	$125.33	$0.00	$130.54		$0.00	$0.00	$0.00	$0.00	$0.00	$125.70	$125.70	$130.54	$0.00	$35.29	$0.00	$0.00	$0.00	$0.00	$76.79	$121.63	$122.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6644	ERX	HCPCS 25000001	61314-0016-01	PROPARACAINE HCL 0.5 % OP SOLN	BOTH IP/OP	$169.36 	$125.33	$0.00	$130.54		$0.00	$0.00	$0.00	$0.00	$0.00	$125.70	$125.70	$130.54	$0.00	$35.29	$0.00	$0.00	$0.00	$0.00	$76.79	$121.63	$122.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6654	ERX	HCPCS 25000001	99999-6010-68	PROPRANOLOL HCL 20 MG/5ML PO SOLN	BOTH IP/OP	$20.12 	$14.89	$0.00	$29.18		$0.00	$0.00	$0.00	$0.00	$0.00	$14.93	$14.93	$15.51	$0.00	$4.19	$0.00	$0.00	$0.00	$0.00	$18.24	$14.45	$29.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6654	ERX	HCPCS 25000001	99999-6004-71	PROPRANOLOL HCL 20 MG/5ML PO SOLN	BOTH IP/OP	$20.12 	$14.89	$0.00	$29.18		$0.00	$0.00	$0.00	$0.00	$0.00	$14.93	$14.93	$15.51	$0.00	$4.19	$0.00	$0.00	$0.00	$0.00	$18.24	$28.89	$29.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6654	ERX	HCPCS 25000001	00054-3727-63	PROPRANOLOL HCL 20 MG/5ML PO SOLN	BOTH IP/OP	$20.12 	$14.89	$0.00	$164.66		$0.00	$0.00	$0.00	$0.00	$0.00	$14.93	$14.93	$15.51	$0.00	$4.19	$0.00	$0.00	$0.00	$0.00	$18.24	$164.66	$29.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6656	ERX	HCPCS 63700001	00378-0182-01	PROPRANOLOL HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6656	ERX	HCPCS 63700001	00378-0182-10	PROPRANOLOL HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6656	ERX	HCPCS 63700001	00591-5554-01	PROPRANOLOL HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6656	ERX	HCPCS 63700001	00603-5482-21	PROPRANOLOL HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6656	ERX	HCPCS 63700001	00603-5482-32	PROPRANOLOL HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6656	ERX	HCPCS 63700001	00904-6550-61	PROPRANOLOL HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6658	ERX	HCPCS 63700001	00115-1661-01	PROPRANOLOL HCL 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6658	ERX	HCPCS 63700001	00378-0184-01	PROPRANOLOL HCL 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6658	ERX	HCPCS 63700001	00591-5556-01	PROPRANOLOL HCL 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6658	ERX	HCPCS 63700001	00603-5484-21	PROPRANOLOL HCL 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6659	ERX	HCPCS 63700001	00378-0187-01	PROPRANOLOL HCL 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6659	ERX	HCPCS 63700001	00603-5485-21	PROPRANOLOL HCL 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6660	ERX	HCPCS 63700001	00378-0185-01	PROPRANOLOL HCL 80 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6660	ERX	HCPCS 63700001	00603-5486-21	PROPRANOLOL HCL 80 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6662	ERX	HCPCS 63700001	00228-2348-10	PROPYLTHIOURACIL 50 MG PO TABS	BOTH IP/OP	$14.08 	$10.42	$0.00	$10.22		$0.00	$0.00	$0.00	$2.51	$0.00	$0.00	$0.00	$0.00	$0.00	$2.93	$0.00	$0.00	$0.00	$0.00	$6.39	$4.75	$10.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6662	ERX	HCPCS 63700001	67253-0651-10	PROPYLTHIOURACIL 50 MG PO TABS	BOTH IP/OP	$14.08 	$10.42	$0.00	$10.22		$0.00	$0.00	$0.00	$2.51	$0.00	$0.00	$0.00	$0.00	$0.00	$2.93	$0.00	$0.00	$0.00	$0.00	$6.39	$4.75	$10.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6662	ERX	HCPCS 63700001	67253-0651-11	PROPYLTHIOURACIL 50 MG PO TABS	BOTH IP/OP	$14.08 	$10.42	$0.00	$10.22		$0.00	$0.00	$0.00	$2.51	$0.00	$0.00	$0.00	$0.00	$0.00	$2.93	$0.00	$0.00	$0.00	$0.00	$6.39	$4.75	$10.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6662	ERX	HCPCS 63700001	68084-0964-25	PROPYLTHIOURACIL 50 MG PO TABS	BOTH IP/OP	$14.08 	$10.42	$0.00	$10.22		$0.00	$0.00	$0.00	$2.51	$0.00	$0.00	$0.00	$0.00	$0.00	$2.93	$0.00	$0.00	$0.00	$0.00	$6.39	$4.75	$10.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6677	ERX	HCPCS J2720	63323-0229-05	PROTAMINE SULFATE 10 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.60	$16.33	$16.33	$16.96	$0.00	$1.63	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.28	$0.00	$0.00	$1.22	$0.00	$0.00	$0.00	$0.00	$0.00
6677	ERX	HCPCS J2720	63323-0229-15	PROTAMINE SULFATE 10 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.60	$16.33	$16.33	$16.96	$0.00	$1.63	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.28	$0.00	$0.00	$1.22	$0.00	$0.00	$0.00	$0.00	$0.00
6677	ERX	HCPCS J2720	63323-0229-30	PROTAMINE SULFATE 10 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.60	$16.33	$16.33	$16.96	$0.00	$1.63	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.28	$0.00	$0.00	$1.22	$0.00	$0.00	$0.00	$0.00	$0.00
6714	ERX	HCPCS 63700001	00904-5053-24	PSEUDOEPHEDRINE HCL 30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6714	ERX	HCPCS 63700001	00904-5053-59	PSEUDOEPHEDRINE HCL 30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6714	ERX	HCPCS 63700001	45802-0432-62	PSEUDOEPHEDRINE HCL 30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6715	ERX	HCPCS 63700001	00904-5125-59	PSEUDOEPHEDRINE HCL 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6715	ERX	HCPCS 63700001	00904-6728-52	PSEUDOEPHEDRINE HCL 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6738	ERX	HCPCS 63700001	61748-0012-01	PYRAZINAMIDE 500 MG PO TABS	BOTH IP/OP	$51.58 	$38.17	$0.00	$37.42		$0.00	$0.00	$0.00	$9.18	$0.00	$0.00	$0.00	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$23.39	$37.05	$37.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6738	ERX	HCPCS 63700001	61748-0012-11	PYRAZINAMIDE 500 MG PO TABS	BOTH IP/OP	$51.58 	$38.17	$0.00	$37.42		$0.00	$0.00	$0.00	$9.18	$0.00	$0.00	$0.00	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$23.39	$37.05	$37.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6744	ERX	HCPCS J3415	63323-0180-01	PYRIDOXINE HCL 100 MG/ML IJ SOLN	BOTH IP/OP	$41.66 	$30.83	$0.00	$32.11	$18.75	$18.75	$0.00	$0.00	$0.00	$0.00	$30.92	$30.92	$32.11	$0.00	$8.68	$0.00	$0.00	$0.00	$0.00	$17.33	$27.45	$27.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6777	ERX	HCPCS 63700001	00185-4346-01	QUINIDINE SULFATE 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6781	ERX	HCPCS 63700001	00093-3002-56	QUININE SULFATE 324 MG PO CAPS	BOTH IP/OP	$26.85 	$19.87	$0.00	$21.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.43	$21.27	$21.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6781	ERX	HCPCS 63700001	13310-0153-07	QUININE SULFATE 324 MG PO CAPS	BOTH IP/OP	$26.85 	$19.87	$0.00	$21.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.43	$21.27	$21.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6781	ERX	HCPCS 63700001	53489-0700-07	QUININE SULFATE 324 MG PO CAPS	BOTH IP/OP	$26.85 	$19.87	$0.00	$21.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.43	$21.27	$21.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6839	ERX	HCPCS 25000001	00327-0012-30	RENACIDIN IR SOLN	BOTH IP/OP	$28.92 	$21.40	$0.00	$22.29		$0.00	$0.00	$0.00	$0.00	$0.00	$21.46	$21.46	$22.29	$0.00	$6.03	$0.00	$0.00	$0.00	$0.00	$13.11	$20.77	$20.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6969	ERX	HCPCS 25000001	51801-0004-40	ROSE BENGAL 1.3 MG OP STRP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7030	ERX	HCPCS 25000001	00904-3865-75	SALINE NASAL SPRAY 0.65 % NA SOLN	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7030	ERX	HCPCS 25000001	45802-0357-58	SALINE NASAL SPRAY 0.65 % NA SOLN	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7034	ERX	HCPCS 63700001	51293-0803-01	SALSALATE 500 MG PO TABS	BOTH IP/OP	$7.96 	$5.89	$0.00	$5.78		$0.00	$0.00	$0.00	$1.42	$0.00	$0.00	$0.00	$0.00	$0.00	$1.66	$0.00	$0.00	$0.00	$0.00	$3.61	$5.72	$5.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7035	ERX	HCPCS 63700001	10135-0493-01	SALSALATE 750 MG PO TABS	BOTH IP/OP	$8.50 	$6.29	$0.00	$6.17		$0.00	$0.00	$0.00	$2.09	$0.00	$0.00	$0.00	$0.00	$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$3.86	$6.11	$6.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7035	ERX	HCPCS 63700001	51293-0804-01	SALSALATE 750 MG PO TABS	BOTH IP/OP	$8.50 	$6.29	$0.00	$6.17		$0.00	$0.00	$0.00	$2.09	$0.00	$0.00	$0.00	$0.00	$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$3.86	$6.11	$6.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7222	ERX	HCPCS 25000001	62991-2927-03	SILVER NITRATE CRYS	BOTH IP/OP	"$1,160.70 "	$858.92	$0.00	$894.67		$0.00	$0.00	$0.00	$0.00	$0.00	$861.47	$861.47	$894.67	$0.00	$241.89	$0.00	$0.00	$0.00	$0.00	$526.69	$834.28	$842.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7224	ERX	HCPCS 25000001	43598-0210-50	SILVER SULFADIAZINE 1 % EX CREA	BOTH IP/OP	$63.27 	$46.82	$0.00	$294.75		$0.00	$0.00	$0.00	$0.00	$0.00	$46.96	$46.96	$48.77	$0.00	$13.19	$0.00	$0.00	$0.00	$0.00	$184.22	$45.44	$294.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7224	ERX	HCPCS 25000001	43598-0210-55	SILVER SULFADIAZINE 1 % EX CREA	BOTH IP/OP	$63.27 	$46.82	$0.00	$294.75		$0.00	$0.00	$0.00	$0.00	$0.00	$46.96	$46.96	$48.77	$0.00	$13.19	$0.00	$0.00	$0.00	$0.00	$184.22	$45.44	$294.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7224	ERX	HCPCS 25000001	61570-0131-50	SILVER SULFADIAZINE 1 % EX CREA	BOTH IP/OP	$63.27 	$46.82	$0.00	$294.75		$0.00	$0.00	$0.00	$0.00	$0.00	$46.96	$46.96	$48.77	$0.00	$13.19	$0.00	$0.00	$0.00	$0.00	$184.22	$45.44	$294.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7224	ERX	HCPCS 25000001	67877-0124-05	SILVER SULFADIAZINE 1 % EX CREA	BOTH IP/OP	$63.27 	$46.82	$0.00	$294.75		$0.00	$0.00	$0.00	$0.00	$0.00	$46.96	$46.96	$48.77	$0.00	$13.19	$0.00	$0.00	$0.00	$0.00	$184.22	$45.44	$294.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7224	ERX	HCPCS 25000001	67877-0124-50	SILVER SULFADIAZINE 1 % EX CREA	BOTH IP/OP	$63.27 	$46.82	$0.00	$294.75		$0.00	$0.00	$0.00	$0.00	$0.00	$46.96	$46.96	$48.77	$0.00	$13.19	$0.00	$0.00	$0.00	$0.00	$184.22	$45.44	$294.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7224	ERX	HCPCS 25000001	43598-0210-40	SILVER SULFADIAZINE 1 % EX CREA	BOTH IP/OP	$63.27 	$46.82	$0.00	$294.75		$0.00	$0.00	$0.00	$0.00	$0.00	$46.96	$46.96	$48.77	$0.00	$13.19	$0.00	$0.00	$0.00	$0.00	$184.22	$291.80	$294.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7224	ERX	HCPCS 25000001	61570-0131-40	SILVER SULFADIAZINE 1 % EX CREA	BOTH IP/OP	$63.27 	$46.82	$0.00	$294.75		$0.00	$0.00	$0.00	$0.00	$0.00	$46.96	$46.96	$48.77	$0.00	$13.19	$0.00	$0.00	$0.00	$0.00	$184.22	$291.80	$294.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7224	ERX	HCPCS 25000001	67877-0124-40	SILVER SULFADIAZINE 1 % EX CREA	BOTH IP/OP	$63.27 	$46.82	$0.00	$294.75		$0.00	$0.00	$0.00	$0.00	$0.00	$46.96	$46.96	$48.77	$0.00	$13.19	$0.00	$0.00	$0.00	$0.00	$184.22	$291.80	$294.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7227	ERX	HCPCS 63700001	00904-5068-60	SIMETHICONE 80 MG PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7227	ERX	HCPCS 63700001	63739-0225-10	SIMETHICONE 80 MG PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7227	ERX	HCPCS 63700001	69618-0033-01	SIMETHICONE 80 MG PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7228	ERX	HCPCS 63700001	00536-2220-75	SIMETHICONE 40 MG/0.6ML PO SUSP	BOTH IP/OP	$22.58 	$16.71	$0.00	$17.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.67	$17.88	$10.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7228	ERX	HCPCS 63700001	00904-5894-30	SIMETHICONE 40 MG/0.6ML PO SUSP	BOTH IP/OP	$22.58 	$16.71	$0.00	$17.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.67	$17.88	$10.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7228	ERX	HCPCS 63700001	49348-0740-27	SIMETHICONE 40 MG/0.6ML PO SUSP	BOTH IP/OP	$22.58 	$16.71	$0.00	$17.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.67	$17.88	$10.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7228	ERX	HCPCS 63700001	56184-0120-41	SIMETHICONE 40 MG/0.6ML PO SUSP	BOTH IP/OP	$22.58 	$16.71	$0.00	$17.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.67	$17.88	$10.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7242	ERX	HCPCS 25000001	00395-2661-16	SIMPLE SYRUP PO SYRP	BOTH IP/OP	$83.99 	$62.15	$0.00	$64.74		$0.00	$0.00	$0.00	$0.00	$0.00	$62.34	$62.34	$64.74	$0.00	$17.50	$0.00	$0.00	$0.00	$0.00	$36.43	$57.70	$58.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7242	ERX	HCPCS 25000001	00802-3920-16	SIMPLE SYRUP PO SYRP	BOTH IP/OP	$83.99 	$62.15	$0.00	$64.74		$0.00	$0.00	$0.00	$0.00	$0.00	$62.34	$62.34	$64.74	$0.00	$17.50	$0.00	$0.00	$0.00	$0.00	$36.43	$57.70	$58.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7301	ERX	HCPCS 25000001	00409-3299-06	SODIUM ACETATE 2 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7301	ERX	HCPCS 25000001	00409-3299-15	SODIUM ACETATE 2 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7301	ERX	HCPCS 25000001	00409-3299-25	SODIUM ACETATE 2 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7301	ERX	HCPCS 25000001	00409-3299-45	SODIUM ACETATE 2 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7301	ERX	HCPCS 25000001	00409-7299-25	SODIUM ACETATE 2 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7301	ERX	HCPCS 25000001	00409-7299-73	SODIUM ACETATE 2 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7306	ERX	HCPCS 25000001	00409-5555-02	SODIUM BICARBONATE 4.2 % IV SOLN	BOTH IP/OP	$54.35 	$40.22	$0.00	$41.89		$0.00	$0.00	$0.00	$0.00	$0.00	$40.34	$40.34	$41.89	$0.00	$11.33	$0.00	$0.00	$0.00	$0.00	$24.65	$17.42	$39.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7306	ERX	HCPCS 25000001	00409-5555-12	SODIUM BICARBONATE 4.2 % IV SOLN	BOTH IP/OP	$54.35 	$40.22	$0.00	$41.89		$0.00	$0.00	$0.00	$0.00	$0.00	$40.34	$40.34	$41.89	$0.00	$11.33	$0.00	$0.00	$0.00	$0.00	$24.65	$17.42	$39.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7306	ERX	HCPCS 25000001	63323-0083-05	SODIUM BICARBONATE 4.2 % IV SOLN	BOTH IP/OP	$54.35 	$40.22	$0.00	$41.89		$0.00	$0.00	$0.00	$0.00	$0.00	$40.34	$40.34	$41.89	$0.00	$11.33	$0.00	$0.00	$0.00	$0.00	$24.65	$17.42	$39.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7306	ERX	HCPCS 25000001	00409-5534-34	SODIUM BICARBONATE 4.2 % IV SOLN	BOTH IP/OP	$54.35 	$40.22	$0.00	$41.89		$0.00	$0.00	$0.00	$0.00	$0.00	$40.34	$40.34	$41.89	$0.00	$11.33	$0.00	$0.00	$0.00	$0.00	$24.65	$39.04	$39.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7308	ERX	HCPCS 25000001	00409-4916-34	SODIUM BICARBONATE 7.5 % IV SOLN	BOTH IP/OP	$70.03 	$51.82	$0.00	$56.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.02	$55.46	$56.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7309	ERX	HCPCS 25000001	00409-6625-02	SODIUM BICARBONATE 8.4 % IV SOLN	BOTH IP/OP	$22.14 	$16.38	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.07	$17.53	$17.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7309	ERX	HCPCS 25000001	00409-6625-25	SODIUM BICARBONATE 8.4 % IV SOLN	BOTH IP/OP	$22.14 	$16.38	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.07	$17.53	$17.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7309	ERX	HCPCS 25000001	00409-6637-34	SODIUM BICARBONATE 8.4 % IV SOLN	BOTH IP/OP	$22.14 	$16.38	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.07	$17.53	$17.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7309	ERX	HCPCS 25000001	51754-5001-05	SODIUM BICARBONATE 8.4 % IV SOLN	BOTH IP/OP	$22.14 	$16.38	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.07	$17.53	$17.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7309	ERX	HCPCS 25000001	63323-0089-50	SODIUM BICARBONATE 8.4 % IV SOLN	BOTH IP/OP	$22.14 	$16.38	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.07	$17.53	$17.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7309	ERX	HCPCS 25000001	76329-3352-01	SODIUM BICARBONATE 8.4 % IV SOLN	BOTH IP/OP	$22.14 	$16.38	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.07	$17.53	$17.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7313	ERX	HCPCS 63700001	64980-0294-10	SODIUM BICARBONATE 650 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7313	ERX	HCPCS 63700001	66553-0008-01	SODIUM BICARBONATE 650 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7313	ERX	HCPCS 63700001	77333-0831-10	SODIUM BICARBONATE 650 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7318	ERX	HCPCS 25000001	00990-7730-37	SODIUM CHLORIDE 0.45 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38		$0.00	$0.00	$0.00	$0.00	$0.00	$18.66	$18.66	$19.38	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7318	ERX	HCPCS 25000001	00264-7802-10	SODIUM CHLORIDE 0.45 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38		$0.00	$0.00	$0.00	$0.00	$0.00	$18.66	$18.66	$19.38	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7318	ERX	HCPCS 25000001	00338-0043-03	SODIUM CHLORIDE 0.45 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38		$0.00	$0.00	$0.00	$0.00	$0.00	$18.66	$18.66	$19.38	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7318	ERX	HCPCS 25000001	00409-7985-03	SODIUM CHLORIDE 0.45 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38		$0.00	$0.00	$0.00	$0.00	$0.00	$18.66	$18.66	$19.38	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7318	ERX	HCPCS 25000001	00264-7802-00	SODIUM CHLORIDE 0.45 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38		$0.00	$0.00	$0.00	$0.00	$0.00	$18.66	$18.66	$19.38	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7318	ERX	HCPCS 25000001	00338-0043-04	SODIUM CHLORIDE 0.45 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38		$0.00	$0.00	$0.00	$0.00	$0.00	$18.66	$18.66	$19.38	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7320	ERX	HCPCS J7131	00409-6660-75	SODIUM CHLORIDE 2.5 MEQ/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7321	ERX	HCPCS 25000001	00264-7805-10	SODIUM CHLORIDE 3 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7321	ERX	HCPCS 25000001	00338-0054-03	SODIUM CHLORIDE 3 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7322	ERX	HCPCS 25000001	00409-1141-02	SODIUM CHLORIDE 4 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7322	ERX	HCPCS 25000001	63323-0088-61	SODIUM CHLORIDE 4 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7322	ERX	HCPCS 25000001	63323-0088-63	SODIUM CHLORIDE 4 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7322	ERX	HCPCS 25000001	63323-0187-30	SODIUM CHLORIDE 4 MEQ/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7323	ERX	HCPCS 25000001	00264-7806-10	SODIUM CHLORIDE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7323	ERX	HCPCS 25000001	00338-0056-03	SODIUM CHLORIDE 5 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7325	ERX	HCPCS 25000001	00378-6985-01	SODIUM CHLORIDE 0.9 % IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7325	ERX	HCPCS 25000001	00487-9301-03	SODIUM CHLORIDE 0.9 % IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7325	ERX	HCPCS 25000001	00487-9301-33	SODIUM CHLORIDE 0.9 % IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7327	ERX	HCPCS 25000001	00378-6997-89	SODIUM CHLORIDE 3 % IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7328	ERX	HCPCS 63700001	00223-1760-02	SODIUM CHLORIDE 1000 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7331	ERX	HCPCS 25000001	17478-0622-35	SODIUM CHLORIDE (HYPERTONIC) 5 % OP OINT	BOTH IP/OP	$80.37 	$59.47	$0.00	$61.95		$0.00	$0.00	$0.00	$0.00	$0.00	$59.65	$59.65	$61.95	$0.00	$16.75	$0.00	$0.00	$0.00	$0.00	$36.45	$57.73	$58.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7331	ERX	HCPCS 25000001	24208-0385-55	SODIUM CHLORIDE (HYPERTONIC) 5 % OP OINT	BOTH IP/OP	$80.37 	$59.47	$0.00	$61.95		$0.00	$0.00	$0.00	$0.00	$0.00	$59.65	$59.65	$61.95	$0.00	$16.75	$0.00	$0.00	$0.00	$0.00	$36.45	$57.73	$58.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7332	ERX	HCPCS 25000001	17478-0623-12	SODIUM CHLORIDE (HYPERTONIC) 5 % OP SOLN	BOTH IP/OP	$61.79 	$45.72	$0.00	$47.63		$0.00	$0.00	$0.00	$0.00	$0.00	$45.86	$45.86	$47.63	$0.00	$12.88	$0.00	$0.00	$0.00	$0.00	$23.00	$36.43	$36.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7356	ERX	HCPCS 25000001	10135-0146-17	SODIUM POLYSTYRENE SULFONATE PO POWD	BOTH IP/OP	$27.97 	$20.70	$0.00	$21.56		$0.00	$0.00	$0.00	$0.00	$0.00	$20.76	$20.76	$21.56	$0.00	$5.83	$0.00	$0.00	$0.00	$0.00	$12.69	$20.09	$20.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7356	ERX	HCPCS 25000001	10702-0036-45	SODIUM POLYSTYRENE SULFONATE PO POWD	BOTH IP/OP	$27.97 	$20.70	$0.00	$21.56		$0.00	$0.00	$0.00	$0.00	$0.00	$20.76	$20.76	$21.56	$0.00	$5.83	$0.00	$0.00	$0.00	$0.00	$12.69	$20.09	$20.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7356	ERX	HCPCS 25000001	11534-0166-15	SODIUM POLYSTYRENE SULFONATE PO POWD	BOTH IP/OP	$27.97 	$20.70	$0.00	$21.56		$0.00	$0.00	$0.00	$0.00	$0.00	$20.76	$20.76	$21.56	$0.00	$5.83	$0.00	$0.00	$0.00	$0.00	$12.69	$20.09	$20.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7356	ERX	HCPCS 25000001	24658-0760-16	SODIUM POLYSTYRENE SULFONATE PO POWD	BOTH IP/OP	$27.97 	$20.70	$0.00	$21.56		$0.00	$0.00	$0.00	$0.00	$0.00	$20.76	$20.76	$21.56	$0.00	$5.83	$0.00	$0.00	$0.00	$0.00	$12.69	$20.09	$20.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7356	ERX	HCPCS 25000001	99999-6007-33	SODIUM POLYSTYRENE SULFONATE PO POWD	BOTH IP/OP	$27.97 	$20.70	$0.00	$21.56		$0.00	$0.00	$0.00	$0.00	$0.00	$20.76	$20.76	$21.56	$0.00	$5.83	$0.00	$0.00	$0.00	$0.00	$12.69	$20.09	$20.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7359	ERX	HCPCS 25000001	24208-0670-04	SULFACETAMIDE SODIUM 10 % OP SOLN	BOTH IP/OP	$211.69 	$156.65	$0.00	$163.17		$0.00	$0.00	$0.00	$0.00	$0.00	$157.12	$157.12	$163.17	$0.00	$44.12	$0.00	$0.00	$0.00	$0.00	$96.09	$152.20	$153.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7359	ERX	HCPCS 25000001	61314-0701-01	SULFACETAMIDE SODIUM 10 % OP SOLN	BOTH IP/OP	$211.69 	$156.65	$0.00	$163.17		$0.00	$0.00	$0.00	$0.00	$0.00	$157.12	$157.12	$163.17	$0.00	$44.12	$0.00	$0.00	$0.00	$0.00	$96.09	$152.20	$153.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7359	ERX	HCPCS 25000001	11980-0011-05	SULFACETAMIDE SODIUM 10 % OP SOLN	BOTH IP/OP	$211.69 	$156.65	$0.00	$385.51		$0.00	$0.00	$0.00	$0.00	$0.00	$157.12	$157.12	$163.17	$0.00	$44.12	$0.00	$0.00	$0.00	$0.00	$96.09	$385.51	$153.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7364	ERX	HCPCS 25000001	60267-0705-50	SODIUM THIOSULFATE 25 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7413	ERX	HCPCS 25000001	54162-0700-16	SORBITOL 70 % PO SOLN	BOTH IP/OP	$18.02 	$13.33	$0.00	$14.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.27	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7437	ERX	HCPCS 63700001	00378-2146-01	SPIRONOLACTONE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7437	ERX	HCPCS 63700001	00904-6927-61	SPIRONOLACTONE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7437	ERX	HCPCS 63700001	51079-0103-01	SPIRONOLACTONE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7437	ERX	HCPCS 63700001	51079-0103-20	SPIRONOLACTONE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7437	ERX	HCPCS 63700001	59746-0216-01	SPIRONOLACTONE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7437	ERX	HCPCS 63700001	63739-0544-10	SPIRONOLACTONE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7484	ERX	HCPCS 25000001	00409-4887-20	STERILE WATER FOR INJECTION IJ SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$20.19		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$11.88	$17.42	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7484	ERX	HCPCS 25000001	00517-3020-25	STERILE WATER FOR INJECTION IJ SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$20.19		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$11.88	$17.42	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7484	ERX	HCPCS 25000001	00409-4887-50	STERILE WATER FOR INJECTION IJ SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$20.19		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$11.88	$17.42	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7484	ERX	HCPCS 25000001	63323-0185-50	STERILE WATER FOR INJECTION IJ SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$20.19		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$11.88	$17.42	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7484	ERX	HCPCS 25000001	00990-7990-09	STERILE WATER FOR INJECTION IJ SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$20.19		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$11.88	$18.06	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7484	ERX	HCPCS 25000001	00409-4887-10	STERILE WATER FOR INJECTION IJ SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$20.19		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$11.88	$18.81	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7484	ERX	HCPCS 25000001	00641-6147-01	STERILE WATER FOR INJECTION IJ SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$20.19		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$11.88	$18.81	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7484	ERX	HCPCS 25000001	00641-6147-10	STERILE WATER FOR INJECTION IJ SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$20.19		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$11.88	$18.81	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7484	ERX	HCPCS 25000001	00641-6147-25	STERILE WATER FOR INJECTION IJ SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$20.19		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$11.88	$18.81	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7484	ERX	HCPCS 25000001	63323-0185-10	STERILE WATER FOR INJECTION IJ SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$20.19		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$11.88	$18.81	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7485	ERX	HCPCS 25000001	00338-0004-04	STERILE WATER FOR IRRIGATION IR SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7508	ERX	HCPCS J3000	39822-0706-02	STREPTOMYCIN SULFATE 1 G IM SOLR	BOTH IP/OP	$325.32 	$240.74	$0.00	$250.76		$0.00	$0.00	$0.00	$0.00	$0.00	$241.45	$241.45	$250.76	$0.00	$40.59	$0.00	$0.00	$0.00	$0.00	$147.66	$233.89	$236.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7536	ERX	HCPCS J0330	00409-6629-02	SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7536	ERX	HCPCS J0330	00781-3411-70	SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7536	ERX	HCPCS J0330	00781-3411-95	SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7536	ERX	HCPCS J0330	70069-0301-25	SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7536	ERX	HCPCS J0330	70121-1581-01	SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7536	ERX	HCPCS J0330	70121-1581-05	SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7554	ERX	HCPCS 63700001	00185-0757-01	SULFADIAZINE 500 MG PO TABS	BOTH IP/OP	$21.15 	$15.65	$0.00	$15.34		$0.00	$0.00	$0.00	$13.77	$0.00	$0.00	$0.00	$0.00	$0.00	$4.41	$0.00	$0.00	$0.00	$0.00	$9.59	$15.19	$15.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7556	ERX	HCPCS 25000001	00703-9514-01	SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN	BOTH IP/OP	$63.06 	$46.66	$0.00	$48.61		$0.00	$0.00	$0.00	$0.00	$0.00	$46.80	$46.80	$48.61	$0.00	$13.14	$0.00	$0.00	$0.00	$0.00	$28.60	$45.29	$45.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7556	ERX	HCPCS 25000001	00703-9514-03	SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN	BOTH IP/OP	$63.06 	$46.66	$0.00	$48.61		$0.00	$0.00	$0.00	$0.00	$0.00	$46.80	$46.80	$48.61	$0.00	$13.14	$0.00	$0.00	$0.00	$0.00	$28.60	$45.29	$45.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7557	ERX	HCPCS 63700001	57237-0232-01	SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7557	ERX	HCPCS 63700001	65862-0419-01	SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7562	ERX	HCPCS 63700001	00591-0796-01	SULFASALAZINE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7562	ERX	HCPCS 63700001	50268-0730-11	SULFASALAZINE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7562	ERX	HCPCS 63700001	50268-0730-15	SULFASALAZINE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7579	ERX	HCPCS 63700001	00591-5660-01	SULINDAC 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7579	ERX	HCPCS 63700001	00591-5660-05	SULINDAC 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7579	ERX	HCPCS 63700001	42806-0011-01	SULINDAC 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7579	ERX	HCPCS 63700001	51079-0667-20	SULINDAC 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7711	ERX	HCPCS 63700001	00591-2472-60	TAMOXIFEN CITRATE 10 MG PO TABS	BOTH IP/OP	$7.94 	$5.88	$0.00	$5.76		$0.00	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.70	$5.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7753	ERX	HCPCS 63700001	00378-4010-01	TEMAZEPAM 15 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7753	ERX	HCPCS 63700001	63739-0231-10	TEMAZEPAM 15 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7753	ERX	HCPCS 63700001	63739-0877-10	TEMAZEPAM 15 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7753	ERX	HCPCS 63700001	67877-0146-01	TEMAZEPAM 15 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7784	ERX	HCPCS J1071	00009-0417-01	TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN	BOTH IP/OP	$26.40 	$19.54	$0.00	$20.35	$11.88	$11.88	$0.00	$0.00	$0.00	$5.50	$19.59	$19.59	$20.35	$0.00	$1.76	$0.00	$15.62	$15.62	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$1.76	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00
7784	ERX	HCPCS J1071	00143-9659-01	TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN	BOTH IP/OP	$26.40 	$19.54	$0.00	$20.35	$11.88	$11.88	$0.00	$0.00	$0.00	$5.50	$19.59	$19.59	$20.35	$0.00	$1.76	$0.00	$15.62	$15.62	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$1.76	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00
7784	ERX	HCPCS J1071	00574-0820-10	TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN	BOTH IP/OP	$26.40 	$19.54	$0.00	$20.35	$11.88	$11.88	$0.00	$0.00	$0.00	$5.50	$19.59	$19.59	$20.35	$0.00	$1.76	$0.00	$15.62	$15.62	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$1.76	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00
7784	ERX	HCPCS J1071	62756-0015-40	TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN	BOTH IP/OP	$26.40 	$19.54	$0.00	$20.35	$11.88	$11.88	$0.00	$0.00	$0.00	$5.50	$19.59	$19.59	$20.35	$0.00	$1.76	$0.00	$15.62	$15.62	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$1.76	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00
7785	ERX	HCPCS J3121	00143-9750-01	TESTOSTERONE ENANTHATE 200 MG/ML IM SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$2.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.94	$0.00	$0.00	$2.80	$0.00	$0.00	$0.00	$0.00	$0.00
7785	ERX	HCPCS J3121	99999-6005-75	TESTOSTERONE ENANTHATE 200 MG/ML IM SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$2.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.94	$0.00	$0.00	$2.80	$0.00	$0.00	$0.00	$0.00	$0.00
7789	ERX	HCPCS J1670	13533-0634-02	TETANUS IMMUNE GLOBULIN 250 UNIT/ML IM INJ	BOTH IP/OP	"$1,602.44 "	"$1,185.81"	$0.00	"$1,281.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$801.22	"$1,269.13"	"$1,281.95"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7795	ERX	HCPCS 25000001	00065-0741-14	TETRACAINE HCL 0.5 % OP SOLN	BOTH IP/OP	$53.25 	$39.41	$0.00	$45.15		$0.00	$0.00	$0.00	$0.00	$0.00	$43.48	$43.48	$45.15	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$24.15	$38.25	$38.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7796	ERX	HCPCS 63700001	23155-0017-01	TETRACYCLINE HCL 250 MG PO CAPS	BOTH IP/OP	$29.93 	$22.15	$0.00	$23.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.97	$23.70	$23.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7821	ERX	HCPCS 63700001	00121-4794-15	THEOPHYLLINE 80 MG/15ML PO SOLN	BOTH IP/OP	$52.48 	$38.84	$0.00	$38.08		$0.00	$0.00	$0.00	$9.34	$0.00	$0.00	$0.00	$0.00	$0.00	$10.94	$0.00	$0.00	$0.00	$0.00	$23.80	$37.70	$38.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7821	ERX	HCPCS 63700001	00121-4820-40	THEOPHYLLINE 80 MG/15ML PO SOLN	BOTH IP/OP	$52.48 	$38.84	$0.00	$38.08		$0.00	$0.00	$0.00	$9.34	$0.00	$0.00	$0.00	$0.00	$0.00	$10.94	$0.00	$0.00	$0.00	$0.00	$23.80	$37.70	$38.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7821	ERX	HCPCS 63700001	27808-0033-01	THEOPHYLLINE 80 MG/15ML PO SOLN	BOTH IP/OP	$52.48 	$38.84	$0.00	$38.08		$0.00	$0.00	$0.00	$9.34	$0.00	$0.00	$0.00	$0.00	$0.00	$10.94	$0.00	$0.00	$0.00	$0.00	$23.80	$37.70	$38.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7825	ERX	HCPCS 63700001	00904-0539-61	THERA PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7876	ERX	HCPCS J3411	63323-0013-01	THIAMINE HCL 100 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
7876	ERX	HCPCS J3411	63323-0013-02	THIAMINE HCL 100 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
7876	ERX	HCPCS J3411	63323-0013-09	THIAMINE HCL 100 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
7876	ERX	HCPCS J3411	63323-0013-21	THIAMINE HCL 100 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
7876	ERX	HCPCS J3411	67457-0196-00	THIAMINE HCL 100 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
7876	ERX	HCPCS J3411	67457-0196-02	THIAMINE HCL 100 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
7886	ERX	HCPCS 63700001	76388-0880-25	THIOGUANINE 40 MG PO TABS	BOTH IP/OP	$117.09 	$86.65	$0.00	$84.94		$0.00	$0.00	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$0.00	$24.40	$0.00	$0.00	$0.00	$0.00	$53.09	$84.09	$84.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7894	ERX	HCPCS 63700001	51079-0565-01	THIORIDAZINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7894	ERX	HCPCS 63700001	51079-0565-20	THIORIDAZINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7894	ERX	HCPCS 63700001	53489-0148-01	THIORIDAZINE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7895	ERX	HCPCS 63700001	51079-0580-20	THIORIDAZINE HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7899	ERX	HCPCS 63700001	51079-0566-01	THIORIDAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7899	ERX	HCPCS 63700001	51079-0566-20	THIORIDAZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7900	ERX	HCPCS 63700001	00378-0616-01	THIORIDAZINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7900	ERX	HCPCS 63700001	51079-0567-01	THIORIDAZINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7900	ERX	HCPCS 63700001	53489-0150-01	THIORIDAZINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7902	ERX	HCPCS 63700001	00378-1001-01	THIOTHIXENE 1 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7903	ERX	HCPCS 63700001	00378-5010-01	THIOTHIXENE 10 MG PO CAPS	BOTH IP/OP	$14.07 	$10.41	$0.00	$10.21		$0.00	$0.00	$0.00	$2.50	$0.00	$0.00	$0.00	$0.00	$0.00	$2.93	$0.00	$0.00	$0.00	$0.00	$6.38	$10.11	$10.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7906	ERX	HCPCS 63700001	00378-3005-01	THIOTHIXENE 5 MG PO CAPS	BOTH IP/OP	$15.17 	$11.23	$0.00	$11.01		$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$6.88	$10.90	$11.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7906	ERX	HCPCS 63700001	51079-0588-01	THIOTHIXENE 5 MG PO CAPS	BOTH IP/OP	$15.17 	$11.23	$0.00	$11.01		$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$6.88	$10.90	$11.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7906	ERX	HCPCS 63700001	51079-0588-20	THIOTHIXENE 5 MG PO CAPS	BOTH IP/OP	$15.17 	$11.23	$0.00	$11.01		$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$6.88	$10.90	$11.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7906	ERX	HCPCS 63700001	70954-0016-10	THIOTHIXENE 5 MG PO CAPS	BOTH IP/OP	$15.17 	$11.23	$0.00	$11.01		$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$6.88	$10.90	$11.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7940	ERX	HCPCS 63700001	00456-0457-01	THYROID 15 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7947	ERX	HCPCS 63700001	00456-0459-01	THYROID 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7993	ERX	HCPCS 25000001	63323-0305-02	TOBRAMYCIN SULFATE 10 MG/ML IJ SOLN	BOTH IP/OP	$26.55 	$19.65	$0.00	$20.46		$0.00	$0.00	$0.00	$0.00	$0.00	$19.71	$19.71	$20.46	$0.00	$5.53	$0.00	$0.00	$0.00	$0.00	$12.04	$19.07	$19.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7995	ERX	HCPCS 25000001	17478-0290-10	TOBRAMYCIN 0.3 % OP SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$42.14		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$26.34	$41.71	$42.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7995	ERX	HCPCS 25000001	24208-0290-05	TOBRAMYCIN 0.3 % OP SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$42.14		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$26.34	$41.71	$42.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7995	ERX	HCPCS 25000001	61314-0643-05	TOBRAMYCIN 0.3 % OP SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$42.14		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$26.34	$41.71	$42.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7995	ERX	HCPCS 25000001	70069-0131-01	TOBRAMYCIN 0.3 % OP SOLN	BOTH IP/OP	$26.19 	$19.38	$0.00	$42.14		$0.00	$0.00	$0.00	$0.00	$0.00	$19.44	$19.44	$20.19	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$26.34	$41.71	$42.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8083	ERX	HCPCS 63700001	00904-6869-61	TRAZODONE HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8083	ERX	HCPCS 63700001	50111-0434-01	TRAZODONE HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8085	ERX	HCPCS 63700001	00904-6868-61	TRAZODONE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8085	ERX	HCPCS 63700001	50111-0433-01	TRAZODONE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8085	ERX	HCPCS 63700001	50111-0433-02	TRAZODONE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8112	ERX	HCPCS 63700001	45802-0063-35	TRIAMCINOLONE ACETONIDE 0.025 % EX CREA	BOTH IP/OP	$18.67 	$13.82	$0.00	$13.54		$0.00	$0.00	$0.00	$3.32	$0.00	$0.00	$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$8.47	$13.41	$13.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8113	ERX	HCPCS 63700001	00168-0004-15	TRIAMCINOLONE ACETONIDE 0.1 % EX CREA	BOTH IP/OP	$15.09 	$11.17	$0.00	$16.97		$0.00	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00	$3.14	$0.00	$0.00	$0.00	$0.00	$10.61	$16.80	$16.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8113	ERX	HCPCS 63700001	52565-0056-15	TRIAMCINOLONE ACETONIDE 0.1 % EX CREA	BOTH IP/OP	$15.09 	$11.17	$0.00	$16.97		$0.00	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00	$3.14	$0.00	$0.00	$0.00	$0.00	$10.61	$16.80	$16.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8113	ERX	HCPCS 63700001	00168-0004-80	TRIAMCINOLONE ACETONIDE 0.1 % EX CREA	BOTH IP/OP	$15.09 	$11.17	$0.00	$92.81		$0.00	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00	$3.14	$0.00	$0.00	$0.00	$0.00	$10.61	$92.81	$16.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8113	ERX	HCPCS 63700001	45802-0064-36	TRIAMCINOLONE ACETONIDE 0.1 % EX CREA	BOTH IP/OP	$15.09 	$11.17	$0.00	$92.81		$0.00	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00	$3.14	$0.00	$0.00	$0.00	$0.00	$10.61	$92.81	$16.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8114	ERX	HCPCS 63700001	00168-0002-15	TRIAMCINOLONE ACETONIDE 0.5 % EX CREA	BOTH IP/OP	$46.51 	$34.42	$0.00	$33.74		$0.00	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$21.09	$33.41	$33.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8114	ERX	HCPCS 63700001	45802-0065-35	TRIAMCINOLONE ACETONIDE 0.5 % EX CREA	BOTH IP/OP	$46.51 	$34.42	$0.00	$33.74		$0.00	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$21.09	$33.41	$33.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8117	ERX	HCPCS 25000001	45802-0054-35	TRIAMCINOLONE ACETONIDE 0.025 % EX OINT	BOTH IP/OP	$25.65 	$18.98	$0.00	$19.77		$0.00	$0.00	$0.00	$0.00	$0.00	$19.04	$19.04	$19.77	$0.00	$5.35	$0.00	$0.00	$0.00	$0.00	$11.63	$18.42	$18.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8118	ERX	HCPCS 63700001	45802-0055-35	TRIAMCINOLONE ACETONIDE 0.1 % EX OINT	BOTH IP/OP	$159.48 	$118.02	$0.00	$115.68		$0.00	$0.00	$0.00	$28.39	$0.00	$0.00	$0.00	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$72.30	$114.52	$115.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8118	ERX	HCPCS 63700001	45802-0055-05	TRIAMCINOLONE ACETONIDE 0.1 % EX OINT	BOTH IP/OP	$159.48 	$118.02	$0.00	$115.68		$0.00	$0.00	$0.00	$28.39	$0.00	$0.00	$0.00	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$72.30	$114.52	$115.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8118	ERX	HCPCS 63700001	52565-0014-26	TRIAMCINOLONE ACETONIDE 0.1 % EX OINT	BOTH IP/OP	$159.48 	$118.02	$0.00	$115.68		$0.00	$0.00	$0.00	$28.39	$0.00	$0.00	$0.00	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$72.30	$114.52	$115.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8118	ERX	HCPCS 63700001	00168-0006-80	TRIAMCINOLONE ACETONIDE 0.1 % EX OINT	BOTH IP/OP	$159.48 	$118.02	$0.00	$115.68		$0.00	$0.00	$0.00	$28.39	$0.00	$0.00	$0.00	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$72.30	$114.52	$115.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8118	ERX	HCPCS 63700001	45802-0055-36	TRIAMCINOLONE ACETONIDE 0.1 % EX OINT	BOTH IP/OP	$159.48 	$118.02	$0.00	$115.68		$0.00	$0.00	$0.00	$28.39	$0.00	$0.00	$0.00	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$72.30	$114.52	$115.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8118	ERX	HCPCS 63700001	51672-1284-08	TRIAMCINOLONE ACETONIDE 0.1 % EX OINT	BOTH IP/OP	$159.48 	$118.02	$0.00	$115.68		$0.00	$0.00	$0.00	$28.39	$0.00	$0.00	$0.00	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$72.30	$114.52	$115.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8118	ERX	HCPCS 63700001	52565-0014-80	TRIAMCINOLONE ACETONIDE 0.1 % EX OINT	BOTH IP/OP	$159.48 	$118.02	$0.00	$115.68		$0.00	$0.00	$0.00	$28.39	$0.00	$0.00	$0.00	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$72.30	$114.52	$115.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8120	ERX	HCPCS J3301	00003-0293-05	TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP	BOTH IP/OP	$42.74 	$31.63	$0.00	$34.14	$19.23	$19.23	$0.00	$0.00	$0.00	$7.10	$31.72	$31.72	$32.94	$0.00	$5.64	$0.00	$25.28	$25.28	$0.00	$21.34	$33.80	$34.14	$0.00		$0.00	$7.33	$0.00	$0.00	$6.98	$0.00	$0.00	$0.00	$0.00	$0.00
8120	ERX	HCPCS J3301	00703-0241-01	TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP	BOTH IP/OP	$42.74 	$31.63	$0.00	$34.14	$19.23	$19.23	$0.00	$0.00	$0.00	$7.10	$31.72	$31.72	$32.94	$0.00	$5.64	$0.00	$25.28	$25.28	$0.00	$21.34	$33.80	$34.14	$0.00		$0.00	$7.33	$0.00	$0.00	$6.98	$0.00	$0.00	$0.00	$0.00	$0.00
8120	ERX	HCPCS J3301	70121-1049-01	TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP	BOTH IP/OP	$42.74 	$31.63	$0.00	$34.14	$19.23	$19.23	$0.00	$0.00	$0.00	$7.10	$31.72	$31.72	$32.94	$0.00	$5.64	$0.00	$25.28	$25.28	$0.00	$21.34	$33.80	$34.14	$0.00		$0.00	$7.33	$0.00	$0.00	$6.98	$0.00	$0.00	$0.00	$0.00	$0.00
8120	ERX	HCPCS J3301	70121-1049-05	TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP	BOTH IP/OP	$42.74 	$31.63	$0.00	$34.14	$19.23	$19.23	$0.00	$0.00	$0.00	$7.10	$31.72	$31.72	$32.94	$0.00	$5.64	$0.00	$25.28	$25.28	$0.00	$21.34	$33.80	$34.14	$0.00		$0.00	$7.33	$0.00	$0.00	$6.98	$0.00	$0.00	$0.00	$0.00	$0.00
8121	ERX	HCPCS 25000001	00713-0655-40	TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE	BOTH IP/OP	$279.65 	$206.94	$0.00	$215.55		$0.00	$0.00	$0.00	$0.00	$0.00	$207.56	$207.56	$215.55	$0.00	$58.28	$0.00	$0.00	$0.00	$0.00	$126.93	$201.06	$203.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8121	ERX	HCPCS 25000001	51672-1267-05	TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE	BOTH IP/OP	$279.65 	$206.94	$0.00	$215.55		$0.00	$0.00	$0.00	$0.00	$0.00	$207.56	$207.56	$215.55	$0.00	$58.28	$0.00	$0.00	$0.00	$0.00	$126.93	$201.06	$203.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8121	ERX	HCPCS 25000001	64980-0320-05	TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE	BOTH IP/OP	$279.65 	$206.94	$0.00	$215.55		$0.00	$0.00	$0.00	$0.00	$0.00	$207.56	$207.56	$215.55	$0.00	$58.28	$0.00	$0.00	$0.00	$0.00	$126.93	$201.06	$203.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8132	ERX	HCPCS 63700001	00378-1352-01	TRIAMTERENE-HCTZ 37.5-25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8132	ERX	HCPCS 63700001	00591-0424-01	TRIAMTERENE-HCTZ 37.5-25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8132	ERX	HCPCS 63700001	00591-0424-05	TRIAMTERENE-HCTZ 37.5-25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8132	ERX	HCPCS 63700001	00781-1123-01	TRIAMTERENE-HCTZ 37.5-25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8132	ERX	HCPCS 63700001	60505-2656-01	TRIAMTERENE-HCTZ 37.5-25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8134	ERX	HCPCS 63700001	51079-0433-01	TRIAMTERENE-HCTZ 75-50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8134	ERX	HCPCS 63700001	51079-0433-20	TRIAMTERENE-HCTZ 75-50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8134	ERX	HCPCS 63700001	60505-2657-01	TRIAMTERENE-HCTZ 75-50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8162	ERX	HCPCS 63700001	00378-2410-01	TRIFLUOPERAZINE HCL 10 MG PO TABS	BOTH IP/OP	$10.26 	$7.59	$0.00	$7.44		$0.00	$0.00	$0.00	$1.83	$0.00	$0.00	$0.00	$0.00	$0.00	$2.14	$0.00	$0.00	$0.00	$0.00	$4.65	$7.37	$7.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8163	ERX	HCPCS 63700001	00378-2402-01	TRIFLUOPERAZINE HCL 2 MG PO TABS	BOTH IP/OP	$8.38 	$6.20	$0.00	$6.08		$0.00	$0.00	$0.00	$1.49	$0.00	$0.00	$0.00	$0.00	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$3.80	$6.02	$6.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8163	ERX	HCPCS 63700001	51079-0573-01	TRIFLUOPERAZINE HCL 2 MG PO TABS	BOTH IP/OP	$8.38 	$6.20	$0.00	$6.08		$0.00	$0.00	$0.00	$1.49	$0.00	$0.00	$0.00	$0.00	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$3.80	$6.02	$6.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8163	ERX	HCPCS 63700001	51079-0573-20	TRIFLUOPERAZINE HCL 2 MG PO TABS	BOTH IP/OP	$8.38 	$6.20	$0.00	$6.08		$0.00	$0.00	$0.00	$1.49	$0.00	$0.00	$0.00	$0.00	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$3.80	$6.02	$6.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8164	ERX	HCPCS 63700001	00781-8034-01	TRIFLUOPERAZINE HCL 5 MG PO TABS	BOTH IP/OP	$6.81 	$5.04	$0.00	$4.94		$0.00	$0.00	$0.00	$1.21	$0.00	$0.00	$0.00	$0.00	$0.00	$1.42	$0.00	$0.00	$0.00	$0.00	$3.09	$4.89	$4.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8166	ERX	HCPCS 63700001	00591-5335-01	TRIHEXYPHENIDYL HCL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8167	ERX	HCPCS 63700001	00591-5337-01	TRIHEXYPHENIDYL HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8167	ERX	HCPCS 63700001	16571-0161-10	TRIHEXYPHENIDYL HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8182	ERX	HCPCS 63700001	43386-0330-01	TRIMETHOPRIM 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8249	ERX	HCPCS 25000001	17478-0101-12	TROPICAMIDE 0.5 % OP SOLN	BOTH IP/OP	$96.52 	$71.42	$0.00	$74.40		$0.00	$0.00	$0.00	$0.00	$0.00	$71.64	$71.64	$74.40	$0.00	$20.11	$0.00	$0.00	$0.00	$0.00	$43.76	$69.32	$70.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8249	ERX	HCPCS 25000001	24208-0590-64	TROPICAMIDE 0.5 % OP SOLN	BOTH IP/OP	$96.52 	$71.42	$0.00	$74.40		$0.00	$0.00	$0.00	$0.00	$0.00	$71.64	$71.64	$74.40	$0.00	$20.11	$0.00	$0.00	$0.00	$0.00	$43.76	$69.32	$70.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8249	ERX	HCPCS 25000001	61314-0354-01	TROPICAMIDE 0.5 % OP SOLN	BOTH IP/OP	$96.52 	$71.42	$0.00	$74.40		$0.00	$0.00	$0.00	$0.00	$0.00	$71.64	$71.64	$74.40	$0.00	$20.11	$0.00	$0.00	$0.00	$0.00	$43.76	$69.32	$70.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8250	ERX	HCPCS 25000001	17478-0102-12	TROPICAMIDE 1 % OP SOLN	BOTH IP/OP	$44.63 	$33.03	$0.00	$34.40		$0.00	$0.00	$0.00	$0.00	$0.00	$33.12	$33.12	$34.40	$0.00	$9.30	$0.00	$0.00	$0.00	$0.00	$20.24	$32.05	$32.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8250	ERX	HCPCS 25000001	61314-0355-02	TROPICAMIDE 1 % OP SOLN	BOTH IP/OP	$44.63 	$33.03	$0.00	$34.40		$0.00	$0.00	$0.00	$0.00	$0.00	$33.12	$33.12	$34.40	$0.00	$9.30	$0.00	$0.00	$0.00	$0.00	$20.24	$32.05	$32.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8250	ERX	HCPCS 25000001	24208-0585-59	TROPICAMIDE 1 % OP SOLN	BOTH IP/OP	$44.63 	$33.03	$0.00	$34.40		$0.00	$0.00	$0.00	$0.00	$0.00	$33.12	$33.12	$34.40	$0.00	$9.30	$0.00	$0.00	$0.00	$0.00	$20.24	$32.05	$32.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8250	ERX	HCPCS 25000001	61314-0355-01	TROPICAMIDE 1 % OP SOLN	BOTH IP/OP	$44.63 	$33.03	$0.00	$34.40		$0.00	$0.00	$0.00	$0.00	$0.00	$33.12	$33.12	$34.40	$0.00	$9.30	$0.00	$0.00	$0.00	$0.00	$20.24	$32.05	$32.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8259	ERX	HCPCS 25000001	42023-0104-01	TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8259	ERX	HCPCS 25000001	49281-0752-21	TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8259	ERX	HCPCS 25000001	49281-0752-22	TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8259	ERX	HCPCS 25000001	99999-6005-54	TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8443	ERX	HCPCS J3370	00409-4332-01	VANCOMYCIN HCL 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$3.62	$16.33	$16.33	$16.96	$0.00	$3.34	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
8443	ERX	HCPCS J3370	00409-6534-01	VANCOMYCIN HCL 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$3.62	$16.33	$16.33	$16.96	$0.00	$3.34	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
8443	ERX	HCPCS J3370	47781-0598-07	VANCOMYCIN HCL 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$3.62	$16.33	$16.33	$16.96	$0.00	$3.34	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
8443	ERX	HCPCS J3370	47781-0598-91	VANCOMYCIN HCL 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$3.62	$16.33	$16.33	$16.96	$0.00	$3.34	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
8443	ERX	HCPCS J3370	67457-0339-50	VANCOMYCIN HCL 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$3.62	$16.33	$16.33	$16.96	$0.00	$3.34	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
8443	ERX	HCPCS J3370	70860-0104-10	VANCOMYCIN HCL 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$3.62	$16.33	$16.33	$16.96	$0.00	$3.34	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
8527	ERX	HCPCS 25000001	00409-1144-05	VERAPAMIL HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$80.83 	$59.81	$0.00	$62.30		$0.00	$0.00	$0.00	$0.00	$0.00	$59.99	$59.99	$62.30	$0.00	$16.84	$0.00	$0.00	$0.00	$0.00	$36.66	$58.06	$58.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8527	ERX	HCPCS 25000001	42571-0313-75	VERAPAMIL HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$80.83 	$59.81	$0.00	$62.30		$0.00	$0.00	$0.00	$0.00	$0.00	$59.99	$59.99	$62.30	$0.00	$16.84	$0.00	$0.00	$0.00	$0.00	$36.66	$58.06	$58.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8527	ERX	HCPCS 25000001	42571-0313-87	VERAPAMIL HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$80.83 	$59.81	$0.00	$62.30		$0.00	$0.00	$0.00	$0.00	$0.00	$59.99	$59.99	$62.30	$0.00	$16.84	$0.00	$0.00	$0.00	$0.00	$36.66	$58.06	$58.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8527	ERX	HCPCS 25000001	42571-0313-97	VERAPAMIL HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$80.83 	$59.81	$0.00	$62.30		$0.00	$0.00	$0.00	$0.00	$0.00	$59.99	$59.99	$62.30	$0.00	$16.84	$0.00	$0.00	$0.00	$0.00	$36.66	$58.06	$58.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8527	ERX	HCPCS 25000001	51754-0203-04	VERAPAMIL HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$80.83 	$59.81	$0.00	$62.30		$0.00	$0.00	$0.00	$0.00	$0.00	$59.99	$59.99	$62.30	$0.00	$16.84	$0.00	$0.00	$0.00	$0.00	$36.66	$58.06	$58.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8527	ERX	HCPCS 25000001	70121-1585-05	VERAPAMIL HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$80.83 	$59.81	$0.00	$62.30		$0.00	$0.00	$0.00	$0.00	$0.00	$59.99	$59.99	$62.30	$0.00	$16.84	$0.00	$0.00	$0.00	$0.00	$36.66	$58.06	$58.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8527	ERX	HCPCS 25000001	72485-0108-05	VERAPAMIL HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$80.83 	$59.81	$0.00	$62.30		$0.00	$0.00	$0.00	$0.00	$0.00	$59.99	$59.99	$62.30	$0.00	$16.84	$0.00	$0.00	$0.00	$0.00	$36.66	$58.06	$58.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8527	ERX	HCPCS 25000001	72485-0108-25	VERAPAMIL HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$80.83 	$59.81	$0.00	$62.30		$0.00	$0.00	$0.00	$0.00	$0.00	$59.99	$59.99	$62.30	$0.00	$16.84	$0.00	$0.00	$0.00	$0.00	$36.66	$58.06	$58.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8528	ERX	HCPCS 63700001	00904-2924-61	VERAPAMIL HCL 120 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8530	ERX	HCPCS 63700001	00591-0343-01	VERAPAMIL HCL 80 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8530	ERX	HCPCS 63700001	00904-2920-61	VERAPAMIL HCL 80 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8594	ERX	HCPCS J9360	63323-0278-10	VINBLASTINE SULFATE 1 MG/ML IV SOLN	BOTH IP/OP	$196.37 	$145.31	$0.00	$151.36	$88.37	$88.37	$0.00	$0.00	$0.00	$40.93	$145.75	$145.75	$151.36	$0.00	$39.40	$0.00	$116.15	$116.15	$0.00	$81.40	$128.94	$130.24	$0.00		$0.00	$45.71	$0.00	$0.00	$43.52	$0.00	$0.00	$0.00	$0.00	$0.00
8597	ERX	HCPCS J9370	61703-0309-06	VINCRISTINE SULFATE 1 MG/ML IV SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$25.65	$25.65	$0.00	$0.00	$0.00	$0.00	$42.31	$42.31	$43.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$11.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8597	ERX	HCPCS J9370	61703-0309-16	VINCRISTINE SULFATE 1 MG/ML IV SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$25.65	$25.65	$0.00	$0.00	$0.00	$0.00	$42.31	$42.31	$43.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$11.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8597	ERX	HCPCS J9370	61703-0309-25	VINCRISTINE SULFATE 1 MG/ML IV SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$25.65	$25.65	$0.00	$0.00	$0.00	$0.00	$42.31	$42.31	$43.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$11.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8597	ERX	HCPCS J9370	61703-0309-26	VINCRISTINE SULFATE 1 MG/ML IV SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$25.65	$25.65	$0.00	$0.00	$0.00	$0.00	$42.31	$42.31	$43.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$11.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8639	ERX	HCPCS 63700001	00904-2085-60	VITAMIN A 3 MG (10000 UT) PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8647	ERX	HCPCS 63700001	31604-0012-81	VITAMIN B-1 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8647	ERX	HCPCS 63700001	37864-0905-99	VITAMIN B-1 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8647	ERX	HCPCS 63700001	48433-0108-01	VITAMIN B-1 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8647	ERX	HCPCS 63700001	51645-0905-99	VITAMIN B-1 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8647	ERX	HCPCS 63700001	54629-0057-01	VITAMIN B-1 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8647	ERX	HCPCS 63700001	77333-0934-10	VITAMIN B-1 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8647	ERX	HCPCS 63700001	77333-0934-25	VITAMIN B-1 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8654	ERX	HCPCS 63700001	10006-0730-43	VITAMIN B-12 1000 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8654	ERX	HCPCS 63700001	74312-0013-80	VITAMIN B-12 1000 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8654	ERX	HCPCS 63700001	77333-0938-10	VITAMIN B-12 1000 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8654	ERX	HCPCS 63700001	77333-0938-25	VITAMIN B-12 1000 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8661	ERX	HCPCS 63700001	43292-0555-38	VITAMIN B-2 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8667	ERX	HCPCS 63700001	00904-0520-60	VITAMIN B-6 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8667	ERX	HCPCS 63700001	77333-0940-10	VITAMIN B-6 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8667	ERX	HCPCS 63700001	77333-0940-25	VITAMIN B-6 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8680	ERX	HCPCS 63700001	00904-0523-61	VITAMIN C 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8680	ERX	HCPCS 63700001	00904-0523-72	VITAMIN C 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8680	ERX	HCPCS 63700001	00904-0523-80	VITAMIN C 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8680	ERX	HCPCS 63700001	57896-0841-01	VITAMIN C 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8698	ERX	HCPCS 63700001	00904-0270-60	VITAMIN E 100 UNITS PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8701	ERX	HCPCS 63700001	00904-0274-60	VITAMIN E 400 UNITS PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8701	ERX	HCPCS 63700001	10006-0700-34	VITAMIN E 400 UNITS PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8718	ERX	HCPCS J3430	00409-9158-01	VITAMIN K1 10 MG/ML IJ SOLN	BOTH IP/OP	$49.25 	$36.45	$0.00	$37.96		$0.00	$0.00	$0.00	$0.00	$0.00	$36.55	$36.55	$37.96	$0.00	$8.37	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8718	ERX	HCPCS J3430	00409-9158-31	VITAMIN K1 10 MG/ML IJ SOLN	BOTH IP/OP	$49.25 	$36.45	$0.00	$37.96		$0.00	$0.00	$0.00	$0.00	$0.00	$36.55	$36.55	$37.96	$0.00	$8.37	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8718	ERX	HCPCS J3430	43598-0405-16	VITAMIN K1 10 MG/ML IJ SOLN	BOTH IP/OP	$49.25 	$36.45	$0.00	$37.96		$0.00	$0.00	$0.00	$0.00	$0.00	$36.55	$36.55	$37.96	$0.00	$8.37	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8748	ERX	HCPCS 63700001	00832-1219-01	WARFARIN SODIUM 10 MG PO TABS	BOTH IP/OP	$14.59 	$10.80	$0.00	$11.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.30	$11.56	$11.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8749	ERX	HCPCS 63700001	00832-1212-01	WARFARIN SODIUM 2 MG PO TABS	BOTH IP/OP	$9.81 	$7.26	$0.00	$7.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.91	$7.77	$7.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8749	ERX	HCPCS 63700001	00832-1212-89	WARFARIN SODIUM 2 MG PO TABS	BOTH IP/OP	$9.81 	$7.26	$0.00	$7.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.91	$7.77	$7.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8749	ERX	HCPCS 63700001	51672-4028-01	WARFARIN SODIUM 2 MG PO TABS	BOTH IP/OP	$9.81 	$7.26	$0.00	$7.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.91	$7.77	$7.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8750	ERX	HCPCS 63700001	00832-1213-01	WARFARIN SODIUM 2.5 MG PO TABS	BOTH IP/OP	$10.13 	$7.50	$0.00	$8.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.07	$8.02	$8.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8750	ERX	HCPCS 63700001	57237-0121-01	WARFARIN SODIUM 2.5 MG PO TABS	BOTH IP/OP	$10.13 	$7.50	$0.00	$8.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.07	$8.02	$8.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8750	ERX	HCPCS 63700001	68084-0027-01	WARFARIN SODIUM 2.5 MG PO TABS	BOTH IP/OP	$10.13 	$7.50	$0.00	$8.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.07	$8.02	$8.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8751	ERX	HCPCS 63700001	00832-1216-01	WARFARIN SODIUM 5 MG PO TABS	BOTH IP/OP	$10.55 	$7.81	$0.00	$8.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.28	$8.36	$8.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8751	ERX	HCPCS 63700001	57237-0124-01	WARFARIN SODIUM 5 MG PO TABS	BOTH IP/OP	$10.55 	$7.81	$0.00	$8.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.28	$8.36	$8.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8752	ERX	HCPCS 63700001	00832-1218-01	WARFARIN SODIUM 7.5 MG PO TABS	BOTH IP/OP	$14.06 	$10.40	$0.00	$11.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.03	$11.14	$11.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8752	ERX	HCPCS 63700001	51672-4034-01	WARFARIN SODIUM 7.5 MG PO TABS	BOTH IP/OP	$14.06 	$10.40	$0.00	$11.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.03	$11.14	$11.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8752	ERX	HCPCS 63700001	57237-0126-01	WARFARIN SODIUM 7.5 MG PO TABS	BOTH IP/OP	$14.06 	$10.40	$0.00	$11.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.03	$11.14	$11.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8780	ERX	HCPCS 63700001	00168-0053-21	WHITE PETROLATUM EX OINT	BOTH IP/OP	$92.80 	$68.67	$0.00	$67.32		$0.00	$0.00	$0.00	$16.52	$0.00	$0.00	$0.00	$0.00	$0.00	$19.34	$0.00	$0.00	$0.00	$0.00	$42.08	$66.65	$67.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8780	ERX	HCPCS 63700001	00168-0053-16	WHITE PETROLATUM EX OINT	BOTH IP/OP	$92.80 	$68.67	$0.00	$67.32		$0.00	$0.00	$0.00	$16.52	$0.00	$0.00	$0.00	$0.00	$0.00	$19.34	$0.00	$0.00	$0.00	$0.00	$42.08	$66.65	$67.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8865	ERX	HCPCS 25000001	00409-4090-01	ZINC CHLORIDE 1 MG/ML IV SOLN	BOTH IP/OP	$97.82 	$72.39	$0.00	$75.40		$0.00	$0.00	$0.00	$0.00	$0.00	$72.60	$72.60	$75.40	$0.00	$20.39	$0.00	$0.00	$0.00	$0.00	$40.81	$64.64	$65.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8874	ERX	HCPCS 63700001	00536-5700-98	ZINC OXIDE 20 % EX OINT	BOTH IP/OP	$137.76 	$101.94	$0.00	$109.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.50	$109.11	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8874	ERX	HCPCS 63700001	00168-0062-31	ZINC OXIDE 20 % EX OINT	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8874	ERX	HCPCS 63700001	75834-0170-01	ZINC OXIDE 20 % EX OINT	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8874	ERX	HCPCS 63700001	00536-5700-28	ZINC OXIDE 20 % EX OINT	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8878	ERX	HCPCS 25000001	00517-6110-25	ZINC SULFATE 1 MG/ML IV SOLN	BOTH IP/OP	$111.65 	$82.62	$0.00	$89.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.83	$88.43	$89.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8880	ERX	HCPCS 63700001	37864-0991-01	ZINC SULFATE 220 (50 ZN) MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8880	ERX	HCPCS 63700001	77333-0983-10	ZINC SULFATE 220 (50 ZN) MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8946	ERX	HCPCS 25000001	51672-2114-00	ACETAMINOPHEN 80 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8946	ERX	HCPCS 25000001	51672-2114-02	ACETAMINOPHEN 80 MG RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8958	ERX	HCPCS 63700001	00591-3369-01	BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS	BOTH IP/OP	$7.08 	$5.24	$0.00	$5.14		$0.00	$0.00	$0.00	$1.26	$0.00	$0.00	$0.00	$0.00	$0.00	$1.48	$0.00	$0.00	$0.00	$0.00	$3.21	$5.08	$5.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8958	ERX	HCPCS 63700001	00603-2544-21	BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS	BOTH IP/OP	$7.08 	$5.24	$0.00	$5.14		$0.00	$0.00	$0.00	$1.26	$0.00	$0.00	$0.00	$0.00	$0.00	$1.48	$0.00	$0.00	$0.00	$0.00	$3.21	$5.08	$5.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8958	ERX	HCPCS 63700001	10702-0253-01	BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS	BOTH IP/OP	$7.08 	$5.24	$0.00	$5.14		$0.00	$0.00	$0.00	$1.26	$0.00	$0.00	$0.00	$0.00	$0.00	$1.48	$0.00	$0.00	$0.00	$0.00	$3.21	$5.08	$5.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8958	ERX	HCPCS 63700001	68084-0396-65	BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS	BOTH IP/OP	$7.08 	$5.24	$0.00	$5.14		$0.00	$0.00	$0.00	$1.26	$0.00	$0.00	$0.00	$0.00	$0.00	$1.48	$0.00	$0.00	$0.00	$0.00	$3.21	$5.08	$5.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8962	ERX	HCPCS 63700001	29033-0030-01	ACETAZOLAMIDE ER 500 MG PO CP12	BOTH IP/OP	$18.00 	$13.32	$0.00	$13.06		$0.00	$0.00	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$8.16	$12.93	$13.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8962	ERX	HCPCS 63700001	50742-0233-01	ACETAZOLAMIDE ER 500 MG PO CP12	BOTH IP/OP	$18.00 	$13.32	$0.00	$13.06		$0.00	$0.00	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$8.16	$12.93	$13.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8963	ERX	HCPCS 25000001	00338-0656-04	ACETIC ACID 0.25 % IR SOLN	BOTH IP/OP	$33.52 	$24.80	$0.00	$25.84		$0.00	$0.00	$0.00	$0.00	$0.00	$24.88	$24.88	$25.84	$0.00	$6.99	$0.00	$0.00	$0.00	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8968	ERX	HCPCS 63700001	00378-8700-06	ACYCLOVIR 5 % EX OINT	BOTH IP/OP	"$1,164.52 "	$861.74	$0.00	$845.47		$0.00	$0.00	$0.00	$207.28	$0.00	$0.00	$0.00	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$528.42	$837.02	$845.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8968	ERX	HCPCS 63700001	13668-0515-01	ACYCLOVIR 5 % EX OINT	BOTH IP/OP	"$1,164.52 "	$861.74	$0.00	$845.47		$0.00	$0.00	$0.00	$207.28	$0.00	$0.00	$0.00	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$528.42	$837.02	$845.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8968	ERX	HCPCS 63700001	00187-0993-95	ACYCLOVIR 5 % EX OINT	BOTH IP/OP	"$1,164.52 "	$861.74	$0.00	"$1,516.10"		$0.00	$0.00	$0.00	$207.28	$0.00	$0.00	$0.00	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$528.42	"$1,516.10"	$845.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8969	ERX	HCPCS 63700001	00904-5789-61	ACYCLOVIR 200 MG PO CAPS	BOTH IP/OP	$6.41 	$4.74	$0.00	$4.80		$0.00	$0.00	$0.00	$1.14	$0.00	$0.00	$0.00	$0.00	$0.00	$1.34	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8969	ERX	HCPCS 63700001	68084-0107-01	ACYCLOVIR 200 MG PO CAPS	BOTH IP/OP	$6.41 	$4.74	$0.00	$4.80		$0.00	$0.00	$0.00	$1.14	$0.00	$0.00	$0.00	$0.00	$0.00	$1.34	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8970	ERX	HCPCS 63700001	99999-6004-74	ACYCLOVIR 200 MG/5ML PO SUSP	BOTH IP/OP	$181.76 	$134.50	$0.00	$132.00		$0.00	$0.00	$0.00	$32.35	$0.00	$0.00	$0.00	$0.00	$0.00	$37.88	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8970	ERX	HCPCS 63700001	00378-8712-73	ACYCLOVIR 200 MG/5ML PO SUSP	BOTH IP/OP	$181.76 	$134.50	$0.00	$934.16		$0.00	$0.00	$0.00	$32.35	$0.00	$0.00	$0.00	$0.00	$0.00	$37.88	$0.00	$0.00	$0.00	$0.00	$82.50	$934.16	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8970	ERX	HCPCS 63700001	00472-0082-16	ACYCLOVIR 200 MG/5ML PO SUSP	BOTH IP/OP	$181.76 	$134.50	$0.00	$934.16		$0.00	$0.00	$0.00	$32.35	$0.00	$0.00	$0.00	$0.00	$0.00	$37.88	$0.00	$0.00	$0.00	$0.00	$82.50	$934.16	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8970	ERX	HCPCS 63700001	50383-0810-16	ACYCLOVIR 200 MG/5ML PO SUSP	BOTH IP/OP	$181.76 	$134.50	$0.00	$934.16		$0.00	$0.00	$0.00	$32.35	$0.00	$0.00	$0.00	$0.00	$0.00	$37.88	$0.00	$0.00	$0.00	$0.00	$82.50	$934.16	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8971	ERX	HCPCS 63700001	00904-5790-61	ACYCLOVIR 400 MG PO TABS	BOTH IP/OP	$7.17 	$5.31	$0.00	$5.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.59	$5.68	$5.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8971	ERX	HCPCS 63700001	31722-0777-01	ACYCLOVIR 400 MG PO TABS	BOTH IP/OP	$7.17 	$5.31	$0.00	$5.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.59	$5.68	$5.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8971	ERX	HCPCS 63700001	31722-0777-05	ACYCLOVIR 400 MG PO TABS	BOTH IP/OP	$7.17 	$5.31	$0.00	$5.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.59	$5.68	$5.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8971	ERX	HCPCS 63700001	50268-0061-15	ACYCLOVIR 400 MG PO TABS	BOTH IP/OP	$7.17 	$5.31	$0.00	$5.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.59	$5.68	$5.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8971	ERX	HCPCS 63700001	60505-5306-01	ACYCLOVIR 400 MG PO TABS	BOTH IP/OP	$7.17 	$5.31	$0.00	$5.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.59	$5.68	$5.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8971	ERX	HCPCS 63700001	60505-5306-08	ACYCLOVIR 400 MG PO TABS	BOTH IP/OP	$7.17 	$5.31	$0.00	$5.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.59	$5.68	$5.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8971	ERX	HCPCS 63700001	61442-0112-05	ACYCLOVIR 400 MG PO TABS	BOTH IP/OP	$7.17 	$5.31	$0.00	$5.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.59	$5.68	$5.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8971	ERX	HCPCS 63700001	63304-0504-01	ACYCLOVIR 400 MG PO TABS	BOTH IP/OP	$7.17 	$5.31	$0.00	$5.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.59	$5.68	$5.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8971	ERX	HCPCS 63700001	63739-0682-10	ACYCLOVIR 400 MG PO TABS	BOTH IP/OP	$7.17 	$5.31	$0.00	$5.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.59	$5.68	$5.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8971	ERX	HCPCS 63700001	68084-0108-01	ACYCLOVIR 400 MG PO TABS	BOTH IP/OP	$7.17 	$5.31	$0.00	$5.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.59	$5.68	$5.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8972	ERX	HCPCS 63700001	31722-0778-01	ACYCLOVIR 800 MG PO TABS	BOTH IP/OP	$13.31 	$9.85	$0.00	$10.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.66	$10.54	$10.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8972	ERX	HCPCS 63700001	60505-5307-01	ACYCLOVIR 800 MG PO TABS	BOTH IP/OP	$13.31 	$9.85	$0.00	$10.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.66	$10.54	$10.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8972	ERX	HCPCS 63700001	68084-0109-01	ACYCLOVIR 800 MG PO TABS	BOTH IP/OP	$13.31 	$9.85	$0.00	$10.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.66	$10.54	$10.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8979	ERX	HCPCS 63700001	00591-2712-02	ALBENDAZOLE 200 MG PO TABS	BOTH IP/OP	$373.28 	$276.23	$0.00	$298.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.64	$295.64	$298.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8979	ERX	HCPCS 63700001	52054-0550-22	ALBENDAZOLE 200 MG PO TABS	BOTH IP/OP	$373.28 	$276.23	$0.00	$298.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.64	$295.64	$298.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8979	ERX	HCPCS 63700001	69097-0237-72	ALBENDAZOLE 200 MG PO TABS	BOTH IP/OP	$373.28 	$276.23	$0.00	$298.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.64	$295.64	$298.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8979	ERX	HCPCS 63700001	70710-1021-08	ALBENDAZOLE 200 MG PO TABS	BOTH IP/OP	$373.28 	$276.23	$0.00	$298.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.64	$295.64	$298.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8981	ERX	HCPCS P9047	00944-0493-01	ALBUMIN HUMAN 25 % IV SOLN	BOTH IP/OP	$199.88 	$147.91	$0.00	$154.07	$89.95	$89.95	$52.45	$52.45	$52.45	$60.16	$148.35	$148.35	$154.07	$52.45	$61.63	$34.09	$118.23	$118.23	$55.07	$90.72	$143.70	$145.15	$76.05		$76.05	$61.63	$0.00	$0.00	$58.68	$52.45	$0.00	$0.00	$0.00	$0.00
8981	ERX	HCPCS P9047	76125-0792-25	ALBUMIN HUMAN 25 % IV SOLN	BOTH IP/OP	$199.88 	$147.91	$0.00	$154.07	$89.95	$89.95	$52.45	$52.45	$52.45	$60.16	$148.35	$148.35	$154.07	$52.45	$61.63	$34.09	$118.23	$118.23	$55.07	$90.72	$143.70	$145.15	$76.05		$76.05	$61.63	$0.00	$0.00	$58.68	$52.45	$0.00	$0.00	$0.00	$0.00
8982	ERX	HCPCS P9045	00944-0495-05	ALBUMIN HUMAN 5 % IV SOLN	BOTH IP/OP	$199.53 	$147.65	$0.00	$153.80	$89.79	$89.79	$52.45	$52.45	$52.45	$27.86	$148.09	$148.09	$153.80	$52.45	$41.58	$34.09	$118.02	$118.02	$55.07	$90.57	$143.45	$144.90	$76.05		$76.05	$28.35	$0.00	$0.00	$28.84	$52.45	$0.00	$0.00	$0.00	$0.00
8982	ERX	HCPCS P9045	44206-0310-25	ALBUMIN HUMAN 5 % IV SOLN	BOTH IP/OP	$199.53 	$147.65	$0.00	$153.80	$89.79	$89.79	$52.45	$52.45	$52.45	$27.86	$148.09	$148.09	$153.80	$52.45	$41.58	$34.09	$118.02	$118.02	$55.07	$90.57	$143.45	$144.90	$76.05		$76.05	$28.35	$0.00	$0.00	$28.84	$52.45	$0.00	$0.00	$0.00	$0.00
8982	ERX	HCPCS P9045	44206-0310-50	ALBUMIN HUMAN 5 % IV SOLN	BOTH IP/OP	$199.53 	$147.65	$0.00	$153.80	$89.79	$89.79	$52.45	$52.45	$52.45	$27.86	$148.09	$148.09	$153.80	$52.45	$41.58	$34.09	$118.02	$118.02	$55.07	$90.57	$143.45	$144.90	$76.05		$76.05	$28.35	$0.00	$0.00	$28.84	$52.45	$0.00	$0.00	$0.00	$0.00
8982	ERX	HCPCS P9045	68516-5214-02	ALBUMIN HUMAN 5 % IV SOLN	BOTH IP/OP	$199.53 	$147.65	$0.00	$153.80	$89.79	$89.79	$52.45	$52.45	$52.45	$27.86	$148.09	$148.09	$153.80	$52.45	$41.58	$34.09	$118.02	$118.02	$55.07	$90.57	$143.45	$144.90	$76.05		$76.05	$28.35	$0.00	$0.00	$28.84	$52.45	$0.00	$0.00	$0.00	$0.00
8982	ERX	HCPCS P9045	76125-0790-26	ALBUMIN HUMAN 5 % IV SOLN	BOTH IP/OP	$199.53 	$147.65	$0.00	$153.80	$89.79	$89.79	$52.45	$52.45	$52.45	$27.86	$148.09	$148.09	$153.80	$52.45	$41.58	$34.09	$118.02	$118.02	$55.07	$90.57	$143.45	$144.90	$76.05		$76.05	$28.35	$0.00	$0.00	$28.84	$52.45	$0.00	$0.00	$0.00	$0.00
8982	ERX	HCPCS P9045	99999-6006-39	ALBUMIN HUMAN 5 % IV SOLN	BOTH IP/OP	$199.53 	$147.65	$0.00	$153.80	$89.79	$89.79	$52.45	$52.45	$52.45	$27.86	$148.09	$148.09	$153.80	$52.45	$41.58	$34.09	$118.02	$118.02	$55.07	$90.57	$143.45	$144.90	$76.05		$76.05	$28.35	$0.00	$0.00	$28.84	$52.45	$0.00	$0.00	$0.00	$0.00
8985	ERX	HCPCS 25000001	00168-0263-15	ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA	BOTH IP/OP	$185.57 	$137.32	$0.00	$143.04		$0.00	$0.00	$0.00	$0.00	$0.00	$137.73	$137.73	$143.04	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$84.14	$133.27	$134.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8985	ERX	HCPCS 25000001	51672-1306-01	ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA	BOTH IP/OP	$185.57 	$137.32	$0.00	$143.04		$0.00	$0.00	$0.00	$0.00	$0.00	$137.73	$137.73	$143.04	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$84.14	$133.27	$134.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8985	ERX	HCPCS 25000001	68462-0300-17	ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA	BOTH IP/OP	$185.57 	$137.32	$0.00	$143.04		$0.00	$0.00	$0.00	$0.00	$0.00	$137.73	$137.73	$143.04	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$84.14	$133.27	$134.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8985	ERX	HCPCS 25000001	51672-1306-06	ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA	BOTH IP/OP	$185.57 	$137.32	$0.00	$348.39		$0.00	$0.00	$0.00	$0.00	$0.00	$137.73	$137.73	$143.04	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$84.14	$348.39	$134.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8985	ERX	HCPCS 25000001	51672-1306-03	ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA	BOTH IP/OP	$185.57 	$137.32	$0.00	$464.52		$0.00	$0.00	$0.00	$0.00	$0.00	$137.73	$137.73	$143.04	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$84.14	$464.52	$134.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8985	ERX	HCPCS 25000001	68462-0300-65	ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA	BOTH IP/OP	$185.57 	$137.32	$0.00	$464.52		$0.00	$0.00	$0.00	$0.00	$0.00	$137.73	$137.73	$143.04	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$84.14	$464.52	$134.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8986	ERX	HCPCS 25000001	00168-0264-15	ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT	BOTH IP/OP	$83.78 	$62.00	$0.00	$64.58		$0.00	$0.00	$0.00	$0.00	$0.00	$62.18	$62.18	$64.58	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$38.00	$60.18	$60.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8986	ERX	HCPCS 25000001	51672-1316-01	ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT	BOTH IP/OP	$83.78 	$62.00	$0.00	$64.58		$0.00	$0.00	$0.00	$0.00	$0.00	$62.18	$62.18	$64.58	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$38.00	$60.18	$60.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8986	ERX	HCPCS 25000001	68462-0299-17	ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT	BOTH IP/OP	$83.78 	$62.00	$0.00	$64.58		$0.00	$0.00	$0.00	$0.00	$0.00	$62.18	$62.18	$64.58	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$38.00	$60.18	$60.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8986	ERX	HCPCS 25000001	00168-0264-45	ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT	BOTH IP/OP	$83.78 	$62.00	$0.00	$149.66		$0.00	$0.00	$0.00	$0.00	$0.00	$62.18	$62.18	$64.58	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$38.00	$149.66	$60.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8986	ERX	HCPCS 25000001	00168-0264-60	ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT	BOTH IP/OP	$83.78 	$62.00	$0.00	$199.54		$0.00	$0.00	$0.00	$0.00	$0.00	$62.18	$62.18	$64.58	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$38.00	$199.54	$60.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9001	ERX	HCPCS J0270	00009-3169-06	ALPROSTADIL 500 MCG/ML IJ SOLN	BOTH IP/OP	$436.84 	$323.26	$0.00	$336.72		$0.00	$0.00	$0.00	$0.00	$0.00	$324.22	$324.22	$336.72	$0.00	$91.04	$0.00	$0.00	$0.00	$0.00	$198.27	$314.06	$317.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9001	ERX	HCPCS J0270	00703-1501-01	ALPROSTADIL 500 MCG/ML IJ SOLN	BOTH IP/OP	$436.84 	$323.26	$0.00	$336.72		$0.00	$0.00	$0.00	$0.00	$0.00	$324.22	$324.22	$336.72	$0.00	$91.04	$0.00	$0.00	$0.00	$0.00	$198.27	$314.06	$317.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9002	ERX	HCPCS J2997	50242-0085-27	ALTEPLASE 100 MG IV SOLR	BOTH IP/OP	"$2,386.66 "	"$1,766.13"	$0.00	"$1,839.64"	"$1,074.00"	"$1,074.00"	$876.70	$876.70	$876.70	$497.44	"$1,771.38"	"$1,771.38"	"$1,839.64"	$877.50	$497.38	$570.38	"$1,176.62"	"$1,176.62"	$920.20	"$1,082.45"	"$1,714.59"	"$1,731.91"	"$1,270.75"		"$1,270.75"	$338.81	$0.00	$0.00	$344.65	$878.85	$0.00	$0.00	$0.00	$0.00
9003	ERX	HCPCS J2997	50242-0044-13	ALTEPLASE 50 MG IV SOLR	BOTH IP/OP	"$11,933.30 "	"$8,830.64"	$0.00	"$9,198.19"	"$5,369.99"	"$5,369.99"	"$4,383.50"	"$4,383.50"	"$4,383.50"	"$2,487.20"	"$8,856.90"	"$8,856.90"	"$9,198.19"	"$4,387.50"	"$2,486.90"	"$2,851.88"	"$5,883.12"	"$5,883.12"	"$4,601.00"	"$5,412.23"	"$8,572.97"	"$8,659.57"	"$6,353.76"		"$6,353.76"	"$1,694.03"	$0.00	$0.00	"$1,723.25"	"$4,394.25"	$0.00	$0.00	$0.00	$0.00
9009	ERX	HCPCS 25000001	00121-1761-30	ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP	BOTH IP/OP	$7.92 	$5.86	$0.00	$6.10		$0.00	$0.00	$0.00	$0.00	$0.00	$5.88	$5.88	$6.10	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.69	$5.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9009	ERX	HCPCS 25000001	00904-6833-14	ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP	BOTH IP/OP	$7.92 	$5.86	$0.00	$6.10		$0.00	$0.00	$0.00	$0.00	$0.00	$5.88	$5.88	$6.10	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.69	$5.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9009	ERX	HCPCS 25000001	49348-0019-39	ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP	BOTH IP/OP	$7.92 	$5.86	$0.00	$6.10		$0.00	$0.00	$0.00	$0.00	$0.00	$5.88	$5.88	$6.10	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.69	$5.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9009	ERX	HCPCS 25000001	57896-0629-12	ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP	BOTH IP/OP	$7.92 	$5.86	$0.00	$6.10		$0.00	$0.00	$0.00	$0.00	$0.00	$5.88	$5.88	$6.10	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.69	$5.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9020	ERX	HCPCS 25000001	51224-0162-12	ALUM SULFATE-CA ACETATE EX PACK	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9028	ERX	HCPCS 25000001	00096-0707-37	ALUMINUM CHLORIDE 20 % EX SOLN	BOTH IP/OP	$35.04 	$25.93	$0.00	$27.01		$0.00	$0.00	$0.00	$0.00	$0.00	$26.01	$26.01	$27.01	$0.00	$7.30	$0.00	$0.00	$0.00	$0.00	$14.82	$23.47	$23.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9028	ERX	HCPCS 25000001	00096-0707-60	ALUMINUM CHLORIDE 20 % EX SOLN	BOTH IP/OP	$35.04 	$25.93	$0.00	$35.04		$0.00	$0.00	$0.00	$0.00	$0.00	$26.01	$26.01	$27.01	$0.00	$7.30	$0.00	$0.00	$0.00	$0.00	$14.82	$35.04	$23.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9063	ERX	HCPCS 63700001	49411-0050-30	AMINOCAPROIC ACID 500 MG PO TABS	BOTH IP/OP	$94.31 	$69.79	$0.00	$68.41		$0.00	$0.00	$0.00	$16.79	$0.00	$0.00	$0.00	$0.00	$0.00	$19.65	$0.00	$0.00	$0.00	$0.00	$42.76	$67.72	$68.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9063	ERX	HCPCS 63700001	69680-0115-30	AMINOCAPROIC ACID 500 MG PO TABS	BOTH IP/OP	$94.31 	$69.79	$0.00	$68.41		$0.00	$0.00	$0.00	$16.79	$0.00	$0.00	$0.00	$0.00	$0.00	$19.65	$0.00	$0.00	$0.00	$0.00	$42.76	$67.72	$68.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9066	ERX	HCPCS 63700001	00245-0147-01	AMIODARONE HCL 200 MG PO TABS	BOTH IP/OP	$12.85 	$9.51	$0.00	$10.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.43	$10.18	$10.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9066	ERX	HCPCS 63700001	00245-0147-89	AMIODARONE HCL 200 MG PO TABS	BOTH IP/OP	$12.85 	$9.51	$0.00	$10.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.43	$10.18	$10.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9066	ERX	HCPCS 63700001	16714-0844-01	AMIODARONE HCL 200 MG PO TABS	BOTH IP/OP	$12.85 	$9.51	$0.00	$10.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.43	$10.18	$10.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9066	ERX	HCPCS 63700001	51672-4025-04	AMIODARONE HCL 200 MG PO TABS	BOTH IP/OP	$12.85 	$9.51	$0.00	$10.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.43	$10.18	$10.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9066	ERX	HCPCS 63700001	63739-0387-10	AMIODARONE HCL 200 MG PO TABS	BOTH IP/OP	$12.85 	$9.51	$0.00	$10.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.43	$10.18	$10.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9066	ERX	HCPCS 63700001	68382-0227-14	AMIODARONE HCL 200 MG PO TABS	BOTH IP/OP	$12.85 	$9.51	$0.00	$10.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.43	$10.18	$10.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9069	ERX	HCPCS 63700001	00904-6371-61	AMLODIPINE BESYLATE 10 MG PO TABS	BOTH IP/OP	$9.02 	$6.67	$0.00	$7.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.51	$7.14	$7.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9069	ERX	HCPCS 63700001	10135-0526-05	AMLODIPINE BESYLATE 10 MG PO TABS	BOTH IP/OP	$9.02 	$6.67	$0.00	$7.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.51	$7.14	$7.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9069	ERX	HCPCS 63700001	63739-0631-10	AMLODIPINE BESYLATE 10 MG PO TABS	BOTH IP/OP	$9.02 	$6.67	$0.00	$7.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.51	$7.14	$7.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9069	ERX	HCPCS 63700001	67877-0199-05	AMLODIPINE BESYLATE 10 MG PO TABS	BOTH IP/OP	$9.02 	$6.67	$0.00	$7.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.51	$7.14	$7.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9069	ERX	HCPCS 63700001	68382-0123-16	AMLODIPINE BESYLATE 10 MG PO TABS	BOTH IP/OP	$9.02 	$6.67	$0.00	$7.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.51	$7.14	$7.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9069	ERX	HCPCS 63700001	69097-0128-05	AMLODIPINE BESYLATE 10 MG PO TABS	BOTH IP/OP	$9.02 	$6.67	$0.00	$7.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.51	$7.14	$7.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9070	ERX	HCPCS 63700001	00904-6369-61	AMLODIPINE BESYLATE 2.5 MG PO TABS	BOTH IP/OP	$6.58 	$4.87	$0.00	$5.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$5.21	$5.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9070	ERX	HCPCS 63700001	68382-0121-16	AMLODIPINE BESYLATE 2.5 MG PO TABS	BOTH IP/OP	$6.58 	$4.87	$0.00	$5.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$5.21	$5.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9071	ERX	HCPCS 63700001	00904-6370-61	AMLODIPINE BESYLATE 5 MG PO TABS	BOTH IP/OP	$6.58 	$4.87	$0.00	$5.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$5.21	$5.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9071	ERX	HCPCS 63700001	50268-0084-11	AMLODIPINE BESYLATE 5 MG PO TABS	BOTH IP/OP	$6.58 	$4.87	$0.00	$5.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$5.21	$5.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9071	ERX	HCPCS 63700001	50268-0084-15	AMLODIPINE BESYLATE 5 MG PO TABS	BOTH IP/OP	$6.58 	$4.87	$0.00	$5.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.29	$5.21	$5.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9081	ERX	HCPCS 63700001	00555-0972-02	AMPHETAMINE-DEXTROAMPHETAMINE 10 MG PO TABS	BOTH IP/OP	$7.19 	$5.32	$0.00	$5.22		$0.00	$0.00	$0.00	$1.28	$0.00	$0.00	$0.00	$0.00	$0.00	$1.50	$0.00	$0.00	$0.00	$0.00	$3.26	$5.16	$5.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9083	ERX	HCPCS J0295	00049-0013-83	AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9083	ERX	HCPCS J0295	00641-6116-10	AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9083	ERX	HCPCS J0295	25021-0142-20	AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9083	ERX	HCPCS J0295	44567-0210-10	AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9083	ERX	HCPCS J0295	55150-0116-20	AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9083	ERX	HCPCS J0295	66794-0206-41	AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9083	ERX	HCPCS J0295	67457-0348-10	AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9084	ERX	HCPCS J0295	00049-0014-83	AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR	BOTH IP/OP	$80.20 	$59.35	$0.00	$61.82	$36.09	$36.09	$0.00	$0.00	$0.00	$8.48	$59.52	$59.52	$61.82	$0.00	$5.19	$0.00	$47.44	$47.44	$0.00	$36.37	$57.61	$58.19	$0.00		$0.00	$6.06	$0.00	$0.00	$5.77	$0.00	$0.00	$0.00	$0.00	$0.00
9084	ERX	HCPCS J0295	00641-6117-10	AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR	BOTH IP/OP	$80.20 	$59.35	$0.00	$61.82	$36.09	$36.09	$0.00	$0.00	$0.00	$8.48	$59.52	$59.52	$61.82	$0.00	$5.19	$0.00	$47.44	$47.44	$0.00	$36.37	$57.61	$58.19	$0.00		$0.00	$6.06	$0.00	$0.00	$5.77	$0.00	$0.00	$0.00	$0.00	$0.00
9084	ERX	HCPCS J0295	44567-0211-10	AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR	BOTH IP/OP	$80.20 	$59.35	$0.00	$61.82	$36.09	$36.09	$0.00	$0.00	$0.00	$8.48	$59.52	$59.52	$61.82	$0.00	$5.19	$0.00	$47.44	$47.44	$0.00	$36.37	$57.61	$58.19	$0.00		$0.00	$6.06	$0.00	$0.00	$5.77	$0.00	$0.00	$0.00	$0.00	$0.00
9084	ERX	HCPCS J0295	55150-0117-20	AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR	BOTH IP/OP	$80.20 	$59.35	$0.00	$61.82	$36.09	$36.09	$0.00	$0.00	$0.00	$8.48	$59.52	$59.52	$61.82	$0.00	$5.19	$0.00	$47.44	$47.44	$0.00	$36.37	$57.61	$58.19	$0.00		$0.00	$6.06	$0.00	$0.00	$5.77	$0.00	$0.00	$0.00	$0.00	$0.00
9084	ERX	HCPCS J0295	67457-0349-10	AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR	BOTH IP/OP	$80.20 	$59.35	$0.00	$61.82	$36.09	$36.09	$0.00	$0.00	$0.00	$8.48	$59.52	$59.52	$61.82	$0.00	$5.19	$0.00	$47.44	$47.44	$0.00	$36.37	$57.61	$58.19	$0.00		$0.00	$6.06	$0.00	$0.00	$5.77	$0.00	$0.00	$0.00	$0.00	$0.00
9096	ERX	HCPCS 63700001	11086-0037-01	ANTHRALIN 1 % EX CREA	BOTH IP/OP	"$1,226.40 "	$907.54	$0.00	$890.40		$0.00	$0.00	$0.00	$218.30	$0.00	$0.00	$0.00	$0.00	$0.00	$255.58	$0.00	$0.00	$0.00	$0.00	$556.50	$881.50	$890.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9119	ERX	HCPCS 25000001	61314-0665-05	APRACLONIDINE HCL 0.5 % OP SOLN	BOTH IP/OP	$530.56 	$392.61	$0.00	$424.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$265.28	$420.20	$424.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9120	ERX	HCPCS 25000001	00065-0660-10	APRACLONIDINE HCL 1 % OP SOLN	BOTH IP/OP	"$2,068.25 "	"$1,530.51"	$0.00	"$1,594.21"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,535.06"	"$1,535.06"	"$1,594.21"	$0.00	$431.02	$0.00	$0.00	$0.00	$0.00	$958.27	"$1,517.89"	"$1,533.22"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9123	ERX	HCPCS 25000001	00009-0436-01	ARGININE HCL (DIAGNOSTIC) 10 % IV SOLN	BOTH IP/OP	$157.30 	$116.40	$0.00	$121.25		$0.00	$0.00	$0.00	$0.00	$0.00	$116.75	$116.75	$121.25	$0.00	$32.78	$0.00	$0.00	$0.00	$0.00	$66.94	$106.03	$107.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9183	ERX	HCPCS J7500	60219-1076-01	AZATHIOPRINE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$2.70	$2.70	$0.00	$0.00	$0.00	$1.25	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
9183	ERX	HCPCS J7500	68084-0229-01	AZATHIOPRINE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$2.70	$2.70	$0.00	$0.00	$0.00	$1.25	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
9183	ERX	HCPCS J7500	68462-0502-01	AZATHIOPRINE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$2.70	$2.70	$0.00	$0.00	$0.00	$1.25	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$3.55	$3.55	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.94	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$0.00
9185	ERX	HCPCS 25000001	63323-0401-20	AZTREONAM 1 G IJ SOLR	BOTH IP/OP	$83.57 	$61.84	$0.00	$64.42		$0.00	$0.00	$0.00	$0.00	$0.00	$62.03	$62.03	$64.42	$0.00	$17.42	$0.00	$0.00	$0.00	$0.00	$37.57	$59.50	$60.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9185	ERX	HCPCS 25000001	63323-0401-26	AZTREONAM 1 G IJ SOLR	BOTH IP/OP	$83.57 	$61.84	$0.00	$64.42		$0.00	$0.00	$0.00	$0.00	$0.00	$62.03	$62.03	$64.42	$0.00	$17.42	$0.00	$0.00	$0.00	$0.00	$37.57	$59.50	$60.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9186	ERX	HCPCS 25000001	00003-2570-16	AZTREONAM 2 G IJ SOLR	BOTH IP/OP	$84.90 	$62.83	$0.00	$65.44		$0.00	$0.00	$0.00	$0.00	$0.00	$63.01	$63.01	$65.44	$0.00	$17.69	$0.00	$0.00	$0.00	$0.00	$35.15	$55.68	$56.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9186	ERX	HCPCS 25000001	63323-0402-20	AZTREONAM 2 G IJ SOLR	BOTH IP/OP	$84.90 	$62.83	$0.00	$65.44		$0.00	$0.00	$0.00	$0.00	$0.00	$63.01	$63.01	$65.44	$0.00	$17.69	$0.00	$0.00	$0.00	$0.00	$35.15	$55.68	$56.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9186	ERX	HCPCS 25000001	63323-0402-30	AZTREONAM 2 G IJ SOLR	BOTH IP/OP	$84.90 	$62.83	$0.00	$65.44		$0.00	$0.00	$0.00	$0.00	$0.00	$63.01	$63.01	$65.44	$0.00	$17.69	$0.00	$0.00	$0.00	$0.00	$35.15	$55.68	$56.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9219	ERX	HCPCS 25000001	00574-7045-12	BELLADONNA ALKALOIDS-OPIUM 16.2-30 MG RECTAL SUPP	BOTH IP/OP	$106.22 	$78.60	$0.00	$81.87		$0.00	$0.00	$0.00	$0.00	$0.00	$78.84	$78.84	$81.87	$0.00	$22.14	$0.00	$0.00	$0.00	$0.00	$48.16	$76.29	$77.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9254	ERX	HCPCS 25000001	00781-7054-49	BENZOYL PEROXIDE-ERYTHROMYCIN 5-3 % EX GEL	BOTH IP/OP	$605.59 	$448.14	$0.00	$466.79		$0.00	$0.00	$0.00	$0.00	$0.00	$449.47	$449.47	$466.79	$0.00	$126.20	$0.00	$0.00	$0.00	$0.00	$274.80	$435.28	$439.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9259	ERX	HCPCS J0515	00143-9729-01	BENZTROPINE MESYLATE 1 MG/ML IJ SOLN	BOTH IP/OP	$69.14 	$51.16	$0.00	$53.29	$31.11	$31.11	$0.00	$0.00	$0.00	$32.05	$51.32	$51.32	$53.29	$0.00	$22.92	$0.00	$40.90	$40.90	$0.00	$31.35	$49.66	$50.16	$0.00		$0.00	$0.00	$0.00	$0.00	$19.84	$0.00	$0.00	$0.00	$0.00	$0.00
9259	ERX	HCPCS J0515	00143-9729-05	BENZTROPINE MESYLATE 1 MG/ML IJ SOLN	BOTH IP/OP	$69.14 	$51.16	$0.00	$53.29	$31.11	$31.11	$0.00	$0.00	$0.00	$32.05	$51.32	$51.32	$53.29	$0.00	$22.92	$0.00	$40.90	$40.90	$0.00	$31.35	$49.66	$50.16	$0.00		$0.00	$0.00	$0.00	$0.00	$19.84	$0.00	$0.00	$0.00	$0.00	$0.00
9259	ERX	HCPCS J0515	63323-0970-02	BENZTROPINE MESYLATE 1 MG/ML IJ SOLN	BOTH IP/OP	$69.14 	$51.16	$0.00	$53.29	$31.11	$31.11	$0.00	$0.00	$0.00	$32.05	$51.32	$51.32	$53.29	$0.00	$22.92	$0.00	$40.90	$40.90	$0.00	$31.35	$49.66	$50.16	$0.00		$0.00	$0.00	$0.00	$0.00	$19.84	$0.00	$0.00	$0.00	$0.00	$0.00
9259	ERX	HCPCS J0515	68382-0860-02	BENZTROPINE MESYLATE 1 MG/ML IJ SOLN	BOTH IP/OP	$69.14 	$51.16	$0.00	$53.29	$31.11	$31.11	$0.00	$0.00	$0.00	$32.05	$51.32	$51.32	$53.29	$0.00	$22.92	$0.00	$40.90	$40.90	$0.00	$31.35	$49.66	$50.16	$0.00		$0.00	$0.00	$0.00	$0.00	$19.84	$0.00	$0.00	$0.00	$0.00	$0.00
9259	ERX	HCPCS J0515	68382-0860-10	BENZTROPINE MESYLATE 1 MG/ML IJ SOLN	BOTH IP/OP	$69.14 	$51.16	$0.00	$53.29	$31.11	$31.11	$0.00	$0.00	$0.00	$32.05	$51.32	$51.32	$53.29	$0.00	$22.92	$0.00	$40.90	$40.90	$0.00	$31.35	$49.66	$50.16	$0.00		$0.00	$0.00	$0.00	$0.00	$19.84	$0.00	$0.00	$0.00	$0.00	$0.00
9260	ERX	HCPCS 25000001	49471-0001-05	BENZYLPENICILLOYL POLYLYSINE 0.25 ML ID SOLN	BOTH IP/OP	$599.16 	$443.38	$0.00	$461.83		$0.00	$0.00	$0.00	$0.00	$0.00	$444.70	$444.70	$461.83	$0.00	$124.86	$0.00	$0.00	$0.00	$0.00	$252.54	$400.02	$404.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9266	ERX	HCPCS J0702	00085-4320-01	BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP	BOTH IP/OP	$52.71 	$39.01	$0.00	$40.63	$23.72	$23.72	$0.00	$0.00	$0.00	$7.14	$39.12	$39.12	$40.63	$0.00	$9.45	$0.00	$31.18	$31.18	$0.00	$23.49	$37.20	$37.58	$0.00		$0.00	$8.31	$0.00	$0.00	$7.91	$0.00	$0.00	$0.00	$0.00	$0.00
9266	ERX	HCPCS J0702	00517-0720-01	BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP	BOTH IP/OP	$52.71 	$39.01	$0.00	$40.63	$23.72	$23.72	$0.00	$0.00	$0.00	$7.14	$39.12	$39.12	$40.63	$0.00	$9.45	$0.00	$31.18	$31.18	$0.00	$23.49	$37.20	$37.58	$0.00		$0.00	$8.31	$0.00	$0.00	$7.91	$0.00	$0.00	$0.00	$0.00	$0.00
9266	ERX	HCPCS J0702	51754-5060-01	BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP	BOTH IP/OP	$52.71 	$39.01	$0.00	$40.63	$23.72	$23.72	$0.00	$0.00	$0.00	$7.14	$39.12	$39.12	$40.63	$0.00	$9.45	$0.00	$31.18	$31.18	$0.00	$23.49	$37.20	$37.58	$0.00		$0.00	$8.31	$0.00	$0.00	$7.91	$0.00	$0.00	$0.00	$0.00	$0.00
9284	ERX	HCPCS 63700001	00904-1315-46	BISMUTH SUBSALICYLATE 262 MG PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9289	ERX	HCPCS J9040	00703-3154-01	BLEOMYCIN SULFATE 15 UNITS IJ SOLR	BOTH IP/OP	$159.81 	$118.26	$0.00	$123.18	$71.91	$71.91	$0.00	$0.00	$0.00	$37.40	$118.61	$118.61	$123.18	$0.00	$29.66	$0.00	$94.53	$94.53	$0.00	$72.45	$114.76	$115.92	$0.00		$0.00	$26.64	$0.00	$0.00	$25.36	$0.00	$0.00	$0.00	$0.00	$0.00
9289	ERX	HCPCS J9040	61703-0332-18	BLEOMYCIN SULFATE 15 UNITS IJ SOLR	BOTH IP/OP	$159.81 	$118.26	$0.00	$123.18	$71.91	$71.91	$0.00	$0.00	$0.00	$37.40	$118.61	$118.61	$123.18	$0.00	$29.66	$0.00	$94.53	$94.53	$0.00	$72.45	$114.76	$115.92	$0.00		$0.00	$26.64	$0.00	$0.00	$25.36	$0.00	$0.00	$0.00	$0.00	$0.00
9289	ERX	HCPCS J9040	63323-0136-10	BLEOMYCIN SULFATE 15 UNITS IJ SOLR	BOTH IP/OP	$159.81 	$118.26	$0.00	$123.18	$71.91	$71.91	$0.00	$0.00	$0.00	$37.40	$118.61	$118.61	$123.18	$0.00	$29.66	$0.00	$94.53	$94.53	$0.00	$72.45	$114.76	$115.92	$0.00		$0.00	$26.64	$0.00	$0.00	$25.36	$0.00	$0.00	$0.00	$0.00	$0.00
9297	ERX	HCPCS 63700001	00574-0106-01	BROMOCRIPTINE MESYLATE 2.5 MG PO TABS	BOTH IP/OP	$17.34 	$12.83	$0.00	$12.58		$0.00	$0.00	$0.00	$3.09	$0.00	$0.00	$0.00	$0.00	$0.00	$3.61	$0.00	$0.00	$0.00	$0.00	$7.87	$12.46	$12.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9297	ERX	HCPCS 63700001	00574-0106-03	BROMOCRIPTINE MESYLATE 2.5 MG PO TABS	BOTH IP/OP	$17.34 	$12.83	$0.00	$12.58		$0.00	$0.00	$0.00	$3.09	$0.00	$0.00	$0.00	$0.00	$0.00	$3.61	$0.00	$0.00	$0.00	$0.00	$7.87	$12.46	$12.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9297	ERX	HCPCS 63700001	00781-5325-01	BROMOCRIPTINE MESYLATE 2.5 MG PO TABS	BOTH IP/OP	$17.34 	$12.83	$0.00	$12.58		$0.00	$0.00	$0.00	$3.09	$0.00	$0.00	$0.00	$0.00	$0.00	$3.61	$0.00	$0.00	$0.00	$0.00	$7.87	$12.46	$12.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9297	ERX	HCPCS 63700001	00781-5325-31	BROMOCRIPTINE MESYLATE 2.5 MG PO TABS	BOTH IP/OP	$17.34 	$12.83	$0.00	$12.58		$0.00	$0.00	$0.00	$3.09	$0.00	$0.00	$0.00	$0.00	$0.00	$3.61	$0.00	$0.00	$0.00	$0.00	$7.87	$12.46	$12.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9297	ERX	HCPCS 63700001	63304-0962-01	BROMOCRIPTINE MESYLATE 2.5 MG PO TABS	BOTH IP/OP	$17.34 	$12.83	$0.00	$12.58		$0.00	$0.00	$0.00	$3.09	$0.00	$0.00	$0.00	$0.00	$0.00	$3.61	$0.00	$0.00	$0.00	$0.00	$7.87	$12.46	$12.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9297	ERX	HCPCS 63700001	63304-0962-30	BROMOCRIPTINE MESYLATE 2.5 MG PO TABS	BOTH IP/OP	$17.34 	$12.83	$0.00	$12.58		$0.00	$0.00	$0.00	$3.09	$0.00	$0.00	$0.00	$0.00	$0.00	$3.61	$0.00	$0.00	$0.00	$0.00	$7.87	$12.46	$12.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9308	ERX	HCPCS S0171	00409-1412-10	BUMETANIDE 0.25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$1.21	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$13.20		$13.20	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
9308	ERX	HCPCS S0171	00641-6007-10	BUMETANIDE 0.25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$1.21	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$13.20		$13.20	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
9308	ERX	HCPCS S0171	00641-6008-01	BUMETANIDE 0.25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$1.21	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$13.20		$13.20	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
9308	ERX	HCPCS S0171	00641-6008-10	BUMETANIDE 0.25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$1.21	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$13.20		$13.20	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
9308	ERX	HCPCS S0171	00641-6161-10	BUMETANIDE 0.25 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$1.21	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$13.20		$13.20	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
9309	ERX	HCPCS 63700001	42799-0119-01	BUMETANIDE 0.5 MG PO TABS	BOTH IP/OP	$10.07 	$7.45	$0.00	$7.31		$0.00	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$0.00	$2.10	$0.00	$0.00	$0.00	$0.00	$4.57	$7.24	$7.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9310	ERX	HCPCS 63700001	16714-0832-01	BUMETANIDE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9310	ERX	HCPCS 63700001	42799-0120-01	BUMETANIDE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9316	ERX	HCPCS 25000001	00409-1761-02	BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9316	ERX	HCPCS 25000001	00409-3613-01	BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9320	ERX	HCPCS J0592	00143-9246-05	BUPRENORPHINE HCL 0.3 MG/ML IJ SOLN	BOTH IP/OP	$76.28 	$56.45	$0.00	$58.80		$0.00	$0.00	$0.00	$0.00	$0.00	$56.62	$56.62	$58.80	$0.00	$15.90	$0.00	$0.00	$0.00	$0.00	$34.59	$54.79	$55.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9320	ERX	HCPCS J0592	00409-2012-32	BUPRENORPHINE HCL 0.3 MG/ML IJ SOLN	BOTH IP/OP	$76.28 	$56.45	$0.00	$58.80		$0.00	$0.00	$0.00	$0.00	$0.00	$56.62	$56.62	$58.80	$0.00	$15.90	$0.00	$0.00	$0.00	$0.00	$34.59	$54.79	$55.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9321	ERX	HCPCS 63700001	23155-0192-01	BUPROPION HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9321	ERX	HCPCS 63700001	60505-0157-01	BUPROPION HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9322	ERX	HCPCS 63700001	23155-0191-01	BUPROPION HCL 75 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9323	ERX	HCPCS 63700001	00093-0054-01	BUSPIRONE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9323	ERX	HCPCS 63700001	00378-1150-01	BUSPIRONE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9323	ERX	HCPCS 63700001	51079-0986-01	BUSPIRONE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9323	ERX	HCPCS 63700001	51079-0986-20	BUSPIRONE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9323	ERX	HCPCS 63700001	64380-0742-06	BUSPIRONE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9324	ERX	HCPCS 63700001	00093-0053-01	BUSPIRONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9324	ERX	HCPCS 63700001	51079-0985-01	BUSPIRONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9324	ERX	HCPCS 63700001	51079-0985-20	BUSPIRONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9324	ERX	HCPCS 63700001	64380-0741-06	BUSPIRONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9324	ERX	HCPCS 63700001	64380-0741-08	BUSPIRONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9325	ERX	HCPCS J8510	76388-0713-25	BUSULFAN 2 MG PO TABS	BOTH IP/OP	$108.50 	$80.29	$0.00	$83.63		$0.00	$0.00	$0.00	$0.00	$0.00	$80.53	$80.53	$83.63	$0.00	$22.61	$0.00	$0.00	$0.00	$0.00	$49.19	$77.92	$78.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9333	ERX	HCPCS J0595	00409-1623-01	BUTORPHANOL TARTRATE 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$3.46	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9347	ERX	HCPCS J0630	67457-0675-02	CALCITONIN (SALMON) 200 UNIT/ML IJ SOLN	BOTH IP/OP	"$8,494.26 "	"$6,285.75"	$0.00	"$5,319.64"		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,770.20"	$0.00	$0.00	$0.00	$0.00	"$3,324.78"	"$5,266.44"	"$5,319.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9348	ERX	HCPCS J0636	17478-0931-01	CALCITRIOL 1 MCG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.21	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9350	ERX	HCPCS 63700001	00054-0007-13	CALCITRIOL 0.25 MCG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9350	ERX	HCPCS 63700001	00054-0007-25	CALCITRIOL 0.25 MCG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9350	ERX	HCPCS 63700001	23155-0118-01	CALCITRIOL 0.25 MCG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9350	ERX	HCPCS 63700001	23155-0662-01	CALCITRIOL 0.25 MCG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9350	ERX	HCPCS 63700001	23155-0662-03	CALCITRIOL 0.25 MCG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9394	ERX	HCPCS 25000001	17478-0080-50	CAPREOMYCIN SULFATE 1 G IJ SOLR	BOTH IP/OP	$754.94 	$558.66	$0.00	$581.91		$0.00	$0.00	$0.00	$0.00	$0.00	$560.32	$560.32	$581.91	$0.00	$157.33	$0.00	$0.00	$0.00	$0.00	$342.57	$542.63	$548.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9400	ERX	HCPCS 63700001	00143-1174-01	CAPTOPRIL 100 MG PO TABS	BOTH IP/OP	$15.95 	$11.80	$0.00	$11.58		$0.00	$0.00	$0.00	$2.84	$0.00	$0.00	$0.00	$0.00	$0.00	$3.32	$0.00	$0.00	$0.00	$0.00	$7.24	$11.46	$11.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9400	ERX	HCPCS 63700001	00378-3022-01	CAPTOPRIL 100 MG PO TABS	BOTH IP/OP	$15.95 	$11.80	$0.00	$11.58		$0.00	$0.00	$0.00	$2.84	$0.00	$0.00	$0.00	$0.00	$0.00	$3.32	$0.00	$0.00	$0.00	$0.00	$7.24	$11.46	$11.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9400	ERX	HCPCS 63700001	00781-8080-01	CAPTOPRIL 100 MG PO TABS	BOTH IP/OP	$15.95 	$11.80	$0.00	$11.58		$0.00	$0.00	$0.00	$2.84	$0.00	$0.00	$0.00	$0.00	$0.00	$3.32	$0.00	$0.00	$0.00	$0.00	$7.24	$11.46	$11.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9401	ERX	HCPCS 63700001	00143-1171-01	CAPTOPRIL 12.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9401	ERX	HCPCS 63700001	00378-3007-01	CAPTOPRIL 12.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9401	ERX	HCPCS 63700001	00781-8052-01	CAPTOPRIL 12.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9401	ERX	HCPCS 63700001	51079-0863-20	CAPTOPRIL 12.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9402	ERX	HCPCS 63700001	00143-1172-01	CAPTOPRIL 25 MG PO TABS	BOTH IP/OP	$7.07 	$5.23	$0.00	$5.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.54	$5.60	$5.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9402	ERX	HCPCS 63700001	00378-3012-01	CAPTOPRIL 25 MG PO TABS	BOTH IP/OP	$7.07 	$5.23	$0.00	$5.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.54	$5.60	$5.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9402	ERX	HCPCS 63700001	00781-8061-01	CAPTOPRIL 25 MG PO TABS	BOTH IP/OP	$7.07 	$5.23	$0.00	$5.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.54	$5.60	$5.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9402	ERX	HCPCS 63700001	00904-5046-61	CAPTOPRIL 25 MG PO TABS	BOTH IP/OP	$7.07 	$5.23	$0.00	$5.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.54	$5.60	$5.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9402	ERX	HCPCS 63700001	51079-0864-01	CAPTOPRIL 25 MG PO TABS	BOTH IP/OP	$7.07 	$5.23	$0.00	$5.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.54	$5.60	$5.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9402	ERX	HCPCS 63700001	51079-0864-20	CAPTOPRIL 25 MG PO TABS	BOTH IP/OP	$7.07 	$5.23	$0.00	$5.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.54	$5.60	$5.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9403	ERX	HCPCS 63700001	00143-1173-01	CAPTOPRIL 50 MG PO TABS	BOTH IP/OP	$9.87 	$7.30	$0.00	$7.16		$0.00	$0.00	$0.00	$1.76	$0.00	$0.00	$0.00	$0.00	$0.00	$2.06	$0.00	$0.00	$0.00	$0.00	$4.48	$7.09	$7.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9403	ERX	HCPCS 63700001	00781-8075-01	CAPTOPRIL 50 MG PO TABS	BOTH IP/OP	$9.87 	$7.30	$0.00	$7.16		$0.00	$0.00	$0.00	$1.76	$0.00	$0.00	$0.00	$0.00	$0.00	$2.06	$0.00	$0.00	$0.00	$0.00	$4.48	$7.09	$7.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9406	ERX	HCPCS 63700001	63739-0107-10	CARBIDOPA-LEVODOPA 10-100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9407	ERX	HCPCS 63700001	00228-2539-10	CARBIDOPA-LEVODOPA 25-100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9407	ERX	HCPCS 63700001	00228-2539-50	CARBIDOPA-LEVODOPA 25-100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9407	ERX	HCPCS 63700001	51079-0884-20	CARBIDOPA-LEVODOPA 25-100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9407	ERX	HCPCS 63700001	68084-0093-01	CARBIDOPA-LEVODOPA 25-100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9408	ERX	HCPCS 63700001	00904-6238-61	CARBIDOPA-LEVODOPA 25-250 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9413	ERX	HCPCS 25000001	00009-0856-08	CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN	BOTH IP/OP	"$1,117.75 "	$827.14	$0.00	$861.56		$0.00	$0.00	$0.00	$0.00	$0.00	$829.59	$829.59	$861.56	$0.00	$232.94	$0.00	$0.00	$0.00	$0.00	$507.20	$803.40	$811.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9413	ERX	HCPCS 25000001	43598-0698-11	CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN	BOTH IP/OP	"$1,117.75 "	$827.14	$0.00	$861.56		$0.00	$0.00	$0.00	$0.00	$0.00	$829.59	$829.59	$861.56	$0.00	$232.94	$0.00	$0.00	$0.00	$0.00	$507.20	$803.40	$811.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9413	ERX	HCPCS 25000001	43598-0698-58	CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN	BOTH IP/OP	"$1,117.75 "	$827.14	$0.00	$861.56		$0.00	$0.00	$0.00	$0.00	$0.00	$829.59	$829.59	$861.56	$0.00	$232.94	$0.00	$0.00	$0.00	$0.00	$507.20	$803.40	$811.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9430	ERX	HCPCS 63700001	00143-9985-01	CEFACLOR 250 MG PO CAPS	BOTH IP/OP	$7.57 	$5.60	$0.00	$6.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.79	$6.00	$6.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9430	ERX	HCPCS 63700001	61442-0171-30	CEFACLOR 250 MG PO CAPS	BOTH IP/OP	$7.57 	$5.60	$0.00	$6.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.79	$6.00	$6.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9431	ERX	HCPCS 63700001	00143-9986-01	CEFACLOR 500 MG PO CAPS	BOTH IP/OP	$14.81 	$10.96	$0.00	$11.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.41	$11.73	$11.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9431	ERX	HCPCS 63700001	61442-0172-30	CEFACLOR 500 MG PO CAPS	BOTH IP/OP	$14.81 	$10.96	$0.00	$11.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.41	$11.73	$11.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9446	ERX	HCPCS 63700001	65862-0751-50	CEFIXIME 100 MG/5ML PO SUSR	BOTH IP/OP	$794.83 	$588.17	$0.00	$577.06		$0.00	$0.00	$0.00	$141.48	$0.00	$0.00	$0.00	$0.00	$0.00	$165.64	$0.00	$0.00	$0.00	$0.00	$360.67	$571.29	$577.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9446	ERX	HCPCS 63700001	68180-0202-03	CEFIXIME 100 MG/5ML PO SUSR	BOTH IP/OP	$794.83 	$588.17	$0.00	$577.06		$0.00	$0.00	$0.00	$141.48	$0.00	$0.00	$0.00	$0.00	$0.00	$165.64	$0.00	$0.00	$0.00	$0.00	$360.67	$571.29	$577.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9452	ERX	HCPCS J0698		CEFOTAXIME SODIUM 1 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9452	ERX	HCPCS J0698	00143-9931-25	CEFOTAXIME SODIUM 1 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9455	ERX	HCPCS 25000001		CEFOTAXIME SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9455	ERX	HCPCS 25000001	00143-9930-10	CEFOTAXIME SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9461	ERX	HCPCS J0694	25021-0109-10	CEFOXITIN SODIUM 1 G IV SOLR	BOTH IP/OP	$30.17 	$22.33	$0.00	$23.26	$13.58	$13.58	$0.00	$0.00	$0.00	$8.06	$22.39	$22.39	$23.26	$0.00	$5.42	$0.00	$17.85	$17.85	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$6.22	$0.00	$0.00	$5.92	$0.00	$0.00	$0.00	$0.00	$0.00
9461	ERX	HCPCS J0694	44567-0245-25	CEFOXITIN SODIUM 1 G IV SOLR	BOTH IP/OP	$30.17 	$22.33	$0.00	$23.26	$13.58	$13.58	$0.00	$0.00	$0.00	$8.06	$22.39	$22.39	$23.26	$0.00	$5.42	$0.00	$17.85	$17.85	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$6.22	$0.00	$0.00	$5.92	$0.00	$0.00	$0.00	$0.00	$0.00
9461	ERX	HCPCS J0694	44567-0245-85	CEFOXITIN SODIUM 1 G IV SOLR	BOTH IP/OP	$30.17 	$22.33	$0.00	$23.26	$13.58	$13.58	$0.00	$0.00	$0.00	$8.06	$22.39	$22.39	$23.26	$0.00	$5.42	$0.00	$17.85	$17.85	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$6.22	$0.00	$0.00	$5.92	$0.00	$0.00	$0.00	$0.00	$0.00
9461	ERX	HCPCS J0694	63323-0341-25	CEFOXITIN SODIUM 1 G IV SOLR	BOTH IP/OP	$30.17 	$22.33	$0.00	$23.26	$13.58	$13.58	$0.00	$0.00	$0.00	$8.06	$22.39	$22.39	$23.26	$0.00	$5.42	$0.00	$17.85	$17.85	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$6.22	$0.00	$0.00	$5.92	$0.00	$0.00	$0.00	$0.00	$0.00
9463	ERX	HCPCS J0694	25021-0110-20	CEFOXITIN SODIUM 2 G IV SOLR	BOTH IP/OP	$92.41 	$68.38	$0.00	$71.23	$41.58	$41.58	$0.00	$0.00	$0.00	$16.12	$68.59	$68.59	$71.23	$0.00	$10.84	$0.00	$54.66	$54.66	$0.00	$41.90	$66.36	$67.03	$0.00		$0.00	$12.43	$0.00	$0.00	$11.84	$0.00	$0.00	$0.00	$0.00	$0.00
9463	ERX	HCPCS J0694	44567-0246-25	CEFOXITIN SODIUM 2 G IV SOLR	BOTH IP/OP	$92.41 	$68.38	$0.00	$71.23	$41.58	$41.58	$0.00	$0.00	$0.00	$16.12	$68.59	$68.59	$71.23	$0.00	$10.84	$0.00	$54.66	$54.66	$0.00	$41.90	$66.36	$67.03	$0.00		$0.00	$12.43	$0.00	$0.00	$11.84	$0.00	$0.00	$0.00	$0.00	$0.00
9463	ERX	HCPCS J0694	44567-0246-85	CEFOXITIN SODIUM 2 G IV SOLR	BOTH IP/OP	$92.41 	$68.38	$0.00	$71.23	$41.58	$41.58	$0.00	$0.00	$0.00	$16.12	$68.59	$68.59	$71.23	$0.00	$10.84	$0.00	$54.66	$54.66	$0.00	$41.90	$66.36	$67.03	$0.00		$0.00	$12.43	$0.00	$0.00	$11.84	$0.00	$0.00	$0.00	$0.00	$0.00
9463	ERX	HCPCS J0694	63323-0342-25	CEFOXITIN SODIUM 2 G IV SOLR	BOTH IP/OP	$92.41 	$68.38	$0.00	$71.23	$41.58	$41.58	$0.00	$0.00	$0.00	$16.12	$68.59	$68.59	$71.23	$0.00	$10.84	$0.00	$54.66	$54.66	$0.00	$41.90	$66.36	$67.03	$0.00		$0.00	$12.43	$0.00	$0.00	$11.84	$0.00	$0.00	$0.00	$0.00	$0.00
9468	ERX	HCPCS 63700001	16714-0394-01	CEFPODOXIME PROXETIL 100 MG PO TABS	BOTH IP/OP	$28.23 	$20.89	$0.00	$20.49		$0.00	$0.00	$0.00	$5.02	$0.00	$0.00	$0.00	$0.00	$0.00	$5.88	$0.00	$0.00	$0.00	$0.00	$12.81	$20.28	$20.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9469	ERX	HCPCS 63700001	65862-0096-20	CEFPODOXIME PROXETIL 200 MG PO TABS	BOTH IP/OP	$35.44 	$26.23	$0.00	$25.71		$0.00	$0.00	$0.00	$6.31	$0.00	$0.00	$0.00	$0.00	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.07	$25.45	$25.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9474	ERX	HCPCS J0713	00409-5082-16	CEFTAZIDIME 1 G IJ SOLR	BOTH IP/OP	$22.63 	$16.75	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.80	$16.80	$17.44	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
9474	ERX	HCPCS J0713	25021-0127-20	CEFTAZIDIME 1 G IJ SOLR	BOTH IP/OP	$22.63 	$16.75	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.80	$16.80	$17.44	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
9474	ERX	HCPCS J0713	44567-0235-25	CEFTAZIDIME 1 G IJ SOLR	BOTH IP/OP	$22.63 	$16.75	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.80	$16.80	$17.44	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
9476	ERX	HCPCS J0713	00409-5084-11	CEFTAZIDIME 2 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
9476	ERX	HCPCS J0713	25021-0128-50	CEFTAZIDIME 2 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
9476	ERX	HCPCS J0713	44567-0236-10	CEFTAZIDIME 2 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
9487	ERX	HCPCS J0696	00409-7332-01	CEFTRIAXONE SODIUM 1 G IJ SOLR	BOTH IP/OP	$177.56 	$131.39	$0.00	$136.86	$79.90	$79.90	$0.00	$0.00	$0.00	$5.64	$131.79	$131.79	$136.86	$0.00	$2.36	$0.00	$105.03	$105.03	$0.00	$80.50	$127.51	$128.80	$0.00		$0.00	$2.82	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00
9487	ERX	HCPCS J0696	00409-7332-11	CEFTRIAXONE SODIUM 1 G IJ SOLR	BOTH IP/OP	$177.56 	$131.39	$0.00	$136.86	$79.90	$79.90	$0.00	$0.00	$0.00	$5.64	$131.79	$131.79	$136.86	$0.00	$2.36	$0.00	$105.03	$105.03	$0.00	$80.50	$127.51	$128.80	$0.00		$0.00	$2.82	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00
9487	ERX	HCPCS J0696	00781-3208-95	CEFTRIAXONE SODIUM 1 G IJ SOLR	BOTH IP/OP	$177.56 	$131.39	$0.00	$136.86	$79.90	$79.90	$0.00	$0.00	$0.00	$5.64	$131.79	$131.79	$136.86	$0.00	$2.36	$0.00	$105.03	$105.03	$0.00	$80.50	$127.51	$128.80	$0.00		$0.00	$2.82	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00
9487	ERX	HCPCS J0696	25021-0106-10	CEFTRIAXONE SODIUM 1 G IJ SOLR	BOTH IP/OP	$177.56 	$131.39	$0.00	$136.86	$79.90	$79.90	$0.00	$0.00	$0.00	$5.64	$131.79	$131.79	$136.86	$0.00	$2.36	$0.00	$105.03	$105.03	$0.00	$80.50	$127.51	$128.80	$0.00		$0.00	$2.82	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00
9487	ERX	HCPCS J0696	44567-0701-25	CEFTRIAXONE SODIUM 1 G IJ SOLR	BOTH IP/OP	$177.56 	$131.39	$0.00	$136.86	$79.90	$79.90	$0.00	$0.00	$0.00	$5.64	$131.79	$131.79	$136.86	$0.00	$2.36	$0.00	$105.03	$105.03	$0.00	$80.50	$127.51	$128.80	$0.00		$0.00	$2.82	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00
9488	ERX	HCPCS J0696	00143-9856-25	CEFTRIAXONE SODIUM 2 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$11.28	$16.33	$16.33	$16.96	$0.00	$4.73	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.64	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00
9488	ERX	HCPCS J0696	00409-7335-03	CEFTRIAXONE SODIUM 2 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$11.28	$16.33	$16.33	$16.96	$0.00	$4.73	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.64	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00
9488	ERX	HCPCS J0696	00409-7335-20	CEFTRIAXONE SODIUM 2 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$11.28	$16.33	$16.33	$16.96	$0.00	$4.73	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.64	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00
9488	ERX	HCPCS J0696	00409-7335-21	CEFTRIAXONE SODIUM 2 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$11.28	$16.33	$16.33	$16.96	$0.00	$4.73	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.64	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00
9488	ERX	HCPCS J0696	44567-0702-25	CEFTRIAXONE SODIUM 2 G IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$11.28	$16.33	$16.33	$16.96	$0.00	$4.73	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.64	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00
9489	ERX	HCPCS J0696	00409-7337-01	CEFTRIAXONE SODIUM 250 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.41	$16.33	$16.33	$16.96	$0.00	$0.59	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.71	$0.00	$0.00	$0.67	$0.00	$0.00	$0.00	$0.00	$0.00
9489	ERX	HCPCS J0696	00409-7337-11	CEFTRIAXONE SODIUM 250 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.41	$16.33	$16.33	$16.96	$0.00	$0.59	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.71	$0.00	$0.00	$0.67	$0.00	$0.00	$0.00	$0.00	$0.00
9490	ERX	HCPCS J0696	00143-9858-25	CEFTRIAXONE SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9490	ERX	HCPCS J0696	00409-7338-01	CEFTRIAXONE SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9490	ERX	HCPCS J0696	00409-7338-11	CEFTRIAXONE SODIUM 500 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9491	ERX	HCPCS J0696	00409-7334-10	CEFTRIAXONE SODIUM 10 G IV SOLR	BOTH IP/OP	$80.22 	$59.36	$0.00	$61.83	$36.10	$36.10	$0.00	$0.00	$0.00	$56.40	$59.54	$59.54	$61.83	$0.00	$23.64	$0.00	$47.45	$47.45	$0.00	$35.83	$56.75	$57.32	$0.00		$0.00	$28.20	$0.00	$0.00	$26.85	$0.00	$0.00	$0.00	$0.00	$0.00
9491	ERX	HCPCS J0696	00781-3210-46	CEFTRIAXONE SODIUM 10 G IV SOLR	BOTH IP/OP	$80.22 	$59.36	$0.00	$61.83	$36.10	$36.10	$0.00	$0.00	$0.00	$56.40	$59.54	$59.54	$61.83	$0.00	$23.64	$0.00	$47.45	$47.45	$0.00	$35.83	$56.75	$57.32	$0.00		$0.00	$28.20	$0.00	$0.00	$26.85	$0.00	$0.00	$0.00	$0.00	$0.00
9491	ERX	HCPCS J0696	25021-0108-99	CEFTRIAXONE SODIUM 10 G IV SOLR	BOTH IP/OP	$80.22 	$59.36	$0.00	$61.83	$36.10	$36.10	$0.00	$0.00	$0.00	$56.40	$59.54	$59.54	$61.83	$0.00	$23.64	$0.00	$47.45	$47.45	$0.00	$35.83	$56.75	$57.32	$0.00		$0.00	$28.20	$0.00	$0.00	$26.85	$0.00	$0.00	$0.00	$0.00	$0.00
9495	ERX	HCPCS 63700001	16714-0400-01	CEFUROXIME AXETIL 250 MG PO TABS	BOTH IP/OP	$18.44 	$13.65	$0.00	$13.38		$0.00	$0.00	$0.00	$3.28	$0.00	$0.00	$0.00	$0.00	$0.00	$3.84	$0.00	$0.00	$0.00	$0.00	$8.36	$13.24	$13.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9495	ERX	HCPCS 63700001	57237-0058-20	CEFUROXIME AXETIL 250 MG PO TABS	BOTH IP/OP	$18.44 	$13.65	$0.00	$13.38		$0.00	$0.00	$0.00	$3.28	$0.00	$0.00	$0.00	$0.00	$0.00	$3.84	$0.00	$0.00	$0.00	$0.00	$8.36	$13.24	$13.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9495	ERX	HCPCS 63700001	64679-0921-01	CEFUROXIME AXETIL 250 MG PO TABS	BOTH IP/OP	$18.44 	$13.65	$0.00	$13.38		$0.00	$0.00	$0.00	$3.28	$0.00	$0.00	$0.00	$0.00	$0.00	$3.84	$0.00	$0.00	$0.00	$0.00	$8.36	$13.24	$13.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9495	ERX	HCPCS 63700001	64679-0921-02	CEFUROXIME AXETIL 250 MG PO TABS	BOTH IP/OP	$18.44 	$13.65	$0.00	$13.38		$0.00	$0.00	$0.00	$3.28	$0.00	$0.00	$0.00	$0.00	$0.00	$3.84	$0.00	$0.00	$0.00	$0.00	$8.36	$13.24	$13.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9495	ERX	HCPCS 63700001	68180-0302-20	CEFUROXIME AXETIL 250 MG PO TABS	BOTH IP/OP	$18.44 	$13.65	$0.00	$13.38		$0.00	$0.00	$0.00	$3.28	$0.00	$0.00	$0.00	$0.00	$0.00	$3.84	$0.00	$0.00	$0.00	$0.00	$8.36	$13.24	$13.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9499	ERX	HCPCS 63700001	50268-0151-11	CEPHALEXIN 250 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9499	ERX	HCPCS 63700001	50268-0151-15	CEPHALEXIN 250 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9499	ERX	HCPCS 63700001	60687-0152-01	CEPHALEXIN 250 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9499	ERX	HCPCS 63700001	67877-0220-01	CEPHALEXIN 250 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9500	ERX	HCPCS 63700001	00093-3147-05	CEPHALEXIN 500 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9500	ERX	HCPCS 63700001	60687-0163-01	CEPHALEXIN 500 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9500	ERX	HCPCS 63700001	60687-0163-11	CEPHALEXIN 500 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9500	ERX	HCPCS 63700001	65862-0019-05	CEPHALEXIN 500 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9500	ERX	HCPCS 63700001	68180-0122-02	CEPHALEXIN 500 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9501	ERX	HCPCS 63700001	00093-4175-73	CEPHALEXIN 125 MG/5ML PO SUSR	BOTH IP/OP	$83.30 	$61.64	$0.00	$66.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.65	$65.97	$66.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9501	ERX	HCPCS 63700001	68180-0440-01	CEPHALEXIN 125 MG/5ML PO SUSR	BOTH IP/OP	$83.30 	$61.64	$0.00	$66.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.65	$65.97	$66.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9502	ERX	HCPCS 63700001	00093-4177-73	CEPHALEXIN 250 MG/5ML PO SUSR	BOTH IP/OP	$177.67 	$131.48	$0.00	$80.64		$0.00	$0.00	$0.00	$31.63	$0.00	$0.00	$0.00	$0.00	$0.00	$37.03	$0.00	$0.00	$0.00	$0.00	$50.40	$79.83	$80.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9502	ERX	HCPCS 63700001	68180-0441-01	CEPHALEXIN 250 MG/5ML PO SUSR	BOTH IP/OP	$177.67 	$131.48	$0.00	$80.64		$0.00	$0.00	$0.00	$31.63	$0.00	$0.00	$0.00	$0.00	$0.00	$37.03	$0.00	$0.00	$0.00	$0.00	$50.40	$79.83	$80.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9502	ERX	HCPCS 63700001	00093-4177-74	CEPHALEXIN 250 MG/5ML PO SUSR	BOTH IP/OP	$177.67 	$131.48	$0.00	$127.73		$0.00	$0.00	$0.00	$31.63	$0.00	$0.00	$0.00	$0.00	$0.00	$37.03	$0.00	$0.00	$0.00	$0.00	$50.40	$127.73	$80.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9506	ERX	HCPCS 63700001	00378-3637-01	CETIRIZINE HCL 10 MG PO TABS	BOTH IP/OP	$10.45 	$7.73	$0.00	$7.58		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.74	$7.51	$7.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9506	ERX	HCPCS 63700001	00904-6717-61	CETIRIZINE HCL 10 MG PO TABS	BOTH IP/OP	$10.45 	$7.73	$0.00	$7.58		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.74	$7.51	$7.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9506	ERX	HCPCS 63700001	16571-0402-10	CETIRIZINE HCL 10 MG PO TABS	BOTH IP/OP	$10.45 	$7.73	$0.00	$7.58		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.74	$7.51	$7.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9506	ERX	HCPCS 63700001	16714-0799-04	CETIRIZINE HCL 10 MG PO TABS	BOTH IP/OP	$10.45 	$7.73	$0.00	$7.58		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.74	$7.51	$7.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9506	ERX	HCPCS 63700001	45802-0919-39	CETIRIZINE HCL 10 MG PO TABS	BOTH IP/OP	$10.45 	$7.73	$0.00	$7.58		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.74	$7.51	$7.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9506	ERX	HCPCS 63700001	51079-0597-01	CETIRIZINE HCL 10 MG PO TABS	BOTH IP/OP	$10.45 	$7.73	$0.00	$7.58		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.74	$7.51	$7.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9506	ERX	HCPCS 63700001	51079-0597-20	CETIRIZINE HCL 10 MG PO TABS	BOTH IP/OP	$10.45 	$7.73	$0.00	$7.58		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.74	$7.51	$7.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9513	ERX	HCPCS 63700001	76388-0635-25	CHLORAMBUCIL 2 MG PO TABS	BOTH IP/OP	$534.60 	$395.60	$0.00	$356.16		$0.00	$0.00	$0.00	$95.16	$0.00	$0.00	$0.00	$0.00	$0.00	$111.41	$0.00	$0.00	$0.00	$0.00	$222.60	$352.60	$356.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9516	ERX	HCPCS 25000001	00116-2001-16	CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN	BOTH IP/OP	$8.93 	$6.61	$0.00	$6.88		$0.00	$0.00	$0.00	$0.00	$0.00	$6.63	$6.63	$6.88	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$4.05	$6.42	$6.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9516	ERX	HCPCS 25000001	69339-0138-15	CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN	BOTH IP/OP	$8.93 	$6.61	$0.00	$6.88		$0.00	$0.00	$0.00	$0.00	$0.00	$6.63	$6.63	$6.88	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$4.05	$6.42	$6.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9516	ERX	HCPCS 25000001	69339-0138-17	CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN	BOTH IP/OP	$8.93 	$6.61	$0.00	$6.88		$0.00	$0.00	$0.00	$0.00	$0.00	$6.63	$6.63	$6.88	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$4.05	$6.42	$6.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9516	ERX	HCPCS 25000001	69339-0138-19	CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN	BOTH IP/OP	$8.93 	$6.61	$0.00	$6.88		$0.00	$0.00	$0.00	$0.00	$0.00	$6.63	$6.63	$6.88	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$4.05	$6.42	$6.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9516	ERX	HCPCS 25000001	99999-6004-28	CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN	BOTH IP/OP	$8.93 	$6.61	$0.00	$6.88		$0.00	$0.00	$0.00	$0.00	$0.00	$6.63	$6.63	$6.88	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$4.05	$6.42	$6.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9523	ERX	HCPCS J2400	63323-0475-37	CHLOROPROCAINE HCL 1 % IJ SOLN	BOTH IP/OP	$83.61 	$61.87	$0.00	$64.45		$0.00	$0.00	$0.00	$0.00	$0.00	$62.06	$62.06	$64.45	$0.00	$17.42	$0.00	$0.00	$0.00	$0.00	$37.91	$60.04	$60.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9525	ERX	HCPCS 25000001	65649-0311-12	CHLOROTHIAZIDE 250 MG/5ML PO SUSP	BOTH IP/OP	$7.32 	$5.42	$0.00	$70.90		$0.00	$0.00	$0.00	$0.00	$0.00	$5.43	$5.43	$5.64	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$44.31	$5.26	$70.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9525	ERX	HCPCS 25000001	99999-6008-62	CHLOROTHIAZIDE 250 MG/5ML PO SUSP	BOTH IP/OP	$7.32 	$5.42	$0.00	$70.90		$0.00	$0.00	$0.00	$0.00	$0.00	$5.43	$5.43	$5.64	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$44.31	$5.26	$70.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9525	ERX	HCPCS 25000001	99999-6012-04	CHLOROTHIAZIDE 250 MG/5ML PO SUSP	BOTH IP/OP	$7.32 	$5.42	$0.00	$70.90		$0.00	$0.00	$0.00	$0.00	$0.00	$5.43	$5.43	$5.64	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$44.31	$5.26	$70.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9525	ERX	HCPCS 25000001	99999-6004-75	CHLOROTHIAZIDE 250 MG/5ML PO SUSP	BOTH IP/OP	$7.32 	$5.42	$0.00	$70.90		$0.00	$0.00	$0.00	$0.00	$0.00	$5.43	$5.43	$5.64	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$44.31	$70.19	$70.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9526	ERX	HCPCS J1205	00517-1820-01	CHLOROTHIAZIDE SODIUM 500 MG IV SOLR	BOTH IP/OP	$138.96 	$102.83	$0.00	$107.11		$0.00	$0.00	$0.00	$0.00	$0.00	$103.14	$103.14	$107.11	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9526	ERX	HCPCS J1205	17478-0419-40	CHLOROTHIAZIDE SODIUM 500 MG IV SOLR	BOTH IP/OP	$138.96 	$102.83	$0.00	$107.11		$0.00	$0.00	$0.00	$0.00	$0.00	$103.14	$103.14	$107.11	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9526	ERX	HCPCS J1205	25021-0305-20	CHLOROTHIAZIDE SODIUM 500 MG IV SOLR	BOTH IP/OP	$138.96 	$102.83	$0.00	$107.11		$0.00	$0.00	$0.00	$0.00	$0.00	$103.14	$103.14	$107.11	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9526	ERX	HCPCS J1205	25021-0305-66	CHLOROTHIAZIDE SODIUM 500 MG IV SOLR	BOTH IP/OP	$138.96 	$102.83	$0.00	$107.11		$0.00	$0.00	$0.00	$0.00	$0.00	$103.14	$103.14	$107.11	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9526	ERX	HCPCS J1205	47335-0330-40	CHLOROTHIAZIDE SODIUM 500 MG IV SOLR	BOTH IP/OP	$138.96 	$102.83	$0.00	$107.11		$0.00	$0.00	$0.00	$0.00	$0.00	$103.14	$103.14	$107.11	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9526	ERX	HCPCS J1205	63323-0658-20	CHLOROTHIAZIDE SODIUM 500 MG IV SOLR	BOTH IP/OP	$138.96 	$102.83	$0.00	$107.11		$0.00	$0.00	$0.00	$0.00	$0.00	$103.14	$103.14	$107.11	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9526	ERX	HCPCS J1205	63323-0658-27	CHLOROTHIAZIDE SODIUM 500 MG IV SOLR	BOTH IP/OP	$138.96 	$102.83	$0.00	$107.11		$0.00	$0.00	$0.00	$0.00	$0.00	$103.14	$103.14	$107.11	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9526	ERX	HCPCS J1205	67457-0263-30	CHLOROTHIAZIDE SODIUM 500 MG IV SOLR	BOTH IP/OP	$138.96 	$102.83	$0.00	$107.11		$0.00	$0.00	$0.00	$0.00	$0.00	$103.14	$103.14	$107.11	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9526	ERX	HCPCS J1205	76478-0711-40	CHLOROTHIAZIDE SODIUM 500 MG IV SOLR	BOTH IP/OP	$138.96 	$102.83	$0.00	$107.11		$0.00	$0.00	$0.00	$0.00	$0.00	$103.14	$103.14	$107.11	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9578	ERX	HCPCS 63700001	00904-5351-24	CHLORPHENIRAMINE-PSEUDOEPH 4-60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9578	ERX	HCPCS 63700001	00904-5351-96	CHLORPHENIRAMINE-PSEUDOEPH 4-60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9598	ERX	HCPCS 25000001	45802-0138-35	CICLOPIROX OLAMINE 0.77 % EX CREA	BOTH IP/OP	$122.00 	$90.28	$0.00	$94.04		$0.00	$0.00	$0.00	$0.00	$0.00	$90.55	$90.55	$94.04	$0.00	$25.42	$0.00	$0.00	$0.00	$0.00	$55.31	$87.61	$88.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9598	ERX	HCPCS 25000001	51672-1318-01	CICLOPIROX OLAMINE 0.77 % EX CREA	BOTH IP/OP	$122.00 	$90.28	$0.00	$94.04		$0.00	$0.00	$0.00	$0.00	$0.00	$90.55	$90.55	$94.04	$0.00	$25.42	$0.00	$0.00	$0.00	$0.00	$55.31	$87.61	$88.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9598	ERX	HCPCS 25000001	68462-0297-17	CICLOPIROX OLAMINE 0.77 % EX CREA	BOTH IP/OP	$122.00 	$90.28	$0.00	$94.04		$0.00	$0.00	$0.00	$0.00	$0.00	$90.55	$90.55	$94.04	$0.00	$25.42	$0.00	$0.00	$0.00	$0.00	$55.31	$87.61	$88.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9603	ERX	HCPCS J0743	00006-3516-59	IMIPENEM-CILASTATIN 500 MG IV SOLR	BOTH IP/OP	$151.25 	$111.93	$0.00	$116.58		$0.00	$0.00	$0.00	$0.00	$0.00	$112.26	$112.26	$116.58	$0.00	$17.89	$0.00	$0.00	$0.00	$0.00	$68.57	$108.61	$109.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9603	ERX	HCPCS J0743	63323-0322-93	IMIPENEM-CILASTATIN 500 MG IV SOLR	BOTH IP/OP	$151.25 	$111.93	$0.00	$116.58		$0.00	$0.00	$0.00	$0.00	$0.00	$112.26	$112.26	$116.58	$0.00	$17.89	$0.00	$0.00	$0.00	$0.00	$68.57	$108.61	$109.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9607	ERX	HCPCS 63700001	00378-0541-01	CIMETIDINE 800 MG PO TABS	BOTH IP/OP	$21.03 	$15.56	$0.00	$15.26		$0.00	$0.00	$0.00	$3.74	$0.00	$0.00	$0.00	$0.00	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$9.54	$15.10	$15.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9610	ERX	HCPCS 25000001	61314-0656-25	CIPROFLOXACIN HCL 0.3 % OP SOLN	BOTH IP/OP	$70.40 	$52.10	$0.00	$54.26		$0.00	$0.00	$0.00	$0.00	$0.00	$52.25	$52.25	$54.26	$0.00	$14.67	$0.00	$0.00	$0.00	$0.00	$23.94	$37.92	$38.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9610	ERX	HCPCS 25000001	69315-0308-02	CIPROFLOXACIN HCL 0.3 % OP SOLN	BOTH IP/OP	$70.40 	$52.10	$0.00	$54.26		$0.00	$0.00	$0.00	$0.00	$0.00	$52.25	$52.25	$54.26	$0.00	$14.67	$0.00	$0.00	$0.00	$0.00	$23.94	$37.92	$38.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9610	ERX	HCPCS 25000001	61314-0656-05	CIPROFLOXACIN HCL 0.3 % OP SOLN	BOTH IP/OP	$70.40 	$52.10	$0.00	$54.26		$0.00	$0.00	$0.00	$0.00	$0.00	$52.25	$52.25	$54.26	$0.00	$14.67	$0.00	$0.00	$0.00	$0.00	$23.94	$50.56	$38.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9610	ERX	HCPCS 25000001	69315-0308-05	CIPROFLOXACIN HCL 0.3 % OP SOLN	BOTH IP/OP	$70.40 	$52.10	$0.00	$54.26		$0.00	$0.00	$0.00	$0.00	$0.00	$52.25	$52.25	$54.26	$0.00	$14.67	$0.00	$0.00	$0.00	$0.00	$23.94	$50.56	$38.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9616	ERX	HCPCS 63700001	65862-0225-60	CLARITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$17.18 	$12.71	$0.00	$13.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.59	$13.61	$13.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9617	ERX	HCPCS 63700001	00527-1932-06	CLARITHROMYCIN 500 MG PO TABS	BOTH IP/OP	$25.21 	$18.66	$0.00	$18.29		$0.00	$0.00	$0.00	$4.49	$0.00	$0.00	$0.00	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$11.43	$18.11	$18.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9617	ERX	HCPCS 63700001	00781-1962-60	CLARITHROMYCIN 500 MG PO TABS	BOTH IP/OP	$25.21 	$18.66	$0.00	$18.29		$0.00	$0.00	$0.00	$4.49	$0.00	$0.00	$0.00	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$11.43	$18.11	$18.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9617	ERX	HCPCS 63700001	57237-0045-60	CLARITHROMYCIN 500 MG PO TABS	BOTH IP/OP	$25.21 	$18.66	$0.00	$18.29		$0.00	$0.00	$0.00	$4.49	$0.00	$0.00	$0.00	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$11.43	$18.11	$18.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9617	ERX	HCPCS 63700001	65862-0226-60	CLARITHROMYCIN 500 MG PO TABS	BOTH IP/OP	$25.21 	$18.66	$0.00	$18.29		$0.00	$0.00	$0.00	$4.49	$0.00	$0.00	$0.00	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$11.43	$18.11	$18.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9623	ERX	HCPCS 25000001	00168-0202-30	CLINDAMYCIN PHOSPHATE 1 % EX GEL	BOTH IP/OP	$348.27 	$257.72	$0.00	$268.45		$0.00	$0.00	$0.00	$0.00	$0.00	$258.49	$258.49	$268.45	$0.00	$72.58	$0.00	$0.00	$0.00	$0.00	$158.07	$250.38	$252.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9623	ERX	HCPCS 25000001	59762-3743-01	CLINDAMYCIN PHOSPHATE 1 % EX GEL	BOTH IP/OP	$348.27 	$257.72	$0.00	$268.45		$0.00	$0.00	$0.00	$0.00	$0.00	$258.49	$258.49	$268.45	$0.00	$72.58	$0.00	$0.00	$0.00	$0.00	$158.07	$250.38	$252.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9624	ERX	HCPCS 25000001	00009-3448-01	CLINDAMYCIN PHOSPHATE 2 % VA CREA	BOTH IP/OP	$437.88 	$324.03	$0.00	$337.52		$0.00	$0.00	$0.00	$0.00	$0.00	$324.99	$324.99	$337.52	$0.00	$91.25	$0.00	$0.00	$0.00	$0.00	$198.74	$314.80	$317.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9624	ERX	HCPCS 25000001	00168-0277-40	CLINDAMYCIN PHOSPHATE 2 % VA CREA	BOTH IP/OP	$437.88 	$324.03	$0.00	$337.52		$0.00	$0.00	$0.00	$0.00	$0.00	$324.99	$324.99	$337.52	$0.00	$91.25	$0.00	$0.00	$0.00	$0.00	$198.74	$314.80	$317.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9624	ERX	HCPCS 25000001	59762-5009-01	CLINDAMYCIN PHOSPHATE 2 % VA CREA	BOTH IP/OP	$437.88 	$324.03	$0.00	$337.52		$0.00	$0.00	$0.00	$0.00	$0.00	$324.99	$324.99	$337.52	$0.00	$91.25	$0.00	$0.00	$0.00	$0.00	$198.74	$314.80	$317.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9626	ERX	HCPCS S0077	00781-3289-09	CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN	BOTH IP/OP	$62.23 	$46.05	$0.00	$47.97	$28.00	$28.00	$0.00	$0.00	$2.70	$7.07	$46.19	$46.19	$47.97	$0.00	$3.31	$0.00	$36.81	$36.81	$0.00	$28.22	$44.69	$45.14	$33.86		$33.86	$3.29	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$0.00
9626	ERX	HCPCS S0077	00781-9221-09	CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN	BOTH IP/OP	$62.23 	$46.05	$0.00	$47.97	$28.00	$28.00	$0.00	$0.00	$2.70	$7.07	$46.19	$46.19	$47.97	$0.00	$3.31	$0.00	$36.81	$36.81	$0.00	$28.22	$44.69	$45.14	$33.86		$33.86	$3.29	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$0.00
9626	ERX	HCPCS S0077	00781-9221-91	CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN	BOTH IP/OP	$62.23 	$46.05	$0.00	$47.97	$28.00	$28.00	$0.00	$0.00	$2.70	$7.07	$46.19	$46.19	$47.97	$0.00	$3.31	$0.00	$36.81	$36.81	$0.00	$28.22	$44.69	$45.14	$33.86		$33.86	$3.29	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$0.00
9627	ERX	HCPCS S0077	00781-3290-09	CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN	BOTH IP/OP	$75.84 	$56.12	$0.00	$58.46	$34.13	$34.13	$0.00	$0.00	$4.06	$10.61	$56.29	$56.29	$58.46	$0.00	$4.97	$0.00	$44.86	$44.86	$0.00	$34.39	$54.47	$55.02	$41.27		$41.27	$4.94	$0.00	$0.00	$4.70	$0.00	$0.00	$0.00	$0.00	$0.00
9627	ERX	HCPCS S0077	00781-9222-09	CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN	BOTH IP/OP	$75.84 	$56.12	$0.00	$58.46	$34.13	$34.13	$0.00	$0.00	$4.06	$10.61	$56.29	$56.29	$58.46	$0.00	$4.97	$0.00	$44.86	$44.86	$0.00	$34.39	$54.47	$55.02	$41.27		$41.27	$4.94	$0.00	$0.00	$4.70	$0.00	$0.00	$0.00	$0.00	$0.00
9627	ERX	HCPCS S0077	00781-9222-91	CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN	BOTH IP/OP	$75.84 	$56.12	$0.00	$58.46	$34.13	$34.13	$0.00	$0.00	$4.06	$10.61	$56.29	$56.29	$58.46	$0.00	$4.97	$0.00	$44.86	$44.86	$0.00	$34.39	$54.47	$55.02	$41.27		$41.27	$4.94	$0.00	$0.00	$4.70	$0.00	$0.00	$0.00	$0.00	$0.00
9630	ERX	HCPCS 25000001	00168-0163-15	CLOBETASOL PROPIONATE 0.05 % EX CREA	BOTH IP/OP	$430.87 	$318.84	$0.00	$332.11		$0.00	$0.00	$0.00	$0.00	$0.00	$319.79	$319.79	$332.11	$0.00	$89.79	$0.00	$0.00	$0.00	$0.00	$195.56	$309.77	$312.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9630	ERX	HCPCS 25000001	00472-0400-15	CLOBETASOL PROPIONATE 0.05 % EX CREA	BOTH IP/OP	$430.87 	$318.84	$0.00	$332.11		$0.00	$0.00	$0.00	$0.00	$0.00	$319.79	$319.79	$332.11	$0.00	$89.79	$0.00	$0.00	$0.00	$0.00	$195.56	$309.77	$312.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9630	ERX	HCPCS 25000001	50383-0267-15	CLOBETASOL PROPIONATE 0.05 % EX CREA	BOTH IP/OP	$430.87 	$318.84	$0.00	$332.11		$0.00	$0.00	$0.00	$0.00	$0.00	$319.79	$319.79	$332.11	$0.00	$89.79	$0.00	$0.00	$0.00	$0.00	$195.56	$309.77	$312.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9630	ERX	HCPCS 25000001	51672-1258-01	CLOBETASOL PROPIONATE 0.05 % EX CREA	BOTH IP/OP	$430.87 	$318.84	$0.00	$332.11		$0.00	$0.00	$0.00	$0.00	$0.00	$319.79	$319.79	$332.11	$0.00	$89.79	$0.00	$0.00	$0.00	$0.00	$195.56	$309.77	$312.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9630	ERX	HCPCS 25000001	52565-0051-15	CLOBETASOL PROPIONATE 0.05 % EX CREA	BOTH IP/OP	$430.87 	$318.84	$0.00	$332.11		$0.00	$0.00	$0.00	$0.00	$0.00	$319.79	$319.79	$332.11	$0.00	$89.79	$0.00	$0.00	$0.00	$0.00	$195.56	$309.77	$312.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9630	ERX	HCPCS 25000001	00472-0400-30	CLOBETASOL PROPIONATE 0.05 % EX CREA	BOTH IP/OP	$430.87 	$318.84	$0.00	$538.28		$0.00	$0.00	$0.00	$0.00	$0.00	$319.79	$319.79	$332.11	$0.00	$89.79	$0.00	$0.00	$0.00	$0.00	$195.56	$538.28	$312.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9630	ERX	HCPCS 25000001	10337-0163-30	CLOBETASOL PROPIONATE 0.05 % EX CREA	BOTH IP/OP	$430.87 	$318.84	$0.00	$538.28		$0.00	$0.00	$0.00	$0.00	$0.00	$319.79	$319.79	$332.11	$0.00	$89.79	$0.00	$0.00	$0.00	$0.00	$195.56	$538.28	$312.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9630	ERX	HCPCS 25000001	00472-0400-60	CLOBETASOL PROPIONATE 0.05 % EX CREA	BOTH IP/OP	$430.87 	$318.84	$0.00	$975.00		$0.00	$0.00	$0.00	$0.00	$0.00	$319.79	$319.79	$332.11	$0.00	$89.79	$0.00	$0.00	$0.00	$0.00	$195.56	$975.00	$312.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9630	ERX	HCPCS 25000001	52565-0051-60	CLOBETASOL PROPIONATE 0.05 % EX CREA	BOTH IP/OP	$430.87 	$318.84	$0.00	$975.00		$0.00	$0.00	$0.00	$0.00	$0.00	$319.79	$319.79	$332.11	$0.00	$89.79	$0.00	$0.00	$0.00	$0.00	$195.56	$975.00	$312.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9631	ERX	HCPCS 25000001	00168-0162-15	CLOBETASOL PROPIONATE 0.05 % EX OINT	BOTH IP/OP	$522.30 	$386.50	$0.00	$402.59		$0.00	$0.00	$0.00	$0.00	$0.00	$387.65	$387.65	$402.59	$0.00	$108.85	$0.00	$0.00	$0.00	$0.00	$237.06	$375.50	$379.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9631	ERX	HCPCS 25000001	10337-0162-15	CLOBETASOL PROPIONATE 0.05 % EX OINT	BOTH IP/OP	$522.30 	$386.50	$0.00	$402.59		$0.00	$0.00	$0.00	$0.00	$0.00	$387.65	$387.65	$402.59	$0.00	$108.85	$0.00	$0.00	$0.00	$0.00	$237.06	$375.50	$379.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9631	ERX	HCPCS 25000001	43386-0096-60	CLOBETASOL PROPIONATE 0.05 % EX OINT	BOTH IP/OP	$522.30 	$386.50	$0.00	$402.59		$0.00	$0.00	$0.00	$0.00	$0.00	$387.65	$387.65	$402.59	$0.00	$108.85	$0.00	$0.00	$0.00	$0.00	$237.06	$375.50	$379.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9631	ERX	HCPCS 25000001	50383-0268-15	CLOBETASOL PROPIONATE 0.05 % EX OINT	BOTH IP/OP	$522.30 	$386.50	$0.00	$402.59		$0.00	$0.00	$0.00	$0.00	$0.00	$387.65	$387.65	$402.59	$0.00	$108.85	$0.00	$0.00	$0.00	$0.00	$237.06	$375.50	$379.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9631	ERX	HCPCS 25000001	51672-1259-01	CLOBETASOL PROPIONATE 0.05 % EX OINT	BOTH IP/OP	$522.30 	$386.50	$0.00	$402.59		$0.00	$0.00	$0.00	$0.00	$0.00	$387.65	$387.65	$402.59	$0.00	$108.85	$0.00	$0.00	$0.00	$0.00	$237.06	$375.50	$379.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9631	ERX	HCPCS 25000001	52565-0039-15	CLOBETASOL PROPIONATE 0.05 % EX OINT	BOTH IP/OP	$522.30 	$386.50	$0.00	$402.59		$0.00	$0.00	$0.00	$0.00	$0.00	$387.65	$387.65	$402.59	$0.00	$108.85	$0.00	$0.00	$0.00	$0.00	$237.06	$375.50	$379.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9631	ERX	HCPCS 25000001	51672-1259-02	CLOBETASOL PROPIONATE 0.05 % EX OINT	BOTH IP/OP	$522.30 	$386.50	$0.00	$652.50		$0.00	$0.00	$0.00	$0.00	$0.00	$387.65	$387.65	$402.59	$0.00	$108.85	$0.00	$0.00	$0.00	$0.00	$237.06	$652.50	$379.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9631	ERX	HCPCS 25000001	00168-0162-46	CLOBETASOL PROPIONATE 0.05 % EX OINT	BOTH IP/OP	$522.30 	$386.50	$0.00	$978.75		$0.00	$0.00	$0.00	$0.00	$0.00	$387.65	$387.65	$402.59	$0.00	$108.85	$0.00	$0.00	$0.00	$0.00	$237.06	$978.75	$379.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9632	ERX	HCPCS 25000001	00472-0402-25	CLOBETASOL PROPIONATE 0.05 % EX SOLN	BOTH IP/OP	$346.59 	$256.48	$0.00	$267.15		$0.00	$0.00	$0.00	$0.00	$0.00	$257.24	$257.24	$267.15	$0.00	$72.23	$0.00	$0.00	$0.00	$0.00	$157.31	$249.17	$251.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9632	ERX	HCPCS 25000001	50383-0266-25	CLOBETASOL PROPIONATE 0.05 % EX SOLN	BOTH IP/OP	$346.59 	$256.48	$0.00	$267.15		$0.00	$0.00	$0.00	$0.00	$0.00	$257.24	$257.24	$267.15	$0.00	$72.23	$0.00	$0.00	$0.00	$0.00	$157.31	$249.17	$251.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9632	ERX	HCPCS 25000001	51672-1293-02	CLOBETASOL PROPIONATE 0.05 % EX SOLN	BOTH IP/OP	$346.59 	$256.48	$0.00	$267.15		$0.00	$0.00	$0.00	$0.00	$0.00	$257.24	$257.24	$267.15	$0.00	$72.23	$0.00	$0.00	$0.00	$0.00	$157.31	$249.17	$251.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9632	ERX	HCPCS 25000001	60432-0133-25	CLOBETASOL PROPIONATE 0.05 % EX SOLN	BOTH IP/OP	$346.59 	$256.48	$0.00	$267.15		$0.00	$0.00	$0.00	$0.00	$0.00	$257.24	$257.24	$267.15	$0.00	$72.23	$0.00	$0.00	$0.00	$0.00	$157.31	$249.17	$251.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9632	ERX	HCPCS 25000001	00168-0269-50	CLOBETASOL PROPIONATE 0.05 % EX SOLN	BOTH IP/OP	$346.59 	$256.48	$0.00	$432.99		$0.00	$0.00	$0.00	$0.00	$0.00	$257.24	$257.24	$267.15	$0.00	$72.23	$0.00	$0.00	$0.00	$0.00	$157.31	$432.99	$251.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9632	ERX	HCPCS 25000001	51672-1293-03	CLOBETASOL PROPIONATE 0.05 % EX SOLN	BOTH IP/OP	$346.59 	$256.48	$0.00	$432.99		$0.00	$0.00	$0.00	$0.00	$0.00	$257.24	$257.24	$267.15	$0.00	$72.23	$0.00	$0.00	$0.00	$0.00	$157.31	$432.99	$251.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9632	ERX	HCPCS 25000001	60432-0133-50	CLOBETASOL PROPIONATE 0.05 % EX SOLN	BOTH IP/OP	$346.59 	$256.48	$0.00	$432.99		$0.00	$0.00	$0.00	$0.00	$0.00	$257.24	$257.24	$267.15	$0.00	$72.23	$0.00	$0.00	$0.00	$0.00	$157.31	$432.99	$251.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9635	ERX	HCPCS 63700001	00378-3025-01	CLOMIPRAMINE HCL 25 MG PO CAPS	BOTH IP/OP	$47.11 	$34.86	$0.00	$34.18		$0.00	$0.00	$0.00	$8.39	$0.00	$0.00	$0.00	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.36	$33.83	$34.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9635	ERX	HCPCS 63700001	00781-2027-01	CLOMIPRAMINE HCL 25 MG PO CAPS	BOTH IP/OP	$47.11 	$34.86	$0.00	$34.18		$0.00	$0.00	$0.00	$8.39	$0.00	$0.00	$0.00	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.36	$33.83	$34.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9635	ERX	HCPCS 63700001	51672-4011-05	CLOMIPRAMINE HCL 25 MG PO CAPS	BOTH IP/OP	$47.11 	$34.86	$0.00	$34.18		$0.00	$0.00	$0.00	$8.39	$0.00	$0.00	$0.00	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.36	$33.83	$34.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9636	ERX	HCPCS 63700001	00406-9908-03	CLOMIPRAMINE HCL 75 MG PO CAPS	BOTH IP/OP	$47.11 	$34.86	$0.00	$34.18		$0.00	$0.00	$0.00	$8.39	$0.00	$0.00	$0.00	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.36	$33.83	$34.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9636	ERX	HCPCS 63700001	51672-4013-05	CLOMIPRAMINE HCL 75 MG PO CAPS	BOTH IP/OP	$47.11 	$34.86	$0.00	$34.18		$0.00	$0.00	$0.00	$8.39	$0.00	$0.00	$0.00	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.36	$33.83	$34.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9637	ERX	HCPCS 25000001	00093-0832-01	CLONAZEPAM 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9637	ERX	HCPCS 25000001	00228-3003-11	CLONAZEPAM 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9637	ERX	HCPCS 25000001	16714-0752-01	CLONAZEPAM 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9637	ERX	HCPCS 25000001	16729-0136-00	CLONAZEPAM 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9637	ERX	HCPCS 25000001	63739-0263-10	CLONAZEPAM 0.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9638	ERX	HCPCS 25000001	00093-3212-01	CLONAZEPAM 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9638	ERX	HCPCS 25000001	00228-3004-11	CLONAZEPAM 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9638	ERX	HCPCS 25000001	16714-0750-01	CLONAZEPAM 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9638	ERX	HCPCS 25000001	16729-0137-00	CLONAZEPAM 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9644	ERX	HCPCS 63700001	00054-4146-22	CLOTRIMAZOLE 10 MG MT TROC	BOTH IP/OP	$13.48 	$9.98	$0.00	$9.78		$0.00	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$6.11	$9.68	$9.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9644	ERX	HCPCS 63700001	00574-0107-77	CLOTRIMAZOLE 10 MG MT TROC	BOTH IP/OP	$13.48 	$9.98	$0.00	$9.78		$0.00	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$6.11	$9.68	$9.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9647	ERX	HCPCS 63700001	00093-7772-93	CLOZAPINE 100 MG PO TABS	BOTH IP/OP	$14.33 	$10.60	$0.00	$10.40		$0.00	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$0.00	$2.99	$0.00	$0.00	$0.00	$0.00	$6.50	$10.30	$10.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9647	ERX	HCPCS 63700001	00378-0860-01	CLOZAPINE 100 MG PO TABS	BOTH IP/OP	$14.33 	$10.60	$0.00	$10.40		$0.00	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$0.00	$2.99	$0.00	$0.00	$0.00	$0.00	$6.50	$10.30	$10.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9647	ERX	HCPCS 63700001	51079-0922-20	CLOZAPINE 100 MG PO TABS	BOTH IP/OP	$14.33 	$10.60	$0.00	$10.40		$0.00	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$0.00	$2.99	$0.00	$0.00	$0.00	$0.00	$6.50	$10.30	$10.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9648	ERX	HCPCS 63700001	00093-4359-93	CLOZAPINE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9648	ERX	HCPCS 63700001	00378-0825-01	CLOZAPINE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9648	ERX	HCPCS 63700001	51079-0921-20	CLOZAPINE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9682	ERX	HCPCS 25000001	50484-0010-30	COLLAGENASE 250 UNIT/GM EX OINT	BOTH IP/OP	$960.98 	$711.13	$0.00	$740.72		$0.00	$0.00	$0.00	$0.00	$0.00	$713.24	$713.24	$740.72	$0.00	$200.27	$0.00	$0.00	$0.00	$0.00	$395.60	$626.62	$632.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9686	ERX	HCPCS J0834	00548-5900-00	COSYNTROPIN 0.25 MG IJ SOLR	BOTH IP/OP	$355.52 	$263.08	$0.00	$274.03	$159.98	$159.98	$0.00	$0.00	$0.00	$74.10	$263.87	$263.87	$274.03	$0.00	$41.87	$0.00	$210.29	$210.29	$0.00	$161.36	$255.59	$258.18	$0.00		$0.00	$44.56	$0.00	$0.00	$42.42	$0.00	$0.00	$0.00	$0.00	$0.00
9686	ERX	HCPCS J0834	67457-0227-02	COSYNTROPIN 0.25 MG IJ SOLR	BOTH IP/OP	$355.52 	$263.08	$0.00	$274.03	$159.98	$159.98	$0.00	$0.00	$0.00	$74.10	$263.87	$263.87	$274.03	$0.00	$41.87	$0.00	$210.29	$210.29	$0.00	$161.36	$255.59	$258.18	$0.00		$0.00	$44.56	$0.00	$0.00	$42.42	$0.00	$0.00	$0.00	$0.00	$0.00
9690	ERX	HCPCS J7631	00172-6406-49	CROMOLYN SODIUM 20 MG/2ML IN NEBU	BOTH IP/OP	$28.49 	$21.08	$0.00	$21.96		$0.00	$0.00	$0.00	$0.00	$0.00	$21.15	$21.15	$21.96	$0.00	$5.94	$0.00	$0.00	$0.00	$0.00	$12.92	$20.47	$20.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9691	ERX	HCPCS 25000001	17478-0291-11	CROMOLYN SODIUM 4 % OP SOLN	BOTH IP/OP	$143.60 	$106.26	$0.00	$110.69		$0.00	$0.00	$0.00	$0.00	$0.00	$106.58	$106.58	$110.69	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$65.10	$103.12	$104.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9691	ERX	HCPCS 25000001	61314-0237-10	CROMOLYN SODIUM 4 % OP SOLN	BOTH IP/OP	$143.60 	$106.26	$0.00	$110.69		$0.00	$0.00	$0.00	$0.00	$0.00	$106.58	$106.58	$110.69	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$65.10	$103.12	$104.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9699	ERX	HCPCS 25000001	00065-0395-15	CYCLOPENTOLATE HCL 0.5 % OP SOLN	BOTH IP/OP	$327.92 	$242.66	$0.00	$269.26		$0.00	$0.00	$0.00	$0.00	$0.00	$259.27	$259.27	$269.26	$0.00	$68.34	$0.00	$0.00	$0.00	$0.00	$148.84	$235.76	$238.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9699	ERX	HCPCS 25000001	17478-0096-15	CYCLOPENTOLATE HCL 0.5 % OP SOLN	BOTH IP/OP	$327.92 	$242.66	$0.00	$269.26		$0.00	$0.00	$0.00	$0.00	$0.00	$259.27	$259.27	$269.26	$0.00	$68.34	$0.00	$0.00	$0.00	$0.00	$148.84	$235.76	$238.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9700	ERX	HCPCS 25000001	00065-0397-02	CYCLOPENTOLATE HCL 2 % OP SOLN	BOTH IP/OP	$167.07 	$123.63	$0.00	$141.69		$0.00	$0.00	$0.00	$0.00	$0.00	$136.43	$136.43	$141.69	$0.00	$34.82	$0.00	$0.00	$0.00	$0.00	$75.74	$119.97	$121.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9700	ERX	HCPCS 25000001	17478-0097-02	CYCLOPENTOLATE HCL 2 % OP SOLN	BOTH IP/OP	$167.07 	$123.63	$0.00	$141.69		$0.00	$0.00	$0.00	$0.00	$0.00	$136.43	$136.43	$141.69	$0.00	$34.82	$0.00	$0.00	$0.00	$0.00	$75.74	$119.97	$121.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9700	ERX	HCPCS 25000001	17478-0097-10	CYCLOPENTOLATE HCL 2 % OP SOLN	BOTH IP/OP	$167.07 	$123.63	$0.00	$141.69		$0.00	$0.00	$0.00	$0.00	$0.00	$136.43	$136.43	$141.69	$0.00	$34.82	$0.00	$0.00	$0.00	$0.00	$75.74	$135.27	$121.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9701	ERX	HCPCS 25000001	00065-0359-02	CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OP SOLN	BOTH IP/OP	$210.67 	$155.90	$0.00	$178.62		$0.00	$0.00	$0.00	$0.00	$0.00	$171.99	$171.99	$178.62	$0.00	$43.90	$0.00	$0.00	$0.00	$0.00	$60.48	$95.80	$96.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9701	ERX	HCPCS 25000001	00065-0359-05	CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OP SOLN	BOTH IP/OP	$210.67 	$155.90	$0.00	$178.62		$0.00	$0.00	$0.00	$0.00	$0.00	$171.99	$171.99	$178.62	$0.00	$43.90	$0.00	$0.00	$0.00	$0.00	$60.48	$151.46	$96.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9704	ERX	HCPCS 63700001	13845-1202-02	CYCLOSERINE 250 MG PO CAPS	BOTH IP/OP	$290.10 	$214.67	$0.00	$210.67		$0.00	$0.00	$0.00	$51.64	$0.00	$0.00	$0.00	$0.00	$0.00	$60.46	$0.00	$0.00	$0.00	$0.00	$131.67	$208.57	$210.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9705	ERX	HCPCS j7516	00078-0109-01	CYCLOSPORINE 50 MG/ML IV SOLN	BOTH IP/OP	$181.14 	$134.04	$0.00	$139.62		$0.00	$0.00	$0.00	$0.00	$0.00	$134.44	$134.44	$139.62	$0.00	$37.75	$0.00	$0.00	$0.00	$0.00	$82.12	$130.08	$131.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9705	ERX	HCPCS j7516	00574-0866-10	CYCLOSPORINE 50 MG/ML IV SOLN	BOTH IP/OP	$181.14 	$134.04	$0.00	$139.62		$0.00	$0.00	$0.00	$0.00	$0.00	$134.44	$134.44	$139.62	$0.00	$37.75	$0.00	$0.00	$0.00	$0.00	$82.12	$130.08	$131.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9706	ERX	HCPCS J7502	00078-0241-15	CYCLOSPORINE 100 MG PO CAPS	BOTH IP/OP	$58.54 	$43.32	$0.00	$45.12	$26.34	$26.34	$0.00	$0.00	$0.00	$12.20	$43.45	$43.45	$45.12	$0.00	$12.20	$0.00	$34.63	$34.63	$0.00	$26.55	$42.05	$42.47	$0.00		$0.00	$8.31	$0.00	$0.00	$8.45	$0.00	$0.00	$0.00	$0.00	$0.00
9706	ERX	HCPCS J7502	00078-0241-61	CYCLOSPORINE 100 MG PO CAPS	BOTH IP/OP	$58.54 	$43.32	$0.00	$45.12	$26.34	$26.34	$0.00	$0.00	$0.00	$12.20	$43.45	$43.45	$45.12	$0.00	$12.20	$0.00	$34.63	$34.63	$0.00	$26.55	$42.05	$42.47	$0.00		$0.00	$8.31	$0.00	$0.00	$8.45	$0.00	$0.00	$0.00	$0.00	$0.00
9706	ERX	HCPCS J7502	60505-0134-00	CYCLOSPORINE 100 MG PO CAPS	BOTH IP/OP	$58.54 	$43.32	$0.00	$45.12	$26.34	$26.34	$0.00	$0.00	$0.00	$12.20	$43.45	$43.45	$45.12	$0.00	$12.20	$0.00	$34.63	$34.63	$0.00	$26.55	$42.05	$42.47	$0.00		$0.00	$8.31	$0.00	$0.00	$8.45	$0.00	$0.00	$0.00	$0.00	$0.00
9707	ERX	HCPCS J7515	00078-0240-15	CYCLOSPORINE (SANDIMMUNE) 25 MG PO CAPS	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61		$0.00	$0.00	$0.00	$0.00	$0.00	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$0.00	$0.00	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9707	ERX	HCPCS J7515	00078-0240-61	CYCLOSPORINE (SANDIMMUNE) 25 MG PO CAPS	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61		$0.00	$0.00	$0.00	$0.00	$0.00	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$0.00	$0.00	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9707	ERX	HCPCS J7515	60505-0133-00	CYCLOSPORINE (SANDIMMUNE) 25 MG PO CAPS	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61		$0.00	$0.00	$0.00	$0.00	$0.00	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$0.00	$0.00	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9708	ERX	HCPCS J7502	00078-0110-22	CYCLOSPORINE 100 MG/ML PO SOLN	BOTH IP/OP	"$2,330.49 "	"$1,724.56"	$0.00	"$1,796.34"	"$1,048.72"	"$1,048.72"	$0.00	$0.00	$0.00	$485.73	"$1,729.69"	"$1,729.69"	"$1,796.34"	$0.00	$485.67	$0.00	"$1,148.93"	"$1,148.93"	$0.00	"$1,079.76"	"$1,710.34"	"$1,727.62"	$0.00		$0.00	$337.96	$0.00	$0.00	$343.80	$0.00	$0.00	$0.00	$0.00	$0.00
9715	ERX	HCPCS 63700001	00555-0633-02	DANAZOL 50 MG PO CAPS	BOTH IP/OP	$15.20 	$11.25	$0.00	$11.03		$0.00	$0.00	$0.00	$2.71	$0.00	$0.00	$0.00	$0.00	$0.00	$3.17	$0.00	$0.00	$0.00	$0.00	$6.90	$10.92	$11.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9716	ERX	HCPCS 25000001	00143-9297-01	DANTROLENE SODIUM 20 MG IV SOLR	BOTH IP/OP	$295.27 	$218.50	$0.00	$227.59		$0.00	$0.00	$0.00	$0.00	$0.00	$219.15	$219.15	$227.59	$0.00	$61.53	$0.00	$0.00	$0.00	$0.00	$134.02	$212.29	$214.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9716	ERX	HCPCS 25000001	27505-0003-67	DANTROLENE SODIUM 20 MG IV SOLR	BOTH IP/OP	$295.27 	$218.50	$0.00	$227.59		$0.00	$0.00	$0.00	$0.00	$0.00	$219.15	$219.15	$227.59	$0.00	$61.53	$0.00	$0.00	$0.00	$0.00	$134.02	$212.29	$214.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9716	ERX	HCPCS 25000001	42023-0123-06	DANTROLENE SODIUM 20 MG IV SOLR	BOTH IP/OP	$295.27 	$218.50	$0.00	$227.59		$0.00	$0.00	$0.00	$0.00	$0.00	$219.15	$219.15	$227.59	$0.00	$61.53	$0.00	$0.00	$0.00	$0.00	$134.02	$212.29	$214.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9717	ERX	HCPCS 63700001	00115-4433-01	DANTROLENE SODIUM 100 MG PO CAPS	BOTH IP/OP	$9.09 	$6.73	$0.00	$6.59		$0.00	$0.00	$0.00	$1.62	$0.00	$0.00	$0.00	$0.00	$0.00	$1.89	$0.00	$0.00	$0.00	$0.00	$4.12	$6.53	$6.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9718	ERX	HCPCS 63700001	00115-4411-01	DANTROLENE SODIUM 25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9718	ERX	HCPCS 63700001	68084-0300-21	DANTROLENE SODIUM 25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9719	ERX	HCPCS 63700001	00115-4422-01	DANTROLENE SODIUM 50 MG PO CAPS	BOTH IP/OP	$7.25 	$5.37	$0.00	$5.26		$0.00	$0.00	$0.00	$1.29	$0.00	$0.00	$0.00	$0.00	$0.00	$1.51	$0.00	$0.00	$0.00	$0.00	$3.29	$5.21	$5.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9719	ERX	HCPCS 63700001	42023-0125-01	DANTROLENE SODIUM 50 MG PO CAPS	BOTH IP/OP	$7.25 	$5.37	$0.00	$5.26		$0.00	$0.00	$0.00	$1.29	$0.00	$0.00	$0.00	$0.00	$0.00	$1.51	$0.00	$0.00	$0.00	$0.00	$3.29	$5.21	$5.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9722	ERX	HCPCS J0895	00409-2337-25	DEFEROXAMINE MESYLATE 2 G IJ SOLR	BOTH IP/OP	$148.48 	$109.88	$0.00	$114.45		$0.00	$0.00	$0.00	$0.00	$0.00	$110.20	$110.20	$114.45	$0.00	$36.01	$0.00	$0.00	$0.00	$0.00	$66.32	$105.05	$106.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9722	ERX	HCPCS J0895	63323-0599-30	DEFEROXAMINE MESYLATE 2 G IJ SOLR	BOTH IP/OP	$148.48 	$109.88	$0.00	$114.45		$0.00	$0.00	$0.00	$0.00	$0.00	$110.20	$110.20	$114.45	$0.00	$36.01	$0.00	$0.00	$0.00	$0.00	$66.32	$105.05	$106.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9723	ERX	HCPCS J0895	00078-0467-61	DEFEROXAMINE MESYLATE 500 MG IJ SOLR	BOTH IP/OP	$42.92 	$31.76	$0.00	$34.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.46	$33.99	$34.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9723	ERX	HCPCS J0895	00409-2336-10	DEFEROXAMINE MESYLATE 500 MG IJ SOLR	BOTH IP/OP	$42.92 	$31.76	$0.00	$34.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.46	$33.99	$34.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9723	ERX	HCPCS J0895	63323-0597-10	DEFEROXAMINE MESYLATE 500 MG IJ SOLR	BOTH IP/OP	$42.92 	$31.76	$0.00	$34.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.46	$33.99	$34.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9726	ERX	HCPCS 63700001	62584-0159-01	DEMECLOCYCLINE HCL 150 MG PO TABS	BOTH IP/OP	$44.55 	$32.97	$0.00	$32.33		$0.00	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00	$9.28	$0.00	$0.00	$0.00	$0.00	$20.21	$32.00	$32.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9726	ERX	HCPCS 63700001	65162-0554-10	DEMECLOCYCLINE HCL 150 MG PO TABS	BOTH IP/OP	$44.55 	$32.97	$0.00	$32.33		$0.00	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00	$9.28	$0.00	$0.00	$0.00	$0.00	$20.21	$32.00	$32.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9727	ERX	HCPCS 63700001	42806-0144-48	DEMECLOCYCLINE HCL 300 MG PO TABS	BOTH IP/OP	$131.77 	$97.51	$0.00	$95.58		$0.00	$0.00	$0.00	$23.46	$0.00	$0.00	$0.00	$0.00	$0.00	$27.46	$0.00	$0.00	$0.00	$0.00	$59.74	$94.63	$95.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9727	ERX	HCPCS 63700001	65162-0555-48	DEMECLOCYCLINE HCL 300 MG PO TABS	BOTH IP/OP	$131.77 	$97.51	$0.00	$95.58		$0.00	$0.00	$0.00	$23.46	$0.00	$0.00	$0.00	$0.00	$0.00	$27.46	$0.00	$0.00	$0.00	$0.00	$59.74	$94.63	$95.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9748	ERX	HCPCS J2597	00703-5054-01	DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN	BOTH IP/OP	$66.00 	$48.84	$0.00	$73.33		$0.00	$0.00	$0.00	$0.00	$0.00	$70.61	$70.61	$73.33	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$42.60	$67.48	$68.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9748	ERX	HCPCS J2597	43598-0931-09	DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN	BOTH IP/OP	$66.00 	$48.84	$0.00	$73.33		$0.00	$0.00	$0.00	$0.00	$0.00	$70.61	$70.61	$73.33	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$42.60	$67.48	$68.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9748	ERX	HCPCS J2597	55566-2200-00	DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN	BOTH IP/OP	$66.00 	$48.84	$0.00	$73.33		$0.00	$0.00	$0.00	$0.00	$0.00	$70.61	$70.61	$73.33	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$42.60	$67.48	$68.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9748	ERX	HCPCS J2597	55566-2300-00	DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN	BOTH IP/OP	$66.00 	$48.84	$0.00	$73.33		$0.00	$0.00	$0.00	$0.00	$0.00	$70.61	$70.61	$73.33	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$42.60	$67.48	$68.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9748	ERX	HCPCS J2597	62756-0529-40	DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN	BOTH IP/OP	$66.00 	$48.84	$0.00	$73.33		$0.00	$0.00	$0.00	$0.00	$0.00	$70.61	$70.61	$73.33	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$42.60	$67.48	$68.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9748	ERX	HCPCS J2597	69918-0899-10	DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN	BOTH IP/OP	$66.00 	$48.84	$0.00	$73.33		$0.00	$0.00	$0.00	$0.00	$0.00	$70.61	$70.61	$73.33	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$42.60	$67.48	$68.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9748	ERX	HCPCS J2597	69918-0901-10	DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN	BOTH IP/OP	$66.00 	$48.84	$0.00	$73.33		$0.00	$0.00	$0.00	$0.00	$0.00	$70.61	$70.61	$73.33	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$42.60	$67.48	$68.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9759	ERX	HCPCS 25000001	00409-7418-03	DEXTRAN 40 IN D5W 10 % IV SOLN	BOTH IP/OP	$135.10 	$99.97	$0.00	$104.14		$0.00	$0.00	$0.00	$0.00	$0.00	$100.27	$100.27	$104.14	$0.00	$28.15	$0.00	$0.00	$0.00	$0.00	$56.00	$88.70	$89.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9788	ERX	HCPCS J7120	00264-7751-10	DEXTROSE IN LACTATED RINGERS 5 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$1.13	$18.66	$18.66	$19.38	$0.00	$2.95	$0.00	$14.87	$14.87	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$2.77	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00
9788	ERX	HCPCS J7120	00338-0125-03	DEXTROSE IN LACTATED RINGERS 5 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$1.13	$18.66	$18.66	$19.38	$0.00	$2.95	$0.00	$14.87	$14.87	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$2.77	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00
9788	ERX	HCPCS J7120	00264-7751-00	DEXTROSE IN LACTATED RINGERS 5 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$1.13	$18.66	$18.66	$19.38	$0.00	$2.95	$0.00	$14.87	$14.87	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$2.77	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00
9788	ERX	HCPCS J7120	00338-0125-04	DEXTROSE IN LACTATED RINGERS 5 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$1.13	$18.66	$18.66	$19.38	$0.00	$2.95	$0.00	$14.87	$14.87	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$2.77	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00
9823	ERX	HCPCS Q9958	00270-1410-30	DIATRIZOATE MEGLUMINE 18 % UR SOLN	BOTH IP/OP	$149.39 	$110.55	$0.00	$110.88	$67.23	$67.23	$0.00	$0.00	$0.00	$31.14	$110.88	$110.88	$0.00	$0.00	$24.68	$0.00	$88.36	$88.36	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9828	ERX	HCPCS Q9963	00270-0445-40	DIATRIZOATE MEGLUMINE & SODIUM 66-10 % (37% IODINE) SOLN	BOTH IP/OP	$290.24 	$214.78	$0.00	$215.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.42	$215.42	$0.00	$0.00	$23.97	$0.00	$0.00	$0.00	$0.00	$131.74	$208.67	$210.78	$0.00		$0.00	$22.82	$0.00	$0.00	$41.94	$0.00	$0.00	$0.00	$0.00	$0.00
9859	ERX	HCPCS J1110	00574-0850-05	DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN	BOTH IP/OP	$273.48 	$202.38	$0.00	$210.80		$0.00	$0.00	$0.00	$0.00	$0.00	$202.98	$202.98	$210.80	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$124.13	$196.62	$198.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9859	ERX	HCPCS J1110	00574-0850-10	DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN	BOTH IP/OP	$273.48 	$202.38	$0.00	$210.80		$0.00	$0.00	$0.00	$0.00	$0.00	$202.98	$202.98	$210.80	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$124.13	$196.62	$198.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9872	ERX	HCPCS J0470	17478-0526-03	DIMERCAPROL 100 MG/ML IM SOLN	BOTH IP/OP	$646.90 	$478.71	$0.00	$498.63		$0.00	$0.00	$0.00	$0.00	$0.00	$480.13	$480.13	$498.63	$0.00	$134.81	$0.00	$0.00	$0.00	$0.00	$293.61	$465.08	$469.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9875	ERX	HCPCS 25000001	00009-0827-03	DINOPROSTONE 20 MG VA SUPP	BOTH IP/OP	"$5,432.10 "	"$4,019.75"	$0.00	"$4,345.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,716.05"	"$4,302.22"	"$4,345.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9891	ERX	HCPCS J1245	00641-2569-41	DIPYRIDAMOLE 5 MG/ML IV SOLN	BOTH IP/OP	$91.72 	$67.87	$0.00	$70.70		$0.00	$0.00	$0.00	$0.00	$0.00	$68.07	$68.07	$70.70	$0.00	$21.44	$0.00	$0.00	$0.00	$0.00	$41.58	$65.86	$66.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9891	ERX	HCPCS J1245	00641-2569-44	DIPYRIDAMOLE 5 MG/ML IV SOLN	BOTH IP/OP	$91.72 	$67.87	$0.00	$70.70		$0.00	$0.00	$0.00	$0.00	$0.00	$68.07	$68.07	$70.70	$0.00	$21.44	$0.00	$0.00	$0.00	$0.00	$41.58	$65.86	$66.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9894	ERX	HCPCS 63700001	00904-5522-61	DOXAZOSIN MESYLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9894	ERX	HCPCS 63700001	16729-0211-01	DOXAZOSIN MESYLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9894	ERX	HCPCS 63700001	68084-0836-25	DOXAZOSIN MESYLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9894	ERX	HCPCS 63700001	68084-0836-95	DOXAZOSIN MESYLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9895	ERX	HCPCS 63700001	00378-4022-01	DOXAZOSIN MESYLATE 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9895	ERX	HCPCS 63700001	51079-0958-01	DOXAZOSIN MESYLATE 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9895	ERX	HCPCS 63700001	51079-0958-20	DOXAZOSIN MESYLATE 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9896	ERX	HCPCS 63700001	00904-5524-61	DOXAZOSIN MESYLATE 4 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9896	ERX	HCPCS 63700001	16729-0213-01	DOXAZOSIN MESYLATE 4 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9897	ERX	HCPCS 63700001	16729-0415-01	DOXAZOSIN MESYLATE 8 MG PO TABS	BOTH IP/OP	$6.23 	$4.61	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9897	ERX	HCPCS 63700001	68382-0786-01	DOXAZOSIN MESYLATE 8 MG PO TABS	BOTH IP/OP	$6.23 	$4.61	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9900	ERX	HCPCS 63700001	49884-0727-03	DOXYCYCLINE MONOHYDRATE 100 MG PO CAPS	BOTH IP/OP	$9.93 	$7.35	$0.00	$7.21		$0.00	$0.00	$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$0.00	$2.07	$0.00	$0.00	$0.00	$0.00	$4.51	$7.14	$7.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9900	ERX	HCPCS 63700001	63304-0616-50	DOXYCYCLINE MONOHYDRATE 100 MG PO CAPS	BOTH IP/OP	$9.93 	$7.35	$0.00	$7.21		$0.00	$0.00	$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$0.00	$2.07	$0.00	$0.00	$0.00	$0.00	$4.51	$7.14	$7.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9902	ERX	HCPCS 25000001	69097-0228-43	DOXYCYCLINE MONOHYDRATE 25 MG/5ML PO SUSR	BOTH IP/OP	$92.82 	$68.69	$0.00	$74.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.41	$73.51	$74.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9904	ERX	HCPCS Q0167	00527-1450-06	DRONABINOL 2.5 MG PO CAPS	BOTH IP/OP	$22.40 	$16.58	$0.00	$17.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.20	$17.74	$17.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9904	ERX	HCPCS Q0167	17478-0761-06	DRONABINOL 2.5 MG PO CAPS	BOTH IP/OP	$22.40 	$16.58	$0.00	$17.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.20	$17.74	$17.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9904	ERX	HCPCS Q0167	42858-0867-06	DRONABINOL 2.5 MG PO CAPS	BOTH IP/OP	$22.40 	$16.58	$0.00	$17.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.20	$17.74	$17.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9914	ERX	HCPCS 25000001	00046-1065-05	ECHOTHIOPHATE IODIDE 0.125 % OP SOLR	BOTH IP/OP	$324.52 	$240.14	$0.00	$259.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.26	$257.02	$259.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9915	ERX	HCPCS 63700001	45802-0466-35	ECONAZOLE NITRATE 1 % EX CREA	BOTH IP/OP	$365.40 	$270.40	$0.00	$265.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.15	$0.00	$0.00	$0.00	$0.00	$165.85	$262.70	$265.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9915	ERX	HCPCS 63700001	52565-0022-15	ECONAZOLE NITRATE 1 % EX CREA	BOTH IP/OP	$365.40 	$270.40	$0.00	$265.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.15	$0.00	$0.00	$0.00	$0.00	$165.85	$262.70	$265.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9927	ERX	HCPCS 63700001	16714-0443-01	ENALAPRIL MALEATE 5 MG PO TABS	BOTH IP/OP	$6.36 	$4.71	$0.00	$4.80		$0.00	$0.00	$0.00	$1.13	$0.00	$0.00	$0.00	$0.00	$0.00	$1.33	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9927	ERX	HCPCS 63700001	64679-0924-02	ENALAPRIL MALEATE 5 MG PO TABS	BOTH IP/OP	$6.36 	$4.71	$0.00	$4.80		$0.00	$0.00	$0.00	$1.13	$0.00	$0.00	$0.00	$0.00	$0.00	$1.33	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9929	ERX	HCPCS 25000001	00143-9786-01	ENALAPRILAT 1.25 MG/ML IV INJ	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9929	ERX	HCPCS 25000001	00143-9786-10	ENALAPRILAT 1.25 MG/ML IV INJ	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9929	ERX	HCPCS 25000001	00409-2122-02	ENALAPRILAT 1.25 MG/ML IV INJ	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9938	ERX	HCPCS J0885	59676-0310-00	EPOETIN ALFA 10000 UNIT/ML IJ SOLN	BOTH IP/OP	$936.41 	$692.94	$0.00	$679.86		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.15	$0.00	$0.00	$0.00	$0.00	$424.92	$673.07	$679.86	$0.00		$0.00	$133.00	$0.00	$0.00	$118.59	$0.00	$0.00	$0.00	$0.00	$0.00
9938	ERX	HCPCS J0885	59676-0310-01	EPOETIN ALFA 10000 UNIT/ML IJ SOLN	BOTH IP/OP	$936.41 	$692.94	$0.00	$679.86		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.15	$0.00	$0.00	$0.00	$0.00	$424.92	$673.07	$679.86	$0.00		$0.00	$133.00	$0.00	$0.00	$118.59	$0.00	$0.00	$0.00	$0.00	$0.00
9938	ERX	HCPCS J0885	59676-0310-02	EPOETIN ALFA 10000 UNIT/ML IJ SOLN	BOTH IP/OP	$936.41 	$692.94	$0.00	$679.86		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.15	$0.00	$0.00	$0.00	$0.00	$424.92	$673.07	$679.86	$0.00		$0.00	$133.00	$0.00	$0.00	$118.59	$0.00	$0.00	$0.00	$0.00	$0.00
9939	ERX	HCPCS J0885	55513-0126-01	EPOETIN ALFA (EPOGEN) 2000 UNIT/ML IJ SOLN	BOTH IP/OP	$153.59 	$113.66	$0.00	$111.42		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.01	$0.00	$0.00	$0.00	$0.00	$69.64	$110.30	$111.42	$0.00		$0.00	$21.80	$0.00	$0.00	$23.72	$0.00	$0.00	$0.00	$0.00	$0.00
9939	ERX	HCPCS J0885	55513-0126-10	EPOETIN ALFA (EPOGEN) 2000 UNIT/ML IJ SOLN	BOTH IP/OP	$153.59 	$113.66	$0.00	$111.42		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.01	$0.00	$0.00	$0.00	$0.00	$69.64	$110.30	$111.42	$0.00		$0.00	$21.80	$0.00	$0.00	$23.72	$0.00	$0.00	$0.00	$0.00	$0.00
9941	ERX	HCPCS J0885	55513-0148-10	EPOETIN ALFA (EPOGEN) 4000 UNIT/ML IJ SOLN	BOTH IP/OP	$153.60 	$113.66	$0.00	$111.42		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.01	$0.00	$0.00	$0.00	$0.00	$69.64	$110.31	$111.42	$0.00		$0.00	$21.80	$0.00	$0.00	$23.72	$0.00	$0.00	$0.00	$0.00	$0.00
9949	ERX	HCPCS 63700001	00781-5405-01	ERGOTAMINE-CAFFEINE 1-100 MG PO TABS	BOTH IP/OP	$64.69 	$47.87	$0.00	$46.94		$0.00	$0.00	$0.00	$11.51	$0.00	$0.00	$0.00	$0.00	$0.00	$13.48	$0.00	$0.00	$0.00	$0.00	$29.34	$46.47	$46.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9963	ERX	HCPCS 63700001	61570-0072-01	ESTERIFIED ESTROGENS 0.3 MG PO TABS	BOTH IP/OP	$9.24 	$6.84	$0.00	$6.41		$0.00	$0.00	$0.00	$1.64	$0.00	$0.00	$0.00	$0.00	$0.00	$1.93	$0.00	$0.00	$0.00	$0.00	$4.01	$6.34	$6.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9964	ERX	HCPCS 63700001	61570-0073-01	ESTERIFIED ESTROGENS 0.625 MG PO TABS	BOTH IP/OP	$13.12 	$9.71	$0.00	$9.10		$0.00	$0.00	$0.00	$2.34	$0.00	$0.00	$0.00	$0.00	$0.00	$2.73	$0.00	$0.00	$0.00	$0.00	$5.69	$9.01	$9.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9965	ERX	HCPCS 63700001	61570-0074-01	ESTERIFIED ESTROGENS 1.25 MG PO TABS	BOTH IP/OP	$18.30 	$13.54	$0.00	$12.70		$0.00	$0.00	$0.00	$3.26	$0.00	$0.00	$0.00	$0.00	$0.00	$3.81	$0.00	$0.00	$0.00	$0.00	$7.94	$12.58	$12.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9967	ERX	HCPCS 63700001	00378-1454-01	ESTRADIOL 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9967	ERX	HCPCS 63700001	00555-0886-02	ESTRADIOL 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9968	ERX	HCPCS 63700001	00378-1458-01	ESTRADIOL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9968	ERX	HCPCS 63700001	00555-0887-02	ESTRADIOL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9968	ERX	HCPCS 63700001	00555-0887-04	ESTRADIOL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9969	ERX	HCPCS 25000001	00430-3754-14	ESTRADIOL 0.1 MG/GM VA CREA	BOTH IP/OP	$81.58 	$60.37	$0.00	$62.88		$0.00	$0.00	$0.00	$0.00	$0.00	$60.55	$60.55	$62.88	$0.00	$17.00	$0.00	$0.00	$0.00	$0.00	$37.00	$58.60	$59.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9971	ERX	HCPCS 63700001	00013-0132-02	ESTRAMUSTINE PHOSPHATE SODIUM 140 MG PO CAPS	BOTH IP/OP	$77.63 	$57.45	$0.00	$58.50		$0.00	$0.00	$0.00	$13.82	$0.00	$0.00	$0.00	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$36.56	$57.91	$58.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9972	ERX	HCPCS J1410	00046-0749-05	ESTROGENS CONJUGATED 25 MG IJ SOLR	BOTH IP/OP	"$1,192.45 "	$882.41	$0.00	$919.14	$536.60	$536.60	$341.50	$341.50	$341.50	$92.23	$885.04	$885.04	$919.14	$341.46	$401.21	$221.95	$705.33	$705.33	$0.00	$495.52	$784.90	$792.82	$0.00		$0.00	$362.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9973	ERX	HCPCS 63700001	00046-1100-81	ESTROGENS CONJUGATED 0.3 MG PO TABS	BOTH IP/OP	$32.11 	$23.76	$0.00	$21.54		$0.00	$0.00	$0.00	$5.72	$0.00	$0.00	$0.00	$0.00	$0.00	$6.69	$0.00	$0.00	$0.00	$0.00	$13.47	$21.33	$21.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9974	ERX	HCPCS 63700001	00046-1102-81	ESTROGENS CONJUGATED 0.625 MG PO TABS	BOTH IP/OP	$32.11 	$23.76	$0.00	$21.54		$0.00	$0.00	$0.00	$5.72	$0.00	$0.00	$0.00	$0.00	$0.00	$6.69	$0.00	$0.00	$0.00	$0.00	$13.47	$21.33	$21.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9977	ERX	HCPCS 63700001	00046-0872-21	"ESTROGENS, CONJUGATED 0.625 MG/GM VA CREA"	BOTH IP/OP	"$1,458.11 "	"$1,079.00"	$0.00	$997.89		$0.00	$0.00	$0.00	$259.54	$0.00	$0.00	$0.00	$0.00	$0.00	$303.87	$0.00	$0.00	$0.00	$0.00	$623.68	$987.91	$997.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9979	ERX	HCPCS 25000001	25010-0210-27	ETHACRYNATE SODIUM 50 MG IV SOLR	BOTH IP/OP	"$13,599.76 "	"$10,063.82"	$0.00	"$10,482.70"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$10,482.70"	$0.00	"$2,834.19"	$0.00	$0.00	$0.00	$0.00	"$6,168.03"	"$9,770.16"	"$9,868.85"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9980	ERX	HCPCS 63700001	25010-0215-15	ETHACRYNIC ACID 25 MG PO TABS	BOTH IP/OP	$113.23 	$83.79	$0.00	$82.14		$0.00	$0.00	$0.00	$20.15	$0.00	$0.00	$0.00	$0.00	$0.00	$23.60	$0.00	$0.00	$0.00	$0.00	$51.34	$81.31	$82.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9982	ERX	HCPCS 63700001	54879-0001-01	ETHAMBUTOL HCL 100 MG PO TABS	BOTH IP/OP	$17.52 	$12.96	$0.00	$14.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.76	$13.88	$14.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9982	ERX	HCPCS 63700001	68180-0280-01	ETHAMBUTOL HCL 100 MG PO TABS	BOTH IP/OP	$17.52 	$12.96	$0.00	$14.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.76	$13.88	$14.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9983	ERX	HCPCS 63700001	54879-0002-01	ETHAMBUTOL HCL 400 MG PO TABS	BOTH IP/OP	$11.27 	$8.34	$0.00	$9.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.64	$8.93	$9.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9983	ERX	HCPCS 63700001	68850-0012-02	ETHAMBUTOL HCL 400 MG PO TABS	BOTH IP/OP	$11.27 	$8.34	$0.00	$9.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.64	$8.93	$9.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9988	ERX	HCPCS 25000001	00008-4117-01	ETHIONAMIDE 250 MG PO TABS	BOTH IP/OP	$28.19 	$20.86	$0.00	$21.73		$0.00	$0.00	$0.00	$0.00	$0.00	$20.92	$20.92	$21.73	$0.00	$5.87	$0.00	$0.00	$0.00	$0.00	$12.59	$19.94	$20.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9989	ERX	HCPCS 63700001	00071-0237-24	ETHOSUXIMIDE 250 MG PO CAPS	BOTH IP/OP	$19.44 	$14.39	$0.00	$13.50		$0.00	$0.00	$0.00	$3.46	$0.00	$0.00	$0.00	$0.00	$0.00	$4.05	$0.00	$0.00	$0.00	$0.00	$8.44	$13.36	$13.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9989	ERX	HCPCS 63700001	23155-0532-01	ETHOSUXIMIDE 250 MG PO CAPS	BOTH IP/OP	$19.44 	$14.39	$0.00	$13.50		$0.00	$0.00	$0.00	$3.46	$0.00	$0.00	$0.00	$0.00	$0.00	$4.05	$0.00	$0.00	$0.00	$0.00	$8.44	$13.36	$13.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9989	ERX	HCPCS 63700001	61748-0025-01	ETHOSUXIMIDE 250 MG PO CAPS	BOTH IP/OP	$19.44 	$14.39	$0.00	$13.50		$0.00	$0.00	$0.00	$3.46	$0.00	$0.00	$0.00	$0.00	$0.00	$4.05	$0.00	$0.00	$0.00	$0.00	$8.44	$13.36	$13.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10001	ERX	HCPCS J8560	00378-3266-94	ETOPOSIDE 50 MG PO CAPS	BOTH IP/OP	$337.48 	$249.74	$0.00	$260.13		$0.00	$0.00	$0.00	$0.00	$0.00	$250.48	$250.48	$260.13	$0.00	$70.33	$0.00	$0.00	$0.00	$0.00	$153.17	$242.62	$245.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10010	ERX	HCPCS 63700001	68180-0150-01	FAMOTIDINE 40 MG/5ML PO SUSR	BOTH IP/OP	$594.56 	$439.97	$0.00	$431.76		$0.00	$0.00	$0.00	$105.83	$0.00	$0.00	$0.00	$0.00	$0.00	$123.91	$0.00	$0.00	$0.00	$0.00	$269.85	$427.44	$431.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10011	ERX	HCPCS 63700001	00172-5728-60	FAMOTIDINE 20 MG PO TABS	BOTH IP/OP	$10.15 	$7.51	$0.00	$7.37		$0.00	$0.00	$0.00	$1.81	$0.00	$0.00	$0.00	$0.00	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$4.61	$7.29	$7.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10011	ERX	HCPCS 63700001	42291-0281-10	FAMOTIDINE 20 MG PO TABS	BOTH IP/OP	$10.15 	$7.51	$0.00	$7.37		$0.00	$0.00	$0.00	$1.81	$0.00	$0.00	$0.00	$0.00	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$4.61	$7.29	$7.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10011	ERX	HCPCS 63700001	62332-0001-31	FAMOTIDINE 20 MG PO TABS	BOTH IP/OP	$10.15 	$7.51	$0.00	$7.37		$0.00	$0.00	$0.00	$1.81	$0.00	$0.00	$0.00	$0.00	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$4.61	$7.29	$7.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10014	ERX	HCPCS 25000001	00338-0519-09	FAT EMULSION PLANT BASED 20 % IV EMUL	BOTH IP/OP	$173.25 	$128.21	$0.00	$138.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.63	$137.21	$138.60	$0.00		$0.00	$0.00	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$0.00
10023	ERX	HCPCS 25000001	99999-6004-76	FELBAMATE 600 MG/5ML PO SUSP	BOTH IP/OP	$313.55 	$232.03	$0.00	"$3,057.36"		$0.00	$0.00	$0.00	$0.00	$0.00	$232.72	$232.72	$241.68	$0.00	$65.34	$0.00	$0.00	$0.00	$0.00	"$1,910.85"	$225.43	"$3,057.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10023	ERX	HCPCS 25000001	00037-0442-67	FELBAMATE 600 MG/5ML PO SUSP	BOTH IP/OP	$313.55 	$232.03	$0.00	"$3,057.36"		$0.00	$0.00	$0.00	$0.00	$0.00	$232.72	$232.72	$241.68	$0.00	$65.34	$0.00	$0.00	$0.00	$0.00	"$1,910.85"	"$3,026.79"	"$3,057.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10025	ERX	HCPCS 63700001	00037-0431-01	FELBAMATE 600 MG PO TABS	BOTH IP/OP	$22.74 	$16.83	$0.00	$18.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.37	$18.01	$18.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10025	ERX	HCPCS 63700001	51525-0431-01	FELBAMATE 600 MG PO TABS	BOTH IP/OP	$22.74 	$16.83	$0.00	$18.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.37	$18.01	$18.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10037	ERX	HCPCS 63700001	00093-7355-56	FINASTERIDE 5 MG PO TABS	BOTH IP/OP	$13.12 	$9.71	$0.00	$9.52		$0.00	$0.00	$0.00	$2.34	$0.00	$0.00	$0.00	$0.00	$0.00	$2.73	$0.00	$0.00	$0.00	$0.00	$5.95	$9.42	$9.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10037	ERX	HCPCS 63700001	00093-7355-98	FINASTERIDE 5 MG PO TABS	BOTH IP/OP	$13.12 	$9.71	$0.00	$9.52		$0.00	$0.00	$0.00	$2.34	$0.00	$0.00	$0.00	$0.00	$0.00	$2.73	$0.00	$0.00	$0.00	$0.00	$5.95	$9.42	$9.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10037	ERX	HCPCS 63700001	16729-0090-01	FINASTERIDE 5 MG PO TABS	BOTH IP/OP	$13.12 	$9.71	$0.00	$9.52		$0.00	$0.00	$0.00	$2.34	$0.00	$0.00	$0.00	$0.00	$0.00	$2.73	$0.00	$0.00	$0.00	$0.00	$5.95	$9.42	$9.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10037	ERX	HCPCS 63700001	50268-0323-15	FINASTERIDE 5 MG PO TABS	BOTH IP/OP	$13.12 	$9.71	$0.00	$9.52		$0.00	$0.00	$0.00	$2.34	$0.00	$0.00	$0.00	$0.00	$0.00	$2.73	$0.00	$0.00	$0.00	$0.00	$5.95	$9.42	$9.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10037	ERX	HCPCS 63700001	57237-0062-30	FINASTERIDE 5 MG PO TABS	BOTH IP/OP	$13.12 	$9.71	$0.00	$9.52		$0.00	$0.00	$0.00	$2.34	$0.00	$0.00	$0.00	$0.00	$0.00	$2.73	$0.00	$0.00	$0.00	$0.00	$5.95	$9.42	$9.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10037	ERX	HCPCS 63700001	65862-0149-90	FINASTERIDE 5 MG PO TABS	BOTH IP/OP	$13.12 	$9.71	$0.00	$9.52		$0.00	$0.00	$0.00	$2.34	$0.00	$0.00	$0.00	$0.00	$0.00	$2.73	$0.00	$0.00	$0.00	$0.00	$5.95	$9.42	$9.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10037	ERX	HCPCS 63700001	76282-0412-90	FINASTERIDE 5 MG PO TABS	BOTH IP/OP	$13.12 	$9.71	$0.00	$9.52		$0.00	$0.00	$0.00	$2.34	$0.00	$0.00	$0.00	$0.00	$0.00	$2.73	$0.00	$0.00	$0.00	$0.00	$5.95	$9.42	$9.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10041	ERX	HCPCS 63700001	00054-0011-21	FLECAINIDE ACETATE 100 MG PO TABS	BOTH IP/OP	$15.00 	$11.10	$0.00	$10.89		$0.00	$0.00	$0.00	$2.67	$0.00	$0.00	$0.00	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$6.81	$10.78	$10.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10041	ERX	HCPCS 63700001	00054-0011-25	FLECAINIDE ACETATE 100 MG PO TABS	BOTH IP/OP	$15.00 	$11.10	$0.00	$10.89		$0.00	$0.00	$0.00	$2.67	$0.00	$0.00	$0.00	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$6.81	$10.78	$10.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10041	ERX	HCPCS 63700001	50268-0321-11	FLECAINIDE ACETATE 100 MG PO TABS	BOTH IP/OP	$15.00 	$11.10	$0.00	$10.89		$0.00	$0.00	$0.00	$2.67	$0.00	$0.00	$0.00	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$6.81	$10.78	$10.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10041	ERX	HCPCS 63700001	50268-0321-15	FLECAINIDE ACETATE 100 MG PO TABS	BOTH IP/OP	$15.00 	$11.10	$0.00	$10.89		$0.00	$0.00	$0.00	$2.67	$0.00	$0.00	$0.00	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$6.81	$10.78	$10.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10041	ERX	HCPCS 63700001	65162-0642-10	FLECAINIDE ACETATE 100 MG PO TABS	BOTH IP/OP	$15.00 	$11.10	$0.00	$10.89		$0.00	$0.00	$0.00	$2.67	$0.00	$0.00	$0.00	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$6.81	$10.78	$10.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10042	ERX	HCPCS 63700001	00054-0012-21	FLECAINIDE ACETATE 150 MG PO TABS	BOTH IP/OP	$18.20 	$13.47	$0.00	$13.21		$0.00	$0.00	$0.00	$3.24	$0.00	$0.00	$0.00	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$8.26	$13.08	$13.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10042	ERX	HCPCS 63700001	00054-0012-25	FLECAINIDE ACETATE 150 MG PO TABS	BOTH IP/OP	$18.20 	$13.47	$0.00	$13.21		$0.00	$0.00	$0.00	$3.24	$0.00	$0.00	$0.00	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$8.26	$13.08	$13.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10042	ERX	HCPCS 63700001	53746-0643-01	FLECAINIDE ACETATE 150 MG PO TABS	BOTH IP/OP	$18.20 	$13.47	$0.00	$13.21		$0.00	$0.00	$0.00	$3.24	$0.00	$0.00	$0.00	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$8.26	$13.08	$13.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10042	ERX	HCPCS 63700001	65162-0643-10	FLECAINIDE ACETATE 150 MG PO TABS	BOTH IP/OP	$18.20 	$13.47	$0.00	$13.21		$0.00	$0.00	$0.00	$3.24	$0.00	$0.00	$0.00	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$8.26	$13.08	$13.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10043	ERX	HCPCS 63700001	00054-0010-20	FLECAINIDE ACETATE 50 MG PO TABS	BOTH IP/OP	$8.47 	$6.27	$0.00	$6.14		$0.00	$0.00	$0.00	$1.51	$0.00	$0.00	$0.00	$0.00	$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$3.84	$6.08	$6.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10043	ERX	HCPCS 63700001	00054-0010-21	FLECAINIDE ACETATE 50 MG PO TABS	BOTH IP/OP	$8.47 	$6.27	$0.00	$6.14		$0.00	$0.00	$0.00	$1.51	$0.00	$0.00	$0.00	$0.00	$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$3.84	$6.08	$6.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10043	ERX	HCPCS 63700001	00054-0010-25	FLECAINIDE ACETATE 50 MG PO TABS	BOTH IP/OP	$8.47 	$6.27	$0.00	$6.14		$0.00	$0.00	$0.00	$1.51	$0.00	$0.00	$0.00	$0.00	$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$3.84	$6.08	$6.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10043	ERX	HCPCS 63700001	65162-0641-10	FLECAINIDE ACETATE 50 MG PO TABS	BOTH IP/OP	$8.47 	$6.27	$0.00	$6.14		$0.00	$0.00	$0.00	$1.51	$0.00	$0.00	$0.00	$0.00	$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$3.84	$6.08	$6.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10044	ERX	HCPCS 63700001	00172-5411-46	FLUCONAZOLE 100 MG PO TABS	BOTH IP/OP	$33.46 	$24.76	$0.00	$26.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.73	$26.50	$26.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10044	ERX	HCPCS 63700001	16714-0691-01	FLUCONAZOLE 100 MG PO TABS	BOTH IP/OP	$33.46 	$24.76	$0.00	$26.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.73	$26.50	$26.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10044	ERX	HCPCS 63700001	16714-0691-02	FLUCONAZOLE 100 MG PO TABS	BOTH IP/OP	$33.46 	$24.76	$0.00	$26.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.73	$26.50	$26.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10044	ERX	HCPCS 63700001	55111-0144-01	FLUCONAZOLE 100 MG PO TABS	BOTH IP/OP	$33.46 	$24.76	$0.00	$26.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.73	$26.50	$26.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10044	ERX	HCPCS 63700001	55111-0144-30	FLUCONAZOLE 100 MG PO TABS	BOTH IP/OP	$33.46 	$24.76	$0.00	$26.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.73	$26.50	$26.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10044	ERX	HCPCS 63700001	68462-0102-30	FLUCONAZOLE 100 MG PO TABS	BOTH IP/OP	$33.46 	$24.76	$0.00	$26.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.73	$26.50	$26.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10045	ERX	HCPCS 63700001	00172-5413-46	FLUCONAZOLE 200 MG PO TABS	BOTH IP/OP	$68.49 	$50.68	$0.00	$49.70		$0.00	$0.00	$0.00	$12.19	$0.00	$0.00	$0.00	$0.00	$0.00	$14.27	$0.00	$0.00	$0.00	$0.00	$31.06	$49.20	$49.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10045	ERX	HCPCS 63700001	00904-6501-61	FLUCONAZOLE 200 MG PO TABS	BOTH IP/OP	$68.49 	$50.68	$0.00	$49.70		$0.00	$0.00	$0.00	$12.19	$0.00	$0.00	$0.00	$0.00	$0.00	$14.27	$0.00	$0.00	$0.00	$0.00	$31.06	$49.20	$49.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10045	ERX	HCPCS 63700001	16714-0693-01	FLUCONAZOLE 200 MG PO TABS	BOTH IP/OP	$68.49 	$50.68	$0.00	$49.70		$0.00	$0.00	$0.00	$12.19	$0.00	$0.00	$0.00	$0.00	$0.00	$14.27	$0.00	$0.00	$0.00	$0.00	$31.06	$49.20	$49.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10045	ERX	HCPCS 63700001	68084-0735-01	FLUCONAZOLE 200 MG PO TABS	BOTH IP/OP	$68.49 	$50.68	$0.00	$49.70		$0.00	$0.00	$0.00	$12.19	$0.00	$0.00	$0.00	$0.00	$0.00	$14.27	$0.00	$0.00	$0.00	$0.00	$31.06	$49.20	$49.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10049	ERX	HCPCS j1450	00338-6046-48	FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN	BOTH IP/OP	$41.04 	$30.37	$0.00	$32.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$6.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10049	ERX	HCPCS j1450	00409-4688-18	FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN	BOTH IP/OP	$41.04 	$30.37	$0.00	$32.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$6.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10049	ERX	HCPCS j1450	25021-0113-82	FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN	BOTH IP/OP	$41.04 	$30.37	$0.00	$32.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$6.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10049	ERX	HCPCS j1450	25021-0184-66	FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN	BOTH IP/OP	$41.04 	$30.37	$0.00	$32.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$6.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10049	ERX	HCPCS j1450	25021-0184-82	FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN	BOTH IP/OP	$41.04 	$30.37	$0.00	$32.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$6.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10049	ERX	HCPCS j1450	70655-0002-06	FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN	BOTH IP/OP	$41.04 	$30.37	$0.00	$32.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$6.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10049	ERX	HCPCS j1450	70655-0002-10	FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN	BOTH IP/OP	$41.04 	$30.37	$0.00	$32.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$6.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10050	ERX	HCPCS J1450	00338-6045-37	FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN	BOTH IP/OP	$63.84 	$47.24	$0.00	$51.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.92	$50.56	$51.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10050	ERX	HCPCS J1450	00409-4688-12	FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN	BOTH IP/OP	$63.84 	$47.24	$0.00	$51.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.92	$50.56	$51.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10050	ERX	HCPCS J1450	00409-4688-16	FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN	BOTH IP/OP	$63.84 	$47.24	$0.00	$51.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.92	$50.56	$51.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10050	ERX	HCPCS J1450	25021-0113-87	FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN	BOTH IP/OP	$63.84 	$47.24	$0.00	$51.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.92	$50.56	$51.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10050	ERX	HCPCS J1450	25021-0184-87	FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN	BOTH IP/OP	$63.84 	$47.24	$0.00	$51.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.92	$50.56	$51.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10050	ERX	HCPCS J1450	70655-0088-06	FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN	BOTH IP/OP	$63.84 	$47.24	$0.00	$51.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.92	$50.56	$51.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10050	ERX	HCPCS J1450	70655-0088-10	FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN	BOTH IP/OP	$63.84 	$47.24	$0.00	$51.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.92	$50.56	$51.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10051	ERX	HCPCS 63700001	00054-0427-25	FLUCYTOSINE 250 MG PO CAPS	BOTH IP/OP	$144.75 	$107.12	$0.00	$105.00		$0.00	$0.00	$0.00	$25.77	$0.00	$0.00	$0.00	$0.00	$0.00	$30.17	$0.00	$0.00	$0.00	$0.00	$65.63	$103.95	$105.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10051	ERX	HCPCS 63700001	42794-0009-08	FLUCYTOSINE 250 MG PO CAPS	BOTH IP/OP	$144.75 	$107.12	$0.00	$105.00		$0.00	$0.00	$0.00	$25.77	$0.00	$0.00	$0.00	$0.00	$0.00	$30.17	$0.00	$0.00	$0.00	$0.00	$65.63	$103.95	$105.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10052	ERX	HCPCS 63700001	00054-0428-25	FLUCYTOSINE 500 MG PO CAPS	BOTH IP/OP	$245.80 	$181.89	$0.00	$178.50		$0.00	$0.00	$0.00	$43.75	$0.00	$0.00	$0.00	$0.00	$0.00	$51.22	$0.00	$0.00	$0.00	$0.00	$111.57	$176.72	$178.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10052	ERX	HCPCS 63700001	42494-0340-01	FLUCYTOSINE 500 MG PO CAPS	BOTH IP/OP	$245.80 	$181.89	$0.00	$178.50		$0.00	$0.00	$0.00	$43.75	$0.00	$0.00	$0.00	$0.00	$0.00	$51.22	$0.00	$0.00	$0.00	$0.00	$111.57	$176.72	$178.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10052	ERX	HCPCS 63700001	42794-0010-08	FLUCYTOSINE 500 MG PO CAPS	BOTH IP/OP	$245.80 	$181.89	$0.00	$178.50		$0.00	$0.00	$0.00	$43.75	$0.00	$0.00	$0.00	$0.00	$0.00	$51.22	$0.00	$0.00	$0.00	$0.00	$111.57	$176.72	$178.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10052	ERX	HCPCS 63700001	43386-0770-01	FLUCYTOSINE 500 MG PO CAPS	BOTH IP/OP	$245.80 	$181.89	$0.00	$178.50		$0.00	$0.00	$0.00	$43.75	$0.00	$0.00	$0.00	$0.00	$0.00	$51.22	$0.00	$0.00	$0.00	$0.00	$111.57	$176.72	$178.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10054	ERX	HCPCS 63700001	00115-7033-01	FLUDROCORTISONE ACETATE 0.1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10054	ERX	HCPCS 63700001	00555-0997-02	FLUDROCORTISONE ACETATE 0.1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10054	ERX	HCPCS 63700001	68084-0288-01	FLUDROCORTISONE ACETATE 0.1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10054	ERX	HCPCS 63700001	68084-0288-11	FLUDROCORTISONE ACETATE 0.1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10061	ERX	HCPCS 25000001	59390-0218-05	FLUORESCEIN-BENOXINATE 0.25-0.4 % OP SOLN	BOTH IP/OP	$148.23 	$109.69	$0.00	$114.26		$0.00	$0.00	$0.00	$0.00	$0.00	$110.02	$110.02	$114.26	$0.00	$30.89	$0.00	$0.00	$0.00	$0.00	$67.20	$106.44	$107.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10063	ERX	HCPCS 25000001	00065-0096-05	FLUOROMETHOLONE ACETATE 0.1 % OP SUSP	BOTH IP/OP	$362.72 	$268.41	$0.00	$279.58		$0.00	$0.00	$0.00	$0.00	$0.00	$269.21	$269.21	$279.58	$0.00	$75.59	$0.00	$0.00	$0.00	$0.00	$164.63	$260.77	$263.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10065	ERX	HCPCS 25000001	66530-0249-40	FLUOROURACIL 5 % EX CREA	BOTH IP/OP	$751.61 	$556.19	$0.00	$579.34		$0.00	$0.00	$0.00	$0.00	$0.00	$557.84	$557.84	$579.34	$0.00	$156.64	$0.00	$0.00	$0.00	$0.00	$341.06	$540.23	$545.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10069	ERX	HCPCS 63700001	00904-5784-61	FLUOXETINE HCL 10 MG PO CAPS	BOTH IP/OP	$10.89 	$8.06	$0.00	$7.90		$0.00	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$4.94	$7.82	$7.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10069	ERX	HCPCS 63700001	65862-0192-01	FLUOXETINE HCL 10 MG PO CAPS	BOTH IP/OP	$10.89 	$8.06	$0.00	$7.90		$0.00	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$4.94	$7.82	$7.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10069	ERX	HCPCS 63700001	65862-0192-99	FLUOXETINE HCL 10 MG PO CAPS	BOTH IP/OP	$10.89 	$8.06	$0.00	$7.90		$0.00	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$4.94	$7.82	$7.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10070	ERX	HCPCS 63700001	00904-5785-61	FLUOXETINE HCL 20 MG PO CAPS	BOTH IP/OP	$10.41 	$7.70	$0.00	$7.55		$0.00	$0.00	$0.00	$1.85	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.72	$7.48	$7.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10070	ERX	HCPCS 63700001	68084-0605-01	FLUOXETINE HCL 20 MG PO CAPS	BOTH IP/OP	$10.41 	$7.70	$0.00	$7.55		$0.00	$0.00	$0.00	$1.85	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.72	$7.48	$7.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10072	ERX	HCPCS 63700001	00121-0654-02	FLUPHENAZINE HCL 2.5 MG/5ML PO ELIX	BOTH IP/OP	$110.01 	$81.41	$0.00	$79.80		$0.00	$0.00	$0.00	$26.38	$0.00	$0.00	$0.00	$0.00	$0.00	$22.93	$0.00	$0.00	$0.00	$0.00	$49.88	$79.00	$79.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10078	ERX	HCPCS 63700001	00093-0711-01	FLURBIPROFEN 100 MG PO TABS	BOTH IP/OP	$7.94 	$5.88	$0.00	$5.76		$0.00	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.70	$5.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10078	ERX	HCPCS 63700001	00378-0093-01	FLURBIPROFEN 100 MG PO TABS	BOTH IP/OP	$7.94 	$5.88	$0.00	$5.76		$0.00	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.70	$5.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10082	ERX	HCPCS 25000001	45802-0222-11	FLUTICASONE PROPIONATE 0.05 % EX CREA	BOTH IP/OP	$132.36 	$97.95	$0.00	$102.02		$0.00	$0.00	$0.00	$0.00	$0.00	$98.24	$98.24	$102.02	$0.00	$27.58	$0.00	$0.00	$0.00	$0.00	$60.01	$95.06	$96.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10083	ERX	HCPCS 25000001	00713-0632-31	FLUTICASONE PROPIONATE 0.005 % EX OINT	BOTH IP/OP	$132.36 	$97.95	$0.00	$102.02		$0.00	$0.00	$0.00	$0.00	$0.00	$98.24	$98.24	$102.02	$0.00	$27.58	$0.00	$0.00	$0.00	$0.00	$60.01	$95.06	$96.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10083	ERX	HCPCS 25000001	45802-0221-11	FLUTICASONE PROPIONATE 0.005 % EX OINT	BOTH IP/OP	$132.36 	$97.95	$0.00	$102.02		$0.00	$0.00	$0.00	$0.00	$0.00	$98.24	$98.24	$102.02	$0.00	$27.58	$0.00	$0.00	$0.00	$0.00	$60.01	$95.06	$96.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10084	ERX	HCPCS 63700001	60505-0166-01	FLUVOXAMINE MALEATE 100 MG PO TABS	BOTH IP/OP	$11.07 	$8.19	$0.00	$8.03		$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$0.00	$2.31	$0.00	$0.00	$0.00	$0.00	$5.02	$7.95	$8.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10085	ERX	HCPCS 63700001	62559-0159-01	FLUVOXAMINE MALEATE 50 MG PO TABS	BOTH IP/OP	$9.79 	$7.24	$0.00	$7.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.90	$7.75	$7.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10100	ERX	HCPCS A9579	00270-1111-01	GADOTERIDOL 279.3 MG/ML IV SOLN	BOTH IP/OP	$242.21 	$179.24	$0.00	$179.77	$108.99	$108.99	$0.00	$0.00	$0.00	$50.48	$179.77	$179.77	$0.00	$0.00	$50.48	$0.00	$143.27	$143.27	$0.00	$109.94	$174.14	$175.90	$0.00		$0.00	$34.41	$0.00	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00
10100	ERX	HCPCS A9579	00270-1111-02	GADOTERIDOL 279.3 MG/ML IV SOLN	BOTH IP/OP	$242.21 	$179.24	$0.00	$179.77	$108.99	$108.99	$0.00	$0.00	$0.00	$50.48	$179.77	$179.77	$0.00	$0.00	$50.48	$0.00	$143.27	$143.27	$0.00	$109.94	$174.14	$175.90	$0.00		$0.00	$34.41	$0.00	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00
10100	ERX	HCPCS A9579	00270-1111-03	GADOTERIDOL 279.3 MG/ML IV SOLN	BOTH IP/OP	$242.21 	$179.24	$0.00	$179.77	$108.99	$108.99	$0.00	$0.00	$0.00	$50.48	$179.77	$179.77	$0.00	$0.00	$50.48	$0.00	$143.27	$143.27	$0.00	$109.94	$174.14	$175.90	$0.00		$0.00	$34.41	$0.00	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00
10101	ERX	HCPCS J1570	42023-0173-25	GANCICLOVIR SODIUM 500 MG IV SOLR	BOTH IP/OP	$392.20 	$290.23	$0.00	$302.31		$0.00	$0.00	$0.00	$0.00	$0.00	$291.09	$291.09	$302.31	$0.00	$58.04	$0.00	$0.00	$0.00	$0.00	$178.01	$281.96	$284.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10101	ERX	HCPCS J1570	63323-0315-10	GANCICLOVIR SODIUM 500 MG IV SOLR	BOTH IP/OP	$392.20 	$290.23	$0.00	$302.31		$0.00	$0.00	$0.00	$0.00	$0.00	$291.09	$291.09	$302.31	$0.00	$58.04	$0.00	$0.00	$0.00	$0.00	$178.01	$281.96	$284.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10116	ERX	HCPCS 63700001	51079-0811-01	GLIPIZIDE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10116	ERX	HCPCS 63700001	51079-0811-20	GLIPIZIDE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10117	ERX	HCPCS 63700001	00904-6637-61	GLIPIZIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10117	ERX	HCPCS 63700001	51079-0810-20	GLIPIZIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10126	ERX	HCPCS 63700001	00093-8343-01	GLYBURIDE 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10126	ERX	HCPCS 63700001	00093-9433-01	GLYBURIDE 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10126	ERX	HCPCS 63700001	51079-0872-01	GLYBURIDE 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10126	ERX	HCPCS 63700001	51079-0872-20	GLYBURIDE 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10126	ERX	HCPCS 63700001	65862-0029-01	GLYBURIDE 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10130	ERX	HCPCS 25000001	13107-0014-01	GLYCOPYRROLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10130	ERX	HCPCS 25000001	42291-0303-90	GLYCOPYRROLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10130	ERX	HCPCS 25000001	49884-0065-01	GLYCOPYRROLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10130	ERX	HCPCS 25000001	64980-0272-01	GLYCOPYRROLATE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10137	ERX	HCPCS J9202	70720-0950-36	GOSERELIN ACETATE 3.6 MG SC IMPL	BOTH IP/OP	"$2,435.46 "	"$1,802.24"	$0.00	"$1,877.25"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,807.60"	"$1,807.60"	"$1,877.25"	$0.00	$617.13	$0.00	$0.00	$0.00	$0.00	"$1,005.33"	"$1,448.98"	"$1,608.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10149	ERX	HCPCS 63700001	00378-1160-01	GUANFACINE HCL 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10149	ERX	HCPCS 63700001	00591-0444-01	GUANFACINE HCL 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10162	ERX	HCPCS J1631	00143-9295-01	HALOPERIDOL DECANOATE 100 MG/ML IM SOLN	BOTH IP/OP	$55.60 	$41.14	$0.00	$42.86	$25.02	$25.02	$0.00	$0.00	$0.00	$3.87	$41.27	$41.27	$42.86	$0.00	$11.24	$0.00	$32.89	$32.89	$0.00	$25.22	$39.94	$40.34	$0.00		$0.00	$19.36	$0.00	$0.00	$18.44	$0.00	$0.00	$0.00	$0.00	$0.00
10162	ERX	HCPCS J1631	10147-0922-05	HALOPERIDOL DECANOATE 100 MG/ML IM SOLN	BOTH IP/OP	$55.60 	$41.14	$0.00	$42.86	$25.02	$25.02	$0.00	$0.00	$0.00	$3.87	$41.27	$41.27	$42.86	$0.00	$11.24	$0.00	$32.89	$32.89	$0.00	$25.22	$39.94	$40.34	$0.00		$0.00	$19.36	$0.00	$0.00	$18.44	$0.00	$0.00	$0.00	$0.00	$0.00
10162	ERX	HCPCS J1631	25021-0833-01	HALOPERIDOL DECANOATE 100 MG/ML IM SOLN	BOTH IP/OP	$55.60 	$41.14	$0.00	$42.86	$25.02	$25.02	$0.00	$0.00	$0.00	$3.87	$41.27	$41.27	$42.86	$0.00	$11.24	$0.00	$32.89	$32.89	$0.00	$25.22	$39.94	$40.34	$0.00		$0.00	$19.36	$0.00	$0.00	$18.44	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	00069-0058-01	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	00069-0137-01	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	00069-0137-03	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	00409-2720-03	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	00409-2720-31	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	00409-2720-32	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	00641-2450-55	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	25021-0400-10	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	25021-0400-30	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	63323-0540-01	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	63323-0540-11	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	63323-0540-15	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	63323-0540-31	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	63323-0540-36	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	63323-0540-67	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	67457-0384-99	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	67457-0385-10	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10176	ERX	HCPCS J1644	67457-0385-99	HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
10177	ERX	HCPCS J1644	25021-0403-04	HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.35	$16.33	$16.33	$16.96	$0.00	$2.91	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.82	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00
10177	ERX	HCPCS J1644	67457-0603-05	HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.35	$16.33	$16.33	$16.96	$0.00	$2.91	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.82	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00
10177	ERX	HCPCS J1644	67457-0603-99	HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.35	$16.33	$16.33	$16.96	$0.00	$2.91	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.82	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00
10181	ERX	HCPCS J1644	00069-0059-03	HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10181	ERX	HCPCS J1644	00641-0400-12	HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10181	ERX	HCPCS J1644	25021-0402-01	HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10181	ERX	HCPCS J1644	63323-0262-01	HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10181	ERX	HCPCS J1644	63739-0953-25	HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10203	ERX	HCPCS 25000001	51927-1647-00	HYDROCHLORIC ACID 37 % LIQD	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10209	ERX	HCPCS 63700001	00009-0012-01	HYDROCORTISONE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10209	ERX	HCPCS 63700001	42543-0140-50	HYDROCORTISONE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10209	ERX	HCPCS 63700001	59762-0073-01	HYDROCORTISONE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10209	ERX	HCPCS 63700001	72789-0095-50	HYDROCORTISONE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10210	ERX	HCPCS 25000001	62559-0138-07	HYDROCORTISONE 100 MG/60ML RECTAL ENEM	BOTH IP/OP	$46.06 	$34.08	$0.00	$36.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.03	$36.48	$36.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10217	ERX	HCPCS 25000001	00574-0420-25	HYDROCORTISONE MICRONIZED POWD	BOTH IP/OP	$312.30 	$231.10	$0.00	$240.72		$0.00	$0.00	$0.00	$0.00	$0.00	$231.79	$231.79	$240.72	$0.00	$65.08	$0.00	$0.00	$0.00	$0.00	$141.75	$224.53	$226.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10230	ERX	HCPCS 25000001	42192-0151-01	HYDROQUINONE 4 % EX CREA	BOTH IP/OP	$359.12 	$265.75	$0.00	$276.81		$0.00	$0.00	$0.00	$0.00	$0.00	$266.54	$266.54	$276.81	$0.00	$74.84	$0.00	$0.00	$0.00	$0.00	$163.00	$258.18	$260.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10235	ERX	HCPCS 63700001	00378-0373-01	HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS	BOTH IP/OP	$10.79 	$7.98	$0.00	$8.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.40	$8.55	$8.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10235	ERX	HCPCS 63700001	00591-3041-01	HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS	BOTH IP/OP	$10.79 	$7.98	$0.00	$8.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.40	$8.55	$8.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10235	ERX	HCPCS 63700001	00781-5994-01	HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS	BOTH IP/OP	$10.79 	$7.98	$0.00	$8.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.40	$8.55	$8.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10235	ERX	HCPCS 63700001	43598-0721-01	HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS	BOTH IP/OP	$10.79 	$7.98	$0.00	$8.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.40	$8.55	$8.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10235	ERX	HCPCS 63700001	63739-0777-10	HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS	BOTH IP/OP	$10.79 	$7.98	$0.00	$8.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.40	$8.55	$8.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10235	ERX	HCPCS 63700001	66993-0057-02	HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS	BOTH IP/OP	$10.79 	$7.98	$0.00	$8.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.40	$8.55	$8.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10235	ERX	HCPCS 63700001	68084-0269-01	HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS	BOTH IP/OP	$10.79 	$7.98	$0.00	$8.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.40	$8.55	$8.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10235	ERX	HCPCS 63700001	68084-0269-11	HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS	BOTH IP/OP	$10.79 	$7.98	$0.00	$8.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.40	$8.55	$8.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10236	ERX	HCPCS 63700001	00555-0882-02	HYDROXYUREA 500 MG PO CAPS	BOTH IP/OP	$6.18 	$4.57	$0.00	$4.80		$0.00	$0.00	$0.00	$1.10	$0.00	$0.00	$0.00	$0.00	$0.00	$1.29	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10236	ERX	HCPCS 63700001	49884-0724-01	HYDROXYUREA 500 MG PO CAPS	BOTH IP/OP	$6.18 	$4.57	$0.00	$4.80		$0.00	$0.00	$0.00	$1.10	$0.00	$0.00	$0.00	$0.00	$0.00	$1.29	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10236	ERX	HCPCS 63700001	68084-0284-01	HYDROXYUREA 500 MG PO CAPS	BOTH IP/OP	$6.18 	$4.57	$0.00	$4.80		$0.00	$0.00	$0.00	$1.10	$0.00	$0.00	$0.00	$0.00	$0.00	$1.29	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10236	ERX	HCPCS 63700001	68084-0284-11	HYDROXYUREA 500 MG PO CAPS	BOTH IP/OP	$6.18 	$4.57	$0.00	$4.80		$0.00	$0.00	$0.00	$1.10	$0.00	$0.00	$0.00	$0.00	$0.00	$1.29	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10246	ERX	HCPCS 25000001	45802-0140-26	IBUPROFEN 100 MG/5ML PO SUSP	BOTH IP/OP	$18.39 	$13.61	$0.00	$14.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.20	$14.56	$14.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10246	ERX	HCPCS 25000001	49348-0229-34	IBUPROFEN 100 MG/5ML PO SUSP	BOTH IP/OP	$14.14 	$10.46	$0.00	$14.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.20	$11.20	$14.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10246	ERX	HCPCS 25000001	51672-2130-08	IBUPROFEN 100 MG/5ML PO SUSP	BOTH IP/OP	$14.14 	$10.46	$0.00	$14.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.20	$11.20	$14.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10246	ERX	HCPCS 25000001	00121-1836-05	IBUPROFEN 100 MG/5ML PO SUSP	BOTH IP/OP	$6.00 	$4.44	$0.00	$14.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.20	$4.75	$14.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10246	ERX	HCPCS 25000001	00121-4774-40	IBUPROFEN 100 MG/5ML PO SUSP	BOTH IP/OP	$6.00 	$4.44	$0.00	$14.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.20	$4.75	$14.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10246	ERX	HCPCS 25000001	68094-0494-61	IBUPROFEN 100 MG/5ML PO SUSP	BOTH IP/OP	$6.00 	$4.44	$0.00	$14.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.20	$4.75	$14.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10248	ERX	HCPCS J9208	10019-0925-01	IFOSFAMIDE 1 G IV SOLR	BOTH IP/OP	$241.73 	$178.88	$0.00	$186.33		$0.00	$0.00	$0.00	$0.00	$0.00	$179.41	$179.41	$186.33	$0.00	$31.44	$0.00	$0.00	$0.00	$0.00	$109.72	$173.79	$175.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10248	ERX	HCPCS J9208	10019-0925-82	IFOSFAMIDE 1 G IV SOLR	BOTH IP/OP	$241.73 	$178.88	$0.00	$186.33		$0.00	$0.00	$0.00	$0.00	$0.00	$179.41	$179.41	$186.33	$0.00	$31.44	$0.00	$0.00	$0.00	$0.00	$109.72	$173.79	$175.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10248	ERX	HCPCS J9208	63323-0142-10	IFOSFAMIDE 1 G IV SOLR	BOTH IP/OP	$241.73 	$178.88	$0.00	$186.33		$0.00	$0.00	$0.00	$0.00	$0.00	$179.41	$179.41	$186.33	$0.00	$31.44	$0.00	$0.00	$0.00	$0.00	$109.72	$173.79	$175.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10266	ERX	HCPCS 25000001	17238-0424-06	INDOCYANINE GREEN 25 MG IV SOLR	BOTH IP/OP	$34.38 	$25.44	$0.00	$26.50		$0.00	$0.00	$0.00	$0.00	$0.00	$25.52	$25.52	$26.50	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$15.59	$24.69	$24.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10266	ERX	HCPCS 25000001	17478-0701-02	INDOCYANINE GREEN 25 MG IV SOLR	BOTH IP/OP	$34.38 	$25.44	$0.00	$26.50		$0.00	$0.00	$0.00	$0.00	$0.00	$25.52	$25.52	$26.50	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$15.59	$24.69	$24.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10266	ERX	HCPCS 25000001	66259-0701-25	INDOCYANINE GREEN 25 MG IV SOLR	BOTH IP/OP	$34.38 	$25.44	$0.00	$26.50		$0.00	$0.00	$0.00	$0.00	$0.00	$25.52	$25.52	$26.50	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$15.59	$24.69	$24.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10266	ERX	HCPCS 25000001	70100-0424-02	INDOCYANINE GREEN 25 MG IV SOLR	BOTH IP/OP	$34.38 	$25.44	$0.00	$26.50		$0.00	$0.00	$0.00	$0.00	$0.00	$25.52	$25.52	$26.50	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$15.59	$24.69	$24.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10267	ERX	HCPCS 25000001	00409-1113-01	INDOMETHACIN SODIUM 1 MG IV SOLR	BOTH IP/OP	"$1,387.59 "	"$1,026.82"	$0.00	"$1,069.55"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,029.87"	"$1,029.87"	"$1,069.55"	$0.00	$289.17	$0.00	$0.00	$0.00	$0.00	$629.64	$997.35	"$1,007.42"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10267	ERX	HCPCS 25000001	63323-0659-03	INDOMETHACIN SODIUM 1 MG IV SOLR	BOTH IP/OP	"$1,387.59 "	"$1,026.82"	$0.00	"$1,069.55"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,029.87"	"$1,029.87"	"$1,069.55"	$0.00	$289.17	$0.00	$0.00	$0.00	$0.00	$629.64	$997.35	"$1,007.42"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10267	ERX	HCPCS 25000001	63323-0659-09	INDOMETHACIN SODIUM 1 MG IV SOLR	BOTH IP/OP	"$1,387.59 "	"$1,026.82"	$0.00	"$1,069.55"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,029.87"	"$1,029.87"	"$1,069.55"	$0.00	$289.17	$0.00	$0.00	$0.00	$0.00	$629.64	$997.35	"$1,007.42"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10267	ERX	HCPCS 25000001	68382-0470-01	INDOMETHACIN SODIUM 1 MG IV SOLR	BOTH IP/OP	"$1,387.59 "	"$1,026.82"	$0.00	"$1,069.55"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,029.87"	"$1,029.87"	"$1,069.55"	$0.00	$289.17	$0.00	$0.00	$0.00	$0.00	$629.64	$997.35	"$1,007.42"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10284	ERX	HCPCS J1815	00002-8315-01	INSULIN NOVOLIN NPH 100 UNIT/ML SC SUSP	BOTH IP/OP	$10.00 	$7.40	$0.00	$201.38	$5.43	$5.43	$0.00	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$2.08	$0.00	$5.92	$5.92	$0.00	$5.00	$7.92	$8.00	$0.00		$0.00	$0.00	$0.00	$0.00	$201.38	$0.00	$0.00	$0.00	$0.00	$0.00
10284	ERX	HCPCS J1815	00169-1834-11	INSULIN NOVOLIN NPH 100 UNIT/ML SC SUSP	BOTH IP/OP	$10.00 	$7.40	$0.00	$201.38	$5.43	$5.43	$0.00	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$2.08	$0.00	$5.92	$5.92	$0.00	$5.00	$7.92	$8.00	$0.00		$0.00	$0.00	$0.00	$0.00	$201.38	$0.00	$0.00	$0.00	$0.00	$0.00
10289	ERX	HCPCS J1815	00002-8215-01	INSULIN NOVOLIN REGULAR 100 UNIT/ML IJ SOLN	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$5.43	$5.43	$0.00	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$2.08	$0.00	$5.92	$5.92	$0.00	$5.00	$7.92	$8.00	$0.00		$0.00	$0.00	$0.00	$0.00	$1.01	$0.00	$0.00	$0.00	$0.00	$0.00
10289	ERX	HCPCS J1815	00169-1833-11	INSULIN NOVOLIN REGULAR 100 UNIT/ML IJ SOLN	BOTH IP/OP	$10.00 	$7.40	$0.00	$8.00	$5.43	$5.43	$0.00	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$2.08	$0.00	$5.92	$5.92	$0.00	$5.00	$7.92	$8.00	$0.00		$0.00	$0.00	$0.00	$0.00	$1.01	$0.00	$0.00	$0.00	$0.00	$0.00
10321	ERX	HCPCS Q9966	00407-1412-30	IOHEXOL 240 MG/ML IJ SOLN	BOTH IP/OP	$235.53 	$174.29	$0.00	$177.29	$105.99	$105.99	$0.00	$0.00	$0.00	$49.09	$174.81	$174.81	$0.00	$0.00	$40.54	$0.00	$139.32	$139.32	$0.00	$110.81	$175.52	$177.29	$0.00		$0.00	$38.60	$0.00	$0.00	$35.28	$0.00	$0.00	$0.00	$0.00	$0.00
10322	ERX	HCPCS Q9967	00407-1413-10	IOHEXOL 300 MG/ML IJ SOLN	BOTH IP/OP	$128.43 	$95.04	$0.00	$95.32	$57.79	$57.79	$0.00	$0.00	$0.00	$26.77	$95.32	$95.32	$0.00	$0.00	$4.23	$0.00	$75.97	$75.97	$0.00	$58.23	$92.23	$93.16	$0.00		$0.00	$4.03	$0.00	$0.00	$18.54	$0.00	$0.00	$0.00	$0.00	$0.00
10322	ERX	HCPCS Q9967	00407-1413-61	IOHEXOL 300 MG/ML IJ SOLN	BOTH IP/OP	$128.43 	$95.04	$0.00	$95.32	$57.79	$57.79	$0.00	$0.00	$0.00	$26.77	$95.32	$95.32	$0.00	$0.00	$4.23	$0.00	$75.97	$75.97	$0.00	$58.23	$92.23	$93.16	$0.00		$0.00	$4.03	$0.00	$0.00	$18.54	$0.00	$0.00	$0.00	$0.00	$0.00
10322	ERX	HCPCS Q9967	00407-1413-63	IOHEXOL 300 MG/ML IJ SOLN	BOTH IP/OP	$128.43 	$95.04	$0.00	$95.32	$57.79	$57.79	$0.00	$0.00	$0.00	$26.77	$95.32	$95.32	$0.00	$0.00	$4.23	$0.00	$75.97	$75.97	$0.00	$58.23	$92.23	$93.16	$0.00		$0.00	$4.03	$0.00	$0.00	$18.54	$0.00	$0.00	$0.00	$0.00	$0.00
10322	ERX	HCPCS Q9967	00407-1413-65	IOHEXOL 300 MG/ML IJ SOLN	BOTH IP/OP	$128.43 	$95.04	$0.00	$95.32	$57.79	$57.79	$0.00	$0.00	$0.00	$26.77	$95.32	$95.32	$0.00	$0.00	$4.23	$0.00	$75.97	$75.97	$0.00	$58.23	$92.23	$93.16	$0.00		$0.00	$4.03	$0.00	$0.00	$18.54	$0.00	$0.00	$0.00	$0.00	$0.00
10322	ERX	HCPCS Q9967	00407-1413-87	IOHEXOL 300 MG/ML IJ SOLN	BOTH IP/OP	$128.43 	$95.04	$0.00	$95.32	$57.79	$57.79	$0.00	$0.00	$0.00	$26.77	$95.32	$95.32	$0.00	$0.00	$4.23	$0.00	$75.97	$75.97	$0.00	$58.23	$92.23	$93.16	$0.00		$0.00	$4.03	$0.00	$0.00	$18.54	$0.00	$0.00	$0.00	$0.00	$0.00
10322	ERX	HCPCS Q9967	00407-1413-88	IOHEXOL 300 MG/ML IJ SOLN	BOTH IP/OP	$128.43 	$95.04	$0.00	$95.32	$57.79	$57.79	$0.00	$0.00	$0.00	$26.77	$95.32	$95.32	$0.00	$0.00	$4.23	$0.00	$75.97	$75.97	$0.00	$58.23	$92.23	$93.16	$0.00		$0.00	$4.03	$0.00	$0.00	$18.54	$0.00	$0.00	$0.00	$0.00	$0.00
10323	ERX	HCPCS Q9967	00407-1414-84	IOHEXOL 350 MG/ML IV SOLN	BOTH IP/OP	$314.39 	$232.65	$0.00	$233.34	$141.48	$141.48	$0.00	$0.00	$0.00	$65.53	$233.34	$233.34	$0.00	$0.00	$10.58	$0.00	$185.96	$185.96	$0.00	$142.70	$226.03	$228.31	$0.00		$0.00	$10.07	$0.00	$0.00	$45.43	$0.00	$0.00	$0.00	$0.00	$0.00
10323	ERX	HCPCS Q9967	00407-1414-86	IOHEXOL 350 MG/ML IV SOLN	BOTH IP/OP	$314.39 	$232.65	$0.00	$233.34	$141.48	$141.48	$0.00	$0.00	$0.00	$65.53	$233.34	$233.34	$0.00	$0.00	$10.58	$0.00	$185.96	$185.96	$0.00	$142.70	$226.03	$228.31	$0.00		$0.00	$10.07	$0.00	$0.00	$45.43	$0.00	$0.00	$0.00	$0.00	$0.00
10323	ERX	HCPCS Q9967	00407-1414-89	IOHEXOL 350 MG/ML IV SOLN	BOTH IP/OP	$314.39 	$232.65	$0.00	$233.34	$141.48	$141.48	$0.00	$0.00	$0.00	$65.53	$233.34	$233.34	$0.00	$0.00	$10.58	$0.00	$185.96	$185.96	$0.00	$142.70	$226.03	$228.31	$0.00		$0.00	$10.07	$0.00	$0.00	$45.43	$0.00	$0.00	$0.00	$0.00	$0.00
10323	ERX	HCPCS Q9967	00407-1414-91	IOHEXOL 350 MG/ML IV SOLN	BOTH IP/OP	$314.39 	$232.65	$0.00	$233.34	$141.48	$141.48	$0.00	$0.00	$0.00	$65.53	$233.34	$233.34	$0.00	$0.00	$10.58	$0.00	$185.96	$185.96	$0.00	$142.70	$226.03	$228.31	$0.00		$0.00	$10.07	$0.00	$0.00	$45.43	$0.00	$0.00	$0.00	$0.00	$0.00
10323	ERX	HCPCS Q9967	00407-1414-93	IOHEXOL 350 MG/ML IV SOLN	BOTH IP/OP	$314.39 	$232.65	$0.00	$233.34	$141.48	$141.48	$0.00	$0.00	$0.00	$65.53	$233.34	$233.34	$0.00	$0.00	$10.58	$0.00	$185.96	$185.96	$0.00	$142.70	$226.03	$228.31	$0.00		$0.00	$10.07	$0.00	$0.00	$45.43	$0.00	$0.00	$0.00	$0.00	$0.00
10328	ERX	HCPCS Q9967	00270-1316-37	IOPAMIDOL 76 % IV SOLN	BOTH IP/OP	$167.07 	$123.63	$0.00	$124.00	$75.18	$75.18	$0.00	$0.00	$0.00	$34.82	$124.00	$124.00	$0.00	$0.00	$5.64	$0.00	$98.82	$98.82	$0.00	$75.74	$119.97	$121.18	$0.00		$0.00	$5.37	$0.00	$0.00	$24.12	$0.00	$0.00	$0.00	$0.00	$0.00
10358	ERX	HCPCS Q9968	55150-0240-05	ISOSULFAN BLUE 1 % SC SOLN	BOTH IP/OP	"$1,903.65 "	"$1,408.70"	$0.00	"$1,467.33"	$856.64	$856.64	$232.89	$232.89	$232.89	$396.77	"$1,412.89"	"$1,412.89"	"$1,467.33"	$201.78	$396.72	$131.16	$938.50	$938.50	$201.63	$882.00	"$1,397.09"	"$1,411.20"	$278.44		$278.44	$276.07	$0.00	$0.00	$280.83	$217.98	$0.00	$0.00	$0.00	$0.00
10358	ERX	HCPCS Q9968	67457-0220-05	ISOSULFAN BLUE 1 % SC SOLN	BOTH IP/OP	"$1,903.65 "	"$1,408.70"	$0.00	"$1,467.33"	$856.64	$856.64	$232.89	$232.89	$232.89	$396.77	"$1,412.89"	"$1,412.89"	"$1,467.33"	$201.78	$396.72	$131.16	$938.50	$938.50	$201.63	$882.00	"$1,397.09"	"$1,411.20"	$278.44		$278.44	$276.07	$0.00	$0.00	$280.83	$217.98	$0.00	$0.00	$0.00	$0.00
10359	ERX	HCPCS 63700001	00555-1054-86	ISOTRETINOIN 10 MG PO CAPS	BOTH IP/OP	$79.15 	$58.57	$0.00	$57.42		$0.00	$0.00	$0.00	$14.09	$0.00	$0.00	$0.00	$0.00	$0.00	$16.49	$0.00	$0.00	$0.00	$0.00	$35.89	$56.84	$57.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10360	ERX	HCPCS 63700001	00555-1055-86	ISOTRETINOIN 20 MG PO CAPS	BOTH IP/OP	$93.85 	$69.45	$0.00	$68.08		$0.00	$0.00	$0.00	$16.71	$0.00	$0.00	$0.00	$0.00	$0.00	$19.56	$0.00	$0.00	$0.00	$0.00	$42.55	$67.40	$68.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10361	ERX	HCPCS 63700001	55111-0137-81	ISOTRETINOIN 40 MG PO CAPS	BOTH IP/OP	$95.84 	$70.92	$0.00	$69.53		$0.00	$0.00	$0.00	$17.06	$0.00	$0.00	$0.00	$0.00	$0.00	$19.97	$0.00	$0.00	$0.00	$0.00	$43.46	$68.83	$69.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10364	ERX	HCPCS 63700001	10147-1700-07	ITRACONAZOLE 100 MG PO CAPS	BOTH IP/OP	$93.20 	$68.97	$0.00	$67.61		$0.00	$0.00	$0.00	$16.59	$0.00	$0.00	$0.00	$0.00	$0.00	$19.42	$0.00	$0.00	$0.00	$0.00	$42.26	$66.93	$67.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10364	ERX	HCPCS 63700001	67877-0454-30	ITRACONAZOLE 100 MG PO CAPS	BOTH IP/OP	$93.20 	$68.97	$0.00	$67.61		$0.00	$0.00	$0.00	$16.59	$0.00	$0.00	$0.00	$0.00	$0.00	$19.42	$0.00	$0.00	$0.00	$0.00	$42.26	$66.93	$67.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10368	ERX	HCPCS 63700001	00168-0099-15	KETOCONAZOLE 2 % EX CREA	BOTH IP/OP	$441.26 	$326.53	$0.00	$91.96		$0.00	$0.00	$0.00	$78.54	$0.00	$0.00	$0.00	$0.00	$0.00	$91.96	$0.00	$0.00	$0.00	$0.00	$54.08	$85.65	$86.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10368	ERX	HCPCS 63700001	51672-1298-01	KETOCONAZOLE 2 % EX CREA	BOTH IP/OP	$441.26 	$326.53	$0.00	$91.96		$0.00	$0.00	$0.00	$78.54	$0.00	$0.00	$0.00	$0.00	$0.00	$91.96	$0.00	$0.00	$0.00	$0.00	$54.08	$85.65	$86.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10368	ERX	HCPCS 63700001	51672-1298-02	KETOCONAZOLE 2 % EX CREA	BOTH IP/OP	$441.26 	$326.53	$0.00	$154.18		$0.00	$0.00	$0.00	$78.54	$0.00	$0.00	$0.00	$0.00	$0.00	$91.96	$0.00	$0.00	$0.00	$0.00	$54.08	$154.18	$86.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10369	ERX	HCPCS 63700001	00378-0261-01	KETOCONAZOLE 200 MG PO TABS	BOTH IP/OP	$14.41 	$10.66	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.21	$11.41	$11.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10369	ERX	HCPCS 63700001	51672-4026-01	KETOCONAZOLE 200 MG PO TABS	BOTH IP/OP	$14.41 	$10.66	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.21	$11.41	$11.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10369	ERX	HCPCS 63700001	51672-4026-06	KETOCONAZOLE 200 MG PO TABS	BOTH IP/OP	$14.41 	$10.66	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.21	$11.41	$11.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10371	ERX	HCPCS 63700001	00093-0314-01	KETOROLAC TROMETHAMINE 10 MG PO TABS	BOTH IP/OP	$9.50 	$7.03	$0.00	$6.89		$0.00	$0.00	$0.00	$1.69	$0.00	$0.00	$0.00	$0.00	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$4.31	$6.82	$6.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10371	ERX	HCPCS 63700001	00378-1134-01	KETOROLAC TROMETHAMINE 10 MG PO TABS	BOTH IP/OP	$9.50 	$7.03	$0.00	$6.89		$0.00	$0.00	$0.00	$1.69	$0.00	$0.00	$0.00	$0.00	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$4.31	$6.82	$6.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10371	ERX	HCPCS 63700001	69543-0388-10	KETOROLAC TROMETHAMINE 10 MG PO TABS	BOTH IP/OP	$9.50 	$7.03	$0.00	$6.89		$0.00	$0.00	$0.00	$1.69	$0.00	$0.00	$0.00	$0.00	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$4.31	$6.82	$6.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10372	ERX	HCPCS 25000001	00143-9622-01	LABETALOL HCL 5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10372	ERX	HCPCS 25000001	00409-2267-20	LABETALOL HCL 5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10372	ERX	HCPCS 25000001	00409-2267-54	LABETALOL HCL 5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10372	ERX	HCPCS 25000001	00409-2339-34	LABETALOL HCL 5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10372	ERX	HCPCS 25000001	17478-0420-40	LABETALOL HCL 5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10372	ERX	HCPCS 25000001	47781-0586-29	LABETALOL HCL 5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10372	ERX	HCPCS 25000001	47781-0586-56	LABETALOL HCL 5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10372	ERX	HCPCS 25000001	72266-0102-01	LABETALOL HCL 5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10372	ERX	HCPCS 25000001	72266-0103-01	LABETALOL HCL 5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10372	ERX	HCPCS 25000001	99999-6007-13	LABETALOL HCL 5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10372	ERX	HCPCS 25000001	99999-6011-99	LABETALOL HCL 5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10373	ERX	HCPCS 63700001	00185-0010-01	LABETALOL HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10373	ERX	HCPCS 63700001	00591-0605-01	LABETALOL HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10373	ERX	HCPCS 63700001	00904-5928-61	LABETALOL HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10373	ERX	HCPCS 63700001	10135-0641-01	LABETALOL HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10374	ERX	HCPCS 63700001	00185-0117-05	LABETALOL HCL 200 MG PO TABS	BOTH IP/OP	$13.26 	$9.81	$0.00	$10.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.63	$10.50	$10.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10374	ERX	HCPCS 63700001	00904-5929-61	LABETALOL HCL 200 MG PO TABS	BOTH IP/OP	$13.26 	$9.81	$0.00	$10.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.63	$10.50	$10.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10374	ERX	HCPCS 63700001	10135-0642-01	LABETALOL HCL 200 MG PO TABS	BOTH IP/OP	$13.26 	$9.81	$0.00	$10.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.63	$10.50	$10.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10375	ERX	HCPCS 63700001	00185-0118-01	LABETALOL HCL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10375	ERX	HCPCS 63700001	00185-0118-05	LABETALOL HCL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10375	ERX	HCPCS 63700001	00591-0607-01	LABETALOL HCL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10375	ERX	HCPCS 63700001	00904-5930-61	LABETALOL HCL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10375	ERX	HCPCS 63700001	49884-0124-01	LABETALOL HCL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10375	ERX	HCPCS 63700001	49884-0124-05	LABETALOL HCL 300 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10380	ERX	HCPCS 63700001	92771-0612-08	AMMONIUM LACTATE 12 % EX LOTN	BOTH IP/OP	$127.67 	$94.48	$0.00	$92.62		$0.00	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00	$26.61	$0.00	$0.00	$0.00	$0.00	$57.89	$22.72	$92.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10380	ERX	HCPCS 63700001	45802-0419-54	AMMONIUM LACTATE 12 % EX LOTN	BOTH IP/OP	$127.67 	$94.48	$0.00	$92.62		$0.00	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00	$26.61	$0.00	$0.00	$0.00	$0.00	$57.89	$91.69	$92.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10380	ERX	HCPCS 63700001	00904-5984-26	AMMONIUM LACTATE 12 % EX LOTN	BOTH IP/OP	$127.67 	$94.48	$0.00	$165.04		$0.00	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00	$26.61	$0.00	$0.00	$0.00	$0.00	$57.89	$165.04	$92.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10380	ERX	HCPCS 63700001	45802-0525-55	AMMONIUM LACTATE 12 % EX LOTN	BOTH IP/OP	$127.67 	$94.48	$0.00	$165.04		$0.00	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00	$26.61	$0.00	$0.00	$0.00	$0.00	$57.89	$165.04	$92.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10392	ERX	HCPCS J9217	00074-3642-03	LEUPROLIDE ACETATE 7.5 MG IM KIT	BOTH IP/OP	"$4,793.33 "	"$3,547.06"	$0.00	"$3,875.74"	"$2,262.69"	"$2,262.69"	$200.73	$200.73	$200.73	$246.83	"$3,731.94"	"$3,731.94"	"$3,875.74"	$139.09	$163.43	$90.41	"$2,363.11"	"$2,363.11"	$235.93	"$2,047.05"	"$3,242.53"	"$3,275.28"	$325.81		$325.81	$270.33	$0.00	$0.00	$257.40	$205.89	$0.00	$0.00	$0.00	$0.00
10394	ERX	HCPCS 25000001	24208-0505-05	LEVOBUNOLOL HCL 0.5 % OP SOLN	BOTH IP/OP	$93.34 	$69.07	$0.00	$71.95		$0.00	$0.00	$0.00	$0.00	$0.00	$69.28	$69.28	$71.95	$0.00	$19.45	$0.00	$0.00	$0.00	$0.00	$42.32	$67.03	$67.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10403	ERX	HCPCS 63700001	00781-5183-92	LEVOTHYROXINE SODIUM 88 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10404	ERX	HCPCS 63700001	00781-5185-92	LEVOTHYROXINE SODIUM 112 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10405	ERX	HCPCS 63700001	00378-1823-77	LEVOTHYROXINE SODIUM 137 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10405	ERX	HCPCS 63700001	00781-5191-92	LEVOTHYROXINE SODIUM 137 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10406	ERX	HCPCS 63700001	00781-5188-92	LEVOTHYROXINE SODIUM 175 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10426	ERX	HCPCS 25000001	00409-3177-01	LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10427	ERX	HCPCS 25000001	00409-3178-01	LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10427	ERX	HCPCS 25000001	00409-3178-02	LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10427	ERX	HCPCS 25000001	00409-3178-16	LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10427	ERX	HCPCS 25000001	63323-0482-03	LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10427	ERX	HCPCS 25000001	63323-0482-17	LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10427	ERX	HCPCS 25000001	63323-0482-27	LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10428	ERX	HCPCS 25000001	63323-0487-17	LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN MPF	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10428	ERX	HCPCS 25000001	63323-0487-31	LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN MPF	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10428	ERX	HCPCS 25000001	63323-0487-37	LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN MPF	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10429	ERX	HCPCS 25000001	00409-1209-01	LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 IJ SOLN MPF	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10429	ERX	HCPCS 25000001	00409-1209-65	LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 IJ SOLN MPF	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10430	ERX	HCPCS 25000001	00362-1095-60	LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10430	ERX	HCPCS 25000001	51004-1095-06	LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10430	ERX	HCPCS 25000001	00409-3182-01	LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10430	ERX	HCPCS 25000001	63323-0483-27	LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10431	ERX	HCPCS 25000001	00409-3183-01	LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10431	ERX	HCPCS 25000001	63323-0489-02	LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10431	ERX	HCPCS 25000001	63323-0489-17	LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10431	ERX	HCPCS 25000001	63323-0489-21	LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10431	ERX	HCPCS 25000001	63323-0489-27	LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10434	ERX	HCPCS 25000001	00115-1468-45	LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA	BOTH IP/OP	$168.84 	$124.94	$0.00	$135.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.42	$133.72	$135.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10434	ERX	HCPCS 25000001	00115-1468-53	LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA	BOTH IP/OP	$30.56 	$22.61	$0.00	$135.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.42	$24.20	$135.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10434	ERX	HCPCS 25000001	00115-1468-60	LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA	BOTH IP/OP	$30.56 	$22.61	$0.00	$135.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.42	$24.20	$135.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10434	ERX	HCPCS 25000001	00168-0357-55	LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA	BOTH IP/OP	$30.56 	$22.61	$0.00	$135.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.42	$24.20	$135.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10443	ERX	HCPCS 63700001	42794-0018-02	LIOTHYRONINE SODIUM 5 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10443	ERX	HCPCS 63700001	51862-0320-01	LIOTHYRONINE SODIUM 5 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10443	ERX	HCPCS 63700001	59762-1206-01	LIOTHYRONINE SODIUM 5 MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10449	ERX	HCPCS 63700001	00904-6798-61	LISINOPRIL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10449	ERX	HCPCS 63700001	43547-0353-10	LISINOPRIL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10449	ERX	HCPCS 63700001	60687-0325-01	LISINOPRIL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10449	ERX	HCPCS 63700001	60687-0325-11	LISINOPRIL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10449	ERX	HCPCS 63700001	68180-0980-01	LISINOPRIL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10450	ERX	HCPCS 63700001	00904-6800-61	LISINOPRIL 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10450	ERX	HCPCS 63700001	68084-0199-01	LISINOPRIL 40 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10451	ERX	HCPCS 63700001	00904-6797-61	LISINOPRIL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10451	ERX	HCPCS 63700001	43547-0352-10	LISINOPRIL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10451	ERX	HCPCS 63700001	68180-0513-01	LISINOPRIL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10452	ERX	HCPCS 63700001	00591-0861-01	LISINOPRIL-HCTZ 20-12.5 MG TABLET	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10452	ERX	HCPCS 63700001	68180-0519-01	LISINOPRIL-HCTZ 20-12.5 MG TABLET	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10453	ERX	HCPCS 63700001	68180-0520-01	LISINOPRIL-HCTZ 20-25 MG TABLET	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10454	ERX	HCPCS 63700001	00054-0021-25	LITHIUM CARBONATE ER 300 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10454	ERX	HCPCS 63700001	68462-0223-01	LITHIUM CARBONATE ER 300 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10455	ERX	HCPCS 63700001	00054-0020-25	LITHIUM CARBONATE ER 450 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10455	ERX	HCPCS 63700001	51079-0142-01	LITHIUM CARBONATE ER 450 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10455	ERX	HCPCS 63700001	51079-0142-20	LITHIUM CARBONATE ER 450 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10455	ERX	HCPCS 63700001	68462-0224-01	LITHIUM CARBONATE ER 450 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10460	ERX	HCPCS 63700001	58181-3042-05	LOMUSTINE 100 MG PO CAPS	BOTH IP/OP	"$2,724.26 "	"$2,015.95"	$0.00	"$1,976.90"		$0.00	$0.00	$0.00	$484.92	$0.00	$0.00	$0.00	$0.00	$0.00	$567.74	$0.00	$0.00	$0.00	$0.00	"$1,235.56"	"$1,957.13"	"$1,976.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10461	ERX	HCPCS 63700001	58181-3041-05	LOMUSTINE 40 MG PO CAPS	BOTH IP/OP	"$1,275.08 "	$943.56	$0.00	$925.74		$0.00	$0.00	$0.00	$226.96	$0.00	$0.00	$0.00	$0.00	$0.00	$265.73	$0.00	$0.00	$0.00	$0.00	$578.59	$916.49	$925.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10466	ERX	HCPCS 63700001	00904-6852-61	LORATADINE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10466	ERX	HCPCS 63700001	45802-0650-87	LORATADINE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10466	ERX	HCPCS 63700001	51079-0246-20	LORATADINE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10466	ERX	HCPCS 63700001	68084-0248-01	LORATADINE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10466	ERX	HCPCS 63700001	68084-0248-11	LORATADINE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10467	ERX	HCPCS J2060	00409-1985-30	LORAZEPAM 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
10467	ERX	HCPCS J2060	00409-6778-02	LORAZEPAM 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
10467	ERX	HCPCS J2060	00409-6778-11	LORAZEPAM 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
10467	ERX	HCPCS J2060	00641-6044-01	LORAZEPAM 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
10467	ERX	HCPCS J2060	00641-6044-25	LORAZEPAM 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
10467	ERX	HCPCS J2060	00641-6046-10	LORAZEPAM 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
10467	ERX	HCPCS J2060	00641-6048-25	LORAZEPAM 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
10467	ERX	HCPCS J2060	00641-6050-10	LORAZEPAM 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
10467	ERX	HCPCS J2060	76329-8261-00	LORAZEPAM 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
10467	ERX	HCPCS J2060	76329-8261-01	LORAZEPAM 2 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
10475	ERX	HCPCS J7504	00009-7224-01	"LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML IV INJ"	BOTH IP/OP	"$7,764.17 "	"$5,745.49"	$0.00	"$5,984.62"		$0.00	$0.00	$0.00	$0.00	$0.00	"$5,762.57"	"$5,762.57"	"$5,984.62"	$0.00	"$1,618.05"	$0.00	$0.00	$0.00	$0.00	"$2,682.94"	"$4,249.78"	"$4,292.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10475	ERX	HCPCS J7504	00009-7224-02	"LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML IV INJ"	BOTH IP/OP	"$7,764.17 "	"$5,745.49"	$0.00	"$5,984.62"		$0.00	$0.00	$0.00	$0.00	$0.00	"$5,762.57"	"$5,762.57"	"$5,984.62"	$0.00	"$1,618.05"	$0.00	$0.00	$0.00	$0.00	"$2,682.94"	"$4,249.78"	"$4,292.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10478	ERX	HCPCS 25000001	51079-0623-81	MAFENIDE ACETATE 85 MG/GM EX CREA	BOTH IP/OP	$488.10 	$361.19	$0.00	$461.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.72	$0.00	$0.00	$0.00	$0.00	$288.72	$350.90	$461.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10478	ERX	HCPCS 25000001	51079-0623-82	MAFENIDE ACETATE 85 MG/GM EX CREA	BOTH IP/OP	$488.10 	$361.19	$0.00	$461.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.72	$0.00	$0.00	$0.00	$0.00	$288.72	$457.32	$461.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10521	ERX	HCPCS 63700001	99999-6005-55	MEGESTROL ACETATE 40 MG/ML PO SUSP	BOTH IP/OP	$138.96 	$102.83	$0.00	$351.36		$0.00	$0.00	$0.00	$24.73	$0.00	$0.00	$0.00	$0.00	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$219.60	$99.79	$351.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10521	ERX	HCPCS 63700001	00054-3542-58	MEGESTROL ACETATE 40 MG/ML PO SUSP	BOTH IP/OP	$138.96 	$102.83	$0.00	$351.36		$0.00	$0.00	$0.00	$24.73	$0.00	$0.00	$0.00	$0.00	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$219.60	$347.85	$351.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10521	ERX	HCPCS 63700001	49884-0907-38	MEGESTROL ACETATE 40 MG/ML PO SUSP	BOTH IP/OP	$138.96 	$102.83	$0.00	$351.36		$0.00	$0.00	$0.00	$24.73	$0.00	$0.00	$0.00	$0.00	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$219.60	$347.85	$351.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10521	ERX	HCPCS 63700001	50383-0859-24	MEGESTROL ACETATE 40 MG/ML PO SUSP	BOTH IP/OP	$138.96 	$102.83	$0.00	$351.36		$0.00	$0.00	$0.00	$24.73	$0.00	$0.00	$0.00	$0.00	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$219.60	$347.85	$351.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10521	ERX	HCPCS 63700001	60432-0126-08	MEGESTROL ACETATE 40 MG/ML PO SUSP	BOTH IP/OP	$138.96 	$102.83	$0.00	$351.36		$0.00	$0.00	$0.00	$24.73	$0.00	$0.00	$0.00	$0.00	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$219.60	$347.85	$351.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10521	ERX	HCPCS 63700001	60432-0126-16	MEGESTROL ACETATE 40 MG/ML PO SUSP	BOTH IP/OP	$138.96 	$102.83	$0.00	$601.44		$0.00	$0.00	$0.00	$24.73	$0.00	$0.00	$0.00	$0.00	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$219.60	$601.44	$351.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10523	ERX	HCPCS J8600	52609-0001-05	MELPHALAN 2 MG PO TABS	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60		$0.00	$0.00	$0.00	$0.00	$0.00	$42.31	$42.31	$43.94	$0.00	$11.88	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10531	ERX	HCPCS 63700001	00054-4581-11	MERCAPTOPURINE 50 MG PO TABS	BOTH IP/OP	$17.14 	$12.68	$0.00	$12.44		$0.00	$0.00	$0.00	$3.05	$0.00	$0.00	$0.00	$0.00	$0.00	$3.57	$0.00	$0.00	$0.00	$0.00	$7.78	$12.32	$12.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10531	ERX	HCPCS 63700001	00378-3547-52	MERCAPTOPURINE 50 MG PO TABS	BOTH IP/OP	$17.14 	$12.68	$0.00	$12.44		$0.00	$0.00	$0.00	$3.05	$0.00	$0.00	$0.00	$0.00	$0.00	$3.57	$0.00	$0.00	$0.00	$0.00	$7.78	$12.32	$12.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10533	ERX	HCPCS 63700001	54092-0189-81	MESALAMINE ER 250 MG PO CPCR	BOTH IP/OP	$30.53 	$22.59	$0.00	$22.15		$0.00	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00	$6.36	$0.00	$0.00	$0.00	$0.00	$13.85	$21.93	$22.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10535	ERX	HCPCS 25000001	45802-0098-28	MESALAMINE 4 G RECTAL ENEM	BOTH IP/OP	$93.80 	$69.41	$0.00	$72.30		$0.00	$0.00	$0.00	$0.00	$0.00	$69.62	$69.62	$72.30	$0.00	$19.55	$0.00	$0.00	$0.00	$0.00	$42.53	$67.36	$68.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10535	ERX	HCPCS 25000001	45802-0098-51	MESALAMINE 4 G RECTAL ENEM	BOTH IP/OP	$93.80 	$69.41	$0.00	$72.30		$0.00	$0.00	$0.00	$0.00	$0.00	$69.62	$69.62	$72.30	$0.00	$19.55	$0.00	$0.00	$0.00	$0.00	$42.53	$67.36	$68.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10535	ERX	HCPCS 25000001	62559-0420-07	MESALAMINE 4 G RECTAL ENEM	BOTH IP/OP	$93.80 	$69.41	$0.00	$72.30		$0.00	$0.00	$0.00	$0.00	$0.00	$69.62	$69.62	$72.30	$0.00	$19.55	$0.00	$0.00	$0.00	$0.00	$42.53	$67.36	$68.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10537	ERX	HCPCS J9209	00338-1305-01	MESNA 100 MG/ML IV SOLN	BOTH IP/OP	$92.64 	$68.55	$0.00	$71.41	$41.69	$41.69	$0.00	$0.00	$0.00	$34.25	$68.76	$68.76	$71.41	$0.00	$12.41	$0.00	$54.80	$54.80	$0.00	$42.00	$66.53	$67.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10537	ERX	HCPCS J9209	10019-0953-01	MESNA 100 MG/ML IV SOLN	BOTH IP/OP	$92.64 	$68.55	$0.00	$71.41	$41.69	$41.69	$0.00	$0.00	$0.00	$34.25	$68.76	$68.76	$71.41	$0.00	$12.41	$0.00	$54.80	$54.80	$0.00	$42.00	$66.53	$67.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10537	ERX	HCPCS J9209	25021-0201-10	MESNA 100 MG/ML IV SOLN	BOTH IP/OP	$92.64 	$68.55	$0.00	$71.41	$41.69	$41.69	$0.00	$0.00	$0.00	$34.25	$68.76	$68.76	$71.41	$0.00	$12.41	$0.00	$54.80	$54.80	$0.00	$42.00	$66.53	$67.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10537	ERX	HCPCS J9209	25021-0201-11	MESNA 100 MG/ML IV SOLN	BOTH IP/OP	$92.64 	$68.55	$0.00	$71.41	$41.69	$41.69	$0.00	$0.00	$0.00	$34.25	$68.76	$68.76	$71.41	$0.00	$12.41	$0.00	$54.80	$54.80	$0.00	$42.00	$66.53	$67.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10537	ERX	HCPCS J9209	63323-0733-10	MESNA 100 MG/ML IV SOLN	BOTH IP/OP	$92.64 	$68.55	$0.00	$71.41	$41.69	$41.69	$0.00	$0.00	$0.00	$34.25	$68.76	$68.76	$71.41	$0.00	$12.41	$0.00	$54.80	$54.80	$0.00	$42.00	$66.53	$67.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10537	ERX	HCPCS J9209	63323-0733-11	MESNA 100 MG/ML IV SOLN	BOTH IP/OP	$92.64 	$68.55	$0.00	$71.41	$41.69	$41.69	$0.00	$0.00	$0.00	$34.25	$68.76	$68.76	$71.41	$0.00	$12.41	$0.00	$54.80	$54.80	$0.00	$42.00	$66.53	$67.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10544	ERX	HCPCS 63700001	00904-6689-61	METFORMIN HCL 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10544	ERX	HCPCS 63700001	60687-0155-01	METFORMIN HCL 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10544	ERX	HCPCS 63700001	63739-0640-10	METFORMIN HCL 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10546	ERX	HCPCS J1230	17478-0380-20	METHADONE HCL 10 MG/ML IJ SOLN	BOTH IP/OP	$32.63 	$24.15	$0.00	$25.15		$0.00	$0.00	$0.00	$0.00	$0.00	$24.22	$24.22	$25.15	$0.00	$6.80	$0.00	$0.00	$0.00	$0.00	$14.80	$23.44	$23.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10546	ERX	HCPCS J1230	67457-0217-20	METHADONE HCL 10 MG/ML IJ SOLN	BOTH IP/OP	$32.63 	$24.15	$0.00	$25.15		$0.00	$0.00	$0.00	$0.00	$0.00	$24.22	$24.22	$25.15	$0.00	$6.80	$0.00	$0.00	$0.00	$0.00	$14.80	$23.44	$23.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10546	ERX	HCPCS J1230	99999-6005-49	METHADONE HCL 10 MG/ML IJ SOLN	BOTH IP/OP	$32.63 	$24.15	$0.00	$25.15		$0.00	$0.00	$0.00	$0.00	$0.00	$24.22	$24.22	$25.15	$0.00	$6.80	$0.00	$0.00	$0.00	$0.00	$14.80	$23.44	$23.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10552	ERX	HCPCS 63700001	49884-0641-01	METHIMAZOLE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10552	ERX	HCPCS 63700001	51293-0821-01	METHIMAZOLE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10552	ERX	HCPCS 63700001	60687-0370-01	METHIMAZOLE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10552	ERX	HCPCS 63700001	60687-0370-11	METHIMAZOLE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10552	ERX	HCPCS 63700001	64980-0261-01	METHIMAZOLE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10553	ERX	HCPCS 63700001	00185-0205-01	METHIMAZOLE 5 MG PO TABS	BOTH IP/OP	$9.33 	$6.90	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.67	$7.39	$7.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10553	ERX	HCPCS 63700001	49884-0640-01	METHIMAZOLE 5 MG PO TABS	BOTH IP/OP	$9.33 	$6.90	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.67	$7.39	$7.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10553	ERX	HCPCS 63700001	51293-0820-01	METHIMAZOLE 5 MG PO TABS	BOTH IP/OP	$9.33 	$6.90	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.67	$7.39	$7.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10553	ERX	HCPCS 63700001	60687-0357-01	METHIMAZOLE 5 MG PO TABS	BOTH IP/OP	$9.33 	$6.90	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.67	$7.39	$7.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10553	ERX	HCPCS 63700001	60687-0357-11	METHIMAZOLE 5 MG PO TABS	BOTH IP/OP	$9.33 	$6.90	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.67	$7.39	$7.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10553	ERX	HCPCS 63700001	60793-0104-01	METHIMAZOLE 5 MG PO TABS	BOTH IP/OP	$9.33 	$6.90	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.67	$7.39	$7.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10571	ERX	HCPCS J2210	00517-0740-01	METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$130.63 	$96.67	$0.00	$104.74	$61.15	$61.15	$0.00	$0.00	$0.00	$0.00	$100.85	$100.85	$104.74	$0.00	$23.05	$0.00	$0.00	$0.00	$0.00	$56.95	$90.20	$91.11	$0.00		$0.00	$21.20	$0.00	$0.00	$20.18	$0.00	$0.00	$0.00	$0.00	$0.00
10571	ERX	HCPCS J2210	00517-0740-20	METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$130.63 	$96.67	$0.00	$104.74	$61.15	$61.15	$0.00	$0.00	$0.00	$0.00	$100.85	$100.85	$104.74	$0.00	$23.05	$0.00	$0.00	$0.00	$0.00	$56.95	$90.20	$91.11	$0.00		$0.00	$21.20	$0.00	$0.00	$20.18	$0.00	$0.00	$0.00	$0.00	$0.00
10571	ERX	HCPCS J2210	51991-0144-17	METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$130.63 	$96.67	$0.00	$104.74	$61.15	$61.15	$0.00	$0.00	$0.00	$0.00	$100.85	$100.85	$104.74	$0.00	$23.05	$0.00	$0.00	$0.00	$0.00	$56.95	$90.20	$91.11	$0.00		$0.00	$21.20	$0.00	$0.00	$20.18	$0.00	$0.00	$0.00	$0.00	$0.00
10571	ERX	HCPCS J2210	51991-0144-99	METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN	BOTH IP/OP	$130.63 	$96.67	$0.00	$104.74	$61.15	$61.15	$0.00	$0.00	$0.00	$0.00	$100.85	$100.85	$104.74	$0.00	$23.05	$0.00	$0.00	$0.00	$0.00	$56.95	$90.20	$91.11	$0.00		$0.00	$21.20	$0.00	$0.00	$20.18	$0.00	$0.00	$0.00	$0.00	$0.00
10572	ERX	HCPCS 63700001	27437-0050-56	METHYLERGONOVINE MALEATE 0.2 MG PO TABS	BOTH IP/OP	$259.06 	$191.70	$0.00	$188.14		$0.00	$0.00	$0.00	$46.11	$0.00	$0.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$0.00	$0.00	$117.59	$186.25	$188.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10572	ERX	HCPCS 63700001	43386-0140-28	METHYLERGONOVINE MALEATE 0.2 MG PO TABS	BOTH IP/OP	$259.06 	$191.70	$0.00	$188.14		$0.00	$0.00	$0.00	$46.11	$0.00	$0.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$0.00	$0.00	$117.59	$186.25	$188.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10572	ERX	HCPCS 63700001	69238-1605-08	METHYLERGONOVINE MALEATE 0.2 MG PO TABS	BOTH IP/OP	$259.06 	$191.70	$0.00	$188.14		$0.00	$0.00	$0.00	$46.11	$0.00	$0.00	$0.00	$0.00	$0.00	$53.99	$0.00	$0.00	$0.00	$0.00	$117.59	$186.25	$188.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10573	ERX	HCPCS 63700001	00009-0020-01	METHYLPREDNISOLONE 2 MG PO TABS	BOTH IP/OP	$8.26 	$6.11	$0.00	$5.90		$0.00	$0.00	$0.00	$1.47	$0.00	$0.00	$0.00	$0.00	$0.00	$1.72	$0.00	$0.00	$0.00	$0.00	$3.69	$5.84	$5.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10576	ERX	HCPCS J7509	00009-0022-01	METHYLPREDNISOLONE 8 MG PO TABS	BOTH IP/OP	$8.99 	$6.65	$0.00	$6.93	$4.05	$4.05	$0.00	$0.00	$0.00	$1.87	$6.67	$6.67	$6.93	$0.00	$1.87	$0.00	$5.32	$5.32	$0.00	$4.02	$6.36	$6.42	$0.00		$0.00	$1.26	$0.00	$0.00	$1.28	$0.00	$0.00	$0.00	$0.00	$0.00
10576	ERX	HCPCS J7509	59746-0002-04	METHYLPREDNISOLONE 8 MG PO TABS	BOTH IP/OP	$8.99 	$6.65	$0.00	$6.93	$4.05	$4.05	$0.00	$0.00	$0.00	$1.87	$6.67	$6.67	$6.93	$0.00	$1.87	$0.00	$5.32	$5.32	$0.00	$4.02	$6.36	$6.42	$0.00		$0.00	$1.26	$0.00	$0.00	$1.28	$0.00	$0.00	$0.00	$0.00	$0.00
10576	ERX	HCPCS J7509	59762-0049-01	METHYLPREDNISOLONE 8 MG PO TABS	BOTH IP/OP	$8.99 	$6.65	$0.00	$6.93	$4.05	$4.05	$0.00	$0.00	$0.00	$1.87	$6.67	$6.67	$6.93	$0.00	$1.87	$0.00	$5.32	$5.32	$0.00	$4.02	$6.36	$6.42	$0.00		$0.00	$1.26	$0.00	$0.00	$1.28	$0.00	$0.00	$0.00	$0.00	$0.00
10577	ERX	HCPCS J2930	00009-0698-01	METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$59.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10577	ERX	HCPCS J2930	25021-0810-30	METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$59.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10577	ERX	HCPCS J2930	63323-0265-30	METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$59.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10578	ERX	HCPCS J2930	00009-0047-22	METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR	BOTH IP/OP	$31.33 	$23.18	$0.00	$24.15	$14.10	$14.10	$0.00	$0.00	$0.00	$3.71	$23.25	$23.25	$24.15	$0.00	$6.54	$0.00	$18.53	$18.53	$0.00	$14.14	$22.40	$22.62	$0.00		$0.00	$7.43	$0.00	$0.00	$7.07	$0.00	$0.00	$0.00	$0.00	$0.00
10578	ERX	HCPCS J2930	00009-0047-26	METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR	BOTH IP/OP	$31.33 	$23.18	$0.00	$24.15	$14.10	$14.10	$0.00	$0.00	$0.00	$3.71	$23.25	$23.25	$24.15	$0.00	$6.54	$0.00	$18.53	$18.53	$0.00	$14.14	$22.40	$22.62	$0.00		$0.00	$7.43	$0.00	$0.00	$7.07	$0.00	$0.00	$0.00	$0.00	$0.00
10578	ERX	HCPCS J2930	00009-0047-27	METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR	BOTH IP/OP	$31.33 	$23.18	$0.00	$24.15	$14.10	$14.10	$0.00	$0.00	$0.00	$3.71	$23.25	$23.25	$24.15	$0.00	$6.54	$0.00	$18.53	$18.53	$0.00	$14.14	$22.40	$22.62	$0.00		$0.00	$7.43	$0.00	$0.00	$7.07	$0.00	$0.00	$0.00	$0.00	$0.00
10580	ERX	HCPCS J2920	00009-0039-28	METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.64	$16.33	$16.33	$16.96	$0.00	$4.83	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.38	$0.00	$0.00	$5.12	$0.00	$0.00	$0.00	$0.00	$0.00
10580	ERX	HCPCS J2920	00009-0039-32	METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.64	$16.33	$16.33	$16.96	$0.00	$4.83	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.38	$0.00	$0.00	$5.12	$0.00	$0.00	$0.00	$0.00	$0.00
10580	ERX	HCPCS J2920	00009-0039-33	METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.64	$16.33	$16.33	$16.96	$0.00	$4.83	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.38	$0.00	$0.00	$5.12	$0.00	$0.00	$0.00	$0.00	$0.00
10581	ERX	HCPCS J2930	00009-0003-02	METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR	BOTH IP/OP	$112.49 	$83.24	$0.00	$86.71	$50.62	$50.62	$0.00	$0.00	$0.00	$14.85	$83.49	$83.49	$86.71	$0.00	$26.16	$0.00	$66.54	$66.54	$0.00	$48.55	$76.90	$77.67	$0.00		$0.00	$29.70	$0.00	$0.00	$28.28	$0.00	$0.00	$0.00	$0.00	$0.00
10581	ERX	HCPCS J2930	00009-0758-01	METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR	BOTH IP/OP	$112.49 	$83.24	$0.00	$86.71	$50.62	$50.62	$0.00	$0.00	$0.00	$14.85	$83.49	$83.49	$86.71	$0.00	$26.16	$0.00	$66.54	$66.54	$0.00	$48.55	$76.90	$77.67	$0.00		$0.00	$29.70	$0.00	$0.00	$28.28	$0.00	$0.00	$0.00	$0.00	$0.00
10586	ERX	HCPCS 63700001	00185-5600-01	METOLAZONE 10 MG PO TABS	BOTH IP/OP	$11.82 	$8.75	$0.00	$8.58		$0.00	$0.00	$0.00	$2.10	$0.00	$0.00	$0.00	$0.00	$0.00	$2.46	$0.00	$0.00	$0.00	$0.00	$5.36	$8.49	$8.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10586	ERX	HCPCS 63700001	00378-6174-01	METOLAZONE 10 MG PO TABS	BOTH IP/OP	$11.82 	$8.75	$0.00	$8.58		$0.00	$0.00	$0.00	$2.10	$0.00	$0.00	$0.00	$0.00	$0.00	$2.46	$0.00	$0.00	$0.00	$0.00	$5.36	$8.49	$8.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10586	ERX	HCPCS 63700001	00527-2217-37	METOLAZONE 10 MG PO TABS	BOTH IP/OP	$11.82 	$8.75	$0.00	$8.58		$0.00	$0.00	$0.00	$2.10	$0.00	$0.00	$0.00	$0.00	$0.00	$2.46	$0.00	$0.00	$0.00	$0.00	$5.36	$8.49	$8.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10586	ERX	HCPCS 63700001	65580-0645-71	METOLAZONE 10 MG PO TABS	BOTH IP/OP	$11.82 	$8.75	$0.00	$8.58		$0.00	$0.00	$0.00	$2.10	$0.00	$0.00	$0.00	$0.00	$0.00	$2.46	$0.00	$0.00	$0.00	$0.00	$5.36	$8.49	$8.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10587	ERX	HCPCS 63700001	00185-5050-01	METOLAZONE 2.5 MG PO TABS	BOTH IP/OP	$10.27 	$7.60	$0.00	$7.45		$0.00	$0.00	$0.00	$1.83	$0.00	$0.00	$0.00	$0.00	$0.00	$2.14	$0.00	$0.00	$0.00	$0.00	$4.66	$7.37	$7.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10587	ERX	HCPCS 63700001	00378-6172-01	METOLAZONE 2.5 MG PO TABS	BOTH IP/OP	$10.27 	$7.60	$0.00	$7.45		$0.00	$0.00	$0.00	$1.83	$0.00	$0.00	$0.00	$0.00	$0.00	$2.14	$0.00	$0.00	$0.00	$0.00	$4.66	$7.37	$7.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10587	ERX	HCPCS 63700001	00527-2215-37	METOLAZONE 2.5 MG PO TABS	BOTH IP/OP	$10.27 	$7.60	$0.00	$7.45		$0.00	$0.00	$0.00	$1.83	$0.00	$0.00	$0.00	$0.00	$0.00	$2.14	$0.00	$0.00	$0.00	$0.00	$4.66	$7.37	$7.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10588	ERX	HCPCS 63700001	00185-0055-01	METOLAZONE 5 MG PO TABS	BOTH IP/OP	$11.67 	$8.64	$0.00	$8.46		$0.00	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00	$2.43	$0.00	$0.00	$0.00	$0.00	$5.29	$8.38	$8.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10588	ERX	HCPCS 63700001	00378-6173-01	METOLAZONE 5 MG PO TABS	BOTH IP/OP	$11.67 	$8.64	$0.00	$8.46		$0.00	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00	$2.43	$0.00	$0.00	$0.00	$0.00	$5.29	$8.38	$8.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10588	ERX	HCPCS 63700001	00527-2216-37	METOLAZONE 5 MG PO TABS	BOTH IP/OP	$11.67 	$8.64	$0.00	$8.46		$0.00	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00	$2.43	$0.00	$0.00	$0.00	$0.00	$5.29	$8.38	$8.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10592	ERX	HCPCS 63700001	00245-0860-70	METRONIDAZOLE 0.75 % VA GEL	BOTH IP/OP	$547.79 	$405.36	$0.00	$397.80		$0.00	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00	$114.16	$0.00	$0.00	$0.00	$0.00	$248.63	$393.82	$397.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10592	ERX	HCPCS 63700001	00781-7077-87	METRONIDAZOLE 0.75 % VA GEL	BOTH IP/OP	$547.79 	$405.36	$0.00	$397.80		$0.00	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00	$114.16	$0.00	$0.00	$0.00	$0.00	$248.63	$393.82	$397.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10594	ERX	HCPCS 63700001	25010-0305-15	METYROSINE 250 MG PO CAPS	BOTH IP/OP	"$1,309.85 "	$969.29	$0.00	$937.41		$0.00	$0.00	$0.00	$233.15	$0.00	$0.00	$0.00	$0.00	$0.00	$272.97	$0.00	$0.00	$0.00	$0.00	$585.88	$928.03	$937.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10595	ERX	HCPCS 63700001	00093-8739-01	MEXILETINE HCL 150 MG PO CAPS	BOTH IP/OP	$10.63 	$7.87	$0.00	$7.71		$0.00	$0.00	$0.00	$1.89	$0.00	$0.00	$0.00	$0.00	$0.00	$2.22	$0.00	$0.00	$0.00	$0.00	$4.82	$7.63	$7.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10595	ERX	HCPCS 63700001	62559-0820-01	MEXILETINE HCL 150 MG PO CAPS	BOTH IP/OP	$10.63 	$7.87	$0.00	$7.71		$0.00	$0.00	$0.00	$1.89	$0.00	$0.00	$0.00	$0.00	$0.00	$2.22	$0.00	$0.00	$0.00	$0.00	$4.82	$7.63	$7.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10596	ERX	HCPCS 63700001	00093-8740-01	MEXILETINE HCL 200 MG PO CAPS	BOTH IP/OP	$12.69 	$9.39	$0.00	$9.21		$0.00	$0.00	$0.00	$2.26	$0.00	$0.00	$0.00	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$5.76	$9.12	$9.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10608	ERX	HCPCS J2250	00409-2308-49	MIDAZOLAM HCL 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.94	$16.33	$16.33	$16.96	$0.00	$0.76	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.71	$0.00	$0.00	$0.67	$0.00	$0.00	$0.00	$0.00	$0.00
10608	ERX	HCPCS J2250	00641-6061-25	MIDAZOLAM HCL 5 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.94	$16.33	$16.33	$16.96	$0.00	$0.76	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.71	$0.00	$0.00	$0.67	$0.00	$0.00	$0.00	$0.00	$0.00
10609	ERX	HCPCS 63700001	00245-0211-11	MIDODRINE HCL 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10609	ERX	HCPCS 63700001	42291-0560-90	MIDODRINE HCL 2.5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10610	ERX	HCPCS 63700001	00245-0212-01	MIDODRINE HCL 5 MG PO TABS	BOTH IP/OP	$17.42 	$12.89	$0.00	$12.64		$0.00	$0.00	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$0.00	$3.63	$0.00	$0.00	$0.00	$0.00	$7.90	$12.51	$12.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10610	ERX	HCPCS 63700001	00245-0212-11	MIDODRINE HCL 5 MG PO TABS	BOTH IP/OP	$17.42 	$12.89	$0.00	$12.64		$0.00	$0.00	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$0.00	$3.63	$0.00	$0.00	$0.00	$0.00	$7.90	$12.51	$12.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10610	ERX	HCPCS 63700001	00378-1902-01	MIDODRINE HCL 5 MG PO TABS	BOTH IP/OP	$17.42 	$12.89	$0.00	$12.64		$0.00	$0.00	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$0.00	$3.63	$0.00	$0.00	$0.00	$0.00	$7.90	$12.51	$12.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10610	ERX	HCPCS 63700001	42291-0561-90	MIDODRINE HCL 5 MG PO TABS	BOTH IP/OP	$17.42 	$12.89	$0.00	$12.64		$0.00	$0.00	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$0.00	$3.63	$0.00	$0.00	$0.00	$0.00	$7.90	$12.51	$12.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10610	ERX	HCPCS 63700001	51079-0453-20	MIDODRINE HCL 5 MG PO TABS	BOTH IP/OP	$17.42 	$12.89	$0.00	$12.64		$0.00	$0.00	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$0.00	$3.63	$0.00	$0.00	$0.00	$0.00	$7.90	$12.51	$12.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10610	ERX	HCPCS 63700001	60505-1321-01	MIDODRINE HCL 5 MG PO TABS	BOTH IP/OP	$17.42 	$12.89	$0.00	$12.64		$0.00	$0.00	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$0.00	$3.63	$0.00	$0.00	$0.00	$0.00	$7.90	$12.51	$12.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10612	ERX	HCPCS J2265	70842-0160-01	MINOCYCLINE HCL 100 MG IV SOLR	BOTH IP/OP	$564.56 	$417.77	$0.00	$451.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.28	$447.13	$451.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10612	ERX	HCPCS J2265	70842-0160-10	MINOCYCLINE HCL 100 MG IV SOLR	BOTH IP/OP	$564.56 	$417.77	$0.00	$451.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.28	$447.13	$451.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10628	ERX	HCPCS 63700001	00025-1451-34	MISOPROSTOL 100 MCG PO TABS	BOTH IP/OP	$10.39 	$7.69	$0.00	$7.54		$0.00	$0.00	$0.00	$1.85	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.72	$7.47	$7.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10628	ERX	HCPCS 63700001	43386-0160-06	MISOPROSTOL 100 MCG PO TABS	BOTH IP/OP	$10.39 	$7.69	$0.00	$7.54		$0.00	$0.00	$0.00	$1.85	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.72	$7.47	$7.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10628	ERX	HCPCS 63700001	59762-5007-01	MISOPROSTOL 100 MCG PO TABS	BOTH IP/OP	$10.39 	$7.69	$0.00	$7.54		$0.00	$0.00	$0.00	$1.85	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.72	$7.47	$7.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10628	ERX	HCPCS 63700001	68084-0040-01	MISOPROSTOL 100 MCG PO TABS	BOTH IP/OP	$10.39 	$7.69	$0.00	$7.54		$0.00	$0.00	$0.00	$1.85	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.72	$7.47	$7.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10629	ERX	HCPCS 63700001	00025-1461-60	MISOPROSTOL 200 MCG PO TABS	BOTH IP/OP	$26.38 	$19.52	$0.00	$21.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.19	$20.89	$21.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10629	ERX	HCPCS 63700001	43386-0161-01	MISOPROSTOL 200 MCG PO TABS	BOTH IP/OP	$26.38 	$19.52	$0.00	$21.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.19	$20.89	$21.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10629	ERX	HCPCS 63700001	59762-5008-01	MISOPROSTOL 200 MCG PO TABS	BOTH IP/OP	$26.38 	$19.52	$0.00	$21.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.19	$20.89	$21.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10629	ERX	HCPCS 63700001	59762-5008-02	MISOPROSTOL 200 MCG PO TABS	BOTH IP/OP	$26.38 	$19.52	$0.00	$21.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.19	$20.89	$21.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10629	ERX	HCPCS 63700001	68084-0041-01	MISOPROSTOL 200 MCG PO TABS	BOTH IP/OP	$26.38 	$19.52	$0.00	$21.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.19	$20.89	$21.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10630	ERX	HCPCS J9280	16729-0108-11	MITOMYCIN 20 MG IV SOLR	BOTH IP/OP	"$1,033.42 "	$764.73	$0.00	$796.56	$465.04	$465.04	$101.33	$101.33	$101.33	$35.96	$767.00	$767.00	$796.56	$77.26	$90.78	$50.22	$611.27	$611.27	$184.27	$468.94	$742.79	$750.30	$254.47		$254.47	$187.74	$0.00	$0.00	$178.76	$114.42	$0.00	$0.00	$0.00	$0.00
10631	ERX	HCPCS J9280	16729-0116-38	MITOMYCIN 40 MG IV SOLR	BOTH IP/OP	"$1,033.42 "	$764.73	$0.00	$796.56	$465.04	$465.04	$101.33	$101.33	$101.33	$35.96	$767.00	$767.00	$796.56	$77.26	$90.78	$50.22	$611.27	$611.27	$184.27	$468.94	$742.79	$750.30	$254.47		$254.47	$187.74	$0.00	$0.00	$178.76	$114.42	$0.00	$0.00	$0.00	$0.00
10632	ERX	HCPCS J9280	16729-0115-05	MITOMYCIN 5 MG IV SOLR	BOTH IP/OP	"$1,411.35 "	"$1,044.40"	$0.00	"$1,087.87"	$635.11	$635.11	$101.33	$101.33	$101.33	$35.96	"$1,047.50"	"$1,047.50"	"$1,087.87"	$77.26	$90.78	$50.22	$834.81	$834.81	$184.27	$653.91	"$1,035.79"	"$1,046.25"	$254.47		$254.47	$187.74	$0.00	$0.00	$178.76	$114.42	$0.00	$0.00	$0.00	$0.00
10646	ERX	HCPCS 25000001	45802-0257-42	MOMETASONE FUROATE 0.1 % EX CREA	BOTH IP/OP	$183.64 	$135.89	$0.00	$141.55		$0.00	$0.00	$0.00	$0.00	$0.00	$136.30	$136.30	$141.55	$0.00	$38.27	$0.00	$0.00	$0.00	$0.00	$83.35	$132.03	$133.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10648	ERX	HCPCS 25000001	45802-0119-42	MOMETASONE FUROATE 0.1 % EX OINT	BOTH IP/OP	$172.14 	$127.38	$0.00	$132.69		$0.00	$0.00	$0.00	$0.00	$0.00	$127.76	$127.76	$132.69	$0.00	$35.87	$0.00	$0.00	$0.00	$0.00	$78.05	$123.62	$124.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10674	ERX	HCPCS 25000001	00093-1010-42	MUPIROCIN 2 % EX OINT	BOTH IP/OP	$47.11 	$34.86	$0.00	$36.31		$0.00	$0.00	$0.00	$0.00	$0.00	$34.97	$34.97	$36.31	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.36	$33.83	$34.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10674	ERX	HCPCS 25000001	45802-0112-22	MUPIROCIN 2 % EX OINT	BOTH IP/OP	$47.11 	$34.86	$0.00	$36.31		$0.00	$0.00	$0.00	$0.00	$0.00	$34.97	$34.97	$36.31	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.36	$33.83	$34.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10674	ERX	HCPCS 25000001	51672-1312-00	MUPIROCIN 2 % EX OINT	BOTH IP/OP	$47.11 	$34.86	$0.00	$36.31		$0.00	$0.00	$0.00	$0.00	$0.00	$34.97	$34.97	$36.31	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.36	$33.83	$34.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10674	ERX	HCPCS 25000001	68462-0180-22	MUPIROCIN 2 % EX OINT	BOTH IP/OP	$47.11 	$34.86	$0.00	$36.31		$0.00	$0.00	$0.00	$0.00	$0.00	$34.97	$34.97	$36.31	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.36	$33.83	$34.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10676	ERX	HCPCS 63700001	68462-0358-01	NABUMETONE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10685	ERX	HCPCS 63700001	00406-1170-03	DEPADE: NALTREXONE HCL 50 MG PO TABS	BOTH IP/OP	$17.92 	$13.26	$0.00	$13.00		$0.00	$0.00	$0.00	$3.19	$0.00	$0.00	$0.00	$0.00	$0.00	$3.73	$0.00	$0.00	$0.00	$0.00	$8.13	$12.87	$13.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10685	ERX	HCPCS 63700001	51224-0206-30	DEPADE: NALTREXONE HCL 50 MG PO TABS	BOTH IP/OP	$17.92 	$13.26	$0.00	$13.00		$0.00	$0.00	$0.00	$3.19	$0.00	$0.00	$0.00	$0.00	$0.00	$3.73	$0.00	$0.00	$0.00	$0.00	$8.13	$12.87	$13.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10692	ERX	HCPCS 25000001	00065-0645-15	NATAMYCIN 5 % OP SUSP	BOTH IP/OP	"$1,046.74 "	$774.59	$0.00	$837.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$523.37	$829.02	$837.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10712	ERX	HCPCS 63700001	42806-0501-09	NICARDIPINE HCL 20 MG PO CAPS	BOTH IP/OP	$64.92 	$48.04	$0.00	$47.10		$0.00	$0.00	$0.00	$11.56	$0.00	$0.00	$0.00	$0.00	$0.00	$13.53	$0.00	$0.00	$0.00	$0.00	$29.44	$46.63	$47.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10722	ERX	HCPCS 63700001	23155-0512-00	NIMODIPINE 30 MG PO CAPS	BOTH IP/OP	$28.90 	$21.39	$0.00	$20.97		$0.00	$0.00	$0.00	$5.14	$0.00	$0.00	$0.00	$0.00	$0.00	$6.02	$0.00	$0.00	$0.00	$0.00	$13.11	$20.76	$20.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10722	ERX	HCPCS 63700001	23155-0512-11	NIMODIPINE 30 MG PO CAPS	BOTH IP/OP	$28.90 	$21.39	$0.00	$20.97		$0.00	$0.00	$0.00	$5.14	$0.00	$0.00	$0.00	$0.00	$0.00	$6.02	$0.00	$0.00	$0.00	$0.00	$13.11	$20.76	$20.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10722	ERX	HCPCS 63700001	23155-0512-30	NIMODIPINE 30 MG PO CAPS	BOTH IP/OP	$28.90 	$21.39	$0.00	$20.97		$0.00	$0.00	$0.00	$5.14	$0.00	$0.00	$0.00	$0.00	$0.00	$6.02	$0.00	$0.00	$0.00	$0.00	$13.11	$20.76	$20.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10722	ERX	HCPCS 63700001	63739-0797-33	NIMODIPINE 30 MG PO CAPS	BOTH IP/OP	$28.90 	$21.39	$0.00	$20.97		$0.00	$0.00	$0.00	$5.14	$0.00	$0.00	$0.00	$0.00	$0.00	$6.02	$0.00	$0.00	$0.00	$0.00	$13.11	$20.76	$20.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10724	ERX	HCPCS 63700001	00185-0122-01	NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS	BOTH IP/OP	$14.82 	$10.97	$0.00	$10.75		$0.00	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00	$3.09	$0.00	$0.00	$0.00	$0.00	$6.72	$10.64	$10.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10724	ERX	HCPCS 63700001	16714-0439-01	NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS	BOTH IP/OP	$14.82 	$10.97	$0.00	$10.75		$0.00	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00	$3.09	$0.00	$0.00	$0.00	$0.00	$6.72	$10.64	$10.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10724	ERX	HCPCS 63700001	68084-0446-01	NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS	BOTH IP/OP	$14.82 	$10.97	$0.00	$10.75		$0.00	$0.00	$0.00	$2.64	$0.00	$0.00	$0.00	$0.00	$0.00	$3.09	$0.00	$0.00	$0.00	$0.00	$6.72	$10.64	$10.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10747	ERX	HCPCS 63700001	00555-0211-10	NORETHINDRONE ACETATE 5 MG PO TABS	BOTH IP/OP	$11.10 	$8.21	$0.00	$8.06		$0.00	$0.00	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$0.00	$2.31	$0.00	$0.00	$0.00	$0.00	$5.04	$7.98	$8.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10747	ERX	HCPCS 63700001	51285-0424-10	NORETHINDRONE ACETATE 5 MG PO TABS	BOTH IP/OP	$11.10 	$8.21	$0.00	$8.06		$0.00	$0.00	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$0.00	$2.31	$0.00	$0.00	$0.00	$0.00	$5.04	$7.98	$8.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10747	ERX	HCPCS 63700001	65162-0475-05	NORETHINDRONE ACETATE 5 MG PO TABS	BOTH IP/OP	$11.10 	$8.21	$0.00	$8.06		$0.00	$0.00	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$0.00	$2.31	$0.00	$0.00	$0.00	$0.00	$5.04	$7.98	$8.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10749	ERX	HCPCS 63700001	16714-0360-01	NORGESTIMATE-ETH ESTRADIOL 0.25-35 MG-MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10749	ERX	HCPCS 63700001	16714-0360-04	NORGESTIMATE-ETH ESTRADIOL 0.25-35 MG-MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10749	ERX	HCPCS 63700001	99999-6009-94	NORGESTIMATE-ETH ESTRADIOL 0.25-35 MG-MCG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10752	ERX	HCPCS 63700001	16714-0365-04	NORGESTREL-ETHINYL ESTRADIOL 0.3-30 MG-MCG PO TABS	BOTH IP/OP	$117.81 	$87.18	$0.00	$85.46		$0.00	$0.00	$0.00	$20.97	$0.00	$0.00	$0.00	$0.00	$0.00	$24.55	$0.00	$0.00	$0.00	$0.00	$53.41	$84.60	$85.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10778	ERX	HCPCS Q0162	00904-6551-61	ONDANSETRON HCL 4 MG PO TABS	BOTH IP/OP	$86.73 	$64.18	$0.00	$69.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.37	$68.69	$69.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10778	ERX	HCPCS Q0162	55111-0153-30	ONDANSETRON HCL 4 MG PO TABS	BOTH IP/OP	$86.73 	$64.18	$0.00	$69.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.37	$68.69	$69.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10778	ERX	HCPCS Q0162	68084-0220-01	ONDANSETRON HCL 4 MG PO TABS	BOTH IP/OP	$86.73 	$64.18	$0.00	$69.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.37	$68.69	$69.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10778	ERX	HCPCS Q0162	68084-0220-11	ONDANSETRON HCL 4 MG PO TABS	BOTH IP/OP	$86.73 	$64.18	$0.00	$69.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.37	$68.69	$69.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10779	ERX	HCPCS Q0162	00904-6552-61	ONDANSETRON HCL 8 MG PO TABS	BOTH IP/OP	$144.41 	$106.86	$0.00	$115.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.21	$114.37	$115.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10779	ERX	HCPCS Q0162	55111-0154-30	ONDANSETRON HCL 8 MG PO TABS	BOTH IP/OP	$144.41 	$106.86	$0.00	$115.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.21	$114.37	$115.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10779	ERX	HCPCS Q0162	62756-0131-01	ONDANSETRON HCL 8 MG PO TABS	BOTH IP/OP	$144.41 	$106.86	$0.00	$115.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.21	$114.37	$115.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10779	ERX	HCPCS Q0162	63304-0459-30	ONDANSETRON HCL 8 MG PO TABS	BOTH IP/OP	$144.41 	$106.86	$0.00	$115.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.21	$114.37	$115.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10779	ERX	HCPCS Q0162	63739-0333-10	ONDANSETRON HCL 8 MG PO TABS	BOTH IP/OP	$144.41 	$106.86	$0.00	$115.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.21	$114.37	$115.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10779	ERX	HCPCS Q0162	68084-0221-01	ONDANSETRON HCL 8 MG PO TABS	BOTH IP/OP	$144.41 	$106.86	$0.00	$115.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.21	$114.37	$115.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10803	ERX	HCPCS 63700001	00245-0271-11	OXANDROLONE 2.5 MG PO TABS	BOTH IP/OP	$23.18 	$17.15	$0.00	$16.82		$0.00	$0.00	$0.00	$4.13	$0.00	$0.00	$0.00	$0.00	$0.00	$4.83	$0.00	$0.00	$0.00	$0.00	$10.51	$16.65	$16.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10803	ERX	HCPCS 63700001	49884-0301-01	OXANDROLONE 2.5 MG PO TABS	BOTH IP/OP	$23.18 	$17.15	$0.00	$16.82		$0.00	$0.00	$0.00	$4.13	$0.00	$0.00	$0.00	$0.00	$0.00	$4.83	$0.00	$0.00	$0.00	$0.00	$10.51	$16.65	$16.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10810	ERX	HCPCS 63700001	99999-6004-78	OXYBUTYNIN CHLORIDE 5 MG/5ML PO SYRP	BOTH IP/OP	$52.80 	$39.07	$0.00	$131.12		$0.00	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$0.00	$0.00	$0.00	$0.00	$81.95	$37.92	$131.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10810	ERX	HCPCS 63700001	54838-0510-80	OXYBUTYNIN CHLORIDE 5 MG/5ML PO SYRP	BOTH IP/OP	$52.80 	$39.07	$0.00	$131.12		$0.00	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$0.00	$0.00	$0.00	$0.00	$81.95	$129.81	$131.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10810	ERX	HCPCS 63700001	60432-0092-16	OXYBUTYNIN CHLORIDE 5 MG/5ML PO SYRP	BOTH IP/OP	$52.80 	$39.07	$0.00	$131.12		$0.00	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$0.00	$0.00	$0.00	$0.00	$81.95	$129.81	$131.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10811	ERX	HCPCS 25000001	00327-0001-10	OXYCHLOROSENE SODIUM POWD	BOTH IP/OP	$25.98 	$19.23	$0.00	$20.03		$0.00	$0.00	$0.00	$0.00	$0.00	$19.28	$19.28	$20.03	$0.00	$5.41	$0.00	$0.00	$0.00	$0.00	$11.78	$18.66	$18.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10812	ERX	HCPCS 25000001	00406-8557-30	OXYCODONE HCL 100 MG/5ML PO CONC	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10812	ERX	HCPCS 25000001	66689-0025-30	OXYCODONE HCL 100 MG/5ML PO CONC	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10812	ERX	HCPCS 25000001	68308-0020-03	OXYCODONE HCL 100 MG/5ML PO CONC	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10812	ERX	HCPCS 25000001	99999-6005-57	OXYCODONE HCL 100 MG/5ML PO CONC	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10813	ERX	HCPCS 25000001	00054-0390-63	OXYCODONE HCL 5 MG/5ML PO SOLN	BOTH IP/OP	$36.14 	$26.74	$0.00	$27.86		$0.00	$0.00	$0.00	$0.00	$0.00	$26.82	$26.82	$27.86	$0.00	$7.53	$0.00	$0.00	$0.00	$0.00	$16.39	$25.96	$26.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10813	ERX	HCPCS 25000001	66689-0401-01	OXYCODONE HCL 5 MG/5ML PO SOLN	BOTH IP/OP	$36.14 	$26.74	$0.00	$27.86		$0.00	$0.00	$0.00	$0.00	$0.00	$26.82	$26.82	$27.86	$0.00	$7.53	$0.00	$0.00	$0.00	$0.00	$16.39	$25.96	$26.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10813	ERX	HCPCS 25000001	66689-0401-50	OXYCODONE HCL 5 MG/5ML PO SOLN	BOTH IP/OP	$36.14 	$26.74	$0.00	$27.86		$0.00	$0.00	$0.00	$0.00	$0.00	$26.82	$26.82	$27.86	$0.00	$7.53	$0.00	$0.00	$0.00	$0.00	$16.39	$25.96	$26.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10813	ERX	HCPCS 25000001	66689-0403-16	OXYCODONE HCL 5 MG/5ML PO SOLN	BOTH IP/OP	$36.14 	$26.74	$0.00	$27.86		$0.00	$0.00	$0.00	$0.00	$0.00	$26.82	$26.82	$27.86	$0.00	$7.53	$0.00	$0.00	$0.00	$0.00	$16.39	$25.96	$26.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10813	ERX	HCPCS 25000001	99999-6004-35	OXYCODONE HCL 5 MG/5ML PO SOLN	BOTH IP/OP	$36.14 	$26.74	$0.00	$27.86		$0.00	$0.00	$0.00	$0.00	$0.00	$26.82	$26.82	$27.86	$0.00	$7.53	$0.00	$0.00	$0.00	$0.00	$16.39	$25.96	$26.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10814	ERX	HCPCS 25000001	00406-0552-23	OXYCODONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10814	ERX	HCPCS 25000001	00406-0552-62	OXYCODONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10814	ERX	HCPCS 25000001	42858-0001-10	OXYCODONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10814	ERX	HCPCS 25000001	57664-0223-88	OXYCODONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10814	ERX	HCPCS 25000001	68084-0354-01	OXYCODONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10814	ERX	HCPCS 25000001	68084-0354-11	OXYCODONE HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10839	ERX	HCPCS 63700001	52268-0100-01	PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR	BOTH IP/OP	$83.80 	$62.01	$0.00	$60.80		$0.00	$0.00	$0.00	$14.92	$0.00	$0.00	$0.00	$0.00	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$38.00	$48.15	$60.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10839	ERX	HCPCS 63700001	52268-0101-01	PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR	BOTH IP/OP	$83.80 	$62.01	$0.00	$60.80		$0.00	$0.00	$0.00	$14.92	$0.00	$0.00	$0.00	$0.00	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$38.00	$48.15	$60.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10845	ERX	HCPCS J2430	59923-0601-10	PAMIDRONATE DISODIUM 30 MG IV SOLR	BOTH IP/OP	$78.93 	$58.41	$0.00	$63.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.47	$62.51	$63.14	$0.00		$0.00	$12.35	$0.00	$0.00	$12.57	$0.00	$0.00	$0.00	$0.00	$0.00
10854	ERX	HCPCS 63700001	23155-0038-01	PAROMOMYCIN SULFATE 250 MG PO CAPS	BOTH IP/OP	$23.76 	$17.58	$0.00	$17.24		$0.00	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$0.00	$4.95	$0.00	$0.00	$0.00	$0.00	$10.78	$17.07	$17.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10855	ERX	HCPCS 63700001	00904-5677-61	PAROXETINE HCL 20 MG PO TABS	BOTH IP/OP	$10.37 	$7.67	$0.00	$8.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.19	$8.21	$8.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10855	ERX	HCPCS 63700001	13107-0155-30	PAROXETINE HCL 20 MG PO TABS	BOTH IP/OP	$10.37 	$7.67	$0.00	$8.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.19	$8.21	$8.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10855	ERX	HCPCS 63700001	51079-0774-01	PAROXETINE HCL 20 MG PO TABS	BOTH IP/OP	$10.37 	$7.67	$0.00	$8.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.19	$8.21	$8.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10855	ERX	HCPCS 63700001	51079-0774-20	PAROXETINE HCL 20 MG PO TABS	BOTH IP/OP	$10.37 	$7.67	$0.00	$8.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.19	$8.21	$8.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10855	ERX	HCPCS 63700001	63739-0963-10	PAROXETINE HCL 20 MG PO TABS	BOTH IP/OP	$10.37 	$7.67	$0.00	$8.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.19	$8.21	$8.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10855	ERX	HCPCS 63700001	63874-0538-10	PAROXETINE HCL 20 MG PO TABS	BOTH IP/OP	$10.37 	$7.67	$0.00	$8.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.19	$8.21	$8.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10855	ERX	HCPCS 63700001	68084-0045-01	PAROXETINE HCL 20 MG PO TABS	BOTH IP/OP	$10.37 	$7.67	$0.00	$8.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.19	$8.21	$8.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10855	ERX	HCPCS 63700001	68084-0045-11	PAROXETINE HCL 20 MG PO TABS	BOTH IP/OP	$10.37 	$7.67	$0.00	$8.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.19	$8.21	$8.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10855	ERX	HCPCS 63700001	68382-0098-06	PAROXETINE HCL 20 MG PO TABS	BOTH IP/OP	$10.37 	$7.67	$0.00	$8.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.19	$8.21	$8.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10856	ERX	HCPCS 63700001	13107-0156-30	PAROXETINE HCL 30 MG PO TABS	BOTH IP/OP	$10.38 	$7.68	$0.00	$8.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.19	$8.22	$8.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10897	ERX	HCPCS J0561	60793-0700-10	PENICILLIN G BENZATHINE 600000 UNIT/ML IM SUSP	BOTH IP/OP	$440.87 	$326.24	$0.00	$339.82	$198.39	$198.39	$90.26	$90.26	$90.26	$91.89	$327.21	$327.21	$339.82	$89.69	$105.39	$58.30	$260.77	$260.77	$87.07	$181.91	$288.14	$291.05	$120.23		$120.23	$97.01	$0.00	$0.00	$92.37	$82.92	$0.00	$0.00	$0.00	$0.00
10910	ERX	HCPCS J9268	00409-0801-01	PENTOSTATIN 10 MG IV SOLR	BOTH IP/OP	"$6,614.75 "	"$4,894.92"	$0.00	"$5,098.65"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,909.47"	"$4,909.47"	"$5,098.65"	$0.00	"$1,378.51"	$0.00	$0.00	$0.00	$0.00	"$2,713.76"	"$4,298.60"	"$4,342.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10917	ERX	HCPCS 25000001	00472-0242-60	PERMETHRIN 5 % EX CREA	BOTH IP/OP	$415.91 	$307.77	$0.00	$320.58		$0.00	$0.00	$0.00	$0.00	$0.00	$308.69	$308.69	$320.58	$0.00	$86.68	$0.00	$0.00	$0.00	$0.00	$188.77	$299.00	$302.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10917	ERX	HCPCS 25000001	16714-0897-01	PERMETHRIN 5 % EX CREA	BOTH IP/OP	$415.91 	$307.77	$0.00	$320.58		$0.00	$0.00	$0.00	$0.00	$0.00	$308.69	$308.69	$320.58	$0.00	$86.68	$0.00	$0.00	$0.00	$0.00	$188.77	$299.00	$302.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10917	ERX	HCPCS 25000001	45802-0269-37	PERMETHRIN 5 % EX CREA	BOTH IP/OP	$415.91 	$307.77	$0.00	$320.58		$0.00	$0.00	$0.00	$0.00	$0.00	$308.69	$308.69	$320.58	$0.00	$86.68	$0.00	$0.00	$0.00	$0.00	$188.77	$299.00	$302.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10918	ERX	HCPCS 25000001	63736-0120-03	PERMETHRIN 1 % EX LIQD	BOTH IP/OP	$42.28 	$31.29	$0.00	$32.59		$0.00	$0.00	$0.00	$0.00	$0.00	$31.38	$31.38	$32.59	$0.00	$8.81	$0.00	$0.00	$0.00	$0.00	$19.17	$24.33	$30.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10933	ERX	HCPCS 63700001	59762-0119-01	PHENELZINE SULFATE 15 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10945	ERX	HCPCS 63700001	49884-0038-01	PHENOXYBENZAMINE HCL 10 MG PO CAPS	BOTH IP/OP	$434.94 	$321.86	$0.00	$315.85		$0.00	$0.00	$0.00	$77.42	$0.00	$0.00	$0.00	$0.00	$0.00	$90.64	$0.00	$0.00	$0.00	$0.00	$197.41	$312.69	$315.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10945	ERX	HCPCS 63700001	59212-0001-01	PHENOXYBENZAMINE HCL 10 MG PO CAPS	BOTH IP/OP	$434.94 	$321.86	$0.00	$315.85		$0.00	$0.00	$0.00	$77.42	$0.00	$0.00	$0.00	$0.00	$0.00	$90.64	$0.00	$0.00	$0.00	$0.00	$197.41	$312.69	$315.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10947	ERX	HCPCS J2760	00143-9564-01	PHENTOLAMINE MESYLATE 5 MG IJ SOLR	BOTH IP/OP	"$1,385.60 "	"$1,025.34"	$0.00	"$1,068.02"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,028.39"	"$1,028.39"	"$1,068.02"	$0.00	$288.76	$0.00	$0.00	$0.00	$0.00	$641.98	"$1,016.90"	"$1,027.17"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10947	ERX	HCPCS J2760	00143-9564-10	PHENTOLAMINE MESYLATE 5 MG IJ SOLR	BOTH IP/OP	"$1,385.60 "	"$1,025.34"	$0.00	"$1,068.02"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,028.39"	"$1,028.39"	"$1,068.02"	$0.00	$288.76	$0.00	$0.00	$0.00	$0.00	$641.98	"$1,016.90"	"$1,027.17"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11018	ERX	HCPCS 63700001	00071-0007-40	PHENYTOIN 50 MG PO CHEW	BOTH IP/OP	$9.55 	$7.07	$0.00	$6.60		$0.00	$0.00	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$4.13	$6.53	$6.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11018	ERX	HCPCS 63700001	51672-4146-01	PHENYTOIN 50 MG PO CHEW	BOTH IP/OP	$9.55 	$7.07	$0.00	$6.60		$0.00	$0.00	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$4.13	$6.53	$6.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11019	ERX	HCPCS 63700001	00071-3740-66	PHENYTOIN SODIUM EXTENDED 30 MG PO CAPS	BOTH IP/OP	$6.19 	$4.58	$0.00	$4.80		$0.00	$0.00	$0.00	$1.10	$0.00	$0.00	$0.00	$0.00	$0.00	$1.29	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11024	ERX	HCPCS 63700001	00187-1704-05	PHYTONADIONE 5 MG PO TABS	BOTH IP/OP	$244.68 	$181.06	$0.00	$177.70		$0.00	$0.00	$0.00	$43.55	$0.00	$0.00	$0.00	$0.00	$0.00	$50.99	$0.00	$0.00	$0.00	$0.00	$111.06	$175.92	$177.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11024	ERX	HCPCS 63700001	68682-0170-30	PHYTONADIONE 5 MG PO TABS	BOTH IP/OP	$244.68 	$181.06	$0.00	$177.70		$0.00	$0.00	$0.00	$43.55	$0.00	$0.00	$0.00	$0.00	$0.00	$50.99	$0.00	$0.00	$0.00	$0.00	$111.06	$175.92	$177.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11037	ERX	HCPCS 90732	00006-4837-01	PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ	BOTH IP/OP	$472.08 	$349.34	$9.40	$363.88	$212.44	$212.44	$122.74	$122.74	$119.92	$9.40	$350.38	$350.38	$363.88	$122.74	$147.95	$79.78	$279.24	$279.24	$56.21	$192.51	$304.93	$308.01	$56.21		$56.21	$134.20	$105.11	$105.11	$127.78	$105.11	$0.00	$0.00	$0.00	$0.00
11037	ERX	HCPCS 90732	00006-4837-03	PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ	BOTH IP/OP	$472.08 	$349.34	$9.40	$363.88	$212.44	$212.44	$122.74	$122.74	$119.92	$9.40	$350.38	$350.38	$363.88	$122.74	$147.95	$79.78	$279.24	$279.24	$56.21	$192.51	$304.93	$308.01	$56.21		$56.21	$134.20	$105.11	$105.11	$127.78	$105.11	$0.00	$0.00	$0.00	$0.00
11038	ERX	HCPCS 25000001	00574-0611-05	PODOFILOX 0.5 % EX SOLN	BOTH IP/OP	$363.39 	$268.91	$0.00	$280.10		$0.00	$0.00	$0.00	$0.00	$0.00	$269.71	$269.71	$280.10	$0.00	$75.73	$0.00	$0.00	$0.00	$0.00	$164.93	$261.25	$263.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11038	ERX	HCPCS 25000001	00591-3204-13	PODOFILOX 0.5 % EX SOLN	BOTH IP/OP	$363.39 	$268.91	$0.00	$280.10		$0.00	$0.00	$0.00	$0.00	$0.00	$269.71	$269.71	$280.10	$0.00	$75.73	$0.00	$0.00	$0.00	$0.00	$164.93	$261.25	$263.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11058	ERX	HCPCS 25000001	60258-0002-16	K & NA CIT-CIT AC 550-500-334 MG/5ML PO SYRP	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11074	ERX	HCPCS J3480	00338-0709-48	POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN	BOTH IP/OP	$24.31 	$17.99	$0.00	$18.74	$10.94	$10.94	$0.00	$0.00	$0.00	$0.12	$18.04	$18.04	$18.74	$0.00	$0.85	$0.00	$14.38	$14.38	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.82	$0.00	$0.00	$0.78	$0.00	$0.00	$0.00	$0.00	$0.00
11076	ERX	HCPCS J3480	00338-0705-48	POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$1.69	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.65	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$0.00
11076	ERX	HCPCS J3480	00990-7075-26	POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$1.69	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.65	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$0.00
11083	ERX	HCPCS 63700001	00245-0071-11	POTASSIUM CITRATE ER 10 MEQ (1080 MG) PO TBCR	BOTH IP/OP	$11.56 	$8.55	$0.00	$8.39		$0.00	$0.00	$0.00	$2.06	$0.00	$0.00	$0.00	$0.00	$0.00	$2.41	$0.00	$0.00	$0.00	$0.00	$5.25	$8.31	$8.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11087	ERX	HCPCS 25000001	00486-1111-01	POTASSIUM PHOSPHATE MONOBASIC 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11110	ERX	HCPCS 63700001	00093-0771-98	PRAVASTATIN SODIUM 10 MG PO TABS	BOTH IP/OP	$13.48 	$9.98	$0.00	$9.78		$0.00	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$6.11	$9.68	$9.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11110	ERX	HCPCS 63700001	00904-5891-61	PRAVASTATIN SODIUM 10 MG PO TABS	BOTH IP/OP	$13.48 	$9.98	$0.00	$9.78		$0.00	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$6.11	$9.68	$9.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11110	ERX	HCPCS 63700001	60505-0168-09	PRAVASTATIN SODIUM 10 MG PO TABS	BOTH IP/OP	$13.48 	$9.98	$0.00	$9.78		$0.00	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$6.11	$9.68	$9.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11110	ERX	HCPCS 63700001	68462-0195-90	PRAVASTATIN SODIUM 10 MG PO TABS	BOTH IP/OP	$13.48 	$9.98	$0.00	$9.78		$0.00	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$6.11	$9.68	$9.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11111	ERX	HCPCS 63700001	00093-7201-98	PRAVASTATIN SODIUM 20 MG PO TABS	BOTH IP/OP	$10.46 	$7.74	$0.00	$7.59		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11111	ERX	HCPCS 63700001	00904-5892-61	PRAVASTATIN SODIUM 20 MG PO TABS	BOTH IP/OP	$10.46 	$7.74	$0.00	$7.59		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11111	ERX	HCPCS 63700001	16729-0009-15	PRAVASTATIN SODIUM 20 MG PO TABS	BOTH IP/OP	$10.46 	$7.74	$0.00	$7.59		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11111	ERX	HCPCS 63700001	51079-0458-01	PRAVASTATIN SODIUM 20 MG PO TABS	BOTH IP/OP	$10.46 	$7.74	$0.00	$7.59		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11111	ERX	HCPCS 63700001	51079-0458-20	PRAVASTATIN SODIUM 20 MG PO TABS	BOTH IP/OP	$10.46 	$7.74	$0.00	$7.59		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11111	ERX	HCPCS 63700001	63739-0649-10	PRAVASTATIN SODIUM 20 MG PO TABS	BOTH IP/OP	$10.46 	$7.74	$0.00	$7.59		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11112	ERX	HCPCS 63700001	00904-5893-61	PRAVASTATIN SODIUM 40 MG PO TABS	BOTH IP/OP	$18.00 	$13.32	$0.00	$13.06		$0.00	$0.00	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$8.16	$12.93	$13.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11112	ERX	HCPCS 63700001	55111-0231-05	PRAVASTATIN SODIUM 40 MG PO TABS	BOTH IP/OP	$18.00 	$13.32	$0.00	$13.06		$0.00	$0.00	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$8.16	$12.93	$13.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11112	ERX	HCPCS 63700001	68462-0197-90	PRAVASTATIN SODIUM 40 MG PO TABS	BOTH IP/OP	$18.00 	$13.32	$0.00	$13.06		$0.00	$0.00	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$8.16	$12.93	$13.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11113	ERX	HCPCS 63700001	50419-0747-01	PRAZIQUANTEL 600 MG PO TABS	BOTH IP/OP	$345.78 	$255.88	$0.00	$251.11		$0.00	$0.00	$0.00	$61.55	$0.00	$0.00	$0.00	$0.00	$0.00	$72.06	$0.00	$0.00	$0.00	$0.00	$156.95	$248.60	$251.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11129	ERX	HCPCS 63700001	53746-0544-01	PRIMIDONE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11129	ERX	HCPCS 63700001	68084-0202-01	PRIMIDONE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11129	ERX	HCPCS 63700001	68084-0202-11	PRIMIDONE 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11138	ERX	HCPCS 25000001	00574-7226-12	PROCHLORPERAZINE 25 MG RECTAL SUPP	BOTH IP/OP	$52.73 	$39.02	$0.00	$40.64		$0.00	$0.00	$0.00	$0.00	$0.00	$39.14	$39.14	$40.64	$0.00	$10.99	$0.00	$0.00	$0.00	$0.00	$23.91	$37.87	$38.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11143	ERX	HCPCS 25000001	00713-0536-06	PROMETHAZINE HCL 12.5 MG RECTAL SUPP	BOTH IP/OP	$74.19 	$54.90	$0.00	$57.19		$0.00	$0.00	$0.00	$0.00	$0.00	$55.06	$55.06	$57.19	$0.00	$15.46	$0.00	$0.00	$0.00	$0.00	$33.64	$53.29	$53.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11143	ERX	HCPCS 25000001	00713-0536-12	PROMETHAZINE HCL 12.5 MG RECTAL SUPP	BOTH IP/OP	$74.19 	$54.90	$0.00	$57.19		$0.00	$0.00	$0.00	$0.00	$0.00	$55.06	$55.06	$57.19	$0.00	$15.46	$0.00	$0.00	$0.00	$0.00	$33.64	$53.29	$53.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11143	ERX	HCPCS 25000001	45802-0758-30	PROMETHAZINE HCL 12.5 MG RECTAL SUPP	BOTH IP/OP	$74.19 	$54.90	$0.00	$57.19		$0.00	$0.00	$0.00	$0.00	$0.00	$55.06	$55.06	$57.19	$0.00	$15.46	$0.00	$0.00	$0.00	$0.00	$33.64	$53.29	$53.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11144	ERX	HCPCS 25000001	00713-0526-12	PROMETHAZINE HCL 25 MG RECTAL SUPP	BOTH IP/OP	$74.19 	$54.90	$0.00	$57.19		$0.00	$0.00	$0.00	$0.00	$0.00	$55.06	$55.06	$57.19	$0.00	$15.46	$0.00	$0.00	$0.00	$0.00	$33.64	$53.29	$53.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11144	ERX	HCPCS 25000001	45802-0759-30	PROMETHAZINE HCL 25 MG RECTAL SUPP	BOTH IP/OP	$74.19 	$54.90	$0.00	$57.19		$0.00	$0.00	$0.00	$0.00	$0.00	$55.06	$55.06	$57.19	$0.00	$15.46	$0.00	$0.00	$0.00	$0.00	$33.64	$53.29	$53.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11144	ERX	HCPCS 25000001	51672-5297-01	PROMETHAZINE HCL 25 MG RECTAL SUPP	BOTH IP/OP	$74.19 	$54.90	$0.00	$57.19		$0.00	$0.00	$0.00	$0.00	$0.00	$55.06	$55.06	$57.19	$0.00	$15.46	$0.00	$0.00	$0.00	$0.00	$33.64	$53.29	$53.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11146	ERX	HCPCS 63700001	00591-0582-01	PROPAFENONE HCL 150 MG PO TABS	BOTH IP/OP	$6.40 	$4.74	$0.00	$5.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.20	$5.07	$5.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11146	ERX	HCPCS 63700001	53489-0551-01	PROPAFENONE HCL 150 MG PO TABS	BOTH IP/OP	$6.40 	$4.74	$0.00	$5.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.20	$5.07	$5.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11146	ERX	HCPCS 63700001	62559-0230-01	PROPAFENONE HCL 150 MG PO TABS	BOTH IP/OP	$6.40 	$4.74	$0.00	$5.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.20	$5.07	$5.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11146	ERX	HCPCS 63700001	63739-0509-10	PROPAFENONE HCL 150 MG PO TABS	BOTH IP/OP	$6.40 	$4.74	$0.00	$5.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.20	$5.07	$5.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11147	ERX	HCPCS 63700001	00591-0583-01	PROPAFENONE HCL 225 MG PO TABS	BOTH IP/OP	$9.77 	$7.23	$0.00	$7.09		$0.00	$0.00	$0.00	$1.74	$0.00	$0.00	$0.00	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$4.43	$7.02	$7.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11147	ERX	HCPCS 63700001	00603-5449-21	PROPAFENONE HCL 225 MG PO TABS	BOTH IP/OP	$9.77 	$7.23	$0.00	$7.09		$0.00	$0.00	$0.00	$1.74	$0.00	$0.00	$0.00	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$4.43	$7.02	$7.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11147	ERX	HCPCS 63700001	53489-0552-01	PROPAFENONE HCL 225 MG PO TABS	BOTH IP/OP	$9.77 	$7.23	$0.00	$7.09		$0.00	$0.00	$0.00	$1.74	$0.00	$0.00	$0.00	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$4.43	$7.02	$7.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11164	ERX	HCPCS 63700001	00054-0210-25	PROTRIPTYLINE HCL 5 MG PO TABS	BOTH IP/OP	$24.03 	$17.78	$0.00	$17.43		$0.00	$0.00	$0.00	$4.28	$0.00	$0.00	$0.00	$0.00	$0.00	$5.01	$0.00	$0.00	$0.00	$0.00	$10.90	$17.26	$17.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11164	ERX	HCPCS 63700001	64980-0158-01	PROTRIPTYLINE HCL 5 MG PO TABS	BOTH IP/OP	$24.03 	$17.78	$0.00	$17.43		$0.00	$0.00	$0.00	$4.28	$0.00	$0.00	$0.00	$0.00	$0.00	$5.01	$0.00	$0.00	$0.00	$0.00	$10.90	$17.26	$17.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11217	ERX	HCPCS 63700001	37000-0023-04	PSYLLIUM 28 % PO PACK	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11217	ERX	HCPCS 63700001	37000-0740-87	PSYLLIUM 28 % PO PACK	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11239	ERX	HCPCS 63700001	00115-3511-01	PYRIDOSTIGMINE BROMIDE 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11239	ERX	HCPCS 63700001	68682-0302-10	PYRIDOSTIGMINE BROMIDE 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11240	ERX	HCPCS 63700001	00115-1404-08	PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR	BOTH IP/OP	$95.76 	$70.86	$0.00	$69.46		$0.00	$0.00	$0.00	$17.05	$0.00	$0.00	$0.00	$0.00	$0.00	$19.96	$0.00	$0.00	$0.00	$0.00	$43.42	$68.77	$69.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11240	ERX	HCPCS 63700001	00187-3013-30	PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR	BOTH IP/OP	$95.76 	$70.86	$0.00	$69.46		$0.00	$0.00	$0.00	$17.05	$0.00	$0.00	$0.00	$0.00	$0.00	$19.96	$0.00	$0.00	$0.00	$0.00	$43.42	$68.77	$69.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11240	ERX	HCPCS 63700001	47781-0335-30	PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR	BOTH IP/OP	$95.76 	$70.86	$0.00	$69.46		$0.00	$0.00	$0.00	$17.05	$0.00	$0.00	$0.00	$0.00	$0.00	$19.96	$0.00	$0.00	$0.00	$0.00	$43.42	$68.77	$69.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11240	ERX	HCPCS 63700001	64980-0220-03	PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR	BOTH IP/OP	$95.76 	$70.86	$0.00	$69.46		$0.00	$0.00	$0.00	$17.05	$0.00	$0.00	$0.00	$0.00	$0.00	$19.96	$0.00	$0.00	$0.00	$0.00	$43.42	$68.77	$69.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11246	ERX	HCPCS 63700001	69413-0330-10	PYRIMETHAMINE 25 MG PO TABS	BOTH IP/OP	"$4,068.00 "	"$3,010.32"	$0.00	"$2,952.00"		$0.00	$0.00	$0.00	$724.10	$0.00	$0.00	$0.00	$0.00	$0.00	$847.77	$0.00	$0.00	$0.00	$0.00	"$1,845.00"	"$2,922.48"	"$2,952.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11246	ERX	HCPCS 63700001	69413-0330-30	PYRIMETHAMINE 25 MG PO TABS	BOTH IP/OP	"$4,068.00 "	"$3,010.32"	$0.00	"$2,952.00"		$0.00	$0.00	$0.00	$724.10	$0.00	$0.00	$0.00	$0.00	$0.00	$847.77	$0.00	$0.00	$0.00	$0.00	"$1,845.00"	"$2,922.48"	"$2,952.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11257	ERX	HCPCS 90675	49281-0250-51	"RABIES VIRUS VACCINE, HDC IM INJ"	BOTH IP/OP	"$1,419.71 "	"$1,050.59"	$0.00	$951.88	$0.00	$0.00	$0.00	$0.00	$0.00	$174.76	$0.00	$0.00	$0.00	$327.53	$384.85	$212.90	$839.76	$839.76	$312.47	$594.93	$942.36	$951.88	$431.50		$431.50	$326.44	$0.00	$0.00	$310.83	$294.72	$0.00	$0.00	$0.00	$0.00
11259	ERX	HCPCS 63700001	68180-0591-01	RAMIPRIL 10 MG PO CAPS	BOTH IP/OP	$9.29 	$6.87	$0.00	$7.21		$0.00	$0.00	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$4.51	$7.14	$7.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11286	ERX	HCPCS 63700001	65862-0290-84	RIBAVIRIN 200 MG PO CAPS	BOTH IP/OP	$41.63 	$30.81	$0.00	$30.20		$0.00	$0.00	$0.00	$7.41	$0.00	$0.00	$0.00	$0.00	$0.00	$8.68	$0.00	$0.00	$0.00	$0.00	$18.88	$29.90	$30.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11286	ERX	HCPCS 63700001	68382-0260-12	RIBAVIRIN 200 MG PO CAPS	BOTH IP/OP	$41.63 	$30.81	$0.00	$30.20		$0.00	$0.00	$0.00	$7.41	$0.00	$0.00	$0.00	$0.00	$0.00	$8.68	$0.00	$0.00	$0.00	$0.00	$18.88	$29.90	$30.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11290	ERX	HCPCS 63700001	00013-5301-17	RIFABUTIN 150 MG PO CAPS	BOTH IP/OP	$90.12 	$66.69	$0.00	$64.40		$0.00	$0.00	$0.00	$16.04	$0.00	$0.00	$0.00	$0.00	$0.00	$18.78	$0.00	$0.00	$0.00	$0.00	$40.25	$63.76	$64.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11290	ERX	HCPCS 63700001	59762-1350-01	RIFABUTIN 150 MG PO CAPS	BOTH IP/OP	$90.12 	$66.69	$0.00	$64.40		$0.00	$0.00	$0.00	$16.04	$0.00	$0.00	$0.00	$0.00	$0.00	$18.78	$0.00	$0.00	$0.00	$0.00	$40.25	$63.76	$64.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11291	ERX	HCPCS 25000001	00068-0597-01	RIFAMPIN 600 MG IV SOLR	BOTH IP/OP	$359.98 	$266.39	$0.00	$277.47		$0.00	$0.00	$0.00	$0.00	$0.00	$267.18	$267.18	$277.47	$0.00	$75.02	$0.00	$0.00	$0.00	$0.00	$163.39	$258.80	$261.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11291	ERX	HCPCS 25000001	00068-0599-01	RIFAMPIN 600 MG IV SOLR	BOTH IP/OP	$359.98 	$266.39	$0.00	$277.47		$0.00	$0.00	$0.00	$0.00	$0.00	$267.18	$267.18	$277.47	$0.00	$75.02	$0.00	$0.00	$0.00	$0.00	$163.39	$258.80	$261.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11291	ERX	HCPCS 25000001	63323-0351-20	RIFAMPIN 600 MG IV SOLR	BOTH IP/OP	$359.98 	$266.39	$0.00	$277.47		$0.00	$0.00	$0.00	$0.00	$0.00	$267.18	$267.18	$277.47	$0.00	$75.02	$0.00	$0.00	$0.00	$0.00	$163.39	$258.80	$261.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11291	ERX	HCPCS 25000001	67457-0445-60	RIFAMPIN 600 MG IV SOLR	BOTH IP/OP	$359.98 	$266.39	$0.00	$277.47		$0.00	$0.00	$0.00	$0.00	$0.00	$267.18	$267.18	$277.47	$0.00	$75.02	$0.00	$0.00	$0.00	$0.00	$163.39	$258.80	$261.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11293	ERX	HCPCS 63700001	00527-1315-01	RIFAMPIN 300 MG PO CAPS	BOTH IP/OP	$7.97 	$5.90	$0.00	$5.78		$0.00	$0.00	$0.00	$2.84	$0.00	$0.00	$0.00	$0.00	$0.00	$1.66	$0.00	$0.00	$0.00	$0.00	$3.62	$5.73	$5.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11293	ERX	HCPCS 63700001	00527-1315-06	RIFAMPIN 300 MG PO CAPS	BOTH IP/OP	$7.97 	$5.90	$0.00	$5.78		$0.00	$0.00	$0.00	$2.84	$0.00	$0.00	$0.00	$0.00	$0.00	$1.66	$0.00	$0.00	$0.00	$0.00	$3.62	$5.73	$5.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11293	ERX	HCPCS 63700001	61748-0018-01	RIFAMPIN 300 MG PO CAPS	BOTH IP/OP	$7.97 	$5.90	$0.00	$5.78		$0.00	$0.00	$0.00	$2.84	$0.00	$0.00	$0.00	$0.00	$0.00	$1.66	$0.00	$0.00	$0.00	$0.00	$3.62	$5.73	$5.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11293	ERX	HCPCS 63700001	63739-0415-10	RIFAMPIN 300 MG PO CAPS	BOTH IP/OP	$7.97 	$5.90	$0.00	$5.78		$0.00	$0.00	$0.00	$2.84	$0.00	$0.00	$0.00	$0.00	$0.00	$1.66	$0.00	$0.00	$0.00	$0.00	$3.62	$5.73	$5.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11308	ERX	HCPCS 25000001	11086-0030-10	SALICYLIC ACID 6 % EX GEL	BOTH IP/OP	$213.06 	$157.66	$0.00	$164.23		$0.00	$0.00	$0.00	$0.00	$0.00	$158.13	$158.13	$164.23	$0.00	$44.40	$0.00	$0.00	$0.00	$0.00	$96.71	$153.18	$154.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11323	ERX	HCPCS 25000001	11017-0252-20	SALICYLIC ACID 17 % EX SOLN	BOTH IP/OP	$25.42 	$18.81	$0.00	$19.59		$0.00	$0.00	$0.00	$0.00	$0.00	$18.87	$18.87	$19.59	$0.00	$5.30	$0.00	$0.00	$0.00	$0.00	$11.53	$18.26	$18.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11340	ERX	HCPCS 63700001	60505-3438-03	SELEGILINE HCL 5 MG PO TABS	BOTH IP/OP	$8.81 	$6.52	$0.00	$6.39		$0.00	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$0.00	$1.84	$0.00	$0.00	$0.00	$0.00	$4.00	$6.33	$6.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11349	ERX	HCPCS 63700001	00904-6522-61	SENNOSIDES 8.6 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11349	ERX	HCPCS 63700001	57896-0451-01	SENNOSIDES 8.6 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11349	ERX	HCPCS 63700001	70677-0041-01	SENNOSIDES 8.6 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11349	ERX	HCPCS 63700001	70677-0058-01	SENNOSIDES 8.6 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11350	ERX	HCPCS 63700001	16714-0613-04	SERTRALINE HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11350	ERX	HCPCS 63700001	16714-0613-06	SERTRALINE HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11350	ERX	HCPCS 63700001	60687-0253-01	SERTRALINE HCL 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11351	ERX	HCPCS 63700001	60687-0242-01	SERTRALINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11351	ERX	HCPCS 63700001	60687-0242-11	SERTRALINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11351	ERX	HCPCS 63700001	69097-0834-02	SERTRALINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11351	ERX	HCPCS 63700001	76282-0213-60	SERTRALINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11351	ERX	HCPCS 63700001	76282-0213-90	SERTRALINE HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11359	ERX	HCPCS 25000001	12870-0001-01	SILVER NITRATE-POT NITRATE 75-25 % EX MISC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11359	ERX	HCPCS 25000001	12870-0001-02	SILVER NITRATE-POT NITRATE 75-25 % EX MISC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11364	ERX	HCPCS 63700001	16714-0682-02	SIMVASTATIN 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11364	ERX	HCPCS 63700001	63739-0571-10	SIMVASTATIN 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11365	ERX	HCPCS 63700001	16714-0683-01	SIMVASTATIN 20 MG PO TABS	BOTH IP/OP	$18.70 	$13.84	$0.00	$14.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.35	$14.81	$14.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11365	ERX	HCPCS 63700001	63739-0572-10	SIMVASTATIN 20 MG PO TABS	BOTH IP/OP	$18.70 	$13.84	$0.00	$14.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.35	$14.81	$14.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11365	ERX	HCPCS 63700001	68084-0512-01	SIMVASTATIN 20 MG PO TABS	BOTH IP/OP	$18.70 	$13.84	$0.00	$14.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.35	$14.81	$14.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11366	ERX	HCPCS 63700001	60687-0210-01	SIMVASTATIN 40 MG PO TABS	BOTH IP/OP	$18.70 	$13.84	$0.00	$14.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.35	$14.81	$14.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11366	ERX	HCPCS 63700001	60687-0210-11	SIMVASTATIN 40 MG PO TABS	BOTH IP/OP	$18.70 	$13.84	$0.00	$14.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.35	$14.81	$14.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11366	ERX	HCPCS 63700001	63739-0573-10	SIMVASTATIN 40 MG PO TABS	BOTH IP/OP	$18.70 	$13.84	$0.00	$14.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.35	$14.81	$14.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11366	ERX	HCPCS 63700001	68180-0464-09	SIMVASTATIN 40 MG PO TABS	BOTH IP/OP	$18.70 	$13.84	$0.00	$14.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.35	$14.81	$14.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11367	ERX	HCPCS 63700001	63739-0570-10	SIMVASTATIN 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11394	ERX	HCPCS 25000001	00121-0595-16	SOD CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11394	ERX	HCPCS 25000001	00121-1190-00	SOD CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11400	ERX	HCPCS 25000001	00409-6609-25	SODIUM BICARBONATE 4 % IV SOLN	BOTH IP/OP	$34.79 	$25.74	$0.00	$27.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.40	$27.55	$27.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11403	ERX	HCPCS 25000001	00338-0048-04	SODIUM CHLORIDE 0.9 % IR SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$54.11		$0.00	$0.00	$0.00	$0.00	$0.00	$52.10	$52.10	$54.11	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11403	ERX	HCPCS 25000001	00264-2201-10	SODIUM CHLORIDE 0.9 % IR SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$54.11		$0.00	$0.00	$0.00	$0.00	$0.00	$52.10	$52.10	$54.11	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11403	ERX	HCPCS 25000001	00338-0048-03	SODIUM CHLORIDE 0.9 % IR SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$54.11		$0.00	$0.00	$0.00	$0.00	$0.00	$52.10	$52.10	$54.11	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11403	ERX	HCPCS 25000001	99999-6011-64	SODIUM CHLORIDE 0.9 % IR SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$54.11		$0.00	$0.00	$0.00	$0.00	$0.00	$52.10	$52.10	$54.11	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11418	ERX	HCPCS J2941	00002-7335-11	SOMATROPIN (HUMATROPE) 5 MG IJ SOLR	BOTH IP/OP	"$1,929.32 "	"$1,427.70"	$0.00	"$1,543.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.66	"$1,528.02"	"$1,543.46"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11420	ERX	HCPCS 63700001	00093-1063-01	SOTALOL HCL 240 MG PO TABS	BOTH IP/OP	$21.33 	$15.78	$0.00	$15.48		$0.00	$0.00	$0.00	$3.80	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$0.00	$0.00	$0.00	$0.00	$9.68	$15.33	$15.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11420	ERX	HCPCS 63700001	60505-0082-00	SOTALOL HCL 240 MG PO TABS	BOTH IP/OP	$21.33 	$15.78	$0.00	$15.48		$0.00	$0.00	$0.00	$3.80	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$0.00	$0.00	$0.00	$0.00	$9.68	$15.33	$15.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11421	ERX	HCPCS 63700001	60505-0080-00	SOTALOL HCL 80 MG PO TABS	BOTH IP/OP	$9.73 	$7.20	$0.00	$7.06		$0.00	$0.00	$0.00	$1.73	$0.00	$0.00	$0.00	$0.00	$0.00	$2.03	$0.00	$0.00	$0.00	$0.00	$4.41	$6.99	$7.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11421	ERX	HCPCS 63700001	68084-0654-01	SOTALOL HCL 80 MG PO TABS	BOTH IP/OP	$9.73 	$7.20	$0.00	$7.06		$0.00	$0.00	$0.00	$1.73	$0.00	$0.00	$0.00	$0.00	$0.00	$2.03	$0.00	$0.00	$0.00	$0.00	$4.41	$6.99	$7.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11425	ERX	HCPCS 63700001	53746-0515-01	SPIRONOLACTONE 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11425	ERX	HCPCS 63700001	59746-0218-01	SPIRONOLACTONE 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11425	ERX	HCPCS 63700001	60687-0487-01	SPIRONOLACTONE 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11425	ERX	HCPCS 63700001	60687-0487-11	SPIRONOLACTONE 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11436	ERX	HCPCS J9320	00703-4636-01	STREPTOZOCIN 1 G IV SOLR	BOTH IP/OP	"$1,223.72 "	$905.55	$0.00	$943.24		$0.00	$0.00	$0.00	$0.00	$0.00	$908.24	$908.24	$943.24	$0.00	$255.02	$0.00	$0.00	$0.00	$0.00	$555.29	$879.57	$888.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11438	ERX	HCPCS 63700001	55292-0201-11	SUCCIMER 100 MG PO CAPS	BOTH IP/OP	$103.11 	$76.30	$0.00	$64.13		$0.00	$0.00	$0.00	$18.35	$0.00	$0.00	$0.00	$0.00	$0.00	$21.49	$0.00	$0.00	$0.00	$0.00	$40.08	$63.49	$64.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11441	ERX	HCPCS 63700001	00121-0747-10	SUCRALFATE 1 GM/10ML PO SUSP	BOTH IP/OP	$58.71 	$43.45	$0.00	$42.59		$0.00	$0.00	$0.00	$10.45	$0.00	$0.00	$0.00	$0.00	$0.00	$12.24	$0.00	$0.00	$0.00	$0.00	$26.62	$42.17	$42.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11441	ERX	HCPCS 63700001	00121-0747-40	SUCRALFATE 1 GM/10ML PO SUSP	BOTH IP/OP	$58.71 	$43.45	$0.00	$42.59		$0.00	$0.00	$0.00	$10.45	$0.00	$0.00	$0.00	$0.00	$0.00	$12.24	$0.00	$0.00	$0.00	$0.00	$26.62	$42.17	$42.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11441	ERX	HCPCS 63700001	58914-0170-14	SUCRALFATE 1 GM/10ML PO SUSP	BOTH IP/OP	$58.71 	$43.45	$0.00	$42.59		$0.00	$0.00	$0.00	$10.45	$0.00	$0.00	$0.00	$0.00	$0.00	$12.24	$0.00	$0.00	$0.00	$0.00	$26.62	$42.17	$42.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11441	ERX	HCPCS 63700001	66689-0790-01	SUCRALFATE 1 GM/10ML PO SUSP	BOTH IP/OP	$58.71 	$43.45	$0.00	$42.59		$0.00	$0.00	$0.00	$10.45	$0.00	$0.00	$0.00	$0.00	$0.00	$12.24	$0.00	$0.00	$0.00	$0.00	$26.62	$42.17	$42.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11441	ERX	HCPCS 63700001	66689-0790-50	SUCRALFATE 1 GM/10ML PO SUSP	BOTH IP/OP	$58.71 	$43.45	$0.00	$42.59		$0.00	$0.00	$0.00	$10.45	$0.00	$0.00	$0.00	$0.00	$0.00	$12.24	$0.00	$0.00	$0.00	$0.00	$26.62	$42.17	$42.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11442	ERX	HCPCS 63700001	00093-2210-01	SUCRALFATE 1 G PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11442	ERX	HCPCS 63700001	00093-2210-05	SUCRALFATE 1 G PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11442	ERX	HCPCS 63700001	00093-2210-98	SUCRALFATE 1 G PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11442	ERX	HCPCS 63700001	51079-0753-20	SUCRALFATE 1 G PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11442	ERX	HCPCS 63700001	59762-0401-01	SUCRALFATE 1 G PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11442	ERX	HCPCS 63700001	63739-0943-10	SUCRALFATE 1 G PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11498	ERX	HCPCS 25000001	00591-2473-19	TAMOXIFEN CITRATE 20 MG PO TABS	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60		$0.00	$0.00	$0.00	$0.00	$0.00	$42.31	$42.31	$43.94	$0.00	$11.88	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11498	ERX	HCPCS 25000001	51862-0446-01	TAMOXIFEN CITRATE 20 MG PO TABS	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60		$0.00	$0.00	$0.00	$0.00	$0.00	$42.31	$42.31	$43.94	$0.00	$11.88	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11498	ERX	HCPCS 25000001	51862-0446-30	TAMOXIFEN CITRATE 20 MG PO TABS	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60		$0.00	$0.00	$0.00	$0.00	$0.00	$42.31	$42.31	$43.94	$0.00	$11.88	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11498	ERX	HCPCS 25000001	68382-0827-01	TAMOXIFEN CITRATE 20 MG PO TABS	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60		$0.00	$0.00	$0.00	$0.00	$0.00	$42.31	$42.31	$43.94	$0.00	$11.88	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11501	ERX	HCPCS Q2017	44567-0507-01	TENIPOSIDE 10 MG/ML IV SOLN	BOTH IP/OP	"$6,140.04 "	"$4,543.63"	$0.00	"$4,912.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,070.02"	"$4,862.91"	"$4,912.03"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11507	ERX	HCPCS J3105	00143-9746-01	TERBUTALINE SULFATE 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.94	$16.33	$16.33	$16.96	$0.00	$2.97	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.49	$0.00	$0.00	$2.37	$0.00	$0.00	$0.00	$0.00	$0.00
11507	ERX	HCPCS J3105	00143-9746-10	TERBUTALINE SULFATE 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.94	$16.33	$16.33	$16.96	$0.00	$2.97	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.49	$0.00	$0.00	$2.37	$0.00	$0.00	$0.00	$0.00	$0.00
11507	ERX	HCPCS J3105	63323-0665-01	TERBUTALINE SULFATE 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.94	$16.33	$16.33	$16.96	$0.00	$2.97	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.49	$0.00	$0.00	$2.37	$0.00	$0.00	$0.00	$0.00	$0.00
11507	ERX	HCPCS J3105	70860-0801-01	TERBUTALINE SULFATE 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.94	$16.33	$16.33	$16.96	$0.00	$2.97	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.49	$0.00	$0.00	$2.37	$0.00	$0.00	$0.00	$0.00	$0.00
11508	ERX	HCPCS 63700001	00115-2611-01	TERBUTALINE SULFATE 2.5 MG PO TABS	BOTH IP/OP	$57.53 	$42.57	$0.00	$41.74		$0.00	$0.00	$0.00	$10.24	$0.00	$0.00	$0.00	$0.00	$0.00	$11.99	$0.00	$0.00	$0.00	$0.00	$26.09	$41.33	$41.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11508	ERX	HCPCS 63700001	00527-1318-01	TERBUTALINE SULFATE 2.5 MG PO TABS	BOTH IP/OP	$57.53 	$42.57	$0.00	$41.74		$0.00	$0.00	$0.00	$10.24	$0.00	$0.00	$0.00	$0.00	$0.00	$11.99	$0.00	$0.00	$0.00	$0.00	$26.09	$41.33	$41.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11508	ERX	HCPCS 63700001	10135-0579-01	TERBUTALINE SULFATE 2.5 MG PO TABS	BOTH IP/OP	$57.53 	$42.57	$0.00	$41.74		$0.00	$0.00	$0.00	$10.24	$0.00	$0.00	$0.00	$0.00	$0.00	$11.99	$0.00	$0.00	$0.00	$0.00	$26.09	$41.33	$41.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11508	ERX	HCPCS 63700001	62559-0721-01	TERBUTALINE SULFATE 2.5 MG PO TABS	BOTH IP/OP	$57.53 	$42.57	$0.00	$41.74		$0.00	$0.00	$0.00	$10.24	$0.00	$0.00	$0.00	$0.00	$0.00	$11.99	$0.00	$0.00	$0.00	$0.00	$26.09	$41.33	$41.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11509	ERX	HCPCS 63700001	00115-2622-01	TERBUTALINE SULFATE 5 MG PO TABS	BOTH IP/OP	$70.25 	$51.99	$0.00	$50.98		$0.00	$0.00	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$0.00	$14.64	$0.00	$0.00	$0.00	$0.00	$31.86	$50.47	$50.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11509	ERX	HCPCS 63700001	00527-1311-01	TERBUTALINE SULFATE 5 MG PO TABS	BOTH IP/OP	$70.25 	$51.99	$0.00	$50.98		$0.00	$0.00	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$0.00	$14.64	$0.00	$0.00	$0.00	$0.00	$31.86	$50.47	$50.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11509	ERX	HCPCS 63700001	10135-0580-01	TERBUTALINE SULFATE 5 MG PO TABS	BOTH IP/OP	$70.25 	$51.99	$0.00	$50.98		$0.00	$0.00	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$0.00	$14.64	$0.00	$0.00	$0.00	$0.00	$31.86	$50.47	$50.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11509	ERX	HCPCS 63700001	62559-0722-01	TERBUTALINE SULFATE 5 MG PO TABS	BOTH IP/OP	$70.25 	$51.99	$0.00	$50.98		$0.00	$0.00	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$0.00	$14.64	$0.00	$0.00	$0.00	$0.00	$31.86	$50.47	$50.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11510	ERX	HCPCS 63700001	00168-0346-46	TERCONAZOLE 0.4 % VA CREA	BOTH IP/OP	$171.97 	$127.26	$0.00	$124.74		$0.00	$0.00	$0.00	$30.61	$0.00	$0.00	$0.00	$0.00	$0.00	$35.84	$0.00	$0.00	$0.00	$0.00	$77.97	$123.50	$124.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11510	ERX	HCPCS 63700001	51672-1304-06	TERCONAZOLE 0.4 % VA CREA	BOTH IP/OP	$171.97 	$127.26	$0.00	$124.74		$0.00	$0.00	$0.00	$30.61	$0.00	$0.00	$0.00	$0.00	$0.00	$35.84	$0.00	$0.00	$0.00	$0.00	$77.97	$123.50	$124.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11511	ERX	HCPCS 63700001	51672-1302-00	TERCONAZOLE 0.8 % VA CREA	BOTH IP/OP	$158.03 	$116.94	$0.00	$114.63		$0.00	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$0.00	$32.93	$0.00	$0.00	$0.00	$0.00	$71.65	$113.49	$114.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11512	ERX	HCPCS 63700001	45802-0717-08	TERCONAZOLE 80 MG VA SUPP	BOTH IP/OP	$125.95 	$93.20	$0.00	$91.36		$0.00	$0.00	$0.00	$22.42	$0.00	$0.00	$0.00	$0.00	$0.00	$26.25	$0.00	$0.00	$0.00	$0.00	$57.10	$90.45	$91.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11517	ERX	HCPCS 25000001	17478-0045-32	TETRACAINE HCL 1 % IJ SOLN	BOTH IP/OP	$175.89 	$130.16	$0.00	$135.58		$0.00	$0.00	$0.00	$0.00	$0.00	$130.55	$130.55	$135.58	$0.00	$36.66	$0.00	$0.00	$0.00	$0.00	$79.74	$126.31	$127.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11562	ERX	HCPCS 25000001	17478-0288-10	TIMOLOL MALEATE 0.5 % OP SOLN	BOTH IP/OP	$71.23 	$52.71	$0.00	$54.90		$0.00	$0.00	$0.00	$0.00	$0.00	$52.87	$52.87	$54.90	$0.00	$14.84	$0.00	$0.00	$0.00	$0.00	$32.30	$51.16	$51.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11562	ERX	HCPCS 25000001	61314-0227-05	TIMOLOL MALEATE 0.5 % OP SOLN	BOTH IP/OP	$71.23 	$52.71	$0.00	$54.90		$0.00	$0.00	$0.00	$0.00	$0.00	$52.87	$52.87	$54.90	$0.00	$14.84	$0.00	$0.00	$0.00	$0.00	$32.30	$51.16	$51.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11562	ERX	HCPCS 25000001	64980-0514-05	TIMOLOL MALEATE 0.5 % OP SOLN	BOTH IP/OP	$71.23 	$52.71	$0.00	$54.90		$0.00	$0.00	$0.00	$0.00	$0.00	$52.87	$52.87	$54.90	$0.00	$14.84	$0.00	$0.00	$0.00	$0.00	$32.30	$51.16	$51.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11565	ERX	HCPCS J3260	39822-0412-01	TOBRAMYCIN SULFATE 1.2 G IJ SOLR	BOTH IP/OP	$347.00 	$256.78	$0.00	$463.75	$156.15	$156.15	$0.00	$0.00	$0.00	$38.42	$257.54	$257.54	$267.47	$0.00	$67.70	$0.00	$205.25	$205.25	$0.00	$289.85	$459.11	$463.75	$0.00		$0.00	$65.04	$0.00	$0.00	$61.93	$0.00	$0.00	$0.00	$0.00	$0.00
11565	ERX	HCPCS J3260	39822-0412-06	TOBRAMYCIN SULFATE 1.2 G IJ SOLR	BOTH IP/OP	$347.00 	$256.78	$0.00	$463.75	$156.15	$156.15	$0.00	$0.00	$0.00	$38.42	$257.54	$257.54	$267.47	$0.00	$67.70	$0.00	$205.25	$205.25	$0.00	$289.85	$459.11	$463.75	$0.00		$0.00	$65.04	$0.00	$0.00	$61.93	$0.00	$0.00	$0.00	$0.00	$0.00
11565	ERX	HCPCS J3260	63323-0303-51	TOBRAMYCIN SULFATE 1.2 G IJ SOLR	BOTH IP/OP	$347.00 	$256.78	$0.00	$463.75	$156.15	$156.15	$0.00	$0.00	$0.00	$38.42	$257.54	$257.54	$267.47	$0.00	$67.70	$0.00	$205.25	$205.25	$0.00	$289.85	$459.11	$463.75	$0.00		$0.00	$65.04	$0.00	$0.00	$61.93	$0.00	$0.00	$0.00	$0.00	$0.00
11565	ERX	HCPCS J3260	63323-0303-55	TOBRAMYCIN SULFATE 1.2 G IJ SOLR	BOTH IP/OP	$347.00 	$256.78	$0.00	$463.75	$156.15	$156.15	$0.00	$0.00	$0.00	$38.42	$257.54	$257.54	$267.47	$0.00	$67.70	$0.00	$205.25	$205.25	$0.00	$289.85	$459.11	$463.75	$0.00		$0.00	$65.04	$0.00	$0.00	$61.93	$0.00	$0.00	$0.00	$0.00	$0.00
11566	ERX	HCPCS 25000001	00065-0648-35	TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP OINT	BOTH IP/OP	$725.71 	$537.03	$0.00	$580.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$362.86	$574.76	$580.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11567	ERX	HCPCS 25000001	00065-0647-25	TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP	BOTH IP/OP	$329.72 	$243.99	$0.00	$254.15		$0.00	$0.00	$0.00	$0.00	$0.00	$244.72	$244.72	$254.15	$0.00	$68.71	$0.00	$0.00	$0.00	$0.00	$149.66	$237.06	$239.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11567	ERX	HCPCS 25000001	61314-0647-25	TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP	BOTH IP/OP	$329.72 	$243.99	$0.00	$254.15		$0.00	$0.00	$0.00	$0.00	$0.00	$244.72	$244.72	$254.15	$0.00	$68.71	$0.00	$0.00	$0.00	$0.00	$149.66	$237.06	$239.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11576	ERX	HCPCS 25000001	00472-0117-20	TRETINOIN 0.025 % EX CREA	BOTH IP/OP	$329.65 	$243.94	$0.00	$311.30		$0.00	$0.00	$0.00	$0.00	$0.00	$244.67	$244.67	$254.09	$0.00	$68.70	$0.00	$0.00	$0.00	$0.00	$194.56	$308.18	$311.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11577	ERX	HCPCS 25000001	00187-5162-20	TRETINOIN 0.05 % EX CREA	BOTH IP/OP	$329.65 	$243.94	$0.00	$254.09		$0.00	$0.00	$0.00	$0.00	$0.00	$244.67	$244.67	$254.09	$0.00	$68.70	$0.00	$0.00	$0.00	$0.00	$149.63	$237.01	$239.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11577	ERX	HCPCS 25000001	00574-2205-20	TRETINOIN 0.05 % EX CREA	BOTH IP/OP	$329.65 	$243.94	$0.00	$254.09		$0.00	$0.00	$0.00	$0.00	$0.00	$244.67	$244.67	$254.09	$0.00	$68.70	$0.00	$0.00	$0.00	$0.00	$149.63	$237.01	$239.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11578	ERX	HCPCS 25000001	00187-5164-20	TRETINOIN 0.1 % EX CREA	BOTH IP/OP	$329.65 	$243.94	$0.00	$254.09		$0.00	$0.00	$0.00	$0.00	$0.00	$244.67	$244.67	$254.09	$0.00	$68.70	$0.00	$0.00	$0.00	$0.00	$149.63	$237.01	$239.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11584	ERX	HCPCS J3301	00003-0494-20	TRIAMCINOLONE ACETONIDE 10 MG/ML IJ SUSP	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.77	$16.33	$16.33	$16.96	$0.00	$1.41	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.83	$0.00	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$0.00
11589	ERX	HCPCS 25000001	10481-3008-01	TRICHLOROACETIC ACID 80 % EX LIQD	BOTH IP/OP	$244.15 	$180.67	$0.00	$195.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.08	$193.37	$195.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11595	ERX	HCPCS 25000001	61314-0044-75	TRIFLURIDINE 1 % OP SOLN	BOTH IP/OP	$650.98 	$481.73	$0.00	$501.78		$0.00	$0.00	$0.00	$0.00	$0.00	$483.16	$483.16	$501.78	$0.00	$135.66	$0.00	$0.00	$0.00	$0.00	$295.40	$467.91	$472.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11596	ERX	HCPCS 25000001	17478-0703-11	POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN	BOTH IP/OP	$56.32 	$41.68	$0.00	$43.41		$0.00	$0.00	$0.00	$0.00	$0.00	$41.80	$41.80	$43.41	$0.00	$11.74	$0.00	$0.00	$0.00	$0.00	$25.54	$40.46	$40.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11596	ERX	HCPCS 25000001	24208-0315-10	POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN	BOTH IP/OP	$56.32 	$41.68	$0.00	$43.41		$0.00	$0.00	$0.00	$0.00	$0.00	$41.80	$41.80	$43.41	$0.00	$11.74	$0.00	$0.00	$0.00	$0.00	$25.54	$40.46	$40.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11596	ERX	HCPCS 25000001	60758-0908-10	POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN	BOTH IP/OP	$56.32 	$41.68	$0.00	$43.41		$0.00	$0.00	$0.00	$0.00	$0.00	$41.80	$41.80	$43.41	$0.00	$11.74	$0.00	$0.00	$0.00	$0.00	$25.54	$40.46	$40.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11596	ERX	HCPCS 25000001	61314-0628-10	POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN	BOTH IP/OP	$56.32 	$41.68	$0.00	$43.41		$0.00	$0.00	$0.00	$0.00	$0.00	$41.80	$41.80	$43.41	$0.00	$11.74	$0.00	$0.00	$0.00	$0.00	$25.54	$40.46	$40.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11599	ERX	HCPCS 63700001	00904-2725-61	SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11599	ERX	HCPCS 63700001	57237-0233-05	SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11599	ERX	HCPCS 63700001	63739-0228-10	SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11624	ERX	HCPCS 63700001	00591-3159-01	URSODIOL 300 MG PO CAPS	BOTH IP/OP	$35.96 	$26.61	$0.00	$23.23		$0.00	$0.00	$0.00	$6.40	$0.00	$0.00	$0.00	$0.00	$0.00	$7.49	$0.00	$0.00	$0.00	$0.00	$14.52	$23.00	$23.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11624	ERX	HCPCS 63700001	42806-0503-01	URSODIOL 300 MG PO CAPS	BOTH IP/OP	$35.96 	$26.61	$0.00	$23.23		$0.00	$0.00	$0.00	$6.40	$0.00	$0.00	$0.00	$0.00	$0.00	$7.49	$0.00	$0.00	$0.00	$0.00	$14.52	$23.00	$23.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11624	ERX	HCPCS 63700001	51079-0383-01	URSODIOL 300 MG PO CAPS	BOTH IP/OP	$35.96 	$26.61	$0.00	$23.23		$0.00	$0.00	$0.00	$6.40	$0.00	$0.00	$0.00	$0.00	$0.00	$7.49	$0.00	$0.00	$0.00	$0.00	$14.52	$23.00	$23.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11627	ERX	HCPCS J3370	00143-9359-01	VANCOMYCIN HCL 10 G IV SOLR	BOTH IP/OP	$680.55 	$503.61	$0.00	$544.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.28	$539.00	$544.44	$0.00		$0.00	$79.67	$0.00	$0.00	$75.85	$0.00	$0.00	$0.00	$0.00	$0.00
11627	ERX	HCPCS J3370	00409-6510-01	VANCOMYCIN HCL 10 G IV SOLR	BOTH IP/OP	$680.55 	$503.61	$0.00	$544.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.28	$539.00	$544.44	$0.00		$0.00	$79.67	$0.00	$0.00	$75.85	$0.00	$0.00	$0.00	$0.00	$0.00
11627	ERX	HCPCS J3370	25021-0158-99	VANCOMYCIN HCL 10 G IV SOLR	BOTH IP/OP	$680.55 	$503.61	$0.00	$544.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.28	$539.00	$544.44	$0.00		$0.00	$79.67	$0.00	$0.00	$75.85	$0.00	$0.00	$0.00	$0.00	$0.00
11627	ERX	HCPCS J3370	63323-0314-61	VANCOMYCIN HCL 10 G IV SOLR	BOTH IP/OP	$680.55 	$503.61	$0.00	$544.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.28	$539.00	$544.44	$0.00		$0.00	$79.67	$0.00	$0.00	$75.85	$0.00	$0.00	$0.00	$0.00	$0.00
11627	ERX	HCPCS J3370	67457-0342-10	VANCOMYCIN HCL 10 G IV SOLR	BOTH IP/OP	$680.55 	$503.61	$0.00	$544.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.28	$539.00	$544.44	$0.00		$0.00	$79.67	$0.00	$0.00	$75.85	$0.00	$0.00	$0.00	$0.00	$0.00
11628	ERX	HCPCS 63700001	47781-0729-02	VANCOMYCIN HCL 125 MG PO CAPS	BOTH IP/OP	$109.64 	$81.13	$0.00	$87.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.82	$86.83	$87.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11634	ERX	HCPCS 25000001	00409-1632-01	VECURONIUM BROMIDE 10 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11634	ERX	HCPCS 25000001	00409-1632-21	VECURONIUM BROMIDE 10 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11634	ERX	HCPCS 25000001	00703-2914-01	VECURONIUM BROMIDE 10 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11634	ERX	HCPCS 25000001	00703-2914-03	VECURONIUM BROMIDE 10 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11634	ERX	HCPCS 25000001	47335-0931-40	VECURONIUM BROMIDE 10 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11634	ERX	HCPCS 25000001	47335-0931-44	VECURONIUM BROMIDE 10 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11634	ERX	HCPCS 25000001	63323-0781-10	VECURONIUM BROMIDE 10 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11634	ERX	HCPCS 25000001	67457-0438-00	VECURONIUM BROMIDE 10 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11634	ERX	HCPCS 25000001	67457-0438-10	VECURONIUM BROMIDE 10 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11641	ERX	HCPCS 25000001	61703-0418-18	VITAMIN A 15 MG/ML IM SOLN	BOTH IP/OP	$422.73 	$312.82	$0.00	$338.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.37	$334.80	$338.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11664	ERX	HCPCS 63700001	00832-1211-01	WARFARIN SODIUM 1 MG PO TABS	BOTH IP/OP	$28.16 	$20.84	$0.00	$22.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.08	$22.30	$22.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11664	ERX	HCPCS 63700001	00832-1211-89	WARFARIN SODIUM 1 MG PO TABS	BOTH IP/OP	$28.16 	$20.84	$0.00	$22.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.08	$22.30	$22.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11691	ERX	HCPCS J3485	49702-0213-26	ZIDOVUDINE 10 MG/ML IV SOLN	BOTH IP/OP	$135.18 	$100.03	$0.00	$104.20		$0.00	$0.00	$0.00	$0.00	$0.00	$100.33	$100.33	$104.20	$0.00	$28.17	$0.00	$0.00	$0.00	$0.00	$61.29	$97.08	$98.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11692	ERX	HCPCS 63700001	65862-0107-01	ZIDOVUDINE 100 MG PO CAPS	BOTH IP/OP	$8.46 	$6.26	$0.00	$6.14		$0.00	$0.00	$0.00	$1.51	$0.00	$0.00	$0.00	$0.00	$0.00	$1.76	$0.00	$0.00	$0.00	$0.00	$3.84	$6.08	$6.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11700	ERX	HCPCS 63700001	63739-0526-10	ZOLPIDEM TARTRATE 10 MG PO TABS	BOTH IP/OP	$19.47 	$14.41	$0.00	$14.13		$0.00	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$8.83	$13.99	$14.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11701	ERX	HCPCS 63700001	00904-6082-61	ZOLPIDEM TARTRATE 5 MG PO TABS	BOTH IP/OP	$17.56 	$12.99	$0.00	$14.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.78	$13.91	$14.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11701	ERX	HCPCS 63700001	16714-0621-01	ZOLPIDEM TARTRATE 5 MG PO TABS	BOTH IP/OP	$17.56 	$12.99	$0.00	$14.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.78	$13.91	$14.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11701	ERX	HCPCS 63700001	68084-0189-01	ZOLPIDEM TARTRATE 5 MG PO TABS	BOTH IP/OP	$17.56 	$12.99	$0.00	$14.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.78	$13.91	$14.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11701	ERX	HCPCS 63700001	68084-0189-11	ZOLPIDEM TARTRATE 5 MG PO TABS	BOTH IP/OP	$17.56 	$12.99	$0.00	$14.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.78	$13.91	$14.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11930	ERX	HCPCS 25000001	00065-0345-10	LODOXAMIDE TROMETHAMINE 0.1 % OP SOLN	BOTH IP/OP	$599.42 	$443.57	$0.00	$462.03		$0.00	$0.00	$0.00	$0.00	$0.00	$444.89	$444.89	$462.03	$0.00	$124.92	$0.00	$0.00	$0.00	$0.00	$272.00	$430.85	$435.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11931	ERX	HCPCS 90648	49281-0545-03	HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR	BOTH IP/OP	$83.91 	$62.09	$0.00	$64.68	$37.76	$37.76	$0.00	$0.00	$0.00	$17.49	$62.28	$62.28	$64.68	$0.00	$17.49	$0.00	$49.63	$49.63	$0.00	$35.74	$56.60	$57.18	$0.00		$0.00	$11.19	$0.00	$0.00	$11.38	$0.00	$0.00	$0.00	$0.00	$0.00
11934	ERX	HCPCS 25000001	00168-0357-56	LIDOCAINE-PRILOCAINE 2.5-2.5 % EX KIT	BOTH IP/OP	$191.38 	$141.62	$0.00	$147.52		$0.00	$0.00	$0.00	$0.00	$0.00	$142.04	$142.04	$147.52	$0.00	$39.88	$0.00	$0.00	$0.00	$0.00	$86.77	$137.44	$138.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12025	ERX	HCPCS 63700001	50268-0523-15	MECLIZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12025	ERX	HCPCS 63700001	68084-0491-01	MECLIZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12025	ERX	HCPCS 63700001	68084-0491-11	MECLIZINE HCL 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12203	ERX	HCPCS 63700001	16714-0311-01	VENLAFAXINE HCL 25 MG PO TABS	BOTH IP/OP	$7.39 	$5.47	$0.00	$5.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.70	$5.85	$5.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12203	ERX	HCPCS 63700001	50268-0798-15	VENLAFAXINE HCL 25 MG PO TABS	BOTH IP/OP	$7.39 	$5.47	$0.00	$5.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.70	$5.85	$5.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12203	ERX	HCPCS 63700001	68084-0896-25	VENLAFAXINE HCL 25 MG PO TABS	BOTH IP/OP	$7.39 	$5.47	$0.00	$5.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.70	$5.85	$5.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12206	ERX	HCPCS 63700001	16714-0314-01	VENLAFAXINE HCL 75 MG PO TABS	BOTH IP/OP	$8.31 	$6.15	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.16	$6.58	$6.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12207	ERX	HCPCS 63700001	16714-0656-01	VENLAFAXINE HCL 37.5 MG PO TABS	BOTH IP/OP	$8.38 	$6.20	$0.00	$6.08		$0.00	$0.00	$0.00	$1.49	$0.00	$0.00	$0.00	$0.00	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$3.80	$6.02	$6.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12207	ERX	HCPCS 63700001	68084-0844-01	VENLAFAXINE HCL 37.5 MG PO TABS	BOTH IP/OP	$8.38 	$6.20	$0.00	$6.08		$0.00	$0.00	$0.00	$1.49	$0.00	$0.00	$0.00	$0.00	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$3.80	$6.02	$6.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12207	ERX	HCPCS 63700001	68084-0844-11	VENLAFAXINE HCL 37.5 MG PO TABS	BOTH IP/OP	$8.38 	$6.20	$0.00	$6.08		$0.00	$0.00	$0.00	$1.49	$0.00	$0.00	$0.00	$0.00	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$3.80	$6.02	$6.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12211	ERX	HCPCS J7639	50242-0100-39	DORNASE ALFA 1 MG/ML IN SOLN	BOTH IP/OP	$463.35 	$342.88	$0.00	$357.15		$0.00	$0.00	$0.00	$0.00	$0.00	$343.90	$343.90	$357.15	$0.00	$96.56	$0.00	$0.00	$0.00	$0.00	$210.30	$333.12	$336.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12211	ERX	HCPCS J7639	50242-0100-40	DORNASE ALFA 1 MG/ML IN SOLN	BOTH IP/OP	$463.35 	$342.88	$0.00	$357.15		$0.00	$0.00	$0.00	$0.00	$0.00	$343.90	$343.90	$357.15	$0.00	$96.56	$0.00	$0.00	$0.00	$0.00	$210.30	$333.12	$336.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12244	ERX	HCPCS 63700001	51672-4154-03	CALCIPOTRIENE 0.005 % EX OINT	BOTH IP/OP	"$1,118.31 "	$827.55	$0.00	$811.92		$0.00	$0.00	$0.00	$199.06	$0.00	$0.00	$0.00	$0.00	$0.00	$233.06	$0.00	$0.00	$0.00	$0.00	$507.45	$803.80	$811.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12244	ERX	HCPCS 63700001	51672-5278-03	CALCIPOTRIENE 0.005 % EX OINT	BOTH IP/OP	"$1,118.31 "	$827.55	$0.00	$811.92		$0.00	$0.00	$0.00	$199.06	$0.00	$0.00	$0.00	$0.00	$0.00	$233.06	$0.00	$0.00	$0.00	$0.00	$507.45	$803.80	$811.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12370	ERX	HCPCS 25000001	00143-9593-01	NICARDIPINE HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12370	ERX	HCPCS 25000001	00143-9593-10	NICARDIPINE HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12370	ERX	HCPCS 25000001	00143-9689-01	NICARDIPINE HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12370	ERX	HCPCS 25000001	00143-9689-10	NICARDIPINE HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12370	ERX	HCPCS 25000001	00517-0735-01	NICARDIPINE HCL 2.5 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12411	ERX	HCPCS 63700001	00378-8020-93	FLUVASTATIN SODIUM 20 MG PO CAPS	BOTH IP/OP	$20.98 	$15.53	$0.00	$15.22		$0.00	$0.00	$0.00	$3.73	$0.00	$0.00	$0.00	$0.00	$0.00	$4.37	$0.00	$0.00	$0.00	$0.00	$9.52	$15.07	$15.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12412	ERX	HCPCS 63700001	00093-7443-01	FLUVASTATIN SODIUM 40 MG PO CAPS	BOTH IP/OP	$20.94 	$15.50	$0.00	$15.19		$0.00	$0.00	$0.00	$3.73	$0.00	$0.00	$0.00	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$9.50	$15.04	$15.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12556	ERX	HCPCS Q0163	49348-0045-34	DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD	BOTH IP/OP	$28.80 	$21.31	$0.00	$22.20	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$22.20	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$1.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12556	ERX	HCPCS Q0163	58602-0022-24	DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD	BOTH IP/OP	$28.80 	$21.31	$0.00	$22.20	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$22.20	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$1.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12556	ERX	HCPCS Q0163	49348-0045-37	DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD	BOTH IP/OP	$28.80 	$21.31	$0.00	$22.20	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$22.20	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$5.50	$20.69	$8.80	$0.00		$0.00	$1.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12556	ERX	HCPCS Q0163	54838-0135-70	DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD	BOTH IP/OP	$28.80 	$21.31	$0.00	$22.20	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$22.20	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$5.50	$20.69	$8.80	$0.00		$0.00	$1.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12580	ERX	HCPCS 25000001	00487-9801-01	IPRATROPIUM BROMIDE 0.02 % IN SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12580	ERX	HCPCS 25000001	00487-9801-25	IPRATROPIUM BROMIDE 0.02 % IN SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12580	ERX	HCPCS 25000001	00781-7157-86	IPRATROPIUM BROMIDE 0.02 % IN SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12580	ERX	HCPCS 25000001	76204-0100-01	IPRATROPIUM BROMIDE 0.02 % IN SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12580	ERX	HCPCS 25000001	76204-0100-25	IPRATROPIUM BROMIDE 0.02 % IN SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12587	ERX	HCPCS J2543	63323-0304-74	PIPERACILLIN SOD-TAZOBACTAM SO 40.5 (36-4.5) G IV SOLR	BOTH IP/OP	$591.77 	$437.91	$0.00	$456.14	$321.33	$321.33	$0.00	$0.00	$0.00	$123.34	$439.21	$439.21	$456.14	$0.00	$123.32	$0.00	$350.03	$350.03	$0.00	$268.59	$425.44	$429.74	$0.00		$0.00	$84.07	$0.00	$0.00	$74.51	$0.00	$0.00	$0.00	$0.00	$0.00
12587	ERX	HCPCS J2543	63323-0304-78	PIPERACILLIN SOD-TAZOBACTAM SO 40.5 (36-4.5) G IV SOLR	BOTH IP/OP	$591.77 	$437.91	$0.00	$456.14	$321.33	$321.33	$0.00	$0.00	$0.00	$123.34	$439.21	$439.21	$456.14	$0.00	$123.32	$0.00	$350.03	$350.03	$0.00	$268.59	$425.44	$429.74	$0.00		$0.00	$84.07	$0.00	$0.00	$74.51	$0.00	$0.00	$0.00	$0.00	$0.00
12724	ERX	HCPCS 63700001	16714-0501-01	TERBINAFINE HCL 250 MG PO TABS	BOTH IP/OP	$48.15 	$35.63	$0.00	$38.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.08	$38.13	$38.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12724	ERX	HCPCS 63700001	16714-0501-02	TERBINAFINE HCL 250 MG PO TABS	BOTH IP/OP	$48.15 	$35.63	$0.00	$38.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.08	$38.13	$38.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12724	ERX	HCPCS 63700001	16714-0795-02	TERBINAFINE HCL 250 MG PO TABS	BOTH IP/OP	$48.15 	$35.63	$0.00	$38.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.08	$38.13	$38.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12724	ERX	HCPCS 63700001	51991-0526-01	TERBINAFINE HCL 250 MG PO TABS	BOTH IP/OP	$48.15 	$35.63	$0.00	$38.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.08	$38.13	$38.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12729	ERX	HCPCS 63700001	00007-3650-22	TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12729	ERX	HCPCS 63700001	00781-2074-10	TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12729	ERX	HCPCS 63700001	51079-0935-01	TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12729	ERX	HCPCS 63700001	51079-0935-20	TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12803	ERX	HCPCS 63700001	00527-1313-01	PILOCARPINE HCL 5 MG PO TABS	BOTH IP/OP	$7.61 	$5.63	$0.00	$5.52		$0.00	$0.00	$0.00	$1.35	$0.00	$0.00	$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$3.45	$5.46	$5.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12885	ERX	HCPCS 63700001	00781-6022-52	CLARITHROMYCIN 125 MG/5ML PO SUSR	BOTH IP/OP	$231.84 	$171.56	$0.00	$185.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$115.92	$183.62	$185.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12886	ERX	HCPCS 63700001	00781-6023-52	CLARITHROMYCIN 250 MG/5ML PO SUSR	BOTH IP/OP	$666.96 	$493.55	$0.00	$484.34		$0.00	$0.00	$0.00	$118.72	$0.00	$0.00	$0.00	$0.00	$0.00	$138.99	$0.00	$0.00	$0.00	$0.00	$302.72	$258.83	$484.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12886	ERX	HCPCS 63700001	00781-6023-46	CLARITHROMYCIN 250 MG/5ML PO SUSR	BOTH IP/OP	$666.96 	$493.55	$0.00	$484.34		$0.00	$0.00	$0.00	$118.72	$0.00	$0.00	$0.00	$0.00	$0.00	$138.99	$0.00	$0.00	$0.00	$0.00	$302.72	$479.50	$484.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12933	ERX	HCPCS J7507	00378-2046-01	TACROLIMUS 1 MG PO CAPS	BOTH IP/OP	$18.69 	$13.83	$0.00	$13.56		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$8.48	$13.42	$13.56	$0.00		$0.00	$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00
12933	ERX	HCPCS J7507	00469-0617-73	TACROLIMUS 1 MG PO CAPS	BOTH IP/OP	$18.69 	$13.83	$0.00	$13.56		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$8.48	$13.42	$13.56	$0.00		$0.00	$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00
12933	ERX	HCPCS J7507	00781-2103-01	TACROLIMUS 1 MG PO CAPS	BOTH IP/OP	$18.69 	$13.83	$0.00	$13.56		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$8.48	$13.42	$13.56	$0.00		$0.00	$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00
12933	ERX	HCPCS J7507	16729-0042-01	TACROLIMUS 1 MG PO CAPS	BOTH IP/OP	$18.69 	$13.83	$0.00	$13.56		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$8.48	$13.42	$13.56	$0.00		$0.00	$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00
12933	ERX	HCPCS J7507	55111-0526-01	TACROLIMUS 1 MG PO CAPS	BOTH IP/OP	$18.69 	$13.83	$0.00	$13.56		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$8.48	$13.42	$13.56	$0.00		$0.00	$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00
12933	ERX	HCPCS J7507	68084-0450-01	TACROLIMUS 1 MG PO CAPS	BOTH IP/OP	$18.69 	$13.83	$0.00	$13.56		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$8.48	$13.42	$13.56	$0.00		$0.00	$0.00	$0.00	$0.00	$2.70	$0.00	$0.00	$0.00	$0.00	$0.00
12934	ERX	HCPCS J7507	16729-0043-01	TACROLIMUS 5 MG PO CAPS	BOTH IP/OP	$126.69 	$93.75	$0.00	$101.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.35	$100.34	$101.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12934	ERX	HCPCS J7507	55111-0527-01	TACROLIMUS 5 MG PO CAPS	BOTH IP/OP	$126.69 	$93.75	$0.00	$101.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.35	$100.34	$101.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12934	ERX	HCPCS J7507	69452-0155-20	TACROLIMUS 5 MG PO CAPS	BOTH IP/OP	$126.69 	$93.75	$0.00	$101.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.35	$100.34	$101.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12935	ERX	HCPCS J7525	00469-3016-01	TACROLIMUS 5 MG/ML IV SOLN	BOTH IP/OP	"$5,807.66 "	"$4,297.67"	$0.00	$612.52		$0.00	$0.00	$0.00	$0.00	$0.00	$589.79	$589.79	$612.52	$0.00	$156.38	$0.00	$0.00	$0.00	$0.00	$330.58	$523.64	$528.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13073	ERX	HCPCS 63700001	68462-0260-01	VERAPAMIL HCL CR 240 MG PO TBCR	BOTH IP/OP	$9.62 	$7.12	$0.00	$7.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.81	$7.62	$7.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13132	ERX	HCPCS 63700001	16714-0697-01	VALACYCLOVIR HCL 1 G PO TABS	BOTH IP/OP	$52.97 	$39.20	$0.00	$38.43		$0.00	$0.00	$0.00	$9.43	$0.00	$0.00	$0.00	$0.00	$0.00	$11.04	$0.00	$0.00	$0.00	$0.00	$24.02	$38.05	$38.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13132	ERX	HCPCS 63700001	57237-0043-30	VALACYCLOVIR HCL 1 G PO TABS	BOTH IP/OP	$52.97 	$39.20	$0.00	$38.43		$0.00	$0.00	$0.00	$9.43	$0.00	$0.00	$0.00	$0.00	$0.00	$11.04	$0.00	$0.00	$0.00	$0.00	$24.02	$38.05	$38.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13133	ERX	HCPCS 63700001	00378-4275-77	VALACYCLOVIR HCL 500 MG PO TABS	BOTH IP/OP	$30.27 	$22.40	$0.00	$21.97		$0.00	$0.00	$0.00	$5.39	$0.00	$0.00	$0.00	$0.00	$0.00	$6.31	$0.00	$0.00	$0.00	$0.00	$13.73	$21.75	$21.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13133	ERX	HCPCS 63700001	00781-5208-92	VALACYCLOVIR HCL 500 MG PO TABS	BOTH IP/OP	$30.27 	$22.40	$0.00	$21.97		$0.00	$0.00	$0.00	$5.39	$0.00	$0.00	$0.00	$0.00	$0.00	$6.31	$0.00	$0.00	$0.00	$0.00	$13.73	$21.75	$21.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13133	ERX	HCPCS 63700001	16714-0698-03	VALACYCLOVIR HCL 500 MG PO TABS	BOTH IP/OP	$30.27 	$22.40	$0.00	$21.97		$0.00	$0.00	$0.00	$5.39	$0.00	$0.00	$0.00	$0.00	$0.00	$6.31	$0.00	$0.00	$0.00	$0.00	$13.73	$21.75	$21.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13133	ERX	HCPCS 63700001	57237-0042-90	VALACYCLOVIR HCL 500 MG PO TABS	BOTH IP/OP	$30.27 	$22.40	$0.00	$21.97		$0.00	$0.00	$0.00	$5.39	$0.00	$0.00	$0.00	$0.00	$0.00	$6.31	$0.00	$0.00	$0.00	$0.00	$13.73	$21.75	$21.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13178	ERX	HCPCS 25000001	00019-1333-21	IOVERSOL 74 % IJ SOLN	BOTH IP/OP	$255.15 	$188.81	$0.00	$204.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.58	$202.08	$204.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13178	ERX	HCPCS 25000001	00019-1333-06	IOVERSOL 74 % IJ SOLN	BOTH IP/OP	$79.80 	$59.05	$0.00	$204.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.58	$63.20	$204.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13184	ERX	HCPCS 63700001	00378-2120-01	VERAPAMIL HCL ER 120 MG PO TBCR	BOTH IP/OP	$8.11 	$6.00	$0.00	$6.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13184	ERX	HCPCS 63700001	68462-0292-01	VERAPAMIL HCL ER 120 MG PO TBCR	BOTH IP/OP	$8.11 	$6.00	$0.00	$6.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13309	ERX	HCPCS 63700001	31722-0516-60	STAVUDINE 20 MG PO CAPS	BOTH IP/OP	$24.05 	$17.80	$0.00	$19.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.03	$19.05	$19.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13309	ERX	HCPCS 63700001	65862-0112-60	STAVUDINE 20 MG PO CAPS	BOTH IP/OP	$24.05 	$17.80	$0.00	$19.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.03	$19.05	$19.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13310	ERX	HCPCS 63700001	31722-0517-60	STAVUDINE 30 MG PO CAPS	BOTH IP/OP	$25.54 	$18.90	$0.00	$20.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.77	$20.23	$20.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13310	ERX	HCPCS 63700001	65862-0046-60	STAVUDINE 30 MG PO CAPS	BOTH IP/OP	$25.54 	$18.90	$0.00	$20.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.77	$20.23	$20.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13311	ERX	HCPCS 63700001	31722-0518-60	STAVUDINE 40 MG PO CAPS	BOTH IP/OP	$26.02 	$19.25	$0.00	$20.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.01	$20.61	$20.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13311	ERX	HCPCS 63700001	65862-0047-60	STAVUDINE 40 MG PO CAPS	BOTH IP/OP	$26.02 	$19.25	$0.00	$20.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.01	$20.61	$20.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13369	ERX	HCPCS 63700001		SUMATRIPTAN SUCCINATE 100 MG PO TABS	BOTH IP/OP	$97.05 	$71.82	$0.00	$70.39		$0.00	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00	$20.23	$0.00	$0.00	$0.00	$0.00	$44.00	$69.69	$70.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13369	ERX	HCPCS 63700001	16714-0533-11	SUMATRIPTAN SUCCINATE 100 MG PO TABS	BOTH IP/OP	$97.05 	$71.82	$0.00	$70.39		$0.00	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00	$20.23	$0.00	$0.00	$0.00	$0.00	$44.00	$69.69	$70.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13369	ERX	HCPCS 63700001	62756-0522-69	SUMATRIPTAN SUCCINATE 100 MG PO TABS	BOTH IP/OP	$97.05 	$71.82	$0.00	$70.39		$0.00	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00	$20.23	$0.00	$0.00	$0.00	$0.00	$44.00	$69.69	$70.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13369	ERX	HCPCS 63700001	63304-0099-19	SUMATRIPTAN SUCCINATE 100 MG PO TABS	BOTH IP/OP	$97.05 	$71.82	$0.00	$70.39		$0.00	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00	$20.23	$0.00	$0.00	$0.00	$0.00	$44.00	$69.69	$70.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13393	ERX	HCPCS 25000001	00338-0520-13	FAT EMULSION PLANT BASED 30 % IV EMUL	BOTH IP/OP	$204.75 	$151.52	$0.00	$163.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.38	$162.16	$163.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13444	ERX	HCPCS 63700001	00093-1024-06	NEFAZODONE HCL 100 MG PO TABS	BOTH IP/OP	$20.11 	$14.88	$0.00	$14.59		$0.00	$0.00	$0.00	$3.58	$0.00	$0.00	$0.00	$0.00	$0.00	$4.19	$0.00	$0.00	$0.00	$0.00	$9.12	$14.45	$14.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13445	ERX	HCPCS 63700001	00093-7113-06	NEFAZODONE HCL 150 MG PO TABS	BOTH IP/OP	$20.49 	$15.16	$0.00	$14.87		$0.00	$0.00	$0.00	$3.65	$0.00	$0.00	$0.00	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$9.30	$14.72	$14.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13577	ERX	HCPCS 63700001		FLUCONAZOLE 150 MG PO TABS	BOTH IP/OP	$56.96 	$42.15	$0.00	$41.33		$0.00	$0.00	$0.00	$10.14	$0.00	$0.00	$0.00	$0.00	$0.00	$11.87	$0.00	$0.00	$0.00	$0.00	$25.83	$40.91	$41.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13577	ERX	HCPCS 63700001	00049-3500-79	FLUCONAZOLE 150 MG PO TABS	BOTH IP/OP	$56.96 	$42.15	$0.00	$41.33		$0.00	$0.00	$0.00	$10.14	$0.00	$0.00	$0.00	$0.00	$0.00	$11.87	$0.00	$0.00	$0.00	$0.00	$25.83	$40.91	$41.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13577	ERX	HCPCS 63700001	00172-5412-11	FLUCONAZOLE 150 MG PO TABS	BOTH IP/OP	$56.96 	$42.15	$0.00	$41.33		$0.00	$0.00	$0.00	$10.14	$0.00	$0.00	$0.00	$0.00	$0.00	$11.87	$0.00	$0.00	$0.00	$0.00	$25.83	$40.91	$41.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13577	ERX	HCPCS 63700001	00172-5412-79	FLUCONAZOLE 150 MG PO TABS	BOTH IP/OP	$56.96 	$42.15	$0.00	$41.33		$0.00	$0.00	$0.00	$10.14	$0.00	$0.00	$0.00	$0.00	$0.00	$11.87	$0.00	$0.00	$0.00	$0.00	$25.83	$40.91	$41.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13577	ERX	HCPCS 63700001	16714-0692-10	FLUCONAZOLE 150 MG PO TABS	BOTH IP/OP	$56.96 	$42.15	$0.00	$41.33		$0.00	$0.00	$0.00	$10.14	$0.00	$0.00	$0.00	$0.00	$0.00	$11.87	$0.00	$0.00	$0.00	$0.00	$25.83	$40.91	$41.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13577	ERX	HCPCS 63700001	16714-0692-11	FLUCONAZOLE 150 MG PO TABS	BOTH IP/OP	$56.96 	$42.15	$0.00	$41.33		$0.00	$0.00	$0.00	$10.14	$0.00	$0.00	$0.00	$0.00	$0.00	$11.87	$0.00	$0.00	$0.00	$0.00	$25.83	$40.91	$41.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13577	ERX	HCPCS 63700001	55111-0145-12	FLUCONAZOLE 150 MG PO TABS	BOTH IP/OP	$56.96 	$42.15	$0.00	$41.33		$0.00	$0.00	$0.00	$10.14	$0.00	$0.00	$0.00	$0.00	$0.00	$11.87	$0.00	$0.00	$0.00	$0.00	$25.83	$40.91	$41.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13577	ERX	HCPCS 63700001	59762-5017-01	FLUCONAZOLE 150 MG PO TABS	BOTH IP/OP	$56.96 	$42.15	$0.00	$41.33		$0.00	$0.00	$0.00	$10.14	$0.00	$0.00	$0.00	$0.00	$0.00	$11.87	$0.00	$0.00	$0.00	$0.00	$25.83	$40.91	$41.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13577	ERX	HCPCS 63700001	68462-0103-40	FLUCONAZOLE 150 MG PO TABS	BOTH IP/OP	$56.96 	$42.15	$0.00	$41.33		$0.00	$0.00	$0.00	$10.14	$0.00	$0.00	$0.00	$0.00	$0.00	$11.87	$0.00	$0.00	$0.00	$0.00	$25.83	$40.91	$41.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13654	ERX	HCPCS 25000001	00904-6784-80	ASPIRIN EC 325 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13654	ERX	HCPCS 25000001	57896-0921-10	ASPIRIN EC 325 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13654	ERX	HCPCS 25000001	63739-0523-01	ASPIRIN EC 325 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13691	ERX	HCPCS J1950	00074-3641-03	LEUPROLIDE ACETATE 3.75 MG IM KIT	BOTH IP/OP	"$4,022.42 "	"$2,976.59"	$0.00	"$3,252.41"	"$1,898.78"	"$1,898.78"	"$1,366.01"	"$1,366.01"	"$1,366.01"	$549.12	"$3,131.73"	"$3,131.73"	"$3,252.41"	"$1,406.37"	"$1,652.48"	$914.14	"$1,983.05"	"$1,983.05"	"$1,332.69"	"$1,717.82"	"$2,721.03"	"$2,748.51"	"$1,840.38"		"$1,840.38"	"$1,493.54"	$0.00	$0.00	"$1,422.11"	"$1,244.34"	$0.00	$0.00	$0.00	$0.00
13691	ERX	HCPCS J1950	00074-3641-04	LEUPROLIDE ACETATE 3.75 MG IM KIT	BOTH IP/OP	"$4,022.42 "	"$2,976.59"	$0.00	"$3,252.41"	"$1,898.78"	"$1,898.78"	"$1,366.01"	"$1,366.01"	"$1,366.01"	$549.12	"$3,131.73"	"$3,131.73"	"$3,252.41"	"$1,406.37"	"$1,652.48"	$914.14	"$1,983.05"	"$1,983.05"	"$1,332.69"	"$1,717.82"	"$2,721.03"	"$2,748.51"	"$1,840.38"		"$1,840.38"	"$1,493.54"	$0.00	$0.00	"$1,422.11"	"$1,244.34"	$0.00	$0.00	$0.00	$0.00
13748	ERX	HCPCS 63700001	49348-0135-34	GUAIFENESIN 100 MG/5ML PO LIQD	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$1.96	$0.00	$0.00	$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13748	ERX	HCPCS 63700001	61787-0063-04	GUAIFENESIN 100 MG/5ML PO LIQD	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$1.96	$0.00	$0.00	$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13818	ERX	HCPCS 25000001	54162-0017-09	BACITRACIN ZINC 500 UNIT/GM EX OINT	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13884	ERX	HCPCS 63700001	59762-0450-01	COLESTIPOL HCL 1 G PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13979	ERX	HCPCS 63700001	00093-1136-56	ACITRETIN 25 MG PO CAPS	BOTH IP/OP	$134.46 	$99.50	$0.00	$107.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.23	$106.49	$107.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13979	ERX	HCPCS 63700001	00145-0091-25	ACITRETIN 25 MG PO CAPS	BOTH IP/OP	$134.46 	$99.50	$0.00	$107.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.23	$106.49	$107.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13979	ERX	HCPCS 63700001	42291-0088-30	ACITRETIN 25 MG PO CAPS	BOTH IP/OP	$134.46 	$99.50	$0.00	$107.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.23	$106.49	$107.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13979	ERX	HCPCS 63700001	66993-0896-30	ACITRETIN 25 MG PO CAPS	BOTH IP/OP	$134.46 	$99.50	$0.00	$107.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.23	$106.49	$107.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13980	ERX	HCPCS 63700001	00115-1750-08	ACITRETIN 10 MG PO CAPS	BOTH IP/OP	$120.44 	$89.13	$0.00	$87.37		$0.00	$0.00	$0.00	$21.44	$0.00	$0.00	$0.00	$0.00	$0.00	$25.10	$0.00	$0.00	$0.00	$0.00	$54.61	$86.49	$87.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13980	ERX	HCPCS 63700001	42291-0086-30	ACITRETIN 10 MG PO CAPS	BOTH IP/OP	$120.44 	$89.13	$0.00	$87.37		$0.00	$0.00	$0.00	$21.44	$0.00	$0.00	$0.00	$0.00	$0.00	$25.10	$0.00	$0.00	$0.00	$0.00	$54.61	$86.49	$87.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13981	ERX	HCPCS 63700001	16714-0700-01	LAMOTRIGINE 25 MG PO TABS	BOTH IP/OP	$15.81 	$11.70	$0.00	$12.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.91	$12.52	$12.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13981	ERX	HCPCS 63700001	63739-0670-10	LAMOTRIGINE 25 MG PO TABS	BOTH IP/OP	$15.81 	$11.70	$0.00	$12.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.91	$12.52	$12.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13981	ERX	HCPCS 63700001	68084-0318-01	LAMOTRIGINE 25 MG PO TABS	BOTH IP/OP	$15.81 	$11.70	$0.00	$12.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.91	$12.52	$12.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13982	ERX	HCPCS 63700001	13668-0047-01	LAMOTRIGINE 100 MG PO TABS	BOTH IP/OP	$19.91 	$14.73	$0.00	$14.44		$0.00	$0.00	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$0.00	$4.15	$0.00	$0.00	$0.00	$0.00	$9.03	$14.30	$14.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13982	ERX	HCPCS 63700001	16714-0701-01	LAMOTRIGINE 100 MG PO TABS	BOTH IP/OP	$19.91 	$14.73	$0.00	$14.44		$0.00	$0.00	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$0.00	$4.15	$0.00	$0.00	$0.00	$0.00	$9.03	$14.30	$14.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13982	ERX	HCPCS 63700001	68084-0319-01	LAMOTRIGINE 100 MG PO TABS	BOTH IP/OP	$19.91 	$14.73	$0.00	$14.44		$0.00	$0.00	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$0.00	$4.15	$0.00	$0.00	$0.00	$0.00	$9.03	$14.30	$14.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13983	ERX	HCPCS 63700001	00173-0644-60	LAMOTRIGINE 200 MG PO TABS	BOTH IP/OP	$25.71 	$19.03	$0.00	$18.66		$0.00	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00	$5.36	$0.00	$0.00	$0.00	$0.00	$11.66	$18.47	$18.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13983	ERX	HCPCS 63700001	16714-0703-01	LAMOTRIGINE 200 MG PO TABS	BOTH IP/OP	$25.71 	$19.03	$0.00	$18.66		$0.00	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00	$5.36	$0.00	$0.00	$0.00	$0.00	$11.66	$18.47	$18.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13983	ERX	HCPCS 63700001	51672-4133-04	LAMOTRIGINE 200 MG PO TABS	BOTH IP/OP	$25.71 	$19.03	$0.00	$18.66		$0.00	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00	$5.36	$0.00	$0.00	$0.00	$0.00	$11.66	$18.47	$18.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13983	ERX	HCPCS 63700001	68382-0010-14	LAMOTRIGINE 200 MG PO TABS	BOTH IP/OP	$25.71 	$19.03	$0.00	$18.66		$0.00	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00	$5.36	$0.00	$0.00	$0.00	$0.00	$11.66	$18.47	$18.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14087	ERX	HCPCS 25000001	00093-0150-01	ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14087	ERX	HCPCS 25000001	00406-0484-62	ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14087	ERX	HCPCS 25000001	00603-2338-21	ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14087	ERX	HCPCS 25000001	65162-0033-10	ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14087	ERX	HCPCS 25000001	68084-0372-01	ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14113	ERX	HCPCS 63700001	10939-0441-44	ASPIRIN EC 81 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14113	ERX	HCPCS 63700001	63739-0212-01	ASPIRIN EC 81 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14113	ERX	HCPCS 63700001	63739-0522-01	ASPIRIN EC 81 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14113	ERX	HCPCS 63700001	63739-0522-10	ASPIRIN EC 81 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14132	ERX	HCPCS 63700001	45802-0465-64	KETOCONAZOLE 2 % EX SHAM	BOTH IP/OP	$97.44 	$72.11	$0.00	$77.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.72	$77.17	$77.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14190	ERX	HCPCS 25000001	00472-0339-56	HYDROCORTISONE-ALOE 1 % EX CREA	BOTH IP/OP	$14.55 	$10.77	$0.00	$11.22		$0.00	$0.00	$0.00	$0.00	$0.00	$10.80	$10.80	$11.22	$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$6.60	$10.45	$10.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14196	ERX	HCPCS 63700001	00046-1107-11	CONJ ESTROG-MEDROXYPROGEST ACE 0.625-2.5 MG PO TABS	BOTH IP/OP	$40.16 	$29.72	$0.00	$26.42		$0.00	$0.00	$0.00	$7.15	$0.00	$0.00	$0.00	$0.00	$0.00	$8.37	$0.00	$0.00	$0.00	$0.00	$16.52	$26.16	$26.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14232	ERX	HCPCS 63700001	16714-0695-01	FLUCONAZOLE 10 MG/ML PO SUSR	BOTH IP/OP	$133.35 	$98.68	$0.00	$96.73		$0.00	$0.00	$0.00	$23.74	$0.00	$0.00	$0.00	$0.00	$0.00	$27.79	$0.00	$0.00	$0.00	$0.00	$60.46	$95.76	$96.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14232	ERX	HCPCS 63700001	59762-5029-01	FLUCONAZOLE 10 MG/ML PO SUSR	BOTH IP/OP	$133.35 	$98.68	$0.00	$96.73		$0.00	$0.00	$0.00	$23.74	$0.00	$0.00	$0.00	$0.00	$0.00	$27.79	$0.00	$0.00	$0.00	$0.00	$60.46	$95.76	$96.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14232	ERX	HCPCS 63700001	99999-6004-82	FLUCONAZOLE 10 MG/ML PO SUSR	BOTH IP/OP	$133.35 	$98.68	$0.00	$96.73		$0.00	$0.00	$0.00	$23.74	$0.00	$0.00	$0.00	$0.00	$0.00	$27.79	$0.00	$0.00	$0.00	$0.00	$60.46	$95.76	$96.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14233	ERX	HCPCS 63700001	00049-3450-19	FLUCONAZOLE 40 MG/ML PO SUSR	BOTH IP/OP	$130.24 	$96.38	$0.00	$93.01		$0.00	$0.00	$0.00	$23.18	$0.00	$0.00	$0.00	$0.00	$0.00	$27.14	$0.00	$0.00	$0.00	$0.00	$58.13	$92.08	$93.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14233	ERX	HCPCS 63700001	00054-0003-85	FLUCONAZOLE 40 MG/ML PO SUSR	BOTH IP/OP	$130.24 	$96.38	$0.00	$93.01		$0.00	$0.00	$0.00	$23.18	$0.00	$0.00	$0.00	$0.00	$0.00	$27.14	$0.00	$0.00	$0.00	$0.00	$58.13	$92.08	$93.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14233	ERX	HCPCS 63700001	16714-0696-01	FLUCONAZOLE 40 MG/ML PO SUSR	BOTH IP/OP	$130.24 	$96.38	$0.00	$93.01		$0.00	$0.00	$0.00	$23.18	$0.00	$0.00	$0.00	$0.00	$0.00	$27.14	$0.00	$0.00	$0.00	$0.00	$58.13	$92.08	$93.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14233	ERX	HCPCS 63700001	59762-5030-01	FLUCONAZOLE 40 MG/ML PO SUSR	BOTH IP/OP	$130.24 	$96.38	$0.00	$93.01		$0.00	$0.00	$0.00	$23.18	$0.00	$0.00	$0.00	$0.00	$0.00	$27.14	$0.00	$0.00	$0.00	$0.00	$58.13	$92.08	$93.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14266	ERX	HCPCS 63700001	16714-0702-01	LAMOTRIGINE 150 MG PO TABS	BOTH IP/OP	$19.79 	$14.64	$0.00	$15.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.90	$15.67	$15.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14266	ERX	HCPCS 63700001	29300-0113-16	LAMOTRIGINE 150 MG PO TABS	BOTH IP/OP	$19.79 	$14.64	$0.00	$15.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.90	$15.67	$15.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14266	ERX	HCPCS 63700001	51672-4132-04	LAMOTRIGINE 150 MG PO TABS	BOTH IP/OP	$19.79 	$14.64	$0.00	$15.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.90	$15.67	$15.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14468	ERX	HCPCS 25000001	99999-6007-11	ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$57.52		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$35.95	$4.75	$57.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14468	ERX	HCPCS 25000001	00121-0504-16	ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$57.52		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$35.95	$56.94	$57.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14468	ERX	HCPCS 25000001	50383-0079-16	ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$57.52		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$35.95	$56.94	$57.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14471	ERX	HCPCS 63700001	00006-3519-36	DORZOLAMIDE HCL 2 % OP SOLN	BOTH IP/OP	$216.03 	$159.86	$0.00	$172.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.02	$171.10	$172.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14471	ERX	HCPCS 63700001	24208-0485-10	DORZOLAMIDE HCL 2 % OP SOLN	BOTH IP/OP	$216.03 	$159.86	$0.00	$172.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.02	$171.10	$172.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14471	ERX	HCPCS 63700001	42571-0141-26	DORZOLAMIDE HCL 2 % OP SOLN	BOTH IP/OP	$216.03 	$159.86	$0.00	$172.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.02	$171.10	$172.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14471	ERX	HCPCS 63700001	50383-0232-10	DORZOLAMIDE HCL 2 % OP SOLN	BOTH IP/OP	$216.03 	$159.86	$0.00	$172.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.02	$171.10	$172.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14471	ERX	HCPCS 63700001	61314-0019-10	DORZOLAMIDE HCL 2 % OP SOLN	BOTH IP/OP	$216.03 	$159.86	$0.00	$172.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.02	$171.10	$172.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14553	ERX	HCPCS 63700001	59746-0385-06	TERAZOSIN HCL 5 MG PO CAPS	BOTH IP/OP	$6.10 	$4.51	$0.00	$4.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.05	$4.83	$4.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14626	ERX	HCPCS 63700001	68462-0293-01	VERAPAMIL HCL ER 180 MG PO TBCR	BOTH IP/OP	$9.47 	$7.01	$0.00	$7.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.74	$7.50	$7.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14632	ERX	HCPCS 63700001	00378-4151-01	TRAMADOL HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14632	ERX	HCPCS 63700001	00378-4151-05	TRAMADOL HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14632	ERX	HCPCS 63700001	00904-6365-61	TRAMADOL HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14632	ERX	HCPCS 63700001	51079-0991-01	TRAMADOL HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14632	ERX	HCPCS 63700001	51079-0991-20	TRAMADOL HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14632	ERX	HCPCS 63700001	57664-0377-08	TRAMADOL HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14632	ERX	HCPCS 63700001	65162-0627-10	TRAMADOL HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14632	ERX	HCPCS 63700001	68084-0808-01	TRAMADOL HCL 50 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14633	ERX	HCPCS J9214	00085-1168-01	INTERFERON ALFA-2B 6000000 UNIT/ML IJ SOLN	BOTH IP/OP	"$2,050.80 "	"$1,517.59"	$0.00	"$1,640.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,025.40"	"$1,624.23"	"$1,640.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14643	ERX	HCPCS J0885	59676-0320-04	EPOETIN ALFA 20000 UNIT/ML IJ SOLN	BOTH IP/OP	"$1,661.23 "	"$1,229.31"	$0.00	"$1,231.49"		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.20	$0.00	$0.00	$0.00	$0.00	$769.68	"$1,219.17"	"$1,231.49"	$0.00		$0.00	$240.91	$0.00	$0.00	$237.19	$0.00	$0.00	$0.00	$0.00	$0.00
14678	ERX	HCPCS 25000001	49281-0790-51	TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOLN	BOTH IP/OP	$469.20 	$347.21	$0.00	$361.66		$0.00	$0.00	$0.00	$0.00	$0.00	$348.24	$348.24	$361.66	$0.00	$97.78	$0.00	$0.00	$0.00	$0.00	$192.80	$305.39	$308.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14719	ERX	HCPCS 63700001	23155-0103-05	METFORMIN HCL 850 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14719	ERX	HCPCS 63700001	57664-0435-51	METFORMIN HCL 850 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14719	ERX	HCPCS 63700001	60687-0143-01	METFORMIN HCL 850 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14719	ERX	HCPCS 63700001	60687-0143-11	METFORMIN HCL 850 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14719	ERX	HCPCS 63700001	63739-0702-10	METFORMIN HCL 850 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14792	ERX	HCPCS 63700001	00185-0034-51	TIZANIDINE HCL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14792	ERX	HCPCS 63700001	42291-0808-15	TIZANIDINE HCL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14792	ERX	HCPCS 63700001	55111-0179-15	TIZANIDINE HCL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14792	ERX	HCPCS 63700001	57664-0502-89	TIZANIDINE HCL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14792	ERX	HCPCS 63700001	60505-0251-03	TIZANIDINE HCL 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14793	ERX	HCPCS 63700001	00185-4400-51	TIZANIDINE HCL 4 MG PO TABS	BOTH IP/OP	$9.69 	$7.17	$0.00	$7.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.85	$7.67	$7.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14793	ERX	HCPCS 63700001	55111-0180-15	TIZANIDINE HCL 4 MG PO TABS	BOTH IP/OP	$9.69 	$7.17	$0.00	$7.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.85	$7.67	$7.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14793	ERX	HCPCS 63700001	60505-0252-03	TIZANIDINE HCL 4 MG PO TABS	BOTH IP/OP	$9.69 	$7.17	$0.00	$7.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.85	$7.67	$7.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14820	ERX	HCPCS 63700001	55111-0338-01	AMLODIPINE-BENAZEPRIL HCL 2.5-10 MG PO CAPS	BOTH IP/OP	$11.13 	$8.24	$0.00	$8.07		$0.00	$0.00	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$0.00	$2.32	$0.00	$0.00	$0.00	$0.00	$5.05	$7.99	$8.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14820	ERX	HCPCS 63700001	65862-0582-01	AMLODIPINE-BENAZEPRIL HCL 2.5-10 MG PO CAPS	BOTH IP/OP	$11.13 	$8.24	$0.00	$8.07		$0.00	$0.00	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$0.00	$2.32	$0.00	$0.00	$0.00	$0.00	$5.05	$7.99	$8.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14821	ERX	HCPCS 63700001	55111-0339-01	AMLODIPINE-BENAZEPRIL HCL 5-10 MG PO CAPS	BOTH IP/OP	$11.35 	$8.40	$0.00	$8.23		$0.00	$0.00	$0.00	$2.02	$0.00	$0.00	$0.00	$0.00	$0.00	$2.37	$0.00	$0.00	$0.00	$0.00	$5.15	$8.15	$8.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14822	ERX	HCPCS 63700001	55111-0340-01	AMLODIPINE-BENAZEPRIL HCL 5-20 MG PO CAPS	BOTH IP/OP	$11.98 	$8.87	$0.00	$8.70		$0.00	$0.00	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$2.50	$0.00	$0.00	$0.00	$0.00	$5.44	$8.61	$8.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14822	ERX	HCPCS 63700001	57237-0144-01	AMLODIPINE-BENAZEPRIL HCL 5-20 MG PO CAPS	BOTH IP/OP	$11.98 	$8.87	$0.00	$8.70		$0.00	$0.00	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$2.50	$0.00	$0.00	$0.00	$0.00	$5.44	$8.61	$8.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14823	ERX	HCPCS 63700001	31722-0700-90	LOSARTAN POTASSIUM 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14823	ERX	HCPCS 63700001	63739-0673-10	LOSARTAN POTASSIUM 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14823	ERX	HCPCS 63700001	68084-0346-01	LOSARTAN POTASSIUM 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14823	ERX	HCPCS 63700001	68180-0376-09	LOSARTAN POTASSIUM 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14824	ERX	HCPCS 63700001	00006-0952-31	LOSARTAN POTASSIUM 50 MG PO TABS	BOTH IP/OP	$9.43 	$6.98	$0.00	$6.84		$0.00	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$4.28	$6.77	$6.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14824	ERX	HCPCS 63700001	31722-0701-30	LOSARTAN POTASSIUM 50 MG PO TABS	BOTH IP/OP	$9.43 	$6.98	$0.00	$6.84		$0.00	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$4.28	$6.77	$6.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14824	ERX	HCPCS 63700001	31722-0701-90	LOSARTAN POTASSIUM 50 MG PO TABS	BOTH IP/OP	$9.43 	$6.98	$0.00	$6.84		$0.00	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$4.28	$6.77	$6.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14824	ERX	HCPCS 63700001	50268-0517-11	LOSARTAN POTASSIUM 50 MG PO TABS	BOTH IP/OP	$9.43 	$6.98	$0.00	$6.84		$0.00	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$4.28	$6.77	$6.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14824	ERX	HCPCS 63700001	50268-0517-15	LOSARTAN POTASSIUM 50 MG PO TABS	BOTH IP/OP	$9.43 	$6.98	$0.00	$6.84		$0.00	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$4.28	$6.77	$6.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14824	ERX	HCPCS 63700001	65862-0202-30	LOSARTAN POTASSIUM 50 MG PO TABS	BOTH IP/OP	$9.43 	$6.98	$0.00	$6.84		$0.00	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$4.28	$6.77	$6.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14824	ERX	HCPCS 63700001	65862-0202-90	LOSARTAN POTASSIUM 50 MG PO TABS	BOTH IP/OP	$9.43 	$6.98	$0.00	$6.84		$0.00	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$4.28	$6.77	$6.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14824	ERX	HCPCS 63700001	68084-0347-01	LOSARTAN POTASSIUM 50 MG PO TABS	BOTH IP/OP	$9.43 	$6.98	$0.00	$6.84		$0.00	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$4.28	$6.77	$6.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14824	ERX	HCPCS 63700001	68180-0377-09	LOSARTAN POTASSIUM 50 MG PO TABS	BOTH IP/OP	$9.43 	$6.98	$0.00	$6.84		$0.00	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$4.28	$6.77	$6.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14825	ERX	HCPCS 63700001	00456-4300-01	FOSFOMYCIN TROMETHAMINE 3 G PO PACK	BOTH IP/OP	$367.99 	$272.31	$0.00	$267.23		$0.00	$0.00	$0.00	$65.50	$0.00	$0.00	$0.00	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$167.02	$264.56	$267.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14845	ERX	HCPCS J1265	00338-1007-03	DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN	BOTH IP/OP	$84.92 	$62.84	$0.00	$65.46		$0.00	$0.00	$0.00	$0.00	$0.00	$63.03	$63.03	$65.46	$0.00	$17.70	$0.00	$0.00	$0.00	$0.00	$37.63	$59.60	$60.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14845	ERX	HCPCS J1265	00409-7809-24	DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN	BOTH IP/OP	$84.92 	$62.84	$0.00	$65.46		$0.00	$0.00	$0.00	$0.00	$0.00	$63.03	$63.03	$65.46	$0.00	$17.70	$0.00	$0.00	$0.00	$0.00	$37.63	$59.60	$60.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14868	ERX	HCPCS J2001	00264-9594-20	LIDOCAINE IN D5W 4-5 MG/ML-% IV SOLN	BOTH IP/OP	$28.29 	$20.93	$0.00	$21.81		$0.00	$0.00	$0.00	$0.00	$0.00	$21.00	$21.00	$21.81	$0.00	$3.06	$0.00	$0.00	$0.00	$0.00	$12.83	$20.31	$20.52	$0.00		$0.00	$3.53	$0.00	$0.00	$3.36	$0.00	$0.00	$0.00	$0.00	$0.00
14923	ERX	HCPCS 25000001	00409-1966-07	SODIUM CHLORIDE BACTERIOSTATIC 0.9 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14952	ERX	HCPCS 63700001	80681-0104-00	CO-ENZYME Q-10 30 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14953	ERX	HCPCS 63700001	00173-0547-00	ATOVAQUONE 750 MG/5ML PO SUSP	BOTH IP/OP	$140.89 	$104.26	$0.00	$102.20		$0.00	$0.00	$0.00	$25.08	$0.00	$0.00	$0.00	$0.00	$0.00	$29.36	$0.00	$0.00	$0.00	$0.00	$63.88	$101.18	$102.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14953	ERX	HCPCS 63700001	16714-0900-01	ATOVAQUONE 750 MG/5ML PO SUSP	BOTH IP/OP	$140.89 	$104.26	$0.00	$102.20		$0.00	$0.00	$0.00	$25.08	$0.00	$0.00	$0.00	$0.00	$0.00	$29.36	$0.00	$0.00	$0.00	$0.00	$63.88	$101.18	$102.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14953	ERX	HCPCS 63700001	31722-0629-21	ATOVAQUONE 750 MG/5ML PO SUSP	BOTH IP/OP	$140.89 	$104.26	$0.00	$102.20		$0.00	$0.00	$0.00	$25.08	$0.00	$0.00	$0.00	$0.00	$0.00	$29.36	$0.00	$0.00	$0.00	$0.00	$63.88	$101.18	$102.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14953	ERX	HCPCS 63700001	66993-0062-72	ATOVAQUONE 750 MG/5ML PO SUSP	BOTH IP/OP	$140.89 	$104.26	$0.00	$102.20		$0.00	$0.00	$0.00	$25.08	$0.00	$0.00	$0.00	$0.00	$0.00	$29.36	$0.00	$0.00	$0.00	$0.00	$63.88	$101.18	$102.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14953	ERX	HCPCS 63700001	68180-0282-01	ATOVAQUONE 750 MG/5ML PO SUSP	BOTH IP/OP	$140.89 	$104.26	$0.00	$102.20		$0.00	$0.00	$0.00	$25.08	$0.00	$0.00	$0.00	$0.00	$0.00	$29.36	$0.00	$0.00	$0.00	$0.00	$63.88	$101.18	$102.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14953	ERX	HCPCS 63700001	99999-6008-29	ATOVAQUONE 750 MG/5ML PO SUSP	BOTH IP/OP	$140.89 	$104.26	$0.00	$102.20		$0.00	$0.00	$0.00	$25.08	$0.00	$0.00	$0.00	$0.00	$0.00	$29.36	$0.00	$0.00	$0.00	$0.00	$63.88	$101.18	$102.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14958	ERX	HCPCS 63700001	00006-0717-31	LOSARTAN-HCTZ 50-12.5 MG PO TABS	BOTH IP/OP	$10.43 	$7.72	$0.00	$7.57		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.73	$7.49	$7.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14958	ERX	HCPCS 63700001	00006-0717-54	LOSARTAN-HCTZ 50-12.5 MG PO TABS	BOTH IP/OP	$10.43 	$7.72	$0.00	$7.57		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.73	$7.49	$7.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14958	ERX	HCPCS 63700001	00093-7367-98	LOSARTAN-HCTZ 50-12.5 MG PO TABS	BOTH IP/OP	$10.43 	$7.72	$0.00	$7.57		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.73	$7.49	$7.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14958	ERX	HCPCS 63700001	16714-0226-01	LOSARTAN-HCTZ 50-12.5 MG PO TABS	BOTH IP/OP	$10.43 	$7.72	$0.00	$7.57		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.73	$7.49	$7.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14958	ERX	HCPCS 63700001	16714-0226-02	LOSARTAN-HCTZ 50-12.5 MG PO TABS	BOTH IP/OP	$10.43 	$7.72	$0.00	$7.57		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.73	$7.49	$7.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14958	ERX	HCPCS 63700001	62332-0048-90	LOSARTAN-HCTZ 50-12.5 MG PO TABS	BOTH IP/OP	$10.43 	$7.72	$0.00	$7.57		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.73	$7.49	$7.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14958	ERX	HCPCS 63700001	65862-0468-90	LOSARTAN-HCTZ 50-12.5 MG PO TABS	BOTH IP/OP	$10.43 	$7.72	$0.00	$7.57		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.73	$7.49	$7.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14958	ERX	HCPCS 63700001	68180-0215-09	LOSARTAN-HCTZ 50-12.5 MG PO TABS	BOTH IP/OP	$10.43 	$7.72	$0.00	$7.57		$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$0.00	$2.17	$0.00	$0.00	$0.00	$0.00	$4.73	$7.49	$7.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14979	ERX	HCPCS 25000001	00409-3977-03	BACTERIOSTATIC WATER(BENZ ALC) IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15113	ERX	HCPCS J7517	00093-7334-01	MYCOPHENOLATE MOFETIL 250 MG PO CAPS	BOTH IP/OP	$16.63 	$12.31	$0.00	$12.82		$0.00	$0.00	$0.00	$0.00	$0.00	$12.34	$12.34	$12.82	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$7.54	$11.94	$12.06	$0.00		$0.00	$2.36	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00
15113	ERX	HCPCS J7517	00093-7334-05	MYCOPHENOLATE MOFETIL 250 MG PO CAPS	BOTH IP/OP	$16.63 	$12.31	$0.00	$12.82		$0.00	$0.00	$0.00	$0.00	$0.00	$12.34	$12.34	$12.82	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$7.54	$11.94	$12.06	$0.00		$0.00	$2.36	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00
15113	ERX	HCPCS J7517	51079-0721-20	MYCOPHENOLATE MOFETIL 250 MG PO CAPS	BOTH IP/OP	$16.63 	$12.31	$0.00	$12.82		$0.00	$0.00	$0.00	$0.00	$0.00	$12.34	$12.34	$12.82	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$7.54	$11.94	$12.06	$0.00		$0.00	$2.36	$0.00	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00
15119	ERX	HCPCS 25000001	00074-4456-04	SEVOFLURANE IN SOLN	BOTH IP/OP	$658.46 	$487.26	$0.00	$507.54		$0.00	$0.00	$0.00	$0.00	$0.00	$488.71	$488.71	$507.54	$0.00	$137.22	$0.00	$0.00	$0.00	$0.00	$298.79	$473.28	$478.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15168	ERX	HCPCS 63700001	99999-6009-06	SENNOSIDES 8.8 MG/5ML PO SYRP	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$1.96	$0.00	$0.00	$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15168	ERX	HCPCS 63700001	54162-0007-08	SENNOSIDES 8.8 MG/5ML PO SYRP	BOTH IP/OP	$11.00 	$8.14	$0.00	$38.36		$0.00	$0.00	$0.00	$1.96	$0.00	$0.00	$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$38.36	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15235	ERX	HCPCS J1642	64253-0333-35	HEPARIN SODIUM LOCK FLUSH 100 UNIT/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$18.80	$9.90	$9.90	$0.00	$0.00	$0.00	$5.29	$16.33	$16.33	$16.96	$0.00	$0.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$18.80	$0.00	$0.00	$17.90	$0.00	$0.00	$0.00	$0.00	$0.00
15255	ERX	HCPCS 25000001	10956-0618-01	PYRANTEL PAMOATE 144 (50 BASE) MG/ML PO SUSP	BOTH IP/OP	$32.44 	$24.01	$0.00	$25.00		$0.00	$0.00	$0.00	$0.00	$0.00	$24.08	$24.08	$25.00	$0.00	$6.76	$0.00	$0.00	$0.00	$0.00	$13.91	$22.03	$22.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15327	ERX	HCPCS 63700001	16714-0531-11	SUMATRIPTAN SUCCINATE 25 MG PO TABS	BOTH IP/OP	$104.43 	$77.28	$0.00	$75.75		$0.00	$0.00	$0.00	$18.59	$0.00	$0.00	$0.00	$0.00	$0.00	$21.76	$0.00	$0.00	$0.00	$0.00	$47.35	$74.99	$75.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15327	ERX	HCPCS 63700001	55111-0291-09	SUMATRIPTAN SUCCINATE 25 MG PO TABS	BOTH IP/OP	$104.43 	$77.28	$0.00	$75.75		$0.00	$0.00	$0.00	$18.59	$0.00	$0.00	$0.00	$0.00	$0.00	$21.76	$0.00	$0.00	$0.00	$0.00	$47.35	$74.99	$75.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15328	ERX	HCPCS 63700001	00378-5631-59	SUMATRIPTAN SUCCINATE 50 MG PO TABS	BOTH IP/OP	$87.99 	$65.11	$0.00	$70.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.00	$69.69	$70.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15328	ERX	HCPCS 63700001	16714-0532-11	SUMATRIPTAN SUCCINATE 50 MG PO TABS	BOTH IP/OP	$87.99 	$65.11	$0.00	$70.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.00	$69.69	$70.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15330	ERX	HCPCS J0153	00409-1932-02	ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN	BOTH IP/OP	$514.69 	$380.87	$0.00	$396.72	$231.61	$231.61	$0.00	$0.00	$0.00	$107.27	$382.00	$382.00	$396.72	$0.00	$55.73	$0.00	$304.44	$304.44	$0.00	$233.60	$370.02	$373.76	$0.00		$0.00	$65.57	$0.00	$0.00	$62.43	$0.00	$0.00	$0.00	$0.00	$0.00
15330	ERX	HCPCS J0153	00703-8777-01	ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN	BOTH IP/OP	$514.69 	$380.87	$0.00	$396.72	$231.61	$231.61	$0.00	$0.00	$0.00	$107.27	$382.00	$382.00	$396.72	$0.00	$55.73	$0.00	$304.44	$304.44	$0.00	$233.60	$370.02	$373.76	$0.00		$0.00	$65.57	$0.00	$0.00	$62.43	$0.00	$0.00	$0.00	$0.00	$0.00
15330	ERX	HCPCS J0153	55150-0193-30	ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN	BOTH IP/OP	$514.69 	$380.87	$0.00	$396.72	$231.61	$231.61	$0.00	$0.00	$0.00	$107.27	$382.00	$382.00	$396.72	$0.00	$55.73	$0.00	$304.44	$304.44	$0.00	$233.60	$370.02	$373.76	$0.00		$0.00	$65.57	$0.00	$0.00	$62.43	$0.00	$0.00	$0.00	$0.00	$0.00
15330	ERX	HCPCS J0153	67457-0857-30	ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN	BOTH IP/OP	$514.69 	$380.87	$0.00	$396.72	$231.61	$231.61	$0.00	$0.00	$0.00	$107.27	$382.00	$382.00	$396.72	$0.00	$55.73	$0.00	$304.44	$304.44	$0.00	$233.60	$370.02	$373.76	$0.00		$0.00	$65.57	$0.00	$0.00	$62.43	$0.00	$0.00	$0.00	$0.00	$0.00
15340	ERX	HCPCS 63700001	00228-2550-11	DICLOFENAC SODIUM 50 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15340	ERX	HCPCS 63700001	61442-0102-01	DICLOFENAC SODIUM 50 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15341	ERX	HCPCS 63700001	00228-2551-06	DICLOFENAC SODIUM 75 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15341	ERX	HCPCS 63700001	00228-2551-11	DICLOFENAC SODIUM 75 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15341	ERX	HCPCS 63700001	68084-0333-01	DICLOFENAC SODIUM 75 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15341	ERX	HCPCS 63700001	68084-0333-11	DICLOFENAC SODIUM 75 MG PO TBEC	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15349	ERX	HCPCS 63700001	00378-3635-01	CETIRIZINE HCL 5 MG PO TABS	BOTH IP/OP	$9.49 	$7.02	$0.00	$7.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15349	ERX	HCPCS 63700001	16571-0401-10	CETIRIZINE HCL 5 MG PO TABS	BOTH IP/OP	$9.49 	$7.02	$0.00	$7.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15349	ERX	HCPCS 63700001	60505-2632-01	CETIRIZINE HCL 5 MG PO TABS	BOTH IP/OP	$9.49 	$7.02	$0.00	$7.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15372	ERX	HCPCS 63700001	00225-0525-47	AYR SALINE NASAL NA GEL	BOTH IP/OP	$12.88 	$9.53	$0.00	$9.35		$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$0.00	$2.68	$0.00	$0.00	$0.00	$0.00	$5.85	$9.26	$9.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15661	ERX	HCPCS 63700001	16714-0631-01	ALENDRONATE SODIUM 10 MG PO TABS	BOTH IP/OP	$12.25 	$9.07	$0.00	$8.89		$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$5.56	$8.80	$8.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15661	ERX	HCPCS 63700001	16714-0631-02	ALENDRONATE SODIUM 10 MG PO TABS	BOTH IP/OP	$12.25 	$9.07	$0.00	$8.89		$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$5.56	$8.80	$8.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15661	ERX	HCPCS 63700001	64980-0340-01	ALENDRONATE SODIUM 10 MG PO TABS	BOTH IP/OP	$12.25 	$9.07	$0.00	$8.89		$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$5.56	$8.80	$8.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15738	ERX	HCPCS 63700001	60505-0823-06	CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN	BOTH IP/OP	$398.30 	$294.74	$0.00	$764.43		$0.00	$0.00	$0.00	$70.90	$0.00	$0.00	$0.00	$0.00	$0.00	$83.01	$0.00	$0.00	$0.00	$0.00	$477.77	$756.79	$764.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15746	ERX	HCPCS 63700001	16714-0816-01	BICALUTAMIDE 50 MG PO TABS	BOTH IP/OP	$80.79 	$59.78	$0.00	$64.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.40	$63.99	$64.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15746	ERX	HCPCS 63700001	16714-0816-02	BICALUTAMIDE 50 MG PO TABS	BOTH IP/OP	$80.79 	$59.78	$0.00	$64.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.40	$63.99	$64.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15746	ERX	HCPCS 63700001	60429-0177-01	BICALUTAMIDE 50 MG PO TABS	BOTH IP/OP	$80.79 	$59.78	$0.00	$64.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.40	$63.99	$64.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15747	ERX	HCPCS 63700001	00378-3632-01	CARVEDILOL 6.25 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15747	ERX	HCPCS 63700001	00904-6301-61	CARVEDILOL 6.25 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15747	ERX	HCPCS 63700001	51079-0930-01	CARVEDILOL 6.25 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15747	ERX	HCPCS 63700001	51079-0930-20	CARVEDILOL 6.25 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15747	ERX	HCPCS 63700001	68084-0854-01	CARVEDILOL 6.25 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15748	ERX	HCPCS 63700001	00093-7296-01	CARVEDILOL 25 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15748	ERX	HCPCS 63700001	00378-3634-01	CARVEDILOL 25 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15748	ERX	HCPCS 63700001	00904-6303-61	CARVEDILOL 25 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15748	ERX	HCPCS 63700001	51079-0932-01	CARVEDILOL 25 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15748	ERX	HCPCS 63700001	51079-0932-20	CARVEDILOL 25 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15749	ERX	HCPCS 63700001	00093-7295-01	CARVEDILOL 12.5 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15749	ERX	HCPCS 63700001	00781-5223-01	CARVEDILOL 12.5 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15749	ERX	HCPCS 63700001	00904-6302-61	CARVEDILOL 12.5 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15749	ERX	HCPCS 63700001	51079-0931-01	CARVEDILOL 12.5 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15749	ERX	HCPCS 63700001	51079-0931-20	CARVEDILOL 12.5 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15749	ERX	HCPCS 63700001	68382-0094-01	CARVEDILOL 12.5 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15796	ERX	HCPCS 63700001	00069-3110-19	AZITHROMYCIN 100 MG/5ML PO SUSR	BOTH IP/OP	$122.98 	$91.01	$0.00	$87.91		$0.00	$0.00	$0.00	$21.89	$0.00	$0.00	$0.00	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$54.95	$87.03	$87.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15796	ERX	HCPCS 63700001	59762-3110-01	AZITHROMYCIN 100 MG/5ML PO SUSR	BOTH IP/OP	$122.98 	$91.01	$0.00	$87.91		$0.00	$0.00	$0.00	$21.89	$0.00	$0.00	$0.00	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$54.95	$87.03	$87.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15797	ERX	HCPCS 63700001	00093-2026-23	AZITHROMYCIN 200 MG/5ML PO SUSR	BOTH IP/OP	$134.62 	$99.62	$0.00	$97.66		$0.00	$0.00	$0.00	$23.96	$0.00	$0.00	$0.00	$0.00	$0.00	$28.05	$0.00	$0.00	$0.00	$0.00	$61.04	$96.68	$97.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15797	ERX	HCPCS 63700001	59762-3120-01	AZITHROMYCIN 200 MG/5ML PO SUSR	BOTH IP/OP	$134.62 	$99.62	$0.00	$97.66		$0.00	$0.00	$0.00	$23.96	$0.00	$0.00	$0.00	$0.00	$0.00	$28.05	$0.00	$0.00	$0.00	$0.00	$61.04	$96.68	$97.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15797	ERX	HCPCS 63700001	59762-3140-01	AZITHROMYCIN 200 MG/5ML PO SUSR	BOTH IP/OP	$134.62 	$99.62	$0.00	$97.66		$0.00	$0.00	$0.00	$23.96	$0.00	$0.00	$0.00	$0.00	$0.00	$28.05	$0.00	$0.00	$0.00	$0.00	$61.04	$96.72	$97.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15816	ERX	HCPCS 63700001	00121-1276-00	GUAIFENESIN-DM 100-10 MG/5ML PO SYRP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15852	ERX	HCPCS J2274	00409-3815-12	MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$33.92		$0.00	$0.00	$0.00	$0.00	$0.00	$32.66	$32.66	$33.92	$0.00	$13.01	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15852	ERX	HCPCS J2274	00641-6019-01	MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$33.92		$0.00	$0.00	$0.00	$0.00	$0.00	$32.66	$32.66	$33.92	$0.00	$13.01	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15852	ERX	HCPCS J2274	00641-6019-10	MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$33.92		$0.00	$0.00	$0.00	$0.00	$0.00	$32.66	$32.66	$33.92	$0.00	$13.01	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15852	ERX	HCPCS J2274	99999-6012-28	MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$33.92		$0.00	$0.00	$0.00	$0.00	$0.00	$32.66	$32.66	$33.92	$0.00	$13.01	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15859	ERX	HCPCS 25000001	00338-1049-02	NITROGLYCERIN IN D5W 200-5 MCG/ML-% IV SOLN	BOTH IP/OP	$95.54 	$70.70	$0.00	$73.64		$0.00	$0.00	$0.00	$0.00	$0.00	$70.91	$70.91	$73.64	$0.00	$19.91	$0.00	$0.00	$0.00	$0.00	$14.73	$23.32	$23.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15861	ERX	HCPCS J7042	00338-0085-03	DEXTROSE-NACL 5-0.45 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$0.73	$18.66	$18.66	$19.38	$0.00	$2.53	$0.00	$14.87	$14.87	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
15861	ERX	HCPCS J7042	00409-7926-03	DEXTROSE-NACL 5-0.45 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$0.73	$18.66	$18.66	$19.38	$0.00	$2.53	$0.00	$14.87	$14.87	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
15861	ERX	HCPCS J7042	00264-7612-00	DEXTROSE-NACL 5-0.45 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$0.73	$18.66	$18.66	$19.38	$0.00	$2.53	$0.00	$14.87	$14.87	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
15861	ERX	HCPCS J7042	00338-0085-04	DEXTROSE-NACL 5-0.45 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$0.73	$18.66	$18.66	$19.38	$0.00	$2.53	$0.00	$14.87	$14.87	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
15863	ERX	HCPCS J7042	00338-0077-03	DEXTROSE-NACL 5-0.2 % IV SOLN	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$0.73	$21.77	$21.77	$22.61	$0.00	$2.53	$0.00	$17.35	$17.35	$0.00	$11.40	$17.42	$18.24	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
15863	ERX	HCPCS J7042	00264-7616-00	DEXTROSE-NACL 5-0.2 % IV SOLN	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$0.73	$21.77	$21.77	$22.61	$0.00	$2.53	$0.00	$17.35	$17.35	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
15863	ERX	HCPCS J7042	00338-0077-04	DEXTROSE-NACL 5-0.2 % IV SOLN	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$0.73	$21.77	$21.77	$22.61	$0.00	$2.53	$0.00	$17.35	$17.35	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
15865	ERX	HCPCS J7042	00264-7623-20	DEXTROSE-NACL 10-0.2 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.36	$16.33	$16.33	$16.96	$0.00	$1.27	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.09	$0.00	$0.00	$1.04	$0.00	$0.00	$0.00	$0.00	$0.00
15880	ERX	HCPCS 63700001	50742-0623-60	LAMIVUDINE 150 MG PO TABS	BOTH IP/OP	$29.98 	$22.19	$0.00	$21.75		$0.00	$0.00	$0.00	$5.34	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$13.60	$21.53	$21.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15880	ERX	HCPCS 63700001	60505-3251-06	LAMIVUDINE 150 MG PO TABS	BOTH IP/OP	$29.98 	$22.19	$0.00	$21.75		$0.00	$0.00	$0.00	$5.34	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$13.60	$21.53	$21.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15880	ERX	HCPCS 63700001	64380-0710-03	LAMIVUDINE 150 MG PO TABS	BOTH IP/OP	$29.98 	$22.19	$0.00	$21.75		$0.00	$0.00	$0.00	$5.34	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$13.60	$21.53	$21.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15880	ERX	HCPCS 63700001	65862-0025-60	LAMIVUDINE 150 MG PO TABS	BOTH IP/OP	$29.98 	$22.19	$0.00	$21.75		$0.00	$0.00	$0.00	$5.34	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$13.60	$21.53	$21.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15881	ERX	HCPCS 63700001	99999-6010-41	LAMIVUDINE 10 MG/ML PO SOLN	BOTH IP/OP	$62.73 	$46.42	$0.00	$153.93		$0.00	$0.00	$0.00	$11.17	$0.00	$0.00	$0.00	$0.00	$0.00	$13.07	$0.00	$0.00	$0.00	$0.00	$96.21	$45.06	$153.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15881	ERX	HCPCS 63700001	99999-6004-86	LAMIVUDINE 10 MG/ML PO SOLN	BOTH IP/OP	$62.73 	$46.42	$0.00	$153.93		$0.00	$0.00	$0.00	$11.17	$0.00	$0.00	$0.00	$0.00	$0.00	$13.07	$0.00	$0.00	$0.00	$0.00	$96.21	$152.39	$153.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15881	ERX	HCPCS 63700001	49702-0205-48	LAMIVUDINE 10 MG/ML PO SOLN	BOTH IP/OP	$62.73 	$46.42	$0.00	$321.18		$0.00	$0.00	$0.00	$11.17	$0.00	$0.00	$0.00	$0.00	$0.00	$13.07	$0.00	$0.00	$0.00	$0.00	$96.21	$321.18	$153.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15881	ERX	HCPCS 63700001	54838-0566-70	LAMIVUDINE 10 MG/ML PO SOLN	BOTH IP/OP	$62.73 	$46.42	$0.00	$321.18		$0.00	$0.00	$0.00	$11.17	$0.00	$0.00	$0.00	$0.00	$0.00	$13.07	$0.00	$0.00	$0.00	$0.00	$96.21	$321.18	$153.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15882	ERX	HCPCS J7042	00338-0089-04	DEXTROSE-NACL 5-0.9 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$0.73	$18.66	$18.66	$19.38	$0.00	$2.53	$0.00	$14.87	$14.87	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
15882	ERX	HCPCS J7042	00338-0089-03	DEXTROSE-NACL 5-0.9 % IV SOLN	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$0.73	$18.66	$18.66	$19.38	$0.00	$2.53	$0.00	$14.87	$14.87	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
15898	ERX	HCPCS J1325	66215-0402-01	EPOPROSTENOL SODIUM 1.5 MG IV SOLR	BOTH IP/OP	$195.05 	$144.34	$0.00	$150.34		$0.00	$0.00	$0.00	$0.00	$0.00	$144.77	$144.77	$150.34	$0.00	$40.65	$0.00	$0.00	$0.00	$0.00	$88.54	$140.24	$141.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15906	ERX	HCPCS J1580	00338-0503-48	GENTAMICIN IN SALINE 0.8-0.9 MG/ML-% IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.02	$16.33	$16.33	$16.96	$0.00	$1.97	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.31	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$0.00
15908	ERX	HCPCS J1580	00338-0505-48	GENTAMICIN IN SALINE 1-0.9 MG/ML-% IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.02	$16.33	$16.33	$16.96	$0.00	$1.97	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.31	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$0.00
15911	ERX	HCPCS J1580	00338-0509-41	GENTAMICIN IN SALINE 1.6-0.9 MG/ML-% IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.02	$16.33	$16.33	$16.96	$0.00	$1.97	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.31	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$0.00
16005	ERX	HCPCS 63700001	00555-0808-02	TRETINOIN 10 MG PO CAPS	BOTH IP/OP	$627.52 	$464.36	$0.00	$455.70		$0.00	$0.00	$0.00	$111.70	$0.00	$0.00	$0.00	$0.00	$0.00	$130.78	$0.00	$0.00	$0.00	$0.00	$284.81	$451.14	$455.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16005	ERX	HCPCS 63700001	10370-0268-01	TRETINOIN 10 MG PO CAPS	BOTH IP/OP	$627.52 	$464.36	$0.00	$455.70		$0.00	$0.00	$0.00	$111.70	$0.00	$0.00	$0.00	$0.00	$0.00	$130.78	$0.00	$0.00	$0.00	$0.00	$284.81	$451.14	$455.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16005	ERX	HCPCS 63700001	68084-0075-21	TRETINOIN 10 MG PO CAPS	BOTH IP/OP	$627.52 	$464.36	$0.00	$455.70		$0.00	$0.00	$0.00	$111.70	$0.00	$0.00	$0.00	$0.00	$0.00	$130.78	$0.00	$0.00	$0.00	$0.00	$284.81	$451.14	$455.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16032	ERX	HCPCS 63700001	00046-2575-12	CONJ ESTROG-MEDROXYPROGEST ACE PO TABS	BOTH IP/OP	$40.16 	$29.72	$0.00	$26.42		$0.00	$0.00	$0.00	$7.15	$0.00	$0.00	$0.00	$0.00	$0.00	$8.37	$0.00	$0.00	$0.00	$0.00	$16.52	$26.16	$26.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16050	ERX	HCPCS 25000001	00904-6710-15	GLUCOSE 4 G PO CHEW	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16052	ERX	HCPCS 63700001	00591-2464-01	DESMOPRESSIN ACETATE 0.1 MG PO TABS	BOTH IP/OP	$22.15 	$16.39	$0.00	$16.07		$0.00	$0.00	$0.00	$3.94	$0.00	$0.00	$0.00	$0.00	$0.00	$4.62	$0.00	$0.00	$0.00	$0.00	$10.05	$15.91	$16.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16052	ERX	HCPCS 63700001	10702-0169-01	DESMOPRESSIN ACETATE 0.1 MG PO TABS	BOTH IP/OP	$22.15 	$16.39	$0.00	$16.07		$0.00	$0.00	$0.00	$3.94	$0.00	$0.00	$0.00	$0.00	$0.00	$4.62	$0.00	$0.00	$0.00	$0.00	$10.05	$15.91	$16.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16052	ERX	HCPCS 63700001	68084-0606-11	DESMOPRESSIN ACETATE 0.1 MG PO TABS	BOTH IP/OP	$22.15 	$16.39	$0.00	$16.07		$0.00	$0.00	$0.00	$3.94	$0.00	$0.00	$0.00	$0.00	$0.00	$4.62	$0.00	$0.00	$0.00	$0.00	$10.05	$15.91	$16.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16052	ERX	HCPCS 63700001	68084-0606-21	DESMOPRESSIN ACETATE 0.1 MG PO TABS	BOTH IP/OP	$22.15 	$16.39	$0.00	$16.07		$0.00	$0.00	$0.00	$3.94	$0.00	$0.00	$0.00	$0.00	$0.00	$4.62	$0.00	$0.00	$0.00	$0.00	$10.05	$15.91	$16.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16052	ERX	HCPCS 63700001	68462-0275-01	DESMOPRESSIN ACETATE 0.1 MG PO TABS	BOTH IP/OP	$22.15 	$16.39	$0.00	$16.07		$0.00	$0.00	$0.00	$3.94	$0.00	$0.00	$0.00	$0.00	$0.00	$4.62	$0.00	$0.00	$0.00	$0.00	$10.05	$15.91	$16.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16052	ERX	HCPCS 63700001	69918-0101-01	DESMOPRESSIN ACETATE 0.1 MG PO TABS	BOTH IP/OP	$22.15 	$16.39	$0.00	$16.07		$0.00	$0.00	$0.00	$3.94	$0.00	$0.00	$0.00	$0.00	$0.00	$4.62	$0.00	$0.00	$0.00	$0.00	$10.05	$15.91	$16.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16124	ERX	HCPCS 63700001	67877-0286-60	(RILUTEK) RILUZOLE 50 MG PO TABS	BOTH IP/OP	$126.22 	$93.40	$0.00	$91.55		$0.00	$0.00	$0.00	$22.47	$0.00	$0.00	$0.00	$0.00	$0.00	$26.30	$0.00	$0.00	$0.00	$0.00	$57.22	$90.64	$91.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16124	ERX	HCPCS 63700001	68462-0381-60	(RILUTEK) RILUZOLE 50 MG PO TABS	BOTH IP/OP	$126.22 	$93.40	$0.00	$91.55		$0.00	$0.00	$0.00	$22.47	$0.00	$0.00	$0.00	$0.00	$0.00	$26.30	$0.00	$0.00	$0.00	$0.00	$57.22	$90.64	$91.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16205	ERX	HCPCS 63700001	00093-7536-56	ANASTROZOLE 1 MG PO TABS	BOTH IP/OP	$73.45 	$54.35	$0.00	$58.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.73	$58.17	$58.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16205	ERX	HCPCS 63700001	00904-6195-46	ANASTROZOLE 1 MG PO TABS	BOTH IP/OP	$73.45 	$54.35	$0.00	$58.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.73	$58.17	$58.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16205	ERX	HCPCS 63700001	16729-0035-10	ANASTROZOLE 1 MG PO TABS	BOTH IP/OP	$73.45 	$54.35	$0.00	$58.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.73	$58.17	$58.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16205	ERX	HCPCS 63700001	60505-2985-03	ANASTROZOLE 1 MG PO TABS	BOTH IP/OP	$73.45 	$54.35	$0.00	$58.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.73	$58.17	$58.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16205	ERX	HCPCS 63700001	68382-0209-06	ANASTROZOLE 1 MG PO TABS	BOTH IP/OP	$73.45 	$54.35	$0.00	$58.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.73	$58.17	$58.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16208	ERX	HCPCS 25000001	60258-0001-16	CYTRA-2 500-334 MG/5ML PO SOLN	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16218	ERX	HCPCS 63700001	00054-3120-41	CALCITRIOL 1 MCG/ML PO SOLN	BOTH IP/OP	$601.43 	$445.06	$0.00	$436.75		$0.00	$0.00	$0.00	$107.05	$0.00	$0.00	$0.00	$0.00	$0.00	$125.34	$0.00	$0.00	$0.00	$0.00	$272.97	$432.38	$436.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16218	ERX	HCPCS 63700001	30698-0911-15	CALCITRIOL 1 MCG/ML PO SOLN	BOTH IP/OP	$601.43 	$445.06	$0.00	$436.75		$0.00	$0.00	$0.00	$107.05	$0.00	$0.00	$0.00	$0.00	$0.00	$125.34	$0.00	$0.00	$0.00	$0.00	$272.97	$432.38	$436.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16218	ERX	HCPCS 63700001	63304-0241-59	CALCITRIOL 1 MCG/ML PO SOLN	BOTH IP/OP	$601.43 	$445.06	$0.00	$436.75		$0.00	$0.00	$0.00	$107.05	$0.00	$0.00	$0.00	$0.00	$0.00	$125.34	$0.00	$0.00	$0.00	$0.00	$272.97	$432.38	$436.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16355	ERX	HCPCS 63700001	55111-0320-01	GLIMEPIRIDE 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16356	ERX	HCPCS 63700001	68084-0326-01	GLIMEPIRIDE 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16356	ERX	HCPCS 63700001	68084-0326-11	GLIMEPIRIDE 2 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16357	ERX	HCPCS 63700001	55111-0322-01	GLIMEPIRIDE 4 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16369	ERX	HCPCS J0692	25021-0121-20	CEFEPIME HCL 1 G IJ SOLR	BOTH IP/OP	$78.49 	$58.08	$0.00	$60.50	$35.32	$35.32	$0.00	$0.00	$0.00	$16.36	$58.26	$58.26	$60.50	$0.00	$16.36	$0.00	$46.43	$46.43	$0.00	$35.59	$56.37	$56.94	$0.00		$0.00	$11.14	$0.00	$0.00	$11.33	$0.00	$0.00	$0.00	$0.00	$0.00
16369	ERX	HCPCS J0692	44567-0240-10	CEFEPIME HCL 1 G IJ SOLR	BOTH IP/OP	$78.49 	$58.08	$0.00	$60.50	$35.32	$35.32	$0.00	$0.00	$0.00	$16.36	$58.26	$58.26	$60.50	$0.00	$16.36	$0.00	$46.43	$46.43	$0.00	$35.59	$56.37	$56.94	$0.00		$0.00	$11.14	$0.00	$0.00	$11.33	$0.00	$0.00	$0.00	$0.00	$0.00
16369	ERX	HCPCS J0692	60505-6144-04	CEFEPIME HCL 1 G IJ SOLR	BOTH IP/OP	$78.49 	$58.08	$0.00	$60.50	$35.32	$35.32	$0.00	$0.00	$0.00	$16.36	$58.26	$58.26	$60.50	$0.00	$16.36	$0.00	$46.43	$46.43	$0.00	$35.59	$56.37	$56.94	$0.00		$0.00	$11.14	$0.00	$0.00	$11.33	$0.00	$0.00	$0.00	$0.00	$0.00
16369	ERX	HCPCS J0692	60505-6146-04	CEFEPIME HCL 1 G IJ SOLR	BOTH IP/OP	$78.49 	$58.08	$0.00	$60.50	$35.32	$35.32	$0.00	$0.00	$0.00	$16.36	$58.26	$58.26	$60.50	$0.00	$16.36	$0.00	$46.43	$46.43	$0.00	$35.59	$56.37	$56.94	$0.00		$0.00	$11.14	$0.00	$0.00	$11.33	$0.00	$0.00	$0.00	$0.00	$0.00
16369	ERX	HCPCS J0692	63323-0326-20	CEFEPIME HCL 1 G IJ SOLR	BOTH IP/OP	$78.49 	$58.08	$0.00	$60.50	$35.32	$35.32	$0.00	$0.00	$0.00	$16.36	$58.26	$58.26	$60.50	$0.00	$16.36	$0.00	$46.43	$46.43	$0.00	$35.59	$56.37	$56.94	$0.00		$0.00	$11.14	$0.00	$0.00	$11.33	$0.00	$0.00	$0.00	$0.00	$0.00
16371	ERX	HCPCS J0692	44567-0241-10	CEFEPIME HCL 2 G IJ SOLR	BOTH IP/OP	$155.79 	$115.28	$0.00	$120.08	$70.11	$70.11	$0.00	$0.00	$0.00	$32.47	$115.63	$115.63	$120.08	$0.00	$32.47	$0.00	$92.15	$92.15	$0.00	$70.63	$111.88	$113.01	$0.00		$0.00	$22.11	$0.00	$0.00	$22.49	$0.00	$0.00	$0.00	$0.00	$0.00
16371	ERX	HCPCS J0692	60505-6145-04	CEFEPIME HCL 2 G IJ SOLR	BOTH IP/OP	$155.79 	$115.28	$0.00	$120.08	$70.11	$70.11	$0.00	$0.00	$0.00	$32.47	$115.63	$115.63	$120.08	$0.00	$32.47	$0.00	$92.15	$92.15	$0.00	$70.63	$111.88	$113.01	$0.00		$0.00	$22.11	$0.00	$0.00	$22.49	$0.00	$0.00	$0.00	$0.00	$0.00
16371	ERX	HCPCS J0692	60505-6147-00	CEFEPIME HCL 2 G IJ SOLR	BOTH IP/OP	$155.79 	$115.28	$0.00	$120.08	$70.11	$70.11	$0.00	$0.00	$0.00	$32.47	$115.63	$115.63	$120.08	$0.00	$32.47	$0.00	$92.15	$92.15	$0.00	$70.63	$111.88	$113.01	$0.00		$0.00	$22.11	$0.00	$0.00	$22.49	$0.00	$0.00	$0.00	$0.00	$0.00
16371	ERX	HCPCS J0692	60505-6147-04	CEFEPIME HCL 2 G IJ SOLR	BOTH IP/OP	$155.79 	$115.28	$0.00	$120.08	$70.11	$70.11	$0.00	$0.00	$0.00	$32.47	$115.63	$115.63	$120.08	$0.00	$32.47	$0.00	$92.15	$92.15	$0.00	$70.63	$111.88	$113.01	$0.00		$0.00	$22.11	$0.00	$0.00	$22.49	$0.00	$0.00	$0.00	$0.00	$0.00
16440	ERX	HCPCS 63700001	99999-6004-87	RITONAVIR 80 MG/ML PO SOLN	BOTH IP/OP	$630.81 	$466.80	$0.00	"$2,834.32"		$0.00	$0.00	$0.00	$112.28	$0.00	$0.00	$0.00	$0.00	$0.00	$131.46	$0.00	$0.00	$0.00	$0.00	"$1,771.45"	$453.40	"$2,834.32"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16440	ERX	HCPCS 63700001	00074-1940-63	RITONAVIR 80 MG/ML PO SOLN	BOTH IP/OP	$630.81 	$466.80	$0.00	"$2,834.32"		$0.00	$0.00	$0.00	$112.28	$0.00	$0.00	$0.00	$0.00	$0.00	$131.46	$0.00	$0.00	$0.00	$0.00	"$1,771.45"	"$2,805.98"	"$2,834.32"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16632	ERX	HCPCS 63700001	00904-5676-61	PAROXETINE HCL 10 MG PO TABS	BOTH IP/OP	$11.80 	$8.73	$0.00	$8.56		$0.00	$0.00	$0.00	$2.10	$0.00	$0.00	$0.00	$0.00	$0.00	$2.46	$0.00	$0.00	$0.00	$0.00	$5.35	$8.47	$8.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16632	ERX	HCPCS 63700001	13107-0154-30	PAROXETINE HCL 10 MG PO TABS	BOTH IP/OP	$11.80 	$8.73	$0.00	$8.56		$0.00	$0.00	$0.00	$2.10	$0.00	$0.00	$0.00	$0.00	$0.00	$2.46	$0.00	$0.00	$0.00	$0.00	$5.35	$8.47	$8.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16633	ERX	HCPCS 63700001	60505-0101-02	PAROXETINE HCL 40 MG PO TABS	BOTH IP/OP	$12.72 	$9.41	$0.00	$9.22		$0.00	$0.00	$0.00	$2.26	$0.00	$0.00	$0.00	$0.00	$0.00	$2.65	$0.00	$0.00	$0.00	$0.00	$5.77	$9.13	$9.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16633	ERX	HCPCS 63700001	68084-0047-01	PAROXETINE HCL 40 MG PO TABS	BOTH IP/OP	$12.72 	$9.41	$0.00	$9.22		$0.00	$0.00	$0.00	$2.26	$0.00	$0.00	$0.00	$0.00	$0.00	$2.65	$0.00	$0.00	$0.00	$0.00	$5.77	$9.13	$9.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16633	ERX	HCPCS 63700001	68382-0001-16	PAROXETINE HCL 40 MG PO TABS	BOTH IP/OP	$12.72 	$9.41	$0.00	$9.22		$0.00	$0.00	$0.00	$2.26	$0.00	$0.00	$0.00	$0.00	$0.00	$2.65	$0.00	$0.00	$0.00	$0.00	$5.77	$9.13	$9.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16639	ERX	HCPCS 25000001	00703-9258-09	GLYCINE DILUENT IV SOLN	BOTH IP/OP	$64.22 	$47.52	$0.00	$51.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.11	$50.86	$51.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16644	ERX	HCPCS 63700001	00006-0571-43	INDINAVIR SULFATE 200 MG PO CAPS	BOTH IP/OP	$11.58 	$8.57	$0.00	$9.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.79	$9.17	$9.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16645	ERX	HCPCS 63700001	00006-0573-62	INDINAVIR SULFATE 400 MG PO CAPS	BOTH IP/OP	$11.58 	$8.57	$0.00	$9.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.79	$9.17	$9.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16825	ERX	HCPCS 25000001	00942-0641-03	ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61		$0.00	$0.00	$0.00	$0.00	$0.00	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$0.00	$0.00	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16825	ERX	HCPCS 25000001	00942-0641-04	ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61		$0.00	$0.00	$0.00	$0.00	$0.00	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$0.00	$0.00	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16830	ERX	HCPCS 63700001	07610-0226-40	MELATONIN 3 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16830	ERX	HCPCS 63700001	20555-0036-01	MELATONIN 3 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16830	ERX	HCPCS 63700001	31604-0027-41	MELATONIN 3 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16830	ERX	HCPCS 63700001	50268-0524-11	MELATONIN 3 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16830	ERX	HCPCS 63700001	50268-0524-15	MELATONIN 3 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16830	ERX	HCPCS 63700001	77333-0516-10	MELATONIN 3 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17010	ERX	HCPCS 63700001	43199-0014-01	HYOSCYAMINE SULFATE ER 0.375 MG PO TB12	BOTH IP/OP	$6.71 	$4.97	$0.00	$4.86		$0.00	$0.00	$0.00	$1.19	$0.00	$0.00	$0.00	$0.00	$0.00	$1.40	$0.00	$0.00	$0.00	$0.00	$3.04	$4.82	$4.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17010	ERX	HCPCS 63700001	51525-0115-01	HYOSCYAMINE SULFATE ER 0.375 MG PO TB12	BOTH IP/OP	$6.71 	$4.97	$0.00	$4.86		$0.00	$0.00	$0.00	$1.19	$0.00	$0.00	$0.00	$0.00	$0.00	$1.40	$0.00	$0.00	$0.00	$0.00	$3.04	$4.82	$4.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17010	ERX	HCPCS 63700001	68047-0255-01	HYOSCYAMINE SULFATE ER 0.375 MG PO TB12	BOTH IP/OP	$6.71 	$4.97	$0.00	$4.86		$0.00	$0.00	$0.00	$1.19	$0.00	$0.00	$0.00	$0.00	$0.00	$1.40	$0.00	$0.00	$0.00	$0.00	$3.04	$4.82	$4.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17012	ERX	HCPCS J9040	00703-3155-01	BLEOMYCIN SULFATE 30 UNITS IJ SOLR	BOTH IP/OP	$377.47 	$279.33	$0.00	$290.95	$169.86	$169.86	$0.00	$0.00	$0.00	$74.80	$280.16	$280.16	$290.95	$0.00	$59.31	$0.00	$223.27	$223.27	$0.00	$168.79	$267.36	$270.06	$0.00		$0.00	$53.27	$0.00	$0.00	$50.73	$0.00	$0.00	$0.00	$0.00	$0.00
17012	ERX	HCPCS J9040	61703-0323-22	BLEOMYCIN SULFATE 30 UNITS IJ SOLR	BOTH IP/OP	$377.47 	$279.33	$0.00	$290.95	$169.86	$169.86	$0.00	$0.00	$0.00	$74.80	$280.16	$280.16	$290.95	$0.00	$59.31	$0.00	$223.27	$223.27	$0.00	$168.79	$267.36	$270.06	$0.00		$0.00	$53.27	$0.00	$0.00	$50.73	$0.00	$0.00	$0.00	$0.00	$0.00
17023	ERX	HCPCS 63700001	43199-0011-01	HYOSCYAMINE SULFATE 0.125 MG SL SUBL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17023	ERX	HCPCS 63700001	70156-0105-01	HYOSCYAMINE SULFATE 0.125 MG SL SUBL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17122	ERX	HCPCS J9201	25021-0235-50	GEMCITABINE HCL 1 G IV SOLR	BOTH IP/OP	$206.75 	$153.00	$0.00	$811.87	$93.04	$93.04	$0.00	$0.00	$0.00	$811.87	$153.45	$153.45	$159.36	$0.00	$22.42	$0.00	$122.29	$122.29	$0.00	$93.84	$148.64	$150.14	$0.00		$0.00	$24.44	$0.00	$0.00	$23.27	$0.00	$0.00	$0.00	$0.00	$0.00
17122	ERX	HCPCS J9201	63323-0125-53	GEMCITABINE HCL 1 G IV SOLR	BOTH IP/OP	$206.75 	$153.00	$0.00	$811.87	$93.04	$93.04	$0.00	$0.00	$0.00	$811.87	$153.45	$153.45	$159.36	$0.00	$22.42	$0.00	$122.29	$122.29	$0.00	$93.84	$148.64	$150.14	$0.00		$0.00	$24.44	$0.00	$0.00	$23.27	$0.00	$0.00	$0.00	$0.00	$0.00
17280	ERX	HCPCS 63700001	60505-0055-01	SELEGILINE HCL 5 MG PO CAPS	BOTH IP/OP	$8.76 	$6.48	$0.00	$7.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.38	$6.94	$7.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17285	ERX	HCPCS J9351	16729-0151-31	TOPOTECAN HCL 4 MG IV SOLR	BOTH IP/OP	$823.44 	$609.35	$0.00	$759.50	$370.55	$370.55	$0.00	$0.00	$0.00	$171.63	$611.16	$611.16	$634.71	$0.00	$36.00	$0.00	$487.06	$487.06	$0.00	$474.69	$751.90	$759.50	$0.00		$0.00	$46.06	$0.00	$0.00	$43.86	$0.00	$0.00	$0.00	$0.00	$0.00
17377	ERX	HCPCS 25000001	13668-0589-06	RISPERIDONE 1 MG/ML PO SOLN	BOTH IP/OP	$465.28 	$344.31	$0.00	$372.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.64	$368.50	$372.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17377	ERX	HCPCS 25000001	51991-0716-41	RISPERIDONE 1 MG/ML PO SOLN	BOTH IP/OP	$465.28 	$344.31	$0.00	$372.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.64	$368.50	$372.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17377	ERX	HCPCS 25000001	65162-0673-84	RISPERIDONE 1 MG/ML PO SOLN	BOTH IP/OP	$465.28 	$344.31	$0.00	$372.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.64	$368.50	$372.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17378	ERX	HCPCS J0740	23155-0216-31	CIDOFOVIR 75 MG/ML IV SOLN	BOTH IP/OP	"$2,299.92 "	"$1,701.94"	$0.00	"$1,772.78"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,707.00"	"$1,707.00"	"$1,772.78"	$0.00	$479.30	$0.00	$0.00	$0.00	$0.00	"$1,065.60"	"$1,687.91"	"$1,704.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17379	ERX	HCPCS J2185	00781-3000-95	MEROPENEM 500 MG IV SOLR	BOTH IP/OP	$100.36 	$74.27	$0.00	$72.80		$0.00	$0.00	$0.00	$0.00	$20.92	$34.21	$34.21	$35.53	$0.00	$4.66	$0.00	$59.36	$59.36	$0.00	$45.50	$72.07	$72.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17379	ERX	HCPCS J2185	55150-0207-20	MEROPENEM 500 MG IV SOLR	BOTH IP/OP	$100.36 	$74.27	$0.00	$72.80		$0.00	$0.00	$0.00	$0.00	$20.92	$34.21	$34.21	$35.53	$0.00	$4.66	$0.00	$59.36	$59.36	$0.00	$45.50	$72.07	$72.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17379	ERX	HCPCS J2185	63323-0507-20	MEROPENEM 500 MG IV SOLR	BOTH IP/OP	$100.36 	$74.27	$0.00	$72.80		$0.00	$0.00	$0.00	$0.00	$20.92	$34.21	$34.21	$35.53	$0.00	$4.66	$0.00	$59.36	$59.36	$0.00	$45.50	$72.07	$72.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17379	ERX	HCPCS J2185	63323-0507-21	MEROPENEM 500 MG IV SOLR	BOTH IP/OP	$100.36 	$74.27	$0.00	$72.80		$0.00	$0.00	$0.00	$0.00	$20.92	$34.21	$34.21	$35.53	$0.00	$4.66	$0.00	$59.36	$59.36	$0.00	$45.50	$72.07	$72.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17379	ERX	HCPCS J2185	70121-1454-01	MEROPENEM 500 MG IV SOLR	BOTH IP/OP	$100.36 	$74.27	$0.00	$72.80		$0.00	$0.00	$0.00	$0.00	$20.92	$34.21	$34.21	$35.53	$0.00	$4.66	$0.00	$59.36	$59.36	$0.00	$45.50	$72.07	$72.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17379	ERX	HCPCS J2185	70121-1454-07	MEROPENEM 500 MG IV SOLR	BOTH IP/OP	$100.36 	$74.27	$0.00	$72.80		$0.00	$0.00	$0.00	$0.00	$20.92	$34.21	$34.21	$35.53	$0.00	$4.66	$0.00	$59.36	$59.36	$0.00	$45.50	$72.07	$72.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17380	ERX	HCPCS J2185	00069-0314-01	MEROPENEM 1 G IV SOLR	BOTH IP/OP	$180.44 	$133.53	$0.00	$131.04		$0.00	$0.00	$0.00	$0.00	$37.61	$63.03	$63.03	$65.46	$0.00	$9.33	$0.00	$106.73	$106.73	$0.00	$81.90	$129.73	$131.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17380	ERX	HCPCS J2185	00069-0314-10	MEROPENEM 1 G IV SOLR	BOTH IP/OP	$180.44 	$133.53	$0.00	$131.04		$0.00	$0.00	$0.00	$0.00	$37.61	$63.03	$63.03	$65.46	$0.00	$9.33	$0.00	$106.73	$106.73	$0.00	$81.90	$129.73	$131.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17380	ERX	HCPCS J2185	00781-3098-95	MEROPENEM 1 G IV SOLR	BOTH IP/OP	$180.44 	$133.53	$0.00	$131.04		$0.00	$0.00	$0.00	$0.00	$37.61	$63.03	$63.03	$65.46	$0.00	$9.33	$0.00	$106.73	$106.73	$0.00	$81.90	$129.73	$131.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17380	ERX	HCPCS J2185	55150-0208-30	MEROPENEM 1 G IV SOLR	BOTH IP/OP	$180.44 	$133.53	$0.00	$131.04		$0.00	$0.00	$0.00	$0.00	$37.61	$63.03	$63.03	$65.46	$0.00	$9.33	$0.00	$106.73	$106.73	$0.00	$81.90	$129.73	$131.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17380	ERX	HCPCS J2185	63323-0508-30	MEROPENEM 1 G IV SOLR	BOTH IP/OP	$180.44 	$133.53	$0.00	$131.04		$0.00	$0.00	$0.00	$0.00	$37.61	$63.03	$63.03	$65.46	$0.00	$9.33	$0.00	$106.73	$106.73	$0.00	$81.90	$129.73	$131.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17380	ERX	HCPCS J2185	70121-1453-01	MEROPENEM 1 G IV SOLR	BOTH IP/OP	$180.44 	$133.53	$0.00	$131.04		$0.00	$0.00	$0.00	$0.00	$37.61	$63.03	$63.03	$65.46	$0.00	$9.33	$0.00	$106.73	$106.73	$0.00	$81.90	$129.73	$131.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17380	ERX	HCPCS J2185	70121-1453-07	MEROPENEM 1 G IV SOLR	BOTH IP/OP	$180.44 	$133.53	$0.00	$131.04		$0.00	$0.00	$0.00	$0.00	$37.61	$63.03	$63.03	$65.46	$0.00	$9.33	$0.00	$106.73	$106.73	$0.00	$81.90	$129.73	$131.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17387	ERX	HCPCS 63700001	50111-0789-10	AZITHROMYCIN 600 MG PO TABS	BOTH IP/OP	$70.92 	$52.48	$0.00	$56.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.46	$56.17	$56.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17387	ERX	HCPCS 63700001	60687-0314-25	AZITHROMYCIN 600 MG PO TABS	BOTH IP/OP	$70.92 	$52.48	$0.00	$56.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.46	$56.17	$56.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17387	ERX	HCPCS 63700001	69452-0173-13	AZITHROMYCIN 600 MG PO TABS	BOTH IP/OP	$70.92 	$52.48	$0.00	$56.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.46	$56.17	$56.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17403	ERX	HCPCS 63700001	00597-0046-60	NEVIRAPINE 200 MG PO TABS	BOTH IP/OP	$68.86 	$50.96	$0.00	$55.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.43	$54.54	$55.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17403	ERX	HCPCS 63700001	31722-0505-60	NEVIRAPINE 200 MG PO TABS	BOTH IP/OP	$68.86 	$50.96	$0.00	$55.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.43	$54.54	$55.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17405	ERX	HCPCS J1815	00002-7510-01	INSULIN LISPRO 100 UNIT/ML SC SOLN	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$8.15	$8.15	$0.00	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$3.13	$0.00	$8.87	$8.87	$0.00	$7.50	$11.88	$12.00	$0.00		$0.00	$0.00	$0.00	$0.00	$1.01	$0.00	$0.00	$0.00	$0.00	$0.00
17464	ERX	HCPCS 63700001	00093-1003-01	BUSPIRONE HCL 15 MG PO TABS	BOTH IP/OP	$8.46 	$6.26	$0.00	$6.14		$0.00	$0.00	$0.00	$1.51	$0.00	$0.00	$0.00	$0.00	$0.00	$1.76	$0.00	$0.00	$0.00	$0.00	$3.84	$6.08	$6.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17464	ERX	HCPCS 63700001	68382-0182-01	BUSPIRONE HCL 15 MG PO TABS	BOTH IP/OP	$8.46 	$6.26	$0.00	$6.14		$0.00	$0.00	$0.00	$1.51	$0.00	$0.00	$0.00	$0.00	$0.00	$1.76	$0.00	$0.00	$0.00	$0.00	$3.84	$6.08	$6.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17465	ERX	HCPCS 63700001	00052-0107-30	MIRTAZAPINE 30 MG PO TABS	BOTH IP/OP	$25.08 	$18.56	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.54	$19.86	$20.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17465	ERX	HCPCS 63700001	51079-0087-20	MIRTAZAPINE 30 MG PO TABS	BOTH IP/OP	$25.08 	$18.56	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.54	$19.86	$20.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17465	ERX	HCPCS 63700001	68084-0120-01	MIRTAZAPINE 30 MG PO TABS	BOTH IP/OP	$25.08 	$18.56	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.54	$19.86	$20.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17465	ERX	HCPCS 63700001	68084-0120-11	MIRTAZAPINE 30 MG PO TABS	BOTH IP/OP	$25.08 	$18.56	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.54	$19.86	$20.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17466	ERX	HCPCS 63700001	00904-6519-61	MIRTAZAPINE 15 MG PO TABS	BOTH IP/OP	$12.90 	$9.55	$0.00	$10.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.45	$10.22	$10.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17466	ERX	HCPCS 63700001	51079-0086-20	MIRTAZAPINE 15 MG PO TABS	BOTH IP/OP	$12.90 	$9.55	$0.00	$10.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.45	$10.22	$10.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17500	ERX	HCPCS 25000001	62991-2015-01	CAFFEINE ANHYDROUS POWD	BOTH IP/OP	$300.85 	$222.63	$0.00	$231.90		$0.00	$0.00	$0.00	$0.00	$0.00	$223.29	$223.29	$231.90	$0.00	$62.70	$0.00	$0.00	$0.00	$0.00	$136.56	$216.30	$218.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17524	ERX	HCPCS 25000001	59584-0138-01	CANDIDA ALBICANS SKN TST ANTGN ID SOLN	BOTH IP/OP	$112.56 	$83.29	$0.00	$86.76		$0.00	$0.00	$0.00	$0.00	$0.00	$83.54	$83.54	$86.76	$0.00	$23.46	$0.00	$0.00	$0.00	$0.00	$47.25	$74.84	$75.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17594	ERX	HCPCS Q9966	00407-2222-19	IODIXANOL 270 MG/ML IV SOLN	BOTH IP/OP	$208.90 	$154.59	$0.00	$155.05	$94.01	$94.01	$0.00	$0.00	$0.00	$43.54	$155.05	$155.05	$0.00	$0.00	$27.03	$0.00	$123.56	$123.56	$0.00	$94.82	$150.19	$151.70	$0.00		$0.00	$25.73	$0.00	$0.00	$30.19	$0.00	$0.00	$0.00	$0.00	$0.00
17801	ERX	HCPCS 25000001	50383-0889-15	ACETIC ACID 2 % OT SOLN	BOTH IP/OP	$154.42 	$114.27	$0.00	$119.03		$0.00	$0.00	$0.00	$0.00	$0.00	$114.61	$114.61	$119.03	$0.00	$32.18	$0.00	$0.00	$0.00	$0.00	$70.01	$110.90	$112.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17837	ERX	HCPCS 25000001	00085-1132-04	ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS	BOTH IP/OP	$591.08 	$437.40	$0.00	$455.60		$0.00	$0.00	$0.00	$0.00	$0.00	$438.70	$438.70	$455.60	$0.00	$123.18	$0.00	$0.00	$0.00	$0.00	$126.41	$200.23	$202.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17837	ERX	HCPCS 25000001	00173-0682-24	ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS	BOTH IP/OP	$591.08 	$437.40	$0.00	$455.60		$0.00	$0.00	$0.00	$0.00	$0.00	$438.70	$438.70	$455.60	$0.00	$123.18	$0.00	$0.00	$0.00	$0.00	$126.41	$200.23	$202.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17837	ERX	HCPCS 25000001	59310-0579-22	ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS	BOTH IP/OP	$591.08 	$437.40	$0.00	$455.60		$0.00	$0.00	$0.00	$0.00	$0.00	$438.70	$438.70	$455.60	$0.00	$123.18	$0.00	$0.00	$0.00	$0.00	$126.41	$387.74	$202.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17881	ERX	HCPCS 63700001	17478-0715-10	BRIMONIDINE TARTRATE 0.2 % OP SOLN	BOTH IP/OP	$52.38 	$38.76	$0.00	$38.00		$0.00	$0.00	$0.00	$9.32	$0.00	$0.00	$0.00	$0.00	$0.00	$10.92	$0.00	$0.00	$0.00	$0.00	$23.75	$37.62	$38.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17881	ERX	HCPCS 63700001	24208-0411-05	BRIMONIDINE TARTRATE 0.2 % OP SOLN	BOTH IP/OP	$52.38 	$38.76	$0.00	$38.00		$0.00	$0.00	$0.00	$9.32	$0.00	$0.00	$0.00	$0.00	$0.00	$10.92	$0.00	$0.00	$0.00	$0.00	$23.75	$37.62	$38.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17881	ERX	HCPCS 63700001	61314-0143-05	BRIMONIDINE TARTRATE 0.2 % OP SOLN	BOTH IP/OP	$52.38 	$38.76	$0.00	$38.00		$0.00	$0.00	$0.00	$9.32	$0.00	$0.00	$0.00	$0.00	$0.00	$10.92	$0.00	$0.00	$0.00	$0.00	$23.75	$37.62	$38.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17881	ERX	HCPCS 63700001	70069-0231-01	BRIMONIDINE TARTRATE 0.2 % OP SOLN	BOTH IP/OP	$52.38 	$38.76	$0.00	$38.00		$0.00	$0.00	$0.00	$9.32	$0.00	$0.00	$0.00	$0.00	$0.00	$10.92	$0.00	$0.00	$0.00	$0.00	$23.75	$37.62	$38.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17936	ERX	HCPCS 63700001	00904-6377-61	OLANZAPINE 5 MG PO TABS	BOTH IP/OP	$50.16 	$37.12	$0.00	$40.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.08	$39.73	$40.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17936	ERX	HCPCS 63700001	43598-0164-30	OLANZAPINE 5 MG PO TABS	BOTH IP/OP	$50.16 	$37.12	$0.00	$40.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.08	$39.73	$40.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17936	ERX	HCPCS 63700001	60505-3111-00	OLANZAPINE 5 MG PO TABS	BOTH IP/OP	$50.16 	$37.12	$0.00	$40.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.08	$39.73	$40.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17936	ERX	HCPCS 63700001	66993-0681-30	OLANZAPINE 5 MG PO TABS	BOTH IP/OP	$50.16 	$37.12	$0.00	$40.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.08	$39.73	$40.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17936	ERX	HCPCS 63700001	68084-0723-01	OLANZAPINE 5 MG PO TABS	BOTH IP/OP	$50.16 	$37.12	$0.00	$40.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.08	$39.73	$40.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17937	ERX	HCPCS 63700001	00904-6376-61	OLANZAPINE 10 MG PO TABS	BOTH IP/OP	$75.68 	$56.00	$0.00	$60.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.84	$59.94	$60.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17937	ERX	HCPCS 63700001	33342-0070-07	OLANZAPINE 10 MG PO TABS	BOTH IP/OP	$75.68 	$56.00	$0.00	$60.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.84	$59.94	$60.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17937	ERX	HCPCS 63700001	43598-0166-30	OLANZAPINE 10 MG PO TABS	BOTH IP/OP	$75.68 	$56.00	$0.00	$60.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.84	$59.94	$60.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17937	ERX	HCPCS 63700001	60505-3113-00	OLANZAPINE 10 MG PO TABS	BOTH IP/OP	$75.68 	$56.00	$0.00	$60.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.84	$59.94	$60.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17937	ERX	HCPCS 63700001	68084-0740-01	OLANZAPINE 10 MG PO TABS	BOTH IP/OP	$75.68 	$56.00	$0.00	$60.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.84	$59.94	$60.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17937	ERX	HCPCS 63700001	69543-0383-30	OLANZAPINE 10 MG PO TABS	BOTH IP/OP	$75.68 	$56.00	$0.00	$60.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.84	$59.94	$60.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17938	ERX	HCPCS 63700001	60505-3112-00	OLANZAPINE 7.5 MG PO TABS	BOTH IP/OP	$67.39 	$49.87	$0.00	$48.90		$0.00	$0.00	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.04	$0.00	$0.00	$0.00	$0.00	$30.56	$48.41	$48.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17946	ERX	HCPCS J8540	00054-3176-44	DEXAMETHASONE 1 MG/ML PO CONC	BOTH IP/OP	$124.14 	$91.86	$0.00	$95.69	$55.86	$55.86	$0.00	$0.00	$0.00	$8.46	$92.14	$92.14	$95.69	$0.00	$25.87	$0.00	$73.43	$73.43	$0.00	$56.28	$89.15	$90.05	$0.00		$0.00	$17.62	$0.00	$0.00	$17.92	$0.00	$0.00	$0.00	$0.00	$0.00
17961	ERX	HCPCS 63700001	31722-0509-60	ZIDOVUDINE 300 MG PO TABS	BOTH IP/OP	$25.21 	$18.66	$0.00	$18.30		$0.00	$0.00	$0.00	$4.49	$0.00	$0.00	$0.00	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$11.44	$18.11	$18.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17961	ERX	HCPCS 63700001	65862-0024-60	ZIDOVUDINE 300 MG PO TABS	BOTH IP/OP	$25.21 	$18.66	$0.00	$18.30		$0.00	$0.00	$0.00	$4.49	$0.00	$0.00	$0.00	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$11.44	$18.11	$18.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18031	ERX	HCPCS 25000001	00187-0245-03	DIHYDROERGOTAMINE MESYLATE 4 MG/ML NA SOLN	BOTH IP/OP	"$1,485.21 "	"$1,099.06"	$0.00	"$1,144.80"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,102.32"	"$1,102.32"	"$1,144.80"	$0.00	$309.52	$0.00	$0.00	$0.00	$0.00	$688.13	"$1,090.00"	"$1,101.01"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18192	ERX	HCPCS J2795	00409-9300-20	ROPIVACAINE HCL 2 MG/ML IJ SOLN	BOTH IP/OP	$24.35 	$18.02	$0.00	$18.77	$10.96	$10.96	$0.00	$0.00	$0.00	$5.08	$18.07	$18.07	$18.77	$0.00	$5.07	$0.00	$14.40	$14.40	$0.00	$11.04	$17.49	$17.66	$0.00		$0.00	$3.46	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
18192	ERX	HCPCS J2795	00409-9300-21	ROPIVACAINE HCL 2 MG/ML IJ SOLN	BOTH IP/OP	$24.35 	$18.02	$0.00	$18.77	$10.96	$10.96	$0.00	$0.00	$0.00	$5.08	$18.07	$18.07	$18.77	$0.00	$5.07	$0.00	$14.40	$14.40	$0.00	$11.04	$17.49	$17.66	$0.00		$0.00	$3.46	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
18192	ERX	HCPCS J2795	55150-0195-20	ROPIVACAINE HCL 2 MG/ML IJ SOLN	BOTH IP/OP	$24.35 	$18.02	$0.00	$18.77	$10.96	$10.96	$0.00	$0.00	$0.00	$5.08	$18.07	$18.07	$18.77	$0.00	$5.07	$0.00	$14.40	$14.40	$0.00	$11.04	$17.49	$17.66	$0.00		$0.00	$3.46	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
18192	ERX	HCPCS J2795	63323-0285-07	ROPIVACAINE HCL 2 MG/ML IJ SOLN	BOTH IP/OP	$24.35 	$18.02	$0.00	$18.77	$10.96	$10.96	$0.00	$0.00	$0.00	$5.08	$18.07	$18.07	$18.77	$0.00	$5.07	$0.00	$14.40	$14.40	$0.00	$11.04	$17.49	$17.66	$0.00		$0.00	$3.46	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
18192	ERX	HCPCS J2795	63323-0285-13	ROPIVACAINE HCL 2 MG/ML IJ SOLN	BOTH IP/OP	$24.35 	$18.02	$0.00	$18.77	$10.96	$10.96	$0.00	$0.00	$0.00	$5.08	$18.07	$18.07	$18.77	$0.00	$5.07	$0.00	$14.40	$14.40	$0.00	$11.04	$17.49	$17.66	$0.00		$0.00	$3.46	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
18192	ERX	HCPCS J2795	63323-0285-23	ROPIVACAINE HCL 2 MG/ML IJ SOLN	BOTH IP/OP	$24.35 	$18.02	$0.00	$18.77	$10.96	$10.96	$0.00	$0.00	$0.00	$5.08	$18.07	$18.07	$18.77	$0.00	$5.07	$0.00	$14.40	$14.40	$0.00	$11.04	$17.49	$17.66	$0.00		$0.00	$3.46	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
18193	ERX	HCPCS J2795	63323-0287-20	ROPIVACAINE HCL 7.5 MG/ML IJ SOLN	BOTH IP/OP	$93.80 	$69.41	$0.00	$72.30	$42.21	$42.21	$0.00	$0.00	$0.00	$19.55	$69.62	$69.62	$72.30	$0.00	$19.55	$0.00	$55.48	$55.48	$0.00	$32.32	$51.19	$51.71	$0.00		$0.00	$10.12	$0.00	$0.00	$10.29	$0.00	$0.00	$0.00	$0.00	$0.00
18195	ERX	HCPCS J2795	55150-0197-20	ROPIVACAINE HCL 5 MG/ML IJ SOLN	BOTH IP/OP	$52.80 	$39.07	$0.00	$40.70	$23.76	$23.76	$0.00	$0.00	$0.00	$11.00	$39.19	$39.19	$40.70	$0.00	$11.00	$0.00	$31.23	$31.23	$0.00	$23.94	$37.92	$38.30	$0.00		$0.00	$7.49	$0.00	$0.00	$7.62	$0.00	$0.00	$0.00	$0.00	$0.00
18195	ERX	HCPCS J2795	55150-0198-30	ROPIVACAINE HCL 5 MG/ML IJ SOLN	BOTH IP/OP	$52.80 	$39.07	$0.00	$40.70	$23.76	$23.76	$0.00	$0.00	$0.00	$11.00	$39.19	$39.19	$40.70	$0.00	$11.00	$0.00	$31.23	$31.23	$0.00	$23.94	$37.92	$38.30	$0.00		$0.00	$7.49	$0.00	$0.00	$7.62	$0.00	$0.00	$0.00	$0.00	$0.00
18195	ERX	HCPCS J2795	63323-0286-23	ROPIVACAINE HCL 5 MG/ML IJ SOLN	BOTH IP/OP	$52.80 	$39.07	$0.00	$40.70	$23.76	$23.76	$0.00	$0.00	$0.00	$11.00	$39.19	$39.19	$40.70	$0.00	$11.00	$0.00	$31.23	$31.23	$0.00	$23.94	$37.92	$38.30	$0.00		$0.00	$7.49	$0.00	$0.00	$7.62	$0.00	$0.00	$0.00	$0.00	$0.00
18195	ERX	HCPCS J2795	63323-0286-31	ROPIVACAINE HCL 5 MG/ML IJ SOLN	BOTH IP/OP	$52.80 	$39.07	$0.00	$40.70	$23.76	$23.76	$0.00	$0.00	$0.00	$11.00	$39.19	$39.19	$40.70	$0.00	$11.00	$0.00	$31.23	$31.23	$0.00	$23.94	$37.92	$38.30	$0.00		$0.00	$7.49	$0.00	$0.00	$7.62	$0.00	$0.00	$0.00	$0.00	$0.00
18195	ERX	HCPCS J2795	63323-0286-35	ROPIVACAINE HCL 5 MG/ML IJ SOLN	BOTH IP/OP	$52.80 	$39.07	$0.00	$40.70	$23.76	$23.76	$0.00	$0.00	$0.00	$11.00	$39.19	$39.19	$40.70	$0.00	$11.00	$0.00	$31.23	$31.23	$0.00	$23.94	$37.92	$38.30	$0.00		$0.00	$7.49	$0.00	$0.00	$7.62	$0.00	$0.00	$0.00	$0.00	$0.00
18265	ERX	HCPCS 25000001	00517-9310-25	TRACE MINERALS CR-CU-MN-ZN 1-100-30-500 MCG/ML IV SOLN	BOTH IP/OP	$36.67 	$27.14	$0.00	$28.27		$0.00	$0.00	$0.00	$0.00	$0.00	$27.22	$27.22	$28.27	$0.00	$7.64	$0.00	$0.00	$0.00	$0.00	$16.63	$26.33	$26.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18266	ERX	HCPCS 2500003	00517-9203-25	TRACE MINERALS CR-CU-MN-ZN 1-100-25-1000 MCG/ML IV SOLN	BOTH IP/OP	$61.10 	$45.21	$0.00	$47.10		$0.00	$0.00	$0.00	$0.00	$0.00	$45.35	$45.35	$47.10	$0.00	$12.73	$0.00	$0.00	$0.00	$0.00	$25.54	$40.45	$40.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18287	ERX	HCPCS 63700001	29300-0127-13	BISOPROLOL FUMARATE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18288	ERX	HCPCS 63700001	00185-0771-01	BISOPROLOL FUMARATE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18292	ERX	HCPCS 63700001	50111-0916-01	TORSEMIDE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18292	ERX	HCPCS 63700001	50268-0755-11	TORSEMIDE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18292	ERX	HCPCS 63700001	50268-0755-15	TORSEMIDE 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18293	ERX	HCPCS 63700001	00054-0077-25	TORSEMIDE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18293	ERX	HCPCS 63700001	00054-0077-29	TORSEMIDE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18293	ERX	HCPCS 63700001	31722-0531-01	TORSEMIDE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18293	ERX	HCPCS 63700001	50111-0917-01	TORSEMIDE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18293	ERX	HCPCS 63700001	50268-0756-15	TORSEMIDE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18293	ERX	HCPCS 63700001	68084-0539-01	TORSEMIDE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18293	ERX	HCPCS 63700001	68084-0539-11	TORSEMIDE 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18294	ERX	HCPCS 63700001	31722-0532-01	TORSEMIDE 100 MG PO TABS	BOTH IP/OP	$12.75 	$9.44	$0.00	$9.25		$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00	$2.66	$0.00	$0.00	$0.00	$0.00	$5.78	$9.16	$9.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18294	ERX	HCPCS 63700001	50111-0918-01	TORSEMIDE 100 MG PO TABS	BOTH IP/OP	$12.75 	$9.44	$0.00	$9.25		$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00	$2.66	$0.00	$0.00	$0.00	$0.00	$5.78	$9.16	$9.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18295	ERX	HCPCS 63700001	31722-0529-01	TORSEMIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18295	ERX	HCPCS 63700001	50111-0915-01	TORSEMIDE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18302	ERX	HCPCS J2543	00781-3114-91	PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR	BOTH IP/OP	$90.27 	$66.80	$0.00	$69.58	$40.62	$40.62	$0.00	$0.00	$0.00	$26.18	$67.00	$67.00	$69.58	$0.00	$6.94	$0.00	$53.39	$53.39	$0.00	$40.93	$64.83	$65.48	$0.00		$0.00	$8.70	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
18302	ERX	HCPCS J2543	00781-3114-95	PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR	BOTH IP/OP	$90.27 	$66.80	$0.00	$69.58	$40.62	$40.62	$0.00	$0.00	$0.00	$26.18	$67.00	$67.00	$69.58	$0.00	$6.94	$0.00	$53.39	$53.39	$0.00	$40.93	$64.83	$65.48	$0.00		$0.00	$8.70	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
18302	ERX	HCPCS J2543	44567-0803-10	PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR	BOTH IP/OP	$90.27 	$66.80	$0.00	$69.58	$40.62	$40.62	$0.00	$0.00	$0.00	$26.18	$67.00	$67.00	$69.58	$0.00	$6.94	$0.00	$53.39	$53.39	$0.00	$40.93	$64.83	$65.48	$0.00		$0.00	$8.70	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
18302	ERX	HCPCS J2543	55150-0121-50	PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR	BOTH IP/OP	$90.27 	$66.80	$0.00	$69.58	$40.62	$40.62	$0.00	$0.00	$0.00	$26.18	$67.00	$67.00	$69.58	$0.00	$6.94	$0.00	$53.39	$53.39	$0.00	$40.93	$64.83	$65.48	$0.00		$0.00	$8.70	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
18302	ERX	HCPCS J2543	67457-0523-00	PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR	BOTH IP/OP	$90.27 	$66.80	$0.00	$69.58	$40.62	$40.62	$0.00	$0.00	$0.00	$26.18	$67.00	$67.00	$69.58	$0.00	$6.94	$0.00	$53.39	$53.39	$0.00	$40.93	$64.83	$65.48	$0.00		$0.00	$8.70	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
18302	ERX	HCPCS J2543	67457-0523-45	PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR	BOTH IP/OP	$90.27 	$66.80	$0.00	$69.58	$40.62	$40.62	$0.00	$0.00	$0.00	$26.18	$67.00	$67.00	$69.58	$0.00	$6.94	$0.00	$53.39	$53.39	$0.00	$40.93	$64.83	$65.48	$0.00		$0.00	$8.70	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
18303	ERX	HCPCS J2543	00409-3385-13	PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR	BOTH IP/OP	$52.58 	$38.91	$0.00	$40.53	$23.66	$23.66	$0.00	$0.00	$0.00	$19.63	$39.02	$39.02	$40.53	$0.00	$5.21	$0.00	$31.10	$31.10	$0.00	$23.49	$37.21	$37.58	$0.00		$0.00	$6.52	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
18303	ERX	HCPCS J2543	00781-3113-95	PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR	BOTH IP/OP	$52.58 	$38.91	$0.00	$40.53	$23.66	$23.66	$0.00	$0.00	$0.00	$19.63	$39.02	$39.02	$40.53	$0.00	$5.21	$0.00	$31.10	$31.10	$0.00	$23.49	$37.21	$37.58	$0.00		$0.00	$6.52	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
18303	ERX	HCPCS J2543	55150-0120-30	PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR	BOTH IP/OP	$52.58 	$38.91	$0.00	$40.53	$23.66	$23.66	$0.00	$0.00	$0.00	$19.63	$39.02	$39.02	$40.53	$0.00	$5.21	$0.00	$31.10	$31.10	$0.00	$23.49	$37.21	$37.58	$0.00		$0.00	$6.52	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
18304	ERX	HCPCS J2543	00409-3383-02	PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR	BOTH IP/OP	$35.05 	$25.94	$0.00	$27.02	$15.77	$15.77	$0.00	$0.00	$0.00	$13.09	$26.01	$26.01	$27.02	$0.00	$3.47	$0.00	$20.73	$20.73	$0.00	$15.66	$24.81	$25.06	$0.00		$0.00	$4.35	$0.00	$0.00	$4.14	$0.00	$0.00	$0.00	$0.00	$0.00
18304	ERX	HCPCS J2543	00781-3110-95	PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR	BOTH IP/OP	$35.05 	$25.94	$0.00	$27.02	$15.77	$15.77	$0.00	$0.00	$0.00	$13.09	$26.01	$26.01	$27.02	$0.00	$3.47	$0.00	$20.73	$20.73	$0.00	$15.66	$24.81	$25.06	$0.00		$0.00	$4.35	$0.00	$0.00	$4.14	$0.00	$0.00	$0.00	$0.00	$0.00
18304	ERX	HCPCS J2543	44567-0801-10	PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR	BOTH IP/OP	$35.05 	$25.94	$0.00	$27.02	$15.77	$15.77	$0.00	$0.00	$0.00	$13.09	$26.01	$26.01	$27.02	$0.00	$3.47	$0.00	$20.73	$20.73	$0.00	$15.66	$24.81	$25.06	$0.00		$0.00	$4.35	$0.00	$0.00	$4.14	$0.00	$0.00	$0.00	$0.00	$0.00
18304	ERX	HCPCS J2543	55150-0119-30	PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR	BOTH IP/OP	$35.05 	$25.94	$0.00	$27.02	$15.77	$15.77	$0.00	$0.00	$0.00	$13.09	$26.01	$26.01	$27.02	$0.00	$3.47	$0.00	$20.73	$20.73	$0.00	$15.66	$24.81	$25.06	$0.00		$0.00	$4.35	$0.00	$0.00	$4.14	$0.00	$0.00	$0.00	$0.00	$0.00
18307	ERX	HCPCS 63700001	00904-6667-61	GABAPENTIN 400 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18307	ERX	HCPCS 63700001	16714-0505-02	GABAPENTIN 400 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18307	ERX	HCPCS 63700001	63739-0984-10	GABAPENTIN 400 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18307	ERX	HCPCS 63700001	68084-0774-01	GABAPENTIN 400 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18307	ERX	HCPCS 63700001	68084-0774-11	GABAPENTIN 400 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18308	ERX	HCPCS 63700001	00904-6666-61	GABAPENTIN 300 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$5.05		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.16	$5.00	$5.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18308	ERX	HCPCS 63700001	16714-0662-01	GABAPENTIN 300 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$5.05		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.16	$5.00	$5.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18308	ERX	HCPCS 63700001	49483-0606-50	GABAPENTIN 300 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$5.05		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.16	$5.00	$5.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18308	ERX	HCPCS 63700001	50228-0180-05	GABAPENTIN 300 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$5.05		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.16	$5.00	$5.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18308	ERX	HCPCS 63700001	63739-0236-10	GABAPENTIN 300 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$5.05		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.16	$5.00	$5.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18308	ERX	HCPCS 63700001	63739-0689-10	GABAPENTIN 300 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$5.05		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.16	$5.00	$5.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18308	ERX	HCPCS 63700001	65862-0199-01	GABAPENTIN 300 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$5.05		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.16	$5.00	$5.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18308	ERX	HCPCS 63700001	67877-0223-01	GABAPENTIN 300 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$5.05		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.16	$5.00	$5.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18308	ERX	HCPCS 63700001	68084-0762-01	GABAPENTIN 300 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$5.05		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.16	$5.00	$5.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18309	ERX	HCPCS 63700001	00904-6665-61	GABAPENTIN 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18309	ERX	HCPCS 63700001	16714-0503-01	GABAPENTIN 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18309	ERX	HCPCS 63700001	16714-0661-01	GABAPENTIN 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18309	ERX	HCPCS 63700001	63739-0591-10	GABAPENTIN 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18309	ERX	HCPCS 63700001	68084-0783-01	GABAPENTIN 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18309	ERX	HCPCS 63700001	69097-0813-07	GABAPENTIN 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18310	ERX	HCPCS 63700001	00904-6362-61	RISPERIDONE 4 MG PO TABS	BOTH IP/OP	$23.59 	$17.46	$0.00	$18.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.80	$18.68	$18.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18310	ERX	HCPCS 63700001	50458-0595-60	RISPERIDONE 4 MG PO TABS	BOTH IP/OP	$23.59 	$17.46	$0.00	$18.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.80	$18.68	$18.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18310	ERX	HCPCS 63700001	51079-0465-01	RISPERIDONE 4 MG PO TABS	BOTH IP/OP	$23.59 	$17.46	$0.00	$18.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.80	$18.68	$18.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18310	ERX	HCPCS 63700001	51079-0465-20	RISPERIDONE 4 MG PO TABS	BOTH IP/OP	$23.59 	$17.46	$0.00	$18.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.80	$18.68	$18.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18311	ERX	HCPCS 63700001	00904-6360-61	RISPERIDONE 2 MG PO TABS	BOTH IP/OP	$14.95 	$11.06	$0.00	$11.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.48	$11.84	$11.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18311	ERX	HCPCS 63700001	51079-0463-01	RISPERIDONE 2 MG PO TABS	BOTH IP/OP	$14.95 	$11.06	$0.00	$11.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.48	$11.84	$11.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18311	ERX	HCPCS 63700001	51079-0463-20	RISPERIDONE 2 MG PO TABS	BOTH IP/OP	$14.95 	$11.06	$0.00	$11.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.48	$11.84	$11.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18312	ERX	HCPCS 63700001	00904-6361-61	RISPERIDONE 3 MG PO TABS	BOTH IP/OP	$17.56 	$12.99	$0.00	$14.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.78	$13.91	$14.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18312	ERX	HCPCS 63700001	68084-0274-01	RISPERIDONE 3 MG PO TABS	BOTH IP/OP	$17.56 	$12.99	$0.00	$14.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.78	$13.91	$14.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18312	ERX	HCPCS 63700001	68084-0274-11	RISPERIDONE 3 MG PO TABS	BOTH IP/OP	$17.56 	$12.99	$0.00	$14.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.78	$13.91	$14.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18313	ERX	HCPCS 63700001	00904-6359-61	RISPERIDONE 1 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.48	$7.09	$7.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18315	ERX	HCPCS J1250	00338-1075-02	DOBUTAMINE IN D5W 2 MG/ML IV SOLN	BOTH IP/OP	$172.74 	$127.83	$0.00	$133.15	$77.73	$77.73	$0.00	$0.00	$0.00	$13.16	$128.21	$128.21	$133.15	$0.00	$19.29	$0.00	$102.18	$102.18	$0.00	$73.07	$115.73	$116.90	$0.00		$0.00	$14.29	$0.00	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00
18315	ERX	HCPCS J1250	00409-2347-32	DOBUTAMINE IN D5W 2 MG/ML IV SOLN	BOTH IP/OP	$172.74 	$127.83	$0.00	$133.15	$77.73	$77.73	$0.00	$0.00	$0.00	$13.16	$128.21	$128.21	$133.15	$0.00	$19.29	$0.00	$102.18	$102.18	$0.00	$73.07	$115.73	$116.90	$0.00		$0.00	$14.29	$0.00	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$0.00
18385	ERX	HCPCS 63700001	00591-3540-60	BUPROPION HCL ER (SR) 100 MG PO TB12	BOTH IP/OP	$6.98 	$5.17	$0.00	$5.06		$0.00	$0.00	$0.00	$1.24	$0.00	$0.00	$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$3.17	$5.01	$5.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18385	ERX	HCPCS 63700001	43547-0288-10	BUPROPION HCL ER (SR) 100 MG PO TB12	BOTH IP/OP	$6.98 	$5.17	$0.00	$5.06		$0.00	$0.00	$0.00	$1.24	$0.00	$0.00	$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$3.17	$5.01	$5.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18385	ERX	HCPCS 63700001	43598-0751-01	BUPROPION HCL ER (SR) 100 MG PO TB12	BOTH IP/OP	$6.98 	$5.17	$0.00	$5.06		$0.00	$0.00	$0.00	$1.24	$0.00	$0.00	$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$3.17	$5.01	$5.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18385	ERX	HCPCS 63700001	68084-0697-01	BUPROPION HCL ER (SR) 100 MG PO TB12	BOTH IP/OP	$6.98 	$5.17	$0.00	$5.06		$0.00	$0.00	$0.00	$1.24	$0.00	$0.00	$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$3.17	$5.01	$5.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18386	ERX	HCPCS 63700001	00173-0135-55	BUPROPION HCL ER (SR) 150 MG PO TB12	BOTH IP/OP	$38.44 	$28.45	$0.00	$27.07		$0.00	$0.00	$0.00	$6.84	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$0.00	$0.00	$0.00	$16.92	$26.80	$27.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18386	ERX	HCPCS 63700001	00185-0415-05	BUPROPION HCL ER (SR) 150 MG PO TB12	BOTH IP/OP	$38.44 	$28.45	$0.00	$27.07		$0.00	$0.00	$0.00	$6.84	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$0.00	$0.00	$0.00	$16.92	$26.80	$27.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18386	ERX	HCPCS 63700001	00185-0415-60	BUPROPION HCL ER (SR) 150 MG PO TB12	BOTH IP/OP	$38.44 	$28.45	$0.00	$27.07		$0.00	$0.00	$0.00	$6.84	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$0.00	$0.00	$0.00	$16.92	$26.80	$27.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18386	ERX	HCPCS 63700001	00591-3541-60	BUPROPION HCL ER (SR) 150 MG PO TB12	BOTH IP/OP	$38.44 	$28.45	$0.00	$27.07		$0.00	$0.00	$0.00	$6.84	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$0.00	$0.00	$0.00	$16.92	$26.80	$27.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18386	ERX	HCPCS 63700001	00904-6585-61	BUPROPION HCL ER (SR) 150 MG PO TB12	BOTH IP/OP	$38.44 	$28.45	$0.00	$27.07		$0.00	$0.00	$0.00	$6.84	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$0.00	$0.00	$0.00	$16.92	$26.80	$27.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18386	ERX	HCPCS 63700001	63739-0714-10	BUPROPION HCL ER (SR) 150 MG PO TB12	BOTH IP/OP	$38.44 	$28.45	$0.00	$27.07		$0.00	$0.00	$0.00	$6.84	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$0.00	$0.00	$0.00	$16.92	$26.80	$27.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18386	ERX	HCPCS 63700001	68084-0708-25	BUPROPION HCL ER (SR) 150 MG PO TB12	BOTH IP/OP	$38.44 	$28.45	$0.00	$27.07		$0.00	$0.00	$0.00	$6.84	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$0.00	$0.00	$0.00	$0.00	$16.92	$26.80	$27.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18400	ERX	HCPCS 25000001	63323-0724-05	REMIFENTANIL HCL 2 MG IV SOLR	BOTH IP/OP	$494.25 	$365.75	$0.00	$380.97		$0.00	$0.00	$0.00	$0.00	$0.00	$366.83	$366.83	$380.97	$0.00	$103.00	$0.00	$0.00	$0.00	$0.00	$224.33	$355.33	$358.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18400	ERX	HCPCS 25000001	67457-0198-05	REMIFENTANIL HCL 2 MG IV SOLR	BOTH IP/OP	$494.25 	$365.75	$0.00	$380.97		$0.00	$0.00	$0.00	$0.00	$0.00	$366.83	$366.83	$380.97	$0.00	$103.00	$0.00	$0.00	$0.00	$0.00	$224.33	$355.33	$358.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18400	ERX	HCPCS 25000001	67457-0198-99	REMIFENTANIL HCL 2 MG IV SOLR	BOTH IP/OP	$494.25 	$365.75	$0.00	$380.97		$0.00	$0.00	$0.00	$0.00	$0.00	$366.83	$366.83	$380.97	$0.00	$103.00	$0.00	$0.00	$0.00	$0.00	$224.33	$355.33	$358.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18551	ERX	HCPCS 63700001	00093-0051-01	CARVEDILOL 3.125 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18551	ERX	HCPCS 63700001	00904-6300-61	CARVEDILOL 3.125 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18551	ERX	HCPCS 63700001	51079-0771-01	CARVEDILOL 3.125 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18551	ERX	HCPCS 63700001	51079-0771-20	CARVEDILOL 3.125 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18551	ERX	HCPCS 63700001	55111-0252-01	CARVEDILOL 3.125 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18551	ERX	HCPCS 63700001	68382-0092-01	CARVEDILOL 3.125 MG PO TABS	BOTH IP/OP	$8.95 	$6.62	$0.00	$6.49		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.06	$6.42	$6.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18621	ERX	HCPCS 25000001	00013-8303-04	LATANOPROST 0.005 % OP SOLN	BOTH IP/OP	$785.75 	$581.46	$0.00	$605.66		$0.00	$0.00	$0.00	$0.00	$0.00	$583.18	$583.18	$605.66	$0.00	$163.75	$0.00	$0.00	$0.00	$0.00	$339.89	$538.39	$543.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18621	ERX	HCPCS 25000001	17478-0625-12	LATANOPROST 0.005 % OP SOLN	BOTH IP/OP	$785.75 	$581.46	$0.00	$605.66		$0.00	$0.00	$0.00	$0.00	$0.00	$583.18	$583.18	$605.66	$0.00	$163.75	$0.00	$0.00	$0.00	$0.00	$339.89	$538.39	$543.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18621	ERX	HCPCS 25000001	24208-0463-25	LATANOPROST 0.005 % OP SOLN	BOTH IP/OP	$785.75 	$581.46	$0.00	$605.66		$0.00	$0.00	$0.00	$0.00	$0.00	$583.18	$583.18	$605.66	$0.00	$163.75	$0.00	$0.00	$0.00	$0.00	$339.89	$538.39	$543.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18621	ERX	HCPCS 25000001	59762-0333-02	LATANOPROST 0.005 % OP SOLN	BOTH IP/OP	$785.75 	$581.46	$0.00	$605.66		$0.00	$0.00	$0.00	$0.00	$0.00	$583.18	$583.18	$605.66	$0.00	$163.75	$0.00	$0.00	$0.00	$0.00	$339.89	$538.39	$543.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18621	ERX	HCPCS 25000001	61314-0547-01	LATANOPROST 0.005 % OP SOLN	BOTH IP/OP	$785.75 	$581.46	$0.00	$605.66		$0.00	$0.00	$0.00	$0.00	$0.00	$583.18	$583.18	$605.66	$0.00	$163.75	$0.00	$0.00	$0.00	$0.00	$339.89	$538.39	$543.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18786	ERX	HCPCS 63700001	00904-6477-61	DONEPEZIL HCL 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18787	ERX	HCPCS 63700001	00904-6478-61	DONEPEZIL HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18787	ERX	HCPCS 63700001	60687-0303-01	DONEPEZIL HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18908	ERX	HCPCS 25000001	00187-4302-02	NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18908	ERX	HCPCS 25000001	25021-0310-02	NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18918	ERX	HCPCS 63700001	00904-6351-61	LEVOFLOXACIN 250 MG PO TABS	BOTH IP/OP	$70.44 	$52.13	$0.00	$51.11		$0.00	$0.00	$0.00	$12.54	$0.00	$0.00	$0.00	$0.00	$0.00	$14.68	$0.00	$0.00	$0.00	$0.00	$31.95	$50.60	$51.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18918	ERX	HCPCS 63700001	65862-0536-50	LEVOFLOXACIN 250 MG PO TABS	BOTH IP/OP	$70.44 	$52.13	$0.00	$51.11		$0.00	$0.00	$0.00	$12.54	$0.00	$0.00	$0.00	$0.00	$0.00	$14.68	$0.00	$0.00	$0.00	$0.00	$31.95	$50.60	$51.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18918	ERX	HCPCS 63700001	68180-0240-01	LEVOFLOXACIN 250 MG PO TABS	BOTH IP/OP	$70.44 	$52.13	$0.00	$51.11		$0.00	$0.00	$0.00	$12.54	$0.00	$0.00	$0.00	$0.00	$0.00	$14.68	$0.00	$0.00	$0.00	$0.00	$31.95	$50.60	$51.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18919	ERX	HCPCS 63700001	00904-6352-61	LEVOFLOXACIN 500 MG PO TABS	BOTH IP/OP	$71.83 	$53.15	$0.00	$57.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.92	$56.89	$57.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18919	ERX	HCPCS 63700001	65862-0537-50	LEVOFLOXACIN 500 MG PO TABS	BOTH IP/OP	$71.83 	$53.15	$0.00	$57.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.92	$56.89	$57.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18920	ERX	HCPCS 63700001	68084-0342-01	TOPIRAMATE 25 MG PO TABS	BOTH IP/OP	$7.71 	$5.71	$0.00	$6.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.86	$6.11	$6.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18921	ERX	HCPCS 63700001	47335-0712-86	TOPIRAMATE 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18921	ERX	HCPCS 63700001	62756-0712-86	TOPIRAMATE 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18921	ERX	HCPCS 63700001	68084-0345-11	TOPIRAMATE 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18921	ERX	HCPCS 63700001	68084-0345-21	TOPIRAMATE 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18921	ERX	HCPCS 63700001	68382-0141-14	TOPIRAMATE 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18921	ERX	HCPCS 63700001	69097-0125-03	TOPIRAMATE 200 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18922	ERX	HCPCS 63700001	62756-0711-86	TOPIRAMATE 100 MG PO TABS	BOTH IP/OP	$29.13 	$21.56	$0.00	$21.13		$0.00	$0.00	$0.00	$5.19	$0.00	$0.00	$0.00	$0.00	$0.00	$6.07	$0.00	$0.00	$0.00	$0.00	$13.21	$20.92	$21.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18922	ERX	HCPCS 63700001	68084-0344-01	TOPIRAMATE 100 MG PO TABS	BOTH IP/OP	$29.13 	$21.56	$0.00	$21.13		$0.00	$0.00	$0.00	$5.19	$0.00	$0.00	$0.00	$0.00	$0.00	$6.07	$0.00	$0.00	$0.00	$0.00	$13.21	$20.92	$21.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18925	ERX	HCPCS J1956	17478-0107-20	LEVOFLOXACIN 25 MG/ML IV SOLN	BOTH IP/OP	$84.92 	$62.84	$0.00	$65.46	$38.21	$38.21	$0.00	$0.00	$0.00	$17.70	$63.03	$63.03	$65.46	$0.00	$17.70	$0.00	$50.23	$50.23	$0.00	$38.50	$60.98	$61.60	$0.00		$0.00	$12.05	$0.00	$0.00	$12.26	$0.00	$0.00	$0.00	$0.00	$0.00
18925	ERX	HCPCS J1956	17478-0107-30	LEVOFLOXACIN 25 MG/ML IV SOLN	BOTH IP/OP	$84.92 	$62.84	$0.00	$65.46	$38.21	$38.21	$0.00	$0.00	$0.00	$17.70	$63.03	$63.03	$65.46	$0.00	$17.70	$0.00	$50.23	$50.23	$0.00	$38.50	$60.98	$61.60	$0.00		$0.00	$12.05	$0.00	$0.00	$12.26	$0.00	$0.00	$0.00	$0.00	$0.00
18925	ERX	HCPCS J1956	55150-0156-20	LEVOFLOXACIN 25 MG/ML IV SOLN	BOTH IP/OP	$84.92 	$62.84	$0.00	$65.46	$38.21	$38.21	$0.00	$0.00	$0.00	$17.70	$63.03	$63.03	$65.46	$0.00	$17.70	$0.00	$50.23	$50.23	$0.00	$38.50	$60.98	$61.60	$0.00		$0.00	$12.05	$0.00	$0.00	$12.26	$0.00	$0.00	$0.00	$0.00	$0.00
19176	ERX	HCPCS 63700001	00904-6290-61	ATORVASTATIN CALCIUM 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19176	ERX	HCPCS 63700001	50268-0093-11	ATORVASTATIN CALCIUM 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19176	ERX	HCPCS 63700001	50268-0093-15	ATORVASTATIN CALCIUM 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19176	ERX	HCPCS 63700001	60505-2578-09	ATORVASTATIN CALCIUM 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19176	ERX	HCPCS 63700001	62175-0890-46	ATORVASTATIN CALCIUM 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19177	ERX	HCPCS 63700001	00378-3952-77	ATORVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$24.20 	$17.91	$0.00	$17.56		$0.00	$0.00	$0.00	$4.31	$0.00	$0.00	$0.00	$0.00	$0.00	$5.04	$0.00	$0.00	$0.00	$0.00	$10.98	$17.38	$17.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19177	ERX	HCPCS 63700001	00904-6292-61	ATORVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$24.20 	$17.91	$0.00	$17.56		$0.00	$0.00	$0.00	$4.31	$0.00	$0.00	$0.00	$0.00	$0.00	$5.04	$0.00	$0.00	$0.00	$0.00	$10.98	$17.38	$17.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19177	ERX	HCPCS 63700001	51079-0210-01	ATORVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$24.20 	$17.91	$0.00	$17.56		$0.00	$0.00	$0.00	$4.31	$0.00	$0.00	$0.00	$0.00	$0.00	$5.04	$0.00	$0.00	$0.00	$0.00	$10.98	$17.38	$17.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19177	ERX	HCPCS 63700001	51079-0210-20	ATORVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$24.20 	$17.91	$0.00	$17.56		$0.00	$0.00	$0.00	$4.31	$0.00	$0.00	$0.00	$0.00	$0.00	$5.04	$0.00	$0.00	$0.00	$0.00	$10.98	$17.38	$17.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19177	ERX	HCPCS 63700001	55111-0123-90	ATORVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$24.20 	$17.91	$0.00	$17.56		$0.00	$0.00	$0.00	$4.31	$0.00	$0.00	$0.00	$0.00	$0.00	$5.04	$0.00	$0.00	$0.00	$0.00	$10.98	$17.38	$17.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19177	ERX	HCPCS 63700001	60505-2580-09	ATORVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$24.20 	$17.91	$0.00	$17.56		$0.00	$0.00	$0.00	$4.31	$0.00	$0.00	$0.00	$0.00	$0.00	$5.04	$0.00	$0.00	$0.00	$0.00	$10.98	$17.38	$17.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19177	ERX	HCPCS 63700001	68084-0099-01	ATORVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$24.20 	$17.91	$0.00	$17.56		$0.00	$0.00	$0.00	$4.31	$0.00	$0.00	$0.00	$0.00	$0.00	$5.04	$0.00	$0.00	$0.00	$0.00	$10.98	$17.38	$17.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19178	ERX	HCPCS 63700001	00904-6291-61	ATORVASTATIN CALCIUM 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19178	ERX	HCPCS 63700001	55111-0122-90	ATORVASTATIN CALCIUM 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19178	ERX	HCPCS 63700001	60505-2579-09	ATORVASTATIN CALCIUM 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19178	ERX	HCPCS 63700001	68084-0098-01	ATORVASTATIN CALCIUM 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19179	ERX	HCPCS 25000001	42291-0153-30	AZELASTINE HCL 0.1 % NA SOLN	BOTH IP/OP	$320.99 	$237.53	$0.00	$256.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.50	$254.22	$256.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19179	ERX	HCPCS 25000001	60505-0833-05	AZELASTINE HCL 0.1 % NA SOLN	BOTH IP/OP	$320.99 	$237.53	$0.00	$256.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.50	$254.22	$256.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19226	ERX	HCPCS 63700001	00093-5420-88	CABERGOLINE 0.5 MG PO TABS	BOTH IP/OP	$141.51 	$104.72	$0.00	$102.65		$0.00	$0.00	$0.00	$25.19	$0.00	$0.00	$0.00	$0.00	$0.00	$29.49	$0.00	$0.00	$0.00	$0.00	$64.16	$101.62	$102.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19226	ERX	HCPCS 63700001	49884-0673-14	CABERGOLINE 0.5 MG PO TABS	BOTH IP/OP	$141.51 	$104.72	$0.00	$102.65		$0.00	$0.00	$0.00	$25.19	$0.00	$0.00	$0.00	$0.00	$0.00	$29.49	$0.00	$0.00	$0.00	$0.00	$64.16	$101.62	$102.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19226	ERX	HCPCS 63700001	50742-0118-08	CABERGOLINE 0.5 MG PO TABS	BOTH IP/OP	$141.51 	$104.72	$0.00	$102.65		$0.00	$0.00	$0.00	$25.19	$0.00	$0.00	$0.00	$0.00	$0.00	$29.49	$0.00	$0.00	$0.00	$0.00	$64.16	$101.62	$102.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19226	ERX	HCPCS 63700001	59762-1005-01	CABERGOLINE 0.5 MG PO TABS	BOTH IP/OP	$141.51 	$104.72	$0.00	$102.65		$0.00	$0.00	$0.00	$25.19	$0.00	$0.00	$0.00	$0.00	$0.00	$29.49	$0.00	$0.00	$0.00	$0.00	$64.16	$101.62	$102.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19333	ERX	HCPCS J0735	00143-9724-01	CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN	BOTH IP/OP	$39.90 	$29.53	$0.00	$31.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.95	$31.60	$31.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19333	ERX	HCPCS J0735	39822-2000-01	CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN	BOTH IP/OP	$39.90 	$29.53	$0.00	$31.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.95	$31.60	$31.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19333	ERX	HCPCS J0735	67457-0218-10	CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN	BOTH IP/OP	$39.90 	$29.53	$0.00	$31.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.95	$31.60	$31.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19451	ERX	HCPCS 90700	58160-0810-11	DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP	BOTH IP/OP	$105.04 	$77.73	$0.00	$84.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.52	$83.19	$84.03	$0.00		$0.00	$16.44	$0.00	$0.00	$16.72	$0.00	$0.00	$0.00	$0.00	$0.00
19451	ERX	HCPCS 90700	58160-0810-52	DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP	BOTH IP/OP	$105.04 	$77.73	$0.00	$84.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.52	$83.19	$84.03	$0.00		$0.00	$16.44	$0.00	$0.00	$16.72	$0.00	$0.00	$0.00	$0.00	$0.00
19452	ERX	HCPCS 25000001	17478-0105-05	OLOPATADINE HCL 0.1 % OP SOLN	BOTH IP/OP	$924.14 	$683.86	$0.00	$739.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$462.07	$731.92	$739.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19452	ERX	HCPCS 25000001	61314-0271-05	OLOPATADINE HCL 0.1 % OP SOLN	BOTH IP/OP	$924.14 	$683.86	$0.00	$739.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$462.07	$731.92	$739.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19452	ERX	HCPCS 25000001	65862-0757-05	OLOPATADINE HCL 0.1 % OP SOLN	BOTH IP/OP	$924.14 	$683.86	$0.00	$739.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$462.07	$731.92	$739.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19452	ERX	HCPCS 25000001	70069-0007-01	OLOPATADINE HCL 0.1 % OP SOLN	BOTH IP/OP	$924.14 	$683.86	$0.00	$739.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$462.07	$731.92	$739.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19527	ERX	HCPCS 63700001	00904-5460-52	OYSTER SHELL CALCIUM/D 500-200 MG-UNIT PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19527	ERX	HCPCS 63700001	00904-5460-72	OYSTER SHELL CALCIUM/D 500-200 MG-UNIT PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19527	ERX	HCPCS 63700001	00904-5460-92	OYSTER SHELL CALCIUM/D 500-200 MG-UNIT PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19691	ERX	HCPCS 25000001	61010-8100-01	BENZOCAINE 20 % MT GEL	BOTH IP/OP	$36.21 	$26.80	$0.00	$27.91		$0.00	$0.00	$0.00	$0.00	$0.00	$26.88	$26.88	$27.91	$0.00	$7.55	$0.00	$0.00	$0.00	$0.00	$16.42	$26.01	$26.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19691	ERX	HCPCS 25000001	00283-0293-31	BENZOCAINE 20 % MT GEL	BOTH IP/OP	$36.21 	$26.80	$0.00	$27.91		$0.00	$0.00	$0.00	$0.00	$0.00	$26.88	$26.88	$27.91	$0.00	$7.55	$0.00	$0.00	$0.00	$0.00	$16.42	$26.01	$26.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19691	ERX	HCPCS 25000001	00283-0871-31	BENZOCAINE 20 % MT GEL	BOTH IP/OP	$36.21 	$26.80	$0.00	$27.91		$0.00	$0.00	$0.00	$0.00	$0.00	$26.88	$26.88	$27.91	$0.00	$7.55	$0.00	$0.00	$0.00	$0.00	$16.42	$26.01	$26.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19703	ERX	HCPCS 63700001	00065-0246-10	BETAXOLOL HCL 0.25 % OP SUSP	BOTH IP/OP	"$1,088.11 "	$805.20	$0.00	$790.00		$0.00	$0.00	$0.00	$193.68	$0.00	$0.00	$0.00	$0.00	$0.00	$226.76	$0.00	$0.00	$0.00	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19704	ERX	HCPCS 25000001	00065-0023-15	CARBACHOL 0.01 % IO SOLN	BOTH IP/OP	$173.75 	$128.58	$0.00	$140.64		$0.00	$0.00	$0.00	$0.00	$0.00	$135.42	$135.42	$140.64	$0.00	$36.21	$0.00	$0.00	$0.00	$0.00	$76.49	$121.15	$122.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19711	ERX	HCPCS 25000001	00168-0203-60	CLINDAMYCIN PHOSPHATE 1 % EX LOTN	BOTH IP/OP	$403.81 	$298.82	$0.00	$311.26		$0.00	$0.00	$0.00	$0.00	$0.00	$299.71	$299.71	$311.26	$0.00	$84.15	$0.00	$0.00	$0.00	$0.00	$183.28	$290.31	$293.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19711	ERX	HCPCS 25000001	59762-3744-01	CLINDAMYCIN PHOSPHATE 1 % EX LOTN	BOTH IP/OP	$403.81 	$298.82	$0.00	$311.26		$0.00	$0.00	$0.00	$0.00	$0.00	$299.71	$299.71	$311.26	$0.00	$84.15	$0.00	$0.00	$0.00	$0.00	$183.28	$290.31	$293.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19713	ERX	HCPCS j1730	00575-6200-30	DIAZOXIDE 50 MG/ML PO SUSP	BOTH IP/OP	"$1,320.31 "	$977.03	$0.00	"$1,017.69"		$0.00	$0.00	$0.00	$0.00	$0.00	$979.93	$979.93	"$1,017.69"	$0.00	$275.15	$0.00	$0.00	$0.00	$0.00	$547.60	$867.40	$876.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19714	ERX	HCPCS 25000001	17478-0892-25	DICLOFENAC SODIUM 0.1 % OP SOLN	BOTH IP/OP	$253.42 	$187.53	$0.00	$195.34		$0.00	$0.00	$0.00	$0.00	$0.00	$188.09	$188.09	$195.34	$0.00	$52.81	$0.00	$0.00	$0.00	$0.00	$78.35	$124.11	$125.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19714	ERX	HCPCS 25000001	61314-0014-25	DICLOFENAC SODIUM 0.1 % OP SOLN	BOTH IP/OP	$253.42 	$187.53	$0.00	$195.34		$0.00	$0.00	$0.00	$0.00	$0.00	$188.09	$188.09	$195.34	$0.00	$52.81	$0.00	$0.00	$0.00	$0.00	$78.35	$124.11	$125.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19714	ERX	HCPCS 25000001	61314-0014-05	DICLOFENAC SODIUM 0.1 % OP SOLN	BOTH IP/OP	$253.42 	$187.53	$0.00	$195.34		$0.00	$0.00	$0.00	$0.00	$0.00	$188.09	$188.09	$195.34	$0.00	$52.81	$0.00	$0.00	$0.00	$0.00	$78.35	$182.20	$125.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19732	ERX	HCPCS 25000001	00037-6830-15	HYDROCORTISONE ACETATE 10 % EX FOAM	BOTH IP/OP	"$1,395.30 "	"$1,032.52"	$0.00	"$1,075.50"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.59"	"$1,035.59"	"$1,075.50"	$0.00	$290.78	$0.00	$0.00	$0.00	$0.00	$633.14	"$1,002.89"	"$1,013.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19733	ERX	HCPCS 25000001	17478-0209-10	KETOROLAC TROMETHAMINE 0.5 % OP SOLN	BOTH IP/OP	$359.09 	$265.73	$0.00	$445.20		$0.00	$0.00	$0.00	$0.00	$0.00	$266.52	$266.52	$276.79	$0.00	$74.83	$0.00	$0.00	$0.00	$0.00	$278.25	$258.16	$445.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19733	ERX	HCPCS 25000001	60505-1003-01	KETOROLAC TROMETHAMINE 0.5 % OP SOLN	BOTH IP/OP	$359.09 	$265.73	$0.00	$445.20		$0.00	$0.00	$0.00	$0.00	$0.00	$266.52	$266.52	$276.79	$0.00	$74.83	$0.00	$0.00	$0.00	$0.00	$278.25	$258.16	$445.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19733	ERX	HCPCS 25000001	61314-0126-05	KETOROLAC TROMETHAMINE 0.5 % OP SOLN	BOTH IP/OP	$359.09 	$265.73	$0.00	$445.20		$0.00	$0.00	$0.00	$0.00	$0.00	$266.52	$266.52	$276.79	$0.00	$74.83	$0.00	$0.00	$0.00	$0.00	$278.25	$258.16	$445.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19733	ERX	HCPCS 25000001	61314-0126-10	KETOROLAC TROMETHAMINE 0.5 % OP SOLN	BOTH IP/OP	$359.09 	$265.73	$0.00	$445.20		$0.00	$0.00	$0.00	$0.00	$0.00	$266.52	$266.52	$276.79	$0.00	$74.83	$0.00	$0.00	$0.00	$0.00	$278.25	$440.75	$445.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19736	ERX	HCPCS J1050	00009-0746-30	MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP	BOTH IP/OP	$187.38 	$138.66	$0.00	$246.58	$84.32	$84.32	$0.00	$0.00	$0.00	$39.05	$139.07	$139.07	$144.43	$0.00	$100.64	$0.00	$110.84	$110.84	$0.00	$154.12	$244.12	$246.58	$0.00		$0.00	$98.70	$0.00	$0.00	$93.98	$0.00	$0.00	$0.00	$0.00	$0.00
19736	ERX	HCPCS J1050	00009-0746-35	MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP	BOTH IP/OP	$187.38 	$138.66	$0.00	$246.58	$84.32	$84.32	$0.00	$0.00	$0.00	$39.05	$139.07	$139.07	$144.43	$0.00	$100.64	$0.00	$110.84	$110.84	$0.00	$154.12	$244.12	$246.58	$0.00		$0.00	$98.70	$0.00	$0.00	$93.98	$0.00	$0.00	$0.00	$0.00	$0.00
19736	ERX	HCPCS J1050	00548-5400-00	MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP	BOTH IP/OP	$187.38 	$138.66	$0.00	$246.58	$84.32	$84.32	$0.00	$0.00	$0.00	$39.05	$139.07	$139.07	$144.43	$0.00	$100.64	$0.00	$110.84	$110.84	$0.00	$154.12	$244.12	$246.58	$0.00		$0.00	$98.70	$0.00	$0.00	$93.98	$0.00	$0.00	$0.00	$0.00	$0.00
19736	ERX	HCPCS J1050	00703-6801-01	MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP	BOTH IP/OP	$187.38 	$138.66	$0.00	$246.58	$84.32	$84.32	$0.00	$0.00	$0.00	$39.05	$139.07	$139.07	$144.43	$0.00	$100.64	$0.00	$110.84	$110.84	$0.00	$154.12	$244.12	$246.58	$0.00		$0.00	$98.70	$0.00	$0.00	$93.98	$0.00	$0.00	$0.00	$0.00	$0.00
19736	ERX	HCPCS J1050	59762-4537-01	MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP	BOTH IP/OP	$187.38 	$138.66	$0.00	$246.58	$84.32	$84.32	$0.00	$0.00	$0.00	$39.05	$139.07	$139.07	$144.43	$0.00	$100.64	$0.00	$110.84	$110.84	$0.00	$154.12	$244.12	$246.58	$0.00		$0.00	$98.70	$0.00	$0.00	$93.98	$0.00	$0.00	$0.00	$0.00	$0.00
19736	ERX	HCPCS J1050	59762-4537-02	MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP	BOTH IP/OP	$187.38 	$138.66	$0.00	$246.58	$84.32	$84.32	$0.00	$0.00	$0.00	$39.05	$139.07	$139.07	$144.43	$0.00	$100.64	$0.00	$110.84	$110.84	$0.00	$154.12	$244.12	$246.58	$0.00		$0.00	$98.70	$0.00	$0.00	$93.98	$0.00	$0.00	$0.00	$0.00	$0.00
19736	ERX	HCPCS J1050	67457-0887-00	MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP	BOTH IP/OP	$187.38 	$138.66	$0.00	$246.58	$84.32	$84.32	$0.00	$0.00	$0.00	$39.05	$139.07	$139.07	$144.43	$0.00	$100.64	$0.00	$110.84	$110.84	$0.00	$154.12	$244.12	$246.58	$0.00		$0.00	$98.70	$0.00	$0.00	$93.98	$0.00	$0.00	$0.00	$0.00	$0.00
19736	ERX	HCPCS J1050	67457-0887-99	MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP	BOTH IP/OP	$187.38 	$138.66	$0.00	$246.58	$84.32	$84.32	$0.00	$0.00	$0.00	$39.05	$139.07	$139.07	$144.43	$0.00	$100.64	$0.00	$110.84	$110.84	$0.00	$154.12	$244.12	$246.58	$0.00		$0.00	$98.70	$0.00	$0.00	$93.98	$0.00	$0.00	$0.00	$0.00	$0.00
19741	ERX	HCPCS 63700001	00115-1474-46	METRONIDAZOLE 0.75 % EX GEL	BOTH IP/OP	$932.55 	$690.09	$0.00	$677.06		$0.00	$0.00	$0.00	$165.99	$0.00	$0.00	$0.00	$0.00	$0.00	$194.34	$0.00	$0.00	$0.00	$0.00	$423.16	$670.29	$677.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19741	ERX	HCPCS 63700001	00168-0275-45	METRONIDAZOLE 0.75 % EX GEL	BOTH IP/OP	$932.55 	$690.09	$0.00	$677.06		$0.00	$0.00	$0.00	$165.99	$0.00	$0.00	$0.00	$0.00	$0.00	$194.34	$0.00	$0.00	$0.00	$0.00	$423.16	$670.29	$677.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19741	ERX	HCPCS 63700001	51672-4116-06	METRONIDAZOLE 0.75 % EX GEL	BOTH IP/OP	$932.55 	$690.09	$0.00	$677.06		$0.00	$0.00	$0.00	$165.99	$0.00	$0.00	$0.00	$0.00	$0.00	$194.34	$0.00	$0.00	$0.00	$0.00	$423.16	$670.29	$677.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19741	ERX	HCPCS 63700001	66993-0962-45	METRONIDAZOLE 0.75 % EX GEL	BOTH IP/OP	$932.55 	$690.09	$0.00	$677.06		$0.00	$0.00	$0.00	$165.99	$0.00	$0.00	$0.00	$0.00	$0.00	$194.34	$0.00	$0.00	$0.00	$0.00	$423.16	$670.29	$677.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19743	ERX	HCPCS 63700001	00378-7272-53	"MICRONOR, JOLIVETTE, NORETHINDRONE 0.35 MG TAB PO"	BOTH IP/OP	$206.48 	$152.80	$0.00	$165.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.24	$163.53	$165.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19743	ERX	HCPCS 63700001	00378-7272-85	"MICRONOR, JOLIVETTE, NORETHINDRONE 0.35 MG TAB PO"	BOTH IP/OP	$206.48 	$152.80	$0.00	$165.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.24	$163.53	$165.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19743	ERX	HCPCS 63700001	50458-0194-06	"MICRONOR, JOLIVETTE, NORETHINDRONE 0.35 MG TAB PO"	BOTH IP/OP	$206.48 	$152.80	$0.00	$165.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.24	$163.53	$165.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19769	ERX	HCPCS 25000001	00065-0644-35	TOBRAMYCIN 0.3 % OP OINT	BOTH IP/OP	$751.11 	$555.82	$0.00	$578.96		$0.00	$0.00	$0.00	$0.00	$0.00	$557.47	$557.47	$578.96	$0.00	$156.53	$0.00	$0.00	$0.00	$0.00	$340.83	$539.87	$545.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19776	ERX	HCPCS 25000001	00536-1109-45	UREA 20 % EX CREA	BOTH IP/OP	$60.91 	$45.07	$0.00	$46.95		$0.00	$0.00	$0.00	$0.00	$0.00	$45.21	$45.21	$46.95	$0.00	$12.69	$0.00	$0.00	$0.00	$0.00	$27.62	$43.75	$44.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19791	ERX	HCPCS 63700001	00065-0411-30	POVIDONE-IODINE 5 % OP SOLN	BOTH IP/OP	$72.16 	$53.40	$0.00	$50.80		$0.00	$0.00	$0.00	$13.47	$0.00	$0.00	$0.00	$0.00	$0.00	$15.04	$0.00	$0.00	$0.00	$0.00	$31.75	$50.29	$50.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19805	ERX	HCPCS 63700001	00168-0323-46	METRONIDAZOLE 0.75 % EX CREA	BOTH IP/OP	"$1,943.71 "	"$1,438.35"	$0.00	"$1,440.90"		$0.00	$0.00	$0.00	$345.98	$0.00	$0.00	$0.00	$0.00	$0.00	$405.07	$0.00	$0.00	$0.00	$0.00	$900.56	"$1,426.49"	"$1,440.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19805	ERX	HCPCS 63700001	00299-3836-45	METRONIDAZOLE 0.75 % EX CREA	BOTH IP/OP	"$1,943.71 "	"$1,438.35"	$0.00	"$1,440.90"		$0.00	$0.00	$0.00	$345.98	$0.00	$0.00	$0.00	$0.00	$0.00	$405.07	$0.00	$0.00	$0.00	$0.00	$900.56	"$1,426.49"	"$1,440.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19805	ERX	HCPCS 63700001	00713-0633-37	METRONIDAZOLE 0.75 % EX CREA	BOTH IP/OP	"$1,943.71 "	"$1,438.35"	$0.00	"$1,440.90"		$0.00	$0.00	$0.00	$345.98	$0.00	$0.00	$0.00	$0.00	$0.00	$405.07	$0.00	$0.00	$0.00	$0.00	$900.56	"$1,426.49"	"$1,440.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19805	ERX	HCPCS 63700001	66993-0960-45	METRONIDAZOLE 0.75 % EX CREA	BOTH IP/OP	"$1,943.71 "	"$1,438.35"	$0.00	"$1,440.90"		$0.00	$0.00	$0.00	$345.98	$0.00	$0.00	$0.00	$0.00	$0.00	$405.07	$0.00	$0.00	$0.00	$0.00	$900.56	"$1,426.49"	"$1,440.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19813	ERX	HCPCS J7195	70504-0270-01	COAGULATION FACTOR IX (RECOMB IXINITY) 500 UNITS IV SOLR	BOTH IP/OP	"$2,384.30 "	"$1,764.38"	$0.00	"$1,837.82"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,769.63"	"$1,769.63"	"$1,837.82"	$0.00	$496.89	$0.00	$0.00	$0.00	$0.00	"$1,081.38"	"$1,712.90"	"$1,730.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19813	ERX	HCPCS J7195	70504-0282-05	COAGULATION FACTOR IX (RECOMB IXINITY) 500 UNITS IV SOLR	BOTH IP/OP	"$2,384.30 "	"$1,764.38"	$0.00	"$1,837.82"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,769.63"	"$1,769.63"	"$1,837.82"	$0.00	$496.89	$0.00	$0.00	$0.00	$0.00	"$1,081.38"	"$1,712.90"	"$1,730.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19814	ERX	HCPCS J7195	70504-0271-01	COAGULATION FACTOR IX (RECOMB IXINITY) 1000 UNITS IV SOLR	BOTH IP/OP	"$4,768.60 "	"$3,528.76"	$0.00	"$3,675.64"		$0.00	$0.00	$0.00	$0.00	$0.00	"$3,539.25"	"$3,539.25"	"$3,675.64"	$0.00	$993.78	$0.00	$0.00	$0.00	$0.00	"$2,162.75"	"$3,425.80"	"$3,460.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19814	ERX	HCPCS J7195	70504-0283-05	COAGULATION FACTOR IX (RECOMB IXINITY) 1000 UNITS IV SOLR	BOTH IP/OP	"$4,768.60 "	"$3,528.76"	$0.00	"$3,675.64"		$0.00	$0.00	$0.00	$0.00	$0.00	"$3,539.25"	"$3,539.25"	"$3,675.64"	$0.00	$993.78	$0.00	$0.00	$0.00	$0.00	"$2,162.75"	"$3,425.80"	"$3,460.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19882	ERX	HCPCS 63700001	16714-0611-01	SERTRALINE HCL 25 MG PO TABS	BOTH IP/OP	$11.94 	$8.84	$0.00	$8.66		$0.00	$0.00	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$2.49	$0.00	$0.00	$0.00	$0.00	$5.42	$8.58	$8.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19882	ERX	HCPCS 63700001	16714-0611-04	SERTRALINE HCL 25 MG PO TABS	BOTH IP/OP	$11.94 	$8.84	$0.00	$8.66		$0.00	$0.00	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$2.49	$0.00	$0.00	$0.00	$0.00	$5.42	$8.58	$8.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19882	ERX	HCPCS 63700001	60687-0231-01	SERTRALINE HCL 25 MG PO TABS	BOTH IP/OP	$11.94 	$8.84	$0.00	$8.66		$0.00	$0.00	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$2.49	$0.00	$0.00	$0.00	$0.00	$5.42	$8.58	$8.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19882	ERX	HCPCS 63700001	60687-0231-11	SERTRALINE HCL 25 MG PO TABS	BOTH IP/OP	$11.94 	$8.84	$0.00	$8.66		$0.00	$0.00	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$2.49	$0.00	$0.00	$0.00	$0.00	$5.42	$8.58	$8.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19882	ERX	HCPCS 63700001	76282-0212-18	SERTRALINE HCL 25 MG PO TABS	BOTH IP/OP	$11.94 	$8.84	$0.00	$8.66		$0.00	$0.00	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$2.49	$0.00	$0.00	$0.00	$0.00	$5.42	$8.58	$8.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19898	ERX	HCPCS J9214	00085-1133-01	INTERFERON ALFA-2B 10000000 UNIT/ML IJ SOLN	BOTH IP/OP	$982.82 	$727.29	$0.00	$786.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$491.41	$778.39	$786.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19928	ERX	HCPCS 63700001	65162-0087-74	ITRACONAZOLE 10 MG/ML ORAL SOLUTION	BOTH IP/OP	$182.66 	$135.17	$0.00	$132.50		$0.00	$0.00	$0.00	$32.51	$0.00	$0.00	$0.00	$0.00	$0.00	$38.07	$0.00	$0.00	$0.00	$0.00	$82.81	$131.17	$132.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19928	ERX	HCPCS 63700001	99999-6009-61	ITRACONAZOLE 10 MG/ML ORAL SOLUTION	BOTH IP/OP	$182.66 	$135.17	$0.00	$132.50		$0.00	$0.00	$0.00	$32.51	$0.00	$0.00	$0.00	$0.00	$0.00	$38.07	$0.00	$0.00	$0.00	$0.00	$82.81	$131.17	$132.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20032	ERX	HCPCS 63700001	63010-0010-30	NELFINAVIR MESYLATE 250 MG PO TABS	BOTH IP/OP	$93.73 	$69.36	$0.00	$67.98		$0.00	$0.00	$0.00	$16.68	$0.00	$0.00	$0.00	$0.00	$0.00	$19.53	$0.00	$0.00	$0.00	$0.00	$42.49	$67.30	$67.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20039	ERX	HCPCS 25000001	00173-0523-00	SUMATRIPTAN 20 MG/ACT NA SOLN	BOTH IP/OP	$359.18 	$265.79	$0.00	$276.86		$0.00	$0.00	$0.00	$0.00	$0.00	$266.58	$266.58	$276.86	$0.00	$74.85	$0.00	$0.00	$0.00	$0.00	$153.66	$243.40	$245.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20077	ERX	HCPCS 63700001	67108-3565-09	MESNA 400 MG PO TABS	BOTH IP/OP	$633.76 	$468.98	$0.00	$460.23		$0.00	$0.00	$0.00	$112.81	$0.00	$0.00	$0.00	$0.00	$0.00	$132.08	$0.00	$0.00	$0.00	$0.00	$287.65	$455.63	$460.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20103	ERX	HCPCS 25000001	92771-0810-16	LUBRISKIN EX LOTN	BOTH IP/OP	$12.56 	$9.29	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.95	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20103	ERX	HCPCS 25000001	92771-0810-08	LUBRISKIN EX LOTN	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.71	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20140	ERX	HCPCS 63700001	54162-0500-02	HYDROPHOR EX OINT	BOTH IP/OP	$46.59 	$34.48	$0.00	$37.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.30	$36.90	$37.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20140	ERX	HCPCS 63700001	54162-0500-01	HYDROPHOR EX OINT	BOTH IP/OP	$46.59 	$34.48	$0.00	$37.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.30	$36.90	$37.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20140	ERX	HCPCS 63700001	10356-0101-10	HYDROPHOR EX OINT	BOTH IP/OP	$46.59 	$34.48	$0.00	$37.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.30	$36.90	$37.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20156	ERX	HCPCS J9100	61703-0319-22	CYTARABINE (PF) 100 MG/ML IJ SOLN	BOTH IP/OP	$87.78 	$64.96	$0.00	$70.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.89	$69.52	$70.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20156	ERX	HCPCS J9100	63323-0120-20	CYTARABINE (PF) 100 MG/ML IJ SOLN	BOTH IP/OP	$87.78 	$64.96	$0.00	$70.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.89	$69.52	$70.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20156	ERX	HCPCS J9100	67457-0452-20	CYTARABINE (PF) 100 MG/ML IJ SOLN	BOTH IP/OP	$87.78 	$64.96	$0.00	$70.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.89	$69.52	$70.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20330	ERX	HCPCS 25000001	00023-8335-03	TAZAROTENE 0.05 % EX GEL	BOTH IP/OP	"$1,205.14 "	$891.80	$0.00	$964.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$602.57	$954.47	$964.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20446	ERX	HCPCS 63700001	00172-5241-60	ANAGRELIDE HCL 0.5 MG PO CAPS	BOTH IP/OP	$41.58 	$30.77	$0.00	$30.17		$0.00	$0.00	$0.00	$7.40	$0.00	$0.00	$0.00	$0.00	$0.00	$8.67	$0.00	$0.00	$0.00	$0.00	$18.86	$29.87	$30.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20446	ERX	HCPCS 63700001	54092-0063-01	ANAGRELIDE HCL 0.5 MG PO CAPS	BOTH IP/OP	$41.58 	$30.77	$0.00	$30.17		$0.00	$0.00	$0.00	$7.40	$0.00	$0.00	$0.00	$0.00	$0.00	$8.67	$0.00	$0.00	$0.00	$0.00	$18.86	$29.87	$30.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20447	ERX	HCPCS 63700001	00172-5240-60	ANAGRELIDE HCL 1 MG PO CAPS	BOTH IP/OP	$92.91 	$68.75	$0.00	$67.40		$0.00	$0.00	$0.00	$16.54	$0.00	$0.00	$0.00	$0.00	$0.00	$19.36	$0.00	$0.00	$0.00	$0.00	$42.13	$66.73	$67.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20472	ERX	HCPCS 25000001	00143-9310-10	ETOMIDATE 2 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20472	ERX	HCPCS 25000001	00143-9506-10	ETOMIDATE 2 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20472	ERX	HCPCS 25000001	55150-0221-10	ETOMIDATE 2 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20472	ERX	HCPCS 25000001	55150-0222-20	ETOMIDATE 2 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20472	ERX	HCPCS 25000001	68382-0545-07	ETOMIDATE 2 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20472	ERX	HCPCS 25000001	72266-0146-10	ETOMIDATE 2 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20566	ERX	HCPCS 63700001	50268-0525-15	MELOXICAM 7.5 MG PO TABS	BOTH IP/OP	$12.99 	$9.61	$0.00	$9.42		$0.00	$0.00	$0.00	$2.31	$0.00	$0.00	$0.00	$0.00	$0.00	$2.71	$0.00	$0.00	$0.00	$0.00	$5.89	$9.33	$9.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20566	ERX	HCPCS 63700001	68382-0050-01	MELOXICAM 7.5 MG PO TABS	BOTH IP/OP	$12.99 	$9.61	$0.00	$9.42		$0.00	$0.00	$0.00	$2.31	$0.00	$0.00	$0.00	$0.00	$0.00	$2.71	$0.00	$0.00	$0.00	$0.00	$5.89	$9.33	$9.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20580	ERX	HCPCS 63700001	50268-0526-15	MELOXICAM 15 MG PO TABS	BOTH IP/OP	$19.54 	$14.46	$0.00	$14.18		$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$8.86	$14.03	$14.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20580	ERX	HCPCS 63700001	68382-0051-01	MELOXICAM 15 MG PO TABS	BOTH IP/OP	$19.54 	$14.46	$0.00	$14.18		$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$8.86	$14.03	$14.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20638	ERX	HCPCS 63700001	00555-9045-58	"FALMINA,ORSYTHIA,LEVONORG-ETHINYL ESTRAD 0.1/0.02MG TAB"	BOTH IP/OP	$123.09 	$91.09	$0.00	$98.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.55	$97.49	$98.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20638	ERX	HCPCS 63700001	16714-0359-04	"FALMINA,ORSYTHIA,LEVONORG-ETHINYL ESTRAD 0.1/0.02MG TAB"	BOTH IP/OP	$123.09 	$91.09	$0.00	$98.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.55	$97.49	$98.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20718	ERX	HCPCS 63700001	68462-0536-70	IMIQUIMOD 5 % EX CREA	BOTH IP/OP	$140.20 	$103.75	$0.00	$101.70		$0.00	$0.00	$0.00	$24.96	$0.00	$0.00	$0.00	$0.00	$0.00	$29.22	$0.00	$0.00	$0.00	$0.00	$63.56	$100.68	$101.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	00069-3060-75	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	00781-5776-69	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	00904-6708-06	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	50111-0787-10	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	50111-0787-51	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	50268-0098-15	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	51224-0022-30	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	59762-2198-01	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	59762-2198-03	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	59762-2198-07	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	60687-0282-01	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	65862-0641-63	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20943	ERX	HCPCS 63700001	65862-0641-69	AZITHROMYCIN 250 MG PO TABS	BOTH IP/OP	$16.02 	$11.85	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20954	ERX	HCPCS J1955	54482-0147-01	LEVOCARNITINE 200 MG/ML IV SOLN	BOTH IP/OP	$157.72 	$116.71	$0.00	$121.57		$0.00	$0.00	$0.00	$0.00	$0.00	$117.06	$117.06	$121.57	$0.00	$24.74	$0.00	$0.00	$0.00	$0.00	$69.56	$110.18	$111.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21044	ERX	HCPCS J1950	00074-3663-03	LEUPROLIDE ACETATE (3 MONTH) 11.25 MG IM KIT	BOTH IP/OP	"$12,067.34 "	"$8,929.83"	$0.00	"$9,757.29"	"$5,696.39"	"$5,696.39"	"$4,098.03"	"$4,098.03"	"$4,098.03"	"$1,647.37"	"$9,395.25"	"$9,395.25"	"$9,757.29"	"$4,219.10"	"$4,957.44"	"$2,742.41"	"$5,949.20"	"$5,949.20"	"$3,998.07"	"$5,153.51"	"$8,163.16"	"$8,245.62"	"$5,521.14"		"$5,521.14"	"$4,480.63"	$0.00	$0.00	"$4,266.32"	"$3,733.01"	$0.00	$0.00	$0.00	$0.00
21045	ERX	HCPCS J9217	00074-3346-03	LEUPROLIDE ACETATE (3 MONTH) 22.5 MG IM KIT	BOTH IP/OP	"$14,379.96 "	"$10,641.17"	$0.00	"$11,627.18"	"$6,788.05"	"$6,788.05"	$602.20	$602.20	$602.20	$740.50	"$11,195.76"	"$11,195.76"	"$11,627.18"	$417.27	$490.29	$271.23	"$7,089.32"	"$7,089.32"	$707.80	"$6,141.14"	"$9,727.56"	"$9,825.82"	$977.44		$977.44	$811.00	$0.00	$0.00	$772.21	$617.66	$0.00	$0.00	$0.00	$0.00
21057	ERX	HCPCS 63700001	00904-6283-61	OLANZAPINE 2.5 MG PO TABS	BOTH IP/OP	$46.92 	$34.72	$0.00	$34.04		$0.00	$0.00	$0.00	$8.35	$0.00	$0.00	$0.00	$0.00	$0.00	$9.78	$0.00	$0.00	$0.00	$0.00	$21.28	$33.70	$34.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21057	ERX	HCPCS 63700001	60505-3110-00	OLANZAPINE 2.5 MG PO TABS	BOTH IP/OP	$46.92 	$34.72	$0.00	$34.04		$0.00	$0.00	$0.00	$8.35	$0.00	$0.00	$0.00	$0.00	$0.00	$9.78	$0.00	$0.00	$0.00	$0.00	$21.28	$33.70	$34.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21057	ERX	HCPCS 63700001	68084-0525-01	OLANZAPINE 2.5 MG PO TABS	BOTH IP/OP	$46.92 	$34.72	$0.00	$34.04		$0.00	$0.00	$0.00	$8.35	$0.00	$0.00	$0.00	$0.00	$0.00	$9.78	$0.00	$0.00	$0.00	$0.00	$21.28	$33.70	$34.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21061	ERX	HCPCS 63700001	62756-0184-13	OXCARBAZEPINE 300 MG PO TABS	BOTH IP/OP	$10.60 	$7.84	$0.00	$8.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$8.40	$8.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21061	ERX	HCPCS 63700001	62756-0184-88	OXCARBAZEPINE 300 MG PO TABS	BOTH IP/OP	$10.60 	$7.84	$0.00	$8.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$8.40	$8.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21061	ERX	HCPCS 63700001	68084-0853-01	OXCARBAZEPINE 300 MG PO TABS	BOTH IP/OP	$10.60 	$7.84	$0.00	$8.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$8.40	$8.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21062	ERX	HCPCS 63700001	00904-6085-61	CITALOPRAM HYDROBROMIDE 20 MG PO TABS	BOTH IP/OP	$11.29 	$8.35	$0.00	$8.19		$0.00	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$0.00	$2.35	$0.00	$0.00	$0.00	$0.00	$5.12	$8.11	$8.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21062	ERX	HCPCS 63700001	13668-0010-01	CITALOPRAM HYDROBROMIDE 20 MG PO TABS	BOTH IP/OP	$11.29 	$8.35	$0.00	$8.19		$0.00	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$0.00	$2.35	$0.00	$0.00	$0.00	$0.00	$5.12	$8.11	$8.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21062	ERX	HCPCS 63700001	55111-0343-30	CITALOPRAM HYDROBROMIDE 20 MG PO TABS	BOTH IP/OP	$11.29 	$8.35	$0.00	$8.19		$0.00	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$0.00	$2.35	$0.00	$0.00	$0.00	$0.00	$5.12	$8.11	$8.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21062	ERX	HCPCS 63700001	57664-0508-88	CITALOPRAM HYDROBROMIDE 20 MG PO TABS	BOTH IP/OP	$11.29 	$8.35	$0.00	$8.19		$0.00	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$0.00	$2.35	$0.00	$0.00	$0.00	$0.00	$5.12	$8.11	$8.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21062	ERX	HCPCS 63700001	68084-0744-01	CITALOPRAM HYDROBROMIDE 20 MG PO TABS	BOTH IP/OP	$11.29 	$8.35	$0.00	$8.19		$0.00	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$0.00	$2.35	$0.00	$0.00	$0.00	$0.00	$5.12	$8.11	$8.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21063	ERX	HCPCS J0456	00069-3150-83	AZITHROMYCIN 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$21.89	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$4.28	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00
21063	ERX	HCPCS J0456	55150-0174-10	AZITHROMYCIN 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$21.89	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$4.28	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00
21063	ERX	HCPCS J0456	63323-0398-10	AZITHROMYCIN 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$21.89	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$4.28	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00
21063	ERX	HCPCS J0456	63323-0398-12	AZITHROMYCIN 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$21.89	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$4.28	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00
21063	ERX	HCPCS J0456	67457-0860-50	AZITHROMYCIN 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$21.89	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$4.28	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00
21063	ERX	HCPCS J0456	70860-0100-10	AZITHROMYCIN 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$21.89	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$4.28	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00
21063	ERX	HCPCS J0456	70860-0100-41	AZITHROMYCIN 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$21.89	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$4.28	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00
21063	ERX	HCPCS J0456	70860-0125-66	AZITHROMYCIN 500 MG IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$21.89	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$4.28	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00
21064	ERX	HCPCS 25000001	00904-6488-38	LUBRIFRESH P.M. OP OINT	BOTH IP/OP	$18.85 	$13.95	$0.00	$15.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.43	$14.93	$15.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21108	ERX	HCPCS J9217	00074-3683-03	LEUPROLIDE ACETATE (4 MONTH) 30 MG IM KIT	BOTH IP/OP	"$19,173.30 "	"$14,188.24"	$0.00	"$15,502.93"	"$9,050.75"	"$9,050.75"	$802.93	$802.93	$802.93	$987.33	"$14,927.71"	"$14,927.71"	"$15,502.93"	$556.36	$653.72	$361.63	"$9,452.44"	"$9,452.44"	$943.73	"$8,188.19"	"$12,970.09"	"$13,101.10"	"$1,303.25"		"$1,303.25"	"$1,081.33"	$0.00	$0.00	"$1,029.61"	$823.54	$0.00	$0.00	$0.00	$0.00
21135	ERX	HCPCS 25000001	47335-0788-91	DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN	BOTH IP/OP	$719.05 	$532.10	$0.00	$554.24		$0.00	$0.00	$0.00	$0.00	$0.00	$533.68	$533.68	$554.24	$0.00	$149.85	$0.00	$0.00	$0.00	$0.00	$326.29	$516.84	$522.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21135	ERX	HCPCS 25000001	68382-0384-01	DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN	BOTH IP/OP	$719.05 	$532.10	$0.00	$554.24		$0.00	$0.00	$0.00	$0.00	$0.00	$533.68	$533.68	$554.24	$0.00	$149.85	$0.00	$0.00	$0.00	$0.00	$326.29	$516.84	$522.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21135	ERX	HCPCS 25000001	69918-0501-05	DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN	BOTH IP/OP	$719.05 	$532.10	$0.00	$554.24		$0.00	$0.00	$0.00	$0.00	$0.00	$533.68	$533.68	$554.24	$0.00	$149.85	$0.00	$0.00	$0.00	$0.00	$326.29	$516.84	$522.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21157	ERX	HCPCS 63700001	62756-0185-88	OXCARBAZEPINE 600 MG PO TABS	BOTH IP/OP	$21.22 	$15.70	$0.00	$15.39		$0.00	$0.00	$0.00	$3.78	$0.00	$0.00	$0.00	$0.00	$0.00	$4.42	$0.00	$0.00	$0.00	$0.00	$9.62	$15.24	$15.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21157	ERX	HCPCS 63700001	68084-0867-01	OXCARBAZEPINE 600 MG PO TABS	BOTH IP/OP	$21.22 	$15.70	$0.00	$15.39		$0.00	$0.00	$0.00	$3.78	$0.00	$0.00	$0.00	$0.00	$0.00	$4.42	$0.00	$0.00	$0.00	$0.00	$9.62	$15.24	$15.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21157	ERX	HCPCS 63700001	68084-0867-11	OXCARBAZEPINE 600 MG PO TABS	BOTH IP/OP	$21.22 	$15.70	$0.00	$15.39		$0.00	$0.00	$0.00	$3.78	$0.00	$0.00	$0.00	$0.00	$0.00	$4.42	$0.00	$0.00	$0.00	$0.00	$9.62	$15.24	$15.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21284	ERX	HCPCS 63700001	13107-0068-01	AMPHETAMINE-DEXTROAMPHETAMINE 5 MG PO TABS	BOTH IP/OP	$7.19 	$5.32	$0.00	$5.22		$0.00	$0.00	$0.00	$1.28	$0.00	$0.00	$0.00	$0.00	$0.00	$1.50	$0.00	$0.00	$0.00	$0.00	$3.26	$5.16	$5.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21284	ERX	HCPCS 63700001	42806-0339-01	AMPHETAMINE-DEXTROAMPHETAMINE 5 MG PO TABS	BOTH IP/OP	$7.19 	$5.32	$0.00	$5.22		$0.00	$0.00	$0.00	$1.28	$0.00	$0.00	$0.00	$0.00	$0.00	$1.50	$0.00	$0.00	$0.00	$0.00	$3.26	$5.16	$5.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21285	ERX	HCPCS J0795	55566-0302-01	CORTICORELIN OVINE TRIFLUTATE 100 MCG IV SOLR	BOTH IP/OP	"$2,244.90 "	"$1,661.23"	$0.00	"$1,795.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,122.45"	"$1,777.96"	"$1,795.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21287	ERX	HCPCS 63700001	00597-0183-90	PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS	BOTH IP/OP	$32.02 	$23.69	$0.00	$25.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.01	$25.36	$25.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21287	ERX	HCPCS 63700001	33342-0031-10	PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS	BOTH IP/OP	$32.02 	$23.69	$0.00	$25.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.01	$25.36	$25.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21287	ERX	HCPCS 63700001	68382-0196-16	PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS	BOTH IP/OP	$32.02 	$23.69	$0.00	$25.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.01	$25.36	$25.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21287	ERX	HCPCS 63700001	68462-0330-90	PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS	BOTH IP/OP	$32.02 	$23.69	$0.00	$25.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.01	$25.36	$25.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21288	ERX	HCPCS 63700001	33342-0034-10	PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS	BOTH IP/OP	$33.62 	$24.88	$0.00	$26.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.81	$26.63	$26.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21288	ERX	HCPCS 63700001	68382-0199-16	PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS	BOTH IP/OP	$33.62 	$24.88	$0.00	$26.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.81	$26.63	$26.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21288	ERX	HCPCS 63700001	68462-0333-90	PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS	BOTH IP/OP	$33.62 	$24.88	$0.00	$26.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.81	$26.63	$26.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21289	ERX	HCPCS 63700001	00781-5252-92	PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS	BOTH IP/OP	$11.21 	$8.30	$0.00	$8.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.61	$8.88	$8.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21289	ERX	HCPCS 63700001	33342-0035-10	PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS	BOTH IP/OP	$11.21 	$8.30	$0.00	$8.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.61	$8.88	$8.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21289	ERX	HCPCS 63700001	68382-0200-16	PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS	BOTH IP/OP	$11.21 	$8.30	$0.00	$8.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.61	$8.88	$8.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21289	ERX	HCPCS 63700001	68462-0334-90	PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS	BOTH IP/OP	$11.21 	$8.30	$0.00	$8.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.61	$8.88	$8.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21290	ERX	HCPCS 63700001	13668-0092-90	PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS	BOTH IP/OP	$13.58 	$10.05	$0.00	$9.86		$0.00	$0.00	$0.00	$2.42	$0.00	$0.00	$0.00	$0.00	$0.00	$2.83	$0.00	$0.00	$0.00	$0.00	$6.16	$9.76	$9.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21290	ERX	HCPCS 63700001	33342-0032-10	PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS	BOTH IP/OP	$13.58 	$10.05	$0.00	$9.86		$0.00	$0.00	$0.00	$2.42	$0.00	$0.00	$0.00	$0.00	$0.00	$2.83	$0.00	$0.00	$0.00	$0.00	$6.16	$9.76	$9.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21290	ERX	HCPCS 63700001	68382-0197-16	PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS	BOTH IP/OP	$13.58 	$10.05	$0.00	$9.86		$0.00	$0.00	$0.00	$2.42	$0.00	$0.00	$0.00	$0.00	$0.00	$2.83	$0.00	$0.00	$0.00	$0.00	$6.16	$9.76	$9.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21290	ERX	HCPCS 63700001	68462-0331-90	PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS	BOTH IP/OP	$13.58 	$10.05	$0.00	$9.86		$0.00	$0.00	$0.00	$2.42	$0.00	$0.00	$0.00	$0.00	$0.00	$2.83	$0.00	$0.00	$0.00	$0.00	$6.16	$9.76	$9.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21300	ERX	HCPCS 63700001	00904-5448-61	PENTOXIFYLLINE ER 400 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21321	ERX	HCPCS 63700001	52544-0256-12	PROGESTERONE 8 % VA GEL	BOTH IP/OP	$12.03 	$8.90	$0.00	$8.73		$0.00	$0.00	$0.00	$2.14	$0.00	$0.00	$0.00	$0.00	$0.00	$2.51	$0.00	$0.00	$0.00	$0.00	$5.46	$8.64	$8.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21321	ERX	HCPCS 63700001	52544-0256-54	PROGESTERONE 8 % VA GEL	BOTH IP/OP	$12.03 	$8.90	$0.00	$8.73		$0.00	$0.00	$0.00	$2.14	$0.00	$0.00	$0.00	$0.00	$0.00	$2.51	$0.00	$0.00	$0.00	$0.00	$5.46	$8.64	$8.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21374	ERX	HCPCS J7517	00004-0260-01	MYCOPHENOLATE MOFETIL 500 MG PO TABS	BOTH IP/OP	$83.34 	$61.67	$0.00	$64.24		$0.00	$0.00	$0.00	$0.00	$0.00	$61.85	$61.85	$64.24	$0.00	$17.37	$0.00	$0.00	$0.00	$0.00	$37.79	$59.85	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
21374	ERX	HCPCS J7517	00054-0166-25	MYCOPHENOLATE MOFETIL 500 MG PO TABS	BOTH IP/OP	$83.34 	$61.67	$0.00	$64.24		$0.00	$0.00	$0.00	$0.00	$0.00	$61.85	$61.85	$64.24	$0.00	$17.37	$0.00	$0.00	$0.00	$0.00	$37.79	$59.85	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
21374	ERX	HCPCS J7517	16729-0019-01	MYCOPHENOLATE MOFETIL 500 MG PO TABS	BOTH IP/OP	$83.34 	$61.67	$0.00	$64.24		$0.00	$0.00	$0.00	$0.00	$0.00	$61.85	$61.85	$64.24	$0.00	$17.37	$0.00	$0.00	$0.00	$0.00	$37.79	$59.85	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
21374	ERX	HCPCS J7517	51079-0379-01	MYCOPHENOLATE MOFETIL 500 MG PO TABS	BOTH IP/OP	$83.34 	$61.67	$0.00	$64.24		$0.00	$0.00	$0.00	$0.00	$0.00	$61.85	$61.85	$64.24	$0.00	$17.37	$0.00	$0.00	$0.00	$0.00	$37.79	$59.85	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
21374	ERX	HCPCS J7517	51079-0379-20	MYCOPHENOLATE MOFETIL 500 MG PO TABS	BOTH IP/OP	$83.34 	$61.67	$0.00	$64.24		$0.00	$0.00	$0.00	$0.00	$0.00	$61.85	$61.85	$64.24	$0.00	$17.37	$0.00	$0.00	$0.00	$0.00	$37.79	$59.85	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
21374	ERX	HCPCS J7517	60687-0438-01	MYCOPHENOLATE MOFETIL 500 MG PO TABS	BOTH IP/OP	$83.34 	$61.67	$0.00	$64.24		$0.00	$0.00	$0.00	$0.00	$0.00	$61.85	$61.85	$64.24	$0.00	$17.37	$0.00	$0.00	$0.00	$0.00	$37.79	$59.85	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
21374	ERX	HCPCS J7517	60687-0438-11	MYCOPHENOLATE MOFETIL 500 MG PO TABS	BOTH IP/OP	$83.34 	$61.67	$0.00	$64.24		$0.00	$0.00	$0.00	$0.00	$0.00	$61.85	$61.85	$64.24	$0.00	$17.37	$0.00	$0.00	$0.00	$0.00	$37.79	$59.85	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
21374	ERX	HCPCS J7517	64380-0725-06	MYCOPHENOLATE MOFETIL 500 MG PO TABS	BOTH IP/OP	$83.34 	$61.67	$0.00	$64.24		$0.00	$0.00	$0.00	$0.00	$0.00	$61.85	$61.85	$64.24	$0.00	$17.37	$0.00	$0.00	$0.00	$0.00	$37.79	$59.85	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
21374	ERX	HCPCS J7517	67877-0225-01	MYCOPHENOLATE MOFETIL 500 MG PO TABS	BOTH IP/OP	$83.34 	$61.67	$0.00	$64.24		$0.00	$0.00	$0.00	$0.00	$0.00	$61.85	$61.85	$64.24	$0.00	$17.37	$0.00	$0.00	$0.00	$0.00	$37.79	$59.85	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
21374	ERX	HCPCS J7517	67877-0225-05	MYCOPHENOLATE MOFETIL 500 MG PO TABS	BOTH IP/OP	$83.34 	$61.67	$0.00	$64.24		$0.00	$0.00	$0.00	$0.00	$0.00	$61.85	$61.85	$64.24	$0.00	$17.37	$0.00	$0.00	$0.00	$0.00	$37.79	$59.85	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
21381	ERX	HCPCS 25000001	10858-0081-07	BARIUM SULFATE PO CAPS	BOTH IP/OP	$75.60 	$55.94	$0.00	$60.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.80	$59.88	$60.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21381	ERX	HCPCS 25000001	10858-0081-10	BARIUM SULFATE PO CAPS	BOTH IP/OP	$75.60 	$55.94	$0.00	$60.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.80	$59.88	$60.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21509	ERX	HCPCS 63700001	00078-0249-15	LETROZOLE 2.5 MG PO TABS	BOTH IP/OP	$108.41 	$80.22	$0.00	$78.64		$0.00	$0.00	$0.00	$19.30	$0.00	$0.00	$0.00	$0.00	$0.00	$22.59	$0.00	$0.00	$0.00	$0.00	$49.15	$77.85	$78.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21509	ERX	HCPCS 63700001	00093-7620-56	LETROZOLE 2.5 MG PO TABS	BOTH IP/OP	$108.41 	$80.22	$0.00	$78.64		$0.00	$0.00	$0.00	$19.30	$0.00	$0.00	$0.00	$0.00	$0.00	$22.59	$0.00	$0.00	$0.00	$0.00	$49.15	$77.85	$78.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21509	ERX	HCPCS 63700001	16729-0034-10	LETROZOLE 2.5 MG PO TABS	BOTH IP/OP	$108.41 	$80.22	$0.00	$78.64		$0.00	$0.00	$0.00	$19.30	$0.00	$0.00	$0.00	$0.00	$0.00	$22.59	$0.00	$0.00	$0.00	$0.00	$49.15	$77.85	$78.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21509	ERX	HCPCS 63700001	50268-0476-15	LETROZOLE 2.5 MG PO TABS	BOTH IP/OP	$108.41 	$80.22	$0.00	$78.64		$0.00	$0.00	$0.00	$19.30	$0.00	$0.00	$0.00	$0.00	$0.00	$22.59	$0.00	$0.00	$0.00	$0.00	$49.15	$77.85	$78.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21509	ERX	HCPCS 63700001	51991-0759-33	LETROZOLE 2.5 MG PO TABS	BOTH IP/OP	$108.41 	$80.22	$0.00	$78.64		$0.00	$0.00	$0.00	$19.30	$0.00	$0.00	$0.00	$0.00	$0.00	$22.59	$0.00	$0.00	$0.00	$0.00	$49.15	$77.85	$78.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21509	ERX	HCPCS 63700001	60505-3255-03	LETROZOLE 2.5 MG PO TABS	BOTH IP/OP	$108.41 	$80.22	$0.00	$78.64		$0.00	$0.00	$0.00	$19.30	$0.00	$0.00	$0.00	$0.00	$0.00	$22.59	$0.00	$0.00	$0.00	$0.00	$49.15	$77.85	$78.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21570	ERX	HCPCS J9030	00052-0602-02	BCG LIVE 50 MG IS SUSR	BOTH IP/OP	$633.30 	$468.64	$0.00	$488.15	$284.99	$284.99	$0.00	$0.00	$0.00	$132.00	$470.04	$470.04	$488.15	$0.00	$167.44	$0.00	$374.60	$374.60	$148.10	$287.44	$455.30	$459.90	$204.52		$204.52	$166.26	$0.00	$0.00	$158.31	$141.05	$0.00	$0.00	$0.00	$0.00
21688	ERX	HCPCS 63700001	00378-5525-01	ROPINIROLE HCL 0.25 MG PO TABS	BOTH IP/OP	$10.48 	$7.76	$0.00	$7.60		$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21688	ERX	HCPCS 63700001	43547-0268-10	ROPINIROLE HCL 0.25 MG PO TABS	BOTH IP/OP	$10.48 	$7.76	$0.00	$7.60		$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21688	ERX	HCPCS 63700001	62332-0030-31	ROPINIROLE HCL 0.25 MG PO TABS	BOTH IP/OP	$10.48 	$7.76	$0.00	$7.60		$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21689	ERX	HCPCS 63700001	00904-6374-61	ROPINIROLE HCL 1 MG PO TABS	BOTH IP/OP	$10.50 	$7.77	$0.00	$7.62		$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$4.76	$7.54	$7.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21689	ERX	HCPCS 63700001	43547-0270-10	ROPINIROLE HCL 1 MG PO TABS	BOTH IP/OP	$10.50 	$7.77	$0.00	$7.62		$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$4.76	$7.54	$7.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21689	ERX	HCPCS 63700001	68462-0255-01	ROPINIROLE HCL 1 MG PO TABS	BOTH IP/OP	$10.50 	$7.77	$0.00	$7.62		$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$4.76	$7.54	$7.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21690	ERX	HCPCS 63700001	43547-0271-10	ROPINIROLE HCL 2 MG PO TABS	BOTH IP/OP	$10.48 	$7.76	$0.00	$7.60		$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21690	ERX	HCPCS 63700001	62332-0033-31	ROPINIROLE HCL 2 MG PO TABS	BOTH IP/OP	$10.48 	$7.76	$0.00	$7.60		$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21690	ERX	HCPCS 63700001	68462-0256-01	ROPINIROLE HCL 2 MG PO TABS	BOTH IP/OP	$10.48 	$7.76	$0.00	$7.60		$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21691	ERX	HCPCS 63700001	43547-0274-10	ROPINIROLE HCL 5 MG PO TABS	BOTH IP/OP	$10.90 	$8.07	$0.00	$7.90		$0.00	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$4.94	$7.82	$7.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21800	ERX	HCPCS 63700001	43547-0269-10	ROPINIROLE HCL 0.5 MG PO TABS	BOTH IP/OP	$10.48 	$7.76	$0.00	$7.60		$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21810	ERX	HCPCS 63700001	31722-0506-60	COMBIVIR: LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS	BOTH IP/OP	$65.06 	$48.14	$0.00	$47.21		$0.00	$0.00	$0.00	$11.58	$0.00	$0.00	$0.00	$0.00	$0.00	$13.56	$0.00	$0.00	$0.00	$0.00	$29.51	$46.74	$47.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21810	ERX	HCPCS 63700001	64380-0707-03	COMBIVIR: LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS	BOTH IP/OP	$65.06 	$48.14	$0.00	$47.21		$0.00	$0.00	$0.00	$11.58	$0.00	$0.00	$0.00	$0.00	$0.00	$13.56	$0.00	$0.00	$0.00	$0.00	$29.51	$46.74	$47.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21823	ERX	HCPCS 63700001	00054-0220-20	QUETIAPINE FUMARATE 25 MG PO TABS	BOTH IP/OP	$19.54 	$14.46	$0.00	$14.18		$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$8.86	$14.03	$14.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21823	ERX	HCPCS 63700001	00310-0275-10	QUETIAPINE FUMARATE 25 MG PO TABS	BOTH IP/OP	$19.54 	$14.46	$0.00	$14.18		$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$8.86	$14.03	$14.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21823	ERX	HCPCS 63700001	00904-6638-61	QUETIAPINE FUMARATE 25 MG PO TABS	BOTH IP/OP	$19.54 	$14.46	$0.00	$14.18		$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$8.86	$14.03	$14.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21823	ERX	HCPCS 63700001	16729-0145-01	QUETIAPINE FUMARATE 25 MG PO TABS	BOTH IP/OP	$19.54 	$14.46	$0.00	$14.18		$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$8.86	$14.03	$14.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21823	ERX	HCPCS 63700001	50268-0630-15	QUETIAPINE FUMARATE 25 MG PO TABS	BOTH IP/OP	$19.54 	$14.46	$0.00	$14.18		$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$8.86	$14.03	$14.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21823	ERX	HCPCS 63700001	60687-0327-01	QUETIAPINE FUMARATE 25 MG PO TABS	BOTH IP/OP	$19.54 	$14.46	$0.00	$14.18		$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$8.86	$14.03	$14.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21824	ERX	HCPCS 63700001	00054-0221-20	QUETIAPINE FUMARATE 100 MG PO TABS	BOTH IP/OP	$26.07 	$19.29	$0.00	$20.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.04	$20.65	$20.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21824	ERX	HCPCS 63700001	50268-0632-15	QUETIAPINE FUMARATE 100 MG PO TABS	BOTH IP/OP	$26.07 	$19.29	$0.00	$20.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.04	$20.65	$20.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21824	ERX	HCPCS 63700001	63739-0665-10	QUETIAPINE FUMARATE 100 MG PO TABS	BOTH IP/OP	$26.07 	$19.29	$0.00	$20.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.04	$20.65	$20.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21825	ERX	HCPCS 63700001	16714-0455-01	QUETIAPINE FUMARATE 200 MG PO TABS	BOTH IP/OP	$54.21 	$40.12	$0.00	$39.34		$0.00	$0.00	$0.00	$9.65	$0.00	$0.00	$0.00	$0.00	$0.00	$11.30	$0.00	$0.00	$0.00	$0.00	$24.59	$38.94	$39.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21825	ERX	HCPCS 63700001	47335-0905-88	QUETIAPINE FUMARATE 200 MG PO TABS	BOTH IP/OP	$54.21 	$40.12	$0.00	$39.34		$0.00	$0.00	$0.00	$9.65	$0.00	$0.00	$0.00	$0.00	$0.00	$11.30	$0.00	$0.00	$0.00	$0.00	$24.59	$38.94	$39.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21827	ERX	HCPCS 25000001	63459-0404-30	TIAGABINE HCL 4 MG PO TABS	BOTH IP/OP	$59.89 	$44.32	$0.00	$46.16		$0.00	$0.00	$0.00	$0.00	$0.00	$44.45	$44.45	$46.16	$0.00	$12.48	$0.00	$0.00	$0.00	$0.00	$22.69	$35.94	$36.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21867	ERX	HCPCS 63700001	76336-0455-18	METYRAPONE 250 MG PO CAPS	BOTH IP/OP	$149.19 	$110.40	$0.00	$98.47		$0.00	$0.00	$0.00	$33.19	$0.00	$0.00	$0.00	$0.00	$0.00	$31.09	$0.00	$0.00	$0.00	$0.00	$61.55	$97.49	$98.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21900	ERX	HCPCS J0289	00469-3051-30	AMPHOTERICIN B LIPOSOME 50 MG IV SUSR	BOTH IP/OP	$936.59 	$693.08	$0.00	$764.49		$0.00	$0.00	$0.00	$0.00	$0.00	$736.12	$736.12	$764.49	$0.00	$195.19	$0.00	$0.00	$0.00	$0.00	$412.61	$653.57	$660.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21905	ERX	HCPCS 25000001	00085-1288-01	MOMETASONE FUROATE 50 MCG/ACT NA SUSP	BOTH IP/OP	$799.55 	$591.67	$0.00	$639.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$399.78	$633.24	$639.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22120	ERX	HCPCS 90675	58160-0964-12	"RABIES VACCINE, PCEC IM SUSR"	BOTH IP/OP	"$1,264.92 "	$936.04	$0.00	"$1,023.75"	$597.68	$597.68	$341.95	$341.95	$341.95	$174.76	$985.77	$985.77	"$1,023.75"	$327.53	$384.85	$212.90	$748.20	$748.20	$312.47	$551.91	$874.22	$883.05	$431.50		$431.50	$326.44	$0.00	$0.00	$310.83	$294.72	$0.00	$0.00	$0.00	$0.00
22142	ERX	HCPCS 25000001	00904-6294-61	CLOPIDOGREL BISULFATE 75 MG PO TABS	BOTH IP/OP	$29.40 	$21.76	$0.00	$23.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.70	$23.28	$23.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22142	ERX	HCPCS 25000001	47335-0894-83	CLOPIDOGREL BISULFATE 75 MG PO TABS	BOTH IP/OP	$29.40 	$21.76	$0.00	$23.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.70	$23.28	$23.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22142	ERX	HCPCS 25000001	55111-0196-30	CLOPIDOGREL BISULFATE 75 MG PO TABS	BOTH IP/OP	$29.40 	$21.76	$0.00	$23.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.70	$23.28	$23.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22142	ERX	HCPCS 25000001	55111-0196-90	CLOPIDOGREL BISULFATE 75 MG PO TABS	BOTH IP/OP	$29.40 	$21.76	$0.00	$23.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.70	$23.28	$23.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22142	ERX	HCPCS 25000001	65862-0357-30	CLOPIDOGREL BISULFATE 75 MG PO TABS	BOTH IP/OP	$29.40 	$21.76	$0.00	$23.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.70	$23.28	$23.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22142	ERX	HCPCS 25000001	68084-0536-01	CLOPIDOGREL BISULFATE 75 MG PO TABS	BOTH IP/OP	$29.40 	$21.76	$0.00	$23.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.70	$23.28	$23.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22143	ERX	HCPCS 63700001	00093-7290-01	RALOXIFENE HCL 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22143	ERX	HCPCS 63700001	00093-7290-56	RALOXIFENE HCL 60 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22148	ERX	HCPCS 63700001	69543-0120-10	ACARBOSE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22220	ERX	HCPCS 25000001	50484-0810-15	BECAPLERMIN 0.01 % EX GEL	BOTH IP/OP	"$3,344.71 "	"$2,475.09"	$0.00	"$2,578.10"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,482.44"	"$2,482.44"	"$2,578.10"	$0.00	$697.04	$0.00	$0.00	$0.00	$0.00	"$1,444.76"	"$2,288.50"	"$2,311.62"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22290	ERX	HCPCS 25000001	00093-4136-73	CEFDINIR 125 MG/5ML PO SUSR	BOTH IP/OP	$280.38 	$207.48	$0.00	$216.12		$0.00	$0.00	$0.00	$0.00	$0.00	$208.10	$208.10	$216.12	$0.00	$58.43	$0.00	$0.00	$0.00	$0.00	$127.26	$201.58	$203.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22290	ERX	HCPCS 25000001	00781-6077-46	CEFDINIR 125 MG/5ML PO SUSR	BOTH IP/OP	$280.38 	$207.48	$0.00	$216.12		$0.00	$0.00	$0.00	$0.00	$0.00	$208.10	$208.10	$216.12	$0.00	$58.43	$0.00	$0.00	$0.00	$0.00	$127.26	$201.58	$203.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22290	ERX	HCPCS 25000001	65862-0218-01	CEFDINIR 125 MG/5ML PO SUSR	BOTH IP/OP	$280.38 	$207.48	$0.00	$216.12		$0.00	$0.00	$0.00	$0.00	$0.00	$208.10	$208.10	$216.12	$0.00	$58.43	$0.00	$0.00	$0.00	$0.00	$127.26	$201.58	$203.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22456	ERX	HCPCS 63700001	59528-0331-02	CALCIUM ACETATE (PHOS BINDER) 667 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22456	ERX	HCPCS 63700001	71321-0803-20	CALCIUM ACETATE (PHOS BINDER) 667 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22469	ERX	HCPCS 63700001	00904-5224-52	LACTASE 3000 UNITS PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22472	ERX	HCPCS J1885	00338-0069-10	KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.32	$16.33	$16.33	$16.96	$0.00	$0.57	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22472	ERX	HCPCS J1885	00409-3793-01	KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.32	$16.33	$16.33	$16.96	$0.00	$0.57	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22472	ERX	HCPCS J1885	00641-6041-25	KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.32	$16.33	$16.33	$16.96	$0.00	$0.57	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22472	ERX	HCPCS J1885	25021-0700-01	KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.32	$16.33	$16.33	$16.96	$0.00	$0.57	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22472	ERX	HCPCS J1885	47781-0583-68	KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.32	$16.33	$16.33	$16.96	$0.00	$0.57	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22472	ERX	HCPCS J1885	63323-0161-01	KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.32	$16.33	$16.33	$16.96	$0.00	$0.57	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22472	ERX	HCPCS J1885	63323-0161-12	KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.32	$16.33	$16.33	$16.96	$0.00	$0.57	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22472	ERX	HCPCS J1885	70860-0700-02	KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.32	$16.33	$16.33	$16.96	$0.00	$0.57	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22472	ERX	HCPCS J1885	70860-0700-41	KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.32	$16.33	$16.33	$16.96	$0.00	$0.57	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22472	ERX	HCPCS J1885	72611-0719-25	KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.32	$16.33	$16.33	$16.96	$0.00	$0.57	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22473	ERX	HCPCS J1885	00338-0072-25	KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22473	ERX	HCPCS J1885	00409-3795-01	KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22473	ERX	HCPCS J1885	00641-6042-01	KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22473	ERX	HCPCS J1885	00641-6042-25	KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22473	ERX	HCPCS J1885	25021-0701-01	KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22473	ERX	HCPCS J1885	47781-0584-68	KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22473	ERX	HCPCS J1885	63323-0162-01	KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22473	ERX	HCPCS J1885	63323-0162-12	KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22473	ERX	HCPCS J1885	70860-0701-01	KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22473	ERX	HCPCS J1885	70860-0701-03	KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22473	ERX	HCPCS J1885	72611-0722-25	KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.61	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$0.00
22509	ERX	HCPCS 63700001	00904-6808-61	MONTELUKAST SODIUM 10 MG PO TABS	BOTH IP/OP	$23.08 	$17.08	$0.00	$16.74		$0.00	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00	$4.81	$0.00	$0.00	$0.00	$0.00	$10.47	$16.58	$16.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22509	ERX	HCPCS 63700001	50268-0575-15	MONTELUKAST SODIUM 10 MG PO TABS	BOTH IP/OP	$23.08 	$17.08	$0.00	$16.74		$0.00	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00	$4.81	$0.00	$0.00	$0.00	$0.00	$10.47	$16.58	$16.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22509	ERX	HCPCS 63700001	65862-0574-90	MONTELUKAST SODIUM 10 MG PO TABS	BOTH IP/OP	$23.08 	$17.08	$0.00	$16.74		$0.00	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00	$4.81	$0.00	$0.00	$0.00	$0.00	$10.47	$16.58	$16.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22509	ERX	HCPCS 63700001	68084-0875-01	MONTELUKAST SODIUM 10 MG PO TABS	BOTH IP/OP	$23.08 	$17.08	$0.00	$16.74		$0.00	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00	$4.81	$0.00	$0.00	$0.00	$0.00	$10.47	$16.58	$16.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22510	ERX	HCPCS 63700001	50268-0574-15	MONTELUKAST SODIUM 5 MG PO CHEW	BOTH IP/OP	$21.08 	$15.60	$0.00	$15.30		$0.00	$0.00	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$0.00	$4.39	$0.00	$0.00	$0.00	$0.00	$9.56	$15.14	$15.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22510	ERX	HCPCS 63700001	57237-0213-30	MONTELUKAST SODIUM 5 MG PO CHEW	BOTH IP/OP	$21.08 	$15.60	$0.00	$15.30		$0.00	$0.00	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$0.00	$4.39	$0.00	$0.00	$0.00	$0.00	$9.56	$15.14	$15.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22510	ERX	HCPCS 63700001	65862-0568-90	MONTELUKAST SODIUM 5 MG PO CHEW	BOTH IP/OP	$21.08 	$15.60	$0.00	$15.30		$0.00	$0.00	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$0.00	$4.39	$0.00	$0.00	$0.00	$0.00	$9.56	$15.14	$15.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22560	ERX	HCPCS 63700001	99999-6005-56	SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP	BOTH IP/OP	$85.47 	$63.25	$0.00	$61.99		$0.00	$0.00	$0.00	$15.21	$0.00	$0.00	$0.00	$0.00	$0.00	$17.81	$0.00	$0.00	$0.00	$0.00	$38.75	$61.37	$61.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22560	ERX	HCPCS 63700001	00121-0854-16	SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP	BOTH IP/OP	$85.47 	$63.25	$0.00	$451.69		$0.00	$0.00	$0.00	$15.21	$0.00	$0.00	$0.00	$0.00	$0.00	$17.81	$0.00	$0.00	$0.00	$0.00	$38.75	$451.69	$61.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22560	ERX	HCPCS 63700001	50383-0823-16	SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP	BOTH IP/OP	$85.47 	$63.25	$0.00	$451.69		$0.00	$0.00	$0.00	$15.21	$0.00	$0.00	$0.00	$0.00	$0.00	$17.81	$0.00	$0.00	$0.00	$0.00	$38.75	$451.69	$61.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22560	ERX	HCPCS 63700001	50383-0824-16	SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP	BOTH IP/OP	$85.47 	$63.25	$0.00	$451.69		$0.00	$0.00	$0.00	$15.21	$0.00	$0.00	$0.00	$0.00	$0.00	$17.81	$0.00	$0.00	$0.00	$0.00	$38.75	$451.69	$61.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22560	ERX	HCPCS 63700001	65862-0496-47	SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP	BOTH IP/OP	$85.47 	$63.25	$0.00	$451.69		$0.00	$0.00	$0.00	$15.21	$0.00	$0.00	$0.00	$0.00	$0.00	$17.81	$0.00	$0.00	$0.00	$0.00	$38.75	$451.69	$61.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22588	ERX	HCPCS 63700001	00006-0960-31	LOSARTAN POTASSIUM 100 MG PO TABS	BOTH IP/OP	$25.45 	$18.83	$0.00	$18.46		$0.00	$0.00	$0.00	$4.53	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$0.00	$0.00	$0.00	$0.00	$11.54	$18.28	$18.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22588	ERX	HCPCS 63700001	00904-6389-61	LOSARTAN POTASSIUM 100 MG PO TABS	BOTH IP/OP	$25.45 	$18.83	$0.00	$18.46		$0.00	$0.00	$0.00	$4.53	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$0.00	$0.00	$0.00	$0.00	$11.54	$18.28	$18.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22588	ERX	HCPCS 63700001	13668-0115-90	LOSARTAN POTASSIUM 100 MG PO TABS	BOTH IP/OP	$25.45 	$18.83	$0.00	$18.46		$0.00	$0.00	$0.00	$4.53	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$0.00	$0.00	$0.00	$0.00	$11.54	$18.28	$18.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22588	ERX	HCPCS 63700001	31722-0702-30	LOSARTAN POTASSIUM 100 MG PO TABS	BOTH IP/OP	$25.45 	$18.83	$0.00	$18.46		$0.00	$0.00	$0.00	$4.53	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$0.00	$0.00	$0.00	$0.00	$11.54	$18.28	$18.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22588	ERX	HCPCS 63700001	31722-0702-90	LOSARTAN POTASSIUM 100 MG PO TABS	BOTH IP/OP	$25.45 	$18.83	$0.00	$18.46		$0.00	$0.00	$0.00	$4.53	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$0.00	$0.00	$0.00	$0.00	$11.54	$18.28	$18.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22588	ERX	HCPCS 63700001	50268-0518-15	LOSARTAN POTASSIUM 100 MG PO TABS	BOTH IP/OP	$25.45 	$18.83	$0.00	$18.46		$0.00	$0.00	$0.00	$4.53	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$0.00	$0.00	$0.00	$0.00	$11.54	$18.28	$18.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22588	ERX	HCPCS 63700001	63739-0698-10	LOSARTAN POTASSIUM 100 MG PO TABS	BOTH IP/OP	$25.45 	$18.83	$0.00	$18.46		$0.00	$0.00	$0.00	$4.53	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$0.00	$0.00	$0.00	$0.00	$11.54	$18.28	$18.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22588	ERX	HCPCS 63700001	65862-0203-30	LOSARTAN POTASSIUM 100 MG PO TABS	BOTH IP/OP	$25.45 	$18.83	$0.00	$18.46		$0.00	$0.00	$0.00	$4.53	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$0.00	$0.00	$0.00	$0.00	$11.54	$18.28	$18.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22588	ERX	HCPCS 63700001	65862-0203-99	LOSARTAN POTASSIUM 100 MG PO TABS	BOTH IP/OP	$25.45 	$18.83	$0.00	$18.46		$0.00	$0.00	$0.00	$4.53	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$0.00	$0.00	$0.00	$0.00	$11.54	$18.28	$18.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22588	ERX	HCPCS 63700001	68084-0348-01	LOSARTAN POTASSIUM 100 MG PO TABS	BOTH IP/OP	$25.45 	$18.83	$0.00	$18.46		$0.00	$0.00	$0.00	$4.53	$0.00	$0.00	$0.00	$0.00	$0.00	$5.30	$0.00	$0.00	$0.00	$0.00	$11.54	$18.28	$18.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22953	ERX	HCPCS 63700001	00065-0275-10	BRINZOLAMIDE 1 % OP SUSP	BOTH IP/OP	"$1,202.69 "	$889.99	$0.00	$827.67		$0.00	$0.00	$0.00	$214.08	$0.00	$0.00	$0.00	$0.00	$0.00	$250.64	$0.00	$0.00	$0.00	$0.00	$517.30	$819.40	$827.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22959	ERX	HCPCS 25000001	99999-6004-88	PAROXETINE HCL 10 MG/5ML PO SUSP	BOTH IP/OP	$263.17 	$194.75	$0.00	$202.85		$0.00	$0.00	$0.00	$0.00	$0.00	$195.32	$195.32	$202.85	$0.00	$54.84	$0.00	$0.00	$0.00	$0.00	$119.45	$189.21	$191.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22959	ERX	HCPCS 25000001	60505-0402-05	PAROXETINE HCL 10 MG/5ML PO SUSP	BOTH IP/OP	$263.17 	$194.75	$0.00	$925.05		$0.00	$0.00	$0.00	$0.00	$0.00	$195.32	$195.32	$202.85	$0.00	$54.84	$0.00	$0.00	$0.00	$0.00	$119.45	$925.05	$191.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22981	ERX	HCPCS J0287	57665-0101-41	AMPHOTERICIN B LIPID 5 MG/ML IV SUSP	BOTH IP/OP	$423.36 	$313.29	$0.00	$326.33		$0.00	$0.00	$0.00	$0.00	$0.00	$314.22	$314.22	$326.33	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22993	ERX	HCPCS J8520	00004-1100-20	CAPECITABINE 150 MG PO TABS	BOTH IP/OP	$68.17 	$50.45	$0.00	$52.55		$0.00	$0.00	$0.00	$0.00	$0.00	$50.60	$50.60	$52.55	$0.00	$14.21	$0.00	$0.00	$0.00	$0.00	$30.92	$48.97	$49.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22994	ERX	HCPCS J8521	00004-1101-50	CAPECITABINE 500 MG PO TABS	BOTH IP/OP	$188.16 	$139.24	$0.00	$145.03		$0.00	$0.00	$0.00	$0.00	$0.00	$139.65	$139.65	$145.03	$0.00	$39.21	$0.00	$0.00	$0.00	$0.00	$85.41	$135.28	$136.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22994	ERX	HCPCS J8521	72485-0205-12	CAPECITABINE 500 MG PO TABS	BOTH IP/OP	$188.16 	$139.24	$0.00	$145.03		$0.00	$0.00	$0.00	$0.00	$0.00	$139.65	$139.65	$145.03	$0.00	$39.21	$0.00	$0.00	$0.00	$0.00	$85.41	$135.28	$136.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23009	ERX	HCPCS 63700001	00003-6335-17	HYDROXYUREA 200 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23010	ERX	HCPCS 63700001	00003-6336-17	HYDROXYUREA 300 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23011	ERX	HCPCS 63700001	00003-6337-17	HYDROXYUREA 400 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23036	ERX	HCPCS 25000001	51552-0071-05	POTASSIUM HYDROXIDE 10 % SOLN	BOTH IP/OP	$220.35 	$163.06	$0.00	$169.85		$0.00	$0.00	$0.00	$0.00	$0.00	$163.54	$163.54	$169.85	$0.00	$45.92	$0.00	$0.00	$0.00	$0.00	$100.02	$158.42	$160.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23063	ERX	HCPCS 25000001		CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN	BOTH IP/OP	$18.56 	$13.73	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.28	$14.70	$14.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23063	ERX	HCPCS 25000001	00536-1268-12	CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN	BOTH IP/OP	$18.56 	$13.73	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.28	$14.70	$14.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23063	ERX	HCPCS 25000001	54162-0550-07	CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN	BOTH IP/OP	$18.56 	$13.73	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.28	$14.70	$14.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23063	ERX	HCPCS 25000001	54162-0550-09	CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN	BOTH IP/OP	$18.56 	$13.73	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.28	$14.70	$14.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23065	ERX	HCPCS 63700001	19076-9022-00	ELTA EX CREA	BOTH IP/OP	$128.04 	$94.75	$0.00	$92.88		$0.00	$0.00	$0.00	$22.79	$0.00	$0.00	$0.00	$0.00	$0.00	$26.68	$0.00	$0.00	$0.00	$0.00	$58.05	$91.95	$92.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23128	ERX	HCPCS J0133	55150-0154-10	ACYCLOVIR SODIUM 50 MG/ML IV SOLN	BOTH IP/OP	$67.04 	$49.61	$0.00	$51.67	$30.17	$30.17	$0.00	$0.00	$0.00	$10.58	$49.76	$49.76	$51.67	$0.00	$4.70	$0.00	$39.65	$39.65	$0.00	$30.40	$48.15	$48.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23128	ERX	HCPCS J0133	55150-0154-11	ACYCLOVIR SODIUM 50 MG/ML IV SOLN	BOTH IP/OP	$67.04 	$49.61	$0.00	$51.67	$30.17	$30.17	$0.00	$0.00	$0.00	$10.58	$49.76	$49.76	$51.67	$0.00	$4.70	$0.00	$39.65	$39.65	$0.00	$30.40	$48.15	$48.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23128	ERX	HCPCS J0133	63323-0325-10	ACYCLOVIR SODIUM 50 MG/ML IV SOLN	BOTH IP/OP	$67.04 	$49.61	$0.00	$51.67	$30.17	$30.17	$0.00	$0.00	$0.00	$10.58	$49.76	$49.76	$51.67	$0.00	$4.70	$0.00	$39.65	$39.65	$0.00	$30.40	$48.15	$48.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23128	ERX	HCPCS J0133	55150-0155-21	ACYCLOVIR SODIUM 50 MG/ML IV SOLN	BOTH IP/OP	$67.04 	$49.61	$0.00	$116.42	$30.17	$30.17	$0.00	$0.00	$0.00	$10.58	$49.76	$49.76	$51.67	$0.00	$4.70	$0.00	$39.65	$39.65	$0.00	$30.40	$116.42	$48.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23128	ERX	HCPCS J0133	63323-0325-20	ACYCLOVIR SODIUM 50 MG/ML IV SOLN	BOTH IP/OP	$67.04 	$49.61	$0.00	$116.42	$30.17	$30.17	$0.00	$0.00	$0.00	$10.58	$49.76	$49.76	$51.67	$0.00	$4.70	$0.00	$39.65	$39.65	$0.00	$30.40	$116.42	$48.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23233	ERX	HCPCS 25000001	49884-0902-78	MAFENIDE ACETATE 5 % EX PACK	BOTH IP/OP	$680.56 	$503.61	$0.00	$524.58		$0.00	$0.00	$0.00	$0.00	$0.00	$505.11	$505.11	$524.58	$0.00	$141.83	$0.00	$0.00	$0.00	$0.00	$308.82	$489.17	$494.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23233	ERX	HCPCS 25000001	50742-0310-25	MAFENIDE ACETATE 5 % EX PACK	BOTH IP/OP	$680.56 	$503.61	$0.00	$524.58		$0.00	$0.00	$0.00	$0.00	$0.00	$505.11	$505.11	$524.58	$0.00	$141.83	$0.00	$0.00	$0.00	$0.00	$308.82	$489.17	$494.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23233	ERX	HCPCS 25000001	50742-0310-50	MAFENIDE ACETATE 5 % EX PACK	BOTH IP/OP	$680.56 	$503.61	$0.00	$524.58		$0.00	$0.00	$0.00	$0.00	$0.00	$505.11	$505.11	$524.58	$0.00	$141.83	$0.00	$0.00	$0.00	$0.00	$308.82	$489.17	$494.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23233	ERX	HCPCS 25000001	51079-0624-85	MAFENIDE ACETATE 5 % EX PACK	BOTH IP/OP	$680.56 	$503.61	$0.00	$524.58		$0.00	$0.00	$0.00	$0.00	$0.00	$505.11	$505.11	$524.58	$0.00	$141.83	$0.00	$0.00	$0.00	$0.00	$308.82	$489.17	$494.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23365	ERX	HCPCS 63700001	00088-2102-01	RIFAPENTINE 150 MG PO TABS	BOTH IP/OP	$38.20 	$28.27	$0.00	$55.43		$0.00	$0.00	$0.00	$6.80	$0.00	$0.00	$0.00	$0.00	$0.00	$7.96	$0.00	$0.00	$0.00	$0.00	$34.65	$54.88	$55.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23365	ERX	HCPCS 63700001	00088-2102-24	RIFAPENTINE 150 MG PO TABS	BOTH IP/OP	$38.20 	$28.27	$0.00	$55.43		$0.00	$0.00	$0.00	$6.80	$0.00	$0.00	$0.00	$0.00	$0.00	$7.96	$0.00	$0.00	$0.00	$0.00	$34.65	$54.88	$55.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23449	ERX	HCPCS 63700001	16714-0685-01	SIMVASTATIN 80 MG PO TABS	BOTH IP/OP	$20.55 	$15.21	$0.00	$14.91		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.28	$0.00	$0.00	$0.00	$0.00	$9.32	$14.76	$14.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23449	ERX	HCPCS 63700001	16714-0685-02	SIMVASTATIN 80 MG PO TABS	BOTH IP/OP	$20.55 	$15.21	$0.00	$14.91		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.28	$0.00	$0.00	$0.00	$0.00	$9.32	$14.76	$14.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23449	ERX	HCPCS 63700001	65862-0054-30	SIMVASTATIN 80 MG PO TABS	BOTH IP/OP	$20.55 	$15.21	$0.00	$14.91		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.28	$0.00	$0.00	$0.00	$0.00	$9.32	$14.76	$14.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23458	ERX	HCPCS 63700001	00143-9285-01	AMOXICILLIN 875 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23458	ERX	HCPCS 63700001	57237-0029-01	AMOXICILLIN 875 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23458	ERX	HCPCS 63700001	65862-0015-01	AMOXICILLIN 875 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23461	ERX	HCPCS 25000001	00496-0882-05	LIDOCAINE 4 % EX CREA	BOTH IP/OP	$35.20 	$26.05	$0.00	$27.13		$0.00	$0.00	$0.00	$0.00	$0.00	$26.13	$26.13	$27.13	$0.00	$7.34	$0.00	$0.00	$0.00	$0.00	$15.96	$25.28	$25.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23461	ERX	HCPCS 25000001	00496-0882-06	LIDOCAINE 4 % EX CREA	BOTH IP/OP	$35.20 	$26.05	$0.00	$27.13		$0.00	$0.00	$0.00	$0.00	$0.00	$26.13	$26.13	$27.13	$0.00	$7.34	$0.00	$0.00	$0.00	$0.00	$15.96	$25.28	$25.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23461	ERX	HCPCS 25000001	52565-0122-07	LIDOCAINE 4 % EX CREA	BOTH IP/OP	$35.20 	$26.05	$0.00	$27.13		$0.00	$0.00	$0.00	$0.00	$0.00	$26.13	$26.13	$27.13	$0.00	$7.34	$0.00	$0.00	$0.00	$0.00	$15.96	$25.28	$25.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23490	ERX	HCPCS 63700001	13668-0011-01	CITALOPRAM HYDROBROMIDE 40 MG PO TABS	BOTH IP/OP	$9.54 	$7.06	$0.00	$7.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.77	$7.56	$7.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23599	ERX	HCPCS 63700001	59572-0205-14	THALIDOMIDE 50 MG PO CAPS	BOTH IP/OP	$543.47 	$402.17	$0.00	$434.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.74	$430.43	$434.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23599	ERX	HCPCS 63700001	59572-0205-94	THALIDOMIDE 50 MG PO CAPS	BOTH IP/OP	$543.47 	$402.17	$0.00	$434.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.74	$430.43	$434.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23796	ERX	HCPCS J1745	57894-0030-01	INFLIXIMAB 100 MG IV SOLR	BOTH IP/OP	"$3,167.12 "	"$2,343.67"	$0.00	"$2,441.22"	"$1,425.20"	"$1,425.20"	$378.76	$378.76	$378.76	$668.93	"$2,350.64"	"$2,350.64"	"$2,441.22"	$395.32	$464.50	$256.96	"$1,561.39"	"$1,561.39"	$664.49	"$1,436.42"	"$2,275.28"	"$2,298.26"	$917.63		$917.63	$673.86	$0.00	$0.00	$641.63	$512.00	$0.00	$0.00	$0.00	$0.00
23814	ERX	HCPCS 63700001	00173-0675-02	ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS	BOTH IP/OP	$34.53 	$25.55	$0.00	$25.06		$0.00	$0.00	$0.00	$6.15	$0.00	$0.00	$0.00	$0.00	$0.00	$7.20	$0.00	$0.00	$0.00	$0.00	$15.66	$24.81	$25.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23814	ERX	HCPCS 63700001	00378-4162-01	ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS	BOTH IP/OP	$34.53 	$25.55	$0.00	$25.06		$0.00	$0.00	$0.00	$6.15	$0.00	$0.00	$0.00	$0.00	$0.00	$7.20	$0.00	$0.00	$0.00	$0.00	$15.66	$24.81	$25.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23814	ERX	HCPCS 63700001	68462-0404-01	ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS	BOTH IP/OP	$34.53 	$25.55	$0.00	$25.06		$0.00	$0.00	$0.00	$6.15	$0.00	$0.00	$0.00	$0.00	$0.00	$7.20	$0.00	$0.00	$0.00	$0.00	$15.66	$24.81	$25.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23814	ERX	HCPCS 63700001	68462-0404-67	ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS	BOTH IP/OP	$34.53 	$25.55	$0.00	$25.06		$0.00	$0.00	$0.00	$6.15	$0.00	$0.00	$0.00	$0.00	$0.00	$7.20	$0.00	$0.00	$0.00	$0.00	$15.66	$24.81	$25.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23872	ERX	HCPCS 63700001	00088-2160-30	LEFLUNOMIDE 10 MG PO TABS	BOTH IP/OP	$188.87 	$139.76	$0.00	$130.62		$0.00	$0.00	$0.00	$35.23	$0.00	$0.00	$0.00	$0.00	$0.00	$39.36	$0.00	$0.00	$0.00	$0.00	$81.64	$129.32	$130.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23872	ERX	HCPCS 63700001	23155-0043-03	LEFLUNOMIDE 10 MG PO TABS	BOTH IP/OP	$188.87 	$139.76	$0.00	$130.62		$0.00	$0.00	$0.00	$35.23	$0.00	$0.00	$0.00	$0.00	$0.00	$39.36	$0.00	$0.00	$0.00	$0.00	$81.64	$129.32	$130.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23872	ERX	HCPCS 63700001	62332-0061-30	LEFLUNOMIDE 10 MG PO TABS	BOTH IP/OP	$188.87 	$139.76	$0.00	$130.62		$0.00	$0.00	$0.00	$35.23	$0.00	$0.00	$0.00	$0.00	$0.00	$39.36	$0.00	$0.00	$0.00	$0.00	$81.64	$129.32	$130.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23873	ERX	HCPCS 63700001	23155-0044-03	LEFLUNOMIDE 20 MG PO TABS	BOTH IP/OP	$68.75 	$50.88	$0.00	$49.88		$0.00	$0.00	$0.00	$12.24	$0.00	$0.00	$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$31.18	$49.38	$49.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23873	ERX	HCPCS 63700001	60505-2503-01	LEFLUNOMIDE 20 MG PO TABS	BOTH IP/OP	$68.75 	$50.88	$0.00	$49.88		$0.00	$0.00	$0.00	$12.24	$0.00	$0.00	$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$31.18	$49.38	$49.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23873	ERX	HCPCS 63700001	62332-0062-30	LEFLUNOMIDE 20 MG PO TABS	BOTH IP/OP	$68.75 	$50.88	$0.00	$49.88		$0.00	$0.00	$0.00	$12.24	$0.00	$0.00	$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$31.18	$49.38	$49.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23876	ERX	HCPCS 25000001	00409-7419-03	DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN	BOTH IP/OP	$138.96 	$102.83	$0.00	$107.11		$0.00	$0.00	$0.00	$0.00	$0.00	$103.14	$103.14	$107.11	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$57.75	$91.48	$92.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23898	ERX	HCPCS 63700001	00056-0470-30	EFAVIRENZ 50 MG PO CAPS	BOTH IP/OP	$54.83 	$40.57	$0.00	$39.78		$0.00	$0.00	$0.00	$9.76	$0.00	$0.00	$0.00	$0.00	$0.00	$11.43	$0.00	$0.00	$0.00	$0.00	$24.86	$39.38	$39.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23900	ERX	HCPCS 63700001	00056-0474-92	EFAVIRENZ 200 MG PO CAPS	BOTH IP/OP	$54.79 	$40.54	$0.00	$39.75		$0.00	$0.00	$0.00	$9.75	$0.00	$0.00	$0.00	$0.00	$0.00	$11.42	$0.00	$0.00	$0.00	$0.00	$24.85	$39.35	$39.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23968	ERX	HCPCS 25000001	00004-0298-09	MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR	BOTH IP/OP	$756.71 	$559.97	$0.00	$583.27		$0.00	$0.00	$0.00	$0.00	$0.00	$561.63	$561.63	$583.27	$0.00	$157.70	$0.00	$0.00	$0.00	$0.00	$343.37	$543.90	$549.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23968	ERX	HCPCS 25000001	17478-0422-40	MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR	BOTH IP/OP	$756.71 	$559.97	$0.00	$583.27		$0.00	$0.00	$0.00	$0.00	$0.00	$561.63	$561.63	$583.27	$0.00	$157.70	$0.00	$0.00	$0.00	$0.00	$343.37	$543.90	$549.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23968	ERX	HCPCS 25000001	42023-0172-04	MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR	BOTH IP/OP	$756.71 	$559.97	$0.00	$583.27		$0.00	$0.00	$0.00	$0.00	$0.00	$561.63	$561.63	$583.27	$0.00	$157.70	$0.00	$0.00	$0.00	$0.00	$343.37	$543.90	$549.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24119	ERX	HCPCS 25000001	00597-0047-24	NEVIRAPINE 50 MG/5ML PO SUSP	BOTH IP/OP	$623.92 	$461.70	$0.00	$499.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.96	$494.14	$499.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24119	ERX	HCPCS 25000001	65862-0057-24	NEVIRAPINE 50 MG/5ML PO SUSP	BOTH IP/OP	$623.92 	$461.70	$0.00	$499.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.96	$494.14	$499.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24176	ERX	HCPCS 25000001	00054-3566-99	MIDAZOLAM HCL 2 MG/ML PO SYRP	BOTH IP/OP	$6.00 	$4.44	$0.00	$9.24		$0.00	$0.00	$0.00	$0.00	$0.00	$8.90	$8.90	$9.24	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24176	ERX	HCPCS 25000001	00574-0150-04	MIDAZOLAM HCL 2 MG/ML PO SYRP	BOTH IP/OP	$6.00 	$4.44	$0.00	$9.24		$0.00	$0.00	$0.00	$0.00	$0.00	$8.90	$8.90	$9.24	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24176	ERX	HCPCS 25000001	68094-0762-59	MIDAZOLAM HCL 2 MG/ML PO SYRP	BOTH IP/OP	$6.00 	$4.44	$0.00	$9.24		$0.00	$0.00	$0.00	$0.00	$0.00	$8.90	$8.90	$9.24	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24176	ERX	HCPCS 25000001	68094-0762-62	MIDAZOLAM HCL 2 MG/ML PO SYRP	BOTH IP/OP	$6.00 	$4.44	$0.00	$9.24		$0.00	$0.00	$0.00	$0.00	$0.00	$8.90	$8.90	$9.24	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24188	ERX	HCPCS 25000001	00006-5424-02	ANTIVENIN LATRODECTUS MACTANS IJ KIT	BOTH IP/OP	$128.35 	$94.98	$0.00	$98.93		$0.00	$0.00	$0.00	$0.00	$0.00	$95.26	$95.26	$98.93	$0.00	$26.75	$0.00	$0.00	$0.00	$0.00	$58.19	$92.17	$93.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24190	ERX	HCPCS 63700001	00224-1801-84	PSYLLIUM 100 % PO PACK	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24268	ERX	HCPCS 63700001	00143-2260-01	ISOSORBIDE MONONITRATE CR 60 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24268	ERX	HCPCS 63700001	00904-6450-61	ISOSORBIDE MONONITRATE CR 60 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24268	ERX	HCPCS 63700001	13668-0105-01	ISOSORBIDE MONONITRATE CR 60 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24268	ERX	HCPCS 63700001	62175-0119-37	ISOSORBIDE MONONITRATE CR 60 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24268	ERX	HCPCS 63700001	68084-0592-01	ISOSORBIDE MONONITRATE CR 60 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24325	ERX	HCPCS 25000001	57782-0397-26	CROMOLYN SODIUM 5.2 MG/ACT NA AERS	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24384	ERX	HCPCS 63700001	00006-0747-31	LOSARTAN-HCTZ 100-25 MG PO TABS	BOTH IP/OP	$28.16 	$20.84	$0.00	$20.43		$0.00	$0.00	$0.00	$5.01	$0.00	$0.00	$0.00	$0.00	$0.00	$5.87	$0.00	$0.00	$0.00	$0.00	$12.77	$20.23	$20.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24384	ERX	HCPCS 63700001	00093-7368-98	LOSARTAN-HCTZ 100-25 MG PO TABS	BOTH IP/OP	$28.16 	$20.84	$0.00	$20.43		$0.00	$0.00	$0.00	$5.01	$0.00	$0.00	$0.00	$0.00	$0.00	$5.87	$0.00	$0.00	$0.00	$0.00	$12.77	$20.23	$20.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24384	ERX	HCPCS 63700001	16714-0225-01	LOSARTAN-HCTZ 100-25 MG PO TABS	BOTH IP/OP	$28.16 	$20.84	$0.00	$20.43		$0.00	$0.00	$0.00	$5.01	$0.00	$0.00	$0.00	$0.00	$0.00	$5.87	$0.00	$0.00	$0.00	$0.00	$12.77	$20.23	$20.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24384	ERX	HCPCS 63700001	16714-0225-02	LOSARTAN-HCTZ 100-25 MG PO TABS	BOTH IP/OP	$28.16 	$20.84	$0.00	$20.43		$0.00	$0.00	$0.00	$5.01	$0.00	$0.00	$0.00	$0.00	$0.00	$5.87	$0.00	$0.00	$0.00	$0.00	$12.77	$20.23	$20.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24384	ERX	HCPCS 63700001	68180-0217-09	LOSARTAN-HCTZ 100-25 MG PO TABS	BOTH IP/OP	$28.16 	$20.84	$0.00	$20.43		$0.00	$0.00	$0.00	$5.01	$0.00	$0.00	$0.00	$0.00	$0.00	$5.87	$0.00	$0.00	$0.00	$0.00	$12.77	$20.23	$20.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24385	ERX	HCPCS 25000001	50383-0901-10	HYDROCORTISONE-ACETIC ACID 1-2 % OT SOLN	BOTH IP/OP	$638.89 	$472.78	$0.00	$511.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.45	$506.00	$511.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24398	ERX	HCPCS 63700001	00904-6691-61	METFORMIN HCL 1000 MG PO TABS	BOTH IP/OP	$6.04 	$4.47	$0.00	$4.80		$0.00	$0.00	$0.00	$1.08	$0.00	$0.00	$0.00	$0.00	$0.00	$1.26	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24398	ERX	HCPCS 63700001	23155-0104-05	METFORMIN HCL 1000 MG PO TABS	BOTH IP/OP	$6.04 	$4.47	$0.00	$4.80		$0.00	$0.00	$0.00	$1.08	$0.00	$0.00	$0.00	$0.00	$0.00	$1.26	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24398	ERX	HCPCS 63700001	57664-0474-53	METFORMIN HCL 1000 MG PO TABS	BOTH IP/OP	$6.04 	$4.47	$0.00	$4.80		$0.00	$0.00	$0.00	$1.08	$0.00	$0.00	$0.00	$0.00	$0.00	$1.26	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24398	ERX	HCPCS 63700001	57664-0474-58	METFORMIN HCL 1000 MG PO TABS	BOTH IP/OP	$6.04 	$4.47	$0.00	$4.80		$0.00	$0.00	$0.00	$1.08	$0.00	$0.00	$0.00	$0.00	$0.00	$1.26	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24409	ERX	HCPCS J3240	58468-0030-02	THYROTROPIN ALFA 1.1 MG IM SOLR	BOTH IP/OP	"$3,657.89 "	"$2,706.84"	$0.00	"$2,926.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.87"	"$1,828.95"	"$2,897.05"	"$2,926.31"	"$2,457.92"		"$2,457.92"	"$1,997.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24435	ERX	HCPCS J2353	00078-0818-81	OCTREOTIDE ACETATE 20 MG IM KIT	BOTH IP/OP	"$11,565.98 "	"$8,558.83"	$0.00	"$8,915.06"	"$5,204.69"	"$5,204.69"	"$4,131.24"	"$4,131.24"	"$4,131.24"	"$2,410.64"	"$8,584.27"	"$8,584.27"	"$8,915.06"	"$4,107.44"	"$4,826.24"	"$2,669.84"	"$5,702.03"	"$5,702.03"	"$4,337.87"	"$4,348.66"	"$6,888.27"	"$6,957.85"	"$5,990.39"		"$5,990.39"	"$4,843.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24438	ERX	HCPCS 63700001	00378-4105-91	ABACAVIR SULFATE 300 MG PO TABS	BOTH IP/OP	$42.09 	$31.15	$0.00	$30.54		$0.00	$0.00	$0.00	$7.49	$0.00	$0.00	$0.00	$0.00	$0.00	$8.77	$0.00	$0.00	$0.00	$0.00	$19.09	$30.24	$30.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24438	ERX	HCPCS 63700001	31722-0557-60	ABACAVIR SULFATE 300 MG PO TABS	BOTH IP/OP	$42.09 	$31.15	$0.00	$30.54		$0.00	$0.00	$0.00	$7.49	$0.00	$0.00	$0.00	$0.00	$0.00	$8.77	$0.00	$0.00	$0.00	$0.00	$19.09	$30.24	$30.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24438	ERX	HCPCS 63700001	60505-3583-06	ABACAVIR SULFATE 300 MG PO TABS	BOTH IP/OP	$42.09 	$31.15	$0.00	$30.54		$0.00	$0.00	$0.00	$7.49	$0.00	$0.00	$0.00	$0.00	$0.00	$8.77	$0.00	$0.00	$0.00	$0.00	$19.09	$30.24	$30.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24438	ERX	HCPCS 63700001	64380-0717-03	ABACAVIR SULFATE 300 MG PO TABS	BOTH IP/OP	$42.09 	$31.15	$0.00	$30.54		$0.00	$0.00	$0.00	$7.49	$0.00	$0.00	$0.00	$0.00	$0.00	$8.77	$0.00	$0.00	$0.00	$0.00	$19.09	$30.24	$30.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24438	ERX	HCPCS 63700001	65862-0073-60	ABACAVIR SULFATE 300 MG PO TABS	BOTH IP/OP	$42.09 	$31.15	$0.00	$30.54		$0.00	$0.00	$0.00	$7.49	$0.00	$0.00	$0.00	$0.00	$0.00	$8.77	$0.00	$0.00	$0.00	$0.00	$19.09	$30.24	$30.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24438	ERX	HCPCS 63700001	69097-0514-03	ABACAVIR SULFATE 300 MG PO TABS	BOTH IP/OP	$42.09 	$31.15	$0.00	$30.54		$0.00	$0.00	$0.00	$7.49	$0.00	$0.00	$0.00	$0.00	$0.00	$8.77	$0.00	$0.00	$0.00	$0.00	$19.09	$30.24	$30.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24439	ERX	HCPCS 63700001	99999-6005-00	ABACAVIR SULFATE 20 MG/ML PO SOLN	BOTH IP/OP	$305.64 	$226.17	$0.00	$221.97		$0.00	$0.00	$0.00	$54.40	$0.00	$0.00	$0.00	$0.00	$0.00	$63.70	$0.00	$0.00	$0.00	$0.00	$138.73	$219.75	$221.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24439	ERX	HCPCS 63700001	31722-0562-24	ABACAVIR SULFATE 20 MG/ML PO SOLN	BOTH IP/OP	$305.64 	$226.17	$0.00	$425.53		$0.00	$0.00	$0.00	$54.40	$0.00	$0.00	$0.00	$0.00	$0.00	$63.70	$0.00	$0.00	$0.00	$0.00	$138.73	$425.53	$221.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24439	ERX	HCPCS 63700001	49702-0222-48	ABACAVIR SULFATE 20 MG/ML PO SOLN	BOTH IP/OP	$305.64 	$226.17	$0.00	$425.53		$0.00	$0.00	$0.00	$54.40	$0.00	$0.00	$0.00	$0.00	$0.00	$63.70	$0.00	$0.00	$0.00	$0.00	$138.73	$425.53	$221.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24467	ERX	HCPCS 25000001	99999-6007-34	VITAMIN E 15 UNIT/0.3ML PO SOLN	BOTH IP/OP	$67.88 	$50.23	$0.00	$52.32		$0.00	$0.00	$0.00	$0.00	$0.00	$50.38	$50.38	$52.32	$0.00	$14.15	$0.00	$0.00	$0.00	$0.00	$30.78	$48.76	$49.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24467	ERX	HCPCS 25000001	54838-0005-30	VITAMIN E 15 UNIT/0.3ML PO SOLN	BOTH IP/OP	$67.88 	$50.23	$0.00	$112.27		$0.00	$0.00	$0.00	$0.00	$0.00	$50.38	$50.38	$52.32	$0.00	$14.15	$0.00	$0.00	$0.00	$0.00	$30.78	$112.27	$49.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24473	ERX	HCPCS 63700001	00093-2065-06	CILOSTAZOL 50 MG PO TABS	BOTH IP/OP	$6.94 	$5.14	$0.00	$5.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.47	$5.50	$5.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24473	ERX	HCPCS 63700001	00185-0123-60	CILOSTAZOL 50 MG PO TABS	BOTH IP/OP	$6.94 	$5.14	$0.00	$5.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.47	$5.50	$5.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24474	ERX	HCPCS 63700001	00093-2064-06	CILOSTAZOL 100 MG PO TABS	BOTH IP/OP	$7.65 	$5.66	$0.00	$5.55		$0.00	$0.00	$0.00	$1.36	$0.00	$0.00	$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$3.47	$5.50	$5.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24500	ERX	HCPCS 63700001	00025-1520-34	CELECOXIB 100 MG PO CAPS	BOTH IP/OP	$19.36 	$14.33	$0.00	$14.05		$0.00	$0.00	$0.00	$3.45	$0.00	$0.00	$0.00	$0.00	$0.00	$4.03	$0.00	$0.00	$0.00	$0.00	$8.78	$13.91	$14.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24500	ERX	HCPCS 63700001	00904-6502-61	CELECOXIB 100 MG PO CAPS	BOTH IP/OP	$19.36 	$14.33	$0.00	$14.05		$0.00	$0.00	$0.00	$3.45	$0.00	$0.00	$0.00	$0.00	$0.00	$4.03	$0.00	$0.00	$0.00	$0.00	$8.78	$13.91	$14.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24500	ERX	HCPCS 63700001	16714-0732-01	CELECOXIB 100 MG PO CAPS	BOTH IP/OP	$19.36 	$14.33	$0.00	$14.05		$0.00	$0.00	$0.00	$3.45	$0.00	$0.00	$0.00	$0.00	$0.00	$4.03	$0.00	$0.00	$0.00	$0.00	$8.78	$13.91	$14.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24500	ERX	HCPCS 63700001	60687-0436-01	CELECOXIB 100 MG PO CAPS	BOTH IP/OP	$19.36 	$14.33	$0.00	$14.05		$0.00	$0.00	$0.00	$3.45	$0.00	$0.00	$0.00	$0.00	$0.00	$4.03	$0.00	$0.00	$0.00	$0.00	$8.78	$13.91	$14.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24501	ERX	HCPCS 63700001	33342-0157-11	CELECOXIB 200 MG PO CAPS	BOTH IP/OP	$31.72 	$23.47	$0.00	$23.02		$0.00	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00	$6.61	$0.00	$0.00	$0.00	$0.00	$14.39	$22.79	$23.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24501	ERX	HCPCS 63700001	65862-0909-01	CELECOXIB 200 MG PO CAPS	BOTH IP/OP	$31.72 	$23.47	$0.00	$23.02		$0.00	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00	$6.61	$0.00	$0.00	$0.00	$0.00	$14.39	$22.79	$23.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24513	ERX	HCPCS J0885	59676-0340-01	EPOETIN ALFA 40000 UNIT/ML IJ SOLN	BOTH IP/OP	"$2,899.13 "	"$2,145.36"	$0.00	"$2,103.79"	"$1,574.23"	"$1,574.23"	$328.88	$328.88	$328.88	$604.25	$0.00	$0.00	$0.00	$326.12	$604.18	$211.98	"$1,714.84"	"$1,714.84"	$463.30	"$1,314.87"	"$2,082.75"	"$2,103.79"	$639.80		$639.80	$411.55	$0.00	$0.00	$472.58	$387.84	$0.00	$0.00	$0.00	$0.00
24521	ERX	HCPCS 63700001	00143-2230-01	ISOSORBIDE MONONITRATE ER 30 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24521	ERX	HCPCS 63700001	00904-6449-61	ISOSORBIDE MONONITRATE ER 30 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24521	ERX	HCPCS 63700001	13668-0104-01	ISOSORBIDE MONONITRATE ER 30 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24521	ERX	HCPCS 63700001	62175-0128-37	ISOSORBIDE MONONITRATE ER 30 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24521	ERX	HCPCS 63700001	68084-0591-01	ISOSORBIDE MONONITRATE ER 30 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24521	ERX	HCPCS 63700001	68084-0591-11	ISOSORBIDE MONONITRATE ER 30 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24585	ERX	HCPCS J7511	58468-0080-01	ANTI-THYMOCYTE GLOB (RABBIT) 25 MG IV SOLR	BOTH IP/OP	"$2,494.25 "	"$1,845.75"	$0.00	"$2,032.16"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,956.76"	"$1,956.76"	"$2,032.16"	$0.00	$519.80	$0.00	$0.00	$0.00	$0.00	"$1,076.36"	"$1,704.95"	"$1,722.17"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24702	ERX	HCPCS 63700001	49884-0534-11	MODAFINIL 100 MG PO TABS	BOTH IP/OP	$101.82 	$75.35	$0.00	$73.86		$0.00	$0.00	$0.00	$18.12	$0.00	$0.00	$0.00	$0.00	$0.00	$21.22	$0.00	$0.00	$0.00	$0.00	$46.16	$73.12	$73.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24702	ERX	HCPCS 63700001	60505-2526-03	MODAFINIL 100 MG PO TABS	BOTH IP/OP	$101.82 	$75.35	$0.00	$73.86		$0.00	$0.00	$0.00	$18.12	$0.00	$0.00	$0.00	$0.00	$0.00	$21.22	$0.00	$0.00	$0.00	$0.00	$46.16	$73.12	$73.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24702	ERX	HCPCS 63700001	65862-0601-30	MODAFINIL 100 MG PO TABS	BOTH IP/OP	$101.82 	$75.35	$0.00	$73.86		$0.00	$0.00	$0.00	$18.12	$0.00	$0.00	$0.00	$0.00	$0.00	$21.22	$0.00	$0.00	$0.00	$0.00	$46.16	$73.12	$73.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24711	ERX	HCPCS 63700001	68180-0518-01	LISINOPRIL-HCTZ 10-12.5 MG TABLET	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24711	ERX	HCPCS 63700001	68180-0518-02	LISINOPRIL-HCTZ 10-12.5 MG TABLET	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24914	ERX	HCPCS 63700001	00781-2102-01	TACROLIMUS 0.5 MG PO CAPS	BOTH IP/OP	$9.35 	$6.92	$0.00	$6.78		$0.00	$0.00	$0.00	$1.66	$0.00	$0.00	$0.00	$0.00	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$4.24	$6.72	$6.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24914	ERX	HCPCS 63700001	16729-0041-01	TACROLIMUS 0.5 MG PO CAPS	BOTH IP/OP	$9.35 	$6.92	$0.00	$6.78		$0.00	$0.00	$0.00	$1.66	$0.00	$0.00	$0.00	$0.00	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$4.24	$6.72	$6.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24914	ERX	HCPCS 63700001	51079-0817-01	TACROLIMUS 0.5 MG PO CAPS	BOTH IP/OP	$9.35 	$6.92	$0.00	$6.78		$0.00	$0.00	$0.00	$1.66	$0.00	$0.00	$0.00	$0.00	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$4.24	$6.72	$6.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24914	ERX	HCPCS 63700001	51079-0817-20	TACROLIMUS 0.5 MG PO CAPS	BOTH IP/OP	$9.35 	$6.92	$0.00	$6.78		$0.00	$0.00	$0.00	$1.66	$0.00	$0.00	$0.00	$0.00	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$4.24	$6.72	$6.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24914	ERX	HCPCS 63700001	68084-0449-01	TACROLIMUS 0.5 MG PO CAPS	BOTH IP/OP	$9.35 	$6.92	$0.00	$6.78		$0.00	$0.00	$0.00	$1.66	$0.00	$0.00	$0.00	$0.00	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$4.24	$6.72	$6.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24915	ERX	HCPCS 25000001	00378-9691-52	LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU	BOTH IP/OP	$8.39 	$6.21	$0.00	$6.47		$0.00	$0.00	$0.00	$0.00	$0.00	$6.23	$6.23	$6.47	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$3.81	$6.03	$6.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24915	ERX	HCPCS 25000001	00378-9691-62	LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU	BOTH IP/OP	$8.39 	$6.21	$0.00	$6.47		$0.00	$0.00	$0.00	$0.00	$0.00	$6.23	$6.23	$6.47	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$3.81	$6.03	$6.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24915	ERX	HCPCS 25000001	43598-0410-25	LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU	BOTH IP/OP	$8.39 	$6.21	$0.00	$6.47		$0.00	$0.00	$0.00	$0.00	$0.00	$6.23	$6.23	$6.47	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$3.81	$6.03	$6.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24915	ERX	HCPCS 25000001	66993-0022-27	LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU	BOTH IP/OP	$8.39 	$6.21	$0.00	$6.47		$0.00	$0.00	$0.00	$0.00	$0.00	$6.23	$6.23	$6.47	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$3.81	$6.03	$6.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24915	ERX	HCPCS 25000001	76204-0800-01	LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU	BOTH IP/OP	$8.39 	$6.21	$0.00	$6.47		$0.00	$0.00	$0.00	$0.00	$0.00	$6.23	$6.23	$6.47	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$3.81	$6.03	$6.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24915	ERX	HCPCS 25000001	76204-0800-11	LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU	BOTH IP/OP	$8.39 	$6.21	$0.00	$6.47		$0.00	$0.00	$0.00	$0.00	$0.00	$6.23	$6.23	$6.47	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$3.81	$6.03	$6.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24916	ERX	HCPCS J7614	43598-0409-25	LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU	BOTH IP/OP	$26.98 	$19.97	$0.00	$20.80		$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.80	$0.00	$5.62	$0.00	$0.00	$0.00	$0.00	$12.24	$19.38	$19.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24916	ERX	HCPCS J7614	76204-0900-01	LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU	BOTH IP/OP	$26.98 	$19.97	$0.00	$20.80		$0.00	$0.00	$0.00	$0.00	$0.00	$20.02	$20.02	$20.80	$0.00	$5.62	$0.00	$0.00	$0.00	$0.00	$12.24	$19.38	$19.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24932	ERX	HCPCS J2916	00024-2792-10	NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN	BOTH IP/OP	$147.30 	$109.00	$0.00	$113.54	$66.29	$66.29	$0.00	$0.00	$0.00	$27.85	$109.33	$109.33	$113.54	$0.00	$12.79	$0.00	$87.13	$87.13	$0.00	$66.78	$105.78	$106.85	$0.00		$0.00	$11.69	$0.00	$0.00	$11.13	$0.00	$0.00	$0.00	$0.00	$0.00
24932	ERX	HCPCS J2916	00143-9298-01	NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN	BOTH IP/OP	$147.30 	$109.00	$0.00	$113.54	$66.29	$66.29	$0.00	$0.00	$0.00	$27.85	$109.33	$109.33	$113.54	$0.00	$12.79	$0.00	$87.13	$87.13	$0.00	$66.78	$105.78	$106.85	$0.00		$0.00	$11.69	$0.00	$0.00	$11.13	$0.00	$0.00	$0.00	$0.00	$0.00
24932	ERX	HCPCS J2916	00143-9298-10	NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN	BOTH IP/OP	$147.30 	$109.00	$0.00	$113.54	$66.29	$66.29	$0.00	$0.00	$0.00	$27.85	$109.33	$109.33	$113.54	$0.00	$12.79	$0.00	$87.13	$87.13	$0.00	$66.78	$105.78	$106.85	$0.00		$0.00	$11.69	$0.00	$0.00	$11.13	$0.00	$0.00	$0.00	$0.00	$0.00
24932	ERX	HCPCS J2916	00143-9570-10	NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN	BOTH IP/OP	$147.30 	$109.00	$0.00	$113.54	$66.29	$66.29	$0.00	$0.00	$0.00	$27.85	$109.33	$109.33	$113.54	$0.00	$12.79	$0.00	$87.13	$87.13	$0.00	$66.78	$105.78	$106.85	$0.00		$0.00	$11.69	$0.00	$0.00	$11.13	$0.00	$0.00	$0.00	$0.00	$0.00
24945	ERX	HCPCS 63700001	13107-0032-34	MIRTAZAPINE 45 MG PO TABS	BOTH IP/OP	$11.95 	$8.84	$0.00	$8.66		$0.00	$0.00	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$2.49	$0.00	$0.00	$0.00	$0.00	$5.42	$8.58	$8.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24945	ERX	HCPCS 63700001	51079-0088-01	MIRTAZAPINE 45 MG PO TABS	BOTH IP/OP	$11.95 	$8.84	$0.00	$8.66		$0.00	$0.00	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$2.49	$0.00	$0.00	$0.00	$0.00	$5.42	$8.58	$8.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24945	ERX	HCPCS 63700001	51079-0088-20	MIRTAZAPINE 45 MG PO TABS	BOTH IP/OP	$11.95 	$8.84	$0.00	$8.66		$0.00	$0.00	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$2.49	$0.00	$0.00	$0.00	$0.00	$5.42	$8.58	$8.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24945	ERX	HCPCS 63700001	60505-0249-01	MIRTAZAPINE 45 MG PO TABS	BOTH IP/OP	$11.95 	$8.84	$0.00	$8.66		$0.00	$0.00	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$2.49	$0.00	$0.00	$0.00	$0.00	$5.42	$8.58	$8.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24945	ERX	HCPCS 63700001	68084-0121-01	MIRTAZAPINE 45 MG PO TABS	BOTH IP/OP	$11.95 	$8.84	$0.00	$8.66		$0.00	$0.00	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$2.49	$0.00	$0.00	$0.00	$0.00	$5.42	$8.58	$8.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25005	ERX	HCPCS J7517	00004-0261-29	MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR	BOTH IP/OP	$47.45 	$35.11	$0.00	$36.57		$0.00	$0.00	$0.00	$0.00	$0.00	$35.22	$35.22	$36.57	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$21.52	$34.09	$34.43	$0.00		$0.00	$6.74	$0.00	$0.00	$6.85	$0.00	$0.00	$0.00	$0.00	$0.00
25005	ERX	HCPCS J7517	67877-0230-22	MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR	BOTH IP/OP	$47.45 	$35.11	$0.00	$36.57		$0.00	$0.00	$0.00	$0.00	$0.00	$35.22	$35.22	$36.57	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$21.52	$34.09	$34.43	$0.00		$0.00	$6.74	$0.00	$0.00	$6.85	$0.00	$0.00	$0.00	$0.00	$0.00
25118	ERX	HCPCS 63700001	00143-9927-01	CIPROFLOXACIN HCL 250 MG PO TABS	BOTH IP/OP	$19.00 	$14.06	$0.00	$13.78		$0.00	$0.00	$0.00	$3.38	$0.00	$0.00	$0.00	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$8.62	$13.65	$13.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25118	ERX	HCPCS 63700001	16714-0651-02	CIPROFLOXACIN HCL 250 MG PO TABS	BOTH IP/OP	$19.00 	$14.06	$0.00	$13.78		$0.00	$0.00	$0.00	$3.38	$0.00	$0.00	$0.00	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$8.62	$13.65	$13.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25118	ERX	HCPCS 63700001	55111-0126-01	CIPROFLOXACIN HCL 250 MG PO TABS	BOTH IP/OP	$19.00 	$14.06	$0.00	$13.78		$0.00	$0.00	$0.00	$3.38	$0.00	$0.00	$0.00	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$8.62	$13.65	$13.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25118	ERX	HCPCS 63700001	63739-0700-10	CIPROFLOXACIN HCL 250 MG PO TABS	BOTH IP/OP	$19.00 	$14.06	$0.00	$13.78		$0.00	$0.00	$0.00	$3.38	$0.00	$0.00	$0.00	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$8.62	$13.65	$13.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25119	ERX	HCPCS 63700001	16714-0652-02	CIPROFLOXACIN HCL 500 MG PO TABS	BOTH IP/OP	$12.08 	$8.94	$0.00	$9.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.04	$9.57	$9.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25119	ERX	HCPCS 63700001	63739-0559-10	CIPROFLOXACIN HCL 500 MG PO TABS	BOTH IP/OP	$12.08 	$8.94	$0.00	$9.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.04	$9.57	$9.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25119	ERX	HCPCS 63700001	68084-0070-01	CIPROFLOXACIN HCL 500 MG PO TABS	BOTH IP/OP	$12.08 	$8.94	$0.00	$9.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.04	$9.57	$9.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25119	ERX	HCPCS 63700001	68084-0070-11	CIPROFLOXACIN HCL 500 MG PO TABS	BOTH IP/OP	$12.08 	$8.94	$0.00	$9.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.04	$9.57	$9.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25120	ERX	HCPCS 63700001	16571-0413-05	CIPROFLOXACIN HCL 750 MG PO TABS	BOTH IP/OP	$29.11 	$21.54	$0.00	$23.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.56	$23.06	$23.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25120	ERX	HCPCS 63700001	16714-0653-01	CIPROFLOXACIN HCL 750 MG PO TABS	BOTH IP/OP	$29.11 	$21.54	$0.00	$23.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.56	$23.06	$23.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25120	ERX	HCPCS 63700001	68084-0071-01	CIPROFLOXACIN HCL 750 MG PO TABS	BOTH IP/OP	$29.11 	$21.54	$0.00	$23.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.56	$23.06	$23.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25174	ERX	HCPCS 25000001	00264-1965-10	HETASTARCH-NACL 6-0.9 % IV SOLN	BOTH IP/OP	$79.13 	$58.56	$0.00	$60.99		$0.00	$0.00	$0.00	$0.00	$0.00	$58.73	$58.73	$60.99	$0.00	$16.49	$0.00	$0.00	$0.00	$0.00	$35.88	$56.83	$57.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25238	ERX	HCPCS 63700001	00378-6320-01	VERAPAMIL HCL CR 120 MG PO CP24	BOTH IP/OP	$7.32 	$5.42	$0.00	$5.31		$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$3.32	$5.26	$5.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25238	ERX	HCPCS 63700001	00591-2880-01	VERAPAMIL HCL CR 120 MG PO CP24	BOTH IP/OP	$7.32 	$5.42	$0.00	$5.31		$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$3.32	$5.26	$5.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25246	ERX	HCPCS 25000001	00093-4161-73	AMOXICILLIN 400 MG/5ML PO SUSR	BOTH IP/OP	$37.24 	$27.56	$0.00	$29.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$29.49	$29.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25246	ERX	HCPCS 25000001	00143-9887-01	AMOXICILLIN 400 MG/5ML PO SUSR	BOTH IP/OP	$37.24 	$27.56	$0.00	$29.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$29.49	$29.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25246	ERX	HCPCS 25000001	00781-6157-46	AMOXICILLIN 400 MG/5ML PO SUSR	BOTH IP/OP	$37.24 	$27.56	$0.00	$29.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$29.49	$29.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25246	ERX	HCPCS 25000001	00143-9887-50	AMOXICILLIN 400 MG/5ML PO SUSR	BOTH IP/OP	$18.62 	$13.78	$0.00	$29.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$14.75	$29.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25246	ERX	HCPCS 25000001	00781-6157-52	AMOXICILLIN 400 MG/5ML PO SUSR	BOTH IP/OP	$18.62 	$13.78	$0.00	$29.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.62	$14.75	$29.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25354	ERX	HCPCS 63700001	00955-1722-50	DOXERCALCIFEROL 2.5 MCG PO CAPS	BOTH IP/OP	$141.43 	$104.66	$0.00	$113.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.72	$112.01	$113.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25408	ERX	HCPCS 25000001	67457-0187-50	ALLOPURINOL SODIUM 500 MG IV SOLR	BOTH IP/OP	"$10,812.91 "	"$8,001.55"	$0.00	"$8,334.59"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,334.59"	$0.00	"$2,253.41"	$0.00	$0.00	$0.00	$0.00	"$4,904.09"	"$7,768.07"	"$7,846.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25471	ERX	HCPCS 25000001	24208-0601-10	KETOTIFEN FUMARATE 0.025 % OP SOLN	BOTH IP/OP	$51.08 	$37.80	$0.00	$39.37		$0.00	$0.00	$0.00	$0.00	$0.00	$37.91	$37.91	$39.37	$0.00	$10.65	$0.00	$0.00	$0.00	$0.00	$19.69	$31.18	$31.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25471	ERX	HCPCS 25000001	17478-0717-10	KETOTIFEN FUMARATE 0.025 % OP SOLN	BOTH IP/OP	$51.08 	$37.80	$0.00	$39.37		$0.00	$0.00	$0.00	$0.00	$0.00	$37.91	$37.91	$39.37	$0.00	$10.65	$0.00	$0.00	$0.00	$0.00	$19.69	$36.69	$31.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25471	ERX	HCPCS 25000001	49348-0107-17	KETOTIFEN FUMARATE 0.025 % OP SOLN	BOTH IP/OP	$51.08 	$37.80	$0.00	$39.37		$0.00	$0.00	$0.00	$0.00	$0.00	$37.91	$37.91	$39.37	$0.00	$10.65	$0.00	$0.00	$0.00	$0.00	$19.69	$36.69	$31.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25518	ERX	HCPCS 25000001	63323-0011-15	CHLORAMPHENICOL SOD SUCCINATE 1 G IV SOLR	BOTH IP/OP	$180.28 	$133.41	$0.00	$138.96		$0.00	$0.00	$0.00	$0.00	$0.00	$133.80	$133.80	$138.96	$0.00	$37.57	$0.00	$0.00	$0.00	$0.00	$81.74	$129.47	$130.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25519	ERX	HCPCS 63700001	00904-6357-61	RISPERIDONE 0.25 MG PO TABS	BOTH IP/OP	$15.01 	$11.11	$0.00	$10.89		$0.00	$0.00	$0.00	$2.67	$0.00	$0.00	$0.00	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$6.81	$10.78	$10.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25520	ERX	HCPCS 63700001	00904-6358-61	RISPERIDONE 0.5 MG PO TABS	BOTH IP/OP	$16.24 	$12.02	$0.00	$12.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.12	$12.86	$12.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25520	ERX	HCPCS 63700001	68084-0271-01	RISPERIDONE 0.5 MG PO TABS	BOTH IP/OP	$16.24 	$12.02	$0.00	$12.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.12	$12.86	$12.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25528	ERX	HCPCS 63700001	33342-0054-07	PIOGLITAZONE HCL 15 MG PO TABS	BOTH IP/OP	$65.13 	$48.20	$0.00	$47.26		$0.00	$0.00	$0.00	$11.59	$0.00	$0.00	$0.00	$0.00	$0.00	$13.57	$0.00	$0.00	$0.00	$0.00	$29.54	$46.78	$47.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25528	ERX	HCPCS 63700001	33342-0054-10	PIOGLITAZONE HCL 15 MG PO TABS	BOTH IP/OP	$65.13 	$48.20	$0.00	$47.26		$0.00	$0.00	$0.00	$11.59	$0.00	$0.00	$0.00	$0.00	$0.00	$13.57	$0.00	$0.00	$0.00	$0.00	$29.54	$46.78	$47.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25528	ERX	HCPCS 63700001	64764-0151-04	PIOGLITAZONE HCL 15 MG PO TABS	BOTH IP/OP	$65.13 	$48.20	$0.00	$47.26		$0.00	$0.00	$0.00	$11.59	$0.00	$0.00	$0.00	$0.00	$0.00	$13.57	$0.00	$0.00	$0.00	$0.00	$29.54	$46.78	$47.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25528	ERX	HCPCS 63700001	65862-0512-90	PIOGLITAZONE HCL 15 MG PO TABS	BOTH IP/OP	$65.13 	$48.20	$0.00	$47.26		$0.00	$0.00	$0.00	$11.59	$0.00	$0.00	$0.00	$0.00	$0.00	$13.57	$0.00	$0.00	$0.00	$0.00	$29.54	$46.78	$47.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25798	ERX	HCPCS 25000001	00264-9341-55	TROPHAMINE 10 % IV SOLN	BOTH IP/OP	$181.42 	$134.25	$0.00	$139.84		$0.00	$0.00	$0.00	$0.00	$0.00	$134.65	$134.65	$139.84	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25820	ERX	HCPCS 63700001	00006-0032-20	IVERMECTIN 3 MG PO TABS	BOTH IP/OP	$23.40 	$17.32	$0.00	$16.98		$0.00	$0.00	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$0.00	$4.88	$0.00	$0.00	$0.00	$0.00	$10.61	$16.81	$16.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25820	ERX	HCPCS 63700001	42799-0806-01	IVERMECTIN 3 MG PO TABS	BOTH IP/OP	$23.40 	$17.32	$0.00	$16.98		$0.00	$0.00	$0.00	$4.17	$0.00	$0.00	$0.00	$0.00	$0.00	$4.88	$0.00	$0.00	$0.00	$0.00	$10.61	$16.81	$16.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25855	ERX	HCPCS 63700001	50268-0351-15	GABAPENTIN 600 MG PO TABS	BOTH IP/OP	$10.56 	$7.81	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$4.79	$7.59	$7.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25855	ERX	HCPCS 63700001	58657-0623-01	GABAPENTIN 600 MG PO TABS	BOTH IP/OP	$10.56 	$7.81	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$4.79	$7.59	$7.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25855	ERX	HCPCS 63700001	63739-0560-10	GABAPENTIN 600 MG PO TABS	BOTH IP/OP	$10.56 	$7.81	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$4.79	$7.59	$7.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25856	ERX	HCPCS 63700001	00228-2637-11	GABAPENTIN 800 MG PO TABS	BOTH IP/OP	$12.75 	$9.44	$0.00	$9.25		$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00	$2.66	$0.00	$0.00	$0.00	$0.00	$5.78	$9.16	$9.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25856	ERX	HCPCS 63700001	00904-6586-61	GABAPENTIN 800 MG PO TABS	BOTH IP/OP	$12.75 	$9.44	$0.00	$9.25		$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00	$2.66	$0.00	$0.00	$0.00	$0.00	$5.78	$9.16	$9.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25856	ERX	HCPCS 63700001	16714-0332-01	GABAPENTIN 800 MG PO TABS	BOTH IP/OP	$12.75 	$9.44	$0.00	$9.25		$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00	$2.66	$0.00	$0.00	$0.00	$0.00	$5.78	$9.16	$9.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25856	ERX	HCPCS 63700001	16714-0332-02	GABAPENTIN 800 MG PO TABS	BOTH IP/OP	$12.75 	$9.44	$0.00	$9.25		$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00	$2.66	$0.00	$0.00	$0.00	$0.00	$5.78	$9.16	$9.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25892	ERX	HCPCS J8700	00085-3004-03	TEMOZOLOMIDE 5 MG PO CAPS	BOTH IP/OP	$95.68 	$70.80	$0.00	$76.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.84	$75.78	$76.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25892	ERX	HCPCS J8700	00085-3004-04	TEMOZOLOMIDE 5 MG PO CAPS	BOTH IP/OP	$95.68 	$70.80	$0.00	$76.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.84	$75.78	$76.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25893	ERX	HCPCS J8700	65162-0802-51	TEMOZOLOMIDE 20 MG PO CAPS	BOTH IP/OP	$199.75 	$147.82	$0.00	$153.97		$0.00	$0.00	$0.00	$0.00	$0.00	$148.25	$148.25	$153.97	$0.00	$41.63	$0.00	$0.00	$0.00	$0.00	$90.67	$143.61	$145.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25894	ERX	HCPCS J8700	16729-0050-53	TEMOZOLOMIDE 100 MG PO CAPS	BOTH IP/OP	$840.26 	$621.79	$0.00	$647.67		$0.00	$0.00	$0.00	$0.00	$0.00	$623.64	$623.64	$647.67	$0.00	$175.11	$0.00	$0.00	$0.00	$0.00	$381.29	$603.96	$610.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25895	ERX	HCPCS J8700	65162-0806-51	TEMOZOLOMIDE 250 MG PO CAPS	BOTH IP/OP	"$1,863.77 "	"$1,379.19"	$0.00	"$1,436.59"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,383.29"	"$1,383.29"	"$1,436.59"	$0.00	$388.41	$0.00	$0.00	$0.00	$0.00	$863.52	"$1,367.82"	"$1,381.63"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26224	ERX	HCPCS 63700001	50268-0636-15	PANTOPRAZOLE SODIUM 20 MG PO TBEC	BOTH IP/OP	$16.70 	$12.36	$0.00	$12.12		$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$7.58	$12.00	$12.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26224	ERX	HCPCS 63700001	65862-0559-90	PANTOPRAZOLE SODIUM 20 MG PO TBEC	BOTH IP/OP	$16.70 	$12.36	$0.00	$12.12		$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$7.58	$12.00	$12.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26224	ERX	HCPCS 63700001	68084-0643-01	PANTOPRAZOLE SODIUM 20 MG PO TBEC	BOTH IP/OP	$16.70 	$12.36	$0.00	$12.12		$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$7.58	$12.00	$12.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26224	ERX	HCPCS 63700001	68084-0643-11	PANTOPRAZOLE SODIUM 20 MG PO TBEC	BOTH IP/OP	$16.70 	$12.36	$0.00	$12.12		$0.00	$0.00	$0.00	$2.97	$0.00	$0.00	$0.00	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$7.58	$12.00	$12.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26225	ERX	HCPCS 63700001	55111-0333-90	PANTOPRAZOLE SODIUM 40 MG PO TBEC	BOTH IP/OP	$17.15 	$12.69	$0.00	$12.44		$0.00	$0.00	$0.00	$3.05	$0.00	$0.00	$0.00	$0.00	$0.00	$3.57	$0.00	$0.00	$0.00	$0.00	$7.78	$12.32	$12.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26225	ERX	HCPCS 63700001	63739-0564-10	PANTOPRAZOLE SODIUM 40 MG PO TBEC	BOTH IP/OP	$17.15 	$12.69	$0.00	$12.44		$0.00	$0.00	$0.00	$3.05	$0.00	$0.00	$0.00	$0.00	$0.00	$3.57	$0.00	$0.00	$0.00	$0.00	$7.78	$12.32	$12.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26225	ERX	HCPCS 63700001	66993-0068-80	PANTOPRAZOLE SODIUM 40 MG PO TBEC	BOTH IP/OP	$17.15 	$12.69	$0.00	$12.44		$0.00	$0.00	$0.00	$3.05	$0.00	$0.00	$0.00	$0.00	$0.00	$3.57	$0.00	$0.00	$0.00	$0.00	$7.78	$12.32	$12.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26225	ERX	HCPCS 63700001	68084-0813-09	PANTOPRAZOLE SODIUM 40 MG PO TBEC	BOTH IP/OP	$17.15 	$12.69	$0.00	$12.44		$0.00	$0.00	$0.00	$3.05	$0.00	$0.00	$0.00	$0.00	$0.00	$3.57	$0.00	$0.00	$0.00	$0.00	$7.78	$12.32	$12.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26226	ERX	HCPCS 25000001	00008-0923-55	PANTOPRAZOLE SODIUM 40 MG IV SOLR	BOTH IP/OP	$25.52 	$18.88	$0.00	$19.67		$0.00	$0.00	$0.00	$0.00	$0.00	$18.94	$18.94	$19.67	$0.00	$5.32	$0.00	$0.00	$0.00	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26226	ERX	HCPCS 25000001	00008-0923-60	PANTOPRAZOLE SODIUM 40 MG IV SOLR	BOTH IP/OP	$25.52 	$18.88	$0.00	$19.67		$0.00	$0.00	$0.00	$0.00	$0.00	$18.94	$18.94	$19.67	$0.00	$5.32	$0.00	$0.00	$0.00	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26226	ERX	HCPCS 25000001	00143-9284-10	PANTOPRAZOLE SODIUM 40 MG IV SOLR	BOTH IP/OP	$25.52 	$18.88	$0.00	$19.67		$0.00	$0.00	$0.00	$0.00	$0.00	$18.94	$18.94	$19.67	$0.00	$5.32	$0.00	$0.00	$0.00	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26226	ERX	HCPCS 25000001	00143-9300-01	PANTOPRAZOLE SODIUM 40 MG IV SOLR	BOTH IP/OP	$25.52 	$18.88	$0.00	$19.67		$0.00	$0.00	$0.00	$0.00	$0.00	$18.94	$18.94	$19.67	$0.00	$5.32	$0.00	$0.00	$0.00	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26226	ERX	HCPCS 25000001	00143-9300-10	PANTOPRAZOLE SODIUM 40 MG IV SOLR	BOTH IP/OP	$25.52 	$18.88	$0.00	$19.67		$0.00	$0.00	$0.00	$0.00	$0.00	$18.94	$18.94	$19.67	$0.00	$5.32	$0.00	$0.00	$0.00	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26226	ERX	HCPCS 25000001	55150-0202-00	PANTOPRAZOLE SODIUM 40 MG IV SOLR	BOTH IP/OP	$25.52 	$18.88	$0.00	$19.67		$0.00	$0.00	$0.00	$0.00	$0.00	$18.94	$18.94	$19.67	$0.00	$5.32	$0.00	$0.00	$0.00	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26226	ERX	HCPCS 25000001	55150-0202-10	PANTOPRAZOLE SODIUM 40 MG IV SOLR	BOTH IP/OP	$25.52 	$18.88	$0.00	$19.67		$0.00	$0.00	$0.00	$0.00	$0.00	$18.94	$18.94	$19.67	$0.00	$5.32	$0.00	$0.00	$0.00	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26335	ERX	HCPCS J2770	61570-0260-01	QUINUPRISTIN-DALFOPRISTIN 500 MG IV SOLR	BOTH IP/OP	"$1,448.36 "	"$1,071.79"	$0.00	"$1,116.40"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,074.97"	"$1,074.97"	"$1,116.40"	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$639.10	"$1,012.33"	"$1,022.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26335	ERX	HCPCS J2770	61570-0260-10	QUINUPRISTIN-DALFOPRISTIN 500 MG IV SOLR	BOTH IP/OP	"$1,448.36 "	"$1,071.79"	$0.00	"$1,116.40"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,074.97"	"$1,074.97"	"$1,116.40"	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$639.10	"$1,012.33"	"$1,022.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26336	ERX	HCPCS J7520	00008-1030-06	SIROLIMUS 1 MG/ML PO SOLN	BOTH IP/OP	"$5,122.16 "	"$3,790.40"	$0.00	"$3,948.16"	"$2,304.97"	"$2,304.97"	$0.00	$0.00	$0.00	"$1,067.59"	"$3,801.67"	"$3,801.67"	"$3,948.16"	$0.00	"$1,067.46"	$0.00	"$2,525.22"	"$2,525.22"	$0.00	"$2,222.61"	"$3,520.61"	"$3,556.18"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26371	ERX	HCPCS 63700001	51079-0923-01	CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR	BOTH IP/OP	$7.30 	$5.40	$0.00	$5.30		$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$0.00	$1.52	$0.00	$0.00	$0.00	$0.00	$3.31	$5.24	$5.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26371	ERX	HCPCS 63700001	51079-0923-20	CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR	BOTH IP/OP	$7.30 	$5.40	$0.00	$5.30		$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$0.00	$1.52	$0.00	$0.00	$0.00	$0.00	$3.31	$5.24	$5.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26371	ERX	HCPCS 63700001	68084-0282-01	CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR	BOTH IP/OP	$7.30 	$5.40	$0.00	$5.30		$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$0.00	$1.52	$0.00	$0.00	$0.00	$0.00	$3.31	$5.24	$5.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26429	ERX	HCPCS 63700001	00378-5504-01	ROPINIROLE HCL 4 MG PO TABS	BOTH IP/OP	$10.88 	$8.05	$0.00	$7.90		$0.00	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$4.94	$7.82	$7.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26429	ERX	HCPCS 63700001	43547-0273-10	ROPINIROLE HCL 4 MG PO TABS	BOTH IP/OP	$10.88 	$8.05	$0.00	$7.90		$0.00	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$4.94	$7.82	$7.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26429	ERX	HCPCS 63700001	68462-0258-01	ROPINIROLE HCL 4 MG PO TABS	BOTH IP/OP	$10.88 	$8.05	$0.00	$7.90		$0.00	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$4.94	$7.82	$7.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26546	ERX	HCPCS 63700001	16714-0819-01	OSELTAMIVIR PHOSPHATE 75 MG PO CAPS	BOTH IP/OP	$64.77 	$47.93	$0.00	$46.99		$0.00	$0.00	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00	$0.00	$29.37	$46.52	$46.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26546	ERX	HCPCS 63700001	33342-0258-66	OSELTAMIVIR PHOSPHATE 75 MG PO CAPS	BOTH IP/OP	$64.77 	$47.93	$0.00	$46.99		$0.00	$0.00	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00	$0.00	$29.37	$46.52	$46.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26546	ERX	HCPCS 63700001	42291-0664-10	OSELTAMIVIR PHOSPHATE 75 MG PO CAPS	BOTH IP/OP	$64.77 	$47.93	$0.00	$46.99		$0.00	$0.00	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00	$0.00	$29.37	$46.52	$46.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26546	ERX	HCPCS 63700001	47781-0470-13	OSELTAMIVIR PHOSPHATE 75 MG PO CAPS	BOTH IP/OP	$64.77 	$47.93	$0.00	$46.99		$0.00	$0.00	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00	$0.00	$29.37	$46.52	$46.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26546	ERX	HCPCS 63700001	64380-0799-01	OSELTAMIVIR PHOSPHATE 75 MG PO CAPS	BOTH IP/OP	$64.77 	$47.93	$0.00	$46.99		$0.00	$0.00	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00	$0.00	$29.37	$46.52	$46.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26546	ERX	HCPCS 63700001	70710-1010-02	OSELTAMIVIR PHOSPHATE 75 MG PO CAPS	BOTH IP/OP	$64.77 	$47.93	$0.00	$46.99		$0.00	$0.00	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00	$0.00	$29.37	$46.52	$46.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26547	ERX	HCPCS 63700001	33342-0260-11	ENTACAPONE 200 MG PO TABS	BOTH IP/OP	$16.56 	$12.25	$0.00	$12.01		$0.00	$0.00	$0.00	$2.95	$0.00	$0.00	$0.00	$0.00	$0.00	$3.45	$0.00	$0.00	$0.00	$0.00	$7.51	$11.89	$12.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26547	ERX	HCPCS 63700001	64679-0781-02	ENTACAPONE 200 MG PO TABS	BOTH IP/OP	$16.56 	$12.25	$0.00	$12.01		$0.00	$0.00	$0.00	$2.95	$0.00	$0.00	$0.00	$0.00	$0.00	$3.45	$0.00	$0.00	$0.00	$0.00	$7.51	$11.89	$12.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26551	ERX	HCPCS 63700001	00009-7663-04	EXEMESTANE 25 MG PO TABS	BOTH IP/OP	$78.10 	$57.79	$0.00	$56.65		$0.00	$0.00	$0.00	$13.90	$0.00	$0.00	$0.00	$0.00	$0.00	$16.28	$0.00	$0.00	$0.00	$0.00	$35.41	$56.08	$56.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26551	ERX	HCPCS 63700001	00054-0080-13	EXEMESTANE 25 MG PO TABS	BOTH IP/OP	$78.10 	$57.79	$0.00	$56.65		$0.00	$0.00	$0.00	$13.90	$0.00	$0.00	$0.00	$0.00	$0.00	$16.28	$0.00	$0.00	$0.00	$0.00	$35.41	$56.08	$56.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26551	ERX	HCPCS 63700001	00832-0595-30	EXEMESTANE 25 MG PO TABS	BOTH IP/OP	$78.10 	$57.79	$0.00	$56.65		$0.00	$0.00	$0.00	$13.90	$0.00	$0.00	$0.00	$0.00	$0.00	$16.28	$0.00	$0.00	$0.00	$0.00	$35.41	$56.08	$56.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26551	ERX	HCPCS 63700001	47781-0108-30	EXEMESTANE 25 MG PO TABS	BOTH IP/OP	$78.10 	$57.79	$0.00	$56.65		$0.00	$0.00	$0.00	$13.90	$0.00	$0.00	$0.00	$0.00	$0.00	$16.28	$0.00	$0.00	$0.00	$0.00	$35.41	$56.08	$56.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26688	ERX	HCPCS 63700001	60258-0161-01	RENA-VITE RX 1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26816	ERX	HCPCS 63700001	00904-6051-61	LEVETIRACETAM 250 MG PO TABS	BOTH IP/OP	$10.93 	$8.09	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.47	$8.66	$8.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26816	ERX	HCPCS 63700001	68084-0859-01	LEVETIRACETAM 250 MG PO TABS	BOTH IP/OP	$10.93 	$8.09	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.47	$8.66	$8.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26816	ERX	HCPCS 63700001	68180-0112-16	LEVETIRACETAM 250 MG PO TABS	BOTH IP/OP	$10.93 	$8.09	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.47	$8.66	$8.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26817	ERX	HCPCS 63700001	00904-6052-61	LEVETIRACETAM 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26817	ERX	HCPCS 63700001	16714-0355-01	LEVETIRACETAM 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26817	ERX	HCPCS 63700001	16714-0355-02	LEVETIRACETAM 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26817	ERX	HCPCS 63700001	50268-0473-11	LEVETIRACETAM 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26817	ERX	HCPCS 63700001	50268-0473-15	LEVETIRACETAM 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26817	ERX	HCPCS 63700001	51079-0821-01	LEVETIRACETAM 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26817	ERX	HCPCS 63700001	51079-0821-20	LEVETIRACETAM 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26817	ERX	HCPCS 63700001	63739-0411-10	LEVETIRACETAM 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26817	ERX	HCPCS 63700001	68084-0870-01	LEVETIRACETAM 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26818	ERX	HCPCS 63700001	00378-5617-78	LEVETIRACETAM 750 MG PO TABS	BOTH IP/OP	$19.95 	$14.76	$0.00	$14.48		$0.00	$0.00	$0.00	$3.55	$0.00	$0.00	$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$9.05	$14.34	$14.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26818	ERX	HCPCS 63700001	00904-6053-61	LEVETIRACETAM 750 MG PO TABS	BOTH IP/OP	$19.95 	$14.76	$0.00	$14.48		$0.00	$0.00	$0.00	$3.55	$0.00	$0.00	$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$9.05	$14.34	$14.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26818	ERX	HCPCS 63700001	16714-0356-01	LEVETIRACETAM 750 MG PO TABS	BOTH IP/OP	$19.95 	$14.76	$0.00	$14.48		$0.00	$0.00	$0.00	$3.55	$0.00	$0.00	$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$9.05	$14.34	$14.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26818	ERX	HCPCS 63700001	50268-0474-11	LEVETIRACETAM 750 MG PO TABS	BOTH IP/OP	$19.95 	$14.76	$0.00	$14.48		$0.00	$0.00	$0.00	$3.55	$0.00	$0.00	$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$9.05	$14.34	$14.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26818	ERX	HCPCS 63700001	50474-0596-40	LEVETIRACETAM 750 MG PO TABS	BOTH IP/OP	$19.95 	$14.76	$0.00	$14.48		$0.00	$0.00	$0.00	$3.55	$0.00	$0.00	$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$9.05	$14.34	$14.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26818	ERX	HCPCS 63700001	63739-0787-10	LEVETIRACETAM 750 MG PO TABS	BOTH IP/OP	$19.95 	$14.76	$0.00	$14.48		$0.00	$0.00	$0.00	$3.55	$0.00	$0.00	$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$9.05	$14.34	$14.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26818	ERX	HCPCS 63700001	68084-0882-01	LEVETIRACETAM 750 MG PO TABS	BOTH IP/OP	$19.95 	$14.76	$0.00	$14.48		$0.00	$0.00	$0.00	$3.55	$0.00	$0.00	$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$9.05	$14.34	$14.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26818	ERX	HCPCS 63700001	68084-0882-11	LEVETIRACETAM 750 MG PO TABS	BOTH IP/OP	$19.95 	$14.76	$0.00	$14.48		$0.00	$0.00	$0.00	$3.55	$0.00	$0.00	$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$9.05	$14.34	$14.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26854	ERX	HCPCS 63700001	51991-0943-33	MOXIFLOXACIN HCL 400 MG PO TABS	BOTH IP/OP	$105.09 	$77.77	$0.00	$76.23		$0.00	$0.00	$0.00	$18.71	$0.00	$0.00	$0.00	$0.00	$0.00	$21.90	$0.00	$0.00	$0.00	$0.00	$47.65	$75.47	$76.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26854	ERX	HCPCS 63700001	65862-0603-30	MOXIFLOXACIN HCL 400 MG PO TABS	BOTH IP/OP	$105.09 	$77.77	$0.00	$76.23		$0.00	$0.00	$0.00	$18.71	$0.00	$0.00	$0.00	$0.00	$0.00	$21.90	$0.00	$0.00	$0.00	$0.00	$47.65	$75.47	$76.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26950	ERX	HCPCS 63700001	51285-0063-90	ESTRADIOL-NORGESTIMATE 1/1-0.09 MG (15/15) PO TABS	BOTH IP/OP	$30.03 	$22.22	$0.00	$18.21		$0.00	$0.00	$0.00	$5.35	$0.00	$0.00	$0.00	$0.00	$0.00	$6.26	$0.00	$0.00	$0.00	$0.00	$11.38	$18.03	$18.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26952	ERX	HCPCS 63700001	00904-6286-06	OLANZAPINE 15 MG PO TABS	BOTH IP/OP	$115.31 	$85.33	$0.00	$83.65		$0.00	$0.00	$0.00	$20.53	$0.00	$0.00	$0.00	$0.00	$0.00	$24.03	$0.00	$0.00	$0.00	$0.00	$52.28	$82.81	$83.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26952	ERX	HCPCS 63700001	55111-0167-30	OLANZAPINE 15 MG PO TABS	BOTH IP/OP	$115.31 	$85.33	$0.00	$83.65		$0.00	$0.00	$0.00	$20.53	$0.00	$0.00	$0.00	$0.00	$0.00	$24.03	$0.00	$0.00	$0.00	$0.00	$52.28	$82.81	$83.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26952	ERX	HCPCS 63700001	68084-0528-01	OLANZAPINE 15 MG PO TABS	BOTH IP/OP	$115.31 	$85.33	$0.00	$83.65		$0.00	$0.00	$0.00	$20.53	$0.00	$0.00	$0.00	$0.00	$0.00	$24.03	$0.00	$0.00	$0.00	$0.00	$52.28	$82.81	$83.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26965	ERX	HCPCS 63700001	00069-5800-43	DOFETILIDE 125 MCG PO CAPS	BOTH IP/OP	$54.62 	$40.42	$0.00	$37.92		$0.00	$0.00	$0.00	$9.72	$0.00	$0.00	$0.00	$0.00	$0.00	$11.38	$0.00	$0.00	$0.00	$0.00	$23.70	$37.54	$37.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26965	ERX	HCPCS 63700001	00069-5800-60	DOFETILIDE 125 MCG PO CAPS	BOTH IP/OP	$54.62 	$40.42	$0.00	$37.92		$0.00	$0.00	$0.00	$9.72	$0.00	$0.00	$0.00	$0.00	$0.00	$11.38	$0.00	$0.00	$0.00	$0.00	$23.70	$37.54	$37.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26965	ERX	HCPCS 63700001	42291-0411-60	DOFETILIDE 125 MCG PO CAPS	BOTH IP/OP	$54.62 	$40.42	$0.00	$37.92		$0.00	$0.00	$0.00	$9.72	$0.00	$0.00	$0.00	$0.00	$0.00	$11.38	$0.00	$0.00	$0.00	$0.00	$23.70	$37.54	$37.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26965	ERX	HCPCS 63700001	51862-0125-60	DOFETILIDE 125 MCG PO CAPS	BOTH IP/OP	$54.62 	$40.42	$0.00	$37.92		$0.00	$0.00	$0.00	$9.72	$0.00	$0.00	$0.00	$0.00	$0.00	$11.38	$0.00	$0.00	$0.00	$0.00	$23.70	$37.54	$37.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26965	ERX	HCPCS 63700001	69452-0131-17	DOFETILIDE 125 MCG PO CAPS	BOTH IP/OP	$54.62 	$40.42	$0.00	$37.92		$0.00	$0.00	$0.00	$9.72	$0.00	$0.00	$0.00	$0.00	$0.00	$11.38	$0.00	$0.00	$0.00	$0.00	$23.70	$37.54	$37.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26966	ERX	HCPCS 63700001	00069-5810-60	DOFETILIDE 250 MCG PO CAPS	BOTH IP/OP	$32.54 	$24.08	$0.00	$26.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.27	$25.77	$26.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26966	ERX	HCPCS 63700001	59762-0038-02	DOFETILIDE 250 MCG PO CAPS	BOTH IP/OP	$32.54 	$24.08	$0.00	$26.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.27	$25.77	$26.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26967	ERX	HCPCS 25000001	00069-5820-43	DOFETILIDE 500 MCG PO CAPS	BOTH IP/OP	$35.85 	$26.53	$0.00	$27.63		$0.00	$0.00	$0.00	$0.00	$0.00	$26.61	$26.61	$27.63	$0.00	$7.47	$0.00	$0.00	$0.00	$0.00	$16.26	$25.75	$26.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26967	ERX	HCPCS 25000001	00069-5820-60	DOFETILIDE 500 MCG PO CAPS	BOTH IP/OP	$35.85 	$26.53	$0.00	$27.63		$0.00	$0.00	$0.00	$0.00	$0.00	$26.61	$26.61	$27.63	$0.00	$7.47	$0.00	$0.00	$0.00	$0.00	$16.26	$25.75	$26.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26967	ERX	HCPCS 25000001	51862-0005-60	DOFETILIDE 500 MCG PO CAPS	BOTH IP/OP	$35.85 	$26.53	$0.00	$27.63		$0.00	$0.00	$0.00	$0.00	$0.00	$26.61	$26.61	$27.63	$0.00	$7.47	$0.00	$0.00	$0.00	$0.00	$16.26	$25.75	$26.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27022	ERX	HCPCS 25000001	00045-0646-12	BUDESONIDE 32 MCG/ACT NA SUSP	BOTH IP/OP	$72.59 	$53.72	$0.00	$58.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.30	$57.49	$58.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27023	ERX	HCPCS 63700001	51672-2080-02	TERBINAFINE HCL 1 % EX CREA	BOTH IP/OP	$90.09 	$66.67	$0.00	$71.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.31	$71.35	$26.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27023	ERX	HCPCS 63700001	51672-2080-01	TERBINAFINE HCL 1 % EX CREA	BOTH IP/OP	$65.21 	$48.26	$0.00	$51.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.31	$51.65	$26.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27023	ERX	HCPCS 63700001	00067-8100-12	TERBINAFINE HCL 1 % EX CREA	BOTH IP/OP	$32.61 	$24.13	$0.00	$26.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.31	$25.83	$26.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27027	ERX	HCPCS 63700001	00187-5526-75	BEXAROTENE 75 MG PO CAPS	BOTH IP/OP	$871.61 	$644.99	$0.00	$632.82		$0.00	$0.00	$0.00	$155.15	$0.00	$0.00	$0.00	$0.00	$0.00	$181.64	$0.00	$0.00	$0.00	$0.00	$395.51	$626.49	$632.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27032	ERX	HCPCS J7674	64281-0100-00	METHACHOLINE CHLORIDE 100 MG IN SOLR	BOTH IP/OP	$324.80 	$240.35	$0.00	$250.36		$0.00	$0.00	$0.00	$0.00	$0.00	$241.07	$241.07	$250.36	$0.00	$67.69	$0.00	$0.00	$0.00	$0.00	$141.75	$224.53	$226.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27032	ERX	HCPCS J7674	64281-0100-06	METHACHOLINE CHLORIDE 100 MG IN SOLR	BOTH IP/OP	$324.80 	$240.35	$0.00	$250.36		$0.00	$0.00	$0.00	$0.00	$0.00	$241.07	$241.07	$250.36	$0.00	$67.69	$0.00	$0.00	$0.00	$0.00	$141.75	$224.53	$226.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27049	ERX	HCPCS 63700001	62756-0183-88	OXCARBAZEPINE 150 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27049	ERX	HCPCS 63700001	68084-0845-01	OXCARBAZEPINE 150 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27099	ERX	HCPCS 25000001	00574-0121-08	CHARCOAL ACTIVATED PO LIQD	BOTH IP/OP	$156.57 	$115.86	$0.00	$120.68		$0.00	$0.00	$0.00	$0.00	$0.00	$116.21	$116.21	$120.68	$0.00	$32.63	$0.00	$0.00	$0.00	$0.00	$70.98	$112.43	$113.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27099	ERX	HCPCS 25000001	00574-0121-74	CHARCOAL ACTIVATED PO LIQD	BOTH IP/OP	$156.57 	$115.86	$0.00	$120.68		$0.00	$0.00	$0.00	$0.00	$0.00	$116.21	$116.21	$120.68	$0.00	$32.63	$0.00	$0.00	$0.00	$0.00	$70.98	$112.43	$113.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27099	ERX	HCPCS 25000001	00574-0121-76	CHARCOAL ACTIVATED PO LIQD	BOTH IP/OP	$156.57 	$115.86	$0.00	$120.68		$0.00	$0.00	$0.00	$0.00	$0.00	$116.21	$116.21	$120.68	$0.00	$32.63	$0.00	$0.00	$0.00	$0.00	$70.98	$112.43	$113.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27099	ERX	HCPCS 25000001	66689-0201-08	CHARCOAL ACTIVATED PO LIQD	BOTH IP/OP	$156.57 	$115.86	$0.00	$120.68		$0.00	$0.00	$0.00	$0.00	$0.00	$116.21	$116.21	$120.68	$0.00	$32.63	$0.00	$0.00	$0.00	$0.00	$70.98	$112.43	$113.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27099	ERX	HCPCS 25000001	66689-0202-04	CHARCOAL ACTIVATED PO LIQD	BOTH IP/OP	$156.57 	$115.86	$0.00	$120.68		$0.00	$0.00	$0.00	$0.00	$0.00	$116.21	$116.21	$120.68	$0.00	$32.63	$0.00	$0.00	$0.00	$0.00	$70.98	$112.43	$113.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27099	ERX	HCPCS 25000001	66689-0202-08	CHARCOAL ACTIVATED PO LIQD	BOTH IP/OP	$156.57 	$115.86	$0.00	$120.68		$0.00	$0.00	$0.00	$0.00	$0.00	$116.21	$116.21	$120.68	$0.00	$32.63	$0.00	$0.00	$0.00	$0.00	$70.98	$112.43	$113.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27112	ERX	HCPCS 63700001	00093-3099-56	RISEDRONATE SODIUM 5 MG PO TABS	BOTH IP/OP	$37.11 	$27.46	$0.00	$26.93		$0.00	$0.00	$0.00	$6.61	$0.00	$0.00	$0.00	$0.00	$0.00	$7.73	$0.00	$0.00	$0.00	$0.00	$16.83	$26.66	$26.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27181	ERX	HCPCS 63700001	62175-0320-46	NIACIN ER (ANTIHYPERLIPIDEMIC) 500 MG PO TBCR	BOTH IP/OP	$21.86 	$16.18	$0.00	$15.86		$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$0.00	$4.56	$0.00	$0.00	$0.00	$0.00	$9.92	$15.71	$15.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27181	ERX	HCPCS 63700001	65162-0321-09	NIACIN ER (ANTIHYPERLIPIDEMIC) 500 MG PO TBCR	BOTH IP/OP	$21.86 	$16.18	$0.00	$15.86		$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$0.00	$4.56	$0.00	$0.00	$0.00	$0.00	$9.92	$15.71	$15.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27182	ERX	HCPCS 63700001	47335-0614-81	NIACIN ER (ANTIHYPERLIPIDEMIC) 750 MG PO TBCR	BOTH IP/OP	$25.30 	$18.72	$0.00	$18.36		$0.00	$0.00	$0.00	$4.50	$0.00	$0.00	$0.00	$0.00	$0.00	$5.27	$0.00	$0.00	$0.00	$0.00	$11.48	$18.18	$18.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27183	ERX	HCPCS 63700001	47335-0613-81	NIACIN ER (ANTIHYPERLIPIDEMIC) 1000 MG PO TBCR	BOTH IP/OP	$31.37 	$23.21	$0.00	$33.35		$0.00	$0.00	$0.00	$5.58	$0.00	$0.00	$0.00	$0.00	$0.00	$6.54	$0.00	$0.00	$0.00	$0.00	$20.85	$33.02	$33.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27183	ERX	HCPCS 63700001	65162-0323-09	NIACIN ER (ANTIHYPERLIPIDEMIC) 1000 MG PO TBCR	BOTH IP/OP	$31.37 	$23.21	$0.00	$33.35		$0.00	$0.00	$0.00	$5.58	$0.00	$0.00	$0.00	$0.00	$0.00	$6.54	$0.00	$0.00	$0.00	$0.00	$20.85	$33.02	$33.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27234	ERX	HCPCS 63700001	00781-5554-31	MONTELUKAST SODIUM 4 MG PO CHEW	BOTH IP/OP	$23.71 	$17.55	$0.00	$17.20		$0.00	$0.00	$0.00	$4.22	$0.00	$0.00	$0.00	$0.00	$0.00	$4.94	$0.00	$0.00	$0.00	$0.00	$10.75	$17.03	$17.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27234	ERX	HCPCS 63700001	27241-0016-03	MONTELUKAST SODIUM 4 MG PO CHEW	BOTH IP/OP	$23.71 	$17.55	$0.00	$17.20		$0.00	$0.00	$0.00	$4.22	$0.00	$0.00	$0.00	$0.00	$0.00	$4.94	$0.00	$0.00	$0.00	$0.00	$10.75	$17.03	$17.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27234	ERX	HCPCS 63700001	42291-0622-90	MONTELUKAST SODIUM 4 MG PO CHEW	BOTH IP/OP	$23.71 	$17.55	$0.00	$17.20		$0.00	$0.00	$0.00	$4.22	$0.00	$0.00	$0.00	$0.00	$0.00	$4.94	$0.00	$0.00	$0.00	$0.00	$10.75	$17.03	$17.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27278	ERX	HCPCS 63700001	13668-0106-01	ISOSORBIDE MONONITRATE ER 120 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27278	ERX	HCPCS 63700001	62175-0129-37	ISOSORBIDE MONONITRATE ER 120 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27291	ERX	HCPCS J0713	00409-5093-11	CEFTAZIDIME 2 G IV SOLR	BOTH IP/OP	$24.02 	$17.77	$0.00	$21.74		$0.00	$0.00	$0.00	$0.00	$0.00	$17.83	$17.83	$18.51	$0.00	$5.01	$0.00	$0.00	$0.00	$0.00	$13.59	$21.52	$21.74	$0.00		$0.00	$4.25	$0.00	$0.00	$4.33	$0.00	$0.00	$0.00	$0.00	$0.00
27299	ERX	HCPCS J0697	00143-9977-22	CEFUROXIME SODIUM 1.5 G IV SOLR	BOTH IP/OP	$29.40 	$21.76	$0.00	$22.66		$0.00	$0.00	$0.00	$0.00	$0.00	$21.82	$21.82	$22.66	$0.00	$4.73	$0.00	$0.00	$0.00	$0.00	$13.33	$21.11	$21.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27314	ERX	HCPCS J2941	00013-2626-81	SOMATROPIN (ZOMACTON) 5 MG SC SOLR	BOTH IP/OP	"$1,016.16 "	$751.96	$0.00	$783.26		$0.00	$0.00	$0.00	$0.00	$0.00	$754.19	$754.19	$783.26	$0.00	$211.77	$0.00	$0.00	$0.00	$0.00	$461.10	$730.38	$737.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27314	ERX	HCPCS J2941	55566-1801-01	SOMATROPIN (ZOMACTON) 5 MG SC SOLR	BOTH IP/OP	"$1,016.16 "	$751.96	$0.00	$783.26		$0.00	$0.00	$0.00	$0.00	$0.00	$754.19	$754.19	$783.26	$0.00	$211.77	$0.00	$0.00	$0.00	$0.00	$461.10	$730.38	$737.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27325	ERX	HCPCS 90744	58160-0820-52	HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSP	BOTH IP/OP	$103.93 	$76.91	$0.00	$83.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.97	$82.31	$83.14	$62.36		$62.36	$16.27	$27.02	$27.02	$0.00	$27.02	$0.00	$0.00	$0.00	$0.00
27326	ERX	HCPCS 90746	58160-0821-11	HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP	BOTH IP/OP	$233.36 	$172.69	$0.00	$186.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.68	$184.82	$186.69	$140.02		$140.02	$78.80	$60.67	$60.67	$75.03	$60.67	$0.00	$0.00	$0.00	$0.00
27326	ERX	HCPCS 90746	58160-0821-43	HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP	BOTH IP/OP	$233.36 	$172.69	$0.00	$186.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.68	$184.82	$186.69	$140.02		$140.02	$78.80	$60.67	$60.67	$75.03	$60.67	$0.00	$0.00	$0.00	$0.00
27326	ERX	HCPCS 90746	58160-0821-52	HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP	BOTH IP/OP	$233.36 	$172.69	$0.00	$186.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.68	$184.82	$186.69	$140.02		$140.02	$78.80	$60.67	$60.67	$75.03	$60.67	$0.00	$0.00	$0.00	$0.00
27386	ERX	HCPCS 25000001	63323-0254-10	MINERAL OIL LIGHT OIL	BOTH IP/OP	$76.64 	$56.71	$0.00	$59.07		$0.00	$0.00	$0.00	$0.00	$0.00	$56.88	$56.88	$59.07	$0.00	$15.97	$0.00	$0.00	$0.00	$0.00	$31.73	$50.26	$50.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27393	ERX	HCPCS 63600001	00409-1134-03	MORPHINE SULFATE 50 MG/ML IV SOLN	BOTH IP/OP	$126.42 	$93.55	$0.00	$97.44		$0.00	$0.00	$0.00	$0.00	$0.00	$93.83	$93.83	$97.44	$0.00	$26.35	$0.00	$0.00	$0.00	$0.00	$28.88	$45.75	$46.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27393	ERX	HCPCS 63600001	00409-1134-05	MORPHINE SULFATE 50 MG/ML IV SOLN	BOTH IP/OP	$126.42 	$93.55	$0.00	$97.44		$0.00	$0.00	$0.00	$0.00	$0.00	$93.83	$93.83	$97.44	$0.00	$26.35	$0.00	$0.00	$0.00	$0.00	$28.88	$89.54	$46.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27430	ERX	HCPCS 25000001	13925-0515-10	PENTAMIDINE ISETHIONATE 300 MG IJ SOLR	BOTH IP/OP	$584.79 	$432.74	$0.00	$450.76		$0.00	$0.00	$0.00	$0.00	$0.00	$434.03	$434.03	$450.76	$0.00	$121.87	$0.00	$0.00	$0.00	$0.00	$265.36	$420.33	$424.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27430	ERX	HCPCS 25000001	63323-0113-10	PENTAMIDINE ISETHIONATE 300 MG IJ SOLR	BOTH IP/OP	$584.79 	$432.74	$0.00	$450.76		$0.00	$0.00	$0.00	$0.00	$0.00	$434.03	$434.03	$450.76	$0.00	$121.87	$0.00	$0.00	$0.00	$0.00	$265.36	$420.33	$424.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27431	ERX	HCPCS Q2050	43598-0283-35	DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ	BOTH IP/OP	"$2,408.70 "	"$1,782.44"	$0.00	"$1,906.99"	"$1,083.92"	"$1,083.92"	$401.03	$401.03	$401.03	$502.03	"$1,787.74"	"$1,787.74"	"$1,856.63"	$468.06	$549.97	$304.24	"$1,187.49"	"$1,187.49"	$745.65	"$1,191.87"	"$1,887.92"	"$1,906.99"	"$1,029.70"		"$1,029.70"	$694.47	$0.00	$0.00	$661.26	$635.41	$0.00	$0.00	$0.00	$0.00
27431	ERX	HCPCS Q2050	47335-0049-40	DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ	BOTH IP/OP	"$2,408.70 "	"$1,782.44"	$0.00	"$1,906.99"	"$1,083.92"	"$1,083.92"	$401.03	$401.03	$401.03	$502.03	"$1,787.74"	"$1,787.74"	"$1,856.63"	$468.06	$549.97	$304.24	"$1,187.49"	"$1,187.49"	$745.65	"$1,191.87"	"$1,887.92"	"$1,906.99"	"$1,029.70"		"$1,029.70"	$694.47	$0.00	$0.00	$661.26	$635.41	$0.00	$0.00	$0.00	$0.00
27459	ERX	HCPCS 63700001	00378-4642-26	ESTRADIOL 0.05 MG/24HR TD PTTW	BOTH IP/OP	$47.50 	$35.15	$0.00	$34.46		$0.00	$0.00	$0.00	$8.46	$0.00	$0.00	$0.00	$0.00	$0.00	$9.90	$0.00	$0.00	$0.00	$0.00	$21.54	$34.12	$34.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27461	ERX	HCPCS 25000001	00378-4640-16	ESTRADIOL 0.1 MG/24HR TD PTTW	BOTH IP/OP	$67.23 	$49.75	$0.00	$53.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.62	$53.25	$53.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27461	ERX	HCPCS 25000001	00378-4640-26	ESTRADIOL 0.1 MG/24HR TD PTTW	BOTH IP/OP	$67.23 	$49.75	$0.00	$53.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.62	$53.25	$53.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27471	ERX	HCPCS 25000001		NITROGLYCERIN 0.1 MG/HR TD PT24	BOTH IP/OP	$7.79 	$5.76	$0.00	$6.00		$0.00	$0.00	$0.00	$0.00	$0.00	$5.78	$5.78	$6.00	$0.00	$1.62	$0.00	$0.00	$0.00	$0.00	$3.54	$5.60	$5.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27471	ERX	HCPCS 25000001	00378-9102-93	NITROGLYCERIN 0.1 MG/HR TD PT24	BOTH IP/OP	$7.79 	$5.76	$0.00	$6.00		$0.00	$0.00	$0.00	$0.00	$0.00	$5.78	$5.78	$6.00	$0.00	$1.62	$0.00	$0.00	$0.00	$0.00	$3.54	$5.60	$5.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27471	ERX	HCPCS 25000001	47781-0296-03	NITROGLYCERIN 0.1 MG/HR TD PT24	BOTH IP/OP	$7.79 	$5.76	$0.00	$6.00		$0.00	$0.00	$0.00	$0.00	$0.00	$5.78	$5.78	$6.00	$0.00	$1.62	$0.00	$0.00	$0.00	$0.00	$3.54	$5.60	$5.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27472	ERX	HCPCS 25000001	00378-9104-93	NITROGLYCERIN 0.2 MG/HR TD PT24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27473	ERX	HCPCS 25000001	50742-0515-30	NITROGLYCERIN 0.3 MG/HR TD PT24	BOTH IP/OP	$181.82 	$134.55	$0.00	$140.15		$0.00	$0.00	$0.00	$0.00	$0.00	$134.95	$134.95	$140.15	$0.00	$37.89	$0.00	$0.00	$0.00	$0.00	$65.95	$104.46	$105.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27474	ERX	HCPCS 25000001		NITROGLYCERIN 0.4 MG/HR TD PT24	BOTH IP/OP	$7.74 	$5.73	$0.00	$5.97		$0.00	$0.00	$0.00	$0.00	$0.00	$5.74	$5.74	$5.97	$0.00	$1.61	$0.00	$0.00	$0.00	$0.00	$3.51	$5.56	$5.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27474	ERX	HCPCS 25000001	00378-9112-93	NITROGLYCERIN 0.4 MG/HR TD PT24	BOTH IP/OP	$7.74 	$5.73	$0.00	$5.97		$0.00	$0.00	$0.00	$0.00	$0.00	$5.74	$5.74	$5.97	$0.00	$1.61	$0.00	$0.00	$0.00	$0.00	$3.51	$5.56	$5.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27474	ERX	HCPCS 25000001	47781-0298-03	NITROGLYCERIN 0.4 MG/HR TD PT24	BOTH IP/OP	$7.74 	$5.73	$0.00	$5.97		$0.00	$0.00	$0.00	$0.00	$0.00	$5.74	$5.74	$5.97	$0.00	$1.61	$0.00	$0.00	$0.00	$0.00	$3.51	$5.56	$5.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27475	ERX	HCPCS 25000001		NITROGLYCERIN 0.6 MG/HR TD PT24	BOTH IP/OP	$10.04 	$7.43	$0.00	$7.74		$0.00	$0.00	$0.00	$0.00	$0.00	$7.45	$7.45	$7.74	$0.00	$2.09	$0.00	$0.00	$0.00	$0.00	$4.56	$7.22	$7.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27475	ERX	HCPCS 25000001	00378-9116-93	NITROGLYCERIN 0.6 MG/HR TD PT24	BOTH IP/OP	$10.04 	$7.43	$0.00	$7.74		$0.00	$0.00	$0.00	$0.00	$0.00	$7.45	$7.45	$7.74	$0.00	$2.09	$0.00	$0.00	$0.00	$0.00	$4.56	$7.22	$7.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27489	ERX	HCPCS 63700001	53489-0368-01	FELODIPINE ER 2.5 MG PO TB24	BOTH IP/OP	$6.34 	$4.69	$0.00	$4.80		$0.00	$0.00	$0.00	$1.13	$0.00	$0.00	$0.00	$0.00	$0.00	$1.32	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27490	ERX	HCPCS 63700001	00603-3582-21	FELODIPINE ER 5 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27490	ERX	HCPCS 63700001	53489-0369-01	FELODIPINE ER 5 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27491	ERX	HCPCS 63700001	53489-0370-01	FELODIPINE ER 10 MG PO TB24	BOTH IP/OP	$10.32 	$7.64	$0.00	$8.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.16	$8.17	$8.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27494	ERX	HCPCS 63700001	00378-2223-01	NISOLDIPINE ER 30 MG PO TB24	BOTH IP/OP	$75.18 	$55.63	$0.00	$54.54		$0.00	$0.00	$0.00	$13.38	$0.00	$0.00	$0.00	$0.00	$0.00	$15.67	$0.00	$0.00	$0.00	$0.00	$34.09	$54.00	$54.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27495	ERX	HCPCS 63700001	00378-2224-01	NISOLDIPINE ER 40 MG PO TB24	BOTH IP/OP	$75.18 	$55.63	$0.00	$54.54		$0.00	$0.00	$0.00	$13.38	$0.00	$0.00	$0.00	$0.00	$0.00	$15.67	$0.00	$0.00	$0.00	$0.00	$34.09	$54.00	$54.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27520	ERX	HCPCS 63700001	00573-2660-12	LORATADINE-PSEUDOEPHEDRINE ER 5-120 MG PO TB12	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27520	ERX	HCPCS 63700001	00573-2660-24	LORATADINE-PSEUDOEPHEDRINE ER 5-120 MG PO TB12	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27529	ERX	HCPCS 63700001	63824-0057-18	PSEUDOEPHEDRINE-GUAIFENESIN ER 60-600 MG PO TB12	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27529	ERX	HCPCS 63700001	63824-0057-36	PSEUDOEPHEDRINE-GUAIFENESIN ER 60-600 MG PO TB12	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27631	ERX	HCPCS 63700001	68084-0313-01	DIVALPROEX SODIUM 125 MG PO CSDR	BOTH IP/OP	$8.20 	$6.07	$0.00	$6.56		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.10	$6.49	$6.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27631	ERX	HCPCS 63700001	68084-0313-11	DIVALPROEX SODIUM 125 MG PO CSDR	BOTH IP/OP	$8.20 	$6.07	$0.00	$6.56		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.10	$6.49	$6.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27632	ERX	HCPCS 63700001	54092-0172-12	CARBAMAZEPINE ER 200 MG PO CP12	BOTH IP/OP	$8.92 	$6.60	$0.00	$6.47		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$4.05	$6.41	$6.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27633	ERX	HCPCS 63700001	54092-0173-12	CARBAMAZEPINE ER 300 MG PO CP12	BOTH IP/OP	$8.92 	$6.60	$0.00	$6.47		$0.00	$0.00	$0.00	$1.59	$0.00	$0.00	$0.00	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$4.05	$6.41	$6.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27634	ERX	HCPCS 63700001	00078-0510-05	CARBAMAZEPINE ER 100 MG PO TB12	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27634	ERX	HCPCS 63700001	00781-8016-01	CARBAMAZEPINE ER 100 MG PO TB12	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27635	ERX	HCPCS 63700001	00078-0511-05	CARBAMAZEPINE ER 200 MG PO TB12	BOTH IP/OP	$8.72 	$6.45	$0.00	$6.33		$0.00	$0.00	$0.00	$1.55	$0.00	$0.00	$0.00	$0.00	$0.00	$1.82	$0.00	$0.00	$0.00	$0.00	$3.96	$6.26	$6.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27635	ERX	HCPCS 63700001	00781-5987-01	CARBAMAZEPINE ER 200 MG PO TB12	BOTH IP/OP	$8.72 	$6.45	$0.00	$6.33		$0.00	$0.00	$0.00	$1.55	$0.00	$0.00	$0.00	$0.00	$0.00	$1.82	$0.00	$0.00	$0.00	$0.00	$3.96	$6.26	$6.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27635	ERX	HCPCS 63700001	51672-4124-01	CARBAMAZEPINE ER 200 MG PO TB12	BOTH IP/OP	$8.72 	$6.45	$0.00	$6.33		$0.00	$0.00	$0.00	$1.55	$0.00	$0.00	$0.00	$0.00	$0.00	$1.82	$0.00	$0.00	$0.00	$0.00	$3.96	$6.26	$6.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27636	ERX	HCPCS 63700001	00078-0512-05	CARBAMAZEPINE ER 400 MG PO TB12	BOTH IP/OP	$27.21 	$20.14	$0.00	$19.74		$0.00	$0.00	$0.00	$4.84	$0.00	$0.00	$0.00	$0.00	$0.00	$5.67	$0.00	$0.00	$0.00	$0.00	$12.34	$19.54	$19.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27636	ERX	HCPCS 63700001	00781-5988-01	CARBAMAZEPINE ER 400 MG PO TB12	BOTH IP/OP	$27.21 	$20.14	$0.00	$19.74		$0.00	$0.00	$0.00	$4.84	$0.00	$0.00	$0.00	$0.00	$0.00	$5.67	$0.00	$0.00	$0.00	$0.00	$12.34	$19.54	$19.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27636	ERX	HCPCS 63700001	51672-4125-01	CARBAMAZEPINE ER 400 MG PO TB12	BOTH IP/OP	$27.21 	$20.14	$0.00	$19.74		$0.00	$0.00	$0.00	$4.84	$0.00	$0.00	$0.00	$0.00	$0.00	$5.67	$0.00	$0.00	$0.00	$0.00	$12.34	$19.54	$19.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27641	ERX	HCPCS 63700001	00093-7335-06	TOPIRAMATE 15 MG PO CPSP	BOTH IP/OP	$29.96 	$22.17	$0.00	$21.31		$0.00	$0.00	$0.00	$5.44	$0.00	$0.00	$0.00	$0.00	$0.00	$6.24	$0.00	$0.00	$0.00	$0.00	$13.32	$21.10	$21.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27641	ERX	HCPCS 63700001	50458-0647-65	TOPIRAMATE 15 MG PO CPSP	BOTH IP/OP	$29.96 	$22.17	$0.00	$21.31		$0.00	$0.00	$0.00	$5.44	$0.00	$0.00	$0.00	$0.00	$0.00	$6.24	$0.00	$0.00	$0.00	$0.00	$13.32	$21.10	$21.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27641	ERX	HCPCS 63700001	68382-0004-14	TOPIRAMATE 15 MG PO CPSP	BOTH IP/OP	$29.96 	$22.17	$0.00	$21.31		$0.00	$0.00	$0.00	$5.44	$0.00	$0.00	$0.00	$0.00	$0.00	$6.24	$0.00	$0.00	$0.00	$0.00	$13.32	$21.10	$21.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27642	ERX	HCPCS 63700001	00093-7336-06	TOPIRAMATE 25 MG PO CPSP	BOTH IP/OP	$12.26 	$9.07	$0.00	$8.90		$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$5.56	$8.81	$8.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27642	ERX	HCPCS 63700001	50458-0645-65	TOPIRAMATE 25 MG PO CPSP	BOTH IP/OP	$12.26 	$9.07	$0.00	$8.90		$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$5.56	$8.81	$8.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27642	ERX	HCPCS 63700001	68382-0005-14	TOPIRAMATE 25 MG PO CPSP	BOTH IP/OP	$12.26 	$9.07	$0.00	$8.90		$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$5.56	$8.81	$8.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27644	ERX	HCPCS 25000001	65162-0596-06	ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12	BOTH IP/OP	$35.01 	$25.91	$0.00	$26.99		$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$26.99	$0.00	$7.30	$0.00	$0.00	$0.00	$0.00	$15.88	$25.15	$25.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27659	ERX	HCPCS 63700001	62175-0261-37	NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27659	ERX	HCPCS 63700001	71205-0964-00	NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27661	ERX	HCPCS 25000001	49938-0107-04	AMINOSALICYLIC ACID 4 G PO PACK	BOTH IP/OP	$33.52 	$24.80	$0.00	$25.84		$0.00	$0.00	$0.00	$0.00	$0.00	$24.88	$24.88	$25.84	$0.00	$6.99	$0.00	$0.00	$0.00	$0.00	$15.20	$24.08	$24.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27662	ERX	HCPCS 25000001	17478-0403-03	FLUORESCEIN SODIUM 0.6 MG OP STRP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27663	ERX	HCPCS 25000001	17238-0900-11	FLUORESCEIN SODIUM 1 MG OP STRP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27663	ERX	HCPCS 25000001	17238-0900-30	FLUORESCEIN SODIUM 1 MG OP STRP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27663	ERX	HCPCS 25000001	17238-0900-99	FLUORESCEIN SODIUM 1 MG OP STRP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27663	ERX	HCPCS 25000001	17478-0404-01	FLUORESCEIN SODIUM 1 MG OP STRP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27667	ERX	HCPCS 25000001	45802-0050-03	DIBUCAINE (PERIANAL) 1 % EX OINT	BOTH IP/OP	$25.11 	$18.58	$0.00	$19.35		$0.00	$0.00	$0.00	$0.00	$0.00	$18.64	$18.64	$19.35	$0.00	$5.23	$0.00	$0.00	$0.00	$0.00	$11.39	$18.03	$18.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27691	ERX	HCPCS 63700001	00781-2147-31	LANSOPRAZOLE 15 MG PO CPDR	BOTH IP/OP	$23.75 	$17.58	$0.00	$17.23		$0.00	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$0.00	$4.95	$0.00	$0.00	$0.00	$0.00	$10.77	$17.06	$17.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27692	ERX	HCPCS 63700001	00093-7351-56	LANSOPRAZOLE 30 MG PO CPDR	BOTH IP/OP	$24.72 	$18.29	$0.00	$17.94		$0.00	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00	$5.15	$0.00	$0.00	$0.00	$0.00	$11.21	$17.76	$17.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27692	ERX	HCPCS 63700001	00378-8030-93	LANSOPRAZOLE 30 MG PO CPDR	BOTH IP/OP	$24.72 	$18.29	$0.00	$17.94		$0.00	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00	$5.15	$0.00	$0.00	$0.00	$0.00	$11.21	$17.76	$17.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27692	ERX	HCPCS 63700001	51079-0121-01	LANSOPRAZOLE 30 MG PO CPDR	BOTH IP/OP	$24.72 	$18.29	$0.00	$17.94		$0.00	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00	$5.15	$0.00	$0.00	$0.00	$0.00	$11.21	$17.76	$17.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27694	ERX	HCPCS 63700001	16714-0747-01	OMEPRAZOLE 20 MG PO CPDR	BOTH IP/OP	$16.52 	$12.22	$0.00	$13.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.26	$13.08	$13.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27694	ERX	HCPCS 63700001	16714-0747-02	OMEPRAZOLE 20 MG PO CPDR	BOTH IP/OP	$16.52 	$12.22	$0.00	$13.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.26	$13.08	$13.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27694	ERX	HCPCS 63700001	63739-0358-10	OMEPRAZOLE 20 MG PO CPDR	BOTH IP/OP	$16.52 	$12.22	$0.00	$13.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.26	$13.08	$13.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27695	ERX	HCPCS 63700001	00781-2234-31	OMEPRAZOLE 40 MG PO CPDR	BOTH IP/OP	$7.72 	$5.71	$0.00	$6.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.86	$6.11	$6.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27695	ERX	HCPCS 63700001	63739-0445-10	OMEPRAZOLE 40 MG PO CPDR	BOTH IP/OP	$7.72 	$5.71	$0.00	$6.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.86	$6.11	$6.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27697	ERX	HCPCS Q0162	00781-5238-64	ONDANSETRON 4 MG PO TBDP	BOTH IP/OP	$78.03 	$57.74	$0.00	$62.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.02	$61.80	$62.42	$0.00		$0.00	$0.00	$0.00	$0.00	$12.42	$0.00	$0.00	$0.00	$0.00	$0.00
27697	ERX	HCPCS Q0162	57237-0077-10	ONDANSETRON 4 MG PO TBDP	BOTH IP/OP	$78.03 	$57.74	$0.00	$62.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.02	$61.80	$62.42	$0.00		$0.00	$0.00	$0.00	$0.00	$12.42	$0.00	$0.00	$0.00	$0.00	$0.00
27697	ERX	HCPCS Q0162	65862-0390-10	ONDANSETRON 4 MG PO TBDP	BOTH IP/OP	$78.03 	$57.74	$0.00	$62.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.02	$61.80	$62.42	$0.00		$0.00	$0.00	$0.00	$0.00	$12.42	$0.00	$0.00	$0.00	$0.00	$0.00
27698	ERX	HCPCS Q0162	00781-5239-06	ONDANSETRON 8 MG PO TBDP	BOTH IP/OP	$129.97 	$96.18	$0.00	$103.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.99	$102.94	$103.98	$0.00		$0.00	$0.00	$0.00	$0.00	$20.69	$0.00	$0.00	$0.00	$0.00	$0.00
27698	ERX	HCPCS Q0162	65862-0391-10	ONDANSETRON 8 MG PO TBDP	BOTH IP/OP	$129.97 	$96.18	$0.00	$103.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.99	$102.94	$103.98	$0.00		$0.00	$0.00	$0.00	$0.00	$20.69	$0.00	$0.00	$0.00	$0.00	$0.00
27735	ERX	HCPCS Q9958	00270-0149-57	DIATRIZOATE MEGLUMINE 30 % UR SOLN	BOTH IP/OP	$230.07 	$170.25	$0.00	$170.76	$103.53	$103.53	$0.00	$0.00	$0.00	$47.95	$170.76	$170.76	$0.00	$0.00	$24.68	$0.00	$136.09	$136.09	$0.00	$104.43	$165.41	$167.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27770	ERX	HCPCS 25000001	24208-0342-05	DESMOPRESSIN ACE SPRAY REFRIG 0.01 % NA SOLN	BOTH IP/OP	$719.08 	$532.12	$0.00	$554.27		$0.00	$0.00	$0.00	$0.00	$0.00	$533.70	$533.70	$554.27	$0.00	$149.86	$0.00	$0.00	$0.00	$0.00	$326.30	$516.85	$522.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27780	ERX	HCPCS 63700001	50268-0816-15	ZONISAMIDE 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27780	ERX	HCPCS 63700001	60687-0230-01	ZONISAMIDE 100 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00264-7800-00	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00338-0049-04	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	99999-6008-99	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	99999-6009-26	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	99999-6008-17	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00264-1800-32	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00338-0049-18	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00338-0049-38	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00338-0049-48	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00338-0553-18	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00990-7984-37	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	99999-6010-80	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00264-7800-20	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00338-0049-02	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00990-7983-02	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	99999-6008-15	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00264-1800-31	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00338-0049-11	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00338-0049-31	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00338-0049-41	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00338-0553-11	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00990-7984-13	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	00338-0049-03	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	99999-6008-16	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27838	ERX	HCPCS J7040	99999-6010-79	SODIUM CHLORIDE 0.9 % IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.05	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
27855	ERX	HCPCS 25000001	00013-2150-36	ESTRADIOL 2 MG VA RING	BOTH IP/OP	"$1,568.04 "	"$1,160.35"	$0.00	"$1,208.65"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,163.80"	"$1,163.80"	"$1,208.65"	$0.00	$326.78	$0.00	$0.00	$0.00	$0.00	$684.81	"$1,084.73"	"$1,095.69"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27857	ERX	HCPCS 63700001	00093-7384-98	VENLAFAXINE HCL ER 37.5 MG PO CP24	BOTH IP/OP	$17.45 	$12.91	$0.00	$12.66		$0.00	$0.00	$0.00	$3.11	$0.00	$0.00	$0.00	$0.00	$0.00	$3.64	$0.00	$0.00	$0.00	$0.00	$7.92	$12.54	$12.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27857	ERX	HCPCS 63700001	65862-0527-30	VENLAFAXINE HCL ER 37.5 MG PO CP24	BOTH IP/OP	$17.45 	$12.91	$0.00	$12.66		$0.00	$0.00	$0.00	$3.11	$0.00	$0.00	$0.00	$0.00	$0.00	$3.64	$0.00	$0.00	$0.00	$0.00	$7.92	$12.54	$12.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27857	ERX	HCPCS 63700001	68382-0034-06	VENLAFAXINE HCL ER 37.5 MG PO CP24	BOTH IP/OP	$17.45 	$12.91	$0.00	$12.66		$0.00	$0.00	$0.00	$3.11	$0.00	$0.00	$0.00	$0.00	$0.00	$3.64	$0.00	$0.00	$0.00	$0.00	$7.92	$12.54	$12.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27857	ERX	HCPCS 63700001	68382-0034-16	VENLAFAXINE HCL ER 37.5 MG PO CP24	BOTH IP/OP	$17.45 	$12.91	$0.00	$12.66		$0.00	$0.00	$0.00	$3.11	$0.00	$0.00	$0.00	$0.00	$0.00	$3.64	$0.00	$0.00	$0.00	$0.00	$7.92	$12.54	$12.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27858	ERX	HCPCS 63700001	00008-0833-21	VENLAFAXINE HCL ER 75 MG PO CP24	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27858	ERX	HCPCS 63700001	00093-7385-56	VENLAFAXINE HCL ER 75 MG PO CP24	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27858	ERX	HCPCS 63700001	00093-7385-98	VENLAFAXINE HCL ER 75 MG PO CP24	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27858	ERX	HCPCS 63700001	65862-0528-90	VENLAFAXINE HCL ER 75 MG PO CP24	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27859	ERX	HCPCS 63700001	00093-7386-56	VENLAFAXINE HCL ER 150 MG PO CP24	BOTH IP/OP	$21.30 	$15.76	$0.00	$15.46		$0.00	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00	$4.44	$0.00	$0.00	$0.00	$0.00	$9.66	$15.30	$15.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27859	ERX	HCPCS 63700001	00093-7386-98	VENLAFAXINE HCL ER 150 MG PO CP24	BOTH IP/OP	$21.30 	$15.76	$0.00	$15.46		$0.00	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00	$4.44	$0.00	$0.00	$0.00	$0.00	$9.66	$15.30	$15.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27859	ERX	HCPCS 63700001	63739-0512-10	VENLAFAXINE HCL ER 150 MG PO CP24	BOTH IP/OP	$21.30 	$15.76	$0.00	$15.46		$0.00	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00	$4.44	$0.00	$0.00	$0.00	$0.00	$9.66	$15.30	$15.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27860	ERX	HCPCS 63700001	00536-1106-88	NICOTINE 7 MG/24HR TD PT24	BOTH IP/OP	$7.93 	$5.87	$0.00	$5.75		$0.00	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.69	$5.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27860	ERX	HCPCS 63700001	70677-0030-01	NICOTINE 7 MG/24HR TD PT24	BOTH IP/OP	$7.93 	$5.87	$0.00	$5.75		$0.00	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.69	$5.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27862	ERX	HCPCS 63700001		NICOTINE 14 MG/24HR TD PT24	BOTH IP/OP	$8.98 	$6.65	$0.00	$6.51		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.07	$6.45	$6.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27862	ERX	HCPCS 63700001	00536-5895-88	NICOTINE 14 MG/24HR TD PT24	BOTH IP/OP	$8.98 	$6.65	$0.00	$6.51		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$4.07	$6.45	$6.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27863	ERX	HCPCS 63700001		NICOTINE 21 MG/24HR TD PT24	BOTH IP/OP	$7.93 	$5.87	$0.00	$5.75		$0.00	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.69	$5.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27863	ERX	HCPCS 63700001	00536-5896-71	NICOTINE 21 MG/24HR TD PT24	BOTH IP/OP	$7.93 	$5.87	$0.00	$5.75		$0.00	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.69	$5.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27863	ERX	HCPCS 63700001	00536-5896-88	NICOTINE 21 MG/24HR TD PT24	BOTH IP/OP	$7.93 	$5.87	$0.00	$5.75		$0.00	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.69	$5.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27863	ERX	HCPCS 63700001	43598-0448-71	NICOTINE 21 MG/24HR TD PT24	BOTH IP/OP	$7.93 	$5.87	$0.00	$5.75		$0.00	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.69	$5.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27863	ERX	HCPCS 63700001	49348-0144-46	NICOTINE 21 MG/24HR TD PT24	BOTH IP/OP	$7.93 	$5.87	$0.00	$5.75		$0.00	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.69	$5.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27863	ERX	HCPCS 63700001	70677-0032-01	NICOTINE 21 MG/24HR TD PT24	BOTH IP/OP	$7.93 	$5.87	$0.00	$5.75		$0.00	$0.00	$0.00	$1.41	$0.00	$0.00	$0.00	$0.00	$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$3.60	$5.69	$5.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27898	ERX	HCPCS 25000001	00054-3500-49	LIDOCAINE VISCOUS HCL 2 % MT SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27898	ERX	HCPCS 25000001	50383-0775-04	LIDOCAINE VISCOUS HCL 2 % MT SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27898	ERX	HCPCS 25000001	50383-0775-17	LIDOCAINE VISCOUS HCL 2 % MT SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27898	ERX	HCPCS 25000001	63739-0694-57	LIDOCAINE VISCOUS HCL 2 % MT SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27898	ERX	HCPCS 25000001	99999-6007-04	LIDOCAINE VISCOUS HCL 2 % MT SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27905	ERX	HCPCS 63700001	00378-9121-98	FENTANYL 25 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$60.42 	$44.71	$0.00	$43.84		$0.00	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00	$12.59	$0.00	$0.00	$0.00	$0.00	$27.40	$43.40	$43.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27905	ERX	HCPCS 63700001	47781-0424-47	FENTANYL 25 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$60.42 	$44.71	$0.00	$43.84		$0.00	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00	$12.59	$0.00	$0.00	$0.00	$0.00	$27.40	$43.40	$43.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27905	ERX	HCPCS 63700001	60505-7006-02	FENTANYL 25 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$60.42 	$44.71	$0.00	$43.84		$0.00	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00	$12.59	$0.00	$0.00	$0.00	$0.00	$27.40	$43.40	$43.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27905	ERX	HCPCS 63700001	60505-7081-02	FENTANYL 25 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$60.42 	$44.71	$0.00	$43.84		$0.00	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00	$12.59	$0.00	$0.00	$0.00	$0.00	$27.40	$43.40	$43.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27905	ERX	HCPCS 63700001	67767-0120-08	FENTANYL 25 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$60.42 	$44.71	$0.00	$43.84		$0.00	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00	$12.59	$0.00	$0.00	$0.00	$0.00	$27.40	$43.40	$43.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27906	ERX	HCPCS 63700001	47781-0426-47	FENTANYL 50 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$150.09 	$111.07	$0.00	$108.87		$0.00	$0.00	$0.00	$26.72	$0.00	$0.00	$0.00	$0.00	$0.00	$31.28	$0.00	$0.00	$0.00	$0.00	$68.05	$107.78	$108.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27906	ERX	HCPCS 63700001	60505-7007-02	FENTANYL 50 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$150.09 	$111.07	$0.00	$108.87		$0.00	$0.00	$0.00	$26.72	$0.00	$0.00	$0.00	$0.00	$0.00	$31.28	$0.00	$0.00	$0.00	$0.00	$68.05	$107.78	$108.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27907	ERX	HCPCS 63700001	47781-0427-47	FENTANYL 75 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$205.80 	$152.29	$0.00	$149.46		$0.00	$0.00	$0.00	$36.63	$0.00	$0.00	$0.00	$0.00	$0.00	$42.89	$0.00	$0.00	$0.00	$0.00	$93.41	$147.96	$149.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27907	ERX	HCPCS 63700001	60505-7008-02	FENTANYL 75 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$205.80 	$152.29	$0.00	$149.46		$0.00	$0.00	$0.00	$36.63	$0.00	$0.00	$0.00	$0.00	$0.00	$42.89	$0.00	$0.00	$0.00	$0.00	$93.41	$147.96	$149.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27907	ERX	HCPCS 63700001	60505-7013-02	FENTANYL 75 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$205.80 	$152.29	$0.00	$149.46		$0.00	$0.00	$0.00	$36.63	$0.00	$0.00	$0.00	$0.00	$0.00	$42.89	$0.00	$0.00	$0.00	$0.00	$93.41	$147.96	$149.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27908	ERX	HCPCS 63700001	47781-0428-11	FENTANYL 100 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$273.14 	$202.12	$0.00	$198.36		$0.00	$0.00	$0.00	$48.62	$0.00	$0.00	$0.00	$0.00	$0.00	$56.92	$0.00	$0.00	$0.00	$0.00	$123.98	$196.38	$198.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27908	ERX	HCPCS 63700001	47781-0428-47	FENTANYL 100 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$273.14 	$202.12	$0.00	$198.36		$0.00	$0.00	$0.00	$48.62	$0.00	$0.00	$0.00	$0.00	$0.00	$56.92	$0.00	$0.00	$0.00	$0.00	$123.98	$196.38	$198.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27908	ERX	HCPCS 63700001	60505-7009-02	FENTANYL 100 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$273.14 	$202.12	$0.00	$198.36		$0.00	$0.00	$0.00	$48.62	$0.00	$0.00	$0.00	$0.00	$0.00	$56.92	$0.00	$0.00	$0.00	$0.00	$123.98	$196.38	$198.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27999	ERX	HCPCS 25000001	00574-2002-02	SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP	BOTH IP/OP	$42.87 	$31.72	$0.00	$34.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.44	$33.95	$34.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27999	ERX	HCPCS 25000001	00574-2002-16	SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP	BOTH IP/OP	$42.87 	$31.72	$0.00	$34.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.44	$33.95	$34.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27999	ERX	HCPCS 25000001	46287-0006-01	SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP	BOTH IP/OP	$42.87 	$31.72	$0.00	$34.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.44	$33.95	$34.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27999	ERX	HCPCS 25000001	46287-0006-60	SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP	BOTH IP/OP	$42.87 	$31.72	$0.00	$34.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.44	$33.95	$34.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27999	ERX	HCPCS 25000001	99999-6010-75	SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP	BOTH IP/OP	$42.87 	$31.72	$0.00	$34.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.44	$33.95	$34.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28001	ERX	HCPCS 25000001	00093-9614-13	SILVER NITRATE 0.5 % EX SOLN	BOTH IP/OP	$293.15 	$216.93	$0.00	$225.96		$0.00	$0.00	$0.00	$0.00	$0.00	$217.58	$217.58	$225.96	$0.00	$61.09	$0.00	$0.00	$0.00	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28158	ERX	HCPCS 63700001	00904-6287-06	OLANZAPINE 20 MG PO TABS	BOTH IP/OP	$153.75 	$113.78	$0.00	$111.53		$0.00	$0.00	$0.00	$27.37	$0.00	$0.00	$0.00	$0.00	$0.00	$32.04	$0.00	$0.00	$0.00	$0.00	$69.71	$110.41	$111.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28158	ERX	HCPCS 63700001	55111-0168-30	OLANZAPINE 20 MG PO TABS	BOTH IP/OP	$153.75 	$113.78	$0.00	$111.53		$0.00	$0.00	$0.00	$27.37	$0.00	$0.00	$0.00	$0.00	$0.00	$32.04	$0.00	$0.00	$0.00	$0.00	$69.71	$110.41	$111.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28158	ERX	HCPCS 63700001	60505-3140-00	OLANZAPINE 20 MG PO TABS	BOTH IP/OP	$153.75 	$113.78	$0.00	$111.53		$0.00	$0.00	$0.00	$27.37	$0.00	$0.00	$0.00	$0.00	$0.00	$32.04	$0.00	$0.00	$0.00	$0.00	$69.71	$110.41	$111.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28159	ERX	HCPCS 63700001	00002-4453-01	OLANZAPINE 5 MG PO TBDP	BOTH IP/OP	$58.66 	$43.41	$0.00	$42.56		$0.00	$0.00	$0.00	$10.44	$0.00	$0.00	$0.00	$0.00	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28159	ERX	HCPCS 63700001	00002-4453-85	OLANZAPINE 5 MG PO TBDP	BOTH IP/OP	$58.66 	$43.41	$0.00	$42.56		$0.00	$0.00	$0.00	$10.44	$0.00	$0.00	$0.00	$0.00	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28159	ERX	HCPCS 63700001	00093-5245-65	OLANZAPINE 5 MG PO TBDP	BOTH IP/OP	$58.66 	$43.41	$0.00	$42.56		$0.00	$0.00	$0.00	$10.44	$0.00	$0.00	$0.00	$0.00	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28159	ERX	HCPCS 63700001	13668-0086-30	OLANZAPINE 5 MG PO TBDP	BOTH IP/OP	$58.66 	$43.41	$0.00	$42.56		$0.00	$0.00	$0.00	$10.44	$0.00	$0.00	$0.00	$0.00	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28159	ERX	HCPCS 63700001	33342-0083-07	OLANZAPINE 5 MG PO TBDP	BOTH IP/OP	$58.66 	$43.41	$0.00	$42.56		$0.00	$0.00	$0.00	$10.44	$0.00	$0.00	$0.00	$0.00	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28159	ERX	HCPCS 63700001	49884-0320-55	OLANZAPINE 5 MG PO TBDP	BOTH IP/OP	$58.66 	$43.41	$0.00	$42.56		$0.00	$0.00	$0.00	$10.44	$0.00	$0.00	$0.00	$0.00	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28159	ERX	HCPCS 63700001	50268-0615-11	OLANZAPINE 5 MG PO TBDP	BOTH IP/OP	$58.66 	$43.41	$0.00	$42.56		$0.00	$0.00	$0.00	$10.44	$0.00	$0.00	$0.00	$0.00	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28159	ERX	HCPCS 63700001	50268-0615-13	OLANZAPINE 5 MG PO TBDP	BOTH IP/OP	$58.66 	$43.41	$0.00	$42.56		$0.00	$0.00	$0.00	$10.44	$0.00	$0.00	$0.00	$0.00	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28159	ERX	HCPCS 63700001	55111-0262-81	OLANZAPINE 5 MG PO TBDP	BOTH IP/OP	$58.66 	$43.41	$0.00	$42.56		$0.00	$0.00	$0.00	$10.44	$0.00	$0.00	$0.00	$0.00	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28159	ERX	HCPCS 63700001	60505-3275-00	OLANZAPINE 5 MG PO TBDP	BOTH IP/OP	$58.66 	$43.41	$0.00	$42.56		$0.00	$0.00	$0.00	$10.44	$0.00	$0.00	$0.00	$0.00	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28159	ERX	HCPCS 63700001	60505-3275-03	OLANZAPINE 5 MG PO TBDP	BOTH IP/OP	$58.66 	$43.41	$0.00	$42.56		$0.00	$0.00	$0.00	$10.44	$0.00	$0.00	$0.00	$0.00	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28160	ERX	HCPCS 63700001	00002-4454-01	OLANZAPINE 10 MG PO TBDP	BOTH IP/OP	$79.78 	$59.04	$0.00	$57.87		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$16.63	$0.00	$0.00	$0.00	$0.00	$36.17	$57.29	$57.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28160	ERX	HCPCS 63700001	00002-4454-85	OLANZAPINE 10 MG PO TBDP	BOTH IP/OP	$79.78 	$59.04	$0.00	$57.87		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$16.63	$0.00	$0.00	$0.00	$0.00	$36.17	$57.29	$57.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28160	ERX	HCPCS 63700001	13668-0088-30	OLANZAPINE 10 MG PO TBDP	BOTH IP/OP	$79.78 	$59.04	$0.00	$57.87		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$16.63	$0.00	$0.00	$0.00	$0.00	$36.17	$57.29	$57.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28160	ERX	HCPCS 63700001	49884-0321-55	OLANZAPINE 10 MG PO TBDP	BOTH IP/OP	$79.78 	$59.04	$0.00	$57.87		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$16.63	$0.00	$0.00	$0.00	$0.00	$36.17	$57.29	$57.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28160	ERX	HCPCS 63700001	50268-0616-13	OLANZAPINE 10 MG PO TBDP	BOTH IP/OP	$79.78 	$59.04	$0.00	$57.87		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$16.63	$0.00	$0.00	$0.00	$0.00	$36.17	$57.29	$57.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28160	ERX	HCPCS 63700001	55111-0263-81	OLANZAPINE 10 MG PO TBDP	BOTH IP/OP	$79.78 	$59.04	$0.00	$57.87		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$16.63	$0.00	$0.00	$0.00	$0.00	$36.17	$57.29	$57.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28160	ERX	HCPCS 63700001	59746-0307-32	OLANZAPINE 10 MG PO TBDP	BOTH IP/OP	$79.78 	$59.04	$0.00	$57.87		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$16.63	$0.00	$0.00	$0.00	$0.00	$36.17	$57.29	$57.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28160	ERX	HCPCS 63700001	60505-3276-00	OLANZAPINE 10 MG PO TBDP	BOTH IP/OP	$79.78 	$59.04	$0.00	$57.87		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$16.63	$0.00	$0.00	$0.00	$0.00	$36.17	$57.29	$57.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28160	ERX	HCPCS 63700001	60505-3276-03	OLANZAPINE 10 MG PO TBDP	BOTH IP/OP	$79.78 	$59.04	$0.00	$57.87		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$16.63	$0.00	$0.00	$0.00	$0.00	$36.17	$57.29	$57.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28161	ERX	HCPCS 63700001	13668-0089-30	OLANZAPINE 15 MG PO TBDP	BOTH IP/OP	$117.09 	$86.65	$0.00	$84.94		$0.00	$0.00	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$0.00	$24.40	$0.00	$0.00	$0.00	$0.00	$53.09	$84.09	$84.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28161	ERX	HCPCS 63700001	33342-0085-07	OLANZAPINE 15 MG PO TBDP	BOTH IP/OP	$117.09 	$86.65	$0.00	$84.94		$0.00	$0.00	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$0.00	$24.40	$0.00	$0.00	$0.00	$0.00	$53.09	$84.09	$84.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28161	ERX	HCPCS 63700001	49884-0322-52	OLANZAPINE 15 MG PO TBDP	BOTH IP/OP	$117.09 	$86.65	$0.00	$84.94		$0.00	$0.00	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$0.00	$24.40	$0.00	$0.00	$0.00	$0.00	$53.09	$84.09	$84.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28162	ERX	HCPCS 63700001	00002-4456-01	OLANZAPINE 20 MG PO TBDP	BOTH IP/OP	$154.40 	$114.26	$0.00	$112.00		$0.00	$0.00	$0.00	$27.48	$0.00	$0.00	$0.00	$0.00	$0.00	$32.18	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28162	ERX	HCPCS 63700001	00002-4456-85	OLANZAPINE 20 MG PO TBDP	BOTH IP/OP	$154.40 	$114.26	$0.00	$112.00		$0.00	$0.00	$0.00	$27.48	$0.00	$0.00	$0.00	$0.00	$0.00	$32.18	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28162	ERX	HCPCS 63700001	00093-5248-65	OLANZAPINE 20 MG PO TBDP	BOTH IP/OP	$154.40 	$114.26	$0.00	$112.00		$0.00	$0.00	$0.00	$27.48	$0.00	$0.00	$0.00	$0.00	$0.00	$32.18	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28162	ERX	HCPCS 63700001	13668-0090-30	OLANZAPINE 20 MG PO TBDP	BOTH IP/OP	$154.40 	$114.26	$0.00	$112.00		$0.00	$0.00	$0.00	$27.48	$0.00	$0.00	$0.00	$0.00	$0.00	$32.18	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28162	ERX	HCPCS 63700001	55111-0265-81	OLANZAPINE 20 MG PO TBDP	BOTH IP/OP	$154.40 	$114.26	$0.00	$112.00		$0.00	$0.00	$0.00	$27.48	$0.00	$0.00	$0.00	$0.00	$0.00	$32.18	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28162	ERX	HCPCS 63700001	60505-3278-00	OLANZAPINE 20 MG PO TBDP	BOTH IP/OP	$154.40 	$114.26	$0.00	$112.00		$0.00	$0.00	$0.00	$27.48	$0.00	$0.00	$0.00	$0.00	$0.00	$32.18	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28162	ERX	HCPCS 63700001	60505-3278-03	OLANZAPINE 20 MG PO TBDP	BOTH IP/OP	$154.40 	$114.26	$0.00	$112.00		$0.00	$0.00	$0.00	$27.48	$0.00	$0.00	$0.00	$0.00	$0.00	$32.18	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28188	ERX	HCPCS 25000001	67618-0200-08	CHLORHEXIDINE GLUCONATE 4 % EX LIQD	BOTH IP/OP	$36.75 	$27.20	$0.00	$28.33		$0.00	$0.00	$0.00	$0.00	$0.00	$27.28	$27.28	$28.33	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$16.67	$26.40	$26.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28203	ERX	HCPCS 25000001	00378-9055-16	LIDOCAINE 5 % EX PTCH	BOTH IP/OP	$39.22 	$29.02	$0.00	$30.23		$0.00	$0.00	$0.00	$0.00	$0.00	$29.11	$29.11	$30.23	$0.00	$8.17	$0.00	$0.00	$0.00	$0.00	$17.79	$28.17	$28.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28203	ERX	HCPCS 25000001	00591-2679-30	LIDOCAINE 5 % EX PTCH	BOTH IP/OP	$39.22 	$29.02	$0.00	$30.23		$0.00	$0.00	$0.00	$0.00	$0.00	$29.11	$29.11	$30.23	$0.00	$8.17	$0.00	$0.00	$0.00	$0.00	$17.79	$28.17	$28.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28203	ERX	HCPCS 25000001	00591-3525-30	LIDOCAINE 5 % EX PTCH	BOTH IP/OP	$39.22 	$29.02	$0.00	$30.23		$0.00	$0.00	$0.00	$0.00	$0.00	$29.11	$29.11	$30.23	$0.00	$8.17	$0.00	$0.00	$0.00	$0.00	$17.79	$28.17	$28.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28203	ERX	HCPCS 25000001	00603-1880-10	LIDOCAINE 5 % EX PTCH	BOTH IP/OP	$39.22 	$29.02	$0.00	$30.23		$0.00	$0.00	$0.00	$0.00	$0.00	$29.11	$29.11	$30.23	$0.00	$8.17	$0.00	$0.00	$0.00	$0.00	$17.79	$28.17	$28.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28203	ERX	HCPCS 25000001	00603-1880-16	LIDOCAINE 5 % EX PTCH	BOTH IP/OP	$39.22 	$29.02	$0.00	$30.23		$0.00	$0.00	$0.00	$0.00	$0.00	$29.11	$29.11	$30.23	$0.00	$8.17	$0.00	$0.00	$0.00	$0.00	$17.79	$28.17	$28.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28205	ERX	HCPCS 25000001	00295-1201-31	PEPPERMINT SPIRIT SPRT	BOTH IP/OP	$40.73 	$30.14	$0.00	$31.39		$0.00	$0.00	$0.00	$0.00	$0.00	$30.23	$30.23	$31.39	$0.00	$8.49	$0.00	$0.00	$0.00	$0.00	$16.93	$26.82	$27.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28205	ERX	HCPCS 25000001	00395-2243-91	PEPPERMINT SPIRIT SPRT	BOTH IP/OP	$40.73 	$30.14	$0.00	$31.39		$0.00	$0.00	$0.00	$0.00	$0.00	$30.23	$30.23	$31.39	$0.00	$8.49	$0.00	$0.00	$0.00	$0.00	$16.93	$26.82	$27.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28224	ERX	HCPCS 63700001	00904-6553-04	LINEZOLID 600 MG PO TABS	BOTH IP/OP	$540.82 	$400.21	$0.00	$432.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.41	$428.33	$432.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28224	ERX	HCPCS 63700001	59762-1307-02	LINEZOLID 600 MG PO TABS	BOTH IP/OP	$540.82 	$400.21	$0.00	$432.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.41	$428.33	$432.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28224	ERX	HCPCS 63700001	65162-0777-02	LINEZOLID 600 MG PO TABS	BOTH IP/OP	$540.82 	$400.21	$0.00	$432.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.41	$428.33	$432.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28224	ERX	HCPCS 63700001	67877-0419-20	LINEZOLID 600 MG PO TABS	BOTH IP/OP	$540.82 	$400.21	$0.00	$432.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.41	$428.33	$432.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28225	ERX	HCPCS 25000001	00009-5136-01	LINEZOLID 100 MG/5ML PO SUSR	BOTH IP/OP	"$2,119.27 "	"$1,568.26"	$0.00	"$1,633.53"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.92"	"$1,572.92"	"$1,633.53"	$0.00	$441.66	$0.00	$0.00	$0.00	$0.00	$967.32	"$1,532.23"	"$1,547.71"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28225	ERX	HCPCS 25000001	00054-0319-50	LINEZOLID 100 MG/5ML PO SUSR	BOTH IP/OP	"$2,119.27 "	"$1,568.26"	$0.00	"$1,633.53"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.92"	"$1,572.92"	"$1,633.53"	$0.00	$441.66	$0.00	$0.00	$0.00	$0.00	$967.32	"$1,532.23"	"$1,547.71"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28225	ERX	HCPCS 25000001	59762-1308-01	LINEZOLID 100 MG/5ML PO SUSR	BOTH IP/OP	"$2,119.27 "	"$1,568.26"	$0.00	"$1,633.53"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.92"	"$1,572.92"	"$1,633.53"	$0.00	$441.66	$0.00	$0.00	$0.00	$0.00	$967.32	"$1,532.23"	"$1,547.71"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28246	ERX	HCPCS 25000001	00173-0520-00	SALMETEROL XINAFOATE 50 MCG/DOSE IN AEPB	BOTH IP/OP	"$1,316.09 "	$973.91	$0.00	"$1,014.44"		$0.00	$0.00	$0.00	$0.00	$0.00	$976.80	$976.80	"$1,014.44"	$0.00	$274.27	$0.00	$0.00	$0.00	$0.00	$19.19	$30.40	$30.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28252	ERX	HCPCS 63700001	00115-5522-10	FENOFIBRATE 160 MG PO TABS	BOTH IP/OP	$9.96 	$7.37	$0.00	$7.22		$0.00	$0.00	$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$4.52	$7.15	$7.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28252	ERX	HCPCS 63700001	42858-0660-45	FENOFIBRATE 160 MG PO TABS	BOTH IP/OP	$9.96 	$7.37	$0.00	$7.22		$0.00	$0.00	$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$4.52	$7.15	$7.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28252	ERX	HCPCS 63700001	68180-0363-09	FENOFIBRATE 160 MG PO TABS	BOTH IP/OP	$9.96 	$7.37	$0.00	$7.22		$0.00	$0.00	$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$4.52	$7.15	$7.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28278	ERX	HCPCS 63700001	55111-0352-60	RIVASTIGMINE TARTRATE 1.5 MG PO CAPS	BOTH IP/OP	$17.79 	$13.16	$0.00	$12.90		$0.00	$0.00	$0.00	$3.17	$0.00	$0.00	$0.00	$0.00	$0.00	$3.71	$0.00	$0.00	$0.00	$0.00	$8.07	$12.77	$12.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28278	ERX	HCPCS 63700001	63739-0576-10	RIVASTIGMINE TARTRATE 1.5 MG PO CAPS	BOTH IP/OP	$17.79 	$13.16	$0.00	$12.90		$0.00	$0.00	$0.00	$3.17	$0.00	$0.00	$0.00	$0.00	$0.00	$3.71	$0.00	$0.00	$0.00	$0.00	$8.07	$12.77	$12.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28279	ERX	HCPCS 63700001	55111-0353-60	RIVASTIGMINE TARTRATE 3 MG PO CAPS	BOTH IP/OP	$15.33 	$11.34	$0.00	$12.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.67	$12.14	$12.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28279	ERX	HCPCS 63700001	63739-0577-10	RIVASTIGMINE TARTRATE 3 MG PO CAPS	BOTH IP/OP	$15.33 	$11.34	$0.00	$12.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.67	$12.14	$12.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28280	ERX	HCPCS 63700001	00781-2616-60	RIVASTIGMINE TARTRATE 4.5 MG PO CAPS	BOTH IP/OP	$17.69 	$13.09	$0.00	$12.83		$0.00	$0.00	$0.00	$3.15	$0.00	$0.00	$0.00	$0.00	$0.00	$3.69	$0.00	$0.00	$0.00	$0.00	$8.02	$12.70	$12.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28280	ERX	HCPCS 63700001	62756-0147-86	RIVASTIGMINE TARTRATE 4.5 MG PO CAPS	BOTH IP/OP	$17.69 	$13.09	$0.00	$12.83		$0.00	$0.00	$0.00	$3.15	$0.00	$0.00	$0.00	$0.00	$0.00	$3.69	$0.00	$0.00	$0.00	$0.00	$8.02	$12.70	$12.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28280	ERX	HCPCS 63700001	63739-0578-10	RIVASTIGMINE TARTRATE 4.5 MG PO CAPS	BOTH IP/OP	$17.69 	$13.09	$0.00	$12.83		$0.00	$0.00	$0.00	$3.15	$0.00	$0.00	$0.00	$0.00	$0.00	$3.69	$0.00	$0.00	$0.00	$0.00	$8.02	$12.70	$12.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28281	ERX	HCPCS 63700001	00781-2617-60	RIVASTIGMINE TARTRATE 6 MG PO CAPS	BOTH IP/OP	$26.14 	$19.34	$0.00	$20.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.07	$20.70	$20.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28281	ERX	HCPCS 63700001	51991-0796-06	RIVASTIGMINE TARTRATE 6 MG PO CAPS	BOTH IP/OP	$26.14 	$19.34	$0.00	$20.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.07	$20.70	$20.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28281	ERX	HCPCS 63700001	55111-0355-60	RIVASTIGMINE TARTRATE 6 MG PO CAPS	BOTH IP/OP	$26.14 	$19.34	$0.00	$20.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.07	$20.70	$20.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28282	ERX	HCPCS J1815	00088-2220-33	INSULIN GLARGINE (LANTUS) 100 UNIT/ML SC SOLN	BOTH IP/OP	$12.50 	$9.25	$0.00	$201.38	$6.79	$6.79	$0.00	$0.00	$0.00	$2.61	$0.00	$0.00	$0.00	$0.00	$2.61	$0.00	$7.39	$7.39	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$0.00	$0.00	$0.00	$201.38	$0.00	$0.00	$0.00	$0.00	$0.00
28372	ERX	HCPCS 25000001	65597-0701-18	COLESEVELAM HCL 625 MG PO TABS	BOTH IP/OP	$18.71 	$13.85	$0.00	$14.42		$0.00	$0.00	$0.00	$0.00	$0.00	$13.89	$13.89	$14.42	$0.00	$3.90	$0.00	$0.00	$0.00	$0.00	$8.49	$13.44	$13.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28372	ERX	HCPCS 25000001	67877-0506-51	COLESEVELAM HCL 625 MG PO TABS	BOTH IP/OP	$18.71 	$13.85	$0.00	$14.42		$0.00	$0.00	$0.00	$0.00	$0.00	$13.89	$13.89	$14.42	$0.00	$3.90	$0.00	$0.00	$0.00	$0.00	$8.49	$13.44	$13.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28400	ERX	HCPCS 25000001	52919-0006-05	STERILE WATER FOR INJECTION IV SOLN	BOTH IP/OP	$41.90 	$31.01	$0.00	$32.30		$0.00	$0.00	$0.00	$0.00	$0.00	$31.10	$31.10	$32.30	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$17.10	$17.42	$27.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28400	ERX	HCPCS 25000001	52919-0011-04	STERILE WATER FOR INJECTION IV SOLN	BOTH IP/OP	$41.90 	$31.01	$0.00	$32.30		$0.00	$0.00	$0.00	$0.00	$0.00	$31.10	$31.10	$32.30	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$17.10	$17.42	$27.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28400	ERX	HCPCS 25000001	00264-7850-10	STERILE WATER FOR INJECTION IV SOLN	BOTH IP/OP	$41.90 	$31.01	$0.00	$32.30		$0.00	$0.00	$0.00	$0.00	$0.00	$31.10	$31.10	$32.30	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$17.10	$17.42	$27.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28400	ERX	HCPCS 25000001	00264-7385-50	STERILE WATER FOR INJECTION IV SOLN	BOTH IP/OP	$41.90 	$31.01	$0.00	$32.30		$0.00	$0.00	$0.00	$0.00	$0.00	$31.10	$31.10	$32.30	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$17.10	$18.06	$27.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28400	ERX	HCPCS 25000001	00264-7850-00	STERILE WATER FOR INJECTION IV SOLN	BOTH IP/OP	$41.90 	$31.01	$0.00	$32.30		$0.00	$0.00	$0.00	$0.00	$0.00	$31.10	$31.10	$32.30	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$17.10	$27.09	$27.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28400	ERX	HCPCS 25000001	00338-0013-04	STERILE WATER FOR INJECTION IV SOLN	BOTH IP/OP	$41.90 	$31.01	$0.00	$32.30		$0.00	$0.00	$0.00	$0.00	$0.00	$31.10	$31.10	$32.30	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$17.10	$27.09	$27.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28558	ERX	HCPCS 25000001	00023-5902-04	TRIPTORELIN PAMOATE 3.75 MG IM SUSR	BOTH IP/OP	"$2,342.14 "	"$1,733.18"	$0.00	"$1,873.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,171.07"	"$1,854.97"	"$1,873.71"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28643	ERX	HCPCS 63700001	50742-0260-01	NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28643	ERX	HCPCS 63700001	62175-0260-55	NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28643	ERX	HCPCS 63700001	71205-0963-00	NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28645	ERX	HCPCS 63700001	00378-3953-77	ATORVASTATIN CALCIUM 80 MG PO TABS	BOTH IP/OP	$8.14 	$6.02	$0.00	$5.90		$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$3.69	$5.84	$5.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28645	ERX	HCPCS 63700001	00904-6293-04	ATORVASTATIN CALCIUM 80 MG PO TABS	BOTH IP/OP	$8.14 	$6.02	$0.00	$5.90		$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$3.69	$5.84	$5.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28645	ERX	HCPCS 63700001	16714-0877-01	ATORVASTATIN CALCIUM 80 MG PO TABS	BOTH IP/OP	$8.14 	$6.02	$0.00	$5.90		$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$3.69	$5.84	$5.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28645	ERX	HCPCS 63700001	51079-0211-01	ATORVASTATIN CALCIUM 80 MG PO TABS	BOTH IP/OP	$8.14 	$6.02	$0.00	$5.90		$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$3.69	$5.84	$5.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28645	ERX	HCPCS 63700001	51079-0211-03	ATORVASTATIN CALCIUM 80 MG PO TABS	BOTH IP/OP	$8.14 	$6.02	$0.00	$5.90		$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$3.69	$5.84	$5.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28686	ERX	HCPCS 63700001	68462-0402-01	ATOVAQUONE-PROGUANIL HCL 62.5-25 MG PO TABS	BOTH IP/OP	$22.51 	$16.66	$0.00	$16.33		$0.00	$0.00	$0.00	$4.01	$0.00	$0.00	$0.00	$0.00	$0.00	$4.69	$0.00	$0.00	$0.00	$0.00	$10.21	$16.16	$16.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28774	ERX	HCPCS J7626	00487-9601-01	BUDESONIDE 0.25 MG/2ML IN SUSP	BOTH IP/OP	$24.94 	$18.46	$0.00	$19.22		$0.00	$0.00	$0.00	$0.00	$0.00	$18.51	$18.51	$19.22	$0.00	$5.20	$0.00	$0.00	$0.00	$0.00	$11.31	$17.91	$18.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28774	ERX	HCPCS J7626	00487-9601-30	BUDESONIDE 0.25 MG/2ML IN SUSP	BOTH IP/OP	$24.94 	$18.46	$0.00	$19.22		$0.00	$0.00	$0.00	$0.00	$0.00	$18.51	$18.51	$19.22	$0.00	$5.20	$0.00	$0.00	$0.00	$0.00	$11.31	$17.91	$18.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28774	ERX	HCPCS J7626	69097-0318-87	BUDESONIDE 0.25 MG/2ML IN SUSP	BOTH IP/OP	$24.94 	$18.46	$0.00	$19.22		$0.00	$0.00	$0.00	$0.00	$0.00	$18.51	$18.51	$19.22	$0.00	$5.20	$0.00	$0.00	$0.00	$0.00	$11.31	$17.91	$18.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28775	ERX	HCPCS J7626	00093-6816-73	BUDESONIDE 0.5 MG/2ML IN SUSP	BOTH IP/OP	$51.58 	$38.17	$0.00	$39.76		$0.00	$0.00	$0.00	$0.00	$0.00	$38.28	$38.28	$39.76	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$23.39	$37.05	$37.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28775	ERX	HCPCS J7626	00186-1989-04	BUDESONIDE 0.5 MG/2ML IN SUSP	BOTH IP/OP	$51.58 	$38.17	$0.00	$39.76		$0.00	$0.00	$0.00	$0.00	$0.00	$38.28	$38.28	$39.76	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$23.39	$37.05	$37.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28775	ERX	HCPCS J7626	00487-9701-01	BUDESONIDE 0.5 MG/2ML IN SUSP	BOTH IP/OP	$51.58 	$38.17	$0.00	$39.76		$0.00	$0.00	$0.00	$0.00	$0.00	$38.28	$38.28	$39.76	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$23.39	$37.05	$37.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28775	ERX	HCPCS J7626	00487-9701-30	BUDESONIDE 0.5 MG/2ML IN SUSP	BOTH IP/OP	$51.58 	$38.17	$0.00	$39.76		$0.00	$0.00	$0.00	$0.00	$0.00	$38.28	$38.28	$39.76	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$23.39	$37.05	$37.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28775	ERX	HCPCS J7626	00781-7516-87	BUDESONIDE 0.5 MG/2ML IN SUSP	BOTH IP/OP	$51.58 	$38.17	$0.00	$39.76		$0.00	$0.00	$0.00	$0.00	$0.00	$38.28	$38.28	$39.76	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$23.39	$37.05	$37.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28775	ERX	HCPCS J7626	69097-0319-86	BUDESONIDE 0.5 MG/2ML IN SUSP	BOTH IP/OP	$51.58 	$38.17	$0.00	$39.76		$0.00	$0.00	$0.00	$0.00	$0.00	$38.28	$38.28	$39.76	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$23.39	$37.05	$37.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28775	ERX	HCPCS J7626	69097-0319-87	BUDESONIDE 0.5 MG/2ML IN SUSP	BOTH IP/OP	$51.58 	$38.17	$0.00	$39.76		$0.00	$0.00	$0.00	$0.00	$0.00	$38.28	$38.28	$39.76	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$23.39	$37.05	$37.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28810	ERX	HCPCS 25000001	24208-0635-62	NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP	BOTH IP/OP	$338.29 	$250.33	$0.00	$260.75		$0.00	$0.00	$0.00	$0.00	$0.00	$251.08	$251.08	$260.75	$0.00	$70.50	$0.00	$0.00	$0.00	$0.00	$153.54	$243.21	$245.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28810	ERX	HCPCS 25000001	61314-0645-11	NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP	BOTH IP/OP	$338.29 	$250.33	$0.00	$260.75		$0.00	$0.00	$0.00	$0.00	$0.00	$251.08	$251.08	$260.75	$0.00	$70.50	$0.00	$0.00	$0.00	$0.00	$153.54	$243.21	$245.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28824	ERX	HCPCS 25000001	10631-0407-01	HYDROCORTISONE (PERIANAL) 2.5 % EX CREA	BOTH IP/OP	$303.00 	$224.22	$0.00	$233.55		$0.00	$0.00	$0.00	$0.00	$0.00	$224.89	$224.89	$233.55	$0.00	$63.15	$0.00	$0.00	$0.00	$0.00	$145.53	$217.85	$220.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28824	ERX	HCPCS 25000001	64980-0301-30	HYDROCORTISONE (PERIANAL) 2.5 % EX CREA	BOTH IP/OP	$303.00 	$224.22	$0.00	$233.55		$0.00	$0.00	$0.00	$0.00	$0.00	$224.89	$224.89	$233.55	$0.00	$63.15	$0.00	$0.00	$0.00	$0.00	$145.53	$230.52	$220.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28836	ERX	HCPCS 63700001	00121-0431-30	MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$1.96	$0.00	$0.00	$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28836	ERX	HCPCS 63700001	00536-2470-85	MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$1.96	$0.00	$0.00	$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28836	ERX	HCPCS 63700001	99999-6006-91	MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$1.96	$0.00	$0.00	$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28842	ERX	HCPCS J7515	00093-5740-65	CYCLOSPORINE MODIFIED (GENGRAF) 25 MG PO CAPS	BOTH IP/OP	$11.53 	$8.53	$0.00	$8.89		$0.00	$0.00	$0.00	$0.00	$0.00	$8.56	$8.56	$8.89	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$5.23	$8.28	$8.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28843	ERX	HCPCS J7502	00093-5742-19	CYCLOSPORINE MODIFIED 100 MG PO CAPS	BOTH IP/OP	$23.03 	$17.04	$0.00	$17.75	$10.36	$10.36	$0.00	$0.00	$0.00	$4.80	$17.09	$17.09	$17.75	$0.00	$4.80	$0.00	$13.62	$13.62	$0.00	$10.45	$16.54	$16.71	$0.00		$0.00	$3.27	$0.00	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$0.00
28843	ERX	HCPCS J7502	00093-5742-65	CYCLOSPORINE MODIFIED 100 MG PO CAPS	BOTH IP/OP	$23.03 	$17.04	$0.00	$17.75	$10.36	$10.36	$0.00	$0.00	$0.00	$4.80	$17.09	$17.09	$17.75	$0.00	$4.80	$0.00	$13.62	$13.62	$0.00	$10.45	$16.54	$16.71	$0.00		$0.00	$3.27	$0.00	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$0.00
28844	ERX	HCPCS J7502	00172-7313-20	CYCLOSPORINE MODIFIED (GENGRAF) 100 MG/ML PO SOLN	BOTH IP/OP	$874.69 	$647.27	$0.00	$674.21	$393.61	$393.61	$0.00	$0.00	$0.00	$182.31	$649.19	$649.19	$674.21	$0.00	$182.29	$0.00	$517.38	$517.38	$0.00	$396.91	$628.70	$635.05	$0.00		$0.00	$124.23	$0.00	$0.00	$126.37	$0.00	$0.00	$0.00	$0.00	$0.00
28849	ERX	HCPCS 25000001	00037-6822-10	HYDROCORT-PRAMOXINE (PERIANAL) 1-1 % EX FOAM	BOTH IP/OP	$633.30 	$468.64	$0.00	$488.15		$0.00	$0.00	$0.00	$0.00	$0.00	$470.04	$470.04	$488.15	$0.00	$131.98	$0.00	$0.00	$0.00	$0.00	$273.76	$433.63	$438.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28899	ERX	HCPCS 25000001	00406-8515-23	OXYCODONE HCL 15 MG PO TABS	BOTH IP/OP	$7.11 	$5.26	$0.00	$5.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.56	$5.63	$5.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28899	ERX	HCPCS 25000001	00406-8515-62	OXYCODONE HCL 15 MG PO TABS	BOTH IP/OP	$7.11 	$5.26	$0.00	$5.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.56	$5.63	$5.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28899	ERX	HCPCS 25000001	57664-0187-88	OXYCODONE HCL 15 MG PO TABS	BOTH IP/OP	$7.11 	$5.26	$0.00	$5.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.56	$5.63	$5.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28899	ERX	HCPCS 25000001	68084-0184-01	OXYCODONE HCL 15 MG PO TABS	BOTH IP/OP	$7.11 	$5.26	$0.00	$5.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.56	$5.63	$5.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28899	ERX	HCPCS 25000001	68094-0005-59	OXYCODONE HCL 15 MG PO TABS	BOTH IP/OP	$7.11 	$5.26	$0.00	$5.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.56	$5.63	$5.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28899	ERX	HCPCS 25000001	68094-0005-61	OXYCODONE HCL 15 MG PO TABS	BOTH IP/OP	$7.11 	$5.26	$0.00	$5.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.56	$5.63	$5.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28900	ERX	HCPCS 25000001	00406-8530-62	OXYCODONE HCL 30 MG PO TABS	BOTH IP/OP	$13.54 	$10.02	$0.00	$10.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.77	$10.72	$10.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28900	ERX	HCPCS 25000001	68084-0185-01	OXYCODONE HCL 30 MG PO TABS	BOTH IP/OP	$13.54 	$10.02	$0.00	$10.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.77	$10.72	$10.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28912	ERX	HCPCS J9120	55292-0811-55	DACTINOMYCIN 0.5 MG IV SOLR	BOTH IP/OP	"$4,119.05 "	"$3,048.10"	$0.00	"$3,174.96"	"$1,853.57"	"$1,853.57"	$838.88	$838.88	$838.88	$591.51	"$3,057.16"	"$3,057.16"	"$3,174.96"	$890.64	"$1,046.51"	$578.92	"$2,030.69"	"$2,030.69"	$0.00	"$1,868.16"	"$2,959.16"	"$2,989.05"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28912	ERX	HCPCS J9120	66993-0489-83	DACTINOMYCIN 0.5 MG IV SOLR	BOTH IP/OP	"$4,119.05 "	"$3,048.10"	$0.00	"$3,174.96"	"$1,853.57"	"$1,853.57"	$838.88	$838.88	$838.88	$591.51	"$3,057.16"	"$3,057.16"	"$3,174.96"	$890.64	"$1,046.51"	$578.92	"$2,030.69"	"$2,030.69"	$0.00	"$1,868.16"	"$2,959.16"	"$2,989.05"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28912	ERX	HCPCS J9120	67457-0513-05	DACTINOMYCIN 0.5 MG IV SOLR	BOTH IP/OP	"$4,119.05 "	"$3,048.10"	$0.00	"$3,174.96"	"$1,853.57"	"$1,853.57"	$838.88	$838.88	$838.88	$591.51	"$3,057.16"	"$3,057.16"	"$3,174.96"	$890.64	"$1,046.51"	$578.92	"$2,030.69"	"$2,030.69"	$0.00	"$1,868.16"	"$2,959.16"	"$2,989.05"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28913	ERX	HCPCS 25000001	08065-1830-85	SODIUM HYALURONATE 10 MG/ML IO SOLN	BOTH IP/OP	$694.15 	$513.67	$0.00	$561.81		$0.00	$0.00	$0.00	$0.00	$0.00	$540.97	$540.97	$561.81	$0.00	$144.66	$0.00	$0.00	$0.00	$0.00	$305.81	$484.40	$489.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28917	ERX	HCPCS 25000001	08065-1831-50	NA HYALUR & NA CHOND-NA HYALUR 0.55-0.5 ML IO KIT	BOTH IP/OP	$779.70 	$576.98	$0.00	$631.07		$0.00	$0.00	$0.00	$0.00	$0.00	$607.65	$607.65	$631.07	$0.00	$162.49	$0.00	$0.00	$0.00	$0.00	$343.51	$544.12	$549.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28923	ERX	HCPCS 25000001	08065-1839-05	NA CHONDROIT SULF-NA HYALURON 40-30 MG/ML IO SOLN	BOTH IP/OP	$568.80 	$420.91	$0.00	$455.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$284.40	$450.49	$455.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28929	ERX	HCPCS 63700001	99999-6004-92	KALETRA:LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN	BOTH IP/OP	$530.41 	$392.50	$0.00	"$1,179.96"		$0.00	$0.00	$0.00	$94.41	$0.00	$0.00	$0.00	$0.00	$0.00	$110.54	$0.00	$0.00	$0.00	$0.00	$737.48	$381.33	"$1,179.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28929	ERX	HCPCS 63700001	00074-3956-46	KALETRA:LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN	BOTH IP/OP	$530.41 	$392.50	$0.00	"$1,179.96"		$0.00	$0.00	$0.00	$94.41	$0.00	$0.00	$0.00	$0.00	$0.00	$110.54	$0.00	$0.00	$0.00	$0.00	$737.48	"$1,168.16"	"$1,179.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28929	ERX	HCPCS 63700001	00527-1947-48	KALETRA:LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN	BOTH IP/OP	$530.41 	$392.50	$0.00	"$1,179.96"		$0.00	$0.00	$0.00	$94.41	$0.00	$0.00	$0.00	$0.00	$0.00	$110.54	$0.00	$0.00	$0.00	$0.00	$737.48	"$1,168.16"	"$1,179.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28947	ERX	HCPCS J0883	00143-9674-01	ARGATROBAN 250 MG/2.5ML IV SOLN	BOTH IP/OP	"$1,585.08 "	"$1,172.96"	$0.00	"$1,221.78"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,176.45"	"$1,176.45"	"$1,221.78"	$0.00	$330.33	$0.00	$0.00	$0.00	$0.00	$734.40	"$1,163.29"	"$1,175.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28947	ERX	HCPCS J0883	00409-1140-01	ARGATROBAN 250 MG/2.5ML IV SOLN	BOTH IP/OP	"$1,585.08 "	"$1,172.96"	$0.00	"$1,221.78"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,176.45"	"$1,176.45"	"$1,221.78"	$0.00	$330.33	$0.00	$0.00	$0.00	$0.00	$734.40	"$1,163.29"	"$1,175.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28947	ERX	HCPCS J0883	42023-0182-01	ARGATROBAN 250 MG/2.5ML IV SOLN	BOTH IP/OP	"$1,585.08 "	"$1,172.96"	$0.00	"$1,221.78"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,176.45"	"$1,176.45"	"$1,221.78"	$0.00	$330.33	$0.00	$0.00	$0.00	$0.00	$734.40	"$1,163.29"	"$1,175.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28947	ERX	HCPCS J0883	63323-0526-03	ARGATROBAN 250 MG/2.5ML IV SOLN	BOTH IP/OP	"$1,585.08 "	"$1,172.96"	$0.00	"$1,221.78"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,176.45"	"$1,176.45"	"$1,221.78"	$0.00	$330.33	$0.00	$0.00	$0.00	$0.00	$734.40	"$1,163.29"	"$1,175.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28947	ERX	HCPCS J0883	67457-0212-02	ARGATROBAN 250 MG/2.5ML IV SOLN	BOTH IP/OP	"$1,585.08 "	"$1,172.96"	$0.00	"$1,221.78"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,176.45"	"$1,176.45"	"$1,221.78"	$0.00	$330.33	$0.00	$0.00	$0.00	$0.00	$734.40	"$1,163.29"	"$1,175.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28958	ERX	HCPCS J7520	00008-1041-10	SIROLIMUS 1 MG PO TABS	BOTH IP/OP	$71.44 	$52.87	$0.00	$55.07	$32.15	$32.15	$0.00	$0.00	$0.00	$14.89	$53.02	$53.02	$55.07	$0.00	$14.89	$0.00	$42.26	$42.26	$0.00	$32.40	$51.31	$51.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28958	ERX	HCPCS J7520	55111-0653-01	SIROLIMUS 1 MG PO TABS	BOTH IP/OP	$71.44 	$52.87	$0.00	$55.07	$32.15	$32.15	$0.00	$0.00	$0.00	$14.89	$53.02	$53.02	$55.07	$0.00	$14.89	$0.00	$42.26	$42.26	$0.00	$32.40	$51.31	$51.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28964	ERX	HCPCS 63700001	00904-6353-61	LEVOFLOXACIN 750 MG PO TABS	BOTH IP/OP	$123.89 	$91.68	$0.00	$99.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.95	$98.12	$99.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28964	ERX	HCPCS 63700001	55111-0281-30	LEVOFLOXACIN 750 MG PO TABS	BOTH IP/OP	$123.89 	$91.68	$0.00	$99.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.95	$98.12	$99.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28975	ERX	HCPCS 63700001	64875-0001-03	MIFEPRISTONE 200 MG PO TABS	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28995	ERX	HCPCS 63700001	67877-0159-01	METFORMIN HCL ER 500 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28995	ERX	HCPCS 63700001	70010-0491-01	METFORMIN HCL ER 500 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29048	ERX	HCPCS 63700001	16714-0633-01	ALENDRONATE SODIUM 70 MG PO TABS	BOTH IP/OP	$78.80 	$58.31	$0.00	$57.16		$0.00	$0.00	$0.00	$14.03	$0.00	$0.00	$0.00	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$35.73	$56.59	$57.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29071	ERX	HCPCS J9017		ARSENIC TRIOXIDE 10 MG/10ML IV SOLN	BOTH IP/OP	"$1,846.16 "	"$1,366.16"	$0.00	"$1,423.02"	$830.77	$830.77	$128.11	$128.11	$128.11	$384.79	"$1,370.22"	"$1,370.22"	"$1,423.02"	$131.14	$154.09	$85.24	$910.16	$910.16	$465.30	$855.36	"$1,354.89"	"$1,368.58"	$642.55		$642.55	$517.82	$0.00	$0.00	$493.06	$286.69	$0.00	$0.00	$0.00	$0.00
29071	ERX	HCPCS J9017	50742-0438-10	ARSENIC TRIOXIDE 10 MG/10ML IV SOLN	BOTH IP/OP	"$1,846.16 "	"$1,366.16"	$0.00	"$1,423.02"	$830.77	$830.77	$128.11	$128.11	$128.11	$384.79	"$1,370.22"	"$1,370.22"	"$1,423.02"	$131.14	$154.09	$85.24	$910.16	$910.16	$465.30	$855.36	"$1,354.89"	"$1,368.58"	$642.55		$642.55	$517.82	$0.00	$0.00	$493.06	$286.69	$0.00	$0.00	$0.00	$0.00
29071	ERX	HCPCS J9017	63323-0637-10	ARSENIC TRIOXIDE 10 MG/10ML IV SOLN	BOTH IP/OP	"$1,846.16 "	"$1,366.16"	$0.00	"$1,423.02"	$830.77	$830.77	$128.11	$128.11	$128.11	$384.79	"$1,370.22"	"$1,370.22"	"$1,423.02"	$131.14	$154.09	$85.24	$910.16	$910.16	$465.30	$855.36	"$1,354.89"	"$1,368.58"	$642.55		$642.55	$517.82	$0.00	$0.00	$493.06	$286.69	$0.00	$0.00	$0.00	$0.00
29072	ERX	HCPCS 63700001	16714-0632-01	ALENDRONATE SODIUM 35 MG PO TABS	BOTH IP/OP	$71.63 	$53.01	$0.00	$57.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.82	$56.73	$57.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29109	ERX	HCPCS 63700001	65862-0312-30	DIDANOSINE 250 MG PO CPDR	BOTH IP/OP	$29.91 	$22.13	$0.00	$23.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.96	$23.69	$23.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29110	ERX	HCPCS 63700001	65862-0313-30	DIDANOSINE 400 MG PO CPDR	BOTH IP/OP	$46.71 	$34.57	$0.00	$37.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.36	$36.99	$37.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29132	ERX	HCPCS J1756	00517-2340-01	IRON SUCROSE 20 MG/ML IV SOLN	BOTH IP/OP	$229.02 	$169.47	$0.00	$185.36	$108.22	$108.22	$0.00	$0.00	$0.00	$43.48	$178.48	$178.48	$185.36	$0.00	$26.79	$0.00	$135.47	$135.47	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$24.68	$0.00	$0.00	$23.49	$0.00	$0.00	$0.00	$0.00	$0.00
29132	ERX	HCPCS J1756	00517-2340-10	IRON SUCROSE 20 MG/ML IV SOLN	BOTH IP/OP	$229.02 	$169.47	$0.00	$185.36	$108.22	$108.22	$0.00	$0.00	$0.00	$43.48	$178.48	$178.48	$185.36	$0.00	$26.79	$0.00	$135.47	$135.47	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$24.68	$0.00	$0.00	$23.49	$0.00	$0.00	$0.00	$0.00	$0.00
29132	ERX	HCPCS J1756	00517-2340-25	IRON SUCROSE 20 MG/ML IV SOLN	BOTH IP/OP	$229.02 	$169.47	$0.00	$185.36	$108.22	$108.22	$0.00	$0.00	$0.00	$43.48	$178.48	$178.48	$185.36	$0.00	$26.79	$0.00	$135.47	$135.47	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$24.68	$0.00	$0.00	$23.49	$0.00	$0.00	$0.00	$0.00	$0.00
29167	ERX	HCPCS 63700001	49702-0217-18	TRIZIVIR:ABACAVIR-LAMIVUDINE-ZIDOVUDINE PO TAB	BOTH IP/OP	$111.84 	$82.76	$0.00	$81.13		$0.00	$0.00	$0.00	$19.91	$0.00	$0.00	$0.00	$0.00	$0.00	$23.31	$0.00	$0.00	$0.00	$0.00	$50.71	$80.32	$81.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29167	ERX	HCPCS 63700001	68180-0286-07	TRIZIVIR:ABACAVIR-LAMIVUDINE-ZIDOVUDINE PO TAB	BOTH IP/OP	$111.84 	$82.76	$0.00	$81.13		$0.00	$0.00	$0.00	$19.91	$0.00	$0.00	$0.00	$0.00	$0.00	$23.31	$0.00	$0.00	$0.00	$0.00	$50.71	$80.32	$81.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29169	ERX	HCPCS 63700001	42192-0608-16	GABAPENTIN 250 MG/5ML PO SOLN	BOTH IP/OP	$9.51 	$7.04	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.76	$7.53	$7.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29169	ERX	HCPCS 63700001	50383-0311-09	GABAPENTIN 250 MG/5ML PO SOLN	BOTH IP/OP	$9.51 	$7.04	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.76	$7.53	$7.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29169	ERX	HCPCS 63700001	59762-5050-01	GABAPENTIN 250 MG/5ML PO SOLN	BOTH IP/OP	$9.51 	$7.04	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.76	$7.53	$7.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29169	ERX	HCPCS 63700001	99999-6010-82	GABAPENTIN 250 MG/5ML PO SOLN	BOTH IP/OP	$9.51 	$7.04	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.76	$7.53	$7.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29169	ERX	HCPCS 63700001	99999-6012-40	GABAPENTIN 250 MG/5ML PO SOLN	BOTH IP/OP	$9.51 	$7.04	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.76	$7.53	$7.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29267	ERX	HCPCS 63700001	00904-6642-61	QUETIAPINE FUMARATE 300 MG PO TABS	BOTH IP/OP	$42.53 	$31.47	$0.00	$30.86		$0.00	$0.00	$0.00	$7.57	$0.00	$0.00	$0.00	$0.00	$0.00	$8.86	$0.00	$0.00	$0.00	$0.00	$19.29	$30.55	$30.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29267	ERX	HCPCS 63700001	50268-0634-15	QUETIAPINE FUMARATE 300 MG PO TABS	BOTH IP/OP	$42.53 	$31.47	$0.00	$30.86		$0.00	$0.00	$0.00	$7.57	$0.00	$0.00	$0.00	$0.00	$0.00	$8.86	$0.00	$0.00	$0.00	$0.00	$19.29	$30.55	$30.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29270	ERX	HCPCS 63700001	60687-0195-01	DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29270	ERX	HCPCS 63700001	63739-0014-10	DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29272	ERX	HCPCS 63700001	60687-0206-01	DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24	BOTH IP/OP	$6.87 	$5.08	$0.00	$5.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.44	$5.44	$5.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29272	ERX	HCPCS 63700001	63739-0015-10	DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24	BOTH IP/OP	$6.87 	$5.08	$0.00	$5.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.44	$5.44	$5.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29274	ERX	HCPCS 63700001	10370-0831-11	DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24	BOTH IP/OP	$8.60 	$6.36	$0.00	$6.24		$0.00	$0.00	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$3.90	$6.18	$6.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29274	ERX	HCPCS 63700001	60687-0217-01	DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24	BOTH IP/OP	$8.60 	$6.36	$0.00	$6.24		$0.00	$0.00	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$3.90	$6.18	$6.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29274	ERX	HCPCS 63700001	60687-0217-11	DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24	BOTH IP/OP	$8.60 	$6.36	$0.00	$6.24		$0.00	$0.00	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$3.90	$6.18	$6.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29274	ERX	HCPCS 63700001	63739-0016-10	DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24	BOTH IP/OP	$8.60 	$6.36	$0.00	$6.24		$0.00	$0.00	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$3.90	$6.18	$6.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29276	ERX	HCPCS 63700001	60687-0228-01	DILTIAZEM HCL ER COATED BEADS 300 MG PO CP24	BOTH IP/OP	$11.23 	$8.31	$0.00	$8.15		$0.00	$0.00	$0.00	$2.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.34	$0.00	$0.00	$0.00	$0.00	$5.10	$8.07	$8.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29277	ERX	HCPCS 63700001	47335-0673-81	DILTIAZEM HCL ER BEADS 360 MG PO CP24	BOTH IP/OP	$9.83 	$7.27	$0.00	$7.14		$0.00	$0.00	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$0.00	$2.05	$0.00	$0.00	$0.00	$0.00	$4.46	$7.06	$7.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29277	ERX	HCPCS 63700001	68682-0371-90	DILTIAZEM HCL ER BEADS 360 MG PO CP24	BOTH IP/OP	$9.83 	$7.27	$0.00	$7.14		$0.00	$0.00	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$0.00	$2.05	$0.00	$0.00	$0.00	$0.00	$4.46	$7.06	$7.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29302	ERX	HCPCS J7510	99999-6005-14	PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN	BOTH IP/OP	$214.45 	$158.69	$0.00	$363.08		$0.00	$0.00	$0.00	$0.00	$44.70	$349.60	$349.60	$363.08	$0.00	$44.69	$0.00	$278.62	$278.62	$0.00	$97.34	$154.18	$155.74	$0.00		$0.00	$30.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29302	ERX	HCPCS J7510	00121-0759-08	PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN	BOTH IP/OP	$214.45 	$158.69	$0.00	$363.08		$0.00	$0.00	$0.00	$0.00	$44.70	$349.60	$349.60	$363.08	$0.00	$44.69	$0.00	$278.62	$278.62	$0.00	$97.34	$184.48	$155.74	$0.00		$0.00	$30.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29302	ERX	HCPCS J7510	60432-0212-08	PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN	BOTH IP/OP	$214.45 	$158.69	$0.00	$363.08		$0.00	$0.00	$0.00	$0.00	$44.70	$349.60	$349.60	$363.08	$0.00	$44.69	$0.00	$278.62	$278.62	$0.00	$97.34	$184.48	$155.74	$0.00		$0.00	$30.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29313	ERX	HCPCS J0840	50633-0110-11	CROTALIDAE POLYVAL IMMUNE FAB IV SOLR	BOTH IP/OP	"$17,345.96 "	"$12,836.01"	$0.00	"$13,370.27"		$0.00	$0.00	$0.00	$0.00	$0.00	"$12,874.17"	"$12,874.17"	"$13,370.27"	$0.00	"$3,614.90"	$0.00	$0.00	$0.00	$0.00	"$7,867.08"	"$12,461.45"	"$12,587.33"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29335	ERX	HCPCS J1800	00143-9872-01	PROPRANOLOL HCL 1 MG/ML IV SOLN	BOTH IP/OP	$40.23 	$29.77	$0.00	$31.01		$0.00	$0.00	$0.00	$0.00	$0.00	$29.86	$29.86	$31.01	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$18.24	$28.89	$29.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29335	ERX	HCPCS J1800	00143-9872-10	PROPRANOLOL HCL 1 MG/ML IV SOLN	BOTH IP/OP	$40.23 	$29.77	$0.00	$31.01		$0.00	$0.00	$0.00	$0.00	$0.00	$29.86	$29.86	$31.01	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$18.24	$28.89	$29.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29434	ERX	HCPCS 63700001	00093-7163-56	TOLTERODINE TARTRATE ER 2 MG PO CP24	BOTH IP/OP	$33.68 	$24.92	$0.00	$24.43		$0.00	$0.00	$0.00	$6.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.02	$0.00	$0.00	$0.00	$0.00	$15.27	$24.19	$24.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29434	ERX	HCPCS 63700001	00093-7163-98	TOLTERODINE TARTRATE ER 2 MG PO CP24	BOTH IP/OP	$33.68 	$24.92	$0.00	$24.43		$0.00	$0.00	$0.00	$6.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.02	$0.00	$0.00	$0.00	$0.00	$15.27	$24.19	$24.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29434	ERX	HCPCS 63700001	13668-0189-30	TOLTERODINE TARTRATE ER 2 MG PO CP24	BOTH IP/OP	$33.68 	$24.92	$0.00	$24.43		$0.00	$0.00	$0.00	$6.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.02	$0.00	$0.00	$0.00	$0.00	$15.27	$24.19	$24.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29434	ERX	HCPCS 63700001	31722-0607-30	TOLTERODINE TARTRATE ER 2 MG PO CP24	BOTH IP/OP	$33.68 	$24.92	$0.00	$24.43		$0.00	$0.00	$0.00	$6.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.02	$0.00	$0.00	$0.00	$0.00	$15.27	$24.19	$24.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29434	ERX	HCPCS 63700001	59762-0047-01	TOLTERODINE TARTRATE ER 2 MG PO CP24	BOTH IP/OP	$33.68 	$24.92	$0.00	$24.43		$0.00	$0.00	$0.00	$6.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.02	$0.00	$0.00	$0.00	$0.00	$15.27	$24.19	$24.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29435	ERX	HCPCS 63700001	00093-7164-05	TOLTERODINE TARTRATE ER 4 MG PO CP24	BOTH IP/OP	$40.01 	$29.61	$0.00	$29.02		$0.00	$0.00	$0.00	$7.12	$0.00	$0.00	$0.00	$0.00	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$18.14	$28.73	$29.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29435	ERX	HCPCS 63700001	00093-7164-56	TOLTERODINE TARTRATE ER 4 MG PO CP24	BOTH IP/OP	$40.01 	$29.61	$0.00	$29.02		$0.00	$0.00	$0.00	$7.12	$0.00	$0.00	$0.00	$0.00	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$18.14	$28.73	$29.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29435	ERX	HCPCS 63700001	31722-0608-30	TOLTERODINE TARTRATE ER 4 MG PO CP24	BOTH IP/OP	$40.01 	$29.61	$0.00	$29.02		$0.00	$0.00	$0.00	$7.12	$0.00	$0.00	$0.00	$0.00	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$18.14	$28.73	$29.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29435	ERX	HCPCS 63700001	59762-0048-01	TOLTERODINE TARTRATE ER 4 MG PO CP24	BOTH IP/OP	$40.01 	$29.61	$0.00	$29.02		$0.00	$0.00	$0.00	$7.12	$0.00	$0.00	$0.00	$0.00	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$18.14	$28.73	$29.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29437	ERX	HCPCS 63700001	00078-0351-05	NATEGLINIDE 60 MG PO TABS	BOTH IP/OP	$6.97 	$5.16	$0.00	$5.06		$0.00	$0.00	$0.00	$1.24	$0.00	$0.00	$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$3.16	$5.01	$5.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29437	ERX	HCPCS 63700001	00591-3354-01	NATEGLINIDE 60 MG PO TABS	BOTH IP/OP	$6.97 	$5.16	$0.00	$5.06		$0.00	$0.00	$0.00	$1.24	$0.00	$0.00	$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$3.16	$5.01	$5.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29437	ERX	HCPCS 63700001	49884-0984-01	NATEGLINIDE 60 MG PO TABS	BOTH IP/OP	$6.97 	$5.16	$0.00	$5.06		$0.00	$0.00	$0.00	$1.24	$0.00	$0.00	$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$3.16	$5.01	$5.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29437	ERX	HCPCS 63700001	55111-0328-90	NATEGLINIDE 60 MG PO TABS	BOTH IP/OP	$6.97 	$5.16	$0.00	$5.06		$0.00	$0.00	$0.00	$1.24	$0.00	$0.00	$0.00	$0.00	$0.00	$1.45	$0.00	$0.00	$0.00	$0.00	$3.16	$5.01	$5.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29438	ERX	HCPCS 63700001	00078-0352-05	NATEGLINIDE 120 MG PO TABS	BOTH IP/OP	$7.24 	$5.36	$0.00	$5.26		$0.00	$0.00	$0.00	$1.29	$0.00	$0.00	$0.00	$0.00	$0.00	$1.51	$0.00	$0.00	$0.00	$0.00	$3.29	$5.20	$5.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29438	ERX	HCPCS 63700001	49884-0985-01	NATEGLINIDE 120 MG PO TABS	BOTH IP/OP	$7.24 	$5.36	$0.00	$5.26		$0.00	$0.00	$0.00	$1.29	$0.00	$0.00	$0.00	$0.00	$0.00	$1.51	$0.00	$0.00	$0.00	$0.00	$3.29	$5.20	$5.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29438	ERX	HCPCS 63700001	55111-0329-90	NATEGLINIDE 120 MG PO TABS	BOTH IP/OP	$7.24 	$5.36	$0.00	$5.26		$0.00	$0.00	$0.00	$1.29	$0.00	$0.00	$0.00	$0.00	$0.00	$1.51	$0.00	$0.00	$0.00	$0.00	$3.29	$5.20	$5.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29464	ERX	HCPCS J2274	00641-6020-10	MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN	BOTH IP/OP	$48.61 	$35.97	$0.00	$37.47		$0.00	$0.00	$0.00	$0.00	$0.00	$36.08	$36.08	$37.47	$0.00	$13.01	$0.00	$0.00	$0.00	$0.00	$22.04	$34.91	$35.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29464	ERX	HCPCS J2274	15082-0248-70	MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN	BOTH IP/OP	$48.61 	$35.97	$0.00	$37.47		$0.00	$0.00	$0.00	$0.00	$0.00	$36.08	$36.08	$37.47	$0.00	$13.01	$0.00	$0.00	$0.00	$0.00	$22.04	$34.91	$35.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29464	ERX	HCPCS J2274	42852-0248-70	MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN	BOTH IP/OP	$48.61 	$35.97	$0.00	$37.47		$0.00	$0.00	$0.00	$0.00	$0.00	$36.08	$36.08	$37.47	$0.00	$13.01	$0.00	$0.00	$0.00	$0.00	$22.04	$34.91	$35.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29531	ERX	HCPCS 63700001	65862-0021-06	MIRTAZAPINE 15 MG PO TBDP	BOTH IP/OP	$9.87 	$7.30	$0.00	$7.16		$0.00	$0.00	$0.00	$1.76	$0.00	$0.00	$0.00	$0.00	$0.00	$2.06	$0.00	$0.00	$0.00	$0.00	$4.48	$7.09	$7.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29532	ERX	HCPCS 63700001	00052-0108-30	MIRTAZAPINE 30 MG PO TBDP	BOTH IP/OP	$10.17 	$7.53	$0.00	$7.38		$0.00	$0.00	$0.00	$1.81	$0.00	$0.00	$0.00	$0.00	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$4.61	$7.30	$7.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29532	ERX	HCPCS 63700001	65862-0022-06	MIRTAZAPINE 30 MG PO TBDP	BOTH IP/OP	$10.17 	$7.53	$0.00	$7.38		$0.00	$0.00	$0.00	$1.81	$0.00	$0.00	$0.00	$0.00	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$4.61	$7.30	$7.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29567	ERX	HCPCS J0637	00006-3822-10	CASPOFUNGIN ACETATE 50 MG IV SOLR	BOTH IP/OP	"$1,183.33 "	$875.66	$0.00	$912.11		$0.00	$0.00	$0.00	$0.00	$0.00	$878.27	$878.27	$912.11	$0.00	$246.61	$0.00	$0.00	$0.00	$0.00	$536.96	$850.54	$859.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29568	ERX	HCPCS J0637	00006-3823-10	CASPOFUNGIN ACETATE 70 MG IV SOLR	BOTH IP/OP	"$1,229.50 "	$909.83	$0.00	$947.70		$0.00	$0.00	$0.00	$0.00	$0.00	$912.53	$912.53	$947.70	$0.00	$256.23	$0.00	$0.00	$0.00	$0.00	$557.91	$883.72	$892.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29745	ERX	HCPCS 63700001	00093-6450-56	ESOMEPRAZOLE 20 MG PO CPDR	BOTH IP/OP	$37.82 	$27.99	$0.00	$27.44		$0.00	$0.00	$0.00	$6.73	$0.00	$0.00	$0.00	$0.00	$0.00	$7.88	$0.00	$0.00	$0.00	$0.00	$17.15	$27.17	$27.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29745	ERX	HCPCS 63700001	00186-5020-31	ESOMEPRAZOLE 20 MG PO CPDR	BOTH IP/OP	$37.82 	$27.99	$0.00	$27.44		$0.00	$0.00	$0.00	$6.73	$0.00	$0.00	$0.00	$0.00	$0.00	$7.88	$0.00	$0.00	$0.00	$0.00	$17.15	$27.17	$27.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29745	ERX	HCPCS 63700001	00378-2350-93	ESOMEPRAZOLE 20 MG PO CPDR	BOTH IP/OP	$37.82 	$27.99	$0.00	$27.44		$0.00	$0.00	$0.00	$6.73	$0.00	$0.00	$0.00	$0.00	$0.00	$7.88	$0.00	$0.00	$0.00	$0.00	$17.15	$27.17	$27.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29745	ERX	HCPCS 63700001	31722-0572-30	ESOMEPRAZOLE 20 MG PO CPDR	BOTH IP/OP	$37.82 	$27.99	$0.00	$27.44		$0.00	$0.00	$0.00	$6.73	$0.00	$0.00	$0.00	$0.00	$0.00	$7.88	$0.00	$0.00	$0.00	$0.00	$17.15	$27.17	$27.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29745	ERX	HCPCS 63700001	43598-0509-30	ESOMEPRAZOLE 20 MG PO CPDR	BOTH IP/OP	$37.82 	$27.99	$0.00	$27.44		$0.00	$0.00	$0.00	$6.73	$0.00	$0.00	$0.00	$0.00	$0.00	$7.88	$0.00	$0.00	$0.00	$0.00	$17.15	$27.17	$27.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29745	ERX	HCPCS 63700001	65862-0783-30	ESOMEPRAZOLE 20 MG PO CPDR	BOTH IP/OP	$37.82 	$27.99	$0.00	$27.44		$0.00	$0.00	$0.00	$6.73	$0.00	$0.00	$0.00	$0.00	$0.00	$7.88	$0.00	$0.00	$0.00	$0.00	$17.15	$27.17	$27.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29746	ERX	HCPCS 63700001	00093-6451-98	ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR	BOTH IP/OP	$33.61 	$24.87	$0.00	$26.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.81	$26.62	$26.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29746	ERX	HCPCS 63700001	00186-5040-31	ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR	BOTH IP/OP	$33.61 	$24.87	$0.00	$26.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.81	$26.62	$26.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29746	ERX	HCPCS 63700001	16714-0736-01	ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR	BOTH IP/OP	$33.61 	$24.87	$0.00	$26.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.81	$26.62	$26.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29746	ERX	HCPCS 63700001	43598-0510-10	ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR	BOTH IP/OP	$33.61 	$24.87	$0.00	$26.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.81	$26.62	$26.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29746	ERX	HCPCS 63700001	65862-0784-30	ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR	BOTH IP/OP	$33.61 	$24.87	$0.00	$26.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.81	$26.62	$26.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29778	ERX	HCPCS 63700001	00781-2164-60	ZIPRASIDONE HCL 20 MG PO CAPS	BOTH IP/OP	$35.48 	$26.26	$0.00	$25.74		$0.00	$0.00	$0.00	$6.32	$0.00	$0.00	$0.00	$0.00	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.09	$25.49	$25.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29778	ERX	HCPCS 63700001	00904-6269-08	ZIPRASIDONE HCL 20 MG PO CAPS	BOTH IP/OP	$35.48 	$26.26	$0.00	$25.74		$0.00	$0.00	$0.00	$6.32	$0.00	$0.00	$0.00	$0.00	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.09	$25.49	$25.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29778	ERX	HCPCS 63700001	00904-6269-45	ZIPRASIDONE HCL 20 MG PO CAPS	BOTH IP/OP	$35.48 	$26.26	$0.00	$25.74		$0.00	$0.00	$0.00	$6.32	$0.00	$0.00	$0.00	$0.00	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.09	$25.49	$25.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29778	ERX	HCPCS 63700001	33342-0144-09	ZIPRASIDONE HCL 20 MG PO CAPS	BOTH IP/OP	$35.48 	$26.26	$0.00	$25.74		$0.00	$0.00	$0.00	$6.32	$0.00	$0.00	$0.00	$0.00	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.09	$25.49	$25.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29778	ERX	HCPCS 63700001	65862-0702-60	ZIPRASIDONE HCL 20 MG PO CAPS	BOTH IP/OP	$35.48 	$26.26	$0.00	$25.74		$0.00	$0.00	$0.00	$6.32	$0.00	$0.00	$0.00	$0.00	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.09	$25.49	$25.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29778	ERX	HCPCS 63700001	68084-0103-09	ZIPRASIDONE HCL 20 MG PO CAPS	BOTH IP/OP	$35.48 	$26.26	$0.00	$25.74		$0.00	$0.00	$0.00	$6.32	$0.00	$0.00	$0.00	$0.00	$0.00	$7.39	$0.00	$0.00	$0.00	$0.00	$16.09	$25.49	$25.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29779	ERX	HCPCS 63700001	16714-0836-01	ZIPRASIDONE HCL 40 MG PO CAPS	BOTH IP/OP	$37.56 	$27.79	$0.00	$27.25		$0.00	$0.00	$0.00	$6.69	$0.00	$0.00	$0.00	$0.00	$0.00	$7.83	$0.00	$0.00	$0.00	$0.00	$17.03	$26.98	$27.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29779	ERX	HCPCS 63700001	60505-2529-06	ZIPRASIDONE HCL 40 MG PO CAPS	BOTH IP/OP	$37.56 	$27.79	$0.00	$27.25		$0.00	$0.00	$0.00	$6.69	$0.00	$0.00	$0.00	$0.00	$0.00	$7.83	$0.00	$0.00	$0.00	$0.00	$17.03	$26.98	$27.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29779	ERX	HCPCS 63700001	65862-0703-60	ZIPRASIDONE HCL 40 MG PO CAPS	BOTH IP/OP	$37.56 	$27.79	$0.00	$27.25		$0.00	$0.00	$0.00	$6.69	$0.00	$0.00	$0.00	$0.00	$0.00	$7.83	$0.00	$0.00	$0.00	$0.00	$17.03	$26.98	$27.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29779	ERX	HCPCS 63700001	68084-0104-09	ZIPRASIDONE HCL 40 MG PO CAPS	BOTH IP/OP	$37.56 	$27.79	$0.00	$27.25		$0.00	$0.00	$0.00	$6.69	$0.00	$0.00	$0.00	$0.00	$0.00	$7.83	$0.00	$0.00	$0.00	$0.00	$17.03	$26.98	$27.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29780	ERX	HCPCS 63700001	00781-2167-60	ZIPRASIDONE HCL 60 MG PO CAPS	BOTH IP/OP	$41.34 	$30.59	$0.00	$33.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.67	$32.74	$33.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29780	ERX	HCPCS 63700001	00904-6271-08	ZIPRASIDONE HCL 60 MG PO CAPS	BOTH IP/OP	$41.34 	$30.59	$0.00	$33.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.67	$32.74	$33.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29780	ERX	HCPCS 63700001	33342-0146-09	ZIPRASIDONE HCL 60 MG PO CAPS	BOTH IP/OP	$41.34 	$30.59	$0.00	$33.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.67	$32.74	$33.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29780	ERX	HCPCS 63700001	55111-0258-60	ZIPRASIDONE HCL 60 MG PO CAPS	BOTH IP/OP	$41.34 	$30.59	$0.00	$33.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.67	$32.74	$33.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29780	ERX	HCPCS 63700001	59762-2003-01	ZIPRASIDONE HCL 60 MG PO CAPS	BOTH IP/OP	$41.34 	$30.59	$0.00	$33.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.67	$32.74	$33.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29780	ERX	HCPCS 63700001	65862-0704-60	ZIPRASIDONE HCL 60 MG PO CAPS	BOTH IP/OP	$41.34 	$30.59	$0.00	$33.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.67	$32.74	$33.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29780	ERX	HCPCS 63700001	68084-0105-09	ZIPRASIDONE HCL 60 MG PO CAPS	BOTH IP/OP	$41.34 	$30.59	$0.00	$33.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.67	$32.74	$33.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29780	ERX	HCPCS 63700001	68180-0333-07	ZIPRASIDONE HCL 60 MG PO CAPS	BOTH IP/OP	$41.34 	$30.59	$0.00	$33.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.67	$32.74	$33.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29781	ERX	HCPCS 63700001	00781-2168-60	ZIPRASIDONE HCL 80 MG PO CAPS	BOTH IP/OP	$45.58 	$33.73	$0.00	$33.07		$0.00	$0.00	$0.00	$8.11	$0.00	$0.00	$0.00	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$20.67	$32.74	$33.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29781	ERX	HCPCS 63700001	00904-6272-08	ZIPRASIDONE HCL 80 MG PO CAPS	BOTH IP/OP	$45.58 	$33.73	$0.00	$33.07		$0.00	$0.00	$0.00	$8.11	$0.00	$0.00	$0.00	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$20.67	$32.74	$33.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29781	ERX	HCPCS 63700001	68084-0106-09	ZIPRASIDONE HCL 80 MG PO CAPS	BOTH IP/OP	$45.58 	$33.73	$0.00	$33.07		$0.00	$0.00	$0.00	$8.11	$0.00	$0.00	$0.00	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$20.67	$32.74	$33.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29805	ERX	HCPCS 25000001	10019-0055-61	ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN	BOTH IP/OP	"$1,453.64 "	"$1,075.69"	$0.00	"$1,120.47"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,078.89"	"$1,078.89"	"$1,120.47"	$0.00	$302.94	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29805	ERX	HCPCS 25000001	10019-0672-10	ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN	BOTH IP/OP	"$1,453.64 "	"$1,075.69"	$0.00	"$1,120.47"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,078.89"	"$1,078.89"	"$1,120.47"	$0.00	$302.94	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29805	ERX	HCPCS 25000001	25021-0308-84	ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN	BOTH IP/OP	"$1,453.64 "	"$1,075.69"	$0.00	"$1,120.47"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,078.89"	"$1,078.89"	"$1,120.47"	$0.00	$302.94	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29822	ERX	HCPCS 63700001	00225-0295-15	HYOSCYAMINE SULFATE 0.125 MG PO TBDP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29858	ERX	HCPCS 63700001	00904-6322-61	METOPROLOL SUCCINATE ER 25 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29858	ERX	HCPCS 63700001	50742-0615-01	METOPROLOL SUCCINATE ER 25 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29858	ERX	HCPCS 63700001	51079-0169-20	METOPROLOL SUCCINATE ER 25 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29858	ERX	HCPCS 63700001	55111-0466-01	METOPROLOL SUCCINATE ER 25 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29904	ERX	HCPCS 63700001	68180-0429-01	BIMATOPROST 0.03 % OP SOLN	BOTH IP/OP	$452.36 	$334.75	$0.00	$328.50		$0.00	$0.00	$0.00	$80.52	$0.00	$0.00	$0.00	$0.00	$0.00	$94.27	$0.00	$0.00	$0.00	$0.00	$205.32	$325.22	$328.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29967	ERX	HCPCS 63700001	24689-0785-01	BUSPIRONE HCL 7.5 MG PO TABS	BOTH IP/OP	$6.63 	$4.91	$0.00	$4.81		$0.00	$0.00	$0.00	$1.18	$0.00	$0.00	$0.00	$0.00	$0.00	$1.38	$0.00	$0.00	$0.00	$0.00	$3.01	$4.76	$4.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29967	ERX	HCPCS 63700001	64380-0787-06	BUSPIRONE HCL 7.5 MG PO TABS	BOTH IP/OP	$6.63 	$4.91	$0.00	$4.81		$0.00	$0.00	$0.00	$1.18	$0.00	$0.00	$0.00	$0.00	$0.00	$1.38	$0.00	$0.00	$0.00	$0.00	$3.01	$4.76	$4.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30070	ERX	HCPCS 63700001	00904-6323-61	METOPROLOL SUCCINATE ER 50 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30070	ERX	HCPCS 63700001	50268-0541-11	METOPROLOL SUCCINATE ER 50 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30070	ERX	HCPCS 63700001	50268-0541-15	METOPROLOL SUCCINATE ER 50 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30070	ERX	HCPCS 63700001	50742-0616-01	METOPROLOL SUCCINATE ER 50 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30070	ERX	HCPCS 63700001	55111-0467-01	METOPROLOL SUCCINATE ER 50 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30070	ERX	HCPCS 63700001	55111-0467-05	METOPROLOL SUCCINATE ER 50 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30070	ERX	HCPCS 63700001	62037-0831-01	METOPROLOL SUCCINATE ER 50 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30071	ERX	HCPCS 63700001	00904-6324-61	METOPROLOL SUCCINATE ER 100 MG PO TB24	BOTH IP/OP	$8.57 	$6.34	$0.00	$6.22		$0.00	$0.00	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$3.89	$6.16	$6.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30071	ERX	HCPCS 63700001	50742-0617-01	METOPROLOL SUCCINATE ER 100 MG PO TB24	BOTH IP/OP	$8.57 	$6.34	$0.00	$6.22		$0.00	$0.00	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$3.89	$6.16	$6.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30071	ERX	HCPCS 63700001	55111-0468-01	METOPROLOL SUCCINATE ER 100 MG PO TB24	BOTH IP/OP	$8.57 	$6.34	$0.00	$6.22		$0.00	$0.00	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$3.89	$6.16	$6.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30071	ERX	HCPCS 63700001	63739-0454-10	METOPROLOL SUCCINATE ER 100 MG PO TB24	BOTH IP/OP	$8.57 	$6.34	$0.00	$6.22		$0.00	$0.00	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$3.89	$6.16	$6.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30072	ERX	HCPCS 63700001	00378-4598-77	METOPROLOL SUCCINATE ER 200 MG PO TB24	BOTH IP/OP	$10.56 	$7.81	$0.00	$7.66		$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$4.79	$7.59	$7.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30072	ERX	HCPCS 63700001	50742-0618-01	METOPROLOL SUCCINATE ER 200 MG PO TB24	BOTH IP/OP	$10.56 	$7.81	$0.00	$7.66		$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$4.79	$7.59	$7.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30072	ERX	HCPCS 63700001	55111-0469-01	METOPROLOL SUCCINATE ER 200 MG PO TB24	BOTH IP/OP	$10.56 	$7.81	$0.00	$7.66		$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$4.79	$7.59	$7.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30072	ERX	HCPCS 63700001	55111-0469-05	METOPROLOL SUCCINATE ER 200 MG PO TB24	BOTH IP/OP	$10.56 	$7.81	$0.00	$7.66		$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$4.79	$7.59	$7.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30148	ERX	HCPCS 63700001	00004-0038-22	VALGANCICLOVIR HCL 450 MG PO TABS	BOTH IP/OP	$223.46 	$165.36	$0.00	$162.29		$0.00	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00	$46.57	$0.00	$0.00	$0.00	$0.00	$101.43	$160.67	$162.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30148	ERX	HCPCS 63700001	00603-6330-20	VALGANCICLOVIR HCL 450 MG PO TABS	BOTH IP/OP	$223.46 	$165.36	$0.00	$162.29		$0.00	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00	$46.57	$0.00	$0.00	$0.00	$0.00	$101.43	$160.67	$162.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30148	ERX	HCPCS 63700001	16714-0765-01	VALGANCICLOVIR HCL 450 MG PO TABS	BOTH IP/OP	$223.46 	$165.36	$0.00	$162.29		$0.00	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00	$46.57	$0.00	$0.00	$0.00	$0.00	$101.43	$160.67	$162.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30148	ERX	HCPCS 63700001	55111-0762-60	VALGANCICLOVIR HCL 450 MG PO TABS	BOTH IP/OP	$223.46 	$165.36	$0.00	$162.29		$0.00	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00	$46.57	$0.00	$0.00	$0.00	$0.00	$101.43	$160.67	$162.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30148	ERX	HCPCS 63700001	63739-0357-33	VALGANCICLOVIR HCL 450 MG PO TABS	BOTH IP/OP	$223.46 	$165.36	$0.00	$162.29		$0.00	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00	$46.57	$0.00	$0.00	$0.00	$0.00	$101.43	$160.67	$162.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30148	ERX	HCPCS 63700001	65862-0753-60	VALGANCICLOVIR HCL 450 MG PO TABS	BOTH IP/OP	$223.46 	$165.36	$0.00	$162.29		$0.00	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00	$46.57	$0.00	$0.00	$0.00	$0.00	$101.43	$160.67	$162.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30183	ERX	HCPCS 25000001	47781-0570-89	LIDOCAINE-TRANSPARENT DRESSING 4 % EX KIT	BOTH IP/OP	$115.80 	$85.69	$0.00	$89.26		$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$85.95	$89.26	$0.00	$24.13	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30213	ERX	HCPCS 63700001	51285-0369-01	METHOTREXATE SODIUM 15 MG PO TABS	BOTH IP/OP	$220.06 	$162.84	$0.00	$146.08		$0.00	$0.00	$0.00	$39.17	$0.00	$0.00	$0.00	$0.00	$0.00	$45.86	$0.00	$0.00	$0.00	$0.00	$91.30	$144.62	$146.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30264	ERX	HCPCS 63700001	00904-6084-61	CITALOPRAM HYDROBROMIDE 10 MG PO TABS	BOTH IP/OP	$10.17 	$7.53	$0.00	$7.38		$0.00	$0.00	$0.00	$1.81	$0.00	$0.00	$0.00	$0.00	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$4.62	$7.31	$7.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30264	ERX	HCPCS 63700001	13668-0009-01	CITALOPRAM HYDROBROMIDE 10 MG PO TABS	BOTH IP/OP	$10.17 	$7.53	$0.00	$7.38		$0.00	$0.00	$0.00	$1.81	$0.00	$0.00	$0.00	$0.00	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$4.62	$7.31	$7.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30264	ERX	HCPCS 63700001	68084-0737-01	CITALOPRAM HYDROBROMIDE 10 MG PO TABS	BOTH IP/OP	$10.17 	$7.53	$0.00	$7.38		$0.00	$0.00	$0.00	$1.81	$0.00	$0.00	$0.00	$0.00	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$4.62	$7.31	$7.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30264	ERX	HCPCS 63700001	68084-0737-11	CITALOPRAM HYDROBROMIDE 10 MG PO TABS	BOTH IP/OP	$10.17 	$7.53	$0.00	$7.38		$0.00	$0.00	$0.00	$1.81	$0.00	$0.00	$0.00	$0.00	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$4.62	$7.31	$7.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30433	ERX	HCPCS 63700001	50419-0402-03	DROSPIRENONE-ETHINYL ESTRADIOL 3-0.03 MG PO TABS	BOTH IP/OP	$504.18 	$373.09	$0.00	$366.13		$0.00	$0.00	$0.00	$89.74	$0.00	$0.00	$0.00	$0.00	$0.00	$105.07	$0.00	$0.00	$0.00	$0.00	$228.83	$362.47	$366.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30479	ERX	HCPCS 63700001	00054-0199-59	OXCARBAZEPINE 300 MG/5ML PO SUSP	BOTH IP/OP	$11.08 	$8.20	$0.00	$8.04		$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$0.00	$2.31	$0.00	$0.00	$0.00	$0.00	$5.03	$7.96	$8.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30479	ERX	HCPCS 63700001	00078-0357-52	OXCARBAZEPINE 300 MG/5ML PO SUSP	BOTH IP/OP	$11.08 	$8.20	$0.00	$8.04		$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$0.00	$2.31	$0.00	$0.00	$0.00	$0.00	$5.03	$7.96	$8.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30479	ERX	HCPCS 63700001	00781-6270-43	OXCARBAZEPINE 300 MG/5ML PO SUSP	BOTH IP/OP	$11.08 	$8.20	$0.00	$8.04		$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$0.00	$2.31	$0.00	$0.00	$0.00	$0.00	$5.03	$7.96	$8.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30479	ERX	HCPCS 63700001	65162-0649-78	OXCARBAZEPINE 300 MG/5ML PO SUSP	BOTH IP/OP	$11.08 	$8.20	$0.00	$8.04		$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$0.00	$2.31	$0.00	$0.00	$0.00	$0.00	$5.03	$7.96	$8.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30479	ERX	HCPCS 63700001	99999-6007-93	OXCARBAZEPINE 300 MG/5ML PO SUSP	BOTH IP/OP	$11.08 	$8.20	$0.00	$8.04		$0.00	$0.00	$0.00	$1.97	$0.00	$0.00	$0.00	$0.00	$0.00	$2.31	$0.00	$0.00	$0.00	$0.00	$5.03	$7.96	$8.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30699	ERX	HCPCS 63700001	43547-0272-10	ROPINIROLE HCL 3 MG PO TABS	BOTH IP/OP	$10.48 	$7.76	$0.00	$7.60		$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31086	ERX	HCPCS J0690	66288-1100-01	CEFAZOLIN SODIUM 100 G IJ SOLR	BOTH IP/OP	$403.20 	$298.37	$0.00	$310.79	$181.44	$181.44	$0.00	$0.00	$0.00	$138.65	$299.26	$299.26	$310.79	$0.00	$175.31	$0.00	$238.49	$238.49	$0.00	$173.85	$275.38	$278.16	$0.00		$0.00	$192.70	$0.00	$0.00	$183.48	$0.00	$0.00	$0.00	$0.00	$0.00
31087	ERX	HCPCS J0690	66288-1300-01	CEFAZOLIN SODIUM 300 G IJ SOLR	BOTH IP/OP	"$1,016.16 "	$751.96	$0.00	$783.26	$457.27	$457.27	$0.00	$0.00	$0.00	$415.95	$754.19	$754.19	$783.26	$0.00	$525.93	$0.00	$601.06	$601.06	$0.00	$461.10	$730.38	$737.76	$0.00		$0.00	$578.10	$0.00	$0.00	$550.45	$0.00	$0.00	$0.00	$0.00	$0.00
31097	ERX	HCPCS J9267	44567-0506-01	PACLITAXEL 300 MG/50ML IV CONC	BOTH IP/OP	$229.02 	$169.47	$0.00	$176.53	$103.06	$103.06	$0.00	$0.00	$0.00	$47.73	$169.98	$169.98	$176.53	$0.00	$47.24	$0.00	$135.47	$135.47	$0.00	$103.95	$164.66	$166.32	$0.00		$0.00	$49.35	$0.00	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$0.00
31097	ERX	HCPCS J9267	47781-0595-07	PACLITAXEL 300 MG/50ML IV CONC	BOTH IP/OP	$229.02 	$169.47	$0.00	$176.53	$103.06	$103.06	$0.00	$0.00	$0.00	$47.73	$169.98	$169.98	$176.53	$0.00	$47.24	$0.00	$135.47	$135.47	$0.00	$103.95	$164.66	$166.32	$0.00		$0.00	$49.35	$0.00	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$0.00
31097	ERX	HCPCS J9267	61703-0342-50	PACLITAXEL 300 MG/50ML IV CONC	BOTH IP/OP	$229.02 	$169.47	$0.00	$176.53	$103.06	$103.06	$0.00	$0.00	$0.00	$47.73	$169.98	$169.98	$176.53	$0.00	$47.24	$0.00	$135.47	$135.47	$0.00	$103.95	$164.66	$166.32	$0.00		$0.00	$49.35	$0.00	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$0.00
31097	ERX	HCPCS J9267	63323-0763-50	PACLITAXEL 300 MG/50ML IV CONC	BOTH IP/OP	$229.02 	$169.47	$0.00	$176.53	$103.06	$103.06	$0.00	$0.00	$0.00	$47.73	$169.98	$169.98	$176.53	$0.00	$47.24	$0.00	$135.47	$135.47	$0.00	$103.95	$164.66	$166.32	$0.00		$0.00	$49.35	$0.00	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$0.00
31097	ERX	HCPCS J9267	67457-0434-51	PACLITAXEL 300 MG/50ML IV CONC	BOTH IP/OP	$229.02 	$169.47	$0.00	$176.53	$103.06	$103.06	$0.00	$0.00	$0.00	$47.73	$169.98	$169.98	$176.53	$0.00	$47.24	$0.00	$135.47	$135.47	$0.00	$103.95	$164.66	$166.32	$0.00		$0.00	$49.35	$0.00	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$0.00
31097	ERX	HCPCS J9267	70860-0200-50	PACLITAXEL 300 MG/50ML IV CONC	BOTH IP/OP	$229.02 	$169.47	$0.00	$176.53	$103.06	$103.06	$0.00	$0.00	$0.00	$47.73	$169.98	$169.98	$176.53	$0.00	$47.24	$0.00	$135.47	$135.47	$0.00	$103.95	$164.66	$166.32	$0.00		$0.00	$49.35	$0.00	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$0.00
31177	ERX	HCPCS 63700001	00093-8675-78	AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR	BOTH IP/OP	$148.23 	$109.69	$0.00	$203.18		$0.00	$0.00	$0.00	$26.38	$0.00	$0.00	$0.00	$0.00	$0.00	$30.89	$0.00	$0.00	$0.00	$0.00	$126.99	$106.44	$203.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31177	ERX	HCPCS 63700001	16714-0294-01	AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR	BOTH IP/OP	$148.23 	$109.69	$0.00	$203.18		$0.00	$0.00	$0.00	$26.38	$0.00	$0.00	$0.00	$0.00	$0.00	$30.89	$0.00	$0.00	$0.00	$0.00	$126.99	$106.44	$203.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31177	ERX	HCPCS 63700001	16714-0294-02	AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR	BOTH IP/OP	$148.23 	$109.69	$0.00	$203.18		$0.00	$0.00	$0.00	$26.38	$0.00	$0.00	$0.00	$0.00	$0.00	$30.89	$0.00	$0.00	$0.00	$0.00	$126.99	$201.14	$203.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31209	ERX	HCPCS 63700001	00078-0358-34	VALSARTAN 80 MG PO TABS	BOTH IP/OP	$39.50 	$29.23	$0.00	$28.66		$0.00	$0.00	$0.00	$7.03	$0.00	$0.00	$0.00	$0.00	$0.00	$8.23	$0.00	$0.00	$0.00	$0.00	$17.91	$28.37	$28.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31209	ERX	HCPCS 63700001	00378-5813-77	VALSARTAN 80 MG PO TABS	BOTH IP/OP	$39.50 	$29.23	$0.00	$28.66		$0.00	$0.00	$0.00	$7.03	$0.00	$0.00	$0.00	$0.00	$0.00	$8.23	$0.00	$0.00	$0.00	$0.00	$17.91	$28.37	$28.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31209	ERX	HCPCS 63700001	33342-0063-10	VALSARTAN 80 MG PO TABS	BOTH IP/OP	$39.50 	$29.23	$0.00	$28.66		$0.00	$0.00	$0.00	$7.03	$0.00	$0.00	$0.00	$0.00	$0.00	$8.23	$0.00	$0.00	$0.00	$0.00	$17.91	$28.37	$28.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31209	ERX	HCPCS 63700001	59746-0361-90	VALSARTAN 80 MG PO TABS	BOTH IP/OP	$39.50 	$29.23	$0.00	$28.66		$0.00	$0.00	$0.00	$7.03	$0.00	$0.00	$0.00	$0.00	$0.00	$8.23	$0.00	$0.00	$0.00	$0.00	$17.91	$28.37	$28.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31210	ERX	HCPCS 63700001	00078-0359-34	VALSARTAN 160 MG PO TABS	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31210	ERX	HCPCS 63700001	33342-0064-10	VALSARTAN 160 MG PO TABS	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31210	ERX	HCPCS 63700001	59746-0362-90	VALSARTAN 160 MG PO TABS	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31210	ERX	HCPCS 63700001	65862-0572-90	VALSARTAN 160 MG PO TABS	BOTH IP/OP	$19.00 	$14.06	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31211	ERX	HCPCS 63700001	00078-0360-34	VALSARTAN 320 MG PO TABS	BOTH IP/OP	$53.72 	$39.75	$0.00	$38.98		$0.00	$0.00	$0.00	$9.56	$0.00	$0.00	$0.00	$0.00	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$24.36	$38.59	$38.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31211	ERX	HCPCS 63700001	33342-0065-10	VALSARTAN 320 MG PO TABS	BOTH IP/OP	$53.72 	$39.75	$0.00	$38.98		$0.00	$0.00	$0.00	$9.56	$0.00	$0.00	$0.00	$0.00	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$24.36	$38.59	$38.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31239	ERX	HCPCS 63700001	50580-0728-24	CETIRIZINE-PSEUDOEPHEDRINE ER 5-120 MG PO TB12	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31270	ERX	HCPCS Q9957	11994-0011-04	PERFLUTREN LIPID MICROSPHERE 6.52 MG/ML IV SUSP	BOTH IP/OP	"$1,065.54 "	$788.50	$0.00	$821.32		$0.00	$0.00	$0.00	$0.00	$0.00	$790.84	$790.84	$821.32	$0.00	$222.06	$0.00	$0.00	$0.00	$0.00	$422.36	$669.01	$675.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31310	ERX	HCPCS J2997	50242-0041-64	ALTEPLASE 2 MG IJ SOLR	BOTH IP/OP	$617.14 	$456.68	$0.00	$475.69	$277.71	$277.71	$175.34	$175.34	$175.34	$128.63	$458.04	$458.04	$475.69	$175.50	$128.61	$114.08	$365.04	$365.04	$184.04	$280.10	$443.68	$448.16	$254.15		$254.15	$87.67	$0.00	$0.00	$89.18	$175.77	$0.00	$0.00	$0.00	$0.00
31336	ERX	HCPCS 63700001	00115-5511-10	FENOFIBRATE 54 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31336	ERX	HCPCS 63700001	42858-0454-45	FENOFIBRATE 54 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31415	ERX	HCPCS 63700001	00187-0650-42	METHOXSALEN RAPID 10 MG PO CAPS	BOTH IP/OP	$310.80 	$229.99	$0.00	$248.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.40	$246.15	$248.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31432	ERX	HCPCS J1162	50633-0120-11	DIGOXIN IMMUNE FAB 40 MG IV SOLR	BOTH IP/OP	"$112,086.96 "	"$82,944.35"	$0.00	"$86,396.63"		$0.00	$0.00	$0.00	$0.00	$0.00	"$83,190.94"	"$83,190.94"	"$86,396.63"	$0.00	"$23,358.92"	$0.00	$0.00	$0.00	$0.00	"$48,880.20"	"$74,445.31"	"$78,208.32"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31530	ERX	HCPCS 25000001	00052-0273-01	ETONOGESTREL-ETHINYL ESTRADIOL 0.12-0.015 MG/24HR VA RING	BOTH IP/OP	$655.73 	$485.24	$0.00	$505.44		$0.00	$0.00	$0.00	$0.00	$0.00	$486.68	$486.68	$505.44	$0.00	$136.65	$0.00	$0.00	$0.00	$0.00	$297.62	$471.42	$476.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31530	ERX	HCPCS 25000001	00052-0273-03	ETONOGESTREL-ETHINYL ESTRADIOL 0.12-0.015 MG/24HR VA RING	BOTH IP/OP	$655.73 	$485.24	$0.00	$505.44		$0.00	$0.00	$0.00	$0.00	$0.00	$486.68	$486.68	$505.44	$0.00	$136.65	$0.00	$0.00	$0.00	$0.00	$297.62	$471.42	$476.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31576	ERX	HCPCS 63700001	00574-9850-10	BUDESONIDE 3 MG PO CPEP	BOTH IP/OP	$71.62 	$53.00	$0.00	$57.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.81	$56.72	$57.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31576	ERX	HCPCS 63700001	16714-0829-01	BUDESONIDE 3 MG PO CPEP	BOTH IP/OP	$71.62 	$53.00	$0.00	$57.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.81	$56.72	$57.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31684	ERX	HCPCS 63700001	42291-0800-30	TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS	BOTH IP/OP	$23.36 	$17.29	$0.00	$16.94		$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$0.00	$4.87	$0.00	$0.00	$0.00	$0.00	$10.59	$16.77	$16.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31684	ERX	HCPCS 63700001	61958-0401-01	TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS	BOTH IP/OP	$23.36 	$17.29	$0.00	$16.94		$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$0.00	$4.87	$0.00	$0.00	$0.00	$0.00	$10.59	$16.77	$16.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31684	ERX	HCPCS 63700001	64380-0714-04	TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS	BOTH IP/OP	$23.36 	$17.29	$0.00	$16.94		$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$0.00	$4.87	$0.00	$0.00	$0.00	$0.00	$10.59	$16.77	$16.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31684	ERX	HCPCS 63700001	65862-0421-30	TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS	BOTH IP/OP	$23.36 	$17.29	$0.00	$16.94		$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$0.00	$4.87	$0.00	$0.00	$0.00	$0.00	$10.59	$16.77	$16.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31688	ERX	HCPCS J2501	00074-4637-01	PARICALCITOL 2 MCG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.30	$16.33	$16.33	$16.96	$0.00	$0.76	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.90	$0.00	$0.00	$0.86	$0.00	$0.00	$0.00	$0.00	$0.00
31688	ERX	HCPCS J2501	55150-0212-01	PARICALCITOL 2 MCG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.30	$16.33	$16.33	$16.96	$0.00	$0.76	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.90	$0.00	$0.00	$0.86	$0.00	$0.00	$0.00	$0.00	$0.00
31688	ERX	HCPCS J2501	67457-0379-25	PARICALCITOL 2 MCG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.30	$16.33	$16.33	$16.96	$0.00	$0.76	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.90	$0.00	$0.00	$0.86	$0.00	$0.00	$0.00	$0.00	$0.00
31784	ERX	HCPCS 25000001	66658-0234-01	ANAKINRA 100 MG/0.67ML SC SOSY	BOTH IP/OP	$597.05 	$441.82	$0.00	$460.21		$0.00	$0.00	$0.00	$0.00	$0.00	$443.13	$443.13	$460.21	$0.00	$124.43	$0.00	$0.00	$0.00	$0.00	$283.67	$449.33	$453.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31784	ERX	HCPCS 25000001	66658-0234-07	ANAKINRA 100 MG/0.67ML SC SOSY	BOTH IP/OP	$597.05 	$441.82	$0.00	$460.21		$0.00	$0.00	$0.00	$0.00	$0.00	$443.13	$443.13	$460.21	$0.00	$124.43	$0.00	$0.00	$0.00	$0.00	$283.67	$449.33	$453.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31876	ERX	HCPCS 63700001	66215-0102-06	BOSENTAN 125 MG PO TABS	BOTH IP/OP	$679.29 	$502.67	$0.00	$493.18		$0.00	$0.00	$0.00	$120.91	$0.00	$0.00	$0.00	$0.00	$0.00	$141.56	$0.00	$0.00	$0.00	$0.00	$308.24	$488.25	$493.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31921	ERX	HCPCS J1650	00548-5607-00	ENOXAPARIN SODIUM 150 MG/ML SC SOLN	BOTH IP/OP	$409.82 	$303.27	$0.00	$315.89	$184.42	$184.42	$0.00	$0.00	$0.00	$85.42	$304.17	$304.17	$315.89	$0.00	$85.41	$0.00	$242.41	$242.41	$0.00	$186.01	$294.63	$297.61	$0.00		$0.00	$58.22	$0.00	$0.00	$59.22	$0.00	$0.00	$0.00	$0.00	$0.00
31921	ERX	HCPCS J1650	00781-3655-69	ENOXAPARIN SODIUM 150 MG/ML SC SOLN	BOTH IP/OP	$409.82 	$303.27	$0.00	$315.89	$184.42	$184.42	$0.00	$0.00	$0.00	$85.42	$304.17	$304.17	$315.89	$0.00	$85.41	$0.00	$242.41	$242.41	$0.00	$186.01	$294.63	$297.61	$0.00		$0.00	$58.22	$0.00	$0.00	$59.22	$0.00	$0.00	$0.00	$0.00	$0.00
31921	ERX	HCPCS J1650	00955-1015-10	ENOXAPARIN SODIUM 150 MG/ML SC SOLN	BOTH IP/OP	$409.82 	$303.27	$0.00	$315.89	$184.42	$184.42	$0.00	$0.00	$0.00	$85.42	$304.17	$304.17	$315.89	$0.00	$85.41	$0.00	$242.41	$242.41	$0.00	$186.01	$294.63	$297.61	$0.00		$0.00	$58.22	$0.00	$0.00	$59.22	$0.00	$0.00	$0.00	$0.00	$0.00
31921	ERX	HCPCS J1650	63323-0537-84	ENOXAPARIN SODIUM 150 MG/ML SC SOLN	BOTH IP/OP	$409.82 	$303.27	$0.00	$315.89	$184.42	$184.42	$0.00	$0.00	$0.00	$85.42	$304.17	$304.17	$315.89	$0.00	$85.41	$0.00	$242.41	$242.41	$0.00	$186.01	$294.63	$297.61	$0.00		$0.00	$58.22	$0.00	$0.00	$59.22	$0.00	$0.00	$0.00	$0.00	$0.00
31922	ERX	HCPCS J1335	00006-3843-71	ERTAPENEM SODIUM 1 G IJ SOLR	BOTH IP/OP	$243.74 	$180.37	$0.00	$187.87	$109.68	$109.68	$0.00	$0.00	$0.00	$50.80	$180.90	$180.90	$187.87	$0.00	$33.18	$0.00	$144.17	$144.17	$0.00	$110.64	$175.25	$177.02	$0.00		$0.00	$45.47	$0.00	$0.00	$43.30	$0.00	$0.00	$0.00	$0.00	$0.00
31922	ERX	HCPCS J1335	42023-0221-10	ERTAPENEM SODIUM 1 G IJ SOLR	BOTH IP/OP	$243.74 	$180.37	$0.00	$187.87	$109.68	$109.68	$0.00	$0.00	$0.00	$50.80	$180.90	$180.90	$187.87	$0.00	$33.18	$0.00	$144.17	$144.17	$0.00	$110.64	$175.25	$177.02	$0.00		$0.00	$45.47	$0.00	$0.00	$43.30	$0.00	$0.00	$0.00	$0.00	$0.00
31922	ERX	HCPCS J1335	55150-0282-20	ERTAPENEM SODIUM 1 G IJ SOLR	BOTH IP/OP	$243.74 	$180.37	$0.00	$187.87	$109.68	$109.68	$0.00	$0.00	$0.00	$50.80	$180.90	$180.90	$187.87	$0.00	$33.18	$0.00	$144.17	$144.17	$0.00	$110.64	$175.25	$177.02	$0.00		$0.00	$45.47	$0.00	$0.00	$43.30	$0.00	$0.00	$0.00	$0.00	$0.00
32052	ERX	HCPCS 25000001	00187-5100-01	PIMECROLIMUS 1 % EX CREA	BOTH IP/OP	$939.08 	$694.92	$0.00	$723.84		$0.00	$0.00	$0.00	$0.00	$0.00	$696.99	$696.99	$723.84	$0.00	$195.70	$0.00	$0.00	$0.00	$0.00	$426.12	$674.97	$681.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32052	ERX	HCPCS 25000001	68462-0609-35	PIMECROLIMUS 1 % EX CREA	BOTH IP/OP	$939.08 	$694.92	$0.00	$723.84		$0.00	$0.00	$0.00	$0.00	$0.00	$696.99	$696.99	$723.84	$0.00	$195.70	$0.00	$0.00	$0.00	$0.00	$426.12	$674.97	$681.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32052	ERX	HCPCS 25000001	68682-0110-01	PIMECROLIMUS 1 % EX CREA	BOTH IP/OP	$939.08 	$694.92	$0.00	$723.84		$0.00	$0.00	$0.00	$0.00	$0.00	$696.99	$696.99	$723.84	$0.00	$195.70	$0.00	$0.00	$0.00	$0.00	$426.12	$674.97	$681.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32128	ERX	HCPCS 63700001	00093-7270-98	PRAVASTATIN SODIUM 80 MG PO TABS	BOTH IP/OP	$20.09 	$14.87	$0.00	$14.58		$0.00	$0.00	$0.00	$3.58	$0.00	$0.00	$0.00	$0.00	$0.00	$4.19	$0.00	$0.00	$0.00	$0.00	$9.11	$14.43	$14.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32128	ERX	HCPCS 63700001	16729-0011-15	PRAVASTATIN SODIUM 80 MG PO TABS	BOTH IP/OP	$20.09 	$14.87	$0.00	$14.58		$0.00	$0.00	$0.00	$3.58	$0.00	$0.00	$0.00	$0.00	$0.00	$4.19	$0.00	$0.00	$0.00	$0.00	$9.11	$14.43	$14.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32128	ERX	HCPCS 63700001	60505-1323-09	PRAVASTATIN SODIUM 80 MG PO TABS	BOTH IP/OP	$20.09 	$14.87	$0.00	$14.58		$0.00	$0.00	$0.00	$3.58	$0.00	$0.00	$0.00	$0.00	$0.00	$4.19	$0.00	$0.00	$0.00	$0.00	$9.11	$14.43	$14.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32128	ERX	HCPCS 63700001	68462-0198-90	PRAVASTATIN SODIUM 80 MG PO TABS	BOTH IP/OP	$20.09 	$14.87	$0.00	$14.58		$0.00	$0.00	$0.00	$3.58	$0.00	$0.00	$0.00	$0.00	$0.00	$4.19	$0.00	$0.00	$0.00	$0.00	$9.11	$14.43	$14.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32215	ERX	HCPCS J1652	55111-0678-02	FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN	BOTH IP/OP	$189.65 	$140.34	$0.00	$146.18		$0.00	$0.00	$0.00	$0.00	$0.00	$140.76	$140.76	$146.18	$0.00	$39.52	$0.00	$0.00	$0.00	$0.00	$86.08	$136.35	$137.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32215	ERX	HCPCS J1652	55111-0678-10	FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN	BOTH IP/OP	$189.65 	$140.34	$0.00	$146.18		$0.00	$0.00	$0.00	$0.00	$0.00	$140.76	$140.76	$146.18	$0.00	$39.52	$0.00	$0.00	$0.00	$0.00	$86.08	$136.35	$137.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32215	ERX	HCPCS J1652	55511-0678-11	FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN	BOTH IP/OP	$189.65 	$140.34	$0.00	$146.18		$0.00	$0.00	$0.00	$0.00	$0.00	$140.76	$140.76	$146.18	$0.00	$39.52	$0.00	$0.00	$0.00	$0.00	$86.08	$136.35	$137.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32298	ERX	HCPCS 63700001	00056-0510-30	EFAVIRENZ 600 MG PO TABS	BOTH IP/OP	$151.41 	$112.04	$0.00	$109.83		$0.00	$0.00	$0.00	$26.95	$0.00	$0.00	$0.00	$0.00	$0.00	$31.55	$0.00	$0.00	$0.00	$0.00	$68.65	$108.73	$109.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32298	ERX	HCPCS 63700001	69097-0301-02	EFAVIRENZ 600 MG PO TABS	BOTH IP/OP	$151.41 	$112.04	$0.00	$109.83		$0.00	$0.00	$0.00	$26.95	$0.00	$0.00	$0.00	$0.00	$0.00	$31.55	$0.00	$0.00	$0.00	$0.00	$68.65	$108.73	$109.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32354	ERX	HCPCS 25000001	42192-0139-01	SULFACETAMIDE SODIUM-SULFUR 10-5 % EX CREA	BOTH IP/OP	$398.53 	$294.91	$0.00	$307.19		$0.00	$0.00	$0.00	$0.00	$0.00	$295.79	$295.79	$307.19	$0.00	$83.05	$0.00	$0.00	$0.00	$0.00	$180.88	$286.51	$289.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32375	ERX	HCPCS 25000001	24208-0344-25	FLUNISOLIDE 25 MCG/ACT (0.025%) NA SOLN	BOTH IP/OP	$249.67 	$184.76	$0.00	$192.45		$0.00	$0.00	$0.00	$0.00	$0.00	$185.31	$185.31	$192.45	$0.00	$52.03	$0.00	$0.00	$0.00	$0.00	$113.33	$179.51	$181.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32589	ERX	HCPCS J2430	61703-0324-18	PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN	BOTH IP/OP	$70.48 	$52.16	$0.00	$54.33	$31.72	$31.72	$0.00	$0.00	$0.00	$36.23	$52.31	$52.31	$54.33	$0.00	$14.69	$0.00	$41.69	$41.69	$0.00	$31.49	$49.87	$50.38	$0.00		$0.00	$9.85	$0.00	$0.00	$10.02	$0.00	$0.00	$0.00	$0.00	$0.00
32589	ERX	HCPCS J2430	67457-0430-10	PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN	BOTH IP/OP	$70.48 	$52.16	$0.00	$54.33	$31.72	$31.72	$0.00	$0.00	$0.00	$36.23	$52.31	$52.31	$54.33	$0.00	$14.69	$0.00	$41.69	$41.69	$0.00	$31.49	$49.87	$50.38	$0.00		$0.00	$9.85	$0.00	$0.00	$10.02	$0.00	$0.00	$0.00	$0.00	$0.00
32703	ERX	HCPCS 25000001	08212-4271-81	ILEX SKIN PROTECTANT 58.3 % EX PSTE	BOTH IP/OP	$26.15 	$19.35	$0.00	$20.16		$0.00	$0.00	$0.00	$0.00	$0.00	$19.41	$19.41	$20.16	$0.00	$5.45	$0.00	$0.00	$0.00	$0.00	$11.86	$18.79	$18.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32810	ERX	HCPCS 25000001	89141-0456-02	GELCLAIR MT GEL	BOTH IP/OP	$188.53 	$139.51	$0.00	$145.32		$0.00	$0.00	$0.00	$0.00	$0.00	$139.93	$139.93	$145.32	$0.00	$39.29	$0.00	$0.00	$0.00	$0.00	$85.57	$135.54	$136.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32810	ERX	HCPCS 25000001	89141-0456-03	GELCLAIR MT GEL	BOTH IP/OP	$188.53 	$139.51	$0.00	$145.32		$0.00	$0.00	$0.00	$0.00	$0.00	$139.93	$139.93	$145.32	$0.00	$39.29	$0.00	$0.00	$0.00	$0.00	$85.57	$135.54	$136.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32893	ERX	HCPCS J9217	62935-0753-75	LEUPROLIDE ACETATE 7.5 MG SC KIT	BOTH IP/OP	"$1,403.86 "	"$1,038.86"	$0.00	"$1,082.10"	$631.74	$631.74	$200.73	$200.73	$200.73	$246.83	"$1,041.94"	"$1,041.94"	"$1,082.10"	$139.09	$163.43	$90.41	$830.38	$830.38	$235.93	$650.44	"$1,030.30"	"$1,040.70"	$325.81		$325.81	$270.33	$0.00	$0.00	$257.40	$205.89	$0.00	$0.00	$0.00	$0.00
32895	ERX	HCPCS 63700001	00430-0472-03	RISEDRONATE SODIUM 35 MG PO TABS	BOTH IP/OP	$343.72 	$254.35	$0.00	$249.60		$0.00	$0.00	$0.00	$61.18	$0.00	$0.00	$0.00	$0.00	$0.00	$71.63	$0.00	$0.00	$0.00	$0.00	$156.00	$247.10	$249.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32960	ERX	HCPCS J7192	00026-3783-35	ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 500 UNITS IV KIT	BOTH IP/OP	"$2,364.00 "	"$1,749.36"	$0.00	"$1,891.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,182.00"	"$1,872.29"	"$1,891.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32961	ERX	HCPCS J7192	00026-3785-55	ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 1000 UNITS IV KIT	BOTH IP/OP	"$4,452.20 "	"$3,294.63"	$0.00	"$3,431.76"		$0.00	$0.00	$0.00	$0.00	$0.00	"$3,304.42"	"$3,304.42"	"$3,431.76"	$0.00	$927.84	$0.00	$0.00	$0.00	$0.00	"$2,019.25"	"$3,198.49"	"$3,230.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32961	ERX	HCPCS J7192	00026-4785-01	ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 1000 UNITS IV KIT	BOTH IP/OP	"$4,452.20 "	"$3,294.63"	$0.00	"$3,431.76"		$0.00	$0.00	$0.00	$0.00	$0.00	"$3,304.42"	"$3,304.42"	"$3,431.76"	$0.00	$927.84	$0.00	$0.00	$0.00	$0.00	"$2,019.25"	"$3,198.49"	"$3,230.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32979	ERX	HCPCS 63700001	00078-0401-34	IMATINIB MESYLATE 100 MG PO TABS	BOTH IP/OP	"$1,312.44 "	$971.21	$0.00	$952.86		$0.00	$0.00	$0.00	$233.61	$0.00	$0.00	$0.00	$0.00	$0.00	$273.51	$0.00	$0.00	$0.00	$0.00	$595.54	$943.34	$952.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33008	ERX	HCPCS 63700001	00049-3170-30	VORICONAZOLE 50 MG PO TABS	BOTH IP/OP	$14.97 	$11.08	$0.00	$10.70		$0.00	$0.00	$0.00	$2.66	$0.00	$0.00	$0.00	$0.00	$0.00	$3.12	$0.00	$0.00	$0.00	$0.00	$6.69	$10.60	$10.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33008	ERX	HCPCS 63700001	00781-5667-31	VORICONAZOLE 50 MG PO TABS	BOTH IP/OP	$14.97 	$11.08	$0.00	$10.70		$0.00	$0.00	$0.00	$2.66	$0.00	$0.00	$0.00	$0.00	$0.00	$3.12	$0.00	$0.00	$0.00	$0.00	$6.69	$10.60	$10.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33008	ERX	HCPCS 63700001	16714-0514-01	VORICONAZOLE 50 MG PO TABS	BOTH IP/OP	$14.97 	$11.08	$0.00	$10.70		$0.00	$0.00	$0.00	$2.66	$0.00	$0.00	$0.00	$0.00	$0.00	$3.12	$0.00	$0.00	$0.00	$0.00	$6.69	$10.60	$10.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33009	ERX	HCPCS 63700001	00049-3180-30	VORICONAZOLE 200 MG PO TABS	BOTH IP/OP	$18.73 	$13.86	$0.00	$13.38		$0.00	$0.00	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$0.00	$3.90	$0.00	$0.00	$0.00	$0.00	$8.37	$13.25	$13.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33009	ERX	HCPCS 63700001	00781-5668-31	VORICONAZOLE 200 MG PO TABS	BOTH IP/OP	$18.73 	$13.86	$0.00	$13.38		$0.00	$0.00	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$0.00	$3.90	$0.00	$0.00	$0.00	$0.00	$8.37	$13.25	$13.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33009	ERX	HCPCS 63700001	16714-0515-01	VORICONAZOLE 200 MG PO TABS	BOTH IP/OP	$18.73 	$13.86	$0.00	$13.38		$0.00	$0.00	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$0.00	$3.90	$0.00	$0.00	$0.00	$0.00	$8.37	$13.25	$13.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33009	ERX	HCPCS 63700001	51079-0165-03	VORICONAZOLE 200 MG PO TABS	BOTH IP/OP	$18.73 	$13.86	$0.00	$13.38		$0.00	$0.00	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$0.00	$3.90	$0.00	$0.00	$0.00	$0.00	$8.37	$13.25	$13.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33010	ERX	HCPCS J3465	00049-3190-01	VORICONAZOLE 200 MG IV SOLR	BOTH IP/OP	$512.67 	$379.38	$0.00	$395.17		$0.00	$0.00	$0.00	$0.00	$0.00	$380.50	$380.50	$395.17	$0.00	$106.84	$0.00	$0.00	$0.00	$0.00	$232.69	$368.57	$372.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33010	ERX	HCPCS J3465	00049-3190-28	VORICONAZOLE 200 MG IV SOLR	BOTH IP/OP	$512.67 	$379.38	$0.00	$395.17		$0.00	$0.00	$0.00	$0.00	$0.00	$380.50	$380.50	$395.17	$0.00	$106.84	$0.00	$0.00	$0.00	$0.00	$232.69	$368.57	$372.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33010	ERX	HCPCS J3465	00781-3416-94	VORICONAZOLE 200 MG IV SOLR	BOTH IP/OP	$512.67 	$379.38	$0.00	$395.17		$0.00	$0.00	$0.00	$0.00	$0.00	$380.50	$380.50	$395.17	$0.00	$106.84	$0.00	$0.00	$0.00	$0.00	$232.69	$368.57	$372.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33010	ERX	HCPCS J3465	47781-0466-71	VORICONAZOLE 200 MG IV SOLR	BOTH IP/OP	$512.67 	$379.38	$0.00	$395.17		$0.00	$0.00	$0.00	$0.00	$0.00	$380.50	$380.50	$395.17	$0.00	$106.84	$0.00	$0.00	$0.00	$0.00	$232.69	$368.57	$372.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33083	ERX	HCPCS 63700001	00245-0213-11	MIDODRINE HCL 10 MG PO TABS	BOTH IP/OP	$36.62 	$27.10	$0.00	$13.24		$0.00	$0.00	$0.00	$6.52	$0.00	$0.00	$0.00	$0.00	$0.00	$7.63	$0.00	$0.00	$0.00	$0.00	$8.28	$13.11	$13.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33083	ERX	HCPCS 63700001	00378-1903-01	MIDODRINE HCL 10 MG PO TABS	BOTH IP/OP	$36.62 	$27.10	$0.00	$13.24		$0.00	$0.00	$0.00	$6.52	$0.00	$0.00	$0.00	$0.00	$0.00	$7.63	$0.00	$0.00	$0.00	$0.00	$8.28	$13.11	$13.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33083	ERX	HCPCS 63700001	42291-0562-90	MIDODRINE HCL 10 MG PO TABS	BOTH IP/OP	$36.62 	$27.10	$0.00	$13.24		$0.00	$0.00	$0.00	$6.52	$0.00	$0.00	$0.00	$0.00	$0.00	$7.63	$0.00	$0.00	$0.00	$0.00	$8.28	$13.11	$13.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33111	ERX	HCPCS 63700001	55111-0341-01	AMLODIPINE-BENAZEPRIL HCL 10-20 MG PO CAPS	BOTH IP/OP	$13.92 	$10.30	$0.00	$10.10		$0.00	$0.00	$0.00	$2.48	$0.00	$0.00	$0.00	$0.00	$0.00	$2.90	$0.00	$0.00	$0.00	$0.00	$6.31	$10.00	$10.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33111	ERX	HCPCS 63700001	65862-0586-01	AMLODIPINE-BENAZEPRIL HCL 10-20 MG PO CAPS	BOTH IP/OP	$13.92 	$10.30	$0.00	$10.10		$0.00	$0.00	$0.00	$2.48	$0.00	$0.00	$0.00	$0.00	$0.00	$2.90	$0.00	$0.00	$0.00	$0.00	$6.31	$10.00	$10.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33175	ERX	HCPCS J3486	00049-3920-83	ZIPRASIDONE MESYLATE 20 MG IM SOLR	BOTH IP/OP	$82.44 	$61.01	$0.00	$63.54	$37.10	$37.10	$0.00	$0.00	$0.00	$17.18	$61.19	$61.19	$63.54	$0.00	$17.44	$0.00	$48.76	$48.76	$0.00	$37.39	$59.22	$59.82	$0.00		$0.00	$21.10	$0.00	$0.00	$20.09	$0.00	$0.00	$0.00	$0.00	$0.00
33175	ERX	HCPCS J3486	43598-0848-58	ZIPRASIDONE MESYLATE 20 MG IM SOLR	BOTH IP/OP	$82.44 	$61.01	$0.00	$63.54	$37.10	$37.10	$0.00	$0.00	$0.00	$17.18	$61.19	$61.19	$63.54	$0.00	$17.44	$0.00	$48.76	$48.76	$0.00	$37.39	$59.22	$59.82	$0.00		$0.00	$21.10	$0.00	$0.00	$20.09	$0.00	$0.00	$0.00	$0.00	$0.00
33175	ERX	HCPCS J3486	72266-0160-01	ZIPRASIDONE MESYLATE 20 MG IM SOLR	BOTH IP/OP	$82.44 	$61.01	$0.00	$63.54	$37.10	$37.10	$0.00	$0.00	$0.00	$17.18	$61.19	$61.19	$63.54	$0.00	$17.44	$0.00	$48.76	$48.76	$0.00	$37.39	$59.22	$59.82	$0.00		$0.00	$21.10	$0.00	$0.00	$20.09	$0.00	$0.00	$0.00	$0.00	$0.00
33175	ERX	HCPCS J3486	72266-0160-10	ZIPRASIDONE MESYLATE 20 MG IM SOLR	BOTH IP/OP	$82.44 	$61.01	$0.00	$63.54	$37.10	$37.10	$0.00	$0.00	$0.00	$17.18	$61.19	$61.19	$63.54	$0.00	$17.44	$0.00	$48.76	$48.76	$0.00	$37.39	$59.22	$59.82	$0.00		$0.00	$21.10	$0.00	$0.00	$20.09	$0.00	$0.00	$0.00	$0.00	$0.00
33226	ERX	HCPCS 63700001	00093-2272-34	AMOXICILLIN-POT CLAVULANATE 400-57 MG PO CHEW	BOTH IP/OP	$22.59 	$16.72	$0.00	$16.39		$0.00	$0.00	$0.00	$4.02	$0.00	$0.00	$0.00	$0.00	$0.00	$4.71	$0.00	$0.00	$0.00	$0.00	$10.25	$16.23	$16.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33227	ERX	HCPCS 63700001	00093-2274-34	AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS	BOTH IP/OP	$15.86 	$11.74	$0.00	$11.51		$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$0.00	$0.00	$0.00	$3.31	$0.00	$0.00	$0.00	$0.00	$7.20	$11.40	$11.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33227	ERX	HCPCS 63700001	16714-0296-01	AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS	BOTH IP/OP	$15.86 	$11.74	$0.00	$11.51		$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$0.00	$0.00	$0.00	$3.31	$0.00	$0.00	$0.00	$0.00	$7.20	$11.40	$11.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33227	ERX	HCPCS 63700001	16714-0494-01	AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS	BOTH IP/OP	$15.86 	$11.74	$0.00	$11.51		$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$0.00	$0.00	$0.00	$3.31	$0.00	$0.00	$0.00	$0.00	$7.20	$11.40	$11.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33227	ERX	HCPCS 63700001	65862-0502-20	AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS	BOTH IP/OP	$15.86 	$11.74	$0.00	$11.51		$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$0.00	$0.00	$0.00	$3.31	$0.00	$0.00	$0.00	$0.00	$7.20	$11.40	$11.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33227	ERX	HCPCS 63700001	66685-1002-02	AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS	BOTH IP/OP	$15.86 	$11.74	$0.00	$11.51		$0.00	$0.00	$0.00	$2.82	$0.00	$0.00	$0.00	$0.00	$0.00	$3.31	$0.00	$0.00	$0.00	$0.00	$7.20	$11.40	$11.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33228	ERX	HCPCS 63700001	00093-2275-34	AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS	BOTH IP/OP	$20.58 	$15.23	$0.00	$14.93		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.29	$0.00	$0.00	$0.00	$0.00	$9.33	$14.78	$14.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33228	ERX	HCPCS 63700001	00781-1852-20	AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS	BOTH IP/OP	$20.58 	$15.23	$0.00	$14.93		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.29	$0.00	$0.00	$0.00	$0.00	$9.33	$14.78	$14.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33228	ERX	HCPCS 63700001	16714-0297-01	AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS	BOTH IP/OP	$20.58 	$15.23	$0.00	$14.93		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.29	$0.00	$0.00	$0.00	$0.00	$9.33	$14.78	$14.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33228	ERX	HCPCS 63700001	16714-0297-02	AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS	BOTH IP/OP	$20.58 	$15.23	$0.00	$14.93		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.29	$0.00	$0.00	$0.00	$0.00	$9.33	$14.78	$14.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33228	ERX	HCPCS 63700001	16714-0478-01	AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS	BOTH IP/OP	$20.58 	$15.23	$0.00	$14.93		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.29	$0.00	$0.00	$0.00	$0.00	$9.33	$14.78	$14.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33228	ERX	HCPCS 63700001	16714-0478-02	AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS	BOTH IP/OP	$20.58 	$15.23	$0.00	$14.93		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.29	$0.00	$0.00	$0.00	$0.00	$9.33	$14.78	$14.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33228	ERX	HCPCS 63700001	43598-0221-14	AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS	BOTH IP/OP	$20.58 	$15.23	$0.00	$14.93		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.29	$0.00	$0.00	$0.00	$0.00	$9.33	$14.78	$14.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33228	ERX	HCPCS 63700001	65862-0503-01	AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS	BOTH IP/OP	$20.58 	$15.23	$0.00	$14.93		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.29	$0.00	$0.00	$0.00	$0.00	$9.33	$14.78	$14.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33228	ERX	HCPCS 63700001	65862-0503-20	AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS	BOTH IP/OP	$20.58 	$15.23	$0.00	$14.93		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.29	$0.00	$0.00	$0.00	$0.00	$9.33	$14.78	$14.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33228	ERX	HCPCS 63700001	66685-1001-00	AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS	BOTH IP/OP	$20.58 	$15.23	$0.00	$14.93		$0.00	$0.00	$0.00	$3.66	$0.00	$0.00	$0.00	$0.00	$0.00	$4.29	$0.00	$0.00	$0.00	$0.00	$9.33	$14.78	$14.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33230	ERX	HCPCS 63700001	16714-0293-01	AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR	BOTH IP/OP	$180.65 	$133.68	$0.00	$98.42		$0.00	$0.00	$0.00	$32.16	$0.00	$0.00	$0.00	$0.00	$0.00	$37.65	$0.00	$0.00	$0.00	$0.00	$61.52	$97.44	$98.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33230	ERX	HCPCS 63700001	66685-1012-00	AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR	BOTH IP/OP	$180.65 	$133.68	$0.00	$98.42		$0.00	$0.00	$0.00	$32.16	$0.00	$0.00	$0.00	$0.00	$0.00	$37.65	$0.00	$0.00	$0.00	$0.00	$61.52	$97.44	$98.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33512	ERX	HCPCS 63700001	00093-5851-01	ESCITALOPRAM OXALATE 10 MG PO TABS	BOTH IP/OP	$18.15 	$13.43	$0.00	$13.17		$0.00	$0.00	$0.00	$3.23	$0.00	$0.00	$0.00	$0.00	$0.00	$3.78	$0.00	$0.00	$0.00	$0.00	$8.23	$13.04	$13.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33512	ERX	HCPCS 63700001	00904-6426-61	ESCITALOPRAM OXALATE 10 MG PO TABS	BOTH IP/OP	$18.15 	$13.43	$0.00	$13.17		$0.00	$0.00	$0.00	$3.23	$0.00	$0.00	$0.00	$0.00	$0.00	$3.78	$0.00	$0.00	$0.00	$0.00	$8.23	$13.04	$13.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33512	ERX	HCPCS 63700001	43547-0281-10	ESCITALOPRAM OXALATE 10 MG PO TABS	BOTH IP/OP	$18.15 	$13.43	$0.00	$13.17		$0.00	$0.00	$0.00	$3.23	$0.00	$0.00	$0.00	$0.00	$0.00	$3.78	$0.00	$0.00	$0.00	$0.00	$8.23	$13.04	$13.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33512	ERX	HCPCS 63700001	76282-0250-90	ESCITALOPRAM OXALATE 10 MG PO TABS	BOTH IP/OP	$18.15 	$13.43	$0.00	$13.17		$0.00	$0.00	$0.00	$3.23	$0.00	$0.00	$0.00	$0.00	$0.00	$3.78	$0.00	$0.00	$0.00	$0.00	$8.23	$13.04	$13.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33513	ERX	HCPCS 63700001	00456-2020-01	ESCITALOPRAM OXALATE 20 MG PO TABS	BOTH IP/OP	$18.94 	$14.02	$0.00	$13.74		$0.00	$0.00	$0.00	$3.37	$0.00	$0.00	$0.00	$0.00	$0.00	$3.95	$0.00	$0.00	$0.00	$0.00	$8.59	$13.61	$13.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33513	ERX	HCPCS 63700001	00904-6427-61	ESCITALOPRAM OXALATE 20 MG PO TABS	BOTH IP/OP	$18.94 	$14.02	$0.00	$13.74		$0.00	$0.00	$0.00	$3.37	$0.00	$0.00	$0.00	$0.00	$0.00	$3.95	$0.00	$0.00	$0.00	$0.00	$8.59	$13.61	$13.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33513	ERX	HCPCS 63700001	43547-0282-10	ESCITALOPRAM OXALATE 20 MG PO TABS	BOTH IP/OP	$18.94 	$14.02	$0.00	$13.74		$0.00	$0.00	$0.00	$3.37	$0.00	$0.00	$0.00	$0.00	$0.00	$3.95	$0.00	$0.00	$0.00	$0.00	$8.59	$13.61	$13.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33513	ERX	HCPCS 63700001	65862-0375-01	ESCITALOPRAM OXALATE 20 MG PO TABS	BOTH IP/OP	$18.94 	$14.02	$0.00	$13.74		$0.00	$0.00	$0.00	$3.37	$0.00	$0.00	$0.00	$0.00	$0.00	$3.95	$0.00	$0.00	$0.00	$0.00	$8.59	$13.61	$13.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33541	ERX	HCPCS 63700001	00378-5807-93	VALSARTAN 40 MG PO TABS	BOTH IP/OP	$17.00 	$12.58	$0.00	$12.33		$0.00	$0.00	$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$7.71	$12.20	$12.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33541	ERX	HCPCS 63700001	33342-0062-07	VALSARTAN 40 MG PO TABS	BOTH IP/OP	$17.00 	$12.58	$0.00	$12.33		$0.00	$0.00	$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$7.71	$12.20	$12.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33541	ERX	HCPCS 63700001	59746-0360-30	VALSARTAN 40 MG PO TABS	BOTH IP/OP	$17.00 	$12.58	$0.00	$12.33		$0.00	$0.00	$0.00	$3.03	$0.00	$0.00	$0.00	$0.00	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$7.71	$12.20	$12.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33591	ERX	HCPCS J2783	00024-5150-10	RASBURICASE 1.5 MG IV SOLR	BOTH IP/OP	"$2,598.18 "	"$1,922.65"	$0.00	"$2,060.76"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,984.29"	"$1,984.29"	"$2,060.76"	$0.00	"$1,110.58"	$0.00	$0.00	$0.00	$0.00	"$1,121.60"	"$1,776.61"	"$1,794.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33666	ERX	HCPCS J1815	00169-3685-12	INSULIN ASPART PROT & ASPART (70-30) 100 UNIT/ML SC SUSP	BOTH IP/OP	"$1,051.61 "	$778.19	$0.00	$763.50	$571.02	$571.02	$0.00	$0.00	$0.00	$219.18	$0.00	$0.00	$0.00	$0.00	$219.16	$0.00	$622.03	$622.03	$0.00	$477.19	$755.87	$763.50	$0.00		$0.00	$0.00	$0.00	$0.00	$201.38	$0.00	$0.00	$0.00	$0.00	$0.00
33669	ERX	HCPCS J9217	62935-0223-05	LEUPROLIDE ACETATE (3 MONTH) 22.5 MG SC KIT	BOTH IP/OP	"$3,674.95 "	"$2,719.46"	$0.00	"$2,832.65"	"$1,653.73"	"$1,653.73"	$602.20	$602.20	$602.20	$740.50	"$2,727.55"	"$2,727.55"	"$2,832.65"	$417.27	$490.29	$271.23	"$1,811.75"	"$1,811.75"	$707.80	"$1,666.74"	"$2,640.11"	"$2,666.78"	$977.44		$977.44	$811.00	$0.00	$0.00	$772.21	$617.66	$0.00	$0.00	$0.00	$0.00
33816	ERX	HCPCS 63700001	61958-0501-01	ADEFOVIR DIPIVOXIL 10 MG PO TABS	BOTH IP/OP	$226.29 	$167.45	$0.00	$156.81		$0.00	$0.00	$0.00	$40.28	$0.00	$0.00	$0.00	$0.00	$0.00	$47.16	$0.00	$0.00	$0.00	$0.00	$98.01	$155.24	$156.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33826	ERX	HCPCS 63700001	00245-0272-06	OXANDROLONE 10 MG PO TABS	BOTH IP/OP	$78.57 	$58.14	$0.00	$57.01		$0.00	$0.00	$0.00	$13.99	$0.00	$0.00	$0.00	$0.00	$0.00	$16.37	$0.00	$0.00	$0.00	$0.00	$35.63	$56.44	$57.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33826	ERX	HCPCS 63700001	49884-0302-02	OXANDROLONE 10 MG PO TABS	BOTH IP/OP	$78.57 	$58.14	$0.00	$57.01		$0.00	$0.00	$0.00	$13.99	$0.00	$0.00	$0.00	$0.00	$0.00	$16.37	$0.00	$0.00	$0.00	$0.00	$35.63	$56.44	$57.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33863	ERX	HCPCS J7192	00026-3786-65	ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 2000 UNITS IV KIT	BOTH IP/OP	"$8,904.40 "	"$6,589.26"	$0.00	"$6,863.51"		$0.00	$0.00	$0.00	$0.00	$0.00	"$6,608.85"	"$6,608.85"	"$6,863.51"	$0.00	"$1,855.68"	$0.00	$0.00	$0.00	$0.00	"$4,038.50"	"$6,396.98"	"$6,461.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33863	ERX	HCPCS J7192	00026-4786-01	ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 2000 UNITS IV KIT	BOTH IP/OP	"$8,904.40 "	"$6,589.26"	$0.00	"$6,863.51"		$0.00	$0.00	$0.00	$0.00	$0.00	"$6,608.85"	"$6,608.85"	"$6,863.51"	$0.00	"$1,855.68"	$0.00	$0.00	$0.00	$0.00	"$4,038.50"	"$6,396.98"	"$6,461.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33937	ERX	HCPCS 63700001	31722-0754-30	LAMIVUDINE 300 MG PO TABS	BOTH IP/OP	$59.95 	$44.36	$0.00	$43.50		$0.00	$0.00	$0.00	$10.67	$0.00	$0.00	$0.00	$0.00	$0.00	$12.49	$0.00	$0.00	$0.00	$0.00	$27.19	$43.06	$43.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33937	ERX	HCPCS 63700001	60505-3252-03	LAMIVUDINE 300 MG PO TABS	BOTH IP/OP	$59.95 	$44.36	$0.00	$43.50		$0.00	$0.00	$0.00	$10.67	$0.00	$0.00	$0.00	$0.00	$0.00	$12.49	$0.00	$0.00	$0.00	$0.00	$27.19	$43.06	$43.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33937	ERX	HCPCS 63700001	64380-0711-04	LAMIVUDINE 300 MG PO TABS	BOTH IP/OP	$59.95 	$44.36	$0.00	$43.50		$0.00	$0.00	$0.00	$10.67	$0.00	$0.00	$0.00	$0.00	$0.00	$12.49	$0.00	$0.00	$0.00	$0.00	$27.19	$43.06	$43.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33937	ERX	HCPCS 63700001	65862-0553-30	LAMIVUDINE 300 MG PO TABS	BOTH IP/OP	$59.95 	$44.36	$0.00	$43.50		$0.00	$0.00	$0.00	$10.67	$0.00	$0.00	$0.00	$0.00	$0.00	$12.49	$0.00	$0.00	$0.00	$0.00	$27.19	$43.06	$43.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34153	ERX	HCPCS 63700001	00591-3713-19	EZETIMIBE 10 MG PO TABS	BOTH IP/OP	$10.96 	$8.11	$0.00	$7.95		$0.00	$0.00	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$0.00	$2.28	$0.00	$0.00	$0.00	$0.00	$4.97	$7.87	$7.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34153	ERX	HCPCS 63700001	00781-5690-92	EZETIMIBE 10 MG PO TABS	BOTH IP/OP	$10.96 	$8.11	$0.00	$7.95		$0.00	$0.00	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$0.00	$2.28	$0.00	$0.00	$0.00	$0.00	$4.97	$7.87	$7.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34153	ERX	HCPCS 63700001	59651-0052-90	EZETIMIBE 10 MG PO TABS	BOTH IP/OP	$10.96 	$8.11	$0.00	$7.95		$0.00	$0.00	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$0.00	$2.28	$0.00	$0.00	$0.00	$0.00	$4.97	$7.87	$7.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34153	ERX	HCPCS 63700001	66582-0414-31	EZETIMIBE 10 MG PO TABS	BOTH IP/OP	$10.96 	$8.11	$0.00	$7.95		$0.00	$0.00	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$0.00	$2.28	$0.00	$0.00	$0.00	$0.00	$4.97	$7.87	$7.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34153	ERX	HCPCS 63700001	68382-0773-16	EZETIMIBE 10 MG PO TABS	BOTH IP/OP	$10.96 	$8.11	$0.00	$7.95		$0.00	$0.00	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$0.00	$2.28	$0.00	$0.00	$0.00	$0.00	$4.97	$7.87	$7.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34153	ERX	HCPCS 63700001	69238-1154-03	EZETIMIBE 10 MG PO TABS	BOTH IP/OP	$10.96 	$8.11	$0.00	$7.95		$0.00	$0.00	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$0.00	$2.28	$0.00	$0.00	$0.00	$0.00	$4.97	$7.87	$7.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34369	ERX	HCPCS 63700001	16714-0785-01	ARIPIPRAZOLE 10 MG PO TABS	BOTH IP/OP	$123.03 	$91.04	$0.00	$89.25		$0.00	$0.00	$0.00	$21.90	$0.00	$0.00	$0.00	$0.00	$0.00	$25.64	$0.00	$0.00	$0.00	$0.00	$55.78	$88.36	$89.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34369	ERX	HCPCS 63700001	27241-0053-03	ARIPIPRAZOLE 10 MG PO TABS	BOTH IP/OP	$123.03 	$91.04	$0.00	$89.25		$0.00	$0.00	$0.00	$21.90	$0.00	$0.00	$0.00	$0.00	$0.00	$25.64	$0.00	$0.00	$0.00	$0.00	$55.78	$88.36	$89.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34369	ERX	HCPCS 63700001	43598-0556-30	ARIPIPRAZOLE 10 MG PO TABS	BOTH IP/OP	$123.03 	$91.04	$0.00	$89.25		$0.00	$0.00	$0.00	$21.90	$0.00	$0.00	$0.00	$0.00	$0.00	$25.64	$0.00	$0.00	$0.00	$0.00	$55.78	$88.36	$89.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34369	ERX	HCPCS 63700001	65162-0898-03	ARIPIPRAZOLE 10 MG PO TABS	BOTH IP/OP	$123.03 	$91.04	$0.00	$89.25		$0.00	$0.00	$0.00	$21.90	$0.00	$0.00	$0.00	$0.00	$0.00	$25.64	$0.00	$0.00	$0.00	$0.00	$55.78	$88.36	$89.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34369	ERX	HCPCS 63700001	65862-0663-30	ARIPIPRAZOLE 10 MG PO TABS	BOTH IP/OP	$123.03 	$91.04	$0.00	$89.25		$0.00	$0.00	$0.00	$21.90	$0.00	$0.00	$0.00	$0.00	$0.00	$25.64	$0.00	$0.00	$0.00	$0.00	$55.78	$88.36	$89.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34370	ERX	HCPCS 63700001	27241-0054-03	ARIPIPRAZOLE 15 MG PO TABS	BOTH IP/OP	$123.54 	$91.42	$0.00	$89.62		$0.00	$0.00	$0.00	$21.99	$0.00	$0.00	$0.00	$0.00	$0.00	$25.75	$0.00	$0.00	$0.00	$0.00	$56.01	$88.72	$89.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34370	ERX	HCPCS 63700001	31722-0828-30	ARIPIPRAZOLE 15 MG PO TABS	BOTH IP/OP	$123.54 	$91.42	$0.00	$89.62		$0.00	$0.00	$0.00	$21.99	$0.00	$0.00	$0.00	$0.00	$0.00	$25.75	$0.00	$0.00	$0.00	$0.00	$56.01	$88.72	$89.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34370	ERX	HCPCS 63700001	43598-0557-30	ARIPIPRAZOLE 15 MG PO TABS	BOTH IP/OP	$123.54 	$91.42	$0.00	$89.62		$0.00	$0.00	$0.00	$21.99	$0.00	$0.00	$0.00	$0.00	$0.00	$25.75	$0.00	$0.00	$0.00	$0.00	$56.01	$88.72	$89.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34370	ERX	HCPCS 63700001	65862-0664-30	ARIPIPRAZOLE 15 MG PO TABS	BOTH IP/OP	$123.54 	$91.42	$0.00	$89.62		$0.00	$0.00	$0.00	$21.99	$0.00	$0.00	$0.00	$0.00	$0.00	$25.75	$0.00	$0.00	$0.00	$0.00	$56.01	$88.72	$89.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34370	ERX	HCPCS 63700001	67877-0433-03	ARIPIPRAZOLE 15 MG PO TABS	BOTH IP/OP	$123.54 	$91.42	$0.00	$89.62		$0.00	$0.00	$0.00	$21.99	$0.00	$0.00	$0.00	$0.00	$0.00	$25.75	$0.00	$0.00	$0.00	$0.00	$56.01	$88.72	$89.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34371	ERX	HCPCS 63700001	16714-0787-01	ARIPIPRAZOLE 20 MG PO TABS	BOTH IP/OP	$174.20 	$128.91	$0.00	$126.37		$0.00	$0.00	$0.00	$31.01	$0.00	$0.00	$0.00	$0.00	$0.00	$36.30	$0.00	$0.00	$0.00	$0.00	$78.98	$125.10	$126.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34371	ERX	HCPCS 63700001	31722-0829-30	ARIPIPRAZOLE 20 MG PO TABS	BOTH IP/OP	$174.20 	$128.91	$0.00	$126.37		$0.00	$0.00	$0.00	$31.01	$0.00	$0.00	$0.00	$0.00	$0.00	$36.30	$0.00	$0.00	$0.00	$0.00	$78.98	$125.10	$126.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34371	ERX	HCPCS 63700001	43547-0306-03	ARIPIPRAZOLE 20 MG PO TABS	BOTH IP/OP	$174.20 	$128.91	$0.00	$126.37		$0.00	$0.00	$0.00	$31.01	$0.00	$0.00	$0.00	$0.00	$0.00	$36.30	$0.00	$0.00	$0.00	$0.00	$78.98	$125.10	$126.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34371	ERX	HCPCS 63700001	67877-0434-03	ARIPIPRAZOLE 20 MG PO TABS	BOTH IP/OP	$174.20 	$128.91	$0.00	$126.37		$0.00	$0.00	$0.00	$31.01	$0.00	$0.00	$0.00	$0.00	$0.00	$36.30	$0.00	$0.00	$0.00	$0.00	$78.98	$125.10	$126.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34372	ERX	HCPCS 63700001	65862-0666-30	ARIPIPRAZOLE 30 MG PO TABS	BOTH IP/OP	$175.28 	$129.71	$0.00	$127.15		$0.00	$0.00	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00	$36.53	$0.00	$0.00	$0.00	$0.00	$79.47	$125.88	$127.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34418	ERX	HCPCS 63700001	16714-0484-01	DIVALPROEX SODIUM ER 250 MG PO TB24	BOTH IP/OP	$10.29 	$7.61	$0.00	$7.46		$0.00	$0.00	$0.00	$1.83	$0.00	$0.00	$0.00	$0.00	$0.00	$2.14	$0.00	$0.00	$0.00	$0.00	$4.67	$7.39	$7.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34418	ERX	HCPCS 63700001	65862-0594-01	DIVALPROEX SODIUM ER 250 MG PO TB24	BOTH IP/OP	$10.29 	$7.61	$0.00	$7.46		$0.00	$0.00	$0.00	$1.83	$0.00	$0.00	$0.00	$0.00	$0.00	$2.14	$0.00	$0.00	$0.00	$0.00	$4.67	$7.39	$7.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34447	ERX	HCPCS 63700001	00002-3229-30	ATOMOXETINE HCL 40 MG PO CAPS	BOTH IP/OP	$72.01 	$53.29	$0.00	$52.24		$0.00	$0.00	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$15.01	$0.00	$0.00	$0.00	$0.00	$32.65	$51.72	$52.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34448	ERX	HCPCS 63700001	00002-3239-30	ATOMOXETINE HCL 60 MG PO CAPS	BOTH IP/OP	$72.01 	$53.29	$0.00	$52.24		$0.00	$0.00	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$0.00	$15.01	$0.00	$0.00	$0.00	$0.00	$32.65	$51.72	$52.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34505	ERX	HCPCS 63700001	00406-0123-23	HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34505	ERX	HCPCS 63700001	00406-0123-62	HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34505	ERX	HCPCS 63700001	13107-0019-01	HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34505	ERX	HCPCS 63700001	51862-0585-01	HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34505	ERX	HCPCS 63700001	53746-0109-01	HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34505	ERX	HCPCS 63700001	57664-0126-13	HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34505	ERX	HCPCS 63700001	57664-0126-88	HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34505	ERX	HCPCS 63700001	63739-0704-10	HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34505	ERX	HCPCS 63700001	68084-0895-11	HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34524	ERX	HCPCS J2543	00206-8861-02	PIPERACILLIN-TAZOBACTAM IN DEX 3-0.375 GM/50ML IV SOLN	BOTH IP/OP	$109.00 	$80.66	$0.00	$84.02	$49.05	$49.05	$0.00	$0.00	$0.00	$19.63	$80.90	$80.90	$84.02	$0.00	$5.21	$0.00	$64.47	$64.47	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$6.52	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
34550	ERX	HCPCS 90723	58160-0811-52	DTAP-HEPATITIS B RECOMB-IPV IM SUSP	BOTH IP/OP	$360.55 	$266.81	$0.00	$277.91	$162.25	$162.25	$0.00	$0.00	$79.00	$75.15	$267.60	$267.60	$277.91	$0.00	$75.14	$0.00	$213.27	$213.27	$0.00	$155.54	$246.38	$248.86	$186.65		$186.65	$48.68	$0.00	$0.00	$49.52	$0.00	$0.00	$0.00	$0.00	$0.00
34683	ERX	HCPCS 63700001		ELETRIPTAN HYDROBROMIDE 20 MG PO TABS	BOTH IP/OP	$213.27 	$157.82	$0.00	$154.88		$0.00	$0.00	$0.00	$37.96	$0.00	$0.00	$0.00	$0.00	$0.00	$44.45	$0.00	$0.00	$0.00	$0.00	$96.80	$153.33	$154.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34683	ERX	HCPCS 63700001	00049-2330-45	ELETRIPTAN HYDROBROMIDE 20 MG PO TABS	BOTH IP/OP	$213.27 	$157.82	$0.00	$154.88		$0.00	$0.00	$0.00	$37.96	$0.00	$0.00	$0.00	$0.00	$0.00	$44.45	$0.00	$0.00	$0.00	$0.00	$96.80	$153.33	$154.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34683	ERX	HCPCS 63700001	00093-8310-18	ELETRIPTAN HYDROBROMIDE 20 MG PO TABS	BOTH IP/OP	$213.27 	$157.82	$0.00	$154.88		$0.00	$0.00	$0.00	$37.96	$0.00	$0.00	$0.00	$0.00	$0.00	$44.45	$0.00	$0.00	$0.00	$0.00	$96.80	$153.33	$154.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34684	ERX	HCPCS 63700001	00049-2340-45	ELETRIPTAN HYDROBROMIDE 40 MG PO TABS	BOTH IP/OP	$285.38 	$211.18	$0.00	$197.57		$0.00	$0.00	$0.00	$50.80	$0.00	$0.00	$0.00	$0.00	$0.00	$59.47	$0.00	$0.00	$0.00	$0.00	$123.48	$195.59	$197.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34684	ERX	HCPCS 63700001	00049-2340-79	ELETRIPTAN HYDROBROMIDE 40 MG PO TABS	BOTH IP/OP	$285.38 	$211.18	$0.00	$197.57		$0.00	$0.00	$0.00	$50.80	$0.00	$0.00	$0.00	$0.00	$0.00	$59.47	$0.00	$0.00	$0.00	$0.00	$123.48	$195.59	$197.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34684	ERX	HCPCS 63700001	59762-2322-08	ELETRIPTAN HYDROBROMIDE 40 MG PO TABS	BOTH IP/OP	$285.38 	$211.18	$0.00	$197.57		$0.00	$0.00	$0.00	$50.80	$0.00	$0.00	$0.00	$0.00	$0.00	$59.47	$0.00	$0.00	$0.00	$0.00	$123.48	$195.59	$197.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34708	ERX	HCPCS 25000001	67546-0212-21	NITAZOXANIDE 100 MG/5ML PO SUSR	BOTH IP/OP	"$1,622.38 "	"$1,200.56"	$0.00	"$1,250.53"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,204.13"	"$1,204.13"	"$1,250.53"	$0.00	$338.10	$0.00	$0.00	$0.00	$0.00	$751.68	"$1,190.66"	"$1,202.69"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34711	ERX	HCPCS 63700001	00054-0176-13	BUPRENORPHINE HCL 2 MG SL SUBL	BOTH IP/OP	$17.35 	$12.84	$0.00	$12.59		$0.00	$0.00	$0.00	$3.09	$0.00	$0.00	$0.00	$0.00	$0.00	$3.62	$0.00	$0.00	$0.00	$0.00	$7.87	$12.47	$12.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34711	ERX	HCPCS 63700001	42858-0501-03	BUPRENORPHINE HCL 2 MG SL SUBL	BOTH IP/OP	$17.35 	$12.84	$0.00	$12.59		$0.00	$0.00	$0.00	$3.09	$0.00	$0.00	$0.00	$0.00	$0.00	$3.62	$0.00	$0.00	$0.00	$0.00	$7.87	$12.47	$12.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34711	ERX	HCPCS 63700001	50383-0924-93	BUPRENORPHINE HCL 2 MG SL SUBL	BOTH IP/OP	$17.35 	$12.84	$0.00	$12.59		$0.00	$0.00	$0.00	$3.09	$0.00	$0.00	$0.00	$0.00	$0.00	$3.62	$0.00	$0.00	$0.00	$0.00	$7.87	$12.47	$12.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34712	ERX	HCPCS 63700001	42858-0502-03	BUPRENORPHINE HCL 8 MG SL SUBL	BOTH IP/OP	$6.00 	$4.44	$0.00	$25.30		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$15.81	$25.04	$25.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34712	ERX	HCPCS 63700001	50383-0930-93	BUPRENORPHINE HCL 8 MG SL SUBL	BOTH IP/OP	$6.00 	$4.44	$0.00	$25.30		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$15.81	$25.04	$25.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34713	ERX	HCPCS 25000001	00054-0188-13	BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL	BOTH IP/OP	$24.42 	$18.07	$0.00	$18.82		$0.00	$0.00	$0.00	$0.00	$0.00	$18.12	$18.12	$18.82	$0.00	$5.09	$0.00	$0.00	$0.00	$0.00	$11.07	$17.53	$17.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34713	ERX	HCPCS 25000001	62175-0452-32	BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL	BOTH IP/OP	$24.42 	$18.07	$0.00	$18.82		$0.00	$0.00	$0.00	$0.00	$0.00	$18.12	$18.12	$18.82	$0.00	$5.09	$0.00	$0.00	$0.00	$0.00	$11.07	$17.53	$17.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34713	ERX	HCPCS 25000001	62756-0969-83	BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL	BOTH IP/OP	$24.42 	$18.07	$0.00	$18.82		$0.00	$0.00	$0.00	$0.00	$0.00	$18.12	$18.12	$18.82	$0.00	$5.09	$0.00	$0.00	$0.00	$0.00	$11.07	$17.53	$17.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34713	ERX	HCPCS 25000001	65162-0416-03	BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL	BOTH IP/OP	$24.42 	$18.07	$0.00	$18.82		$0.00	$0.00	$0.00	$0.00	$0.00	$18.12	$18.12	$18.82	$0.00	$5.09	$0.00	$0.00	$0.00	$0.00	$11.07	$17.53	$17.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34714	ERX	HCPCS 25000001	00054-0189-13	BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL	BOTH IP/OP	$43.67 	$32.32	$0.00	$33.66		$0.00	$0.00	$0.00	$0.00	$0.00	$32.41	$32.41	$33.66	$0.00	$9.10	$0.00	$0.00	$0.00	$0.00	$19.80	$31.36	$31.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34714	ERX	HCPCS 25000001	62175-0458-32	BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL	BOTH IP/OP	$43.67 	$32.32	$0.00	$33.66		$0.00	$0.00	$0.00	$0.00	$0.00	$32.41	$32.41	$33.66	$0.00	$9.10	$0.00	$0.00	$0.00	$0.00	$19.80	$31.36	$31.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34714	ERX	HCPCS 25000001	62756-0970-83	BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL	BOTH IP/OP	$43.67 	$32.32	$0.00	$33.66		$0.00	$0.00	$0.00	$0.00	$0.00	$32.41	$32.41	$33.66	$0.00	$9.10	$0.00	$0.00	$0.00	$0.00	$19.80	$31.36	$31.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
34814	ERX	HCPCS 25000001	61314-0646-10	NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SOLN	BOTH IP/OP	$352.40 	$260.78	$0.00	$271.63		$0.00	$0.00	$0.00	$0.00	$0.00	$261.55	$261.55	$271.63	$0.00	$73.44	$0.00	$0.00	$0.00	$0.00	$159.95	$253.35	$255.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35134	ERX	HCPCS 63700001	27808-0156-01	ROSUVASTATIN CALCIUM 10 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.20		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35134	ERX	HCPCS 63700001	57237-0169-90	ROSUVASTATIN CALCIUM 10 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.20		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35134	ERX	HCPCS 63700001	57237-0169-99	ROSUVASTATIN CALCIUM 10 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.20		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35134	ERX	HCPCS 63700001	60505-4503-09	ROSUVASTATIN CALCIUM 10 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.20		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35134	ERX	HCPCS 63700001	68462-0262-90	ROSUVASTATIN CALCIUM 10 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.20		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35134	ERX	HCPCS 63700001	70377-0007-12	ROSUVASTATIN CALCIUM 10 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.20		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35135	ERX	HCPCS 63700001	16729-0286-15	ROSUVASTATIN CALCIUM 20 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.20		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35135	ERX	HCPCS 63700001	27808-0157-01	ROSUVASTATIN CALCIUM 20 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.20		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35135	ERX	HCPCS 63700001	57237-0170-90	ROSUVASTATIN CALCIUM 20 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.20		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35135	ERX	HCPCS 63700001	57237-0170-99	ROSUVASTATIN CALCIUM 20 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.20		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35135	ERX	HCPCS 63700001	60505-4504-09	ROSUVASTATIN CALCIUM 20 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.20		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.93	$27.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35136	ERX	HCPCS 63700001	27808-0158-01	ROSUVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.19		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.92	$27.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35136	ERX	HCPCS 63700001	51407-0156-30	ROSUVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.19		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.92	$27.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35136	ERX	HCPCS 63700001	57237-0171-05	ROSUVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.19		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.92	$27.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35136	ERX	HCPCS 63700001	57237-0171-30	ROSUVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.19		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.92	$27.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35136	ERX	HCPCS 63700001	57237-0171-90	ROSUVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.19		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.92	$27.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35136	ERX	HCPCS 63700001	68462-0264-30	ROSUVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.19		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.92	$27.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35136	ERX	HCPCS 63700001	70377-0009-11	ROSUVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.19		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.92	$27.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35136	ERX	HCPCS 63700001	72205-0005-99	ROSUVASTATIN CALCIUM 40 MG PO TABS	BOTH IP/OP	$37.48 	$27.74	$0.00	$27.19		$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$0.00	$0.00	$0.00	$0.00	$17.00	$26.92	$27.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35184	ERX	HCPCS 63700001	50268-0190-15	CYCLOBENZAPRINE HCL 5 MG PO TABS	BOTH IP/OP	$6.88 	$5.09	$0.00	$4.99		$0.00	$0.00	$0.00	$1.22	$0.00	$0.00	$0.00	$0.00	$0.00	$1.43	$0.00	$0.00	$0.00	$0.00	$3.12	$4.94	$4.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35184	ERX	HCPCS 63700001	52817-0330-10	CYCLOBENZAPRINE HCL 5 MG PO TABS	BOTH IP/OP	$6.88 	$5.09	$0.00	$4.99		$0.00	$0.00	$0.00	$1.22	$0.00	$0.00	$0.00	$0.00	$0.00	$1.43	$0.00	$0.00	$0.00	$0.00	$3.12	$4.94	$4.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35184	ERX	HCPCS 63700001	69097-0845-07	CYCLOBENZAPRINE HCL 5 MG PO TABS	BOTH IP/OP	$6.88 	$5.09	$0.00	$4.99		$0.00	$0.00	$0.00	$1.22	$0.00	$0.00	$0.00	$0.00	$0.00	$1.43	$0.00	$0.00	$0.00	$0.00	$3.12	$4.94	$4.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35209	ERX	HCPCS 63700001	00023-9163-30	CYCLOSPORINE 0.05 % OP EMUL	BOTH IP/OP	$51.53 	$38.13	$0.00	$35.61		$0.00	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00	$10.74	$0.00	$0.00	$0.00	$0.00	$22.26	$35.25	$35.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35262	ERX	HCPCS J7520	00008-1042-05	SIROLIMUS 2 MG PO TABS	BOTH IP/OP	$275.26 	$203.69	$0.00	$212.17	$123.87	$123.87	$0.00	$0.00	$0.00	$57.37	$204.30	$204.30	$212.17	$0.00	$57.36	$0.00	$162.82	$162.82	$0.00	$119.54	$189.34	$191.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35263	ERX	HCPCS 63700001	59572-0210-15	THALIDOMIDE 100 MG PO CAPS	BOTH IP/OP	$972.04 	$719.31	$0.00	$705.73		$0.00	$0.00	$0.00	$173.02	$0.00	$0.00	$0.00	$0.00	$0.00	$202.57	$0.00	$0.00	$0.00	$0.00	$441.08	$698.67	$705.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35264	ERX	HCPCS 63700001	59572-0220-16	THALIDOMIDE 200 MG PO CAPS	BOTH IP/OP	"$1,004.37 "	$743.23	$0.00	$803.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.19	$795.46	$803.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35264	ERX	HCPCS 63700001	59572-0220-96	THALIDOMIDE 200 MG PO CAPS	BOTH IP/OP	"$1,004.37 "	$743.23	$0.00	$803.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.19	$795.46	$803.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35439	ERX	HCPCS J2850	67066-0006-01	SECRETIN ACETATE 16 MCG IV SOLR	BOTH IP/OP	$26.72 	$19.77	$0.00	$20.60		$0.00	$0.00	$0.00	$0.00	$0.00	$19.83	$19.83	$20.60	$0.00	$5.57	$0.00	$0.00	$0.00	$0.00	$12.12	$19.19	$19.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35488	ERX	HCPCS J8501		APREPITANT 80 MG PO CAPS	BOTH IP/OP	$594.98 	$440.29	$0.00	$458.61	$267.74	$267.74	$0.00	$0.00	$0.00	$125.02	$441.59	$441.59	$458.61	$0.00	$123.99	$0.00	$351.93	$351.93	$0.00	$269.99	$427.66	$431.98	$0.00		$0.00	$84.51	$0.00	$0.00	$85.96	$0.00	$0.00	$0.00	$0.00	$0.00
35488	ERX	HCPCS J8501	68462-0584-76	APREPITANT 80 MG PO CAPS	BOTH IP/OP	$594.98 	$440.29	$0.00	$458.61	$267.74	$267.74	$0.00	$0.00	$0.00	$125.02	$441.59	$441.59	$458.61	$0.00	$123.99	$0.00	$351.93	$351.93	$0.00	$269.99	$427.66	$431.98	$0.00		$0.00	$84.51	$0.00	$0.00	$85.96	$0.00	$0.00	$0.00	$0.00	$0.00
35489	ERX	HCPCS J8501		APREPITANT 125 MG PO CAPS	BOTH IP/OP	$585.21 	$433.06	$0.00	$451.08	$263.34	$263.34	$0.00	$0.00	$0.00	$195.34	$434.34	$434.34	$451.08	$0.00	$121.96	$0.00	$346.15	$346.15	$0.00	$265.61	$420.73	$424.98	$0.00		$0.00	$83.14	$0.00	$0.00	$84.57	$0.00	$0.00	$0.00	$0.00	$0.00
35489	ERX	HCPCS J8501	00781-2323-68	APREPITANT 125 MG PO CAPS	BOTH IP/OP	$585.21 	$433.06	$0.00	$451.08	$263.34	$263.34	$0.00	$0.00	$0.00	$195.34	$434.34	$434.34	$451.08	$0.00	$121.96	$0.00	$346.15	$346.15	$0.00	$265.61	$420.73	$424.98	$0.00		$0.00	$83.14	$0.00	$0.00	$84.57	$0.00	$0.00	$0.00	$0.00	$0.00
35489	ERX	HCPCS J8501	68462-0585-76	APREPITANT 125 MG PO CAPS	BOTH IP/OP	$585.21 	$433.06	$0.00	$451.08	$263.34	$263.34	$0.00	$0.00	$0.00	$195.34	$434.34	$434.34	$451.08	$0.00	$121.96	$0.00	$346.15	$346.15	$0.00	$265.61	$420.73	$424.98	$0.00		$0.00	$83.14	$0.00	$0.00	$84.57	$0.00	$0.00	$0.00	$0.00	$0.00
35490	ERX	HCPCS J8501	00006-3862-03	APREPITANT 80 & 125 MG PO MISC	BOTH IP/OP	$904.45 	$669.29	$0.00	$697.15	$407.00	$407.00	$0.00	$0.00	$0.00	$7.81	$671.28	$671.28	$697.15	$0.00	$188.49	$0.00	$534.98	$534.98	$0.00	$410.41	$650.09	$656.66	$0.00		$0.00	$128.46	$0.00	$0.00	$130.67	$0.00	$0.00	$0.00	$0.00	$0.00
35639	ERX	HCPCS 25000001	10019-0075-87	ESMOLOL HCL-SODIUM CHLORIDE 2000 MG/100ML IV SOLN	BOTH IP/OP	"$1,566.18 "	"$1,158.97"	$0.00	"$1,207.21"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,162.42"	"$1,162.42"	"$1,207.21"	$0.00	$326.39	$0.00	$0.00	$0.00	$0.00	$725.64	"$1,149.41"	"$1,161.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35639	ERX	HCPCS 25000001	25021-0309-82	ESMOLOL HCL-SODIUM CHLORIDE 2000 MG/100ML IV SOLN	BOTH IP/OP	"$1,566.18 "	"$1,158.97"	$0.00	"$1,207.21"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,162.42"	"$1,162.42"	"$1,207.21"	$0.00	$326.39	$0.00	$0.00	$0.00	$0.00	$725.64	"$1,149.41"	"$1,161.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35640	ERX	HCPCS J3489	00409-4215-01	ZOLEDRONIC ACID 4 MG/5ML IV CONC	BOTH IP/OP	$183.22 	$135.58	$0.00	$141.23	$82.45	$82.45	$0.00	$0.00	$0.00	$38.19	$135.99	$135.99	$141.23	$0.00	$38.76	$0.00	$108.37	$108.37	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$51.14	$0.00	$0.00	$48.69	$0.00	$0.00	$0.00	$0.00	$0.00
35640	ERX	HCPCS J3489	25021-0801-66	ZOLEDRONIC ACID 4 MG/5ML IV CONC	BOTH IP/OP	$183.22 	$135.58	$0.00	$141.23	$82.45	$82.45	$0.00	$0.00	$0.00	$38.19	$135.99	$135.99	$141.23	$0.00	$38.76	$0.00	$108.37	$108.37	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$51.14	$0.00	$0.00	$48.69	$0.00	$0.00	$0.00	$0.00	$0.00
35640	ERX	HCPCS J3489	55111-0685-07	ZOLEDRONIC ACID 4 MG/5ML IV CONC	BOTH IP/OP	$183.22 	$135.58	$0.00	$141.23	$82.45	$82.45	$0.00	$0.00	$0.00	$38.19	$135.99	$135.99	$141.23	$0.00	$38.76	$0.00	$108.37	$108.37	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$51.14	$0.00	$0.00	$48.69	$0.00	$0.00	$0.00	$0.00	$0.00
35640	ERX	HCPCS J3489	63323-0961-98	ZOLEDRONIC ACID 4 MG/5ML IV CONC	BOTH IP/OP	$183.22 	$135.58	$0.00	$141.23	$82.45	$82.45	$0.00	$0.00	$0.00	$38.19	$135.99	$135.99	$141.23	$0.00	$38.76	$0.00	$108.37	$108.37	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$51.14	$0.00	$0.00	$48.69	$0.00	$0.00	$0.00	$0.00	$0.00
35640	ERX	HCPCS J3489	67457-0390-54	ZOLEDRONIC ACID 4 MG/5ML IV CONC	BOTH IP/OP	$183.22 	$135.58	$0.00	$141.23	$82.45	$82.45	$0.00	$0.00	$0.00	$38.19	$135.99	$135.99	$141.23	$0.00	$38.76	$0.00	$108.37	$108.37	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$51.14	$0.00	$0.00	$48.69	$0.00	$0.00	$0.00	$0.00	$0.00
35687	ERX	HCPCS 63700001	00781-5311-08	RISPERIDONE 1 MG PO TBDP	BOTH IP/OP	$56.09 	$41.51	$0.00	$44.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.05	$44.42	$44.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35687	ERX	HCPCS 63700001	49884-0315-91	RISPERIDONE 1 MG PO TBDP	BOTH IP/OP	$56.09 	$41.51	$0.00	$44.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.05	$44.42	$44.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35688	ERX	HCPCS 63700001	49884-0401-91	RISPERIDONE 2 MG PO TBDP	BOTH IP/OP	$84.00 	$62.16	$0.00	$67.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.00	$66.53	$67.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35699	ERX	HCPCS 25000001	00065-4013-03	MOXIFLOXACIN HCL 0.5 % OP SOLN	BOTH IP/OP	$585.75 	$433.46	$0.00	$451.50		$0.00	$0.00	$0.00	$0.00	$0.00	$434.74	$434.74	$451.50	$0.00	$122.07	$0.00	$0.00	$0.00	$0.00	$265.86	$421.11	$425.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35699	ERX	HCPCS 25000001	00781-7135-93	MOXIFLOXACIN HCL 0.5 % OP SOLN	BOTH IP/OP	$585.75 	$433.46	$0.00	$451.50		$0.00	$0.00	$0.00	$0.00	$0.00	$434.74	$434.74	$451.50	$0.00	$122.07	$0.00	$0.00	$0.00	$0.00	$265.86	$421.11	$425.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35699	ERX	HCPCS 25000001	60505-0582-04	MOXIFLOXACIN HCL 0.5 % OP SOLN	BOTH IP/OP	$585.75 	$433.46	$0.00	$451.50		$0.00	$0.00	$0.00	$0.00	$0.00	$434.74	$434.74	$451.50	$0.00	$122.07	$0.00	$0.00	$0.00	$0.00	$265.86	$421.11	$425.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35699	ERX	HCPCS 25000001	65862-0840-03	MOXIFLOXACIN HCL 0.5 % OP SOLN	BOTH IP/OP	$585.75 	$433.46	$0.00	$451.50		$0.00	$0.00	$0.00	$0.00	$0.00	$434.74	$434.74	$451.50	$0.00	$122.07	$0.00	$0.00	$0.00	$0.00	$265.86	$421.11	$425.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35780	ERX	HCPCS 63700001	00310-0482-30	GEFITINIB 250 MG PO TABS	BOTH IP/OP	$909.75 	$673.22	$0.00	$660.50		$0.00	$0.00	$0.00	$161.94	$0.00	$0.00	$0.00	$0.00	$0.00	$189.59	$0.00	$0.00	$0.00	$0.00	$412.82	$653.90	$660.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35942	ERX	HCPCS 63700001	00245-5317-01	KCL CRYS ER 10 MEQ PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35942	ERX	HCPCS 63700001	00245-5317-89	KCL CRYS ER 10 MEQ PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35942	ERX	HCPCS 63700001	63739-0446-10	KCL CRYS ER 10 MEQ PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35942	ERX	HCPCS 63700001	66758-0170-13	KCL CRYS ER 10 MEQ PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35943	ERX	HCPCS 63700001	00245-5319-01	POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35943	ERX	HCPCS 63700001	00245-5319-89	POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35943	ERX	HCPCS 63700001	00781-5720-01	POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35943	ERX	HCPCS 63700001	00781-5720-10	POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35943	ERX	HCPCS 63700001	63739-0447-10	POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35943	ERX	HCPCS 63700001	66758-0190-13	POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35943	ERX	HCPCS 63700001	68084-0360-09	POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35957	ERX	HCPCS 63700001	00046-1106-11	CONJ ESTROG-MEDROXYPROGEST ACE 0.45-1.5 MG PO TABS	BOTH IP/OP	$40.16 	$29.72	$0.00	$26.42		$0.00	$0.00	$0.00	$7.15	$0.00	$0.00	$0.00	$0.00	$0.00	$8.37	$0.00	$0.00	$0.00	$0.00	$16.52	$26.16	$26.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36046	ERX	HCPCS J3480	00338-0704-34	POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN	BOTH IP/OP	$33.52 	$24.80	$0.00	$25.84	$15.08	$15.08	$0.00	$0.00	$0.00	$0.24	$24.88	$24.88	$25.84	$0.00	$1.69	$0.00	$19.83	$19.83	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$1.65	$0.00	$0.00	$1.57	$0.00	$0.00	$0.00	$0.00	$0.00
36092	ERX	HCPCS 63700001	00078-0649-30	IMATINIB MESYLATE 400 MG PO TABS	BOTH IP/OP	"$1,182.30 "	$874.90	$0.00	$858.38		$0.00	$0.00	$0.00	$210.45	$0.00	$0.00	$0.00	$0.00	$0.00	$246.39	$0.00	$0.00	$0.00	$0.00	$536.49	$849.80	$858.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36092	ERX	HCPCS 63700001	16714-0705-01	IMATINIB MESYLATE 400 MG PO TABS	BOTH IP/OP	"$1,182.30 "	$874.90	$0.00	$858.38		$0.00	$0.00	$0.00	$210.45	$0.00	$0.00	$0.00	$0.00	$0.00	$246.39	$0.00	$0.00	$0.00	$0.00	$536.49	$849.80	$858.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36092	ERX	HCPCS 63700001	60505-2901-03	IMATINIB MESYLATE 400 MG PO TABS	BOTH IP/OP	"$1,182.30 "	$874.90	$0.00	$858.38		$0.00	$0.00	$0.00	$210.45	$0.00	$0.00	$0.00	$0.00	$0.00	$246.39	$0.00	$0.00	$0.00	$0.00	$536.49	$849.80	$858.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36149	ERX	HCPCS 63700001	00003-3624-12	ATAZANAVIR SULFATE 150 MG PO CAPS	BOTH IP/OP	$203.10 	$150.29	$0.00	$147.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.33	$0.00	$0.00	$0.00	$0.00	$92.19	$146.02	$147.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36149	ERX	HCPCS 63700001	16714-0860-01	ATAZANAVIR SULFATE 150 MG PO CAPS	BOTH IP/OP	$203.10 	$150.29	$0.00	$147.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.33	$0.00	$0.00	$0.00	$0.00	$92.19	$146.02	$147.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36150	ERX	HCPCS 63700001	00003-3631-12	ATAZANAVIR SULFATE 200 MG PO CAPS	BOTH IP/OP	$203.10 	$150.29	$0.00	$147.50		$0.00	$0.00	$0.00	$36.15	$0.00	$0.00	$0.00	$0.00	$0.00	$42.33	$0.00	$0.00	$0.00	$0.00	$92.19	$146.02	$147.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36150	ERX	HCPCS 63700001	16714-0861-01	ATAZANAVIR SULFATE 200 MG PO CAPS	BOTH IP/OP	$203.10 	$150.29	$0.00	$147.50		$0.00	$0.00	$0.00	$36.15	$0.00	$0.00	$0.00	$0.00	$0.00	$42.33	$0.00	$0.00	$0.00	$0.00	$92.19	$146.02	$147.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36150	ERX	HCPCS 63700001	65862-0712-60	ATAZANAVIR SULFATE 200 MG PO CAPS	BOTH IP/OP	$203.10 	$150.29	$0.00	$147.50		$0.00	$0.00	$0.00	$36.15	$0.00	$0.00	$0.00	$0.00	$0.00	$42.33	$0.00	$0.00	$0.00	$0.00	$92.19	$146.02	$147.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36198	ERX	HCPCS 63700001	00046-1101-81	ESTROGENS CONJUGATED 0.45 MG PO TABS	BOTH IP/OP	$32.11 	$23.76	$0.00	$21.54		$0.00	$0.00	$0.00	$5.72	$0.00	$0.00	$0.00	$0.00	$0.00	$6.69	$0.00	$0.00	$0.00	$0.00	$13.47	$21.33	$21.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36252	ERX	HCPCS 63700001	61958-0601-01	EMTRICITABINE 200 MG PO CAPS	BOTH IP/OP	$80.93 	$59.89	$0.00	$58.71		$0.00	$0.00	$0.00	$14.41	$0.00	$0.00	$0.00	$0.00	$0.00	$16.87	$0.00	$0.00	$0.00	$0.00	$36.70	$58.12	$58.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36252	ERX	HCPCS 63700001	69097-0642-02	EMTRICITABINE 200 MG PO CAPS	BOTH IP/OP	$80.93 	$59.89	$0.00	$58.71		$0.00	$0.00	$0.00	$14.41	$0.00	$0.00	$0.00	$0.00	$0.00	$16.87	$0.00	$0.00	$0.00	$0.00	$36.70	$58.12	$58.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36438	ERX	HCPCS 63700001	00904-6656-40	ARIPIPRAZOLE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$89.11		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$55.70	$88.22	$89.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36438	ERX	HCPCS 63700001	16714-0784-01	ARIPIPRAZOLE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$89.11		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$55.70	$88.22	$89.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36438	ERX	HCPCS 63700001	33342-0123-07	ARIPIPRAZOLE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$89.11		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$55.70	$88.22	$89.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36438	ERX	HCPCS 63700001	43598-0555-30	ARIPIPRAZOLE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$89.11		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$55.70	$88.22	$89.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36438	ERX	HCPCS 63700001	65862-0662-30	ARIPIPRAZOLE 5 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$89.11		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$55.70	$88.22	$89.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36576	ERX	HCPCS 25000001	00065-8533-02	CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP	BOTH IP/OP	$785.54 	$581.30	$0.00	$605.49		$0.00	$0.00	$0.00	$0.00	$0.00	$583.03	$583.03	$605.49	$0.00	$163.71	$0.00	$0.00	$0.00	$0.00	$356.45	$564.62	$570.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36576	ERX	HCPCS 25000001	00781-6186-67	CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP	BOTH IP/OP	$785.54 	$581.30	$0.00	$605.49		$0.00	$0.00	$0.00	$0.00	$0.00	$583.03	$583.03	$605.49	$0.00	$163.71	$0.00	$0.00	$0.00	$0.00	$356.45	$564.62	$570.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36576	ERX	HCPCS 25000001	43598-0326-75	CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP	BOTH IP/OP	$785.54 	$581.30	$0.00	$605.49		$0.00	$0.00	$0.00	$0.00	$0.00	$583.03	$583.03	$605.49	$0.00	$163.71	$0.00	$0.00	$0.00	$0.00	$356.45	$564.62	$570.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36590	ERX	HCPCS 25000001	00121-0799-16	LEVETIRACETAM 100 MG/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36590	ERX	HCPCS 25000001	00472-0235-16	LEVETIRACETAM 100 MG/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36590	ERX	HCPCS 25000001	16714-0358-01	LEVETIRACETAM 100 MG/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36590	ERX	HCPCS 25000001	50383-0241-16	LEVETIRACETAM 100 MG/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36590	ERX	HCPCS 25000001	50474-0001-48	LEVETIRACETAM 100 MG/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36590	ERX	HCPCS 25000001	51991-0651-16	LEVETIRACETAM 100 MG/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36590	ERX	HCPCS 25000001	99999-6012-25	LEVETIRACETAM 100 MG/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36590	ERX	HCPCS 25000001	99999-6004-94	LEVETIRACETAM 100 MG/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$106.78		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$106.78	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36612	ERX	HCPCS 63700001	00310-0755-90	ROSUVASTATIN CALCIUM 5 MG PO TABS	BOTH IP/OP	$46.35 	$34.30	$0.00	$33.63		$0.00	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00	$9.66	$0.00	$0.00	$0.00	$0.00	$21.02	$33.30	$33.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36612	ERX	HCPCS 63700001	16714-0988-01	ROSUVASTATIN CALCIUM 5 MG PO TABS	BOTH IP/OP	$46.35 	$34.30	$0.00	$33.63		$0.00	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00	$9.66	$0.00	$0.00	$0.00	$0.00	$21.02	$33.30	$33.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36612	ERX	HCPCS 63700001	27808-0155-01	ROSUVASTATIN CALCIUM 5 MG PO TABS	BOTH IP/OP	$46.35 	$34.30	$0.00	$33.63		$0.00	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00	$9.66	$0.00	$0.00	$0.00	$0.00	$21.02	$33.30	$33.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36612	ERX	HCPCS 63700001	60505-4502-09	ROSUVASTATIN CALCIUM 5 MG PO TABS	BOTH IP/OP	$46.35 	$34.30	$0.00	$33.63		$0.00	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00	$9.66	$0.00	$0.00	$0.00	$0.00	$21.02	$33.30	$33.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36612	ERX	HCPCS 63700001	68462-0261-90	ROSUVASTATIN CALCIUM 5 MG PO TABS	BOTH IP/OP	$46.35 	$34.30	$0.00	$33.63		$0.00	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00	$9.66	$0.00	$0.00	$0.00	$0.00	$21.02	$33.30	$33.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36612	ERX	HCPCS 63700001	70377-0006-12	ROSUVASTATIN CALCIUM 5 MG PO TABS	BOTH IP/OP	$46.35 	$34.30	$0.00	$33.63		$0.00	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00	$9.66	$0.00	$0.00	$0.00	$0.00	$21.02	$33.30	$33.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36631	ERX	HCPCS 25000001	00023-9277-05	KETOROLAC TROMETHAMINE 0.4 % OP SOLN	BOTH IP/OP	$992.16 	$734.20	$0.00	$764.76		$0.00	$0.00	$0.00	$0.00	$0.00	$736.38	$736.38	$764.76	$0.00	$206.77	$0.00	$0.00	$0.00	$0.00	$428.77	$679.17	$686.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36631	ERX	HCPCS 25000001	60758-0773-05	KETOROLAC TROMETHAMINE 0.4 % OP SOLN	BOTH IP/OP	$992.16 	$734.20	$0.00	$764.76		$0.00	$0.00	$0.00	$0.00	$0.00	$736.38	$736.38	$764.76	$0.00	$206.77	$0.00	$0.00	$0.00	$0.00	$428.77	$679.17	$686.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36775	ERX	HCPCS 63700001	00187-0730-90	BUPROPION HCL ER (XL) 150 MG PO TB24	BOTH IP/OP	$21.88 	$16.19	$0.00	$15.87		$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$0.00	$4.56	$0.00	$0.00	$0.00	$0.00	$9.92	$15.71	$15.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36775	ERX	HCPCS 63700001	10370-0101-03	BUPROPION HCL ER (XL) 150 MG PO TB24	BOTH IP/OP	$21.88 	$16.19	$0.00	$15.87		$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$0.00	$4.56	$0.00	$0.00	$0.00	$0.00	$9.92	$15.71	$15.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36775	ERX	HCPCS 63700001	16729-0443-15	BUPROPION HCL ER (XL) 150 MG PO TB24	BOTH IP/OP	$21.88 	$16.19	$0.00	$15.87		$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$0.00	$4.56	$0.00	$0.00	$0.00	$0.00	$9.92	$15.71	$15.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36775	ERX	HCPCS 63700001	69097-0875-02	BUPROPION HCL ER (XL) 150 MG PO TB24	BOTH IP/OP	$21.88 	$16.19	$0.00	$15.87		$0.00	$0.00	$0.00	$3.89	$0.00	$0.00	$0.00	$0.00	$0.00	$4.56	$0.00	$0.00	$0.00	$0.00	$9.92	$15.71	$15.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36776	ERX	HCPCS 63700001	10370-0102-03	BUPROPION HCL ER (XL) 300 MG PO TB24	BOTH IP/OP	$19.98 	$14.79	$0.00	$14.50		$0.00	$0.00	$0.00	$3.56	$0.00	$0.00	$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$9.06	$14.35	$14.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36776	ERX	HCPCS 63700001	16729-0444-10	BUPROPION HCL ER (XL) 300 MG PO TB24	BOTH IP/OP	$19.98 	$14.79	$0.00	$14.50		$0.00	$0.00	$0.00	$3.56	$0.00	$0.00	$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$9.06	$14.35	$14.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36776	ERX	HCPCS 63700001	68180-0320-09	BUPROPION HCL ER (XL) 300 MG PO TB24	BOTH IP/OP	$19.98 	$14.79	$0.00	$14.50		$0.00	$0.00	$0.00	$3.56	$0.00	$0.00	$0.00	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$9.06	$14.35	$14.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36962	ERX	HCPCS 63700001	00121-0544-10	DOCUSATE SODIUM 50 MG/5ML PO LIQD	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36962	ERX	HCPCS 63700001	50383-0771-16	DOCUSATE SODIUM 50 MG/5ML PO LIQD	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36962	ERX	HCPCS 63700001	99999-6006-70	DOCUSATE SODIUM 50 MG/5ML PO LIQD	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36966	ERX	HCPCS 63700001	00456-3210-63	MEMANTINE HCL 10 MG PO TABS	BOTH IP/OP	$33.80 	$25.01	$0.00	$27.04		$0.00	$0.00	$0.00	$6.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.90	$26.77	$27.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36966	ERX	HCPCS 63700001	00904-6506-61	MEMANTINE HCL 10 MG PO TABS	BOTH IP/OP	$33.80 	$25.01	$0.00	$27.04		$0.00	$0.00	$0.00	$6.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.90	$26.77	$27.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36966	ERX	HCPCS 63700001	55111-0597-60	MEMANTINE HCL 10 MG PO TABS	BOTH IP/OP	$33.80 	$25.01	$0.00	$27.04		$0.00	$0.00	$0.00	$6.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.90	$26.77	$27.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36976	ERX	HCPCS 25000001	00904-6305-21	PHENOL 1.4 % MT LIQD	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36976	ERX	HCPCS 25000001	49348-0991-36	PHENOL 1.4 % MT LIQD	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36982	ERX	HCPCS 25000001	47335-0956-88	ALFUZOSIN HCL ER 10 MG PO TB24	BOTH IP/OP	$17.66 	$13.07	$0.00	$13.61		$0.00	$0.00	$0.00	$0.00	$0.00	$13.11	$13.11	$13.61	$0.00	$3.68	$0.00	$0.00	$0.00	$0.00	$8.01	$12.69	$12.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36983	ERX	HCPCS 63700001	00185-5368-30	EPLERENONE 25 MG PO TABS	BOTH IP/OP	$18.19 	$13.46	$0.00	$13.19		$0.00	$0.00	$0.00	$3.24	$0.00	$0.00	$0.00	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$8.25	$13.06	$13.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36983	ERX	HCPCS 63700001	00378-1030-93	EPLERENONE 25 MG PO TABS	BOTH IP/OP	$18.19 	$13.46	$0.00	$13.19		$0.00	$0.00	$0.00	$3.24	$0.00	$0.00	$0.00	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$8.25	$13.06	$13.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36984	ERX	HCPCS 63700001	00185-5369-30	EPLERENONE 50 MG PO TABS	BOTH IP/OP	$18.19 	$13.46	$0.00	$13.20		$0.00	$0.00	$0.00	$3.24	$0.00	$0.00	$0.00	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$8.25	$13.07	$13.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36984	ERX	HCPCS 63700001	00378-1031-93	EPLERENONE 50 MG PO TABS	BOTH IP/OP	$18.19 	$13.46	$0.00	$13.20		$0.00	$0.00	$0.00	$3.24	$0.00	$0.00	$0.00	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$8.25	$13.07	$13.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36986	ERX	HCPCS 63700001	00002-4464-30	TADALAFIL 20 MG PO TABS	BOTH IP/OP	$560.45 	$414.73	$0.00	$406.99		$0.00	$0.00	$0.00	$99.76	$0.00	$0.00	$0.00	$0.00	$0.00	$116.80	$0.00	$0.00	$0.00	$0.00	$254.37	$402.92	$406.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36987	ERX	HCPCS 63700001	62756-0258-02	ZONISAMIDE 25 MG PO CAPS	BOTH IP/OP	$50.13 	$37.10	$0.00	$40.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.07	$39.70	$40.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36987	ERX	HCPCS 63700001	68462-0128-01	ZONISAMIDE 25 MG PO CAPS	BOTH IP/OP	$50.13 	$37.10	$0.00	$40.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.07	$39.70	$40.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36988	ERX	HCPCS 63700001	62756-0259-02	ZONISAMIDE 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36988	ERX	HCPCS 63700001	68462-0129-01	ZONISAMIDE 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36989	ERX	HCPCS J0878	00143-9378-01	DAPTOMYCIN 500 MG IV SOLR	BOTH IP/OP	$261.43 	$193.46	$0.00	$367.64	$117.64	$117.64	$0.00	$0.00	$0.00	$223.25	$194.03	$194.03	$201.51	$0.00	$33.49	$0.00	$154.64	$154.64	$173.25	$229.78	$363.96	$367.64	$239.25		$239.25	$170.38	$0.00	$0.00	$162.23	$68.00	$0.00	$0.00	$0.00	$0.00
36989	ERX	HCPCS J0878	25021-0174-15	DAPTOMYCIN 500 MG IV SOLR	BOTH IP/OP	$261.43 	$193.46	$0.00	$367.64	$117.64	$117.64	$0.00	$0.00	$0.00	$223.25	$194.03	$194.03	$201.51	$0.00	$33.49	$0.00	$154.64	$154.64	$173.25	$229.78	$363.96	$367.64	$239.25		$239.25	$170.38	$0.00	$0.00	$162.23	$68.00	$0.00	$0.00	$0.00	$0.00
36989	ERX	HCPCS J0878	63323-0371-10	DAPTOMYCIN 500 MG IV SOLR	BOTH IP/OP	$261.43 	$193.46	$0.00	$367.64	$117.64	$117.64	$0.00	$0.00	$0.00	$223.25	$194.03	$194.03	$201.51	$0.00	$33.49	$0.00	$154.64	$154.64	$173.25	$229.78	$363.96	$367.64	$239.25		$239.25	$170.38	$0.00	$0.00	$162.23	$68.00	$0.00	$0.00	$0.00	$0.00
36989	ERX	HCPCS J0878	63323-0371-19	DAPTOMYCIN 500 MG IV SOLR	BOTH IP/OP	$261.43 	$193.46	$0.00	$367.64	$117.64	$117.64	$0.00	$0.00	$0.00	$223.25	$194.03	$194.03	$201.51	$0.00	$33.49	$0.00	$154.64	$154.64	$173.25	$229.78	$363.96	$367.64	$239.25		$239.25	$170.38	$0.00	$0.00	$162.23	$68.00	$0.00	$0.00	$0.00	$0.00
36989	ERX	HCPCS J0878	63323-0871-15	DAPTOMYCIN 500 MG IV SOLR	BOTH IP/OP	$261.43 	$193.46	$0.00	$367.64	$117.64	$117.64	$0.00	$0.00	$0.00	$223.25	$194.03	$194.03	$201.51	$0.00	$33.49	$0.00	$154.64	$154.64	$173.25	$229.78	$363.96	$367.64	$239.25		$239.25	$170.38	$0.00	$0.00	$162.23	$68.00	$0.00	$0.00	$0.00	$0.00
36989	ERX	HCPCS J0878	67919-0011-01	DAPTOMYCIN 500 MG IV SOLR	BOTH IP/OP	$261.43 	$193.46	$0.00	$367.64	$117.64	$117.64	$0.00	$0.00	$0.00	$223.25	$194.03	$194.03	$201.51	$0.00	$33.49	$0.00	$154.64	$154.64	$173.25	$229.78	$363.96	$367.64	$239.25		$239.25	$170.38	$0.00	$0.00	$162.23	$68.00	$0.00	$0.00	$0.00	$0.00
37170	ERX	HCPCS 63700001	00456-3205-11	MEMANTINE HCL 5 MG PO TABS	BOTH IP/OP	$33.79 	$25.00	$0.00	$27.03		$0.00	$0.00	$0.00	$6.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.90	$26.76	$27.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37170	ERX	HCPCS 63700001	00456-3205-60	MEMANTINE HCL 5 MG PO TABS	BOTH IP/OP	$33.79 	$25.00	$0.00	$27.03		$0.00	$0.00	$0.00	$6.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.90	$26.76	$27.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37170	ERX	HCPCS 63700001	00456-3205-63	MEMANTINE HCL 5 MG PO TABS	BOTH IP/OP	$33.79 	$25.00	$0.00	$27.03		$0.00	$0.00	$0.00	$6.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.90	$26.76	$27.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37170	ERX	HCPCS 63700001	53746-0173-60	MEMANTINE HCL 5 MG PO TABS	BOTH IP/OP	$33.79 	$25.00	$0.00	$27.03		$0.00	$0.00	$0.00	$6.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.90	$26.76	$27.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37170	ERX	HCPCS 63700001	60687-0173-11	MEMANTINE HCL 5 MG PO TABS	BOTH IP/OP	$33.79 	$25.00	$0.00	$27.03		$0.00	$0.00	$0.00	$6.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.90	$26.76	$27.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37170	ERX	HCPCS 63700001	60687-0173-57	MEMANTINE HCL 5 MG PO TABS	BOTH IP/OP	$33.79 	$25.00	$0.00	$27.03		$0.00	$0.00	$0.00	$6.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.90	$26.76	$27.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37182	ERX	HCPCS 63700001	49702-0207-18	FOSAMPRENAVIR CALCIUM 700 MG PO TABS	BOTH IP/OP	$89.45 	$66.19	$0.00	$64.88		$0.00	$0.00	$0.00	$15.92	$0.00	$0.00	$0.00	$0.00	$0.00	$18.64	$0.00	$0.00	$0.00	$0.00	$40.55	$64.23	$64.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37459	ERX	HCPCS 63700001	00046-1105-11	CONJ ESTROG-MEDROXYPROGEST ACE 0.3-1.5 MG PO TABS	BOTH IP/OP	$783.51 	$579.80	$0.00	$515.90		$0.00	$0.00	$0.00	$139.46	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$0.00	$0.00	$0.00	$0.00	$322.44	$510.74	$515.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37482	ERX	HCPCS 63700001	00245-0036-42	CHOLESTYRAMINE LIGHT 4 G PO PACK	BOTH IP/OP	$21.42 	$15.85	$0.00	$15.54		$0.00	$0.00	$0.00	$3.81	$0.00	$0.00	$0.00	$0.00	$0.00	$4.46	$0.00	$0.00	$0.00	$0.00	$9.71	$15.38	$15.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37482	ERX	HCPCS 63700001	00245-0036-89	CHOLESTYRAMINE LIGHT 4 G PO PACK	BOTH IP/OP	$21.42 	$15.85	$0.00	$15.54		$0.00	$0.00	$0.00	$3.81	$0.00	$0.00	$0.00	$0.00	$0.00	$4.46	$0.00	$0.00	$0.00	$0.00	$9.71	$15.38	$15.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37579	ERX	HCPCS 25000001	00065-0795-15	BSS IO SOLN	BOTH IP/OP	$51.35 	$38.00	$0.00	$41.57		$0.00	$0.00	$0.00	$0.00	$0.00	$40.03	$40.03	$41.57	$0.00	$10.70	$0.00	$0.00	$0.00	$0.00	$22.61	$35.81	$36.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37616	ERX	HCPCS 63700001	29300-0116-16	TOPIRAMATE 50 MG PO TABS	BOTH IP/OP	$19.38 	$14.34	$0.00	$15.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.69	$15.35	$15.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37616	ERX	HCPCS 63700001	68382-0139-14	TOPIRAMATE 50 MG PO TABS	BOTH IP/OP	$19.38 	$14.34	$0.00	$15.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.69	$15.35	$15.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37616	ERX	HCPCS 63700001	69097-0123-03	TOPIRAMATE 50 MG PO TABS	BOTH IP/OP	$19.38 	$14.34	$0.00	$15.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.69	$15.35	$15.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37616	ERX	HCPCS 63700001	69097-0817-03	TOPIRAMATE 50 MG PO TABS	BOTH IP/OP	$19.38 	$14.34	$0.00	$15.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.69	$15.35	$15.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37630	ERX	HCPCS 63700001	45802-0040-64	SELENIUM SULFIDE 2.5 % EX LOTN	BOTH IP/OP	$82.97 	$61.40	$0.00	$60.27		$0.00	$0.00	$0.00	$14.77	$0.00	$0.00	$0.00	$0.00	$0.00	$17.29	$0.00	$0.00	$0.00	$0.00	$37.67	$59.59	$60.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37630	ERX	HCPCS 63700001	60432-0528-04	SELENIUM SULFIDE 2.5 % EX LOTN	BOTH IP/OP	$82.97 	$61.40	$0.00	$60.27		$0.00	$0.00	$0.00	$14.77	$0.00	$0.00	$0.00	$0.00	$0.00	$17.29	$0.00	$0.00	$0.00	$0.00	$37.67	$59.67	$60.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37630	ERX	HCPCS 63700001	60432-0528-05	SELENIUM SULFIDE 2.5 % EX LOTN	BOTH IP/OP	$82.97 	$61.40	$0.00	$60.27		$0.00	$0.00	$0.00	$14.77	$0.00	$0.00	$0.00	$0.00	$0.00	$17.29	$0.00	$0.00	$0.00	$0.00	$37.67	$59.67	$60.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37635	ERX	HCPCS 63700001	43547-0280-10	ESCITALOPRAM OXALATE 5 MG PO TABS	BOTH IP/OP	$17.39 	$12.87	$0.00	$12.62		$0.00	$0.00	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$0.00	$3.62	$0.00	$0.00	$0.00	$0.00	$7.89	$12.49	$12.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37637	ERX	HCPCS 63700001	00378-0018-01	METOPROLOL TARTRATE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37637	ERX	HCPCS 63700001	51079-0255-01	METOPROLOL TARTRATE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37637	ERX	HCPCS 63700001	51079-0255-20	METOPROLOL TARTRATE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37637	ERX	HCPCS 63700001	52817-0360-10	METOPROLOL TARTRATE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37637	ERX	HCPCS 63700001	57664-0506-52	METOPROLOL TARTRATE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37637	ERX	HCPCS 63700001	62332-0112-31	METOPROLOL TARTRATE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37637	ERX	HCPCS 63700001	62584-0265-01	METOPROLOL TARTRATE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37637	ERX	HCPCS 63700001	62584-0265-11	METOPROLOL TARTRATE 25 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37642	ERX	HCPCS 63700001	00009-0760-04	CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR	BOTH IP/OP	$143.60 	$106.26	$0.00	$102.48		$0.00	$0.00	$0.00	$25.56	$0.00	$0.00	$0.00	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$64.05	$101.46	$102.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37642	ERX	HCPCS 63700001	00574-0129-01	CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR	BOTH IP/OP	$143.60 	$106.26	$0.00	$102.48		$0.00	$0.00	$0.00	$25.56	$0.00	$0.00	$0.00	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$64.05	$101.46	$102.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37642	ERX	HCPCS 63700001	16714-0483-01	CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR	BOTH IP/OP	$143.60 	$106.26	$0.00	$102.48		$0.00	$0.00	$0.00	$25.56	$0.00	$0.00	$0.00	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$64.05	$101.46	$102.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37642	ERX	HCPCS 63700001	59762-0016-01	CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR	BOTH IP/OP	$143.60 	$106.26	$0.00	$102.48		$0.00	$0.00	$0.00	$25.56	$0.00	$0.00	$0.00	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$64.05	$101.46	$102.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37642	ERX	HCPCS 63700001	64980-0511-10	CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR	BOTH IP/OP	$143.60 	$106.26	$0.00	$102.48		$0.00	$0.00	$0.00	$25.56	$0.00	$0.00	$0.00	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$64.05	$101.46	$102.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37642	ERX	HCPCS 63700001	65862-0596-01	CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR	BOTH IP/OP	$143.60 	$106.26	$0.00	$102.48		$0.00	$0.00	$0.00	$25.56	$0.00	$0.00	$0.00	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$64.05	$101.46	$102.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37643	ERX	HCPCS 63700001	00378-1258-91	PROPAFENONE HCL ER 225 MG PO CP12	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37643	ERX	HCPCS 63700001	49884-0113-02	PROPAFENONE HCL ER 225 MG PO CP12	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37644	ERX	HCPCS 63700001	49884-0210-02	PROPAFENONE HCL ER 325 MG PO CP12	BOTH IP/OP	$41.90 	$31.01	$0.00	$30.40		$0.00	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37644	ERX	HCPCS 63700001	66993-0115-60	PROPAFENONE HCL ER 325 MG PO CP12	BOTH IP/OP	$41.90 	$31.01	$0.00	$30.40		$0.00	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37644	ERX	HCPCS 63700001	68462-0409-60	PROPAFENONE HCL ER 325 MG PO CP12	BOTH IP/OP	$41.90 	$31.01	$0.00	$30.40		$0.00	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37645	ERX	HCPCS 63700001	49884-0211-02	PROPAFENONE HCL ER 425 MG PO CP12	BOTH IP/OP	$41.90 	$31.01	$0.00	$30.40		$0.00	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37645	ERX	HCPCS 63700001	66993-0116-60	PROPAFENONE HCL ER 425 MG PO CP12	BOTH IP/OP	$41.90 	$31.01	$0.00	$30.40		$0.00	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37645	ERX	HCPCS 63700001	68462-0410-60	PROPAFENONE HCL ER 425 MG PO CP12	BOTH IP/OP	$41.90 	$31.01	$0.00	$30.40		$0.00	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37648	ERX	HCPCS 63700001	00591-0900-30	GLIPIZIDE ER 2.5 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37648	ERX	HCPCS 63700001	59762-0540-01	GLIPIZIDE ER 2.5 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37648	ERX	HCPCS 63700001	68084-0295-21	GLIPIZIDE ER 2.5 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37649	ERX	HCPCS 63700001	68084-0111-01	GLIPIZIDE ER 5 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37649	ERX	HCPCS 63700001	68084-0111-11	GLIPIZIDE ER 5 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37650	ERX	HCPCS 63700001	00591-0845-10	GLIPIZIDE ER 10 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37650	ERX	HCPCS 63700001	68084-0112-01	GLIPIZIDE ER 10 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37650	ERX	HCPCS 63700001	68084-0112-11	GLIPIZIDE ER 10 MG PO TB24	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37651	ERX	HCPCS 63700001	63824-0008-15	GUAIFENESIN ER 600 MG PO TB12	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37651	ERX	HCPCS 63700001	70677-0055-01	GUAIFENESIN ER 600 MG PO TB12	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37662	ERX	HCPCS 63700001	50742-0622-01	NIFEDIPINE 90 MG PO TB24	BOTH IP/OP	$12.71 	$9.41	$0.00	$9.22		$0.00	$0.00	$0.00	$2.26	$0.00	$0.00	$0.00	$0.00	$0.00	$2.65	$0.00	$0.00	$0.00	$0.00	$5.77	$9.13	$9.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37848	ERX	HCPCS 25000001	66689-0023-01	HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN	BOTH IP/OP	$14.88 	$11.01	$0.00	$11.47		$0.00	$0.00	$0.00	$0.00	$0.00	$11.04	$11.04	$11.47	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$6.16	$9.76	$9.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37848	ERX	HCPCS 25000001	66689-0023-50	HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN	BOTH IP/OP	$14.88 	$11.01	$0.00	$11.47		$0.00	$0.00	$0.00	$0.00	$0.00	$11.04	$11.04	$11.47	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$6.16	$9.76	$9.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37894	ERX	HCPCS J9305	00002-7623-01	PEMETREXED DISODIUM 500 MG IV SOLR	BOTH IP/OP	"$10,436.55 "	"$7,723.05"	$0.00	"$8,285.83"	"$4,837.34"	"$4,837.34"	"$3,801.85"	"$3,801.85"	"$3,801.85"	"$2,832.93"	"$7,978.39"	"$7,978.39"	"$8,285.83"	"$3,746.45"	"$4,402.08"	"$2,435.19"	"$5,145.22"	"$5,145.22"	"$3,647.28"	"$4,549.59"	"$7,206.55"	"$7,279.34"	"$5,036.72"		"$5,036.72"	"$4,158.91"	$0.00	$0.00	"$3,959.99"	"$3,620.25"	$0.00	$0.00	$0.00	$0.00
37989	ERX	HCPCS J9055	66733-0948-23	CETUXIMAB 100 MG/50ML IV SOLN	BOTH IP/OP	"$2,155.14 "	"$1,594.80"	$0.00	"$1,710.99"	$998.89	$998.89	$676.18	$676.18	$676.18	$584.45	"$1,647.51"	"$1,647.51"	"$1,710.99"	$667.05	$783.78	$433.58	"$1,062.48"	"$1,062.48"	$651.50	$959.76	"$1,520.26"	"$1,535.62"	$899.70		$899.70	$742.72	$0.00	$0.00	$707.19	$647.13	$0.00	$0.00	$0.00	$0.00
38062	ERX	HCPCS J7518	00078-0385-66	MYCOPHENOLATE SODIUM 180 MG PO TBEC	BOTH IP/OP	$19.15 	$14.17	$0.00	$13.90		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.99	$0.00	$0.00	$0.00	$0.00	$8.69	$13.76	$13.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38062	ERX	HCPCS J7518	00378-4201-78	MYCOPHENOLATE SODIUM 180 MG PO TBEC	BOTH IP/OP	$19.15 	$14.17	$0.00	$13.90		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.99	$0.00	$0.00	$0.00	$0.00	$8.69	$13.76	$13.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38062	ERX	HCPCS J7518	16729-0261-29	MYCOPHENOLATE SODIUM 180 MG PO TBEC	BOTH IP/OP	$19.15 	$14.17	$0.00	$13.90		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.99	$0.00	$0.00	$0.00	$0.00	$8.69	$13.76	$13.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38063	ERX	HCPCS 63700001	16729-0189-29	MYCOPHENOLATE SODIUM 360 MG PO TBEC	BOTH IP/OP	$38.29 	$28.33	$0.00	$27.78		$0.00	$0.00	$0.00	$6.82	$0.00	$0.00	$0.00	$0.00	$0.00	$7.98	$0.00	$0.00	$0.00	$0.00	$17.37	$27.51	$27.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38063	ERX	HCPCS 63700001	60505-2966-07	MYCOPHENOLATE SODIUM 360 MG PO TBEC	BOTH IP/OP	$38.29 	$28.33	$0.00	$27.78		$0.00	$0.00	$0.00	$6.82	$0.00	$0.00	$0.00	$0.00	$0.00	$7.98	$0.00	$0.00	$0.00	$0.00	$17.37	$27.51	$27.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38063	ERX	HCPCS 63700001	68084-0918-25	MYCOPHENOLATE SODIUM 360 MG PO TBEC	BOTH IP/OP	$38.29 	$28.33	$0.00	$27.78		$0.00	$0.00	$0.00	$6.82	$0.00	$0.00	$0.00	$0.00	$0.00	$7.98	$0.00	$0.00	$0.00	$0.00	$17.37	$27.51	$27.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38100	ERX	HCPCS 63700001	55513-0073-30	CINACALCET HCL 30 MG PO TABS	BOTH IP/OP	$118.31 	$87.55	$0.00	$85.82		$0.00	$0.00	$0.00	$21.06	$0.00	$0.00	$0.00	$0.00	$0.00	$24.66	$0.00	$0.00	$0.00	$0.00	$53.64	$84.97	$85.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38100	ERX	HCPCS 63700001	67877-0503-30	CINACALCET HCL 30 MG PO TABS	BOTH IP/OP	$118.31 	$87.55	$0.00	$85.82		$0.00	$0.00	$0.00	$21.06	$0.00	$0.00	$0.00	$0.00	$0.00	$24.66	$0.00	$0.00	$0.00	$0.00	$53.64	$84.97	$85.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38100	ERX	HCPCS 63700001	70436-0007-04	CINACALCET HCL 30 MG PO TABS	BOTH IP/OP	$118.31 	$87.55	$0.00	$85.82		$0.00	$0.00	$0.00	$21.06	$0.00	$0.00	$0.00	$0.00	$0.00	$24.66	$0.00	$0.00	$0.00	$0.00	$53.64	$84.97	$85.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38101	ERX	HCPCS 63700001	47335-0380-83	CINACALCET HCL 60 MG PO TABS	BOTH IP/OP	$214.61 	$158.81	$0.00	$155.86		$0.00	$0.00	$0.00	$38.20	$0.00	$0.00	$0.00	$0.00	$0.00	$44.72	$0.00	$0.00	$0.00	$0.00	$97.41	$154.30	$155.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38101	ERX	HCPCS 63700001	55513-0074-30	CINACALCET HCL 60 MG PO TABS	BOTH IP/OP	$214.61 	$158.81	$0.00	$155.86		$0.00	$0.00	$0.00	$38.20	$0.00	$0.00	$0.00	$0.00	$0.00	$44.72	$0.00	$0.00	$0.00	$0.00	$97.41	$154.30	$155.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38101	ERX	HCPCS 63700001	70436-0008-04	CINACALCET HCL 60 MG PO TABS	BOTH IP/OP	$214.61 	$158.81	$0.00	$155.86		$0.00	$0.00	$0.00	$38.20	$0.00	$0.00	$0.00	$0.00	$0.00	$44.72	$0.00	$0.00	$0.00	$0.00	$97.41	$154.30	$155.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38102	ERX	HCPCS 63700001	55513-0075-30	CINACALCET HCL 90 MG PO TABS	BOTH IP/OP	$335.91 	$248.57	$0.00	$243.95		$0.00	$0.00	$0.00	$59.79	$0.00	$0.00	$0.00	$0.00	$0.00	$70.00	$0.00	$0.00	$0.00	$0.00	$152.47	$241.51	$243.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38102	ERX	HCPCS 63700001	69097-0412-02	CINACALCET HCL 90 MG PO TABS	BOTH IP/OP	$335.91 	$248.57	$0.00	$243.95		$0.00	$0.00	$0.00	$59.79	$0.00	$0.00	$0.00	$0.00	$0.00	$70.00	$0.00	$0.00	$0.00	$0.00	$152.47	$241.51	$243.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38224	ERX	HCPCS 63700001	00228-2778-11	PROPRANOLOL HCL ER 60 MG PO CP24	BOTH IP/OP	$8.63 	$6.39	$0.00	$6.21		$0.00	$0.00	$0.00	$1.54	$0.00	$0.00	$0.00	$0.00	$0.00	$1.80	$0.00	$0.00	$0.00	$0.00	$3.88	$6.15	$6.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38224	ERX	HCPCS 63700001	42291-0522-01	PROPRANOLOL HCL ER 60 MG PO CP24	BOTH IP/OP	$8.63 	$6.39	$0.00	$6.21		$0.00	$0.00	$0.00	$1.54	$0.00	$0.00	$0.00	$0.00	$0.00	$1.80	$0.00	$0.00	$0.00	$0.00	$3.88	$6.15	$6.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38224	ERX	HCPCS 63700001	62559-0530-01	PROPRANOLOL HCL ER 60 MG PO CP24	BOTH IP/OP	$8.63 	$6.39	$0.00	$6.21		$0.00	$0.00	$0.00	$1.54	$0.00	$0.00	$0.00	$0.00	$0.00	$1.80	$0.00	$0.00	$0.00	$0.00	$3.88	$6.15	$6.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38225	ERX	HCPCS 63700001	00228-2779-11	PROPRANOLOL HCL ER 80 MG PO CP24	BOTH IP/OP	$9.56 	$7.07	$0.00	$6.94		$0.00	$0.00	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$4.34	$6.87	$6.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38225	ERX	HCPCS 63700001	42291-0523-01	PROPRANOLOL HCL ER 80 MG PO CP24	BOTH IP/OP	$9.56 	$7.07	$0.00	$6.94		$0.00	$0.00	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$4.34	$6.87	$6.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38225	ERX	HCPCS 63700001	42291-0523-10	PROPRANOLOL HCL ER 80 MG PO CP24	BOTH IP/OP	$9.56 	$7.07	$0.00	$6.94		$0.00	$0.00	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$4.34	$6.87	$6.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38225	ERX	HCPCS 63700001	62559-0531-01	PROPRANOLOL HCL ER 80 MG PO CP24	BOTH IP/OP	$9.56 	$7.07	$0.00	$6.94		$0.00	$0.00	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$4.34	$6.87	$6.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38226	ERX	HCPCS 63700001	00228-2780-11	PROPRANOLOL HCL ER 120 MG PO CP24	BOTH IP/OP	$12.50 	$9.25	$0.00	$9.07		$0.00	$0.00	$0.00	$2.23	$0.00	$0.00	$0.00	$0.00	$0.00	$2.61	$0.00	$0.00	$0.00	$0.00	$5.67	$8.98	$9.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38227	ERX	HCPCS 63700001	00228-2781-11	PROPRANOLOL HCL ER 160 MG PO CP24	BOTH IP/OP	$9.56 	$7.07	$0.00	$7.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.78	$7.57	$7.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38227	ERX	HCPCS 63700001	62559-0533-01	PROPRANOLOL HCL ER 160 MG PO CP24	BOTH IP/OP	$9.56 	$7.07	$0.00	$7.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.78	$7.57	$7.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38245	ERX	HCPCS 63700001	50383-0779-31	LACTULOSE 10 GM/15ML SOLN	BOTH IP/OP	$6.23 	$4.61	$0.00	$4.80		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38245	ERX	HCPCS 63700001	50383-0779-16	LACTULOSE 10 GM/15ML SOLN	BOTH IP/OP	$6.23 	$4.61	$0.00	$100.96		$0.00	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.00	$100.96	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38263	ERX	HCPCS 25000001	00002-7597-01	OLANZAPINE 10 MG IM SOLR	BOTH IP/OP	$43.48 	$32.18	$0.00	$33.51		$0.00	$0.00	$0.00	$0.00	$0.00	$32.27	$32.27	$33.51	$0.00	$9.06	$0.00	$0.00	$0.00	$0.00	$19.72	$31.23	$31.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38263	ERX	HCPCS 25000001	00517-0955-01	OLANZAPINE 10 MG IM SOLR	BOTH IP/OP	$43.48 	$32.18	$0.00	$33.51		$0.00	$0.00	$0.00	$0.00	$0.00	$32.27	$32.27	$33.51	$0.00	$9.06	$0.00	$0.00	$0.00	$0.00	$19.72	$31.23	$31.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38263	ERX	HCPCS 25000001	00781-3159-72	OLANZAPINE 10 MG IM SOLR	BOTH IP/OP	$43.48 	$32.18	$0.00	$33.51		$0.00	$0.00	$0.00	$0.00	$0.00	$32.27	$32.27	$33.51	$0.00	$9.06	$0.00	$0.00	$0.00	$0.00	$19.72	$31.23	$31.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38270	ERX	HCPCS J9070	00781-3244-94	CYCLOPHOSPHAMIDE 1 G IJ SOLR	BOTH IP/OP	"$2,276.61 "	"$1,684.69"	$0.00	"$1,754.81"	"$1,024.47"	"$1,024.47"	$274.73	$274.73	$274.73	$474.50	"$1,689.70"	"$1,689.70"	"$1,754.81"	$291.53	$342.55	$189.49	"$1,122.37"	"$1,122.37"	$358.46	"$1,054.80"	"$1,670.80"	"$1,687.68"	$495.02		$495.02	$390.57	$0.00	$0.00	$371.89	$345.66	$0.00	$0.00	$0.00	$0.00
38270	ERX	HCPCS J9070	10019-0956-01	CYCLOPHOSPHAMIDE 1 G IJ SOLR	BOTH IP/OP	"$2,276.61 "	"$1,684.69"	$0.00	"$1,754.81"	"$1,024.47"	"$1,024.47"	$274.73	$274.73	$274.73	$474.50	"$1,689.70"	"$1,689.70"	"$1,754.81"	$291.53	$342.55	$189.49	"$1,122.37"	"$1,122.37"	$358.46	"$1,054.80"	"$1,670.80"	"$1,687.68"	$495.02		$495.02	$390.57	$0.00	$0.00	$371.89	$345.66	$0.00	$0.00	$0.00	$0.00
38270	ERX	HCPCS J9070	16714-0857-01	CYCLOPHOSPHAMIDE 1 G IJ SOLR	BOTH IP/OP	"$2,276.61 "	"$1,684.69"	$0.00	"$1,754.81"	"$1,024.47"	"$1,024.47"	$274.73	$274.73	$274.73	$474.50	"$1,689.70"	"$1,689.70"	"$1,754.81"	$291.53	$342.55	$189.49	"$1,122.37"	"$1,122.37"	$358.46	"$1,054.80"	"$1,670.80"	"$1,687.68"	$495.02		$495.02	$390.57	$0.00	$0.00	$371.89	$345.66	$0.00	$0.00	$0.00	$0.00
38270	ERX	HCPCS J9070	70121-1239-01	CYCLOPHOSPHAMIDE 1 G IJ SOLR	BOTH IP/OP	"$2,276.61 "	"$1,684.69"	$0.00	"$1,754.81"	"$1,024.47"	"$1,024.47"	$274.73	$274.73	$274.73	$474.50	"$1,689.70"	"$1,689.70"	"$1,754.81"	$291.53	$342.55	$189.49	"$1,122.37"	"$1,122.37"	$358.46	"$1,054.80"	"$1,670.80"	"$1,687.68"	$495.02		$495.02	$390.57	$0.00	$0.00	$371.89	$345.66	$0.00	$0.00	$0.00	$0.00
38271	ERX	HCPCS J9070	00781-3233-94	CYCLOPHOSPHAMIDE 500 MG IJ SOLR	BOTH IP/OP	"$1,283.34 "	$949.67	$0.00	$989.20	$577.50	$577.50	$137.37	$137.37	$137.37	$267.48	$952.49	$952.49	$989.20	$145.77	$171.27	$94.75	$759.10	$759.10	$179.23	$582.34	$922.43	$931.74	$247.51		$247.51	$195.29	$0.00	$0.00	$185.94	$172.83	$0.00	$0.00	$0.00	$0.00
38271	ERX	HCPCS J9070	10019-0955-01	CYCLOPHOSPHAMIDE 500 MG IJ SOLR	BOTH IP/OP	"$1,283.34 "	$949.67	$0.00	$989.20	$577.50	$577.50	$137.37	$137.37	$137.37	$267.48	$952.49	$952.49	$989.20	$145.77	$171.27	$94.75	$759.10	$759.10	$179.23	$582.34	$922.43	$931.74	$247.51		$247.51	$195.29	$0.00	$0.00	$185.94	$172.83	$0.00	$0.00	$0.00	$0.00
38271	ERX	HCPCS J9070	16714-0859-01	CYCLOPHOSPHAMIDE 500 MG IJ SOLR	BOTH IP/OP	"$1,283.34 "	$949.67	$0.00	$989.20	$577.50	$577.50	$137.37	$137.37	$137.37	$267.48	$952.49	$952.49	$989.20	$145.77	$171.27	$94.75	$759.10	$759.10	$179.23	$582.34	$922.43	$931.74	$247.51		$247.51	$195.29	$0.00	$0.00	$185.94	$172.83	$0.00	$0.00	$0.00	$0.00
38280	ERX	HCPCS J9070	00781-3255-94	CYCLOPHOSPHAMIDE 2 G IJ SOLR	BOTH IP/OP	"$3,973.08 "	"$2,940.08"	$0.00	"$3,062.45"	"$1,787.89"	"$1,787.89"	$549.46	$549.46	$549.46	$828.09	"$2,948.82"	"$2,948.82"	"$3,062.45"	$583.06	$685.10	$378.99	"$1,958.73"	"$1,958.73"	$716.92	"$1,801.95"	"$2,854.29"	"$2,883.12"	$990.03		$990.03	$781.14	$0.00	$0.00	$743.78	$691.32	$0.00	$0.00	$0.00	$0.00
38280	ERX	HCPCS J9070	10019-0957-01	CYCLOPHOSPHAMIDE 2 G IJ SOLR	BOTH IP/OP	"$3,973.08 "	"$2,940.08"	$0.00	"$3,062.45"	"$1,787.89"	"$1,787.89"	$549.46	$549.46	$549.46	$828.09	"$2,948.82"	"$2,948.82"	"$3,062.45"	$583.06	$685.10	$378.99	"$1,958.73"	"$1,958.73"	$716.92	"$1,801.95"	"$2,854.29"	"$2,883.12"	$990.03		$990.03	$781.14	$0.00	$0.00	$743.78	$691.32	$0.00	$0.00	$0.00	$0.00
38280	ERX	HCPCS J9070	10019-0957-11	CYCLOPHOSPHAMIDE 2 G IJ SOLR	BOTH IP/OP	"$3,973.08 "	"$2,940.08"	$0.00	"$3,062.45"	"$1,787.89"	"$1,787.89"	$549.46	$549.46	$549.46	$828.09	"$2,948.82"	"$2,948.82"	"$3,062.45"	$583.06	$685.10	$378.99	"$1,958.73"	"$1,958.73"	$716.92	"$1,801.95"	"$2,854.29"	"$2,883.12"	$990.03		$990.03	$781.14	$0.00	$0.00	$743.78	$691.32	$0.00	$0.00	$0.00	$0.00
38280	ERX	HCPCS J9070	70121-1240-01	CYCLOPHOSPHAMIDE 2 G IJ SOLR	BOTH IP/OP	"$3,973.08 "	"$2,940.08"	$0.00	"$3,062.45"	"$1,787.89"	"$1,787.89"	$549.46	$549.46	$549.46	$828.09	"$2,948.82"	"$2,948.82"	"$3,062.45"	$583.06	$685.10	$378.99	"$1,958.73"	"$1,958.73"	$716.92	"$1,801.95"	"$2,854.29"	"$2,883.12"	$990.03		$990.03	$781.14	$0.00	$0.00	$743.78	$691.32	$0.00	$0.00	$0.00	$0.00
38303	ERX	HCPCS J0132	00574-0805-30	ACETYLCYSTEINE 200 MG/ML IV SOLN	BOTH IP/OP	$755.55 	$559.11	$0.00	$582.38	$340.00	$340.00	$0.00	$0.00	$0.00	$117.74	$560.77	$560.77	$582.38	$0.00	$157.46	$0.00	$446.91	$446.91	$0.00	$342.85	$543.07	$548.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38303	ERX	HCPCS J0132	00574-0815-30	ACETYLCYSTEINE 200 MG/ML IV SOLN	BOTH IP/OP	$755.55 	$559.11	$0.00	$582.38	$340.00	$340.00	$0.00	$0.00	$0.00	$117.74	$560.77	$560.77	$582.38	$0.00	$157.46	$0.00	$446.91	$446.91	$0.00	$342.85	$543.07	$548.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38303	ERX	HCPCS J0132	17478-0660-30	ACETYLCYSTEINE 200 MG/ML IV SOLN	BOTH IP/OP	$755.55 	$559.11	$0.00	$582.38	$340.00	$340.00	$0.00	$0.00	$0.00	$117.74	$560.77	$560.77	$582.38	$0.00	$157.46	$0.00	$446.91	$446.91	$0.00	$342.85	$543.07	$548.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38303	ERX	HCPCS J0132	25021-0812-30	ACETYLCYSTEINE 200 MG/ML IV SOLN	BOTH IP/OP	$755.55 	$559.11	$0.00	$582.38	$340.00	$340.00	$0.00	$0.00	$0.00	$117.74	$560.77	$560.77	$582.38	$0.00	$157.46	$0.00	$446.91	$446.91	$0.00	$342.85	$543.07	$548.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38303	ERX	HCPCS J0132	63323-0963-30	ACETYLCYSTEINE 200 MG/ML IV SOLN	BOTH IP/OP	$755.55 	$559.11	$0.00	$582.38	$340.00	$340.00	$0.00	$0.00	$0.00	$117.74	$560.77	$560.77	$582.38	$0.00	$157.46	$0.00	$446.91	$446.91	$0.00	$342.85	$543.07	$548.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38303	ERX	HCPCS J0132	66220-0207-30	ACETYLCYSTEINE 200 MG/ML IV SOLN	BOTH IP/OP	$755.55 	$559.11	$0.00	$582.38	$340.00	$340.00	$0.00	$0.00	$0.00	$117.74	$560.77	$560.77	$582.38	$0.00	$157.46	$0.00	$446.91	$446.91	$0.00	$342.85	$543.07	$548.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38315	ERX	HCPCS 25000001	00597-0075-41	TIOTROPIUM BROMIDE MONOHYDRATE 18 MCG IN CAPS	BOTH IP/OP	"$1,485.63 "	"$1,099.37"	$0.00	"$1,190.94"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,146.75"	"$1,146.75"	"$1,190.94"	$0.00	$309.61	$0.00	$0.00	$0.00	$0.00	$655.56	"$1,038.41"	"$1,048.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38315	ERX	HCPCS 25000001	00597-0075-75	TIOTROPIUM BROMIDE MONOHYDRATE 18 MCG IN CAPS	BOTH IP/OP	"$1,485.63 "	"$1,099.37"	$0.00	"$1,190.94"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,146.75"	"$1,146.75"	"$1,190.94"	$0.00	$309.61	$0.00	$0.00	$0.00	$0.00	$655.56	"$1,038.41"	"$1,048.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38318	ERX	HCPCS 63700001	63010-0027-70	NELFINAVIR MESYLATE 625 MG PO TABS	BOTH IP/OP	$50.87 	$37.64	$0.00	$36.91		$0.00	$0.00	$0.00	$9.05	$0.00	$0.00	$0.00	$0.00	$0.00	$10.60	$0.00	$0.00	$0.00	$0.00	$23.07	$36.54	$36.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38421	ERX	HCPCS 63700001	13107-0001-30	MIRTAZAPINE 7.5 MG PO TABS	BOTH IP/OP	$10.01 	$7.41	$0.00	$8.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.01	$7.93	$8.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38421	ERX	HCPCS 63700001	16714-0706-01	MIRTAZAPINE 7.5 MG PO TABS	BOTH IP/OP	$10.01 	$7.41	$0.00	$8.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.01	$7.93	$8.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38479	ERX	HCPCS 63700001	00093-5417-84	CLOZAPINE 25 MG PO TBDP	BOTH IP/OP	$11.40 	$8.44	$0.00	$9.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.70	$9.03	$9.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38480	ERX	HCPCS 63700001	00093-5419-19	CLOZAPINE 100 MG PO TBDP	BOTH IP/OP	$34.26 	$25.35	$0.00	$24.86		$0.00	$0.00	$0.00	$6.10	$0.00	$0.00	$0.00	$0.00	$0.00	$7.14	$0.00	$0.00	$0.00	$0.00	$15.54	$24.61	$24.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38480	ERX	HCPCS 63700001	00093-5419-84	CLOZAPINE 100 MG PO TBDP	BOTH IP/OP	$34.26 	$25.35	$0.00	$24.86		$0.00	$0.00	$0.00	$6.10	$0.00	$0.00	$0.00	$0.00	$0.00	$7.14	$0.00	$0.00	$0.00	$0.00	$15.54	$24.61	$24.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38488	ERX	HCPCS 63700001	00121-0721-04	FLUOXETINE HCL 20 MG/5ML PO SOLN	BOTH IP/OP	$14.33 	$10.60	$0.00	$10.40		$0.00	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$0.00	$2.99	$0.00	$0.00	$0.00	$0.00	$6.50	$10.30	$10.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38488	ERX	HCPCS 63700001	00121-4721-05	FLUOXETINE HCL 20 MG/5ML PO SOLN	BOTH IP/OP	$14.33 	$10.60	$0.00	$10.40		$0.00	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$0.00	$2.99	$0.00	$0.00	$0.00	$0.00	$6.50	$10.30	$10.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38488	ERX	HCPCS 63700001	54838-0523-40	FLUOXETINE HCL 20 MG/5ML PO SOLN	BOTH IP/OP	$14.33 	$10.60	$0.00	$10.40		$0.00	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$0.00	$2.99	$0.00	$0.00	$0.00	$0.00	$6.50	$10.30	$10.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38489	ERX	HCPCS 63700001	99999-6005-07	ETHOSUXIMIDE 250 MG/5ML PO SOLN	BOTH IP/OP	$105.15 	$77.81	$0.00	$76.27		$0.00	$0.00	$0.00	$18.72	$0.00	$0.00	$0.00	$0.00	$0.00	$21.91	$0.00	$0.00	$0.00	$0.00	$47.67	$75.51	$76.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38489	ERX	HCPCS 63700001	00121-0670-16	ETHOSUXIMIDE 250 MG/5ML PO SOLN	BOTH IP/OP	$105.15 	$77.81	$0.00	$492.40		$0.00	$0.00	$0.00	$18.72	$0.00	$0.00	$0.00	$0.00	$0.00	$21.91	$0.00	$0.00	$0.00	$0.00	$47.67	$492.40	$76.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38703	ERX	HCPCS J0153	17478-0542-02	ADENOSINE 6 MG/2ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$4.59	$0.00	$0.00	$0.00	$0.00	$1.86	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
38703	ERX	HCPCS J0153	17478-0953-02	ADENOSINE 6 MG/2ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$4.59	$0.00	$0.00	$0.00	$0.00	$1.86	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
38703	ERX	HCPCS J0153	25021-0301-67	ADENOSINE 6 MG/2ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$4.59	$0.00	$0.00	$0.00	$0.00	$1.86	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
38703	ERX	HCPCS J0153	63323-0651-21	ADENOSINE 6 MG/2ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$4.59	$0.00	$0.00	$0.00	$0.00	$1.86	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
38703	ERX	HCPCS J0153	63323-0651-89	ADENOSINE 6 MG/2ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$4.59	$0.00	$0.00	$0.00	$0.00	$1.86	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
38703	ERX	HCPCS J0153	67457-0855-02	ADENOSINE 6 MG/2ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$4.59	$0.00	$0.00	$0.00	$0.00	$1.86	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.19	$0.00	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00
38907	ERX	HCPCS 63700001	43386-0551-02	TINIDAZOLE 500 MG PO TABS	BOTH IP/OP	$88.80 	$65.71	$0.00	$71.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.40	$70.33	$71.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39063	ERX	HCPCS 63700001	65649-0301-03	RIFAXIMIN 200 MG PO TABS	BOTH IP/OP	$134.02 	$99.17	$0.00	$202.72		$0.00	$0.00	$0.00	$23.86	$0.00	$0.00	$0.00	$0.00	$0.00	$27.93	$0.00	$0.00	$0.00	$0.00	$126.70	$200.69	$202.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39136	ERX	HCPCS 63700001	00574-2008-15	NYSTATIN 100000 UNIT/GM EX POWD	BOTH IP/OP	$106.02 	$78.45	$0.00	$76.90		$0.00	$0.00	$0.00	$18.87	$0.00	$0.00	$0.00	$0.00	$0.00	$22.09	$0.00	$0.00	$0.00	$0.00	$48.07	$76.13	$76.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39136	ERX	HCPCS 63700001	16714-0769-01	NYSTATIN 100000 UNIT/GM EX POWD	BOTH IP/OP	$106.02 	$78.45	$0.00	$76.90		$0.00	$0.00	$0.00	$18.87	$0.00	$0.00	$0.00	$0.00	$0.00	$22.09	$0.00	$0.00	$0.00	$0.00	$48.07	$76.13	$76.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39136	ERX	HCPCS 63700001	43386-0530-01	NYSTATIN 100000 UNIT/GM EX POWD	BOTH IP/OP	$106.02 	$78.45	$0.00	$76.90		$0.00	$0.00	$0.00	$18.87	$0.00	$0.00	$0.00	$0.00	$0.00	$22.09	$0.00	$0.00	$0.00	$0.00	$48.07	$76.13	$76.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39136	ERX	HCPCS 63700001	68308-0152-15	NYSTATIN 100000 UNIT/GM EX POWD	BOTH IP/OP	$106.02 	$78.45	$0.00	$76.90		$0.00	$0.00	$0.00	$18.87	$0.00	$0.00	$0.00	$0.00	$0.00	$22.09	$0.00	$0.00	$0.00	$0.00	$48.07	$76.13	$76.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39254	ERX	HCPCS 63700001	67546-0111-12	NITAZOXANIDE 500 MG PO TABS	BOTH IP/OP	$542.85 	$401.71	$0.00	$394.21		$0.00	$0.00	$0.00	$96.63	$0.00	$0.00	$0.00	$0.00	$0.00	$113.13	$0.00	$0.00	$0.00	$0.00	$246.38	$390.27	$394.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39255	ERX	HCPCS 63700001	61958-0701-01	TRUVADA:EMTRICITABINE-TENOFOVIR 200-300 MG TAB PO	BOTH IP/OP	$255.71 	$189.23	$0.00	$185.70		$0.00	$0.00	$0.00	$45.52	$0.00	$0.00	$0.00	$0.00	$0.00	$53.29	$0.00	$0.00	$0.00	$0.00	$116.07	$183.85	$185.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39267	ERX	HCPCS J9045	00703-4248-01	CARBOPLATIN 450 MG/45ML IV SOLN	BOTH IP/OP	$270.61 	$200.25	$0.00	$208.59	$121.77	$121.77	$0.00	$0.00	$0.00	$60.81	$200.85	$200.85	$208.59	$0.00	$27.95	$0.00	$160.07	$160.07	$0.00	$122.83	$194.56	$196.53	$0.00		$0.00	$28.45	$0.00	$0.00	$27.09	$0.00	$0.00	$0.00	$0.00	$0.00
39267	ERX	HCPCS J9045	61703-0339-50	CARBOPLATIN 450 MG/45ML IV SOLN	BOTH IP/OP	$270.61 	$200.25	$0.00	$208.59	$121.77	$121.77	$0.00	$0.00	$0.00	$60.81	$200.85	$200.85	$208.59	$0.00	$27.95	$0.00	$160.07	$160.07	$0.00	$122.83	$194.56	$196.53	$0.00		$0.00	$28.45	$0.00	$0.00	$27.09	$0.00	$0.00	$0.00	$0.00	$0.00
39275	ERX	HCPCS 63700001	00002-3235-60	DULOXETINE HCL 20 MG PO CPEP	BOTH IP/OP	$39.53 	$29.25	$0.00	$27.84		$0.00	$0.00	$0.00	$7.25	$0.00	$0.00	$0.00	$0.00	$0.00	$8.24	$0.00	$0.00	$0.00	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39275	ERX	HCPCS 63700001	13668-0109-60	DULOXETINE HCL 20 MG PO CPEP	BOTH IP/OP	$39.53 	$29.25	$0.00	$27.84		$0.00	$0.00	$0.00	$7.25	$0.00	$0.00	$0.00	$0.00	$0.00	$8.24	$0.00	$0.00	$0.00	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39275	ERX	HCPCS 63700001	27241-0097-06	DULOXETINE HCL 20 MG PO CPEP	BOTH IP/OP	$39.53 	$29.25	$0.00	$27.84		$0.00	$0.00	$0.00	$7.25	$0.00	$0.00	$0.00	$0.00	$0.00	$8.24	$0.00	$0.00	$0.00	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39275	ERX	HCPCS 63700001	57237-0017-60	DULOXETINE HCL 20 MG PO CPEP	BOTH IP/OP	$39.53 	$29.25	$0.00	$27.84		$0.00	$0.00	$0.00	$7.25	$0.00	$0.00	$0.00	$0.00	$0.00	$8.24	$0.00	$0.00	$0.00	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39275	ERX	HCPCS 63700001	60505-2995-06	DULOXETINE HCL 20 MG PO CPEP	BOTH IP/OP	$39.53 	$29.25	$0.00	$27.84		$0.00	$0.00	$0.00	$7.25	$0.00	$0.00	$0.00	$0.00	$0.00	$8.24	$0.00	$0.00	$0.00	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39275	ERX	HCPCS 63700001	69097-0297-03	DULOXETINE HCL 20 MG PO CPEP	BOTH IP/OP	$39.53 	$29.25	$0.00	$27.84		$0.00	$0.00	$0.00	$7.25	$0.00	$0.00	$0.00	$0.00	$0.00	$8.24	$0.00	$0.00	$0.00	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39276	ERX	HCPCS 63700001	27241-0098-09	DULOXETINE HCL 30 MG PO CPEP	BOTH IP/OP	$32.90 	$24.35	$0.00	$23.87		$0.00	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00	$6.86	$0.00	$0.00	$0.00	$0.00	$14.92	$23.63	$23.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39276	ERX	HCPCS 63700001	57237-0018-30	DULOXETINE HCL 30 MG PO CPEP	BOTH IP/OP	$32.90 	$24.35	$0.00	$23.87		$0.00	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00	$6.86	$0.00	$0.00	$0.00	$0.00	$14.92	$23.63	$23.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39276	ERX	HCPCS 63700001	57237-0018-90	DULOXETINE HCL 30 MG PO CPEP	BOTH IP/OP	$32.90 	$24.35	$0.00	$23.87		$0.00	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00	$6.86	$0.00	$0.00	$0.00	$0.00	$14.92	$23.63	$23.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39277	ERX	HCPCS 63700001	00228-2892-03	DULOXETINE HCL 60 MG PO CPEP	BOTH IP/OP	$29.80 	$22.05	$0.00	$23.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.90	$23.60	$23.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39277	ERX	HCPCS 63700001	27241-0099-03	DULOXETINE HCL 60 MG PO CPEP	BOTH IP/OP	$29.80 	$22.05	$0.00	$23.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.90	$23.60	$23.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39277	ERX	HCPCS 63700001	47335-0383-83	DULOXETINE HCL 60 MG PO CPEP	BOTH IP/OP	$29.80 	$22.05	$0.00	$23.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.90	$23.60	$23.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39277	ERX	HCPCS 63700001	57237-0019-30	DULOXETINE HCL 60 MG PO CPEP	BOTH IP/OP	$29.80 	$22.05	$0.00	$23.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.90	$23.60	$23.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39277	ERX	HCPCS 63700001	57237-0019-99	DULOXETINE HCL 60 MG PO CPEP	BOTH IP/OP	$29.80 	$22.05	$0.00	$23.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.90	$23.60	$23.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39301	ERX	HCPCS 63700001	00093-5382-56	EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS	BOTH IP/OP	$179.30 	$132.68	$0.00	$130.06		$0.00	$0.00	$0.00	$31.92	$0.00	$0.00	$0.00	$0.00	$0.00	$37.37	$0.00	$0.00	$0.00	$0.00	$81.29	$128.76	$130.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39301	ERX	HCPCS 63700001	35573-0402-30	EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS	BOTH IP/OP	$179.30 	$132.68	$0.00	$130.06		$0.00	$0.00	$0.00	$31.92	$0.00	$0.00	$0.00	$0.00	$0.00	$37.37	$0.00	$0.00	$0.00	$0.00	$81.29	$128.76	$130.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39301	ERX	HCPCS 63700001	66993-0482-30	EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS	BOTH IP/OP	$179.30 	$132.68	$0.00	$130.06		$0.00	$0.00	$0.00	$31.92	$0.00	$0.00	$0.00	$0.00	$0.00	$37.37	$0.00	$0.00	$0.00	$0.00	$81.29	$128.76	$130.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39301	ERX	HCPCS 63700001	68180-0288-06	EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS	BOTH IP/OP	$179.30 	$132.68	$0.00	$130.06		$0.00	$0.00	$0.00	$31.92	$0.00	$0.00	$0.00	$0.00	$0.00	$37.37	$0.00	$0.00	$0.00	$0.00	$81.29	$128.76	$130.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39301	ERX	HCPCS 63700001	69097-0362-02	EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS	BOTH IP/OP	$179.30 	$132.68	$0.00	$130.06		$0.00	$0.00	$0.00	$31.92	$0.00	$0.00	$0.00	$0.00	$0.00	$37.37	$0.00	$0.00	$0.00	$0.00	$81.29	$128.76	$130.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39522	ERX	HCPCS 25000001	00781-6078-46	CEFDINIR 250 MG/5ML PO SUSR	BOTH IP/OP	$529.20 	$391.61	$0.00	$407.91		$0.00	$0.00	$0.00	$0.00	$0.00	$392.77	$392.77	$407.91	$0.00	$110.29	$0.00	$0.00	$0.00	$0.00	$240.19	$380.46	$384.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39594	ERX	HCPCS 63700001	49411-0051-30	AMINOCAPROIC ACID 1000 MG PO TABS	BOTH IP/OP	$188.61 	$139.57	$0.00	$136.82		$0.00	$0.00	$0.00	$33.57	$0.00	$0.00	$0.00	$0.00	$0.00	$39.31	$0.00	$0.00	$0.00	$0.00	$85.51	$135.45	$136.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39700	ERX	HCPCS 25000001	00019-1323-16	IOVERSOL 68 % IJ SOLN	BOTH IP/OP	$189.48 	$140.22	$0.00	$151.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.74	$150.07	$151.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39700	ERX	HCPCS 25000001	00019-1323-06	IOVERSOL 68 % IJ SOLN	BOTH IP/OP	$73.50 	$54.39	$0.00	$151.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.74	$58.21	$151.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39720	ERX	HCPCS 63700001	00093-5352-86	ACAMPROSATE CALCIUM 333 MG PO TBEC	BOTH IP/OP	$7.37 	$5.45	$0.00	$5.34		$0.00	$0.00	$0.00	$1.31	$0.00	$0.00	$0.00	$0.00	$0.00	$1.54	$0.00	$0.00	$0.00	$0.00	$3.34	$5.29	$5.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39744	ERX	HCPCS 25000001	00143-9684-10	FLUMAZENIL 0.5 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39744	ERX	HCPCS 25000001	00143-9784-10	FLUMAZENIL 0.5 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39802	ERX	HCPCS 25000001	00386-0004-04	PENTAFLUOROPROP-TETRAFLUOROETH EX AERO	BOTH IP/OP	$129.41 	$95.76	$0.00	$99.75		$0.00	$0.00	$0.00	$0.00	$0.00	$96.05	$96.05	$99.75	$0.00	$26.97	$0.00	$0.00	$0.00	$0.00	$57.66	$91.33	$92.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39802	ERX	HCPCS 25000001	00386-0008-02	PENTAFLUOROPROP-TETRAFLUOROETH EX AERO	BOTH IP/OP	$129.41 	$95.76	$0.00	$99.75		$0.00	$0.00	$0.00	$0.00	$0.00	$96.05	$96.05	$99.75	$0.00	$26.97	$0.00	$0.00	$0.00	$0.00	$57.66	$91.33	$92.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39802	ERX	HCPCS 25000001	00386-0008-03	PENTAFLUOROPROP-TETRAFLUOROETH EX AERO	BOTH IP/OP	$129.41 	$95.76	$0.00	$99.75		$0.00	$0.00	$0.00	$0.00	$0.00	$96.05	$96.05	$99.75	$0.00	$26.97	$0.00	$0.00	$0.00	$0.00	$57.66	$91.33	$92.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39918	ERX	HCPCS J3260	00409-3578-01	TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.56	$16.33	$16.33	$16.96	$0.00	$4.51	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.34	$0.00	$0.00	$4.13	$0.00	$0.00	$0.00	$0.00	$0.00
39918	ERX	HCPCS J3260	36000-0244-01	TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.56	$16.33	$16.33	$16.96	$0.00	$4.51	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.34	$0.00	$0.00	$4.13	$0.00	$0.00	$0.00	$0.00	$0.00
39918	ERX	HCPCS J3260	36000-0244-25	TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.56	$16.33	$16.33	$16.96	$0.00	$4.51	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.34	$0.00	$0.00	$4.13	$0.00	$0.00	$0.00	$0.00	$0.00
39918	ERX	HCPCS J3260	63323-0306-02	TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.56	$16.33	$16.33	$16.96	$0.00	$4.51	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.34	$0.00	$0.00	$4.13	$0.00	$0.00	$0.00	$0.00	$0.00
39918	ERX	HCPCS J3260	67457-0473-22	TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$2.56	$16.33	$16.33	$16.96	$0.00	$4.51	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.34	$0.00	$0.00	$4.13	$0.00	$0.00	$0.00	$0.00	$0.00
39975	ERX	HCPCS 63700001	54092-0252-45	LANTHANUM CARBONATE 500 MG PO CHEW	BOTH IP/OP	$60.37 	$44.67	$0.00	$43.81		$0.00	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00	$12.58	$0.00	$0.00	$0.00	$0.00	$27.38	$43.37	$43.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
39975	ERX	HCPCS 63700001	54092-0252-90	LANTHANUM CARBONATE 500 MG PO CHEW	BOTH IP/OP	$60.37 	$44.67	$0.00	$43.81		$0.00	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00	$12.58	$0.00	$0.00	$0.00	$0.00	$27.38	$43.37	$43.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40055	ERX	HCPCS J9045	00703-4239-01	CARBOPLATIN 600 MG/60ML IV SOLN	BOTH IP/OP	$166.32 	$123.08	$0.00	$133.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$37.93	$0.00	$0.00	$36.11	$0.00	$0.00	$0.00	$0.00	$0.00
40055	ERX	HCPCS J9045	16729-0295-12	CARBOPLATIN 600 MG/60ML IV SOLN	BOTH IP/OP	$166.32 	$123.08	$0.00	$133.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$37.93	$0.00	$0.00	$36.11	$0.00	$0.00	$0.00	$0.00	$0.00
40055	ERX	HCPCS J9045	25021-0202-51	CARBOPLATIN 600 MG/60ML IV SOLN	BOTH IP/OP	$166.32 	$123.08	$0.00	$133.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$37.93	$0.00	$0.00	$36.11	$0.00	$0.00	$0.00	$0.00	$0.00
40055	ERX	HCPCS J9045	25021-0205-51	CARBOPLATIN 600 MG/60ML IV SOLN	BOTH IP/OP	$166.32 	$123.08	$0.00	$133.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$37.93	$0.00	$0.00	$36.11	$0.00	$0.00	$0.00	$0.00	$0.00
40055	ERX	HCPCS J9045	61703-0339-56	CARBOPLATIN 600 MG/60ML IV SOLN	BOTH IP/OP	$166.32 	$123.08	$0.00	$133.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$37.93	$0.00	$0.00	$36.11	$0.00	$0.00	$0.00	$0.00	$0.00
40055	ERX	HCPCS J9045	63323-0172-60	CARBOPLATIN 600 MG/60ML IV SOLN	BOTH IP/OP	$166.32 	$123.08	$0.00	$133.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$37.93	$0.00	$0.00	$36.11	$0.00	$0.00	$0.00	$0.00	$0.00
40055	ERX	HCPCS J9045	71288-0100-51	CARBOPLATIN 600 MG/60ML IV SOLN	BOTH IP/OP	$166.32 	$123.08	$0.00	$133.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$37.93	$0.00	$0.00	$36.11	$0.00	$0.00	$0.00	$0.00	$0.00
40089	ERX	HCPCS 63700001	50242-0062-01	ERLOTINIB HCL 25 MG PO TABS	BOTH IP/OP	$365.63 	$270.57	$0.00	$265.51		$0.00	$0.00	$0.00	$65.08	$0.00	$0.00	$0.00	$0.00	$0.00	$76.20	$0.00	$0.00	$0.00	$0.00	$165.95	$262.86	$265.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40090	ERX	HCPCS 63700001	50242-0063-01	ERLOTINIB HCL 100 MG PO TABS	BOTH IP/OP	$872.74 	$645.83	$0.00	$633.63		$0.00	$0.00	$0.00	$155.35	$0.00	$0.00	$0.00	$0.00	$0.00	$181.88	$0.00	$0.00	$0.00	$0.00	$396.02	$627.30	$633.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40091	ERX	HCPCS 63700001	50242-0064-01	ERLOTINIB HCL 150 MG PO TABS	BOTH IP/OP	$987.13 	$730.48	$0.00	$716.68		$0.00	$0.00	$0.00	$175.71	$0.00	$0.00	$0.00	$0.00	$0.00	$205.72	$0.00	$0.00	$0.00	$0.00	$447.93	$709.51	$716.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40321	ERX	HCPCS 63700001	00378-5271-01	ESZOPICLONE 2 MG PO TABS	BOTH IP/OP	$48.87 	$36.16	$0.00	$35.46		$0.00	$0.00	$0.00	$8.70	$0.00	$0.00	$0.00	$0.00	$0.00	$10.18	$0.00	$0.00	$0.00	$0.00	$22.16	$35.10	$35.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40369	ERX	HCPCS 25000001	69918-0560-30	MESALAMINE 1000 MG RECTAL SUPP	BOTH IP/OP	$77.89 	$57.64	$0.00	$124.43		$0.00	$0.00	$0.00	$0.00	$0.00	$119.81	$119.81	$124.43	$0.00	$16.23	$0.00	$0.00	$0.00	$0.00	$35.32	$55.95	$56.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40401	ERX	HCPCS 63700001	00004-0244-51	SAQUINAVIR MESYLATE 500 MG PO TABS	BOTH IP/OP	$92.78 	$68.66	$0.00	$67.30		$0.00	$0.00	$0.00	$16.51	$0.00	$0.00	$0.00	$0.00	$0.00	$19.34	$0.00	$0.00	$0.00	$0.00	$42.06	$66.62	$67.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40413	ERX	HCPCS 63600001	66215-0302-00	ILOPROST 10 MCG/ML IN SOLN	BOTH IP/OP	$155.99 	$115.43	$0.00	$120.24		$0.00	$0.00	$0.00	$0.00	$0.00	$115.78	$115.78	$120.24	$0.00	$32.51	$0.00	$0.00	$0.00	$0.00	$70.72	$112.02	$113.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40413	ERX	HCPCS 63600001	66215-0302-30	ILOPROST 10 MCG/ML IN SOLN	BOTH IP/OP	$155.99 	$115.43	$0.00	$120.24		$0.00	$0.00	$0.00	$0.00	$0.00	$115.78	$115.78	$120.24	$0.00	$32.51	$0.00	$0.00	$0.00	$0.00	$70.72	$112.02	$113.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40449	ERX	HCPCS J3471	24208-0002-02	HYALURONIDASE OVINE 200 UNIT/ML IJ SOLN	BOTH IP/OP	$296.65 	$219.52	$0.00	$228.66	$133.49	$133.49	$0.00	$0.00	$0.00	$17.63	$220.17	$220.17	$228.66	$0.00	$61.82	$0.00	$175.47	$175.47	$0.00	$122.14	$193.46	$195.42	$0.00		$0.00	$38.23	$0.00	$0.00	$38.89	$0.00	$0.00	$0.00	$0.00	$0.00
40475	ERX	HCPCS J9264	68817-0134-50	NAB-PACLITAXEL 100 MG IV SUSR	BOTH IP/OP	"$4,100.59 "	"$3,034.44"	$0.00	"$3,302.97"	"$1,928.30"	"$1,928.30"	"$1,404.40"	"$1,404.40"	"$1,404.40"	"$1,065.73"	"$3,180.42"	"$3,180.42"	"$3,302.97"	"$1,407.70"	"$1,654.05"	$915.01	"$2,021.59"	"$2,021.59"	"$1,313.87"	"$1,779.70"	"$2,819.04"	"$2,847.52"	"$1,814.39"		"$1,814.39"	"$1,474.63"	$0.00	$0.00	"$1,404.09"	"$1,326.90"	$0.00	$0.00	$0.00	$0.00
40540	ERX	HCPCS 90734	49281-0589-05	MENINGOCOCCAL A C Y&W-135 CONJ IM INJ	BOTH IP/OP	$469.43 	$347.38	$0.00	$375.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$234.72	$371.79	$375.54	$281.66		$281.66	$143.71	$0.00	$0.00	$136.84	$0.00	$0.00	$0.00	$0.00	$0.00
40661	ERX	HCPCS J0202	58468-0357-01	ALEMTUZUMAB 30 MG/ML IV SOLN	BOTH IP/OP	"$4,341.90 "	"$3,213.01"	$0.00	"$3,473.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,170.95"	"$3,438.78"	"$3,473.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40661	ERX	HCPCS J0202	58468-0357-03	ALEMTUZUMAB 30 MG/ML IV SOLN	BOTH IP/OP	"$4,341.90 "	"$3,213.01"	$0.00	"$3,473.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,170.95"	"$3,438.78"	"$3,473.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40697	ERX	HCPCS 25000001	00173-0718-20	FLUTICASONE PROPIONATE HFA 44 MCG/ACT IN AERO	BOTH IP/OP	$716.73 	$530.38	$0.00	$552.46		$0.00	$0.00	$0.00	$0.00	$0.00	$531.96	$531.96	$552.46	$0.00	$149.37	$0.00	$0.00	$0.00	$0.00	$306.55	$485.58	$490.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40698	ERX	HCPCS 25000001	00173-0719-20	FLUTICASONE PROPIONATE HFA 110 MCG/ACT IN AERO	BOTH IP/OP	$959.51 	$710.04	$0.00	$739.59		$0.00	$0.00	$0.00	$0.00	$0.00	$712.15	$712.15	$739.59	$0.00	$199.96	$0.00	$0.00	$0.00	$0.00	$410.40	$650.07	$656.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40699	ERX	HCPCS 25000001	00173-0720-20	FLUTICASONE PROPIONATE HFA 220 MCG/ACT IN AERO	BOTH IP/OP	"$1,321.93 "	$978.23	$0.00	"$1,019.92"		$0.00	$0.00	$0.00	$0.00	$0.00	$981.14	$981.14	"$1,018.94"	$0.00	$275.49	$0.00	$0.00	$0.00	$0.00	$637.45	"$1,009.72"	"$1,019.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40801	ERX	HCPCS J9217	62935-0453-45	LEUPROLIDE ACETATE (6 MONTH) 45 MG SC KIT	BOTH IP/OP	"$7,349.89 "	"$5,438.92"	$0.00	"$5,665.30"	"$3,307.45"	"$3,307.45"	"$1,204.40"	"$1,204.40"	"$1,204.40"	"$1,480.99"	"$5,455.09"	"$5,455.09"	"$5,665.30"	$834.54	$980.58	$542.45	"$3,623.50"	"$3,623.50"	"$1,415.60"	"$3,333.47"	"$5,280.21"	"$5,333.54"	"$1,954.87"		"$1,954.87"	"$1,621.99"	$0.00	$0.00	"$1,544.41"	"$1,235.32"	$0.00	$0.00	$0.00	$0.00
40872	ERX	HCPCS J2250	00641-6057-25	MIDAZOLAM HCL 2 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.38	$16.33	$16.33	$16.96	$0.00	$0.30	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
40872	ERX	HCPCS J2250	23155-0600-31	MIDAZOLAM HCL 2 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.38	$16.33	$16.33	$16.96	$0.00	$0.30	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
40872	ERX	HCPCS J2250	23155-0600-41	MIDAZOLAM HCL 2 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.38	$16.33	$16.33	$16.96	$0.00	$0.30	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
40872	ERX	HCPCS J2250	47781-0588-46	MIDAZOLAM HCL 2 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.38	$16.33	$16.33	$16.96	$0.00	$0.30	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
40872	ERX	HCPCS J2250	47781-0588-68	MIDAZOLAM HCL 2 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.38	$16.33	$16.33	$16.96	$0.00	$0.30	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
40872	ERX	HCPCS J2250	70860-0600-02	MIDAZOLAM HCL 2 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.38	$16.33	$16.33	$16.96	$0.00	$0.30	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
40872	ERX	HCPCS J2250	70860-0600-41	MIDAZOLAM HCL 2 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.38	$16.33	$16.33	$16.96	$0.00	$0.30	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
40994	ERX	HCPCS 25000001	00132-0079-12	GLYCERIN (ADULT) 2 G RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40994	ERX	HCPCS 25000001	00132-0079-24	GLYCERIN (ADULT) 2 G RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41124	ERX	HCPCS 25000001	62991-2502-01	PHENOL LIQD	BOTH IP/OP	$963.60 	$713.06	$0.00	$742.74		$0.00	$0.00	$0.00	$0.00	$0.00	$715.18	$715.18	$742.74	$0.00	$200.81	$0.00	$0.00	$0.00	$0.00	$437.25	$692.60	$699.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41137	ERX	HCPCS A9577	00270-5164-13	GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN	BOTH IP/OP	$242.21 	$179.24	$0.00	$179.77	$108.99	$108.99	$0.00	$0.00	$0.00	$50.48	$179.77	$179.77	$0.00	$0.00	$50.48	$0.00	$143.27	$143.27	$0.00	$109.94	$174.14	$175.90	$0.00		$0.00	$34.41	$0.00	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00
41137	ERX	HCPCS A9577	00270-5164-14	GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN	BOTH IP/OP	$242.21 	$179.24	$0.00	$179.77	$108.99	$108.99	$0.00	$0.00	$0.00	$50.48	$179.77	$179.77	$0.00	$0.00	$50.48	$0.00	$143.27	$143.27	$0.00	$109.94	$174.14	$175.90	$0.00		$0.00	$34.41	$0.00	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00
41137	ERX	HCPCS A9577	00270-5164-15	GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN	BOTH IP/OP	$242.21 	$179.24	$0.00	$179.77	$108.99	$108.99	$0.00	$0.00	$0.00	$50.48	$179.77	$179.77	$0.00	$0.00	$50.48	$0.00	$143.27	$143.27	$0.00	$109.94	$174.14	$175.90	$0.00		$0.00	$34.41	$0.00	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00
41139	ERX	HCPCS 63700001	10147-0892-03	GALANTAMINE HYDROBROMIDE ER 16 MG PO CP24	BOTH IP/OP	$25.58 	$18.93	$0.00	$18.56		$0.00	$0.00	$0.00	$4.55	$0.00	$0.00	$0.00	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$11.60	$18.37	$18.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41142	ERX	HCPCS 25000001	00597-0087-17	IPRATROPIUM BROMIDE HFA 17 MCG/ACT IN AERS	BOTH IP/OP	"$2,320.66 "	"$1,717.29"	$0.00	"$1,895.70"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,791.25"	"$1,791.25"	"$1,860.27"	$0.00	$483.63	$0.00	$0.00	$0.00	$0.00	"$1,184.81"	"$1,876.74"	"$1,895.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41144	ERX	HCPCS J2248	00469-3250-10	MICAFUNGIN SODIUM 50 MG IV SOLR	BOTH IP/OP	$342.21 	$253.24	$0.00	$273.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$171.11	$271.03	$273.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41147	ERX	HCPCS 63700001	65162-0446-03	ENTECAVIR 0.5 MG PO TABS	BOTH IP/OP	$155.36 	$114.97	$0.00	$124.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.68	$123.05	$124.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41147	ERX	HCPCS 63700001	65862-0841-30	ENTECAVIR 0.5 MG PO TABS	BOTH IP/OP	$155.36 	$114.97	$0.00	$124.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.68	$123.05	$124.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41147	ERX	HCPCS 63700001	68382-0920-06	ENTECAVIR 0.5 MG PO TABS	BOTH IP/OP	$155.36 	$114.97	$0.00	$124.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.68	$123.05	$124.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41293	ERX	HCPCS 90715	58160-0842-52	TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSP	BOTH IP/OP	$158.70 	$117.44	$0.00	$126.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.35	$125.69	$126.96	$0.00		$0.00	$39.53	$0.00	$0.00	$37.64	$0.00	$0.00	$0.00	$0.00	$0.00
41294	ERX	HCPCS J9185	25021-0242-02	FLUDARABINE PHOSPHATE 50 MG/2ML IV SOLN	BOTH IP/OP	$762.12 	$563.97	$0.00	$587.44	$342.95	$342.95	$0.00	$0.00	$0.00	$233.27	$565.65	$565.65	$587.44	$0.00	$81.48	$0.00	$450.79	$450.79	$0.00	$345.83	$547.79	$553.32	$0.00		$0.00	$0.00	$0.00	$0.00	$53.58	$0.00	$0.00	$0.00	$0.00	$0.00
41294	ERX	HCPCS J9185	63323-0192-02	FLUDARABINE PHOSPHATE 50 MG/2ML IV SOLN	BOTH IP/OP	$762.12 	$563.97	$0.00	$587.44	$342.95	$342.95	$0.00	$0.00	$0.00	$233.27	$565.65	$565.65	$587.44	$0.00	$81.48	$0.00	$450.79	$450.79	$0.00	$345.83	$547.79	$553.32	$0.00		$0.00	$0.00	$0.00	$0.00	$53.58	$0.00	$0.00	$0.00	$0.00	$0.00
41382	ERX	HCPCS 63700001	00378-9119-98	FENTANYL 12 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$78.37 	$57.99	$0.00	$56.85		$0.00	$0.00	$0.00	$13.95	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$0.00	$0.00	$0.00	$0.00	$35.53	$56.28	$56.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41382	ERX	HCPCS 63700001	47781-0423-11	FENTANYL 12 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$78.37 	$57.99	$0.00	$56.85		$0.00	$0.00	$0.00	$13.95	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$0.00	$0.00	$0.00	$0.00	$35.53	$56.28	$56.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41382	ERX	HCPCS 63700001	47781-0423-47	FENTANYL 12 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$78.37 	$57.99	$0.00	$56.85		$0.00	$0.00	$0.00	$13.95	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$0.00	$0.00	$0.00	$0.00	$35.53	$56.28	$56.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41382	ERX	HCPCS 63700001	60505-7080-02	FENTANYL 12 MCG/HR TD PATCH 72 HR	BOTH IP/OP	$78.37 	$57.99	$0.00	$56.85		$0.00	$0.00	$0.00	$13.95	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$0.00	$0.00	$0.00	$0.00	$35.53	$56.28	$56.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41581	ERX	HCPCS J1610	00597-0053-45	GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR	BOTH IP/OP	$345.95 	$256.00	$0.00	$288.94	$155.68	$155.68	$166.77	$166.77	$166.77	$88.07	$256.76	$256.76	$266.66	$171.74	$201.79	$111.63	$204.63	$204.63	$209.24	$157.02	$248.71	$251.22	$288.94		$288.94	$255.63	$0.00	$0.00	$243.41	$199.13	$0.00	$0.00	$0.00	$0.00
41581	ERX	HCPCS J1610	00597-0260-10	GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR	BOTH IP/OP	$345.95 	$256.00	$0.00	$288.94	$155.68	$155.68	$166.77	$166.77	$166.77	$88.07	$256.76	$256.76	$266.66	$171.74	$201.79	$111.63	$204.63	$204.63	$209.24	$157.02	$248.71	$251.22	$288.94		$288.94	$255.63	$0.00	$0.00	$243.41	$199.13	$0.00	$0.00	$0.00	$0.00
41623	ERX	HCPCS 25000001	99999-6010-71	LEVOCARNITINE 1 GM/10ML PO SOLN	BOTH IP/OP	$49.28 	$36.47	$0.00	$129.52		$0.00	$0.00	$0.00	$0.00	$0.00	$36.58	$36.58	$37.99	$0.00	$10.27	$0.00	$0.00	$0.00	$0.00	$80.95	$35.39	$129.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41623	ERX	HCPCS 25000001	50383-0171-04	LEVOCARNITINE 1 GM/10ML PO SOLN	BOTH IP/OP	$49.28 	$36.47	$0.00	$129.52		$0.00	$0.00	$0.00	$0.00	$0.00	$36.58	$36.58	$37.99	$0.00	$10.27	$0.00	$0.00	$0.00	$0.00	$80.95	$128.22	$129.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41623	ERX	HCPCS 25000001	54482-0145-08	LEVOCARNITINE 1 GM/10ML PO SOLN	BOTH IP/OP	$49.28 	$36.47	$0.00	$129.52		$0.00	$0.00	$0.00	$0.00	$0.00	$36.58	$36.58	$37.99	$0.00	$10.27	$0.00	$0.00	$0.00	$0.00	$80.95	$128.22	$129.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41623	ERX	HCPCS 25000001	64980-0503-12	LEVOCARNITINE 1 GM/10ML PO SOLN	BOTH IP/OP	$49.28 	$36.47	$0.00	$129.52		$0.00	$0.00	$0.00	$0.00	$0.00	$36.58	$36.58	$37.99	$0.00	$10.27	$0.00	$0.00	$0.00	$0.00	$80.95	$128.22	$129.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41624	ERX	HCPCS J3430	00409-9157-01	VITAMIN K1 1 MG/0.5ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.19	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41624	ERX	HCPCS J3430	00409-9157-31	VITAMIN K1 1 MG/0.5ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.19	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41624	ERX	HCPCS J3430	00409-9157-50	VITAMIN K1 1 MG/0.5ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.19	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41628	ERX	HCPCS 90715	49281-0400-10	TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP	BOTH IP/OP	$175.49 	$129.86	$0.00	$140.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.75	$138.99	$140.39	$0.00		$0.00	$39.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41628	ERX	HCPCS 90715	49281-0400-58	TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP	BOTH IP/OP	$175.49 	$129.86	$0.00	$140.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.75	$138.99	$140.39	$0.00		$0.00	$39.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41652	ERX	HCPCS J3243	00781-3481-70	TIGECYCLINE 50 MG IV SOLR	BOTH IP/OP	$525.84 	$389.12	$0.00	$405.32		$0.00	$0.00	$0.00	$0.00	$0.00	$390.28	$390.28	$405.32	$0.00	$109.59	$0.00	$0.00	$0.00	$0.00	$238.67	$378.05	$381.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41652	ERX	HCPCS J3243	00781-3481-92	TIGECYCLINE 50 MG IV SOLR	BOTH IP/OP	$525.84 	$389.12	$0.00	$405.32		$0.00	$0.00	$0.00	$0.00	$0.00	$390.28	$390.28	$405.32	$0.00	$109.59	$0.00	$0.00	$0.00	$0.00	$238.67	$378.05	$381.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41652	ERX	HCPCS J3243	63323-0960-10	TIGECYCLINE 50 MG IV SOLR	BOTH IP/OP	$525.84 	$389.12	$0.00	$405.32		$0.00	$0.00	$0.00	$0.00	$0.00	$390.28	$390.28	$405.32	$0.00	$109.59	$0.00	$0.00	$0.00	$0.00	$238.67	$378.05	$381.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41673	ERX	HCPCS J9390	64370-0532-02	VINORELBINE TARTRATE 50 MG/5ML IV SOLN	BOTH IP/OP	$311.10 	$230.21	$0.00	$248.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.55	$246.39	$248.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41675	ERX	HCPCS 90378	60574-4113-01	PALIVIZUMAB 100 MG/ML IM SOLN	BOTH IP/OP	"$8,338.46 "	"$6,170.46"	$0.00	"$6,427.28"		$0.00	$0.00	$0.00	$0.00	$0.00	"$6,188.81"	"$6,188.81"	"$6,427.28"	$0.00	"$3,826.46"	$0.00	$0.00	$0.00	$0.00	"$3,653.95"	"$5,787.85"	"$5,846.31"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41676	ERX	HCPCS 63700001	00597-0003-02	TIPRANAVIR 250 MG PO CAPS	BOTH IP/OP	$142.38 	$105.36	$0.00	$99.31		$0.00	$0.00	$0.00	$26.36	$0.00	$0.00	$0.00	$0.00	$0.00	$29.67	$0.00	$0.00	$0.00	$0.00	$62.07	$98.32	$99.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41793	ERX	HCPCS 25000001	67457-0163-02	SODIUM TETRADECYL SULFATE 3 % IV SOLN	BOTH IP/OP	$89.17 	$65.99	$0.00	$68.73		$0.00	$0.00	$0.00	$0.00	$0.00	$66.18	$66.18	$68.73	$0.00	$18.58	$0.00	$0.00	$0.00	$0.00	$40.43	$64.98	$64.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41822	ERX	HCPCS 63700001	00173-0884-08	OMEGA-3-ACID ETHYL ESTERS 1 G PO CAPS	BOTH IP/OP	$22.76 	$16.84	$0.00	$18.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.38	$18.03	$18.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41822	ERX	HCPCS 63700001	42291-0657-12	OMEGA-3-ACID ETHYL ESTERS 1 G PO CAPS	BOTH IP/OP	$22.76 	$16.84	$0.00	$18.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.38	$18.03	$18.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41822	ERX	HCPCS 63700001	60505-3170-07	OMEGA-3-ACID ETHYL ESTERS 1 G PO CAPS	BOTH IP/OP	$22.76 	$16.84	$0.00	$18.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.38	$18.03	$18.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41828	ERX	HCPCS 25000001	00085-1341-06	MOMETASONE FUROATE 220 MCG/INH IN AEPB	BOTH IP/OP	$279.57 	$206.88	$0.00	$223.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.79	$221.42	$223.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41828	ERX	HCPCS 25000001	00085-1341-07	MOMETASONE FUROATE 220 MCG/INH IN AEPB	BOTH IP/OP	$279.57 	$206.88	$0.00	$223.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.79	$221.42	$223.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41831	ERX	HCPCS 25000001	50383-0933-35	LIDOCAINE 5 % EX OINT	BOTH IP/OP	$795.00 	$588.30	$0.00	$636.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$397.50	$629.64	$636.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41831	ERX	HCPCS 25000001	52565-0008-14	LIDOCAINE 5 % EX OINT	BOTH IP/OP	$795.00 	$588.30	$0.00	$636.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$397.50	$629.64	$636.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41831	ERX	HCPCS 25000001	68462-0418-20	LIDOCAINE 5 % EX OINT	BOTH IP/OP	$795.00 	$588.30	$0.00	$636.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$397.50	$629.64	$636.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41832	ERX	HCPCS 63700001	00093-5517-98	SILDENAFIL CITRATE 20 MG PO TABS	BOTH IP/OP	$85.11 	$62.98	$0.00	$61.74		$0.00	$0.00	$0.00	$15.15	$0.00	$0.00	$0.00	$0.00	$0.00	$17.74	$0.00	$0.00	$0.00	$0.00	$38.59	$61.12	$61.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41832	ERX	HCPCS 63700001	52817-0295-90	SILDENAFIL CITRATE 20 MG PO TABS	BOTH IP/OP	$85.11 	$62.98	$0.00	$61.74		$0.00	$0.00	$0.00	$15.15	$0.00	$0.00	$0.00	$0.00	$0.00	$17.74	$0.00	$0.00	$0.00	$0.00	$38.59	$61.12	$61.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41893	ERX	HCPCS 63700001	24338-0010-18	ISOSORB DINITRATE-HYDRALAZINE 20-37.5 MG PO TABS	BOTH IP/OP	$16.98 	$12.57	$0.00	$13.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.49	$13.45	$13.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41938	ERX	HCPCS 63700001	00054-4538-25	METHADONE HCL 40 MG PO TBSO	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42064	ERX	HCPCS 63700001	64764-0805-30	RAMELTEON 8 MG PO TABS	BOTH IP/OP	$65.21 	$48.26	$0.00	$47.31		$0.00	$0.00	$0.00	$11.61	$0.00	$0.00	$0.00	$0.00	$0.00	$13.59	$0.00	$0.00	$0.00	$0.00	$29.57	$46.84	$47.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42162	ERX	HCPCS 63700001	00071-1012-68	PREGABALIN 25 MG PO CAPS	BOTH IP/OP	$43.18 	$31.95	$0.00	$29.86		$0.00	$0.00	$0.00	$7.69	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$0.00	$0.00	$18.67	$29.57	$29.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42162	ERX	HCPCS 63700001	50228-0350-90	PREGABALIN 25 MG PO CAPS	BOTH IP/OP	$43.18 	$31.95	$0.00	$29.86		$0.00	$0.00	$0.00	$7.69	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$0.00	$0.00	$18.67	$29.57	$29.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42162	ERX	HCPCS 63700001	62332-0119-90	PREGABALIN 25 MG PO CAPS	BOTH IP/OP	$43.18 	$31.95	$0.00	$29.86		$0.00	$0.00	$0.00	$7.69	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$0.00	$0.00	$18.67	$29.57	$29.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42162	ERX	HCPCS 63700001	76282-0568-90	PREGABALIN 25 MG PO CAPS	BOTH IP/OP	$43.18 	$31.95	$0.00	$29.86		$0.00	$0.00	$0.00	$7.69	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$0.00	$0.00	$18.67	$29.57	$29.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42163	ERX	HCPCS 63700001	00071-1013-41	PREGABALIN 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42163	ERX	HCPCS 63700001	00071-1013-68	PREGABALIN 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42163	ERX	HCPCS 63700001	50228-0351-90	PREGABALIN 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42163	ERX	HCPCS 63700001	60687-0484-01	PREGABALIN 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42163	ERX	HCPCS 63700001	62332-0120-90	PREGABALIN 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42163	ERX	HCPCS 63700001	76282-0569-90	PREGABALIN 50 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42164	ERX	HCPCS 63700001	00071-1014-41	PREGABALIN 75 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42164	ERX	HCPCS 63700001	00071-1014-68	PREGABALIN 75 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42164	ERX	HCPCS 63700001	50228-0352-90	PREGABALIN 75 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42164	ERX	HCPCS 63700001	62332-0121-90	PREGABALIN 75 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42164	ERX	HCPCS 63700001	76282-0570-90	PREGABALIN 75 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42165	ERX	HCPCS 63700001	00071-1015-41	PREGABALIN 100 MG PO CAPS	BOTH IP/OP	$47.49 	$35.14	$0.00	$32.85		$0.00	$0.00	$0.00	$8.45	$0.00	$0.00	$0.00	$0.00	$0.00	$9.90	$0.00	$0.00	$0.00	$0.00	$20.53	$32.52	$32.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42165	ERX	HCPCS 63700001	00904-7001-61	PREGABALIN 100 MG PO CAPS	BOTH IP/OP	$47.49 	$35.14	$0.00	$32.85		$0.00	$0.00	$0.00	$8.45	$0.00	$0.00	$0.00	$0.00	$0.00	$9.90	$0.00	$0.00	$0.00	$0.00	$20.53	$32.52	$32.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42165	ERX	HCPCS 63700001	50228-0353-90	PREGABALIN 100 MG PO CAPS	BOTH IP/OP	$47.49 	$35.14	$0.00	$32.85		$0.00	$0.00	$0.00	$8.45	$0.00	$0.00	$0.00	$0.00	$0.00	$9.90	$0.00	$0.00	$0.00	$0.00	$20.53	$32.52	$32.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42165	ERX	HCPCS 63700001	60687-0506-01	PREGABALIN 100 MG PO CAPS	BOTH IP/OP	$47.49 	$35.14	$0.00	$32.85		$0.00	$0.00	$0.00	$8.45	$0.00	$0.00	$0.00	$0.00	$0.00	$9.90	$0.00	$0.00	$0.00	$0.00	$20.53	$32.52	$32.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42165	ERX	HCPCS 63700001	60687-0506-11	PREGABALIN 100 MG PO CAPS	BOTH IP/OP	$47.49 	$35.14	$0.00	$32.85		$0.00	$0.00	$0.00	$8.45	$0.00	$0.00	$0.00	$0.00	$0.00	$9.90	$0.00	$0.00	$0.00	$0.00	$20.53	$32.52	$32.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42165	ERX	HCPCS 63700001	62332-0122-90	PREGABALIN 100 MG PO CAPS	BOTH IP/OP	$47.49 	$35.14	$0.00	$32.85		$0.00	$0.00	$0.00	$8.45	$0.00	$0.00	$0.00	$0.00	$0.00	$9.90	$0.00	$0.00	$0.00	$0.00	$20.53	$32.52	$32.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42166	ERX	HCPCS 63700001	00071-1016-41	PREGABALIN 150 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42166	ERX	HCPCS 63700001	00071-1016-68	PREGABALIN 150 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42166	ERX	HCPCS 63700001	43598-0295-66	PREGABALIN 150 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42166	ERX	HCPCS 63700001	43598-0295-79	PREGABALIN 150 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42166	ERX	HCPCS 63700001	50228-0354-90	PREGABALIN 150 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42166	ERX	HCPCS 63700001	60687-0517-01	PREGABALIN 150 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42166	ERX	HCPCS 63700001	62332-0123-90	PREGABALIN 150 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42166	ERX	HCPCS 63700001	72205-0015-90	PREGABALIN 150 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42167	ERX	HCPCS 63700001	00071-1017-68	PREGABALIN 200 MG PO CAPS	BOTH IP/OP	$43.18 	$31.95	$0.00	$29.86		$0.00	$0.00	$0.00	$7.69	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$0.00	$0.00	$18.67	$29.57	$29.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42167	ERX	HCPCS 63700001	50228-0355-90	PREGABALIN 200 MG PO CAPS	BOTH IP/OP	$43.18 	$31.95	$0.00	$29.86		$0.00	$0.00	$0.00	$7.69	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$0.00	$0.00	$18.67	$29.57	$29.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42167	ERX	HCPCS 63700001	62332-0124-90	PREGABALIN 200 MG PO CAPS	BOTH IP/OP	$43.18 	$31.95	$0.00	$29.86		$0.00	$0.00	$0.00	$7.69	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$0.00	$0.00	$18.67	$29.57	$29.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42168	ERX	HCPCS 63700001	50228-0356-90	PREGABALIN 225 MG PO CAPS	BOTH IP/OP	$24.52 	$18.14	$0.00	$17.79		$0.00	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00	$5.11	$0.00	$0.00	$0.00	$0.00	$11.12	$17.61	$17.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42168	ERX	HCPCS 63700001	62332-0125-90	PREGABALIN 225 MG PO CAPS	BOTH IP/OP	$24.52 	$18.14	$0.00	$17.79		$0.00	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00	$5.11	$0.00	$0.00	$0.00	$0.00	$11.12	$17.61	$17.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42169	ERX	HCPCS 63700001	00071-1018-68	PREGABALIN 300 MG PO CAPS	BOTH IP/OP	$43.18 	$31.95	$0.00	$29.86		$0.00	$0.00	$0.00	$7.69	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$0.00	$0.00	$18.67	$29.57	$29.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42169	ERX	HCPCS 63700001	50228-0357-90	PREGABALIN 300 MG PO CAPS	BOTH IP/OP	$43.18 	$31.95	$0.00	$29.86		$0.00	$0.00	$0.00	$7.69	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$0.00	$0.00	$18.67	$29.57	$29.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42169	ERX	HCPCS 63700001	62332-0126-90	PREGABALIN 300 MG PO CAPS	BOTH IP/OP	$43.18 	$31.95	$0.00	$29.86		$0.00	$0.00	$0.00	$7.69	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$0.00	$0.00	$18.67	$29.57	$29.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42219	ERX	HCPCS 63700001	00904-6836-20	LOPERAMIDE HCL 1 MG/7.5ML PO LIQD	BOTH IP/OP	$14.59 	$10.80	$0.00	$8.80		$0.00	$0.00	$0.00	$2.60	$0.00	$0.00	$0.00	$0.00	$0.00	$3.04	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42219	ERX	HCPCS 63700001	70677-0054-01	LOPERAMIDE HCL 1 MG/7.5ML PO LIQD	BOTH IP/OP	$14.59 	$10.80	$0.00	$8.80		$0.00	$0.00	$0.00	$2.60	$0.00	$0.00	$0.00	$0.00	$0.00	$3.04	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42918	ERX	HCPCS 63700001	99999-6005-12	ZIDOVUDINE 50 MG/5ML PO SYRP	BOTH IP/OP	$111.64 	$82.61	$0.00	$80.98		$0.00	$0.00	$0.00	$19.87	$0.00	$0.00	$0.00	$0.00	$0.00	$23.27	$0.00	$0.00	$0.00	$0.00	$50.61	$80.17	$80.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42918	ERX	HCPCS 63700001	65862-0048-24	ZIDOVUDINE 50 MG/5ML PO SYRP	BOTH IP/OP	$111.64 	$82.61	$0.00	$144.30		$0.00	$0.00	$0.00	$19.87	$0.00	$0.00	$0.00	$0.00	$0.00	$23.27	$0.00	$0.00	$0.00	$0.00	$50.61	$144.30	$80.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42939	ERX	HCPCS 25000001	65628-0063-01	PROGESTERONE 200 MG VA SUPP	BOTH IP/OP	$28.50 	$21.09	$0.00	$21.97		$0.00	$0.00	$0.00	$0.00	$0.00	$21.15	$21.15	$21.97	$0.00	$5.94	$0.00	$0.00	$0.00	$0.00	$12.92	$20.47	$20.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43010	ERX	HCPCS 63700001	00904-5313-46	PRENATAL 27-0.8 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43010	ERX	HCPCS 63700001	00904-5313-60	PRENATAL 27-0.8 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43230	ERX	HCPCS 63700001	13668-0117-30	LOSARTAN-HCTZ 100-12.5 MG PO TABS	BOTH IP/OP	$14.28 	$10.57	$0.00	$10.37		$0.00	$0.00	$0.00	$2.54	$0.00	$0.00	$0.00	$0.00	$0.00	$2.98	$0.00	$0.00	$0.00	$0.00	$6.48	$10.26	$10.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43230	ERX	HCPCS 63700001	13668-0117-90	LOSARTAN-HCTZ 100-12.5 MG PO TABS	BOTH IP/OP	$14.28 	$10.57	$0.00	$10.37		$0.00	$0.00	$0.00	$2.54	$0.00	$0.00	$0.00	$0.00	$0.00	$2.98	$0.00	$0.00	$0.00	$0.00	$6.48	$10.26	$10.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43230	ERX	HCPCS 63700001	16714-0224-01	LOSARTAN-HCTZ 100-12.5 MG PO TABS	BOTH IP/OP	$14.28 	$10.57	$0.00	$10.37		$0.00	$0.00	$0.00	$2.54	$0.00	$0.00	$0.00	$0.00	$0.00	$2.98	$0.00	$0.00	$0.00	$0.00	$6.48	$10.26	$10.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43230	ERX	HCPCS 63700001	16714-0224-02	LOSARTAN-HCTZ 100-12.5 MG PO TABS	BOTH IP/OP	$14.28 	$10.57	$0.00	$10.37		$0.00	$0.00	$0.00	$2.54	$0.00	$0.00	$0.00	$0.00	$0.00	$2.98	$0.00	$0.00	$0.00	$0.00	$6.48	$10.26	$10.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43230	ERX	HCPCS 63700001	62332-0049-90	LOSARTAN-HCTZ 100-12.5 MG PO TABS	BOTH IP/OP	$14.28 	$10.57	$0.00	$10.37		$0.00	$0.00	$0.00	$2.54	$0.00	$0.00	$0.00	$0.00	$0.00	$2.98	$0.00	$0.00	$0.00	$0.00	$6.48	$10.26	$10.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43391	ERX	HCPCS 63700001	00074-6799-22	KALETRA:LOPINAVIR-RITONAVIR 200-50 MG PO TABS	BOTH IP/OP	$79.07 	$58.51	$0.00	$57.35		$0.00	$0.00	$0.00	$14.07	$0.00	$0.00	$0.00	$0.00	$0.00	$16.48	$0.00	$0.00	$0.00	$0.00	$35.85	$56.78	$57.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43416	ERX	HCPCS 63700001	00078-0469-15	DEFERASIROX 250 MG PO TBSO	BOTH IP/OP	$340.53 	$251.99	$0.00	$247.29		$0.00	$0.00	$0.00	$60.61	$0.00	$0.00	$0.00	$0.00	$0.00	$70.97	$0.00	$0.00	$0.00	$0.00	$154.56	$244.82	$247.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43417	ERX	HCPCS 63700001	00078-0470-15	DEFERASIROX 500 MG PO TBSO	BOTH IP/OP	$591.85 	$437.97	$0.00	$429.70		$0.00	$0.00	$0.00	$105.35	$0.00	$0.00	$0.00	$0.00	$0.00	$123.34	$0.00	$0.00	$0.00	$0.00	$268.57	$425.41	$429.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43472	ERX	HCPCS 25000001	63402-0510-01	LEVALBUTEROL TARTRATE 45 MCG/ACT IN AERO	BOTH IP/OP	$284.15 	$210.27	$0.00	$219.02		$0.00	$0.00	$0.00	$0.00	$0.00	$210.90	$210.90	$219.02	$0.00	$59.22	$0.00	$0.00	$0.00	$0.00	$128.97	$204.29	$206.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43548	ERX	HCPCS 63700001	54092-0254-10	LANTHANUM CARBONATE 1000 MG PO CHEW	BOTH IP/OP	$60.37 	$44.67	$0.00	$43.81		$0.00	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00	$12.58	$0.00	$0.00	$0.00	$0.00	$27.38	$43.37	$43.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43548	ERX	HCPCS 63700001	54092-0254-90	LANTHANUM CARBONATE 1000 MG PO CHEW	BOTH IP/OP	$60.37 	$44.67	$0.00	$43.81		$0.00	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00	$12.58	$0.00	$0.00	$0.00	$0.00	$27.38	$43.37	$43.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43556	ERX	HCPCS 63700001	00054-0057-46	DIGOXIN 0.05 MG/ML PO SOLN	BOTH IP/OP	$564.48 	$417.72	$0.00	$409.92		$0.00	$0.00	$0.00	$100.48	$0.00	$0.00	$0.00	$0.00	$0.00	$117.64	$0.00	$0.00	$0.00	$0.00	$256.20	$405.82	$409.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43675	ERX	HCPCS 63700001	50419-0488-58	SORAFENIB TOSYLATE 200 MG PO TABS	BOTH IP/OP	"$1,212.39 "	$897.17	$0.00	$847.21		$0.00	$0.00	$0.00	$230.70	$0.00	$0.00	$0.00	$0.00	$0.00	$252.66	$0.00	$0.00	$0.00	$0.00	$529.51	$838.74	$847.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43718	ERX	HCPCS 63700001	59572-0405-00	LENALIDOMIDE 5 MG PO CAPS	BOTH IP/OP	"$2,478.15 "	"$1,833.83"	$0.00	"$1,757.98"		$0.00	$0.00	$0.00	$460.96	$0.00	$0.00	$0.00	$0.00	$0.00	$516.45	$0.00	$0.00	$0.00	$0.00	"$1,098.74"	"$1,740.40"	"$1,757.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43718	ERX	HCPCS 63700001	59572-0405-28	LENALIDOMIDE 5 MG PO CAPS	BOTH IP/OP	"$2,478.15 "	"$1,833.83"	$0.00	"$1,757.98"		$0.00	$0.00	$0.00	$460.96	$0.00	$0.00	$0.00	$0.00	$0.00	$516.45	$0.00	$0.00	$0.00	$0.00	"$1,098.74"	"$1,740.40"	"$1,757.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43719	ERX	HCPCS 63700001	59572-0410-00	LENALIDOMIDE 10 MG PO CAPS	BOTH IP/OP	"$2,478.15 "	"$1,833.83"	$0.00	"$1,757.98"		$0.00	$0.00	$0.00	$460.96	$0.00	$0.00	$0.00	$0.00	$0.00	$516.45	$0.00	$0.00	$0.00	$0.00	"$1,098.74"	"$1,740.40"	"$1,757.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43719	ERX	HCPCS 63700001	59572-0410-28	LENALIDOMIDE 10 MG PO CAPS	BOTH IP/OP	"$2,478.15 "	"$1,833.83"	$0.00	"$1,757.98"		$0.00	$0.00	$0.00	$460.96	$0.00	$0.00	$0.00	$0.00	$0.00	$516.45	$0.00	$0.00	$0.00	$0.00	"$1,098.74"	"$1,740.40"	"$1,757.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70257	ERX	HCPCS 63700001	49884-0402-91	RISPERIDONE 3 MG PO TBDP	BOTH IP/OP	$49.37 	$36.53	$0.00	$35.82		$0.00	$0.00	$0.00	$8.79	$0.00	$0.00	$0.00	$0.00	$0.00	$10.29	$0.00	$0.00	$0.00	$0.00	$22.39	$35.46	$35.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70261	ERX	HCPCS J1815	00169-3687-12	INSULIN DETEMIR (LEVEMIR) 100 UNIT/ML SC SOLN	BOTH IP/OP	$15.00 	$11.10	$0.00	$201.38	$8.15	$8.15	$0.00	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$3.13	$0.00	$8.87	$8.87	$0.00	$7.50	$11.88	$12.00	$0.00		$0.00	$0.00	$0.00	$0.00	$201.38	$0.00	$0.00	$0.00	$0.00	$0.00
70267	ERX	HCPCS J9261	00078-0683-06	NELARABINE 5 MG/ML IV SOLN	BOTH IP/OP	"$2,117.88 "	"$1,567.23"	$0.00	"$1,694.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,058.94"	"$1,677.36"	"$1,694.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70284	ERX	HCPCS 63700001	60258-0006-01	K & NA PHOSPHATES 280-160-250 MG PO PACK	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70306	ERX	HCPCS 63700001	13668-0216-30	ARIPIPRAZOLE 2 MG PO TABS	BOTH IP/OP	$122.48 	$90.64	$0.00	$88.85		$0.00	$0.00	$0.00	$21.80	$0.00	$0.00	$0.00	$0.00	$0.00	$25.52	$0.00	$0.00	$0.00	$0.00	$55.53	$87.96	$88.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70306	ERX	HCPCS 63700001	16714-0783-01	ARIPIPRAZOLE 2 MG PO TABS	BOTH IP/OP	$122.48 	$90.64	$0.00	$88.85		$0.00	$0.00	$0.00	$21.80	$0.00	$0.00	$0.00	$0.00	$0.00	$25.52	$0.00	$0.00	$0.00	$0.00	$55.53	$87.96	$88.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70306	ERX	HCPCS 63700001	65862-0661-30	ARIPIPRAZOLE 2 MG PO TABS	BOTH IP/OP	$122.48 	$90.64	$0.00	$88.85		$0.00	$0.00	$0.00	$21.80	$0.00	$0.00	$0.00	$0.00	$0.00	$25.52	$0.00	$0.00	$0.00	$0.00	$55.53	$87.96	$88.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70324	ERX	HCPCS 63700001	00093-4405-93	CLOZAPINE 200 MG PO TABS	BOTH IP/OP	$27.29 	$20.19	$0.00	$19.80		$0.00	$0.00	$0.00	$4.86	$0.00	$0.00	$0.00	$0.00	$0.00	$5.69	$0.00	$0.00	$0.00	$0.00	$12.38	$19.60	$19.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70397	ERX	HCPCS 63700001	00904-6639-61	QUETIAPINE FUMARATE 50 MG PO TABS	BOTH IP/OP	$25.94 	$19.20	$0.00	$18.82		$0.00	$0.00	$0.00	$4.62	$0.00	$0.00	$0.00	$0.00	$0.00	$5.41	$0.00	$0.00	$0.00	$0.00	$11.76	$18.63	$18.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70397	ERX	HCPCS 63700001	50268-0631-15	QUETIAPINE FUMARATE 50 MG PO TABS	BOTH IP/OP	$25.94 	$19.20	$0.00	$18.82		$0.00	$0.00	$0.00	$4.62	$0.00	$0.00	$0.00	$0.00	$0.00	$5.41	$0.00	$0.00	$0.00	$0.00	$11.76	$18.63	$18.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70397	ERX	HCPCS 63700001	60687-0338-01	QUETIAPINE FUMARATE 50 MG PO TABS	BOTH IP/OP	$25.94 	$19.20	$0.00	$18.82		$0.00	$0.00	$0.00	$4.62	$0.00	$0.00	$0.00	$0.00	$0.00	$5.41	$0.00	$0.00	$0.00	$0.00	$11.76	$18.63	$18.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70398	ERX	HCPCS 63700001	16714-0457-01	QUETIAPINE FUMARATE 400 MG PO TABS	BOTH IP/OP	$83.22 	$61.58	$0.00	$60.61		$0.00	$0.00	$0.00	$14.81	$0.00	$0.00	$0.00	$0.00	$0.00	$17.34	$0.00	$0.00	$0.00	$0.00	$37.88	$60.00	$60.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70405	ERX	HCPCS J7187	63833-0616-02	ANTIHEMOPHILIC FACTOR-VWF 500-1200 UNITS IV SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70424	ERX	HCPCS 63700001	00069-0550-38	SUNITINIB MALATE 12.5 MG PO CAPS	BOTH IP/OP	$747.09 	$552.85	$0.00	$489.65		$0.00	$0.00	$0.00	$132.98	$0.00	$0.00	$0.00	$0.00	$0.00	$155.69	$0.00	$0.00	$0.00	$0.00	$306.03	$484.75	$489.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70425	ERX	HCPCS 63700001	00069-0770-38	SUNITINIB MALATE 25 MG PO CAPS	BOTH IP/OP	"$1,325.32 "	$980.74	$0.00	$979.30		$0.00	$0.00	$0.00	$235.91	$0.00	$0.00	$0.00	$0.00	$0.00	$276.20	$0.00	$0.00	$0.00	$0.00	$612.06	$969.50	$979.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70426	ERX	HCPCS 63700001	00069-0980-38	SUNITINIB MALATE 50 MG PO CAPS	BOTH IP/OP	"$2,307.19 "	"$1,707.32"	$0.00	"$1,543.98"		$0.00	$0.00	$0.00	$410.68	$0.00	$0.00	$0.00	$0.00	$0.00	$480.82	$0.00	$0.00	$0.00	$0.00	$964.99	"$1,528.54"	"$1,543.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70434	ERX	HCPCS 63700001	50228-0423-60	RANOLAZINE ER 500 MG PO TB12	BOTH IP/OP	$34.46 	$25.50	$0.00	$23.86		$0.00	$0.00	$0.00	$6.13	$0.00	$0.00	$0.00	$0.00	$0.00	$7.18	$0.00	$0.00	$0.00	$0.00	$14.91	$23.62	$23.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70434	ERX	HCPCS 63700001	61958-1003-01	RANOLAZINE ER 500 MG PO TB12	BOTH IP/OP	$34.46 	$25.50	$0.00	$23.86		$0.00	$0.00	$0.00	$6.13	$0.00	$0.00	$0.00	$0.00	$0.00	$7.18	$0.00	$0.00	$0.00	$0.00	$14.91	$23.62	$23.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70472	ERX	HCPCS 63700001	64764-0240-60	LUBIPROSTONE 24 MCG PO CAPS	BOTH IP/OP	$31.10 	$23.01	$0.00	$22.57		$0.00	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00	$6.48	$0.00	$0.00	$0.00	$0.00	$14.11	$22.34	$22.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70536	ERX	HCPCS 25000001	00054-3270-99	FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP	BOTH IP/OP	$268.59 	$198.76	$0.00	$214.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.30	$212.72	$214.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70536	ERX	HCPCS 25000001	50383-0700-16	FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP	BOTH IP/OP	$268.59 	$198.76	$0.00	$214.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.30	$212.72	$214.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70536	ERX	HCPCS 25000001	60432-0264-15	FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP	BOTH IP/OP	$268.59 	$198.76	$0.00	$214.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.30	$212.72	$214.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70536	ERX	HCPCS 25000001	60505-0829-01	FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP	BOTH IP/OP	$268.59 	$198.76	$0.00	$214.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.30	$212.72	$214.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70545	ERX	HCPCS 25000001	42023-0105-01	METHOHEXITAL SODIUM 0.5 G IJ SOLR	BOTH IP/OP	$340.76 	$252.16	$0.00	$262.66		$0.00	$0.00	$0.00	$0.00	$0.00	$252.91	$252.91	$262.66	$0.00	$71.01	$0.00	$0.00	$0.00	$0.00	$147.30	$233.32	$235.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70678	ERX	HCPCS 25000001	39822-1201-02	NEOMYCIN-POLYMYXIN B GU 40-200000 IR SOLN	BOTH IP/OP	$167.36 	$123.85	$0.00	$133.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.68	$132.55	$133.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70693	ERX	HCPCS 25000001	00002-7511-01	HUMALOG MIX 75-25 VIAL	BOTH IP/OP	$997.59 	$738.22	$0.00	$768.94		$0.00	$0.00	$0.00	$0.00	$0.00	$740.41	$740.41	$768.94	$0.00	$207.90	$0.00	$0.00	$0.00	$0.00	$452.68	$717.04	$724.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70773	ERX	HCPCS 63700001	16714-0357-01	LEVETIRACETAM 1000 MG PO TABS	BOTH IP/OP	$6.39 	$4.73	$0.00	$5.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.20	$5.06	$5.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70773	ERX	HCPCS 63700001	16729-0067-12	LEVETIRACETAM 1000 MG PO TABS	BOTH IP/OP	$6.39 	$4.73	$0.00	$5.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.20	$5.06	$5.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70773	ERX	HCPCS 63700001	31722-0539-60	LEVETIRACETAM 1000 MG PO TABS	BOTH IP/OP	$6.39 	$4.73	$0.00	$5.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.20	$5.06	$5.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70773	ERX	HCPCS 63700001	68084-0893-01	LEVETIRACETAM 1000 MG PO TABS	BOTH IP/OP	$6.39 	$4.73	$0.00	$5.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.20	$5.06	$5.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70773	ERX	HCPCS 63700001	68180-0115-07	LEVETIRACETAM 1000 MG PO TABS	BOTH IP/OP	$6.39 	$4.73	$0.00	$5.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.20	$5.06	$5.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70784	ERX	HCPCS 63700001	50419-0405-03	DROSPIRENONE-ETHINYL ESTRADIOL 3-0.02 MG PO TABS	BOTH IP/OP	$639.00 	$472.86	$0.00	$442.24		$0.00	$0.00	$0.00	$119.37	$0.00	$0.00	$0.00	$0.00	$0.00	$133.17	$0.00	$0.00	$0.00	$0.00	$276.40	$437.82	$442.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76364	ERX	HCPCS J0894	16714-0749-01	DECITABINE 50 MG IV SOLR	BOTH IP/OP	"$1,314.00 "	$972.36	$0.00	"$2,381.28"		$0.00	$0.00	$0.00	$0.00	$0.00	$975.25	$975.25	"$1,012.83"	$0.00	$201.28	$0.00	$0.00	$0.00	$392.96	"$1,488.30"	"$2,357.47"	"$2,381.28"	$542.66		$542.66	$252.63	$0.00	$0.00	$240.54	$214.05	$0.00	$0.00	$0.00	$0.00
76364	ERX	HCPCS J0894	16729-0224-05	DECITABINE 50 MG IV SOLR	BOTH IP/OP	"$1,314.00 "	$972.36	$0.00	"$2,381.28"		$0.00	$0.00	$0.00	$0.00	$0.00	$975.25	$975.25	"$1,012.83"	$0.00	$201.28	$0.00	$0.00	$0.00	$392.96	"$1,488.30"	"$2,357.47"	"$2,381.28"	$542.66		$542.66	$252.63	$0.00	$0.00	$240.54	$214.05	$0.00	$0.00	$0.00	$0.00
76364	ERX	HCPCS J0894	25021-0231-20	DECITABINE 50 MG IV SOLR	BOTH IP/OP	"$1,314.00 "	$972.36	$0.00	"$2,381.28"		$0.00	$0.00	$0.00	$0.00	$0.00	$975.25	$975.25	"$1,012.83"	$0.00	$201.28	$0.00	$0.00	$0.00	$392.96	"$1,488.30"	"$2,357.47"	"$2,381.28"	$542.66		$542.66	$252.63	$0.00	$0.00	$240.54	$214.05	$0.00	$0.00	$0.00	$0.00
76364	ERX	HCPCS J0894	47335-0361-41	DECITABINE 50 MG IV SOLR	BOTH IP/OP	"$1,314.00 "	$972.36	$0.00	"$2,381.28"		$0.00	$0.00	$0.00	$0.00	$0.00	$975.25	$975.25	"$1,012.83"	$0.00	$201.28	$0.00	$0.00	$0.00	$392.96	"$1,488.30"	"$2,357.47"	"$2,381.28"	$542.66		$542.66	$252.63	$0.00	$0.00	$240.54	$214.05	$0.00	$0.00	$0.00	$0.00
76364	ERX	HCPCS J0894	55111-0556-10	DECITABINE 50 MG IV SOLR	BOTH IP/OP	"$1,314.00 "	$972.36	$0.00	"$2,381.28"		$0.00	$0.00	$0.00	$0.00	$0.00	$975.25	$975.25	"$1,012.83"	$0.00	$201.28	$0.00	$0.00	$0.00	$392.96	"$1,488.30"	"$2,357.47"	"$2,381.28"	$542.66		$542.66	$252.63	$0.00	$0.00	$240.54	$214.05	$0.00	$0.00	$0.00	$0.00
76396	ERX	HCPCS 25000001	68968-5555-03	METHYLPHENIDATE 30 MG/9HR TD PTCH	BOTH IP/OP	$73.91 	$54.69	$0.00	$56.97		$0.00	$0.00	$0.00	$0.00	$0.00	$54.86	$54.86	$56.97	$0.00	$15.40	$0.00	$0.00	$0.00	$0.00	$30.13	$47.72	$48.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76437	ERX	HCPCS 63700001	55111-0587-01	AMLODIPINE-BENAZEPRIL 5-40 MG PO CAPSULE	BOTH IP/OP	$16.80 	$12.43	$0.00	$12.19		$0.00	$0.00	$0.00	$2.99	$0.00	$0.00	$0.00	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$7.62	$12.07	$12.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76437	ERX	HCPCS 63700001	65862-0585-01	AMLODIPINE-BENAZEPRIL 5-40 MG PO CAPSULE	BOTH IP/OP	$16.80 	$12.43	$0.00	$12.19		$0.00	$0.00	$0.00	$2.99	$0.00	$0.00	$0.00	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$7.62	$12.07	$12.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76438	ERX	HCPCS 63700001	55111-0586-01	AMLODIPINE-BENAZEPRIL HCL 10-40 MG PO CAPS	BOTH IP/OP	$20.29 	$15.01	$0.00	$14.72		$0.00	$0.00	$0.00	$3.61	$0.00	$0.00	$0.00	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$9.20	$14.57	$14.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76438	ERX	HCPCS 63700001	65862-0587-01	AMLODIPINE-BENAZEPRIL HCL 10-40 MG PO CAPS	BOTH IP/OP	$20.29 	$15.01	$0.00	$14.72		$0.00	$0.00	$0.00	$3.61	$0.00	$0.00	$0.00	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$9.20	$14.57	$14.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76444	ERX	HCPCS 63700001	00069-0468-56	VARENICLINE TARTRATE 0.5 MG PO TABS	BOTH IP/OP	$36.03 	$26.66	$0.00	$28.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.02	$28.54	$28.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76445	ERX	HCPCS 63700001	00069-0469-56	VARENICLINE TARTRATE 1 MG PO TABS	BOTH IP/OP	$36.03 	$26.66	$0.00	$28.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.02	$28.54	$28.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76446	ERX	HCPCS 63700001	00069-0471-03	VARENICLINE STARTING 0.5 MG X 11 & 1 MG X 42 PO MISC	BOTH IP/OP	$38.07 	$28.17	$0.00	$30.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.04	$30.15	$30.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76472	ERX	HCPCS 25000001	49348-0636-34	LORATADINE 5 MG/5ML PO SYRP	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76472	ERX	HCPCS 25000001	51672-2073-08	LORATADINE 5 MG/5ML PO SYRP	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76618	ERX	HCPCS 25000001	00065-0356-10	OPTI-FREE REPLENISH SOLN	BOTH IP/OP	$40.23 	$29.77	$0.00	$31.01		$0.00	$0.00	$0.00	$0.00	$0.00	$29.86	$29.86	$31.01	$0.00	$8.38	$0.00	$0.00	$0.00	$0.00	$18.24	$28.89	$29.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76641	ERX	HCPCS 25000001	24208-0539-20	ACETYLCHOLINE CHLORIDE 20 MG IO SOLR	BOTH IP/OP	$461.64 	$341.61	$0.00	$355.83		$0.00	$0.00	$0.00	$0.00	$0.00	$342.63	$342.63	$355.83	$0.00	$96.21	$0.00	$0.00	$0.00	$0.00	$190.05	$301.04	$304.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76717	ERX	HCPCS 63700001	00003-0527-11	DASATINIB 20 MG PO TABS	BOTH IP/OP	"$1,742.93 "	"$1,289.77"	$0.00	"$1,236.42"		$0.00	$0.00	$0.00	$324.20	$0.00	$0.00	$0.00	$0.00	$0.00	$363.23	$0.00	$0.00	$0.00	$0.00	$772.77	"$1,224.06"	"$1,236.42"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76718	ERX	HCPCS 63700001	00003-0528-11	DASATINIB 50 MG PO TABS	BOTH IP/OP	"$1,742.93 "	"$1,289.77"	$0.00	"$1,236.42"		$0.00	$0.00	$0.00	$324.20	$0.00	$0.00	$0.00	$0.00	$0.00	$363.23	$0.00	$0.00	$0.00	$0.00	$772.76	"$1,224.05"	"$1,236.42"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76719	ERX	HCPCS 63700001	00003-0524-11	DASATINIB 70 MG PO TABS	BOTH IP/OP	$982.50 	$727.05	$0.00	$682.61		$0.00	$0.00	$0.00	$182.75	$0.00	$0.00	$0.00	$0.00	$0.00	$204.75	$0.00	$0.00	$0.00	$0.00	$426.63	$675.78	$682.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76780	ERX	HCPCS 25000001	66993-0490-36	IBUPROFEN LYSINE 10 MG/ML IV SOLN	BOTH IP/OP	"$1,417.99 "	"$1,049.31"	$0.00	"$1,092.99"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,052.43"	"$1,052.43"	"$1,092.99"	$0.00	$295.51	$0.00	$0.00	$0.00	$0.00	$656.99	"$1,040.66"	"$1,051.18"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76783	ERX	HCPCS 63700001	59572-0415-21	LENALIDOMIDE 15 MG PO CAPS	BOTH IP/OP	"$2,478.15 "	"$1,833.83"	$0.00	"$1,757.98"		$0.00	$0.00	$0.00	$460.96	$0.00	$0.00	$0.00	$0.00	$0.00	$516.45	$0.00	$0.00	$0.00	$0.00	"$1,098.74"	"$1,740.40"	"$1,757.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76784	ERX	HCPCS 63700001	59572-0425-00	LENALIDOMIDE 25 MG PO CAPS	BOTH IP/OP	"$2,478.15 "	"$1,833.83"	$0.00	"$1,757.98"		$0.00	$0.00	$0.00	$460.96	$0.00	$0.00	$0.00	$0.00	$0.00	$516.45	$0.00	$0.00	$0.00	$0.00	"$1,098.74"	"$1,740.40"	"$1,757.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76784	ERX	HCPCS 63700001	59572-0425-21	LENALIDOMIDE 25 MG PO CAPS	BOTH IP/OP	"$2,478.15 "	"$1,833.83"	$0.00	"$1,757.98"		$0.00	$0.00	$0.00	$460.96	$0.00	$0.00	$0.00	$0.00	$0.00	$516.45	$0.00	$0.00	$0.00	$0.00	"$1,098.74"	"$1,740.40"	"$1,757.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76829	ERX	HCPCS 63700001	00121-1744-00	GUAIFENESIN 100 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76829	ERX	HCPCS 63700001	00121-1744-05	GUAIFENESIN 100 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76829	ERX	HCPCS 63700001	99999-6007-12	GUAIFENESIN 100 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76835	ERX	HCPCS 63700001	15584-0101-01	ATRIPLA:EFAVIRENZ-EMTRICITAB-TENOFOV 600-200-300MGTAB	BOTH IP/OP	$402.49 	$297.84	$0.00	$292.29		$0.00	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$0.00	$83.88	$0.00	$0.00	$0.00	$0.00	$182.68	$289.37	$292.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76843	ERX	HCPCS J8501	00006-0464-05	APREPITANT 40 MG PO CAPS	BOTH IP/OP	$432.04 	$319.71	$0.00	$345.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.02	$342.18	$345.63	$0.00		$0.00	$67.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76843	ERX	HCPCS J8501	00781-2321-06	APREPITANT 40 MG PO CAPS	BOTH IP/OP	$432.04 	$319.71	$0.00	$345.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.02	$342.18	$345.63	$0.00		$0.00	$67.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76843	ERX	HCPCS J8501	00781-2321-51	APREPITANT 40 MG PO CAPS	BOTH IP/OP	$432.04 	$319.71	$0.00	$345.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.02	$342.18	$345.63	$0.00		$0.00	$67.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76843	ERX	HCPCS J8501	68462-0583-40	APREPITANT 40 MG PO CAPS	BOTH IP/OP	$432.04 	$319.71	$0.00	$345.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.02	$342.18	$345.63	$0.00		$0.00	$67.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76843	ERX	HCPCS J8501	68462-0583-85	APREPITANT 40 MG PO CAPS	BOTH IP/OP	$432.04 	$319.71	$0.00	$345.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.02	$342.18	$345.63	$0.00		$0.00	$67.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76913	ERX	HCPCS 25000001	00121-1680-16	KCL 20 MEQ/15ML (10%) PO SOLN	BOTH IP/OP	$97.97 	$72.50	$0.00	$75.52		$0.00	$0.00	$0.00	$0.00	$0.00	$72.71	$72.71	$75.52	$0.00	$20.42	$0.00	$0.00	$0.00	$0.00	$35.34	$4.75	$56.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76913	ERX	HCPCS 25000001	00603-1542-58	KCL 20 MEQ/15ML (10%) PO SOLN	BOTH IP/OP	$97.97 	$72.50	$0.00	$75.52		$0.00	$0.00	$0.00	$0.00	$0.00	$72.71	$72.71	$75.52	$0.00	$20.42	$0.00	$0.00	$0.00	$0.00	$35.34	$4.75	$56.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76913	ERX	HCPCS 25000001	43386-0168-01	KCL 20 MEQ/15ML (10%) PO SOLN	BOTH IP/OP	$97.97 	$72.50	$0.00	$75.52		$0.00	$0.00	$0.00	$0.00	$0.00	$72.71	$72.71	$75.52	$0.00	$20.42	$0.00	$0.00	$0.00	$0.00	$35.34	$4.75	$56.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76913	ERX	HCPCS 25000001	66689-0047-50	KCL 20 MEQ/15ML (10%) PO SOLN	BOTH IP/OP	$97.97 	$72.50	$0.00	$75.52		$0.00	$0.00	$0.00	$0.00	$0.00	$72.71	$72.71	$75.52	$0.00	$20.42	$0.00	$0.00	$0.00	$0.00	$35.34	$4.75	$56.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76913	ERX	HCPCS 25000001	99999-6006-99	KCL 20 MEQ/15ML (10%) PO SOLN	BOTH IP/OP	$97.97 	$72.50	$0.00	$75.52		$0.00	$0.00	$0.00	$0.00	$0.00	$72.71	$72.71	$75.52	$0.00	$20.42	$0.00	$0.00	$0.00	$0.00	$35.34	$4.75	$56.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76974	ERX	HCPCS 25000001	00713-0102-06	GLYCERIN (LAXATIVE) 1.2 G RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76997	ERX	HCPCS 63700001	00904-5824-60	CHOLECALCIFEROL-D3 1000 UNITS PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76997	ERX	HCPCS 63700001	00904-5824-93	CHOLECALCIFEROL-D3 1000 UNITS PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76997	ERX	HCPCS 63700001	20555-0033-00	CHOLECALCIFEROL-D3 1000 UNITS PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76997	ERX	HCPCS 63700001	80681-0169-00	CHOLECALCIFEROL-D3 1000 UNITS PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77006	ERX	HCPCS J2270	99999-6011-51	MORPHINE SULFATE PCA 5 MG/ML IV SOLN	BOTH IP/OP	$303.63 	$224.69	$0.00	$234.04	$136.63	$136.63	$0.00	$0.00	$0.00	$63.28	$225.35	$225.35	$234.04	$0.00	$19.92	$0.00	$179.60	$179.60	$0.00	$137.82	$218.30	$220.50	$0.00		$0.00	$11.93	$0.00	$0.00	$11.36	$0.00	$0.00	$0.00	$0.00	$0.00
77006	ERX	HCPCS J2270	99999-6007-23	MORPHINE SULFATE PCA 5 MG/ML IV SOLN	BOTH IP/OP	$303.63 	$224.69	$0.00	$550.94	$136.63	$136.63	$0.00	$0.00	$0.00	$63.28	$225.35	$225.35	$234.04	$0.00	$19.92	$0.00	$179.60	$179.60	$0.00	$137.82	$550.94	$220.50	$0.00		$0.00	$11.93	$0.00	$0.00	$11.36	$0.00	$0.00	$0.00	$0.00	$0.00
77007	ERX	HCPCS J1050	00009-0626-01	MEDROXYPROGESTERONE ACETATE 400 MG/ML IM SUSP	BOTH IP/OP	$685.44 	$507.23	$0.00	$548.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$542.87	$548.35	$0.00		$0.00	$263.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77012	ERX	HCPCS J7307	00052-4330-01	ETONOGESTREL 68 MG SC IMPL	BOTH IP/OP	"$2,795.11 "	"$2,068.38"	$0.00	"$2,154.47"	"$1,257.80"	"$1,257.80"	$0.00	$0.00	$942.30	$827.51	"$2,074.53"	"$2,074.53"	"$2,154.47"	$0.00	"$1,211.00"	$0.00	"$1,377.99"	"$1,377.99"	$0.00	"$1,207.32"	"$1,821.32"	"$1,931.71"	"$1,448.78"		"$1,448.78"	"$1,098.41"	$0.00	$0.00	"$1,045.88"	$0.00	$0.00	$0.00	$0.00	$0.00
77164	ERX	HCPCS 25000001	17238-0610-15	HYPROMELLOSE 2.5 % OP SOLN	BOTH IP/OP	$29.64 	$21.93	$0.00	$23.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.82	$23.47	$23.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77164	ERX	HCPCS 25000001	17478-0064-12	HYPROMELLOSE 2.5 % OP SOLN	BOTH IP/OP	$29.64 	$21.93	$0.00	$23.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.82	$23.47	$23.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77174	ERX	HCPCS 25000001	00173-0716-20	FLUTICASONE-SALMETEROL 115-21 MCG/ACT IN AERO	BOTH IP/OP	"$1,421.75 "	"$1,052.10"	$0.00	"$1,095.88"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,055.22"	"$1,055.22"	"$1,095.88"	$0.00	$296.29	$0.00	$0.00	$0.00	$0.00	$626.35	$992.14	"$1,002.16"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77195	ERX	HCPCS J1953	00143-9574-25	LEVETIRACETAM 500 MG/5ML IV SOLN	BOTH IP/OP	$31.43 	$23.26	$0.00	$24.23	$14.14	$14.14	$0.00	$0.00	$0.00	$6.55	$23.33	$23.33	$24.23	$0.00	$6.55	$0.00	$18.59	$18.59	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$4.46	$0.00	$0.00	$4.54	$0.00	$0.00	$0.00	$0.00	$0.00
77195	ERX	HCPCS J1953	00143-9673-25	LEVETIRACETAM 500 MG/5ML IV SOLN	BOTH IP/OP	$31.43 	$23.26	$0.00	$24.23	$14.14	$14.14	$0.00	$0.00	$0.00	$6.55	$23.33	$23.33	$24.23	$0.00	$6.55	$0.00	$18.59	$18.59	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$4.46	$0.00	$0.00	$4.54	$0.00	$0.00	$0.00	$0.00	$0.00
77195	ERX	HCPCS J1953	00409-1886-02	LEVETIRACETAM 500 MG/5ML IV SOLN	BOTH IP/OP	$31.43 	$23.26	$0.00	$24.23	$14.14	$14.14	$0.00	$0.00	$0.00	$6.55	$23.33	$23.33	$24.23	$0.00	$6.55	$0.00	$18.59	$18.59	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$4.46	$0.00	$0.00	$4.54	$0.00	$0.00	$0.00	$0.00	$0.00
77195	ERX	HCPCS J1953	25021-0780-05	LEVETIRACETAM 500 MG/5ML IV SOLN	BOTH IP/OP	$31.43 	$23.26	$0.00	$24.23	$14.14	$14.14	$0.00	$0.00	$0.00	$6.55	$23.33	$23.33	$24.23	$0.00	$6.55	$0.00	$18.59	$18.59	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$4.46	$0.00	$0.00	$4.54	$0.00	$0.00	$0.00	$0.00	$0.00
77195	ERX	HCPCS J1953	50474-0002-63	LEVETIRACETAM 500 MG/5ML IV SOLN	BOTH IP/OP	$31.43 	$23.26	$0.00	$24.23	$14.14	$14.14	$0.00	$0.00	$0.00	$6.55	$23.33	$23.33	$24.23	$0.00	$6.55	$0.00	$18.59	$18.59	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$4.46	$0.00	$0.00	$4.54	$0.00	$0.00	$0.00	$0.00	$0.00
77195	ERX	HCPCS J1953	55150-0177-05	LEVETIRACETAM 500 MG/5ML IV SOLN	BOTH IP/OP	$31.43 	$23.26	$0.00	$24.23	$14.14	$14.14	$0.00	$0.00	$0.00	$6.55	$23.33	$23.33	$24.23	$0.00	$6.55	$0.00	$18.59	$18.59	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$4.46	$0.00	$0.00	$4.54	$0.00	$0.00	$0.00	$0.00	$0.00
77308	ERX	HCPCS 25000001	00517-6510-25	SELENIUM 40 MCG/ML IV SOLN	BOTH IP/OP	$77.56 	$57.39	$0.00	$62.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.78	$61.43	$62.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77318	ERX	HCPCS J1250	00409-2344-01	DOBUTAMINE HCL 250 MG/20ML IV SOLN	BOTH IP/OP	$28.33 	$20.96	$0.00	$21.84	$12.75	$12.75	$0.00	$0.00	$0.00	$6.58	$21.03	$21.03	$21.84	$0.00	$9.65	$0.00	$16.76	$16.76	$0.00	$12.66	$20.05	$20.25	$0.00		$0.00	$7.14	$0.00	$0.00	$6.80	$0.00	$0.00	$0.00	$0.00	$0.00
77318	ERX	HCPCS J1250	00409-2344-02	DOBUTAMINE HCL 250 MG/20ML IV SOLN	BOTH IP/OP	$28.33 	$20.96	$0.00	$21.84	$12.75	$12.75	$0.00	$0.00	$0.00	$6.58	$21.03	$21.03	$21.84	$0.00	$9.65	$0.00	$16.76	$16.76	$0.00	$12.66	$20.05	$20.25	$0.00		$0.00	$7.14	$0.00	$0.00	$6.80	$0.00	$0.00	$0.00	$0.00	$0.00
77318	ERX	HCPCS J1250	00409-2344-88	DOBUTAMINE HCL 250 MG/20ML IV SOLN	BOTH IP/OP	$28.33 	$20.96	$0.00	$21.84	$12.75	$12.75	$0.00	$0.00	$0.00	$6.58	$21.03	$21.03	$21.84	$0.00	$9.65	$0.00	$16.76	$16.76	$0.00	$12.66	$20.05	$20.25	$0.00		$0.00	$7.14	$0.00	$0.00	$6.80	$0.00	$0.00	$0.00	$0.00	$0.00
77371	ERX	HCPCS 25000001	00085-1328-01	POSACONAZOLE 40 MG/ML PO SUSP	BOTH IP/OP	"$3,904.06 "	"$2,889.00"	$0.00	"$3,009.25"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,897.59"	"$2,897.59"	"$3,009.25"	$0.00	$813.61	$0.00	$0.00	$0.00	$0.00	"$1,770.65"	"$2,804.71"	"$2,833.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77411	ERX	HCPCS 25000001	63323-0406-03	CAFFEINE CITRATE 20 MG/ML PO SOLN	BOTH IP/OP	"$1,414.48 "	"$1,046.72"	$0.00	"$1,090.28"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,049.83"	"$1,049.83"	"$1,090.28"	$0.00	$294.78	$0.00	$0.00	$0.00	$0.00	$84.78	$134.28	$135.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77411	ERX	HCPCS 25000001	99999-6004-97	CAFFEINE CITRATE 20 MG/ML PO SOLN	BOTH IP/OP	"$1,414.48 "	"$1,046.72"	$0.00	"$1,090.28"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,049.83"	"$1,049.83"	"$1,090.28"	$0.00	$294.78	$0.00	$0.00	$0.00	$0.00	$84.78	"$1,016.68"	$135.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77412	ERX	HCPCS J0706	25021-0601-03	CAFFEINE CITRATE 60 MG/3ML IV SOLN	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77412	ERX	HCPCS J0706	42571-0244-69	CAFFEINE CITRATE 60 MG/3ML IV SOLN	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77412	ERX	HCPCS J0706	47335-0289-40	CAFFEINE CITRATE 60 MG/3ML IV SOLN	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77412	ERX	HCPCS J0706	51754-0500-01	CAFFEINE CITRATE 60 MG/3ML IV SOLN	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77412	ERX	HCPCS J0706	51754-0502-01	CAFFEINE CITRATE 60 MG/3ML IV SOLN	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77412	ERX	HCPCS J0706	55150-0187-03	CAFFEINE CITRATE 60 MG/3ML IV SOLN	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77412	ERX	HCPCS J0706	72485-0104-01	CAFFEINE CITRATE 60 MG/3ML IV SOLN	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77539	ERX	HCPCS 63700001	00006-0568-40	VORINOSTAT 100 MG PO CAPS	BOTH IP/OP	"$1,314.85 "	$972.99	$0.00	$954.62		$0.00	$0.00	$0.00	$234.04	$0.00	$0.00	$0.00	$0.00	$0.00	$274.01	$0.00	$0.00	$0.00	$0.00	$596.64	$945.07	$954.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77615	ERX	HCPCS 63700001	00006-0221-01	SITAGLIPTIN PHOSPHATE 25 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77615	ERX	HCPCS 63700001	00006-0221-28	SITAGLIPTIN PHOSPHATE 25 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77615	ERX	HCPCS 63700001	00006-0221-31	SITAGLIPTIN PHOSPHATE 25 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77615	ERX	HCPCS 63700001	00006-0221-54	SITAGLIPTIN PHOSPHATE 25 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77616	ERX	HCPCS 63700001	00006-0112-01	SITAGLIPTIN PHOSPHATE 50 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77616	ERX	HCPCS 63700001	00006-0112-28	SITAGLIPTIN PHOSPHATE 50 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77616	ERX	HCPCS 63700001	00006-0112-31	SITAGLIPTIN PHOSPHATE 50 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77616	ERX	HCPCS 63700001	00006-0112-54	SITAGLIPTIN PHOSPHATE 50 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77617	ERX	HCPCS 63700001	00006-0277-01	SITAGLIPTIN PHOSPHATE 100 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77617	ERX	HCPCS 63700001	00006-0277-28	SITAGLIPTIN PHOSPHATE 100 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77617	ERX	HCPCS 63700001	00006-0277-31	SITAGLIPTIN PHOSPHATE 100 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77617	ERX	HCPCS 63700001	00006-0277-54	SITAGLIPTIN PHOSPHATE 100 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77617	ERX	HCPCS 63700001	00006-0277-82	SITAGLIPTIN PHOSPHATE 100 MG PO TABS	BOTH IP/OP	$83.27 	$61.62	$0.00	$57.57		$0.00	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77648	ERX	HCPCS 63700001	00003-3622-12	ATAZANAVIR SULFATE 300 MG PO CAPS	BOTH IP/OP	$191.13 	$141.44	$0.00	$138.80		$0.00	$0.00	$0.00	$34.02	$0.00	$0.00	$0.00	$0.00	$0.00	$39.83	$0.00	$0.00	$0.00	$0.00	$86.75	$137.41	$138.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77648	ERX	HCPCS 63700001	00093-5528-56	ATAZANAVIR SULFATE 300 MG PO CAPS	BOTH IP/OP	$191.13 	$141.44	$0.00	$138.80		$0.00	$0.00	$0.00	$34.02	$0.00	$0.00	$0.00	$0.00	$0.00	$39.83	$0.00	$0.00	$0.00	$0.00	$86.75	$137.41	$138.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77648	ERX	HCPCS 63700001	65862-0713-30	ATAZANAVIR SULFATE 300 MG PO CAPS	BOTH IP/OP	$191.13 	$141.44	$0.00	$138.80		$0.00	$0.00	$0.00	$34.02	$0.00	$0.00	$0.00	$0.00	$0.00	$39.83	$0.00	$0.00	$0.00	$0.00	$86.75	$137.41	$138.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77685	ERX	HCPCS J2248	00469-3211-10	MICAFUNGIN SODIUM 100 MG IV SOLR	BOTH IP/OP	$594.66 	$440.05	$0.00	$475.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$297.33	$470.97	$475.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77710	ERX	HCPCS 25000001	00121-1576-10	METOCLOPRAMIDE HCL 10 MG/10ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77822	ERX	HCPCS 63700001	00173-0388-79	BECLOMETHASONE DIPROP MONOHYD 42 MCG/SPRAY NA SUSP	BOTH IP/OP	"$1,027.92 "	$760.66	$0.00	$746.30		$0.00	$0.00	$0.00	$182.97	$0.00	$0.00	$0.00	$0.00	$0.00	$214.22	$0.00	$0.00	$0.00	$0.00	$466.44	$738.83	$746.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
78003	ERX	HCPCS 63700001	50383-0087-07	GUAIFENESIN-CODEINE 100-10 MG/5ML PO SYRP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
78030	ERX	HCPCS 25000001	58914-0214-60	AQUADEKS PO LIQD	BOTH IP/OP	$96.81 	$71.64	$0.00	$74.62		$0.00	$0.00	$0.00	$0.00	$0.00	$71.85	$71.85	$74.62	$0.00	$20.18	$0.00	$0.00	$0.00	$0.00	$43.89	$69.52	$70.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
78064	ERX	HCPCS 63700001	10147-0952-03	PALIPERIDONE ER 3 MG PO TB24	BOTH IP/OP	$168.31 	$124.55	$0.00	$134.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.16	$133.30	$134.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
78064	ERX	HCPCS 63700001	50458-0550-01	PALIPERIDONE ER 3 MG PO TB24	BOTH IP/OP	$168.31 	$124.55	$0.00	$134.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.16	$133.30	$134.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
78065	ERX	HCPCS 63700001	00378-3980-93	PALIPERIDONE ER 6 MG PO TB24	BOTH IP/OP	$168.31 	$124.55	$0.00	$134.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.16	$133.30	$134.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
78065	ERX	HCPCS 63700001	50458-0551-10	PALIPERIDONE ER 6 MG PO TB24	BOTH IP/OP	$168.31 	$124.55	$0.00	$134.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.16	$133.30	$134.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
78066	ERX	HCPCS 63700001	00591-3695-30	PALIPERIDONE ER 9 MG PO TB24	BOTH IP/OP	$177.16 	$131.10	$0.00	$128.50		$0.00	$0.00	$0.00	$31.53	$0.00	$0.00	$0.00	$0.00	$0.00	$36.92	$0.00	$0.00	$0.00	$0.00	$80.32	$127.22	$128.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
78420	ERX	HCPCS J9025	59572-0102-01	AZACITIDINE 100 MG IJ SUSR	BOTH IP/OP	"$1,818.94 "	"$1,346.02"	$0.00	"$1,402.04"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,350.02"	"$1,350.02"	"$1,402.04"	$0.00	$108.81	$0.00	$0.00	$0.00	$0.00	$842.75	"$1,334.92"	"$1,348.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
78615	ERX	HCPCS 63700001	00186-4020-01	ESOMEPRAZOLE 20 MG PO PACK	BOTH IP/OP	$48.15 	$35.63	$0.00	$34.94		$0.00	$0.00	$0.00	$8.57	$0.00	$0.00	$0.00	$0.00	$0.00	$10.03	$0.00	$0.00	$0.00	$0.00	$21.84	$34.59	$34.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
78616	ERX	HCPCS 63700001	00186-4040-01	ESOMEPRAZOLE 40 MG PO PACK	BOTH IP/OP	$48.15 	$35.63	$0.00	$34.94		$0.00	$0.00	$0.00	$8.57	$0.00	$0.00	$0.00	$0.00	$0.00	$10.03	$0.00	$0.00	$0.00	$0.00	$21.84	$34.59	$34.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
78879	ERX	HCPCS 63700001	00904-2533-21	CALAMINE 8-8 % EX LOTN	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$1.96	$0.00	$0.00	$0.00	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79088	ERX	HCPCS 63700001	00121-0775-16	GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79088	ERX	HCPCS 63700001	00121-1775-00	GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79088	ERX	HCPCS 63700001	00121-1775-05	GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79088	ERX	HCPCS 63700001	50383-0087-07	GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79088	ERX	HCPCS 63700001	69543-0276-16	GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79088	ERX	HCPCS 63700001	99999-6006-93	GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81426	ERX	HCPCS 63700001	00904-6364-61	DIVALPROEX SODIUM ER 500 MG PO TB24	BOTH IP/OP	$10.36 	$7.67	$0.00	$7.51		$0.00	$0.00	$0.00	$1.84	$0.00	$0.00	$0.00	$0.00	$0.00	$2.16	$0.00	$0.00	$0.00	$0.00	$4.70	$7.44	$7.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81426	ERX	HCPCS 63700001	16714-0485-01	DIVALPROEX SODIUM ER 500 MG PO TB24	BOTH IP/OP	$10.36 	$7.67	$0.00	$7.51		$0.00	$0.00	$0.00	$1.84	$0.00	$0.00	$0.00	$0.00	$0.00	$2.16	$0.00	$0.00	$0.00	$0.00	$4.70	$7.44	$7.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81426	ERX	HCPCS 63700001	16714-0485-02	DIVALPROEX SODIUM ER 500 MG PO TB24	BOTH IP/OP	$10.36 	$7.67	$0.00	$7.51		$0.00	$0.00	$0.00	$1.84	$0.00	$0.00	$0.00	$0.00	$0.00	$2.16	$0.00	$0.00	$0.00	$0.00	$4.70	$7.44	$7.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81426	ERX	HCPCS 63700001	65862-0595-01	DIVALPROEX SODIUM ER 500 MG PO TB24	BOTH IP/OP	$10.36 	$7.67	$0.00	$7.51		$0.00	$0.00	$0.00	$1.84	$0.00	$0.00	$0.00	$0.00	$0.00	$2.16	$0.00	$0.00	$0.00	$0.00	$4.70	$7.44	$7.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81453	ERX	HCPCS 63700001	00186-0372-20	BUDESONIDE-FORMOTEROL FUMARATE 80-4.5 MCG/ACT IN AERO	BOTH IP/OP	"$1,392.01 "	"$1,030.09"	$0.00	$991.83		$0.00	$0.00	$0.00	$247.78	$0.00	$0.00	$0.00	$0.00	$0.00	$290.09	$0.00	$0.00	$0.00	$0.00	$619.90	$981.91	$991.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81453	ERX	HCPCS 63700001	00186-0372-28	BUDESONIDE-FORMOTEROL FUMARATE 80-4.5 MCG/ACT IN AERO	BOTH IP/OP	"$1,392.01 "	"$1,030.09"	$0.00	$991.83		$0.00	$0.00	$0.00	$247.78	$0.00	$0.00	$0.00	$0.00	$0.00	$290.09	$0.00	$0.00	$0.00	$0.00	$619.90	$981.91	$991.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81454	ERX	HCPCS 63700001	00186-0370-28	BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO	BOTH IP/OP	$902.67 	$667.98	$0.00	"$1,140.94"		$0.00	$0.00	$0.00	$160.68	$0.00	$0.00	$0.00	$0.00	$0.00	$188.12	$0.00	$0.00	$0.00	$0.00	$713.09	$623.60	"$1,140.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81454	ERX	HCPCS 63700001	00186-0370-20	BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO	BOTH IP/OP	$902.67 	$667.98	$0.00	"$1,140.94"		$0.00	$0.00	$0.00	$160.68	$0.00	$0.00	$0.00	$0.00	$0.00	$188.12	$0.00	$0.00	$0.00	$0.00	$713.09	"$1,129.53"	"$1,140.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81461	ERX	HCPCS J8700	00781-2694-75	TEMOZOLOMIDE 140 MG PO CAPS	BOTH IP/OP	"$1,032.53 "	$764.07	$0.00	$795.87		$0.00	$0.00	$0.00	$0.00	$0.00	$766.34	$766.34	$795.87	$0.00	$215.18	$0.00	$0.00	$0.00	$0.00	$468.53	$742.15	$749.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81474	ERX	HCPCS 63700001	59417-0103-10	LISDEXAMFETAMINE DIMESYLATE 30 MG PO CAPS	BOTH IP/OP	$56.15 	$41.55	$0.00	$38.80		$0.00	$0.00	$0.00	$10.49	$0.00	$0.00	$0.00	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$24.25	$38.41	$38.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81479	ERX	HCPCS 63700001	58914-0601-20	BIS SUBCIT-METRONID-TETRACYC 140-125-125 MG PO CAPS	BOTH IP/OP	$106.71 	$78.97	$0.00	$77.41		$0.00	$0.00	$0.00	$18.99	$0.00	$0.00	$0.00	$0.00	$0.00	$22.24	$0.00	$0.00	$0.00	$0.00	$48.38	$76.63	$77.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81540	ERX	HCPCS 63700001	00006-0577-61	JANUMET 50-1000 MG (SITAGLIPTIN-METFORMIN) PO TABS	BOTH IP/OP	$41.64 	$30.81	$0.00	$28.78		$0.00	$0.00	$0.00	$7.78	$0.00	$0.00	$0.00	$0.00	$0.00	$8.68	$0.00	$0.00	$0.00	$0.00	$17.99	$28.50	$28.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81541	ERX	HCPCS 63700001	00006-0575-61	JANUMET 50-500 MG (SITAGLIPTIN-METFORMIN) PO TABS	BOTH IP/OP	$41.64 	$30.81	$0.00	$28.78		$0.00	$0.00	$0.00	$7.78	$0.00	$0.00	$0.00	$0.00	$0.00	$8.68	$0.00	$0.00	$0.00	$0.00	$17.99	$28.50	$28.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81696	ERX	HCPCS J1300	25682-0001-01	ECULIZUMAB 300 MG/30ML IV SOLN	BOTH IP/OP	"$17,690.38 "	"$13,090.88"	$0.00	"$13,635.74"		$0.00	$0.00	$0.00	$0.00	"$3,687.12"	"$13,129.80"	"$13,129.80"	"$13,635.74"	"$6,876.84"	"$8,080.29"	"$4,469.95"	"$8,721.36"	"$8,721.36"	"$7,260.09"	"$8,023.29"	"$12,708.89"	"$12,837.26"	"$10,025.84"		"$10,025.84"	"$8,124.42"	$0.00	$0.00	"$7,735.83"	"$6,914.37"	$0.00	$0.00	$0.00	$0.00
81725	ERX	HCPCS 25000001	99073-0708-22	FREESTYLE LITE TEST VI STRP	BOTH IP/OP	$302.24 	$223.66	$0.00	$232.97		$0.00	$0.00	$0.00	$0.00	$0.00	$224.32	$224.32	$232.97	$0.00	$62.99	$0.00	$0.00	$0.00	$0.00	$137.19	$217.30	$219.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81823	ERX	HCPCS 25000001	00574-0069-15	GLUCOSE 40 % PO GEL	BOTH IP/OP	$16.56 	$12.25	$0.00	$12.76		$0.00	$0.00	$0.00	$0.00	$0.00	$12.29	$12.29	$12.76	$0.00	$3.45	$0.00	$0.00	$0.00	$0.00	$7.51	$11.89	$12.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81823	ERX	HCPCS 25000001	00574-0069-30	GLUCOSE 40 % PO GEL	BOTH IP/OP	$16.56 	$12.25	$0.00	$12.76		$0.00	$0.00	$0.00	$0.00	$0.00	$12.29	$12.29	$12.76	$0.00	$3.45	$0.00	$0.00	$0.00	$0.00	$7.51	$11.89	$12.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81823	ERX	HCPCS 25000001	00574-0070-30	GLUCOSE 40 % PO GEL	BOTH IP/OP	$16.56 	$12.25	$0.00	$12.76		$0.00	$0.00	$0.00	$0.00	$0.00	$12.29	$12.29	$12.76	$0.00	$3.45	$0.00	$0.00	$0.00	$0.00	$7.51	$11.89	$12.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82021	ERX	HCPCS 25000001	00121-0677-16	TRICITRATES 550-500-334 MG/5ML PO SOLN	BOTH IP/OP	$206.81 	$153.04	$0.00	$159.41		$0.00	$0.00	$0.00	$0.00	$0.00	$153.49	$153.49	$159.41	$0.00	$43.10	$0.00	$0.00	$0.00	$0.00	$93.87	$148.69	$150.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82085	ERX	HCPCS 25000001	10019-0120-01	ESMOLOL HCL 100 MG/10ML IV SOLN	BOTH IP/OP	$57.86 	$42.82	$0.00	$44.60		$0.00	$0.00	$0.00	$0.00	$0.00	$42.94	$42.94	$44.60	$0.00	$12.06	$0.00	$0.00	$0.00	$0.00	$26.24	$41.56	$41.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82085	ERX	HCPCS 25000001	25021-0314-10	ESMOLOL HCL 100 MG/10ML IV SOLN	BOTH IP/OP	$57.86 	$42.82	$0.00	$44.60		$0.00	$0.00	$0.00	$0.00	$0.00	$42.94	$42.94	$44.60	$0.00	$12.06	$0.00	$0.00	$0.00	$0.00	$26.24	$41.56	$41.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82085	ERX	HCPCS 25000001	55150-0194-10	ESMOLOL HCL 100 MG/10ML IV SOLN	BOTH IP/OP	$57.86 	$42.82	$0.00	$44.60		$0.00	$0.00	$0.00	$0.00	$0.00	$42.94	$42.94	$44.60	$0.00	$12.06	$0.00	$0.00	$0.00	$0.00	$26.24	$41.56	$41.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82085	ERX	HCPCS 25000001	63323-0652-10	ESMOLOL HCL 100 MG/10ML IV SOLN	BOTH IP/OP	$57.86 	$42.82	$0.00	$44.60		$0.00	$0.00	$0.00	$0.00	$0.00	$42.94	$42.94	$44.60	$0.00	$12.06	$0.00	$0.00	$0.00	$0.00	$26.24	$41.56	$41.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82085	ERX	HCPCS 25000001	67457-0182-00	ESMOLOL HCL 100 MG/10ML IV SOLN	BOTH IP/OP	$57.86 	$42.82	$0.00	$44.60		$0.00	$0.00	$0.00	$0.00	$0.00	$42.94	$42.94	$44.60	$0.00	$12.06	$0.00	$0.00	$0.00	$0.00	$26.24	$41.56	$41.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82085	ERX	HCPCS 25000001	67457-0182-10	ESMOLOL HCL 100 MG/10ML IV SOLN	BOTH IP/OP	$57.86 	$42.82	$0.00	$44.60		$0.00	$0.00	$0.00	$0.00	$0.00	$42.94	$42.94	$44.60	$0.00	$12.06	$0.00	$0.00	$0.00	$0.00	$26.24	$41.56	$41.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82100	ERX	HCPCS 63700001	50474-0802-03	ROTIGOTINE 2 MG/24HR TD PT24	BOTH IP/OP	$110.01 	$81.41	$0.00	$79.01		$0.00	$0.00	$0.00	$20.93	$0.00	$0.00	$0.00	$0.00	$0.00	$22.93	$0.00	$0.00	$0.00	$0.00	$49.38	$78.22	$79.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82134	ERX	HCPCS 25000001	83490-0307-60	SODIUM CHLORIDE 7 % IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82177	ERX	HCPCS Q9956	00407-2707-03	PERFLUTREN PROTEIN A MICROSPH IV SUSP	BOTH IP/OP	$108.39 	$80.21	$0.00	$83.55	$48.78	$48.78	$0.00	$0.00	$0.00	$22.59	$80.45	$80.45	$83.55	$0.00	$22.59	$0.00	$64.11	$64.11	$0.00	$49.14	$77.84	$78.62	$0.00		$0.00	$15.38	$0.00	$0.00	$15.65	$0.00	$0.00	$0.00	$0.00	$0.00
82228	ERX	HCPCS J9330	00008-1179-01	TEMSIROLIMUS 25 MG/ML IV SOLN	BOTH IP/OP	"$5,016.07 "	"$3,711.89"	$0.00	"$3,866.39"	"$2,257.23"	"$2,257.23"	$868.70	$868.70	$868.70	"$1,045.47"	"$3,722.93"	"$3,722.93"	"$3,866.39"	$956.18	"$1,123.51"	$621.51	"$2,472.92"	"$2,472.92"	"$1,394.79"	"$2,176.60"	"$3,447.73"	"$3,482.56"	"$1,926.14"		"$1,926.14"	"$1,407.94"	$0.00	$0.00	"$1,340.60"	"$1,112.85"	$0.00	$0.00	$0.00	$0.00
82301	ERX	HCPCS S0077	00009-0775-26	CLINDAMYCIN PHOSPHATE 600 MG/4ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$2.70	$7.07	$16.33	$16.33	$16.96	$0.00	$3.31	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$13.20		$13.20	$3.29	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$0.00
82301	ERX	HCPCS S0077	63323-0282-04	CLINDAMYCIN PHOSPHATE 600 MG/4ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$2.70	$7.07	$16.33	$16.33	$16.96	$0.00	$3.31	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$13.20		$13.20	$3.29	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$0.00
82302	ERX	HCPCS S0077	00009-0902-18	CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$2.70	$7.07	$16.33	$16.33	$16.96	$0.00	$3.31	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$13.20		$13.20	$3.29	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$0.00
82302	ERX	HCPCS S0077	25021-0115-06	CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$2.70	$7.07	$16.33	$16.33	$16.96	$0.00	$3.31	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$13.20		$13.20	$3.29	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$0.00
82302	ERX	HCPCS S0077	67457-0816-06	CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$2.70	$7.07	$16.33	$16.33	$16.96	$0.00	$3.31	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$13.20		$13.20	$3.29	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$0.00
82363	ERX	HCPCS 63700001	62332-0205-90	AMLODIPINE-VALSARTAN 5 MG-160 MG TABS	BOTH IP/OP	$22.91 	$16.95	$0.00	$16.62		$0.00	$0.00	$0.00	$4.08	$0.00	$0.00	$0.00	$0.00	$0.00	$4.77	$0.00	$0.00	$0.00	$0.00	$10.39	$16.46	$16.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82363	ERX	HCPCS 63700001	65862-0737-30	AMLODIPINE-VALSARTAN 5 MG-160 MG TABS	BOTH IP/OP	$22.91 	$16.95	$0.00	$16.62		$0.00	$0.00	$0.00	$4.08	$0.00	$0.00	$0.00	$0.00	$0.00	$4.77	$0.00	$0.00	$0.00	$0.00	$10.39	$16.46	$16.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82364	ERX	HCPCS 63700001	65862-0738-30	AMLODIPINE-VALSARTAN 5 MG-320 MG TABS	BOTH IP/OP	$29.06 	$21.50	$0.00	$21.09		$0.00	$0.00	$0.00	$5.17	$0.00	$0.00	$0.00	$0.00	$0.00	$6.06	$0.00	$0.00	$0.00	$0.00	$13.18	$20.88	$21.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82365	ERX	HCPCS 63700001	00378-1722-93	AMLODIPINE-VALSARTAN 10-160 MG TABLET	BOTH IP/OP	$26.00 	$19.24	$0.00	$18.86		$0.00	$0.00	$0.00	$4.63	$0.00	$0.00	$0.00	$0.00	$0.00	$5.42	$0.00	$0.00	$0.00	$0.00	$11.79	$18.68	$18.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82365	ERX	HCPCS 63700001	62332-0206-90	AMLODIPINE-VALSARTAN 10-160 MG TABLET	BOTH IP/OP	$26.00 	$19.24	$0.00	$18.86		$0.00	$0.00	$0.00	$4.63	$0.00	$0.00	$0.00	$0.00	$0.00	$5.42	$0.00	$0.00	$0.00	$0.00	$11.79	$18.68	$18.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82365	ERX	HCPCS 63700001	65862-0739-30	AMLODIPINE-VALSARTAN 10-160 MG TABLET	BOTH IP/OP	$26.00 	$19.24	$0.00	$18.86		$0.00	$0.00	$0.00	$4.63	$0.00	$0.00	$0.00	$0.00	$0.00	$5.42	$0.00	$0.00	$0.00	$0.00	$11.79	$18.68	$18.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82366	ERX	HCPCS 63700001	00078-0491-15	AMLODIPINE-VALSARTAN 10 MG-320 MG TABS	BOTH IP/OP	$33.00 	$24.42	$0.00	$23.94		$0.00	$0.00	$0.00	$5.87	$0.00	$0.00	$0.00	$0.00	$0.00	$6.88	$0.00	$0.00	$0.00	$0.00	$14.97	$23.70	$23.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82366	ERX	HCPCS 63700001	00378-1724-93	AMLODIPINE-VALSARTAN 10 MG-320 MG TABS	BOTH IP/OP	$33.00 	$24.42	$0.00	$23.94		$0.00	$0.00	$0.00	$5.87	$0.00	$0.00	$0.00	$0.00	$0.00	$6.88	$0.00	$0.00	$0.00	$0.00	$14.97	$23.70	$23.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82366	ERX	HCPCS 63700001	62332-0208-90	AMLODIPINE-VALSARTAN 10 MG-320 MG TABS	BOTH IP/OP	$33.00 	$24.42	$0.00	$23.94		$0.00	$0.00	$0.00	$5.87	$0.00	$0.00	$0.00	$0.00	$0.00	$6.88	$0.00	$0.00	$0.00	$0.00	$14.97	$23.70	$23.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82366	ERX	HCPCS 63700001	65862-0740-30	AMLODIPINE-VALSARTAN 10 MG-320 MG TABS	BOTH IP/OP	$33.00 	$24.42	$0.00	$23.94		$0.00	$0.00	$0.00	$5.87	$0.00	$0.00	$0.00	$0.00	$0.00	$6.88	$0.00	$0.00	$0.00	$0.00	$14.97	$23.70	$23.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82504	ERX	HCPCS 63700001	00078-0501-15	RIVASTIGMINE 4.6 MG/24HR TD PT24	BOTH IP/OP	$105.92 	$78.38	$0.00	$76.83		$0.00	$0.00	$0.00	$18.85	$0.00	$0.00	$0.00	$0.00	$0.00	$22.07	$0.00	$0.00	$0.00	$0.00	$48.02	$76.06	$76.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82504	ERX	HCPCS 63700001	00078-0501-61	RIVASTIGMINE 4.6 MG/24HR TD PT24	BOTH IP/OP	$105.92 	$78.38	$0.00	$76.83		$0.00	$0.00	$0.00	$18.85	$0.00	$0.00	$0.00	$0.00	$0.00	$22.07	$0.00	$0.00	$0.00	$0.00	$48.02	$76.06	$76.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87795	ERX	HCPCS 25000001	10702-0056-01	OXYCODONE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87795	ERX	HCPCS 25000001	42858-0002-10	OXYCODONE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87795	ERX	HCPCS 25000001	68084-0968-01	OXYCODONE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87795	ERX	HCPCS 25000001	68084-0968-11	OXYCODONE HCL 10 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87801	ERX	HCPCS 25000001	67768-3063-06	CALCIUM GLUCONATE (ANTIDOTE) 2.5 % EX GEL	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87801	ERX	HCPCS 25000001	99999-6009-13	CALCIUM GLUCONATE (ANTIDOTE) 2.5 % EX GEL	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87822	ERX	HCPCS 25000001	42858-0004-01	OXYCODONE HCL 20 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87834	ERX	HCPCS 63700001	00023-9211-05	COMBIGAN: BRIMONIDINE-TIMOLOL 0.2-0.5 % OP SOLN	BOTH IP/OP	$681.21 	$504.10	$0.00	$471.02		$0.00	$0.00	$0.00	$127.32	$0.00	$0.00	$0.00	$0.00	$0.00	$141.96	$0.00	$0.00	$0.00	$0.00	$294.39	$466.31	$471.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87861	ERX	HCPCS J1930	15054-1120-03	LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN	BOTH IP/OP	"$25,932.15 "	"$19,189.79"	$0.00	"$19,988.50"	"$11,669.47"	"$11,669.47"	"$7,941.96"	"$7,941.96"	"$7,941.96"	"$5,404.91"	"$19,246.84"	"$19,246.84"	"$19,988.50"	"$8,116.56"	"$9,536.96"	"$5,275.76"	"$12,784.55"	"$12,784.55"	"$7,852.82"	"$10,769.88"	"$17,059.49"	"$17,231.81"	"$10,844.38"		"$10,844.38"	"$8,138.89"	$0.00	$0.00	"$8,138.89"	"$8,450.04"	$0.00	$0.00	$0.00	$0.00
87861	ERX	HCPCS J1930	15054-1120-04	LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN	BOTH IP/OP	"$25,932.15 "	"$19,189.79"	$0.00	"$19,988.50"	"$11,669.47"	"$11,669.47"	"$7,941.96"	"$7,941.96"	"$7,941.96"	"$5,404.91"	"$19,246.84"	"$19,246.84"	"$19,988.50"	"$8,116.56"	"$9,536.96"	"$5,275.76"	"$12,784.55"	"$12,784.55"	"$7,852.82"	"$10,769.88"	"$17,059.49"	"$17,231.81"	"$10,844.38"		"$10,844.38"	"$8,138.89"	$0.00	$0.00	"$8,138.89"	"$8,450.04"	$0.00	$0.00	$0.00	$0.00
87865	ERX	HCPCS 25000001	66490-0650-20	DIAZEPAM 2.5 MG RECTAL GEL	BOTH IP/OP	"$1,036.08 "	$766.70	$0.00	$902.66		$0.00	$0.00	$0.00	$0.00	$0.00	$768.98	$768.98	$798.61	$0.00	$215.92	$0.00	$0.00	$0.00	$0.00	$564.17	$893.64	$902.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87867	ERX	HCPCS 25000001	00187-0658-20	DIAZEPAM 10 MG RECTAL GEL	BOTH IP/OP	"$1,229.03 "	$909.48	$0.00	$947.34		$0.00	$0.00	$0.00	$0.00	$0.00	$912.19	$912.19	$947.34	$0.00	$256.13	$0.00	$0.00	$0.00	$0.00	$278.85	$441.70	$446.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87869	ERX	HCPCS 25000001	00187-0659-20	DIAZEPAM 20 MG RECTAL GEL	BOTH IP/OP	"$1,229.03 "	$909.48	$0.00	$947.34		$0.00	$0.00	$0.00	$0.00	$0.00	$912.19	$912.19	$947.34	$0.00	$256.13	$0.00	$0.00	$0.00	$0.00	$362.51	$574.21	$580.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87889	ERX	HCPCS 25000001	00088-2500-33	INSULIN GLULISINE 100 UNIT/ML IJ SOLN	BOTH IP/OP	$994.97 	$736.28	$0.00	$766.92		$0.00	$0.00	$0.00	$0.00	$0.00	$738.47	$738.47	$766.92	$0.00	$207.35	$0.00	$0.00	$0.00	$0.00	$451.49	$715.15	$722.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87912	ERX	HCPCS 63700001	51801-0011-17	POTASSIUM BICARB-CITRIC ACID 20 MEQ PO TBEF	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87912	ERX	HCPCS 63700001	51801-0011-30	POTASSIUM BICARB-CITRIC ACID 20 MEQ PO TBEF	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87912	ERX	HCPCS 63700001	51801-0012-30	POTASSIUM BICARB-CITRIC ACID 20 MEQ PO TBEF	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87998	ERX	HCPCS 63700001	49702-0223-18	MARAVIROC 150 MG PO TABS	BOTH IP/OP	$126.08 	$93.30	$0.00	$87.15		$0.00	$0.00	$0.00	$22.44	$0.00	$0.00	$0.00	$0.00	$0.00	$26.28	$0.00	$0.00	$0.00	$0.00	$54.47	$86.28	$87.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87999	ERX	HCPCS 63700001	49702-0224-18	MARAVIROC 300 MG PO TABS	BOTH IP/OP	$126.08 	$93.30	$0.00	$87.15		$0.00	$0.00	$0.00	$22.44	$0.00	$0.00	$0.00	$0.00	$0.00	$26.28	$0.00	$0.00	$0.00	$0.00	$54.47	$86.28	$87.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88007	ERX	HCPCS 63700001	50228-0424-60	RANOLAZINE ER 1000 MG PO TB12	BOTH IP/OP	$56.57 	$41.86	$0.00	$39.17		$0.00	$0.00	$0.00	$10.07	$0.00	$0.00	$0.00	$0.00	$0.00	$11.79	$0.00	$0.00	$0.00	$0.00	$24.48	$38.78	$39.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88007	ERX	HCPCS 63700001	61958-1004-01	RANOLAZINE ER 1000 MG PO TB12	BOTH IP/OP	$56.57 	$41.86	$0.00	$39.17		$0.00	$0.00	$0.00	$10.07	$0.00	$0.00	$0.00	$0.00	$0.00	$11.79	$0.00	$0.00	$0.00	$0.00	$24.48	$38.78	$39.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88008	ERX	HCPCS J9178	00009-5091-01	EPIRUBICIN HCL 50 MG/25ML IV SOLN	BOTH IP/OP	$172.03 	$127.30	$0.00	$137.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.02	$136.25	$137.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88010	ERX	HCPCS Q2009	00069-5474-02	FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN	BOTH IP/OP	$197.79 	$146.36	$0.00	$152.46	$89.01	$89.01	$0.00	$0.00	$0.00	$41.22	$146.80	$146.80	$152.46	$0.00	$41.22	$0.00	$116.99	$116.99	$18.11	$89.78	$142.20	$143.64	$25.01		$25.01	$28.10	$0.00	$0.00	$28.58	$17.25	$0.00	$0.00	$0.00	$0.00
88010	ERX	HCPCS Q2009	00069-6001-21	FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN	BOTH IP/OP	$197.79 	$146.36	$0.00	$152.46	$89.01	$89.01	$0.00	$0.00	$0.00	$41.22	$146.80	$146.80	$152.46	$0.00	$41.22	$0.00	$116.99	$116.99	$18.11	$89.78	$142.20	$143.64	$25.01		$25.01	$28.10	$0.00	$0.00	$28.58	$17.25	$0.00	$0.00	$0.00	$0.00
88010	ERX	HCPCS Q2009	00641-6137-01	FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN	BOTH IP/OP	$197.79 	$146.36	$0.00	$152.46	$89.01	$89.01	$0.00	$0.00	$0.00	$41.22	$146.80	$146.80	$152.46	$0.00	$41.22	$0.00	$116.99	$116.99	$18.11	$89.78	$142.20	$143.64	$25.01		$25.01	$28.10	$0.00	$0.00	$28.58	$17.25	$0.00	$0.00	$0.00	$0.00
88010	ERX	HCPCS Q2009	00641-6137-10	FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN	BOTH IP/OP	$197.79 	$146.36	$0.00	$152.46	$89.01	$89.01	$0.00	$0.00	$0.00	$41.22	$146.80	$146.80	$152.46	$0.00	$41.22	$0.00	$116.99	$116.99	$18.11	$89.78	$142.20	$143.64	$25.01		$25.01	$28.10	$0.00	$0.00	$28.58	$17.25	$0.00	$0.00	$0.00	$0.00
88010	ERX	HCPCS Q2009	63323-0403-10	FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN	BOTH IP/OP	$197.79 	$146.36	$0.00	$152.46	$89.01	$89.01	$0.00	$0.00	$0.00	$41.22	$146.80	$146.80	$152.46	$0.00	$41.22	$0.00	$116.99	$116.99	$18.11	$89.78	$142.20	$143.64	$25.01		$25.01	$28.10	$0.00	$0.00	$28.58	$17.25	$0.00	$0.00	$0.00	$0.00
88010	ERX	HCPCS Q2009	67457-0517-00	FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN	BOTH IP/OP	$197.79 	$146.36	$0.00	$152.46	$89.01	$89.01	$0.00	$0.00	$0.00	$41.22	$146.80	$146.80	$152.46	$0.00	$41.22	$0.00	$116.99	$116.99	$18.11	$89.78	$142.20	$143.64	$25.01		$25.01	$28.10	$0.00	$0.00	$28.58	$17.25	$0.00	$0.00	$0.00	$0.00
88010	ERX	HCPCS Q2009	67457-0517-01	FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN	BOTH IP/OP	$197.79 	$146.36	$0.00	$152.46	$89.01	$89.01	$0.00	$0.00	$0.00	$41.22	$146.80	$146.80	$152.46	$0.00	$41.22	$0.00	$116.99	$116.99	$18.11	$89.78	$142.20	$143.64	$25.01		$25.01	$28.10	$0.00	$0.00	$28.58	$17.25	$0.00	$0.00	$0.00	$0.00
88010	ERX	HCPCS Q2009	70121-1390-07	FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN	BOTH IP/OP	$197.79 	$146.36	$0.00	$152.46	$89.01	$89.01	$0.00	$0.00	$0.00	$41.22	$146.80	$146.80	$152.46	$0.00	$41.22	$0.00	$116.99	$116.99	$18.11	$89.78	$142.20	$143.64	$25.01		$25.01	$28.10	$0.00	$0.00	$28.58	$17.25	$0.00	$0.00	$0.00	$0.00
88011	ERX	HCPCS Q2009	00069-5471-02	FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN	BOTH IP/OP	$75.42 	$55.81	$0.00	$58.13	$33.94	$33.94	$0.00	$0.00	$0.00	$15.72	$55.98	$55.98	$58.13	$0.00	$15.72	$0.00	$44.61	$44.61	$3.62	$34.20	$54.17	$54.72	$5.00		$5.00	$10.70	$0.00	$0.00	$10.89	$3.45	$0.00	$0.00	$0.00	$0.00
88011	ERX	HCPCS Q2009	00069-6001-25	FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN	BOTH IP/OP	$75.42 	$55.81	$0.00	$58.13	$33.94	$33.94	$0.00	$0.00	$0.00	$15.72	$55.98	$55.98	$58.13	$0.00	$15.72	$0.00	$44.61	$44.61	$3.62	$34.20	$54.17	$54.72	$5.00		$5.00	$10.70	$0.00	$0.00	$10.89	$3.45	$0.00	$0.00	$0.00	$0.00
88011	ERX	HCPCS Q2009	00641-6136-25	FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN	BOTH IP/OP	$75.42 	$55.81	$0.00	$58.13	$33.94	$33.94	$0.00	$0.00	$0.00	$15.72	$55.98	$55.98	$58.13	$0.00	$15.72	$0.00	$44.61	$44.61	$3.62	$34.20	$54.17	$54.72	$5.00		$5.00	$10.70	$0.00	$0.00	$10.89	$3.45	$0.00	$0.00	$0.00	$0.00
88011	ERX	HCPCS Q2009	70121-1381-05	FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN	BOTH IP/OP	$75.42 	$55.81	$0.00	$58.13	$33.94	$33.94	$0.00	$0.00	$0.00	$15.72	$55.98	$55.98	$58.13	$0.00	$15.72	$0.00	$44.61	$44.61	$3.62	$34.20	$54.17	$54.72	$5.00		$5.00	$10.70	$0.00	$0.00	$10.89	$3.45	$0.00	$0.00	$0.00	$0.00
88093	ERX	HCPCS J0348	00049-0116-28	ANIDULAFUNGIN 100 MG IV SOLR	BOTH IP/OP	$668.89 	$494.98	$0.00	$515.58	$301.00	$301.00	$0.00	$0.00	$0.00	$139.41	$496.45	$496.45	$515.58	$0.00	$66.39	$0.00	$395.65	$395.65	$0.00	$286.20	$453.34	$457.92	$0.00		$0.00	$61.10	$0.00	$0.00	$58.18	$0.00	$0.00	$0.00	$0.00	$0.00
88241	ERX	HCPCS J9211	00703-4154-11	IDARUBICIN HCL 5 MG/5ML IV SOLN	BOTH IP/OP	$342.91 	$253.75	$0.00	$264.32		$0.00	$0.00	$0.00	$0.00	$0.00	$254.51	$254.51	$264.32	$0.00	$71.46	$0.00	$0.00	$0.00	$0.00	$155.65	$246.54	$249.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88242	ERX	HCPCS J9211	00013-2586-91	IDARUBICIN HCL 10 MG/10ML IV SOLN	BOTH IP/OP	$434.59 	$321.60	$0.00	$334.98		$0.00	$0.00	$0.00	$0.00	$0.00	$322.55	$322.55	$334.98	$0.00	$90.57	$0.00	$0.00	$0.00	$0.00	$194.32	$307.80	$310.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88242	ERX	HCPCS J9211	00703-4155-11	IDARUBICIN HCL 10 MG/10ML IV SOLN	BOTH IP/OP	$434.59 	$321.60	$0.00	$334.98		$0.00	$0.00	$0.00	$0.00	$0.00	$322.55	$322.55	$334.98	$0.00	$90.57	$0.00	$0.00	$0.00	$0.00	$194.32	$307.80	$310.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88243	ERX	HCPCS J9211	00703-4156-11	IDARUBICIN HCL 20 MG/20ML IV SOLN	BOTH IP/OP	$730.45 	$540.53	$0.00	$584.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$365.23	$578.52	$584.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88317	ERX	HCPCS 25000001	68803-0612-10	TRYPAN BLUE 0.06 % OP SOLN	BOTH IP/OP	$290.65 	$215.08	$0.00	$224.03		$0.00	$0.00	$0.00	$0.00	$0.00	$215.72	$215.72	$224.03	$0.00	$60.57	$0.00	$0.00	$0.00	$0.00	$131.93	$208.97	$211.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88376	ERX	HCPCS J9060	00703-5747-11	CISPLATIN 50 MG/50ML IV SOLN	BOTH IP/OP	$83.57 	$61.84	$0.00	$64.42	$37.61	$37.61	$0.00	$0.00	$0.00	$13.10	$62.03	$62.03	$64.42	$0.00	$10.42	$0.00	$49.43	$49.43	$0.00	$37.89	$60.02	$60.62	$0.00		$0.00	$11.34	$0.00	$0.00	$10.80	$0.00	$0.00	$0.00	$0.00	$0.00
88376	ERX	HCPCS J9060	63323-0103-51	CISPLATIN 50 MG/50ML IV SOLN	BOTH IP/OP	$83.57 	$61.84	$0.00	$64.42	$37.61	$37.61	$0.00	$0.00	$0.00	$13.10	$62.03	$62.03	$64.42	$0.00	$10.42	$0.00	$49.43	$49.43	$0.00	$37.89	$60.02	$60.62	$0.00		$0.00	$11.34	$0.00	$0.00	$10.80	$0.00	$0.00	$0.00	$0.00	$0.00
88377	ERX	HCPCS J9060	00703-5748-11	CISPLATIN 100 MG/100ML IV SOLN	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$22.68	$0.00	$0.00	$21.59	$0.00	$0.00	$0.00	$0.00	$0.00
88377	ERX	HCPCS J9060	16729-0288-38	CISPLATIN 100 MG/100ML IV SOLN	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$22.68	$0.00	$0.00	$21.59	$0.00	$0.00	$0.00	$0.00	$0.00
88377	ERX	HCPCS J9060	44567-0510-01	CISPLATIN 100 MG/100ML IV SOLN	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$22.68	$0.00	$0.00	$21.59	$0.00	$0.00	$0.00	$0.00	$0.00
88377	ERX	HCPCS J9060	63323-0103-65	CISPLATIN 100 MG/100ML IV SOLN	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$22.68	$0.00	$0.00	$21.59	$0.00	$0.00	$0.00	$0.00	$0.00
88378	ERX	HCPCS J9060	63323-0103-64	CISPLATIN 200 MG/200ML IV SOLN	BOTH IP/OP	$300.51 	$222.38	$0.00	$231.63	$135.23	$135.23	$0.00	$0.00	$0.00	$52.41	$223.04	$223.04	$231.63	$0.00	$41.69	$0.00	$177.75	$177.75	$0.00	$136.40	$216.05	$218.23	$0.00		$0.00	$45.36	$0.00	$0.00	$43.19	$0.00	$0.00	$0.00	$0.00	$0.00
88567	ERX	HCPCS 63700001	00597-0101-90	PRAMIPEXOLE DIHYDROCHLORIDE 0.75 MG PO TABS	BOTH IP/OP	$32.02 	$23.69	$0.00	$25.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.01	$25.36	$25.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88567	ERX	HCPCS 63700001	13668-0184-90	PRAMIPEXOLE DIHYDROCHLORIDE 0.75 MG PO TABS	BOTH IP/OP	$32.02 	$23.69	$0.00	$25.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.01	$25.36	$25.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88608	ERX	HCPCS 63700001	00006-0227-61	RALTEGRAVIR POTASSIUM 400 MG PO TABS	BOTH IP/OP	$133.96 	$99.13	$0.00	$92.58		$0.00	$0.00	$0.00	$25.03	$0.00	$0.00	$0.00	$0.00	$0.00	$27.92	$0.00	$0.00	$0.00	$0.00	$57.86	$91.65	$92.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88704	ERX	HCPCS 63700001	00004-0802-85	OSELTAMIVIR PHOSPHATE 30 MG PO CAPS	BOTH IP/OP	$47.07 	$34.83	$0.00	$37.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.54	$37.28	$37.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88704	ERX	HCPCS 63700001	16714-0817-01	OSELTAMIVIR PHOSPHATE 30 MG PO CAPS	BOTH IP/OP	$47.07 	$34.83	$0.00	$37.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.54	$37.28	$37.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88704	ERX	HCPCS 63700001	31722-0630-31	OSELTAMIVIR PHOSPHATE 30 MG PO CAPS	BOTH IP/OP	$47.07 	$34.83	$0.00	$37.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.54	$37.28	$37.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88704	ERX	HCPCS 63700001	47781-0468-13	OSELTAMIVIR PHOSPHATE 30 MG PO CAPS	BOTH IP/OP	$47.07 	$34.83	$0.00	$37.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.54	$37.28	$37.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88704	ERX	HCPCS 63700001	63739-0038-07	OSELTAMIVIR PHOSPHATE 30 MG PO CAPS	BOTH IP/OP	$47.07 	$34.83	$0.00	$37.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.54	$37.28	$37.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88704	ERX	HCPCS 63700001	68180-0675-11	OSELTAMIVIR PHOSPHATE 30 MG PO CAPS	BOTH IP/OP	$47.07 	$34.83	$0.00	$37.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.54	$37.28	$37.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88705	ERX	HCPCS 63700001	00004-0801-85	OSELTAMIVIR PHOSPHATE 45 MG PO CAPS	BOTH IP/OP	$70.07 	$51.85	$0.00	$50.83		$0.00	$0.00	$0.00	$12.47	$0.00	$0.00	$0.00	$0.00	$0.00	$14.60	$0.00	$0.00	$0.00	$0.00	$31.77	$50.32	$50.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88720	ERX	HCPCS 63700001	00078-0526-51	NILOTINIB HCL 200 MG PO CAPS	BOTH IP/OP	$566.86 	$419.48	$0.00	$384.72		$0.00	$0.00	$0.00	$106.95	$0.00	$0.00	$0.00	$0.00	$0.00	$118.13	$0.00	$0.00	$0.00	$0.00	$240.45	$380.87	$384.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88806	ERX	HCPCS 63700001	00074-0522-60	KALETRA:LOPINAVIR-RITONAVIR 100-25 MG PO TABS	BOTH IP/OP	$21.46 	$15.88	$0.00	$15.57		$0.00	$0.00	$0.00	$3.82	$0.00	$0.00	$0.00	$0.00	$0.00	$4.47	$0.00	$0.00	$0.00	$0.00	$9.73	$15.41	$15.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88945	ERX	HCPCS 63700001	53191-0362-01	CHOLECALCIFEROL-D3 50000 UNITS PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89128	ERX	HCPCS J3300	00065-0543-01	TRIAMCINOLONE ACETONIDE 40 MG/ML IO SUSP	BOTH IP/OP	$75.63 	$55.97	$0.00	$58.30		$0.00	$0.00	$0.00	$0.00	$15.76	$56.13	$56.13	$58.30	$0.00	$15.76	$0.00	$44.74	$44.74	$0.00	$34.30	$54.32	$54.87	$0.00		$0.00	$10.73	$0.00	$0.00	$10.92	$0.00	$0.00	$0.00	$0.00	$0.00
89201	ERX	HCPCS 63700001	00955-1050-27	SEVELAMER CARBONATE 800 MG PO TABS	BOTH IP/OP	$25.54 	$18.90	$0.00	$18.54		$0.00	$0.00	$0.00	$4.55	$0.00	$0.00	$0.00	$0.00	$0.00	$5.32	$0.00	$0.00	$0.00	$0.00	$11.59	$18.35	$18.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89201	ERX	HCPCS 63700001	16714-0814-01	SEVELAMER CARBONATE 800 MG PO TABS	BOTH IP/OP	$25.54 	$18.90	$0.00	$18.54		$0.00	$0.00	$0.00	$4.55	$0.00	$0.00	$0.00	$0.00	$0.00	$5.32	$0.00	$0.00	$0.00	$0.00	$11.59	$18.35	$18.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89201	ERX	HCPCS 63700001	65162-0058-27	SEVELAMER CARBONATE 800 MG PO TABS	BOTH IP/OP	$25.54 	$18.90	$0.00	$18.54		$0.00	$0.00	$0.00	$4.55	$0.00	$0.00	$0.00	$0.00	$0.00	$5.32	$0.00	$0.00	$0.00	$0.00	$11.59	$18.35	$18.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89201	ERX	HCPCS 63700001	65862-0921-27	SEVELAMER CARBONATE 800 MG PO TABS	BOTH IP/OP	$25.54 	$18.90	$0.00	$18.54		$0.00	$0.00	$0.00	$4.55	$0.00	$0.00	$0.00	$0.00	$0.00	$5.32	$0.00	$0.00	$0.00	$0.00	$11.59	$18.35	$18.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89284	ERX	HCPCS 63700001	00456-1405-30	NEBIVOLOL HCL 5 MG PO TABS	BOTH IP/OP	$26.47 	$19.59	$0.00	$18.30		$0.00	$0.00	$0.00	$4.95	$0.00	$0.00	$0.00	$0.00	$0.00	$5.52	$0.00	$0.00	$0.00	$0.00	$11.44	$18.11	$18.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89286	ERX	HCPCS 63700001	00456-1410-30	NEBIVOLOL HCL 10 MG PO TABS	BOTH IP/OP	$26.47 	$19.59	$0.00	$18.30		$0.00	$0.00	$0.00	$4.95	$0.00	$0.00	$0.00	$0.00	$0.00	$5.52	$0.00	$0.00	$0.00	$0.00	$11.44	$18.11	$18.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89346	ERX	HCPCS 25000001	00904-6467-07	CLOPIDOGREL BISULFATE 300 MG PO TABS	BOTH IP/OP	$108.29 	$80.13	$0.00	$86.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.15	$85.77	$86.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89346	ERX	HCPCS 25000001	55111-0671-06	CLOPIDOGREL BISULFATE 300 MG PO TABS	BOTH IP/OP	$108.29 	$80.13	$0.00	$86.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.15	$85.77	$86.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89346	ERX	HCPCS 25000001	55111-0671-31	CLOPIDOGREL BISULFATE 300 MG PO TABS	BOTH IP/OP	$108.29 	$80.13	$0.00	$86.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.15	$85.77	$86.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89346	ERX	HCPCS 25000001	68084-0752-25	CLOPIDOGREL BISULFATE 300 MG PO TABS	BOTH IP/OP	$108.29 	$80.13	$0.00	$86.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.15	$85.77	$86.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89346	ERX	HCPCS 25000001	68084-0752-95	CLOPIDOGREL BISULFATE 300 MG PO TABS	BOTH IP/OP	$108.29 	$80.13	$0.00	$86.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.15	$85.77	$86.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89350	ERX	HCPCS J9305	00002-7640-01	PEMETREXED DISODIUM 100 MG IV SOLR	BOTH IP/OP	"$2,392.10 "	"$1,770.15"	$0.00	"$1,899.15"	"$1,108.74"	"$1,108.74"	$760.37	$760.37	$760.37	$566.59	"$1,828.68"	"$1,828.68"	"$1,899.15"	$749.29	$880.42	$487.04	"$1,179.31"	"$1,179.31"	$729.46	"$1,065.27"	"$1,687.38"	"$1,704.42"	"$1,007.34"		"$1,007.34"	$831.78	$0.00	$0.00	$792.00	$724.05	$0.00	$0.00	$0.00	$0.00
89432	ERX	HCPCS 63700001	59676-0570-01	ETRAVIRINE 100 MG PO TABS	BOTH IP/OP	$108.97 	$80.64	$0.00	$77.50		$0.00	$0.00	$0.00	$19.78	$0.00	$0.00	$0.00	$0.00	$0.00	$22.71	$0.00	$0.00	$0.00	$0.00	$48.44	$76.72	$77.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89570	ERX	HCPCS 25000001	00338-0322-01	THROMBIN (RECOMBINANT) 5000 UNITS EX SOLR	BOTH IP/OP	$314.76 	$232.92	$0.00	$251.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.38	$249.29	$251.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89570	ERX	HCPCS 25000001	65293-0006-41	THROMBIN (RECOMBINANT) 5000 UNITS EX SOLR	BOTH IP/OP	$314.76 	$232.92	$0.00	$251.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.38	$249.29	$251.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89740	ERX	HCPCS 63700001	60258-0171-01	MAGNESIUM OXIDE 400 (241.3 MG) MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89740	ERX	HCPCS 63700001	63739-0354-01	MAGNESIUM OXIDE 400 (241.3 MG) MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89740	ERX	HCPCS 63700001	63739-0354-10	MAGNESIUM OXIDE 400 (241.3 MG) MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89783	ERX	HCPCS 63700001	59417-0102-10	LISDEXAMFETAMINE DIMESYLATE 20 MG PO CAPS	BOTH IP/OP	$56.15 	$41.55	$0.00	$38.80		$0.00	$0.00	$0.00	$10.49	$0.00	$0.00	$0.00	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$24.25	$38.41	$38.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89791	ERX	HCPCS 63700001	00008-0844-01	PANTOPRAZOLE SODIUM 40 MG PO PACK	BOTH IP/OP	$83.13 	$61.52	$0.00	$57.71		$0.00	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00	$17.32	$0.00	$0.00	$0.00	$0.00	$36.07	$57.13	$57.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89791	ERX	HCPCS 63700001	00008-0844-02	PANTOPRAZOLE SODIUM 40 MG PO PACK	BOTH IP/OP	$83.13 	$61.52	$0.00	$57.71		$0.00	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00	$17.32	$0.00	$0.00	$0.00	$0.00	$36.07	$57.13	$57.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90996	ERX	HCPCS 63600001	31382-0753-05	MEPIVACAINE HCL 3 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91001	ERX	HCPCS 63700001	10122-0901-12	ZILEUTON 600 MG PO TABS	BOTH IP/OP	$145.10 	$107.37	$0.00	$105.26		$0.00	$0.00	$0.00	$25.83	$0.00	$0.00	$0.00	$0.00	$0.00	$30.24	$0.00	$0.00	$0.00	$0.00	$65.79	$104.20	$105.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91018	ERX	HCPCS 25000001	00065-0474-01	HYPROMELLOSE 0.3 % OP GEL	BOTH IP/OP	$29.64 	$21.93	$0.00	$23.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.82	$23.47	$23.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91018	ERX	HCPCS 25000001	00065-8064-01	HYPROMELLOSE 0.3 % OP GEL	BOTH IP/OP	$29.64 	$21.93	$0.00	$23.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.82	$23.47	$23.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91018	ERX	HCPCS 25000001	00078-0429-47	HYPROMELLOSE 0.3 % OP GEL	BOTH IP/OP	$29.64 	$21.93	$0.00	$23.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.82	$23.47	$23.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91033	ERX	HCPCS 90633	58160-0825-52	HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSP	BOTH IP/OP	$160.84 	$119.02	$0.00	$123.98	$72.38	$72.38	$0.00	$0.00	$0.00	$9.40	$119.38	$119.38	$123.98	$0.00	$33.52	$0.00	$95.14	$95.14	$0.00	$70.84	$112.20	$113.34	$0.00		$0.00	$22.17	$0.00	$0.00	$22.55	$0.00	$0.00	$0.00	$0.00	$0.00
91034	ERX	HCPCS 90632	58160-0826-52	HEPATITIS A VACCINE 1440 EL U/ML IM SUSP	BOTH IP/OP	$318.74 	$235.87	$0.00	$245.68	$143.43	$143.43	$0.00	$0.00	$0.00	$56.67	$236.57	$236.57	$245.68	$0.00	$75.29	$0.00	$188.53	$188.53	$0.00	$135.14	$214.05	$216.22	$0.00		$0.00	$70.39	$0.00	$0.00	$67.03	$0.00	$0.00	$0.00	$0.00	$0.00
91037	ERX	HCPCS J3470	00548-9090-10	HYALURONIDASE BOVINE 150 UNIT/ML IJ SOLN	BOTH IP/OP	$232.36 	$171.95	$0.00	$179.10	$104.56	$104.56	$0.00	$0.00	$0.00	$29.38	$172.46	$172.46	$179.10	$0.00	$48.42	$0.00	$137.44	$137.44	$0.00	$105.47	$167.06	$168.74	$0.00		$0.00	$33.01	$0.00	$0.00	$33.58	$0.00	$0.00	$0.00	$0.00	$0.00
91047	ERX	HCPCS 90371	13533-0636-03	HEPATITIS B IMMUNE GLOBULIN IM SOLN	BOTH IP/OP	$323.73 	$239.56	$0.00	$258.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.87	$256.39	$258.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91047	ERX	HCPCS 90371	13533-0636-05	HEPATITIS B IMMUNE GLOBULIN IM SOLN	BOTH IP/OP	$323.73 	$239.56	$0.00	$258.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.87	$256.39	$258.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91047	ERX	HCPCS 90371	59730-4202-01	HEPATITIS B IMMUNE GLOBULIN IM SOLN	BOTH IP/OP	$323.73 	$239.56	$0.00	$258.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.87	$256.39	$258.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91054	ERX	HCPCS J9206	00009-7529-03	IRINOTECAN HCL 100 MG/5ML IV SOLN	BOTH IP/OP	$157.49 	$116.54	$0.00	$127.61	$70.87	$70.87	$0.00	$0.00	$0.00	$127.61	$116.89	$116.89	$121.39	$0.00	$13.79	$0.00	$93.16	$93.16	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$14.57	$0.00	$0.00	$13.87	$0.00	$0.00	$0.00	$0.00	$0.00
91054	ERX	HCPCS J9206	63323-0193-55	IRINOTECAN HCL 100 MG/5ML IV SOLN	BOTH IP/OP	$157.49 	$116.54	$0.00	$127.61	$70.87	$70.87	$0.00	$0.00	$0.00	$127.61	$116.89	$116.89	$121.39	$0.00	$13.79	$0.00	$93.16	$93.16	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$14.57	$0.00	$0.00	$13.87	$0.00	$0.00	$0.00	$0.00	$0.00
91073	ERX	HCPCS 63700001	00008-1211-30	DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24	BOTH IP/OP	$73.41 	$54.32	$0.00	$50.20		$0.00	$0.00	$0.00	$13.07	$0.00	$0.00	$0.00	$0.00	$0.00	$15.30	$0.00	$0.00	$0.00	$0.00	$31.38	$49.70	$50.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91073	ERX	HCPCS 63700001	51991-0311-33	DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24	BOTH IP/OP	$73.41 	$54.32	$0.00	$50.20		$0.00	$0.00	$0.00	$13.07	$0.00	$0.00	$0.00	$0.00	$0.00	$15.30	$0.00	$0.00	$0.00	$0.00	$31.38	$49.70	$50.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91073	ERX	HCPCS 63700001	59762-1211-03	DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24	BOTH IP/OP	$73.41 	$54.32	$0.00	$50.20		$0.00	$0.00	$0.00	$13.07	$0.00	$0.00	$0.00	$0.00	$0.00	$15.30	$0.00	$0.00	$0.00	$0.00	$31.38	$49.70	$50.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91238	ERX	HCPCS J0744	00409-4777-02	CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
91238	ERX	HCPCS J0744	25021-0114-87	CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
91238	ERX	HCPCS J0744	36000-0009-24	CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
91278	ERX	HCPCS J2354	00641-6174-10	OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91278	ERX	HCPCS J2354	00703-3301-04	OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91278	ERX	HCPCS J2354	25021-0451-01	OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91278	ERX	HCPCS J2354	67457-0239-01	OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91279	ERX	HCPCS J2354	00078-0181-01	OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN	BOTH IP/OP	$49.98 	$36.99	$0.00	$38.52		$0.00	$0.00	$0.00	$0.00	$0.00	$37.10	$37.10	$38.52	$0.00	$4.44	$0.00	$0.00	$0.00	$0.00	$22.67	$35.90	$36.26	$0.00		$0.00	$0.00	$0.00	$0.00	$4.21	$0.00	$0.00	$0.00	$0.00	$0.00
91279	ERX	HCPCS J2354	00703-3311-01	OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN	BOTH IP/OP	$49.98 	$36.99	$0.00	$38.52		$0.00	$0.00	$0.00	$0.00	$0.00	$37.10	$37.10	$38.52	$0.00	$4.44	$0.00	$0.00	$0.00	$0.00	$22.67	$35.90	$36.26	$0.00		$0.00	$0.00	$0.00	$0.00	$4.21	$0.00	$0.00	$0.00	$0.00	$0.00
91279	ERX	HCPCS J2354	00703-3311-04	OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN	BOTH IP/OP	$49.98 	$36.99	$0.00	$38.52		$0.00	$0.00	$0.00	$0.00	$0.00	$37.10	$37.10	$38.52	$0.00	$4.44	$0.00	$0.00	$0.00	$0.00	$22.67	$35.90	$36.26	$0.00		$0.00	$0.00	$0.00	$0.00	$4.21	$0.00	$0.00	$0.00	$0.00	$0.00
91279	ERX	HCPCS J2354	25021-0452-01	OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN	BOTH IP/OP	$49.98 	$36.99	$0.00	$38.52		$0.00	$0.00	$0.00	$0.00	$0.00	$37.10	$37.10	$38.52	$0.00	$4.44	$0.00	$0.00	$0.00	$0.00	$22.67	$35.90	$36.26	$0.00		$0.00	$0.00	$0.00	$0.00	$4.21	$0.00	$0.00	$0.00	$0.00	$0.00
91279	ERX	HCPCS J2354	63323-0376-01	OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN	BOTH IP/OP	$49.98 	$36.99	$0.00	$38.52		$0.00	$0.00	$0.00	$0.00	$0.00	$37.10	$37.10	$38.52	$0.00	$4.44	$0.00	$0.00	$0.00	$0.00	$22.67	$35.90	$36.26	$0.00		$0.00	$0.00	$0.00	$0.00	$4.21	$0.00	$0.00	$0.00	$0.00	$0.00
91279	ERX	HCPCS J2354	67457-0245-01	OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN	BOTH IP/OP	$49.98 	$36.99	$0.00	$38.52		$0.00	$0.00	$0.00	$0.00	$0.00	$37.10	$37.10	$38.52	$0.00	$4.44	$0.00	$0.00	$0.00	$0.00	$22.67	$35.90	$36.26	$0.00		$0.00	$0.00	$0.00	$0.00	$4.21	$0.00	$0.00	$0.00	$0.00	$0.00
91281	ERX	HCPCS J2354	00641-6176-01	OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN	BOTH IP/OP	$206.91 	$153.11	$0.00	$159.49		$0.00	$0.00	$0.00	$0.00	$0.00	$153.57	$153.57	$159.49	$0.00	$22.21	$0.00	$0.00	$0.00	$0.00	$93.92	$148.76	$150.26	$0.00		$0.00	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$0.00	$0.00	$0.00
91281	ERX	HCPCS J2354	00641-6176-10	OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN	BOTH IP/OP	$206.91 	$153.11	$0.00	$159.49		$0.00	$0.00	$0.00	$0.00	$0.00	$153.57	$153.57	$159.49	$0.00	$22.21	$0.00	$0.00	$0.00	$0.00	$93.92	$148.76	$150.26	$0.00		$0.00	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$0.00	$0.00	$0.00
91281	ERX	HCPCS J2354	00703-3321-01	OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN	BOTH IP/OP	$206.91 	$153.11	$0.00	$159.49		$0.00	$0.00	$0.00	$0.00	$0.00	$153.57	$153.57	$159.49	$0.00	$22.21	$0.00	$0.00	$0.00	$0.00	$93.92	$148.76	$150.26	$0.00		$0.00	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$0.00	$0.00	$0.00
91281	ERX	HCPCS J2354	00703-3321-04	OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN	BOTH IP/OP	$206.91 	$153.11	$0.00	$159.49		$0.00	$0.00	$0.00	$0.00	$0.00	$153.57	$153.57	$159.49	$0.00	$22.21	$0.00	$0.00	$0.00	$0.00	$93.92	$148.76	$150.26	$0.00		$0.00	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$0.00	$0.00	$0.00
91281	ERX	HCPCS J2354	25021-0453-01	OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN	BOTH IP/OP	$206.91 	$153.11	$0.00	$159.49		$0.00	$0.00	$0.00	$0.00	$0.00	$153.57	$153.57	$159.49	$0.00	$22.21	$0.00	$0.00	$0.00	$0.00	$93.92	$148.76	$150.26	$0.00		$0.00	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$0.00	$0.00	$0.00
91281	ERX	HCPCS J2354	63323-0377-01	OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN	BOTH IP/OP	$206.91 	$153.11	$0.00	$159.49		$0.00	$0.00	$0.00	$0.00	$0.00	$153.57	$153.57	$159.49	$0.00	$22.21	$0.00	$0.00	$0.00	$0.00	$93.92	$148.76	$150.26	$0.00		$0.00	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$0.00	$0.00	$0.00
91281	ERX	HCPCS J2354	67457-0246-01	OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN	BOTH IP/OP	$206.91 	$153.11	$0.00	$159.49		$0.00	$0.00	$0.00	$0.00	$0.00	$153.57	$153.57	$159.49	$0.00	$22.21	$0.00	$0.00	$0.00	$0.00	$93.92	$148.76	$150.26	$0.00		$0.00	$0.00	$0.00	$0.00	$21.03	$0.00	$0.00	$0.00	$0.00	$0.00
91363	ERX	HCPCS J1451	00517-0710-01	FOMEPIZOLE 1.5 GM/1.5ML IV SOLN	BOTH IP/OP	"$2,644.50 "	"$1,956.93"	$0.00	"$2,115.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,322.25"	"$2,094.44"	"$2,115.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91363	ERX	HCPCS J1451	67457-0211-02	FOMEPIZOLE 1.5 GM/1.5ML IV SOLN	BOTH IP/OP	"$2,644.50 "	"$1,956.93"	$0.00	"$2,115.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,322.25"	"$2,094.44"	"$2,115.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91363	ERX	HCPCS J1451	70710-1478-01	FOMEPIZOLE 1.5 GM/1.5ML IV SOLN	BOTH IP/OP	"$2,644.50 "	"$1,956.93"	$0.00	"$2,115.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,322.25"	"$2,094.44"	"$2,115.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91408	ERX	HCPCS J2785	00469-6501-89	REGADENOSON 0.4 MG/5ML IV SOLN	BOTH IP/OP	$876.88 	$648.89	$0.00	$675.90	$394.60	$394.60	$0.00	$0.00	$0.00	$182.76	$650.82	$650.82	$675.90	$0.00	$280.58	$0.00	$518.67	$518.67	$0.00	$386.31	$611.91	$618.09	$0.00		$0.00	$278.62	$0.00	$0.00	$265.29	$0.00	$0.00	$0.00	$0.00	$0.00
91534	ERX	HCPCS 63700001	64764-0080-60	LUBIPROSTONE 8 MCG PO CAPS	BOTH IP/OP	$31.10 	$23.01	$0.00	$22.57		$0.00	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00	$6.48	$0.00	$0.00	$0.00	$0.00	$14.11	$22.34	$22.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91651	ERX	HCPCS J2212	65649-0551-02	METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN	BOTH IP/OP	$585.22 	$433.06	$0.00	$451.09		$0.00	$0.00	$0.00	$0.00	$0.00	$434.35	$434.35	$451.09	$0.00	$121.96	$0.00	$0.00	$0.00	$0.00	$228.14	$361.37	$365.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91651	ERX	HCPCS J2212	65649-0551-07	METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN	BOTH IP/OP	$585.22 	$433.06	$0.00	$451.09		$0.00	$0.00	$0.00	$0.00	$0.00	$434.35	$434.35	$451.09	$0.00	$121.96	$0.00	$0.00	$0.00	$0.00	$228.14	$361.37	$365.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91870	ERX	HCPCS 63700001	67919-0020-10	ALVIMOPAN 12 MG PO CAPS	BOTH IP/OP	$637.17 	$471.51	$0.00	$440.58		$0.00	$0.00	$0.00	$113.42	$0.00	$0.00	$0.00	$0.00	$0.00	$132.79	$0.00	$0.00	$0.00	$0.00	$275.36	$436.17	$440.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91877	ERX	HCPCS 25000001	00085-1461-02	MOMETASONE FUROATE 110 MCG/INH IN AEPB	BOTH IP/OP	$621.59 	$459.98	$0.00	$451.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.54	$0.00	$0.00	$0.00	$0.00	$282.06	$446.78	$451.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92074	ERX	HCPCS 25000001	49281-0510-05	DTAP-IPV-HIB VACCINE IM SUSR	BOTH IP/OP	$425.59 	$314.94	$0.00	$328.04		$0.00	$0.00	$0.00	$0.00	$0.00	$315.87	$315.87	$328.04	$0.00	$88.69	$0.00	$0.00	$0.00	$0.00	$181.56	$287.58	$290.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92079	ERX	HCPCS 25000001	00143-9660-10	METOPROLOL TARTRATE 5 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92079	ERX	HCPCS 25000001	00143-9873-25	METOPROLOL TARTRATE 5 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92079	ERX	HCPCS 25000001	36000-0033-10	METOPROLOL TARTRATE 5 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92079	ERX	HCPCS 25000001	47781-0587-17	METOPROLOL TARTRATE 5 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92079	ERX	HCPCS 25000001	70860-0300-05	METOPROLOL TARTRATE 5 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92079	ERX	HCPCS 25000001	70860-0300-41	METOPROLOL TARTRATE 5 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92788	ERX	HCPCS 90696	58160-0812-11	DTAP-IPV VACCINE IM SUSP	BOTH IP/OP	$200.78 	$148.58	$0.00	$160.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.39	$159.02	$160.62	$0.00		$0.00	$31.42	$0.00	$0.00	$31.96	$0.00	$0.00	$0.00	$0.00	$0.00
92851	ERX	HCPCS 63700001	59676-0562-01	DARUNAVIR ETHANOLATE 600 MG PO TABS	BOTH IP/OP	$142.45 	$105.41	$0.00	$98.89		$0.00	$0.00	$0.00	$26.78	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$0.00	$0.00	$0.00	$0.00	$61.81	$97.90	$98.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92854	ERX	HCPCS J7189	00169-7202-01	COAGULATION FACTOR VIIA RECOMB 2 MG IV SOLR	BOTH IP/OP	"$12,158.80 "	"$8,997.51"	$0.00	"$9,372.00"		$0.00	$0.00	$0.00	$0.00	$0.00	"$9,024.26"	"$9,024.26"	"$9,372.00"	$0.00	"$2,533.89"	$0.00	$0.00	$0.00	$0.00	"$5,514.50"	"$8,734.97"	"$8,823.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92895	ERX	HCPCS J3370	00338-3552-48	VANCOMYCIN HCL IN DEXTROSE 1000 MG/200ML IV SOLN	BOTH IP/OP	$125.07 	$92.55	$0.00	$96.40	$56.28	$56.28	$0.00	$0.00	$0.00	$7.24	$92.83	$92.83	$96.40	$0.00	$6.68	$0.00	$73.98	$73.98	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$7.97	$0.00	$0.00	$7.59	$0.00	$0.00	$0.00	$0.00	$0.00
92897	ERX	HCPCS 63700001	00003-0852-22	DASATINIB 100 MG PO TABS	BOTH IP/OP	"$1,570.67 "	"$1,162.30"	$0.00	"$1,114.22"		$0.00	$0.00	$0.00	$292.16	$0.00	$0.00	$0.00	$0.00	$0.00	$327.33	$0.00	$0.00	$0.00	$0.00	$696.39	"$1,103.07"	"$1,114.22"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93084	ERX	HCPCS J0282	00143-9875-10	AMIODARONE HCL 150 MG/3ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
93084	ERX	HCPCS J0282	00143-9875-25	AMIODARONE HCL 150 MG/3ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
93084	ERX	HCPCS J0282	55150-0180-03	AMIODARONE HCL 150 MG/3ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
93084	ERX	HCPCS J0282	63323-0616-03	AMIODARONE HCL 150 MG/3ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
93084	ERX	HCPCS J0282	67457-0153-03	AMIODARONE HCL 150 MG/3ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
93106	ERX	HCPCS J1170	17478-0540-50	HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN	BOTH IP/OP	$428.40 	$317.02	$0.00	$455.31	$192.78	$192.78	$0.00	$0.00	$0.00	$195.34	$317.96	$317.96	$330.21	$0.00	$428.40	$0.00	$253.40	$253.40	$0.00	$194.44	$307.99	$311.10	$0.00		$0.00	$455.31	$0.00	$0.00	$433.54	$0.00	$0.00	$0.00	$0.00	$0.00
93352	ERX	HCPCS 63700001		FLORANEX PO PACK	BOTH IP/OP	$8.52 	$6.30	$0.00	$6.18		$0.00	$0.00	$0.00	$1.52	$0.00	$0.00	$0.00	$0.00	$0.00	$1.78	$0.00	$0.00	$0.00	$0.00	$3.87	$6.12	$6.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93352	ERX	HCPCS 63700001	64980-0146-12	FLORANEX PO PACK	BOTH IP/OP	$8.52 	$6.30	$0.00	$6.18		$0.00	$0.00	$0.00	$1.52	$0.00	$0.00	$0.00	$0.00	$0.00	$1.78	$0.00	$0.00	$0.00	$0.00	$3.87	$6.12	$6.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93523	ERX	HCPCS J2250	00409-2596-05	MIDAZOLAM HCL 50 MG/10ML IJ SOLN	BOTH IP/OP	$29.67 	$21.96	$0.00	$22.87	$13.35	$13.35	$0.00	$0.00	$0.00	$9.40	$22.02	$22.02	$22.87	$0.00	$7.58	$0.00	$17.55	$17.55	$0.00	$13.46	$21.31	$21.53	$0.00		$0.00	$7.05	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$0.00
93523	ERX	HCPCS J2250	00641-6060-01	MIDAZOLAM HCL 50 MG/10ML IJ SOLN	BOTH IP/OP	$29.67 	$21.96	$0.00	$22.87	$13.35	$13.35	$0.00	$0.00	$0.00	$9.40	$22.02	$22.02	$22.87	$0.00	$7.58	$0.00	$17.55	$17.55	$0.00	$13.46	$21.31	$21.53	$0.00		$0.00	$7.05	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$0.00
93523	ERX	HCPCS J2250	00641-6060-10	MIDAZOLAM HCL 50 MG/10ML IJ SOLN	BOTH IP/OP	$29.67 	$21.96	$0.00	$22.87	$13.35	$13.35	$0.00	$0.00	$0.00	$9.40	$22.02	$22.02	$22.87	$0.00	$7.58	$0.00	$17.55	$17.55	$0.00	$13.46	$21.31	$21.53	$0.00		$0.00	$7.05	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$0.00
93523	ERX	HCPCS J2250	00641-6190-10	MIDAZOLAM HCL 50 MG/10ML IJ SOLN	BOTH IP/OP	$29.67 	$21.96	$0.00	$22.87	$13.35	$13.35	$0.00	$0.00	$0.00	$9.40	$22.02	$22.02	$22.87	$0.00	$7.58	$0.00	$17.55	$17.55	$0.00	$13.46	$21.31	$21.53	$0.00		$0.00	$7.05	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$0.00
93523	ERX	HCPCS J2250	47781-0589-91	MIDAZOLAM HCL 50 MG/10ML IJ SOLN	BOTH IP/OP	$29.67 	$21.96	$0.00	$22.87	$13.35	$13.35	$0.00	$0.00	$0.00	$9.40	$22.02	$22.02	$22.87	$0.00	$7.58	$0.00	$17.55	$17.55	$0.00	$13.46	$21.31	$21.53	$0.00		$0.00	$7.05	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$0.00
93523	ERX	HCPCS J2250	70860-0601-10	MIDAZOLAM HCL 50 MG/10ML IJ SOLN	BOTH IP/OP	$29.67 	$21.96	$0.00	$22.87	$13.35	$13.35	$0.00	$0.00	$0.00	$9.40	$22.02	$22.02	$22.87	$0.00	$7.58	$0.00	$17.55	$17.55	$0.00	$13.46	$21.31	$21.53	$0.00		$0.00	$7.05	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$0.00
93566	ERX	HCPCS J2796	55513-0221-01	ROMIPLOSTIM 250 MCG SC SOLR	BOTH IP/OP	"$5,599.43 "	"$4,143.58"	$0.00	"$4,570.68"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,401.09"	"$4,401.09"	"$4,570.68"	$0.00	"$2,451.81"	$0.00	$0.00	$0.00	$0.00	"$2,398.07"	"$3,798.54"	"$3,836.91"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93574	ERX	HCPCS A9581	50419-0320-05	GADOXETATE DISODIUM 0.25 MOL/L IV SOLN	BOTH IP/OP	$572.38 	$423.56	$0.00	$424.82	$257.57	$257.57	$0.00	$0.00	$0.00	$119.30	$424.82	$424.82	$0.00	$0.00	$119.28	$0.00	$338.56	$338.56	$0.00	$259.79	$411.50	$415.66	$0.00		$0.00	$81.31	$0.00	$0.00	$82.72	$0.00	$0.00	$0.00	$0.00	$0.00
93748	ERX	HCPCS J9293	61703-0343-18	MITOXANTRONE HCL 20 MG/10ML IV CONC	BOTH IP/OP	$604.65 	$447.44	$0.00	$466.06		$0.00	$0.00	$0.00	$0.00	$0.00	$448.77	$448.77	$466.06	$0.00	$123.54	$0.00	$0.00	$0.00	$0.00	$270.30	$428.16	$432.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93748	ERX	HCPCS J9293	63323-0132-10	MITOXANTRONE HCL 20 MG/10ML IV CONC	BOTH IP/OP	$604.65 	$447.44	$0.00	$466.06		$0.00	$0.00	$0.00	$0.00	$0.00	$448.77	$448.77	$466.06	$0.00	$123.54	$0.00	$0.00	$0.00	$0.00	$270.30	$428.16	$432.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93823	ERX	HCPCS 63700001	00597-0002-01	TIPRANAVIR 100 MG/ML PO SOLN	BOTH IP/OP	"$1,702.25 "	"$1,259.67"	$0.00	"$1,361.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$851.13	"$1,348.18"	"$1,361.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93927	ERX	HCPCS 25000001	46287-0500-30	SORBITOL 70 % SOLN	BOTH IP/OP	$12.32 	$9.12	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$9.14	$9.14	$9.50	$0.00	$2.57	$0.00	$0.00	$0.00	$0.00	$13.50	$8.71	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93927	ERX	HCPCS 25000001	99999-6005-16	SORBITOL 70 % SOLN	BOTH IP/OP	$12.32 	$9.12	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$9.14	$9.14	$9.50	$0.00	$2.57	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93927	ERX	HCPCS 25000001	46287-0500-01	SORBITOL 70 % SOLN	BOTH IP/OP	$12.32 	$9.12	$0.00	$29.90		$0.00	$0.00	$0.00	$0.00	$0.00	$9.14	$9.14	$9.50	$0.00	$2.57	$0.00	$0.00	$0.00	$0.00	$13.50	$29.90	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93931	ERX	HCPCS 25000001	00487-0201-01	IPRATROPIUM-ALBUTEROL BASE 0.5-2.5 (3) MG/3ML IN SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$6.65		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$6.65	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93931	ERX	HCPCS 25000001	00487-0201-60	IPRATROPIUM-ALBUTEROL BASE 0.5-2.5 (3) MG/3ML IN SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$6.65		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$6.65	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93931	ERX	HCPCS 25000001	76204-0600-01	IPRATROPIUM-ALBUTEROL BASE 0.5-2.5 (3) MG/3ML IN SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$6.65		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$6.65	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94096	ERX	HCPCS J2405	00409-4755-03	ONDANSETRON HCL 4 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.99	$16.33	$16.33	$16.96	$0.00	$0.42	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.42	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
94096	ERX	HCPCS J2405	00641-6078-25	ONDANSETRON HCL 4 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.99	$16.33	$16.33	$16.96	$0.00	$0.42	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.42	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
94096	ERX	HCPCS J2405	00641-6080-25	ONDANSETRON HCL 4 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.99	$16.33	$16.33	$16.96	$0.00	$0.42	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.42	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
94096	ERX	HCPCS J2405	23155-0547-41	ONDANSETRON HCL 4 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.99	$16.33	$16.33	$16.96	$0.00	$0.42	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.42	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
94096	ERX	HCPCS J2405	23155-0547-42	ONDANSETRON HCL 4 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.99	$16.33	$16.33	$16.96	$0.00	$0.42	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.42	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
94096	ERX	HCPCS J2405	36000-0012-25	ONDANSETRON HCL 4 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.99	$16.33	$16.33	$16.96	$0.00	$0.42	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.42	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
94096	ERX	HCPCS J2405	55150-0125-02	ONDANSETRON HCL 4 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.99	$16.33	$16.33	$16.96	$0.00	$0.42	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.42	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
94096	ERX	HCPCS J2405	60505-6130-05	ONDANSETRON HCL 4 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.99	$16.33	$16.33	$16.96	$0.00	$0.42	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.42	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
94096	ERX	HCPCS J2405	70860-0776-02	ONDANSETRON HCL 4 MG/2ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.99	$16.33	$16.33	$16.96	$0.00	$0.42	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.42	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
94097	ERX	HCPCS J2405	00143-9890-01	ONDANSETRON HCL 40 MG/20ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.99	$16.33	$16.33	$16.96	$0.00	$0.42	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.42	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
94097	ERX	HCPCS J2405	63323-0374-20	ONDANSETRON HCL 40 MG/20ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.99	$16.33	$16.33	$16.96	$0.00	$0.42	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.42	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
94141	ERX	HCPCS 25000001	63824-0713-16	BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94141	ERX	HCPCS 25000001	63824-0715-16	BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94141	ERX	HCPCS 25000001	99999-6009-97	BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94219	ERX	HCPCS 25000001	10122-0313-10	NICARDIPINE HCL IN NACL 20-0.86 MG/200ML-% IV SOLN	BOTH IP/OP	$409.92 	$303.34	$0.00	$315.97		$0.00	$0.00	$0.00	$0.00	$0.00	$304.24	$304.24	$315.97	$0.00	$85.43	$0.00	$0.00	$0.00	$0.00	$186.05	$294.70	$297.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94576	ERX	HCPCS 25000001	10122-0325-10	NICARDIPINE HCL IN NACL 40-0.83 MG/200ML-% IV SOLN	BOTH IP/OP	$712.48 	$527.24	$0.00	$549.18		$0.00	$0.00	$0.00	$0.00	$0.00	$528.80	$528.80	$549.18	$0.00	$148.48	$0.00	$0.00	$0.00	$0.00	$323.30	$512.11	$517.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95687	ERX	HCPCS 63700001	65649-0103-02	MESALAMINE ER 0.375 G PO CP24	BOTH IP/OP	$78.80 	$58.31	$0.00	$57.16		$0.00	$0.00	$0.00	$14.03	$0.00	$0.00	$0.00	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$35.73	$56.59	$57.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95693	ERX	HCPCS 63700001	39328-0057-50	FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN	BOTH IP/OP	$36.67 	$27.14	$0.00	$26.60		$0.00	$0.00	$0.00	$6.53	$0.00	$0.00	$0.00	$0.00	$0.00	$7.64	$0.00	$0.00	$0.00	$0.00	$16.63	$26.33	$26.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95693	ERX	HCPCS 63700001	50383-0627-50	FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN	BOTH IP/OP	$36.67 	$27.14	$0.00	$26.60		$0.00	$0.00	$0.00	$6.53	$0.00	$0.00	$0.00	$0.00	$0.00	$7.64	$0.00	$0.00	$0.00	$0.00	$16.63	$26.33	$26.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95693	ERX	HCPCS 63700001	54838-0011-50	FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN	BOTH IP/OP	$36.67 	$27.14	$0.00	$26.60		$0.00	$0.00	$0.00	$6.53	$0.00	$0.00	$0.00	$0.00	$0.00	$7.64	$0.00	$0.00	$0.00	$0.00	$16.63	$26.33	$26.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95811	ERX	HCPCS 25000001	00409-9558-05	ROCURONIUM BROMIDE 50 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95811	ERX	HCPCS 25000001	00781-3220-95	ROCURONIUM BROMIDE 50 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95811	ERX	HCPCS 25000001	25021-0662-05	ROCURONIUM BROMIDE 50 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95811	ERX	HCPCS 25000001	39822-4200-02	ROCURONIUM BROMIDE 50 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95811	ERX	HCPCS 25000001	63323-0426-05	ROCURONIUM BROMIDE 50 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95811	ERX	HCPCS 25000001	67457-0228-05	ROCURONIUM BROMIDE 50 MG/5ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	00143-9251-01	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	00143-9251-10	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	00409-9558-10	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	00409-9558-31	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	00409-9558-50	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	00409-9558-70	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	00781-3220-70	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	00781-3220-92	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	25021-0662-10	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	39822-4200-05	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	39822-4200-06	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	67457-0228-10	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95812	ERX	HCPCS 25000001	70860-0651-10	ROCURONIUM BROMIDE 100 MG/10ML IV SOLN	BOTH IP/OP	$36.00 	$26.64	$0.00	$27.75		$0.00	$0.00	$0.00	$0.00	$0.00	$26.72	$26.72	$27.75	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96941	ERX	HCPCS 63700001	43598-0552-30	LAMOTRIGINE 100 MG PO TBDP	BOTH IP/OP	$42.81 	$31.68	$0.00	$31.06		$0.00	$0.00	$0.00	$7.62	$0.00	$0.00	$0.00	$0.00	$0.00	$8.92	$0.00	$0.00	$0.00	$0.00	$19.42	$30.75	$31.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96968	ERX	HCPCS 63700001	00131-2477-35	LACOSAMIDE 50 MG PO TABS	BOTH IP/OP	$50.06 	$37.04	$0.00	$34.62		$0.00	$0.00	$0.00	$8.02	$0.00	$0.00	$0.00	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$21.64	$34.28	$34.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96968	ERX	HCPCS 63700001	00131-2477-60	LACOSAMIDE 50 MG PO TABS	BOTH IP/OP	$50.06 	$37.04	$0.00	$34.62		$0.00	$0.00	$0.00	$8.02	$0.00	$0.00	$0.00	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$21.64	$34.28	$34.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96969	ERX	HCPCS 63700001	00131-2478-60	LACOSAMIDE 100 MG PO TABS	BOTH IP/OP	$79.32 	$58.70	$0.00	$59.55		$0.00	$0.00	$0.00	$12.54	$0.00	$0.00	$0.00	$0.00	$0.00	$16.53	$0.00	$0.00	$0.00	$0.00	$37.22	$58.96	$59.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96970	ERX	HCPCS 63700001	00131-2479-35	LACOSAMIDE 150 MG PO TABS	BOTH IP/OP	$82.89 	$61.34	$0.00	$57.33		$0.00	$0.00	$0.00	$13.28	$0.00	$0.00	$0.00	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$35.83	$56.75	$57.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96970	ERX	HCPCS 63700001	00131-2479-60	LACOSAMIDE 150 MG PO TABS	BOTH IP/OP	$82.89 	$61.34	$0.00	$57.33		$0.00	$0.00	$0.00	$13.28	$0.00	$0.00	$0.00	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$35.83	$56.75	$57.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96971	ERX	HCPCS 63700001	00131-2480-35	LACOSAMIDE 200 MG PO TABS	BOTH IP/OP	$82.91 	$61.35	$0.00	$57.34		$0.00	$0.00	$0.00	$13.28	$0.00	$0.00	$0.00	$0.00	$0.00	$17.28	$0.00	$0.00	$0.00	$0.00	$35.84	$56.77	$57.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96971	ERX	HCPCS 63700001	00131-2480-60	LACOSAMIDE 200 MG PO TABS	BOTH IP/OP	$82.91 	$61.35	$0.00	$57.34		$0.00	$0.00	$0.00	$13.28	$0.00	$0.00	$0.00	$0.00	$0.00	$17.28	$0.00	$0.00	$0.00	$0.00	$35.84	$56.77	$57.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96972	ERX	HCPCS C9254	00131-1810-67	LACOSAMIDE 200 MG/20ML IV SOLN	BOTH IP/OP	$94.63 	$70.03	$0.00	$77.97	$45.52	$45.52	$0.00	$0.00	$0.00	$19.72	$75.08	$75.08	$77.97	$0.00	$19.72	$0.00	$55.97	$55.97	$0.00	$40.90	$64.79	$65.44	$0.00		$0.00	$12.80	$0.00	$0.00	$13.02	$0.00	$0.00	$0.00	$0.00	$0.00
96976	ERX	HCPCS 25000001	00186-0917-06	BUDESONIDE 90 MCG/ACT IN AEPB	BOTH IP/OP	$672.22 	$497.44	$0.00	$518.15		$0.00	$0.00	$0.00	$0.00	$0.00	$498.92	$498.92	$518.15	$0.00	$140.09	$0.00	$0.00	$0.00	$0.00	$294.72	$466.84	$471.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96977	ERX	HCPCS 25000001	00186-0916-12	BUDESONIDE 180 MCG/ACT IN AEPB	BOTH IP/OP	$900.15 	$666.11	$0.00	$693.84		$0.00	$0.00	$0.00	$0.00	$0.00	$668.09	$668.09	$693.84	$0.00	$187.59	$0.00	$0.00	$0.00	$0.00	$394.64	$625.11	$631.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96982	ERX	HCPCS J9100	61703-0305-38	CYTARABINE (PF) 20 MG/ML IJ SOLN	BOTH IP/OP	$127.38 	$94.26	$0.00	$98.18		$0.00	$0.00	$0.00	$0.00	$0.00	$94.54	$94.54	$98.18	$0.00	$8.03	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96982	ERX	HCPCS J9100	61703-0303-46	CYTARABINE (PF) 20 MG/ML IJ SOLN	BOTH IP/OP	$127.38 	$94.26	$0.00	$98.18		$0.00	$0.00	$0.00	$0.00	$0.00	$94.54	$94.54	$98.18	$0.00	$8.03	$0.00	$0.00	$0.00	$0.00	$28.50	$90.09	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96986	ERX	HCPCS J9155	55566-8303-01	DEGARELIX ACETATE 80 MG SC SOLR	BOTH IP/OP	"$1,518.11 "	"$1,123.40"	$0.00	"$1,170.16"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,126.74"	"$1,126.74"	"$1,170.16"	$0.00	$387.28	$0.00	$0.00	$0.00	$0.00	$703.37	"$1,114.14"	"$1,125.39"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96988	ERX	HCPCS 25000001	66220-0160-10	CONIVAPTAN HCL IN DEXTROSE 20-5 MG/100ML-% IV SOLN	BOTH IP/OP	"$2,518.10 "	"$1,863.39"	$0.00	"$1,940.95"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,868.93"	"$1,868.93"	"$1,940.95"	$0.00	$524.77	$0.00	$0.00	$0.00	$0.00	"$1,146.24"	"$1,815.64"	"$1,833.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97005	ERX	HCPCS 63700001	30768-0003-48	MILK THISTLE XTRA PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97053	ERX	HCPCS 63700001	59676-0563-01	DARUNAVIR ETHANOLATE 75 MG PO TABS	BOTH IP/OP	$142.45 	$105.41	$0.00	$98.88		$0.00	$0.00	$0.00	$26.77	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$0.00	$0.00	$0.00	$0.00	$61.80	$97.89	$98.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97133	ERX	HCPCS 63700001	64764-0918-30	FEBUXOSTAT 40 MG PO TABS	BOTH IP/OP	$55.32 	$40.94	$0.00	$40.14		$0.00	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$25.09	$39.73	$40.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97134	ERX	HCPCS 63700001	64764-0677-30	FEBUXOSTAT 80 MG PO TABS	BOTH IP/OP	$55.32 	$40.94	$0.00	$40.14		$0.00	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$25.09	$39.73	$40.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97252	ERX	HCPCS J3490	99999-6010-51	DILTIAZEM HCL 25 MG/5ML IV SOLN	BOTH IP/OP	$811.76 	$600.70	$0.00	$625.70	$365.29	$365.29	$0.00	$0.00	$0.00	$169.19	$602.49	$602.49	$625.70	$0.00	$169.17	$0.00	$480.16	$480.16	$0.00	$368.35	$583.47	$589.36	$0.00		$0.00	$115.29	$0.00	$0.00	$117.28	$0.00	$0.00	$0.00	$0.00	$0.00
97253	ERX	HCPCS 25000001	00641-6015-10	DILTIAZEM HCL 125 MG/25ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97254	ERX	HCPCS 25000001	00409-1171-02	DILTIAZEM HCL 50 MG/10ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97254	ERX	HCPCS 25000001	00641-6014-01	DILTIAZEM HCL 50 MG/10ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97254	ERX	HCPCS 25000001	00641-6014-10	DILTIAZEM HCL 50 MG/10ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97254	ERX	HCPCS 25000001	00641-9218-10	DILTIAZEM HCL 50 MG/10ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97254	ERX	HCPCS 25000001	17478-0937-10	DILTIAZEM HCL 50 MG/10ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97266	ERX	HCPCS 63700001	00456-1420-90	NEBIVOLOL HCL 20 MG PO TABS	BOTH IP/OP	$26.47 	$19.59	$0.00	$18.30		$0.00	$0.00	$0.00	$4.95	$0.00	$0.00	$0.00	$0.00	$0.00	$5.52	$0.00	$0.00	$0.00	$0.00	$11.44	$18.11	$18.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97343	ERX	HCPCS 63700001	00781-3174-14	SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN	BOTH IP/OP	$294.95 	$218.26	$0.00	$214.20		$0.00	$0.00	$0.00	$52.50	$0.00	$0.00	$0.00	$0.00	$0.00	$61.47	$0.00	$0.00	$0.00	$0.00	$133.88	$212.06	$214.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97343	ERX	HCPCS 63700001	55150-0173-01	SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN	BOTH IP/OP	$294.95 	$218.26	$0.00	$214.20		$0.00	$0.00	$0.00	$52.50	$0.00	$0.00	$0.00	$0.00	$0.00	$61.47	$0.00	$0.00	$0.00	$0.00	$133.88	$212.06	$214.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97343	ERX	HCPCS 63700001	63323-0273-01	SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN	BOTH IP/OP	$294.95 	$218.26	$0.00	$214.20		$0.00	$0.00	$0.00	$52.50	$0.00	$0.00	$0.00	$0.00	$0.00	$61.47	$0.00	$0.00	$0.00	$0.00	$133.88	$212.06	$214.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97371	ERX	HCPCS J3370	00143-9355-10	VANCOMYCIN HCL 750 MG IV SOLR	BOTH IP/OP	$47.77 	$35.35	$0.00	$36.82	$21.50	$21.50	$0.00	$0.00	$0.00	$3.62	$35.45	$35.45	$36.82	$0.00	$3.34	$0.00	$28.26	$28.26	$0.00	$21.66	$34.31	$34.66	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
97371	ERX	HCPCS J3370	00409-6531-02	VANCOMYCIN HCL 750 MG IV SOLR	BOTH IP/OP	$47.77 	$35.35	$0.00	$36.82	$21.50	$21.50	$0.00	$0.00	$0.00	$3.62	$35.45	$35.45	$36.82	$0.00	$3.34	$0.00	$28.26	$28.26	$0.00	$21.66	$34.31	$34.66	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
97371	ERX	HCPCS J3370	63323-0203-20	VANCOMYCIN HCL 750 MG IV SOLR	BOTH IP/OP	$47.77 	$35.35	$0.00	$36.82	$21.50	$21.50	$0.00	$0.00	$0.00	$3.62	$35.45	$35.45	$36.82	$0.00	$3.34	$0.00	$28.26	$28.26	$0.00	$21.66	$34.31	$34.66	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
97389	ERX	HCPCS J7527	00078-0566-51	EVEROLIMUS 5 MG PO TABS	BOTH IP/OP	"$1,743.45 "	"$1,290.15"	$0.00	"$1,343.85"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,293.99"	"$1,293.99"	"$1,343.85"	$0.00	$363.33	$0.00	$0.00	$0.00	$0.00	$807.78	"$1,279.52"	"$1,292.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97390	ERX	HCPCS J7527	00078-0567-51	EVEROLIMUS 10 MG PO TABS	BOTH IP/OP	"$1,743.45 "	"$1,290.15"	$0.00	"$1,343.85"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,293.99"	"$1,293.99"	"$1,343.85"	$0.00	$363.33	$0.00	$0.00	$0.00	$0.00	$807.78	"$1,279.52"	"$1,292.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97480	ERX	HCPCS J7510	99999-6010-77	PREDNISOLONE 15 MG/5ML PO SOLN	BOTH IP/OP	$119.28 	$88.27	$0.00	$145.76		$0.00	$0.00	$0.00	$0.00	$24.86	$88.53	$88.53	$91.94	$0.00	$24.86	$0.00	$70.55	$70.55	$0.00	$91.10	$85.65	$145.76	$0.00		$0.00	$28.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97480	ERX	HCPCS J7510	99999-6004-79	PREDNISOLONE 15 MG/5ML PO SOLN	BOTH IP/OP	$119.28 	$88.27	$0.00	$145.76		$0.00	$0.00	$0.00	$0.00	$24.86	$88.53	$88.53	$91.94	$0.00	$24.86	$0.00	$70.55	$70.55	$0.00	$91.10	$144.30	$145.76	$0.00		$0.00	$28.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97480	ERX	HCPCS J7510	50383-0042-24	PREDNISOLONE 15 MG/5ML PO SOLN	BOTH IP/OP	$119.28 	$88.27	$0.00	$279.44		$0.00	$0.00	$0.00	$0.00	$24.86	$88.53	$88.53	$91.94	$0.00	$24.86	$0.00	$70.55	$70.55	$0.00	$91.10	$279.44	$145.76	$0.00		$0.00	$28.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97480	ERX	HCPCS J7510	50383-0042-48	PREDNISOLONE 15 MG/5ML PO SOLN	BOTH IP/OP	$119.28 	$88.27	$0.00	$446.40		$0.00	$0.00	$0.00	$0.00	$24.86	$88.53	$88.53	$91.94	$0.00	$24.86	$0.00	$70.55	$70.55	$0.00	$91.10	$446.40	$145.76	$0.00		$0.00	$28.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97660	ERX	HCPCS 25000001	48582-0512-01	BIOTENE ORALBALANCE DRY MOUTH MT GEL	BOTH IP/OP	$23.76 	$17.58	$0.00	$18.31		$0.00	$0.00	$0.00	$0.00	$0.00	$17.63	$17.63	$18.31	$0.00	$4.95	$0.00	$0.00	$0.00	$0.00	$10.78	$17.07	$17.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97716	ERX	HCPCS J1885	00409-3796-01	KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.63	$16.33	$16.33	$16.96	$0.00	$1.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.22	$0.00	$0.00	$1.16	$0.00	$0.00	$0.00	$0.00	$0.00
97716	ERX	HCPCS J1885	00641-6043-25	KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.63	$16.33	$16.33	$16.96	$0.00	$1.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.22	$0.00	$0.00	$1.16	$0.00	$0.00	$0.00	$0.00	$0.00
97716	ERX	HCPCS J1885	25021-0701-02	KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.63	$16.33	$16.33	$16.96	$0.00	$1.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.22	$0.00	$0.00	$1.16	$0.00	$0.00	$0.00	$0.00	$0.00
97716	ERX	HCPCS J1885	47781-0585-68	KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.63	$16.33	$16.33	$16.96	$0.00	$1.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.22	$0.00	$0.00	$1.16	$0.00	$0.00	$0.00	$0.00	$0.00
97716	ERX	HCPCS J1885	63323-0162-02	KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.63	$16.33	$16.33	$16.96	$0.00	$1.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.22	$0.00	$0.00	$1.16	$0.00	$0.00	$0.00	$0.00	$0.00
97716	ERX	HCPCS J1885	63323-0162-14	KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.63	$16.33	$16.33	$16.96	$0.00	$1.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.22	$0.00	$0.00	$1.16	$0.00	$0.00	$0.00	$0.00	$0.00
97744	ERX	HCPCS 63700001	68180-0771-06	AMLOD/VALSA/HCTZ 5-160-12.5 MG TAB	BOTH IP/OP	$21.65 	$16.02	$0.00	$17.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.83	$17.15	$17.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97745	ERX	HCPCS 63700001	68180-0773-06	AMLOD/VALSA/HCTZ 5-160-25 MG TAB	BOTH IP/OP	$21.65 	$16.02	$0.00	$17.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.83	$17.15	$17.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97747	ERX	HCPCS 63700001	68180-0774-06	AMLOD/VALSA/HCTZ 10-160-25 MG TABS	BOTH IP/OP	$24.56 	$18.17	$0.00	$19.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.28	$19.45	$19.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97748	ERX	HCPCS 63700001	68180-0775-06	AMLOD/VALSA/HCTZ 10-320-25 MG TABS	BOTH IP/OP	$31.17 	$23.07	$0.00	$24.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.59	$24.69	$24.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97790	ERX	HCPCS J3260	63323-0306-30	TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN	BOTH IP/OP	$101.91 	$75.41	$0.00	$78.55	$45.86	$45.86	$0.00	$0.00	$0.00	$38.42	$75.64	$75.64	$78.55	$0.00	$67.70	$0.00	$60.28	$60.28	$0.00	$46.20	$73.18	$73.92	$0.00		$0.00	$65.04	$0.00	$0.00	$61.93	$0.00	$0.00	$0.00	$0.00	$0.00
97790	ERX	HCPCS J3260	67457-0428-00	TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN	BOTH IP/OP	$101.91 	$75.41	$0.00	$78.55	$45.86	$45.86	$0.00	$0.00	$0.00	$38.42	$75.64	$75.64	$78.55	$0.00	$67.70	$0.00	$60.28	$60.28	$0.00	$46.20	$73.18	$73.92	$0.00		$0.00	$65.04	$0.00	$0.00	$61.93	$0.00	$0.00	$0.00	$0.00	$0.00
97790	ERX	HCPCS J3260	67457-0428-30	TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN	BOTH IP/OP	$101.91 	$75.41	$0.00	$78.55	$45.86	$45.86	$0.00	$0.00	$0.00	$38.42	$75.64	$75.64	$78.55	$0.00	$67.70	$0.00	$60.28	$60.28	$0.00	$46.20	$73.18	$73.92	$0.00		$0.00	$65.04	$0.00	$0.00	$61.93	$0.00	$0.00	$0.00	$0.00	$0.00
97830	ERX	HCPCS 63700001	00173-0772-02	LAMOTRIGINE 25 MG PO TBDP	BOTH IP/OP	$33.73 	$24.96	$0.00	$26.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.87	$26.71	$26.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97893	ERX	HCPCS 63700001	59148-0020-50	TOLVAPTAN 15 MG PO TABS	BOTH IP/OP	$819.33 	$606.30	$0.00	$594.86		$0.00	$0.00	$0.00	$145.84	$0.00	$0.00	$0.00	$0.00	$0.00	$170.75	$0.00	$0.00	$0.00	$0.00	$371.79	$588.91	$594.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97893	ERX	HCPCS 63700001	99999-6011-58	TOLVAPTAN 15 MG PO TABS	BOTH IP/OP	$819.33 	$606.30	$0.00	$594.86		$0.00	$0.00	$0.00	$145.84	$0.00	$0.00	$0.00	$0.00	$0.00	$170.75	$0.00	$0.00	$0.00	$0.00	$371.79	$588.91	$594.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97894	ERX	HCPCS 25000001	59148-0021-50	TOLVAPTAN 30 MG PO TABS	BOTH IP/OP	"$1,677.22 "	"$1,241.14"	$0.00	"$1,292.80"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,244.83"	"$1,244.83"	"$1,292.80"	$0.00	$349.53	$0.00	$0.00	$0.00	$0.00	$740.09	"$1,172.29"	"$1,184.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98035	ERX	HCPCS 63700001	00032-1212-01	PANCRELIPASE (LIP-PROT-AMYL) 12000 UNITS PO CPEP	BOTH IP/OP	$17.84 	$13.20	$0.00	$12.19		$0.00	$0.00	$0.00	$3.37	$0.00	$0.00	$0.00	$0.00	$0.00	$3.72	$0.00	$0.00	$0.00	$0.00	$7.62	$12.07	$12.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98127	ERX	HCPCS 25000001	08271-0361-00	LANCETS ULTRA THIN MISC	BOTH IP/OP	$11.32 	$8.38	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.40	$8.40	$8.73	$0.00	$2.36	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98249	ERX	HCPCS J9190	16729-0276-38	FLUOROURACIL 5 GM/100ML IV SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98249	ERX	HCPCS J9190	63323-0117-61	FLUOROURACIL 5 GM/100ML IV SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$1.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98329	ERX	HCPCS 25000001	00024-4142-60	DRONEDARONE HCL 400 MG PO TABS	BOTH IP/OP	$57.94 	$42.88	$0.00	$46.76		$0.00	$0.00	$0.00	$0.00	$0.00	$45.02	$45.02	$46.76	$0.00	$12.07	$0.00	$0.00	$0.00	$0.00	$25.02	$39.63	$40.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98372	ERX	HCPCS 63700001	60505-4642-03	PRASUGREL HCL 5 MG PO TABS	BOTH IP/OP	$69.17 	$51.19	$0.00	$50.18		$0.00	$0.00	$0.00	$12.31	$0.00	$0.00	$0.00	$0.00	$0.00	$14.42	$0.00	$0.00	$0.00	$0.00	$31.37	$49.68	$50.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98373	ERX	HCPCS 63700001	00002-5123-30	PRASUGREL HCL 10 MG PO TABS	BOTH IP/OP	$69.17 	$51.19	$0.00	$50.18		$0.00	$0.00	$0.00	$12.31	$0.00	$0.00	$0.00	$0.00	$0.00	$14.42	$0.00	$0.00	$0.00	$0.00	$31.37	$49.68	$50.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98373	ERX	HCPCS 63700001	00378-5186-93	PRASUGREL HCL 10 MG PO TABS	BOTH IP/OP	$69.17 	$51.19	$0.00	$50.18		$0.00	$0.00	$0.00	$12.31	$0.00	$0.00	$0.00	$0.00	$0.00	$14.42	$0.00	$0.00	$0.00	$0.00	$31.37	$49.68	$50.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98373	ERX	HCPCS 63700001	16729-0273-10	PRASUGREL HCL 10 MG PO TABS	BOTH IP/OP	$69.17 	$51.19	$0.00	$50.18		$0.00	$0.00	$0.00	$12.31	$0.00	$0.00	$0.00	$0.00	$0.00	$14.42	$0.00	$0.00	$0.00	$0.00	$31.37	$49.68	$50.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98373	ERX	HCPCS 63700001	60505-4643-03	PRASUGREL HCL 10 MG PO TABS	BOTH IP/OP	$69.17 	$51.19	$0.00	$50.18		$0.00	$0.00	$0.00	$12.31	$0.00	$0.00	$0.00	$0.00	$0.00	$14.42	$0.00	$0.00	$0.00	$0.00	$31.37	$49.68	$50.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98373	ERX	HCPCS 63700001	65162-0002-03	PRASUGREL HCL 10 MG PO TABS	BOTH IP/OP	$69.17 	$51.19	$0.00	$50.18		$0.00	$0.00	$0.00	$12.31	$0.00	$0.00	$0.00	$0.00	$0.00	$14.42	$0.00	$0.00	$0.00	$0.00	$31.37	$49.68	$50.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98373	ERX	HCPCS 63700001	65862-0830-30	PRASUGREL HCL 10 MG PO TABS	BOTH IP/OP	$69.17 	$51.19	$0.00	$50.18		$0.00	$0.00	$0.00	$12.31	$0.00	$0.00	$0.00	$0.00	$0.00	$14.42	$0.00	$0.00	$0.00	$0.00	$31.37	$49.68	$50.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98373	ERX	HCPCS 63700001	67877-0605-30	PRASUGREL HCL 10 MG PO TABS	BOTH IP/OP	$69.17 	$51.19	$0.00	$50.18		$0.00	$0.00	$0.00	$12.31	$0.00	$0.00	$0.00	$0.00	$0.00	$14.42	$0.00	$0.00	$0.00	$0.00	$31.37	$49.68	$50.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99404	ERX	HCPCS 25000001	42799-0217-01	OPIUM 10 MG/ML (1%) PO TINC	BOTH IP/OP	"$1,916.55 "	"$1,418.25"	$0.00	"$1,477.28"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,422.46"	"$1,422.46"	"$1,477.28"	$0.00	$399.41	$0.00	$0.00	$0.00	$0.00	$887.98	"$1,406.55"	"$1,420.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99404	ERX	HCPCS 25000001	62559-0153-04	OPIUM 10 MG/ML (1%) PO TINC	BOTH IP/OP	"$1,916.55 "	"$1,418.25"	$0.00	"$1,477.28"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,422.46"	"$1,422.46"	"$1,477.28"	$0.00	$399.41	$0.00	$0.00	$0.00	$0.00	$887.98	"$1,406.55"	"$1,420.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99438	ERX	HCPCS 63700001	16714-0809-01	LEVONORGESTREL 1.5 MG PO TABS	BOTH IP/OP	$136.50 	$101.01	$0.00	$109.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.25	$108.11	$109.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99438	ERX	HCPCS 63700001	51285-0146-19	LEVONORGESTREL 1.5 MG PO TABS	BOTH IP/OP	$136.50 	$101.01	$0.00	$109.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.25	$108.11	$109.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99438	ERX	HCPCS 63700001	51285-0162-88	LEVONORGESTREL 1.5 MG PO TABS	BOTH IP/OP	$136.50 	$101.01	$0.00	$109.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.25	$108.11	$109.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99438	ERX	HCPCS 63700001	62756-0720-60	LEVONORGESTREL 1.5 MG PO TABS	BOTH IP/OP	$136.50 	$101.01	$0.00	$109.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.25	$108.11	$109.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99438	ERX	HCPCS 63700001	68180-0852-11	LEVONORGESTREL 1.5 MG PO TABS	BOTH IP/OP	$136.50 	$101.01	$0.00	$109.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.25	$108.11	$109.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99438	ERX	HCPCS 63700001	69536-0146-19	LEVONORGESTREL 1.5 MG PO TABS	BOTH IP/OP	$136.50 	$101.01	$0.00	$109.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.25	$108.11	$109.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99452	ERX	HCPCS J7312	00023-3348-07	DEXAMETHASONE 0.7 MG INTRAVITREAL IMPL	BOTH IP/OP	"$3,615.10 "	"$2,675.17"	$0.00	"$2,786.52"	"$1,626.80"	"$1,626.80"	"$1,399.97"	"$1,399.97"	"$1,399.97"	$753.48	"$2,683.13"	"$2,683.13"	"$2,786.52"	"$1,397.82"	"$1,642.44"	$908.58	"$1,782.24"	"$1,782.24"	"$1,470.19"	"$1,639.59"	"$2,597.11"	"$2,623.34"	"$2,030.26"		"$2,030.26"	"$1,645.82"	$0.00	$0.00	"$1,567.10"	"$1,400.55"	$0.00	$0.00	$0.00	$0.00
99602	ERX	HCPCS J9263	00703-3985-01	OXALIPLATIN 50 MG/10ML IV SOLN	BOTH IP/OP	$208.20 	$154.07	$0.00	"$1,124.48"	$93.69	$93.69	$0.00	$0.00	$0.00	"$1,124.48"	$154.53	$154.53	$160.48	$0.00	$12.93	$0.00	$123.15	$123.15	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$17.63	$0.00	$0.00	$16.78	$0.00	$0.00	$0.00	$0.00	$0.00
99602	ERX	HCPCS J9263	00781-3315-70	OXALIPLATIN 50 MG/10ML IV SOLN	BOTH IP/OP	$208.20 	$154.07	$0.00	"$1,124.48"	$93.69	$93.69	$0.00	$0.00	$0.00	"$1,124.48"	$154.53	$154.53	$160.48	$0.00	$12.93	$0.00	$123.15	$123.15	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$17.63	$0.00	$0.00	$16.78	$0.00	$0.00	$0.00	$0.00	$0.00
99602	ERX	HCPCS J9263	00781-9315-70	OXALIPLATIN 50 MG/10ML IV SOLN	BOTH IP/OP	$208.20 	$154.07	$0.00	"$1,124.48"	$93.69	$93.69	$0.00	$0.00	$0.00	"$1,124.48"	$154.53	$154.53	$160.48	$0.00	$12.93	$0.00	$123.15	$123.15	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$17.63	$0.00	$0.00	$16.78	$0.00	$0.00	$0.00	$0.00	$0.00
99602	ERX	HCPCS J9263	25021-0233-10	OXALIPLATIN 50 MG/10ML IV SOLN	BOTH IP/OP	$208.20 	$154.07	$0.00	"$1,124.48"	$93.69	$93.69	$0.00	$0.00	$0.00	"$1,124.48"	$154.53	$154.53	$160.48	$0.00	$12.93	$0.00	$123.15	$123.15	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$17.63	$0.00	$0.00	$16.78	$0.00	$0.00	$0.00	$0.00	$0.00
99602	ERX	HCPCS J9263	61703-0363-18	OXALIPLATIN 50 MG/10ML IV SOLN	BOTH IP/OP	$208.20 	$154.07	$0.00	"$1,124.48"	$93.69	$93.69	$0.00	$0.00	$0.00	"$1,124.48"	$154.53	$154.53	$160.48	$0.00	$12.93	$0.00	$123.15	$123.15	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$17.63	$0.00	$0.00	$16.78	$0.00	$0.00	$0.00	$0.00	$0.00
99602	ERX	HCPCS J9263	67457-0469-10	OXALIPLATIN 50 MG/10ML IV SOLN	BOTH IP/OP	$208.20 	$154.07	$0.00	"$1,124.48"	$93.69	$93.69	$0.00	$0.00	$0.00	"$1,124.48"	$154.53	$154.53	$160.48	$0.00	$12.93	$0.00	$123.15	$123.15	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$17.63	$0.00	$0.00	$16.78	$0.00	$0.00	$0.00	$0.00	$0.00
99604	ERX	HCPCS J9263	00703-3986-01	OXALIPLATIN 100 MG/20ML IV SOLN	BOTH IP/OP	$208.20 	$154.07	$0.00	"$2,248.95"	$93.69	$93.69	$0.00	$0.00	$0.00	"$2,248.95"	$154.53	$154.53	$160.48	$0.00	$25.85	$0.00	$123.15	$123.15	$0.00	$183.00	$289.87	$292.80	$0.00		$0.00	$35.25	$0.00	$0.00	$33.56	$0.00	$0.00	$0.00	$0.00	$0.00
99604	ERX	HCPCS J9263	00781-3317-80	OXALIPLATIN 100 MG/20ML IV SOLN	BOTH IP/OP	$208.20 	$154.07	$0.00	"$2,248.95"	$93.69	$93.69	$0.00	$0.00	$0.00	"$2,248.95"	$154.53	$154.53	$160.48	$0.00	$25.85	$0.00	$123.15	$123.15	$0.00	$183.00	$289.87	$292.80	$0.00		$0.00	$35.25	$0.00	$0.00	$33.56	$0.00	$0.00	$0.00	$0.00	$0.00
99604	ERX	HCPCS J9263	00955-1727-20	OXALIPLATIN 100 MG/20ML IV SOLN	BOTH IP/OP	$208.20 	$154.07	$0.00	"$2,248.95"	$93.69	$93.69	$0.00	$0.00	$0.00	"$2,248.95"	$154.53	$154.53	$160.48	$0.00	$25.85	$0.00	$123.15	$123.15	$0.00	$183.00	$289.87	$292.80	$0.00		$0.00	$35.25	$0.00	$0.00	$33.56	$0.00	$0.00	$0.00	$0.00	$0.00
99604	ERX	HCPCS J9263	25021-0233-20	OXALIPLATIN 100 MG/20ML IV SOLN	BOTH IP/OP	$208.20 	$154.07	$0.00	"$2,248.95"	$93.69	$93.69	$0.00	$0.00	$0.00	"$2,248.95"	$154.53	$154.53	$160.48	$0.00	$25.85	$0.00	$123.15	$123.15	$0.00	$183.00	$289.87	$292.80	$0.00		$0.00	$35.25	$0.00	$0.00	$33.56	$0.00	$0.00	$0.00	$0.00	$0.00
99604	ERX	HCPCS J9263	61703-0363-22	OXALIPLATIN 100 MG/20ML IV SOLN	BOTH IP/OP	$208.20 	$154.07	$0.00	"$2,248.95"	$93.69	$93.69	$0.00	$0.00	$0.00	"$2,248.95"	$154.53	$154.53	$160.48	$0.00	$25.85	$0.00	$123.15	$123.15	$0.00	$183.00	$289.87	$292.80	$0.00		$0.00	$35.25	$0.00	$0.00	$33.56	$0.00	$0.00	$0.00	$0.00	$0.00
99686	ERX	HCPCS 63700001	00955-1052-90	SEVELAMER CARBONATE 0.8 G PO PACK	BOTH IP/OP	$47.55 	$35.19	$0.00	$34.50		$0.00	$0.00	$0.00	$8.46	$0.00	$0.00	$0.00	$0.00	$0.00	$9.91	$0.00	$0.00	$0.00	$0.00	$21.56	$34.15	$34.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99686	ERX	HCPCS 63700001	65862-0930-90	SEVELAMER CARBONATE 0.8 G PO PACK	BOTH IP/OP	$47.55 	$35.19	$0.00	$34.50		$0.00	$0.00	$0.00	$8.46	$0.00	$0.00	$0.00	$0.00	$0.00	$9.91	$0.00	$0.00	$0.00	$0.00	$21.56	$34.15	$34.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99687	ERX	HCPCS 63700001	58468-0131-01	SEVELAMER CARBONATE 2.4 G PO PACK	BOTH IP/OP	$82.67 	$61.18	$0.00	$59.97		$0.00	$0.00	$0.00	$14.72	$0.00	$0.00	$0.00	$0.00	$0.00	$17.23	$0.00	$0.00	$0.00	$0.00	$37.48	$59.37	$59.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99687	ERX	HCPCS 63700001	58468-0131-02	SEVELAMER CARBONATE 2.4 G PO PACK	BOTH IP/OP	$82.67 	$61.18	$0.00	$59.97		$0.00	$0.00	$0.00	$14.72	$0.00	$0.00	$0.00	$0.00	$0.00	$17.23	$0.00	$0.00	$0.00	$0.00	$37.48	$59.37	$59.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99744	ERX	HCPCS 25000001	58160-0818-11	HAEMOPHILUS B POLYSAC CONJ VAC 10 MCG IJ SOLR	BOTH IP/OP	$59.72 	$44.19	$0.00	$46.03		$0.00	$0.00	$0.00	$0.00	$0.00	$44.32	$44.32	$46.03	$0.00	$12.45	$0.00	$0.00	$0.00	$0.00	$25.15	$39.83	$40.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99746	ERX	HCPCS 63700001	00456-2405-60	ASENAPINE MALEATE 5 MG SL SUBL	BOTH IP/OP	$92.71 	$68.61	$0.00	$67.25		$0.00	$0.00	$0.00	$16.50	$0.00	$0.00	$0.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$42.03	$66.58	$67.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99765	ERX	HCPCS Q4074	66215-0303-00	ILOPROST 20 MCG/ML IN SOLN	BOTH IP/OP	$81.12 	$60.03	$0.00	$62.53		$0.00	$0.00	$0.00	$0.00	$0.00	$60.21	$60.21	$62.53	$0.00	$16.91	$0.00	$0.00	$0.00	$0.00	$36.78	$58.25	$58.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99765	ERX	HCPCS Q4074	66215-0303-30	ILOPROST 20 MCG/ML IN SOLN	BOTH IP/OP	$81.12 	$60.03	$0.00	$62.53		$0.00	$0.00	$0.00	$0.00	$0.00	$60.21	$60.21	$62.53	$0.00	$16.91	$0.00	$0.00	$0.00	$0.00	$36.78	$58.25	$58.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100004	ERX	HCPCS 63700001	16714-0866-01	PALIPERIDONE ER 1.5 MG PO TB24	BOTH IP/OP	$117.84 	$87.20	$0.00	$85.48		$0.00	$0.00	$0.00	$20.98	$0.00	$0.00	$0.00	$0.00	$0.00	$24.56	$0.00	$0.00	$0.00	$0.00	$53.43	$84.63	$85.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100004	ERX	HCPCS 63700001	50458-0554-01	PALIPERIDONE ER 1.5 MG PO TB24	BOTH IP/OP	$117.84 	$87.20	$0.00	$85.48		$0.00	$0.00	$0.00	$20.98	$0.00	$0.00	$0.00	$0.00	$0.00	$24.56	$0.00	$0.00	$0.00	$0.00	$53.43	$84.63	$85.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100055	ERX	HCPCS 25000001	00904-6422-81	PEG 3350 17 G PO PACK	BOTH IP/OP	$7.11 	$5.26	$0.00	$5.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.56	$5.63	$5.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100055	ERX	HCPCS 25000001	00904-6422-86	PEG 3350 17 G PO PACK	BOTH IP/OP	$7.11 	$5.26	$0.00	$5.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.56	$5.63	$5.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100055	ERX	HCPCS 25000001	00904-6931-81	PEG 3350 17 G PO PACK	BOTH IP/OP	$7.11 	$5.26	$0.00	$5.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.56	$5.63	$5.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100055	ERX	HCPCS 25000001	00904-6931-86	PEG 3350 17 G PO PACK	BOTH IP/OP	$7.11 	$5.26	$0.00	$5.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.56	$5.63	$5.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100212	ERX	HCPCS 25000001	24571-0105-06	PRISMASOL BGK 4/2.5 32-4-2.5 MEQ/L IV SOLN	BOTH IP/OP	$252.00 	$186.48	$0.00	$201.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.00	$199.58	$201.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100215	ERX	HCPCS 25000001	24571-0103-06	PRISMASOL BGK 2/3.5 32-2-3.5 MEQ/L IV SOLN	BOTH IP/OP	$252.00 	$186.48	$0.00	$201.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.00	$199.58	$201.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100258	ERX	HCPCS J9302	00078-0669-13	OFATUMUMAB 100 MG/5ML IV CONC	BOTH IP/OP	"$1,875.28 "	"$1,387.71"	$0.00	"$1,445.47"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.83"	"$1,391.83"	"$1,445.47"	$0.00	$751.49	$0.00	$0.00	$0.00	$0.00	$868.86	"$1,376.27"	"$1,390.17"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100258	ERX	HCPCS J9302	00078-0669-61	OFATUMUMAB 100 MG/5ML IV CONC	BOTH IP/OP	"$1,875.28 "	"$1,387.71"	$0.00	"$1,445.47"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.83"	"$1,391.83"	"$1,445.47"	$0.00	$751.49	$0.00	$0.00	$0.00	$0.00	$868.86	"$1,376.27"	"$1,390.17"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100265	ERX	HCPCS J0597	63833-0825-02	C1 ESTERASE INHIBITOR (HUMAN) 500 UNITS IV KIT	BOTH IP/OP	"$4,631,757.00 "	"$3,427,500.18"	$0.00	"$3,570,158.30"		$0.00	$0.00	$0.00	$0.00	$0.00	"$3,437,690.05"	"$3,437,690.05"	"$3,570,158.30"	$0.00	"$965,258.16"	$0.00	$0.00	$0.00	$0.00	"$1,906,500.00"	"$3,019,896.00"	"$3,050,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100482	ERX	HCPCS 63700001	42291-0266-01	VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100482	ERX	HCPCS 63700001	64380-0737-06	VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100482	ERX	HCPCS 63700001	69452-0151-20	VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100597	ERX	HCPCS 25000001	63481-0684-47	DICLOFENAC SODIUM 1 % TD GEL	BOTH IP/OP	$172.62 	$127.74	$0.00	$138.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.31	$136.72	$138.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100597	ERX	HCPCS 25000001	65162-0833-66	DICLOFENAC SODIUM 1 % TD GEL	BOTH IP/OP	$172.62 	$127.74	$0.00	$138.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.31	$136.72	$138.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100597	ERX	HCPCS 25000001	76282-0663-39	DICLOFENAC SODIUM 1 % TD GEL	BOTH IP/OP	$172.62 	$127.74	$0.00	$138.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.31	$136.72	$138.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101313	ERX	HCPCS 25000001	00132-0081-12	GLYCERIN (LAXATIVE) 1 G RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101316	ERX	HCPCS 63700001	99999-6012-26	VALGANCICLOVIR HCL 50 MG/ML PO SOLR	BOTH IP/OP	$343.74 	$254.37	$0.00	"$1,640.49"		$0.00	$0.00	$0.00	$61.19	$0.00	$0.00	$0.00	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	"$1,025.31"	$247.13	"$1,640.49"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101316	ERX	HCPCS 63700001	00591-2579-20	VALGANCICLOVIR HCL 50 MG/ML PO SOLR	BOTH IP/OP	$343.74 	$254.37	$0.00	"$1,640.49"		$0.00	$0.00	$0.00	$61.19	$0.00	$0.00	$0.00	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	"$1,025.31"	"$1,624.08"	"$1,640.49"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101316	ERX	HCPCS 63700001	27241-0159-19	VALGANCICLOVIR HCL 50 MG/ML PO SOLR	BOTH IP/OP	$343.74 	$254.37	$0.00	"$1,640.49"		$0.00	$0.00	$0.00	$61.19	$0.00	$0.00	$0.00	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	"$1,025.31"	"$1,624.08"	"$1,640.49"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101323	ERX	HCPCS J3490	55150-0166-13	SILDENAFIL CITRATE 10 MG/12.5ML IV SOLN	BOTH IP/OP	$642.40 	$475.38	$0.00	$495.16	$289.08	$289.08	$0.00	$0.00	$0.00	$133.89	$476.79	$476.79	$495.16	$0.00	$133.88	$0.00	$379.98	$379.98	$0.00	$291.50	$461.74	$466.40	$0.00		$0.00	$91.24	$0.00	$0.00	$92.81	$0.00	$0.00	$0.00	$0.00	$0.00
101445	ERX	HCPCS J1742	00009-3794-01	IBUTILIDE FUMARATE 1 MG/10ML IV SOLN	BOTH IP/OP	"$1,412.69 "	"$1,045.39"	$0.00	"$1,088.90"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,048.50"	"$1,048.50"	"$1,088.90"	$0.00	$294.40	$0.00	$0.00	$0.00	$0.00	$651.27	"$1,031.60"	"$1,042.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101445	ERX	HCPCS J1742	00009-3794-22	IBUTILIDE FUMARATE 1 MG/10ML IV SOLN	BOTH IP/OP	"$1,412.69 "	"$1,045.39"	$0.00	"$1,088.90"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,048.50"	"$1,048.50"	"$1,088.90"	$0.00	$294.40	$0.00	$0.00	$0.00	$0.00	$651.27	"$1,031.60"	"$1,042.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101445	ERX	HCPCS J1742	67457-0366-10	IBUTILIDE FUMARATE 1 MG/10ML IV SOLN	BOTH IP/OP	"$1,412.69 "	"$1,045.39"	$0.00	"$1,088.90"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,048.50"	"$1,048.50"	"$1,088.90"	$0.00	$294.40	$0.00	$0.00	$0.00	$0.00	$651.27	"$1,031.60"	"$1,042.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101583	ERX	HCPCS 63700001	68462-0719-29	NORGESTIM-ETH ESTRAD TRIPHASIC 0.18/0.215/0.25 MG-25 MCG PO TABS	BOTH IP/OP	$541.06 	$400.38	$0.00	$392.91		$0.00	$0.00	$0.00	$96.31	$0.00	$0.00	$0.00	$0.00	$0.00	$112.76	$0.00	$0.00	$0.00	$0.00	$245.57	$388.98	$392.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101584	ERX	HCPCS 63700001	16714-0363-04	"ORTHO TRI-CYCLEN,TRINESSA,0.18/0.215/0.25 MG-35 MCG PO TABS"	BOTH IP/OP	$188.75 	$139.68	$0.00	$151.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.38	$149.49	$151.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101700	ERX	HCPCS 63700001	00054-0407-13	RITONAVIR 100 MG PO TABS	BOTH IP/OP	$35.19 	$26.04	$0.00	$28.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.60	$27.87	$28.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101700	ERX	HCPCS 63700001	00074-3333-30	RITONAVIR 100 MG PO TABS	BOTH IP/OP	$35.19 	$26.04	$0.00	$28.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.60	$27.87	$28.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101700	ERX	HCPCS 63700001	31722-0597-30	RITONAVIR 100 MG PO TABS	BOTH IP/OP	$35.19 	$26.04	$0.00	$28.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.60	$27.87	$28.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101700	ERX	HCPCS 63700001	65862-0687-30	RITONAVIR 100 MG PO TABS	BOTH IP/OP	$35.19 	$26.04	$0.00	$28.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.60	$27.87	$28.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101739	ERX	HCPCS 90734	58160-0955-09	MENVEO MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR	BOTH IP/OP	$580.85 	$429.83	$0.00	$447.72	$261.38	$261.38	$0.00	$0.00	$129.14	$9.40	$431.11	$431.11	$447.72	$0.00	$158.35	$0.00	$343.57	$343.57	$0.00	$246.19	$389.96	$393.90	$295.42		$295.42	$143.71	$0.00	$0.00	$136.84	$0.00	$0.00	$0.00	$0.00	$0.00
101739	ERX	HCPCS 90734	58160-0958-01	MENVEO MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR	BOTH IP/OP	$580.85 	$429.83	$0.00	$447.72	$261.38	$261.38	$0.00	$0.00	$129.14	$9.40	$431.11	$431.11	$447.72	$0.00	$158.35	$0.00	$343.57	$343.57	$0.00	$246.19	$389.96	$393.90	$295.42		$295.42	$143.71	$0.00	$0.00	$136.84	$0.00	$0.00	$0.00	$0.00	$0.00
102036	ERX	HCPCS 63700001	00173-0695-04	FLUTICASONE-SALMETEROL 100-50 MCG/DOSE IN AEPB	BOTH IP/OP	$611.81 	$452.74	$0.00	$444.29		$0.00	$0.00	$0.00	$108.90	$0.00	$0.00	$0.00	$0.00	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$277.68	$439.85	$444.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102037	ERX	HCPCS 25000001	00173-0696-04	FLUTICASONE-SALMETEROL 250-50 MCG/DOSE IN AEPB	BOTH IP/OP	$611.81 	$452.74	$0.00	$471.58		$0.00	$0.00	$0.00	$0.00	$0.00	$454.09	$454.09	$471.58	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$277.68	$439.85	$444.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102038	ERX	HCPCS 25000001	00173-0697-00	FLUTICASONE-SALMETEROL 500-50 MCG/DOSE IN AEPB	BOTH IP/OP	$866.54 	$641.24	$0.00	$667.93		$0.00	$0.00	$0.00	$0.00	$0.00	$643.15	$643.15	$667.93	$0.00	$180.59	$0.00	$0.00	$0.00	$0.00	$393.21	$622.84	$629.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102038	ERX	HCPCS 25000001	00173-0697-04	FLUTICASONE-SALMETEROL 500-50 MCG/DOSE IN AEPB	BOTH IP/OP	$866.54 	$641.24	$0.00	$667.93		$0.00	$0.00	$0.00	$0.00	$0.00	$643.15	$643.15	$667.93	$0.00	$180.59	$0.00	$0.00	$0.00	$0.00	$393.21	$622.84	$629.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102040	ERX	HCPCS 63700001	00173-0526-00	LAMOTRIGINE 5 MG PO CHEW	BOTH IP/OP	$71.91 	$53.21	$0.00	$46.44		$0.00	$0.00	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$14.99	$0.00	$0.00	$0.00	$0.00	$29.03	$45.98	$46.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102040	ERX	HCPCS 63700001	68462-0228-01	LAMOTRIGINE 5 MG PO CHEW	BOTH IP/OP	$71.91 	$53.21	$0.00	$46.44		$0.00	$0.00	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$14.99	$0.00	$0.00	$0.00	$0.00	$29.03	$45.98	$46.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102053	ERX	HCPCS 63700001	00228-2996-11	TAMSULOSIN HCL 0.4 MG PO CAPS	BOTH IP/OP	$38.39 	$28.41	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.20	$30.40	$30.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102053	ERX	HCPCS 63700001	00228-2996-50	TAMSULOSIN HCL 0.4 MG PO CAPS	BOTH IP/OP	$38.39 	$28.41	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.20	$30.40	$30.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102053	ERX	HCPCS 63700001	00597-0058-01	TAMSULOSIN HCL 0.4 MG PO CAPS	BOTH IP/OP	$38.39 	$28.41	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.20	$30.40	$30.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102053	ERX	HCPCS 63700001	00781-2076-01	TAMSULOSIN HCL 0.4 MG PO CAPS	BOTH IP/OP	$38.39 	$28.41	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.20	$30.40	$30.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102053	ERX	HCPCS 63700001	00904-6401-61	TAMSULOSIN HCL 0.4 MG PO CAPS	BOTH IP/OP	$38.39 	$28.41	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.20	$30.40	$30.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102053	ERX	HCPCS 63700001	50268-0740-11	TAMSULOSIN HCL 0.4 MG PO CAPS	BOTH IP/OP	$38.39 	$28.41	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.20	$30.40	$30.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102053	ERX	HCPCS 63700001	50268-0740-15	TAMSULOSIN HCL 0.4 MG PO CAPS	BOTH IP/OP	$38.39 	$28.41	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.20	$30.40	$30.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102053	ERX	HCPCS 63700001	57237-0014-01	TAMSULOSIN HCL 0.4 MG PO CAPS	BOTH IP/OP	$38.39 	$28.41	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.20	$30.40	$30.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102053	ERX	HCPCS 63700001	63739-0567-10	TAMSULOSIN HCL 0.4 MG PO CAPS	BOTH IP/OP	$38.39 	$28.41	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.20	$30.40	$30.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102053	ERX	HCPCS 63700001	65862-0598-01	TAMSULOSIN HCL 0.4 MG PO CAPS	BOTH IP/OP	$38.39 	$28.41	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.20	$30.40	$30.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102053	ERX	HCPCS 63700001	65862-0598-05	TAMSULOSIN HCL 0.4 MG PO CAPS	BOTH IP/OP	$38.39 	$28.41	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.20	$30.40	$30.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102053	ERX	HCPCS 63700001	68084-0299-01	TAMSULOSIN HCL 0.4 MG PO CAPS	BOTH IP/OP	$38.39 	$28.41	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.20	$30.40	$30.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102058	ERX	HCPCS 90670	00005-1971-02	PNEUMOCOCCAL 13-VAL CONJ VACC IM SUSP	BOTH IP/OP	$792.98 	$586.81	$93.73	$611.23	$356.84	$356.84	$206.17	$206.17	$230.14	$165.28	$588.55	$588.55	$611.23	$206.17	$283.63	$134.01	$469.05	$469.05	$93.73	$320.99	$508.45	$513.58	$93.73		$93.73	$252.18	$166.91	$166.91	$240.12	$166.91	$0.00	$0.00	$0.00	$0.00
102397	ERX	HCPCS 63700001	65649-0303-03	RIFAXIMIN 550 MG PO TABS	BOTH IP/OP	$206.49 	$152.80	$0.00	$128.81		$0.00	$0.00	$0.00	$36.76	$0.00	$0.00	$0.00	$0.00	$0.00	$43.03	$0.00	$0.00	$0.00	$0.00	$80.51	$127.52	$128.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102404	ERX	HCPCS 63700001	00173-0696-04	ADVAIR DISKUS 250-50 MCG/DOSE IN AEPB	BOTH IP/OP	$611.81 	$452.74	$0.00	$444.29		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$277.68	$439.85	$444.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102415	ERX	HCPCS 25000001	00143-9595-01	LIDOCAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102415	ERX	HCPCS 25000001	00143-9595-25	LIDOCAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102415	ERX	HCPCS 25000001	00409-4279-02	LIDOCAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102415	ERX	HCPCS 25000001	00409-4279-16	LIDOCAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102415	ERX	HCPCS 25000001	00409-4713-25	LIDOCAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102415	ERX	HCPCS 25000001	00409-4713-42	LIDOCAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102415	ERX	HCPCS 25000001	55150-0161-02	LIDOCAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102415	ERX	HCPCS 25000001	55150-0162-05	LIDOCAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102415	ERX	HCPCS 25000001	63323-0492-09	LIDOCAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102415	ERX	HCPCS 25000001	63323-0492-27	LIDOCAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102415	ERX	HCPCS 25000001	63323-0492-57	LIDOCAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102416	ERX	HCPCS 25000001	00143-9594-01	LIDOCAINE HCL (PF) 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102416	ERX	HCPCS 25000001	00143-9594-25	LIDOCAINE HCL (PF) 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102416	ERX	HCPCS 25000001	55150-0165-05	LIDOCAINE HCL (PF) 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102416	ERX	HCPCS 25000001	63323-0495-07	LIDOCAINE HCL (PF) 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102429	ERX	HCPCS J0585	00023-1145-01	ONABOTULINUMTOXINA 100 UNITS IJ SOLR	BOTH IP/OP	"$1,933.18 "	"$1,430.55"	$0.00	"$1,490.10"	$869.93	$869.93	$618.50	$618.50	$618.50	$642.73	"$1,434.81"	"$1,434.81"	"$1,490.10"	$608.50	$714.99	$395.53	$953.06	$953.06	$642.92	$865.44	"$1,370.86"	"$1,384.70"	$887.84		$887.84	$719.10	$0.00	$0.00	$684.71	$609.50	$0.00	$0.00	$0.00	$0.00
102430	ERX	HCPCS J3480	00264-7865-00	KCL IN NACL 20-0.9 MEQ/L-% IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102430	ERX	HCPCS J3480	00338-0691-04	KCL IN NACL 20-0.9 MEQ/L-% IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102431	ERX	HCPCS J3480	00338-0695-04	KCL IN NACL 40-0.9 MEQ/L-% IV SOLN	BOTH IP/OP	$50.28 	$37.21	$0.00	$38.76	$22.63	$22.63	$0.00	$0.00	$0.00	$0.47	$37.32	$37.32	$38.76	$0.00	$3.38	$0.00	$29.74	$29.74	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$3.29	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$0.00
102431	ERX	HCPCS J3480	00990-7116-09	KCL IN NACL 40-0.9 MEQ/L-% IV SOLN	BOTH IP/OP	$50.28 	$37.21	$0.00	$38.76	$22.63	$22.63	$0.00	$0.00	$0.00	$0.47	$37.32	$37.32	$38.76	$0.00	$3.38	$0.00	$29.74	$29.74	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$3.29	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$0.00
102452	ERX	HCPCS 25000001	00264-7652-00	KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN	BOTH IP/OP	$46.09 	$34.11	$0.00	$35.53		$0.00	$0.00	$0.00	$0.00	$0.00	$34.21	$34.21	$35.53	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102452	ERX	HCPCS 25000001	00338-0803-04	KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN	BOTH IP/OP	$46.09 	$34.11	$0.00	$35.53		$0.00	$0.00	$0.00	$0.00	$0.00	$34.21	$34.21	$35.53	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102453	ERX	HCPCS 25000001	00338-0807-04	KCL IN DEXTROSE-NACL 40-5-0.9 MEQ/L-%-% IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102456	ERX	HCPCS 25000001	00264-7634-00	KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN	BOTH IP/OP	$46.09 	$34.11	$0.00	$35.53		$0.00	$0.00	$0.00	$0.00	$0.00	$34.21	$34.21	$35.53	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102456	ERX	HCPCS 25000001	00338-0669-04	KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN	BOTH IP/OP	$46.09 	$34.11	$0.00	$35.53		$0.00	$0.00	$0.00	$0.00	$0.00	$34.21	$34.21	$35.53	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102456	ERX	HCPCS 25000001	00409-7993-09	KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN	BOTH IP/OP	$46.09 	$34.11	$0.00	$35.53		$0.00	$0.00	$0.00	$0.00	$0.00	$34.21	$34.21	$35.53	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102458	ERX	HCPCS 25000001	00338-0663-04	KCL IN DEXTROSE-NACL 20-5-0.2 MEQ/L-%-% IV SOLN	BOTH IP/OP	$41.90 	$31.01	$0.00	$32.30		$0.00	$0.00	$0.00	$0.00	$0.00	$31.10	$31.10	$32.30	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102459	ERX	HCPCS 25000001	00264-7635-00	KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61		$0.00	$0.00	$0.00	$0.00	$0.00	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$0.00	$0.00	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102459	ERX	HCPCS 25000001	00338-0671-04	KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61		$0.00	$0.00	$0.00	$0.00	$0.00	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$0.00	$0.00	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102464	ERX	HCPCS 25000001	00264-7638-00	KCL IN DEXTROSE-NACL 40-5-0.45 MEQ/L-%-% IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102464	ERX	HCPCS 25000001	00338-0675-04	KCL IN DEXTROSE-NACL 40-5-0.45 MEQ/L-%-% IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102609	ERX	HCPCS J3315	00023-5906-23	TRIPTORELIN PAMOATE 22.5 MG IM SUSR	BOTH IP/OP	"$12,003.43 "	"$8,882.54"	$0.00	"$9,602.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,506.72"	"$9,602.74"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103164	ERX	HCPCS 63700001	00591-3720-30	TRANEXAMIC ACID 650 MG PO TABS	BOTH IP/OP	$39.63 	$29.33	$0.00	$31.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.82	$31.39	$31.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103164	ERX	HCPCS 63700001	60505-3638-03	TRANEXAMIC ACID 650 MG PO TABS	BOTH IP/OP	$39.63 	$29.33	$0.00	$31.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.82	$31.39	$31.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103164	ERX	HCPCS 63700001	69918-0301-30	TRANEXAMIC ACID 650 MG PO TABS	BOTH IP/OP	$39.63 	$29.33	$0.00	$31.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.82	$31.39	$31.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103332	ERX	HCPCS 25000001	54162-0185-16	MINERAL OIL LIGHT 100 % EX OIL	BOTH IP/OP	$14.35 	$10.62	$0.00	$11.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.37	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103727	ERX	HCPCS 25000001	00143-9637-10	VALPROATE SODIUM 500 MG/5ML IV SOLN	BOTH IP/OP	$72.61 	$53.73	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.31	$57.51	$58.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103727	ERX	HCPCS 25000001	00143-9785-10	VALPROATE SODIUM 500 MG/5ML IV SOLN	BOTH IP/OP	$72.61 	$53.73	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.31	$57.51	$58.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103727	ERX	HCPCS 25000001	63323-0494-01	VALPROATE SODIUM 500 MG/5ML IV SOLN	BOTH IP/OP	$72.61 	$53.73	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.31	$57.51	$58.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103727	ERX	HCPCS 25000001	63323-0494-05	VALPROATE SODIUM 500 MG/5ML IV SOLN	BOTH IP/OP	$72.61 	$53.73	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.31	$57.51	$58.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103756	ERX	HCPCS 63700001	00078-0592-51	NILOTINIB HCL 150 MG PO CAPS	BOTH IP/OP	$566.86 	$419.48	$0.00	$384.72		$0.00	$0.00	$0.00	$106.95	$0.00	$0.00	$0.00	$0.00	$0.00	$118.13	$0.00	$0.00	$0.00	$0.00	$240.45	$380.87	$384.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104015	ERX	HCPCS J9043	00024-5824-11	CABAZITAXEL 60 MG/1.5ML IV SOLN	BOTH IP/OP	"$32,884.41 "	"$24,334.46"	$0.00	"$26,183.76"	"$15,286.32"	"$15,286.32"	"$11,478.66"	"$11,478.66"	"$11,478.66"	"$6,853.93"	"$25,212.23"	"$25,212.23"	"$26,183.76"	"$11,339.82"	"$13,324.29"	"$7,370.88"	"$16,212.01"	"$16,212.01"	"$10,940.96"	"$14,196.06"	"$22,486.56"	"$22,713.70"	"$15,108.94"		"$15,108.94"	"$8,138.89"	$0.00	$0.00	"$8,138.89"	"$10,888.38"	$0.00	$0.00	$0.00	$0.00
104022	ERX	HCPCS 63700001	67618-0107-60	MAGNESIUM CHLORIDE DELAY RELEASE 71.5 MG PO TAB	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104100	ERX	HCPCS J7527	00078-0594-51	EVEROLIMUS 2.5 MG PO TABS	BOTH IP/OP	"$1,666.80 "	"$1,233.43"	$0.00	"$1,284.77"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,237.10"	"$1,237.10"	"$1,284.77"	$0.00	$347.36	$0.00	$0.00	$0.00	$0.00	$772.27	"$1,223.27"	"$1,235.62"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104174	ERX	HCPCS J1650	00075-0624-30	ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN	BOTH IP/OP	$30.02 	$22.21	$0.00	$23.14	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$23.14	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$13.62	$21.57	$21.78	$0.00		$0.00	$4.26	$0.00	$0.00	$4.34	$0.00	$0.00	$0.00	$0.00	$0.00
104174	ERX	HCPCS J1650	00548-5601-00	ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN	BOTH IP/OP	$30.02 	$22.21	$0.00	$23.14	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$23.14	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$13.62	$21.57	$21.78	$0.00		$0.00	$4.26	$0.00	$0.00	$4.34	$0.00	$0.00	$0.00	$0.00	$0.00
104174	ERX	HCPCS J1650	00548-5631-00	ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN	BOTH IP/OP	$30.02 	$22.21	$0.00	$23.14	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$23.14	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$13.62	$21.57	$21.78	$0.00		$0.00	$4.26	$0.00	$0.00	$4.34	$0.00	$0.00	$0.00	$0.00	$0.00
104174	ERX	HCPCS J1650	00703-8530-23	ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN	BOTH IP/OP	$30.02 	$22.21	$0.00	$23.14	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$23.14	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$13.62	$21.57	$21.78	$0.00		$0.00	$4.26	$0.00	$0.00	$4.34	$0.00	$0.00	$0.00	$0.00	$0.00
104174	ERX	HCPCS J1650	00781-3133-63	ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN	BOTH IP/OP	$30.02 	$22.21	$0.00	$23.14	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$23.14	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$13.62	$21.57	$21.78	$0.00		$0.00	$4.26	$0.00	$0.00	$4.34	$0.00	$0.00	$0.00	$0.00	$0.00
104174	ERX	HCPCS J1650	00955-1003-01	ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN	BOTH IP/OP	$30.02 	$22.21	$0.00	$23.14	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$23.14	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$13.62	$21.57	$21.78	$0.00		$0.00	$4.26	$0.00	$0.00	$4.34	$0.00	$0.00	$0.00	$0.00	$0.00
104174	ERX	HCPCS J1650	00955-1003-10	ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN	BOTH IP/OP	$30.02 	$22.21	$0.00	$23.14	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$23.14	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$13.62	$21.57	$21.78	$0.00		$0.00	$4.26	$0.00	$0.00	$4.34	$0.00	$0.00	$0.00	$0.00	$0.00
104174	ERX	HCPCS J1650	63323-0568-83	ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN	BOTH IP/OP	$30.02 	$22.21	$0.00	$23.14	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$23.14	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$13.62	$21.57	$21.78	$0.00		$0.00	$4.26	$0.00	$0.00	$4.34	$0.00	$0.00	$0.00	$0.00	$0.00
104175	ERX	HCPCS J1650	00548-5602-00	ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN	BOTH IP/OP	$42.94 	$31.78	$0.00	$98.91	$19.32	$19.32	$0.00	$0.00	$0.00	$8.95	$31.87	$31.87	$33.10	$0.00	$8.95	$0.00	$25.40	$25.40	$0.00	$19.47	$98.91	$31.15	$0.00		$0.00	$19.55	$0.00	$0.00	$6.20	$0.00	$0.00	$0.00	$0.00	$0.00
104175	ERX	HCPCS J1650	00703-8540-23	ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN	BOTH IP/OP	$42.94 	$31.78	$0.00	$98.91	$19.32	$19.32	$0.00	$0.00	$0.00	$8.95	$31.87	$31.87	$33.10	$0.00	$8.95	$0.00	$25.40	$25.40	$0.00	$19.47	$98.91	$31.15	$0.00		$0.00	$19.55	$0.00	$0.00	$6.20	$0.00	$0.00	$0.00	$0.00	$0.00
104175	ERX	HCPCS J1650	00781-3224-64	ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN	BOTH IP/OP	$42.94 	$31.78	$0.00	$98.91	$19.32	$19.32	$0.00	$0.00	$0.00	$8.95	$31.87	$31.87	$33.10	$0.00	$8.95	$0.00	$25.40	$25.40	$0.00	$19.47	$98.91	$31.15	$0.00		$0.00	$19.55	$0.00	$0.00	$6.20	$0.00	$0.00	$0.00	$0.00	$0.00
104175	ERX	HCPCS J1650	00955-1004-01	ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN	BOTH IP/OP	$42.94 	$31.78	$0.00	$98.91	$19.32	$19.32	$0.00	$0.00	$0.00	$8.95	$31.87	$31.87	$33.10	$0.00	$8.95	$0.00	$25.40	$25.40	$0.00	$19.47	$98.91	$31.15	$0.00		$0.00	$19.55	$0.00	$0.00	$6.20	$0.00	$0.00	$0.00	$0.00	$0.00
104175	ERX	HCPCS J1650	00955-1004-10	ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN	BOTH IP/OP	$42.94 	$31.78	$0.00	$98.91	$19.32	$19.32	$0.00	$0.00	$0.00	$8.95	$31.87	$31.87	$33.10	$0.00	$8.95	$0.00	$25.40	$25.40	$0.00	$19.47	$98.91	$31.15	$0.00		$0.00	$19.55	$0.00	$0.00	$6.20	$0.00	$0.00	$0.00	$0.00	$0.00
104176	ERX	HCPCS J1650	00548-5603-00	ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN	BOTH IP/OP	$22.88 	$16.93	$0.00	$18.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.44	$18.12	$18.30	$0.00		$0.00	$3.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104176	ERX	HCPCS J1650	00781-3356-66	ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN	BOTH IP/OP	$22.88 	$16.93	$0.00	$18.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.44	$18.12	$18.30	$0.00		$0.00	$3.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104176	ERX	HCPCS J1650	00955-1006-01	ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN	BOTH IP/OP	$22.88 	$16.93	$0.00	$18.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.44	$18.12	$18.30	$0.00		$0.00	$3.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104176	ERX	HCPCS J1650	00955-1006-10	ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN	BOTH IP/OP	$22.88 	$16.93	$0.00	$18.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.44	$18.12	$18.30	$0.00		$0.00	$3.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104176	ERX	HCPCS J1650	63323-0607-88	ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN	BOTH IP/OP	$22.88 	$16.93	$0.00	$18.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.44	$18.12	$18.30	$0.00		$0.00	$3.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104177	ERX	HCPCS J1650	00548-5604-00	ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN	BOTH IP/OP	$63.45 	$46.95	$0.00	$50.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104177	ERX	HCPCS J1650	00781-3428-68	ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN	BOTH IP/OP	$63.45 	$46.95	$0.00	$50.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104177	ERX	HCPCS J1650	00955-1008-01	ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN	BOTH IP/OP	$63.45 	$46.95	$0.00	$50.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104177	ERX	HCPCS J1650	00955-1008-10	ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN	BOTH IP/OP	$63.45 	$46.95	$0.00	$50.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104177	ERX	HCPCS J1650	63323-0531-90	ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN	BOTH IP/OP	$63.45 	$46.95	$0.00	$50.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104178	ERX	HCPCS J1650	00955-1010-10	ENOXAPARIN SODIUM 100 MG/ML SC SOLN	BOTH IP/OP	$75.15 	$55.61	$0.00	$60.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.58	$59.52	$60.12	$0.00		$0.00	$11.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104178	ERX	HCPCS J1650	63323-0605-84	ENOXAPARIN SODIUM 100 MG/ML SC SOLN	BOTH IP/OP	$75.15 	$55.61	$0.00	$60.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.58	$59.52	$60.12	$0.00		$0.00	$11.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104179	ERX	HCPCS J1650	00548-5606-00	ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN	BOTH IP/OP	$100.17 	$74.13	$0.00	$80.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.09	$79.33	$80.14	$0.00		$0.00	$15.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104179	ERX	HCPCS J1650	00781-3612-68	ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN	BOTH IP/OP	$100.17 	$74.13	$0.00	$80.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.09	$79.33	$80.14	$0.00		$0.00	$15.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104179	ERX	HCPCS J1650	00955-1012-10	ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN	BOTH IP/OP	$100.17 	$74.13	$0.00	$80.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.09	$79.33	$80.14	$0.00		$0.00	$15.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104179	ERX	HCPCS J1650	16714-0056-01	ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN	BOTH IP/OP	$100.17 	$74.13	$0.00	$80.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.09	$79.33	$80.14	$0.00		$0.00	$15.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104179	ERX	HCPCS J1650	63323-0609-90	ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN	BOTH IP/OP	$100.17 	$74.13	$0.00	$80.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.09	$79.33	$80.14	$0.00		$0.00	$15.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104407	ERX	HCPCS J0588	00259-1610-01	INCOBOTULINUMTOXINA 100 UNITS IM SOLR	BOTH IP/OP	"$1,498.06 "	"$1,108.56"	$0.00	"$1,154.70"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,111.86"	"$1,111.86"	"$1,154.70"	$0.00	$593.02	$0.00	$0.00	$0.00	$0.00	$694.08	"$1,099.42"	"$1,110.53"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104804	ERX	HCPCS 63700001	00023-3205-03	BIMATOPROST 0.01 % OP SOLN	BOTH IP/OP	$760.93 	$563.09	$0.00	$526.14		$0.00	$0.00	$0.00	$142.22	$0.00	$0.00	$0.00	$0.00	$0.00	$158.58	$0.00	$0.00	$0.00	$0.00	$328.84	$520.88	$526.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104817	ERX	HCPCS 25000001	00310-6512-01	EXENATIDE 5 MCG/0.02ML SC SOPN	BOTH IP/OP	$57.12 	$42.27	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.56	$45.24	$45.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104818	ERX	HCPCS 25000001	00310-6524-01	EXENATIDE 10 MCG/0.04ML SC SOPN	BOTH IP/OP	$57.12 	$42.27	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.56	$45.24	$45.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104822	ERX	HCPCS 25000001	00409-1746-10	BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104822	ERX	HCPCS 25000001	00409-1746-30	BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104822	ERX	HCPCS 25000001	00409-1746-71	BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104822	ERX	HCPCS 25000001	00409-9042-01	BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104822	ERX	HCPCS 25000001	00409-9042-17	BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104822	ERX	HCPCS 25000001	63323-0468-01	BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104822	ERX	HCPCS 25000001	63323-0468-02	BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104822	ERX	HCPCS 25000001	63323-0468-17	BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104822	ERX	HCPCS 25000001	63323-0468-37	BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104823	ERX	HCPCS 25000001	00409-9045-01	BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104823	ERX	HCPCS 25000001	00409-9045-17	BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104823	ERX	HCPCS 25000001	31382-0557-05	BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104823	ERX	HCPCS 25000001	63323-0462-01	BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104823	ERX	HCPCS 25000001	63323-0462-17	BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104823	ERX	HCPCS 25000001	63323-0462-31	BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104823	ERX	HCPCS 25000001	63323-0462-37	BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104825	ERX	HCPCS J0670	00409-1036-30	MEPIVACAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.24	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104825	ERX	HCPCS J0670	63323-0260-37	MEPIVACAINE HCL (PF) 1 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.24	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104826	ERX	HCPCS J0670	00409-1067-20	MEPIVACAINE HCL (PF) 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.24	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104826	ERX	HCPCS J0670	63323-0294-27	MEPIVACAINE HCL (PF) 2 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.27	$16.33	$16.33	$16.96	$0.00	$3.24	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104827	ERX	HCPCS 25000001	00409-1159-02	BUPIVACAINE HCL (PF) 0.25 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104827	ERX	HCPCS 25000001	00409-1559-10	BUPIVACAINE HCL (PF) 0.25 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104827	ERX	HCPCS 25000001	00409-1559-30	BUPIVACAINE HCL (PF) 0.25 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104827	ERX	HCPCS 25000001	55150-0167-10	BUPIVACAINE HCL (PF) 0.25 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104827	ERX	HCPCS 25000001	55150-0168-30	BUPIVACAINE HCL (PF) 0.25 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104827	ERX	HCPCS 25000001	63323-0464-01	BUPIVACAINE HCL (PF) 0.25 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104827	ERX	HCPCS 25000001	63323-0464-17	BUPIVACAINE HCL (PF) 0.25 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104827	ERX	HCPCS 25000001	63323-0464-31	BUPIVACAINE HCL (PF) 0.25 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104827	ERX	HCPCS 25000001	63323-0464-37	BUPIVACAINE HCL (PF) 0.25 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104828	ERX	HCPCS 25000001	00409-1162-01	BUPIVACAINE HCL (PF) 0.5 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104828	ERX	HCPCS 25000001	00409-1162-02	BUPIVACAINE HCL (PF) 0.5 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104828	ERX	HCPCS 25000001	00409-1162-09	BUPIVACAINE HCL (PF) 0.5 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104828	ERX	HCPCS 25000001	00409-1162-10	BUPIVACAINE HCL (PF) 0.5 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104828	ERX	HCPCS 25000001	55150-0169-10	BUPIVACAINE HCL (PF) 0.5 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104828	ERX	HCPCS 25000001	55150-0170-30	BUPIVACAINE HCL (PF) 0.5 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104828	ERX	HCPCS 25000001	63323-0466-17	BUPIVACAINE HCL (PF) 0.5 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104828	ERX	HCPCS 25000001	63323-0466-37	BUPIVACAINE HCL (PF) 0.5 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104858	ERX	HCPCS 25000001	12496-1202-01	SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM	BOTH IP/OP	$25.20 	$18.65	$0.00	$19.42		$0.00	$0.00	$0.00	$0.00	$0.00	$18.70	$18.70	$19.42	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$11.43	$18.10	$18.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104858	ERX	HCPCS 25000001	12496-1202-03	SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM	BOTH IP/OP	$25.20 	$18.65	$0.00	$19.42		$0.00	$0.00	$0.00	$0.00	$0.00	$18.70	$18.70	$19.42	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$11.43	$18.10	$18.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104859	ERX	HCPCS 25000001	12496-1208-01	SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM	BOTH IP/OP	$45.16 	$33.42	$0.00	$34.81		$0.00	$0.00	$0.00	$0.00	$0.00	$33.52	$33.52	$34.81	$0.00	$9.41	$0.00	$0.00	$0.00	$0.00	$20.48	$32.43	$32.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104859	ERX	HCPCS 25000001	12496-1208-03	SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM	BOTH IP/OP	$45.16 	$33.42	$0.00	$34.81		$0.00	$0.00	$0.00	$0.00	$0.00	$33.52	$33.52	$34.81	$0.00	$9.41	$0.00	$0.00	$0.00	$0.00	$20.48	$32.43	$32.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104955	ERX	HCPCS J0257	00944-2884-01	ALPHA1-PROTEINASE INHIBITOR 1000 MG/50ML IV SOLN	BOTH IP/OP	"$1,813.00 "	"$1,341.62"	$0.00	"$1,437.39"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.05"	"$1,384.05"	"$1,437.39"	$0.00	$581.63	$0.00	$0.00	$0.00	$0.00	$816.00	"$1,292.54"	"$1,305.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104955	ERX	HCPCS J0257	00944-2884-02	ALPHA1-PROTEINASE INHIBITOR 1000 MG/50ML IV SOLN	BOTH IP/OP	"$1,813.00 "	"$1,341.62"	$0.00	"$1,437.39"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.05"	"$1,384.05"	"$1,437.39"	$0.00	$581.63	$0.00	$0.00	$0.00	$0.00	$816.00	"$1,292.54"	"$1,305.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
105032	ERX	HCPCS 25000001	00409-4278-01	LIDOCAINE HCL (PF) 0.5 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
105032	ERX	HCPCS 25000001	63323-0491-57	LIDOCAINE HCL (PF) 0.5 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
105342	ERX	HCPCS 63700001	00597-0360-82	DABIGATRAN ETEXILATE MESYLATE 150 MG PO CAPS	BOTH IP/OP	$39.97 	$29.58	$0.00	$27.89		$0.00	$0.00	$0.00	$7.40	$0.00	$0.00	$0.00	$0.00	$0.00	$8.33	$0.00	$0.00	$0.00	$0.00	$17.43	$27.61	$27.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
105514	ERX	HCPCS 63700001	00597-0355-09	DABIGATRAN ETEXILATE MESYLATE 75 MG PO CAPS	BOTH IP/OP	$30.45 	$22.53	$0.00	$24.36		$0.00	$0.00	$0.00	$7.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.23	$24.12	$24.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
105737	ERX	HCPCS J9179	62856-0389-01	ERIBULIN MESYLATE 1 MG/2ML IV SOLN	BOTH IP/OP	"$3,384.58 "	"$2,504.59"	$0.00	"$2,663.18"	"$1,554.79"	"$1,554.79"	"$1,274.36"	"$1,274.36"	"$1,274.36"	$705.43	"$2,564.37"	"$2,564.37"	"$2,663.18"	"$1,239.30"	"$1,456.18"	$805.55	"$1,668.60"	"$1,668.60"	"$1,199.88"	"$1,451.40"	"$2,299.02"	"$2,322.24"	"$1,656.97"		"$1,656.97"	$0.00	$0.00	$0.00	"$1,300.49"	"$1,174.22"	$0.00	$0.00	$0.00	$0.00
105747	ERX	HCPCS J1453	00006-3061-00	FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR	BOTH IP/OP	"$1,054.12 "	$780.05	$0.00	$812.52	$474.35	$474.35	$0.00	$0.00	$0.00	$219.70	$782.37	$782.37	$812.52	$36.45	$42.83	$23.69	$623.51	$623.51	$310.12	$478.33	$757.67	$765.32	$428.26		$428.26	$348.98	$0.00	$0.00	$332.28	$161.25	$0.00	$0.00	$0.00	$0.00
105747	ERX	HCPCS J1453	00006-3061-04	FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR	BOTH IP/OP	"$1,054.12 "	$780.05	$0.00	$812.52	$474.35	$474.35	$0.00	$0.00	$0.00	$219.70	$782.37	$782.37	$812.52	$36.45	$42.83	$23.69	$623.51	$623.51	$310.12	$478.33	$757.67	$765.32	$428.26		$428.26	$348.98	$0.00	$0.00	$332.28	$161.25	$0.00	$0.00	$0.00	$0.00
105747	ERX	HCPCS J1453	60505-6105-01	FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR	BOTH IP/OP	"$1,054.12 "	$780.05	$0.00	$812.52	$474.35	$474.35	$0.00	$0.00	$0.00	$219.70	$782.37	$782.37	$812.52	$36.45	$42.83	$23.69	$623.51	$623.51	$310.12	$478.33	$757.67	$765.32	$428.26		$428.26	$348.98	$0.00	$0.00	$332.28	$161.25	$0.00	$0.00	$0.00	$0.00
105747	ERX	HCPCS J1453	67457-0889-10	FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR	BOTH IP/OP	"$1,054.12 "	$780.05	$0.00	$812.52	$474.35	$474.35	$0.00	$0.00	$0.00	$219.70	$782.37	$782.37	$812.52	$36.45	$42.83	$23.69	$623.51	$623.51	$310.12	$478.33	$757.67	$765.32	$428.26		$428.26	$348.98	$0.00	$0.00	$332.28	$161.25	$0.00	$0.00	$0.00	$0.00
105747	ERX	HCPCS J1453	71288-0418-10	FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR	BOTH IP/OP	"$1,054.12 "	$780.05	$0.00	$812.52	$474.35	$474.35	$0.00	$0.00	$0.00	$219.70	$782.37	$782.37	$812.52	$36.45	$42.83	$23.69	$623.51	$623.51	$310.12	$478.33	$757.67	$765.32	$428.26		$428.26	$348.98	$0.00	$0.00	$332.28	$161.25	$0.00	$0.00	$0.00	$0.00
105747	ERX	HCPCS J1453	71839-0104-01	FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR	BOTH IP/OP	"$1,054.12 "	$780.05	$0.00	$812.52	$474.35	$474.35	$0.00	$0.00	$0.00	$219.70	$782.37	$782.37	$812.52	$36.45	$42.83	$23.69	$623.51	$623.51	$310.12	$478.33	$757.67	$765.32	$428.26		$428.26	$348.98	$0.00	$0.00	$332.28	$161.25	$0.00	$0.00	$0.00	$0.00
105768	ERX	HCPCS J0897	55513-0730-01	DENOSUMAB 120 MG/1.7ML SC SOLN	BOTH IP/OP	"$6,755.71 "	"$4,999.23"	$0.00	"$5,514.53"	"$3,219.43"	"$3,219.43"	"$2,544.60"	"$2,544.60"	"$2,544.60"	"$1,408.06"	"$5,309.91"	"$5,309.91"	"$5,514.53"	"$2,542.68"	"$2,987.65"	"$1,652.74"	"$3,330.57"	"$3,330.57"	"$2,428.78"	"$2,893.27"	"$4,582.94"	"$4,629.23"	"$3,354.02"		"$3,354.02"	"$2,718.48"	$0.00	$0.00	"$2,588.46"	"$2,388.12"	$0.00	$0.00	$0.00	$0.00
106031	ERX	HCPCS 25000001	63402-0304-30	LURASIDONE HCL 40 MG PO TABS	BOTH IP/OP	$196.92 	$145.72	$0.00	$151.79		$0.00	$0.00	$0.00	$0.00	$0.00	$146.15	$146.15	$151.79	$0.00	$41.04	$0.00	$0.00	$0.00	$0.00	$80.86	$128.07	$129.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106032	ERX	HCPCS 25000001	63402-0308-10	LURASIDONE HCL 80 MG PO TABS	BOTH IP/OP	$186.89 	$138.30	$0.00	$129.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.95	$0.00	$0.00	$0.00	$0.00	$80.86	$128.07	$129.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106032	ERX	HCPCS 25000001	63402-0308-30	LURASIDONE HCL 80 MG PO TABS	BOTH IP/OP	$186.89 	$138.30	$0.00	$129.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.95	$0.00	$0.00	$0.00	$0.00	$80.86	$128.07	$129.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106033	ERX	HCPCS J0712	00456-0400-01	CEFTAROLINE FOSAMIL 400 MG IV SOLR	BOTH IP/OP	$742.20 	$549.23	$0.00	$600.69		$0.00	$0.00	$0.00	$0.00	$0.00	$578.40	$578.40	$600.69	$0.00	$154.67	$0.00	$0.00	$0.00	$0.00	$320.75	$508.07	$513.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106033	ERX	HCPCS J0712	00456-0400-10	CEFTAROLINE FOSAMIL 400 MG IV SOLR	BOTH IP/OP	$742.20 	$549.23	$0.00	$600.69		$0.00	$0.00	$0.00	$0.00	$0.00	$578.40	$578.40	$600.69	$0.00	$154.67	$0.00	$0.00	$0.00	$0.00	$320.75	$508.07	$513.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106034	ERX	HCPCS J0712	00456-0600-01	CEFTAROLINE FOSAMIL 600 MG IV SOLR	BOTH IP/OP	$742.20 	$549.23	$0.00	$600.69		$0.00	$0.00	$0.00	$0.00	$0.00	$578.40	$578.40	$600.69	$0.00	$154.67	$0.00	$0.00	$0.00	$0.00	$320.75	$508.07	$513.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106034	ERX	HCPCS J0712	00456-0600-10	CEFTAROLINE FOSAMIL 600 MG IV SOLR	BOTH IP/OP	$742.20 	$549.23	$0.00	$600.69		$0.00	$0.00	$0.00	$0.00	$0.00	$578.40	$578.40	$600.69	$0.00	$154.67	$0.00	$0.00	$0.00	$0.00	$320.75	$508.07	$513.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106035	ERX	HCPCS 25000001	64597-0301-60	DEXTROMETHORPHAN-QUINIDINE 20-10 MG PO CAPS	BOTH IP/OP	$110.01 	$81.41	$0.00	$84.80		$0.00	$0.00	$0.00	$0.00	$0.00	$81.65	$81.65	$84.80	$0.00	$22.93	$0.00	$0.00	$0.00	$0.00	$43.77	$69.32	$70.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106115	ERX	HCPCS J1561	13533-0800-20	IMMUNE GLOBULIN (HUMAN) 5 GM/50ML IJ SOLN	BOTH IP/OP	"$2,022.02 "	"$1,496.29"	$0.00	"$1,558.57"	$909.91	$909.91	$465.09	$465.09	$465.09	$421.44	"$1,500.74"	"$1,500.74"	"$1,558.57"	$482.19	$566.57	$313.42	$996.86	$996.86	$410.97	$879.72	"$1,359.45"	"$1,407.55"	$567.53		$567.53	$474.11	$0.00	$0.00	$451.44	$416.91	$0.00	$0.00	$0.00	$0.00
106116	ERX	HCPCS J1561	13533-0800-71	IMMUNE GLOBULIN (HUMAN) 10 GM/100ML IJ SOLN	BOTH IP/OP	"$3,528.77 "	"$2,611.29"	$0.00	"$2,719.98"	"$1,587.95"	"$1,587.95"	$930.18	$930.18	$930.18	$735.48	"$2,619.05"	"$2,619.05"	"$2,719.98"	$964.38	"$1,133.15"	$626.85	"$1,739.68"	"$1,739.68"	$821.94	"$1,502.86"	"$2,322.56"	"$2,404.57"	"$1,135.06"		"$1,135.06"	$948.23	$0.00	$0.00	$902.87	$833.82	$0.00	$0.00	$0.00	$0.00
106117	ERX	HCPCS J1561	13533-0800-24	IMMUNE GLOBULIN (HUMAN) 20 GM/200ML IJ SOLN	BOTH IP/OP	"$7,057.53 "	"$5,222.57"	$0.00	"$5,439.94"	"$3,175.89"	"$3,175.89"	"$1,860.36"	"$1,860.36"	"$1,860.36"	"$1,470.97"	"$5,238.10"	"$5,238.10"	"$5,439.94"	"$1,928.76"	"$2,266.29"	"$1,253.69"	"$3,479.36"	"$3,479.36"	"$1,643.88"	"$3,005.71"	"$4,645.12"	"$4,809.14"	"$2,270.12"		"$2,270.12"	"$1,896.45"	$0.00	$0.00	"$1,805.74"	"$1,667.64"	$0.00	$0.00	$0.00	$0.00
106117	ERX	HCPCS J1561	13533-0800-25	IMMUNE GLOBULIN (HUMAN) 20 GM/200ML IJ SOLN	BOTH IP/OP	"$7,057.53 "	"$5,222.57"	$0.00	"$5,439.94"	"$3,175.89"	"$3,175.89"	"$1,860.36"	"$1,860.36"	"$1,860.36"	"$1,470.97"	"$5,238.10"	"$5,238.10"	"$5,439.94"	"$1,928.76"	"$2,266.29"	"$1,253.69"	"$3,479.36"	"$3,479.36"	"$1,643.88"	"$3,005.71"	"$4,645.12"	"$4,809.14"	"$2,270.12"		"$2,270.12"	"$1,896.45"	$0.00	$0.00	"$1,805.74"	"$1,667.64"	$0.00	$0.00	$0.00	$0.00
106201	ERX	HCPCS 63700001	00121-4675-00	VALPROIC ACID 250 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106201	ERX	HCPCS 63700001	00121-4675-05	VALPROIC ACID 250 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106201	ERX	HCPCS 63700001	00121-4675-40	VALPROIC ACID 250 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106201	ERX	HCPCS 63700001	50383-0792-07	VALPROIC ACID 250 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106201	ERX	HCPCS 63700001	68094-0193-61	VALPROIC ACID 250 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106201	ERX	HCPCS 63700001	68094-0193-62	VALPROIC ACID 250 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106621	ERX	HCPCS 63700001	00003-0857-22	DASATINIB 140 MG PO TABS	BOTH IP/OP	"$1,570.67 "	"$1,162.30"	$0.00	"$1,114.22"		$0.00	$0.00	$0.00	$292.16	$0.00	$0.00	$0.00	$0.00	$0.00	$327.33	$0.00	$0.00	$0.00	$0.00	$696.39	"$1,103.07"	"$1,114.22"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106632	ERX	HCPCS 63700001	59676-0571-01	ETRAVIRINE 200 MG PO TABS	BOTH IP/OP	$108.97 	$80.64	$0.00	$77.50		$0.00	$0.00	$0.00	$19.78	$0.00	$0.00	$0.00	$0.00	$0.00	$22.71	$0.00	$0.00	$0.00	$0.00	$48.44	$76.72	$77.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106862	ERX	HCPCS J9351	00409-0302-01	TOPOTECAN HCL 4 MG/4ML IV SOLN	BOTH IP/OP	$558.64 	$413.39	$0.00	$430.60	$251.39	$251.39	$0.00	$0.00	$0.00	$116.43	$414.62	$414.62	$430.60	$0.00	$36.00	$0.00	$330.44	$330.44	$0.00	$249.80	$395.68	$399.67	$0.00		$0.00	$46.06	$0.00	$0.00	$43.86	$0.00	$0.00	$0.00	$0.00	$0.00
106862	ERX	HCPCS J9351	67457-0662-05	TOPOTECAN HCL 4 MG/4ML IV SOLN	BOTH IP/OP	$558.64 	$413.39	$0.00	$430.60	$251.39	$251.39	$0.00	$0.00	$0.00	$116.43	$414.62	$414.62	$430.60	$0.00	$36.00	$0.00	$330.44	$330.44	$0.00	$249.80	$395.68	$399.67	$0.00		$0.00	$46.06	$0.00	$0.00	$43.86	$0.00	$0.00	$0.00	$0.00	$0.00
107058	ERX	HCPCS J1652	55111-0679-10	FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN	BOTH IP/OP	$432.13 	$319.78	$0.00	$333.09		$0.00	$0.00	$0.00	$0.00	$0.00	$320.73	$320.73	$333.09	$0.00	$90.06	$0.00	$0.00	$0.00	$0.00	$196.14	$310.68	$313.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107058	ERX	HCPCS J1652	55111-0679-11	FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN	BOTH IP/OP	$432.13 	$319.78	$0.00	$333.09		$0.00	$0.00	$0.00	$0.00	$0.00	$320.73	$320.73	$333.09	$0.00	$90.06	$0.00	$0.00	$0.00	$0.00	$196.14	$310.68	$313.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107059	ERX	HCPCS J1652	55111-0680-02	FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN	BOTH IP/OP	$456.29 	$337.65	$0.00	$351.71		$0.00	$0.00	$0.00	$0.00	$0.00	$338.66	$338.66	$351.71	$0.00	$95.09	$0.00	$0.00	$0.00	$0.00	$196.14	$310.68	$313.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107059	ERX	HCPCS J1652	55111-0680-10	FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN	BOTH IP/OP	$456.29 	$337.65	$0.00	$351.71		$0.00	$0.00	$0.00	$0.00	$0.00	$338.66	$338.66	$351.71	$0.00	$95.09	$0.00	$0.00	$0.00	$0.00	$196.14	$310.68	$313.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107059	ERX	HCPCS J1652	55150-0232-00	FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN	BOTH IP/OP	$456.29 	$337.65	$0.00	$351.71		$0.00	$0.00	$0.00	$0.00	$0.00	$338.66	$338.66	$351.71	$0.00	$95.09	$0.00	$0.00	$0.00	$0.00	$196.14	$310.68	$313.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107059	ERX	HCPCS J1652	55150-0232-10	FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN	BOTH IP/OP	$456.29 	$337.65	$0.00	$351.71		$0.00	$0.00	$0.00	$0.00	$0.00	$338.66	$338.66	$351.71	$0.00	$95.09	$0.00	$0.00	$0.00	$0.00	$196.14	$310.68	$313.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107059	ERX	HCPCS J1652	67457-0584-00	FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN	BOTH IP/OP	$456.29 	$337.65	$0.00	$351.71		$0.00	$0.00	$0.00	$0.00	$0.00	$338.66	$338.66	$351.71	$0.00	$95.09	$0.00	$0.00	$0.00	$0.00	$196.14	$310.68	$313.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107060	ERX	HCPCS J1652	55111-0681-02	FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN	BOTH IP/OP	$456.29 	$337.65	$0.00	$379.38		$0.00	$0.00	$0.00	$0.00	$0.00	$338.66	$338.66	$351.71	$0.00	$95.09	$0.00	$0.00	$0.00	$0.00	$196.14	$379.38	$313.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107060	ERX	HCPCS J1652	55111-0681-10	FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN	BOTH IP/OP	$456.29 	$337.65	$0.00	$379.38		$0.00	$0.00	$0.00	$0.00	$0.00	$338.66	$338.66	$351.71	$0.00	$95.09	$0.00	$0.00	$0.00	$0.00	$196.14	$379.38	$313.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107060	ERX	HCPCS J1652	55111-0681-11	FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN	BOTH IP/OP	$456.29 	$337.65	$0.00	$379.38		$0.00	$0.00	$0.00	$0.00	$0.00	$338.66	$338.66	$351.71	$0.00	$95.09	$0.00	$0.00	$0.00	$0.00	$196.14	$379.38	$313.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107068	ERX	HCPCS 25000001	00051-8450-30	TESTOSTERONE 50 MG/5GM (1%) TD GEL	BOTH IP/OP	$98.88 	$73.17	$0.00	$76.22		$0.00	$0.00	$0.00	$0.00	$0.00	$73.39	$73.39	$76.22	$0.00	$20.61	$0.00	$0.00	$0.00	$0.00	$44.83	$71.01	$71.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107078	ERX	HCPCS J0561	60793-0701-10	PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSP	BOTH IP/OP	$381.78 	$282.52	$0.00	$294.28	$171.80	$171.80	$90.26	$90.26	$90.26	$79.57	$283.36	$283.36	$294.28	$89.69	$105.39	$58.30	$225.82	$225.82	$87.07	$157.53	$249.52	$252.04	$120.23		$120.23	$97.01	$0.00	$0.00	$92.37	$82.92	$0.00	$0.00	$0.00	$0.00
107084	ERX	HCPCS J9303	55513-0954-01	PANITUMUMAB 100 MG/5ML IV SOLN	BOTH IP/OP	"$3,684.78 "	"$2,726.74"	$0.00	"$3,007.79"	"$1,755.98"	"$1,755.98"	"$1,304.07"	"$1,304.07"	"$1,304.07"	$768.00	"$2,896.19"	"$2,896.19"	"$3,007.79"	"$1,303.79"	"$1,531.95"	$847.46	"$1,816.60"	"$1,816.60"	"$1,250.25"	"$1,578.08"	"$2,499.68"	"$2,524.93"	"$1,726.53"		"$1,726.53"	"$1,392.61"	$0.00	$0.00	"$1,326.00"	"$1,228.01"	$0.00	$0.00	$0.00	$0.00
107086	ERX	HCPCS J9303	55513-0956-01	PANITUMUMAB 400 MG/20ML IV SOLN	BOTH IP/OP	"$14,739.05 "	"$10,906.90"	$0.00	"$12,031.15"	"$7,023.89"	"$7,023.89"	"$5,216.28"	"$5,216.28"	"$5,216.28"	"$3,071.99"	"$11,584.74"	"$11,584.74"	"$12,031.15"	"$5,215.16"	"$6,127.81"	"$3,389.85"	"$7,266.35"	"$7,266.35"	"$5,000.98"	"$6,312.32"	"$9,998.71"	"$10,099.71"	"$6,906.12"		"$6,906.12"	"$5,570.44"	$0.00	$0.00	"$5,304.01"	"$4,912.04"	$0.00	$0.00	$0.00	$0.00
107089	ERX	HCPCS 90378	60574-4114-01	PALIVIZUMAB 50 MG/0.5ML IM SOLN	BOTH IP/OP	"$4,415.91 "	"$3,267.77"	$0.00	"$3,403.78"		$0.00	$0.00	$0.00	$0.00	$0.00	"$3,277.49"	"$3,277.49"	"$3,403.78"	$0.00	"$1,913.23"	$0.00	$0.00	$0.00	$0.00	"$1,935.06"	"$3,065.14"	"$3,096.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107090	ERX	HCPCS J3262	50242-0135-01	TOCILIZUMAB 80 MG/4ML IV SOLN	BOTH IP/OP	"$1,433.29 "	"$1,060.63"	$0.00	"$1,104.78"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,063.79"	"$1,063.79"	"$1,104.78"	$0.00	$521.98	$0.00	$0.00	$0.00	$0.00	$664.08	"$1,051.89"	"$1,062.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107091	ERX	HCPCS J3262	50242-0136-01	TOCILIZUMAB 200 MG/10ML IV SOLN	BOTH IP/OP	"$3,126.67 "	"$2,313.74"	$0.00	"$2,410.04"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,320.61"	"$2,320.61"	"$2,410.04"	$0.00	"$1,304.96"	$0.00	$0.00	$0.00	$0.00	"$1,418.07"	"$2,246.22"	"$2,268.91"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107092	ERX	HCPCS J3262	50242-0137-01	TOCILIZUMAB 400 MG/20ML IV SOLN	BOTH IP/OP	"$6,253.33 "	"$4,627.46"	$0.00	"$4,820.07"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,641.22"	"$4,641.22"	"$4,820.07"	$0.00	"$2,609.91"	$0.00	$0.00	$0.00	$0.00	"$2,836.14"	"$4,492.44"	"$4,537.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107094	ERX	HCPCS J9035	50242-0060-01	BEVACIZUMAB 100 MG/4ML IV SOLN	BOTH IP/OP	"$2,476.90 "	"$1,832.91"	$0.00	"$1,909.19"	"$1,114.61"	"$1,114.61"	$678.61	$678.61	$678.61	$674.22	"$1,838.36"	"$1,838.36"	"$1,909.19"	$704.12	$827.34	$457.68	"$1,221.11"	"$1,221.11"	$852.41	"$1,147.60"	"$1,817.80"	"$1,836.16"	"$1,177.14"		"$1,177.14"	$947.52	$0.00	$0.00	$902.20	$783.99	$0.00	$0.00	$0.00	$0.00
107095	ERX	HCPCS J9035	50242-0061-01	BEVACIZUMAB 400 MG/16ML IV SOLN	BOTH IP/OP	"$8,645.21 "	"$6,397.46"	$0.00	"$6,663.73"	"$3,890.34"	"$3,890.34"	"$2,714.44"	"$2,714.44"	"$2,714.44"	"$2,696.86"	"$6,416.47"	"$6,416.47"	"$6,663.73"	"$2,816.48"	"$3,309.36"	"$1,830.71"	"$4,262.09"	"$4,262.09"	"$3,409.64"	"$3,920.95"	"$6,210.78"	"$6,273.51"	"$4,708.56"		"$4,708.56"	"$3,790.08"	$0.00	$0.00	"$3,608.80"	"$3,135.96"	$0.00	$0.00	$0.00	$0.00
107101	ERX	HCPCS J9055	66733-0958-23	CETUXIMAB 200 MG/100ML IV SOLN	BOTH IP/OP	"$3,761.10 "	"$2,783.21"	$0.00	"$2,985.98"	"$1,743.24"	"$1,743.24"	"$1,352.36"	"$1,352.36"	"$1,352.36"	"$1,168.89"	"$2,875.19"	"$2,875.19"	"$2,985.98"	"$1,334.10"	"$1,567.57"	$867.17	"$1,854.22"	"$1,854.22"	"$1,303.01"	"$1,639.59"	"$2,597.11"	"$2,623.34"	"$1,799.39"		"$1,799.39"	"$1,485.44"	$0.00	$0.00	"$1,414.39"	"$1,294.26"	$0.00	$0.00	$0.00	$0.00
107125	ERX	HCPCS J9395	00310-0720-10	FULVESTRANT 250 MG/5ML IM SOLN	BOTH IP/OP	"$2,465.04 "	"$1,824.13"	$0.00	"$1,900.05"	"$1,109.27"	"$1,109.27"	$156.46	$156.46	$156.46	$956.22	"$1,829.55"	"$1,829.55"	"$1,900.05"	$159.79	$187.75	$103.86	"$1,215.26"	"$1,215.26"	$996.18	"$1,118.00"	"$1,888.95"	"$1,788.79"	"$1,375.67"		"$1,375.67"	$998.28	$0.00	$0.00	$950.53	$494.81	$0.00	$0.00	$0.00	$0.00
107125	ERX	HCPCS J9395	00310-7720-10	FULVESTRANT 250 MG/5ML IM SOLN	BOTH IP/OP	"$2,465.04 "	"$1,824.13"	$0.00	"$1,900.05"	"$1,109.27"	"$1,109.27"	$156.46	$156.46	$156.46	$956.22	"$1,829.55"	"$1,829.55"	"$1,900.05"	$159.79	$187.75	$103.86	"$1,215.26"	"$1,215.26"	$996.18	"$1,118.00"	"$1,888.95"	"$1,788.79"	"$1,375.67"		"$1,375.67"	$998.28	$0.00	$0.00	$950.53	$494.81	$0.00	$0.00	$0.00	$0.00
107125	ERX	HCPCS J9395	00781-3079-12	FULVESTRANT 250 MG/5ML IM SOLN	BOTH IP/OP	"$2,465.04 "	"$1,824.13"	$0.00	"$1,900.05"	"$1,109.27"	"$1,109.27"	$156.46	$156.46	$156.46	$956.22	"$1,829.55"	"$1,829.55"	"$1,900.05"	$159.79	$187.75	$103.86	"$1,215.26"	"$1,215.26"	$996.18	"$1,118.00"	"$1,888.95"	"$1,788.79"	"$1,375.67"		"$1,375.67"	$998.28	$0.00	$0.00	$950.53	$494.81	$0.00	$0.00	$0.00	$0.00
107125	ERX	HCPCS J9395	25021-0462-74	FULVESTRANT 250 MG/5ML IM SOLN	BOTH IP/OP	"$2,465.04 "	"$1,824.13"	$0.00	"$1,900.05"	"$1,109.27"	"$1,109.27"	$156.46	$156.46	$156.46	$956.22	"$1,829.55"	"$1,829.55"	"$1,900.05"	$159.79	$187.75	$103.86	"$1,215.26"	"$1,215.26"	$996.18	"$1,118.00"	"$1,888.95"	"$1,788.79"	"$1,375.67"		"$1,375.67"	$998.28	$0.00	$0.00	$950.53	$494.81	$0.00	$0.00	$0.00	$0.00
107125	ERX	HCPCS J9395	67457-0311-05	FULVESTRANT 250 MG/5ML IM SOLN	BOTH IP/OP	"$2,465.04 "	"$1,824.13"	$0.00	"$1,900.05"	"$1,109.27"	"$1,109.27"	$156.46	$156.46	$156.46	$956.22	"$1,829.55"	"$1,829.55"	"$1,900.05"	$159.79	$187.75	$103.86	"$1,215.26"	"$1,215.26"	$996.18	"$1,118.00"	"$1,888.95"	"$1,788.79"	"$1,375.67"		"$1,375.67"	$998.28	$0.00	$0.00	$950.53	$494.81	$0.00	$0.00	$0.00	$0.00
107142	ERX	HCPCS 90744	00006-4093-02	HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP	BOTH IP/OP	$118.01 	$87.33	$0.00	$90.96	$53.10	$53.10	$30.68	$30.68	$28.21	$24.60	$87.59	$87.59	$90.96	$30.68	$24.59	$19.94	$69.80	$69.80	$0.00	$50.04	$79.26	$80.06	$60.04		$60.04	$15.66	$27.03	$27.03	$0.00	$27.03	$0.00	$0.00	$0.00	$0.00
107142	ERX	HCPCS 90744	00006-4981-00	HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP	BOTH IP/OP	$118.01 	$87.33	$0.00	$90.96	$53.10	$53.10	$30.68	$30.68	$28.21	$24.60	$87.59	$87.59	$90.96	$30.68	$24.59	$19.94	$69.80	$69.80	$0.00	$50.04	$79.26	$80.06	$60.04		$60.04	$15.66	$27.03	$27.03	$0.00	$27.03	$0.00	$0.00	$0.00	$0.00
107142	ERX	HCPCS 90744	00006-4981-01	HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP	BOTH IP/OP	$118.01 	$87.33	$0.00	$90.96	$53.10	$53.10	$30.68	$30.68	$28.21	$24.60	$87.59	$87.59	$90.96	$30.68	$24.59	$19.94	$69.80	$69.80	$0.00	$50.04	$79.26	$80.06	$60.04		$60.04	$15.66	$27.03	$27.03	$0.00	$27.03	$0.00	$0.00	$0.00	$0.00
107147	ERX	HCPCS J1956	00143-9722-01	LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN	BOTH IP/OP	$30.17 	$22.33	$0.00	$23.26	$13.58	$13.58	$0.00	$0.00	$0.00	$6.29	$22.39	$22.39	$23.26	$0.00	$6.29	$0.00	$17.85	$17.85	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$4.28	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00
107147	ERX	HCPCS J1956	00143-9722-24	LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN	BOTH IP/OP	$30.17 	$22.33	$0.00	$23.26	$13.58	$13.58	$0.00	$0.00	$0.00	$6.29	$22.39	$22.39	$23.26	$0.00	$6.29	$0.00	$17.85	$17.85	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$4.28	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00
107147	ERX	HCPCS J1956	36000-0046-24	LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN	BOTH IP/OP	$30.17 	$22.33	$0.00	$23.26	$13.58	$13.58	$0.00	$0.00	$0.00	$6.29	$22.39	$22.39	$23.26	$0.00	$6.29	$0.00	$17.85	$17.85	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$4.28	$0.00	$0.00	$4.36	$0.00	$0.00	$0.00	$0.00	$0.00
107148	ERX	HCPCS J1956	00143-9721-01	LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN	BOTH IP/OP	$30.59 	$22.64	$0.00	$23.58	$13.77	$13.77	$0.00	$0.00	$0.00	$6.38	$22.70	$22.70	$23.58	$0.00	$6.37	$0.00	$18.09	$18.09	$0.00	$13.87	$21.97	$22.19	$0.00		$0.00	$4.34	$0.00	$0.00	$4.42	$0.00	$0.00	$0.00	$0.00	$0.00
107148	ERX	HCPCS J1956	00143-9721-24	LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN	BOTH IP/OP	$30.59 	$22.64	$0.00	$23.58	$13.77	$13.77	$0.00	$0.00	$0.00	$6.38	$22.70	$22.70	$23.58	$0.00	$6.37	$0.00	$18.09	$18.09	$0.00	$13.87	$21.97	$22.19	$0.00		$0.00	$4.34	$0.00	$0.00	$4.42	$0.00	$0.00	$0.00	$0.00	$0.00
107148	ERX	HCPCS J1956	36000-0047-24	LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN	BOTH IP/OP	$30.59 	$22.64	$0.00	$23.58	$13.77	$13.77	$0.00	$0.00	$0.00	$6.38	$22.70	$22.70	$23.58	$0.00	$6.37	$0.00	$18.09	$18.09	$0.00	$13.87	$21.97	$22.19	$0.00		$0.00	$4.34	$0.00	$0.00	$4.42	$0.00	$0.00	$0.00	$0.00	$0.00
107149	ERX	HCPCS J1956	00143-9720-24	LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN	BOTH IP/OP	$55.31 	$40.93	$0.00	$42.63	$24.89	$24.89	$0.00	$0.00	$0.00	$11.53	$41.05	$41.05	$42.63	$0.00	$11.53	$0.00	$32.72	$32.72	$0.00	$25.08	$39.73	$40.13	$0.00		$0.00	$7.85	$0.00	$0.00	$7.99	$0.00	$0.00	$0.00	$0.00	$0.00
107149	ERX	HCPCS J1956	25021-0132-83	LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN	BOTH IP/OP	$55.31 	$40.93	$0.00	$42.63	$24.89	$24.89	$0.00	$0.00	$0.00	$11.53	$41.05	$41.05	$42.63	$0.00	$11.53	$0.00	$32.72	$32.72	$0.00	$25.08	$39.73	$40.13	$0.00		$0.00	$7.85	$0.00	$0.00	$7.99	$0.00	$0.00	$0.00	$0.00	$0.00
107150	ERX	HCPCS J2543	00206-8862-02	PIPERACILLIN-TAZOBACTAM IN DEX 4-0.5 GM/100ML IV SOLN FROZEN	BOTH IP/OP	$117.73 	$87.12	$0.00	$90.75	$52.98	$52.98	$0.00	$0.00	$0.00	$26.18	$87.38	$87.38	$90.75	$0.00	$6.94	$0.00	$69.64	$69.64	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$8.70	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
107151	ERX	HCPCS J9171	00955-1021-04	DOCETAXEL 80 MG/4ML IV CONC	BOTH IP/OP	"$2,486.40 "	"$1,839.94"	$0.00	"$1,916.52"	"$1,118.88"	"$1,118.88"	$0.00	$0.00	$0.00	$518.23	"$1,845.41"	"$1,845.41"	"$1,916.52"	$0.00	$45.03	$0.00	"$1,225.80"	"$1,225.80"	$72.66	"$1,152.00"	$992.22	"$1,843.20"	$100.34		$100.34	$91.18	$0.00	$0.00	$86.82	$69.44	$0.00	$0.00	$0.00	$0.00
107151	ERX	HCPCS J9171	16729-0267-64	DOCETAXEL 80 MG/4ML IV CONC	BOTH IP/OP	"$2,486.40 "	"$1,839.94"	$0.00	"$1,916.52"	"$1,118.88"	"$1,118.88"	$0.00	$0.00	$0.00	$518.23	"$1,845.41"	"$1,845.41"	"$1,916.52"	$0.00	$45.03	$0.00	"$1,225.80"	"$1,225.80"	$72.66	"$1,152.00"	$992.22	"$1,843.20"	$100.34		$100.34	$91.18	$0.00	$0.00	$86.82	$69.44	$0.00	$0.00	$0.00	$0.00
107151	ERX	HCPCS J9171	43598-0259-40	DOCETAXEL 80 MG/4ML IV CONC	BOTH IP/OP	"$2,486.40 "	"$1,839.94"	$0.00	"$1,916.52"	"$1,118.88"	"$1,118.88"	$0.00	$0.00	$0.00	$518.23	"$1,845.41"	"$1,845.41"	"$1,916.52"	$0.00	$45.03	$0.00	"$1,225.80"	"$1,225.80"	$72.66	"$1,152.00"	$992.22	"$1,843.20"	$100.34		$100.34	$91.18	$0.00	$0.00	$86.82	$69.44	$0.00	$0.00	$0.00	$0.00
107151	ERX	HCPCS J9171	45963-0765-52	DOCETAXEL 80 MG/4ML IV CONC	BOTH IP/OP	"$2,486.40 "	"$1,839.94"	$0.00	"$1,916.52"	"$1,118.88"	"$1,118.88"	$0.00	$0.00	$0.00	$518.23	"$1,845.41"	"$1,845.41"	"$1,916.52"	$0.00	$45.03	$0.00	"$1,225.80"	"$1,225.80"	$72.66	"$1,152.00"	$992.22	"$1,843.20"	$100.34		$100.34	$91.18	$0.00	$0.00	$86.82	$69.44	$0.00	$0.00	$0.00	$0.00
107156	ERX	HCPCS 90713	49281-0860-10	POLIOVIRUS VACCINE INACTIVATED IJ INJ	BOTH IP/OP	$178.89 	$132.38	$0.00	$137.89	$80.50	$80.50	$0.00	$0.00	$0.00	$9.40	$132.77	$132.77	$137.89	$0.00	$43.35	$0.00	$105.81	$105.81	$0.00	$73.59	$116.56	$117.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107157	ERX	HCPCS J0744	00409-4777-23	CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107158	ERX	HCPCS J0278	00641-6167-10	AMIKACIN SULFATE 500 MG/2ML IJ SOLN	BOTH IP/OP	$61.62 	$45.60	$0.00	$47.50	$27.73	$27.73	$0.00	$0.00	$0.00	$3.11	$45.73	$45.73	$47.50	$0.00	$6.23	$0.00	$36.45	$36.45	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107158	ERX	HCPCS J0278	00703-9032-01	AMIKACIN SULFATE 500 MG/2ML IJ SOLN	BOTH IP/OP	$61.62 	$45.60	$0.00	$47.50	$27.73	$27.73	$0.00	$0.00	$0.00	$3.11	$45.73	$45.73	$47.50	$0.00	$6.23	$0.00	$36.45	$36.45	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107158	ERX	HCPCS J0278	00703-9032-03	AMIKACIN SULFATE 500 MG/2ML IJ SOLN	BOTH IP/OP	$61.62 	$45.60	$0.00	$47.50	$27.73	$27.73	$0.00	$0.00	$0.00	$3.11	$45.73	$45.73	$47.50	$0.00	$6.23	$0.00	$36.45	$36.45	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107158	ERX	HCPCS J0278	23155-0290-41	AMIKACIN SULFATE 500 MG/2ML IJ SOLN	BOTH IP/OP	$61.62 	$45.60	$0.00	$47.50	$27.73	$27.73	$0.00	$0.00	$0.00	$3.11	$45.73	$45.73	$47.50	$0.00	$6.23	$0.00	$36.45	$36.45	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107158	ERX	HCPCS J0278	25021-0173-02	AMIKACIN SULFATE 500 MG/2ML IJ SOLN	BOTH IP/OP	$61.62 	$45.60	$0.00	$47.50	$27.73	$27.73	$0.00	$0.00	$0.00	$3.11	$45.73	$45.73	$47.50	$0.00	$6.23	$0.00	$36.45	$36.45	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107159	ERX	HCPCS J0278	00703-9040-01	AMIKACIN SULFATE 1 GM/4ML IJ SOLN	BOTH IP/OP	$33.29 	$24.63	$0.00	$26.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.65	$26.37	$26.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107159	ERX	HCPCS J0278	00703-9040-03	AMIKACIN SULFATE 1 GM/4ML IJ SOLN	BOTH IP/OP	$33.29 	$24.63	$0.00	$26.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.65	$26.37	$26.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107159	ERX	HCPCS J0278	23155-0290-42	AMIKACIN SULFATE 1 GM/4ML IJ SOLN	BOTH IP/OP	$33.29 	$24.63	$0.00	$26.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.65	$26.37	$26.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107159	ERX	HCPCS J0278	63323-0815-04	AMIKACIN SULFATE 1 GM/4ML IJ SOLN	BOTH IP/OP	$33.29 	$24.63	$0.00	$26.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.65	$26.37	$26.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107160	ERX	HCPCS 25000001	63323-0282-60	CLINDAMYCIN PHOSPHATE 9 GM/60ML IJ SOLN	BOTH IP/OP	$108.63 	$80.39	$0.00	$83.73		$0.00	$0.00	$0.00	$0.00	$0.00	$80.63	$80.63	$83.73	$0.00	$22.64	$0.00	$0.00	$0.00	$0.00	$49.25	$78.00	$78.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107378	ERX	HCPCS J0490	49401-0101-01	BELIMUMAB 120 MG IV SOLR	BOTH IP/OP	"$1,778.45 "	"$1,316.05"	$0.00	"$1,370.83"	$800.30	$800.30	$578.80	$578.80	$578.80	$370.67	"$1,319.97"	"$1,319.97"	"$1,370.83"	$570.79	$670.68	$371.01	"$1,051.95"	"$1,051.95"	$0.00	$780.32	"$1,236.02"	"$1,248.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107379	ERX	HCPCS J0490	49401-0102-01	BELIMUMAB 400 MG IV SOLR	BOTH IP/OP	"$5,172.65 "	"$3,827.76"	$0.00	"$3,987.08"	"$2,327.69"	"$2,327.69"	"$1,929.32"	"$1,929.32"	"$1,929.32"	"$1,078.11"	"$3,839.14"	"$3,839.14"	"$3,987.08"	"$1,902.64"	"$2,235.60"	"$1,236.72"	"$2,550.12"	"$2,550.12"	$0.00	"$2,221.64"	"$3,519.08"	"$3,554.62"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107443	ERX	HCPCS J9171	00409-0201-10	DOCETAXEL 80 MG/8ML IV SOLN	BOTH IP/OP	"$3,431.06 "	"$2,538.98"	$0.00	"$2,644.66"	"$1,543.98"	"$1,543.98"	$0.00	$0.00	$0.00	$715.12	"$2,546.53"	"$2,546.53"	"$2,644.66"	$0.00	$45.03	$0.00	"$1,691.51"	"$1,691.51"	$72.66	"$1,556.13"	"$2,464.90"	"$2,489.80"	$100.34		$100.34	$91.18	$0.00	$0.00	$86.82	$69.44	$0.00	$0.00	$0.00	$0.00
107443	ERX	HCPCS J9171	66758-0050-02	DOCETAXEL 80 MG/8ML IV SOLN	BOTH IP/OP	"$3,431.06 "	"$2,538.98"	$0.00	"$2,644.66"	"$1,543.98"	"$1,543.98"	$0.00	$0.00	$0.00	$715.12	"$2,546.53"	"$2,546.53"	"$2,644.66"	$0.00	$45.03	$0.00	"$1,691.51"	"$1,691.51"	$72.66	"$1,556.13"	"$2,464.90"	"$2,489.80"	$100.34		$100.34	$91.18	$0.00	$0.00	$86.82	$69.44	$0.00	$0.00	$0.00	$0.00
107443	ERX	HCPCS J9171	67457-0532-08	DOCETAXEL 80 MG/8ML IV SOLN	BOTH IP/OP	"$3,431.06 "	"$2,538.98"	$0.00	"$2,644.66"	"$1,543.98"	"$1,543.98"	$0.00	$0.00	$0.00	$715.12	"$2,546.53"	"$2,546.53"	"$2,644.66"	$0.00	$45.03	$0.00	"$1,691.51"	"$1,691.51"	$72.66	"$1,556.13"	"$2,464.90"	"$2,489.80"	$100.34		$100.34	$91.18	$0.00	$0.00	$86.82	$69.44	$0.00	$0.00	$0.00	$0.00
107446	ERX	HCPCS J9171	00409-0201-02	DOCETAXEL 20 MG/2ML IV SOLN	BOTH IP/OP	$290.58 	$215.03	$0.00	$207.90	$0.00	$0.00	$0.00	$0.00	$0.00	$60.56	$0.00	$0.00	$0.00	$0.00	$11.26	$0.00	$171.88	$171.88	$18.17	$129.94	$205.82	$207.90	$25.09		$25.09	$22.80	$0.00	$0.00	$21.70	$17.36	$0.00	$0.00	$0.00	$0.00
107491	ERX	HCPCS J9228	00003-2327-11	IPILIMUMAB 50 MG/10ML IV SOLN	BOTH IP/OP	"$20,958.73 "	"$15,509.46"	$0.00	"$16,478.08"	"$9,620.05"	"$9,620.05"	"$8,035.15"	"$8,035.15"	"$8,035.15"	"$4,368.32"	"$15,866.67"	"$15,866.67"	"$16,478.08"	"$7,932.40"	"$9,320.57"	"$5,156.06"	"$10,332.65"	"$10,332.65"	"$8,039.22"	"$9,226.74"	"$14,615.15"	"$14,762.78"	"$11,101.78"		"$11,101.78"	"$8,138.89"	$0.00	$0.00	"$8,138.89"	"$7,864.60"	$0.00	$0.00	$0.00	$0.00
107492	ERX	HCPCS J9228	00003-2328-22	IPILIMUMAB 200 MG/40ML IV SOLN	BOTH IP/OP	"$83,834.70 "	"$62,037.68"	$0.00	"$65,912.15"	"$38,480.11"	"$38,480.11"	"$32,140.60"	"$32,140.60"	"$32,140.60"	"$9,417.94"	"$63,466.52"	"$63,466.52"	"$65,912.15"	"$31,729.60"	"$37,282.28"	"$20,624.24"	"$41,330.51"	"$41,330.51"	"$32,156.88"	"$36,906.85"	"$58,460.45"	"$59,050.96"	"$44,407.12"		"$44,407.12"	"$8,138.89"	$0.00	$0.00	"$8,138.89"	"$31,458.40"	$0.00	$0.00	$0.00	$0.00
107815	ERX	HCPCS 63700001	00597-0123-30	NEVIRAPINE ER 400 MG PO TB24	BOTH IP/OP	$83.11 	$61.50	$0.00	$60.30		$0.00	$0.00	$0.00	$14.79	$0.00	$0.00	$0.00	$0.00	$0.00	$17.32	$0.00	$0.00	$0.00	$0.00	$37.69	$59.69	$60.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107815	ERX	HCPCS 63700001	33342-0238-07	NEVIRAPINE ER 400 MG PO TB24	BOTH IP/OP	$83.11 	$61.50	$0.00	$60.30		$0.00	$0.00	$0.00	$14.79	$0.00	$0.00	$0.00	$0.00	$0.00	$17.32	$0.00	$0.00	$0.00	$0.00	$37.69	$59.69	$60.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107815	ERX	HCPCS 63700001	47781-0317-30	NEVIRAPINE ER 400 MG PO TB24	BOTH IP/OP	$83.11 	$61.50	$0.00	$60.30		$0.00	$0.00	$0.00	$14.79	$0.00	$0.00	$0.00	$0.00	$0.00	$17.32	$0.00	$0.00	$0.00	$0.00	$37.69	$59.69	$60.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
107843	ERX	HCPCS 63700001	62103-0333-02	ZINC OXIDE 16 % EX OINT	BOTH IP/OP	$23.89 	$17.68	$0.00	$12.14		$0.00	$0.00	$0.00	$4.25	$0.00	$0.00	$0.00	$0.00	$0.00	$4.98	$0.00	$0.00	$0.00	$0.00	$7.59	$12.01	$12.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
108161	ERX	HCPCS 63700001	00456-1120-30	VILAZODONE HCL 20 MG PO TABS	BOTH IP/OP	$50.31 	$37.23	$0.00	$34.76		$0.00	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00	$10.48	$0.00	$0.00	$0.00	$0.00	$21.73	$34.41	$34.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
108272	ERX	HCPCS 63600001	57894-0150-12	ABIRATERONE ACETATE 250 MG PO TABS	BOTH IP/OP	"$1,073.22 "	$794.18	$0.00	$827.24		$0.00	$0.00	$0.00	$0.00	$0.00	$796.54	$796.54	$827.24	$0.00	$223.66	$0.00	$0.00	$0.00	$0.00	$487.00	$771.40	$779.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
108272	ERX	HCPCS 63600001	57894-0155-12	ABIRATERONE ACETATE 250 MG PO TABS	BOTH IP/OP	"$1,073.22 "	$794.18	$0.00	$827.24		$0.00	$0.00	$0.00	$0.00	$0.00	$796.54	$796.54	$827.24	$0.00	$223.66	$0.00	$0.00	$0.00	$0.00	$487.00	$771.40	$779.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
108405	ERX	HCPCS 63700001	59676-0278-01	RILPIVIRINE HCL 25 MG PO TABS	BOTH IP/OP	$188.02 	$139.13	$0.00	$130.52		$0.00	$0.00	$0.00	$31.77	$0.00	$0.00	$0.00	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$81.58	$129.21	$130.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
108619	ERX	HCPCS J0282	43066-0150-10	AMIODARONE HCL IN DEXTROSE 150-4.21 MG/100ML-% IV SOLN	BOTH IP/OP	$160.58 	$118.83	$0.00	$123.78		$0.00	$0.00	$0.00	$0.00	$0.00	$119.18	$119.18	$123.78	$0.00	$33.46	$0.00	$0.00	$0.00	$0.00	$72.80	$115.32	$116.48	$0.00		$0.00	$22.79	$0.00	$0.00	$23.18	$0.00	$0.00	$0.00	$0.00	$0.00
108620	ERX	HCPCS J0282	43066-0360-20	AMIODARONE HCL IN DEXTROSE 360-4.14 MG/200ML-% IV SOLN	BOTH IP/OP	$192.24 	$142.26	$0.00	$148.18		$0.00	$0.00	$0.00	$0.00	$0.00	$142.68	$142.68	$148.18	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$87.26	$138.21	$139.61	$0.00		$0.00	$27.31	$0.00	$0.00	$27.78	$0.00	$0.00	$0.00	$0.00	$0.00
108708	ERX	HCPCS 63700001	52015-0080-01	FIDAXOMICIN 200 MG PO TABS	BOTH IP/OP	$746.74 	$552.59	$0.00	$516.34		$0.00	$0.00	$0.00	$139.56	$0.00	$0.00	$0.00	$0.00	$0.00	$155.62	$0.00	$0.00	$0.00	$0.00	$322.71	$511.17	$516.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109063	ERX	HCPCS J9217	00074-3473-03	LEUPROLIDE ACETATE (6 MONTH) 45 MG IM KIT	BOTH IP/OP	"$28,760.36 "	"$21,282.67"	$0.00	"$23,254.75"	"$13,576.33"	"$13,576.33"	"$1,204.40"	"$1,204.40"	"$1,204.40"	"$1,480.99"	"$22,391.90"	"$22,391.90"	"$23,254.75"	$834.54	$980.58	$542.45	"$14,178.86"	"$14,178.86"	"$1,415.60"	"$12,282.46"	"$19,455.41"	"$19,651.93"	"$1,954.87"		"$1,954.87"	"$1,621.99"	$0.00	$0.00	"$1,544.41"	"$1,235.32"	$0.00	$0.00	$0.00	$0.00
109481	ERX	HCPCS 63700001	50458-0580-10	RIVAROXABAN 10 MG PO TABS	BOTH IP/OP	$82.55 	$61.09	$0.00	$57.15		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$17.20	$0.00	$0.00	$0.00	$0.00	$35.72	$56.58	$57.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109481	ERX	HCPCS 63700001	50458-0580-30	RIVAROXABAN 10 MG PO TABS	BOTH IP/OP	$82.55 	$61.09	$0.00	$57.15		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$17.20	$0.00	$0.00	$0.00	$0.00	$35.72	$56.58	$57.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109484	ERX	HCPCS 63700001	00186-0777-39	TICAGRELOR 90 MG PO TABS	BOTH IP/OP	$35.65 	$26.38	$0.00	$23.90		$0.00	$0.00	$0.00	$6.35	$0.00	$0.00	$0.00	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$14.94	$23.66	$23.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109651	ERX	HCPCS 25000001	00004-0822-05	OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR	BOTH IP/OP	$612.47 	$453.23	$0.00	$472.09		$0.00	$0.00	$0.00	$0.00	$0.00	$454.58	$454.58	$472.09	$0.00	$127.64	$0.00	$0.00	$0.00	$0.00	$277.98	$440.32	$444.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109651	ERX	HCPCS 25000001	47781-0384-26	OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR	BOTH IP/OP	$612.47 	$453.23	$0.00	$472.09		$0.00	$0.00	$0.00	$0.00	$0.00	$454.58	$454.58	$472.09	$0.00	$127.64	$0.00	$0.00	$0.00	$0.00	$277.98	$440.32	$444.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110050	ERX	HCPCS 25000001	99999-6006-74	PENICILLIN G 100 UNITS/ML ID INJ	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110052	ERX	HCPCS 25000001	99999-6006-75	PENICILLIN G 1000 UNITS/ML ID INJ	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110156	ERX	HCPCS 63700001	00904-2137-61	FERROUS GLUCONATE 324 (37.5 FE) MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110232	ERX	HCPCS 63700001	61958-1101-01	COMPLERA:EMTRICITAB-RILPIVIR-TENOFOVIR200-25-300MGTAB	BOTH IP/OP	$438.35 	$324.38	$0.00	$287.64		$0.00	$0.00	$0.00	$78.03	$0.00	$0.00	$0.00	$0.00	$0.00	$91.35	$0.00	$0.00	$0.00	$0.00	$179.78	$284.76	$287.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110284	ERX	HCPCS 63700001	50242-0090-02	VEMURAFENIB 240 MG PO TABS	BOTH IP/OP	$575.10 	$425.57	$0.00	$460.08		$0.00	$0.00	$0.00	$112.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.55	$455.48	$460.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110289	ERX	HCPCS 63700001	27434-0010-17	COPPER GLUCONATE 2 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110289	ERX	HCPCS 63700001	66536-0014-44	COPPER GLUCONATE 2 MG PO CAPS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110307	ERX	HCPCS J9042	51144-0050-01	BRENTUXIMAB VEDOTIN 50 MG IV SOLR	BOTH IP/OP	"$26,306.40 "	"$19,466.74"	$0.00	"$20,276.97"	"$11,837.88"	"$11,837.88"	"$9,827.35"	"$9,827.35"	"$9,827.35"	"$5,482.91"	"$19,524.61"	"$19,524.61"	"$20,276.97"	"$9,466.75"	"$11,123.43"	"$6,153.39"	"$12,969.06"	"$12,969.06"	"$8,527.94"	"$10,568.16"	"$16,739.97"	"$16,909.06"	"$11,776.68"		"$11,776.68"	"$8,138.89"	$0.00	$0.00	"$8,138.89"	"$8,793.05"	$0.00	$0.00	$0.00	$0.00
110346	ERX	HCPCS J1744	54092-0702-02	ICATIBANT ACETATE 30 MG/3ML SC SOLN	BOTH IP/OP	"$5,424.00 "	"$4,013.76"	$0.00	"$21,938.27"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,025.69"	"$4,025.69"	"$4,180.82"	$0.00	"$1,130.36"	$0.00	$0.00	$0.00	$0.00	"$13,711.42"	"$21,718.89"	"$21,938.27"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110349	ERX	HCPCS 63700001	00069-8141-20	CRIZOTINIB 200 MG PO CAPS	BOTH IP/OP	"$1,145.16 "	$847.42	$0.00	$750.55		$0.00	$0.00	$0.00	$203.84	$0.00	$0.00	$0.00	$0.00	$0.00	$238.65	$0.00	$0.00	$0.00	$0.00	$469.10	$743.05	$750.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110350	ERX	HCPCS 63700001	00069-8140-20	CRIZOTINIB 250 MG PO CAPS	BOTH IP/OP	"$1,145.16 "	$847.42	$0.00	$750.55		$0.00	$0.00	$0.00	$203.84	$0.00	$0.00	$0.00	$0.00	$0.00	$238.65	$0.00	$0.00	$0.00	$0.00	$469.10	$743.05	$750.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110577	ERX	HCPCS 25000001	11704-0370-01	HYDROXOCOBALAMIN 5 G IV SOLR	BOTH IP/OP	"$2,552.66 "	"$1,888.97"	$0.00	"$1,967.59"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,894.58"	"$1,894.58"	"$1,967.59"	$0.00	$531.97	$0.00	$0.00	$0.00	$0.00	"$1,182.70"	"$1,873.40"	"$1,892.32"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110604	ERX	HCPCS J3489	25021-0826-82	ZOLEDRONIC ACID 4 MG/100ML IV SOLN	BOTH IP/OP	$249.84 	$184.88	$0.00	$457.92	$112.43	$112.43	$0.00	$0.00	$0.00	$52.07	$185.43	$185.43	$192.58	$0.00	$38.76	$0.00	$147.78	$147.78	$0.00	$286.20	$453.34	$457.92	$0.00		$0.00	$51.14	$0.00	$0.00	$48.69	$0.00	$0.00	$0.00	$0.00	$0.00
110863	ERX	HCPCS 25000001	00004-0357-30	PEGINTERFERON ALFA-2A 180 MCG/0.5ML SC SOLN	BOTH IP/OP	"$2,512.87 "	"$1,859.52"	$0.00	"$2,010.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,256.44"	"$1,990.19"	"$2,010.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111020	ERX	HCPCS 25000001	65702-0407-10	ACCU-CHEK AVIVA PLUS VI STRP	BOTH IP/OP	$325.14 	$240.60	$0.00	$250.62		$0.00	$0.00	$0.00	$0.00	$0.00	$241.32	$241.32	$250.62	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$147.58	$233.77	$236.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111272	ERX	HCPCS 25000001	51991-0900-01	CLOBAZAM 10 MG PO TABS	BOTH IP/OP	$76.70 	$56.76	$0.00	$74.02		$0.00	$0.00	$0.00	$0.00	$0.00	$56.93	$56.93	$59.12	$0.00	$15.98	$0.00	$0.00	$0.00	$0.00	$46.26	$73.28	$74.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111272	ERX	HCPCS 25000001	67386-0314-01	CLOBAZAM 10 MG PO TABS	BOTH IP/OP	$76.70 	$56.76	$0.00	$74.02		$0.00	$0.00	$0.00	$0.00	$0.00	$56.93	$56.93	$59.12	$0.00	$15.98	$0.00	$0.00	$0.00	$0.00	$46.26	$73.28	$74.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111273	ERX	HCPCS 25000001	67386-0315-01	CLOBAZAM 20 MG PO TABS	BOTH IP/OP	$161.10 	$119.21	$0.00	$133.23		$0.00	$0.00	$0.00	$0.00	$0.00	$119.57	$119.57	$124.18	$0.00	$33.57	$0.00	$0.00	$0.00	$0.00	$83.27	$131.90	$133.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111314	ERX	HCPCS C9290	65250-0133-09	BUPIVACAINE LIPOSOME 1.3 % IJ SUSP	BOTH IP/OP	$663.55 	$491.03	$0.00	"$1,074.10"	$313.54	$313.54	$0.00	$0.00	$0.00	$138.30	"$1,034.26"	"$1,034.26"	"$1,074.10"	$0.00	$138.28	$0.00	$784.98	$784.98	$0.00	$286.76	$454.23	$458.82	$0.00		$0.00	$0.00	$0.00	$0.00	$91.30	$0.00	$0.00	$0.00	$0.00	$0.00
111314	ERX	HCPCS C9290	65250-0133-10	BUPIVACAINE LIPOSOME 1.3 % IJ SUSP	BOTH IP/OP	$663.55 	$491.03	$0.00	"$1,074.10"	$313.54	$313.54	$0.00	$0.00	$0.00	$138.30	"$1,034.26"	"$1,034.26"	"$1,074.10"	$0.00	$138.28	$0.00	$784.98	$784.98	$0.00	$286.76	$454.23	$458.82	$0.00		$0.00	$0.00	$0.00	$0.00	$91.30	$0.00	$0.00	$0.00	$0.00	$0.00
111314	ERX	HCPCS C9290	65250-0266-09	BUPIVACAINE LIPOSOME 1.3 % IJ SUSP	BOTH IP/OP	$663.55 	$491.03	$0.00	"$1,074.10"	$313.54	$313.54	$0.00	$0.00	$0.00	$138.30	"$1,034.26"	"$1,034.26"	"$1,074.10"	$0.00	$138.28	$0.00	$784.98	$784.98	$0.00	$286.76	$454.23	$458.82	$0.00		$0.00	$0.00	$0.00	$0.00	$91.30	$0.00	$0.00	$0.00	$0.00	$0.00
111314	ERX	HCPCS C9290	65250-0266-20	BUPIVACAINE LIPOSOME 1.3 % IJ SUSP	BOTH IP/OP	$663.55 	$491.03	$0.00	"$1,074.10"	$313.54	$313.54	$0.00	$0.00	$0.00	$138.30	"$1,034.26"	"$1,034.26"	"$1,074.10"	$0.00	$138.28	$0.00	$784.98	$784.98	$0.00	$286.76	$454.23	$458.82	$0.00		$0.00	$0.00	$0.00	$0.00	$91.30	$0.00	$0.00	$0.00	$0.00	$0.00
111320	ERX	HCPCS J9201	00409-0181-01	GEMCITABINE HCL 1 GM/26.3ML IV SOLN	BOTH IP/OP	$188.64 	$139.59	$0.00	$811.87	$84.89	$84.89	$0.00	$0.00	$0.00	$811.87	$140.01	$140.01	$145.40	$0.00	$22.42	$0.00	$111.58	$111.58	$0.00	$84.38	$133.66	$135.01	$0.00		$0.00	$24.44	$0.00	$0.00	$23.27	$0.00	$0.00	$0.00	$0.00	$0.00
111320	ERX	HCPCS J9201	25021-0239-26	GEMCITABINE HCL 1 GM/26.3ML IV SOLN	BOTH IP/OP	$188.64 	$139.59	$0.00	$811.87	$84.89	$84.89	$0.00	$0.00	$0.00	$811.87	$140.01	$140.01	$145.40	$0.00	$22.42	$0.00	$111.58	$111.58	$0.00	$84.38	$133.66	$135.01	$0.00		$0.00	$24.44	$0.00	$0.00	$23.27	$0.00	$0.00	$0.00	$0.00	$0.00
111320	ERX	HCPCS J9201	60505-6114-00	GEMCITABINE HCL 1 GM/26.3ML IV SOLN	BOTH IP/OP	$188.64 	$139.59	$0.00	$811.87	$84.89	$84.89	$0.00	$0.00	$0.00	$811.87	$140.01	$140.01	$145.40	$0.00	$22.42	$0.00	$111.58	$111.58	$0.00	$84.38	$133.66	$135.01	$0.00		$0.00	$24.44	$0.00	$0.00	$23.27	$0.00	$0.00	$0.00	$0.00	$0.00
111367	ERX	HCPCS 63700001	50458-0578-10	RIVAROXABAN 15 MG PO TABS	BOTH IP/OP	$82.55 	$61.09	$0.00	$57.15		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$17.20	$0.00	$0.00	$0.00	$0.00	$35.72	$56.58	$57.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111367	ERX	HCPCS 63700001	50458-0578-30	RIVAROXABAN 15 MG PO TABS	BOTH IP/OP	$82.55 	$61.09	$0.00	$57.15		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$17.20	$0.00	$0.00	$0.00	$0.00	$35.72	$56.58	$57.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111368	ERX	HCPCS 63700001	50458-0579-01	RIVAROXABAN 20 MG PO TABS	BOTH IP/OP	$82.55 	$61.09	$0.00	$57.15		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$17.20	$0.00	$0.00	$0.00	$0.00	$35.72	$56.58	$57.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111368	ERX	HCPCS 63700001	50458-0579-10	RIVAROXABAN 20 MG PO TABS	BOTH IP/OP	$82.55 	$61.09	$0.00	$57.15		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$17.20	$0.00	$0.00	$0.00	$0.00	$35.72	$56.58	$57.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111368	ERX	HCPCS 63700001	50458-0579-90	RIVAROXABAN 20 MG PO TABS	BOTH IP/OP	$82.55 	$61.09	$0.00	$57.15		$0.00	$0.00	$0.00	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$17.20	$0.00	$0.00	$0.00	$0.00	$35.72	$56.58	$57.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111436	ERX	HCPCS 63700001	50881-0005-60	RUXOLITINIB PHOSPHATE 5 MG PO TABS	BOTH IP/OP	$883.19 	$653.56	$0.00	$584.02		$0.00	$0.00	$0.00	$161.93	$0.00	$0.00	$0.00	$0.00	$0.00	$184.06	$0.00	$0.00	$0.00	$0.00	$365.02	$578.18	$584.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111437	ERX	HCPCS 63700001	50881-0010-60	RUXOLITINIB PHOSPHATE 10 MG PO TABS	BOTH IP/OP	$883.19 	$653.56	$0.00	$584.02		$0.00	$0.00	$0.00	$161.93	$0.00	$0.00	$0.00	$0.00	$0.00	$184.06	$0.00	$0.00	$0.00	$0.00	$365.02	$578.18	$584.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111438	ERX	HCPCS 63700001	50881-0015-60	RUXOLITINIB PHOSPHATE 15 MG PO TABS	BOTH IP/OP	$883.19 	$653.56	$0.00	$584.02		$0.00	$0.00	$0.00	$161.93	$0.00	$0.00	$0.00	$0.00	$0.00	$184.06	$0.00	$0.00	$0.00	$0.00	$365.02	$578.18	$584.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111439	ERX	HCPCS 63700001	50881-0020-60	RUXOLITINIB PHOSPHATE 20 MG PO TABS	BOTH IP/OP	$883.19 	$653.56	$0.00	$584.02		$0.00	$0.00	$0.00	$161.93	$0.00	$0.00	$0.00	$0.00	$0.00	$184.06	$0.00	$0.00	$0.00	$0.00	$365.02	$578.18	$584.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111440	ERX	HCPCS 63700001	50881-0025-60	RUXOLITINIB PHOSPHATE 25 MG PO TABS	BOTH IP/OP	$883.19 	$653.56	$0.00	$584.02		$0.00	$0.00	$0.00	$161.93	$0.00	$0.00	$0.00	$0.00	$0.00	$184.06	$0.00	$0.00	$0.00	$0.00	$365.02	$578.18	$584.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111479	ERX	HCPCS J0178	61755-0005-02	AFLIBERCEPT 2 MG/0.05ML INTRAVITREAL SOLN	BOTH IP/OP	"$5,017.20 "	"$3,712.73"	$0.00	"$3,867.26"	"$2,257.74"	"$2,257.74"	"$1,831.49"	"$1,831.49"	"$1,831.49"	"$1,045.71"	"$3,723.77"	"$3,723.77"	"$3,867.26"	"$1,835.89"	"$2,157.17"	"$1,193.33"	"$2,473.48"	"$2,473.48"	"$2,000.19"	"$2,275.50"	"$3,604.39"	"$3,640.80"	"$2,762.17"		"$2,762.17"	"$2,220.82"	$0.00	$0.00	"$2,114.60"	"$1,863.53"	$0.00	$0.00	$0.00	$0.00
111525	ERX	HCPCS J3490	63323-0648-10	LEVOTHYROXINE SODIUM 500 MCG IV SOLR	BOTH IP/OP	$425.71 	$315.03	$0.00	$328.14	$191.57	$191.57	$0.00	$0.00	$0.00	$88.73	$315.96	$315.96	$328.14	$0.00	$88.72	$0.00	$251.81	$251.81	$0.00	$193.22	$306.05	$309.14	$0.00		$0.00	$60.48	$0.00	$0.00	$61.52	$0.00	$0.00	$0.00	$0.00	$0.00
111526	ERX	HCPCS 25000001	42023-0201-01	LEVOTHYROXINE SODIUM 100 MCG IV SOLR	BOTH IP/OP	$425.72 	$315.03	$0.00	$328.14		$0.00	$0.00	$0.00	$0.00	$0.00	$315.97	$315.97	$328.14	$0.00	$88.72	$0.00	$0.00	$0.00	$0.00	$193.22	$306.06	$309.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111526	ERX	HCPCS 25000001	63323-0649-07	LEVOTHYROXINE SODIUM 100 MCG IV SOLR	BOTH IP/OP	$425.72 	$315.03	$0.00	$328.14		$0.00	$0.00	$0.00	$0.00	$0.00	$315.97	$315.97	$328.14	$0.00	$88.72	$0.00	$0.00	$0.00	$0.00	$193.22	$306.06	$309.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111526	ERX	HCPCS 25000001	63323-0649-16	LEVOTHYROXINE SODIUM 100 MCG IV SOLR	BOTH IP/OP	$425.72 	$315.03	$0.00	$328.14		$0.00	$0.00	$0.00	$0.00	$0.00	$315.97	$315.97	$328.14	$0.00	$88.72	$0.00	$0.00	$0.00	$0.00	$193.22	$306.06	$309.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111526	ERX	HCPCS 25000001	70860-0451-10	LEVOTHYROXINE SODIUM 100 MCG IV SOLR	BOTH IP/OP	$425.72 	$315.03	$0.00	$328.14		$0.00	$0.00	$0.00	$0.00	$0.00	$315.97	$315.97	$328.14	$0.00	$88.72	$0.00	$0.00	$0.00	$0.00	$193.22	$306.06	$309.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111662	ERX	HCPCS 25000001	46783-0221-52	POLIDOCANOL 1 % IV SOLN	BOTH IP/OP	$101.91 	$75.41	$0.00	$78.55		$0.00	$0.00	$0.00	$0.00	$0.00	$75.64	$75.64	$78.55	$0.00	$21.24	$0.00	$0.00	$0.00	$0.00	$46.20	$73.18	$73.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
112303	ERX	HCPCS J1953	55150-0246-47	LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN	BOTH IP/OP	$128.54 	$95.12	$0.00	$99.08	$57.84	$57.84	$0.00	$0.00	$0.00	$26.79	$95.40	$95.40	$99.08	$0.00	$26.79	$0.00	$76.03	$76.03	$0.00	$58.28	$92.31	$93.24	$0.00		$0.00	$18.24	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$0.00
112303	ERX	HCPCS J1953	67457-0255-10	LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN	BOTH IP/OP	$128.54 	$95.12	$0.00	$99.08	$57.84	$57.84	$0.00	$0.00	$0.00	$26.79	$95.40	$95.40	$99.08	$0.00	$26.79	$0.00	$76.03	$76.03	$0.00	$58.28	$92.31	$93.24	$0.00		$0.00	$18.24	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$0.00
112304	ERX	HCPCS J1953	43598-0636-10	LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN	BOTH IP/OP	$99.59 	$73.70	$0.00	$149.94	$44.82	$44.82	$0.00	$0.00	$0.00	$20.76	$73.92	$73.92	$76.76	$0.00	$20.75	$0.00	$58.91	$58.91	$0.00	$93.72	$148.44	$149.94	$0.00		$0.00	$29.33	$0.00	$0.00	$29.84	$0.00	$0.00	$0.00	$0.00	$0.00
112304	ERX	HCPCS J1953	43598-0636-52	LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN	BOTH IP/OP	$99.59 	$73.70	$0.00	$149.94	$44.82	$44.82	$0.00	$0.00	$0.00	$20.76	$73.92	$73.92	$76.76	$0.00	$20.75	$0.00	$58.91	$58.91	$0.00	$93.72	$148.44	$149.94	$0.00		$0.00	$29.33	$0.00	$0.00	$29.84	$0.00	$0.00	$0.00	$0.00	$0.00
112304	ERX	HCPCS J1953	43598-0757-10	LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN	BOTH IP/OP	$99.59 	$73.70	$0.00	$149.94	$44.82	$44.82	$0.00	$0.00	$0.00	$20.76	$73.92	$73.92	$76.76	$0.00	$20.75	$0.00	$58.91	$58.91	$0.00	$93.72	$148.44	$149.94	$0.00		$0.00	$29.33	$0.00	$0.00	$29.84	$0.00	$0.00	$0.00	$0.00	$0.00
112304	ERX	HCPCS J1953	43598-0757-52	LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN	BOTH IP/OP	$99.59 	$73.70	$0.00	$149.94	$44.82	$44.82	$0.00	$0.00	$0.00	$20.76	$73.92	$73.92	$76.76	$0.00	$20.75	$0.00	$58.91	$58.91	$0.00	$93.72	$148.44	$149.94	$0.00		$0.00	$29.33	$0.00	$0.00	$29.84	$0.00	$0.00	$0.00	$0.00	$0.00
112304	ERX	HCPCS J1953	55150-0247-47	LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN	BOTH IP/OP	$99.59 	$73.70	$0.00	$149.94	$44.82	$44.82	$0.00	$0.00	$0.00	$20.76	$73.92	$73.92	$76.76	$0.00	$20.75	$0.00	$58.91	$58.91	$0.00	$93.72	$148.44	$149.94	$0.00		$0.00	$29.33	$0.00	$0.00	$29.84	$0.00	$0.00	$0.00	$0.00	$0.00
112304	ERX	HCPCS J1953	67457-0265-00	LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN	BOTH IP/OP	$99.59 	$73.70	$0.00	$149.94	$44.82	$44.82	$0.00	$0.00	$0.00	$20.76	$73.92	$73.92	$76.76	$0.00	$20.75	$0.00	$58.91	$58.91	$0.00	$93.72	$148.44	$149.94	$0.00		$0.00	$29.33	$0.00	$0.00	$29.84	$0.00	$0.00	$0.00	$0.00	$0.00
112304	ERX	HCPCS J1953	67457-0265-10	LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN	BOTH IP/OP	$99.59 	$73.70	$0.00	$149.94	$44.82	$44.82	$0.00	$0.00	$0.00	$20.76	$73.92	$73.92	$76.76	$0.00	$20.75	$0.00	$58.91	$58.91	$0.00	$93.72	$148.44	$149.94	$0.00		$0.00	$29.33	$0.00	$0.00	$29.84	$0.00	$0.00	$0.00	$0.00	$0.00
112304	ERX	HCPCS J1953	70860-0603-82	LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN	BOTH IP/OP	$99.59 	$73.70	$0.00	$149.94	$44.82	$44.82	$0.00	$0.00	$0.00	$20.76	$73.92	$73.92	$76.76	$0.00	$20.75	$0.00	$58.91	$58.91	$0.00	$93.72	$148.44	$149.94	$0.00		$0.00	$29.33	$0.00	$0.00	$29.84	$0.00	$0.00	$0.00	$0.00	$0.00
112305	ERX	HCPCS J1953	43598-0637-10	LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN	BOTH IP/OP	$185.28 	$137.11	$0.00	$142.81	$83.38	$83.38	$0.00	$0.00	$0.00	$38.62	$137.51	$137.51	$142.81	$0.00	$38.61	$0.00	$109.59	$109.59	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$26.29	$0.00	$0.00	$26.75	$0.00	$0.00	$0.00	$0.00	$0.00
112305	ERX	HCPCS J1953	43598-0637-52	LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN	BOTH IP/OP	$185.28 	$137.11	$0.00	$142.81	$83.38	$83.38	$0.00	$0.00	$0.00	$38.62	$137.51	$137.51	$142.81	$0.00	$38.61	$0.00	$109.59	$109.59	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$26.29	$0.00	$0.00	$26.75	$0.00	$0.00	$0.00	$0.00	$0.00
112305	ERX	HCPCS J1953	43598-0759-10	LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN	BOTH IP/OP	$185.28 	$137.11	$0.00	$142.81	$83.38	$83.38	$0.00	$0.00	$0.00	$38.62	$137.51	$137.51	$142.81	$0.00	$38.61	$0.00	$109.59	$109.59	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$26.29	$0.00	$0.00	$26.75	$0.00	$0.00	$0.00	$0.00	$0.00
112305	ERX	HCPCS J1953	43598-0759-52	LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN	BOTH IP/OP	$185.28 	$137.11	$0.00	$142.81	$83.38	$83.38	$0.00	$0.00	$0.00	$38.62	$137.51	$137.51	$142.81	$0.00	$38.61	$0.00	$109.59	$109.59	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$26.29	$0.00	$0.00	$26.75	$0.00	$0.00	$0.00	$0.00	$0.00
112305	ERX	HCPCS J1953	55150-0248-47	LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN	BOTH IP/OP	$185.28 	$137.11	$0.00	$142.81	$83.38	$83.38	$0.00	$0.00	$0.00	$38.62	$137.51	$137.51	$142.81	$0.00	$38.61	$0.00	$109.59	$109.59	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$26.29	$0.00	$0.00	$26.75	$0.00	$0.00	$0.00	$0.00	$0.00
112305	ERX	HCPCS J1953	67457-0266-00	LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN	BOTH IP/OP	$185.28 	$137.11	$0.00	$142.81	$83.38	$83.38	$0.00	$0.00	$0.00	$38.62	$137.51	$137.51	$142.81	$0.00	$38.61	$0.00	$109.59	$109.59	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$26.29	$0.00	$0.00	$26.75	$0.00	$0.00	$0.00	$0.00	$0.00
112305	ERX	HCPCS J1953	67457-0266-10	LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN	BOTH IP/OP	$185.28 	$137.11	$0.00	$142.81	$83.38	$83.38	$0.00	$0.00	$0.00	$38.62	$137.51	$137.51	$142.81	$0.00	$38.61	$0.00	$109.59	$109.59	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$26.29	$0.00	$0.00	$26.75	$0.00	$0.00	$0.00	$0.00	$0.00
112380	ERX	HCPCS 25000001	63402-0302-30	LURASIDONE HCL 20 MG PO TABS	BOTH IP/OP	$196.92 	$145.72	$0.00	$151.79		$0.00	$0.00	$0.00	$0.00	$0.00	$146.15	$146.15	$151.79	$0.00	$41.04	$0.00	$0.00	$0.00	$0.00	$80.86	$128.07	$129.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
112618	ERX	HCPCS J2212	65649-0552-04	METHYLNALTREXONE BROMIDE 8 MG/0.4ML SC SOLN	BOTH IP/OP	$585.21 	$433.06	$0.00	$451.08		$0.00	$0.00	$0.00	$0.00	$0.00	$434.34	$434.34	$451.08	$0.00	$121.96	$0.00	$0.00	$0.00	$0.00	$228.14	$361.37	$365.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
112638	ERX	HCPCS 63600001	50242-0140-01	VISMODEGIB 150 MG PO CAPS	BOTH IP/OP	"$1,306.00 "	$966.44	$0.00	"$1,037.87"		$0.00	$0.00	$0.00	$0.00	$0.00	$998.39	$998.39	"$1,036.86"	$0.00	$272.17	$0.00	$0.00	$0.00	$0.00	$648.67	"$1,027.49"	"$1,037.87"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
112683	ERX	HCPCS 25000001	00006-0078-82	JANUMET XR 50-500 MG (SITAGLIPTIN-METFORMIN ER) PO TB24	BOTH IP/OP	$41.64 	$30.81	$0.00	$33.68		$0.00	$0.00	$0.00	$0.00	$0.00	$32.43	$32.43	$33.68	$0.00	$8.68	$0.00	$0.00	$0.00	$0.00	$17.99	$28.50	$28.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
112684	ERX	HCPCS 25000001	00006-0080-82	JANUMET XR 50-1000 MG (SITAGLIPTIN-METFORMIN ER) PO TB24	BOTH IP/OP	$41.64 	$30.81	$0.00	$33.68		$0.00	$0.00	$0.00	$0.00	$0.00	$32.43	$32.43	$33.68	$0.00	$8.68	$0.00	$0.00	$0.00	$0.00	$17.99	$28.50	$28.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
112685	ERX	HCPCS 25000001	00006-0081-31	JANUMET XR 100-1000 MG (SITAGLIPTIN-METFORMIN ER) PO TB24	BOTH IP/OP	$83.27 	$61.62	$0.00	$62.06		$0.00	$0.00	$0.00	$0.00	$0.00	$59.75	$59.75	$62.06	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$35.98	$56.99	$57.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
112904	ERX	HCPCS 25000001	65702-0101-10	ACCU-CHEK AVIVA PLUS W/DEVICE KIT	BOTH IP/OP	$100.59 	$74.44	$0.00	$80.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.30	$79.67	$80.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
112975	ERX	HCPCS J7527	00078-0620-51	EVEROLIMUS 7.5 MG PO TABS	BOTH IP/OP	"$1,743.45 "	"$1,290.15"	$0.00	"$1,343.85"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,293.99"	"$1,293.99"	"$1,343.85"	$0.00	$363.33	$0.00	$0.00	$0.00	$0.00	$807.78	"$1,279.52"	"$1,292.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
113303	ERX	HCPCS 63700001	00487-2784-01	RACEPINEPHRINE HCL 2.25 % IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
113303	ERX	HCPCS 63700001	00487-5901-99	RACEPINEPHRINE HCL 2.25 % IN NEBU	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
113304	ERX	HCPCS 90716	00006-4827-00	VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML SC INJ	BOTH IP/OP	$608.24 	$450.10	$0.00	$468.83	$273.71	$273.71	$0.00	$0.00	$136.66	$9.40	$451.44	$451.44	$468.83	$0.00	$177.40	$0.00	$359.77	$359.77	$0.00	$248.15	$393.07	$397.04	$297.78		$297.78	$159.48	$0.00	$0.00	$151.85	$0.00	$0.00	$0.00	$0.00	$0.00
113363	ERX	HCPCS 25000001	00054-3188-63	DIAZEPAM 5 MG/5ML PO SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
113624	ERX	HCPCS J1324	00004-0380-01	ENFUVIRTIDE 90 MG SC SOLR	BOTH IP/OP	$248.84 	$184.14	$0.00	$191.81		$0.00	$0.00	$0.00	$0.00	$0.00	$184.69	$184.69	$191.81	$0.00	$51.86	$0.00	$0.00	$0.00	$0.00	$112.95	$178.90	$180.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
113624	ERX	HCPCS J1324	00004-0381-40	ENFUVIRTIDE 90 MG SC SOLR	BOTH IP/OP	$248.84 	$184.14	$0.00	$191.81		$0.00	$0.00	$0.00	$0.00	$0.00	$184.69	$184.69	$191.81	$0.00	$51.86	$0.00	$0.00	$0.00	$0.00	$112.95	$178.90	$180.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
114621	ERX	HCPCS 25000001	49100-0400-08	CULTURELLE KIDS PO PACK	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115133	ERX	HCPCS 25000001	99999-6007-10	TRICHLOROACETIC ACID 40 % EX SOLN	BOTH IP/OP	$83.80 	$62.01	$0.00	$64.59		$0.00	$0.00	$0.00	$0.00	$0.00	$62.20	$62.20	$64.59	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$38.00	$60.19	$60.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115145	ERX	HCPCS J7315	49771-0002-01	MITOMYCIN 0.2 MG OP KIT	BOTH IP/OP	"$1,436.64 "	"$1,063.11"	$0.00	"$1,107.36"	$646.49	$646.49	$0.00	$0.00	$0.00	$299.43	"$1,066.27"	"$1,066.27"	"$1,107.36"	$0.00	$299.40	$0.00	$849.77	$849.77	$0.00	$570.81	$904.16	$913.30	$0.00		$0.00	$178.66	$0.00	$0.00	$195.92	$0.00	$0.00	$0.00	$0.00	$0.00
115145	ERX	HCPCS J7315	49771-0002-03	MITOMYCIN 0.2 MG OP KIT	BOTH IP/OP	"$1,436.64 "	"$1,063.11"	$0.00	"$1,107.36"	$646.49	$646.49	$0.00	$0.00	$0.00	$299.43	"$1,066.27"	"$1,066.27"	"$1,107.36"	$0.00	$299.40	$0.00	$849.77	$849.77	$0.00	$570.81	$904.16	$913.30	$0.00		$0.00	$178.66	$0.00	$0.00	$195.92	$0.00	$0.00	$0.00	$0.00	$0.00
115244	ERX	HCPCS J9306	50242-0145-01	PERTUZUMAB 420 MG/14ML IV SOLN	BOTH IP/OP	"$14,997.78 "	"$11,098.36"	$0.00	"$12,080.51"	"$7,052.71"	"$7,052.71"	"$5,693.10"	"$5,693.10"	"$5,693.10"	"$3,125.91"	"$11,632.27"	"$11,632.27"	"$12,080.51"	"$5,693.94"	"$6,690.38"	"$3,701.06"	"$7,393.91"	"$7,393.91"	"$5,419.89"	"$6,509.18"	"$10,310.53"	"$10,414.68"	"$7,484.61"		"$7,484.61"	"$6,227.97"	$0.00	$0.00	"$5,930.09"	"$5,435.64"	$0.00	$0.00	$0.00	$0.00
115824	ERX	HCPCS J9250	00143-9519-01	METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$25.65	$25.65	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$43.94	$0.00	$2.62	$0.00	$33.72	$33.72	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$2.94	$0.00	$0.00	$2.80	$0.00	$0.00	$0.00	$0.00	$0.00
115824	ERX	HCPCS J9250	00143-9519-10	METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$25.65	$25.65	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$43.94	$0.00	$2.62	$0.00	$33.72	$33.72	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$2.94	$0.00	$0.00	$2.80	$0.00	$0.00	$0.00	$0.00	$0.00
115824	ERX	HCPCS J9250	00703-3671-01	METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$25.65	$25.65	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$43.94	$0.00	$2.62	$0.00	$33.72	$33.72	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$2.94	$0.00	$0.00	$2.80	$0.00	$0.00	$0.00	$0.00	$0.00
115824	ERX	HCPCS J9250	16729-0277-30	METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$25.65	$25.65	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$43.94	$0.00	$2.62	$0.00	$33.72	$33.72	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$2.94	$0.00	$0.00	$2.80	$0.00	$0.00	$0.00	$0.00	$0.00
115826	ERX	HCPCS J9260	00703-3678-01	METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN	BOTH IP/OP	$170.15 	$125.91	$0.00	$131.15	$76.57	$76.57	$0.00	$0.00	$0.00	$54.05	$126.29	$126.29	$131.15	$0.00	$50.69	$0.00	$100.64	$100.64	$0.00	$76.02	$120.42	$121.63	$0.00		$0.00	$58.52	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
115826	ERX	HCPCS J9260	61703-0408-41	METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN	BOTH IP/OP	$170.15 	$125.91	$0.00	$131.15	$76.57	$76.57	$0.00	$0.00	$0.00	$54.05	$126.29	$126.29	$131.15	$0.00	$50.69	$0.00	$100.64	$100.64	$0.00	$76.02	$120.42	$121.63	$0.00		$0.00	$58.52	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
115839	ERX	HCPCS J9047	76075-0101-01	CARFILZOMIB 60 MG IV SOLR	BOTH IP/OP	"$6,994.55 "	"$5,175.97"	$0.00	"$5,709.51"	"$3,333.26"	"$3,333.26"	"$2,466.66"	"$2,466.66"	"$2,466.66"	"$1,457.84"	"$5,497.66"	"$5,497.66"	"$5,709.51"	"$2,466.18"	"$2,897.76"	"$1,603.02"	"$3,448.31"	"$3,448.31"	"$2,368.74"	"$2,995.57"	"$4,744.97"	"$4,792.90"	"$3,271.11"		"$3,271.11"	"$2,646.57"	$0.00	$0.00	"$2,519.99"	"$2,338.32"	$0.00	$0.00	$0.00	$0.00
116010	ERX	HCPCS J2300	99999-6011-83	NALBUPHINE (NUBAIN) 10 MG/0.5 ML IV SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$1.22	$20.04	$20.04	$20.81	$0.00	$3.35	$0.00	$15.97	$15.97	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$3.70	$0.00	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00
116012	ERX	HCPCS 63700001	61958-1201-01	STRIBILD:150-150-200-300 MG PO TABS	BOTH IP/OP	$505.27 	$373.90	$0.00	$331.55		$0.00	$0.00	$0.00	$89.94	$0.00	$0.00	$0.00	$0.00	$0.00	$105.30	$0.00	$0.00	$0.00	$0.00	$207.22	$328.24	$331.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116047	ERX	HCPCS J9302	00078-0690-61	OFATUMUMAB 1000 MG/50ML IV CONC	BOTH IP/OP	"$16,363.42 "	"$12,108.93"	$0.00	"$12,612.92"		$0.00	$0.00	$0.00	$0.00	$0.00	"$12,144.93"	"$12,144.93"	"$12,612.92"	$0.00	"$7,514.95"	$0.00	$0.00	$0.00	$0.00	"$7,421.47"	"$11,755.60"	"$11,874.34"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116049	ERX	HCPCS 63700001	00006-0473-61	RALTEGRAVIR POTASSIUM 25 MG PO CHEW	BOTH IP/OP	$9.09 	$6.73	$0.00	$6.29		$0.00	$0.00	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$0.00	$1.89	$0.00	$0.00	$0.00	$0.00	$3.93	$6.23	$6.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116050	ERX	HCPCS 63700001	00006-0477-61	RALTEGRAVIR POTASSIUM 100 MG PO CHEW	BOTH IP/OP	$36.36 	$26.91	$0.00	$25.14		$0.00	$0.00	$0.00	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$7.58	$0.00	$0.00	$0.00	$0.00	$15.71	$24.88	$25.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116053	ERX	HCPCS J1100	63323-0506-01	DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.53	$16.33	$16.33	$16.96	$0.00	$0.68	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.71	$0.00	$0.00	$0.67	$0.00	$0.00	$0.00	$0.00	$0.00
116053	ERX	HCPCS J1100	70069-0021-25	DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.53	$16.33	$16.33	$16.96	$0.00	$0.68	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.71	$0.00	$0.00	$0.67	$0.00	$0.00	$0.00	$0.00	$0.00
116158	ERX	HCPCS 63600001	49281-0225-10	DIPHTHERIA-TETANUS TOXOIDS DT 25-5 LFU/0.5ML IM SUSP	BOTH IP/OP	$261.35 	$193.40	$0.00	$201.45		$0.00	$0.00	$0.00	$0.00	$0.00	$193.97	$193.97	$201.45	$0.00	$54.47	$0.00	$0.00	$0.00	$0.00	$107.73	$170.64	$172.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116294	ERX	HCPCS 25000001	63402-0312-30	LURASIDONE HCL 120 MG PO TABS	BOTH IP/OP	$293.94 	$217.52	$0.00	$226.57		$0.00	$0.00	$0.00	$0.00	$0.00	$218.16	$218.16	$226.57	$0.00	$61.26	$0.00	$0.00	$0.00	$0.00	$120.70	$191.19	$193.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116340	ERX	HCPCS 25000001	00054-0404-44	MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116340	ERX	HCPCS 25000001	00054-0404-50	MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116340	ERX	HCPCS 25000001	00406-8003-12	MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116340	ERX	HCPCS 25000001	99999-6005-51	MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116365	ERX	HCPCS J2270	00409-1891-01	MORPHINE SULFATE (PF) 4 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$3.98	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.39	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00
116365	ERX	HCPCS J2270	00409-1891-03	MORPHINE SULFATE (PF) 4 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$3.98	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.39	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00
116365	ERX	HCPCS J2270	00641-6125-01	MORPHINE SULFATE (PF) 4 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$3.98	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.39	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00
116365	ERX	HCPCS J2270	00641-6125-25	MORPHINE SULFATE (PF) 4 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$3.98	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.39	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00
116374	ERX	HCPCS J2270	00409-1893-01	MORPHINE SULFATE (PF) 10 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116374	ERX	HCPCS J2270	00641-6127-01	MORPHINE SULFATE (PF) 10 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116374	ERX	HCPCS J2270	00641-6127-25	MORPHINE SULFATE (PF) 10 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116385	ERX	HCPCS 63700001	00469-0125-99	ENZALUTAMIDE 40 MG PO CAPS	BOTH IP/OP	$716.91 	$530.51	$0.00	$505.34		$0.00	$0.00	$0.00	$135.14	$0.00	$0.00	$0.00	$0.00	$0.00	$149.40	$0.00	$0.00	$0.00	$0.00	$315.84	$500.28	$505.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116397	ERX	HCPCS J8999	00069-0135-01	BOSUTINIB 100 MG PO TABS	BOTH IP/OP	$583.36 	$431.69	$0.00	$449.65		$0.00	$0.00	$0.00	$0.00	$0.00	$432.97	$432.97	$449.65	$0.00	$121.57	$0.00	$0.00	$0.00	$0.00	$239.02	$378.60	$382.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116398	ERX	HCPCS 63600001	00069-0136-01	BOSUTINIB 500 MG PO TABS	BOTH IP/OP	"$1,798.68 "	"$1,331.02"	$0.00	"$1,386.42"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,334.98"	"$1,334.98"	"$1,386.42"	$0.00	$374.84	$0.00	$0.00	$0.00	$0.00	$752.31	"$1,191.65"	"$1,203.69"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
117006	ERX	HCPCS 25000001	12496-1204-01	SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM	BOTH IP/OP	$45.16 	$33.42	$0.00	$34.81		$0.00	$0.00	$0.00	$0.00	$0.00	$33.52	$33.52	$34.81	$0.00	$9.41	$0.00	$0.00	$0.00	$0.00	$20.48	$32.43	$32.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
117006	ERX	HCPCS 25000001	12496-1204-03	SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM	BOTH IP/OP	$45.16 	$33.42	$0.00	$34.81		$0.00	$0.00	$0.00	$0.00	$0.00	$33.52	$33.52	$34.81	$0.00	$9.41	$0.00	$0.00	$0.00	$0.00	$20.48	$32.43	$32.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
117007	ERX	HCPCS 25000001	12496-1212-01	SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM	BOTH IP/OP	$83.20 	$61.57	$0.00	$64.13		$0.00	$0.00	$0.00	$0.00	$0.00	$61.75	$61.75	$64.13	$0.00	$17.34	$0.00	$0.00	$0.00	$0.00	$37.72	$59.75	$60.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
117007	ERX	HCPCS 25000001	12496-1212-03	SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM	BOTH IP/OP	$83.20 	$61.57	$0.00	$64.13		$0.00	$0.00	$0.00	$0.00	$0.00	$61.75	$61.75	$64.13	$0.00	$17.34	$0.00	$0.00	$0.00	$0.00	$37.72	$59.75	$60.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
117011	ERX	HCPCS 63700001	00456-1201-30	LINACLOTIDE 145 MCG PO CAPS	BOTH IP/OP	$78.32 	$57.96	$0.00	$54.12		$0.00	$0.00	$0.00	$14.64	$0.00	$0.00	$0.00	$0.00	$0.00	$16.32	$0.00	$0.00	$0.00	$0.00	$33.83	$53.58	$54.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
117021	ERX	HCPCS 25000001	50419-0171-03	REGORAFENIB 40 MG PO TABS	BOTH IP/OP	"$1,387.29 "	"$1,026.59"	$0.00	"$1,121.74"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,080.12"	"$1,080.12"	"$1,121.74"	$0.00	$289.11	$0.00	$0.00	$0.00	$0.00	$618.63	$979.90	$989.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
117385	ERX	HCPCS 63700001	59676-0566-30	DARUNAVIR ETHANOLATE 800 MG PO TABS	BOTH IP/OP	$256.12 	$189.53	$0.00	$177.99		$0.00	$0.00	$0.00	$48.14	$0.00	$0.00	$0.00	$0.00	$0.00	$53.38	$0.00	$0.00	$0.00	$0.00	$111.25	$176.21	$177.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
117945	ERX	HCPCS 25000001	24208-0503-07	LOTEPREDNOL ETABONATE 0.5 % OP GEL	BOTH IP/OP	$795.97 	$589.02	$0.00	$613.53		$0.00	$0.00	$0.00	$0.00	$0.00	$590.77	$590.77	$613.53	$0.00	$165.88	$0.00	$0.00	$0.00	$0.00	$321.45	$509.17	$514.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118046	ERX	HCPCS 63700001	42937-0705-18	PRENATAL PLUS IRON 29-1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118105	ERX	HCPCS 63600001	76189-0535-30	PONATINIB HCL 15 MG PO TABS	BOTH IP/OP	"$1,589.86 "	"$1,176.50"	$0.00	"$1,271.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$794.93	"$1,259.17"	"$1,271.89"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118189	ERX	HCPCS 25000001	54643-5649-01	INFUVITE ADULT IV INJ	BOTH IP/OP	$55.44 	$41.03	$0.00	$42.73		$0.00	$0.00	$0.00	$0.00	$0.00	$41.15	$41.15	$42.73	$0.00	$11.55	$0.00	$0.00	$0.00	$0.00	$23.07	$36.54	$36.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118319	ERX	HCPCS 63700001	00003-0893-21	APIXABAN 2.5 MG PO TABS	BOTH IP/OP	$41.83 	$30.95	$0.00	$28.63		$0.00	$0.00	$0.00	$7.89	$0.00	$0.00	$0.00	$0.00	$0.00	$8.72	$0.00	$0.00	$0.00	$0.00	$17.90	$28.35	$28.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118319	ERX	HCPCS 63700001	00003-0893-31	APIXABAN 2.5 MG PO TABS	BOTH IP/OP	$41.83 	$30.95	$0.00	$28.63		$0.00	$0.00	$0.00	$7.89	$0.00	$0.00	$0.00	$0.00	$0.00	$8.72	$0.00	$0.00	$0.00	$0.00	$17.90	$28.35	$28.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118352	ERX	HCPCS 63700001	00003-0894-21	APIXABAN 5 MG PO TABS	BOTH IP/OP	$41.83 	$30.95	$0.00	$28.63		$0.00	$0.00	$0.00	$7.89	$0.00	$0.00	$0.00	$0.00	$0.00	$8.72	$0.00	$0.00	$0.00	$0.00	$17.90	$28.35	$28.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118352	ERX	HCPCS 63700001	00003-0894-31	APIXABAN 5 MG PO TABS	BOTH IP/OP	$41.83 	$30.95	$0.00	$28.63		$0.00	$0.00	$0.00	$7.89	$0.00	$0.00	$0.00	$0.00	$0.00	$8.72	$0.00	$0.00	$0.00	$0.00	$17.90	$28.35	$28.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118810	ERX	HCPCS 63700001	00536-4085-01	PRENATAL VITAMINS 28-0.8 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118851	ERX	HCPCS 25000001	59572-0501-00	POMALIDOMIDE 1 MG PO CAPS	BOTH IP/OP	"$2,461.44 "	"$1,821.47"	$0.00	"$1,982.66"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.09"	"$1,909.09"	"$1,982.66"	$0.00	$512.96	$0.00	$0.00	$0.00	$0.00	"$1,068.29"	"$1,692.17"	"$1,709.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118851	ERX	HCPCS 25000001	59572-0501-21	POMALIDOMIDE 1 MG PO CAPS	BOTH IP/OP	"$2,461.44 "	"$1,821.47"	$0.00	"$1,982.66"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.09"	"$1,909.09"	"$1,982.66"	$0.00	$512.96	$0.00	$0.00	$0.00	$0.00	"$1,068.29"	"$1,692.17"	"$1,709.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118852	ERX	HCPCS 25000001	59572-0502-00	POMALIDOMIDE 2 MG PO CAPS	BOTH IP/OP	"$2,461.44 "	"$1,821.47"	$0.00	"$1,982.66"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.09"	"$1,909.09"	"$1,982.66"	$0.00	$512.96	$0.00	$0.00	$0.00	$0.00	"$1,068.29"	"$1,692.17"	"$1,709.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118852	ERX	HCPCS 25000001	59572-0502-21	POMALIDOMIDE 2 MG PO CAPS	BOTH IP/OP	"$2,461.44 "	"$1,821.47"	$0.00	"$1,982.66"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.09"	"$1,909.09"	"$1,982.66"	$0.00	$512.96	$0.00	$0.00	$0.00	$0.00	"$1,068.29"	"$1,692.17"	"$1,709.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118853	ERX	HCPCS 25000001	59572-0503-00	POMALIDOMIDE 3 MG PO CAPS	BOTH IP/OP	"$2,461.44 "	"$1,821.47"	$0.00	"$1,982.66"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.09"	"$1,909.09"	"$1,982.66"	$0.00	$512.96	$0.00	$0.00	$0.00	$0.00	"$1,068.29"	"$1,692.17"	"$1,709.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118853	ERX	HCPCS 25000001	59572-0503-21	POMALIDOMIDE 3 MG PO CAPS	BOTH IP/OP	"$2,461.44 "	"$1,821.47"	$0.00	"$1,982.66"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.09"	"$1,909.09"	"$1,982.66"	$0.00	$512.96	$0.00	$0.00	$0.00	$0.00	"$1,068.29"	"$1,692.17"	"$1,709.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118854	ERX	HCPCS 25000001	59572-0504-00	POMALIDOMIDE 4 MG PO CAPS	BOTH IP/OP	"$2,461.44 "	"$1,821.47"	$0.00	"$1,982.66"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.09"	"$1,909.09"	"$1,982.66"	$0.00	$512.96	$0.00	$0.00	$0.00	$0.00	"$1,068.29"	"$1,692.17"	"$1,709.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118854	ERX	HCPCS 25000001	59572-0504-21	POMALIDOMIDE 4 MG PO CAPS	BOTH IP/OP	"$2,461.44 "	"$1,821.47"	$0.00	"$1,982.66"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.09"	"$1,909.09"	"$1,982.66"	$0.00	$512.96	$0.00	$0.00	$0.00	$0.00	"$1,068.29"	"$1,692.17"	"$1,709.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
118951	ERX	HCPCS J9354	50242-0087-01	ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR	BOTH IP/OP	"$14,303.91 "	"$10,584.89"	$0.00	"$11,521.61"	"$6,726.42"	"$6,726.42"	"$5,464.16"	"$5,464.16"	"$5,464.16"	"$2,981.29"	"$11,094.11"	"$11,094.11"	"$11,521.61"	"$5,469.44"	"$6,426.59"	"$3,555.14"	"$7,051.83"	"$7,051.83"	"$5,269.15"	"$6,208.04"	"$9,833.54"	"$9,932.86"	"$7,276.45"		"$7,276.45"	"$6,036.68"	$0.00	$0.00	"$5,747.95"	"$5,250.88"	$0.00	$0.00	$0.00	$0.00
119091	ERX	HCPCS 63700001	00406-8330-23	MORPHINE SULFATE CR 30 MG PO TB12	BOTH IP/OP	$14.17 	$10.49	$0.00	$10.28		$0.00	$0.00	$0.00	$2.52	$0.00	$0.00	$0.00	$0.00	$0.00	$2.95	$0.00	$0.00	$0.00	$0.00	$6.43	$10.18	$10.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119091	ERX	HCPCS 63700001	00406-8330-62	MORPHINE SULFATE CR 30 MG PO TB12	BOTH IP/OP	$14.17 	$10.49	$0.00	$10.28		$0.00	$0.00	$0.00	$2.52	$0.00	$0.00	$0.00	$0.00	$0.00	$2.95	$0.00	$0.00	$0.00	$0.00	$6.43	$10.18	$10.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119102	ERX	HCPCS 63700001	00456-3407-33	MEMANTINE HCL ER 7 MG PO CP24	BOTH IP/OP	$77.90 	$57.65	$0.00	$56.52		$0.00	$0.00	$0.00	$13.87	$0.00	$0.00	$0.00	$0.00	$0.00	$16.23	$0.00	$0.00	$0.00	$0.00	$35.33	$55.95	$56.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119105	ERX	HCPCS 63700001	00456-3428-33	MEMANTINE HCL ER 28 MG PO CP24	BOTH IP/OP	$64.03 	$47.38	$0.00	$46.46		$0.00	$0.00	$0.00	$11.40	$0.00	$0.00	$0.00	$0.00	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$29.04	$45.99	$46.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119105	ERX	HCPCS 63700001	10370-0349-11	MEMANTINE HCL ER 28 MG PO CP24	BOTH IP/OP	$64.03 	$47.38	$0.00	$46.46		$0.00	$0.00	$0.00	$11.40	$0.00	$0.00	$0.00	$0.00	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$29.04	$45.99	$46.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119105	ERX	HCPCS 63700001	43975-0266-03	MEMANTINE HCL ER 28 MG PO CP24	BOTH IP/OP	$64.03 	$47.38	$0.00	$46.46		$0.00	$0.00	$0.00	$11.40	$0.00	$0.00	$0.00	$0.00	$0.00	$13.34	$0.00	$0.00	$0.00	$0.00	$29.04	$45.99	$46.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119111	ERX	HCPCS 63700001	99999-6007-75	DARUNAVIR ETHANOLATE 100 MG/ML PO SUSP	BOTH IP/OP	$136.30 	$100.86	$0.00	$732.60		$0.00	$0.00	$0.00	$24.26	$0.00	$0.00	$0.00	$0.00	$0.00	$28.40	$0.00	$0.00	$0.00	$0.00	$287.19	$732.60	$459.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119111	ERX	HCPCS 63700001	59676-0565-01	DARUNAVIR ETHANOLATE 100 MG/ML PO SUSP	BOTH IP/OP	$136.30 	$100.86	$0.00	"$1,910.98"		$0.00	$0.00	$0.00	$24.26	$0.00	$0.00	$0.00	$0.00	$0.00	$28.40	$0.00	$0.00	$0.00	$0.00	$287.19	"$1,910.98"	$459.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119120	ERX	HCPCS J2270	00409-1890-01	MORPHINE SULFATE (PF) 2 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$3.98	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.39	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00
119120	ERX	HCPCS J2270	00409-1890-03	MORPHINE SULFATE (PF) 2 MG/ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$3.98	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.39	$0.00	$0.00	$2.27	$0.00	$0.00	$0.00	$0.00	$0.00
119123	ERX	HCPCS 25000001	00074-4380-10	CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN	BOTH IP/OP	$106.54 	$78.84	$0.00	$82.12		$0.00	$0.00	$0.00	$0.00	$0.00	$79.07	$79.07	$82.12	$0.00	$22.20	$0.00	$0.00	$0.00	$0.00	$48.30	$76.51	$77.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119123	ERX	HCPCS 25000001	00074-4380-81	CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN	BOTH IP/OP	$106.54 	$78.84	$0.00	$82.12		$0.00	$0.00	$0.00	$0.00	$0.00	$79.07	$79.07	$82.12	$0.00	$22.20	$0.00	$0.00	$0.00	$0.00	$48.30	$76.51	$77.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119123	ERX	HCPCS 25000001	00781-3152-95	CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN	BOTH IP/OP	$106.54 	$78.84	$0.00	$82.12		$0.00	$0.00	$0.00	$0.00	$0.00	$79.07	$79.07	$82.12	$0.00	$22.20	$0.00	$0.00	$0.00	$0.00	$48.30	$76.51	$77.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119123	ERX	HCPCS 25000001	00781-9038-70	CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN	BOTH IP/OP	$106.54 	$78.84	$0.00	$82.12		$0.00	$0.00	$0.00	$0.00	$0.00	$79.07	$79.07	$82.12	$0.00	$22.20	$0.00	$0.00	$0.00	$0.00	$48.30	$76.51	$77.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119123	ERX	HCPCS 25000001	00781-9038-95	CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN	BOTH IP/OP	$106.54 	$78.84	$0.00	$82.12		$0.00	$0.00	$0.00	$0.00	$0.00	$79.07	$79.07	$82.12	$0.00	$22.20	$0.00	$0.00	$0.00	$0.00	$48.30	$76.51	$77.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119123	ERX	HCPCS 25000001	63323-0417-10	CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN	BOTH IP/OP	$106.54 	$78.84	$0.00	$82.12		$0.00	$0.00	$0.00	$0.00	$0.00	$79.07	$79.07	$82.12	$0.00	$22.20	$0.00	$0.00	$0.00	$0.00	$48.30	$76.51	$77.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119129	ERX	HCPCS 63700001	00406-8315-01	MORPHINE SULFATE CR 15 MG PO TB12	BOTH IP/OP	$7.85 	$5.81	$0.00	$5.70		$0.00	$0.00	$0.00	$1.40	$0.00	$0.00	$0.00	$0.00	$0.00	$1.64	$0.00	$0.00	$0.00	$0.00	$3.56	$5.64	$5.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119129	ERX	HCPCS 63700001	00406-8315-23	MORPHINE SULFATE CR 15 MG PO TB12	BOTH IP/OP	$7.85 	$5.81	$0.00	$5.70		$0.00	$0.00	$0.00	$1.40	$0.00	$0.00	$0.00	$0.00	$0.00	$1.64	$0.00	$0.00	$0.00	$0.00	$3.56	$5.64	$5.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119129	ERX	HCPCS 63700001	00406-8315-62	MORPHINE SULFATE CR 15 MG PO TB12	BOTH IP/OP	$7.85 	$5.81	$0.00	$5.70		$0.00	$0.00	$0.00	$1.40	$0.00	$0.00	$0.00	$0.00	$0.00	$1.64	$0.00	$0.00	$0.00	$0.00	$3.56	$5.64	$5.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119131	ERX	HCPCS 63700001	00406-8390-01	MORPHINE SULFATE CR 100 MG PO TB12	BOTH IP/OP	$32.00 	$23.68	$0.00	$23.22		$0.00	$0.00	$0.00	$5.70	$0.00	$0.00	$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$14.51	$22.98	$23.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119131	ERX	HCPCS 63700001	00406-8390-62	MORPHINE SULFATE CR 100 MG PO TB12	BOTH IP/OP	$32.00 	$23.68	$0.00	$23.22		$0.00	$0.00	$0.00	$5.70	$0.00	$0.00	$0.00	$0.00	$0.00	$6.67	$0.00	$0.00	$0.00	$0.00	$14.51	$22.98	$23.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119134	ERX	HCPCS 25000001	00143-9680-25	GLYCOPYRROLATE 1 MG/5ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119134	ERX	HCPCS 25000001	62295-3325-05	GLYCOPYRROLATE 1 MG/5ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119134	ERX	HCPCS 25000001	70121-1396-05	GLYCOPYRROLATE 1 MG/5ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119650	ERX	HCPCS 63700001	00065-4147-27	(SIMBRINZA) BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OP SUSP	BOTH IP/OP	$545.97 	$404.02	$0.00	$436.78		$0.00	$0.00	$0.00	$118.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$432.41	$436.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
119955	ERX	HCPCS 63700001	50268-0851-15	VITAMIN B1 100 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
120301	ERX	HCPCS 25000001	00904-6488-38	ARTIFICIAL TEARS 83-15 % OP OINT	BOTH IP/OP	$14.02 	$10.37	$0.00	$11.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.01	$11.10	$11.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
120319	ERX	HCPCS C9132	63833-0386-02	PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT	BOTH IP/OP	"$3,683.80 "	"$2,726.01"	$0.00	"$2,839.47"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,734.12"	"$2,734.12"	"$2,839.47"	$0.00	$767.70	$0.00	$0.00	$0.00	$0.00	"$1,609.25"	"$2,435.40"	"$2,574.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
120319	ERX	HCPCS C9132	63833-0396-01	PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT	BOTH IP/OP	"$3,683.80 "	"$2,726.01"	$0.00	"$2,839.47"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,734.12"	"$2,734.12"	"$2,839.47"	$0.00	$767.70	$0.00	$0.00	$0.00	$0.00	"$1,609.25"	"$2,435.40"	"$2,574.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
120606	ERX	HCPCS 63700001	00078-0681-66	DABRAFENIB MESYLATE 75 MG PO CAPS	BOTH IP/OP	$677.79 	$501.56	$0.00	$466.44		$0.00	$0.00	$0.00	$127.28	$0.00	$0.00	$0.00	$0.00	$0.00	$141.25	$0.00	$0.00	$0.00	$0.00	$291.53	$461.78	$466.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
120607	ERX	HCPCS 63700001	00078-0666-15	TRAMETINIB DIMETHYL SULFOXIDE 0.5 MG PO TABS	BOTH IP/OP	"$1,534.24 "	"$1,135.34"	$0.00	"$1,078.06"		$0.00	$0.00	$0.00	$288.11	$0.00	$0.00	$0.00	$0.00	$0.00	$319.74	$0.00	$0.00	$0.00	$0.00	$673.79	"$1,067.28"	"$1,078.06"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
120608	ERX	HCPCS 63700001	00078-0668-15	TRAMETINIB DIMETHYL SULFOXIDE 2 MG PO TABS	BOTH IP/OP	"$1,305.45 "	$966.03	$0.00	"$1,012.85"		$0.00	$0.00	$0.00	$245.15	$0.00	$0.00	$0.00	$0.00	$0.00	$272.06	$0.00	$0.00	$0.00	$0.00	$633.03	"$1,002.72"	"$1,012.85"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
120650	ERX	HCPCS J2710	00641-6149-10	NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.12	$16.33	$16.33	$16.96	$0.00	$2.00	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.03	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$0.00
120650	ERX	HCPCS J2710	63323-0415-10	NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.12	$16.33	$16.33	$16.96	$0.00	$2.00	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.03	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$0.00
120650	ERX	HCPCS J2710	76014-0003-10	NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.12	$16.33	$16.33	$16.96	$0.00	$2.00	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.03	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$0.00
120650	ERX	HCPCS J2710	76014-0003-33	NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.12	$16.33	$16.33	$16.96	$0.00	$2.00	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.03	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$0.00
120829	ERX	HCPCS 63700001	99999-6011-84	NIMODIPINE 60 MG/20ML PO SOLN	BOTH IP/OP	$171.64 	$127.01	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.82	$135.94	$137.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121069	ERX	HCPCS J1602	57894-0350-01	GOLIMUMAB 50 MG/4ML IV SOLN	BOTH IP/OP	"$5,421.82 "	"$4,012.15"	$0.00	"$4,179.14"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,024.07"	"$4,024.07"	"$4,179.14"	$0.00	$988.06	$0.00	$0.00	$0.00	$0.00	"$2,346.37"	"$3,716.65"	"$3,754.19"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121091	ERX	HCPCS J1439	00517-0650-01	FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN	BOTH IP/OP	"$3,279.05 "	"$2,426.50"	$0.00	"$2,527.49"	"$1,475.57"	"$1,475.57"	$842.25	$842.25	$842.25	$683.44	"$2,433.71"	"$2,433.71"	"$2,527.49"	$840.00	$987.00	$546.00	"$1,616.57"	"$1,616.57"	$863.89	"$1,401.79"	"$2,220.43"	"$2,242.86"	"$1,192.99"		"$1,192.99"	$978.19	$0.00	$0.00	$931.40	$840.00	$0.00	$0.00	$0.00	$0.00
121434	ERX	HCPCS 63700001	49702-0228-13	DOLUTEGRAVIR SODIUM 50 MG PO TABS	BOTH IP/OP	$279.18 	$206.59	$0.00	$184.11		$0.00	$0.00	$0.00	$49.69	$0.00	$0.00	$0.00	$0.00	$0.00	$58.18	$0.00	$0.00	$0.00	$0.00	$115.07	$182.27	$184.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121712	ERX	HCPCS 90680	00006-4047-41	ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN	BOTH IP/OP	$364.38 	$269.64	$0.00	$280.86	$163.97	$163.97	$0.00	$0.00	$0.00	$75.95	$270.44	$270.44	$280.86	$0.00	$75.94	$0.00	$215.53	$215.53	$0.00	$154.47	$244.67	$247.14	$0.00		$0.00	$48.35	$0.00	$0.00	$51.14	$0.00	$0.00	$0.00	$0.00	$0.00
121715	ERX	HCPCS 25000001	00409-1165-01	BUPIVACAINE HCL (PF) 0.75 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121715	ERX	HCPCS 25000001	00409-1582-10	BUPIVACAINE HCL (PF) 0.75 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121715	ERX	HCPCS 25000001	55150-0171-10	BUPIVACAINE HCL (PF) 0.75 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121715	ERX	HCPCS 25000001	63323-0472-17	BUPIVACAINE HCL (PF) 0.75 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121718	ERX	HCPCS J2260	00143-9710-01	MILRINONE LACTATE 10 MG/10ML IV SOLN	BOTH IP/OP	$31.43 	$23.26	$0.00	$24.23	$14.14	$14.14	$0.00	$0.00	$0.00	$6.55	$23.33	$23.33	$24.23	$0.00	$4.43	$0.00	$18.59	$18.59	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$3.60	$0.00	$0.00	$3.42	$0.00	$0.00	$0.00	$0.00	$0.00
121718	ERX	HCPCS J2260	00143-9710-10	MILRINONE LACTATE 10 MG/10ML IV SOLN	BOTH IP/OP	$31.43 	$23.26	$0.00	$24.23	$14.14	$14.14	$0.00	$0.00	$0.00	$6.55	$23.33	$23.33	$24.23	$0.00	$4.43	$0.00	$18.59	$18.59	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$3.60	$0.00	$0.00	$3.42	$0.00	$0.00	$0.00	$0.00	$0.00
121718	ERX	HCPCS J2260	00409-0212-01	MILRINONE LACTATE 10 MG/10ML IV SOLN	BOTH IP/OP	$31.43 	$23.26	$0.00	$24.23	$14.14	$14.14	$0.00	$0.00	$0.00	$6.55	$23.33	$23.33	$24.23	$0.00	$4.43	$0.00	$18.59	$18.59	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$3.60	$0.00	$0.00	$3.42	$0.00	$0.00	$0.00	$0.00	$0.00
121718	ERX	HCPCS J2260	63323-0617-10	MILRINONE LACTATE 10 MG/10ML IV SOLN	BOTH IP/OP	$31.43 	$23.26	$0.00	$24.23	$14.14	$14.14	$0.00	$0.00	$0.00	$6.55	$23.33	$23.33	$24.23	$0.00	$4.43	$0.00	$18.59	$18.59	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$3.60	$0.00	$0.00	$3.42	$0.00	$0.00	$0.00	$0.00	$0.00
121722	ERX	HCPCS J9181	00143-9511-01	ETOPOSIDE 500 MG/25ML IV SOLN	BOTH IP/OP	$197.27 	$145.98	$0.00	$152.06	$88.77	$88.77	$0.00	$0.00	$0.00	$41.12	$146.41	$146.41	$152.06	$0.00	$46.71	$0.00	$116.69	$116.69	$0.00	$89.54	$141.83	$143.26	$0.00		$0.00	$36.43	$0.00	$0.00	$34.68	$0.00	$0.00	$0.00	$0.00	$0.00
121722	ERX	HCPCS J9181	16729-0114-08	ETOPOSIDE 500 MG/25ML IV SOLN	BOTH IP/OP	$197.27 	$145.98	$0.00	$152.06	$88.77	$88.77	$0.00	$0.00	$0.00	$41.12	$146.41	$146.41	$152.06	$0.00	$46.71	$0.00	$116.69	$116.69	$0.00	$89.54	$141.83	$143.26	$0.00		$0.00	$36.43	$0.00	$0.00	$34.68	$0.00	$0.00	$0.00	$0.00	$0.00
121723	ERX	HCPCS J9181	00703-5657-01	ETOPOSIDE 1 GM/50ML IV SOLN	BOTH IP/OP	$501.48 	$371.10	$0.00	$386.54	$225.67	$225.67	$0.00	$0.00	$0.00	$104.52	$372.20	$372.20	$386.54	$0.00	$93.41	$0.00	$296.63	$296.63	$0.00	$227.61	$360.53	$364.18	$0.00		$0.00	$72.85	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
121723	ERX	HCPCS J9181	63323-0104-50	ETOPOSIDE 1 GM/50ML IV SOLN	BOTH IP/OP	$501.48 	$371.10	$0.00	$386.54	$225.67	$225.67	$0.00	$0.00	$0.00	$104.52	$372.20	$372.20	$386.54	$0.00	$93.41	$0.00	$296.63	$296.63	$0.00	$227.61	$360.53	$364.18	$0.00		$0.00	$72.85	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
121727	ERX	HCPCS 63700001	60258-0172-01	MAGNESIUM GLUCONATE 500 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121730	ERX	HCPCS 25000001	59011-0410-10	OXYCODONE HCL ER 10 MG PO T12A	BOTH IP/OP	$24.06 	$17.80	$0.00	$18.55		$0.00	$0.00	$0.00	$0.00	$0.00	$17.86	$17.86	$18.55	$0.00	$5.01	$0.00	$0.00	$0.00	$0.00	$9.90	$15.67	$15.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121730	ERX	HCPCS 25000001	59011-0410-20	OXYCODONE HCL ER 10 MG PO T12A	BOTH IP/OP	$24.06 	$17.80	$0.00	$18.55		$0.00	$0.00	$0.00	$0.00	$0.00	$17.86	$17.86	$18.55	$0.00	$5.01	$0.00	$0.00	$0.00	$0.00	$9.90	$15.67	$15.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121733	ERX	HCPCS 25000001	59011-0420-10	OXYCODONE HCL ER 20 MG PO T12A	BOTH IP/OP	$44.81 	$33.16	$0.00	$34.54		$0.00	$0.00	$0.00	$0.00	$0.00	$33.26	$33.26	$34.54	$0.00	$9.34	$0.00	$0.00	$0.00	$0.00	$18.43	$29.19	$29.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121733	ERX	HCPCS 25000001	59011-0420-20	OXYCODONE HCL ER 20 MG PO T12A	BOTH IP/OP	$44.81 	$33.16	$0.00	$34.54		$0.00	$0.00	$0.00	$0.00	$0.00	$33.26	$33.26	$34.54	$0.00	$9.34	$0.00	$0.00	$0.00	$0.00	$18.43	$29.19	$29.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121735	ERX	HCPCS 25000001	59011-0440-10	OXYCODONE HCL ER 40 MG PO T12A	BOTH IP/OP	$74.83 	$55.37	$0.00	$57.68		$0.00	$0.00	$0.00	$0.00	$0.00	$55.54	$55.54	$57.68	$0.00	$15.59	$0.00	$0.00	$0.00	$0.00	$30.78	$48.75	$49.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121735	ERX	HCPCS 25000001	59011-0440-20	OXYCODONE HCL ER 40 MG PO T12A	BOTH IP/OP	$74.83 	$55.37	$0.00	$57.68		$0.00	$0.00	$0.00	$0.00	$0.00	$55.54	$55.54	$57.68	$0.00	$15.59	$0.00	$0.00	$0.00	$0.00	$30.78	$48.75	$49.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121737	ERX	HCPCS 25000001	59011-0480-20	OXYCODONE HCL ER 80 MG PO T12A	BOTH IP/OP	$123.37 	$91.29	$0.00	$95.09		$0.00	$0.00	$0.00	$0.00	$0.00	$91.57	$91.57	$95.09	$0.00	$25.71	$0.00	$0.00	$0.00	$0.00	$50.73	$80.36	$81.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121854	ERX	HCPCS 25000001	63402-0306-30	LURASIDONE HCL 60 MG PO TABS	BOTH IP/OP	$196.92 	$145.72	$0.00	$151.79		$0.00	$0.00	$0.00	$0.00	$0.00	$146.15	$146.15	$151.79	$0.00	$41.04	$0.00	$0.00	$0.00	$0.00	$80.86	$128.07	$129.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121934	ERX	HCPCS 25000001	00143-9532-25	DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN	BOTH IP/OP	$183.43 	$135.74	$0.00	$141.39		$0.00	$0.00	$0.00	$0.00	$0.00	$136.14	$136.14	$141.39	$0.00	$38.23	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121934	ERX	HCPCS 25000001	16729-0239-30	DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN	BOTH IP/OP	$183.43 	$135.74	$0.00	$141.39		$0.00	$0.00	$0.00	$0.00	$0.00	$136.14	$136.14	$141.39	$0.00	$38.23	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121934	ERX	HCPCS 25000001	16729-0239-93	DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN	BOTH IP/OP	$183.43 	$135.74	$0.00	$141.39		$0.00	$0.00	$0.00	$0.00	$0.00	$136.14	$136.14	$141.39	$0.00	$38.23	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121934	ERX	HCPCS 25000001	16729-0432-30	DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN	BOTH IP/OP	$183.43 	$135.74	$0.00	$141.39		$0.00	$0.00	$0.00	$0.00	$0.00	$136.14	$136.14	$141.39	$0.00	$38.23	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121934	ERX	HCPCS 25000001	16729-0432-93	DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN	BOTH IP/OP	$183.43 	$135.74	$0.00	$141.39		$0.00	$0.00	$0.00	$0.00	$0.00	$136.14	$136.14	$141.39	$0.00	$38.23	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121934	ERX	HCPCS 25000001	42023-0146-25	DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN	BOTH IP/OP	$183.43 	$135.74	$0.00	$141.39		$0.00	$0.00	$0.00	$0.00	$0.00	$136.14	$136.14	$141.39	$0.00	$38.23	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121934	ERX	HCPCS 25000001	55150-0209-02	DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN	BOTH IP/OP	$183.43 	$135.74	$0.00	$141.39		$0.00	$0.00	$0.00	$0.00	$0.00	$136.14	$136.14	$141.39	$0.00	$38.23	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121934	ERX	HCPCS 25000001	57664-0596-50	DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN	BOTH IP/OP	$183.43 	$135.74	$0.00	$141.39		$0.00	$0.00	$0.00	$0.00	$0.00	$136.14	$136.14	$141.39	$0.00	$38.23	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121934	ERX	HCPCS 25000001	63323-0421-02	DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN	BOTH IP/OP	$183.43 	$135.74	$0.00	$141.39		$0.00	$0.00	$0.00	$0.00	$0.00	$136.14	$136.14	$141.39	$0.00	$38.23	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121934	ERX	HCPCS 25000001	70860-0605-03	DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN	BOTH IP/OP	$183.43 	$135.74	$0.00	$141.39		$0.00	$0.00	$0.00	$0.00	$0.00	$136.14	$136.14	$141.39	$0.00	$38.23	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121934	ERX	HCPCS 25000001	70860-0605-41	DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN	BOTH IP/OP	$183.43 	$135.74	$0.00	$141.39		$0.00	$0.00	$0.00	$0.00	$0.00	$136.14	$136.14	$141.39	$0.00	$38.23	$0.00	$0.00	$0.00	$0.00	$83.16	$131.73	$133.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121955	ERX	HCPCS J9041	63020-0049-01	BORTEZOMIB 3.5 MG IJ SOLR	BOTH IP/OP	"$4,347.34 "	"$3,217.03"	$0.00	"$3,350.93"	"$1,956.30"	"$1,956.30"	"$1,567.79"	"$1,567.79"	"$1,567.79"	"$1,491.60"	"$3,226.60"	"$3,226.60"	"$3,350.93"	"$1,580.74"	"$1,857.37"	"$1,027.48"	"$2,143.24"	"$2,143.24"	"$1,642.25"	"$1,971.69"	"$3,123.16"	"$3,154.70"	"$2,267.87"		"$2,267.87"	"$1,844.87"	$0.00	$0.00	"$1,756.63"	"$1,574.55"	$0.00	$0.00	$0.00	$0.00
122027	ERX	HCPCS 63700001	64764-0750-30	VORTIOXETINE HBR 20 MG PO TABS	BOTH IP/OP	$70.90 	$52.47	$0.00	$48.99		$0.00	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00	$14.78	$0.00	$0.00	$0.00	$0.00	$30.62	$48.50	$48.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
122192	ERX	HCPCS J9301	50242-0070-01	OBINUTUZUMAB 1000 MG/40ML IV SOLN	BOTH IP/OP	"$18,573.86 "	"$13,744.66"	$0.00	"$14,889.37"		$0.00	$0.00	$0.00	$0.00	$0.00	"$14,336.91"	"$14,336.91"	"$14,889.37"	$0.00	"$7,582.98"	$0.00	$0.00	$0.00	$0.00	"$8,178.60"	"$12,954.90"	"$13,085.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
122260	ERX	HCPCS 63700001	57962-0140-09	IBRUTINIB 140 MG PO CAPS	BOTH IP/OP	"$1,161.80 "	$859.73	$0.00	$785.38		$0.00	$0.00	$0.00	$222.10	$0.00	$0.00	$0.00	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$490.86	$777.52	$785.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
122260	ERX	HCPCS 63700001	57962-0140-12	IBRUTINIB 140 MG PO CAPS	BOTH IP/OP	"$1,161.80 "	$859.73	$0.00	$785.38		$0.00	$0.00	$0.00	$222.10	$0.00	$0.00	$0.00	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$490.86	$777.52	$785.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
122312	ERX	HCPCS 25000001	00085-4324-02	POSACONAZOLE 100 MG PO TBEC	BOTH IP/OP	$720.39 	$533.09	$0.00	$555.28		$0.00	$0.00	$0.00	$0.00	$0.00	$534.67	$534.67	$555.28	$0.00	$150.13	$0.00	$0.00	$0.00	$0.00	$326.89	$517.79	$523.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
122959	ERX	HCPCS 63700001	00310-6205-30	DAPAGLIFLOZIN PROPANEDIOL 5 MG PO TABS	BOTH IP/OP	$84.74 	$62.71	$0.00	$57.94		$0.00	$0.00	$0.00	$15.08	$0.00	$0.00	$0.00	$0.00	$0.00	$17.66	$0.00	$0.00	$0.00	$0.00	$36.22	$57.36	$57.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
122960	ERX	HCPCS 63700001	00310-6210-30	DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS	BOTH IP/OP	$84.74 	$62.71	$0.00	$57.94		$0.00	$0.00	$0.00	$15.08	$0.00	$0.00	$0.00	$0.00	$0.00	$17.66	$0.00	$0.00	$0.00	$0.00	$36.22	$57.36	$57.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123430	ERX	HCPCS J9181	00703-5653-01	ETOPOSIDE 100 MG/5ML IV SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$25.65	$25.65	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$43.94	$0.00	$9.34	$0.00	$33.72	$33.72	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$7.29	$0.00	$0.00	$6.94	$0.00	$0.00	$0.00	$0.00	$0.00
123430	ERX	HCPCS J9181	16729-0114-31	ETOPOSIDE 100 MG/5ML IV SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$25.65	$25.65	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$43.94	$0.00	$9.34	$0.00	$33.72	$33.72	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$7.29	$0.00	$0.00	$6.94	$0.00	$0.00	$0.00	$0.00	$0.00
123430	ERX	HCPCS J9181	63323-0104-05	ETOPOSIDE 100 MG/5ML IV SOLN	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$25.65	$25.65	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$43.94	$0.00	$9.34	$0.00	$33.72	$33.72	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$7.29	$0.00	$0.00	$6.94	$0.00	$0.00	$0.00	$0.00	$0.00
123462	ERX	HCPCS 25000001	00169-4060-13	(VICTOZA) LIRAGLUTIDE 18 MG/3ML SC SOPN	BOTH IP/OP	$455.28 	$336.91	$0.00	$367.63		$0.00	$0.00	$0.00	$0.00	$0.00	$353.99	$353.99	$367.63	$0.00	$94.88	$0.00	$0.00	$0.00	$0.00	$196.80	$311.73	$314.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123464	ERX	HCPCS J1720	00009-0011-03	HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR	BOTH IP/OP	$34.43 	$25.48	$0.00	$26.54	$15.49	$15.49	$0.00	$0.00	$0.00	$7.18	$25.55	$25.55	$26.54	$0.00	$17.40	$0.00	$20.37	$20.37	$0.00	$12.39	$19.63	$19.82	$0.00		$0.00	$15.33	$0.00	$0.00	$14.60	$0.00	$0.00	$0.00	$0.00	$0.00
123464	ERX	HCPCS J1720	00009-0825-01	HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR	BOTH IP/OP	$34.43 	$25.48	$0.00	$26.54	$15.49	$15.49	$0.00	$0.00	$0.00	$7.18	$25.55	$25.55	$26.54	$0.00	$17.40	$0.00	$20.37	$20.37	$0.00	$12.39	$19.63	$19.82	$0.00		$0.00	$15.33	$0.00	$0.00	$14.60	$0.00	$0.00	$0.00	$0.00	$0.00
123468	ERX	HCPCS 25000001	00641-6022-25	FAMOTIDINE 20 MG/2ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123468	ERX	HCPCS 25000001	63323-0739-11	FAMOTIDINE 20 MG/2ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123468	ERX	HCPCS 25000001	63323-0739-12	FAMOTIDINE 20 MG/2ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123468	ERX	HCPCS 25000001	67457-0433-22	FAMOTIDINE 20 MG/2ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123472	ERX	HCPCS J1100	55150-0238-05	DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.06	$16.33	$16.33	$16.96	$0.00	$1.36	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$1.34	$0.00	$0.00	$0.00	$0.00	$0.00
123472	ERX	HCPCS J1100	63323-0165-05	DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.06	$16.33	$16.33	$16.96	$0.00	$1.36	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$1.34	$0.00	$0.00	$0.00	$0.00	$0.00
123472	ERX	HCPCS J1100	67457-0422-00	DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.06	$16.33	$16.33	$16.96	$0.00	$1.36	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$1.34	$0.00	$0.00	$0.00	$0.00	$0.00
123472	ERX	HCPCS J1100	67457-0422-54	DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.06	$16.33	$16.33	$16.96	$0.00	$1.36	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.41	$0.00	$0.00	$1.34	$0.00	$0.00	$0.00	$0.00	$0.00
123476	ERX	HCPCS J0171	49502-0102-02	EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ	BOTH IP/OP	"$1,066.29 "	$789.05	$0.00	$821.90	$479.83	$479.83	$0.00	$0.00	$0.00	$222.24	$791.40	$791.40	$821.90	$0.00	$2.60	$0.00	$630.71	$630.71	$0.00	$483.85	$766.41	$774.15	$0.00		$0.00	$2.89	$0.00	$0.00	$2.75	$0.00	$0.00	$0.00	$0.00	$0.00
123476	ERX	HCPCS J0171	49502-0500-02	EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ	BOTH IP/OP	"$1,066.29 "	$789.05	$0.00	$821.90	$479.83	$479.83	$0.00	$0.00	$0.00	$222.24	$791.40	$791.40	$821.90	$0.00	$2.60	$0.00	$630.71	$630.71	$0.00	$483.85	$766.41	$774.15	$0.00		$0.00	$2.89	$0.00	$0.00	$2.75	$0.00	$0.00	$0.00	$0.00	$0.00
123622	ERX	HCPCS 25000001	00085-4331-01	POSACONAZOLE 300 MG/16.7ML IV SOLN	BOTH IP/OP	"$1,648.64 "	"$1,219.99"	$0.00	"$1,270.77"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,223.62"	"$1,223.62"	"$1,270.77"	$0.00	$343.58	$0.00	$0.00	$0.00	$0.00	$763.85	"$1,209.93"	"$1,222.15"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123623	ERX	HCPCS C9132	63833-0387-02	PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS/40 ML IV KIT	BOTH IP/OP	"$7,367.60 "	"$5,452.02"	$0.00	"$5,678.95"		$0.00	$0.00	$0.00	$0.00	$0.00	"$5,468.23"	"$5,468.23"	"$5,678.95"	$0.00	"$1,535.41"	$0.00	$0.00	$0.00	$0.00	"$3,218.50"	"$4,870.80"	"$5,149.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123623	ERX	HCPCS C9132	63833-0397-01	PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS/40 ML IV KIT	BOTH IP/OP	"$7,367.60 "	"$5,452.02"	$0.00	"$5,678.95"		$0.00	$0.00	$0.00	$0.00	$0.00	"$5,468.23"	"$5,468.23"	"$5,678.95"	$0.00	"$1,535.41"	$0.00	$0.00	$0.00	$0.00	"$3,218.50"	"$4,870.80"	"$5,149.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123656	ERX	HCPCS 63700001	59572-0631-06	APREMILAST 30 MG PO TABS	BOTH IP/OP	$226.28 	$167.45	$0.00	$181.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$113.14	$179.21	$181.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123657	ERX	HCPCS 25000001	59572-0632-55	APREMILAST 10 & 20 & 30 MG PO TBPK	BOTH IP/OP	$246.85 	$182.67	$0.00	$197.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.43	$195.51	$197.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123886	ERX	HCPCS J0171	76329-9060-00	EPINEPHRINE 30 MG/30ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123899	ERX	HCPCS 25000001	41167-0058-20	LIDOCAINE 4 % EX CREAM- LARGE TUBE	BOTH IP/OP	$41.35 	$30.60	$0.00	$36.75		$0.00	$0.00	$0.00	$0.00	$0.00	$30.69	$30.69	$31.87	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$22.97	$36.38	$36.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
123951	ERX	HCPCS J7327	59676-0820-01	HYALURONAN 88 MG/4ML I-ARTICULAR SOSY	BOTH IP/OP	"$89,496.00 "	"$66,227.04"	$0.00	"$3,135.61"	"$1,830.60"	"$1,830.60"	$790.78	$790.78	$790.78	$847.87	"$3,019.27"	"$3,019.27"	"$3,135.61"	$762.80	$847.77	$495.82	"$2,005.52"	"$2,005.52"	$807.98	"$1,845.00"	"$2,922.48"	"$2,952.00"	"$1,115.78"		"$1,115.78"	$577.49	$0.00	$0.00	$587.45	$766.34	$0.00	$0.00	$0.00	$0.00
123968	ERX	HCPCS J9308	00002-7669-01	RAMUCIRUMAB 100 MG/10ML IV SOLN	BOTH IP/OP	"$3,407.05 "	"$2,521.22"	$0.00	"$2,704.92"	"$1,579.16"	"$1,579.16"	"$1,271.14"	"$1,271.14"	"$1,271.14"	$710.11	"$2,604.56"	"$2,604.56"	"$2,704.92"	"$1,253.80"	"$1,473.22"	$814.97	"$1,679.68"	"$1,679.68"	"$1,226.80"	"$1,485.23"	"$2,352.60"	"$2,376.36"	"$1,694.15"		"$1,694.15"	"$1,402.25"	$0.00	$0.00	"$1,335.18"	"$1,221.26"	$0.00	$0.00	$0.00	$0.00
124207	ERX	HCPCS 63700001	00378-0088-01	CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124207	ERX	HCPCS 63700001	51079-0978-01	CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124207	ERX	HCPCS 63700001	51079-0978-20	CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124207	ERX	HCPCS 63700001	62756-0461-88	CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124207	ERX	HCPCS 63700001	68084-0281-01	CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124207	ERX	HCPCS 63700001	68084-0281-11	CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124228	ERX	HCPCS J3380	64764-0300-20	VEDOLIZUMAB 300 MG IV SOLR	BOTH IP/OP	"$19,734.23 "	"$14,603.33"	$0.00	"$16,123.82"	"$9,413.23"	"$9,413.23"	"$6,387.90"	"$6,387.90"	"$6,387.90"	"$4,113.11"	"$15,525.55"	"$15,525.55"	"$16,123.82"	"$6,383.70"	"$7,500.85"	"$4,149.41"	"$9,728.98"	"$9,728.98"	"$6,257.16"	"$8,275.01"	"$13,107.62"	"$13,240.02"	"$8,640.84"		"$8,640.84"	"$7,134.60"	$0.00	$0.00	"$6,793.35"	"$6,197.40"	$0.00	$0.00	$0.00	$0.00
124458	ERX	HCPCS 63700001	00069-0830-38	SUNITINIB MALATE 37.5 MG PO CAPS	BOTH IP/OP	"$1,987.98 "	"$1,471.11"	$0.00	"$1,330.37"		$0.00	$0.00	$0.00	$353.86	$0.00	$0.00	$0.00	$0.00	$0.00	$414.30	$0.00	$0.00	$0.00	$0.00	$831.48	"$1,317.06"	"$1,330.37"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124486	ERX	HCPCS J0875	57970-0100-01	DALBAVANCIN HCL 500 MG IV SOLR	BOTH IP/OP	"$4,415.57 "	"$3,267.52"	$0.00	"$3,505.62"	"$2,046.61"	"$2,046.61"	"$1,589.10"	"$1,589.10"	"$1,589.10"	$920.32	"$3,375.55"	"$3,375.55"	"$3,505.62"	"$1,588.90"	"$1,866.96"	"$1,032.79"	"$2,176.88"	"$2,176.88"	"$1,569.23"	"$1,944.32"	"$3,079.79"	"$3,110.90"	"$2,167.03"		"$2,167.03"	"$1,769.55"	$0.00	$0.00	"$1,684.91"	"$1,494.50"	$0.00	$0.00	$0.00	$0.00
124555	ERX	HCPCS 25000001	00536-1186-12	PHENYLEPHRINE-COCOA BUTTER 0.25-88.44 % RECTAL SUPP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124599	ERX	HCPCS 63700001	00006-3603-61	RALTEGRAVIR POTASSIUM 100 MG PO PACK	BOTH IP/OP	$28.50 	$21.09	$0.00	$22.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124607	ERX	HCPCS J8530	00054-0383-25	CYCLOPHOSPHAMIDE 50 MG PO CAPS	BOTH IP/OP	$71.99 	$53.27	$0.00	$55.49		$0.00	$0.00	$0.00	$0.00	$0.00	$53.43	$53.43	$55.49	$0.00	$15.00	$0.00	$0.00	$0.00	$0.00	$32.65	$51.71	$52.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124728	ERX	HCPCS 25000001	00310-6530-04	EXENATIDE ER 2 MG SC PEN	BOTH IP/OP	$584.48 	$432.52	$0.00	$467.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$292.24	$462.91	$467.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124810	ERX	HCPCS 25000001	69543-0268-10	VIRT-PHOS 250 NEUTRAL 155-852-130 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
125122	ERX	HCPCS 63700001	49702-0231-13	TRIUMEQ:ABACAVIR-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS	BOTH IP/OP	$448.77 	$332.09	$0.00	$295.94		$0.00	$0.00	$0.00	$79.88	$0.00	$0.00	$0.00	$0.00	$0.00	$93.52	$0.00	$0.00	$0.00	$0.00	$184.96	$292.98	$295.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
125240	ERX	HCPCS 63600001	57894-0061-03	USTEKINUMAB 90 MG/ML SC SOSY	BOTH IP/OP	"$65,605.50 "	"$48,548.07"	$0.00	"$53,299.42"		$0.00	$0.00	$0.00	$0.00	$0.00	"$51,321.79"	"$51,321.79"	"$53,299.42"	$0.00	"$13,672.19"	$0.00	$0.00	$0.00	$0.00	"$28,391.90"	"$44,972.77"	"$45,427.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
125241	ERX	HCPCS 63700001	58406-0435-01	ETANERCEPT 50 MG/ML SC SOSY	BOTH IP/OP	"$3,417.54 "	"$2,528.98"	$0.00	"$2,734.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.77"	"$2,706.69"	"$2,734.03"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
125244	ERX	HCPCS 63600001	00006-4897-00	HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP	BOTH IP/OP	$129.34 	$95.71	$0.00	$99.70		$0.00	$0.00	$0.00	$0.00	$0.00	$96.00	$96.00	$99.70	$0.00	$26.95	$0.00	$0.00	$0.00	$0.00	$54.83	$86.85	$87.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
125258	ERX	HCPCS J7321	89130-4444-01	SODIUM HYALURONATE 25 MG/2.5ML I-ARTICULAR SOSY	BOTH IP/OP	$831.18 	$615.07	$0.00	$640.67	$374.03	$374.03	$0.00	$0.00	$0.00	$173.24	$616.90	$616.90	$640.67	$0.00	$90.76	$0.00	$491.64	$491.64	$0.00	$366.18	$580.03	$585.89	$0.00		$0.00	$97.35	$0.00	$0.00	$92.69	$0.00	$0.00	$0.00	$0.00	$0.00
125724	ERX	HCPCS J2370	00641-6142-25	PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.96	$16.33	$16.33	$16.96	$0.00	$4.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.31	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00
125724	ERX	HCPCS J2370	00641-6188-01	PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.96	$16.33	$16.33	$16.96	$0.00	$4.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.31	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00
125724	ERX	HCPCS J2370	00641-6188-10	PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.96	$16.33	$16.33	$16.96	$0.00	$4.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.31	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00
125724	ERX	HCPCS J2370	42023-0213-25	PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.96	$16.33	$16.33	$16.96	$0.00	$4.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.31	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00
125724	ERX	HCPCS J2370	42023-0214-01	PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.96	$16.33	$16.33	$16.96	$0.00	$4.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.31	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00
125724	ERX	HCPCS J2370	42023-0214-10	PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.96	$16.33	$16.33	$16.96	$0.00	$4.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.31	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00
125724	ERX	HCPCS J2370	63323-0751-01	PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.96	$16.33	$16.33	$16.96	$0.00	$4.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.31	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00
125724	ERX	HCPCS J2370	70121-1577-01	PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.96	$16.33	$16.33	$16.96	$0.00	$4.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.31	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00
125724	ERX	HCPCS J2370	70121-1577-05	PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.96	$16.33	$16.33	$16.96	$0.00	$4.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.31	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00
125724	ERX	HCPCS J2370	76014-0004-10	PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.96	$16.33	$16.33	$16.96	$0.00	$4.14	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$4.31	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00
126034	ERX	HCPCS J7188	00944-5001-01	OBIZUR:ANTIHEMOPHILIC FACTOR RPFVIII 500 UNITS IV SOLR	BOTH IP/OP	"$3,672.50 "	"$2,717.65"	$0.00	"$2,830.76"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,725.73"	"$2,725.73"	"$2,830.76"	$0.00	$765.35	$0.00	$0.00	$0.00	$0.00	"$1,665.63"	"$2,638.35"	"$2,665.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126034	ERX	HCPCS J7188	00944-5011-01	OBIZUR:ANTIHEMOPHILIC FACTOR RPFVIII 500 UNITS IV SOLR	BOTH IP/OP	"$3,672.50 "	"$2,717.65"	$0.00	"$2,830.76"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,725.73"	"$2,725.73"	"$2,830.76"	$0.00	$765.35	$0.00	$0.00	$0.00	$0.00	"$1,665.63"	"$2,638.35"	"$2,665.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126056	ERX	HCPCS 25000001	00005-0100-05	MENINGOCOCCAL B VAC (RECOMB) IM SUSY	BOTH IP/OP	$588.78 	$435.70	$0.00	$453.83		$0.00	$0.00	$0.00	$0.00	$0.00	$436.99	$436.99	$453.83	$0.00	$122.70	$0.00	$0.00	$0.00	$0.00	$274.08	$434.13	$438.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126084	ERX	HCPCS 25000001	42023-0164-25	VASOPRESSIN 20 UNIT/ML IV SOLN	BOTH IP/OP	$197.44 	$146.11	$0.00	$179.23		$0.00	$0.00	$0.00	$0.00	$0.00	$146.54	$146.54	$152.19	$0.00	$41.15	$0.00	$0.00	$0.00	$0.00	$112.02	$177.44	$179.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126108	ERX	HCPCS 25000001	08317-5411-00	GLUCOCARD SHINE W/DEVICE KIT	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126110	ERX	HCPCS 25000001	08317-5400-50	GLUCOCARD SHINE TEST VI STRP	BOTH IP/OP	$75.42 	$55.81	$0.00	$58.13		$0.00	$0.00	$0.00	$0.00	$0.00	$55.98	$55.98	$58.13	$0.00	$15.72	$0.00	$0.00	$0.00	$0.00	$34.20	$54.17	$54.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126226	ERX	HCPCS J2547	61364-0181-03	PERAMIVIR 200 MG/20ML IV SOLN	BOTH IP/OP	"$1,109.60 "	$821.10	$0.00	$855.28		$0.00	$0.00	$0.00	$0.00	$0.00	$823.55	$823.55	$855.28	$0.00	$231.24	$0.00	$0.00	$0.00	$0.00	$503.50	$797.54	$805.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126226	ERX	HCPCS J2547	72769-0181-03	PERAMIVIR 200 MG/20ML IV SOLN	BOTH IP/OP	"$1,109.60 "	$821.10	$0.00	$855.28		$0.00	$0.00	$0.00	$0.00	$0.00	$823.55	$823.55	$855.28	$0.00	$231.24	$0.00	$0.00	$0.00	$0.00	$503.50	$797.54	$805.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126229	ERX	HCPCS 63700001	00173-0873-10	UMECLIDINIUM BROMIDE 62.5 MCG/INH IN AEPB	BOTH IP/OP	"$1,240.77 "	$918.17	$0.00	$874.63		$0.00	$0.00	$0.00	$220.86	$0.00	$0.00	$0.00	$0.00	$0.00	$258.58	$0.00	$0.00	$0.00	$0.00	$546.65	$865.89	$874.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126242	ERX	HCPCS J7313	68611-0190-02	FLUOCINOLONE ACETONIDE 0.19 MG INTRAVITREAL IMPL	BOTH IP/OP	"$23,865.60 "	"$17,660.54"	$0.00	"$18,395.60"		$0.00	$0.00	$0.00	$0.00	$0.00	"$17,713.05"	"$17,713.05"	"$18,395.60"	$0.00	"$10,960.39"	$0.00	$0.00	$0.00	$0.00	"$10,824.00"	"$17,145.22"	"$17,318.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126317	ERX	HCPCS 90651	00006-4119-01	HPV 9-VALENT RECOMB VACCINE IM SUSP	BOTH IP/OP	$888.19 	$657.26	$0.00	$684.62	$399.69	$399.69	$0.00	$0.00	$229.60	$185.12	$659.21	$659.21	$684.62	$0.00	$297.98	$0.00	$525.36	$525.36	$0.00	$362.22	$573.75	$579.54	$434.66		$434.66	$267.82	$0.00	$0.00	$255.01	$0.00	$0.00	$0.00	$0.00	$0.00
126317	ERX	HCPCS 90651	00006-4119-03	HPV 9-VALENT RECOMB VACCINE IM SUSP	BOTH IP/OP	$888.19 	$657.26	$0.00	$684.62	$399.69	$399.69	$0.00	$0.00	$229.60	$185.12	$659.21	$659.21	$684.62	$0.00	$297.98	$0.00	$525.36	$525.36	$0.00	$362.22	$573.75	$579.54	$434.66		$434.66	$267.82	$0.00	$0.00	$255.01	$0.00	$0.00	$0.00	$0.00	$0.00
126371	ERX	HCPCS J0695	67919-0030-01	CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR	BOTH IP/OP	$504.89 	$373.62	$0.00	$389.17		$0.00	$0.00	$0.00	$0.00	$0.00	$374.73	$374.73	$389.17	$0.00	$105.22	$0.00	$0.00	$0.00	$0.00	$229.16	$362.98	$366.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126373	ERX	HCPCS J9299	00003-3772-11	NIVOLUMAB 40 MG/4ML IV SOLN	BOTH IP/OP	"$3,064.28 "	"$2,267.57"	$0.00	"$2,409.19"	"$1,406.51"	"$1,406.51"	"$1,169.80"	"$1,169.80"	"$1,169.80"	$638.67	"$2,319.80"	"$2,319.80"	"$2,409.19"	"$1,154.52"	"$1,356.56"	$750.44	"$1,510.69"	"$1,510.69"	"$1,167.81"	"$1,349.00"	"$2,136.81"	"$2,158.39"	"$1,612.69"		"$1,612.69"	"$1,323.52"	$0.00	$0.00	"$1,260.22"	"$1,141.36"	$0.00	$0.00	$0.00	$0.00
126374	ERX	HCPCS J9299	00003-3774-12	NIVOLUMAB 100 MG/10ML IV SOLN	BOTH IP/OP	"$7,660.64 "	"$5,668.87"	$0.00	"$6,022.92"	"$3,516.24"	"$3,516.24"	"$2,924.50"	"$2,924.50"	"$2,924.50"	"$1,596.67"	"$5,799.45"	"$5,799.45"	"$6,022.92"	"$2,886.30"	"$3,391.40"	"$1,876.10"	"$3,776.70"	"$3,776.70"	"$2,919.53"	"$3,372.48"	"$5,342.01"	"$5,395.97"	"$4,031.73"		"$4,031.73"	"$3,308.80"	$0.00	$0.00	"$3,150.54"	"$2,853.40"	$0.00	$0.00	$0.00	$0.00
126594	ERX	HCPCS 90620	58160-0976-02	MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY	BOTH IP/OP	$704.90 	$521.63	$0.00	$543.34	$317.21	$317.21	$0.00	$0.00	$171.96	$146.92	$523.18	$523.18	$543.34	$0.00	$225.31	$0.00	$416.95	$416.95	$0.00	$293.95	$465.61	$470.31	$352.73		$352.73	$200.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126594	ERX	HCPCS 90620	58160-0976-20	MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY	BOTH IP/OP	$704.90 	$521.63	$0.00	$543.34	$317.21	$317.21	$0.00	$0.00	$171.96	$146.92	$523.18	$523.18	$543.34	$0.00	$225.31	$0.00	$416.95	$416.95	$0.00	$293.95	$465.61	$470.31	$352.73		$352.73	$200.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126697	ERX	HCPCS J9271	00006-3026-02	PEMBROLIZUMAB 100 MG/4ML IV SOLN	BOTH IP/OP	"$13,924.39 "	"$10,304.05"	$0.00	"$10,732.92"	"$6,265.98"	"$6,265.98"	"$5,230.00"	"$5,230.00"	"$5,230.00"	"$2,902.19"	"$10,334.68"	"$10,334.68"	"$10,732.92"	"$5,275.40"	"$6,198.60"	"$3,429.01"	"$6,864.72"	"$6,864.72"	"$5,185.85"	"$6,070.01"	"$9,472.82"	"$9,712.01"	"$7,161.41"		"$7,161.41"	"$5,905.55"	$0.00	$0.00	"$5,623.09"	"$5,092.70"	$0.00	$0.00	$0.00	$0.00
126882	ERX	HCPCS 63700001	59676-0575-30	PREZCOBIX:DARUNAVIR-COBICISTAT 800-150 MG PO TABS	BOTH IP/OP	$292.74 	$216.63	$0.00	$203.44		$0.00	$0.00	$0.00	$55.03	$0.00	$0.00	$0.00	$0.00	$0.00	$61.01	$0.00	$0.00	$0.00	$0.00	$127.15	$201.41	$203.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126886	ERX	HCPCS 63700002	68546-0317-30	GLATIRAMER ACETATE 20 MG/ML SC SOSY	BOTH IP/OP	$830.92 	$614.88	$0.00	$640.47		$0.00	$0.00	$0.00	$0.00	$0.00	$616.71	$616.71	$640.47	$0.00	$173.16	$0.00	$0.00	$0.00	$0.00	$377.05	$597.24	$603.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126887	ERX	HCPCS 25000001	00409-4093-01	CHROMIC CHLORIDE 40 MCG/10ML IV SOLN	BOTH IP/OP	$91.87 	$67.98	$0.00	$70.81		$0.00	$0.00	$0.00	$0.00	$0.00	$68.19	$68.19	$70.81	$0.00	$19.15	$0.00	$0.00	$0.00	$0.00	$41.04	$65.01	$65.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126888	ERX	HCPCS 25000001	63323-0086-05	POTASSIUM PHOSPHATES 15 MMOLE/5ML IV SOLN	BOTH IP/OP	$74.46 	$55.10	$0.00	$57.39		$0.00	$0.00	$0.00	$0.00	$0.00	$55.26	$55.26	$57.39	$0.00	$15.52	$0.00	$0.00	$0.00	$0.00	$33.77	$53.48	$54.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126888	ERX	HCPCS 25000001	65219-0052-29	POTASSIUM PHOSPHATES 15 MMOLE/5ML IV SOLN	BOTH IP/OP	$74.46 	$55.10	$0.00	$57.39		$0.00	$0.00	$0.00	$0.00	$0.00	$55.26	$55.26	$57.39	$0.00	$15.52	$0.00	$0.00	$0.00	$0.00	$33.77	$53.48	$54.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126893	ERX	HCPCS 25000001	00781-3040-95	PYRIDOSTIGMINE BROMIDE 10 MG/2ML IV SOLN	BOTH IP/OP	$32.18 	$23.81	$0.00	$24.80		$0.00	$0.00	$0.00	$0.00	$0.00	$23.88	$23.88	$24.80	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$14.60	$23.12	$23.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126894	ERX	HCPCS J0135 	00074-4339-02	ADALIMUMAB 40 MG/0.8ML SC PNKT	BOTH IP/OP	"$8,092.86 "	"$5,988.72"	$0.00	"$6,699.59"		$0.00	$0.00	$0.00	$0.00	$0.00	"$6,451.01"	"$6,451.01"	"$6,699.59"	$0.00	"$1,686.55"	$0.00	$0.00	$0.00	$0.00	"$3,417.54"	"$5,413.38"	"$5,468.06"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126894	ERX	HCPCS J0135 	00074-4339-06	ADALIMUMAB 40 MG/0.8ML SC PNKT	BOTH IP/OP	"$8,092.86 "	"$5,988.72"	$0.00	"$6,699.59"		$0.00	$0.00	$0.00	$0.00	$0.00	"$6,451.01"	"$6,451.01"	"$6,699.59"	$0.00	"$1,686.55"	$0.00	$0.00	$0.00	$0.00	"$3,417.54"	"$5,413.38"	"$5,468.06"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126894	ERX	HCPCS J0135 	00074-4339-07	ADALIMUMAB 40 MG/0.8ML SC PNKT	BOTH IP/OP	"$8,092.86 "	"$5,988.72"	$0.00	"$6,699.59"		$0.00	$0.00	$0.00	$0.00	$0.00	"$6,451.01"	"$6,451.01"	"$6,699.59"	$0.00	"$1,686.55"	$0.00	$0.00	$0.00	$0.00	"$3,417.54"	"$5,413.38"	"$5,468.06"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126921	ERX	HCPCS 25000001	00078-0639-68	SECUKINUMAB 150 MG/ML SC SOAJ	BOTH IP/OP	"$16,080.36 "	"$11,899.47"	$0.00	"$13,262.36"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$13,262.36"	$0.00	"$3,351.15"	$0.00	$0.00	$0.00	$0.00	"$6,815.97"	"$10,796.49"	"$10,905.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126934	ERX	HCPCS 63700001	00003-3641-11	EVOTAZ:ATAZANAVIR-COBICISTAT 300-150 MG PO TABS	BOTH IP/OP	$222.84 	$164.90	$0.00	$161.83		$0.00	$0.00	$0.00	$39.67	$0.00	$0.00	$0.00	$0.00	$0.00	$46.44	$0.00	$0.00	$0.00	$0.00	$101.15	$160.21	$161.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126960	ERX	HCPCS 25000001	00069-0187-21	PALBOCICLIB 75 MG PO CAPS	BOTH IP/OP	"$2,068.13 "	"$1,530.42"	$0.00	"$1,594.11"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,534.97"	"$1,534.97"	"$1,594.11"	$0.00	$431.00	$0.00	$0.00	$0.00	$0.00	$853.68	"$1,352.22"	"$1,365.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126961	ERX	HCPCS 25000001	00069-0188-21	PALBOCICLIB 100 MG PO CAPS	BOTH IP/OP	"$2,068.13 "	"$1,530.42"	$0.00	"$1,594.11"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,534.97"	"$1,534.97"	"$1,594.11"	$0.00	$431.00	$0.00	$0.00	$0.00	$0.00	$853.68	"$1,352.22"	"$1,365.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
126962	ERX	HCPCS 25000001	00069-0189-21	PALBOCICLIB 125 MG PO CAPS	BOTH IP/OP	"$2,068.13 "	"$1,530.42"	$0.00	"$1,594.11"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,534.97"	"$1,534.97"	"$1,594.11"	$0.00	$431.00	$0.00	$0.00	$0.00	$0.00	$853.68	"$1,352.22"	"$1,365.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127008	ERX	HCPCS 63700001	62856-0720-05	LENVATINIB (20 MG DAILY DOSE) 2 X 10 MG PO CPPK	BOTH IP/OP	"$2,109.61 "	"$1,561.11"	$0.00	"$1,460.82"		$0.00	$0.00	$0.00	$385.82	$0.00	$0.00	$0.00	$0.00	$0.00	$439.64	$0.00	$0.00	$0.00	$0.00	$913.01	"$1,446.21"	"$1,460.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127008	ERX	HCPCS 63700001	62856-0720-30	LENVATINIB (20 MG DAILY DOSE) 2 X 10 MG PO CPPK	BOTH IP/OP	"$2,109.61 "	"$1,561.11"	$0.00	"$1,460.82"		$0.00	$0.00	$0.00	$385.82	$0.00	$0.00	$0.00	$0.00	$0.00	$439.64	$0.00	$0.00	$0.00	$0.00	$913.01	"$1,446.21"	"$1,460.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127009	ERX	HCPCS 63700001	62856-0714-05	LENVATINIB (14 MG DAILY DOSE) 10 & 4 MG PO CPPK	BOTH IP/OP	"$1,189.20 "	$880.01	$0.00	$806.50		$0.00	$0.00	$0.00	$217.49	$0.00	$0.00	$0.00	$0.00	$0.00	$247.83	$0.00	$0.00	$0.00	$0.00	$504.06	$798.43	$806.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127009	ERX	HCPCS 63700001	62856-0714-30	LENVATINIB (14 MG DAILY DOSE) 10 & 4 MG PO CPPK	BOTH IP/OP	"$1,189.20 "	$880.01	$0.00	$806.50		$0.00	$0.00	$0.00	$217.49	$0.00	$0.00	$0.00	$0.00	$0.00	$247.83	$0.00	$0.00	$0.00	$0.00	$504.06	$798.43	$806.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127013	ERX	HCPCS 63700001	62856-0710-05	LENVATINIB (10 MG DAILY DOSE) 10 MG PO CPPK	BOTH IP/OP	"$2,109.61 "	"$1,561.11"	$0.00	"$1,460.82"		$0.00	$0.00	$0.00	$385.82	$0.00	$0.00	$0.00	$0.00	$0.00	$439.64	$0.00	$0.00	$0.00	$0.00	$913.01	"$1,446.21"	"$1,460.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127013	ERX	HCPCS 63700001	62856-0710-30	LENVATINIB (10 MG DAILY DOSE) 10 MG PO CPPK	BOTH IP/OP	"$2,109.61 "	"$1,561.11"	$0.00	"$1,460.82"		$0.00	$0.00	$0.00	$385.82	$0.00	$0.00	$0.00	$0.00	$0.00	$439.64	$0.00	$0.00	$0.00	$0.00	$913.01	"$1,446.21"	"$1,460.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127014	ERX	HCPCS 63700001	62856-0724-05	LENVATINIB (24 MG DAILY DOSE) 2 X 10 MG & 4 MG PO CPPK	BOTH IP/OP	$792.81 	$586.68	$0.00	$537.66		$0.00	$0.00	$0.00	$144.99	$0.00	$0.00	$0.00	$0.00	$0.00	$165.22	$0.00	$0.00	$0.00	$0.00	$336.04	$532.29	$537.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127014	ERX	HCPCS 63700001	62856-0724-30	LENVATINIB (24 MG DAILY DOSE) 2 X 10 MG & 4 MG PO CPPK	BOTH IP/OP	$792.81 	$586.68	$0.00	$537.66		$0.00	$0.00	$0.00	$144.99	$0.00	$0.00	$0.00	$0.00	$0.00	$165.22	$0.00	$0.00	$0.00	$0.00	$336.04	$532.29	$537.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127054	ERX	HCPCS 25000001		SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)	BOTH IP/OP	$82.61 	$61.13	$0.00	$63.68		$0.00	$0.00	$0.00	$0.00	$0.00	$61.31	$61.31	$63.68	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$37.45	$59.32	$59.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127054	ERX	HCPCS 25000001	00378-6470-16	SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)	BOTH IP/OP	$82.61 	$61.13	$0.00	$63.68		$0.00	$0.00	$0.00	$0.00	$0.00	$61.31	$61.31	$63.68	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$37.45	$59.32	$59.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127054	ERX	HCPCS 25000001	00378-6470-99	SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)	BOTH IP/OP	$82.61 	$61.13	$0.00	$63.68		$0.00	$0.00	$0.00	$0.00	$0.00	$61.31	$61.31	$63.68	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$37.45	$59.32	$59.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127054	ERX	HCPCS 25000001	10019-0553-03	SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)	BOTH IP/OP	$82.61 	$61.13	$0.00	$63.68		$0.00	$0.00	$0.00	$0.00	$0.00	$61.31	$61.31	$63.68	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$37.45	$59.32	$59.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127054	ERX	HCPCS 25000001	10019-0553-04	SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)	BOTH IP/OP	$82.61 	$61.13	$0.00	$63.68		$0.00	$0.00	$0.00	$0.00	$0.00	$61.31	$61.31	$63.68	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$37.45	$59.32	$59.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127054	ERX	HCPCS 25000001	45802-0580-84	SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)	BOTH IP/OP	$82.61 	$61.13	$0.00	$63.68		$0.00	$0.00	$0.00	$0.00	$0.00	$61.31	$61.31	$63.68	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$37.45	$59.32	$59.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127054	ERX	HCPCS 25000001	66758-0208-58	SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)	BOTH IP/OP	$82.61 	$61.13	$0.00	$63.68		$0.00	$0.00	$0.00	$0.00	$0.00	$61.31	$61.31	$63.68	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$37.45	$59.32	$59.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127096	ERX	HCPCS 25000001		PLENAMINE 15 % IV SOLN	BOTH IP/OP	"$1,448.32 "	"$1,071.76"	$0.00	"$1,116.37"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,074.94"	"$1,074.94"	"$1,116.37"	$0.00	$301.83	$0.00	$0.00	$0.00	$0.00	$657.20	"$1,041.00"	"$1,051.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127096	ERX	HCPCS 25000001	00338-0502-06	PLENAMINE 15 % IV SOLN	BOTH IP/OP	"$1,448.32 "	"$1,071.76"	$0.00	"$1,116.37"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,074.94"	"$1,074.94"	"$1,116.37"	$0.00	$301.83	$0.00	$0.00	$0.00	$0.00	$657.20	"$1,041.00"	"$1,051.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127226	ERX	HCPCS 25000001		NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN	BOTH IP/OP	$94.65 	$70.04	$0.00	$72.96		$0.00	$0.00	$0.00	$0.00	$0.00	$70.25	$70.25	$72.96	$0.00	$19.73	$0.00	$0.00	$0.00	$0.00	$42.49	$67.30	$67.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127226	ERX	HCPCS 25000001	00143-9318-01	NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN	BOTH IP/OP	$94.65 	$70.04	$0.00	$72.96		$0.00	$0.00	$0.00	$0.00	$0.00	$70.25	$70.25	$72.96	$0.00	$19.73	$0.00	$0.00	$0.00	$0.00	$42.49	$67.30	$67.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127226	ERX	HCPCS 25000001	00143-9318-10	NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN	BOTH IP/OP	$94.65 	$70.04	$0.00	$72.96		$0.00	$0.00	$0.00	$0.00	$0.00	$70.25	$70.25	$72.96	$0.00	$19.73	$0.00	$0.00	$0.00	$0.00	$42.49	$67.30	$67.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127226	ERX	HCPCS 25000001	00409-3375-04	NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN	BOTH IP/OP	$94.65 	$70.04	$0.00	$72.96		$0.00	$0.00	$0.00	$0.00	$0.00	$70.25	$70.25	$72.96	$0.00	$19.73	$0.00	$0.00	$0.00	$0.00	$42.49	$67.30	$67.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127226	ERX	HCPCS 25000001	00409-3375-14	NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN	BOTH IP/OP	$94.65 	$70.04	$0.00	$72.96		$0.00	$0.00	$0.00	$0.00	$0.00	$70.25	$70.25	$72.96	$0.00	$19.73	$0.00	$0.00	$0.00	$0.00	$42.49	$67.30	$67.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127226	ERX	HCPCS 25000001	36000-0162-10	NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN	BOTH IP/OP	$94.65 	$70.04	$0.00	$72.96		$0.00	$0.00	$0.00	$0.00	$0.00	$70.25	$70.25	$72.96	$0.00	$19.73	$0.00	$0.00	$0.00	$0.00	$42.49	$67.30	$67.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127226	ERX	HCPCS 25000001	67457-0852-00	NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN	BOTH IP/OP	$94.65 	$70.04	$0.00	$72.96		$0.00	$0.00	$0.00	$0.00	$0.00	$70.25	$70.25	$72.96	$0.00	$19.73	$0.00	$0.00	$0.00	$0.00	$42.49	$67.30	$67.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127226	ERX	HCPCS 25000001	67457-0852-04	NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN	BOTH IP/OP	$94.65 	$70.04	$0.00	$72.96		$0.00	$0.00	$0.00	$0.00	$0.00	$70.25	$70.25	$72.96	$0.00	$19.73	$0.00	$0.00	$0.00	$0.00	$42.49	$67.30	$67.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127226	ERX	HCPCS 25000001	70121-1576-07	NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN	BOTH IP/OP	$94.65 	$70.04	$0.00	$72.96		$0.00	$0.00	$0.00	$0.00	$0.00	$70.25	$70.25	$72.96	$0.00	$19.73	$0.00	$0.00	$0.00	$0.00	$42.49	$67.30	$67.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127500	ERX	HCPCS J0714	00456-2700-10	CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR	BOTH IP/OP	"$1,257.27 "	$930.38	$0.00	$969.10		$0.00	$0.00	$0.00	$0.00	$0.00	$933.15	$933.15	$969.10	$0.00	$262.02	$0.00	$0.00	$0.00	$0.00	$570.51	$903.69	$912.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127503	ERX	HCPCS 25000001	00469-0520-14	ISAVUCONAZONIUM SULFATE 186 MG PO CAPS	BOTH IP/OP	$668.17 	$494.45	$0.00	$545.41		$0.00	$0.00	$0.00	$0.00	$0.00	$525.17	$525.17	$545.41	$0.00	$139.25	$0.00	$0.00	$0.00	$0.00	$294.36	$466.27	$470.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
127504	ERX	HCPCS J1833	00469-0420-99	ISAVUCONAZONIUM SULFATE 372 MG IV SOLR	BOTH IP/OP	"$1,138.28 "	$842.33	$0.00	$929.15		$0.00	$0.00	$0.00	$0.00	$0.00	$894.68	$894.68	$929.15	$0.00	$237.22	$0.00	$0.00	$0.00	$306.23	$501.48	$794.34	$802.36	$422.89		$422.89	$156.96	$0.00	$0.00	$159.67	$294.25	$0.00	$0.00	$0.00	$0.00
127505	ERX	HCPCS J7297	00023-5858-01	LEVONORGESTREL 19.5 MCG/DAY IU IUD	BOTH IP/OP	"$2,266.18 "	"$1,676.97"	$0.00	"$1,812.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.09"	"$1,794.81"	"$1,812.94"	"$1,359.71"		"$1,359.71"	$880.55	$0.00	$0.00	$838.43	$0.00	$0.00	$0.00	$0.00	$0.00
127687	ERX	HCPCS 63700001	55513-0800-60	IVABRADINE HCL 5 MG PO TABS	BOTH IP/OP	$41.19 	$30.48	$0.00	$28.22		$0.00	$0.00	$0.00	$7.76	$0.00	$0.00	$0.00	$0.00	$0.00	$8.58	$0.00	$0.00	$0.00	$0.00	$17.64	$27.94	$28.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
128092	ERX	HCPCS J1610	63323-0593-03	GLUCAGON HCL 1 MG IJ SOLR	BOTH IP/OP	$343.73 	$254.36	$0.00	$288.94	$154.68	$154.68	$166.77	$166.77	$166.77	$88.07	$255.12	$255.12	$264.95	$171.74	$201.79	$111.63	$203.32	$203.32	$209.24	$156.01	$247.12	$249.62	$288.94		$288.94	$255.63	$0.00	$0.00	$243.41	$199.13	$0.00	$0.00	$0.00	$0.00
128092	ERX	HCPCS J1610	63323-0596-11	GLUCAGON HCL 1 MG IJ SOLR	BOTH IP/OP	$343.73 	$254.36	$0.00	$288.94	$154.68	$154.68	$166.77	$166.77	$166.77	$88.07	$255.12	$255.12	$264.95	$171.74	$201.79	$111.63	$203.32	$203.32	$209.24	$156.01	$247.12	$249.62	$288.94		$288.94	$255.63	$0.00	$0.00	$243.41	$199.13	$0.00	$0.00	$0.00	$0.00
128092	ERX	HCPCS J1610	63323-0596-13	GLUCAGON HCL 1 MG IJ SOLR	BOTH IP/OP	$343.73 	$254.36	$0.00	$288.94	$154.68	$154.68	$166.77	$166.77	$166.77	$88.07	$255.12	$255.12	$264.95	$171.74	$201.79	$111.63	$203.32	$203.32	$209.24	$156.01	$247.12	$249.62	$288.94		$288.94	$255.63	$0.00	$0.00	$243.41	$199.13	$0.00	$0.00	$0.00	$0.00
128092	ERX	HCPCS J1610	63323-0596-16	GLUCAGON HCL 1 MG IJ SOLR	BOTH IP/OP	$343.73 	$254.36	$0.00	$288.94	$154.68	$154.68	$166.77	$166.77	$166.77	$88.07	$255.12	$255.12	$264.95	$171.74	$201.79	$111.63	$203.32	$203.32	$209.24	$156.01	$247.12	$249.62	$288.94		$288.94	$255.63	$0.00	$0.00	$243.41	$199.13	$0.00	$0.00	$0.00	$0.00
128482	ERX	HCPCS C9460	10122-0620-01	CANGRELOR TETRASODIUM 50 MG IV SOLR	BOTH IP/OP	"$2,260.83 "	"$1,673.01"	$0.00	"$1,742.65"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,677.99"	"$1,677.99"	"$1,742.65"	$0.00	$471.16	$0.00	$0.00	$0.00	$0.00	"$1,078.56"	"$1,708.44"	"$1,725.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
128482	ERX	HCPCS C9460	10122-0620-10	CANGRELOR TETRASODIUM 50 MG IV SOLR	BOTH IP/OP	"$2,260.83 "	"$1,673.01"	$0.00	"$1,742.65"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,677.99"	"$1,677.99"	"$1,742.65"	$0.00	$471.16	$0.00	$0.00	$0.00	$0.00	"$1,078.56"	"$1,708.44"	"$1,725.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
128545	ERX	HCPCS 25000001	00078-0659-20	SACUBITRIL-VALSARTAN 24-26 MG PO TABS	BOTH IP/OP	$35.21 	$26.06	$0.00	$28.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.61	$27.89	$28.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
128546	ERX	HCPCS 25000001	00078-0777-20	SACUBITRIL-VALSARTAN 49-51 MG PO TABS	BOTH IP/OP	$35.21 	$26.06	$0.00	$28.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.61	$27.89	$28.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
128547	ERX	HCPCS 25000001	00078-0696-20	SACUBITRIL-VALSARTAN 97-103 MG PO TABS	BOTH IP/OP	$48.85 	$36.15	$0.00	$40.29		$0.00	$0.00	$0.00	$0.00	$0.00	$38.79	$38.79	$40.29	$0.00	$10.18	$0.00	$0.00	$0.00	$0.00	$20.71	$32.80	$33.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
128559	ERX	HCPCS 63700001	99999-6006-28	AMINOCAPROIC ACID 0.25 GM/ML PO SOLN	BOTH IP/OP	$338.69 	$250.63	$0.00	"$5,500.63"		$0.00	$0.00	$0.00	$60.29	$0.00	$0.00	$0.00	$0.00	$0.00	$70.58	$0.00	$0.00	$0.00	$0.00	"$3,437.90"	$243.49	"$5,500.63"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
128559	ERX	HCPCS 63700001	49411-0052-08	AMINOCAPROIC ACID 0.25 GM/ML PO SOLN	BOTH IP/OP	$338.69 	$250.63	$0.00	"$5,500.63"		$0.00	$0.00	$0.00	$60.29	$0.00	$0.00	$0.00	$0.00	$0.00	$70.58	$0.00	$0.00	$0.00	$0.00	"$3,437.90"	"$5,445.63"	"$5,500.63"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
128685	ERX	HCPCS J2280	63323-0850-74	MOXIFLOXACIN HCL 400 MG/250ML IV SOLN	BOTH IP/OP	$191.72 	$141.87	$0.00	$147.78		$0.00	$0.00	$0.00	$0.00	$0.00	$142.29	$142.29	$147.78	$0.00	$39.95	$0.00	$0.00	$0.00	$0.00	$87.02	$137.84	$139.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129082	ERX	HCPCS Q5101	61314-0318-05	FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY	BOTH IP/OP	$961.37 	$711.41	$0.00	$741.02		$0.00	$0.00	$0.00	$0.00	$0.00	$713.53	$713.53	$741.02	$0.00	$112.10	$0.00	$0.00	$0.00	$0.00	$436.24	$691.00	$697.98	$0.00		$0.00	$193.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129082	ERX	HCPCS Q5101	61314-0318-10	FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY	BOTH IP/OP	$961.37 	$711.41	$0.00	$741.02		$0.00	$0.00	$0.00	$0.00	$0.00	$713.53	$713.53	$741.02	$0.00	$112.10	$0.00	$0.00	$0.00	$0.00	$436.24	$691.00	$697.98	$0.00		$0.00	$193.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129083	ERX	HCPCS Q5101	61314-0326-10	FILGRASTIM-SNDZ 480 MCG/0.8ML IJ SOSY	BOTH IP/OP	"$1,264.28 "	$935.57	$0.00	"$1,011.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.14	"$1,001.31"	"$1,011.42"	$0.00		$0.00	$310.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129084	ERX	HCPCS J9310	50242-0051-21	RITUXIMAB 100 MG/10ML IV SOLN	BOTH IP/OP	"$2,547.97 "	"$1,885.50"	$0.00	"$1,963.98"	"$1,146.59"	"$1,146.59"	$856.33	$856.33	$856.33	$531.06	"$1,891.10"	"$1,891.10"	"$1,963.98"	$869.37	"$1,021.51"	$565.09	"$1,256.15"	"$1,256.15"	$994.00	"$1,155.61"	"$1,830.49"	"$1,848.98"	"$1,372.67"		"$1,372.67"	"$1,109.32"	$0.00	$0.00	"$1,056.26"	$946.67	$0.00	$0.00	$0.00	$0.00
129085	ERX	HCPCS J9310	50242-0053-06	RITUXIMAB 500 MG/50ML IV SOLN	BOTH IP/OP	"$12,739.85 "	"$9,427.49"	$0.00	"$9,819.88"	"$5,732.93"	"$5,732.93"	"$4,281.65"	"$4,281.65"	"$4,281.65"	"$2,655.30"	"$9,455.52"	"$9,455.52"	"$9,819.88"	"$4,346.85"	"$5,107.55"	"$2,825.45"	"$6,280.75"	"$6,280.75"	"$4,970.02"	"$5,778.03"	"$9,152.40"	"$9,244.85"	"$6,863.36"		"$6,863.36"	"$5,546.59"	$0.00	$0.00	"$5,281.30"	"$4,733.35"	$0.00	$0.00	$0.00	$0.00
129088	ERX	HCPCS J3475	00409-6729-23	MAGNESIUM SULFATE 4 GM/100ML IV SOLN	BOTH IP/OP	$36.88 	$27.29	$0.00	$28.43	$16.60	$16.60	$0.00	$0.00	$0.00	$0.47	$27.37	$27.37	$28.43	$0.00	$7.07	$0.00	$21.81	$21.81	$0.00	$16.53	$26.18	$26.45	$0.00		$0.00	$5.92	$0.00	$0.00	$5.64	$0.00	$0.00	$0.00	$0.00	$0.00
129091	ERX	HCPCS J3475	00409-6730-13	MAGNESIUM SULFATE 4 GM/50ML IV SOLN	BOTH IP/OP	$52.71 	$39.01	$0.00	$41.60	$23.72	$23.72	$0.00	$0.00	$0.00	$0.47	$39.12	$39.12	$40.63	$0.00	$7.07	$0.00	$31.18	$31.18	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$5.92	$0.00	$0.00	$5.64	$0.00	$0.00	$0.00	$0.00	$0.00
129092	ERX	HCPCS J2505	55513-0190-01	PEGFILGRASTIM 6 MG/0.6ML SC SOSY	BOTH IP/OP	"$17,405.60 "	"$12,880.14"	$0.00	"$13,416.24"		$0.00	$0.00	$0.00	$0.00	$0.00	"$12,918.44"	"$12,918.44"	"$13,416.24"	$0.00	"$3,627.33"	$0.00	$0.00	$0.00	"$4,654.18"	"$7,664.21"	"$12,140.10"	"$12,262.73"	"$6,427.20"		"$6,427.20"	"$5,002.09"	$0.00	$0.00	"$4,762.84"	"$3,807.30"	$0.00	$0.00	$0.00	$0.00
129102	ERX	HCPCS J3230	00641-1398-35	CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN	BOTH IP/OP	$83.22 	$61.58	$0.00	$64.15	$37.45	$37.45	$0.00	$0.00	$0.00	$9.35	$61.77	$61.77	$64.15	$0.00	$38.62	$0.00	$49.22	$49.22	$0.00	$37.74	$59.78	$60.38	$0.00		$0.00	$37.08	$0.00	$0.00	$35.31	$0.00	$0.00	$0.00	$0.00	$0.00
129103	ERX	HCPCS 63700001	62175-0310-37	METHYLPHENIDATE HCL ER 18 MG PO TB24	BOTH IP/OP	$26.08 	$19.30	$0.00	$18.92		$0.00	$0.00	$0.00	$4.64	$0.00	$0.00	$0.00	$0.00	$0.00	$5.44	$0.00	$0.00	$0.00	$0.00	$11.83	$18.73	$18.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129105	ERX	HCPCS 63700001	00406-0136-01	METHYLPHENIDATE HCL ER 36 MG PO TB24	BOTH IP/OP	$27.57 	$20.40	$0.00	$20.01		$0.00	$0.00	$0.00	$4.91	$0.00	$0.00	$0.00	$0.00	$0.00	$5.75	$0.00	$0.00	$0.00	$0.00	$12.51	$19.81	$20.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129106	ERX	HCPCS 63700001	00406-0154-01	METHYLPHENIDATE HCL ER 54 MG PO TB24	BOTH IP/OP	$30.00 	$22.20	$0.00	$21.77		$0.00	$0.00	$0.00	$5.34	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$13.61	$21.55	$21.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129107	ERX	HCPCS J0881	55513-0057-04	DARBEPOETIN ALFA 25 MCG/0.42ML IJ SOSY	BOTH IP/OP	$678.03 	$501.74	$0.00	$522.63	$305.11	$305.11	$77.35	$77.35	$77.35	$89.89	$503.23	$503.23	$522.63	$78.85	$92.65	$51.25	$401.05	$401.05	$101.12	$307.67	$487.34	$492.26	$139.64		$139.64	$112.21	$0.00	$0.00	$106.85	$94.65	$0.00	$0.00	$0.00	$0.00
129109	ERX	HCPCS J0881	55513-0021-01	DARBEPOETIN ALFA 40 MCG/0.4ML IJ SOSY	BOTH IP/OP	"$1,084.84 "	$802.78	$0.00	$836.19	$488.18	$488.18	$123.76	$123.76	$123.76	$143.82	$805.17	$805.17	$836.19	$126.16	$148.24	$82.00	$641.68	$641.68	$161.78	$492.27	$779.75	$787.62	$223.42		$223.42	$179.54	$0.00	$0.00	$170.95	$151.44	$0.00	$0.00	$0.00	$0.00
129109	ERX	HCPCS J0881	55513-0021-04	DARBEPOETIN ALFA 40 MCG/0.4ML IJ SOSY	BOTH IP/OP	"$1,084.84 "	$802.78	$0.00	$836.19	$488.18	$488.18	$123.76	$123.76	$123.76	$143.82	$805.17	$805.17	$836.19	$126.16	$148.24	$82.00	$641.68	$641.68	$161.78	$492.27	$779.75	$787.62	$223.42		$223.42	$179.54	$0.00	$0.00	$170.95	$151.44	$0.00	$0.00	$0.00	$0.00
129111	ERX	HCPCS J0881	55513-0023-01	DARBEPOETIN ALFA 60 MCG/0.3ML IJ SOSY	BOTH IP/OP	"$1,443.36 "	"$1,068.09"	$0.00	"$1,112.54"	$649.51	$649.51	$185.64	$185.64	$185.64	$215.73	"$1,071.26"	"$1,071.26"	"$1,112.54"	$189.24	$222.36	$123.01	$853.75	$853.75	$242.68	$668.74	"$1,059.28"	"$1,069.98"	$335.12		$335.12	$269.31	$0.00	$0.00	$256.43	$227.16	$0.00	$0.00	$0.00	$0.00
129111	ERX	HCPCS J0881	55513-0023-04	DARBEPOETIN ALFA 60 MCG/0.3ML IJ SOSY	BOTH IP/OP	"$1,443.36 "	"$1,068.09"	$0.00	"$1,112.54"	$649.51	$649.51	$185.64	$185.64	$185.64	$215.73	"$1,071.26"	"$1,071.26"	"$1,112.54"	$189.24	$222.36	$123.01	$853.75	$853.75	$242.68	$668.74	"$1,059.28"	"$1,069.98"	$335.12		$335.12	$269.31	$0.00	$0.00	$256.43	$227.16	$0.00	$0.00	$0.00	$0.00
129113	ERX	HCPCS J0881	55513-0025-01	DARBEPOETIN ALFA 100 MCG/0.5ML IJ SOSY	BOTH IP/OP	"$2,405.60 "	"$1,780.14"	$0.00	"$1,854.24"	"$1,082.52"	"$1,082.52"	$309.40	$309.40	$309.40	$359.55	"$1,785.44"	"$1,785.44"	"$1,854.24"	$315.40	$370.60	$205.01	"$1,185.96"	"$1,185.96"	$404.46	"$1,114.56"	"$1,765.46"	"$1,783.30"	$558.54		$558.54	$448.85	$0.00	$0.00	$427.38	$378.60	$0.00	$0.00	$0.00	$0.00
129113	ERX	HCPCS J0881	55513-0025-04	DARBEPOETIN ALFA 100 MCG/0.5ML IJ SOSY	BOTH IP/OP	"$2,405.60 "	"$1,780.14"	$0.00	"$1,854.24"	"$1,082.52"	"$1,082.52"	$309.40	$309.40	$309.40	$359.55	"$1,785.44"	"$1,785.44"	"$1,854.24"	$315.40	$370.60	$205.01	"$1,185.96"	"$1,185.96"	$404.46	"$1,114.56"	"$1,765.46"	"$1,783.30"	$558.54		$558.54	$448.85	$0.00	$0.00	$427.38	$378.60	$0.00	$0.00	$0.00	$0.00
129115	ERX	HCPCS J0881	55513-0027-04	DARBEPOETIN ALFA 150 MCG/0.3ML IJ SOSY	BOTH IP/OP	"$3,148.64 "	"$2,329.99"	$0.00	"$2,426.97"	"$1,416.89"	"$1,416.89"	$464.10	$464.10	$464.10	$539.33	"$2,336.92"	"$2,336.92"	"$2,426.97"	$473.10	$555.89	$307.52	"$1,552.28"	"$1,552.28"	$606.69	"$1,428.03"	"$2,262.00"	"$2,284.85"	$837.81		$837.81	$673.28	$0.00	$0.00	$641.07	$567.90	$0.00	$0.00	$0.00	$0.00
129116	ERX	HCPCS J0881	55513-0028-01	DARBEPOETIN ALFA 200 MCG/0.4ML IJ SOSY	BOTH IP/OP	"$4,198.18 "	"$3,106.65"	$0.00	"$3,235.96"	"$1,889.18"	"$1,889.18"	$618.80	$618.80	$618.80	$719.10	"$3,115.89"	"$3,115.89"	"$3,235.96"	$630.80	$741.19	$410.02	"$2,069.70"	"$2,069.70"	$808.92	"$1,904.04"	"$3,016.00"	"$3,046.46"	"$1,117.08"		"$1,117.08"	$897.70	$0.00	$0.00	$854.76	$757.20	$0.00	$0.00	$0.00	$0.00
129117	ERX	HCPCS J0881	55513-0111-01	DARBEPOETIN ALFA 300 MCG/0.6ML IJ SOSY	BOTH IP/OP	"$6,297.27 "	"$4,659.98"	$0.00	"$4,853.94"	"$2,833.77"	"$2,833.77"	$928.20	$928.20	$928.20	"$1,078.65"	"$4,673.83"	"$4,673.83"	"$4,853.94"	$946.20	"$1,111.79"	$615.03	"$3,104.55"	"$3,104.55"	"$1,213.38"	"$2,856.06"	"$4,524.00"	"$4,569.70"	"$1,675.62"		"$1,675.62"	"$1,346.55"	$0.00	$0.00	"$1,282.14"	"$1,135.80"	$0.00	$0.00	$0.00	$0.00
129118	ERX	HCPCS J0881	55513-0032-01	DARBEPOETIN ALFA 500 MCG/ML IJ SOSY	BOTH IP/OP	"$10,495.44 "	"$7,766.63"	$0.00	"$8,089.89"	"$4,722.95"	"$4,722.95"	"$1,547.00"	"$1,547.00"	"$1,547.00"	"$1,797.75"	"$7,789.72"	"$7,789.72"	"$8,089.89"	"$1,577.00"	"$1,852.98"	"$1,025.05"	"$5,174.25"	"$5,174.25"	"$2,022.30"	"$4,760.10"	"$7,540.00"	"$7,616.16"	"$2,792.70"		"$2,792.70"	"$2,244.25"	$0.00	$0.00	"$2,136.91"	"$1,893.00"	$0.00	$0.00	$0.00	$0.00
129167	ERX	HCPCS 63700001	00186-0776-60	TICAGRELOR 60 MG PO TABS	BOTH IP/OP	$35.65 	$26.38	$0.00	$23.90		$0.00	$0.00	$0.00	$6.35	$0.00	$0.00	$0.00	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$14.94	$23.66	$23.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129213	ERX	HCPCS J2710	62295-3324-05	NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.12	$16.33	$16.33	$16.96	$0.00	$2.00	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.03	$0.00	$0.00	$1.94	$0.00	$0.00	$0.00	$0.00	$0.00
129243	ERX	HCPCS 25000001	64842-1025-01	TRIFLURIDINE-TIPIRACIL 15-6.14 MG PO TABS	BOTH IP/OP	$628.00 	$464.72	$0.00	$507.78		$0.00	$0.00	$0.00	$0.00	$0.00	$488.94	$488.94	$507.78	$0.00	$130.88	$0.00	$0.00	$0.00	$0.00	$273.35	$432.99	$437.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129243	ERX	HCPCS 25000001	64842-1025-02	TRIFLURIDINE-TIPIRACIL 15-6.14 MG PO TABS	BOTH IP/OP	$628.00 	$464.72	$0.00	$507.78		$0.00	$0.00	$0.00	$0.00	$0.00	$488.94	$488.94	$507.78	$0.00	$130.88	$0.00	$0.00	$0.00	$0.00	$273.35	$432.99	$437.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129243	ERX	HCPCS 25000001	64842-1025-03	TRIFLURIDINE-TIPIRACIL 15-6.14 MG PO TABS	BOTH IP/OP	$628.00 	$464.72	$0.00	$507.78		$0.00	$0.00	$0.00	$0.00	$0.00	$488.94	$488.94	$507.78	$0.00	$130.88	$0.00	$0.00	$0.00	$0.00	$273.35	$432.99	$437.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129244	ERX	HCPCS 25000001	64842-1020-01	TRIFLURIDINE-TIPIRACIL 20-8.19 MG PO TABS	BOTH IP/OP	$837.34 	$619.63	$0.00	$677.04		$0.00	$0.00	$0.00	$0.00	$0.00	$651.92	$651.92	$677.04	$0.00	$174.50	$0.00	$0.00	$0.00	$0.00	$364.47	$577.31	$583.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129244	ERX	HCPCS 25000001	64842-1020-02	TRIFLURIDINE-TIPIRACIL 20-8.19 MG PO TABS	BOTH IP/OP	$837.34 	$619.63	$0.00	$677.04		$0.00	$0.00	$0.00	$0.00	$0.00	$651.92	$651.92	$677.04	$0.00	$174.50	$0.00	$0.00	$0.00	$0.00	$364.47	$577.31	$583.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129244	ERX	HCPCS 25000001	64842-1020-03	TRIFLURIDINE-TIPIRACIL 20-8.19 MG PO TABS	BOTH IP/OP	$837.34 	$619.63	$0.00	$677.04		$0.00	$0.00	$0.00	$0.00	$0.00	$651.92	$651.92	$677.04	$0.00	$174.50	$0.00	$0.00	$0.00	$0.00	$364.47	$577.31	$583.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129506	ERX	HCPCS J9352	59676-0610-01	TRABECTEDIN 1 MG IV SOLR	BOTH IP/OP	"$8,399.84 "	"$6,215.88"	$0.00	"$6,604.10"		$0.00	$0.00	$0.00	$0.00	$0.00	"$6,359.06"	"$6,359.06"	"$6,604.10"	$0.00	"$3,819.09"	$0.00	$0.00	$0.00	$0.00	"$3,734.96"	"$5,916.18"	"$5,975.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129598	ERX	HCPCS J3490	00597-0197-05	IDARUCIZUMAB 2.5 GM/50ML IV SOLN	BOTH IP/OP	"$11,605.33 "	"$8,587.94"	$0.00	"$9,303.19"	"$5,431.29"	"$5,431.29"	$0.00	$0.00	$0.00	"$2,418.84"	"$8,958.01"	"$8,958.01"	"$9,303.19"	$0.00	"$2,418.55"	$0.00	"$5,721.43"	"$5,721.43"	$0.00	"$4,928.41"	"$7,806.59"	"$7,885.45"	$0.00		$0.00	"$1,542.59"	$0.00	$0.00	"$1,569.20"	$0.00	$0.00	$0.00	$0.00	$0.00
129781	ERX	HCPCS 63700001	53436-0084-04	PATIROMER SORBITEX CALCIUM 8.4 G PO PACK	BOTH IP/OP	$174.79 	$129.34	$0.00	$134.40		$0.00	$0.00	$0.00	$31.11	$0.00	$0.00	$0.00	$0.00	$0.00	$36.43	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129834	ERX	HCPCS 25000001	61958-1901-01	GENVOYA:150-150-200-10 MG PO TABLET	BOTH IP/OP	$481.67 	$356.44	$0.00	$371.27		$0.00	$0.00	$0.00	$0.00	$0.00	$357.50	$357.50	$371.27	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$197.54	$312.90	$316.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129853	ERX	HCPCS 25000001	50242-0717-01	COBIMETINIB FUMARATE 20 MG PO TABS	BOTH IP/OP	$448.32 	$331.76	$0.00	$345.57		$0.00	$0.00	$0.00	$0.00	$0.00	$332.74	$332.74	$345.57	$0.00	$93.43	$0.00	$0.00	$0.00	$0.00	$203.48	$322.31	$325.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129873	ERX	HCPCS 63700001	00310-1349-30	OSIMERTINIB MESYLATE 40 MG PO TABS	BOTH IP/OP	"$1,575.60 "	"$1,165.94"	$0.00	"$1,168.02"		$0.00	$0.00	$0.00	$280.46	$0.00	$0.00	$0.00	$0.00	$0.00	$328.36	$0.00	$0.00	$0.00	$0.00	$730.01	"$1,156.34"	"$1,168.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129874	ERX	HCPCS 63700001	00310-1350-30	OSIMERTINIB MESYLATE 80 MG PO TABS	BOTH IP/OP	"$1,575.60 "	"$1,165.94"	$0.00	"$1,168.02"		$0.00	$0.00	$0.00	$280.46	$0.00	$0.00	$0.00	$0.00	$0.00	$328.36	$0.00	$0.00	$0.00	$0.00	$730.01	"$1,156.34"	"$1,168.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129889	ERX	HCPCS J9145	57894-0502-05	DARATUMUMAB 100 MG/5ML IV SOLN	BOTH IP/OP	"$1,809.95 "	"$1,339.36"	$0.00	"$1,470.46"	$858.47	$858.47	$572.22	$572.22	$572.22	$377.24	"$1,415.89"	"$1,415.89"	"$1,470.46"	$575.52	$676.24	$374.09	$892.31	$892.31	$566.45	$800.19	"$1,267.49"	"$1,280.30"	$782.25		$782.25	$634.85	$0.00	$0.00	$604.49	$539.48	$0.00	$0.00	$0.00	$0.00
129890	ERX	HCPCS J9145	57894-0502-20	DARATUMUMAB 400 MG/20ML IV SOLN	BOTH IP/OP	"$6,317.34 "	"$4,674.83"	$0.00	"$5,132.38"	"$2,996.33"	"$2,996.33"	"$2,288.88"	"$2,288.88"	"$2,288.88"	"$1,316.69"	"$4,941.95"	"$4,941.95"	"$5,132.38"	"$2,302.08"	"$2,704.94"	"$1,496.35"	"$3,114.45"	"$3,114.45"	"$2,265.82"	"$2,733.95"	"$4,330.57"	"$4,374.31"	"$3,128.98"		"$3,128.98"	"$2,539.41"	$0.00	$0.00	"$2,417.95"	"$2,157.92"	$0.00	$0.00	$0.00	$0.00
129908	ERX	HCPCS 25000001	69547-0353-02	NALOXONE HCL 4 MG/0.1ML NA LIQD	BOTH IP/OP	$260.25 	$192.59	$0.00	$200.60		$0.00	$0.00	$0.00	$0.00	$0.00	$193.16	$193.16	$200.60	$0.00	$54.24	$0.00	$0.00	$0.00	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129912	ERX	HCPCS 63700001	63020-0078-02	IXAZOMIB CITRATE 2.3 MG PO CAPS	BOTH IP/OP	"$8,589.50 "	"$6,356.23"	$0.00	"$6,871.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,294.75"	"$6,802.88"	"$6,871.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129913	ERX	HCPCS 63700001	63020-0079-02	IXAZOMIB CITRATE 3 MG PO CAPS	BOTH IP/OP	"$8,589.50 "	"$6,356.23"	$0.00	"$6,871.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,294.75"	"$6,802.88"	"$6,871.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129914	ERX	HCPCS 63700001	63020-0080-02	IXAZOMIB CITRATE 4 MG PO CAPS	BOTH IP/OP	"$8,589.50 "	"$6,356.23"	$0.00	"$6,871.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,294.75"	"$6,802.88"	"$6,871.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129989	ERX	HCPCS J1976	00003-2291-11	ELOTUZUMAB 300 MG IV SOLR	BOTH IP/OP	"$5,425.79 "	"$4,015.08"	$0.00	"$4,244.93"	"$2,478.23"	"$2,478.23"	"$2,058.00"	"$2,058.00"	"$2,058.00"	"$1,130.87"	"$4,087.42"	"$4,087.42"	"$4,244.93"	"$2,031.30"	"$2,387.13"	"$1,320.35"	"$2,674.91"	"$2,674.91"	"$2,046.24"	"$2,388.61"	"$3,783.56"	"$3,821.78"	"$2,825.76"		"$2,825.76"	"$2,319.45"	$0.00	$0.00	"$2,208.51"	"$1,948.80"	$0.00	$0.00	$0.00	$0.00
129990	ERX	HCPCS J1976	00003-4522-11	ELOTUZUMAB 400 MG IV SOLR	BOTH IP/OP	"$7,234.36 "	"$5,353.43"	$0.00	"$5,659.88"	"$3,304.29"	"$3,304.29"	"$2,744.00"	"$2,744.00"	"$2,744.00"	"$1,507.82"	"$5,449.87"	"$5,449.87"	"$5,659.88"	"$2,708.40"	"$3,182.84"	"$1,760.46"	"$3,566.54"	"$3,566.54"	"$2,728.32"	"$3,184.80"	"$5,044.72"	"$5,095.68"	"$3,767.68"		"$3,767.68"	"$3,092.60"	$0.00	$0.00	"$2,944.68"	"$2,598.40"	$0.00	$0.00	$0.00	$0.00
130051	ERX	HCPCS J9034	63459-0348-04	BENDAMUSTINE HCL 100 MG/4ML IV SOLN	BOTH IP/OP	"$6,708.95 "	"$4,964.62"	$0.00	"$5,171.26"	"$3,019.03"	"$3,019.03"	"$1,907.60"	"$1,907.60"	"$1,907.60"	"$1,398.31"	"$4,979.38"	"$4,979.38"	"$5,171.26"	"$1,964.60"	"$2,308.29"	"$1,276.99"	"$3,307.51"	"$3,307.51"	"$2,399.15"	"$3,042.78"	"$4,819.76"	"$4,868.44"	"$3,313.11"		"$3,313.11"	"$2,553.28"	$0.00	$0.00	"$2,431.15"	"$2,284.90"	$0.00	$0.00	$0.00	$0.00
130073	ERX	HCPCS 25000001	50242-0130-01	ALECTINIB HCL 150 MG PO CAPS	BOTH IP/OP	$275.13 	$203.60	$0.00	$742.38		$0.00	$0.00	$0.00	$0.00	$0.00	$714.84	$714.84	$742.38	$0.00	$57.34	$0.00	$0.00	$0.00	$0.00	$121.25	$192.05	$193.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130409	ERX	HCPCS 25000001	00006-5423-12	SUGAMMADEX SODIUM 200 MG/2ML IV SOLN	BOTH IP/OP	$443.28 	$328.03	$0.00	$358.71		$0.00	$0.00	$0.00	$0.00	$0.00	$345.41	$345.41	$358.71	$0.00	$92.38	$0.00	$0.00	$0.00	$0.00	$191.64	$303.56	$306.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130411	ERX	HCPCS 25000001	00006-5423-15	SUGAMMADEX SODIUM 500 MG/5ML IV SOLN	BOTH IP/OP	$705.54 	$522.10	$0.00	$570.97	$333.34	$333.34	$0.00	$0.00	$0.00	$147.05	$549.78	$549.78	$570.97	$0.00	$147.03	$0.00	$417.33	$417.33	$0.00	$304.97	$483.06	$487.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130411	ERX	HCPCS 25000001	00006-5425-15	SUGAMMADEX SODIUM 500 MG/5ML IV SOLN	BOTH IP/OP	$705.54 	$522.10	$0.00	$570.97	$333.34	$333.34	$0.00	$0.00	$0.00	$147.05	$549.78	$549.78	$570.97	$0.00	$147.03	$0.00	$417.33	$417.33	$0.00	$304.97	$483.06	$487.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130462	ERX	HCPCS 63700001	63044-0150-05	PRENATAL VITAMIN PLUS LOW IRON 27-1 MG PO TABS	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130656	ERX	HCPCS 25000001	69468-0151-04	URIDINE TRIACETATE 10 G PO PACK	BOTH IP/OP	"$10,883.26 "	"$8,053.61"	$0.00	"$8,388.82"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,388.82"	$0.00	"$2,268.07"	$0.00	$0.00	$0.00	$0.00	"$4,935.99"	"$7,818.61"	"$7,897.58"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130656	ERX	HCPCS 25000001	69468-0151-20	URIDINE TRIACETATE 10 G PO PACK	BOTH IP/OP	"$10,883.26 "	"$8,053.61"	$0.00	"$8,388.82"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$8,388.82"	$0.00	"$2,268.07"	$0.00	$0.00	$0.00	$0.00	"$4,935.99"	"$7,818.61"	"$7,897.58"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130661	ERX	HCPCS 25000001	00006-3074-02	ELBASVIR-GRAZOPREVIR 50-100 MG PO TABS	BOTH IP/OP	$911.04 	$674.17	$0.00	$702.23		$0.00	$0.00	$0.00	$0.00	$0.00	$676.17	$676.17	$702.23	$0.00	$189.86	$0.00	$0.00	$0.00	$0.00	$413.40	$654.83	$661.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130884	ERX	HCPCS J2020	00009-4992-01	LINEZOLID 600 MG/300ML IV SOLN	BOTH IP/OP	$270.66 	$200.29	$0.00	$208.62		$0.00	$0.00	$0.00	$0.00	$0.00	$200.88	$200.88	$208.62	$0.00	$23.35	$0.00	$0.00	$0.00	$0.00	$122.85	$194.59	$196.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130884	ERX	HCPCS J2020	00009-4992-02	LINEZOLID 600 MG/300ML IV SOLN	BOTH IP/OP	$270.66 	$200.29	$0.00	$208.62		$0.00	$0.00	$0.00	$0.00	$0.00	$200.88	$200.88	$208.62	$0.00	$23.35	$0.00	$0.00	$0.00	$0.00	$122.85	$194.59	$196.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130884	ERX	HCPCS J2020	00009-5140-04	LINEZOLID 600 MG/300ML IV SOLN	BOTH IP/OP	$270.66 	$200.29	$0.00	$208.62		$0.00	$0.00	$0.00	$0.00	$0.00	$200.88	$200.88	$208.62	$0.00	$23.35	$0.00	$0.00	$0.00	$0.00	$122.85	$194.59	$196.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130884	ERX	HCPCS J2020	00781-3433-95	LINEZOLID 600 MG/300ML IV SOLN	BOTH IP/OP	$270.66 	$200.29	$0.00	$208.62		$0.00	$0.00	$0.00	$0.00	$0.00	$200.88	$200.88	$208.62	$0.00	$23.35	$0.00	$0.00	$0.00	$0.00	$122.85	$194.59	$196.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130884	ERX	HCPCS J2020	25021-0169-87	LINEZOLID 600 MG/300ML IV SOLN	BOTH IP/OP	$270.66 	$200.29	$0.00	$208.62		$0.00	$0.00	$0.00	$0.00	$0.00	$200.88	$200.88	$208.62	$0.00	$23.35	$0.00	$0.00	$0.00	$0.00	$122.85	$194.59	$196.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130884	ERX	HCPCS J2020	55150-0242-51	LINEZOLID 600 MG/300ML IV SOLN	BOTH IP/OP	$270.66 	$200.29	$0.00	$208.62		$0.00	$0.00	$0.00	$0.00	$0.00	$200.88	$200.88	$208.62	$0.00	$23.35	$0.00	$0.00	$0.00	$0.00	$122.85	$194.59	$196.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130884	ERX	HCPCS J2020	63323-0713-13	LINEZOLID 600 MG/300ML IV SOLN	BOTH IP/OP	$270.66 	$200.29	$0.00	$208.62		$0.00	$0.00	$0.00	$0.00	$0.00	$200.88	$200.88	$208.62	$0.00	$23.35	$0.00	$0.00	$0.00	$0.00	$122.85	$194.59	$196.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130886	ERX	HCPCS J9065	63323-0140-10	CLADRIBINE 10 MG/10ML IV SOLN	BOTH IP/OP	"$1,351.98 "	"$1,000.47"	$0.00	"$1,042.11"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,003.44"	"$1,003.44"	"$1,042.11"	$0.00	$211.77	$0.00	$0.00	$0.00	$0.00	$626.40	$992.22	"$1,002.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130887	ERX	HCPCS 25000001	00074-4382-20	CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN	BOTH IP/OP	"$1,040.69 "	$770.11	$0.00	$802.16		$0.00	$0.00	$0.00	$0.00	$0.00	$772.40	$772.40	$802.16	$0.00	$216.88	$0.00	$0.00	$0.00	$0.00	$472.23	$748.01	$755.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130887	ERX	HCPCS 25000001	00074-4382-93	CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN	BOTH IP/OP	"$1,040.69 "	$770.11	$0.00	$802.16		$0.00	$0.00	$0.00	$0.00	$0.00	$772.40	$772.40	$802.16	$0.00	$216.88	$0.00	$0.00	$0.00	$0.00	$472.23	$748.01	$755.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130897	ERX	HCPCS J1455	76310-0024-01	FOSCARNET SODIUM 6000 MG/250ML IV SOLN	BOTH IP/OP	"$1,469.18 "	"$1,087.19"	$0.00	"$1,132.44"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,090.43"	"$1,090.43"	"$1,132.44"	$0.00	$306.18	$0.00	$0.00	$0.00	$0.00	$680.70	"$1,078.23"	"$1,089.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130897	ERX	HCPCS J1455	76310-0024-11	FOSCARNET SODIUM 6000 MG/250ML IV SOLN	BOTH IP/OP	"$1,469.18 "	"$1,087.19"	$0.00	"$1,132.44"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,090.43"	"$1,090.43"	"$1,132.44"	$0.00	$306.18	$0.00	$0.00	$0.00	$0.00	$680.70	"$1,078.23"	"$1,089.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130897	ERX	HCPCS J1455	76310-0024-15	FOSCARNET SODIUM 6000 MG/250ML IV SOLN	BOTH IP/OP	"$1,469.18 "	"$1,087.19"	$0.00	"$1,132.44"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,090.43"	"$1,090.43"	"$1,132.44"	$0.00	$306.18	$0.00	$0.00	$0.00	$0.00	$680.70	"$1,078.23"	"$1,089.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130897	ERX	HCPCS J1455	76310-0024-25	FOSCARNET SODIUM 6000 MG/250ML IV SOLN	BOTH IP/OP	"$1,469.18 "	"$1,087.19"	$0.00	"$1,132.44"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,090.43"	"$1,090.43"	"$1,132.44"	$0.00	$306.18	$0.00	$0.00	$0.00	$0.00	$680.70	"$1,078.23"	"$1,089.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130900	ERX	HCPCS 25000001	00013-1114-21	TRANEXAMIC ACID 1000 MG/10ML IV SOLN	BOTH IP/OP	$141.05 	$104.38	$0.00	$151.20		$0.00	$0.00	$0.00	$0.00	$0.00	$104.69	$104.69	$108.72	$0.00	$29.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130900	ERX	HCPCS 25000001	39822-1000-01	TRANEXAMIC ACID 1000 MG/10ML IV SOLN	BOTH IP/OP	$141.05 	$104.38	$0.00	$151.20		$0.00	$0.00	$0.00	$0.00	$0.00	$104.69	$104.69	$108.72	$0.00	$29.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130900	ERX	HCPCS 25000001	39822-1001-06	TRANEXAMIC ACID 1000 MG/10ML IV SOLN	BOTH IP/OP	$141.05 	$104.38	$0.00	$151.20		$0.00	$0.00	$0.00	$0.00	$0.00	$104.69	$104.69	$108.72	$0.00	$29.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130900	ERX	HCPCS 25000001	39822-1001-07	TRANEXAMIC ACID 1000 MG/10ML IV SOLN	BOTH IP/OP	$141.05 	$104.38	$0.00	$151.20		$0.00	$0.00	$0.00	$0.00	$0.00	$104.69	$104.69	$108.72	$0.00	$29.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130900	ERX	HCPCS 25000001	47781-0601-91	TRANEXAMIC ACID 1000 MG/10ML IV SOLN	BOTH IP/OP	$141.05 	$104.38	$0.00	$151.20		$0.00	$0.00	$0.00	$0.00	$0.00	$104.69	$104.69	$108.72	$0.00	$29.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130900	ERX	HCPCS 25000001	55150-0188-10	TRANEXAMIC ACID 1000 MG/10ML IV SOLN	BOTH IP/OP	$141.05 	$104.38	$0.00	$151.20		$0.00	$0.00	$0.00	$0.00	$0.00	$104.69	$104.69	$108.72	$0.00	$29.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130900	ERX	HCPCS 25000001	63323-0563-10	TRANEXAMIC ACID 1000 MG/10ML IV SOLN	BOTH IP/OP	$141.05 	$104.38	$0.00	$151.20		$0.00	$0.00	$0.00	$0.00	$0.00	$104.69	$104.69	$108.72	$0.00	$29.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130900	ERX	HCPCS 25000001	67850-0042-10	TRANEXAMIC ACID 1000 MG/10ML IV SOLN	BOTH IP/OP	$141.05 	$104.38	$0.00	$151.20		$0.00	$0.00	$0.00	$0.00	$0.00	$104.69	$104.69	$108.72	$0.00	$29.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130900	ERX	HCPCS 25000001	70860-0400-10	TRANEXAMIC ACID 1000 MG/10ML IV SOLN	BOTH IP/OP	$141.05 	$104.38	$0.00	$151.20		$0.00	$0.00	$0.00	$0.00	$0.00	$104.69	$104.69	$108.72	$0.00	$29.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130900	ERX	HCPCS 25000001	70860-0400-41	TRANEXAMIC ACID 1000 MG/10ML IV SOLN	BOTH IP/OP	$141.05 	$104.38	$0.00	$151.20		$0.00	$0.00	$0.00	$0.00	$0.00	$104.69	$104.69	$108.72	$0.00	$29.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130905	ERX	HCPCS J2704	00409-4699-30	PROPOFOL 200 MG/20ML IV EMUL	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$6.11	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$17.35	$17.35	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$4.16	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$0.00
130905	ERX	HCPCS J2704	00409-4699-50	PROPOFOL 200 MG/20ML IV EMUL	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$6.11	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$17.35	$17.35	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$4.16	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$0.00
130905	ERX	HCPCS J2704	00591-2136-95	PROPOFOL 200 MG/20ML IV EMUL	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$6.11	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$17.35	$17.35	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$4.16	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$0.00
130905	ERX	HCPCS J2704	25021-0608-20	PROPOFOL 200 MG/20ML IV EMUL	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$6.11	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$17.35	$17.35	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$4.16	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$0.00
130905	ERX	HCPCS J2704	43598-0265-20	PROPOFOL 200 MG/20ML IV EMUL	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$6.11	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$17.35	$17.35	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$4.16	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$0.00
130905	ERX	HCPCS J2704	43598-0265-25	PROPOFOL 200 MG/20ML IV EMUL	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$6.11	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$17.35	$17.35	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$4.16	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$0.00
130905	ERX	HCPCS J2704	43598-0265-58	PROPOFOL 200 MG/20ML IV EMUL	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$6.11	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$17.35	$17.35	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$4.16	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$0.00
130905	ERX	HCPCS J2704	63323-0269-29	PROPOFOL 200 MG/20ML IV EMUL	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$6.11	$21.77	$21.77	$22.61	$0.00	$6.11	$0.00	$17.35	$17.35	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$4.16	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$0.00
131019	ERX	HCPCS 63700001	61958-2101-01	ODEFSEY:EMTRICIT-RILPIV-TENOFOV AF 200-25-25 MG TAB	BOTH IP/OP	$438.35 	$324.38	$0.00	$287.64		$0.00	$0.00	$0.00	$78.03	$0.00	$0.00	$0.00	$0.00	$0.00	$91.35	$0.00	$0.00	$0.00	$0.00	$179.78	$284.76	$287.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131430	ERX	HCPCS 25000001	00299-3921-08	CETAPHIL GENTLE CLEANSER EX LIQD	BOTH IP/OP	$26.82 	$19.85	$0.00	$20.67		$0.00	$0.00	$0.00	$0.00	$0.00	$19.91	$19.91	$20.67	$0.00	$5.59	$0.00	$0.00	$0.00	$0.00	$12.16	$19.26	$19.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131443	ERX	HCPCS J1815	00002-8824-27	INSULIN REGULAR HUMAN (CONC) 500 UNIT/ML SC SOPN	BOTH IP/OP	$15.00 	$11.10	$0.00	$302.08	$8.15	$8.15	$0.00	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$3.13	$0.00	$8.87	$8.87	$0.00	$7.50	$11.88	$12.00	$0.00		$0.00	$0.00	$0.00	$0.00	$302.08	$0.00	$0.00	$0.00	$0.00	$0.00
131448	ERX	HCPCS 63700001	50474-0470-66	BRIVARACETAM 25 MG PO TABS	BOTH IP/OP	$93.78 	$69.40	$0.00	$66.05		$0.00	$0.00	$0.00	$17.84	$0.00	$0.00	$0.00	$0.00	$0.00	$19.54	$0.00	$0.00	$0.00	$0.00	$41.28	$65.39	$66.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131449	ERX	HCPCS 25000001	50474-0570-09	BRIVARACETAM 50 MG PO TABS	BOTH IP/OP	$93.78 	$69.40	$0.00	$77.27		$0.00	$0.00	$0.00	$0.00	$0.00	$74.41	$74.41	$77.27	$0.00	$19.54	$0.00	$0.00	$0.00	$0.00	$41.28	$65.39	$66.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131451	ERX	HCPCS 25000001	50474-0770-09	BRIVARACETAM 100 MG PO TABS	BOTH IP/OP	$93.78 	$69.40	$0.00	$77.27		$0.00	$0.00	$0.00	$0.00	$0.00	$74.41	$74.41	$77.27	$0.00	$19.54	$0.00	$0.00	$0.00	$0.00	$41.28	$65.39	$66.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131458	ERX	HCPCS J2786	59310-0610-31	RESLIZUMAB 100 MG/10ML IV SOLN	BOTH IP/OP	"$2,682.17 "	"$1,984.81"	$0.00	"$2,067.42"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,990.71"	"$1,990.71"	"$2,067.42"	$0.00	"$1,188.40"	$0.00	$0.00	$0.00	$0.00	"$1,169.73"	"$1,815.83"	"$1,871.57"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131469	ERX	HCPCS J0330	62295-3323-07	SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
131499	ERX	HCPCS 63700001	61958-2002-01	DESCOVY:EMTRICITABINE-TENOFOVIR AF 200-25 MG TAB	BOTH IP/OP	$282.99 	$209.41	$0.00	$185.70		$0.00	$0.00	$0.00	$50.37	$0.00	$0.00	$0.00	$0.00	$0.00	$58.98	$0.00	$0.00	$0.00	$0.00	$116.07	$183.85	$185.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131521	ERX	HCPCS J7183	68982-0182-02	WILATE:ANTIHEMOPHILIC FACTOR-VWF 1000-1000 UNITS IV KIT	BOTH IP/OP	"$4,113.20 "	"$3,043.77"	$0.00	"$3,170.45"		$0.00	$0.00	$0.00	$0.00	$0.00	"$3,052.82"	"$3,052.82"	"$3,170.45"	$0.00	$857.19	$0.00	$0.00	$0.00	$0.00	"$1,722.00"	"$2,727.65"	"$2,755.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131529	ERX	HCPCS 25000001	00074-0576-22	VENETOCLAX 100 MG PO TABS	BOTH IP/OP	$433.72 	$320.95	$0.00	$349.36		$0.00	$0.00	$0.00	$0.00	$0.00	$336.39	$336.39	$349.36	$0.00	$90.39	$0.00	$0.00	$0.00	$0.00	$187.48	$296.97	$299.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131530	ERX	HCPCS 25000001	00074-0579-28	VENETOCLAX 10 & 50 & 100 MG PO TBPK	BOTH IP/OP	"$7,555.64 "	"$5,591.17"	$0.00	"$6,085.96"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,085.96"	$0.00	"$1,574.60"	$0.00	$0.00	$0.00	$0.00	$119.41	$189.14	$191.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131538	ERX	HCPCS 25000001	24571-0116-06	PHOXILLUM BK4/2.5 32-4-2.5-1 MEQ-MMOL/L IV SOLN	BOTH IP/OP	$252.00 	$186.48	$0.00	$201.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.00	$199.58	$201.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131594	ERX	HCPCS 63700001	42388-0024-26	CABOZANTINIB S-MALATE 20 MG PO TABS	BOTH IP/OP	"$2,244.27 "	"$1,660.76"	$0.00	"$1,547.63"		$0.00	$0.00	$0.00	$429.44	$0.00	$0.00	$0.00	$0.00	$0.00	$467.71	$0.00	$0.00	$0.00	$0.00	$967.27	"$1,532.16"	"$1,547.63"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131595	ERX	HCPCS 63700001	42388-0025-26	CABOZANTINIB S-MALATE 40 MG PO TABS	BOTH IP/OP	"$2,244.27 "	"$1,660.76"	$0.00	"$1,547.63"		$0.00	$0.00	$0.00	$429.44	$0.00	$0.00	$0.00	$0.00	$0.00	$467.71	$0.00	$0.00	$0.00	$0.00	$967.27	"$1,532.16"	"$1,547.63"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131596	ERX	HCPCS 63700001	42388-0023-26	CABOZANTINIB S-MALATE 60 MG PO TABS	BOTH IP/OP	"$2,244.27 "	"$1,660.76"	$0.00	"$1,547.63"		$0.00	$0.00	$0.00	$429.44	$0.00	$0.00	$0.00	$0.00	$0.00	$467.71	$0.00	$0.00	$0.00	$0.00	$967.27	"$1,532.16"	"$1,547.63"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131610	ERX	HCPCS 63700001	24510-0115-10	OXYCODONE ER 13.5 MG PO C12A	BOTH IP/OP	$39.84 	$29.48	$0.00	$26.30		$0.00	$0.00	$0.00	$7.79	$0.00	$0.00	$0.00	$0.00	$0.00	$8.30	$0.00	$0.00	$0.00	$0.00	$16.44	$26.04	$26.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131700	ERX	HCPCS J9022	50242-0917-01	ATEZOLIZUMAB 1200 MG/20ML IV SOLN	BOTH IP/OP	"$25,682.24 "	"$19,004.86"	$0.00	"$20,587.71"	"$12,019.29"	"$12,019.29"	"$9,549.12"	"$9,549.12"	"$9,549.12"	"$5,352.82"	"$19,823.82"	"$19,823.82"	"$20,587.71"	"$9,569.88"	"$11,244.61"	"$6,220.42"	"$12,661.34"	"$12,661.34"	"$9,703.01"	"$11,308.67"	"$17,912.93"	"$18,093.86"	"$13,399.39"		"$13,399.39"	"$8,138.89"	$0.00	$0.00	"$8,138.89"	"$9,240.96"	$0.00	$0.00	$0.00	$0.00
131713	ERX	HCPCS 63700001	62856-0708-05	LENVATINIB (8 MG DAILY DOSE) 2 X 4 MG PO CPPK	BOTH IP/OP	"$1,189.20 "	$880.01	$0.00	"$1,460.82"		$0.00	$0.00	$0.00	$217.49	$0.00	$0.00	$0.00	$0.00	$0.00	$247.83	$0.00	$0.00	$0.00	$0.00	$913.01	"$1,446.21"	"$1,460.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131713	ERX	HCPCS 63700001	62856-0708-30	LENVATINIB (8 MG DAILY DOSE) 2 X 4 MG PO CPPK	BOTH IP/OP	"$1,189.20 "	$880.01	$0.00	"$1,460.82"		$0.00	$0.00	$0.00	$217.49	$0.00	$0.00	$0.00	$0.00	$0.00	$247.83	$0.00	$0.00	$0.00	$0.00	$913.01	"$1,446.21"	"$1,460.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131714	ERX	HCPCS 63700001	62856-0718-05	LENVATINIB (18 MG DAILY DOSE) 10 MG & 2 X 4 MG PO CPPK	BOTH IP/OP	$792.81 	$586.68	$0.00	$537.66		$0.00	$0.00	$0.00	$144.99	$0.00	$0.00	$0.00	$0.00	$0.00	$165.22	$0.00	$0.00	$0.00	$0.00	$336.04	$532.29	$537.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131714	ERX	HCPCS 63700001	62856-0718-30	LENVATINIB (18 MG DAILY DOSE) 10 MG & 2 X 4 MG PO CPPK	BOTH IP/OP	$792.81 	$586.68	$0.00	$537.66		$0.00	$0.00	$0.00	$144.99	$0.00	$0.00	$0.00	$0.00	$0.00	$165.22	$0.00	$0.00	$0.00	$0.00	$336.04	$532.29	$537.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131923	ERX	HCPCS 25000001	00781-3269-71	EPHEDRINE SULFATE 50 MG/ML IV SOLN	BOTH IP/OP	$25.35 	$18.76	$0.00	$20.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.68	$20.08	$20.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131923	ERX	HCPCS 25000001	00781-3269-95	EPHEDRINE SULFATE 50 MG/ML IV SOLN	BOTH IP/OP	$25.35 	$18.76	$0.00	$20.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.68	$20.08	$20.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131923	ERX	HCPCS 25000001	42023-0216-25	EPHEDRINE SULFATE 50 MG/ML IV SOLN	BOTH IP/OP	$25.35 	$18.76	$0.00	$20.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.68	$20.08	$20.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131923	ERX	HCPCS 25000001	76014-0005-25	EPHEDRINE SULFATE 50 MG/ML IV SOLN	BOTH IP/OP	$25.35 	$18.76	$0.00	$20.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.68	$20.08	$20.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131923	ERX	HCPCS 25000001	76014-0005-30	EPHEDRINE SULFATE 50 MG/ML IV SOLN	BOTH IP/OP	$25.35 	$18.76	$0.00	$20.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.68	$20.08	$20.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132039	ERX	HCPCS J9047	76075-0102-01	CARFILZOMIB 30 MG IV SOLR	BOTH IP/OP	"$3,497.29 "	"$2,587.99"	$0.00	"$2,854.76"	"$1,666.63"	"$1,666.63"	"$1,233.33"	"$1,233.33"	"$1,233.33"	$728.92	"$2,748.83"	"$2,748.83"	"$2,854.76"	"$1,233.09"	"$1,448.88"	$801.51	"$1,724.16"	"$1,724.16"	"$1,184.37"	"$1,497.79"	"$2,372.49"	"$2,396.46"	"$1,635.56"		"$1,635.56"	"$1,323.29"	$0.00	$0.00	"$1,259.99"	"$1,169.16"	$0.00	$0.00	$0.00	$0.00
132135	ERX	HCPCS 63700001	72626-2701-01	(EPCLUSA) SOFOSBUVIR-VELPATASVIR 400-100 MG PO TABS	BOTH IP/OP	"$1,001.15 "	$740.85	$0.00	$726.86		$0.00	$0.00	$0.00	$178.20	$0.00	$0.00	$0.00	$0.00	$0.00	$208.64	$0.00	$0.00	$0.00	$0.00	$454.29	$719.60	$726.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132336	ERX	HCPCS 25000001	00310-4600-39	BEVESPI:GLYCOPYRROLATE-FORMOTEROL 9-4.8 MCG/ACT IN AERO	BOTH IP/OP	"$1,354.27 "	"$1,002.16"	$0.00	"$1,043.87"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,005.14"	"$1,005.14"	"$1,043.87"	$0.00	$282.23	$0.00	$0.00	$0.00	$0.00	$609.17	$964.92	$974.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132337	ERX	HCPCS 90674	70461-0320-04	INFLUENZA VAC SUBUNIT QUAD 0.5 ML IM SUSY	BOTH IP/OP	$107.69 	$79.69	$0.00	$86.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.72	$53.85	$85.29	$86.15	$15.72		$15.72	$16.85	$28.00	$28.00	$17.14	$28.00	$0.00	$0.00	$0.00	$0.00
132344	ERX	HCPCS 25000001	00065-0426-36	GENTEAL TEARS 0.1-0.2-0.3 % OP SOLN	BOTH IP/OP	$30.17 	$22.33	$0.00	$23.26		$0.00	$0.00	$0.00	$0.00	$0.00	$22.39	$22.39	$23.26	$0.00	$6.29	$0.00	$0.00	$0.00	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132344	ERX	HCPCS 25000001	00065-0426-37	GENTEAL TEARS 0.1-0.2-0.3 % OP SOLN	BOTH IP/OP	$30.17 	$22.33	$0.00	$23.26		$0.00	$0.00	$0.00	$0.00	$0.00	$22.39	$22.39	$23.26	$0.00	$6.29	$0.00	$0.00	$0.00	$0.00	$13.68	$21.67	$21.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132810	ERX	HCPCS 25800001	63323-0820-74	FAT EMUL FISH OIL/PLANT BASED 20 % IV EMUL	BOTH IP/OP	$158.26 	$117.11	$0.00	$121.99		$0.00	$0.00	$0.00	$0.00	$0.00	$117.46	$117.46	$121.99	$0.00	$32.98	$0.00	$0.00	$0.00	$0.00	$54.69	$86.63	$87.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132810	ERX	HCPCS 25800001	63323-0820-50	FAT EMUL FISH OIL/PLANT BASED 20 % IV EMUL	BOTH IP/OP	$158.26 	$117.11	$0.00	$121.99		$0.00	$0.00	$0.00	$0.00	$0.00	$117.46	$117.46	$121.99	$0.00	$32.98	$0.00	$0.00	$0.00	$0.00	$54.69	$113.65	$87.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132815	ERX	HCPCS J3490	00517-0374-01	METHYLENE BLUE 50 MG/10ML IV SOLN	BOTH IP/OP	$833.84 	$617.04	$0.00	$703.40	$410.65	$410.65	$0.00	$0.00	$0.00	$173.79	$677.30	$677.30	$703.40	$0.00	$173.77	$0.00	$493.22	$493.22	$0.00	$378.37	$599.34	$605.39	$0.00		$0.00	$118.43	$0.00	$0.00	$120.47	$0.00	$0.00	$0.00	$0.00	$0.00
132815	ERX	HCPCS J3490	00517-0374-05	METHYLENE BLUE 50 MG/10ML IV SOLN	BOTH IP/OP	$833.84 	$617.04	$0.00	$703.40	$410.65	$410.65	$0.00	$0.00	$0.00	$173.79	$677.30	$677.30	$703.40	$0.00	$173.77	$0.00	$493.22	$493.22	$0.00	$378.37	$599.34	$605.39	$0.00		$0.00	$118.43	$0.00	$0.00	$120.47	$0.00	$0.00	$0.00	$0.00	$0.00
132818	ERX	HCPCS J2400	00143-9210-01	CHLOROPROCAINE HCL (PF) 3 % IJ SOLN	BOTH IP/OP	$103.68 	$76.72	$0.00	$79.92		$0.00	$0.00	$0.00	$0.00	$0.00	$76.95	$76.95	$79.92	$0.00	$21.61	$0.00	$0.00	$0.00	$0.00	$47.01	$74.46	$75.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132818	ERX	HCPCS J2400	00143-9210-10	CHLOROPROCAINE HCL (PF) 3 % IJ SOLN	BOTH IP/OP	$103.68 	$76.72	$0.00	$79.92		$0.00	$0.00	$0.00	$0.00	$0.00	$76.95	$76.95	$79.92	$0.00	$21.61	$0.00	$0.00	$0.00	$0.00	$47.01	$74.46	$75.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132818	ERX	HCPCS J2400	63323-0478-27	CHLOROPROCAINE HCL (PF) 3 % IJ SOLN	BOTH IP/OP	$103.68 	$76.72	$0.00	$79.92		$0.00	$0.00	$0.00	$0.00	$0.00	$76.95	$76.95	$79.92	$0.00	$21.61	$0.00	$0.00	$0.00	$0.00	$47.01	$74.46	$75.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132822	ERX	HCPCS J3246	25208-0002-02	TIROFIBAN HCL IN NACL 12.5-0.9 MG/250ML-% IV SOLN	BOTH IP/OP	$837.31 	$619.61	$0.00	$645.40		$0.00	$0.00	$0.00	$0.00	$0.00	$621.45	$621.45	$645.40	$0.00	$174.50	$0.00	$0.00	$0.00	$0.00	$379.95	$601.83	$607.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132824	ERX	HCPCS J2310	00409-1219-01	NALOXONE HCL 4 MG/10ML IJ SOLN	BOTH IP/OP	$478.77 	$354.29	$0.00	$369.04	$215.45	$215.45	$0.00	$0.00	$0.00	$17.48	$355.34	$355.34	$369.04	$0.00	$51.39	$0.00	$283.19	$283.19	$0.00	$217.30	$344.20	$347.68	$0.00		$0.00	$62.42	$0.00	$0.00	$59.43	$0.00	$0.00	$0.00	$0.00	$0.00
132824	ERX	HCPCS J2310	17478-0042-10	NALOXONE HCL 4 MG/10ML IJ SOLN	BOTH IP/OP	$478.77 	$354.29	$0.00	$369.04	$215.45	$215.45	$0.00	$0.00	$0.00	$17.48	$355.34	$355.34	$369.04	$0.00	$51.39	$0.00	$283.19	$283.19	$0.00	$217.30	$344.20	$347.68	$0.00		$0.00	$62.42	$0.00	$0.00	$59.43	$0.00	$0.00	$0.00	$0.00	$0.00
132824	ERX	HCPCS J2310	67457-0299-10	NALOXONE HCL 4 MG/10ML IJ SOLN	BOTH IP/OP	$478.77 	$354.29	$0.00	$369.04	$215.45	$215.45	$0.00	$0.00	$0.00	$17.48	$355.34	$355.34	$369.04	$0.00	$51.39	$0.00	$283.19	$283.19	$0.00	$217.30	$344.20	$347.68	$0.00		$0.00	$62.42	$0.00	$0.00	$59.43	$0.00	$0.00	$0.00	$0.00	$0.00
132826	ERX	HCPCS J7195	58394-0633-03	COAGULATION FACTOR IX (RECOMB) 250 UNITS IV KIT	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132827	ERX	HCPCS J7195	58394-0634-03	COAGULATION FACTOR IX (RECOMB) 500 UNITS IV KIT	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132828	ERX	HCPCS J7195	58394-0635-03	COAGULATION FACTOR IX (RECOMB BENEFIX) 1000 UNITS IV KIT	BOTH IP/OP	"$3,706.40 "	"$2,742.74"	$0.00	"$2,856.89"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,750.89"	"$2,750.89"	"$2,856.89"	$0.00	$772.41	$0.00	$0.00	$0.00	$0.00	"$1,681.00"	"$2,662.70"	"$2,689.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132829	ERX	HCPCS J7195	58394-0636-03	COAGULATION FACTOR IX (RECOMB) 2000 UNITS IV KIT	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132871	ERX	HCPCS 63700001	65649-0150-90	METHYLNALTREXONE BROMIDE 150 MG PO TABS	BOTH IP/OP	$112.06 	$82.92	$0.00	$69.82		$0.00	$0.00	$0.00	$19.95	$0.00	$0.00	$0.00	$0.00	$0.00	$23.35	$0.00	$0.00	$0.00	$0.00	$43.64	$69.12	$69.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
133343	ERX	HCPCS 25000001	61703-0421-53	M.V.I. PEDIATRIC IV SOLR	BOTH IP/OP	$28.73 	$21.26	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.37	$22.75	$22.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
133367	ERX	HCPCS J3358	57894-0054-27	USTEKINUMAB 130 MG/26ML IV SOLN	BOTH IP/OP	"$4,770.32 "	"$3,530.04"	$0.00	"$3,875.52"	"$2,262.56"	"$2,262.56"	"$1,509.95"	"$1,509.95"	"$1,509.95"	$994.25	"$3,731.72"	"$3,731.72"	"$3,875.52"	"$1,518.40"	"$1,784.12"	$986.96	"$2,351.77"	"$2,351.77"	"$1,643.05"	"$2,064.45"	"$3,270.08"	"$3,303.11"	"$2,268.97"		"$2,268.97"	"$1,822.31"	$0.00	$0.00	"$1,735.15"	"$1,564.81"	$0.00	$0.00	$0.00	$0.00
133767	ERX	HCPCS 63700001	59310-0302-40	BECLOMETHASONE DIPROP HFA 40 MCG/ACT IN AERB	BOTH IP/OP	$699.80 	$517.85	$0.00	$483.90		$0.00	$0.00	$0.00	$124.56	$0.00	$0.00	$0.00	$0.00	$0.00	$145.84	$0.00	$0.00	$0.00	$0.00	$302.44	$479.06	$483.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
133768	ERX	HCPCS 63700001	59310-0304-80	BECLOMETHASONE DIPROP HFA 80 MCG/ACT IN AERB	BOTH IP/OP	$937.01 	$693.39	$0.00	$647.92		$0.00	$0.00	$0.00	$166.79	$0.00	$0.00	$0.00	$0.00	$0.00	$195.27	$0.00	$0.00	$0.00	$0.00	$404.95	$641.44	$647.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
133781	ERX	HCPCS Q5103	00069-0809-01	INFLIXIMAB-DYYB 100 MG IV SOLR	BOTH IP/OP	"$2,566.33 "	"$1,899.08"	$0.00	"$1,978.13"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,904.73"	"$1,904.73"	"$1,978.13"	$0.00	$534.82	$0.00	$0.00	$0.00	$0.00	"$1,163.93"	"$1,843.67"	"$1,862.29"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
133797	ERX	HCPCS J7999	42852-0862-25	NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN	BOTH IP/OP	$190.85 	$141.23	$0.00	$147.11		$0.00	$0.00	$0.00	$0.00	$0.00	$141.65	$141.65	$147.11	$0.00	$39.77	$0.00	$0.00	$0.00	$0.00	$86.63	$137.21	$138.60	$0.00		$0.00	$27.11	$0.00	$0.00	$27.58	$0.00	$0.00	$0.00	$0.00	$0.00
133797	ERX	HCPCS J7999	70324-0676-01	NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN	BOTH IP/OP	$190.85 	$141.23	$0.00	$147.11		$0.00	$0.00	$0.00	$0.00	$0.00	$141.65	$141.65	$147.11	$0.00	$39.77	$0.00	$0.00	$0.00	$0.00	$86.63	$137.21	$138.60	$0.00		$0.00	$27.11	$0.00	$0.00	$27.58	$0.00	$0.00	$0.00	$0.00	$0.00
133797	ERX	HCPCS J7999	76154-0475-15	NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN	BOTH IP/OP	$190.85 	$141.23	$0.00	$147.11		$0.00	$0.00	$0.00	$0.00	$0.00	$141.65	$141.65	$147.11	$0.00	$39.77	$0.00	$0.00	$0.00	$0.00	$86.63	$137.21	$138.60	$0.00		$0.00	$27.11	$0.00	$0.00	$27.58	$0.00	$0.00	$0.00	$0.00	$0.00
133797	ERX	HCPCS J7999	99999-6011-03	NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN	BOTH IP/OP	$190.85 	$141.23	$0.00	$147.11		$0.00	$0.00	$0.00	$0.00	$0.00	$141.65	$141.65	$147.11	$0.00	$39.77	$0.00	$0.00	$0.00	$0.00	$86.63	$137.21	$138.60	$0.00		$0.00	$27.11	$0.00	$0.00	$27.58	$0.00	$0.00	$0.00	$0.00	$0.00
133838	ERX	HCPCS J7296	50419-0424-01	LEVONORGESTREL 19.5 MG IU IUD	BOTH IP/OP	"$2,710.06 "	"$2,005.44"	$0.00	"$2,193.35"	"$1,280.50"	"$1,280.50"	$0.00	$0.00	$915.37	$564.84	"$2,111.97"	"$2,111.97"	"$2,193.35"	$0.00	"$1,174.15"	$0.00	"$1,336.06"	"$1,336.06"	$0.00	"$1,172.82"	"$1,857.75"	"$1,876.51"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
134020	ERX	HCPCS J9285	00002-8926-01	OLARATUMAB 500 MG/50ML IV SOLN	BOTH IP/OP	"$6,041.76 "	"$4,470.90"	$0.00	"$4,833.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,020.88"	"$4,785.07"	"$4,833.41"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
134049	ERX	HCPCS J3246	25208-0001-04	TIROFIBAN HCL 3.75 MG/15ML IV CONC	BOTH IP/OP	$233.19 	$172.56	$0.00	$179.74		$0.00	$0.00	$0.00	$0.00	$0.00	$173.07	$173.07	$179.74	$0.00	$48.60	$0.00	$0.00	$0.00	$0.00	$105.84	$167.65	$169.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
134129	ERX	HCPCS 63700001	61958-2301-01	TENOFOVIR ALAFENAMIDE FUMARATE 25 MG PO TABS	BOTH IP/OP	$180.13 	$133.30	$0.00	$131.34		$0.00	$0.00	$0.00	$32.06	$0.00	$0.00	$0.00	$0.00	$0.00	$37.54	$0.00	$0.00	$0.00	$0.00	$82.09	$130.02	$131.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
134529	ERX	HCPCS 25000001	62530-0000-11	UREA 15 G PO PACK	BOTH IP/OP	$17.60 	$13.02	$0.00	$13.57		$0.00	$0.00	$0.00	$0.00	$0.00	$13.06	$13.06	$13.57	$0.00	$3.67	$0.00	$0.00	$0.00	$0.00	$7.98	$12.64	$12.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
134557	ERX	HCPCS 63600001	69660-0201-91	RUCAPARIB CAMSYLATE 200 MG PO TABS	BOTH IP/OP	$583.64 	$431.89	$0.00	$449.87		$0.00	$0.00	$0.00	$0.00	$0.00	$433.18	$433.18	$449.87	$0.00	$121.63	$0.00	$0.00	$0.00	$0.00	$254.71	$403.46	$407.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
134558	ERX	HCPCS 63600001	69660-0203-91	RUCAPARIB CAMSYLATE 300 MG PO TABS	BOTH IP/OP	$583.64 	$431.89	$0.00	$449.87		$0.00	$0.00	$0.00	$0.00	$0.00	$433.18	$433.18	$449.87	$0.00	$121.63	$0.00	$0.00	$0.00	$0.00	$254.71	$403.46	$407.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
134827	ERX	HCPCS J7999	71285-6044-01	OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN	BOTH IP/OP	$53.55 	$39.63	$0.00	$41.28		$0.00	$0.00	$0.00	$0.00	$0.00	$39.74	$39.74	$41.28	$0.00	$11.16	$0.00	$0.00	$0.00	$0.00	$24.29	$38.47	$38.86	$0.00		$0.00	$7.60	$0.00	$0.00	$7.73	$0.00	$0.00	$0.00	$0.00	$0.00
134827	ERX	HCPCS J7999	99999-6006-08	OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN	BOTH IP/OP	$53.55 	$39.63	$0.00	$41.28		$0.00	$0.00	$0.00	$0.00	$0.00	$39.74	$39.74	$41.28	$0.00	$11.16	$0.00	$0.00	$0.00	$0.00	$24.29	$38.47	$38.86	$0.00		$0.00	$7.60	$0.00	$0.00	$7.73	$0.00	$0.00	$0.00	$0.00	$0.00
134890	ERX	HCPCS 25000001	00283-0679-02	BENZOCAINE 20 % MT AERO	BOTH IP/OP	$116.62 	$86.30	$0.00	$113.96		$0.00	$0.00	$0.00	$0.00	$0.00	$86.56	$86.56	$89.89	$0.00	$24.30	$0.00	$0.00	$0.00	$0.00	$71.23	$112.82	$113.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
134890	ERX	HCPCS 25000001	00283-0679-60	BENZOCAINE 20 % MT AERO	BOTH IP/OP	$116.62 	$86.30	$0.00	$113.96		$0.00	$0.00	$0.00	$0.00	$0.00	$86.56	$86.56	$89.89	$0.00	$24.30	$0.00	$0.00	$0.00	$0.00	$71.23	$112.82	$113.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
134897	ERX	HCPCS 25000001	63323-0170-05	SODIUM PHOSPHATES 15 MMOLE/5ML IV SOLN	BOTH IP/OP	$81.17 	$60.07	$0.00	$62.57		$0.00	$0.00	$0.00	$0.00	$0.00	$60.24	$60.24	$62.57	$0.00	$16.92	$0.00	$0.00	$0.00	$0.00	$36.81	$58.30	$58.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
134898	ERX	HCPCS 25000001	00409-7391-72	SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN	BOTH IP/OP	$152.92 	$113.16	$0.00	$117.87		$0.00	$0.00	$0.00	$0.00	$0.00	$113.50	$113.50	$117.87	$0.00	$31.87	$0.00	$0.00	$0.00	$0.00	$69.33	$109.82	$110.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
134898	ERX	HCPCS 25000001	63323-0170-15	SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN	BOTH IP/OP	$152.92 	$113.16	$0.00	$117.87		$0.00	$0.00	$0.00	$0.00	$0.00	$113.50	$113.50	$117.87	$0.00	$31.87	$0.00	$0.00	$0.00	$0.00	$69.33	$109.82	$110.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
134923	ERX	HCPCS J0461	00409-1630-10	ATROPINE SULFATE 1 MG/10ML IJ SOSY	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$0.89	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.94	$0.00	$0.00	$0.90	$0.00	$0.00	$0.00	$0.00	$0.00
134923	ERX	HCPCS J0461	00409-1630-15	ATROPINE SULFATE 1 MG/10ML IJ SOSY	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$0.89	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.94	$0.00	$0.00	$0.90	$0.00	$0.00	$0.00	$0.00	$0.00
134923	ERX	HCPCS J0461	00409-4911-11	ATROPINE SULFATE 1 MG/10ML IJ SOSY	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$0.89	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.94	$0.00	$0.00	$0.90	$0.00	$0.00	$0.00	$0.00	$0.00
134923	ERX	HCPCS J0461	00409-4911-34	ATROPINE SULFATE 1 MG/10ML IJ SOSY	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$0.89	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.94	$0.00	$0.00	$0.90	$0.00	$0.00	$0.00	$0.00	$0.00
134923	ERX	HCPCS J0461	76329-3339-01	ATROPINE SULFATE 1 MG/10ML IJ SOSY	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$0.89	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.94	$0.00	$0.00	$0.90	$0.00	$0.00	$0.00	$0.00	$0.00
134969	ERX	HCPCS J0461	00641-6006-01	ATROPINE SULFATE 8 MG/20ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$1.79	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.88	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$0.00
134969	ERX	HCPCS J0461	00641-6006-10	ATROPINE SULFATE 8 MG/20ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$1.79	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.88	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$0.00
135137	ERX	HCPCS 25000001	00121-1971-00	ACETAMINOPHEN 650 MG/20.3ML PO SOLN	BOTH IP/OP	$10.21 	$7.56	$0.00	$7.87		$0.00	$0.00	$0.00	$0.00	$0.00	$7.58	$7.58	$7.87	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$4.63	$7.33	$7.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
135137	ERX	HCPCS 25000001	00121-1971-21	ACETAMINOPHEN 650 MG/20.3ML PO SOLN	BOTH IP/OP	$10.21 	$7.56	$0.00	$7.87		$0.00	$0.00	$0.00	$0.00	$0.00	$7.58	$7.58	$7.87	$0.00	$2.13	$0.00	$0.00	$0.00	$0.00	$4.63	$7.33	$7.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
135307	ERX	HCPCS J9285	00002-7190-01	OLARATUMAB 190 MG/19ML IV SOLN	BOTH IP/OP	"$2,295.87 "	"$1,698.94"	$0.00	"$1,836.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,147.94"	"$1,818.33"	"$1,836.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
135334	ERX	HCPCS 25000001	61938-0456-03	CALFACTANT IN NACL 35-0.9 MG/ML-% INTRATRACHEA SUSP	BOTH IP/OP	"$1,412.54 "	"$1,045.28"	$0.00	"$1,088.79"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,048.39"	"$1,048.39"	"$1,088.79"	$0.00	$294.37	$0.00	$0.00	$0.00	$0.00	$617.40	$977.96	$987.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
135357	ERX	HCPCS 25000001	70183-0125-84	TELOTRISTAT ETHYL(AS ETIPRATE) 250 MG PO TABS	BOTH IP/OP	$295.16 	$218.42	$0.00	$236.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.58	$233.77	$236.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
135365	ERX	HCPCS 25000001	49348-0274-72	SM DOUBLE ANTIBIOTIC 500-10000 UNIT/GM EX OINT	BOTH IP/OP	$13.93 	$10.31	$0.00	$10.74		$0.00	$0.00	$0.00	$0.00	$0.00	$10.34	$10.34	$10.74	$0.00	$2.90	$0.00	$0.00	$0.00	$0.00	$6.32	$10.00	$10.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
135444	ERX	HCPCS 25000001	51754-1006-01	NITROPRUSSIDE SODIUM-NACL 50-0.9 MG/100ML-% IV SOLN	BOTH IP/OP	$229.02 	$169.47	$0.00	$176.53		$0.00	$0.00	$0.00	$0.00	$0.00	$169.98	$169.98	$176.53	$0.00	$47.73	$0.00	$0.00	$0.00	$0.00	$103.95	$164.66	$166.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
135513	ERX	HCPCS C9399	44087-3535-01	AVELUMAB 200 MG/10ML IV SOLN	BOTH IP/OP	"$4,617.41 "	"$3,416.88"	$0.00	"$3,612.48"	"$2,109.00"	"$2,109.00"	$0.00	$0.00	$834.23	$962.38	"$3,478.44"	"$3,478.44"	"$3,612.48"	$0.00	$962.27	$0.00	"$2,276.38"	"$2,276.38"	$0.00	"$2,022.78"	"$3,204.08"	"$3,236.45"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
135585	ERX	HCPCS J2260	00143-9719-01	MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN	BOTH IP/OP	$143.21 	$105.98	$0.00	$110.39	$64.44	$64.44	$0.00	$0.00	$0.00	$29.85	$106.29	$106.29	$110.39	$0.00	$8.87	$0.00	$84.71	$84.71	$0.00	$60.73	$96.19	$97.16	$0.00		$0.00	$7.19	$0.00	$0.00	$6.85	$0.00	$0.00	$0.00	$0.00	$0.00
135585	ERX	HCPCS J2260	00143-9719-10	MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN	BOTH IP/OP	$143.21 	$105.98	$0.00	$110.39	$64.44	$64.44	$0.00	$0.00	$0.00	$29.85	$106.29	$106.29	$110.39	$0.00	$8.87	$0.00	$84.71	$84.71	$0.00	$60.73	$96.19	$97.16	$0.00		$0.00	$7.19	$0.00	$0.00	$6.85	$0.00	$0.00	$0.00	$0.00	$0.00
135585	ERX	HCPCS J2260	00338-6010-48	MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN	BOTH IP/OP	$143.21 	$105.98	$0.00	$110.39	$64.44	$64.44	$0.00	$0.00	$0.00	$29.85	$106.29	$106.29	$110.39	$0.00	$8.87	$0.00	$84.71	$84.71	$0.00	$60.73	$96.19	$97.16	$0.00		$0.00	$7.19	$0.00	$0.00	$6.85	$0.00	$0.00	$0.00	$0.00	$0.00
135585	ERX	HCPCS J2260	00409-2776-23	MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN	BOTH IP/OP	$143.21 	$105.98	$0.00	$110.39	$64.44	$64.44	$0.00	$0.00	$0.00	$29.85	$106.29	$106.29	$110.39	$0.00	$8.87	$0.00	$84.71	$84.71	$0.00	$60.73	$96.19	$97.16	$0.00		$0.00	$7.19	$0.00	$0.00	$6.85	$0.00	$0.00	$0.00	$0.00	$0.00
135586	ERX	HCPCS 25000001	00065-0092-65	FLUORESCEIN SODIUM 10 % IV SOLN	BOTH IP/OP	$38.24 	$28.30	$0.00	$29.48		$0.00	$0.00	$0.00	$0.00	$0.00	$28.38	$28.38	$29.48	$0.00	$7.97	$0.00	$0.00	$0.00	$0.00	$17.34	$27.47	$27.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
135586	ERX	HCPCS 25000001	17478-0253-10	FLUORESCEIN SODIUM 10 % IV SOLN	BOTH IP/OP	$38.24 	$28.30	$0.00	$29.48		$0.00	$0.00	$0.00	$0.00	$0.00	$28.38	$28.38	$29.48	$0.00	$7.97	$0.00	$0.00	$0.00	$0.00	$17.34	$27.47	$27.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
135587	ERX	HCPCS 25000001	17478-0250-20	FLUORESCEIN SODIUM 25 % IV SOLN	BOTH IP/OP	$176.12 	$130.33	$0.00	$135.75		$0.00	$0.00	$0.00	$0.00	$0.00	$130.72	$130.72	$135.75	$0.00	$36.70	$0.00	$0.00	$0.00	$0.00	$79.85	$126.48	$127.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
135612	ERX	HCPCS J2350	50242-0150-01	OCRELIZUMAB 300 MG/10ML IV SOLN	BOTH IP/OP	"$46,186.47 "	"$34,177.99"	$0.00	"$37,202.57"	"$21,719.20"	"$21,719.20"	"$17,672.10"	"$17,672.10"	"$17,672.10"	"$9,417.94"	"$35,822.19"	"$35,822.19"	"$37,202.57"	"$17,487.30"	"$20,547.58"	"$11,366.75"	"$22,769.93"	"$22,769.93"	"$18,086.36"	"$19,987.50"	"$31,660.20"	"$31,980.00"	"$24,976.40"		"$24,976.40"	"$8,138.89"	$0.00	$0.00	"$8,138.89"	"$17,225.10"	$0.00	$0.00	$0.00	$0.00
136063	ERX	HCPCS J8999	00069-0193-01	BOSUTINIB 400 MG PO TABS	BOTH IP/OP	"$1,798.68 "	"$1,331.02"	$0.00	"$1,386.42"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,334.98"	"$1,334.98"	"$1,386.42"	$0.00	$374.84	$0.00	$0.00	$0.00	$0.00	$752.31	"$1,191.65"	"$1,203.69"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
136139	ERX	HCPCS 63700001	69656-0103-90	NIRAPARIB TOSYLATE 100 MG PO CAPS	BOTH IP/OP	$591.01 	$437.35	$0.00	$468.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.08	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
136459	ERX	HCPCS J9355	50242-0132-01	TRASTUZUMAB 150 MG IV SOLR	BOTH IP/OP	"$4,226.43 "	"$3,127.56"	$0.00	"$3,257.73"	"$1,901.89"	"$1,901.89"	"$1,296.15"	"$1,296.15"	"$1,296.15"	"$1,086.41"	"$3,136.86"	"$3,136.86"	"$3,257.73"	"$1,347.17"	"$1,582.92"	$875.66	"$2,083.63"	"$2,083.63"	"$1,679.30"	"$1,916.86"	"$3,036.30"	"$3,066.97"	"$2,319.03"		"$2,319.03"	"$1,865.78"	$0.00	$0.00	"$1,776.54"	"$1,534.76"	$0.00	$0.00	$0.00	$0.00
136518	ERX	HCPCS 63700001	00078-0698-51	MIDOSTAURIN 25 MG PO CAPS	BOTH IP/OP	"$1,184.06 "	$876.20	$0.00	$814.85		$0.00	$0.00	$0.00	$222.36	$0.00	$0.00	$0.00	$0.00	$0.00	$246.76	$0.00	$0.00	$0.00	$0.00	$509.28	$806.70	$814.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
136518	ERX	HCPCS 63700001	00078-0698-99	MIDOSTAURIN 25 MG PO CAPS	BOTH IP/OP	"$1,184.06 "	$876.20	$0.00	$814.85		$0.00	$0.00	$0.00	$222.36	$0.00	$0.00	$0.00	$0.00	$0.00	$246.76	$0.00	$0.00	$0.00	$0.00	$509.28	$806.70	$814.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
136524	ERX	HCPCS J9173	00310-4500-12	DURVALUMAB 120 MG/2.4ML IV SOLN	BOTH IP/OP	"$2,457.60 "	"$1,818.62"	$0.00	"$1,894.32"	"$1,105.92"	"$1,105.92"	$922.31	$922.31	$922.31	$512.23	"$1,824.03"	"$1,824.03"	"$1,894.32"	$922.36	"$1,083.77"	$599.53	"$1,211.60"	"$1,211.60"	$940.41	"$1,098.15"	"$1,739.46"	"$1,757.03"	"$1,298.67"		"$1,298.67"	"$1,065.68"	$0.00	$0.00	"$1,014.71"	$895.63	$0.00	$0.00	$0.00	$0.00
136525	ERX	HCPCS J9173	00310-4611-50	DURVALUMAB 500 MG/10ML IV SOLN	BOTH IP/OP	"$10,239.93 "	"$7,577.55"	$0.00	"$7,892.94"	"$4,607.97"	"$4,607.97"	"$3,842.95"	"$3,842.95"	"$3,842.95"	"$2,134.26"	"$7,600.08"	"$7,600.08"	"$7,892.94"	"$3,843.15"	"$4,515.70"	"$2,498.05"	"$5,048.29"	"$5,048.29"	"$3,918.39"	"$4,575.58"	"$7,247.72"	"$7,320.93"	"$5,411.11"		"$5,411.11"	"$4,440.33"	$0.00	$0.00	"$4,227.95"	"$3,731.80"	$0.00	$0.00	$0.00	$0.00
136642	ERX	HCPCS 25000001	56151-1625-01	GLUCOSE 15 GM/32ML PO GEL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
136839	ERX	HCPCS J9017	63459-0601-06	ARSENIC TRIOXIDE 12 MG/6ML IV SOLN	BOTH IP/OP	"$5,784.05 "	"$4,280.20"	$0.00	"$2,229.18"	"$1,301.41"	"$1,301.41"	$153.73	$153.73	$153.73	$602.77	"$2,146.46"	"$2,146.46"	"$2,229.18"	$157.37	$184.91	$102.29	"$1,425.77"	"$1,425.77"	$558.36	"$1,095.93"	"$1,735.95"	"$1,753.49"	$771.06		$771.06	$621.39	$0.00	$0.00	$591.67	$344.03	$0.00	$0.00	$0.00	$0.00
137000	ERX	HCPCS J9311	50242-0108-01	RITUXIMAB-HYALURONIDASE HUMAN 1400-23400 MG -UT/11.7ML SC SOLN	BOTH IP/OP	"$17,835.69 "	"$13,198.41"	$0.00	"$13,747.75"		$0.00	$0.00	$0.00	$0.00	$0.00	"$13,237.65"	"$13,237.65"	"$13,747.75"	$0.00	"$6,241.13"	$0.00	$0.00	$0.00	$0.00	"$8,089.20"	"$12,813.28"	"$12,942.71"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
137001	ERX	HCPCS J9311	50242-0109-01	RITUXIMAB-HYALURONIDASE HUMAN 1600-26800 MG -UT/13.4ML SC SOLN	BOTH IP/OP	"$20,383.65 "	"$15,083.90"	$0.00	"$15,711.72"		$0.00	$0.00	$0.00	$0.00	$0.00	"$15,128.75"	"$15,128.75"	"$15,711.72"	$0.00	"$7,132.72"	$0.00	$0.00	$0.00	$0.00	"$9,244.80"	"$14,643.76"	"$14,791.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
137149	ERX	HCPCS Q5104	00006-4305-01	INFLIXIMAB-ABDA 100 MG IV SOLR	BOTH IP/OP	"$2,341.55 "	"$1,732.75"	$0.00	"$1,804.87"	"$1,053.70"	"$1,053.70"	$395.84	$395.84	$395.84	$488.04	"$1,737.90"	"$1,737.90"	"$1,804.87"	$387.92	$455.81	$252.15	"$1,154.38"	"$1,154.38"	$560.65	"$1,084.89"	"$1,718.46"	"$1,735.82"	$774.23		$774.23	$608.06	$0.00	$0.00	$578.98	$533.95	$0.00	$0.00	$0.00	$0.00
137149	ERX	HCPCS Q5104	00006-4305-02	INFLIXIMAB-ABDA 100 MG IV SOLR	BOTH IP/OP	"$2,341.55 "	"$1,732.75"	$0.00	"$1,804.87"	"$1,053.70"	"$1,053.70"	$395.84	$395.84	$395.84	$488.04	"$1,737.90"	"$1,737.90"	"$1,804.87"	$387.92	$455.81	$252.15	"$1,154.38"	"$1,154.38"	$560.65	"$1,084.89"	"$1,718.46"	"$1,735.82"	$774.23		$774.23	$608.06	$0.00	$0.00	$578.98	$533.95	$0.00	$0.00	$0.00	$0.00
137213	ERX	HCPCS 25000001	70437-0240-26	NERATINIB MALEATE 40 MG PO TABS	BOTH IP/OP	$319.78 	$236.64	$0.00	$246.49		$0.00	$0.00	$0.00	$0.00	$0.00	$237.34	$237.34	$246.49	$0.00	$66.64	$0.00	$0.00	$0.00	$0.00	$145.15	$229.91	$232.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
137683	ERX	HCPCS 25000001	99999-6004-60	CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
137683	ERX	HCPCS 25000001	99999-6010-66	CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
137683	ERX	HCPCS 25000001	00121-0766-16	CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP	BOTH IP/OP	$11.00 	$8.14	$0.00	$37.02		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$37.02	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
137683	ERX	HCPCS 25000001	00054-3117-63	CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP	BOTH IP/OP	$11.00 	$8.14	$0.00	$37.62		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$37.62	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
137687	ERX	HCPCS 25000001	00023-4554-30	CARBOXYMETHYLCELLULOSE SOD PF 1 % OP GEL	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
137688	ERX	HCPCS J0401	59148-0045-80	ARIPIPRAZOLE ER 300 MG IM PRSY	BOTH IP/OP	"$4,858.15 "	"$3,595.03"	$0.00	"$4,003.03"	"$2,337.01"	"$2,337.01"	"$1,797.00"	"$1,797.00"	"$1,797.00"	"$1,012.56"	"$3,854.50"	"$3,854.50"	"$4,003.03"	"$1,801.80"	"$2,117.12"	"$1,171.17"	"$2,395.07"	"$2,395.07"	$0.00	"$1,119.17"	"$1,772.77"	"$1,790.67"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
137726	ERX	HCPCS J3490	70842-0120-06	MEROPENEM-VABORBACTAM 2 (1-1) G IV SOLR	BOTH IP/OP	$655.84 	$485.32	$0.00	$555.48	$324.30	$324.30	$0.00	$0.00	$0.00	$136.69	$534.87	$534.87	$555.48	$0.00	$136.68	$0.00	$387.93	$387.93	$0.00	$283.34	$448.81	$453.34	$0.00		$0.00	$88.69	$0.00	$0.00	$90.22	$0.00	$0.00	$0.00	$0.00	$0.00
137728	ERX	HCPCS J9203	00008-4510-01	GEMTUZUMAB OZOGAMICIN 4.5 MG IV SOLR	BOTH IP/OP	"$24,670.39 "	"$18,256.09"	$0.00	"$19,015.94"		$0.00	$0.00	$0.00	$0.00	$0.00	"$18,310.36"	"$18,310.36"	"$19,015.94"	$0.00	"$10,997.58"	$0.00	$0.00	$0.00	$0.00	"$10,700.25"	"$16,949.19"	"$17,120.39"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
137823	ERX	HCPCS 25000001	00409-4712-01	LIDOCAINE IN DEXTROSE 5-7.5 % INTRASPINAL SOLN	BOTH IP/OP	$46.57 	$34.46	$0.00	$35.90		$0.00	$0.00	$0.00	$0.00	$0.00	$34.56	$34.56	$35.90	$0.00	$9.71	$0.00	$0.00	$0.00	$0.00	$20.81	$32.96	$33.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
137829	ERX	HCPCS J0171	42023-0159-01	EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$0.87	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.96	$0.00	$0.00	$0.92	$0.00	$0.00	$0.00	$0.00	$0.00
137829	ERX	HCPCS J0171	42023-0159-25	EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$0.87	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.96	$0.00	$0.00	$0.92	$0.00	$0.00	$0.00	$0.00	$0.00
137999	ERX	HCPCS J3370	66288-7100-01	VANCOMYCIN HCL 100 G IV SOLR	BOTH IP/OP	"$1,554.00 "	"$1,149.96"	$0.00	"$1,197.82"	$699.30	$699.30	$0.00	$0.00	$0.00	$723.80	"$1,153.38"	"$1,153.38"	"$1,197.82"	$0.00	$667.87	$0.00	$919.19	$919.19	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$796.65	$0.00	$0.00	$758.55	$0.00	$0.00	$0.00	$0.00	$0.00
138034	ERX	HCPCS 25000001	00002-4483-54	ABEMACICLIB 50 MG PO TABS	BOTH IP/OP	$817.07 	$604.63	$0.00	$664.42		$0.00	$0.00	$0.00	$0.00	$0.00	$639.77	$639.77	$664.42	$0.00	$170.28	$0.00	$0.00	$0.00	$0.00	$351.43	$556.66	$562.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
138035	ERX	HCPCS 25000001	00002-4815-54	ABEMACICLIB 100 MG PO TABS	BOTH IP/OP	$817.07 	$604.63	$0.00	$664.42		$0.00	$0.00	$0.00	$0.00	$0.00	$639.77	$639.77	$664.42	$0.00	$170.28	$0.00	$0.00	$0.00	$0.00	$351.43	$556.66	$562.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
138036	ERX	HCPCS 25000001	00002-5337-54	ABEMACICLIB 150 MG PO TABS	BOTH IP/OP	$817.07 	$604.63	$0.00	$664.42		$0.00	$0.00	$0.00	$0.00	$0.00	$639.77	$639.77	$664.42	$0.00	$170.28	$0.00	$0.00	$0.00	$0.00	$351.43	$556.66	$562.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
138037	ERX	HCPCS 25000001	00002-6216-54	ABEMACICLIB 200 MG PO TABS	BOTH IP/OP	$817.07 	$604.63	$0.00	$664.42		$0.00	$0.00	$0.00	$0.00	$0.00	$639.77	$639.77	$664.42	$0.00	$170.28	$0.00	$0.00	$0.00	$0.00	$351.43	$556.66	$562.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
138138	ERX	HCPCS J0171	42023-0168-01	EPINEPHRINE 30 MG/30ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$2.60	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.89	$0.00	$0.00	$2.75	$0.00	$0.00	$0.00	$0.00	$0.00
138195	ERX	HCPCS J7170	50242-0921-01	EMICIZUMAB-KXWH 60 MG/0.4ML SC SOLN	BOTH IP/OP	"$16,711.21 "	"$12,366.30"	$0.00	"$13,203.03"		$0.00	$0.00	$0.00	$0.00	$0.00	"$12,713.14"	"$12,713.14"	"$13,203.03"	$0.00	"$3,482.62"	$0.00	$0.00	$0.00	$0.00	"$7,394.34"	"$11,712.63"	"$11,830.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
138537	ERX	HCPCS J3490	68547-0501-02	ANGIOTENSIN II ACETATE 2.5 MG/ML IV SOLN	BOTH IP/OP	"$4,068.00 "	"$3,010.32"	$0.00	"$3,135.61"	"$1,830.60"	"$1,830.60"	$0.00	$0.00	$0.00	$847.87	"$3,019.27"	"$3,019.27"	"$3,135.61"	$0.00	$847.77	$0.00	"$2,005.52"	"$2,005.52"	$0.00	"$1,845.00"	"$2,922.48"	"$2,952.00"	$0.00		$0.00	$577.49	$0.00	$0.00	$587.45	$0.00	$0.00	$0.00	$0.00	$0.00
138555	ERX	HCPCS J9299	00003-3734-13	NIVOLUMAB 240 MG/24ML IV SOLN	BOTH IP/OP	"$18,385.58 "	"$13,605.33"	$0.00	"$14,455.06"	"$8,438.99"	"$8,438.99"	"$7,018.80"	"$7,018.80"	"$7,018.80"	"$3,832.01"	"$13,918.71"	"$13,918.71"	"$14,455.06"	"$6,927.12"	"$8,139.37"	"$4,502.63"	"$9,064.09"	"$9,064.09"	"$7,006.86"	"$8,093.97"	"$12,820.85"	"$12,950.35"	"$9,676.14"		"$9,676.14"	"$7,941.12"	$0.00	$0.00	"$7,561.30"	"$6,848.16"	$0.00	$0.00	$0.00	$0.00
138899	ERX	HCPCS J8499	61958-2501-01	BIKTARVY:BICTEGRAVIR-EMTRICITABINE-TENOFOVIR ALAFENAMIDE 50-200-25 PO TAB	BOTH IP/OP	$481.67 	$356.44	$0.00	$316.06	$261.55	$261.55	$0.00	$0.00	$85.74	$100.39	$0.00	$0.00	$0.00	$0.00	$100.38	$0.00	$284.91	$284.91	$0.00	$197.54	$312.90	$316.06	$237.05		$237.05	$0.00	$0.00	$0.00	$62.90	$0.00	$0.00	$0.00	$0.00	$0.00
138939	ERX	HCPCS 25000001	59676-0600-12	APALUTAMIDE 60 MG PO TABS	BOTH IP/OP	"$1,329.53 "	$983.85	$0.00	"$1,080.15"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,040.07"	"$1,040.07"	"$1,080.15"	$0.00	$277.07	$0.00	$0.00	$0.00	$0.00	$649.02	"$1,028.04"	"$1,038.42"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139004	ERX	HCPCS 63700001	57962-0070-28	IBRUTINIB 70 MG PO CAPS	BOTH IP/OP	"$5,395.18 "	"$3,992.43"	$0.00	"$3,645.33"		$0.00	$0.00	$0.00	"$1,031.41"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,124.36"	$0.00	$0.00	$0.00	$0.00	"$2,278.33"	"$3,608.87"	"$3,645.33"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139005	ERX	HCPCS J8999	57962-0014-28	IBRUTINIB 140 MG PO TABS	BOTH IP/OP	"$2,697.59 "	"$1,996.22"	$0.00	"$1,822.66"		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.18	$0.00	$0.00	$0.00	$0.00	"$1,139.17"	"$1,804.44"	"$1,822.66"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139006	ERX	HCPCS 63700001	57962-0280-28	IBRUTINIB 280 MG PO TABS	BOTH IP/OP	"$2,697.59 "	"$1,996.22"	$0.00	"$1,822.66"		$0.00	$0.00	$0.00	$515.70	$0.00	$0.00	$0.00	$0.00	$0.00	$562.18	$0.00	$0.00	$0.00	$0.00	"$1,139.17"	"$1,804.44"	"$1,822.66"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139007	ERX	HCPCS 63700001	57962-0420-28	IBRUTINIB 420 MG PO TABS	BOTH IP/OP	"$1,545.75 "	"$1,143.86"	$0.00	"$1,066.93"		$0.00	$0.00	$0.00	$295.50	$0.00	$0.00	$0.00	$0.00	$0.00	$322.13	$0.00	$0.00	$0.00	$0.00	$666.83	"$1,056.26"	"$1,066.93"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139008	ERX	HCPCS 63700001	57962-0560-28	IBRUTINIB 560 MG PO TABS	BOTH IP/OP	"$1,545.75 "	"$1,143.86"	$0.00	"$1,066.93"		$0.00	$0.00	$0.00	$295.50	$0.00	$0.00	$0.00	$0.00	$0.00	$322.13	$0.00	$0.00	$0.00	$0.00	$666.83	"$1,056.26"	"$1,066.93"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139272	ERX	HCPCS J0690	00338-3503-41	CEFAZOLIN 1G IN 50ML DEXTROSE (ISO-OSMOTIC) PREMIXED SOLUTION	BOTH IP/OP	$26.40 	$19.54	$0.00	$20.35	$11.88	$11.88	$0.00	$0.00	$0.00	$1.39	$19.59	$19.59	$20.35	$0.00	$1.75	$0.00	$15.62	$15.62	$0.00	$11.97	$18.96	$19.15	$0.00		$0.00	$1.93	$0.00	$0.00	$1.83	$0.00	$0.00	$0.00	$0.00	$0.00
139273	ERX	HCPCS 25000001	00781-3126-46	NAFCILLIN SODIUM 10 G IV SOLR	BOTH IP/OP	$466.27 	$345.04	$0.00	$359.40		$0.00	$0.00	$0.00	$0.00	$0.00	$346.07	$346.07	$359.40	$0.00	$97.17	$0.00	$0.00	$0.00	$0.00	$211.63	$335.21	$338.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139273	ERX	HCPCS 25000001	00781-3126-95	NAFCILLIN SODIUM 10 G IV SOLR	BOTH IP/OP	$466.27 	$345.04	$0.00	$359.40		$0.00	$0.00	$0.00	$0.00	$0.00	$346.07	$346.07	$359.40	$0.00	$97.17	$0.00	$0.00	$0.00	$0.00	$211.63	$335.21	$338.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139275	ERX	HCPCS 25000001	00065-0418-81	DEXTRAN 70-HYPROMELLOSE 0.1-0.3 % OP SOLN	BOTH IP/OP	$16.53 	$12.23	$0.00	$13.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.27	$13.09	$13.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139276	ERX	HCPCS 25000001	00065-0416-63	DEXTRAN 70-HYPROMELLOSE (PF) 0.1-0.3 % OP SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139276	ERX	HCPCS 25000001	00065-8063-01	DEXTRAN 70-HYPROMELLOSE (PF) 0.1-0.3 % OP SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139283	ERX	HCPCS 25000001	00023-0506-01	POLYVINYL ALCOHOL-POVIDONE PF 1.4-0.6 % OP SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139283	ERX	HCPCS 25000001	00023-0506-50	POLYVINYL ALCOHOL-POVIDONE PF 1.4-0.6 % OP SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139285	ERX	HCPCS 25000001	71740-0112-30	POTASSIUM IODIDE (EXPECTORANT) 1 GM/ML PO SOLN	BOTH IP/OP	"$1,379.70 "	"$1,020.98"	$0.00	"$1,063.47"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.01"	"$1,024.01"	"$1,063.47"	$0.00	$287.53	$0.00	$0.00	$0.00	$0.00	$39.48	$62.54	$63.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139286	ERX	HCPCS J0583	00409-8300-10	BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR	BOTH IP/OP	$584.64 	$432.63	$0.00	$450.64		$0.00	$0.00	$0.00	$0.00	$0.00	$433.92	$433.92	$450.64	$0.00	$121.84	$0.00	$0.00	$0.00	$0.00	$265.35	$420.31	$424.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139286	ERX	HCPCS J0583	00781-3158-94	BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR	BOTH IP/OP	$584.64 	$432.63	$0.00	$450.64		$0.00	$0.00	$0.00	$0.00	$0.00	$433.92	$433.92	$450.64	$0.00	$121.84	$0.00	$0.00	$0.00	$0.00	$265.35	$420.31	$424.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139286	ERX	HCPCS J0583	00781-3158-95	BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR	BOTH IP/OP	$584.64 	$432.63	$0.00	$450.64		$0.00	$0.00	$0.00	$0.00	$0.00	$433.92	$433.92	$450.64	$0.00	$121.84	$0.00	$0.00	$0.00	$0.00	$265.35	$420.31	$424.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139286	ERX	HCPCS J0583	55111-0652-37	BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR	BOTH IP/OP	$584.64 	$432.63	$0.00	$450.64		$0.00	$0.00	$0.00	$0.00	$0.00	$433.92	$433.92	$450.64	$0.00	$121.84	$0.00	$0.00	$0.00	$0.00	$265.35	$420.31	$424.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139286	ERX	HCPCS J0583	70860-0402-10	BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR	BOTH IP/OP	$584.64 	$432.63	$0.00	$450.64		$0.00	$0.00	$0.00	$0.00	$0.00	$433.92	$433.92	$450.64	$0.00	$121.84	$0.00	$0.00	$0.00	$0.00	$265.35	$420.31	$424.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139292	ERX	HCPCS J0770	39822-0615-01	COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR	BOTH IP/OP	$99.75 	$73.82	$0.00	$79.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.88	$79.00	$79.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139292	ERX	HCPCS J0770	42023-0131-01	COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR	BOTH IP/OP	$99.75 	$73.82	$0.00	$79.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.88	$79.00	$79.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139292	ERX	HCPCS J0770	63323-0393-06	COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR	BOTH IP/OP	$99.75 	$73.82	$0.00	$79.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.88	$79.00	$79.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139365	ERX	HCPCS J1746	62064-0122-02	IBALIZUMAB-UIYK 200 MG/1.33ML IV SOLN	BOTH IP/OP	"$3,628.66 "	"$2,685.21"	$0.00	"$2,796.97"	"$1,632.90"	"$1,632.90"	"$1,325.06"	"$1,325.06"	"$1,325.06"	$756.30	"$2,693.19"	"$2,693.19"	"$2,796.97"	"$1,327.88"	"$1,560.26"	$863.12	"$1,788.93"	"$1,788.93"	"$1,263.26"	"$1,521.70"	"$2,410.37"	"$2,434.72"	"$1,744.50"		"$1,744.50"	"$1,333.63"	$0.00	$0.00	"$1,269.84"	"$1,203.10"	$0.00	$0.00	$0.00	$0.00
139459	ERX	HCPCS 25000001	00078-0951-66	NILOTINIB HCL 50 MG PO CAPS	BOTH IP/OP	"$1,310.87 "	$970.04	$0.00	$384.72		$0.00	$0.00	$0.00	$247.33	$0.00	$0.00	$0.00	$0.00	$0.00	$273.19	$0.00	$0.00	$0.00	$0.00	$240.45	$380.87	$384.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139649	ERX	HCPCS 25000001	62327-0222-02	TALC 2 G PL POWD	BOTH IP/OP	$427.40 	$316.28	$0.00	$348.09		$0.00	$0.00	$0.00	$0.00	$0.00	$335.17	$335.17	$348.09	$0.00	$89.07	$0.00	$0.00	$0.00	$0.00	$193.98	$307.26	$310.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139651	ERX	HCPCS 25000001	62327-0333-03	TALC 3 G PL POWD	BOTH IP/OP	$536.26 	$396.83	$0.00	$441.32		$0.00	$0.00	$0.00	$0.00	$0.00	$424.95	$424.95	$441.32	$0.00	$111.76	$0.00	$0.00	$0.00	$0.00	$243.39	$385.53	$389.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139651	ERX	HCPCS 25000001	62327-0333-43	TALC 3 G PL POWD	BOTH IP/OP	$536.26 	$396.83	$0.00	$441.32		$0.00	$0.00	$0.00	$0.00	$0.00	$424.95	$424.95	$441.32	$0.00	$111.76	$0.00	$0.00	$0.00	$0.00	$243.39	$385.53	$389.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139692	ERX	HCPCS 90375	13533-0318-05	RABIES IMMUNE GLOBULIN 1500 UNIT/5ML IJ SOLN	BOTH IP/OP	"$9,091.15 "	"$6,727.45"	$0.00	"$7,007.46"		$0.00	$0.00	$0.00	$0.00	$0.00	"$6,747.45"	"$6,747.45"	"$7,007.46"	$0.00	$314.08	$0.00	$0.00	$0.00	$0.00	"$4,123.20"	"$6,531.15"	"$6,597.12"	$0.00		$0.00	$325.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139937	ERX	HCPCS 63700001	00074-3399-30	RITONAVIR 100 MG PO PACK	BOTH IP/OP	$43.11 	$31.90	$0.00	$31.28		$0.00	$0.00	$0.00	$7.67	$0.00	$0.00	$0.00	$0.00	$0.00	$8.98	$0.00	$0.00	$0.00	$0.00	$19.55	$30.97	$31.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139948	ERX	HCPCS 25000001	64950-0362-04	COCAINE HCL 40 MG/ML NA SOLN	BOTH IP/OP	$858.48 	$635.28	$0.00	$661.72		$0.00	$0.00	$0.00	$0.00	$0.00	$637.16	$637.16	$661.72	$0.00	$178.91	$0.00	$0.00	$0.00	$0.00	$389.55	$617.05	$623.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
139956	ERX	HCPCS J0171	70324-0077-01	EPINEPHRINE HCL-NACL 8-0.9 MG/250ML-% IV SOLN	BOTH IP/OP	$260.25 	$192.59	$0.00	$200.60	$117.11	$117.11	$0.00	$0.00	$0.00	$54.24	$193.16	$193.16	$200.60	$0.00	$69.37	$0.00	$153.94	$153.94	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$77.08	$0.00	$0.00	$73.39	$0.00	$0.00	$0.00	$0.00	$0.00
139956	ERX	HCPCS J0171	76154-0814-15	EPINEPHRINE HCL-NACL 8-0.9 MG/250ML-% IV SOLN	BOTH IP/OP	$260.25 	$192.59	$0.00	$200.60	$117.11	$117.11	$0.00	$0.00	$0.00	$54.24	$193.16	$193.16	$200.60	$0.00	$69.37	$0.00	$153.94	$153.94	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$77.08	$0.00	$0.00	$73.39	$0.00	$0.00	$0.00	$0.00	$0.00
140052	ERX	HCPCS Q5106	00069-1305-01	EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN	BOTH IP/OP	$102.19 	$75.62	$0.00	$74.13	$55.49	$55.49	$0.00	$0.00	$0.00	$21.30	$0.00	$0.00	$0.00	$0.00	$21.30	$0.00	$60.45	$60.45	$20.22	$46.33	$73.39	$74.13	$27.93		$27.93	$14.50	$0.00	$0.00	$20.81	$19.26	$0.00	$0.00	$0.00	$0.00
140052	ERX	HCPCS Q5106	00069-1305-10	EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN	BOTH IP/OP	$102.19 	$75.62	$0.00	$74.13	$55.49	$55.49	$0.00	$0.00	$0.00	$21.30	$0.00	$0.00	$0.00	$0.00	$21.30	$0.00	$60.45	$60.45	$20.22	$46.33	$73.39	$74.13	$27.93		$27.93	$14.50	$0.00	$0.00	$20.81	$19.26	$0.00	$0.00	$0.00	$0.00
140054	ERX	HCPCS Q5106	00069-1307-01	EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN	BOTH IP/OP	$183.72 	$135.95	$0.00	$133.42	$99.76	$99.76	$0.00	$0.00	$0.00	$38.29	$0.00	$0.00	$0.00	$0.00	$38.29	$0.00	$108.67	$108.67	$40.45	$83.39	$132.09	$133.42	$55.85		$55.85	$26.10	$0.00	$0.00	$41.62	$38.52	$0.00	$0.00	$0.00	$0.00
140054	ERX	HCPCS Q5106	00069-1307-10	EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN	BOTH IP/OP	$183.72 	$135.95	$0.00	$133.42	$99.76	$99.76	$0.00	$0.00	$0.00	$38.29	$0.00	$0.00	$0.00	$0.00	$38.29	$0.00	$108.67	$108.67	$40.45	$83.39	$132.09	$133.42	$55.85		$55.85	$26.10	$0.00	$0.00	$41.62	$38.52	$0.00	$0.00	$0.00	$0.00
140055	ERX	HCPCS Q5106	00069-1308-01	EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN	BOTH IP/OP	$444.73 	$329.10	$0.00	$322.96	$241.49	$241.49	$0.00	$0.00	$0.00	$92.69	$0.00	$0.00	$0.00	$0.00	$92.68	$0.00	$263.06	$263.06	$101.12	$201.85	$319.73	$322.96	$139.64		$139.64	$63.18	$0.00	$0.00	$104.05	$96.30	$0.00	$0.00	$0.00	$0.00
140055	ERX	HCPCS Q5106	00069-1308-10	EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN	BOTH IP/OP	$444.73 	$329.10	$0.00	$322.96	$241.49	$241.49	$0.00	$0.00	$0.00	$92.69	$0.00	$0.00	$0.00	$0.00	$92.68	$0.00	$263.06	$263.06	$101.12	$201.85	$319.73	$322.96	$139.64		$139.64	$63.18	$0.00	$0.00	$104.05	$96.30	$0.00	$0.00	$0.00	$0.00
140089	ERX	HCPCS J9150	00703-5233-13	DAUNORUBICIN HCL 20 MG/4ML IV SOLN	BOTH IP/OP	$540.87 	$400.24	$0.00	$416.90		$0.00	$0.00	$0.00	$0.00	$0.00	$401.43	$401.43	$416.90	$0.00	$94.84	$0.00	$0.00	$0.00	$0.00	$245.49	$388.85	$392.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140312	ERX	HCPCS J0878	25021-0179-15	DAPTOMYCIN 350 MG IV SOLR	BOTH IP/OP	$970.61 	$718.25	$0.00	$748.15	$436.77	$436.77	$0.00	$0.00	$0.00	$156.28	$720.39	$720.39	$748.15	$0.00	$23.44	$0.00	$574.12	$574.12	$121.28	$440.43	$697.64	$704.69	$167.48		$167.48	$119.26	$0.00	$0.00	$113.56	$47.60	$0.00	$0.00	$0.00	$0.00
140312	ERX	HCPCS J0878	25021-0179-16	DAPTOMYCIN 350 MG IV SOLR	BOTH IP/OP	$970.61 	$718.25	$0.00	$748.15	$436.77	$436.77	$0.00	$0.00	$0.00	$156.28	$720.39	$720.39	$748.15	$0.00	$23.44	$0.00	$574.12	$574.12	$121.28	$440.43	$697.64	$704.69	$167.48		$167.48	$119.26	$0.00	$0.00	$113.56	$47.60	$0.00	$0.00	$0.00	$0.00
140359	ERX	HCPCS Q5108	67457-0833-06	PEGFILGRASTIM-JMDB 6 MG/0.6ML SC SOSY	BOTH IP/OP	"$11,322.60 "	"$8,378.72"	$0.00	"$8,727.46"	"$5,095.17"	"$5,095.17"	"$2,449.66"	"$2,449.66"	"$2,449.66"	"$2,359.91"	"$8,403.63"	"$8,403.63"	"$8,727.46"	"$2,534.22"	"$2,977.71"	"$1,647.24"	"$5,582.04"	"$5,582.04"	"$4,125.40"	"$5,135.25"	"$8,134.24"	"$8,216.40"	"$5,696.99"		"$5,696.99"	"$1,607.33"	$0.00	$0.00	"$1,635.06"	"$3,928.96"	$0.00	$0.00	$0.00	$0.00
140422	ERX	HCPCS J1644	00409-7651-03	HEPARIN (PORCINE) 50 UNIT/ML 500 ML IV SOLN	BOTH IP/OP	$39.81 	$29.46	$0.00	$30.69	$17.91	$17.91	$0.00	$0.00	$0.00	$5.88	$29.55	$29.55	$30.69	$0.00	$7.29	$0.00	$23.55	$23.55	$0.00	$17.10	$27.09	$27.36	$0.00		$0.00	$7.05	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$0.00
140467	ERX	HCPCS 63700001	70255-0010-02	BINIMETINIB 15 MG PO TABS	BOTH IP/OP	$303.55 	$224.63	$0.00	$200.91		$0.00	$0.00	$0.00	$54.03	$0.00	$0.00	$0.00	$0.00	$0.00	$63.26	$0.00	$0.00	$0.00	$0.00	$125.57	$198.90	$200.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140469	ERX	HCPCS 63700001	70255-0025-01	ENCORAFENIB 75 MG PO CAPS	BOTH IP/OP	$309.38 	$228.94	$0.00	$204.78		$0.00	$0.00	$0.00	$55.07	$0.00	$0.00	$0.00	$0.00	$0.00	$64.47	$0.00	$0.00	$0.00	$0.00	$127.99	$202.73	$204.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140469	ERX	HCPCS 63700001	70255-0025-02	ENCORAFENIB 75 MG PO CAPS	BOTH IP/OP	$309.38 	$228.94	$0.00	$204.78		$0.00	$0.00	$0.00	$55.07	$0.00	$0.00	$0.00	$0.00	$0.00	$64.47	$0.00	$0.00	$0.00	$0.00	$127.99	$202.73	$204.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140469	ERX	HCPCS 63700001	70255-0025-03	ENCORAFENIB 75 MG PO CAPS	BOTH IP/OP	$309.38 	$228.94	$0.00	$204.78		$0.00	$0.00	$0.00	$55.07	$0.00	$0.00	$0.00	$0.00	$0.00	$64.47	$0.00	$0.00	$0.00	$0.00	$127.99	$202.73	$204.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140469	ERX	HCPCS 63700001	70255-0025-04	ENCORAFENIB 75 MG PO CAPS	BOTH IP/OP	$309.38 	$228.94	$0.00	$204.78		$0.00	$0.00	$0.00	$55.07	$0.00	$0.00	$0.00	$0.00	$0.00	$64.47	$0.00	$0.00	$0.00	$0.00	$127.99	$202.73	$204.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140572	ERX	HCPCS 25000001	71334-0100-01	IVOSIDENIB 250 MG PO TABS	BOTH IP/OP	"$1,470.09 "	"$1,087.87"	$0.00	"$1,052.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.37	$0.00	$0.00	$0.00	$0.00	$658.10	"$1,042.43"	"$1,052.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140767	ERX	HCPCS J9047	76075-0103-01	CARFILZOMIB 10 MG IV SOLR	BOTH IP/OP	"$1,335.98 "	$988.63	$0.00	"$1,090.52"	$636.66	$636.66	$411.11	$411.11	$411.11	$278.45	"$1,050.06"	"$1,050.06"	"$1,090.52"	$411.03	$482.96	$267.17	$790.23	$790.23	$394.79	$645.39	"$1,022.29"	"$1,032.62"	$545.19		$545.19	$441.10	$0.00	$0.00	$420.00	$389.72	$0.00	$0.00	$0.00	$0.00
140769	ERX	HCPCS 63600001	76329-3316-01	EPINEPHRINE 1 MG/10ML IJ SOSY	BOTH IP/OP	$44.00 	$32.56	$0.00	$38.18	$22.29	$22.29	$0.00	$0.00	$0.00	$9.17	$36.76	$36.76	$38.18	$0.00	$8.67	$0.00	$26.03	$26.03	$0.00	$19.95	$31.60	$31.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140776	ERX	HCPCS 25000001	00310-1105-30	SODIUM ZIRCONIUM CYCLOSILICATE 5 G PO PACK	BOTH IP/OP	$112.64 	$83.35	$0.00	$86.84		$0.00	$0.00	$0.00	$0.00	$0.00	$83.62	$83.62	$86.84	$0.00	$23.47	$0.00	$0.00	$0.00	$0.00	$47.23	$74.81	$75.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140796	ERX	HCPCS 90739	43528-0003-05	HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY	BOTH IP/OP	$510.05 	$377.44	$0.00	$414.59	$242.04	$242.04	$139.85	$139.85	$131.10	$106.31	$399.21	$399.21	$414.59	$132.61	$169.45	$86.20	$301.69	$301.69	$0.00	$220.52	$349.30	$352.82	$264.62		$264.62	$154.04	$114.67	$114.67	$146.67	$114.67	$0.00	$0.00	$0.00	$0.00
140845	ERX	HCPCS J2370	69374-0957-10	PHENYLEPHRINE HCL 1 MG/10ML IV SOSY	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60	$12.15	$12.15	$0.00	$0.00	$0.00	$0.96	$20.04	$20.04	$20.81	$0.00	$4.14	$0.00	$15.97	$15.97	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$4.31	$0.00	$0.00	$4.11	$0.00	$0.00	$0.00	$0.00	$0.00
140890	ERX	HCPCS J9204	42747-0761-01	MOGAMULIZUMAB-KPKC 20 MG/5ML IV SOLN	BOTH IP/OP	"$10,909.21 "	"$8,072.82"	$0.00	"$8,534.95"	"$4,982.78"	"$4,982.78"	"$4,252.70"	"$4,252.70"	"$4,252.70"	"$2,273.75"	"$8,218.27"	"$8,218.27"	"$8,534.95"	"$4,200.90"	"$4,936.06"	"$2,730.59"	"$5,378.24"	"$5,378.24"	$0.00	"$4,802.60"	"$7,607.32"	"$7,684.16"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140942	ERX	HCPCS 63700001	62856-0712-05	LENVATINIB (12 MG DAILY DOSE) 3 X 4 MG PO CPPK	BOTH IP/OP	$792.81 	$586.68	$0.00	"$1,460.82"		$0.00	$0.00	$0.00	$144.99	$0.00	$0.00	$0.00	$0.00	$0.00	$165.22	$0.00	$0.00	$0.00	$0.00	$913.01	"$1,446.21"	"$1,460.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140942	ERX	HCPCS 63700001	62856-0712-30	LENVATINIB (12 MG DAILY DOSE) 3 X 4 MG PO CPPK	BOTH IP/OP	$792.81 	$586.68	$0.00	"$1,460.82"		$0.00	$0.00	$0.00	$144.99	$0.00	$0.00	$0.00	$0.00	$0.00	$165.22	$0.00	$0.00	$0.00	$0.00	$913.01	"$1,446.21"	"$1,460.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140943	ERX	HCPCS 63700001	62856-0704-05	LENVATINIB (4 MG DAILY DOSE) 4 MG PO CPPK	BOTH IP/OP	"$2,109.61 "	"$1,561.11"	$0.00	"$1,460.82"		$0.00	$0.00	$0.00	$385.82	$0.00	$0.00	$0.00	$0.00	$0.00	$439.64	$0.00	$0.00	$0.00	$0.00	$913.01	"$1,446.21"	"$1,460.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140943	ERX	HCPCS 63700001	62856-0704-30	LENVATINIB (4 MG DAILY DOSE) 4 MG PO CPPK	BOTH IP/OP	"$2,109.61 "	"$1,561.11"	$0.00	"$1,460.82"		$0.00	$0.00	$0.00	$385.82	$0.00	$0.00	$0.00	$0.00	$0.00	$439.64	$0.00	$0.00	$0.00	$0.00	$913.01	"$1,446.21"	"$1,460.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141226	ERX	HCPCS J2357	50242-0215-01	OMALIZUMAB 150 MG/ML SC SOSY	BOTH IP/OP	"$47,284.06 "	"$34,990.20"	$0.00	"$37,539.84"	"$21,916.10"	"$21,916.10"	"$16,878.15"	"$16,878.15"	"$16,878.15"	"$9,417.94"	"$36,146.95"	"$36,146.95"	"$37,539.84"	"$16,950.60"	"$19,916.96"	"$11,017.89"	"$23,311.04"	"$23,311.04"	"$1,158.51"	"$1,388.04"	"$2,198.65"	"$2,220.86"	"$1,599.84"		"$1,599.84"	"$1,316.94"	$0.00	$0.00	"$1,253.95"	"$1,130.79"	$0.00	$0.00	$0.00	$0.00
141227	ERX	HCPCS J2357	50242-0214-01	OMALIZUMAB 75 MG/0.5ML SC SOSY	BOTH IP/OP	"$3,152.25 "	"$2,332.67"	$0.00	"$1,434.03"	$837.20	$837.20	$562.61	$562.61	$562.61	$348.98	"$1,380.83"	"$1,380.83"	"$1,434.03"	$565.02	$663.90	$367.26	$890.49	$890.49	$579.25	$812.51	"$1,287.02"	"$1,300.02"	$799.92		$799.92	$658.47	$0.00	$0.00	$626.98	$565.40	$0.00	$0.00	$0.00	$0.00
141229	ERX	HCPCS J0841	66621-0790-02	CROTALIDAE IMMUNE FAB (EQUINE) IV SOLR	BOTH IP/OP	"$13,234.56 "	"$9,793.57"	$0.00	"$10,201.20"		$0.00	$0.00	$0.00	$0.00	$0.00	"$9,822.69"	"$9,822.69"	"$10,201.20"	$0.00	"$2,758.08"	$0.00	$0.00	$0.00	$0.00	"$6,002.40"	"$9,507.80"	"$9,603.84"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141259	ERX	HCPCS 63700001	00378-0871-16	CLONIDINE 0.1 MG/24HR TD PTWK	BOTH IP/OP	$127.86 	$94.62	$0.00	$92.75		$0.00	$0.00	$0.00	$22.76	$0.00	$0.00	$0.00	$0.00	$0.00	$26.65	$0.00	$0.00	$0.00	$0.00	$57.97	$91.82	$92.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141259	ERX	HCPCS 63700001	00378-0871-99	CLONIDINE 0.1 MG/24HR TD PTWK	BOTH IP/OP	$127.86 	$94.62	$0.00	$92.75		$0.00	$0.00	$0.00	$22.76	$0.00	$0.00	$0.00	$0.00	$0.00	$26.65	$0.00	$0.00	$0.00	$0.00	$57.97	$91.82	$92.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141259	ERX	HCPCS 63700001	00591-3508-04	CLONIDINE 0.1 MG/24HR TD PTWK	BOTH IP/OP	$127.86 	$94.62	$0.00	$92.75		$0.00	$0.00	$0.00	$22.76	$0.00	$0.00	$0.00	$0.00	$0.00	$26.65	$0.00	$0.00	$0.00	$0.00	$57.97	$91.82	$92.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141260	ERX	HCPCS 63700001	00378-0872-16	CLONIDINE 0.2 MG/24HR TD PTWK	BOTH IP/OP	$193.51 	$143.20	$0.00	$140.53		$0.00	$0.00	$0.00	$34.44	$0.00	$0.00	$0.00	$0.00	$0.00	$40.33	$0.00	$0.00	$0.00	$0.00	$87.83	$139.12	$140.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141260	ERX	HCPCS 63700001	00378-0872-99	CLONIDINE 0.2 MG/24HR TD PTWK	BOTH IP/OP	$193.51 	$143.20	$0.00	$140.53		$0.00	$0.00	$0.00	$34.44	$0.00	$0.00	$0.00	$0.00	$0.00	$40.33	$0.00	$0.00	$0.00	$0.00	$87.83	$139.12	$140.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141261	ERX	HCPCS 63700001	00378-0873-99	CLONIDINE 0.3 MG/24HR TD PTWK	BOTH IP/OP	$268.44 	$198.65	$0.00	$194.95		$0.00	$0.00	$0.00	$47.78	$0.00	$0.00	$0.00	$0.00	$0.00	$55.94	$0.00	$0.00	$0.00	$0.00	$121.85	$193.00	$194.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141261	ERX	HCPCS 63700001	51862-0455-01	CLONIDINE 0.3 MG/24HR TD PTWK	BOTH IP/OP	$268.44 	$198.65	$0.00	$194.95		$0.00	$0.00	$0.00	$47.78	$0.00	$0.00	$0.00	$0.00	$0.00	$55.94	$0.00	$0.00	$0.00	$0.00	$121.85	$193.00	$194.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141261	ERX	HCPCS 63700001	51862-0455-04	CLONIDINE 0.3 MG/24HR TD PTWK	BOTH IP/OP	$268.44 	$198.65	$0.00	$194.95		$0.00	$0.00	$0.00	$47.78	$0.00	$0.00	$0.00	$0.00	$0.00	$55.94	$0.00	$0.00	$0.00	$0.00	$121.85	$193.00	$194.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141262	ERX	HCPCS 90710	00006-4171-00	MEASLES-MUMPS-RUBELLA-VARICELL SC SUSR	BOTH IP/OP	$874.31 	$646.99	$0.00	$673.92	$393.44	$393.44	$0.00	$0.00	$0.00	$182.23	$648.91	$648.91	$673.92	$0.00	$182.21	$0.00	$517.15	$517.15	$0.00	$356.86	$565.26	$570.97	$0.00		$0.00	$111.70	$0.00	$0.00	$119.24	$0.00	$0.00	$0.00	$0.00	$0.00
141263	ERX	HCPCS J3370	00409-6533-01	VANCOMYCIN HCL 1 G IV SOLR	BOTH IP/OP	$36.58 	$27.07	$0.00	$29.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.29	$28.97	$29.26	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
141263	ERX	HCPCS J3370	00409-6533-31	VANCOMYCIN HCL 1 G IV SOLR	BOTH IP/OP	$36.58 	$27.07	$0.00	$29.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.29	$28.97	$29.26	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
141263	ERX	HCPCS J3370	63323-0284-20	VANCOMYCIN HCL 1 G IV SOLR	BOTH IP/OP	$36.58 	$27.07	$0.00	$29.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.29	$28.97	$29.26	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
141263	ERX	HCPCS J3370	67457-0340-00	VANCOMYCIN HCL 1 G IV SOLR	BOTH IP/OP	$36.58 	$27.07	$0.00	$29.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.29	$28.97	$29.26	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
141263	ERX	HCPCS J3370	67457-0340-01	VANCOMYCIN HCL 1 G IV SOLR	BOTH IP/OP	$36.58 	$27.07	$0.00	$29.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.29	$28.97	$29.26	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
141263	ERX	HCPCS J3370	70860-0105-20	VANCOMYCIN HCL 1 G IV SOLR	BOTH IP/OP	$36.58 	$27.07	$0.00	$29.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.29	$28.97	$29.26	$0.00		$0.00	$3.98	$0.00	$0.00	$3.79	$0.00	$0.00	$0.00	$0.00	$0.00
141264	ERX	HCPCS J3370	00409-6509-01	VANCOMYCIN HCL 5 G IV SOLR	BOTH IP/OP	$363.93 	$269.31	$0.00	$280.52	$163.77	$163.77	$0.00	$0.00	$0.00	$36.19	$270.11	$270.11	$280.52	$0.00	$33.39	$0.00	$215.26	$215.26	$0.00	$162.75	$257.80	$260.40	$0.00		$0.00	$39.83	$0.00	$0.00	$37.93	$0.00	$0.00	$0.00	$0.00	$0.00
141264	ERX	HCPCS J3370	25021-0157-99	VANCOMYCIN HCL 5 G IV SOLR	BOTH IP/OP	$363.93 	$269.31	$0.00	$280.52	$163.77	$163.77	$0.00	$0.00	$0.00	$36.19	$270.11	$270.11	$280.52	$0.00	$33.39	$0.00	$215.26	$215.26	$0.00	$162.75	$257.80	$260.40	$0.00		$0.00	$39.83	$0.00	$0.00	$37.93	$0.00	$0.00	$0.00	$0.00	$0.00
141264	ERX	HCPCS J3370	67457-0341-05	VANCOMYCIN HCL 5 G IV SOLR	BOTH IP/OP	$363.93 	$269.31	$0.00	$280.52	$163.77	$163.77	$0.00	$0.00	$0.00	$36.19	$270.11	$270.11	$280.52	$0.00	$33.39	$0.00	$215.26	$215.26	$0.00	$162.75	$257.80	$260.40	$0.00		$0.00	$39.83	$0.00	$0.00	$37.93	$0.00	$0.00	$0.00	$0.00	$0.00
141306	ERX	HCPCS 63700001	00006-3069-01	DORAVIRINE 100 MG PO TABS	BOTH IP/OP	$211.16 	$156.26	$0.00	$146.06		$0.00	$0.00	$0.00	$39.46	$0.00	$0.00	$0.00	$0.00	$0.00	$44.01	$0.00	$0.00	$0.00	$0.00	$91.29	$144.60	$146.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141425	ERX	HCPCS J0713	00264-3145-11	CEFTAZIDIME AND DEXTROSE 2-5 GM-%(50ML) IV SOLR	BOTH IP/OP	$101.86 	$75.38	$0.00	$78.51		$0.00	$0.00	$0.00	$0.00	$0.00	$75.60	$75.60	$78.51	$0.00	$21.23	$0.00	$0.00	$0.00	$0.00	$46.18	$73.15	$73.89	$0.00		$0.00	$14.45	$0.00	$0.00	$14.70	$0.00	$0.00	$0.00	$0.00	$0.00
141430	ERX	HCPCS J0690	00264-3105-11	CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR	BOTH IP/OP	$64.21 	$47.52	$0.00	$49.49	$28.89	$28.89	$0.00	$0.00	$0.00	$2.77	$47.66	$47.66	$49.49	$0.00	$3.51	$0.00	$37.98	$37.98	$0.00	$29.12	$46.12	$46.58	$0.00		$0.00	$3.85	$0.00	$0.00	$3.67	$0.00	$0.00	$0.00	$0.00	$0.00
141478	ERX	HCPCS J9119	61755-0008-01	CEMIPLIMAB-RWLC 350 MG/7ML IV SOLN	BOTH IP/OP	"$25,550.40 "	"$18,907.30"	$0.00	"$19,694.25"	"$11,497.68"	"$11,497.68"	"$9,685.90"	"$9,685.90"	"$9,685.90"	"$5,325.34"	"$18,963.51"	"$18,963.51"	"$19,694.25"	"$9,639.70"	"$11,326.65"	"$6,265.81"	"$12,596.35"	"$12,596.35"	"$10,086.77"	"$11,193.00"	"$17,729.71"	"$17,908.80"	"$13,929.35"		"$13,929.35"	"$8,138.89"	$0.00	$0.00	"$8,138.89"	"$9,606.45"	$0.00	$0.00	$0.00	$0.00
141582	ERX	HCPCS 25000001	00069-0296-30	TALAZOPARIB TOSYLATE 0.25 MG PO CAPS	BOTH IP/OP	"$2,242.16 "	"$1,659.20"	$0.00	"$1,728.26"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,664.13"	"$1,664.13"	"$1,728.26"	$0.00	$467.27	$0.00	$0.00	$0.00	$0.00	$979.78	"$1,551.97"	"$1,567.65"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141584	ERX	HCPCS 25000001	00069-1195-30	TALAZOPARIB TOSYLATE 1 MG PO CAPS	BOTH IP/OP	"$1,681.61 "	"$1,244.39"	$0.00	"$1,296.18"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,248.09"	"$1,248.09"	"$1,296.18"	$0.00	$350.45	$0.00	$0.00	$0.00	$0.00	$734.84	"$1,163.98"	"$1,175.74"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141712	ERX	HCPCS 63700001	00069-0227-01	LORLATINIB 25 MG PO TABS	BOTH IP/OP	$727.09 	$538.05	$0.00	$476.54		$0.00	$0.00	$0.00	$129.42	$0.00	$0.00	$0.00	$0.00	$0.00	$151.53	$0.00	$0.00	$0.00	$0.00	$297.84	$471.78	$476.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
141713	ERX	HCPCS 63700001	00069-0231-01	LORLATINIB 100 MG PO TABS	BOTH IP/OP	"$1,934.75 "	"$1,431.72"	$0.00	"$1,294.74"		$0.00	$0.00	$0.00	$344.39	$0.00	$0.00	$0.00	$0.00	$0.00	$403.20	$0.00	$0.00	$0.00	$0.00	$809.22	"$1,281.80"	"$1,294.74"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
142188	ERX	HCPCS 63700001	00173-0889-39	TAFENOQUINE SUCCINATE 150 MG PO TABS	BOTH IP/OP	$80.45 	$59.53	$0.00	$58.37		$0.00	$0.00	$0.00	$14.32	$0.00	$0.00	$0.00	$0.00	$0.00	$16.77	$0.00	$0.00	$0.00	$0.00	$36.48	$57.78	$58.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
142198	ERX	HCPCS Q5111	70114-0101-01	PEGFILGRASTIM-CBQV 6 MG/0.6ML SC SOSY	BOTH IP/OP	"$11,322.60 "	"$8,378.72"	$0.00	"$8,727.46"	"$5,095.17"	"$5,095.17"	"$2,425.19"	"$2,425.19"	"$2,425.19"	"$2,359.91"	"$8,403.63"	"$8,403.63"	"$8,727.46"	"$2,668.50"	"$3,135.49"	"$1,734.53"	"$5,582.04"	"$5,582.04"	"$4,372.91"	"$5,135.25"	"$8,134.24"	"$8,216.40"	"$6,038.77"		"$6,038.77"	"$4,744.93"	$0.00	$0.00	"$4,517.98"	"$4,164.67"	$0.00	$0.00	$0.00	$0.00
142286	ERX	HCPCS 25000001	67684-1901-02	LIPIODOL IJ OIL	BOTH IP/OP	$400.41 	$296.30	$0.00	$358.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.00	$317.12	$358.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
142324	ERX	HCPCS J3490	00169-2662-11	INSULIN DEGLUDEC 100 UNIT/ML SC SOLN	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$2.61	$0.00	$0.00	$0.00	$0.00	$2.61	$0.00	$7.39	$7.39	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$0.00	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
142346	ERX	HCPCS 63700001	00078-0972-61	ELTROMBOPAG OLAMINE 12.5 MG PO PACK	BOTH IP/OP	$658.79 	$487.50	$0.00	$447.02		$0.00	$0.00	$0.00	$125.47	$0.00	$0.00	$0.00	$0.00	$0.00	$137.29	$0.00	$0.00	$0.00	$0.00	$279.39	$442.55	$447.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
142802	ERX	HCPCS C9047	58468-0225-01	CAPLACIZUMAB-YHDP 11 MG IJ KIT	BOTH IP/OP	"$19,797.60 "	"$14,650.22"	$0.00	"$15,870.39"		$0.00	$0.00	$0.00	$0.00	$0.00	"$15,281.53"	"$15,281.53"	"$15,870.39"	$0.00	"$4,125.82"	$0.00	$0.00	$0.00	$0.00	"$8,979.00"	"$14,222.74"	"$14,366.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143112	ERX	HCPCS J0780	00641-6135-25	PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN	BOTH IP/OP	$46.51 	$34.42	$0.00	$35.85	$20.93	$20.93	$0.00	$0.00	$0.00	$2.40	$34.52	$34.52	$35.85	$0.00	$5.57	$0.00	$27.51	$27.51	$0.00	$21.09	$33.41	$33.74	$0.00		$0.00	$10.15	$0.00	$0.00	$9.67	$0.00	$0.00	$0.00	$0.00	$0.00
143112	ERX	HCPCS J0780	23155-0294-41	PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN	BOTH IP/OP	$46.51 	$34.42	$0.00	$35.85	$20.93	$20.93	$0.00	$0.00	$0.00	$2.40	$34.52	$34.52	$35.85	$0.00	$5.57	$0.00	$27.51	$27.51	$0.00	$21.09	$33.41	$33.74	$0.00		$0.00	$10.15	$0.00	$0.00	$9.67	$0.00	$0.00	$0.00	$0.00	$0.00
143112	ERX	HCPCS J0780	23155-0294-42	PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN	BOTH IP/OP	$46.51 	$34.42	$0.00	$35.85	$20.93	$20.93	$0.00	$0.00	$0.00	$2.40	$34.52	$34.52	$35.85	$0.00	$5.57	$0.00	$27.51	$27.51	$0.00	$21.09	$33.41	$33.74	$0.00		$0.00	$10.15	$0.00	$0.00	$9.67	$0.00	$0.00	$0.00	$0.00	$0.00
143112	ERX	HCPCS J0780	23155-0497-42	PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN	BOTH IP/OP	$46.51 	$34.42	$0.00	$35.85	$20.93	$20.93	$0.00	$0.00	$0.00	$2.40	$34.52	$34.52	$35.85	$0.00	$5.57	$0.00	$27.51	$27.51	$0.00	$21.09	$33.41	$33.74	$0.00		$0.00	$10.15	$0.00	$0.00	$9.67	$0.00	$0.00	$0.00	$0.00	$0.00
143112	ERX	HCPCS J0780	67457-0640-00	PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN	BOTH IP/OP	$46.51 	$34.42	$0.00	$35.85	$20.93	$20.93	$0.00	$0.00	$0.00	$2.40	$34.52	$34.52	$35.85	$0.00	$5.57	$0.00	$27.51	$27.51	$0.00	$21.09	$33.41	$33.74	$0.00		$0.00	$10.15	$0.00	$0.00	$9.67	$0.00	$0.00	$0.00	$0.00	$0.00
143112	ERX	HCPCS J0780	67457-0640-02	PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN	BOTH IP/OP	$46.51 	$34.42	$0.00	$35.85	$20.93	$20.93	$0.00	$0.00	$0.00	$2.40	$34.52	$34.52	$35.85	$0.00	$5.57	$0.00	$27.51	$27.51	$0.00	$21.09	$33.41	$33.74	$0.00		$0.00	$10.15	$0.00	$0.00	$9.67	$0.00	$0.00	$0.00	$0.00	$0.00
143120	ERX	HCPCS J1190	47781-0578-07	DEXRAZOXANE HCL 500 MG IV SOLR	BOTH IP/OP	"$1,352.93 "	"$1,001.17"	$0.00	"$1,082.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$676.47	"$1,071.52"	"$1,082.34"	$0.00		$0.00	$0.00	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
143121	ERX	HCPCS J2426	50458-0560-01	PALIPERIDONE PALMITATE ER 39 MG/0.25ML IM SUSY	BOTH IP/OP	"$1,522.82 "	"$1,126.89"	$0.00	"$1,237.20"		$0.00	$0.00	$0.00	$0.00	$317.39	"$1,191.29"	"$1,191.29"	"$1,237.20"	$493.86	$580.28	$321.01	$900.75	$900.75	$476.25	$673.25	"$1,066.43"	"$1,077.20"	$657.68		$657.68	$530.65	$0.00	$0.00	$505.27	$469.17	$0.00	$0.00	$0.00	$0.00
143122	ERX	HCPCS J2426	50458-0561-01	PALIPERIDONE PALMITATE ER 78 MG/0.5ML IM SUSY	BOTH IP/OP	"$2,657.67 "	"$1,966.68"	$0.00	"$2,159.17"		$0.00	$0.00	$0.00	$0.00	$553.92	"$2,079.06"	"$2,079.06"	"$2,159.17"	$987.71	"$1,160.56"	$642.01	"$1,310.23"	"$1,310.23"	$952.50	"$1,150.17"	"$1,821.86"	"$1,840.26"	"$1,315.35"		"$1,315.35"	"$1,061.31"	$0.00	$0.00	"$1,010.54"	$938.34	$0.00	$0.00	$0.00	$0.00
143139	ERX	HCPCS 25000001	76329-3390-01	LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143140	ERX	HCPCS 25000001	00409-1323-05	LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOSY	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143142	ERX	HCPCS 90636	58160-0815-52	HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY	BOTH IP/OP	$469.89 	$347.72	$0.00	$362.19	$211.45	$211.45	$0.00	$0.00	$0.00	$107.88	$348.75	$348.75	$362.19	$0.00	$132.01	$0.00	$277.94	$277.94	$0.00	$199.25	$315.60	$318.79	$0.00		$0.00	$122.20	$0.00	$0.00	$116.36	$0.00	$0.00	$0.00	$0.00	$0.00
143143	ERX	HCPCS J0897	55513-0710-01	DENOSUMAB 60 MG/ML SC SOSY	BOTH IP/OP	"$3,672.71 "	"$2,717.81"	$0.00	"$2,997.95"	"$1,750.23"	"$1,750.23"	"$1,272.30"	"$1,272.30"	"$1,272.30"	$765.48	"$2,886.71"	"$2,886.71"	"$2,997.95"	"$1,271.34"	"$1,493.82"	$826.37	"$1,810.65"	"$1,810.65"	"$1,214.39"	"$1,572.92"	"$2,491.50"	"$2,516.66"	"$1,677.01"		"$1,677.01"	"$1,359.24"	$0.00	$0.00	"$1,294.23"	"$1,194.06"	$0.00	$0.00	$0.00	$0.00
143147	ERX	HCPCS 63600001	64193-0426-02	ANTIINHIBITOR COAGULANT CMPLX 500 UNITS IV SOLR	BOTH IP/OP	"$3,051.00 "	"$2,257.74"	$0.00	"$2,351.71"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,264.45"	"$2,264.45"	"$2,351.71"	$0.00	$635.83	$0.00	$0.00	$0.00	$0.00	"$1,383.75"	"$2,191.86"	"$2,214.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143148	ERX	HCPCS J7198	64193-0324-01	ANTIINHIBITOR COAGULANT CMPLX 1000 UNITS IV SOLR	BOTH IP/OP	"$6,102.00 "	"$4,515.48"	$0.00	"$4,703.42"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,528.90"	"$4,528.90"	"$4,703.42"	$0.00	"$1,271.66"	$0.00	$0.00	$0.00	$0.00	"$2,767.50"	"$4,383.72"	"$4,428.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143148	ERX	HCPCS J7198	64193-0424-02	ANTIINHIBITOR COAGULANT CMPLX 1000 UNITS IV SOLR	BOTH IP/OP	"$6,102.00 "	"$4,515.48"	$0.00	"$4,703.42"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,528.90"	"$4,528.90"	"$4,703.42"	$0.00	"$1,271.66"	$0.00	$0.00	$0.00	$0.00	"$2,767.50"	"$4,383.72"	"$4,428.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143149	ERX	HCPCS J7198	64193-0325-01	ANTIINHIBITOR COAGULANT CMPLX 2500 UNITS IV SOLR	BOTH IP/OP	"$15,255.00 "	"$11,288.70"	$0.00	"$11,758.55"		$0.00	$0.00	$0.00	$0.00	$0.00	"$11,322.26"	"$11,322.26"	"$11,758.55"	$0.00	"$3,179.14"	$0.00	$0.00	$0.00	$0.00	"$6,918.75"	"$10,959.30"	"$11,070.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143149	ERX	HCPCS J7198	64193-0425-02	ANTIINHIBITOR COAGULANT CMPLX 2500 UNITS IV SOLR	BOTH IP/OP	"$15,255.00 "	"$11,288.70"	$0.00	"$11,758.55"		$0.00	$0.00	$0.00	$0.00	$0.00	"$11,322.26"	"$11,322.26"	"$11,758.55"	$0.00	"$3,179.14"	$0.00	$0.00	$0.00	$0.00	"$6,918.75"	"$10,959.30"	"$11,070.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143152	ERX	HCPCS 25000001	17478-0711-10	LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX GEL	BOTH IP/OP	$35.20 	$26.05	$0.00	$50.71		$0.00	$0.00	$0.00	$0.00	$0.00	$26.13	$26.13	$27.13	$0.00	$7.34	$0.00	$0.00	$0.00	$0.00	$31.70	$25.28	$50.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143152	ERX	HCPCS 25000001	17478-0711-31	LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX GEL	BOTH IP/OP	$35.20 	$26.05	$0.00	$50.71		$0.00	$0.00	$0.00	$0.00	$0.00	$26.13	$26.13	$27.13	$0.00	$7.34	$0.00	$0.00	$0.00	$0.00	$31.70	$25.28	$50.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143152	ERX	HCPCS 25000001	17478-0711-30	LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX GEL	BOTH IP/OP	$35.20 	$26.05	$0.00	$50.71		$0.00	$0.00	$0.00	$0.00	$0.00	$26.13	$26.13	$27.13	$0.00	$7.34	$0.00	$0.00	$0.00	$0.00	$31.70	$50.20	$50.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143153	ERX	HCPCS J1644	00264-9872-10	HEPARIN (PORCINE) IN NACL 1000-0.9 UT/500ML-% IV SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.24	$16.33	$16.33	$16.96	$0.00	$0.29	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
143157	ERX	HCPCS J3370	70594-0042-03	VANCOMYCIN HCL 1000 MG/200ML IV SOLN	BOTH IP/OP	$80.45 	$59.53	$0.00	$100.80	$36.20	$36.20	$0.00	$0.00	$0.00	$7.24	$59.71	$59.71	$62.01	$0.00	$6.68	$0.00	$47.59	$47.59	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$7.97	$0.00	$0.00	$7.59	$0.00	$0.00	$0.00	$0.00	$0.00
143158	ERX	HCPCS J3370	70594-0043-02	VANCOMYCIN HCL 1500 MG/300ML IV SOLN	BOTH IP/OP	$106.54 	$78.84	$0.00	$136.08	$47.94	$47.94	$0.00	$0.00	$0.00	$10.86	$79.07	$79.07	$82.12	$0.00	$10.02	$0.00	$63.02	$63.02	$0.00	$85.05	$134.72	$136.08	$0.00		$0.00	$11.95	$0.00	$0.00	$11.38	$0.00	$0.00	$0.00	$0.00	$0.00
143187	ERX	HCPCS 25000001	99999-6005-85	PYRIDOSTIGMINE BROMIDE 60 MG/5ML PO SOLN	BOTH IP/OP	"$4,078.16 "	"$3,017.84"	$0.00	"$3,143.45"		$0.00	$0.00	$0.00	$0.00	$0.00	"$3,026.81"	"$3,026.81"	"$3,143.45"	$0.00	$849.89	$0.00	$0.00	$0.00	$0.00	$20.18	$31.97	$32.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143187	ERX	HCPCS 25000001	00187-3012-20	PYRIDOSTIGMINE BROMIDE 60 MG/5ML PO SOLN	BOTH IP/OP	"$4,078.16 "	"$3,017.84"	$0.00	"$3,143.45"		$0.00	$0.00	$0.00	$0.00	$0.00	"$3,026.81"	"$3,026.81"	"$3,143.45"	$0.00	$849.89	$0.00	$0.00	$0.00	$0.00	$20.18	"$2,561.16"	$32.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143206	ERX	HCPCS J9022	50242-0918-01	ATEZOLIZUMAB 840 MG/14ML IV SOLN	BOTH IP/OP	"$17,977.57 "	"$13,303.40"	$0.00	"$14,411.40"	"$8,413.51"	"$8,413.51"	"$6,684.38"	"$6,684.38"	"$6,684.38"	"$3,746.98"	"$13,876.68"	"$13,876.68"	"$14,411.40"	"$6,698.92"	"$7,871.23"	"$4,354.30"	"$8,862.94"	"$8,862.94"	"$6,792.11"	"$7,916.05"	"$12,539.02"	"$12,665.68"	"$9,379.57"		"$9,379.57"	"$7,684.78"	$0.00	$0.00	"$7,317.22"	"$6,468.67"	$0.00	$0.00	$0.00	$0.00
143520	ERX	HCPCS 63700001	49702-0246-13	DOVATO:DOLUTEGRAVIR-LAMIVUDINE 50-300 MG PO TABS	BOTH IP/OP	$356.46 	$263.78	$0.00	$242.77		$0.00	$0.00	$0.00	$63.45	$0.00	$0.00	$0.00	$0.00	$0.00	$74.29	$0.00	$0.00	$0.00	$0.00	$151.73	$240.34	$242.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144008	ERX	HCPCS J9309	50242-0105-01	POLATUZUMAB VEDOTIN-PIIQ 140 MG IV SOLR	BOTH IP/OP	"$40,680.00 "	"$30,103.20"	$0.00	"$32,610.39"		$0.00	$0.00	$0.00	$0.00	$0.00	"$31,400.40"	"$31,400.40"	"$32,610.39"	$0.00	"$18,682.43"	$0.00	$0.00	$0.00	$0.00	"$18,450.00"	"$29,224.80"	"$29,520.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144263	ERX	HCPCS Q5107	55513-0206-01	BEVACIZUMAB-AWWB 100 MG/4ML IV SOLN	BOTH IP/OP	"$2,168.56 "	"$1,604.73"	$0.00	"$1,671.53"	$975.85	$975.85	$397.68	$397.68	$397.68	$451.98	"$1,609.51"	"$1,609.51"	"$1,671.53"	$445.57	$523.54	$289.62	"$1,069.10"	"$1,069.10"	$0.00	$975.46	"$1,545.13"	"$1,560.74"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144264	ERX	HCPCS Q5107	55513-0207-01	BEVACIZUMAB-AWWB 400 MG/16ML IV SOLN	BOTH IP/OP	"$7,568.91 "	"$5,600.99"	$0.00	"$5,834.12"	"$3,406.01"	"$3,406.01"	"$1,590.72"	"$1,590.72"	"$1,590.72"	"$1,577.55"	"$5,617.65"	"$5,617.65"	"$5,834.12"	"$1,782.28"	"$2,094.18"	"$1,158.48"	"$3,731.47"	"$3,731.47"	$0.00	"$3,332.81"	"$5,279.17"	"$5,332.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144270	ERX	HCPCS J3370	70594-0044-02	VANCOMYCIN HCL 2000 MG/400ML IV SOLN	BOTH IP/OP	$129.70 	$95.98	$0.00	$181.44	$58.37	$58.37	$0.00	$0.00	$0.00	$14.48	$96.26	$96.26	$99.97	$0.00	$13.36	$0.00	$76.72	$76.72	$0.00	$113.40	$179.63	$181.44	$0.00		$0.00	$15.93	$0.00	$0.00	$15.17	$0.00	$0.00	$0.00	$0.00	$0.00
144275	ERX	HCPCS Q5117	55513-0132-01	TRASTUZUMAB-ANNS 420 MG IV SOLR	BOTH IP/OP	"$10,327.80 "	"$7,642.57"	$0.00	"$7,960.67"	"$4,647.51"	"$4,647.51"	"$1,991.18"	"$1,991.18"	"$1,991.18"	"$2,152.57"	"$7,665.29"	"$7,665.29"	"$7,960.67"	"$2,233.69"	"$2,624.58"	"$1,451.90"	"$5,091.61"	"$5,091.61"	$0.00	"$4,547.63"	"$7,203.45"	"$7,276.21"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144426	ERX	HCPCS 63700001	24338-0124-03	ERYTHROMYCIN 333 MG PO TBEC	BOTH IP/OP	$44.26 	$32.75	$0.00	$32.11		$0.00	$0.00	$0.00	$7.88	$0.00	$0.00	$0.00	$0.00	$0.00	$9.22	$0.00	$0.00	$0.00	$0.00	$20.07	$31.79	$32.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144426	ERX	HCPCS 63700001	24338-0124-13	ERYTHROMYCIN 333 MG PO TBEC	BOTH IP/OP	$44.26 	$32.75	$0.00	$32.11		$0.00	$0.00	$0.00	$7.88	$0.00	$0.00	$0.00	$0.00	$0.00	$9.22	$0.00	$0.00	$0.00	$0.00	$20.07	$31.79	$32.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144426	ERX	HCPCS 63700001	52536-0183-03	ERYTHROMYCIN 333 MG PO TBEC	BOTH IP/OP	$44.26 	$32.75	$0.00	$32.11		$0.00	$0.00	$0.00	$7.88	$0.00	$0.00	$0.00	$0.00	$0.00	$9.22	$0.00	$0.00	$0.00	$0.00	$20.07	$31.79	$32.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144767	ERX	HCPCS 25000001	50383-0261-61	DORZOLAMIDE HCL-TIMOLOL MAL PF 2-0.5 % OP SOLN	BOTH IP/OP	$163.57 	$121.04	$0.00	$126.08		$0.00	$0.00	$0.00	$0.00	$0.00	$121.40	$121.40	$126.08	$0.00	$34.09	$0.00	$0.00	$0.00	$0.00	$74.16	$117.47	$118.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144767	ERX	HCPCS 25000001	65862-0947-15	DORZOLAMIDE HCL-TIMOLOL MAL PF 2-0.5 % OP SOLN	BOTH IP/OP	$163.57 	$121.04	$0.00	$126.08		$0.00	$0.00	$0.00	$0.00	$0.00	$121.40	$121.40	$126.08	$0.00	$34.09	$0.00	$0.00	$0.00	$0.00	$74.16	$117.47	$118.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144767	ERX	HCPCS 25000001	65862-0947-60	DORZOLAMIDE HCL-TIMOLOL MAL PF 2-0.5 % OP SOLN	BOTH IP/OP	$163.57 	$121.04	$0.00	$126.08		$0.00	$0.00	$0.00	$0.00	$0.00	$121.40	$121.40	$126.08	$0.00	$34.09	$0.00	$0.00	$0.00	$0.00	$74.16	$117.47	$118.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144934	ERX	HCPCS 90707	00006-4681-00	"MEASLES, MUMPS & RUBELLA VAC IJ SOLR"	BOTH IP/OP	$350.54 	$259.40	$0.00	$270.20	$157.74	$157.74	$0.00	$0.00	$0.00	$11.75	$260.17	$260.17	$270.20	$0.00	$102.59	$0.00	$207.34	$207.34	$0.00	$148.00	$234.42	$236.79	$0.00		$0.00	$92.45	$0.00	$0.00	$88.03	$0.00	$0.00	$0.00	$0.00	$0.00
144934	ERX	HCPCS 90707	00006-4681-01	"MEASLES, MUMPS & RUBELLA VAC IJ SOLR"	BOTH IP/OP	$350.54 	$259.40	$0.00	$270.20	$157.74	$157.74	$0.00	$0.00	$0.00	$11.75	$260.17	$260.17	$270.20	$0.00	$102.59	$0.00	$207.34	$207.34	$0.00	$148.00	$234.42	$236.79	$0.00		$0.00	$92.45	$0.00	$0.00	$88.03	$0.00	$0.00	$0.00	$0.00	$0.00
144938	ERX	HCPCS 25000001	00078-0639-41	SECUKINUMAB (300 MG DOSE) 150 MG/ML SC SOAJ	BOTH IP/OP	"$8,040.18 "	"$5,949.73"	$0.00	"$6,631.18"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$6,631.18"	$0.00	"$1,675.57"	$0.00	$0.00	$0.00	$0.00	"$3,407.99"	"$5,398.25"	"$5,452.78"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144946	ERX	HCPCS J2794	50458-0306-11	RISPERIDONE MICROSPHERES ER 25 MG IM SRER	BOTH IP/OP	"$1,656.28 "	"$1,225.65"	$0.00	"$1,339.21"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,289.52"	"$1,289.52"	"$1,339.21"	$0.00	$648.72	$0.00	$0.00	$0.00	$0.00	$732.24	"$1,159.87"	"$1,171.58"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144962	ERX	HCPCS 25000001	00409-4888-01	SODIUM CHLORIDE (PF) 0.9 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144962	ERX	HCPCS 25000001	00409-4888-10	SODIUM CHLORIDE (PF) 0.9 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144962	ERX	HCPCS 25000001	00409-4888-12	SODIUM CHLORIDE (PF) 0.9 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144962	ERX	HCPCS 25000001	63323-0186-01	SODIUM CHLORIDE (PF) 0.9 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144962	ERX	HCPCS 25000001	63323-0186-10	SODIUM CHLORIDE (PF) 0.9 % IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145128	ERX	HCPCS 63700001	99999-6009-67	ERGOCALCIFEROL 8000 UNIT/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145128	ERX	HCPCS 63700001	00091-4150-60	ERGOCALCIFEROL 8000 UNIT/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$248.93		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$248.93	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145128	ERX	HCPCS 63700001	39328-0357-60	ERGOCALCIFEROL 8000 UNIT/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$248.93		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$248.93	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145128	ERX	HCPCS 63700001	69543-0234-60	ERGOCALCIFEROL 8000 UNIT/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$248.93		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$248.93	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145128	ERX	HCPCS 63700001	75834-0010-60	ERGOCALCIFEROL 8000 UNIT/ML PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$248.93		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$248.93	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145154	ERX	HCPCS 25000001	76329-3011-05	LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY	BOTH IP/OP	$32.23 	$23.85	$0.00	$24.84		$0.00	$0.00	$0.00	$0.00	$0.00	$23.92	$23.92	$24.84	$0.00	$6.72	$0.00	$0.00	$0.00	$0.00	$14.62	$20.77	$23.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145154	ERX	HCPCS 25000001	76329-3012-05	LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY	BOTH IP/OP	$32.23 	$23.85	$0.00	$24.84		$0.00	$0.00	$0.00	$0.00	$0.00	$23.92	$23.92	$24.84	$0.00	$6.72	$0.00	$0.00	$0.00	$0.00	$14.62	$20.77	$23.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145154	ERX	HCPCS 25000001	76329-3013-05	LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY	BOTH IP/OP	$32.23 	$23.85	$0.00	$24.84		$0.00	$0.00	$0.00	$0.00	$0.00	$23.92	$23.92	$24.84	$0.00	$6.72	$0.00	$0.00	$0.00	$0.00	$14.62	$23.15	$23.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145230	ERX	HCPCS 25000001	00087-0866-44	CHOLECALCIFEROL 400 UNIT/ML PO LIQD	BOTH IP/OP	$96.50 	$71.41	$0.00	$74.38		$0.00	$0.00	$0.00	$0.00	$0.00	$71.62	$71.62	$74.38	$0.00	$20.11	$0.00	$0.00	$0.00	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145230	ERX	HCPCS 25000001	54838-0006-50	CHOLECALCIFEROL 400 UNIT/ML PO LIQD	BOTH IP/OP	$96.50 	$71.41	$0.00	$74.38		$0.00	$0.00	$0.00	$0.00	$0.00	$71.62	$71.62	$74.38	$0.00	$20.11	$0.00	$0.00	$0.00	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145469	ERX	HCPCS q5114	67457-0847-44	TRASTUZUMAB-DKST 420 MG IV SOLR	BOTH IP/OP	"$10,026.97 "	"$7,419.96"	$0.00	"$7,728.79"		$0.00	$0.00	$0.00	$0.00	$0.00	"$7,442.02"	"$7,442.02"	"$7,728.79"	$0.00	"$2,089.62"	$0.00	$0.00	$0.00	$0.00	"$4,547.63"	"$7,203.45"	"$7,276.21"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145473	ERX	HCPCS Q5114	67457-0991-15	TRASTUZUMAB-DKST 150 MG IV SOLR	BOTH IP/OP	"$3,592.48 "	"$2,658.44"	$0.00	"$2,769.08"	"$1,616.62"	"$1,616.62"	$835.73	$835.73	$835.73	$748.76	"$2,666.34"	"$2,666.34"	"$2,769.08"	$898.59	"$1,055.84"	$584.08	"$1,771.09"	"$1,771.09"	$0.00	"$1,629.33"	"$2,580.86"	"$2,606.93"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145641	ERX	HCPCS Q5117	55513-0141-01	TRASTUZUMAB-ANNS 150 MG IV SOLR	BOTH IP/OP	"$3,688.51 "	"$2,729.50"	$0.00	"$2,843.10"	"$1,659.83"	"$1,659.83"	$711.14	$711.14	$711.14	$768.78	"$2,737.61"	"$2,737.61"	"$2,843.10"	$797.75	$937.35	$518.53	"$1,818.44"	"$1,818.44"	$0.00	"$1,624.16"	"$2,572.66"	"$2,598.65"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145743	ERX	HCPCS Q5115	63459-0103-10	RITUXIMAB-ABBS 100 MG/10ML IV SOLN	BOTH IP/OP	"$2,293.14 "	"$1,696.92"	$0.00	"$1,767.55"	"$1,031.91"	"$1,031.91"	$573.47	$573.47	$573.47	$477.95	"$1,701.97"	"$1,701.97"	"$1,767.55"	$605.77	$711.78	$393.75	"$1,130.52"	"$1,130.52"	$0.00	"$1,040.03"	"$1,647.41"	"$1,664.05"	$0.00		$0.00	$325.53	$0.00	$0.00	$331.15	$0.00	$0.00	$0.00	$0.00	$0.00
145744	ERX	HCPCS Q5115	63459-0104-50	RITUXIMAB-ABBS 500 MG/50ML IV SOLN	BOTH IP/OP	"$11,465.66 "	"$8,484.59"	$0.00	"$8,837.73"	"$5,159.55"	"$5,159.55"	"$2,867.35"	"$2,867.35"	"$2,867.35"	"$2,389.73"	"$8,509.81"	"$8,509.81"	"$8,837.73"	"$3,028.85"	"$3,558.90"	"$1,968.75"	"$5,652.57"	"$5,652.57"	$0.00	"$5,200.14"	"$8,237.01"	"$8,320.22"	$0.00		$0.00	"$1,627.64"	$0.00	$0.00	"$1,655.72"	$0.00	$0.00	$0.00	$0.00	$0.00
145824	ERX	HCPCS C9053	00078-0883-61	CRIZANLIZUMAB-TMCA 100 MG/10ML IV SOLN	BOTH IP/OP	"$6,488.83 "	"$4,801.73"	$0.00	"$5,039.07"	"$2,941.86"	"$2,941.86"	"$2,482.44"	"$2,482.44"	"$2,482.44"	"$1,352.43"	"$4,852.10"	"$4,852.10"	"$5,039.07"	"$2,465.82"	"$2,897.34"	"$1,602.78"	"$3,198.99"	"$3,198.99"	$0.00	"$2,899.29"	"$4,592.47"	"$4,638.86"	$0.00		$0.00	$907.48	$0.00	$0.00	$923.13	$0.00	$0.00	$0.00	$0.00	$0.00
146009	ERX	HCPCS 25000001	44677-0102-02	LANSINOH LANOLIN EX CREA	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
146059	ERX	HCPCS J9177	51144-0020-01	ENFORTUMAB VEDOTIN-EJFV 20 MG IV SOLR	BOTH IP/OP	"$6,413.88 "	"$4,746.27"	$0.00	"$4,943.82"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$4,943.82"	$0.00	"$1,336.65"	$0.00	$0.00	$0.00	$0.00	"$2,696.16"	"$4,110.96"	"$4,313.86"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
146060	ERX	HCPCS J9177	51144-0030-01	ENFORTUMAB VEDOTIN-EJFV 30 MG IV SOLR	BOTH IP/OP	"$9,620.82 "	"$7,119.41"	$0.00	"$7,415.73"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	"$7,415.73"	$0.00	"$2,004.98"	$0.00	$0.00	$0.00	$0.00	"$4,044.24"	"$6,166.43"	"$6,470.78"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
146089	ERX	HCPCS J9358	65597-0406-01	FAM-TRASTUZUMAB DERUXTEC-NXKI 100 MG IV SOLR	BOTH IP/OP	"$6,414.88 "	"$4,747.01"	$0.00	"$5,068.20"	"$2,958.86"	"$2,958.86"	"$2,460.00"	"$2,460.00"	"$2,460.00"	"$1,337.02"	"$4,880.15"	"$4,880.15"	"$5,068.20"	"$2,426.70"	"$2,851.37"	"$1,577.36"	"$3,162.54"	"$3,162.54"	$0.00	"$2,824.04"	"$4,473.28"	"$4,518.46"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
146213	ERX	HCPCS Q5118	00069-0315-01	BEVACIZUMAB-BVZR 100 MG/4ML IV SOLN	BOTH IP/OP	"$1,906.45 "	"$1,410.77"	$0.00	"$1,469.49"	$857.90	$857.90	$505.89	$505.89	$505.89	$397.35	"$1,414.97"	"$1,414.97"	"$1,469.49"	$523.69	$615.34	$340.40	$939.88	$939.88	$0.00	$883.30	"$1,399.15"	"$1,413.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
146214	ERX	HCPCS Q5118	00069-0342-01	BEVACIZUMAB-BVZR 400 MG/16ML IV SOLN	BOTH IP/OP	"$6,654.17 "	"$4,924.09"	$0.00	"$5,129.03"	"$2,994.38"	"$2,994.38"	"$2,023.56"	"$2,023.56"	"$2,023.56"	"$1,386.90"	"$4,938.72"	"$4,938.72"	"$5,129.03"	"$2,094.76"	"$2,461.34"	"$1,361.59"	"$3,280.51"	"$3,280.51"	$0.00	"$3,017.93"	"$4,780.40"	"$4,828.69"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
146561	ERX	HCPCS J3490	59630-0266-01	CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR	BOTH IP/OP	$573.81 	$424.62	$0.00	$442.29		$0.00	$0.00	$0.00	$0.00	$0.00	$425.88	$425.88	$442.29	$0.00	$119.58	$0.00	$0.00	$0.00	$0.00	$251.63	$398.57	$402.60	$0.00		$0.00	$78.76	$0.00	$0.00	$80.12	$0.00	$0.00	$0.00	$0.00	$0.00
146561	ERX	HCPCS J3490	59630-0266-10	CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR	BOTH IP/OP	$573.81 	$424.62	$0.00	$442.29		$0.00	$0.00	$0.00	$0.00	$0.00	$425.88	$425.88	$442.29	$0.00	$119.58	$0.00	$0.00	$0.00	$0.00	$251.63	$398.57	$402.60	$0.00		$0.00	$78.76	$0.00	$0.00	$80.12	$0.00	$0.00	$0.00	$0.00	$0.00
146761	ERX	HCPCS 25000001	00409-7295-01	POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN	BOTH IP/OP	$140.24 	$103.78	$0.00	$108.10		$0.00	$0.00	$0.00	$0.00	$0.00	$104.09	$104.09	$108.10	$0.00	$29.23	$0.00	$0.00	$0.00	$0.00	$33.24	$52.64	$53.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
146761	ERX	HCPCS 25000001	63323-0086-15	POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN	BOTH IP/OP	$140.24 	$103.78	$0.00	$108.10		$0.00	$0.00	$0.00	$0.00	$0.00	$104.09	$104.09	$108.10	$0.00	$29.23	$0.00	$0.00	$0.00	$0.00	$33.24	$52.64	$53.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147244	ERX	HCPCS Q5113	63459-0305-47	TRASTUZUMAB-PKRB 420 MG IV SOLR	BOTH IP/OP	"$10,650.03 "	"$7,881.02"	$0.00	"$8,209.04"		$0.00	$0.00	$0.00	$0.00	$0.00	"$7,904.45"	"$7,904.45"	"$8,209.04"	$0.00	"$2,827.90"	$0.00	$0.00	$0.00	$0.00	"$4,830.21"	"$7,651.05"	"$7,728.34"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147295	ERX	HCPCS Q5113	63459-0303-43	TRASTUZUMAB-PKRB 150 MG IV SOLR	BOTH IP/OP	"$3,803.58 "	"$2,814.65"	$0.00	"$2,931.80"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,823.02"	"$2,823.02"	"$2,931.80"	$0.00	"$1,009.97"	$0.00	$0.00	$0.00	$0.00	"$1,725.08"	"$2,732.52"	"$2,760.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147298	ERX	HCPCS J9155	55566-8403-01	DEGARELIX ACETATE(240 MG DOSE) 120 MG/VIAL SC SOLR	BOTH IP/OP	"$1,579.06 "	"$1,168.50"	$0.00	"$1,217.14"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,171.98"	"$1,171.98"	"$1,217.14"	$0.00	$387.28	$0.00	$0.00	$0.00	$0.00	$731.61	"$1,158.87"	"$1,170.58"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147299	ERX	HCPCS 25000001	39328-0064-12	SODIUM HYPOCHLORITE 0.125 % EX SOLN	BOTH IP/OP	$57.48 	$42.54	$0.00	$41.70		$0.00	$0.00	$0.00	$0.00	$0.00	$36.78	$36.78	$38.19	$0.00	$11.98	$0.00	$0.00	$0.00	$0.00	$26.07	$38.44	$41.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147300	ERX	HCPCS 25000001	39328-0063-25	SODIUM HYPOCHLORITE 0.25 % EX SOLN	BOTH IP/OP	$57.48 	$42.54	$0.00	$41.70		$0.00	$0.00	$0.00	$0.00	$0.00	$36.78	$36.78	$38.19	$0.00	$11.98	$0.00	$0.00	$0.00	$0.00	$26.07	$38.44	$41.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147301	ERX	HCPCS 25000001	39328-0062-50	SODIUM HYPOCHLORITE 0.5 % EX SOLN	BOTH IP/OP	$57.48 	$42.54	$0.00	$41.70		$0.00	$0.00	$0.00	$0.00	$0.00	$36.78	$36.78	$38.19	$0.00	$11.98	$0.00	$0.00	$0.00	$0.00	$26.07	$38.44	$41.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147303	ERX	HCPCS 25000001	00069-0284-03	PALBOCICLIB 75 MG PO TABS	BOTH IP/OP	"$2,068.13 "	"$1,530.42"	$0.00	"$1,594.11"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,534.97"	"$1,534.97"	"$1,594.11"	$0.00	$431.00	$0.00	$0.00	$0.00	$0.00	$853.68	"$1,352.22"	"$1,365.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147303	ERX	HCPCS 25000001	00069-0284-07	PALBOCICLIB 75 MG PO TABS	BOTH IP/OP	"$2,068.13 "	"$1,530.42"	$0.00	"$1,594.11"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,534.97"	"$1,534.97"	"$1,594.11"	$0.00	$431.00	$0.00	$0.00	$0.00	$0.00	$853.68	"$1,352.22"	"$1,365.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147304	ERX	HCPCS 25000001	00069-0486-03	PALBOCICLIB 100 MG PO TABS	BOTH IP/OP	"$2,068.13 "	"$1,530.42"	$0.00	"$1,594.11"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,534.97"	"$1,534.97"	"$1,594.11"	$0.00	$431.00	$0.00	$0.00	$0.00	$0.00	$853.68	"$1,352.22"	"$1,365.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147304	ERX	HCPCS 25000001	00069-0486-07	PALBOCICLIB 100 MG PO TABS	BOTH IP/OP	"$2,068.13 "	"$1,530.42"	$0.00	"$1,594.11"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,534.97"	"$1,534.97"	"$1,594.11"	$0.00	$431.00	$0.00	$0.00	$0.00	$0.00	$853.68	"$1,352.22"	"$1,365.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147305	ERX	HCPCS 25000001	00069-0688-03	PALBOCICLIB 125 MG PO TABS	BOTH IP/OP	"$2,068.13 "	"$1,530.42"	$0.00	"$1,594.11"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,534.97"	"$1,534.97"	"$1,594.11"	$0.00	$431.00	$0.00	$0.00	$0.00	$0.00	$853.68	"$1,352.22"	"$1,365.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147305	ERX	HCPCS 25000001	00069-0688-07	PALBOCICLIB 125 MG PO TABS	BOTH IP/OP	"$2,068.13 "	"$1,530.42"	$0.00	"$1,594.11"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,534.97"	"$1,534.97"	"$1,594.11"	$0.00	$431.00	$0.00	$0.00	$0.00	$0.00	$853.68	"$1,352.22"	"$1,365.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147467	ERX	HCPCS 25000001	62559-0430-01	HYDROCORTISONE (PERIANAL) 1 % EX CREA	BOTH IP/OP	$208.24 	$154.10	$0.00	$160.51		$0.00	$0.00	$0.00	$0.00	$0.00	$154.56	$154.56	$160.51	$0.00	$43.40	$0.00	$0.00	$0.00	$0.00	$94.52	$149.71	$151.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147467	ERX	HCPCS 25000001	64980-0302-30	HYDROCORTISONE (PERIANAL) 1 % EX CREA	BOTH IP/OP	$208.24 	$154.10	$0.00	$160.51		$0.00	$0.00	$0.00	$0.00	$0.00	$154.56	$154.56	$160.51	$0.00	$43.40	$0.00	$0.00	$0.00	$0.00	$94.52	$149.71	$151.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147467	ERX	HCPCS 25000001	65649-0501-30	HYDROCORTISONE (PERIANAL) 1 % EX CREA	BOTH IP/OP	$208.24 	$154.10	$0.00	$160.51		$0.00	$0.00	$0.00	$0.00	$0.00	$154.56	$154.56	$160.51	$0.00	$43.40	$0.00	$0.00	$0.00	$0.00	$94.52	$149.71	$151.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147827	ERX	HCPCS Q5112	00006-5033-02	TRASTUZUMAB-DTTB 150 MG IV SOLR	BOTH IP/OP	"$3,592.48 "	"$2,658.44"	$0.00	"$2,769.08"		$0.00	$0.00	$0.00	$0.00	$0.00	"$2,666.34"	"$2,666.34"	"$2,769.08"	$0.00	"$1,172.94"	$0.00	$0.00	$0.00	$0.00	"$1,629.33"	"$2,580.86"	"$2,606.93"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147869	ERX	HCPCS J3490	61958-2901-01	REMDESIVIR 100 MG IV SOLR	BOTH IP/OP	"$1,616.16 "	"$1,195.96"	$0.00	"$1,245.74"	$727.27	$727.27	$0.00	$0.00	$0.00	$336.85	"$1,199.51"	"$1,199.51"	"$1,245.74"	$0.00	$336.81	$0.00	$955.96	$955.96	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$238.42	$0.00	$0.00	$0.00	$0.00	$0.00
147917	ERX	HCPCS 63700001	24338-0230-05	NIMODIPINE 6 MG/ML PO SOLN	BOTH IP/OP	$180.55 	$133.61	$0.00	$137.33		$0.00	$0.00	$0.00	$32.14	$0.00	$0.00	$0.00	$0.00	$0.00	$37.63	$0.00	$0.00	$0.00	$0.00	$85.83	$135.95	$137.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147917	ERX	HCPCS 63700001	24338-0230-12	NIMODIPINE 6 MG/ML PO SOLN	BOTH IP/OP	$180.55 	$133.61	$0.00	$137.33		$0.00	$0.00	$0.00	$32.14	$0.00	$0.00	$0.00	$0.00	$0.00	$37.63	$0.00	$0.00	$0.00	$0.00	$85.83	$135.95	$137.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147933	ERX	HCPCS Q5112	00006-5034-02	TRASTUZUMAB-DTTB 420 MG IV SOLR	BOTH IP/OP	"$10,058.93 "	"$7,443.61"	$0.00	"$7,753.42"		$0.00	$0.00	$0.00	$0.00	$0.00	"$7,465.74"	"$7,465.74"	"$7,753.42"	$0.00	"$3,284.24"	$0.00	$0.00	$0.00	$0.00	"$4,562.13"	"$7,226.41"	"$7,299.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147956	ERX	HCPCS 25000001	51144-0001-60	TUCATINIB 50 MG PO TABS	BOTH IP/OP	$360.53 	$266.79	$0.00	$277.90		$0.00	$0.00	$0.00	$0.00	$0.00	$267.59	$267.59	$277.90	$0.00	$75.13	$0.00	$0.00	$0.00	$0.00	$144.90	$229.52	$231.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147957	ERX	HCPCS 25000001	51144-0002-12	TUCATINIB 150 MG PO TABS	BOTH IP/OP	$630.02 	$466.21	$0.00	$485.62		$0.00	$0.00	$0.00	$0.00	$0.00	$467.60	$467.60	$485.62	$0.00	$131.30	$0.00	$0.00	$0.00	$0.00	$282.13	$446.89	$451.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147957	ERX	HCPCS 25000001	51144-0002-60	TUCATINIB 150 MG PO TABS	BOTH IP/OP	$630.02 	$466.21	$0.00	$485.62		$0.00	$0.00	$0.00	$0.00	$0.00	$467.60	$467.60	$485.62	$0.00	$131.30	$0.00	$0.00	$0.00	$0.00	$282.13	$446.89	$451.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147974	ERX	HCPCS C9066	55135-0132-01	SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR	BOTH IP/OP	"$5,935.08 "	"$4,391.96"	$0.00	"$4,574.76"	"$2,670.79"	"$2,670.79"	"$2,250.58"	"$2,250.58"	"$2,250.58"	"$1,237.02"	"$4,405.02"	"$4,405.02"	"$4,574.76"	"$2,185.49"	"$2,567.95"	"$1,420.57"	"$2,925.99"	"$2,925.99"	$0.00	"$2,475.38"	"$3,920.99"	"$3,960.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
147993	ERX	HCPCS J2250	51754-9130-01	MIDAZOLAM HCL-SODIUM CHLORIDE 50-0.8 MG/50ML-% IV SOLN	BOTH IP/OP	$75.34 	$55.75	$0.00	$58.07	$33.90	$33.90	$0.00	$0.00	$0.00	$9.40	$55.92	$55.92	$58.07	$0.00	$7.58	$0.00	$44.56	$44.56	$0.00	$34.86	$55.22	$55.78	$0.00		$0.00	$7.05	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$0.00
147993	ERX	HCPCS J2250	51754-9130-05	MIDAZOLAM HCL-SODIUM CHLORIDE 50-0.8 MG/50ML-% IV SOLN	BOTH IP/OP	$75.34 	$55.75	$0.00	$58.07	$33.90	$33.90	$0.00	$0.00	$0.00	$9.40	$55.92	$55.92	$58.07	$0.00	$7.58	$0.00	$44.56	$44.56	$0.00	$34.86	$55.22	$55.78	$0.00		$0.00	$7.05	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$0.00
147994	ERX	HCPCS J2250	51754-9131-01	MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.8 MG/100ML-% IV SOLN	BOTH IP/OP	$116.91 	$86.51	$0.00	$90.11	$52.61	$52.61	$0.00	$0.00	$0.00	$18.80	$86.77	$86.77	$90.11	$0.00	$15.16	$0.00	$69.15	$69.15	$0.00	$53.70	$85.06	$85.92	$0.00		$0.00	$14.10	$0.00	$0.00	$13.43	$0.00	$0.00	$0.00	$0.00	$0.00
147994	ERX	HCPCS J2250	51754-9131-05	MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.8 MG/100ML-% IV SOLN	BOTH IP/OP	$116.91 	$86.51	$0.00	$90.11	$52.61	$52.61	$0.00	$0.00	$0.00	$18.80	$86.77	$86.77	$90.11	$0.00	$15.16	$0.00	$69.15	$69.15	$0.00	$53.70	$85.06	$85.92	$0.00		$0.00	$14.10	$0.00	$0.00	$13.43	$0.00	$0.00	$0.00	$0.00	$0.00
148482	ERX	HCPCS 25000001	70324-0326-03	SODIUM BICARBONATE-DEXTROSE 150-5 MEQ/L-% IV SOLN	BOTH IP/OP	$162.12 	$119.97	$0.00	$124.96		$0.00	$0.00	$0.00	$0.00	$0.00	$120.33	$120.33	$124.96	$0.00	$33.79	$0.00	$0.00	$0.00	$0.00	$73.50	$116.42	$117.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
148738	ERX	HCPCS 63700001	00087-0402-03	POLY-VI-SOL 50 MG/ML PO SOLN	BOTH IP/OP	$32.49 	$24.04	$0.00	$25.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.25	$25.73	$25.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
148740	ERX	HCPCS 63700001	00087-0405-01	POLY-VI-SOL/IRON 11 MG/ML PO SOLN	BOTH IP/OP	$35.83 	$26.51	$0.00	$25.99		$0.00	$0.00	$0.00	$6.38	$0.00	$0.00	$0.00	$0.00	$0.00	$7.47	$0.00	$0.00	$0.00	$0.00	$16.25	$25.73	$25.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
149258	ERX	HCPCS J3370	70594-0057-01	VANCOMYCIN HCL 1250 MG/250ML IV SOLN	BOTH IP/OP	$87.82 	$64.99	$0.00	$126.00	$39.52	$39.52	$0.00	$0.00	$0.00	$7.24	$65.18	$65.18	$67.69	$0.00	$6.68	$0.00	$51.95	$51.95	$0.00	$78.75	$124.74	$126.00	$0.00		$0.00	$0.00	$0.00	$0.00	$7.59	$0.00	$0.00	$0.00	$0.00	$0.00
149258	ERX	HCPCS J3370	70594-0057-02	VANCOMYCIN HCL 1250 MG/250ML IV SOLN	BOTH IP/OP	$87.82 	$64.99	$0.00	$126.00	$39.52	$39.52	$0.00	$0.00	$0.00	$7.24	$65.18	$65.18	$67.69	$0.00	$6.68	$0.00	$51.95	$51.95	$0.00	$78.75	$124.74	$126.00	$0.00		$0.00	$0.00	$0.00	$0.00	$7.59	$0.00	$0.00	$0.00	$0.00	$0.00
149259	ERX	HCPCS J3370	70594-0058-01	VANCOMYCIN HCL 1750 MG/350ML IV SOLN	BOTH IP/OP	$120.24 	$88.98	$0.00	$158.76	$54.11	$54.11	$0.00	$0.00	$0.00	$10.86	$89.24	$89.24	$92.68	$0.00	$10.02	$0.00	$71.12	$71.12	$0.00	$99.23	$157.17	$158.76	$0.00		$0.00	$0.00	$0.00	$0.00	$11.38	$0.00	$0.00	$0.00	$0.00	$0.00
149259	ERX	HCPCS J3370	70594-0058-02	VANCOMYCIN HCL 1750 MG/350ML IV SOLN	BOTH IP/OP	$120.24 	$88.98	$0.00	$158.76	$54.11	$54.11	$0.00	$0.00	$0.00	$10.86	$89.24	$89.24	$92.68	$0.00	$10.02	$0.00	$71.12	$71.12	$0.00	$99.23	$157.17	$158.76	$0.00		$0.00	$0.00	$0.00	$0.00	$11.38	$0.00	$0.00	$0.00	$0.00	$0.00
400291	ERX	HCPCS J7040	00264-7800-10	SODIUM CHLORIDE 0.9 % IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.63	$16.33	$16.33	$16.96	$0.00	$1.53	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.52	$0.00	$0.00	$1.44	$0.00	$0.00	$0.00	$0.00	$0.00
400291	ERX	HCPCS J7040	00338-0049-03	SODIUM CHLORIDE 0.9 % IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.63	$16.33	$16.33	$16.96	$0.00	$1.53	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.52	$0.00	$0.00	$1.44	$0.00	$0.00	$0.00	$0.00	$0.00
400291	ERX	HCPCS J7040	00338-0049-04	SODIUM CHLORIDE 0.9 % IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.63	$16.33	$16.33	$16.96	$0.00	$1.53	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.52	$0.00	$0.00	$1.44	$0.00	$0.00	$0.00	$0.00	$0.00
400292	ERX	HCPCS 25000001	00338-0043-03	SODIUM CHLORIDE 0.45 % IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400292	ERX	HCPCS 25000001	00338-0043-04	SODIUM CHLORIDE 0.45 % IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400293	ERX	HCPCS 25000001	00338-0017-02	DEXTROSE 5 % IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400293	ERX	HCPCS 25000001	00338-0017-03	DEXTROSE 5 % IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400293	ERX	HCPCS 25000001	00338-0017-04	DEXTROSE 5 % IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400294	ERX	HCPCS 25000001	00338-0089-03	DEXTROSE 5 % AND 0.9 % NACL IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400294	ERX	HCPCS 25000001	00338-0089-04	DEXTROSE 5 % AND 0.9 % NACL IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400295	ERX	HCPCS 25000001	00338-0085-03	DEXTROSE 5 % AND 0.45 % NACL IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400295	ERX	HCPCS 25000001	00338-0085-04	DEXTROSE 5 % AND 0.45 % NACL IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400296	ERX	HCPCS 25000001	00264-7750-00	LACTATED RINGERS IV BOLUS ML	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400296	ERX	HCPCS 25000001	00264-7750-20	LACTATED RINGERS IV BOLUS ML	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400296	ERX	HCPCS 25000001	00338-0117-03	LACTATED RINGERS IV BOLUS ML	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400296	ERX	HCPCS 25000001	00338-0117-04	LACTATED RINGERS IV BOLUS ML	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400296	ERX	HCPCS 25000001	00409-7953-03	LACTATED RINGERS IV BOLUS ML	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400297	ERX	HCPCS 25000001	00264-7751-10	DEXTROSE 5 % IN LACTATED RINGERS IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400297	ERX	HCPCS 25000001	00338-0125-04	DEXTROSE 5 % IN LACTATED RINGERS IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600002	ERX	HCPCS 25000001	99999-6008-77	ACETIC ACID 6% SOLN	BOTH IP/OP	$11.00 	$8.14	$0.00	$11.86		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$7.41	$8.71	$11.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600002	ERX	HCPCS 25000001	99999-6000-02	ACETIC ACID 6% SOLN	BOTH IP/OP	$11.00 	$8.14	$0.00	$11.86		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$7.41	$11.74	$11.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600003	ERX	HCPCS 25000001	99999-6006-90	ADULT MAGIC MOUTHWASH(MLX:BEN:NYS:LIDO)	BOTH IP/OP	$6.00 	$4.44	$0.00	$17.94		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$11.21	$17.76	$17.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600007	ERX	HCPCS J0290	99999-6000-07	AMPICILLIN 1 G/100ML NS MB PLUS	BOTH IP/OP	$69.81 	$51.66	$0.00	$53.81	$31.41	$31.41	$0.00	$0.00	$0.00	$5.22	$51.81	$51.81	$53.81	$0.00	$1.90	$0.00	$41.29	$41.29	$0.00	$32.36	$51.25	$51.77	$0.00		$0.00	$2.30	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$0.00
600007	ERX	HCPCS J0290	99999-6010-85	AMPICILLIN 1 G/100ML NS MB PLUS	BOTH IP/OP	$69.81 	$51.66	$0.00	$53.81	$31.41	$31.41	$0.00	$0.00	$0.00	$5.22	$51.81	$51.81	$53.81	$0.00	$1.90	$0.00	$41.29	$41.29	$0.00	$32.36	$51.25	$51.77	$0.00		$0.00	$2.30	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$0.00
600008	ERX	HCPCS J0290	99999-6000-08	AMPICILLIN 2 G/ NS 100ML MB PLUS	BOTH IP/OP	$80.07 	$59.25	$0.00	$61.72	$36.03	$36.03	$0.00	$0.00	$0.00	$10.43	$59.43	$59.43	$61.72	$0.00	$3.79	$0.00	$47.36	$47.36	$0.00	$37.01	$58.62	$59.21	$0.00		$0.00	$4.61	$0.00	$0.00	$4.39	$0.00	$0.00	$0.00	$0.00	$0.00
600009	ERX	HCPCS J0713	99999-6011-20	CEFTAZIDIME 1G/D5W 100 ML MB PLUS	BOTH IP/OP	$59.70 	$44.18	$0.00	$46.02		$0.00	$0.00	$0.00	$0.00	$0.00	$44.31	$44.31	$46.02	$0.00	$12.44	$0.00	$0.00	$0.00	$0.00	$27.77	$43.99	$44.43	$0.00		$0.00	$8.69	$0.00	$0.00	$8.84	$0.00	$0.00	$0.00	$0.00	$0.00
600010	ERX	HCPCS J0713	99999-6000-10	CEFTAZIDIME 2 G/D5W 100ML MB PLUS	BOTH IP/OP	$115.98 	$85.83	$0.00	$89.40		$0.00	$0.00	$0.00	$0.00	$0.00	$86.08	$86.08	$89.40	$0.00	$24.17	$0.00	$0.00	$0.00	$0.00	$53.28	$84.40	$85.25	$0.00		$0.00	$16.68	$0.00	$0.00	$16.96	$0.00	$0.00	$0.00	$0.00	$0.00
600011	ERX	HCPCS 25000001	99999-6011-16	NAFCILLIN 1 G/D5W 100 ML MB PLUS	BOTH IP/OP	$106.26 	$78.63	$0.00	$81.91		$0.00	$0.00	$0.00	$0.00	$0.00	$78.87	$78.87	$81.91	$0.00	$22.14	$0.00	$0.00	$0.00	$0.00	$48.87	$77.41	$78.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600012	ERX	HCPCS 25000001	99999-6000-12	NAFCILLIN 2GM/D5W 100ML MB PLUS	BOTH IP/OP	$157.82 	$116.79	$0.00	$121.65		$0.00	$0.00	$0.00	$0.00	$0.00	$117.13	$117.13	$121.65	$0.00	$32.89	$0.00	$0.00	$0.00	$0.00	$72.25	$114.44	$115.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600013	ERX	HCPCS J0743	99999-6000-13	IMIPENEM-CILAST 500MG/NS 100ML MB PLUS	BOTH IP/OP	$203.22 	$150.38	$0.00	$156.64		$0.00	$0.00	$0.00	$0.00	$0.00	$150.83	$150.83	$156.64	$0.00	$17.89	$0.00	$0.00	$0.00	$0.00	$92.93	$147.20	$148.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600014	ERX	HCPCS J0696	99999-6011-31	CEFTRIAXONE 1 G/D5W 100 ML MB PLUS	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$5.64	$38.59	$38.59	$40.08	$0.00	$2.36	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$2.82	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00
600015	ERX	HCPCS J0295	99999-6000-15	AMPICILLIN-SULB 1.5 G/NS 50ML MB PLUS	BOTH IP/OP	$109.57 	$81.08	$0.00	$84.46	$49.31	$49.31	$0.00	$0.00	$0.00	$4.24	$81.32	$81.32	$84.46	$0.00	$2.60	$0.00	$64.81	$64.81	$0.00	$50.38	$79.79	$80.60	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
600016	ERX	HCPCS J0295	99999-6000-16	AMPICILLIN-SULB 3 G/NS 100ML MB PLUS	BOTH IP/OP	$142.11 	$105.16	$0.00	$109.54	$63.95	$63.95	$0.00	$0.00	$0.00	$8.48	$105.47	$105.47	$109.54	$0.00	$5.19	$0.00	$84.06	$84.06	$0.00	$65.13	$103.17	$104.21	$0.00		$0.00	$6.06	$0.00	$0.00	$5.77	$0.00	$0.00	$0.00	$0.00	$0.00
600017	ERX	HCPCS j3370	99999-6000-17	VANCOMYCIN 1000 MG/250 ML D5W MB PLUS	BOTH IP/OP	$53.61 	$39.67	$0.00	$41.60		$0.00	$0.00	$0.00	$0.00	$0.00	$39.79	$39.79	$41.32	$0.00	$11.17	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$31.20		$31.20	$8.14	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
600018	ERX	HCPCS J0697	99999-6000-18	CEFUROXIME 0.75 G/D5W 100 ML MB PLUS	BOTH IP/OP	$99.00 	$73.26	$0.00	$76.31		$0.00	$0.00	$0.00	$0.00	$0.00	$73.48	$73.48	$76.31	$0.00	$2.37	$0.00	$0.00	$0.00	$0.00	$45.58	$72.20	$72.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600018	ERX	HCPCS J0697	99999-6011-23	CEFUROXIME 0.75 G/D5W 100 ML MB PLUS	BOTH IP/OP	$99.00 	$73.26	$0.00	$76.31		$0.00	$0.00	$0.00	$0.00	$0.00	$73.48	$73.48	$76.31	$0.00	$2.37	$0.00	$0.00	$0.00	$0.00	$45.58	$72.20	$72.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600019	ERX	HCPCS J0697	99999-6000-19	CEFUROXIME 1.5 G/D5W 100ML MB PLUS	BOTH IP/OP	$126.71 	$93.77	$0.00	$97.67		$0.00	$0.00	$0.00	$0.00	$0.00	$94.04	$94.04	$97.67	$0.00	$4.73	$0.00	$0.00	$0.00	$0.00	$58.15	$92.10	$93.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600020	ERX	HCPCS J0690	99999-6000-20	CEFAZOLIN 1GM/D5W 50ML MB PLUS	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$1.39	$38.59	$38.59	$40.08	$0.00	$1.75	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$1.93	$0.00	$0.00	$1.83	$0.00	$0.00	$0.00	$0.00	$0.00
600021	ERX	HCPCS 25000001	99999-6000-21	DOXYCYCLINE 100MG/ NS 100ML MB PLUS	BOTH IP/OP	$109.78 	$81.24	$0.00	$84.62		$0.00	$0.00	$0.00	$0.00	$0.00	$81.48	$81.48	$84.62	$0.00	$22.88	$0.00	$0.00	$0.00	$0.00	$50.47	$79.94	$80.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600021	ERX	HCPCS 25000001	99999-6010-83	DOXYCYCLINE 100MG/ NS 100ML MB PLUS	BOTH IP/OP	$109.78 	$81.24	$0.00	$84.62		$0.00	$0.00	$0.00	$0.00	$0.00	$81.48	$81.48	$84.62	$0.00	$22.88	$0.00	$0.00	$0.00	$0.00	$50.47	$79.94	$80.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600022	ERX	HCPCS j3370	99999-6000-22	VANCOMYCIN 500MG/100 ML D5W MB PLUS	BOTH IP/OP	$58.60 	$43.36	$0.00	$45.17		$0.00	$0.00	$0.00	$0.00	$0.00	$43.49	$43.49	$45.17	$0.00	$12.21	$0.00	$0.00	$0.00	$0.00	$27.27	$43.20	$43.63	$32.72		$32.72	$8.54	$0.00	$0.00	$8.68	$0.00	$0.00	$0.00	$0.00	$0.00
600023	ERX	HCPCS J0694	99999-6011-24	CEFOXITIN 1 G/D5W 100 ML MB PLUS	BOTH IP/OP	$119.15 	$88.17	$0.00	$91.84	$53.62	$53.62	$0.00	$0.00	$0.00	$8.06	$88.43	$88.43	$91.84	$0.00	$5.42	$0.00	$70.48	$70.48	$0.00	$54.72	$86.67	$87.54	$0.00		$0.00	$6.22	$0.00	$0.00	$5.92	$0.00	$0.00	$0.00	$0.00	$0.00
600027	ERX	HCPCS J0694	99999-6000-27	CEFOXITIN 2 G/D5W 100ML MB PLUS	BOTH IP/OP	$107.14 	$79.28	$0.00	$82.58	$48.21	$48.21	$0.00	$0.00	$0.00	$16.12	$79.52	$79.52	$82.58	$0.00	$10.84	$0.00	$63.37	$63.37	$0.00	$49.28	$78.05	$78.84	$0.00		$0.00	$12.43	$0.00	$0.00	$11.84	$0.00	$0.00	$0.00	$0.00	$0.00
600028	ERX	HCPCS 25000001	99999-6000-28	UVC FLUID 100ML	BOTH IP/OP	$34.95 	$25.86	$0.00	$26.94		$0.00	$0.00	$0.00	$0.00	$0.00	$25.94	$25.94	$26.94	$0.00	$7.28	$0.00	$0.00	$0.00	$0.00	$15.85	$25.11	$25.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600029	ERX	HCPCS 25000001	99999-6000-29	UAC FLUID 100ML	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600030	ERX	HCPCS 25000001	99999-6000-30	PAL FLUID 100ML	BOTH IP/OP	$68.57 	$50.74	$0.00	$52.85		$0.00	$0.00	$0.00	$0.00	$0.00	$50.89	$50.89	$52.85	$0.00	$14.29	$0.00	$0.00	$0.00	$0.00	$31.10	$49.25	$49.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600031	ERX	HCPCS J0456	99999-6000-31	AZITHROMYCIN 500MG/D5W 250ML MB PLUS	BOTH IP/OP	$52.51 	$38.86	$0.00	$41.60	$23.63	$23.63	$0.00	$0.00	$0.00	$10.94	$38.97	$38.97	$40.47	$0.00	$10.94	$0.00	$31.06	$31.06	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$8.14	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
600032	ERX	HCPCS J0698	99999-6011-21	CEFOTAXIME 1 G/D5W 100 ML MB PLUS	BOTH IP/OP	$96.99 	$71.77	$0.00	$74.76		$0.00	$0.00	$0.00	$0.00	$0.00	$71.99	$71.99	$74.76	$0.00	$11.52	$0.00	$0.00	$0.00	$0.00	$44.67	$70.76	$71.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600033	ERX	HCPCS J2543	99999-6000-33	PIPERACIL-TAZO 2.25 G/D5W 50ML MB PLUS	BOTH IP/OP	$77.49 	$57.34	$0.00	$59.73	$34.87	$34.87	$0.00	$0.00	$0.00	$13.09	$57.51	$57.51	$59.73	$0.00	$3.47	$0.00	$45.84	$45.84	$0.00	$35.84	$56.77	$57.34	$0.00		$0.00	$4.35	$0.00	$0.00	$4.14	$0.00	$0.00	$0.00	$0.00	$0.00
600034	ERX	HCPCS J2543	99999-6000-34	PIPERACIL-TAZ 3.375 G/D5W 50ML MB PLUS	BOTH IP/OP	$95.90 	$70.97	$0.00	$73.92	$43.16	$43.16	$0.00	$0.00	$0.00	$19.63	$71.18	$71.18	$73.92	$0.00	$5.21	$0.00	$56.72	$56.72	$0.00	$44.19	$69.99	$70.70	$0.00		$0.00	$6.52	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
600035	ERX	HCPCS J2543	99999-6000-35	PIPERACIL-TAZO 4.5 G/100 ML D5W MB PLUS	BOTH IP/OP	$103.43 	$76.54	$0.00	$79.72	$46.54	$46.54	$0.00	$0.00	$0.00	$26.18	$76.77	$76.77	$79.72	$0.00	$6.94	$0.00	$61.18	$61.18	$0.00	$47.59	$75.38	$76.14	$0.00		$0.00	$8.70	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
600036	ERX	HCPCS J3010	99999-6000-36	FENTANYL 2000MCG/NS 100ML PREMIX	BOTH IP/OP	$239.43 	$177.18	$0.00	$184.55	$107.74	$107.74	$0.00	$0.00	$0.00	$49.90	$177.70	$177.70	$184.55	$0.00	$14.90	$0.00	$141.62	$141.62	$0.00	$108.68	$172.14	$173.88	$0.00		$0.00	$23.27	$0.00	$0.00	$22.15	$0.00	$0.00	$0.00	$0.00	$0.00
600037	ERX	HCPCS J2250	99999-6000-37	MIDAZOLAM 50MG/NS 50ML PREMIX	BOTH IP/OP	$113.53 	$84.01	$0.00	$87.51	$51.09	$51.09	$0.00	$0.00	$0.00	$9.40	$84.26	$84.26	$87.51	$0.00	$7.58	$0.00	$67.15	$67.15	$0.00	$51.47	$81.53	$82.35	$0.00		$0.00	$7.05	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$0.00
600038	ERX	HCPCS J1335	99999-6000-38	ERTAPENEM 1 G/NS 50ML MB PLUS	BOTH IP/OP	$481.37 	$356.21	$0.00	$197.19	$115.12	$115.12	$0.00	$0.00	$0.00	$100.33	$189.87	$189.87	$197.19	$0.00	$66.36	$0.00	$151.32	$151.32	$0.00	$116.81	$185.02	$186.89	$0.00		$0.00	$90.95	$0.00	$0.00	$86.60	$0.00	$0.00	$0.00	$0.00	$0.00
600040	ERX	HCPCS J2185	99999-6000-40	MEROPENEM 1 G/NS 100 ML MB PLUS	BOTH IP/OP	$185.73 	$137.44	$0.00	$143.16		$0.00	$0.00	$0.00	$0.00	$38.71	$137.85	$137.85	$143.16	$0.00	$9.33	$0.00	$109.86	$109.86	$0.00	$84.91	$134.49	$135.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600041	ERX	HCPCS J2700	99999-6000-41	OXACILLIN 2 G/D5W 100ML MB PLUS	BOTH IP/OP	$131.69 	$97.45	$0.00	$101.51		$0.00	$0.00	$0.00	$0.00	$0.00	$97.74	$97.74	$101.51	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$60.41	$95.68	$96.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600042	ERX	HCPCS J2700	99999-6011-22	OXACILLIN 1 G/D5W 100 ML MB PLUS	BOTH IP/OP	$103.21 	$76.38	$0.00	$79.55		$0.00	$0.00	$0.00	$0.00	$0.00	$76.60	$76.60	$79.55	$0.00	$6.02	$0.00	$0.00	$0.00	$0.00	$47.49	$75.22	$75.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600043	ERX	HCPCS J0696	99999-6011-32	CEFTRIAXONE 2 G/D5W 100 ML MB PLUS	BOTH IP/OP	$158.60 	$117.36	$0.00	$122.25	$71.37	$71.37	$0.00	$0.00	$0.00	$11.28	$117.71	$117.71	$122.25	$0.00	$4.73	$0.00	$93.81	$93.81	$0.00	$72.60	$115.00	$116.16	$0.00		$0.00	$5.64	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00
600046	ERX	HCPCS 25000001	99999-6000-46	TOBRAMYCIN FORT 95MG/7ML OPHTH SOLN	BOTH IP/OP	$41.90 	$31.01	$0.00	$32.30		$0.00	$0.00	$0.00	$0.00	$0.00	$31.10	$31.10	$32.30	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600048	ERX	HCPCS 25000001	99999-6000-48	CEFAZOLIN FORT OPHTH 50 MG/ML 10ML	BOTH IP/OP	$52.38 	$38.76	$0.00	$40.37		$0.00	$0.00	$0.00	$0.00	$0.00	$38.88	$38.88	$40.37	$0.00	$10.92	$0.00	$0.00	$0.00	$0.00	$23.75	$37.62	$38.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600049	ERX	HCPCS 25000001	99999-6000-49	VANCOMYCIN 30 MG/ML (3%) OPHTH SOLN	BOTH IP/OP	$87.52 	$64.76	$0.00	$67.46		$0.00	$0.00	$0.00	$0.00	$0.00	$64.96	$64.96	$67.46	$0.00	$18.24	$0.00	$0.00	$0.00	$0.00	$39.68	$62.85	$63.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600051	ERX	HCPCS 25000001	99999-6000-51	GENTAMICIN FORT 95MG/7ML OPHTH SOL	BOTH IP/OP	$41.90 	$31.01	$0.00	$32.30		$0.00	$0.00	$0.00	$0.00	$0.00	$31.10	$31.10	$32.30	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600052	ERX	HCPCS 25000001	99999-6000-52	LEECH	BOTH IP/OP	$83.80 	$62.01	$0.00	$64.59		$0.00	$0.00	$0.00	$0.00	$0.00	$62.20	$62.20	$64.59	$0.00	$17.46	$0.00	$0.00	$0.00	$0.00	$38.00	$60.19	$60.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600053	ERX	HCPCS 25000001	99999-6000-53	BEER	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600054	ERX	HCPCS 25000001	99999-6000-54	L.E.T. TOPICAL GEL 3ML	BOTH IP/OP	$20.95 	$15.50	$0.00	$16.15		$0.00	$0.00	$0.00	$0.00	$0.00	$15.55	$15.55	$16.15	$0.00	$4.37	$0.00	$0.00	$0.00	$0.00	$9.50	$15.05	$15.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600055	ERX	HCPCS 25000001	99999-6000-55	MIDAZOLAM 2MG/1 ML ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600056	ERX	HCPCS 25000001	99999-6000-56	MIDAZOLAM 5MG/2.5ML ORAL SYRINGE	BOTH IP/OP	$12.57 	$9.30	$0.00	$9.69		$0.00	$0.00	$0.00	$0.00	$0.00	$9.33	$9.33	$9.69	$0.00	$2.62	$0.00	$0.00	$0.00	$0.00	$5.70	$9.03	$9.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600058	ERX	HCPCS 25000001	99999-6000-58	METHADONE 1MG/1ML ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600060	ERX	HCPCS 25000001	99999-6000-60	METHADONE 0.5MG/0.5ML ORAL SYRINGE (NICU)	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600061	ERX	HCPCS 63700001	99999-6000-61	METHADONE 5MG/5ML ORAL SYRINGE	BOTH IP/OP	$10.48 	$7.76	$0.00	$7.60		$0.00	$0.00	$0.00	$1.87	$0.00	$0.00	$0.00	$0.00	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$4.75	$7.52	$7.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600062	ERX	HCPCS 25000001	99999-6000-62	OXYCODONE LIQ 120MG/6ML ORAL SYRINGE	BOTH IP/OP	$28.85 	$21.35	$0.00	$22.24		$0.00	$0.00	$0.00	$0.00	$0.00	$21.41	$21.41	$22.24	$0.00	$6.01	$0.00	$0.00	$0.00	$0.00	$13.08	$20.72	$20.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600063	ERX	HCPCS 25000001	99999-6000-63	DIAZEPAM ELIXIR 1MG/ML ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600065	ERX	HCPCS 63700001	99999-6000-65	OXANDROLONE 1MG/1ML ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600066	ERX	HCPCS 63700001	99999-6000-66	OXANDROLONE 10MG/10ML ORAL SYRINGE	BOTH IP/OP	$644.22 	$476.72	$0.00	$467.82		$0.00	$0.00	$0.00	$114.67	$0.00	$0.00	$0.00	$0.00	$0.00	$134.26	$0.00	$0.00	$0.00	$0.00	$292.39	$463.15	$467.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600067	ERX	HCPCS 25000001	99999-6000-67	MORPHINE SULFATE 20MG/ML O/S 5ML	BOTH IP/OP	$11.53 	$8.53	$0.00	$8.89		$0.00	$0.00	$0.00	$0.00	$0.00	$8.56	$8.56	$8.89	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$5.23	$8.28	$8.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600068	ERX	HCPCS 25000001	99999-6000-68	MORPHINE SULFATE 20MG/ML O/S 3ML	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600069	ERX	HCPCS 25000001	99999-6000-69	MORPHINE SULFATE 20MG/ML O/S 2ML	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600079	ERX	HCPCS 25000001	99999-6000-79	CALCITRIOL 1MCG/ML ORAL SYRINGE (NICU)	BOTH IP/OP	$49.99 	$36.99	$0.00	$38.53		$0.00	$0.00	$0.00	$0.00	$0.00	$37.10	$37.10	$38.53	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$22.67	$35.91	$36.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600107	ERX	HCPCS 63700001	99999-6001-07	FUROSEMIDE 10MG/ML ORAL SYRINGE (NICU)	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600109	ERX	HCPCS 25000001	99999-6001-09	NEVIRAPINE 10MG/ML ORAL SYRINGE (NICU)	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600112	ERX	HCPCS 25000001	99999-6001-12	ALUM-MG HYDRX-SIMETH 15ML ORAL SYRINGE	BOTH IP/OP	$18.86 	$13.96	$0.00	$14.54		$0.00	$0.00	$0.00	$0.00	$0.00	$14.00	$14.00	$14.54	$0.00	$3.93	$0.00	$0.00	$0.00	$0.00	$8.55	$13.54	$13.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600126	ERX	HCPCS 63700001	99999-6001-26	KALETRA 80MG/20MG/ML ORAL SYRINGE	BOTH IP/OP	$54.22 	$40.12	$0.00	$39.34		$0.00	$0.00	$0.00	$9.65	$0.00	$0.00	$0.00	$0.00	$0.00	$11.30	$0.00	$0.00	$0.00	$0.00	$24.59	$38.95	$39.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600134	ERX	HCPCS 63700001	99999-6001-34	POSACONAZOLE 200MG/5 ML ORAL SYRINGE	BOTH IP/OP	$110.21 	$81.56	$0.00	$79.94		$0.00	$0.00	$0.00	$19.62	$0.00	$0.00	$0.00	$0.00	$0.00	$22.97	$0.00	$0.00	$0.00	$0.00	$49.97	$79.14	$79.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600137	ERX	HCPCS 63700001	99999-6001-37	ERGOCALCIFEROL 8000 UNITS/ML (NICU) ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600138	ERX	HCPCS 25000001	99999-6001-38	PENICILLIN VK 50MG/ML ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600141	ERX	HCPCS 25000001	99999-6001-41	TRIFLUOPERAZINE 10MG/ML ORAL SYRINGE	BOTH IP/OP	$10.02 	$7.41	$0.00	$7.72		$0.00	$0.00	$0.00	$0.00	$0.00	$7.44	$7.44	$7.72	$0.00	$2.09	$0.00	$0.00	$0.00	$0.00	$4.55	$7.20	$7.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600144	ERX	HCPCS 63700001	99999-6001-44	ZIDOVUDINE 10MG/ML ORAL SYRINGE (NICU)	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600151	ERX	HCPCS 25000001	99999-6001-51	BACLOFEN 1MG/ML ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600152	ERX	HCPCS 25000001	99999-6001-52	BACLOFEN 10MG/ML ORAL SYRINGE HI CONC	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600153	ERX	HCPCS 25000001	99999-6001-53	SIMETHICONE 40MG/0.6ML ORAL SYRINGE (NICU)	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600157	ERX	HCPCS 25000001	99999-6001-57	LANSOPRAZOLE 3MG/ML ORAL SYRINGE (NICU)	BOTH IP/OP	$68.89 	$50.98	$0.00	$53.10		$0.00	$0.00	$0.00	$0.00	$0.00	$51.13	$51.13	$53.10	$0.00	$14.36	$0.00	$0.00	$0.00	$0.00	$31.24	$49.48	$49.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600159	ERX	HCPCS 63700001	99999-6001-59	MULTIPLE VIT W/IRON ORAL SYRINGE (NICU)	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600162	ERX	HCPCS 25000001	99999-6001-62	PREDNISOLONE 9MG/3ML ORAL SYRINGE	BOTH IP/OP	$16.97 	$12.56	$0.00	$13.08		$0.00	$0.00	$0.00	$0.00	$0.00	$12.60	$12.60	$13.08	$0.00	$3.54	$0.00	$0.00	$0.00	$0.00	$7.70	$12.19	$12.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600163	ERX	HCPCS 25000001	99999-6001-63	PREDNISOLONE 30MG/10ML ORAL SYRINGE	BOTH IP/OP	$173.70 	$128.54	$0.00	$133.89		$0.00	$0.00	$0.00	$0.00	$0.00	$128.92	$128.92	$133.89	$0.00	$36.20	$0.00	$0.00	$0.00	$0.00	$78.75	$124.74	$126.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600164	ERX	HCPCS 25000001	99999-6001-64	PREDNISOLONE 15MG/5ML ORAL SYRINGE	BOTH IP/OP	$28.29 	$20.93	$0.00	$21.81		$0.00	$0.00	$0.00	$0.00	$0.00	$21.00	$21.00	$21.81	$0.00	$5.90	$0.00	$0.00	$0.00	$0.00	$12.83	$20.31	$20.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600166	ERX	HCPCS 25000001	99999-6001-66	CHLORHEXIDINE MTHWASH 0.12% 1ML ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600175	ERX	HCPCS 63700001	99999-6001-75	NYSTATIN 100000U/ML ORAL SYRINGE (NICU)	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600176	ERX	HCPCS 25000001	99999-6001-76	NYSTATIN 50000U/0.5ML ORAL SYRNGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600177	ERX	HCPCS 63700001	99999-6001-77	NYSTATIN 200000U/2ML ORAL SYRNGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600181	ERX	HCPCS 63700001	99999-6001-81	SODIUM CHLORIDE 4 MEQ/ML ORAL SYRINGE (NICU)	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600191	ERX	HCPCS 63700001	99999-6001-91	FLUOXETINE 4MG/ML ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600199	ERX	HCPCS 63700001	99999-6001-99	FLUPHENAZINE 2.5MG/5ML ORAL SYRINGE	BOTH IP/OP	$38.89 	$28.78	$0.00	$28.22		$0.00	$0.00	$0.00	$6.92	$0.00	$0.00	$0.00	$0.00	$0.00	$8.10	$0.00	$0.00	$0.00	$0.00	$17.64	$27.93	$28.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600200	ERX	HCPCS 63700001	99999-6002-00	FLUPHENAZINE 0.5MG/ML ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600206	ERX	HCPCS 63700001	99999-6002-06	SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 1	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600207	ERX	HCPCS 63700001	99999-6002-07	SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 2	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600208	ERX	HCPCS 63700001	99999-6002-08	SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 3	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600209	ERX	HCPCS 63700001	99999-6002-09	SULFAMETHOXAZOLE-TMP SUSP 5ML O/S DOSE # 5	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600210	ERX	HCPCS 63700001	99999-6002-10	SULFAMETHOXAZOLE-TMP SUSP 20ML O/S DOSE # 6	BOTH IP/OP	$10.06 	$7.44	$0.00	$7.30		$0.00	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$0.00	$2.10	$0.00	$0.00	$0.00	$0.00	$4.56	$7.22	$7.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600211	ERX	HCPCS 63700001	99999-6002-11	SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 4	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600220	ERX	HCPCS 63700001	99999-6002-20	MULTIPLE VITAMIN (NICU) ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600221	ERX	HCPCS 25000001	99999-6002-21	GUAIFENESIN DM 1ML ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600231	ERX	HCPCS 25000001	99999-6002-31	NITAZOXANIDE 100MG/5ML ORAL SYRNGE	BOTH IP/OP	$129.31 	$95.69	$0.00	$99.67		$0.00	$0.00	$0.00	$0.00	$0.00	$95.97	$95.97	$99.67	$0.00	$26.95	$0.00	$0.00	$0.00	$0.00	$58.63	$92.86	$93.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600232	ERX	HCPCS 25000001	99999-6002-32	BENADRYL/MAALOX 1:1	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600237	ERX	HCPCS 63700001	99999-6002-37	RISPERIDONE 2 MG/2 ML ORAL SYRINGE	BOTH IP/OP	$55.15 	$40.81	$0.00	$40.01		$0.00	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00	$11.49	$0.00	$0.00	$0.00	$0.00	$25.01	$39.61	$40.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600240	ERX	HCPCS 25000001	99999-6002-40	HYDROMORPHONE 15000MCG/30ML NS PED	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600241	ERX	HCPCS 25000001	99999-6002-41	HYDROMORPHONE 30000MCG/30ML NS PED	BOTH IP/OP	$41.57 	$30.76	$0.00	$32.04		$0.00	$0.00	$0.00	$0.00	$0.00	$30.85	$30.85	$32.04	$0.00	$8.66	$0.00	$0.00	$0.00	$0.00	$18.85	$29.86	$30.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600245	ERX	HCPCS 25000001	99999-6010-93	AZTREONAM 1 G/100ML D5W MB PLUS	BOTH IP/OP	$195.23 	$144.47	$0.00	$150.48		$0.00	$0.00	$0.00	$0.00	$0.00	$144.90	$144.90	$150.48	$0.00	$40.69	$0.00	$0.00	$0.00	$0.00	$89.21	$141.31	$142.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600246	ERX	HCPCS 25000001	99999-6010-94	AZTREONAM 2 G/100ML D5W MB PLUS	BOTH IP/OP	$318.60 	$235.76	$0.00	$245.58		$0.00	$0.00	$0.00	$0.00	$0.00	$236.46	$236.46	$245.58	$0.00	$66.40	$0.00	$0.00	$0.00	$0.00	$145.30	$230.16	$232.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600247	ERX	HCPCS 25000001	99999-6002-47	KETAMINE 50MG/1 ML IV SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600253	ERX	HCPCS 25000001	99999-6002-53	AMPHOTERICIN B 5MCG/0.1ML OPHTH SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600255	ERX	HCPCS 25000001	99999-6002-55	GANCICLOVIR 2MG/0.1 ML OPHTH SYRINGE	BOTH IP/OP	$337.54 	$249.78	$0.00	$260.18		$0.00	$0.00	$0.00	$0.00	$0.00	$250.52	$250.52	$260.18	$0.00	$70.34	$0.00	$0.00	$0.00	$0.00	$153.21	$242.68	$245.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600263	ERX	HCPCS 25000001	99999-6002-63	NICARDIPINE 1MG/10ML NS	BOTH IP/OP	$160.97 	$119.12	$0.00	$124.08		$0.00	$0.00	$0.00	$0.00	$0.00	$119.47	$119.47	$124.08	$0.00	$33.55	$0.00	$0.00	$0.00	$0.00	$72.98	$115.59	$116.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600273	ERX	HCPCS 25000001	99999-6002-73	AMIKACIN 400MCG/0.1ML OPHTH SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600283	ERX	HCPCS 25000001	99999-6002-83	VORICONAZOLE 40MCG/0.1 ML NS OPHTH SYRINGE	BOTH IP/OP	$512.67 	$379.38	$0.00	$395.17		$0.00	$0.00	$0.00	$0.00	$0.00	$380.50	$380.50	$395.17	$0.00	$106.84	$0.00	$0.00	$0.00	$0.00	$232.69	$368.57	$372.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600285	ERX	HCPCS 25000001	99999-6002-85	COSYNTROPIN 1 MCG/1 ML (NICU) IV SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600297	ERX	HCPCS 25000001	99999-6002-97	NACL 0.45% FLUSH 2ML IV SYRINGE (NICU)	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600306	ERX	HCPCS 25000001	99999-6003-06	CEFTAZIDIME 2.25MG/0.1ML OPHTH SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600307	ERX	HCPCS 25000001	99999-6003-07	VITAMIN A 5000U/0.1ML IM SYRINGE (NICU)	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600313	ERX	HCPCS 25000001	99999-6003-13	VANCOMYCIN 0.75MG/0.1ML OPHTH SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600314	ERX	HCPCS 25000001	99999-6003-14	VANCOMYCIN 1MG/0.1ML OPHTH SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600316	ERX	HCPCS 25000001	99999-6003-16	VASOPRESSIN 4 UNITS/10 ML NS	BOTH IP/OP	$45.26 	$33.49	$0.00	$34.89		$0.00	$0.00	$0.00	$0.00	$0.00	$33.59	$33.59	$34.89	$0.00	$9.43	$0.00	$0.00	$0.00	$0.00	$20.52	$32.50	$32.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600328	ERX	HCPCS 25000001	99999-6003-28	HEPARIN FLUSH 1 UNIT/ML 0.45% NS (NICU) 6ML	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600328	ERX	HCPCS 25000001	99999-6011-72	HEPARIN FLUSH 1 UNIT/ML 0.45% NS (NICU) 6ML	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600333	ERX	HCPCS J2997	99999-6003-33	ALTEPLASE 1MG/1 ML SW IV SYRINGE(NICU)	BOTH IP/OP	$570.57 	$422.22	$0.00	$439.80	$256.76	$256.76	$87.67	$87.67	$87.67	$118.92	$423.48	$423.48	$439.80	$87.75	$118.91	$57.04	$337.49	$337.49	$92.02	$258.97	$410.20	$414.34	$127.08		$127.08	$81.06	$0.00	$0.00	$82.45	$87.89	$0.00	$0.00	$0.00	$0.00
600340	ERX	HCPCS 25000001	99999-6003-40	EPHEDRINE 50MG/10ML NS IV SYRINGE	BOTH IP/OP	$63.53 	$47.01	$0.00	$48.97		$0.00	$0.00	$0.00	$0.00	$0.00	$47.15	$47.15	$48.97	$0.00	$13.24	$0.00	$0.00	$0.00	$0.00	$28.81	$45.63	$46.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600356	ERX	HCPCS 25000001	99999-6003-56	ON-Q PUMP 270 ML 2 ML/HR SINGLE LUMEN	BOTH IP/OP	$541.34 	$400.59	$0.00	$417.26		$0.00	$0.00	$0.00	$0.00	$0.00	$401.78	$401.78	$417.26	$0.00	$112.82	$0.00	$0.00	$0.00	$0.00	$245.70	$389.18	$393.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600357	ERX	HCPCS 25000001	99999-6003-57	ON-Q PUMP 400 ML 4 ML/HR DUAL LUMEN	BOTH IP/OP	"$1,424.50 "	"$1,054.13"	$0.00	"$1,098.00"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,057.26"	"$1,057.26"	"$1,098.00"	$0.00	$296.87	$0.00	$0.00	$0.00	$0.00	$660.00	"$1,045.44"	"$1,056.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600358	ERX	HCPCS 25000001	99999-6003-58	ON-Q PUMP 400 ML 5 ML/HR SINGLE LUMEN	BOTH IP/OP	$766.50 	$567.21	$0.00	$590.82		$0.00	$0.00	$0.00	$0.00	$0.00	$568.90	$568.90	$590.82	$0.00	$159.74	$0.00	$0.00	$0.00	$0.00	$347.82	$550.94	$556.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600359	ERX	HCPCS 25000001	99999-6003-59	ON-Q C-BLOC PUMP 400ML	BOTH IP/OP	$876.00 	$648.24	$0.00	$675.22		$0.00	$0.00	$0.00	$0.00	$0.00	$650.17	$650.17	$675.22	$0.00	$182.56	$0.00	$0.00	$0.00	$0.00	$397.50	$629.64	$636.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600360	ERX	HCPCS 25000001	99999-6003-60	FOSCARNET SODIUM 2.4MG/0.1ML OPHTH SYRINGE	BOTH IP/OP	$826.36 	$611.51	$0.00	$636.96		$0.00	$0.00	$0.00	$0.00	$0.00	$613.32	$613.32	$636.96	$0.00	$172.21	$0.00	$0.00	$0.00	$0.00	$374.98	$593.96	$599.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600362	ERX	HCPCS J0690	99999-6003-62	CEFAZOLIN 1GM/NS 50ML MB PLUS-OR ONLY	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$1.39	$38.59	$38.59	$40.08	$0.00	$1.75	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$1.93	$0.00	$0.00	$1.83	$0.00	$0.00	$0.00	$0.00	$0.00
600364	ERX	HCPCS J2543	99999-6003-64	PIPERACIL-TAZ 3.375 G/NS 50ML MB PLUS	BOTH IP/OP	$95.90 	$70.97	$0.00	$73.92	$43.16	$43.16	$0.00	$0.00	$0.00	$19.63	$71.18	$71.18	$73.92	$0.00	$5.21	$0.00	$56.72	$56.72	$0.00	$44.19	$69.99	$70.70	$0.00		$0.00	$6.52	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
600365	ERX	HCPCS J2543	99999-6003-65	PIPERACIL-TAZO 4.5 G/NS 100ML MB PLUS	BOTH IP/OP	$103.43 	$76.54	$0.00	$79.72	$46.54	$46.54	$0.00	$0.00	$0.00	$26.18	$76.77	$76.77	$79.72	$0.00	$6.94	$0.00	$61.18	$61.18	$0.00	$47.59	$75.38	$76.14	$0.00		$0.00	$8.70	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
600367	ERX	HCPCS J0694	99999-6011-25	CEFOXITIN 1 G/NS 100 ML MB PLUS-OR ONLY	BOTH IP/OP	$119.15 	$88.17	$0.00	$91.84	$53.62	$53.62	$0.00	$0.00	$0.00	$8.06	$88.43	$88.43	$91.84	$0.00	$5.42	$0.00	$70.48	$70.48	$0.00	$54.72	$86.67	$87.54	$0.00		$0.00	$6.22	$0.00	$0.00	$5.92	$0.00	$0.00	$0.00	$0.00	$0.00
600368	ERX	HCPCS 25000001	99999-6003-68	PENICILLIN G 2 MU/NS 50ML-OR ONLY	BOTH IP/OP	$199.22 	$147.42	$0.00	$153.56		$0.00	$0.00	$0.00	$0.00	$0.00	$147.86	$147.86	$153.56	$0.00	$41.52	$0.00	$0.00	$0.00	$0.00	$90.43	$143.23	$144.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600369	ERX	HCPCS 25000001	99999-6003-69	DESMOPRESSIN 0.25MCG/0.5ML NS SYRINGE	BOTH IP/OP	$36.98 	$27.37	$0.00	$28.50		$0.00	$0.00	$0.00	$0.00	$0.00	$27.45	$27.45	$28.50	$0.00	$7.71	$0.00	$0.00	$0.00	$0.00	$16.77	$26.56	$26.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600378	ERX	HCPCS 25000001	99999-6003-78	KAOPECTATE AND BENADRYL 1:1 ORAL SOLUTION	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600380	ERX	HCPCS 25000001	99999-6003-80	GENTAMICIN 0.5ML (80MG/ML) WITH 0.5ML OF DEXAMETHASONE-OR	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60		$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600381	ERX	HCPCS 25000001	99999-6003-81	"EPINEPHRINE 0.3ML (1:1000,1MG/ML) IN 500ML BSS PLUS-OR"	BOTH IP/OP	$100.50 	$74.37	$0.00	$77.47		$0.00	$0.00	$0.00	$0.00	$0.00	$74.59	$74.59	$77.47	$0.00	$20.94	$0.00	$0.00	$0.00	$0.00	$46.27	$73.28	$74.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600382	ERX	HCPCS 25000001	99999-6003-82	LIDOCAINE 2% 3ML/.75% MARCAINE 3ML/200MG WYDASE 1ML	BOTH IP/OP	$233.03 	$172.44	$0.00	$179.62		$0.00	$0.00	$0.00	$0.00	$0.00	$172.95	$172.95	$179.62	$0.00	$48.56	$0.00	$0.00	$0.00	$0.00	$106.46	$168.63	$170.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600383	ERX	HCPCS 25000001	99999-6003-83	SUGARCAINE MIXTURE 5ML-OR	BOTH IP/OP	$48.63 	$35.99	$0.00	$37.48		$0.00	$0.00	$0.00	$0.00	$0.00	$36.09	$36.09	$37.48	$0.00	$10.13	$0.00	$0.00	$0.00	$0.00	$22.05	$34.93	$35.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600384	ERX	HCPCS 25000001	99999-6003-84	LIDOCAINE/BUPIVACAINE/HYALURONIDASE - OR EYE BLOCK	BOTH IP/OP	$241.22 	$178.50	$0.00	$185.93		$0.00	$0.00	$0.00	$0.00	$0.00	$179.03	$179.03	$185.93	$0.00	$50.27	$0.00	$0.00	$0.00	$0.00	$110.18	$174.53	$176.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600385	ERX	HCPCS 25000001	99999-6003-85	LIDOCAINE/EPI/NS-OR TUMESCENT MIXTURE	BOTH IP/OP	$62.73 	$46.42	$0.00	$48.35		$0.00	$0.00	$0.00	$0.00	$0.00	$46.56	$46.56	$48.35	$0.00	$13.07	$0.00	$0.00	$0.00	$0.00	$29.15	$46.17	$46.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600386	ERX	HCPCS 25000001	99999-6003-86	LIDOCAINE 1% 14 ML/PAPAVERINE (30 MG/ML) 2 ML-OR	BOTH IP/OP	$54.06 	$40.00	$0.00	$41.67		$0.00	$0.00	$0.00	$0.00	$0.00	$40.12	$40.12	$41.67	$0.00	$11.27	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600388	ERX	HCPCS 25000001	99999-6003-88	"BACITRACIN 50,000 UNITS IN 1000 ML NS - OR NEURO"	BOTH IP/OP	$96.20 	$71.19	$0.00	$76.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.10	$76.19	$76.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600389	ERX	HCPCS 25000001	99999-6003-89	IOHEXOL 300 MG/ML 50 ML MIXED WITH 50ML STERILE WATER-OR GU	BOTH IP/OP	$245.76 	$181.86	$0.00	$189.43		$0.00	$0.00	$0.00	$0.00	$0.00	$182.40	$182.40	$189.43	$0.00	$51.22	$0.00	$0.00	$0.00	$0.00	$112.24	$177.79	$179.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600390	ERX	HCPCS 25000001	99999-6003-90	VASOPRESSIN 20 UNITS IN 50 ML NS - OR GYN	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60		$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600391	ERX	HCPCS 25000001	99999-6003-91	VASOPRESSIN 20 UNITS IN 100 ML NS - OR GYN	BOTH IP/OP	$52.00 	$38.48	$0.00	$585.28		$0.00	$0.00	$0.00	$0.00	$0.00	$563.56	$563.56	$585.28	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600392	ERX	HCPCS 25000001	99999-6003-92	VASOPRESSIN 20 UNITS IN 200 ML OF NS - OR GYN	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60		$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600393	ERX	HCPCS 25000001	99999-6003-93	INDIGO CARMINE 5 ML/100 ML 0.9% SODIUM CHLORIDE -OR	BOTH IP/OP	$94.61 	$70.01	$0.00	$72.93		$0.00	$0.00	$0.00	$0.00	$0.00	$70.22	$70.22	$72.93	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$43.60	$69.06	$69.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600394	ERX	HCPCS 25000001	99999-6003-94	INDIGO CARMINE 5 ML/200 ML 0.9% SODIUM CHLORIDE -OR	BOTH IP/OP	$94.61 	$70.01	$0.00	$72.93		$0.00	$0.00	$0.00	$0.00	$0.00	$70.22	$70.22	$72.93	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$43.60	$69.06	$69.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600395	ERX	HCPCS 25000001	99999-6003-95	INDIGO CARMINE 5 ML/250 ML 0.9% SODIUM CHLORIDE -OR	BOTH IP/OP	$94.61 	$70.01	$0.00	$72.93		$0.00	$0.00	$0.00	$0.00	$0.00	$70.22	$70.22	$72.93	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$43.60	$69.06	$69.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600396	ERX	HCPCS 25000001	99999-6003-96	INDIGO CARMINE 5 ML/300 ML 0.9% SODIUM CHLORIDE -OR	BOTH IP/OP	$94.61 	$70.01	$0.00	$72.93		$0.00	$0.00	$0.00	$0.00	$0.00	$70.22	$70.22	$72.93	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$43.60	$69.06	$69.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600397	ERX	HCPCS J3475	15082-0902-05	MAGNESIUM SULFATE 2 G IN 50ML D5W PREMIX	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$0.24	$38.59	$38.59	$40.08	$0.00	$3.53	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$2.96	$0.00	$0.00	$2.82	$0.00	$0.00	$0.00	$0.00	$0.00
600397	ERX	HCPCS J3475	42852-0902-05	MAGNESIUM SULFATE 2 G IN 50ML D5W PREMIX	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$0.24	$38.59	$38.59	$40.08	$0.00	$3.53	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$2.96	$0.00	$0.00	$2.82	$0.00	$0.00	$0.00	$0.00	$0.00
600397	ERX	HCPCS J3475	99999-6008-51	MAGNESIUM SULFATE 2 G IN 50ML D5W PREMIX	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$0.24	$38.59	$38.59	$40.08	$0.00	$3.53	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$2.96	$0.00	$0.00	$2.82	$0.00	$0.00	$0.00	$0.00	$0.00
600398	ERX	HCPCS J3475	15082-0903-05	MAGNESIUM SULFATE 4 G IN 50ML D5W PREMIX	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.47	$16.33	$16.33	$16.96	$0.00	$7.07	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.92	$0.00	$0.00	$5.64	$0.00	$0.00	$0.00	$0.00	$0.00
600398	ERX	HCPCS J3475	99999-6006-44	MAGNESIUM SULFATE 4 G IN 50ML D5W PREMIX	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$0.47	$16.33	$16.33	$16.96	$0.00	$7.07	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$5.92	$0.00	$0.00	$5.64	$0.00	$0.00	$0.00	$0.00	$0.00
600399	ERX	HCPCS J3475	24200-0015-13	MAGNESIUM SULFATE 50 G IN 600ML LR PREMIX	BOTH IP/OP	$92.59 	$68.52	$0.00	$88.36	$41.67	$41.67	$0.00	$0.00	$0.00	$5.88	$68.72	$68.72	$71.37	$0.00	$88.36	$0.00	$54.77	$54.77	$0.00	$42.68	$67.60	$68.28	$0.00		$0.00	$74.03	$0.00	$0.00	$70.48	$0.00	$0.00	$0.00	$0.00	$0.00
600399	ERX	HCPCS J3475	24200-1015-13	MAGNESIUM SULFATE 50 G IN 600ML LR PREMIX	BOTH IP/OP	$92.59 	$68.52	$0.00	$88.36	$41.67	$41.67	$0.00	$0.00	$0.00	$5.88	$68.72	$68.72	$71.37	$0.00	$88.36	$0.00	$54.77	$54.77	$0.00	$42.68	$67.60	$68.28	$0.00		$0.00	$74.03	$0.00	$0.00	$70.48	$0.00	$0.00	$0.00	$0.00	$0.00
600399	ERX	HCPCS J3475	99999-6006-77	MAGNESIUM SULFATE 50 G IN 600ML LR PREMIX	BOTH IP/OP	$92.59 	$68.52	$0.00	$88.36	$41.67	$41.67	$0.00	$0.00	$0.00	$5.88	$68.72	$68.72	$71.37	$0.00	$88.36	$0.00	$54.77	$54.77	$0.00	$42.68	$67.60	$68.28	$0.00		$0.00	$74.03	$0.00	$0.00	$70.48	$0.00	$0.00	$0.00	$0.00	$0.00
600403	ERX	HCPCS 25000001	15082-0211-10	FENTANYL 200MCG + 0.1% BUPIVACAINE/100ML NS EPIDURAL	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60		$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600403	ERX	HCPCS 25000001	99999-6007-22	FENTANYL 200MCG + 0.1% BUPIVACAINE/100ML NS EPIDURAL	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60		$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600420	ERX	HCPCS 25000001	99999-6008-76	ACETIC ACID 3% SOLN	BOTH IP/OP	$11.00 	$8.14	$0.00	$175.78		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$109.86	$8.71	$175.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600420	ERX	HCPCS 25000001	99999-6004-23	ACETIC ACID 3% SOLN	BOTH IP/OP	$11.00 	$8.14	$0.00	$175.78		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$109.86	$174.02	$175.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600421	ERX	HCPCS 25000001	535rf-p401-0j	NXSTAGE RFP 401 DIALYSIS SOLUTION	BOTH IP/OP	$91.68 	$67.84	$0.00	$70.67		$0.00	$0.00	$0.00	$0.00	$0.00	$68.04	$68.04	$70.67	$0.00	$19.11	$0.00	$0.00	$0.00	$0.00	$41.57	$65.84	$66.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600421	ERX	HCPCS 25000001	99999-6004-24	NXSTAGE RFP 401 DIALYSIS SOLUTION	BOTH IP/OP	$91.68 	$67.84	$0.00	$70.67		$0.00	$0.00	$0.00	$0.00	$0.00	$68.04	$68.04	$70.67	$0.00	$19.11	$0.00	$0.00	$0.00	$0.00	$41.57	$65.84	$66.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600422	ERX	HCPCS 25000001	535rf-p400-0i	NXSTAGE RFP 400 DIALYSIS SOLUTION	BOTH IP/OP	$91.68 	$67.84	$0.00	$70.67		$0.00	$0.00	$0.00	$0.00	$0.00	$68.04	$68.04	$70.67	$0.00	$19.11	$0.00	$0.00	$0.00	$0.00	$41.57	$65.84	$66.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600422	ERX	HCPCS 25000001	99999-6004-25	NXSTAGE RFP 400 DIALYSIS SOLUTION	BOTH IP/OP	$91.68 	$67.84	$0.00	$70.67		$0.00	$0.00	$0.00	$0.00	$0.00	$68.04	$68.04	$70.67	$0.00	$19.11	$0.00	$0.00	$0.00	$0.00	$41.57	$65.84	$66.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600423	ERX	HCPCS 25000001	99999-6004-27	CLINDAMYCIN 50MG/ML OPHTH SOLN 5 ML	BOTH IP/OP	$48.61 	$35.97	$0.00	$37.47		$0.00	$0.00	$0.00	$0.00	$0.00	$36.08	$36.08	$37.47	$0.00	$10.13	$0.00	$0.00	$0.00	$0.00	$22.04	$34.91	$35.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600426	ERX	HCPCS 25000001	99999-6004-26	MECHLORETHAMINE 0.01% OINT	BOTH IP/OP	"$2,072.00 "	"$1,533.28"	$0.00	"$1,597.10"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,537.84"	"$1,537.84"	"$1,597.10"	$0.00	$431.80	$0.00	$0.00	$0.00	$0.00	$960.00	"$1,520.64"	"$1,536.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600435	ERX	HCPCS 25000001	99999-6004-39	CHOCOLATE SYRUP	BOTH IP/OP	$11.00 	$8.14	$0.00	$8.80		$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$8.48	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.71	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600438	ERX	HCPCS 25000001	99999-6005-87	OR NEOMYCIN-POLYMYXIN B (NEOSPORIN GU) 3 ML/3000 ML NS IR	BOTH IP/OP	$238.80 	$176.71	$0.00	$184.07		$0.00	$0.00	$0.00	$0.00	$0.00	$177.24	$177.24	$184.07	$0.00	$49.77	$0.00	$0.00	$0.00	$0.00	$108.39	$171.69	$173.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600450	ERX	HCPCS 25000001	99999-6004-58	PENICILLIN 160 UNITS/ML D5W DESENSITIZATION	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600453	ERX	HCPCS J1644	15082-0747-99	HEPARIN 4000 UNITS/1000 ML NS IR	BOTH IP/OP	$131.24 	$97.12	$0.00	$101.16	$59.06	$59.06	$0.00	$0.00	$0.00	$0.94	$97.41	$97.41	$101.16	$0.00	$1.17	$0.00	$77.63	$77.63	$0.00	$59.50	$94.25	$95.20	$0.00		$0.00	$1.13	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00
600453	ERX	HCPCS J1644	42852-0747-99	HEPARIN 4000 UNITS/1000 ML NS IR	BOTH IP/OP	$131.24 	$97.12	$0.00	$101.16	$59.06	$59.06	$0.00	$0.00	$0.00	$0.94	$97.41	$97.41	$101.16	$0.00	$1.17	$0.00	$77.63	$77.63	$0.00	$59.50	$94.25	$95.20	$0.00		$0.00	$1.13	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00
600453	ERX	HCPCS J1644	71285-7022-01	HEPARIN 4000 UNITS/1000 ML NS IR	BOTH IP/OP	$131.24 	$97.12	$0.00	$101.16	$59.06	$59.06	$0.00	$0.00	$0.00	$0.94	$97.41	$97.41	$101.16	$0.00	$1.17	$0.00	$77.63	$77.63	$0.00	$59.50	$94.25	$95.20	$0.00		$0.00	$1.13	$0.00	$0.00	$1.07	$0.00	$0.00	$0.00	$0.00	$0.00
600456	ERX	HCPCS 25000001	99999-6005-64	DEXTROSE 5% FLUSH 2 ML IV SYRINGE (NICU)	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600457	ERX	HCPCS 25000001	00338-0023-03	DEXTROSE 10% (NICU) IV BOLUS SYRINGE	BOTH IP/OP	$27.24 	$20.16	$0.00	$21.00		$0.00	$0.00	$0.00	$0.00	$0.00	$20.22	$20.22	$21.00	$0.00	$5.68	$0.00	$0.00	$0.00	$0.00	$11.40	$18.06	$18.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600493	ERX	HCPCS 25000001	99999-6005-84	MYCOPHENOLATE MOFETIL 200 MG/ML ORAL SYRINGE	BOTH IP/OP	$27.48 	$20.34	$0.00	$21.18		$0.00	$0.00	$0.00	$0.00	$0.00	$20.40	$20.40	$21.18	$0.00	$5.73	$0.00	$0.00	$0.00	$0.00	$12.46	$19.74	$19.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600494	ERX	HCPCS 25000001	99999-6005-83	MULTIVITAMIN (AQUADEKS) ORAL SYRINGE (NICU)	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600496	ERX	HCPCS 63700001	99999-6005-77	VITAMIN K 1 MG/ML (NICU) ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600499	ERX	HCPCS 25000001	99999-6005-65	AMPHOTERICIN 1MG/ML (NICU) COMPOUNDING	BOTH IP/OP	$94.57 	$69.98	$0.00	$72.89		$0.00	$0.00	$0.00	$0.00	$0.00	$70.19	$70.19	$72.89	$0.00	$19.71	$0.00	$0.00	$0.00	$0.00	$42.88	$67.91	$68.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600501	ERX	HCPCS 25000001	99999-6005-66	OR ONLY-CEFAZOLIN 1G/NS 1000ML IRRIGATION SOLN	BOTH IP/OP	$67.23 	$49.75	$0.00	$51.82		$0.00	$0.00	$0.00	$0.00	$0.00	$49.90	$49.90	$51.82	$0.00	$14.01	$0.00	$0.00	$0.00	$0.00	$31.19	$49.40	$49.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600502	ERX	HCPCS 25000001	99999-6005-67	OR ONLY-CEFAZOLIN 1GM/NS 1500ML IRRIG	BOTH IP/OP	$90.27 	$66.80	$0.00	$69.58		$0.00	$0.00	$0.00	$0.00	$0.00	$67.00	$67.00	$69.58	$0.00	$18.81	$0.00	$0.00	$0.00	$0.00	$41.64	$65.95	$66.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600506	ERX	HCPCS C9257	99999-6005-71	BEVACIZUMAB 5 MG/0.2 ML OPHTH SYRINGE	BOTH IP/OP	$132.69 	$98.19	$0.00	$102.28	$59.71	$59.71	$8.49	$8.49	$8.49	$27.66	$98.48	$98.48	$102.28	$8.80	$27.65	$5.72	$78.49	$78.49	$42.63	$60.16	$95.29	$96.26	$58.87		$58.87	$18.83	$0.00	$0.00	$19.15	$39.20	$0.00	$0.00	$0.00	$0.00
600511	ERX	HCPCS 25000001	99999-6005-80	HYDROXYPROGESTERONE-17 250 MG/ML IM INJ	BOTH IP/OP	"$2,144.52 "	"$1,586.94"	$0.00	"$1,653.00"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,591.66"	"$1,591.66"	"$1,653.00"	$0.00	$446.92	$0.00	$0.00	$0.00	$0.00	$993.60	"$1,573.86"	"$1,589.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600521	ERX	HCPCS 25000001	99999-6005-97	"OR BACITRACIN 50,000 UNITS IN 1500 ML NS IR-NEURO"	BOTH IP/OP	$114.65 	$84.84	$0.00	$88.37		$0.00	$0.00	$0.00	$0.00	$0.00	$85.09	$85.09	$88.37	$0.00	$23.89	$0.00	$0.00	$0.00	$0.00	$51.98	$82.33	$83.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600522	ERX	HCPCS 25000001	99999-6005-98	OR NEOMYCIN-POLYMYXIN B 2 ML/1500 ML NS IR	BOTH IP/OP	$125.22 	$92.66	$0.00	$96.52		$0.00	$0.00	$0.00	$0.00	$0.00	$92.94	$92.94	$96.52	$0.00	$26.10	$0.00	$0.00	$0.00	$0.00	$56.77	$89.92	$90.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600523	ERX	HCPCS 25000001	99999-6005-99	"OR CEFAZOLIN 1G+BACITRACIN 50,000UNITS+GENT80/1500 ML"	BOTH IP/OP	$127.48 	$94.34	$0.00	$98.26		$0.00	$0.00	$0.00	$0.00	$0.00	$94.62	$94.62	$98.26	$0.00	$26.57	$0.00	$0.00	$0.00	$0.00	$57.80	$91.55	$92.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600524	ERX	HCPCS 25000001	99999-6006-06	CIDOFOVIR 1% CREAM 37.5G	BOTH IP/OP	"$2,310.55 "	"$1,709.81"	$0.00	"$1,780.97"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,714.89"	"$1,714.89"	"$1,780.97"	$0.00	$481.52	$0.00	$0.00	$0.00	$0.00	"$1,070.53"	"$1,695.71"	"$1,712.84"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600531	ERX	HCPCS 25000001	99999-6006-16	OR CHLORHEXIDINE 0.12% 473 ML WITH 500 ML NSIR	BOTH IP/OP	$81.33 	$60.18	$0.00	$62.69		$0.00	$0.00	$0.00	$0.00	$0.00	$60.36	$60.36	$62.69	$0.00	$16.95	$0.00	$0.00	$0.00	$0.00	$36.88	$58.42	$59.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600534	ERX	HCPCS 25000001	99999-6006-19	CEFTRIAXONE +LIDOCAINE 1% IM INJ	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600536	ERX	HCPCS 25000001	99999-6006-22	OXYCHLOROSENE 0.4% IRRIGATION SOLN (2 G/500 ML NS)	BOTH IP/OP	$14.25 	$10.55	$0.00	$10.98		$0.00	$0.00	$0.00	$0.00	$0.00	$10.58	$10.58	$10.98	$0.00	$2.97	$0.00	$0.00	$0.00	$0.00	$6.46	$10.23	$10.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600539	ERX	HCPCS 25000001	99999-6006-24	AMIKACIN 250 MG/ML NEBU SOLN	BOTH IP/OP	$18.61 	$13.77	$0.00	$14.34		$0.00	$0.00	$0.00	$0.00	$0.00	$13.81	$13.81	$14.34	$0.00	$3.88	$0.00	$0.00	$0.00	$0.00	$8.44	$13.37	$13.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600541	ERX	HCPCS 25000001	99999-6006-26	TOBRAMYCIN 40 MG/ML NEBU SOLN	BOTH IP/OP	$17.05 	$12.62	$0.00	$13.14		$0.00	$0.00	$0.00	$0.00	$0.00	$12.65	$12.65	$13.14	$0.00	$3.55	$0.00	$0.00	$0.00	$0.00	$7.73	$12.24	$12.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600543	ERX	HCPCS J0878	99999-6006-30	DAPTOMYCIN 500MG/NS 50ML MB PLUS	BOTH IP/OP	$941.23 	$696.51	$0.00	$725.50	$423.55	$423.55	$0.00	$0.00	$0.00	$223.25	$698.58	$698.58	$725.50	$0.00	$33.49	$0.00	$556.74	$556.74	$173.25	$427.79	$677.62	$684.46	$239.25		$239.25	$170.38	$0.00	$0.00	$162.23	$68.00	$0.00	$0.00	$0.00	$0.00
600544	ERX	HCPCS 25000001	99999-6006-32	SODIUM BICARBONATE 1% ET IRRIGATION SOLUTION	BOTH IP/OP	$20.54 	$15.20	$0.00	$15.83		$0.00	$0.00	$0.00	$0.00	$0.00	$15.24	$15.24	$15.83	$0.00	$4.28	$0.00	$0.00	$0.00	$0.00	$9.31	$14.75	$14.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600548	ERX	HCPCS 25000001	99999-6006-38	PODOPHYLLUM 40% IN BENZOIN	BOTH IP/OP	$277.54 	$205.38	$0.00	$213.93		$0.00	$0.00	$0.00	$0.00	$0.00	$205.99	$205.99	$213.93	$0.00	$57.84	$0.00	$0.00	$0.00	$0.00	$125.97	$199.54	$201.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600550	ERX	HCPCS 25000001	99999-6006-43	VITAMIN K1 1 MG/0.1ML (NICU) >=1250 G	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600556	ERX	HCPCS 25000001		"PENICILLIN G 10,000 UNITS/ML ID INJ"	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600557	ERX	HCPCS 25000001	99999-6006-55	SQUARIC ACID 2% TOP SOLN	BOTH IP/OP	$504.00 	$372.96	$0.00	$388.48		$0.00	$0.00	$0.00	$0.00	$0.00	$374.07	$374.07	$388.48	$0.00	$105.03	$0.00	$0.00	$0.00	$0.00	$228.75	$362.34	$366.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600559	ERX	HCPCS 25000001	99999-6006-58	HISTAMINE BASE 1 MG/ML ID SOLN	BOTH IP/OP	$32.84 	$24.30	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.42	$26.01	$26.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600560	ERX	HCPCS J0640	99999-6006-60	LEUCOVORIN 50 MG/50 ML NS IVPB MB PLUS	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$1.05	$38.59	$38.59	$40.08	$0.00	$4.30	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$3.91	$0.00	$0.00	$3.73	$0.00	$0.00	$0.00	$0.00	$0.00
600561	ERX	HCPCS 25000001	99999-6006-59	POLYMYXIN B 10 MG/ML D5W DESENSITIZATION	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600562	ERX	HCPCS 25000001	99999-6006-61	POLYMYXIN B 1 MG/ML D5W DESENSITIZATION	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600563	ERX	HCPCS 25000001	99999-6006-62	POLYMYXIN B 0.1 MG/ML D5W DESENSITIZATION	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600564	ERX	HCPCS 25000001	99999-6006-63	POLYMYXIN B 0.01 MG/ML D5W DESENSITIZATION	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600565	ERX	HCPCS 25000001	99999-6006-64	POLYMYXIN B 0.001 MG/ML D5W DESENSITIZATION	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600566	ERX	HCPCS 25000001	99999-6006-65	POLYMYXIN B 0.0001 MG/ML D5W DESENSITIZATION	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600570	ERX	HCPCS 25000001	00002-1036-13	DOMPERIDONE 10 MG TABLET	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600571	ERX	HCPCS 25000001	99999-6006-72	VANCOMYCIN 15 MG/ML(1.5%) OPHTH SOLN	BOTH IP/OP	$58.65 	$43.40	$0.00	$45.21		$0.00	$0.00	$0.00	$0.00	$0.00	$43.53	$43.53	$45.21	$0.00	$12.22	$0.00	$0.00	$0.00	$0.00	$26.60	$42.13	$42.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600575	ERX	HCPCS J8530	99999-6006-76	CYCLOPHOSPHAMIDE 100 MG/10 ML ORAL SYRINGE	BOTH IP/OP	$115.80 	$85.69	$0.00	$89.26		$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$85.95	$89.26	$0.00	$24.13	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600578	ERX	HCPCS 25000001	99999-6006-82	VANCOMYCIN 10MG-HEPARIN 5000 UNITS/2 ML FLUSH	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60		$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600589	ERX	HCPCS 25000001	99999-6007-00	STREPTOMYCIN 5 MG/ML NS (NICU) IV SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600595	ERX	HCPCS 25000001	99999-6007-08	TRICHLOROACETIC ACID 70 % EXTERNAL SOLN	BOTH IP/OP	$184.61 	$136.61	$0.00	$142.30		$0.00	$0.00	$0.00	$0.00	$0.00	$137.02	$137.02	$142.30	$0.00	$38.47	$0.00	$0.00	$0.00	$0.00	$83.79	$132.72	$134.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600603	ERX	HCPCS 25000001	99999-6007-15	DILTIAZEM 2% OINTMENT	BOTH IP/OP	$21.46 	$15.88	$0.00	$16.54		$0.00	$0.00	$0.00	$0.00	$0.00	$15.93	$15.93	$16.54	$0.00	$4.47	$0.00	$0.00	$0.00	$0.00	$9.73	$15.41	$15.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600608	ERX	HCPCS J0610	24200-0066-10	CALCIUM GLUCONATE 3 GM IN SODIUM CHLORIDE 250 ML	BOTH IP/OP	$62.85 	$46.51	$0.00	$48.44	$28.28	$28.28	$0.00	$0.00	$0.00	$1.02	$46.65	$46.65	$48.44	$0.00	$14.55	$0.00	$37.18	$37.18	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$12.13	$0.00	$0.00	$11.55	$0.00	$0.00	$0.00	$0.00	$0.00
600626	ERX	HCPCS 25000001	99999-6007-47	BOSENTAN 6.25 MG/ML (NICU) ORAL SYRINGE	BOTH IP/OP	$52.92 	$39.16	$0.00	$40.79		$0.00	$0.00	$0.00	$0.00	$0.00	$39.28	$39.28	$40.79	$0.00	$11.03	$0.00	$0.00	$0.00	$0.00	$24.00	$38.02	$38.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600627	ERX	HCPCS 25000001	99999-6007-49	CEFTAZIDIME 50MG/ML FORTIFIED OPHTH SOLN 10 ML	BOTH IP/OP	$41.90 	$31.01	$0.00	$32.30		$0.00	$0.00	$0.00	$0.00	$0.00	$31.10	$31.10	$32.30	$0.00	$8.73	$0.00	$0.00	$0.00	$0.00	$19.00	$30.10	$30.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600632	ERX	HCPCS 25000001	99999-6007-51	GENTAMICIN 40 MG/ML NEBU SOLN	BOTH IP/OP	$10.19 	$7.54	$0.00	$7.85		$0.00	$0.00	$0.00	$0.00	$0.00	$7.56	$7.56	$7.85	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$4.62	$7.32	$7.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600633	ERX	HCPCS 63700001	99999-6007-52	AZATHIOPRINE 50 MG/ML ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600638	ERX	HCPCS 25000001	99999-6007-56	CYCLOSPORINE 2% OPHTH SOLN	BOTH IP/OP	$126.11 	$93.32	$0.00	$97.21		$0.00	$0.00	$0.00	$0.00	$0.00	$93.60	$93.60	$97.21	$0.00	$26.28	$0.00	$0.00	$0.00	$0.00	$57.18	$90.57	$91.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600639	ERX	HCPCS 25000001	99999-6007-57	DEXTROSE 5% FLUSH IV SYRINGE (ADULT)	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600640	ERX	HCPCS 25000001	99999-6007-58	PEDIATRACE ELEMENTS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600641	ERX	HCPCS 25000001	99999-6007-59	METRONIDAZOLE 0.005 MG/ML NS IV DESENSITIZATION	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600642	ERX	HCPCS 25000001	99999-6007-60	METRONIDAZOLE 0.05 MG/ML NS IV DESENSITIZATION	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600643	ERX	HCPCS 25000001	99999-6007-61	METRONIDAZOLE 0.5 MG/ML NS IV DESENSITIZATION	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600644	ERX	HCPCS 25000001	99999-6007-62	METRONIDAZOLE 5 MG/ML NS IV DESENSITIZATION	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600646	ERX	HCPCS 25000001	99999-6007-64	VANCOMYCIN 125 MG/5 ML ORAL SOLUTION UNIT-DOSE CUP	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600647	ERX	HCPCS 25000001	99999-6007-65	HEPARIN SODIUM NEBU 5000 UNITS/1 ML SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600658	ERX	HCPCS 25000001	99999-6007-79	ASPIRIN 1 MG/1 ML SUSP DESENSITIZATION BTL A	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600660	ERX	HCPCS 63600001	99999-6007-81	TERBUTALINE SULFATE 1 MG/ML NEBU SOLN	BOTH IP/OP	$83.33 	$61.66	$0.00	$64.23		$0.00	$0.00	$0.00	$0.00	$0.00	$61.85	$61.85	$64.23	$0.00	$17.37	$0.00	$0.00	$0.00	$0.00	$37.78	$59.84	$60.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600661	ERX	HCPCS 25000001	99999-6007-85	CLINDAMYCIN 1 MG/0.1 ML NS 0.5 ML INTRAVITREAL SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600668	ERX	HCPCS 25000001	99999-6007-92	OSELTAMIVIR PEDS 6 MG/ML ORAL SYRINGE	BOTH IP/OP	$9.28 	$6.87	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.89	$6.89	$7.15	$0.00	$1.93	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600672	ERX	HCPCS 63700001	99999-6007-94	CHOLECALCIFEROL 400 UNIT/ML (NICU) ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600673	ERX	HCPCS 25000001	99999-6007-95	AMPHOTERICIN B ORAL SOLUTION 1MG/ML	BOTH IP/OP	$612.87 	$453.52	$0.00	$472.40		$0.00	$0.00	$0.00	$0.00	$0.00	$454.87	$454.87	$472.40	$0.00	$127.72	$0.00	$0.00	$0.00	$0.00	$278.16	$440.61	$445.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600676	ERX	HCPCS 25000001	99999-6007-97	MORPHINE SULF 0.4 MG/1 ML ORAL SYRINGE (NICU)	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600683	ERX	HCPCS Q4074	99999-6008-05	ILOPROST 5 MCG/0.25 ML NEB SYRINGE	BOTH IP/OP	$50.34 	$37.25	$0.00	$38.80		$0.00	$0.00	$0.00	$0.00	$0.00	$37.36	$37.36	$38.80	$0.00	$10.49	$0.00	$0.00	$0.00	$0.00	$22.83	$36.15	$36.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600686	ERX	HCPCS J0712	99999-6008-78	CEFTAROLINE FOSAMIL 400MG/NS 250 ML MB PLUS	BOTH IP/OP	$524.43 	$388.08	$0.00	$404.23		$0.00	$0.00	$0.00	$0.00	$0.00	$389.23	$389.23	$404.23	$0.00	$109.29	$0.00	$0.00	$0.00	$0.00	$238.72	$378.12	$381.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600689	ERX	HCPCS 25000001	99999-6008-11	DIGOXIN 2 MG (0.25 MG/ML)/8 ML SYRINGE INTRA-AMNIOTIC	BOTH IP/OP	$29.74 	$22.01	$0.00	$22.92		$0.00	$0.00	$0.00	$0.00	$0.00	$22.07	$22.07	$22.92	$0.00	$6.20	$0.00	$0.00	$0.00	$0.00	$13.49	$21.36	$21.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600690	ERX	HCPCS 25000001	85412-0034-62	STERILE EMPTY CONTAINER 1000 ML	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600690	ERX	HCPCS 25000001	99999-6009-23	STERILE EMPTY CONTAINER 1000 ML	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600692	ERX	HCPCS J2543	99999-6008-21	PIPERACIL-TAZ 2.25 G/NS 50 ML MB PLUS	BOTH IP/OP	$77.44 	$57.31	$0.00	$59.69	$34.85	$34.85	$0.00	$0.00	$0.00	$13.09	$57.48	$57.48	$59.69	$0.00	$3.47	$0.00	$45.81	$45.81	$0.00	$35.81	$56.72	$57.30	$0.00		$0.00	$4.35	$0.00	$0.00	$4.14	$0.00	$0.00	$0.00	$0.00	$0.00
600698	ERX	HCPCS 25000001	99999-6008-27	LIDOCAINE HCL 0.1 % IJ SOLN-ALLERGY CLINIC	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600699	ERX	HCPCS 25000001	99999-6008-28	LIDOCAINE HCL 0.01 % IJ SOLN-ALLERGY CLINIC	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600700	ERX	HCPCS 25000001	99999-6008-30	ONDANSETRON 0.8 MG/ML ORAL SYRINGE (NICU)	BOTH IP/OP	$26.13 	$19.34	$0.00	$20.14		$0.00	$0.00	$0.00	$0.00	$0.00	$19.39	$19.39	$20.14	$0.00	$5.45	$0.00	$0.00	$0.00	$0.00	$11.85	$18.77	$18.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600701	ERX	HCPCS J0696	00409-7332-01	CEFTRIAXONE CUSTOM 1 G VIAL FOR DESENSITIZATION	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$5.64	$16.33	$16.33	$16.96	$0.00	$2.36	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$2.82	$0.00	$0.00	$2.69	$0.00	$0.00	$0.00	$0.00	$0.00
600706	ERX	HCPCS Q9967	00407-1413-58	IOHEXOL 300 MG/ML 30 ML PO SOLUTION	BOTH IP/OP	$192.35 	$142.34	$0.00	$142.76	$86.56	$86.56	$0.00	$0.00	$0.00	$40.09	$142.76	$142.76	$0.00	$0.00	$0.14	$0.00	$113.78	$113.78	$0.00	$87.21	$138.13	$139.53	$0.00		$0.00	$0.13	$0.00	$0.00	$27.77	$0.00	$0.00	$0.00	$0.00	$0.00
600706	ERX	HCPCS Q9967	00407-1413-59	IOHEXOL 300 MG/ML 30 ML PO SOLUTION	BOTH IP/OP	$192.35 	$142.34	$0.00	$142.76	$86.56	$86.56	$0.00	$0.00	$0.00	$40.09	$142.76	$142.76	$0.00	$0.00	$0.14	$0.00	$113.78	$113.78	$0.00	$87.21	$138.13	$139.53	$0.00		$0.00	$0.13	$0.00	$0.00	$27.77	$0.00	$0.00	$0.00	$0.00	$0.00
600707	ERX	HCPCS 95165	99999-6008-39	ALLERGEN EXTRACTS PREPARATION	BOTH IP/OP	$96.50 	$71.41	$0.00	$74.38		$0.00	$0.00	$0.00	$0.00	$0.00	$71.62	$71.62	$74.38	$0.00	$20.11	$0.00	$0.00	$0.00	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600710	ERX	HCPCS 25000001	99999-6008-42	METHOHEXITAL 1MG/ML SW IV SYRINGE-NEURO	BOTH IP/OP	$27.21 	$20.14	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.20	$20.20	$20.97	$0.00	$5.67	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600714	ERX	HCPCS 25000001	99999-6008-45	KPHOS 0.05 MM/ML D5W (NICU) IV SYRINGE	BOTH IP/OP	$28.83 	$21.33	$0.00	$22.22		$0.00	$0.00	$0.00	$0.00	$0.00	$21.40	$21.40	$22.22	$0.00	$6.01	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600715	ERX	HCPCS 25000001	99999-6008-46	SODIUM PHOSPHATE 0.05 MM/ML D5W (NICU) IV SYRINGE	BOTH IP/OP	$28.83 	$21.33	$0.00	$22.22		$0.00	$0.00	$0.00	$0.00	$0.00	$21.40	$21.40	$22.22	$0.00	$6.01	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600722	ERX	HCPCS 25000001	00338-0221-04	PLASMA-LYTE A IV BOLUS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600725	ERX	HCPCS 25000001	99999-6008-55	VORICONAZOLE 100MCG/0.1 ML NS OPHTH SYRINGE	BOTH IP/OP	$512.67 	$379.38	$0.00	$395.17		$0.00	$0.00	$0.00	$0.00	$0.00	$380.50	$380.50	$395.17	$0.00	$106.84	$0.00	$0.00	$0.00	$0.00	$232.69	$368.57	$372.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600726	ERX	HCPCS 25000001	99999-6008-56	DEXTROSE 25% SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600727	ERX	HCPCS 25000001	99999-6008-57	AMPHOTERICIN B 0.15% OPHTHALMIC SOLN	BOTH IP/OP	$57.32 	$42.42	$0.00	$44.18		$0.00	$0.00	$0.00	$0.00	$0.00	$42.54	$42.54	$44.18	$0.00	$11.95	$0.00	$0.00	$0.00	$0.00	$26.00	$41.18	$41.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600732	ERX	HCPCS 25000001	99999-6008-64	ASCORBIC ACID OPHTH SOLN 100 MG/ML	BOTH IP/OP	$30.13 	$22.30	$0.00	$23.22		$0.00	$0.00	$0.00	$0.00	$0.00	$22.36	$22.36	$23.22	$0.00	$6.28	$0.00	$0.00	$0.00	$0.00	$13.67	$21.65	$21.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600733	ERX	HCPCS J9214	99999-6008-65	INTERFERON ALFA-2B OPHTH SOLN 1000000 UNITS/ML	BOTH IP/OP	"$5,464.68 "	"$4,043.86"	$0.00	"$4,212.18"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,055.89"	"$4,055.89"	"$4,212.18"	$0.00	$39.06	$0.00	$0.00	$0.00	$0.00	"$2,478.45"	"$3,925.86"	"$3,965.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600735	ERX	HCPCS 25000001	99999-6008-66	METRONIDAZOLE 0.0005MG/ML ORAL SYRINGE DESENSITIZATIO	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600736	ERX	HCPCS 25000001	99999-6008-67	METRONIDAZOLE 0.005MG/ML ORAL SYRINGE DESENSITIZATION	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600737	ERX	HCPCS 25000001	99999-6008-68	METRONIDAZOLE 0.05MG/ML ORAL SYRINGE DESENSITIZATION	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600738	ERX	HCPCS 25000001	99999-6008-69	METRONIDAZOLE 0.5MG/ML ORAL SYRINGE DESENSITIZATION	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600739	ERX	HCPCS 25000001	99999-6008-70	METRONIDAZOLE 5MG/ML ORAL SYRINGE DESENSITIZATION	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600743	ERX	HCPCS 63700001	99999-6008-74	MERCAPTOPURINE 25 MG PO TAB	BOTH IP/OP	$8.57 	$6.34	$0.00	$6.22		$0.00	$0.00	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$0.00	$1.79	$0.00	$0.00	$0.00	$0.00	$3.89	$6.16	$6.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600744	ERX	HCPCS 25000001	99999-6008-75	WHISKY (40% ABV)	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600745	ERX	HCPCS J0712	99999-6008-79	CEFTAROLINE FOSAMIL 600MG/NS 250 ML MB PLUS	BOTH IP/OP	$524.43 	$388.08	$0.00	$404.23		$0.00	$0.00	$0.00	$0.00	$0.00	$389.23	$389.23	$404.23	$0.00	$109.29	$0.00	$0.00	$0.00	$0.00	$238.72	$378.12	$381.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600747	ERX	HCPCS J3301	99999-6008-81	TRIAMCINOLONE 40MG/1 ML + LIDOCAINE 1% 1 ML	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$3.55	$38.59	$38.59	$40.08	$0.00	$2.82	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$3.67	$0.00	$0.00	$3.49	$0.00	$0.00	$0.00	$0.00	$0.00
600756	ERX	HCPCS 25000001	99999-6008-94	GENTIAN VIOLET 0.00165% SOLUTION 	BOTH IP/OP	$144.75 	$107.12	$0.00	$111.57		$0.00	$0.00	$0.00	$0.00	$0.00	$107.43	$107.43	$111.57	$0.00	$30.17	$0.00	$0.00	$0.00	$0.00	$65.63	$103.95	$105.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600765	ERX	HCPCS 25000001	99999-6009-00	NALOXONE ORAL SYRINGE 0.4 MG/ML	BOTH IP/OP	$329.65 	$243.94	$0.00	$254.09		$0.00	$0.00	$0.00	$0.00	$0.00	$244.67	$244.67	$254.09	$0.00	$68.70	$0.00	$0.00	$0.00	$0.00	$149.63	$237.01	$239.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600767	ERX	HCPCS 25000001	99999-6009-02	GLYCOPYRROLATE 0.2 MG/ML NEBU SOLN	BOTH IP/OP	$6.00 	$4.44	$0.00	$4.80		$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$4.62	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$4.75	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600768	ERX	HCPCS J1580	99999-6009-04	GENTAMICIN 80 MG/500 ML NS FOR IRRIGATION	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$1.02	$38.59	$38.59	$40.08	$0.00	$1.97	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$2.31	$0.00	$0.00	$2.20	$0.00	$0.00	$0.00	$0.00	$0.00
600772	ERX	HCPCS 25000001	99999-6009-09	PEDIATRIC MAGIC MOUTH WASH	BOTH IP/OP	$594.72 	$440.09	$0.00	$458.41		$0.00	$0.00	$0.00	$0.00	$0.00	$441.40	$441.40	$458.41	$0.00	$123.94	$0.00	$0.00	$0.00	$0.00	$269.93	$427.56	$431.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600773	ERX	HCPCS 25000001	15082-0828-68	GLYCOPYRROLATE 0.6 MG/3 ML IV SYRINGE	BOTH IP/OP	$136.88 	$101.29	$0.00	$105.51		$0.00	$0.00	$0.00	$0.00	$0.00	$101.59	$101.59	$105.51	$0.00	$28.53	$0.00	$0.00	$0.00	$0.00	$62.06	$98.30	$99.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600774	ERX	HCPCS 25000001	99999-6009-11	WBC NUCLEAR ISOTOPE	BOTH IP/OP	"$1,022.00 "	$756.28	$0.00	$787.76		$0.00	$0.00	$0.00	$0.00	$0.00	$758.53	$758.53	$787.76	$0.00	$212.98	$0.00	$0.00	$0.00	$0.00	$463.75	$734.58	$742.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600779	ERX	HCPCS 25000001	99999-6009-17	DEXTROSE 5 % FLUSH-AMPHO PANEL	BOTH IP/OP	"$1,787.10 "	"$1,322.45"	$0.00	"$1,377.50"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,326.39"	"$1,326.39"	"$1,377.50"	$0.00	$372.43	$0.00	$0.00	$0.00	$0.00	$828.00	"$1,311.55"	"$1,324.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600779	ERX	HCPCS 25000001	99999-6010-37	DEXTROSE 5 % FLUSH-AMPHO PANEL	BOTH IP/OP	"$1,787.10 "	"$1,322.45"	$0.00	"$1,377.50"		$0.00	$0.00	$0.00	$0.00	$0.00	"$1,326.39"	"$1,326.39"	"$1,377.50"	$0.00	$372.43	$0.00	$0.00	$0.00	$0.00	$828.00	"$1,311.55"	"$1,324.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600789	ERX	HCPCS J0690	99999-6009-29	CEFAZOLIN 2 G/D5W 100 ML IVPB	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$2.77	$38.59	$38.59	$40.08	$0.00	$3.51	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$3.85	$0.00	$0.00	$3.67	$0.00	$0.00	$0.00	$0.00	$0.00
600798	ERX	HCPCS 25000001	99999-6009-41	RBC NUCLEAR ISOTOPE	BOTH IP/OP	"$1,022.00 "	$756.28	$0.00	$787.76		$0.00	$0.00	$0.00	$0.00	$0.00	$758.53	$758.53	$787.76	$0.00	$212.98	$0.00	$0.00	$0.00	$0.00	$463.75	$734.58	$742.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600799	ERX	HCPCS 25000001	99999-6009-42	METRONIDAZOLE 20MG/ML PEDIATRIC ORAL SUSPENSION	BOTH IP/OP	$348.60 	$257.96	$0.00	$268.70		$0.00	$0.00	$0.00	$0.00	$0.00	$258.73	$258.73	$268.70	$0.00	$72.65	$0.00	$0.00	$0.00	$0.00	$158.22	$250.62	$253.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600801	ERX	HCPCS 63700001	99999-6009-44	MISOPROSTOL 25 MCG PO TABLET	BOTH IP/OP	$13.92 	$10.30	$0.00	$10.10		$0.00	$0.00	$0.00	$2.48	$0.00	$0.00	$0.00	$0.00	$0.00	$2.90	$0.00	$0.00	$0.00	$0.00	$6.32	$10.00	$10.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600811	ERX	HCPCS 25000001		NITROGLYCERIN 200 MCG/ML D5W 5 ML IV SYRINGE ANGIO	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600811	ERX	HCPCS 25000001	99999-6009-52	NITROGLYCERIN 200 MCG/ML D5W 5 ML IV SYRINGE ANGIO	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600814	ERX	HCPCS 25000001	99999-6009-55	ARGATROBAN 100 MCG/1000 ML NS	BOTH IP/OP	"$1,138.80 "	$842.71	$0.00	$877.79		$0.00	$0.00	$0.00	$0.00	$0.00	$845.22	$845.22	$877.79	$0.00	$237.33	$0.00	$0.00	$0.00	$0.00	$516.75	$818.53	$826.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600816	ERX	HCPCS 63700001	99999-6011-79	HYDROXYUREA ORAL SOLN 100 MG/ML	BOTH IP/OP	$9.52 	$7.04	$0.00	$7.20		$0.00	$0.00	$0.00	$1.69	$0.00	$0.00	$0.00	$0.00	$0.00	$1.98	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600821	ERX	HCPCS J1956	99999-6009-64	LEVOFLOXACIN 7.5 MG/1.5 ML D5W PO SOLN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20	$4.05	$4.05	$0.00	$0.00	$0.00	$1.88	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$5.32	$5.32	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$1.41	$0.00	$0.00	$1.43	$0.00	$0.00	$0.00	$0.00	$0.00
600822	ERX	HCPCS J1956	99999-6009-65	LEVOFLOXACIN 75 MG/15 ML D5W PO SOLN	BOTH IP/OP	$14.08 	$10.42	$0.00	$10.85	$6.34	$6.34	$0.00	$0.00	$0.00	$2.93	$10.45	$10.45	$10.85	$0.00	$2.93	$0.00	$8.33	$8.33	$0.00	$6.39	$10.11	$10.22	$0.00		$0.00	$2.00	$0.00	$0.00	$2.03	$0.00	$0.00	$0.00	$0.00	$0.00
600824	ERX	HCPCS 25000001		CANTHARIDIN 0.7% TOPICAL LIQUID	BOTH IP/OP	$670.32 	$496.04	$0.00	$516.68		$0.00	$0.00	$0.00	$0.00	$0.00	$497.51	$497.51	$516.68	$0.00	$139.69	$0.00	$0.00	$0.00	$0.00	$304.24	$481.92	$486.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600827	ERX	HCPCS C9132	99999-6009-70	"PROTHROMBIN COMPLEX CONCENTRATE, 4-FACTOR (KCENTRA) IV 1500 UNITS/60ML"	BOTH IP/OP	"$5,989.00 "	"$4,431.86"	$0.00	"$6,519.00"		$0.00	$0.00	$0.00	$0.00	$0.00	"$4,445.04"	"$4,445.04"	"$4,616.32"	$0.00	"$1,248.11"	$0.00	$0.00	$0.00	$0.00	"$4,074.38"	"$6,453.81"	"$6,519.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600845	ERX	HCPCS J3370	99999-6009-81	VANCOMYCIN 1.5 G IN D5W 500 ML PREMIX	BOTH IP/OP	$86.23 	$63.81	$0.00	$66.47	$38.80	$38.80	$0.00	$0.00	$0.00	$10.86	$64.00	$64.00	$66.47	$0.00	$10.02	$0.00	$51.01	$51.01	$0.00	$39.80	$63.04	$63.68	$0.00		$0.00	$11.95	$0.00	$0.00	$11.38	$0.00	$0.00	$0.00	$0.00	$0.00
600855	ERX	HCPCS J2543	99999-6009-85	PIPERACIL-TAZO 4.5 G/50 ML D5W MB PLUS	BOTH IP/OP	$103.43 	$76.54	$0.00	$79.72	$46.54	$46.54	$0.00	$0.00	$0.00	$26.18	$76.77	$76.77	$79.72	$0.00	$6.94	$0.00	$61.18	$61.18	$0.00	$47.59	$75.38	$76.14	$0.00		$0.00	$8.70	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
600858	ERX	HCPCS 25000001	00264-7750-00	LACTATED RINGERS IV BOLUS ML/KG	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$0.00	$18.66	$18.66	$19.38	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600858	ERX	HCPCS 25000001	00338-0117-04	LACTATED RINGERS IV BOLUS ML/KG	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$0.00	$18.66	$18.66	$19.38	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600858	ERX	HCPCS 25000001	00264-7750-20	LACTATED RINGERS IV BOLUS ML/KG	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$0.00	$18.66	$18.66	$19.38	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600858	ERX	HCPCS 25000001	00338-0117-03	LACTATED RINGERS IV BOLUS ML/KG	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$0.00	$18.66	$18.66	$19.38	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600858	ERX	HCPCS 25000001	00409-7953-03	LACTATED RINGERS IV BOLUS ML/KG	BOTH IP/OP	$25.14 	$18.60	$0.00	$19.38	$11.31	$11.31	$0.00	$0.00	$0.00	$0.00	$18.66	$18.66	$19.38	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600859	ERX	HCPCS 25000001	99999-6009-88	GENTAMICIN 160MG+POLYMIXIN B 200MG+NEOMYCIN 1000MG/2L  IRRIGATION SOLN	BOTH IP/OP	$672.00 	$497.28	$0.00	$517.98		$0.00	$0.00	$0.00	$0.00	$0.00	$498.76	$498.76	$517.98	$0.00	$140.04	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600865	ERX	HCPCS 25000001	99999-6009-95	AMIKACIN 4 MG/ML OPHTH SOLN 10 ML	BOTH IP/OP	$18.61 	$13.77	$0.00	$14.34		$0.00	$0.00	$0.00	$0.00	$0.00	$13.81	$13.81	$14.34	$0.00	$3.88	$0.00	$0.00	$0.00	$0.00	$8.44	$13.37	$13.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600868	ERX	HCPCS J3301	99999-6009-98	TRIAMCINOLONE ACETONIDE 2.5 MG/ML IJ SUSP	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.77	$16.33	$16.33	$16.96	$0.00	$1.41	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.83	$0.00	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$0.00
600869	ERX	HCPCS J3301	99999-6009-99	TRIAMCINOLONE ACETONIDE 5 MG/ML IJ SUSP	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.77	$16.33	$16.33	$16.96	$0.00	$1.41	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.83	$0.00	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$0.00
600870	ERX	HCPCS J3301	99999-6010-00	TRIAMCINOLONE ACETONIDE 4 MG/ML IJ SUSP	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.77	$16.33	$16.33	$16.96	$0.00	$1.41	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.83	$0.00	$0.00	$1.75	$0.00	$0.00	$0.00	$0.00	$0.00
600871	ERX	HCPCS J3301	99999-6010-01	TRIAMCINOLONE ACETONIDE 20 MG/ML IJ SUSP	BOTH IP/OP	$22.78 	$16.86	$0.00	$17.60	$10.25	$10.25	$0.00	$0.00	$0.00	$3.55	$16.91	$16.91	$17.56	$0.00	$2.82	$0.00	$13.47	$13.47	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.67	$0.00	$0.00	$3.49	$0.00	$0.00	$0.00	$0.00	$0.00
600878	ERX	HCPCS 25000001	68065-1134-72	"ON-Q PAIN PUMP SINGLE LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR"	BOTH IP/OP	$803.00 	$594.22	$0.00	$618.95		$0.00	$0.00	$0.00	$0.00	$0.00	$595.99	$595.99	$618.95	$0.00	$167.35	$0.00	$0.00	$0.00	$0.00	$364.38	$577.17	$583.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600878	ERX	HCPCS 25000001	99999-6010-06	"ON-Q PAIN PUMP SINGLE LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR"	BOTH IP/OP	$803.00 	$594.22	$0.00	$618.95		$0.00	$0.00	$0.00	$0.00	$0.00	$595.99	$595.99	$618.95	$0.00	$167.35	$0.00	$0.00	$0.00	$0.00	$364.38	$577.17	$583.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600878	ERX	HCPCS 25000001	99999-6011-27	"ON-Q PAIN PUMP SINGLE LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR"	BOTH IP/OP	$803.00 	$594.22	$0.00	$618.95		$0.00	$0.00	$0.00	$0.00	$0.00	$595.99	$595.99	$618.95	$0.00	$167.35	$0.00	$0.00	$0.00	$0.00	$364.38	$577.17	$583.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600879	ERX	HCPCS 25000001		"ON-Q PAIN PUMP DUAL LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR"	BOTH IP/OP	$968.28 	$716.53	$0.00	$746.35		$0.00	$0.00	$0.00	$0.00	$0.00	$718.66	$718.66	$746.35	$0.00	$201.79	$0.00	$0.00	$0.00	$0.00	$439.37	$695.96	$702.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600879	ERX	HCPCS 25000001	68065-1316-14	"ON-Q PAIN PUMP DUAL LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR"	BOTH IP/OP	$968.28 	$716.53	$0.00	$746.35		$0.00	$0.00	$0.00	$0.00	$0.00	$718.66	$718.66	$746.35	$0.00	$201.79	$0.00	$0.00	$0.00	$0.00	$439.37	$695.96	$702.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600879	ERX	HCPCS 25000001	99999-6010-07	"ON-Q PAIN PUMP DUAL LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR"	BOTH IP/OP	$968.28 	$716.53	$0.00	$746.35		$0.00	$0.00	$0.00	$0.00	$0.00	$718.66	$718.66	$746.35	$0.00	$201.79	$0.00	$0.00	$0.00	$0.00	$439.37	$695.96	$702.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600880	ERX	HCPCS J0692	99999-6011-00	CEFEPIME 1 G/100 ML NS MB PLUS	BOTH IP/OP	$54.14 	$40.06	$0.00	$41.73	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.18	$40.18	$41.73	$0.00	$11.28	$0.00	$32.02	$32.02	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$8.14	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
600881	ERX	HCPCS J0692	99999-6011-01	CEFEPIME 2 G/100 ML NS MB PLUS	BOTH IP/OP	$65.28 	$48.31	$0.00	$50.32	$29.38	$29.38	$0.00	$0.00	$0.00	$13.61	$48.45	$48.45	$50.32	$0.00	$13.60	$0.00	$38.61	$38.61	$0.00	$30.30	$48.00	$48.48	$0.00		$0.00	$9.48	$0.00	$0.00	$9.65	$0.00	$0.00	$0.00	$0.00	$0.00
600885	ERX	HCPCS J0295	99999-6010-13	AMPICILLIN-SULB 3 G/D5W 100ML MB PLUS	BOTH IP/OP	$142.00 	$105.08	$0.00	$109.45	$63.90	$63.90	$0.00	$0.00	$0.00	$8.48	$105.39	$105.39	$109.45	$0.00	$5.19	$0.00	$83.99	$83.99	$0.00	$65.08	$103.08	$104.12	$0.00		$0.00	$6.06	$0.00	$0.00	$5.77	$0.00	$0.00	$0.00	$0.00	$0.00
600886	ERX	HCPCS J0290	99999-6012-11	AMPICILLIN 2 G/100ML D5W MB PLUS	BOTH IP/OP	$80.07 	$59.25	$0.00	$61.72	$36.03	$36.03	$0.00	$0.00	$0.00	$10.43	$59.43	$59.43	$61.72	$0.00	$3.79	$0.00	$47.36	$47.36	$0.00	$37.01	$58.62	$59.21	$0.00		$0.00	$4.61	$0.00	$0.00	$4.39	$0.00	$0.00	$0.00	$0.00	$0.00
600889	ERX	HCPCS J3370	99999-6010-17	VANCOMYCIN 1.5 G IN NS 250 ML PREMIX	BOTH IP/OP	$309.95 	$229.36	$0.00	$238.91	$139.48	$139.48	$0.00	$0.00	$0.00	$10.86	$230.04	$230.04	$238.91	$0.00	$10.02	$0.00	$183.34	$183.34	$0.00	$141.38	$223.94	$226.20	$0.00		$0.00	$11.95	$0.00	$0.00	$11.38	$0.00	$0.00	$0.00	$0.00	$0.00
600892	ERX	HCPCS J0740		CIDOFOVIR INTRALESIONAL 15 MG/ML INJ	BOTH IP/OP	$596.74 	$441.59	$0.00	$459.97		$0.00	$0.00	$0.00	$0.00	$0.00	$442.90	$442.90	$459.97	$0.00	$124.36	$0.00	$0.00	$0.00	$0.00	$270.84	$429.01	$433.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600893	ERX	HCPCS 25000001	99999-6011-34	ADULT MAGIC MOUTHWASH(MLX:BEN:LIDO) SUSPENSION	BOTH IP/OP	$24.73 	$18.30	$0.00	$66.08		$0.00	$0.00	$0.00	$0.00	$0.00	$18.35	$18.35	$19.06	$0.00	$5.15	$0.00	$0.00	$0.00	$0.00	$41.30	$17.76	$66.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600893	ERX	HCPCS 25000001	99999-6011-33	ADULT MAGIC MOUTHWASH(MLX:BEN:LIDO) SUSPENSION	BOTH IP/OP	$24.73 	$18.30	$0.00	$66.08		$0.00	$0.00	$0.00	$0.00	$0.00	$18.35	$18.35	$19.06	$0.00	$5.15	$0.00	$0.00	$0.00	$0.00	$41.30	$65.42	$66.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600894	ERX	HCPCS 25000001	99999-6011-35	NITROFURANTOIN 10MG/ML ORAL SUSPENSION  	BOTH IP/OP	$57.07 	$42.23	$0.00	$43.99		$0.00	$0.00	$0.00	$0.00	$0.00	$42.36	$42.36	$43.99	$0.00	$11.89	$0.00	$0.00	$0.00	$0.00	$25.88	$40.99	$41.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600895	ERX	HCPCS J3010	99999-6011-36	FENTANYL DRIP SYRINGE	BOTH IP/OP	$82.42 	$60.99	$0.00	$63.53	$37.09	$37.09	$0.00	$0.00	$0.00	$17.18	$61.17	$61.17	$63.53	$0.00	$18.62	$0.00	$48.75	$48.75	$0.00	$37.37	$59.19	$59.78	$0.00		$0.00	$29.08	$0.00	$0.00	$27.69	$0.00	$0.00	$0.00	$0.00	$0.00
600897	ERX	HCPCS J3010	99999-6011-36	FENTANYL CITRATE PF PCA 50 MCG/ML IV SOLN 50 ML	BOTH IP/OP	$82.42 	$60.99	$0.00	$63.53	$37.09	$37.09	$0.00	$0.00	$0.00	$17.18	$61.17	$61.17	$63.53	$0.00	$18.62	$0.00	$48.75	$48.75	$0.00	$37.37	$59.19	$59.78	$0.00		$0.00	$29.08	$0.00	$0.00	$27.69	$0.00	$0.00	$0.00	$0.00	$0.00
600898	ERX	HCPCS J3010	99999-6011-38	FENTANYL 2500 MCG/50 ML PREMIX	BOTH IP/OP	$97.42 	$72.09	$0.00	$75.09	$43.84	$43.84	$0.00	$0.00	$0.00	$20.30	$72.31	$72.31	$75.09	$0.00	$18.62	$0.00	$57.62	$57.62	$0.00	$44.87	$71.07	$71.78	$0.00		$0.00	$29.08	$0.00	$0.00	$27.69	$0.00	$0.00	$0.00	$0.00	$0.00
600900	ERX	HCPCS J3010	99999-6011-41	FENTANYL 5000 MCG/100 ML PREMIX	BOTH IP/OP	$179.83 	$133.07	$0.00	$138.61	$80.92	$80.92	$0.00	$0.00	$0.00	$37.48	$133.47	$133.47	$138.61	$0.00	$37.25	$0.00	$106.37	$106.37	$0.00	$82.23	$130.24	$131.56	$0.00		$0.00	$58.16	$0.00	$0.00	$55.38	$0.00	$0.00	$0.00	$0.00	$0.00
600915	ERX	HCPCS J0834	99999-6011-50	COSYNTROPIN 2 MCG/ML SYRINGE- ENDOCRINOLOGY CLINIC	BOTH IP/OP	$22.00 	$16.28	$0.00	$44.56	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$22.00	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$44.56	$0.00	$0.00	$42.42	$0.00	$0.00	$0.00	$0.00	$0.00
600925	ERX	HCPCS 25000001	99999-6011-65	GANCICLOVIR 5 MG/ML NS (NICU) IV SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600926	ERX	HCPCS J1561	99999-6011-67	IMMUNE GLOBULIN (HUMAN) 10 GM/100ML- MD	BOTH IP/OP	"$3,154.06 "	"$2,334.00"	$0.00	"$2,431.15"	"$1,419.33"	"$1,419.33"	$930.18	$930.18	$930.18	$657.38	"$2,340.94"	"$2,340.94"	"$2,431.15"	$964.38	"$1,133.15"	$626.85	"$1,554.95"	"$1,554.95"	$821.94	"$1,430.49"	"$2,265.90"	"$2,288.78"	"$1,135.06"		"$1,135.06"	$948.23	$0.00	$0.00	$902.87	$833.82	$0.00	$0.00	$0.00	$0.00
600931	ERX	HCPCS J9250	99999-6011-73	METHOTREXATE PF OPHTHALMIC INJECTION 0.4 MG/0.1 ML	BOTH IP/OP	$57.00 	$42.18	$0.00	$45.60	$25.65	$25.65	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$43.94	$0.00	$0.26	$0.00	$33.72	$33.72	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.29	$0.00	$0.00	$0.28	$0.00	$0.00	$0.00	$0.00	$0.00
600932	ERX	HCPCS 25000001	99999-6011-74	SELENIUM 4 MCG/ML IV SOLN- TPN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600975	ERX	HCPCS J3490	99999-6012-29	REMDESIVIR 100 MG/ NS 100 ML MB+ - EMERGENCY USE	BOTH IP/OP	"$1,361.80 "	"$1,007.73"	$0.00	"$1,049.68"	$612.81	$612.81	$0.00	$0.00	$0.00	$283.83	"$1,010.73"	"$1,010.73"	"$1,049.68"	$0.00	$283.80	$0.00	$805.50	$805.50	$0.00	$631.50	"$1,000.30"	"$1,010.40"	$0.00		$0.00	$197.66	$0.00	$0.00	$201.07	$0.00	$0.00	$0.00	$0.00	$0.00
600981	ERX	HCPCS 25000001	99999-6012-35	TRANEXAMIC ACID - NEBULIZER 1000 MG/10 ML FOR HEMOPTYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600982	ERX	HCPCS 25000001	99999-6012-36	VANCOMYCIN 500 MG/20 ML ORAL SOLUTION UNIT-DOSE CUP	BOTH IP/OP	$10.06 	$7.44	$0.00	$7.75		$0.00	$0.00	$0.00	$0.00	$0.00	$7.47	$7.47	$7.75	$0.00	$2.10	$0.00	$0.00	$0.00	$0.00	$4.56	$7.22	$7.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600983	ERX	HCPCS 25000001	99999-6012-37	DEXMEDETOMIDINE 1000 MCG/ 250 ML NS PREMIXED	BOTH IP/OP	$708.80 	$524.51	$0.00	$546.34		$0.00	$0.00	$0.00	$0.00	$0.00	$526.07	$526.07	$546.34	$0.00	$147.71	$0.00	$0.00	$0.00	$0.00	$322.32	$510.55	$515.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600990	ERX	HCPCS J2543	99999-6010-18	PIPERACIL-TAZO 4.5 G/NS 70 ML IVPB	BOTH IP/OP	$103.43 	$76.54	$0.00	$79.72	$46.54	$46.54	$0.00	$0.00	$0.00	$26.18	$76.77	$76.77	$79.72	$0.00	$6.94	$0.00	$61.18	$61.18	$0.00	$47.59	$75.38	$76.14	$0.00		$0.00	$8.70	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
600991	ERX	HCPCS 25000001	99999-6010-19	PEDIATRIC OPHTHALMIC DILATING DROPS-EYE CLINIC USE ONLY (CYCLOPENTOLATE/PHENYLEPHRINE/TETRACAINE/TROPICAMIDE)	BOTH IP/OP	$193.00 	$142.82	$0.00	$148.76		$0.00	$0.00	$0.00	$0.00	$0.00	$143.24	$143.24	$148.76	$0.00	$40.22	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600995	ERX	HCPCS 25000001	99999-6010-28	UVC FLUID 250 ML	BOTH IP/OP	$80.49 	$59.56	$0.00	$62.04		$0.00	$0.00	$0.00	$0.00	$0.00	$59.74	$59.74	$62.04	$0.00	$16.77	$0.00	$0.00	$0.00	$0.00	$36.49	$57.80	$58.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600996	ERX	HCPCS 25000001	99999-6010-29	UAC FLUID 60 ML	BOTH IP/OP	$22.00 	$16.28	$0.00	$40.08		$0.00	$0.00	$0.00	$0.00	$0.00	$38.59	$38.59	$40.08	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600997	ERX	HCPCS 25000001	99999-6010-30	PAL FLUID 60 ML	BOTH IP/OP	$62.85 	$46.51	$0.00	$51.94		$0.00	$0.00	$0.00	$0.00	$0.00	$50.01	$50.01	$51.94	$0.00	$13.10	$0.00	$0.00	$0.00	$0.00	$28.50	$45.14	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601004	ERX	HCPCS J0697	00143-9979-22	CEFUROXIME SODIUM 750 MG IM SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$2.37	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601004	ERX	HCPCS J0697	25021-0118-10	CEFUROXIME SODIUM 750 MG IM SOLR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$2.37	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601005	ERX	HCPCS J0697	00143-9567-25	CEFUROXIME SODIUM 1.5 G IM SOLR	BOTH IP/OP	$29.40 	$21.76	$0.00	$22.66		$0.00	$0.00	$0.00	$0.00	$0.00	$21.82	$21.82	$22.66	$0.00	$4.73	$0.00	$0.00	$0.00	$0.00	$13.33	$21.11	$21.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601005	ERX	HCPCS J0697	00143-9977-22	CEFUROXIME SODIUM 1.5 G IM SOLR	BOTH IP/OP	$29.40 	$21.76	$0.00	$22.66		$0.00	$0.00	$0.00	$0.00	$0.00	$21.82	$21.82	$22.66	$0.00	$4.73	$0.00	$0.00	$0.00	$0.00	$13.33	$21.11	$21.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601007	ERX	HCPCS J2185	99999-6010-39	MEROPENEM 500 MG/NS 100ML MB PLUS     	BOTH IP/OP	$189.43 	$140.18	$0.00	$146.01		$0.00	$0.00	$0.00	$0.00	$39.48	$140.59	$140.59	$146.01	$0.00	$4.66	$0.00	$112.05	$112.05	$0.00	$86.68	$137.29	$138.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601009	ERX	HCPCS J0295	99999-6010-92	AMPICILLIN-SULB 1.5 G/D5W 100ML MB PLUS	BOTH IP/OP	$109.96 	$81.37	$0.00	$84.76	$49.48	$49.48	$0.00	$0.00	$0.00	$4.24	$81.61	$81.61	$84.76	$0.00	$2.60	$0.00	$65.04	$65.04	$0.00	$50.55	$80.07	$80.88	$0.00		$0.00	$3.03	$0.00	$0.00	$2.89	$0.00	$0.00	$0.00	$0.00	$0.00
601010	ERX	HCPCS 25000001	42852-0301-67	KETAMINE 50MG/5ML IV SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601010	ERX	HCPCS 25000001	71286-3022-01	KETAMINE 50MG/5ML IV SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601010	ERX	HCPCS 25000001	99999-6010-44	KETAMINE 50MG/5ML IV SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601011	ERX	HCPCS J1335	99999-6010-45	ERTAPENEM 1 G/NS 100ML MB PLUS	BOTH IP/OP	$255.82 	$189.31	$0.00	$197.19	$115.12	$115.12	$0.00	$0.00	$0.00	$53.32	$189.87	$189.87	$197.19	$0.00	$66.36	$0.00	$151.32	$151.32	$0.00	$116.81	$185.02	$186.89	$0.00		$0.00	$90.95	$0.00	$0.00	$86.60	$0.00	$0.00	$0.00	$0.00	$0.00
601016	ERX	HCPCS 25000001	99999-6010-53	MORPHINE 0.1% TOPICAL GEL 15G	BOTH IP/OP	$59.88 	$44.31	$0.00	$46.16		$0.00	$0.00	$0.00	$0.00	$0.00	$44.44	$44.44	$46.16	$0.00	$12.48	$0.00	$0.00	$0.00	$0.00	$27.16	$43.01	$43.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601018	ERX	HCPCS J1650	99999-6010-54	ENOXAPARIN SODIUM 10 MG/0.1ML SC SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
601019	ERX	HCPCS J1650	99999-6010-55	ENOXAPARIN SODIUM 20 MG/0.2ML SC SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
601020	ERX	HCPCS 25000001	99999-6010-57	ZINC (ELEMENTAL) 1 MG/ML (NICU) ORAL SYRINGE	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20		$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$6.94	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601021	ERX	HCPCS J2590	42852-0703-99	OXYTOCIN 20 UNITS IN 1000ML NS PREMIX 	BOTH IP/OP	$208.00 	$153.92	$0.00	$160.33	$93.60	$93.60	$0.00	$0.00	$0.00	$2.94	$154.38	$154.38	$160.33	$0.00	$43.35	$0.00	$123.03	$123.03	$0.00	$95.00	$150.48	$152.00	$0.00		$0.00	$29.74	$0.00	$0.00	$30.25	$0.00	$0.00	$0.00	$0.00	$0.00
601021	ERX	HCPCS J2590	71285-6043-01	OXYTOCIN 20 UNITS IN 1000ML NS PREMIX 	BOTH IP/OP	$208.00 	$153.92	$0.00	$160.33	$93.60	$93.60	$0.00	$0.00	$0.00	$2.94	$154.38	$154.38	$160.33	$0.00	$43.35	$0.00	$123.03	$123.03	$0.00	$95.00	$150.48	$152.00	$0.00		$0.00	$29.74	$0.00	$0.00	$30.25	$0.00	$0.00	$0.00	$0.00	$0.00
601021	ERX	HCPCS J2590	99999-6011-30	OXYTOCIN 20 UNITS IN 1000ML NS PREMIX 	BOTH IP/OP	$208.00 	$153.92	$0.00	$160.33	$93.60	$93.60	$0.00	$0.00	$0.00	$2.94	$154.38	$154.38	$160.33	$0.00	$43.35	$0.00	$123.03	$123.03	$0.00	$95.00	$150.48	$152.00	$0.00		$0.00	$29.74	$0.00	$0.00	$30.25	$0.00	$0.00	$0.00	$0.00	$0.00
601024	ERX	HCPCS 25000001	99999-6010-63	KETAMINE 10MG/1 ML IV SYRINGE	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601025	ERX	HCPCS 25000001	99999-6010-64	NITROGLYCERIN 0.2 % OINT	BOTH IP/OP	$173.99 	$128.75	$0.00	$134.11		$0.00	$0.00	$0.00	$0.00	$0.00	$129.14	$129.14	$134.11	$0.00	$36.26	$0.00	$0.00	$0.00	$0.00	$78.98	$125.10	$126.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601028	ERX	HCPCS P9041	99999-6010-76	ALBUMIN 5 % IV CONTINUOUS INFUSION SYRINGE (NICU)	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60		$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$20.81	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601030	ERX	HCPCS J1170	00409-1283-04	HYDROMORPHONE 0.5MG/0.5ML INJ	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
601030	ERX	HCPCS J1170	00409-1283-05	HYDROMORPHONE 0.5MG/0.5ML INJ	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
601030	ERX	HCPCS J1170	76045-0009-05	HYDROMORPHONE 0.5MG/0.5ML INJ	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
601030	ERX	HCPCS J1170	76045-0009-06	HYDROMORPHONE 0.5MG/0.5ML INJ	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
601030	ERX	HCPCS J1170	76045-0009-96	HYDROMORPHONE 0.5MG/0.5ML INJ	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$1.56	$16.33	$16.33	$16.96	$0.00	$3.88	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.64	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$0.00
601033	ERX	HCPCS 25000001		SYMTUZA:DARUNAVIR-COBICISTAT-TENOFOVIR AF-EMTRICITABINE 800-150-10-200MG TABLET	BOTH IP/OP	$467.99 	$346.31	$0.00	$360.73		$0.00	$0.00	$0.00	$0.00	$0.00	$347.34	$347.34	$360.73	$0.00	$97.53	$0.00	$0.00	$0.00	$0.00	$212.41	$336.45	$339.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601034	ERX	HCPCS 25000001	99999-6010-84	ESMOLOL DRIP (NICU) 10 MG/ML	BOTH IP/OP	$179.68 	$132.96	$0.00	$138.50		$0.00	$0.00	$0.00	$0.00	$0.00	$133.36	$133.36	$138.50	$0.00	$37.45	$0.00	$0.00	$0.00	$0.00	$81.56	$129.18	$130.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601034	ERX	HCPCS 25000001	99999-6010-90	ESMOLOL DRIP (NICU) 10 MG/ML	BOTH IP/OP	$179.68 	$132.96	$0.00	$250.16		$0.00	$0.00	$0.00	$0.00	$0.00	$133.36	$133.36	$138.50	$0.00	$37.45	$0.00	$0.00	$0.00	$0.00	$81.56	$250.16	$130.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601035	ERX	HCPCS 25000001	76154-0477-05	VASOPRESSIN 20 UNITS/100 ML NS PREMIX	BOTH IP/OP	$359.52 	$266.04	$0.00	$277.12		$0.00	$0.00	$0.00	$0.00	$0.00	$266.84	$266.84	$277.12	$0.00	$74.92	$0.00	$0.00	$0.00	$0.00	$163.18	$258.47	$261.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601036	ERX	HCPCS 25000001	76154-0477-05	VASOPRESSIN 20 UNITS/100 ML NS FOR DIABETES INSIPIDUS PREMIX	BOTH IP/OP	$359.52 	$266.04	$0.00	$277.12		$0.00	$0.00	$0.00	$0.00	$0.00	$266.84	$266.84	$277.12	$0.00	$74.92	$0.00	$0.00	$0.00	$0.00	$163.18	$258.47	$261.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601047	ERX	HCPCS j3370	99999-6011-04	VANCOMYCIN 500MG/NS 100ML MB PLUS	BOTH IP/OP	$58.60 	$43.36	$0.00	$45.17		$0.00	$0.00	$0.00	$0.00	$0.00	$43.49	$43.49	$45.17	$0.00	$12.21	$0.00	$0.00	$0.00	$0.00	$27.27	$43.20	$43.63	$32.72		$32.72	$8.54	$0.00	$0.00	$8.68	$0.00	$0.00	$0.00	$0.00	$0.00
601048	ERX	HCPCS J3370	99999-6011-05	VANCOMYCIN 750MG/D5W 250ML MB PLUS	BOTH IP/OP	$62.12 	$45.97	$0.00	$49.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.20	$0.00	$0.00		$0.00	$3.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601049	ERX	HCPCS J3370	99999-6011-06	VANCOMYCIN 750MG/NS 250ML MB PLUS	BOTH IP/OP	$62.12 	$45.97	$0.00	$49.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.20	$0.00	$0.00		$0.00	$3.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601050	ERX	HCPCS J1335	00006-3843-71	ERTAPENEM SODIUM 1 G IJ SOLR FOR DESENSITIZATION	BOTH IP/OP	$472.03 	$349.30	$0.00	$363.84	$212.41	$212.41	$0.00	$0.00	$0.00	$98.38	$350.34	$350.34	$363.84	$0.00	$66.36	$0.00	$279.21	$279.21	$0.00	$214.24	$339.36	$342.78	$0.00		$0.00	$90.95	$0.00	$0.00	$86.60	$0.00	$0.00	$0.00	$0.00	$0.00
601050	ERX	HCPCS J1335	42023-0221-10	ERTAPENEM SODIUM 1 G IJ SOLR FOR DESENSITIZATION	BOTH IP/OP	$472.03 	$349.30	$0.00	$363.84	$212.41	$212.41	$0.00	$0.00	$0.00	$98.38	$350.34	$350.34	$363.84	$0.00	$66.36	$0.00	$279.21	$279.21	$0.00	$214.24	$339.36	$342.78	$0.00		$0.00	$90.95	$0.00	$0.00	$86.60	$0.00	$0.00	$0.00	$0.00	$0.00
601050	ERX	HCPCS J1335	55150-0282-20	ERTAPENEM SODIUM 1 G IJ SOLR FOR DESENSITIZATION	BOTH IP/OP	$472.03 	$349.30	$0.00	$363.84	$212.41	$212.41	$0.00	$0.00	$0.00	$98.38	$350.34	$350.34	$363.84	$0.00	$66.36	$0.00	$279.21	$279.21	$0.00	$214.24	$339.36	$342.78	$0.00		$0.00	$90.95	$0.00	$0.00	$86.60	$0.00	$0.00	$0.00	$0.00	$0.00
601053	ERX	HCPCS 25000001	99999-6100-01	METHACHOLINE (PROVOCHOLINE) 1 MG/ML INHALATION SOLN C	BOTH IP/OP	$115.80 	$85.69	$0.00	$89.26		$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$85.95	$89.26	$0.00	$24.13	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601053	ERX	HCPCS 25000001	99999-6011-09	METHACHOLINE (PROVOCHOLINE) 1 MG/ML INHALATION SOLN C	BOTH IP/OP	$115.80 	$85.69	$0.00	$362.34		$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$85.95	$89.26	$0.00	$24.13	$0.00	$0.00	$0.00	$0.00	$52.50	$362.34	$84.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601054	ERX	HCPCS 25000001	99999-6100-02	METHACHOLINE (PROVOCHOLINE) 0.25 MG/ML INH SOLN D	BOTH IP/OP	$115.80 	$85.69	$0.00	$89.26		$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$85.95	$89.26	$0.00	$24.13	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601054	ERX	HCPCS 25000001	99999-6011-10	METHACHOLINE (PROVOCHOLINE) 0.25 MG/ML INH SOLN D	BOTH IP/OP	$115.80 	$85.69	$0.00	$362.34		$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$85.95	$89.26	$0.00	$24.13	$0.00	$0.00	$0.00	$0.00	$52.50	$362.34	$84.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601055	ERX	HCPCS 25000001	99999-6100-03	METHACHOLINE (PROVOCHOLINE) 0.0625 MG/ML INH SOLN E	BOTH IP/OP	$115.80 	$85.69	$0.00	$366.00		$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$85.95	$89.26	$0.00	$24.13	$0.00	$0.00	$0.00	$0.00	$228.75	$83.16	$366.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601055	ERX	HCPCS 25000001	99999-6011-11	METHACHOLINE (PROVOCHOLINE) 0.0625 MG/ML INH SOLN E	BOTH IP/OP	$115.80 	$85.69	$0.00	$366.00		$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$85.95	$89.26	$0.00	$24.13	$0.00	$0.00	$0.00	$0.00	$228.75	$362.34	$366.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601058	ERX	HCPCS 25000001	99999-6100-04	METHACHOLINE (PROVOCHOLINE) 4 MG/ML INH SOLN B	BOTH IP/OP	$115.80 	$85.69	$0.00	$89.26		$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$85.95	$89.26	$0.00	$24.13	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601058	ERX	HCPCS 25000001	99999-6011-14	METHACHOLINE (PROVOCHOLINE) 4 MG/ML INH SOLN B	BOTH IP/OP	$115.80 	$85.69	$0.00	$362.34		$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$85.95	$89.26	$0.00	$24.13	$0.00	$0.00	$0.00	$0.00	$52.50	$362.34	$84.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601059	ERX	HCPCS 25000001	99999-6100-05	METHACHOLINE (PROVOCHOLINE) 16 MG/ML INH SOLN A	BOTH IP/OP	$115.80 	$85.69	$0.00	$89.26		$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$85.95	$89.26	$0.00	$24.13	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601059	ERX	HCPCS 25000001	99999-6011-15	METHACHOLINE (PROVOCHOLINE) 16 MG/ML INH SOLN A	BOTH IP/OP	$115.80 	$85.69	$0.00	$149.69		$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$85.95	$89.26	$0.00	$24.13	$0.00	$0.00	$0.00	$0.00	$52.50	$149.69	$84.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601060	ERX	HCPCS 25000001	99999-6011-17	NAFCILLIN 2 G/NS 100ML MB PLUS	BOTH IP/OP	$106.26 	$78.63	$0.00	$81.91		$0.00	$0.00	$0.00	$0.00	$0.00	$78.87	$78.87	$81.91	$0.00	$22.14	$0.00	$0.00	$0.00	$0.00	$48.87	$77.41	$78.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601061	ERX	HCPCS 25000001	99999-6011-18	NAFCILLIN 1 G/NS 100ML MB PLUS	BOTH IP/OP	$106.26 	$78.63	$0.00	$81.91		$0.00	$0.00	$0.00	$0.00	$0.00	$78.87	$78.87	$81.91	$0.00	$22.14	$0.00	$0.00	$0.00	$0.00	$48.87	$77.41	$78.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00338-0017-04	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00338-0017-18	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00338-0017-38	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00338-0017-48	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00338-0551-18	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00264-7510-20	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00338-0017-02	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00264-1510-31	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00338-0017-11	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00338-0017-31	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00338-0017-41	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00338-0551-11	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00264-7510-10	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	00338-0017-03	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601063	ERX	HCPCS 63600001	63323-0624-75	DEXTROSE 5% FLUID - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601064	ERX	HCPCS 63600001	99999-6006-29	SODIUM CHLORIDE 3% IV SOLUTION - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601064	ERX	HCPCS 63600001	00264-7805-10	SODIUM CHLORIDE 3% IV SOLUTION - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601064	ERX	HCPCS 63600001	00338-0054-03	SODIUM CHLORIDE 3% IV SOLUTION - DIALYSIS	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601072	ERX	HCPCS J1940	00409-6102-10	FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$1.23	$21.77	$21.77	$22.61	$0.00	$2.80	$0.00	$17.35	$17.35	$0.00	$13.11	$20.77	$20.98	$0.00		$0.00	$3.47	$0.00	$0.00	$3.30	$0.00	$0.00	$0.00	$0.00	$0.00
601072	ERX	HCPCS J1940	00409-6102-27	FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$1.23	$21.77	$21.77	$22.61	$0.00	$2.80	$0.00	$17.35	$17.35	$0.00	$13.11	$20.77	$20.98	$0.00		$0.00	$3.47	$0.00	$0.00	$3.30	$0.00	$0.00	$0.00	$0.00	$0.00
601072	ERX	HCPCS J1940	00409-6102-37	FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$1.23	$21.77	$21.77	$22.61	$0.00	$2.80	$0.00	$17.35	$17.35	$0.00	$13.11	$20.77	$20.98	$0.00		$0.00	$3.47	$0.00	$0.00	$3.30	$0.00	$0.00	$0.00	$0.00	$0.00
601072	ERX	HCPCS J1940	23155-0473-44	FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY	BOTH IP/OP	$29.33 	$21.70	$0.00	$22.61	$13.20	$13.20	$0.00	$0.00	$0.00	$1.23	$21.77	$21.77	$22.61	$0.00	$2.80	$0.00	$17.35	$17.35	$0.00	$13.11	$20.77	$20.98	$0.00		$0.00	$3.47	$0.00	$0.00	$3.30	$0.00	$0.00	$0.00	$0.00	$0.00
601073	ERX	HCPCS 25000001	99999-6012-08	DOXYCYCLINE 100MG/D5W 100ML MB PLUS	BOTH IP/OP	$109.78 	$81.24	$0.00	$84.62		$0.00	$0.00	$0.00	$0.00	$0.00	$81.48	$81.48	$84.62	$0.00	$22.88	$0.00	$0.00	$0.00	$0.00	$50.47	$79.94	$80.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
601074	ERX	HCPCS J0290	99999-6012-12	AMPICILLIN 1 G/50 ML NS MB PLUS	BOTH IP/OP	$69.81 	$51.66	$0.00	$53.81	$31.41	$31.41	$0.00	$0.00	$0.00	$5.22	$51.81	$51.81	$53.81	$0.00	$1.90	$0.00	$41.29	$41.29	$0.00	$32.36	$51.25	$51.77	$0.00		$0.00	$2.30	$0.00	$0.00	$2.19	$0.00	$0.00	$0.00	$0.00	$0.00
900083	ERX	HCPCS 63700001	99999-9000-83	AMLODIPINE 1MG/ML ORAL SUSP	BOTH IP/OP	$36.13 	$26.74	$0.00	$26.22		$0.00	$0.00	$0.00	$6.43	$0.00	$0.00	$0.00	$0.00	$0.00	$7.53	$0.00	$0.00	$0.00	$0.00	$16.39	$25.95	$26.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900092	ERX	HCPCS 25000001	99999-9000-92	OMEPRAZOLE 2MG/ML ORAL SUSP 50ML	BOTH IP/OP	$56.10 	$41.51	$0.00	$43.24		$0.00	$0.00	$0.00	$0.00	$0.00	$41.64	$41.64	$43.24	$0.00	$11.69	$0.00	$0.00	$0.00	$0.00	$25.44	$40.30	$40.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900093	ERX	HCPCS 63700001	99999-9000-93	PYRAZINAMIDE 100MG/ML 120ML SUSP	BOTH IP/OP	$9.00 	$6.66	$0.00	$84.34		$0.00	$0.00	$0.00	$1.60	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$52.71	$83.49	$84.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900094	ERX	HCPCS 63700001	99999-9000-94	RIFABUTIN 1200MG/60ML SUSPENSION	BOTH IP/OP	$153.98 	$113.95	$0.00	$111.70		$0.00	$0.00	$0.00	$27.41	$0.00	$0.00	$0.00	$0.00	$0.00	$32.09	$0.00	$0.00	$0.00	$0.00	$69.81	$110.58	$111.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900095	ERX	HCPCS 63700001	99999-6010-59	RIFAMPIN 10MG/ML ORAL SUSP	BOTH IP/OP	$16.60 	$12.28	$0.00	$48.16		$0.00	$0.00	$0.00	$2.95	$0.00	$0.00	$0.00	$0.00	$0.00	$3.46	$0.00	$0.00	$0.00	$0.00	$30.10	$11.92	$48.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900095	ERX	HCPCS 63700001	99999-9000-95	RIFAMPIN 10MG/ML ORAL SUSP	BOTH IP/OP	$16.60 	$12.28	$0.00	$48.16		$0.00	$0.00	$0.00	$2.95	$0.00	$0.00	$0.00	$0.00	$0.00	$3.46	$0.00	$0.00	$0.00	$0.00	$30.10	$47.68	$48.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900097	ERX	HCPCS 25000001	99999-6006-02	DAKINS (1/8 STRENGTH) 0.0625% EX SOLN	BOTH IP/OP	$39.22 	$29.02	$0.00	$30.23		$0.00	$0.00	$0.00	$0.00	$0.00	$29.11	$29.11	$30.23	$0.00	$8.17	$0.00	$0.00	$0.00	$0.00	$17.79	$28.17	$28.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900098	ERX	HCPCS 25000001	99999-6008-14	URSODIOL 15MG/ML ORAL SOLUTION	BOTH IP/OP	$19.45 	$14.39	$0.00	$42.32		$0.00	$0.00	$0.00	$0.00	$0.00	$14.44	$14.44	$14.99	$0.00	$4.05	$0.00	$0.00	$0.00	$0.00	$26.45	$13.97	$42.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900098	ERX	HCPCS 25000001	99999-6008-54	URSODIOL 15MG/ML ORAL SOLUTION	BOTH IP/OP	$19.45 	$14.39	$0.00	$42.32		$0.00	$0.00	$0.00	$0.00	$0.00	$14.44	$14.44	$14.99	$0.00	$4.05	$0.00	$0.00	$0.00	$0.00	$26.45	$41.90	$42.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900131	ERX	HCPCS J1644	99999-6006-11	HEPARIN 1500 UNITS IN NS 500 ML IR USE ONLY	BOTH IP/OP	$75.42 	$55.81	$0.00	$58.13	$33.94	$33.94	$0.00	$0.00	$0.00	$0.24	$55.98	$55.98	$58.13	$0.00	$0.29	$0.00	$44.61	$44.61	$0.00	$34.20	$54.17	$54.72	$0.00		$0.00	$0.28	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
900147	ERX	HCPCS 63700001	99999-6005-86	OPIUM TINCTURE 6MG/0.6ML ORAL SYRINGE	BOTH IP/OP	$11.55 	$8.55	$0.00	$8.38		$0.00	$0.00	$0.00	$2.06	$0.00	$0.00	$0.00	$0.00	$0.00	$2.41	$0.00	$0.00	$0.00	$0.00	$5.24	$8.30	$8.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900288	ERX	HCPCS 25000001	99999-6010-21	"MAFENIDE 5% (PLUS NYSTATIN 500,000 UNITS) TOP SOL-50GM/1000ML SW"	BOTH IP/OP	$185.11 	$136.98	$0.00	$142.68		$0.00	$0.00	$0.00	$0.00	$0.00	$137.39	$137.39	$142.68	$0.00	$38.58	$0.00	$0.00	$0.00	$0.00	$83.93	$132.94	$134.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900333	ERX	HCPCS J9201	00409-0181-01	GEMCITABINE 2G INTRAVESICAL SYRINGE-UROLOGY CLINIC ONLY	BOTH IP/OP	$365.32 	$270.34	$0.00	"$1,623.73"	$164.39	$164.39	$0.00	$0.00	$0.00	"$1,623.73"	$271.14	$271.14	$281.59	$0.00	$44.84	$0.00	$216.09	$216.09	$0.00	$163.40	$258.83	$261.44	$0.00		$0.00	$48.88	$0.00	$0.00	$46.54	$0.00	$0.00	$0.00	$0.00	$0.00
900333	ERX	HCPCS J9201	60505-6114-00	GEMCITABINE 2G INTRAVESICAL SYRINGE-UROLOGY CLINIC ONLY	BOTH IP/OP	$365.32 	$270.34	$0.00	"$1,623.73"	$164.39	$164.39	$0.00	$0.00	$0.00	"$1,623.73"	$271.14	$271.14	$281.59	$0.00	$44.84	$0.00	$216.09	$216.09	$0.00	$163.40	$258.83	$261.44	$0.00		$0.00	$48.88	$0.00	$0.00	$46.54	$0.00	$0.00	$0.00	$0.00	$0.00
900575	ERX	HCPCS 25000001	99999-6009-03	PHENYLEPHRINE BOLUS FROM IV BAG FOR CARDIAC NARRATOR	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60		$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$16.96	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900576	ERX	HCPCS 63600001	99999-6009-80	EPINEPHRINE 16000 MCG/500 ML NS - ANE	BOTH IP/OP	$167.91 	$124.25	$0.00	$138.74	$75.56	$75.56	$0.00	$0.00	$0.00	$35.00	$124.62	$124.62	$129.43	$0.00	$138.74	$0.00	$99.32	$99.32	$0.00	$76.13	$120.58	$121.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00409-9093-35	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00409-9093-37	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00409-9093-45	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00409-9094-12	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00409-9094-22	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00409-9094-25	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00409-9094-31	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00409-9094-61	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00641-6027-01	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00641-6027-25	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00641-6028-01	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00641-6028-25	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00641-6029-01	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00641-6029-25	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	00641-6030-01	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	17478-0030-05	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	63323-0806-14	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
4083037	ERX	HCPCS J3010	63323-0806-50	FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN	BOTH IP/OP	$22.00 	$16.28	$0.00	$67.84	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$65.32	$65.32	$67.84	$0.00	$0.74	$0.00	$52.04	$52.04	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$1.16	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$0.00
40811150	ERX	HCPCS J2704	00409-4699-33	PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML	BOTH IP/OP	$132.02 	$97.69	$0.00	$158.44	$59.41	$59.41	$0.00	$0.00	$0.00	$27.52	$152.57	$152.57	$158.44	$0.00	$27.51	$0.00	$121.59	$121.59	$0.00	$59.85	$52.82	$95.76	$0.00		$0.00	$18.73	$0.00	$0.00	$19.06	$0.00	$0.00	$0.00	$0.00	$0.00
40811150	ERX	HCPCS J2704	25021-0608-50	PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML	BOTH IP/OP	$132.02 	$97.69	$0.00	$158.44	$59.41	$59.41	$0.00	$0.00	$0.00	$27.52	$152.57	$152.57	$158.44	$0.00	$27.51	$0.00	$121.59	$121.59	$0.00	$59.85	$52.82	$95.76	$0.00		$0.00	$18.73	$0.00	$0.00	$19.06	$0.00	$0.00	$0.00	$0.00	$0.00
40811150	ERX	HCPCS J2704	43598-0548-21	PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML	BOTH IP/OP	$132.02 	$97.69	$0.00	$158.44	$59.41	$59.41	$0.00	$0.00	$0.00	$27.52	$152.57	$152.57	$158.44	$0.00	$27.51	$0.00	$121.59	$121.59	$0.00	$59.85	$52.82	$95.76	$0.00		$0.00	$18.73	$0.00	$0.00	$19.06	$0.00	$0.00	$0.00	$0.00	$0.00
40811150	ERX	HCPCS J2704	43598-0548-50	PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML	BOTH IP/OP	$132.02 	$97.69	$0.00	$158.44	$59.41	$59.41	$0.00	$0.00	$0.00	$27.52	$152.57	$152.57	$158.44	$0.00	$27.51	$0.00	$121.59	$121.59	$0.00	$59.85	$52.82	$95.76	$0.00		$0.00	$18.73	$0.00	$0.00	$19.06	$0.00	$0.00	$0.00	$0.00	$0.00
40811150	ERX	HCPCS J2704	00409-4699-24	PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML	BOTH IP/OP	$132.02 	$97.69	$0.00	$158.44	$59.41	$59.41	$0.00	$0.00	$0.00	$27.52	$152.57	$152.57	$158.44	$0.00	$27.51	$0.00	$121.59	$121.59	$0.00	$59.85	$94.80	$95.76	$0.00		$0.00	$18.73	$0.00	$0.00	$19.06	$0.00	$0.00	$0.00	$0.00	$0.00
40811150	ERX	HCPCS J2704	00409-4699-54	PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML	BOTH IP/OP	$132.02 	$97.69	$0.00	$158.44	$59.41	$59.41	$0.00	$0.00	$0.00	$27.52	$152.57	$152.57	$158.44	$0.00	$27.51	$0.00	$121.59	$121.59	$0.00	$59.85	$94.80	$95.76	$0.00		$0.00	$18.73	$0.00	$0.00	$19.06	$0.00	$0.00	$0.00	$0.00	$0.00
40811150	ERX	HCPCS J2704	00591-2136-57	PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML	BOTH IP/OP	$132.02 	$97.69	$0.00	$158.44	$59.41	$59.41	$0.00	$0.00	$0.00	$27.52	$152.57	$152.57	$158.44	$0.00	$27.51	$0.00	$121.59	$121.59	$0.00	$59.85	$94.80	$95.76	$0.00		$0.00	$18.73	$0.00	$0.00	$19.06	$0.00	$0.00	$0.00	$0.00	$0.00
40811150	ERX	HCPCS J2704	25021-0608-51	PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML	BOTH IP/OP	$132.02 	$97.69	$0.00	$158.44	$59.41	$59.41	$0.00	$0.00	$0.00	$27.52	$152.57	$152.57	$158.44	$0.00	$27.51	$0.00	$121.59	$121.59	$0.00	$59.85	$94.80	$95.76	$0.00		$0.00	$18.73	$0.00	$0.00	$19.06	$0.00	$0.00	$0.00	$0.00	$0.00
40811150	ERX	HCPCS J2704	43598-0549-10	PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML	BOTH IP/OP	$132.02 	$97.69	$0.00	$158.44	$59.41	$59.41	$0.00	$0.00	$0.00	$27.52	$152.57	$152.57	$158.44	$0.00	$27.51	$0.00	$121.59	$121.59	$0.00	$59.85	$94.80	$95.76	$0.00		$0.00	$18.73	$0.00	$0.00	$19.06	$0.00	$0.00	$0.00	$0.00	$0.00
40811150	ERX	HCPCS J2704	43598-0549-52	PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML	BOTH IP/OP	$132.02 	$97.69	$0.00	$158.44	$59.41	$59.41	$0.00	$0.00	$0.00	$27.52	$152.57	$152.57	$158.44	$0.00	$27.51	$0.00	$121.59	$121.59	$0.00	$59.85	$94.80	$95.76	$0.00		$0.00	$18.73	$0.00	$0.00	$19.06	$0.00	$0.00	$0.00	$0.00	$0.00
40811150	ERX	HCPCS J2704	63323-0269-67	PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML	BOTH IP/OP	$132.02 	$97.69	$0.00	$158.44	$59.41	$59.41	$0.00	$0.00	$0.00	$27.52	$152.57	$152.57	$158.44	$0.00	$27.51	$0.00	$121.59	$121.59	$0.00	$59.85	$94.80	$95.76	$0.00		$0.00	$18.73	$0.00	$0.00	$19.06	$0.00	$0.00	$0.00	$0.00	$0.00
600015848	ERX	HCPCS J1644	00409-7651-03	HEPARIN IN NS 50-0.45 UNIT/ML-% IJ SOLN	BOTH IP/OP	$39.81 	$29.46	$0.00	$30.69	$17.91	$17.91	$0.00	$0.00	$0.00	$5.88	$29.55	$29.55	$30.69	$0.00	$7.29	$0.00	$23.55	$23.55	$0.00	$17.10	$27.09	$27.36	$0.00		$0.00	$7.05	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$0.00
4.081E+12	ERX	HCPCS J1815	00002-7510-01	INSULIN LISPRO 100 UNIT/ML SC SOLN	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$8.15	$8.15	$0.00	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$3.13	$0.00	$8.87	$8.87	$0.00	$7.50	$11.88	$12.00	$0.00		$0.00	$0.00	$0.00	$0.00	$1.01	$0.00	$0.00	$0.00	$0.00	$0.00
15	SUP	Custom 27203010		00015  -  HANDGRIP CRCH CHLD GRY	BOTH IP/OP	$15.40 	$11.40	$0.00	$12.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.43	$11.43	$0.00	$0.00	$3.21	$0.00	$0.00	$0.00	$0.00	$7.70	$12.20	$12.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15.201	SUP	HCPCS C1713		015.2010  -  PLATE SQ RECT GRID MESH 1.5 MM SCR CRANIAL TI TIMESH BONE	BOTH IP/OP	"$1,010.00 "	$747.40	$0.00	$808.00	$454.50	$454.50	$0.00	$0.00	$0.00	$210.51	$749.62	$749.62	$0.00	$0.00	$210.48	$0.00	$597.42	$597.42	$0.00	$505.00	$799.92	$808.00	$0.00		$0.00	$158.07	$0.00	$0.00	$160.79	$0.00	$0.00	$0.00	$0.00	$0.00
76	SUP	Custom 27203010		000076  -  PLUG CATH CAP STRL LATEX FREE	BOTH IP/OP	$0.78 	$0.58	$0.00	$0.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.58	$0.58	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.39	$0.62	$0.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86	SUP	HCPCS C1886		0086  -  NOVASURE 2007 ENDOMETRIAL ABLATION SYSTEM	BOTH IP/OP	"$3,050.00 "	"$2,257.00"	$0.00	"$2,440.00"	"$1,656.15"	"$1,656.15"	$0.00	$0.00	$0.00	$635.70	"$2,263.71"	"$2,263.71"	$0.00	$0.00	$635.62	$0.00	"$1,804.08"	"$1,804.08"	$0.00	"$1,525.00"	"$2,415.60"	"$2,440.00"	$0.00		$0.00	$477.33	$0.00	$0.00	$485.56	$0.00	$0.00	$0.00	$0.00	$0.00
90	SUP	Custom 27803010		90  -  PLATE BN 152X152MM MESH PNL TI CRNM	BOTH IP/OP	"$2,316.25 "	"$1,714.03"	$0.00	"$1,853.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,719.12"	"$1,719.12"	$0.00	$0.00	$482.71	$0.00	$0.00	$0.00	$0.00	"$1,158.13"	"$1,834.47"	"$1,853.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100	SUP	Custom 27203010		CONTROL VRTRL 1 LOW POS IMMUN	BOTH IP/OP	$272.50 	$201.65	$0.00	$218.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.25	$215.82	$218.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.107	SUP	Custom 27803010		101.107  -  SPACER SPNL SM 22X10X7MM NS LF SUST RDLCNT PEEK LMBR INTRBD	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.109	SUP	Custom 27803010		101.109  -  SPACER SPNL SM 22X10X9MM NS LF SUST RDLCNT PEEK LMBR INTRBD	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.111	SUP	Custom 27803010		101.111  -  SPACER SPNL SM 22X10X11MM NS LF SUST RDLCNT PEEK LMBR INTRBD	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.113	SUP	Custom 27803010		101.113  -  SPACER SPNL SM 22X10X13MM NS LF SUST RDLCNT PEEK LMBR INTRBD	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.115	SUP	Custom 27803010		101.115  -  SPACER SPNL SM 22X10X15MM NS LF SUST RDLCNT PEEK LMBR INTRBD	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.117	SUP	Custom 27803010		101.117  -  SPACER SPNL SM 22X10X17MM NS LF SUST RDLCNT PEEK LMBR INTRBD	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.205	SUP	Custom 27803010		101.205  -  SPACER SPNL 13MM MED PRLL 14X5MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.206	SUP	Custom 27803010		101.206  -  SPACER SPNL 13MM MED PRLL 14X6MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.207	SUP	Custom 27803010		101.207  -  SPACER SPNL 13MM MED PRLL 14X7MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.208	SUP	Custom 27803010		101.208  -  SPACER SPNL 13MM MED PRLL 14X8MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.209	SUP	Custom 27803010		101.209  -  SPACER SPNL 13MM MED PRLL 14X9MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.21	SUP	Custom 27803010		101.210  -  SPACER SPNL 13MM MED PRLL 14X10MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.211	SUP	Custom 27803010		101.211  -  SPACER SPNL 13MM MED PRLL 14X11MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.212	SUP	Custom 27803010		101.212  -  SPACER SPNL 13MM MED PRLL 14X12MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.225	SUP	Custom 27803010		101.225  -  SPACER SPNL 7D LRDTC 13MM MED 14X5MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.226	SUP	Custom 27803010		101.226  -  SPACER SPNL 7D LRDTC 13MM MED 14X6MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.227	SUP	Custom 27803010		101.227  -  SPACER SPNL 7D LRDTC 13MM MED 14X7MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.228	SUP	Custom 27803010		101.228  -  SPACER SPNL 7D LRDTC 13MM MED 14X8MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.229	SUP	Custom 27803010		101.229  -  SPACER SPNL 7D LRDTC 13MM MED 14X9MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.23	SUP	Custom 27803010		101.230  -  SPACER SPNL 7D LRDTC 13MM MED 14X10MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.231	SUP	Custom 27803010		101.231  -  SPACER SPNL 7D LRDTC 13MM MED 14X11MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.232	SUP	Custom 27803010		101.232  -  SPACER SPNL 7D LRDTC 13MM MED 14X12MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.245	SUP	Custom 27803010		101.245  -  SPACER SPNL 13MM MED CNVX 14X5MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.246	SUP	Custom 27803010		101.246  -  SPACER SPNL 13MM MED CNVX 14X6MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.247	SUP	Custom 27803010		101.247  -  SPACER SPNL 13MM MED CNVX 14X7MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.248	SUP	Custom 27803010		101.248  -  SPACER SPNL 13MM MED CNVX 14X8MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.249	SUP	Custom 27803010		101.249  -  SPACER SPNL 13MM MED CNVX 14X9MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.25	SUP	Custom 27803010		101.250  -  SPACER SPNL 13MM MED CNVX 14X10MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.251	SUP	Custom 27803010		101.251  -  SPACER SPNL 13MM MED CNVX 14X11MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.252	SUP	Custom 27803010		101.252  -  SPACER SPNL 13MM MED CNVX 14X12MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.309	SUP	Custom 27803010		101.309  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST RDLCNT PEEK THORLMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.311	SUP	Custom 27803010		101.311  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST RDLCNT PEEK THORLMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.313	SUP	Custom 27803010		101.313  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST RDLCNT PEEK THORLMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.315	SUP	Custom 27803010		101.315  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST RDLCNT PEEK THORLMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.317	SUP	Custom 27803010		101.317  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST RDLCNT PEEK THORLMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.319	SUP	Custom 27803010		101.319  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST RDLCNT PEEK THORLMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.321	SUP	Custom 27803010		101.321  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST RDLCNT PEEK THORLMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.409	SUP	Custom 27803010		101.409  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST RDLCNT PEEK LAT INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.411	SUP	Custom 27803010		101.411  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.413	SUP	Custom 27803010		101.413  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.415	SUP	Custom 27803010		101.415  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.417	SUP	Custom 27803010		101.417  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.419	SUP	Custom 27803010		101.419  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.421	SUP	Custom 27803010		101.421  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.509	SUP	Custom 27803010		101.509  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.511	SUP	Custom 27803010		101.511  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.513	SUP	Custom 27803010		101.513  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.515	SUP	Custom 27803010		101.515  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.517	SUP	Custom 27803010		101.517  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.519	SUP	Custom 27803010		101.519  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.521	SUP	Custom 27803010		101.521  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.607	SUP	Custom 27803010		101.607  -  SPACER SPNL ARCH 27X9.5X7MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.609	SUP	Custom 27803010		101.609  -  SPACER SPNL ARCH 27X9.5X9MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.611	SUP	Custom 27803010		101.611  -  SPACER SPNL ARCH 27X9.5X11MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.613	SUP	Custom 27803010		101.613  -  SPACER SPNL ARCH 27X9.5X13MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.615	SUP	Custom 27803010		101.615  -  SPACER SPNL ARCH 27X9.5X15MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.617	SUP	Custom 27803010		101.617  -  SPACER SPNL ARCH 27X9.5X17MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.707	SUP	Custom 27803010		101.707  -  SPACER SPNL SM NAR 22X8X7MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.709	SUP	Custom 27803010		101.709  -  SPACER SPNL SM NAR 22X8X9MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.711	SUP	Custom 27803010		101.711  -  SPACER SPNL SM NAR 22X8X11MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.713	SUP	Custom 27803010		101.713  -  SPACER SPNL SM NAR 22X8X13MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.715	SUP	Custom 27803010		101.715  -  SPACER SPNL SM NAR 22X8X15MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.717	SUP	Custom 27803010		101.717  -  SPACER SPNL SM NAR 22X8X17MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.805	SUP	Custom 27803010		101.805  -  SPACER SPNL 11MM MED NAR PRLL 12X5MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.806	SUP	Custom 27803010		101.806  -  SPACER SPNL 11MM MED NAR PRLL 12X6MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.807	SUP	Custom 27803010		101.807  -  SPACER SPNL 11MM MED NAR PRLL 12X7MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.808	SUP	Custom 27803010		101.808  -  SPACER SPNL 11MM MED NAR PRLL 12X8MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.809	SUP	Custom 27803010		101.809  -  SPACER SPNL 11MM MED NAR PRLL 12X9MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.81	SUP	Custom 27803010		101.810  -  SPACER SPNL 11MM MED NAR PRLL 12X10MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.811	SUP	Custom 27803010		101.811  -  SPACER SPNL 11MM MED NAR PRLL 12X11MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.812	SUP	Custom 27803010		101.812  -  SPACER SPNL 11MM MED NAR PRLL 12X12MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.825	SUP	Custom 27803010		101.825  -  SPACER SPNL 7D LRDTC MED NAR 12X5MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.826	SUP	Custom 27803010		101.826  -  SPACER SPNL 7D LRDTC MED NAR 12X6MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.827	SUP	Custom 27803010		101.827  -  SPACER SPNL 7D LRDTC MED NAR 12X7MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.828	SUP	Custom 27803010		101.828  -  SPACER SPNL 7D LRDTC MED NAR 12X8MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.829	SUP	Custom 27803010		101.829  -  SPACER SPNL 7D LRDTC MED NAR 12X9MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.83	SUP	Custom 27803010		101.830  -  SPACER SPNL 7D LRDTC MED NAR 12X10MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.831	SUP	Custom 27803010		101.831  -  SPACER SPNL 7D LRDTC MED NAR 12X11MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.832	SUP	Custom 27803010		101.832  -  SPACER SPNL 7D LRDTC MED NAR 12X12MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.845	SUP	Custom 27803010		101.845  -  SPACER SPNL 11MM MED CNVX NAR 12X5MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.846	SUP	Custom 27803010		101.846  -  SPACER SPNL 11MM MED CNVX NAR 12X6MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.847	SUP	Custom 27803010		101.847  -  SPACER SPNL 11MM MED CNVX NAR 12X7MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.848	SUP	Custom 27803010		101.848  -  SPACER SPNL 11MM MED CNVX NAR 12X8MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.849	SUP	Custom 27803010		101.849  -  SPACER SPNL 11MM MED CNVX NAR 12X9MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.85	SUP	Custom 27803010		101.850  -  SPACER SPNL 11MM MED CNVX NAR 12X10MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.851	SUP	Custom 27803010		101.851  -  SPACER SPNL 11MM MED CNVX NAR 12X11MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101.852	SUP	Custom 27803010		101.852  -  SPACER SPNL 11MM MED CNVX NAR 12X12MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.041	SUP	HCPCS C1713		102.041  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 70MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.042	SUP	HCPCS C1713		102.042  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 75MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.043	SUP	HCPCS C1713		102.043  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 80MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.044	SUP	HCPCS C1713		102.044  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 85MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.045	SUP	HCPCS C1713		102.045  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 90MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.051	SUP	HCPCS C1713		102.051  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 70MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.052	SUP	HCPCS C1713		102.052  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 75MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.053	SUP	HCPCS C1713		102.053  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 80MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.054	SUP	HCPCS C1713		102.054  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 85MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.055	SUP	HCPCS C1713		102.055  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 90MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.061	SUP	HCPCS C1713		102.061  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 70MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.062	SUP	HCPCS C1713		102.062  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 75MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.063	SUP	HCPCS C1713		102.063  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 80MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.064	SUP	HCPCS C1713		102.064  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 85MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.065	SUP	HCPCS C1713		102.065  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 90MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.071	SUP	HCPCS C1713		102.071  -  7.0MM PROTEX PEDICLE SCREW 70MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.072	SUP	HCPCS C1713		102.072  -  7.0MM PROTEX PEDICLE SCREW 75MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.073	SUP	HCPCS C1713		102.073  -  7.0MM PROTEX PEDICLE SCREW 80MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.074	SUP	HCPCS C1713		102.074  -  7.0MM PROTEX PEDICLE SCREW 85MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.075	SUP	HCPCS C1713		102.075  -  7.0MM PROTEX PEDICLE SCREW 90MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.081	SUP	HCPCS C1713		102.081  -  8.0MM PROTEX PEDICLE SCREW 70MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.082	SUP	HCPCS C1713		102.082  -  8.0MM PROTEX PEDICLE SCREW 75MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.083	SUP	HCPCS C1713		102.083  -  8.0MM PROTEX PEDICLE SCREW 80MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.084	SUP	HCPCS C1713		102.084  -  8.0MM PROTEX PEDICLE SCREW 85MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.085	SUP	HCPCS C1713		102.085  -  8.0MM PROTEX PEDICLE SCREW 90MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.091	SUP	HCPCS C1713		102.091  -  9.0MM PROTEX PEDICLE SCREW 70MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.092	SUP	HCPCS C1713		102.092  -  9.0MM PROTEX PEDICLE SCREW 75MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.093	SUP	HCPCS C1713		102.093  -  9.0MM PROTEX PEDICLE SCREW 80MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.094	SUP	HCPCS C1713		102.094  -  9.0MM PROTEX PEDICLE SCREW 85MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.095	SUP	HCPCS C1713		102.095  -  9.0MM PROTEX PEDICLE SCREW 90MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.352	SUP	HCPCS C1713		102.352  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.353	SUP	HCPCS C1713		102.353  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.354	SUP	HCPCS C1713		102.354  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.355	SUP	HCPCS C1713		102.355  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.356	SUP	HCPCS C1713		102.356  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.357	SUP	HCPCS C1713		102.357  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.362	SUP	HCPCS C1713		102.362  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.363	SUP	HCPCS C1713		102.363  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.364	SUP	HCPCS C1713		102.364  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.365	SUP	HCPCS C1713		102.365  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.366	SUP	HCPCS C1713		102.366  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.367	SUP	HCPCS C1713		102.367  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.368	SUP	HCPCS C1713		102.368  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 60MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.369	SUP	HCPCS C1713		102.369  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 65MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.372	SUP	HCPCS C1713		102.372  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.373	SUP	HCPCS C1713		102.373  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.374	SUP	HCPCS C1713		102.374  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.375	SUP	HCPCS C1713		102.375  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.376	SUP	HCPCS C1713		102.376  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.377	SUP	HCPCS C1713		102.377  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.378	SUP	HCPCS C1713		102.378  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 60MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.379	SUP	HCPCS C1713		102.379  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 65MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.382	SUP	HCPCS C1713		102.382  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.383	SUP	HCPCS C1713		102.383  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.384	SUP	HCPCS C1713		102.384  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.385	SUP	HCPCS C1713		102.385  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.386	SUP	HCPCS C1713		102.386  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.387	SUP	HCPCS C1713		102.387  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.388	SUP	HCPCS C1713		102.388  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 60MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.389	SUP	HCPCS C1713		102.389  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 65MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.392	SUP	HCPCS C1713		102.392  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.393	SUP	HCPCS C1713		102.393  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.394	SUP	HCPCS C1713		102.394  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.395	SUP	HCPCS C1713		102.395  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.396	SUP	HCPCS C1713		102.396  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.397	SUP	HCPCS C1713		102.397  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.398	SUP	HCPCS C1713		102.398  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 60MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.399	SUP	HCPCS C1713		102.399  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 65MM	BOTH IP/OP	"$3,627.50 "	"$2,684.35"	$0.00	"$2,902.00"	"$1,632.38"	"$1,632.38"	$0.00	$0.00	$0.00	$756.06	"$2,692.33"	"$2,692.33"	$0.00	$0.00	$755.97	$0.00	"$1,788.36"	"$1,788.36"	$0.00	"$1,813.75"	"$2,872.98"	"$2,902.00"	$0.00		$0.00	$567.70	$0.00	$0.00	$577.50	$0.00	$0.00	$0.00	$0.00	$0.00
102.452	SUP	HCPCS C1713		102.452  -  5.0MM PROTEX PEDICLE SCREW 30MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.453	SUP	HCPCS C1713		102.453  -  5.0MM PROTEX PEDICLE SCREW 35MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.454	SUP	HCPCS C1713		102.454  -  5.0MM PROTEX PEDICLE SCREW 40MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.455	SUP	HCPCS C1713		102.455  -  5.0MM PROTEX PEDICLE SCREW 45MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.456	SUP	HCPCS C1713		102.456  -  5.0MM PROTEX PEDICLE SCREW 50MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.457	SUP	HCPCS C1713		102.457  -  5.0MM PROTEX PEDICLE SCREW 55MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.462	SUP	HCPCS C1713		102.462  -  6.0MM PROTEX PEDICLE SCREW 30MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.463	SUP	HCPCS C1713		102.463  -  6.0MM PROTEX PEDICLE SCREW 35MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.464	SUP	HCPCS C1713		102.464  -  6.0MM PROTEX PEDICLE SCREW 40MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.465	SUP	HCPCS C1713		102.465  -  6.0MM PROTEX PEDICLE SCREW 45MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.466	SUP	HCPCS C1713		102.466  -  6.0MM PROTEX PEDICLE SCREW 50MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.467	SUP	HCPCS C1713		102.467  -  6.0MM PROTEX PEDICLE SCREW 55MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.468	SUP	HCPCS C1713		102.468  -  6.0MM PROTEX PEDICLE SCREW 60MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.469	SUP	HCPCS C1713		102.469  -  6.0MM PROTEX PEDICLE SCREW 65MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.472	SUP	HCPCS C1713		102.472  -  7.0MM PROTEX PEDICLE SCREW 30MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.473	SUP	HCPCS C1713		102.473  -  7.0MM PROTEX PEDICLE SCREW 35MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.474	SUP	HCPCS C1713		102.474  -  7.0MM PROTEX PEDICLE SCREW 40MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.475	SUP	HCPCS C1713		102.475  -  7.0MM PROTEX PEDICLE SCREW 45MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.476	SUP	HCPCS C1713		102.476  -  7.0MM PROTEX PEDICLE SCREW 50MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.477	SUP	HCPCS C1713		102.477  -  7.0MM PROTEX PEDICLE SCREW 55MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.478	SUP	HCPCS C1713		102.478  -  7.0MM PROTEX PEDICLE SCREW 60MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.479	SUP	HCPCS C1713		102.479  -  7.0MM PROTEX PEDICLE SCREW 65MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.482	SUP	HCPCS C1713		102.482  -  8.0MM PROTEX PEDICLE SCREW 30MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.483	SUP	HCPCS C1713		102.483  -  8.0MM PROTEX PEDICLE SCREW 35MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.484	SUP	HCPCS C1713		102.484  -  8.0MM PROTEX PEDICLE SCREW 40MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.485	SUP	HCPCS C1713		102.485  -  8.0MM PROTEX PEDICLE SCREW 45MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.486	SUP	HCPCS C1713		102.486  -  8.0MM PROTEX PEDICLE SCREW 50MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.487	SUP	HCPCS C1713		102.487  -  8.0MM PROTEX PEDICLE SCREW 55MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.488	SUP	HCPCS C1713		102.488  -  8.0MM PROTEX PEDICLE SCREW 60MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.489	SUP	HCPCS C1713		102.489  -  8.0MM PROTEX PEDICLE SCREW 65MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.49	SUP	HCPCS C1713		102.490  -  PROTEX LOCKING CAP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
102.492	SUP	HCPCS C1713		102.492  -  9.0MM PROTEX PEDICLE SCREW 30MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.493	SUP	HCPCS C1713		102.493  -  9.0MM PROTEX PEDICLE SCREW 35MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.494	SUP	HCPCS C1713		102.494  -  9.0MM PROTEX PEDICLE SCREW 40MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.495	SUP	HCPCS C1713		102.495  -  9.0MM PROTEX PEDICLE SCREW 45MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.496	SUP	HCPCS C1713		102.496  -  9.0MM PROTEX PEDICLE SCREW 50MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.497	SUP	HCPCS C1713		102.497  -  9.0MM PROTEX PEDICLE SCREW 55MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.498	SUP	HCPCS C1713		102.498  -  9.0MM PROTEX PEDICLE SCREW 60MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.499	SUP	HCPCS C1713		102.499  -  9.0MM PROTEX PEDICLE SCREW 65MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
102.51	SUP	Custom 27803010		"102.510  -  6.5MM STRAIGHT ROD, 100MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.512	SUP	Custom 27803010		"102.512  -  6.5MM STRAIGHT ROD, 125MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.515	SUP	Custom 27803010		"102.515  -  6.5MM STRAIGHT ROD, 150MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.517	SUP	Custom 27803010		"102.517  -  6.5MM STRAIGHT ROD, 200MM"	BOTH IP/OP	$795.00 	$588.30	$0.00	$636.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$590.05	$590.05	$0.00	$0.00	$165.68	$0.00	$0.00	$0.00	$0.00	$397.50	$629.64	$636.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.519	SUP	Custom 27803010		"102.519  -  6.5MM STRAIGHT ROD, 300MM"	BOTH IP/OP	$927.50 	$686.35	$0.00	$742.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.39	$688.39	$0.00	$0.00	$193.29	$0.00	$0.00	$0.00	$0.00	$463.75	$734.58	$742.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.52	SUP	Custom 27803010		"102.520  -  6.5MM STRAIGHT ROD, 400MM"	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.71"	"$1,133.71"	$0.00	$0.00	$318.33	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.521	SUP	Custom 27803010		102.521  -  ROD SPNL STRG 6.5MM 500MM PRTX	BOTH IP/OP	"$1,060.00 "	$784.40	$0.00	$848.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$786.73	$786.73	$0.00	$0.00	$220.90	$0.00	$0.00	$0.00	$0.00	$530.00	$839.52	$848.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.53	SUP	Custom 27803010		"102.530  -  6.5MM STRAIGHT ROD, 30MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.535	SUP	Custom 27803010		"102.535  -  6.5MM STRAIGHT ROD, 35MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.54	SUP	Custom 27803010		"102.540  -  6.5MM STRAIGHT ROD, 40MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.545	SUP	Custom 27803010		"102.545  -  6.5MM STRAIGHT ROD, 45MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.55	SUP	Custom 27803010		"102.550  -  6.5MM STRAIGHT ROD, 50MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.555	SUP	Custom 27803010		"102.555  -  6.5MM STRAIGHT ROD, 55MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.56	SUP	Custom 27803010		"102.560  -  6.5MM STRAIGHT ROD, 60MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.565	SUP	Custom 27803010		"102.565  -  6.5MM STRAIGHT ROD, 65MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.57	SUP	Custom 27803010		"102.570  -  6.5MM STRAIGHT ROD, 70MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.575	SUP	Custom 27803010		"102.575  -  6.5MM STRAIGHT ROD, 75MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.58	SUP	Custom 27803010		"102.580  -  6.5MM STRAIGHT ROD, 80MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.585	SUP	Custom 27803010		"102.585  -  6.5MM STRAIGHT ROD, 85MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.61	SUP	Custom 27803010		"102.610  -  6.5MM CURVED ROD, 100MM"	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$0.00	$0.00	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.612	SUP	Custom 27803010		"102.612  -  6.5MM CURVED ROD, 120MM"	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$0.00	$0.00	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.615	SUP	Custom 27803010		"102.615  -  6.5MM CURVED ROD, 150MM"	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$0.00	$0.00	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.635	SUP	Custom 27803010		"102.635  -  6.5MM CURVED ROD, 35MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.64	SUP	Custom 27803010		"102.640  -  6.5MM CURVED ROD, 40MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.645	SUP	Custom 27803010		"102.645  -  6.5MM CURVED ROD, 45MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.65	SUP	Custom 27803010		"102.650  -  6.5MM CURVED ROD, 50MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.655	SUP	Custom 27803010		"102.655  -  6.5MM CURVED ROD, 55MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.66	SUP	Custom 27803010		"102.660  -  6.5MM CURVED ROD, 60MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.665	SUP	Custom 27803010		"102.665  -  6.5MM CURVED ROD, 65MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.67	SUP	Custom 27803010		"102.670  -  6.5MM CURVED ROD, 70MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.675	SUP	Custom 27803010		"102.675  -  6.5MM CURVED ROD, 75MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.68	SUP	Custom 27803010		"102.680  -  6.5MM CURVED ROD, 80MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.685	SUP	Custom 27803010		"102.685  -  6.5MM CURVED ROD, 85MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.911	SUP	Custom 27803010		"102.911  -  ADJUSTABLE T CONNECTOR, 28MM-40MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.912	SUP	Custom 27803010		"102.912  -  ADJUSTABLE T CONNECTOR, 38MM-50MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.913	SUP	Custom 27803010		"102.913  -  ADJUSTABLE T CONNECTOR, 48MM-60MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.914	SUP	Custom 27803010		"102.914  -  ADJUSTABLE T CONNECTOR, 58MM-70MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.915	SUP	Custom 27803010		"102.915  -  ADJUSTABLE T CONNECTOR, 68MM-80MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.916	SUP	Custom 27803010		"102.916  -  ADJUSTABLE T CONNECTOR, 78MM-90MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.921	SUP	Custom 27803010		"102.921  -  PROTEX LAMINA HOOK, SMALL"	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.922	SUP	Custom 27803010		"102.922  -  PROTEX LAMINA HOOK, MEDIUM"	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.923	SUP	Custom 27803010		"102.923  -  PROTEX LAMINA HOOK, LARGE"	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.925	SUP	Custom 27803010		"102.925  -  PROTEX ANGLED LAMINA HOOK, SMALL"	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.926	SUP	Custom 27803010		"102.926  -  PROTEX ANGLED LAMINA HOOK, MEDIUM"	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.927	SUP	Custom 27803010		"102.927  -  PROTEX ANGLED LAMINA HOOK, LARGE"	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.941	SUP	Custom 27803010		102.941  -  PROTEX PEDICLE HOOK	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.951	SUP	Custom 27803010		"102.951  -  PROTEX TRANSVERSE PROCESS HOOK, RIGHT"	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.952	SUP	Custom 27803010		"102.952  -  PROTEX TRANSVERSE PROCESS HOOK, LEFT"	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.971	SUP	Custom 27803010		"102.971  -  PARALLEL CONNECTOR, 6.5MM TO 6.5MM"	BOTH IP/OP	"$2,120.00 "	"$1,568.80"	$0.00	"$1,696.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,573.46"	"$1,573.46"	$0.00	$0.00	$441.81	$0.00	$0.00	$0.00	$0.00	"$1,060.00"	"$1,679.04"	"$1,696.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.974	SUP	Custom 27803010		"102.974  -  OFFSET CONNECTOR, 15MM"	BOTH IP/OP	$572.50 	$423.65	$0.00	$458.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.91	$424.91	$0.00	$0.00	$119.31	$0.00	$0.00	$0.00	$0.00	$286.25	$453.42	$458.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.975	SUP	Custom 27803010		"102.975  -  OFFSET CONNECTOR, 20MM"	BOTH IP/OP	$572.50 	$423.65	$0.00	$458.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.91	$424.91	$0.00	$0.00	$119.31	$0.00	$0.00	$0.00	$0.00	$286.25	$453.42	$458.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.976	SUP	Custom 27803010		"102.976  -  OFFSET CONNECTOR, 25MM"	BOTH IP/OP	$572.50 	$423.65	$0.00	$458.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.91	$424.91	$0.00	$0.00	$119.31	$0.00	$0.00	$0.00	$0.00	$286.25	$453.42	$458.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.99	SUP	Custom 27803010		"102.990  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 15MM"	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$983.42	$983.42	$0.00	$0.00	$276.13	$0.00	$0.00	$0.00	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.991	SUP	Custom 27803010		"102.991  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 20MM"	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$983.42	$983.42	$0.00	$0.00	$276.13	$0.00	$0.00	$0.00	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.992	SUP	Custom 27803010		"102.992  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 25MM"	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$983.42	$983.42	$0.00	$0.00	$276.13	$0.00	$0.00	$0.00	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.993	SUP	Custom 27803010		"102.993  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 30MM"	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$983.42	$983.42	$0.00	$0.00	$276.13	$0.00	$0.00	$0.00	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.994	SUP	Custom 27803010		"102.994  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 35MM"	BOTH IP/OP	"$1,325.00 "	$980.50	$0.00	"$1,060.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$983.42	$983.42	$0.00	$0.00	$276.13	$0.00	$0.00	$0.00	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.995	SUP	Custom 27803010		"102.995  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 100MM"	BOTH IP/OP	"$1,457.50 "	"$1,078.55"	$0.00	"$1,166.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,081.76"	"$1,081.76"	$0.00	$0.00	$303.74	$0.00	$0.00	$0.00	$0.00	$728.75	"$1,154.34"	"$1,166.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.996	SUP	Custom 27803010		"102.996  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 120MM"	BOTH IP/OP	"$1,457.50 "	"$1,078.55"	$0.00	"$1,166.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,081.76"	"$1,081.76"	$0.00	$0.00	$303.74	$0.00	$0.00	$0.00	$0.00	$728.75	"$1,154.34"	"$1,166.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102.997	SUP	Custom 27803010		"102.997  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 150MM"	BOTH IP/OP	"$1,457.50 "	"$1,078.55"	$0.00	"$1,166.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,081.76"	"$1,081.76"	$0.00	$0.00	$303.74	$0.00	$0.00	$0.00	$0.00	$728.75	"$1,154.34"	"$1,166.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103	SUP	HCPCS C1767		103  -  GENERATOR ELECTROSURGICAL NCP DEMIPULSE	BOTH IP/OP	"$54,430.00 "	"$40,278.20"	$0.00	"$43,108.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	"$43,108.56"	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104	SUP	HCPCS C1713		104  -  PLATE 104 SINGLE T 3H X 3H	BOTH IP/OP	$325.00 	$240.50	$0.00	$323.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$241.33	$241.33	$0.00	$3.00	$323.14	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
105	SUP	HCPCS C1713		105  -  PLATE 105 SINGLE T 3H X 2H	BOTH IP/OP	$408.00 	$301.92	$0.00	$323.14	$0.00	$0.00	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$3.00	$323.14	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
109.041	SUP	HCPCS C1713		"109.041  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 70MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.042	SUP	HCPCS C1713		"109.042  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 75MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.043	SUP	HCPCS C1713		"109.043  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 80MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.044	SUP	HCPCS C1713		"109.044  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 85MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.045	SUP	HCPCS C1713		"109.045  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 90MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.051	SUP	HCPCS C1713		"109.051  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 70MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.052	SUP	HCPCS C1713		"109.052  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 75MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.053	SUP	HCPCS C1713		"109.053  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 80MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.054	SUP	HCPCS C1713		"109.054  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 85MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.055	SUP	HCPCS C1713		"109.055  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 90MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.061	SUP	HCPCS C1713		"109.061  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 70MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.062	SUP	HCPCS C1713		"109.062  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 75MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.063	SUP	HCPCS C1713		"109.063  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 80MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.064	SUP	HCPCS C1713		"109.064  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 85MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.065	SUP	HCPCS C1713		"109.065  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 90MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.071	SUP	HCPCS C1713		109.071  -  7.0MM PROTEX SOLID PEDICLE SCREW 70MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.072	SUP	HCPCS C1713		109.072  -  7.0MM PROTEX SOLID PEDICLE SCREW 75MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.073	SUP	HCPCS C1713		109.073  -  7.0MM PROTEX SOLID PEDICLE SCREW 80MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.074	SUP	HCPCS C1713		109.074  -  7.0MM PROTEX SOLID PEDICLE SCREW 85MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.075	SUP	HCPCS C1713		109.075  -  7.0MM PROTEX SOLID PEDICLE SCREW 90MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.081	SUP	HCPCS C1713		109.081  -  8.0MM PROTEX SOLID PEDICLE SCREW 70MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.082	SUP	HCPCS C1713		109.082  -  8.0MM PROTEX SOLID PEDICLE SCREW 75MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.083	SUP	HCPCS C1713		109.083  -  8.0MM PROTEX SOLID PEDICLE SCREW 80MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.084	SUP	HCPCS C1713		109.084  -  8.0MM PROTEX SOLID PEDICLE SCREW 85MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.085	SUP	HCPCS C1713		109.085  -  8.0MM PROTEX SOLID PEDICLE SCREW 90MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.091	SUP	HCPCS C1713		109.091  -  9.0MM PROTEX SOLID PEDICLE SCREW 70MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.092	SUP	HCPCS C1713		109.092  -  9.0MM PROTEX SOLID PEDICLE SCREW 75MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.093	SUP	HCPCS C1713		109.093  -  9.0MM PROTEX SOLID PEDICLE SCREW 80MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.094	SUP	HCPCS C1713		109.094  -  9.0MM PROTEX SOLID PEDICLE SCREW 85MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.095	SUP	HCPCS C1713		109.095  -  9.0MM PROTEX SOLID PEDICLE SCREW 90MM	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.351	SUP	HCPCS C1713		"109.351  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 25MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.352	SUP	HCPCS C1713		"109.352  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.353	SUP	HCPCS C1713		"109.353  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.354	SUP	HCPCS C1713		"109.354  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.355	SUP	HCPCS C1713		"109.355  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.356	SUP	HCPCS C1713		"109.356  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.357	SUP	HCPCS C1713		"109.357  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.358	SUP	HCPCS C1713		"109.358  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.359	SUP	HCPCS C1713		"109.359  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.362	SUP	HCPCS C1713		"109.362  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.363	SUP	HCPCS C1713		"109.363  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.364	SUP	HCPCS C1713		"109.364  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.365	SUP	HCPCS C1713		"109.365  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.366	SUP	HCPCS C1713		"109.366  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.367	SUP	HCPCS C1713		"109.367  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.368	SUP	HCPCS C1713		"109.368  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.369	SUP	HCPCS C1713		"109.369  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.372	SUP	HCPCS C1713		"109.372  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.373	SUP	HCPCS C1713		"109.373  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.374	SUP	HCPCS C1713		"109.374  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.375	SUP	HCPCS C1713		"109.375  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.376	SUP	HCPCS C1713		"109.376  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.377	SUP	HCPCS C1713		"109.377  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.378	SUP	HCPCS C1713		"109.378  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.379	SUP	HCPCS C1713		"109.379  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.382	SUP	HCPCS C1713		"109.382  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.383	SUP	HCPCS C1713		"109.383  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.384	SUP	HCPCS C1713		"109.384  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.385	SUP	HCPCS C1713		"109.385  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.386	SUP	HCPCS C1713		"109.386  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.387	SUP	HCPCS C1713		"109.387  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.388	SUP	HCPCS C1713		"109.388  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.389	SUP	HCPCS C1713		"109.389  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.392	SUP	HCPCS C1713		"109.392  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.393	SUP	HCPCS C1713		"109.393  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.394	SUP	HCPCS C1713		"109.394  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.395	SUP	HCPCS C1713		"109.395  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.396	SUP	HCPCS C1713		"109.396  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.397	SUP	HCPCS C1713		"109.397  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.398	SUP	HCPCS C1713		"109.398  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.399	SUP	HCPCS C1713		"109.399  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM"	BOTH IP/OP	"$2,517.50 "	"$1,862.95"	$0.00	"$2,014.00"	"$1,132.88"	"$1,132.88"	$0.00	$0.00	$0.00	$524.71	"$1,868.49"	"$1,868.49"	$0.00	$0.00	$524.65	$0.00	"$1,241.13"	"$1,241.13"	$0.00	"$1,258.75"	"$1,993.86"	"$2,014.00"	$0.00		$0.00	$393.99	$0.00	$0.00	$400.79	$0.00	$0.00	$0.00	$0.00	$0.00
109.441	SUP	HCPCS C1713		"109.441  -  4.5MM PROTEX SOLID PEDICLE SCREW, 25MM"	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.442	SUP	HCPCS C1713		"109.442  -  4.5MM PROTEX SOLID PEDICLE SCREW, 30MM"	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.443	SUP	HCPCS C1713		"109.443  -  4.5MM PROTEX SOLID PEDICLE SCREW, 35MM"	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.444	SUP	HCPCS C1713		"109.444  -  4.5MM PROTEX SOLID PEDICLE SCREW, 40MM"	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.445	SUP	HCPCS C1713		"109.445  -  4.5MM PROTEX SOLID PEDICLE SCREW, 45MM"	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.446	SUP	HCPCS C1713		"109.446  -  4.5MM PROTEX SOLID PEDICLE SCREW, 50MM"	BOTH IP/OP	"$4,580.00 "	"$3,389.20"	$0.00	"$3,664.00"	"$2,061.00"	"$2,061.00"	$0.00	$0.00	$0.00	$954.59	"$3,399.28"	"$3,399.28"	$0.00	$0.00	$954.47	$0.00	"$2,257.94"	"$2,257.94"	$0.00	"$2,290.00"	"$3,627.36"	"$3,664.00"	$0.00		$0.00	$716.77	$0.00	$0.00	$729.14	$0.00	$0.00	$0.00	$0.00	$0.00
109.452	SUP	HCPCS C1713		109.452  -  5.0MM PROTEX SOLID PEDICLE SCREW 30MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.453	SUP	HCPCS C1713		109.453  -  5.0MM PROTEX SOLID PEDICLE SCREW 35MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.454	SUP	HCPCS C1713		109.454  -  5.0MM PROTEX SOLID PEDICLE SCREW 40MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.455	SUP	HCPCS C1713		109.455  -  5.0MM PROTEX SOLID PEDICLE SCREW 45MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.456	SUP	HCPCS C1713		109.456  -  5.0MM PROTEX SOLID PEDICLE SCREW 50MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.457	SUP	HCPCS C1713		109.457  -  5.0MM PROTEX SOLID PEDICLE SCREW 55MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.462	SUP	HCPCS C1713		109.462  -  6.0MM PROTEX SOLID PEDICLE SCREW 30MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.463	SUP	HCPCS C1713		109.463  -  6.0MM PROTEX SOLID PEDICLE SCREW 35MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.464	SUP	HCPCS C1713		109.464  -  6.0MM PROTEX SOLID PEDICLE SCREW 40MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.465	SUP	HCPCS C1713		109.465  -  6.0MM PROTEX SOLID PEDICLE SCREW 45MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.466	SUP	HCPCS C1713		109.466  -  6.0MM PROTEX SOLID PEDICLE SCREW 50MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.467	SUP	HCPCS C1713		109.467  -  6.0MM PROTEX SOLID PEDICLE SCREW 55MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.468	SUP	HCPCS C1713		109.468  -  6.0MM PROTEX SOLID PEDICLE SCREW 60MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.469	SUP	HCPCS C1713		109.469  -  6.0MM PROTEX SOLID PEDICLE SCREW 65MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.472	SUP	HCPCS C1713		109.472  -  7.0MM PROTEX SOLID PEDICLE SCREW 30MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.473	SUP	HCPCS C1713		109.473  -  7.0MM PROTEX SOLID PEDICLE SCREW 35MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.474	SUP	HCPCS C1713		109.474  -  7.0MM PROTEX SOLID PEDICLE SCREW 40MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.475	SUP	HCPCS C1713		109.475  -  7.0MM PROTEX SOLID PEDICLE SCREW 45MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.476	SUP	HCPCS C1713		109.476  -  7.0MM PROTEX SOLID PEDICLE SCREW 50MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.477	SUP	HCPCS C1713		109.477  -  7.0MM PROTEX SOLID PEDICLE SCREW 55MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.478	SUP	HCPCS C1713		109.478  -  7.0MM PROTEX SOLID PEDICLE SCREW 60MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.479	SUP	HCPCS C1713		109.479  -  7.0MM PROTEX SOLID PEDICLE SCREW 65MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.482	SUP	HCPCS C1713		109.482  -  8.0MM PROTEX SOLID PEDICLE SCREW 30MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.483	SUP	HCPCS C1713		109.483  -  8.0MM PROTEX SOLID PEDICLE SCREW 35MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.484	SUP	HCPCS C1713		109.484  -  8.0MM PROTEX SOLID PEDICLE SCREW 40MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.485	SUP	HCPCS C1713		109.485  -  8.0MM PROTEX SOLID PEDICLE SCREW 45MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.486	SUP	HCPCS C1713		109.486  -  8.0MM PROTEX SOLID PEDICLE SCREW 50MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.487	SUP	HCPCS C1713		109.487  -  8.0MM PROTEX SOLID PEDICLE SCREW 55MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.488	SUP	HCPCS C1713		109.488  -  8.0MM PROTEX SOLID PEDICLE SCREW 60MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.489	SUP	HCPCS C1713		109.489  -  8.0MM PROTEX SOLID PEDICLE SCREW 65MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.492	SUP	HCPCS C1713		109.492  -  9.0MM PROTEX SOLID PEDICLE SCREW 30MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.493	SUP	HCPCS C1713		109.493  -  9.0MM PROTEX SOLID PEDICLE SCREW 35MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.494	SUP	HCPCS C1713		109.494  -  9.0MM PROTEX SOLID PEDICLE SCREW 40MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.495	SUP	HCPCS C1713		109.495  -  9.0MM PROTEX SOLID PEDICLE SCREW 45MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.496	SUP	HCPCS C1713		109.496  -  9.0MM PROTEX SOLID PEDICLE SCREW 50MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.497	SUP	HCPCS C1713		109.497  -  9.0MM PROTEX SOLID PEDICLE SCREW 55MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.498	SUP	HCPCS C1713		109.498  -  9.0MM PROTEX SOLID PEDICLE SCREW 60MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.499	SUP	HCPCS C1713		109.499  -  9.0MM PROTEX SOLID PEDICLE SCREW 65MM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,311.75"	"$1,311.75"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,437.10"	"$1,437.10"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
109.51	SUP	HCPCS C1713		"109.510  -  6.00MM STRAIGHT ROD, 100MM"	BOTH IP/OP	$670.00 	$495.80	$0.00	$536.00	$301.50	$301.50	$0.00	$0.00	$0.00	$139.64	$497.27	$497.27	$0.00	$0.00	$139.63	$0.00	$396.31	$396.31	$0.00	$335.00	$530.64	$536.00	$0.00		$0.00	$104.86	$0.00	$0.00	$106.66	$0.00	$0.00	$0.00	$0.00	$0.00
109.512	SUP	Custom 27803010		"109.512  -  6.00MM STRAIGHT ROD, 125MM"	BOTH IP/OP	$670.00 	$495.80	$0.00	$536.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$497.27	$497.27	$0.00	$0.00	$139.63	$0.00	$0.00	$0.00	$0.00	$335.00	$530.64	$536.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.515	SUP	Custom 27803010		"109.515  -  6.00MM STRAIGHT ROD, 150MM"	BOTH IP/OP	$670.00 	$495.80	$0.00	$536.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$497.27	$497.27	$0.00	$0.00	$139.63	$0.00	$0.00	$0.00	$0.00	$335.00	$530.64	$536.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.517	SUP	Custom 27803010		"109.517  -  6.00MM STRAIGHT ROD, 200MM"	BOTH IP/OP	$795.00 	$588.30	$0.00	$636.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$590.05	$590.05	$0.00	$0.00	$165.68	$0.00	$0.00	$0.00	$0.00	$397.50	$629.64	$636.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.519	SUP	Custom 27803010		"109.519  -  6.00MM STRAIGHT ROD, 300MM"	BOTH IP/OP	$927.50 	$686.35	$0.00	$742.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.39	$688.39	$0.00	$0.00	$193.29	$0.00	$0.00	$0.00	$0.00	$463.75	$734.58	$742.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.52	SUP	Custom 27803010		"109.520  -  6.00MM STRAIGHT ROD, 400MM"	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.71"	"$1,133.71"	$0.00	$0.00	$318.33	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.521	SUP	Custom 27803010		"109.521  -  6.00MM STRAIGHT ROD, 500MM"	BOTH IP/OP	"$1,060.00 "	$784.40	$0.00	$848.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$786.73	$786.73	$0.00	$0.00	$220.90	$0.00	$0.00	$0.00	$0.00	$530.00	$839.52	$848.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.53	SUP	Custom 27803010		"109.530  -  6.00MM STRAIGHT ROD, 30MM"	BOTH IP/OP	$670.00 	$495.80	$0.00	$536.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$497.27	$497.27	$0.00	$0.00	$139.63	$0.00	$0.00	$0.00	$0.00	$335.00	$530.64	$536.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.535	SUP	Custom 27803010		"109.535  -  6.00MM STRAIGHT ROD, 35MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.54	SUP	Custom 27803010		"109.540  -  6.00MM STRAIGHT ROD, 40MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.545	SUP	Custom 27803010		"109.545  -  6.00MM STRAIGHT ROD, 45MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.55	SUP	Custom 27803010		"109.550  -  6.00MM STRAIGHT ROD, 50MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.555	SUP	Custom 27803010		"109.555  -  6.00MM STRAIGHT ROD, 55MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.56	SUP	Custom 27803010		"109.560  -  6.00MM STRAIGHT ROD, 60MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.565	SUP	Custom 27803010		"109.565  -  6.00MM STRAIGHT ROD, 65MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.57	SUP	Custom 27803010		"109.570  -  6.00MM STRAIGHT ROD, 70MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.575	SUP	Custom 27803010		"109.575  -  6.00MM STRAIGHT ROD, 75MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.58	SUP	Custom 27803010		"109.580  -  6.00MM STRAIGHT ROD, 80MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.585	SUP	Custom 27803010		"109.585  -  6.00MM STRAIGHT ROD, 85MM"	BOTH IP/OP	$465.00 	$344.10	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.12	$345.12	$0.00	$0.00	$96.91	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.61	SUP	Custom 27803010		"109.610  -  6.00MM CURVED ROD, 100MM"	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$0.00	$0.00	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.612	SUP	Custom 27803010		"109.612  -  6.00MM CURVED ROD, 120MM"	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$0.00	$0.00	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.615	SUP	Custom 27803010		"109.615  -  6.00MM CURVED ROD, 150MM"	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$0.00	$0.00	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.635	SUP	Custom 27803010		"109.635  -  6.00MM CURVED ROD, 35MM"	BOTH IP/OP	$530.00 	$392.20	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$0.00	$0.00	$0.00	$265.00	$419.76	$424.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.64	SUP	Custom 27803010		"109.640  -  6.00MM CURVED ROD, 40MM"	BOTH IP/OP	$530.00 	$392.20	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$0.00	$0.00	$0.00	$265.00	$419.76	$424.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.645	SUP	Custom 27803010		"109.645  -  6.00MM CURVED ROD, 45MM"	BOTH IP/OP	$530.00 	$392.20	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$0.00	$0.00	$0.00	$265.00	$419.76	$424.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.65	SUP	Custom 27803010		"109.650  -  6.00MM CURVED ROD, 50MM"	BOTH IP/OP	$530.00 	$392.20	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$0.00	$0.00	$0.00	$265.00	$419.76	$424.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.655	SUP	Custom 27803010		"109.655  -  6.00MM CURVED ROD, 55MM"	BOTH IP/OP	$530.00 	$392.20	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$0.00	$0.00	$0.00	$265.00	$419.76	$424.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.66	SUP	Custom 27803010		"109.660  -  6.00MM CURVED ROD, 60MM"	BOTH IP/OP	$530.00 	$392.20	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$0.00	$0.00	$0.00	$265.00	$419.76	$424.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.665	SUP	Custom 27803010		"109.665  -  6.00MM CURVED ROD, 65MM"	BOTH IP/OP	$530.00 	$392.20	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$0.00	$0.00	$0.00	$265.00	$419.76	$424.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.67	SUP	Custom 27803010		"109.670  -  6.00MM CURVED ROD, 70MM"	BOTH IP/OP	$530.00 	$392.20	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$0.00	$0.00	$0.00	$265.00	$419.76	$424.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.675	SUP	Custom 27803010		"109.675  -  6.00MM CURVED ROD, 75MM"	BOTH IP/OP	$530.00 	$392.20	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$0.00	$0.00	$0.00	$265.00	$419.76	$424.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.68	SUP	Custom 27803010		"109.680  -  6.00MM CURVED ROD, 80MM"	BOTH IP/OP	$530.00 	$392.20	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$0.00	$0.00	$0.00	$265.00	$419.76	$424.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.685	SUP	Custom 27803010		"109.685  -  6.00MM CURVED ROD, 85MM"	BOTH IP/OP	$530.00 	$392.20	$0.00	$424.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$0.00	$0.00	$0.00	$265.00	$419.76	$424.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.921	SUP	Custom 27803010		"109.921  -  PROTEX LAMINA HOOK, 6.0MM ROD, SMALL"	BOTH IP/OP	"$2,120.00 "	"$1,568.80"	$0.00	"$1,696.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,573.46"	"$1,573.46"	$0.00	$0.00	$441.81	$0.00	$0.00	$0.00	$0.00	"$1,060.00"	"$1,679.04"	"$1,696.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.922	SUP	Custom 27803010		"109.922  -  PROTEX LAMINA HOOK, 6.0MM ROD, MEDIUM"	BOTH IP/OP	"$2,120.00 "	"$1,568.80"	$0.00	"$1,696.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,573.46"	"$1,573.46"	$0.00	$0.00	$441.81	$0.00	$0.00	$0.00	$0.00	"$1,060.00"	"$1,679.04"	"$1,696.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.923	SUP	Custom 27803010		"109.923  -  PROTEX LAMINA HOOK, 6.0MM ROD, LARGE"	BOTH IP/OP	"$2,120.00 "	"$1,568.80"	$0.00	"$1,696.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,573.46"	"$1,573.46"	$0.00	$0.00	$441.81	$0.00	$0.00	$0.00	$0.00	"$1,060.00"	"$1,679.04"	"$1,696.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.925	SUP	Custom 27803010		"109.925  -  PROTEX ANGLED LAMINA HOOK, 6.0MM ROD, SMALL"	BOTH IP/OP	"$2,120.00 "	"$1,568.80"	$0.00	"$1,696.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,573.46"	"$1,573.46"	$0.00	$0.00	$441.81	$0.00	$0.00	$0.00	$0.00	"$1,060.00"	"$1,679.04"	"$1,696.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.926	SUP	Custom 27803010		"109.926  -  PROTEX ANGLED LAMINA HOOK, 6.0MM ROD, MEDIUM"	BOTH IP/OP	"$2,120.00 "	"$1,568.80"	$0.00	"$1,696.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,573.46"	"$1,573.46"	$0.00	$0.00	$441.81	$0.00	$0.00	$0.00	$0.00	"$1,060.00"	"$1,679.04"	"$1,696.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.927	SUP	Custom 27803010		"109.927  -  PROTEX ANGLED LAMINA HOOK, 6.0MM ROD, LARGE"	BOTH IP/OP	"$2,120.00 "	"$1,568.80"	$0.00	"$1,696.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,573.46"	"$1,573.46"	$0.00	$0.00	$441.81	$0.00	$0.00	$0.00	$0.00	"$1,060.00"	"$1,679.04"	"$1,696.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.941	SUP	Custom 27803010		"109.941  -  PROTEX PEDICLE HOOK, 6.0MM ROD"	BOTH IP/OP	"$2,120.00 "	"$1,568.80"	$0.00	"$1,696.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,573.46"	"$1,573.46"	$0.00	$0.00	$441.81	$0.00	$0.00	$0.00	$0.00	"$1,060.00"	"$1,679.04"	"$1,696.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.951	SUP	Custom 27803010		"109.951  -  PROTEX TRANSVERSE PROCESS HOOK, 6.0MM ROD, RIGHT"	BOTH IP/OP	"$2,120.00 "	"$1,568.80"	$0.00	"$1,696.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,573.46"	"$1,573.46"	$0.00	$0.00	$441.81	$0.00	$0.00	$0.00	$0.00	"$1,060.00"	"$1,679.04"	"$1,696.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
109.952	SUP	Custom 27803010		"109.952  -  PROTEX TRANSVERSE PROCESS HOOK, 6.0MM ROD, LEFT"	BOTH IP/OP	"$2,120.00 "	"$1,568.80"	$0.00	"$1,696.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,573.46"	"$1,573.46"	$0.00	$0.00	$441.81	$0.00	$0.00	$0.00	$0.00	"$1,060.00"	"$1,679.04"	"$1,696.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110.01	SUP	HCPCS C1713		"110.010  -  4.0MM RIGID SCREW, SELF-DRILLING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.012	SUP	HCPCS C1713		"110.012  -  4.0MM RIGID SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.014	SUP	HCPCS C1713		"110.014  -  4.0MM RIGID SCREW, SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.016	SUP	HCPCS C1713		110.016  -  SCREW BONE 4MM 16MM ASR TI ANT CERV SPN SLFDRILL RGD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.026	SUP	HCPCS C1713		"110.026  -  4.0MM RIGID SCREW, SELF-TAPPING, 6MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.028	SUP	HCPCS C1713		"110.028  -  4.0MM RIGID SCREW, SELF-TAPPING, 8MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.03	SUP	HCPCS C1713		"110.030  -  4.0MM RIGID SCREW, SELF-TAPPING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.032	SUP	HCPCS C1713		"110.032  -  4.0MM RIGID SCREW, SELF-TAPPING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.034	SUP	HCPCS C1713		110.034  -  SCREW BONE 4MM 14MM ASR TI ANT CERV SPN SLFTAP RGD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.036	SUP	HCPCS C1713		110.036  -  SCREW BONE 4MM 16MM ASR TI ANT CERV SPN SLFTAP RGD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.038	SUP	HCPCS C1713		110.038  -  SCREW BONE 4MM 18MM ASR SPNL SLFTAP RGD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.04	SUP	HCPCS C1713		"110.040  -  4.0MM RIGID SCREW, SELF-TAPPING, 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.05	SUP	HCPCS C1713		110.050  -  SCREW SET TI ANT CERV SPN RGD	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
110.11	SUP	HCPCS C1713		"110.110  -  ASSURE CERVICAL PLATE 1-LEVEL, 10MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
110.112	SUP	HCPCS C1713		"110.112  -  ASSURE CERVICAL PLATE 1-LEVEL, 12MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
110.114	SUP	HCPCS C1713		110.114  -  PLATE 14MM TI 1 LVL ASR BONE ANT CERV SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
110.116	SUP	HCPCS C1713		110.116  -  PLATE 16MM TI 1 LVL ASR BONE ANT CERV SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
110.118	SUP	HCPCS C1713		"110.118  -  ASSURE CERVICAL PLATE 1-LEVEL, 18MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
110.12	SUP	HCPCS C1713		"110.120  -  ASSURE CERVICAL PLATE 1-LEVEL, 20MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
110.122	SUP	HCPCS C1713		"110.122  -  ASSURE CERVICAL PLATE 1-LEVEL, 22MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
110.124	SUP	HCPCS C1713		110.124  -  PLATE 24MM TI 1 LVL ASR BONE ANT CERV SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
110.126	SUP	HCPCS C1713		"110.126  -  ASSURE CERVICAL PLATE 1-LEVEL, 26MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
110.224	SUP	HCPCS C1713		"110.224  -  ASSURE CERVICAL PLATE 2-LEVEL, 24MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
110.226	SUP	HCPCS C1713		"110.226  -  ASSURE CERVICAL PLATE 2-LEVEL, 26MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
110.228	SUP	HCPCS C1713		110.228  -  PLATE 28MM TI 2 LVL ASR BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
110.23	SUP	HCPCS C1713		110.230  -  PLATE 30MM TI 2 LVL ASR BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
110.232	SUP	HCPCS C1713		110.232  -  PLATE 32MM TI 2 LVL ASR BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
110.234	SUP	HCPCS C1713		110.234  -  PLATE 34MM TI 2 LVL ASR BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
110.236	SUP	HCPCS C1713		110.236  -  PLATE 36MM TI 2 LVL ASR BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
110.238	SUP	HCPCS C1713		"110.238  -  ASSURE CERVICAL PLATE 2-LEVEL, 38MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
110.24	SUP	HCPCS C1713		"110.240  -  ASSURE CERVICAL PLATE 2-LEVEL, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
110.242	SUP	HCPCS C1713		"110.242  -  ASSURE CERVICAL PLATE 2-LEVEL, 42MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
110.244	SUP	HCPCS C1713		"110.244  -  ASSURE CERVICAL PLATE 2-LEVEL, 44MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
110.246	SUP	HCPCS C1713		"110.246  -  ASSURE CERVICAL PLATE 2-LEVEL, 46MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
110.339	SUP	HCPCS C1713		"110.339  -  ASSURE CERVICAL PLATE 3-LEVEL, 39MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
110.342	SUP	HCPCS C1713		"110.342  -  ASSURE CERVICAL PLATE 3-LEVEL, 42MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
110.345	SUP	HCPCS C1713		"110.345  -  ASSURE CERVICAL PLATE 3-LEVEL, 45MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
110.348	SUP	HCPCS C1713		"110.348  -  ASSURE CERVICAL PLATE 3-LEVEL, 48MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
110.351	SUP	HCPCS C1713		"110.351  -  ASSURE CERVICAL PLATE 3-LEVEL, 51MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
110.354	SUP	HCPCS C1713		"110.354  -  ASSURE CERVICAL PLATE 3-LEVEL, 54MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
110.357	SUP	HCPCS C1713		"110.357  -  ASSURE CERVICAL PLATE 3-LEVEL, 57MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
110.36	SUP	HCPCS C1713		"110.360  -  ASSURE CERVICAL PLATE 3-LEVEL, 60MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
110.363	SUP	HCPCS C1713		"110.363  -  ASSURE CERVICAL PLATE 3-LEVEL, 63MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
110.366	SUP	HCPCS C1713		"110.366  -  ASSURE CERVICAL PLATE 3-LEVEL, 66MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
110.369	SUP	HCPCS C1713		"110.369  -  ASSURE CERVICAL PLATE 3-LEVEL, 69MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
110.46	SUP	HCPCS C1713		"110.460  -  ASSURE CERVICAL PLATE 4-LEVEL, 60MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
110.464	SUP	HCPCS C1713		"110.464  -  ASSURE CERVICAL PLATE 4-LEVEL, 64MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
110.468	SUP	HCPCS C1713		"110.468  -  ASSURE CERVICAL PLATE 4-LEVEL, 68MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
110.472	SUP	HCPCS C1713		"110.472  -  ASSURE CERVICAL PLATE 4-LEVEL, 72MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
110.476	SUP	HCPCS C1713		"110.476  -  ASSURE CERVICAL PLATE 4-LEVEL, 76MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
110.48	SUP	HCPCS C1713		"110.480  -  ASSURE CERVICAL PLATE 4-LEVEL, 80MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
110.484	SUP	HCPCS C1713		"110.484  -  ASSURE CERVICAL PLATE 4-LEVEL, 84MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
110.488	SUP	HCPCS C1713		"110.488  -  ASSURE CERVICAL PLATE 4-LEVEL, 88MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
110.492	SUP	HCPCS C1713		"110.492  -  ASSURE CERVICAL PLATE 4-LEVEL, 92MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
110.496	SUP	HCPCS C1713		"110.496  -  ASSURE CERVICAL PLATE 4-LEVEL, 96MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
110.5	SUP	HCPCS C1713		"110.500  -  ASSURE CERVICAL PLATE 4-LEVEL, 100MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
110.512	SUP	HCPCS C1713		"110.512  -  4.5MM RIGID SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.514	SUP	HCPCS C1713		"110.514  -  4.5MM RIGID SCREW, SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.516	SUP	HCPCS C1713		"110.516  -  4.5MM RIGID SCREW, SELF-DRILLING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.526	SUP	HCPCS C1713		"110.526  -  4.5MM RIGID SCREW, SELF-TAPPING, 6MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.528	SUP	HCPCS C1713		"110.528  -  4.5MM RIGID SCREW, SELF-TAPPING, 8MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.53	SUP	HCPCS C1713		"110.530  -  4.5MM RIGID SCREW, SELF-TAPPING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.532	SUP	HCPCS C1713		"110.532  -  4.5MM RIGID SCREW, SELF-TAPPING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.534	SUP	HCPCS C1713		"110.534  -  4.5MM RIGID SCREW, SELF-TAPPING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.536	SUP	HCPCS C1713		110.536  -  SCREW BONE 4.5MM 16MM ASR TI SPNL SLFTAP RGD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.538	SUP	HCPCS C1713		"110.538  -  4.5MM RIGID SCREW, SELF-TAPPING, 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.54	SUP	HCPCS C1713		"110.540  -  4.5MM RIGID SCREW, SELF-TAPPING, 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.61	SUP	HCPCS C1713		"110.610  -  4.0MM STANDARD SCREW, SELF-DRILLING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.612	SUP	HCPCS C1713		"110.612  -  4.0MM STANDARD SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.614	SUP	HCPCS C1713		"110.614  -  4.0MM STANDARD SCREW, SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.616	SUP	HCPCS C1713		110.616  -  SCREW BONE 4MM 16MM ASR TI STD SPNL SLFDRILL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.712	SUP	HCPCS C1713		"110.712  -  4.5MM STANDARD SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.714	SUP	HCPCS C1713		"110.714  -  4.5MM STANDARD SCREW, SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.716	SUP	HCPCS C1713		110.716  -  SCREW BONE 4.5MM 16MM ASR TI STD SPNL SLFDRILL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.806	SUP	HCPCS C1713		110.806  -  SCREW BN STD 4MM 6MM PRTX CT ST SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.808	SUP	HCPCS C1713		110.808  -  SCREW BONE 4MM 8MM TI STD SPNL SLFTAP	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
110.81	SUP	HCPCS C1713		"110.810  -  4.0MM STANDARD SCREW, SELF-TAPPING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.812	SUP	HCPCS C1713		"110.812  -  4.0MM STANDARD SCREW, SELF-TAPPING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.814	SUP	HCPCS C1713		110.814  -  SCREW BONE 4MM 14MM ASR TI STD ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.816	SUP	HCPCS C1713		110.816  -  SCREW BONE 4MM 16MM ASR TI STD SPNL SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.818	SUP	HCPCS C1713		110.818  -  SCREW BONE 4MM 18MM ASR TI STD SPNL SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.82	SUP	HCPCS C1713		"110.820  -  4.0MM STANDARD SCREW, SELF-TAPPING, 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.906	SUP	HCPCS C1713		"110.906  -  4.5MM STANDARD SCREW, SELF-TAPPING, 6MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.908	SUP	HCPCS C1713		"110.908  -  4.5MM STANDARD SCREW, SELF-TAPPING, 8MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.91	SUP	HCPCS C1713		"110.910  -  4.5MM STANDARD SCREW, SELF-TAPPING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.912	SUP	HCPCS C1713		110.912  -  SCREW BONE 4.5MM 12MM ASR TI STD ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.914	SUP	HCPCS C1713		"110.914  -  4.5MM STANDARD SCREW, SELF-TAPPING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.916	SUP	HCPCS C1713		110.916  -  SCREW BONE 4.5MM 16MM ASR TI STD ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.918	SUP	HCPCS C1713		110.918  -  SCREW BONE 4.5MM 18MM ASR TI STD SPNL SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
110.92	SUP	HCPCS C1713		110.920  -  SCREW BONE 4.5MM 20MM PRTX TI STD THORLMBR SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
111	SUP	Custom 27203010		111  -  ADAPTER SUCTION 15MM 15MM CLOSE SYSTEM SWIVEL LATEX FREE	BOTH IP/OP	$79.68 	$58.96	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.14	$59.14	$0.00	$0.00	$16.60	$0.00	$0.00	$0.00	$0.00	$39.84	$63.11	$63.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115	SUP	HCPCS C1713		"115.000  -  SET SCREW, M4 X 0.75, ROUND TIP, 2.5MM HEX"	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
115.222	SUP	HCPCS C1713		"115.222  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 22MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.224	SUP	HCPCS C1713		"115.224  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 24MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.226	SUP	HCPCS C1713		"115.226  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 26MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.228	SUP	HCPCS C1713		"115.228  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 28MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.23	SUP	HCPCS C1713		"115.230  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 30MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.232	SUP	HCPCS C1713		"115.232  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 32MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.234	SUP	HCPCS C1713		"115.234  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 34MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.236	SUP	HCPCS C1713		"115.236  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 36MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.308	SUP	HCPCS C1713		115.308  -  SCREW BONE 3.5MM 8MM PRTX CTTI OCT SPN POLYAX	BOTH IP/OP	"$3,097.50 "	"$2,292.15"	$0.00	"$2,478.00"	"$1,393.88"	"$1,393.88"	$0.00	$0.00	$0.00	$645.60	"$2,298.96"	"$2,298.96"	$0.00	$0.00	$645.52	$0.00	"$1,527.07"	"$1,527.07"	$0.00	"$1,548.75"	"$2,453.22"	"$2,478.00"	$0.00		$0.00	$484.76	$0.00	$0.00	$493.12	$0.00	$0.00	$0.00	$0.00	$0.00
115.31	SUP	HCPCS C1713		115.310  -  SCREW BONE 3.5MM 10MM PRTX CTTI POST THOR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.312	SUP	HCPCS C1713		115.312  -  SCREW BONE 3.5MM 12MM PRTX CTTI OCT SPN POLYAX	BOTH IP/OP	"$3,097.50 "	"$2,292.15"	$0.00	"$2,478.00"	"$1,393.88"	"$1,393.88"	$0.00	$0.00	$0.00	$645.60	"$2,298.96"	"$2,298.96"	$0.00	$0.00	$645.52	$0.00	"$1,527.07"	"$1,527.07"	$0.00	"$1,548.75"	"$2,453.22"	"$2,478.00"	$0.00		$0.00	$484.76	$0.00	$0.00	$493.12	$0.00	$0.00	$0.00	$0.00	$0.00
115.314	SUP	HCPCS C1713		115.314  -  SCREW BONE 3.5MM 14MM PRTX CTTI OCT SPN POLYAX	BOTH IP/OP	"$3,097.50 "	"$2,292.15"	$0.00	"$2,478.00"	"$1,393.88"	"$1,393.88"	$0.00	$0.00	$0.00	$645.60	"$2,298.96"	"$2,298.96"	$0.00	$0.00	$645.52	$0.00	"$1,527.07"	"$1,527.07"	$0.00	"$1,548.75"	"$2,453.22"	"$2,478.00"	$0.00		$0.00	$484.76	$0.00	$0.00	$493.12	$0.00	$0.00	$0.00	$0.00	$0.00
115.316	SUP	HCPCS C1713		115.316  -  SCREW BONE 3.5MM 16MM PRTX CTTI OCT SPN POLYAX	BOTH IP/OP	"$3,097.50 "	"$2,292.15"	$0.00	"$2,478.00"	"$1,393.88"	"$1,393.88"	$0.00	$0.00	$0.00	$645.60	"$2,298.96"	"$2,298.96"	$0.00	$0.00	$645.52	$0.00	"$1,527.07"	"$1,527.07"	$0.00	"$1,548.75"	"$2,453.22"	"$2,478.00"	$0.00		$0.00	$484.76	$0.00	$0.00	$493.12	$0.00	$0.00	$0.00	$0.00	$0.00
115.318	SUP	HCPCS C1713		115.318  -  3.5MM PROTEX CT POLYAXIAL SCREW 18MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.32	SUP	HCPCS C1713		115.320  -  3.5MM PROTEX CT POLYAXIAL SCREW 20MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.322	SUP	HCPCS C1713		115.322  -  3.5MM PROTEX CT POLYAXIAL SCREW 22MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.324	SUP	HCPCS C1713		115.324  -  3.5MM PROTEX CT POLYAXIAL SCREW 24MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.326	SUP	HCPCS C1713		115.326  -  3.5MM PROTEX CT POLYAXIAL SCREW 26MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.328	SUP	HCPCS C1713		115.328  -  3.5MM PROTEX CT POLYAXIAL SCREW 28MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.33	SUP	HCPCS C1713		115.330  -  3.5MM PROTEX CT POLYAXIAL SCREW 30MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.332	SUP	HCPCS C1713		115.332  -  3.5MM PROTEX CT POLYAXIAL SCREW 32MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.334	SUP	HCPCS C1713		115.334  -  3.5MM PROTEX CT POLYAXIAL SCREW 34MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.336	SUP	HCPCS C1713		115.336  -  3.5MM PROTEX CT POLYAXIAL SCREW 36MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.338	SUP	HCPCS C1713		115.338  -  3.5MM PROTEX CT POLYAXIAL SCREW 38MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.34	SUP	HCPCS C1713		115.340  -  3.5MM PROTEX CT POLYAXIAL SCREW 40MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.342	SUP	HCPCS C1713		115.342  -  3.5MM PROTEX CT POLYAXIAL SCREW 42MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.344	SUP	HCPCS C1713		115.344  -  3.5MM PROTEX CT POLYAXIAL SCREW 44MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.346	SUP	HCPCS C1713		115.346  -  3.5MM PROTEX CT POLYAXIAL SCREW 46MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.348	SUP	HCPCS C1713		115.348  -  3.5MM PROTEX CT POLYAXIAL SCREW 48MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.35	SUP	HCPCS C1713		115.350  -  3.5MM PROTEX CT POLYAXIAL SCREW 50MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.41	SUP	HCPCS C1713		115.410  -  SCREW BONE 4MM 10MM PRTX CTTI OCT SPN POLYAX SLFTAP	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.412	SUP	HCPCS C1713		115.412  -  SCREW BN 4MM 12MM PRTX CT PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.414	SUP	HCPCS C1713		115.414  -  SCREW BN 4MM 14MM PRTX CT PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.416	SUP	HCPCS C1713		115.416  -  4.0MM PROTEX CT POLYAXIAL SCREW 16MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.418	SUP	HCPCS C1713		115.418  -  SCREW BN 4MM 18MM PRTX CT PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.42	SUP	HCPCS C1713		115.420  -  4.0MM PROTEX CT POLYAXIAL SCREW 20MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.422	SUP	HCPCS C1713		115.422  -  4.0MM PROTEX CT POLYAXIAL SCREW 22MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.424	SUP	HCPCS C1713		115.424  -  4.0MM PROTEX CT POLYAXIAL SCREW 24MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.426	SUP	HCPCS C1713		115.426  -  4.0MM PROTEX CT POLYAXIAL SCREW 26MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.428	SUP	HCPCS C1713		115.428  -  4.0MM PROTEX CT POLYAXIAL SCREW 28MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.43	SUP	HCPCS C1713		115.430  -  4.0MM PROTEX CT POLYAXIAL SCREW 30MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.432	SUP	HCPCS C1713		115.432  -  4.0MM PROTEX CT POLYAXIAL SCREW 32MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.434	SUP	HCPCS C1713		115.434  -  4.0MM PROTEX CT POLYAXIAL SCREW 34MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.436	SUP	HCPCS C1713		115.436  -  4.0MM PROTEX CT POLYAXIAL SCREW 36MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.438	SUP	HCPCS C1713		115.438  -  4.0MM PROTEX CT POLYAXIAL SCREW 38MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.44	SUP	HCPCS C1713		115.440  -  4.0MM PROTEX CT POLYAXIAL SCREW 40MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.442	SUP	HCPCS C1713		115.442  -  4.0MM PROTEX CT POLYAXIAL SCREW 42MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.444	SUP	HCPCS C1713		115.444  -  4.0MM PROTEX CT POLYAXIAL SCREW 44MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.446	SUP	HCPCS C1713		115.446  -  4.0MM PROTEX CT POLYAXIAL SCREW 46MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.448	SUP	HCPCS C1713		115.448  -  4.0MM PROTEX CT POLYAXIAL SCREW 48MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.45	SUP	HCPCS C1713		115.450  -  4.0MM PROTEX CT POLYAXIAL SCREW 50MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.5	SUP	Custom 27803010		115.500  -  CAP LCK PRTX CTTI STD OCT SPN POLYAX	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.501	SUP	Custom 27803010		115.501  -  PROTEX CT HOOK	BOTH IP/OP	$955.00 	$706.70	$0.00	$764.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.80	$708.80	$0.00	$0.00	$199.02	$0.00	$0.00	$0.00	$0.00	$477.50	$756.36	$764.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.503	SUP	Custom 27803010		"115.503  -  PROTEX CT HOOK, RIGHT"	BOTH IP/OP	$955.00 	$706.70	$0.00	$764.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.80	$708.80	$0.00	$0.00	$199.02	$0.00	$0.00	$0.00	$0.00	$477.50	$756.36	$764.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.504	SUP	Custom 27803010		"115.504  -  PROTEX CT HOOK, LEFT"	BOTH IP/OP	$955.00 	$706.70	$0.00	$764.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.80	$708.80	$0.00	$0.00	$199.02	$0.00	$0.00	$0.00	$0.00	$477.50	$756.36	$764.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.506	SUP	Custom 27803010		"115.506  -  PROTEX CT HOOK, 7MM OFFSET, LEFT"	BOTH IP/OP	$955.00 	$706.70	$0.00	$764.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.80	$708.80	$0.00	$0.00	$199.02	$0.00	$0.00	$0.00	$0.00	$477.50	$756.36	$764.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.507	SUP	Custom 27803010		"115.507  -  PROTEX CT HOOK, 5MM OFFSET, LEFT"	BOTH IP/OP	$955.00 	$706.70	$0.00	$764.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.80	$708.80	$0.00	$0.00	$199.02	$0.00	$0.00	$0.00	$0.00	$477.50	$756.36	$764.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.508	SUP	Custom 27803010		"115.508  -  PROTEX CT HOOK, 7MM OFFSET, RIGHT"	BOTH IP/OP	$955.00 	$706.70	$0.00	$764.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.80	$708.80	$0.00	$0.00	$199.02	$0.00	$0.00	$0.00	$0.00	$477.50	$756.36	$764.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.509	SUP	Custom 27803010		"115.509  -  PROTEX CT HOOK, 5MM OFFSET, RIGHT"	BOTH IP/OP	$955.00 	$706.70	$0.00	$764.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.80	$708.80	$0.00	$0.00	$199.02	$0.00	$0.00	$0.00	$0.00	$477.50	$756.36	$764.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.51	SUP	HCPCS C1713		115.510  -  4.5MM PROTEX CT POLYAXIAL SCREW 10MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.512	SUP	HCPCS C1713		115.512  -  4.5MM PROTEX CT POLYAXIAL SCREW 12MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.514	SUP	HCPCS C1713		115.514  -  4.5MM PROTEX CT POLYAXIAL SCREW 14MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.516	SUP	HCPCS C1713		115.516  -  4.5MM PROTEX CT POLYAXIAL SCREW 16MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.518	SUP	HCPCS C1713		115.518  -  4.5MM PROTEX CT POLYAXIAL SCREW 18MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.52	SUP	HCPCS C1713		115.520  -  SCREW BONE 4.5MM 20MM PRTX CTTI OCT SPN SLFTAP	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.522	SUP	HCPCS C1713		115.522  -  4.5MM PROTEX CT POLYAXIAL SCREW 22MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.524	SUP	HCPCS C1713		115.524  -  SCREW BONE 4.5MM 24MM PRTX CTTI OCT SPN POLYAX	BOTH IP/OP	"$3,365.00 "	"$2,490.10"	$0.00	"$2,692.00"	"$1,514.25"	"$1,514.25"	$0.00	$0.00	$0.00	$701.35	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$701.27	$0.00	"$1,658.95"	"$1,658.95"	$0.00	"$1,682.50"	"$2,665.08"	"$2,692.00"	$0.00		$0.00	$526.62	$0.00	$0.00	$535.71	$0.00	$0.00	$0.00	$0.00	$0.00
115.526	SUP	HCPCS C1713		115.526  -  SCREW BONE 4.5MM 26MM PRTX CT OCT SPN SLFTAP LP POLYAX	BOTH IP/OP	"$3,365.00 "	"$2,490.10"	$0.00	"$2,692.00"	"$1,514.25"	"$1,514.25"	$0.00	$0.00	$0.00	$701.35	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$701.27	$0.00	"$1,658.95"	"$1,658.95"	$0.00	"$1,682.50"	"$2,665.08"	"$2,692.00"	$0.00		$0.00	$526.62	$0.00	$0.00	$535.71	$0.00	$0.00	$0.00	$0.00	$0.00
115.528	SUP	HCPCS C1713		115.528  -  4.5MM PROTEX CT POLYAXIAL SCREW 28MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.53	SUP	HCPCS C1713		115.530  -  4.5MM PROTEX CT POLYAXIAL SCREW 30MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.532	SUP	HCPCS C1713		115.532  -  4.5MM PROTEX CT POLYAXIAL SCREW 32MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.534	SUP	HCPCS C1713		115.534  -  4.5MM PROTEX CT POLYAXIAL SCREW 34MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.536	SUP	HCPCS C1713		115.536  -  4.5MM PROTEX CT POLYAXIAL SCREW 36MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.538	SUP	HCPCS C1713		115.538  -  4.5MM PROTEX CT POLYAXIAL SCREW 38MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.54	SUP	HCPCS C1713		115.540  -  4.5MM PROTEX CT POLYAXIAL SCREW 40MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.542	SUP	HCPCS C1713		115.542  -  4.5MM PROTEX CT POLYAXIAL SCREW 42MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.544	SUP	HCPCS C1713		115.544  -  4.5MM PROTEX CT POLYAXIAL SCREW 44MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.546	SUP	HCPCS C1713		115.546  -  4.5MM PROTEX CT POLYAXIAL SCREW 46MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.548	SUP	HCPCS C1713		115.548  -  4.5MM PROTEX CT POLYAXIAL SCREW 48MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.55	SUP	HCPCS C1713		115.550  -  4.5MM PROTEX CT POLYAXIAL SCREW 50MM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
115.701	SUP	Custom 27803010		115.701  -  ROD SPNL 80MM CONNCTNG GLOBUS	BOTH IP/OP	$777.50 	$575.35	$0.00	$622.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$577.06	$577.06	$0.00	$0.00	$162.03	$0.00	$0.00	$0.00	$0.00	$388.75	$615.78	$622.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.702	SUP	Custom 27803010		"115.702  -  3.2MM STRAIGHT TI ROD, 120MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.703	SUP	Custom 27803010		115.703  -  ROD SPNL STRG 3.2MM 240MM NS PRTX CTTI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.704	SUP	Custom 27803010		"115.704  -  3.2MM STRAIGHT TI ROD, 40MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.801	SUP	Custom 27803010		115.801  -  ROD SPNL 80MM 3.7MM PRTX CTTI STR	BOTH IP/OP	$777.50 	$575.35	$0.00	$622.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$577.06	$577.06	$0.00	$0.00	$162.03	$0.00	$0.00	$0.00	$0.00	$388.75	$615.78	$622.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.802	SUP	Custom 27803010		115.802  -  ROD SPNL 120MM 3.7MM PRTX CTTI STR	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$0.00	$0.00	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.803	SUP	Custom 27803010		"115.803  -  3.7MM STRAIGHT ROD, 240MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.804	SUP	Custom 27803010		"115.804  -  3.7MM STRAIGHT ROD, 40MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.911	SUP	Custom 27803010		115.911  -  CONCTR ROD 20-41MM 3.7MM PRTX CTTI TRNSVRS ADJ OCT SPN	BOTH IP/OP	"$3,482.50 "	"$2,577.05"	$0.00	"$2,786.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,584.71"	"$2,584.71"	$0.00	$0.00	$725.75	$0.00	$0.00	$0.00	$0.00	"$1,741.25"	"$2,758.14"	"$2,786.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.912	SUP	Custom 27803010		"115.912  -  ADJUSTABLE T-CONNECTOR FOR 3.7MM ROD, 41-56MM"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.918	SUP	Custom 27803010		"115.918  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 21-33MM, STRAIGHT"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.919	SUP	Custom 27803010		"115.919  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 26-46MM, CURVED"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.92	SUP	Custom 27803010		"115.920  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 26-46MM, STRAIGHT"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.921	SUP	Custom 27803010		"115.921  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 36-56MM, CURVED"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.922	SUP	Custom 27803010		"115.922  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 36-56, STRAIGHT"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.923	SUP	Custom 27803010		"115.923  -  TOP-LOADING T-CONNECTOR FOR 3.7MM ROD, 21-33MM, STRAIGHT"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.924	SUP	Custom 27803010		115.924  -  CONCTR ROD 26-46MM CVD TOP LD T 3.7MM	BOTH IP/OP	"$3,915.00 "	"$2,897.10"	$0.00	"$3,132.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,905.71"	"$2,905.71"	$0.00	$0.00	$815.89	$0.00	$0.00	$0.00	$0.00	"$1,957.50"	"$3,100.68"	"$3,132.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.925	SUP	Custom 27803010		"115.925  -  TOP-LOADING T-CONNECTOR FOR 3.7MM ROD, 26-46MM, STRAIGHT"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.926	SUP	Custom 27803010		"115.926  -  TOP-LOADING T-CONNECTOR FOR 3.7MM ROD, 36-56MM, CURVED"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.927	SUP	Custom 27803010		"115.927  -  TOP-LOADING T-CONNECTOR FOR 3.7MM ROD, 36-56, STRAIGHT"	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.93	SUP	Custom 27803010		"115.930  -  CLAMP FOR T-CONNECTOR, LEFT"	BOTH IP/OP	"$1,832.50 "	"$1,356.05"	$0.00	"$1,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,360.08"	"$1,360.08"	$0.00	$0.00	$381.89	$0.00	$0.00	$0.00	$0.00	$916.25	"$1,451.34"	"$1,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.931	SUP	Custom 27803010		"115.931  -  CLAMP FOR T-CONNECTOR, RIGHT"	BOTH IP/OP	"$1,832.50 "	"$1,356.05"	$0.00	"$1,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,360.08"	"$1,360.08"	$0.00	$0.00	$381.89	$0.00	$0.00	$0.00	$0.00	$916.25	"$1,451.34"	"$1,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.949	SUP	Custom 27803010		"115.949  -  SET SCREW, M4.5X0.75, ROUND TIP, 2.5MM HEX"	BOTH IP/OP	$192.50 	$142.45	$0.00	$154.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.87	$142.87	$0.00	$0.00	$40.12	$0.00	$0.00	$0.00	$0.00	$96.25	$152.46	$154.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.95	SUP	Custom 27803010		"115.950  -  OCCIPITAL CLAMP, SINGLE, SHORT"	BOTH IP/OP	$795.00 	$588.30	$0.00	$636.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$590.05	$590.05	$0.00	$0.00	$165.68	$0.00	$0.00	$0.00	$0.00	$397.50	$629.64	$636.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.951	SUP	Custom 27803010		"115.951  -  OCCIPITAL CLAMP, SINGLE, LONG"	BOTH IP/OP	$795.00 	$588.30	$0.00	$636.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$590.05	$590.05	$0.00	$0.00	$165.68	$0.00	$0.00	$0.00	$0.00	$397.50	$629.64	$636.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.952	SUP	HCPCS C1713		"115.952  -  SET SCREW, M4.5 X 0.75"	BOTH IP/OP	$192.50 	$142.45	$0.00	$154.00	$86.63	$86.63	$0.00	$0.00	$0.00	$40.12	$142.87	$142.87	$0.00	$0.00	$40.12	$0.00	$113.86	$113.86	$0.00	$96.25	$152.46	$154.00	$0.00		$0.00	$30.13	$0.00	$0.00	$30.65	$0.00	$0.00	$0.00	$0.00	$0.00
115.953	SUP	Custom 27803010		"115.953  -  3.7MM OCCIPITAL ROD, 240MM, 100 DEG"	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.71"	"$1,133.71"	$0.00	$0.00	$318.33	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.954	SUP	Custom 27803010		"115.954  -  3.7MM OCCIPITAL ROD, 240MM, 115 DEG"	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.71"	"$1,133.71"	$0.00	$0.00	$318.33	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.955	SUP	Custom 27803010		115.955  -  ROD SPNL 240MM 3.7MM PRTX CTTI 130 OCCPTL	BOTH IP/OP	"$1,547.50 "	"$1,145.15"	$0.00	"$1,238.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,148.55"	"$1,148.55"	$0.00	$0.00	$322.50	$0.00	$0.00	$0.00	$0.00	$773.75	"$1,225.62"	"$1,238.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.956	SUP	Custom 27803010		"115.956  -  OCCIPITAL CLAMP, TRIPLE, SHORT"	BOTH IP/OP	"$1,272.50 "	$941.65	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.45	$944.45	$0.00	$0.00	$265.19	$0.00	$0.00	$0.00	$0.00	$636.25	"$1,007.82"	"$1,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.957	SUP	Custom 27803010		"115.957  -  OCCIPITAL CLAMP, TRIPLE, LONG"	BOTH IP/OP	"$1,272.50 "	$941.65	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.45	$944.45	$0.00	$0.00	$265.19	$0.00	$0.00	$0.00	$0.00	$636.25	"$1,007.82"	"$1,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.958	SUP	Custom 27803010		"115.958  -  OCCIPITAL CLAMP, DOUBLE, SHORT"	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	$828.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.18	$768.18	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	$517.50	$819.72	$828.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.959	SUP	Custom 27803010		115.959  -  CLAMP SPNL LNG OCCPTL DBL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$0.00	$0.00	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.96	SUP	Custom 27803010		"115.960  -  PARALLEL CONNECTOR, 3.7MM ROD TO 3.7MM ROD"	BOTH IP/OP	"$1,432.50 "	"$1,060.05"	$0.00	"$1,146.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,063.20"	"$1,063.20"	$0.00	$0.00	$298.53	$0.00	$0.00	$0.00	$0.00	$716.25	"$1,134.54"	"$1,146.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.961	SUP	Custom 27803010		"115.961  -  PARALLEL CONNECTOR, 3.7MM ROD TO 4.5MM ROD"	BOTH IP/OP	"$1,432.50 "	"$1,060.05"	$0.00	"$1,146.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,063.20"	"$1,063.20"	$0.00	$0.00	$298.53	$0.00	$0.00	$0.00	$0.00	$716.25	"$1,134.54"	"$1,146.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.962	SUP	Custom 27803010		"115.962  -  PARALLEL CONNECTOR, 3.7MM ROD TO 5.0MM ROD"	BOTH IP/OP	"$1,432.50 "	"$1,060.05"	$0.00	"$1,146.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,063.20"	"$1,063.20"	$0.00	$0.00	$298.53	$0.00	$0.00	$0.00	$0.00	$716.25	"$1,134.54"	"$1,146.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.963	SUP	Custom 27803010		"115.963  -  PARALLEL CONNECTOR, 3.7MM ROD TO 5.5MM ROD"	BOTH IP/OP	"$1,432.50 "	"$1,060.05"	$0.00	"$1,146.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,063.20"	"$1,063.20"	$0.00	$0.00	$298.53	$0.00	$0.00	$0.00	$0.00	$716.25	"$1,134.54"	"$1,146.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.964	SUP	Custom 27803010		"115.964  -  PARALLEL CONNECTOR, 3.7MM ROD TO 6.0MM ROD"	BOTH IP/OP	"$1,432.50 "	"$1,060.05"	$0.00	"$1,146.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,063.20"	"$1,063.20"	$0.00	$0.00	$298.53	$0.00	$0.00	$0.00	$0.00	$716.25	"$1,134.54"	"$1,146.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.965	SUP	Custom 27803010		"115.965  -  PARALLEL CONNECTOR, 3.7MM ROD TO 6.5MM ROD"	BOTH IP/OP	"$1,432.50 "	"$1,060.05"	$0.00	"$1,146.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,063.20"	"$1,063.20"	$0.00	$0.00	$298.53	$0.00	$0.00	$0.00	$0.00	$716.25	"$1,134.54"	"$1,146.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.966	SUP	Custom 27803010		"115.966  -  PARALLEL CONNECTOR, 3.7MM ROD TO 4.0MM ROD"	BOTH IP/OP	"$1,717.50 "	"$1,270.95"	$0.00	"$1,374.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,274.73"	"$1,274.73"	$0.00	$0.00	$357.93	$0.00	$0.00	$0.00	$0.00	$858.75	"$1,360.26"	"$1,374.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.979	SUP	Custom 27803010		"115.979  -  TAPERED ROD, 3.2MM TO 3.7MM, 240MM"	BOTH IP/OP	"$1,620.00 "	"$1,198.80"	$0.00	"$1,296.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,202.36"	"$1,202.36"	$0.00	$0.00	$337.61	$0.00	$0.00	$0.00	$0.00	$810.00	"$1,283.04"	"$1,296.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.981	SUP	Custom 27803010		"115.981  -  TAPERED ROD, 3.7MM TO 6.5MM, 350MM"	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.71"	"$1,133.71"	$0.00	$0.00	$318.33	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.983	SUP	Custom 27803010		"115.983  -  TAPERED ROD, 3.7MM TO 6.0MM, 350MM"	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.71"	"$1,133.71"	$0.00	$0.00	$318.33	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.984	SUP	Custom 27803010		"115.984  -  TAPERED ROD, 3.7MM TO 5.5MM, 350MM"	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.71"	"$1,133.71"	$0.00	$0.00	$318.33	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.985	SUP	Custom 27803010		"115.985  -  TAPERED ROD, 3.7MM TO 5.0MM, 350MM"	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.71"	"$1,133.71"	$0.00	$0.00	$318.33	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.986	SUP	Custom 27803010		"115.986  -  TAPERED ROD, 3.7MM TO 4.5MM, 350MM"	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.71"	"$1,133.71"	$0.00	$0.00	$318.33	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.987	SUP	Custom 27803010		"115.987  -  TAPERED ROD, 3.7MM TO 4.0MM, 350MM"	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.71"	"$1,133.71"	$0.00	$0.00	$318.33	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.988	SUP	Custom 27803010		"115.988  -  TAPERED ROD, 3.2MM TO 5.5MM, 350MM"	BOTH IP/OP	"$1,620.00 "	"$1,198.80"	$0.00	"$1,296.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,202.36"	"$1,202.36"	$0.00	$0.00	$337.61	$0.00	$0.00	$0.00	$0.00	$810.00	"$1,283.04"	"$1,296.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.989	SUP	Custom 27803010		"115.989  -  TAPERED ROD, 3.7MM TO 5.5MM, 500MM"	BOTH IP/OP	"$1,060.00 "	$784.40	$0.00	$848.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$786.73	$786.73	$0.00	$0.00	$220.90	$0.00	$0.00	$0.00	$0.00	$530.00	$839.52	$848.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.99	SUP	Custom 27803010		115.990  -  LATERAL CONNECTOR	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.71"	"$1,133.71"	$0.00	$0.00	$318.33	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
115.991	SUP	Custom 27803010		"115.991  -  LATERAL CONNECTOR, SHORT"	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.71"	"$1,133.71"	$0.00	$0.00	$318.33	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.001	SUP	Custom 27203010		116.001  -  SPACER SPNL 0D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.002	SUP	Custom 27203010		116.002  -  SPACER SPNL 0D 25MM LG 32X32MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.003	SUP	Custom 27203010		116.003  -  SPACER SPNL 0D 25MM LG 32X44MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.004	SUP	Custom 27203010		116.004  -  SPACER SPNL 8D 25MM LG 32X39MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.005	SUP	Custom 27203010		116.005  -  SPACER SPNL 8D 25MM LG 32X40MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.006	SUP	Custom 27203010		116.006  -  SPACER SPNL 8D 25MM LG 32X60MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.007	SUP	Custom 27203010		116.007  -  SPACER SPNL 16D 25MM LG 32X41MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.008	SUP	Custom 27203010		116.008  -  SPACER SPNL 16D 25MM LG 32X57MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.009	SUP	Custom 27203010		116.009  -  SPACER SPNL -8D 25MM LG 32X47MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.01	SUP	Custom 27203010		116.010  -  SPACER SPNL 8D 25MM LG 32X61MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.011	SUP	Custom 27203010		116.011  -  SPACER SPNL 16D 25MM LG 32X47MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.012	SUP	Custom 27203010		116.012  -  SPACER SPNL 16D 25MM LG 32X58MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.013	SUP	Custom 27203010		116.013  -  SPACER SPNL 16D 25MM LG 32X73MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.014	SUP	Custom 27203010		116.014  -  SPACER SPNL 0D 25MM LG 32X39MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.015	SUP	Custom 27203010		116.015  -  SPACER SPNL 16D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.016	SUP	Custom 27203010		116.016  -  SPACER SPNL -8D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.017	SUP	Custom 27803010		116.017  -  SPACER SPNL 0D 25MM LG 32X41MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.018	SUP	Custom 27203010		116.018  -  SPACER SPNL 8D 25MM LG 32X41MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.019	SUP	Custom 27203010		116.019  -  SPACER SPNL 0D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.02	SUP	Custom 27203010		116.020  -  SPACER SPNL 8D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.021	SUP	Custom 27203010		116.021  -  SPACER SPNL 16D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.022	SUP	Custom 27203010		116.022  -  SPACER SPNL -8D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.023	SUP	Custom 27203010		116.023  -  SPACER SPNL 0D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.024	SUP	Custom 27203010		116.024  -  SPACER SPNL 0D 25MM LG 32X32MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,607.50 "	"$13,769.55"	$0.00	"$14,886.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,877.80"	$0.00	$0.00	$0.00	$0.00	"$9,303.75"	"$14,737.14"	"$14,886.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.101	SUP	Custom 27203010		116.101  -  SPACER SPNL 0D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.102	SUP	Custom 27203010		116.102  -  SPACER SPNL 0D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.103	SUP	Custom 27203010		116.103  -  SPACER SPNL 0D 12MM SM 14X23MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.104	SUP	Custom 27203010		116.104  -  SPACER SPNL 0D 12MM SM 14X32MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.105	SUP	Custom 27203010		116.105  -  SPACER SPNL 0D 12MM SM 14X42MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.106	SUP	Custom 27203010		116.106  -  SPACER SPNL 0D 12MM SM 14X56MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.107	SUP	Custom 27203010		116.107  -  SPACER SPNL 7D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.108	SUP	Custom 27203010		116.108  -  SPACER SPNL 7D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.109	SUP	Custom 27203010		116.109  -  SPACER SPNL 7D 12MM SM 14X26MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.11	SUP	Custom 27203010		116.110  -  SPACER SPNL 7D 12MM SM 14X28MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.111	SUP	Custom 27203010		116.111  -  SPACER SPNL 7D 12MM SM 14X42MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.112	SUP	Custom 27203010		116.112  -  SPACER SPNL 7D 12MM SM 14X56MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.113	SUP	Custom 27203010		116.113  -  SPACER SPNL 16D 12MM SM 14X56MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.114	SUP	Custom 27203010		116.114  -  SPACER SPNL 0D 12MM SM 14X74MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.115	SUP	Custom 27203010		116.115  -  SPACER SPNL 7D 12MM SM 14X74MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.116	SUP	Custom 27203010		116.116  -  SPACER SPNL 16D 12MM SM 14X74MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.117	SUP	Custom 27203010		116.117  -  SPACER SPNL 0D 12MM SM 14X19MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.118	SUP	Custom 27203010		116.118  -  SPACER SPNL 7D 12MM SM 14X19MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.119	SUP	Custom 27203010		116.119  -  SPACER SPNL 0D 12MM SM 14X29MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.12	SUP	Custom 27203010		116.120  -  SPACER SPNL 7D 12MM SM 14X29MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.121	SUP	Custom 27203010		116.121  -  SPACER SPNL 0D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.122	SUP	Custom 27203010		116.122  -  SPACER SPNL 7D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.123	SUP	Custom 27203010		116.123  -  SPACER SPNL 0D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.124	SUP	Custom 27203010		116.124  -  SPACER SPNL 7D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.125	SUP	Custom 27203010		116.125  -  SPACER SPNL 0D 12MM SM 14X19MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.126	SUP	Custom 27203010		116.126  -  SPACER SPNL 7D 12MM SM 14X29MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$14,315.00 "	"$10,593.10"	$0.00	"$11,452.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,983.25"	$0.00	$0.00	$0.00	$0.00	"$7,157.50"	"$11,337.48"	"$11,452.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.201	SUP	Custom 27203010		116.201  -  SPACER SPNL -6D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.202	SUP	Custom 27203010		116.202  -  SPACER SPNL -6D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.203	SUP	Custom 27203010		116.203  -  SPACER SPNL -6D 21MM MED 23X37MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$17,655.00 "	"$13,064.70"	$0.00	"$14,124.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,679.30"	$0.00	$0.00	$0.00	$0.00	"$8,827.50"	"$13,982.76"	"$14,124.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.204	SUP	Custom 27203010		116.204  -  SPACER SPNL -6D 21MM MED 23X49MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$20,040.00 "	"$14,829.60"	$0.00	"$16,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,176.34"	$0.00	$0.00	$0.00	$0.00	"$10,020.00"	"$15,871.68"	"$16,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.205	SUP	Custom 27203010		116.205  -  SPACER SPNL 0D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.206	SUP	Custom 27203010		116.206  -  SPACER SPNL 0D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.207	SUP	Custom 27203010		116.207  -  SPACER SPNL 0D 21MM MED 23X37MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$17,655.00 "	"$13,064.70"	$0.00	"$14,124.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,679.30"	$0.00	$0.00	$0.00	$0.00	"$8,827.50"	"$13,982.76"	"$14,124.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.208	SUP	Custom 27203010		116.208  -  SPACER SPNL 0D 21MM MED 23X49MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$20,040.00 "	"$14,829.60"	$0.00	"$16,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,176.34"	$0.00	$0.00	$0.00	$0.00	"$10,020.00"	"$15,871.68"	"$16,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.209	SUP	Custom 27203010		116.209  -  SPACER SPNL 0D 21MM MED 23X33MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.21	SUP	Custom 27203010		116.210  -  SPACER SPNL -6D 21MM MED 23X33MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.211	SUP	Custom 27203010		116.211  -  SPACER SPNL 0D 21MM MED 23X43MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,017.50 "	"$13,332.95"	$0.00	"$14,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,754.85"	$0.00	$0.00	$0.00	$0.00	"$9,008.75"	"$14,269.86"	"$14,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.212	SUP	Custom 27203010		116.212  -  SPACER SPNL -6D 21MM MED 23X43MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,017.50 "	"$13,332.95"	$0.00	"$14,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,754.85"	$0.00	$0.00	$0.00	$0.00	"$9,008.75"	"$14,269.86"	"$14,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.213	SUP	Custom 27203010		116.213  -  SPACER SPNL 8D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.214	SUP	Custom 27203010		116.214  -  SPACER SPNL 8D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.215	SUP	Custom 27203010		116.215  -  SPACER SPNL 8D 21MM MED 23X33MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.216	SUP	Custom 27203010		116.216  -  SPACER SPNL 8D 21MM MED 23X37MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,017.50 "	"$13,332.95"	$0.00	"$14,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,754.85"	$0.00	$0.00	$0.00	$0.00	"$9,008.75"	"$14,269.86"	"$14,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.217	SUP	Custom 27203010		116.217  -  SPACER SPNL 8D 21MM MED 23X43MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,017.50 "	"$13,332.95"	$0.00	"$14,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,754.85"	$0.00	$0.00	$0.00	$0.00	"$9,008.75"	"$14,269.86"	"$14,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.218	SUP	Custom 27203010		116.218  -  SPACER SPNL 8D 21MM MED 23X49MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$18,017.50 "	"$13,332.95"	$0.00	"$14,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,754.85"	$0.00	$0.00	$0.00	$0.00	"$9,008.75"	"$14,269.86"	"$14,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.219	SUP	Custom 27203010		116.219  -  SPACER SPNL 8D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.22	SUP	Custom 27203010		116.220  -  SPACER SPNL 8D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.221	SUP	Custom 27203010		116.221  -  SPACER SPNL -6D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.222	SUP	Custom 27203010		116.222  -  SPACER SPNL -6D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.223	SUP	Custom 27203010		116.223  -  SPACER SPNL 0D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.224	SUP	Custom 27203010		116.224  -  SPACER SPNL 0D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH	BOTH IP/OP	"$16,222.50 "	"$12,004.65"	$0.00	"$12,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,380.77"	$0.00	$0.00	$0.00	$0.00	"$8,111.25"	"$12,848.22"	"$12,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.301	SUP	Custom 27203010		116.301  -  SPACER SPNL 0D 21MM S/MED 23X18MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$15,267.50 "	"$11,297.95"	$0.00	"$12,214.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,181.75"	$0.00	$0.00	$0.00	$0.00	"$7,633.75"	"$12,091.86"	"$12,214.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.302	SUP	Custom 27203010		116.302  -  SPACER SPNL 0D 21MM S/MED 23X19MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$15,267.50 "	"$11,297.95"	$0.00	"$12,214.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,181.75"	$0.00	$0.00	$0.00	$0.00	"$7,633.75"	"$12,091.86"	"$12,214.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.303	SUP	Custom 27203010		116.303  -  SPACER SPNL 0D 21MM S/MED 23X21MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$15,267.50 "	"$11,297.95"	$0.00	"$12,214.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,181.75"	$0.00	$0.00	$0.00	$0.00	"$7,633.75"	"$12,091.86"	"$12,214.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.304	SUP	Custom 27203010		116.304  -  SPACER SPNL 0D 21MM S/MED 23X18MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$15,267.50 "	"$11,297.95"	$0.00	"$12,214.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,181.75"	$0.00	$0.00	$0.00	$0.00	"$7,633.75"	"$12,091.86"	"$12,214.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.305	SUP	Custom 27203010		116.305  -  SPACER SPNL 0D 21MM S/MED 23X19MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$15,267.50 "	"$11,297.95"	$0.00	"$12,214.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,181.75"	$0.00	$0.00	$0.00	$0.00	"$7,633.75"	"$12,091.86"	"$12,214.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.306	SUP	Custom 27203010		116.306  -  SPACER SPNL 0D 21MM S/MED 23X21MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$15,267.50 "	"$11,297.95"	$0.00	"$12,214.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,181.75"	$0.00	$0.00	$0.00	$0.00	"$7,633.75"	"$12,091.86"	"$12,214.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.401	SUP	Custom 27203010		116.401  -  SPACER SPNL 0D 25MM MED LG 32X24MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$17,412.50 "	"$12,885.25"	$0.00	"$13,930.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,628.77"	$0.00	$0.00	$0.00	$0.00	"$8,706.25"	"$13,790.70"	"$13,930.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.402	SUP	Custom 27203010		116.402  -  SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$17,412.50 "	"$12,885.25"	$0.00	"$13,930.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,628.77"	$0.00	$0.00	$0.00	$0.00	"$8,706.25"	"$13,790.70"	"$13,930.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.403	SUP	Custom 27203010		116.403  -  SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$18,130.00 "	"$13,416.20"	$0.00	"$14,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,778.29"	$0.00	$0.00	$0.00	$0.00	"$9,065.00"	"$14,358.96"	"$14,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.404	SUP	Custom 27203010		116.404  -  SPACER SPNL 0D 25MM MED LG 32X41MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$20,277.50 "	"$15,005.35"	$0.00	"$16,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,225.83"	$0.00	$0.00	$0.00	$0.00	"$10,138.75"	"$16,059.78"	"$16,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.405	SUP	Custom 27203010		116.405  -  SPACER SPNL 0D 25MM MED LG 32X51MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$20,992.50 "	"$15,534.45"	$0.00	"$16,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,374.84"	$0.00	$0.00	$0.00	$0.00	"$10,496.25"	"$16,626.06"	"$16,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.406	SUP	Custom 27203010		116.406  -  SPACER SPNL 0D 25MM MED LG 32X24MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$17,417.50 "	"$12,888.95"	$0.00	"$13,934.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,629.81"	$0.00	$0.00	$0.00	$0.00	"$8,708.75"	"$13,794.66"	"$13,934.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.407	SUP	Custom 27203010		116.407  -  SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$17,417.50 "	"$12,888.95"	$0.00	"$13,934.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,629.81"	$0.00	$0.00	$0.00	$0.00	"$8,708.75"	"$13,794.66"	"$13,934.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.408	SUP	Custom 27203010		116.408  -  SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$18,130.00 "	"$13,416.20"	$0.00	"$14,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,778.29"	$0.00	$0.00	$0.00	$0.00	"$9,065.00"	"$14,358.96"	"$14,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.409	SUP	Custom 27203010		116.409  -  SPACER SPNL 0D 25MM MED LG 32X41MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$20,277.50 "	"$15,005.35"	$0.00	"$16,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,225.83"	$0.00	$0.00	$0.00	$0.00	"$10,138.75"	"$16,059.78"	"$16,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.41	SUP	Custom 27203010		116.410  -  SPACER SPNL 0D 25MM MED LG 32X51MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$20,992.50 "	"$15,534.45"	$0.00	"$16,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,374.84"	$0.00	$0.00	$0.00	$0.00	"$10,496.25"	"$16,626.06"	"$16,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.411	SUP	Custom 27203010		116.411  -  SPACER SPNL 0D 25MM MED LG 32X36MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$19,202.50 "	"$14,209.85"	$0.00	"$15,362.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,001.80"	$0.00	$0.00	$0.00	$0.00	"$9,601.25"	"$15,208.38"	"$15,362.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.412	SUP	Custom 27203010		116.412  -  SPACER SPNL 0D 25MM MED LG 32X36MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$19,202.50 "	"$14,209.85"	$0.00	"$15,362.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,001.80"	$0.00	$0.00	$0.00	$0.00	"$9,601.25"	"$15,208.38"	"$15,362.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.413	SUP	Custom 27203010		116.413  -  SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$17,417.50 "	"$12,888.95"	$0.00	"$13,934.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,629.81"	$0.00	$0.00	$0.00	$0.00	"$8,708.75"	"$13,794.66"	"$13,934.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.414	SUP	Custom 27203010		116.414  -  SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$17,417.50 "	"$12,888.95"	$0.00	"$13,934.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,629.81"	$0.00	$0.00	$0.00	$0.00	"$8,708.75"	"$13,794.66"	"$13,934.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.415	SUP	Custom 27203010		116.415  -  SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$18,130.00 "	"$13,416.20"	$0.00	"$14,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,778.29"	$0.00	$0.00	$0.00	$0.00	"$9,065.00"	"$14,358.96"	"$14,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
116.416	SUP	Custom 27203010		116.416  -  SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT	BOTH IP/OP	"$18,130.00 "	"$13,416.20"	$0.00	"$14,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,778.29"	$0.00	$0.00	$0.00	$0.00	"$9,065.00"	"$14,358.96"	"$14,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
117.112	SUP	HCPCS C1713		"117.112  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 12MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
117.114	SUP	HCPCS C1713		"117.114  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 14MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
117.116	SUP	HCPCS C1713		"117.116  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 16MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
117.118	SUP	HCPCS C1713		"117.118  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 18MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
117.12	SUP	HCPCS C1713		"117.120  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 20MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
117.122	SUP	HCPCS C1713		"117.122  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 22MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
117.124	SUP	HCPCS C1713		"117.124  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 24MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
117.126	SUP	HCPCS C1713		"117.126  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 26MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
117.226	SUP	HCPCS C1713		"117.226  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 26MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
117.228	SUP	HCPCS C1713		"117.228  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 28MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
117.23	SUP	HCPCS C1713		"117.230  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
117.232	SUP	HCPCS C1713		"117.232  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 32MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
117.234	SUP	HCPCS C1713		"117.234  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 34MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
117.236	SUP	HCPCS C1713		"117.236  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 36MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
117.238	SUP	HCPCS C1713		"117.238  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 38MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
117.24	SUP	HCPCS C1713		"117.240  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
117.242	SUP	HCPCS C1713		"117.242  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 42MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
117.244	SUP	HCPCS C1713		"117.244  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 44MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
117.246	SUP	HCPCS C1713		"117.246  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 46MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
117.345	SUP	HCPCS C1713		"117.345  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 45MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
117.348	SUP	HCPCS C1713		"117.348  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 48MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
117.351	SUP	HCPCS C1713		"117.351  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 51MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
117.354	SUP	HCPCS C1713		"117.354  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 54MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
117.357	SUP	HCPCS C1713		"117.357  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 57MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
117.36	SUP	HCPCS C1713		117.360  -  PLATE BN 60MM NS ASR LVL 3 TRANSLATIONAL SPNE CRV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
117.363	SUP	HCPCS C1713		"117.363  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 63MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
117.366	SUP	HCPCS C1713		"117.366  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 66MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
117.369	SUP	HCPCS C1713		"117.369  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 69MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
117.46	SUP	HCPCS C1713		"117.460  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 60MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
117.464	SUP	HCPCS C1713		"117.464  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 64MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
117.468	SUP	HCPCS C1713		"117.468  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 68MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
117.472	SUP	HCPCS C1713		"117.472  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 72MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
117.476	SUP	HCPCS C1713		"117.476  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 76MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
117.48	SUP	HCPCS C1713		"117.480  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 80MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
117.484	SUP	HCPCS C1713		"117.484  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 84MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
117.488	SUP	HCPCS C1713		"117.488  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 88MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
117.492	SUP	HCPCS C1713		"117.492  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 92MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
117.496	SUP	HCPCS C1713		"117.496  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 96MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
117.5	SUP	HCPCS C1713		"117.500  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 100MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
124	SUP	HCPCS C1713		124.000  -  LOCKING CAPS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
124.001	SUP	Custom 27803010		"124.001  -  5.5MM STRAIGHT ROD, CP, 300MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.002	SUP	Custom 27803010		"124.002  -  5.5MM STRAIGHT ROD, CP, 400MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.003	SUP	Custom 27803010		"124.003  -  5.5MM STRAIGHT ROD, CP, 500MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.004	SUP	Custom 27803010		"124.004  -  5.5MM STRAIGHT ROD, CP2, 300MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.005	SUP	Custom 27803010		"124.005  -  5.5MM STRAIGHT ROD, CP2, 400MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.006	SUP	Custom 27803010		"124.006  -  5.5MM STRAIGHT ROD, CP2, 500MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.012	SUP	Custom 27803010		"124.012  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 24MM-25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.013	SUP	Custom 27803010		"124.013  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 26MM-28MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.014	SUP	Custom 27803010		"124.014  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 29MM-34MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.051	SUP	HCPCS C1713		124.051  -  5.0MM REVERE PEDICLE SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.052	SUP	HCPCS C1713		124.052  -  5.0MM REVERE PEDICLE SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.053	SUP	HCPCS C1713		124.053  -  5.0MM REVERE PEDICLE SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.054	SUP	HCPCS C1713		124.054  -  5.0MM REVERE PEDICLE SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.055	SUP	HCPCS C1713		124.055  -  5.0MM REVERE PEDICLE SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.056	SUP	HCPCS C1713		124.056  -  5.0MM REVERE PEDICLE SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.057	SUP	HCPCS C1713		124.057  -  5.0MM REVERE PEDICLE SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.071	SUP	HCPCS C1713		124.071  -  7.5MM REVERE PEDICLE SCREW 70MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.072	SUP	HCPCS C1713		124.072  -  7.5MM REVERE PEDICLE SCREW 75MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.073	SUP	HCPCS C1713		124.073  -  7.5MM REVERE PEDICLE SCREW 80MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.074	SUP	HCPCS C1713		124.074  -  7.5MM REVERE PEDICLE SCREW 85MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.075	SUP	HCPCS C1713		124.075  -  7.5MM REVERE PEDICLE SCREW 90MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.081	SUP	HCPCS C1713		124.081  -  8.5MM REVERE PEDICLE SCREW 70MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.082	SUP	HCPCS C1713		124.082  -  8.5MM REVERE PEDICLE SCREW 75MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.083	SUP	HCPCS C1713		124.083  -  8.5MM REVERE PEDICLE SCREW 80MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.084	SUP	HCPCS C1713		124.084  -  8.5MM REVERE PEDICLE SCREW 85MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.085	SUP	HCPCS C1713		124.085  -  8.5MM REVERE PEDICLE SCREW 90MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.111	SUP	HCPCS C1713		"124.111  -  5.5MM REVERE MONOAXIAL SCREW, 27MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.112	SUP	HCPCS C1713		"124.112  -  5.5MM REVERE MONOAXIAL SCREW, 32MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.113	SUP	HCPCS C1713		"124.113  -  5.5MM REVERE MONOAXIAL SCREW, 37MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.114	SUP	HCPCS C1713		"124.114  -  5.5MM REVERE MONOAXIAL SCREW, 42MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.115	SUP	HCPCS C1713		"124.115  -  5.5MM REVERE MONOAXIAL SCREW, 47MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.121	SUP	HCPCS C1713		"124.121  -  6.5MM REVERE MONOAXIAL SCREW, 27MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.122	SUP	HCPCS C1713		"124.122  -  6.5MM REVERE MONOAXIAL SCREW, 32MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.123	SUP	HCPCS C1713		"124.123  -  6.5MM REVERE MONOAXIAL SCREW, 37MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.124	SUP	HCPCS C1713		"124.124  -  6.5MM REVERE MONOAXIAL SCREW, 42MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.125	SUP	HCPCS C1713		"124.125  -  6.5MM REVERE MONOAXIAL SCREW, 47MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.131	SUP	HCPCS C1713		"124.131  -  7.5MM REVERE MONOAXIAL SCREW, 27MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.132	SUP	HCPCS C1713		"124.132  -  7.5MM REVERE MONOAXIAL SCREW, 32MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.133	SUP	HCPCS C1713		"124.133  -  7.5MM REVERE MONOAXIAL SCREW, 37MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.134	SUP	HCPCS C1713		"124.134  -  7.5MM REVERE MONOAXIAL SCREW, 42MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.135	SUP	HCPCS C1713		"124.135  -  7.5MM REVERE MONOAXIAL SCREW, 47MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.171	SUP	HCPCS C1713		124.171  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 75MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.172	SUP	HCPCS C1713		124.172  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 80MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.173	SUP	HCPCS C1713		124.173  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 85MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.174	SUP	HCPCS C1713		124.174  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 90MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.175	SUP	HCPCS C1713		124.175  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 95MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.176	SUP	HCPCS C1713		124.176  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 100MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.181	SUP	HCPCS C1713		124.181  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 75MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.182	SUP	HCPCS C1713		124.182  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 80MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.183	SUP	HCPCS C1713		124.183  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 85MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.184	SUP	HCPCS C1713		124.184  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 90MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.185	SUP	HCPCS C1713		124.185  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 95MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.186	SUP	HCPCS C1713		124.186  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 100MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.2	SUP	HCPCS C1713		124.200  -  4.0MM REVERE MONOAXIAL SCREW 20MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.201	SUP	HCPCS C1713		124.201  -  4.0MM REVERE MONOAXIAL SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.202	SUP	HCPCS C1713		124.202  -  4.0MM REVERE MONOAXIAL SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.203	SUP	HCPCS C1713		124.203  -  4.0MM REVERE MONOAXIAL SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.204	SUP	HCPCS C1713		124.204  -  4.0MM REVERE MONOAXIAL SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.241	SUP	HCPCS C1713		124.241  -  4.5MM REVERE MONOAXIAL SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.242	SUP	HCPCS C1713		124.242  -  4.5MM REVERE MONOAXIAL SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.243	SUP	HCPCS C1713		124.243  -  4.5MM REVERE MONOAXIAL SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.244	SUP	HCPCS C1713		124.244  -  4.5MM REVERE MONOAXIAL SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.245	SUP	HCPCS C1713		124.245  -  4.5MM REVERE MONOAXIAL SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.251	SUP	HCPCS C1713		124.251  -  5.5MM REVERE MONOAXIAL SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.252	SUP	HCPCS C1713		124.252  -  5.5MM REVERE MONOAXIAL SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.253	SUP	HCPCS C1713		124.253  -  5.5MM REVERE MONOAXIAL SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.254	SUP	HCPCS C1713		124.254  -  5.5MM REVERE MONOAXIAL SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.255	SUP	HCPCS C1713		124.255  -  5.5MM REVERE MONOAXIAL SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.256	SUP	HCPCS C1713		124.256  -  5.5MM REVERE MONOAXIAL SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.257	SUP	HCPCS C1713		124.257  -  5.5MM REVERE MONOAXIAL SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.258	SUP	HCPCS C1713		124.258  -  5.5MM REVERE MONOAXIAL SCREW 60MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.259	SUP	HCPCS C1713		124.259  -  5.5MM REVERE MONOAXIAL SCREW 65MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.261	SUP	HCPCS C1713		124.261  -  6.5MM REVERE MONOAXIAL SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.262	SUP	HCPCS C1713		124.262  -  6.5MM REVERE MONOAXIAL SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.263	SUP	HCPCS C1713		124.263  -  6.5MM REVERE MONOAXIAL SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.264	SUP	HCPCS C1713		124.264  -  6.5MM REVERE MONOAXIAL SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.265	SUP	HCPCS C1713		124.265  -  6.5MM REVERE MONOAXIAL SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.266	SUP	HCPCS C1713		124.266  -  6.5MM REVERE MONOAXIAL SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.267	SUP	HCPCS C1713		124.267  -  6.5MM REVERE MONOAXIAL SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.268	SUP	HCPCS C1713		124.268  -  6.5MM REVERE MONOAXIAL SCREW 60MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.269	SUP	HCPCS C1713		124.269  -  6.5MM REVERE MONOAXIAL SCREW 65MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.271	SUP	HCPCS C1713		124.271  -  7.5MM REVERE MONOAXIAL SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.272	SUP	HCPCS C1713		124.272  -  7.5MM REVERE MONOAXIAL SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.273	SUP	HCPCS C1713		124.273  -  7.5MM REVERE MONOAXIAL SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.274	SUP	HCPCS C1713		124.274  -  7.5MM REVERE MONOAXIAL SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.275	SUP	HCPCS C1713		124.275  -  7.5MM REVERE MONOAXIAL SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.276	SUP	HCPCS C1713		124.276  -  7.5MM REVERE MONOAXIAL SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.277	SUP	HCPCS C1713		124.277  -  7.5MM REVERE MONOAXIAL SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.278	SUP	HCPCS C1713		124.278  -  7.5MM REVERE MONOAXIAL SCREW 60MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.279	SUP	HCPCS C1713		124.279  -  7.5MM REVERE MONOAXIAL SCREW 65MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.281	SUP	HCPCS C1713		124.281  -  8.5MM REVERE MONOAXIAL SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.282	SUP	HCPCS C1713		124.282  -  8.5MM REVERE MONOAXIAL SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.283	SUP	HCPCS C1713		124.283  -  8.5MM REVERE MONOAXIAL SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.284	SUP	HCPCS C1713		124.284  -  8.5MM REVERE MONOAXIAL SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.285	SUP	HCPCS C1713		124.285  -  8.5MM REVERE MONOAXIAL SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.286	SUP	HCPCS C1713		124.286  -  8.5MM REVERE MONOAXIAL SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.287	SUP	HCPCS C1713		124.287  -  8.5MM REVERE MONOAXIAL SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.288	SUP	HCPCS C1713		124.288  -  8.5MM REVERE MONOAXIAL SCREW 60MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.289	SUP	HCPCS C1713		124.289  -  8.5MM REVERE MONOAXIAL SCREW 65MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.351	SUP	HCPCS C1713		124.351  -  5.5MM REVERE CANNULATED PEDICLE SCREW 25MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.352	SUP	HCPCS C1713		124.352  -  5.5MM REVERE CANNULATED PEDICLE SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.353	SUP	HCPCS C1713		124.353  -  5.5MM REVERE CANNULATED PEDICLE SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.354	SUP	HCPCS C1713		124.354  -  5.5MM REVERE CANNULATED PEDICLE SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.355	SUP	HCPCS C1713		124.355  -  5.5MM REVERE CANNULATED PEDICLE SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.356	SUP	HCPCS C1713		124.356  -  5.5MM REVERE CANNULATED PEDICLE SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.357	SUP	HCPCS C1713		124.357  -  5.5MM REVERE CANNULATED PEDICLE SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.361	SUP	HCPCS C1713		124.361  -  6.5MM REVERE CANNULATED PEDICLE SCREW 25MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.362	SUP	HCPCS C1713		124.362  -  6.5MM REVERE CANNULATED PEDICLE SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.363	SUP	HCPCS C1713		124.363  -  6.5MM REVERE CANNULATED PEDICLE SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.364	SUP	HCPCS C1713		124.364  -  6.5MM REVERE CANNULATED PEDICLE SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.365	SUP	HCPCS C1713		124.365  -  6.5MM REVERE CANNULATED PEDICLE SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.366	SUP	HCPCS C1713		124.366  -  6.5MM REVERE CANNULATED PEDICLE SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.367	SUP	HCPCS C1713		124.367  -  6.5MM REVERE CANNULATED PEDICLE SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.368	SUP	HCPCS C1713		124.368  -  6.5MM REVERE CANNULATED PEDICLE SCREW 60MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.369	SUP	HCPCS C1713		124.369  -  6.5MM REVERE CANNULATED PEDICLE SCREW 65MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.371	SUP	HCPCS C1713		124.371  -  7.5MM REVERE CANNULATED PEDICLE SCREW 25MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.372	SUP	HCPCS C1713		124.372  -  7.5MM REVERE CANNULATED PEDICLE SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.373	SUP	HCPCS C1713		124.373  -  7.5MM REVERE CANNULATED PEDICLE SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.374	SUP	HCPCS C1713		124.374  -  7.5MM REVERE CANNULATED PEDICLE SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.375	SUP	HCPCS C1713		124.375  -  7.5MM REVERE CANNULATED PEDICLE SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.376	SUP	HCPCS C1713		124.376  -  7.5MM REVERE CANNULATED PEDICLE SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.377	SUP	HCPCS C1713		124.377  -  7.5MM REVERE CANNULATED PEDICLE SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.378	SUP	HCPCS C1713		124.378  -  7.5MM REVERE CANNULATED PEDICLE SCREW 60MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.379	SUP	HCPCS C1713		124.379  -  7.5MM REVERE CANNULATED PEDICLE SCREW 65MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.381	SUP	HCPCS C1713		124.381  -  8.5MM REVERE CANNULATED PEDICLE SCREW 25MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.382	SUP	HCPCS C1713		124.382  -  8.5MM REVERE CANNULATED PEDICLE SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.383	SUP	HCPCS C1713		124.383  -  8.5MM REVERE CANNULATED PEDICLE SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.384	SUP	HCPCS C1713		124.384  -  8.5MM REVERE CANNULATED PEDICLE SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.385	SUP	HCPCS C1713		124.385  -  8.5MM REVERE CANNULATED PEDICLE SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.386	SUP	HCPCS C1713		124.386  -  8.5MM REVERE CANNULATED PEDICLE SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.387	SUP	HCPCS C1713		124.387  -  8.5MM REVERE CANNULATED PEDICLE SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.388	SUP	HCPCS C1713		124.388  -  8.5MM REVERE CANNULATED PEDICLE SCREW 60MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.389	SUP	HCPCS C1713		124.389  -  8.5MM REVERE CANNULATED PEDICLE SCREW 65MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.441	SUP	HCPCS C1713		124.441  -  4.5MM REVERE PEDICLE SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.442	SUP	HCPCS C1713		124.442  -  SCREW BONE 4.5MM 30MM REVERE TI PDCL SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.443	SUP	HCPCS C1713		124.443  -  SCREW BONE 4.5MM 35MM REVERE TI PDCL SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.444	SUP	HCPCS C1713		124.444  -  SCREW BONE 4.5MM 40MM REVERE TI PDCL SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.445	SUP	HCPCS C1713		124.445  -  4.5MM REVERE PEDICLE SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.451	SUP	HCPCS C1713		124.451  -  5.5MM REVERE PEDICLE SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.452	SUP	HCPCS C1713		124.452  -  SCREW BONE 5.5MM 30MM REVERE TI PDCL SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.453	SUP	HCPCS C1713		124.453  -  SCREW BONE 5.5MM 35MM REVERE TI PDCL SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.454	SUP	HCPCS C1713		124.454  -  SCREW BONE 5.5MM 40MM REVERE TI PDCL SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.455	SUP	HCPCS C1713		124.455  -  SCREW BONE 5.5MM 45MM REVERE TI PDCL SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.456	SUP	HCPCS C1713		124.456  -  5.5MM REVERE PEDICLE SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.457	SUP	HCPCS C1713		124.457  -  5.5MM REVERE PEDICLE SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.461	SUP	HCPCS C1713		124.461  -  6.5MM REVERE PEDICLE SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.462	SUP	HCPCS C1713		124.462  -  6.5MM REVERE PEDICLE SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.463	SUP	HCPCS C1713		124.463  -  6.5MM REVERE PEDICLE SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.464	SUP	HCPCS C1713		124.464  -  SCREW BONE 6.5MM 40MM REVERE TI PDCL SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.465	SUP	HCPCS C1713		124.465  -  SCREW BONE 6.5MM 45MM REVERE TI PDCL SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.466	SUP	HCPCS C1713		124.466  -  SCREW BONE 6.5MM 50MM REVERE TI PDCL SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.467	SUP	HCPCS C1713		124.467  -  6.5MM REVERE PEDICLE SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.468	SUP	HCPCS C1713		124.468  -  6.5MM REVERE PEDICLE SCREW 60MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.469	SUP	HCPCS C1713		124.469  -  6.5MM REVERE PEDICLE SCREW 65MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.471	SUP	HCPCS C1713		124.471  -  7.5MM REVERE PEDICLE SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.472	SUP	HCPCS C1713		124.472  -  7.5MM REVERE PEDICLE SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.473	SUP	HCPCS C1713		124.473  -  7.5MM REVERE PEDICLE SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.474	SUP	HCPCS C1713		124.474  -  7.5MM REVERE PEDICLE SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.475	SUP	HCPCS C1713		124.475  -  SCREW BONE 7.5MM 45MM REVERE TI PDCL SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.476	SUP	HCPCS C1713		124.476  -  7.5MM REVERE PEDICLE SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.477	SUP	HCPCS C1713		124.477  -  7.5MM REVERE PEDICLE SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.478	SUP	HCPCS C1713		124.478  -  7.5MM REVERE PEDICLE SCREW 60MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.479	SUP	HCPCS C1713		124.479  -  7.5MM REVERE PEDICLE SCREW 65MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.481	SUP	HCPCS C1713		124.481  -  8.5MM REVERE PEDICLE SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.482	SUP	HCPCS C1713		124.482  -  8.5MM REVERE PEDICLE SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.483	SUP	HCPCS C1713		124.483  -  8.5MM REVERE PEDICLE SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.484	SUP	HCPCS C1713		124.484  -  8.5MM REVERE PEDICLE SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.485	SUP	HCPCS C1713		124.485  -  8.5MM REVERE PEDICLE SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.486	SUP	HCPCS C1713		124.486  -  8.5MM REVERE PEDICLE SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.487	SUP	HCPCS C1713		124.487  -  8.5MM REVERE PEDICLE SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.488	SUP	HCPCS C1713		124.488  -  8.5MM REVERE PEDICLE SCREW 60MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.489	SUP	HCPCS C1713		124.489  -  8.5MM REVERE PEDICLE SCREW 65MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.51	SUP	Custom 27803010		"124.510  -  5.5MM STRAIGHT ROD, 100MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.512	SUP	Custom 27803010		"124.512  -  5.5MM STRAIGHT ROD, 125MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.515	SUP	Custom 27803010		124.515  -  ROD SPNL 150MM 5.5MM REVERE PDCL TI STR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.517	SUP	Custom 27803010		124.517  -  ROD SPNL 200MM 5.5MM REVERE PDCL TI STR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.519	SUP	Custom 27803010		124.519  -  ROD SPNL 350MM 5.5MM REVERE PDCL TI STR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.52	SUP	Custom 27803010		"124.520  -  5.5MM STRAIGHT ROD, 400MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.521	SUP	Custom 27803010		"124.521  -  5.5MM STRAIGHT ROD, 500MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.53	SUP	Custom 27803010		"124.530  -  5.5MM STRAIGHT ROD, 30MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.535	SUP	Custom 27803010		"124.535  -  5.5MM STRAIGHT ROD, 35MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.54	SUP	Custom 27803010		124.540  -  ROD SPNL 40MM 5.5MM REVERE TI STR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.545	SUP	Custom 27803010		"124.545  -  5.5MM STRAIGHT ROD, 45MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.55	SUP	Custom 27803010		"124.550  -  5.5MM STRAIGHT ROD, 50MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.555	SUP	Custom 27803010		"124.555  -  5.5MM STRAIGHT ROD, 55MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.56	SUP	Custom 27803010		"124.560  -  5.5MM STRAIGHT ROD, 60MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.565	SUP	Custom 27803010		"124.565  -  5.5MM STRAIGHT ROD, 65MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.57	SUP	Custom 27803010		"124.570  -  5.5MM STRAIGHT ROD, 70MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.575	SUP	Custom 27803010		"124.575  -  5.5MM STRAIGHT ROD, 75MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.58	SUP	Custom 27803010		"124.580  -  5.5MM STRAIGHT ROD, 80MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.585	SUP	Custom 27803010		124.585  -  ROD SPNL 85MM 5.5MM REVERE PDCL TI STR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.61	SUP	Custom 27803010		"124.610  -  5.5MM CURVED ROD, 100MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.612	SUP	Custom 27803010		"124.612  -  5.5MM CURVED ROD, 125MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.615	SUP	Custom 27803010		"124.615  -  5.5MM CURVED ROD, 150MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.635	SUP	Custom 27803010		"124.635  -  5.5MM CURVED ROD, 35MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.64	SUP	Custom 27803010		124.640  -  ROD SPNL 40MM 5.5MM REVERE PDCL TI CVD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.645	SUP	Custom 27803010		124.645  -  ROD SPNL 45MM 5.5MM REVERE PDCL TI CVD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.65	SUP	Custom 27803010		"124.650  -  5.5MM CURVED ROD, 50MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.655	SUP	Custom 27803010		124.655  -  ROD SPNL 55MM 5.5MM REVERE PDCL TI CVD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.66	SUP	Custom 27803010		"124.660  -  5.5MM CURVED ROD, 60MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.665	SUP	Custom 27803010		124.665  -  ROD SPNL 65MM 5.5MM REVERE PDCL TI CVD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.67	SUP	Custom 27803010		"124.670  -  5.5MM CURVED ROD, 70MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.675	SUP	Custom 27803010		"124.675  -  5.5MM CURVED ROD, 75MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.68	SUP	Custom 27803010		"124.680  -  5.5MM CURVED ROD, 80MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.685	SUP	Custom 27803010		"124.685  -  5.5MM CURVED ROD, 85MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.69	SUP	Custom 27803010		"124.690  -  5.5MM CURVED ROD, 90MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.695	SUP	Custom 27803010		"124.695  -  5.5MM CURVED ROD, 95MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.751	SUP	HCPCS C1713		124.751  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.752	SUP	HCPCS C1713		124.752  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.753	SUP	HCPCS C1713		124.753  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.754	SUP	HCPCS C1713		124.754  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.755	SUP	HCPCS C1713		124.755  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.756	SUP	HCPCS C1713		124.756  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.757	SUP	HCPCS C1713		124.757  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 60MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.758	SUP	HCPCS C1713		124.758  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 65MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.761	SUP	HCPCS C1713		124.761  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.762	SUP	HCPCS C1713		124.762  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.763	SUP	HCPCS C1713		124.763  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.764	SUP	HCPCS C1713		124.764  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.765	SUP	HCPCS C1713		124.765  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.766	SUP	HCPCS C1713		124.766  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.767	SUP	HCPCS C1713		124.767  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 60MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.768	SUP	HCPCS C1713		124.768  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 65MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.771	SUP	HCPCS C1713		124.771  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.772	SUP	HCPCS C1713		124.772  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.773	SUP	HCPCS C1713		124.773  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.774	SUP	HCPCS C1713		124.774  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.775	SUP	HCPCS C1713		124.775  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.776	SUP	HCPCS C1713		124.776  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.777	SUP	HCPCS C1713		124.777  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 60MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.778	SUP	HCPCS C1713		124.778  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 65MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.779	SUP	HCPCS C1713		124.779  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 70MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.781	SUP	HCPCS C1713		124.781  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.782	SUP	HCPCS C1713		124.782  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.783	SUP	HCPCS C1713		124.783  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.784	SUP	HCPCS C1713		124.784  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.785	SUP	HCPCS C1713		124.785  -  SCREW BN 7MM 50MM NS REVERE 2 DIA PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.786	SUP	HCPCS C1713		124.786  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.787	SUP	HCPCS C1713		124.787  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 60MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.788	SUP	HCPCS C1713		124.788  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 65MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.789	SUP	HCPCS C1713		124.789  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 70MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
124.851	SUP	HCPCS C1713		124.851  -  5.0MM REVERE MONOAXIAL SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.852	SUP	HCPCS C1713		124.852  -  5.0MM REVERE MONOAXIAL SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.853	SUP	HCPCS C1713		124.853  -  5.0MM REVERE MONOAXIAL SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.854	SUP	HCPCS C1713		124.854  -  5.0MM REVERE MONOAXIAL SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.855	SUP	HCPCS C1713		124.855  -  5.0MM REVERE MONOAXIAL SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.856	SUP	HCPCS C1713		124.856  -  5.0MM REVERE MONOAXIAL SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.857	SUP	HCPCS C1713		124.857  -  5.0MM REVERE MONOAXIAL SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.871	SUP	HCPCS C1713		124.871  -  7.5MM REVERE MONOAXIAL SCREW 70MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.872	SUP	HCPCS C1713		124.872  -  7.5MM REVERE MONOAXIAL SCREW 75MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.873	SUP	HCPCS C1713		124.873  -  7.5MM REVERE MONOAXIAL SCREW 80MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.874	SUP	HCPCS C1713		124.874  -  7.5MM REVERE MONOAXIAL SCREW 85MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.875	SUP	HCPCS C1713		124.875  -  7.5MM REVERE MONOAXIAL SCREW 90MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.881	SUP	HCPCS C1713		124.881  -  8.5MM REVERE MONOAXIAL SCREW 70MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.882	SUP	HCPCS C1713		124.882  -  8.5MM REVERE MONOAXIAL SCREW 75MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.883	SUP	HCPCS C1713		124.883  -  8.5MM REVERE MONOAXIAL SCREW 80MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.884	SUP	HCPCS C1713		124.884  -  8.5MM REVERE MONOAXIAL SCREW 85MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.885	SUP	HCPCS C1713		124.885  -  8.5MM REVERE MONOAXIAL SCREW 90MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
124.891	SUP	Custom 27803010		"124.891  -  REVERE LOW PROFILE PEDICLE HOOK, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.892	SUP	Custom 27803010		"124.892  -  REVERE LOW PROFILE PEDICLE HOOK, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.893	SUP	Custom 27803010		"124.893  -  REVERE LOW PROFILE PEDICLE HOOK, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.901	SUP	Custom 27803010		"124.901  -  REVERE THORACIC LAMINA HOOK, NARROW, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.902	SUP	Custom 27803010		"124.902  -  REVERE THORACIC LAMINA HOOK, NARROW, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.904	SUP	Custom 27803010		"124.904  -  REVERE THORACIC LAMINA HOOK, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.905	SUP	Custom 27803010		"124.905  -  REVERE THORACIC LAMINA HOOK, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.907	SUP	Custom 27803010		"124.907  -  REVERE UPGOING THORACIC LAMINA HOOK, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.908	SUP	Custom 27803010		"124.908  -  REVERE UPGOING THORACIC LAMINA HOOK, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.912	SUP	Custom 27803010		124.912  -  CONCTR ROD 29-33MM REVERE TRNSVRS ADJ TI PDCL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.913	SUP	Custom 27803010		"124.913  -  REVERE ADJUSTABLE T CONNECTOR, 33MM-41MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.914	SUP	Custom 27803010		124.914  -  CONCTR ROD 38-51MM REVERE TRNSVRS ADJ TI PDCL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.915	SUP	Custom 27803010		124.915  -  CONCTR ROD 48-68MM REVERE TRNSVRS ADJ TI PDCL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.916	SUP	Custom 27803010		124.916  -  CONCTR ROD 58-71MM REVERE TRNSVRS ADJ TI PDCL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.917	SUP	Custom 27803010		"124.917  -  REVERE ADJUSTABLE T CONNECTOR, 68MM-81MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.918	SUP	Custom 27803010		"124.918  -  REVERE ADJUSTABLE T CONNECTOR, 78MM-91MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.921	SUP	Custom 27803010		"124.921  -  REVERE OFFSET LAMINA HOOK, RIGHT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.922	SUP	Custom 27803010		"124.922  -  REVERE OFFSET LAMINA HOOK, LEFT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.924	SUP	Custom 27803010		"124.924  -  REVERE TRANSVERSE PROCESS HOOK, RIGHT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.925	SUP	Custom 27803010		"124.925  -  REVERE TRANSVERSE PROCESS HOOK, LEFT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.927	SUP	Custom 27803010		"124.927  -  REVERE PEDICLE HOOK, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.928	SUP	Custom 27803010		"124.928  -  REVERE PEDICLE HOOK, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.929	SUP	Custom 27803010		"124.929  -  REVERE PEDICLE HOOK, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.931	SUP	Custom 27803010		"124.931  -  REVERE LAMINA HOOK, TRANSVERSE, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.932	SUP	Custom 27803010		"124.932  -  REVERE LAMINA HOOK, TRANSVERSE, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.933	SUP	Custom 27803010		"124.933  -  REVERE LAMINA HOOK, TRANSVERSE, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.935	SUP	Custom 27803010		"124.935  -  REVERE PEDICLE HOOK, TRANSVERSE, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.936	SUP	Custom 27803010		"124.936  -  REVERE PEDICLE HOOK, TRANSVERSE, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.937	SUP	Custom 27803010		"124.937  -  REVERE PEDICLE HOOK, TRANSVERSE, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.94	SUP	Custom 27803010		"124.940  -  REVERE LAMINA HOOK, NARROW, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.941	SUP	Custom 27803010		"124.941  -  REVERE LAMINA HOOK, NARROW, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.942	SUP	Custom 27803010		"124.942  -  REVERE LAMINA HOOK, NARROW, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.944	SUP	Custom 27803010		"124.944  -  REVERE LAMINA HOOK, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.945	SUP	Custom 27803010		"124.945  -  REVERE LAMINA HOOK, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.946	SUP	Custom 27803010		"124.946  -  REVERE LAMINA HOOK, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.948	SUP	Custom 27803010		"124.948  -  REVERE LAMINA HOOK, WIDE, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.949	SUP	Custom 27803010		"124.949  -  REVERE LAMINA HOOK, WIDE, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.95	SUP	Custom 27803010		"124.950  -  REVERE LAMINA HOOK, WIDE, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.952	SUP	Custom 27803010		"124.952  -  REVERE LAMINA HOOK, TALL BODY, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.953	SUP	Custom 27803010		"124.953  -  REVERE LAMINA HOOK, TALL BODY, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.954	SUP	Custom 27803010		"124.954  -  REVERE LAMINA HOOK, TALL BODY, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.955	SUP	Custom 27803010		"124.955  -  REVERE ANGLED LAMINA HOOK, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.956	SUP	Custom 27803010		"124.956  -  REVERE ANGLED LAMINA HOOK, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.957	SUP	Custom 27803010		"124.957  -  REVERE ANGLED LAMINA HOOK, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.96	SUP	Custom 27803010		"124.960  -  PARALLEL CONNECTOR, 5.5MM TO 5.5MM"	BOTH IP/OP	"$1,272.50 "	$941.65	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.45	$944.45	$0.00	$0.00	$265.19	$0.00	$0.00	$0.00	$0.00	$636.25	"$1,007.82"	"$1,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.961	SUP	Custom 27803010		"124.961  -  PARALLEL CONNECTOR, 5.5MM TO 5.5MM, WIDE"	BOTH IP/OP	"$1,272.50 "	$941.65	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.45	$944.45	$0.00	$0.00	$265.19	$0.00	$0.00	$0.00	$0.00	$636.25	"$1,007.82"	"$1,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.962	SUP	Custom 27803010		"124.962  -  ROD TO ROD CLAMP, 5.5MM TO 5.5MM"	BOTH IP/OP	"$1,287.50 "	$952.75	$0.00	"$1,030.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.58	$955.58	$0.00	$0.00	$268.32	$0.00	$0.00	$0.00	$0.00	$643.75	"$1,019.70"	"$1,030.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.963	SUP	Custom 27803010		"124.963  -  ROD TO ROD CLAMP, 5.5MM TO 5.5MM, WIDE"	BOTH IP/OP	"$1,287.50 "	$952.75	$0.00	"$1,030.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.58	$955.58	$0.00	$0.00	$268.32	$0.00	$0.00	$0.00	$0.00	$643.75	"$1,019.70"	"$1,030.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.964	SUP	Custom 27803010		"124.964  -  PARALLEL CONNECTOR CLAMP, 5.5MM TO 5.5MM"	BOTH IP/OP	"$1,287.50 "	$952.75	$0.00	"$1,030.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.58	$955.58	$0.00	$0.00	$268.32	$0.00	$0.00	$0.00	$0.00	$643.75	"$1,019.70"	"$1,030.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.965	SUP	Custom 27803010		"124.965  -  PARALLEL CONNECTOR CLAMP, 5.5MM TO 5.5MM, WIDE"	BOTH IP/OP	"$1,287.50 "	$952.75	$0.00	"$1,030.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.58	$955.58	$0.00	$0.00	$268.32	$0.00	$0.00	$0.00	$0.00	$643.75	"$1,019.70"	"$1,030.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.97	SUP	Custom 27803010		"124.970  -  5.5MM OFFSET CONNECTOR, 15MM"	BOTH IP/OP	"$1,145.00 "	$847.30	$0.00	$916.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$849.82	$849.82	$0.00	$0.00	$238.62	$0.00	$0.00	$0.00	$0.00	$572.50	$906.84	$916.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.971	SUP	Custom 27803010		"124.971  -  5.5MM OFFSET CONNECTOR, 20MM"	BOTH IP/OP	"$1,145.00 "	$847.30	$0.00	$916.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$849.82	$849.82	$0.00	$0.00	$238.62	$0.00	$0.00	$0.00	$0.00	$572.50	$906.84	$916.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.972	SUP	Custom 27803010		"124.972  -  5.5MM OFFSET CONNECTOR, 25MM"	BOTH IP/OP	"$1,145.00 "	$847.30	$0.00	$916.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$849.82	$849.82	$0.00	$0.00	$238.62	$0.00	$0.00	$0.00	$0.00	$572.50	$906.84	$916.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.973	SUP	Custom 27803010		"124.973  -  5.5MM ROD CLAMP, 100MM"	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$0.00	$0.00	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.974	SUP	Custom 27803010		"124.974  -  5.5MM ROD CLAMP, 120MM"	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$0.00	$0.00	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.975	SUP	Custom 27803010		"124.975  -  5.5MM ROD CLAMP, 150MM"	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$0.00	$0.00	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.976	SUP	Custom 27803010		"124.976  -  5.5MM OFFSET CONNECTOR, 30MM"	BOTH IP/OP	"$1,287.50 "	$952.75	$0.00	"$1,030.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.58	$955.58	$0.00	$0.00	$268.32	$0.00	$0.00	$0.00	$0.00	$643.75	"$1,019.70"	"$1,030.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.977	SUP	Custom 27803010		"124.977  -  5.5MM OFFSET CONNECTOR, 35MM"	BOTH IP/OP	"$1,287.50 "	$952.75	$0.00	"$1,030.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.58	$955.58	$0.00	$0.00	$268.32	$0.00	$0.00	$0.00	$0.00	$643.75	"$1,019.70"	"$1,030.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.98	SUP	Custom 27803010		"124.980  -  IN-LINE CONNECTOR, 5.5MM TO 5.5MM"	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$0.00	$0.00	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.99	SUP	Custom 27803010		"124.990  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 15MM"	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$0.00	$0.00	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.991	SUP	Custom 27803010		"124.991  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 20MM"	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$0.00	$0.00	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.992	SUP	Custom 27803010		"124.992  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 25MM"	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$0.00	$0.00	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.993	SUP	Custom 27803010		"124.993  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 30MM"	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$0.00	$0.00	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.994	SUP	Custom 27803010		"124.994  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 35MM"	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$0.00	$0.00	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.995	SUP	Custom 27803010		"124.995  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 100MM"	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$0.00	$0.00	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.996	SUP	Custom 27803010		"124.996  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 120MM"	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$0.00	$0.00	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124.997	SUP	Custom 27803010		"124.997  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 150MM"	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$0.00	$0.00	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129.436	SUP	HCPCS C1713		"129.436  -  GATEWAY THORACOLUMBAR PLATE, 36MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.438	SUP	HCPCS C1713		"129.438  -  GATEWAY THORACOLUMBAR PLATE, 38MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.44	SUP	HCPCS C1713		"129.440  -  GATEWAY THORACOLUMBAR PLATE, 40MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.442	SUP	HCPCS C1713		"129.442  -  GATEWAY THORACOLUMBAR PLATE, 42MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.444	SUP	HCPCS C1713		"129.444  -  GATEWAY THORACOLUMBAR PLATE, 44MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.448	SUP	HCPCS C1713		"129.448  -  GATEWAY THORACOLUMBAR PLATE, 48MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.452	SUP	HCPCS C1713		"129.452  -  GATEWAY THORACOLUMBAR PLATE, 52MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.456	SUP	HCPCS C1713		"129.456  -  GATEWAY THORACOLUMBAR PLATE, 56MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.46	SUP	HCPCS C1713		"129.460  -  GATEWAY THORACOLUMBAR PLATE, 60MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.464	SUP	HCPCS C1713		"129.464  -  GATEWAY THORACOLUMBAR PLATE, 64MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.468	SUP	HCPCS C1713		"129.468  -  GATEWAY THORACOLUMBAR PLATE, 68MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.472	SUP	HCPCS C1713		"129.472  -  GATEWAY THORACOLUMBAR PLATE, 72MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.476	SUP	HCPCS C1713		"129.476  -  GATEWAY THORACOLUMBAR PLATE, 76MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.48	SUP	HCPCS C1713		"129.480  -  GATEWAY THORACOLUMBAR PLATE, 80MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.484	SUP	HCPCS C1713		"129.484  -  GATEWAY THORACOLUMBAR PLATE, 84MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.488	SUP	HCPCS C1713		"129.488  -  GATEWAY THORACOLUMBAR PLATE, 88MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.492	SUP	HCPCS C1713		"129.492  -  GATEWAY THORACOLUMBAR PLATE, 92MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.496	SUP	HCPCS C1713		"129.496  -  GATEWAY THORACOLUMBAR PLATE, 96MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.5	SUP	HCPCS C1713		"129.500  -  GATEWAY THORACOLUMBAR PLATE, 100MM"	BOTH IP/OP	"$14,030.00 "	"$10,382.20"	$0.00	"$11,224.00"	"$6,313.50"	"$6,313.50"	$0.00	$0.00	$0.00	"$2,924.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,923.85"	$0.00	"$6,916.79"	"$6,916.79"	$0.00	"$7,015.00"	"$11,111.76"	"$11,224.00"	$0.00		$0.00	"$2,195.70"	$0.00	$0.00	"$2,233.58"	$0.00	$0.00	$0.00	$0.00	$0.00
129.65	SUP	Custom 27203010		"129.650  -  SINGLE STAPLE, 5.0MM"	BOTH IP/OP	"$1,772.50 "	"$1,311.65"	$0.00	"$1,418.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,315.55"	"$1,315.55"	$0.00	$0.00	$369.39	$0.00	$0.00	$0.00	$0.00	$886.25	"$1,403.82"	"$1,418.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129.655	SUP	Custom 27203010		"129.655  -  SINGLE STAPLE, 5.5MM"	BOTH IP/OP	"$1,772.50 "	"$1,311.65"	$0.00	"$1,418.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,315.55"	"$1,315.55"	$0.00	$0.00	$369.39	$0.00	$0.00	$0.00	$0.00	$886.25	"$1,403.82"	"$1,418.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129.665	SUP	Custom 27203010		"129.665  -  SINGLE STAPLE, 6.5MM"	BOTH IP/OP	"$1,772.50 "	"$1,311.65"	$0.00	"$1,418.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,315.55"	"$1,315.55"	$0.00	$0.00	$369.39	$0.00	$0.00	$0.00	$0.00	$886.25	"$1,403.82"	"$1,418.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129.675	SUP	Custom 27203010		"129.675  -  SINGLE STAPLE, 7.5MM"	BOTH IP/OP	"$1,772.50 "	"$1,311.65"	$0.00	"$1,418.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,315.55"	"$1,315.55"	$0.00	$0.00	$369.39	$0.00	$0.00	$0.00	$0.00	$886.25	"$1,403.82"	"$1,418.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
129.685	SUP	Custom 27203010		"129.685  -  SINGLE STAPLE, 8.5MM"	BOTH IP/OP	"$1,772.50 "	"$1,311.65"	$0.00	"$1,418.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,315.55"	"$1,315.55"	$0.00	$0.00	$369.39	$0.00	$0.00	$0.00	$0.00	$886.25	"$1,403.82"	"$1,418.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
130.12	SUP	HCPCS C1713		"130.120  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 20MM"	BOTH IP/OP	"$11,635.00 "	"$8,609.90"	$0.00	"$9,308.00"	"$5,235.75"	"$5,235.75"	$0.00	$0.00	$0.00	"$2,425.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,424.73"	$0.00	"$5,736.06"	"$5,736.06"	$0.00	"$5,817.50"	"$9,214.92"	"$9,308.00"	$0.00		$0.00	"$1,820.88"	$0.00	$0.00	"$1,852.29"	$0.00	$0.00	$0.00	$0.00	$0.00
130.122	SUP	HCPCS C1713		"130.122  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 22MM"	BOTH IP/OP	"$11,635.00 "	"$8,609.90"	$0.00	"$9,308.00"	"$5,235.75"	"$5,235.75"	$0.00	$0.00	$0.00	"$2,425.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,424.73"	$0.00	"$5,736.06"	"$5,736.06"	$0.00	"$5,817.50"	"$9,214.92"	"$9,308.00"	$0.00		$0.00	"$1,820.88"	$0.00	$0.00	"$1,852.29"	$0.00	$0.00	$0.00	$0.00	$0.00
130.124	SUP	HCPCS C1713		"130.124  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 24MM"	BOTH IP/OP	"$11,635.00 "	"$8,609.90"	$0.00	"$9,308.00"	"$5,235.75"	"$5,235.75"	$0.00	$0.00	$0.00	"$2,425.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,424.73"	$0.00	"$5,736.06"	"$5,736.06"	$0.00	"$5,817.50"	"$9,214.92"	"$9,308.00"	$0.00		$0.00	"$1,820.88"	$0.00	$0.00	"$1,852.29"	$0.00	$0.00	$0.00	$0.00	$0.00
130.126	SUP	HCPCS C1713		"130.126  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 26MM"	BOTH IP/OP	"$11,635.00 "	"$8,609.90"	$0.00	"$9,308.00"	"$5,235.75"	"$5,235.75"	$0.00	$0.00	$0.00	"$2,425.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,424.73"	$0.00	"$5,736.06"	"$5,736.06"	$0.00	"$5,817.50"	"$9,214.92"	"$9,308.00"	$0.00		$0.00	"$1,820.88"	$0.00	$0.00	"$1,852.29"	$0.00	$0.00	$0.00	$0.00	$0.00
130.128	SUP	HCPCS C1713		"130.128  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 28MM"	BOTH IP/OP	"$11,635.00 "	"$8,609.90"	$0.00	"$9,308.00"	"$5,235.75"	"$5,235.75"	$0.00	$0.00	$0.00	"$2,425.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,424.73"	$0.00	"$5,736.06"	"$5,736.06"	$0.00	"$5,817.50"	"$9,214.92"	"$9,308.00"	$0.00		$0.00	"$1,820.88"	$0.00	$0.00	"$1,852.29"	$0.00	$0.00	$0.00	$0.00	$0.00
130.13	SUP	HCPCS C1713		"130.130  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 30MM"	BOTH IP/OP	"$11,635.00 "	"$8,609.90"	$0.00	"$9,308.00"	"$5,235.75"	"$5,235.75"	$0.00	$0.00	$0.00	"$2,425.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,424.73"	$0.00	"$5,736.06"	"$5,736.06"	$0.00	"$5,817.50"	"$9,214.92"	"$9,308.00"	$0.00		$0.00	"$1,820.88"	$0.00	$0.00	"$1,852.29"	$0.00	$0.00	$0.00	$0.00	$0.00
130.132	SUP	HCPCS C1713		"130.132  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 32MM"	BOTH IP/OP	"$11,635.00 "	"$8,609.90"	$0.00	"$9,308.00"	"$5,235.75"	"$5,235.75"	$0.00	$0.00	$0.00	"$2,425.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,424.73"	$0.00	"$5,736.06"	"$5,736.06"	$0.00	"$5,817.50"	"$9,214.92"	"$9,308.00"	$0.00		$0.00	"$1,820.88"	$0.00	$0.00	"$1,852.29"	$0.00	$0.00	$0.00	$0.00	$0.00
130.134	SUP	HCPCS C1713		"130.134  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 34MM"	BOTH IP/OP	"$11,635.00 "	"$8,609.90"	$0.00	"$9,308.00"	"$5,235.75"	"$5,235.75"	$0.00	$0.00	$0.00	"$2,425.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,424.73"	$0.00	"$5,736.06"	"$5,736.06"	$0.00	"$5,817.50"	"$9,214.92"	"$9,308.00"	$0.00		$0.00	"$1,820.88"	$0.00	$0.00	"$1,852.29"	$0.00	$0.00	$0.00	$0.00	$0.00
130.136	SUP	HCPCS C1713		"130.136  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 36MM"	BOTH IP/OP	"$11,635.00 "	"$8,609.90"	$0.00	"$9,308.00"	"$5,235.75"	"$5,235.75"	$0.00	$0.00	$0.00	"$2,425.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,424.73"	$0.00	"$5,736.06"	"$5,736.06"	$0.00	"$5,817.50"	"$9,214.92"	"$9,308.00"	$0.00		$0.00	"$1,820.88"	$0.00	$0.00	"$1,852.29"	$0.00	$0.00	$0.00	$0.00	$0.00
130.138	SUP	HCPCS C1713		"130.138  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 38MM"	BOTH IP/OP	"$11,635.00 "	"$8,609.90"	$0.00	"$9,308.00"	"$5,235.75"	"$5,235.75"	$0.00	$0.00	$0.00	"$2,425.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,424.73"	$0.00	"$5,736.06"	"$5,736.06"	$0.00	"$5,817.50"	"$9,214.92"	"$9,308.00"	$0.00		$0.00	"$1,820.88"	$0.00	$0.00	"$1,852.29"	$0.00	$0.00	$0.00	$0.00	$0.00
130.142	SUP	HCPCS C1713		"130.142  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 42MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.148	SUP	HCPCS C1713		"130.148  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 48MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.154	SUP	HCPCS C1713		"130.154  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 54MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.16	SUP	HCPCS C1713		"130.160  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 60MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.163	SUP	HCPCS C1713		"130.163  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 63MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.166	SUP	HCPCS C1713		"130.166  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 66MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.169	SUP	HCPCS C1713		"130.169  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 69MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.172	SUP	HCPCS C1713		"130.172  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 72MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.175	SUP	HCPCS C1713		"130.175  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 75MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.178	SUP	HCPCS C1713		"130.178  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 78MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.181	SUP	HCPCS C1713		"130.181  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 81MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.184	SUP	HCPCS C1713		"130.184  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 84MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.187	SUP	HCPCS C1713		"130.187  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 87MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.19	SUP	HCPCS C1713		"130.190  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 90MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.193	SUP	HCPCS C1713		"130.193  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 93MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.196	SUP	HCPCS C1713		"130.196  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 96MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.199	SUP	HCPCS C1713		"130.199  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 99MM"	BOTH IP/OP	"$12,925.00 "	"$9,564.50"	$0.00	"$10,340.00"	"$5,816.25"	"$5,816.25"	$0.00	$0.00	$0.00	"$2,693.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,693.57"	$0.00	"$6,372.03"	"$6,372.03"	$0.00	"$6,462.50"	"$10,236.60"	"$10,340.00"	$0.00		$0.00	"$2,022.76"	$0.00	$0.00	"$2,057.66"	$0.00	$0.00	$0.00	$0.00	$0.00
130.22	SUP	HCPCS C1713		"130.220  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 20MM"	BOTH IP/OP	"$12,277.50 "	"$9,085.35"	$0.00	"$9,822.00"	"$5,524.88"	"$5,524.88"	$0.00	$0.00	$0.00	"$2,558.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,558.63"	$0.00	"$6,052.81"	"$6,052.81"	$0.00	"$6,138.75"	"$9,723.78"	"$9,822.00"	$0.00		$0.00	"$1,921.43"	$0.00	$0.00	"$1,954.58"	$0.00	$0.00	$0.00	$0.00	$0.00
130.222	SUP	HCPCS C1713		"130.222  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 22MM"	BOTH IP/OP	"$12,277.50 "	"$9,085.35"	$0.00	"$9,822.00"	"$5,524.88"	"$5,524.88"	$0.00	$0.00	$0.00	"$2,558.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,558.63"	$0.00	"$6,052.81"	"$6,052.81"	$0.00	"$6,138.75"	"$9,723.78"	"$9,822.00"	$0.00		$0.00	"$1,921.43"	$0.00	$0.00	"$1,954.58"	$0.00	$0.00	$0.00	$0.00	$0.00
130.224	SUP	HCPCS C1713		"130.224  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 24MM"	BOTH IP/OP	"$12,277.50 "	"$9,085.35"	$0.00	"$9,822.00"	"$5,524.88"	"$5,524.88"	$0.00	$0.00	$0.00	"$2,558.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,558.63"	$0.00	"$6,052.81"	"$6,052.81"	$0.00	"$6,138.75"	"$9,723.78"	"$9,822.00"	$0.00		$0.00	"$1,921.43"	$0.00	$0.00	"$1,954.58"	$0.00	$0.00	$0.00	$0.00	$0.00
130.226	SUP	HCPCS C1713		"130.226  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 26MM"	BOTH IP/OP	"$12,277.50 "	"$9,085.35"	$0.00	"$9,822.00"	"$5,524.88"	"$5,524.88"	$0.00	$0.00	$0.00	"$2,558.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,558.63"	$0.00	"$6,052.81"	"$6,052.81"	$0.00	"$6,138.75"	"$9,723.78"	"$9,822.00"	$0.00		$0.00	"$1,921.43"	$0.00	$0.00	"$1,954.58"	$0.00	$0.00	$0.00	$0.00	$0.00
130.228	SUP	HCPCS C1713		"130.228  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 28MM"	BOTH IP/OP	"$12,277.50 "	"$9,085.35"	$0.00	"$9,822.00"	"$5,524.88"	"$5,524.88"	$0.00	$0.00	$0.00	"$2,558.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,558.63"	$0.00	"$6,052.81"	"$6,052.81"	$0.00	"$6,138.75"	"$9,723.78"	"$9,822.00"	$0.00		$0.00	"$1,921.43"	$0.00	$0.00	"$1,954.58"	$0.00	$0.00	$0.00	$0.00	$0.00
130.23	SUP	HCPCS C1713		130.230  -  PLATE BN 30MM NS CITADEL LVL 1 SPNE LS ANT	BOTH IP/OP	"$12,277.50 "	"$9,085.35"	$0.00	"$9,822.00"	"$5,524.88"	"$5,524.88"	$0.00	$0.00	$0.00	"$2,558.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,558.63"	$0.00	"$6,052.81"	"$6,052.81"	$0.00	"$6,138.75"	"$9,723.78"	"$9,822.00"	$0.00		$0.00	"$1,921.43"	$0.00	$0.00	"$1,954.58"	$0.00	$0.00	$0.00	$0.00	$0.00
130.232	SUP	HCPCS C1713		130.232  -  PLATE BN 32MM NS CITADEL LVL 1 SPNE LS ANT	BOTH IP/OP	"$12,277.50 "	"$9,085.35"	$0.00	"$9,822.00"	"$5,524.88"	"$5,524.88"	$0.00	$0.00	$0.00	"$2,558.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,558.63"	$0.00	"$6,052.81"	"$6,052.81"	$0.00	"$6,138.75"	"$9,723.78"	"$9,822.00"	$0.00		$0.00	"$1,921.43"	$0.00	$0.00	"$1,954.58"	$0.00	$0.00	$0.00	$0.00	$0.00
130.234	SUP	HCPCS C1713		130.234  -  PLATE BN 34MM NS CITADEL LVL 1 SPNE LS ANT	BOTH IP/OP	"$12,277.50 "	"$9,085.35"	$0.00	"$9,822.00"	"$5,524.88"	"$5,524.88"	$0.00	$0.00	$0.00	"$2,558.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,558.63"	$0.00	"$6,052.81"	"$6,052.81"	$0.00	"$6,138.75"	"$9,723.78"	"$9,822.00"	$0.00		$0.00	"$1,921.43"	$0.00	$0.00	"$1,954.58"	$0.00	$0.00	$0.00	$0.00	$0.00
130.236	SUP	HCPCS C1713		"130.236  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 36MM"	BOTH IP/OP	"$12,277.50 "	"$9,085.35"	$0.00	"$9,822.00"	"$5,524.88"	"$5,524.88"	$0.00	$0.00	$0.00	"$2,558.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,558.63"	$0.00	"$6,052.81"	"$6,052.81"	$0.00	"$6,138.75"	"$9,723.78"	"$9,822.00"	$0.00		$0.00	"$1,921.43"	$0.00	$0.00	"$1,954.58"	$0.00	$0.00	$0.00	$0.00	$0.00
130.238	SUP	HCPCS C1713		130.238  -  PLATE BN 38MM NS CITADEL LVL 1 SPNE LS ANT	BOTH IP/OP	"$12,277.50 "	"$9,085.35"	$0.00	"$9,822.00"	"$5,524.88"	"$5,524.88"	$0.00	$0.00	$0.00	"$2,558.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,558.63"	$0.00	"$6,052.81"	"$6,052.81"	$0.00	"$6,138.75"	"$9,723.78"	"$9,822.00"	$0.00		$0.00	"$1,921.43"	$0.00	$0.00	"$1,954.58"	$0.00	$0.00	$0.00	$0.00	$0.00
130.263	SUP	HCPCS C1713		"130.263  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 63MM"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.266	SUP	HCPCS C1713		"130.266  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 66MM"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.269	SUP	HCPCS C1713		"130.269  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 69MM"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.272	SUP	HCPCS C1713		"130.272  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 72MM"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.275	SUP	HCPCS C1713		"130.275  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 75MM"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.278	SUP	HCPCS C1713		"130.278  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 78MM"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.281	SUP	HCPCS C1713		"130.281  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 81MM"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.284	SUP	HCPCS C1713		"130.284  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 84MM"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.287	SUP	HCPCS C1713		"130.287  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 87MM"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.29	SUP	HCPCS C1713		"130.290  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 90MM"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.501	SUP	HCPCS C1713		"130.501  -  CLAMPING SET SCREW, 2.25MM"	BOTH IP/OP	$7.50 	$5.55	$0.00	$6.00	$3.38	$3.38	$0.00	$0.00	$0.00	$1.56	$5.57	$5.57	$0.00	$0.00	$1.56	$0.00	$4.44	$4.44	$0.00	$3.75	$5.94	$6.00	$0.00		$0.00	$1.17	$0.00	$0.00	$1.19	$0.00	$0.00	$0.00	$0.00	$0.00
130.542	SUP	HCPCS C1713		"130.542  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 42"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.548	SUP	HCPCS C1713		"130.548  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 48"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.554	SUP	HCPCS C1713		"130.554  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 54"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.56	SUP	HCPCS C1713		"130.560  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 60"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.566	SUP	HCPCS C1713		"130.566  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 66"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.572	SUP	HCPCS C1713		"130.572  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 72"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.578	SUP	HCPCS C1713		"130.578  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 78"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.584	SUP	HCPCS C1713		"130.584  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 84"	BOTH IP/OP	"$13,572.50 "	"$10,043.65"	$0.00	"$10,858.00"	"$6,107.63"	"$6,107.63"	$0.00	$0.00	$0.00	"$2,828.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,828.51"	$0.00	"$6,691.24"	"$6,691.24"	$0.00	"$6,786.25"	"$10,749.42"	"$10,858.00"	$0.00		$0.00	"$2,124.10"	$0.00	$0.00	"$2,160.74"	$0.00	$0.00	$0.00	$0.00	$0.00
130.622	SUP	HCPCS C1713		"130.622  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 22MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.624	SUP	HCPCS C1713		"130.624  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 24MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.626	SUP	HCPCS C1713		"130.626  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 26MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.628	SUP	HCPCS C1713		"130.628  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 28MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.63	SUP	HCPCS C1713		"130.630  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 30MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.633	SUP	HCPCS C1713		"130.633  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 33MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.636	SUP	HCPCS C1713		"130.636  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 36MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.639	SUP	HCPCS C1713		"130.639  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 39MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.642	SUP	HCPCS C1713		"130.642  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 42MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.645	SUP	HCPCS C1713		"130.645  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 45MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.648	SUP	HCPCS C1713		"130.648  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 48MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.651	SUP	HCPCS C1713		"130.651  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 51MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.654	SUP	HCPCS C1713		"130.654  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 54MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.657	SUP	HCPCS C1713		"130.657  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 57MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.822	SUP	HCPCS C1713		"130.822  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 22MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.824	SUP	HCPCS C1713		"130.824  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 24MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.826	SUP	HCPCS C1713		"130.826  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 26MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.828	SUP	HCPCS C1713		"130.828  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 28MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.83	SUP	HCPCS C1713		"130.830  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 30MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.833	SUP	HCPCS C1713		"130.833  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 33MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.836	SUP	HCPCS C1713		"130.836  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 36MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.839	SUP	HCPCS C1713		"130.839  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 39MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.842	SUP	HCPCS C1713		"130.842  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 42MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.845	SUP	HCPCS C1713		"130.845  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 45MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.848	SUP	HCPCS C1713		"130.848  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 48MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.851	SUP	HCPCS C1713		"130.851  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 51MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.854	SUP	HCPCS C1713		"130.854  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 54MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
130.857	SUP	HCPCS C1713		"130.857  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 57MM"	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$873.00	$873.00	$0.00	$0.00	$0.00	$404.34	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	"$1,147.51"	"$1,147.51"	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$303.61	$0.00	$0.00	$308.85	$0.00	$0.00	$0.00	$0.00	$0.00
131.001	SUP	Custom 27203010		"131.001  -  DUAL STAPLE, SMALL, ROSTRAL"	BOTH IP/OP	"$2,712.50 "	"$2,007.25"	$0.00	"$2,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,013.22"	"$2,013.22"	$0.00	$0.00	$565.29	$0.00	$0.00	$0.00	$0.00	"$1,356.25"	"$2,148.30"	"$2,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.002	SUP	Custom 27203010		"131.002  -  DUAL STAPLE, SMALL, CAUDAL"	BOTH IP/OP	"$2,712.50 "	"$2,007.25"	$0.00	"$2,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,013.22"	"$2,013.22"	$0.00	$0.00	$565.29	$0.00	$0.00	$0.00	$0.00	"$1,356.25"	"$2,148.30"	"$2,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.003	SUP	Custom 27203010		"131.003  -  DUAL STAPLE, MEDIUM, ROSTRAL"	BOTH IP/OP	"$2,712.50 "	"$2,007.25"	$0.00	"$2,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,013.22"	"$2,013.22"	$0.00	$0.00	$565.29	$0.00	$0.00	$0.00	$0.00	"$1,356.25"	"$2,148.30"	"$2,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.004	SUP	Custom 27203010		"131.004  -  DUAL STAPLE, MEDIUM, CAUDAL"	BOTH IP/OP	"$2,712.50 "	"$2,007.25"	$0.00	"$2,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,013.22"	"$2,013.22"	$0.00	$0.00	$565.29	$0.00	$0.00	$0.00	$0.00	"$1,356.25"	"$2,148.30"	"$2,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.005	SUP	Custom 27203010		"131.005  -  DUAL STAPLE, LARGE, ROSTRAL"	BOTH IP/OP	"$2,712.50 "	"$2,007.25"	$0.00	"$2,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,013.22"	"$2,013.22"	$0.00	$0.00	$565.29	$0.00	$0.00	$0.00	$0.00	"$1,356.25"	"$2,148.30"	"$2,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.006	SUP	Custom 27203010		"131.006  -  DUAL STAPLE, LARGE, CAUDAL"	BOTH IP/OP	"$2,712.50 "	"$2,007.25"	$0.00	"$2,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,013.22"	"$2,013.22"	$0.00	$0.00	$565.29	$0.00	$0.00	$0.00	$0.00	"$1,356.25"	"$2,148.30"	"$2,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.007	SUP	Custom 27203010		"131.007  -  DUAL STAPLE, X-LARGE, ROSTRAL"	BOTH IP/OP	"$2,712.50 "	"$2,007.25"	$0.00	"$2,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,013.22"	"$2,013.22"	$0.00	$0.00	$565.29	$0.00	$0.00	$0.00	$0.00	"$1,356.25"	"$2,148.30"	"$2,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.008	SUP	Custom 27203010		"131.008  -  DUAL STAPLE, X-LARGE, CAUDAL"	BOTH IP/OP	"$2,712.50 "	"$2,007.25"	$0.00	"$2,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,013.22"	"$2,013.22"	$0.00	$0.00	$565.29	$0.00	$0.00	$0.00	$0.00	"$1,356.25"	"$2,148.30"	"$2,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.011	SUP	Custom 27203010		"131.011  -  SINGLE STAPLE, SMALL"	BOTH IP/OP	"$1,945.00 "	"$1,439.30"	$0.00	"$1,556.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,443.58"	"$1,443.58"	$0.00	$0.00	$405.34	$0.00	$0.00	$0.00	$0.00	$972.50	"$1,540.44"	"$1,556.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.012	SUP	Custom 27203010		"131.012  -  SINGLE STAPLE, MEDIUM"	BOTH IP/OP	"$1,945.00 "	"$1,439.30"	$0.00	"$1,556.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,443.58"	"$1,443.58"	$0.00	$0.00	$405.34	$0.00	$0.00	$0.00	$0.00	$972.50	"$1,540.44"	"$1,556.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.013	SUP	Custom 27203010		131.013  -  STAPLE BONE LG SGL	BOTH IP/OP	"$1,945.00 "	"$1,439.30"	$0.00	"$1,556.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,443.58"	"$1,443.58"	$0.00	$0.00	$405.34	$0.00	$0.00	$0.00	$0.00	$972.50	"$1,540.44"	"$1,556.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.113	SUP	Custom 27803010		"131.113  -  CROSS CONNECTOR, 13MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.114	SUP	Custom 27803010		"131.114  -  CROSS CONNECTOR, 14MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.115	SUP	Custom 27803010		"131.115  -  CROSS CONNECTOR, 15MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.116	SUP	Custom 27803010		"131.116  -  CROSS CONNECTOR, 16MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.117	SUP	Custom 27803010		"131.117  -  CROSS CONNECTOR, 17MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.118	SUP	Custom 27803010		"131.118  -  CROSS CONNECTOR, 18MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.119	SUP	Custom 27803010		"131.119  -  CROSS CONNECTOR, 19MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.12	SUP	Custom 27803010		"131.120  -  CROSS CONNECTOR, 20MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.121	SUP	Custom 27803010		"131.121  -  CROSS CONNECTOR, 21MM"	BOTH IP/OP	"$2,545.00 "	"$1,883.30"	$0.00	"$2,036.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.90"	"$1,888.90"	$0.00	$0.00	$530.38	$0.00	$0.00	$0.00	$0.00	"$1,272.50"	"$2,015.64"	"$2,036.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.122	SUP	Custom 27803010		"131.122  -  CROSS CONNECTOR, 22MM"	BOTH IP/OP	"$2,545.00 "	"$1,883.30"	$0.00	"$2,036.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.90"	"$1,888.90"	$0.00	$0.00	$530.38	$0.00	$0.00	$0.00	$0.00	"$1,272.50"	"$2,015.64"	"$2,036.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.123	SUP	Custom 27803010		"131.123  -  CROSS CONNECTOR, 23MM"	BOTH IP/OP	"$2,545.00 "	"$1,883.30"	$0.00	"$2,036.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.90"	"$1,888.90"	$0.00	$0.00	$530.38	$0.00	$0.00	$0.00	$0.00	"$1,272.50"	"$2,015.64"	"$2,036.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.124	SUP	Custom 27803010		"131.124  -  CROSS CONNECTOR, 24MM"	BOTH IP/OP	"$2,545.00 "	"$1,883.30"	$0.00	"$2,036.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.90"	"$1,888.90"	$0.00	$0.00	$530.38	$0.00	$0.00	$0.00	$0.00	"$1,272.50"	"$2,015.64"	"$2,036.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.125	SUP	Custom 27803010		"131.125  -  CROSS CONNECTOR, 25MM"	BOTH IP/OP	"$2,545.00 "	"$1,883.30"	$0.00	"$2,036.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.90"	"$1,888.90"	$0.00	$0.00	$530.38	$0.00	$0.00	$0.00	$0.00	"$1,272.50"	"$2,015.64"	"$2,036.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.126	SUP	Custom 27803010		"131.126  -  CROSS CONNECTOR, 26MM"	BOTH IP/OP	"$2,545.00 "	"$1,883.30"	$0.00	"$2,036.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.90"	"$1,888.90"	$0.00	$0.00	$530.38	$0.00	$0.00	$0.00	$0.00	"$1,272.50"	"$2,015.64"	"$2,036.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.127	SUP	Custom 27803010		"131.127  -  CROSS CONNECTOR, 27MM"	BOTH IP/OP	"$2,545.00 "	"$1,883.30"	$0.00	"$2,036.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.90"	"$1,888.90"	$0.00	$0.00	$530.38	$0.00	$0.00	$0.00	$0.00	"$1,272.50"	"$2,015.64"	"$2,036.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.128	SUP	Custom 27803010		"131.128  -  CROSS CONNECTOR, 28MM"	BOTH IP/OP	"$2,545.00 "	"$1,883.30"	$0.00	"$2,036.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.90"	"$1,888.90"	$0.00	$0.00	$530.38	$0.00	$0.00	$0.00	$0.00	"$1,272.50"	"$2,015.64"	"$2,036.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131.201	SUP	HCPCS C1713		"131.201  -  STAPLE WASHER, SMALL"	BOTH IP/OP	$722.50 	$534.65	$0.00	$578.00	$325.13	$325.13	$0.00	$0.00	$0.00	$150.59	$536.24	$536.24	$0.00	$0.00	$150.57	$0.00	$427.36	$427.36	$0.00	$361.25	$572.22	$578.00	$0.00		$0.00	$113.07	$0.00	$0.00	$115.02	$0.00	$0.00	$0.00	$0.00	$0.00
131.202	SUP	HCPCS C1713		"131.202  -  STAPLE WASHER, MEDIUM"	BOTH IP/OP	$797.50 	$590.15	$0.00	$638.00	$358.88	$358.88	$0.00	$0.00	$0.00	$166.22	$591.90	$591.90	$0.00	$0.00	$166.20	$0.00	$471.72	$471.72	$0.00	$398.75	$631.62	$638.00	$0.00		$0.00	$124.81	$0.00	$0.00	$126.96	$0.00	$0.00	$0.00	$0.00	$0.00
131.203	SUP	HCPCS C1713		"131.203  -  STAPLE WASHER, LARGE"	BOTH IP/OP	$840.00 	$621.60	$0.00	$672.00	$378.00	$378.00	$0.00	$0.00	$0.00	$175.08	$623.45	$623.45	$0.00	$0.00	$175.06	$0.00	$496.86	$496.86	$0.00	$420.00	$665.28	$672.00	$0.00		$0.00	$131.46	$0.00	$0.00	$133.73	$0.00	$0.00	$0.00	$0.00	$0.00
131.351	SUP	HCPCS C1713		"131.351  -  5.5MM BONE SCREW, ANTERIOR PLATE, 25MM"	BOTH IP/OP	"$1,910.00 "	"$1,413.40"	$0.00	"$1,528.00"	$859.50	$859.50	$0.00	$0.00	$0.00	$398.09	"$1,417.60"	"$1,417.60"	$0.00	$0.00	$398.04	$0.00	"$1,129.77"	"$1,129.77"	$0.00	$955.00	"$1,512.72"	"$1,528.00"	$0.00		$0.00	$298.92	$0.00	$0.00	$304.07	$0.00	$0.00	$0.00	$0.00	$0.00
131.352	SUP	HCPCS C1713		"131.352  -  5.5MM BONE SCREW, ANTERIOR PLATE, 30MM"	BOTH IP/OP	"$1,910.00 "	"$1,413.40"	$0.00	"$1,528.00"	$859.50	$859.50	$0.00	$0.00	$0.00	$398.09	"$1,417.60"	"$1,417.60"	$0.00	$0.00	$398.04	$0.00	"$1,129.77"	"$1,129.77"	$0.00	$955.00	"$1,512.72"	"$1,528.00"	$0.00		$0.00	$298.92	$0.00	$0.00	$304.07	$0.00	$0.00	$0.00	$0.00	$0.00
131.353	SUP	HCPCS C1713		"131.353  -  5.5MM BONE SCREW, ANTERIOR PLATE, 35MM"	BOTH IP/OP	"$1,910.00 "	"$1,413.40"	$0.00	"$1,528.00"	$859.50	$859.50	$0.00	$0.00	$0.00	$398.09	"$1,417.60"	"$1,417.60"	$0.00	$0.00	$398.04	$0.00	"$1,129.77"	"$1,129.77"	$0.00	$955.00	"$1,512.72"	"$1,528.00"	$0.00		$0.00	$298.92	$0.00	$0.00	$304.07	$0.00	$0.00	$0.00	$0.00	$0.00
131.354	SUP	HCPCS C1713		"131.354  -  5.5MM BONE SCREW, ANTERIOR PLATE, 40MM"	BOTH IP/OP	"$1,910.00 "	"$1,413.40"	$0.00	"$1,528.00"	$859.50	$859.50	$0.00	$0.00	$0.00	$398.09	"$1,417.60"	"$1,417.60"	$0.00	$0.00	$398.04	$0.00	"$1,129.77"	"$1,129.77"	$0.00	$955.00	"$1,512.72"	"$1,528.00"	$0.00		$0.00	$298.92	$0.00	$0.00	$304.07	$0.00	$0.00	$0.00	$0.00	$0.00
131.355	SUP	HCPCS C1713		"131.355  -  5.5MM BONE SCREW, ANTERIOR PLATE, 45MM"	BOTH IP/OP	"$1,910.00 "	"$1,413.40"	$0.00	"$1,528.00"	$859.50	$859.50	$0.00	$0.00	$0.00	$398.09	"$1,417.60"	"$1,417.60"	$0.00	$0.00	$398.04	$0.00	"$1,129.77"	"$1,129.77"	$0.00	$955.00	"$1,512.72"	"$1,528.00"	$0.00		$0.00	$298.92	$0.00	$0.00	$304.07	$0.00	$0.00	$0.00	$0.00	$0.00
131.356	SUP	HCPCS C1713		"131.356  -  5.5MM BONE SCREW, ANTERIOR PLATE, 50MM"	BOTH IP/OP	"$1,910.00 "	"$1,413.40"	$0.00	"$1,528.00"	$859.50	$859.50	$0.00	$0.00	$0.00	$398.09	"$1,417.60"	"$1,417.60"	$0.00	$0.00	$398.04	$0.00	"$1,129.77"	"$1,129.77"	$0.00	$955.00	"$1,512.72"	"$1,528.00"	$0.00		$0.00	$298.92	$0.00	$0.00	$304.07	$0.00	$0.00	$0.00	$0.00	$0.00
131.361	SUP	HCPCS C1713		"131.361  -  6.5MM BONE SCREW, ANTERIOR PLATE, 25MM"	BOTH IP/OP	"$1,910.00 "	"$1,413.40"	$0.00	"$1,528.00"	$859.50	$859.50	$0.00	$0.00	$0.00	$398.09	"$1,417.60"	"$1,417.60"	$0.00	$0.00	$398.04	$0.00	"$1,129.77"	"$1,129.77"	$0.00	$955.00	"$1,512.72"	"$1,528.00"	$0.00		$0.00	$298.92	$0.00	$0.00	$304.07	$0.00	$0.00	$0.00	$0.00	$0.00
131.362	SUP	HCPCS C1713		"131.362  -  6.5MM BONE SCREW, ANTERIOR PLATE, 30MM"	BOTH IP/OP	"$1,910.00 "	"$1,413.40"	$0.00	"$1,528.00"	$859.50	$859.50	$0.00	$0.00	$0.00	$398.09	"$1,417.60"	"$1,417.60"	$0.00	$0.00	$398.04	$0.00	"$1,129.77"	"$1,129.77"	$0.00	$955.00	"$1,512.72"	"$1,528.00"	$0.00		$0.00	$298.92	$0.00	$0.00	$304.07	$0.00	$0.00	$0.00	$0.00	$0.00
131.363	SUP	HCPCS C1713		"131.363  -  6.5MM BONE SCREW, ANTERIOR PLATE, 35MM"	BOTH IP/OP	"$1,910.00 "	"$1,413.40"	$0.00	"$1,528.00"	$859.50	$859.50	$0.00	$0.00	$0.00	$398.09	"$1,417.60"	"$1,417.60"	$0.00	$0.00	$398.04	$0.00	"$1,129.77"	"$1,129.77"	$0.00	$955.00	"$1,512.72"	"$1,528.00"	$0.00		$0.00	$298.92	$0.00	$0.00	$304.07	$0.00	$0.00	$0.00	$0.00	$0.00
131.364	SUP	HCPCS C1713		"131.364  -  6.5MM BONE SCREW, ANTERIOR PLATE, 40MM"	BOTH IP/OP	"$1,910.00 "	"$1,413.40"	$0.00	"$1,528.00"	$859.50	$859.50	$0.00	$0.00	$0.00	$398.09	"$1,417.60"	"$1,417.60"	$0.00	$0.00	$398.04	$0.00	"$1,129.77"	"$1,129.77"	$0.00	$955.00	"$1,512.72"	"$1,528.00"	$0.00		$0.00	$298.92	$0.00	$0.00	$304.07	$0.00	$0.00	$0.00	$0.00	$0.00
131.365	SUP	HCPCS C1713		"131.365  -  6.5MM BONE SCREW, ANTERIOR PLATE, 45MM"	BOTH IP/OP	"$1,910.00 "	"$1,413.40"	$0.00	"$1,528.00"	$859.50	$859.50	$0.00	$0.00	$0.00	$398.09	"$1,417.60"	"$1,417.60"	$0.00	$0.00	$398.04	$0.00	"$1,129.77"	"$1,129.77"	$0.00	$955.00	"$1,512.72"	"$1,528.00"	$0.00		$0.00	$298.92	$0.00	$0.00	$304.07	$0.00	$0.00	$0.00	$0.00	$0.00
131.366	SUP	HCPCS C1713		"131.366  -  6.5MM BONE SCREW, ANTERIOR PLATE, 50MM"	BOTH IP/OP	"$1,910.00 "	"$1,413.40"	$0.00	"$1,528.00"	$859.50	$859.50	$0.00	$0.00	$0.00	$398.09	"$1,417.60"	"$1,417.60"	$0.00	$0.00	$398.04	$0.00	"$1,129.77"	"$1,129.77"	$0.00	$955.00	"$1,512.72"	"$1,528.00"	$0.00		$0.00	$298.92	$0.00	$0.00	$304.07	$0.00	$0.00	$0.00	$0.00	$0.00
132.14	SUP	Custom 27803010		"132.140  -  5.5MM CURVED ROD, CONE TIP, 40MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132.145	SUP	Custom 27803010		"132.145  -  5.5MM CURVED ROD, CONE TIP, 45MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132.15	SUP	Custom 27803010		"132.150  -  5.5MM CURVED ROD, CONE TIP, 50MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132.155	SUP	Custom 27803010		"132.155  -  5.5MM CURVED ROD, CONE TIP, 55MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132.16	SUP	Custom 27803010		"132.160  -  5.5MM CURVED ROD, CONE TIP, 60MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132.165	SUP	Custom 27803010		"132.165  -  5.5MM CURVED ROD, CONE TIP, 65MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132.17	SUP	Custom 27803010		"132.170  -  5.5MM CURVED ROD, CONE TIP, 70MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132.175	SUP	Custom 27803010		"132.175  -  5.5MM CURVED ROD, CONE TIP, 75MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132.18	SUP	Custom 27803010		"132.180  -  5.5MM CURVED ROD, CONE TIP, 80MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132.185	SUP	Custom 27803010		"132.185  -  5.5MM CURVED ROD, CONE TIP, 85MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
136.404	SUP	HCPCS C1713		"136.404  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 4MM"	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
136.406	SUP	HCPCS C1713		"136.406  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 6MM"	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
136.408	SUP	HCPCS C1713		"136.408  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 8MM"	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
136.41	SUP	HCPCS C1713		"136.410  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 10MM"	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
136.412	SUP	HCPCS C1713		"136.412  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
136.504	SUP	HCPCS C1713		"136.504  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 4MM"	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
136.506	SUP	HCPCS C1713		"136.506  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 6MM"	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
136.508	SUP	HCPCS C1713		"136.508  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 8MM"	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
136.51	SUP	HCPCS C1713		"136.510  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 10MM"	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
136.512	SUP	HCPCS C1713		"136.512  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 12MM"	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
136.704	SUP	HCPCS C1713		"136.704  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 4MM"	BOTH IP/OP	$527.50 	$390.35	$0.00	$422.00	$237.38	$237.38	$0.00	$0.00	$0.00	$109.94	$391.51	$391.51	$0.00	$0.00	$109.93	$0.00	$312.02	$312.02	$0.00	$263.75	$417.78	$422.00	$0.00		$0.00	$82.55	$0.00	$0.00	$83.98	$0.00	$0.00	$0.00	$0.00	$0.00
136.706	SUP	HCPCS C1713		"136.706  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 6MM"	BOTH IP/OP	$527.50 	$390.35	$0.00	$422.00	$237.38	$237.38	$0.00	$0.00	$0.00	$109.94	$391.51	$391.51	$0.00	$0.00	$109.93	$0.00	$312.02	$312.02	$0.00	$263.75	$417.78	$422.00	$0.00		$0.00	$82.55	$0.00	$0.00	$83.98	$0.00	$0.00	$0.00	$0.00	$0.00
136.708	SUP	HCPCS C1713		"136.708  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 8MM"	BOTH IP/OP	$527.50 	$390.35	$0.00	$422.00	$237.38	$237.38	$0.00	$0.00	$0.00	$109.94	$391.51	$391.51	$0.00	$0.00	$109.93	$0.00	$312.02	$312.02	$0.00	$263.75	$417.78	$422.00	$0.00		$0.00	$82.55	$0.00	$0.00	$83.98	$0.00	$0.00	$0.00	$0.00	$0.00
136.71	SUP	HCPCS C1713		"136.710  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 10MM"	BOTH IP/OP	$527.50 	$390.35	$0.00	$422.00	$237.38	$237.38	$0.00	$0.00	$0.00	$109.94	$391.51	$391.51	$0.00	$0.00	$109.93	$0.00	$312.02	$312.02	$0.00	$263.75	$417.78	$422.00	$0.00		$0.00	$82.55	$0.00	$0.00	$83.98	$0.00	$0.00	$0.00	$0.00	$0.00
136.712	SUP	HCPCS C1713		"136.712  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 12MM"	BOTH IP/OP	$527.50 	$390.35	$0.00	$422.00	$237.38	$237.38	$0.00	$0.00	$0.00	$109.94	$391.51	$391.51	$0.00	$0.00	$109.93	$0.00	$312.02	$312.02	$0.00	$263.75	$417.78	$422.00	$0.00		$0.00	$82.55	$0.00	$0.00	$83.98	$0.00	$0.00	$0.00	$0.00	$0.00
141	SUP	Custom 27203010		KIT OSOM STRP GRP A DPSTK CLIA WVD MCBLTST 50 TST	BOTH IP/OP	$174.90 	$129.43	$0.00	$139.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.45	$138.52	$139.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
142	SUP	HCPCS A4624		142  -  CATHETER SCT 16FR 12FR STRL LF HALYARD DRCT O2 PORT ATRM TIP	BOTH IP/OP	$109.00 	$80.66	$0.00	$88.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.90	$80.90	$0.00	$0.00	$22.72	$0.00	$0.00	$0.00	$0.00	$55.32	$87.63	$88.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
145	SUP	Custom 27203010		CONTROL CARD MRKR LQCHK 3LVL 3ML IMMUN	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.01	SUP	HCPCS C1713		"150.010  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.011	SUP	HCPCS C1713		"150.011  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 11MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.012	SUP	HCPCS C1713		"150.012  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.013	SUP	HCPCS C1713		"150.013  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 13MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.014	SUP	HCPCS C1713		150.014  -  SCREW BONE 4.2MM 14MM PRTX CTTI OCT SPN SLFDRILL FIXANG	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.015	SUP	HCPCS C1713		"150.015  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 15MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.016	SUP	HCPCS C1713		150.016  -  SCREW BN 4.2MM 16MM NS PRTX CTTI SLF DRL FX ANG SPNE OCT PRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.03	SUP	HCPCS C1713		"150.030  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.031	SUP	HCPCS C1713		"150.031  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 11MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.032	SUP	HCPCS C1713		"150.032  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.033	SUP	HCPCS C1713		"150.033  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 13MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.034	SUP	HCPCS C1713		"150.034  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.035	SUP	HCPCS C1713		"150.035  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 15MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.036	SUP	HCPCS C1713		"150.036  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.038	SUP	HCPCS C1713		"150.038  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.04	SUP	HCPCS C1713		"150.040  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.042	SUP	HCPCS C1713		"150.042  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 22MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.044	SUP	HCPCS C1713		"150.044  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 24MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.046	SUP	HCPCS C1713		"150.046  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 26MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.11	SUP	HCPCS C1713		150.110  -  PLATE BN 10MM NS PRV LVL 1 SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
150.112	SUP	HCPCS C1713		150.112  -  PLATE BN 12MM NS PRV LVL 1 SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
150.114	SUP	HCPCS C1713		150.114  -  PLATE BN 14MM NS PRV LVL 1 SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
150.116	SUP	HCPCS C1713		150.116  -  PLATE BN 16MM NS PRV LVL 1 SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
150.118	SUP	HCPCS C1713		150.118  -  PLATE BN 18MM NS PRV LVL 1 SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
150.12	SUP	HCPCS C1713		"150.120  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, 20MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
150.122	SUP	HCPCS C1713		"150.122  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, 22MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
150.124	SUP	HCPCS C1713		150.124  -  PLATE BN 24MM NS PRV LVL 1 SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
150.126	SUP	HCPCS C1713		"150.126  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, 26MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
150.13	SUP	HCPCS C1713		"150.130  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, EXTRA LORDOTIC,"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
150.132	SUP	HCPCS C1713		"150.132  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, EXTRA LORDOTIC,"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
150.134	SUP	HCPCS C1713		"150.134  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, EXTRA LORDOTIC,"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
150.224	SUP	HCPCS C1713		150.224  -  PLATE BN 24MM NS PRV LVL 2 SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.226	SUP	HCPCS C1713		150.226  -  PLATE BN 26MM NS PRV LVL 2 SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.228	SUP	HCPCS C1713		150.228  -  PLATE BN 28MM NS PRV LVL 2 SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.23	SUP	HCPCS C1713		150.230  -  PLATE BN 30MM NS PRV LVL 2 SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.232	SUP	HCPCS C1713		150.232  -  PLATE BN 32MM NS PRV 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.234	SUP	HCPCS C1713		150.234  -  PLATE BN 34MM NS PRV LVL 2 SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.236	SUP	HCPCS C1713		150.236  -  PLATE BN 36MM NS PRV LVL 2 SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.238	SUP	HCPCS C1713		150.238  -  PLATE BN 38MM NS PRV LVL 2 SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.24	SUP	HCPCS C1713		150.240  -  PLATE BN 40MM NS PRV LVL 2 SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.242	SUP	HCPCS C1713		"150.242  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, 42MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.244	SUP	HCPCS C1713		"150.244  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, 44MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.246	SUP	HCPCS C1713		"150.246  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, 46MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.254	SUP	HCPCS C1713		"150.254  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, EXTRA LORDOTIC,"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.256	SUP	HCPCS C1713		"150.256  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, EXTRA LORDOTIC,"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
150.339	SUP	HCPCS C1713		150.339  -  PLATE BN 39MM NS PRV LVL 3 SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.342	SUP	HCPCS C1713		150.342  -  PLATE BN 42MM NS PRV LVL 3 SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.345	SUP	HCPCS C1713		150.345  -  PLATE BN 45MM NS PRV 3 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.348	SUP	HCPCS C1713		150.348  -  PLATE BN 48MM NS PRV LVL 3 SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.351	SUP	HCPCS C1713		150.351  -  PLATE BN 51MM NS PRV LVL 3 SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.354	SUP	HCPCS C1713		150.354  -  PLATE BN 54MM NS PRV LVL 3 SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.357	SUP	HCPCS C1713		150.357  -  PLATE BN 57MM NS PRV LVL 3 SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.36	SUP	HCPCS C1713		"150.360  -  PROVIDENCE ANTERIOR CERVICAL PLATE 3-LEVEL, 60MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.363	SUP	HCPCS C1713		"150.363  -  PROVIDENCE ANTERIOR CERVICAL PLATE 3-LEVEL, 63MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.366	SUP	HCPCS C1713		150.366  -  PLATE BN 66MM NS PRV LVL 3 SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.369	SUP	HCPCS C1713		150.369  -  PLATE BN 69MM NS PRV LVL 3 SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.379	SUP	HCPCS C1713		"150.379  -  PROVIDENCE ANTERIOR CERVICAL PLATE 3-LEVEL, EXTRA LORDOTIC,"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
150.46	SUP	HCPCS C1713		150.460  -  PLATE BN 60MM NS PRV LVL 4 SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.463	SUP	HCPCS C1713		150.463  -  PLATE BN 63MM NS PRV LVL 4 SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.466	SUP	HCPCS C1713		150.466  -  PLATE BN 66MM NS PRV LVL 4 SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.469	SUP	HCPCS C1713		"150.469  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 69MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.472	SUP	HCPCS C1713		"150.472  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 72MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.475	SUP	HCPCS C1713		"150.475  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 75MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.478	SUP	HCPCS C1713		150.478  -  PLATE BN 78MM NS PRV LVL 4 SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.481	SUP	HCPCS C1713		"150.481  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 81MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.484	SUP	HCPCS C1713		"150.484  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 84MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.487	SUP	HCPCS C1713		"150.487  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 87MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.49	SUP	HCPCS C1713		"150.490  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 90MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.493	SUP	HCPCS C1713		"150.493  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 93MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.51	SUP	HCPCS C1713		"150.510  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.511	SUP	HCPCS C1713		"150.511  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 11MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.512	SUP	HCPCS C1713		"150.512  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.513	SUP	HCPCS C1713		"150.513  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 13MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.514	SUP	HCPCS C1713		"150.514  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.515	SUP	HCPCS C1713		"150.515  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 15MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.516	SUP	HCPCS C1713		150.516  -  SCREW BN 4.6MM 16MM NS PRTX CTTI SLF DRL FX ANG SPNE OCT PRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.53	SUP	HCPCS C1713		"150.530  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.531	SUP	HCPCS C1713		"150.531  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 11MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.532	SUP	HCPCS C1713		"150.532  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.533	SUP	HCPCS C1713		"150.533  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 13MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.534	SUP	HCPCS C1713		"150.534  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.535	SUP	HCPCS C1713		"150.535  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 15MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.536	SUP	HCPCS C1713		"150.536  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.538	SUP	HCPCS C1713		"150.538  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.54	SUP	HCPCS C1713		"150.540  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.542	SUP	HCPCS C1713		"150.542  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 22MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.544	SUP	HCPCS C1713		"150.544  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 24MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.546	SUP	HCPCS C1713		"150.546  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 26MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.58	SUP	HCPCS C1713		"150.580  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 80MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.583	SUP	HCPCS C1713		"150.583  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 83MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.586	SUP	HCPCS C1713		"150.586  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 86MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.589	SUP	HCPCS C1713		"150.589  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 89MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.592	SUP	HCPCS C1713		"150.592  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 92MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.595	SUP	HCPCS C1713		150.595  -  PLATE BN 95MM NS PRV LVL 5 SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.598	SUP	HCPCS C1713		"150.598  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 98MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.601	SUP	HCPCS C1713		"150.601  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 101MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.604	SUP	HCPCS C1713		"150.604  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 104MM"	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
150.61	SUP	HCPCS C1713		"150.610  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.611	SUP	HCPCS C1713		"150.611  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 11MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.612	SUP	HCPCS C1713		"150.612  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.613	SUP	HCPCS C1713		"150.613  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 13MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.614	SUP	HCPCS C1713		150.614  -  SCREW BONE 4.2MM 14MM PRTX CT SPNL SLFDRILL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.615	SUP	HCPCS C1713		"150.615  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 15MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.616	SUP	HCPCS C1713		150.616  -  SCREW BN 4.2MM 16MM NS PRTX CTTI SLF DRL VA SPNE OCT PRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.618	SUP	HCPCS C1713		"150.618  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.71	SUP	HCPCS C1713		"150.710  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.711	SUP	HCPCS C1713		"150.711  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 11MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.712	SUP	HCPCS C1713		"150.712  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.713	SUP	HCPCS C1713		"150.713  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 13MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.714	SUP	HCPCS C1713		"150.714  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.715	SUP	HCPCS C1713		"150.715  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 15MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.716	SUP	HCPCS C1713		150.716  -  SCREW BONE 4.6MM 16MM PRTX CTTI OCT SPN SLFDRILL VAR ANG	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.81	SUP	HCPCS C1713		"150.810  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.811	SUP	HCPCS C1713		"150.811  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 11MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.812	SUP	HCPCS C1713		"150.812  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.813	SUP	HCPCS C1713		"150.813  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 13MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.814	SUP	HCPCS C1713		"150.814  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.815	SUP	HCPCS C1713		"150.815  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 15MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.816	SUP	HCPCS C1713		"150.816  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.818	SUP	HCPCS C1713		"150.818  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.82	SUP	HCPCS C1713		"150.820  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.822	SUP	HCPCS C1713		"150.822  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 22MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.824	SUP	HCPCS C1713		"150.824  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 24MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.826	SUP	HCPCS C1713		"150.826  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 26MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.91	SUP	HCPCS C1713		"150.910  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.911	SUP	HCPCS C1713		"150.911  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 11MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.912	SUP	HCPCS C1713		"150.912  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.913	SUP	HCPCS C1713		"150.913  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 13MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.914	SUP	HCPCS C1713		"150.914  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.915	SUP	HCPCS C1713		"150.915  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 15MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.916	SUP	HCPCS C1713		"150.916  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.918	SUP	HCPCS C1713		"150.918  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.92	SUP	HCPCS C1713		"150.920  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.922	SUP	HCPCS C1713		"150.922  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 22MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.924	SUP	HCPCS C1713		"150.924  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 24MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
150.926	SUP	HCPCS C1713		"150.926  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 26MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
151	SUP	Custom 27203010		MARKER RAD A-SPOT LT IMG SEE THR PALPABLE MASS 3ANG MAMGR	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.001	SUP	Custom 27803010		151.001  -  SPACER SPNL 0D 12MM 12X15MM NS LF FORTIFY NO SPK	BOTH IP/OP	"$16,080.00 "	"$11,899.20"	$0.00	"$12,864.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,351.07"	$0.00	$0.00	$0.00	$0.00	"$8,040.00"	"$12,735.36"	"$12,864.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.002	SUP	Custom 27803010		151.002  -  SPACER SPNL 0D 12MM 12X16MM NS LF FORTIFY	BOTH IP/OP	"$16,080.00 "	"$11,899.20"	$0.00	"$12,864.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,351.07"	$0.00	$0.00	$0.00	$0.00	"$8,040.00"	"$12,735.36"	"$12,864.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.003	SUP	Custom 27803010		151.003  -  SPACER SPNL 3.5D 12MM 12X16MM NS LF FORTIFY NO SPK	BOTH IP/OP	"$16,080.00 "	"$11,899.20"	$0.00	"$12,864.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,351.07"	$0.00	$0.00	$0.00	$0.00	"$8,040.00"	"$12,735.36"	"$12,864.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.004	SUP	Custom 27803010		151.004  -  SPACER SPNL 3.5D 12MM 12X17MM NS LF FORTIFY	BOTH IP/OP	"$16,080.00 "	"$11,899.20"	$0.00	"$12,864.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,351.07"	$0.00	$0.00	$0.00	$0.00	"$8,040.00"	"$12,735.36"	"$12,864.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.05	SUP	Custom 27803010		151.050  -  SPACER SPNL 12MM 12X18MM NS LF FORTIFY	BOTH IP/OP	"$16,080.00 "	"$11,899.20"	$0.00	"$12,864.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,351.07"	$0.00	$0.00	$0.00	$0.00	"$8,040.00"	"$12,735.36"	"$12,864.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.051	SUP	Custom 27803010		151.051  -  SPACER SPNL 12MM 12X19MM NS LF FORTIFY	BOTH IP/OP	"$16,080.00 "	"$11,899.20"	$0.00	"$12,864.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,351.07"	$0.00	$0.00	$0.00	$0.00	"$8,040.00"	"$12,735.36"	"$12,864.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.052	SUP	Custom 27803010		151.052  -  SPACER SPNL 12MM 12X21MM NS LF FORTIFY	BOTH IP/OP	"$16,080.00 "	"$11,899.20"	$0.00	"$12,864.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,351.07"	$0.00	$0.00	$0.00	$0.00	"$8,040.00"	"$12,735.36"	"$12,864.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.053	SUP	Custom 27803010		151.053  -  SPACER SPNL 12MM 12X25MM NS LF FORTIFY	BOTH IP/OP	"$16,080.00 "	"$11,899.20"	$0.00	"$12,864.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,351.07"	$0.00	$0.00	$0.00	$0.00	"$8,040.00"	"$12,735.36"	"$12,864.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.054	SUP	Custom 27803010		151.054  -  SPACER SPNL 12MM 12X33MM NS LF FORTIFY	BOTH IP/OP	"$16,080.00 "	"$11,899.20"	$0.00	"$12,864.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,351.07"	$0.00	$0.00	$0.00	$0.00	"$8,040.00"	"$12,735.36"	"$12,864.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.055	SUP	Custom 27803010		151.055  -  SPACER SPNL 12MM 12X48MM NS LF FORTIFY	BOTH IP/OP	"$16,080.00 "	"$11,899.20"	$0.00	"$12,864.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,351.07"	$0.00	$0.00	$0.00	$0.00	"$8,040.00"	"$12,735.36"	"$12,864.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.056	SUP	Custom 27803010		151.056  -  SPACER SPNL 12MM 12X67MM NS LF FORTIFY	BOTH IP/OP	"$16,080.00 "	"$11,899.20"	$0.00	"$12,864.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,351.07"	$0.00	$0.00	$0.00	$0.00	"$8,040.00"	"$12,735.36"	"$12,864.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.15	SUP	Custom 27803010		151.150  -  SPACER SPNL 20MM 20X23MM NS LF FORTIFY	BOTH IP/OP	"$21,100.00 "	"$15,614.00"	$0.00	"$16,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,397.24"	$0.00	$0.00	$0.00	$0.00	"$10,550.00"	"$16,711.20"	"$16,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.151	SUP	Custom 27803010		151.151  -  SPACER SPNL 20MM 20X26MM NS LF FORTIFY	BOTH IP/OP	"$21,100.00 "	"$15,614.00"	$0.00	"$16,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,397.24"	$0.00	$0.00	$0.00	$0.00	"$10,550.00"	"$16,711.20"	"$16,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.152	SUP	Custom 27803010		151.152  -  SPACER SPNL 20MM 20X31MM NS LF FORTIFY	BOTH IP/OP	"$21,100.00 "	"$15,614.00"	$0.00	"$16,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,397.24"	$0.00	$0.00	$0.00	$0.00	"$10,550.00"	"$16,711.20"	"$16,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.153	SUP	Custom 27803010		151.153  -  SPACER SPNL 20MM 20X41MM NS LF FORTIFY	BOTH IP/OP	"$21,100.00 "	"$15,614.00"	$0.00	"$16,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,397.24"	$0.00	$0.00	$0.00	$0.00	"$10,550.00"	"$16,711.20"	"$16,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.154	SUP	Custom 27803010		151.154  -  SPACER SPNL 20MM 20X62MM NS LF FORTIFY	BOTH IP/OP	"$21,100.00 "	"$15,614.00"	$0.00	"$16,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,397.24"	$0.00	$0.00	$0.00	$0.00	"$10,550.00"	"$16,711.20"	"$16,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.155	SUP	Custom 27803010		151.155  -  SPACER SPNL 20MM 20X90MM NS LF FORTIFY	BOTH IP/OP	"$21,100.00 "	"$15,614.00"	$0.00	"$16,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,397.24"	$0.00	$0.00	$0.00	$0.00	"$10,550.00"	"$16,711.20"	"$16,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151.32	SUP	HCPCS C1713		151.320  -  SPACER SPNL 0D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.321	SUP	HCPCS C1713		151.321  -  SPACER SPNL 0D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.322	SUP	HCPCS C1713		151.322  -  SPACER SPNL 3.5D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.323	SUP	HCPCS C1713		151.323  -  SPACER SPNL 3.5D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.324	SUP	HCPCS C1713		151.324  -  SPACER SPNL 7D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.331	SUP	HCPCS C1713		151.331  -  SPACER SPNL 0D 15MM 18X12MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.333	SUP	HCPCS C1713		151.333  -  SPACER SPNL 3.5D 15MM 18X12MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.334	SUP	HCPCS C1713		151.334  -  SPACER SPNL 7D 15MM 18X12MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.371	SUP	HCPCS C1713		151.371  -  SPACER SPNL 0D 12MM 14X12MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.373	SUP	HCPCS C1713		151.373  -  SPACER SPNL 3.5D 12MM 14X12MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.374	SUP	HCPCS C1713		151.374  -  SPACER SPNL 7D 12MM 14X12MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.381	SUP	HCPCS C1713		151.381  -  SPACER SPNL 0D 15MM 18X12MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.383	SUP	HCPCS C1713		151.383  -  SPACER SPNL 3.5D 15MM 18X12MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.384	SUP	HCPCS C1713		151.384  -  SPACER SPNL 7D 15MM 18X12MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.401	SUP	HCPCS C1713		151.401  -  SPACER SPNL 0D 20MM 20X20MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.403	SUP	HCPCS C1713		151.403  -  SPACER SPNL 4D 20MM 20X20MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.404	SUP	HCPCS C1713		151.404  -  SPACER SPNL 8D 20MM 20X20MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.411	SUP	HCPCS C1713		151.411  -  SPACER SPNL 0D 21MM 23X20MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.413	SUP	HCPCS C1713		151.413  -  SPACER SPNL 4D 21MM 23X20MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.414	SUP	HCPCS C1713		151.414  -  SPACER SPNL 8D 21MM 23X20MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.431	SUP	HCPCS C1713		151.431  -  SPACER SPNL 0D 25MM 30X20MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.433	SUP	HCPCS C1713		151.433  -  SPACER SPNL 4D 25MM 30X20MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.434	SUP	HCPCS C1713		151.434  -  SPACER SPNL 8D 25MM 30X20MM NS LF FORTIFY FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.451	SUP	HCPCS C1713		151.451  -  SPACER SPNL 0D 20MM 20X20MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.453	SUP	HCPCS C1713		151.453  -  SPACER SPNL 4D 20MM 20X20MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.454	SUP	HCPCS C1713		151.454  -  SPACER SPNL 8D 20MM 20X20MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.461	SUP	HCPCS C1713		151.461  -  SPACER SPNL 0D 21MM 23X20MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.463	SUP	HCPCS C1713		151.463  -  SPACER SPNL 4D 21MM 23X20MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.464	SUP	HCPCS C1713		151.464  -  SPACER SPNL 8D 21MM 23X20MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.481	SUP	HCPCS C1713		151.481  -  SPACER SPNL 0D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.483	SUP	HCPCS C1713		151.483  -  SPACER SPNL 4D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.484	SUP	HCPCS C1713		151.484  -  SPACER SPNL 8D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.485	SUP	HCPCS C1713		151.485  -  SPACER SPNL 12D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.486	SUP	HCPCS C1713		151.486  -  SPACER SPNL 16D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.601	SUP	HCPCS C1713		151.601  -  SPACER SPNL 0D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.603	SUP	HCPCS C1713		151.603  -  SPACER SPNL 4D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.604	SUP	HCPCS C1713		151.604  -  SPACER SPNL 8D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.605	SUP	HCPCS C1713		151.605  -  SPACER SPNL 12D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.611	SUP	HCPCS C1713		151.611  -  SPACER SPNL 0D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.613	SUP	HCPCS C1713		151.613  -  SPACER SPNL 4D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.614	SUP	HCPCS C1713		151.614  -  SPACER SPNL 8D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.615	SUP	HCPCS C1713		151.615  -  SPACER SPNL 12D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.621	SUP	HCPCS C1713		151.621  -  SPACER SPNL 0D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.623	SUP	HCPCS C1713		151.623  -  SPACER SPNL 4D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.624	SUP	HCPCS C1713		151.624  -  SPACER SPNL 8D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.625	SUP	HCPCS C1713		151.625  -  SPACER SPNL 12D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.651	SUP	HCPCS C1713		151.651  -  SPACER SPNL 0D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.653	SUP	HCPCS C1713		151.653  -  SPACER SPNL 4D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.654	SUP	HCPCS C1713		151.654  -  SPACER SPNL 8D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.655	SUP	HCPCS C1713		151.655  -  SPACER SPNL 12D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.661	SUP	HCPCS C1713		151.661  -  SPACER SPNL 0D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.663	SUP	HCPCS C1713		151.663  -  SPACER SPNL 4D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.664	SUP	HCPCS C1713		151.664  -  SPACER SPNL 8D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.665	SUP	HCPCS C1713		151.665  -  SPACER SPNL 12D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.671	SUP	HCPCS C1713		151.671  -  SPACER SPNL 0D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.673	SUP	HCPCS C1713		151.673  -  SPACER SPNL 4D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.674	SUP	HCPCS C1713		151.674  -  SPACER SPNL 8D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL PRFL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.675	SUP	HCPCS C1713		151.675  -  SPACER SPNL 12D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
151.701	SUP	HCPCS C1713		151.701  -  SPACER SPNL 0D 14MM 16X12MM NS LF FORTIFY UPR EPLT SGTL PRFL	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.703	SUP	HCPCS C1713		151.703  -  SPACER SPNL 3.5D 14MM 16X12MM NS LF FORTIFY UPR EPLT SGTL	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.704	SUP	HCPCS C1713		151.704  -  SPACER SPNL 7D 14MM 16X12MM NS LF FORTIFY UPR EPLT SGTL PRFL	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.751	SUP	HCPCS C1713		151.751  -  SPACER SPNL 0D 14MM 16X12MM NS LF FORTIFY LWR EPLT SGTL PRFL	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.753	SUP	HCPCS C1713		151.753  -  SPACER SPNL 3.5D 14MM 16X12MM NS LF FORTIFY LWR EPLT SGTL	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
151.754	SUP	HCPCS C1713		151.754  -  SPACER SPNL 7D 14MM 16X12MM NS LF FORTIFY LWR EPLT SGTL PRFL	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
154.7	SUP	Custom 27803010		"154.700  -  REVERE IN-LINE EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, LEFT"	BOTH IP/OP	"$10,800.00 "	"$7,992.00"	$0.00	"$8,640.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,250.72"	$0.00	$0.00	$0.00	$0.00	"$5,400.00"	"$8,553.60"	"$8,640.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.705	SUP	Custom 27803010		"154.705  -  REVERE IN-LINE EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, RIGH"	BOTH IP/OP	"$10,800.00 "	"$7,992.00"	$0.00	"$8,640.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,250.72"	$0.00	$0.00	$0.00	$0.00	"$5,400.00"	"$8,553.60"	"$8,640.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.71	SUP	Custom 27803010		"154.710  -  REVERE IN-LINE EXTENSION CLAMP, 6.0MM-6.5MM, 5.5MM ROD, LEFT"	BOTH IP/OP	"$10,800.00 "	"$7,992.00"	$0.00	"$8,640.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,250.72"	$0.00	$0.00	$0.00	$0.00	"$5,400.00"	"$8,553.60"	"$8,640.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.715	SUP	Custom 27803010		"154.715  -  REVERE IN-LINE EXTENSION CLAMP, 6.0MM-6.5MM, 5.5MM ROD, RIGH"	BOTH IP/OP	"$10,800.00 "	"$7,992.00"	$0.00	"$8,640.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,250.72"	$0.00	$0.00	$0.00	$0.00	"$5,400.00"	"$8,553.60"	"$8,640.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.72	SUP	Custom 27803010		"154.720  -  REVERE OFFSET EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, LEFT,"	BOTH IP/OP	"$10,800.00 "	"$7,992.00"	$0.00	"$8,640.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,250.72"	$0.00	$0.00	$0.00	$0.00	"$5,400.00"	"$8,553.60"	"$8,640.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.725	SUP	Custom 27803010		"154.725  -  REVERE OFFSET EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, RIGHT"	BOTH IP/OP	"$10,800.00 "	"$7,992.00"	$0.00	"$8,640.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,250.72"	$0.00	$0.00	$0.00	$0.00	"$5,400.00"	"$8,553.60"	"$8,640.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.73	SUP	Custom 27803010		"154.730  -  REVERE OFFSET EXTENSION CLAMP, 6.0MM-6.5MM, 5.5MM ROD, LEFT,"	BOTH IP/OP	"$10,800.00 "	"$7,992.00"	$0.00	"$8,640.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,250.72"	$0.00	$0.00	$0.00	$0.00	"$5,400.00"	"$8,553.60"	"$8,640.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.735	SUP	Custom 27803010		"154.735  -  REVERE OFFSET EXTENSION CLAMP, 6.0MM-6.5MM, 5.5MM ROD, RIGHT"	BOTH IP/OP	"$10,800.00 "	"$7,992.00"	$0.00	"$8,640.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,250.72"	$0.00	$0.00	$0.00	$0.00	"$5,400.00"	"$8,553.60"	"$8,640.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.74	SUP	Custom 27803010		"154.740  -  REVERE Y OFFSET CONNECTOR, 5.5MM-6.0MM"	BOTH IP/OP	"$2,620.00 "	"$1,938.80"	$0.00	"$2,096.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,944.56"	"$1,944.56"	$0.00	$0.00	$546.01	$0.00	$0.00	$0.00	$0.00	"$1,310.00"	"$2,075.04"	"$2,096.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.745	SUP	Custom 27803010		"154.745  -  REVERE Y OFFSET CONNECTOR, 6.0MM-6.5MM"	BOTH IP/OP	"$2,620.00 "	"$1,938.80"	$0.00	"$2,096.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,944.56"	"$1,944.56"	$0.00	$0.00	$546.01	$0.00	$0.00	$0.00	$0.00	"$1,310.00"	"$2,075.04"	"$2,096.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.754	SUP	Custom 27803010		"154.754  -  PARALLEL CONNECTOR CLAMP, 5.5MM TO 6.5MM, SINGLE"	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.756	SUP	Custom 27803010		"154.756  -  PARALLEL CONNECTOR CLAMP, 5.5MM TO 6.5MM, 18MM WIDE, SINGLE"	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.758	SUP	Custom 27803010		"154.758  -  ROD TO ROD CLAMP, 5.5MM TO 5.5MM, SINGLE"	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.76	SUP	Custom 27803010		"154.760  -  ROD TO ROD CLAMP, 5.5MM TO 5.5MM, 18MM WIDE, SINGLE"	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.854	SUP	Custom 27803010		"154.854  -  PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM, SINGLE"	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.856	SUP	Custom 27803010		"154.856  -  PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM, 18MM WIDE, SINGLE"	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.858	SUP	Custom 27803010		"154.858  -  ROD TO ROD CLAMP, 6.5MM TO 6.5MM, SINGLE"	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.86	SUP	Custom 27803010		"154.860  -  ROD TO ROD CLAMP, 6.5MM TO 6.5MM, 18MM WIDE, SINGLE"	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.862	SUP	Custom 27803010		"154.862  -  ROD TO ROD CLAMP, 5.5MM TO 6.5MM"	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.864	SUP	Custom 27803010		"154.864  -  ROD TO ROD CLAMP, 5.5MM TO 6.5MM, WIDE"	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.865	SUP	Custom 27803010		"154.865  -  ROD TO ROD CLAMP ASSEMBLY, 5.5MM TO 6.5MM, 18MM WIDE"	BOTH IP/OP	"$1,445.00 "	"$1,069.30"	$0.00	"$1,156.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,072.48"	"$1,072.48"	$0.00	$0.00	$301.14	$0.00	$0.00	$0.00	$0.00	$722.50	"$1,144.44"	"$1,156.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.866	SUP	Custom 27803010		"154.866  -  PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM"	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.868	SUP	Custom 27803010		"154.868  -  PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM WIDE"	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
154.869	SUP	Custom 27803010		"154.869  -  PARALLEL CONNECTOR CLAMP ASSEMBLY, 6.5MM TO 6.5MM, 18MM WIDE"	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.13	$987.13	$0.00	$0.00	$277.17	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.051	SUP	HCPCS C1713		"155.051  -  BEACON 5.0MM POSTED SCREW, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.052	SUP	HCPCS C1713		"155.052  -  BEACON 5.0MM POSTED SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.053	SUP	HCPCS C1713		"155.053  -  BEACON 5.0MM POSTED SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.054	SUP	HCPCS C1713		"155.054  -  BEACON 5.0MM POSTED SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.055	SUP	HCPCS C1713		"155.055  -  BEACON 5.0MM POSTED SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.056	SUP	HCPCS C1713		"155.056  -  BEACON 5.0MM POSTED SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.057	SUP	HCPCS C1713		"155.057  -  BEACON 5.0MM POSTED SCREW, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.071	SUP	HCPCS C1713		"155.071  -  BEACON 7.5MM POSTED SCREW, 70MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.072	SUP	HCPCS C1713		"155.072  -  BEACON 7.5MM POSTED SCREW, 75MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.073	SUP	HCPCS C1713		"155.073  -  BEACON 7.5MM POSTED SCREW, 80MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.074	SUP	HCPCS C1713		"155.074  -  BEACON 7.5MM POSTED SCREW, 85MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.075	SUP	HCPCS C1713		"155.075  -  BEACON 7.5MM POSTED SCREW, 90MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.081	SUP	HCPCS C1713		"155.081  -  BEACON 8.5MM POSTED SCREW, 70MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.082	SUP	HCPCS C1713		"155.082  -  BEACON 8.5MM POSTED SCREW, 75MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.083	SUP	HCPCS C1713		"155.083  -  BEACON 8.5MM POSTED SCREW, 80MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.084	SUP	HCPCS C1713		"155.084  -  BEACON 8.5MM POSTED SCREW, 85MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.085	SUP	HCPCS C1713		"155.085  -  BEACON 8.5MM POSTED SCREW, 90MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.091	SUP	HCPCS C1713		"155.091  -  BEACON 9.5MM POSTED SCREW, 70MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.092	SUP	HCPCS C1713		"155.092  -  BEACON 9.5MM POSTED SCREW, 75MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.093	SUP	HCPCS C1713		"155.093  -  BEACON 9.5MM POSTED SCREW, 80MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.094	SUP	HCPCS C1713		"155.094  -  BEACON 9.5MM POSTED SCREW, 85MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.095	SUP	HCPCS C1713		"155.095  -  BEACON 9.5MM POSTED SCREW, 90MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.101	SUP	Custom 27803010		"155.101  -  BEACON 5.5MM STRAIGHT CLAMP, LARGE"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.102	SUP	Custom 27803010		"155.102  -  BEACON 5.5MM STRAIGHT CLAMP, MEDIUM"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.103	SUP	Custom 27803010		"155.103  -  BEACON 5.5MM STRAIGHT CLAMP, SMALL"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.104	SUP	Custom 27803010		"155.104  -  BEACON 5.5MM LEFT OFFSET CLAMP, LARGE"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.105	SUP	Custom 27803010		"155.105  -  BEACON 5.5MM LEFT OFFSET CLAMP, MEDIUM"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.106	SUP	Custom 27803010		"155.106  -  BEACON 5.5MM LEFT OFFSET CLAMP, SMALL"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.107	SUP	Custom 27803010		"155.107  -  BEACON 5.5MM RIGHT OFFSET CLAMP, LARGE"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.108	SUP	Custom 27803010		"155.108  -  BEACON 5.5MM RIGHT OFFSET CLAMP, MEDIUM"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.109	SUP	Custom 27803010		"155.109  -  BEACON 5.5MM RIGHT OFFSET CLAMP, SMALL"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.111	SUP	Custom 27803010		"155.111  -  BEACON 6.35MM STRAIGHT CLAMP, LARGE"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.112	SUP	Custom 27803010		"155.112  -  BEACON 6.35MM STRAIGHT CLAMP, MEDIUM"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.113	SUP	Custom 27803010		"155.113  -  BEACON 6.35MM STRAIGHT CLAMP, SMALL"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.114	SUP	Custom 27803010		"155.114  -  BEACON 6.35MM LEFT OFFSET CLAMP, LARGE"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.115	SUP	Custom 27803010		"155.115  -  BEACON 6.35MM LEFT OFFSET CLAMP, MEDIUM"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.116	SUP	Custom 27803010		"155.116  -  BEACON 6.35MM LEFT OFFSET CLAMP, SMALL"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.117	SUP	Custom 27803010		"155.117  -  BEACON 6.35MM RIGHT OFFSET CLAMP, LARGE"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.118	SUP	Custom 27803010		"155.118  -  BEACON 6.35MM RIGHT OFFSET CLAMP, MEDIUM"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.119	SUP	Custom 27803010		"155.119  -  BEACON 6.35MM RIGHT OFFSET CLAMP, SMALL"	BOTH IP/OP	"$4,995.00 "	"$3,696.30"	$0.00	"$3,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,707.29"	"$3,707.29"	$0.00	$0.00	"$1,040.96"	$0.00	$0.00	$0.00	$0.00	"$2,497.50"	"$3,956.04"	"$3,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.151	SUP	HCPCS C1713		"155.151  -  BEACON 5.0MM REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.152	SUP	HCPCS C1713		"155.152  -  BEACON 5.0MM REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.153	SUP	HCPCS C1713		"155.153  -  BEACON 5.0MM REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.154	SUP	HCPCS C1713		"155.154  -  BEACON 5.0MM REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.155	SUP	HCPCS C1713		"155.155  -  BEACON 5.0MM REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.156	SUP	HCPCS C1713		"155.156  -  BEACON 5.0MM REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.157	SUP	HCPCS C1713		"155.157  -  BEACON 5.0MM REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.171	SUP	HCPCS C1713		"155.171  -  BEACON 7.5MM REDUCTION SCREW, 70MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.172	SUP	HCPCS C1713		"155.172  -  BEACON 7.5MM REDUCTION SCREW, 75MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.173	SUP	HCPCS C1713		"155.173  -  BEACON 7.5MM REDUCTION SCREW, 80MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.174	SUP	HCPCS C1713		"155.174  -  BEACON 7.5MM REDUCTION SCREW, 85MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.175	SUP	HCPCS C1713		"155.175  -  BEACON 7.5MM REDUCTION SCREW, 90MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.181	SUP	HCPCS C1713		"155.181  -  BEACON 8.5MM REDUCTION SCREW, 70MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.182	SUP	HCPCS C1713		"155.182  -  BEACON 8.5MM REDUCTION SCREW, 75MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.183	SUP	HCPCS C1713		"155.183  -  BEACON 8.5MM REDUCTION SCREW, 80MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.184	SUP	HCPCS C1713		"155.184  -  BEACON 8.5MM REDUCTION SCREW, 85MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.185	SUP	HCPCS C1713		"155.185  -  BEACON 8.5MM REDUCTION SCREW, 90MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.341	SUP	HCPCS C1713		"155.341  -  BEACON 4.5MM REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.342	SUP	HCPCS C1713		"155.342  -  BEACON 4.5MM REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.343	SUP	HCPCS C1713		"155.343  -  BEACON 4.5MM REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.344	SUP	HCPCS C1713		"155.344  -  BEACON 4.5MM REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.345	SUP	HCPCS C1713		"155.345  -  BEACON 4.5MM REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.351	SUP	HCPCS C1713		"155.351  -  BEACON 5.5MM REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.352	SUP	HCPCS C1713		"155.352  -  BEACON 5.5MM REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.353	SUP	HCPCS C1713		"155.353  -  BEACON 5.5MM REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.354	SUP	HCPCS C1713		"155.354  -  BEACON 5.5MM REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.355	SUP	HCPCS C1713		"155.355  -  BEACON 5.5MM REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.356	SUP	HCPCS C1713		"155.356  -  BEACON 5.5MM REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.357	SUP	HCPCS C1713		"155.357  -  BEACON 5.5MM REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.361	SUP	HCPCS C1713		"155.361  -  BEACON 6.5MM REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.362	SUP	HCPCS C1713		"155.362  -  BEACON 6.5MM REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.363	SUP	HCPCS C1713		"155.363  -  BEACON 6.5MM REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.364	SUP	HCPCS C1713		"155.364  -  BEACON 6.5MM REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.365	SUP	HCPCS C1713		"155.365  -  BEACON 6.5MM REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.366	SUP	HCPCS C1713		"155.366  -  BEACON 6.5MM REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.367	SUP	HCPCS C1713		"155.367  -  BEACON 6.5MM REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.368	SUP	HCPCS C1713		"155.368  -  BEACON 6.5MM REDUCTION SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.369	SUP	HCPCS C1713		"155.369  -  BEACON 6.5MM REDUCTION SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.371	SUP	HCPCS C1713		"155.371  -  BEACON 7.5MM REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.372	SUP	HCPCS C1713		"155.372  -  BEACON 7.5MM REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.373	SUP	HCPCS C1713		"155.373  -  BEACON 7.5MM REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.374	SUP	HCPCS C1713		"155.374  -  BEACON 7.5MM REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.375	SUP	HCPCS C1713		"155.375  -  BEACON 7.5MM REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.376	SUP	HCPCS C1713		"155.376  -  BEACON 7.5MM REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.377	SUP	HCPCS C1713		"155.377  -  BEACON 7.5MM REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.378	SUP	HCPCS C1713		"155.378  -  BEACON 7.5MM REDUCTION SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.379	SUP	HCPCS C1713		"155.379  -  BEACON 7.5MM REDUCTION SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.381	SUP	HCPCS C1713		"155.381  -  BEACON 8.5MM REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.382	SUP	HCPCS C1713		"155.382  -  BEACON 8.5MM REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.383	SUP	HCPCS C1713		"155.383  -  BEACON 8.5MM REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.384	SUP	HCPCS C1713		"155.384  -  BEACON 8.5MM REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.385	SUP	HCPCS C1713		"155.385  -  BEACON 8.5MM REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.386	SUP	HCPCS C1713		"155.386  -  BEACON 8.5MM REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.387	SUP	HCPCS C1713		"155.387  -  BEACON 8.5MM REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.388	SUP	HCPCS C1713		"155.388  -  BEACON 8.5MM REDUCTION SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.389	SUP	HCPCS C1713		"155.389  -  BEACON 8.5MM REDUCTION SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
155.441	SUP	HCPCS C1713		"155.441  -  BEACON 4.5MM POSTED SCREW, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.442	SUP	HCPCS C1713		"155.442  -  BEACON 4.5MM POSTED SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.443	SUP	HCPCS C1713		"155.443  -  BEACON 4.5MM POSTED SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.444	SUP	HCPCS C1713		"155.444  -  BEACON 4.5MM POSTED SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.445	SUP	HCPCS C1713		"155.445  -  BEACON 4.5MM POSTED SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.451	SUP	HCPCS C1713		"155.451  -  BEACON 5.5MM POSTED SCREW, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.452	SUP	HCPCS C1713		"155.452  -  BEACON 5.5MM POSTED SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.453	SUP	HCPCS C1713		"155.453  -  BEACON 5.5MM POSTED SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.454	SUP	HCPCS C1713		"155.454  -  BEACON 5.5MM POSTED SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.455	SUP	HCPCS C1713		"155.455  -  BEACON 5.5MM POSTED SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.456	SUP	HCPCS C1713		"155.456  -  BEACON 5.5MM POSTED SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.457	SUP	HCPCS C1713		"155.457  -  BEACON 5.5MM POSTED SCREW, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.461	SUP	HCPCS C1713		"155.461  -  BEACON 6.5MM POSTED SCREW, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.462	SUP	HCPCS C1713		"155.462  -  BEACON 6.5MM POSTED SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.463	SUP	HCPCS C1713		"155.463  -  BEACON 6.5MM POSTED SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.464	SUP	HCPCS C1713		"155.464  -  BEACON 6.5MM POSTED SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.465	SUP	HCPCS C1713		"155.465  -  BEACON 6.5MM POSTED SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.466	SUP	HCPCS C1713		"155.466  -  BEACON 6.5MM POSTED SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.467	SUP	HCPCS C1713		"155.467  -  BEACON 6.5MM POSTED SCREW, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.468	SUP	HCPCS C1713		"155.468  -  BEACON 6.5MM POSTED SCREW, 60MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.469	SUP	HCPCS C1713		"155.469  -  BEACON 6.5MM POSTED SCREW, 65MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.471	SUP	HCPCS C1713		"155.471  -  BEACON 7.5MM POSTED SCREW, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.472	SUP	HCPCS C1713		"155.472  -  BEACON 7.5MM POSTED SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.473	SUP	HCPCS C1713		"155.473  -  BEACON 7.5MM POSTED SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.474	SUP	HCPCS C1713		"155.474  -  BEACON 7.5MM POSTED SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.475	SUP	HCPCS C1713		"155.475  -  BEACON 7.5MM POSTED SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.476	SUP	HCPCS C1713		"155.476  -  BEACON 7.5MM POSTED SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.477	SUP	HCPCS C1713		"155.477  -  BEACON 7.5MM POSTED SCREW, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.478	SUP	HCPCS C1713		"155.478  -  BEACON 7.5MM POSTED SCREW, 60MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.479	SUP	HCPCS C1713		"155.479  -  BEACON 7.5MM POSTED SCREW, 65MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.481	SUP	HCPCS C1713		"155.481  -  BEACON 8.5MM POSTED SCREW, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.482	SUP	HCPCS C1713		"155.482  -  BEACON 8.5MM POSTED SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.483	SUP	HCPCS C1713		"155.483  -  BEACON 8.5MM POSTED SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.484	SUP	HCPCS C1713		"155.484  -  BEACON 8.5MM POSTED SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.485	SUP	HCPCS C1713		"155.485  -  BEACON 8.5MM POSTED SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.486	SUP	HCPCS C1713		"155.486  -  BEACON 8.5MM POSTED SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.487	SUP	HCPCS C1713		"155.487  -  BEACON 8.5MM POSTED SCREW, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.488	SUP	HCPCS C1713		"155.488  -  BEACON 8.5MM POSTED SCREW, 60MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.489	SUP	HCPCS C1713		"155.489  -  BEACON 8.5MM POSTED SCREW, 65MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.491	SUP	HCPCS C1713		"155.491  -  BEACON 9.5MM POSTED SCREW, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.492	SUP	HCPCS C1713		"155.492  -  BEACON 9.5MM POSTED SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.493	SUP	HCPCS C1713		"155.493  -  BEACON 9.5MM POSTED SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.494	SUP	HCPCS C1713		"155.494  -  BEACON 9.5MM POSTED SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.495	SUP	HCPCS C1713		"155.495  -  BEACON 9.5MM POSTED SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.496	SUP	HCPCS C1713		"155.496  -  BEACON 9.5MM POSTED SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.497	SUP	HCPCS C1713		"155.497  -  BEACON 9.5MM POSTED SCREW, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.498	SUP	HCPCS C1713		"155.498  -  BEACON 9.5MM POSTED SCREW, 60MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.499	SUP	HCPCS C1713		"155.499  -  BEACON 9.5MM POSTED SCREW, 65MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.51	SUP	Custom 27803010		"155.510  -  6.35MM STRAIGHT ROD, 100MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.512	SUP	Custom 27803010		"155.512  -  6.35MM STRAIGHT ROD, 125MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.515	SUP	Custom 27803010		155.515  -  ROD SPNL STRG 6.35MM 150MM BCN HEX END	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.517	SUP	Custom 27803010		"155.517  -  6.35MM STRAIGHT ROD, HEX END, 200MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.519	SUP	Custom 27803010		"155.519  -  6.35MM STRAIGHT ROD, HEX END, 300MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.52	SUP	Custom 27803010		"155.520  -  6.35MM STRAIGHT ROD, HEX END, 400MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.521	SUP	Custom 27803010		"155.521  -  6.35MM STRAIGHT ROD, HEX END, 500MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.53	SUP	Custom 27803010		"155.530  -  6.35MM STRAIGHT ROD, 30MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.535	SUP	Custom 27803010		"155.535  -  6.35MM STRAIGHT ROD, 35MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.54	SUP	Custom 27803010		"155.540  -  6.35MM STRAIGHT ROD, 40MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.545	SUP	Custom 27803010		"155.545  -  6.35MM STRAIGHT ROD, 45MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.55	SUP	Custom 27803010		"155.550  -  6.35MM STRAIGHT ROD, 50MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.555	SUP	Custom 27803010		"155.555  -  6.35MM STRAIGHT ROD, 55MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.56	SUP	Custom 27803010		"155.560  -  6.35MM STRAIGHT ROD, 60MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.565	SUP	Custom 27803010		"155.565  -  6.35MM STRAIGHT ROD, 65MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.57	SUP	Custom 27803010		"155.570  -  6.35MM STRAIGHT ROD, 70MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.575	SUP	Custom 27803010		"155.575  -  6.35MM STRAIGHT ROD, 75MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.58	SUP	Custom 27803010		"155.580  -  6.35MM STRAIGHT ROD, 80MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.585	SUP	Custom 27803010		"155.585  -  6.35MM STRAIGHT ROD, 85MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.61	SUP	Custom 27803010		"155.610  -  6.35MM CURVED ROD, 100MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.635	SUP	Custom 27803010		"155.635  -  6.35MM CURVED ROD, 35MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.64	SUP	Custom 27803010		"155.640  -  6.35MM CURVED ROD, 40MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.645	SUP	Custom 27803010		"155.645  -  6.35MM CURVED ROD, 45MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.65	SUP	Custom 27803010		"155.650  -  6.35MM CURVED ROD, 50MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.655	SUP	Custom 27803010		"155.655  -  6.35MM CURVED ROD, 55MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.66	SUP	Custom 27803010		"155.660  -  6.35MM CURVED ROD, 60MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.665	SUP	Custom 27803010		"155.665  -  6.35MM CURVED ROD, 65MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.67	SUP	Custom 27803010		"155.670  -  6.35MM CURVED ROD, 70MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.675	SUP	Custom 27803010		"155.675  -  6.35MM CURVED ROD, 75MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.68	SUP	Custom 27803010		"155.680  -  6.35MM CURVED ROD, 80MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.685	SUP	Custom 27803010		"155.685  -  6.35MM CURVED ROD, 85MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.69	SUP	Custom 27803010		"155.690  -  6.35MM CURVED ROD, 90MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.695	SUP	HCPCS C1713		"155.695  -  6.35MM CURVED ROD, 95MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
155.761	SUP	HCPCS C1713		"155.761  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.762	SUP	HCPCS C1713		"155.762  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.763	SUP	HCPCS C1713		"155.763  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.764	SUP	HCPCS C1713		"155.764  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.765	SUP	HCPCS C1713		"155.765  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.766	SUP	HCPCS C1713		"155.766  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.767	SUP	HCPCS C1713		"155.767  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.768	SUP	HCPCS C1713		"155.768  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 60MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.769	SUP	HCPCS C1713		"155.769  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 65MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.771	SUP	HCPCS C1713		"155.771  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.772	SUP	HCPCS C1713		"155.772  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.773	SUP	HCPCS C1713		"155.773  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.774	SUP	HCPCS C1713		"155.774  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.775	SUP	HCPCS C1713		"155.775  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.776	SUP	HCPCS C1713		"155.776  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.777	SUP	HCPCS C1713		"155.777  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.778	SUP	HCPCS C1713		"155.778  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 60MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.779	SUP	HCPCS C1713		"155.779  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 65MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
155.95	SUP	Custom 27803010		"155.950  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 15MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.951	SUP	Custom 27803010		"155.951  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 20MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.952	SUP	Custom 27803010		"155.952  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 25MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.953	SUP	Custom 27803010		"155.953  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 30MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.954	SUP	Custom 27803010		"155.954  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 35MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.96	SUP	Custom 27803010		"155.960  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 15MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.961	SUP	Custom 27803010		"155.961  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 20MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.962	SUP	Custom 27803010		"155.962  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 25MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.963	SUP	Custom 27803010		"155.963  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 30MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.964	SUP	Custom 27803010		"155.964  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 35MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.97	SUP	Custom 27803010		"155.970  -  BEACON 6.35MM OFFSET CONNECTOR, OPEN, 15MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.971	SUP	Custom 27803010		"155.971  -  BEACON 6.35MM OFFSET CONNECTOR, OPEN, 20MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.972	SUP	Custom 27803010		"155.972  -  BEACON 6.35MM OFFSET CONNECTOR, OPEN, 25MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.973	SUP	Custom 27803010		"155.973  -  BEACON 6.35MM OFFSET CONNECTOR, OPEN, 30MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.974	SUP	Custom 27803010		"155.974  -  BEACON 6.35 OFFSET CONNECTOR, OPEN, 35MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.98	SUP	Custom 27803010		"155.980  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 15MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.981	SUP	Custom 27803010		"155.981  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 20MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.982	SUP	Custom 27803010		"155.982  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 25MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.983	SUP	Custom 27803010		"155.983  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 30MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
155.984	SUP	Custom 27803010		"155.984  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 35MM"	BOTH IP/OP	"$1,410.00 "	"$1,043.40"	$0.00	"$1,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,046.50"	"$1,046.50"	$0.00	$0.00	$293.84	$0.00	$0.00	$0.00	$0.00	$705.00	"$1,116.72"	"$1,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
170.051	SUP	HCPCS C1713		170.051  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 25MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.052	SUP	HCPCS C1713		170.052  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.053	SUP	HCPCS C1713		170.053  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.054	SUP	HCPCS C1713		170.054  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.055	SUP	HCPCS C1713		170.055  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.056	SUP	HCPCS C1713		170.056  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.057	SUP	HCPCS C1713		170.057  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.141	SUP	HCPCS C1713		170.141  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 25MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.142	SUP	HCPCS C1713		170.142  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.143	SUP	HCPCS C1713		170.143  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.144	SUP	HCPCS C1713		170.144  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.145	SUP	HCPCS C1713		170.145  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.146	SUP	HCPCS C1713		170.146  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.147	SUP	HCPCS C1713		170.147  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.151	SUP	HCPCS C1713		170.151  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 25MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.152	SUP	HCPCS C1713		170.152  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.153	SUP	HCPCS C1713		170.153  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.154	SUP	HCPCS C1713		170.154  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.155	SUP	HCPCS C1713		170.155  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.156	SUP	HCPCS C1713		170.156  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.157	SUP	HCPCS C1713		170.157  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.161	SUP	HCPCS C1713		170.161  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 25MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.162	SUP	HCPCS C1713		170.162  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.163	SUP	HCPCS C1713		170.163  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.164	SUP	HCPCS C1713		170.164  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.165	SUP	HCPCS C1713		170.165  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.166	SUP	HCPCS C1713		170.166  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
170.167	SUP	HCPCS C1713		170.167  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.012	SUP	HCPCS C1713		"171.012  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.014	SUP	HCPCS C1713		"171.014  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.016	SUP	HCPCS C1713		"171.016  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.113	SUP	HCPCS C1713		"171.113  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 13MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
171.115	SUP	HCPCS C1713		"171.115  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 15MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
171.117	SUP	HCPCS C1713		"171.117  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 17MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
171.119	SUP	HCPCS C1713		"171.119  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 19MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
171.121	SUP	HCPCS C1713		"171.121  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 21MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
171.123	SUP	HCPCS C1713		"171.123  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 23MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
171.125	SUP	HCPCS C1713		"171.125  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
171.163	SUP	HCPCS C1713		"171.163  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 13MM, EXTRA LORDOTIC"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
171.165	SUP	HCPCS C1713		"171.165  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 15MM, EXTRA LORDOTIC"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
171.167	SUP	HCPCS C1713		"171.167  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 17MM, EXTRA LORDOTIC"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
171.169	SUP	HCPCS C1713		"171.169  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 19MM, EXTRA LORDOTIC"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
171.226	SUP	HCPCS C1713		"171.226  -  VIP CERVICAL PLATE 2-LEVEL, 26MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.228	SUP	HCPCS C1713		"171.228  -  VIP CERVICAL PLATE 2-LEVEL, 28MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.23	SUP	HCPCS C1713		"171.230  -  VIP CERVICAL PLATE 2-LEVEL, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.232	SUP	HCPCS C1713		"171.232  -  VIP CERVICAL PLATE 2-LEVEL, 32MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.234	SUP	HCPCS C1713		"171.234  -  VIP CERVICAL PLATE 2-LEVEL, 34MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.236	SUP	HCPCS C1713		"171.236  -  VIP CERVICAL PLATE 2-LEVEL, 36MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.238	SUP	HCPCS C1713		"171.238  -  VIP CERVICAL PLATE 2-LEVEL, 38MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.24	SUP	HCPCS C1713		"171.240  -  VIP CERVICAL PLATE 2-LEVEL, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.242	SUP	HCPCS C1713		"171.242  -  VIP CERVICAL PLATE 2-LEVEL, 42MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.244	SUP	HCPCS C1713		"171.244  -  VIP CERVICAL PLATE 2-LEVEL, 44MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.246	SUP	HCPCS C1713		"171.246  -  VIP CERVICAL PLATE 2-LEVEL, 46MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.276	SUP	HCPCS C1713		"171.276  -  VIP ANTERIOR CERVICAL PLATE 2-LEVEL, 26MM, EXTRA LORDOTIC"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.278	SUP	HCPCS C1713		"171.278  -  VIP ANTERIOR CERVICAL PLATE 2-LEVEL, 28MM, EXTRA LORDOTIC"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.28	SUP	HCPCS C1713		"171.280  -  VIP ANTERIOR CERVICAL PLATE 2-LEVEL, 30MM, EXTRA LORDOTIC"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.282	SUP	HCPCS C1713		"171.282  -  VIP ANTERIOR CERVICAL PLATE 2-LEVEL, 32MM, EXTRA LORDOTIC"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
171.312	SUP	HCPCS C1713		"171.312  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.314	SUP	HCPCS C1713		"171.314  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.316	SUP	HCPCS C1713		"171.316  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.318	SUP	HCPCS C1713		"171.318  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.32	SUP	HCPCS C1713		"171.320  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.322	SUP	HCPCS C1713		"171.322  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 22MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.324	SUP	HCPCS C1713		"171.324  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 24MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.326	SUP	HCPCS C1713		"171.326  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 26MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.412	SUP	HCPCS C1713		"171.412  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.414	SUP	HCPCS C1713		"171.414  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.416	SUP	HCPCS C1713		"171.416  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-DRILLING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.512	SUP	HCPCS C1713		"171.512  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.514	SUP	HCPCS C1713		"171.514  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.516	SUP	HCPCS C1713		"171.516  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.518	SUP	HCPCS C1713		"171.518  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.52	SUP	HCPCS C1713		"171.520  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.522	SUP	HCPCS C1713		"171.522  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 22MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.524	SUP	HCPCS C1713		"171.524  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 24MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.526	SUP	HCPCS C1713		"171.526  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 26MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.612	SUP	HCPCS C1713		"171.612  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.614	SUP	HCPCS C1713		"171.614  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.616	SUP	HCPCS C1713		"171.616  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.712	SUP	HCPCS C1713		"171.712  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.714	SUP	HCPCS C1713		"171.714  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.716	SUP	HCPCS C1713		"171.716  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.718	SUP	HCPCS C1713		"171.718  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.72	SUP	HCPCS C1713		"171.720  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.722	SUP	HCPCS C1713		"171.722  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 22MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.724	SUP	HCPCS C1713		"171.724  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 24MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.726	SUP	HCPCS C1713		"171.726  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 26MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.812	SUP	HCPCS C1713		"171.812  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.814	SUP	HCPCS C1713		"171.814  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.816	SUP	HCPCS C1713		"171.816  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-DRILLING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.912	SUP	HCPCS C1713		"171.912  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.914	SUP	HCPCS C1713		"171.914  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.916	SUP	HCPCS C1713		"171.916  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.918	SUP	HCPCS C1713		"171.918  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.92	SUP	HCPCS C1713		"171.920  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.922	SUP	HCPCS C1713		"171.922  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 22MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.924	SUP	HCPCS C1713		"171.924  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 24MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
171.926	SUP	HCPCS C1713		"171.926  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 26MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
172.511	SUP	Custom 27803010		"172.511  -  H-LINK 05.5MM ROD, 38MM-51MM X 40MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.512	SUP	Custom 27803010		"172.512  -  H-LINK 05.5MM ROD, 48MM-61MM X 40MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.513	SUP	Custom 27803010		"172.513  -  H-LINK 05.5MM ROD, 58MM-71MM X 40MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.521	SUP	Custom 27803010		"172.521  -  H-LINK 05.5MM ROD, 38MM-51MM X 45MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.522	SUP	Custom 27803010		"172.522  -  H-LINK 05.5MM ROD, 48MM-61MM X 45MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.523	SUP	Custom 27803010		"172.523  -  H-LINK 05.5MM ROD, 58MM-71MM X 45MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.531	SUP	Custom 27803010		"172.531  -  H-LINK 05.5MM ROD, 38MM-51MM X 35MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.532	SUP	Custom 27803010		"172.532  -  H-LINK 05.5MM ROD, 48MM-61MM X 35MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.533	SUP	Custom 27803010		"172.533  -  H-LINK 05.5MM ROD, 58MM-71MM X 35MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.581	SUP	Custom 27803010		"172.581  -  H-LINK 05.5MM ROD, 38MM-51MM X 100MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.582	SUP	Custom 27803010		"172.582  -  H-LINK 05.5MM ROD, 48MM-61MM X 100MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.583	SUP	Custom 27803010		"172.583  -  H-LINK 05.5MM ROD, 58MM-71MM X 100MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.611	SUP	Custom 27803010		"172.611  -  H-LINK 06.35MM ROD, 38MM-51MM X 40MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.612	SUP	Custom 27803010		"172.612  -  H-LINK 06.35MM ROD, 48MM-61MM X 40MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.613	SUP	Custom 27803010		"172.613  -  H-LINK 06.35MM ROD, 58MM-71MM X 40MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.621	SUP	Custom 27803010		"172.621  -  H-LINK 06.35MM ROD, 38MM-51MM X 45MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.622	SUP	Custom 27803010		"172.622  -  H-LINK 06.35MM ROD, 48MM-61MM X 45MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.623	SUP	Custom 27803010		"172.623  -  H-LINK 06.35MM ROD, 58MM-71MM X 45MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.681	SUP	Custom 27803010		"172.681  -  H-LINK 06.35MM ROD, 38MM-51MM X 100MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.682	SUP	Custom 27803010		"172.682  -  H-LINK 06.35MM ROD, 48MM-61MM X 100MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
172.683	SUP	Custom 27803010		"172.683  -  H-LINK 06.35MM ROD, 58MM-71MM X 100MM"	BOTH IP/OP	"$5,527.50 "	"$4,090.35"	$0.00	"$4,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.51"	"$4,102.51"	$0.00	$0.00	"$1,151.93"	$0.00	$0.00	$0.00	$0.00	"$2,763.75"	"$4,377.78"	"$4,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
176.12	SUP	HCPCS C1713		"176.120  -  BONE SCREW, FIXED ANGLE 5.5MM, 20MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.125	SUP	HCPCS C1713		"176.125  -  BONE SCREW, FIXED ANGLE 5.5MM, 25MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.13	SUP	HCPCS C1713		"176.130  -  BONE SCREW, FIXED ANGLE 5.5MM, 30MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.135	SUP	HCPCS C1713		"176.135  -  BONE SCREW, FIXED ANGLE 5.5MM, 35MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.14	SUP	HCPCS C1713		"176.140  -  BONE SCREW, FIXED ANGLE 5.5MM, 40MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.145	SUP	HCPCS C1713		"176.145  -  BONE SCREW, FIXED ANGLE 5.5MM, 45MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.15	SUP	HCPCS C1713		"176.150  -  BONE SCREW, FIXED ANGLE 5.5MM, 50MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.22	SUP	HCPCS C1713		"176.220  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 20MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.225	SUP	HCPCS C1713		"176.225  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 25MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.23	SUP	HCPCS C1713		"176.230  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 30MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.235	SUP	HCPCS C1713		"176.235  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 35MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.24	SUP	HCPCS C1713		"176.240  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 40MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.245	SUP	HCPCS C1713		"176.245  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 45MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
176.25	SUP	HCPCS C1713		"176.250  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 50MM"	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
182.222	SUP	HCPCS C1713		"182.222  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 22MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.224	SUP	HCPCS C1713		"182.224  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 24MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.226	SUP	HCPCS C1713		"182.226  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 26MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.228	SUP	HCPCS C1713		"182.228  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 28MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.23	SUP	HCPCS C1713		"182.230  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.232	SUP	HCPCS C1713		"182.232  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 32MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.234	SUP	HCPCS C1713		"182.234  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 34MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.236	SUP	HCPCS C1713		"182.236  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 36MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.308	SUP	HCPCS C1713		"182.308  -  3.5MM ELLIPSE POLYAXIAL SCREW, 8MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.31	SUP	HCPCS C1713		"182.310  -  3.5MM ELLIPSE POLYAXIAL SCREW, 10MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.312	SUP	HCPCS C1713		"182.312  -  3.5MM ELLIPSE POLYAXIAL SCREW, 12MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.314	SUP	HCPCS C1713		"182.314  -  3.5MM ELLIPSE POLYAXIAL SCREW, 14MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.316	SUP	HCPCS C1713		"182.316  -  3.5MM ELLIPSE POLYAXIAL SCREW, 16MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.318	SUP	HCPCS C1713		"182.318  -  3.5MM ELLIPSE POLYAXIAL SCREW, 18MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.32	SUP	HCPCS C1713		"182.320  -  3.5MM ELLIPSE POLYAXIAL SCREW, 20MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.322	SUP	HCPCS C1713		"182.322  -  3.5MM ELLIPSE POLYAXIAL SCREW, 22MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.324	SUP	HCPCS C1713		"182.324  -  3.5MM ELLIPSE POLYAXIAL SCREW, 24MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.326	SUP	HCPCS C1713		"182.326  -  3.5MM ELLIPSE POLYAXIAL SCREW, 26MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.328	SUP	HCPCS C1713		"182.328  -  3.5MM ELLIPSE POLYAXIAL SCREW, 28MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.33	SUP	HCPCS C1713		"182.330  -  3.5MM ELLIPSE POLYAXIAL SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.332	SUP	HCPCS C1713		"182.332  -  3.5MM ELLIPSE POLYAXIAL SCREW, 32MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.334	SUP	HCPCS C1713		"182.334  -  3.5MM ELLIPSE POLYAXIAL SCREW, 34MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.336	SUP	HCPCS C1713		"182.336  -  3.5MM ELLIPSE POLYAXIAL SCREW, 36MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.338	SUP	HCPCS C1713		"182.338  -  3.5MM ELLIPSE POLYAXIAL SCREW, 38MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.34	SUP	HCPCS C1713		"182.340  -  3.5MM ELLIPSE POLYAXIAL SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.342	SUP	HCPCS C1713		"182.342  -  3.5MM ELLIPSE POLYAXIAL SCREW, 42MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.344	SUP	HCPCS C1713		"182.344  -  3.5MM ELLIPSE POLYAXIAL SCREW, 44MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.346	SUP	HCPCS C1713		"182.346  -  3.5MM ELLIPSE POLYAXIAL SCREW, 46MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.348	SUP	HCPCS C1713		"182.348  -  3.5MM ELLIPSE POLYAXIAL SCREW, 48MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.35	SUP	HCPCS C1713		"182.350  -  3.5MM ELLIPSE POLYAXIAL SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.41	SUP	HCPCS C1713		"182.410  -  4.0MM ELLIPSE POLYAXIAL SCREW, 10MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.412	SUP	HCPCS C1713		"182.412  -  4.0MM ELLIPSE POLYAXIAL SCREW, 12MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.414	SUP	HCPCS C1713		"182.414  -  4.0MM ELLIPSE POLYAXIAL SCREW, 14MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.416	SUP	HCPCS C1713		"182.416  -  4.0MM ELLIPSE POLYAXIAL SCREW, 16MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.418	SUP	HCPCS C1713		"182.418  -  4.0MM ELLIPSE POLYAXIAL SCREW, 18MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.42	SUP	HCPCS C1713		"182.420  -  4.0MM ELLIPSE POLYAXIAL SCREW, 20MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.422	SUP	HCPCS C1713		"182.422  -  4.0MM ELLIPSE POLYAXIAL SCREW, 22MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.424	SUP	HCPCS C1713		"182.424  -  4.0MM ELLIPSE POLYAXIAL SCREW, 24MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.426	SUP	HCPCS C1713		"182.426  -  4.0MM ELLIPSE POLYAXIAL SCREW, 26MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.428	SUP	HCPCS C1713		"182.428  -  4.0MM ELLIPSE POLYAXIAL SCREW, 28MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.43	SUP	HCPCS C1713		"182.430  -  4.0MM ELLIPSE POLYAXIAL SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.432	SUP	HCPCS C1713		"182.432  -  4.0MM ELLIPSE POLYAXIAL SCREW, 32MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.434	SUP	HCPCS C1713		"182.434  -  4.0MM ELLIPSE POLYAXIAL SCREW, 34MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.436	SUP	HCPCS C1713		"182.436  -  4.0MM ELLIPSE POLYAXIAL SCREW, 36MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.438	SUP	HCPCS C1713		"182.438  -  4.0MM ELLIPSE POLYAXIAL SCREW, 38MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.44	SUP	HCPCS C1713		"182.440  -  4.0MM ELLIPSE POLYAXIAL SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.442	SUP	HCPCS C1713		"182.442  -  4.0MM ELLIPSE POLYAXIAL SCREW, 42MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.444	SUP	HCPCS C1713		"182.444  -  4.0MM ELLIPSE POLYAXIAL SCREW, 44MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.446	SUP	HCPCS C1713		"182.446  -  4.0MM ELLIPSE POLYAXIAL SCREW, 46MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.448	SUP	HCPCS C1713		"182.448  -  4.0MM ELLIPSE POLYAXIAL SCREW, 48MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.45	SUP	HCPCS C1713		"182.450  -  4.0MM ELLIPSE POLYAXIAL SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.5	SUP	HCPCS C1713		182.500  -  ELLIPSE LOCKING CAP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
182.501	SUP	Custom 27803010		182.501  -  ELLIPSE INLINE HOOK	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.503	SUP	Custom 27803010		"182.503  -  ELLIPSE INLINE HOOK, RIGHT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.504	SUP	Custom 27803010		"182.504  -  ELLIPSE INLINE HOOK, LEFT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.506	SUP	Custom 27803010		"182.506  -  ELLIPSE OFFSET HOOK, LEFT, 7MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.507	SUP	Custom 27803010		"182.507  -  ELLIPSE OFFSET HOOK, LEFT, 5MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.508	SUP	Custom 27803010		"182.508  -  ELLIPSE OFFSET HOOK, RIGHT, 7MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.509	SUP	Custom 27803010		"182.509  -  ELLIPSE OFFSET HOOK, RIGHT, 5MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.51	SUP	HCPCS C1713		"182.510  -  4.5MM ELLIPSE POLYAXIAL SCREW, 10MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.512	SUP	HCPCS C1713		"182.512  -  4.5MM ELLIPSE POLYAXIAL SCREW, 12MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.514	SUP	HCPCS C1713		"182.514  -  4.5MM ELLIPSE POLYAXIAL SCREW, 14MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.516	SUP	HCPCS C1713		"182.516  -  4.5MM ELLIPSE POLYAXIAL SCREW, 16MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.518	SUP	HCPCS C1713		"182.518  -  4.5MM ELLIPSE POLYAXIAL SCREW, 18MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.52	SUP	HCPCS C1713		"182.520  -  4.5MM ELLIPSE POLYAXIAL SCREW, 20MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.522	SUP	HCPCS C1713		"182.522  -  4.5MM ELLIPSE POLYAXIAL SCREW, 22MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.524	SUP	HCPCS C1713		"182.524  -  4.5MM ELLIPSE POLYAXIAL SCREW, 24MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.526	SUP	HCPCS C1713		"182.526  -  4.5MM ELLIPSE POLYAXIAL SCREW, 26MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.528	SUP	HCPCS C1713		"182.528  -  4.5MM ELLIPSE POLYAXIAL SCREW, 28MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.53	SUP	HCPCS C1713		"182.530  -  4.5MM ELLIPSE POLYAXIAL SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.532	SUP	HCPCS C1713		"182.532  -  4.5MM ELLIPSE POLYAXIAL SCREW, 32MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.534	SUP	HCPCS C1713		"182.534  -  4.5MM ELLIPSE POLYAXIAL SCREW, 34MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.536	SUP	HCPCS C1713		"182.536  -  4.5MM ELLIPSE POLYAXIAL SCREW, 36MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.538	SUP	HCPCS C1713		"182.538  -  4.5MM ELLIPSE POLYAXIAL SCREW, 38MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.54	SUP	HCPCS C1713		"182.540  -  4.5MM ELLIPSE POLYAXIAL SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.542	SUP	HCPCS C1713		"182.542  -  4.5MM ELLIPSE POLYAXIAL SCREW, 42MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.544	SUP	HCPCS C1713		"182.544  -  4.5MM ELLIPSE POLYAXIAL SCREW, 44MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.546	SUP	HCPCS C1713		"182.546  -  4.5MM ELLIPSE POLYAXIAL SCREW, 46MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.548	SUP	HCPCS C1713		"182.548  -  4.5MM ELLIPSE POLYAXIAL SCREW, 48MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.55	SUP	HCPCS C1713		"182.550  -  4.5MM ELLIPSE POLYAXIAL SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
182.801	SUP	Custom 27803010		"182.801  -  3.5MM ELLIPSE ROD, 80MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.802	SUP	Custom 27803010		"182.802  -  3.5MM ELLIPSE ROD, 120MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.803	SUP	Custom 27803010		"182.803  -  3.5MM ELLIPSE ROD, 240MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.804	SUP	Custom 27803010		"182.804  -  3.5MM ELLIPSE ROD, 40MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.9	SUP	Custom 27803010		182.900  -  ELLIPSE LOCKING CAP FOR HEAD-TO-HEAD T-CONNECTOR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.901	SUP	Custom 27803010		182.901  -  ELLIPSE LOCKING NUT FOR HEAD-TO-HEAD T-CONNECTOR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.911	SUP	Custom 27803010		"182.911  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 21-27MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.912	SUP	Custom 27803010		"182.912  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 27-33MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.913	SUP	Custom 27803010		"182.913  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 33-39MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.914	SUP	Custom 27803010		"182.914  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 39-45MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.915	SUP	Custom 27803010		"182.915  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 45-51MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.916	SUP	Custom 27803010		"182.916  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 51-57MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.917	SUP	Custom 27803010		"182.917  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 57-63MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.923	SUP	Custom 27803010		"182.923  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 21-33, STRAIG"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.924	SUP	Custom 27803010		"182.924  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 26-46, CURVED"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.925	SUP	Custom 27803010		"182.925  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 26-46, STRAIG"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.926	SUP	Custom 27803010		"182.926  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 36-56, CURVED"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.927	SUP	Custom 27803010		"182.927  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 36-56, STRAIG"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.95	SUP	HCPCS C1713		"182.950  -  ELLIPSE OCCIPITAL PLATE, SMALL"	BOTH IP/OP	"$7,145.00 "	"$5,287.30"	$0.00	"$5,716.00"	"$3,215.25"	"$3,215.25"	$0.00	$0.00	$0.00	"$1,489.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,489.02"	$0.00	"$3,522.49"	"$3,522.49"	$0.00	"$3,572.50"	"$5,658.84"	"$5,716.00"	$0.00		$0.00	"$1,118.19"	$0.00	$0.00	"$1,137.48"	$0.00	$0.00	$0.00	$0.00	$0.00
182.952	SUP	HCPCS C1713		"182.952  -  ELLIPSE OCCIPITAL PLATE, LARGE"	BOTH IP/OP	"$7,145.00 "	"$5,287.30"	$0.00	"$5,716.00"	"$3,215.25"	"$3,215.25"	$0.00	$0.00	$0.00	"$1,489.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,489.02"	$0.00	"$3,522.49"	"$3,522.49"	$0.00	"$3,572.50"	"$5,658.84"	"$5,716.00"	$0.00		$0.00	"$1,118.19"	$0.00	$0.00	"$1,137.48"	$0.00	$0.00	$0.00	$0.00	$0.00
182.953	SUP	Custom 27803010		182.953  -  ROD SPNL 100D 3.5MM 240MM ELLIPSE OCPTL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.954	SUP	Custom 27803010		182.954  -  ROD SPNL 115D 3.5MM 240MM ELLIPSE OCPTL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.955	SUP	Custom 27803010		182.955  -  ROD SPNL 130D 3.5MM 240MM ELLIPSE OCPTL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.96	SUP	Custom 27803010		182.960  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 3.5MM ROD	BOTH IP/OP	"$1,357.50 "	"$1,004.55"	$0.00	"$1,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,007.54"	"$1,007.54"	$0.00	$0.00	$282.90	$0.00	$0.00	$0.00	$0.00	$678.75	"$1,075.14"	"$1,086.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.961	SUP	Custom 27803010		182.961  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 4.0MM ROD	BOTH IP/OP	"$1,357.50 "	"$1,004.55"	$0.00	"$1,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,007.54"	"$1,007.54"	$0.00	$0.00	$282.90	$0.00	$0.00	$0.00	$0.00	$678.75	"$1,075.14"	"$1,086.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.962	SUP	Custom 27803010		182.962  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 4.5MM ROD	BOTH IP/OP	"$1,357.50 "	"$1,004.55"	$0.00	"$1,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,007.54"	"$1,007.54"	$0.00	$0.00	$282.90	$0.00	$0.00	$0.00	$0.00	$678.75	"$1,075.14"	"$1,086.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.963	SUP	Custom 27803010		182.963  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 5.0MM ROD	BOTH IP/OP	"$1,357.50 "	"$1,004.55"	$0.00	"$1,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,007.54"	"$1,007.54"	$0.00	$0.00	$282.90	$0.00	$0.00	$0.00	$0.00	$678.75	"$1,075.14"	"$1,086.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.964	SUP	Custom 27803010		182.964  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 5.5MM ROD	BOTH IP/OP	"$1,357.50 "	"$1,004.55"	$0.00	"$1,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,007.54"	"$1,007.54"	$0.00	$0.00	$282.90	$0.00	$0.00	$0.00	$0.00	$678.75	"$1,075.14"	"$1,086.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.965	SUP	Custom 27803010		182.965  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 6.0MM ROD	BOTH IP/OP	"$1,357.50 "	"$1,004.55"	$0.00	"$1,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,007.54"	"$1,007.54"	$0.00	$0.00	$282.90	$0.00	$0.00	$0.00	$0.00	$678.75	"$1,075.14"	"$1,086.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.966	SUP	Custom 27803010		182.966  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 6.35MM ROD	BOTH IP/OP	"$1,357.50 "	"$1,004.55"	$0.00	"$1,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,007.54"	"$1,007.54"	$0.00	$0.00	$282.90	$0.00	$0.00	$0.00	$0.00	$678.75	"$1,075.14"	"$1,086.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.967	SUP	Custom 27803010		182.967  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 6.5MM ROD	BOTH IP/OP	"$1,357.50 "	"$1,004.55"	$0.00	"$1,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,007.54"	"$1,007.54"	$0.00	$0.00	$282.90	$0.00	$0.00	$0.00	$0.00	$678.75	"$1,075.14"	"$1,086.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.975	SUP	Custom 27803010		182.975  -  ELLIPSE LATERAL CONNECTOR	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.98	SUP	Custom 27803010		"182.980  -  ELLIPSE TAPERED ROD, 3.5MM TO 4.0MM, 350MM"	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.981	SUP	Custom 27803010		"182.981  -  ELLIPSE TAPERED ROD, 3.5MM TO 4.5MM, 350MM"	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.982	SUP	Custom 27803010		"182.982  -  ELLIPSE TAPERED ROD, 3.5MM TO 5.0MM, 350MM"	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.983	SUP	Custom 27803010		"182.983  -  ELLIPSE TAPERED ROD, 3.5MM TO 5.5MM, 350MM"	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.984	SUP	Custom 27803010		"182.984  -  ELLIPSE TAPERED ROD, 3.5MM TO 6.0MM, 350MM"	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.985	SUP	Custom 27803010		"182.985  -  ELLIPSE TAPERED ROD, 3.5MM TO 6.35MM, 350MM"	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.986	SUP	Custom 27803010		"182.986  -  ELLIPSE TAPERED ROD, 3.5MM TO 6.5MM, 350MM"	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.989	SUP	Custom 27803010		"182.989  -  ELLIPSE TAPERED ROD, 3.5MM TO 5.5MM, 500MM"	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.99	SUP	Custom 27803010		"182.990  -  ELLIPSE LATERAL CONNECTOR, LONG"	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
182.991	SUP	Custom 27803010		"182.991  -  ELLIPSE LATERAL CONNECTOR, SHORT"	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
184.012	SUP	HCPCS C1713		"184.012  -  4.2MM BONE SCREW, VARIABLE, SELF-TAPPING, 12MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.014	SUP	HCPCS C1713		"184.014  -  4.2MM BONE SCREW, VARIABLE, SELF-TAPPING, 14MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.016	SUP	HCPCS C1713		"184.016  -  4.2MM BONE SCREW, VARIABLE, SELF-TAPPING, 16MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.018	SUP	HCPCS C1713		"184.018  -  4.2MM BONE SCREW, VARIABLE, SELF-TAPPING, 18MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.02	SUP	HCPCS C1713		184.020  -  SCREW BN 4.2MM 20MM VA ST SPNE	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.032	SUP	HCPCS C1713		"184.032  -  4.2MM BONE SCREW, FIXED, SELF-TAPPING, 12MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.034	SUP	HCPCS C1713		"184.034  -  4.2MM BONE SCREW, FIXED, SELF-TAPPING, 14MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.036	SUP	HCPCS C1713		"184.036  -  4.2MM BONE SCREW, FIXED, SELF-TAPPING, 16MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.038	SUP	HCPCS C1713		"184.038  -  4.2MM BONE SCREW, FIXED, SELF-TAPPING, 18MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.04	SUP	HCPCS C1713		184.040  -  SCREW BN 4.2MM 20MM FX ANG ST SPNE	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.052	SUP	HCPCS C1713		"184.052  -  4.2MM BONE SCREW, VARIABLE, SELF-DRILLING, 12MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.054	SUP	HCPCS C1713		"184.054  -  4.2MM BONE SCREW, VARIABLE, SELF-DRILLING, 14MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.056	SUP	HCPCS C1713		"184.056  -  4.2MM BONE SCREW, VARIABLE, SELF-DRILLING, 16MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.058	SUP	HCPCS C1713		"184.058  -  4.2MM BONE SCREW, VARIABLE, SELF-DRILLING, 18MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.06	SUP	HCPCS C1713		184.060  -  SCREW BN 4.2MM 20MM VA SLF DRL SPNE	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.072	SUP	HCPCS C1713		"184.072  -  4.2MM BONE SCREW, FIXED, SELF-DRILLING, 12MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.074	SUP	HCPCS C1713		"184.074  -  4.2MM BONE SCREW, FIXED, SELF-DRILLING, 14MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.076	SUP	HCPCS C1713		"184.076  -  4.2MM BONE SCREW, FIXED, SELF-DRILLING, 16MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.078	SUP	HCPCS C1713		"184.078  -  4.2MM BONE SCREW, FIXED, SELF-DRILLING, 18MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.08	SUP	HCPCS C1713		184.080  -  SCREW BN 4.2MM 20MM FX ANG SLF DRL SPNE	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.112	SUP	HCPCS C1713		"184.112  -  3.6MM BONE SCREW, VARIABLE, SELF-TAPPING, 12MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.114	SUP	HCPCS C1713		"184.114  -  3.6MM BONE SCREW, VARIABLE, SELF-TAPPING, 14MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.116	SUP	HCPCS C1713		"184.116  -  3.6MM BONE SCREW, VARIABLE, SELF-TAPPING, 16MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.118	SUP	HCPCS C1713		"184.118  -  3.6MM BONE SCREW, VARIABLE, SELF-TAPPING, 18MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.12	SUP	HCPCS C1713		184.120  -  SCREW BN 3.6MM 20MM VA ST SPNE	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.132	SUP	HCPCS C1713		"184.132  -  3.6MM BONE SCREW, FIXED, SELF-TAPPING, 12MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.134	SUP	HCPCS C1713		"184.134  -  3.6MM BONE SCREW, FIXED, SELF-TAPPING, 14MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.136	SUP	HCPCS C1713		"184.136  -  3.6MM BONE SCREW, FIXED, SELF-TAPPING, 16MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.138	SUP	HCPCS C1713		"184.138  -  3.6MM BONE SCREW, FIXED, SELF-TAPPING, 18MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.14	SUP	HCPCS C1713		184.140  -  SCREW BN 3.6MM 20MM FX ANG ST SPNE	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.152	SUP	HCPCS C1713		"184.152  -  3.6MM BONE SCREW, VARIABLE, SELF-DRILLING, 12MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.154	SUP	HCPCS C1713		"184.154  -  3.6MM BONE SCREW, VARIABLE, SELF-DRILLING, 14MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.156	SUP	HCPCS C1713		"184.156  -  3.6MM BONE SCREW, VARIABLE, SELF-DRILLING, 16MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.158	SUP	HCPCS C1713		"184.158  -  3.6MM BONE SCREW, VARIABLE, SELF-DRILLING, 18MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.16	SUP	HCPCS C1713		184.160  -  SCREW BN 3.6MM 20MM VA SLF DRL SPNE	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.172	SUP	HCPCS C1713		"184.172  -  3.6MM BONE SCREW, FIXED, SELF-DRILLING, 12MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.174	SUP	HCPCS C1713		"184.174  -  3.6MM BONE SCREW, FIXED, SELF-DRILLING, 14MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.176	SUP	HCPCS C1713		"184.176  -  3.6MM BONE SCREW, FIXED, SELF-DRILLING, 16MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.178	SUP	HCPCS C1713		"184.178  -  3.6MM BONE SCREW, FIXED, SELF-DRILLING, 18MM"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
184.18	SUP	HCPCS C1713		184.180  -  SCREW BN 3.6MM 20MM FX ANG SLF DRL SPNE	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
185	SUP	HCPCS C1713		185.000  -  REVOLVE LOCKING CAP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
185.081	SUP	HCPCS C1713		"185.081  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 70MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.082	SUP	HCPCS C1713		"185.082  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 75MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.083	SUP	HCPCS C1713		"185.083  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 80MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.084	SUP	HCPCS C1713		"185.084  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 85MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.085	SUP	HCPCS C1713		"185.085  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 90MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.24	SUP	Custom 27803010		"185.240  -  5.5MM REVOLVE ROD, 40MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.245	SUP	Custom 27803010		"185.245  -  5.5MM REVOLVE ROD, 45MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.25	SUP	Custom 27803010		"185.250  -  5.5MM REVOLVE ROD, 50MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.255	SUP	Custom 27803010		"185.255  -  5.5MM REVOLVE ROD, 55MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.26	SUP	Custom 27803010		"185.260  -  5.5MM REVOLVE ROD, 60MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.265	SUP	Custom 27803010		"185.265  -  5.5MM REVOLVE ROD, 65MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.27	SUP	Custom 27803010		"185.270  -  5.5MM REVOLVE ROD, 70MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.275	SUP	Custom 27803010		"185.275  -  5.5MM REVOLVE ROD, 75MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.28	SUP	Custom 27803010		"185.280  -  5.5MM REVOLVE ROD, 80MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.29	SUP	Custom 27803010		"185.290  -  5.5MM REVOLVE ROD, 90MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.3	SUP	Custom 27803010		"185.300  -  5.5MM REVOLVE ROD, 100MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.31	SUP	Custom 27803010		"185.310  -  5.5MM REVOLVE ROD, 110MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.32	SUP	Custom 27803010		"185.320  -  5.5MM REVOLVE ROD, 120MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.33	SUP	Custom 27803010		"185.330  -  5.5MM REVOLVE ROD, 130MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.34	SUP	Custom 27803010		"185.340  -  5.5MM REVOLVE ROD, 140MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.35	SUP	Custom 27803010		"185.350  -  5.5MM REVOLVE ROD, 150MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.36	SUP	Custom 27803010		"185.360  -  5.5MM REVOLVE ROD, 160MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.37	SUP	Custom 27803010		"185.370  -  5.5MM REVOLVE ROD, 170MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.38	SUP	Custom 27803010		"185.380  -  5.5MM REVOLVE ROD, 180MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.39	SUP	Custom 27803010		"185.390  -  5.5MM REVOLVE ROD, 190MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.4	SUP	Custom 27803010		"185.400  -  5.5MM REVOLVE ROD, 200MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.41	SUP	Custom 27803010		"185.410  -  5.5MM REVOLVE ROD, 210MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.42	SUP	Custom 27803010		"185.420  -  5.5MM REVOLVE ROD, 220MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.43	SUP	Custom 27803010		"185.430  -  5.5MM REVOLVE ROD, 230MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.44	SUP	Custom 27803010		"185.440  -  5.5MM REVOLVE ROD, 240MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
185.451	SUP	HCPCS C1713		"185.451  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.452	SUP	HCPCS C1713		"185.452  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.453	SUP	HCPCS C1713		"185.453  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.454	SUP	HCPCS C1713		"185.454  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.455	SUP	HCPCS C1713		"185.455  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.456	SUP	HCPCS C1713		"185.456  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.457	SUP	HCPCS C1713		"185.457  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.461	SUP	HCPCS C1713		"185.461  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.462	SUP	HCPCS C1713		"185.462  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.463	SUP	HCPCS C1713		"185.463  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.464	SUP	HCPCS C1713		"185.464  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.465	SUP	HCPCS C1713		"185.465  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.466	SUP	HCPCS C1713		"185.466  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.467	SUP	HCPCS C1713		"185.467  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.468	SUP	HCPCS C1713		"185.468  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.469	SUP	HCPCS C1713		"185.469  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.471	SUP	HCPCS C1713		"185.471  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.472	SUP	HCPCS C1713		"185.472  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.473	SUP	HCPCS C1713		"185.473  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.474	SUP	HCPCS C1713		"185.474  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.475	SUP	HCPCS C1713		"185.475  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.476	SUP	HCPCS C1713		"185.476  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.477	SUP	HCPCS C1713		"185.477  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.478	SUP	HCPCS C1713		"185.478  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.479	SUP	HCPCS C1713		"185.479  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.481	SUP	HCPCS C1713		"185.481  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.482	SUP	HCPCS C1713		"185.482  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.483	SUP	HCPCS C1713		"185.483  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.484	SUP	HCPCS C1713		"185.484  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.485	SUP	HCPCS C1713		"185.485  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.486	SUP	HCPCS C1713		"185.486  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.487	SUP	HCPCS C1713		"185.487  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.488	SUP	HCPCS C1713		"185.488  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.489	SUP	HCPCS C1713		"185.489  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
185.5	SUP	Custom 27803010		"185.500  -  5.5MM REVOLVE ROD, 300MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
192.142	SUP	HCPCS C1768		STENT URET 7FR 24CM WO GUIDEWIRE DUAL DRMTR PLRS UL HDR+	BOTH IP/OP	$356.40 	$263.74	$0.00	$285.12	$160.38	$160.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.20	$282.27	$285.12	$0.00		$0.00	$55.78	$0.00	$0.00	$56.74	$0.00	$0.00	$0.00	$0.00	$0.00
198	SUP	Custom 27203010		198  -  CATHETER SUCTION 8FR 2.6MM 12IN SOFT Y ADAPTER TACTILE	BOTH IP/OP	$32.35 	$23.94	$0.00	$25.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.01	$24.01	$0.00	$0.00	$6.74	$0.00	$0.00	$0.00	$0.00	$16.18	$25.62	$25.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
200.006	SUP	HCPCS C1713		200.006  -  SCREW BONE STANDARD 1.5MM 3MM 6MM CRCIFRM RECESS DCP	BOTH IP/OP	$54.45 	$40.29	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.35	$40.41	$40.41	$0.00	$0.00	$11.35	$0.00	$32.21	$32.21	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$7.04	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
200.007	SUP	HCPCS C1713		200.007  -  SCREW BONE STANDARD 1.5MM 3MM 7MM CRCIFRM RECESS DCP	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
200.008	SUP	HCPCS C1713		200.008  -  SCREW BONE STANDARD 1.5MM 3MM 8MM CRCIFRM RECESS DCP	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
200.009	SUP	HCPCS C1713		200.009  -  SCREW BONE STANDARD 1.5MM 3MM 9MM CRCIFRM RECESS DCP	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
200.01	SUP	HCPCS C1713		200.010  -  SCREW BONE STANDARD 1.5MM 10MM CRCIFRM RECESS DCP STAINLESS	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
200.011	SUP	HCPCS C1713		200.011  -  SCREW BONE STANDARD 1.5MM 3MM 11MM CRCIFRM RECESS DCP	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
200.012	SUP	HCPCS C1713		200.012  -  SCREW BONE STANDARD 1.5MM 3MM 12MM CRCIFRM RECESS DCP	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
200.014	SUP	HCPCS C1713		200.014  -  SCREW BONE STANDARD 1.5MM 3MM 14MM CRCIFRM RECESS DCP	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
200.016	SUP	HCPCS C1713		200.016  -  SCREW BONE STANDARD 1.5MM 3MM 16MM CRCIFRM RECESS DCP	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
200.018	SUP	HCPCS C1713		200.018  -  SCREW BONE STANDARD 1.5MM 3MM 18MM CRCIFRM RECESS DCP	BOTH IP/OP	$51.33 	$37.98	$0.00	$41.06	$23.10	$23.10	$0.00	$0.00	$0.00	$10.70	$38.09	$38.09	$0.00	$0.00	$10.70	$0.00	$30.36	$30.36	$0.00	$25.66	$40.65	$41.06	$0.00		$0.00	$8.03	$0.00	$0.00	$8.17	$0.00	$0.00	$0.00	$0.00	$0.00
200.02	SUP	HCPCS C1713		200.020  -  SCREW BONE STANDARD 1.5MM 3MM 20MM CRCIFRM RECESS DCP	BOTH IP/OP	$51.33 	$37.98	$0.00	$41.06	$23.10	$23.10	$0.00	$0.00	$0.00	$10.70	$38.09	$38.09	$0.00	$0.00	$10.70	$0.00	$30.36	$30.36	$0.00	$25.66	$40.65	$41.06	$0.00		$0.00	$8.03	$0.00	$0.00	$8.17	$0.00	$0.00	$0.00	$0.00	$0.00
200.19	SUP	Custom 27203010		200.190  -  PIN FIX 1.8MM 12MM T8 STARDRIVE RECESS BUTTRESS LCP	BOTH IP/OP	$212.90 	$157.55	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.01	$158.01	$0.00	$0.00	$44.37	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
200.191	SUP	Custom 27203010		200.191  -  PIN FIX 1.8MM 14MM T8 STARDRIVE RECESS BUTTRESS LCP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
200.192	SUP	Custom 27203010		200.192  -  PIN FIX 1.8MM 16MM T8 STARDRIVE RECESS BUTTRESS LCP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
200.193	SUP	Custom 27203010		200.193  -  PIN FIX 1.8MM 18MM T8 STARDRIVE RECESS BUTTRESS LCP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
200.195	SUP	Custom 27203010		200.195  -  PIN FIX ROUND 1.8MM 22MM T8 STARDRIVE RECESS BUTTRESS SMOOTH	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
200.197	SUP	Custom 27203010		200.197  -  PIN FIX 1.8MM 24MM BUTTRESS STARDRIVE STAINLESS STEEL	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
200.198	SUP	Custom 27203010		200.198  -  PIN FIX 1.8MM 26MM BUTTRESS STARDRIVE STAINLESS STEEL	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
200.199	SUP	Custom 27203010		200.199  -  PIN FIX 1.8MM 28MM BUTTRESS STARDRIVE STAINLESS STEEL	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
200.526	SUP	HCPCS C1713		200.526  -  SCREW BONE 1MM 1.6MM 6MM SELF TAP CRCIFRM LP HEAD STAINLESS	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
200.527	SUP	HCPCS C1713		200.527  -  SCREW BONE LP 1MM 1.6MM 7MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
200.528	SUP	HCPCS C1713		200.528  -  SCREW BONE 1MM 1.6MM 8MM SELF TAP CRCIFRM LP HEAD STAINLESS	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
200.529	SUP	HCPCS C1713		200.529  -  SCREW BONE LP 1MM 1.6MM 9MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
200.53	SUP	HCPCS C1713		200.530  -  SCREW BONE LP 1MM 1.6MM 10MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$133.05 	$98.46	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$27.73	$98.75	$98.75	$0.00	$0.00	$27.73	$0.00	$78.70	$78.70	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
200.531	SUP	HCPCS C1713		200.531  -  SCREW BONE LP 1MM 1.6MM 11MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
200.532	SUP	HCPCS C1713		200.532  -  SCREW BONE LP 1MM 1.6MM 12MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
200.533	SUP	HCPCS C1713		200.533  -  SCREW BONE 1MM 1.6MM 13MM SELF TAP CRCIFRM LP HEAD STAINLESS	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
200.534	SUP	HCPCS C1713		200.534  -  SCREW BONE LP 1MM 1.6MM 14MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
200.686	SUP	HCPCS C1713		200.686  -  SCREW BONE 1.3MM 2.4MM 6MM SELF TAP CRCIFRM RECESS LP HEAD	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
200.687	SUP	HCPCS C1713		200.687  -  SCREW BONE LP 1.3MM 2.4MM 7MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
200.688	SUP	HCPCS C1713		200.688  -  SCREW BONE LP 1.3MM 2.4MM 8MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
200.689	SUP	HCPCS C1713		200.689  -  SCREW BONE LP 1.3MM 2.4MM 9MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
200.69	SUP	HCPCS C1713		200.690  -  SCREW BONE 1.3MM 2.4MM 10MM SLFTAP CRCIFRM RECESS LP HEAD	BOTH IP/OP	$139.20 	$103.01	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.01	$103.31	$103.31	$0.00	$0.00	$29.01	$0.00	$82.34	$82.34	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
200.691	SUP	HCPCS C1713		200.691  -  SCREW BONE LP 1.3MM 2.4MM 11MM SELF TAP CRCIFRM DCP	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
200.692	SUP	HCPCS C1713		200.692  -  SCREW BONE LP 1.3MM 2.4MM 12MM SELF TAP CRCIFRM DCP	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
200.693	SUP	HCPCS C1713		200.693  -  SCREW BONE 1.3MM 2.4MM 13MM SELF TAP CRCIFRM LP HEAD	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
200.694	SUP	HCPCS C1713		200.694  -  SCREW BONE LP 1.3MM 2.4MM 14MM SELF TAP CRCIFRM DCP	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
200.696	SUP	HCPCS C1713		200.696  -  SCREW BONE LP 1.3MM 2.4MM 16MM SELF TAP CRCIFRM DCP	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
200.698	SUP	HCPCS C1713		200.698  -  SCREW BONE LP 1.3MM 2.4MM 18MM SELF TAP CRCIFRM DCP	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
200.806	SUP	HCPCS C1713		200.806  -  SCREW BONE LP 1.5MM 3MM 6MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.807	SUP	HCPCS C1713		200.807  -  SCREW BONE LP 1.5MM 3MM 7MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.808	SUP	HCPCS C1713		200.808  -  SCREW BONE LP 1.5MM 3MM 8MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.809	SUP	HCPCS C1713		200.809  -  SCREW BONE LP 1.5MM 3MM 9MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.81	SUP	HCPCS C1713		200.810  -  SCREW BONE LP 1.5MM 3MM 10MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$59.03 	$43.68	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.30	$43.81	$43.81	$0.00	$0.00	$12.30	$0.00	$34.91	$34.91	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.811	SUP	HCPCS C1713		200.811  -  SCREW BONE LP 1.5MM 3MM 11MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.812	SUP	HCPCS C1713		200.812  -  SCREW BONE LP 1.5MM 3MM 12MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.813	SUP	HCPCS C1713		200.813  -  SCREW BONE LP 1.5MM 3MM 13MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.814	SUP	HCPCS C1713		200.814  -  SCREW BONE LP 1.5MM 3MM 14MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.816	SUP	HCPCS C1713		200.816  -  SCREW BONE LP 1.5MM 3MM 16MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.818	SUP	HCPCS C1713		200.818  -  SCREW BONE LP 1.5MM 3MM 18MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.45	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.82	SUP	HCPCS C1713		200.820  -  SCREW BONE LP 1.5MM 3MM 20MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$59.03 	$43.68	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.30	$43.81	$43.81	$0.00	$0.00	$12.30	$0.00	$34.91	$34.91	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.822	SUP	HCPCS C1713		200.822  -  SCREW BONE LP 1.5MM 3MM 22MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
200.824	SUP	HCPCS C1713		200.824  -  SCREW BONE LP 1.5MM 3MM 24MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.006	SUP	HCPCS C1713		201.006  -  SCREW BN STD 2MM 3.5MM 6MM NS CRFRM SS CORT MN FRAG SET MDLR	BOTH IP/OP	$53.75 	$39.78	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$11.20	$39.89	$39.89	$0.00	$0.00	$11.20	$0.00	$31.79	$31.79	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.04	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.008	SUP	HCPCS C1713		201.008  -  SCREW BONE STANDARD 2MM 8MM CRCIFRM RECESS DCP STAINLESS	BOTH IP/OP	$53.75 	$39.78	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$11.20	$39.89	$39.89	$0.00	$0.00	$11.20	$0.00	$31.79	$31.79	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.04	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.01	SUP	HCPCS C1713		201.010  -  SCREW BONE STANDARD 2MM 10MM CRCIFRM HEAD DCP STAINLESS	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.04	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.012	SUP	HCPCS C1713		201.012  -  SCREW BONE STANDARD 2MM 3.5MM 12MM CRCIFRM RECESS DCP	BOTH IP/OP	$53.75 	$39.78	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$11.20	$39.89	$39.89	$0.00	$0.00	$11.20	$0.00	$31.79	$31.79	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.04	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.014	SUP	HCPCS C1713		201.014  -  SCREW BONE STANDARD 2MM 3.5MM 14MM CRCIFRM DCP STAINLESS	BOTH IP/OP	$53.75 	$39.78	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$11.20	$39.89	$39.89	$0.00	$0.00	$11.20	$0.00	$31.79	$31.79	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.04	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.016	SUP	HCPCS C1713		201.016  -  SCREW BONE STANDARD 2MM 3.5MM 16MM CRCIFRM RECESS DCP	BOTH IP/OP	$53.75 	$39.78	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$11.20	$39.89	$39.89	$0.00	$0.00	$11.20	$0.00	$31.79	$31.79	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.04	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.018	SUP	HCPCS C1713		201.018  -  SCREW BONE STANDARD 2MM 18MM CRCIFRM RECESS DCP STAINLESS	BOTH IP/OP	$53.75 	$39.78	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$11.20	$39.89	$39.89	$0.00	$0.00	$11.20	$0.00	$31.79	$31.79	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.02	SUP	HCPCS C1713		201.020  -  SCREW BONE STANDARD 2MM 20MM CRCIFRM RECESS DCP STAINLESS	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.022	SUP	HCPCS C1713		201.022  -  SCREW BONE STANDARD 2MM 3.5MM 22MM CRCIFRM DCP STAINLESS	BOTH IP/OP	$50.68 	$37.50	$0.00	$40.54	$22.80	$22.80	$0.00	$0.00	$0.00	$10.56	$37.61	$37.61	$0.00	$0.00	$10.56	$0.00	$29.97	$29.97	$0.00	$25.34	$40.14	$40.54	$0.00		$0.00	$7.93	$0.00	$0.00	$8.07	$0.00	$0.00	$0.00	$0.00	$0.00
201.024	SUP	HCPCS C1713		201.024  -  SCREW BONE 2MM 24MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$50.68 	$37.50	$0.00	$40.54	$22.80	$22.80	$0.00	$0.00	$0.00	$10.56	$37.61	$37.61	$0.00	$0.00	$10.56	$0.00	$29.97	$29.97	$0.00	$25.34	$40.14	$40.54	$0.00		$0.00	$7.93	$0.00	$0.00	$8.07	$0.00	$0.00	$0.00	$0.00	$0.00
201.026	SUP	HCPCS C1713		201.026  -  SCREW BONE 2MM 26MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.028	SUP	HCPCS C1713		201.028  -  SCREW BONE 2MM 28MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.03	SUP	HCPCS C1713		201.030  -  SCREW BONE 2MM 30MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.032	SUP	HCPCS C1713		201.032  -  SCREW BONE 2MM 32MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.034	SUP	HCPCS C1713		201.034  -  SCREW BONE 2MM 34MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.036	SUP	HCPCS C1713		201.036  -  SCREW BONE 2MM 36MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.038	SUP	HCPCS C1713		201.038  -  SCREW BONE 2MM 38MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.04	SUP	HCPCS C1713		201.040  -  SCREW BONE 2MM 40MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.042	SUP	HCPCS C1713		201.042  -  SCREW BONE 2MM 42MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$53.75 	$39.78	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$11.20	$39.89	$39.89	$0.00	$0.00	$11.20	$0.00	$31.79	$31.79	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.044	SUP	HCPCS C1713		201.044  -  SCREW BONE 2MM 44MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$53.75 	$39.78	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$11.20	$39.89	$39.89	$0.00	$0.00	$11.20	$0.00	$31.79	$31.79	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.046	SUP	HCPCS C1713		201.046  -  SCREW BONE 2MM 46MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$53.75 	$39.78	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$11.20	$39.89	$39.89	$0.00	$0.00	$11.20	$0.00	$31.79	$31.79	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
201.506	SUP	HCPCS C1713		201.506  -  SCREW BONE 2.4MM 3.5MM 6MM SLFTAP STAINLESS STEEL MAXILLA	BOTH IP/OP	$91.25 	$67.53	$0.00	$73.00	$41.06	$41.06	$0.00	$0.00	$0.00	$19.02	$67.73	$67.73	$0.00	$0.00	$19.02	$0.00	$53.97	$53.97	$0.00	$45.63	$72.27	$73.00	$0.00		$0.00	$14.28	$0.00	$0.00	$14.53	$0.00	$0.00	$0.00	$0.00	$0.00
201.508	SUP	HCPCS C1713		201.508  -  SCREW BONE 2.4MM 3.5MM 8MM SLFTAP STAINLESS STEEL MAXILLA	BOTH IP/OP	$91.25 	$67.53	$0.00	$73.00	$41.06	$41.06	$0.00	$0.00	$0.00	$19.02	$67.73	$67.73	$0.00	$0.00	$19.02	$0.00	$53.97	$53.97	$0.00	$45.63	$72.27	$73.00	$0.00		$0.00	$14.28	$0.00	$0.00	$14.53	$0.00	$0.00	$0.00	$0.00	$0.00
201.51	SUP	HCPCS C1713		201.510  -  SCREW BONE 2.4MM 3.5MM 10MM SLFTAP STAINLESS STEEL MAXILLA	BOTH IP/OP	$91.25 	$67.53	$0.00	$73.00	$41.06	$41.06	$0.00	$0.00	$0.00	$19.02	$67.73	$67.73	$0.00	$0.00	$19.02	$0.00	$53.97	$53.97	$0.00	$45.63	$72.27	$73.00	$0.00		$0.00	$14.28	$0.00	$0.00	$14.53	$0.00	$0.00	$0.00	$0.00	$0.00
201.512	SUP	HCPCS C1713		201.512  -  SCREW SS 12MM 2.4MM CORT MAXL SLFTAP BONE NONSTRL	BOTH IP/OP	$75.38 	$55.78	$0.00	$60.30	$33.92	$33.92	$0.00	$0.00	$0.00	$15.71	$55.94	$55.94	$0.00	$0.00	$15.71	$0.00	$44.58	$44.58	$0.00	$37.69	$59.70	$60.30	$0.00		$0.00	$11.80	$0.00	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.514	SUP	HCPCS C1713		201.514  -  SCREW BONE 2.4MM 14MM SLFTAP STAINLESS STEEL MAXILLA	BOTH IP/OP	$91.25 	$67.53	$0.00	$73.00	$41.06	$41.06	$0.00	$0.00	$0.00	$19.02	$67.73	$67.73	$0.00	$0.00	$19.02	$0.00	$53.97	$53.97	$0.00	$45.63	$72.27	$73.00	$0.00		$0.00	$14.28	$0.00	$0.00	$14.53	$0.00	$0.00	$0.00	$0.00	$0.00
201.612	SUP	HCPCS C1713		201.612  -  SCREW BONE 2.4MM 3.5MM 12MM SELF TAP CRCIFRM STAINLESS STEEL	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.614	SUP	HCPCS C1713		201.614  -  SCREW BONE 2.4MM 3.5MM 14MM SELF TAP STAINLESS STEEL CORTEX	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.616	SUP	HCPCS C1713		201.616  -  SCREW BONE 2.4MM 3.5MM 16MM SELF TAP CRCIFRM LCP STAINLESS	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.618	SUP	HCPCS C1713		201.618  -  SCREW BONE 2.4MM 3.5MM 18MM SELF TAP CRCIFRM STAINLESS STEEL	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.62	SUP	HCPCS C1713		201.620  -  SCREW BONE 2.4MM 20MM SLFTAP STAINLESS STEEL RAD CORTICAL	BOTH IP/OP	$87.35 	$64.64	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.21	$64.83	$64.83	$0.00	$0.00	$18.20	$0.00	$51.67	$51.67	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.622	SUP	HCPCS C1713		201.622  -  SCREW BONE 2.4MM 3.5MM 22MM SELF TAP CRCIFRM STAINLESS STEEL	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.624	SUP	HCPCS C1713		201.624  -  SCREW BONE 2.4MM 3.5MM 24MM SELF TAP CRCIFRM STAINLESS STEEL	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.626	SUP	HCPCS C1713		201.626  -  SCREW BONE 2.4MM 3.5MM 26MM SELF TAP CRCIFRM STAINLESS STEEL	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.628	SUP	HCPCS C1713		201.628  -  SCREW BONE 2.4MM 28MM SLFTAP STAINLESS STEEL RAD CORTICAL	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.63	SUP	HCPCS C1713		201.630  -  SCREW BONE 2.4MM 3.5MM 30MM SLFTAP CRCIFRM RECESS STAINLESS	BOTH IP/OP	$87.35 	$64.64	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.21	$64.83	$64.83	$0.00	$0.00	$18.20	$0.00	$51.67	$51.67	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.636	SUP	HCPCS C1713		201.636  -  SCREW BONE CONE LP 2.4MM 4.5MM 6MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$92.78 	$68.66	$0.00	$72.06	$40.53	$40.53	$0.00	$0.00	$0.00	$19.34	$68.86	$68.86	$0.00	$0.00	$19.33	$0.00	$54.88	$54.88	$0.00	$45.04	$71.34	$72.06	$0.00		$0.00	$13.69	$0.00	$0.00	$14.34	$0.00	$0.00	$0.00	$0.00	$0.00
201.637	SUP	HCPCS C1713		201.637  -  SCREW BONE CONE LP 2.4MM 4.5MM 7MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$92.78 	$68.66	$0.00	$72.06	$40.53	$40.53	$0.00	$0.00	$0.00	$19.34	$68.86	$68.86	$0.00	$0.00	$19.33	$0.00	$54.88	$54.88	$0.00	$45.04	$71.34	$72.06	$0.00		$0.00	$13.69	$0.00	$0.00	$14.34	$0.00	$0.00	$0.00	$0.00	$0.00
201.638	SUP	HCPCS C1713		201.638  -  SCREW BONE CONE LP 2.4MM 4.5MM 8MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.639	SUP	HCPCS C1713		201.639  -  SCREW BONE CONE LP 2.4MM 4.5MM 9MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$92.78 	$68.66	$0.00	$72.06	$40.53	$40.53	$0.00	$0.00	$0.00	$19.34	$68.86	$68.86	$0.00	$0.00	$19.33	$0.00	$54.88	$54.88	$0.00	$45.04	$71.34	$72.06	$0.00		$0.00	$13.69	$0.00	$0.00	$14.34	$0.00	$0.00	$0.00	$0.00	$0.00
201.64	SUP	HCPCS C1713		201.640  -  SCREW BONE CONE LP 2.4MM 4.5MM 10MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$87.35 	$64.64	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.21	$64.83	$64.83	$0.00	$0.00	$18.20	$0.00	$51.67	$51.67	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.641	SUP	HCPCS C1713		201.641  -  SCREW BONE CONE LP 2.4MM 4.5MM 11MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$92.78 	$68.66	$0.00	$72.06	$40.53	$40.53	$0.00	$0.00	$0.00	$19.34	$68.86	$68.86	$0.00	$0.00	$19.33	$0.00	$54.88	$54.88	$0.00	$45.04	$71.34	$72.06	$0.00		$0.00	$13.69	$0.00	$0.00	$14.34	$0.00	$0.00	$0.00	$0.00	$0.00
201.642	SUP	HCPCS C1713		201.642  -  SCREW BONE CONE LP 2.4MM 4.5MM 12MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.643	SUP	HCPCS C1713		201.643  -  SCREW BONE CONE LP 2.4MM 4.5MM 13MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$92.78 	$68.66	$0.00	$72.06	$40.53	$40.53	$0.00	$0.00	$0.00	$19.34	$68.86	$68.86	$0.00	$0.00	$19.33	$0.00	$54.88	$54.88	$0.00	$45.04	$71.34	$72.06	$0.00		$0.00	$13.69	$0.00	$0.00	$14.34	$0.00	$0.00	$0.00	$0.00	$0.00
201.644	SUP	HCPCS C1713		201.644  -  SCREW BONE CONE LP 2.4MM 4.5MM 14MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.646	SUP	HCPCS C1713		201.646  -  SCREW BONE CONE LP 2.4MM 4.5MM 16MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.648	SUP	HCPCS C1713		201.648  -  SCREW BONE CONE LP 2.4MM 4.5MM 18MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.65	SUP	HCPCS C1713		201.650  -  SCREW BONE CONE LP 2.4MM 4.5MM 20MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$87.35 	$64.64	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.21	$64.83	$64.83	$0.00	$0.00	$18.20	$0.00	$51.67	$51.67	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.652	SUP	HCPCS C1713		201.652  -  SCREW BONE CONE LP 2.4MM 4.5MM 22MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.654	SUP	HCPCS C1713		201.654  -  SCREW BONE CONE LP 2.4MM 4.5MM 24MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.656	SUP	HCPCS C1713		201.656  -  SCREW BONE CONE LP 2.4MM 4.5MM 26MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.658	SUP	HCPCS C1713		201.658  -  SCREW BONE CONE LP 2.4MM 4.5MM 28MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.66	SUP	HCPCS C1713		201.660  -  SCREW BONE CONE LP 2.4MM 4.5MM 30MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$87.35 	$64.64	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.21	$64.83	$64.83	$0.00	$0.00	$18.20	$0.00	$51.67	$51.67	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.662	SUP	HCPCS C1713		201.662  -  SCREW BONE CONE LP 2.4MM 4.5MM 32MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.664	SUP	HCPCS C1713		201.664  -  SCREW BONE CONE LP 2.4MM 4.5MM 34MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.666	SUP	HCPCS C1713		201.666  -  SCREW BONE 2.4MM 4MM 36MM SELF TAP STAINLESS STEEL SMALL	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.668	SUP	HCPCS C1713		201.668  -  SCREW BONE CONE LP 2.4MM 4.5MM 38MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$89.98 	$66.59	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.75	$66.78	$66.78	$0.00	$0.00	$18.75	$0.00	$53.22	$53.22	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.67	SUP	HCPCS C1713		201.670  -  SCREW BONE CONE LP 2.4MM 4.5MM 40MM SELF TAP THREAD CRCIFRM	BOTH IP/OP	$87.35 	$64.64	$0.00	$69.88	$39.31	$39.31	$0.00	$0.00	$0.00	$18.21	$64.83	$64.83	$0.00	$0.00	$18.20	$0.00	$51.67	$51.67	$0.00	$43.68	$69.18	$69.88	$0.00		$0.00	$13.27	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
201.676	SUP	HCPCS C1713		201.676  -  SCREW BONE 3.5MM HEAD 2.4MM 6MM SLFTAP STAINLESS STEEL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.677	SUP	HCPCS C1713		201.677  -  SCREW BONE 2.3MM 3.5MM 7MM HEAD SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.678	SUP	HCPCS C1713		201.678  -  SCREW BONE 3.5MM HEAD 2.4MM 8MM SLFTAP STAINLESS STEEL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.679	SUP	HCPCS C1713		201.679  -  SCREW BONE 2.3MM 3.5MM 9MM HEAD SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.68	SUP	HCPCS C1713		201.680  -  CLIP ANEURYSM 10MM OPENING 20X1.88MM SUPER BAYONET LATEX	BOTH IP/OP	$113.28 	$83.83	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$23.61	$84.07	$84.07	$0.00	$0.00	$23.61	$0.00	$67.00	$67.00	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.681	SUP	HCPCS C1713		201.681  -  SCREW BONE 2.3MM 3.5MM 11MM HEAD SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.683	SUP	HCPCS C1713		201.683  -  SCREW BONE 3.5MM HEAD 2.4MM 13MM SLFTAP STAINLESS STEEL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.685	SUP	HCPCS C1713		201.685  -  SCREW BONE 3.5MM HEAD 2.3MM 15MM SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.686	SUP	HCPCS C1713		201.686  -  SCREW BONE 2.3MM 3.5MM 32MM HEAD SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.687	SUP	HCPCS C1713		201.687  -  SCREW BONE 2.3MM 3.5MM 34MM HEAD SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.688	SUP	HCPCS C1713		201.688  -  SCREW BONE 2.3MM 3.5MM 36MM HEAD SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.689	SUP	HCPCS C1713		201.689  -  SCREW BONE 2.3MM 3.5MM 38MM HEAD SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.69	SUP	HCPCS C1713		201.690  -  SCREW BONE 3.5MM HEAD 2.3MM 40MM SLFTAP CORTICAL	BOTH IP/OP	$113.28 	$83.83	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$23.61	$84.07	$84.07	$0.00	$0.00	$23.61	$0.00	$67.00	$67.00	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.691	SUP	HCPCS C1713		201.691  -  SCREW BONE 2.3MM 3.5MM 42MM HEAD SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.692	SUP	HCPCS C1713		201.692  -  SCREW BONE 2.4MM 44MM SLFTAP STAINLESS STEEL CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.693	SUP	HCPCS C1713		201.693  -  SCREW BONE 2.3MM 3.5MM 46MM HEAD SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.694	SUP	HCPCS C1713		201.694  -  SCREW BONE 2.3MM 3.5MM 48MM HEAD SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.695	SUP	HCPCS C1713		201.695  -  SCREW BONE 3.5MM HEAD 2.3MM 50MM SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.696	SUP	HCPCS C1713		201.696  -  SCREW BONE 3.5MM HEAD 2.4MM 52MM SLFTAP STAINLESS STEEL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.697	SUP	HCPCS C1713		201.697  -  SCREW BONE 2.3MM 3.5MM 54MM HEAD SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.698	SUP	HCPCS C1713		201.698  -  SCREW BONE 3.5MM HEAD 2.4MM 56MM SLFTAP STAINLESS STEEL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.699	SUP	HCPCS C1713		201.699  -  SCREW BONE 2.3MM 3.5MM 58MM HEAD SLFTAP CORTICAL	BOTH IP/OP	$116.68 	$86.34	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$24.32	$86.60	$86.60	$0.00	$0.00	$24.32	$0.00	$69.01	$69.01	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.7	SUP	HCPCS C1713		201.700  -  SCREW BONE 2.4MM 3.5MM 60MM SLFTAP CRCIFRM RECESS STAINLESS	BOTH IP/OP	$113.28 	$83.83	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$23.61	$84.07	$84.07	$0.00	$0.00	$23.61	$0.00	$67.00	$67.00	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
201.756	SUP	HCPCS C1713		201.756  -  SCREW BONE T8 LP 2.4MM 4MM 6MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.757	SUP	HCPCS C1713		201.757  -  SCREW BONE T8 LP 2.4MM 4MM 7MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.758	SUP	HCPCS C1713		201.758  -  SCREW BONE T8 LP 2.4MM 4MM 8MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.759	SUP	HCPCS C1713		201.759  -  SCREW BONE T8 LP 2.4MM 4MM 9MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.76	SUP	HCPCS C1713		201.760  -  SCREW BONE T8 LP 2.4MM 4MM 10MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$102.35 	$75.74	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.33	$75.96	$75.96	$0.00	$0.00	$21.33	$0.00	$60.54	$60.54	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.761	SUP	HCPCS C1713		201.761  -  SCREW BONE T8 LP 2.4MM 4MM 11MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.762	SUP	HCPCS C1713		201.762  -  SCREW BONE T8 LP 2.4MM 4MM 12MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.763	SUP	HCPCS C1713		201.763  -  SCREW BONE T8 LP 2.4MM 4MM 13MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.764	SUP	HCPCS C1713		201.764  -  SCREW BONE T8 LP 2.4MM 4MM 14MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.766	SUP	HCPCS C1713		201.766  -  SCREW BONE 2.4MM 4MM 16MM T8 STARDRIVE SELF TAP LP HEAD VAR	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.768	SUP	HCPCS C1713		201.768  -  SCREW BONE T8 LP 2.4MM 4MM 18MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.77	SUP	HCPCS C1713		201.770  -  SCREW BONE T8 LP 2.4MM 4MM 20MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$102.35 	$75.74	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.33	$75.96	$75.96	$0.00	$0.00	$21.33	$0.00	$60.54	$60.54	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.772	SUP	HCPCS C1713		201.772  -  SCREW BONE T8 LP 2.4MM 4MM 22MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.774	SUP	HCPCS C1713		201.774  -  SCREW BONE T8 LP 2.4MM 4MM 24MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.776	SUP	HCPCS C1713		201.776  -  SCREW BONE T8 LP 2.4MM 4MM 26MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.778	SUP	HCPCS C1713		201.778  -  SCREW BONE T8 LP 2.4MM 4MM 28MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.78	SUP	HCPCS C1713		201.780  -  SCREW BONE T8 LP 2.4MM 4MM 30MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$102.35 	$75.74	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.33	$75.96	$75.96	$0.00	$0.00	$21.33	$0.00	$60.54	$60.54	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.782	SUP	HCPCS C1713		201.782  -  SCREW BONE 2.4MM 3.5MM 32MM SELF TAP CRCIFRM T8 STARDRIVE	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.784	SUP	HCPCS C1713		201.784  -  SCREW BONE T8 LP 2.4MM 4MM 34MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.786	SUP	HCPCS C1713		201.786  -  SCREW BONE T8 LP 2.4MM 4MM 36MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.788	SUP	HCPCS C1713		201.788  -  SCREW BONE 2.4MM 4MM 38MM VARIABLESELF TAPPING T8 STARDRIVE	BOTH IP/OP	$105.43 	$78.02	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.97	$78.25	$78.25	$0.00	$0.00	$21.97	$0.00	$62.36	$62.36	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.79	SUP	HCPCS C1713		201.790  -  SCREW BONE T8 LP 2.4MM 4MM 40MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$102.35 	$75.74	$0.00	$81.88	$46.06	$46.06	$0.00	$0.00	$0.00	$21.33	$75.96	$75.96	$0.00	$0.00	$21.33	$0.00	$60.54	$60.54	$0.00	$51.18	$81.06	$81.88	$0.00		$0.00	$15.55	$0.00	$0.00	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00
201.806	SUP	HCPCS C1713		201.806  -  SCREW BONE 2MM 3.5MM 6MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.807	SUP	HCPCS C1713		201.807  -  SCREW BONE 2MM 3.5MM 7MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.808	SUP	HCPCS C1713		201.808  -  SCREW BONE 2MM 3.5MM 8MM SELF TAP CRCIFRM STAINLESS STEEL FT	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.809	SUP	HCPCS C1713		201.809  -  SCREW BONE 2MM 3.5MM 9MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.81	SUP	HCPCS C1713		201.810  -  SCREW BONE 2MM 3.5MM 10MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$59.03 	$43.68	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.30	$43.81	$43.81	$0.00	$0.00	$12.30	$0.00	$34.91	$34.91	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.811	SUP	HCPCS C1713		201.811  -  SCREW BONE 2MM 3.5MM 11MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.812	SUP	HCPCS C1713		201.812  -  SCREW BONE 2MM 3.5MM 12MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.813	SUP	HCPCS C1713		201.813  -  SCREW BN 2MM 13MM NS ST SS CORT MDLR HND SYS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.814	SUP	HCPCS C1713		201.814  -  SCREW BONE 2MM 3.5MM 14MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.816	SUP	HCPCS C1713		201.816  -  SCREW BONE 2MM 3.5MM 16MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.818	SUP	HCPCS C1713		201.818  -  SCREW BONE 2MM 3.5MM 18MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.82	SUP	HCPCS C1713		201.820  -  SCREW BONE 2MM 3.5MM 20MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$59.03 	$43.68	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.30	$43.81	$43.81	$0.00	$0.00	$12.30	$0.00	$34.91	$34.91	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.822	SUP	HCPCS C1713		201.822  -  SCREW BONE 2MM 3.5MM 22MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.824	SUP	HCPCS C1713		201.824  -  SCREW BONE 2MM 3.5MM 24MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.826	SUP	HCPCS C1713		201.826  -  SCREW BONE 2MM 3.5MM 26MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.828	SUP	HCPCS C1713		201.828  -  SCREW BONE 2MM 3.5MM 28MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.83	SUP	HCPCS C1713		201.830  -  SCREW BONE 2MM 3.5MM 30MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$59.03 	$43.68	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.30	$43.81	$43.81	$0.00	$0.00	$12.30	$0.00	$34.91	$34.91	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.832	SUP	HCPCS C1713		201.832  -  SCREW BONE 2MM 3.5MM 32MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.834	SUP	HCPCS C1713		201.834  -  SCREW BONE 2MM 3.5MM 34MM SELF TAP CRCIFRM LCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.836	SUP	HCPCS C1713		201.836  -  SCREW BONE 2MM 3.5MM 36MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.838	SUP	HCPCS C1713		201.838  -  SCREW BONE 2MM 3.5MM 38MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$60.80 	$44.99	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.84	SUP	HCPCS C1713		201.840  -  SCREW BONE 2MM 3.5MM 40MM SELF TAP CRCIFRM LCP STAINLESS	BOTH IP/OP	$59.03 	$43.68	$0.00	$47.22	$26.56	$26.56	$0.00	$0.00	$0.00	$12.30	$43.81	$43.81	$0.00	$0.00	$12.30	$0.00	$34.91	$34.91	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$8.97	$0.00	$0.00	$9.40	$0.00	$0.00	$0.00	$0.00	$0.00
201.876	SUP	HCPCS C1713		201.876  -  SCREW BONE T6 2MM 6MM SELF TAP STARDRIVE LCP STAINLESS STEEL	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.877	SUP	HCPCS C1713		201.877  -  SCREW BONE T6 2MM 7MM SELF TAP STARDRIVE LCP STAINLESS STEEL	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.878	SUP	HCPCS C1713		201.878  -  SCREW BONE T6 2MM 8MM SELF TAP STARDRIVE LCP STAINLESS STEEL	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.879	SUP	HCPCS C1713		201.879  -  SCREW BONE T6 2MM 9MM SELF TAP STARDRIVE LCP STAINLESS STEEL	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.88	SUP	HCPCS C1713		201.880  -  SCREW BONE T6 2MM 10MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$208.80 	$154.51	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$43.52	$154.97	$154.97	$0.00	$0.00	$43.51	$0.00	$123.51	$123.51	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.881	SUP	HCPCS C1713		201.881  -  SCREW BONE T6 2MM 11MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.882	SUP	HCPCS C1713		201.882  -  SCREW BONE T6 2MM 12MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.883	SUP	HCPCS C1713		201.883  -  SCREW BONE T6 2MM 13MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.884	SUP	HCPCS C1713		201.884  -  SCREW BONE T6 2MM 14MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.886	SUP	HCPCS C1713		201.886  -  SCREW BONE T6 2MM 16MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.888	SUP	HCPCS C1713		201.888  -  SCREW BONE T6 2MM 18MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.89	SUP	HCPCS C1713		201.890  -  SCREW BONE T6 2MM 20MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$208.80 	$154.51	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$43.52	$154.97	$154.97	$0.00	$0.00	$43.51	$0.00	$123.51	$123.51	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.892	SUP	HCPCS C1713		201.892  -  SCREW BONE T6 2MM 22MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.894	SUP	HCPCS C1713		201.894  -  SCREW BONE T6 2MM 24MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.896	SUP	HCPCS C1713		201.896  -  SCREW BONE T6 2MM 26MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.898	SUP	HCPCS C1713		201.898  -  SCREW BONE T6 2MM 28MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.9	SUP	HCPCS C1713		201.900  -  SCREW BONE 2MM 30MM T6 STAR DRIVE RECESS SLFTAP LCP	BOTH IP/OP	$208.80 	$154.51	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$43.52	$154.97	$154.97	$0.00	$0.00	$43.51	$0.00	$123.51	$123.51	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
201.928	SUP	HCPCS C1713		201.928  -  SCREW BONE 8MM 2MM MAXFACL SS SLF DRILING IMF NONSTRL	BOTH IP/OP	$205.88 	$152.35	$0.00	$164.70	$92.64	$92.64	$0.00	$0.00	$0.00	$42.91	$152.80	$152.80	$0.00	$0.00	$42.90	$0.00	$121.78	$121.78	$0.00	$102.94	$163.06	$164.70	$0.00		$0.00	$32.22	$0.00	$0.00	$32.78	$0.00	$0.00	$0.00	$0.00	$0.00
201.962	SUP	Custom 27203010		201.962  -  PIN FIX 1.8MM 12MM BUTTRESS STAINLESS STEEL DISTAL RAD	BOTH IP/OP	$117.35 	$86.84	$0.00	$91.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.10	$87.10	$0.00	$0.00	$24.46	$0.00	$0.00	$0.00	$0.00	$56.98	$90.25	$91.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.964	SUP	Custom 27203010		201.964  -  PIN FIX 1.8MM 14MM BUTTRESS STAINLESS STEEL DISTAL RAD	BOTH IP/OP	$117.35 	$86.84	$0.00	$91.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.10	$87.10	$0.00	$0.00	$24.46	$0.00	$0.00	$0.00	$0.00	$56.98	$90.25	$91.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.966	SUP	Custom 27203010		201.966  -  PIN FIX 1.8MM 16MM BUTTRESS STAINLESS STEEL DISTAL RAD	BOTH IP/OP	$117.35 	$86.84	$0.00	$91.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.10	$87.10	$0.00	$0.00	$24.46	$0.00	$0.00	$0.00	$0.00	$56.98	$90.25	$91.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.968	SUP	Custom 27203010		201.968  -  PIN FIX 1.8MM 18MM BUTTRESS LCP STAINLESS STEEL DISTAL RAD	BOTH IP/OP	$117.35 	$86.84	$0.00	$91.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.10	$87.10	$0.00	$0.00	$24.46	$0.00	$0.00	$0.00	$0.00	$56.98	$90.25	$91.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.972	SUP	Custom 27203010		201.972  -  PIN FIX 1.8MM 22MM BUTTRESS STAINLESS STEEL DISTAL RAD	BOTH IP/OP	$117.35 	$86.84	$0.00	$91.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.10	$87.10	$0.00	$0.00	$24.46	$0.00	$0.00	$0.00	$0.00	$56.98	$90.25	$91.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.974	SUP	Custom 27203010		201.974  -  PIN FIX 1.8MM 24MM BUTTRESS STAINLESS STEEL DISTAL RAD	BOTH IP/OP	$117.35 	$86.84	$0.00	$91.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.10	$87.10	$0.00	$0.00	$24.46	$0.00	$0.00	$0.00	$0.00	$56.98	$90.25	$91.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.976	SUP	Custom 27203010		201.976  -  PIN FIX 1.8MM 26MM BUTTRESS STAINLESS STEEL DISTAL RAD	BOTH IP/OP	$117.35 	$86.84	$0.00	$91.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.10	$87.10	$0.00	$0.00	$24.46	$0.00	$0.00	$0.00	$0.00	$56.98	$90.25	$91.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.978	SUP	Custom 27203010		201.978  -  PIN FIX 1.8MM 28MM BUTTRESS STAINLESS STEEL DISTAL RAD	BOTH IP/OP	$117.35 	$86.84	$0.00	$91.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.10	$87.10	$0.00	$0.00	$24.46	$0.00	$0.00	$0.00	$0.00	$56.98	$90.25	$91.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.98	SUP	Custom 27203010		201.980  -  PIN FIX 1.8MM 30MM BUTTRESS STAINLESS STEEL DISTAL RAD	BOTH IP/OP	$113.95 	$84.32	$0.00	$91.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.57	$84.57	$0.00	$0.00	$23.75	$0.00	$0.00	$0.00	$0.00	$56.98	$90.25	$91.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
202.006	SUP	HCPCS C1713		202.006  -  SCREW BONE 2.5MM STANDARD 2.7MM 6MM SPHERICAL HEAD SMALL	BOTH IP/OP	$56.58 	$41.87	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.79	$41.99	$41.99	$0.00	$0.00	$11.79	$0.00	$33.46	$33.46	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.008	SUP	HCPCS C1713		202.008  -  SCREW BONE STANDARD 2.7MM 5MM 8MM SPHERICAL HEAD SMALL	BOTH IP/OP	$56.58 	$41.87	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.79	$41.99	$41.99	$0.00	$0.00	$11.79	$0.00	$33.46	$33.46	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.01	SUP	HCPCS C1713		202.010  -  SCREW BN STD FT 2.7MM 5MM 10MM NS 2.5MM SPHRCL HD SM HEX	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$6.67	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.012	SUP	HCPCS C1713		202.012  -  SCREW BONE STANDARD 2.7MM 5MM 12MM SPHERICAL HEAD SMALL	BOTH IP/OP	$56.58 	$41.87	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.79	$41.99	$41.99	$0.00	$0.00	$11.79	$0.00	$33.46	$33.46	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.014	SUP	HCPCS C1713		202.014  -  SCREW BONE STANDARD 2.7MM 5MM 14MM SPHERICAL HEAD SMALL	BOTH IP/OP	$56.58 	$41.87	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.79	$41.99	$41.99	$0.00	$0.00	$11.79	$0.00	$33.46	$33.46	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.016	SUP	HCPCS C1713		202.016  -  SCREW BONE STANDARD 2.7MM 5MM 16MM SPHERICAL HEAD SMALL	BOTH IP/OP	$56.58 	$41.87	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.79	$41.99	$41.99	$0.00	$0.00	$11.79	$0.00	$33.46	$33.46	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.018	SUP	HCPCS C1713		202.018  -  SCREW BONE STANDARD 2.7MM 5MM 18MM SPHERICAL HEAD SMALL	BOTH IP/OP	$56.58 	$41.87	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.79	$41.99	$41.99	$0.00	$0.00	$11.79	$0.00	$33.46	$33.46	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.02	SUP	HCPCS C1713		202.020  -  SCREW BONE STANDARD 2.7MM 5MM 20MM SPHERICAL HEAD SMALL	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.022	SUP	HCPCS C1713		202.022  -  SCREW BONE STANDARD 2.7MM 5MM 22MM SPHERICAL HEAD SMALL	BOTH IP/OP	$56.58 	$41.87	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.79	$41.99	$41.99	$0.00	$0.00	$11.79	$0.00	$33.46	$33.46	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.024	SUP	HCPCS C1713		202.024  -  SCREW BONE STANDARD 2.7MM 5MM 24MM SPHERICAL HEAD SMALL	BOTH IP/OP	$56.58 	$41.87	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.79	$41.99	$41.99	$0.00	$0.00	$11.79	$0.00	$33.46	$33.46	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.026	SUP	HCPCS C1713		202.026  -  SCREW BONE STANDARD 2.7MM 26MM DCP STAINLESS STEEL CORTICAL	BOTH IP/OP	$56.58 	$41.87	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.79	$41.99	$41.99	$0.00	$0.00	$11.79	$0.00	$33.46	$33.46	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.028	SUP	HCPCS C1713		202.028  -  SCREW BONE 2.7MM 28MM DCP SS CORT NONSTRL SM FRAG	BOTH IP/OP	$42.60 	$31.52	$0.00	$34.08	$19.17	$19.17	$0.00	$0.00	$0.00	$8.88	$31.62	$31.62	$0.00	$0.00	$8.88	$0.00	$25.20	$25.20	$0.00	$21.30	$33.74	$34.08	$0.00		$0.00	$6.67	$0.00	$0.00	$6.78	$0.00	$0.00	$0.00	$0.00	$0.00
202.03	SUP	HCPCS C1713		202.030  -  SCREW BONE 2.7MM 30MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.032	SUP	HCPCS C1713		202.032  -  SCREW BONE 2.7MM 32MM DCP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.034	SUP	HCPCS C1713		202.034  -  SCREW BONE STANDARD 2.7MM 5MM 34MM 2.5MM SMALL HEXAGON	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$6.67	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.036	SUP	HCPCS C1713		202.036  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 36MM	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.038	SUP	HCPCS C1713		202.038  -  SCREW BONE STANDARD 2.7MM 5MM 38MM 2.5MM SMALL HEXAGON	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.04	SUP	HCPCS C1713		202.040  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 40MM	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.045	SUP	HCPCS C1713		202.045  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 45MM	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.05	SUP	HCPCS C1713		202.050  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 50MM	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.055	SUP	HCPCS C1713		202.055  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 55MM	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
202.208	SUP	HCPCS C1713		202.208  -  SCREW BONE T8 2.7MM 2.1MM 8MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.21	SUP	HCPCS C1713		202.210  -  SCREW BONE 2.7MM 10MM LOCKING SLFTAP T8 STARDRIVE RECESS LCP	BOTH IP/OP	$215.63 	$159.57	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.212	SUP	HCPCS C1713		202.212  -  SCREW BONE T8 2.7MM 2.1MM 12MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.214	SUP	HCPCS C1713		202.214  -  SCREW BONE T8 2.7MM 2.1MM 14MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.216	SUP	HCPCS C1713		202.216  -  SCREW BONE 2.7MM 2.1MM 16MM T8 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.218	SUP	HCPCS C1713		202.218  -  SCREW BONE T8 2.7MM 2.1MM 18MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.22	SUP	HCPCS C1713		202.220  -  SCREW BONE T8 2.7MM 2.1MM 20MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$215.63 	$159.57	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.222	SUP	HCPCS C1713		202.222  -  SCREW BONE T8 2.7MM 2.1MM 22MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.224	SUP	HCPCS C1713		202.224  -  SCREW BONE T8 2.7MM 2.1MM 24MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.226	SUP	HCPCS C1713		202.226  -  SCREW BONE 2.7MM 26MM LOCKING SLFTAP T8 STARDRIVE RECESS LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.228	SUP	HCPCS C1713		202.228  -  SCREW BONE T8 2.7MM 2.1MM 28MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.23	SUP	HCPCS C1713		202.230  -  SCREW BONE T8 2.7MM 2.1MM 30MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$215.63 	$159.57	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.232	SUP	HCPCS C1713		202.232  -  SCREW BONE T8 2.7MM 2.1MM 32MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.234	SUP	HCPCS C1713		202.234  -  SCREW BONE T8 2.7MM 2.1MM 34MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.236	SUP	HCPCS C1713		202.236  -  SCREW BONE T8 2.7MM 2.1MM 36MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.238	SUP	HCPCS C1713		202.238  -  SCREW BONE T8 2.7MM 2.1MM 38MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.24	SUP	HCPCS C1713		202.240  -  SCREW BONE T8 2.7MM 2.1MM 40MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$215.63 	$159.57	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.242	SUP	HCPCS C1713		202.242  -  SCREW BONE 2.7MM 42MM T8 STARDRIVE RECESS SLFTAP LOCKING LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.244	SUP	HCPCS C1713		202.244  -  SCREW BONE T8 2.7MM 2.1MM 44MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.246	SUP	HCPCS C1713		202.246  -  SCREW BONE T8 2.7MM 2.1MM 46MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.248	SUP	HCPCS C1713		202.248  -  SCREW BONE T8 2.7MM 2.1MM 48MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.25	SUP	HCPCS C1713		202.250  -  SCREW BONE T8 2.7MM 2.1MM 50MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$215.63 	$159.57	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.255	SUP	HCPCS C1713		202.255  -  SCREW BONE T8 2.7MM 2.1MM 55MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.26	SUP	HCPCS C1713		202.260  -  SCREW BONE T8 2.7MM 2.1MM 60MM SELF TAP MODULAR STARDRIVE	BOTH IP/OP	$215.63 	$159.57	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
202.608	SUP	HCPCS C1713		202.608  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 8MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.609	SUP	HCPCS C1713		202.609  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 9MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.61	SUP	HCPCS C1713		202.610  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 10MM SELF DRILL SELF	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.611	SUP	HCPCS C1713		202.611  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 11MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.612	SUP	HCPCS C1713		202.612  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 12MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.613	SUP	HCPCS C1713		202.613  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 13MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.614	SUP	HCPCS C1713		202.614  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 14MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.615	SUP	HCPCS C1713		202.615  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 15MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.616	SUP	HCPCS C1713		202.616  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 16MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.617	SUP	HCPCS C1713		202.617  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 17MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.618	SUP	HCPCS C1713		202.618  -  SCREW BONE SHORT THREAD 3MM 18MM CANN STAINLESS STEEL WRIST	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.619	SUP	HCPCS C1713		202.619  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 19MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.62	SUP	HCPCS C1713		202.620  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 20MM SELF DRILL SELF	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.621	SUP	HCPCS C1713		202.621  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 21MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.622	SUP	HCPCS C1713		202.622  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 22MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.623	SUP	HCPCS C1713		202.623  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 23MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.624	SUP	HCPCS C1713		202.624  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 24MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.625	SUP	HCPCS C1713		202.625  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 25MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.626	SUP	HCPCS C1713		202.626  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 26MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.627	SUP	HCPCS C1713		202.627  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 27MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.628	SUP	HCPCS C1713		202.628  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 28MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.629	SUP	HCPCS C1713		202.629  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 29MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.63	SUP	HCPCS C1713		202.630  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 30MM SELF DRILL SELF	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.632	SUP	HCPCS C1713		202.632  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 32MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.634	SUP	HCPCS C1713		202.634  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 34MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.636	SUP	HCPCS C1713		202.636  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 36MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.638	SUP	HCPCS C1713		202.638  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 38MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.64	SUP	HCPCS C1713		202.640  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 40MM SELF DRILL SELF	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.714	SUP	HCPCS C1713		202.714  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 14MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.715	SUP	HCPCS C1713		202.715  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 15MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.716	SUP	HCPCS C1713		202.716  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 16MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.717	SUP	HCPCS C1713		202.717  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 17MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.718	SUP	HCPCS C1713		202.718  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 18MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.719	SUP	HCPCS C1713		202.719  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 19MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.72	SUP	HCPCS C1713		202.720  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 20MM SELF DRILL SELF	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.721	SUP	HCPCS C1713		202.721  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 21MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.722	SUP	HCPCS C1713		202.722  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 22MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$75.48	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.723	SUP	HCPCS C1713		202.723  -  SCREW BONE LNGTHRD 3MM 4MM 23MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.724	SUP	HCPCS C1713		202.724  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 24MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.725	SUP	HCPCS C1713		202.725  -  SCREW BONE LNGTHRD 3MM 4MM 25MM CANN CRCIFRM RECESS SLFDRILL	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.726	SUP	HCPCS C1713		202.726  -  SCREW BONE LNGTHRD 3MM 26MM CANN STAINLESS STEEL WRIST HAND	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.727	SUP	HCPCS C1713		202.727  -  SCREW BONE LNGTHRD 3MM 27MM CANN STAINLESS STEEL WRIST HAND	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.728	SUP	HCPCS C1713		202.728  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 28MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.729	SUP	HCPCS C1713		202.729  -  SCREW BONE LNGTHRD 3MM 29MM CANN STAINLESS STEEL WRIST HAND	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.73	SUP	HCPCS C1713		202.730  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 30MM SELF DRILL SELF	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.732	SUP	HCPCS C1713		202.732  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 32MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.734	SUP	HCPCS C1713		202.734  -  SCREW BONE LNGTHRD 3MM 34MM CANN STAINLESS STEEL WRIST HAND	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.736	SUP	HCPCS C1713		202.736  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 36MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.738	SUP	HCPCS C1713		202.738  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 38MM SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.74	SUP	HCPCS C1713		202.740  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 40MM SELF DRILL SELF	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
202.806	SUP	HCPCS C1713		202.806  -  SCREW BONE 2.7MM 5MM 6MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.808	SUP	HCPCS C1713		202.808  -  SCREW BONE 2.7MM 5MM 8MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.81	SUP	HCPCS C1713		202.810  -  SCREW BONE 2.7MM 5MM 10MM SLFTAP SMALL HEXAGONAL SOCKET	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.812	SUP	HCPCS C1713		202.812  -  SCREW BONE SHORT THREAD 2.7MM 12MM SLFTAP DCP STAINLESS	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.814	SUP	HCPCS C1713		202.814  -  SCREW BONE 2.7MM 5MM 14MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.816	SUP	HCPCS C1713		202.816  -  SCREW BONE 2.7MM 16MM SLFTAP LC-DCP STAINLESS STEEL CORTICAL	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.818	SUP	HCPCS C1713		202.818  -  SCREW BN FT 2.7MM 5MM 18MM NS 2.5MM ST SPHRCL HD SM HEX SCKT	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.82	SUP	HCPCS C1713		202.820  -  SCREW BONE SHORT THREAD 2.7MM 20MM SLFTAP DCP STAINLESS	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.822	SUP	HCPCS C1713		202.822  -  SCREW BONE 2.7MM 22MM SLFTAP LCP DCP STAINLESS STEEL	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.824	SUP	HCPCS C1713		202.824  -  SCREW BN FT 2.7MM 5MM 24MM NS 2.5MM ST SPHRCL HD SM HEX SCKT	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.826	SUP	HCPCS C1713		202.826  -  SCREW BONE SHORT THREAD 2.7MM 26MM SLFTAP DCP STAINLESS	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.828	SUP	HCPCS C1713		202.828  -  SCREW BONE FULTHD 2.7MM 5MM 28MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.83	SUP	HCPCS C1713		202.83  -  SCREW BONE 2.7MM 30MM LCP DCP SS CORT DISTAL RADL/TIBIAL	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$39.62	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.83	SUP	HCPCS C1713		202.830  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE 2.7MM 5MM 30MM SELF	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.832	SUP	HCPCS C1713		202.832  -  SCREW BONE 2.7MM 5MM 32MM SLFTAP SPHERICAL HEAD SMALL	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.834	SUP	HCPCS C1713		202.834  -  SCREW BONE 2.7MM 5MM 34MM SLFTAP SPHERICAL HEAD SMALL	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.836	SUP	HCPCS C1713		202.836  -  SCREW BONE 2.7MM 5MM 36MM SLFTAP SPHERICAL HEAD SMALL	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.838	SUP	HCPCS C1713		202.838  -  SCREW BONE 2.7MM 5MM 38MM SLFTAP SPHERICAL HEAD SMALL	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.84	SUP	HCPCS C1713		202.84  -  SCREW BONE 2.7MM 40MM LCP DCP SS CORT DISTAL RADL/TIBIAL	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$39.58	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.84	SUP	HCPCS C1713		202.840  -  SCREW BONE 2.7MM 40MM SLFTAP LCP DCP STAINLESS STEEL	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.842	SUP	HCPCS C1713		202.842  -  SCREW BONE 2.7MM 5MM 42MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.844	SUP	HCPCS C1713		202.844  -  SCREW BONE 2.7MM 5MM 44MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.845	SUP	HCPCS C1713		202.845  -  SCREW BONE 2.7MM 5MM 45MM SLFTAP SPHERICAL HEAD SMALL	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.846	SUP	HCPCS C1713		202.846  -  SCREW BONE 2.7MM 5MM 46MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.848	SUP	HCPCS C1713		202.848  -  SCREW BONE 2.7MM 5MM 48MM SELF TAP CRCIFRM DCP STAINLESS	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.85	SUP	HCPCS C1713		202.85  -  SCREW BONE 2.7MM 50MM LCP DCP SS CORT DISTAL RADL/TIBIAL	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$39.58	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.85	SUP	HCPCS C1713		202.850  -  SCREW BONE SHORT THREAD 2.7MM 50MM SLFTAP DCP STAINLESS	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.855	SUP	HCPCS C1713		202.855  -  SCREW BONE 2.7MM 55MM SLFTAP LCP DCP STAINLESS STEEL	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
202.87	SUP	HCPCS C1713		202.870  -  SCREW BONE T8 2.7MM 5MM 10MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$69.60 	$51.50	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.51	$51.66	$51.66	$0.00	$0.00	$14.50	$0.00	$41.17	$41.17	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.872	SUP	HCPCS C1713		202.872  -  SCREW BONE T8 2.7MM 5MM 12MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.874	SUP	HCPCS C1713		202.874  -  SCREW BONE 2.7MM 14MM T8 STARDRIVE SELF TAP LCP STAINLESS	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.876	SUP	HCPCS C1713		202.876  -  SCREW BONE 2.7MM 16MM T8 STARDRIVE RECESS SLFTAP LCP	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.878	SUP	HCPCS C1713		202.878  -  SCREW BONE T8 2.7MM 5MM 18MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.88	SUP	HCPCS C1713		202.880  -  SCREW BONE T8 2.7MM 5MM 20MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$69.60 	$51.50	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.51	$51.66	$51.66	$0.00	$0.00	$14.50	$0.00	$41.17	$41.17	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.882	SUP	HCPCS C1713		202.882  -  SCREW BONE T8 2.7MM 5MM 22MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.884	SUP	HCPCS C1713		202.884  -  SCREW BONE T8 2.7MM 5MM 24MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.886	SUP	HCPCS C1713		202.886  -  SCREW BONE T8 2.7MM 5MM 26MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.888	SUP	HCPCS C1713		202.888  -  SCREW BONE T8 2.7MM 5MM 28MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.89	SUP	HCPCS C1713		202.890  -  SCREW BONE T8 2.7MM 5MM 30MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$69.60 	$51.50	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.51	$51.66	$51.66	$0.00	$0.00	$14.50	$0.00	$41.17	$41.17	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.892	SUP	HCPCS C1713		202.892  -  SCREW BONE T8 2.7MM 5MM 32MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.894	SUP	HCPCS C1713		202.894  -  SCREW BONE T8 2.7MM 5MM 34MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.896	SUP	HCPCS C1713		202.896  -  SCREW BONE T8 2.7MM 5MM 36MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.898	SUP	HCPCS C1713		202.898  -  SCREW BONE T8 2.7MM 5MM 38MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.9	SUP	HCPCS C1713		202.900  -  SCREW BONE T8 2.7MM 5MM 40MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$69.60 	$51.50	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.51	$51.66	$51.66	$0.00	$0.00	$14.50	$0.00	$41.17	$41.17	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.962	SUP	HCPCS C1713		202.962  -  SCREW BONE T8 2.7MM 5MM 42MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.963	SUP	HCPCS C1713		202.963  -  SCREW BONE T8 2.7MM 5MM 44MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.965	SUP	HCPCS C1713		202.965  -  SCREW BONE T8 2.7MM 5MM 46MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.966	SUP	HCPCS C1713		202.966  -  SCREW BONE T8 2.7MM 5MM 48MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.967	SUP	HCPCS C1713		202.967  -  SCREW BONE T8 2.7MM 5MM 50MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.968	SUP	HCPCS C1713		202.968  -  SCREW BONE T8 2.7MM 5MM 55MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
202.969	SUP	HCPCS C1713		202.969  -  SCREW BONE T8 2.7MM 5MM 60MM VAR ANG SELF TAP MODULAR	BOTH IP/OP	$71.70 	$53.06	$0.00	$55.68	$31.32	$31.32	$0.00	$0.00	$0.00	$14.94	$53.22	$53.22	$0.00	$0.00	$14.94	$0.00	$42.41	$42.41	$0.00	$34.80	$55.12	$55.68	$0.00		$0.00	$10.58	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
204.01	SUP	HCPCS C1713		204.010  -  SCREW BONE STANDARD 3.5MM 6MM 10MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.012	SUP	HCPCS C1713		204.012  -  SCREW BONE STANDARD 3.5MM 6MM 12MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.014	SUP	HCPCS C1713		204.014  -  SCREW BONE 3.5MM 14MM SMALL HEXAGONAL SOCKET DCP LC-DCP	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.016	SUP	HCPCS C1713		204.016  -  SCREW BONE STANDARD 3.5MM 6MM 16MM HEXAGONAL SOCKET LC-DCP	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.018	SUP	HCPCS C1713		204.018  -  SCREW BONE STANDARD 3.5MM 6MM 18MM HEXAGONAL SOCKET LC-DCP	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.02	SUP	HCPCS C1713		204.020  -  SCREW BONE STANDARD 3.5MM 6MM 20MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.022	SUP	HCPCS C1713		204.022  -  SCREW BONE STANDARD SMALL HEXAGON 3.5MM 6MM 22MM SOCKET DCP	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$6.76	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.024	SUP	HCPCS C1713		204.024  -  SCREW BONE 2.5MM STANDARD 3.5MM 6MM 24MM SMALL HEXAGONAL	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.026	SUP	HCPCS C1713		204.026  -  SCREW BONE 4MM 26MM LOCKING SLFTAP STARDRIVE RECESS LCP	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.028	SUP	HCPCS C1713		204.028  -  SCREW BONE STANDARD 3.5MM 6MM 28MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.03	SUP	HCPCS C1713		204.030  -  SCREW BONE SMALL STANDARD 3.5MM 6MM 30MM HEXAGONAL SOCKET	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.032	SUP	HCPCS C1713		204.032  -  SCREW BONE STANDARD 3.5MM 6MM 32MM SLFTAP SMALL HEXAGON	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.034	SUP	HCPCS C1713		204.034  -  SCREW BONE T25 3.5MM 2.4MM 34MM LOCKING SLFTAP STARDRIVE	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.036	SUP	HCPCS C1713		204.036  -  SCREW BONE 3.5MM 36MM SMALL FRAGMENT LC-DCP STAINLESS STEEL	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.038	SUP	HCPCS C1713		204.038  -  SCREW BONE STANDARD 3.5MM 6MM 38MM SLFTAP SMALL HEXAGON	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.04	SUP	HCPCS C1713		204.040  -  SCREW BONE STANDARD 3.5MM 6MM 40MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.045	SUP	HCPCS C1713		204.045  -  SCREW BONE 2.5MM SMALL STANDARD 3.5MM 45MM SMALL HEXAGONAL	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.05	SUP	HCPCS C1713		204.050  -  SCREW BONE STANDARD 3.5MM 6MM 50MM SLFTAP SMALL HEXAGON	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.055	SUP	HCPCS C1713		204.055  -  SCREW BONE STANDARD 3.5MM 6MM 55MM HEXAGONAL SOCKET LC-DCP	BOTH IP/OP	$28.45 	$21.05	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.93	$21.12	$21.12	$0.00	$0.00	$5.93	$0.00	$16.83	$16.83	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.06	SUP	HCPCS C1713		204.060  -  SCREW BONE STANDARD 3.5MM 6MM 60MM SELF TAP SMALL HEXAGONAL	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
204.065	SUP	HCPCS C1713		204.065  -  SCREW BONE STANDARD 3.5MM 6MM 65MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$46.03 	$34.06	$0.00	$35.74	$20.10	$20.10	$0.00	$0.00	$0.00	$9.59	$34.16	$34.16	$0.00	$0.00	$9.59	$0.00	$27.22	$27.22	$0.00	$22.34	$35.39	$35.74	$0.00		$0.00	$6.79	$0.00	$0.00	$7.11	$0.00	$0.00	$0.00	$0.00	$0.00
204.07	SUP	HCPCS C1713		204.070  -  SCREW BONE STANDARD 3.5MM 6MM 70MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$44.68 	$33.06	$0.00	$35.74	$20.10	$20.10	$0.00	$0.00	$0.00	$9.31	$33.16	$33.16	$0.00	$0.00	$9.31	$0.00	$26.43	$26.43	$0.00	$22.34	$35.39	$35.74	$0.00		$0.00	$10.33	$0.00	$0.00	$7.11	$0.00	$0.00	$0.00	$0.00	$0.00
204.075	SUP	HCPCS C1713		204.075  -  SCREW BONE STANDARD 3.5MM 6MM 75MM SLFTAP SMALL HEXAGON	BOTH IP/OP	$46.03 	$34.06	$0.00	$35.74	$20.10	$20.10	$0.00	$0.00	$0.00	$9.59	$34.16	$34.16	$0.00	$0.00	$9.59	$0.00	$27.22	$27.22	$0.00	$22.34	$35.39	$35.74	$0.00		$0.00	$10.33	$0.00	$0.00	$7.11	$0.00	$0.00	$0.00	$0.00	$0.00
204.08	SUP	HCPCS C1713		204.080  -  SCREW BONE STANDARD 3.5MM 6MM 80MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$44.68 	$33.06	$0.00	$35.74	$20.10	$20.10	$0.00	$0.00	$0.00	$9.31	$33.16	$33.16	$0.00	$0.00	$9.31	$0.00	$26.43	$26.43	$0.00	$22.34	$35.39	$35.74	$0.00		$0.00	$6.79	$0.00	$0.00	$7.11	$0.00	$0.00	$0.00	$0.00	$0.00
204.085	SUP	HCPCS C1713		204.085  -  SCREW BONE STANDARD 3.5MM 6MM 85MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$46.03 	$34.06	$0.00	$35.74	$20.10	$20.10	$0.00	$0.00	$0.00	$9.59	$34.16	$34.16	$0.00	$0.00	$9.59	$0.00	$27.22	$27.22	$0.00	$22.34	$35.39	$35.74	$0.00		$0.00	$10.33	$0.00	$0.00	$7.11	$0.00	$0.00	$0.00	$0.00	$0.00
204.09	SUP	HCPCS C1713		204.090  -  SCREW BONE STANDARD 3.5MM 6MM 90MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$44.68 	$33.06	$0.00	$35.74	$20.10	$20.10	$0.00	$0.00	$0.00	$9.31	$33.16	$33.16	$0.00	$0.00	$9.31	$0.00	$26.43	$26.43	$0.00	$22.34	$35.39	$35.74	$0.00		$0.00	$6.79	$0.00	$0.00	$7.11	$0.00	$0.00	$0.00	$0.00	$0.00
204.095	SUP	HCPCS C1713		204.095  -  SCREW BONE STANDARD 3.5MM 6MM 95MM SLFTAP SMALL HEXAGON	BOTH IP/OP	$46.03 	$34.06	$0.00	$35.74	$20.10	$20.10	$0.00	$0.00	$0.00	$9.59	$34.16	$34.16	$0.00	$0.00	$9.59	$0.00	$27.22	$27.22	$0.00	$22.34	$35.39	$35.74	$0.00		$0.00	$6.79	$0.00	$0.00	$7.11	$0.00	$0.00	$0.00	$0.00	$0.00
204.1	SUP	HCPCS C1713		204.100  -  SCREW BONE 3.5MM 100MM LC-DCP STAINLESS STEEL CORTICAL	BOTH IP/OP	$44.68 	$33.06	$0.00	$35.74	$20.10	$20.10	$0.00	$0.00	$0.00	$9.31	$33.16	$33.16	$0.00	$0.00	$9.31	$0.00	$26.43	$26.43	$0.00	$22.34	$35.39	$35.74	$0.00		$0.00	$6.79	$0.00	$0.00	$7.11	$0.00	$0.00	$0.00	$0.00	$0.00
204.105	SUP	HCPCS C1713		204.105  -  SCREW BONE STANDARD 3.5MM 6MM 105MM SLFTAP SMALL HEXAGON	BOTH IP/OP	$46.03 	$34.06	$0.00	$35.74	$20.10	$20.10	$0.00	$0.00	$0.00	$9.59	$34.16	$34.16	$0.00	$0.00	$9.59	$0.00	$27.22	$27.22	$0.00	$22.34	$35.39	$35.74	$0.00		$0.00	$6.79	$0.00	$0.00	$7.11	$0.00	$0.00	$0.00	$0.00	$0.00
204.11	SUP	HCPCS C1713		204.110  -  SCREW BONE STANDARD 3.5MM 6MM 110MM SLFTAP SMALL HEXAGON	BOTH IP/OP	$44.68 	$33.06	$0.00	$35.74	$20.10	$20.10	$0.00	$0.00	$0.00	$9.31	$33.16	$33.16	$0.00	$0.00	$9.31	$0.00	$26.43	$26.43	$0.00	$22.34	$35.39	$35.74	$0.00		$0.00	$6.79	$0.00	$0.00	$7.11	$0.00	$0.00	$0.00	$0.00	$0.00
204.115	SUP	HCPCS C1713		204.115  -  SCREW BONE 3.5MM 115MM LC-DCP STAINLESS STEEL CORTICAL	BOTH IP/OP	$46.03 	$34.06	$0.00	$35.74	$20.10	$20.10	$0.00	$0.00	$0.00	$9.59	$34.16	$34.16	$0.00	$0.00	$9.59	$0.00	$27.22	$27.22	$0.00	$22.34	$35.39	$35.74	$0.00		$0.00	$6.79	$0.00	$0.00	$7.11	$0.00	$0.00	$0.00	$0.00	$0.00
204.12	SUP	HCPCS C1713		204.120  -  SCREW BONE STANDARD 3.5MM 6MM 120MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$44.68 	$33.06	$0.00	$35.74	$20.10	$20.10	$0.00	$0.00	$0.00	$9.31	$33.16	$33.16	$0.00	$0.00	$9.31	$0.00	$26.43	$26.43	$0.00	$22.34	$35.39	$35.74	$0.00		$0.00	$6.79	$0.00	$0.00	$7.11	$0.00	$0.00	$0.00	$0.00	$0.00
204.216	SUP	HCPCS C1713		204.216  -  SCREW BONE PTHRD 3.5MM 6MM 16MM 6MM SHAFT SMALL HEXAGONAL	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.218	SUP	HCPCS C1713		204.218  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 18MM 6MM SELF TAP SOCKET	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.22	SUP	HCPCS C1713		204.220  -  SCREW BONE PTHRD 3.5MM 6MM 20MM 6MM SHAFT SMALL HEXAGONAL	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.222	SUP	HCPCS C1713		204.222  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 22MM 6MM SELF TAP SOCKET	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.224	SUP	HCPCS C1713		204.224  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 24MM 10MM SELF TAP SOCKET	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.226	SUP	HCPCS C1713		204.226  -  SCREW BONE PTHRD 3.5MM 6MM 26MM 10MM SHAFT SMALL HEXAGONAL	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.228	SUP	HCPCS C1713		204.228  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 28MM 10MM SELF TAP SOCKET	BOTH IP/OP	$33.73 	$24.96	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$7.03	$25.03	$25.03	$0.00	$0.00	$7.03	$0.00	$19.95	$19.95	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.23	SUP	HCPCS C1713		204.230  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 30MM 10MM SELF TAP SOCKET	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.232	SUP	HCPCS C1713		204.232  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 32MM 12MM SELF TAP SOCKET	BOTH IP/OP	$33.73 	$24.96	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$7.03	$25.03	$25.03	$0.00	$0.00	$7.03	$0.00	$19.95	$19.95	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.234	SUP	HCPCS C1713		204.234  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 34MM 12MM SELF TAP SOCKET	BOTH IP/OP	$33.73 	$24.96	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$7.03	$25.03	$25.03	$0.00	$0.00	$7.03	$0.00	$19.95	$19.95	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.236	SUP	HCPCS C1713		204.236  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 36MM 12MM SELF TAP SOCKET	BOTH IP/OP	$33.73 	$24.96	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$7.03	$25.03	$25.03	$0.00	$0.00	$7.03	$0.00	$19.95	$19.95	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.238	SUP	HCPCS C1713		204.238  -  SCREW BONE PTHRD 3.5MM 6MM 38MM 12MM SHAFT SMALL HEXAGONAL	BOTH IP/OP	$33.73 	$24.96	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$7.03	$25.03	$25.03	$0.00	$0.00	$7.03	$0.00	$19.95	$19.95	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.24	SUP	HCPCS C1713		204.240  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 40MM 12MM SELF TAP SOCKET	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
204.245	SUP	HCPCS C1713		204.245  -  SCREW BONE 3.5MM 45MM SHAFT LC-DCP STAINLESS STEEL TIBIA	BOTH IP/OP	$31.80 	$23.53	$0.00	$25.44	$14.31	$14.31	$0.00	$0.00	$0.00	$6.63	$23.60	$23.60	$0.00	$0.00	$6.63	$0.00	$18.81	$18.81	$0.00	$15.90	$25.19	$25.44	$0.00		$0.00	$4.98	$0.00	$0.00	$5.06	$0.00	$0.00	$0.00	$0.00	$0.00
204.25	SUP	HCPCS C1713		204.250  -  SCREW BONE 3.5MM 6MM 50MM SMALL HEXAGON SOCKET DCP LC-DCP	BOTH IP/OP	$31.80 	$23.53	$0.00	$25.44	$14.31	$14.31	$0.00	$0.00	$0.00	$6.63	$23.60	$23.60	$0.00	$0.00	$6.63	$0.00	$18.81	$18.81	$0.00	$15.90	$25.19	$25.44	$0.00		$0.00	$4.98	$0.00	$0.00	$5.06	$0.00	$0.00	$0.00	$0.00	$0.00
204.64	SUP	HCPCS C1713		204.640  -  SCREW BONE 3.5MM 6MM 40MM SELF TAP SMALL HEXAGONAL SOCKET	BOTH IP/OP	$51.85 	$38.37	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$10.81	$38.48	$38.48	$0.00	$0.00	$10.81	$0.00	$30.67	$30.67	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.645	SUP	HCPCS C1713		204.645  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 45MM SELF TAP SOCKET	BOTH IP/OP	$53.43 	$39.54	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$11.14	$39.65	$39.65	$0.00	$0.00	$11.13	$0.00	$31.60	$31.60	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.65	SUP	HCPCS C1713		204.650  -  SCREW BONE 3.5MM 6MM 50MM SELF TAP SMALL HEXAGONAL SOCKET	BOTH IP/OP	$51.85 	$38.37	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$10.81	$38.48	$38.48	$0.00	$0.00	$10.81	$0.00	$30.67	$30.67	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.655	SUP	HCPCS C1713		204.655  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 55MM SELF TAP SOCKET	BOTH IP/OP	$53.43 	$39.54	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$11.14	$39.65	$39.65	$0.00	$0.00	$11.13	$0.00	$31.60	$31.60	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.66	SUP	HCPCS C1713		204.660  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 60MM SELF TAP SOCKET	BOTH IP/OP	$51.85 	$38.37	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$10.81	$38.48	$38.48	$0.00	$0.00	$10.81	$0.00	$30.67	$30.67	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.665	SUP	HCPCS C1713		204.665  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 65MM SELF TAP SOCKET	BOTH IP/OP	$53.43 	$39.54	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$11.14	$39.65	$39.65	$0.00	$0.00	$11.13	$0.00	$31.60	$31.60	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.67	SUP	HCPCS C1713		204.670  -  SCREW BONE 3.5MM 6MM 70MM SELF TAP SMALL HEXAGONAL SOCKET	BOTH IP/OP	$51.85 	$38.37	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$10.81	$38.48	$38.48	$0.00	$0.00	$10.81	$0.00	$30.67	$30.67	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.675	SUP	HCPCS C1713		204.675  -  SCREW BONE 3.5MM 6MM 75MM SELF TAP SMALL HEXAGONAL SOCKET	BOTH IP/OP	$53.43 	$39.54	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$11.14	$39.65	$39.65	$0.00	$0.00	$11.13	$0.00	$31.60	$31.60	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.68	SUP	HCPCS C1713		204.680  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 80MM SELF TAP SOCKET	BOTH IP/OP	$51.85 	$38.37	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$10.81	$38.48	$38.48	$0.00	$0.00	$10.81	$0.00	$30.67	$30.67	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.685	SUP	HCPCS C1713		204.685  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 85MM SELF TAP SOCKET	BOTH IP/OP	$53.43 	$39.54	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$11.14	$39.65	$39.65	$0.00	$0.00	$11.13	$0.00	$31.60	$31.60	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.69	SUP	HCPCS C1713		204.690  -  SCREW BONE 3.5MM 6MM 90MM SELF TAP SMALL HEXAGONAL SOCKET	BOTH IP/OP	$51.85 	$38.37	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$10.81	$38.48	$38.48	$0.00	$0.00	$10.81	$0.00	$30.67	$30.67	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.695	SUP	HCPCS C1713		204.695  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 95MM SELF TAP SOCKET	BOTH IP/OP	$53.43 	$39.54	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$11.14	$39.65	$39.65	$0.00	$0.00	$11.13	$0.00	$31.60	$31.60	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.7	SUP	HCPCS C1713		204.700  -  SCREW BONE 3.5MM 6MM 100MM SELF TAP SMALL HEXAGONAL SOCKET	BOTH IP/OP	$51.85 	$38.37	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$10.81	$38.48	$38.48	$0.00	$0.00	$10.81	$0.00	$30.67	$30.67	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.705	SUP	HCPCS C1713		204.705  -  SCREW BONE 3.5MM 6MM 105MM SELF TAP SMALL HEXAGONAL SOCKET	BOTH IP/OP	$53.43 	$39.54	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$11.14	$39.65	$39.65	$0.00	$0.00	$11.13	$0.00	$31.60	$31.60	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.71	SUP	HCPCS C1713		204.710  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 110MM SELF TAP SOCKET	BOTH IP/OP	$51.85 	$38.37	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$10.81	$38.48	$38.48	$0.00	$0.00	$10.81	$0.00	$30.67	$30.67	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.715	SUP	HCPCS C1713		204.715  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 115MM SELF TAP SOCKET	BOTH IP/OP	$53.43 	$39.54	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$11.14	$39.65	$39.65	$0.00	$0.00	$11.13	$0.00	$31.60	$31.60	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.72	SUP	HCPCS C1713		204.720  -  SCREW BONE 3.5MM 120MM SLFTAP LC-DCP STAINLESS STEEL CORTEX	BOTH IP/OP	$51.85 	$38.37	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$10.81	$38.48	$38.48	$0.00	$0.00	$10.81	$0.00	$30.67	$30.67	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.725	SUP	HCPCS C1713		204.725  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 125MM SELF TAP SOCKET	BOTH IP/OP	$53.43 	$39.54	$0.00	$41.48	$23.33	$23.33	$0.00	$0.00	$0.00	$11.14	$39.65	$39.65	$0.00	$0.00	$11.13	$0.00	$31.60	$31.60	$0.00	$25.93	$41.07	$41.48	$0.00		$0.00	$7.88	$0.00	$0.00	$8.25	$0.00	$0.00	$0.00	$0.00	$0.00
204.73	SUP	HCPCS C1713		204.730  -  SCREW BONE 3.5MM 6MM 130MM SLFTAP LP SMALL HEXAGONAL SOCKET	BOTH IP/OP	$165.13 	$122.20	$0.00	$132.10	$74.31	$74.31	$0.00	$0.00	$0.00	$34.42	$122.56	$122.56	$0.00	$0.00	$34.41	$0.00	$97.67	$97.67	$0.00	$82.56	$130.78	$132.10	$0.00		$0.00	$25.09	$0.00	$0.00	$26.29	$0.00	$0.00	$0.00	$0.00	$0.00
204.735	SUP	HCPCS C1713		204.735  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 135MM SELF TAP SOCKET	BOTH IP/OP	$170.10 	$125.87	$0.00	$132.10	$74.31	$74.31	$0.00	$0.00	$0.00	$35.45	$126.25	$126.25	$0.00	$0.00	$35.45	$0.00	$100.61	$100.61	$0.00	$82.56	$130.78	$132.10	$0.00		$0.00	$25.09	$0.00	$0.00	$26.29	$0.00	$0.00	$0.00	$0.00	$0.00
204.74	SUP	HCPCS C1713		204.740  -  SCREW BONE 3.5MM 6MM 140MM SLFTAP LP SMALL HEXAGONAL SOCKET	BOTH IP/OP	$165.13 	$122.20	$0.00	$132.10	$74.31	$74.31	$0.00	$0.00	$0.00	$34.42	$122.56	$122.56	$0.00	$0.00	$34.41	$0.00	$97.67	$97.67	$0.00	$82.56	$130.78	$132.10	$0.00		$0.00	$25.09	$0.00	$0.00	$26.29	$0.00	$0.00	$0.00	$0.00	$0.00
204.745	SUP	HCPCS C1713		204.745  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 145MM SELF TAP SOCKET	BOTH IP/OP	$170.10 	$125.87	$0.00	$132.10	$74.31	$74.31	$0.00	$0.00	$0.00	$35.45	$126.25	$126.25	$0.00	$0.00	$35.45	$0.00	$100.61	$100.61	$0.00	$82.56	$130.78	$132.10	$0.00		$0.00	$25.09	$0.00	$0.00	$26.29	$0.00	$0.00	$0.00	$0.00	$0.00
204.75	SUP	HCPCS C1713		204.750  -  SCREW BONE 3.5MM 6MM 150MM SLFTAP LP SMALL HEXAGONAL SOCKET	BOTH IP/OP	$165.13 	$122.20	$0.00	$132.10	$74.31	$74.31	$0.00	$0.00	$0.00	$34.42	$122.56	$122.56	$0.00	$0.00	$34.41	$0.00	$97.67	$97.67	$0.00	$82.56	$130.78	$132.10	$0.00		$0.00	$25.09	$0.00	$0.00	$26.29	$0.00	$0.00	$0.00	$0.00	$0.00
204.81	SUP	HCPCS C1713		204.810  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 10MM SELF TAP LC-DCP DCP	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.812	SUP	HCPCS C1713		204.812  -  SCREW BONE FULTHD 3.5MM 6MM 12MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.814	SUP	HCPCS C1713		204.814  -  SCREW BONE FULTHD 3.5MM 6MM 14MM SELF TAP SMALL HEXAGONAL	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.816	SUP	HCPCS C1713		204.816  -  SCREW BONE FULTHD 3.5MM 6MM 16MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.818	SUP	HCPCS C1713		204.818  -  SCREW BONE 3.5MM 18MM SLFTAP LCP STAINLESS STEEL CORTICAL	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.82	SUP	HCPCS C1713		204.820  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 20MM SELF TAP LC-DCP DCP	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.822	SUP	HCPCS C1713		204.822  -  SCREW BONE 3.5MM 22MM SLFTAP LCP STAINLESS STEEL CORTICAL	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.824	SUP	HCPCS C1713		204.824  -  SCREW BONE 3.5MM 24MM SLFTAP LCP STAINLESS STEEL CORTICAL	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.826	SUP	HCPCS C1713		204.826  -  SCREW BONE 3.5MM 26MM SLFTAP LCP STAINLESS STEEL CORTICAL	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.828	SUP	HCPCS C1713		204.828  -  SCREW BONE 3.5MM 28MM SLFTAP HEXAGONAL RECESS DCP LC-DCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.83	SUP	HCPCS C1713		204.830  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 30MM SELF TAP LC-DCP DCP	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.832	SUP	HCPCS C1713		204.832  -  SCREW BONE FULTHD 3.5MM 6MM 32MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.834	SUP	HCPCS C1713		204.834  -  SCREW BONE FULTHD 3.5MM 6MM 34MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.836	SUP	HCPCS C1713		204.836  -  SCREW BONE FULTHD 3.5MM 6MM 36MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.838	SUP	HCPCS C1713		204.838  -  SCREW BONE 3.5MM 38MM SLFTAP HEXAGONAL RECESS DCP LC-DCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.84	SUP	HCPCS C1713		204.840  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 40MM SELF TAP LC-DCP DCP	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.842	SUP	HCPCS C1713		204.842  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 42MM SELF TAP SOCKET DCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.844	SUP	HCPCS C1713		204.844  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 44MM SELF TAP SOCKET DCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.845	SUP	HCPCS C1713		204.845  -  SCREW BONE 3.5MM 45MM SLFTAP LCP STAINLESS STEEL CORTICAL	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.846	SUP	HCPCS C1713		204.846  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 46MM SELF TAP SOCKET DCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.848	SUP	HCPCS C1713		204.848  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 48MM SELF TAP SOCKET DCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.85	SUP	HCPCS C1713		204.850  -  SCREW BONE FULTHD 3.5MM 6MM 50MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.855	SUP	HCPCS C1713		204.855  -  SCREW BONE 3.5MM 55MM SLFTAP HEXAGONAL RECESS DCP LC-DCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.86	SUP	HCPCS C1713		204.860  -  SCREW BONE FULTHD 3.5MM 6MM 60MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.865	SUP	HCPCS C1713		204.865  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 65MM SELF TAP SOCKET DCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.87	SUP	HCPCS C1713		204.870  -  SCREW BONE FULTHD 3.5MM 6MM 70MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.875	SUP	HCPCS C1713		204.875  -  SCREW BONE FULTHD 3.5MM 6MM 75MM SLFTAP SMALL HEXAGONAL	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.88	SUP	HCPCS C1713		204.880  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 80MM SELF TAP SOCKET DCP	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.885	SUP	HCPCS C1713		204.885  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 85MM SELF TAP SOCKET DCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.89	SUP	HCPCS C1713		204.890  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 90MM SELF TAP SOCKET DCP	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$8.63	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.89	SUP	HCPCS C1713		204.89  -  SCREW BONE 3.5MM 90MM LC DCP SS CORT PROX MDL PLVC TIBIAL	BOTH IP/OP	$38.55 	$28.53	$0.00	$40.04	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$40.04	$30.84	$0.00		$0.00	$8.63	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.895	SUP	HCPCS C1713		204.895  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 95MM SELF TAP SOCKET DCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.9	SUP	HCPCS C1713		204.900  -  SCREW BONE 3.5MM 100MM SLFTAP LC-DCP STAINLESS STEEL TIBIA	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.905	SUP	HCPCS C1713		204.905  -  SCREW BONE 3.5MM 105MM SLFTAP LC-DCP STAINLESS STEEL TIBIA	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
204.91	SUP	HCPCS C1713		204.910  -  SCREW BONE 3.5MM 110MM SLFTAP LC-DCP STAINLESS STEEL TIBIA	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
205.01	SUP	HCPCS C1713		205.010  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$343.93 	$254.51	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$71.68	$255.26	$255.26	$0.00	$0.00	$71.67	$0.00	$203.43	$203.43	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.012	SUP	HCPCS C1713		205.012  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$70.23	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.014	SUP	HCPCS C1713		205.014  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.016	SUP	HCPCS C1713		205.016  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.018	SUP	HCPCS C1713		205.018  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.02	SUP	HCPCS C1713		205.020  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$343.93 	$254.51	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$71.68	$255.26	$255.26	$0.00	$0.00	$71.67	$0.00	$203.43	$203.43	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.022	SUP	HCPCS C1713		205.022  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.024	SUP	HCPCS C1713		205.024  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.026	SUP	HCPCS C1713		205.026  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.028	SUP	HCPCS C1713		205.028  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.03	SUP	HCPCS C1713		205.030  -  SCREW BONE PTHRD 3.5MM 30MM 10MM CANN HEMISPHERICAL HEAD	BOTH IP/OP	$343.93 	$254.51	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$71.68	$255.26	$255.26	$0.00	$0.00	$71.67	$0.00	$203.43	$203.43	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.032	SUP	HCPCS C1713		205.032  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.034	SUP	HCPCS C1713		205.034  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.036	SUP	HCPCS C1713		205.036  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.038	SUP	HCPCS C1713		205.038  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.04	SUP	HCPCS C1713		205.040  -  SCREW BONE PTHRD 3.5MM 40MM 13MM CANN HEMISPHERICAL HEAD	BOTH IP/OP	$343.93 	$254.51	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$71.68	$255.26	$255.26	$0.00	$0.00	$71.67	$0.00	$203.43	$203.43	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.042	SUP	HCPCS C1713		205.042  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.044	SUP	HCPCS C1713		205.044  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.046	SUP	HCPCS C1713		205.046  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.048	SUP	HCPCS C1713		205.048  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5	BOTH IP/OP	$354.23 	$262.13	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$73.83	$262.91	$262.91	$0.00	$0.00	$73.82	$0.00	$209.52	$209.52	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.05	SUP	HCPCS C1713		205.050  -  SCREW BONE PTHRD 3.5MM 50MM 16MM CANN HEMISPHERICAL HEAD	BOTH IP/OP	$343.93 	$254.51	$0.00	$275.14	$154.77	$154.77	$0.00	$0.00	$0.00	$71.68	$255.26	$255.26	$0.00	$0.00	$71.67	$0.00	$203.43	$203.43	$0.00	$171.96	$272.39	$275.14	$0.00		$0.00	$52.26	$0.00	$0.00	$54.75	$0.00	$0.00	$0.00	$0.00	$0.00
205.21	SUP	HCPCS C1713		205.210  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$353.48 	$261.58	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$73.67	$262.35	$262.35	$0.00	$0.00	$73.66	$0.00	$209.08	$209.08	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.212	SUP	HCPCS C1713		205.212  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.214	SUP	HCPCS C1713		205.214  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.216	SUP	HCPCS C1713		205.216  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.218	SUP	HCPCS C1713		205.218  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.22	SUP	HCPCS C1713		205.220  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$353.48 	$261.58	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$73.67	$262.35	$262.35	$0.00	$0.00	$73.66	$0.00	$209.08	$209.08	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$70.23	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.222	SUP	HCPCS C1713		205.222  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$70.23	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.224	SUP	HCPCS C1713		205.224  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.226	SUP	HCPCS C1713		205.226  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.228	SUP	HCPCS C1713		205.228  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$70.23	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.23	SUP	HCPCS C1713		205.230  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$353.48 	$261.58	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$73.67	$262.35	$262.35	$0.00	$0.00	$73.66	$0.00	$209.08	$209.08	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.232	SUP	HCPCS C1713		205.232  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.234	SUP	HCPCS C1713		205.234  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.236	SUP	HCPCS C1713		205.236  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.238	SUP	HCPCS C1713		205.238  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.24	SUP	HCPCS C1713		205.240  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$353.48 	$261.58	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$73.67	$262.35	$262.35	$0.00	$0.00	$73.66	$0.00	$209.08	$209.08	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.242	SUP	HCPCS C1713		205.242  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.244	SUP	HCPCS C1713		205.244  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.246	SUP	HCPCS C1713		205.246  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.248	SUP	HCPCS C1713		205.248  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$364.08 	$269.42	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$75.88	$270.22	$270.22	$0.00	$0.00	$75.87	$0.00	$215.35	$215.35	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
205.25	SUP	HCPCS C1713		205.250  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5	BOTH IP/OP	$353.48 	$261.58	$0.00	$282.78	$159.06	$159.06	$0.00	$0.00	$0.00	$73.67	$262.35	$262.35	$0.00	$0.00	$73.66	$0.00	$209.08	$209.08	$0.00	$176.74	$279.96	$282.78	$0.00		$0.00	$53.71	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$0.00
206.01	SUP	HCPCS C1713		206.010  -  SCREW BN FT 4MM 6MM 10MM NS SM HEX SCKT SS CANC SM FRAG SET	BOTH IP/OP	$31.73 	$23.48	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.01	SUP	HCPCS C1713		206.01  -  SCREW BONE 4MM 10MM LC DCP SS CANC PROX MDL TIBIAL FULTHD	BOTH IP/OP	$31.73 	$23.48	$0.00	$33.17	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$33.17	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.012	SUP	HCPCS C1713		206.012  -  SCREW BONE FULTHD 4MM 12MM FULTHRD LCP STAINLESS STEEL	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.014	SUP	HCPCS C1713		206.014  -  SCREW BONE PTHRD 4MM 6MM 14MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.016	SUP	HCPCS C1713		206.016  -  SCREW BONE PTHRD 4MM 6MM 16MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.018	SUP	HCPCS C1713		206.018  -  SCREW BONE PTHRD 4MM 6MM 18MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.02	SUP	HCPCS C1713		206.020  -  SCREW BONE PTHRD 4MM 6MM 20MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$31.73 	$23.48	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.02	SUP	HCPCS C1713		206.02  -  SCREW BONE 4MM 20MM LC DCP SS CANC PROX MDL TIBIAL FULTHD	BOTH IP/OP	$31.73 	$23.48	$0.00	$32.19	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$32.19	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.022	SUP	HCPCS C1713		206.022  -  SCREW BONE FULTHD 4MM 22MM LOCKING SLFTAP LCP STAINLESS	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.024	SUP	HCPCS C1713		206.024  -  SCREW BONE PTHRD 4MM 6MM 24MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.026	SUP	HCPCS C1713		206.026  -  SCREW BONE 2.5MM FULTHD 4MM 26MM SELF TAP HEXAGONAL SHAFT	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.028	SUP	HCPCS C1713		206.028  -  SCREW BONE 2.5MM FULTHD 4MM 28MM SELF TAP HEXAGONAL SHAFT	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.03	SUP	HCPCS C1713		206.030  -  SCREW BONE FULTHD HEXAGON 4MM 6MM 30MM SELF TAP SOCKET LCP	BOTH IP/OP	$31.73 	$23.48	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.03	SUP	HCPCS C1713		206.03  -  SCREW BONE 4MM 30MM LC DCP SS CANC PROX MDL TIBIAL FULTHD	BOTH IP/OP	$31.73 	$23.48	$0.00	$32.19	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$32.19	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.032	SUP	HCPCS C1713		206.032  -  SCREW BONE FULTHD 4MM 32MM LOCK SELF TAP LCP STAINLESS STEEL	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.035	SUP	HCPCS C1713		206.035  -  SCREW BONE 2.5MM FULTHD 4MM 35MM SELF TAP HEXAGONAL SHAFT	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.036	SUP	HCPCS C1713		206.036  -  SCREW BONE 2.5MM FULTHD 4MM 36MM SELF TAP HEXAGONAL SHAFT	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.04	SUP	HCPCS C1713		206.040  -  SCREW BONE 2.5MM FULTHD 4MM 40MM LOCKING HEXAGONAL SOCKET	BOTH IP/OP	$31.73 	$23.48	$0.00	$31.62	$17.79	$17.79	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$19.76	$25.13	$31.62	$0.00		$0.00	$6.19	$0.00	$0.00	$6.29	$0.00	$0.00	$0.00	$0.00	$0.00
206.04	SUP	HCPCS C1713		206.04  -  SCREW BONE 4MM 40MM LC DCP SS CANC PROX MDL TIBIAL FULTHD	BOTH IP/OP	$31.73 	$23.48	$0.00	$31.62	$17.79	$17.79	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$19.76	$31.31	$31.62	$0.00		$0.00	$6.19	$0.00	$0.00	$6.29	$0.00	$0.00	$0.00	$0.00	$0.00
206.045	SUP	HCPCS C1713		206.045  -  SCREW BONE FULTHD 4MM 45MM LOCKING SLFTAP LCP STAINLESS	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.05	SUP	HCPCS C1713		206.050  -  SCREW BONE FULTHD 4MM 6MM 50MM 15MM SMALL HEXOGONAL SOCKET	BOTH IP/OP	$31.73 	$23.48	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.055	SUP	HCPCS C1713		206.055  -  SCREW BONE PTHRD 4MM 6MM 55MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.06	SUP	HCPCS C1713		206.060  -  SCREW BONE FULTHD 4MM 60MM 15MM LOCKING SLFTAP LCP STAINLESS	BOTH IP/OP	$31.73 	$23.48	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$7.23	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.06	SUP	HCPCS C1713		206.06  -  SCREW BONE 4MM 60MM LC DCP SS CANC PROX MDL TIBIAL FULTHD	BOTH IP/OP	$31.73 	$23.48	$0.00	$32.19	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$32.19	$25.38	$0.00		$0.00	$7.23	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
206.065	SUP	HCPCS C1713		206.065  -  SCREW BONE FULTHD 4MM 65MM LOCKING SLFTAP LCP STAINLESS	BOTH IP/OP	$35.83 	$26.51	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.47	$26.59	$26.59	$0.00	$0.00	$7.47	$0.00	$21.19	$21.19	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
206.07	SUP	HCPCS C1713		206.070  -  SCREW BONE FULTHD 4MM 70MM LOCKING SLFTAP LCP STAINLESS	BOTH IP/OP	$34.80 	$25.75	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.25	$25.83	$25.83	$0.00	$0.00	$7.25	$0.00	$20.58	$20.58	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
206.08	SUP	HCPCS C1713		206.080  -  SCREW BONE FULTHD 4MM 80MM LOCKING SLFTAP LCP STAINLESS	BOTH IP/OP	$34.80 	$25.75	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.25	$25.83	$25.83	$0.00	$0.00	$7.25	$0.00	$20.58	$20.58	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
206.085	SUP	HCPCS C1713		206.085  -  SCREW BONE FULTHD 4MM 85MM LOCKING SLFTAP LCP STAINLESS	BOTH IP/OP	$35.83 	$26.51	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.47	$26.59	$26.59	$0.00	$0.00	$7.47	$0.00	$21.19	$21.19	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
206.09	SUP	HCPCS C1713		206.090  -  SCREW BONE FULTHD 4MM 90MM LOCKING SLFTAP LCP STAINLESS	BOTH IP/OP	$34.80 	$25.75	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.25	$25.83	$25.83	$0.00	$0.00	$7.25	$0.00	$20.58	$20.58	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
206.095	SUP	HCPCS C1713		206.095  -  SCREW BONE FULTHD 4MM 95MM LOCKING SLFTAP LCP STAINLESS	BOTH IP/OP	$35.83 	$26.51	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.47	$26.59	$26.59	$0.00	$0.00	$7.47	$0.00	$21.19	$21.19	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
206.1	SUP	HCPCS C1713		206.100  -  SCREW BONE FULTHD 4MM 100MM LOCKING SLFTAP LCP STAINLESS	BOTH IP/OP	$34.80 	$25.75	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.25	$25.83	$25.83	$0.00	$0.00	$7.25	$0.00	$20.58	$20.58	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
206.414	SUP	HCPCS C1713		206.414  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 14MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.416	SUP	HCPCS C1713		206.416  -  SCREW BONE 2.5MM SMALL FULTHD HEXAGON 4MM 6MM 16MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.418	SUP	HCPCS C1713		206.418  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 18MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.42	SUP	HCPCS C1713		206.420  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 20MM SELF TAP	BOTH IP/OP	$47.78 	$35.36	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$9.96	$35.46	$35.46	$0.00	$0.00	$9.96	$0.00	$28.26	$28.26	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.422	SUP	HCPCS C1713		206.422  -  SCREW BONE 2.5MM SMALL FULTHD HEXAGON 4MM 6MM 22MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.424	SUP	HCPCS C1713		206.424  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 24MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.426	SUP	HCPCS C1713		206.426  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 26MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.428	SUP	HCPCS C1713		206.428  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 28MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.43	SUP	HCPCS C1713		206.430  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 30MM SELF TAP	BOTH IP/OP	$47.78 	$35.36	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$9.96	$35.46	$35.46	$0.00	$0.00	$9.96	$0.00	$28.26	$28.26	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.432	SUP	HCPCS C1713		206.432  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 32MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.434	SUP	HCPCS C1713		206.434  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 34MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.436	SUP	HCPCS C1713		206.436  -  SCREW BONE 2.5MM SMALL FULTHD HEXAGON 4MM 6MM 36MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.438	SUP	HCPCS C1713		206.438  -  SCREW BONE FULTHD 4MM 6MM 38MM SLFTAP HEXAGON RECESS LCP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.44	SUP	HCPCS C1713		206.440  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 40MM SELF TAP	BOTH IP/OP	$47.78 	$35.36	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$9.96	$35.46	$35.46	$0.00	$0.00	$9.96	$0.00	$28.26	$28.26	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.442	SUP	HCPCS C1713		206.442  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 42MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.444	SUP	HCPCS C1713		206.444  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 44MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$10.24	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.446	SUP	HCPCS C1713		206.446  -  SCREW BONE 2.5MM FULTHD 4MM 6MM 46MM SELF TAP SMALL	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.448	SUP	HCPCS C1713		206.448  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 48MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.45	SUP	HCPCS C1713		206.450  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 50MM SELF TAP	BOTH IP/OP	$47.78 	$35.36	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$9.96	$35.46	$35.46	$0.00	$0.00	$9.96	$0.00	$28.26	$28.26	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.452	SUP	HCPCS C1713		206.452  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 52MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.454	SUP	HCPCS C1713		206.454  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 54MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.456	SUP	HCPCS C1713		206.456  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 56MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.458	SUP	HCPCS C1713		206.458  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 58MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.46	SUP	HCPCS C1713		206.460  -  SCREW BONE FULTHD 4MM 6MM 60MM SLFTAP HEXAGON RECESS LCP	BOTH IP/OP	$47.78 	$35.36	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$9.96	$35.46	$35.46	$0.00	$0.00	$9.96	$0.00	$28.26	$28.26	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.465	SUP	HCPCS C1713		206.465  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 65MM SELF TAP	BOTH IP/OP	$49.20 	$36.41	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$10.25	$36.52	$36.52	$0.00	$0.00	$10.25	$0.00	$29.10	$29.10	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.47	SUP	HCPCS C1713		206.470  -  SCREW BONE FULTHD 4MM 6MM 70MM SELF TAP SMALL HEXAGONAL	BOTH IP/OP	$47.78 	$35.36	$0.00	$38.22	$21.50	$21.50	$0.00	$0.00	$0.00	$9.96	$35.46	$35.46	$0.00	$0.00	$9.96	$0.00	$28.26	$28.26	$0.00	$23.89	$37.84	$38.22	$0.00		$0.00	$7.26	$0.00	$0.00	$7.61	$0.00	$0.00	$0.00	$0.00	$0.00
206.475	SUP	HCPCS C1713		206.475  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 75MM SELF TAP	BOTH IP/OP	$87.85 	$65.01	$0.00	$68.22	$38.37	$38.37	$0.00	$0.00	$0.00	$18.31	$65.20	$65.20	$0.00	$0.00	$18.31	$0.00	$51.96	$51.96	$0.00	$42.64	$67.54	$68.22	$0.00		$0.00	$12.96	$0.00	$0.00	$13.58	$0.00	$0.00	$0.00	$0.00	$0.00
206.48	SUP	HCPCS C1713		206.480  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 80MM SELF TAP	BOTH IP/OP	$85.28 	$63.11	$0.00	$68.22	$38.37	$38.37	$0.00	$0.00	$0.00	$17.77	$63.29	$63.29	$0.00	$0.00	$17.77	$0.00	$50.44	$50.44	$0.00	$42.64	$67.54	$68.22	$0.00		$0.00	$12.96	$0.00	$0.00	$13.58	$0.00	$0.00	$0.00	$0.00	$0.00
206.485	SUP	HCPCS C1713		206.485  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 85MM SELF TAP	BOTH IP/OP	$87.85 	$65.01	$0.00	$68.22	$38.37	$38.37	$0.00	$0.00	$0.00	$18.31	$65.20	$65.20	$0.00	$0.00	$18.31	$0.00	$51.96	$51.96	$0.00	$42.64	$67.54	$68.22	$0.00		$0.00	$12.96	$0.00	$0.00	$13.58	$0.00	$0.00	$0.00	$0.00	$0.00
206.49	SUP	HCPCS C1713		206.490  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 90MM SELF TAP	BOTH IP/OP	$85.28 	$63.11	$0.00	$68.22	$38.37	$38.37	$0.00	$0.00	$0.00	$17.77	$63.29	$63.29	$0.00	$0.00	$17.77	$0.00	$50.44	$50.44	$0.00	$42.64	$67.54	$68.22	$0.00		$0.00	$12.96	$0.00	$0.00	$13.58	$0.00	$0.00	$0.00	$0.00	$0.00
206.495	SUP	HCPCS C1713		206.495  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 95MM SELF TAP	BOTH IP/OP	$87.85 	$65.01	$0.00	$68.22	$38.37	$38.37	$0.00	$0.00	$0.00	$18.31	$65.20	$65.20	$0.00	$0.00	$18.31	$0.00	$51.96	$51.96	$0.00	$42.64	$67.54	$68.22	$0.00		$0.00	$12.96	$0.00	$0.00	$13.58	$0.00	$0.00	$0.00	$0.00	$0.00
206.5	SUP	HCPCS C1713		206.500  -  SCREW BONE 4MM 100MM SLFTAP STAINLESS STEEL CORTICAL NONSTRL	BOTH IP/OP	$85.28 	$63.11	$0.00	$68.22	$38.37	$38.37	$0.00	$0.00	$0.00	$17.77	$63.29	$63.29	$0.00	$0.00	$17.77	$0.00	$50.44	$50.44	$0.00	$42.64	$67.54	$68.22	$0.00		$0.00	$12.96	$0.00	$0.00	$13.58	$0.00	$0.00	$0.00	$0.00	$0.00
207.01	SUP	HCPCS C1713		207.010  -  SCREW BONE PTHRD 4MM 2.5MM 10MM 7MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$30.03 	$22.22	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.012	SUP	HCPCS C1713		207.012  -  SCREW BONE PTHRD 4MM 2.5MM 12MM 7MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$7.23	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.014	SUP	HCPCS C1713		207.014  -  SCREW BONE PTHRD 4MM 14MM 5MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.016	SUP	HCPCS C1713		207.016  -  SCREW BONE PTHRD 4MM 16MM 6MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.018	SUP	HCPCS C1713		207.018  -  SCREW BONE PTHRD 4MM 2.5MM 18MM 7MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.02	SUP	HCPCS C1713		207.020  -  SCREW BONE PTHRD 4MM 20MM LCP STAINLESS STEEL CANCELLOUS RAD	BOTH IP/OP	$30.03 	$22.22	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.02	SUP	HCPCS C1713		207.02  -  SCREW BONE 4MM 20MM LC DCP SS CANC PROX MDL TIBIAL P/T NSTRL	BOTH IP/OP	$30.03 	$22.22	$0.00	$32.19	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$32.19	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.022	SUP	HCPCS C1713		207.022  -  SCREW BONE PTHRD 4MM 22MM 9MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.024	SUP	HCPCS C1713		207.024  -  SCREW BONE PTHRD 4MM 24MM 10MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.026	SUP	HCPCS C1713		207.026  -  SCREW BONE PTHRD 4MM 26MM 12MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.028	SUP	HCPCS C1713		207.028  -  SCREW BONE PTHRD 4MM 28MM 14MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.03	SUP	HCPCS C1713		207.030  -  SCREW BONE PTHRD 4MM 30MM 6MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$30.03 	$22.22	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.035	SUP	HCPCS C1713		207.035  -  SCREW BONE PTHRD 4MM 35MM LCP STAINLESS STEEL CANCELLOUS RAD	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.04	SUP	HCPCS C1713		207.040  -  SCREW BONE PTHRD 4MM 40MM 14MM SMALL HEXAGONAL SOCKET LCP	BOTH IP/OP	$30.03 	$22.22	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.045	SUP	HCPCS C1713		207.045  -  SCREW BONE PTHRD 4MM 45MM SELF TAP HEXAGONAL SHAFT LC-DCP	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.05	SUP	HCPCS C1713		207.050  -  SCREW BONE 4MM 50MM LCP SS PTHRD CANC TIB NONSTRL SM FRAG	BOTH IP/OP	$30.03 	$22.22	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.055	SUP	HCPCS C1713		207.055  -  SCREW BONE SMALL HEXAGON 4MM 6MM 55MM 15MM SOCKET LCP	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.06	SUP	HCPCS C1713		207.060  -  SCREW BONE SMALL HEXAGON 4MM 6MM 60MM 15MM SOCKET LCP	BOTH IP/OP	$30.03 	$22.22	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
207.065	SUP	HCPCS C1713		207.065  -  SCREW BONE PTHRD 4MM 65MM PTHRD LCP STAINLESS STEEL	BOTH IP/OP	$35.15 	$26.01	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.33	$26.09	$26.09	$0.00	$0.00	$7.33	$0.00	$20.79	$20.79	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
207.07	SUP	HCPCS C1713		207.070  -  SCREW BONE PTHRD 4MM 70MM PTTHRD LCP STAINLESS STEEL	BOTH IP/OP	$34.13 	$25.26	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.11	$25.33	$25.33	$0.00	$0.00	$7.11	$0.00	$20.18	$20.18	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
207.075	SUP	HCPCS C1713		207.075  -  SCREW BONE PTHRD 4MM 75MM PTHRD LCP STAINLESS STEEL	BOTH IP/OP	$35.15 	$26.01	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.33	$26.09	$26.09	$0.00	$0.00	$7.33	$0.00	$20.79	$20.79	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
207.08	SUP	HCPCS C1713		207.080  -  SCREW BONE PTHRD 4MM 80MM PTTHRD LCP STAINLESS STEEL	BOTH IP/OP	$34.13 	$25.26	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.11	$25.33	$25.33	$0.00	$0.00	$7.11	$0.00	$20.18	$20.18	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
207.085	SUP	HCPCS C1713		207.085  -  SCREW BONE 4MM 85MM PTHRD LC-DCP DCP STAINLESS STEEL	BOTH IP/OP	$35.15 	$26.01	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.33	$26.09	$26.09	$0.00	$0.00	$7.33	$0.00	$20.79	$20.79	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
207.09	SUP	HCPCS C1713		207.090  -  SCREW BONE PTHRD 4MM 90MM PTTHRD LCP STAINLESS STEEL	BOTH IP/OP	$34.13 	$25.26	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.11	$25.33	$25.33	$0.00	$0.00	$7.11	$0.00	$20.18	$20.18	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
207.095	SUP	HCPCS C1713		207.095  -  SCREW BONE PTHRD 4MM 95MM PTHRD LCP STAINLESS STEEL	BOTH IP/OP	$35.15 	$26.01	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.33	$26.09	$26.09	$0.00	$0.00	$7.33	$0.00	$20.79	$20.79	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
207.1	SUP	HCPCS C1713		207.100  -  SCREW BONE 4MM 100MM PTTHRD LC-DCP DCP STAINLESS STEEL	BOTH IP/OP	$34.13 	$25.26	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.11	$25.33	$25.33	$0.00	$0.00	$7.11	$0.00	$20.18	$20.18	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
207.61	SUP	HCPCS C1713		207.610  -  SCREW BONE SHORT THREAD 4MM 10MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$73.99	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.612	SUP	HCPCS C1713		207.612  -  SCREW BONE SHORT THREAD 4MM 12MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$73.99	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.614	SUP	HCPCS C1713		207.614  -  SCREW BONE SHORT THREAD 4MM 14MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$73.99	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.616	SUP	HCPCS C1713		207.616  -  SCREW BONE SHORT THREAD 4MM 16MM 1/3MM CANN LCP STAINLESS	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.618	SUP	HCPCS C1713		207.618  -  SCREW BONE SHORT THREAD 4MM 18MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.622	SUP	HCPCS C1713		207.622  -  SCREW BONE SHORT THREAD 4MM 22MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.624	SUP	HCPCS C1713		207.624  -  SCREW BONE SHORT THREAD 4MM 24MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.626	SUP	HCPCS C1713		207.626  -  SCREW BONE SHORT THREAD 4MM 26MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.628	SUP	HCPCS C1713		207.628  -  SCREW BONE SHORT THREAD 4MM 28MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.63	SUP	HCPCS C1713		207.630  -  SCREW BONE SHORT THREAD 4MM 30MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.63	SUP	HCPCS C1713		207.63  -  SCREW BONE 4MM 30MM LCP SS ST ORTH CANN NSTRL SM FRAG SET	BOTH IP/OP	$357.58 	$264.61	$0.00	$344.35	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$344.35	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.632	SUP	HCPCS C1713		207.632  -  SCREW BONE SHORT THREAD 4MM 32MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.634	SUP	HCPCS C1713		207.634  -  SCREW BONE SHORT THREAD 4MM 34MM 11MM CANN LCP STAINLESS	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.636	SUP	HCPCS C1713		207.636  -  SCREW BONE SHORT THREAD 4MM 36MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.638	SUP	HCPCS C1713		207.638  -  SCREW BONE SHORT THREAD 4MM 38MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.64	SUP	HCPCS C1713		207.640  -  SCREW BONE SHORT THREAD 4MM 40MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.64	SUP	HCPCS C1713		207.64  -  SCREW BONE 4MM 40MM LCP SS ST ORTH CANN NSTRL SM FRAG SET	BOTH IP/OP	$357.58 	$264.61	$0.00	$329.46	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$329.46	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.642	SUP	HCPCS C1713		207.642  -  SCREW BONE SHORT THREAD 4MM 42MM CANN SHORT THREAD LCP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.644	SUP	HCPCS C1713		207.644  -  SCREW BONE SHORT THREAD 4MM 44MM 1/3MM CANN LCP STAINLESS	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.646	SUP	HCPCS C1713		207.646  -  SCREW BONE SHORT THREAD 4MM 46MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.648	SUP	HCPCS C1713		207.648  -  SCREW BONE SHORT THREAD 4MM 48MM CANN LCP STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.65	SUP	HCPCS C1713		207.650  -  SCREW BONE SHORT THREAD HEXAGON LP 4MM 5MM 50MM SELF DRILL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.65	SUP	HCPCS C1713		207.65  -  SCREW BONE 4MM 50MM LCP SS ST ORTH CANN NSTRL SM FRAG SET	BOTH IP/OP	$357.58 	$264.61	$0.00	$329.46	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$329.46	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.652	SUP	HCPCS C1713		207.652  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.654	SUP	HCPCS C1713		207.654  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.656	SUP	HCPCS C1713		207.656  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.658	SUP	HCPCS C1713		207.658  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.66	SUP	HCPCS C1713		207.660  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.664	SUP	HCPCS C1713		207.664  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.668	SUP	HCPCS C1713		207.668  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.672	SUP	HCPCS C1713		207.672  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.716	SUP	HCPCS C1713		207.716  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.718	SUP	HCPCS C1713		207.718  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.72	SUP	HCPCS C1713		207.720  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.722	SUP	HCPCS C1713		207.722  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.724	SUP	HCPCS C1713		207.724  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.726	SUP	HCPCS C1713		207.726  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.728	SUP	HCPCS C1713		207.728  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$73.99	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.73	SUP	HCPCS C1713		207.730  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.732	SUP	HCPCS C1713		207.732  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.734	SUP	HCPCS C1713		207.734  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.736	SUP	HCPCS C1713		207.736  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.738	SUP	HCPCS C1713		207.738  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.74	SUP	HCPCS C1713		207.740  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.74	SUP	HCPCS C1713		207.74  -  SCREW BONE 4MM 40MM SS L/T ORTH CANN NSTRL	BOTH IP/OP	$357.58 	$264.61	$0.00	$344.35	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$344.35	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.742	SUP	HCPCS C1713		207.742  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.744	SUP	HCPCS C1713		207.744  -  SCREW BONE LNGTHRD 4MM 5MM 44MM CANN SLFDRILL SLFTAP SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.746	SUP	HCPCS C1713		207.746  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.748	SUP	HCPCS C1713		207.748  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.75	SUP	HCPCS C1713		207.750  -  SCREW BONE LNGTHRD 4MM 5MM 50MM CANN SLFDRILL SLFTAP SMALL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.75	SUP	HCPCS C1713		207.75  -  SCREW BONE 4MM 50MM SS L/T ORTH CANN NSTRL	BOTH IP/OP	$357.58 	$264.61	$0.00	$329.46	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$329.46	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.752	SUP	HCPCS C1713		207.752  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.754	SUP	HCPCS C1713		207.754  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.756	SUP	HCPCS C1713		207.756  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.758	SUP	HCPCS C1713		207.758  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.76	SUP	HCPCS C1713		207.760  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.764	SUP	HCPCS C1713		207.764  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.768	SUP	HCPCS C1713		207.768  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.772	SUP	HCPCS C1713		207.772  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
207.916	SUP	HCPCS C1713		207.916  -  SCREW BONE 5MM 4MM 6MM 16MM 8MM DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.918	SUP	HCPCS C1713		207.918  -  SCREW BONE 5MM 4MM 6MM 18MM 8MM DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.92	SUP	HCPCS C1713		207.920  -  SCREW BONE 5MM 4MM 6MM 20MM 10MM DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$35.48 	$26.26	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.39	$26.33	$26.33	$0.00	$0.00	$7.39	$0.00	$20.98	$20.98	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.922	SUP	HCPCS C1713		207.922  -  SCREW BONE 5MM 4MM 6MM 22MM 10MM DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.924	SUP	HCPCS C1713		207.924  -  SCREW BONE 5MM 4MM 6MM 24MM 10MM DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.926	SUP	HCPCS C1713		207.926  -  SCREW BONE 5MM 4MM 6MM 26MM 12MM DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.928	SUP	HCPCS C1713		207.928  -  SCREW BONE 5MM 4MM 6MM 28MM 12MM DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.93	SUP	HCPCS C1713		207.930  -  SCREW BONE 5MM 4MM 6MM 30MM 12MM DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$35.48 	$26.26	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.39	$26.33	$26.33	$0.00	$0.00	$7.39	$0.00	$20.98	$20.98	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.932	SUP	HCPCS C1713		207.932  -  SCREW BONE 5MM 4MM 6MM 32MM 14MM DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.934	SUP	HCPCS C1713		207.934  -  SCREW BONE 5MM 4MM 6MM 34MM 14MM DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.936	SUP	HCPCS C1713		207.936  -  SCREW BONE 5MM 4MM 6MM 36MM 14MM DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.938	SUP	HCPCS C1713		207.938  -  SCREW BONE 5MM HEAD 4MM 38MM PTHRD LC-DCP DCP STAINLESS	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.94	SUP	HCPCS C1713		207.940  -  SCREW BONE 5MM HEAD 4MM 40MM PTHRD LC-DCP STAINLESS STEEL	BOTH IP/OP	$35.48 	$26.26	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.39	$26.33	$26.33	$0.00	$0.00	$7.39	$0.00	$20.98	$20.98	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.942	SUP	HCPCS C1713		207.942  -  SCREW BONE 5MM HEAD 4MM 42MM PTHRD LC-DCP DCP STAINLESS	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.944	SUP	HCPCS C1713		207.944  -  SCREW BONE 5MM HEAD 4MM 44MM PTHRD LC-DCP DCP STAINLESS	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.946	SUP	HCPCS C1713		207.946  -  SCREW BONE 5MM HEAD 4MM 46MM PTHRD LC-DCP STAINLESS STEEL	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.948	SUP	HCPCS C1713		207.948  -  SCREW BONE 5MM HEAD 4MM 48MM PTHRD LC-DCP DCP STAINLESS	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.95	SUP	HCPCS C1713		207.950  -  SCREW BONE 5MM HEAD 4MM 50MM PTHRD LC-DCP STAINLESS STEEL	BOTH IP/OP	$35.48 	$26.26	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.39	$26.33	$26.33	$0.00	$0.00	$7.39	$0.00	$20.98	$20.98	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
207.952	SUP	HCPCS C1713		207.952  -  SCREW BONE 5MM HEAD 4MM 52MM PTHRD LC-DCP DCP STAINLESS	BOTH IP/OP	$36.55 	$27.05	$0.00	$28.38	$15.96	$15.96	$0.00	$0.00	$0.00	$7.62	$27.13	$27.13	$0.00	$0.00	$7.62	$0.00	$21.62	$21.62	$0.00	$17.74	$28.10	$28.38	$0.00		$0.00	$5.39	$0.00	$0.00	$5.65	$0.00	$0.00	$0.00	$0.00	$0.00
208.03	SUP	HCPCS C1713		208.030  -  SCREW BONE 7MM 8MM 30MM 16MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.035	SUP	HCPCS C1713		208.035  -  SCREW BONE 7MM 8MM 35MM 16MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.04	SUP	HCPCS C1713		208.040  -  SCREW BONE 7MM 8MM 40MM 16MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.045	SUP	HCPCS C1713		208.045  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.05	SUP	HCPCS C1713		208.050  -  SCREW BONE 7MM 8MM 50MM 16MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.055	SUP	HCPCS C1713		208.055  -  SCREW BONE 7MM 8MM 55MM 16MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.06	SUP	HCPCS C1713		208.060  -  SCREW BONE 7MM 8MM 60MM 16MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.065	SUP	HCPCS C1713		208.065  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.07	SUP	HCPCS C1713		208.070  -  SCREW BONE 7MM 8MM 70MM 16MM CANN LARGE HEXAGONAL SOCKET	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.075	SUP	HCPCS C1713		208.075  -  SCREW BONE 7MM 8MM 75MM 16MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.08	SUP	HCPCS C1713		208.080  -  SCREW BONE 3.5MM 7MM 8MM 80MM 16MM CANN LARGE HEXAGONAL	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.085	SUP	HCPCS C1713		208.085  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.09	SUP	HCPCS C1713		208.090  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.095	SUP	HCPCS C1713		208.095  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.1	SUP	HCPCS C1713		208.100  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.105	SUP	HCPCS C1713		208.105  -  SCREW BONE 7MM 8MM 105MM 16MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.11	SUP	HCPCS C1713		208.110  -  SCREW BONE 7MM 8MM 110MM 16MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.115	SUP	HCPCS C1713		208.115  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.12	SUP	HCPCS C1713		208.120  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.125	SUP	HCPCS C1713		208.125  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.13	SUP	HCPCS C1713		208.130  -  SCREW BONE 7MM 8MM 130MM 16MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
208.135	SUP	HCPCS C1713		208.135  -  SCREW BONE 7MM 135MM 16MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
208.14	SUP	HCPCS C1713		208.140  -  SCREW BONE 7MM 140MM 16MM THREADED CANN STAINLESS STEEL	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
208.145	SUP	HCPCS C1713		208.145  -  SCREW BONE 7MM 145MM 16MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
208.15	SUP	HCPCS C1713		208.150  -  SCREW BONE 7MM 150MM 16MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
208.401	SUP	HCPCS C1713		208.401  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 30	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.402	SUP	HCPCS C1713		208.402  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 35	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.403	SUP	HCPCS C1713		208.403  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 40	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.404	SUP	HCPCS C1713		208.404  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 45	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.405	SUP	HCPCS C1713		208.405  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 50	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.406	SUP	HCPCS C1713		208.406  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 55	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.407	SUP	HCPCS C1713		208.407  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 60	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.408	SUP	HCPCS C1713		208.408  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 65	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.409	SUP	HCPCS C1713		208.409  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 70	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.41	SUP	HCPCS C1713		208.410  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 75	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.411	SUP	HCPCS C1713		208.411  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 80	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.412	SUP	HCPCS C1713		208.412  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 85	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.413	SUP	HCPCS C1713		208.413  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 90	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.414	SUP	HCPCS C1713		208.414  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 95	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.415	SUP	HCPCS C1713		208.415  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.416	SUP	HCPCS C1713		208.416  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.417	SUP	HCPCS C1713		208.417  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.418	SUP	HCPCS C1713		208.418  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.419	SUP	HCPCS C1713		208.419  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.42	SUP	HCPCS C1713		208.420  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.421	SUP	HCPCS C1713		208.421  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.422	SUP	HCPCS C1713		208.422  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.423	SUP	HCPCS C1713		208.423  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.424	SUP	HCPCS C1713		208.424  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.425	SUP	HCPCS C1713		208.425  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.426	SUP	HCPCS C1713		208.426  -  SCREW BONE 6.5MM 160MM 16MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.427	SUP	HCPCS C1713		208.427  -  SCREW BONE 6.5MM 170MM 16MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.428	SUP	HCPCS C1713		208.428  -  SCREW BONE 6.5MM 180MM 16MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.431	SUP	HCPCS C1713		208.431  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 45	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.432	SUP	HCPCS C1713		208.432  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 50	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.433	SUP	HCPCS C1713		208.433  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 55	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.434	SUP	HCPCS C1713		208.434  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 60	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.435	SUP	HCPCS C1713		208.435  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 65	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.436	SUP	HCPCS C1713		208.436  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 70	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.437	SUP	HCPCS C1713		208.437  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 75	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.438	SUP	HCPCS C1713		208.438  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 80	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.439	SUP	HCPCS C1713		208.439  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 85	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.44	SUP	HCPCS C1713		208.440  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 90	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.441	SUP	HCPCS C1713		208.441  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 95	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.442	SUP	HCPCS C1713		208.442  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.443	SUP	HCPCS C1713		208.443  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.444	SUP	HCPCS C1713		208.444  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.445	SUP	HCPCS C1713		208.445  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.446	SUP	HCPCS C1713		208.446  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.447	SUP	HCPCS C1713		208.447  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.448	SUP	HCPCS C1713		208.448  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.449	SUP	HCPCS C1713		208.449  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.45	SUP	HCPCS C1713		208.450  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.451	SUP	HCPCS C1713		208.451  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.452	SUP	HCPCS C1713		208.452  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.453	SUP	HCPCS C1713		208.453  -  SCREW BONE 6.5MM 160MM 32MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.454	SUP	HCPCS C1713		208.454  -  SCREW BONE 6.5MM 170MM 32MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.455	SUP	HCPCS C1713		208.455  -  SCREW BONE 6.5MM 180MM 32MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.46	SUP	HCPCS C1713		208.460  -  SCREW BONE FULTHD HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.461	SUP	HCPCS C1713		208.461  -  SCREW BONE FULTHD HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.462	SUP	HCPCS C1713		208.462  -  SCREW BONE FULTHD HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.463	SUP	HCPCS C1713		208.463  -  SCREW BONE 6.5MM 35MM FULTHRD STAINLESS STEEL CANN NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.464	SUP	HCPCS C1713		208.464  -  SCREW BONE 6.5MM 40MM FULTHRD STAINLESS STEEL CANN NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.465	SUP	HCPCS C1713		208.465  -  SCREW BONE FULTHD 6.5MM 45MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.466	SUP	HCPCS C1713		208.466  -  SCREW BONE FULTHD 6.5MM 50MM CANN STAINLESS STEEL FEMUR	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.467	SUP	HCPCS C1713		208.467  -  SCREW BONE FULTHD 6.5MM 55MM CANN STAINLESS STEEL FEMUR	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.468	SUP	HCPCS C1713		208.468  -  SCREW BONE FULTHD 6.5MM 60MM CANN STAINLESS STEEL FEMUR	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.469	SUP	HCPCS C1713		208.469  -  SCREW BONE FULTHD 6.5MM 65MM CANN STAINLESS STEEL FEMUR	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.47	SUP	HCPCS C1713		208.470  -  SCREW BONE FULTHD 6.5MM 70MM CANN STAINLESS STEEL FEMUR	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.471	SUP	HCPCS C1713		208.471  -  SCREW BONE FULTHD 6.5MM 75MM CANN STAINLESS STEEL FEMUR	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.472	SUP	HCPCS C1713		208.472  -  SCREW BONE FULTHD 6.5MM 80MM CANN STAINLESS STEEL FEMUR	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.473	SUP	HCPCS C1713		208.473  -  SCREW BONE FULTHD 6.5MM 85MM CANN STAINLESS STEEL FEMUR	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.474	SUP	HCPCS C1713		208.474  -  SCREW BONE FULTHD 6.5MM 90MM CANN STAINLESS STEEL FEMUR	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.475	SUP	HCPCS C1713		208.475  -  SCREW BONE FULTHD 6.5MM 95MM CANN STAINLESS STEEL FEMUR	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.476	SUP	HCPCS C1713		208.476  -  SCREW BONE FULTHD 6.5MM 100MM CANN STAINLESS STEEL FEMUR	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.477	SUP	HCPCS C1713		208.477  -  SCREW BONE FULTHD 6.5MM 105MM CANN FULTHRD STAINLESS STEEL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.478	SUP	HCPCS C1713		208.478  -  SCREW BONE FULTHD 6.5MM 110MM CANN FULTHRD STAINLESS STEEL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.479	SUP	HCPCS C1713		208.479  -  SCREW BONE 6.5MM 115MM CANN FULTHRD STAINLESS STEEL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.48	SUP	HCPCS C1713		208.480  -  SCREW BONE 6.5MM 120MM FULTHRD STAINLESS STEEL CANN NONSTRL	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.481	SUP	HCPCS C1713		208.481  -  SCREW BONE 6.5MM 125MM CANN FULTHRD STAINLESS STEEL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.482	SUP	HCPCS C1713		208.482  -  SCREW BONE 6.5MM 130MM CANN FULTHRD STAINLESS STEEL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
208.483	SUP	HCPCS C1713		208.483  -  SCREW BONE FULTHD 6.5MM 140MM CANN STAINLESS STEEL	BOTH IP/OP	$501.83 	$371.35	$0.00	$389.78	$219.25	$219.25	$0.00	$0.00	$0.00	$104.59	$372.45	$372.45	$0.00	$0.00	$104.58	$0.00	$296.83	$296.83	$0.00	$243.61	$385.89	$389.78	$0.00		$0.00	$74.03	$0.00	$0.00	$77.57	$0.00	$0.00	$0.00	$0.00	$0.00
208.484	SUP	HCPCS C1713		208.484  -  SCREW BONE FULTHD 6.5MM 150MM CANN STAINLESS STEEL	BOTH IP/OP	$501.83 	$371.35	$0.00	$389.78	$219.25	$219.25	$0.00	$0.00	$0.00	$104.59	$372.45	$372.45	$0.00	$0.00	$104.58	$0.00	$296.83	$296.83	$0.00	$243.61	$385.89	$389.78	$0.00		$0.00	$74.03	$0.00	$0.00	$77.57	$0.00	$0.00	$0.00	$0.00	$0.00
208.485	SUP	HCPCS C1713		208.485  -  SCREW BONE FULTHD 6.5MM 160MM CANN STAINLESS STEEL	BOTH IP/OP	$501.83 	$371.35	$0.00	$389.78	$219.25	$219.25	$0.00	$0.00	$0.00	$104.59	$372.45	$372.45	$0.00	$0.00	$104.58	$0.00	$296.83	$296.83	$0.00	$243.61	$385.89	$389.78	$0.00		$0.00	$74.03	$0.00	$0.00	$77.57	$0.00	$0.00	$0.00	$0.00	$0.00
208.486	SUP	HCPCS C1713		208.486  -  SCREW BONE FULTHD 6.5MM 170MM CANN STAINLESS STEEL	BOTH IP/OP	$501.83 	$371.35	$0.00	$389.78	$219.25	$219.25	$0.00	$0.00	$0.00	$104.59	$372.45	$372.45	$0.00	$0.00	$104.58	$0.00	$296.83	$296.83	$0.00	$243.61	$385.89	$389.78	$0.00		$0.00	$74.03	$0.00	$0.00	$77.57	$0.00	$0.00	$0.00	$0.00	$0.00
208.487	SUP	HCPCS C1713		208.487  -  SCREW BONE 6.5MM 180MM CANN FULTHD STAINLESS STEEL	BOTH IP/OP	$501.83 	$371.35	$0.00	$389.78	$219.25	$219.25	$0.00	$0.00	$0.00	$104.59	$372.45	$372.45	$0.00	$0.00	$104.58	$0.00	$296.83	$296.83	$0.00	$243.61	$385.89	$389.78	$0.00		$0.00	$74.03	$0.00	$0.00	$77.57	$0.00	$0.00	$0.00	$0.00	$0.00
208.83	SUP	HCPCS C1713		208.830  -  SCREW BONE PTHRD 7.3MM 30MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$96.14	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.835	SUP	HCPCS C1713		208.835  -  SCREW BONE PTHRD 7.3MM 35MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.84	SUP	HCPCS C1713		208.840  -  SCREW BONE 7.3MM 40MM 16MM CANN STAINLESS STEEL FEMUR	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.845	SUP	HCPCS C1713		208.845  -  SCREW BONE PTHRD 7.3MM 45MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.85	SUP	HCPCS C1713		208.850  -  SCREW BONE 7.3MM 50MM 16MM CANN STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.855	SUP	HCPCS C1713		208.855  -  SCREW BONE PTHRD 7.3MM 55MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.86	SUP	HCPCS C1713		208.860  -  SCREW BONE PTHRD 7.3MM 60MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.865	SUP	HCPCS C1713		208.865  -  SCREW BONE PTHRD 7.3MM 65MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.87	SUP	HCPCS C1713		208.870  -  SCREW BONE PTHRD 7.3MM 70MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.875	SUP	HCPCS C1713		208.875  -  SCREW BONE PTHRD 7.3MM 75MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.88	SUP	HCPCS C1713		208.880  -  SCREW BONE PTHRD 7.3MM 80MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.885	SUP	HCPCS C1713		208.885  -  SCREW BONE PTHRD 7.3MM 85MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.89	SUP	HCPCS C1713		208.890  -  SCREW BONE 7.3MM 90MM 16MM CANN STAINLESS STEEL CANN NONSTRL	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.895	SUP	HCPCS C1713		208.895  -  SCREW BONE PTHRD 7.3MM 95MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$96.14	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.9	SUP	HCPCS C1713		208.900  -  SCREW BONE PTHRD 7.3MM 100MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.905	SUP	HCPCS C1713		208.905  -  SCREW BONE PTHRD 7.3MM 105MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.91	SUP	HCPCS C1713		208.910  -  SCREW BONE PTHRD 7.3MM 110MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.915	SUP	HCPCS C1713		208.915  -  SCREW BONE PTHRD 7.3MM 115MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.92	SUP	HCPCS C1713		208.920  -  SCREW BONE PTHRD 7.3MM 120MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.925	SUP	HCPCS C1713		208.925  -  SCREW BONE PTHRD 7.3MM 125MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.93	SUP	HCPCS C1713		208.930  -  SCREW BONE PTHRD 7.3MM 130MM 16MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.935	SUP	HCPCS C1713		208.935  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.94	SUP	HCPCS C1713		208.940  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.945	SUP	HCPCS C1713		208.945  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.95	SUP	HCPCS C1713		208.950  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
208.955	SUP	HCPCS C1713		208.955  -  SCREW BONE 7.3MM 8.2MM 155MM 16X4MM CANNULARED SLFDRILL	BOTH IP/OP	$500.43 	$370.32	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$104.30	$371.42	$371.42	$0.00	$0.00	$104.29	$0.00	$296.00	$296.00	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
208.96	SUP	HCPCS C1713		208.960  -  SCREW BONE 7.3MM 8.2MM 160MM 16X4MM CANNULARED SLFDRILL	BOTH IP/OP	$485.85 	$359.53	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$101.26	$360.60	$360.60	$0.00	$0.00	$101.25	$0.00	$287.38	$287.38	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
208.965	SUP	HCPCS C1713		208.965  -  SCREW BONE 7.3MM 8.2MM 165MM 16X4MM CANNULARED SLFDRILL	BOTH IP/OP	$500.43 	$370.32	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$104.30	$371.42	$371.42	$0.00	$0.00	$104.29	$0.00	$296.00	$296.00	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
208.97	SUP	HCPCS C1713		208.970  -  SCREW BONE 7.3MM 8.2MM 170MM 16X4MM CANNULARED SLFDRILL	BOTH IP/OP	$485.85 	$359.53	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$101.26	$360.60	$360.60	$0.00	$0.00	$101.25	$0.00	$287.38	$287.38	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
208.975	SUP	HCPCS C1713		208.975  -  SCREW BONE 7.3MM 8.2MM 75MM 16X4MM L THREAD SLFDRILL SLFTAP	BOTH IP/OP	$500.43 	$370.32	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$104.30	$371.42	$371.42	$0.00	$0.00	$104.29	$0.00	$296.00	$296.00	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
208.98	SUP	HCPCS C1713		208.980  -  SCREW BONE 7.3MM 8.2MM 80MM 16X4MM L THREAD SLFDRILL SLFTAP	BOTH IP/OP	$485.85 	$359.53	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$101.26	$360.60	$360.60	$0.00	$0.00	$101.25	$0.00	$287.38	$287.38	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209	SUP	Custom 27203010		MARKER RAD OSPT SKN SEM RDLCNT RING	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
209.045	SUP	HCPCS C1713		209.045  -  SCREW BONE 7MM 8MM 45MM 32MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.05	SUP	HCPCS C1713		209.050  -  SCREW BONE 7MM 8MM 50MM 32MM CANN LARGE HEXOGONAL SOCKET	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.055	SUP	HCPCS C1713		209.055  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.06	SUP	HCPCS C1713		209.060  -  SCREW BONE REVERSE CUT FLUTE 7MM 8MM 60MM 32MM CANN LARGE	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.065	SUP	HCPCS C1713		209.065  -  SCREW BONE 7MM 8MM 65MM 32MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.07	SUP	HCPCS C1713		209.070  -  SCREW BONE 7MM 8MM 70MM 32MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.075	SUP	HCPCS C1713		209.075  -  SCREW BONE 7MM 8MM 75MM 32MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.08	SUP	HCPCS C1713		209.080  -  SCREW BONE LARGE 7MM 8MM 80MM 32MM CANN THREADED LARGE	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.085	SUP	HCPCS C1713		209.085  -  SCREW BONE 7MM 8MM 85MM 32MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.09	SUP	HCPCS C1713		209.090  -  SCREW BONE 7MM 8MM 90MM 32MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.095	SUP	HCPCS C1713		209.095  -  SCREW BONE 7MM 8MM 95MM 32MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.1	SUP	HCPCS C1713		209.100  -  SCREW BONE 7MM 8MM 100MM 32MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.105	SUP	HCPCS C1713		209.105  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.11	SUP	HCPCS C1713		209.110  -  SCREW BONE 7MM 8MM 110MM 32MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.115	SUP	HCPCS C1713		209.115  -  SCREW BONE 7MM 8MM 115MM 32MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.12	SUP	HCPCS C1713		209.120  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.125	SUP	HCPCS C1713		209.125  -  SCREW BONE 7MM 8MM 125MM 32MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.13	SUP	HCPCS C1713		209.130  -  SCREW BONE 7MM 8MM 130MM 32MM CANN THREADED LARGE HEXOGONAL	BOTH IP/OP	$481.75 	$356.50	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$100.41	$357.55	$357.55	$0.00	$0.00	$100.40	$0.00	$284.96	$284.96	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
209.135	SUP	HCPCS C1713		209.135  -  SCREW BONE 7MM 135MM 32MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.14	SUP	HCPCS C1713		209.140  -  SCREW BONE 7MM 140MM 32MM CANN THREADED	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.145	SUP	HCPCS C1713		209.145  -  SCREW BONE 7MM 145MM 32MM CANN THREADED	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.15	SUP	HCPCS C1713		209.150  -  SCREW BONE 7MM 150MM 32MM CANN THREADED	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.42	SUP	HCPCS C1713		209.420  -  SCREW BONE 7MM 20MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.425	SUP	HCPCS C1713		209.425  -  SCREW BONE FULTHD 7MM 25MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.43	SUP	HCPCS C1713		209.430  -  SCREW ORTHOPEDIC 7MM 30MM CANN FULTHRD STAINLESS STEEL	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.435	SUP	HCPCS C1713		209.435  -  SCREW BONE FULTHD 7MM 35MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.44	SUP	HCPCS C1713		209.440  -  SCREW BONE 7MM 40MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.445	SUP	HCPCS C1713		209.445  -  SCREW BONE FULTHD 7MM 45MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.45	SUP	HCPCS C1713		209.450  -  SCREW BONE FULTHD 7MM 50MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.455	SUP	HCPCS C1713		209.455  -  SCREW BONE FULTHD 7MM 55MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.46	SUP	HCPCS C1713		209.460  -  SCREW BONE 7MM 60MM CANN FULTHRD STAINLESS STEEL NONSTRL	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.465	SUP	HCPCS C1713		209.465  -  SCREW BONE FULTHD 7MM 65MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.47	SUP	HCPCS C1713		209.470  -  SCREW BONE 7MM 70MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.475	SUP	HCPCS C1713		209.475  -  SCREW BONE FULTHD 7MM 75MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.48	SUP	HCPCS C1713		209.480  -  SCREW BONE 7MM 80MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.485	SUP	HCPCS C1713		209.485  -  SCREW BONE 7MM 85MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.49	SUP	HCPCS C1713		209.490  -  SCREW BONE 7MM 90MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.495	SUP	HCPCS C1713		209.495  -  SCREW BONE 7MM 95MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.5	SUP	HCPCS C1713		209.500  -  SCREW BONE 7MM 100MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.505	SUP	HCPCS C1713		209.505  -  SCREW BONE FULTHD 7MM 105MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.51	SUP	HCPCS C1713		209.510  -  SCREW BONE FULTHD 7MM 8MM 110MM CANN LARGE HEXAGONAL SOCKET	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.515	SUP	HCPCS C1713		209.515  -  SCREW BONE FULTHD 7MM 115MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.52	SUP	HCPCS C1713		209.520  -  SCREW BONE 7MM 120MM CANN FULTHRD STAINLESS STEEL CORTICAL	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.525	SUP	HCPCS C1713		209.525  -  SCREW BONE FULTHD 7MM 125MM CANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$511.68 	$378.64	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$106.65	$379.77	$379.77	$0.00	$0.00	$106.63	$0.00	$302.66	$302.66	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.53	SUP	HCPCS C1713		209.530  -  SCREW BONE 7MM 130MM FULTHRD STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$496.78 	$367.62	$0.00	$397.42	$223.55	$223.55	$0.00	$0.00	$0.00	$103.54	$368.71	$368.71	$0.00	$0.00	$103.53	$0.00	$293.84	$293.84	$0.00	$248.39	$393.45	$397.42	$0.00		$0.00	$75.48	$0.00	$0.00	$79.09	$0.00	$0.00	$0.00	$0.00	$0.00
209.62	SUP	HCPCS C1713		209.620  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.625	SUP	HCPCS C1713		209.625  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.63	SUP	HCPCS C1713		209.630  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.635	SUP	HCPCS C1713		209.635  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.64	SUP	HCPCS C1713		209.640  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.645	SUP	HCPCS C1713		209.645  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.65	SUP	HCPCS C1713		209.650  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.655	SUP	HCPCS C1713		209.655  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.66	SUP	HCPCS C1713		209.660  -  SCREW BONE FULLY THREAD LARGE HEXAGON 7.3MM 4MM 60MM CANN	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.665	SUP	HCPCS C1713		209.665  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.67	SUP	HCPCS C1713		209.670  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.675	SUP	HCPCS C1713		209.675  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.68	SUP	HCPCS C1713		209.680  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.685	SUP	HCPCS C1713		209.685  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.69	SUP	HCPCS C1713		209.690  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.695	SUP	HCPCS C1713		209.695  -  SCREW BONE FULTHD 7.3MM 8.2MM 95MM CANN SHAFT LP HEAD	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.7	SUP	HCPCS C1713		209.700  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.705	SUP	HCPCS C1713		209.705  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.71	SUP	HCPCS C1713		209.710  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.715	SUP	HCPCS C1713		209.715  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.72	SUP	HCPCS C1713		209.720  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.725	SUP	HCPCS C1713		209.725  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.73	SUP	HCPCS C1713		209.730  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.735	SUP	HCPCS C1713		209.735  -  SCREW BONE FULTHD 7.3MM 8.2MM 135MM 4MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$500.43 	$370.32	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$104.30	$371.42	$371.42	$0.00	$0.00	$104.29	$0.00	$296.00	$296.00	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.74	SUP	HCPCS C1713		209.740  -  SCREW BONE 4MM FULTHD 7.3MM 8.2MM 140MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$485.85 	$359.53	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$101.26	$360.60	$360.60	$0.00	$0.00	$101.25	$0.00	$287.38	$287.38	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.745	SUP	HCPCS C1713		209.745  -  SCREW BONE FULTHD 7.3MM 8.2MM 145MM 4MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$500.43 	$370.32	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$104.30	$371.42	$371.42	$0.00	$0.00	$104.29	$0.00	$296.00	$296.00	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.75	SUP	HCPCS C1713		209.750  -  SCREW BONE FULTHD 7.3MM 50MM CANN NONSTRL	BOTH IP/OP	$485.85 	$359.53	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$101.26	$360.60	$360.60	$0.00	$0.00	$101.25	$0.00	$287.38	$287.38	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.755	SUP	HCPCS C1713		209.755  -  SCREW BONE FULTHD 7.3MM 55MM CANN NONSTRL	BOTH IP/OP	$500.43 	$370.32	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$104.30	$371.42	$371.42	$0.00	$0.00	$104.29	$0.00	$296.00	$296.00	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.76	SUP	HCPCS C1713		209.760  -  SCREW BONE 4MM FULTHD 7.3MM 8.2MM 160MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$485.85 	$359.53	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$101.26	$360.60	$360.60	$0.00	$0.00	$101.25	$0.00	$287.38	$287.38	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.765	SUP	HCPCS C1713		209.765  -  SCREW BONE FULTHD 7.3MM 8.2MM 165MM 4MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$500.43 	$370.32	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$104.30	$371.42	$371.42	$0.00	$0.00	$104.29	$0.00	$296.00	$296.00	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.77	SUP	HCPCS C1713		209.770  -  SCREW BONE FULTHD 7.3MM 8.2MM 170MM 4MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$485.85 	$359.53	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$101.26	$360.60	$360.60	$0.00	$0.00	$101.25	$0.00	$287.38	$287.38	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.775	SUP	HCPCS C1713		209.775  -  SCREW BONE FULTHD 7.3MM 75MM CANN STAINLESS STEEL	BOTH IP/OP	$500.43 	$370.32	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$104.30	$371.42	$371.42	$0.00	$0.00	$104.29	$0.00	$296.00	$296.00	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.78	SUP	HCPCS C1713		209.780  -  SCREW BONE FULTHD 7.3MM 8.2MM 180MM 4MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$485.85 	$359.53	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$101.26	$360.60	$360.60	$0.00	$0.00	$101.25	$0.00	$287.38	$287.38	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.845	SUP	HCPCS C1713		209.845  -  SCREW BONE PTHRD 7.3MM 8.2MM 45MM 32MM CANN SHAFT LP HEAD	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.85	SUP	HCPCS C1713		209.850  -  SCREW BONE 7.3MM 8.2MM 50MM 32MM CANN SHAFT LP HEAD SLFDRILL	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.855	SUP	HCPCS C1713		209.855  -  SCREW BONE 4MM 7.3MM 8.2MM 55MM 32MM CANN SHAFT LP HEAD	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.86	SUP	HCPCS C1713		209.860  -  SCREW BONE PTHRD 7.3MM 8.2MM 60MM 32MM CANN SHAFT LP HEAD	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.865	SUP	HCPCS C1713		209.865  -  SCREW BONE 4MM 7.3MM 8.2MM 65MM 32MM CANN SHAFT LP HEAD	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.87	SUP	HCPCS C1713		209.870  -  SCREW BONE PTHRD 7.3MM 8.2MM 70MM 32MM CANN SHAFT LP HEAD	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.875	SUP	HCPCS C1713		209.875  -  SCREW BONE 4MM 7.3MM 8.2MM 75MM 32MM CANN SHAFT LP HEAD	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.88	SUP	HCPCS C1713		209.880  -  SCREW BONE PTHRD 7.3MM 8.2MM 80MM 32MM CANN SHAFT LP HEAD	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.885	SUP	HCPCS C1713		209.885  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 85MM 32MM CANN SHAFT LP	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.89	SUP	HCPCS C1713		209.890  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 90MM 32MM CANN SHAFT LP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.895	SUP	HCPCS C1713		209.895  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 95MM 32MM CANN SHAFT LP	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.9	SUP	HCPCS C1713		209.900  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 100MM 32MM CANN SHAFT LP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.905	SUP	HCPCS C1713		209.905  -  SCREW BONE 4MM 7.3MM 8.2MM 105MM 32MM CANN SHAFT LP HEAD	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.91	SUP	HCPCS C1713		209.910  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 110MM 32MM CANN SHAFT LP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.915	SUP	HCPCS C1713		209.915  -  SCREW BONE 7.3MM 8.2MM 115MM 32MM CANN SHAFT LP HEAD	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.92	SUP	HCPCS C1713		209.920  -  SCREW BONE 4MM 7.3MM 8.2MM 120MM 32MM CANN SHAFT LP HEAD	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.925	SUP	HCPCS C1713		209.925  -  SCREW BONE 4MM 7.3MM 8.2MM 125MM 32MM CANN SHAFT LP HEAD	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.93	SUP	HCPCS C1713		209.930  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 130MM 32MM CANN SHAFT LP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.935	SUP	HCPCS C1713		209.935  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.94	SUP	HCPCS C1713		209.940  -  SCREW BONE HEXAGON 7.3MM 4MM 140MM 32MM CANN SELF DRILL SELF	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.945	SUP	HCPCS C1713		209.945  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.95	SUP	HCPCS C1713		209.950  -  SCREW BONE HEXAGON 7.3MM 4MM 150MM 32MM CANN SELF DRILL SELF	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
209.955	SUP	HCPCS C1713		209.955  -  SCREW BONE 7.3MM 8.2MM 155MM 32X4MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$500.43 	$370.32	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$104.30	$371.42	$371.42	$0.00	$0.00	$104.29	$0.00	$296.00	$296.00	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.96	SUP	HCPCS C1713		209.960  -  SCREW BONE 7.3MM 160MM CANN THREADED STAINLESS STEEL NONSTRL	BOTH IP/OP	$485.85 	$359.53	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$101.26	$360.60	$360.60	$0.00	$0.00	$101.25	$0.00	$287.38	$287.38	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.965	SUP	HCPCS C1713		209.965  -  SCREW BONE 7.3MM 8.2MM 165MM 32X4MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$500.43 	$370.32	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$104.30	$371.42	$371.42	$0.00	$0.00	$104.29	$0.00	$296.00	$296.00	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.97	SUP	HCPCS C1713		209.970  -  SCREW BONE 7.3MM 8.2MM 170MM 32X4MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$485.85 	$359.53	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$101.26	$360.60	$360.60	$0.00	$0.00	$101.25	$0.00	$287.38	$287.38	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.975	SUP	HCPCS C1713		209.975  -  SCREW BONE 7.3MM 8.2MM 175MM 32X4MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$500.43 	$370.32	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$104.30	$371.42	$371.42	$0.00	$0.00	$104.29	$0.00	$296.00	$296.00	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
209.98	SUP	HCPCS C1713		209.980  -  SCREW BONE 7.3MM 180MM CANN STAINLESS STEEL NONSTRL	BOTH IP/OP	$485.85 	$359.53	$0.00	$388.68	$218.63	$218.63	$0.00	$0.00	$0.00	$101.26	$360.60	$360.60	$0.00	$0.00	$101.25	$0.00	$287.38	$287.38	$0.00	$242.93	$384.79	$388.68	$0.00		$0.00	$73.82	$0.00	$0.00	$77.35	$0.00	$0.00	$0.00	$0.00	$0.00
211.81	SUP	HCPCS C1713		211.810  -  SCREW BONE .5 THREAD T8 2.4MM 3.5MM 10MM SELF DRILL SELF TAP	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.811	SUP	HCPCS C1713		211.811  -  SCREW BONE LNGTHRD 2.4MM 11MM 5MM CANN STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.812	SUP	HCPCS C1713		211.812  -  SCREW BONE .5 THREAD T8 2.4MM 3.5MM 12MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.813	SUP	HCPCS C1713		211.813  -  SCREW BONE LNGTHRD 2.4MM 13MM 6MM CANN STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.814	SUP	HCPCS C1713		211.814  -  SCREW BONE .5 THREAD T8 2.4MM 3.5MM 14MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.815	SUP	HCPCS C1713		211.815  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 15MM 7MM CANN REVERSE CUTTING	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.816	SUP	HCPCS C1713		211.816  -  SCREW BONE .5 THREAD T8 2.4MM 3.5MM 16MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.817	SUP	HCPCS C1713		211.817  -  SCREW BONE LNGTHRD 2.4MM 17MM 8MM CANN STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.818	SUP	HCPCS C1713		211.818  -  SCREW BONE LNGTHRD 2.4MM 35MM 18MM 8MM CANN T8 STARDRIVE	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.819	SUP	HCPCS C1713		211.819  -  SCREW BONE LNGTHRD 2.4MM 19MM 9MM CANN STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.82	SUP	HCPCS C1713		211.820  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 20MM 9MM CANN REVERSE CUTTING	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.822	SUP	HCPCS C1713		211.822  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 22MM 10MM CANN REVERSE	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.824	SUP	HCPCS C1713		211.824  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 24MM 10MM CANN REVERSE	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.826	SUP	HCPCS C1713		211.826  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 26MM 12MM CANN REVERSE	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.828	SUP	HCPCS C1713		211.828  -  SCREW BONE LNGTHRD 2.4MM 28MM 12MM CANN STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.83	SUP	HCPCS C1713		211.830  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 30MM 14MM CANN REVERSE	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.841	SUP	HCPCS C1713		211.841  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 17MM 5MM CANN SLFDRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.842	SUP	HCPCS C1713		211.842  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 18MM 5MM CANN T8	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.843	SUP	HCPCS C1713		211.843  -  SCREW BONE SHORT THREAD 2.4MM 19MM 5MM CANN STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.844	SUP	HCPCS C1713		211.844  -  SCREW BONE SHORT THREAD 20MM 204MM 5MM CANN STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.845	SUP	HCPCS C1713		211.845  -  SCREW BONE SHORT THREAD 2.4MM 22MM 5MM CANN STAINLESS STEEL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.846	SUP	HCPCS C1713		211.846  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 24MM 6MM CANN REVERSE	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.847	SUP	HCPCS C1713		211.847  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 26MM 6MM CANN REVERSE	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.848	SUP	HCPCS C1713		211.848  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 28MM 6MM CANN REVERSE	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.849	SUP	HCPCS C1713		211.849  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 30MM 6MM CANN REVERSE	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
211.89	SUP	HCPCS C1713		211.890  -  SCREW BONE 2.4MM 90MM COMPRESSION LCP DHHS STAINLESS STEEL	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
212.101	SUP	HCPCS C1713		212.101  -  SCREW BONE FULTHD 3.5MM 2.9MM 10MM T15 STARDRIVE RECESS	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.102	SUP	HCPCS C1713		212.102  -  SCREW BONE FULTHD 3.5MM 12MM STARDRIVE RECESS SLFTAP TIP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.103	SUP	HCPCS C1713		212.103  -  SCREW BONE FULTHD 3.5MM 14MM STARDRIVE RECESS SLFTAP TIP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.104	SUP	HCPCS C1713		212.104  -  SCREW BONE FULTHD 3.5MM 16MM STARDRIVE RECESS SLFTAP TIP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.105	SUP	HCPCS C1713		212.105  -  SCREW BONE 3.5MM 18MM LOCKING SLFTAP T15 STAR DRIVE RECESS	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.106	SUP	HCPCS C1713		212.106  -  SCREW BONE 3.5MM 20MM LOCKING SLFTAP STARDRIVE RECESS LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.107	SUP	HCPCS C1713		212.107  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 22MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.108	SUP	HCPCS C1713		212.108  -  SCREW BONE 3.5MM 24MM T15 STARDRIVE RECESS ANGULAR STABILITY	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.109	SUP	HCPCS C1713		212.109  -  SCREW BONE FULTHD 3.5MM 26MM STARDRIVE RECESS SLFTAP TIP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.11	SUP	HCPCS C1713		212.110  -  SCREW BONE 3.5MM 28MM LOCKING STARDRIVE SLFTAP LCP STAINLESS	BOTH IP/OP	$227.93 	$168.67	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.11	SUP	HCPCS C1713		212.11  -  SCREW BONE 3.5MM 28MM LCP SS PROX MDL PLVC TIBIAL SLFTAP LCK	BOTH IP/OP	$227.93 	$168.67	$0.00	$197.35	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$197.35	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.111	SUP	HCPCS C1713		212.111  -  SCREW BONE 3.5MM 30MM LOCKING SLFTAP STARDRIVE RECESS LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.112	SUP	HCPCS C1713		212.112  -  SCREW BONE FULTHD 3.5MM 32MM STARDRIVE RECESS SLFTAP TIP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.113	SUP	HCPCS C1713		212.113  -  SCREW BONE 3.5MM 34MM T15 STARDRIVE RECESS ANGULAR STABILITY	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.114	SUP	HCPCS C1713		212.114  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 35MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.115	SUP	HCPCS C1713		212.115  -  SCREW BONE FULTHD 3.5MM 36MM T15 STARDRIVE SELF TAP FIX	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.116	SUP	HCPCS C1713		212.116  -  SCREW BONE FULTHD 3.5MM 38MM T15 STARDRIVE SELF TAP FIX	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.117	SUP	HCPCS C1713		212.117  -  SCREW BONE 3.5MM 40MM LOCKING STARDRIVE SLFTAP LCP STAINLESS	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.118	SUP	HCPCS C1713		212.118  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 42MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.119	SUP	HCPCS C1713		212.119  -  SCREW BONE FULTHD 3.5MM 45MM STARDRIVE SELF TAP LOCK LP LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.12	SUP	HCPCS C1713		212.120  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 48MM FIX ANGLE SELF TAP	BOTH IP/OP	$227.93 	$168.67	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.121	SUP	HCPCS C1713		212.121  -  SCREW BONE 3.5MM 50MM LOCKING SLFTAP T15 STAR DRIVE RECESS	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.122	SUP	HCPCS C1713		212.122  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 52MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.123	SUP	HCPCS C1713		212.123  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 55MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.124	SUP	HCPCS C1713		212.124  -  SCREW BONE FULTHD 3.5MM 60MM STARDRIVE RECESS SLFTAP TIP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.125	SUP	HCPCS C1713		212.125  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 65MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.126	SUP	HCPCS C1713		212.126  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 70MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.127	SUP	HCPCS C1713		212.127  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 75MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.128	SUP	HCPCS C1713		212.128  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 80MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.129	SUP	HCPCS C1713		212.129  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 85MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.13	SUP	HCPCS C1713		212.130  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 90MM FIX ANGLE SELF TAP	BOTH IP/OP	$227.93 	$168.67	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.131	SUP	HCPCS C1713		212.131  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 95MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.134	SUP	HCPCS C1713		212.134  -  SCREW BONE FULTHD CONE LP 3.5MM 44MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.136	SUP	HCPCS C1713		212.136  -  SCREW BONE FULTHD CONE LP 3.5MM 46MM FIX ANGLE SELF TAP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
212.201	SUP	HCPCS C1713		212.201  -  SCREW BONE FULTHD 5MM 14MM T25 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.202	SUP	HCPCS C1713		212.202  -  SCREW BONE T25 FULTHD CONE 5MM 16MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.203	SUP	HCPCS C1713		212.203  -  SCREW BONE FULTHD 5MM 18MM T25 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.205	SUP	HCPCS C1713		212.205  -  SCREW BONE T25 FULTHD CONE 5MM 22MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.206	SUP	HCPCS C1713		212.206  -  SCREW BONE FULTHD 5MM 24MM SLFTAP TIP LOCKING FIXANG CONICAL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.207	SUP	HCPCS C1713		212.207  -  SCREW BONE FULTHD CONICAL 5MM 26MM SELF TAP LOCK FIX ANGLE T	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.208	SUP	HCPCS C1713		212.208  -  SCREW BONE T25 FULTHD CONE 5MM 28MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.209	SUP	HCPCS C1713		212.209  -  SCREW BONE T25 FULTHD CONE 5MM 30MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.21	SUP	HCPCS C1713		212.210  -  SCREW BONE FULTHD 5MM 32MM T25 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$266.13 	$196.94	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$55.47	$197.52	$197.52	$0.00	$0.00	$55.46	$0.00	$157.41	$157.41	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.211	SUP	HCPCS C1713		212.211  -  SCREW BONE T25 FULTHD CONE 5MM 34MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.212	SUP	HCPCS C1713		212.212  -  SCREW BONE T25 FULTHD CONE 5MM 36MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.213	SUP	HCPCS C1713		212.213  -  SCREW BONE T25 FULTHD CONE 5MM 38MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.214	SUP	HCPCS C1713		212.214  -  SCREW BONE T25 FULTHD CONE 5MM 40MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.215	SUP	HCPCS C1713		212.215  -  SCREW BONE T25 FULTHD CONE 5MM 42MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.216	SUP	HCPCS C1713		212.216  -  SCREW BONE FULTHD 5MM 44MM SLFTAP LOCKING FIXANG T25	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.217	SUP	HCPCS C1713		212.217  -  SCREW BONE T25 FULTHD CONE 5MM 46MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.218	SUP	HCPCS C1713		212.218  -  SCREW BONE T25 FULTHD CONE 5MM 48MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.219	SUP	HCPCS C1713		212.219  -  SCREW BONE T25 FULTHD CONE 5MM 50MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.22	SUP	HCPCS C1713		212.220  -  SCREW BONE T25 FULTHD CONE 5MM 55MM FIX ANGLE SELF TAP	BOTH IP/OP	$266.13 	$196.94	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$55.47	$197.52	$197.52	$0.00	$0.00	$55.46	$0.00	$157.41	$157.41	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.221	SUP	HCPCS C1713		212.221  -  SCREW BONE T25 FULTHD CONE 5MM 60MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.222	SUP	HCPCS C1713		212.222  -  SCREW BONE FULTHD 5MM 65MM T25 STARDRIVE RECESS SLFTAP TIP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.223	SUP	HCPCS C1713		212.223  -  SCREW BONE T25 FULTHD CONE 5MM 70MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.224	SUP	HCPCS C1713		212.224  -  SCREW BONE FULTHD 5MM 75MM SLFTAP TIP LOCKING FIXANG T25	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.225	SUP	HCPCS C1713		212.225  -  SCREW BONE FULTHD 5MM 80MM T25 STARDRIVE SELF TAP LOCK FIX	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.226	SUP	HCPCS C1713		212.226  -  SCREW BONE T25 FULTHD CONE 5MM 85MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.227	SUP	HCPCS C1713		212.227  -  SCREW BONE T25 FULTHD CONE 5MM 90MM FIX ANGLE SELF TAP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
212.251	SUP	HCPCS C1713		212.251  -  SCREW BONE 5MM 51MM SLFDRILL LOCKING THREADED LCP STAINLESS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.252	SUP	HCPCS C1713		212.252  -  SCREW BONE 5MM 18MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.253	SUP	HCPCS C1713		212.253  -  SCREW BONE 5MM 22MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.254	SUP	HCPCS C1713		212.254  -  SCREW BONE 5MM 26MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.255	SUP	HCPCS C1713		212.255  -  SCREW BONE 5MM 30MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.256	SUP	HCPCS C1713		212.256  -  SCREW BONE 5MM 35MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.257	SUP	HCPCS C1713		212.257  -  SCREW BONE 5MM 40MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.258	SUP	HCPCS C1713		212.258  -  SCREW BONE 5MM 45MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.259	SUP	HCPCS C1713		212.259  -  SCREW BONE 5MM 50MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.26	SUP	HCPCS C1713		212.260  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.261	SUP	HCPCS C1713		212.261  -  SCREW BONE 5MM 60MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.262	SUP	HCPCS C1713		212.262  -  SCREW BONE 5MM 65MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.263	SUP	HCPCS C1713		212.263  -  SCREW BONE 5MM 70MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.264	SUP	HCPCS C1713		212.264  -  SCREW BONE 5MM 75MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.265	SUP	HCPCS C1713		212.265  -  SCREW BONE 5MM 80MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.266	SUP	HCPCS C1713		212.266  -  SCREW BONE 5MM 85MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.267	SUP	HCPCS C1713		212.267  -  SCREW BONE 5MM 90MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
212.317	SUP	HCPCS C1713		212.317  -  SCREW BONE FULTHD 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
212.319	SUP	HCPCS C1713		212.319  -  SCREW BONE FULTHD 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
212.321	SUP	HCPCS C1713		212.321  -  SCREW BONE FULTHD 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
212.323	SUP	HCPCS C1713		212.323  -  SCREW BONE FULTHD 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
212.324	SUP	HCPCS C1713		212.324  -  SCREW BONE FULTHD 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
212.325	SUP	HCPCS C1713		212.325  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 65MM SELF TAP SMOOTH	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.326	SUP	HCPCS C1713		212.326  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 70MM SELF TAP SMOOTH	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.327	SUP	HCPCS C1713		212.327  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 75MM SELF TAP SMOOTH	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.328	SUP	HCPCS C1713		212.328  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 80MM SELF TAP SMOOTH	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.329	SUP	HCPCS C1713		212.329  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 85MM SELF TAP SMOOTH	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.33	SUP	HCPCS C1713		212.330  -  SCREW BONE FULTHD 3.5MM 2.9MM 90MM SLFTAP STARDRIVE RECESS	BOTH IP/OP	$249.75 	$184.82	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$52.05	$185.36	$185.36	$0.00	$0.00	$52.05	$0.00	$147.73	$147.73	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.331	SUP	HCPCS C1713		212.331  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 95MM SELF TAP SMOOTH	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.417	SUP	HCPCS C1713		212.417  -  SCREW BONE 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
212.419	SUP	HCPCS C1713		212.419  -  SCREW BONE 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
212.421	SUP	HCPCS C1713		212.421  -  SCREW BONE 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
212.423	SUP	HCPCS C1713		212.423  -  SCREW BONE 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
212.424	SUP	HCPCS C1713		212.424  -  SCREW BONE 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
212.425	SUP	HCPCS C1713		212.425  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 65MM SELF TAP SMOOTH	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.426	SUP	HCPCS C1713		212.426  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 70MM SELF TAP SMOOTH	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.427	SUP	HCPCS C1713		212.427  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 75MM SELF TAP SMOOTH	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.428	SUP	HCPCS C1713		212.428  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 80MM SELF TAP SMOOTH	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.429	SUP	HCPCS C1713		212.429  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 85MM SELF TAP SMOOTH	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.43	SUP	HCPCS C1713		212.430  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 90MM SELF TAP SMOOTH	BOTH IP/OP	$249.75 	$184.82	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$52.05	$185.36	$185.36	$0.00	$0.00	$52.05	$0.00	$147.73	$147.73	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.431	SUP	HCPCS C1713		212.431  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 95MM SELF TAP SMOOTH	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
212.504	SUP	HCPCS C1713		212.504  -  SCREW BONE 5MM 20MM STARDRIVE SS PROX FEM LCK SLFTAP T25	BOTH IP/OP	$314.40 	$232.66	$0.00	$251.52	$141.48	$141.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.20	$249.00	$251.52	$0.00		$0.00	$49.20	$0.00	$0.00	$50.05	$0.00	$0.00	$0.00	$0.00	$0.00
212.806	SUP	HCPCS C1713		212.806  -  SCREW BONE T8 CONE 2.4MM 1.9MM 6MM FIX ANGLE SELF TAP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.807	SUP	HCPCS C1713		212.807  -  SCREW BONE T8 CONE 2.4MM 1.9MM 7MM FIX ANGLE SELF TAP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.808	SUP	HCPCS C1713		212.808  -  SCREW BONE T8 CONE 2.4MM 1.9MM 8MM FIX ANGLE SELF TAP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.809	SUP	HCPCS C1713		212.809  -  SCREW BONE T8 CONE 2.4MM 1.9MM 9MM FIX ANGLE SELF TAP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.81	SUP	HCPCS C1713		212.810  -  SCREW BONE T8 CONE 2.4MM 1.9MM 10MM FIX ANGLE SELF TAP	BOTH IP/OP	$212.90 	$157.55	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$44.37	$158.01	$158.01	$0.00	$0.00	$44.37	$0.00	$125.93	$125.93	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.811	SUP	HCPCS C1713		212.811  -  SCREW BONE T8 CONE 2.4MM 1.9MM 11MM FIX ANGLE SELF TAP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.812	SUP	HCPCS C1713		212.812  -  SCREW BONE T8 2.4MM 12MM SELF TAP LOCK STARDRIVE LCP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.813	SUP	HCPCS C1713		212.813  -  SCREW BONE T8 CONE 2.4MM 1.9MM 13MM FIX ANGLE SELF TAP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.814	SUP	HCPCS C1713		212.814  -  SCREW BONE T8 2.4MM 14MM SELF TAP LOCK STARDRIVE LCP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.816	SUP	HCPCS C1713		212.816  -  SCREW BONE T8 CONE 2.4MM 1.9MM 16MM FIX ANGLE SELF TAP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.818	SUP	HCPCS C1713		212.818  -  SCREW BONE 2.4MM 1.9MM 18MM T8 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.82	SUP	HCPCS C1713		212.820  -  SCREW BONE 2.4MM 20MM T8 STARDRIVE RECESS SLFTAP LOCKING	BOTH IP/OP	$212.90 	$157.55	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$44.37	$158.01	$158.01	$0.00	$0.00	$44.37	$0.00	$125.93	$125.93	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.822	SUP	HCPCS C1713		212.822  -  SCREW BONE 2.4MM 22MM T8 STARDRIVE RECESS SLFTAP LOCKING	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.824	SUP	HCPCS C1713		212.824  -  SCREW BONE T8 CONE 2.4MM 1.9MM 24MM FIX ANGLE SELF TAP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.826	SUP	HCPCS C1713		212.826  -  SCREW BONE 2.4MM 26MM T8 STARDRIVE RECESS SLFTAP LOCKING	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.828	SUP	HCPCS C1713		212.828  -  SCREW BONE 2.4MM 1.9MM 28MM FIX ANGLE SELF TAP T8 STARDRIVE	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
212.83	SUP	HCPCS C1713		212.830  -  SCREW BONE T8 CONE 2.4MM 1.9MM 30MM FIX ANGLE SELF TAP	BOTH IP/OP	$212.90 	$157.55	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$44.37	$158.01	$158.01	$0.00	$0.00	$44.37	$0.00	$125.93	$125.93	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
213.018	SUP	HCPCS C1713		213.018  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 18MM SELF TAP THREAD	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.02	SUP	HCPCS C1713		213.020  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 20MM SELF TAP THREAD	BOTH IP/OP	$227.93 	$168.67	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.022	SUP	HCPCS C1713		213.022  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 22MM SELF TAP THREAD	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.024	SUP	HCPCS C1713		213.024  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 24MM SELF TAP THREAD	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.026	SUP	HCPCS C1713		213.026  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 26MM SELF TAP THREAD	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.028	SUP	HCPCS C1713		213.028  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 28MM SELF TAP THREAD	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.03	SUP	HCPCS C1713		213.030  -  SCREW BONE 2.5MM 3.5MM 30MM SELF TAP LOCK SMALL HEXAGONAL	BOTH IP/OP	$227.93 	$168.67	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.032	SUP	HCPCS C1713		213.032  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 32MM SELF TAP THREAD	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.034	SUP	HCPCS C1713		213.034  -  SCREW BONE 3.5MM 2.9MM 34MM SELF TAP LOCK SMALL HEXAGONAL	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.036	SUP	HCPCS C1713		213.036  -  SCREW BONE 3.5MM 2.9MM 36MM SELF TAP LOCK SMALL HEXAGONAL	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.038	SUP	HCPCS C1713		213.038  -  SCREW BONE 3.5MM 2.9MM 38MM SELF TAP LOCK SMALL HEXAGONAL	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.04	SUP	HCPCS C1713		213.040  -  SCREW BONE 2.5MM 3.5MM 40MM SELF TAP SMALL HEXAGONAL RECESS	BOTH IP/OP	$227.93 	$168.67	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.045	SUP	HCPCS C1713		213.045  -  SCREW BONE 3.5MM 2.9MM 45MM SLFTAP LOCKING SMALL HEXAGONAL	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.05	SUP	HCPCS C1713		213.050  -  SCREW BONE 3.5MM 2.9MM 50MM SLFTAP LOCKING SMALL HEXAGONAL	BOTH IP/OP	$227.93 	$168.67	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
213.414	SUP	HCPCS C1713		213.414  -  SCREW BONE 5MM 14MM SLFDRILL LOCKING LISS STAINLESS STEEL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
213.418	SUP	HCPCS C1713		213.418  -  SCREW BONE 5MM 18MM SLFDRILL LOCKING LCP LISS STAINLESS	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
213.422	SUP	HCPCS C1713		213.422  -  SCREW BONE 5MM 22MM SLFDRILL LOCKING LISS STAINLESS STEEL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
213.426	SUP	HCPCS C1713		213.426  -  SCREW BONE 5MM 26MM SLFDRILL LOCKING LCP LISS STAINLESS	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
213.43	SUP	HCPCS C1713		213.430  -  SCREW BONE 5MM 30MM SLFDRILL LOCKING LISS STAINLESS STEEL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
213.435	SUP	HCPCS C1713		213.435  -  SCREW BONE 5MM 35MM SLFDRILL LOCKING STAINLESS STEEL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
213.44	SUP	HCPCS C1713		213.440  -  SCREW BONE 5MM 40MM SLFDRILL LOCKING LCP LISS STAINLESS	BOTH IP/OP	$390.33 	$288.84	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$81.35	$289.70	$289.70	$0.00	$0.00	$81.34	$0.00	$230.88	$230.88	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
213.445	SUP	HCPCS C1713		213.445  -  SCREW BONE 5MM 45MM SLFDRILL LOCKING STAINLESS STEEL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
213.45	SUP	HCPCS C1713		213.450  -  SCREW BONE 5MM 50MM SLFDRILL LOCKING STAINLESS STEEL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
213.455	SUP	HCPCS C1713		213.455  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING LCP LISS STAINLESS	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
213.465	SUP	HCPCS C1713		213.465  -  SCREW BONE 5MM 65MM SLFDRILL LOCKING LCP LISS STAINLESS	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
213.47	SUP	HCPCS C1713		213.470  -  SCREW BONE 5MM 70MM SLFDRILL LOCKING STAINLESS STEEL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
213.475	SUP	HCPCS C1713		213.475  -  SCREW BONE 5MM 75MM SLFDRILL LOCKING LCP LISS STAINLESS	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
213.48	SUP	HCPCS C1713		213.480  -  SCREW BONE 5MM 80MM SLFDRILL LOCKING STAINLESS STEEL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
213.485	SUP	HCPCS C1713		213.485  -  SCREW BONE 5MM 85MM SLFDRILL LOCKING LCP LISS STAINLESS	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
213.49	SUP	HCPCS C1713		213.490  -  SCREW BONE 5MM 90MM SLFDRILL LOCKING STAINLESS STEEL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
213.508	SUP	HCPCS C1713		213.508  -  SCREW BONE 4.5MM 8MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.509	SUP	HCPCS C1713		213.509  -  SCREW BONE 4.5MM 9MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.51	SUP	HCPCS C1713		213.510  -  SCREW BONE 4.5MM 10MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.511	SUP	HCPCS C1713		213.511  -  SCREW BONE 4.5MM 11MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.512	SUP	HCPCS C1713		213.512  -  SCREW BONE 4.5MM 12MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.513	SUP	HCPCS C1713		213.513  -  SCREW BONE 4.5MM 13MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.514	SUP	HCPCS C1713		213.514  -  SCREW BONE 4.5MM 14MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.515	SUP	HCPCS C1713		213.515  -  SCREW BONE 4.5MM 15MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.516	SUP	HCPCS C1713		213.516  -  SCREW BONE 4.5MM 16MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.517	SUP	HCPCS C1713		213.517  -  SCREW BONE 4.5MM 17MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.518	SUP	HCPCS C1713		213.518  -  SCREW BONE 4.5MM 18MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.519	SUP	HCPCS C1713		213.519  -  SCREW BONE 4.5MM 19MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.52	SUP	HCPCS C1713		213.520  -  SCREW BONE 4.5MM 20MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.521	SUP	HCPCS C1713		213.521  -  SCREW BONE 4.5MM 21MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.522	SUP	HCPCS C1713		213.522  -  SCREW BONE 4.5MM 22MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.523	SUP	HCPCS C1713		213.523  -  SCREW BONE 4.5MM 23MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.524	SUP	HCPCS C1713		213.524  -  SCREW BONE 4.5MM 24MM SS STRNL CANN NONSTRL	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.525	SUP	HCPCS C1713		213.525  -  4.5MM STERNAL CANNULATED SCREW 25MM	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.526	SUP	HCPCS C1713		213.526  -  4.5MM STERNAL CANNULATED SCREW 26MM	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.527	SUP	HCPCS C1713		213.527  -  4.5MM STERNAL CANNULATED SCREW 27MM	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
213.528	SUP	HCPCS C1713		213.528  -  4.5MM STERNAL CANNULATED SCREW 28MM	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$106.31	$106.31	$0.00	$0.00	$0.00	$49.24	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$139.74	$139.74	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$36.97	$0.00	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00
214.014	SUP	HCPCS C1713		214.014  -  SCREW BONE STANDARD 4.5MM 8MM 14MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.016	SUP	HCPCS C1713		214.016  -  SCREW BONE STANDARD 4.5MM 8MM 16MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.018	SUP	HCPCS C1713		214.018  -  SCREW BONE 4.5MM 8MM 18MM HEXAGONAL SOCKET STAINLESS STEEL	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.02	SUP	HCPCS C1713		214.020  -  SCREW BONE STANDARD 4.5MM 8MM 20MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$29.68 	$21.96	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.19	$22.02	$22.02	$0.00	$0.00	$6.18	$0.00	$17.55	$17.55	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.022	SUP	HCPCS C1713		214.022  -  SCREW BONE STANDARD 4.5MM 8MM 22MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.024	SUP	HCPCS C1713		214.024  -  SCREW BONE STANDARD 4.5MM 8MM 24MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.026	SUP	HCPCS C1713		214.026  -  SCREW BONE STANDARD 4.5MM 8MM 26MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.028	SUP	HCPCS C1713		214.028  -  SCREW BONE STANDARD 4.5MM 8MM 28MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.03	SUP	HCPCS C1713		214.030  -  SCREW BONE STANDARD 4.5MM 8MM 30MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$29.68 	$21.96	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.19	$22.02	$22.02	$0.00	$0.00	$6.18	$0.00	$17.55	$17.55	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.032	SUP	HCPCS C1713		214.032  -  SCREW BONE STANDARD 4.5MM 8MM 32MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.034	SUP	HCPCS C1713		214.034  -  SCREW BONE STANDARD 4.5MM 8MM 34MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.036	SUP	HCPCS C1713		214.036  -  SCREW BONE STANDARD 4.5MM 8MM 36MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.038	SUP	HCPCS C1713		214.038  -  SCREW BONE STANDARD 4.5MM 8MM 38MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.04	SUP	HCPCS C1713		214.040  -  SCREW BONE STANDARD 4.5MM 8MM 40MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$29.68 	$21.96	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.19	$22.02	$22.02	$0.00	$0.00	$6.18	$0.00	$17.55	$17.55	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.042	SUP	HCPCS C1713		214.042  -  SCREW BONE 4.5MM 8MM 42MM HEXAGONAL SOCKET STAINLESS STEEL	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.044	SUP	HCPCS C1713		214.044  -  SCREW BONE STANDARD 4.5MM 8MM 44MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.046	SUP	HCPCS C1713		214.046  -  SCREW BONE STANDARD 4.5MM 8MM 46MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.048	SUP	HCPCS C1713		214.048  -  SCREW BONE STANDARD LARGE HEXAGON 4.5MM 8MM 48MM SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.05	SUP	HCPCS C1713		214.050  -  SCREW BONE STANDARD 4.5MM 8MM 50MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$29.68 	$21.96	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.19	$22.02	$22.02	$0.00	$0.00	$6.18	$0.00	$17.55	$17.55	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.052	SUP	HCPCS C1713		214.052  -  SCREW BONE STANDARD 4.5MM 8MM 52MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.054	SUP	HCPCS C1713		214.054  -  SCREW BONE STANDARD 4.5MM 8MM 54MM LARGE HEXGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.056	SUP	HCPCS C1713		214.056  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 56MM LARGE HEXAGONAL	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.058	SUP	HCPCS C1713		214.058  -  SCREW BONE STANDARD 4.5MM 8MM 58MM CORTEX PROXIMAL MEDIAL	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.06	SUP	HCPCS C1713		214.060  -  SCREW BONE STANDARD 4.5MM 8MM 60MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$29.68 	$21.96	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.19	$22.02	$22.02	$0.00	$0.00	$6.18	$0.00	$17.55	$17.55	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.062	SUP	HCPCS C1713		214.062  -  SCREW BONE STANDARD 4.5MM 8MM 62MM NONSELF TAP LARGE HEXAGON	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.064	SUP	HCPCS C1713		214.064  -  SCREW BONE STANDARD 4.5MM 8MM 64MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.066	SUP	HCPCS C1713		214.066  -  SCREW BONE STANDARD 4.5MM 8MM 66MM NONSELF TAP LARGE HEXAGON	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.068	SUP	HCPCS C1713		214.068  -  SCREW BONE STANDARD 4.5MM 8MM 68MM NONSELF TAP LARGE HEXAGON	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.07	SUP	HCPCS C1713		214.070  -  SCREW BONE STANDARD 4.5MM 8MM 70MM NONSELF TAP LARGE HEXAGON	BOTH IP/OP	$29.68 	$21.96	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.19	$22.02	$22.02	$0.00	$0.00	$6.18	$0.00	$17.55	$17.55	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.072	SUP	HCPCS C1713		214.072  -  SCREW BONE STANDARD 4.5MM 8MM 72MM NONSELF TAPPING LARGE	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
214.076	SUP	HCPCS C1713		214.076  -  SCREW BONE 4.5MM 76MM LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$51.30 	$37.96	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.69	$38.07	$38.07	$0.00	$0.00	$10.69	$0.00	$30.34	$30.34	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.08	SUP	HCPCS C1713		214.080  -  SCREW BONE STANDARD 4.5MM 8MM 80MM NONSELF TAPPING LARGE	BOTH IP/OP	$49.80 	$36.85	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.38	$36.96	$36.96	$0.00	$0.00	$10.38	$0.00	$29.46	$29.46	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.085	SUP	HCPCS C1713		214.085  -  SCREW BONE STANDARD 4.5MM 8MM 85MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$51.30 	$37.96	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.69	$38.07	$38.07	$0.00	$0.00	$10.69	$0.00	$30.34	$30.34	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.09	SUP	HCPCS C1713		214.090  -  SCREW BONE 4.5MM 90MM LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$49.80 	$36.85	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.38	$36.96	$36.96	$0.00	$0.00	$10.38	$0.00	$29.46	$29.46	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.095	SUP	HCPCS C1713		214.095  -  SCREW BONE STANDARD 4.5MM 8MM 95MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$51.30 	$37.96	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.69	$38.07	$38.07	$0.00	$0.00	$10.69	$0.00	$30.34	$30.34	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.1	SUP	HCPCS C1713		214.100  -  SCREW BONE 4.5MM 100MM LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$49.80 	$36.85	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.38	$36.96	$36.96	$0.00	$0.00	$10.38	$0.00	$29.46	$29.46	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.105	SUP	HCPCS C1713		214.105  -  SCREW BONE 4.5MM 105MM LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$51.30 	$37.96	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.69	$38.07	$38.07	$0.00	$0.00	$10.69	$0.00	$30.34	$30.34	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.11	SUP	HCPCS C1713		214.110  -  SCREW BONE 4.5MM 110MM LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$49.80 	$36.85	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.38	$36.96	$36.96	$0.00	$0.00	$10.38	$0.00	$29.46	$29.46	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.115	SUP	HCPCS C1713		214.115  -  SCREW BONE 4.5MM 115MM LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$51.30 	$37.96	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.69	$38.07	$38.07	$0.00	$0.00	$10.69	$0.00	$30.34	$30.34	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.12	SUP	HCPCS C1713		214.120  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 120MM LARGE HEXGONAL	BOTH IP/OP	$49.80 	$36.85	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.38	$36.96	$36.96	$0.00	$0.00	$10.38	$0.00	$29.46	$29.46	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.125	SUP	HCPCS C1713		214.125  -  SCREW BONE 4.5MM 125MM LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$51.30 	$37.96	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.69	$38.07	$38.07	$0.00	$0.00	$10.69	$0.00	$30.34	$30.34	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.13	SUP	HCPCS C1713		214.130  -  SCREW BONE 4.5MM 130MM DHS/DCP LC-DCP DCS STAINLESS STEEL	BOTH IP/OP	$49.80 	$36.85	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.38	$36.96	$36.96	$0.00	$0.00	$10.38	$0.00	$29.46	$29.46	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.135	SUP	HCPCS C1713		214.135  -  SCREW BONE 4.5MM 135MM LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$51.30 	$37.96	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.69	$38.07	$38.07	$0.00	$0.00	$10.69	$0.00	$30.34	$30.34	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.14	SUP	HCPCS C1713		214.140  -  SCREW BONE 4.5MM 140MM DHS/DCP LC-DCP DCS STAINLESS STEEL	BOTH IP/OP	$49.80 	$36.85	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.38	$36.96	$36.96	$0.00	$0.00	$10.38	$0.00	$29.46	$29.46	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.145	SUP	HCPCS C1713		214.145  -  SCREW BONE 4.5MM 145MM LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$51.30 	$37.96	$0.00	$39.84	$22.41	$22.41	$0.00	$0.00	$0.00	$10.69	$38.07	$38.07	$0.00	$0.00	$10.69	$0.00	$30.34	$30.34	$0.00	$24.90	$39.44	$39.84	$0.00		$0.00	$7.57	$0.00	$0.00	$7.93	$0.00	$0.00	$0.00	$0.00	$0.00
214.15	SUP	HCPCS C1713		214.150  -  SCREW BONE 4.5MM 150MM LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$68.90 	$50.99	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.36	$51.14	$51.14	$0.00	$0.00	$14.36	$0.00	$40.75	$40.75	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.155	SUP	HCPCS C1713		214.155  -  SCREW BONE 4.5MM 155MM LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.16	SUP	HCPCS C1713		214.160  -  SCREW BONE 4.5MM 160MM NON SLFTAP STAINLESS STEEL CORTICAL	BOTH IP/OP	$68.90 	$50.99	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.36	$51.14	$51.14	$0.00	$0.00	$14.36	$0.00	$40.75	$40.75	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.222	SUP	HCPCS C1713		214.222  -  SCREW BONE 4.5MM 22MM SHAFT LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
214.224	SUP	HCPCS C1713		214.224  -  SCREW BONE 4.5MM 24MM SHAFT LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
214.226	SUP	HCPCS C1713		214.226  -  SCREW BONE 4.5MM 26MM SHAFT LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
214.228	SUP	HCPCS C1713		214.228  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 28MM 12MM SOCKET DCP	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
214.23	SUP	HCPCS C1713		214.230  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 30MM 12MM SOCKET DCP	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
214.232	SUP	HCPCS C1713		214.232  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 32MM 12MM SOCKET DCP	BOTH IP/OP	$31.03 	$22.96	$0.00	$24.82	$13.96	$13.96	$0.00	$0.00	$0.00	$6.47	$23.03	$23.03	$0.00	$0.00	$6.47	$0.00	$18.35	$18.35	$0.00	$15.51	$24.58	$24.82	$0.00		$0.00	$4.71	$0.00	$0.00	$4.94	$0.00	$0.00	$0.00	$0.00	$0.00
214.234	SUP	HCPCS C1713		214.234  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 34MM 12MM SOCKET DCP	BOTH IP/OP	$31.03 	$22.96	$0.00	$24.82	$13.96	$13.96	$0.00	$0.00	$0.00	$6.47	$23.03	$23.03	$0.00	$0.00	$6.47	$0.00	$18.35	$18.35	$0.00	$15.51	$24.58	$24.82	$0.00		$0.00	$4.71	$0.00	$0.00	$4.94	$0.00	$0.00	$0.00	$0.00	$0.00
214.236	SUP	HCPCS C1713		214.236  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 36MM 12MM SOCKET DCP	BOTH IP/OP	$31.03 	$22.96	$0.00	$24.82	$13.96	$13.96	$0.00	$0.00	$0.00	$6.47	$23.03	$23.03	$0.00	$0.00	$6.47	$0.00	$18.35	$18.35	$0.00	$15.51	$24.58	$24.82	$0.00		$0.00	$4.71	$0.00	$0.00	$4.94	$0.00	$0.00	$0.00	$0.00	$0.00
214.238	SUP	HCPCS C1713		214.238  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 38MM 12MM SOCKET DCP	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
214.24	SUP	HCPCS C1713		214.240  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 40MM 12MM SOCKET DCP	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
214.242	SUP	HCPCS C1713		214.242  -  SCREW BONE PTHRD 4.5MM 8MM 42MM 12MM LCP STAINLESS STEEL	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.244	SUP	HCPCS C1713		214.244  -  SCREW BONE PTHRD 4.5MM 8MM 44MM 12MM LCP STAINLESS STEEL	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.246	SUP	HCPCS C1713		214.246  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 46MM 12MM SOCKET DCP	BOTH IP/OP	$34.45 	$25.49	$0.00	$27.56	$15.50	$15.50	$0.00	$0.00	$0.00	$7.18	$25.57	$25.57	$0.00	$0.00	$7.18	$0.00	$20.38	$20.38	$0.00	$17.23	$27.28	$27.56	$0.00		$0.00	$5.23	$0.00	$0.00	$5.48	$0.00	$0.00	$0.00	$0.00	$0.00
214.248	SUP	HCPCS C1713		214.248  -  SCREW BONE PTHRD 4.5MM 8MM 50MM 12MM LCP STAINLESS STEEL	BOTH IP/OP	$34.45 	$25.49	$0.00	$27.56	$15.50	$15.50	$0.00	$0.00	$0.00	$7.18	$25.57	$25.57	$0.00	$0.00	$7.18	$0.00	$20.38	$20.38	$0.00	$17.23	$27.28	$27.56	$0.00		$0.00	$5.23	$0.00	$0.00	$5.48	$0.00	$0.00	$0.00	$0.00	$0.00
214.25	SUP	HCPCS C1713		214.250  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 50MM 12MM SOCKET DCP	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.252	SUP	HCPCS C1713		214.252  -  SCREW BONE 4.5MM 52MM SHAFT LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.254	SUP	HCPCS C1713		214.254  -  SCREW BONE 4.5MM 54MM SHAFT LC-DCP STAINLESS STEEL CORTICAL	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.256	SUP	HCPCS C1713		214.256  -  SCREW BONE 4.5MM 8MM 56MM 15MM SHAFT LC-DCP DHS DCS	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.26	SUP	HCPCS C1713		214.260  -  SCREW BONE 4.5MM 60MM SHAFT LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.268	SUP	HCPCS C1713		214.268  -  SCREW BONE 4.5MM 68MM SHAFT LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.272	SUP	HCPCS C1713		214.272  -  SCREW BONE 4.5MM 8MM 72MM 18MM SHAFT LC-DCP DHS DCS	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.276	SUP	HCPCS C1713		214.276  -  SCREW BONE 4.5MM 76MM SHAFT LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.28	SUP	HCPCS C1713		214.280  -  SCREW BONE 4.5MM 80MM SHAFT DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.29	SUP	HCPCS C1713		214.290  -  SCREW BONE 4.5MM 90MM SHAFT LC-DCP STAINLESS STEEL	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.295	SUP	HCPCS C1713		214.295  -  SCREW BONE 4.5MM 95MM SHAFT LC-DCP STAINLESS STEEL	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.3	SUP	HCPCS C1713		214.300  -  SCREW BONE 4.5MM 100MM SHAFT LC-DCP DCP STAINLESS STEEL	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
214.52	SUP	HCPCS C1713		214.520  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.522	SUP	HCPCS C1713		214.522  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.524	SUP	HCPCS C1713		214.524  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.526	SUP	HCPCS C1713		214.526  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.528	SUP	HCPCS C1713		214.528  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.53	SUP	HCPCS C1713		214.530  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.532	SUP	HCPCS C1713		214.532  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.534	SUP	HCPCS C1713		214.534  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.536	SUP	HCPCS C1713		214.536  -  SCREW BONE PTHRD 4.5MM 6.5MM 36MM CANN SLFTAP SLFDRILL LARGE	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.538	SUP	HCPCS C1713		214.538  -  SCREW BONE PTHRD 4.5MM 6.5MM 38MM CANN LARGE HEXAGONAL	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$75.11	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.54	SUP	HCPCS C1713		214.540  -  SCREW BONE PTHRD 4.5MM 6.5MM 40MM CANN REVERSE CUTTING FLUTE	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$75.11	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.542	SUP	HCPCS C1713		214.542  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.544	SUP	HCPCS C1713		214.544  -  SCREW BONE PTHRD 4.5MM 6.5MM 44MM CANN SLFTAP SLFDRILL LARGE	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$75.11	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.546	SUP	HCPCS C1713		214.546  -  SCREW BONE PTHRD 4.5MM 6.5MM 46MM CANN LP HEMISPHERICAL HEAD	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.548	SUP	HCPCS C1713		214.548  -  SCREW BONE PTHRD 4.5MM 6.5MM 48MM CANN SLFTAP SLFDRILL LARGE	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.55	SUP	HCPCS C1713		214.550  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.552	SUP	HCPCS C1713		214.552  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.554	SUP	HCPCS C1713		214.554  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.556	SUP	HCPCS C1713		214.556  -  SCREW BONE PTHRD 4.5MM 6.5MM 56MM CANN SLFTAP SLFDRILL LARGE	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.56	SUP	HCPCS C1713		214.560  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.564	SUP	HCPCS C1713		214.564  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.568	SUP	HCPCS C1713		214.568  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.572	SUP	HCPCS C1713		214.572  -  SCREW BONE 4.5MM 72MM 24MM CANN PTTHRD STAINLESS STEEL	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
214.576	SUP	HCPCS C1713		214.576  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.58	SUP	HCPCS C1713		214.580  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$376.68 	$278.74	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$78.51	$279.57	$279.57	$0.00	$0.00	$78.50	$0.00	$222.80	$222.80	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.72	SUP	HCPCS C1713		214.720  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$376.68 	$278.74	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$78.51	$279.57	$279.57	$0.00	$0.00	$78.50	$0.00	$222.80	$222.80	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.722	SUP	HCPCS C1713		214.722  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.724	SUP	HCPCS C1713		214.724  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.726	SUP	HCPCS C1713		214.726  -  SCREW BONE HEMISPHERE FULTHD 4.5MM 6.5MM 1.75MM 26MM CANN	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.728	SUP	HCPCS C1713		214.728  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.73	SUP	HCPCS C1713		214.730  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$376.68 	$278.74	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$78.51	$279.57	$279.57	$0.00	$0.00	$78.50	$0.00	$222.80	$222.80	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.732	SUP	HCPCS C1713		214.732  -  SCREW BONE HEMISPHERE FULTHD 4.5MM 6.5MM 1.75MM 32MM CANN	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.734	SUP	HCPCS C1713		214.734  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.736	SUP	HCPCS C1713		214.736  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.738	SUP	HCPCS C1713		214.738  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.74	SUP	HCPCS C1713		214.740  -  SCREW BONE 3.5MM FULTHD 4.5MM 6.5MM 40MM CANN SELF DRILL	BOTH IP/OP	$376.68 	$278.74	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$78.51	$279.57	$279.57	$0.00	$0.00	$78.50	$0.00	$222.80	$222.80	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.742	SUP	HCPCS C1713		214.742  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.744	SUP	HCPCS C1713		214.744  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.746	SUP	HCPCS C1713		214.746  -  SCREW BONE FULTHD 4.5MM 6.5MM 46MM CANN SELF TAP LARGE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.748	SUP	HCPCS C1713		214.748  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.75	SUP	HCPCS C1713		214.750  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$376.68 	$278.74	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$78.51	$279.57	$279.57	$0.00	$0.00	$78.50	$0.00	$222.80	$222.80	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.752	SUP	HCPCS C1713		214.752  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.754	SUP	HCPCS C1713		214.754  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.756	SUP	HCPCS C1713		214.756  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.76	SUP	HCPCS C1713		214.760  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$376.68 	$278.74	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$78.51	$279.57	$279.57	$0.00	$0.00	$78.50	$0.00	$222.80	$222.80	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.764	SUP	HCPCS C1713		214.764  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.768	SUP	HCPCS C1713		214.768  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.772	SUP	HCPCS C1713		214.772  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.776	SUP	HCPCS C1713		214.776  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.777	SUP	HCPCS C1713		214.777  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
214.814	SUP	HCPCS C1713		214.814  -  SCREW BONE 4.5MM 8MM 14MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.816	SUP	HCPCS C1713		214.816  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 16MM SELF TAP SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.818	SUP	HCPCS C1713		214.818  -  SCREW BONE 4.5MM 8MM 18MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.82	SUP	HCPCS C1713		214.820  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 20MM SELF TAP SOCKET LCP	BOTH IP/OP	$38.88 	$28.77	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$22.99	$22.99	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.822	SUP	HCPCS C1713		214.822  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 22MM SELF TAP SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.824	SUP	HCPCS C1713		214.824  -  SCREW BONE 4.5MM 8MM 24MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.826	SUP	HCPCS C1713		214.826  -  SCREW BONE 4.5MM 8MM 26MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.828	SUP	HCPCS C1713		214.828  -  SCREW BONE 4.5MM 28MM SLFTAP LCP STAINLESS STEEL PEDIATRIC	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.83	SUP	HCPCS C1713		214.830  -  SCREW BONE 4.5MM 8MM 30MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$38.88 	$28.77	$0.00	$46.68	$17.49	$17.49	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$46.68	$46.68	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.83	SUP	HCPCS C1713		214.83  -  SCREW BONE 4.5MM 8MM 30MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$38.88 	$28.77	$0.00	$89.69	$17.49	$17.49	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$46.68	$46.68	$0.00	$19.44	$89.69	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.832	SUP	HCPCS C1713		214.832  -  SCREW BONE 4.5MM 8MM 32MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.834	SUP	HCPCS C1713		214.834  -  SCREW BONE 4.5MM 8MM 34MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.836	SUP	HCPCS C1713		214.836  -  SCREW BONE 4.5MM 8MM 36MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.838	SUP	HCPCS C1713		214.838  -  SCREW BONE 4.5MM 38MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.84	SUP	HCPCS C1713		214.840  -  SCREW BONE STANDARD 4.5MM 40MM SLFTAP TIP LCP STAINLESS	BOTH IP/OP	$40.05 	$29.64	$0.00	$181.20	$101.93	$101.93	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$46.68	$46.68	$0.00	$113.25	$30.79	$181.20	$0.00		$0.00	$35.45	$0.00	$0.00	$36.06	$0.00	$0.00	$0.00	$0.00	$0.00
214.84	SUP	HCPCS C1713		214.84  -  SCREW BN 4.5MM 8MM 40MM NS ST LG HEX SCKT SS CORT LG FRAG	BOTH IP/OP	$40.05 	$29.64	$0.00	$181.20	$101.93	$101.93	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$46.68	$46.68	$0.00	$113.25	$179.39	$181.20	$0.00		$0.00	$35.45	$0.00	$0.00	$36.06	$0.00	$0.00	$0.00	$0.00	$0.00
214.842	SUP	HCPCS C1713		214.842  -  SCREW BONE 4.5MM 8MM 42MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.844	SUP	HCPCS C1713		214.844  -  SCREW BONE 4.5MM 8MM 44MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.846	SUP	HCPCS C1713		214.846  -  SCREW BONE 4.5MM 46MM SLFTAP TIP LCP STAINLESS STEEL	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.848	SUP	HCPCS C1713		214.848  -  SCREW BONE 4.5MM 48MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.85	SUP	HCPCS C1713		214.850  -  SCREW BONE 4.5MM 8MM 50MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$90.60	$50.96	$50.96	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$46.68	$46.68	$0.00	$56.63	$30.79	$90.60	$0.00		$0.00	$17.72	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
214.85	SUP	HCPCS C1713		214.85  -  SCREW BONE 4.5MM 8MM 50MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$90.60	$50.96	$50.96	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$46.68	$46.68	$0.00	$56.63	$89.69	$90.60	$0.00		$0.00	$17.72	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
214.852	SUP	HCPCS C1713		214.852  -  SCREW BONE 4.5MM 52MM SELF TAP LC-DCP DHS DCS STAINLESS	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.854	SUP	HCPCS C1713		214.854  -  SCREW BONE 4.5MM 54MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.856	SUP	HCPCS C1713		214.856  -  SCREW BONE 4.5MM 56MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.858	SUP	HCPCS C1713		214.858  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 58MM SELF TAP SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.86	SUP	HCPCS C1713		214.860  -  SCREW BONE 4.5MM 8MM 60MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$38.88 	$28.77	$0.00	$46.68	$17.49	$17.49	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$46.68	$46.68	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.86	SUP	HCPCS C1713		214.86  -  SCREW BONE 4.5MM 8MM 60MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$38.88 	$28.77	$0.00	$59.80	$17.49	$17.49	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$46.68	$46.68	$0.00	$19.44	$59.80	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.862	SUP	HCPCS C1713		214.862  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 62MM SELF TAP SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.864	SUP	HCPCS C1713		214.864  -  SCREW BONE 4.5MM 8MM 64MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.866	SUP	HCPCS C1713		214.866  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 66MM SELF TAP SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.868	SUP	HCPCS C1713		214.868  -  SCREW BONE 4.5MM 8MM 68MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.87	SUP	HCPCS C1713		214.870  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 70MM SELF TAP SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$60.40	$33.98	$33.98	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$46.68	$46.68	$0.00	$37.75	$30.79	$60.40	$0.00		$0.00	$11.82	$0.00	$0.00	$12.02	$0.00	$0.00	$0.00	$0.00	$0.00
214.87	SUP	HCPCS C1713		214.87  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 70MM SELF TAP SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$60.40	$33.98	$33.98	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$46.68	$46.68	$0.00	$37.75	$59.80	$60.40	$0.00		$0.00	$11.82	$0.00	$0.00	$12.02	$0.00	$0.00	$0.00	$0.00	$0.00
214.872	SUP	HCPCS C1713		214.872  -  SCREW BONE 4.5MM 8MM 72MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
214.876	SUP	HCPCS C1713		214.876  -  SCREW BONE 4.5MM 8MM 76MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.88	SUP	HCPCS C1713		214.880  -  SCREW BONE 4.5MM 80MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$14.27	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.885	SUP	HCPCS C1713		214.885  -  SCREW BONE 4.5MM 8MM 85MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$14.27	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.89	SUP	HCPCS C1713		214.890  -  SCREW BONE 4.5MM 8MM 90MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.895	SUP	HCPCS C1713		214.895  -  SCREW BONE 4.5MM 8MM 95MM SELF TAP LARGE HEXAGONAL SOCKET	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.9	SUP	HCPCS C1713		214.900  -  SCREW BONE 4.5MM 8MM 100MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$14.27	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.905	SUP	HCPCS C1713		214.905  -  SCREW BONE 4.5MM 8MM 105MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.91	SUP	HCPCS C1713		214.910  -  SCREW BONE 4.5MM 8MM 110MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.915	SUP	HCPCS C1713		214.915  -  SCREW BONE 4.5MM 8MM 115MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.92	SUP	HCPCS C1713		214.920  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 120MM SELF TAP SOCKET LCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.925	SUP	HCPCS C1713		214.925  -  SCREW BONE 4.5MM 8MM 125MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.93	SUP	HCPCS C1713		214.930  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 130MM SELF TAP SOCKET LCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.935	SUP	HCPCS C1713		214.935  -  SCREW BONE 4.5MM 8MM 135MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.94	SUP	HCPCS C1713		214.940  -  SCREW BONE 4.5MM 8MM 140MM SLFTAP LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
214.945	SUP	HCPCS C1713		214.945  -  SCREW BONE 4.5MM 8MM 145MM SELF TAP HEXAGONAL SOCKET LCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
215.025	SUP	HCPCS C1713		215.025  -  SCREW BONE 3.5MM HEXAGON 4.5MM 8MM 25MM 12MM DCP LC-DCP	BOTH IP/OP	$56.30 	$41.66	$0.00	$45.04	$25.34	$25.34	$0.00	$0.00	$0.00	$11.73	$41.79	$41.79	$0.00	$0.00	$11.73	$0.00	$33.30	$33.30	$0.00	$28.15	$44.59	$45.04	$0.00		$0.00	$8.81	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00
215.03	SUP	HCPCS C1713		215.030  -  SCREW BONE PTHRD 4.5MM 8MM 30MM 15MM HEXAGONAL SOCKET LCP	BOTH IP/OP	$56.30 	$41.66	$0.00	$45.04	$25.34	$25.34	$0.00	$0.00	$0.00	$11.73	$41.79	$41.79	$0.00	$0.00	$11.73	$0.00	$33.30	$33.30	$0.00	$28.15	$44.59	$45.04	$0.00		$0.00	$8.81	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00
215.035	SUP	HCPCS C1713		215.035  -  SCREW BONE 4.5MM 35MM IMPLANT LC-DCP DCP MALLEOLAR LARGE	BOTH IP/OP	$56.30 	$41.66	$0.00	$45.04	$25.34	$25.34	$0.00	$0.00	$0.00	$11.73	$41.79	$41.79	$0.00	$0.00	$11.73	$0.00	$33.30	$33.30	$0.00	$28.15	$44.59	$45.04	$0.00		$0.00	$8.81	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00
215.04	SUP	HCPCS C1713		215.040  -  SCREW BONE 4.5MM 40MM DCP LC-DCP STAINLESS STEEL MALLEOLAR	BOTH IP/OP	$56.30 	$41.66	$0.00	$45.04	$25.34	$25.34	$0.00	$0.00	$0.00	$11.73	$41.79	$41.79	$0.00	$0.00	$11.73	$0.00	$33.30	$33.30	$0.00	$28.15	$44.59	$45.04	$0.00		$0.00	$8.81	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00
215.045	SUP	HCPCS C1713		215.045  -  SCREW BONE 3.5MM 4.5MM 8MM 45MM 22MM HEXAGONAL SOCKET LC-DCP	BOTH IP/OP	$56.30 	$41.66	$0.00	$45.04	$25.34	$25.34	$0.00	$0.00	$0.00	$11.73	$41.79	$41.79	$0.00	$0.00	$11.73	$0.00	$33.30	$33.30	$0.00	$28.15	$44.59	$45.04	$0.00		$0.00	$8.81	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00
215.05	SUP	HCPCS C1713		215.050  -  SCREW BONE PTHRD 4.5MM 8MM 50MM 24MM HEXAGONAL SOCKET LCP	BOTH IP/OP	$56.30 	$41.66	$0.00	$45.04	$25.34	$25.34	$0.00	$0.00	$0.00	$11.73	$41.79	$41.79	$0.00	$0.00	$11.73	$0.00	$33.30	$33.30	$0.00	$28.15	$44.59	$45.04	$0.00		$0.00	$8.81	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00
215.055	SUP	HCPCS C1713		215.055  -  SCREW BONE 3.5MM HEXAGON 4.5MM 8MM 55MM 26MM DCP LC-DCP	BOTH IP/OP	$56.30 	$41.66	$0.00	$45.04	$25.34	$25.34	$0.00	$0.00	$0.00	$11.73	$41.79	$41.79	$0.00	$0.00	$11.73	$0.00	$33.30	$33.30	$0.00	$28.15	$44.59	$45.04	$0.00		$0.00	$8.81	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00
215.06	SUP	HCPCS C1713		215.060  -  SCREW BONE 3.5MM 4.5MM 8MM 60MM 28MM HEXAGONAL SOCKET LCP	BOTH IP/OP	$56.30 	$41.66	$0.00	$45.04	$25.34	$25.34	$0.00	$0.00	$0.00	$11.73	$41.79	$41.79	$0.00	$0.00	$11.73	$0.00	$33.30	$33.30	$0.00	$28.15	$44.59	$45.04	$0.00		$0.00	$8.81	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00
215.065	SUP	HCPCS C1713		215.065  -  SCREW BONE 3.5MM 4.5MM 65MM 30MM HEXAGONAL SOCKET LCP	BOTH IP/OP	$56.30 	$41.66	$0.00	$45.04	$25.34	$25.34	$0.00	$0.00	$0.00	$11.73	$41.79	$41.79	$0.00	$0.00	$11.73	$0.00	$33.30	$33.30	$0.00	$28.15	$44.59	$45.04	$0.00		$0.00	$8.81	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00
215.07	SUP	HCPCS C1713		215.070  -  SCREW BONE 3.5MM 4.5MM 8MM 70MM 32MM HEXAGONAL SOCKET LCP	BOTH IP/OP	$56.30 	$41.66	$0.00	$45.04	$25.34	$25.34	$0.00	$0.00	$0.00	$11.73	$41.79	$41.79	$0.00	$0.00	$11.73	$0.00	$33.30	$33.30	$0.00	$28.15	$44.59	$45.04	$0.00		$0.00	$8.81	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00
215.075	SUP	HCPCS C1713		215.075  -  SCREW BONE 4.5MM 75MM LC-DCP STAINLESS STEEL MALLEOLAR	BOTH IP/OP	$56.30 	$41.66	$0.00	$45.04	$25.34	$25.34	$0.00	$0.00	$0.00	$11.73	$41.79	$41.79	$0.00	$0.00	$11.73	$0.00	$33.30	$33.30	$0.00	$28.15	$44.59	$45.04	$0.00		$0.00	$8.81	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00
215.08	SUP	HCPCS C1713		215.080  -  SCREW BONE 4.5MM 80MM LC-DCP STAINLESS STEEL MALLEOLAR	BOTH IP/OP	$56.30 	$41.66	$0.00	$45.04	$25.34	$25.34	$0.00	$0.00	$0.00	$11.73	$41.79	$41.79	$0.00	$0.00	$11.73	$0.00	$33.30	$33.30	$0.00	$28.15	$44.59	$45.04	$0.00		$0.00	$8.81	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00
215.222	SUP	HCPCS C1713		"215.222  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 22MM"	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	"$1,800.00"	"$1,800.00"	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$636.80	$0.00	$0.00	$0.00	$0.00	$0.00
215.224	SUP	HCPCS C1713		"215.224  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 24MM"	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	"$1,800.00"	"$1,800.00"	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$636.80	$0.00	$0.00	$0.00	$0.00	$0.00
215.226	SUP	HCPCS C1713		"215.226  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 26MM"	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	"$1,800.00"	"$1,800.00"	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$636.80	$0.00	$0.00	$0.00	$0.00	$0.00
215.228	SUP	HCPCS C1713		"215.228  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 28MM"	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	"$1,800.00"	"$1,800.00"	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$636.80	$0.00	$0.00	$0.00	$0.00	$0.00
215.23	SUP	HCPCS C1713		"215.230  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 30MM"	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	"$1,800.00"	"$1,800.00"	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$636.80	$0.00	$0.00	$0.00	$0.00	$0.00
215.232	SUP	HCPCS C1713		"215.232  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 32MM"	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	"$1,800.00"	"$1,800.00"	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$636.80	$0.00	$0.00	$0.00	$0.00	$0.00
215.234	SUP	HCPCS C1713		"215.234  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 34MM"	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	"$1,800.00"	"$1,800.00"	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$636.80	$0.00	$0.00	$0.00	$0.00	$0.00
215.236	SUP	HCPCS C1713		"215.236  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 36MM"	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	"$1,800.00"	"$1,800.00"	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$636.80	$0.00	$0.00	$0.00	$0.00	$0.00
215.308	SUP	HCPCS C1713		"215.308  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 8MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.31	SUP	HCPCS C1713		"215.310  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 10MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.312	SUP	HCPCS C1713		"215.312  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 12MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.314	SUP	HCPCS C1713		"215.314  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 14MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.316	SUP	HCPCS C1713		"215.316  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 16MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.318	SUP	HCPCS C1713		"215.318  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 18MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.32	SUP	HCPCS C1713		"215.320  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 20MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.322	SUP	HCPCS C1713		"215.322  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 22MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.324	SUP	HCPCS C1713		"215.324  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 24MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.326	SUP	HCPCS C1713		"215.326  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 26MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.328	SUP	HCPCS C1713		"215.328  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 28MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.33	SUP	HCPCS C1713		"215.330  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 30MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.335	SUP	HCPCS C1713		"215.335  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 35MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.34	SUP	HCPCS C1713		"215.340  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 40MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.345	SUP	HCPCS C1713		"215.345  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 45MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.35	SUP	HCPCS C1713		"215.350  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 50MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.41	SUP	HCPCS C1713		"215.410  -  4.0MM SS PROTEX? CT POLYAXIAL SCREW, 10MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.412	SUP	HCPCS C1713		"215.412  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 12MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.414	SUP	HCPCS C1713		"215.414  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 14MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.416	SUP	HCPCS C1713		"215.416  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 16MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.418	SUP	HCPCS C1713		"215.418  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 18MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.42	SUP	HCPCS C1713		"215.420  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 20MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.422	SUP	HCPCS C1713		"215.422  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 22MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.424	SUP	HCPCS C1713		"215.424  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 24MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.426	SUP	HCPCS C1713		"215.426  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 26MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.428	SUP	HCPCS C1713		"215.428  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 28MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.43	SUP	HCPCS C1713		"215.430  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 30MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.435	SUP	HCPCS C1713		"215.435  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 35MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.44	SUP	HCPCS C1713		"215.440  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 40MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.445	SUP	HCPCS C1713		"215.445  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 45MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.45	SUP	HCPCS C1713		"215.450  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 50MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.5	SUP	HCPCS C1713		215.500  -  SS PROTEX CT LOCKING CAP	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
215.501	SUP	HCPCS C1713		215.501  -  SS PROTEX HOOK	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.503	SUP	Custom 27803010		"215.503  -  SS PROTEX HOOK, RIGHT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.504	SUP	Custom 27803010		"215.504  -  SS PROTEX HOOK, LEFT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.506	SUP	Custom 27803010		"215.506  -  SS PROTEX HOOK, 7MM OFFSET, LEFT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.507	SUP	Custom 27803010		"215.507  -  SS PROTEX HOOK, 5MM OFFSET, LEFT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.508	SUP	Custom 27803010		"215.508  -  SS PROTEX HOOK, 7MM OFFSET, RIGHT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.509	SUP	Custom 27803010		"215.509  -  SS PROTEX HOOK, 5MM OFFSET, RIGHT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.51	SUP	HCPCS C1713		"215.510  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 10MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.512	SUP	HCPCS C1713		"215.512  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 12MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.514	SUP	HCPCS C1713		"215.514  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 14MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.516	SUP	HCPCS C1713		"215.516  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 16MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.518	SUP	HCPCS C1713		"215.518  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 18MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.52	SUP	HCPCS C1713		"215.520  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 20MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.522	SUP	HCPCS C1713		"215.522  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 22MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.524	SUP	HCPCS C1713		"215.524  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 24MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.526	SUP	HCPCS C1713		"215.526  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 26MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.528	SUP	HCPCS C1713		"215.528  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 28MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.53	SUP	HCPCS C1713		"215.530  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 30MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.535	SUP	HCPCS C1713		"215.535  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 35MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.54	SUP	HCPCS C1713		"215.540  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 40MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.545	SUP	HCPCS C1713		"215.545  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 45MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.55	SUP	HCPCS C1713		"215.550  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 50MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.625	SUP	HCPCS C1713		"215.625  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 25MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.63	SUP	HCPCS C1713		"215.630  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 30MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.635	SUP	HCPCS C1713		"215.635  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 35MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.64	SUP	HCPCS C1713		"215.640  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 40MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.645	SUP	HCPCS C1713		"215.645  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 45MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.65	SUP	HCPCS C1713		"215.650  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 50MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.801	SUP	Custom 27803010		"215.801  -  3.7MM SS STRAIGHT ROD, 80MM"	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$612.32	$612.32	$0.00	$0.00	$171.93	$0.00	$0.00	$0.00	$0.00	$412.50	$653.40	$660.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.802	SUP	Custom 27803010		"215.802  -  3.7MM SS STRAIGHT ROD, 120MM"	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.803	SUP	Custom 27803010		"215.803  -  3.7MM SS STRAIGHT ROD, 240MM"	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.804	SUP	Custom 27803010		"215.804  -  3.7MM SS STRAIGHT ROD, 40MM"	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$0.00	$0.00	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.806	SUP	HCPCS C1713		"215.806  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 6MM"	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
215.808	SUP	HCPCS C1713		"215.808  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 8MM"	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
215.81	SUP	HCPCS C1713		"215.810  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 10MM"	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
215.812	SUP	HCPCS C1713		"215.812  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 12MM"	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
215.814	SUP	HCPCS C1713		"215.814  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 14MM"	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
215.816	SUP	HCPCS C1713		"215.816  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 16MM"	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
215.906	SUP	HCPCS C1713		"215.906  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 6MM"	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
215.908	SUP	HCPCS C1713		"215.908  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 8MM"	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
215.91	SUP	HCPCS C1713		"215.910  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 10MM"	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
215.912	SUP	HCPCS C1713		"215.912  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 12MM"	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
215.914	SUP	HCPCS C1713		"215.914  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 14MM"	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
215.916	SUP	HCPCS C1713		"215.916  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 16MM"	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
215.923	SUP	Custom 27803010		"215.923  -  SS TOP LOADING T-CONNECTOR FOR 3.7MM ROD, 21-33MM, STRAIGHT"	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	$0.00	$0.00	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.925	SUP	Custom 27803010		"215.925  -  SS TOP LOADING T-CONNECTOR FOR 3.7MM ROD, 26-46MM, STRAIGHT"	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	$0.00	$0.00	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.927	SUP	Custom 27803010		"215.927  -  SS TOP LOADING T-CONNECTOR FOR 3.7MM ROD, 36-56MM, STRAIGHT"	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	$0.00	$0.00	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.949	SUP	HCPCS C1713		"215.949  -  SS SET SCREW, M4.5 X 0.75, ROUND TIP, 2.5MM HEX"	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
215.95	SUP	Custom 27803010		"215.950  -  SS OCCIPITAL CLAMP, SINGLE, SHORT"	BOTH IP/OP	"$1,050.00 "	$777.00	$0.00	$840.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$779.31	$779.31	$0.00	$0.00	$218.82	$0.00	$0.00	$0.00	$0.00	$525.00	$831.60	$840.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.951	SUP	Custom 27803010		"215.951  -  SS OCCIPITAL CLAMP, SINGLE, LONG"	BOTH IP/OP	"$1,050.00 "	$777.00	$0.00	$840.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$779.31	$779.31	$0.00	$0.00	$218.82	$0.00	$0.00	$0.00	$0.00	$525.00	$831.60	$840.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.952	SUP	HCPCS C1713		"215.952  -  SS SET SCREW, M4.5 X 0.75"	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
215.953	SUP	Custom 27803010		"215.953  -  SS 3.7MM OCCIPITAL ROD, 240MM, 100DEG"	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$0.00	$0.00	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.954	SUP	Custom 27803010		"215.954  -  SS 3.7MM OCCIPITAL ROD, 240MM, 115DEG"	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$0.00	$0.00	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.955	SUP	Custom 27803010		"215.955  -  SS 3.7MM OCCIPITAL ROD, 240MM, 130DEG"	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$0.00	$0.00	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.956	SUP	Custom 27803010		"215.956  -  SS OCCIPITAL CLAMP, TRIPLE, SHORT"	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$0.00	$0.00	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.957	SUP	Custom 27803010		"215.957  -  SS OCCIPITAL CLAMP, TRIPLE, LONG"	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$0.00	$0.00	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.958	SUP	Custom 27803010		"215.958  -  SS OCCIPITAL CLAMP, DOUBLE, SHORT"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$0.00	$0.00	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.959	SUP	Custom 27803010		"215.959  -  SS OCCIPITAL CLAMP, DOUBLE, LONG"	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$0.00	$0.00	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.96	SUP	Custom 27803010		"215.960  -  SS PARALLEL CONNECTOR, 3.7MM ROD TO 3.7MM ROD"	BOTH IP/OP	"$1,787.50 "	"$1,322.75"	$0.00	"$1,430.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,326.68"	"$1,326.68"	$0.00	$0.00	$372.52	$0.00	$0.00	$0.00	$0.00	$893.75	"$1,415.70"	"$1,430.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.963	SUP	Custom 27803010		"215.963  -  SS PARALLEL CONNECTOR, 3.7MM ROD TO 5.5MM ROD"	BOTH IP/OP	"$1,787.50 "	"$1,322.75"	$0.00	"$1,430.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,326.68"	"$1,326.68"	$0.00	$0.00	$372.52	$0.00	$0.00	$0.00	$0.00	$893.75	"$1,415.70"	"$1,430.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.984	SUP	Custom 27803010		"215.984  -  SS TAPERED ROD, 3.7MM TO 5.5MM, 350MM"	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.99	SUP	Custom 27803010		215.990  -  SS LATERAL CONNECTOR	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
215.991	SUP	Custom 27803010		"215.991  -  SS LATERAL CONNECTOR, SHORT"	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
216.03	SUP	HCPCS C1713		216.030  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 30MM 16MM SOCKET LCP DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
216.035	SUP	HCPCS C1713		216.035  -  SCREW BONE PTHRD 6.5MM 8MM 35MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
216.04	SUP	HCPCS C1713		216.040  -  SCREW BONE PTHRD 6.5MM 8MM 40MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
216.045	SUP	HCPCS C1713		216.045  -  SCREW BONE PTHRD 6.5MM 8MM 45MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
216.05	SUP	HCPCS C1713		216.050  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 50MM 16MM SOCKET LCP DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
216.055	SUP	HCPCS C1713		216.055  -  SCREW BONE PTHRD 6.5MM 8MM 55MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
216.06	SUP	HCPCS C1713		216.060  -  SCREW BONE PTHRD 6.5MM 8MM 60MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
216.065	SUP	HCPCS C1713		216.065  -  SCREW BONE PTHRD 6.5MM 8MM 65MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
216.07	SUP	HCPCS C1713		216.070  -  SCREW BONE PTHRD 6.5MM 8MM 70MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
216.075	SUP	HCPCS C1713		216.075  -  SCREW BONE PTHRD 6.5MM 8MM 75MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
216.08	SUP	HCPCS C1713		216.080  -  SCREW BONE PTHRD 6.5MM 8MM 80MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
216.085	SUP	HCPCS C1713		216.085  -  SCREW BONE PTHRD 6.5MM 8MM 85MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$15.02	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
216.09	SUP	HCPCS C1713		216.090  -  SCREW BONE PTHRD 6.5MM 8MM 90MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$15.02	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
216.095	SUP	HCPCS C1713		216.095  -  SCREW BONE PTHRD 6.5MM 8MM 95MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$15.02	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
216.1	SUP	HCPCS C1713		216.100  -  SCREW BONE PTHRD 6.5MM 8MM 100MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$15.02	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
216.105	SUP	HCPCS C1713		216.105  -  SCREW BONE PTHRD 6.5MM 8MM 105MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$15.02	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
216.11	SUP	HCPCS C1713		216.110  -  SCREW BONE PTHRD 6.5MM 110MM 16MM THREAD LCP STAINLESS STEEL	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$15.02	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
216.115	SUP	HCPCS C1713		216.115  -  SCREW BONE PTHRD 6.5MM 8MM 115MM 16MM HEXAGONAL SOCKET LCP	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
216.12	SUP	HCPCS C1713		216.120  -  SCREW BONE PTHRD 6.5MM 8MM 120MM 16MM HEXAGONAL SOCKET LCP	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
216.125	SUP	HCPCS C1713		216.125  -  SCREW BONE 6.5MM 125MM 16MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
216.13	SUP	HCPCS C1713		216.130  -  SCREW BONE PTHRD 6.5MM 8MM 130MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
216.135	SUP	HCPCS C1713		216.135  -  SCREW BONE 6.5MM 135MM 16MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
216.14	SUP	HCPCS C1713		216.140  -  SCREW BONE PTHRD 6.5MM 8MM 140MM 16MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
216.145	SUP	HCPCS C1713		216.145  -  SCREW BONE 6.5MM 145MM 16MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
216.15	SUP	HCPCS C1713		216.150  -  SCREW BONE 6.5MM 150MM 16MM LOCKING THREADED LC-DCP	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
216.24	SUP	HCPCS C1713		216.240  -  SCREW BONE 6.5MM 40MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$57.63 	$42.65	$0.00	$46.10	$25.93	$25.93	$0.00	$0.00	$0.00	$12.01	$42.77	$42.77	$0.00	$0.00	$12.01	$0.00	$34.09	$34.09	$0.00	$28.81	$45.64	$46.10	$0.00		$0.00	$9.02	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
216.25	SUP	HCPCS C1713		216.250  -  SCREW BONE 6.5MM 8MM 50MM 24MM LARGE HEXAGONAL SOCKET DCP	BOTH IP/OP	$57.63 	$42.65	$0.00	$46.10	$25.93	$25.93	$0.00	$0.00	$0.00	$12.01	$42.77	$42.77	$0.00	$0.00	$12.01	$0.00	$34.09	$34.09	$0.00	$28.81	$45.64	$46.10	$0.00		$0.00	$9.02	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
216.26	SUP	HCPCS C1713		216.260  -  SCREW BONE 6.5MM 60MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$57.63 	$42.65	$0.00	$46.10	$25.93	$25.93	$0.00	$0.00	$0.00	$12.01	$42.77	$42.77	$0.00	$0.00	$12.01	$0.00	$34.09	$34.09	$0.00	$28.81	$45.64	$46.10	$0.00		$0.00	$9.02	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
216.27	SUP	HCPCS C1713		216.270  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 70MM 24MM SOCKET LCP DCP	BOTH IP/OP	$57.63 	$42.65	$0.00	$46.10	$25.93	$25.93	$0.00	$0.00	$0.00	$12.01	$42.77	$42.77	$0.00	$0.00	$12.01	$0.00	$34.09	$34.09	$0.00	$28.81	$45.64	$46.10	$0.00		$0.00	$9.02	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
216.28	SUP	HCPCS C1713		216.280  -  SCREW BONE 6.5MM 80MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$57.63 	$42.65	$0.00	$46.10	$25.93	$25.93	$0.00	$0.00	$0.00	$12.01	$42.77	$42.77	$0.00	$0.00	$12.01	$0.00	$34.09	$34.09	$0.00	$28.81	$45.64	$46.10	$0.00		$0.00	$9.02	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
216.29	SUP	HCPCS C1713		216.290  -  SCREW BONE 6.5MM 90MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$62.28 	$46.09	$0.00	$49.82	$28.02	$28.02	$0.00	$0.00	$0.00	$12.98	$46.22	$46.22	$0.00	$0.00	$12.98	$0.00	$36.84	$36.84	$0.00	$31.14	$49.33	$49.82	$0.00		$0.00	$9.75	$0.00	$0.00	$9.91	$0.00	$0.00	$0.00	$0.00	$0.00
216.295	SUP	HCPCS C1713		216.295  -  SCREW BONE 6.5MM 95MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$62.28 	$46.09	$0.00	$49.82	$28.02	$28.02	$0.00	$0.00	$0.00	$12.98	$46.22	$46.22	$0.00	$0.00	$12.98	$0.00	$36.84	$36.84	$0.00	$31.14	$49.33	$49.82	$0.00		$0.00	$9.75	$0.00	$0.00	$9.91	$0.00	$0.00	$0.00	$0.00	$0.00
216.3	SUP	HCPCS C1713		216.300  -  SCREW BONE 6.5MM 100MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$62.28 	$46.09	$0.00	$49.82	$28.02	$28.02	$0.00	$0.00	$0.00	$12.98	$46.22	$46.22	$0.00	$0.00	$12.98	$0.00	$36.84	$36.84	$0.00	$31.14	$49.33	$49.82	$0.00		$0.00	$9.75	$0.00	$0.00	$9.91	$0.00	$0.00	$0.00	$0.00	$0.00
216.305	SUP	HCPCS C1713		216.305  -  SCREW BONE 6.5MM 105MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$62.28 	$46.09	$0.00	$49.82	$28.02	$28.02	$0.00	$0.00	$0.00	$12.98	$46.22	$46.22	$0.00	$0.00	$12.98	$0.00	$36.84	$36.84	$0.00	$31.14	$49.33	$49.82	$0.00		$0.00	$9.75	$0.00	$0.00	$9.91	$0.00	$0.00	$0.00	$0.00	$0.00
216.31	SUP	HCPCS C1713		216.310  -  SCREW BONE 6.5MM 110MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$62.28 	$46.09	$0.00	$49.82	$28.02	$28.02	$0.00	$0.00	$0.00	$12.98	$46.22	$46.22	$0.00	$0.00	$12.98	$0.00	$36.84	$36.84	$0.00	$31.14	$49.33	$49.82	$0.00		$0.00	$9.75	$0.00	$0.00	$9.91	$0.00	$0.00	$0.00	$0.00	$0.00
216.315	SUP	HCPCS C1713		216.315  -  SCREW BONE 6.5MM 115MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$77.50 	$57.35	$0.00	$62.00	$34.88	$34.88	$0.00	$0.00	$0.00	$16.15	$57.52	$57.52	$0.00	$0.00	$16.15	$0.00	$45.84	$45.84	$0.00	$38.75	$61.38	$62.00	$0.00		$0.00	$12.13	$0.00	$0.00	$12.34	$0.00	$0.00	$0.00	$0.00	$0.00
216.32	SUP	HCPCS C1713		216.320  -  SCREW BONE 6.5MM 120MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$77.50 	$57.35	$0.00	$62.00	$34.88	$34.88	$0.00	$0.00	$0.00	$16.15	$57.52	$57.52	$0.00	$0.00	$16.15	$0.00	$45.84	$45.84	$0.00	$38.75	$61.38	$62.00	$0.00		$0.00	$12.13	$0.00	$0.00	$12.34	$0.00	$0.00	$0.00	$0.00	$0.00
216.325	SUP	HCPCS C1713		216.325  -  SCREW BONE 6.5MM 125MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$77.50 	$57.35	$0.00	$62.00	$34.88	$34.88	$0.00	$0.00	$0.00	$16.15	$57.52	$57.52	$0.00	$0.00	$16.15	$0.00	$45.84	$45.84	$0.00	$38.75	$61.38	$62.00	$0.00		$0.00	$12.13	$0.00	$0.00	$12.34	$0.00	$0.00	$0.00	$0.00	$0.00
216.33	SUP	HCPCS C1713		216.330  -  SCREW BONE 6.5MM 130MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$77.50 	$57.35	$0.00	$62.00	$34.88	$34.88	$0.00	$0.00	$0.00	$16.15	$57.52	$57.52	$0.00	$0.00	$16.15	$0.00	$45.84	$45.84	$0.00	$38.75	$61.38	$62.00	$0.00		$0.00	$12.13	$0.00	$0.00	$12.34	$0.00	$0.00	$0.00	$0.00	$0.00
216.34	SUP	HCPCS C1713		216.340  -  SCREW BONE 6.5MM 140MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$77.50 	$57.35	$0.00	$62.00	$34.88	$34.88	$0.00	$0.00	$0.00	$16.15	$57.52	$57.52	$0.00	$0.00	$16.15	$0.00	$45.84	$45.84	$0.00	$38.75	$61.38	$62.00	$0.00		$0.00	$12.13	$0.00	$0.00	$12.34	$0.00	$0.00	$0.00	$0.00	$0.00
216.35	SUP	HCPCS C1713		216.350  -  SCREW BONE 6.5MM 150MM 24MM THREAD LC-DCP STAINLESS STEEL	BOTH IP/OP	$77.50 	$57.35	$0.00	$62.00	$34.88	$34.88	$0.00	$0.00	$0.00	$16.15	$57.52	$57.52	$0.00	$0.00	$16.15	$0.00	$45.84	$45.84	$0.00	$38.75	$61.38	$62.00	$0.00		$0.00	$12.13	$0.00	$0.00	$12.34	$0.00	$0.00	$0.00	$0.00	$0.00
217.045	SUP	HCPCS C1713		217.045  -  SCREW BONE PTHRD 6.5MM 8MM 45MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
217.05	SUP	HCPCS C1713		217.050  -  SCREW BONE PTHRD 6.5MM 8MM 50MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
217.055	SUP	HCPCS C1713		217.055  -  SCREW BONE PTHRD 6.5MM 55MM 32MM LCP STAINLESS STEEL HUMERUS	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
217.06	SUP	HCPCS C1713		217.060  -  SCREW BONE PTHRD 6.5MM 60MM 32MM LCP STAINLESS STEEL HUMERUS	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
217.065	SUP	HCPCS C1713		217.065  -  SCREW BONE PTHRD 6.5MM 8MM 65MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
217.07	SUP	HCPCS C1713		217.070  -  SCREW BONE PTHRD 6.5MM 8MM 70MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
217.075	SUP	HCPCS C1713		217.075  -  SCREW BONE PTHRD 6.5MM 8MM 75MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
217.08	SUP	HCPCS C1713		217.080  -  SCREW BONE PTHRD 6.5MM 80MM 32MM LCP STAINLESS STEEL HUMERUS	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
217.08	SUP	HCPCS C1713		217.08  -  SCREW BONE 6.5MM 80MM 32MM LC DCP SS CANC PERIART NSTRL LG	BOTH IP/OP	$59.35 	$43.92	$0.00	$61.88	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$61.88	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
217.085	SUP	HCPCS C1713		217.085  -  SCREW BONE PTHRD 6.5MM 8MM 85MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
217.09	SUP	HCPCS C1713		217.090  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 90MM 32MM SOCKET LCP DCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$15.02	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
217.095	SUP	HCPCS C1713		217.095  -  SCREW BONE PTHRD 6.5MM 8MM 95MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
217.1	SUP	HCPCS C1713		217.100  -  SCREW BONE PTHRD 6.5MM 8MM 100MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$15.02	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
217.105	SUP	HCPCS C1713		217.105  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 105MM 32MM SOCKET LCP DCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
217.11	SUP	HCPCS C1713		217.110  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 110MM 32MM SOCKET LCP DCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
217.115	SUP	HCPCS C1713		217.115  -  SCREW BONE 6.5MM 8MM 115MM 32MM HEXAGONAL SOCKET LC-DCP	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
217.12	SUP	HCPCS C1713		217.120  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 120MM 32MM SOCKET LCP DCP	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
217.125	SUP	HCPCS C1713		217.125  -  SCREW BONE 6.5MM 8MM 125MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
217.13	SUP	HCPCS C1713		217.130  -  SCREW BONE 6.5MM 8MM 130MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
217.135	SUP	HCPCS C1713		217.135  -  SCREW BONE 6.5MM 8MM 135MM 32MM LARGE HEXAGONAL SOCKET DCP	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
217.14	SUP	HCPCS C1713		217.140  -  SCREW BONE 6.5MM 8MM 140MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
217.145	SUP	HCPCS C1713		217.145  -  SCREW BONE 6.5MM 8MM 145MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
217.15	SUP	HCPCS C1713		217.150  -  SCREW BONE 6.5MM 8MM 150MM 32MM LARGE HEXAGONAL SOCKET DCP	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
218.009	SUP	HCPCS C1713		218.009  -  SCREW BONE 6.5MM 60MM LCP STAINLESS STEEL CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.01	SUP	HCPCS C1713		218.010  -  CASE STERILIZATION 2IN 11X7IN CASTANEDA RETRACTOR KIT	BOTH IP/OP	$266.13 	$196.94	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$55.47	$197.52	$197.52	$0.00	$0.00	$55.46	$0.00	$157.41	$157.41	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.011	SUP	HCPCS C1713		218.011  -  SCREW BONE 6.5MM 70MM LCP STAINLESS STEEL CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.012	SUP	HCPCS C1713		218.012  -  SCREW BONE 6.5MM 75MM LCP STAINLESS STEEL CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.013	SUP	HCPCS C1713		218.013  -  SCREW BONE 6.5MM 80MM LCP STAINLESS STEEL CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.014	SUP	HCPCS C1713		218.014  -  SCREW BONE 6.5MM 85MM LCP STAINLESS STEEL CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.015	SUP	HCPCS C1713		218.015  -  SCREW BONE 6.5MM 90MM LCP STAINLESS STEEL CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.016	SUP	HCPCS C1713		218.016  -  SCREW BONE 6.5MM 95MM LCP STAINLESS STEEL CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.017	SUP	HCPCS C1713		218.017  -  SCREW BONE 6.5MM 100MM LCP STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.018	SUP	HCPCS C1713		218.018  -  SCREW BONE 6.5MM 105MM LCP STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.019	SUP	HCPCS C1713		218.019  -  SCREW BONE 6.5MM 110MM LCP STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.02	SUP	HCPCS C1713		218.020  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 20MM SOCKET LCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.025	SUP	HCPCS C1713		218.025  -  SCREW BONE 6.5MM 25MM FULTHD LC-DCP STAINLESS STEEL	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.03	SUP	HCPCS C1713		218.030  -  SCREW BONE FULTHD 6.5MM 8MM 30MM LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.035	SUP	HCPCS C1713		218.035  -  SCREW BONE FULTHD 6.5MM 8MM 35MM LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.04	SUP	HCPCS C1713		218.040  -  SCREW BONE FULTHD 6.5MM 8MM 40MM LARGE HEXAGONAL SOCKET LCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.045	SUP	HCPCS C1713		218.045  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 45MM SOCKET LCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$13.61	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.05	SUP	HCPCS C1713		218.050  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 50MM SOCKET LCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.055	SUP	HCPCS C1713		218.055  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 55MM SOCKET LCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.06	SUP	HCPCS C1713		218.060  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 60MM SOCKET LCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.065	SUP	HCPCS C1713		218.065  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 65MM SOCKET LCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.07	SUP	HCPCS C1713		218.070  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 70MM SOCKET LCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.075	SUP	HCPCS C1713		218.075  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 75MM SOCKET LCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.08	SUP	HCPCS C1713		218.080  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 80MM SOCKET LCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
218.085	SUP	HCPCS C1713		218.085  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 85MM SOCKET LCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
218.09	SUP	HCPCS C1713		218.090  -  SCREW BONE FULTHD 6.5MM 8MM 90MM 3.5MM HEXAGONAL SOCKET DCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
218.095	SUP	HCPCS C1713		218.095  -  SCREW BONE FULTHD 6.5MM 8MM 95MM 3.5MM HEXAGONAL SOCKET DCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
218.1	SUP	HCPCS C1713		218.100  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 100MM SOCKET LCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
218.105	SUP	HCPCS C1713		218.105  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 105MM SOCKET LCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
218.11	SUP	HCPCS C1713		218.110  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 110MM SOCKET LCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
218.115	SUP	HCPCS C1713		218.115  -  SCREW BONE FULTHD 6.5MM 8MM 115MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
218.12	SUP	HCPCS C1713		218.120  -  SCREW BONE FULTHD 6.5MM 8MM 120MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
218.125	SUP	HCPCS C1713		218.125  -  SCREW BONE FULTHD 6.5MM 8MM 125MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
218.13	SUP	HCPCS C1713		218.130  -  SCREW BONE 6.5MM 130MM FULTHRD LC-DCP STAINLESS STEEL	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
218.135	SUP	HCPCS C1713		218.135  -  SCREW BONE FULTHD 6.5MM 8MM 135MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
218.14	SUP	HCPCS C1713		218.140  -  SCREW BONE 6.5MM 140MM FULTHRD DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
218.145	SUP	HCPCS C1713		218.145  -  SCREW BONE FULTHD 6.5MM 8MM 145MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
218.15	SUP	HCPCS C1713		218.150  -  SCREW BONE 6.5MM 150MM FULTHRD DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
218.215	SUP	HCPCS C1713		218.215  -  SCREW BONE FULTHD 6.5MM 115MM LCP STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.22	SUP	HCPCS C1713		218.220  -  SCREW BONE FULTHD LP 6.5MM 8MM 120MM HIGH BENDING STABILITY	BOTH IP/OP	$266.13 	$196.94	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$55.47	$197.52	$197.52	$0.00	$0.00	$55.46	$0.00	$157.41	$157.41	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.225	SUP	HCPCS C1713		218.225  -  SCREW BONE FULTHD 6.5MM 125MM LCP STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
218.23	SUP	HCPCS C1713		218.230  -  SCREW BONE FULTHD LP 6.5MM 8MM 130MM HIGH BENDING STABILITY	BOTH IP/OP	$266.13 	$196.94	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$55.47	$197.52	$197.52	$0.00	$0.00	$55.46	$0.00	$157.41	$157.41	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
219.89	SUP	Custom 27803010		219.89  -  WASHER ORTHOPEDIC THREAD LCP STAINLESS STEEL NONSTRL 3 MM	BOTH IP/OP	$258.65 	$191.40	$0.00	$200.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.97	$191.97	$0.00	$0.00	$53.90	$0.00	$0.00	$0.00	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
219.91	SUP	Custom 27803010		219.91  -  WASHER ORTHOPEDIC 10MM LCP STAINLESS STEEL NONSTRL 4.5MM	BOTH IP/OP	$49.90 	$36.93	$0.00	$38.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.04	$37.04	$0.00	$0.00	$10.40	$0.00	$0.00	$0.00	$0.00	$24.21	$38.36	$38.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
219.931	SUP	Custom 27803010		219.931  -  WASHER ORTHOPEDIC 8MM 3.2MM SPIKE LCP STAINLESS STEEL	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
219.941	SUP	Custom 27803010		219.941  -  WASHER ORTHOPEDIC 13.5MM 4MM SPIKE LCP STAINLESS STEEL	BOTH IP/OP	$229.13 	$169.56	$0.00	$177.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.06	$170.06	$0.00	$0.00	$47.75	$0.00	$0.00	$0.00	$0.00	$111.23	$176.18	$177.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
219.951	SUP	Custom 27803010		219.951  -  WASHER ORTHOPEDIC 13.5MM 5.5MM SPIKE LC-DCP PEEK-OPTIMA 6%	BOTH IP/OP	$226.33 	$167.48	$0.00	$175.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.98	$167.98	$0.00	$0.00	$47.17	$0.00	$0.00	$0.00	$0.00	$109.86	$174.03	$175.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
219.96	SUP	Custom 27803010		219.96  -  NUT ORTHOPEDIC LC-DCP STAINLESS STEEL NONSTRL 4.5 MM	BOTH IP/OP	$55.85 	$41.33	$0.00	$43.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.45	$41.45	$0.00	$0.00	$11.64	$0.00	$0.00	$0.00	$0.00	$27.11	$42.95	$43.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
219.97	SUP	Custom 27803010		219.97  -  WASHER ORTHOPEDIC 4.5MM FRAGMENT DCP STAINLESS STEEL NONSTRL	BOTH IP/OP	$42.85 	$31.71	$0.00	$33.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.80	$31.80	$0.00	$0.00	$8.93	$0.00	$0.00	$0.00	$0.00	$20.80	$32.95	$33.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
219.972	SUP	Custom 27803010		219.972  -  WASHER ORTHOPEDIC 6.5MM 3.3MM LCP STAINLESS STEEL NONSTRL 3	BOTH IP/OP	$55.85 	$41.33	$0.00	$43.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.45	$41.45	$0.00	$0.00	$11.64	$0.00	$0.00	$0.00	$0.00	$27.11	$42.95	$43.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
219.98	SUP	Custom 27803010		219.98  -  WASHER ORTHOPEDIC SMALL 7MM 3.6MM LCP STAINLESS STEEL	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
219.99	SUP	Custom 27803010		219.99  -  WASHER ORTHOPEDIC 13MM 6.6MM LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	$52.70 	$39.00	$0.00	$40.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.11	$39.11	$0.00	$0.00	$10.98	$0.00	$0.00	$0.00	$0.00	$25.59	$40.53	$40.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
221.306	SUP	HCPCS C1713		221.306  -  PLATE BONE STR 6 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
221.312	SUP	HCPCS C1713		221.312  -  PLATE BONE STR 12 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC	BOTH IP/OP	$465.28 	$344.31	$0.00	$361.38	$203.28	$203.28	$0.00	$0.00	$0.00	$96.97	$345.33	$345.33	$0.00	$0.00	$96.96	$0.00	$275.21	$275.21	$0.00	$225.86	$357.77	$361.38	$0.00		$0.00	$68.64	$0.00	$0.00	$71.91	$0.00	$0.00	$0.00	$0.00	$0.00
221.32	SUP	HCPCS C1713		221.320  -  PLATE BN H 19MMX.5MM NS 8 HL XTD LOPRFL PRECONTOUR SS HND RT	BOTH IP/OP	$431.25 	$319.13	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$89.88	$320.07	$320.07	$0.00	$0.00	$89.87	$0.00	$255.08	$255.08	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
221.321	SUP	HCPCS C1713		221.321  -  PLATE BN H 19MMX.5MM NS 8 HL XTD LOPRFL PRECONTOUR SS HND LT	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
221.333	SUP	HCPCS C1713		221.333  -  SCREW BONE 4MM 46MM T25 STARDRIVE RECESS LOCK SELF TAP LCP	BOTH IP/OP	$425.93 	$315.19	$0.00	$330.82	$186.09	$186.09	$0.00	$0.00	$0.00	$88.77	$316.12	$316.12	$0.00	$0.00	$88.76	$0.00	$251.93	$251.93	$0.00	$206.76	$327.52	$330.82	$0.00		$0.00	$62.83	$0.00	$0.00	$65.83	$0.00	$0.00	$0.00	$0.00	$0.00
221.334	SUP	HCPCS C1713		221.334  -  PLATE BONE T 4X8 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
221.335	SUP	HCPCS C1713		221.335  -  PLATE BONE Y 3X8 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC	BOTH IP/OP	$425.93 	$315.19	$0.00	$330.82	$186.09	$186.09	$0.00	$0.00	$0.00	$88.77	$316.12	$316.12	$0.00	$0.00	$88.76	$0.00	$251.93	$251.93	$0.00	$206.76	$327.52	$330.82	$0.00		$0.00	$62.83	$0.00	$0.00	$65.83	$0.00	$0.00	$0.00	$0.00	$0.00
222.02	SUP	HCPCS C1713		222.02  -  PLATE BN SMTB 39X12X1MM NS 2 HL SS 3.5/4.5MM SCR LG FRAG	BOTH IP/OP	$122.13 	$90.38	$0.00	$97.70	$54.96	$54.96	$0.00	$0.00	$0.00	$25.45	$90.64	$90.64	$0.00	$0.00	$25.45	$0.00	$72.24	$72.24	$0.00	$61.06	$96.73	$97.70	$0.00		$0.00	$18.56	$0.00	$0.00	$19.44	$0.00	$0.00	$0.00	$0.00	$0.00
222.03	SUP	HCPCS C1713		222.03  -  PLATE BN SMTB 55X12X1MM NS 3 HL SS 3.5/4.5MM SCR LG FRAG	BOTH IP/OP	$130.33 	$96.44	$0.00	$104.26	$58.65	$58.65	$0.00	$0.00	$0.00	$27.16	$96.73	$96.73	$0.00	$0.00	$27.16	$0.00	$77.09	$77.09	$0.00	$65.16	$103.22	$104.26	$0.00		$0.00	$19.80	$0.00	$0.00	$20.75	$0.00	$0.00	$0.00	$0.00	$0.00
222.04	SUP	HCPCS C1713		222.04  -  PLATE BONE SEMITUBULAR 71X12X1MM 4 HOLE SEMITUBULAR DCP	BOTH IP/OP	$140.58 	$104.03	$0.00	$112.46	$63.26	$63.26	$0.00	$0.00	$0.00	$29.30	$104.33	$104.33	$0.00	$0.00	$29.30	$0.00	$83.15	$83.15	$0.00	$70.29	$111.34	$112.46	$0.00		$0.00	$21.36	$0.00	$0.00	$22.38	$0.00	$0.00	$0.00	$0.00	$0.00
222.05	SUP	HCPCS C1713		222.05  -  PLATE BONE SEMITUBULAR 87X12X1MM 5 HOLE SEMITUBULAR DCP	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$22.60	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
222.06	SUP	HCPCS C1713		222.06  -  PLATE BONE SEMITUBULAR 103X12X1MM 6 HOLE SEMITUBULAR DCP	BOTH IP/OP	$158.30 	$117.14	$0.00	$126.64	$71.24	$71.24	$0.00	$0.00	$0.00	$32.99	$117.49	$117.49	$0.00	$0.00	$32.99	$0.00	$93.63	$93.63	$0.00	$79.15	$125.37	$126.64	$0.00		$0.00	$24.05	$0.00	$0.00	$25.20	$0.00	$0.00	$0.00	$0.00	$0.00
222.07	SUP	HCPCS C1713		222.07  -  PLATE BONE SEMITUBULAR 119X12X1MM 7 HOLE SEMITUBULAR DCP	BOTH IP/OP	$169.23 	$125.23	$0.00	$135.38	$76.15	$76.15	$0.00	$0.00	$0.00	$35.27	$125.60	$125.60	$0.00	$0.00	$35.27	$0.00	$100.10	$100.10	$0.00	$84.61	$134.03	$135.38	$0.00		$0.00	$25.71	$0.00	$0.00	$26.94	$0.00	$0.00	$0.00	$0.00	$0.00
222.08	SUP	HCPCS C1713		222.08  -  PLATE BONE SEMITUBULAR 135X12X1MM 8 HOLE SEMITUBULAR DCP	BOTH IP/OP	$184.25 	$136.35	$0.00	$147.40	$82.91	$82.91	$0.00	$0.00	$0.00	$38.40	$136.75	$136.75	$0.00	$0.00	$38.40	$0.00	$108.98	$108.98	$0.00	$92.13	$145.93	$147.40	$0.00		$0.00	$27.99	$0.00	$0.00	$29.33	$0.00	$0.00	$0.00	$0.00	$0.00
222.09	SUP	HCPCS C1713		222.09  -  PLATE BONE 151X12X1MM 9 HOLE SEMITUBULAR DCP LC-DCP	BOTH IP/OP	$206.08 	$152.50	$0.00	$164.86	$92.73	$92.73	$0.00	$0.00	$0.00	$42.95	$152.95	$152.95	$0.00	$0.00	$42.95	$0.00	$121.89	$121.89	$0.00	$103.04	$163.22	$164.86	$0.00		$0.00	$31.31	$0.00	$0.00	$32.81	$0.00	$0.00	$0.00	$0.00	$0.00
222.1	SUP	HCPCS C1713		222.10  -  PLATE BONE TUBE 167X12X1MM 10 HOLE LOCK LCP STAINLESS STEEL	BOTH IP/OP	$201.98 	$149.47	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$42.10	$149.91	$149.91	$0.00	$0.00	$42.09	$0.00	$119.47	$119.47	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
222.11	SUP	HCPCS C1713		222.11  -  PLATE BONE 183X12X1MM 11 HOLE SEMITUBULAR LC-DCP STAINLESS	BOTH IP/OP	$229.13 	$169.56	$0.00	$177.96	$100.10	$100.10	$0.00	$0.00	$0.00	$47.76	$170.06	$170.06	$0.00	$0.00	$47.75	$0.00	$135.53	$135.53	$0.00	$111.23	$176.18	$177.96	$0.00		$0.00	$33.80	$0.00	$0.00	$35.41	$0.00	$0.00	$0.00	$0.00	$0.00
222.12	SUP	HCPCS C1713		222.12  -  PLATE BONE 199X12X1MM 12 HOLE SEMITUBULAR LC-DCP STAINLESS	BOTH IP/OP	$227.93 	$168.67	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
222.22	SUP	HCPCS C1713		222.220  -  ANCHOR SUTURE 2MM 2 END THREAD TAB TACIT	BOTH IP/OP	"$2,763.63 "	"$2,045.09"	$0.00	"$2,210.90"	"$1,243.63"	"$1,243.63"	$0.00	$0.00	$0.00	$576.01	"$2,051.16"	"$2,051.16"	$0.00	$0.00	$575.94	$0.00	"$1,362.47"	"$1,362.47"	$0.00	"$1,381.81"	"$2,188.79"	"$2,210.90"	$0.00		$0.00	$419.91	$0.00	$0.00	$439.97	$0.00	$0.00	$0.00	$0.00	$0.00
222.221	SUP	HCPCS C1713		222.221  -  PLATE BONE 140MM 5 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$2,846.53 "	"$2,106.43"	$0.00	"$2,210.90"	"$1,243.63"	"$1,243.63"	$0.00	$0.00	$0.00	$593.29	"$2,112.69"	"$2,112.69"	$0.00	$0.00	$593.22	$0.00	"$1,403.34"	"$1,403.34"	$0.00	"$1,381.81"	"$2,188.79"	"$2,210.90"	$0.00		$0.00	$419.91	$0.00	$0.00	$439.97	$0.00	$0.00	$0.00	$0.00	$0.00
222.222	SUP	HCPCS C1713		222.222  -  PLATE BONE 180MM 7 HOLE LCP STAINLESS STEEL TIBIA RIGHT	BOTH IP/OP	"$2,904.15 "	"$2,149.07"	$0.00	"$2,255.66"	"$1,268.81"	"$1,268.81"	$0.00	$0.00	$0.00	$605.30	"$2,155.46"	"$2,155.46"	$0.00	$0.00	$605.22	$0.00	"$1,431.75"	"$1,431.75"	$0.00	"$1,409.79"	"$2,233.11"	"$2,255.66"	$0.00		$0.00	$428.41	$0.00	$0.00	$448.88	$0.00	$0.00	$0.00	$0.00	$0.00
222.223	SUP	HCPCS C1713		222.223  -  PLATE BONE 180MM 7 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$2,904.15 "	"$2,149.07"	$0.00	"$2,255.66"	"$1,268.81"	"$1,268.81"	$0.00	$0.00	$0.00	$605.30	"$2,155.46"	"$2,155.46"	$0.00	$0.00	$605.22	$0.00	"$1,431.75"	"$1,431.75"	$0.00	"$1,409.79"	"$2,233.11"	"$2,255.66"	$0.00		$0.00	$428.41	$0.00	$0.00	$448.88	$0.00	$0.00	$0.00	$0.00	$0.00
222.224	SUP	HCPCS C1713		222.224  -  PLATE BONE 220MM 9 HOLE LCP STAINLESS STEEL TIBIA RIGHT	BOTH IP/OP	"$2,964.60 "	"$2,193.80"	$0.00	"$2,302.60"	"$1,295.21"	"$1,295.21"	$0.00	$0.00	$0.00	$617.90	"$2,200.33"	"$2,200.33"	$0.00	$0.00	$617.82	$0.00	"$1,461.55"	"$1,461.55"	$0.00	"$1,439.13"	"$2,279.57"	"$2,302.60"	$0.00		$0.00	$437.33	$0.00	$0.00	$458.22	$0.00	$0.00	$0.00	$0.00	$0.00
222.225	SUP	HCPCS C1713		222.225  -  PLATE BONE 220MM 9 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$2,964.60 "	"$2,193.80"	$0.00	"$2,302.60"	"$1,295.21"	"$1,295.21"	$0.00	$0.00	$0.00	$617.90	"$2,200.33"	"$2,200.33"	$0.00	$0.00	$617.82	$0.00	"$1,461.55"	"$1,461.55"	$0.00	"$1,439.13"	"$2,279.57"	"$2,302.60"	$0.00		$0.00	$437.33	$0.00	$0.00	$458.22	$0.00	$0.00	$0.00	$0.00	$0.00
222.226	SUP	HCPCS C1713		222.226  -  PLATE BONE 260MM 11 HOLE LCP STAINLESS STEEL TIBIA RIGHT	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,347.38"	"$1,320.40"	"$1,320.40"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,467.11"	"$2,323.91"	"$2,347.38"	$0.00		$0.00	$445.83	$0.00	$0.00	$467.13	$0.00	$0.00	$0.00	$0.00	$0.00
222.227	SUP	HCPCS C1713		222.227  -  PLATE BONE 260MM 11 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,347.38"	"$1,320.40"	"$1,320.40"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,467.11"	"$2,323.91"	"$2,347.38"	$0.00		$0.00	$445.83	$0.00	$0.00	$467.13	$0.00	$0.00	$0.00	$0.00	$0.00
222.228	SUP	HCPCS C1713		222.228  -  PLATE BONE 300MM 13 HOLE LCP STAINLESS STEEL TIBIA RIGHT	BOTH IP/OP	"$3,081.28 "	"$2,280.15"	$0.00	"$2,393.22"	"$1,346.19"	"$1,346.19"	$0.00	$0.00	$0.00	$642.21	"$2,286.92"	"$2,286.92"	$0.00	$0.00	$642.14	$0.00	"$1,519.07"	"$1,519.07"	$0.00	"$1,495.76"	"$2,369.29"	"$2,393.22"	$0.00		$0.00	$454.54	$0.00	$0.00	$476.25	$0.00	$0.00	$0.00	$0.00	$0.00
222.229	SUP	HCPCS C1713		222.229  -  PLATE BONE 300MM 13 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$3,081.28 "	"$2,280.15"	$0.00	"$2,393.22"	"$1,346.19"	"$1,346.19"	$0.00	$0.00	$0.00	$642.21	"$2,286.92"	"$2,286.92"	$0.00	$0.00	$642.14	$0.00	"$1,519.07"	"$1,519.07"	$0.00	"$1,495.76"	"$2,369.29"	"$2,393.22"	$0.00		$0.00	$454.54	$0.00	$0.00	$476.25	$0.00	$0.00	$0.00	$0.00	$0.00
222.25	SUP	HCPCS C1713		222.250  -  PLATE BONE 156MM 5 HOLE LCP STAINLESS STEEL FEMUR RIGHT	BOTH IP/OP	"$2,763.63 "	"$2,045.09"	$0.00	"$2,210.90"	"$1,243.63"	"$1,243.63"	$0.00	$0.00	$0.00	$576.01	"$2,051.16"	"$2,051.16"	$0.00	$0.00	$575.94	$0.00	"$1,362.47"	"$1,362.47"	$0.00	"$1,381.81"	"$2,188.79"	"$2,210.90"	$0.00		$0.00	$419.91	$0.00	$0.00	$439.97	$0.00	$0.00	$0.00	$0.00	$0.00
222.251	SUP	HCPCS C1713		222.251  -  PLATE BONE 156MM 5 HOLE LCP STAINLESS STEEL LEFT CNDYLR	BOTH IP/OP	"$2,846.53 "	"$2,106.43"	$0.00	"$2,210.90"	"$1,243.63"	"$1,243.63"	$0.00	$0.00	$0.00	$593.29	"$2,112.69"	"$2,112.69"	$0.00	$0.00	$593.22	$0.00	"$1,403.34"	"$1,403.34"	$0.00	"$1,381.81"	"$2,188.79"	"$2,210.90"	$0.00		$0.00	$419.91	$0.00	$0.00	$439.97	$0.00	$0.00	$0.00	$0.00	$0.00
222.252	SUP	HCPCS C1713		222.252  -  PLATE BONE 196MM 7 HOLE LCP STAINLESS STEEL FEMUR RIGHT	BOTH IP/OP	"$2,904.15 "	"$2,149.07"	$0.00	"$2,255.66"	"$1,268.81"	"$1,268.81"	$0.00	$0.00	$0.00	$605.30	"$2,155.46"	"$2,155.46"	$0.00	$0.00	$605.22	$0.00	"$1,431.75"	"$1,431.75"	$0.00	"$1,409.79"	"$2,233.11"	"$2,255.66"	$0.00		$0.00	$428.41	$0.00	$0.00	$448.88	$0.00	$0.00	$0.00	$0.00	$0.00
222.253	SUP	HCPCS C1713		222.253  -  PLATE BONE 196MM 7 HOLE LCP STAINLESS STEEL FEMUR LEFT	BOTH IP/OP	"$2,904.15 "	"$2,149.07"	$0.00	"$2,255.66"	"$1,268.81"	"$1,268.81"	$0.00	$0.00	$0.00	$605.30	"$2,155.46"	"$2,155.46"	$0.00	$0.00	$605.22	$0.00	"$1,431.75"	"$1,431.75"	$0.00	"$1,409.79"	"$2,233.11"	"$2,255.66"	$0.00		$0.00	$428.41	$0.00	$0.00	$448.88	$0.00	$0.00	$0.00	$0.00	$0.00
222.254	SUP	HCPCS C1713		222.254  -  PLATE BONE 236MM 9 HOLE LCP STAINLESS STEEL FEMUR RIGHT	BOTH IP/OP	"$2,964.60 "	"$2,193.80"	$0.00	"$2,302.60"	"$1,295.21"	"$1,295.21"	$0.00	$0.00	$0.00	$617.90	"$2,200.33"	"$2,200.33"	$0.00	$0.00	$617.82	$0.00	"$1,461.55"	"$1,461.55"	$0.00	"$1,439.13"	"$2,279.57"	"$2,302.60"	$0.00		$0.00	$437.33	$0.00	$0.00	$458.22	$0.00	$0.00	$0.00	$0.00	$0.00
222.255	SUP	HCPCS C1713		222.255  -  PLATE BONE 236MM 9 HOLE LCP STAINLESS STEEL FEMUR LEFT	BOTH IP/OP	"$2,964.60 "	"$2,193.80"	$0.00	"$2,302.60"	"$1,295.21"	"$1,295.21"	$0.00	$0.00	$0.00	$617.90	"$2,200.33"	"$2,200.33"	$0.00	$0.00	$617.82	$0.00	"$1,461.55"	"$1,461.55"	$0.00	"$1,439.13"	"$2,279.57"	"$2,302.60"	$0.00		$0.00	$437.33	$0.00	$0.00	$458.22	$0.00	$0.00	$0.00	$0.00	$0.00
222.256	SUP	HCPCS C1713		222.256  -  PLATE BONE 276MM 11 HOLE LCP STAINLESS STEEL FEMUR RIGHT	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,347.38"	"$1,320.40"	"$1,320.40"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,467.11"	"$2,323.91"	"$2,347.38"	$0.00		$0.00	$445.83	$0.00	$0.00	$467.13	$0.00	$0.00	$0.00	$0.00	$0.00
222.257	SUP	HCPCS C1713		222.257  -  PLATE BONE 276MM 11 HOLE LCP STAINLESS STEEL FEMUR LEFT	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,347.38"	"$1,320.40"	"$1,320.40"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,467.11"	"$2,323.91"	"$2,347.38"	$0.00		$0.00	$445.83	$0.00	$0.00	$467.13	$0.00	$0.00	$0.00	$0.00	$0.00
222.258	SUP	HCPCS C1713		222.258  -  PLATE BONE 316MM 13 HOLE LCP STAINLESS STEEL FEMUR RIGHT	BOTH IP/OP	"$3,081.28 "	"$2,280.15"	$0.00	"$2,393.22"	"$1,346.19"	"$1,346.19"	$0.00	$0.00	$0.00	$642.21	"$2,286.92"	"$2,286.92"	$0.00	$0.00	$642.14	$0.00	"$1,519.07"	"$1,519.07"	$0.00	"$1,495.76"	"$2,369.29"	"$2,393.22"	$0.00		$0.00	$454.54	$0.00	$0.00	$476.25	$0.00	$0.00	$0.00	$0.00	$0.00
222.259	SUP	HCPCS C1713		222.259  -  PLATE BONE 316MM 13 HOLE LCP STAINLESS STEEL FEMUR LEFT	BOTH IP/OP	"$3,081.28 "	"$2,280.15"	$0.00	"$2,393.22"	"$1,346.19"	"$1,346.19"	$0.00	$0.00	$0.00	$642.21	"$2,286.92"	"$2,286.92"	$0.00	$0.00	$642.14	$0.00	"$1,519.07"	"$1,519.07"	$0.00	"$1,495.76"	"$2,369.29"	"$2,393.22"	$0.00		$0.00	$454.54	$0.00	$0.00	$476.25	$0.00	$0.00	$0.00	$0.00	$0.00
222.402	SUP	HCPCS C1713		222.402  -  SCREW BONE 5MM 14MM SLFTAP LOCKING LCP LISS STAINLESS STEEL	BOTH IP/OP	$404.85 	$299.59	$0.00	$314.44	$176.87	$176.87	$0.00	$0.00	$0.00	$84.38	$300.48	$300.48	$0.00	$0.00	$84.37	$0.00	$239.47	$239.47	$0.00	$196.53	$311.30	$314.44	$0.00		$0.00	$59.72	$0.00	$0.00	$62.57	$0.00	$0.00	$0.00	$0.00	$0.00
222.404	SUP	HCPCS C1713		222.404  -  SCREW BONE 5MM 18MM SLFTAP LOCKING LCP LISS STAINLESS STEEL	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
222.537	SUP	HCPCS C1713		222.537  -  SCREW BONE 5MM 35MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$444.08 	$328.62	$0.00	$355.26	$199.83	$199.83	$0.00	$0.00	$0.00	$92.56	$329.59	$329.59	$0.00	$0.00	$92.55	$0.00	$262.67	$262.67	$0.00	$222.04	$351.71	$355.26	$0.00		$0.00	$69.50	$0.00	$0.00	$70.70	$0.00	$0.00	$0.00	$0.00	$0.00
222.538	SUP	HCPCS C1713		222.538  -  SCREW BONE 5MM 40MM LCP TI PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$444.08 	$328.62	$0.00	$355.26	$199.83	$199.83	$0.00	$0.00	$0.00	$92.56	$329.59	$329.59	$0.00	$0.00	$92.55	$0.00	$262.67	$262.67	$0.00	$222.04	$351.71	$355.26	$0.00		$0.00	$69.50	$0.00	$0.00	$70.70	$0.00	$0.00	$0.00	$0.00	$0.00
222.541	SUP	HCPCS C1713		222.541  -  SCREW BONE 5MM 55MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$444.08 	$328.62	$0.00	$355.26	$199.83	$199.83	$0.00	$0.00	$0.00	$92.56	$329.59	$329.59	$0.00	$0.00	$92.55	$0.00	$262.67	$262.67	$0.00	$222.04	$351.71	$355.26	$0.00		$0.00	$69.50	$0.00	$0.00	$70.70	$0.00	$0.00	$0.00	$0.00	$0.00
222.542	SUP	HCPCS C1713		222.542  -  SCREW BONE 5MM 60MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$444.08 	$328.62	$0.00	$355.26	$199.83	$199.83	$0.00	$0.00	$0.00	$92.56	$329.59	$329.59	$0.00	$0.00	$92.55	$0.00	$262.67	$262.67	$0.00	$222.04	$351.71	$355.26	$0.00		$0.00	$69.50	$0.00	$0.00	$70.70	$0.00	$0.00	$0.00	$0.00	$0.00
222.543	SUP	HCPCS C1713		222.543  -  SCREW BONE 5MM 65MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$387.78 	$286.96	$0.00	$310.22	$174.50	$174.50	$0.00	$0.00	$0.00	$80.82	$287.81	$287.81	$0.00	$0.00	$80.81	$0.00	$229.37	$229.37	$0.00	$193.89	$307.12	$310.22	$0.00		$0.00	$60.69	$0.00	$0.00	$61.73	$0.00	$0.00	$0.00	$0.00	$0.00
222.545	SUP	HCPCS C1713		222.545  -  SCREW BONE 5MM 75MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$444.08 	$328.62	$0.00	$355.26	$199.83	$199.83	$0.00	$0.00	$0.00	$92.56	$329.59	$329.59	$0.00	$0.00	$92.55	$0.00	$262.67	$262.67	$0.00	$222.04	$351.71	$355.26	$0.00		$0.00	$69.50	$0.00	$0.00	$70.70	$0.00	$0.00	$0.00	$0.00	$0.00
222.546	SUP	HCPCS C1713		222.546  -  SCREW BONE 5MM 80MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$444.08 	$328.62	$0.00	$355.26	$199.83	$199.83	$0.00	$0.00	$0.00	$92.56	$329.59	$329.59	$0.00	$0.00	$92.55	$0.00	$262.67	$262.67	$0.00	$222.04	$351.71	$355.26	$0.00		$0.00	$69.50	$0.00	$0.00	$70.70	$0.00	$0.00	$0.00	$0.00	$0.00
222.547	SUP	HCPCS C1713		222.547  -  SCREW BONE 5MM 85MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$444.08 	$328.62	$0.00	$355.26	$199.83	$199.83	$0.00	$0.00	$0.00	$92.56	$329.59	$329.59	$0.00	$0.00	$92.55	$0.00	$262.67	$262.67	$0.00	$222.04	$351.71	$355.26	$0.00		$0.00	$69.50	$0.00	$0.00	$70.70	$0.00	$0.00	$0.00	$0.00	$0.00
222.548	SUP	HCPCS C1713		222.548  -  SCREW BONE 5MM 90MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$444.08 	$328.62	$0.00	$355.26	$199.83	$199.83	$0.00	$0.00	$0.00	$92.56	$329.59	$329.59	$0.00	$0.00	$92.55	$0.00	$262.67	$262.67	$0.00	$222.04	$351.71	$355.26	$0.00		$0.00	$69.50	$0.00	$0.00	$70.70	$0.00	$0.00	$0.00	$0.00	$0.00
222.554	SUP	HCPCS C1713		222.554  -  SCREW BONE 5MM 40MM LCP SS PROX PERIART FEM/TIB CANN CONICAL	BOTH IP/OP	$340.75 	$252.16	$0.00	$272.60	$153.34	$153.34	$0.00	$0.00	$0.00	$71.02	$252.90	$252.90	$0.00	$0.00	$71.01	$0.00	$201.55	$201.55	$0.00	$170.38	$269.87	$272.60	$0.00		$0.00	$53.33	$0.00	$0.00	$54.25	$0.00	$0.00	$0.00	$0.00	$0.00
222.564	SUP	HCPCS C1713		222.564  -  SCREW BONE 5MM 90MM LCP SS PROX PERIART FEM/TIB CANN CONICAL	BOTH IP/OP	$390.60 	$289.04	$0.00	$312.48	$175.77	$175.77	$0.00	$0.00	$0.00	$81.41	$289.90	$289.90	$0.00	$0.00	$81.40	$0.00	$231.04	$231.04	$0.00	$195.30	$309.36	$312.48	$0.00		$0.00	$61.13	$0.00	$0.00	$62.18	$0.00	$0.00	$0.00	$0.00	$0.00
222.571	SUP	HCPCS C1713		222.571  -  SCREW BONE 7.3MM 70MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$657.98 	$486.91	$0.00	$526.38	$296.09	$296.09	$0.00	$0.00	$0.00	$137.14	$488.35	$488.35	$0.00	$0.00	$137.12	$0.00	$389.19	$389.19	$0.00	$328.99	$521.12	$526.38	$0.00		$0.00	$102.97	$0.00	$0.00	$104.75	$0.00	$0.00	$0.00	$0.00	$0.00
222.572	SUP	HCPCS C1713		222.572  -  SCREW BONE 7.3MM 75MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$657.98 	$486.91	$0.00	$526.38	$296.09	$296.09	$0.00	$0.00	$0.00	$137.14	$488.35	$488.35	$0.00	$0.00	$137.12	$0.00	$389.19	$389.19	$0.00	$328.99	$521.12	$526.38	$0.00		$0.00	$102.97	$0.00	$0.00	$104.75	$0.00	$0.00	$0.00	$0.00	$0.00
222.573	SUP	HCPCS C1713		222.573  -  SCREW BONE 7.3MM 80MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$657.98 	$486.91	$0.00	$526.38	$296.09	$296.09	$0.00	$0.00	$0.00	$137.14	$488.35	$488.35	$0.00	$0.00	$137.12	$0.00	$389.19	$389.19	$0.00	$328.99	$521.12	$526.38	$0.00		$0.00	$102.97	$0.00	$0.00	$104.75	$0.00	$0.00	$0.00	$0.00	$0.00
222.575	SUP	HCPCS C1713		222.575  -  SCREW BONE 7.3MM 90MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$657.98 	$486.91	$0.00	$526.38	$296.09	$296.09	$0.00	$0.00	$0.00	$137.14	$488.35	$488.35	$0.00	$0.00	$137.12	$0.00	$389.19	$389.19	$0.00	$328.99	$521.12	$526.38	$0.00		$0.00	$102.97	$0.00	$0.00	$104.75	$0.00	$0.00	$0.00	$0.00	$0.00
222.578	SUP	Custom 27803010		222.578  -  NUT ORTHOPEDIC 4MM 12MM SELF CUTTING SERRATED TIP LCP	BOTH IP/OP	$303.63 	$224.69	$0.00	$235.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.35	$225.35	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$147.39	$233.47	$235.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
222.58	SUP	HCPCS C1713		222.580  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 14MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.581	SUP	HCPCS C1713		222.581  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 16MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.582	SUP	HCPCS C1713		222.582  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 18MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.583	SUP	HCPCS C1713		222.583  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 22MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.584	SUP	HCPCS C1713		222.584  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 26MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.585	SUP	HCPCS C1713		222.585  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 30MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.586	SUP	HCPCS C1713		222.586  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 34MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.587	SUP	HCPCS C1713		222.587  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 38MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.588	SUP	HCPCS C1713		222.588  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 42MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.589	SUP	HCPCS C1713		222.589  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 46MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.59	SUP	HCPCS C1713		222.590  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 50MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.591	SUP	HCPCS C1713		222.591  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 54MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.592	SUP	HCPCS C1713		222.592  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 58MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.593	SUP	HCPCS C1713		222.593  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 62MM SELF TAP LCP	BOTH IP/OP	$262.03 	$193.90	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$54.61	$194.47	$194.47	$0.00	$0.00	$54.61	$0.00	$154.99	$154.99	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.608	SUP	HCPCS C1713		222.608  -  SCREW BONE 7.3MM 85MM LCP SS FULTHD PROX PERIART FEM/TIB	BOTH IP/OP	$514.65 	$380.84	$0.00	$411.72	$231.59	$231.59	$0.00	$0.00	$0.00	$107.27	$381.97	$381.97	$0.00	$0.00	$107.25	$0.00	$304.42	$304.42	$0.00	$257.33	$407.60	$411.72	$0.00		$0.00	$80.54	$0.00	$0.00	$81.93	$0.00	$0.00	$0.00	$0.00	$0.00
222.609	SUP	HCPCS C1713		222.609  -  SCREW BONE 7.3MM 90MM LCP SS FULTHD PROX PERIART FEM/TIB	BOTH IP/OP	$534.23 	$395.33	$0.00	$427.38	$240.40	$240.40	$0.00	$0.00	$0.00	$111.35	$396.50	$396.50	$0.00	$0.00	$111.33	$0.00	$315.99	$315.99	$0.00	$267.11	$423.11	$427.38	$0.00		$0.00	$83.61	$0.00	$0.00	$85.05	$0.00	$0.00	$0.00	$0.00	$0.00
222.645	SUP	HCPCS C1713		222.645  -  SCREW BONE 7.3MM 75MM LCP SS PROX PERIART FEM/TIB CANN	BOTH IP/OP	$534.23 	$395.33	$0.00	$427.38	$240.40	$240.40	$0.00	$0.00	$0.00	$111.35	$396.50	$396.50	$0.00	$0.00	$111.33	$0.00	$315.99	$315.99	$0.00	$267.11	$423.11	$427.38	$0.00		$0.00	$83.61	$0.00	$0.00	$85.05	$0.00	$0.00	$0.00	$0.00	$0.00
222.646	SUP	HCPCS C1713		222.646  -  SCREW BONE 7.3MM 80MM LCP SS PROX PERIART FEM/TIB CANN	BOTH IP/OP	$588.23 	$435.29	$0.00	$470.58	$264.70	$264.70	$0.00	$0.00	$0.00	$122.60	$436.58	$436.58	$0.00	$0.00	$122.59	$0.00	$347.94	$347.94	$0.00	$294.11	$465.88	$470.58	$0.00		$0.00	$92.06	$0.00	$0.00	$93.65	$0.00	$0.00	$0.00	$0.00	$0.00
222.656	SUP	HCPCS C1713		222.656  -  PLATE BN 170X17.5X5.2MM NS LCP CMBN 6 HL LOPRFL LMT CNTCT	BOTH IP/OP	"$2,887.30 "	"$2,136.60"	$0.00	"$2,242.56"	"$1,261.44"	"$1,261.44"	$0.00	$0.00	$0.00	$601.79	"$2,142.95"	"$2,142.95"	$0.00	$0.00	$601.71	$0.00	"$1,423.44"	"$1,423.44"	$0.00	"$1,401.60"	"$2,220.13"	"$2,242.56"	$0.00		$0.00	$425.92	$0.00	$0.00	$446.27	$0.00	$0.00	$0.00	$0.00	$0.00
222.657	SUP	HCPCS C1713		222.657  -  PLATE BN 170X17.5X5.2MM NS LCP CMBN 6 HL LOPRFL LMT CNTCT	BOTH IP/OP	"$2,887.30 "	"$2,136.60"	$0.00	"$2,242.56"	"$1,261.44"	"$1,261.44"	$0.00	$0.00	$0.00	$601.79	"$2,142.95"	"$2,142.95"	$0.00	$0.00	$601.71	$0.00	"$1,423.44"	"$1,423.44"	$0.00	"$1,401.60"	"$2,220.13"	"$2,242.56"	$0.00		$0.00	$425.92	$0.00	$0.00	$446.27	$0.00	$0.00	$0.00	$0.00	$0.00
222.658	SUP	HCPCS C1713		222.658  -  PLATE BN 206X17.5X5.2MM NS LCP CMBN 8 HL LOPRFL LMT CNTCT	BOTH IP/OP	"$2,940.70 "	"$2,176.12"	$0.00	"$2,284.04"	"$1,284.77"	"$1,284.77"	$0.00	$0.00	$0.00	$612.92	"$2,182.59"	"$2,182.59"	$0.00	$0.00	$612.84	$0.00	"$1,449.77"	"$1,449.77"	$0.00	"$1,427.53"	"$2,261.20"	"$2,284.04"	$0.00		$0.00	$433.80	$0.00	$0.00	$454.52	$0.00	$0.00	$0.00	$0.00	$0.00
222.659	SUP	HCPCS C1713		222.659  -  PLATE BN 206X17.5X5.2MM NS LCP CMBN 8 HL LOPRFL LMT CNTCT	BOTH IP/OP	"$2,940.70 "	"$2,176.12"	$0.00	"$2,284.04"	"$1,284.77"	"$1,284.77"	$0.00	$0.00	$0.00	$612.92	"$2,182.59"	"$2,182.59"	$0.00	$0.00	$612.84	$0.00	"$1,449.77"	"$1,449.77"	$0.00	"$1,427.53"	"$2,261.20"	"$2,284.04"	$0.00		$0.00	$433.80	$0.00	$0.00	$454.52	$0.00	$0.00	$0.00	$0.00	$0.00
222.66	SUP	HCPCS C1713		222.660  -  PLATE BN 242X17.5X5.2MM NS LCP CMBN 10 HL LOPRFL LMT CNTCT	BOTH IP/OP	"$2,961.50 "	"$2,191.51"	$0.00	"$2,369.20"	"$1,332.68"	"$1,332.68"	$0.00	$0.00	$0.00	$617.25	"$2,198.03"	"$2,198.03"	$0.00	$0.00	$617.18	$0.00	"$1,460.02"	"$1,460.02"	$0.00	"$1,480.75"	"$2,345.51"	"$2,369.20"	$0.00		$0.00	$449.98	$0.00	$0.00	$471.47	$0.00	$0.00	$0.00	$0.00	$0.00
222.661	SUP	HCPCS C1713		222.661  -  PLATE BN 242X17.5X5.2MM NS LCP CMBN 10 HL LOPRFL LMT CNTCT	BOTH IP/OP	"$3,050.35 "	"$2,257.26"	$0.00	"$2,369.20"	"$1,332.68"	"$1,332.68"	$0.00	$0.00	$0.00	$635.77	"$2,263.97"	"$2,263.97"	$0.00	$0.00	$635.69	$0.00	"$1,503.82"	"$1,503.82"	$0.00	"$1,480.75"	"$2,345.51"	"$2,369.20"	$0.00		$0.00	$449.98	$0.00	$0.00	$471.47	$0.00	$0.00	$0.00	$0.00	$0.00
222.662	SUP	HCPCS C1713		222.662  -  PLATE BN 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL LMT CNTCT	BOTH IP/OP	"$3,112.20 "	"$2,303.03"	$0.00	"$2,417.24"	"$1,359.70"	"$1,359.70"	$0.00	$0.00	$0.00	$648.66	"$2,309.87"	"$2,309.87"	$0.00	$0.00	$648.58	$0.00	"$1,534.31"	"$1,534.31"	$0.00	"$1,510.78"	"$2,393.07"	"$2,417.24"	$0.00		$0.00	$459.10	$0.00	$0.00	$481.03	$0.00	$0.00	$0.00	$0.00	$0.00
222.663	SUP	HCPCS C1713		222.663  -  PLATE BN 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL LMT CNTCT	BOTH IP/OP	"$3,112.20 "	"$2,303.03"	$0.00	"$2,417.24"	"$1,359.70"	"$1,359.70"	$0.00	$0.00	$0.00	$648.66	"$2,309.87"	"$2,309.87"	$0.00	$0.00	$648.58	$0.00	"$1,534.31"	"$1,534.31"	$0.00	"$1,510.78"	"$2,393.07"	"$2,417.24"	$0.00		$0.00	$459.10	$0.00	$0.00	$481.03	$0.00	$0.00	$0.00	$0.00	$0.00
222.664	SUP	HCPCS C1713		222.664  -  PLATE BN 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL LMT CNTCT	BOTH IP/OP	"$3,280.88 "	"$2,427.85"	$0.00	"$2,548.26"	"$1,433.40"	"$1,433.40"	$0.00	$0.00	$0.00	$683.82	"$2,435.07"	"$2,435.07"	$0.00	$0.00	$683.73	$0.00	"$1,617.47"	"$1,617.47"	$0.00	"$1,592.66"	"$2,522.78"	"$2,548.26"	$0.00		$0.00	$483.98	$0.00	$0.00	$507.10	$0.00	$0.00	$0.00	$0.00	$0.00
222.665	SUP	HCPCS C1713		222.665  -  PLATE BN 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL LMT CNTCT	BOTH IP/OP	"$3,280.88 "	"$2,427.85"	$0.00	"$2,548.26"	"$1,433.40"	"$1,433.40"	$0.00	$0.00	$0.00	$683.82	"$2,435.07"	"$2,435.07"	$0.00	$0.00	$683.73	$0.00	"$1,617.47"	"$1,617.47"	$0.00	"$1,592.66"	"$2,522.78"	"$2,548.26"	$0.00		$0.00	$483.98	$0.00	$0.00	$507.10	$0.00	$0.00	$0.00	$0.00	$0.00
222.666	SUP	HCPCS C1713		222.666  -  PLATE BONE CURVE 350X17.5X5.2MM 16 HOLE LP ANATOMIC HEAD	BOTH IP/OP	"$3,249.48 "	"$2,404.62"	$0.00	"$2,599.58"	"$1,462.26"	"$1,462.26"	$0.00	$0.00	$0.00	$677.27	"$2,411.76"	"$2,411.76"	$0.00	$0.00	$677.19	$0.00	"$1,601.99"	"$1,601.99"	$0.00	"$1,624.74"	"$2,573.59"	"$2,599.58"	$0.00		$0.00	$493.73	$0.00	$0.00	$517.32	$0.00	$0.00	$0.00	$0.00	$0.00
222.667	SUP	HCPCS C1713		222.667  -  PLATE BONE CURVE 350X17.5X5.2MM 16 HOLE LP ANATOMIC HEAD	BOTH IP/OP	"$3,249.48 "	"$2,404.62"	$0.00	"$2,599.58"	"$1,462.26"	"$1,462.26"	$0.00	$0.00	$0.00	$677.27	"$2,411.76"	"$2,411.76"	$0.00	$0.00	$677.19	$0.00	"$1,601.99"	"$1,601.99"	$0.00	"$1,624.74"	"$2,573.59"	"$2,599.58"	$0.00		$0.00	$493.73	$0.00	$0.00	$517.32	$0.00	$0.00	$0.00	$0.00	$0.00
222.668	SUP	HCPCS C1713		222.668  -  PLATE BONE CURVE 386X17.5X5.2MM 18 HOLE LP ANATOMIC HEAD	BOTH IP/OP	"$3,314.98 "	"$2,453.09"	$0.00	"$2,651.98"	"$1,491.74"	"$1,491.74"	$0.00	$0.00	$0.00	$690.92	"$2,460.37"	"$2,460.37"	$0.00	$0.00	$690.84	$0.00	"$1,634.28"	"$1,634.28"	$0.00	"$1,657.49"	"$2,625.46"	"$2,651.98"	$0.00		$0.00	$503.68	$0.00	$0.00	$527.74	$0.00	$0.00	$0.00	$0.00	$0.00
222.669	SUP	HCPCS C1713		222.669  -  PLATE BONE CURVE 386X17.5X5.2MM 18 HOLE LP ANATOMIC HEAD	BOTH IP/OP	"$3,314.98 "	"$2,453.09"	$0.00	"$2,651.98"	"$1,491.74"	"$1,491.74"	$0.00	$0.00	$0.00	$690.92	"$2,460.37"	"$2,460.37"	$0.00	$0.00	$690.84	$0.00	"$1,634.28"	"$1,634.28"	$0.00	"$1,657.49"	"$2,625.46"	"$2,651.98"	$0.00		$0.00	$503.68	$0.00	$0.00	$527.74	$0.00	$0.00	$0.00	$0.00	$0.00
222.675	SUP	HCPCS C1713		222.675  -  SCREW BONE 4MM 30MM LCP SS PROX PERIART FEM/TIB CANN LCK	BOTH IP/OP	$318.53 	$235.71	$0.00	$254.82	$143.34	$143.34	$0.00	$0.00	$0.00	$66.39	$236.41	$236.41	$0.00	$0.00	$66.38	$0.00	$188.41	$188.41	$0.00	$159.26	$252.28	$254.82	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
222.676	SUP	HCPCS C1713		222.676  -  SCREW BONE 4MM 34MM LCP SS PROX MDL TIB LCK SLFTAP STARDRIVE	BOTH IP/OP	$444.08 	$328.62	$0.00	$355.26	$199.83	$199.83	$0.00	$0.00	$0.00	$92.56	$329.59	$329.59	$0.00	$0.00	$92.55	$0.00	$262.67	$262.67	$0.00	$222.04	$351.71	$355.26	$0.00		$0.00	$69.50	$0.00	$0.00	$70.70	$0.00	$0.00	$0.00	$0.00	$0.00
222.677	SUP	HCPCS C1713		222.677  -  SCREW BONE 4MM 38MM LCP SS PROX MDL TIB LCK SLFTAP NONSTRL	BOTH IP/OP	$318.53 	$235.71	$0.00	$254.82	$143.34	$143.34	$0.00	$0.00	$0.00	$66.39	$236.41	$236.41	$0.00	$0.00	$66.38	$0.00	$188.41	$188.41	$0.00	$159.26	$252.28	$254.82	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
223.406	SUP	HCPCS C1713		223.406  -  PLATE BONE 86X11X3.3MM 6 HOLE LOCKING TAPERED ROUNDED TIP	BOTH IP/OP	"$1,672.78 "	"$1,237.86"	$0.00	"$1,299.24"	$730.82	$730.82	$0.00	$0.00	$0.00	$348.65	"$1,241.53"	"$1,241.53"	$0.00	$0.00	$348.61	$0.00	$989.45	$989.45	$0.00	$812.03	"$1,286.25"	"$1,299.24"	$0.00		$0.00	$246.76	$0.00	$0.00	$258.55	$0.00	$0.00	$0.00	$0.00	$0.00
223.407	SUP	HCPCS C1713		223.407  -  PLATE BONE 99X11X3.3MM 7 HOLE LOCKING TAPERED ROUNDED TIP	BOTH IP/OP	"$1,705.10 "	"$1,261.77"	$0.00	"$1,324.36"	$744.95	$744.95	$0.00	$0.00	$0.00	$355.39	"$1,265.53"	"$1,265.53"	$0.00	$0.00	$355.34	$0.00	"$1,008.57"	"$1,008.57"	$0.00	$827.73	"$1,311.12"	"$1,324.36"	$0.00		$0.00	$251.53	$0.00	$0.00	$263.55	$0.00	$0.00	$0.00	$0.00	$0.00
223.408	SUP	HCPCS C1713		223.408  -  PLATE BONE 112X11X3.3MM 8 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$1,730.40 "	"$1,280.50"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$360.66	"$1,284.30"	"$1,284.30"	$0.00	$0.00	$360.62	$0.00	"$1,023.53"	"$1,023.53"	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$255.26	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
223.409	SUP	HCPCS C1713		223.409  -  PLATE BONE 125MM 9 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$1,758.53 "	"$1,301.31"	$0.00	"$1,365.84"	$768.29	$768.29	$0.00	$0.00	$0.00	$366.52	"$1,305.18"	"$1,305.18"	$0.00	$0.00	$366.48	$0.00	"$1,040.17"	"$1,040.17"	$0.00	$853.65	"$1,352.18"	"$1,365.84"	$0.00		$0.00	$259.41	$0.00	$0.00	$271.80	$0.00	$0.00	$0.00	$0.00	$0.00
223.41	SUP	HCPCS C1713		223.410  -  PLATE BN TPR 138X11X3.3MM NS LCP CMBN 10 HL RND TIP THN PRFL	BOTH IP/OP	"$1,735.95 "	"$1,284.60"	$0.00	"$1,388.76"	$781.18	$781.18	$0.00	$0.00	$0.00	$361.82	"$1,288.42"	"$1,288.42"	$0.00	$0.00	$361.77	$0.00	"$1,026.81"	"$1,026.81"	$0.00	$867.98	"$1,374.87"	"$1,388.76"	$0.00		$0.00	$330.10	$0.00	$0.00	$276.36	$0.00	$0.00	$0.00	$0.00	$0.00
223.411	SUP	HCPCS C1713		223.411  -  PLATE BONE 151MM 11 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$1,817.55 "	"$1,344.99"	$0.00	"$1,411.70"	$794.08	$794.08	$0.00	$0.00	$0.00	$378.82	"$1,348.99"	"$1,348.99"	$0.00	$0.00	$378.78	$0.00	"$1,075.08"	"$1,075.08"	$0.00	$882.31	"$1,397.59"	"$1,411.70"	$0.00		$0.00	$268.12	$0.00	$0.00	$280.93	$0.00	$0.00	$0.00	$0.00	$0.00
223.412	SUP	HCPCS C1713		223.412  -  PLATE BONE 164MM 12 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,822.22"	"$1,025.00"	"$1,025.00"	$0.00	$0.00	$0.00	$488.99	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	"$1,387.72"	"$1,387.72"	$0.00	"$1,138.89"	"$1,804.00"	"$1,822.22"	$0.00		$0.00	$346.09	$0.00	$0.00	$362.62	$0.00	$0.00	$0.00	$0.00	$0.00
223.414	SUP	HCPCS C1713		223.414  -  PLATE BONE 190MM 14 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$2,422.00 "	"$1,792.28"	$0.00	"$1,881.18"	"$1,058.16"	"$1,058.16"	$0.00	$0.00	$0.00	$504.81	"$1,797.61"	"$1,797.61"	$0.00	$0.00	$504.74	$0.00	"$1,432.61"	"$1,432.61"	$0.00	"$1,175.74"	"$1,862.37"	"$1,881.18"	$0.00		$0.00	$357.29	$0.00	$0.00	$374.35	$0.00	$0.00	$0.00	$0.00	$0.00
223.416	SUP	HCPCS C1713		223.416  -  PLATE BONE 216MM 16 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$2,474.03 "	"$1,830.78"	$0.00	"$1,921.56"	"$1,080.88"	"$1,080.88"	$0.00	$0.00	$0.00	$515.65	"$1,836.22"	"$1,836.22"	$0.00	$0.00	$515.59	$0.00	"$1,463.39"	"$1,463.39"	$0.00	"$1,200.98"	"$1,902.34"	"$1,921.56"	$0.00		$0.00	$364.96	$0.00	$0.00	$382.39	$0.00	$0.00	$0.00	$0.00	$0.00
223.418	SUP	HCPCS C1713		223.418  -  PLATE BONE 242MM 18 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$2,422.00 "	"$1,792.28"	$0.00	"$1,881.18"	"$1,058.16"	"$1,058.16"	$0.00	$0.00	$0.00	$504.81	"$1,797.61"	"$1,797.61"	$0.00	$0.00	$504.74	$0.00	"$1,432.61"	"$1,432.61"	$0.00	"$1,175.74"	"$1,862.37"	"$1,881.18"	$0.00		$0.00	$357.29	$0.00	$0.00	$374.35	$0.00	$0.00	$0.00	$0.00	$0.00
223.506	SUP	HCPCS C1713		223.506  -  PLATE BN 95MM 6 HL SS TIB RT DIST MDL 3.5MM SCR	BOTH IP/OP	"$1,020.53 "	$755.19	$0.00	$792.64	$445.86	$445.86	$0.00	$0.00	$0.00	$212.70	$757.43	$757.43	$0.00	$0.00	$212.68	$0.00	$603.64	$603.64	$0.00	$495.40	$784.71	$792.64	$0.00		$0.00	$150.55	$0.00	$0.00	$157.74	$0.00	$0.00	$0.00	$0.00	$0.00
223.507	SUP	HCPCS C1713		223.507  -  PLATE BN 95MM 6 HL SS TIB LT DIST MDL 3.5MM SCR	BOTH IP/OP	"$1,020.53 "	$755.19	$0.00	$792.64	$445.86	$445.86	$0.00	$0.00	$0.00	$212.70	$757.43	$757.43	$0.00	$0.00	$212.68	$0.00	$603.64	$603.64	$0.00	$495.40	$784.71	$792.64	$0.00		$0.00	$150.55	$0.00	$0.00	$157.74	$0.00	$0.00	$0.00	$0.00	$0.00
223.508	SUP	HCPCS C1713		223.508  -  PLATE BN 121MM 8 HL SS TIB RT DIST MDL 3.5MM SCR	BOTH IP/OP	"$1,186.40 "	$877.94	$0.00	$921.48	$518.33	$518.33	$0.00	$0.00	$0.00	$247.28	$880.55	$880.55	$0.00	$0.00	$247.25	$0.00	$701.76	$701.76	$0.00	$575.93	$912.27	$921.48	$0.00		$0.00	$175.01	$0.00	$0.00	$183.37	$0.00	$0.00	$0.00	$0.00	$0.00
223.509	SUP	HCPCS C1713		223.509  -  PLATE BN 121MM 8 HL SS TIB LT DIST MDL 3.5MM SCR	BOTH IP/OP	"$1,186.40 "	$877.94	$0.00	$921.48	$518.33	$518.33	$0.00	$0.00	$0.00	$247.28	$880.55	$880.55	$0.00	$0.00	$247.25	$0.00	$701.76	$701.76	$0.00	$575.93	$912.27	$921.48	$0.00		$0.00	$175.01	$0.00	$0.00	$183.37	$0.00	$0.00	$0.00	$0.00	$0.00
223.51	SUP	HCPCS C1713		223.510  -  PLATE BONE 147X10.2X2.2MM 10 HOLE LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,315.63 "	$973.57	$0.00	"$1,052.50"	$592.03	$592.03	$0.00	$0.00	$0.00	$274.21	$976.46	$976.46	$0.00	$0.00	$274.18	$0.00	$778.19	$778.19	$0.00	$657.81	"$1,041.98"	"$1,052.50"	$0.00		$0.00	$199.90	$0.00	$0.00	$209.45	$0.00	$0.00	$0.00	$0.00	$0.00
223.511	SUP	HCPCS C1713		223.511  -  PLATE BN 147MM 10 HL SS TIB LT DIST MDL 3.5MM SCR	BOTH IP/OP	"$1,355.10 "	"$1,002.77"	$0.00	"$1,052.50"	$592.03	$592.03	$0.00	$0.00	$0.00	$282.44	"$1,005.76"	"$1,005.76"	$0.00	$0.00	$282.40	$0.00	$801.54	$801.54	$0.00	$657.81	"$1,041.98"	"$1,052.50"	$0.00		$0.00	$199.90	$0.00	$0.00	$209.45	$0.00	$0.00	$0.00	$0.00	$0.00
223.512	SUP	HCPCS C1713		223.512  -  PLATE BONE 173X10.2X2.2MM 11X3.3MM 12 HOLE LCP STAINLESS	BOTH IP/OP	"$1,512.53 "	"$1,119.27"	$0.00	"$1,174.78"	$660.81	$660.81	$0.00	$0.00	$0.00	$315.25	"$1,122.60"	"$1,122.60"	$0.00	$0.00	$315.21	$0.00	$894.66	$894.66	$0.00	$734.24	"$1,163.04"	"$1,174.78"	$0.00		$0.00	$223.12	$0.00	$0.00	$233.78	$0.00	$0.00	$0.00	$0.00	$0.00
223.513	SUP	HCPCS C1713		223.513  -  PLATE BONE 173X10.2X2.2MM 11X3.3MM 12 HOLE LCP STAINLESS	BOTH IP/OP	"$1,512.53 "	"$1,119.27"	$0.00	"$1,174.78"	$660.81	$660.81	$0.00	$0.00	$0.00	$315.25	"$1,122.60"	"$1,122.60"	$0.00	$0.00	$315.21	$0.00	$894.66	$894.66	$0.00	$734.24	"$1,163.04"	"$1,174.78"	$0.00		$0.00	$223.12	$0.00	$0.00	$233.78	$0.00	$0.00	$0.00	$0.00	$0.00
223.514	SUP	HCPCS C1713		223.514  -  PLATE BONE 199X10.2X2.2MM 11X3.3MM 14 HOLE LCP STAINLESS	BOTH IP/OP	"$1,688.23 "	"$1,249.29"	$0.00	"$1,311.26"	$737.58	$737.58	$0.00	$0.00	$0.00	$351.87	"$1,253.00"	"$1,253.00"	$0.00	$0.00	$351.83	$0.00	$998.59	$998.59	$0.00	$819.54	"$1,298.15"	"$1,311.26"	$0.00		$0.00	$249.04	$0.00	$0.00	$260.94	$0.00	$0.00	$0.00	$0.00	$0.00
223.515	SUP	HCPCS C1713		223.515  -  PLATE BONE 199X10.2X2.2MM 11X3.3MM 14 HOLE LCP STAINLESS	BOTH IP/OP	"$1,688.23 "	"$1,249.29"	$0.00	"$1,311.26"	$737.58	$737.58	$0.00	$0.00	$0.00	$351.87	"$1,253.00"	"$1,253.00"	$0.00	$0.00	$351.83	$0.00	$998.59	$998.59	$0.00	$819.54	"$1,298.15"	"$1,311.26"	$0.00		$0.00	$249.04	$0.00	$0.00	$260.94	$0.00	$0.00	$0.00	$0.00	$0.00
223.516	SUP	HCPCS C1713		223.516  -  PLATE BONE 225MM 16 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL	BOTH IP/OP	"$1,911.75 "	"$1,414.70"	$0.00	"$1,484.84"	$835.22	$835.22	$0.00	$0.00	$0.00	$398.46	"$1,418.90"	"$1,418.90"	$0.00	$0.00	$398.41	$0.00	"$1,130.80"	"$1,130.80"	$0.00	$928.03	"$1,469.99"	"$1,484.84"	$0.00		$0.00	$282.01	$0.00	$0.00	$295.48	$0.00	$0.00	$0.00	$0.00	$0.00
223.517	SUP	HCPCS C1713		223.517  -  PLATE BONE 225MM 16 HOLE STAINLESS STEEL TIBIA LEFT DISTAL	BOTH IP/OP	"$1,911.75 "	"$1,414.70"	$0.00	"$1,484.84"	$835.22	$835.22	$0.00	$0.00	$0.00	$398.46	"$1,418.90"	"$1,418.90"	$0.00	$0.00	$398.41	$0.00	"$1,130.80"	"$1,130.80"	$0.00	$928.03	"$1,469.99"	"$1,484.84"	$0.00		$0.00	$282.01	$0.00	$0.00	$295.48	$0.00	$0.00	$0.00	$0.00	$0.00
223.518	SUP	HCPCS C1713		223.518  -  PLATE BONE 251MM 18 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL	BOTH IP/OP	"$2,087.45 "	"$1,544.71"	$0.00	"$1,621.32"	$911.99	$911.99	$0.00	$0.00	$0.00	$435.08	"$1,549.31"	"$1,549.31"	$0.00	$0.00	$435.02	$0.00	"$1,234.73"	"$1,234.73"	$0.00	"$1,013.33"	"$1,605.11"	"$1,621.32"	$0.00		$0.00	$307.93	$0.00	$0.00	$322.64	$0.00	$0.00	$0.00	$0.00	$0.00
223.519	SUP	HCPCS C1713		223.519  -  PLATE BONE 251MM 18 HOLE STAINLESS STEEL TIBIA LEFT DISTAL	BOTH IP/OP	"$2,087.45 "	"$1,544.71"	$0.00	"$1,621.32"	$911.99	$911.99	$0.00	$0.00	$0.00	$435.08	"$1,549.31"	"$1,549.31"	$0.00	$0.00	$435.02	$0.00	"$1,234.73"	"$1,234.73"	$0.00	"$1,013.33"	"$1,605.11"	"$1,621.32"	$0.00		$0.00	$307.93	$0.00	$0.00	$322.64	$0.00	$0.00	$0.00	$0.00	$0.00
223.52	SUP	HCPCS C1713		223.52  -  PLATE BONE 25X11X3.3MM 2 HOLE LC-DCP STAINLESS STEEL DISTAL	BOTH IP/OP	$231.95 	$171.64	$0.00	$180.14	$101.33	$101.33	$0.00	$0.00	$0.00	$48.34	$172.15	$172.15	$0.00	$0.00	$48.34	$0.00	$137.20	$137.20	$0.00	$112.59	$178.34	$180.14	$0.00		$0.00	$34.21	$0.00	$0.00	$35.85	$0.00	$0.00	$0.00	$0.00	$0.00
223.521	SUP	HCPCS C1713		223.521  -  PLATE BN 33MM NS LCP CMBN 2 HL LMT CNTCT TPR END SS 3.5MM	BOTH IP/OP	$490.58 	$363.03	$0.00	$381.04	$214.34	$214.34	$0.00	$0.00	$0.00	$102.25	$364.10	$364.10	$0.00	$0.00	$102.24	$0.00	$290.18	$290.18	$0.00	$238.15	$377.23	$381.04	$0.00		$0.00	$72.37	$0.00	$0.00	$75.83	$0.00	$0.00	$0.00	$0.00	$0.00
223.53	SUP	HCPCS C1713		223.53  -  PLATE BONE 38X11X3.3MM 3 HOLE LC-DCP STAINLESS STEEL DISTAL	BOTH IP/OP	$236.15 	$174.75	$0.00	$183.42	$103.17	$103.17	$0.00	$0.00	$0.00	$49.22	$175.27	$175.27	$0.00	$0.00	$49.21	$0.00	$139.68	$139.68	$0.00	$114.64	$181.59	$183.42	$0.00		$0.00	$34.84	$0.00	$0.00	$36.50	$0.00	$0.00	$0.00	$0.00	$0.00
223.531	SUP	HCPCS C1713		223.531  -  PLATE BN 46X11X3.4MM NS LCP CMBN 3 HL LMT CNTCT TPR END SS	BOTH IP/OP	$510.28 	$377.61	$0.00	$396.32	$222.93	$222.93	$0.00	$0.00	$0.00	$106.35	$378.73	$378.73	$0.00	$0.00	$106.34	$0.00	$301.83	$301.83	$0.00	$247.70	$392.36	$396.32	$0.00		$0.00	$75.27	$0.00	$0.00	$78.87	$0.00	$0.00	$0.00	$0.00	$0.00
223.54	SUP	HCPCS C1713		223.54  -  PLATE BN 51MM NS LC DCP 4 HL SS 3.5MM SCR	BOTH IP/OP	$243.18 	$179.95	$0.00	$188.88	$106.25	$106.25	$0.00	$0.00	$0.00	$50.68	$180.48	$180.48	$0.00	$0.00	$50.68	$0.00	$143.84	$143.84	$0.00	$118.05	$186.99	$188.88	$0.00		$0.00	$35.87	$0.00	$0.00	$37.59	$0.00	$0.00	$0.00	$0.00	$0.00
223.541	SUP	HCPCS C1713		223.541  -  PLATE BN 59MM NS LCP CMBN 4 HL SS 3.5MM SCR SM FRAG	BOTH IP/OP	$532.75 	$394.24	$0.00	$413.80	$232.76	$232.76	$0.00	$0.00	$0.00	$111.04	$395.41	$395.41	$0.00	$0.00	$111.03	$0.00	$315.12	$315.12	$0.00	$258.63	$409.66	$413.80	$0.00		$0.00	$78.59	$0.00	$0.00	$82.35	$0.00	$0.00	$0.00	$0.00	$0.00
223.55	SUP	HCPCS C1713		223.55  -  PLATE BONE 64X11X3.3MM 5 HOLE LC-DCP STAINLESS STEEL	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
223.551	SUP	HCPCS C1713		223.551  -  PLATE BN 72X11X3.4MM NS LCP CMBN 5 HL LMT CNTCT TPR END SS	BOTH IP/OP	$549.63 	$406.73	$0.00	$426.90	$240.13	$240.13	$0.00	$0.00	$0.00	$114.56	$407.93	$407.93	$0.00	$0.00	$114.54	$0.00	$325.10	$325.10	$0.00	$266.81	$422.63	$426.90	$0.00		$0.00	$81.08	$0.00	$0.00	$84.95	$0.00	$0.00	$0.00	$0.00	$0.00
223.56	SUP	HCPCS C1713		223.56  -  PLATE BONE 77X11X3.3MM 6 HOLE LC-DCP STAINLESS STEEL DISTAL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
223.561	SUP	HCPCS C1713		223.561  -  PLATE BN 85X11X3.4MM NS LCP CMBN 6 HL LMT CNTCT TPR END SS	BOTH IP/OP	$584.78 	$432.74	$0.00	$454.18	$255.48	$255.48	$0.00	$0.00	$0.00	$121.88	$434.02	$434.02	$0.00	$0.00	$121.87	$0.00	$345.89	$345.89	$0.00	$283.86	$449.64	$454.18	$0.00		$0.00	$86.26	$0.00	$0.00	$90.38	$0.00	$0.00	$0.00	$0.00	$0.00
223.57	SUP	HCPCS C1713		223.57  -  PLATE BONE 90X11X3.3MM 7 HOLE LC-DCP STAINLESS STEEL DISTAL	BOTH IP/OP	$283.95 	$210.12	$0.00	$220.54	$124.05	$124.05	$0.00	$0.00	$0.00	$59.18	$210.75	$210.75	$0.00	$0.00	$59.18	$0.00	$167.96	$167.96	$0.00	$137.84	$218.34	$220.54	$0.00		$0.00	$41.89	$0.00	$0.00	$43.89	$0.00	$0.00	$0.00	$0.00	$0.00
223.571	SUP	HCPCS C1713		223.571  -  PLATE BN 98X11X3.4MM NS LCP CMBN 7 HL LMT CNTCT TPR END SS	BOTH IP/OP	$608.68 	$450.42	$0.00	$472.74	$265.92	$265.92	$0.00	$0.00	$0.00	$126.86	$451.76	$451.76	$0.00	$0.00	$126.85	$0.00	$360.03	$360.03	$0.00	$295.46	$468.02	$472.74	$0.00		$0.00	$89.79	$0.00	$0.00	$94.08	$0.00	$0.00	$0.00	$0.00	$0.00
223.58	SUP	HCPCS C1713		223.58  -  PLATE BONE 103X11X3.3MM 8 HOLE LC-DCP STAINLESS STEEL DISTAL	BOTH IP/OP	$299.43 	$221.58	$0.00	$232.56	$130.82	$130.82	$0.00	$0.00	$0.00	$62.41	$222.23	$222.23	$0.00	$0.00	$62.40	$0.00	$177.11	$177.11	$0.00	$145.35	$230.23	$232.56	$0.00		$0.00	$44.17	$0.00	$0.00	$46.28	$0.00	$0.00	$0.00	$0.00	$0.00
223.581	SUP	HCPCS C1713		223.581  -  PLATE BN 111X11X3.4MM NS LCP CMBN 8 HL LMT CNTCT TPR END SS	BOTH IP/OP	$639.60 	$473.30	$0.00	$496.76	$279.43	$279.43	$0.00	$0.00	$0.00	$133.31	$474.71	$474.71	$0.00	$0.00	$133.29	$0.00	$378.32	$378.32	$0.00	$310.48	$491.79	$496.76	$0.00		$0.00	$94.35	$0.00	$0.00	$98.86	$0.00	$0.00	$0.00	$0.00	$0.00
223.59	SUP	HCPCS C1713		223.59  -  PLATE BONE 116X11X3.3MM 9 HOLE LC-DCP STAINLESS STEEL DISTAL	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
223.591	SUP	HCPCS C1713		223.591  -  PLATE BN 124X11X3.4MM NS LCP CMBN 9 HL LMT CNTCT TPR END SS	BOTH IP/OP	$664.90 	$492.03	$0.00	$516.42	$290.49	$290.49	$0.00	$0.00	$0.00	$138.58	$493.49	$493.49	$0.00	$0.00	$138.57	$0.00	$393.29	$393.29	$0.00	$322.76	$511.26	$516.42	$0.00		$0.00	$98.08	$0.00	$0.00	$102.77	$0.00	$0.00	$0.00	$0.00	$0.00
223.6	SUP	HCPCS C1713		223.60  -  PLATE BONE 129X11X3.3MM 10 HOLE LOCK LC-DCP STAINLESS STEEL	BOTH IP/OP	$308.43 	$228.24	$0.00	$246.74	$138.79	$138.79	$0.00	$0.00	$0.00	$64.28	$228.91	$228.91	$0.00	$0.00	$64.28	$0.00	$182.43	$182.43	$0.00	$154.21	$244.28	$246.74	$0.00		$0.00	$46.86	$0.00	$0.00	$49.10	$0.00	$0.00	$0.00	$0.00	$0.00
223.6	SUP	HCPCS C1713		223.6  -  PLATE 129MM SS 3.5MM SCR SM FRAG SET 10 HOLE LC DCP LCP BONE	BOTH IP/OP	$308.43 	$228.24	$0.00	$272.59	$138.79	$138.79	$0.00	$0.00	$0.00	$64.28	$228.91	$228.91	$0.00	$0.00	$64.28	$0.00	$182.43	$182.43	$0.00	$154.21	$272.59	$246.74	$0.00		$0.00	$46.86	$0.00	$0.00	$49.10	$0.00	$0.00	$0.00	$0.00	$0.00
223.601	SUP	HCPCS C1713		223.601  -  PLATE BN 137X11X3.4MM NS LCP CMBN 10 HL LMT CNTCT TPR END SS	BOTH IP/OP	$685.98 	$507.63	$0.00	$532.80	$299.70	$299.70	$0.00	$0.00	$0.00	$142.97	$509.13	$509.13	$0.00	$0.00	$142.96	$0.00	$405.75	$405.75	$0.00	$333.00	$527.47	$532.80	$0.00		$0.00	$101.19	$0.00	$0.00	$106.03	$0.00	$0.00	$0.00	$0.00	$0.00
223.61	SUP	HCPCS C1713		223.61  -  PLATE BN 142X11X3.3MM NS LC DCP 11 HL SS 3.5MM SCR SM FRAG	BOTH IP/OP	$344.40 	$254.86	$0.00	$267.50	$150.47	$150.47	$0.00	$0.00	$0.00	$71.78	$255.61	$255.61	$0.00	$0.00	$71.77	$0.00	$203.71	$203.71	$0.00	$167.19	$264.83	$267.50	$0.00		$0.00	$50.80	$0.00	$0.00	$53.23	$0.00	$0.00	$0.00	$0.00	$0.00
223.611	SUP	HCPCS C1713		223.611  -  PLATE BN 150MM NS LCP CMBN 11 HL LMT CNTCT TPR END SS 3.5MM	BOTH IP/OP	$715.50 	$529.47	$0.00	$555.72	$312.59	$312.59	$0.00	$0.00	$0.00	$149.13	$531.04	$531.04	$0.00	$0.00	$149.11	$0.00	$423.22	$423.22	$0.00	$347.33	$550.16	$555.72	$0.00		$0.00	$105.55	$0.00	$0.00	$110.59	$0.00	$0.00	$0.00	$0.00	$0.00
223.62	SUP	HCPCS C1713		223.62  -  PLATE BN 155X11X3.3MM NS LC DCP 12 HL SS 3.5MM SCR SM FRAG	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
223.621	SUP	HCPCS C1713		223.621  -  PLATE BN 163X11X3.4MM NS LCP CMBN 12 HL LMT CNTCT TPR END SS	BOTH IP/OP	$756.28 	$559.65	$0.00	$587.38	$330.40	$330.40	$0.00	$0.00	$0.00	$157.63	$561.31	$561.31	$0.00	$0.00	$157.61	$0.00	$447.34	$447.34	$0.00	$367.11	$581.51	$587.38	$0.00		$0.00	$111.56	$0.00	$0.00	$116.89	$0.00	$0.00	$0.00	$0.00	$0.00
223.631	SUP	HCPCS C1713		223.631  -  PLATE BN 176X11X3.4MM NS LCP CMBN 13 HL SS 3.5MM SCR	BOTH IP/OP	$871.53 	$644.93	$0.00	$676.92	$380.77	$380.77	$0.00	$0.00	$0.00	$181.65	$646.85	$646.85	$0.00	$0.00	$181.63	$0.00	$515.51	$515.51	$0.00	$423.08	$670.15	$676.92	$0.00		$0.00	$128.56	$0.00	$0.00	$134.71	$0.00	$0.00	$0.00	$0.00	$0.00
223.64	SUP	HCPCS C1713		223.64  -  PLATE BN 181X11X3.3MM NS LC DCP 14 HL SS 3.5MM SCR SM FRAG	BOTH IP/OP	$681.75 	$504.50	$0.00	$529.52	$297.86	$297.86	$0.00	$0.00	$0.00	$142.09	$505.99	$505.99	$0.00	$0.00	$142.08	$0.00	$403.26	$403.26	$0.00	$330.95	$524.22	$529.52	$0.00		$0.00	$100.57	$0.00	$0.00	$105.37	$0.00	$0.00	$0.00	$0.00	$0.00
223.641	SUP	HCPCS C1713		223.641  -  PLATE BN 189X11X3.4MM NS LCP CMBN 14 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$1,134.40 "	$839.46	$0.00	$881.08	$495.61	$495.61	$0.00	$0.00	$0.00	$236.44	$841.95	$841.95	$0.00	$0.00	$236.41	$0.00	$671.00	$671.00	$0.00	$550.68	$872.27	$881.08	$0.00		$0.00	$167.34	$0.00	$0.00	$175.33	$0.00	$0.00	$0.00	$0.00	$0.00
223.65	SUP	HCPCS C1713		223.65  -  PLATE BONE 195X11X3.3MM 15 HOLE LC-DCP STAINLESS STEEL	BOTH IP/OP	$714.10 	$528.43	$0.00	$554.64	$311.99	$311.99	$0.00	$0.00	$0.00	$148.84	$530.01	$530.01	$0.00	$0.00	$148.82	$0.00	$422.39	$422.39	$0.00	$346.65	$549.09	$554.64	$0.00		$0.00	$105.34	$0.00	$0.00	$110.37	$0.00	$0.00	$0.00	$0.00	$0.00
223.651	SUP	HCPCS C1713		223.651  -  PLATE BONE 202X11X3.4MM 15 HOLE LCP STAINLESS STEEL PROXIMAL	BOTH IP/OP	"$1,214.53 "	$898.75	$0.00	$943.32	$530.62	$530.62	$0.00	$0.00	$0.00	$253.14	$901.42	$901.42	$0.00	$0.00	$253.11	$0.00	$718.39	$718.39	$0.00	$589.58	$933.89	$943.32	$0.00		$0.00	$179.16	$0.00	$0.00	$187.72	$0.00	$0.00	$0.00	$0.00	$0.00
223.66	SUP	HCPCS C1713		223.66  -  PLATE BONE 208X11X3.3MM 16 HOLE LC-DCP STAINLESS STEEL	BOTH IP/OP	$782.98 	$579.41	$0.00	$608.14	$342.08	$342.08	$0.00	$0.00	$0.00	$163.19	$581.12	$581.12	$0.00	$0.00	$163.17	$0.00	$463.13	$463.13	$0.00	$380.09	$602.06	$608.14	$0.00		$0.00	$115.50	$0.00	$0.00	$121.02	$0.00	$0.00	$0.00	$0.00	$0.00
223.661	SUP	HCPCS C1713		223.661  -  PLATE BN 215X11X3.4MM NS LCP CMBN 16 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$1,270.75 "	$940.36	$0.00	$986.98	$555.18	$555.18	$0.00	$0.00	$0.00	$264.86	$943.15	$943.15	$0.00	$0.00	$264.82	$0.00	$751.65	$751.65	$0.00	$616.86	$977.11	$986.98	$0.00		$0.00	$187.46	$0.00	$0.00	$196.41	$0.00	$0.00	$0.00	$0.00	$0.00
223.671	SUP	HCPCS C1713		223.671  -  PLATE BN 241X11X3.4MM NS LCP CMBN 18 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$1,425.38 "	"$1,054.78"	$0.00	"$1,107.08"	$622.73	$622.73	$0.00	$0.00	$0.00	$297.08	"$1,057.91"	"$1,057.91"	$0.00	$0.00	$297.05	$0.00	$843.11	$843.11	$0.00	$691.93	"$1,096.01"	"$1,107.08"	$0.00		$0.00	$210.27	$0.00	$0.00	$220.31	$0.00	$0.00	$0.00	$0.00	$0.00
223.68	SUP	HCPCS C1713		223.68  -  PLATE BONE 233X11X3.3MM 18 HOLE LC-DCP STAINLESS STEEL	BOTH IP/OP	$875.75 	$648.06	$0.00	$680.20	$382.61	$382.61	$0.00	$0.00	$0.00	$182.53	$649.98	$649.98	$0.00	$0.00	$182.51	$0.00	$518.01	$518.01	$0.00	$425.13	$673.40	$680.20	$0.00		$0.00	$129.19	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00
223.681	SUP	HCPCS C1713		223.681  -  PLATE BN 267X11X3.4MM NS LCP CMBN 20 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$1,582.80 "	"$1,171.27"	$0.00	"$1,229.36"	$691.52	$691.52	$0.00	$0.00	$0.00	$329.90	"$1,174.75"	"$1,174.75"	$0.00	$0.00	$329.86	$0.00	$936.23	$936.23	$0.00	$768.35	"$1,217.07"	"$1,229.36"	$0.00		$0.00	$233.49	$0.00	$0.00	$244.64	$0.00	$0.00	$0.00	$0.00	$0.00
223.691	SUP	HCPCS C1713		223.691  -  PLATE BONE 293X11X3.4MM 22 HOLE LCP STAINLESS STEEL PROXIMAL	BOTH IP/OP	"$1,584.23 "	"$1,172.33"	$0.00	"$1,230.46"	$692.13	$692.13	$0.00	$0.00	$0.00	$330.19	"$1,175.81"	"$1,175.81"	$0.00	$0.00	$330.15	$0.00	$937.07	$937.07	$0.00	$769.04	"$1,218.16"	"$1,230.46"	$0.00		$0.00	$233.70	$0.00	$0.00	$244.86	$0.00	$0.00	$0.00	$0.00	$0.00
223.7	SUP	HCPCS C1713		223.70  -  PLATE BONE 259X11X3.3MM 20 HOLE LC-DCP STAINLESS STEEL	BOTH IP/OP	$941.68 	$696.84	$0.00	$753.34	$423.75	$423.75	$0.00	$0.00	$0.00	$196.27	$698.91	$698.91	$0.00	$0.00	$196.25	$0.00	$557.00	$557.00	$0.00	$470.84	$745.81	$753.34	$0.00		$0.00	$143.08	$0.00	$0.00	$149.91	$0.00	$0.00	$0.00	$0.00	$0.00
224	SUP	Custom 27803010		224.000  -  STAINLESS STEEL REVERE LOCKING CAP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.001	SUP	Custom 27803010		"224.001  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 300MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.002	SUP	Custom 27803010		"224.002  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 400MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.003	SUP	Custom 27803010		"224.003  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 500MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.012	SUP	Custom 27803010		"224.012  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 24MM-25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.013	SUP	Custom 27803010		"224.013  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 26MM-28MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.014	SUP	Custom 27803010		"224.014  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 29MM-34MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.02	SUP	HCPCS C1713		224.02  -  PLATE BN NAR 39X12X3.8MM NS DCP 2 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
224.04	SUP	HCPCS C1713		224.04  -  PLATE BN NAR 71X12X3.8MM NS DCP 4 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$266.13 	$196.94	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$55.47	$197.52	$197.52	$0.00	$0.00	$55.46	$0.00	$157.41	$157.41	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
224.041	SUP	HCPCS C1713		224.041  -  PLATE BONE 61MM 4 HOLE DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$828.40 	$613.02	$0.00	$662.72	$372.78	$372.78	$0.00	$0.00	$0.00	$172.66	$614.84	$614.84	$0.00	$0.00	$172.64	$0.00	$490.00	$490.00	$0.00	$414.20	$656.09	$662.72	$0.00		$0.00	$125.87	$0.00	$0.00	$131.88	$0.00	$0.00	$0.00	$0.00	$0.00
224.05	SUP	HCPCS C1713		224.05  -  PLATE BN NAR 87X12X3.8MM NS DCP 5 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
224.051	SUP	HCPCS C1713		224.051  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.052	SUP	HCPCS C1713		224.052  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.053	SUP	HCPCS C1713		224.053  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.054	SUP	HCPCS C1713		224.054  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.055	SUP	HCPCS C1713		224.055  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.056	SUP	HCPCS C1713		224.056  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.057	SUP	HCPCS C1713		224.057  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.06	SUP	HCPCS C1713		224.06  -  PLATE BN NAR 103X12X3.8MM NS DCP 6 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$312.08 	$230.94	$0.00	$242.38	$136.34	$136.34	$0.00	$0.00	$0.00	$65.04	$231.62	$231.62	$0.00	$0.00	$65.04	$0.00	$184.59	$184.59	$0.00	$151.49	$239.96	$242.38	$0.00		$0.00	$46.03	$0.00	$0.00	$48.23	$0.00	$0.00	$0.00	$0.00	$0.00
224.061	SUP	HCPCS C1713		224.061  -  7.5MM SS REVERE REDUCTION SCREW 70MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.062	SUP	HCPCS C1713		224.062  -  7.5MM SS REVERE REDUCTION SCREW 75MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.063	SUP	HCPCS C1713		224.063  -  7.5MM SS REVERE REDUCTION SCREW 80MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.064	SUP	HCPCS C1713		224.064  -  7.5MM SS REVERE REDUCTION SCREW 85MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.065	SUP	HCPCS C1713		224.065  -  7.5MM SS REVERE REDUCTION SCREW 90MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.07	SUP	HCPCS C1713		224.07  -  PLATE BN NAR 119X12X3.8MM NS DCP 7 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$312.08 	$230.94	$0.00	$242.38	$136.34	$136.34	$0.00	$0.00	$0.00	$65.04	$231.62	$231.62	$0.00	$0.00	$65.04	$0.00	$184.59	$184.59	$0.00	$151.49	$239.96	$242.38	$0.00		$0.00	$46.03	$0.00	$0.00	$48.23	$0.00	$0.00	$0.00	$0.00	$0.00
224.071	SUP	HCPCS C1713		224.071  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 70MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.072	SUP	HCPCS C1713		224.072  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 75MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.073	SUP	HCPCS C1713		224.073  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 80MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.074	SUP	HCPCS C1713		224.074  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 85MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.075	SUP	HCPCS C1713		224.075  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 90MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.08	SUP	HCPCS C1713		224.08  -  PLATE BN NAR 135X12X3.8MM NS DCP 8 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$302.98 	$224.21	$0.00	$242.38	$136.34	$136.34	$0.00	$0.00	$0.00	$63.15	$224.87	$224.87	$0.00	$0.00	$63.14	$0.00	$179.21	$179.21	$0.00	$151.49	$239.96	$242.38	$0.00		$0.00	$46.03	$0.00	$0.00	$48.23	$0.00	$0.00	$0.00	$0.00	$0.00
224.081	SUP	HCPCS C1713		224.081  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 70MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.082	SUP	HCPCS C1713		224.082  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 75MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.083	SUP	HCPCS C1713		224.083  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 80MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.084	SUP	HCPCS C1713		224.084  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 85MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.085	SUP	HCPCS C1713		224.085  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 90MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.09	SUP	HCPCS C1713		224.09  -  PLATE BN NAR 151X12X3.8MM NS DCP 9 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$312.08 	$230.94	$0.00	$242.38	$136.34	$136.34	$0.00	$0.00	$0.00	$65.04	$231.62	$231.62	$0.00	$0.00	$65.04	$0.00	$184.59	$184.59	$0.00	$151.49	$239.96	$242.38	$0.00		$0.00	$46.03	$0.00	$0.00	$48.23	$0.00	$0.00	$0.00	$0.00	$0.00
224.1	SUP	HCPCS C1713		224.10  -  PLATE BN NAR 167X12X3.8MM NS DCP 10 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$399.88 	$295.91	$0.00	$319.90	$179.94	$179.94	$0.00	$0.00	$0.00	$83.34	$296.79	$296.79	$0.00	$0.00	$83.33	$0.00	$236.53	$236.53	$0.00	$199.94	$316.70	$319.90	$0.00		$0.00	$60.76	$0.00	$0.00	$63.66	$0.00	$0.00	$0.00	$0.00	$0.00
224.11	SUP	HCPCS C1713		224.11  -  PLATE BONE NARROW 183X12X3.8MM 11 HOLE DCP STAINLESS STEEL	BOTH IP/OP	$398.83 	$295.13	$0.00	$319.06	$179.47	$179.47	$0.00	$0.00	$0.00	$83.13	$296.01	$296.01	$0.00	$0.00	$83.12	$0.00	$235.90	$235.90	$0.00	$199.41	$315.87	$319.06	$0.00		$0.00	$62.42	$0.00	$0.00	$63.49	$0.00	$0.00	$0.00	$0.00	$0.00
224.111	SUP	HCPCS C1713		224.111  -  SCREW BN 5.5MM 27MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.112	SUP	HCPCS C1713		224.112  -  SCREW BN 5.5MM 32MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.113	SUP	HCPCS C1713		224.113  -  SCREW BN 5.5MM 37MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.114	SUP	HCPCS C1713		224.114  -  SCREW BN 5.5MM 42MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.115	SUP	HCPCS C1713		224.115  -  SCREW BN 5.5MM 47MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.12	SUP	HCPCS C1713		224.12  -  PLATE BN NAR 199X12X3.8MM NS DCP 12 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$399.88 	$295.91	$0.00	$319.90	$179.94	$179.94	$0.00	$0.00	$0.00	$83.34	$296.79	$296.79	$0.00	$0.00	$83.33	$0.00	$236.53	$236.53	$0.00	$199.94	$316.70	$319.90	$0.00		$0.00	$60.76	$0.00	$0.00	$63.66	$0.00	$0.00	$0.00	$0.00	$0.00
224.121	SUP	HCPCS C1713		224.121  -  SCREW BN 6.5MM 27MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.122	SUP	HCPCS C1713		224.122  -  SCREW BN 6.5MM 32MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.123	SUP	HCPCS C1713		224.123  -  SCREW BN 6.5MM 37MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.124	SUP	HCPCS C1713		224.124  -  SCREW BN 6.5MM 42MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.125	SUP	HCPCS C1713		224.125  -  SCREW BN 6.5MM 47MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.131	SUP	HCPCS C1713		224.131  -  SCREW BN 7.5MM 27MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.132	SUP	HCPCS C1713		224.132  -  SCREW BN 7.5MM 32MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.133	SUP	HCPCS C1713		224.133  -  SCREW BN 7.5MM 37MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.134	SUP	HCPCS C1713		224.134  -  SCREW BN 7.5MM 42MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.135	SUP	HCPCS C1713		224.135  -  SCREW BN 7.5MM 47MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.14	SUP	HCPCS C1713		224.14  -  PLATE NAR SS 4.5MM SCR LG FRAG SET 14 HOLE DCP BONE ORTH	BOTH IP/OP	$561.50 	$415.51	$0.00	$449.20	$252.68	$252.68	$0.00	$0.00	$0.00	$117.03	$416.75	$416.75	$0.00	$0.00	$117.02	$0.00	$332.13	$332.13	$0.00	$280.75	$444.71	$449.20	$0.00		$0.00	$87.87	$0.00	$0.00	$89.39	$0.00	$0.00	$0.00	$0.00	$0.00
224.141	SUP	HCPCS C1713		224.141  -  5.5MM SS REVERE REDUCTION SCREW 25MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.142	SUP	HCPCS C1713		224.142  -  5.5MM SS REVERE REDUCTION SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.143	SUP	HCPCS C1713		224.143  -  5.5MM SS REVERE REDUCTION SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.144	SUP	HCPCS C1713		224.144  -  5.5MM SS REVERE REDUCTION SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.145	SUP	HCPCS C1713		224.145  -  5.5MM SS REVERE REDUCTION SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.146	SUP	HCPCS C1713		224.146  -  5.5MM SS REVERE REDUCTION SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.147	SUP	HCPCS C1713		224.147  -  5.5MM SS REVERE REDUCTION SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.151	SUP	HCPCS C1713		224.151  -  6.5MM SS REVERE REDUCTION SCREW 25MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.152	SUP	HCPCS C1713		224.152  -  6.5MM SS REVERE REDUCTION SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.153	SUP	HCPCS C1713		224.153  -  6.5MM SS REVERE REDUCTION SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.154	SUP	HCPCS C1713		224.154  -  6.5MM SS REVERE REDUCTION SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.155	SUP	HCPCS C1713		224.155  -  6.5MM SS REVERE REDUCTION SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.156	SUP	HCPCS C1713		224.156  -  6.5MM SS REVERE REDUCTION SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.157	SUP	HCPCS C1713		224.157  -  6.5MM SS REVERE REDUCTION SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.158	SUP	HCPCS C1713		224.158  -  6.5MM SS REVERE REDUCTION SCREW 60MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.159	SUP	HCPCS C1713		224.159  -  6.5MM SS REVERE REDUCTION SCREW 65MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.161	SUP	HCPCS C1713		224.161  -  7.5MM SS REVERE REDUCTION SCREW 25MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.162	SUP	HCPCS C1713		224.162  -  7.5MM SS REVERE REDUCTION SCREW 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.163	SUP	HCPCS C1713		224.163  -  7.5MM SS REVERE REDUCTION SCREW 35MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.164	SUP	HCPCS C1713		224.164  -  7.5MM SS REVERE REDUCTION SCREW 40MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.165	SUP	HCPCS C1713		224.165  -  7.5MM SS REVERE REDUCTION SCREW 45MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.166	SUP	HCPCS C1713		224.166  -  7.5MM SS REVERE REDUCTION SCREW 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.167	SUP	HCPCS C1713		224.167  -  7.5MM SS REVERE REDUCTION SCREW 55MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.168	SUP	HCPCS C1713		224.168  -  7.5MM SS REVERE REDUCTION SCREW 60MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.169	SUP	HCPCS C1713		224.169  -  7.5MM SS REVERE REDUCTION SCREW 65MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.2	SUP	HCPCS C1713		224.20  -  PLATE BN NAR 326X12X3.8MM NS DCP 20 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$816.13 	$603.94	$0.00	"$1,665.74"	$367.26	$367.26	$0.00	$0.00	$0.00	$170.10	$605.73	$605.73	$0.00	$0.00	$170.08	$0.00	"$1,665.74"	"$1,665.74"	$0.00	$408.06	$646.37	$652.90	$0.00		$0.00	$124.00	$0.00	$0.00	$129.93	$0.00	$0.00	$0.00	$0.00	$0.00
224.2	SUP	HCPCS C1713		"224.200  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 20MM"	BOTH IP/OP	$816.13 	$603.94	$0.00	"$1,665.74"	$367.26	$367.26	$0.00	$0.00	$0.00	$170.10	$605.73	$605.73	$0.00	$0.00	$170.08	$0.00	"$1,665.74"	"$1,665.74"	$0.00	$408.06	"$1,584.00"	$652.90	$0.00		$0.00	$124.00	$0.00	$0.00	$129.93	$0.00	$0.00	$0.00	$0.00	$0.00
224.201	SUP	HCPCS C1713		"224.201  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.202	SUP	HCPCS C1713		"224.202  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.203	SUP	HCPCS C1713		"224.203  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.204	SUP	HCPCS C1713		"224.204  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.241	SUP	HCPCS C1713		"224.241  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.242	SUP	HCPCS C1713		"224.242  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.243	SUP	HCPCS C1713		"224.243  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.244	SUP	HCPCS C1713		"224.244  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.245	SUP	HCPCS C1713		"224.245  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.251	SUP	HCPCS C1713		224.251  -  SCREW BN 5.5MM 25MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.252	SUP	HCPCS C1713		"224.252  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.253	SUP	HCPCS C1713		"224.253  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.254	SUP	HCPCS C1713		"224.254  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.255	SUP	HCPCS C1713		"224.255  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.256	SUP	HCPCS C1713		"224.256  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.257	SUP	HCPCS C1713		"224.257  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.258	SUP	HCPCS C1713		"224.258  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 60MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.259	SUP	HCPCS C1713		"224.259  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 65MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.262	SUP	HCPCS C1713		"224.262  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.263	SUP	HCPCS C1713		"224.263  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.264	SUP	HCPCS C1713		"224.264  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.265	SUP	HCPCS C1713		"224.265  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.266	SUP	HCPCS C1713		"224.266  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.267	SUP	HCPCS C1713		"224.267  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.268	SUP	HCPCS C1713		"224.268  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 60MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.269	SUP	HCPCS C1713		"224.269  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 65MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.271	SUP	HCPCS C1713		"224.271  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.272	SUP	HCPCS C1713		"224.272  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.273	SUP	HCPCS C1713		"224.273  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.274	SUP	HCPCS C1713		"224.274  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.275	SUP	HCPCS C1713		"224.275  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.276	SUP	HCPCS C1713		"224.276  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.277	SUP	HCPCS C1713		"224.277  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.278	SUP	HCPCS C1713		"224.278  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 60MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.279	SUP	HCPCS C1713		"224.279  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 65MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.281	SUP	HCPCS C1713		224.281  -  SCREW BN 8.5MM 25MM REVERE MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.282	SUP	HCPCS C1713		"224.282  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.283	SUP	HCPCS C1713		"224.283  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.284	SUP	HCPCS C1713		"224.284  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.285	SUP	HCPCS C1713		"224.285  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.286	SUP	HCPCS C1713		"224.286  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.287	SUP	HCPCS C1713		"224.287  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.288	SUP	HCPCS C1713		"224.288  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 60MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.289	SUP	HCPCS C1713		"224.289  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 65MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.351	SUP	HCPCS C1713		224.351  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 25MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.352	SUP	HCPCS C1713		224.352  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 30MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.353	SUP	HCPCS C1713		224.353  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 35MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.354	SUP	HCPCS C1713		224.354  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 40MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.355	SUP	HCPCS C1713		224.355  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 45MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.356	SUP	HCPCS C1713		224.356  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 50MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.357	SUP	HCPCS C1713		224.357  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 55MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.361	SUP	HCPCS C1713		224.361  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 25MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.362	SUP	HCPCS C1713		224.362  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 30MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.363	SUP	HCPCS C1713		224.363  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 35MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.364	SUP	HCPCS C1713		224.364  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 40MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.365	SUP	HCPCS C1713		224.365  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 45MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.366	SUP	HCPCS C1713		224.366  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 50MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.367	SUP	HCPCS C1713		224.367  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 55MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.368	SUP	HCPCS C1713		224.368  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 60MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.369	SUP	HCPCS C1713		224.369  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 65MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.371	SUP	HCPCS C1713		224.371  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 25MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.372	SUP	HCPCS C1713		224.372  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 30MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.373	SUP	HCPCS C1713		224.373  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 35MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.374	SUP	HCPCS C1713		224.374  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 40MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.375	SUP	HCPCS C1713		224.375  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 45MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.376	SUP	HCPCS C1713		224.376  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 50MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.377	SUP	HCPCS C1713		224.377  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 55MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.378	SUP	HCPCS C1713		224.378  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 60MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.379	SUP	HCPCS C1713		224.379  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 65MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.381	SUP	HCPCS C1713		224.381  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 25MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.382	SUP	HCPCS C1713		224.382  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 30MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.383	SUP	HCPCS C1713		224.383  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 35MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.384	SUP	HCPCS C1713		224.384  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 40MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.385	SUP	HCPCS C1713		224.385  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 45MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.386	SUP	HCPCS C1713		224.386  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 50MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.387	SUP	HCPCS C1713		224.387  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 55MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.388	SUP	HCPCS C1713		224.388  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 60MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.389	SUP	HCPCS C1713		224.389  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 65MM	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	"$2,368.13"	"$2,368.13"	$0.00	$0.00	$0.00	"$1,096.84"	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	"$2,594.41"	"$2,594.41"	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$823.58	$0.00	$0.00	$837.79	$0.00	$0.00	$0.00	$0.00	$0.00
224.441	SUP	HCPCS C1713		224.441  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.442	SUP	HCPCS C1713		224.442  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.443	SUP	HCPCS C1713		224.443  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.444	SUP	HCPCS C1713		224.444  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.445	SUP	HCPCS C1713		224.445  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.451	SUP	HCPCS C1713		224.451  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.452	SUP	HCPCS C1713		224.452  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.453	SUP	HCPCS C1713		224.453  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.454	SUP	HCPCS C1713		224.454  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.455	SUP	HCPCS C1713		224.455  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.456	SUP	HCPCS C1713		224.456  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.457	SUP	HCPCS C1713		224.457  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.461	SUP	HCPCS C1713		224.461  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.462	SUP	HCPCS C1713		224.462  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.463	SUP	HCPCS C1713		224.463  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.464	SUP	HCPCS C1713		224.464  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.465	SUP	HCPCS C1713		224.465  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.466	SUP	HCPCS C1713		224.466  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.467	SUP	HCPCS C1713		224.467  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.468	SUP	HCPCS C1713		224.468  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 60MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.469	SUP	HCPCS C1713		224.469  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 65MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.471	SUP	HCPCS C1713		224.471  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.472	SUP	HCPCS C1713		224.472  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.473	SUP	HCPCS C1713		224.473  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.474	SUP	HCPCS C1713		224.474  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.475	SUP	HCPCS C1713		224.475  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.476	SUP	HCPCS C1713		224.476  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.477	SUP	HCPCS C1713		224.477  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.478	SUP	HCPCS C1713		224.478  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 60MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.479	SUP	HCPCS C1713		224.479  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 65MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.481	SUP	HCPCS C1713		224.481  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.482	SUP	HCPCS C1713		224.482  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.483	SUP	HCPCS C1713		224.483  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.484	SUP	HCPCS C1713		224.484  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.485	SUP	HCPCS C1713		224.485  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.486	SUP	HCPCS C1713		224.486  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.487	SUP	HCPCS C1713		224.487  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.488	SUP	HCPCS C1713		224.488  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 60MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.489	SUP	HCPCS C1713		224.489  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 65MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.506	SUP	HCPCS C1713		224.506  -  PLATE BONE 125MM 6 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL	BOTH IP/OP	"$1,149.85 "	$850.89	$0.00	$893.10	$502.37	$502.37	$0.00	$0.00	$0.00	$239.66	$853.42	$853.42	$0.00	$0.00	$239.63	$0.00	$680.14	$680.14	$0.00	$558.19	$884.17	$893.10	$0.00		$0.00	$169.62	$0.00	$0.00	$177.73	$0.00	$0.00	$0.00	$0.00	$0.00
224.507	SUP	HCPCS C1713		224.507  -  PLATE BONE 125MM 6 HOLE STAINLESS STEEL TIBIA LEFT DISTAL	BOTH IP/OP	"$1,149.85 "	$850.89	$0.00	$893.10	$502.37	$502.37	$0.00	$0.00	$0.00	$239.66	$853.42	$853.42	$0.00	$0.00	$239.63	$0.00	$680.14	$680.14	$0.00	$558.19	$884.17	$893.10	$0.00		$0.00	$169.62	$0.00	$0.00	$177.73	$0.00	$0.00	$0.00	$0.00	$0.00
224.508	SUP	HCPCS C1713		224.508  -  PLATE BONE 161MM 8 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL	BOTH IP/OP	"$1,296.05 "	$959.08	$0.00	"$1,006.64"	$566.24	$566.24	$0.00	$0.00	$0.00	$270.13	$961.93	$961.93	$0.00	$0.00	$270.10	$0.00	$766.61	$766.61	$0.00	$629.15	$996.57	"$1,006.64"	$0.00		$0.00	$191.19	$0.00	$0.00	$200.32	$0.00	$0.00	$0.00	$0.00	$0.00
224.509	SUP	HCPCS C1713		224.509  -  PLATE BONE 161MM 8 HOLE STAINLESS STEEL TIBIA LEFT DISTAL	BOTH IP/OP	"$1,296.05 "	$959.08	$0.00	"$1,006.64"	$566.24	$566.24	$0.00	$0.00	$0.00	$270.13	$961.93	$961.93	$0.00	$0.00	$270.10	$0.00	$766.61	$766.61	$0.00	$629.15	$996.57	"$1,006.64"	$0.00		$0.00	$191.19	$0.00	$0.00	$200.32	$0.00	$0.00	$0.00	$0.00	$0.00
224.51	SUP	HCPCS C1713		224.510  -  PLATE BONE 197X14X3.8MM 10 HOLE DCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,434.35 "	"$1,061.42"	$0.00	"$1,147.48"	$645.46	$645.46	$0.00	$0.00	$0.00	$298.95	"$1,064.57"	"$1,064.57"	$0.00	$0.00	$298.92	$0.00	$848.42	$848.42	$0.00	$717.18	"$1,136.01"	"$1,147.48"	$0.00		$0.00	$217.94	$0.00	$0.00	$228.35	$0.00	$0.00	$0.00	$0.00	$0.00
224.511	SUP	HCPCS C1713		224.511  -  PLATE BONE 197X14X3.8MM 10 HOLE STAINLESS STEEL LEFT MEDIAL	BOTH IP/OP	"$1,477.38 "	"$1,093.26"	$0.00	"$1,147.48"	$645.46	$645.46	$0.00	$0.00	$0.00	$307.92	"$1,096.51"	"$1,096.51"	$0.00	$0.00	$307.88	$0.00	$873.87	$873.87	$0.00	$717.18	"$1,136.01"	"$1,147.48"	$0.00		$0.00	$217.94	$0.00	$0.00	$228.35	$0.00	$0.00	$0.00	$0.00	$0.00
224.512	SUP	Custom 27803010		224.512  -  PLATE BONE 233X14X3.8MM 12 HOLE STAINLESS STEEL RIGHT MEDIAL	BOTH IP/OP	"$1,650.28 "	"$1,221.21"	$0.00	"$1,281.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,224.83"	"$1,224.83"	$0.00	$0.00	$343.92	$0.00	$0.00	$0.00	$0.00	$801.11	"$1,268.97"	"$1,281.78"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.513	SUP	HCPCS C1713		224.513  -  PLATE BONE 233X14X3.8MM 12 HOLE STAINLESS STEEL LEFT MEDIAL	BOTH IP/OP	"$1,650.28 "	"$1,221.21"	$0.00	"$1,281.78"	$721.00	$721.00	$0.00	$0.00	$0.00	$343.96	"$1,224.83"	"$1,224.83"	$0.00	$0.00	$343.92	$0.00	$976.14	$976.14	$0.00	$801.11	"$1,268.97"	"$1,281.78"	$0.00		$0.00	$243.44	$0.00	$0.00	$255.07	$0.00	$0.00	$0.00	$0.00	$0.00
224.514	SUP	HCPCS C1713		224.514  -  PLATE BONE 269X14X3.8MM 14 HOLE STAINLESS STEEL RIGHT MEDIAL	BOTH IP/OP	"$1,840.05 "	"$1,361.64"	$0.00	"$1,429.16"	$803.90	$803.90	$0.00	$0.00	$0.00	$383.51	"$1,365.69"	"$1,365.69"	$0.00	$0.00	$383.47	$0.00	"$1,088.39"	"$1,088.39"	$0.00	$893.23	"$1,414.87"	"$1,429.16"	$0.00		$0.00	$271.44	$0.00	$0.00	$284.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.515	SUP	Custom 27803010		224.515  -  PLATE BONE 269X14X3.8MM 14 HOLE STAINLESS STEEL LEFT MEDIAL	BOTH IP/OP	"$1,840.05 "	"$1,361.64"	$0.00	"$1,429.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,365.69"	"$1,365.69"	$0.00	$0.00	$383.47	$0.00	$0.00	$0.00	$0.00	$893.23	"$1,414.87"	"$1,429.16"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.517	SUP	Custom 27803010		"224.517  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 200MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.52	SUP	Custom 27803010		224.520  -  ROD SPNL 5.5MM 400MM REVERE STRG SS	BOTH IP/OP	$300.78 	$222.58	$0.00	$396.00	$135.35	$135.35	$0.00	$0.00	$0.00	$62.69	$223.24	$223.24	$0.00	$0.00	$62.68	$0.00	$177.91	$177.91	$0.00	$150.39	$396.00	$240.62	$0.00		$0.00	$47.07	$0.00	$0.00	$47.88	$0.00	$0.00	$0.00	$0.00	$0.00
224.52	SUP	HCPCS C1713		224.52  -  PLATE BONE NARROW 34X13.5X4.2MM 2 HOLE LCP STAINLESS STEEL	BOTH IP/OP	$300.78 	$222.58	$0.00	$240.62	$135.35	$135.35	$0.00	$0.00	$0.00	$62.69	$223.24	$223.24	$0.00	$0.00	$62.68	$0.00	$177.91	$177.91	$0.00	$150.39	$238.22	$240.62	$0.00		$0.00	$47.07	$0.00	$0.00	$47.88	$0.00	$0.00	$0.00	$0.00	$0.00
224.521	SUP	Custom 27803010		224.521  -  PLATE BN NAR 44X13.5X4.2MM NS LCP CMBN 2 HL LMT CNTCT TPR	BOTH IP/OP	$608.68 	$450.42	$0.00	$472.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$451.76	$451.76	$0.00	$0.00	$126.85	$0.00	$0.00	$0.00	$0.00	$295.46	$468.02	$472.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.53	SUP	Custom 27803010		"224.530  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 30MM"	BOTH IP/OP	$310.05 	$229.44	$0.00	$396.00	$139.52	$139.52	$0.00	$0.00	$0.00	$64.62	$230.12	$230.12	$0.00	$0.00	$64.61	$0.00	$183.39	$183.39	$0.00	$155.03	$396.00	$248.04	$0.00		$0.00	$48.52	$0.00	$0.00	$49.36	$0.00	$0.00	$0.00	$0.00	$0.00
224.53	SUP	HCPCS C1713		224.53  -  PLATE BONE NARROW 62X13.5X4.2MM 3 HOLE LC-DCP STAINLESS	BOTH IP/OP	$310.05 	$229.44	$0.00	$248.04	$139.52	$139.52	$0.00	$0.00	$0.00	$64.62	$230.12	$230.12	$0.00	$0.00	$64.61	$0.00	$183.39	$183.39	$0.00	$155.03	$245.56	$248.04	$0.00		$0.00	$48.52	$0.00	$0.00	$49.36	$0.00	$0.00	$0.00	$0.00	$0.00
224.531	SUP	HCPCS C1713		224.531  -  PLATE BN NAR 62X13.5X4.2MM NS LCP CMBN 3 HL LMT CNTCT TPR	BOTH IP/OP	$615.70 	$455.62	$0.00	$478.20	$268.99	$268.99	$0.00	$0.00	$0.00	$128.33	$456.97	$456.97	$0.00	$0.00	$128.31	$0.00	$364.19	$364.19	$0.00	$298.88	$473.42	$478.20	$0.00		$0.00	$90.82	$0.00	$0.00	$95.16	$0.00	$0.00	$0.00	$0.00	$0.00
224.535	SUP	Custom 27803010		"224.535  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 35MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.54	SUP	Custom 27803010		"224.540  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 40MM"	BOTH IP/OP	$319.10 	$236.13	$0.00	$396.00	$139.41	$139.41	$0.00	$0.00	$0.00	$66.51	$236.84	$236.84	$0.00	$0.00	$66.50	$0.00	$188.75	$188.75	$0.00	$154.90	$396.00	$247.84	$0.00		$0.00	$47.07	$0.00	$0.00	$49.32	$0.00	$0.00	$0.00	$0.00	$0.00
224.54	SUP	HCPCS C1713		224.54  -  PLATE BN NAR 70X13.5X4.2MM NS LC DCP 4 HL SS 4.5MM SCR LG	BOTH IP/OP	$319.10 	$236.13	$0.00	$247.84	$139.41	$139.41	$0.00	$0.00	$0.00	$66.51	$236.84	$236.84	$0.00	$0.00	$66.50	$0.00	$188.75	$188.75	$0.00	$154.90	$245.36	$247.84	$0.00		$0.00	$47.07	$0.00	$0.00	$49.32	$0.00	$0.00	$0.00	$0.00	$0.00
224.541	SUP	HCPCS C1713		224.541  -  PLATE BN NAR 80X13.5X4.2MM NS LCP CMBN 4 HL LMT CNTCT TPR	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
224.545	SUP	Custom 27803010		"224.545  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 45MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.55	SUP	Custom 27803010		"224.550  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 50MM"	BOTH IP/OP	$319.10 	$236.13	$0.00	$396.00	$139.41	$139.41	$0.00	$0.00	$0.00	$66.51	$236.84	$236.84	$0.00	$0.00	$66.50	$0.00	$188.75	$188.75	$0.00	$154.90	$396.00	$247.84	$0.00		$0.00	$47.07	$0.00	$0.00	$49.32	$0.00	$0.00	$0.00	$0.00	$0.00
224.55	SUP	HCPCS C1713		224.55  -  PLATE BN NAR 88X13.5X4.2MM NS LC DCP 5 HL SS 4.5MM SCR LG	BOTH IP/OP	$319.10 	$236.13	$0.00	$247.84	$139.41	$139.41	$0.00	$0.00	$0.00	$66.51	$236.84	$236.84	$0.00	$0.00	$66.50	$0.00	$188.75	$188.75	$0.00	$154.90	$245.36	$247.84	$0.00		$0.00	$47.07	$0.00	$0.00	$49.32	$0.00	$0.00	$0.00	$0.00	$0.00
224.551	SUP	HCPCS C1713		224.551  -  PLATE BN NAR 98X13.5X4.2MM NS LCP CMBN 5 HL LMT CNTCT TPR	BOTH IP/OP	$694.40 	$513.86	$0.00	$539.34	$303.38	$303.38	$0.00	$0.00	$0.00	$144.73	$515.38	$515.38	$0.00	$0.00	$144.71	$0.00	$410.74	$410.74	$0.00	$337.09	$533.95	$539.34	$0.00		$0.00	$102.44	$0.00	$0.00	$107.33	$0.00	$0.00	$0.00	$0.00	$0.00
224.555	SUP	Custom 27803010		"224.555  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 55MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.56	SUP	Custom 27803010		"224.560  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 60MM"	BOTH IP/OP	$359.85 	$266.29	$0.00	$396.00	$157.22	$157.22	$0.00	$0.00	$0.00	$75.00	$267.08	$267.08	$0.00	$0.00	$74.99	$0.00	$212.85	$212.85	$0.00	$174.69	$396.00	$279.50	$0.00		$0.00	$53.08	$0.00	$0.00	$55.62	$0.00	$0.00	$0.00	$0.00	$0.00
224.56	SUP	HCPCS C1713		224.56  -  PLATE BN NAR 106X13.5X4.2MM NS LC DCP 6 HL SS 4.5MM SCR LG	BOTH IP/OP	$359.85 	$266.29	$0.00	$279.50	$157.22	$157.22	$0.00	$0.00	$0.00	$75.00	$267.08	$267.08	$0.00	$0.00	$74.99	$0.00	$212.85	$212.85	$0.00	$174.69	$276.71	$279.50	$0.00		$0.00	$53.08	$0.00	$0.00	$55.62	$0.00	$0.00	$0.00	$0.00	$0.00
224.561	SUP	HCPCS C1713		224.561  -  PLATE BN NAR 116MM NS LCP CMBN 6 HL SS 4.5MM SCR LG FRAG SET	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
224.565	SUP	Custom 27803010		"224.565  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 65MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.57	SUP	Custom 27803010		"224.570  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 70MM"	BOTH IP/OP	$359.85 	$266.29	$0.00	$396.00	$157.22	$157.22	$0.00	$0.00	$0.00	$75.00	$267.08	$267.08	$0.00	$0.00	$74.99	$0.00	$212.85	$212.85	$0.00	$174.69	$396.00	$279.50	$0.00		$0.00	$53.08	$0.00	$0.00	$55.62	$0.00	$0.00	$0.00	$0.00	$0.00
224.57	SUP	HCPCS C1713		224.57  -  PLATE BN NAR 124X13.5X4.2MM NS LC DCP 7 HL SS 4.5MM SCR LG	BOTH IP/OP	$359.85 	$266.29	$0.00	$279.50	$157.22	$157.22	$0.00	$0.00	$0.00	$75.00	$267.08	$267.08	$0.00	$0.00	$74.99	$0.00	$212.85	$212.85	$0.00	$174.69	$276.71	$279.50	$0.00		$0.00	$53.08	$0.00	$0.00	$55.62	$0.00	$0.00	$0.00	$0.00	$0.00
224.571	SUP	HCPCS C1713		224.571  -  PLATE BN NAR 134X13.5X4.2MM NS LCP CMBN 7 HL LMT CNTCT TPR	BOTH IP/OP	$850.45 	$629.33	$0.00	$660.54	$371.55	$371.55	$0.00	$0.00	$0.00	$177.26	$631.20	$631.20	$0.00	$0.00	$177.23	$0.00	$503.04	$503.04	$0.00	$412.84	$653.94	$660.54	$0.00		$0.00	$125.45	$0.00	$0.00	$131.45	$0.00	$0.00	$0.00	$0.00	$0.00
224.575	SUP	Custom 27803010		"224.575  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 75MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.58	SUP	Custom 27803010		"224.580  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 80MM"	BOTH IP/OP	$359.85 	$266.29	$0.00	$396.00	$157.22	$157.22	$0.00	$0.00	$0.00	$75.00	$267.08	$267.08	$0.00	$0.00	$74.99	$0.00	$212.85	$212.85	$0.00	$174.69	$396.00	$279.50	$0.00		$0.00	$53.08	$0.00	$0.00	$55.62	$0.00	$0.00	$0.00	$0.00	$0.00
224.58	SUP	HCPCS C1713		224.58  -  PLATE BN NAR 142X13.5X4.2MM NS LC DCP 8 HL SS 4.5MM SCR LG	BOTH IP/OP	$359.85 	$266.29	$0.00	$279.50	$157.22	$157.22	$0.00	$0.00	$0.00	$75.00	$267.08	$267.08	$0.00	$0.00	$74.99	$0.00	$212.85	$212.85	$0.00	$174.69	$276.71	$279.50	$0.00		$0.00	$53.08	$0.00	$0.00	$55.62	$0.00	$0.00	$0.00	$0.00	$0.00
224.581	SUP	HCPCS C1713		224.581  -  PLATE BN NAR 152X13.5X4.2MM NS LCP CMBN 8 HL LMT CNTCT TPR	BOTH IP/OP	$899.65 	$665.74	$0.00	$698.76	$393.05	$393.05	$0.00	$0.00	$0.00	$187.51	$667.72	$667.72	$0.00	$0.00	$187.49	$0.00	$532.14	$532.14	$0.00	$436.73	$691.77	$698.76	$0.00		$0.00	$132.71	$0.00	$0.00	$139.05	$0.00	$0.00	$0.00	$0.00	$0.00
224.585	SUP	Custom 27803010		"224.585  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 85MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.59	SUP	HCPCS C1713		224.59  -  PLATE BN NAR 160X13.5X4.2MM NS LC DCP 9 HL SS 4.5MM SCR LG	BOTH IP/OP	$359.85 	$266.29	$0.00	$279.50	$157.22	$157.22	$0.00	$0.00	$0.00	$75.00	$267.08	$267.08	$0.00	$0.00	$74.99	$0.00	$212.85	$212.85	$0.00	$174.69	$276.71	$279.50	$0.00		$0.00	$53.08	$0.00	$0.00	$55.62	$0.00	$0.00	$0.00	$0.00	$0.00
224.591	SUP	HCPCS C1713		224.591  -  PLATE BN NAR 170X13.5X4.2MM NS LCP CMBN 9 HL LMT CNTCT TPR	BOTH IP/OP	$941.83 	$696.95	$0.00	$731.50	$411.47	$411.47	$0.00	$0.00	$0.00	$196.30	$699.02	$699.02	$0.00	$0.00	$196.28	$0.00	$557.09	$557.09	$0.00	$457.19	$724.19	$731.50	$0.00		$0.00	$138.93	$0.00	$0.00	$145.57	$0.00	$0.00	$0.00	$0.00	$0.00
224.6	SUP	HCPCS C1713		224.60  -  PLATE BN NAR 178X13.5X4.2MM NS LC DCP 10 HL SS 4.5MM SCR LG	BOTH IP/OP	$454.45 	$336.29	$0.00	$363.56	$204.50	$204.50	$0.00	$0.00	$0.00	$94.72	$337.29	$337.29	$0.00	$0.00	$94.71	$0.00	$268.81	$268.81	$0.00	$227.23	$359.92	$363.56	$0.00		$0.00	$69.05	$0.00	$0.00	$72.35	$0.00	$0.00	$0.00	$0.00	$0.00
224.601	SUP	HCPCS C1713		224.601  -  PLATE BN NAR 188X13.5X4.2MM NS LCP CMBN 10 HL LMT CNTCT TPR	BOTH IP/OP	"$1,023.35 "	$757.28	$0.00	$794.84	$447.10	$447.10	$0.00	$0.00	$0.00	$213.29	$759.53	$759.53	$0.00	$0.00	$213.27	$0.00	$605.31	$605.31	$0.00	$496.78	$786.89	$794.84	$0.00		$0.00	$150.96	$0.00	$0.00	$158.17	$0.00	$0.00	$0.00	$0.00	$0.00
224.61	SUP	Custom 27803010		"224.610  -  5.5MM STAINLESS STEEL CURVED ROD, 100MM"	BOTH IP/OP	$468.10 	$346.39	$0.00	$396.00	$204.50	$204.50	$0.00	$0.00	$0.00	$97.56	$347.42	$347.42	$0.00	$0.00	$97.55	$0.00	$276.88	$276.88	$0.00	$227.23	$396.00	$363.56	$0.00		$0.00	$69.05	$0.00	$0.00	$72.35	$0.00	$0.00	$0.00	$0.00	$0.00
224.61	SUP	HCPCS C1713		224.61  -  PLATE BN NAR 196X13.5X4.2MM NS LC DCP 11 HL SS 4.5MM SCR LG	BOTH IP/OP	$468.10 	$346.39	$0.00	$363.56	$204.50	$204.50	$0.00	$0.00	$0.00	$97.56	$347.42	$347.42	$0.00	$0.00	$97.55	$0.00	$276.88	$276.88	$0.00	$227.23	$359.92	$363.56	$0.00		$0.00	$69.05	$0.00	$0.00	$72.35	$0.00	$0.00	$0.00	$0.00	$0.00
224.611	SUP	HCPCS C1713		224.611  -  PLATE BN NAR 206X13.5X4.2MM NS LCP CMBN 11 HL LMT CNTCT TPR	BOTH IP/OP	"$1,102.08 "	$815.54	$0.00	$855.98	$481.49	$481.49	$0.00	$0.00	$0.00	$229.70	$817.96	$817.96	$0.00	$0.00	$229.67	$0.00	$651.88	$651.88	$0.00	$534.99	$847.42	$855.98	$0.00		$0.00	$162.57	$0.00	$0.00	$170.34	$0.00	$0.00	$0.00	$0.00	$0.00
224.612	SUP	Custom 27803010		"224.612  -  5.5MM STAINLESS STEEL CURVED ROD, 125MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.615	SUP	Custom 27803010		"224.615  -  5.5MM STAINLESS STEEL CURVED ROD, 150MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.62	SUP	HCPCS C1713		224.62  -  PLATE BN NAR 214X13.5X4.2MM NS LC DCP 12 HL SS 4.5MM SCR LG	BOTH IP/OP	$468.10 	$346.39	$0.00	$363.56	$204.50	$204.50	$0.00	$0.00	$0.00	$97.56	$347.42	$347.42	$0.00	$0.00	$97.55	$0.00	$276.88	$276.88	$0.00	$227.23	$359.92	$363.56	$0.00		$0.00	$69.05	$0.00	$0.00	$72.35	$0.00	$0.00	$0.00	$0.00	$0.00
224.621	SUP	HCPCS C1713		224.621  -  PLATE BN NAR 224X13.5X4.2MM NS LCP CMBN 12 HL LMT CNTCT TPR	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$920.38	$517.71	$517.71	$0.00	$0.00	$0.00	$246.98	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$700.93	$700.93	$0.00	$575.24	$911.18	$920.38	$0.00		$0.00	$174.81	$0.00	$0.00	$183.16	$0.00	$0.00	$0.00	$0.00	$0.00
224.635	SUP	Custom 27803010		"224.635  -  5.5MM STAINLESS STEEL CURVED ROD, 35MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.64	SUP	Custom 27803010		"224.640  -  5.5MM STAINLESS STEEL CURVED ROD, 40MM"	BOTH IP/OP	$441.23 	$326.51	$0.00	$396.00	$198.55	$198.55	$0.00	$0.00	$0.00	$91.96	$327.48	$327.48	$0.00	$0.00	$91.95	$0.00	$260.98	$260.98	$0.00	$220.61	$396.00	$352.98	$0.00		$0.00	$69.05	$0.00	$0.00	$70.24	$0.00	$0.00	$0.00	$0.00	$0.00
224.64	SUP	HCPCS C1713		224.64  -  PLATE BONE NARROW 250X13.5X4.2MM 14 HOLE LC-DCP STAINLESS	BOTH IP/OP	$441.23 	$326.51	$0.00	$352.98	$198.55	$198.55	$0.00	$0.00	$0.00	$91.96	$327.48	$327.48	$0.00	$0.00	$91.95	$0.00	$260.98	$260.98	$0.00	$220.61	$349.45	$352.98	$0.00		$0.00	$69.05	$0.00	$0.00	$70.24	$0.00	$0.00	$0.00	$0.00	$0.00
224.641	SUP	HCPCS C1713		224.641  -  PLATE BN NAR 260X13.5X4.2MM NS LCP CMBN 14 HL LMT CNTCT TPR	BOTH IP/OP	"$1,328.38 "	$983.00	$0.00	"$1,031.76"	$580.37	$580.37	$0.00	$0.00	$0.00	$276.87	$985.92	$985.92	$0.00	$0.00	$276.83	$0.00	$785.73	$785.73	$0.00	$644.85	"$1,021.44"	"$1,031.76"	$0.00		$0.00	$195.96	$0.00	$0.00	$205.32	$0.00	$0.00	$0.00	$0.00	$0.00
224.645	SUP	Custom 27803010		"224.645  -  5.5MM STAINLESS STEEL CURVED ROD, 45MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.65	SUP	Custom 27803010		"224.650  -  5.5MM STAINLESS STEEL CURVED ROD, 50MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.655	SUP	Custom 27803010		"224.655  -  5.5MM STAINLESS STEEL CURVED ROD, 55MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.66	SUP	Custom 27803010		"224.660  -  5.5MM STAINLESS STEEL CURVED ROD, 60MM"	BOTH IP/OP	$562.28 	$416.09	$0.00	$436.72	$245.66	$245.66	$0.00	$0.00	$0.00	$117.19	$417.32	$417.32	$0.00	$0.00	$117.18	$0.00	$332.59	$332.59	$0.00	$272.95	$396.00	$436.72	$0.00		$0.00	$82.95	$0.00	$0.00	$86.91	$0.00	$0.00	$0.00	$0.00	$0.00
224.66	SUP	HCPCS C1713		224.66  -  PLATE BONE NARROW 286X13.5X4.2MM 16 HOLE LC-DCP STAINLESS	BOTH IP/OP	$562.28 	$416.09	$0.00	$436.72	$245.66	$245.66	$0.00	$0.00	$0.00	$117.19	$417.32	$417.32	$0.00	$0.00	$117.18	$0.00	$332.59	$332.59	$0.00	$272.95	$432.35	$436.72	$0.00		$0.00	$82.95	$0.00	$0.00	$86.91	$0.00	$0.00	$0.00	$0.00	$0.00
224.661	SUP	HCPCS C1713		224.661  -  PLATE BN NAR 296X13.5X4.2MM NS LCP CMBN 16 HL LMT CNTCT TPR	BOTH IP/OP	"$1,553.30 "	"$1,149.44"	$0.00	"$1,206.44"	$678.62	$678.62	$0.00	$0.00	$0.00	$323.75	"$1,152.86"	"$1,152.86"	$0.00	$0.00	$323.71	$0.00	$918.78	$918.78	$0.00	$754.03	"$1,194.38"	"$1,206.44"	$0.00		$0.00	$229.14	$0.00	$0.00	$240.08	$0.00	$0.00	$0.00	$0.00	$0.00
224.665	SUP	Custom 27803010		"224.665  -  5.5MM STAINLESS STEEL CURVED ROD, 65MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.67	SUP	Custom 27803010		"224.670  -  5.5MM STAINLESS STEEL CURVED ROD, 70MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.675	SUP	Custom 27803010		"224.675  -  5.5MM STAINLESS STEEL CURVED ROD, 75MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.68	SUP	Custom 27803010		"224.680  -  5.5MM STAINLESS STEEL CURVED ROD, 80MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.681	SUP	HCPCS C1713		224.681  -  PLATE BONE NARROW 332MM 18 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$1,886.45 "	"$1,395.97"	$0.00	"$1,465.20"	$824.18	$824.18	$0.00	$0.00	$0.00	$393.18	"$1,400.12"	"$1,400.12"	$0.00	$0.00	$393.14	$0.00	"$1,115.84"	"$1,115.84"	$0.00	$915.75	"$1,450.55"	"$1,465.20"	$0.00		$0.00	$278.28	$0.00	$0.00	$291.57	$0.00	$0.00	$0.00	$0.00	$0.00
224.685	SUP	Custom 27803010		"224.685  -  5.5MM STAINLESS STEEL CURVED ROD, 85MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.7	SUP	HCPCS C1713		224.70  -  PLATE BONE NARROW 358MM 20 HOLE LC-DCP STAINLESS STEEL	BOTH IP/OP	"$1,155.95 "	$855.40	$0.00	$924.76	$520.18	$520.18	$0.00	$0.00	$0.00	$240.93	$857.95	$857.95	$0.00	$0.00	$240.90	$0.00	$683.74	$683.74	$0.00	$577.98	$915.51	$924.76	$0.00		$0.00	$175.64	$0.00	$0.00	$184.03	$0.00	$0.00	$0.00	$0.00	$0.00
224.701	SUP	HCPCS C1713		224.701  -  PLATE BONE NARROW 368MM 20 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$2,398.10 "	"$1,774.59"	$0.00	"$1,862.62"	"$1,047.72"	"$1,047.72"	$0.00	$0.00	$0.00	$499.82	"$1,779.87"	"$1,779.87"	$0.00	$0.00	$499.76	$0.00	"$1,418.48"	"$1,418.48"	$0.00	"$1,164.14"	"$1,844.00"	"$1,862.62"	$0.00		$0.00	$353.76	$0.00	$0.00	$370.66	$0.00	$0.00	$0.00	$0.00	$0.00
224.702	SUP	HCPCS C1713		"224.702  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.703	SUP	HCPCS C1713		"224.703  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.704	SUP	HCPCS C1713		"224.704  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.705	SUP	HCPCS C1713		"224.705  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.706	SUP	HCPCS C1713		"224.706  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.707	SUP	HCPCS C1713		"224.707  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.711	SUP	HCPCS C1713		"224.711  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.712	SUP	HCPCS C1713		"224.712  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.713	SUP	HCPCS C1713		"224.713  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.714	SUP	HCPCS C1713		"224.714  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.715	SUP	HCPCS C1713		"224.715  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.716	SUP	HCPCS C1713		"224.716  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.717	SUP	HCPCS C1713		"224.717  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.721	SUP	HCPCS C1713		224.721  -  PLATE BONE NARROW 404MM 22 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$2,618.80 "	"$1,937.91"	$0.00	"$2,034.02"	"$1,144.14"	"$1,144.14"	$0.00	$0.00	$0.00	$545.82	"$1,943.67"	"$1,943.67"	$0.00	$0.00	$545.76	$0.00	"$1,291.07"	"$1,291.07"	$0.00	"$1,271.26"	"$2,013.68"	"$2,034.02"	$0.00		$0.00	$386.32	$0.00	$0.00	$404.77	$0.00	$0.00	$0.00	$0.00	$0.00
224.722	SUP	HCPCS C1713		"224.722  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.723	SUP	HCPCS C1713		"224.723  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.724	SUP	HCPCS C1713		"224.724  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.725	SUP	HCPCS C1713		"224.725  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.726	SUP	HCPCS C1713		"224.726  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.727	SUP	HCPCS C1713		"224.727  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.731	SUP	HCPCS C1713		"224.731  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.732	SUP	HCPCS C1713		"224.732  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.733	SUP	HCPCS C1713		"224.733  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.734	SUP	HCPCS C1713		"224.734  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.735	SUP	HCPCS C1713		"224.735  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.736	SUP	HCPCS C1713		"224.736  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.737	SUP	HCPCS C1713		"224.737  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.753	SUP	HCPCS C1713		224.753  -  PLATE BN 118X11X4.2MM NS LCP CMBN 8 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$1,730.40 "	"$1,280.50"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$360.66	"$1,284.30"	"$1,284.30"	$0.00	$0.00	$360.62	$0.00	"$1,023.53"	"$1,023.53"	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$255.26	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
224.754	SUP	HCPCS C1713		224.754  -  PLATE BN 136X11X4.2MM NS LCP CMBN 9 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$1,758.53 "	"$1,301.31"	$0.00	"$1,365.84"	$768.29	$768.29	$0.00	$0.00	$0.00	$366.52	"$1,305.18"	"$1,305.18"	$0.00	$0.00	$366.48	$0.00	"$1,040.17"	"$1,040.17"	$0.00	$853.65	"$1,352.18"	"$1,365.84"	$0.00		$0.00	$259.41	$0.00	$0.00	$271.80	$0.00	$0.00	$0.00	$0.00	$0.00
224.755	SUP	HCPCS C1713		224.755  -  PLATE BN 154X11X4.2MM NS LCP CMBN 10 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$1,788.05 "	"$1,323.16"	$0.00	"$1,388.76"	$781.18	$781.18	$0.00	$0.00	$0.00	$372.67	"$1,327.09"	"$1,327.09"	$0.00	$0.00	$372.63	$0.00	"$1,057.63"	"$1,057.63"	$0.00	$867.98	"$1,374.87"	"$1,388.76"	$0.00		$0.00	$263.77	$0.00	$0.00	$276.36	$0.00	$0.00	$0.00	$0.00	$0.00
224.756	SUP	HCPCS C1713		224.756  -  PLATE BONE 172MM 11 HOLE LCP STAINLESS STEEL METAPHYSEAL	BOTH IP/OP	"$1,817.55 "	"$1,344.99"	$0.00	"$1,411.70"	$794.08	$794.08	$0.00	$0.00	$0.00	$378.82	"$1,348.99"	"$1,348.99"	$0.00	$0.00	$378.78	$0.00	"$1,075.08"	"$1,075.08"	$0.00	$882.31	"$1,397.59"	"$1,411.70"	$0.00		$0.00	$268.12	$0.00	$0.00	$280.93	$0.00	$0.00	$0.00	$0.00	$0.00
224.757	SUP	HCPCS C1713		224.757  -  PLATE BONE 190MM 12 HOLE LCP STAINLESS STEEL METAPHYSEAL	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,822.22"	"$1,025.00"	"$1,025.00"	$0.00	$0.00	$0.00	$488.99	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	"$1,387.72"	"$1,387.72"	$0.00	"$1,138.89"	"$1,804.00"	"$1,822.22"	$0.00		$0.00	$346.09	$0.00	$0.00	$362.62	$0.00	$0.00	$0.00	$0.00	$0.00
224.758	SUP	HCPCS C1713		224.758  -  PLATE BONE 208MM 8X5 HOLE LCP STAINLESS STEEL METAPHYSEAL	BOTH IP/OP	"$2,370.00 "	"$1,753.80"	$0.00	"$1,840.78"	"$1,035.44"	"$1,035.44"	$0.00	$0.00	$0.00	$493.97	"$1,759.01"	"$1,759.01"	$0.00	$0.00	$493.91	$0.00	"$1,401.86"	"$1,401.86"	$0.00	"$1,150.49"	"$1,822.38"	"$1,840.78"	$0.00		$0.00	$349.61	$0.00	$0.00	$366.32	$0.00	$0.00	$0.00	$0.00	$0.00
224.759	SUP	HCPCS C1713		224.759  -  PLATE BONE 226MM 9X5 HOLE LCP STAINLESS STEEL METAPHYSEAL	BOTH IP/OP	"$2,422.00 "	"$1,792.28"	$0.00	"$1,881.18"	"$1,058.16"	"$1,058.16"	$0.00	$0.00	$0.00	$504.81	"$1,797.61"	"$1,797.61"	$0.00	$0.00	$504.74	$0.00	"$1,432.61"	"$1,432.61"	$0.00	"$1,175.74"	"$1,862.37"	"$1,881.18"	$0.00		$0.00	$357.29	$0.00	$0.00	$374.35	$0.00	$0.00	$0.00	$0.00	$0.00
224.761	SUP	HCPCS C1713		224.761  -  PLATE BONE 262MM 11X5 HOLE LCP STAINLESS STEEL METAPHYSEAL	BOTH IP/OP	"$2,542.90 "	"$1,881.75"	$0.00	"$1,975.06"	"$1,110.97"	"$1,110.97"	$0.00	$0.00	$0.00	$530.00	"$1,887.34"	"$1,887.34"	$0.00	$0.00	$529.94	$0.00	"$1,253.65"	"$1,253.65"	$0.00	"$1,234.41"	"$1,955.31"	"$1,975.06"	$0.00		$0.00	$375.12	$0.00	$0.00	$393.04	$0.00	$0.00	$0.00	$0.00	$0.00
224.763	SUP	HCPCS C1713		224.763  -  PLATE BONE 298MM 13X5 HOLE LCP STAINLESS STEEL METAPHYSEAL	BOTH IP/OP	"$2,590.70 "	"$1,917.12"	$0.00	"$2,012.18"	"$1,131.85"	"$1,131.85"	$0.00	$0.00	$0.00	$539.97	"$1,922.82"	"$1,922.82"	$0.00	$0.00	$539.90	$0.00	"$1,277.22"	"$1,277.22"	$0.00	"$1,257.61"	"$1,992.06"	"$2,012.18"	$0.00		$0.00	$382.17	$0.00	$0.00	$400.42	$0.00	$0.00	$0.00	$0.00	$0.00
224.765	SUP	HCPCS C1713		224.765  -  PLATE BONE 334MM 20 HOLE LCP STAINLESS STEEL METAPHYSEAL	BOTH IP/OP	"$2,708.78 "	"$2,004.50"	$0.00	"$2,103.90"	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$0.00	$564.58	"$2,010.45"	"$2,010.45"	$0.00	$0.00	$564.51	$0.00	"$1,335.43"	"$1,335.43"	$0.00	"$1,314.94"	"$2,082.86"	"$2,103.90"	$0.00		$0.00	$399.59	$0.00	$0.00	$418.68	$0.00	$0.00	$0.00	$0.00	$0.00
224.801	SUP	HCPCS C1713		"224.801  -  SS REVERE 4.5MM UNIPLANAR SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.802	SUP	HCPCS C1713		"224.802  -  SS REVERE 4.5MM UNIPLANAR SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.803	SUP	HCPCS C1713		"224.803  -  SS REVERE 4.5MM UNIPLANAR SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.804	SUP	HCPCS C1713		"224.804  -  SS REVERE 4.5MM UNIPLANAR SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.805	SUP	HCPCS C1713		"224.805  -  SS REVERE 4.5MM UNIPLANAR SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.806	SUP	HCPCS C1713		"224.806  -  SS REVERE 4.5MM UNIPLANAR SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.807	SUP	HCPCS C1713		"224.807  -  SS REVERE 4.5MM UNIPLANAR SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.811	SUP	HCPCS C1713		"224.811  -  SS REVERE 5.0MM UNIPLANAR SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.812	SUP	HCPCS C1713		"224.812  -  SS REVERE 5.0MM UNIPLANAR SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.813	SUP	HCPCS C1713		"224.813  -  SS REVERE 5.0MM UNIPLANAR SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.814	SUP	HCPCS C1713		"224.814  -  SS REVERE 5.0MM UNIPLANAR SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.815	SUP	HCPCS C1713		"224.815  -  SS REVERE 5.0MM UNIPLANAR SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.816	SUP	HCPCS C1713		"224.816  -  SS REVERE 5.0MM UNIPLANAR SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.817	SUP	HCPCS C1713		"224.817  -  SS REVERE 5.0MM UNIPLANAR SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.821	SUP	HCPCS C1713		"224.821  -  SS REVERE 5.5MM UNIPLANAR SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.822	SUP	HCPCS C1713		"224.822  -  SS REVERE 5.5MM UNIPLANAR SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.823	SUP	HCPCS C1713		"224.823  -  SS REVERE 5.5MM UNIPLANAR SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.824	SUP	HCPCS C1713		"224.824  -  SS REVERE 5.5MM UNIPLANAR SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.825	SUP	HCPCS C1713		"224.825  -  SS REVERE 5.5MM UNIPLANAR SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.826	SUP	HCPCS C1713		"224.826  -  SS REVERE 5.5MM UNIPLANAR SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.827	SUP	HCPCS C1713		"224.827  -  SS REVERE 5.5MM UNIPLANAR SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.831	SUP	HCPCS C1713		"224.831  -  SS REVERE 6.5MM UNIPLANAR SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.832	SUP	HCPCS C1713		"224.832  -  SS REVERE 6.5MM UNIPLANAR SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.833	SUP	HCPCS C1713		"224.833  -  SS REVERE 6.5MM UNIPLANAR SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.834	SUP	HCPCS C1713		"224.834  -  SS REVERE 6.5MM UNIPLANAR SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.835	SUP	HCPCS C1713		"224.835  -  SS REVERE 6.5MM UNIPLANAR SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.836	SUP	HCPCS C1713		"224.836  -  SS REVERE 6.5MM UNIPLANAR SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.837	SUP	HCPCS C1713		"224.837  -  SS REVERE 6.5MM UNIPLANAR SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
224.851	SUP	HCPCS C1713		"224.851  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 25MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.852	SUP	HCPCS C1713		"224.852  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.853	SUP	HCPCS C1713		"224.853  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.854	SUP	HCPCS C1713		"224.854  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.855	SUP	HCPCS C1713		"224.855  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.856	SUP	HCPCS C1713		"224.856  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.857	SUP	HCPCS C1713		"224.857  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.871	SUP	HCPCS C1713		"224.871  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 70MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.872	SUP	HCPCS C1713		"224.872  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 75MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.873	SUP	HCPCS C1713		"224.873  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 80MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.874	SUP	HCPCS C1713		"224.874  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 85MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.875	SUP	HCPCS C1713		"224.875  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 90MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.881	SUP	HCPCS C1713		"224.881  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 70MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.882	SUP	HCPCS C1713		"224.882  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 75MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.883	SUP	HCPCS C1713		"224.883  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 80MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.884	SUP	HCPCS C1713		"224.884  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 85MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.885	SUP	HCPCS C1713		"224.885  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 90MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
224.891	SUP	Custom 27803010		"224.891  -  SS REVERE LOW PROFILE PEDICLE HOOK, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.892	SUP	Custom 27803010		"224.892  -  SS REVERE LOW PROFILE PEDICLE HOOK, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.893	SUP	Custom 27803010		"224.893  -  SS REVERE LOW PROFILE PEDICLE HOOK, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.901	SUP	Custom 27803010		"224.901  -  STAINLESS STEEL REVERE THORACIC LAMINA HOOK, NARROW, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.902	SUP	Custom 27803010		"224.902  -  STAINLESS STEEL REVERE THORACIC LAMINA HOOK, NARROW, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.904	SUP	Custom 27803010		"224.904  -  STAINLESS STEEL REVERE THORACIC LAMINA HOOK, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.905	SUP	Custom 27803010		"224.905  -  STAINLESS STEEL REVERE THORACIC LAMINA HOOK, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.907	SUP	Custom 27803010		"224.907  -  STAINLESS STEEL REVERE UPGOING LAMINA HOOK, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.908	SUP	Custom 27803010		"224.908  -  STAINLESS STEEL REVERE UPGOING LAMINA HOOK, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.912	SUP	Custom 27803010		"224.912  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 29MM-33MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.913	SUP	Custom 27803010		"224.913  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 33MM-41MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.914	SUP	Custom 27803010		"224.914  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 38MM-51MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.915	SUP	Custom 27803010		"224.915  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 48MM-61MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.916	SUP	Custom 27803010		"224.916  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 58MM-71MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.917	SUP	Custom 27803010		"224.917  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 68MM-81MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.918	SUP	Custom 27803010		"224.918  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 78MM-91MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.921	SUP	Custom 27803010		"224.921  -  STAINLESS STEEL REVERE OFFSET LAMINA HOOK, RIGHT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.922	SUP	Custom 27803010		"224.922  -  STAINLESS STEEL REVERE OFFSET LAMINA HOOK, LEFT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.924	SUP	Custom 27803010		"224.924  -  STAINLESS STEEL REVERE TRANSVERSE PROCESS HOOK, RIGHT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.925	SUP	Custom 27803010		"224.925  -  STAINLESS STEEL REVERE TRANSVERSE PROCESS HOOK, LEFT"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.927	SUP	Custom 27803010		"224.927  -  STAINLESS STEEL REVERE PEDICLE HOOK, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.928	SUP	Custom 27803010		"224.928  -  STAINLESS STEEL REVERE PEDICLE HOOK, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.929	SUP	Custom 27803010		"224.929  -  STAINLESS STEEL REVERE PEDICLE HOOK, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.931	SUP	Custom 27803010		"224.931  -  STAINLESS STEEL REVERE LAMINA HOOK, TRANSVERSE, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.932	SUP	Custom 27803010		"224.932  -  STAINLESS STEEL REVERE LAMINA HOOK, TRANSVERSE, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.933	SUP	Custom 27803010		"224.933  -  STAINLESS STEEL REVERE LAMINA HOOK, TRANSVERSE, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.935	SUP	Custom 27803010		"224.935  -  STAINLESS STEEL REVERE PEDICLE HOOK, TRANSVERSE, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.936	SUP	Custom 27803010		"224.936  -  STAINLESS STEEL REVERE PEDICLE HOOK, TRANSVERSE, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.937	SUP	Custom 27803010		"224.937  -  STAINLESS STEEL REVERE PEDICLE HOOK, TRANSVERSE, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.94	SUP	Custom 27803010		"224.940  -  STAINLESS STEEL REVERE LAMINA HOOK, NARROW, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.941	SUP	Custom 27803010		"224.941  -  STAINLESS STEEL REVERE LAMINA HOOK, NARROW, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.942	SUP	Custom 27803010		"224.942  -  STAINLESS STEEL REVERE LAMINA HOOK, NARROW, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.944	SUP	Custom 27803010		"224.944  -  STAINLESS STEEL REVERE LAMINA HOOK, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.945	SUP	Custom 27803010		"224.945  -  STAINLESS STEEL REVERE LAMINA HOOK, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.946	SUP	Custom 27803010		"224.946  -  STAINLESS STEEL REVERE LAMINA HOOK, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.948	SUP	Custom 27803010		"224.948  -  STAINLESS STEEL REVERE LAMINA HOOK, WIDE, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.949	SUP	Custom 27803010		"224.949  -  STAINLESS STEEL REVERE LAMINA HOOK, WIDE, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.95	SUP	Custom 27803010		"224.950  -  STAINLESS STEEL REVERE LAMINA HOOK, WIDE, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.952	SUP	Custom 27803010		"224.952  -  STAINLESS STEEL REVERE LAMINA HOOK, TALL BODY, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.953	SUP	Custom 27803010		"224.953  -  STAINLESS STEEL REVERE LAMINA HOOK, TALL BODY, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.954	SUP	Custom 27803010		"224.954  -  STAINLESS STEEL REVERE LAMINA HOOK, TALL BODY, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.955	SUP	Custom 27803010		"224.955  -  STAINLESS STEEL REVERE ANGLED LAMINA HOOK, SMALL"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.956	SUP	Custom 27803010		"224.956  -  STAINLESS STEEL REVERE ANGLED LAMINA HOOK, MEDIUM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.957	SUP	Custom 27803010		"224.957  -  STAINLESS STEEL REVERE ANGLED LAMINA HOOK, LARGE"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.96	SUP	Custom 27803010		"224.960  -  STAINLESS STEEL PARALLEL CONNECTOR, 5.5MM TO 5.5MM"	BOTH IP/OP	"$1,142.50 "	$845.45	$0.00	$914.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$847.96	$847.96	$0.00	$0.00	$238.10	$0.00	$0.00	$0.00	$0.00	$571.25	$904.86	$914.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.961	SUP	Custom 27803010		"224.961  -  STAINLESS STEEL PARALLEL CONNECTOR, 5.5MM TO 5.5MM, WIDE"	BOTH IP/OP	"$1,142.50 "	$845.45	$0.00	$914.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$847.96	$847.96	$0.00	$0.00	$238.10	$0.00	$0.00	$0.00	$0.00	$571.25	$904.86	$914.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.962	SUP	Custom 27803010		"224.962  -  STAINLESS STEEL ROD TO ROD CLAMP, 5.5MM TO 5.5MM"	BOTH IP/OP	"$1,142.50 "	$845.45	$0.00	$914.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$847.96	$847.96	$0.00	$0.00	$238.10	$0.00	$0.00	$0.00	$0.00	$571.25	$904.86	$914.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.963	SUP	Custom 27803010		"224.963  -  STAINLESS STEEL ROD TO ROD CLAMP, 5.5MM TO 5.5MM, WIDE"	BOTH IP/OP	"$1,142.50 "	$845.45	$0.00	$914.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$847.96	$847.96	$0.00	$0.00	$238.10	$0.00	$0.00	$0.00	$0.00	$571.25	$904.86	$914.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.964	SUP	Custom 27803010		"224.964  -  STAINLESS STEEL PARALLEL CONNECTOR CLAMP, 5.5MM TO 5.5MM"	BOTH IP/OP	"$1,142.50 "	$845.45	$0.00	$914.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$847.96	$847.96	$0.00	$0.00	$238.10	$0.00	$0.00	$0.00	$0.00	$571.25	$904.86	$914.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.965	SUP	Custom 27803010		"224.965  -  STAINLESS STEEL PARALLEL CONNECTOR CLAMP, 5.5MM TO 5.5MM, WI"	BOTH IP/OP	"$1,142.50 "	$845.45	$0.00	$914.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$847.96	$847.96	$0.00	$0.00	$238.10	$0.00	$0.00	$0.00	$0.00	$571.25	$904.86	$914.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.97	SUP	Custom 27803010		"224.970  -  5.5MM STAINLESS STEEL OFFSET CONNECTOR, 15MM"	BOTH IP/OP	"$1,025.00 "	$758.50	$0.00	$820.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$760.76	$760.76	$0.00	$0.00	$213.61	$0.00	$0.00	$0.00	$0.00	$512.50	$811.80	$820.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.971	SUP	Custom 27803010		"224.971  -  5.5MMM STAINLESS STEEL OFFSET CONNECTOR, 20MM"	BOTH IP/OP	"$1,025.00 "	$758.50	$0.00	$820.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$760.76	$760.76	$0.00	$0.00	$213.61	$0.00	$0.00	$0.00	$0.00	$512.50	$811.80	$820.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.972	SUP	Custom 27803010		"224.972  -  5.5MM STAINLESS STEEL OFFSET CONNECTOR, 25MM"	BOTH IP/OP	"$1,025.00 "	$758.50	$0.00	$820.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$760.76	$760.76	$0.00	$0.00	$213.61	$0.00	$0.00	$0.00	$0.00	$512.50	$811.80	$820.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.973	SUP	Custom 27803010		"224.973  -  5.5MM STAINLESS STEEL ROD CLAMP, 100MM"	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$0.00	$0.00	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.974	SUP	Custom 27803010		"224.974  -  5.5MM STAINLESS STEEL ROD CLAMP, 120MM"	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$0.00	$0.00	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.975	SUP	Custom 27803010		"224.975  -  5.5MM STAINLESS STEEL ROD CLAMP, 150MM"	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$0.00	$0.00	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.976	SUP	Custom 27803010		"224.976  -  5.5MM STAINLESS STEEL OFFSET CONNECTOR, 30MM"	BOTH IP/OP	"$1,132.50 "	$838.05	$0.00	$906.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$840.54	$840.54	$0.00	$0.00	$236.01	$0.00	$0.00	$0.00	$0.00	$566.25	$896.94	$906.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.977	SUP	Custom 27803010		"224.977  -  5.5MM STAINLESS STEEL OFFSET CONNECTOR, 35MM"	BOTH IP/OP	"$1,132.50 "	$838.05	$0.00	$906.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$840.54	$840.54	$0.00	$0.00	$236.01	$0.00	$0.00	$0.00	$0.00	$566.25	$896.94	$906.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.98	SUP	Custom 27803010		"224.980  -  STAINLESS STEEL IN-LINE CONNECTOR, 5.5MM TO 5.5MM"	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$0.00	$0.00	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.99	SUP	Custom 27803010		"224.990  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 15MM"	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$0.00	$0.00	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.991	SUP	Custom 27803010		"224.991  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 20MM"	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$0.00	$0.00	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.992	SUP	Custom 27803010		"224.992  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 25MM"	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$0.00	$0.00	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.993	SUP	Custom 27803010		"224.993  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 30MM"	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$0.00	$0.00	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.994	SUP	Custom 27803010		"224.994  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 35MM"	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$0.00	$0.00	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.995	SUP	Custom 27803010		"224.995  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 100MM"	BOTH IP/OP	"$1,450.00 "	"$1,073.00"	$0.00	"$1,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,076.19"	"$1,076.19"	$0.00	$0.00	$302.18	$0.00	$0.00	$0.00	$0.00	$725.00	"$1,148.40"	"$1,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.996	SUP	Custom 27803010		"224.996  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 120MM"	BOTH IP/OP	"$1,450.00 "	"$1,073.00"	$0.00	"$1,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,076.19"	"$1,076.19"	$0.00	$0.00	$302.18	$0.00	$0.00	$0.00	$0.00	$725.00	"$1,148.40"	"$1,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.997	SUP	Custom 27803010		"224.997  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 150MM"	BOTH IP/OP	"$1,450.00 "	"$1,073.00"	$0.00	"$1,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,076.19"	"$1,076.19"	$0.00	$0.00	$302.18	$0.00	$0.00	$0.00	$0.00	$725.00	"$1,148.40"	"$1,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
225.007	SUP	HCPCS C1713		225.007  -  PLATE BRD 90MM SS 3.5MM SCR 7 HOLE LC DCP BONE ORTH NONSTRL	BOTH IP/OP	$377.43 	$279.30	$0.00	$301.94	$169.84	$169.84	$0.00	$0.00	$0.00	$78.66	$280.12	$280.12	$0.00	$0.00	$78.66	$0.00	$223.25	$223.25	$0.00	$188.71	$298.92	$301.94	$0.00		$0.00	$59.07	$0.00	$0.00	$60.09	$0.00	$0.00	$0.00	$0.00	$0.00
225.008	SUP	HCPCS C1713		225.008  -  PLATE BRD 103MM SS 3.5MM SCR 8 HOLE LC DCP BONE ORTH NONSTRL	BOTH IP/OP	$393.73 	$291.36	$0.00	$314.98	$177.18	$177.18	$0.00	$0.00	$0.00	$82.06	$292.22	$292.22	$0.00	$0.00	$82.05	$0.00	$232.89	$232.89	$0.00	$196.86	$311.83	$314.98	$0.00		$0.00	$61.62	$0.00	$0.00	$62.68	$0.00	$0.00	$0.00	$0.00	$0.00
225.009	SUP	HCPCS C1713		225.009  -  PLATE BRD SS 3.5MM SCR 9 HOLE LCP BONE ORTH NONSTRL	BOTH IP/OP	$412.38 	$305.16	$0.00	$329.90	$185.57	$185.57	$0.00	$0.00	$0.00	$85.95	$306.06	$306.06	$0.00	$0.00	$85.94	$0.00	$243.92	$243.92	$0.00	$206.19	$326.60	$329.90	$0.00		$0.00	$64.54	$0.00	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$0.00
225.01	SUP	HCPCS C1713		225.010  -  PLATE BRD 129MM SS 3.5MM SCR 10 HOLE LC DCP BONE ORTH	BOTH IP/OP	$417.05 	$308.62	$0.00	$333.64	$187.67	$187.67	$0.00	$0.00	$0.00	$86.92	$309.53	$309.53	$0.00	$0.00	$86.91	$0.00	$246.69	$246.69	$0.00	$208.53	$330.30	$333.64	$0.00		$0.00	$65.27	$0.00	$0.00	$66.39	$0.00	$0.00	$0.00	$0.00	$0.00
225.011	SUP	HCPCS C1713		225.011  -  PLATE BRD 142MM SS 3.5MM SCR 11 HOLE LC DCP BONE ORTH	BOTH IP/OP	$435.70 	$322.42	$0.00	$348.56	$196.07	$196.07	$0.00	$0.00	$0.00	$90.81	$323.38	$323.38	$0.00	$0.00	$90.80	$0.00	$257.72	$257.72	$0.00	$217.85	$345.07	$348.56	$0.00		$0.00	$68.19	$0.00	$0.00	$69.36	$0.00	$0.00	$0.00	$0.00	$0.00
225.012	SUP	HCPCS C1713		225.012  -  PLATE BRD 155MM SS 3.5MM SCR 12 HOLE LC DCP BONE ORTH	BOTH IP/OP	$465.95 	$344.80	$0.00	$372.76	$209.68	$209.68	$0.00	$0.00	$0.00	$97.12	$345.83	$345.83	$0.00	$0.00	$97.10	$0.00	$275.61	$275.61	$0.00	$232.98	$369.03	$372.76	$0.00		$0.00	$72.92	$0.00	$0.00	$74.18	$0.00	$0.00	$0.00	$0.00	$0.00
225.013	SUP	HCPCS C1713		225.013  -  PLATE BRD 168MM SS 3.5MM SCR 13 HOLE LC DCP BONE ORTH	BOTH IP/OP	$628.05 	$464.76	$0.00	$502.44	$282.62	$282.62	$0.00	$0.00	$0.00	$130.90	$466.14	$466.14	$0.00	$0.00	$130.89	$0.00	$371.49	$371.49	$0.00	$314.03	$497.42	$502.44	$0.00		$0.00	$98.29	$0.00	$0.00	$99.99	$0.00	$0.00	$0.00	$0.00	$0.00
225.014	SUP	HCPCS C1713		225.014  -  PLATE BRD 181MM SS 3.5MM SCR 14 HOLE LC DCP BONE RIGHT	BOTH IP/OP	$709.28 	$524.87	$0.00	$567.42	$319.17	$319.17	$0.00	$0.00	$0.00	$147.83	$526.42	$526.42	$0.00	$0.00	$147.81	$0.00	$419.54	$419.54	$0.00	$354.64	$561.75	$567.42	$0.00		$0.00	$111.00	$0.00	$0.00	$112.92	$0.00	$0.00	$0.00	$0.00	$0.00
225.015	SUP	HCPCS C1713		225.015  -  PLATE BRD 194MM SS 3.5MM SCR 15 HOLE LC DCP BONE ORTH	BOTH IP/OP	$788.35 	$583.38	$0.00	$630.68	$354.76	$354.76	$0.00	$0.00	$0.00	$164.31	$585.11	$585.11	$0.00	$0.00	$164.29	$0.00	$466.31	$466.31	$0.00	$394.18	$624.37	$630.68	$0.00		$0.00	$123.38	$0.00	$0.00	$125.51	$0.00	$0.00	$0.00	$0.00	$0.00
225.016	SUP	HCPCS C1713		225.016  -  PLATE BRD 207MM SS 3.5MM SCR 16 HOLE LC DCP BONE ORTH	BOTH IP/OP	$869.60 	$643.50	$0.00	$695.68	$391.32	$391.32	$0.00	$0.00	$0.00	$181.25	$645.42	$645.42	$0.00	$0.00	$181.22	$0.00	$514.37	$514.37	$0.00	$434.80	$688.72	$695.68	$0.00		$0.00	$136.09	$0.00	$0.00	$138.44	$0.00	$0.00	$0.00	$0.00	$0.00
225.017	SUP	HCPCS C1713		225.017  -  PLATE BRD 220MM SS 3.5MM SCR 17 HOLE LC DCP BONE ORTH	BOTH IP/OP	$948.65 	$702.00	$0.00	$758.92	$426.89	$426.89	$0.00	$0.00	$0.00	$197.72	$704.09	$704.09	$0.00	$0.00	$197.70	$0.00	$561.13	$561.13	$0.00	$474.33	$751.33	$758.92	$0.00		$0.00	$148.46	$0.00	$0.00	$151.03	$0.00	$0.00	$0.00	$0.00	$0.00
225.018	SUP	HCPCS C1713		225.018  -  PLATE BRD 233MM SS 3.5MM SCR 18 HOLE LC DCP BONE ORTH	BOTH IP/OP	"$1,029.90 "	$762.13	$0.00	$823.92	$463.46	$463.46	$0.00	$0.00	$0.00	$214.66	$764.39	$764.39	$0.00	$0.00	$214.63	$0.00	$609.19	$609.19	$0.00	$514.95	$815.68	$823.92	$0.00		$0.00	$161.18	$0.00	$0.00	$163.96	$0.00	$0.00	$0.00	$0.00	$0.00
225.02	SUP	HCPCS C1713		225.020  -  PLATE BRD 259MM SS 3.5MM SCR 20 HOLE LC DCP BONE ORTH	BOTH IP/OP	"$1,169.53 "	$865.45	$0.00	$935.62	$526.29	$526.29	$0.00	$0.00	$0.00	$243.76	$868.02	$868.02	$0.00	$0.00	$243.73	$0.00	$691.77	$691.77	$0.00	$584.76	$926.27	$935.62	$0.00		$0.00	$183.03	$0.00	$0.00	$186.19	$0.00	$0.00	$0.00	$0.00	$0.00
225.022	SUP	HCPCS C1713		225.022  -  PLATE BRD 285MM SS 3.5MM SCR 22 HOLE LC DCP BONE ORTH	BOTH IP/OP	"$1,279.00 "	$946.46	$0.00	"$1,023.20"	$575.55	$575.55	$0.00	$0.00	$0.00	$266.58	$949.27	$949.27	$0.00	$0.00	$266.54	$0.00	$756.53	$756.53	$0.00	$639.50	"$1,012.97"	"$1,023.20"	$0.00		$0.00	$200.16	$0.00	$0.00	$203.62	$0.00	$0.00	$0.00	$0.00	$0.00
226.06	SUP	HCPCS C1713		226.06  -  PLATE BN BRD 103X16X4.8MM NS DCP 6 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$416.08 	$307.90	$0.00	$323.18	$181.79	$181.79	$0.00	$0.00	$0.00	$86.72	$308.81	$308.81	$0.00	$0.00	$86.71	$0.00	$246.11	$246.11	$0.00	$201.99	$319.95	$323.18	$0.00		$0.00	$61.38	$0.00	$0.00	$64.31	$0.00	$0.00	$0.00	$0.00	$0.00
226.07	SUP	HCPCS C1713		226.07  -  PLATE BN BRD 119X16X4.8MM NS DCP 7 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$427.33 	$316.22	$0.00	$331.90	$186.69	$186.69	$0.00	$0.00	$0.00	$89.07	$317.16	$317.16	$0.00	$0.00	$89.05	$0.00	$252.76	$252.76	$0.00	$207.44	$328.58	$331.90	$0.00		$0.00	$63.04	$0.00	$0.00	$66.05	$0.00	$0.00	$0.00	$0.00	$0.00
226.08	SUP	HCPCS C1713		226.08  -  PLATE BONE BROAD 135X16X4.8MM 8 HOLE DCP STAINLESS STEEL	BOTH IP/OP	$503.60 	$372.66	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$104.96	$373.77	$373.77	$0.00	$0.00	$104.95	$0.00	$297.88	$297.88	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
226.09	SUP	HCPCS C1713		226.09  -  PLATE BN BRD 151X16X4.8MM NS DCP 9 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$518.70 	$383.84	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
226.1	SUP	HCPCS C1713		226.10  -  PLATE BN BRD 167X16X4.8MM NS DCP 10 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$503.60 	$372.66	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$104.96	$373.77	$373.77	$0.00	$0.00	$104.95	$0.00	$297.88	$297.88	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
226.12	SUP	HCPCS C1713		226.12  -  PLATE BN BRD 199X16X4.8MM NS DCP 12 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
226.14	SUP	HCPCS C1713		226.14  -  PLATE BONE BROAD 231X16X4.8MM 14 HOLE DCP STAINLESS STEEL	BOTH IP/OP	$530.90 	$392.87	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$110.65	$394.03	$394.03	$0.00	$0.00	$110.64	$0.00	$314.03	$314.03	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
226.16	SUP	HCPCS C1713		226.16  -  PLATE BONE BROAD 4.5MM 263X16X4.8MM 16 HOLE DCP STAINLESS	BOTH IP/OP	$563.13 	$416.72	$0.00	$450.50	$253.41	$253.41	$0.00	$0.00	$0.00	$117.37	$417.95	$417.95	$0.00	$0.00	$117.36	$0.00	$333.09	$333.09	$0.00	$281.56	$446.00	$450.50	$0.00		$0.00	$88.13	$0.00	$0.00	$89.65	$0.00	$0.00	$0.00	$0.00	$0.00
226.2	SUP	HCPCS C1713		226.20  -  PLATE BN BRD 326X16X4.8MM NS DCP 20 HL SS 4.5MM SCR LG FRAG	BOTH IP/OP	$918.48 	$679.68	$0.00	$734.78	$413.31	$413.31	$0.00	$0.00	$0.00	$191.43	$681.69	$681.69	$0.00	$0.00	$191.41	$0.00	$543.28	$543.28	$0.00	$459.24	$727.44	$734.78	$0.00		$0.00	$139.55	$0.00	$0.00	$146.22	$0.00	$0.00	$0.00	$0.00	$0.00
226.22	SUP	HCPCS C1713		226.22  -  PLATE BONE BROAD 358MM 22 HOLE DCP STAINLESS STEEL	BOTH IP/OP	$968.58 	$716.75	$0.00	$774.86	$435.86	$435.86	$0.00	$0.00	$0.00	$201.88	$718.88	$718.88	$0.00	$0.00	$201.85	$0.00	$572.91	$572.91	$0.00	$484.29	$767.12	$774.86	$0.00		$0.00	$151.58	$0.00	$0.00	$154.20	$0.00	$0.00	$0.00	$0.00	$0.00
226.24	SUP	HCPCS C1713		226.24  -  PLATE BONE BROAD 390MM 24 HOLE DCP STAINLESS STEEL	BOTH IP/OP	"$1,037.48 "	$767.74	$0.00	$829.98	$466.86	$466.86	$0.00	$0.00	$0.00	$216.24	$770.01	$770.01	$0.00	$0.00	$216.21	$0.00	$613.67	$613.67	$0.00	$518.74	$821.68	$829.98	$0.00		$0.00	$162.36	$0.00	$0.00	$165.17	$0.00	$0.00	$0.00	$0.00	$0.00
226.56	SUP	HCPCS C1713		226.56  -  PLATE BN BRD 106X17.5X5.2MM NS LC DCP 6 HL SS 4.5MM SCR LG	BOTH IP/OP	$489.18 	$361.99	$0.00	$379.94	$213.72	$213.72	$0.00	$0.00	$0.00	$101.96	$363.07	$363.07	$0.00	$0.00	$101.94	$0.00	$289.35	$289.35	$0.00	$237.46	$376.14	$379.94	$0.00		$0.00	$72.16	$0.00	$0.00	$75.61	$0.00	$0.00	$0.00	$0.00	$0.00
226.561	SUP	HCPCS C1713		226.561  -  PLATE BN BRD 116X17.5X5.2MM NS LCP CMBN 6 HL LMT CNTCT TPR	BOTH IP/OP	$784.38 	$580.44	$0.00	$609.22	$342.69	$342.69	$0.00	$0.00	$0.00	$163.48	$582.16	$582.16	$0.00	$0.00	$163.46	$0.00	$463.96	$463.96	$0.00	$380.76	$603.13	$609.22	$0.00		$0.00	$115.71	$0.00	$0.00	$121.23	$0.00	$0.00	$0.00	$0.00	$0.00
226.57	SUP	HCPCS C1713		226.57  -  PLATE BN BRD 124X17.5X5.2MM NS LC DCP 7 HL SS 4.5MM SCR LG	BOTH IP/OP	$529.95 	$392.16	$0.00	$411.60	$231.53	$231.53	$0.00	$0.00	$0.00	$110.45	$393.33	$393.33	$0.00	$0.00	$110.44	$0.00	$313.47	$313.47	$0.00	$257.25	$407.48	$411.60	$0.00		$0.00	$78.18	$0.00	$0.00	$81.91	$0.00	$0.00	$0.00	$0.00	$0.00
226.571	SUP	HCPCS C1713		226.571  -  PLATE BN BRD 134MM NS LCP CMBN 7 HL SS 4.5MM SCR LG FRAG SET	BOTH IP/OP	$833.58 	$616.85	$0.00	$647.44	$364.19	$364.19	$0.00	$0.00	$0.00	$173.74	$618.68	$618.68	$0.00	$0.00	$173.72	$0.00	$493.06	$493.06	$0.00	$404.65	$640.97	$647.44	$0.00		$0.00	$122.97	$0.00	$0.00	$128.84	$0.00	$0.00	$0.00	$0.00	$0.00
226.58	SUP	HCPCS C1713		226.58  -  PLATE BN BRD 142X17.5X5.2MM NS LC DCP 8 HL SS 4.5MM SCR LG	BOTH IP/OP	$588.98 	$435.85	$0.00	$457.46	$257.32	$257.32	$0.00	$0.00	$0.00	$122.76	$437.14	$437.14	$0.00	$0.00	$122.74	$0.00	$348.38	$348.38	$0.00	$285.91	$452.89	$457.46	$0.00		$0.00	$86.88	$0.00	$0.00	$91.03	$0.00	$0.00	$0.00	$0.00	$0.00
226.581	SUP	HCPCS C1713		226.581  -  PLATE BN BRD 152MM NS LCP CMBN 8 HL SS 4.5MM SCR LG FRAG SET	BOTH IP/OP	"$1,019.13 "	$754.16	$0.00	$791.56	$445.25	$445.25	$0.00	$0.00	$0.00	$212.41	$756.39	$756.39	$0.00	$0.00	$212.39	$0.00	$602.81	$602.81	$0.00	$494.73	$783.64	$791.56	$0.00		$0.00	$150.34	$0.00	$0.00	$157.52	$0.00	$0.00	$0.00	$0.00	$0.00
226.59	SUP	HCPCS C1713		226.59  -  PLATE BN BRD 160X17.5X5.2MM NS LC DCP 9 HL SS 4.5MM SCR LG	BOTH IP/OP	$588.98 	$435.85	$0.00	$457.46	$257.32	$257.32	$0.00	$0.00	$0.00	$122.76	$437.14	$437.14	$0.00	$0.00	$122.74	$0.00	$348.38	$348.38	$0.00	$285.91	$452.89	$457.46	$0.00		$0.00	$86.88	$0.00	$0.00	$91.03	$0.00	$0.00	$0.00	$0.00	$0.00
226.591	SUP	HCPCS C1713		226.591  -  PLATE BN BRD 170X17.5X5.2MM NS LCP CMBN 9 HL LMT CNTCT TPR	BOTH IP/OP	"$1,102.08 "	$815.54	$0.00	$855.98	$481.49	$481.49	$0.00	$0.00	$0.00	$229.70	$817.96	$817.96	$0.00	$0.00	$229.67	$0.00	$651.88	$651.88	$0.00	$534.99	$847.42	$855.98	$0.00		$0.00	$162.57	$0.00	$0.00	$170.34	$0.00	$0.00	$0.00	$0.00	$0.00
226.6	SUP	HCPCS C1713		226.60  -  PLATE BN BRD 178X17.5X5.2MM NS LC DCP 10 HL SS 4.5MM SCR LG	BOTH IP/OP	$571.83 	$423.15	$0.00	$457.46	$257.32	$257.32	$0.00	$0.00	$0.00	$119.18	$424.41	$424.41	$0.00	$0.00	$119.17	$0.00	$338.23	$338.23	$0.00	$285.91	$452.89	$457.46	$0.00		$0.00	$86.88	$0.00	$0.00	$91.03	$0.00	$0.00	$0.00	$0.00	$0.00
226.601	SUP	HCPCS C1713		226.601  -  PLATE BN BRD 188X17.5X5.2MM NS LCP CMBN 10 HL LMT CNTCT TPR	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$920.38	$517.71	$517.71	$0.00	$0.00	$0.00	$246.98	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$700.93	$700.93	$0.00	$575.24	$911.18	$920.38	$0.00		$0.00	$174.81	$0.00	$0.00	$183.16	$0.00	$0.00	$0.00	$0.00	$0.00
226.61	SUP	HCPCS C1713		226.61  -  PLATE BN BRD 196X17.5X5.2MM NS LC DCP 11 HL SS 4.5MM SCR LG	BOTH IP/OP	$632.55 	$468.09	$0.00	$491.32	$276.37	$276.37	$0.00	$0.00	$0.00	$131.84	$469.48	$469.48	$0.00	$0.00	$131.82	$0.00	$374.15	$374.15	$0.00	$307.08	$486.41	$491.32	$0.00		$0.00	$93.31	$0.00	$0.00	$97.77	$0.00	$0.00	$0.00	$0.00	$0.00
226.611	SUP	HCPCS C1713		226.611  -  PLATE BN BRD 206X17.5X5.2MM NS LCP CMBN 11 HL LMT CNTCT TPR	BOTH IP/OP	"$1,262.30 "	$934.10	$0.00	$980.44	$551.50	$551.50	$0.00	$0.00	$0.00	$263.09	$936.88	$936.88	$0.00	$0.00	$263.06	$0.00	$746.65	$746.65	$0.00	$612.78	$970.64	$980.44	$0.00		$0.00	$186.21	$0.00	$0.00	$195.11	$0.00	$0.00	$0.00	$0.00	$0.00
226.62	SUP	HCPCS C1713		226.62  -  PLATE BN BRD 214X17.5X5.2MM NS LC DCP 12 HL SS 4.5MM SCR LG	BOTH IP/OP	$632.55 	$468.09	$0.00	$491.32	$276.37	$276.37	$0.00	$0.00	$0.00	$131.84	$469.48	$469.48	$0.00	$0.00	$131.82	$0.00	$374.15	$374.15	$0.00	$307.08	$486.41	$491.32	$0.00		$0.00	$93.31	$0.00	$0.00	$97.77	$0.00	$0.00	$0.00	$0.00	$0.00
226.621	SUP	HCPCS C1713		226.621  -  PLATE BN BRD 224X17.5X5.2MM NS LCP CMBN 12 HL LMT CNTCT TPR	BOTH IP/OP	"$1,339.63 "	$991.33	$0.00	"$1,040.48"	$585.27	$585.27	$0.00	$0.00	$0.00	$279.21	$994.27	$994.27	$0.00	$0.00	$279.18	$0.00	$792.39	$792.39	$0.00	$650.30	"$1,030.08"	"$1,040.48"	$0.00		$0.00	$197.62	$0.00	$0.00	$207.06	$0.00	$0.00	$0.00	$0.00	$0.00
226.622	SUP	HCPCS C1713		226.622  -  PLATE BN BRD CRV 229X17.5X5.2MM NS LCP CMBN 12 HL LMT CNTCT	BOTH IP/OP	"$1,339.63 "	$991.33	$0.00	"$1,040.48"	$585.27	$585.27	$0.00	$0.00	$0.00	$279.21	$994.27	$994.27	$0.00	$0.00	$279.18	$0.00	$792.39	$792.39	$0.00	$650.30	"$1,030.08"	"$1,040.48"	$0.00		$0.00	$197.62	$0.00	$0.00	$207.06	$0.00	$0.00	$0.00	$0.00	$0.00
226.632	SUP	HCPCS C1713		226.632  -  PLATE BONE BROAD CURVE 247MM 13 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$1,419.75 "	"$1,050.62"	$0.00	"$1,102.72"	$620.28	$620.28	$0.00	$0.00	$0.00	$295.91	"$1,053.74"	"$1,053.74"	$0.00	$0.00	$295.88	$0.00	$839.78	$839.78	$0.00	$689.20	"$1,091.69"	"$1,102.72"	$0.00		$0.00	$209.44	$0.00	$0.00	$219.44	$0.00	$0.00	$0.00	$0.00	$0.00
226.64	SUP	HCPCS C1713		226.64  -  PLATE BN BRD 250X17.5X5.2MM NS LC DCP 14 HL SS 4.5MM SCR LG	BOTH IP/OP	$632.55 	$468.09	$0.00	$491.32	$276.37	$276.37	$0.00	$0.00	$0.00	$131.84	$469.48	$469.48	$0.00	$0.00	$131.82	$0.00	$374.15	$374.15	$0.00	$307.08	$486.41	$491.32	$0.00		$0.00	$93.31	$0.00	$0.00	$97.77	$0.00	$0.00	$0.00	$0.00	$0.00
226.641	SUP	HCPCS C1713		226.641  -  PLATE BN BRD 260X17.5X5.2MM NS LCP CMBN 14 HL LMT CNTCT TPR	BOTH IP/OP	"$1,491.45 "	"$1,103.67"	$0.00	"$1,158.40"	$651.60	$651.60	$0.00	$0.00	$0.00	$310.86	"$1,106.95"	"$1,106.95"	$0.00	$0.00	$310.82	$0.00	$882.19	$882.19	$0.00	$724.00	"$1,146.82"	"$1,158.40"	$0.00		$0.00	$220.01	$0.00	$0.00	$230.52	$0.00	$0.00	$0.00	$0.00	$0.00
226.642	SUP	HCPCS C1713		226.642  -  PLATE BN BRD CRV 265X17.5X5.2MM NS LCP CMBN 14 HL LMT CNTCT	BOTH IP/OP	"$1,491.45 "	"$1,103.67"	$0.00	"$1,158.40"	$651.60	$651.60	$0.00	$0.00	$0.00	$310.86	"$1,106.95"	"$1,106.95"	$0.00	$0.00	$310.82	$0.00	$882.19	$882.19	$0.00	$724.00	"$1,146.82"	"$1,158.40"	$0.00		$0.00	$220.01	$0.00	$0.00	$230.52	$0.00	$0.00	$0.00	$0.00	$0.00
226.652	SUP	HCPCS C1713		226.652  -  PLATE BONE BROAD CURVE 282MM 15 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$1,655.90 "	"$1,225.37"	$0.00	"$1,286.14"	$723.45	$723.45	$0.00	$0.00	$0.00	$345.13	"$1,229.01"	"$1,229.01"	$0.00	$0.00	$345.09	$0.00	$979.46	$979.46	$0.00	$803.84	"$1,273.28"	"$1,286.14"	$0.00		$0.00	$244.27	$0.00	$0.00	$255.94	$0.00	$0.00	$0.00	$0.00	$0.00
226.66	SUP	HCPCS C1713		226.66  -  PLATE BN BRD 286X17.5X5.2MM NS LC DCP 16 HL SS 4.5MM SCR LG	BOTH IP/OP	$718.30 	$531.54	$0.00	$557.90	$313.82	$313.82	$0.00	$0.00	$0.00	$149.71	$533.12	$533.12	$0.00	$0.00	$149.69	$0.00	$424.87	$424.87	$0.00	$348.69	$552.32	$557.90	$0.00		$0.00	$105.96	$0.00	$0.00	$111.02	$0.00	$0.00	$0.00	$0.00	$0.00
226.661	SUP	HCPCS C1713		226.661  -  PLATE BN BRD 296X17.5X5.2MM NS LCP CMBN 16 HL LMT CNTCT TPR	BOTH IP/OP	"$1,811.95 "	"$1,340.84"	$0.00	"$1,407.34"	$791.63	$791.63	$0.00	$0.00	$0.00	$377.66	"$1,344.83"	"$1,344.83"	$0.00	$0.00	$377.61	$0.00	"$1,071.77"	"$1,071.77"	$0.00	$879.59	"$1,393.27"	"$1,407.34"	$0.00		$0.00	$267.29	$0.00	$0.00	$280.06	$0.00	$0.00	$0.00	$0.00	$0.00
226.662	SUP	HCPCS C1713		226.662  -  PLATE BN BRD CRV 300X17.5X5.2MM NS LCP CMBN 16 HL LMT CNTCT	BOTH IP/OP	"$1,811.95 "	"$1,340.84"	$0.00	"$1,407.34"	$791.63	$791.63	$0.00	$0.00	$0.00	$377.66	"$1,344.83"	"$1,344.83"	$0.00	$0.00	$377.61	$0.00	"$1,071.77"	"$1,071.77"	$0.00	$879.59	"$1,393.27"	"$1,407.34"	$0.00		$0.00	$267.29	$0.00	$0.00	$280.06	$0.00	$0.00	$0.00	$0.00	$0.00
226.672	SUP	HCPCS C1713		226.672  -  PLATE BONE BROAD CURVE 318MM 17 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$1,897.68 "	"$1,404.28"	$0.00	"$1,473.94"	$829.09	$829.09	$0.00	$0.00	$0.00	$395.52	"$1,408.45"	"$1,408.45"	$0.00	$0.00	$395.48	$0.00	"$1,122.47"	"$1,122.47"	$0.00	$921.21	"$1,459.20"	"$1,473.94"	$0.00		$0.00	$279.94	$0.00	$0.00	$293.31	$0.00	$0.00	$0.00	$0.00	$0.00
226.68	SUP	HCPCS C1713		226.68  -  PLATE BN BRD 332X17.5X5.2MM NS LC DCP 18 HL SS 4.5MM SCR LG	BOTH IP/OP	$788.83 	$583.73	$0.00	$631.06	$354.97	$354.97	$0.00	$0.00	$0.00	$164.41	$585.47	$585.47	$0.00	$0.00	$164.39	$0.00	$466.59	$466.59	$0.00	$394.41	$624.75	$631.06	$0.00		$0.00	$119.86	$0.00	$0.00	$125.58	$0.00	$0.00	$0.00	$0.00	$0.00
226.681	SUP	HCPCS C1713		226.681  -  PLATE BONE BROAD 332X17.5X5.2MM 18 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$2,204.13 "	"$1,631.06"	$0.00	"$1,711.94"	$962.97	$962.97	$0.00	$0.00	$0.00	$459.39	"$1,635.90"	"$1,635.90"	$0.00	$0.00	$459.34	$0.00	"$1,303.74"	"$1,303.74"	$0.00	"$1,069.96"	"$1,694.82"	"$1,711.94"	$0.00		$0.00	$325.14	$0.00	$0.00	$340.68	$0.00	$0.00	$0.00	$0.00	$0.00
226.682	SUP	HCPCS C1713		226.682  -  PLATE BN BRD CRV 336X17.5X5.2MM NS LCP CMBN 18 HL LMT CNTCT	BOTH IP/OP	"$2,067.78 "	"$1,530.16"	$0.00	"$1,606.04"	$903.40	$903.40	$0.00	$0.00	$0.00	$430.98	"$1,534.70"	"$1,534.70"	$0.00	$0.00	$430.92	$0.00	"$1,223.09"	"$1,223.09"	$0.00	"$1,003.78"	"$1,589.98"	"$1,606.04"	$0.00		$0.00	$305.03	$0.00	$0.00	$319.60	$0.00	$0.00	$0.00	$0.00	$0.00
226.7	SUP	HCPCS C1713		226.70  -  PLATE BONE BROAD 358X17.5X5.2MM 20 HOLE LC-DCP STAINLESS	BOTH IP/OP	"$1,155.95 "	$855.40	$0.00	$924.76	$520.18	$520.18	$0.00	$0.00	$0.00	$240.93	$857.95	$857.95	$0.00	$0.00	$240.90	$0.00	$683.74	$683.74	$0.00	$577.98	$915.51	$924.76	$0.00		$0.00	$175.64	$0.00	$0.00	$184.03	$0.00	$0.00	$0.00	$0.00	$0.00
226.701	SUP	HCPCS C1713		226.701  -  PLATE BONE BROAD 368MM 20 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$2,436.08 "	"$1,802.70"	$0.00	"$1,892.08"	"$1,064.30"	"$1,064.30"	$0.00	$0.00	$0.00	$507.74	"$1,808.05"	"$1,808.05"	$0.00	$0.00	$507.68	$0.00	"$1,440.94"	"$1,440.94"	$0.00	"$1,182.55"	"$1,873.16"	"$1,892.08"	$0.00		$0.00	$359.36	$0.00	$0.00	$376.52	$0.00	$0.00	$0.00	$0.00	$0.00
226.72	SUP	HCPCS C1713		226.72  -  PLATE BONE BROAD 394X17.5X5.2MM 22 HOLE LC-DCP STAINLESS	BOTH IP/OP	"$1,209.73 "	$895.20	$0.00	$967.78	$544.38	$544.38	$0.00	$0.00	$0.00	$252.14	$897.86	$897.86	$0.00	$0.00	$252.11	$0.00	$715.55	$715.55	$0.00	$604.86	$958.11	$967.78	$0.00		$0.00	$189.32	$0.00	$0.00	$192.59	$0.00	$0.00	$0.00	$0.00	$0.00
226.721	SUP	HCPCS C1713		226.721  -  PLATE BONE BROAD 404MM 22 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$2,669.40 "	"$1,975.36"	$0.00	"$2,073.32"	"$1,166.24"	"$1,166.24"	$0.00	$0.00	$0.00	$556.37	"$1,981.23"	"$1,981.23"	$0.00	$0.00	$556.30	$0.00	"$1,316.01"	"$1,316.01"	$0.00	"$1,295.83"	"$2,052.59"	"$2,073.32"	$0.00		$0.00	$393.78	$0.00	$0.00	$412.59	$0.00	$0.00	$0.00	$0.00	$0.00
227.11	SUP	HCPCS C1713		227.11  -  PLATE BONE BROAD 179MM 10 HOLE STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$695.63 	$514.77	$0.00	$556.50	$313.03	$313.03	$0.00	$0.00	$0.00	$144.99	$516.29	$516.29	$0.00	$0.00	$144.97	$0.00	$411.46	$411.46	$0.00	$347.81	$550.94	$556.50	$0.00		$0.00	$108.87	$0.00	$0.00	$110.74	$0.00	$0.00	$0.00	$0.00	$0.00
227.13	SUP	HCPCS C1713		227.13  -  PLATE BONE BROAD 199MM 10 HOLE STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$777.78 	$575.56	$0.00	$622.22	$350.00	$350.00	$0.00	$0.00	$0.00	$162.11	$577.26	$577.26	$0.00	$0.00	$162.09	$0.00	$460.05	$460.05	$0.00	$388.89	$616.00	$622.22	$0.00		$0.00	$121.72	$0.00	$0.00	$123.82	$0.00	$0.00	$0.00	$0.00	$0.00
227.14	SUP	HCPCS C1713		227.14  -  PLATE BONE BROAD 209MM 10 HOLE STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$777.78 	$575.56	$0.00	$622.22	$350.00	$350.00	$0.00	$0.00	$0.00	$162.11	$577.26	$577.26	$0.00	$0.00	$162.09	$0.00	$460.05	$460.05	$0.00	$388.89	$616.00	$622.22	$0.00		$0.00	$121.72	$0.00	$0.00	$123.82	$0.00	$0.00	$0.00	$0.00	$0.00
227.18	SUP	HCPCS C1713		227.18  -  PLATE BONE BROAD 249MM 10 HOLE STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$809.58 	$599.09	$0.00	$647.66	$364.31	$364.31	$0.00	$0.00	$0.00	$168.74	$600.87	$600.87	$0.00	$0.00	$168.72	$0.00	$478.86	$478.86	$0.00	$404.79	$641.19	$647.66	$0.00		$0.00	$126.70	$0.00	$0.00	$128.88	$0.00	$0.00	$0.00	$0.00	$0.00
227.81	SUP	HCPCS C1713		227.81  -  PLATE BONE BROAD 135MM 8 HOLE STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$674.43 	$499.08	$0.00	$539.54	$303.49	$303.49	$0.00	$0.00	$0.00	$140.57	$500.56	$500.56	$0.00	$0.00	$140.55	$0.00	$398.92	$398.92	$0.00	$337.21	$534.15	$539.54	$0.00		$0.00	$105.55	$0.00	$0.00	$107.37	$0.00	$0.00	$0.00	$0.00	$0.00
227.83	SUP	HCPCS C1713		227.83  -  PLATE BONE BROAD 155MM 8 HOLE STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$674.43 	$499.08	$0.00	$539.54	$303.49	$303.49	$0.00	$0.00	$0.00	$140.57	$500.56	$500.56	$0.00	$0.00	$140.55	$0.00	$398.92	$398.92	$0.00	$337.21	$534.15	$539.54	$0.00		$0.00	$105.55	$0.00	$0.00	$107.37	$0.00	$0.00	$0.00	$0.00	$0.00
227.84	SUP	HCPCS C1713		227.84  -  PLATE BONE BROAD 185MM 8 HOLE STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$674.43 	$499.08	$0.00	$539.54	$303.49	$303.49	$0.00	$0.00	$0.00	$140.57	$500.56	$500.56	$0.00	$0.00	$140.55	$0.00	$398.92	$398.92	$0.00	$337.21	$534.15	$539.54	$0.00		$0.00	$105.55	$0.00	$0.00	$107.37	$0.00	$0.00	$0.00	$0.00	$0.00
228.85	SUP	HCPCS C1713		228.85  -  PLATE BONE NARROW 175MM 8 HOLE STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$502.18 	$371.61	$0.00	$401.74	$225.98	$225.98	$0.00	$0.00	$0.00	$104.67	$372.71	$372.71	$0.00	$0.00	$104.65	$0.00	$297.04	$297.04	$0.00	$251.09	$397.73	$401.74	$0.00		$0.00	$78.59	$0.00	$0.00	$79.95	$0.00	$0.00	$0.00	$0.00	$0.00
229.33	SUP	HCPCS C1713		229.33  -  PLATE BN STRG 45X12X3MM NS LC DCP 3 HL RECON SS 4.5MM CORT	BOTH IP/OP	$671.93 	$497.23	$0.00	$521.88	$293.56	$293.56	$0.00	$0.00	$0.00	$140.05	$498.70	$498.70	$0.00	$0.00	$140.03	$0.00	$397.44	$397.44	$0.00	$326.18	$516.66	$521.88	$0.00		$0.00	$99.12	$0.00	$0.00	$103.85	$0.00	$0.00	$0.00	$0.00	$0.00
229.331	SUP	HCPCS C1713		229.331  -  PLATE BONE 56MM 3 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	$802.65 	$593.96	$0.00	$623.42	$350.67	$350.67	$0.00	$0.00	$0.00	$167.29	$595.73	$595.73	$0.00	$0.00	$167.27	$0.00	$474.77	$474.77	$0.00	$389.64	$617.19	$623.42	$0.00		$0.00	$118.40	$0.00	$0.00	$124.06	$0.00	$0.00	$0.00	$0.00	$0.00
229.34	SUP	HCPCS C1713		229.34  -  PLATE BN STRG 61X12X3MM NS LC DCP 4 HL RECON SS 4.5MM CORT	BOTH IP/OP	$700.03 	$518.02	$0.00	$543.72	$305.84	$305.84	$0.00	$0.00	$0.00	$145.90	$519.56	$519.56	$0.00	$0.00	$145.89	$0.00	$414.06	$414.06	$0.00	$339.83	$538.28	$543.72	$0.00		$0.00	$103.27	$0.00	$0.00	$108.20	$0.00	$0.00	$0.00	$0.00	$0.00
229.341	SUP	HCPCS C1713		229.341  -  PLATE BONE 75MM 4 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	$840.60 	$622.04	$0.00	$652.90	$367.26	$367.26	$0.00	$0.00	$0.00	$175.20	$623.89	$623.89	$0.00	$0.00	$175.18	$0.00	$497.21	$497.21	$0.00	$408.06	$646.37	$652.90	$0.00		$0.00	$124.00	$0.00	$0.00	$129.93	$0.00	$0.00	$0.00	$0.00	$0.00
229.35	SUP	HCPCS C1713		229.35  -  PLATE BONE STR 77X12X3MM 5 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	$761.88 	$563.79	$0.00	$591.76	$332.87	$332.87	$0.00	$0.00	$0.00	$158.79	$565.46	$565.46	$0.00	$0.00	$158.77	$0.00	$450.65	$450.65	$0.00	$369.85	$585.84	$591.76	$0.00		$0.00	$112.39	$0.00	$0.00	$117.76	$0.00	$0.00	$0.00	$0.00	$0.00
229.351	SUP	HCPCS C1713		229.351  -  PLATE BONE 94MM 5 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	$908.08 	$671.98	$0.00	$705.30	$396.73	$396.73	$0.00	$0.00	$0.00	$189.27	$673.97	$673.97	$0.00	$0.00	$189.24	$0.00	$537.13	$537.13	$0.00	$440.81	$698.25	$705.30	$0.00		$0.00	$133.96	$0.00	$0.00	$140.35	$0.00	$0.00	$0.00	$0.00	$0.00
229.36	SUP	HCPCS C1713		229.36  -  PLATE BN 93X12X3MM NS LC DCP 6 HL RECON SS 4.5MM SCR	BOTH IP/OP	$808.28 	$598.13	$0.00	$627.78	$353.13	$353.13	$0.00	$0.00	$0.00	$168.46	$599.90	$599.90	$0.00	$0.00	$168.44	$0.00	$478.09	$478.09	$0.00	$392.36	$621.51	$627.78	$0.00		$0.00	$119.23	$0.00	$0.00	$124.93	$0.00	$0.00	$0.00	$0.00	$0.00
229.361	SUP	HCPCS C1713		229.361  -  PLATE BONE 113MM 6 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	$969.93 	$717.75	$0.00	$753.34	$423.75	$423.75	$0.00	$0.00	$0.00	$202.16	$719.88	$719.88	$0.00	$0.00	$202.13	$0.00	$573.71	$573.71	$0.00	$470.84	$745.81	$753.34	$0.00		$0.00	$143.08	$0.00	$0.00	$149.91	$0.00	$0.00	$0.00	$0.00	$0.00
229.37	SUP	HCPCS C1713		229.37  -  PLATE BONE STR 109X12X3MM 7 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	$844.83 	$625.17	$0.00	$656.18	$369.10	$369.10	$0.00	$0.00	$0.00	$176.08	$627.03	$627.03	$0.00	$0.00	$176.06	$0.00	$499.71	$499.71	$0.00	$410.11	$649.62	$656.18	$0.00		$0.00	$124.62	$0.00	$0.00	$130.58	$0.00	$0.00	$0.00	$0.00	$0.00
229.371	SUP	HCPCS C1713		229.371  -  PLATE BONE 132MM 7 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	"$1,014.90 "	$751.03	$0.00	$788.28	$443.41	$443.41	$0.00	$0.00	$0.00	$211.53	$753.26	$753.26	$0.00	$0.00	$211.51	$0.00	$600.31	$600.31	$0.00	$492.68	$780.40	$788.28	$0.00		$0.00	$149.72	$0.00	$0.00	$156.87	$0.00	$0.00	$0.00	$0.00	$0.00
229.38	SUP	HCPCS C1713		229.38  -  PLATE BN STRG 125X12X3MM NS LC DCP 8 HL RECON SS 4.5MM CORT	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
229.381	SUP	HCPCS C1713		229.381  -  PLATE BONE 151MM 8 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	"$1,066.93 "	$789.53	$0.00	$828.68	$466.13	$466.13	$0.00	$0.00	$0.00	$222.37	$791.87	$791.87	$0.00	$0.00	$222.35	$0.00	$631.09	$631.09	$0.00	$517.93	$820.39	$828.68	$0.00		$0.00	$157.39	$0.00	$0.00	$164.91	$0.00	$0.00	$0.00	$0.00	$0.00
229.39	SUP	HCPCS C1713		229.39  -  PLATE BONE STR 141X12X3MM 9 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	$954.48 	$706.32	$0.00	$741.34	$417.00	$417.00	$0.00	$0.00	$0.00	$198.94	$708.41	$708.41	$0.00	$0.00	$198.91	$0.00	$564.57	$564.57	$0.00	$463.34	$733.93	$741.34	$0.00		$0.00	$140.80	$0.00	$0.00	$147.53	$0.00	$0.00	$0.00	$0.00	$0.00
229.391	SUP	HCPCS C1713		229.391  -  PLATE BONE 170MM 9 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	"$1,142.83 "	$845.69	$0.00	$887.64	$499.30	$499.30	$0.00	$0.00	$0.00	$238.19	$848.20	$848.20	$0.00	$0.00	$238.16	$0.00	$675.98	$675.98	$0.00	$554.78	$878.76	$887.64	$0.00		$0.00	$168.59	$0.00	$0.00	$176.64	$0.00	$0.00	$0.00	$0.00	$0.00
229.4	SUP	HCPCS C1713		229.40  -  PLATE BN 157MM NS LC DCP 10 HL RECON 4.5MM SCR	BOTH IP/OP	$970.33 	$718.04	$0.00	$776.26	$436.65	$436.65	$0.00	$0.00	$0.00	$202.24	$720.18	$720.18	$0.00	$0.00	$202.22	$0.00	$573.95	$573.95	$0.00	$485.16	$768.50	$776.26	$0.00		$0.00	$147.43	$0.00	$0.00	$154.48	$0.00	$0.00	$0.00	$0.00	$0.00
229.401	SUP	HCPCS C1713		229.401  -  PLATE BONE 189MM 10 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	"$1,197.65 "	$886.26	$0.00	$930.22	$523.25	$523.25	$0.00	$0.00	$0.00	$249.62	$888.90	$888.90	$0.00	$0.00	$249.59	$0.00	$708.41	$708.41	$0.00	$581.39	$920.92	$930.22	$0.00		$0.00	$176.67	$0.00	$0.00	$185.11	$0.00	$0.00	$0.00	$0.00	$0.00
229.41	SUP	HCPCS C1713		229.41  -  PLATE BONE 173MM 11 HOLE STR RECONSTRUCTION LC-DCP DCP	BOTH IP/OP	"$1,034.60 "	$765.60	$0.00	$803.56	$452.00	$452.00	$0.00	$0.00	$0.00	$215.64	$767.88	$767.88	$0.00	$0.00	$215.61	$0.00	$611.97	$611.97	$0.00	$502.23	$795.52	$803.56	$0.00		$0.00	$152.62	$0.00	$0.00	$159.91	$0.00	$0.00	$0.00	$0.00	$0.00
229.411	SUP	HCPCS C1713		229.411  -  PLATE BONE 208MM 11 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	"$1,237.00 "	$915.38	$0.00	$960.78	$540.44	$540.44	$0.00	$0.00	$0.00	$257.82	$918.10	$918.10	$0.00	$0.00	$257.79	$0.00	$731.69	$731.69	$0.00	$600.49	$951.18	$960.78	$0.00		$0.00	$182.48	$0.00	$0.00	$191.20	$0.00	$0.00	$0.00	$0.00	$0.00
229.42	SUP	HCPCS C1713		229.42  -  PLATE BONE STR 189X12X3MM 12 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	"$1,082.38 "	$800.96	$0.00	$840.68	$472.88	$472.88	$0.00	$0.00	$0.00	$225.59	$803.34	$803.34	$0.00	$0.00	$225.57	$0.00	$640.22	$640.22	$0.00	$525.43	$832.27	$840.68	$0.00		$0.00	$159.67	$0.00	$0.00	$167.30	$0.00	$0.00	$0.00	$0.00	$0.00
229.421	SUP	HCPCS C1713		229.421  -  PLATE BONE 227MM 12 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	"$1,296.05 "	$959.08	$0.00	"$1,006.64"	$566.24	$566.24	$0.00	$0.00	$0.00	$270.13	$961.93	$961.93	$0.00	$0.00	$270.10	$0.00	$766.61	$766.61	$0.00	$629.15	$996.57	"$1,006.64"	$0.00		$0.00	$191.19	$0.00	$0.00	$200.32	$0.00	$0.00	$0.00	$0.00	$0.00
229.43	SUP	HCPCS C1713		229.43  -  PLATE BONE STR 205X12X3MM 13 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	"$1,152.68 "	$852.98	$0.00	$895.28	$503.60	$503.60	$0.00	$0.00	$0.00	$240.25	$855.52	$855.52	$0.00	$0.00	$240.22	$0.00	$681.81	$681.81	$0.00	$559.55	$886.33	$895.28	$0.00		$0.00	$170.04	$0.00	$0.00	$178.16	$0.00	$0.00	$0.00	$0.00	$0.00
229.431	SUP	HCPCS C1713		229.431  -  PLATE BONE 246MM 13 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	"$1,378.98 "	"$1,020.45"	$0.00	"$1,071.06"	$602.47	$602.47	$0.00	$0.00	$0.00	$287.41	"$1,023.48"	"$1,023.48"	$0.00	$0.00	$287.38	$0.00	$815.66	$815.66	$0.00	$669.41	"$1,060.35"	"$1,071.06"	$0.00		$0.00	$203.42	$0.00	$0.00	$213.14	$0.00	$0.00	$0.00	$0.00	$0.00
229.44	SUP	HCPCS C1713		229.44  -  PLATE BONE 221MM 14 HOLE RECONSTRUCTION DCP LC-DCP STAINLESS	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$920.38	$517.71	$517.71	$0.00	$0.00	$0.00	$246.98	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$700.93	$700.93	$0.00	$575.24	$911.18	$920.38	$0.00		$0.00	$174.81	$0.00	$0.00	$183.16	$0.00	$0.00	$0.00	$0.00	$0.00
229.441	SUP	HCPCS C1713		229.441  -  PLATE BONE 265MM 14 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	"$1,416.95 "	"$1,048.54"	$0.00	"$1,100.54"	$619.05	$619.05	$0.00	$0.00	$0.00	$295.33	"$1,051.66"	"$1,051.66"	$0.00	$0.00	$295.29	$0.00	$838.13	$838.13	$0.00	$687.84	"$1,089.54"	"$1,100.54"	$0.00		$0.00	$209.02	$0.00	$0.00	$219.01	$0.00	$0.00	$0.00	$0.00	$0.00
229.451	SUP	HCPCS C1713		229.451  -  PLATE BONE 284MM 15 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	"$1,475.98 "	"$1,092.23"	$0.00	"$1,146.40"	$644.85	$644.85	$0.00	$0.00	$0.00	$307.63	"$1,095.47"	"$1,095.47"	$0.00	$0.00	$307.59	$0.00	$873.04	$873.04	$0.00	$716.50	"$1,134.94"	"$1,146.40"	$0.00		$0.00	$217.73	$0.00	$0.00	$228.13	$0.00	$0.00	$0.00	$0.00	$0.00
229.461	SUP	HCPCS C1713		229.461  -  PLATE BONE 303MM 16 HOLE STR RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	"$1,515.33 "	"$1,121.34"	$0.00	"$1,176.96"	$662.04	$662.04	$0.00	$0.00	$0.00	$315.83	"$1,124.67"	"$1,124.67"	$0.00	$0.00	$315.79	$0.00	$896.31	$896.31	$0.00	$735.60	"$1,165.19"	"$1,176.96"	$0.00		$0.00	$223.54	$0.00	$0.00	$234.22	$0.00	$0.00	$0.00	$0.00	$0.00
231.001	SUP	Custom 27203010		"231.001  -  STAINLESS STEEL, DUAL STAPLE, SMALL, ROSTRAL"	BOTH IP/OP	"$2,522.50 "	"$1,866.65"	$0.00	"$2,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,872.20"	"$1,872.20"	$0.00	$0.00	$525.69	$0.00	$0.00	$0.00	$0.00	"$1,261.25"	"$1,997.82"	"$2,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.002	SUP	Custom 27203010		"231.002  -  STAINLESS STEEL, DUAL STAPLE, SMALL, CAUDAL"	BOTH IP/OP	"$2,522.50 "	"$1,866.65"	$0.00	"$2,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,872.20"	"$1,872.20"	$0.00	$0.00	$525.69	$0.00	$0.00	$0.00	$0.00	"$1,261.25"	"$1,997.82"	"$2,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.003	SUP	Custom 27203010		"231.003  -  STAINLESS STEEL, DUAL STAPLE, MEDIUM, ROSTRAL"	BOTH IP/OP	"$2,522.50 "	"$1,866.65"	$0.00	"$2,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,872.20"	"$1,872.20"	$0.00	$0.00	$525.69	$0.00	$0.00	$0.00	$0.00	"$1,261.25"	"$1,997.82"	"$2,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.004	SUP	Custom 27203010		"231.004  -  STAINLESS STEEL, DUAL STAPLE, MEDIUM, CAUDAL"	BOTH IP/OP	"$2,522.50 "	"$1,866.65"	$0.00	"$2,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,872.20"	"$1,872.20"	$0.00	$0.00	$525.69	$0.00	$0.00	$0.00	$0.00	"$1,261.25"	"$1,997.82"	"$2,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.005	SUP	Custom 27203010		"231.005  -  STAINLESS STEEL, DUAL STAPLE, LARGE, ROSTRAL"	BOTH IP/OP	"$2,522.50 "	"$1,866.65"	$0.00	"$2,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,872.20"	"$1,872.20"	$0.00	$0.00	$525.69	$0.00	$0.00	$0.00	$0.00	"$1,261.25"	"$1,997.82"	"$2,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.006	SUP	Custom 27203010		"231.006  -  STAINLESS STEEL, DUAL STAPLE, LARGE, CAUDAL"	BOTH IP/OP	"$2,522.50 "	"$1,866.65"	$0.00	"$2,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,872.20"	"$1,872.20"	$0.00	$0.00	$525.69	$0.00	$0.00	$0.00	$0.00	"$1,261.25"	"$1,997.82"	"$2,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.007	SUP	Custom 27203010		"231.007  -  STAINLESS STEEL, DUAL STAPLE, X-LARGE, ROSTRAL"	BOTH IP/OP	"$2,522.50 "	"$1,866.65"	$0.00	"$2,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,872.20"	"$1,872.20"	$0.00	$0.00	$525.69	$0.00	$0.00	$0.00	$0.00	"$1,261.25"	"$1,997.82"	"$2,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.008	SUP	Custom 27203010		"231.008  -  STAINLESS STEEL, DUAL STAPLE, X-LARGE, CAUDAL"	BOTH IP/OP	"$2,522.50 "	"$1,866.65"	$0.00	"$2,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,872.20"	"$1,872.20"	$0.00	$0.00	$525.69	$0.00	$0.00	$0.00	$0.00	"$1,261.25"	"$1,997.82"	"$2,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.011	SUP	Custom 27203010		"231.011  -  STAINLESS STEEL SINGLE STAPLE, SMALL"	BOTH IP/OP	"$1,822.50 "	"$1,348.65"	$0.00	"$1,458.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,352.66"	"$1,352.66"	$0.00	$0.00	$379.81	$0.00	$0.00	$0.00	$0.00	$911.25	"$1,443.42"	"$1,458.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.012	SUP	Custom 27203010		"231.012  -  STAINLESS STEEL SINGLE STAPLE, MEDIUM"	BOTH IP/OP	"$1,822.50 "	"$1,348.65"	$0.00	"$1,458.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,352.66"	"$1,352.66"	$0.00	$0.00	$379.81	$0.00	$0.00	$0.00	$0.00	$911.25	"$1,443.42"	"$1,458.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.013	SUP	Custom 27203010		"231.013  -  STAINLESS STEEL SINGLE STAPLE, LARGE"	BOTH IP/OP	"$1,822.50 "	"$1,348.65"	$0.00	"$1,458.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,352.66"	"$1,352.66"	$0.00	$0.00	$379.81	$0.00	$0.00	$0.00	$0.00	$911.25	"$1,443.42"	"$1,458.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.113	SUP	Custom 27803010		"231.113  -  STAINLESS STEEL CROSS CONNECTOR, 13MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.114	SUP	Custom 27803010		"231.114  -  STAINLESS STEEL CROSS CONNECTOR, 14MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.115	SUP	Custom 27803010		"231.115  -  STAINLESS STEEL CROSS CONNECTOR, 15MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.116	SUP	Custom 27803010		"231.116  -  STAINLESS STEEL CROSS CONNECTOR, 16MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.117	SUP	Custom 27803010		"231.117  -  STAINLESS STEEL CROSS CONNECTOR, 17MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.118	SUP	Custom 27803010		"231.118  -  STAINLESS STEEL CROSS CONNECTOR, 18MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.119	SUP	Custom 27803010		"231.119  -  STAINLESS STEEL CROSS CONNECTOR, 19MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.12	SUP	Custom 27803010		"231.120  -  STAINLESS STEEL CROSS CONNECTOR, 20MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231.201	SUP	HCPCS C1713		"231.201  -  STAINLESS STEEL WASHER, SMALL"	BOTH IP/OP	$700.00 	$518.00	$0.00	$560.00	$315.00	$315.00	$0.00	$0.00	$0.00	$145.90	$519.54	$519.54	$0.00	$0.00	$145.88	$0.00	$414.05	$414.05	$0.00	$350.00	$554.40	$560.00	$0.00		$0.00	$109.55	$0.00	$0.00	$111.44	$0.00	$0.00	$0.00	$0.00	$0.00
231.202	SUP	HCPCS C1713		"231.202  -  STAINLESS STEEL WASHER, MEDIUM"	BOTH IP/OP	$700.00 	$518.00	$0.00	$560.00	$315.00	$315.00	$0.00	$0.00	$0.00	$145.90	$519.54	$519.54	$0.00	$0.00	$145.88	$0.00	$414.05	$414.05	$0.00	$350.00	$554.40	$560.00	$0.00		$0.00	$109.55	$0.00	$0.00	$111.44	$0.00	$0.00	$0.00	$0.00	$0.00
231.203	SUP	HCPCS C1713		"231.203  -  STAINLESS STEEL WASHER, LARGE"	BOTH IP/OP	$700.00 	$518.00	$0.00	$560.00	$315.00	$315.00	$0.00	$0.00	$0.00	$145.90	$519.54	$519.54	$0.00	$0.00	$145.88	$0.00	$414.05	$414.05	$0.00	$350.00	$554.40	$560.00	$0.00		$0.00	$109.55	$0.00	$0.00	$111.44	$0.00	$0.00	$0.00	$0.00	$0.00
232.006	SUP	HCPCS C1713		232.006  -  PLATE BONE 90D 132MM 30X9.2MM 10 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,876.20 "	"$1,388.39"	$0.00	"$1,500.96"	$844.29	$844.29	$0.00	$0.00	$0.00	$391.05	"$1,392.52"	"$1,392.52"	$0.00	$0.00	$391.00	$0.00	"$1,109.77"	"$1,109.77"	$0.00	$938.10	"$1,485.95"	"$1,500.96"	$0.00		$0.00	$293.63	$0.00	$0.00	$298.69	$0.00	$0.00	$0.00	$0.00	$0.00
232.007	SUP	HCPCS C1713		232.007  -  PLATE BONE 90D 132MM 35X9.2MM 10 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,876.20 "	"$1,388.39"	$0.00	"$1,500.96"	$844.29	$844.29	$0.00	$0.00	$0.00	$391.05	"$1,392.52"	"$1,392.52"	$0.00	$0.00	$391.00	$0.00	"$1,109.77"	"$1,109.77"	$0.00	$938.10	"$1,485.95"	"$1,500.96"	$0.00		$0.00	$293.63	$0.00	$0.00	$298.69	$0.00	$0.00	$0.00	$0.00	$0.00
232.008	SUP	HCPCS C1713		232.008  -  PLATE BONE 90D 132MM 40X9.2MM 10 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,876.20 "	"$1,388.39"	$0.00	"$1,500.96"	$844.29	$844.29	$0.00	$0.00	$0.00	$391.05	"$1,392.52"	"$1,392.52"	$0.00	$0.00	$391.00	$0.00	"$1,109.77"	"$1,109.77"	$0.00	$938.10	"$1,485.95"	"$1,500.96"	$0.00		$0.00	$293.63	$0.00	$0.00	$298.69	$0.00	$0.00	$0.00	$0.00	$0.00
232.009	SUP	HCPCS C1713		232.009  -  PLATE BONE 90D 132MM 45X9.2MM 10 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,876.20 "	"$1,388.39"	$0.00	"$1,500.96"	$844.29	$844.29	$0.00	$0.00	$0.00	$391.05	"$1,392.52"	"$1,392.52"	$0.00	$0.00	$391.00	$0.00	"$1,109.77"	"$1,109.77"	$0.00	$938.10	"$1,485.95"	"$1,500.96"	$0.00		$0.00	$293.63	$0.00	$0.00	$298.69	$0.00	$0.00	$0.00	$0.00	$0.00
232.046	SUP	HCPCS C1713		232.046  -  PLATE BONE 90D 54MM 30X9.2MM 4 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,495.93 "	"$1,106.99"	$0.00	"$1,196.74"	$673.17	$673.17	$0.00	$0.00	$0.00	$311.79	"$1,110.28"	"$1,110.28"	$0.00	$0.00	$311.75	$0.00	$884.84	$884.84	$0.00	$747.96	"$1,184.78"	"$1,196.74"	$0.00		$0.00	$234.11	$0.00	$0.00	$238.15	$0.00	$0.00	$0.00	$0.00	$0.00
232.047	SUP	HCPCS C1713		232.047  -  PLATE BONE 90D 54MM 35X9.2MM 4 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,495.93 "	"$1,106.99"	$0.00	"$1,196.74"	$673.17	$673.17	$0.00	$0.00	$0.00	$311.79	"$1,110.28"	"$1,110.28"	$0.00	$0.00	$311.75	$0.00	$884.84	$884.84	$0.00	$747.96	"$1,184.78"	"$1,196.74"	$0.00		$0.00	$234.11	$0.00	$0.00	$238.15	$0.00	$0.00	$0.00	$0.00	$0.00
232.048	SUP	HCPCS C1713		232.048  -  PLATE BN 90D 40X9.2MM NS 4 HL LMT CNTCT ANG BLDE CNN SS 3.5	BOTH IP/OP	"$1,495.93 "	"$1,106.99"	$0.00	"$1,196.74"	$673.17	$673.17	$0.00	$0.00	$0.00	$311.79	"$1,110.28"	"$1,110.28"	$0.00	$0.00	$311.75	$0.00	$884.84	$884.84	$0.00	$747.96	"$1,184.78"	"$1,196.74"	$0.00		$0.00	$234.11	$0.00	$0.00	$238.15	$0.00	$0.00	$0.00	$0.00	$0.00
232.049	SUP	HCPCS C1713		232.049  -  PLATE BONE 90D 54MM 45X9.2MM 4 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,495.93 "	"$1,106.99"	$0.00	"$1,196.74"	$673.17	$673.17	$0.00	$0.00	$0.00	$311.79	"$1,110.28"	"$1,110.28"	$0.00	$0.00	$311.75	$0.00	$884.84	$884.84	$0.00	$747.96	"$1,184.78"	"$1,196.74"	$0.00		$0.00	$234.11	$0.00	$0.00	$238.15	$0.00	$0.00	$0.00	$0.00	$0.00
232.056	SUP	HCPCS C1713		232.056  -  PLATE BONE 90D 67MM 30X9.2MM 5 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,582.05 "	"$1,170.72"	$0.00	"$1,265.64"	$711.92	$711.92	$0.00	$0.00	$0.00	$329.74	"$1,174.20"	"$1,174.20"	$0.00	$0.00	$329.70	$0.00	$935.78	$935.78	$0.00	$791.03	"$1,252.98"	"$1,265.64"	$0.00		$0.00	$247.59	$0.00	$0.00	$251.86	$0.00	$0.00	$0.00	$0.00	$0.00
232.057	SUP	HCPCS C1713		232.057  -  PLATE BONE 90D 67MM 35X9.2MM 5 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,582.05 "	"$1,170.72"	$0.00	"$1,265.64"	$711.92	$711.92	$0.00	$0.00	$0.00	$329.74	"$1,174.20"	"$1,174.20"	$0.00	$0.00	$329.70	$0.00	$935.78	$935.78	$0.00	$791.03	"$1,252.98"	"$1,265.64"	$0.00		$0.00	$247.59	$0.00	$0.00	$251.86	$0.00	$0.00	$0.00	$0.00	$0.00
232.058	SUP	HCPCS C1713		232.058  -  PLATE BONE 90D 67MM 40X9.2MM 5 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,582.05 "	"$1,170.72"	$0.00	"$1,265.64"	$711.92	$711.92	$0.00	$0.00	$0.00	$329.74	"$1,174.20"	"$1,174.20"	$0.00	$0.00	$329.70	$0.00	$935.78	$935.78	$0.00	$791.03	"$1,252.98"	"$1,265.64"	$0.00		$0.00	$247.59	$0.00	$0.00	$251.86	$0.00	$0.00	$0.00	$0.00	$0.00
232.059	SUP	HCPCS C1713		232.059  -  PLATE BONE 90D 67MM 45X9.2MM 5 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,582.05 "	"$1,170.72"	$0.00	"$1,265.64"	$711.92	$711.92	$0.00	$0.00	$0.00	$329.74	"$1,174.20"	"$1,174.20"	$0.00	$0.00	$329.70	$0.00	$935.78	$935.78	$0.00	$791.03	"$1,252.98"	"$1,265.64"	$0.00		$0.00	$247.59	$0.00	$0.00	$251.86	$0.00	$0.00	$0.00	$0.00	$0.00
232.066	SUP	HCPCS C1713		232.066  -  PLATE BONE 90D 80MM 30X9.2MM 6 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,649.63 "	"$1,220.73"	$0.00	"$1,319.70"	$742.33	$742.33	$0.00	$0.00	$0.00	$343.82	"$1,224.35"	"$1,224.35"	$0.00	$0.00	$343.78	$0.00	$975.75	$975.75	$0.00	$824.81	"$1,306.51"	"$1,319.70"	$0.00		$0.00	$258.17	$0.00	$0.00	$262.62	$0.00	$0.00	$0.00	$0.00	$0.00
232.067	SUP	HCPCS C1713		232.067  -  PLATE BONE 90D 80MM 35X9.2MM 6 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,649.63 "	"$1,220.73"	$0.00	"$1,319.70"	$742.33	$742.33	$0.00	$0.00	$0.00	$343.82	"$1,224.35"	"$1,224.35"	$0.00	$0.00	$343.78	$0.00	$975.75	$975.75	$0.00	$824.81	"$1,306.51"	"$1,319.70"	$0.00		$0.00	$258.17	$0.00	$0.00	$262.62	$0.00	$0.00	$0.00	$0.00	$0.00
232.068	SUP	HCPCS C1713		232.068  -  PLATE BONE 90D 80MM 40X9.2MM 6 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,649.63 "	"$1,220.73"	$0.00	"$1,319.70"	$742.33	$742.33	$0.00	$0.00	$0.00	$343.82	"$1,224.35"	"$1,224.35"	$0.00	$0.00	$343.78	$0.00	$975.75	$975.75	$0.00	$824.81	"$1,306.51"	"$1,319.70"	$0.00		$0.00	$258.17	$0.00	$0.00	$262.62	$0.00	$0.00	$0.00	$0.00	$0.00
232.069	SUP	HCPCS C1713		232.069  -  PLATE BONE 90D 80MM 45X9.2MM 6 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,649.63 "	"$1,220.73"	$0.00	"$1,319.70"	$742.33	$742.33	$0.00	$0.00	$0.00	$343.82	"$1,224.35"	"$1,224.35"	$0.00	$0.00	$343.78	$0.00	$975.75	$975.75	$0.00	$824.81	"$1,306.51"	"$1,319.70"	$0.00		$0.00	$258.17	$0.00	$0.00	$262.62	$0.00	$0.00	$0.00	$0.00	$0.00
232.086	SUP	HCPCS C1713		232.086  -  PLATE BONE 90D 106MM 30X9.2MM 8 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,770.20 "	"$1,309.95"	$0.00	"$1,416.16"	$796.59	$796.59	$0.00	$0.00	$0.00	$368.95	"$1,313.84"	"$1,313.84"	$0.00	$0.00	$368.91	$0.00	"$1,047.07"	"$1,047.07"	$0.00	$885.10	"$1,402.00"	"$1,416.16"	$0.00		$0.00	$277.04	$0.00	$0.00	$281.82	$0.00	$0.00	$0.00	$0.00	$0.00
232.087	SUP	HCPCS C1713		232.087  -  PLATE BN 90D 35X9.2MM NS 8 HL LMT CNTCT ANG BLDE CNN SS 3.5	BOTH IP/OP	"$1,770.20 "	"$1,309.95"	$0.00	"$1,416.16"	$796.59	$796.59	$0.00	$0.00	$0.00	$368.95	"$1,313.84"	"$1,313.84"	$0.00	$0.00	$368.91	$0.00	"$1,047.07"	"$1,047.07"	$0.00	$885.10	"$1,402.00"	"$1,416.16"	$0.00		$0.00	$277.04	$0.00	$0.00	$281.82	$0.00	$0.00	$0.00	$0.00	$0.00
232.088	SUP	HCPCS C1713		232.088  -  PLATE BONE 90D 106MM 40X9.2MM 8 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,770.20 "	"$1,309.95"	$0.00	"$1,416.16"	$796.59	$796.59	$0.00	$0.00	$0.00	$368.95	"$1,313.84"	"$1,313.84"	$0.00	$0.00	$368.91	$0.00	"$1,047.07"	"$1,047.07"	$0.00	$885.10	"$1,402.00"	"$1,416.16"	$0.00		$0.00	$277.04	$0.00	$0.00	$281.82	$0.00	$0.00	$0.00	$0.00	$0.00
232.089	SUP	HCPCS C1713		232.089  -  PLATE BONE 90D 106MM 45X9.2MM 8 HOLE LIMITED CONTACT ANGLED	BOTH IP/OP	"$1,770.20 "	"$1,309.95"	$0.00	"$1,416.16"	$796.59	$796.59	$0.00	$0.00	$0.00	$368.95	"$1,313.84"	"$1,313.84"	$0.00	$0.00	$368.91	$0.00	"$1,047.07"	"$1,047.07"	$0.00	$885.10	"$1,402.00"	"$1,416.16"	$0.00		$0.00	$277.04	$0.00	$0.00	$281.82	$0.00	$0.00	$0.00	$0.00	$0.00
235	SUP	Custom 27803010		235  -  PANEL 235 128MM X 79MM X .025	BOTH IP/OP	"$1,623.50 "	"$1,201.39"	$0.00	"$1,298.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,204.96"	"$1,204.96"	$0.00	$0.00	$338.34	$0.00	$0.00	$0.00	$0.00	$811.75	"$1,285.81"	"$1,298.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
235.17	SUP	HCPCS C1713		235.170  -  PLATE BONE 80D 8MM DISPLACEMENT 35MM DCP CAPOS STAINLESS	BOTH IP/OP	$937.58 	$693.81	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$195.41	$695.87	$695.87	$0.00	$0.00	$195.39	$0.00	$554.58	$554.58	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.19	SUP	HCPCS C1713		235.190  -  PLATE BONE 80D 8MM DISPLACEMENT 45MM ANGLED DCP CAPOS	BOTH IP/OP	$937.58 	$693.81	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$195.41	$695.87	$695.87	$0.00	$0.00	$195.39	$0.00	$554.58	$554.58	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.27	SUP	HCPCS C1713		235.270  -  PLATE BN 90D 8MM DSPL 35MMX74.5MM NS DCP CAPOS 3 HL T PRFL	BOTH IP/OP	$937.58 	$693.81	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$195.41	$695.87	$695.87	$0.00	$0.00	$195.39	$0.00	$554.58	$554.58	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.29	SUP	HCPCS C1713		235.290  -  PLATE BN 90D 8MM DSPL 45MMX74.5MM NS DCP CAPOS 3 HL T PRFL	BOTH IP/OP	$937.58 	$693.81	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$195.41	$695.87	$695.87	$0.00	$0.00	$195.39	$0.00	$554.58	$554.58	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.37	SUP	HCPCS C1713		235.370  -  PLATE BONE 100D 8MM DISPLACEMENT 35MM DCP CAPOS STAINLESS	BOTH IP/OP	$937.58 	$693.81	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$195.41	$695.87	$695.87	$0.00	$0.00	$195.39	$0.00	$554.58	$554.58	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.39	SUP	HCPCS C1713		235.390  -  PLATE BONE 100D 45MM 8MM DCP CAPOS STAINLESS STEEL PEDIATRIC	BOTH IP/OP	$937.58 	$693.81	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$195.41	$695.87	$695.87	$0.00	$0.00	$195.39	$0.00	$554.58	$554.58	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.6	SUP	HCPCS C1713		235.600  -  PLATE BN 90D 10MM DSPL 50MMX78MM NS DCP CAPOS 3 HL T PRFL	BOTH IP/OP	$937.58 	$693.81	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$195.41	$695.87	$695.87	$0.00	$0.00	$195.39	$0.00	$554.58	$554.58	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.601	SUP	HCPCS C1713		235.601  -  PLATE BONE 100D 10MM DISPLACEMENT 50MM DCP CAPOS STAINLESS	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.68	SUP	HCPCS C1713		235.680  -  PLATE BN 90D 10MM DSPL 40MMX78MM NS DCP CAPOS 3 HL T PRFL	BOTH IP/OP	$937.58 	$693.81	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$195.41	$695.87	$695.87	$0.00	$0.00	$195.39	$0.00	$554.58	$554.58	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.681	SUP	HCPCS C1713		235.681  -  PLATE BONE 100D 10MM DISPLACEMENT 40MM DCP CAPOS STAINLESS	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.7	SUP	HCPCS C1713		235.700  -  PLATE BN 90D 15MM DSPL 50MMX78MM NS DCP CAPOS 3 HL T PRFL	BOTH IP/OP	$937.58 	$693.81	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$195.41	$695.87	$695.87	$0.00	$0.00	$195.39	$0.00	$554.58	$554.58	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.701	SUP	HCPCS C1713		235.701  -  PLATE BONE 100D 10MM DISPLACEMENT 50MM DCP CAPOS STAINLESS	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.72	SUP	HCPCS C1713		235.720  -  PLATE BN 90D 15MM DSPL 60MMX78MM NS DCP CAPOS 3 HL T PRFL	BOTH IP/OP	$937.58 	$693.81	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$195.41	$695.87	$695.87	$0.00	$0.00	$195.39	$0.00	$554.58	$554.58	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.721	SUP	HCPCS C1713		235.721  -  PLATE BONE 100D 15MM DISPLACEMENT 60MM DCP CAPOS STAINLESS	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.78	SUP	HCPCS C1713		235.780  -  PLATE BN 90D 15MM DSPL 40MMX78MM NS DCP CAPOS 3 HL T PRFL	BOTH IP/OP	$937.58 	$693.81	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$195.41	$695.87	$695.87	$0.00	$0.00	$195.39	$0.00	$554.58	$554.58	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
235.781	SUP	HCPCS C1713		235.781  -  PLATE BONE 100D 10MM DISPLACEMENT 40MM DCP CAPOS STAINLESS	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.001	SUP	HCPCS C1713		236.001  -  PLATE BONE 90D 4MM DISPLACEMENT 26MM ANGLED DCP CAPOS	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.002	SUP	HCPCS C1713		236.002  -  PLATE BN 90D 4MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.003	SUP	HCPCS C1713		236.003  -  PLATE BONE 90D 4MM DISPLACEMENT 38MM DCP CAPOS STAINLESS	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.011	SUP	HCPCS C1713		236.011  -  PLATE BONE 90D 8MM DISPLACEMENT ANGLED 26MM DCP CAPOS	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.012	SUP	HCPCS C1713		236.012  -  PLATE BN 90D 8MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.013	SUP	HCPCS C1713		236.013  -  PLATE BN 90D 8MM DSPL 38MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.101	SUP	HCPCS C1713		236.101  -  PLATE BONE 100D 4MM DISPLACEMENT 26MM ANGLED DCP CAPOS	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.102	SUP	HCPCS C1713		236.102  -  PLATE BN 100D 4MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.103	SUP	HCPCS C1713		236.103  -  PLATE BN 100D 4MM DSPL 38MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.104	SUP	HCPCS C1713		236.104  -  PLATE BN 100D 4MM DSPL 44MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.111	SUP	HCPCS C1713		236.111  -  PLATE BONE 100D 8MM DISPLACEMENT 26MM CANN ANGLED BLADE DCP	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.112	SUP	HCPCS C1713		236.112  -  PLATE BN 100D 8MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.113	SUP	HCPCS C1713		236.113  -  PLATE BN 100D 8MM DSPL 38MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.114	SUP	HCPCS C1713		236.114  -  PLATE BN 100D 8MM DSPL 44MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
236.25	SUP	HCPCS C1713		236.250  -  PLATE BN 90D 7MM DSPL 25MMX46MM NS 8X2MM DCP CAPOS 3 HL T	BOTH IP/OP	$805.20 	$595.85	$0.00	$644.16	$362.34	$362.34	$0.00	$0.00	$0.00	$167.82	$597.62	$597.62	$0.00	$0.00	$167.80	$0.00	$476.28	$476.28	$0.00	$402.60	$637.72	$644.16	$0.00		$0.00	$122.34	$0.00	$0.00	$128.19	$0.00	$0.00	$0.00	$0.00	$0.00
236.26	SUP	HCPCS C1713		236.260  -  PLATE BN 90D 7MM DSPL 32MMX46MM NS 8X2MM DCP CAPOS 3 HL T	BOTH IP/OP	$805.20 	$595.85	$0.00	$644.16	$362.34	$362.34	$0.00	$0.00	$0.00	$167.82	$597.62	$597.62	$0.00	$0.00	$167.80	$0.00	$476.28	$476.28	$0.00	$402.60	$637.72	$644.16	$0.00		$0.00	$122.34	$0.00	$0.00	$128.19	$0.00	$0.00	$0.00	$0.00	$0.00
236.35	SUP	HCPCS C1713		236.350  -  PLATE BN 90D 12MM DSPL 25MMX46MM NS 8X2MM DCP CAPOS SS INF	BOTH IP/OP	$805.20 	$595.85	$0.00	$644.16	$362.34	$362.34	$0.00	$0.00	$0.00	$167.82	$597.62	$597.62	$0.00	$0.00	$167.80	$0.00	$476.28	$476.28	$0.00	$402.60	$637.72	$644.16	$0.00		$0.00	$122.34	$0.00	$0.00	$128.19	$0.00	$0.00	$0.00	$0.00	$0.00
236.36	SUP	HCPCS C1713		236.360  -  PLATE BN 90D 12MM DSPL 32MMX46MM NS 8X2MM DCP CAPOS 3 HL T	BOTH IP/OP	$805.20 	$595.85	$0.00	$644.16	$362.34	$362.34	$0.00	$0.00	$0.00	$167.82	$597.62	$597.62	$0.00	$0.00	$167.80	$0.00	$476.28	$476.28	$0.00	$402.60	$637.72	$644.16	$0.00		$0.00	$122.34	$0.00	$0.00	$128.19	$0.00	$0.00	$0.00	$0.00	$0.00
236.4	SUP	HCPCS C1713		236.400  -  PLATE BN 115D 5MM DSPL 2 BRCH 30MM NS DCP CAPOS 2 HL SS	BOTH IP/OP	$537.70 	$397.90	$0.00	$430.16	$241.97	$241.97	$0.00	$0.00	$0.00	$112.07	$399.08	$399.08	$0.00	$0.00	$112.06	$0.00	$318.05	$318.05	$0.00	$268.85	$425.86	$430.16	$0.00		$0.00	$81.70	$0.00	$0.00	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00
236.43	SUP	HCPCS C1713		236.430  -  PLATE BN 115D 5MM DSPL 2 BRCH 35MM NS DCP CAPOS 2 HL SS	BOTH IP/OP	$537.70 	$397.90	$0.00	$430.16	$241.97	$241.97	$0.00	$0.00	$0.00	$112.07	$399.08	$399.08	$0.00	$0.00	$112.06	$0.00	$318.05	$318.05	$0.00	$268.85	$425.86	$430.16	$0.00		$0.00	$81.70	$0.00	$0.00	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00
236.502	SUP	HCPCS C1713		236.502  -  PLATE BONE 86MM 2 HOLE LCP STAINLESS STEEL RIGHT OLECRANON	BOTH IP/OP	"$1,644.65 "	"$1,217.04"	$0.00	"$1,277.40"	$718.54	$718.54	$0.00	$0.00	$0.00	$342.79	"$1,220.66"	"$1,220.66"	$0.00	$0.00	$342.75	$0.00	$972.81	$972.81	$0.00	$798.38	"$1,264.63"	"$1,277.40"	$0.00		$0.00	$242.61	$0.00	$0.00	$254.20	$0.00	$0.00	$0.00	$0.00	$0.00
236.503	SUP	HCPCS C1713		236.503  -  PLATE BONE 86MM 2 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$1,644.65 "	"$1,217.04"	$0.00	"$1,277.40"	$718.54	$718.54	$0.00	$0.00	$0.00	$342.79	"$1,220.66"	"$1,220.66"	$0.00	$0.00	$342.75	$0.00	$972.81	$972.81	$0.00	$798.38	"$1,264.63"	"$1,277.40"	$0.00		$0.00	$242.61	$0.00	$0.00	$254.20	$0.00	$0.00	$0.00	$0.00	$0.00
236.504	SUP	HCPCS C1713		236.504  -  PLATE BONE 112MM 4 HOLE PRECONTOUR LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,716.35 "	"$1,270.10"	$0.00	"$1,333.08"	$749.86	$749.86	$0.00	$0.00	$0.00	$357.73	"$1,273.87"	"$1,273.87"	$0.00	$0.00	$357.69	$0.00	"$1,015.22"	"$1,015.22"	$0.00	$833.18	"$1,319.75"	"$1,333.08"	$0.00		$0.00	$253.19	$0.00	$0.00	$265.28	$0.00	$0.00	$0.00	$0.00	$0.00
236.505	SUP	HCPCS C1713		236.505  -  PLATE BONE 112MM 4 HOLE LCP STAINLESS STEEL LEFT OLECRANON	BOTH IP/OP	"$1,716.35 "	"$1,270.10"	$0.00	"$1,333.08"	$749.86	$749.86	$0.00	$0.00	$0.00	$357.73	"$1,273.87"	"$1,273.87"	$0.00	$0.00	$357.69	$0.00	"$1,015.22"	"$1,015.22"	$0.00	$833.18	"$1,319.75"	"$1,333.08"	$0.00		$0.00	$253.19	$0.00	$0.00	$265.28	$0.00	$0.00	$0.00	$0.00	$0.00
236.506	SUP	HCPCS C1713		236.506  -  PLATE BONE 3.5MM 138MM 6 HOLE LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,771.18 "	"$1,310.67"	$0.00	"$1,375.66"	$773.81	$773.81	$0.00	$0.00	$0.00	$369.16	"$1,314.57"	"$1,314.57"	$0.00	$0.00	$369.11	$0.00	"$1,047.65"	"$1,047.65"	$0.00	$859.79	"$1,361.91"	"$1,375.66"	$0.00		$0.00	$348.13	$0.00	$0.00	$273.76	$0.00	$0.00	$0.00	$0.00	$0.00
236.507	SUP	HCPCS C1713		236.507  -  PLATE BONE 138MM 6 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$1,771.18 "	"$1,310.67"	$0.00	"$1,375.66"	$773.81	$773.81	$0.00	$0.00	$0.00	$369.16	"$1,314.57"	"$1,314.57"	$0.00	$0.00	$369.11	$0.00	"$1,047.65"	"$1,047.65"	$0.00	$859.79	"$1,361.91"	"$1,375.66"	$0.00		$0.00	$261.28	$0.00	$0.00	$273.76	$0.00	$0.00	$0.00	$0.00	$0.00
236.508	SUP	HCPCS C1713		236.508  -  PLATE BONE 164MM 8 HOLE LCP STAINLESS STEEL RIGHT OLECRANON	BOTH IP/OP	"$1,826.00 "	"$1,351.24"	$0.00	"$1,418.24"	$797.76	$797.76	$0.00	$0.00	$0.00	$380.58	"$1,355.26"	"$1,355.26"	$0.00	$0.00	$380.54	$0.00	"$1,080.08"	"$1,080.08"	$0.00	$886.40	"$1,404.06"	"$1,418.24"	$0.00		$0.00	$269.36	$0.00	$0.00	$282.23	$0.00	$0.00	$0.00	$0.00	$0.00
236.509	SUP	HCPCS C1713		236.509  -  PLATE BONE 164MM 8 HOLE LCP STAINLESS STEEL LEFT OLECRANON	BOTH IP/OP	"$1,826.00 "	"$1,351.24"	$0.00	"$1,418.24"	$797.76	$797.76	$0.00	$0.00	$0.00	$380.58	"$1,355.26"	"$1,355.26"	$0.00	$0.00	$380.54	$0.00	"$1,080.08"	"$1,080.08"	$0.00	$886.40	"$1,404.06"	"$1,418.24"	$0.00		$0.00	$269.36	$0.00	$0.00	$282.23	$0.00	$0.00	$0.00	$0.00	$0.00
236.51	SUP	HCPCS C1713		236.510  -  PLATE BONE 190MM 10 HOLE LCP STAINLESS STEEL RIGHT OLECRANON	BOTH IP/OP	"$1,821.95 "	"$1,348.24"	$0.00	"$1,457.56"	$819.88	$819.88	$0.00	$0.00	$0.00	$379.74	"$1,352.25"	"$1,352.25"	$0.00	$0.00	$379.69	$0.00	"$1,077.68"	"$1,077.68"	$0.00	$910.98	"$1,442.98"	"$1,457.56"	$0.00		$0.00	$276.83	$0.00	$0.00	$290.05	$0.00	$0.00	$0.00	$0.00	$0.00
236.511	SUP	HCPCS C1713		236.511  -  PLATE BONE 190MM 10 HOLE LCP STAINLESS STEEL LEFT OLECRANON	BOTH IP/OP	"$1,876.60 "	"$1,388.68"	$0.00	"$1,457.56"	$819.88	$819.88	$0.00	$0.00	$0.00	$391.13	"$1,392.81"	"$1,392.81"	$0.00	$0.00	$391.08	$0.00	"$1,110.01"	"$1,110.01"	$0.00	$910.98	"$1,442.98"	"$1,457.56"	$0.00		$0.00	$276.83	$0.00	$0.00	$290.05	$0.00	$0.00	$0.00	$0.00	$0.00
236.512	SUP	HCPCS C1713		236.512  -  PLATE BONE 216MM 12 HOLE LCP STAINLESS STEEL RIGHT OLECRANON	BOTH IP/OP	"$1,910.33 "	"$1,413.64"	$0.00	"$1,483.76"	$834.62	$834.62	$0.00	$0.00	$0.00	$398.16	"$1,417.84"	"$1,417.84"	$0.00	$0.00	$398.11	$0.00	"$1,129.96"	"$1,129.96"	$0.00	$927.35	"$1,468.92"	"$1,483.76"	$0.00		$0.00	$281.81	$0.00	$0.00	$295.27	$0.00	$0.00	$0.00	$0.00	$0.00
236.513	SUP	HCPCS C1713		236.513  -  PLATE BONE 215MM 12 HOLE LCP STAINLESS STEEL LEFT OLECRANON	BOTH IP/OP	"$1,910.33 "	"$1,413.64"	$0.00	"$1,483.76"	$834.62	$834.62	$0.00	$0.00	$0.00	$398.16	"$1,417.84"	"$1,417.84"	$0.00	$0.00	$398.11	$0.00	"$1,129.96"	"$1,129.96"	$0.00	$927.35	"$1,468.92"	"$1,483.76"	$0.00		$0.00	$281.81	$0.00	$0.00	$295.27	$0.00	$0.00	$0.00	$0.00	$0.00
237.2	SUP	HCPCS C1713		237.20  -  PLATE BONE 95D 50MM 12 HOLE ANGLED BLADE DCP STAINLESS STEEL	BOTH IP/OP	"$1,177.78 "	$871.56	$0.00	$942.22	$530.00	$530.00	$0.00	$0.00	$0.00	$245.48	$874.14	$874.14	$0.00	$0.00	$245.45	$0.00	$696.65	$696.65	$0.00	$588.89	$932.80	$942.22	$0.00		$0.00	$178.95	$0.00	$0.00	$187.50	$0.00	$0.00	$0.00	$0.00	$0.00
237.22	SUP	HCPCS C1713		237.22  -  PLATE BN 95D 60MM NS 204MM DCP 12 HL SS HIP CNDRL	BOTH IP/OP	"$1,213.13 "	$897.72	$0.00	$942.22	$530.00	$530.00	$0.00	$0.00	$0.00	$252.85	$900.38	$900.38	$0.00	$0.00	$252.82	$0.00	$717.56	$717.56	$0.00	$588.89	$932.80	$942.22	$0.00		$0.00	$178.95	$0.00	$0.00	$187.50	$0.00	$0.00	$0.00	$0.00	$0.00
237.24	SUP	HCPCS C1713		237.24  -  PLATE BN 95D 70MM NS 240MM DCP 12 HL SS HIP CNDRL	BOTH IP/OP	"$1,213.13 "	$897.72	$0.00	$942.22	$530.00	$530.00	$0.00	$0.00	$0.00	$252.85	$900.38	$900.38	$0.00	$0.00	$252.82	$0.00	$717.56	$717.56	$0.00	$588.89	$932.80	$942.22	$0.00		$0.00	$178.95	$0.00	$0.00	$187.50	$0.00	$0.00	$0.00	$0.00	$0.00
237.26	SUP	HCPCS C1713		237.26  -  PLATE BN 95D 70MM NS 204MM DCP 12 HL SS HIP CNDRL	BOTH IP/OP	"$1,213.13 "	$897.72	$0.00	$942.22	$530.00	$530.00	$0.00	$0.00	$0.00	$252.85	$900.38	$900.38	$0.00	$0.00	$252.82	$0.00	$717.56	$717.56	$0.00	$588.89	$932.80	$942.22	$0.00		$0.00	$178.95	$0.00	$0.00	$187.50	$0.00	$0.00	$0.00	$0.00	$0.00
237.261	SUP	HCPCS C1713		237.261  -  PLATE 95D SS 26 HOLE ANG DCP BONE 60MM CNDYLR NONSTRL	BOTH IP/OP	"$2,689.95 "	"$1,990.56"	$0.00	"$2,151.96"	"$1,210.48"	"$1,210.48"	$0.00	$0.00	$0.00	$560.65	"$1,996.48"	"$1,996.48"	$0.00	$0.00	$560.59	$0.00	"$1,326.15"	"$1,326.15"	$0.00	"$1,344.98"	"$2,130.44"	"$2,151.96"	$0.00		$0.00	$420.98	$0.00	$0.00	$428.24	$0.00	$0.00	$0.00	$0.00	$0.00
237.262	SUP	HCPCS C1713		237.262  -  PLATE 95D SS 26 HOLE ANG DCP BONE 70MM CNDYLR NONSTRL	BOTH IP/OP	"$2,535.53 "	"$1,876.29"	$0.00	"$2,028.42"	"$1,140.99"	"$1,140.99"	$0.00	$0.00	$0.00	$528.47	"$1,881.87"	"$1,881.87"	$0.00	$0.00	$528.40	$0.00	"$1,250.01"	"$1,250.01"	$0.00	"$1,267.76"	"$2,008.14"	"$2,028.42"	$0.00		$0.00	$396.81	$0.00	$0.00	$403.66	$0.00	$0.00	$0.00	$0.00	$0.00
237.4	SUP	HCPCS C1713		237.40  -  PLATE BONE 95D 50MM 235MM 14 HOLE DCP STAINLESS STEEL	BOTH IP/OP	"$1,764.63 "	"$1,305.83"	$0.00	"$1,411.70"	$794.08	$794.08	$0.00	$0.00	$0.00	$367.79	"$1,309.70"	"$1,309.70"	$0.00	$0.00	$367.75	$0.00	"$1,043.78"	"$1,043.78"	$0.00	$882.31	"$1,397.59"	"$1,411.70"	$0.00		$0.00	$268.12	$0.00	$0.00	$280.93	$0.00	$0.00	$0.00	$0.00	$0.00
237.42	SUP	HCPCS C1713		237.42  -  PLATE BONE 95D 60MM 235MM 14 HOLE DCP STAINLESS STEEL	BOTH IP/OP	"$1,817.55 "	"$1,344.99"	$0.00	"$1,411.70"	$794.08	$794.08	$0.00	$0.00	$0.00	$378.82	"$1,348.99"	"$1,348.99"	$0.00	$0.00	$378.78	$0.00	"$1,075.08"	"$1,075.08"	$0.00	$882.31	"$1,397.59"	"$1,411.70"	$0.00		$0.00	$268.12	$0.00	$0.00	$280.93	$0.00	$0.00	$0.00	$0.00	$0.00
237.44	SUP	HCPCS C1713		237.44  -  PLATE BN 95D 70MM NS 235MM DCP 14 HL SS HIP CNDRL	BOTH IP/OP	"$1,817.55 "	"$1,344.99"	$0.00	"$1,411.70"	$794.08	$794.08	$0.00	$0.00	$0.00	$378.82	"$1,348.99"	"$1,348.99"	$0.00	$0.00	$378.78	$0.00	"$1,075.08"	"$1,075.08"	$0.00	$882.31	"$1,397.59"	"$1,411.70"	$0.00		$0.00	$268.12	$0.00	$0.00	$280.93	$0.00	$0.00	$0.00	$0.00	$0.00
237.46	SUP	HCPCS C1713		237.46  -  PLATE BONE 95D 80MM 235MM 14 HOLE DCP STAINLESS STEEL	BOTH IP/OP	"$1,817.55 "	"$1,344.99"	$0.00	"$1,411.70"	$794.08	$794.08	$0.00	$0.00	$0.00	$378.82	"$1,348.99"	"$1,348.99"	$0.00	$0.00	$378.78	$0.00	"$1,075.08"	"$1,075.08"	$0.00	$882.31	"$1,397.59"	"$1,411.70"	$0.00		$0.00	$268.12	$0.00	$0.00	$280.93	$0.00	$0.00	$0.00	$0.00	$0.00
237.5	SUP	HCPCS C1713		237.50  -  PLATE BN 95D 50MM NS 92MM DCP 5 HL SS HIP CNDRL	BOTH IP/OP	$978.53 	$724.11	$0.00	$782.82	$440.34	$440.34	$0.00	$0.00	$0.00	$203.95	$726.26	$726.26	$0.00	$0.00	$203.92	$0.00	$578.80	$578.80	$0.00	$489.26	$775.00	$782.82	$0.00		$0.00	$148.68	$0.00	$0.00	$155.78	$0.00	$0.00	$0.00	$0.00	$0.00
237.52	SUP	HCPCS C1713		237.52  -  PLATE BONE 95D 60MM 92MM 5 HOLE DCP STAINLESS STEEL CONDYLE	BOTH IP/OP	"$1,007.88 "	$745.83	$0.00	$782.82	$440.34	$440.34	$0.00	$0.00	$0.00	$210.07	$748.04	$748.04	$0.00	$0.00	$210.04	$0.00	$596.16	$596.16	$0.00	$489.26	$775.00	$782.82	$0.00		$0.00	$148.68	$0.00	$0.00	$155.78	$0.00	$0.00	$0.00	$0.00	$0.00
237.54	SUP	HCPCS C1713		237.54  -  PLATE BN 95D 70MM NS 92MM DCP 5 HL SS HIP CNDRL	BOTH IP/OP	"$1,007.88 "	$745.83	$0.00	$782.82	$440.34	$440.34	$0.00	$0.00	$0.00	$210.07	$748.04	$748.04	$0.00	$0.00	$210.04	$0.00	$596.16	$596.16	$0.00	$489.26	$775.00	$782.82	$0.00		$0.00	$148.68	$0.00	$0.00	$155.78	$0.00	$0.00	$0.00	$0.00	$0.00
237.56	SUP	HCPCS C1713		237.56  -  PLATE BONE 95D 80MM 92MM 5 HOLE DCP STAINLESS STEEL CONDYLE	BOTH IP/OP	"$1,007.88 "	$745.83	$0.00	$782.82	$440.34	$440.34	$0.00	$0.00	$0.00	$210.07	$748.04	$748.04	$0.00	$0.00	$210.04	$0.00	$596.16	$596.16	$0.00	$489.26	$775.00	$782.82	$0.00		$0.00	$148.68	$0.00	$0.00	$155.78	$0.00	$0.00	$0.00	$0.00	$0.00
237.62	SUP	HCPCS C1713		237.62  -  PLATE BONE 95D 60MM 267MM 16 HOLE DCP STAINLESS STEEL	BOTH IP/OP	"$1,921.58 "	"$1,421.97"	$0.00	"$1,492.50"	$839.53	$839.53	$0.00	$0.00	$0.00	$400.50	"$1,426.19"	"$1,426.19"	$0.00	$0.00	$400.46	$0.00	"$1,136.61"	"$1,136.61"	$0.00	$932.81	"$1,477.58"	"$1,492.50"	$0.00		$0.00	$283.46	$0.00	$0.00	$297.01	$0.00	$0.00	$0.00	$0.00	$0.00
237.64	SUP	HCPCS C1713		237.64  -  PLATE BN 95D 70MM NS 267MM DCP 16 HL SS HIP CNDRL	BOTH IP/OP	"$1,921.58 "	"$1,421.97"	$0.00	"$1,492.50"	$839.53	$839.53	$0.00	$0.00	$0.00	$400.50	"$1,426.19"	"$1,426.19"	$0.00	$0.00	$400.46	$0.00	"$1,136.61"	"$1,136.61"	$0.00	$932.81	"$1,477.58"	"$1,492.50"	$0.00		$0.00	$283.46	$0.00	$0.00	$297.01	$0.00	$0.00	$0.00	$0.00	$0.00
237.66	SUP	HCPCS C1713		237.66  -  PLATE BN 95D 80MM NS 267MM DCP 16 HL SS HIP CNDRL	BOTH IP/OP	"$1,921.58 "	"$1,421.97"	$0.00	"$1,492.50"	$839.53	$839.53	$0.00	$0.00	$0.00	$400.50	"$1,426.19"	"$1,426.19"	$0.00	$0.00	$400.46	$0.00	"$1,136.61"	"$1,136.61"	$0.00	$932.81	"$1,477.58"	"$1,492.50"	$0.00		$0.00	$283.46	$0.00	$0.00	$297.01	$0.00	$0.00	$0.00	$0.00	$0.00
237.7	SUP	HCPCS C1713		237.70  -  PLATE BONE 95D 124MM 50MM 7 HOLE BLADE DCP STAINLESS STEEL	BOTH IP/OP	"$1,031.75 "	$763.50	$0.00	$825.40	$464.29	$464.29	$0.00	$0.00	$0.00	$215.04	$765.76	$765.76	$0.00	$0.00	$215.02	$0.00	$610.28	$610.28	$0.00	$515.88	$817.15	$825.40	$0.00		$0.00	$156.77	$0.00	$0.00	$164.25	$0.00	$0.00	$0.00	$0.00	$0.00
237.72	SUP	HCPCS C1713		237.72  -  PLATE BN 95D 60MM NS 124MM DCP 7 HL SS HIP CNDRL	BOTH IP/OP	"$1,062.70 "	$786.40	$0.00	$825.40	$464.29	$464.29	$0.00	$0.00	$0.00	$221.49	$788.74	$788.74	$0.00	$0.00	$221.47	$0.00	$628.59	$628.59	$0.00	$515.88	$817.15	$825.40	$0.00		$0.00	$156.77	$0.00	$0.00	$164.25	$0.00	$0.00	$0.00	$0.00	$0.00
237.74	SUP	HCPCS C1713		237.74  -  PLATE BN 95D 70MM NS 124MM DCP 7 HL SS HIP CNDRL	BOTH IP/OP	"$1,062.70 "	$786.40	$0.00	$825.40	$464.29	$464.29	$0.00	$0.00	$0.00	$221.49	$788.74	$788.74	$0.00	$0.00	$221.47	$0.00	$628.59	$628.59	$0.00	$515.88	$817.15	$825.40	$0.00		$0.00	$156.77	$0.00	$0.00	$164.25	$0.00	$0.00	$0.00	$0.00	$0.00
237.76	SUP	HCPCS C1713		237.76  -  PLATE BN 95D 80MM NS 124MM DCP 7 HL SS HIP CNDRL	BOTH IP/OP	"$1,062.70 "	$786.40	$0.00	$825.40	$464.29	$464.29	$0.00	$0.00	$0.00	$221.49	$788.74	$788.74	$0.00	$0.00	$221.47	$0.00	$628.59	$628.59	$0.00	$515.88	$817.15	$825.40	$0.00		$0.00	$156.77	$0.00	$0.00	$164.25	$0.00	$0.00	$0.00	$0.00	$0.00
237.82	SUP	HCPCS C1713		237.82  -  PLATE BONE 95D 299MM 60MM 18 HOLE DCP STAINLESS STEEL	BOTH IP/OP	"$2,126.83 "	"$1,573.85"	$0.00	"$1,651.90"	$929.19	$929.19	$0.00	$0.00	$0.00	$443.28	"$1,578.53"	"$1,578.53"	$0.00	$0.00	$443.23	$0.00	"$1,258.02"	"$1,258.02"	$0.00	"$1,032.44"	"$1,635.38"	"$1,651.90"	$0.00		$0.00	$313.74	$0.00	$0.00	$328.73	$0.00	$0.00	$0.00	$0.00	$0.00
237.84	SUP	HCPCS C1713		237.84  -  PLATE BN 95D 80MM NS 299MM DCP 18 HL SS HIP CNDRL	BOTH IP/OP	"$2,126.83 "	"$1,573.85"	$0.00	"$1,651.90"	$929.19	$929.19	$0.00	$0.00	$0.00	$443.28	"$1,578.53"	"$1,578.53"	$0.00	$0.00	$443.23	$0.00	"$1,258.02"	"$1,258.02"	$0.00	"$1,032.44"	"$1,635.38"	"$1,651.90"	$0.00		$0.00	$313.74	$0.00	$0.00	$328.73	$0.00	$0.00	$0.00	$0.00	$0.00
237.86	SUP	HCPCS C1713		237.86  -  PLATE BN 95D 80MM NS 299MM DCP 18 HL SS HIP CNDRL	BOTH IP/OP	"$2,126.83 "	"$1,573.85"	$0.00	"$1,651.90"	$929.19	$929.19	$0.00	$0.00	$0.00	$443.28	"$1,578.53"	"$1,578.53"	$0.00	$0.00	$443.23	$0.00	"$1,258.02"	"$1,258.02"	$0.00	"$1,032.44"	"$1,635.38"	"$1,651.90"	$0.00		$0.00	$313.74	$0.00	$0.00	$328.73	$0.00	$0.00	$0.00	$0.00	$0.00
237.9	SUP	HCPCS C1713		237.90  -  PLATE BN 95D 50MM NS 156MM DCP 9 HL SS HIP CNDRL	BOTH IP/OP	"$1,080.88 "	$799.85	$0.00	$864.70	$486.39	$486.39	$0.00	$0.00	$0.00	$225.28	$802.23	$802.23	$0.00	$0.00	$225.25	$0.00	$639.34	$639.34	$0.00	$540.44	$856.06	$864.70	$0.00		$0.00	$164.23	$0.00	$0.00	$172.08	$0.00	$0.00	$0.00	$0.00	$0.00
237.92	SUP	HCPCS C1713		237.92  -  PLATE BN 95D 60MM NS 156MM DCP 9 HL SS HIP CNDRL	BOTH IP/OP	"$1,113.30 "	$823.84	$0.00	$864.70	$486.39	$486.39	$0.00	$0.00	$0.00	$232.04	$826.29	$826.29	$0.00	$0.00	$232.01	$0.00	$658.52	$658.52	$0.00	$540.44	$856.06	$864.70	$0.00		$0.00	$164.23	$0.00	$0.00	$172.08	$0.00	$0.00	$0.00	$0.00	$0.00
237.94	SUP	HCPCS C1713		237.94  -  PLATE BN 95D 70MM NS 156MM DCP 9 HL SS HIP CNDRL	BOTH IP/OP	"$1,113.30 "	$823.84	$0.00	$864.70	$486.39	$486.39	$0.00	$0.00	$0.00	$232.04	$826.29	$826.29	$0.00	$0.00	$232.01	$0.00	$658.52	$658.52	$0.00	$540.44	$856.06	$864.70	$0.00		$0.00	$164.23	$0.00	$0.00	$172.08	$0.00	$0.00	$0.00	$0.00	$0.00
237.96	SUP	HCPCS C1713		237.96  -  PLATE BN 95D 80MM NS 156MM DCP 9 HL SS HIP CNDRL	BOTH IP/OP	"$1,113.30 "	$823.84	$0.00	$864.70	$486.39	$486.39	$0.00	$0.00	$0.00	$232.04	$826.29	$826.29	$0.00	$0.00	$232.01	$0.00	$658.52	$658.52	$0.00	$540.44	$856.06	$864.70	$0.00		$0.00	$164.23	$0.00	$0.00	$172.08	$0.00	$0.00	$0.00	$0.00	$0.00
237.995	SUP	HCPCS C1713		237.995  -  PLATE BONE 90D 35MM 5 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	"$1,393.90 "	"$1,031.49"	$0.00	"$1,115.12"	$627.26	$627.26	$0.00	$0.00	$0.00	$290.52	"$1,034.55"	"$1,034.55"	$0.00	$0.00	$290.49	$0.00	$824.49	$824.49	$0.00	$696.95	"$1,103.97"	"$1,115.12"	$0.00		$0.00	$218.15	$0.00	$0.00	$221.91	$0.00	$0.00	$0.00	$0.00	$0.00
237.997	SUP	HCPCS C1713		237.997  -  PLATE BONE 90D 35MM 7 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	"$1,393.90 "	"$1,031.49"	$0.00	"$1,115.12"	$627.26	$627.26	$0.00	$0.00	$0.00	$290.52	"$1,034.55"	"$1,034.55"	$0.00	$0.00	$290.49	$0.00	$824.49	$824.49	$0.00	$696.95	"$1,103.97"	"$1,115.12"	$0.00		$0.00	$218.15	$0.00	$0.00	$221.91	$0.00	$0.00	$0.00	$0.00	$0.00
238.24	SUP	HCPCS C1713		238.24  -  PLATE BONE 130D 70MM 12 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	"$1,193.43 "	$883.14	$0.00	$926.94	$521.40	$521.40	$0.00	$0.00	$0.00	$248.74	$885.76	$885.76	$0.00	$0.00	$248.71	$0.00	$705.91	$705.91	$0.00	$579.34	$917.67	$926.94	$0.00		$0.00	$176.05	$0.00	$0.00	$184.46	$0.00	$0.00	$0.00	$0.00	$0.00
238.26	SUP	HCPCS C1713		238.26  -  PLATE BONE 130D 80MM 12 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	"$1,193.43 "	$883.14	$0.00	$926.94	$521.40	$521.40	$0.00	$0.00	$0.00	$248.74	$885.76	$885.76	$0.00	$0.00	$248.71	$0.00	$705.91	$705.91	$0.00	$579.34	$917.67	$926.94	$0.00		$0.00	$176.05	$0.00	$0.00	$184.46	$0.00	$0.00	$0.00	$0.00	$0.00
238.28	SUP	HCPCS C1713		238.28  -  PLATE BONE 130D 90MM 12 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	"$1,193.43 "	$883.14	$0.00	$926.94	$521.40	$521.40	$0.00	$0.00	$0.00	$248.74	$885.76	$885.76	$0.00	$0.00	$248.71	$0.00	$705.91	$705.91	$0.00	$579.34	$917.67	$926.94	$0.00		$0.00	$176.05	$0.00	$0.00	$184.46	$0.00	$0.00	$0.00	$0.00	$0.00
238.36	SUP	HCPCS C1713		238.36  -  PLATE BONE 130D 50MM 4 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	$875.75 	$648.06	$0.00	$680.20	$382.61	$382.61	$0.00	$0.00	$0.00	$182.53	$649.98	$649.98	$0.00	$0.00	$182.51	$0.00	$518.01	$518.01	$0.00	$425.13	$673.40	$680.20	$0.00		$0.00	$129.19	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00
238.38	SUP	HCPCS C1713		238.38  -  PLATE BONE 130D 60MM 4 HOLE ANGLED BLADE DCP STAINLESS STEEL	BOTH IP/OP	$875.75 	$648.06	$0.00	$680.20	$382.61	$382.61	$0.00	$0.00	$0.00	$182.53	$649.98	$649.98	$0.00	$0.00	$182.51	$0.00	$518.01	$518.01	$0.00	$425.13	$673.40	$680.20	$0.00		$0.00	$129.19	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00
238.4	SUP	HCPCS C1713		238.40  -  PLATE BONE 130D 100MM 60MM 4 HOLE DCP STAINLESS STEEL SMALL	BOTH IP/OP	$850.25 	$629.19	$0.00	$680.20	$382.61	$382.61	$0.00	$0.00	$0.00	$177.21	$631.06	$631.06	$0.00	$0.00	$177.19	$0.00	$502.92	$502.92	$0.00	$425.13	$673.40	$680.20	$0.00		$0.00	$129.19	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00
238.41	SUP	HCPCS C1713		238.41  -  PLATE BONE 130D 105MM 4 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	$875.75 	$648.06	$0.00	$680.20	$382.61	$382.61	$0.00	$0.00	$0.00	$182.53	$649.98	$649.98	$0.00	$0.00	$182.51	$0.00	$518.01	$518.01	$0.00	$425.13	$673.40	$680.20	$0.00		$0.00	$129.19	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00
238.42	SUP	HCPCS C1713		238.42  -  PLATE BONE 130D 110MM 4 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	$875.75 	$648.06	$0.00	$680.20	$382.61	$382.61	$0.00	$0.00	$0.00	$182.53	$649.98	$649.98	$0.00	$0.00	$182.51	$0.00	$518.01	$518.01	$0.00	$425.13	$673.40	$680.20	$0.00		$0.00	$129.19	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00
238.44	SUP	HCPCS C1713		238.44  -  PLATE BONE 130D 70MM 4 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	$875.75 	$648.06	$0.00	$680.20	$382.61	$382.61	$0.00	$0.00	$0.00	$182.53	$649.98	$649.98	$0.00	$0.00	$182.51	$0.00	$518.01	$518.01	$0.00	$425.13	$673.40	$680.20	$0.00		$0.00	$129.19	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00
238.45	SUP	HCPCS C1713		238.45  -  PLATE BONE 130D 75MM 4 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	$875.75 	$648.06	$0.00	$680.20	$382.61	$382.61	$0.00	$0.00	$0.00	$182.53	$649.98	$649.98	$0.00	$0.00	$182.51	$0.00	$518.01	$518.01	$0.00	$425.13	$673.40	$680.20	$0.00		$0.00	$129.19	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00
238.46	SUP	HCPCS C1713		238.46  -  PLATE BONE 130D 80MM 4 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	$875.75 	$648.06	$0.00	$680.20	$382.61	$382.61	$0.00	$0.00	$0.00	$182.53	$649.98	$649.98	$0.00	$0.00	$182.51	$0.00	$518.01	$518.01	$0.00	$425.13	$673.40	$680.20	$0.00		$0.00	$129.19	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00
238.47	SUP	HCPCS C1713		238.47  -  PLATE BONE 130D 85MM 4 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	$875.75 	$648.06	$0.00	$680.20	$382.61	$382.61	$0.00	$0.00	$0.00	$182.53	$649.98	$649.98	$0.00	$0.00	$182.51	$0.00	$518.01	$518.01	$0.00	$425.13	$673.40	$680.20	$0.00		$0.00	$129.19	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00
238.48	SUP	HCPCS C1713		238.48  -  PLATE BONE 130D 90MM 4 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	$875.75 	$648.06	$0.00	$680.20	$382.61	$382.61	$0.00	$0.00	$0.00	$182.53	$649.98	$649.98	$0.00	$0.00	$182.51	$0.00	$518.01	$518.01	$0.00	$425.13	$673.40	$680.20	$0.00		$0.00	$129.19	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00
238.49	SUP	HCPCS C1713		238.49  -  PLATE BONE 130D 95MM 4 HOLE ANGLED DCP STAINLESS STEEL	BOTH IP/OP	$875.75 	$648.06	$0.00	$680.20	$382.61	$382.61	$0.00	$0.00	$0.00	$182.53	$649.98	$649.98	$0.00	$0.00	$182.51	$0.00	$518.01	$518.01	$0.00	$425.13	$673.40	$680.20	$0.00		$0.00	$129.19	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00
238.6	SUP	HCPCS C1713		238.60  -  PLATE BONE 130D 104MM 50MM 6 HOLE DCP STAINLESS STEEL SMALL	BOTH IP/OP	$913.03 	$675.64	$0.00	$730.42	$410.86	$410.86	$0.00	$0.00	$0.00	$190.30	$677.65	$677.65	$0.00	$0.00	$190.27	$0.00	$540.05	$540.05	$0.00	$456.51	$723.12	$730.42	$0.00		$0.00	$138.73	$0.00	$0.00	$145.35	$0.00	$0.00	$0.00	$0.00	$0.00
238.62	SUP	HCPCS C1713		238.62  -  PLATE BONE 130D 104MM 60MM 6 HOLE DCP STAINLESS STEEL	BOTH IP/OP	$940.40 	$695.90	$0.00	$730.42	$410.86	$410.86	$0.00	$0.00	$0.00	$196.00	$697.96	$697.96	$0.00	$0.00	$195.98	$0.00	$556.25	$556.25	$0.00	$456.51	$723.12	$730.42	$0.00		$0.00	$138.73	$0.00	$0.00	$145.35	$0.00	$0.00	$0.00	$0.00	$0.00
238.64	SUP	HCPCS C1713		238.64  -  PLATE BN 130D 70MM NS 104MM DCP 6 HL SS HIP CNDRL	BOTH IP/OP	$940.40 	$695.90	$0.00	$730.42	$410.86	$410.86	$0.00	$0.00	$0.00	$196.00	$697.96	$697.96	$0.00	$0.00	$195.98	$0.00	$556.25	$556.25	$0.00	$456.51	$723.12	$730.42	$0.00		$0.00	$138.73	$0.00	$0.00	$145.35	$0.00	$0.00	$0.00	$0.00	$0.00
238.66	SUP	HCPCS C1713		238.66  -  PLATE BONE 130D 104MM 80MM 6 HOLE DCP STAINLESS STEEL	BOTH IP/OP	$940.40 	$695.90	$0.00	$730.42	$410.86	$410.86	$0.00	$0.00	$0.00	$196.00	$697.96	$697.96	$0.00	$0.00	$195.98	$0.00	$556.25	$556.25	$0.00	$456.51	$723.12	$730.42	$0.00		$0.00	$138.73	$0.00	$0.00	$145.35	$0.00	$0.00	$0.00	$0.00	$0.00
238.68	SUP	HCPCS C1713		238.68  -  PLATE BN 130D 90MM NS 104MM DCP 6 HL SS HIP CNDRL	BOTH IP/OP	$940.40 	$695.90	$0.00	$730.42	$410.86	$410.86	$0.00	$0.00	$0.00	$196.00	$697.96	$697.96	$0.00	$0.00	$195.98	$0.00	$556.25	$556.25	$0.00	$456.51	$723.12	$730.42	$0.00		$0.00	$138.73	$0.00	$0.00	$145.35	$0.00	$0.00	$0.00	$0.00	$0.00
238.7	SUP	HCPCS C1713		238.700  -  PLATE BONE 116MM 13.5X3.7MM 4 HOLE LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$2,606.68 "	"$1,928.94"	$0.00	"$2,085.34"	"$1,173.00"	"$1,173.00"	$0.00	$0.00	$0.00	$543.30	"$1,934.67"	"$1,934.67"	$0.00	$0.00	$543.23	$0.00	"$1,285.09"	"$1,285.09"	$0.00	"$1,303.34"	"$2,064.49"	"$2,085.34"	$0.00		$0.00	$396.06	$0.00	$0.00	$414.98	$0.00	$0.00	$0.00	$0.00	$0.00
238.701	SUP	HCPCS C1713		238.701  -  PLATE BONE 116MM 13.5X3.7MM 4 HOLE LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$2,684.88 "	"$1,986.81"	$0.00	"$2,085.34"	"$1,173.00"	"$1,173.00"	$0.00	$0.00	$0.00	$559.60	"$1,992.71"	"$1,992.71"	$0.00	$0.00	$559.53	$0.00	"$1,323.64"	"$1,323.64"	$0.00	"$1,303.34"	"$2,064.49"	"$2,085.34"	$0.00		$0.00	$396.06	$0.00	$0.00	$414.98	$0.00	$0.00	$0.00	$0.00	$0.00
238.702	SUP	HCPCS C1713		238.702  -  PLATE BONE 142MM 6 HOLE LCP STAINLESS STEEL RIGHT DISTAL	BOTH IP/OP	"$2,715.80 "	"$2,009.69"	$0.00	"$2,109.36"	"$1,186.52"	"$1,186.52"	$0.00	$0.00	$0.00	$566.04	"$2,015.67"	"$2,015.67"	$0.00	$0.00	$565.97	$0.00	"$1,338.89"	"$1,338.89"	$0.00	"$1,318.35"	"$2,088.27"	"$2,109.36"	$0.00		$0.00	$400.62	$0.00	$0.00	$419.76	$0.00	$0.00	$0.00	$0.00	$0.00
238.703	SUP	HCPCS C1713		238.703  -  PLATE BONE 142MM 13.5X3.7MM 6 HOLE LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$2,715.80 "	"$2,009.69"	$0.00	"$2,109.36"	"$1,186.52"	"$1,186.52"	$0.00	$0.00	$0.00	$566.04	"$2,015.67"	"$2,015.67"	$0.00	$0.00	$565.97	$0.00	"$1,338.89"	"$1,338.89"	$0.00	"$1,318.35"	"$2,088.27"	"$2,109.36"	$0.00		$0.00	$400.62	$0.00	$0.00	$419.76	$0.00	$0.00	$0.00	$0.00	$0.00
238.704	SUP	HCPCS C1713		238.704  -  PLATE BONE 168MM 13.5X3.7MM 8 HOLE LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$2,742.50 "	"$2,029.45"	$0.00	"$2,130.10"	"$1,198.18"	"$1,198.18"	$0.00	$0.00	$0.00	$571.61	"$2,035.48"	"$2,035.48"	$0.00	$0.00	$571.54	$0.00	"$1,352.05"	"$1,352.05"	$0.00	"$1,331.31"	"$2,108.80"	"$2,130.10"	$0.00		$0.00	$404.56	$0.00	$0.00	$423.89	$0.00	$0.00	$0.00	$0.00	$0.00
238.705	SUP	HCPCS C1713		238.705  -  PLATE BONE 168MM 13.5X3.7MM 8 HOLE LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$2,742.50 "	"$2,029.45"	$0.00	"$2,130.10"	"$1,198.18"	"$1,198.18"	$0.00	$0.00	$0.00	$571.61	"$2,035.48"	"$2,035.48"	$0.00	$0.00	$571.54	$0.00	"$1,352.05"	"$1,352.05"	$0.00	"$1,331.31"	"$2,108.80"	"$2,130.10"	$0.00		$0.00	$404.56	$0.00	$0.00	$423.89	$0.00	$0.00	$0.00	$0.00	$0.00
238.706	SUP	HCPCS C1713		238.706  -  PLATE BONE 194MM 13.5X3.7MM 10 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$2,770.63 "	"$2,050.27"	$0.00	"$2,151.94"	"$1,210.47"	"$1,210.47"	$0.00	$0.00	$0.00	$577.47	"$2,056.36"	"$2,056.36"	$0.00	$0.00	$577.40	$0.00	"$1,365.92"	"$1,365.92"	$0.00	"$1,344.96"	"$2,130.42"	"$2,151.94"	$0.00		$0.00	$408.71	$0.00	$0.00	$428.24	$0.00	$0.00	$0.00	$0.00	$0.00
238.707	SUP	HCPCS C1713		238.707  -  PLATE BONE 194MM 13.5X3.7MM 10 HOLE LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$2,770.63 "	"$2,050.27"	$0.00	"$2,151.94"	"$1,210.47"	"$1,210.47"	$0.00	$0.00	$0.00	$577.47	"$2,056.36"	"$2,056.36"	$0.00	$0.00	$577.40	$0.00	"$1,365.92"	"$1,365.92"	$0.00	"$1,344.96"	"$2,130.42"	"$2,151.94"	$0.00		$0.00	$408.71	$0.00	$0.00	$428.24	$0.00	$0.00	$0.00	$0.00	$0.00
238.708	SUP	HCPCS C1713		238.708  -  PLATE BONE 220MM 13.5X3.7MM 12 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$2,801.55 "	"$2,073.15"	$0.00	"$2,175.96"	"$1,223.98"	"$1,223.98"	$0.00	$0.00	$0.00	$583.91	"$2,079.31"	"$2,079.31"	$0.00	$0.00	$583.84	$0.00	"$1,381.16"	"$1,381.16"	$0.00	"$1,359.98"	"$2,154.20"	"$2,175.96"	$0.00		$0.00	$413.27	$0.00	$0.00	$433.02	$0.00	$0.00	$0.00	$0.00	$0.00
238.709	SUP	HCPCS C1713		238.709  -  PLATE BONE 220MM 13.5X3.7MM 12 HOLE LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$2,801.55 "	"$2,073.15"	$0.00	"$2,175.96"	"$1,223.98"	"$1,223.98"	$0.00	$0.00	$0.00	$583.91	"$2,079.31"	"$2,079.31"	$0.00	$0.00	$583.84	$0.00	"$1,381.16"	"$1,381.16"	$0.00	"$1,359.98"	"$2,154.20"	"$2,175.96"	$0.00		$0.00	$413.27	$0.00	$0.00	$433.02	$0.00	$0.00	$0.00	$0.00	$0.00
238.71	SUP	HCPCS C1713		238.710  -  PLATE BONE 246MM 14 HOLE LCP STAINLESS STEEL RIGHT DISTAL	BOTH IP/OP	"$2,755.43 "	"$2,039.02"	$0.00	"$2,204.34"	"$1,239.94"	"$1,239.94"	$0.00	$0.00	$0.00	$574.30	"$2,045.08"	"$2,045.08"	$0.00	$0.00	$574.23	$0.00	"$1,358.42"	"$1,358.42"	$0.00	"$1,377.71"	"$2,182.30"	"$2,204.34"	$0.00		$0.00	$418.66	$0.00	$0.00	$438.66	$0.00	$0.00	$0.00	$0.00	$0.00
238.711	SUP	HCPCS C1713		238.711  -  PLATE BONE 246MM 13.5X3.7MM 14 HOLE LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$2,838.10 "	"$2,100.19"	$0.00	"$2,204.34"	"$1,239.94"	"$1,239.94"	$0.00	$0.00	$0.00	$591.53	"$2,106.44"	"$2,106.44"	$0.00	$0.00	$591.46	$0.00	"$1,399.18"	"$1,399.18"	$0.00	"$1,377.71"	"$2,182.30"	"$2,204.34"	$0.00		$0.00	$418.66	$0.00	$0.00	$438.66	$0.00	$0.00	$0.00	$0.00	$0.00
238.94	SUP	HCPCS C1713		238.94  -  PLATE BONE 130D 152MM 70MM 9 HOLE DCP STAINLESS STEEL	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
238.96	SUP	HCPCS C1713		238.96  -  PLATE BONE 130D 152MM 80MM 9 HOLE DCP STAINLESS STEEL	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
238.98	SUP	HCPCS C1713		238.98  -  PLATE BONE 130D 154MM 90MM 9 HOLE DCP STAINLESS STEEL	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.2	SUP	HCPCS C1713		239.20  -  PLATE BN 90D 10MM DSPL 50MM NS DCP SS ADLT OSTM	BOTH IP/OP	"$1,007.18 "	$745.31	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$209.92	$747.53	$747.53	$0.00	$0.00	$209.90	$0.00	$595.74	$595.74	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.21	SUP	HCPCS C1713		239.21  -  PLATE BN 90D 10MM DSPL 55MM NS DCP SS ADLT OSTM	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.22	SUP	HCPCS C1713		239.22  -  PLATE BONE 90D 10MM 60MMX94MM 4X1 HOLE BLADE DCP STAINLESS	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.23	SUP	HCPCS C1713		239.23  -  PLATE BONE 90D 10MM 65MMX94MM 4X1 HOLE BLADE DCP STAINLESS	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.24	SUP	HCPCS C1713		239.24  -  PLATE BONE 90D 10MM 70MMX94MM 4X1 HOLE BLADE DCP STAINLESS	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.28	SUP	HCPCS C1713		239.28  -  PLATE BN 90D 10MM DSPL 40MM NS DCP SS ADLT OSTM	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.3	SUP	HCPCS C1713		239.30  -  PLATE BONE 100D 10MM 50MMX94MM 4X1 HOLE BLADE DCP STAINLESS	BOTH IP/OP	"$1,007.18 "	$745.31	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$209.92	$747.53	$747.53	$0.00	$0.00	$209.90	$0.00	$595.74	$595.74	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.32	SUP	HCPCS C1713		239.32  -  PLATE BONE 100D 10MM 60MMX94MM 4X1 HOLE BLADE DCP STAINLESS	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.43	SUP	HCPCS C1713		239.43  -  PLATE BONE 110D 65MMX94MM 4X1 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.45	SUP	HCPCS C1713		239.45  -  PLATE BONE 110D 75MMX94MM 4X1 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.47	SUP	HCPCS C1713		239.47  -  PLATE BONE 110D 85MMX94MM 4X1 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.53	SUP	HCPCS C1713		239.53  -  PLATE BONE 120D 65MMX94MM 4X1 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.55	SUP	HCPCS C1713		239.55  -  PLATE BONE 120D 75MMX94MM 4X1 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.57	SUP	HCPCS C1713		239.57  -  PLATE BONE 120D 85MMX94MM 4X1 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.6	SUP	HCPCS C1713		239.60  -  PLATE BONE 90D 10MM 50MMX94MM 4X1 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,007.18 "	$745.31	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$209.92	$747.53	$747.53	$0.00	$0.00	$209.90	$0.00	$595.74	$595.74	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.62	SUP	HCPCS C1713		239.62  -  PLATE BONE 90D 20MM 60MMX94MM 4X1 HOLE BLADE DCP STAINLESS	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.64	SUP	HCPCS C1713		239.64  -  PLATE BONE 90D 20MM 70MMX94MM 4X1 HOLE BLADE DCP STAINLESS	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.7	SUP	HCPCS C1713		239.70  -  PLATE BONE 90D 15MM 50MMX94MM 4X1 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,007.18 "	$745.31	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$209.92	$747.53	$747.53	$0.00	$0.00	$209.90	$0.00	$595.74	$595.74	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.71	SUP	HCPCS C1713		239.71  -  PLATE BONE 90D 15MM 55MMX94MM 4X1 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.72	SUP	HCPCS C1713		239.72  -  PLATE BONE 90D 15MM 60MMX94MM 4X1 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.73	SUP	HCPCS C1713		239.73  -  PLATE BONE 90D 15MM 65MMX94MM 4X1 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.74	SUP	HCPCS C1713		239.74  -  PLATE BONE 90D 15MM 70MMX94MM 4X1 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.78	SUP	HCPCS C1713		239.78  -  PLATE BONE 90D 15MM 40MMX94MM 4X1 HOLE BLADE DCP STAINLESS	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.8	SUP	HCPCS C1713		239.80  -  PLATE BONE 130D 100MMX94MM 4X1 HOLE: ANGLED BLADE DCP	BOTH IP/OP	"$1,007.18 "	$745.31	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$209.92	$747.53	$747.53	$0.00	$0.00	$209.90	$0.00	$595.74	$595.74	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.81	SUP	HCPCS C1713		239.81  -  PLATE BONE 130D 105MMX94MM 4X1 HOLE: ANGLED BLADE DCP	BOTH IP/OP	$977.85 	$723.61	$0.00	$782.28	$440.03	$440.03	$0.00	$0.00	$0.00	$203.81	$725.76	$725.76	$0.00	$0.00	$203.78	$0.00	$578.40	$578.40	$0.00	$488.93	$774.46	$782.28	$0.00		$0.00	$153.03	$0.00	$0.00	$155.67	$0.00	$0.00	$0.00	$0.00	$0.00
239.83	SUP	HCPCS C1713		239.83  -  PLATE BONE 130D 65MMX94MM 4X1 HOLE: ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.84	SUP	HCPCS C1713		239.84  -  PLATE BONE 130D 65MM 70MM 4X1 HOLE: ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.85	SUP	HCPCS C1713		239.85  -  PLATE BONE 130D 75MMX94MM 4X1 HOLE: ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.86	SUP	HCPCS C1713		239.86  -  PLATE BONE 130D 80MMX94MM 4X1 HOLE: ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.87	SUP	HCPCS C1713		239.87  -  PLATE BONE 130D 85MMX94MM 4X1 HOLE: ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.88	SUP	HCPCS C1713		239.88  -  PLATE BONE 130D 90MMX94MM 4X1 HOLE: ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.89	SUP	HCPCS C1713		239.89  -  PLATE BONE 130D 95MMX94MM 4X1 HOLE: ANGLED BLADE DCP	BOTH IP/OP	"$1,037.40 "	$767.68	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$216.22	$769.96	$769.96	$0.00	$0.00	$216.19	$0.00	$613.62	$613.62	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
239.9	SUP	HCPCS C1713		239.900  -  PLATE BONE 116X11X3.7MM 4 HOLE PRECONTOUR LCP STAINLESS	BOTH IP/OP	"$2,734.95 "	"$2,023.86"	$0.00	"$2,187.96"	"$1,230.73"	"$1,230.73"	$0.00	$0.00	$0.00	$570.03	"$2,029.88"	"$2,029.88"	$0.00	$0.00	$569.96	$0.00	"$1,348.33"	"$1,348.33"	$0.00	"$1,367.48"	"$2,166.08"	"$2,187.96"	$0.00		$0.00	$415.55	$0.00	$0.00	$435.40	$0.00	$0.00	$0.00	$0.00	$0.00
239.901	SUP	HCPCS C1713		239.901  -  PLATE BONE 116X11X3.7MM 4 HOLE PRECONTOUR LCP STAINLESS	BOTH IP/OP	"$2,734.95 "	"$2,023.86"	$0.00	"$2,187.96"	"$1,230.73"	"$1,230.73"	$0.00	$0.00	$0.00	$570.03	"$2,029.88"	"$2,029.88"	$0.00	$0.00	$569.96	$0.00	"$1,348.33"	"$1,348.33"	$0.00	"$1,367.48"	"$2,166.08"	"$2,187.96"	$0.00		$0.00	$415.55	$0.00	$0.00	$435.40	$0.00	$0.00	$0.00	$0.00	$0.00
239.904	SUP	HCPCS C1713		239.904  -  PLATE BONE 142X11X3.7MM 6 HOLE PRECONTOUR LCP STAINLESS	BOTH IP/OP	"$2,763.63 "	"$2,045.09"	$0.00	"$2,210.90"	"$1,243.63"	"$1,243.63"	$0.00	$0.00	$0.00	$576.01	"$2,051.16"	"$2,051.16"	$0.00	$0.00	$575.94	$0.00	"$1,362.47"	"$1,362.47"	$0.00	"$1,381.81"	"$2,188.79"	"$2,210.90"	$0.00		$0.00	$419.91	$0.00	$0.00	$439.97	$0.00	$0.00	$0.00	$0.00	$0.00
239.905	SUP	HCPCS C1713		239.905  -  PLATE BONE 142X11X3.7MM 6 HOLE PRECONTOUR LCP STAINLESS	BOTH IP/OP	"$2,763.63 "	"$2,045.09"	$0.00	"$2,210.90"	"$1,243.63"	"$1,243.63"	$0.00	$0.00	$0.00	$576.01	"$2,051.16"	"$2,051.16"	$0.00	$0.00	$575.94	$0.00	"$1,362.47"	"$1,362.47"	$0.00	"$1,381.81"	"$2,188.79"	"$2,210.90"	$0.00		$0.00	$419.91	$0.00	$0.00	$439.97	$0.00	$0.00	$0.00	$0.00	$0.00
239.908	SUP	HCPCS C1713		239.908  -  PLATE BONE 168X11X3.7MM 8 HOLE PRECONTOURED LCP STAINLESS	BOTH IP/OP	"$2,789.55 "	"$2,064.27"	$0.00	"$2,231.64"	"$1,255.30"	"$1,255.30"	$0.00	$0.00	$0.00	$581.41	"$2,070.40"	"$2,070.40"	$0.00	$0.00	$581.34	$0.00	"$1,375.25"	"$1,375.25"	$0.00	"$1,394.78"	"$2,209.32"	"$2,231.64"	$0.00		$0.00	$423.85	$0.00	$0.00	$444.10	$0.00	$0.00	$0.00	$0.00	$0.00
239.909	SUP	HCPCS C1713		239.909  -  PLATE BONE 168X11X3.7MM 8 HOLE PRECONTOURED LCP STAINLESS	BOTH IP/OP	"$2,789.55 "	"$2,064.27"	$0.00	"$2,231.64"	"$1,255.30"	"$1,255.30"	$0.00	$0.00	$0.00	$581.41	"$2,070.40"	"$2,070.40"	$0.00	$0.00	$581.34	$0.00	"$1,375.25"	"$1,375.25"	$0.00	"$1,394.78"	"$2,209.32"	"$2,231.64"	$0.00		$0.00	$423.85	$0.00	$0.00	$444.10	$0.00	$0.00	$0.00	$0.00	$0.00
239.912	SUP	HCPCS C1713		239.912  -  PLATE BONE 194X11X3.7MM 10 HOLE PRECONTOUR LCP STAINLESS	BOTH IP/OP	"$2,820.95 "	"$2,087.50"	$0.00	"$2,256.76"	"$1,269.43"	"$1,269.43"	$0.00	$0.00	$0.00	$587.96	"$2,093.71"	"$2,093.71"	$0.00	$0.00	$587.89	$0.00	"$1,390.73"	"$1,390.73"	$0.00	"$1,410.48"	"$2,234.19"	"$2,256.76"	$0.00		$0.00	$428.62	$0.00	$0.00	$449.10	$0.00	$0.00	$0.00	$0.00	$0.00
239.913	SUP	HCPCS C1713		239.913  -  PLATE BONE 194X11X3.7MM 10 HOLE PRECONTOUR LCP STAINLESS	BOTH IP/OP	"$2,820.95 "	"$2,087.50"	$0.00	"$2,256.76"	"$1,269.43"	"$1,269.43"	$0.00	$0.00	$0.00	$587.96	"$2,093.71"	"$2,093.71"	$0.00	$0.00	$587.89	$0.00	"$1,390.73"	"$1,390.73"	$0.00	"$1,410.48"	"$2,234.19"	"$2,256.76"	$0.00		$0.00	$428.62	$0.00	$0.00	$449.10	$0.00	$0.00	$0.00	$0.00	$0.00
239.916	SUP	HCPCS C1713		239.916  -  PLATE BONE 220X11X3.7MM 12 HOLE PRECONTOUR LCP STAINLESS	BOTH IP/OP	"$2,850.98 "	"$2,109.73"	$0.00	"$2,280.78"	"$1,282.94"	"$1,282.94"	$0.00	$0.00	$0.00	$594.21	"$2,115.99"	"$2,115.99"	$0.00	$0.00	$594.14	$0.00	"$1,405.53"	"$1,405.53"	$0.00	"$1,425.49"	"$2,257.98"	"$2,280.78"	$0.00		$0.00	$433.18	$0.00	$0.00	$453.88	$0.00	$0.00	$0.00	$0.00	$0.00
239.917	SUP	HCPCS C1713		239.917  -  PLATE BONE 220X11X3.7MM 12 HOLE PRECONTOUR LCP STAINLESS	BOTH IP/OP	"$2,850.98 "	"$2,109.73"	$0.00	"$2,280.78"	"$1,282.94"	"$1,282.94"	$0.00	$0.00	$0.00	$594.21	"$2,115.99"	"$2,115.99"	$0.00	$0.00	$594.14	$0.00	"$1,405.53"	"$1,405.53"	$0.00	"$1,425.49"	"$2,257.98"	"$2,280.78"	$0.00		$0.00	$433.18	$0.00	$0.00	$453.88	$0.00	$0.00	$0.00	$0.00	$0.00
239.92	SUP	HCPCS C1713		239.920  -  PLATE BONE 246X11X3.7MM 14 HOLE PRECONTOUR LCP STAINLESS	BOTH IP/OP	"$2,886.45 "	"$2,135.97"	$0.00	"$2,309.16"	"$1,298.90"	"$1,298.90"	$0.00	$0.00	$0.00	$601.61	"$2,142.32"	"$2,142.32"	$0.00	$0.00	$601.54	$0.00	"$1,423.02"	"$1,423.02"	$0.00	"$1,443.23"	"$2,286.07"	"$2,309.16"	$0.00		$0.00	$438.57	$0.00	$0.00	$459.52	$0.00	$0.00	$0.00	$0.00	$0.00
239.921	SUP	HCPCS C1713		239.921  -  PLATE BONE 246X11X3.7MM 14 HOLE PRECONTOUR LCP STAINLESS	BOTH IP/OP	"$2,886.45 "	"$2,135.97"	$0.00	"$2,309.16"	"$1,298.90"	"$1,298.90"	$0.00	$0.00	$0.00	$601.61	"$2,142.32"	"$2,142.32"	$0.00	$0.00	$601.54	$0.00	"$1,423.02"	"$1,423.02"	$0.00	"$1,443.23"	"$2,286.07"	"$2,309.16"	$0.00		$0.00	$438.57	$0.00	$0.00	$459.52	$0.00	$0.00	$0.00	$0.00	$0.00
239.934	SUP	HCPCS C1713		239.934  -  PLATE BN CNTR 81MM NS LCP CMBN 4 HL LMT CNTCT SS TIB RT PROX	BOTH IP/OP	"$2,663.78 "	"$1,971.20"	$0.00	"$2,068.96"	"$1,163.79"	"$1,163.79"	$0.00	$0.00	$0.00	$555.20	"$1,977.05"	"$1,977.05"	$0.00	$0.00	$555.13	$0.00	"$1,313.24"	"$1,313.24"	$0.00	"$1,293.10"	"$2,048.27"	"$2,068.96"	$0.00		$0.00	$392.95	$0.00	$0.00	$411.72	$0.00	$0.00	$0.00	$0.00	$0.00
239.935	SUP	HCPCS C1713		239.935  -  PLATE BN CNTR 81MM NS LCP CMBN 4 HL LMT CNTCT SS TIB LT PROX	BOTH IP/OP	"$2,663.78 "	"$1,971.20"	$0.00	"$2,068.96"	"$1,163.79"	"$1,163.79"	$0.00	$0.00	$0.00	$555.20	"$1,977.05"	"$1,977.05"	$0.00	$0.00	$555.13	$0.00	"$1,313.24"	"$1,313.24"	$0.00	"$1,293.10"	"$2,048.27"	"$2,068.96"	$0.00		$0.00	$392.95	$0.00	$0.00	$411.72	$0.00	$0.00	$0.00	$0.00	$0.00
239.936	SUP	HCPCS C1713		239.936  -  PLATE BN CNTR 107MM NS LCP CMBN 6 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$2,696.13 "	"$1,995.14"	$0.00	"$2,094.08"	"$1,177.92"	"$1,177.92"	$0.00	$0.00	$0.00	$561.94	"$2,001.06"	"$2,001.06"	$0.00	$0.00	$561.87	$0.00	"$1,329.19"	"$1,329.19"	$0.00	"$1,308.80"	"$2,073.14"	"$2,094.08"	$0.00		$0.00	$397.72	$0.00	$0.00	$416.72	$0.00	$0.00	$0.00	$0.00	$0.00
239.937	SUP	HCPCS C1713		239.937  -  PLATE BN CNTR 107MM NS LCP CMBN 6 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$2,696.13 "	"$1,995.14"	$0.00	"$2,094.08"	"$1,177.92"	"$1,177.92"	$0.00	$0.00	$0.00	$561.94	"$2,001.06"	"$2,001.06"	$0.00	$0.00	$561.87	$0.00	"$1,329.19"	"$1,329.19"	$0.00	"$1,308.80"	"$2,073.14"	"$2,094.08"	$0.00		$0.00	$397.72	$0.00	$0.00	$416.72	$0.00	$0.00	$0.00	$0.00	$0.00
239.938	SUP	HCPCS C1713		239.938  -  PLATE BN CNTR 133MM NS LCP CMBN 8 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$2,727.05 "	"$2,018.02"	$0.00	"$2,118.10"	"$1,191.43"	"$1,191.43"	$0.00	$0.00	$0.00	$568.39	"$2,024.02"	"$2,024.02"	$0.00	$0.00	$568.32	$0.00	"$1,344.44"	"$1,344.44"	$0.00	"$1,323.81"	"$2,096.92"	"$2,118.10"	$0.00		$0.00	$402.28	$0.00	$0.00	$421.50	$0.00	$0.00	$0.00	$0.00	$0.00
239.939	SUP	HCPCS C1713		239.939  -  PLATE BN CNTR 133MM NS LCP CMBN 8 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$2,727.05 "	"$2,018.02"	$0.00	"$2,118.10"	"$1,191.43"	"$1,191.43"	$0.00	$0.00	$0.00	$568.39	"$2,024.02"	"$2,024.02"	$0.00	$0.00	$568.32	$0.00	"$1,344.44"	"$1,344.44"	$0.00	"$1,323.81"	"$2,096.92"	"$2,118.10"	$0.00		$0.00	$402.28	$0.00	$0.00	$421.50	$0.00	$0.00	$0.00	$0.00	$0.00
239.94	SUP	HCPCS C1713		239.940  -  PLATE BN CNTR 159MM NS LCP CMBN 10 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$2,676.28 "	"$1,980.45"	$0.00	"$2,141.02"	"$1,204.32"	"$1,204.32"	$0.00	$0.00	$0.00	$557.80	"$1,986.33"	"$1,986.33"	$0.00	$0.00	$557.74	$0.00	"$1,319.40"	"$1,319.40"	$0.00	"$1,338.14"	"$2,119.61"	"$2,141.02"	$0.00		$0.00	$406.64	$0.00	$0.00	$426.06	$0.00	$0.00	$0.00	$0.00	$0.00
239.941	SUP	HCPCS C1713		239.941  -  PLATE BN CNTR 159MM NS LCP CMBN 10 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$2,756.58 "	"$2,039.87"	$0.00	"$2,141.02"	"$1,204.32"	"$1,204.32"	$0.00	$0.00	$0.00	$574.54	"$2,045.93"	"$2,045.93"	$0.00	$0.00	$574.47	$0.00	"$1,358.99"	"$1,358.99"	$0.00	"$1,338.14"	"$2,119.61"	"$2,141.02"	$0.00		$0.00	$406.64	$0.00	$0.00	$426.06	$0.00	$0.00	$0.00	$0.00	$0.00
239.942	SUP	HCPCS C1713		239.942  -  PLATE BN CNTR 185MM NS LCP CMBN 12 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$2,793.10 "	"$2,066.89"	$0.00	"$2,169.40"	"$1,220.29"	"$1,220.29"	$0.00	$0.00	$0.00	$582.15	"$2,073.04"	"$2,073.04"	$0.00	$0.00	$582.08	$0.00	"$1,377.00"	"$1,377.00"	$0.00	"$1,355.88"	"$2,147.71"	"$2,169.40"	$0.00		$0.00	$412.03	$0.00	$0.00	$431.71	$0.00	$0.00	$0.00	$0.00	$0.00
239.943	SUP	HCPCS C1713		239.943  -  PLATE BN CNTR 185MM NS LCP CMBN 12 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$2,793.10 "	"$2,066.89"	$0.00	"$2,169.40"	"$1,220.29"	"$1,220.29"	$0.00	$0.00	$0.00	$582.15	"$2,073.04"	"$2,073.04"	$0.00	$0.00	$582.08	$0.00	"$1,377.00"	"$1,377.00"	$0.00	"$1,355.88"	"$2,147.71"	"$2,169.40"	$0.00		$0.00	$412.03	$0.00	$0.00	$431.71	$0.00	$0.00	$0.00	$0.00	$0.00
239.944	SUP	HCPCS C1713		239.944  -  PLATE BN CNTR 211MM NS LCP CMBN 14 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$2,822.63 "	"$2,088.75"	$0.00	"$2,192.34"	"$1,233.19"	"$1,233.19"	$0.00	$0.00	$0.00	$588.31	"$2,094.95"	"$2,094.95"	$0.00	$0.00	$588.24	$0.00	"$1,391.55"	"$1,391.55"	$0.00	"$1,370.21"	"$2,170.42"	"$2,192.34"	$0.00		$0.00	$416.38	$0.00	$0.00	$436.28	$0.00	$0.00	$0.00	$0.00	$0.00
239.945	SUP	HCPCS C1713		239.945  -  PLATE BN CNTR 211MM NS LCP CMBN 14 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$2,918.23 "	"$2,159.49"	$0.00	"$2,266.58"	"$1,274.95"	"$1,274.95"	$0.00	$0.00	$0.00	$608.23	"$2,165.91"	"$2,165.91"	$0.00	$0.00	$608.16	$0.00	"$1,438.68"	"$1,438.68"	$0.00	"$1,416.61"	"$2,243.92"	"$2,266.58"	$0.00		$0.00	$430.48	$0.00	$0.00	$451.05	$0.00	$0.00	$0.00	$0.00	$0.00
239.946	SUP	HCPCS C1713		239.946  -  PLATE BN CNTR 237MM NS LCP CMBN 16 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$3,020.83 "	"$2,235.41"	$0.00	"$2,346.28"	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$0.00	$629.62	"$2,242.06"	"$2,242.06"	$0.00	$0.00	$629.54	$0.00	"$1,489.27"	"$1,489.27"	$0.00	"$1,466.43"	"$2,322.82"	"$2,346.28"	$0.00		$0.00	$445.62	$0.00	$0.00	$466.91	$0.00	$0.00	$0.00	$0.00	$0.00
239.947	SUP	HCPCS C1713		239.947  -  PLATE BN CNTR 237MM NS LCP CMBN 16 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$3,020.83 "	"$2,235.41"	$0.00	"$2,346.28"	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$0.00	$629.62	"$2,242.06"	"$2,242.06"	$0.00	$0.00	$629.54	$0.00	"$1,489.27"	"$1,489.27"	$0.00	"$1,466.43"	"$2,322.82"	"$2,346.28"	$0.00		$0.00	$445.62	$0.00	$0.00	$466.91	$0.00	$0.00	$0.00	$0.00	$0.00
239.954	SUP	HCPCS C1713		239.954  -  PLATE 94MM SS 3.5MM SCR 4 HOLE LCP BONE RIGHT PROX TIB	BOTH IP/OP	"$2,655.35 "	"$1,964.96"	$0.00	"$2,610.74"	"$1,468.54"	"$1,468.54"	$0.00	$0.00	$0.00	$553.44	"$1,970.80"	"$1,970.80"	$0.00	$0.00	$553.37	$0.00	"$1,309.09"	"$1,309.09"	$0.00	"$1,631.71"	"$2,584.64"	"$2,610.74"	$0.00		$0.00	$510.73	$0.00	$0.00	$519.54	$0.00	$0.00	$0.00	$0.00	$0.00
239.955	SUP	HCPCS C1713		239.955  -  PLATE BN CNTR 93MM NS LCP CMBN 4 HL LMT CNTCT SS TIB LT PROX	BOTH IP/OP	"$2,502.93 "	"$1,852.17"	$0.00	"$2,002.34"	"$1,126.32"	"$1,126.32"	$0.00	$0.00	$0.00	$521.67	"$1,857.67"	"$1,857.67"	$0.00	$0.00	$521.61	$0.00	"$1,233.94"	"$1,233.94"	$0.00	"$1,251.46"	"$1,982.32"	"$2,002.34"	$0.00		$0.00	$391.71	$0.00	$0.00	$398.47	$0.00	$0.00	$0.00	$0.00	$0.00
239.956	SUP	HCPCS C1713		239.956  -  PLATE 119MM SS 3.5MM SCR 6 HOLE LCP BONE RIGHT MDL PROX TIB	BOTH IP/OP	"$2,690.50 "	"$1,990.97"	$0.00	"$2,643.40"	"$1,486.91"	"$1,486.91"	$0.00	$0.00	$0.00	$560.77	"$1,996.89"	"$1,996.89"	$0.00	$0.00	$560.70	$0.00	"$1,326.42"	"$1,326.42"	$0.00	"$1,652.13"	"$2,616.97"	"$2,643.40"	$0.00		$0.00	$517.12	$0.00	$0.00	$526.04	$0.00	$0.00	$0.00	$0.00	$0.00
239.957	SUP	HCPCS C1713		239.957  -  PLATE BN CNTR 119MM NS LCP CMBN 6 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$2,690.50 "	"$1,990.97"	$0.00	"$2,089.70"	"$1,175.46"	"$1,175.46"	$0.00	$0.00	$0.00	$560.77	"$1,996.89"	"$1,996.89"	$0.00	$0.00	$560.70	$0.00	"$1,326.42"	"$1,326.42"	$0.00	"$1,306.06"	"$2,068.81"	"$2,089.70"	$0.00		$0.00	$396.89	$0.00	$0.00	$415.85	$0.00	$0.00	$0.00	$0.00	$0.00
239.958	SUP	HCPCS C1713		239.958  -  PLATE BN CNTR 145MM NS LCP CMBN 8 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$2,722.83 "	"$2,014.89"	$0.00	"$2,114.82"	"$1,189.59"	"$1,189.59"	$0.00	$0.00	$0.00	$567.50	"$2,020.88"	"$2,020.88"	$0.00	$0.00	$567.44	$0.00	"$1,342.35"	"$1,342.35"	$0.00	"$1,321.76"	"$2,093.68"	"$2,114.82"	$0.00		$0.00	$401.66	$0.00	$0.00	$420.85	$0.00	$0.00	$0.00	$0.00	$0.00
239.959	SUP	HCPCS C1713		239.959  -  PLATE BN CNTR 145MM NS LCP CMBN 8 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$2,722.83 "	"$2,014.89"	$0.00	"$2,114.82"	"$1,189.59"	"$1,189.59"	$0.00	$0.00	$0.00	$567.50	"$2,020.88"	"$2,020.88"	$0.00	$0.00	$567.44	$0.00	"$1,342.35"	"$1,342.35"	$0.00	"$1,321.76"	"$2,093.68"	"$2,114.82"	$0.00		$0.00	$401.66	$0.00	$0.00	$420.85	$0.00	$0.00	$0.00	$0.00	$0.00
239.96	SUP	HCPCS C1713		239.960  -  PLATE BN CNTR 171MM NS LCP CMBN 10 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$2,673.55 "	"$1,978.43"	$0.00	"$2,138.84"	"$1,203.10"	"$1,203.10"	$0.00	$0.00	$0.00	$557.23	"$1,984.31"	"$1,984.31"	$0.00	$0.00	$557.17	$0.00	"$1,318.06"	"$1,318.06"	$0.00	"$1,336.78"	"$2,117.45"	"$2,138.84"	$0.00		$0.00	$406.22	$0.00	$0.00	$425.63	$0.00	$0.00	$0.00	$0.00	$0.00
239.961	SUP	HCPCS C1713		239.961  -  PLATE BN CNTR 171MM NS LCP CMBN 10 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$2,753.75 "	"$2,037.78"	$0.00	"$2,138.84"	"$1,203.10"	"$1,203.10"	$0.00	$0.00	$0.00	$573.95	"$2,043.83"	"$2,043.83"	$0.00	$0.00	$573.88	$0.00	"$1,357.60"	"$1,357.60"	$0.00	"$1,336.78"	"$2,117.45"	"$2,138.84"	$0.00		$0.00	$406.22	$0.00	$0.00	$425.63	$0.00	$0.00	$0.00	$0.00	$0.00
239.962	SUP	HCPCS C1713		239.962  -  PLATE BN CNTR 197MM NS LCP CMBN 12 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$2,783.28 "	"$2,059.63"	$0.00	"$2,161.76"	"$1,215.99"	"$1,215.99"	$0.00	$0.00	$0.00	$580.10	"$2,065.75"	"$2,065.75"	$0.00	$0.00	$580.03	$0.00	"$1,372.15"	"$1,372.15"	$0.00	"$1,351.10"	"$2,140.14"	"$2,161.76"	$0.00		$0.00	$410.58	$0.00	$0.00	$430.19	$0.00	$0.00	$0.00	$0.00	$0.00
239.963	SUP	HCPCS C1713		239.963  -  PLATE BN CNTR 197MM NS LCP CMBN 12 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$2,783.28 "	"$2,059.63"	$0.00	"$2,161.76"	"$1,215.99"	"$1,215.99"	$0.00	$0.00	$0.00	$580.10	"$2,065.75"	"$2,065.75"	$0.00	$0.00	$580.03	$0.00	"$1,372.15"	"$1,372.15"	$0.00	"$1,351.10"	"$2,140.14"	"$2,161.76"	$0.00		$0.00	$410.58	$0.00	$0.00	$430.19	$0.00	$0.00	$0.00	$0.00	$0.00
239.964	SUP	HCPCS C1713		239.964  -  PLATE BN CNTR 223MM NS LCP CMBN 4 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$2,817.00 "	"$2,084.58"	$0.00	"$2,187.96"	"$1,230.73"	"$1,230.73"	$0.00	$0.00	$0.00	$587.13	"$2,090.78"	"$2,090.78"	$0.00	$0.00	$587.06	$0.00	"$1,388.78"	"$1,388.78"	$0.00	"$1,367.48"	"$2,166.08"	"$2,187.96"	$0.00		$0.00	$415.55	$0.00	$0.00	$435.40	$0.00	$0.00	$0.00	$0.00	$0.00
239.965	SUP	HCPCS C1713		239.965  -  PLATE BN CNTR 223MM NS LCP CMBN 4 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$2,817.00 "	"$2,084.58"	$0.00	"$2,187.96"	"$1,230.73"	"$1,230.73"	$0.00	$0.00	$0.00	$587.13	"$2,090.78"	"$2,090.78"	$0.00	$0.00	$587.06	$0.00	"$1,388.78"	"$1,388.78"	$0.00	"$1,367.48"	"$2,166.08"	"$2,187.96"	$0.00		$0.00	$415.55	$0.00	$0.00	$435.40	$0.00	$0.00	$0.00	$0.00	$0.00
239.966	SUP	HCPCS C1713		239.966  -  PLATE BN CNTR 249MM NS LCP CMBN 16 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$3,013.80 "	"$2,230.21"	$0.00	"$2,340.82"	"$1,316.71"	"$1,316.71"	$0.00	$0.00	$0.00	$628.15	"$2,236.84"	"$2,236.84"	$0.00	$0.00	$628.08	$0.00	"$1,485.80"	"$1,485.80"	$0.00	"$1,463.01"	"$2,317.42"	"$2,340.82"	$0.00		$0.00	$444.59	$0.00	$0.00	$465.82	$0.00	$0.00	$0.00	$0.00	$0.00
239.967	SUP	HCPCS C1713		239.967  -  PLATE BN CNTR 249MM NS LCP CMBN 16 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$3,013.80 "	"$2,230.21"	$0.00	"$2,340.82"	"$1,316.71"	"$1,316.71"	$0.00	$0.00	$0.00	$628.15	"$2,236.84"	"$2,236.84"	$0.00	$0.00	$628.08	$0.00	"$1,485.80"	"$1,485.80"	$0.00	"$1,463.01"	"$2,317.42"	"$2,340.82"	$0.00		$0.00	$444.59	$0.00	$0.00	$465.82	$0.00	$0.00	$0.00	$0.00	$0.00
239.968	SUP	HCPCS C1713		239.968  -  PLATE BN CNTR 275MM NS LCP CMBN 18 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$3,122.05 "	"$2,310.32"	$0.00	"$2,424.88"	"$1,364.00"	"$1,364.00"	$0.00	$0.00	$0.00	$650.71	"$2,317.19"	"$2,317.19"	$0.00	$0.00	$650.64	$0.00	"$1,539.17"	"$1,539.17"	$0.00	"$1,515.55"	"$2,400.63"	"$2,424.88"	$0.00		$0.00	$460.55	$0.00	$0.00	$482.55	$0.00	$0.00	$0.00	$0.00	$0.00
239.969	SUP	HCPCS C1713		239.969  -  PLATE BN CNTR 275MM NS LCP CMBN 18 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$3,122.05 "	"$2,310.32"	$0.00	"$2,424.88"	"$1,364.00"	"$1,364.00"	$0.00	$0.00	$0.00	$650.71	"$2,317.19"	"$2,317.19"	$0.00	$0.00	$650.64	$0.00	"$1,539.17"	"$1,539.17"	$0.00	"$1,515.55"	"$2,400.63"	"$2,424.88"	$0.00		$0.00	$460.55	$0.00	$0.00	$482.55	$0.00	$0.00	$0.00	$0.00	$0.00
239.97	SUP	HCPCS C1713		239.970  -  PLATE BN CNTR 301MM NS LCP CMBN 20 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$3,130.73 "	"$2,316.74"	$0.00	"$2,504.58"	"$1,408.83"	"$1,408.83"	$0.00	$0.00	$0.00	$652.52	"$2,323.62"	"$2,323.62"	$0.00	$0.00	$652.44	$0.00	"$1,543.45"	"$1,543.45"	$0.00	"$1,565.36"	"$2,479.54"	"$2,504.58"	$0.00		$0.00	$475.69	$0.00	$0.00	$498.41	$0.00	$0.00	$0.00	$0.00	$0.00
239.971	SUP	HCPCS C1713		239.971  -  PLATE BN CNTR 301MM NS LCP CMBN 20 HL LMT CNTCT SS TIB LT	BOTH IP/OP	"$3,224.65 "	"$2,386.24"	$0.00	"$2,504.58"	"$1,408.83"	"$1,408.83"	$0.00	$0.00	$0.00	$672.10	"$2,393.34"	"$2,393.34"	$0.00	$0.00	$672.02	$0.00	"$1,589.75"	"$1,589.75"	$0.00	"$1,565.36"	"$2,479.54"	"$2,504.58"	$0.00		$0.00	$475.69	$0.00	$0.00	$498.41	$0.00	$0.00	$0.00	$0.00	$0.00
239.984	SUP	HCPCS C1713		239.984  -  PLATE BONE 106MM 4 HOLE PRECONTOUR LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$2,665.20 "	"$1,972.25"	$0.00	"$2,070.06"	"$1,164.41"	"$1,164.41"	$0.00	$0.00	$0.00	$555.49	"$1,978.11"	"$1,978.11"	$0.00	$0.00	$555.43	$0.00	"$1,313.94"	"$1,313.94"	$0.00	"$1,293.79"	"$2,049.36"	"$2,070.06"	$0.00		$0.00	$393.16	$0.00	$0.00	$411.94	$0.00	$0.00	$0.00	$0.00	$0.00
239.985	SUP	HCPCS C1713		239.985  -  PLATE BONE 106MM 4 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$2,665.20 "	"$1,972.25"	$0.00	"$2,070.06"	"$1,164.41"	"$1,164.41"	$0.00	$0.00	$0.00	$555.49	"$1,978.11"	"$1,978.11"	$0.00	$0.00	$555.43	$0.00	"$1,313.94"	"$1,313.94"	$0.00	"$1,293.79"	"$2,049.36"	"$2,070.06"	$0.00		$0.00	$393.16	$0.00	$0.00	$411.94	$0.00	$0.00	$0.00	$0.00	$0.00
239.986	SUP	HCPCS C1713		239.986  -  PLATE BONE 142MM 6 HOLE PRECONTOUR LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$2,697.53 "	"$1,996.17"	$0.00	"$2,095.16"	"$1,178.53"	"$1,178.53"	$0.00	$0.00	$0.00	$562.23	"$2,002.10"	"$2,002.10"	$0.00	$0.00	$562.16	$0.00	"$1,329.88"	"$1,329.88"	$0.00	"$1,309.48"	"$2,074.21"	"$2,095.16"	$0.00		$0.00	$397.93	$0.00	$0.00	$416.94	$0.00	$0.00	$0.00	$0.00	$0.00
239.987	SUP	HCPCS C1713		239.987  -  PLATE BONE 142MM 6 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$2,697.53 "	"$1,996.17"	$0.00	"$2,095.16"	"$1,178.53"	"$1,178.53"	$0.00	$0.00	$0.00	$562.23	"$2,002.10"	"$2,002.10"	$0.00	$0.00	$562.16	$0.00	"$1,329.88"	"$1,329.88"	$0.00	"$1,309.48"	"$2,074.21"	"$2,095.16"	$0.00		$0.00	$397.93	$0.00	$0.00	$416.94	$0.00	$0.00	$0.00	$0.00	$0.00
239.988	SUP	HCPCS C1713		239.988  -  PLATE BONE 178MM 8 HOLE LIMITED CONTACT PROFILE LCP	BOTH IP/OP	"$2,728.45 "	"$2,019.05"	$0.00	"$2,119.18"	"$1,192.04"	"$1,192.04"	$0.00	$0.00	$0.00	$568.68	"$2,025.06"	"$2,025.06"	$0.00	$0.00	$568.61	$0.00	"$1,345.13"	"$1,345.13"	$0.00	"$1,324.49"	"$2,097.99"	"$2,119.18"	$0.00		$0.00	$402.49	$0.00	$0.00	$421.72	$0.00	$0.00	$0.00	$0.00	$0.00
239.989	SUP	HCPCS C1713		239.989  -  PLATE BONE 178MM 8 HOLE LIMITED CONTACT PROFILE LCP	BOTH IP/OP	"$2,728.45 "	"$2,019.05"	$0.00	"$2,119.18"	"$1,192.04"	"$1,192.04"	$0.00	$0.00	$0.00	$568.68	"$2,025.06"	"$2,025.06"	$0.00	$0.00	$568.61	$0.00	"$1,345.13"	"$1,345.13"	$0.00	"$1,324.49"	"$2,097.99"	"$2,119.18"	$0.00		$0.00	$402.49	$0.00	$0.00	$421.72	$0.00	$0.00	$0.00	$0.00	$0.00
239.99	SUP	HCPCS C1713		239.990  -  PLATE BONE 214MM 10 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL	BOTH IP/OP	"$2,677.65 "	"$1,981.46"	$0.00	"$2,142.12"	"$1,204.94"	"$1,204.94"	$0.00	$0.00	$0.00	$558.09	"$1,987.35"	"$1,987.35"	$0.00	$0.00	$558.02	$0.00	"$1,320.08"	"$1,320.08"	$0.00	"$1,338.83"	"$2,120.70"	"$2,142.12"	$0.00		$0.00	$406.85	$0.00	$0.00	$426.28	$0.00	$0.00	$0.00	$0.00	$0.00
239.991	SUP	HCPCS C1713		239.991  -  PLATE BONE 214MM 10 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$2,757.98 "	"$2,040.91"	$0.00	"$2,142.12"	"$1,204.94"	"$1,204.94"	$0.00	$0.00	$0.00	$574.83	"$2,046.97"	"$2,046.97"	$0.00	$0.00	$574.76	$0.00	"$1,359.68"	"$1,359.68"	$0.00	"$1,338.83"	"$2,120.70"	"$2,142.12"	$0.00		$0.00	$406.85	$0.00	$0.00	$426.28	$0.00	$0.00	$0.00	$0.00	$0.00
239.992	SUP	HCPCS C1713		239.992  -  PLATE BONE 250MM 12 HOLE LCP STAINLESS STEEL TIBIA RIGHT	BOTH IP/OP	"$2,887.30 "	"$2,136.60"	$0.00	"$2,242.56"	"$1,261.44"	"$1,261.44"	$0.00	$0.00	$0.00	$601.79	"$2,142.95"	"$2,142.95"	$0.00	$0.00	$601.71	$0.00	"$1,423.44"	"$1,423.44"	$0.00	"$1,401.60"	"$2,220.13"	"$2,242.56"	$0.00		$0.00	$425.92	$0.00	$0.00	$446.27	$0.00	$0.00	$0.00	$0.00	$0.00
239.993	SUP	HCPCS C1713		239.993  -  PLATE BONE 250MM 12 HOLE LIMITED CONTACT PROFILE LCP	BOTH IP/OP	"$2,887.30 "	"$2,136.60"	$0.00	"$2,242.56"	"$1,261.44"	"$1,261.44"	$0.00	$0.00	$0.00	$601.79	"$2,142.95"	"$2,142.95"	$0.00	$0.00	$601.71	$0.00	"$1,423.44"	"$1,423.44"	$0.00	"$1,401.60"	"$2,220.13"	"$2,242.56"	$0.00		$0.00	$425.92	$0.00	$0.00	$446.27	$0.00	$0.00	$0.00	$0.00	$0.00
239.994	SUP	HCPCS C1713		239.994  -  PLATE BONE 286MM 14 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$2,918.23 "	"$2,159.49"	$0.00	"$2,266.58"	"$1,274.95"	"$1,274.95"	$0.00	$0.00	$0.00	$608.23	"$2,165.91"	"$2,165.91"	$0.00	$0.00	$608.16	$0.00	"$1,438.68"	"$1,438.68"	$0.00	"$1,416.61"	"$2,243.92"	"$2,266.58"	$0.00		$0.00	$430.48	$0.00	$0.00	$451.05	$0.00	$0.00	$0.00	$0.00	$0.00
239.995	SUP	HCPCS C1713		239.995  -  PLATE BONE 286MM 14 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$2,918.23 "	"$2,159.49"	$0.00	"$2,266.58"	"$1,274.95"	"$1,274.95"	$0.00	$0.00	$0.00	$608.23	"$2,165.91"	"$2,165.91"	$0.00	$0.00	$608.16	$0.00	"$1,438.68"	"$1,438.68"	$0.00	"$1,416.61"	"$2,243.92"	"$2,266.58"	$0.00		$0.00	$430.48	$0.00	$0.00	$451.05	$0.00	$0.00	$0.00	$0.00	$0.00
239.996	SUP	HCPCS C1713		239.996  -  PLATE BONE 322MM 16 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$2,947.73 "	"$2,181.32"	$0.00	"$2,289.50"	"$1,287.84"	"$1,287.84"	$0.00	$0.00	$0.00	$614.38	"$2,187.80"	"$2,187.80"	$0.00	$0.00	$614.31	$0.00	"$1,453.23"	"$1,453.23"	$0.00	"$1,430.94"	"$2,266.61"	"$2,289.50"	$0.00		$0.00	$434.84	$0.00	$0.00	$455.61	$0.00	$0.00	$0.00	$0.00	$0.00
239.997	SUP	HCPCS C1713		239.997  -  PLATE BONE 322MM 16 HOLE LCP STAINLESS STEEL LEFT PROXIMAL	BOTH IP/OP	"$2,947.73 "	"$2,181.32"	$0.00	"$2,289.50"	"$1,287.84"	"$1,287.84"	$0.00	$0.00	$0.00	$614.38	"$2,187.80"	"$2,187.80"	$0.00	$0.00	$614.31	$0.00	"$1,453.23"	"$1,453.23"	$0.00	"$1,430.94"	"$2,266.61"	"$2,289.50"	$0.00		$0.00	$434.84	$0.00	$0.00	$455.61	$0.00	$0.00	$0.00	$0.00	$0.00
240.002	SUP	HCPCS C1713		240.002  -  PLATE BONE 41MM 2 HOLE LCP STAINLESS STEEL TIBIA RIGHT	BOTH IP/OP	"$2,154.93 "	"$1,594.65"	$0.00	"$1,673.72"	$941.47	$941.47	$0.00	$0.00	$0.00	$449.14	"$1,599.39"	"$1,599.39"	$0.00	$0.00	$449.09	$0.00	"$1,274.64"	"$1,274.64"	$0.00	"$1,046.08"	"$1,656.98"	"$1,673.72"	$0.00		$0.00	$317.89	$0.00	$0.00	$333.07	$0.00	$0.00	$0.00	$0.00	$0.00
240.003	SUP	HCPCS C1713		240.003  -  PLATE BONE 41MM 2 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$2,154.93 "	"$1,594.65"	$0.00	"$1,673.72"	$941.47	$941.47	$0.00	$0.00	$0.00	$449.14	"$1,599.39"	"$1,599.39"	$0.00	$0.00	$449.09	$0.00	"$1,274.64"	"$1,274.64"	$0.00	"$1,046.08"	"$1,656.98"	"$1,673.72"	$0.00		$0.00	$317.89	$0.00	$0.00	$333.07	$0.00	$0.00	$0.00	$0.00	$0.00
240.004	SUP	HCPCS C1713		240.004  -  PLATE BONE 73MM 4 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL	BOTH IP/OP	"$2,160.55 "	"$1,598.81"	$0.00	"$1,678.10"	$943.93	$943.93	$0.00	$0.00	$0.00	$450.31	"$1,603.56"	"$1,603.56"	$0.00	$0.00	$450.26	$0.00	"$1,277.97"	"$1,277.97"	$0.00	"$1,048.81"	"$1,661.32"	"$1,678.10"	$0.00		$0.00	$318.72	$0.00	$0.00	$333.94	$0.00	$0.00	$0.00	$0.00	$0.00
240.005	SUP	HCPCS C1713		240.005  -  PLATE BONE 73MM 4 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$2,160.55 "	"$1,598.81"	$0.00	"$1,678.10"	$943.93	$943.93	$0.00	$0.00	$0.00	$450.31	"$1,603.56"	"$1,603.56"	$0.00	$0.00	$450.26	$0.00	"$1,277.97"	"$1,277.97"	$0.00	"$1,048.81"	"$1,661.32"	"$1,678.10"	$0.00		$0.00	$318.72	$0.00	$0.00	$333.94	$0.00	$0.00	$0.00	$0.00	$0.00
240.006	SUP	HCPCS C1713		240.006  -  PLATE BONE 109MM 6 HOLE LCP STAINLESS STEEL TIBIA RIGHT	BOTH IP/OP	"$2,164.78 "	"$1,601.94"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$451.19	"$1,606.70"	"$1,606.70"	$0.00	$0.00	$451.14	$0.00	"$1,280.46"	"$1,280.46"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$319.34	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
240.007	SUP	HCPCS C1713		240.007  -  PLATE BONE 109MM 6 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$2,164.78 "	"$1,601.94"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$451.19	"$1,606.70"	"$1,606.70"	$0.00	$0.00	$451.14	$0.00	"$1,280.46"	"$1,280.46"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$319.34	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
240.008	SUP	HCPCS C1713		240.008  -  PLATE BONE 145MM 8 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL	BOTH IP/OP	"$2,240.68 "	"$1,658.10"	$0.00	"$1,740.32"	$978.93	$978.93	$0.00	$0.00	$0.00	$467.01	"$1,663.03"	"$1,663.03"	$0.00	$0.00	$466.96	$0.00	"$1,325.36"	"$1,325.36"	$0.00	"$1,087.70"	"$1,722.92"	"$1,740.32"	$0.00		$0.00	$330.54	$0.00	$0.00	$346.32	$0.00	$0.00	$0.00	$0.00	$0.00
240.009	SUP	HCPCS C1713		240.009  -  PLATE BONE 145MM 8 HOLE LCP STAINLESS STEEL LEFT PROXIMAL	BOTH IP/OP	"$2,240.68 "	"$1,658.10"	$0.00	"$1,740.32"	$978.93	$978.93	$0.00	$0.00	$0.00	$467.01	"$1,663.03"	"$1,663.03"	$0.00	$0.00	$466.96	$0.00	"$1,325.36"	"$1,325.36"	$0.00	"$1,087.70"	"$1,722.92"	"$1,740.32"	$0.00		$0.00	$330.54	$0.00	$0.00	$346.32	$0.00	$0.00	$0.00	$0.00	$0.00
240.01	SUP	HCPCS C1713		240.010  -  PLATE BONE 181MM 10 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL	BOTH IP/OP	"$2,180.88 "	"$1,613.85"	$0.00	"$1,744.70"	$981.39	$981.39	$0.00	$0.00	$0.00	$454.55	"$1,618.65"	"$1,618.65"	$0.00	$0.00	$454.49	$0.00	"$1,289.99"	"$1,289.99"	$0.00	"$1,090.44"	"$1,727.26"	"$1,744.70"	$0.00		$0.00	$331.37	$0.00	$0.00	$347.20	$0.00	$0.00	$0.00	$0.00	$0.00
240.011	SUP	HCPCS C1713		240.011  -  PLATE BONE 181MM 10 HOLE LCP STAINLESS STEEL LEFT PROXIMAL	BOTH IP/OP	"$2,246.30 "	"$1,662.26"	$0.00	"$1,744.70"	$981.39	$981.39	$0.00	$0.00	$0.00	$468.19	"$1,667.20"	"$1,667.20"	$0.00	$0.00	$468.13	$0.00	"$1,328.69"	"$1,328.69"	$0.00	"$1,090.44"	"$1,727.26"	"$1,744.70"	$0.00		$0.00	$331.37	$0.00	$0.00	$347.20	$0.00	$0.00	$0.00	$0.00	$0.00
240.012	SUP	HCPCS C1713		240.012  -  PLATE BONE 217MM 12 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL	BOTH IP/OP	"$2,402.33 "	"$1,777.72"	$0.00	"$1,865.88"	"$1,049.56"	"$1,049.56"	$0.00	$0.00	$0.00	$500.70	"$1,783.01"	"$1,783.01"	$0.00	$0.00	$500.64	$0.00	"$1,420.98"	"$1,420.98"	$0.00	"$1,166.18"	"$1,847.22"	"$1,865.88"	$0.00		$0.00	$354.38	$0.00	$0.00	$371.31	$0.00	$0.00	$0.00	$0.00	$0.00
240.013	SUP	HCPCS C1713		240.013  -  PLATE BONE 217MM 12 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$2,336.25 "	"$1,728.83"	$0.00	"$1,814.58"	"$1,020.70"	"$1,020.70"	$0.00	$0.00	$0.00	$486.93	"$1,733.96"	"$1,733.96"	$0.00	$0.00	$486.87	$0.00	"$1,381.89"	"$1,381.89"	$0.00	"$1,134.11"	"$1,796.44"	"$1,814.58"	$0.00		$0.00	$344.64	$0.00	$0.00	$361.10	$0.00	$0.00	$0.00	$0.00	$0.00
240.014	SUP	HCPCS C1713		240.014  -  PLATE BONE 4.5MM 14 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL	BOTH IP/OP	"$2,386.88 "	"$1,766.29"	$0.00	"$1,853.88"	"$1,042.81"	"$1,042.81"	$0.00	$0.00	$0.00	$497.48	"$1,771.54"	"$1,771.54"	$0.00	$0.00	$497.42	$0.00	"$1,411.84"	"$1,411.84"	$0.00	"$1,158.68"	"$1,835.34"	"$1,853.88"	$0.00		$0.00	$352.10	$0.00	$0.00	$368.92	$0.00	$0.00	$0.00	$0.00	$0.00
240.015	SUP	HCPCS C1713		240.015  -  PLATE BONE 4.5MM 14 HOLE LCP STAINLESS STEEL LEFT PROXIMAL	BOTH IP/OP	"$2,386.88 "	"$1,766.29"	$0.00	"$1,853.88"	"$1,042.81"	"$1,042.81"	$0.00	$0.00	$0.00	$497.48	"$1,771.54"	"$1,771.54"	$0.00	$0.00	$497.42	$0.00	"$1,411.84"	"$1,411.84"	$0.00	"$1,158.68"	"$1,835.34"	"$1,853.88"	$0.00		$0.00	$352.10	$0.00	$0.00	$368.92	$0.00	$0.00	$0.00	$0.00	$0.00
240.019	SUP	Custom 27803010		240.019  -  WASHER ORTHOPEDIC 4.5MM 3.5MM LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	$99.10 	$73.33	$0.00	$76.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.55	$73.55	$0.00	$0.00	$20.65	$0.00	$0.00	$0.00	$0.00	$48.10	$76.19	$76.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
240.036	SUP	HCPCS C1713		240.036  -  PLATE BN CNTR 82MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS TIB	BOTH IP/OP	"$2,666.60 "	"$1,973.28"	$0.00	"$2,071.14"	"$1,165.02"	"$1,165.02"	$0.00	$0.00	$0.00	$555.79	"$1,979.15"	"$1,979.15"	$0.00	$0.00	$555.72	$0.00	"$1,314.63"	"$1,314.63"	$0.00	"$1,294.46"	"$2,050.43"	"$2,071.14"	$0.00		$0.00	$393.37	$0.00	$0.00	$412.16	$0.00	$0.00	$0.00	$0.00	$0.00
240.037	SUP	HCPCS C1713		240.037  -  PLATE BN CNTR 82MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS TIB	BOTH IP/OP	"$2,666.60 "	"$1,973.28"	$0.00	"$2,071.14"	"$1,165.02"	"$1,165.02"	$0.00	$0.00	$0.00	$555.79	"$1,979.15"	"$1,979.15"	$0.00	$0.00	$555.72	$0.00	"$1,314.63"	"$1,314.63"	$0.00	"$1,294.46"	"$2,050.43"	"$2,071.14"	$0.00		$0.00	$393.37	$0.00	$0.00	$412.16	$0.00	$0.00	$0.00	$0.00	$0.00
240.038	SUP	HCPCS C1713		240.038  -  PLATE BN CNTR 118MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$2,698.93 "	"$1,997.21"	$0.00	"$2,096.26"	"$1,179.15"	"$1,179.15"	$0.00	$0.00	$0.00	$562.52	"$2,003.14"	"$2,003.14"	$0.00	$0.00	$562.46	$0.00	"$1,330.57"	"$1,330.57"	$0.00	"$1,310.16"	"$2,075.30"	"$2,096.26"	$0.00		$0.00	$398.14	$0.00	$0.00	$417.16	$0.00	$0.00	$0.00	$0.00	$0.00
240.039	SUP	HCPCS C1713		240.039  -  PLATE BN CNTR 118MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$2,698.93 "	"$1,997.21"	$0.00	"$2,096.26"	"$1,179.15"	"$1,179.15"	$0.00	$0.00	$0.00	$562.52	"$2,003.14"	"$2,003.14"	$0.00	$0.00	$562.46	$0.00	"$1,330.57"	"$1,330.57"	$0.00	"$1,310.16"	"$2,075.30"	"$2,096.26"	$0.00		$0.00	$398.14	$0.00	$0.00	$417.16	$0.00	$0.00	$0.00	$0.00	$0.00
240.04	SUP	HCPCS C1713		240.040  -  PLATE BN CNTR 154MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$2,650.35 "	"$1,961.26"	$0.00	"$2,120.28"	"$1,192.66"	"$1,192.66"	$0.00	$0.00	$0.00	$552.40	"$1,967.09"	"$1,967.09"	$0.00	$0.00	$552.33	$0.00	"$1,306.62"	"$1,306.62"	$0.00	"$1,325.18"	"$2,099.08"	"$2,120.28"	$0.00		$0.00	$402.70	$0.00	$0.00	$421.94	$0.00	$0.00	$0.00	$0.00	$0.00
240.041	SUP	HCPCS C1713		240.041  -  PLATE BN CNTR 154MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$2,729.85 "	"$2,020.09"	$0.00	"$2,120.28"	"$1,192.66"	"$1,192.66"	$0.00	$0.00	$0.00	$568.97	"$2,026.09"	"$2,026.09"	$0.00	$0.00	$568.90	$0.00	"$1,345.82"	"$1,345.82"	$0.00	"$1,325.18"	"$2,099.08"	"$2,120.28"	$0.00		$0.00	$402.70	$0.00	$0.00	$421.94	$0.00	$0.00	$0.00	$0.00	$0.00
240.042	SUP	HCPCS C1713		240.042  -  PLATE BN CNTR 190MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$2,759.38 "	"$2,041.94"	$0.00	"$2,143.20"	"$1,205.55"	"$1,205.55"	$0.00	$0.00	$0.00	$575.12	"$2,048.01"	"$2,048.01"	$0.00	$0.00	$575.05	$0.00	"$1,360.37"	"$1,360.37"	$0.00	"$1,339.50"	"$2,121.77"	"$2,143.20"	$0.00		$0.00	$407.05	$0.00	$0.00	$426.50	$0.00	$0.00	$0.00	$0.00	$0.00
240.043	SUP	HCPCS C1713		240.043  -  PLATE BN CNTR 190MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$2,759.38 "	"$2,041.94"	$0.00	"$2,143.20"	"$1,205.55"	"$1,205.55"	$0.00	$0.00	$0.00	$575.12	"$2,048.01"	"$2,048.01"	$0.00	$0.00	$575.05	$0.00	"$1,360.37"	"$1,360.37"	$0.00	"$1,339.50"	"$2,121.77"	"$2,143.20"	$0.00		$0.00	$407.05	$0.00	$0.00	$426.50	$0.00	$0.00	$0.00	$0.00	$0.00
240.044	SUP	HCPCS C1713		240.044  -  PLATE BN CNTR 226MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$2,791.70 "	"$2,065.86"	$0.00	"$2,168.32"	"$1,219.68"	"$1,219.68"	$0.00	$0.00	$0.00	$581.86	"$2,072.00"	"$2,072.00"	$0.00	$0.00	$581.79	$0.00	"$1,376.31"	"$1,376.31"	$0.00	"$1,355.20"	"$2,146.64"	"$2,168.32"	$0.00		$0.00	$411.82	$0.00	$0.00	$431.50	$0.00	$0.00	$0.00	$0.00	$0.00
240.045	SUP	HCPCS C1713		240.045  -  PLATE BN CNTR 226MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$2,791.70 "	"$2,065.86"	$0.00	"$2,168.32"	"$1,219.68"	"$1,219.68"	$0.00	$0.00	$0.00	$581.86	"$2,072.00"	"$2,072.00"	$0.00	$0.00	$581.79	$0.00	"$1,376.31"	"$1,376.31"	$0.00	"$1,355.20"	"$2,146.64"	"$2,168.32"	$0.00		$0.00	$411.82	$0.00	$0.00	$431.50	$0.00	$0.00	$0.00	$0.00	$0.00
240.046	SUP	HCPCS C1713		240.046  -  PLATE BN CNTR 262MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$2,821.23 "	"$2,087.71"	$0.00	"$2,191.24"	"$1,232.57"	"$1,232.57"	$0.00	$0.00	$0.00	$588.01	"$2,093.91"	"$2,093.91"	$0.00	$0.00	$587.94	$0.00	"$1,390.86"	"$1,390.86"	$0.00	"$1,369.53"	"$2,169.33"	"$2,191.24"	$0.00		$0.00	$416.18	$0.00	$0.00	$436.06	$0.00	$0.00	$0.00	$0.00	$0.00
240.047	SUP	HCPCS C1713		240.047  -  PLATE BN CNTR 262MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$2,821.23 "	"$2,087.71"	$0.00	"$2,191.24"	"$1,232.57"	"$1,232.57"	$0.00	$0.00	$0.00	$588.01	"$2,093.91"	"$2,093.91"	$0.00	$0.00	$587.94	$0.00	"$1,390.86"	"$1,390.86"	$0.00	"$1,369.53"	"$2,169.33"	"$2,191.24"	$0.00		$0.00	$416.18	$0.00	$0.00	$436.06	$0.00	$0.00	$0.00	$0.00	$0.00
240.064	SUP	HCPCS C1713		240.064  -  PLATE BONE 4 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL	BOTH IP/OP	$482.30 	$356.90	$0.00	$385.84	$217.04	$217.04	$0.00	$0.00	$0.00	$100.52	$357.96	$357.96	$0.00	$0.00	$100.51	$0.00	$285.28	$285.28	$0.00	$241.15	$381.98	$385.84	$0.00		$0.00	$75.48	$0.00	$0.00	$76.78	$0.00	$0.00	$0.00	$0.00	$0.00
240.065	SUP	HCPCS C1713		240.065  -  PLATE BONE 5 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL	BOTH IP/OP	$514.10 	$380.43	$0.00	$411.28	$231.35	$231.35	$0.00	$0.00	$0.00	$107.15	$381.57	$381.57	$0.00	$0.00	$107.14	$0.00	$304.09	$304.09	$0.00	$257.05	$407.17	$411.28	$0.00		$0.00	$80.46	$0.00	$0.00	$81.84	$0.00	$0.00	$0.00	$0.00	$0.00
240.066	SUP	HCPCS C1713		240.066  -  PLATE BONE 6 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL	BOTH IP/OP	$544.58 	$402.99	$0.00	$435.66	$245.06	$245.06	$0.00	$0.00	$0.00	$113.50	$404.18	$404.18	$0.00	$0.00	$113.49	$0.00	$322.12	$322.12	$0.00	$272.29	$431.31	$435.66	$0.00		$0.00	$85.23	$0.00	$0.00	$86.70	$0.00	$0.00	$0.00	$0.00	$0.00
240.067	SUP	HCPCS C1713		240.067  -  PLATE BONE 7 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL	BOTH IP/OP	$580.35 	$429.46	$0.00	$464.28	$261.16	$261.16	$0.00	$0.00	$0.00	$120.96	$430.74	$430.74	$0.00	$0.00	$120.94	$0.00	$343.28	$343.28	$0.00	$290.18	$459.64	$464.28	$0.00		$0.00	$90.82	$0.00	$0.00	$92.39	$0.00	$0.00	$0.00	$0.00	$0.00
240.068	SUP	HCPCS C1713		240.068  -  PLATE BONE 8 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL	BOTH IP/OP	$614.80 	$454.95	$0.00	$491.84	$276.66	$276.66	$0.00	$0.00	$0.00	$128.14	$456.30	$456.30	$0.00	$0.00	$128.12	$0.00	$363.65	$363.65	$0.00	$307.40	$486.92	$491.84	$0.00		$0.00	$96.22	$0.00	$0.00	$97.88	$0.00	$0.00	$0.00	$0.00	$0.00
240.069	SUP	HCPCS C1713		240.069  -  PLATE BONE 9 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL	BOTH IP/OP	$643.95 	$476.52	$0.00	$515.16	$289.78	$289.78	$0.00	$0.00	$0.00	$134.22	$477.94	$477.94	$0.00	$0.00	$134.20	$0.00	$380.90	$380.90	$0.00	$321.98	$510.01	$515.16	$0.00		$0.00	$100.78	$0.00	$0.00	$102.52	$0.00	$0.00	$0.00	$0.00	$0.00
240.07	SUP	HCPCS C1713		240.070  -  LASER SURG 20 BACKSTOP	BOTH IP/OP	$677.08 	$501.04	$0.00	$541.66	$304.68	$304.68	$0.00	$0.00	$0.00	$141.12	$502.53	$502.53	$0.00	$0.00	$141.10	$0.00	$400.49	$400.49	$0.00	$338.54	$536.25	$541.66	$0.00		$0.00	$105.96	$0.00	$0.00	$107.79	$0.00	$0.00	$0.00	$0.00	$0.00
240.071	SUP	HCPCS C1713		240.071  -  PLATE BONE 11 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL	BOTH IP/OP	$734.05 	$543.20	$0.00	$587.24	$330.32	$330.32	$0.00	$0.00	$0.00	$152.99	$544.81	$544.81	$0.00	$0.00	$152.98	$0.00	$434.19	$434.19	$0.00	$367.03	$581.37	$587.24	$0.00		$0.00	$114.88	$0.00	$0.00	$116.86	$0.00	$0.00	$0.00	$0.00	$0.00
240.072	SUP	HCPCS C1713		240.072  -  PLATE BONE 12 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL	BOTH IP/OP	$760.55 	$562.81	$0.00	$608.44	$342.25	$342.25	$0.00	$0.00	$0.00	$158.52	$564.48	$564.48	$0.00	$0.00	$158.50	$0.00	$449.87	$449.87	$0.00	$380.28	$602.36	$608.44	$0.00		$0.00	$119.03	$0.00	$0.00	$121.08	$0.00	$0.00	$0.00	$0.00	$0.00
240.073	SUP	HCPCS C1713		240.073  -  PLATE BONE 13 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL	BOTH IP/OP	$812.23 	$601.05	$0.00	$649.78	$365.50	$365.50	$0.00	$0.00	$0.00	$169.29	$602.83	$602.83	$0.00	$0.00	$169.27	$0.00	$480.43	$480.43	$0.00	$406.11	$643.29	$649.78	$0.00		$0.00	$127.11	$0.00	$0.00	$129.31	$0.00	$0.00	$0.00	$0.00	$0.00
240.074	SUP	HCPCS C1713		240.074  -  PLATE BONE 14 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL	BOTH IP/OP	$857.28 	$634.39	$0.00	$685.82	$385.77	$385.77	$0.00	$0.00	$0.00	$178.68	$636.27	$636.27	$0.00	$0.00	$178.66	$0.00	$507.08	$507.08	$0.00	$428.64	$678.97	$685.82	$0.00		$0.00	$134.16	$0.00	$0.00	$136.48	$0.00	$0.00	$0.00	$0.00	$0.00
240.075	SUP	HCPCS C1713		240.075  -  PLATE BONE 15 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL	BOTH IP/OP	$912.93 	$675.57	$0.00	$730.34	$410.82	$410.82	$0.00	$0.00	$0.00	$190.28	$677.57	$677.57	$0.00	$0.00	$190.25	$0.00	$540.00	$540.00	$0.00	$456.46	$723.04	$730.34	$0.00		$0.00	$142.87	$0.00	$0.00	$145.34	$0.00	$0.00	$0.00	$0.00	$0.00
240.076	SUP	HCPCS C1713		240.076  -  PLATE BONE 16 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL	BOTH IP/OP	$995.08 	$736.36	$0.00	$796.06	$447.78	$447.78	$0.00	$0.00	$0.00	$207.40	$738.54	$738.54	$0.00	$0.00	$207.37	$0.00	$588.59	$588.59	$0.00	$497.54	$788.10	$796.06	$0.00		$0.00	$155.73	$0.00	$0.00	$158.42	$0.00	$0.00	$0.00	$0.00	$0.00
240.082	SUP	HCPCS C1713		240.082  -  PLATE BONE 173MM 7 HOLE PILON LCP STAINLESS STEEL DISTAL	BOTH IP/OP	"$3,212.00 "	"$2,376.88"	$0.00	"$2,494.76"	"$1,403.30"	"$1,403.30"	$0.00	$0.00	$0.00	$669.46	"$2,383.95"	"$2,383.95"	$0.00	$0.00	$669.38	$0.00	"$1,583.52"	"$1,583.52"	$0.00	"$1,559.23"	"$2,469.81"	"$2,494.76"	$0.00		$0.00	$599.36	$0.00	$0.00	$496.46	$0.00	$0.00	$0.00	$0.00	$0.00
240.083	SUP	HCPCS C1713		240.083  -  PLATE BONE 173MM 9 HOLE PILON CNTOUR LCP STAINLESS STEEL	BOTH IP/OP	"$3,380.70 "	"$2,501.72"	$0.00	"$2,625.78"	"$1,477.00"	"$1,477.00"	$0.00	$0.00	$0.00	$704.62	"$2,509.16"	"$2,509.16"	$0.00	$0.00	$704.54	$0.00	"$1,666.69"	"$1,666.69"	$0.00	"$1,641.11"	"$2,599.53"	"$2,625.78"	$0.00		$0.00	$498.71	$0.00	$0.00	$522.53	$0.00	$0.00	$0.00	$0.00	$0.00
240.13	SUP	HCPCS C1713		240.13  -  PLATE BONE T 68MM 3 HOLE DCP LC-DCP STAINLESS STEEL FT	BOTH IP/OP	$490.25 	$362.79	$0.00	$392.20	$220.61	$220.61	$0.00	$0.00	$0.00	$102.18	$363.86	$363.86	$0.00	$0.00	$102.17	$0.00	$289.98	$289.98	$0.00	$245.13	$388.28	$392.20	$0.00		$0.00	$76.72	$0.00	$0.00	$78.05	$0.00	$0.00	$0.00	$0.00	$0.00
240.14	SUP	HCPCS C1713		240.14  -  PLATE BN T 84MM NS 4 HL SHFT SS 4.5MM SCR LG FRAG SET	BOTH IP/OP	$551.03 	$407.76	$0.00	$427.98	$240.74	$240.74	$0.00	$0.00	$0.00	$114.85	$408.97	$408.97	$0.00	$0.00	$114.83	$0.00	$325.93	$325.93	$0.00	$267.49	$423.70	$427.98	$0.00		$0.00	$81.29	$0.00	$0.00	$85.17	$0.00	$0.00	$0.00	$0.00	$0.00
240.141	SUP	HCPCS C1713		240.141  -  PLATE BN T 83MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS 4.5/5	BOTH IP/OP	"$1,137.20 "	$841.53	$0.00	$883.26	$496.83	$496.83	$0.00	$0.00	$0.00	$237.02	$844.03	$844.03	$0.00	$0.00	$236.99	$0.00	$672.65	$672.65	$0.00	$552.04	$874.43	$883.26	$0.00		$0.00	$167.76	$0.00	$0.00	$175.77	$0.00	$0.00	$0.00	$0.00	$0.00
240.15	SUP	HCPCS C1713		240.15  -  PLATE BONE 100MM 5 HOLE T DCP LC-DCP STAINLESS STEEL FT	BOTH IP/OP	$560.48 	$414.76	$0.00	$448.38	$252.21	$252.21	$0.00	$0.00	$0.00	$116.82	$415.98	$415.98	$0.00	$0.00	$116.80	$0.00	$331.52	$331.52	$0.00	$280.24	$443.90	$448.38	$0.00		$0.00	$87.71	$0.00	$0.00	$89.23	$0.00	$0.00	$0.00	$0.00	$0.00
240.16	SUP	HCPCS C1713		240.16  -  PLATE BN T 116MM NS 6 HL SHFT SS 4.5MM SCR LG FRAG SET	BOTH IP/OP	$638.70 	$472.64	$0.00	$510.96	$287.42	$287.42	$0.00	$0.00	$0.00	$133.12	$474.04	$474.04	$0.00	$0.00	$133.11	$0.00	$377.79	$377.79	$0.00	$319.35	$505.85	$510.96	$0.00		$0.00	$97.05	$0.00	$0.00	$101.68	$0.00	$0.00	$0.00	$0.00	$0.00
240.161	SUP	HCPCS C1713		240.161  -  PLATE BN T 115MM NS LCP CMBN 6 HL LMT CNTCT TPR END SS 4.5/5	BOTH IP/OP	"$1,304.48 "	$965.32	$0.00	"$1,013.20"	$569.93	$569.93	$0.00	$0.00	$0.00	$271.89	$968.18	$968.18	$0.00	$0.00	$271.85	$0.00	$771.60	$771.60	$0.00	$633.25	"$1,003.07"	"$1,013.20"	$0.00		$0.00	$192.43	$0.00	$0.00	$201.63	$0.00	$0.00	$0.00	$0.00	$0.00
240.18	SUP	HCPCS C1713		240.18  -  PLATE BN T 148MM NS 8 HL SHFT SS 4.5MM SCR LG FRAG SET	BOTH IP/OP	$865.25 	$640.29	$0.00	$692.20	$389.36	$389.36	$0.00	$0.00	$0.00	$180.34	$642.19	$642.19	$0.00	$0.00	$180.32	$0.00	$511.80	$511.80	$0.00	$432.63	$685.28	$692.20	$0.00		$0.00	$131.47	$0.00	$0.00	$137.75	$0.00	$0.00	$0.00	$0.00	$0.00
240.181	SUP	HCPCS C1713		240.181  -  PLATE BN T 147MM NS LCP CMBN 8 HL LMT CNTCT TPR END SS 4.5/5	BOTH IP/OP	"$1,505.50 "	"$1,114.07"	$0.00	"$1,169.32"	$657.74	$657.74	$0.00	$0.00	$0.00	$313.78	"$1,117.38"	"$1,117.38"	$0.00	$0.00	$313.75	$0.00	$890.50	$890.50	$0.00	$730.83	"$1,157.63"	"$1,169.32"	$0.00		$0.00	$222.09	$0.00	$0.00	$232.69	$0.00	$0.00	$0.00	$0.00	$0.00
240.34	SUP	HCPCS C1713		240.34  -  PLATE BN TBTRS 80MM NS DCP 4 HL SHFT SS 4.5MM SCR LG FRAG	BOTH IP/OP	$814.88 	$603.01	$0.00	$651.90	$366.69	$366.69	$0.00	$0.00	$0.00	$169.84	$604.80	$604.80	$0.00	$0.00	$169.82	$0.00	$482.00	$482.00	$0.00	$407.44	$645.38	$651.90	$0.00		$0.00	$127.53	$0.00	$0.00	$129.73	$0.00	$0.00	$0.00	$0.00	$0.00
240.35	SUP	HCPCS C1713		240.35  -  PLATE BONE T 96MM 5 HOLE BUTTRESS DCP LC-DCP STAINLESS STEEL	BOTH IP/OP	$857.28 	$634.39	$0.00	$685.82	$385.77	$385.77	$0.00	$0.00	$0.00	$178.68	$636.27	$636.27	$0.00	$0.00	$178.66	$0.00	$507.08	$507.08	$0.00	$428.64	$678.97	$685.82	$0.00		$0.00	$134.16	$0.00	$0.00	$136.48	$0.00	$0.00	$0.00	$0.00	$0.00
240.36	SUP	HCPCS C1713		240.36  -  PLATE BONE T 112MM 6 HOLE BUTTRESS DCP STAINLESS STEEL FT	BOTH IP/OP	$940.40 	$695.90	$0.00	$730.42	$410.86	$410.86	$0.00	$0.00	$0.00	$196.00	$697.96	$697.96	$0.00	$0.00	$195.98	$0.00	$556.25	$556.25	$0.00	$456.51	$723.12	$730.42	$0.00		$0.00	$138.73	$0.00	$0.00	$145.35	$0.00	$0.00	$0.00	$0.00	$0.00
240.403	SUP	HCPCS C1713		240.403  -  PLATE BONE 87MM 3 HOLE BUTTRESS DCP STAINLESS STEEL TIBIAL	BOTH IP/OP	"$1,057.35 "	$782.44	$0.00	$845.88	$475.81	$475.81	$0.00	$0.00	$0.00	$220.38	$784.77	$784.77	$0.00	$0.00	$220.35	$0.00	$625.42	$625.42	$0.00	$528.68	$837.42	$845.88	$0.00		$0.00	$165.48	$0.00	$0.00	$168.33	$0.00	$0.00	$0.00	$0.00	$0.00
240.406	SUP	HCPCS C1713		240.406  -  PLATE BONE LEFT ANGLE L 115MM 6 HOLE BUTTRESS LC-DCP	BOTH IP/OP	"$1,018.10 "	$753.39	$0.00	$814.48	$458.15	$458.15	$0.00	$0.00	$0.00	$212.20	$755.63	$755.63	$0.00	$0.00	$212.17	$0.00	$602.21	$602.21	$0.00	$509.05	$806.34	$814.48	$0.00		$0.00	$154.69	$0.00	$0.00	$162.08	$0.00	$0.00	$0.00	$0.00	$0.00
240.407	SUP	HCPCS C1713		240.407  -  PLATE BONE LEFT ANGLE L 132MM 7 HOLE BUTTRESS LC-DCP	BOTH IP/OP	"$1,075.90 "	$796.17	$0.00	$860.72	$484.16	$484.16	$0.00	$0.00	$0.00	$224.24	$798.53	$798.53	$0.00	$0.00	$224.22	$0.00	$636.39	$636.39	$0.00	$537.95	$852.11	$860.72	$0.00		$0.00	$168.38	$0.00	$0.00	$171.28	$0.00	$0.00	$0.00	$0.00	$0.00
240.408	SUP	HCPCS C1713		240.408  -  PLATE BONE LEFT ANGLE L 148MM 8 HOLE BUTTRESS LC-DCP	BOTH IP/OP	"$1,162.78 "	$860.46	$0.00	$930.22	$523.25	$523.25	$0.00	$0.00	$0.00	$242.35	$863.01	$863.01	$0.00	$0.00	$242.32	$0.00	$687.78	$687.78	$0.00	$581.39	$920.92	$930.22	$0.00		$0.00	$176.67	$0.00	$0.00	$185.11	$0.00	$0.00	$0.00	$0.00	$0.00
240.44	SUP	HCPCS C1713		240.44  -  PLATE BN ANG LT L BTRS 86X14X3.8MM NS DCP 4 HL SHFT SS TIB	BOTH IP/OP	$734.23 	$543.33	$0.00	$587.38	$330.40	$330.40	$0.00	$0.00	$0.00	$153.03	$544.94	$544.94	$0.00	$0.00	$153.01	$0.00	$434.29	$434.29	$0.00	$367.11	$581.51	$587.38	$0.00		$0.00	$111.56	$0.00	$0.00	$116.89	$0.00	$0.00	$0.00	$0.00	$0.00
240.46	SUP	HCPCS C1713		240.46  -  PLATE BN BTRS 118X14X3.8MM NS DCP 5 HL SHFT SS TIBHD RL LG	BOTH IP/OP	"$1,266.50 "	$937.21	$0.00	"$1,013.20"	$569.93	$569.93	$0.00	$0.00	$0.00	$263.97	$940.00	$940.00	$0.00	$0.00	$263.94	$0.00	$749.13	$749.13	$0.00	$633.25	"$1,003.07"	"$1,013.20"	$0.00		$0.00	$192.43	$0.00	$0.00	$201.63	$0.00	$0.00	$0.00	$0.00	$0.00
240.47	SUP	HCPCS C1713		240.47  -  PLATE BN BTRS 149X14X3.8MM NS DCP 7 HL SHFT SS TIBHD RL LG	BOTH IP/OP	"$1,401.48 "	"$1,037.10"	$0.00	"$1,088.52"	$612.29	$612.29	$0.00	$0.00	$0.00	$292.10	"$1,040.17"	"$1,040.17"	$0.00	$0.00	$292.07	$0.00	$828.97	$828.97	$0.00	$680.33	"$1,077.63"	"$1,088.52"	$0.00		$0.00	$206.74	$0.00	$0.00	$216.62	$0.00	$0.00	$0.00	$0.00	$0.00
240.48	SUP	HCPCS C1713		240.48  -  PLATE BN BTRS 181X14X3.8MM NS DCP 9 HL SHFT SS TIBHD RL LG	BOTH IP/OP	"$1,495.65 "	"$1,106.78"	$0.00	"$1,161.68"	$653.45	$653.45	$0.00	$0.00	$0.00	$311.73	"$1,110.07"	"$1,110.07"	$0.00	$0.00	$311.69	$0.00	$884.68	$884.68	$0.00	$726.05	"$1,150.06"	"$1,161.68"	$0.00		$0.00	$220.63	$0.00	$0.00	$231.17	$0.00	$0.00	$0.00	$0.00	$0.00
240.5	SUP	HCPCS C1713		240.50  -  PLATE BONE 240MM 13 HOLE BUTTRESS DCP STAINLESS STEEL TIBIA	BOTH IP/OP	"$1,604.95 "	"$1,187.66"	$0.00	"$1,283.96"	$722.23	$722.23	$0.00	$0.00	$0.00	$334.51	"$1,191.19"	"$1,191.19"	$0.00	$0.00	$334.47	$0.00	$949.33	$949.33	$0.00	$802.48	"$1,271.12"	"$1,283.96"	$0.00		$0.00	$243.86	$0.00	$0.00	$255.51	$0.00	$0.00	$0.00	$0.00	$0.00
240.505	SUP	HCPCS C1713		240.505  -  PLATE BONE RIGHT ANG L 101MM 5 HOLE BUTTRESS LC-DCP	BOTH IP/OP	$983.15 	$727.53	$0.00	$786.52	$442.42	$442.42	$0.00	$0.00	$0.00	$204.91	$729.69	$729.69	$0.00	$0.00	$204.89	$0.00	$581.53	$581.53	$0.00	$491.58	$778.65	$786.52	$0.00		$0.00	$153.86	$0.00	$0.00	$156.52	$0.00	$0.00	$0.00	$0.00	$0.00
240.506	SUP	HCPCS C1713		240.506  -  PLATE BONE RIGHT ANG L 115MM 6 HOLE BUTTRESS LC-DCP	BOTH IP/OP	"$1,018.10 "	$753.39	$0.00	$814.48	$458.15	$458.15	$0.00	$0.00	$0.00	$212.20	$755.63	$755.63	$0.00	$0.00	$212.17	$0.00	$602.21	$602.21	$0.00	$509.05	$806.34	$814.48	$0.00		$0.00	$154.69	$0.00	$0.00	$162.08	$0.00	$0.00	$0.00	$0.00	$0.00
240.508	SUP	HCPCS C1713		240.508  -  PLATE BONE RIGHT ANG L 148MM 8 HOLE BUTTRESS LC-DCP	BOTH IP/OP	"$1,162.78 "	$860.46	$0.00	$930.22	$523.25	$523.25	$0.00	$0.00	$0.00	$242.35	$863.01	$863.01	$0.00	$0.00	$242.32	$0.00	$687.78	$687.78	$0.00	$581.39	$920.92	$930.22	$0.00		$0.00	$176.67	$0.00	$0.00	$185.11	$0.00	$0.00	$0.00	$0.00	$0.00
240.509	SUP	HCPCS C1713		240.509  -  PLATE BONE 162MM BUTTRESS L 9 HOLE LC-DCP TITANIUM LEFT	BOTH IP/OP	"$1,175.28 "	$869.71	$0.00	$940.22	$528.87	$528.87	$0.00	$0.00	$0.00	$244.96	$872.29	$872.29	$0.00	$0.00	$244.93	$0.00	$695.18	$695.18	$0.00	$587.64	$930.82	$940.22	$0.00		$0.00	$183.93	$0.00	$0.00	$187.10	$0.00	$0.00	$0.00	$0.00	$0.00
240.54	SUP	HCPCS C1713		240.54  -  PLATE BN ANG RT L BTRS 86X14X3.8MM NS DCP 4 HL SHFT SS TIB	BOTH IP/OP	$734.23 	$543.33	$0.00	$587.38	$330.40	$330.40	$0.00	$0.00	$0.00	$153.03	$544.94	$544.94	$0.00	$0.00	$153.01	$0.00	$434.29	$434.29	$0.00	$367.11	$581.51	$587.38	$0.00		$0.00	$111.56	$0.00	$0.00	$116.89	$0.00	$0.00	$0.00	$0.00	$0.00
240.56	SUP	HCPCS C1713		240.56  -  PLATE BN BTRS 118X14X3.8MM NS DCP 5 HL SHFT SS TIBHD L/L 4.5	BOTH IP/OP	"$1,304.48 "	$965.32	$0.00	"$1,013.20"	$569.93	$569.93	$0.00	$0.00	$0.00	$271.89	$968.18	$968.18	$0.00	$0.00	$271.85	$0.00	$771.60	$771.60	$0.00	$633.25	"$1,003.07"	"$1,013.20"	$0.00		$0.00	$192.43	$0.00	$0.00	$201.63	$0.00	$0.00	$0.00	$0.00	$0.00
240.57	SUP	HCPCS C1713		240.57  -  PLATE BN BTRS 149X14X3.8MM NS DCP 7 HL SHFT SS TIBHD L/L LG	BOTH IP/OP	"$1,401.48 "	"$1,037.10"	$0.00	"$1,088.52"	$612.29	$612.29	$0.00	$0.00	$0.00	$292.10	"$1,040.17"	"$1,040.17"	$0.00	$0.00	$292.07	$0.00	$828.97	$828.97	$0.00	$680.33	"$1,077.63"	"$1,088.52"	$0.00		$0.00	$206.74	$0.00	$0.00	$216.62	$0.00	$0.00	$0.00	$0.00	$0.00
240.58	SUP	HCPCS C1713		240.58  -  PLATE BN BTRS 181X14X3.8MM NS DCP 9 HL SHFT SS TIBHD L/L LG	BOTH IP/OP	"$1,495.65 "	"$1,106.78"	$0.00	"$1,161.68"	$653.45	$653.45	$0.00	$0.00	$0.00	$311.73	"$1,110.07"	"$1,110.07"	$0.00	$0.00	$311.69	$0.00	$884.68	$884.68	$0.00	$726.05	"$1,150.06"	"$1,161.68"	$0.00		$0.00	$220.63	$0.00	$0.00	$231.17	$0.00	$0.00	$0.00	$0.00	$0.00
240.6	SUP	HCPCS C1713		240.60  -  PLATE BONE 240X14X3.8MM 13 HOLE SHAFT BUTTRESS DCP STAINLESS	BOTH IP/OP	"$1,604.95 "	"$1,187.66"	$0.00	"$1,283.96"	$722.23	$722.23	$0.00	$0.00	$0.00	$334.51	"$1,191.19"	"$1,191.19"	$0.00	$0.00	$334.47	$0.00	$949.33	$949.33	$0.00	$802.48	"$1,271.12"	"$1,283.96"	$0.00		$0.00	$243.86	$0.00	$0.00	$255.51	$0.00	$0.00	$0.00	$0.00	$0.00
240.7	SUP	HCPCS C1713		240.70  -  PLATE BONE BUTTRESS 221X16X5MM 11 HOLE SHAFT DCP STAINLESS	BOTH IP/OP	"$1,539.45 "	"$1,139.19"	$0.00	"$1,231.56"	$692.75	$692.75	$0.00	$0.00	$0.00	$320.86	"$1,142.58"	"$1,142.58"	$0.00	$0.00	$320.82	$0.00	$910.58	$910.58	$0.00	$769.73	"$1,219.24"	"$1,231.56"	$0.00		$0.00	$233.90	$0.00	$0.00	$245.08	$0.00	$0.00	$0.00	$0.00	$0.00
240.71	SUP	HCPCS C1713		240.71  -  PLATE BONE BUTTRESS 253X16X5MM 11 HOLE SHAFT DCP STAINLESS	BOTH IP/OP	"$1,582.05 "	"$1,170.72"	$0.00	"$1,265.64"	$711.92	$711.92	$0.00	$0.00	$0.00	$329.74	"$1,174.20"	"$1,174.20"	$0.00	$0.00	$329.70	$0.00	$935.78	$935.78	$0.00	$791.03	"$1,252.98"	"$1,265.64"	$0.00		$0.00	$247.59	$0.00	$0.00	$251.86	$0.00	$0.00	$0.00	$0.00	$0.00
240.72	SUP	HCPCS C1713		240.72  -  PLATE BONE 285MM BUTTRESS 15 HOLE DCP STAINLESS STEEL	BOTH IP/OP	"$1,624.45 "	"$1,202.09"	$0.00	"$1,299.56"	$731.00	$731.00	$0.00	$0.00	$0.00	$338.58	"$1,205.67"	"$1,205.67"	$0.00	$0.00	$338.54	$0.00	$960.86	$960.86	$0.00	$812.23	"$1,286.56"	"$1,299.56"	$0.00		$0.00	$254.23	$0.00	$0.00	$258.61	$0.00	$0.00	$0.00	$0.00	$0.00
240.73	SUP	HCPCS C1713		240.73  -  PLATE BONE BUTTRESS 221X16X5MM 11 HOLE SHAFT DCP STAINLESS	BOTH IP/OP	"$1,537.00 "	"$1,137.38"	$0.00	"$1,229.60"	$691.65	$691.65	$0.00	$0.00	$0.00	$320.35	"$1,140.76"	"$1,140.76"	$0.00	$0.00	$320.31	$0.00	$909.14	$909.14	$0.00	$768.50	"$1,217.30"	"$1,229.60"	$0.00		$0.00	$240.54	$0.00	$0.00	$244.69	$0.00	$0.00	$0.00	$0.00	$0.00
240.75	SUP	HCPCS C1713		240.75  -  PLATE BONE 285MM 15 HOLE BUTTRESS DCP STAINLESS STEEL	BOTH IP/OP	"$1,624.45 "	"$1,202.09"	$0.00	"$1,299.56"	$731.00	$731.00	$0.00	$0.00	$0.00	$338.58	"$1,205.67"	"$1,205.67"	$0.00	$0.00	$338.54	$0.00	$960.86	$960.86	$0.00	$812.23	"$1,286.56"	"$1,299.56"	$0.00		$0.00	$254.23	$0.00	$0.00	$258.61	$0.00	$0.00	$0.00	$0.00	$0.00
240.8	SUP	HCPCS C1713		240.80  -  PLATE BONE 128MM 4 HOLE HOOK BUTTRESS DCP STAINLESS STEEL	BOTH IP/OP	"$1,257.43 "	$930.50	$0.00	"$1,005.94"	$565.84	$565.84	$0.00	$0.00	$0.00	$262.08	$933.26	$933.26	$0.00	$0.00	$262.05	$0.00	$743.77	$743.77	$0.00	$628.71	$995.88	"$1,005.94"	$0.00		$0.00	$196.79	$0.00	$0.00	$200.18	$0.00	$0.00	$0.00	$0.00	$0.00
240.9	SUP	HCPCS C1713		240.90  -  PLATE 202MM SS LG FRAG SET 10 HOLE CBR HEAD DCP BONE ORTH	BOTH IP/OP	"$1,158.05 "	$856.96	$0.00	$926.44	$521.12	$521.12	$0.00	$0.00	$0.00	$241.37	$859.50	$859.50	$0.00	$0.00	$241.34	$0.00	$684.99	$684.99	$0.00	$579.03	$917.18	$926.44	$0.00		$0.00	$181.23	$0.00	$0.00	$184.36	$0.00	$0.00	$0.00	$0.00	$0.00
240.91	SUP	HCPCS C1713		240.91  -  PLATE BONE 218MM 11 HOLE COBRA HEAD LC-DCP STAINLESS STEEL	BOTH IP/OP	"$1,220.33 "	$903.04	$0.00	$976.26	$549.15	$549.15	$0.00	$0.00	$0.00	$254.35	$905.73	$905.73	$0.00	$0.00	$254.32	$0.00	$721.82	$721.82	$0.00	$610.16	$966.50	$976.26	$0.00		$0.00	$190.98	$0.00	$0.00	$194.28	$0.00	$0.00	$0.00	$0.00	$0.00
240.92	SUP	HCPCS C1713		240.92  -  PLATE BN BTRS 158X16X5MM NS DCP 7 HL SHFT SS FEM LT CNDRL	BOTH IP/OP	"$1,356.55 "	"$1,003.85"	$0.00	"$1,085.24"	$610.45	$610.45	$0.00	$0.00	$0.00	$282.74	"$1,006.83"	"$1,006.83"	$0.00	$0.00	$282.71	$0.00	$802.40	$802.40	$0.00	$678.28	"$1,074.39"	"$1,085.24"	$0.00		$0.00	$206.12	$0.00	$0.00	$215.96	$0.00	$0.00	$0.00	$0.00	$0.00
240.93	SUP	HCPCS C1713		240.93  -  PLATE BN BTRS 190X16X5MM NS DCP 9 HL SHFT SS FEM LT CNDRL	BOTH IP/OP	"$1,467.10 "	"$1,085.65"	$0.00	"$1,173.68"	$660.20	$660.20	$0.00	$0.00	$0.00	$305.78	"$1,088.88"	"$1,088.88"	$0.00	$0.00	$305.74	$0.00	$867.79	$867.79	$0.00	$733.55	"$1,161.94"	"$1,173.68"	$0.00		$0.00	$222.91	$0.00	$0.00	$233.56	$0.00	$0.00	$0.00	$0.00	$0.00
240.94	SUP	HCPCS C1713		240.94  -  PLATE BN BTRS 158X16X5MM NS DCP 7 HL SHFT SS FEM RT CNDRL	BOTH IP/OP	"$1,356.55 "	"$1,003.85"	$0.00	"$1,085.24"	$610.45	$610.45	$0.00	$0.00	$0.00	$282.74	"$1,006.83"	"$1,006.83"	$0.00	$0.00	$282.71	$0.00	$802.40	$802.40	$0.00	$678.28	"$1,074.39"	"$1,085.24"	$0.00		$0.00	$206.12	$0.00	$0.00	$215.96	$0.00	$0.00	$0.00	$0.00	$0.00
240.95	SUP	HCPCS C1713		240.95  -  PLATE BN BTRS 190X16X5MM NS DCP 9 HL SHFT SS FEM RT CNDRL	BOTH IP/OP	"$1,467.10 "	"$1,085.65"	$0.00	"$1,173.68"	$660.20	$660.20	$0.00	$0.00	$0.00	$305.78	"$1,088.88"	"$1,088.88"	$0.00	$0.00	$305.74	$0.00	$867.79	$867.79	$0.00	$733.55	"$1,161.94"	"$1,173.68"	$0.00		$0.00	$222.91	$0.00	$0.00	$233.56	$0.00	$0.00	$0.00	$0.00	$0.00
240.98	SUP	HCPCS C1713		240.98  -  PLATE BONE 170MM 8 HOLE COBRA HEAD DCP STAINLESS STEEL	BOTH IP/OP	"$1,030.85 "	$762.83	$0.00	$824.68	$463.88	$463.88	$0.00	$0.00	$0.00	$214.85	$765.10	$765.10	$0.00	$0.00	$214.83	$0.00	$609.75	$609.75	$0.00	$515.43	$816.43	$824.68	$0.00		$0.00	$161.33	$0.00	$0.00	$164.11	$0.00	$0.00	$0.00	$0.00	$0.00
240.99	SUP	HCPCS C1713		240.99  -  PLATE BONE 186MM 9 HOLE COBRA HEAD DCP STAINLESS STEEL	BOTH IP/OP	"$1,098.43 "	$812.84	$0.00	$878.74	$494.29	$494.29	$0.00	$0.00	$0.00	$228.94	$815.25	$815.25	$0.00	$0.00	$228.91	$0.00	$649.72	$649.72	$0.00	$549.21	$869.96	$878.74	$0.00		$0.00	$171.90	$0.00	$0.00	$174.87	$0.00	$0.00	$0.00	$0.00	$0.00
241.004	SUP	HCPCS C1713		241.004  -  PLATE BN 60MM NS 4 HL SHFT SS TIB RT PROX 3.5MM SCR SM FRAG	BOTH IP/OP	"$2,171.80 "	"$1,607.13"	$0.00	"$1,686.84"	$948.85	$948.85	$0.00	$0.00	$0.00	$452.66	"$1,611.91"	"$1,611.91"	$0.00	$0.00	$452.60	$0.00	"$1,284.62"	"$1,284.62"	$0.00	"$1,054.28"	"$1,669.97"	"$1,686.84"	$0.00		$0.00	$320.38	$0.00	$0.00	$335.68	$0.00	$0.00	$0.00	$0.00	$0.00
241.005	SUP	HCPCS C1713		241.005  -  PLATE BONE 60MM 4 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,171.80 "	"$1,607.13"	$0.00	"$1,686.84"	$948.85	$948.85	$0.00	$0.00	$0.00	$452.66	"$1,611.91"	"$1,611.91"	$0.00	$0.00	$452.60	$0.00	"$1,284.62"	"$1,284.62"	$0.00	"$1,054.28"	"$1,669.97"	"$1,686.84"	$0.00		$0.00	$320.38	$0.00	$0.00	$335.68	$0.00	$0.00	$0.00	$0.00	$0.00
241.006	SUP	HCPCS C1713		241.006  -  PLATE BONE 85MM 6 HOLE STAINLESS STEEL TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,180.23 "	"$1,613.37"	$0.00	"$1,693.38"	$952.53	$952.53	$0.00	$0.00	$0.00	$454.41	"$1,618.16"	"$1,618.16"	$0.00	$0.00	$454.36	$0.00	"$1,289.60"	"$1,289.60"	$0.00	"$1,058.36"	"$1,676.45"	"$1,693.38"	$0.00		$0.00	$321.62	$0.00	$0.00	$336.98	$0.00	$0.00	$0.00	$0.00	$0.00
241.007	SUP	HCPCS C1713		241.007  -  PLATE BONE 85MM 6 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,180.23 "	"$1,613.37"	$0.00	"$1,693.38"	$952.53	$952.53	$0.00	$0.00	$0.00	$454.41	"$1,618.16"	"$1,618.16"	$0.00	$0.00	$454.36	$0.00	"$1,289.60"	"$1,289.60"	$0.00	"$1,058.36"	"$1,676.45"	"$1,693.38"	$0.00		$0.00	$321.62	$0.00	$0.00	$336.98	$0.00	$0.00	$0.00	$0.00	$0.00
241.008	SUP	HCPCS C1713		241.008  -  PLATE BN 111MM NS 8 HL SHFT SS TIB RT PROX 3.5MM SCR SM FRAG	BOTH IP/OP	"$2,250.53 "	"$1,665.39"	$0.00	"$1,747.98"	$983.24	$983.24	$0.00	$0.00	$0.00	$469.07	"$1,670.34"	"$1,670.34"	$0.00	$0.00	$469.01	$0.00	"$1,331.19"	"$1,331.19"	$0.00	"$1,092.49"	"$1,730.50"	"$1,747.98"	$0.00		$0.00	$331.99	$0.00	$0.00	$347.85	$0.00	$0.00	$0.00	$0.00	$0.00
241.009	SUP	HCPCS C1713		241.009  -  PLATE BN 111MM NS 8 HL SHFT SS TIB LT PROX 3.5MM SCR SM FRAG	BOTH IP/OP	"$2,250.53 "	"$1,665.39"	$0.00	"$1,747.98"	$983.24	$983.24	$0.00	$0.00	$0.00	$469.07	"$1,670.34"	"$1,670.34"	$0.00	$0.00	$469.01	$0.00	"$1,331.19"	"$1,331.19"	$0.00	"$1,092.49"	"$1,730.50"	"$1,747.98"	$0.00		$0.00	$331.99	$0.00	$0.00	$347.85	$0.00	$0.00	$0.00	$0.00	$0.00
241.01	SUP	HCPCS C1713		241.010  -  PLATE BONE 137MM 10 HOLE STAINLESS STEEL TIBIA RIGHT	BOTH IP/OP	"$2,197.25 "	"$1,625.97"	$0.00	"$1,757.80"	$988.76	$988.76	$0.00	$0.00	$0.00	$457.96	"$1,630.80"	"$1,630.80"	$0.00	$0.00	$457.91	$0.00	"$1,299.67"	"$1,299.67"	$0.00	"$1,098.63"	"$1,740.22"	"$1,757.80"	$0.00		$0.00	$333.85	$0.00	$0.00	$349.80	$0.00	$0.00	$0.00	$0.00	$0.00
241.011	SUP	HCPCS C1713		241.011  -  PLATE BN 137MM NS 10 HL SHFT SS TIB LT PROX 3.5MM SCR SM	BOTH IP/OP	"$2,263.18 "	"$1,674.75"	$0.00	"$1,757.80"	$988.76	$988.76	$0.00	$0.00	$0.00	$471.70	"$1,679.73"	"$1,679.73"	$0.00	$0.00	$471.65	$0.00	"$1,338.67"	"$1,338.67"	$0.00	"$1,098.63"	"$1,740.22"	"$1,757.80"	$0.00		$0.00	$333.85	$0.00	$0.00	$349.80	$0.00	$0.00	$0.00	$0.00	$0.00
241.012	SUP	HCPCS C1713		241.012  -  PLATE BN 137MM NS 12 HL SHFT SS TIB RT PROX 3.5MM SCR SM	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,823.30"	"$1,025.61"	"$1,025.61"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,139.56"	"$1,805.07"	"$1,823.30"	$0.00		$0.00	$346.30	$0.00	$0.00	$362.84	$0.00	$0.00	$0.00	$0.00	$0.00
241.013	SUP	HCPCS C1713		241.013  -  PLATE BN 163MM NS 12 HL SHFT SS TIB LT PROX 3.5MM SCR SM	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,823.30"	"$1,025.61"	"$1,025.61"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,139.56"	"$1,805.07"	"$1,823.30"	$0.00		$0.00	$346.30	$0.00	$0.00	$362.84	$0.00	$0.00	$0.00	$0.00	$0.00
241.014	SUP	HCPCS C1713		241.014  -  PLATE BONE 163MM 14 HOLE STAINLESS STEEL TIBIA RIGHT	BOTH IP/OP	"$2,398.10 "	"$1,774.59"	$0.00	"$1,862.62"	"$1,047.72"	"$1,047.72"	$0.00	$0.00	$0.00	$499.82	"$1,779.87"	"$1,779.87"	$0.00	$0.00	$499.76	$0.00	"$1,418.48"	"$1,418.48"	$0.00	"$1,164.14"	"$1,844.00"	"$1,862.62"	$0.00		$0.00	$353.76	$0.00	$0.00	$370.66	$0.00	$0.00	$0.00	$0.00	$0.00
241.015	SUP	HCPCS C1713		241.015  -  PLATE BONE 189MM 14 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,398.10 "	"$1,774.59"	$0.00	"$1,862.62"	"$1,047.72"	"$1,047.72"	$0.00	$0.00	$0.00	$499.82	"$1,779.87"	"$1,779.87"	$0.00	$0.00	$499.76	$0.00	"$1,418.48"	"$1,418.48"	$0.00	"$1,164.14"	"$1,844.00"	"$1,862.62"	$0.00		$0.00	$353.76	$0.00	$0.00	$370.66	$0.00	$0.00	$0.00	$0.00	$0.00
241.016	SUP	HCPCS C1713		241.016  -  PLATE BN 215MM NS 16 HL SHFT SS TIB RT PROX 3.5MM SCR SM	BOTH IP/OP	"$2,447.30 "	"$1,811.00"	$0.00	"$1,900.82"	"$1,069.21"	"$1,069.21"	$0.00	$0.00	$0.00	$510.08	"$1,816.39"	"$1,816.39"	$0.00	$0.00	$510.02	$0.00	"$1,447.58"	"$1,447.58"	$0.00	"$1,188.01"	"$1,881.82"	"$1,900.82"	$0.00		$0.00	$361.02	$0.00	$0.00	$378.26	$0.00	$0.00	$0.00	$0.00	$0.00
241.017	SUP	HCPCS C1713		241.017  -  PLATE BONE 215MM 16 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,447.30 "	"$1,811.00"	$0.00	"$1,900.82"	"$1,069.21"	"$1,069.21"	$0.00	$0.00	$0.00	$510.08	"$1,816.39"	"$1,816.39"	$0.00	$0.00	$510.02	$0.00	"$1,447.58"	"$1,447.58"	$0.00	"$1,188.01"	"$1,881.82"	"$1,900.82"	$0.00		$0.00	$361.02	$0.00	$0.00	$378.26	$0.00	$0.00	$0.00	$0.00	$0.00
241.031	SUP	HCPCS C1713		241.031  -  PLATE BN OB R T 52X10X1.5MM NS LCP CMBN 3 HLE/HD 3 HL SHFT	BOTH IP/OP	$662.08 	$489.94	$0.00	$514.24	$289.26	$289.26	$0.00	$0.00	$0.00	$137.99	$491.39	$491.39	$0.00	$0.00	$137.98	$0.00	$391.62	$391.62	$0.00	$321.40	$509.10	$514.24	$0.00		$0.00	$97.67	$0.00	$0.00	$102.33	$0.00	$0.00	$0.00	$0.00	$0.00
241.041	SUP	HCPCS C1713		241.041  -  PLATE BN OB R T 63X10X1.5MM NS LCP CMBN 3 HLE/HD 4 HL SHFT	BOTH IP/OP	$693.00 	$512.82	$0.00	$538.26	$302.77	$302.77	$0.00	$0.00	$0.00	$144.44	$514.34	$514.34	$0.00	$0.00	$144.42	$0.00	$409.91	$409.91	$0.00	$336.41	$532.88	$538.26	$0.00		$0.00	$102.23	$0.00	$0.00	$107.11	$0.00	$0.00	$0.00	$0.00	$0.00
241.051	SUP	HCPCS C1713		241.051  -  PLATE BN OB R T 74X10X1.5MM NS LCP CMBN 3 HLE/HD 5 HL SHFT	BOTH IP/OP	$723.93 	$535.71	$0.00	$562.28	$316.28	$316.28	$0.00	$0.00	$0.00	$150.88	$537.30	$537.30	$0.00	$0.00	$150.87	$0.00	$428.20	$428.20	$0.00	$351.43	$556.66	$562.28	$0.00		$0.00	$141.20	$0.00	$0.00	$111.89	$0.00	$0.00	$0.00	$0.00	$0.00
241.061	SUP	HCPCS C1713		241.061  -  PLATE BONE T 85X10X1.5MM 3X6 HOLE OBLIQUE RIGHT LCP	BOTH IP/OP	$775.95 	$574.20	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$161.73	$575.91	$575.91	$0.00	$0.00	$161.71	$0.00	$458.97	$458.97	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
241.062	SUP	HCPCS C1713		241.062  -  PLATE BONE 15MM 6 HOLE HOOK LC-DCP DCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,272.00 "	$941.28	$0.00	"$1,017.60"	$572.40	$572.40	$0.00	$0.00	$0.00	$265.12	$944.08	$944.08	$0.00	$0.00	$265.08	$0.00	$752.39	$752.39	$0.00	$636.00	"$1,007.42"	"$1,017.60"	$0.00		$0.00	$199.07	$0.00	$0.00	$202.50	$0.00	$0.00	$0.00	$0.00	$0.00
241.063	SUP	HCPCS C1713		241.063  -  PLATE BONE 15MM 6 HOLE HOOK LC-DCP STAINLESS STEEL LEFT	BOTH IP/OP	"$1,272.00 "	$941.28	$0.00	"$1,017.60"	$572.40	$572.40	$0.00	$0.00	$0.00	$265.12	$944.08	$944.08	$0.00	$0.00	$265.08	$0.00	$752.39	$752.39	$0.00	$636.00	"$1,007.42"	"$1,017.60"	$0.00		$0.00	$199.07	$0.00	$0.00	$202.50	$0.00	$0.00	$0.00	$0.00	$0.00
241.064	SUP	HCPCS C1713		241.064  -  PLATE BONE 18MM 6 HOLE HOOK LC-DCP DCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,272.00 "	$941.28	$0.00	"$1,017.60"	$572.40	$572.40	$0.00	$0.00	$0.00	$265.12	$944.08	$944.08	$0.00	$0.00	$265.08	$0.00	$752.39	$752.39	$0.00	$636.00	"$1,007.42"	"$1,017.60"	$0.00		$0.00	$199.07	$0.00	$0.00	$202.50	$0.00	$0.00	$0.00	$0.00	$0.00
241.065	SUP	HCPCS C1713		241.065  -  PLATE BONE 18MM 6 HOLE HOOK LC-DCP STAINLESS STEEL LEFT	BOTH IP/OP	"$1,272.00 "	$941.28	$0.00	"$1,017.60"	$572.40	$572.40	$0.00	$0.00	$0.00	$265.12	$944.08	$944.08	$0.00	$0.00	$265.08	$0.00	$752.39	$752.39	$0.00	$636.00	"$1,007.42"	"$1,017.60"	$0.00		$0.00	$199.07	$0.00	$0.00	$202.50	$0.00	$0.00	$0.00	$0.00	$0.00
241.066	SUP	HCPCS C1713		241.066  -  PLATE BONE 15MM 8 HOLE HOOK LC-DCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,364.75 "	"$1,009.92"	$0.00	"$1,091.80"	$614.14	$614.14	$0.00	$0.00	$0.00	$284.45	"$1,012.92"	"$1,012.92"	$0.00	$0.00	$284.41	$0.00	$807.25	$807.25	$0.00	$682.38	"$1,080.88"	"$1,091.80"	$0.00		$0.00	$213.58	$0.00	$0.00	$217.27	$0.00	$0.00	$0.00	$0.00	$0.00
241.067	SUP	HCPCS C1713		241.067  -  PLATE BONE 15MM 8 HOLE HOOK LC-DCP STAINLESS STEEL LEFT	BOTH IP/OP	"$1,364.75 "	"$1,009.92"	$0.00	"$1,091.80"	$614.14	$614.14	$0.00	$0.00	$0.00	$284.45	"$1,012.92"	"$1,012.92"	$0.00	$0.00	$284.41	$0.00	$807.25	$807.25	$0.00	$682.38	"$1,080.88"	"$1,091.80"	$0.00		$0.00	$213.58	$0.00	$0.00	$217.27	$0.00	$0.00	$0.00	$0.00	$0.00
241.068	SUP	HCPCS C1713		241.068  -  PLATE BONE 18MM 8 HOLE HOOK LC-DCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,364.75 "	"$1,009.92"	$0.00	"$1,091.80"	$614.14	$614.14	$0.00	$0.00	$0.00	$284.45	"$1,012.92"	"$1,012.92"	$0.00	$0.00	$284.41	$0.00	$807.25	$807.25	$0.00	$682.38	"$1,080.88"	"$1,091.80"	$0.00		$0.00	$213.58	$0.00	$0.00	$217.27	$0.00	$0.00	$0.00	$0.00	$0.00
241.069	SUP	HCPCS C1713		241.069  -  PLATE BN 18MM 77X10X3.3MM NS LC DCP 8 HL HK PRECONTOUR SS	BOTH IP/OP	"$1,364.75 "	"$1,009.92"	$0.00	"$1,091.80"	$614.14	$614.14	$0.00	$0.00	$0.00	$284.45	"$1,012.92"	"$1,012.92"	$0.00	$0.00	$284.41	$0.00	$807.25	$807.25	$0.00	$682.38	"$1,080.88"	"$1,091.80"	$0.00		$0.00	$213.58	$0.00	$0.00	$217.27	$0.00	$0.00	$0.00	$0.00	$0.00
241.071	SUP	HCPCS C1713		241.071  -  PLATE BN OB R T 96X10X1.5MM NS LCP CMBN 3 HLE/HD 7 HL SHFT	BOTH IP/OP	$785.78 	$581.48	$0.00	$610.32	$343.31	$343.31	$0.00	$0.00	$0.00	$163.78	$583.20	$583.20	$0.00	$0.00	$163.76	$0.00	$464.79	$464.79	$0.00	$381.45	$604.22	$610.32	$0.00		$0.00	$153.59	$0.00	$0.00	$121.45	$0.00	$0.00	$0.00	$0.00	$0.00
241.081	SUP	HCPCS C1713		241.081  -  PLATE BONE T 107X10X1.5MM 3X8 HOLE OBLIQUE RIGHT LCP	BOTH IP/OP	$853.25 	$631.41	$0.00	$662.72	$372.78	$372.78	$0.00	$0.00	$0.00	$177.84	$633.28	$633.28	$0.00	$0.00	$177.82	$0.00	$504.70	$504.70	$0.00	$414.20	$656.09	$662.72	$0.00		$0.00	$125.87	$0.00	$0.00	$131.88	$0.00	$0.00	$0.00	$0.00	$0.00
241.13	SUP	HCPCS C1713		241.13  -  PLATE BN RT ANG T 50X10X1.2MM NS LC DCP 3 HLE/HD 3 HL SHFT	BOTH IP/OP	$233.38 	$172.70	$0.00	$186.70	$105.02	$105.02	$0.00	$0.00	$0.00	$48.64	$173.21	$173.21	$0.00	$0.00	$48.64	$0.00	$138.04	$138.04	$0.00	$116.69	$184.84	$186.70	$0.00		$0.00	$35.46	$0.00	$0.00	$37.15	$0.00	$0.00	$0.00	$0.00	$0.00
241.131	SUP	HCPCS C1713		241.131  -  PLATE BONE T RIGHT ANG 50X10X1.5MM 3X3 HOLE LCP STAINLESS	BOTH IP/OP	$591.80 	$437.93	$0.00	$459.64	$258.55	$258.55	$0.00	$0.00	$0.00	$123.35	$439.23	$439.23	$0.00	$0.00	$123.33	$0.00	$350.05	$350.05	$0.00	$287.28	$455.04	$459.64	$0.00		$0.00	$87.30	$0.00	$0.00	$91.47	$0.00	$0.00	$0.00	$0.00	$0.00
241.132	SUP	HCPCS C1713		241.132  -  PLATE BONE T RIGHT ANG 50X11X1.5MM 4X3 HOLE LCP STAINLESS	BOTH IP/OP	$607.25 	$449.37	$0.00	$471.66	$265.31	$265.31	$0.00	$0.00	$0.00	$126.57	$450.70	$450.70	$0.00	$0.00	$126.55	$0.00	$359.19	$359.19	$0.00	$294.79	$466.95	$471.66	$0.00		$0.00	$89.58	$0.00	$0.00	$93.86	$0.00	$0.00	$0.00	$0.00	$0.00
241.14	SUP	HCPCS C1713		241.14  -  PLATE BN RT ANG T 56X10X1.2MM NS LC DCP 4 HLE/HD 4 HL SHFT	BOTH IP/OP	$248.80 	$184.11	$0.00	$193.24	$108.70	$108.70	$0.00	$0.00	$0.00	$51.86	$184.66	$184.66	$0.00	$0.00	$51.85	$0.00	$147.17	$147.17	$0.00	$120.78	$191.31	$193.24	$0.00		$0.00	$36.70	$0.00	$0.00	$38.45	$0.00	$0.00	$0.00	$0.00	$0.00
241.141	SUP	HCPCS C1713		241.141  -  PLATE BN RT ANG T 56X11X1.5MM NS LCP CMBN 4 HLE/HD 4 HL SHFT	BOTH IP/OP	$610.08 	$451.46	$0.00	$473.84	$266.54	$266.54	$0.00	$0.00	$0.00	$127.15	$452.80	$452.80	$0.00	$0.00	$127.14	$0.00	$360.86	$360.86	$0.00	$296.15	$469.10	$473.84	$0.00		$0.00	$90.00	$0.00	$0.00	$94.29	$0.00	$0.00	$0.00	$0.00	$0.00
241.142	SUP	HCPCS C1713		241.142  -  PLATE BN RT ANG T 57X10X1.5MM NS LCP CMBN 3 HLE/HD 4 HL SHFT	BOTH IP/OP	$629.75 	$466.02	$0.00	$489.12	$275.13	$275.13	$0.00	$0.00	$0.00	$131.26	$467.40	$467.40	$0.00	$0.00	$131.24	$0.00	$372.50	$372.50	$0.00	$305.70	$484.23	$489.12	$0.00		$0.00	$92.90	$0.00	$0.00	$97.33	$0.00	$0.00	$0.00	$0.00	$0.00
241.15	SUP	HCPCS C1713		241.15  -  PLATE BN RT ANG T 67X10X1.2MM NS LC DCP 3 HLE/HD 5 HL SHFT	BOTH IP/OP	$267.50 	$197.95	$0.00	$214.00	$120.38	$120.38	$0.00	$0.00	$0.00	$55.75	$198.54	$198.54	$0.00	$0.00	$55.75	$0.00	$158.23	$158.23	$0.00	$133.75	$211.86	$214.00	$0.00		$0.00	$40.64	$0.00	$0.00	$42.59	$0.00	$0.00	$0.00	$0.00	$0.00
241.151	SUP	HCPCS C1713		241.151  -  PLATE BN RT ANG T 67X10X1.5MM NS LCP CMBN 3 HLE/HD 5 HL SHFT	BOTH IP/OP	$671.93 	$497.23	$0.00	$521.88	$293.56	$293.56	$0.00	$0.00	$0.00	$140.05	$498.70	$498.70	$0.00	$0.00	$140.03	$0.00	$397.44	$397.44	$0.00	$326.18	$516.66	$521.88	$0.00		$0.00	$99.12	$0.00	$0.00	$103.85	$0.00	$0.00	$0.00	$0.00	$0.00
241.152	SUP	HCPCS C1713		241.152  -  PLATE BONE 67MM 3X5 HOLE T RIGHT ANG LCP STAINLESS STEEL	BOTH IP/OP	$691.60 	$511.78	$0.00	$537.16	$302.15	$302.15	$0.00	$0.00	$0.00	$144.15	$513.31	$513.31	$0.00	$0.00	$144.13	$0.00	$409.08	$409.08	$0.00	$335.73	$531.79	$537.16	$0.00		$0.00	$102.02	$0.00	$0.00	$106.89	$0.00	$0.00	$0.00	$0.00	$0.00
241.16	SUP	HCPCS C1713		241.16  -  PLATE BONE ANGLE RIGHT T 75X10X1.2MM 4X6 HOLE LCP STAINLESS	BOTH IP/OP	$311.18 	$230.27	$0.00	$248.94	$140.03	$140.03	$0.00	$0.00	$0.00	$64.86	$230.95	$230.95	$0.00	$0.00	$64.85	$0.00	$184.06	$184.06	$0.00	$155.59	$246.45	$248.94	$0.00		$0.00	$47.28	$0.00	$0.00	$49.54	$0.00	$0.00	$0.00	$0.00	$0.00
241.161	SUP	HCPCS C1713		241.161  -  PLATE BN RT ANG T 78X11X1.5MM NS LCP CMBN 4 HLE/HD 6 HL SHFT	BOTH IP/OP	$782.98 	$579.41	$0.00	$608.14	$342.08	$342.08	$0.00	$0.00	$0.00	$163.19	$581.12	$581.12	$0.00	$0.00	$163.17	$0.00	$463.13	$463.13	$0.00	$380.09	$602.06	$608.14	$0.00		$0.00	$115.50	$0.00	$0.00	$121.02	$0.00	$0.00	$0.00	$0.00	$0.00
241.162	SUP	HCPCS C1713		241.162  -  PLATE BONE T RIGHT ANG 77X10X1.5MM 3X6 HOLE LCP STAINLESS	BOTH IP/OP	$804.05 	$595.00	$0.00	$624.50	$351.28	$351.28	$0.00	$0.00	$0.00	$167.58	$596.77	$596.77	$0.00	$0.00	$167.56	$0.00	$475.60	$475.60	$0.00	$390.31	$618.26	$624.50	$0.00		$0.00	$118.61	$0.00	$0.00	$124.28	$0.00	$0.00	$0.00	$0.00	$0.00
241.17	SUP	HCPCS C1713		241.17  -  PLATE BONE T RIGHT ANG 90X10X1.2MM 4X7 HOLE LCP STAINLESS	BOTH IP/OP	$399.88 	$295.91	$0.00	$319.90	$179.94	$179.94	$0.00	$0.00	$0.00	$83.34	$296.79	$296.79	$0.00	$0.00	$83.33	$0.00	$236.53	$236.53	$0.00	$199.94	$316.70	$319.90	$0.00		$0.00	$60.76	$0.00	$0.00	$63.66	$0.00	$0.00	$0.00	$0.00	$0.00
241.171	SUP	HCPCS C1713		241.171  -  PLATE BN RT ANG T 87X10X1.5MM NS LCP CMBN 3 HLE/HD 7 HL SHFT	BOTH IP/OP	$981.18 	$726.07	$0.00	$762.08	$428.67	$428.67	$0.00	$0.00	$0.00	$204.50	$728.23	$728.23	$0.00	$0.00	$204.48	$0.00	$580.37	$580.37	$0.00	$476.30	$754.46	$762.08	$0.00		$0.00	$144.74	$0.00	$0.00	$151.65	$0.00	$0.00	$0.00	$0.00	$0.00
241.172	SUP	HCPCS C1713		241.172  -  PLATE BONE T RIGHT ANG 89X11X1.5MM 4X7 HOLE LCP STAINLESS	BOTH IP/OP	$976.95 	$722.94	$0.00	$758.80	$426.83	$426.83	$0.00	$0.00	$0.00	$203.62	$725.09	$725.09	$0.00	$0.00	$203.60	$0.00	$577.87	$577.87	$0.00	$474.25	$751.21	$758.80	$0.00		$0.00	$144.12	$0.00	$0.00	$151.00	$0.00	$0.00	$0.00	$0.00	$0.00
241.18	SUP	HCPCS C1713		241.18  -  PLATE BONE 100MM 4 HOLE HEAD 8 HOLE SHAFT T RIGHT ANG LC-DCP	BOTH IP/OP	$464.03 	$343.38	$0.00	$371.22	$208.81	$208.81	$0.00	$0.00	$0.00	$96.71	$344.40	$344.40	$0.00	$0.00	$96.70	$0.00	$274.47	$274.47	$0.00	$232.01	$367.51	$371.22	$0.00		$0.00	$70.50	$0.00	$0.00	$73.87	$0.00	$0.00	$0.00	$0.00	$0.00
241.181	SUP	HCPCS C1713		241.181  -  PLATE BONE T RIGHT ANG 97X10X1.5MM 3X8 HOLE LCP STAINLESS	BOTH IP/OP	"$1,175.15 "	$869.61	$0.00	$912.74	$513.42	$513.42	$0.00	$0.00	$0.00	$244.93	$872.20	$872.20	$0.00	$0.00	$244.90	$0.00	$695.10	$695.10	$0.00	$570.46	$903.62	$912.74	$0.00		$0.00	$173.36	$0.00	$0.00	$181.64	$0.00	$0.00	$0.00	$0.00	$0.00
241.182	SUP	HCPCS C1713		241.182  -  PLATE BONE T RIGHT ANG 100X10X1.5MM 4X8 HOLE LCP STAINLESS	BOTH IP/OP	"$1,170.95 "	$866.50	$0.00	$909.46	$511.57	$511.57	$0.00	$0.00	$0.00	$244.06	$869.08	$869.08	$0.00	$0.00	$244.03	$0.00	$692.62	$692.62	$0.00	$568.41	$900.37	$909.46	$0.00		$0.00	$172.73	$0.00	$0.00	$180.98	$0.00	$0.00	$0.00	$0.00	$0.00
241.189	SUP	HCPCS C1713		241.189  -  PLATE BONE 112MM 4 HOLE HEAD 9 HOLE SHAFT T RIGHT ANG LC-DCP	BOTH IP/OP	$517.30 	$382.80	$0.00	$401.78	$226.00	$226.00	$0.00	$0.00	$0.00	$107.82	$383.94	$383.94	$0.00	$0.00	$107.81	$0.00	$305.98	$305.98	$0.00	$251.11	$397.77	$401.78	$0.00		$0.00	$76.31	$0.00	$0.00	$79.95	$0.00	$0.00	$0.00	$0.00	$0.00
241.23	SUP	HCPCS C1713		241.23  -  PLATE BN OBLQ T 53X10X1.5MM NS LC DCP 3 HLE/HD 3 HL SHFT SS	BOTH IP/OP	$401.23 	$296.91	$0.00	$320.98	$180.55	$180.55	$0.00	$0.00	$0.00	$83.63	$297.79	$297.79	$0.00	$0.00	$83.62	$0.00	$237.32	$237.32	$0.00	$200.61	$317.77	$320.98	$0.00		$0.00	$60.96	$0.00	$0.00	$63.88	$0.00	$0.00	$0.00	$0.00	$0.00
241.231	SUP	HCPCS C1713		241.231  -  PLATE BONE 53MM 3X3 HOLE T OBLIQUE ANGLE LCP STAINLESS STEEL	BOTH IP/OP	$427.98 	$316.71	$0.00	$342.38	$192.59	$192.59	$0.00	$0.00	$0.00	$89.20	$317.64	$317.64	$0.00	$0.00	$89.19	$0.00	$253.15	$253.15	$0.00	$213.99	$338.96	$342.38	$0.00		$0.00	$66.98	$0.00	$0.00	$68.13	$0.00	$0.00	$0.00	$0.00	$0.00
241.24	SUP	HCPCS C1713		241.24  -  PLATE BN OBLQ T 63X10X1.5MM NS LC DCP 3 HLE/HD 4 HL SHFT SS	BOTH IP/OP	$424.43 	$314.08	$0.00	$339.54	$190.99	$190.99	$0.00	$0.00	$0.00	$88.46	$315.01	$315.01	$0.00	$0.00	$88.45	$0.00	$251.05	$251.05	$0.00	$212.21	$336.15	$339.54	$0.00		$0.00	$64.49	$0.00	$0.00	$67.57	$0.00	$0.00	$0.00	$0.00	$0.00
241.241	SUP	HCPCS C1713		241.241  -  PLATE BONE 63MM 3 HOLE HEAD 3 HOLE SHAFT T OBLIQUE STAINLESS	BOTH IP/OP	$449.18 	$332.39	$0.00	$359.34	$202.13	$202.13	$0.00	$0.00	$0.00	$93.62	$333.38	$333.38	$0.00	$0.00	$93.61	$0.00	$265.69	$265.69	$0.00	$224.59	$355.75	$359.34	$0.00		$0.00	$70.30	$0.00	$0.00	$71.51	$0.00	$0.00	$0.00	$0.00	$0.00
241.25	SUP	HCPCS C1713		241.25  -  PLATE BN OBLQ T 75X10X1.5MM NS LC DCP 3 HLE/HD 5 HL SHFT SS	BOTH IP/OP	$436.73 	$323.18	$0.00	$349.38	$196.53	$196.53	$0.00	$0.00	$0.00	$91.02	$324.14	$324.14	$0.00	$0.00	$91.01	$0.00	$258.32	$258.32	$0.00	$218.36	$345.89	$349.38	$0.00		$0.00	$66.36	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$0.00
241.252	SUP	HCPCS C1713		241.252  -  PLATE BONE 75MM 3 HOLE HEAD 3 HOLE SHAFT T OBLIQUE STAINLESS	BOTH IP/OP	$459.78 	$340.24	$0.00	$367.82	$206.90	$206.90	$0.00	$0.00	$0.00	$95.83	$341.25	$341.25	$0.00	$0.00	$95.82	$0.00	$271.96	$271.96	$0.00	$229.89	$364.15	$367.82	$0.00		$0.00	$71.95	$0.00	$0.00	$73.20	$0.00	$0.00	$0.00	$0.00	$0.00
241.262	SUP	HCPCS C1713		241.262  -  PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,731.83 "	"$1,281.55"	$0.00	"$1,345.10"	$756.62	$756.62	$0.00	$0.00	$0.00	$360.96	"$1,285.36"	"$1,285.36"	$0.00	$0.00	$360.91	$0.00	"$1,024.37"	"$1,024.37"	$0.00	$840.69	"$1,331.65"	"$1,345.10"	$0.00		$0.00	$255.47	$0.00	$0.00	$267.67	$0.00	$0.00	$0.00	$0.00	$0.00
241.263	SUP	HCPCS C1713		241.263  -  PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,731.83 "	"$1,281.55"	$0.00	"$1,345.10"	$756.62	$756.62	$0.00	$0.00	$0.00	$360.96	"$1,285.36"	"$1,285.36"	$0.00	$0.00	$360.91	$0.00	"$1,024.37"	"$1,024.37"	$0.00	$840.69	"$1,331.65"	"$1,345.10"	$0.00		$0.00	$255.47	$0.00	$0.00	$267.67	$0.00	$0.00	$0.00	$0.00	$0.00
241.264	SUP	HCPCS C1713		241.264  -  PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,921.58 "	"$1,421.97"	$0.00	"$1,492.50"	$839.53	$839.53	$0.00	$0.00	$0.00	$400.50	"$1,426.19"	"$1,426.19"	$0.00	$0.00	$400.46	$0.00	"$1,136.61"	"$1,136.61"	$0.00	$932.81	"$1,477.58"	"$1,492.50"	$0.00		$0.00	$283.46	$0.00	$0.00	$297.01	$0.00	$0.00	$0.00	$0.00	$0.00
241.265	SUP	HCPCS C1713		241.265  -  PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,921.58 "	"$1,421.97"	$0.00	"$1,492.50"	$839.53	$839.53	$0.00	$0.00	$0.00	$400.50	"$1,426.19"	"$1,426.19"	$0.00	$0.00	$400.46	$0.00	"$1,136.61"	"$1,136.61"	$0.00	$932.81	"$1,477.58"	"$1,492.50"	$0.00		$0.00	$283.46	$0.00	$0.00	$297.01	$0.00	$0.00	$0.00	$0.00	$0.00
241.266	SUP	HCPCS C1713		241.266  -  PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,112.75 "	"$1,563.44"	$0.00	"$1,640.98"	$923.05	$923.05	$0.00	$0.00	$0.00	$440.35	"$1,568.08"	"$1,568.08"	$0.00	$0.00	$440.30	$0.00	"$1,249.69"	"$1,249.69"	$0.00	"$1,025.61"	"$1,624.57"	"$1,640.98"	$0.00		$0.00	$311.67	$0.00	$0.00	$326.56	$0.00	$0.00	$0.00	$0.00	$0.00
241.267	SUP	HCPCS C1713		241.267  -  PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,112.75 "	"$1,563.44"	$0.00	"$1,640.98"	$923.05	$923.05	$0.00	$0.00	$0.00	$440.35	"$1,568.08"	"$1,568.08"	$0.00	$0.00	$440.30	$0.00	"$1,249.69"	"$1,249.69"	$0.00	"$1,025.61"	"$1,624.57"	"$1,640.98"	$0.00		$0.00	$311.67	$0.00	$0.00	$326.56	$0.00	$0.00	$0.00	$0.00	$0.00
241.268	SUP	HCPCS C1713		241.268  -  PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,281.45 "	"$1,688.27"	$0.00	"$1,772.00"	$996.75	$996.75	$0.00	$0.00	$0.00	$475.51	"$1,693.29"	"$1,693.29"	$0.00	$0.00	$475.45	$0.00	"$1,349.48"	"$1,349.48"	$0.00	"$1,107.50"	"$1,754.28"	"$1,772.00"	$0.00		$0.00	$336.55	$0.00	$0.00	$352.63	$0.00	$0.00	$0.00	$0.00	$0.00
241.269	SUP	HCPCS C1713		241.269  -  PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,281.45 "	"$1,688.27"	$0.00	"$1,772.00"	$996.75	$996.75	$0.00	$0.00	$0.00	$475.51	"$1,693.29"	"$1,693.29"	$0.00	$0.00	$475.45	$0.00	"$1,349.48"	"$1,349.48"	$0.00	"$1,107.50"	"$1,754.28"	"$1,772.00"	$0.00		$0.00	$336.55	$0.00	$0.00	$352.63	$0.00	$0.00	$0.00	$0.00	$0.00
241.272	SUP	HCPCS C1713		241.272  -  PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,986.25 "	"$1,469.83"	$0.00	"$1,542.72"	$867.78	$867.78	$0.00	$0.00	$0.00	$413.98	"$1,474.19"	"$1,474.19"	$0.00	$0.00	$413.93	$0.00	"$1,174.87"	"$1,174.87"	$0.00	$964.20	"$1,527.29"	"$1,542.72"	$0.00		$0.00	$293.00	$0.00	$0.00	$307.00	$0.00	$0.00	$0.00	$0.00	$0.00
241.273	SUP	HCPCS C1713		241.273  -  PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,986.25 "	"$1,469.83"	$0.00	"$1,542.72"	$867.78	$867.78	$0.00	$0.00	$0.00	$413.98	"$1,474.19"	"$1,474.19"	$0.00	$0.00	$413.93	$0.00	"$1,174.87"	"$1,174.87"	$0.00	$964.20	"$1,527.29"	"$1,542.72"	$0.00		$0.00	$293.00	$0.00	$0.00	$307.00	$0.00	$0.00	$0.00	$0.00	$0.00
241.274	SUP	HCPCS C1713		241.274  -  PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,166.18 "	"$1,602.97"	$0.00	"$1,682.46"	$946.38	$946.38	$0.00	$0.00	$0.00	$451.49	"$1,607.74"	"$1,607.74"	$0.00	$0.00	$451.43	$0.00	"$1,281.29"	"$1,281.29"	$0.00	"$1,051.54"	"$1,665.64"	"$1,682.46"	$0.00		$0.00	$319.55	$0.00	$0.00	$334.81	$0.00	$0.00	$0.00	$0.00	$0.00
241.275	SUP	HCPCS C1713		241.275  -  PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,166.18 "	"$1,602.97"	$0.00	"$1,682.46"	$946.38	$946.38	$0.00	$0.00	$0.00	$451.49	"$1,607.74"	"$1,607.74"	$0.00	$0.00	$451.43	$0.00	"$1,281.29"	"$1,281.29"	$0.00	"$1,051.54"	"$1,665.64"	"$1,682.46"	$0.00		$0.00	$319.55	$0.00	$0.00	$334.81	$0.00	$0.00	$0.00	$0.00	$0.00
241.276	SUP	HCPCS C1713		241.276  -  PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,823.30"	"$1,025.61"	"$1,025.61"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,139.56"	"$1,805.07"	"$1,823.30"	$0.00		$0.00	$346.30	$0.00	$0.00	$362.84	$0.00	$0.00	$0.00	$0.00	$0.00
241.277	SUP	HCPCS C1713		241.277  -  PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,823.30"	"$1,025.61"	"$1,025.61"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,139.56"	"$1,805.07"	"$1,823.30"	$0.00		$0.00	$346.30	$0.00	$0.00	$362.84	$0.00	$0.00	$0.00	$0.00	$0.00
241.278	SUP	HCPCS C1713		241.278  -  PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,547.13 "	"$1,884.88"	$0.00	"$1,978.34"	"$1,112.82"	"$1,112.82"	$0.00	$0.00	$0.00	$530.88	"$1,890.48"	"$1,890.48"	$0.00	$0.00	$530.82	$0.00	"$1,255.73"	"$1,255.73"	$0.00	"$1,236.46"	"$1,958.56"	"$1,978.34"	$0.00		$0.00	$375.74	$0.00	$0.00	$393.69	$0.00	$0.00	$0.00	$0.00	$0.00
241.279	SUP	HCPCS C1713		241.279  -  PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,547.13 "	"$1,884.88"	$0.00	"$1,978.34"	"$1,112.82"	"$1,112.82"	$0.00	$0.00	$0.00	$530.88	"$1,890.48"	"$1,890.48"	$0.00	$0.00	$530.82	$0.00	"$1,255.73"	"$1,255.73"	$0.00	"$1,236.46"	"$1,958.56"	"$1,978.34"	$0.00		$0.00	$375.74	$0.00	$0.00	$393.69	$0.00	$0.00	$0.00	$0.00	$0.00
241.282	SUP	HCPCS C1713		241.282  -  PLATE BN 58X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,731.83 "	"$1,281.55"	$0.00	"$1,345.10"	$756.62	$756.62	$0.00	$0.00	$0.00	$360.96	"$1,285.36"	"$1,285.36"	$0.00	$0.00	$360.91	$0.00	"$1,024.37"	"$1,024.37"	$0.00	$840.69	"$1,331.65"	"$1,345.10"	$0.00		$0.00	$255.47	$0.00	$0.00	$267.67	$0.00	$0.00	$0.00	$0.00	$0.00
241.283	SUP	HCPCS C1713		241.283  -  PLATE BN 58X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,731.83 "	"$1,281.55"	$0.00	"$1,345.10"	$756.62	$756.62	$0.00	$0.00	$0.00	$360.96	"$1,285.36"	"$1,285.36"	$0.00	$0.00	$360.91	$0.00	"$1,024.37"	"$1,024.37"	$0.00	$840.69	"$1,331.65"	"$1,345.10"	$0.00		$0.00	$255.47	$0.00	$0.00	$267.67	$0.00	$0.00	$0.00	$0.00	$0.00
241.284	SUP	HCPCS C1713		241.284  -  PLATE BN 83X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,921.58 "	"$1,421.97"	$0.00	"$1,492.50"	$839.53	$839.53	$0.00	$0.00	$0.00	$400.50	"$1,426.19"	"$1,426.19"	$0.00	$0.00	$400.46	$0.00	"$1,136.61"	"$1,136.61"	$0.00	$932.81	"$1,477.58"	"$1,492.50"	$0.00		$0.00	$283.46	$0.00	$0.00	$297.01	$0.00	$0.00	$0.00	$0.00	$0.00
241.285	SUP	HCPCS C1713		241.285  -  PLATE BN 83X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,921.58 "	"$1,421.97"	$0.00	"$1,492.50"	$839.53	$839.53	$0.00	$0.00	$0.00	$400.50	"$1,426.19"	"$1,426.19"	$0.00	$0.00	$400.46	$0.00	"$1,136.61"	"$1,136.61"	$0.00	$932.81	"$1,477.58"	"$1,492.50"	$0.00		$0.00	$283.46	$0.00	$0.00	$297.01	$0.00	$0.00	$0.00	$0.00	$0.00
241.286	SUP	HCPCS C1713		241.286  -  PLATE BN 110X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,112.75 "	"$1,563.44"	$0.00	"$1,640.98"	$923.05	$923.05	$0.00	$0.00	$0.00	$440.35	"$1,568.08"	"$1,568.08"	$0.00	$0.00	$440.30	$0.00	"$1,249.69"	"$1,249.69"	$0.00	"$1,025.61"	"$1,624.57"	"$1,640.98"	$0.00		$0.00	$311.67	$0.00	$0.00	$326.56	$0.00	$0.00	$0.00	$0.00	$0.00
241.287	SUP	HCPCS C1713		241.287  -  PLATE BN 110X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,112.75 "	"$1,563.44"	$0.00	"$1,640.98"	$923.05	$923.05	$0.00	$0.00	$0.00	$440.35	"$1,568.08"	"$1,568.08"	$0.00	$0.00	$440.30	$0.00	"$1,249.69"	"$1,249.69"	$0.00	"$1,025.61"	"$1,624.57"	"$1,640.98"	$0.00		$0.00	$311.67	$0.00	$0.00	$326.56	$0.00	$0.00	$0.00	$0.00	$0.00
241.288	SUP	HCPCS C1713		241.288  -  PLATE BN 136X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,281.45 "	"$1,688.27"	$0.00	"$1,772.00"	$996.75	$996.75	$0.00	$0.00	$0.00	$475.51	"$1,693.29"	"$1,693.29"	$0.00	$0.00	$475.45	$0.00	"$1,349.48"	"$1,349.48"	$0.00	"$1,107.50"	"$1,754.28"	"$1,772.00"	$0.00		$0.00	$336.55	$0.00	$0.00	$352.63	$0.00	$0.00	$0.00	$0.00	$0.00
241.289	SUP	HCPCS C1713		241.289  -  PLATE BN 136X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,281.45 "	"$1,688.27"	$0.00	"$1,772.00"	$996.75	$996.75	$0.00	$0.00	$0.00	$475.51	"$1,693.29"	"$1,693.29"	$0.00	$0.00	$475.45	$0.00	"$1,349.48"	"$1,349.48"	$0.00	"$1,107.50"	"$1,754.28"	"$1,772.00"	$0.00		$0.00	$336.55	$0.00	$0.00	$352.63	$0.00	$0.00	$0.00	$0.00	$0.00
241.3	SUP	HCPCS C1713		241.300  -  PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,279.13 "	"$1,686.56"	$0.00	"$1,823.30"	"$1,025.61"	"$1,025.61"	$0.00	$0.00	$0.00	$475.03	"$1,691.57"	"$1,691.57"	$0.00	$0.00	$474.97	$0.00	"$1,348.10"	"$1,348.10"	$0.00	"$1,139.56"	"$1,805.07"	"$1,823.30"	$0.00		$0.00	$346.30	$0.00	$0.00	$362.84	$0.00	$0.00	$0.00	$0.00	$0.00
241.301	SUP	HCPCS C1713		241.301  -  PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,823.30"	"$1,025.61"	"$1,025.61"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,139.56"	"$1,805.07"	"$1,823.30"	$0.00		$0.00	$346.30	$0.00	$0.00	$362.84	$0.00	$0.00	$0.00	$0.00	$0.00
241.302	SUP	HCPCS C1713		241.302  -  PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,481.05 "	"$1,835.98"	$0.00	"$1,927.02"	"$1,083.95"	"$1,083.95"	$0.00	$0.00	$0.00	$517.11	"$1,841.44"	"$1,841.44"	$0.00	$0.00	$517.05	$0.00	"$1,467.54"	"$1,467.54"	$0.00	"$1,204.39"	"$1,907.75"	"$1,927.02"	$0.00		$0.00	$365.99	$0.00	$0.00	$383.48	$0.00	$0.00	$0.00	$0.00	$0.00
241.303	SUP	HCPCS C1713		241.303  -  PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,481.05 "	"$1,835.98"	$0.00	"$1,927.02"	"$1,083.95"	"$1,083.95"	$0.00	$0.00	$0.00	$517.11	"$1,841.44"	"$1,841.44"	$0.00	$0.00	$517.05	$0.00	"$1,467.54"	"$1,467.54"	$0.00	"$1,204.39"	"$1,907.75"	"$1,927.02"	$0.00		$0.00	$365.99	$0.00	$0.00	$383.48	$0.00	$0.00	$0.00	$0.00	$0.00
241.304	SUP	HCPCS C1713		241.304  -  PLATE BN 201X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,823.30"	"$1,025.61"	"$1,025.61"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,139.56"	"$1,805.07"	"$1,823.30"	$0.00		$0.00	$346.30	$0.00	$0.00	$362.84	$0.00	$0.00	$0.00	$0.00	$0.00
241.305	SUP	HCPCS C1713		241.305  -  PLATE BN 201X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,823.30"	"$1,025.61"	"$1,025.61"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,139.56"	"$1,805.07"	"$1,823.30"	$0.00		$0.00	$346.30	$0.00	$0.00	$362.84	$0.00	$0.00	$0.00	$0.00	$0.00
241.32	SUP	HCPCS C1713		241.32  -  PLATE BN 1/3 TBLR 12MM 25X9X1MM NS .5MM 2 HL COLR SS 3.5MM	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
241.33	SUP	HCPCS C1713		241.33  -  PLATE BN 1/3 TBLR 12MM 37X9X1MM NS .5MM 3 HL COLR SS 3.5MM	BOTH IP/OP	$107.53 	$79.57	$0.00	$83.52	$46.98	$46.98	$0.00	$0.00	$0.00	$22.41	$79.81	$79.81	$0.00	$0.00	$22.41	$0.00	$63.60	$63.60	$0.00	$52.20	$82.68	$83.52	$0.00		$0.00	$15.86	$0.00	$0.00	$16.62	$0.00	$0.00	$0.00	$0.00	$0.00
241.331	SUP	HCPCS C1713		241.331  -  PLATE BONE 33X9X1MM .7MM 1/3 TUBULAR 3 HOLE COLLAR LCP	BOTH IP/OP	$282.55 	$209.09	$0.00	$219.46	$123.45	$123.45	$0.00	$0.00	$0.00	$58.89	$209.71	$209.71	$0.00	$0.00	$58.88	$0.00	$167.13	$167.13	$0.00	$137.16	$217.27	$219.46	$0.00		$0.00	$41.68	$0.00	$0.00	$43.67	$0.00	$0.00	$0.00	$0.00	$0.00
241.34	SUP	HCPCS C1713		241.34  -  PLATE BN 1/3 TBLR 12MM 49X9X1MM NS .5MM 4 HL COLR SS 3.5MM	BOTH IP/OP	$123.70 	$91.54	$0.00	$96.08	$54.05	$54.05	$0.00	$0.00	$0.00	$25.78	$91.81	$91.81	$0.00	$0.00	$25.78	$0.00	$73.17	$73.17	$0.00	$60.05	$95.12	$96.08	$0.00		$0.00	$18.25	$0.00	$0.00	$19.12	$0.00	$0.00	$0.00	$0.00	$0.00
241.341	SUP	HCPCS C1713		241.341  -  PLATE BN 1/3 TBLR 12MM 45X9X1MM NS .7MM LCP 4 HL COLR SS	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
241.35	SUP	HCPCS C1713		241.35  -  PLATE BN 1/3 TBLR 12MM 61X9X1MM NS .5MM 5 HL COLR SS 3.5MM	BOTH IP/OP	$123.70 	$91.54	$0.00	$96.08	$54.05	$54.05	$0.00	$0.00	$0.00	$25.78	$91.81	$91.81	$0.00	$0.00	$25.78	$0.00	$73.17	$73.17	$0.00	$60.05	$95.12	$96.08	$0.00		$0.00	$18.25	$0.00	$0.00	$19.12	$0.00	$0.00	$0.00	$0.00	$0.00
241.351	SUP	HCPCS C1713		241.351  -  PLATE BN 1/3 TBLR 12MM 57X9X1MM NS .7MM LCP 5 HL COLR SS	BOTH IP/OP	$316.28 	$234.05	$0.00	$245.66	$138.18	$138.18	$0.00	$0.00	$0.00	$65.92	$234.74	$234.74	$0.00	$0.00	$65.91	$0.00	$187.08	$187.08	$0.00	$153.54	$243.21	$245.66	$0.00		$0.00	$46.66	$0.00	$0.00	$48.89	$0.00	$0.00	$0.00	$0.00	$0.00
241.36	SUP	HCPCS C1713		241.36  -  PLATE BN 1/3 TBLR 12MM 73X9X1MM NS .5MM 6 HL COLR SS 3.5MM	BOTH IP/OP	$128.60 	$95.16	$0.00	$99.88	$56.18	$56.18	$0.00	$0.00	$0.00	$26.80	$95.45	$95.45	$0.00	$0.00	$26.80	$0.00	$76.07	$76.07	$0.00	$62.43	$98.88	$99.88	$0.00		$0.00	$18.97	$0.00	$0.00	$19.88	$0.00	$0.00	$0.00	$0.00	$0.00
241.361	SUP	HCPCS C1713		241.361  -  PLATE BN 1/3 TBLR 12MM 69X9X1MM NS .7MM LCP 6 HL COLR SS	BOTH IP/OP	$316.28 	$234.05	$0.00	$245.66	$138.18	$138.18	$0.00	$0.00	$0.00	$65.92	$234.74	$234.74	$0.00	$0.00	$65.91	$0.00	$187.08	$187.08	$0.00	$153.54	$243.21	$245.66	$0.00		$0.00	$46.66	$0.00	$0.00	$48.89	$0.00	$0.00	$0.00	$0.00	$0.00
241.37	SUP	HCPCS C1713		241.37  -  PLATE BN 1/3 TBLR 12MM 85X9X1MM NS .5MM 7 HL COLR SS 3.5MM	BOTH IP/OP	$128.60 	$95.16	$0.00	$99.88	$56.18	$56.18	$0.00	$0.00	$0.00	$26.80	$95.45	$95.45	$0.00	$0.00	$26.80	$0.00	$76.07	$76.07	$0.00	$62.43	$98.88	$99.88	$0.00		$0.00	$18.97	$0.00	$0.00	$19.88	$0.00	$0.00	$0.00	$0.00	$0.00
241.371	SUP	HCPCS C1713		241.371  -  PLATE BN 1/3 TBLR 12MM 81X9X1MM NS .7MM LCP 7 HL COLR SS	BOTH IP/OP	$323.30 	$239.24	$0.00	$251.12	$141.26	$141.26	$0.00	$0.00	$0.00	$67.38	$239.95	$239.95	$0.00	$0.00	$67.38	$0.00	$191.23	$191.23	$0.00	$156.95	$248.61	$251.12	$0.00		$0.00	$47.69	$0.00	$0.00	$49.97	$0.00	$0.00	$0.00	$0.00	$0.00
241.38	SUP	HCPCS C1713		241.38  -  PLATE BN 1/3 TBLR 12MM 97X9X1MM NS .5MM 8 HL COLR SS 3.5MM	BOTH IP/OP	$133.55 	$98.83	$0.00	$103.72	$58.34	$58.34	$0.00	$0.00	$0.00	$27.84	$99.12	$99.12	$0.00	$0.00	$27.83	$0.00	$78.99	$78.99	$0.00	$64.83	$102.68	$103.72	$0.00		$0.00	$19.70	$0.00	$0.00	$20.64	$0.00	$0.00	$0.00	$0.00	$0.00
241.381	SUP	HCPCS C1713		241.381  -  PLATE BN 1/3 TBLR 12MM 93X9X1MM NS .7MM LCP 8 HL COLR SS	BOTH IP/OP	$340.18 	$251.73	$0.00	$264.22	$148.62	$148.62	$0.00	$0.00	$0.00	$70.90	$252.48	$252.48	$0.00	$0.00	$70.89	$0.00	$201.21	$201.21	$0.00	$165.14	$261.58	$264.22	$0.00		$0.00	$50.18	$0.00	$0.00	$52.58	$0.00	$0.00	$0.00	$0.00	$0.00
241.39	SUP	HCPCS C1713		241.39  -  PLATE BONE 1/3 TUBE 109X9X1MM .5MM 9 HOLE COLLAR DCP LC-DCP	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
241.391	SUP	HCPCS C1713		241.391  -  PLATE BN 1/3 TBLR 12MM 105X9X1MM NS .7MM LCP 9 HL COLR SS	BOTH IP/OP	$340.18 	$251.73	$0.00	$264.22	$148.62	$148.62	$0.00	$0.00	$0.00	$70.90	$252.48	$252.48	$0.00	$0.00	$70.89	$0.00	$201.21	$201.21	$0.00	$165.14	$261.58	$264.22	$0.00		$0.00	$50.18	$0.00	$0.00	$52.58	$0.00	$0.00	$0.00	$0.00	$0.00
241.4	SUP	HCPCS C1713		241.40  -  PLATE BN 1/3 TBLR 12MM 121X9X1MM NS .5MM 10 HL COLR SS 3.5MM	BOTH IP/OP	$133.05 	$98.46	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$27.73	$98.75	$98.75	$0.00	$0.00	$27.73	$0.00	$78.70	$78.70	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
241.4	SUP	HCPCS C1713		241.4  -  PLATE 121MM SS SM FRAG SET 10 HOLE 1/3 TBLR COLLAR LC DCP	BOTH IP/OP	$133.05 	$98.46	$0.00	$112.90	$59.87	$59.87	$0.00	$0.00	$0.00	$27.73	$98.75	$98.75	$0.00	$0.00	$27.73	$0.00	$78.70	$78.70	$0.00	$66.53	$112.90	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
241.401	SUP	HCPCS C1713		241.401  -  PLATE BN 1/3 TBLR 12MM 117X9X1MM NS .7MM LCP 10 HL COLR SS	BOTH IP/OP	$340.18 	$251.73	$0.00	$264.22	$148.62	$148.62	$0.00	$0.00	$0.00	$70.90	$252.48	$252.48	$0.00	$0.00	$70.89	$0.00	$201.21	$201.21	$0.00	$165.14	$261.58	$264.22	$0.00		$0.00	$50.18	$0.00	$0.00	$52.58	$0.00	$0.00	$0.00	$0.00	$0.00
241.42	SUP	HCPCS C1713		241.42  -  PLATE BN 1/3 TBLR 12MM 145X9X1MM NS .5MM 12 HL COLR SS 3.5MM	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
241.421	SUP	HCPCS C1713		241.421  -  PLATE BN 1/3 TBLR 12MM 141X9X1MM NS .7MM LCP 12 HL COLR SS	BOTH IP/OP	$351.43 	$260.06	$0.00	$272.96	$153.54	$153.54	$0.00	$0.00	$0.00	$73.25	$260.83	$260.83	$0.00	$0.00	$73.24	$0.00	$207.87	$207.87	$0.00	$170.60	$270.23	$272.96	$0.00		$0.00	$51.84	$0.00	$0.00	$54.32	$0.00	$0.00	$0.00	$0.00	$0.00
241.44	SUP	HCPCS C1713		241.440  -  PLATE BONE 80MM 5 HOLE LCP STAINLESS STEEL RIGHT DISTAL	BOTH IP/OP	"$2,774.53 "	"$2,053.15"	$0.00	"$2,219.62"	"$1,248.54"	"$1,248.54"	$0.00	$0.00	$0.00	$578.28	"$2,059.25"	"$2,059.25"	$0.00	$0.00	$578.21	$0.00	"$1,367.84"	"$1,367.84"	$0.00	"$1,387.26"	"$2,197.43"	"$2,219.62"	$0.00		$0.00	$421.57	$0.00	$0.00	$441.70	$0.00	$0.00	$0.00	$0.00	$0.00
241.441	SUP	HCPCS C1713		241.441  -  PLATE BONE 80MM 5 HOLE ANATOMIC TAPERED TIP LCP STAINLESS	BOTH IP/OP	"$2,857.78 "	"$2,114.76"	$0.00	"$2,219.62"	"$1,248.54"	"$1,248.54"	$0.00	$0.00	$0.00	$595.63	"$2,121.04"	"$2,121.04"	$0.00	$0.00	$595.56	$0.00	"$1,408.88"	"$1,408.88"	$0.00	"$1,387.26"	"$2,197.43"	"$2,219.62"	$0.00		$0.00	$421.57	$0.00	$0.00	$441.70	$0.00	$0.00	$0.00	$0.00	$0.00
241.442	SUP	HCPCS C1713		241.442  -  PLATE BONE 106MM 7 HOLE ANATOMIC TAPERED TIP LCP STAINLESS	BOTH IP/OP	"$2,795.93 "	"$2,068.99"	$0.00	"$2,171.60"	"$1,221.53"	"$1,221.53"	$0.00	$0.00	$0.00	$582.74	"$2,075.14"	"$2,075.14"	$0.00	$0.00	$582.67	$0.00	"$1,378.39"	"$1,378.39"	$0.00	"$1,357.25"	"$2,149.88"	"$2,171.60"	$0.00		$0.00	$412.44	$0.00	$0.00	$432.15	$0.00	$0.00	$0.00	$0.00	$0.00
241.443	SUP	HCPCS C1713		241.443  -  PLATE BONE 106MM 7 HOLE ANATOMIC TAPERED TIP LCP STAINLESS	BOTH IP/OP	"$2,795.93 "	"$2,068.99"	$0.00	"$2,171.60"	"$1,221.53"	"$1,221.53"	$0.00	$0.00	$0.00	$582.74	"$2,075.14"	"$2,075.14"	$0.00	$0.00	$582.67	$0.00	"$1,378.39"	"$1,378.39"	$0.00	"$1,357.25"	"$2,149.88"	"$2,171.60"	$0.00		$0.00	$412.44	$0.00	$0.00	$432.15	$0.00	$0.00	$0.00	$0.00	$0.00
241.444	SUP	HCPCS C1713		241.444  -  PLATE BONE 132MM 9 HOLE ANATOMIC TAPERED TIP LCP STAINLESS	BOTH IP/OP	"$2,824.03 "	"$2,089.78"	$0.00	"$2,193.42"	"$1,233.80"	"$1,233.80"	$0.00	$0.00	$0.00	$588.60	"$2,095.99"	"$2,095.99"	$0.00	$0.00	$588.53	$0.00	"$1,392.24"	"$1,392.24"	$0.00	"$1,370.89"	"$2,171.49"	"$2,193.42"	$0.00		$0.00	$416.59	$0.00	$0.00	$436.49	$0.00	$0.00	$0.00	$0.00	$0.00
241.445	SUP	HCPCS C1713		241.445  -  PLATE BONE 132MM 9 HOLE ANATOMIC TAPERED TIP LCP STAINLESS	BOTH IP/OP	"$2,824.03 "	"$2,089.78"	$0.00	"$2,193.42"	"$1,233.80"	"$1,233.80"	$0.00	$0.00	$0.00	$588.60	"$2,095.99"	"$2,095.99"	$0.00	$0.00	$588.53	$0.00	"$1,392.24"	"$1,392.24"	$0.00	"$1,370.89"	"$2,171.49"	"$2,193.42"	$0.00		$0.00	$416.59	$0.00	$0.00	$436.49	$0.00	$0.00	$0.00	$0.00	$0.00
241.446	SUP	HCPCS C1713		241.446  -  PLATE BONE 158MM 11 HOLE ANATOMIC TAPERED TIP LCP STAINLESS	BOTH IP/OP	"$2,850.75 "	"$2,109.56"	$0.00	"$2,214.18"	"$1,245.48"	"$1,245.48"	$0.00	$0.00	$0.00	$594.17	"$2,115.83"	"$2,115.83"	$0.00	$0.00	$594.10	$0.00	"$1,405.42"	"$1,405.42"	$0.00	"$1,383.86"	"$2,192.04"	"$2,214.18"	$0.00		$0.00	$420.53	$0.00	$0.00	$440.62	$0.00	$0.00	$0.00	$0.00	$0.00
241.447	SUP	HCPCS C1713		241.447  -  PLATE BONE 158MM 11 HOLE LCP STAINLESS STEEL LEFT DISTAL	BOTH IP/OP	"$2,850.75 "	"$2,109.56"	$0.00	"$2,214.18"	"$1,245.48"	"$1,245.48"	$0.00	$0.00	$0.00	$594.17	"$2,115.83"	"$2,115.83"	$0.00	$0.00	$594.10	$0.00	"$1,405.42"	"$1,405.42"	$0.00	"$1,383.86"	"$2,192.04"	"$2,214.18"	$0.00		$0.00	$420.53	$0.00	$0.00	$440.62	$0.00	$0.00	$0.00	$0.00	$0.00
241.448	SUP	HCPCS C1713		241.448  -  PLATE BONE 184MM 13 HOLE ANATOMIC TAPERED TIP LCP STAINLESS	BOTH IP/OP	"$2,883.08 "	"$2,133.48"	$0.00	"$2,239.28"	"$1,259.60"	"$1,259.60"	$0.00	$0.00	$0.00	$600.90	"$2,139.82"	"$2,139.82"	$0.00	$0.00	$600.83	$0.00	"$1,421.36"	"$1,421.36"	$0.00	"$1,399.55"	"$2,216.89"	"$2,239.28"	$0.00		$0.00	$425.30	$0.00	$0.00	$445.62	$0.00	$0.00	$0.00	$0.00	$0.00
241.449	SUP	HCPCS C1713		241.449  -  PLATE BONE 184MM 13 HOLE ANATOMIC TAPERED TIP LCP STAINLESS	BOTH IP/OP	"$2,883.08 "	"$2,133.48"	$0.00	"$2,239.28"	"$1,259.60"	"$1,259.60"	$0.00	$0.00	$0.00	$600.90	"$2,139.82"	"$2,139.82"	$0.00	$0.00	$600.83	$0.00	"$1,421.36"	"$1,421.36"	$0.00	"$1,399.55"	"$2,216.89"	"$2,239.28"	$0.00		$0.00	$425.30	$0.00	$0.00	$445.62	$0.00	$0.00	$0.00	$0.00	$0.00
241.45	SUP	HCPCS C1713		241.450  -  PLATE BONE 210MM 15 HOLE LCP STAINLESS STEEL RIGHT DISTAL	BOTH IP/OP	"$2,835.95 "	"$2,098.60"	$0.00	"$2,268.76"	"$1,276.18"	"$1,276.18"	$0.00	$0.00	$0.00	$591.08	"$2,104.84"	"$2,104.84"	$0.00	$0.00	$591.01	$0.00	"$1,398.12"	"$1,398.12"	$0.00	"$1,417.98"	"$2,246.07"	"$2,268.76"	$0.00		$0.00	$430.90	$0.00	$0.00	$451.48	$0.00	$0.00	$0.00	$0.00	$0.00
241.451	SUP	HCPCS C1713		241.451  -  PLATE BONE 210MM 15 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$2,921.03 "	"$2,161.56"	$0.00	"$2,268.76"	"$1,276.18"	"$1,276.18"	$0.00	$0.00	$0.00	$608.81	"$2,167.98"	"$2,167.98"	$0.00	$0.00	$608.74	$0.00	"$1,440.07"	"$1,440.07"	$0.00	"$1,417.98"	"$2,246.07"	"$2,268.76"	$0.00		$0.00	$430.90	$0.00	$0.00	$451.48	$0.00	$0.00	$0.00	$0.00	$0.00
241.452	SUP	HCPCS C1713		241.452  -  PLATE BONE 236MM 17 HOLE LCP STAINLESS STEEL TIBIA RIGHT	BOTH IP/OP	"$3,047.55 "	"$2,255.19"	$0.00	"$2,367.02"	"$1,331.45"	"$1,331.45"	$0.00	$0.00	$0.00	$635.19	"$2,261.89"	"$2,261.89"	$0.00	$0.00	$635.11	$0.00	"$1,502.44"	"$1,502.44"	$0.00	"$1,479.39"	"$2,343.35"	"$2,367.02"	$0.00		$0.00	$449.56	$0.00	$0.00	$471.04	$0.00	$0.00	$0.00	$0.00	$0.00
241.453	SUP	HCPCS C1713		241.453  -  PLATE BONE 236MM 17 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$3,047.55 "	"$2,255.19"	$0.00	"$2,367.02"	"$1,331.45"	"$1,331.45"	$0.00	$0.00	$0.00	$635.19	"$2,261.89"	"$2,261.89"	$0.00	$0.00	$635.11	$0.00	"$1,502.44"	"$1,502.44"	$0.00	"$1,479.39"	"$2,343.35"	"$2,367.02"	$0.00		$0.00	$449.56	$0.00	$0.00	$471.04	$0.00	$0.00	$0.00	$0.00	$0.00
241.454	SUP	HCPCS C1713		241.454  -  PLATE BONE 262MM 19 HOLE LCP STAINLESS STEEL TIBIA RIGHT	BOTH IP/OP	"$3,071.45 "	"$2,272.87"	$0.00	"$2,385.58"	"$1,341.89"	"$1,341.89"	$0.00	$0.00	$0.00	$640.17	"$2,279.63"	"$2,279.63"	$0.00	$0.00	$640.09	$0.00	"$1,514.22"	"$1,514.22"	$0.00	"$1,490.99"	"$2,361.73"	"$2,385.58"	$0.00		$0.00	$453.09	$0.00	$0.00	$474.73	$0.00	$0.00	$0.00	$0.00	$0.00
241.455	SUP	HCPCS C1713		241.455  -  PLATE BONE 262MM 19 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$3,071.45 "	"$2,272.87"	$0.00	"$2,385.58"	"$1,341.89"	"$1,341.89"	$0.00	$0.00	$0.00	$640.17	"$2,279.63"	"$2,279.63"	$0.00	$0.00	$640.09	$0.00	"$1,514.22"	"$1,514.22"	$0.00	"$1,490.99"	"$2,361.73"	"$2,385.58"	$0.00		$0.00	$453.09	$0.00	$0.00	$474.73	$0.00	$0.00	$0.00	$0.00	$0.00
241.456	SUP	HCPCS C1713		241.456  -  PLATE BONE 288MM 21 HOLE LCP STAINLESS STEEL TIBIA RIGHT	BOTH IP/OP	"$3,100.95 "	"$2,294.70"	$0.00	"$2,408.52"	"$1,354.79"	"$1,354.79"	$0.00	$0.00	$0.00	$646.32	"$2,301.53"	"$2,301.53"	$0.00	$0.00	$646.24	$0.00	"$1,528.77"	"$1,528.77"	$0.00	"$1,505.33"	"$2,384.43"	"$2,408.52"	$0.00		$0.00	$457.44	$0.00	$0.00	$479.30	$0.00	$0.00	$0.00	$0.00	$0.00
241.457	SUP	HCPCS C1713		241.457  -  PLATE BONE 288MM 21 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$3,100.95 "	"$2,294.70"	$0.00	"$2,408.52"	"$1,354.79"	"$1,354.79"	$0.00	$0.00	$0.00	$646.32	"$2,301.53"	"$2,301.53"	$0.00	$0.00	$646.24	$0.00	"$1,528.77"	"$1,528.77"	$0.00	"$1,505.33"	"$2,384.43"	"$2,408.52"	$0.00		$0.00	$457.44	$0.00	$0.00	$479.30	$0.00	$0.00	$0.00	$0.00	$0.00
241.61	SUP	HCPCS C1713		241.61  -  PLATE BN 60MMX1.2MM NS LCP SS CALC 3.5MM CORT 4MM CANC 3.5MM	BOTH IP/OP	$974.15 	$720.87	$0.00	$756.62	$425.60	$425.60	$0.00	$0.00	$0.00	$203.04	$723.01	$723.01	$0.00	$0.00	$203.01	$0.00	$576.21	$576.21	$0.00	$472.89	$749.06	$756.62	$0.00		$0.00	$143.70	$0.00	$0.00	$150.57	$0.00	$0.00	$0.00	$0.00	$0.00
241.618	SUP	HCPCS C1713		241.618  -  PLATE BONE MINI 64MM LOCK LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,152.68 "	$852.98	$0.00	$895.28	$503.60	$503.60	$0.00	$0.00	$0.00	$240.25	$855.52	$855.52	$0.00	$0.00	$240.22	$0.00	$681.81	$681.81	$0.00	$559.55	$886.33	$895.28	$0.00		$0.00	$170.04	$0.00	$0.00	$178.16	$0.00	$0.00	$0.00	$0.00	$0.00
241.619	SUP	HCPCS C1713		241.619  -  PLATE BONE MINI 64MM LOCK LCP STAINLESS STEEL LEFT CALCANEAL	BOTH IP/OP	"$1,152.68 "	$852.98	$0.00	$895.28	$503.60	$503.60	$0.00	$0.00	$0.00	$240.25	$855.52	$855.52	$0.00	$0.00	$240.22	$0.00	$681.81	$681.81	$0.00	$559.55	$886.33	$895.28	$0.00		$0.00	$170.04	$0.00	$0.00	$178.16	$0.00	$0.00	$0.00	$0.00	$0.00
241.62	SUP	HCPCS C1713		241.62  -  PLATE BN 70MMX1.2MM NS LCP SS CALC 3.5MM CORT 4MM CANC 3.5MM	BOTH IP/OP	$993.83 	$735.43	$0.00	$771.90	$434.19	$434.19	$0.00	$0.00	$0.00	$207.14	$737.62	$737.62	$0.00	$0.00	$207.11	$0.00	$587.85	$587.85	$0.00	$482.44	$764.18	$771.90	$0.00		$0.00	$146.61	$0.00	$0.00	$153.61	$0.00	$0.00	$0.00	$0.00	$0.00
241.622	SUP	HCPCS C1713		241.622  -  PLATE BN SHRT 69MMX2MM NS LCP LCK SS CALC RT 2.7/3.5MM CORT	BOTH IP/OP	"$1,291.83 "	$955.95	$0.00	"$1,003.36"	$564.39	$564.39	$0.00	$0.00	$0.00	$269.25	$958.79	$958.79	$0.00	$0.00	$269.22	$0.00	$764.11	$764.11	$0.00	$627.10	$993.33	"$1,003.36"	$0.00		$0.00	$190.57	$0.00	$0.00	$199.67	$0.00	$0.00	$0.00	$0.00	$0.00
241.623	SUP	HCPCS C1713		241.623  -  PLATE BN SHRT 69MMX2MM NS LCP LCK SS CALC LT 2.7/3.5MM CORT	BOTH IP/OP	"$1,291.83 "	$955.95	$0.00	"$1,003.36"	$564.39	$564.39	$0.00	$0.00	$0.00	$269.25	$958.79	$958.79	$0.00	$0.00	$269.22	$0.00	$764.11	$764.11	$0.00	$627.10	$993.33	"$1,003.36"	$0.00		$0.00	$190.57	$0.00	$0.00	$199.67	$0.00	$0.00	$0.00	$0.00	$0.00
241.624	SUP	HCPCS C1713		241.624  -  PLATE BN LNG 76MMX2MM NS LCP LCK SS CALC RT 2.7/3.5MM CORT	BOTH IP/OP	"$1,377.58 "	"$1,019.41"	$0.00	"$1,069.96"	$601.85	$601.85	$0.00	$0.00	$0.00	$287.12	"$1,022.44"	"$1,022.44"	$0.00	$0.00	$287.09	$0.00	$814.84	$814.84	$0.00	$668.73	"$1,059.26"	"$1,069.96"	$0.00		$0.00	$203.22	$0.00	$0.00	$212.92	$0.00	$0.00	$0.00	$0.00	$0.00
241.625	SUP	HCPCS C1713		241.625  -  PLATE BONE LONG 76MM LOCKING BENDABLE TAB LCP STAINLESS	BOTH IP/OP	"$1,377.58 "	"$1,019.41"	$0.00	"$1,069.96"	$601.85	$601.85	$0.00	$0.00	$0.00	$287.12	"$1,022.44"	"$1,022.44"	$0.00	$0.00	$287.09	$0.00	$814.84	$814.84	$0.00	$668.73	"$1,059.26"	"$1,069.96"	$0.00		$0.00	$203.22	$0.00	$0.00	$212.92	$0.00	$0.00	$0.00	$0.00	$0.00
241.626	SUP	HCPCS C1713		241.626  -  PLATE BN XLNG 81MMX2MM NS LCP LCK SS CALC RT 2.7/3.5MM CORT	BOTH IP/OP	"$1,423.98 "	"$1,053.75"	$0.00	"$1,106.00"	$622.13	$622.13	$0.00	$0.00	$0.00	$296.79	"$1,056.87"	"$1,056.87"	$0.00	$0.00	$296.76	$0.00	$842.28	$842.28	$0.00	$691.25	"$1,094.94"	"$1,106.00"	$0.00		$0.00	$210.06	$0.00	$0.00	$220.09	$0.00	$0.00	$0.00	$0.00	$0.00
241.627	SUP	HCPCS C1713		241.627  -  PLATE BN XLNG 81MMX2MM NS LCP LCK SS CALC LT 2.7/3.5MM CORT	BOTH IP/OP	"$1,423.98 "	"$1,053.75"	$0.00	"$1,106.00"	$622.13	$622.13	$0.00	$0.00	$0.00	$296.79	"$1,056.87"	"$1,056.87"	$0.00	$0.00	$296.76	$0.00	$842.28	$842.28	$0.00	$691.25	"$1,094.94"	"$1,106.00"	$0.00		$0.00	$210.06	$0.00	$0.00	$220.09	$0.00	$0.00	$0.00	$0.00	$0.00
241.65	SUP	HCPCS C1713		241.65  -  PLATE BN Y 87MMX2MM NS LCP SS CALC 3.5MM CORT 4MM CANC 3.5MM	BOTH IP/OP	$993.83 	$735.43	$0.00	$771.90	$434.19	$434.19	$0.00	$0.00	$0.00	$207.14	$737.62	$737.62	$0.00	$0.00	$207.11	$0.00	$587.85	$587.85	$0.00	$482.44	$764.18	$771.90	$0.00		$0.00	$146.61	$0.00	$0.00	$153.61	$0.00	$0.00	$0.00	$0.00	$0.00
241.68	SUP	HCPCS C1713		241.680  -  PLATE BONE 34MM 2 HOLE LCP STAINLESS STEEL RIGHT RADIAL HEAD	BOTH IP/OP	"$1,112.28 "	$823.09	$0.00	$889.82	$500.52	$500.52	$0.00	$0.00	$0.00	$231.83	$825.53	$825.53	$0.00	$0.00	$231.80	$0.00	$657.91	$657.91	$0.00	$556.14	$880.93	$889.82	$0.00		$0.00	$169.00	$0.00	$0.00	$177.07	$0.00	$0.00	$0.00	$0.00	$0.00
241.681	SUP	HCPCS C1713		241.681  -  PLATE BN 34MM NS LCP CMBN 2 HL RIM PRECONTOUR LMT CNTCT SS	BOTH IP/OP	"$1,145.65 "	$847.78	$0.00	$889.82	$500.52	$500.52	$0.00	$0.00	$0.00	$238.78	$850.30	$850.30	$0.00	$0.00	$238.75	$0.00	$677.65	$677.65	$0.00	$556.14	$880.93	$889.82	$0.00		$0.00	$169.00	$0.00	$0.00	$177.07	$0.00	$0.00	$0.00	$0.00	$0.00
241.682	SUP	HCPCS C1713		241.682  -  PLATE BONE 46MM 3 HOLE HEAD LCP STAINLESS STEEL RIGHT RADIAL	BOTH IP/OP	"$1,177.98 "	$871.71	$0.00	$914.92	$514.64	$514.64	$0.00	$0.00	$0.00	$245.52	$874.29	$874.29	$0.00	$0.00	$245.49	$0.00	$696.77	$696.77	$0.00	$571.83	$905.77	$914.92	$0.00		$0.00	$173.77	$0.00	$0.00	$182.07	$0.00	$0.00	$0.00	$0.00	$0.00
241.683	SUP	HCPCS C1713		241.683  -  PLATE BONE 46MM 3 HOLE RIM LCP STAINLESS STEEL LEFT RADIAL	BOTH IP/OP	"$1,177.98 "	$871.71	$0.00	$914.92	$514.64	$514.64	$0.00	$0.00	$0.00	$245.52	$874.29	$874.29	$0.00	$0.00	$245.49	$0.00	$696.77	$696.77	$0.00	$571.83	$905.77	$914.92	$0.00		$0.00	$173.77	$0.00	$0.00	$182.07	$0.00	$0.00	$0.00	$0.00	$0.00
241.684	SUP	HCPCS C1713		241.684  -  PLATE BONE 56MM 4 HOLE RIM LCP STAINLESS STEEL RIGHT RADIAL	BOTH IP/OP	"$1,199.05 "	$887.30	$0.00	$931.30	$523.86	$523.86	$0.00	$0.00	$0.00	$249.91	$889.93	$889.93	$0.00	$0.00	$249.88	$0.00	$709.24	$709.24	$0.00	$582.06	$921.99	$931.30	$0.00		$0.00	$176.88	$0.00	$0.00	$185.33	$0.00	$0.00	$0.00	$0.00	$0.00
241.685	SUP	HCPCS C1713		241.685  -  PLATE BONE 56MM 4 HOLE RIM LCP STAINLESS STEEL LEFT RADIAL	BOTH IP/OP	"$1,199.05 "	$887.30	$0.00	$931.30	$523.86	$523.86	$0.00	$0.00	$0.00	$249.91	$889.93	$889.93	$0.00	$0.00	$249.88	$0.00	$709.24	$709.24	$0.00	$582.06	$921.99	$931.30	$0.00		$0.00	$176.88	$0.00	$0.00	$185.33	$0.00	$0.00	$0.00	$0.00	$0.00
241.69	SUP	HCPCS C1713		241.690  -  PLATE BN 28MM NS LCP CMBN 2 HL NK PRECONTOUR LMT CNTCT SS	BOTH IP/OP	"$1,112.28 "	$823.09	$0.00	$889.82	$500.52	$500.52	$0.00	$0.00	$0.00	$231.83	$825.53	$825.53	$0.00	$0.00	$231.80	$0.00	$657.91	$657.91	$0.00	$556.14	$880.93	$889.82	$0.00		$0.00	$169.00	$0.00	$0.00	$177.07	$0.00	$0.00	$0.00	$0.00	$0.00
241.691	SUP	HCPCS C1713		241.691  -  PLATE BN 40MM NS LCP CMBN 3 HL NK PRECONTOUR LMT CNTCT SS	BOTH IP/OP	"$1,177.98 "	$871.71	$0.00	$914.92	$514.64	$514.64	$0.00	$0.00	$0.00	$245.52	$874.29	$874.29	$0.00	$0.00	$245.49	$0.00	$696.77	$696.77	$0.00	$571.83	$905.77	$914.92	$0.00		$0.00	$173.77	$0.00	$0.00	$182.07	$0.00	$0.00	$0.00	$0.00	$0.00
241.692	SUP	HCPCS C1713		241.692  -  PLATE BONE 50MM 4 HOLE LCP STAINLESS STEEL RADIAL HEAD	BOTH IP/OP	"$1,200.45 "	$888.33	$0.00	$932.40	$524.48	$524.48	$0.00	$0.00	$0.00	$250.20	$890.97	$890.97	$0.00	$0.00	$250.17	$0.00	$710.07	$710.07	$0.00	$582.75	$923.08	$932.40	$0.00		$0.00	$177.09	$0.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00
241.83	SUP	HCPCS C1713		241.83  -  PLATE BN CLVRLF 88X15X2MM NS 1.2MM LC DCP 3 HL THN BLDE	BOTH IP/OP	$552.73 	$409.02	$0.00	$442.18	$248.73	$248.73	$0.00	$0.00	$0.00	$115.20	$410.23	$410.23	$0.00	$0.00	$115.19	$0.00	$326.94	$326.94	$0.00	$276.36	$437.76	$442.18	$0.00		$0.00	$83.98	$0.00	$0.00	$87.99	$0.00	$0.00	$0.00	$0.00	$0.00
241.84	SUP	HCPCS C1713		241.84  -  PLATE BN CLVRLF 104X15X2MM NS 1.2MM LC DCP 4 HL THN BLDE	BOTH IP/OP	$590.93 	$437.29	$0.00	$472.74	$265.92	$265.92	$0.00	$0.00	$0.00	$123.16	$438.58	$438.58	$0.00	$0.00	$123.15	$0.00	$349.53	$349.53	$0.00	$295.46	$468.02	$472.74	$0.00		$0.00	$89.79	$0.00	$0.00	$94.08	$0.00	$0.00	$0.00	$0.00	$0.00
241.85	SUP	HCPCS C1713		241.85  -  PLATE BN CLVRLF 120X15X2MM NS 5 HL THN BLDE SS 3.5MM SCR	BOTH IP/OP	$768.35 	$568.58	$0.00	$614.68	$345.76	$345.76	$0.00	$0.00	$0.00	$160.14	$570.27	$570.27	$0.00	$0.00	$160.12	$0.00	$454.48	$454.48	$0.00	$384.18	$608.53	$614.68	$0.00		$0.00	$116.75	$0.00	$0.00	$122.32	$0.00	$0.00	$0.00	$0.00	$0.00
241.86	SUP	HCPCS C1713		241.86  -  PLATE BONE THIN CLOVERLEAF 136MM 6 HOLE LC-DCP STAINLESS	BOTH IP/OP	$833.85 	$617.05	$0.00	$667.08	$375.23	$375.23	$0.00	$0.00	$0.00	$173.80	$618.88	$618.88	$0.00	$0.00	$173.77	$0.00	$493.22	$493.22	$0.00	$416.93	$660.41	$667.08	$0.00		$0.00	$126.70	$0.00	$0.00	$132.75	$0.00	$0.00	$0.00	$0.00	$0.00
241.87	SUP	HCPCS C1713		241.87  -  PLATE BN CLVRLF 152X15X2MM NS 1.2MM LC DCP 7 HL THN BLDE	BOTH IP/OP	$898.00 	$664.52	$0.00	$718.40	$404.10	$404.10	$0.00	$0.00	$0.00	$187.17	$666.50	$666.50	$0.00	$0.00	$187.14	$0.00	$531.17	$531.17	$0.00	$449.00	$711.22	$718.40	$0.00		$0.00	$136.44	$0.00	$0.00	$142.96	$0.00	$0.00	$0.00	$0.00	$0.00
241.88	SUP	HCPCS C1713		241.88  -  PLATE BN CLVRLF 168X15X2MM NS 1.2MM LC DCP 8 HL THN BLDE	BOTH IP/OP	$953.95 	$705.92	$0.00	$763.16	$429.28	$429.28	$0.00	$0.00	$0.00	$198.83	$708.02	$708.02	$0.00	$0.00	$198.80	$0.00	$564.26	$564.26	$0.00	$476.98	$755.53	$763.16	$0.00		$0.00	$144.95	$0.00	$0.00	$151.87	$0.00	$0.00	$0.00	$0.00	$0.00
241.89	SUP	HCPCS C1713		241.89  -  PLATE BONE THIN 200X15X1.2MM 10 HOLE CLOVERLEAF THIN BLADE	BOTH IP/OP	"$1,061.30 "	$785.36	$0.00	$824.30	$463.67	$463.67	$0.00	$0.00	$0.00	$221.20	$787.70	$787.70	$0.00	$0.00	$221.17	$0.00	$627.76	$627.76	$0.00	$515.19	$816.06	$824.30	$0.00		$0.00	$156.56	$0.00	$0.00	$164.04	$0.00	$0.00	$0.00	$0.00	$0.00
241.901	SUP	HCPCS C1713		241.901  -  PLATE BN STD 90X12X2.5MM NS LCP CMBN PHLS 3 HL SHFT LCK CMPR	BOTH IP/OP	"$2,857.78 "	"$2,114.76"	$0.00	"$2,219.62"	"$1,248.54"	"$1,248.54"	$0.00	$0.00	$0.00	$595.63	"$2,121.04"	"$2,121.04"	$0.00	$0.00	$595.56	$0.00	"$1,408.88"	"$1,408.88"	$0.00	"$1,387.26"	"$2,197.43"	"$2,219.62"	$0.00		$0.00	$421.57	$0.00	$0.00	$441.70	$0.00	$0.00	$0.00	$0.00	$0.00
241.903	SUP	HCPCS C1713		241.903  -  PLATE BN STD 114X12X2.5MM NS LCP CMBN PHLS 5 HL SHFT LCK	BOTH IP/OP	"$2,947.73 "	"$2,181.32"	$0.00	"$2,289.50"	"$1,287.84"	"$1,287.84"	$0.00	$0.00	$0.00	$614.38	"$2,187.80"	"$2,187.80"	$0.00	$0.00	$614.31	$0.00	"$1,453.23"	"$1,453.23"	$0.00	"$1,430.94"	"$2,266.61"	"$2,289.50"	$0.00		$0.00	$434.84	$0.00	$0.00	$455.61	$0.00	$0.00	$0.00	$0.00	$0.00
241.918	SUP	HCPCS C1713		241.918  -  PLATE BN 142X12X3.7MM NS LCP CMBN PHLS LNG 5 HL SHFT LCK	BOTH IP/OP	"$2,975.85 "	"$2,202.13"	$0.00	"$2,311.34"	"$1,300.13"	"$1,300.13"	$0.00	$0.00	$0.00	$620.24	"$2,208.68"	"$2,208.68"	$0.00	$0.00	$620.17	$0.00	"$1,467.09"	"$1,467.09"	$0.00	"$1,444.59"	"$2,288.23"	"$2,311.34"	$0.00		$0.00	$438.99	$0.00	$0.00	$459.96	$0.00	$0.00	$0.00	$0.00	$0.00
241.919	SUP	HCPCS C1713		241.919  -  PLATE LNG 160MM SS 3.5MM SCR SM FRAG SET 6 HOLE LCP BONE	BOTH IP/OP	"$3,582.78 "	"$2,651.26"	$0.00	"$2,866.22"	"$1,612.25"	"$1,612.25"	$0.00	$0.00	$0.00	$746.74	"$2,659.14"	"$2,659.14"	$0.00	$0.00	$746.65	$0.00	"$1,766.31"	"$1,766.31"	$0.00	"$1,791.39"	"$2,837.56"	"$2,866.22"	$0.00		$0.00	$560.70	$0.00	$0.00	$570.38	$0.00	$0.00	$0.00	$0.00	$0.00
241.921	SUP	HCPCS C1713		241.921  -  PLATE BN 196X12X3.7MM NS LCP CMBN PHLS LNG 8 HL SHFT LCK	BOTH IP/OP	"$3,213.43 "	"$2,377.94"	$0.00	"$2,495.86"	"$1,403.92"	"$1,403.92"	$0.00	$0.00	$0.00	$669.76	"$2,385.00"	"$2,385.00"	$0.00	$0.00	$669.68	$0.00	"$1,584.22"	"$1,584.22"	$0.00	"$1,559.91"	"$2,470.91"	"$2,495.86"	$0.00		$0.00	$474.03	$0.00	$0.00	$496.68	$0.00	$0.00	$0.00	$0.00	$0.00
241.923	SUP	HCPCS C1713		241.923  -  PLATE BN 232X12X3.7MM NS LCP CMBN PHLS LNG 10 HL SHFT LCK	BOTH IP/OP	"$3,332.90 "	"$2,466.35"	$0.00	"$2,588.66"	"$1,456.12"	"$1,456.12"	$0.00	$0.00	$0.00	$694.66	"$2,473.68"	"$2,473.68"	$0.00	$0.00	$694.58	$0.00	"$1,643.12"	"$1,643.12"	$0.00	"$1,617.91"	"$2,562.78"	"$2,588.66"	$0.00		$0.00	$491.66	$0.00	$0.00	$515.14	$0.00	$0.00	$0.00	$0.00	$0.00
241.925	SUP	HCPCS C1713		241.925  -  PLATE BN 268X12X3.7MM NS LCP CMBN PHLS LNG 12 HL SHFT LCK	BOTH IP/OP	"$3,448.18 "	"$2,551.65"	$0.00	"$2,678.18"	"$1,506.48"	"$1,506.48"	$0.00	$0.00	$0.00	$718.69	"$2,559.24"	"$2,559.24"	$0.00	$0.00	$718.60	$0.00	"$1,699.95"	"$1,699.95"	$0.00	"$1,673.86"	"$2,651.40"	"$2,678.18"	$0.00		$0.00	$508.66	$0.00	$0.00	$532.96	$0.00	$0.00	$0.00	$0.00	$0.00
241.931	SUP	HCPCS C1713		241.931  -  PLATE BN OB L T 52X10X1.5MM NS LCP CMBN 3 HLE/HD 3 HL SHFT	BOTH IP/OP	$663.48 	$490.98	$0.00	$515.32	$289.87	$289.87	$0.00	$0.00	$0.00	$138.28	$492.43	$492.43	$0.00	$0.00	$138.27	$0.00	$392.45	$392.45	$0.00	$322.08	$510.17	$515.32	$0.00		$0.00	$97.88	$0.00	$0.00	$102.55	$0.00	$0.00	$0.00	$0.00	$0.00
241.941	SUP	HCPCS C1713		241.941  -  PLATE BN OB L T 63X10X1.5MM NS LCP CMBN 3 HLE/HD 4 HL SHFT	BOTH IP/OP	$695.83 	$514.91	$0.00	$540.44	$304.00	$304.00	$0.00	$0.00	$0.00	$145.03	$516.44	$516.44	$0.00	$0.00	$145.01	$0.00	$411.58	$411.58	$0.00	$337.78	$535.04	$540.44	$0.00		$0.00	$102.64	$0.00	$0.00	$107.55	$0.00	$0.00	$0.00	$0.00	$0.00
241.951	SUP	HCPCS C1713		241.951  -  PLATE BN OB L T 74X10X1.5MM NS LCP CMBN 3 HLE/HD 5 HL SHFT	BOTH IP/OP	$726.75 	$537.80	$0.00	$564.46	$317.51	$317.51	$0.00	$0.00	$0.00	$151.47	$539.39	$539.39	$0.00	$0.00	$151.45	$0.00	$429.87	$429.87	$0.00	$352.79	$558.82	$564.46	$0.00		$0.00	$107.21	$0.00	$0.00	$112.33	$0.00	$0.00	$0.00	$0.00	$0.00
241.961	SUP	HCPCS C1713		241.961  -  PLATE BONE T THK1.5MM 85X10MM 3X6 HOLE LEFT OBLIQUE LOCKING	BOTH IP/OP	$778.75 	$576.28	$0.00	$604.86	$340.23	$340.23	$0.00	$0.00	$0.00	$162.31	$577.99	$577.99	$0.00	$0.00	$162.29	$0.00	$460.63	$460.63	$0.00	$378.04	$598.82	$604.86	$0.00		$0.00	$114.88	$0.00	$0.00	$120.37	$0.00	$0.00	$0.00	$0.00	$0.00
241.971	SUP	HCPCS C1713		241.971  -  PLATE BN OB L T 96X10X1.5MM NS LCP CMBN 3 HLE/HD 7 HL SHFT	BOTH IP/OP	$787.20 	$582.53	$0.00	$611.40	$343.91	$343.91	$0.00	$0.00	$0.00	$164.07	$584.26	$584.26	$0.00	$0.00	$164.05	$0.00	$465.63	$465.63	$0.00	$382.13	$605.29	$611.40	$0.00		$0.00	$116.12	$0.00	$0.00	$121.67	$0.00	$0.00	$0.00	$0.00	$0.00
241.981	SUP	HCPCS C1713		241.981  -  PLATE BONE T THK1.5MM 107X10MM 3X8 HOLE LEFT OBLIQUE LOCKING	BOTH IP/OP	$856.08 	$633.50	$0.00	$664.90	$374.01	$374.01	$0.00	$0.00	$0.00	$178.43	$635.38	$635.38	$0.00	$0.00	$178.41	$0.00	$506.37	$506.37	$0.00	$415.56	$658.25	$664.90	$0.00		$0.00	$126.28	$0.00	$0.00	$132.32	$0.00	$0.00	$0.00	$0.00	$0.00
242.03	SUP	HCPCS C1713		242.03  -  PLATE BN .25 TBLR 23X7X1MM NS .3MM 3 HL COLR SS 2.7MM SCR MN	BOTH IP/OP	$146.20 	$108.19	$0.00	$113.54	$63.87	$63.87	$0.00	$0.00	$0.00	$30.47	$108.51	$108.51	$0.00	$0.00	$30.47	$0.00	$86.48	$86.48	$0.00	$70.96	$112.41	$113.54	$0.00		$0.00	$21.57	$0.00	$0.00	$22.59	$0.00	$0.00	$0.00	$0.00	$0.00
242.04	SUP	HCPCS C1713		242.04  -  PLATE BONE .25 TUBE LP 31X7X1MM .3MM 4 HOLE COLLAR STAINLESS	BOTH IP/OP	$156.03 	$115.46	$0.00	$121.18	$68.16	$68.16	$0.00	$0.00	$0.00	$32.52	$115.80	$115.80	$0.00	$0.00	$32.52	$0.00	$92.29	$92.29	$0.00	$75.74	$119.97	$121.18	$0.00		$0.00	$23.02	$0.00	$0.00	$24.11	$0.00	$0.00	$0.00	$0.00	$0.00
242.05	SUP	HCPCS C1713		242.05  -  PLATE BONE 39X7X1MM .3MM 5 HOLE QUARTER TUBULAR COLLAR LCP	BOTH IP/OP	$165.88 	$122.75	$0.00	$128.84	$72.47	$72.47	$0.00	$0.00	$0.00	$34.57	$123.11	$123.11	$0.00	$0.00	$34.57	$0.00	$98.12	$98.12	$0.00	$80.53	$127.55	$128.84	$0.00		$0.00	$24.47	$0.00	$0.00	$25.64	$0.00	$0.00	$0.00	$0.00	$0.00
242.06	SUP	HCPCS C1713		242.06  -  PLATE BONE .25 TUBULAR 47X7X1MM .3MM 6 HOLE COLLAR DCP	BOTH IP/OP	$179.93 	$133.15	$0.00	$139.76	$78.62	$78.62	$0.00	$0.00	$0.00	$37.50	$133.54	$133.54	$0.00	$0.00	$37.50	$0.00	$106.43	$106.43	$0.00	$87.35	$138.36	$139.76	$0.00		$0.00	$26.54	$0.00	$0.00	$27.81	$0.00	$0.00	$0.00	$0.00	$0.00
242.07	SUP	HCPCS C1713		242.07  -  PLATE BONE .75 TUBE 55X7X1MM .3MM 7 HOLE COLLAR STAINLESS	BOTH IP/OP	$191.18 	$141.47	$0.00	$148.48	$83.52	$83.52	$0.00	$0.00	$0.00	$39.85	$141.89	$141.89	$0.00	$0.00	$39.84	$0.00	$113.08	$113.08	$0.00	$92.80	$147.00	$148.48	$0.00		$0.00	$28.20	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
242.08	SUP	HCPCS C1713		242.08  -  PLATE BONE .25 TUBE 63MM .3MM 8 HOLE COLLAR DCP STAINLESS	BOTH IP/OP	$196.80 	$145.63	$0.00	$152.86	$85.98	$85.98	$0.00	$0.00	$0.00	$41.02	$146.06	$146.06	$0.00	$0.00	$41.01	$0.00	$116.41	$116.41	$0.00	$95.54	$151.34	$152.86	$0.00		$0.00	$29.03	$0.00	$0.00	$30.42	$0.00	$0.00	$0.00	$0.00	$0.00
242.102	SUP	HCPCS C1713		242.102  -  PLATE BONE 139MM 2 HOLE LCP STAINLESS STEEL FEMUR LEFT	BOTH IP/OP	"$2,614.60 "	"$1,934.80"	$0.00	"$2,030.74"	"$1,142.29"	"$1,142.29"	$0.00	$0.00	$0.00	$544.95	"$1,940.56"	"$1,940.56"	$0.00	$0.00	$544.88	$0.00	"$1,289.00"	"$1,289.00"	$0.00	"$1,269.21"	"$2,010.44"	"$2,030.74"	$0.00		$0.00	$385.69	$0.00	$0.00	$404.12	$0.00	$0.00	$0.00	$0.00	$0.00
242.104	SUP	HCPCS C1713		242.104  -  PLATE BN 175MM NS LCP CMBN 4 HL LMT CNTCT SS FEM LT PROX 4.5	BOTH IP/OP	"$2,666.60 "	"$1,973.28"	$0.00	"$2,071.14"	"$1,165.02"	"$1,165.02"	$0.00	$0.00	$0.00	$555.79	"$1,979.15"	"$1,979.15"	$0.00	$0.00	$555.72	$0.00	"$1,314.63"	"$1,314.63"	$0.00	"$1,294.46"	"$2,050.43"	"$2,071.14"	$0.00		$0.00	$393.37	$0.00	$0.00	$412.16	$0.00	$0.00	$0.00	$0.00	$0.00
242.106	SUP	HCPCS C1713		242.106  -  PLATE BN 211MM NS LCP CMBN 6 HL LMT CNTCT SS FEM LT PROX 4.5	BOTH IP/OP	"$2,718.60 "	"$2,011.76"	$0.00	"$2,111.54"	"$1,187.74"	"$1,187.74"	$0.00	$0.00	$0.00	$566.62	"$2,017.74"	"$2,017.74"	$0.00	$0.00	$566.56	$0.00	"$1,340.27"	"$1,340.27"	$0.00	"$1,319.71"	"$2,090.43"	"$2,111.54"	$0.00		$0.00	$401.04	$0.00	$0.00	$420.20	$0.00	$0.00	$0.00	$0.00	$0.00
242.108	SUP	HCPCS C1713		242.108  -  PLATE BN 247MM NS LCP CMBN 8 HL LMT CNTCT SS FEM LT PROX 4.5	BOTH IP/OP	"$2,852.15 "	"$2,110.59"	$0.00	"$2,215.26"	"$1,246.08"	"$1,246.08"	$0.00	$0.00	$0.00	$594.46	"$2,116.87"	"$2,116.87"	$0.00	$0.00	$594.39	$0.00	"$1,406.11"	"$1,406.11"	$0.00	"$1,384.54"	"$2,193.11"	"$2,215.26"	$0.00		$0.00	$420.74	$0.00	$0.00	$440.84	$0.00	$0.00	$0.00	$0.00	$0.00
242.11	SUP	HCPCS C1713		242.110  -  PLATE BN 283MM NS LCP CMBN 10 HL LMT CNTCT SS FEM LT PROX	BOTH IP/OP	"$2,966.98 "	"$2,195.57"	$0.00	"$2,373.58"	"$1,335.14"	"$1,335.14"	$0.00	$0.00	$0.00	$618.39	"$2,202.09"	"$2,202.09"	$0.00	$0.00	$618.32	$0.00	"$1,462.72"	"$1,462.72"	$0.00	"$1,483.49"	"$2,349.85"	"$2,373.58"	$0.00		$0.00	$450.81	$0.00	$0.00	$472.34	$0.00	$0.00	$0.00	$0.00	$0.00
242.112	SUP	HCPCS C1713		242.112  -  PLATE BN 319MM NS LCP CMBN 12 HL LMT CNTCT SS FEM LT PROX	BOTH IP/OP	"$3,235.90 "	"$2,394.57"	$0.00	"$2,513.32"	"$1,413.74"	"$1,413.74"	$0.00	$0.00	$0.00	$674.44	"$2,401.68"	"$2,401.68"	$0.00	$0.00	$674.36	$0.00	"$1,595.30"	"$1,595.30"	$0.00	"$1,570.83"	"$2,488.19"	"$2,513.32"	$0.00		$0.00	$477.35	$0.00	$0.00	$500.15	$0.00	$0.00	$0.00	$0.00	$0.00
242.114	SUP	HCPCS C1713		242.114  -  PLATE BN 355MM NS LCP CMBN 14 HL LMT CNTCT SS FEM LT PROX	BOTH IP/OP	"$3,495.95 "	"$2,587.00"	$0.00	"$2,715.30"	"$1,527.36"	"$1,527.36"	$0.00	$0.00	$0.00	$728.64	"$2,594.69"	"$2,594.69"	$0.00	$0.00	$728.56	$0.00	"$1,723.50"	"$1,723.50"	$0.00	"$1,697.06"	"$2,688.15"	"$2,715.30"	$0.00		$0.00	$515.71	$0.00	$0.00	$540.34	$0.00	$0.00	$0.00	$0.00	$0.00
242.116	SUP	HCPCS C1713		242.116  -  PLATE BN 391MM NS LCP CMBN 16 HL LMT CNTCT SS FEM LT PROX	BOTH IP/OP	"$3,601.38 "	"$2,665.02"	$0.00	"$2,797.20"	"$1,573.43"	"$1,573.43"	$0.00	$0.00	$0.00	$750.62	"$2,672.94"	"$2,672.94"	$0.00	$0.00	$750.53	$0.00	"$1,775.48"	"$1,775.48"	$0.00	"$1,748.25"	"$2,769.23"	"$2,797.20"	$0.00		$0.00	$531.26	$0.00	$0.00	$556.64	$0.00	$0.00	$0.00	$0.00	$0.00
242.12	SUP	HCPCS C1713		242.120  -  PLATE BONE 133MM 2 HOLE HOOK LCP STAINLESS STEEL PROXIMAL	BOTH IP/OP	"$2,941.03 "	"$2,176.36"	$0.00	"$2,352.82"	"$1,323.46"	"$1,323.46"	$0.00	$0.00	$0.00	$612.98	"$2,182.83"	"$2,182.83"	$0.00	$0.00	$612.91	$0.00	"$1,449.93"	"$1,449.93"	$0.00	"$1,470.51"	"$2,329.30"	"$2,352.82"	$0.00		$0.00	$446.87	$0.00	$0.00	$468.21	$0.00	$0.00	$0.00	$0.00	$0.00
242.121	SUP	HCPCS C1713		242.121  -  PLATE BONE 169MM 4 HOLE HOOK LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$3,071.45 "	"$2,272.87"	$0.00	"$2,385.58"	"$1,341.89"	"$1,341.89"	$0.00	$0.00	$0.00	$640.17	"$2,279.63"	"$2,279.63"	$0.00	$0.00	$640.09	$0.00	"$1,514.22"	"$1,514.22"	$0.00	"$1,490.99"	"$2,361.73"	"$2,385.58"	$0.00		$0.00	$453.09	$0.00	$0.00	$474.73	$0.00	$0.00	$0.00	$0.00	$0.00
242.122	SUP	HCPCS C1713		242.122  -  PLATE BONE 205MM 6 HOLE HOOK LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$3,119.23 "	"$2,308.23"	$0.00	"$2,422.70"	"$1,362.77"	"$1,362.77"	$0.00	$0.00	$0.00	$650.12	"$2,315.09"	"$2,315.09"	$0.00	$0.00	$650.05	$0.00	"$1,537.78"	"$1,537.78"	$0.00	"$1,514.19"	"$2,398.48"	"$2,422.70"	$0.00		$0.00	$460.14	$0.00	$0.00	$482.12	$0.00	$0.00	$0.00	$0.00	$0.00
242.123	SUP	HCPCS C1713		242.123  -  PLATE BONE 241MM 8 HOLE HOOK LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$3,234.50 "	"$2,393.53"	$0.00	"$2,512.24"	"$1,413.14"	"$1,413.14"	$0.00	$0.00	$0.00	$674.15	"$2,400.65"	"$2,400.65"	$0.00	$0.00	$674.07	$0.00	"$1,594.61"	"$1,594.61"	$0.00	"$1,570.15"	"$2,487.12"	"$2,512.24"	$0.00		$0.00	$477.14	$0.00	$0.00	$499.94	$0.00	$0.00	$0.00	$0.00	$0.00
242.124	SUP	HCPCS C1713		242.124  -  PLATE BONE 277MM 10 HOLE HOOK LCP STAINLESS STEEL PROXIMAL	BOTH IP/OP	"$3,400.38 "	"$2,516.28"	$0.00	"$2,641.06"	"$1,485.60"	"$1,485.60"	$0.00	$0.00	$0.00	$708.72	"$2,523.76"	"$2,523.76"	$0.00	$0.00	$708.64	$0.00	"$1,676.38"	"$1,676.38"	$0.00	"$1,650.66"	"$2,614.65"	"$2,641.06"	$0.00		$0.00	$501.61	$0.00	$0.00	$525.57	$0.00	$0.00	$0.00	$0.00	$0.00
242.125	SUP	HCPCS C1713		242.125  -  PLATE BONE 313MM 12 HOLE HOOK LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$3,511.43 "	"$2,598.46"	$0.00	"$2,727.32"	"$1,534.12"	"$1,534.12"	$0.00	$0.00	$0.00	$731.87	"$2,606.18"	"$2,606.18"	$0.00	$0.00	$731.78	$0.00	"$1,731.13"	"$1,731.13"	$0.00	"$1,704.58"	"$2,700.05"	"$2,727.32"	$0.00		$0.00	$517.99	$0.00	$0.00	$542.74	$0.00	$0.00	$0.00	$0.00	$0.00
242.126	SUP	HCPCS C1713		242.126  -  PLATE BONE 349MM 14 HOLE HOOK LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$3,552.18 "	"$2,628.61"	$0.00	"$2,758.98"	"$1,551.93"	"$1,551.93"	$0.00	$0.00	$0.00	$740.36	"$2,636.42"	"$2,636.42"	$0.00	$0.00	$740.27	$0.00	"$1,751.22"	"$1,751.22"	$0.00	"$1,724.36"	"$2,731.39"	"$2,758.98"	$0.00		$0.00	$524.01	$0.00	$0.00	$549.04	$0.00	$0.00	$0.00	$0.00	$0.00
242.127	SUP	HCPCS C1713		242.127  -  PLATE BONE 385MM 16 HOLE HOOK LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$3,670.28 "	"$2,716.01"	$0.00	"$2,850.68"	"$1,603.51"	"$1,603.51"	$0.00	$0.00	$0.00	$764.98	"$2,724.08"	"$2,724.08"	$0.00	$0.00	$764.89	$0.00	"$1,809.45"	"$1,809.45"	$0.00	"$1,781.68"	"$2,822.17"	"$2,850.68"	$0.00		$0.00	$541.42	$0.00	$0.00	$567.29	$0.00	$0.00	$0.00	$0.00	$0.00
242.128	SUP	HCPCS C1713		242.128  -  PLATE BONE 421MM 18 HOLE HOOK LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$3,788.35 "	"$2,803.38"	$0.00	"$2,942.40"	"$1,655.10"	"$1,655.10"	$0.00	$0.00	$0.00	$789.59	"$2,811.71"	"$2,811.71"	$0.00	$0.00	$789.49	$0.00	"$1,867.66"	"$1,867.66"	$0.00	"$1,839.00"	"$2,912.98"	"$2,942.40"	$0.00		$0.00	$558.84	$0.00	$0.00	$585.54	$0.00	$0.00	$0.00	$0.00	$0.00
242.204	SUP	HCPCS C1713		242.204  -  PLATE BONE 41MMX2.6MM 4 HOLE LC-DCP STAINLESS STEEL FT	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
242.205	SUP	HCPCS C1713		242.205  -  PLATE BONE 50MM 5 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
242.206	SUP	HCPCS C1713		242.206  -  PLATE BONE 59MM 6 HOLE LC-DCP STAINLESS STEEL FT NONSTRL 2.7	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
242.207	SUP	HCPCS C1713		242.207  -  PLATE BONE 68MM 7 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$281.15 	$208.05	$0.00	$218.36	$122.83	$122.83	$0.00	$0.00	$0.00	$58.60	$208.67	$208.67	$0.00	$0.00	$58.59	$0.00	$166.30	$166.30	$0.00	$136.48	$216.18	$218.36	$0.00		$0.00	$41.47	$0.00	$0.00	$43.45	$0.00	$0.00	$0.00	$0.00	$0.00
242.208	SUP	HCPCS C1713		242.208  -  PLATE BONE 77MM 8 HOLE LC-DCP STAINLESS STEEL FT NONSTRL 2.7	BOTH IP/OP	$293.80 	$217.41	$0.00	$228.18	$128.35	$128.35	$0.00	$0.00	$0.00	$61.24	$218.06	$218.06	$0.00	$0.00	$61.23	$0.00	$173.78	$173.78	$0.00	$142.61	$225.90	$228.18	$0.00		$0.00	$43.34	$0.00	$0.00	$45.41	$0.00	$0.00	$0.00	$0.00	$0.00
242.209	SUP	HCPCS C1713		242.209  -  PLATE BONE 86MM 9 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$300.83 	$222.61	$0.00	$233.64	$131.42	$131.42	$0.00	$0.00	$0.00	$62.70	$223.27	$223.27	$0.00	$0.00	$62.69	$0.00	$177.94	$177.94	$0.00	$146.03	$231.30	$233.64	$0.00		$0.00	$44.38	$0.00	$0.00	$46.49	$0.00	$0.00	$0.00	$0.00	$0.00
242.21	SUP	HCPCS C1713		242.21  -  PLATE BONE 44MM 7 HOLE MULTIPLE FRAGMENT DCP STAINLESS STEEL	BOTH IP/OP	$126.93 	$93.93	$0.00	$101.54	$57.12	$57.12	$0.00	$0.00	$0.00	$26.45	$94.20	$94.20	$0.00	$0.00	$26.45	$0.00	$75.08	$75.08	$0.00	$63.46	$100.53	$101.54	$0.00		$0.00	$19.28	$0.00	$0.00	$20.21	$0.00	$0.00	$0.00	$0.00	$0.00
242.22	SUP	HCPCS C1713		242.220  -  PLATE BONE 95MM 10 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$308.43 	$228.24	$0.00	$246.74	$138.79	$138.79	$0.00	$0.00	$0.00	$64.28	$228.91	$228.91	$0.00	$0.00	$64.28	$0.00	$182.43	$182.43	$0.00	$154.21	$244.28	$246.74	$0.00		$0.00	$46.86	$0.00	$0.00	$49.10	$0.00	$0.00	$0.00	$0.00	$0.00
242.221	SUP	HCPCS C1713		242.221  -  PLATE BONE 104MM 11 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$331.75 	$245.50	$0.00	$257.66	$144.93	$144.93	$0.00	$0.00	$0.00	$69.14	$246.22	$246.22	$0.00	$0.00	$69.14	$0.00	$196.23	$196.23	$0.00	$161.04	$255.09	$257.66	$0.00		$0.00	$48.94	$0.00	$0.00	$51.27	$0.00	$0.00	$0.00	$0.00	$0.00
242.222	SUP	HCPCS C1713		242.222  -  PLATE BONE 113MM 12 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$344.40 	$254.86	$0.00	$267.50	$150.47	$150.47	$0.00	$0.00	$0.00	$71.78	$255.61	$255.61	$0.00	$0.00	$71.77	$0.00	$203.71	$203.71	$0.00	$167.19	$264.83	$267.50	$0.00		$0.00	$50.80	$0.00	$0.00	$53.23	$0.00	$0.00	$0.00	$0.00	$0.00
242.31	SUP	HCPCS C1713		242.31  -  PLATE BN L 32MM NS DCP 3 HLE/HD 2 HL SHFT SS FT LT 2.7MM SCR	BOTH IP/OP	$103.30 	$76.44	$0.00	$80.24	$45.14	$45.14	$0.00	$0.00	$0.00	$21.53	$76.67	$76.67	$0.00	$0.00	$21.53	$0.00	$61.10	$61.10	$0.00	$50.15	$79.44	$80.24	$0.00		$0.00	$15.24	$0.00	$0.00	$15.97	$0.00	$0.00	$0.00	$0.00	$0.00
242.32	SUP	HCPCS C1713		242.32  -  PLATE BONE L 32MM 2X3 HOLE DCP STAINLESS STEEL FT RIGHT	BOTH IP/OP	$103.30 	$76.44	$0.00	$80.24	$45.14	$45.14	$0.00	$0.00	$0.00	$21.53	$76.67	$76.67	$0.00	$0.00	$21.53	$0.00	$61.10	$61.10	$0.00	$50.15	$79.44	$80.24	$0.00		$0.00	$15.24	$0.00	$0.00	$15.97	$0.00	$0.00	$0.00	$0.00	$0.00
242.33	SUP	HCPCS C1713		242.33  -  PLATE BN OB L L 34X7X1MM NS DCP 3 HL SS 2.7MM SCR MN FRAG	BOTH IP/OP	$114.55 	$84.77	$0.00	$88.98	$50.05	$50.05	$0.00	$0.00	$0.00	$23.88	$85.02	$85.02	$0.00	$0.00	$23.87	$0.00	$67.76	$67.76	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$16.90	$0.00	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$0.00
242.34	SUP	HCPCS C1713		242.34  -  PLATE BN OB R L 34X7X1MM NS DCP 3 HL SS 2.7MM SCR MN FRAG	BOTH IP/OP	$114.55 	$84.77	$0.00	$88.98	$50.05	$50.05	$0.00	$0.00	$0.00	$23.88	$85.02	$85.02	$0.00	$0.00	$23.87	$0.00	$67.76	$67.76	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$16.90	$0.00	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$0.00
242.41	SUP	HCPCS C1713		242.41  -  PLATE BN T 32X7X1.2MM NS 3 HL SS 2.7MM SCR MN FRAG SET	BOTH IP/OP	$114.55 	$84.77	$0.00	$88.98	$50.05	$50.05	$0.00	$0.00	$0.00	$23.88	$85.02	$85.02	$0.00	$0.00	$23.87	$0.00	$67.76	$67.76	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$16.90	$0.00	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$0.00
242.458	SUP	HCPCS C1713		242.458  -  PLATE BN 48X6.3X1.6MM NS LCP 5 HLE/HD 3 HL SHFT PRECONTOUR	BOTH IP/OP	"$1,536.43 "	"$1,136.96"	$0.00	"$1,193.34"	$671.25	$671.25	$0.00	$0.00	$0.00	$320.23	"$1,140.33"	"$1,140.33"	$0.00	$0.00	$320.19	$0.00	$908.80	$908.80	$0.00	$745.84	"$1,181.41"	"$1,193.34"	$0.00		$0.00	$226.65	$0.00	$0.00	$237.47	$0.00	$0.00	$0.00	$0.00	$0.00
242.459	SUP	HCPCS C1713		242.459  -  PLATE BN 66X6.3X1.6MM NS LCP 5 HLE/HD 5 HL SHFT PRECONTOUR	BOTH IP/OP	"$1,626.38 "	"$1,203.52"	$0.00	"$1,263.22"	$710.56	$710.56	$0.00	$0.00	$0.00	$338.98	"$1,207.10"	"$1,207.10"	$0.00	$0.00	$338.94	$0.00	$962.00	$962.00	$0.00	$789.51	"$1,250.59"	"$1,263.22"	$0.00		$0.00	$239.92	$0.00	$0.00	$251.38	$0.00	$0.00	$0.00	$0.00	$0.00
242.461	SUP	HCPCS C1713		242.461  -  PLATE BN 48X6.3X1.6MM NS LCP 5 HLE/HD 3 HL SHFT PRECONTOUR	BOTH IP/OP	"$1,536.43 "	"$1,136.96"	$0.00	"$1,193.34"	$671.25	$671.25	$0.00	$0.00	$0.00	$320.23	"$1,140.33"	"$1,140.33"	$0.00	$0.00	$320.19	$0.00	$908.80	$908.80	$0.00	$745.84	"$1,181.41"	"$1,193.34"	$0.00		$0.00	$226.65	$0.00	$0.00	$237.47	$0.00	$0.00	$0.00	$0.00	$0.00
242.462	SUP	HCPCS C1713		242.462  -  PLATE BN 66X6.3X1.6MM NS LCP 5 HLE/HD 5 HL SHFT PRECONTOUR	BOTH IP/OP	"$1,626.38 "	"$1,203.52"	$0.00	"$1,263.22"	$710.56	$710.56	$0.00	$0.00	$0.00	$338.98	"$1,207.10"	"$1,207.10"	$0.00	$0.00	$338.94	$0.00	$962.00	$962.00	$0.00	$789.51	"$1,250.59"	"$1,263.22"	$0.00		$0.00	$239.92	$0.00	$0.00	$251.38	$0.00	$0.00	$0.00	$0.00	$0.00
242.464	SUP	HCPCS C1713		242.464  -  PLATE BN 47X6.3X1.6MM NS LCP 4 HLE/HD 3 HL SHFT PRECONTOUR	BOTH IP/OP	"$1,536.43 "	"$1,136.96"	$0.00	"$1,193.34"	$671.25	$671.25	$0.00	$0.00	$0.00	$320.23	"$1,140.33"	"$1,140.33"	$0.00	$0.00	$320.19	$0.00	$908.80	$908.80	$0.00	$745.84	"$1,181.41"	"$1,193.34"	$0.00		$0.00	$226.65	$0.00	$0.00	$237.47	$0.00	$0.00	$0.00	$0.00	$0.00
242.465	SUP	HCPCS C1713		242.465  -  PLATE BN 65X6.3X1.6MM NS LCP 4 HLE/HD 5 HL SHFT PRECONTOUR	BOTH IP/OP	"$1,626.38 "	"$1,203.52"	$0.00	"$1,263.22"	$710.56	$710.56	$0.00	$0.00	$0.00	$338.98	"$1,207.10"	"$1,207.10"	$0.00	$0.00	$338.94	$0.00	$962.00	$962.00	$0.00	$789.51	"$1,250.59"	"$1,263.22"	$0.00		$0.00	$239.92	$0.00	$0.00	$251.38	$0.00	$0.00	$0.00	$0.00	$0.00
242.467	SUP	HCPCS C1713		242.467  -  PLATE BN 47X6.3X1.6MM NS LCP 4 HLE/HD 3 HL SHFT PRECONTOUR	BOTH IP/OP	"$1,536.43 "	"$1,136.96"	$0.00	"$1,193.34"	$671.25	$671.25	$0.00	$0.00	$0.00	$320.23	"$1,140.33"	"$1,140.33"	$0.00	$0.00	$320.19	$0.00	$908.80	$908.80	$0.00	$745.84	"$1,181.41"	"$1,193.34"	$0.00		$0.00	$226.65	$0.00	$0.00	$237.47	$0.00	$0.00	$0.00	$0.00	$0.00
242.468	SUP	HCPCS C1713		242.468  -  PLATE BN 65X6.3X1.6MM NS LCP 4 HLE/HD 5 HL SHFT PRECONTOUR	BOTH IP/OP	"$1,626.38 "	"$1,203.52"	$0.00	"$1,263.22"	$710.56	$710.56	$0.00	$0.00	$0.00	$338.98	"$1,207.10"	"$1,207.10"	$0.00	$0.00	$338.94	$0.00	$962.00	$962.00	$0.00	$789.51	"$1,250.59"	"$1,263.22"	$0.00		$0.00	$239.92	$0.00	$0.00	$251.38	$0.00	$0.00	$0.00	$0.00	$0.00
242.472	SUP	HCPCS C1713		242.472  -  PLATE SS BONE RIGHT DISTAL DORSAL RAD NONSTRL	BOTH IP/OP	"$1,868.43 "	"$1,382.64"	$0.00	"$1,494.74"	$840.79	$840.79	$0.00	$0.00	$0.00	$389.43	"$1,386.75"	"$1,386.75"	$0.00	$0.00	$389.38	$0.00	"$1,105.17"	"$1,105.17"	$0.00	$934.21	"$1,479.80"	"$1,494.74"	$0.00		$0.00	$292.41	$0.00	$0.00	$297.45	$0.00	$0.00	$0.00	$0.00	$0.00
242.473	SUP	HCPCS C1713		242.473  -  PLATE SS LCP BONE RIGHT DISTAL VOLR RADL NONSTRL	BOTH IP/OP	"$1,542.28 "	"$1,141.29"	$0.00	"$1,233.82"	$694.02	$694.02	$0.00	$0.00	$0.00	$321.45	"$1,144.68"	"$1,144.68"	$0.00	$0.00	$321.41	$0.00	$912.26	$912.26	$0.00	$771.14	"$1,221.49"	"$1,233.82"	$0.00		$0.00	$241.37	$0.00	$0.00	$245.53	$0.00	$0.00	$0.00	$0.00	$0.00
242.477	SUP	HCPCS C1713		242.477  -  PLATE BN T 40X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT	BOTH IP/OP	$877.15 	$649.09	$0.00	$681.28	$383.22	$383.22	$0.00	$0.00	$0.00	$182.82	$651.02	$651.02	$0.00	$0.00	$182.80	$0.00	$518.83	$518.83	$0.00	$425.80	$674.47	$681.28	$0.00		$0.00	$129.39	$0.00	$0.00	$135.57	$0.00	$0.00	$0.00	$0.00	$0.00
242.478	SUP	HCPCS C1713		242.478  -  PLATE BN T 49X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT	BOTH IP/OP	$913.70 	$676.14	$0.00	$709.68	$399.20	$399.20	$0.00	$0.00	$0.00	$190.44	$678.15	$678.15	$0.00	$0.00	$190.42	$0.00	$540.45	$540.45	$0.00	$443.55	$702.58	$709.68	$0.00		$0.00	$134.79	$0.00	$0.00	$141.23	$0.00	$0.00	$0.00	$0.00	$0.00
242.479	SUP	HCPCS C1713		242.479  -  PLATE BN STRG 48X6.3X1.6MM NS LCP CMBN 5 HL LOPRFL RND EDG	BOTH IP/OP	$832.18 	$615.81	$0.00	$646.34	$363.57	$363.57	$0.00	$0.00	$0.00	$173.45	$617.64	$617.64	$0.00	$0.00	$173.43	$0.00	$492.23	$492.23	$0.00	$403.96	$639.88	$646.34	$0.00		$0.00	$122.76	$0.00	$0.00	$128.62	$0.00	$0.00	$0.00	$0.00	$0.00
242.482	SUP	HCPCS C1713		242.482  -  PLATE SS BONE LEFT DISTAL DORSAL RADL NONSTRL	BOTH IP/OP	"$1,868.43 "	"$1,382.64"	$0.00	"$1,494.74"	$840.79	$840.79	$0.00	$0.00	$0.00	$389.43	"$1,386.75"	"$1,386.75"	$0.00	$0.00	$389.38	$0.00	"$1,105.17"	"$1,105.17"	$0.00	$934.21	"$1,479.80"	"$1,494.74"	$0.00		$0.00	$292.41	$0.00	$0.00	$297.45	$0.00	$0.00	$0.00	$0.00	$0.00
242.483	SUP	HCPCS C1713		242.483  -  PLATE SS BONE LEFT DISTAL VOLR RADL NONSTRL	BOTH IP/OP	"$1,542.28 "	"$1,141.29"	$0.00	"$1,233.82"	$694.02	$694.02	$0.00	$0.00	$0.00	$321.45	"$1,144.68"	"$1,144.68"	$0.00	$0.00	$321.41	$0.00	$912.26	$912.26	$0.00	$771.14	"$1,221.49"	"$1,233.82"	$0.00		$0.00	$241.37	$0.00	$0.00	$245.53	$0.00	$0.00	$0.00	$0.00	$0.00
242.49	SUP	HCPCS C1713		242.490  -  PLATE BN STRG 57X6.3X1.6MM NS LCP CMBN 6 HL LOPRFL RND EDG	BOTH IP/OP	$851.60 	$630.18	$0.00	$681.28	$383.22	$383.22	$0.00	$0.00	$0.00	$177.49	$632.06	$632.06	$0.00	$0.00	$177.47	$0.00	$503.72	$503.72	$0.00	$425.80	$674.47	$681.28	$0.00		$0.00	$129.39	$0.00	$0.00	$135.57	$0.00	$0.00	$0.00	$0.00	$0.00
242.491	SUP	HCPCS C1713		242.491  -  PLATE BN 43X7.5X1.6MM NS LCP CMBN 5 HLE/HD 3 HL SHFT	BOTH IP/OP	"$1,536.43 "	"$1,136.96"	$0.00	"$1,193.34"	$671.25	$671.25	$0.00	$0.00	$0.00	$320.23	"$1,140.33"	"$1,140.33"	$0.00	$0.00	$320.19	$0.00	$908.80	$908.80	$0.00	$745.84	"$1,181.41"	"$1,193.34"	$0.00		$0.00	$293.30	$0.00	$0.00	$237.47	$0.00	$0.00	$0.00	$0.00	$0.00
242.492	SUP	HCPCS C1713		242.492  -  PLATE BN 61X7.5X1.6MM NS LCP CMBN 5 HLE/HD 5 HL SHFT	BOTH IP/OP	"$1,626.38 "	"$1,203.52"	$0.00	"$1,263.22"	$710.56	$710.56	$0.00	$0.00	$0.00	$338.98	"$1,207.10"	"$1,207.10"	$0.00	$0.00	$338.94	$0.00	$962.00	$962.00	$0.00	$789.51	"$1,250.59"	"$1,263.22"	$0.00		$0.00	$310.94	$0.00	$0.00	$251.38	$0.00	$0.00	$0.00	$0.00	$0.00
242.493	SUP	HCPCS C1713		242.493  -  PLATE BN 43X7.5X1.6MM NS LCP CMBN 5 HLE/HD 3 HL SHFT	BOTH IP/OP	"$1,536.43 "	"$1,136.96"	$0.00	"$1,193.34"	$671.25	$671.25	$0.00	$0.00	$0.00	$320.23	"$1,140.33"	"$1,140.33"	$0.00	$0.00	$320.19	$0.00	$908.80	$908.80	$0.00	$745.84	"$1,181.41"	"$1,193.34"	$0.00		$0.00	$293.30	$0.00	$0.00	$237.47	$0.00	$0.00	$0.00	$0.00	$0.00
242.494	SUP	HCPCS C1713		242.494  -  PLATE BN 61X7.5X1.6MM NS LCP CMBN 5 HLE/HD 5 HL SHFT	BOTH IP/OP	"$1,626.38 "	"$1,203.52"	$0.00	"$1,263.22"	$710.56	$710.56	$0.00	$0.00	$0.00	$338.98	"$1,207.10"	"$1,207.10"	$0.00	$0.00	$338.94	$0.00	$962.00	$962.00	$0.00	$789.51	"$1,250.59"	"$1,263.22"	$0.00		$0.00	$239.92	$0.00	$0.00	$251.38	$0.00	$0.00	$0.00	$0.00	$0.00
242.5	SUP	HCPCS C1713		242.500  -  PLATE BN -90D L 40X6.3X1.6MM NS LCP CMBN 2 HLE/HD 3 HL SHFT	BOTH IP/OP	$822.95 	$608.98	$0.00	$658.36	$370.33	$370.33	$0.00	$0.00	$0.00	$171.52	$610.79	$610.79	$0.00	$0.00	$171.50	$0.00	$486.77	$486.77	$0.00	$411.48	$651.78	$658.36	$0.00		$0.00	$125.04	$0.00	$0.00	$131.01	$0.00	$0.00	$0.00	$0.00	$0.00
242.501	SUP	HCPCS C1713		242.501  -  PLATE BN -90D L 49X6.3X1.6MM NS LCP CMBN 2 HLE/HD 4 HL SHFT	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
242.502	SUP	HCPCS C1713		242.502  -  PLATE BN +90D L 40X6.3X1.6MM NS LCP CMBN 2 HLE/HD 3 HL SHFT	BOTH IP/OP	$847.63 	$627.25	$0.00	$658.36	$370.33	$370.33	$0.00	$0.00	$0.00	$176.67	$629.11	$629.11	$0.00	$0.00	$176.65	$0.00	$501.37	$501.37	$0.00	$411.48	$651.78	$658.36	$0.00		$0.00	$125.04	$0.00	$0.00	$131.01	$0.00	$0.00	$0.00	$0.00	$0.00
242.503	SUP	HCPCS C1713		242.503  -  PLATE BN +90D L 49X6.3X1.6MM NS LCP CMBN 2 HLE/HD 4 HL SHFT	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
242.504	SUP	HCPCS C1713		242.504  -  PLATE BN +90D L 40X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT	BOTH IP/OP	$847.63 	$627.25	$0.00	$658.36	$370.33	$370.33	$0.00	$0.00	$0.00	$176.67	$629.11	$629.11	$0.00	$0.00	$176.65	$0.00	$501.37	$501.37	$0.00	$411.48	$651.78	$658.36	$0.00		$0.00	$125.04	$0.00	$0.00	$131.01	$0.00	$0.00	$0.00	$0.00	$0.00
242.505	SUP	HCPCS C1713		242.505  -  PLATE BN +90D L 49X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
242.506	SUP	HCPCS C1713		242.506  -  PLATE BN -90D L 40X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT	BOTH IP/OP	$847.63 	$627.25	$0.00	$658.36	$370.33	$370.33	$0.00	$0.00	$0.00	$176.67	$629.11	$629.11	$0.00	$0.00	$176.65	$0.00	$501.37	$501.37	$0.00	$411.48	$651.78	$658.36	$0.00		$0.00	$125.04	$0.00	$0.00	$131.01	$0.00	$0.00	$0.00	$0.00	$0.00
242.507	SUP	HCPCS C1713		242.507  -  PLATE BN -90D L 49X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
242.508	SUP	HCPCS C1713		242.508  -  PLATE BN +20D L 43X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT	BOTH IP/OP	$847.63 	$627.25	$0.00	$658.36	$370.33	$370.33	$0.00	$0.00	$0.00	$176.67	$629.11	$629.11	$0.00	$0.00	$176.65	$0.00	$501.37	$501.37	$0.00	$411.48	$651.78	$658.36	$0.00		$0.00	$125.04	$0.00	$0.00	$131.01	$0.00	$0.00	$0.00	$0.00	$0.00
242.509	SUP	HCPCS C1713		242.509  -  PLATE BN +20D L 52X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
242.51	SUP	HCPCS C1713		242.510  -  PLATE BONE STANDARD BEND 8 HOLE FUSION LCP STAINLESS STEEL	BOTH IP/OP	"$1,973.43 "	"$1,460.34"	$0.00	"$1,578.74"	$888.04	$888.04	$0.00	$0.00	$0.00	$411.31	"$1,464.68"	"$1,464.68"	$0.00	$0.00	$411.26	$0.00	"$1,167.28"	"$1,167.28"	$0.00	$986.71	"$1,562.96"	"$1,578.74"	$0.00		$0.00	$299.85	$0.00	$0.00	$314.17	$0.00	$0.00	$0.00	$0.00	$0.00
242.511	SUP	HCPCS C1713		242.511  -  PLATE BN -20D L 43X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT	BOTH IP/OP	$847.63 	$627.25	$0.00	$658.36	$370.33	$370.33	$0.00	$0.00	$0.00	$176.67	$629.11	$629.11	$0.00	$0.00	$176.65	$0.00	$501.37	$501.37	$0.00	$411.48	$651.78	$658.36	$0.00		$0.00	$125.04	$0.00	$0.00	$131.01	$0.00	$0.00	$0.00	$0.00	$0.00
242.512	SUP	HCPCS C1713		242.512  -  PLATE BN -20D L 52X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
242.52	SUP	HCPCS C1713		242.520  -  PLATE BONE SHORT BEND 8 HOLE STAINLESS STEEL WRIST NONSTRL	BOTH IP/OP	"$1,973.43 "	"$1,460.34"	$0.00	"$1,578.74"	$888.04	$888.04	$0.00	$0.00	$0.00	$411.31	"$1,464.68"	"$1,464.68"	$0.00	$0.00	$411.26	$0.00	"$1,167.28"	"$1,167.28"	$0.00	$986.71	"$1,562.96"	"$1,578.74"	$0.00		$0.00	$299.85	$0.00	$0.00	$314.17	$0.00	$0.00	$0.00	$0.00	$0.00
242.53	SUP	HCPCS C1713		242.530  -  PLATE BONE 9 HOLE STR FUSION STAINLESS STEEL WRIST NONSTRL	BOTH IP/OP	"$1,973.43 "	"$1,460.34"	$0.00	"$1,578.74"	$888.04	$888.04	$0.00	$0.00	$0.00	$411.31	"$1,464.68"	"$1,464.68"	$0.00	$0.00	$411.26	$0.00	"$1,167.28"	"$1,167.28"	$0.00	$986.71	"$1,562.96"	"$1,578.74"	$0.00		$0.00	$299.85	$0.00	$0.00	$314.17	$0.00	$0.00	$0.00	$0.00	$0.00
242.535	SUP	HCPCS C1713		242.535  -  PLATE BN 31MMX1.2MM NS 5 HL MDLR SS HND/MDFT 2.7MM SCR	BOTH IP/OP	$449.83 	$332.87	$0.00	$349.38	$196.53	$196.53	$0.00	$0.00	$0.00	$93.75	$333.86	$333.86	$0.00	$0.00	$93.74	$0.00	$266.07	$266.07	$0.00	$218.36	$345.89	$349.38	$0.00		$0.00	$66.36	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$0.00
242.536	SUP	HCPCS C1713		242.536  -  PLATE BN 45MMX1.2MM NS 8 HL MDLR SS HND/MDFT 2.7MM SCR	BOTH IP/OP	$465.28 	$344.31	$0.00	$361.38	$203.28	$203.28	$0.00	$0.00	$0.00	$96.97	$345.33	$345.33	$0.00	$0.00	$96.96	$0.00	$275.21	$275.21	$0.00	$225.86	$357.77	$361.38	$0.00		$0.00	$68.64	$0.00	$0.00	$71.91	$0.00	$0.00	$0.00	$0.00	$0.00
242.61	SUP	HCPCS C1713		242.61  -  PLATE BONE 57MM 7 HOLE DCP STAINLESS STEEL CONDYLE LEFT	BOTH IP/OP	$532.75 	$394.24	$0.00	$413.80	$232.76	$232.76	$0.00	$0.00	$0.00	$111.04	$395.41	$395.41	$0.00	$0.00	$111.03	$0.00	$315.12	$315.12	$0.00	$258.63	$409.66	$413.80	$0.00		$0.00	$78.59	$0.00	$0.00	$82.35	$0.00	$0.00	$0.00	$0.00	$0.00
242.62	SUP	HCPCS C1713		242.62  -  PLATE BONE 57MM 7 HOLE DCP STAINLESS STEEL CONDYLE RIGHT	BOTH IP/OP	$532.75 	$394.24	$0.00	$413.80	$232.76	$232.76	$0.00	$0.00	$0.00	$111.04	$395.41	$395.41	$0.00	$0.00	$111.03	$0.00	$315.12	$315.12	$0.00	$258.63	$409.66	$413.80	$0.00		$0.00	$78.59	$0.00	$0.00	$82.35	$0.00	$0.00	$0.00	$0.00	$0.00
242.802	SUP	HCPCS C1713		242.802  -  PLATE BONE 139MM 2 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL	BOTH IP/OP	"$2,614.60 "	"$1,934.80"	$0.00	"$2,030.74"	"$1,142.29"	"$1,142.29"	$0.00	$0.00	$0.00	$544.95	"$1,940.56"	"$1,940.56"	$0.00	$0.00	$544.88	$0.00	"$1,289.00"	"$1,289.00"	$0.00	"$1,269.21"	"$2,010.44"	"$2,030.74"	$0.00		$0.00	$385.69	$0.00	$0.00	$404.12	$0.00	$0.00	$0.00	$0.00	$0.00
242.804	SUP	HCPCS C1713		242.804  -  PLATE BN 175MM NS LCP CMBN 4 HL LMT CNTCT SS FEM RT PROX 4.5	BOTH IP/OP	"$2,666.60 "	"$1,973.28"	$0.00	"$2,071.14"	"$1,165.02"	"$1,165.02"	$0.00	$0.00	$0.00	$555.79	"$1,979.15"	"$1,979.15"	$0.00	$0.00	$555.72	$0.00	"$1,314.63"	"$1,314.63"	$0.00	"$1,294.46"	"$2,050.43"	"$2,071.14"	$0.00		$0.00	$511.85	$0.00	$0.00	$412.16	$0.00	$0.00	$0.00	$0.00	$0.00
242.806	SUP	HCPCS C1713		242.806  -  PLATE BN 211MM NS LCP CMBN 6 HL LMT CNTCT SS FEM RT PROX 4.5	BOTH IP/OP	"$2,718.60 "	"$2,011.76"	$0.00	"$2,111.54"	"$1,187.74"	"$1,187.74"	$0.00	$0.00	$0.00	$566.62	"$2,017.74"	"$2,017.74"	$0.00	$0.00	$566.56	$0.00	"$1,340.27"	"$1,340.27"	$0.00	"$1,319.71"	"$2,090.43"	"$2,111.54"	$0.00		$0.00	$401.04	$0.00	$0.00	$420.20	$0.00	$0.00	$0.00	$0.00	$0.00
242.808	SUP	HCPCS C1713		242.808  -  PLATE BN 247MM NS LCP CMBN 8 HL LMT CNTCT SS FEM RT PROX 4.5	BOTH IP/OP	"$2,852.15 "	"$2,110.59"	$0.00	"$2,215.26"	"$1,246.08"	"$1,246.08"	$0.00	$0.00	$0.00	$594.46	"$2,116.87"	"$2,116.87"	$0.00	$0.00	$594.39	$0.00	"$1,406.11"	"$1,406.11"	$0.00	"$1,384.54"	"$2,193.11"	"$2,215.26"	$0.00		$0.00	$420.74	$0.00	$0.00	$440.84	$0.00	$0.00	$0.00	$0.00	$0.00
242.81	SUP	HCPCS C1713		242.810  -  PLATE BONE 283MM 10 HOLE LCP STAINLESS STEEL FEMUR RIGHT	BOTH IP/OP	"$2,966.98 "	"$2,195.57"	$0.00	"$2,373.58"	"$1,335.14"	"$1,335.14"	$0.00	$0.00	$0.00	$618.39	"$2,202.09"	"$2,202.09"	$0.00	$0.00	$618.32	$0.00	"$1,462.72"	"$1,462.72"	$0.00	"$1,483.49"	"$2,349.85"	"$2,373.58"	$0.00		$0.00	$450.81	$0.00	$0.00	$472.34	$0.00	$0.00	$0.00	$0.00	$0.00
242.812	SUP	HCPCS C1713		242.812  -  PLATE BN 319MM NS LCP CMBN 12 HL LMT CNTCT SS FEM RT PROX	BOTH IP/OP	"$3,235.90 "	"$2,394.57"	$0.00	"$2,513.32"	"$1,413.74"	"$1,413.74"	$0.00	$0.00	$0.00	$674.44	"$2,401.68"	"$2,401.68"	$0.00	$0.00	$674.36	$0.00	"$1,595.30"	"$1,595.30"	$0.00	"$1,570.83"	"$2,488.19"	"$2,513.32"	$0.00		$0.00	$477.35	$0.00	$0.00	$500.15	$0.00	$0.00	$0.00	$0.00	$0.00
242.814	SUP	HCPCS C1713		242.814  -  PLATE BN 355MM NS LCP CMBN 14 HL LMT CNTCT SS FEM RT PROX	BOTH IP/OP	"$3,495.95 "	"$2,587.00"	$0.00	"$2,715.30"	"$1,527.36"	"$1,527.36"	$0.00	$0.00	$0.00	$728.64	"$2,594.69"	"$2,594.69"	$0.00	$0.00	$728.56	$0.00	"$1,723.50"	"$1,723.50"	$0.00	"$1,697.06"	"$2,688.15"	"$2,715.30"	$0.00		$0.00	$515.71	$0.00	$0.00	$540.34	$0.00	$0.00	$0.00	$0.00	$0.00
242.816	SUP	HCPCS C1713		242.816  -  PLATE BN 391MM NS LCP CMBN 16 HL LMT CNTCT SS FEM RT PROX	BOTH IP/OP	"$3,601.38 "	"$2,665.02"	$0.00	"$2,797.20"	"$1,573.43"	"$1,573.43"	$0.00	$0.00	$0.00	$750.62	"$2,672.94"	"$2,672.94"	$0.00	$0.00	$750.53	$0.00	"$1,775.48"	"$1,775.48"	$0.00	"$1,748.25"	"$2,769.23"	"$2,797.20"	$0.00		$0.00	$531.26	$0.00	$0.00	$556.64	$0.00	$0.00	$0.00	$0.00	$0.00
243.091	SUP	HCPCS C1713		243.091  -  PLATE BONE STR 12 HOLE ADAPTION STAINLESS STEEL HAND NONSTRL	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
243.13	SUP	HCPCS C1713		243.13  -  PLATE BONE STR 17X5X1MM 3 HOLE DCP STAINLESS STEEL FT	BOTH IP/OP	$103.30 	$76.44	$0.00	$80.24	$45.14	$45.14	$0.00	$0.00	$0.00	$21.53	$76.67	$76.67	$0.00	$0.00	$21.53	$0.00	$61.10	$61.10	$0.00	$50.15	$79.44	$80.24	$0.00		$0.00	$15.24	$0.00	$0.00	$15.97	$0.00	$0.00	$0.00	$0.00	$0.00
243.14	SUP	HCPCS C1713		243.14  -  PLATE BONE STR 23X5X1MM 4 HOLE DCP STAINLESS STEEL FT	BOTH IP/OP	$113.85 	$84.25	$0.00	$88.44	$49.75	$49.75	$0.00	$0.00	$0.00	$23.73	$84.50	$84.50	$0.00	$0.00	$23.73	$0.00	$67.34	$67.34	$0.00	$55.28	$87.56	$88.44	$0.00		$0.00	$16.80	$0.00	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$0.00
243.15	SUP	HCPCS C1713		243.15  -  PLATE BONE STR 29X5X1MM 5 HOLE DCP STAINLESS STEEL FT	BOTH IP/OP	$121.58 	$89.97	$0.00	$94.44	$53.12	$53.12	$0.00	$0.00	$0.00	$25.34	$90.23	$90.23	$0.00	$0.00	$25.34	$0.00	$71.91	$71.91	$0.00	$59.03	$93.50	$94.44	$0.00		$0.00	$23.10	$0.00	$0.00	$18.79	$0.00	$0.00	$0.00	$0.00	$0.00
243.16	SUP	HCPCS C1713		243.16  -  PLATE BN STRG 35X5X1MM NS 6 HL SS 2MM SCR MN FRAG SET	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
243.19	SUP	HCPCS C1713		243.19  -  PLATE BONE 2MM 100MM 20 HOLE DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$420.30 	$311.02	$0.00	$326.44	$183.62	$183.62	$0.00	$0.00	$0.00	$87.60	$311.95	$311.95	$0.00	$0.00	$87.59	$0.00	$248.61	$248.61	$0.00	$204.03	$323.18	$326.44	$0.00		$0.00	$62.00	$0.00	$0.00	$64.96	$0.00	$0.00	$0.00	$0.00	$0.00
243.23	SUP	HCPCS C1713		243.23  -  PLATE BONE 2MM 12 HOLE T DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$371.00 	$274.54	$0.00	$296.80	$166.95	$166.95	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$0.00	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$185.50	$293.83	$296.80	$0.00		$0.00	$58.06	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
243.234	SUP	HCPCS C1713		243.234  -  PLATE BN T 65MMX1.2MM NS DCP 3 HLE/HD 10 HL SHFT SS FT 2MM	BOTH IP/OP	$462.48 	$342.24	$0.00	$359.20	$202.05	$202.05	$0.00	$0.00	$0.00	$96.39	$343.25	$343.25	$0.00	$0.00	$96.38	$0.00	$273.55	$273.55	$0.00	$224.50	$355.61	$359.20	$0.00		$0.00	$68.22	$0.00	$0.00	$71.48	$0.00	$0.00	$0.00	$0.00	$0.00
243.24	SUP	HCPCS C1713		243.24  -  PLATE BONE 2MM 50MM T 4 HOLE HEAD 9 HOLE SHAFT DCP STAINLESS	BOTH IP/OP	$393.60 	$291.26	$0.00	$305.70	$171.96	$171.96	$0.00	$0.00	$0.00	$82.04	$292.13	$292.13	$0.00	$0.00	$82.03	$0.00	$232.81	$232.81	$0.00	$191.06	$302.65	$305.70	$0.00		$0.00	$58.06	$0.00	$0.00	$60.83	$0.00	$0.00	$0.00	$0.00	$0.00
243.31	SUP	HCPCS C1713		243.31  -  PLATE BONE L 17X5X1MM 2 HOLE OBLIQUE DCP STAINLESS STEEL	BOTH IP/OP	$103.73 	$76.76	$0.00	$82.98	$46.68	$46.68	$0.00	$0.00	$0.00	$21.62	$76.98	$76.98	$0.00	$0.00	$21.62	$0.00	$61.35	$61.35	$0.00	$51.86	$82.15	$82.98	$0.00		$0.00	$15.76	$0.00	$0.00	$16.51	$0.00	$0.00	$0.00	$0.00	$0.00
243.32	SUP	HCPCS C1713		243.32  -  PLATE BONE L 17X5X1MM 2 HOLE OBLIQUE DCP STAINLESS STEEL	BOTH IP/OP	$103.73 	$76.76	$0.00	$82.98	$46.68	$46.68	$0.00	$0.00	$0.00	$21.62	$76.98	$76.98	$0.00	$0.00	$21.62	$0.00	$61.35	$61.35	$0.00	$51.86	$82.15	$82.98	$0.00		$0.00	$15.76	$0.00	$0.00	$16.51	$0.00	$0.00	$0.00	$0.00	$0.00
243.33	SUP	HCPCS C1713		243.33  -  PLATE BN OB L L 19X5X1MM NS DCP 2 HL SS 2MM SCR MN FRAG SET	BOTH IP/OP	$103.30 	$76.44	$0.00	$80.24	$45.14	$45.14	$0.00	$0.00	$0.00	$21.53	$76.67	$76.67	$0.00	$0.00	$21.53	$0.00	$61.10	$61.10	$0.00	$50.15	$79.44	$80.24	$0.00		$0.00	$15.24	$0.00	$0.00	$15.97	$0.00	$0.00	$0.00	$0.00	$0.00
243.34	SUP	HCPCS C1713		243.34  -  PLATE BN OB R L 19X5X1MM NS DCP 2 HL SS 2MM SCR MN FRAG SET	BOTH IP/OP	$103.30 	$76.44	$0.00	$80.24	$45.14	$45.14	$0.00	$0.00	$0.00	$21.53	$76.67	$76.67	$0.00	$0.00	$21.53	$0.00	$61.10	$61.10	$0.00	$50.15	$79.44	$80.24	$0.00		$0.00	$15.24	$0.00	$0.00	$15.97	$0.00	$0.00	$0.00	$0.00	$0.00
243.41	SUP	HCPCS C1713		243.41  -  PLATE BONE T 18MM 2X2 HOLE DCP STAINLESS STEEL FT NONSTRL	BOTH IP/OP	$103.30 	$76.44	$0.00	$80.24	$45.14	$45.14	$0.00	$0.00	$0.00	$21.53	$76.67	$76.67	$0.00	$0.00	$21.53	$0.00	$61.10	$61.10	$0.00	$50.15	$79.44	$80.24	$0.00		$0.00	$15.24	$0.00	$0.00	$15.97	$0.00	$0.00	$0.00	$0.00	$0.00
243.48	SUP	HCPCS C1713		243.48  -  PLATE BONE H 6MM 4 HOLE DCP STAINLESS STEEL FT NONSTRL MINI	BOTH IP/OP	$301.60 	$223.18	$0.00	$241.28	$135.72	$135.72	$0.00	$0.00	$0.00	$62.86	$223.85	$223.85	$0.00	$0.00	$62.85	$0.00	$178.40	$178.40	$0.00	$150.80	$238.87	$241.28	$0.00		$0.00	$45.83	$0.00	$0.00	$48.01	$0.00	$0.00	$0.00	$0.00	$0.00
243.54	SUP	HCPCS C1713		243.54  -  PLATE BONE 2MM 22MM 4 HOLE DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$305.70 	$226.22	$0.00	$244.56	$137.57	$137.57	$0.00	$0.00	$0.00	$63.72	$226.89	$226.89	$0.00	$0.00	$63.71	$0.00	$180.82	$180.82	$0.00	$152.85	$242.11	$244.56	$0.00		$0.00	$46.45	$0.00	$0.00	$48.67	$0.00	$0.00	$0.00	$0.00	$0.00
243.55	SUP	HCPCS C1713		243.55  -  PLATE BONE 27X5MM 5 HOLE DCP STAINLESS STEEL NONSTRL 2MM	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$65.99	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$187.28	$187.28	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
243.56	SUP	HCPCS C1713		243.56  -  PLATE BONE 32MM 2MM 6 HOLE DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$330.28 	$244.41	$0.00	$264.22	$148.62	$148.62	$0.00	$0.00	$0.00	$68.84	$245.13	$245.13	$0.00	$0.00	$68.83	$0.00	$195.36	$195.36	$0.00	$165.14	$261.58	$264.22	$0.00		$0.00	$50.18	$0.00	$0.00	$52.58	$0.00	$0.00	$0.00	$0.00	$0.00
243.57	SUP	HCPCS C1713		243.57  -  PLATE BONE 2MM 37MM 7 HOLE RECONSTRUCTION DCP STAINLESS	BOTH IP/OP	$348.00 	$257.52	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$72.53	$258.29	$258.29	$0.00	$0.00	$72.52	$0.00	$205.84	$205.84	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
243.58	SUP	HCPCS C1713		243.58  -  PLATE BONE 2MM 42MM 8 HOLE DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
243.584	SUP	HCPCS C1713		243.584  -  PLATE BN 27MMX1.2MM NS LC DCP 4 HL SS 2MM SCR MDLR HND SYS	BOTH IP/OP	$395.00 	$292.30	$0.00	$306.80	$172.58	$172.58	$0.00	$0.00	$0.00	$82.33	$293.17	$293.17	$0.00	$0.00	$82.32	$0.00	$233.64	$233.64	$0.00	$191.75	$303.73	$306.80	$0.00		$0.00	$58.27	$0.00	$0.00	$61.05	$0.00	$0.00	$0.00	$0.00	$0.00
243.585	SUP	HCPCS C1713		243.585  -  PLATE BONE 33MM 5 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$420.30 	$311.02	$0.00	$326.44	$183.62	$183.62	$0.00	$0.00	$0.00	$87.60	$311.95	$311.95	$0.00	$0.00	$87.59	$0.00	$248.61	$248.61	$0.00	$204.03	$323.18	$326.44	$0.00		$0.00	$62.00	$0.00	$0.00	$64.96	$0.00	$0.00	$0.00	$0.00	$0.00
243.586	SUP	HCPCS C1713		243.586  -  PLATE BN 39MMX1.2MM NS LC DCP 6 HL SS 2MM SCR MDLR HND SYS	BOTH IP/OP	$463.88 	$343.27	$0.00	$360.30	$202.67	$202.67	$0.00	$0.00	$0.00	$96.68	$344.29	$344.29	$0.00	$0.00	$96.67	$0.00	$274.38	$274.38	$0.00	$225.19	$356.70	$360.30	$0.00		$0.00	$68.43	$0.00	$0.00	$71.70	$0.00	$0.00	$0.00	$0.00	$0.00
243.587	SUP	HCPCS C1713		243.587  -  PLATE BONE 45MM 7 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$496.20 	$367.19	$0.00	$385.40	$216.79	$216.79	$0.00	$0.00	$0.00	$103.42	$368.28	$368.28	$0.00	$0.00	$103.41	$0.00	$293.50	$293.50	$0.00	$240.88	$381.55	$385.40	$0.00		$0.00	$73.20	$0.00	$0.00	$76.69	$0.00	$0.00	$0.00	$0.00	$0.00
243.588	SUP	HCPCS C1713		243.588  -  PLATE BN 51MMX1.2MM NS LC DCP 8 HL SS 2MM SCR MDLR HND SYS	BOTH IP/OP	$531.35 	$393.20	$0.00	$412.70	$232.14	$232.14	$0.00	$0.00	$0.00	$110.75	$394.37	$394.37	$0.00	$0.00	$110.73	$0.00	$314.29	$314.29	$0.00	$257.94	$408.58	$412.70	$0.00		$0.00	$78.38	$0.00	$0.00	$82.13	$0.00	$0.00	$0.00	$0.00	$0.00
243.61	SUP	HCPCS C1713		243.61  -  PLATE BN 39X5X1.2MM NS DCP 7 HL SS CNDYL LT 2MM SCR	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
243.62	SUP	HCPCS C1713		243.62  -  PLATE BN 39X5X1.2MM NS DCP 7 HL SS CNDYL RT 2MM SCR	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
244.02	SUP	HCPCS C1713		244.02  -  PLATE BONE 20MM 2 HOLE DCP STAINLESS STEEL NONSTRL 2.7MM	BOTH IP/OP	$218.35 	$161.58	$0.00	$174.68	$98.26	$98.26	$0.00	$0.00	$0.00	$45.51	$162.06	$162.06	$0.00	$0.00	$45.50	$0.00	$129.15	$129.15	$0.00	$109.18	$172.93	$174.68	$0.00		$0.00	$33.18	$0.00	$0.00	$34.76	$0.00	$0.00	$0.00	$0.00	$0.00
244.04	SUP	HCPCS C1713		244.04  -  PLATE BN 36X8X2MM NS DCP 4 HL SS 2.7MM SCR MN FRAG SET	BOTH IP/OP	$245.65 	$181.78	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$51.20	$182.32	$182.32	$0.00	$0.00	$51.19	$0.00	$145.30	$145.30	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
244.05	SUP	HCPCS C1713		244.05  -  PLATE BONE 44X8X2MM 5 HOLE DCP STAINLESS STEEL NONSTRL 2.7MM	BOTH IP/OP	$279.78 	$207.04	$0.00	$223.82	$125.90	$125.90	$0.00	$0.00	$0.00	$58.31	$207.65	$207.65	$0.00	$0.00	$58.31	$0.00	$165.49	$165.49	$0.00	$139.89	$221.59	$223.82	$0.00		$0.00	$42.51	$0.00	$0.00	$44.54	$0.00	$0.00	$0.00	$0.00	$0.00
244.06	SUP	HCPCS C1713		244.06  -  PLATE BONE 52X8X2MM 6 HOLE DCP STAINLESS STEEL NONSTRL 2.7MM	BOTH IP/OP	$302.98 	$224.21	$0.00	$242.38	$136.34	$136.34	$0.00	$0.00	$0.00	$63.15	$224.87	$224.87	$0.00	$0.00	$63.14	$0.00	$179.21	$179.21	$0.00	$151.49	$239.96	$242.38	$0.00		$0.00	$46.03	$0.00	$0.00	$48.23	$0.00	$0.00	$0.00	$0.00	$0.00
244.07	SUP	HCPCS C1713		244.07  -  PLATE BN 60X8X2.5MM NS DCP 7 HL SS 2.7MM SCR MN FRAG SET	BOTH IP/OP	$346.65 	$256.52	$0.00	$277.32	$155.99	$155.99	$0.00	$0.00	$0.00	$72.25	$257.28	$257.28	$0.00	$0.00	$72.24	$0.00	$205.04	$205.04	$0.00	$173.33	$274.55	$277.32	$0.00		$0.00	$52.67	$0.00	$0.00	$55.19	$0.00	$0.00	$0.00	$0.00	$0.00
244.08	SUP	HCPCS C1713		244.08  -  PLATE BONE 68X8X2.5MM 8 HOLE DCP STAINLESS STEEL NONSTRL 2.7	BOTH IP/OP	$384.85 	$284.79	$0.00	$307.88	$173.18	$173.18	$0.00	$0.00	$0.00	$80.21	$285.64	$285.64	$0.00	$0.00	$80.20	$0.00	$227.64	$227.64	$0.00	$192.43	$304.80	$307.88	$0.00		$0.00	$58.48	$0.00	$0.00	$61.27	$0.00	$0.00	$0.00	$0.00	$0.00
244.09	SUP	HCPCS C1713		244.09  -  PLATE BN 76X8X2.5MM NS DCP 9 HL SS 2.7MM SCR MN FRAG SET	BOTH IP/OP	$399.88 	$295.91	$0.00	$319.90	$179.94	$179.94	$0.00	$0.00	$0.00	$83.34	$296.79	$296.79	$0.00	$0.00	$83.33	$0.00	$236.53	$236.53	$0.00	$199.94	$316.70	$319.90	$0.00		$0.00	$60.76	$0.00	$0.00	$63.66	$0.00	$0.00	$0.00	$0.00	$0.00
244.1	SUP	HCPCS C1713		244.10  -  PLATE BONE 84X8X2.5MM 10 HOLE DCP STAINLESS STEEL FT NONSTRL	BOTH IP/OP	$443.55 	$328.23	$0.00	$354.84	$199.60	$199.60	$0.00	$0.00	$0.00	$92.45	$329.20	$329.20	$0.00	$0.00	$92.44	$0.00	$262.36	$262.36	$0.00	$221.78	$351.29	$354.84	$0.00		$0.00	$67.39	$0.00	$0.00	$70.61	$0.00	$0.00	$0.00	$0.00	$0.00
244.12	SUP	HCPCS C1713		244.12  -  PLATE BONE 100X8X2.5MM 12MM 12 HOLE DCP STAINLESS STEEL	BOTH IP/OP	$499.50 	$369.63	$0.00	$399.60	$224.78	$224.78	$0.00	$0.00	$0.00	$104.11	$370.73	$370.73	$0.00	$0.00	$104.10	$0.00	$295.45	$295.45	$0.00	$249.75	$395.60	$399.60	$0.00		$0.00	$75.89	$0.00	$0.00	$79.52	$0.00	$0.00	$0.00	$0.00	$0.00
244.22	SUP	HCPCS C1713		244.22  -  PLATE BONE 2.7MM 26MM 2 HOLE DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$259.30 	$191.88	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$54.04	$192.45	$192.45	$0.00	$0.00	$54.04	$0.00	$153.38	$153.38	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
245	SUP	HCPCS C1713		245.00  -  PLATE BONE STR 118MM 10 HOLE RECONSTRUCTION LC-DCP STAINLESS	BOTH IP/OP	$813.40 	$601.92	$0.00	$650.72	$366.03	$366.03	$0.00	$0.00	$0.00	$169.53	$603.71	$603.71	$0.00	$0.00	$169.51	$0.00	$481.13	$481.13	$0.00	$406.70	$644.21	$650.72	$0.00		$0.00	$123.59	$0.00	$0.00	$129.49	$0.00	$0.00	$0.00	$0.00	$0.00
245	SUP	HCPCS C1713		245  -  PLATE 118MM SS 3.5MM SCR SM FRAG SET 10 HOLE RECON LC DCP	BOTH IP/OP	$813.40 	$601.92	$0.00	$749.45	$366.03	$366.03	$0.00	$0.00	$0.00	$169.53	$603.71	$603.71	$0.00	$0.00	$169.51	$0.00	$481.13	$481.13	$0.00	$406.70	$749.45	$650.72	$0.00		$0.00	$123.59	$0.00	$0.00	$129.49	$0.00	$0.00	$0.00	$0.00	$0.00
245.01	SUP	HCPCS C1713		245.01  -  PLATE BONE 130MM 11 HOLE RECONSTRUCTION LC-DCP STAINLESS	BOTH IP/OP	$879.98 	$651.19	$0.00	$683.46	$384.45	$384.45	$0.00	$0.00	$0.00	$183.41	$653.12	$653.12	$0.00	$0.00	$183.39	$0.00	$520.51	$520.51	$0.00	$427.16	$676.63	$683.46	$0.00		$0.00	$129.81	$0.00	$0.00	$136.01	$0.00	$0.00	$0.00	$0.00	$0.00
245.02	SUP	HCPCS C1713		245.02  -  PLATE BONE STR 142MM 12 HOLE RECONSTRUCTION LC-DCP STAINLESS	BOTH IP/OP	$917.93 	$679.27	$0.00	$712.94	$401.03	$401.03	$0.00	$0.00	$0.00	$191.32	$681.28	$681.28	$0.00	$0.00	$191.30	$0.00	$542.95	$542.95	$0.00	$445.59	$705.81	$712.94	$0.00		$0.00	$135.41	$0.00	$0.00	$141.88	$0.00	$0.00	$0.00	$0.00	$0.00
245.023	SUP	HCPCS C1713		245.023  -  PLATE BN STRG 39X10.2X2.7MM NS LC DCP 3 HL LOPRFL RECON SS	BOTH IP/OP	$607.25 	$449.37	$0.00	$471.66	$265.31	$265.31	$0.00	$0.00	$0.00	$126.57	$450.70	$450.70	$0.00	$0.00	$126.55	$0.00	$359.19	$359.19	$0.00	$294.79	$466.95	$471.66	$0.00		$0.00	$89.58	$0.00	$0.00	$93.86	$0.00	$0.00	$0.00	$0.00	$0.00
245.024	SUP	HCPCS C1713		245.024  -  PLATE BONE 52X10.2X2.7MM 4 HOLE LP STAINLESS STEEL CALCANEUS	BOTH IP/OP	$635.38 	$470.18	$0.00	$493.50	$277.59	$277.59	$0.00	$0.00	$0.00	$132.43	$471.58	$471.58	$0.00	$0.00	$132.41	$0.00	$375.82	$375.82	$0.00	$308.44	$488.57	$493.50	$0.00		$0.00	$93.73	$0.00	$0.00	$98.21	$0.00	$0.00	$0.00	$0.00	$0.00
245.025	SUP	HCPCS C1713		245.025  -  PLATE BN STRG 65X10.2X2.7MM NS LC DCP 5 HL LOPRFL RECON SS	BOTH IP/OP	$662.08 	$489.94	$0.00	$514.24	$289.26	$289.26	$0.00	$0.00	$0.00	$137.99	$491.39	$491.39	$0.00	$0.00	$137.98	$0.00	$391.62	$391.62	$0.00	$321.40	$509.10	$514.24	$0.00		$0.00	$97.67	$0.00	$0.00	$102.33	$0.00	$0.00	$0.00	$0.00	$0.00
245.026	SUP	HCPCS C1713		245.026  -  PLATE BONE 78X10.2X2.7MM 6 HOLE LP RECONSTRUCTION STAINLESS	BOTH IP/OP	$733.78 	$543.00	$0.00	$569.92	$320.58	$320.58	$0.00	$0.00	$0.00	$152.94	$544.61	$544.61	$0.00	$0.00	$152.92	$0.00	$434.03	$434.03	$0.00	$356.20	$564.22	$569.92	$0.00		$0.00	$108.24	$0.00	$0.00	$113.41	$0.00	$0.00	$0.00	$0.00	$0.00
245.027	SUP	HCPCS C1713		245.027  -  PLATE BONE 91X10.2X2.7MM 7 HOLE LP RECONSTRUCTION STAINLESS	BOTH IP/OP	$770.33 	$570.04	$0.00	$598.30	$336.54	$336.54	$0.00	$0.00	$0.00	$160.55	$571.74	$571.74	$0.00	$0.00	$160.54	$0.00	$455.65	$455.65	$0.00	$373.94	$592.32	$598.30	$0.00		$0.00	$113.63	$0.00	$0.00	$119.06	$0.00	$0.00	$0.00	$0.00	$0.00
245.028	SUP	HCPCS C1713		245.028  -  PLATE BN STRG 104X10.2X2.7MM NS LC DCP 8 HL LOPRFL RECON SS	BOTH IP/OP	$801.25 	$592.93	$0.00	$622.32	$350.06	$350.06	$0.00	$0.00	$0.00	$167.00	$594.69	$594.69	$0.00	$0.00	$166.98	$0.00	$473.94	$473.94	$0.00	$388.95	$616.10	$622.32	$0.00		$0.00	$118.20	$0.00	$0.00	$123.84	$0.00	$0.00	$0.00	$0.00	$0.00
245.029	SUP	HCPCS C1713		245.029  -  PLATE BONE 11.7X1.02X.27CM 9 HOLE LP RECONSTRUCTION	BOTH IP/OP	$822.33 	$608.52	$0.00	$638.70	$359.27	$359.27	$0.00	$0.00	$0.00	$171.39	$610.33	$610.33	$0.00	$0.00	$171.37	$0.00	$486.41	$486.41	$0.00	$399.19	$632.32	$638.70	$0.00		$0.00	$121.31	$0.00	$0.00	$127.10	$0.00	$0.00	$0.00	$0.00	$0.00
245.03	SUP	HCPCS C1713		245.030  -  PLATE BONE 130MM 10 HOLE LP STAINLESS STEEL PELVIC NONSTRL	BOTH IP/OP	$826.55 	$611.65	$0.00	"$1,056.80"	$361.11	$361.11	$0.00	$0.00	$0.00	$172.27	$613.47	$613.47	$0.00	$0.00	$172.25	$0.00	"$1,056.80"	"$1,056.80"	$0.00	$401.24	$635.56	$641.98	$0.00		$0.00	$121.93	$0.00	$0.00	$127.75	$0.00	$0.00	$0.00	$0.00	$0.00
245.03	SUP	HCPCS C1713		245.03  -  PLATE BN 154MM NS LC DCP 13 HL RECON SS 3.5MM SCR SM FRAG	BOTH IP/OP	$826.55 	$611.65	$0.00	"$1,056.80"	$361.11	$361.11	$0.00	$0.00	$0.00	$172.27	$613.47	$613.47	$0.00	$0.00	$172.25	$0.00	"$1,056.80"	"$1,056.80"	$0.00	$401.24	$738.25	$641.98	$0.00		$0.00	$121.93	$0.00	$0.00	$127.75	$0.00	$0.00	$0.00	$0.00	$0.00
245.031	SUP	HCPCS C1713		245.031  -  PLATE BONE 143MM 11 HOLE LP RECONSTRUCTION STAINLESS STEEL	BOTH IP/OP	$872.93 	$645.97	$0.00	$678.00	$381.38	$381.38	$0.00	$0.00	$0.00	$181.94	$647.88	$647.88	$0.00	$0.00	$181.92	$0.00	$516.34	$516.34	$0.00	$423.75	$671.22	$678.00	$0.00		$0.00	$128.77	$0.00	$0.00	$134.92	$0.00	$0.00	$0.00	$0.00	$0.00
245.032	SUP	HCPCS C1713		245.032  -  PLATE BN STRG 156X10.2X2.7MM NS LC DCP 12 HL LOPRFL RECON SS	BOTH IP/OP	$906.68 	$670.94	$0.00	$704.22	$396.12	$396.12	$0.00	$0.00	$0.00	$188.97	$672.93	$672.93	$0.00	$0.00	$188.95	$0.00	$536.30	$536.30	$0.00	$440.14	$697.18	$704.22	$0.00		$0.00	$133.75	$0.00	$0.00	$140.14	$0.00	$0.00	$0.00	$0.00	$0.00
245.033	SUP	HCPCS C1713		245.033  -  PLATE BONE 169MM 13 HOLE LP RECONSTRUCTION STAINLESS STEEL	BOTH IP/OP	$950.25 	$703.19	$0.00	$738.06	$415.16	$415.16	$0.00	$0.00	$0.00	$198.06	$705.28	$705.28	$0.00	$0.00	$198.03	$0.00	$562.07	$562.07	$0.00	$461.29	$730.68	$738.06	$0.00		$0.00	$140.18	$0.00	$0.00	$146.87	$0.00	$0.00	$0.00	$0.00	$0.00
245.034	SUP	HCPCS C1713		245.034  -  PLATE BONE 182MM 14 HOLE LP RECONSTRUCTION STAINLESS STEEL	BOTH IP/OP	$985.40 	$729.20	$0.00	$765.36	$430.52	$430.52	$0.00	$0.00	$0.00	$205.38	$731.36	$731.36	$0.00	$0.00	$205.36	$0.00	$582.86	$582.86	$0.00	$478.35	$757.71	$765.36	$0.00		$0.00	$145.36	$0.00	$0.00	$152.31	$0.00	$0.00	$0.00	$0.00	$0.00
245.035	SUP	HCPCS C1713		245.035  -  PLATE BONE 195MM 15 HOLE LP RECONSTRUCTION STAINLESS STEEL	BOTH IP/OP	"$1,034.60 "	$765.60	$0.00	$803.56	$452.00	$452.00	$0.00	$0.00	$0.00	$215.64	$767.88	$767.88	$0.00	$0.00	$215.61	$0.00	$611.97	$611.97	$0.00	$502.23	$795.52	$803.56	$0.00		$0.00	$152.62	$0.00	$0.00	$159.91	$0.00	$0.00	$0.00	$0.00	$0.00
245.036	SUP	HCPCS C1713		245.036  -  PLATE BONE 208MM 16 HOLE LP RECONSTRUCTION STAINLESS STEEL	BOTH IP/OP	"$1,080.98 "	$799.93	$0.00	$839.60	$472.28	$472.28	$0.00	$0.00	$0.00	$225.30	$802.30	$802.30	$0.00	$0.00	$225.28	$0.00	$639.40	$639.40	$0.00	$524.75	$831.20	$839.60	$0.00		$0.00	$159.46	$0.00	$0.00	$167.08	$0.00	$0.00	$0.00	$0.00	$0.00
245.038	SUP	HCPCS C1713		245.038  -  PLATE BONE 234MM 18 HOLE LP RECONSTRUCTION STAINLESS STEEL	BOTH IP/OP	"$1,127.38 "	$834.26	$0.00	$875.62	$492.54	$492.54	$0.00	$0.00	$0.00	$234.97	$836.74	$836.74	$0.00	$0.00	$234.94	$0.00	$666.84	$666.84	$0.00	$547.26	$866.87	$875.62	$0.00		$0.00	$166.30	$0.00	$0.00	$174.25	$0.00	$0.00	$0.00	$0.00	$0.00
245.039	SUP	HCPCS C1713		245.039  -  PLATE BONE 260MM 20 HOLE LP RECONSTRUCTION STAINLESS STEEL	BOTH IP/OP	"$1,353.68 "	"$1,001.72"	$0.00	"$1,051.40"	$591.41	$591.41	$0.00	$0.00	$0.00	$282.14	"$1,004.70"	"$1,004.70"	$0.00	$0.00	$282.11	$0.00	$800.70	$800.70	$0.00	$657.13	"$1,040.89"	"$1,051.40"	$0.00		$0.00	$199.69	$0.00	$0.00	$209.23	$0.00	$0.00	$0.00	$0.00	$0.00
245.04	SUP	HCPCS C1713		245.04  -  PLATE BONE 3.5MM 166MM 14 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	$996.63 	$737.51	$0.00	$774.08	$435.42	$435.42	$0.00	$0.00	$0.00	$207.72	$739.70	$739.70	$0.00	$0.00	$207.70	$0.00	$589.50	$589.50	$0.00	$483.80	$766.34	$774.08	$0.00		$0.00	$147.02	$0.00	$0.00	$154.04	$0.00	$0.00	$0.00	$0.00	$0.00
245.041	SUP	HCPCS C1713		245.041  -  PLATE BN 56MM NS LCP 4 HL RECON SS 3.5MM SCR SM FRAG SYS	BOTH IP/OP	$827.95 	$612.68	$0.00	$643.08	$361.73	$361.73	$0.00	$0.00	$0.00	$172.57	$614.50	$614.50	$0.00	$0.00	$172.54	$0.00	$489.73	$489.73	$0.00	$401.93	$636.65	$643.08	$0.00		$0.00	$122.14	$0.00	$0.00	$127.97	$0.00	$0.00	$0.00	$0.00	$0.00
245.05	SUP	HCPCS C1713		245.05  -  PLATE BONE 3.5MM 178MM 15 HOLE RECONSTRUCTION DCP LC-DCP	BOTH IP/OP	"$1,034.60 "	$765.60	$0.00	$803.56	$452.00	$452.00	$0.00	$0.00	$0.00	$215.64	$767.88	$767.88	$0.00	$0.00	$215.61	$0.00	$611.97	$611.97	$0.00	$502.23	$795.52	$803.56	$0.00		$0.00	$152.62	$0.00	$0.00	$159.91	$0.00	$0.00	$0.00	$0.00	$0.00
245.051	SUP	HCPCS C1713		245.051  -  PLATE BONE STR 70X10.1X3.5MM 5 HOLE RECONSTRUCTION LCP	BOTH IP/OP	$809.68 	$599.16	$0.00	$628.88	$353.75	$353.75	$0.00	$0.00	$0.00	$168.76	$600.94	$600.94	$0.00	$0.00	$168.74	$0.00	$478.92	$478.92	$0.00	$393.05	$622.59	$628.88	$0.00		$0.00	$119.44	$0.00	$0.00	$125.15	$0.00	$0.00	$0.00	$0.00	$0.00
245.06	SUP	HCPCS C1713		245.06  -  PLATE BN 190MM NS LC DCP 16 HL RECON SS 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,079.58 "	$798.89	$0.00	$838.50	$471.66	$471.66	$0.00	$0.00	$0.00	$225.01	$801.26	$801.26	$0.00	$0.00	$224.98	$0.00	$638.57	$638.57	$0.00	$524.06	$830.12	$838.50	$0.00		$0.00	$159.25	$0.00	$0.00	$166.86	$0.00	$0.00	$0.00	$0.00	$0.00
245.061	SUP	HCPCS C1713		245.061  -  PLATE BONE STR 84X10.1X3.5MM 6 HOLE RECONSTRUCTION LCP	BOTH IP/OP	$936.20 	$692.79	$0.00	$727.14	$409.02	$409.02	$0.00	$0.00	$0.00	$195.13	$694.85	$694.85	$0.00	$0.00	$195.10	$0.00	$553.76	$553.76	$0.00	$454.46	$719.87	$727.14	$0.00		$0.00	$138.10	$0.00	$0.00	$144.70	$0.00	$0.00	$0.00	$0.00	$0.00
245.071	SUP	HCPCS C1713		245.071  -  PLATE BONE STR 98X10.1X3.5MM 7 HOLE RECONSTRUCTION LCP	BOTH IP/OP	$982.58 	$727.11	$0.00	$763.16	$429.28	$429.28	$0.00	$0.00	$0.00	$204.79	$729.27	$729.27	$0.00	$0.00	$204.77	$0.00	$581.19	$581.19	$0.00	$476.98	$755.53	$763.16	$0.00		$0.00	$192.28	$0.00	$0.00	$151.87	$0.00	$0.00	$0.00	$0.00	$0.00
245.08	SUP	HCPCS C1713		245.08  -  PLATE BONE STR 214MM 18 HOLE RECONSTRUCTION LC-DCP STAINLESS	BOTH IP/OP	"$1,128.78 "	$835.30	$0.00	$876.72	$493.16	$493.16	$0.00	$0.00	$0.00	$235.26	$837.78	$837.78	$0.00	$0.00	$235.24	$0.00	$667.67	$667.67	$0.00	$547.95	$867.95	$876.72	$0.00		$0.00	$166.51	$0.00	$0.00	$174.47	$0.00	$0.00	$0.00	$0.00	$0.00
245.081	SUP	HCPCS C1713		245.081  -  PLATE BONE STR 112X10.1X3.5MM 8 HOLE RECONSTRUCTION LCP	BOTH IP/OP	"$1,024.75 "	$758.32	$0.00	$795.92	$447.71	$447.71	$0.00	$0.00	$0.00	$213.58	$760.57	$760.57	$0.00	$0.00	$213.56	$0.00	$606.14	$606.14	$0.00	$497.45	$787.96	$795.92	$0.00		$0.00	$151.17	$0.00	$0.00	$158.39	$0.00	$0.00	$0.00	$0.00	$0.00
245.091	SUP	HCPCS C1713		245.091  -  PLATE BN 126X10.1X3.5MM NS LCP CMBN 9 HL RECON SS 3.5MM SCR	BOTH IP/OP	"$1,079.58 "	$798.89	$0.00	$838.50	$471.66	$471.66	$0.00	$0.00	$0.00	$225.01	$801.26	$801.26	$0.00	$0.00	$224.98	$0.00	$638.57	$638.57	$0.00	$524.06	$830.12	$838.50	$0.00		$0.00	$159.25	$0.00	$0.00	$166.86	$0.00	$0.00	$0.00	$0.00	$0.00
245.1	SUP	HCPCS C1713		245.10  -  PLATE BN 238MM NS LC DCP 20 HL RECON SS 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,329.28 "	$983.67	$0.00	"$1,063.42"	$598.17	$598.17	$0.00	$0.00	$0.00	$277.05	$986.59	$986.59	$0.00	$0.00	$277.02	$0.00	$786.27	$786.27	$0.00	$664.64	"$1,052.79"	"$1,063.42"	$0.00		$0.00	$201.97	$0.00	$0.00	$211.62	$0.00	$0.00	$0.00	$0.00	$0.00
245.101	SUP	HCPCS C1713		245.101  -  PLATE BONE STR 140X10.1X3.5MM 10 HOLE RECONSTRUCTION LCP	BOTH IP/OP	"$1,062.70 "	$786.40	$0.00	$825.40	$464.29	$464.29	$0.00	$0.00	$0.00	$221.49	$788.74	$788.74	$0.00	$0.00	$221.47	$0.00	$628.59	$628.59	$0.00	$515.88	$817.15	$825.40	$0.00		$0.00	$156.77	$0.00	$0.00	$164.25	$0.00	$0.00	$0.00	$0.00	$0.00
245.111	SUP	HCPCS C1713		245.111  -  PLATE BN 154X10.1X3.5MM NS LCP CMBN 11 HL SHFT RECON SS 3.5	BOTH IP/OP	"$1,149.85 "	$850.89	$0.00	$893.10	$502.37	$502.37	$0.00	$0.00	$0.00	$239.66	$853.42	$853.42	$0.00	$0.00	$239.63	$0.00	$680.14	$680.14	$0.00	$558.19	$884.17	$893.10	$0.00		$0.00	$169.62	$0.00	$0.00	$177.73	$0.00	$0.00	$0.00	$0.00	$0.00
245.12	SUP	HCPCS C1713		245.12  -  PLATE BONE STR 3.5MM 263MM 22 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	"$1,425.38 "	"$1,054.78"	$0.00	"$1,107.08"	$622.73	$622.73	$0.00	$0.00	$0.00	$297.08	"$1,057.91"	"$1,057.91"	$0.00	$0.00	$297.05	$0.00	$843.11	$843.11	$0.00	$691.93	"$1,096.01"	"$1,107.08"	$0.00		$0.00	$210.27	$0.00	$0.00	$220.31	$0.00	$0.00	$0.00	$0.00	$0.00
245.121	SUP	HCPCS C1713		245.121  -  PLATE BONE STR 168X10.1X3.5MM 12 HOLE RECONSTRUCTION LCP	BOTH IP/OP	"$1,176.58 "	$870.67	$0.00	$913.84	$514.04	$514.04	$0.00	$0.00	$0.00	$245.23	$873.25	$873.25	$0.00	$0.00	$245.20	$0.00	$695.94	$695.94	$0.00	$571.15	$904.70	$913.84	$0.00		$0.00	$173.56	$0.00	$0.00	$181.85	$0.00	$0.00	$0.00	$0.00	$0.00
245.131	SUP	HCPCS C1713		245.131  -  PLATE BONE STR 182X10.1X3.5MM 13 HOLE RECONSTRUCTION LCP	BOTH IP/OP	"$1,273.55 "	$942.43	$0.00	$989.18	$556.41	$556.41	$0.00	$0.00	$0.00	$265.44	$945.23	$945.23	$0.00	$0.00	$265.41	$0.00	$753.30	$753.30	$0.00	$618.24	$979.29	$989.18	$0.00		$0.00	$187.87	$0.00	$0.00	$196.85	$0.00	$0.00	$0.00	$0.00	$0.00
245.14	SUP	HCPCS C1713		245.14  -  PLATE BONE STR 46X10.1X3.5MM 4 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	$635.38 	$470.18	$0.00	$493.50	$277.59	$277.59	$0.00	$0.00	$0.00	$132.43	$471.58	$471.58	$0.00	$0.00	$132.41	$0.00	$375.82	$375.82	$0.00	$308.44	$488.57	$493.50	$0.00		$0.00	$93.73	$0.00	$0.00	$98.21	$0.00	$0.00	$0.00	$0.00	$0.00
245.141	SUP	HCPCS C1713		245.141  -  PLATE BONE STR 196X10.1X3.5MM 14 HOLE RECONSTRUCTION LCP	BOTH IP/OP	"$1,322.75 "	$978.84	$0.00	"$1,027.38"	$577.90	$577.90	$0.00	$0.00	$0.00	$275.69	$981.75	$981.75	$0.00	$0.00	$275.66	$0.00	$782.41	$782.41	$0.00	$642.11	"$1,017.11"	"$1,027.38"	$0.00		$0.00	$195.13	$0.00	$0.00	$204.45	$0.00	$0.00	$0.00	$0.00	$0.00
245.15	SUP	HCPCS C1713		245.15  -  PLATE BONE STR 58MM 5 HOLE RECONSTRUCTION LC-DCP STAINLESS	BOTH IP/OP	$646.63 	$478.51	$0.00	$502.22	$282.50	$282.50	$0.00	$0.00	$0.00	$134.77	$479.93	$479.93	$0.00	$0.00	$134.76	$0.00	$382.48	$382.48	$0.00	$313.89	$497.20	$502.22	$0.00		$0.00	$95.39	$0.00	$0.00	$99.94	$0.00	$0.00	$0.00	$0.00	$0.00
245.16	SUP	HCPCS C1713		245.16  -  PLATE BONE STR 70MM 6 HOLE RECONSTRUCTION LC-DCP STAINLESS	BOTH IP/OP	$742.20 	$549.23	$0.00	$576.48	$324.27	$324.27	$0.00	$0.00	$0.00	$154.69	$550.86	$550.86	$0.00	$0.00	$154.67	$0.00	$439.01	$439.01	$0.00	$360.30	$570.72	$576.48	$0.00		$0.00	$109.49	$0.00	$0.00	$114.72	$0.00	$0.00	$0.00	$0.00	$0.00
245.161	SUP	HCPCS C1713		245.161  -  PLATE BONE STR 224X10.1X3.5MM 16 HOLE RECONSTRUCTION LCP	BOTH IP/OP	"$1,433.80 "	"$1,061.01"	$0.00	"$1,113.64"	$626.42	$626.42	$0.00	$0.00	$0.00	$298.84	"$1,064.17"	"$1,064.17"	$0.00	$0.00	$298.80	$0.00	$848.09	$848.09	$0.00	$696.03	"$1,102.50"	"$1,113.64"	$0.00		$0.00	$211.51	$0.00	$0.00	$221.61	$0.00	$0.00	$0.00	$0.00	$0.00
245.17	SUP	HCPCS C1713		245.17  -  PLATE BONE STR 82MM 7 HOLE RECONSTRUCTION LC-DCP STAINLESS	BOTH IP/OP	$778.75 	$576.28	$0.00	$604.86	$340.23	$340.23	$0.00	$0.00	$0.00	$162.31	$577.99	$577.99	$0.00	$0.00	$162.29	$0.00	$460.63	$460.63	$0.00	$378.04	$598.82	$604.86	$0.00		$0.00	$142.33	$0.00	$0.00	$120.37	$0.00	$0.00	$0.00	$0.00	$0.00
245.18	SUP	HCPCS C1713		245.18  -  PLATE BONE STR 94MM 8 HOLE RECONSTRUCTION LC-DCP STAINLESS	BOTH IP/OP	$811.08 	$600.20	$0.00	$629.96	$354.35	$354.35	$0.00	$0.00	$0.00	$169.05	$601.98	$601.98	$0.00	$0.00	$169.03	$0.00	$479.75	$479.75	$0.00	$393.73	$623.66	$629.96	$0.00		$0.00	$119.65	$0.00	$0.00	$125.36	$0.00	$0.00	$0.00	$0.00	$0.00
245.181	SUP	HCPCS C1713		245.181  -  PLATE BONE STR 252X10.1X3.5MM 18 HOLE RECONSTRUCTION LCP	BOTH IP/OP	"$1,501.28 "	"$1,110.95"	$0.00	"$1,166.04"	$655.90	$655.90	$0.00	$0.00	$0.00	$312.90	"$1,114.25"	"$1,114.25"	$0.00	$0.00	$312.87	$0.00	$888.00	$888.00	$0.00	$728.78	"$1,154.38"	"$1,166.04"	$0.00		$0.00	$221.46	$0.00	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00
245.19	SUP	HCPCS C1713		245.19  -  PLATE BN 106MM NS LC DCP 9 HL RECON SS 3.5MM SCR SM FRAG SET	BOTH IP/OP	$830.78 	$614.78	$0.00	$645.26	$362.96	$362.96	$0.00	$0.00	$0.00	$173.15	$616.60	$616.60	$0.00	$0.00	$173.13	$0.00	$491.40	$491.40	$0.00	$403.29	$638.81	$645.26	$0.00		$0.00	$122.55	$0.00	$0.00	$128.41	$0.00	$0.00	$0.00	$0.00	$0.00
245.2	SUP	HCPCS C1713		245.20  -  PLATE BN 48X8X3.3MM NS 6 HL RECON 2.7MM SCR	BOTH IP/OP	$559.55 	$414.07	$0.00	$447.64	$251.80	$251.80	$0.00	$0.00	$0.00	$116.62	$415.30	$415.30	$0.00	$0.00	$116.61	$0.00	$330.97	$330.97	$0.00	$279.78	$443.16	$447.64	$0.00		$0.00	$85.02	$0.00	$0.00	$89.08	$0.00	$0.00	$0.00	$0.00	$0.00
245.201	SUP	HCPCS C1713		245.201  -  PLATE BONE STR 280X10.1X3.5MM 20 HOLE RECONSTRUCTION LCP	BOTH IP/OP	"$1,823.18 "	"$1,349.15"	$0.00	"$1,416.06"	$796.53	$796.53	$0.00	$0.00	$0.00	$380.00	"$1,353.16"	"$1,353.16"	$0.00	$0.00	$379.95	$0.00	"$1,078.41"	"$1,078.41"	$0.00	$885.04	"$1,401.90"	"$1,416.06"	$0.00		$0.00	$268.95	$0.00	$0.00	$281.80	$0.00	$0.00	$0.00	$0.00	$0.00
245.21	SUP	HCPCS C1713		245.21  -  PLATE BN 64X8X3.3MM NS 8 HL RECON 2.7MM SCR	BOTH IP/OP	$597.43 	$442.10	$0.00	$464.02	$261.01	$261.01	$0.00	$0.00	$0.00	$124.52	$443.41	$443.41	$0.00	$0.00	$124.50	$0.00	$353.38	$353.38	$0.00	$290.01	$459.38	$464.02	$0.00		$0.00	$88.13	$0.00	$0.00	$92.34	$0.00	$0.00	$0.00	$0.00	$0.00
245.22	SUP	HCPCS C1713		245.22  -  PLATE BN 80X8X3.3MM NS 10 HL RECON 2.7MM SCR	BOTH IP/OP	$638.18 	$472.25	$0.00	$495.68	$278.82	$278.82	$0.00	$0.00	$0.00	$133.01	$473.65	$473.65	$0.00	$0.00	$133.00	$0.00	$377.48	$377.48	$0.00	$309.80	$490.72	$495.68	$0.00		$0.00	$94.14	$0.00	$0.00	$98.64	$0.00	$0.00	$0.00	$0.00	$0.00
245.221	SUP	HCPCS C1713		245.221  -  PLATE BN 308X10.1X3.5MM NS LCP CMBN 22 HL RECON SS 3.5MM SCR	BOTH IP/OP	"$1,893.48 "	"$1,401.18"	$0.00	"$1,470.66"	$827.25	$827.25	$0.00	$0.00	$0.00	$394.65	"$1,405.34"	"$1,405.34"	$0.00	$0.00	$394.60	$0.00	"$1,119.99"	"$1,119.99"	$0.00	$919.16	"$1,455.96"	"$1,470.66"	$0.00		$0.00	$279.32	$0.00	$0.00	$292.66	$0.00	$0.00	$0.00	$0.00	$0.00
245.23	SUP	HCPCS C1713		245.23  -  PLATE BONE STR 96MM 12 HOLE RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	$761.88 	$563.79	$0.00	$591.76	$332.87	$332.87	$0.00	$0.00	$0.00	$158.79	$565.46	$565.46	$0.00	$0.00	$158.77	$0.00	$450.65	$450.65	$0.00	$369.85	$585.84	$591.76	$0.00		$0.00	$112.39	$0.00	$0.00	$117.76	$0.00	$0.00	$0.00	$0.00	$0.00
245.24	SUP	HCPCS C1713		245.24  -  PLATE BN 112X8X3.3MM NS 14 HL RECON 2.7MM SCR	BOTH IP/OP	$811.08 	$600.20	$0.00	$629.96	$354.35	$354.35	$0.00	$0.00	$0.00	$169.05	$601.98	$601.98	$0.00	$0.00	$169.03	$0.00	$479.75	$479.75	$0.00	$393.73	$623.66	$629.96	$0.00		$0.00	$119.65	$0.00	$0.00	$125.36	$0.00	$0.00	$0.00	$0.00	$0.00
245.25	SUP	HCPCS C1713		245.25  -  PLATE BONE STR 128X8X3.3MM 16 HOLE RECONSTRUCTION LCP	BOTH IP/OP	$882.78 	$653.26	$0.00	$685.66	$385.68	$385.68	$0.00	$0.00	$0.00	$183.99	$655.20	$655.20	$0.00	$0.00	$183.97	$0.00	$522.16	$522.16	$0.00	$428.54	$678.81	$685.66	$0.00		$0.00	$130.22	$0.00	$0.00	$136.45	$0.00	$0.00	$0.00	$0.00	$0.00
245.26	SUP	HCPCS C1713		245.26  -  PLATE BONE 144MM 18 HOLE RECONSTRUCTION LC-DCP STAINLESS	BOTH IP/OP	"$1,065.88 "	$788.75	$0.00	$852.70	$479.64	$479.64	$0.00	$0.00	$0.00	$222.15	$791.09	$791.09	$0.00	$0.00	$222.13	$0.00	$630.47	$630.47	$0.00	$532.94	$844.18	$852.70	$0.00		$0.00	$161.95	$0.00	$0.00	$169.69	$0.00	$0.00	$0.00	$0.00	$0.00
245.27	SUP	HCPCS C1713		245.27  -  PLATE BONE 160MM 20 HOLE RECONSTRUCTION DCP STAINLESS STEEL	BOTH IP/OP	"$1,109.03 "	$820.68	$0.00	$887.22	$499.06	$499.06	$0.00	$0.00	$0.00	$231.15	$823.12	$823.12	$0.00	$0.00	$231.12	$0.00	$655.99	$655.99	$0.00	$554.51	$878.35	$887.22	$0.00		$0.00	$173.56	$0.00	$0.00	$176.56	$0.00	$0.00	$0.00	$0.00	$0.00
245.28	SUP	HCPCS C1713		245.28  -  PLATE BONE 176MM 22 HOLE RECONSTRUCTION DCP STAINLESS STEEL	BOTH IP/OP	"$1,329.28 "	$983.67	$0.00	"$1,063.42"	$598.17	$598.17	$0.00	$0.00	$0.00	$277.05	$986.59	$986.59	$0.00	$0.00	$277.02	$0.00	$786.27	$786.27	$0.00	$664.64	"$1,052.79"	"$1,063.42"	$0.00		$0.00	$201.97	$0.00	$0.00	$211.62	$0.00	$0.00	$0.00	$0.00	$0.00
245.29	SUP	HCPCS C1713		245.29  -  PLATE BONE 192MM 24 HOLE RECONSTRUCTION DCP STAINLESS STEEL	BOTH IP/OP	"$1,497.13 "	"$1,107.88"	$0.00	"$1,197.70"	$673.71	$673.71	$0.00	$0.00	$0.00	$312.04	"$1,111.17"	"$1,111.17"	$0.00	$0.00	$312.00	$0.00	$885.55	$885.55	$0.00	$748.56	"$1,185.73"	"$1,197.70"	$0.00		$0.00	$227.48	$0.00	$0.00	$238.34	$0.00	$0.00	$0.00	$0.00	$0.00
245.3	SUP	HCPCS C1713		245.30  -  PLATE BONE CURVE 70X10X3.6MM 6 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	$780.63 	$577.67	$0.00	$624.50	$351.28	$351.28	$0.00	$0.00	$0.00	$162.70	$579.38	$579.38	$0.00	$0.00	$162.68	$0.00	$461.74	$461.74	$0.00	$390.31	$618.26	$624.50	$0.00		$0.00	$118.61	$0.00	$0.00	$124.28	$0.00	$0.00	$0.00	$0.00	$0.00
245.31	SUP	HCPCS C1713		245.31  -  PLATE BN CRV 94X10X3.6MM NS LC DCP 8 HL RECON SS 3.5MM CORT	BOTH IP/OP	$872.93 	$645.97	$0.00	$678.00	$381.38	$381.38	$0.00	$0.00	$0.00	$181.94	$647.88	$647.88	$0.00	$0.00	$181.92	$0.00	$516.34	$516.34	$0.00	$423.75	$671.22	$678.00	$0.00		$0.00	$128.77	$0.00	$0.00	$134.92	$0.00	$0.00	$0.00	$0.00	$0.00
245.32	SUP	HCPCS C1713		245.32  -  PLATE BN CRV 118X10X3.6MM NS LC DCP 10 HL RECON SS 3.5MM	BOTH IP/OP	$917.93 	$679.27	$0.00	$712.94	$401.03	$401.03	$0.00	$0.00	$0.00	$191.32	$681.28	$681.28	$0.00	$0.00	$191.30	$0.00	$542.95	$542.95	$0.00	$445.59	$705.81	$712.94	$0.00		$0.00	$135.41	$0.00	$0.00	$141.88	$0.00	$0.00	$0.00	$0.00	$0.00
245.33	SUP	HCPCS C1713		245.33  -  PLATE BONE CURVE 142X10X3.6MM 12 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	$955.88 	$707.35	$0.00	$742.42	$417.61	$417.61	$0.00	$0.00	$0.00	$199.23	$709.45	$709.45	$0.00	$0.00	$199.20	$0.00	$565.40	$565.40	$0.00	$464.01	$735.00	$742.42	$0.00		$0.00	$141.01	$0.00	$0.00	$147.74	$0.00	$0.00	$0.00	$0.00	$0.00
245.34	SUP	HCPCS C1713		245.34  -  PLATE BONE CURVE 166X10X3.6MM 14 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	"$1,072.55 "	$793.69	$0.00	$833.04	$468.59	$468.59	$0.00	$0.00	$0.00	$223.55	$796.05	$796.05	$0.00	$0.00	$223.52	$0.00	$634.41	$634.41	$0.00	$520.65	$824.71	$833.04	$0.00		$0.00	$158.22	$0.00	$0.00	$165.77	$0.00	$0.00	$0.00	$0.00	$0.00
245.341	SUP	HCPCS C1713		245.341  -  PLATE BONE 55MM 4 HOLE SHAFT CVD RECONSTRUCTION LCP	BOTH IP/OP	"$1,291.83 "	$955.95	$0.00	"$1,003.36"	$564.39	$564.39	$0.00	$0.00	$0.00	$269.25	$958.79	$958.79	$0.00	$0.00	$269.22	$0.00	$764.11	$764.11	$0.00	$627.10	$993.33	"$1,003.36"	$0.00		$0.00	$190.57	$0.00	$0.00	$199.67	$0.00	$0.00	$0.00	$0.00	$0.00
245.35	SUP	HCPCS C1713		245.35  -  PLATE BN CRV 190X10X3.6MM NS LC DCP 16 HL RECON SS 3.5MM	BOTH IP/OP	"$1,141.43 "	$844.66	$0.00	$886.54	$498.68	$498.68	$0.00	$0.00	$0.00	$237.90	$847.17	$847.17	$0.00	$0.00	$237.87	$0.00	$675.15	$675.15	$0.00	$554.09	$877.68	$886.54	$0.00		$0.00	$168.38	$0.00	$0.00	$176.42	$0.00	$0.00	$0.00	$0.00	$0.00
245.36	SUP	HCPCS C1713		245.36  -  PLATE BONE CURVE 214X10X3.6MM 18 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	"$1,229.98 "	$910.19	$0.00	$955.32	$537.37	$537.37	$0.00	$0.00	$0.00	$256.36	$912.89	$912.89	$0.00	$0.00	$256.33	$0.00	$727.53	$727.53	$0.00	$597.08	$945.77	$955.32	$0.00		$0.00	$181.44	$0.00	$0.00	$190.11	$0.00	$0.00	$0.00	$0.00	$0.00
245.361	SUP	HCPCS C1713		245.361  -  PLATE BONE 82MM 6 HOLE SHAFT CVD RECONSTRUCTION LCP	BOTH IP/OP	"$1,398.68 "	"$1,035.02"	$0.00	"$1,086.34"	$611.07	$611.07	$0.00	$0.00	$0.00	$291.52	"$1,038.10"	"$1,038.10"	$0.00	$0.00	$291.48	$0.00	$827.32	$827.32	$0.00	$678.96	"$1,075.48"	"$1,086.34"	$0.00		$0.00	$206.33	$0.00	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00
245.381	SUP	HCPCS C1713		245.381  -  PLATE BN CRV 106X10.1X3.5MM NS LCP 8 HL SHFT RECON SS 3.5MM	BOTH IP/OP	"$1,516.75 "	"$1,122.40"	$0.00	"$1,178.06"	$662.66	$662.66	$0.00	$0.00	$0.00	$316.13	"$1,125.73"	"$1,125.73"	$0.00	$0.00	$316.09	$0.00	$897.16	$897.16	$0.00	$736.29	"$1,166.28"	"$1,178.06"	$0.00		$0.00	$223.74	$0.00	$0.00	$234.43	$0.00	$0.00	$0.00	$0.00	$0.00
245.401	SUP	HCPCS C1713		245.401  -  PLATE BONE 140MM 10 HOLE CVD RECONSTRUCTION LCP STAINLESS	BOTH IP/OP	"$1,588.43 "	"$1,175.44"	$0.00	"$1,233.74"	$693.98	$693.98	$0.00	$0.00	$0.00	$331.07	"$1,178.93"	"$1,178.93"	$0.00	$0.00	$331.03	$0.00	$939.55	$939.55	$0.00	$771.09	"$1,221.41"	"$1,233.74"	$0.00		$0.00	$234.32	$0.00	$0.00	$245.51	$0.00	$0.00	$0.00	$0.00	$0.00
245.421	SUP	HCPCS C1713		245.421  -  PLATE BONE 149MM 12 HOLE SHAFT CVD RECONSTRUCTION LCP	BOTH IP/OP	"$1,662.93 "	"$1,230.57"	$0.00	"$1,291.60"	$726.53	$726.53	$0.00	$0.00	$0.00	$346.60	"$1,234.22"	"$1,234.22"	$0.00	$0.00	$346.55	$0.00	$983.62	$983.62	$0.00	$807.25	"$1,278.68"	"$1,291.60"	$0.00		$0.00	$245.31	$0.00	$0.00	$257.03	$0.00	$0.00	$0.00	$0.00	$0.00
245.441	SUP	HCPCS C1713		245.441  -  PLATE BONE 166MM 14 HOLE SHAFT CVD RECONSTRUCTION LCP	BOTH IP/OP	"$1,868.18 "	"$1,382.45"	$0.00	"$1,451.00"	$816.19	$816.19	$0.00	$0.00	$0.00	$389.37	"$1,386.56"	"$1,386.56"	$0.00	$0.00	$389.33	$0.00	"$1,105.03"	"$1,105.03"	$0.00	$906.88	"$1,436.49"	"$1,451.00"	$0.00		$0.00	$275.58	$0.00	$0.00	$288.75	$0.00	$0.00	$0.00	$0.00	$0.00
245.461	SUP	HCPCS C1713		245.461  -  PLATE BONE 180MM 16 HOLE SHAFT CVD RECONSTRUCTION LCP	BOTH IP/OP	"$1,996.08 "	"$1,477.10"	$0.00	"$1,550.36"	$872.08	$872.08	$0.00	$0.00	$0.00	$416.03	"$1,481.49"	"$1,481.49"	$0.00	$0.00	$415.98	$0.00	"$1,180.68"	"$1,180.68"	$0.00	$968.98	"$1,534.86"	"$1,550.36"	$0.00		$0.00	$294.45	$0.00	$0.00	$308.52	$0.00	$0.00	$0.00	$0.00	$0.00
245.481	SUP	HCPCS C1713		245.481  -  PLATE BONE 190MM 18 HOLE SHAFT CVD RECONSTRUCTION LCP	BOTH IP/OP	"$2,152.13 "	"$1,592.58"	$0.00	"$1,671.54"	$940.24	$940.24	$0.00	$0.00	$0.00	$448.56	"$1,597.31"	"$1,597.31"	$0.00	$0.00	$448.50	$0.00	"$1,272.98"	"$1,272.98"	$0.00	"$1,044.71"	"$1,654.83"	"$1,671.54"	$0.00		$0.00	$317.47	$0.00	$0.00	$332.64	$0.00	$0.00	$0.00	$0.00	$0.00
245.876	SUP	HCPCS C1713		245.876  -  PLATE BONE 108MM RAD 78MM 6 HOLE LP CVD RECONSTRUCTION	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
245.878	SUP	HCPCS C1713		245.878  -  PLATE BN 108MM RDS CRV 104X10.2X2.7MM NS 8 HL LOPRFL RECON	BOTH IP/OP	$884.18 	$654.29	$0.00	$686.74	$386.29	$386.29	$0.00	$0.00	$0.00	$184.28	$656.23	$656.23	$0.00	$0.00	$184.26	$0.00	$522.99	$522.99	$0.00	$429.21	$679.88	$686.74	$0.00		$0.00	$130.43	$0.00	$0.00	$136.66	$0.00	$0.00	$0.00	$0.00	$0.00
245.88	SUP	HCPCS C1713		245.880  -  PLATE BONE 108MM RAD CVD 130MM 8 HOLE LP RECONSTRUCTION	BOTH IP/OP	$926.68 	$685.74	$0.00	$741.34	$417.00	$417.00	$0.00	$0.00	$0.00	$193.14	$687.78	$687.78	$0.00	$0.00	$193.12	$0.00	$548.13	$548.13	$0.00	$463.34	$733.93	$741.34	$0.00		$0.00	$140.80	$0.00	$0.00	$147.53	$0.00	$0.00	$0.00	$0.00	$0.00
245.882	SUP	HCPCS C1713		245.882  -  PLATE BN 108MM RDS CRV 156MMX10.2MMX2.7M NS 12 HL LOPRFL	BOTH IP/OP	"$1,030.38 "	$762.48	$0.00	$800.28	$450.16	$450.16	$0.00	$0.00	$0.00	$214.76	$764.74	$764.74	$0.00	$0.00	$214.73	$0.00	$609.47	$609.47	$0.00	$500.18	$792.28	$800.28	$0.00		$0.00	$152.00	$0.00	$0.00	$159.26	$0.00	$0.00	$0.00	$0.00	$0.00
245.884	SUP	HCPCS C1713		245.884  -  PLATE BONE 108MM RAD 182MM 14 HOLE LP CVD RECONSTRUCTION	BOTH IP/OP	"$1,107.68 "	$819.68	$0.00	$860.34	$483.94	$483.94	$0.00	$0.00	$0.00	$230.87	$822.12	$822.12	$0.00	$0.00	$230.84	$0.00	$655.19	$655.19	$0.00	$537.71	$851.74	$860.34	$0.00		$0.00	$163.40	$0.00	$0.00	$171.21	$0.00	$0.00	$0.00	$0.00	$0.00
245.886	SUP	HCPCS C1713		245.886  -  PLATE BONE 108MM RAD 208MM 16 HOLE LP CVD RECONSTRUCTION	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$920.38	$517.71	$517.71	$0.00	$0.00	$0.00	$246.98	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$700.93	$700.93	$0.00	$575.24	$911.18	$920.38	$0.00		$0.00	$174.81	$0.00	$0.00	$183.16	$0.00	$0.00	$0.00	$0.00	$0.00
245.906	SUP	HCPCS C1713		245.906  -  PLATE BONE 88MM RAD 78MM 6 HOLE LP CVD RECONSTRUCTION	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
245.908	SUP	HCPCS C1713		245.908  -  PLATE BN 88MM RDS CRV 104MMX10.2MMX2.7M NS 8 HL LOPRFL RECON	BOTH IP/OP	$884.18 	$654.29	$0.00	$686.74	$386.29	$386.29	$0.00	$0.00	$0.00	$184.28	$656.23	$656.23	$0.00	$0.00	$184.26	$0.00	$522.99	$522.99	$0.00	$429.21	$679.88	$686.74	$0.00		$0.00	$130.43	$0.00	$0.00	$136.66	$0.00	$0.00	$0.00	$0.00	$0.00
245.91	SUP	HCPCS C1713		245.910  -  PLATE BONE 88MM RAD LP CURVE 130MM 10 HOLE RECONSTRUCTION	BOTH IP/OP	$926.68 	$685.74	$0.00	$741.34	$417.00	$417.00	$0.00	$0.00	$0.00	$193.14	$687.78	$687.78	$0.00	$0.00	$193.12	$0.00	$548.13	$548.13	$0.00	$463.34	$733.93	$741.34	$0.00		$0.00	$140.80	$0.00	$0.00	$147.53	$0.00	$0.00	$0.00	$0.00	$0.00
245.912	SUP	HCPCS C1713		245.912  -  PLATE BN 88MM RDS CRV 156MMX10.2MMX2.7M NS 12 HL LOPRFL	BOTH IP/OP	"$1,030.38 "	$762.48	$0.00	$800.28	$450.16	$450.16	$0.00	$0.00	$0.00	$214.76	$764.74	$764.74	$0.00	$0.00	$214.73	$0.00	$609.47	$609.47	$0.00	$500.18	$792.28	$800.28	$0.00		$0.00	$152.00	$0.00	$0.00	$159.26	$0.00	$0.00	$0.00	$0.00	$0.00
245.914	SUP	HCPCS C1713		245.914  -  PLATE BONE 88MM RAD 182MM 14 HOLE LP CVD RECONSTRUCTION	BOTH IP/OP	"$1,107.68 "	$819.68	$0.00	$860.34	$483.94	$483.94	$0.00	$0.00	$0.00	$230.87	$822.12	$822.12	$0.00	$0.00	$230.84	$0.00	$655.19	$655.19	$0.00	$537.71	$851.74	$860.34	$0.00		$0.00	$163.40	$0.00	$0.00	$171.21	$0.00	$0.00	$0.00	$0.00	$0.00
245.916	SUP	HCPCS C1713		245.916  -  PLATE BONE 88MM RAD 208MM 16 HOLE LP CVD RECONSTRUCTION	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$920.38	$517.71	$517.71	$0.00	$0.00	$0.00	$246.98	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$700.93	$700.93	$0.00	$575.24	$911.18	$920.38	$0.00		$0.00	$174.81	$0.00	$0.00	$183.16	$0.00	$0.00	$0.00	$0.00	$0.00
245.92	SUP	HCPCS C1713		245.920  -  PLATE BONE J RIGHT 130X10X3.4MM 3.5MM 10 HOLE RECONSTRUCTION	BOTH IP/OP	$926.68 	$685.74	$0.00	$741.34	$417.00	$417.00	$0.00	$0.00	$0.00	$193.14	$687.78	$687.78	$0.00	$0.00	$193.12	$0.00	$548.13	$548.13	$0.00	$463.34	$733.93	$741.34	$0.00		$0.00	$140.80	$0.00	$0.00	$147.53	$0.00	$0.00	$0.00	$0.00	$0.00
245.922	SUP	HCPCS C1713		245.922  -  PLATE BONE 88MM RAD 156MM 12 HOLE J LP RECONSTRUCTION	BOTH IP/OP	"$1,030.38 "	$762.48	$0.00	$800.28	$450.16	$450.16	$0.00	$0.00	$0.00	$214.76	$764.74	$764.74	$0.00	$0.00	$214.73	$0.00	$609.47	$609.47	$0.00	$500.18	$792.28	$800.28	$0.00		$0.00	$152.00	$0.00	$0.00	$159.26	$0.00	$0.00	$0.00	$0.00	$0.00
245.924	SUP	HCPCS C1713		245.924  -  PLATE BONE 88MM RAD 182MM 14 HOLE J LP RECONSTRUCTION	BOTH IP/OP	"$1,107.68 "	$819.68	$0.00	$860.34	$483.94	$483.94	$0.00	$0.00	$0.00	$230.87	$822.12	$822.12	$0.00	$0.00	$230.84	$0.00	$655.19	$655.19	$0.00	$537.71	$851.74	$860.34	$0.00		$0.00	$163.40	$0.00	$0.00	$171.21	$0.00	$0.00	$0.00	$0.00	$0.00
245.926	SUP	HCPCS C1713		245.926  -  PLATE BN 88MM RDS J 208X10.2X2.7MM NS 16 HL LOPRFL RECON SS	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$920.38	$517.71	$517.71	$0.00	$0.00	$0.00	$246.98	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$700.93	$700.93	$0.00	$575.24	$911.18	$920.38	$0.00		$0.00	$174.81	$0.00	$0.00	$183.16	$0.00	$0.00	$0.00	$0.00	$0.00
245.93	SUP	HCPCS C1713		245.930  -  PLATE BONE 88MM RAD J 130X10.2X2.7MM 10 HOLE LP	BOTH IP/OP	$926.68 	$685.74	$0.00	$741.34	$417.00	$417.00	$0.00	$0.00	$0.00	$193.14	$687.78	$687.78	$0.00	$0.00	$193.12	$0.00	$548.13	$548.13	$0.00	$463.34	$733.93	$741.34	$0.00		$0.00	$140.80	$0.00	$0.00	$147.53	$0.00	$0.00	$0.00	$0.00	$0.00
245.932	SUP	HCPCS C1713		245.932  -  PLATE BONE 88MM RAD 156MM 12 HOLE J LP RECONSTRUCTION	BOTH IP/OP	"$1,030.38 "	$762.48	$0.00	$800.28	$450.16	$450.16	$0.00	$0.00	$0.00	$214.76	$764.74	$764.74	$0.00	$0.00	$214.73	$0.00	$609.47	$609.47	$0.00	$500.18	$792.28	$800.28	$0.00		$0.00	$152.00	$0.00	$0.00	$159.26	$0.00	$0.00	$0.00	$0.00	$0.00
245.934	SUP	HCPCS C1713		245.934  -  PLATE BONE 88MM RAD 182MM 14 HOLE J LP RECONSTRUCTION	BOTH IP/OP	"$1,107.68 "	$819.68	$0.00	$860.34	$483.94	$483.94	$0.00	$0.00	$0.00	$230.87	$822.12	$822.12	$0.00	$0.00	$230.84	$0.00	$655.19	$655.19	$0.00	$537.71	$851.74	$860.34	$0.00		$0.00	$163.40	$0.00	$0.00	$171.21	$0.00	$0.00	$0.00	$0.00	$0.00
245.936	SUP	HCPCS C1713		245.936  -  PLATE BN 88MM RDS J 208X10.2X2.7MM NS 16 HL LOPRFL RECON SS	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$920.38	$517.71	$517.71	$0.00	$0.00	$0.00	$246.98	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$700.93	$700.93	$0.00	$575.24	$911.18	$920.38	$0.00		$0.00	$174.81	$0.00	$0.00	$183.16	$0.00	$0.00	$0.00	$0.00	$0.00
245.98	SUP	HCPCS C1713		245.98  -  PLATE BN 64X8X2.5MM NS 8 HL RECON SS CALC 2.7MM SCR	BOTH IP/OP	$664.90 	$492.03	$0.00	$516.42	$290.49	$290.49	$0.00	$0.00	$0.00	$138.58	$493.49	$493.49	$0.00	$0.00	$138.57	$0.00	$393.29	$393.29	$0.00	$322.76	$511.26	$516.42	$0.00		$0.00	$98.08	$0.00	$0.00	$102.77	$0.00	$0.00	$0.00	$0.00	$0.00
245.99	SUP	HCPCS C1713		245.99  -  PLATE BN 72X8X2.5MM NS 9 HL RECON SS CALC 2.7MM SCR	BOTH IP/OP	$688.80 	$509.71	$0.00	$534.98	$300.93	$300.93	$0.00	$0.00	$0.00	$143.56	$511.23	$511.23	$0.00	$0.00	$143.55	$0.00	$407.43	$407.43	$0.00	$334.36	$529.63	$534.98	$0.00		$0.00	$101.61	$0.00	$0.00	$106.46	$0.00	$0.00	$0.00	$0.00	$0.00
246.031	SUP	HCPCS C1713		246.031  -  PLATE BN STRG 29X3.8X.8MM NS PRO-PK 6 HL LOPRFL PRECONTOUR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
246.19	SUP	HCPCS C1713		246.19  -  PLATE BONE 100MM 20 HOLE STR DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$477.93 	$353.67	$0.00	$371.22	$208.81	$208.81	$0.00	$0.00	$0.00	$99.61	$354.72	$354.72	$0.00	$0.00	$99.60	$0.00	$282.69	$282.69	$0.00	$232.01	$367.51	$371.22	$0.00		$0.00	$70.50	$0.00	$0.00	$73.87	$0.00	$0.00	$0.00	$0.00	$0.00
246.191	SUP	HCPCS C1713		246.191  -  PLATE BN STRG 59X3.8X.8MM NS PRO-PK 12 HL LOPRFL PRECONTOUR	BOTH IP/OP	$465.28 	$344.31	$0.00	$361.38	$203.28	$203.28	$0.00	$0.00	$0.00	$96.97	$345.33	$345.33	$0.00	$0.00	$96.96	$0.00	$275.21	$275.21	$0.00	$225.86	$357.77	$361.38	$0.00		$0.00	$68.64	$0.00	$0.00	$71.91	$0.00	$0.00	$0.00	$0.00	$0.00
246.23	SUP	HCPCS C1713		246.23  -  PLATE BN T 50MM NS DCP 3 HLE/HD 9 HL SHFT SS 1.5MM SCR	BOTH IP/OP	$417.50 	$308.95	$0.00	$324.26	$182.40	$182.40	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$202.66	$321.02	$324.26	$0.00		$0.00	$61.59	$0.00	$0.00	$64.53	$0.00	$0.00	$0.00	$0.00	$0.00
246.233	SUP	HCPCS C1713		246.233  -  PLATE BN T 44X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$425.93 	$315.19	$0.00	$330.82	$186.09	$186.09	$0.00	$0.00	$0.00	$88.77	$316.12	$316.12	$0.00	$0.00	$88.76	$0.00	$251.93	$251.93	$0.00	$206.76	$327.52	$330.82	$0.00		$0.00	$62.83	$0.00	$0.00	$65.83	$0.00	$0.00	$0.00	$0.00	$0.00
246.234	SUP	HCPCS C1713		246.234  -  PLATE BN T 44X4X1MM NS PRO-PK 4 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
246.24	SUP	HCPCS C1713		246.24  -  PLATE BONE 50MM 4 HOLE HEAD 9 HOLE SHAFT T DCP STAINLESS	BOTH IP/OP	$449.83 	$332.87	$0.00	$349.38	$196.53	$196.53	$0.00	$0.00	$0.00	$93.75	$333.86	$333.86	$0.00	$0.00	$93.74	$0.00	$266.07	$266.07	$0.00	$218.36	$345.89	$349.38	$0.00		$0.00	$66.36	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$0.00
246.48	SUP	HCPCS C1713		246.48  -  PLATE BONE 4 HOLE H LCP STAINLESS STEEL ORTHOPEDIC NONSTRL	BOTH IP/OP	$411.88 	$304.79	$0.00	$319.90	$179.94	$179.94	$0.00	$0.00	$0.00	$85.85	$305.69	$305.69	$0.00	$0.00	$85.83	$0.00	$243.62	$243.62	$0.00	$199.94	$316.70	$319.90	$0.00		$0.00	$60.76	$0.00	$0.00	$63.66	$0.00	$0.00	$0.00	$0.00	$0.00
246.482	SUP	HCPCS C1713		246.482  -  PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR SS RT	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
246.483	SUP	HCPCS C1713		246.483  -  PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR SS LT	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
246.61	SUP	HCPCS C1713		246.61  -  PLATE BN 36X3.5X.9MM NS 7 HL SS CNDYL LT 1.5MM SCR MDLR HND	BOTH IP/OP	$529.95 	$392.16	$0.00	$411.60	$231.53	$231.53	$0.00	$0.00	$0.00	$110.45	$393.33	$393.33	$0.00	$0.00	$110.44	$0.00	$313.47	$313.47	$0.00	$257.25	$407.48	$411.60	$0.00		$0.00	$78.18	$0.00	$0.00	$81.91	$0.00	$0.00	$0.00	$0.00	$0.00
246.612	SUP	HCPCS C1713		246.612  -  PLATE BN Y 46X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$425.93 	$315.19	$0.00	$330.82	$186.09	$186.09	$0.00	$0.00	$0.00	$88.77	$316.12	$316.12	$0.00	$0.00	$88.76	$0.00	$251.93	$251.93	$0.00	$206.76	$327.52	$330.82	$0.00		$0.00	$62.83	$0.00	$0.00	$65.83	$0.00	$0.00	$0.00	$0.00	$0.00
246.62	SUP	HCPCS C1713		246.62  -  PLATE BN 36X3.5X.9MM NS 7 HL SS CNDYL RT 1.5MM SCR MDLR HND	BOTH IP/OP	$529.95 	$392.16	$0.00	$411.60	$231.53	$231.53	$0.00	$0.00	$0.00	$110.45	$393.33	$393.33	$0.00	$0.00	$110.44	$0.00	$313.47	$313.47	$0.00	$257.25	$407.48	$411.60	$0.00		$0.00	$78.18	$0.00	$0.00	$81.91	$0.00	$0.00	$0.00	$0.00	$0.00
247.031	SUP	HCPCS C1713		247.031  -  PLATE BN STRG 35X5X1.2MM NS PRO-PK 6 HL LOPRFL PRECONTOUR	BOTH IP/OP	$404.85 	$299.59	$0.00	$314.44	$176.87	$176.87	$0.00	$0.00	$0.00	$84.38	$300.48	$300.48	$0.00	$0.00	$84.37	$0.00	$239.47	$239.47	$0.00	$196.53	$311.30	$314.44	$0.00		$0.00	$59.72	$0.00	$0.00	$62.57	$0.00	$0.00	$0.00	$0.00	$0.00
247.232	SUP	HCPCS C1713		247.232  -  PLATE BN T 53X5X1.2MM NS PRO-PK 2 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
247.233	SUP	HCPCS C1713		247.233  -  PLATE BN T 53X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
247.344	SUP	HCPCS C1713		247.344  -  PLATE BN 31MM NS LCP PRO-PK 4 HL LOPRFL CUT TO LGTH SS 2MM	BOTH IP/OP	$459.65 	$340.14	$0.00	$357.02	$200.82	$200.82	$0.00	$0.00	$0.00	$95.80	$341.15	$341.15	$0.00	$0.00	$95.79	$0.00	$271.88	$271.88	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$67.81	$0.00	$0.00	$71.05	$0.00	$0.00	$0.00	$0.00	$0.00
247.345	SUP	HCPCS C1713		247.345  -  PLATE BN 38MM NS LCP PRO-PK 5 HL LOPRFL CUT TO LGTH SS 2MM	BOTH IP/OP	$459.65 	$340.14	$0.00	$357.02	$200.82	$200.82	$0.00	$0.00	$0.00	$95.80	$341.15	$341.15	$0.00	$0.00	$95.79	$0.00	$271.88	$271.88	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$67.81	$0.00	$0.00	$71.05	$0.00	$0.00	$0.00	$0.00	$0.00
247.346	SUP	HCPCS C1713		247.346  -  PLATE BN 45MM NS LCP PRO-PK 6 HL LOPRFL CUT TO LGTH SS 2MM	BOTH IP/OP	$459.65 	$340.14	$0.00	$357.02	$200.82	$200.82	$0.00	$0.00	$0.00	$95.80	$341.15	$341.15	$0.00	$0.00	$95.79	$0.00	$271.88	$271.88	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$67.81	$0.00	$0.00	$71.05	$0.00	$0.00	$0.00	$0.00	$0.00
247.347	SUP	HCPCS C1713		247.347  -  PLATE BN 52MM NS LCP PRO-PK 7 HL LOPRFL CUT TO LGTH SS 2MM	BOTH IP/OP	$459.65 	$340.14	$0.00	$357.02	$200.82	$200.82	$0.00	$0.00	$0.00	$95.80	$341.15	$341.15	$0.00	$0.00	$95.79	$0.00	$271.88	$271.88	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$67.81	$0.00	$0.00	$71.05	$0.00	$0.00	$0.00	$0.00	$0.00
247.348	SUP	HCPCS C1713		247.348  -  PLATE BN 59MM NS LCP PRO-PK 8 HL LOPRFL CUT TO LGTH SS 2MM	BOTH IP/OP	$459.65 	$340.14	$0.00	$357.02	$200.82	$200.82	$0.00	$0.00	$0.00	$95.80	$341.15	$341.15	$0.00	$0.00	$95.79	$0.00	$271.88	$271.88	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$67.81	$0.00	$0.00	$71.05	$0.00	$0.00	$0.00	$0.00	$0.00
247.349	SUP	HCPCS C1713		247.349  -  PLATE BN 54MM NS LCP PRO-PK 7 HL SHFT LOPRFL CUT TO LGTH SS	BOTH IP/OP	"$1,446.45 "	"$1,070.37"	$0.00	"$1,123.46"	$631.95	$631.95	$0.00	$0.00	$0.00	$301.48	"$1,073.56"	"$1,073.56"	$0.00	$0.00	$301.44	$0.00	$855.58	$855.58	$0.00	$702.16	"$1,112.23"	"$1,123.46"	$0.00		$0.00	$213.38	$0.00	$0.00	$223.57	$0.00	$0.00	$0.00	$0.00	$0.00
247.35	SUP	HCPCS C1713		247.350  -  PLATE BN Y 55MM NS LCP PRO-PK 3 HLE/HD 7 HL SHFT LOPRFL CUT	BOTH IP/OP	$788.83 	$583.73	$0.00	$631.06	$354.97	$354.97	$0.00	$0.00	$0.00	$164.41	$585.47	$585.47	$0.00	$0.00	$164.39	$0.00	$466.59	$466.59	$0.00	$394.41	$624.75	$631.06	$0.00		$0.00	$119.86	$0.00	$0.00	$125.58	$0.00	$0.00	$0.00	$0.00	$0.00
247.351	SUP	HCPCS C1713		247.351  -  PLATE BN T 53MM NS LCP PRO-PK 2 HLE/HD 7 HL SHFT LOPRFL CUT	BOTH IP/OP	$812.50 	$601.25	$0.00	$631.06	$354.97	$354.97	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$394.41	$624.75	$631.06	$0.00		$0.00	$119.86	$0.00	$0.00	$125.58	$0.00	$0.00	$0.00	$0.00	$0.00
247.36	SUP	HCPCS C1713		247.360  -  PLATE BN 73MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH SS 2MM	BOTH IP/OP	$446.28 	$330.25	$0.00	$357.02	$200.82	$200.82	$0.00	$0.00	$0.00	$93.01	$331.23	$331.23	$0.00	$0.00	$93.00	$0.00	$263.97	$263.97	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$67.81	$0.00	$0.00	$71.05	$0.00	$0.00	$0.00	$0.00	$0.00
247.362	SUP	HCPCS C1713		247.362  -  PLATE BN 81MM NS LCP PRO-PK 12 HL ADP LOPRFL CUT TO LGTH SS	BOTH IP/OP	$777.35 	$575.24	$0.00	$603.76	$339.62	$339.62	$0.00	$0.00	$0.00	$162.02	$576.95	$576.95	$0.00	$0.00	$162.00	$0.00	$459.80	$459.80	$0.00	$377.35	$597.72	$603.76	$0.00		$0.00	$114.67	$0.00	$0.00	$120.15	$0.00	$0.00	$0.00	$0.00	$0.00
247.364	SUP	HCPCS C1713		247.364  -  PLATE BN 84MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH SS 2.4	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
247.366	SUP	HCPCS C1713		247.366  -  PLATE BN 88MM NS LCP PRO-PK 12 HL ADP LOPRFL CUT TO LGTH SS	BOTH IP/OP	$856.08 	$633.50	$0.00	$664.90	$374.01	$374.01	$0.00	$0.00	$0.00	$178.43	$635.38	$635.38	$0.00	$0.00	$178.41	$0.00	$506.37	$506.37	$0.00	$415.56	$658.25	$664.90	$0.00		$0.00	$126.28	$0.00	$0.00	$132.32	$0.00	$0.00	$0.00	$0.00	$0.00
247.37	SUP	HCPCS C1713		247.370  -  PLATE BN 97MM NS LCP PRO-PK 12 HL ADP LOPRFL CUT TO LGTH SS	BOTH IP/OP	$831.13 	$615.04	$0.00	$664.90	$374.01	$374.01	$0.00	$0.00	$0.00	$173.23	$616.86	$616.86	$0.00	$0.00	$173.21	$0.00	$491.61	$491.61	$0.00	$415.56	$658.25	$664.90	$0.00		$0.00	$166.74	$0.00	$0.00	$132.32	$0.00	$0.00	$0.00	$0.00	$0.00
247.372	SUP	HCPCS C1713		247.372  -  PLATE BN 76MM NS LCP PRO-PK 8 HL LOPRFL CUT TO LGTH SS 2.7MM	BOTH IP/OP	$775.95 	$574.20	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$161.73	$575.91	$575.91	$0.00	$0.00	$161.71	$0.00	$458.97	$458.97	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$150.97	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
247.374	SUP	HCPCS C1713		247.374  -  PLATE BN 94MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH SS 2.7	BOTH IP/OP	$775.95 	$574.20	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$161.73	$575.91	$575.91	$0.00	$0.00	$161.71	$0.00	$458.97	$458.97	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
247.375	SUP	HCPCS C1713		247.375  -  PLATE BN 44MM NS LCP PRO-PK 5 HL LOPRFL CUT TO LGTH SS 2.4MM	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
247.377	SUP	HCPCS C1713		247.377  -  PLATE BN 60MM NS LCP PRO-PK 7 HL LOPRFL CUT TO LGTH SS 2.4MM	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
247.612	SUP	HCPCS C1713		247.612  -  PLATE BN Y 48X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
247.615	SUP	HCPCS C1713		247.615  -  PLATE BN T 53MM NS LCP PRO-PK 3 HLE/HD 7 HL SHFT LOPRFL CUT	BOTH IP/OP	$812.50 	$601.25	$0.00	$631.06	$354.97	$354.97	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$394.41	$624.75	$631.06	$0.00		$0.00	$119.86	$0.00	$0.00	$125.58	$0.00	$0.00	$0.00	$0.00	$0.00
247.702	SUP	HCPCS C1713		247.702  -  PLATE BONE X SMALL 24X18MM LOCK STAINLESS STEEL ANKLE FT	BOTH IP/OP	"$1,439.43 "	"$1,065.18"	$0.00	"$1,118.00"	$628.88	$628.88	$0.00	$0.00	$0.00	$300.01	"$1,068.34"	"$1,068.34"	$0.00	$0.00	$299.98	$0.00	$851.42	$851.42	$0.00	$698.75	"$1,106.82"	"$1,118.00"	$0.00		$0.00	$212.34	$0.00	$0.00	$222.48	$0.00	$0.00	$0.00	$0.00	$0.00
247.704	SUP	HCPCS C1713		247.704  -  PLATE BN MED X 30X20MM NS LCK RND THRD HL SS FT/ANKL 2.4/2.7	BOTH IP/OP	"$1,457.70 "	"$1,078.70"	$0.00	"$1,132.20"	$636.86	$636.86	$0.00	$0.00	$0.00	$303.82	"$1,081.90"	"$1,081.90"	$0.00	$0.00	$303.78	$0.00	$862.23	$862.23	$0.00	$707.63	"$1,120.88"	"$1,132.20"	$0.00		$0.00	$215.03	$0.00	$0.00	$225.31	$0.00	$0.00	$0.00	$0.00	$0.00
247.706	SUP	HCPCS C1713		247.706  -  PLATE BONE LARGE 36MM LOCK STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	"$1,477.38 "	"$1,093.26"	$0.00	"$1,147.48"	$645.46	$645.46	$0.00	$0.00	$0.00	$307.92	"$1,096.51"	"$1,096.51"	$0.00	$0.00	$307.88	$0.00	$873.87	$873.87	$0.00	$717.18	"$1,136.01"	"$1,147.48"	$0.00		$0.00	$217.94	$0.00	$0.00	$228.35	$0.00	$0.00	$0.00	$0.00	$0.00
247.71	SUP	HCPCS C1713		247.710  -  PLATE BONE 18MM 2 HOLE LOCKING STAINLESS STEEL ANKLE FT	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$306.45	$306.45	$0.00	$0.00	$0.00	$141.94	$505.44	$505.44	$0.00	$0.00	$141.92	$0.00	$402.81	$402.81	$0.00	$340.50	$539.35	$544.80	$0.00		$0.00	$103.47	$0.00	$0.00	$108.42	$0.00	$0.00	$0.00	$0.00	$0.00
247.711	SUP	HCPCS C1713		247.711  -  PLATE BONE XS 2.4MM 4MM	BOTH IP/OP	"$1,460.53 "	"$1,080.79"	$0.00	"$1,134.38"	$638.09	$638.09	$0.00	$0.00	$0.00	$304.41	"$1,084.00"	"$1,084.00"	$0.00	$0.00	$304.37	$0.00	$863.90	$863.90	$0.00	$708.99	"$1,123.04"	"$1,134.38"	$0.00		$0.00	$215.45	$0.00	$0.00	$225.74	$0.00	$0.00	$0.00	$0.00	$0.00
248.02	SUP	HCPCS C1713		248.02  -  PLATE BONE 25MM 2 HOLE DCP STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$238.83 	$176.73	$0.00	$191.06	$107.47	$107.47	$0.00	$0.00	$0.00	$49.78	$177.26	$177.26	$0.00	$0.00	$49.77	$0.00	$141.26	$141.26	$0.00	$119.41	$189.15	$191.06	$0.00		$0.00	$36.29	$0.00	$0.00	$38.02	$0.00	$0.00	$0.00	$0.00	$0.00
248.03	SUP	HCPCS C1713		248.03  -  PLATE BONE 3.5MM 37X10X3.3MM 3 HOLE DCP STAINLESS STEEL	BOTH IP/OP	$245.65 	$181.78	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$51.20	$182.32	$182.32	$0.00	$0.00	$51.19	$0.00	$145.30	$145.30	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
248.04	SUP	HCPCS C1713		248.04  -  PLATE BN 49X10X3.3MM NS DCP 4 HL SS PLV 3.5MM CORT SCR SM	BOTH IP/OP	$261.45 	$193.47	$0.00	$203.08	$114.23	$114.23	$0.00	$0.00	$0.00	$54.49	$194.05	$194.05	$0.00	$0.00	$54.49	$0.00	$154.65	$154.65	$0.00	$126.93	$201.05	$203.08	$0.00		$0.00	$38.57	$0.00	$0.00	$40.41	$0.00	$0.00	$0.00	$0.00	$0.00
248.05	SUP	HCPCS C1713		248.05  -  PLATE BONE 61X10X3.3MM 5 HOLE DCP STAINLESS STEEL PELVIS	BOTH IP/OP	$272.95 	$201.98	$0.00	$218.36	$122.83	$122.83	$0.00	$0.00	$0.00	$56.89	$202.58	$202.58	$0.00	$0.00	$56.88	$0.00	$161.45	$161.45	$0.00	$136.48	$216.18	$218.36	$0.00		$0.00	$41.47	$0.00	$0.00	$43.45	$0.00	$0.00	$0.00	$0.00	$0.00
248.06	SUP	HCPCS C1713		248.06  -  PLATE BN 73X10X3.3MM NS DCP 6 HL SS PLV 3.5MM CORT SCR SM	BOTH IP/OP	$292.38 	$216.36	$0.00	$227.10	$127.74	$127.74	$0.00	$0.00	$0.00	$60.94	$217.00	$217.00	$0.00	$0.00	$60.93	$0.00	$172.94	$172.94	$0.00	$141.94	$224.83	$227.10	$0.00		$0.00	$43.13	$0.00	$0.00	$45.19	$0.00	$0.00	$0.00	$0.00	$0.00
248.07	SUP	HCPCS C1713		248.07  -  PLATE BONE 85X10X3.3MM 7 HOLE DCP STAINLESS STEEL PELVIS	BOTH IP/OP	$303.63 	$224.69	$0.00	$235.82	$132.65	$132.65	$0.00	$0.00	$0.00	$63.28	$225.35	$225.35	$0.00	$0.00	$63.28	$0.00	$179.59	$179.59	$0.00	$147.39	$233.47	$235.82	$0.00		$0.00	$44.79	$0.00	$0.00	$46.93	$0.00	$0.00	$0.00	$0.00	$0.00
248.08	SUP	HCPCS C1713		248.08  -  PLATE BN 97X10X3.3MM NS DCP 8 HL SS PLV 3.5MM CORT SCR SM	BOTH IP/OP	$316.28 	$234.05	$0.00	$245.66	$138.18	$138.18	$0.00	$0.00	$0.00	$65.92	$234.74	$234.74	$0.00	$0.00	$65.91	$0.00	$187.08	$187.08	$0.00	$153.54	$243.21	$245.66	$0.00		$0.00	$46.66	$0.00	$0.00	$48.89	$0.00	$0.00	$0.00	$0.00	$0.00
248.09	SUP	HCPCS C1713		248.09  -  PLATE BN 109X10X3.3MM NS DCP 9 HL SS PLV 3.5MM CORT SCR SM	BOTH IP/OP	$335.95 	$248.60	$0.00	$260.94	$146.78	$146.78	$0.00	$0.00	$0.00	$70.02	$249.34	$249.34	$0.00	$0.00	$70.01	$0.00	$198.71	$198.71	$0.00	$163.09	$258.33	$260.94	$0.00		$0.00	$49.56	$0.00	$0.00	$51.93	$0.00	$0.00	$0.00	$0.00	$0.00
248.1	SUP	HCPCS C1713		248.10  -  PLATE BONE 121X10X3.3MM 10 HOLE DCP STAINLESS STEEL PELVIS	BOTH IP/OP	$328.90 	$243.39	$0.00	$263.12	$148.01	$148.01	$0.00	$0.00	$0.00	$68.55	$244.11	$244.11	$0.00	$0.00	$68.54	$0.00	$194.54	$194.54	$0.00	$164.45	$260.49	$263.12	$0.00		$0.00	$49.97	$0.00	$0.00	$52.36	$0.00	$0.00	$0.00	$0.00	$0.00
248.12	SUP	HCPCS C1713		248.12  -  PLATE BONE 145X10X3.3MM 12 HOLE DCP STAINLESS STEEL PELVIS	BOTH IP/OP	$393.60 	$291.26	$0.00	$305.70	$171.96	$171.96	$0.00	$0.00	$0.00	$82.04	$292.13	$292.13	$0.00	$0.00	$82.03	$0.00	$232.81	$232.81	$0.00	$191.06	$302.65	$305.70	$0.00		$0.00	$58.06	$0.00	$0.00	$60.83	$0.00	$0.00	$0.00	$0.00	$0.00
248.14	SUP	HCPCS C1713		248.14  -  PLATE BONE 169X10X3.3MM 14 HOLE DCP STAINLESS STEEL PELVIS	BOTH IP/OP	$723.93 	$535.71	$0.00	$562.28	$316.28	$316.28	$0.00	$0.00	$0.00	$150.88	$537.30	$537.30	$0.00	$0.00	$150.87	$0.00	$428.20	$428.20	$0.00	$351.43	$556.66	$562.28	$0.00		$0.00	$106.79	$0.00	$0.00	$111.89	$0.00	$0.00	$0.00	$0.00	$0.00
248.16	SUP	HCPCS C1713		248.16  -  PLATE BONE 194X10X3.3MM 16 HOLE DCP STAINLESS STEEL PELVIS	BOTH IP/OP	$833.58 	$616.85	$0.00	$647.44	$364.19	$364.19	$0.00	$0.00	$0.00	$173.74	$618.68	$618.68	$0.00	$0.00	$173.72	$0.00	$493.06	$493.06	$0.00	$404.65	$640.97	$647.44	$0.00		$0.00	$122.97	$0.00	$0.00	$128.84	$0.00	$0.00	$0.00	$0.00	$0.00
248.18	SUP	HCPCS C1713		248.18  -  PLATE BONE 217X10X3.3MM 18 HOLE DCP STAINLESS STEEL PELVIS	BOTH IP/OP	$933.38 	$690.70	$0.00	$724.96	$407.79	$407.79	$0.00	$0.00	$0.00	$194.54	$692.75	$692.75	$0.00	$0.00	$194.52	$0.00	$552.09	$552.09	$0.00	$453.10	$717.71	$724.96	$0.00		$0.00	$137.69	$0.00	$0.00	$144.27	$0.00	$0.00	$0.00	$0.00	$0.00
248.2	SUP	HCPCS C1713		248.20  -  PLATE BONE 3.5MM 242X10X3.3MM 20 HOLE DCP STAINLESS STEEL	BOTH IP/OP	$999.00 	$739.26	$0.00	$799.20	$449.55	$449.55	$0.00	$0.00	$0.00	$208.22	$741.46	$741.46	$0.00	$0.00	$208.19	$0.00	$590.91	$590.91	$0.00	$499.50	$791.21	$799.20	$0.00		$0.00	$151.79	$0.00	$0.00	$159.04	$0.00	$0.00	$0.00	$0.00	$0.00
248.22	SUP	HCPCS C1713		248.22  -  PLATE BONE 3.5MM 265X10X3.3MM 22 HOLE DCP STAINLESS STEEL	BOTH IP/OP	"$1,090.43 "	$806.92	$0.00	$872.34	$490.69	$490.69	$0.00	$0.00	$0.00	$227.27	$809.31	$809.31	$0.00	$0.00	$227.24	$0.00	$644.99	$644.99	$0.00	$545.21	$863.62	$872.34	$0.00		$0.00	$165.68	$0.00	$0.00	$173.60	$0.00	$0.00	$0.00	$0.00	$0.00
249.615	SUP	HCPCS C1713		249.615  -  PLATE BONE T 58MM 7X3 HOLE LCP STAINLESS STEEL SMALL BONE	BOTH IP/OP	"$1,350.88 "	$999.65	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$281.56	"$1,002.62"	"$1,002.62"	$0.00	$0.00	$281.52	$0.00	$799.04	$799.04	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
249.669	SUP	HCPCS C1713		249.669  -  PLATE BONE Y 60MM 3X7 HOLE LCP STAINLESS STEEL ANKLE FT	BOTH IP/OP	"$1,350.88 "	$999.65	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$281.56	"$1,002.62"	"$1,002.62"	$0.00	$0.00	$281.52	$0.00	$799.04	$799.04	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
249.67	SUP	HCPCS C1713		249.670  -  PLATE BONE T 58MM 2X7 HOLE LCP STAINLESS STEEL ANKLE FT	BOTH IP/OP	"$1,311.53 "	$970.53	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$273.35	$973.41	$973.41	$0.00	$0.00	$273.32	$0.00	$775.77	$775.77	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
249.674	SUP	HCPCS C1713		249.674  -  PLATE BONE 36MM 4 HOLE LCP STAINLESS STEEL ANKLE FT NONSTRL	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
249.676	SUP	HCPCS C1713		249.676  -  PLATE BONE 52MM 6 HOLE LP LCP STAINLESS STEEL SMALL BONE	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
249.678	SUP	HCPCS C1713		249.678  -  PLATE BONE 68MM 8 HOLE LCP STAINLESS STEEL SMALL BONE	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
249.679	SUP	HCPCS C1713		249.679  -  PLATE BONE 59MM 7 SHAFT HOLE LCP STAINLESS STEEL CONDYLE	BOTH IP/OP	"$1,103.48 "	$816.58	$0.00	$857.06	$482.10	$482.10	$0.00	$0.00	$0.00	$229.99	$819.00	$819.00	$0.00	$0.00	$229.96	$0.00	$652.71	$652.71	$0.00	$535.66	$848.49	$857.06	$0.00		$0.00	$162.78	$0.00	$0.00	$170.55	$0.00	$0.00	$0.00	$0.00	$0.00
249.68	SUP	HCPCS C1713		249.680  -  PLATE BN 40MM NS LCP 4 HL LOPRFL CUT TO LGTH SS 2.7MM SCR	BOTH IP/OP	$753.35 	$557.48	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$157.02	$559.14	$559.14	$0.00	$0.00	$157.00	$0.00	$445.61	$445.61	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
249.681	SUP	HCPCS C1713		249.681  -  PLATE BONE 49MM 5 HOLE LCP STAINLESS STEEL ANKLE FT NONSTRL	BOTH IP/OP	$775.95 	$574.20	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$161.73	$575.91	$575.91	$0.00	$0.00	$161.71	$0.00	$458.97	$458.97	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
249.682	SUP	HCPCS C1713		249.682  -  PLATE BONE LP 58MM 6 HOLE CUT TO LENGTH LCP STAINLESS STEEL	BOTH IP/OP	$775.95 	$574.20	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$161.73	$575.91	$575.91	$0.00	$0.00	$161.71	$0.00	$458.97	$458.97	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
249.683	SUP	HCPCS C1713		249.683  -  PLATE BONE 6.7CM 7 HOLE LCP STAINLESS STEEL SMALL BONE	BOTH IP/OP	$775.95 	$574.20	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$161.73	$575.91	$575.91	$0.00	$0.00	$161.71	$0.00	$458.97	$458.97	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
249.684	SUP	HCPCS C1713		249.684  -  PLATE BONE 66MM 7 HOLE LCP STAINLESS STEEL CONDYLE NONSTRL	BOTH IP/OP	"$1,203.28 "	$890.43	$0.00	$934.58	$525.70	$525.70	$0.00	$0.00	$0.00	$250.79	$893.07	$893.07	$0.00	$0.00	$250.76	$0.00	$711.74	$711.74	$0.00	$584.11	$925.24	$934.58	$0.00		$0.00	$177.50	$0.00	$0.00	$185.98	$0.00	$0.00	$0.00	$0.00	$0.00
249.685	SUP	HCPCS C1713		249.685  -  PLATE BONE T 32MM 2X3 HOLE LCP STAINLESS STEEL ANKLE FT	BOTH IP/OP	"$1,350.88 "	$999.65	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$281.56	"$1,002.62"	"$1,002.62"	$0.00	$0.00	$281.52	$0.00	$799.04	$799.04	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
249.686	SUP	HCPCS C1713		249.686  -  PLATE BN OB R L 35MM NS LCP 2 HLE/HD 3 HL SHFT LOPRFL CUT TO	BOTH IP/OP	$736.58 	$545.07	$0.00	$572.10	$321.81	$321.81	$0.00	$0.00	$0.00	$153.52	$546.69	$546.69	$0.00	$0.00	$153.50	$0.00	$435.68	$435.68	$0.00	$357.56	$566.38	$572.10	$0.00		$0.00	$108.66	$0.00	$0.00	$113.85	$0.00	$0.00	$0.00	$0.00	$0.00
249.687	SUP	HCPCS C1713		249.687  -  PLATE BN OB L L 35MM NS LCP 2 HLE/HD 3 HL SHFT LOPRFL CUT TO	BOTH IP/OP	$736.58 	$545.07	$0.00	$572.10	$321.81	$321.81	$0.00	$0.00	$0.00	$153.52	$546.69	$546.69	$0.00	$0.00	$153.50	$0.00	$435.68	$435.68	$0.00	$357.56	$566.38	$572.10	$0.00		$0.00	$143.84	$0.00	$0.00	$113.85	$0.00	$0.00	$0.00	$0.00	$0.00
249.688	SUP	HCPCS C1713		249.688  -  PLATE BONE L 32MM 2X3 HOLE RIGHT OBLIQUE LCP STAINLESS STEEL	BOTH IP/OP	$736.58 	$545.07	$0.00	$572.10	$321.81	$321.81	$0.00	$0.00	$0.00	$153.52	$546.69	$546.69	$0.00	$0.00	$153.50	$0.00	$435.68	$435.68	$0.00	$357.56	$566.38	$572.10	$0.00		$0.00	$108.66	$0.00	$0.00	$113.85	$0.00	$0.00	$0.00	$0.00	$0.00
249.689	SUP	HCPCS C1713		249.689  -  PLATE BN L 32MM NS LCP 2 HLE/HD 3 HL SHFT LOPRFL CUT TO LGTH	BOTH IP/OP	$736.58 	$545.07	$0.00	$572.10	$321.81	$321.81	$0.00	$0.00	$0.00	$153.52	$546.69	$546.69	$0.00	$0.00	$153.50	$0.00	$435.68	$435.68	$0.00	$357.56	$566.38	$572.10	$0.00		$0.00	$108.66	$0.00	$0.00	$113.85	$0.00	$0.00	$0.00	$0.00	$0.00
249.69	SUP	HCPCS C1713		249.690  -  PLATE BONE 31MM 5 HOLE LOCKING HIND MIDFT NONSTRL 2.4-2.7MM	BOTH IP/OP	"$1,454.83 "	"$1,076.57"	$0.00	"$1,163.86"	$654.67	$654.67	$0.00	$0.00	$0.00	$303.22	"$1,079.77"	"$1,079.77"	$0.00	$0.00	$303.19	$0.00	$860.53	$860.53	$0.00	$727.41	"$1,152.23"	"$1,163.86"	$0.00		$0.00	$221.05	$0.00	$0.00	$231.61	$0.00	$0.00	$0.00	$0.00	$0.00
249.691	SUP	HCPCS C1713		249.691  -  PLATE BN 45MM NS 8 HL LCK SS HND/MDFT 2.4/2.7MM SCR	BOTH IP/OP	"$1,529.40 "	"$1,131.76"	$0.00	"$1,187.88"	$668.18	$668.18	$0.00	$0.00	$0.00	$318.77	"$1,135.12"	"$1,135.12"	$0.00	$0.00	$318.73	$0.00	$904.64	$904.64	$0.00	$742.43	"$1,176.00"	"$1,187.88"	$0.00		$0.00	$225.61	$0.00	$0.00	$236.39	$0.00	$0.00	$0.00	$0.00	$0.00
249.697	SUP	HCPCS C1713		249.697  -  PLATE BONE 32MM 2X4 HOLE T LCP STAINLESS STEEL CONDYLE	BOTH IP/OP	"$1,350.88 "	$999.65	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$281.56	"$1,002.62"	"$1,002.62"	$0.00	$0.00	$281.52	$0.00	$799.04	$799.04	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
249.698	SUP	HCPCS C1713		249.698  -  PLATE BONE 42MM 2 HOLE HEAD 4 HOLE SHAFT L RIGHT OBLIQUE LCP	BOTH IP/OP	$745.03 	$551.32	$0.00	$578.66	$325.50	$325.50	$0.00	$0.00	$0.00	$155.28	$552.96	$552.96	$0.00	$0.00	$155.26	$0.00	$440.68	$440.68	$0.00	$361.66	$572.88	$578.66	$0.00		$0.00	$109.90	$0.00	$0.00	$115.15	$0.00	$0.00	$0.00	$0.00	$0.00
249.699	SUP	HCPCS C1713		249.699  -  PLATE BONE T 42MM 2 HOLE HEAD 4 HOLE SHAFT LEFT OBLIQUE LCP	BOTH IP/OP	$745.03 	$551.32	$0.00	$578.66	$325.50	$325.50	$0.00	$0.00	$0.00	$155.28	$552.96	$552.96	$0.00	$0.00	$155.26	$0.00	$440.68	$440.68	$0.00	$361.66	$572.88	$578.66	$0.00		$0.00	$109.90	$0.00	$0.00	$115.15	$0.00	$0.00	$0.00	$0.00	$0.00
249.701	SUP	HCPCS C1713		249.701  -  PLATE BONE 40MM 2 HOLE HEAD 4 HOLE SHAFT L LCP STAINLESS	BOTH IP/OP	$745.03 	$551.32	$0.00	$578.66	$325.50	$325.50	$0.00	$0.00	$0.00	$155.28	$552.96	$552.96	$0.00	$0.00	$155.26	$0.00	$440.68	$440.68	$0.00	$361.66	$572.88	$578.66	$0.00		$0.00	$109.90	$0.00	$0.00	$115.15	$0.00	$0.00	$0.00	$0.00	$0.00
249.702	SUP	HCPCS C1713		249.702  -  PLATE BONE L 40MM 2X4 HOLE LCP STAINLESS STEEL LEFT SMALL	BOTH IP/OP	$745.03 	$551.32	$0.00	$578.66	$325.50	$325.50	$0.00	$0.00	$0.00	$155.28	$552.96	$552.96	$0.00	$0.00	$155.26	$0.00	$440.68	$440.68	$0.00	$361.66	$572.88	$578.66	$0.00		$0.00	$109.90	$0.00	$0.00	$115.15	$0.00	$0.00	$0.00	$0.00	$0.00
249.906	SUP	HCPCS C1713		249.906  -  PLATE BN STRG 36X6.3X1.25MM NS 6 HL LOPRFL PRECONTOUR CUT TO	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
249.912	SUP	HCPCS C1713		249.912  -  PLATE BN STRG 72X6.3X1.25MM NS 12 HL LOPRFL PRECONTOUR CUT	BOTH IP/OP	$522.93 	$386.97	$0.00	$406.14	$228.45	$228.45	$0.00	$0.00	$0.00	$108.99	$388.11	$388.11	$0.00	$0.00	$108.98	$0.00	$309.31	$309.31	$0.00	$253.84	$402.08	$406.14	$0.00		$0.00	$77.14	$0.00	$0.00	$80.82	$0.00	$0.00	$0.00	$0.00	$0.00
249.913	SUP	HCPCS C1713		249.913  -  PLATE BN T 54X6.3X1.25MM NS 2 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
249.914	SUP	HCPCS C1713		249.914  -  PLATE BN T 54X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$517.30 	$382.80	$0.00	$401.78	$226.00	$226.00	$0.00	$0.00	$0.00	$107.82	$383.94	$383.94	$0.00	$0.00	$107.81	$0.00	$305.98	$305.98	$0.00	$251.11	$397.77	$401.78	$0.00		$0.00	$76.31	$0.00	$0.00	$79.95	$0.00	$0.00	$0.00	$0.00	$0.00
249.915	SUP	HCPCS C1713		249.915  -  PLATE BN Y 56X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$514.48 	$380.72	$0.00	$399.60	$224.78	$224.78	$0.00	$0.00	$0.00	$107.23	$381.84	$381.84	$0.00	$0.00	$107.22	$0.00	$304.31	$304.31	$0.00	$249.75	$395.60	$399.60	$0.00		$0.00	$75.89	$0.00	$0.00	$79.52	$0.00	$0.00	$0.00	$0.00	$0.00
249.916	SUP	HCPCS C1713		249.916  -  PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH	BOTH IP/OP	$515.90 	$381.77	$0.00	$400.70	$225.39	$225.39	$0.00	$0.00	$0.00	$107.53	$382.90	$382.90	$0.00	$0.00	$107.51	$0.00	$305.15	$305.15	$0.00	$250.44	$396.70	$400.70	$0.00		$0.00	$76.10	$0.00	$0.00	$79.74	$0.00	$0.00	$0.00	$0.00	$0.00
249.917	SUP	HCPCS C1713		249.917  -  PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH	BOTH IP/OP	$515.90 	$381.77	$0.00	$400.70	$225.39	$225.39	$0.00	$0.00	$0.00	$107.53	$382.90	$382.90	$0.00	$0.00	$107.51	$0.00	$305.15	$305.15	$0.00	$250.44	$396.70	$400.70	$0.00		$0.00	$76.10	$0.00	$0.00	$79.74	$0.00	$0.00	$0.00	$0.00	$0.00
249.919	SUP	HCPCS C1713		249.919  -  PLATE BN T 66MM NS 3 HLE/HD 10 HL SHFT LOPRFL CUT TO LGTH SS	BOTH IP/OP	$472.33 	$349.52	$0.00	$366.84	$206.35	$206.35	$0.00	$0.00	$0.00	$98.44	$350.56	$350.56	$0.00	$0.00	$98.43	$0.00	$279.38	$279.38	$0.00	$229.28	$363.17	$366.84	$0.00		$0.00	$69.67	$0.00	$0.00	$73.00	$0.00	$0.00	$0.00	$0.00	$0.00
249.921	SUP	HCPCS C1713		249.921  -  PLATE BN NS LOPRFL CUT TO LGTH SS CUBOID 2.4 MM SCR MODFT	BOTH IP/OP	$688.80 	$509.71	$0.00	$534.98	$300.93	$300.93	$0.00	$0.00	$0.00	$143.56	$511.23	$511.23	$0.00	$0.00	$143.55	$0.00	$407.43	$407.43	$0.00	$334.36	$529.63	$534.98	$0.00		$0.00	$101.61	$0.00	$0.00	$106.46	$0.00	$0.00	$0.00	$0.00	$0.00
249.924	SUP	HCPCS C1713		249.924  -  PLATE BN 31X6.5X1.6MM NS LC DCP 4 HL LOPRFL PRECONTOUR CUT	BOTH IP/OP	$548.23 	$405.69	$0.00	$425.80	$239.51	$239.51	$0.00	$0.00	$0.00	$114.26	$406.89	$406.89	$0.00	$0.00	$114.25	$0.00	$324.28	$324.28	$0.00	$266.13	$421.54	$425.80	$0.00		$0.00	$80.87	$0.00	$0.00	$84.73	$0.00	$0.00	$0.00	$0.00	$0.00
249.926	SUP	HCPCS C1713		249.926  -  PLATE BN 47X6.5X1.6MM NS LC DCP 6 HL LOPRFL PRECONTOUR CUT	BOTH IP/OP	$618.50 	$457.69	$0.00	$480.40	$270.23	$270.23	$0.00	$0.00	$0.00	$128.91	$459.05	$459.05	$0.00	$0.00	$128.90	$0.00	$365.84	$365.84	$0.00	$300.25	$475.60	$480.40	$0.00		$0.00	$91.24	$0.00	$0.00	$95.60	$0.00	$0.00	$0.00	$0.00	$0.00
249.928	SUP	HCPCS C1713		249.928  -  PLATE BN 63X6.5X1.6MM NS LC DCP 8 HL LOPRFL PRECONTOUR CUT	BOTH IP/OP	$667.70 	$494.10	$0.00	$518.60	$291.71	$291.71	$0.00	$0.00	$0.00	$139.17	$495.57	$495.57	$0.00	$0.00	$139.15	$0.00	$394.94	$394.94	$0.00	$324.13	$513.41	$518.60	$0.00		$0.00	$98.50	$0.00	$0.00	$103.20	$0.00	$0.00	$0.00	$0.00	$0.00
254.862	SUP	Custom 27803010		"254.862  -  SS ROD TO ROD CLAMP, 5.5MM TO 6.5MM"	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$0.00	$0.00	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
254.864	SUP	Custom 27803010		"254.864  -  SS ROD TO ROD CLAMP, 5.5MM TO 6.5MM, WIDE"	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$0.00	$0.00	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
254.866	SUP	Custom 27803010		"254.866  -  SS PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM"	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$0.00	$0.00	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
254.868	SUP	Custom 27803010		"254.868  -  SS PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM WIDE"	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$0.00	$0.00	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
260.06	SUP	HCPCS C1713		260.060  -  PLATE 80MM SS 4.5MM SCR 10 HOLE RECON BONE STRNL NONSTRL	BOTH IP/OP	"$2,682.50 "	"$1,985.05"	$0.00	"$2,146.00"	"$1,207.13"	"$1,207.13"	$0.00	$0.00	$0.00	$559.10	"$1,990.95"	"$1,990.95"	$0.00	$0.00	$559.03	$0.00	"$1,322.47"	"$1,322.47"	$0.00	"$1,341.25"	"$2,124.54"	"$2,146.00"	$0.00		$0.00	$419.81	$0.00	$0.00	$427.05	$0.00	$0.00	$0.00	$0.00	$0.00
260.062	SUP	HCPCS C1713		260.062  -  PLATE 96MM SS 4.5MM SCR 12 HOLE RECON BONE STRNL NONSTRL	BOTH IP/OP	"$2,760.00 "	"$2,042.40"	$0.00	"$2,208.00"	"$1,242.00"	"$1,242.00"	$0.00	$0.00	$0.00	$575.25	"$2,048.47"	"$2,048.47"	$0.00	$0.00	$575.18	$0.00	"$1,360.68"	"$1,360.68"	$0.00	"$1,380.00"	"$2,185.92"	"$2,208.00"	$0.00		$0.00	$431.94	$0.00	$0.00	$439.39	$0.00	$0.00	$0.00	$0.00	$0.00
260.064	SUP	HCPCS C1713		260.064  -  PLATE 112MM SS 4.5MM SCR 14 HOLE RECON BONE STRNL NONSTRL	BOTH IP/OP	"$2,835.00 "	"$2,097.90"	$0.00	"$2,268.00"	"$1,275.75"	"$1,275.75"	$0.00	$0.00	$0.00	$590.88	"$2,104.14"	"$2,104.14"	$0.00	$0.00	$590.81	$0.00	"$1,397.66"	"$1,397.66"	$0.00	"$1,417.50"	"$2,245.32"	"$2,268.00"	$0.00		$0.00	$443.68	$0.00	$0.00	$451.33	$0.00	$0.00	$0.00	$0.00	$0.00
260.066	SUP	HCPCS C1713		260.066  -  PLATE 128MM SS 4.5MM SCR 16 HOLE RECON BONE STRNL NONSTRL	BOTH IP/OP	"$2,912.50 "	"$2,155.25"	$0.00	"$2,330.00"	"$1,310.63"	"$1,310.63"	$0.00	$0.00	$0.00	$607.04	"$2,161.66"	"$2,161.66"	$0.00	$0.00	$606.97	$0.00	"$1,435.86"	"$1,435.86"	$0.00	"$1,456.25"	"$2,306.70"	"$2,330.00"	$0.00		$0.00	$455.81	$0.00	$0.00	$463.67	$0.00	$0.00	$0.00	$0.00	$0.00
260.068	SUP	HCPCS C1713		260.068  -  PLATE 144MM SS 4.5MM SCR 18 HOLE RECON BONE STRNL NONSTRL	BOTH IP/OP	"$2,990.00 "	"$2,212.60"	$0.00	"$2,392.00"	"$1,345.50"	"$1,345.50"	$0.00	$0.00	$0.00	$623.19	"$2,219.18"	"$2,219.18"	$0.00	$0.00	$623.12	$0.00	"$1,474.07"	"$1,474.07"	$0.00	"$1,495.00"	"$2,368.08"	"$2,392.00"	$0.00		$0.00	$467.94	$0.00	$0.00	$476.01	$0.00	$0.00	$0.00	$0.00	$0.00
260.07	SUP	HCPCS C1713		260.070  -  PLATE 160MM SS 4.5MM SCR 20 HOLE RECON BONE STRNL NONSTRL	BOTH IP/OP	"$3,067.50 "	"$2,269.95"	$0.00	"$2,454.00"	"$1,380.38"	"$1,380.38"	$0.00	$0.00	$0.00	$639.34	"$2,276.70"	"$2,276.70"	$0.00	$0.00	$639.27	$0.00	"$1,512.28"	"$1,512.28"	$0.00	"$1,533.75"	"$2,429.46"	"$2,454.00"	$0.00		$0.00	$480.06	$0.00	$0.00	$488.35	$0.00	$0.00	$0.00	$0.00	$0.00
260.072	SUP	HCPCS C1713		260.072  -  PLATE 176MM SS 4.5MM SCR 22 HOLE RECON BONE STRNL NONSTRL	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
260.074	SUP	HCPCS C1713		260.074  -  PLATE 192MM SS 4.5MM SCR 24 HOLE RECON BONE STRNL NONSTRL	BOTH IP/OP	"$3,217.50 "	"$2,380.95"	$0.00	"$2,574.00"	"$1,447.88"	"$1,447.88"	$0.00	$0.00	$0.00	$670.61	"$2,388.03"	"$2,388.03"	$0.00	$0.00	$670.53	$0.00	"$1,586.23"	"$1,586.23"	$0.00	"$1,608.75"	"$2,548.26"	"$2,574.00"	$0.00		$0.00	$503.54	$0.00	$0.00	$512.23	$0.00	$0.00	$0.00	$0.00	$0.00
275.9	SUP	Custom 27803010		275.900  -  CAP END 3-4MM STAINLESS STEEL ORTHOPEDIC ELSTIC NAIL	BOTH IP/OP	$151.48 	$112.10	$0.00	$121.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.42	$112.42	$0.00	$0.00	$31.57	$0.00	$0.00	$0.00	$0.00	$75.74	$119.97	$121.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
275.905	SUP	Custom 27803010		275.905  -  CAP END STAINLESS STEEL NONSTRL 1.5-2.5 MM ELAST NAIL	BOTH IP/OP	$156.03 	$115.46	$0.00	$121.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$115.80	$115.80	$0.00	$0.00	$32.52	$0.00	$0.00	$0.00	$0.00	$75.74	$119.97	$121.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
275.915	SUP	HCPCS C1713		275.915  -  NAIL INTRAMEDULLARY 1.5MM 300MM ELAST STAINLESS STEEL	BOTH IP/OP	$493.40 	$365.12	$0.00	$383.22	$215.56	$215.56	$0.00	$0.00	$0.00	$102.84	$366.20	$366.20	$0.00	$0.00	$102.82	$0.00	$291.85	$291.85	$0.00	$239.51	$379.39	$383.22	$0.00		$0.00	$72.78	$0.00	$0.00	$76.26	$0.00	$0.00	$0.00	$0.00	$0.00
275.92	SUP	HCPCS C1713		275.920  -  NAIL INTRAMEDULLARY 2MM 440MM ELAST STAINLESS STEEL	BOTH IP/OP	$513.15 	$379.73	$0.00	$410.52	$230.92	$230.92	$0.00	$0.00	$0.00	$106.95	$380.86	$380.86	$0.00	$0.00	$106.94	$0.00	$303.53	$303.53	$0.00	$256.58	$406.41	$410.52	$0.00		$0.00	$77.97	$0.00	$0.00	$81.69	$0.00	$0.00	$0.00	$0.00	$0.00
275.925	SUP	HCPCS C1713		275.925  -  NAIL INTRAMEDULLARY 2.5MM 440MM ELAST STAINLESS STEEL	BOTH IP/OP	$567.90 	$420.25	$0.00	$441.08	$248.11	$248.11	$0.00	$0.00	$0.00	$118.36	$421.50	$421.50	$0.00	$0.00	$118.35	$0.00	$335.91	$335.91	$0.00	$275.68	$436.67	$441.08	$0.00		$0.00	$83.77	$0.00	$0.00	$87.77	$0.00	$0.00	$0.00	$0.00	$0.00
275.93	SUP	HCPCS C1713		275.930  -  NAIL INTRAMEDULLARY 3MM 440MM ELAST STAINLESS STEEL	BOTH IP/OP	$582.75 	$431.24	$0.00	$466.20	$262.24	$262.24	$0.00	$0.00	$0.00	$121.46	$432.52	$432.52	$0.00	$0.00	$121.45	$0.00	$344.70	$344.70	$0.00	$291.38	$461.54	$466.20	$0.00		$0.00	$88.54	$0.00	$0.00	$92.77	$0.00	$0.00	$0.00	$0.00	$0.00
275.935	SUP	HCPCS C1713		275.935  -  NAIL INTRAMEDULLARY 3.5MM 440MM ELAST STAINLESS STEEL	BOTH IP/OP	$635.38 	$470.18	$0.00	$493.50	$277.59	$277.59	$0.00	$0.00	$0.00	$132.43	$471.58	$471.58	$0.00	$0.00	$132.41	$0.00	$375.82	$375.82	$0.00	$308.44	$488.57	$493.50	$0.00		$0.00	$93.73	$0.00	$0.00	$98.21	$0.00	$0.00	$0.00	$0.00	$0.00
275.94	SUP	HCPCS C1713		275.940  -  NAIL INTRAMEDULLARY 4MM 440MM ELAST STAINLESS STEEL	BOTH IP/OP	$661.90 	$489.81	$0.00	$529.52	$297.86	$297.86	$0.00	$0.00	$0.00	$137.96	$491.26	$491.26	$0.00	$0.00	$137.94	$0.00	$391.51	$391.51	$0.00	$330.95	$524.22	$529.52	$0.00		$0.00	$100.57	$0.00	$0.00	$105.37	$0.00	$0.00	$0.00	$0.00	$0.00
280	SUP	HCPCS C1713		280.000  -  SCREW BONE 12.7MM 8.2MM 2.7MM 100MM 22MM CANN LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.05	SUP	HCPCS C1713		280.050  -  SCREW BONE 12.7MM 8.2MM 2.7MM 105MM 22MM CANN LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.1	SUP	HCPCS C1713		280.100  -  SCREW BONE 12.7MM 8.2MM 2.7MM 110MM 22MM CANN LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.15	SUP	HCPCS C1713		280.150  -  SCREW BONE 12.7MM 8.2MM 115MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.2	SUP	HCPCS C1713		280.200  -  SCREW BONE 12.7MM 8.2MM 120MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.25	SUP	HCPCS C1713		280.250  -  SCREW BONE 12.7MM 8.2MM 125MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.251	SUP	HCPCS C1713		280.251  -  SCREW BONE 12.7MM 50MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.255	SUP	HCPCS C1713		280.255  -  SCREW BONE 12.7MM 55MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.26	SUP	HCPCS C1713		280.260  -  SCREW BONE 12.7MM 60MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.265	SUP	HCPCS C1713		280.265  -  SCREW BONE 12.7MM 65MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.27	SUP	HCPCS C1713		280.270  -  SCREW BONE 12.7MM 70MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.275	SUP	HCPCS C1713		280.275  -  SCREW BONE 12.7MM 75MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.28	SUP	HCPCS C1713		280.280  -  SCREW BONE 12.7MM 80MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.285	SUP	HCPCS C1713		280.285  -  SCREW BN 12MM 8MM 2.7MM 85MM NS 22MM DHS DCS LG CNN SS HIP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.29	SUP	HCPCS C1713		280.290  -  SCREW BONE 12.7MM 90MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.295	SUP	HCPCS C1713		280.295  -  SCREW BONE 12.7MM 95MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.3	SUP	HCPCS C1713		280.300  -  SCREW BONE 12.7MM 130MM 22MM DHS/DCS SS CNDYLR HIP LAG CANN	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.301	SUP	HCPCS C1713		280.301  -  SCREW BONE 12.7MM 100MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.305	SUP	HCPCS C1713		280.305  -  SCREW BONE 12.7MM 105MM 22MM LAG CANN DHS/DCS STAINLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.31	SUP	HCPCS C1713		280.310  -  SCREW BONE 12.7MM 110MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.315	SUP	HCPCS C1713		280.315  -  SCREW BONE 12.7MM 115MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.32	SUP	HCPCS C1713		280.320  -  SCREW BONE 12.7MM 120MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.325	SUP	HCPCS C1713		280.325  -  SCREW BONE 12.7MM 125MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.33	SUP	HCPCS C1713		280.330  -  SCREW BONE 12.7MM 130MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.335	SUP	HCPCS C1713		280.335  -  SCREW BONE 13MM 135MM 22MM LAG CANN OCTAGONAL DHS/DCS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.34	SUP	HCPCS C1713		280.340  -  SCREW BONE 12MM 8MM 2.7MM 140MM 22MM 1 STEP LAG CANN DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.345	SUP	HCPCS C1713		280.345  -  SCREW BONE 12MM 8MM 2.7MM 145MM 22MM 1 STEP LAG CANN DHS/DCS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.35	SUP	HCPCS C1713		280.350  -  SCREW BONE 12.7MM 8.2MM 135MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.4	SUP	HCPCS C1713		280.400  -  SCREW BONE 12.7MM 140MM 22MM 1 STEP LAG THREADED DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.451	SUP	HCPCS C1713		280.451  -  SCREW BONE 12.7MM 8.2MM 2.7MM 145MM 22MM CANN LAG DHS/DCS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.454	SUP	HCPCS C1713		280.454  -  SCREW BONE 14MM 2.7MM 50MM 22MM LAG CANN DHS/DCS STAINLESS	BOTH IP/OP	$722.53 	$534.67	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$150.59	$536.26	$536.26	$0.00	$0.00	$150.57	$0.00	$427.37	$427.37	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.455	SUP	HCPCS C1713		280.455  -  SCREW BONE 14MM 8.2MM 55MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$722.53 	$534.67	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$150.59	$536.26	$536.26	$0.00	$0.00	$150.57	$0.00	$427.37	$427.37	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.46	SUP	HCPCS C1713		280.460  -  SCREW BONE 14MM 8.2MM 60MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.465	SUP	HCPCS C1713		280.465  -  SCREW BONE LARGE 14MM 65MM 14MM THREAD DHS/DCS STAINLESS	BOTH IP/OP	$722.53 	$534.67	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$150.59	$536.26	$536.26	$0.00	$0.00	$150.57	$0.00	$427.37	$427.37	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.47	SUP	HCPCS C1713		280.470  -  SCREW BONE 14MM 8.2MM 70MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.475	SUP	HCPCS C1713		280.475  -  SCREW BONE 14MM 8.2MM 75MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$722.53 	$534.67	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$150.59	$536.26	$536.26	$0.00	$0.00	$150.57	$0.00	$427.37	$427.37	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.48	SUP	HCPCS C1713		280.480  -  SCREW BONE 14MM 8.2MM 80MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.485	SUP	HCPCS C1713		280.485  -  SCREW BONE 14MM 8.2MM 85MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$722.53 	$534.67	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$150.59	$536.26	$536.26	$0.00	$0.00	$150.57	$0.00	$427.37	$427.37	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.49	SUP	HCPCS C1713		280.490  -  SCREW BONE 14MM 8.2MM 90MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.495	SUP	HCPCS C1713		280.495  -  SCREW BONE 14MM 8.2MM 95MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$722.53 	$534.67	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$150.59	$536.26	$536.26	$0.00	$0.00	$150.57	$0.00	$427.37	$427.37	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.501	SUP	HCPCS C1713		280.501  -  SCREW BONE 12.7MM 8.2MM 50MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$702.85 	$520.11	$0.00	$545.90	$307.07	$307.07	$0.00	$0.00	$0.00	$146.49	$521.66	$521.66	$0.00	$0.00	$146.47	$0.00	$415.74	$415.74	$0.00	$341.19	$540.44	$545.90	$0.00		$0.00	$103.68	$0.00	$0.00	$108.63	$0.00	$0.00	$0.00	$0.00	$0.00
280.504	SUP	HCPCS C1713		280.504  -  SCREW BONE 14MM 8MM 2.7MM 100MM 22MM LAG CANN DHS/DCS	BOTH IP/OP	$722.53 	$534.67	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$150.59	$536.26	$536.26	$0.00	$0.00	$150.57	$0.00	$427.37	$427.37	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.505	SUP	HCPCS C1713		280.505  -  SCREW BONE 14MM 8.2MM 105MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$722.53 	$534.67	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$150.59	$536.26	$536.26	$0.00	$0.00	$150.57	$0.00	$427.37	$427.37	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.51	SUP	HCPCS C1713		280.510  -  SCREW BONE 14MM 8.2MM 110MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.515	SUP	HCPCS C1713		280.515  -  SCREW BONE 14MM 8.2MM 115MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$722.53 	$534.67	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$150.59	$536.26	$536.26	$0.00	$0.00	$150.57	$0.00	$427.37	$427.37	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.52	SUP	HCPCS C1713		280.520  -  SCREW BONE 14MM 8.2MM 120MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.525	SUP	HCPCS C1713		280.525  -  SCREW BONE 14MM 8.2MM 125MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$722.53 	$534.67	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$150.59	$536.26	$536.26	$0.00	$0.00	$150.57	$0.00	$427.37	$427.37	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.53	SUP	HCPCS C1713		280.530  -  SCREW BONE 14MM 8.2MM 130MM 22MM CANN LAG DHS/DCS STAINLESS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.535	SUP	HCPCS C1713		280.535  -  SCREW BONE 14MM 135MM 22MM LAG THREAD DHS/DCS STAINLESS	BOTH IP/OP	$722.53 	$534.67	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$150.59	$536.26	$536.26	$0.00	$0.00	$150.57	$0.00	$427.37	$427.37	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.54	SUP	HCPCS C1713		280.540  -  SCREW BONE 14MM 8.2MM 130MM 22MM CANN LAG DHS/DCS STAINLESS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.545	SUP	HCPCS C1713		280.545  -  SCREW BONE 14MM 145MM 22MM LAG THREAD DHS/DCS STAINLESS	BOTH IP/OP	$722.53 	$534.67	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$150.59	$536.26	$536.26	$0.00	$0.00	$150.57	$0.00	$427.37	$427.37	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.55	SUP	HCPCS C1713		280.550  -  SCREW BONE 8MM 55MM 22MM CANN THREADED LAG DHS/DCS STAINLESS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.6	SUP	HCPCS C1713		280.600  -  SCREW BONE 12.7MM 8.2MM 2.7MM 60MM 22MM CANN LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.65	SUP	HCPCS C1713		280.650  -  SCREW BONE 12.7MM 8.2MM 65MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.66	SUP	HCPCS C1713		280.660  -  SCREW BONE 14MM 8.2MM 60MM 22MM 1 STEP LAG CANN DHS/DCS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.67	SUP	HCPCS C1713		280.670  -  SCREW BONE 14MM 70MM 22MM 1 STEP LAG THREAD DHS/DCS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.68	SUP	HCPCS C1713		280.680  -  SCREW BONE 14MM 80MM 22MM LAG CANN DHS/DCS STAINLESS STEEL	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.69	SUP	HCPCS C1713		280.690  -  SCREW BONE 14MM 90MM 22MM LAG CANN DHS/DCS STAINLESS STEEL	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.7	SUP	HCPCS C1713		280.700  -  SCREW BN 12.7MM 8MM 2.7MM 70MM NS 22MM DHS DCS LG CNN SS HIP	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.71	SUP	HCPCS C1713		280.710  -  SCREW BONE 14MM 8.2MM 110MM 22MM 1 STEP LAG CANN DHS/DCS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.72	SUP	HCPCS C1713		280.720  -  SCREW BONE 14MM 8.2MM 120MM 22MM 1 STEP LAG CANN DHS/DCS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.73	SUP	HCPCS C1713		280.730  -  SCREW BONE 14MM 8.2MM 60MM 22MM 1 STEP LAG CANN DHS/DCS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.74	SUP	HCPCS C1713		280.740  -  SCREW BONE 14MM 8.2MM 140MM 22MM 1 STEP LAG CANN DHS/DCS	BOTH IP/OP	$701.48 	$519.10	$0.00	$561.18	$315.66	$315.66	$0.00	$0.00	$0.00	$146.20	$520.63	$520.63	$0.00	$0.00	$146.19	$0.00	$414.92	$414.92	$0.00	$350.74	$555.57	$561.18	$0.00		$0.00	$106.58	$0.00	$0.00	$111.67	$0.00	$0.00	$0.00	$0.00	$0.00
280.75	SUP	HCPCS C1713		280.750  -  SCREW BONE 12.7MM 8.2MM 75MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.8	SUP	HCPCS C1713		280.800  -  SCREW BONE 12.7MM 8.2MM 80MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.85	SUP	HCPCS C1713		280.850  -  SCREW BONE 12.7MM 8.2MM 85MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.9	SUP	HCPCS C1713		280.900  -  SCREW BONE 12.7MM 8MM 2.7MM 90MM 22MM LAG DHS/DCS STAINLESS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.95	SUP	HCPCS C1713		280.950  -  SCREW BONE 12.7MM 8.2MM 95MM 22MM CANN THREADED LAG DHS/DCS	BOTH IP/OP	$622.33 	$460.52	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$129.71	$461.89	$461.89	$0.00	$0.00	$129.69	$0.00	$368.11	$368.11	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
280.99	SUP	HCPCS C1713		280.990  -  SCREW BONE 12.7MM 36MM 22MM COMPRESSION DHS/DCS STAINLESS	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
281.01	SUP	HCPCS C1713		281.010  -  PLATE BONE 130D STANDARD BARREL 174MM 38MM 10 HOLE DHS/DCP	BOTH IP/OP	"$1,295.15 "	$958.41	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$269.94	$961.26	$961.26	$0.00	$0.00	$269.91	$0.00	$766.08	$766.08	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.012	SUP	HCPCS C1713		281.012  -  PLATE BN 130D STD BRL 206MM NS 38MM DHS 12 HL SS HIP 4.5MM	BOTH IP/OP	"$1,334.00 "	$987.16	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$278.04	$990.09	$990.09	$0.00	$0.00	$278.01	$0.00	$789.06	$789.06	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.014	SUP	HCPCS C1713		281.014  -  PLATE BN 130D STD BRL 238MM NS 38MM DHS 14 HL SS HIP 4.5MM	BOTH IP/OP	"$1,772.58 "	"$1,311.71"	$0.00	"$1,376.76"	$774.43	$774.43	$0.00	$0.00	$0.00	$369.45	"$1,315.61"	"$1,315.61"	$0.00	$0.00	$369.40	$0.00	"$1,048.48"	"$1,048.48"	$0.00	$860.48	"$1,362.99"	"$1,376.76"	$0.00		$0.00	$261.48	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
281.02	SUP	HCPCS C1713		281.020  -  PLATE BONE 135D STANDARD BARREL 333X19X5.8MM 38MM 20 HOLE	BOTH IP/OP	"$1,771.45 "	"$1,310.87"	$0.00	"$1,417.16"	$797.15	$797.15	$0.00	$0.00	$0.00	$369.21	"$1,314.77"	"$1,314.77"	$0.00	$0.00	$369.17	$0.00	"$1,047.81"	"$1,047.81"	$0.00	$885.73	"$1,402.99"	"$1,417.16"	$0.00		$0.00	$269.16	$0.00	$0.00	$282.01	$0.00	$0.00	$0.00	$0.00	$0.00
281.021	SUP	HCPCS C1713		281.021  -  PLATE BN 130D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM	BOTH IP/OP	"$1,003.68 "	$742.72	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$209.19	$744.93	$744.93	$0.00	$0.00	$209.17	$0.00	$593.67	$593.67	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.031	SUP	HCPCS C1713		281.031  -  PLATE BONE 130D STANDARD BARREL 62MM 38MM 3 HOLE DHS/DCS	BOTH IP/OP	"$1,003.68 "	$742.72	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$209.19	$744.93	$744.93	$0.00	$0.00	$209.17	$0.00	$593.67	$593.67	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.04	SUP	HCPCS C1713		281.040  -  PLATE BN 130D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.05	SUP	HCPCS C1713		281.050  -  PLATE BN 130D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.06	SUP	HCPCS C1713		281.060  -  PLATE BN 130D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.081	SUP	HCPCS C1713		281.081  -  PLATE BONE 130D STANDARD BARREL 142MM 38MM 8 HOLE	BOTH IP/OP	"$1,334.00 "	$987.16	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$278.04	$990.09	$990.09	$0.00	$0.00	$278.01	$0.00	$789.06	$789.06	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.1	SUP	HCPCS C1713		281.100  -  PLATE BN 135D STD BRL 12.6MM 174X19X5.8MM NS 38MM DHS DCP 10	BOTH IP/OP	"$1,295.15 "	$958.41	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$269.94	$961.26	$961.26	$0.00	$0.00	$269.91	$0.00	$766.08	$766.08	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.102	SUP	HCPCS C1713		281.102  -  PLATE BN 135D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM	BOTH IP/OP	"$1,003.68 "	$742.72	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$209.19	$744.93	$744.93	$0.00	$0.00	$209.17	$0.00	$593.67	$593.67	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.11	SUP	HCPCS C1713		281.110  -  PLATE BN 135D STD BRL 12.6MM 206X19X5.8MM NS 38MM DHS DCP 12	BOTH IP/OP	"$1,295.15 "	$958.41	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$269.94	$961.26	$961.26	$0.00	$0.00	$269.91	$0.00	$766.08	$766.08	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.13	SUP	HCPCS C1713		281.130  -  PLATE BN 135D STD BRL 12.6MM 238X19X5.8MM NS 38MM DHS DCP 14	BOTH IP/OP	"$1,720.95 "	"$1,273.50"	$0.00	"$1,376.76"	$774.43	$774.43	$0.00	$0.00	$0.00	$358.69	"$1,277.29"	"$1,277.29"	$0.00	$0.00	$358.65	$0.00	"$1,017.94"	"$1,017.94"	$0.00	$860.48	"$1,362.99"	"$1,376.76"	$0.00		$0.00	$261.48	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
281.131	SUP	HCPCS C1713		281.131  -  PLATE BN 135D STD BRL 12.6MM 62X19X5.8MM NS 38MM DHS DCP 3	BOTH IP/OP	"$1,003.68 "	$742.72	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$209.19	$744.93	$744.93	$0.00	$0.00	$209.17	$0.00	$593.67	$593.67	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.14	SUP	HCPCS C1713		281.140  -  PLATE BN 135D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.15	SUP	HCPCS C1713		281.150  -  PLATE BN 135D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.16	SUP	HCPCS C1713		281.160  -  PLATE BN 135D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.17	SUP	HCPCS C1713		281.170  -  PLATE BN 135D STD BRL 12.6MM 270X19X5.8MM NS 38MM DHS DCP 16	BOTH IP/OP	"$1,720.95 "	"$1,273.50"	$0.00	"$1,376.76"	$774.43	$774.43	$0.00	$0.00	$0.00	$358.69	"$1,277.29"	"$1,277.29"	$0.00	$0.00	$358.65	$0.00	"$1,017.94"	"$1,017.94"	$0.00	$860.48	"$1,362.99"	"$1,376.76"	$0.00		$0.00	$261.48	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
281.18	SUP	HCPCS C1713		281.180  -  PLATE BN 135D STD BRL 12.6MM 142X19X5.8MM NS 38MM DHS DCP 8	BOTH IP/OP	"$1,295.15 "	$958.41	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$269.94	$961.26	$961.26	$0.00	$0.00	$269.91	$0.00	$766.08	$766.08	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.19	SUP	HCPCS C1713		281.190  -  PLATE BONE 135D STANDARD BARREL 302X19X5.8MM 38MM 18 HOLE	BOTH IP/OP	"$1,771.45 "	"$1,310.87"	$0.00	"$1,417.16"	$797.15	$797.15	$0.00	$0.00	$0.00	$369.21	"$1,314.77"	"$1,314.77"	$0.00	$0.00	$369.17	$0.00	"$1,047.81"	"$1,047.81"	$0.00	$885.73	"$1,402.99"	"$1,417.16"	$0.00		$0.00	$269.16	$0.00	$0.00	$282.01	$0.00	$0.00	$0.00	$0.00	$0.00
281.2	SUP	HCPCS C1713		281.200  -  PLATE BN 140D STD BRL 174MM NS 38MM DHS 10 HL SS HIP 4.5MM	BOTH IP/OP	"$1,295.15 "	$958.41	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$269.94	$961.26	$961.26	$0.00	$0.00	$269.91	$0.00	$766.08	$766.08	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.212	SUP	HCPCS C1713		281.212  -  PLATE BONE STANDARD BARREL 140D 206MM 38MM 12 HOLE DHS	BOTH IP/OP	"$1,334.00 "	$987.16	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$278.04	$990.09	$990.09	$0.00	$0.00	$278.01	$0.00	$789.06	$789.06	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.214	SUP	HCPCS C1713		281.214  -  PLATE BN 140D STD BRL 238MM NS 38MM DHS 14 HL SS HIP 4.5MM	BOTH IP/OP	"$1,772.58 "	"$1,311.71"	$0.00	"$1,376.76"	$774.43	$774.43	$0.00	$0.00	$0.00	$369.45	"$1,315.61"	"$1,315.61"	$0.00	$0.00	$369.40	$0.00	"$1,048.48"	"$1,048.48"	$0.00	$860.48	"$1,362.99"	"$1,376.76"	$0.00		$0.00	$261.48	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
281.216	SUP	HCPCS C1713		281.216  -  PLATE BONE 140D STANDARD BARREL 12.6MM 270MM 38MM 16 HOLE	BOTH IP/OP	"$1,772.58 "	"$1,311.71"	$0.00	"$1,376.76"	$774.43	$774.43	$0.00	$0.00	$0.00	$369.45	"$1,315.61"	"$1,315.61"	$0.00	$0.00	$369.40	$0.00	"$1,048.48"	"$1,048.48"	$0.00	$860.48	"$1,362.99"	"$1,376.76"	$0.00		$0.00	$261.48	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
281.22	SUP	HCPCS C1713		281.220  -  PLATE BN 140D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.23	SUP	HCPCS C1713		281.230  -  PLATE BONE 140D STANDARD BARREL 62MM 38MM 3 HOLE COMPRESSION	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.24	SUP	HCPCS C1713		281.240  -  PLATE BN 140D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$181.76	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.25	SUP	HCPCS C1713		281.250  -  PLATE BN 140D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.26	SUP	HCPCS C1713		281.260  -  PLATE BN 140D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.28	SUP	HCPCS C1713		281.280  -  PLATE BN 140D STD BRL 142MM NS 38MM DHS 8 HL SS HIP 4.5MM	BOTH IP/OP	"$1,295.15 "	$958.41	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$269.94	$961.26	$961.26	$0.00	$0.00	$269.91	$0.00	$766.08	$766.08	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.308	SUP	HCPCS C1713		281.308  -  PLATE BN 145D STD BRL 142MM NS 38MM DHS 8 HL SS HIP 4.5MM	BOTH IP/OP	"$1,334.00 "	$987.16	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$278.04	$990.09	$990.09	$0.00	$0.00	$278.01	$0.00	$789.06	$789.06	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.31	SUP	HCPCS C1713		281.310  -  PLATE BN 145D STD BRL 174MM NS 38MM DHS 10 HL SS HIP 4.5MM	BOTH IP/OP	"$1,295.15 "	$958.41	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$269.94	$961.26	$961.26	$0.00	$0.00	$269.91	$0.00	$766.08	$766.08	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.312	SUP	HCPCS C1713		281.312  -  PLATE BONE 145D 206MM 38MM 12 HOLE ANGLED STANDARD BARREL	BOTH IP/OP	"$1,334.00 "	$987.16	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$278.04	$990.09	$990.09	$0.00	$0.00	$278.01	$0.00	$789.06	$789.06	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.314	SUP	HCPCS C1713		281.314  -  PLATE BONE 145D STANDARD BARREL 238MM 38MM 14 HOLE DHS	BOTH IP/OP	"$1,772.58 "	"$1,311.71"	$0.00	"$1,376.76"	$774.43	$774.43	$0.00	$0.00	$0.00	$369.45	"$1,315.61"	"$1,315.61"	$0.00	$0.00	$369.40	$0.00	"$1,048.48"	"$1,048.48"	$0.00	$860.48	"$1,362.99"	"$1,376.76"	$0.00		$0.00	$261.48	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
281.316	SUP	HCPCS C1713		281.316  -  PLATE BONE 145D STANDARD BARREL 270MM 38MM 16 HOLE DHS	BOTH IP/OP	"$1,772.58 "	"$1,311.71"	$0.00	"$1,376.76"	$774.43	$774.43	$0.00	$0.00	$0.00	$369.45	"$1,315.61"	"$1,315.61"	$0.00	$0.00	$369.40	$0.00	"$1,048.48"	"$1,048.48"	$0.00	$860.48	"$1,362.99"	"$1,376.76"	$0.00		$0.00	$261.48	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
281.32	SUP	HCPCS C1713		281.320  -  PLATE BN 145D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.33	SUP	HCPCS C1713		281.330  -  PLATE BONE 145D STANDARD BARREL 62MM 38MM 3 HOLE COMPRESSION	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.34	SUP	HCPCS C1713		281.340  -  PLATE BN 145D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.35	SUP	HCPCS C1713		281.350  -  PLATE BN 145D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.36	SUP	HCPCS C1713		281.360  -  PLATE BN 145D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.4	SUP	HCPCS C1713		281.400  -  PLATE BN 150D STD BRL 174MM NS 38MM DHS 10 HL SS HIP 4.5MM	BOTH IP/OP	"$1,295.15 "	$958.41	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$269.94	$961.26	$961.26	$0.00	$0.00	$269.91	$0.00	$766.08	$766.08	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.402	SUP	HCPCS C1713		281.402  -  PLATE BONE 150D STANDARD BARREL 46X19X5.8MM 38MM 2 HOLE	BOTH IP/OP	"$1,003.68 "	$742.72	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$209.19	$744.93	$744.93	$0.00	$0.00	$209.17	$0.00	$593.67	$593.67	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.41	SUP	HCPCS C1713		281.410  -  PLATE BONE 150D STANDARD BARREL 12.6MM 206MM 38MM 12 HOLE	BOTH IP/OP	"$1,295.15 "	$958.41	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$269.94	$961.26	$961.26	$0.00	$0.00	$269.91	$0.00	$766.08	$766.08	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.414	SUP	HCPCS C1713		281.414  -  PLATE BONE 150D STANDARD BARREL 238MM 38MM 14 HOLE DHS	BOTH IP/OP	"$1,772.58 "	"$1,311.71"	$0.00	"$1,376.76"	$774.43	$774.43	$0.00	$0.00	$0.00	$369.45	"$1,315.61"	"$1,315.61"	$0.00	$0.00	$369.40	$0.00	"$1,048.48"	"$1,048.48"	$0.00	$860.48	"$1,362.99"	"$1,376.76"	$0.00		$0.00	$261.48	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
281.416	SUP	HCPCS C1713		281.416  -  PLATE BONE 150D STANDARD BARREL 270MM 38MM 16 HOLE DHS	BOTH IP/OP	"$1,772.58 "	"$1,311.71"	$0.00	"$1,376.76"	$774.43	$774.43	$0.00	$0.00	$0.00	$369.45	"$1,315.61"	"$1,315.61"	$0.00	$0.00	$369.40	$0.00	"$1,048.48"	"$1,048.48"	$0.00	$860.48	"$1,362.99"	"$1,376.76"	$0.00		$0.00	$261.48	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
281.418	SUP	HCPCS C1713		281.418  -  PLATE BONE 150D STANDARD BARRAL 302MM 38MM 18 HOLE DHS/DCP	BOTH IP/OP	"$1,824.60 "	"$1,350.20"	$0.00	"$1,417.16"	$797.15	$797.15	$0.00	$0.00	$0.00	$380.29	"$1,354.22"	"$1,354.22"	$0.00	$0.00	$380.25	$0.00	"$1,079.25"	"$1,079.25"	$0.00	$885.73	"$1,402.99"	"$1,417.16"	$0.00		$0.00	$269.16	$0.00	$0.00	$282.01	$0.00	$0.00	$0.00	$0.00	$0.00
281.421	SUP	HCPCS C1713		281.421  -  PLATE BONE 150D STANDARD BARREL 333MM 38MM 20 HOLE DHS/DCP	BOTH IP/OP	"$1,824.60 "	"$1,350.20"	$0.00	"$1,417.16"	$797.15	$797.15	$0.00	$0.00	$0.00	$380.29	"$1,354.22"	"$1,354.22"	$0.00	$0.00	$380.25	$0.00	"$1,079.25"	"$1,079.25"	$0.00	$885.73	"$1,402.99"	"$1,417.16"	$0.00		$0.00	$269.16	$0.00	$0.00	$282.01	$0.00	$0.00	$0.00	$0.00	$0.00
281.43	SUP	HCPCS C1713		281.430  -  PLATE BONE 150D STANDARD BARREL 62MM 38MM 3 HOLE DHS/DCP	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.44	SUP	HCPCS C1713		281.440  -  PLATE BN 150D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$181.76	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.45	SUP	HCPCS C1713		281.450  -  PLATE BN 150D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.46	SUP	HCPCS C1713		281.460  -  PLATE BN 150D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.48	SUP	HCPCS C1713		281.480  -  PLATE BN 150D STD BRL 142MM NS 38MM DHS 8 HL SS HIP 4.5MM	BOTH IP/OP	"$1,295.15 "	$958.41	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$269.94	$961.26	$961.26	$0.00	$0.00	$269.91	$0.00	$766.08	$766.08	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
281.502	SUP	HCPCS C1713		281.502  -  PLATE BONE 130D SHORT BARREL 46MM 25MM 2 HOLE DHS/DCP	BOTH IP/OP	"$1,003.68 "	$742.72	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$209.19	$744.93	$744.93	$0.00	$0.00	$209.17	$0.00	$593.67	$593.67	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.503	SUP	HCPCS C1713		281.503  -  PLATE BONE 130D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP	BOTH IP/OP	"$1,003.68 "	$742.72	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$209.19	$744.93	$744.93	$0.00	$0.00	$209.17	$0.00	$593.67	$593.67	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.504	SUP	HCPCS C1713		281.504  -  PLATE BONE 130D SHORT BARREL 78MM 25MM 4 HOLE DHS/DCP	BOTH IP/OP	"$1,003.68 "	$742.72	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$209.19	$744.93	$744.93	$0.00	$0.00	$209.17	$0.00	$593.67	$593.67	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.505	SUP	HCPCS C1713		281.505  -  PLATE BONE 130D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP	BOTH IP/OP	"$1,003.68 "	$742.72	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$209.19	$744.93	$744.93	$0.00	$0.00	$209.17	$0.00	$593.67	$593.67	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.506	SUP	HCPCS C1713		281.506  -  PLATE BONE 130D SHORT BARREL 110MM 25MM 6 HOLE DHS/DCP	BOTH IP/OP	"$1,003.68 "	$742.72	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$209.19	$744.93	$744.93	$0.00	$0.00	$209.17	$0.00	$593.67	$593.67	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.52	SUP	HCPCS C1713		281.520  -  PLATE BN 135D SHRT BRL 46MM NS 25MM DHS 2 HL SS HIP 4.5MM	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.53	SUP	HCPCS C1713		281.530  -  PLATE BONE 135D SHORT BARREL 62MM 25MM 3 HOLE COMPRESSION	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.54	SUP	HCPCS C1713		281.540  -  PLATE BN 135D SHRT BRL 12.6MM 78X19X5.8MM NS 25MM DHS DCP 4	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.55	SUP	HCPCS C1713		281.550  -  PLATE BONE 135D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.56	SUP	HCPCS C1713		281.560  -  PLATE BONE 135D SHORT BARREL 110MM 6 HOLE DHS STAINLESS	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.62	SUP	HCPCS C1713		281.620  -  PLATE BN 140D SHRT BRL 46MM NS 25MM DHS 2 HL SS HIP 4.5MM	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.63	SUP	HCPCS C1713		281.630  -  PLATE BONE 140D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.64	SUP	HCPCS C1713		281.640  -  PLATE BONE 140D SHORT BARREL 78MM 25MM 4 HOLE DHS/DCP	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.65	SUP	HCPCS C1713		281.650  -  PLATE BONE 140D SHORT BARREL 94MM 25MM 5 HOLE DHS STAINLESS	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.66	SUP	HCPCS C1713		281.660  -  PLATE BONE 140D SHORT BARREL 110MM 25MM 6 HOLE DHS/DCP	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.72	SUP	HCPCS C1713		281.720  -  PLATE BN 145D SHRT BRL 46MM NS 25MM DHS 2 HL SS HIP 4.5MM	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.73	SUP	HCPCS C1713		281.730  -  PLATE BONE 145D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.74	SUP	HCPCS C1713		281.740  -  PLATE BONE 145D SHORT BARREL 78MM 25MM 4 HOLE DHS/DCP	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.75	SUP	HCPCS C1713		281.750  -  PLATE BONE 145D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.76	SUP	HCPCS C1713		281.760  -  PLATE BONE 145D SHORT BARREL 110MM 25MM 6 HOLE DHS/DCP	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.82	SUP	HCPCS C1713		281.820  -  PLATE BONE 150D 2 FLAT LP SHORT BARREL 12.6MM 46X19X5.8MM 25	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.83	SUP	HCPCS C1713		281.830  -  PLATE BONE 150D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.84	SUP	HCPCS C1713		281.840  -  PLATE BN 150D SHRT BRL 12.6MM 78X19X5.8MM NS 25MM DHS DCP 4	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.85	SUP	HCPCS C1713		281.850  -  PLATE BONE 150D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.86	SUP	HCPCS C1713		281.860  -  PLATE BN 150D SHRT BRL 12.6MM 110X19X5.8MM NS 25MM DHS DCP 6	BOTH IP/OP	$974.43 	$721.08	$0.00	$779.54	$438.49	$438.49	$0.00	$0.00	$0.00	$203.09	$723.22	$723.22	$0.00	$0.00	$203.07	$0.00	$576.37	$576.37	$0.00	$487.21	$771.75	$779.54	$0.00		$0.00	$148.06	$0.00	$0.00	$155.13	$0.00	$0.00	$0.00	$0.00	$0.00
281.869	SUP	HCPCS C1713		281.869  -  PLATE BN SHRT 138MM NS SS DHS TROCH STAB	BOTH IP/OP	"$1,073.95 "	$794.72	$0.00	$834.14	$469.20	$469.20	$0.00	$0.00	$0.00	$223.84	$797.09	$797.09	$0.00	$0.00	$223.81	$0.00	$635.24	$635.24	$0.00	$521.34	$825.80	$834.14	$0.00		$0.00	$158.42	$0.00	$0.00	$165.99	$0.00	$0.00	$0.00	$0.00	$0.00
281.87	SUP	HCPCS C1713		281.870  -  PLATE BN LNG 148MM NS SS DHS TROCH STAB	BOTH IP/OP	"$1,042.68 "	$771.58	$0.00	$834.14	$469.20	$469.20	$0.00	$0.00	$0.00	$217.32	$773.87	$773.87	$0.00	$0.00	$217.29	$0.00	$616.74	$616.74	$0.00	$521.34	$825.80	$834.14	$0.00		$0.00	$158.42	$0.00	$0.00	$165.99	$0.00	$0.00	$0.00	$0.00	$0.00
281.9	SUP	HCPCS C1713		281.900  -  PLATE BN 95D SHRT BRL 12.6MM 178X16X5.4MM NS 25MM DCS DCP 10	BOTH IP/OP	"$1,685.48 "	"$1,247.26"	$0.00	"$1,348.38"	$758.46	$758.46	$0.00	$0.00	$0.00	$351.30	"$1,250.96"	"$1,250.96"	$0.00	$0.00	$351.25	$0.00	$996.96	$996.96	$0.00	$842.74	"$1,334.90"	"$1,348.38"	$0.00		$0.00	$256.09	$0.00	$0.00	$268.33	$0.00	$0.00	$0.00	$0.00	$0.00
281.925	SUP	HCPCS C1713		281.925  -  PLATE BN 95D SHRT BRL 210MM NS 25MM DCS 12 HL SS CNDRL 4.5MM	BOTH IP/OP	"$1,962.35 "	"$1,452.14"	$0.00	"$1,524.16"	$857.34	$857.34	$0.00	$0.00	$0.00	$409.00	"$1,456.46"	"$1,456.46"	$0.00	$0.00	$408.95	$0.00	"$1,160.73"	"$1,160.73"	$0.00	$952.60	"$1,508.92"	"$1,524.16"	$0.00		$0.00	$289.48	$0.00	$0.00	$303.31	$0.00	$0.00	$0.00	$0.00	$0.00
281.93	SUP	HCPCS C1713		281.930  -  PLATE BN 95D SHRT BRL 12.6MM 242X16X5.4MM NS 25MM DCS DCP 14	BOTH IP/OP	"$1,905.20 "	"$1,409.85"	$0.00	"$1,524.16"	$857.34	$857.34	$0.00	$0.00	$0.00	$397.09	"$1,414.04"	"$1,414.04"	$0.00	$0.00	$397.04	$0.00	"$1,126.93"	"$1,126.93"	$0.00	$952.60	"$1,508.92"	"$1,524.16"	$0.00		$0.00	$289.48	$0.00	$0.00	$303.31	$0.00	$0.00	$0.00	$0.00	$0.00
281.94	SUP	HCPCS C1713		281.940  -  PLATE BN 95D SHRT BRL 12.6MM 274X16X5.4MM NS 25MM DCS DCP 16	BOTH IP/OP	"$2,030.75 "	"$1,502.76"	$0.00	"$1,624.60"	$913.84	$913.84	$0.00	$0.00	$0.00	$423.26	"$1,507.22"	"$1,507.22"	$0.00	$0.00	$423.21	$0.00	"$1,201.19"	"$1,201.19"	$0.00	"$1,015.38"	"$1,608.35"	"$1,624.60"	$0.00		$0.00	$308.56	$0.00	$0.00	$323.30	$0.00	$0.00	$0.00	$0.00	$0.00
281.95	SUP	HCPCS C1713		281.950  -  PLATE BONE 95D 306MM 25MM 18 HOLE DCS STAINLESS STEEL	BOTH IP/OP	"$2,590.30 "	"$1,916.82"	$0.00	"$2,072.24"	"$1,165.64"	"$1,165.64"	$0.00	$0.00	$0.00	$539.88	"$1,922.52"	"$1,922.52"	$0.00	$0.00	$539.82	$0.00	"$1,277.02"	"$1,277.02"	$0.00	"$1,295.15"	"$2,051.52"	"$2,072.24"	$0.00		$0.00	$393.57	$0.00	$0.00	$412.38	$0.00	$0.00	$0.00	$0.00	$0.00
281.96	SUP	HCPCS C1713		281.960  -  PLATE BN 95D SHRT BRL 12.6MM 114X16X5.4MM NS 25MM DCS DCP 6	BOTH IP/OP	"$1,685.48 "	"$1,247.26"	$0.00	"$1,348.38"	$758.46	$758.46	$0.00	$0.00	$0.00	$351.30	"$1,250.96"	"$1,250.96"	$0.00	$0.00	$351.25	$0.00	$996.96	$996.96	$0.00	$842.74	"$1,334.90"	"$1,348.38"	$0.00		$0.00	$256.09	$0.00	$0.00	$268.33	$0.00	$0.00	$0.00	$0.00	$0.00
281.97	SUP	HCPCS C1713		281.970  -  PLATE BONE 95D 338MM 25MM 20 HOLE DCS DCP STAINLESS STEEL	BOTH IP/OP	"$2,676.28 "	"$1,980.45"	$0.00	"$2,141.02"	"$1,204.32"	"$1,204.32"	$0.00	$0.00	$0.00	$557.80	"$1,986.33"	"$1,986.33"	$0.00	$0.00	$557.74	$0.00	"$1,319.40"	"$1,319.40"	$0.00	"$1,338.14"	"$2,119.61"	"$2,141.02"	$0.00		$0.00	$406.64	$0.00	$0.00	$426.06	$0.00	$0.00	$0.00	$0.00	$0.00
281.98	SUP	HCPCS C1713		281.980  -  PLATE BN 95D SHRT BRL 12.6MM 146X16X5.4MM NS 25MM DCS DCP 8	BOTH IP/OP	"$1,685.48 "	"$1,247.26"	$0.00	"$1,348.38"	$758.46	$758.46	$0.00	$0.00	$0.00	$351.30	"$1,250.96"	"$1,250.96"	$0.00	$0.00	$351.25	$0.00	$996.96	$996.96	$0.00	$842.74	"$1,334.90"	"$1,348.38"	$0.00		$0.00	$256.09	$0.00	$0.00	$268.33	$0.00	$0.00	$0.00	$0.00	$0.00
281.99	SUP	HCPCS C1713		281.990  -  PLATE BONE 95D BARREL 370MM 22 HOLE DCS STAINLESS STEEL	BOTH IP/OP	"$2,795.00 "	"$2,068.30"	$0.00	"$2,236.00"	"$1,257.75"	"$1,257.75"	$0.00	$0.00	$0.00	$582.55	"$2,074.45"	"$2,074.45"	$0.00	$0.00	$582.48	$0.00	"$1,377.94"	"$1,377.94"	$0.00	"$1,397.50"	"$2,213.64"	"$2,236.00"	$0.00		$0.00	$424.68	$0.00	$0.00	$444.96	$0.00	$0.00	$0.00	$0.00	$0.00
282.235	SUP	HCPCS C1713		282.235  -  BLADE IM NAIL 80MM LCP DHHS HIP SS CMPR PLT NONSTRL	BOTH IP/OP	$687.60 	$508.82	$0.00	$550.08	$309.42	$309.42	$0.00	$0.00	$0.00	$143.31	$510.34	$510.34	$0.00	$0.00	$143.30	$0.00	$406.72	$406.72	$0.00	$343.80	$544.58	$550.08	$0.00		$0.00	$107.61	$0.00	$0.00	$109.47	$0.00	$0.00	$0.00	$0.00	$0.00
282.236	SUP	HCPCS C1713		282.236  -  BLADE IM NAIL 85MM LCP DHHS HIP SS CMPR PLT NONSTRL	BOTH IP/OP	$687.60 	$508.82	$0.00	$550.08	$309.42	$309.42	$0.00	$0.00	$0.00	$143.31	$510.34	$510.34	$0.00	$0.00	$143.30	$0.00	$406.72	$406.72	$0.00	$343.80	$544.58	$550.08	$0.00		$0.00	$107.61	$0.00	$0.00	$109.47	$0.00	$0.00	$0.00	$0.00	$0.00
282.24	SUP	HCPCS C1713		282.240  -  BLADE 105MM HLX LCP DHHS SS ORTH SURG NONSTRL	BOTH IP/OP	$741.88 	$548.99	$0.00	$593.50	$333.84	$333.84	$0.00	$0.00	$0.00	$154.63	$550.62	$550.62	$0.00	$0.00	$154.61	$0.00	$438.82	$438.82	$0.00	$370.94	$587.57	$593.50	$0.00		$0.00	$116.10	$0.00	$0.00	$118.11	$0.00	$0.00	$0.00	$0.00	$0.00
282.241	SUP	HCPCS C1713		282.241  -  BLADE FIX 110MM LCP DHHS SS HLCL STRL	BOTH IP/OP	$741.88 	$548.99	$0.00	$593.50	$333.84	$333.84	$0.00	$0.00	$0.00	$154.63	$550.62	$550.62	$0.00	$0.00	$154.61	$0.00	$438.82	$438.82	$0.00	$370.94	$587.57	$593.50	$0.00		$0.00	$116.10	$0.00	$0.00	$118.11	$0.00	$0.00	$0.00	$0.00	$0.00
282.242	SUP	HCPCS C1713		282.242  -  BLADE FIX 115MM LCP DHHS SS HLCL STRL	BOTH IP/OP	$741.88 	$548.99	$0.00	$593.50	$333.84	$333.84	$0.00	$0.00	$0.00	$154.63	$550.62	$550.62	$0.00	$0.00	$154.61	$0.00	$438.82	$438.82	$0.00	$370.94	$587.57	$593.50	$0.00		$0.00	$116.10	$0.00	$0.00	$118.11	$0.00	$0.00	$0.00	$0.00	$0.00
282.5	SUP	HCPCS C1713		282.50  -  PLATE 95D 92 MMX 50MM SS 5 HOLE DCP BONE SM ADLT/YTH 50MM	BOTH IP/OP	$934.85 	$691.79	$0.00	$747.88	$420.68	$420.68	$0.00	$0.00	$0.00	$194.85	$693.85	$693.85	$0.00	$0.00	$194.82	$0.00	$552.96	$552.96	$0.00	$467.43	$740.40	$747.88	$0.00		$0.00	$142.04	$0.00	$0.00	$148.83	$0.00	$0.00	$0.00	$0.00	$0.00
282.52	SUP	HCPCS C1713		282.52  -  PLATE BONE 95D SMALL STATURE 92MM 60MM 5 HOLE DCP STAINLESS	BOTH IP/OP	$962.90 	$712.55	$0.00	$747.88	$420.68	$420.68	$0.00	$0.00	$0.00	$200.69	$714.66	$714.66	$0.00	$0.00	$200.67	$0.00	$569.56	$569.56	$0.00	$467.43	$740.40	$747.88	$0.00		$0.00	$142.04	$0.00	$0.00	$148.83	$0.00	$0.00	$0.00	$0.00	$0.00
282.54	SUP	HCPCS C1713		282.54  -  PLATE BONE 95D SMALL STATURE 92MM 70MM 5 HOLE DCP LC-DCP	BOTH IP/OP	$962.90 	$712.55	$0.00	$747.88	$420.68	$420.68	$0.00	$0.00	$0.00	$200.69	$714.66	$714.66	$0.00	$0.00	$200.67	$0.00	$569.56	$569.56	$0.00	$467.43	$740.40	$747.88	$0.00		$0.00	$142.04	$0.00	$0.00	$148.83	$0.00	$0.00	$0.00	$0.00	$0.00
282.58	SUP	HCPCS C1713		282.58  -  PLATE BONE 95D SMALL STATURE 40MM 92MM 5 HOLE DCP STAINLESS	BOTH IP/OP	$962.90 	$712.55	$0.00	$747.88	$420.68	$420.68	$0.00	$0.00	$0.00	$200.69	$714.66	$714.66	$0.00	$0.00	$200.67	$0.00	$569.56	$569.56	$0.00	$467.43	$740.40	$747.88	$0.00		$0.00	$142.04	$0.00	$0.00	$148.83	$0.00	$0.00	$0.00	$0.00	$0.00
282.6	SUP	HCPCS C1713		282.600  -  SIDEPLATE BONE 130D STANDARD BARREL 54MM 38MM 2 HOLE LCP	BOTH IP/OP	"$1,056.33 "	$781.68	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$220.16	$784.00	$784.00	$0.00	$0.00	$220.14	$0.00	$624.82	$624.82	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.601	SUP	HCPCS C1713		282.601  -  SIDEPLATE BONE 130D STANDARD BARREL 72MM 38MM 3 HOLE LCP	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.602	SUP	HCPCS C1713		282.602  -  SIDEPLATE BONE 130D STANDARD BARREL 90MM 4 HOLE LCP DHHS	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.603	SUP	HCPCS C1713		282.603  -  SIDEPLATE BONE 130D STANDARD BARREL 108MM 5 HOLE LCP DHHS	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.604	SUP	HCPCS C1713		282.604  -  SIDEPLATE BONE 130D STANDARD BARREL 126MM 38MM 6 HOLE LCP	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.61	SUP	HCPCS C1713		282.610  -  SIDEPLATE BONE 135D STANDARD BARREL 54MM 38MM 2 HOLE LCP	BOTH IP/OP	"$1,056.33 "	$781.68	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$220.16	$784.00	$784.00	$0.00	$0.00	$220.14	$0.00	$624.82	$624.82	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.611	SUP	HCPCS C1713		282.611  -  SIDEPLATE BONE 135D STANDARD BARREL 72MM 38MM 3 HOLE LCP	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.612	SUP	HCPCS C1713		282.612  -  SIDEPLATE BONE 135D STANDARD BARREL 90MM 38MM 4 HOLE LCP	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.613	SUP	HCPCS C1713		282.613  -  SIDEPLATE BONE 135D STANDARD BARREL 108MM 38MM 5 HOLE LCP	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.614	SUP	HCPCS C1713		282.614  -  SIDEPLATE BONE 135D STANDARD BARREL 126MM 38MM 6 HOLE LCP	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.63	SUP	HCPCS C1713		282.630  -  SIDEPLATE BONE 140D STANDARD BARREL LP 54MM 38MM 2 HOLE LCP	BOTH IP/OP	"$1,056.33 "	$781.68	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$220.16	$784.00	$784.00	$0.00	$0.00	$220.14	$0.00	$624.82	$624.82	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.631	SUP	HCPCS C1713		282.631  -  SIDEPLATE BONE 140D STANDARD BARREL 72MM 38MM 3 HOLE	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.632	SUP	HCPCS C1713		282.632  -  SIDEPLATE BONE 140D STANDARD BARREL 90MM 38MM 4 HOLE	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.633	SUP	HCPCS C1713		282.633  -  SIDEPLATE BONE 140D STANDARD BARREL 108MM 38MM 5 HOLE	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.634	SUP	HCPCS C1713		282.634  -  SIDEPLATE BONE 140D STANDARD BARREL 126MM 38MM 6 HOLE	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.64	SUP	HCPCS C1713		282.640  -  SIDEPLATE BONE 145D STANDARD BARREL LP 54MM 38MM 2 HOLE LCP	BOTH IP/OP	"$1,056.33 "	$781.68	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$220.16	$784.00	$784.00	$0.00	$0.00	$220.14	$0.00	$624.82	$624.82	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.641	SUP	HCPCS C1713		282.641  -  SIDEPLATE BONE 145D STANDARD BARREL 72MM 38MM 3 HOLE	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.642	SUP	HCPCS C1713		282.642  -  SIDEPLATE BONE 145D STANDARD BARREL 90MM 38MM 4 HOLE	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.643	SUP	HCPCS C1713		282.643  -  SIDEPLATE BONE 145D STANDARD BARREL 108MM 38MM 5 HOLE	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.644	SUP	HCPCS C1713		282.644  -  SIDEPLATE BONE 145D STANDARD BARREL 126MM 38MM 6 HOLE	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.65	SUP	HCPCS C1713		282.650  -  SIDEPLATE BONE 150D STANDARD BARREL LP 54MM 38MM 2 HOLE LCP	BOTH IP/OP	"$1,056.33 "	$781.68	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$220.16	$784.00	$784.00	$0.00	$0.00	$220.14	$0.00	$624.82	$624.82	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.651	SUP	HCPCS C1713		282.651  -  SIDEPLATE BONE 150D STANDARD BARREL 72MM 38MM 3 HOLE LCP	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.652	SUP	HCPCS C1713		282.652  -  SIDEPLATE BONE 150D STANDARD BARREL 90MM 38MM 4 HOLE LCP	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.653	SUP	HCPCS C1713		282.653  -  SIDEPLATE BONE 150D STANDARD BARREL 108MM 38MM 5 HOLE LCP	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.654	SUP	HCPCS C1713		282.654  -  SIDEPLATE BONE 150D STANDARD BARREL 126MM 38MM 6 HOLE LCP	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.67	SUP	HCPCS C1713		282.670  -  SIDEPLATE BONE 130D SHORT BARREL LP 54MM 25MM 2 HOLE LCP	BOTH IP/OP	"$1,056.33 "	$781.68	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$220.16	$784.00	$784.00	$0.00	$0.00	$220.14	$0.00	$624.82	$624.82	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.672	SUP	HCPCS C1713		282.672  -  SIDEPLATE BONE 130D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.676	SUP	HCPCS C1713		282.676  -  SIDEPLATE BONE 135D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.678	SUP	HCPCS C1713		282.678  -  SIDEPLATE BONE 135D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.683	SUP	HCPCS C1713		282.683  -  SIDEPLATE BONE 140D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.688	SUP	HCPCS C1713		282.688  -  SIDEPLATE BONE 145D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.691	SUP	HCPCS C1713		282.691  -  SIDEPLATE BONE 150D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.693	SUP	HCPCS C1713		282.693  -  SIDEPLATE BONE 150D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$845.06	$475.35	$475.35	$0.00	$0.00	$0.00	$226.77	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$643.55	$643.55	$0.00	$528.16	$836.61	$845.06	$0.00		$0.00	$160.50	$0.00	$0.00	$168.17	$0.00	$0.00	$0.00	$0.00	$0.00
282.7	SUP	HCPCS C1713		282.70  -  PLATE BONE 95D SMALL STATURE T PROFILE 124MM 50MM 7 HOLE DCP	BOTH IP/OP	$978.53 	$724.11	$0.00	$782.82	$440.34	$440.34	$0.00	$0.00	$0.00	$203.95	$726.26	$726.26	$0.00	$0.00	$203.92	$0.00	$578.80	$578.80	$0.00	$489.26	$775.00	$782.82	$0.00		$0.00	$148.68	$0.00	$0.00	$155.78	$0.00	$0.00	$0.00	$0.00	$0.00
282.72	SUP	HCPCS C1713		282.72  -  PLATE BONE 95D SMALL STATURE 124MM 60MM 7 HOLE ANGLED DCP	BOTH IP/OP	"$1,007.88 "	$745.83	$0.00	$782.82	$440.34	$440.34	$0.00	$0.00	$0.00	$210.07	$748.04	$748.04	$0.00	$0.00	$210.04	$0.00	$596.16	$596.16	$0.00	$489.26	$775.00	$782.82	$0.00		$0.00	$148.68	$0.00	$0.00	$155.78	$0.00	$0.00	$0.00	$0.00	$0.00
282.74	SUP	HCPCS C1713		282.74  -  PLATE BONE 95D SMALL STATURE 124MM 70MM 7 HOLE CNDYLR DCP	BOTH IP/OP	"$1,007.88 "	$745.83	$0.00	$782.82	$440.34	$440.34	$0.00	$0.00	$0.00	$210.07	$748.04	$748.04	$0.00	$0.00	$210.04	$0.00	$596.16	$596.16	$0.00	$489.26	$775.00	$782.82	$0.00		$0.00	$148.68	$0.00	$0.00	$155.78	$0.00	$0.00	$0.00	$0.00	$0.00
282.78	SUP	HCPCS C1713		282.78  -  PLATE BONE 95D SMALL STATURE 124MM 40MM 7 HOLE DCP CAPOS	BOTH IP/OP	"$1,007.88 "	$745.83	$0.00	$782.82	$440.34	$440.34	$0.00	$0.00	$0.00	$210.07	$748.04	$748.04	$0.00	$0.00	$210.04	$0.00	$596.16	$596.16	$0.00	$489.26	$775.00	$782.82	$0.00		$0.00	$148.68	$0.00	$0.00	$155.78	$0.00	$0.00	$0.00	$0.00	$0.00
282.8	SUP	Custom 27803010		282.80  -  STAPLE BONE 23X20X3MM STAINLESS STEEL NONSTRL	BOTH IP/OP	$251.75 	$186.30	$0.00	$201.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.85	$186.85	$0.00	$0.00	$52.46	$0.00	$0.00	$0.00	$0.00	$125.88	$199.39	$201.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.82	SUP	Custom 27803010		282.82  -  STAPLE BONE 24MM STAINLESS STEEL ORTHOPEDIC NONSTRL	BOTH IP/OP	$251.75 	$186.30	$0.00	$201.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.85	$186.85	$0.00	$0.00	$52.46	$0.00	$0.00	$0.00	$0.00	$125.88	$199.39	$201.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.9	SUP	HCPCS C1713		282.90  -  PLATE BONE 95D SMALL STATURE T PROFILE 156MM 50MM 9 HOLE DCP	BOTH IP/OP	"$1,046.78 "	$774.62	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$218.17	$776.92	$776.92	$0.00	$0.00	$218.15	$0.00	$619.17	$619.17	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
282.92	SUP	HCPCS C1713		282.92  -  PLATE BONE 95D SMALL STATURE 156MM 60MM 9 HOLE ANGLED BLADE	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
282.94	SUP	HCPCS C1713		282.94  -  PLATE BONE 95D SMALL STATURE 156MM 70MM 9 HOLE DCP STAINLESS	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
282.98	SUP	HCPCS C1713		282.98  -  PLATE BONE 95D SMALL STATURE 156X40MM 40MM 9 HOLE CNDYLR DCP	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
283.4	SUP	HCPCS C1713		283.40  -  PLATE BONE 130D SMALL STATURE 50MM 60MM 4 HOLE ANGLED BLADE	BOTH IP/OP	$937.58 	$693.81	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$195.41	$695.87	$695.87	$0.00	$0.00	$195.39	$0.00	$554.58	$554.58	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
283.42	SUP	HCPCS C1713		283.42  -  PLATE BONE 130D SMALL STATURE 60MM 4 HOLE ANGLED BLADE DCP	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
283.44	SUP	HCPCS C1713		283.44  -  PLATE BONE 130D SMALL STATURE 70MM 60MM ANGLED BLADE DCP	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
283.46	SUP	HCPCS C1713		283.46  -  PLATE BONE 130D SMALL STATURE 80MM 60MM 4 HOLE ANGLED BLADE	BOTH IP/OP	$965.70 	$714.62	$0.00	$750.06	$421.91	$421.91	$0.00	$0.00	$0.00	$201.28	$716.74	$716.74	$0.00	$0.00	$201.25	$0.00	$571.21	$571.21	$0.00	$468.79	$742.56	$750.06	$0.00		$0.00	$142.46	$0.00	$0.00	$149.26	$0.00	$0.00	$0.00	$0.00	$0.00
283.6	SUP	HCPCS C1713		283.60  -  PLATE BONE 130D 104MM 50MM 6 HOLE ANGLED BLADE DCP STAINLESS	BOTH IP/OP	$993.55 	$735.23	$0.00	$794.84	$447.10	$447.10	$0.00	$0.00	$0.00	$207.08	$737.41	$737.41	$0.00	$0.00	$207.06	$0.00	$587.68	$587.68	$0.00	$496.78	$786.89	$794.84	$0.00		$0.00	$150.96	$0.00	$0.00	$158.17	$0.00	$0.00	$0.00	$0.00	$0.00
283.62	SUP	HCPCS C1713		283.62  -  PLATE BONE 130D 104MM 60MM 6 HOLE ANGLED BLADE DCP STAINLESS	BOTH IP/OP	"$1,023.35 "	$757.28	$0.00	$794.84	$447.10	$447.10	$0.00	$0.00	$0.00	$213.29	$759.53	$759.53	$0.00	$0.00	$213.27	$0.00	$605.31	$605.31	$0.00	$496.78	$786.89	$794.84	$0.00		$0.00	$150.96	$0.00	$0.00	$158.17	$0.00	$0.00	$0.00	$0.00	$0.00
283.64	SUP	HCPCS C1713		283.64  -  PLATE BLADE 130D 104MM 70MM 6 HOLE ANGLED DCP STAINLESS	BOTH IP/OP	"$1,023.35 "	$757.28	$0.00	$794.84	$447.10	$447.10	$0.00	$0.00	$0.00	$213.29	$759.53	$759.53	$0.00	$0.00	$213.27	$0.00	$605.31	$605.31	$0.00	$496.78	$786.89	$794.84	$0.00		$0.00	$150.96	$0.00	$0.00	$158.17	$0.00	$0.00	$0.00	$0.00	$0.00
283.66	SUP	HCPCS C1713		283.66  -  SCREW BONE 130D 104MM 80MM 6 HOLE ANGLED BLADE DCP STAINLESS	BOTH IP/OP	"$1,023.35 "	$757.28	$0.00	$794.84	$447.10	$447.10	$0.00	$0.00	$0.00	$213.29	$759.53	$759.53	$0.00	$0.00	$213.27	$0.00	$605.31	$605.31	$0.00	$496.78	$786.89	$794.84	$0.00		$0.00	$150.96	$0.00	$0.00	$158.17	$0.00	$0.00	$0.00	$0.00	$0.00
283.9	SUP	HCPCS C1713		283.90  -  PLATE BONE 130D SMALL STATURE 152MM 50MM 9 HOLE DCP CAPOS	BOTH IP/OP	"$1,072.70 "	$793.80	$0.00	$858.16	$482.72	$482.72	$0.00	$0.00	$0.00	$223.58	$796.16	$796.16	$0.00	$0.00	$223.55	$0.00	$634.50	$634.50	$0.00	$536.35	$849.58	$858.16	$0.00		$0.00	$162.99	$0.00	$0.00	$170.77	$0.00	$0.00	$0.00	$0.00	$0.00
283.92	SUP	HCPCS C1713		283.92  -  PLATE BONE 130D 4.5MM 152MM 60MM 9 HOLE BLADE ANGLED DCP	BOTH IP/OP	"$1,104.88 "	$817.61	$0.00	$858.16	$482.72	$482.72	$0.00	$0.00	$0.00	$230.28	$820.04	$820.04	$0.00	$0.00	$230.26	$0.00	$653.53	$653.53	$0.00	$536.35	$849.58	$858.16	$0.00		$0.00	$162.99	$0.00	$0.00	$170.77	$0.00	$0.00	$0.00	$0.00	$0.00
283.94	SUP	HCPCS C1713		283.94  -  PLATE BONE 130D 152MM 70MM 9 HOLE BLADE DCP STAINLESS STEEL	BOTH IP/OP	"$1,104.88 "	$817.61	$0.00	$858.16	$482.72	$482.72	$0.00	$0.00	$0.00	$230.28	$820.04	$820.04	$0.00	$0.00	$230.26	$0.00	$653.53	$653.53	$0.00	$536.35	$849.58	$858.16	$0.00		$0.00	$162.99	$0.00	$0.00	$170.77	$0.00	$0.00	$0.00	$0.00	$0.00
283.96	SUP	HCPCS C1713		283.96  -  PLATE BONE 130D 80MM 152MM 80MM 9 HOLE ANGLED BLADE DCP	BOTH IP/OP	"$1,104.88 "	$817.61	$0.00	$858.16	$482.72	$482.72	$0.00	$0.00	$0.00	$230.28	$820.04	$820.04	$0.00	$0.00	$230.26	$0.00	$653.53	$653.53	$0.00	$536.35	$849.58	$858.16	$0.00		$0.00	$162.99	$0.00	$0.00	$170.77	$0.00	$0.00	$0.00	$0.00	$0.00
288.025	SUP	Custom 27803010		288.025  -  DISTRACTOR SURG 10MM BODY STAINLESS STEEL NONSTRL	BOTH IP/OP	"$11,697.50 "	"$8,656.15"	$0.00	"$9,358.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.76"	$0.00	$0.00	$0.00	$0.00	"$5,848.75"	"$9,264.42"	"$9,358.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.026	SUP	Custom 27803010		288.026  -  DISTRACTOR SURG 15MM BODY STAINLESS STEEL NONSTRL	BOTH IP/OP	"$11,697.50 "	"$8,656.15"	$0.00	"$9,358.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.76"	$0.00	$0.00	$0.00	$0.00	"$5,848.75"	"$9,264.42"	"$9,358.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.027	SUP	Custom 27803010		288.027  -  DISTRACTOR SURG 20MM BODY STAINLESS STEEL NONSTRL	BOTH IP/OP	"$11,697.50 "	"$8,656.15"	$0.00	"$9,358.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.76"	$0.00	$0.00	$0.00	$0.00	"$5,848.75"	"$9,264.42"	"$9,358.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.028	SUP	Custom 27803010		288.028  -  DISTRACTOR SURG 25MM BODY STAINLESS STEEL NONSTRL	BOTH IP/OP	"$11,697.50 "	"$8,656.15"	$0.00	"$9,358.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.76"	$0.00	$0.00	$0.00	$0.00	"$5,848.75"	"$9,264.42"	"$9,358.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.038	SUP	Custom 27803010		288.038  -  FOOTPLATE BONE 6MM SPLINT STAINLESS STEEL RIGHT ANTERIOR	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$0.00	$0.00	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.039	SUP	Custom 27803010		288.039  -  FOOTPLATE BONE 10MM SPLINT STAINLESS STEEL RIGHT ANTERIOR	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$0.00	$0.00	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.04	SUP	Custom 27803010		288.040  -  FOOTPLATE BONE 14MM SPLINT STAINLESS STEEL RIGHT ANTERIOR	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$0.00	$0.00	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.042	SUP	Custom 27803010		288.042  -  FOOTPLATE BONE 6MM SPLINT STAINLESS STEEL LEFT ANTERIOR MAXL	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$0.00	$0.00	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.043	SUP	Custom 27803010		288.043  -  FOOTPLATE BONE 10MM SPLINT STAINLESS STEEL LEFT ANTERIOR	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$0.00	$0.00	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.044	SUP	Custom 27803010		288.044  -  FOOTPLATE BONE 14MM SPLINT STAINLESS STEEL LEFT ANTERIOR	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$0.00	$0.00	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.052	SUP	Custom 27803010		288.052  -  FOOTPLATE BONE SHORT 7MM OFFST STAINLESS STEEL POSTERIOR	BOTH IP/OP	"$2,952.50 "	"$2,184.85"	$0.00	"$2,362.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,191.35"	"$2,191.35"	$0.00	$0.00	$615.30	$0.00	$0.00	$0.00	$0.00	"$1,476.25"	"$2,338.38"	"$2,362.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.053	SUP	Custom 27803010		288.053  -  FOOTPLATE BONE SHORT 12MM OFFST STAINLESS STEEL POSTERIOR	BOTH IP/OP	"$2,952.50 "	"$2,184.85"	$0.00	"$2,362.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,191.35"	"$2,191.35"	$0.00	$0.00	$615.30	$0.00	$0.00	$0.00	$0.00	"$1,476.25"	"$2,338.38"	"$2,362.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.055	SUP	Custom 27803010		288.055  -  FOOTPLATE BONE MEDIUM 7MM OFFST STAINLESS STEEL POSTERIOR	BOTH IP/OP	"$2,952.50 "	"$2,184.85"	$0.00	"$2,362.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,191.35"	"$2,191.35"	$0.00	$0.00	$615.30	$0.00	$0.00	$0.00	$0.00	"$1,476.25"	"$2,338.38"	"$2,362.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.056	SUP	Custom 27803010		288.056  -  FOOTPLATE BONE MEDIUM 12MM OFFST STAINLESS STEEL POSTERIOR	BOTH IP/OP	"$2,952.50 "	"$2,184.85"	$0.00	"$2,362.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,191.35"	"$2,191.35"	$0.00	$0.00	$615.30	$0.00	$0.00	$0.00	$0.00	"$1,476.25"	"$2,338.38"	"$2,362.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.058	SUP	Custom 27803010		288.058  -  FOOTPLATE BONE TALL 7MM OFFST STAINLESS STEEL POSTERIOR MAXL	BOTH IP/OP	"$2,952.50 "	"$2,184.85"	$0.00	"$2,362.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,191.35"	"$2,191.35"	$0.00	$0.00	$615.30	$0.00	$0.00	$0.00	$0.00	"$1,476.25"	"$2,338.38"	"$2,362.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.059	SUP	Custom 27803010		288.059  -  FOOTPLATE BONE TALL 12MM OFFST STAINLESS STEEL POSTERIOR	BOTH IP/OP	"$2,952.50 "	"$2,184.85"	$0.00	"$2,362.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,191.35"	"$2,191.35"	$0.00	$0.00	$615.30	$0.00	$0.00	$0.00	$0.00	"$1,476.25"	"$2,338.38"	"$2,362.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288.065	SUP	HCPCS C1713		288.065  -  SCREW EXTERNAL DISTRCT 3.5MM STAINLESS STEEL NONSTRL	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
291.01	SUP	Custom 27803010		291.01  -  WIRE CERCLAGE 1MM 280MM EYE KWIRE STAINLESS STEEL NONSTRL	BOTH IP/OP	$15.18 	$11.23	$0.00	$11.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.27	$11.27	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$7.37	$11.67	$11.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.02	SUP	Custom 27203010		291.02  -  WIRE CERCLAGE 1.25MM 280MM EYE STAINLESS STEEL NONSTRL	BOTH IP/OP	$15.18 	$11.23	$0.00	$11.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.27	$11.27	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$7.37	$11.67	$11.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.03	SUP	Custom 27803010		291.03  -  WIRE CERCLAGE 1MM 600MM EYE STAINLESS STEEL NONSTRL	BOTH IP/OP	$22.91 	$16.95	$0.00	$17.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.01	$17.01	$0.00	$0.00	$4.77	$0.00	$0.00	$0.00	$0.00	$11.12	$17.62	$17.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.04	SUP	Custom 27203010		291.04  -  WIRE FIX 1.25MM 600MM CERCLAGE EYE STAINLESS STEEL	BOTH IP/OP	$22.91 	$16.95	$0.00	$17.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.01	$17.01	$0.00	$0.00	$4.77	$0.00	$0.00	$0.00	$0.00	$11.12	$17.62	$17.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.05	SUP	Custom 27203010		291.05  -  WIRE CERCLAGE 1MM 10MR COIL STAINLESS STEEL NONSTRL	BOTH IP/OP	$128.60 	$95.16	$0.00	$99.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.45	$95.45	$0.00	$0.00	$26.80	$0.00	$0.00	$0.00	$0.00	$62.43	$98.88	$99.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.06	SUP	Custom 27803010		291.06  -  WIRE CERCLAGE 1.25MM 1MM COIL STAINLESS STEEL NONSTRL	BOTH IP/OP	$128.60 	$95.16	$0.00	$99.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.45	$95.45	$0.00	$0.00	$26.80	$0.00	$0.00	$0.00	$0.00	$62.43	$98.88	$99.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.08	SUP	Custom 27803010		291.08  -  WIRE CERCLAGE .8MM 280MM EYE STAINLESS STEEL NONSTRL	BOTH IP/OP	$10.61 	$7.85	$0.00	$8.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.88	$7.88	$0.00	$0.00	$2.21	$0.00	$0.00	$0.00	$0.00	$5.15	$8.16	$8.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.09	SUP	Custom 27203010		291.09  -  WIRE CERCLAGE .8MM 10MR COIL STAINLESS STEEL NONSTRL	BOTH IP/OP	$128.60 	$95.16	$0.00	$99.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.45	$95.45	$0.00	$0.00	$26.80	$0.00	$0.00	$0.00	$0.00	$62.43	$98.88	$99.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.11	SUP	Custom 27803010		291.11  -  WIRE CERCLAGE 1.5MM 280MM EYE STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$15.18 	$11.23	$0.00	$11.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.27	$11.27	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$7.37	$11.67	$11.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.12	SUP	Custom 27203010		291.12  -  WIRE CERCLAGE 1.5MM 600MM EYE STAINLESS STEEL NONSTRL	BOTH IP/OP	$22.91 	$16.95	$0.00	$17.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.01	$17.01	$0.00	$0.00	$4.77	$0.00	$0.00	$0.00	$0.00	$11.12	$17.62	$17.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.13	SUP	Custom 27203010		291.13  -  WIRE CERCLAGE 1.5MM 10MM COIL STAINLESS STEEL NONSTRL	BOTH IP/OP	$128.60 	$95.16	$0.00	$99.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.45	$95.45	$0.00	$0.00	$26.80	$0.00	$0.00	$0.00	$0.00	$62.43	$98.88	$99.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.22	SUP	Custom 27203010		291.22  -  WIRE FX .4MM 150MM NS CRLGE SFT PCUT SS	BOTH IP/OP	$14.34 	$10.61	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.64	$10.64	$0.00	$0.00	$2.99	$0.00	$0.00	$0.00	$0.00	$6.96	$11.02	$11.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.24	SUP	Custom 27203010		291.24  -  WIRE CERCLAGE .6MM 175MM SOFT PRECUT STAINLESS STEEL NONSTRL	BOTH IP/OP	$15.18 	$11.23	$0.00	$11.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.27	$11.27	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$7.37	$11.67	$11.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.26	SUP	Custom 27203010		291.26  -  WIRE CERCLAGE .8MM 200MM SOFT PRECUT STAINLESS STEEL NONSTRL	BOTH IP/OP	$17.29 	$12.79	$0.00	$13.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.83	$12.83	$0.00	$0.00	$3.60	$0.00	$0.00	$0.00	$0.00	$8.39	$13.30	$13.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.27	SUP	Custom 27203010		291.27  -  WIRE CRLGE 1MM 250MM NS PCUT SFT SS	BOTH IP/OP	$18.84 	$13.94	$0.00	$14.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.98	$13.98	$0.00	$0.00	$3.93	$0.00	$0.00	$0.00	$0.00	$9.14	$14.49	$14.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.28	SUP	Custom 27203010		291.28  -  WIRE CRLGE 1.25MM 300MM NS PCUT SFT SS	BOTH IP/OP	$21.51 	$15.92	$0.00	$16.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.96	$15.96	$0.00	$0.00	$4.48	$0.00	$0.00	$0.00	$0.00	$10.44	$16.54	$16.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.02	SUP	HCPCS C1713		292.020  -  GWIRE ORTH 200MM 1.25MM	BOTH IP/OP	$24.68 	$18.26	$0.00	$19.74	$11.10	$11.10	$0.00	$0.00	$0.00	$5.14	$18.31	$18.31	$0.00	$0.00	$5.14	$0.00	$14.60	$14.60	$0.00	$12.34	$19.55	$19.74	$0.00		$0.00	$3.86	$0.00	$0.00	$3.93	$0.00	$0.00	$0.00	$0.00	$0.00
292.06	SUP	Custom 27203010		292.06  -  WIRE FIX .6MM 70MM TROCAR POINT KWIRE STAINLESS STEEL	BOTH IP/OP	$14.34 	$10.61	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.64	$10.64	$0.00	$0.00	$2.99	$0.00	$0.00	$0.00	$0.00	$6.96	$11.02	$11.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.08	SUP	Custom 27203010		292.08  -  WIRE FIX .8MM 70MM TROCAR POINT KWIRE STAINLESS STEEL	BOTH IP/OP	$14.34 	$10.61	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.64	$10.64	$0.00	$0.00	$2.99	$0.00	$0.00	$0.00	$0.00	$6.96	$11.02	$11.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.1	SUP	Custom 27203010		292.10  -  WIRE FIX 1MM 150MM TROCAR POINT KWIRE STAINLESS STEEL	BOTH IP/OP	$15.64 	$11.57	$0.00	$12.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.60	$11.60	$0.00	$0.00	$3.26	$0.00	$0.00	$0.00	$0.00	$7.82	$12.39	$12.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.11	SUP	Custom 27203010		292.11  -  WIRE FIX 1MM 285MM TROCAR POINT KWIRE STAINLESS STEEL	BOTH IP/OP	$20.66 	$15.29	$0.00	$16.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.34	$15.34	$0.00	$0.00	$4.31	$0.00	$0.00	$0.00	$0.00	$10.03	$15.89	$16.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.13	SUP	Custom 27203010		292.13  -  WIRE FX 1.25MM 285MM NS KRSH TROC PNT SS	BOTH IP/OP	$20.66 	$15.29	$0.00	$16.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.34	$15.34	$0.00	$0.00	$4.31	$0.00	$0.00	$0.00	$0.00	$10.03	$15.89	$16.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.18	SUP	Custom 27203010		292.18  -  WIRE FIX 1.6MM 285MM 5MM THREADED TROCAR POINT KWIRE	BOTH IP/OP	$20.66 	$15.29	$0.00	$16.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.34	$15.34	$0.00	$0.00	$4.31	$0.00	$0.00	$0.00	$0.00	$10.03	$15.89	$16.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.21	SUP	Custom 27203010		292.21  -  WIRE FIX 2MM 285MM TROCAR POINT KWIRE STAINLESS STEEL	BOTH IP/OP	$23.30 	$17.24	$0.00	$18.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.65	$18.45	$18.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.25	SUP	Custom 27203010		292.25  -  WIRE FIX 2.5MM 150MM TROCAR POINT KWIRE STAINLESS STEEL	BOTH IP/OP	$16.59 	$12.28	$0.00	$12.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.31	$12.31	$0.00	$0.00	$3.46	$0.00	$0.00	$0.00	$0.00	$8.05	$12.76	$12.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.26	SUP	Custom 27203010		292.26  -  WIRE FIX 2.5MM 285MM TROCAR KWIRE STAINLESS STEEL NONSTRL	BOTH IP/OP	$20.66 	$15.29	$0.00	$16.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.34	$15.34	$0.00	$0.00	$4.31	$0.00	$0.00	$0.00	$0.00	$10.03	$15.89	$16.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.3	SUP	Custom 27203010		292.30  -  WIRE FIX TROCAR 3MM 150MM KWIRE STAINLESS STEEL NONSTRL	BOTH IP/OP	$16.11 	$11.92	$0.00	$12.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.95	$11.95	$0.00	$0.00	$3.36	$0.00	$0.00	$0.00	$0.00	$8.05	$12.76	$12.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.31	SUP	Custom 27203010		292.31  -  WIRE FIX 3MM 285MM TROCAR POINT KWIRE STAINLESS STEEL	BOTH IP/OP	$20.66 	$15.29	$0.00	$16.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.34	$15.34	$0.00	$0.00	$4.31	$0.00	$0.00	$0.00	$0.00	$10.03	$15.89	$16.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.38	SUP	Custom 27203010		292.38  -  WIRE FIX 1.8MM 350MM SPADE POINT KWIRE STAINLESS STEEL	BOTH IP/OP	$119.20 	$88.21	$0.00	$92.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.47	$88.47	$0.00	$0.00	$24.84	$0.00	$0.00	$0.00	$0.00	$57.86	$91.66	$92.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.39	SUP	Custom 27203010		292.39  -  WIRE FIX 1.8MM 400MM SPADE POINT REDX KWIRE STAINLESS STEEL	BOTH IP/OP	$370.95 	$274.50	$0.00	$288.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.32	$275.32	$0.00	$0.00	$77.31	$0.00	$0.00	$0.00	$0.00	$180.08	$285.24	$288.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.4	SUP	Custom 27203010		292.40  -  WIRE FIX 2MM 350MM SPADE POINT KWIRE STAINLESS STEEL NONSTRL	BOTH IP/OP	$115.73 	$85.64	$0.00	$92.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.89	$85.89	$0.00	$0.00	$24.12	$0.00	$0.00	$0.00	$0.00	$57.86	$91.66	$92.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.41	SUP	Custom 27203010		292.41  -  WIRE FIX 2MM 400MM SPADE POINT REDX KWIRE STAINLESS STEEL	BOTH IP/OP	$370.95 	$274.50	$0.00	$288.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.32	$275.32	$0.00	$0.00	$77.31	$0.00	$0.00	$0.00	$0.00	$180.08	$285.24	$288.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.46	SUP	Custom 27203010		292.46  -  WIRE FX .6MM 70MM NS KRSH 2 END TROC PNT SS	BOTH IP/OP	$17.29 	$12.79	$0.00	$13.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.83	$12.83	$0.00	$0.00	$3.60	$0.00	$0.00	$0.00	$0.00	$8.39	$13.30	$13.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.48	SUP	Custom 27203010		292.48  -  WIRE FX .8MM 70MM NS KRSH 2 END TROC PNT SS	BOTH IP/OP	$17.29 	$12.79	$0.00	$13.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.83	$12.83	$0.00	$0.00	$3.60	$0.00	$0.00	$0.00	$0.00	$8.39	$13.30	$13.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.5	SUP	Custom 27203010		292.50  -  WIRE FIX 1MM 150MM 2 END TROCAR POINT KWIRE STAINLESS STEEL	BOTH IP/OP	$18.97 	$14.04	$0.00	$15.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.08	$14.08	$0.00	$0.00	$3.95	$0.00	$0.00	$0.00	$0.00	$9.49	$15.02	$15.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.52	SUP	Custom 27203010		292.52  -  WIRE FIX TROCAR 1.25MM 150MM KWIRE STAINLESS STEEL NONSTRL	BOTH IP/OP	$19.54 	$14.46	$0.00	$15.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.50	$14.50	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$9.49	$15.02	$15.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.56	SUP	Custom 27203010		292.56  -  WIRE FIX TROCAR 1.6MM 150MM 2 END KWIRE STAINLESS STEEL	BOTH IP/OP	$19.54 	$14.46	$0.00	$15.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.50	$14.50	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$9.49	$15.02	$15.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.58	SUP	Custom 27203010		292.58  -  WIRE FX 2MM 150MM NS KRSH 2 END TROC PNT SS	BOTH IP/OP	$19.54 	$14.46	$0.00	$15.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.50	$14.50	$0.00	$0.00	$4.07	$0.00	$0.00	$0.00	$0.00	$9.49	$15.02	$15.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.6	SUP	Custom 27203010		292.600  -  WIRE FX 1.25MM 100MM NS KRSH THRD TIP SS MN XTRNFXTR	BOTH IP/OP	$81.22 	$60.10	$0.00	$64.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.28	$60.28	$0.00	$0.00	$16.93	$0.00	$0.00	$0.00	$0.00	$40.61	$64.33	$64.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.619	SUP	HCPCS C1769		292.619  -  GUIDEWIRE ORTHOPEDIC .8MM 100MM SPADE POINT STAINLESS STEEL	BOTH IP/OP	$28.26 	$20.91	$0.00	$41.68	$14.90	$14.90	$0.00	$0.00	$0.00	$5.89	$20.97	$20.97	$0.00	$0.00	$5.89	$0.00	$16.71	$16.71	$0.00	$13.72	$21.72	$21.95	$0.00		$0.00	$41.68	$0.00	$0.00	$4.37	$0.00	$0.00	$0.00	$0.00	$0.00
292.62	SUP	HCPCS C1769		292.62  -  GWIRE ORTH 150MM 1.25MM SS THRD	BOTH IP/OP	$59.13 	$43.76	$0.00	$47.30	$32.10	$32.10	$0.00	$0.00	$0.00	$12.32	$43.88	$43.88	$0.00	$0.00	$12.32	$0.00	$34.97	$34.97	$0.00	$29.56	$46.83	$47.30	$0.00		$0.00	$9.25	$0.00	$0.00	$9.41	$0.00	$0.00	$0.00	$0.00	$0.00
292.621	SUP	HCPCS C1713		292.621  -  GUIDEWIRE ORTHOPEDIC 1.25MM 150MM THREADED SPADE POINT ON 2	BOTH IP/OP	$53.05 	$39.26	$0.00	$41.20	$23.18	$23.18	$0.00	$0.00	$0.00	$11.06	$39.37	$39.37	$0.00	$0.00	$11.06	$0.00	$31.38	$31.38	$0.00	$25.75	$40.79	$41.20	$0.00		$0.00	$7.83	$0.00	$0.00	$8.20	$0.00	$0.00	$0.00	$0.00	$0.00
292.622	SUP	HCPCS C1713		292.622  -  GUIDEWIRE ORTHOPEDIC 1.1MM 150MM THREAD STAINLESS STEEL	BOTH IP/OP	$55.50 	$41.07	$0.00	$43.12	$24.26	$24.26	$0.00	$0.00	$0.00	$11.57	$41.19	$41.19	$0.00	$0.00	$11.57	$0.00	$32.83	$32.83	$0.00	$26.95	$42.69	$43.12	$0.00		$0.00	$8.19	$0.00	$0.00	$8.58	$0.00	$0.00	$0.00	$0.00	$0.00
292.623	SUP	HCPCS C1713		292.623  -  GUIDEWIRE ORTHOPEDIC 1.1MM 150MM NONTHREADED STAINLESS STEEL	BOTH IP/OP	$52.70 	$39.00	$0.00	$40.94	$23.03	$23.03	$0.00	$0.00	$0.00	$10.98	$39.11	$39.11	$0.00	$0.00	$10.98	$0.00	$31.17	$31.17	$0.00	$25.59	$40.53	$40.94	$0.00		$0.00	$7.77	$0.00	$0.00	$8.15	$0.00	$0.00	$0.00	$0.00	$0.00
292.626	SUP	HCPCS C1769		292.626  -  GUIDEWIRE ORTHOPEDIC 150MM 1 END SPADE PONT STAINLESS STEEL	BOTH IP/OP	$62.40 	$46.18	$0.00	$49.92	$33.88	$33.88	$0.00	$0.00	$0.00	$13.01	$46.31	$46.31	$0.00	$0.00	$13.00	$0.00	$36.91	$36.91	$0.00	$31.20	$49.42	$49.92	$0.00		$0.00	$9.77	$0.00	$0.00	$9.93	$0.00	$0.00	$0.00	$0.00	$0.00
292.65	SUP	HCPCS C1769		292.65  -  GUIDEWIRE ORTHOPEDIC SPADE 2MM 230MM THREAD BLACK STAINLESS	BOTH IP/OP	$75.20 	$55.65	$0.00	$58.40	$39.64	$39.64	$0.00	$0.00	$0.00	$15.67	$55.81	$55.81	$0.00	$0.00	$15.67	$0.00	$44.48	$44.48	$0.00	$36.50	$57.82	$58.40	$0.00		$0.00	$11.09	$0.00	$0.00	$11.62	$0.00	$0.00	$0.00	$0.00	$0.00
292.651	SUP	HCPCS C1713		292.651  -  GUIDEWIRE ORTHOPEDIC 2MM 230MM THREADED SPADE POINT	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
292.652	SUP	HCPCS C1713		292.652  -  GUIDEWIRE ORTHOPEDIC 2MM 230MM THREADED SPADE POINT	BOTH IP/OP	$73.78 	$54.60	$0.00	$57.30	$32.23	$32.23	$0.00	$0.00	$0.00	$15.38	$54.76	$54.76	$0.00	$0.00	$15.37	$0.00	$43.64	$43.64	$0.00	$35.81	$56.73	$57.30	$0.00		$0.00	$10.88	$0.00	$0.00	$11.40	$0.00	$0.00	$0.00	$0.00	$0.00
292.653	SUP	Custom 27203010		292.653  -  GUIDEWIRE ORTHOPEDIC 2MM 330MM TROCAR THREAD STAINLESS STEEL	BOTH IP/OP	$111.05 	$82.18	$0.00	$86.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.42	$82.42	$0.00	$0.00	$23.14	$0.00	$0.00	$0.00	$0.00	$53.91	$85.40	$86.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.655	SUP	Custom 27203010		292.655  -  GUIDEWIRE ORTHOPEDIC 1.6MM 410MM	BOTH IP/OP	$101.90 	$75.41	$0.00	$79.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.63	$75.63	$0.00	$0.00	$21.24	$0.00	$0.00	$0.00	$0.00	$49.46	$78.35	$79.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.656	SUP	HCPCS C1713		292.656  -  GUIDEWIRE ORTHOPEDIC 2MM 230MM NONTHREADED STAINLESS STEEL	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
292.68	SUP	HCPCS C1713		292.68  -  GUIDEWIRE ORTHOPEDIC 2.8MM 300MM TROCAR THREAD STAINLESS	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
292.69	SUP	Custom 27203010		292.69  -  GUIDEWIRE ORTHOPEDIC 3.2MM 300MM CALIBRATE STAINLESS STEEL	BOTH IP/OP	$231.95 	$171.64	$0.00	$180.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.15	$172.15	$0.00	$0.00	$48.34	$0.00	$0.00	$0.00	$0.00	$112.59	$178.34	$180.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.699	SUP	Custom 27203010		292.699  -  WIRE FX 2MM 280MM NS KRSH THRD SPD PNT TIP SS	BOTH IP/OP	$76.60 	$56.68	$0.00	$59.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.85	$56.85	$0.00	$0.00	$15.96	$0.00	$0.00	$0.00	$0.00	$37.19	$58.91	$59.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.708	SUP	Custom 27203010		292.708  -  WIRE FX 1.6MM 100MM NS KRSH THRD TIP SS MN XTRNFXTR	BOTH IP/OP	$836.60 	$619.08	$0.00	$669.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$620.92	$620.92	$0.00	$0.00	$174.35	$0.00	$0.00	$0.00	$0.00	$418.30	$662.59	$669.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.71	SUP	Custom 27203010		292.71  -  WIRE FIX 1.6MM 15CM 5MM THREADED TROCAR POINT KWIRE	BOTH IP/OP	$294.15 	$217.67	$0.00	$235.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.32	$218.32	$0.00	$0.00	$61.30	$0.00	$0.00	$0.00	$0.00	$147.08	$232.97	$235.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.72	SUP	HCPCS C1713		292.72  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM THREAD STAINLESS STEEL	BOTH IP/OP	$63.25 	$46.81	$0.00	$49.14	$27.64	$27.64	$0.00	$0.00	$0.00	$13.18	$46.94	$46.94	$0.00	$0.00	$13.18	$0.00	$37.41	$37.41	$0.00	$30.71	$48.65	$49.14	$0.00		$0.00	$11.92	$0.00	$0.00	$9.78	$0.00	$0.00	$0.00	$0.00	$0.00
292.721	SUP	HCPCS C1713		292.721  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM THREADED SPADE POINT	BOTH IP/OP	$73.78 	$54.60	$0.00	$57.30	$32.23	$32.23	$0.00	$0.00	$0.00	$15.38	$54.76	$54.76	$0.00	$0.00	$15.37	$0.00	$43.64	$43.64	$0.00	$35.81	$56.73	$57.30	$0.00		$0.00	$10.88	$0.00	$0.00	$11.40	$0.00	$0.00	$0.00	$0.00	$0.00
292.722	SUP	HCPCS C1713		292.722  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM THREADED SPADE POINT	BOTH IP/OP	$55.18 	$40.83	$0.00	$42.84	$24.10	$24.10	$0.00	$0.00	$0.00	$11.50	$40.95	$40.95	$0.00	$0.00	$11.50	$0.00	$32.64	$32.64	$0.00	$26.78	$42.41	$42.84	$0.00		$0.00	$8.14	$0.00	$0.00	$8.53	$0.00	$0.00	$0.00	$0.00	$0.00
292.727	SUP	HCPCS C1713		292.727  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM NONTHREADED SPADE POINT	BOTH IP/OP	$53.05 	$39.26	$0.00	$41.20	$23.18	$23.18	$0.00	$0.00	$0.00	$11.06	$39.37	$39.37	$0.00	$0.00	$11.06	$0.00	$31.38	$31.38	$0.00	$25.75	$40.79	$41.20	$0.00		$0.00	$7.83	$0.00	$0.00	$8.20	$0.00	$0.00	$0.00	$0.00	$0.00
292.73	SUP	Custom 27203010		292.73  -  WIRE FX 1.6MM 150MM NS 15MM KRSH TROC PNT THRD SS	BOTH IP/OP	$29.42 	$21.77	$0.00	$23.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.83	$21.83	$0.00	$0.00	$6.13	$0.00	$0.00	$0.00	$0.00	$14.71	$23.30	$23.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.75	SUP	Custom 27203010		292.75  -  WIRE FX 2.5MM 150MM NS 15MM KRSH TROC PNT THRD SS	BOTH IP/OP	$34.30 	$25.38	$0.00	$25.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.46	$25.46	$0.00	$0.00	$7.15	$0.00	$0.00	$0.00	$0.00	$16.17	$25.61	$25.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.76	SUP	Custom 27203010		292.76  -  WIRE FIX 2.5MM 200MM 15MM THREADED TROCAR POINT KWIRE	BOTH IP/OP	$35.57 	$26.32	$0.00	$27.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.40	$26.40	$0.00	$0.00	$7.41	$0.00	$0.00	$0.00	$0.00	$17.26	$27.35	$27.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.79	SUP	Custom 27203010		292.79  -  WIRE FX 2MM 150MM NS 15MM KRSH TROC PNT THRD SS	BOTH IP/OP	$32.19 	$23.82	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.89	$23.89	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$15.63	$24.75	$25.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.801	SUP	Custom 27203010		292.801  -  WIRE FX 2MM 150MM NS 15MM KRSH CLBRT THRD TROC PNT SS	BOTH IP/OP	$83.25 	$61.61	$0.00	$66.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.79	$61.79	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292.81	SUP	HCPCS C1713		292.81  -  GUIDEWIRE ORTHOPEDIC 2.8MM 300MM 150MM NONTHREADED STAINLESS	BOTH IP/OP	$189.78 	$140.44	$0.00	$147.40	$82.91	$82.91	$0.00	$0.00	$0.00	$39.55	$140.85	$140.85	$0.00	$0.00	$39.55	$0.00	$112.25	$112.25	$0.00	$92.13	$145.93	$147.40	$0.00		$0.00	$27.99	$0.00	$0.00	$29.33	$0.00	$0.00	$0.00	$0.00	$0.00
293.35	SUP	Custom 27203010		293.35  -  PIN FIX 3.5MM 120MM STEINMANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$67.95 	$50.28	$0.00	$52.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.43	$50.43	$0.00	$0.00	$14.16	$0.00	$0.00	$0.00	$0.00	$32.99	$52.26	$52.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.36	SUP	Custom 27203010		293.36  -  PIN FIX 3.5MM 150MM TRACTION STEINMANN STAINLESS STEEL	BOTH IP/OP	$67.95 	$50.28	$0.00	$52.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.43	$50.43	$0.00	$0.00	$14.16	$0.00	$0.00	$0.00	$0.00	$32.99	$52.26	$52.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.4	SUP	Custom 27203010		293.40  -  PIN FIX 4MM 150MM STEINMANN STAINLESS STEEL NONSTRL TRACTION	BOTH IP/OP	$65.98 	$48.83	$0.00	$52.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.97	$48.97	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$32.99	$52.26	$52.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.41	SUP	Custom 27203010		293.41  -  PIN FIX LARGE 4MM 180MM EXTERNAL IMPLANT TRACTION STEINMANN	BOTH IP/OP	$67.95 	$50.28	$0.00	$52.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.43	$50.43	$0.00	$0.00	$14.16	$0.00	$0.00	$0.00	$0.00	$32.99	$52.26	$52.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.42	SUP	Custom 27203010		293.42  -  PIN FIX 4MM 200MM STEINMANN STAINLESS STEEL NONSTRL LARGE	BOTH IP/OP	$67.95 	$50.28	$0.00	$52.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.43	$50.43	$0.00	$0.00	$14.16	$0.00	$0.00	$0.00	$0.00	$32.99	$52.26	$52.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.44	SUP	Custom 27203010		293.44  -  PIN FIX 4.5MM 120MM STEINMANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.45	SUP	Custom 27203010		293.45  -  PIN FIX 4.5MM 150MM STEINMANN STAINLESS STEEL NONSTRL LARGE	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.46	SUP	Custom 27203010		293.46  -  PIN FIX 4.5MM 180MM STEINMANN STAINLESS STEEL NONSTRL LARGE	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.47	SUP	Custom 27203010		293.47  -  PIN FIX 4.5MM 200MM STEINMANN STAINLESS STEEL NONSTRL LARGE	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.48	SUP	Custom 27203010		293.48  -  PIN FIX 4.5MM 250MM STEINMANN STAINLESS STEEL NONSTRL LARGE	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.49	SUP	Custom 27203010		293.49  -  PIN FIX 4.5MM 225MM STEINMANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.5	SUP	Custom 27203010		293.50  -  PIN FIX 5MM 150MM STEINMANN STAINLESS STEEL NONSTRL LARGE	BOTH IP/OP	$122.20 	$90.43	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.70	$90.70	$0.00	$0.00	$25.47	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.51	SUP	Custom 27203010		293.51  -  PIN FIX 5MM 180MM STEINMANN STAINLESS STEEL NONSTRL LARGE	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.52	SUP	Custom 27203010		293.52  -  PIN FIX 5MM 200MM STEINMANN STAINLESS STEEL NONSTRL LARGE	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.53	SUP	Custom 27203010		293.53  -  PIN FIX 5MM 250MM STEINMANN STAINLESS STEEL NONSTRL LARGE	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.54	SUP	Custom 27203010		293.54  -  PIN FIX 5MM 300MM STEINMANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.58	SUP	Custom 27203010		293.58  -  PIN FIX 5MM 225MM STEINMANN STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.59	SUP	Custom 27203010		293.59  -  PIN FIX 5MM 275MM STEINMANN ORTHOPEDIC NONSTRL LARGE EXFIX	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.62	SUP	Custom 27203010		293.62  -  PIN FIX 4MM 150MM CENTRL THREAD STEINMANN STAINLESS STEEL	BOTH IP/OP	$190.48 	$140.96	$0.00	$147.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.37	$141.37	$0.00	$0.00	$39.69	$0.00	$0.00	$0.00	$0.00	$92.46	$146.46	$147.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.63	SUP	Custom 27203010		293.63  -  PIN FIX 4.5MM 5MM 150MM CENTRL THREAD STEINMANN STAINLESS	BOTH IP/OP	$190.48 	$140.96	$0.00	$147.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.37	$141.37	$0.00	$0.00	$39.69	$0.00	$0.00	$0.00	$0.00	$92.46	$146.46	$147.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.67	SUP	Custom 27203010		293.67  -  PIN FIX 4MM 180MM CENTRL THREAD STEINMANN STAINLESS STEEL	BOTH IP/OP	$190.48 	$140.96	$0.00	$147.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.37	$141.37	$0.00	$0.00	$39.69	$0.00	$0.00	$0.00	$0.00	$92.46	$146.46	$147.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.68	SUP	Custom 27203010		293.68  -  PIN FX CNTR THRD 4.5MM 5MM 180MM NS STNM SS LG XTRNFXTR	BOTH IP/OP	$213.88 	$158.27	$0.00	$166.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.74	$158.74	$0.00	$0.00	$44.57	$0.00	$0.00	$0.00	$0.00	$103.83	$164.46	$166.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.69	SUP	Custom 27203010		293.69  -  PIN FIX 5MM 5.5MM 175MM CENTRL THREAD STEINMANN STAINLESS	BOTH IP/OP	$213.88 	$158.27	$0.00	$166.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.74	$158.74	$0.00	$0.00	$44.57	$0.00	$0.00	$0.00	$0.00	$103.83	$164.46	$166.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.72	SUP	Custom 27203010		293.72  -  PIN FIX 4MM 4.5MM 200MM CENTRL THREAD STEINMANN STAINLESS	BOTH IP/OP	$190.48 	$140.96	$0.00	$147.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.37	$141.37	$0.00	$0.00	$39.69	$0.00	$0.00	$0.00	$0.00	$92.46	$146.46	$147.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.73	SUP	Custom 27203010		293.73  -  PIN FIX 4.5MM 200MM CENTRL THREAD STEINMANN STAINLESS STEEL	BOTH IP/OP	$213.88 	$158.27	$0.00	$166.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.74	$158.74	$0.00	$0.00	$44.57	$0.00	$0.00	$0.00	$0.00	$103.83	$164.46	$166.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.74	SUP	Custom 27203010		293.74  -  PIN FX CNTR THRD 5MM 5.5MM 200MM NS STNM SS LG XTRNFXTR	BOTH IP/OP	$213.88 	$158.27	$0.00	$166.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.74	$158.74	$0.00	$0.00	$44.57	$0.00	$0.00	$0.00	$0.00	$103.83	$164.46	$166.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.78	SUP	Custom 27203010		293.78  -  PIN FX CNTR THRD 4.5MM 5MM 225MM NS STNM SS LG XTRNFXTR	BOTH IP/OP	$213.88 	$158.27	$0.00	$166.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.74	$158.74	$0.00	$0.00	$44.57	$0.00	$0.00	$0.00	$0.00	$103.83	$164.46	$166.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.79	SUP	Custom 27203010		293.790  -  PIN FIX CENTRL THREAD 5MM 5.5MM 225MM STEINMANN STAINLESS	BOTH IP/OP	$207.65 	$153.66	$0.00	$166.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.12	$154.12	$0.00	$0.00	$43.27	$0.00	$0.00	$0.00	$0.00	$103.83	$164.46	$166.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.83	SUP	Custom 27203010		293.83  -  PIN FIX 4.5MM 250MM CENTRL THREAD STEINMANN STAINLESS STEEL	BOTH IP/OP	$213.88 	$158.27	$0.00	$166.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.74	$158.74	$0.00	$0.00	$44.57	$0.00	$0.00	$0.00	$0.00	$103.83	$164.46	$166.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.84	SUP	Custom 27203010		293.840  -  PIN FIX 5MM 5.5MM 250MM 3 FLAT END CENTRL THREAD ROUND	BOTH IP/OP	$207.65 	$153.66	$0.00	$166.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.12	$154.12	$0.00	$0.00	$43.27	$0.00	$0.00	$0.00	$0.00	$103.83	$164.46	$166.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.88	SUP	Custom 27203010		293.88  -  PIN FX CNTR THRD 4.5MM 5MM 275MM NS STNM SS LG XTRNFXTR	BOTH IP/OP	$213.88 	$158.27	$0.00	$166.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.74	$158.74	$0.00	$0.00	$44.57	$0.00	$0.00	$0.00	$0.00	$103.83	$164.46	$166.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.89	SUP	Custom 27203010		293.890  -  PIN FIX 5MM 275MM CENTRL THREAD STEINMANN STAINLESS STEEL	BOTH IP/OP	$207.65 	$153.66	$0.00	$166.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.12	$154.12	$0.00	$0.00	$43.27	$0.00	$0.00	$0.00	$0.00	$103.83	$164.46	$166.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.93	SUP	Custom 27203010		293.93  -  PIN FIX 4.5MM 300MM CENTRL THREAD STEINMANN STAINLESS STEEL	BOTH IP/OP	$213.88 	$158.27	$0.00	$166.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.74	$158.74	$0.00	$0.00	$44.57	$0.00	$0.00	$0.00	$0.00	$103.83	$164.46	$166.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.94	SUP	HCPCS C1713		293.940  -  PIN FIX 5MM 300MM CENTRL THREAD STEINMANN STAINLESS STEEL	BOTH IP/OP	$207.65 	$153.66	$0.00	$166.12	$93.44	$93.44	$0.00	$0.00	$0.00	$43.28	$154.12	$154.12	$0.00	$0.00	$43.27	$0.00	$122.82	$122.82	$0.00	$103.83	$164.46	$166.12	$0.00		$0.00	$31.55	$0.00	$0.00	$33.06	$0.00	$0.00	$0.00	$0.00	$0.00
294.3	SUP	HCPCS C1713		294.30  -  SCREW XTRNFX 4MM 3MM 80MM NS 20MM SCHNZ TROC PNT MR	BOTH IP/OP	$124.38 	$92.04	$0.00	$99.50	$55.97	$55.97	$0.00	$0.00	$0.00	$25.92	$92.31	$92.31	$0.00	$0.00	$25.92	$0.00	$73.57	$73.57	$0.00	$62.19	$98.51	$99.50	$0.00		$0.00	$18.90	$0.00	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$0.00
294.43	SUP	HCPCS C1713		294.43  -  SCREW XTRNFX 4MM 60MM NS SCHNZ SPD PNT SS LG XTRNFXTR	BOTH IP/OP	$128.10 	$94.79	$0.00	$99.50	$55.97	$55.97	$0.00	$0.00	$0.00	$26.70	$95.08	$95.08	$0.00	$0.00	$26.70	$0.00	$75.77	$75.77	$0.00	$62.19	$98.51	$99.50	$0.00		$0.00	$18.90	$0.00	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$0.00
294.44	SUP	HCPCS C1713		294.44  -  SCREW XTRNFX 4MM 80MM NS SCHNZ SPD PNT MR CONDITIONAL SS LG	BOTH IP/OP	$128.10 	$94.79	$0.00	$99.50	$55.97	$55.97	$0.00	$0.00	$0.00	$26.70	$95.08	$95.08	$0.00	$0.00	$26.70	$0.00	$75.77	$75.77	$0.00	$62.19	$98.51	$99.50	$0.00		$0.00	$18.90	$0.00	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$0.00
294.45	SUP	HCPCS C1713		294.45  -  SCREW XTRNFX 4MM 100MM NS 25MM SCHNZ SPD PNT SS PLVC LG	BOTH IP/OP	$128.10 	$94.79	$0.00	$99.50	$55.97	$55.97	$0.00	$0.00	$0.00	$26.70	$95.08	$95.08	$0.00	$0.00	$26.70	$0.00	$75.77	$75.77	$0.00	$62.19	$98.51	$99.50	$0.00		$0.00	$18.90	$0.00	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$0.00
294.455	SUP	HCPCS C1713		294.455  -  SCREW BONE 4MM 100MM 38IN SPADE POINT PTHRD SCHANZ	BOTH IP/OP	$128.10 	$94.79	$0.00	$99.50	$55.97	$55.97	$0.00	$0.00	$0.00	$26.70	$95.08	$95.08	$0.00	$0.00	$26.70	$0.00	$75.77	$75.77	$0.00	$62.19	$98.51	$99.50	$0.00		$0.00	$18.90	$0.00	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$0.00
294.46	SUP	HCPCS C1713		294.46  -  SCREW XTRNFX 4MM 120MM NS SCHNZ SPD PNT MR CONDITIONAL SS	BOTH IP/OP	$128.10 	$94.79	$0.00	$99.50	$55.97	$55.97	$0.00	$0.00	$0.00	$26.70	$95.08	$95.08	$0.00	$0.00	$26.70	$0.00	$75.77	$75.77	$0.00	$62.19	$98.51	$99.50	$0.00		$0.00	$18.90	$0.00	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$0.00
294.48	SUP	HCPCS C1713		294.48  -  SCREW XTRNFX 4MM 150MM NS 25MM SCHNZ SPD PNT SS PLVC LG	BOTH IP/OP	$128.10 	$94.79	$0.00	$99.50	$55.97	$55.97	$0.00	$0.00	$0.00	$26.70	$95.08	$95.08	$0.00	$0.00	$26.70	$0.00	$75.77	$75.77	$0.00	$62.19	$98.51	$99.50	$0.00		$0.00	$18.90	$0.00	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$0.00
294.52	SUP	HCPCS C1713		294.52  -  SCREW XTRNFX XLNG 5MM 100MM NS SCHNZ BLNT TROC PNT MR	BOTH IP/OP	$141.48 	$104.70	$0.00	$109.88	$61.81	$61.81	$0.00	$0.00	$0.00	$29.49	$105.00	$105.00	$0.00	$0.00	$29.48	$0.00	$83.68	$83.68	$0.00	$68.68	$108.78	$109.88	$0.00		$0.00	$20.87	$0.00	$0.00	$21.87	$0.00	$0.00	$0.00	$0.00	$0.00
294.53	SUP	HCPCS C1713		294.53  -  SCREW XTRNFX 5MM 125MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL	BOTH IP/OP	$141.48 	$104.70	$0.00	$109.88	$61.81	$61.81	$0.00	$0.00	$0.00	$29.49	$105.00	$105.00	$0.00	$0.00	$29.48	$0.00	$83.68	$83.68	$0.00	$68.68	$108.78	$109.88	$0.00		$0.00	$20.87	$0.00	$0.00	$21.87	$0.00	$0.00	$0.00	$0.00	$0.00
294.54	SUP	HCPCS C1713		294.54  -  SCREW XTRNFX 5MM 150MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL	BOTH IP/OP	$141.48 	$104.70	$0.00	$109.88	$61.81	$61.81	$0.00	$0.00	$0.00	$29.49	$105.00	$105.00	$0.00	$0.00	$29.48	$0.00	$83.68	$83.68	$0.00	$68.68	$108.78	$109.88	$0.00		$0.00	$20.87	$0.00	$0.00	$21.87	$0.00	$0.00	$0.00	$0.00	$0.00
294.55	SUP	HCPCS C1713		294.55  -  SCREW XTRNFX XLNG 5MM 170MM NS 50MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$163.75 	$121.18	$0.00	$127.18	$71.54	$71.54	$0.00	$0.00	$0.00	$34.13	$121.54	$121.54	$0.00	$0.00	$34.13	$0.00	$96.86	$96.86	$0.00	$79.49	$125.91	$127.18	$0.00		$0.00	$34.25	$0.00	$0.00	$25.31	$0.00	$0.00	$0.00	$0.00	$0.00
294.56	SUP	HCPCS C1713		294.56  -  SCREW XTRNFX 5MM 200MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL	BOTH IP/OP	$163.75 	$121.18	$0.00	$127.18	$71.54	$71.54	$0.00	$0.00	$0.00	$34.13	$121.54	$121.54	$0.00	$0.00	$34.13	$0.00	$96.86	$96.86	$0.00	$79.49	$125.91	$127.18	$0.00		$0.00	$24.16	$0.00	$0.00	$25.31	$0.00	$0.00	$0.00	$0.00	$0.00
294.57	SUP	HCPCS C1713		294.57  -  SCREW XTRNFX 5MM 250MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL	BOTH IP/OP	$163.75 	$121.18	$0.00	$127.18	$71.54	$71.54	$0.00	$0.00	$0.00	$34.13	$121.54	$121.54	$0.00	$0.00	$34.13	$0.00	$96.86	$96.86	$0.00	$79.49	$125.91	$127.18	$0.00		$0.00	$24.16	$0.00	$0.00	$25.31	$0.00	$0.00	$0.00	$0.00	$0.00
294.65	SUP	HCPCS C1713		294.65  -  SCREW XTRNFX 6MM 100MM NS 50MM SCHNZ SPD PNT SS LG XTRNFXTR	BOTH IP/OP	$141.48 	$104.70	$0.00	$109.88	$61.81	$61.81	$0.00	$0.00	$0.00	$29.49	$105.00	$105.00	$0.00	$0.00	$29.48	$0.00	$83.68	$83.68	$0.00	$68.68	$108.78	$109.88	$0.00		$0.00	$20.87	$0.00	$0.00	$21.87	$0.00	$0.00	$0.00	$0.00	$0.00
294.66	SUP	HCPCS C1713		294.66  -  SCREW EXFIX BLUNT SPADE 6MM 130MM 50MM TROCAR SCHANZ	BOTH IP/OP	$141.48 	$104.70	$0.00	$109.88	$61.81	$61.81	$0.00	$0.00	$0.00	$29.49	$105.00	$105.00	$0.00	$0.00	$29.48	$0.00	$83.68	$83.68	$0.00	$68.68	$108.78	$109.88	$0.00		$0.00	$20.87	$0.00	$0.00	$21.87	$0.00	$0.00	$0.00	$0.00	$0.00
294.67	SUP	HCPCS C1713		294.67  -  SCREW XTRNFX 6MM 160MM NS 50MM SCHNZ SPD PNT SS LG XTRNFXTR	BOTH IP/OP	$147.05 	$108.82	$0.00	$114.20	$64.24	$64.24	$0.00	$0.00	$0.00	$30.65	$109.14	$109.14	$0.00	$0.00	$30.65	$0.00	$86.98	$86.98	$0.00	$71.38	$113.06	$114.20	$0.00		$0.00	$21.69	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
294.68	SUP	HCPCS C1713		294.68  -  SCREW XTRNFX 6MM 190MM NS 50MM SCHNZ SPD PNT SS LG XTRNFXTR	BOTH IP/OP	$147.05 	$108.82	$0.00	$114.20	$64.24	$64.24	$0.00	$0.00	$0.00	$30.65	$109.14	$109.14	$0.00	$0.00	$30.65	$0.00	$86.98	$86.98	$0.00	$71.38	$113.06	$114.20	$0.00		$0.00	$21.69	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
294.71	SUP	HCPCS C1713		294.71  -  SCREW EXFIX BLUNT SPADE 4.5MM 80MM 18MM TROCAR SCHANZ	BOTH IP/OP	$124.75 	$92.32	$0.00	$96.90	$54.51	$54.51	$0.00	$0.00	$0.00	$26.00	$92.59	$92.59	$0.00	$0.00	$26.00	$0.00	$73.79	$73.79	$0.00	$60.56	$95.93	$96.90	$0.00		$0.00	$18.40	$0.00	$0.00	$19.28	$0.00	$0.00	$0.00	$0.00	$0.00
294.72	SUP	HCPCS C1713		294.72  -  SCREW XTRNFX ST 4.5MM 100MM NS 18MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$124.75 	$92.32	$0.00	$96.90	$54.51	$54.51	$0.00	$0.00	$0.00	$26.00	$92.59	$92.59	$0.00	$0.00	$26.00	$0.00	$73.79	$73.79	$0.00	$60.56	$95.93	$96.90	$0.00		$0.00	$18.40	$0.00	$0.00	$19.28	$0.00	$0.00	$0.00	$0.00	$0.00
294.73	SUP	HCPCS C1713		294.73  -  SCREW XTRNFX ST 4.5MM 125MM NS 18MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$124.75 	$92.32	$0.00	$96.90	$54.51	$54.51	$0.00	$0.00	$0.00	$26.00	$92.59	$92.59	$0.00	$0.00	$26.00	$0.00	$73.79	$73.79	$0.00	$60.56	$95.93	$96.90	$0.00		$0.00	$18.40	$0.00	$0.00	$19.28	$0.00	$0.00	$0.00	$0.00	$0.00
294.74	SUP	HCPCS C1713		294.74  -  SCREW XTRNFX ST 4.5MM 150MM NS 18MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$124.75 	$92.32	$0.00	$96.90	$54.51	$54.51	$0.00	$0.00	$0.00	$26.00	$92.59	$92.59	$0.00	$0.00	$26.00	$0.00	$73.79	$73.79	$0.00	$60.56	$95.93	$96.90	$0.00		$0.00	$18.40	$0.00	$0.00	$19.28	$0.00	$0.00	$0.00	$0.00	$0.00
294.75	SUP	HCPCS C1713		294.75  -  SCREW XTRNFX ST 4.5MM 175MM NS 18MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$147.05 	$108.82	$0.00	$114.20	$64.24	$64.24	$0.00	$0.00	$0.00	$30.65	$109.14	$109.14	$0.00	$0.00	$30.65	$0.00	$86.98	$86.98	$0.00	$71.38	$113.06	$114.20	$0.00		$0.00	$21.69	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
294.76	SUP	HCPCS C1713		294.76  -  SCREW XTRNFX 4.5MM 200MM NS SCHNZ BLNT TROC PNT MR	BOTH IP/OP	$147.05 	$108.82	$0.00	$114.20	$64.24	$64.24	$0.00	$0.00	$0.00	$30.65	$109.14	$109.14	$0.00	$0.00	$30.65	$0.00	$86.98	$86.98	$0.00	$71.38	$113.06	$114.20	$0.00		$0.00	$21.69	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
294.767	SUP	HCPCS C1713		294.767  -  SCREW BONE 4MM 2.5MM 65MM 18MM SLFDRILL TROCAR POINT SCHANZ	BOTH IP/OP	$221.68 	$164.04	$0.00	$172.18	$96.85	$96.85	$0.00	$0.00	$0.00	$46.20	$164.53	$164.53	$0.00	$0.00	$46.20	$0.00	$131.12	$131.12	$0.00	$107.61	$170.46	$172.18	$0.00		$0.00	$32.70	$0.00	$0.00	$34.26	$0.00	$0.00	$0.00	$0.00	$0.00
294.768	SUP	HCPCS C1713		294.768  -  SCREW BONE 4MM 2.5MM 80MM 20MM SLFDRILL TROCAR POINT SCHANZ	BOTH IP/OP	$221.68 	$164.04	$0.00	$172.18	$96.85	$96.85	$0.00	$0.00	$0.00	$46.20	$164.53	$164.53	$0.00	$0.00	$46.20	$0.00	$131.12	$131.12	$0.00	$107.61	$170.46	$172.18	$0.00		$0.00	$32.70	$0.00	$0.00	$34.26	$0.00	$0.00	$0.00	$0.00	$0.00
294.769	SUP	HCPCS C1713		294.769  -  SCREW XTRNFX 4MM 2.5MM 80MM NS 20MM SCHNZ SLF DRL MR	BOTH IP/OP	$249.53 	$184.65	$0.00	$193.80	$109.01	$109.01	$0.00	$0.00	$0.00	$52.01	$185.20	$185.20	$0.00	$0.00	$52.00	$0.00	$147.59	$147.59	$0.00	$121.13	$191.86	$193.80	$0.00		$0.00	$36.81	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$0.00
294.771	SUP	HCPCS C1713		294.771  -  SCREW XTRNFX 4MM 3MM 80MM NS 20MM SCHNZ SLF DRL MR	BOTH IP/OP	$249.53 	$184.65	$0.00	$193.80	$109.01	$109.01	$0.00	$0.00	$0.00	$52.01	$185.20	$185.20	$0.00	$0.00	$52.00	$0.00	$147.59	$147.59	$0.00	$121.13	$191.86	$193.80	$0.00		$0.00	$36.81	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$0.00
294.772	SUP	HCPCS C1713		294.772  -  SCREW BONE 4/3MM 100MM 20MM SLFDRILL SCHANZ STAINLESS STEEL	BOTH IP/OP	$249.53 	$184.65	$0.00	$193.80	$109.01	$109.01	$0.00	$0.00	$0.00	$52.01	$185.20	$185.20	$0.00	$0.00	$52.00	$0.00	$147.59	$147.59	$0.00	$121.13	$191.86	$193.80	$0.00		$0.00	$36.81	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$0.00
294.773	SUP	HCPCS C1713		294.773  -  SCREW BONE 4MM 3MM 65MM 18MM SELF DRILL SCHANZ STAINLESS	BOTH IP/OP	$249.53 	$184.65	$0.00	$193.80	$109.01	$109.01	$0.00	$0.00	$0.00	$52.01	$185.20	$185.20	$0.00	$0.00	$52.00	$0.00	$147.59	$147.59	$0.00	$121.13	$191.86	$193.80	$0.00		$0.00	$36.81	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$0.00
294.774	SUP	HCPCS C1713		294.774  -  SCREW BONE 4MM 60MM 20MM SELF DRILL SCHANZ STAINLESS STEEL	BOTH IP/OP	$249.53 	$184.65	$0.00	$193.80	$109.01	$109.01	$0.00	$0.00	$0.00	$52.01	$185.20	$185.20	$0.00	$0.00	$52.00	$0.00	$147.59	$147.59	$0.00	$121.13	$191.86	$193.80	$0.00		$0.00	$36.81	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$0.00
294.775	SUP	HCPCS C1713		294.775  -  SCREW XTRNFX 4MM 80MM NS 20MM SCHNZ SLF DRL MR CONDITIONAL	BOTH IP/OP	$249.53 	$184.65	$0.00	$193.80	$109.01	$109.01	$0.00	$0.00	$0.00	$52.01	$185.20	$185.20	$0.00	$0.00	$52.00	$0.00	$147.59	$147.59	$0.00	$121.13	$191.86	$193.80	$0.00		$0.00	$36.81	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$0.00
294.776	SUP	HCPCS C1713		294.776  -  SCREW XTRNFX 4MM 100MM NS 30MM SCHNZ SLF DRL MR CONDITIONAL	BOTH IP/OP	$249.53 	$184.65	$0.00	$193.80	$109.01	$109.01	$0.00	$0.00	$0.00	$52.01	$185.20	$185.20	$0.00	$0.00	$52.00	$0.00	$147.59	$147.59	$0.00	$121.13	$191.86	$193.80	$0.00		$0.00	$36.81	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$0.00
294.777	SUP	HCPCS C1713		294.777  -  SCREW XTRNFX 4MM 125MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL	BOTH IP/OP	$249.53 	$184.65	$0.00	$193.80	$109.01	$109.01	$0.00	$0.00	$0.00	$52.01	$185.20	$185.20	$0.00	$0.00	$52.00	$0.00	$147.59	$147.59	$0.00	$121.13	$191.86	$193.80	$0.00		$0.00	$36.81	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$0.00
294.778	SUP	HCPCS C1713		294.778  -  SCREW XTRNFX 4MM 150MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL	BOTH IP/OP	$249.53 	$184.65	$0.00	$193.80	$109.01	$109.01	$0.00	$0.00	$0.00	$52.01	$185.20	$185.20	$0.00	$0.00	$52.00	$0.00	$147.59	$147.59	$0.00	$121.13	$191.86	$193.80	$0.00		$0.00	$36.81	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$0.00
294.779	SUP	HCPCS C1713		294.779  -  SCREW XTRNFX 4MM 175MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL	BOTH IP/OP	$249.53 	$184.65	$0.00	$193.80	$109.01	$109.01	$0.00	$0.00	$0.00	$52.01	$185.20	$185.20	$0.00	$0.00	$52.00	$0.00	$147.59	$147.59	$0.00	$121.13	$191.86	$193.80	$0.00		$0.00	$36.81	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$0.00
294.782	SUP	HCPCS C1713		294.782  -  SCREW XTRNFX 5MM 100MM NS 30MM SCHNZ SLF DRL MR CONDITIONAL	BOTH IP/OP	$281.83 	$208.55	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$58.74	$209.17	$209.17	$0.00	$0.00	$58.73	$0.00	$166.70	$166.70	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$41.57	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
294.783	SUP	HCPCS C1713		294.783  -  SCREW XTRNFX 5MM 125MM NS 40MM SCHNZ SLF DRL SS HIP CNDYL LG	BOTH IP/OP	$281.83 	$208.55	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$58.74	$209.17	$209.17	$0.00	$0.00	$58.73	$0.00	$166.70	$166.70	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$41.57	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
294.784	SUP	HCPCS C1713		294.784  -  SCREW XTRNFX 5MM 150MM NS 60MM SCHNZ SLF DRL MR CONDITIONAL	BOTH IP/OP	$281.83 	$208.55	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$58.74	$209.17	$209.17	$0.00	$0.00	$58.73	$0.00	$166.70	$166.70	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$41.57	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
294.785	SUP	HCPCS C1713		294.785  -  SCREW XTRNFX 5MM 175MM NS 60MM SCHNZ SLF DRL MR CONDITIONAL	BOTH IP/OP	$281.83 	$208.55	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$58.74	$209.17	$209.17	$0.00	$0.00	$58.73	$0.00	$166.70	$166.70	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$41.57	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
294.786	SUP	HCPCS C1713		294.786  -  SCREW XTRNFX 5MM 200MM NS 80MM SCHNZ SLF DRL MR CONDITIONAL	BOTH IP/OP	$281.83 	$208.55	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$58.74	$209.17	$209.17	$0.00	$0.00	$58.73	$0.00	$166.70	$166.70	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$41.57	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
294.788	SUP	HCPCS C1713		294.788  -  SCREW XTRNFX 5MM 250MM NS 80MM SCHNZ SLF DRL MR CONDITIONAL	BOTH IP/OP	$281.83 	$208.55	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$58.74	$209.17	$209.17	$0.00	$0.00	$58.73	$0.00	$166.70	$166.70	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$41.57	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
294.792	SUP	HCPCS C1713		294.792  -  SCREW BONE 6MM 100MM 30MM SLFDRILL SCHANZ STAINLESS STEEL	BOTH IP/OP	$300.78 	$222.58	$0.00	$233.60	$131.40	$131.40	$0.00	$0.00	$0.00	$62.69	$223.24	$223.24	$0.00	$0.00	$62.68	$0.00	$177.91	$177.91	$0.00	$146.00	$231.26	$233.60	$0.00		$0.00	$44.37	$0.00	$0.00	$46.49	$0.00	$0.00	$0.00	$0.00	$0.00
294.793	SUP	HCPCS C1713		294.793  -  SCREW BONE 6MM 125MM 40MM SLFDRILL SCHANZ STAINLESS STEEL	BOTH IP/OP	$300.78 	$222.58	$0.00	$233.60	$131.40	$131.40	$0.00	$0.00	$0.00	$62.69	$223.24	$223.24	$0.00	$0.00	$62.68	$0.00	$177.91	$177.91	$0.00	$146.00	$231.26	$233.60	$0.00		$0.00	$44.37	$0.00	$0.00	$46.49	$0.00	$0.00	$0.00	$0.00	$0.00
294.794	SUP	HCPCS C1713		294.794  -  SCREW BONE 6MM 150MM 60MM SELF DRILL SCHANZ STAINLESS STEEL	BOTH IP/OP	$300.78 	$222.58	$0.00	$233.60	$131.40	$131.40	$0.00	$0.00	$0.00	$62.69	$223.24	$223.24	$0.00	$0.00	$62.68	$0.00	$177.91	$177.91	$0.00	$146.00	$231.26	$233.60	$0.00		$0.00	$44.37	$0.00	$0.00	$46.49	$0.00	$0.00	$0.00	$0.00	$0.00
294.795	SUP	HCPCS C1713		294.795  -  SCREW BONE 6MM 175MM 60MM SLFDRILL SCHANZ STAINLESS STEEL	BOTH IP/OP	$300.78 	$222.58	$0.00	$233.60	$131.40	$131.40	$0.00	$0.00	$0.00	$62.69	$223.24	$223.24	$0.00	$0.00	$62.68	$0.00	$177.91	$177.91	$0.00	$146.00	$231.26	$233.60	$0.00		$0.00	$44.37	$0.00	$0.00	$46.49	$0.00	$0.00	$0.00	$0.00	$0.00
294.796	SUP	HCPCS C1713		294.796  -  SCREW BONE 6MM 200MM 80MM SELF DRILL SCHANZ STAINLESS STEEL	BOTH IP/OP	$300.78 	$222.58	$0.00	$233.60	$131.40	$131.40	$0.00	$0.00	$0.00	$62.69	$223.24	$223.24	$0.00	$0.00	$62.68	$0.00	$177.91	$177.91	$0.00	$146.00	$231.26	$233.60	$0.00		$0.00	$44.37	$0.00	$0.00	$46.49	$0.00	$0.00	$0.00	$0.00	$0.00
294.798	SUP	HCPCS C1713		294.798  -  SCREW XTRNFX 4MM 175MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL	BOTH IP/OP	$300.78 	$222.58	$0.00	$233.60	$131.40	$131.40	$0.00	$0.00	$0.00	$62.69	$223.24	$223.24	$0.00	$0.00	$62.68	$0.00	$177.91	$177.91	$0.00	$146.00	$231.26	$233.60	$0.00		$0.00	$44.37	$0.00	$0.00	$46.49	$0.00	$0.00	$0.00	$0.00	$0.00
294.95	SUP	Custom 27203010		294.950  -  PIN FIX 6MM 225MM TRANSFIXATION STEINMANN STAINLESS STEEL	BOTH IP/OP	$208.73 	$154.46	$0.00	$166.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.92	$154.92	$0.00	$0.00	$43.50	$0.00	$0.00	$0.00	$0.00	$104.36	$165.31	$166.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
296.757	SUP	Custom 27803010		296.757  -  NUT ORTH 6MM SCRL SS RND NONSTRL	BOTH IP/OP	$264.00 	$195.36	$0.00	$211.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.94	$195.94	$0.00	$0.00	$55.02	$0.00	$0.00	$0.00	$0.00	$132.00	$209.09	$211.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
296.758	SUP	Custom 27803010		296.758  -  WASHER SPNL 6MM SCRL SS NONSTRL	BOTH IP/OP	$264.00 	$195.36	$0.00	$211.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.94	$195.94	$0.00	$0.00	$55.02	$0.00	$0.00	$0.00	$0.00	$132.00	$209.09	$211.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
296.759	SUP	Custom 27803010		296.759  -  NUT ORTH 6MM SCRL SS HEX NONSTRL	BOTH IP/OP	$244.75 	$181.12	$0.00	$195.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.65	$181.65	$0.00	$0.00	$51.01	$0.00	$0.00	$0.00	$0.00	$122.38	$193.84	$195.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
296.761	SUP	HCPCS C1713		296.761  -  BAR SPNL 160MM 6MM SCRL SPN SS THRD NONSTRL	BOTH IP/OP	"$1,334.50 "	$987.53	$0.00	"$1,067.60"	$600.53	$600.53	$0.00	$0.00	$0.00	$278.14	$990.47	$990.47	$0.00	$0.00	$278.11	$0.00	$789.36	$789.36	$0.00	$667.25	"$1,056.92"	"$1,067.60"	$0.00		$0.00	$208.85	$0.00	$0.00	$212.45	$0.00	$0.00	$0.00	$0.00	$0.00
296.763	SUP	HCPCS C1713		296.763  -  BAR SPINAL 6MM 200MM THREADED KIT SACRAL NONSTRL	BOTH IP/OP	"$1,210.30 "	$895.62	$0.00	$940.04	$528.77	$528.77	$0.00	$0.00	$0.00	$252.26	$898.28	$898.28	$0.00	$0.00	$252.23	$0.00	$715.89	$715.89	$0.00	$587.53	$930.64	$940.04	$0.00		$0.00	$178.54	$0.00	$0.00	$187.07	$0.00	$0.00	$0.00	$0.00	$0.00
296.765	SUP	HCPCS C1713		296.765  -  BAR SPNL 240MM 6MM SCRL SPN SS THRD NONSTRL	BOTH IP/OP	"$1,415.75 "	"$1,047.66"	$0.00	"$1,132.60"	$637.09	$637.09	$0.00	$0.00	$0.00	$295.08	"$1,050.77"	"$1,050.77"	$0.00	$0.00	$295.04	$0.00	$837.42	$837.42	$0.00	$707.88	"$1,121.27"	"$1,132.60"	$0.00		$0.00	$221.56	$0.00	$0.00	$225.39	$0.00	$0.00	$0.00	$0.00	$0.00
296.766	SUP	HCPCS C1713		296.766  -  BAR SPINAL 6MM 260MM THREAD STAINLESS STEEL SACRAL SPN	BOTH IP/OP	"$1,210.30 "	$895.62	$0.00	$940.04	$528.77	$528.77	$0.00	$0.00	$0.00	$252.26	$898.28	$898.28	$0.00	$0.00	$252.23	$0.00	$715.89	$715.89	$0.00	$587.53	$930.64	$940.04	$0.00		$0.00	$178.54	$0.00	$0.00	$187.07	$0.00	$0.00	$0.00	$0.00	$0.00
304	SUP	HCPCS C1778		304  -  LEAD NEUROSTIMULATOR 3MM 43CM BIPOL PERENNIAFLEX SILICONE	BOTH IP/OP	"$17,070.00 "	"$12,631.80"	$0.00	"$13,656.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,557.39"	$0.00	$0.00	$0.00	$0.00	"$8,535.00"	"$13,519.44"	"$13,656.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.008	SUP	Custom 27803010		304.008  -  SPACER SPNL OBLQ 26X10X8MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.009	SUP	Custom 27803010		304.009  -  SPACER SPNL OBLQ 26X10X9MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.01	SUP	Custom 27803010		304.010  -  SPACER SPNL OBLQ 26X10X10MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.011	SUP	Custom 27803010		304.011  -  SPACER SPNL OBLQ 26X10X11MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.012	SUP	Custom 27803010		304.012  -  SPACER SPNL OBLQ 26X10X12MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.013	SUP	Custom 27803010		304.013  -  SPACER SPNL OBLQ 26X10X13MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.014	SUP	Custom 27803010		304.014  -  SPACER SPNL OBLQ 26X10X14MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.015	SUP	Custom 27803010		304.015  -  SPACER SPNL OBLQ 26X10X15MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.017	SUP	Custom 27803010		304.017  -  SPACER SPNL OBLQ 26X10X17MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.065	SUP	Custom 27803010		304.065  -  SPACER SPNL 13MM MED CNVX 14X5MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.066	SUP	Custom 27803010		304.066  -  SPACER SPNL 13MM MED CNVX 14X6MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.067	SUP	Custom 27803010		304.067  -  SPACER SPNL 13MM MED CNVX 14X7MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.068	SUP	Custom 27803010		304.068  -  SPACER SPNL 13MM MED CNVX 14X8MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.069	SUP	Custom 27803010		304.069  -  SPACER SPNL 13MM MED CNVX 14X9MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.07	SUP	Custom 27803010		304.070  -  SPACER SPNL 13MM MED CNVX 14X10MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.071	SUP	Custom 27803010		304.071  -  SPACER SPNL 13MM MED CNVX 14X11MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.072	SUP	Custom 27803010		304.072  -  SPACER SPNL 13MM MED CNVX 14X12MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.078	SUP	Custom 27803010		304.078  -  SPACER SPNL SM OBLQ 22X8X8MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.079	SUP	Custom 27803010		304.079  -  SPACER SPNL SM OBLQ 22X8X9MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.08	SUP	Custom 27803010		304.080  -  SPACER SPNL SM OBLQ 22X8X10MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.081	SUP	Custom 27803010		304.081  -  SPACER SPNL SM OBLQ 22X8X11MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.082	SUP	Custom 27803010		304.082  -  SPACER SPNL SM OBLQ 22X8X12MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.083	SUP	Custom 27803010		304.083  -  SPACER SPNL SM OBLQ 22X8X13MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.085	SUP	Custom 27803010		304.085  -  SPACER SPNL SM OBLQ 22X8X15MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.087	SUP	Custom 27803010		304.087  -  SPACER SPNL SM OBLQ 22X8X17MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.088	SUP	Custom 27803010		304.088  -  SPACER SPNL SM OBLQ 22X10X8MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.089	SUP	Custom 27803010		304.089  -  SPACER SPNL SM OBLQ 22X10X9MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.09	SUP	Custom 27803010		304.090  -  SPACER SPNL SM OBLQ 22X10X10MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.091	SUP	Custom 27803010		304.091  -  SPACER SPNL SM OBLQ 22X10X11MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.092	SUP	Custom 27803010		304.092  -  SPACER SPNL SM OBLQ 22X10X12MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.093	SUP	Custom 27803010		304.093  -  SPACER SPNL SM OBLQ 22X10X13MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.095	SUP	Custom 27803010		304.095  -  SPACER SPNL SM OBLQ 22X10X15MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.097	SUP	Custom 27803010		304.097  -  SPACER SPNL SM OBLQ 22X10X17MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.104	SUP	Custom 27803010		304.104  -  MARKER SRG 4MM WHT SCR LGTH SLFDRL SCR	BOTH IP/OP	$106.88 	$79.09	$0.00	$85.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.32	$79.32	$0.00	$0.00	$22.27	$0.00	$0.00	$0.00	$0.00	$53.44	$84.65	$85.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.105	SUP	Custom 27803010		304.105  -  MARKER SRG 5MM WHT SCR LGTH SLF DRL SCR	BOTH IP/OP	$106.88 	$79.09	$0.00	$85.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.32	$79.32	$0.00	$0.00	$22.27	$0.00	$0.00	$0.00	$0.00	$53.44	$84.65	$85.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.107	SUP	Custom 27803010		304.107  -  SPACER SPNL SM 22X10X7MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.109	SUP	Custom 27803010		304.109  -  SPACER SPNL SM 22X10X9MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.111	SUP	Custom 27803010		304.111  -  SPACER SPNL SM 22X10X11MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.113	SUP	Custom 27803010		304.113  -  SPACER SPNL SM 22X10X13MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.115	SUP	Custom 27803010		304.115  -  SPACER SPNL SM 22X10X15MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.117	SUP	Custom 27803010		304.117  -  SPACER SPNL SM 22X10X17MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.119	SUP	Custom 27803010		304.119  -  SPACER SPNL SM 22X10X19MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.121	SUP	Custom 27803010		304.121  -  SPACER SPNL SM 22X10X21MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.159	SUP	Custom 27803010		304.159  -  SPACER SPNL SM 18X10X9MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.161	SUP	Custom 27803010		304.161  -  SPACER SPNL SM 18X10X11MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.163	SUP	Custom 27803010		304.163  -  SPACER SPNL SM 18X10X13MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.165	SUP	Custom 27803010		304.165  -  SPACER SPNL SM 18X10X15MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.167	SUP	Custom 27803010		304.167  -  SPACER SPNL SM 18X10X17MM NS LF SUST O RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.205	SUP	Custom 27803010		304.205  -  SPACER SPNL 13MM MED PRLL 14X5MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.206	SUP	Custom 27803010		304.206  -  SPACER SPNL 13MM MED PRLL 14X6MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.207	SUP	Custom 27803010		304.207  -  SPACER SPNL 13MM MED PRLL 14X7MM NS LF SUST R RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.208	SUP	Custom 27803010		304.208  -  SPACER SPNL 13MM MED PRLL 14X8MM NS LF SUST R RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.209	SUP	Custom 27803010		304.209  -  SPACER SPNL 13MM MED PRLL 14X9MM NS LF SUST R RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.21	SUP	Custom 27803010		304.210  -  SPACER SPNL 13MM MED PRLL 14X10MM NS LF SUST R RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.211	SUP	Custom 27803010		304.211  -  SPACER SPNL 13MM MED PRLL 14X11MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.212	SUP	Custom 27803010		304.212  -  SPACER SPNL 13MM MED PRLL 14X12MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.225	SUP	Custom 27803010		304.225  -  SPACER SPNL 7D LRDTC 13MM MED 14X5MM NS LF SUST R RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.226	SUP	Custom 27803010		304.226  -  SPACER SPNL 7D LRDTC 13MM MED 14X6MM NS LF SUST R RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.227	SUP	Custom 27803010		304.227  -  SPACER SPNL 7D LRDTC 13MM MED 14X7MM NS LF SUST R RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.228	SUP	Custom 27803010		304.228  -  SPACER SPNL 7D LRDTC 13MM MED 14X8MM NS LF SUST R RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.229	SUP	Custom 27803010		304.229  -  SPACER SPNL 7D LRDTC 13MM MED 14X9MM NS LF SUST R RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.23	SUP	Custom 27803010		304.230  -  SPACER SPNL 7D LRDTC 13MM MED 14X10MM NS LF SUST R RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.231	SUP	Custom 27803010		304.231  -  SPACER SPNL 7D LRDTC 13MM MED 14X11MM NS LF SUST O RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.232	SUP	Custom 27803010		304.232  -  SPACER SPNL 7D LRDTC 13MM MED 14X12MM NS LF SUST O RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.245	SUP	Custom 27803010		304.245  -  SPACER SPNL 13MM MED CNVX 14X5MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.246	SUP	Custom 27803010		304.246  -  SPACER SPNL 13MM MED CNVX 14X6MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.247	SUP	Custom 27803010		304.247  -  SPACER SPNL 13MM MED CNVX 14X7MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.248	SUP	Custom 27803010		304.248  -  SPACER SPNL 13MM MED CNVX 14X8MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.249	SUP	Custom 27803010		304.249  -  SPACER SPNL 13MM MED CNVX 14X9MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.25	SUP	Custom 27803010		304.250  -  SPACER SPNL 13MM MED CNVX 14X10MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.251	SUP	Custom 27803010		304.251  -  SPACER SPNL 13MM MED CNVX 14X11MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.252	SUP	Custom 27803010		304.252  -  SPACER SPNL 13MM MED CNVX 14X12MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.265	SUP	Custom 27803010		304.265  -  SPACER SPNL 13MM MED PRLL 14X5MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.266	SUP	Custom 27803010		304.266  -  SPACER SPNL 13MM MED PRLL 14X6MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.267	SUP	Custom 27803010		304.267  -  SPACER SPNL 13MM MED PRLL 14X7MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.268	SUP	Custom 27803010		304.268  -  SPACER SPNL 13MM MED PRLL 14X8MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.269	SUP	Custom 27803010		304.269  -  SPACER SPNL 13MM MED PRLL 14X9MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.27	SUP	Custom 27803010		304.270  -  SPACER SPNL 13MM MED PRLL 14X10MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.271	SUP	Custom 27803010		304.271  -  SPACER SPNL 13MM MED PRLL 14X11MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.272	SUP	Custom 27803010		304.272  -  SPACER SPNL 13MM MED PRLL 14X12MM NS LF SUST O RDLCNT BEAD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.275	SUP	Custom 27803010		304.275  -  SPACER SPNL 7D LRDTC 13MM MED 14X5MM NS LF SUST O RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.276	SUP	Custom 27803010		304.276  -  SPACER SPNL 7D LRDTC 13MM MED 14X6MM NS LF SUST O RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.277	SUP	Custom 27803010		304.277  -  SPACER SPNL 7D LRDTC 13MM MED 14X7MM NS LF SUST O RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.278	SUP	Custom 27803010		304.278  -  SPACER SPNL 7D LRDTC 13MM MED 14X8MM NS LF SUST O RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.279	SUP	Custom 27803010		304.279  -  SPACER SPNL 7D LRDTC 13MM MED 14X9MM NS LF SUST O RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.28	SUP	Custom 27803010		304.280  -  SPACER SPNL 7D LRDTC 13MM MED 14X10MM NS LF SUST O RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.281	SUP	Custom 27803010		304.281  -  SPACER SPNL 7D LRDTC 13MM MED 14X11MM NS LF SUST O RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.282	SUP	Custom 27803010		304.282  -  SPACER SPNL 7D LRDTC 13MM MED 14X12MM NS LF SUST O RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.309	SUP	Custom 27803010		304.309  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK THORLMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.311	SUP	Custom 27803010		304.311  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.313	SUP	Custom 27803010		304.313  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.315	SUP	Custom 27803010		304.315  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.317	SUP	Custom 27803010		304.317  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.319	SUP	Custom 27803010		304.319  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.321	SUP	Custom 27803010		304.321  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.351	SUP	Custom 27803010		304.351  -  SPACER SPNL 15D LRDTC 31MM LG 25X11MM NS LF SUST O RDLCNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.352	SUP	Custom 27803010		304.352  -  SPACER SPNL 15D LRDTC 31MM LG 25X13MM NS LF SUST O RDLCNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.353	SUP	Custom 27803010		304.353  -  SPACER SPNL 15D LRDTC 31MM LG 25X15MM NS LF SUST O RDLCNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.354	SUP	Custom 27803010		304.354  -  SPACER SPNL 15D LRDTC 31MM LG 25X17MM NS LF SUST O RDLCNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.355	SUP	Custom 27803010		304.355  -  SPACER SPNL 15D LRDTC 31MM LG 25X19MM NS LF SUST O RDLCNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.356	SUP	Custom 27803010		304.356  -  SPACER SPNL 15D LRDTC 31MM LG 25X21MM NS LF SUST O RDLCNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.359	SUP	Custom 27803010		304.359  -  SPACER SPNL 42MM XL 28X9MM NS LF SUST O RDLCNT PEEK THORLMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.361	SUP	Custom 27803010		304.361  -  SPACER SPNL 42MM XL 28X11MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.363	SUP	Custom 27803010		304.363  -  SPACER SPNL 42MM XL 28X13MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.365	SUP	Custom 27803010		304.365  -  SPACER SPNL 42MM XL 28X15MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.367	SUP	Custom 27803010		304.367  -  SPACER SPNL 42MM XL 28X17MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.369	SUP	Custom 27803010		304.369  -  SPACER SPNL 42MM XL 28X19MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.371	SUP	Custom 27803010		304.371  -  SPACER SPNL 42MM XL 28X21MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.379	SUP	Custom 27803010		304.379  -  SPACER SPNL 42MM XL 28X9MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.381	SUP	Custom 27803010		304.381  -  SPACER SPNL 42MM XL 28X11MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.383	SUP	Custom 27803010		304.383  -  SPACER SPNL 42MM XL 28X13MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.385	SUP	Custom 27803010		304.385  -  SPACER SPNL 42MM XL 28X15MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.387	SUP	Custom 27803010		304.387  -  SPACER SPNL 42MM XL 28X17MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.389	SUP	Custom 27803010		304.389  -  SPACER SPNL 42MM XL 28X19MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.391	SUP	Custom 27803010		304.391  -  SPACER SPNL 42MM XL 28X21MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.409	SUP	Custom 27803010		304.409  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.411	SUP	Custom 27803010		304.411  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST O RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.413	SUP	Custom 27803010		304.413  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST O RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.415	SUP	Custom 27803010		304.415  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST O RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.417	SUP	Custom 27803010		304.417  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST O RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.419	SUP	Custom 27803010		304.419  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST O RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.421	SUP	Custom 27803010		304.421  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST O RDLCNT PEEK LAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.45	SUP	Custom 27803010		304.450  -  SPACER SPNL 4D LRDTC 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.451	SUP	Custom 27803010		304.451  -  SPACER SPNL 4D LRDTC 31MM LG 25X11MM NS LF SUST O RDLCNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.452	SUP	Custom 27803010		304.452  -  SPACER SPNL 4D LRDTC 31MM LG 25X13MM NS LF SUST O RDLCNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.453	SUP	Custom 27803010		304.453  -  SPACER SPNL 4D LRDTC 31MM LG 25X15MM NS LF SUST O RDLCNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.454	SUP	Custom 27803010		304.454  -  SPACER SPNL 4D LRDTC 31MM LG 25X17MM NS LF SUST O RDLCNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.455	SUP	Custom 27803010		304.455  -  SPACER SPNL 4D LRDTC 31MM LG 25X19MM NS LF SUST O RDLCNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.456	SUP	Custom 27803010		304.456  -  SPACER SPNL 4D LRDTC 31MM LG 25X21MM NS LF SUST O RDLCNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.509	SUP	Custom 27803010		304.509  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.511	SUP	Custom 27803010		304.511  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.513	SUP	Custom 27803010		304.513  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.515	SUP	Custom 27803010		304.515  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.517	SUP	Custom 27803010		304.517  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.519	SUP	Custom 27803010		304.519  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.521	SUP	Custom 27803010		304.521  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST O RDLCNT PEEK ALAT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.607	SUP	Custom 27803010		304.607  -  SPACER SPNL SM ARCH 27X9.5X7MM NS LF SUST RDLCNT PEEK TLIF	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.609	SUP	Custom 27803010		304.609  -  SPACER SPNL SM ARCH 27X9.5X9MM NS LF SUST RDLCNT PEEK TLIF	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.611	SUP	Custom 27803010		304.611  -  SPACER SPNL SM ARCH 27X9.5X11MM NS LF SUST RDLCNT PEEK TLIF	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.613	SUP	Custom 27803010		304.613  -  SPACER SPNL SM ARCH 27X9.5X13MM NS LF SUST RDLCNT PEEK TLIF	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.615	SUP	Custom 27803010		304.615  -  SPACER SPNL SM ARCH 27X9.5X15MM NS LF SUST RDLCNT PEEK TLIF	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.617	SUP	Custom 27803010		304.617  -  SPACER SPNL SM ARCH 27X9.5X17MM NS LF SUST RDLCNT PEEK TLIF	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.707	SUP	Custom 27803010		304.707  -  SPACER SPNL SM NAR 22X8X7MM NS LF SUST R RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.709	SUP	Custom 27803010		304.709  -  SPACER SPNL SM NAR 22X8X9MM NS LF SUST R RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.711	SUP	Custom 27803010		304.711  -  SPACER SPNL SM NAR 22X8X11MM NS LF SUST R RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.713	SUP	Custom 27803010		304.713  -  SPACER SPNL SM NAR 22X8X13MM NS LF SUST R RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.715	SUP	Custom 27803010		304.715  -  SPACER SPNL SM NAR 22X8X15MM NS LF SUST R RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.717	SUP	Custom 27803010		304.717  -  SPACER SPNL SM NAR 22X8X17MM NS LF SUST R RDLCNT PEEK LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.808	SUP	Custom 27803010		304.808  -  SPACER SPNL OBLQ 30X10X8MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.809	SUP	Custom 27803010		304.809  -  SPACER SPNL OBLQ 30X10X9MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.81	SUP	Custom 27803010		304.810  -  SPACER SPNL OBLQ 30X10X10MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.811	SUP	Custom 27803010		304.811  -  SPACER SPNL OBLQ 30X10X11MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.812	SUP	Custom 27803010		304.812  -  SPACER SPNL OBLQ 30X10X12MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.813	SUP	Custom 27803010		304.813  -  SPACER SPNL OBLQ 30X10X13MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.814	SUP	Custom 27803010		304.814  -  SPACER SPNL OBLQ 30X10X14MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.815	SUP	Custom 27803010		304.815  -  SPACER SPNL OBLQ 30X10X15MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.817	SUP	Custom 27803010		304.817  -  SPACER SPNL OBLQ 30X10X17MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.868	SUP	Custom 27803010		304.868  -  SPACER SPNL OBLQ 30X12X8MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.869	SUP	Custom 27803010		304.869  -  SPACER SPNL OBLQ 30X12X9MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.87	SUP	Custom 27803010		304.870  -  SPACER SPNL OBLQ 30X12X10MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.871	SUP	Custom 27803010		304.871  -  SPACER SPNL OBLQ 30X12X11MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.872	SUP	Custom 27803010		304.872  -  SPACER SPNL OBLQ 30X12X12MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.873	SUP	Custom 27803010		304.873  -  SPACER SPNL OBLQ 30X12X13MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.874	SUP	Custom 27803010		304.874  -  SPACER SPNL OBLQ 30X12X14MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.875	SUP	Custom 27803010		304.875  -  SPACER SPNL OBLQ 30X12X15MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.877	SUP	Custom 27803010		304.877  -  SPACER SPNL OBLQ 30X12X17MM NS LF SUST RDLCNT PEEK LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.905	SUP	Custom 27803010		304.905  -  SPACER SPNL 11MM MED NAR PRLL 12X5MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.906	SUP	Custom 27803010		304.906  -  SPACER SPNL 11MM MED NAR PRLL 12X6MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.907	SUP	Custom 27803010		304.907  -  SPACER SPNL 11MM MED NAR PRLL 12X7MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.908	SUP	Custom 27803010		304.908  -  SPACER SPNL 11MM MED NAR PRLL 12X8MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.909	SUP	Custom 27803010		304.909  -  SPACER SPNL 11MM MED NAR PRLL 12X9MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.91	SUP	Custom 27803010		304.910  -  SPACER SPNL 11MM MED NAR PRLL 12X10MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.911	SUP	Custom 27803010		304.911  -  SPACER SPNL 11MM MED NAR PRLL 12X11MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.912	SUP	Custom 27803010		304.912  -  SPACER SPNL 11MM MED NAR PRLL 12X12MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.925	SUP	Custom 27803010		304.925  -  SPACER SPNL 11MM LRDTC MED NAR 12X5MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.926	SUP	Custom 27803010		304.926  -  SPACER SPNL 11MM LRDTC MED NAR 12X6MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.927	SUP	Custom 27803010		304.927  -  SPACER SPNL 11MM LRDTC MED NAR 12X7MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.928	SUP	Custom 27803010		304.928  -  SPACER SPNL 11MM LRDTC MED NAR 12X8MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.929	SUP	Custom 27803010		304.929  -  SPACER SPNL 11MM LRDTC MED NAR 12X9MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.93	SUP	Custom 27803010		304.930  -  SPACER SPNL 11MM LRDTC MED NAR 12X10MM NS LF SUST RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.931	SUP	Custom 27803010		304.931  -  SPACER SPNL 11MM LRDTC MED NAR 12X11MM NS LF SUST RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.932	SUP	Custom 27803010		304.932  -  SPACER SPNL 11MM LRDTC MED NAR 12X12MM NS LF SUST RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.945	SUP	Custom 27803010		304.945  -  SPACER SPNL 11MM MED CNVX NAR 12X5MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.946	SUP	Custom 27803010		304.946  -  SPACER SPNL 11MM MED CNVX NAR 12X6MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.947	SUP	Custom 27803010		304.947  -  SPACER SPNL 11MM MED CNVX NAR 12X7MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.948	SUP	Custom 27803010		304.948  -  SPACER SPNL 11MM MED CNVX NAR 12X8MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.949	SUP	Custom 27803010		304.949  -  SPACER SPNL 11MM MED CNVX NAR 12X9MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.95	SUP	Custom 27803010		304.950  -  SPACER SPNL 11MM MED CNVX NAR 12X10MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.951	SUP	Custom 27803010		304.951  -  SPACER SPNL 11MM MED CNVX NAR 12X11MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.952	SUP	Custom 27803010		304.952  -  SPACER SPNL 11MM MED CNVX NAR 12X12MM NS LF SUST RDLCNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.968	SUP	Custom 27803010		304.968  -  SPACER SPNL OBLQ 26X12X8MM NS LF SUST RDLCNT PEEK INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.969	SUP	Custom 27803010		304.969  -  SPACER SPNL OBLQ 26X12X9MM NS LF SUST RDLCNT PEEK INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.97	SUP	Custom 27803010		304.970  -  SPACER SPNL OBLQ 26X12X10MM NS LF SUST RDLCNT PEEK INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.971	SUP	Custom 27803010		304.971  -  SPACER SPNL OBLQ 26X12X11MM NS LF SUST RDLCNT PEEK INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.972	SUP	Custom 27803010		304.972  -  SPACER SPNL OBLQ 26X12X12MM NS LF SUST RDLCNT PEEK INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.973	SUP	Custom 27803010		304.973  -  SPACER SPNL OBLQ 26X12X13MM NS LF SUST RDLCNT PEEK INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.974	SUP	Custom 27803010		304.974  -  SPACER SPNL OBLQ 26X12X14MM NS LF SUST RDLCNT PEEK INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.975	SUP	Custom 27803010		304.975  -  SPACER SPNL OBLQ 26X12X15MM NS LF SUST RDLCNT PEEK INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304.977	SUP	Custom 27803010		304.977  -  SPACER SPNL OBLQ 26X12X17MM NS LF SUST RDLCNT PEEK INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
308	SUP	HCPCS C1879		308  -  MARKER CHARM MARGINMAP BRST BIOP 10MM STRL	BOTH IP/OP	$37.50 	$27.75	$0.00	$30.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.83	$27.83	$0.00	$0.00	$7.82	$0.00	$0.00	$0.00	$0.00	$18.75	$29.70	$30.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
309.521	SUP	HCPCS C1713		309.521  -  SCREW BONE 3.5MM 21MM EXTRACTION FIBULA DISTAL NONSTRL	BOTH IP/OP	$125.10 	$92.57	$0.00	$97.18	$54.66	$54.66	$0.00	$0.00	$0.00	$26.07	$92.85	$92.85	$0.00	$0.00	$26.07	$0.00	$74.00	$74.00	$0.00	$60.74	$96.21	$97.18	$0.00		$0.00	$18.46	$0.00	$0.00	$19.34	$0.00	$0.00	$0.00	$0.00	$0.00
310.02	SUP	Custom 27203010		310.02  -  BIT DRL 3.2MM 225MM NS QC UNV NL SYS	BOTH IP/OP	$286.75 	$212.20	$0.00	$222.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.83	$212.83	$0.00	$0.00	$59.76	$0.00	$0.00	$0.00	$0.00	$139.20	$220.49	$222.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.1	SUP	Custom 27203010		310.10  -  BIT DRILL 1.1MM 45MM JACOBS CHUCK NONSTRL MINI FRAGMENT	BOTH IP/OP	$124.20 	$91.91	$0.00	$99.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.18	$92.18	$0.00	$0.00	$25.88	$0.00	$0.00	$0.00	$0.00	$62.10	$98.37	$99.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.11	SUP	Custom 27203010		310.11  -  BIT DRL 1.1MM 60MM NS QC MN FRAG SYS	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.111	SUP	Custom 27203010		310.111  -  BIT DRL 1.1MM 55MM NS MNQK CPLNG 1.5/2MM ROT CRRT PLT	BOTH IP/OP	$139.18 	$102.99	$0.00	$108.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.30	$103.30	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$67.55	$107.00	$108.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.113	SUP	Custom 27203010		310.113  -  BIT DRL 1.1MM 65MM NS JLTCH CPLNG CPLNG STRYK	BOTH IP/OP	$139.18 	$102.99	$0.00	$108.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.30	$103.30	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$67.55	$107.00	$108.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.133	SUP	Custom 27203010		310.133  -  BIT DRILL 45MM 1.3MM 3MM STOP JLTCH CPLNG NONSTRL	BOTH IP/OP	$326.25 	$241.43	$0.00	$261.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.14	$242.14	$0.00	$0.00	$67.99	$0.00	$0.00	$0.00	$0.00	$163.13	$258.39	$261.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.134	SUP	Custom 27203010		310.134  -  BIT DRILL 52MM 1.3MM 3MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$326.25 	$241.43	$0.00	$261.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.14	$242.14	$0.00	$0.00	$67.99	$0.00	$0.00	$0.00	$0.00	$163.13	$258.39	$261.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.136	SUP	Custom 27203010		310.136  -  BIT DRL 4MM 1.3MM 45MM NS JLTCH CPLNG CPLNG SLF STP STRYK	BOTH IP/OP	$326.25 	$241.43	$0.00	$261.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.14	$242.14	$0.00	$0.00	$67.99	$0.00	$0.00	$0.00	$0.00	$163.13	$258.39	$261.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.137	SUP	Custom 27203010		310.137  -  BIT DRILL 45MM 1.3MM 6MM STOP JLTCH CPLNG NONSTRL	BOTH IP/OP	$326.25 	$241.43	$0.00	$261.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.14	$242.14	$0.00	$0.00	$67.99	$0.00	$0.00	$0.00	$0.00	$163.13	$258.39	$261.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.138	SUP	Custom 27203010		310.138  -  BIT DRILL 52MM 1.3MM 4MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$326.25 	$241.43	$0.00	$261.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.14	$242.14	$0.00	$0.00	$67.99	$0.00	$0.00	$0.00	$0.00	$163.13	$258.39	$261.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.139	SUP	Custom 27203010		310.139  -  BIT DRILL 52MM 1.3MM 6MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$326.25 	$241.43	$0.00	$261.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.14	$242.14	$0.00	$0.00	$67.99	$0.00	$0.00	$0.00	$0.00	$163.13	$258.39	$261.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.14	SUP	Custom 27203010		310.14  -  BIT DRL 1.5MM 70MM NS JCHK MN FRAG SYS	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.141	SUP	Custom 27203010		310.141  -  BIT DRL 1.5MM 65MM NS MNQK CPLNG 1.5/2MM ROT CRRT PLT	BOTH IP/OP	$139.18 	$102.99	$0.00	$108.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.30	$103.30	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$67.55	$107.00	$108.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.143	SUP	Custom 27203010		310.143  -  BIT DRL 1.5MM 75MM NS JLTCH CPLNG CPLNG STRYK	BOTH IP/OP	$139.18 	$102.99	$0.00	$108.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.30	$103.30	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$67.55	$107.00	$108.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.15	SUP	Custom 27203010		310.15  -  BIT DRL 1.5MM 85MM NS QC	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.153	SUP	Custom 27203010		310.153  -  BIT DRILL 75MM 1.5MM JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.16	SUP	Custom 27203010		310.16  -  BIT DRILL 1.5MM 110MM QUICK COUPLING STAINLESS STEEL NONSTRL	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.161	SUP	Custom 27203010		310.161  -  BIT DRILL 1.5MM 110MM J LATCH DEPTH MARK NONSTRL	BOTH IP/OP	$279.73 	$207.00	$0.00	$217.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.61	$207.61	$0.00	$0.00	$58.29	$0.00	$0.00	$0.00	$0.00	$135.79	$215.09	$217.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.162	SUP	Custom 27203010		310.162  -  BIT DRILL 1.8MM 110MM J LATCH DEPTH MARK NONSTRL	BOTH IP/OP	$279.73 	$207.00	$0.00	$217.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.61	$207.61	$0.00	$0.00	$58.29	$0.00	$0.00	$0.00	$0.00	$135.79	$215.09	$217.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.17	SUP	Custom 27203010		310.170  -  BIT DRILL 125MM 1.5MM 8MM STOP QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.171	SUP	Custom 27203010		310.171  -  BIT DRILL 125MM 1.5MM 8MM STOP UNV HALL CPLNG NONSTRL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.172	SUP	Custom 27203010		310.172  -  BIT DRILL 125MM 1.5MM 8MM STOP JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.173	SUP	Custom 27203010		310.173  -  BIT DRILL 125MM 1.5MM 8MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.177	SUP	Custom 27203010		310.177  -  BIT DRILL 1.5MM 4MM STOP JLTCH NONSTRL	BOTH IP/OP	$346.50 	$256.41	$0.00	$277.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.17	$257.17	$0.00	$0.00	$72.21	$0.00	$0.00	$0.00	$0.00	$173.25	$274.43	$277.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.182	SUP	Custom 27203010		310.182  -  BIT DRILL 1.5MM 4MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$346.50 	$256.41	$0.00	$277.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.17	$257.17	$0.00	$0.00	$72.21	$0.00	$0.00	$0.00	$0.00	$173.25	$274.43	$277.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.19	SUP	Custom 27203010		310.19  -  BIT DRL 2MM 100MM NS QC	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$0.00	$0.00	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.2	SUP	Custom 27203010		310.20  -  BIT DRILL STANDARD 2MM 85MM SET BASIC ARTICULATE TENSION	BOTH IP/OP	$131.68 	$97.44	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.73	$97.73	$0.00	$0.00	$27.44	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.201	SUP	Custom 27203010		310.201  -  BIT DRL 2MM 65MM NS MNQK CPLNG	BOTH IP/OP	$139.18 	$102.99	$0.00	$108.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.30	$103.30	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$67.55	$107.00	$108.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.203	SUP	Custom 27203010		310.203  -  BIT DRL 2MM 75MM NS JLTCH CPLNG STRYK	BOTH IP/OP	$139.18 	$102.99	$0.00	$108.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.30	$103.30	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$67.55	$107.00	$108.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.21	SUP	Custom 27203010		310.21  -  BIT DRL 2MM 125MM NS QC	BOTH IP/OP	$151.83 	$112.35	$0.00	$117.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.68	$112.68	$0.00	$0.00	$31.64	$0.00	$0.00	$0.00	$0.00	$73.70	$116.74	$117.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.215	SUP	Custom 27203010		310.215  -  BIT DRILL 1.7MM .9MM 100MM 2.4MM QUICK COUPLING CANN NONSTRL	BOTH IP/OP	$850.45 	$629.33	$0.00	$660.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$631.20	$631.20	$0.00	$0.00	$177.23	$0.00	$0.00	$0.00	$0.00	$412.84	$653.94	$660.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.221	SUP	Custom 27203010		310.221  -  BIT DRL 2MM 150MM NS CNN QC	BOTH IP/OP	$788.60 	$583.56	$0.00	$612.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$585.30	$585.30	$0.00	$0.00	$164.34	$0.00	$0.00	$0.00	$0.00	$382.81	$606.38	$612.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.229	SUP	Custom 27203010		310.229  -  BIT DRL 2.9MM 150MM NS QC 4MM CORT SCR	BOTH IP/OP	$168.68 	$124.82	$0.00	$131.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.19	$125.19	$0.00	$0.00	$35.15	$0.00	$0.00	$0.00	$0.00	$81.89	$129.71	$131.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.23	SUP	Custom 27203010		310.23  -  BIT DRILL 2.5MM 180MM QUICK COUPLING GOLD STAINLESS STEEL	BOTH IP/OP	$151.83 	$112.35	$0.00	$117.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.68	$112.68	$0.00	$0.00	$31.64	$0.00	$0.00	$0.00	$0.00	$73.70	$116.74	$117.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.24	SUP	Custom 27203010		310.24  -  BIT DRILL 2.5MM 95MM JACOBS CHUCK GOLD STAINLESS STEEL	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.243	SUP	Custom 27203010		310.243  -  GUIDEWIRE ORTHOPEDIC 2.5MM 200MM DRILL TIP LCP STAINLESS	BOTH IP/OP	$121.58 	$89.97	$0.00	$94.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.23	$90.23	$0.00	$0.00	$25.34	$0.00	$0.00	$0.00	$0.00	$59.03	$93.50	$94.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.25	SUP	Custom 27203010		310.25  -  BIT DRL 2.5MM 110MM AU NS QC	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.26	SUP	Custom 27203010		310.26  -  BIT DRL 2.7MM 100MM NS QC	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.27	SUP	Custom 27203010		310.27  -  BIT DRL 2.7MM 85MM NS JCHK	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.28	SUP	Custom 27203010		310.28  -  BIT DRL 2.7MM 125MM NS QC	BOTH IP/OP	$151.83 	$112.35	$0.00	$117.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.68	$112.68	$0.00	$0.00	$31.64	$0.00	$0.00	$0.00	$0.00	$73.70	$116.74	$117.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.284	SUP	Custom 27203010		310.284  -  BIT DRILL 2.8MM 165MM 2 FLUTE QUICK COUPLING LCP NONSTRL	BOTH IP/OP	$168.68 	$124.82	$0.00	$131.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.19	$125.19	$0.00	$0.00	$35.15	$0.00	$0.00	$0.00	$0.00	$81.89	$129.71	$131.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.288	SUP	Custom 27203010		310.288  -  BIT DRL 2.8MM 165MM NS QC	BOTH IP/OP	$168.68 	$124.82	$0.00	$131.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.19	$125.19	$0.00	$0.00	$35.15	$0.00	$0.00	$0.00	$0.00	$81.89	$129.71	$131.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.29	SUP	Custom 27203010		310.29  -  BIT DRILL 3.2MM 195MM QUICK COUPLING STAINLESS STEEL NONSTRL	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$0.00	$0.00	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.3	SUP	Custom 27203010		310.30  -  BIT DRL 3.2MM 180MM NS JCHK	BOTH IP/OP	$165.13 	$122.20	$0.00	$132.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.56	$122.56	$0.00	$0.00	$34.41	$0.00	$0.00	$0.00	$0.00	$82.56	$130.78	$132.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.31	SUP	Custom 27203010		310.31  -  BIT DRL 3.2MM 145MM NS QC	BOTH IP/OP	$133.55 	$98.83	$0.00	$103.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.12	$99.12	$0.00	$0.00	$27.83	$0.00	$0.00	$0.00	$0.00	$64.83	$102.68	$103.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.32	SUP	Custom 27203010		310.32  -  BIT DRL 3.2MM 130MM NS JCHK	BOTH IP/OP	$131.43 	$97.26	$0.00	$102.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.54	$97.54	$0.00	$0.00	$27.39	$0.00	$0.00	$0.00	$0.00	$63.80	$101.06	$102.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.35	SUP	Custom 27203010		310.35  -  BIT DRL 3.5MM 110MM NS QC	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$0.00	$0.00	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.36	SUP	Custom 27203010		310.36  -  BIT DRL 3.5MM 95MM NS JCHK	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.37	SUP	Custom 27203010		310.37  -  BIT DRL 3.5MM 195MM NS QC	BOTH IP/OP	$151.83 	$112.35	$0.00	$117.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.68	$112.68	$0.00	$0.00	$31.64	$0.00	$0.00	$0.00	$0.00	$73.70	$116.74	$117.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.38	SUP	Custom 27203010		310.38  -  BIT DRL 3.5MM 180MM NS JCHK	BOTH IP/OP	$151.83 	$112.35	$0.00	$117.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.68	$112.68	$0.00	$0.00	$31.64	$0.00	$0.00	$0.00	$0.00	$73.70	$116.74	$117.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.4	SUP	Custom 27203010		310.40  -  BIT DRILL 4MM 197MM QUICK COUPLING NONSTRL	BOTH IP/OP	$158.30 	$117.14	$0.00	$126.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.49	$117.49	$0.00	$0.00	$32.99	$0.00	$0.00	$0.00	$0.00	$79.15	$125.37	$126.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.401	SUP	Custom 27203010		310.401  -  BIT DRL 4MM 160MM NS QC	BOTH IP/OP	$160.25 	$118.59	$0.00	$124.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.94	$118.94	$0.00	$0.00	$33.40	$0.00	$0.00	$0.00	$0.00	$77.79	$123.22	$124.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.423	SUP	Custom 27203010		310.423  -  BIT DRL 4.3MM 280MM NS QC	BOTH IP/OP	$708.48 	$524.28	$0.00	$550.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.83	$525.83	$0.00	$0.00	$147.65	$0.00	$0.00	$0.00	$0.00	$343.91	$544.76	$550.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.43	SUP	Custom 27203010		310.430  -  BIT DRILL 4.3MM 221MM QUICK COUPLING CANN NONSTRL	BOTH IP/OP	$399.88 	$295.91	$0.00	$319.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.79	$296.79	$0.00	$0.00	$83.33	$0.00	$0.00	$0.00	$0.00	$199.94	$316.70	$319.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.431	SUP	Custom 27203010		310.431  -  BIT DRL 4.3MM 180MM NS QC 5MM LCK SCR	BOTH IP/OP	$223.83 	$165.63	$0.00	$179.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.91	$177.27	$179.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.44	SUP	Custom 27203010		310.44  -  BIT DRL 4.5MM 145MM NS QC	BOTH IP/OP	$133.55 	$98.83	$0.00	$103.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.12	$99.12	$0.00	$0.00	$27.83	$0.00	$0.00	$0.00	$0.00	$64.83	$102.68	$103.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.45	SUP	Custom 27203010		310.45  -  BIT DRILL 4.5MM 130MM JACOBS CHUCK COUPLING STAINLESS STEEL	BOTH IP/OP	$131.43 	$97.26	$0.00	$102.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.54	$97.54	$0.00	$0.00	$27.39	$0.00	$0.00	$0.00	$0.00	$63.80	$101.06	$102.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.48	SUP	Custom 27203010		310.48  -  BIT DRILL 4.5MM 195MM QUICK COUPLING STAINLESS STEEL NONSTRL	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$0.00	$0.00	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.49	SUP	Custom 27203010		310.49  -  BIT DRILL 4.5MM 180MM JACOBS CHUCK STAINLESS STEEL NONSTRL	BOTH IP/OP	$170.10 	$125.87	$0.00	$132.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.25	$126.25	$0.00	$0.00	$35.45	$0.00	$0.00	$0.00	$0.00	$82.56	$130.78	$132.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.495	SUP	Custom 27203010		310.495  -  BIT DRL 7.3MM 2.9MM 300MM NS CNN LG QC	BOTH IP/OP	$834.98 	$617.89	$0.00	$648.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$619.72	$619.72	$0.00	$0.00	$174.01	$0.00	$0.00	$0.00	$0.00	$405.33	$642.03	$648.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.507	SUP	Custom 27203010		310.507  -  BIT DRL 1.5MM 96MM NS MNQK CPLNG D MRK	BOTH IP/OP	$279.73 	$207.00	$0.00	$217.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.61	$207.61	$0.00	$0.00	$58.29	$0.00	$0.00	$0.00	$0.00	$135.79	$215.09	$217.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.509	SUP	Custom 27203010		310.509  -  BIT DRL 1.8MM 110MM NS QC D MRK	BOTH IP/OP	$279.73 	$207.00	$0.00	$217.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.61	$207.61	$0.00	$0.00	$58.29	$0.00	$0.00	$0.00	$0.00	$135.79	$215.09	$217.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.51	SUP	Custom 27203010		310.510  -  BIT DRL 1.8MM 100MM NS QC D MRK	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.511	SUP	Custom 27203010		310.511  -  BIT DRILL 100MM 1.8MM UNV HALL CPLNG NONSTRL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.512	SUP	Custom 27203010		310.512  -  BIT DRL 1.8MM 100MM NS JLTCH CPLNG STRYK	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.513	SUP	Custom 27203010		310.513  -  BIT DRILL 100MM 1.8MM MINI MANDIB QC JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.52	SUP	Custom 27203010		310.520  -  BIT DRL 1.8MM 125MM NS QC	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.521	SUP	Custom 27203010		310.521  -  BIT DRILL 125MM 1.8MM UNV HALL CPLNG NONSTRL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.522	SUP	Custom 27203010		310.522  -  BIT DRL 1.8MM 125MM NS JLTCH CPLNG STRYK	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.523	SUP	Custom 27203010		310.523  -  BIT DRILL 125MM 1.8MM MINI QC 2.4MM SCR NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.53	SUP	Custom 27203010		310.530  -  BIT DRL 2.4MM 100MM NS QC D MRK	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.531	SUP	Custom 27203010		310.531  -  BIT DRILL 100MM 2.4MM UNV HALL CPLNG NONSTRL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.532	SUP	Custom 27203010		310.532  -  BIT DRL 2.4MM 100MM NS JLTCH CPLNG STRYK	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.533	SUP	Custom 27203010		310.533  -  BIT DRILL 100MM 2.4MM MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.54	SUP	Custom 27203010		310.540  -  BIT DRL 2.4MM 125MM NS QC	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.541	SUP	Custom 27203010		310.541  -  BIT DRILL 125MM 2.4MM UNV HALL CPLNG NONSTRL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.542	SUP	Custom 27203010		310.542  -  BIT DRILL 125MM 2.4MM JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.543	SUP	Custom 27203010		310.543  -  BIT DRILL 125MM 2.4MM MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.562	SUP	Custom 27203010		310.562  -  BIT DRILL 75MM 1.8MM JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.572	SUP	Custom 27203010		310.572  -  BIT DRL 2.4MM 75MM NS JLTCH CPLNG STRYK	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.582	SUP	Custom 27203010		310.582  -  BIT DRILL 50MM 1.5MM JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.592	SUP	Custom 27203010		310.592  -  BIT DRILL 50MM 1.8MM JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.6	SUP	Custom 27203010		310.60  -  BIT DRILL 6MM 195MM QUICK COUPLING NONSTRL	BOTH IP/OP	$302.98 	$224.21	$0.00	$242.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.87	$224.87	$0.00	$0.00	$63.14	$0.00	$0.00	$0.00	$0.00	$151.49	$239.96	$242.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.63	SUP	Custom 27203010		310.63  -  BIT DRL 5MM 2.9MM 300MM NS CNN LG QC	BOTH IP/OP	$822.33 	$608.52	$0.00	$638.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.33	$610.33	$0.00	$0.00	$171.37	$0.00	$0.00	$0.00	$0.00	$399.19	$632.32	$638.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.632	SUP	Custom 27203010		310.632  -  BIT DRL SHRT FLUT 5MM 200MM NS CNN QC 7.3MM SCR	BOTH IP/OP	$656.45 	$485.77	$0.00	$509.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$487.22	$487.22	$0.00	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$318.68	$504.78	$509.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.634	SUP	Custom 27203010		310.634  -  BIT DRL LNG FLUT 4.3MM 200MM NS CNN QC 5MM SCR	BOTH IP/OP	$656.45 	$485.77	$0.00	$509.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$487.22	$487.22	$0.00	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$318.68	$504.78	$509.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.65	SUP	Custom 27203010		310.65  -  BIT DRL 3.2MM 1.7MM 170MM NS CNN QC	BOTH IP/OP	$818.13 	$605.42	$0.00	$635.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$607.21	$607.21	$0.00	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$397.14	$629.07	$635.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.66	SUP	Custom 27203010		310.66  -  BIT DRL 4.5MM 1.7MM 170MM NS CNN QC	BOTH IP/OP	$818.13 	$605.42	$0.00	$635.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$607.21	$607.21	$0.00	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$397.14	$629.07	$635.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.67	SUP	Custom 27203010		310.67  -  BIT DRL 2.7MM 160MM NS CNN QC	BOTH IP/OP	$833.58 	$616.85	$0.00	$647.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$618.68	$618.68	$0.00	$0.00	$173.72	$0.00	$0.00	$0.00	$0.00	$404.65	$640.97	$647.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.68	SUP	Custom 27203010		310.68  -  BIT DRL 3.5MM 160MM NS CNN QC	BOTH IP/OP	$833.58 	$616.85	$0.00	$647.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$618.68	$618.68	$0.00	$0.00	$173.72	$0.00	$0.00	$0.00	$0.00	$404.65	$640.97	$647.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.69	SUP	Custom 27203010		310.69  -  BIT DRL 4.5MM 233MM NS CNN JCHK	BOTH IP/OP	$818.13 	$605.42	$0.00	$635.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$607.21	$607.21	$0.00	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$397.14	$629.07	$635.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.8	SUP	Custom 27203010		310.80  -  CNTRSNK DRILL CENTERING PIN 2.4 MM CORT SCR NONSTRL	BOTH IP/OP	"$1,460.25 "	"$1,080.59"	$0.00	"$1,168.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,083.80"	"$1,083.80"	$0.00	$0.00	$304.32	$0.00	$0.00	$0.00	$0.00	$730.13	"$1,156.52"	"$1,168.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.805	SUP	Custom 27203010		310.805  -  COUNTERSINK W/CENTERING PINS FOR 2.4MM SCREWS/HEX COUPLING	BOTH IP/OP	"$1,518.75 "	"$1,123.88"	$0.00	"$1,215.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,127.22"	"$1,127.22"	$0.00	$0.00	$316.51	$0.00	$0.00	$0.00	$0.00	$759.38	"$1,202.85"	"$1,215.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.81	SUP	Custom 27203010		310.81  -  CNTRSNK DRILL QC CENTERING PIN 1.5 MM 2 MM 2.7 MM SCR	BOTH IP/OP	"$1,518.75 "	"$1,123.88"	$0.00	"$1,215.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,127.22"	"$1,127.22"	$0.00	$0.00	$316.51	$0.00	$0.00	$0.00	$0.00	$759.38	"$1,202.85"	"$1,215.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.811	SUP	Custom 27203010		310.811  -  COUNTERSINK W/CENTERING PINS FOR 2.0MM SCREWS/HEX COUPLING	BOTH IP/OP	"$1,584.00 "	"$1,172.16"	$0.00	"$1,267.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,175.64"	"$1,175.64"	$0.00	$0.00	$330.11	$0.00	$0.00	$0.00	$0.00	$792.00	"$1,254.53"	"$1,267.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.883	SUP	Custom 27203010		310.883  -  CNTRSNK DRILL HEX CPLNG 2 MM 2.4 MM SCR	BOTH IP/OP	"$1,471.50 "	"$1,088.91"	$0.00	"$1,177.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,092.15"	"$1,092.15"	$0.00	$0.00	$306.66	$0.00	$0.00	$0.00	$0.00	$735.75	"$1,165.43"	"$1,177.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311.014	SUP	Custom 27203010		311.014  -  SCRDRVR SM SURG RCHT NONSTRL	BOTH IP/OP	"$3,096.00 "	"$2,291.04"	$0.00	"$2,476.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,297.85"	"$2,297.85"	$0.00	$0.00	$645.21	$0.00	$0.00	$0.00	$0.00	"$1,548.00"	"$2,452.03"	"$2,476.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311.12	SUP	HCPCS C1713		311.120  -  TAP MNQK CPLNG SURG 1.3 MM CORTEX SCR	BOTH IP/OP	$326.25 	$241.43	$0.00	$261.00	$146.81	$146.81	$0.00	$0.00	$0.00	$68.00	$242.14	$242.14	$0.00	$0.00	$67.99	$0.00	$192.98	$192.98	$0.00	$163.13	$258.39	$261.00	$0.00		$0.00	$51.06	$0.00	$0.00	$51.94	$0.00	$0.00	$0.00	$0.00	$0.00
311.15	SUP	HCPCS C1713		311.15  -  TAP SURG 50MM MINI QUICK COUPLING NONSTRL 1.5MM CORTICAL	BOTH IP/OP	$184.15 	$136.27	$0.00	$143.02	$80.45	$80.45	$0.00	$0.00	$0.00	$38.38	$136.68	$136.68	$0.00	$0.00	$38.38	$0.00	$108.92	$108.92	$0.00	$89.39	$141.59	$143.02	$0.00		$0.00	$27.16	$0.00	$0.00	$28.46	$0.00	$0.00	$0.00	$0.00	$0.00
311.204	SUP	HCPCS C1713		311.204  -  TAP 100MM SURG 2MM MANDIB LCK SCR	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$109.35	$109.35	$0.00	$0.00	$0.00	$50.65	$180.35	$180.35	$0.00	$0.00	$50.64	$0.00	$143.73	$143.73	$0.00	$121.50	$192.46	$194.40	$0.00		$0.00	$38.03	$0.00	$0.00	$38.69	$0.00	$0.00	$0.00	$0.00	$0.00
311.209	SUP	HCPCS C1713		311.209  -  TAP HEX CPLNG SURG 2 MM COARSE PTCH SCR	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$145.80	$145.80	$0.00	$0.00	$0.00	$67.53	$240.47	$240.47	$0.00	$0.00	$67.52	$0.00	$191.65	$191.65	$0.00	$162.00	$256.61	$259.20	$0.00		$0.00	$50.71	$0.00	$0.00	$51.58	$0.00	$0.00	$0.00	$0.00	$0.00
311.211	SUP	HCPCS C1713		311.211  -  TAP HEX CPLNG SURG 2 MM CORTEX SCR	BOTH IP/OP	$290.25 	$214.79	$0.00	$232.20	$130.61	$130.61	$0.00	$0.00	$0.00	$60.50	$215.42	$215.42	$0.00	$0.00	$60.49	$0.00	$171.68	$171.68	$0.00	$145.13	$229.88	$232.20	$0.00		$0.00	$45.42	$0.00	$0.00	$46.21	$0.00	$0.00	$0.00	$0.00	$0.00
311.23	SUP	HCPCS C1713		311.23  -  TAP QC SURG 2.4 MM CORTEX SCR	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
311.24	SUP	HCPCS C1713		311.24  -  TAP LNG QC SURG 2.4MM CORTEX SCR	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
311.241	SUP	HCPCS C1713		311.241  -  TAP HEX CPLNG SURG 2.4 MM CORTEX SCR	BOTH IP/OP	$423.00 	$313.02	$0.00	$338.40	$190.35	$190.35	$0.00	$0.00	$0.00	$88.16	$313.95	$313.95	$0.00	$0.00	$88.15	$0.00	$250.20	$250.20	$0.00	$211.50	$335.02	$338.40	$0.00		$0.00	$66.20	$0.00	$0.00	$67.34	$0.00	$0.00	$0.00	$0.00	$0.00
311.26	SUP	Custom 27203010		311.26  -  TAP SURG LONG 100MM QUICK COUPLING NONSTRL 2.7MM CORTICAL	BOTH IP/OP	$216.48 	$160.20	$0.00	$168.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.67	$160.67	$0.00	$0.00	$45.11	$0.00	$0.00	$0.00	$0.00	$105.09	$166.46	$168.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311.32	SUP	HCPCS C1713		311.32  -  TAP SURG LONG 110MM QUICK COUPLING GOLD NONSTRL 3.5MM	BOTH IP/OP	$216.48 	$160.20	$0.00	$168.14	$94.58	$94.58	$0.00	$0.00	$0.00	$45.12	$160.67	$160.67	$0.00	$0.00	$45.11	$0.00	$128.04	$128.04	$0.00	$105.09	$166.46	$168.14	$0.00		$0.00	$31.93	$0.00	$0.00	$33.46	$0.00	$0.00	$0.00	$0.00	$0.00
311.34	SUP	HCPCS C1713		311.34  -  TAP SURG 110MM NONSTRL 4MM CANCELLOUS SCREW	BOTH IP/OP	$255.58 	$189.13	$0.00	$279.21	$115.01	$115.01	$0.00	$0.00	$0.00	$53.27	$189.69	$189.69	$0.00	$0.00	$53.26	$0.00	$279.21	$279.21	$0.00	$127.79	$166.46	$204.46	$0.00		$0.00	$31.93	$0.00	$0.00	$40.69	$0.00	$0.00	$0.00	$0.00	$0.00
311.349	SUP	HCPCS C1713		311.349  -  TAP 50MM CLBRT SURG CANC SPNL 3.5 SCR NONSTRL	BOTH IP/OP	$323.75 	$239.58	$0.00	$259.00	$145.69	$145.69	$0.00	$0.00	$0.00	$67.48	$240.29	$240.29	$0.00	$0.00	$67.47	$0.00	$191.50	$191.50	$0.00	$161.88	$256.41	$259.00	$0.00		$0.00	$50.67	$0.00	$0.00	$51.54	$0.00	$0.00	$0.00	$0.00	$0.00
311.449	SUP	Custom 27203010		311.449  -  DEVICE TARGET 4.5MM PUSH PULL REDX LCP NONSTRL 4.5MM LCP	BOTH IP/OP	$484.98 	$358.89	$0.00	$376.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.95	$359.95	$0.00	$0.00	$101.07	$0.00	$0.00	$0.00	$0.00	$235.43	$372.91	$376.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311.63	SUP	Custom 27203010		311.63  -  TAP SURG 147MM CANN NONSTRL 4MM SCREW	BOTH IP/OP	$983.93 	$728.11	$0.00	$787.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$730.27	$730.27	$0.00	$0.00	$205.05	$0.00	$0.00	$0.00	$0.00	$491.96	$656.09	$787.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
312.3	SUP	Custom 27203010		312.30  -  SLEEVE DRILL 3.5MM 2.5MM INSERT LCP NONSTRL	BOTH IP/OP	$204.73 	$151.50	$0.00	$163.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.95	$151.95	$0.00	$0.00	$42.66	$0.00	$0.00	$0.00	$0.00	$102.36	$162.15	$163.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
312.35	SUP	Custom 27203010		312.35  -  SLEEVE DRILL 2.7MM 1.25MM 2 END NONSTRL	BOTH IP/OP	$778.75 	$576.28	$0.00	$604.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$577.99	$577.99	$0.00	$0.00	$162.29	$0.00	$0.00	$0.00	$0.00	$378.04	$598.82	$604.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
312.648	SUP	HCPCS C1713		312.648  -  GUIDE DRILL 2.8MM 2.8MM THRD	BOTH IP/OP	$196.80 	$145.63	$0.00	$191.82	$107.90	$107.90	$0.00	$0.00	$0.00	$0.00	$146.06	$146.06	$0.00	$0.00	$41.01	$0.00	$0.00	$0.00	$0.00	$119.89	$189.91	$191.82	$0.00		$0.00	$37.52	$0.00	$0.00	$38.17	$0.00	$0.00	$0.00	$0.00	$0.00
313.25	SUP	Custom 27203010		313.250  -  BIT DRILL 44.5MM MINI 4MM STOP QC NONSTRL	BOTH IP/OP	$281.25 	$208.13	$0.00	$225.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.74	$208.74	$0.00	$0.00	$58.61	$0.00	$0.00	$0.00	$0.00	$140.63	$222.75	$225.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
314.03	SUP	Custom 27203010		314.03  -  SHAFT SCREWDRIVER 2.5MM SMALL HEXAGON NONSTRL	BOTH IP/OP	$101.90 	$75.41	$0.00	$79.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.63	$75.63	$0.00	$0.00	$21.24	$0.00	$0.00	$0.00	$0.00	$49.46	$78.35	$79.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
314.23	SUP	Custom 27203010		314.23  -  SHAFT SCREWDRIVER 4MM HEXAGONAL CANN QUICK COUPLING	BOTH IP/OP	$601.63 	$445.21	$0.00	$467.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$446.53	$446.53	$0.00	$0.00	$125.38	$0.00	$0.00	$0.00	$0.00	$292.06	$462.63	$467.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
314.467	SUP	Custom 27203010		314.467  -  SHAFT SCREWDRIVER T8 105MM SELF RETAINING QUICK COUPLING	BOTH IP/OP	$556.65 	$411.92	$0.00	$432.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.15	$413.15	$0.00	$0.00	$116.01	$0.00	$0.00	$0.00	$0.00	$270.23	$428.04	$432.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
314.57	SUP	Custom 27203010		314.57  -  SCREWDRIVER SURG LONG SMALL HEXAGONAL 3.5MM CORTEX 4MM	BOTH IP/OP	$423.13 	$313.12	$0.00	$328.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$314.04	$314.04	$0.00	$0.00	$88.18	$0.00	$0.00	$0.00	$0.00	$205.40	$325.35	$328.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
314.743	SUP	Custom 27203010		314.743  -  REAMER SURG 520MM DRIVE SHAFT NONSTRL RIA	BOTH IP/OP	"$8,876.43 "	"$6,568.56"	$0.00	"$6,894.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,849.85"	$0.00	$0.00	$0.00	$0.00	"$4,308.94"	"$6,825.36"	"$6,894.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.05	SUP	Custom 27203010		315.05  -  BIT DRILL 3.5MM 225MM 3 FLUTED QUICK COUPLING NONSTRL	BOTH IP/OP	$224.90 	$166.43	$0.00	$174.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.92	$166.92	$0.00	$0.00	$46.87	$0.00	$0.00	$0.00	$0.00	$109.18	$172.93	$174.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.19	SUP	Custom 27203010		315.19  -  BIT DRILL 2MM 100MM 3 FLUTED QUICK COUPLING NONSTRL	BOTH IP/OP	$192.58 	$142.51	$0.00	$149.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.93	$142.93	$0.00	$0.00	$40.13	$0.00	$0.00	$0.00	$0.00	$93.49	$148.09	$149.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.21	SUP	Custom 27203010		315.21  -  BIT DRILL 2MM 125MM 3 FLUTED QUICK COUPLING NONSTRL	BOTH IP/OP	$192.58 	$142.51	$0.00	$149.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.93	$142.93	$0.00	$0.00	$40.13	$0.00	$0.00	$0.00	$0.00	$93.49	$148.09	$149.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.23	SUP	Custom 27203010		315.23  -  BIT DRILL 2.5MM 180MM 3 FLUTED NONSTRL	BOTH IP/OP	$209.45 	$154.99	$0.00	$162.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.45	$155.45	$0.00	$0.00	$43.65	$0.00	$0.00	$0.00	$0.00	$101.68	$161.05	$162.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.25	SUP	Custom 27203010		315.25  -  BIT DRILL 2.5MM 110MM 3 FLUTED QUICK COUPLING NONSTRL	BOTH IP/OP	$209.45 	$154.99	$0.00	$162.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.45	$155.45	$0.00	$0.00	$43.65	$0.00	$0.00	$0.00	$0.00	$101.68	$161.05	$162.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.26	SUP	Custom 27203010		315.26  -  BIT DRILL 3 FLUTED 2.7MM 110MM QUICK COUPLING NONSTRL	BOTH IP/OP	$216.48 	$160.20	$0.00	$168.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.67	$160.67	$0.00	$0.00	$45.11	$0.00	$0.00	$0.00	$0.00	$105.09	$166.46	$168.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.28	SUP	Custom 27203010		315.28  -  BIT DRL 3 FLUT 2.7MM 125MM NS QC	BOTH IP/OP	$216.48 	$160.20	$0.00	$168.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.67	$160.67	$0.00	$0.00	$45.11	$0.00	$0.00	$0.00	$0.00	$105.09	$166.46	$168.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.29	SUP	Custom 27203010		315.29  -  BIT DRL 3 FLUT 3.2MM 195MM NS QC	BOTH IP/OP	$258.65 	$191.40	$0.00	$200.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.97	$191.97	$0.00	$0.00	$53.90	$0.00	$0.00	$0.00	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.31	SUP	Custom 27203010		315.31  -  BIT DRILL 3.2MM 145MM 3 FLUTED QUICK COUPLING NONSTRL	BOTH IP/OP	$174.30 	$128.98	$0.00	$135.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$0.00	$0.00	$0.00	$84.61	$134.03	$135.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.33	SUP	Custom 27203010		315.330  -  BIT DRILL 3.2MM 210MM 68MM 3 FLUTED QUICK COUPLING	BOTH IP/OP	$302.98 	$224.21	$0.00	$242.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.87	$224.87	$0.00	$0.00	$63.14	$0.00	$0.00	$0.00	$0.00	$151.49	$239.96	$242.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.35	SUP	Custom 27203010		315.35  -  BIT DRILL 3.5MM 110MM 3 FLUTED QUICK COUPLING CANN NONSTRL	BOTH IP/OP	$191.10 	$141.41	$0.00	$148.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.83	$141.83	$0.00	$0.00	$39.83	$0.00	$0.00	$0.00	$0.00	$92.76	$146.94	$148.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.37	SUP	Custom 27203010		315.37  -  BIT DRILL 3.5MM 195MM 3 FLUTE QUICK COUPLING CANN NONSTRL	BOTH IP/OP	$285.93 	$211.59	$0.00	$222.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.21	$212.21	$0.00	$0.00	$59.59	$0.00	$0.00	$0.00	$0.00	$138.79	$219.84	$222.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.4	SUP	Custom 27203010		315.40  -  BIT DRILL 3 FLUTE 4MM 195MM QUICK COUPLING NONSTRL	BOTH IP/OP	$277.58 	$205.41	$0.00	$222.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.02	$206.02	$0.00	$0.00	$57.85	$0.00	$0.00	$0.00	$0.00	$138.79	$219.84	$222.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.4	SUP	Custom 27203010		BIT DRILL 195MM 4MM QC 3 FLT NSTRL	BOTH IP/OP	$277.58 	$205.41	$0.00	$238.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.02	$206.02	$0.00	$0.00	$57.85	$0.00	$0.00	$0.00	$0.00	$138.79	$238.27	$222.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.44	SUP	Custom 27203010		315.44  -  BIT DRILL 4.5MM 145MM QUICK COUPLING 3 FLUTE NONSTRL	BOTH IP/OP	$174.30 	$128.98	$0.00	$135.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$0.00	$0.00	$0.00	$84.61	$134.03	$135.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.48	SUP	Custom 27203010		315.48  -  BIT DRL 3 FLUT 4.5MM 195MM NS QC	BOTH IP/OP	$258.65 	$191.40	$0.00	$200.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.97	$191.97	$0.00	$0.00	$53.90	$0.00	$0.00	$0.00	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.6	SUP	Custom 27203010		315.60  -  BIT DRILL 6MM 195MM QUICK COUPLING 3 FLUTED NONSTRL	BOTH IP/OP	$324.80 	$240.35	$0.00	$259.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.07	$241.07	$0.00	$0.00	$67.69	$0.00	$0.00	$0.00	$0.00	$162.40	$257.24	$259.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.92	SUP	Custom 27203010		315.92  -  BIT DRL 3 FLUT 2.5MM 230MM NS 200MM QC CLBRT	BOTH IP/OP	$350.03 	$259.02	$0.00	$271.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.79	$259.79	$0.00	$0.00	$72.95	$0.00	$0.00	$0.00	$0.00	$169.91	$269.15	$271.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315.93	SUP	Custom 27203010		315.93  -  BIT DRILL 200MM 3.2MM 230MM 3 FLUTED QUICK COUPLING	BOTH IP/OP	$432.95 	$320.38	$0.00	$336.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$321.34	$321.34	$0.00	$0.00	$90.23	$0.00	$0.00	$0.00	$0.00	$210.18	$332.92	$336.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.001	SUP	Custom 27203010		316.001  -  SPACER SPNL 0D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.002	SUP	Custom 27203010		316.002  -  SPACER SPNL 0D 25MM LG 30X41MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.003	SUP	Custom 27203010		316.003  -  SPACER SPNL 0D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.004	SUP	Custom 27803010		316.004  -  SPACER SPNL 0D 25MM LG 30X53MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.005	SUP	Custom 27803010		316.005  -  SPACER SPNL 0D 25MM LG 30X69MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$22,190.00 "	"$16,420.60"	$0.00	"$17,752.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,624.40"	$0.00	$0.00	$0.00	$0.00	"$11,095.00"	"$17,574.48"	"$17,752.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.006	SUP	Custom 27803010		316.006  -  SPACER SPNL 8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.007	SUP	Custom 27803010		316.007  -  SPACER SPNL 8D 25MM LG 30X41MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.008	SUP	Custom 27803010		316.008  -  SPACER SPNL 8D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.009	SUP	Custom 27803010		316.009  -  SPACER SPNL 8D 25MM LG 30X53MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.01	SUP	Custom 27803010		316.010  -  SPACER SPNL 8D 25MM LG 30X69MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$22,190.00 "	"$16,420.60"	$0.00	"$17,752.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,624.40"	$0.00	$0.00	$0.00	$0.00	"$11,095.00"	"$17,574.48"	"$17,752.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.011	SUP	Custom 27803010		316.011  -  SPACER SPNL 8D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.012	SUP	Custom 27803010		316.012  -  SPACER SPNL 16D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.013	SUP	Custom 27803010		316.013  -  SPACER SPNL 16D 25MM LG 30X63MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$22,190.00 "	"$16,420.60"	$0.00	"$17,752.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,624.40"	$0.00	$0.00	$0.00	$0.00	"$11,095.00"	"$17,574.48"	"$17,752.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.014	SUP	Custom 27803010		316.014  -  SPACER SPNL 16D 25MM LG 30X39MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.015	SUP	Custom 27803010		316.015  -  SPACER SPNL 16D 25MM LG 30X48MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.016	SUP	Custom 27803010		316.016  -  SPACER SPNL 16D 25MM LG 30X57MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.017	SUP	Custom 27803010		316.017  -  SPACER SPNL 16D 25MM LG 30X74MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$23,740.00 "	"$17,567.60"	$0.00	"$18,992.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,947.42"	$0.00	$0.00	$0.00	$0.00	"$11,870.00"	"$18,802.08"	"$18,992.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.018	SUP	Custom 27803010		316.018  -  SPACER SPNL 16D 25MM LG 30X91MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$23,740.00 "	"$17,567.60"	$0.00	"$18,992.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,947.42"	$0.00	$0.00	$0.00	$0.00	"$11,870.00"	"$18,802.08"	"$18,992.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.019	SUP	Custom 27803010		316.019  -  SPACER SPNL -8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.02	SUP	Custom 27803010		316.020  -  SPACER SPNL -8D 25MM LG 30X41MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.021	SUP	Custom 27803010		316.021  -  SPACER SPNL -8D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.022	SUP	Custom 27803010		316.022  -  SPACER SPNL -8D 25MM LG 30X53MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.023	SUP	Custom 27803010		316.023  -  SPACER SPNL -8D 25MM LG 30X69MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$22,190.00 "	"$16,420.60"	$0.00	"$17,752.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,624.40"	$0.00	$0.00	$0.00	$0.00	"$11,095.00"	"$17,574.48"	"$17,752.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.024	SUP	Custom 27803010		316.024  -  SPACER SPNL 0D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.025	SUP	Custom 27803010		316.025  -  SPACER SPNL 8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.026	SUP	Custom 27803010		316.026  -  SPACER SPNL -8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.027	SUP	Custom 27803010		316.027  -  SPACER SPNL 16D 25MM LG 30X39MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$20,400.00 "	"$15,096.00"	$0.00	"$16,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,251.36"	$0.00	$0.00	$0.00	$0.00	"$10,200.00"	"$16,156.80"	"$16,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.03	SUP	Custom 27203010		316.03  -  BIT DRILL 44.5MM .7MM 3MM STOP UNV HALL CPLNG NONSTRL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.05	SUP	Custom 27203010		316.05  -  BIT DRILL 44.5MM .76MM 5MM STOP UNV HALL CPLNG NONSTRL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.08	SUP	Custom 27203010		316.08  -  BIT DRILL 44.5MM .76MM 8MM STOP UNV HALL CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.101	SUP	Custom 27803010		316.101  -  SPACER SPNL 0D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.102	SUP	Custom 27803010		316.102  -  SPACER SPNL 0D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.103	SUP	Custom 27803010		316.103  -  SPACER SPNL 0D 13MM SM 15X28MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.104	SUP	Custom 27803010		316.104  -  SPACER SPNL 0D 13MM SM 15X30MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.105	SUP	Custom 27803010		316.105  -  SPACER SPNL 0D 13MM SM 15X32MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.106	SUP	Custom 27803010		316.106  -  SPACER SPNL 0D 13MM SM 15X38MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.107	SUP	Custom 27803010		316.107  -  SPACER SPNL 0D 13MM SM 15X44MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.108	SUP	Custom 27803010		316.108  -  SPACER SPNL 0D 13MM SM 15X52MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,540.00 "	"$12,979.60"	$0.00	"$14,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,655.34"	$0.00	$0.00	$0.00	$0.00	"$8,770.00"	"$13,891.68"	"$14,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.109	SUP	Custom 27803010		316.109  -  SPACER SPNL 0D 13MM SM 15X58MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,540.00 "	"$12,979.60"	$0.00	"$14,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,655.34"	$0.00	$0.00	$0.00	$0.00	"$8,770.00"	"$13,891.68"	"$14,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.11	SUP	Custom 27803010		316.110  -  SPACER SPNL 0D 13MM SM 15X64MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,540.00 "	"$12,979.60"	$0.00	"$14,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,655.34"	$0.00	$0.00	$0.00	$0.00	"$8,770.00"	"$13,891.68"	"$14,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.111	SUP	Custom 27803010		316.111  -  SPACER SPNL 0D 13MM SM 15X72MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$18,972.50 "	"$14,039.65"	$0.00	"$15,178.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,953.87"	$0.00	$0.00	$0.00	$0.00	"$9,486.25"	"$15,026.22"	"$15,178.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.112	SUP	Custom 27803010		316.112  -  SPACER SPNL 0D 13MM SM 15X80MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$18,972.50 "	"$14,039.65"	$0.00	"$15,178.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,953.87"	$0.00	$0.00	$0.00	$0.00	"$9,486.25"	"$15,026.22"	"$15,178.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.113	SUP	Custom 27803010		316.113  -  SPACER SPNL 7D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.114	SUP	Custom 27803010		316.114  -  SPACER SPNL 7D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.115	SUP	Custom 27803010		316.115  -  SPACER SPNL 7D 13MM SM 15X28MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.116	SUP	Custom 27803010		316.116  -  SPACER SPNL 7D 13MM SM 15X30MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.117	SUP	Custom 27803010		316.117  -  SPACER SPNL 7D 13MM SM 15X32MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.118	SUP	Custom 27803010		316.118  -  SPACER SPNL 7D 13MM SM 15X38MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.119	SUP	Custom 27803010		316.119  -  SPACER SPNL 7D 13MM SM 15X44MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.12	SUP	Custom 27803010		316.120  -  SPACER SPNL 7D 13MM SM 15X52MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,540.00 "	"$12,979.60"	$0.00	"$14,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,655.34"	$0.00	$0.00	$0.00	$0.00	"$8,770.00"	"$13,891.68"	"$14,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.121	SUP	Custom 27803010		316.121  -  SPACER SPNL 7D 13MM SM 15X58MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,540.00 "	"$12,979.60"	$0.00	"$14,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,655.34"	$0.00	$0.00	$0.00	$0.00	"$8,770.00"	"$13,891.68"	"$14,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.122	SUP	Custom 27803010		316.122  -  SPACER SPNL 7D 13MM SM 15X64MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,540.00 "	"$12,979.60"	$0.00	"$14,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,655.34"	$0.00	$0.00	$0.00	$0.00	"$8,770.00"	"$13,891.68"	"$14,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.123	SUP	Custom 27803010		316.123  -  SPACER SPNL 7D 13MM SM 15X72MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$18,972.50 "	"$14,039.65"	$0.00	"$15,178.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,953.87"	$0.00	$0.00	$0.00	$0.00	"$9,486.25"	"$15,026.22"	"$15,178.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.124	SUP	Custom 27803010		316.124  -  SPACER SPNL 7D 13MM SM 15X80MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$18,972.50 "	"$14,039.65"	$0.00	"$15,178.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,953.87"	$0.00	$0.00	$0.00	$0.00	"$9,486.25"	"$15,026.22"	"$15,178.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.125	SUP	Custom 27803010		316.125  -  SPACER SPNL 16D 13MM SM 15X56MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,540.00 "	"$12,979.60"	$0.00	"$14,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,655.34"	$0.00	$0.00	$0.00	$0.00	"$8,770.00"	"$13,891.68"	"$14,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.126	SUP	Custom 27803010		316.126  -  SPACER SPNL 16D 13MM SM 15X64MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,540.00 "	"$12,979.60"	$0.00	"$14,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,655.34"	$0.00	$0.00	$0.00	$0.00	"$8,770.00"	"$13,891.68"	"$14,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.127	SUP	Custom 27803010		316.127  -  SPACER SPNL 16D 13MM SM 15X72MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$18,972.50 "	"$14,039.65"	$0.00	"$15,178.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,953.87"	$0.00	$0.00	$0.00	$0.00	"$9,486.25"	"$15,026.22"	"$15,178.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.128	SUP	Custom 27803010		316.128  -  SPACER SPNL 16D 13MM SM 15X80MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$18,972.50 "	"$14,039.65"	$0.00	"$15,178.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,953.87"	$0.00	$0.00	$0.00	$0.00	"$9,486.25"	"$15,026.22"	"$15,178.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.129	SUP	Custom 27803010		316.129  -  SPACER SPNL 0D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.13	SUP	Custom 27203010		316.13  -  BIT DRL 3MM .7MM 44.5MM NS JLTCH CPLNG SLF STP STRYK	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.13	SUP	Custom 27803010		316.130  -  SPACER SPNL 7D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	$371.25 	$274.73	$0.00	"$12,755.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	"$12,755.16"	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.131	SUP	Custom 27803010		316.131  -  SPACER SPNL 0D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.132	SUP	Custom 27803010		316.132  -  SPACER SPNL 7D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$12,884.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	$0.00	$0.00	$0.00	"$8,052.50"	"$12,755.16"	"$12,884.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.15	SUP	Custom 27203010		316.15  -  BIT DRILL 44.5MM .76MM CPLNG JLTCH STOP 5MM NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.18	SUP	Custom 27203010		316.18  -  BIT DRILL 44.5MM .76MM JLTCH STOP 8MM NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.201	SUP	Custom 27803010		316.201  -  SPACER SPNL 6D 21MM MED 23X32MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$18,017.50 "	"$13,332.95"	$0.00	"$14,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,754.85"	$0.00	$0.00	$0.00	$0.00	"$9,008.75"	"$14,269.86"	"$14,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.202	SUP	Custom 27803010		316.202  -  SPACER SPNL 6D 21MM MED 23X34MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$18,017.50 "	"$13,332.95"	$0.00	"$14,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,754.85"	$0.00	$0.00	$0.00	$0.00	"$9,008.75"	"$14,269.86"	"$14,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.203	SUP	Custom 27803010		316.203  -  SPACER SPNL 6D 21MM MED 23X38MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$19,447.50 "	"$14,391.15"	$0.00	"$15,558.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,052.86"	$0.00	$0.00	$0.00	$0.00	"$9,723.75"	"$15,402.42"	"$15,558.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.204	SUP	Custom 27803010		316.204  -  SPACER SPNL -6D 21MM MED 23X46MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$19,807.50 "	"$14,657.55"	$0.00	"$15,846.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,127.88"	$0.00	$0.00	$0.00	$0.00	"$9,903.75"	"$15,687.54"	"$15,846.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.205	SUP	Custom 27803010		316.205  -  SPACER SPNL 6D 21MM MED 23X56MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.206	SUP	Custom 27803010		316.206  -  SPACER SPNL -6D 21MM MED 23X64MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.207	SUP	Custom 27803010		316.207  -  SPACER SPNL 0D 21MM MED 23X32MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$18,017.50 "	"$13,332.95"	$0.00	"$14,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,754.85"	$0.00	$0.00	$0.00	$0.00	"$9,008.75"	"$14,269.86"	"$14,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.208	SUP	Custom 27803010		316.208  -  SPACER SPNL 0D 21MM MED 23X34MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$18,017.50 "	"$13,332.95"	$0.00	"$14,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,754.85"	$0.00	$0.00	$0.00	$0.00	"$9,008.75"	"$14,269.86"	"$14,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.209	SUP	Custom 27803010		316.209  -  SPACER SPNL 0D 21MM MED 23X38MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$19,447.50 "	"$14,391.15"	$0.00	"$15,558.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,052.86"	$0.00	$0.00	$0.00	$0.00	"$9,723.75"	"$15,402.42"	"$15,558.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.21	SUP	Custom 27803010		316.210  -  SPACER SPNL 0D 21MM MED 23X46MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$19,807.50 "	"$14,657.55"	$0.00	"$15,846.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,127.88"	$0.00	$0.00	$0.00	$0.00	"$9,903.75"	"$15,687.54"	"$15,846.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.211	SUP	Custom 27803010		316.211  -  SPACER SPNL 0D 21MM MED 23X56MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.212	SUP	Custom 27803010		316.212  -  SPACER SPNL 0D 21MM MED 23X64MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.213	SUP	Custom 27803010		316.213  -  SPACER SPNL 8D 21MM MED 23X32MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$18,017.50 "	"$13,332.95"	$0.00	"$14,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,754.85"	$0.00	$0.00	$0.00	$0.00	"$9,008.75"	"$14,269.86"	"$14,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.214	SUP	Custom 27803010		316.214  -  SPACER SPNL 8D 21MM MED 23X34MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.215	SUP	Custom 27803010		316.215  -  SPACER SPNL 8D 21MM MED 23X38MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$19,447.50 "	"$14,391.15"	$0.00	"$15,558.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,052.86"	$0.00	$0.00	$0.00	$0.00	"$9,723.75"	"$15,402.42"	"$15,558.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.216	SUP	Custom 27803010		316.216  -  SPACER SPNL 8D 21MM MED 23X46MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$19,807.50 "	"$14,657.55"	$0.00	"$15,846.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,127.88"	$0.00	$0.00	$0.00	$0.00	"$9,903.75"	"$15,687.54"	"$15,846.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.217	SUP	Custom 27803010		316.217  -  SPACER SPNL 8D 21MM MED 23X56MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.218	SUP	Custom 27803010		316.218  -  SPACER SPNL 8D 21MM MED 23X64MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.219	SUP	Custom 27803010		316.219  -  SPACER SPNL 8D 21MM MED 23X73MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.22	SUP	Custom 27803010		316.220  -  SPACER SPNL 8D 21MM MED 23X42MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.221	SUP	Custom 27803010		316.221  -  SPACER SPNL 0D 21MM MED 23X73MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.222	SUP	Custom 27803010		316.222  -  SPACER SPNL 0D 21MM MED 23X82MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$17,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	$0.00	$0.00	$0.00	"$10,916.25"	"$17,291.34"	"$17,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.23	SUP	Custom 27203010		316.23  -  BIT DRILL 60MM .7MM 3MM STOP QC	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.232	SUP	Custom 27203010		316.232  -  BIT DRILL 60MM 1MM UNV HALL CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.235	SUP	Custom 27203010		316.235  -  BIT DRL 1MM 60MM NS JLTCH CPLNG WO SLF STP STRYK	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.236	SUP	Custom 27203010		316.236  -  BIT DRL 1MM 60MM NS JLTCH CPLNG STRYK MDLR HND SYS	BOTH IP/OP	$125.80 	$93.09	$0.00	$97.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.37	$93.37	$0.00	$0.00	$26.22	$0.00	$0.00	$0.00	$0.00	$61.06	$96.73	$97.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.238	SUP	Custom 27203010		316.238  -  BIT DRILL 50MM 1MM MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.25	SUP	Custom 27203010		316.25  -  BIT DRILL 44.5MM .76MM 5MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.28	SUP	Custom 27203010		316.28  -  BIT DRILL 8MM STOP QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.286	SUP	Custom 27203010		316.286  -  BIT DRILL MINI .76MM 44.5MM 6MM MINI QUICK COUPLING STOP	BOTH IP/OP	$278.33 	$205.96	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.57	$206.57	$0.00	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$135.11	$214.02	$216.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.288	SUP	Custom 27203010		316.288  -  BIT DRILL MINI .76MM 44.5MM 8MM QUICK COUPLING STOP LCP	BOTH IP/OP	$278.33 	$205.96	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.57	$206.57	$0.00	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$135.11	$214.02	$216.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.29	SUP	Custom 27203010		316.290  -  BIT DRILL MINI .76MM 10MM QUICK COUPLING STAINLESS STEEL	BOTH IP/OP	$270.23 	$199.97	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.56	$200.56	$0.00	$0.00	$56.31	$0.00	$0.00	$0.00	$0.00	$135.11	$214.02	$216.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.292	SUP	Custom 27203010		316.292  -  BIT DRILL MINI .76MM 44.5MM 12MM MINI QUICK COUPLING STOP	BOTH IP/OP	$278.33 	$205.96	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.57	$206.57	$0.00	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$135.11	$214.02	$216.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.294	SUP	Custom 27203010		316.294  -  BIT DRILL .76MM 44.5MM 14MM MINI QUICK COULPING STOP NONSTRL	BOTH IP/OP	$278.33 	$205.96	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.57	$206.57	$0.00	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$135.11	$214.02	$216.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.301	SUP	Custom 27803010		316.301  -  SPACER SPNL 0D 21MM S/MED 23X23MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,062.50 "	"$12,626.25"	$0.00	"$13,650.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,555.83"	$0.00	$0.00	$0.00	$0.00	"$8,531.25"	"$13,513.50"	"$13,650.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.302	SUP	Custom 27803010		316.302  -  SPACER SPNL 0D 21MM S/MED 23X24MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,062.50 "	"$12,626.25"	$0.00	"$13,650.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,555.83"	$0.00	$0.00	$0.00	$0.00	"$8,531.25"	"$13,513.50"	"$13,650.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.303	SUP	Custom 27803010		316.303  -  SPACER SPNL 0D 21MM S/MED 23X30MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,062.50 "	"$12,626.25"	$0.00	"$13,650.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,555.83"	$0.00	$0.00	$0.00	$0.00	"$8,531.25"	"$13,513.50"	"$13,650.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.304	SUP	Custom 27803010		316.304  -  SPACER SPNL 0D 21MM S/MED 23X23MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,062.50 "	"$12,626.25"	$0.00	"$13,650.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,555.83"	$0.00	$0.00	$0.00	$0.00	"$8,531.25"	"$13,513.50"	"$13,650.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.305	SUP	Custom 27803010		316.305  -  SPACER SPNL 0D 21MM S/MED 23X24MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$17,062.50 "	"$12,626.25"	$0.00	"$13,650.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,555.83"	$0.00	$0.00	$0.00	$0.00	"$8,531.25"	"$13,513.50"	"$13,650.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.306	SUP	Custom 27203010		316.306  -  BIT DRL 6MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR MDLR	BOTH IP/OP	$278.33 	$205.96	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.57	$206.57	$0.00	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$135.11	$214.02	$216.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.308	SUP	Custom 27203010		316.308  -  BIT DRILL 8MM STOP .76MM 44.5MM J LATCH NONSTRL	BOTH IP/OP	$278.33 	$205.96	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.57	$206.57	$0.00	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$135.11	$214.02	$216.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.31	SUP	Custom 27203010		316.310  -  BIT DRL 10MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR	BOTH IP/OP	$270.23 	$199.97	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.56	$200.56	$0.00	$0.00	$56.31	$0.00	$0.00	$0.00	$0.00	$135.11	$214.02	$216.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.312	SUP	Custom 27203010		316.312  -  BIT DRL 12MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR	BOTH IP/OP	$278.33 	$205.96	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.57	$206.57	$0.00	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$135.11	$214.02	$216.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.314	SUP	Custom 27203010		316.314  -  BIT DRL 14MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR	BOTH IP/OP	$278.33 	$205.96	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.57	$206.57	$0.00	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$135.11	$214.02	$216.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.33	SUP	Custom 27203010		316.33  -  BIT DRILL 17MM .76MM 3MM STOP MINI QC 90D SCRDRVR NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.332	SUP	Custom 27203010		316.332  -  BIT DRILL 65MM 1.3MM UNV HALL CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.335	SUP	Custom 27203010		316.335  -  BIT DRILL 65MM 1.3MM JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.338	SUP	Custom 27203010		316.338  -  BIT DRILL 55MM 1.3MM MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.35	SUP	Custom 27203010		316.35  -  BIT DRILL 19MM .76MM 5MM STOP MINI QC 90D SCRDRVR NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.38	SUP	Custom 27203010		316.38  -  BIT DRILL 22MM .76MM 8MM STOP MINI QC 90D SCRDRVR NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.396	SUP	Custom 27203010		316.396  -  BIT DRILL MINI 1MM 50MM QUICK COUPLING STAINLESS STEEL	BOTH IP/OP	$139.18 	$102.99	$0.00	$108.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.30	$103.30	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$67.55	$107.00	$108.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.401	SUP	Custom 27803010		316.401  -  SPACER SPNL 0D 25MM MED LG 30X28MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$19,922.50 "	"$14,742.65"	$0.00	"$15,938.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,151.85"	$0.00	$0.00	$0.00	$0.00	"$9,961.25"	"$15,778.62"	"$15,938.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.402	SUP	Custom 27803010		316.402  -  BIT DRILL MINI 1.3MM 55MM QUICK COUPLING STAINLESS STEEL	BOTH IP/OP	$139.18 	$102.99	$0.00	$108.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.30	$103.30	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$67.55	$107.00	$108.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.403	SUP	Custom 27803010		316.403  -  BIT DRILL 1.3MM 65MM J LATCH NONSTRL	BOTH IP/OP	$139.18 	$102.99	$0.00	$108.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.30	$103.30	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$67.55	$107.00	$108.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.404	SUP	Custom 27803010		316.404  -  SPACER SPNL 0D 25MM MED LG 30X45MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$22,070.00 "	"$16,331.80"	$0.00	"$17,656.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,599.39"	$0.00	$0.00	$0.00	$0.00	"$11,035.00"	"$17,479.44"	"$17,656.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.405	SUP	Custom 27803010		316.405  -  SPACER SPNL 0D 25MM MED LG 30X55MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$22,785.00 "	"$16,860.90"	$0.00	"$18,228.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,748.39"	$0.00	$0.00	$0.00	$0.00	"$11,392.50"	"$18,045.72"	"$18,228.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.406	SUP	Custom 27803010		316.406  -  SPACER SPNL 0D 25MM MED LG 30X61MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$22,785.00 "	"$16,860.90"	$0.00	"$18,228.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,748.39"	$0.00	$0.00	$0.00	$0.00	"$11,392.50"	"$18,045.72"	"$18,228.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.407	SUP	Custom 27803010		316.407  -  SPACER SPNL 3D 25MM MED LG 30X28MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$19,922.50 "	"$14,742.65"	$0.00	"$15,938.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,151.85"	$0.00	$0.00	$0.00	$0.00	"$9,961.25"	"$15,778.62"	"$15,938.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.408	SUP	Custom 27803010		316.408  -  SPACER SPNL 3D 25MM MED LG 30X35MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$19,922.50 "	"$14,742.65"	$0.00	"$15,938.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,151.85"	$0.00	$0.00	$0.00	$0.00	"$9,961.25"	"$15,778.62"	"$15,938.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.409	SUP	Custom 27803010		316.409  -  SPACER SPNL 3D 25MM MED LG 30X39MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$22,070.00 "	"$16,331.80"	$0.00	"$17,656.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,599.39"	$0.00	$0.00	$0.00	$0.00	"$11,035.00"	"$17,479.44"	"$17,656.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.41	SUP	Custom 27803010		316.410  -  SPACER SPNL 3D 25MM MED LG 30X45MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$22,070.00 "	"$16,331.80"	$0.00	"$17,656.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,599.39"	$0.00	$0.00	$0.00	$0.00	"$11,035.00"	"$17,479.44"	"$17,656.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.411	SUP	Custom 27803010		316.411  -  SPACER SPNL 3D 25MM MED LG 30X55MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$22,785.00 "	"$16,860.90"	$0.00	"$18,228.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,748.39"	$0.00	$0.00	$0.00	$0.00	"$11,392.50"	"$18,045.72"	"$18,228.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.412	SUP	Custom 27803010		316.412  -  SPACER SPNL 3D 25MM MED LG 30X61MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$22,785.00 "	"$16,860.90"	$0.00	"$18,228.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,748.39"	$0.00	$0.00	$0.00	$0.00	"$11,392.50"	"$18,045.72"	"$18,228.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.413	SUP	Custom 27803010		316.413  -  SPACER SPNL 3D 25MM MED LG 30X28MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$19,922.50 "	"$14,742.65"	$0.00	"$15,938.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,151.85"	$0.00	$0.00	$0.00	$0.00	"$9,961.25"	"$15,778.62"	"$15,938.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.414	SUP	Custom 27803010		316.414  -  SPACER SPNL 3D 25MM MED LG 30X34MM NS LF XPAND-R RDLCNT SLF	BOTH IP/OP	"$19,922.50 "	"$14,742.65"	$0.00	"$15,938.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,151.85"	$0.00	$0.00	$0.00	$0.00	"$9,961.25"	"$15,778.62"	"$15,938.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.441	SUP	Custom 27203010		316.441  -  BIT DRL 4MM 1MM 44.5MM NS U HL CPLNG SLF STP .5MM SCR	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.442	SUP	Custom 27203010		316.442  -  BIT DRL 6MM 1MM 44.5MM NS U HL CPLNG SLF STP .5MM SCR	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.443	SUP	Custom 27203010		316.443  -  BIT DRL 8MM 1MM 44.5MM NS U HL CPLNG SLF STP .5MM SCR	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.446	SUP	Custom 27203010		316.446  -  BIT DRILL 44.5MM 1MM JLTCH STOP 4MM NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.447	SUP	Custom 27203010		316.447  -  BIT DRILL 6MM 1MM JLTCH STOP NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.448	SUP	Custom 27203010		316.448  -  BIT DRILL 8MM 1MM JLTCH STOP NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.451	SUP	Custom 27203010		316.451  -  BIT DRILL 1MM 4MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.452	SUP	Custom 27203010		316.452  -  BIT DRILL 44.5MM 1MM 6MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.453	SUP	Custom 27203010		316.453  -  BIT DRILL 44.5MM 1MM 8MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.605	SUP	Custom 27203010		316.605  -  BIT DRILL 52MM .76MM 5MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.608	SUP	Custom 27203010		316.608  -  BIT DRILL 52MM .76MM 8MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.614	SUP	Custom 27203010		316.614  -  BIT DRILL 52MM 1MM 4MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.616	SUP	Custom 27203010		316.616  -  BIT DRILL 52MM 1MM 6MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.618	SUP	Custom 27203010		316.618  -  BIT DRILL 52MM 1MM 8MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.624	SUP	Custom 27203010		316.624  -  BIT DRILL 1.1MM STOP HEX 4MM 1.5MM CRANFCL SCR NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.626	SUP	Custom 27203010		316.626  -  BIT DRILL 52MM 1.1MM 6MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.628	SUP	Custom 27203010		316.628  -  BIT DRILL 52MM 1.1MM 8MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.632	SUP	Custom 27203010		316.632  -  BIT DRILL 52MM 1.1MM 12MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.644	SUP	Custom 27203010		316.644  -  BIT DRILL 52MM 1.5MM 4MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.646	SUP	Custom 27203010		316.646  -  BIT DRILL 52MM 1.5MM 6MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.648	SUP	Custom 27203010		316.648  -  BIT DRILL 52MM 1.5MM 8MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.652	SUP	Custom 27203010		316.652  -  BIT DRILL 52MM 1.5MM 12MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.04	SUP	Custom 27203010		317.04  -  BIT DRILL 44.5MM 1.1MM 4MM STOP UNV HALL CPLNG NONSTRL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.06	SUP	Custom 27203010		317.06  -  BIT DRILL 44.5MM 1.1MM 6MM STOP UNV HALL CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.08	SUP	Custom 27203010		317.08  -  BIT DRILL 44.5MM 1.1MM 8MM STOP UNV HALL CPLNG NONSTRL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.106	SUP	Custom 27203010		317.106  -  BIT DRILL 20MM 1.1MM 6MM STOP MINI QC 90D SCRDRVR NONSTRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.112	SUP	Custom 27203010		317.112  -  BIT DRILL 26MM 1.1MM 12MM STOP MINI QC 90D SCRDRVR NONSTRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.118	SUP	Custom 27203010		317.118  -  BIT DRILL 32MM 1.1MM 18MM STOP MINI QC 90D SCRDRVR NONSTRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.12	SUP	Custom 27203010		317.12  -  BIT DRILL 44.5MM 1.1MM 2MM STOP JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.14	SUP	Custom 27203010		317.14  -  BIT DRL 4MM 1.1MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.16	SUP	Custom 27203010		317.16  -  BIT DRL 6MM 1.1MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.18	SUP	Custom 27203010		317.18  -  BIT DRL 8MM 1.1MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.22	SUP	Custom 27203010		317.22  -  BIT DRL 12MM 1.1MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.232	SUP	Custom 27203010		317.232  -  BIT DRILL 65MM 1.1MM UNV HALL CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.235	SUP	Custom 27203010		317.235  -  BIT DRILL 65MM 1.1MM 40MM STOP JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.238	SUP	Custom 27203010		317.238  -  BIT DRILL 65MM 1.1MM MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.24	SUP	Custom 27203010		317.24  -  BIT DRILL 44.5MM 1.1MM 4MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.26	SUP	Custom 27203010		317.26  -  BIT DRILL 44.5MM 1.1MM 6MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.28	SUP	Custom 27203010		317.28  -  BIT DRILL 44.5MM 1.1MM 8MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.32	SUP	Custom 27203010		317.32  -  BIT DRILL 44.5MM 1.1MM 12MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.332	SUP	Custom 27203010		317.332  -  BIT DRILL 110MM 1.1MM UNV HALL CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.335	SUP	Custom 27203010		317.335  -  BIT DRILL 65MM 1.1MM JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.338	SUP	Custom 27203010		317.338  -  BIT DRILL 110MM 1.1MM MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.432	SUP	Custom 27203010		317.432  -  BIT DRILL 85MM 1.5MM UNV HALL CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.435	SUP	Custom 27203010		317.435  -  BIT DRL 1.5MM 85MM NS JLTCH CPLNG WO SLF STP 1/1.5MM SCR	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.438	SUP	Custom 27203010		317.438  -  BIT DRILL 85MM 1.5MM MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.452	SUP	Custom 27203010		317.452  -  BIT DRILL 100MM 2MM UNV HALL CPLNG NONSTRL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.458	SUP	Custom 27203010		317.458  -  BIT DRILL 90MM 2MM MINI QC NONSTRL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.506	SUP	Custom 27203010		317.506  -  BIT DRILL 20MM 1.5MM 6MM STOP MINI QC NONSTRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.512	SUP	Custom 27203010		317.512  -  BIT DRILL 26MM 1.5MM 12MM STOP MINI QC NONSTRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.518	SUP	Custom 27203010		317.518  -  BIT DRILL 32MM 1.5MM 18MM STOP MINI QC NONSTRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.54	SUP	Custom 27203010		317.54  -  BIT DRILL 44.5MM 1.5MM 4MM STOP UNV HALL CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.56	SUP	Custom 27203010		317.56  -  BIT DRILL 44.5MM 1.5MM 6MM STOP UNV HALL CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.58	SUP	Custom 27203010		317.58  -  BIT DRILL 44.5MM 1.5MM 8MM STOP UNV HALL CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.62	SUP	Custom 27203010		317.62  -  BIT DRILL 44.5MM 1.5MM 12MM STOP UNV HALL CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.64	SUP	Custom 27203010		317.64  -  BIT DRL 4MM 1.5MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.66	SUP	Custom 27203010		317.66  -  BIT DRL 6MM 1.5MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.68	SUP	Custom 27203010		317.68  -  BIT DRL 8MM 1.5MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.72	SUP	Custom 27203010		317.72  -  BIT DRL 12MM 1.5MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.74	SUP	Custom 27203010		317.74  -  BIT DRILL 44.5MM 1.5MM 4MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.76	SUP	Custom 27203010		317.76  -  BIT DRILL 44.5MM 1.5MM 6MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.78	SUP	Custom 27203010		317.78  -  BIT DRILL 44.5MM 1.5MM 8MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.781	SUP	Custom 27203010		317.781  -  BIT DRILL 91MM 1.5MM 4MM STOP GUIDE NONSTRL	BOTH IP/OP	$224.00 	$165.76	$0.00	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.25	$166.25	$0.00	$0.00	$46.68	$0.00	$0.00	$0.00	$0.00	$112.00	$177.41	$179.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.782	SUP	Custom 27203010		317.782  -  BIT DRILL 91MM 1.5MM 6MM STOP GUIDE NONSTRL	BOTH IP/OP	$224.00 	$165.76	$0.00	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.25	$166.25	$0.00	$0.00	$46.68	$0.00	$0.00	$0.00	$0.00	$112.00	$177.41	$179.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.806	SUP	Custom 27203010		317.806  -  BIT DRILL 20MM 1.8MM MINI QC	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.812	SUP	Custom 27203010		317.812  -  BIT DRILL 26MM 1.8MM MINI QC	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.818	SUP	Custom 27203010		317.818  -  BIT DRILL 32MM 18MM MINI QC	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.82	SUP	Custom 27203010		317.82  -  BIT DRILL 44.5MM 1.5MM 12MM STOP MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.832	SUP	Custom 27203010		317.832  -  BIT DRILL 110MM 1.5MM HEX CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.835	SUP	Custom 27203010		317.835  -  BIT DRILL 110MM 1.5MM JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.836	SUP	Custom 27203010		317.836  -  BIT DRILL 125MM 1.5MM JLTCH NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.838	SUP	Custom 27203010		317.838  -  BIT DRILL 110MM 1.5MM MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.852	SUP	Custom 27203010		317.852  -  BIT DRILL 110MM 2MM UNV HALL CPLNG NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.855	SUP	Custom 27203010		317.855  -  BIT DRL 2MM 110MM NS JLTCH CPLNG WO SLF STP STRYK	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.856	SUP	Custom 27203010		317.856  -  BIT DRILL 125MM 2MM JLTCH	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.858	SUP	Custom 27203010		317.858  -  BIT DRILL 110MM 2MM MINI QC NONSTRL	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.861	SUP	Custom 27203010		317.861  -  BIT DRL 1.8MM 80MM NS MNQK CPLNG D MRK	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.867	SUP	Custom 27203010		317.867  -  BIT DRL 1.8MM 90MM NS JLTCH CPLNG 2.4MM SCR MDLR HND SYS	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.871	SUP	Custom 27203010		317.871  -  BIT DRL 2.4MM 80MM NS MNQK CPLNG 2.4MM SCR MDLR HND SYS	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.872	SUP	Custom 27203010		317.872  -  BIT DRL 2.4MM 90MM NS JLTCH CPLNG STRYK	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.875	SUP	Custom 27203010		317.875  -  BIT DRL 6MM 1.5MM 100MM NS QC TROC STP	BOTH IP/OP	$380.25 	$281.39	$0.00	$304.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.22	$282.22	$0.00	$0.00	$79.24	$0.00	$0.00	$0.00	$0.00	$190.13	$301.16	$304.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.876	SUP	Custom 27203010		317.876  -  BIT DRL 8-18MM 1.5MM 100MM NS QC TROC CLBRT	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.877	SUP	Custom 27203010		317.877  -  BIT DRL 6MM 1.8MM 100MM NS QC TROC STP	BOTH IP/OP	$380.25 	$281.39	$0.00	$304.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.22	$282.22	$0.00	$0.00	$79.24	$0.00	$0.00	$0.00	$0.00	$190.13	$301.16	$304.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.878	SUP	Custom 27203010		317.878  -  BIT DRL 8-18MM 1.8MM 100MM NS QC TROC CLBRT	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
319.006	SUP	Custom 27203010		319.006  -  GAUGE DEPTH 2 MM 2.4 MM SCREW	BOTH IP/OP	"$1,083.80 "	$802.01	$0.00	$841.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.40	$804.40	$0.00	$0.00	$225.86	$0.00	$0.00	$0.00	$0.00	$526.11	$833.37	$841.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
319.01	SUP	Custom 27203010		319.01  -  GAUGE DEPTH MEASURE LCP NONSTRL 2.7/3.5/4 MM SCREW	BOTH IP/OP	$761.88 	$563.79	$0.00	$591.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$565.46	$565.46	$0.00	$0.00	$158.77	$0.00	$0.00	$0.00	$0.00	$369.85	$585.84	$591.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
323.062	SUP	Custom 27203010		323.062  -  BIT DRL 2MM 140MM NS QC D MRK	BOTH IP/OP	$279.73 	$207.00	$0.00	$217.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.61	$207.61	$0.00	$0.00	$58.29	$0.00	$0.00	$0.00	$0.00	$135.79	$215.09	$217.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
323.36	SUP	Custom 27203010		323.36  -  GUIDE DRILL 3.5MM LCP UNV	BOTH IP/OP	$815.30 	$603.32	$0.00	$810.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.12	$605.12	$0.00	$0.00	$169.91	$0.00	$0.00	$0.00	$0.00	$506.66	$802.56	$810.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
323.46	SUP	Custom 27203010		323.46  -  GUIDE DRILL UNIVERSAL 4.5MM LC-DCP	BOTH IP/OP	$774.53 	$573.15	$0.00	$601.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$574.85	$574.85	$0.00	$0.00	$161.41	$0.00	$0.00	$0.00	$0.00	$375.99	$595.57	$601.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
324.101	SUP	Custom 27203010		324.101  -  HOLDER IMPL VCTR ANT CERV SPN TEMP INS SLFRET HLD SLV ANT	BOTH IP/OP	$264.25 	$195.55	$0.00	$211.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.13	$196.13	$0.00	$0.00	$55.07	$0.00	$0.00	$0.00	$0.00	$132.13	$209.29	$211.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
324.153	SUP	Custom 27203010		324.153  -  BIT DRL 2.5MM 14MM NS STP	BOTH IP/OP	$516.25 	$382.03	$0.00	$413.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$383.16	$383.16	$0.00	$0.00	$107.59	$0.00	$0.00	$0.00	$0.00	$258.13	$408.87	$413.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
324.155	SUP	Custom 27203010		324.155  -  BIT DRL 2.5MM 16MM NS STP	BOTH IP/OP	$516.25 	$382.03	$0.00	$413.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$383.16	$383.16	$0.00	$0.00	$107.59	$0.00	$0.00	$0.00	$0.00	$258.13	$408.87	$413.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
324.174	SUP	HCPCS C1769		324.174  -  GUIDEWIRE ORTHOPEDIC 2.5MM NONSTRL 5MM SCREW	BOTH IP/OP	$275.53 	$203.89	$0.00	$214.00	$145.25	$145.25	$0.00	$0.00	$0.00	$57.43	$204.49	$204.49	$0.00	$0.00	$57.42	$0.00	$162.97	$162.97	$0.00	$133.75	$211.86	$214.00	$0.00		$0.00	$40.64	$0.00	$0.00	$42.59	$0.00	$0.00	$0.00	$0.00	$0.00
324.203	SUP	Custom 27203010		324.203  -  GUIDE DRILL 4.3MM THREAD PERCUTANEOUS	BOTH IP/OP	$718.30 	$531.54	$0.00	$557.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$533.12	$533.12	$0.00	$0.00	$149.69	$0.00	$0.00	$0.00	$0.00	$348.69	$552.32	$557.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
324.21	SUP	Custom 27203010		324.210  -  BIT DRL 2.5MM 300MM NS 200MM QC CLBRT	BOTH IP/OP	$341.20 	$252.49	$0.00	$272.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.24	$253.24	$0.00	$0.00	$71.11	$0.00	$0.00	$0.00	$0.00	$170.60	$270.23	$272.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
324.211	SUP	Custom 27203010		324.211  -  BIT DRL 2.8MM 300MM NS 200MM QC CLBRT	BOTH IP/OP	$351.43 	$260.06	$0.00	$272.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.83	$260.83	$0.00	$0.00	$73.24	$0.00	$0.00	$0.00	$0.00	$170.60	$270.23	$272.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
324.212	SUP	Custom 27203010		324.212  -  BIT DRL 3.2MM 300MM NS QC CLBRT PERC	BOTH IP/OP	$351.43 	$260.06	$0.00	$272.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.83	$260.83	$0.00	$0.00	$73.24	$0.00	$0.00	$0.00	$0.00	$170.60	$270.23	$272.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
324.213	SUP	Custom 27203010		324.213  -  BIT DRL 4.3MM 300MM NS QC CLBRT PERC	BOTH IP/OP	$351.43 	$260.06	$0.00	$272.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.83	$260.83	$0.00	$0.00	$73.24	$0.00	$0.00	$0.00	$0.00	$170.60	$270.23	$272.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
324.214	SUP	Custom 27203010		324.214  -  BIT DRL 2.8MM 200MM NS QC CLBRT	BOTH IP/OP	$324.73 	$240.30	$0.00	$252.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.01	$241.01	$0.00	$0.00	$67.67	$0.00	$0.00	$0.00	$0.00	$157.63	$249.68	$252.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
325.16	SUP	Custom 27203010		325.160  -  ROD EXFIX 3MM 270MM THREAD SELF DRILL NONSTRL	BOTH IP/OP	$459.93 	$340.35	$0.00	$367.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.36	$341.36	$0.00	$0.00	$95.85	$0.00	$0.00	$0.00	$0.00	$229.96	$364.26	$367.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
328.16	SUP	Custom 27203010		328.160  -  ROD EXFIX 5MM 380MM THREADED SLFDRILL TIP NONSTRL	BOTH IP/OP	$556.83 	$412.05	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.28	$413.28	$0.00	$0.00	$116.04	$0.00	$0.00	$0.00	$0.00	$278.41	$441.01	$445.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
328.17	SUP	Custom 27203010		328.170  -  ROD EXFIX BLUNT 5MM 1.6MM 335MM THREAD CANN NONSTRL	BOTH IP/OP	$556.83 	$412.05	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.28	$413.28	$0.00	$0.00	$116.04	$0.00	$0.00	$0.00	$0.00	$278.41	$441.01	$445.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
329.08	SUP	Custom 27203010		329.08  -  IRON BENDING NONSTRL 3.5/4.5 MM RECONSTRUCTION PLATE	BOTH IP/OP	$603.05 	$446.26	$0.00	$468.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$447.58	$447.58	$0.00	$0.00	$125.68	$0.00	$0.00	$0.00	$0.00	$292.74	$463.70	$468.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336.105	SUP	HCPCS C1713		"336.105  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 5MM"	BOTH IP/OP	"$4,877.50 "	"$3,609.35"	$0.00	"$3,902.00"	"$2,194.88"	"$2,194.88"	$0.00	$0.00	$0.00	"$1,016.59"	"$3,620.08"	"$3,620.08"	$0.00	$0.00	"$1,016.47"	$0.00	"$2,404.61"	"$2,404.61"	$0.00	"$2,438.75"	"$3,862.98"	"$3,902.00"	$0.00		$0.00	$763.33	$0.00	$0.00	$776.50	$0.00	$0.00	$0.00	$0.00	$0.00
336.107	SUP	HCPCS C1713		"336.107  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 7MM"	BOTH IP/OP	"$4,877.50 "	"$3,609.35"	$0.00	"$3,902.00"	"$2,194.88"	"$2,194.88"	$0.00	$0.00	$0.00	"$1,016.59"	"$3,620.08"	"$3,620.08"	$0.00	$0.00	"$1,016.47"	$0.00	"$2,404.61"	"$2,404.61"	$0.00	"$2,438.75"	"$3,862.98"	"$3,902.00"	$0.00		$0.00	$763.33	$0.00	$0.00	$776.50	$0.00	$0.00	$0.00	$0.00	$0.00
336.109	SUP	HCPCS C1713		"336.109  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 9MM"	BOTH IP/OP	"$4,877.50 "	"$3,609.35"	$0.00	"$3,902.00"	"$2,194.88"	"$2,194.88"	$0.00	$0.00	$0.00	"$1,016.59"	"$3,620.08"	"$3,620.08"	$0.00	$0.00	"$1,016.47"	$0.00	"$2,404.61"	"$2,404.61"	$0.00	"$2,438.75"	"$3,862.98"	"$3,902.00"	$0.00		$0.00	$763.33	$0.00	$0.00	$776.50	$0.00	$0.00	$0.00	$0.00	$0.00
336.111	SUP	HCPCS C1713		"336.111  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 11MM"	BOTH IP/OP	"$4,877.50 "	"$3,609.35"	$0.00	"$3,902.00"	"$2,194.88"	"$2,194.88"	$0.00	$0.00	$0.00	"$1,016.59"	"$3,620.08"	"$3,620.08"	$0.00	$0.00	"$1,016.47"	$0.00	"$2,404.61"	"$2,404.61"	$0.00	"$2,438.75"	"$3,862.98"	"$3,902.00"	$0.00		$0.00	$763.33	$0.00	$0.00	$776.50	$0.00	$0.00	$0.00	$0.00	$0.00
336.113	SUP	HCPCS C1713		"336.113  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 13MM"	BOTH IP/OP	"$4,877.50 "	"$3,609.35"	$0.00	"$3,902.00"	"$2,194.88"	"$2,194.88"	$0.00	$0.00	$0.00	"$1,016.59"	"$3,620.08"	"$3,620.08"	$0.00	$0.00	"$1,016.47"	$0.00	"$2,404.61"	"$2,404.61"	$0.00	"$2,438.75"	"$3,862.98"	"$3,902.00"	$0.00		$0.00	$763.33	$0.00	$0.00	$776.50	$0.00	$0.00	$0.00	$0.00	$0.00
337.92	SUP	Custom 27203010		337.92  -  CANNULA OPHTHALMIC 45D 25GA GRIESHABER DSP STERILE	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$0.00	$0.00	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
338.002	SUP	Custom 27203010		338.002  -  GUIDEWIRE ORTHOPEDIC 2.5MM 300MM 12MM DRILL TIP THEADED	BOTH IP/OP	$132.13 	$97.78	$0.00	$102.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.06	$98.06	$0.00	$0.00	$27.53	$0.00	$0.00	$0.00	$0.00	$64.14	$101.60	$102.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
338.13	SUP	Custom 27203010		338.13  -  REAMER SURG 3 COMPLETE DHS NONSTRL	BOTH IP/OP	"$2,684.88 "	"$1,986.81"	$0.00	"$2,085.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,992.71"	"$1,992.71"	$0.00	$0.00	$559.53	$0.00	$0.00	$0.00	$0.00	"$1,303.34"	"$2,064.49"	"$2,085.34"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
338.17	SUP	Custom 27203010		338.17  -  TAP SURG 220MM DHS/DCS 12.5MM SCREWS	BOTH IP/OP	$656.45 	$485.77	$0.00	$509.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$487.22	$487.22	$0.00	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$318.68	$504.78	$509.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
338.31	SUP	Custom 27203010		338.31  -  GUIDE SURG COUPLING SCREW SOLID LATEX FREE DHS/DCS STAINLESS	BOTH IP/OP	$746.43 	$552.36	$0.00	$579.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$554.00	$554.00	$0.00	$0.00	$155.55	$0.00	$0.00	$0.00	$0.00	$362.34	$573.95	$579.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
338.333	SUP	Custom 27203010		338.333  -  REAMER SURG HEAD DHS	BOTH IP/OP	"$1,536.43 "	"$1,136.96"	$0.00	"$1,193.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,140.33"	"$1,140.33"	$0.00	$0.00	$320.19	$0.00	$0.00	$0.00	$0.00	$745.84	"$1,181.41"	"$1,193.34"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
338.348	SUP	HCPCS C1713		338.348  -  IMPACTOR SURG CAP LCP DHHS	BOTH IP/OP	$271.30 	$200.76	$0.00	$210.72	$118.53	$118.53	$0.00	$0.00	$0.00	$56.55	$201.36	$201.36	$0.00	$0.00	$56.54	$0.00	$160.47	$160.47	$0.00	$131.70	$208.61	$210.72	$0.00		$0.00	$40.02	$0.00	$0.00	$41.93	$0.00	$0.00	$0.00	$0.00	$0.00
339.21	SUP	Custom 27203010		339.21  -  PROBE VITRECTOMY 30D 25GA DSP POINTED TIP DIATHERMY	BOTH IP/OP	$695.25 	$514.49	$0.00	$556.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$516.01	$516.01	$0.00	$0.00	$144.89	$0.00	$0.00	$0.00	$0.00	$347.63	$550.64	$556.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.715	SUP	Custom 27803010		342.715  -  SPACER SPNL 0D 12MM SM 14X15MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.717	SUP	Custom 27803010		342.717  -  SPACER SPNL 0D 12MM SM 14X17MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.719	SUP	Custom 27803010		342.719  -  SPACER SPNL 0D 12MM SM 14X19MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.721	SUP	Custom 27803010		342.721  -  SPACER SPNL 0D 12MM SM 14X21MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.723	SUP	Custom 27803010		342.723  -  SPACER SPNL 0D 12MM SM 14X23MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.725	SUP	Custom 27803010		342.725  -  SPACER SPNL 0D 12MM SM 14X25MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.727	SUP	Custom 27803010		342.727  -  SPACER SPNL 0D 12MM SM 14X27MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.729	SUP	Custom 27803010		342.729  -  SPACER SPNL 0D 12MM SM 14X29MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.731	SUP	Custom 27803010		342.731  -  SPACER SPNL 0D 12MM SM 14X31MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.733	SUP	Custom 27803010		342.733  -  SPACER SPNL 0D 12MM SM 14X33MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.815	SUP	Custom 27803010		342.815  -  SPACER SPNL 7D 12MM SM 14X15MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.817	SUP	Custom 27803010		342.817  -  SPACER SPNL 7D 12MM SM 14X17MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.819	SUP	Custom 27803010		342.819  -  SPACER SPNL 7D 12MM SM 14X19MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.821	SUP	Custom 27803010		342.821  -  SPACER SPNL 7D 12MM SM 14X21MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.823	SUP	Custom 27803010		342.823  -  SPACER SPNL 7D 12MM SM 14X23MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.825	SUP	Custom 27803010		342.825  -  SPACER SPNL 7D 12MM SM 14X25MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.827	SUP	Custom 27803010		342.827  -  SPACER SPNL 7D 12MM SM 14X27MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.829	SUP	Custom 27803010		342.829  -  SPACER SPNL 7D 12MM SM 14X29MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.831	SUP	Custom 27803010		342.831  -  SPACER SPNL 7D 12MM SM 14X31MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.833	SUP	Custom 27803010		342.833  -  SPACER SPNL 7D 12MM SM 14X33MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.915	SUP	Custom 27803010		342.915  -  SPACER SPNL 5D 12MM SM 14X15MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.917	SUP	Custom 27803010		342.917  -  SPACER SPNL 5D 12MM SM 14X17MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.919	SUP	Custom 27803010		342.919  -  SPACER SPNL 5D 12MM SM 14X19MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.921	SUP	Custom 27803010		342.921  -  SPACER SPNL 5D 12MM SM 14X21MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.923	SUP	Custom 27803010		342.923  -  SPACER SPNL 5D 12MM SM 14X23MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.925	SUP	Custom 27803010		342.925  -  SPACER SPNL 5D 12MM SM 14X25MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.927	SUP	Custom 27803010		342.927  -  SPACER SPNL 5D 12MM SM 14X27MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.929	SUP	Custom 27803010		342.929  -  SPACER SPNL 5D 12MM SM 14X29MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.931	SUP	Custom 27803010		342.931  -  SPACER SPNL 5D 12MM SM 14X31MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342.933	SUP	Custom 27803010		342.933  -  SPACER SPNL 5D 12MM SM 14X33MM NS LF NIKO PEEK-OPTM	BOTH IP/OP	"$7,635.00 "	"$5,649.90"	$0.00	"$6,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,591.13"	$0.00	$0.00	$0.00	$0.00	"$3,817.50"	"$6,046.92"	"$6,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.001	SUP	Custom 27803010		351.001  -  ENDPLATE SPNL 0D 14MM 14X15MM NS LF FORTIFY-R FTPRNT NO SPK	BOTH IP/OP	"$19,050.00 "	"$14,097.00"	$0.00	"$15,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,970.02"	$0.00	$0.00	$0.00	$0.00	"$9,525.00"	"$15,087.60"	"$15,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.002	SUP	Custom 27803010		351.002  -  ENDPLATE SPNL 0D 14MM 14X17MM NS LF FORTIFY-R FTPRNT	BOTH IP/OP	"$19,050.00 "	"$14,097.00"	$0.00	"$15,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,970.02"	$0.00	$0.00	$0.00	$0.00	"$9,525.00"	"$15,087.60"	"$15,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.003	SUP	Custom 27803010		351.003  -  ENDPLATE SPNL 3.5D 14MM 14X17MM NS LF FORTIFY-R FTPRNT NO	BOTH IP/OP	"$19,050.00 "	"$14,097.00"	$0.00	"$15,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,970.02"	$0.00	$0.00	$0.00	$0.00	"$9,525.00"	"$15,087.60"	"$15,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.004	SUP	Custom 27803010		351.004  -  ENDPLATE SPNL 3.5D 14MM 14X19MM NS LF FORTIFY-R FTPRNT	BOTH IP/OP	"$19,050.00 "	"$14,097.00"	$0.00	"$15,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,970.02"	$0.00	$0.00	$0.00	$0.00	"$9,525.00"	"$15,087.60"	"$15,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.005	SUP	Custom 27803010		351.005  -  ENDPLATE SPNL 0D 14MM 14X16MM NS LF FORTIFY-R FTPRNT NO SPK	BOTH IP/OP	"$19,050.00 "	"$14,097.00"	$0.00	"$15,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,970.02"	$0.00	$0.00	$0.00	$0.00	"$9,525.00"	"$15,087.60"	"$15,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.006	SUP	Custom 27803010		351.006  -  ENDPLATE SPNL 0D 14MM 14X18MM NS LF FORTIFY-R FTPRNT	BOTH IP/OP	"$19,050.00 "	"$14,097.00"	$0.00	"$15,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,970.02"	$0.00	$0.00	$0.00	$0.00	"$9,525.00"	"$15,087.60"	"$15,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.007	SUP	Custom 27803010		351.007  -  ENDPLATE SPNL 3.5D 14MM 14X18MM NS LF FORTIFY-R FTPRNT NO	BOTH IP/OP	"$19,050.00 "	"$14,097.00"	$0.00	"$15,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,970.02"	$0.00	$0.00	$0.00	$0.00	"$9,525.00"	"$15,087.60"	"$15,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.008	SUP	Custom 27803010		351.008  -  ENDPLATE SPNL 3.5D 14MM 14X20MM NS LF FORTIFY-R FTPRNT	BOTH IP/OP	"$19,050.00 "	"$14,097.00"	$0.00	"$15,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,970.02"	$0.00	$0.00	$0.00	$0.00	"$9,525.00"	"$15,087.60"	"$15,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.009	SUP	Custom 27803010		351.009  -  ENDPLATE SPNL 0D 14MM 14X18MM NS LF FORTIFY-R FTPRNT NO SPK	BOTH IP/OP	"$19,050.00 "	"$14,097.00"	$0.00	"$15,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,970.02"	$0.00	$0.00	$0.00	$0.00	"$9,525.00"	"$15,087.60"	"$15,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.01	SUP	Custom 27803010		351.010  -  ENDPLATE SPNL 0D 14MM 14X20MM NS LF FORTIFY-R FTPRNT	BOTH IP/OP	"$19,050.00 "	"$14,097.00"	$0.00	"$15,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,970.02"	$0.00	$0.00	$0.00	$0.00	"$9,525.00"	"$15,087.60"	"$15,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.011	SUP	Custom 27803010		351.011  -  ENDPLATE SPNL 3.5D 14MM 14X20MM NS LF FORTIFY-R FTPRNT NO	BOTH IP/OP	"$19,050.00 "	"$14,097.00"	$0.00	"$15,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,970.02"	$0.00	$0.00	$0.00	$0.00	"$9,525.00"	"$15,087.60"	"$15,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.012	SUP	Custom 27803010		351.012  -  ENDPLATE SPNL 3.5D 14MM 14X22MM NS LF FORTIFY-R FTPRNT	BOTH IP/OP	"$19,050.00 "	"$14,097.00"	$0.00	"$15,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,970.02"	$0.00	$0.00	$0.00	$0.00	"$9,525.00"	"$15,087.60"	"$15,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.05	SUP	Custom 27803010		351.050  -  ENDPLATE SPNL 14MM 14X24MM NS LF FORTIFY-R	BOTH IP/OP	"$18,600.00 "	"$13,764.00"	$0.00	"$14,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,876.24"	$0.00	$0.00	$0.00	$0.00	"$9,300.00"	"$14,731.20"	"$14,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.051	SUP	Custom 27803010		351.051  -  ENDPLATE SPNL 14MM 14X28MM NS LF FORTIFY-R	BOTH IP/OP	"$18,600.00 "	"$13,764.00"	$0.00	"$14,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,876.24"	$0.00	$0.00	$0.00	$0.00	"$9,300.00"	"$14,731.20"	"$14,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.052	SUP	Custom 27803010		351.052  -  ENDPLATE SPNL 14MM 14X35MM NS LF FORTIFY-R	BOTH IP/OP	"$18,600.00 "	"$13,764.00"	$0.00	"$14,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,876.24"	$0.00	$0.00	$0.00	$0.00	"$9,300.00"	"$14,731.20"	"$14,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.053	SUP	Custom 27803010		351.053  -  ENDPLATE SPNL 14MM 14X49MM NS LF FORTIFY-R	BOTH IP/OP	"$18,600.00 "	"$13,764.00"	$0.00	"$14,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,876.24"	$0.00	$0.00	$0.00	$0.00	"$9,300.00"	"$14,731.20"	"$14,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.054	SUP	Custom 27803010		351.054  -  ENDPLATE SPNL 14MM 14X66MM NS LF FORTIFY-R	BOTH IP/OP	"$18,600.00 "	"$13,764.00"	$0.00	"$14,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,876.24"	$0.00	$0.00	$0.00	$0.00	"$9,300.00"	"$14,731.20"	"$14,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.15	SUP	Custom 27803010		351.150  -  ENDPLATE SPNL 14MM 20X26MM NS LF FORTIFY-R	BOTH IP/OP	"$23,600.00 "	"$17,464.00"	$0.00	"$18,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,918.24"	$0.00	$0.00	$0.00	$0.00	"$11,800.00"	"$18,691.20"	"$18,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.151	SUP	Custom 27803010		351.151  -  ENDPLATE SPNL 20MM 20X28MM NS LF FORTIFY-R	BOTH IP/OP	"$23,600.00 "	"$17,464.00"	$0.00	"$18,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,918.24"	$0.00	$0.00	$0.00	$0.00	"$11,800.00"	"$18,691.20"	"$18,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.152	SUP	Custom 27803010		351.152  -  ENDPLATE SPNL 20MM 20X33MM NS LF FORTIFY-R	BOTH IP/OP	"$23,600.00 "	"$17,464.00"	$0.00	"$18,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,918.24"	$0.00	$0.00	$0.00	$0.00	"$11,800.00"	"$18,691.20"	"$18,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.153	SUP	Custom 27803010		351.153  -  ENDPLATE SPNL 20MM 20X43MM NS LF FORTIFY-R	BOTH IP/OP	"$23,600.00 "	"$17,464.00"	$0.00	"$18,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,918.24"	$0.00	$0.00	$0.00	$0.00	"$11,800.00"	"$18,691.20"	"$18,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.154	SUP	Custom 27803010		351.154  -  ENDPLATE SPNL 20MM 20X61MM NS LF FORTIFY-R	BOTH IP/OP	"$23,600.00 "	"$17,464.00"	$0.00	"$18,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,918.24"	$0.00	$0.00	$0.00	$0.00	"$11,800.00"	"$18,691.20"	"$18,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.155	SUP	Custom 27803010		351.155  -  ENDPLATE SPNL 20MM 20X80MM NS LF FORTIFY-R	BOTH IP/OP	"$23,600.00 "	"$17,464.00"	$0.00	"$18,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,918.24"	$0.00	$0.00	$0.00	$0.00	"$11,800.00"	"$18,691.20"	"$18,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.156	SUP	Custom 27803010		351.156  -  ENDPLATE SPNL 20MM 20X99MM NS LF FORTIFY-R	BOTH IP/OP	"$23,600.00 "	"$17,464.00"	$0.00	"$18,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,918.24"	$0.00	$0.00	$0.00	$0.00	"$11,800.00"	"$18,691.20"	"$18,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.27	SUP	Custom 27203010		351.27  -  BIT DRILL 13MM 300MM CANN NONSTRL	BOTH IP/OP	"$1,117.40 "	$826.88	$0.00	$867.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$829.33	$829.33	$0.00	$0.00	$232.87	$0.00	$0.00	$0.00	$0.00	$542.43	$859.20	$867.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.3	SUP	HCPCS C1713		351.300  -  SPACER SPNL 0D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT NO	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.301	SUP	HCPCS C1713		351.301  -  SPACER SPNL 0D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.302	SUP	HCPCS C1713		351.302  -  SPACER SPNL 3.5D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.303	SUP	HCPCS C1713		351.303  -  SPACER SPNL 3.5D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.304	SUP	HCPCS C1713		351.304  -  SPACER SPNL 7D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.311	SUP	HCPCS C1713		351.311  -  SPACER SPNL 0D 14MM 16MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.313	SUP	HCPCS C1713		351.313  -  SPACER SPNL 3.5D 14MM 16MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.314	SUP	HCPCS C1713		351.314  -  SPACER SPNL 7D 14MM 16MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.321	SUP	HCPCS C1713		351.321  -  SPACER SPNL 0D 15MM 18MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
351.323	SUP	HCPCS C1713		351.323  -  SPACER SPNL 3.5D 15MM 18MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
351.324	SUP	HCPCS C1713		351.324  -  SPACER SPNL 7D 15MM 18MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
351.351	SUP	HCPCS C1713		351.351  -  SPACER SPNL 0D 14MM 14MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.353	SUP	HCPCS C1713		351.353  -  SPACER SPNL 3.5D 14MM 14MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.354	SUP	HCPCS C1713		351.354  -  SPACER SPNL 7D 14MM 14MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.361	SUP	HCPCS C1713		351.361  -  SPACER SPNL 0D 14MM 16MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.363	SUP	HCPCS C1713		351.363  -  SPACER SPNL 3.5D 14MM 16MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.364	SUP	HCPCS C1713		351.364  -  SPACER SPNL 7D 14MM 16MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.371	SUP	HCPCS C1713		351.371  -  SPACER SPNL 0D 15MM 18MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
351.373	SUP	HCPCS C1713		351.373  -  SPACER SPNL 3.5D 15MM 18MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
351.374	SUP	HCPCS C1713		351.374  -  SPACER SPNL 7D 15MM 18MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
351.401	SUP	HCPCS C1713		351.401  -  SPACER SPNL 0D 20MM 20MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
351.403	SUP	HCPCS C1713		351.403  -  SPACER SPNL 4D 20MM 20MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
351.404	SUP	HCPCS C1713		351.404  -  SPACER SPNL 8D 20MM 20MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
351.411	SUP	HCPCS C1713		351.411  -  SPACER SPNL 0D 21MM 23MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.413	SUP	HCPCS C1713		351.413  -  SPACER SPNL 4D 21MM 23MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.414	SUP	HCPCS C1713		351.414  -  SPACER SPNL 8D 21MM 23MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.431	SUP	HCPCS C1713		351.431  -  SPACER SPNL 0D 25MM 30MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.433	SUP	HCPCS C1713		351.433  -  SPACER SPNL 4D 25MM 30MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.434	SUP	HCPCS C1713		351.434  -  SPACER SPNL 8D 25MM 30MM NS LF FORTIFY-R FTPRNT UPR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.451	SUP	HCPCS C1713		351.451  -  SPACER SPNL 0D 20MM 20MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
351.453	SUP	HCPCS C1713		351.453  -  SPACER SPNL 4D 20MM 20MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
351.454	SUP	HCPCS C1713		351.454  -  SPACER SPNL 8D 20MM 20MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,335.00 "	$987.90	$0.00	"$1,068.00"	$600.75	$600.75	$0.00	$0.00	$0.00	$278.25	$990.84	$990.84	$0.00	$0.00	$278.21	$0.00	$789.65	$789.65	$0.00	$667.50	"$1,057.32"	"$1,068.00"	$0.00		$0.00	$208.93	$0.00	$0.00	$212.53	$0.00	$0.00	$0.00	$0.00	$0.00
351.461	SUP	HCPCS C1713		351.461  -  SPACER SPNL 0D 21MM 23MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.463	SUP	HCPCS C1713		351.463  -  SPACER SPNL 4D 21MM 23MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.464	SUP	HCPCS C1713		351.464  -  SPACER SPNL 8D 21MM 23MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.481	SUP	HCPCS C1713		351.481  -  SPACER SPNL 0D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.483	SUP	HCPCS C1713		351.483  -  SPACER SPNL 4D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.485	SUP	HCPCS C1713		351.485  -  SPACER SPNL 12D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.486	SUP	HCPCS C1713		351.486  -  SPACER SPNL 16D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
351.92	SUP	Custom 27203010		351.92  -  REAMER HAND 6MM 450MM NONSTRL	BOTH IP/OP	$548.48 	$405.88	$0.00	$426.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.08	$407.08	$0.00	$0.00	$114.30	$0.00	$0.00	$0.00	$0.00	$266.25	$421.74	$426.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.95	SUP	Custom 27203010		351.95  -  REAMER HAND 9MM 450MM NONSTRL	BOTH IP/OP	$567.45 	$419.91	$0.00	$440.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.16	$421.16	$0.00	$0.00	$118.26	$0.00	$0.00	$0.00	$0.00	$275.46	$436.34	$440.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.04	SUP	Custom 27203010		352.04  -  MANIPULATOR SURG FLEXIBLE STEM 5MM	BOTH IP/OP	"$4,752.58 "	"$3,516.91"	$0.00	"$4,684.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,527.36"	"$3,527.36"	$0.00	$0.00	$990.44	$0.00	$0.00	$0.00	$0.00	"$2,927.50"	"$4,637.16"	"$4,684.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.085	SUP	Custom 27203010		352.085  -  HEAD RMR 8.5MM MDLRY	BOTH IP/OP	$587.88 	$435.03	$0.00	$456.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$436.32	$436.32	$0.00	$0.00	$122.51	$0.00	$0.00	$0.00	$0.00	$285.38	$452.03	$456.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.1	SUP	Custom 27203010		352.100  -  REAMER SURG 10MM HEAD SDCT MDLRY NSTRL	BOTH IP/OP	$678.55 	$502.13	$0.00	$542.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$339.28	$537.41	$542.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.165	SUP	Custom 27203010		352.165  -  REAMER SURG 16.5MM HEAD SIDE CUT MEDULLARY NONSTRL	BOTH IP/OP	$719.88 	$532.71	$0.00	$575.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$534.29	$534.29	$0.00	$0.00	$150.02	$0.00	$0.00	$0.00	$0.00	$359.94	$570.14	$575.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
355.9	SUP	Custom 27203010		355.90  -  BIT DRILL 4.5MM 4MM 225MM QUICK COUPLING NONSTRL	BOTH IP/OP	$362.55 	$268.29	$0.00	$290.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.08	$269.08	$0.00	$0.00	$75.56	$0.00	$0.00	$0.00	$0.00	$181.28	$287.14	$290.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
356.95	SUP	Custom 27203010		356.95  -  BIT DRILL 4MM 4.5MM 225MM QUICK COUPLING 3 FLUTED NONSTRL	BOTH IP/OP	$446.28 	$330.25	$0.00	$357.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.23	$331.23	$0.00	$0.00	$93.00	$0.00	$0.00	$0.00	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
356.97	SUP	Custom 27203010		356.97  -  BIT DRILL 3.2MM 215MM 80MM 3 FLUTED CALIBRATED QUICK	BOTH IP/OP	$408.45 	$302.25	$0.00	$317.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$303.15	$303.15	$0.00	$0.00	$85.12	$0.00	$0.00	$0.00	$0.00	$198.28	$314.07	$317.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
356.972	SUP	Custom 27203010		356.972  -  BIT DRILL 82MM CALIBRATION 3.2MM 215MM QUICK COUPLING 3	BOTH IP/OP	$404.08 	$299.02	$0.00	$313.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$299.90	$299.90	$0.00	$0.00	$84.21	$0.00	$0.00	$0.00	$0.00	$196.15	$310.70	$313.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
356.98	SUP	Custom 27203010		356.98  -  BIT DRILL 4MM 270MM 95MM 3 FLUTED CALIBRATED QUICK COUPLING	BOTH IP/OP	$477.00 	$352.98	$0.00	$370.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.03	$354.03	$0.00	$0.00	$99.41	$0.00	$0.00	$0.00	$0.00	$231.56	$366.80	$370.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
356.982	SUP	Custom 27203010		356.982  -  BIT DRILL 4MM 215MM 80MM 3 FLUTED CALIBRATED QUICK COUPLING	BOTH IP/OP	$462.43 	$342.20	$0.00	$359.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.21	$343.21	$0.00	$0.00	$96.37	$0.00	$0.00	$0.00	$0.00	$224.48	$355.57	$359.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
357.039	SUP	Custom 27203010		357.039  -  GUIDEWIRE ORTHOPEDIC 2.8MM 350MM THREADED TROCAR POINT	BOTH IP/OP	$92.78 	$68.66	$0.00	$72.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.86	$68.86	$0.00	$0.00	$19.33	$0.00	$0.00	$0.00	$0.00	$45.04	$71.34	$72.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
357.047	SUP	Custom 27203010		357.047  -  BIT DRILL 6.5MM 330MM QUICK COUPLING CANN	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$920.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$575.24	$911.18	$920.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
357.099	SUP	Custom 27203010		357.099  -  BIT DRILL 5MM 330MM 100MM 3 FLUTED CALIBRATED QUICK COUPLING	BOTH IP/OP	$567.93 	$420.27	$0.00	$454.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.51	$421.51	$0.00	$0.00	$118.36	$0.00	$0.00	$0.00	$0.00	$283.96	$449.80	$454.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
357.394	SUP	Custom 27203010		357.394  -  BIT DRL 17MM 300MM NS CNN LG QC	BOTH IP/OP	"$1,514.18 "	"$1,120.49"	$0.00	"$1,176.06"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,123.82"	"$1,123.82"	$0.00	$0.00	$315.55	$0.00	$0.00	$0.00	$0.00	$735.04	"$1,164.30"	"$1,176.06"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
357.399	SUP	Custom 27203010		357.399  -  GUIDEWIRE ORTHOPEDIC 3.2MM 400MM THREAD TIBIA NONSTRL	BOTH IP/OP	$186.73 	$138.18	$0.00	$145.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.59	$138.59	$0.00	$0.00	$38.91	$0.00	$0.00	$0.00	$0.00	$90.64	$143.57	$145.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
357.403	SUP	Custom 27203010		357.403  -  BIT DRILL 6/10MM 435MM LARGE QUICK COUPLING CANN TAPERED	BOTH IP/OP	"$1,088.23 "	$805.29	$0.00	$845.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$807.68	$807.68	$0.00	$0.00	$226.79	$0.00	$0.00	$0.00	$0.00	$528.26	$836.77	$845.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
357.404	SUP	Custom 27203010		357.404  -  BIT DRILL LARGE 11MM 280MM LARGE QUICK COUPLING CANN TAPERED	BOTH IP/OP	$959.85 	$710.29	$0.00	$745.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.40	$712.40	$0.00	$0.00	$200.03	$0.00	$0.00	$0.00	$0.00	$465.95	$738.06	$745.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
357.407	SUP	Custom 27203010		357.407  -  BIT DRL 65MM 3 FLUT 4MM 260MM NS QC CLBRT	BOTH IP/OP	$392.40 	$290.38	$0.00	$304.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$291.24	$291.24	$0.00	$0.00	$81.78	$0.00	$0.00	$0.00	$0.00	$190.49	$301.74	$304.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
358.691	SUP	Custom 27203010		358.691  -  BIT DRILL 102MM STOP 4.5MM 170MM 102MM JACOBS CHUCK CANN	BOTH IP/OP	$693.98 	$513.55	$0.00	$555.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$515.07	$515.07	$0.00	$0.00	$144.62	$0.00	$0.00	$0.00	$0.00	$346.99	$549.63	$555.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
359.079	SUP	Custom 27203010		359.079  -  BIT DRILL LARGE 10.5MM 250MM QUICK COUPLING CANN FLEXIBLE	BOTH IP/OP	$921.20 	$681.69	$0.00	$736.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$683.71	$683.71	$0.00	$0.00	$191.98	$0.00	$0.00	$0.00	$0.00	$460.60	$729.59	$736.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
359.081	SUP	Custom 27203010		359.081  -  BIT DRILL LARGE 8MM 250MM QUICK COUPLING CANN FLEXIBLE	BOTH IP/OP	$921.20 	$681.69	$0.00	$736.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$683.71	$683.71	$0.00	$0.00	$191.98	$0.00	$0.00	$0.00	$0.00	$460.60	$729.59	$736.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
360.01	SUP	Custom 27203010		360.01  -  BIT DRILL LARGE 6MM 190MM QUICK COUPLING CANN NONSTRL	BOTH IP/OP	"$1,097.85 "	$812.41	$0.00	$852.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$814.82	$814.82	$0.00	$0.00	$228.79	$0.00	$0.00	$0.00	$0.00	$532.94	$844.18	$852.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
360.02	SUP	Custom 27203010		360.02  -  BIT DRILL LARGE 7MM 190MM QUICK COUPLING CANN NONSTRL	BOTH IP/OP	"$1,097.85 "	$812.41	$0.00	$852.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$814.82	$814.82	$0.00	$0.00	$228.79	$0.00	$0.00	$0.00	$0.00	$532.94	$844.18	$852.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
360.03	SUP	Custom 27203010		360.03  -  BIT DRILL LARGE 8MM 190MM QUICK COUPLING CANN NONSTRL	BOTH IP/OP	"$1,097.85 "	$812.41	$0.00	$852.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$814.82	$814.82	$0.00	$0.00	$228.79	$0.00	$0.00	$0.00	$0.00	$532.94	$844.18	$852.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
360.04	SUP	Custom 27203010		360.04  -  BIT DRILL LARGE 9MM 190MM QUICK COUPLING CANN NONSTRL	BOTH IP/OP	"$1,097.85 "	$812.41	$0.00	$852.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$814.82	$814.82	$0.00	$0.00	$228.79	$0.00	$0.00	$0.00	$0.00	$532.94	$844.18	$852.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
360.05	SUP	Custom 27203010		360.05  -  BIT DRILL LARGE 10MM 190MM QUICK COUPLING CANN NONSTRL	BOTH IP/OP	"$1,097.85 "	$812.41	$0.00	$852.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$814.82	$814.82	$0.00	$0.00	$228.79	$0.00	$0.00	$0.00	$0.00	$532.94	$844.18	$852.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
360.06	SUP	Custom 27203010		360.06  -  BIT DRILL LARGE 11MM 190MM QUICK COUPLING CANN NONSTRL	BOTH IP/OP	"$1,152.68 "	$852.98	$0.00	$895.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$855.52	$855.52	$0.00	$0.00	$240.22	$0.00	$0.00	$0.00	$0.00	$559.55	$886.33	$895.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
360.07	SUP	Custom 27203010		360.07  -  BIT DRILL LARGE 12MM 190MM QUICK COUPLING CANN NONSTRL	BOTH IP/OP	"$1,152.68 "	$852.98	$0.00	$895.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$855.52	$855.52	$0.00	$0.00	$240.22	$0.00	$0.00	$0.00	$0.00	$559.55	$886.33	$895.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
360.257	SUP	Custom 27203010		360.257  -  BIT DRL 13MM 385MM NS LG QC FLXB	BOTH IP/OP	$794.23 	$587.73	$0.00	$616.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$589.47	$589.47	$0.00	$0.00	$165.52	$0.00	$0.00	$0.00	$0.00	$385.54	$610.70	$616.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
360.258	SUP	Custom 27203010		360.258  -  BIT DRL 15.5MM 385MM NS LG QC FLXB	BOTH IP/OP	$794.23 	$587.73	$0.00	$616.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$589.47	$589.47	$0.00	$0.00	$165.52	$0.00	$0.00	$0.00	$0.00	$385.54	$610.70	$616.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.009	SUP	Custom 27803010		364.009  -  SPACER SPNL 0D 20MM XS 25X9MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.011	SUP	Custom 27803010		364.011  -  SPACER SPNL 0D 20MM XS 25X11MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.013	SUP	Custom 27803010		364.013  -  SPACER SPNL 0D 20MM XS 25X13MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.015	SUP	Custom 27803010		364.015  -  SPACER SPNL 0D 20MM XS 25X15MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.017	SUP	Custom 27803010		364.017  -  SPACER SPNL 0D 20MM XS 25X17MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.109	SUP	Custom 27803010		364.109  -  SPACER SPNL 0D 22MM SM 29X9MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.111	SUP	Custom 27803010		364.111  -  SPACER SPNL 0D 22MM SM 29X11MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.113	SUP	Custom 27803010		364.113  -  SPACER SPNL 0D 22MM SM 29X13MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.115	SUP	Custom 27803010		364.115  -  SPACER SPNL 0D 22MM SM 29X15MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.117	SUP	Custom 27803010		364.117  -  SPACER SPNL 0D 22MM SM 29X17MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.209	SUP	Custom 27803010		364.209  -  SPACER SPNL 8D LRDTC 22MM SM 29X9MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.211	SUP	Custom 27803010		364.211  -  SPACER SPNL 8D LRDTC 22MM SM 29X11MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.213	SUP	Custom 27803010		364.213  -  SPACER SPNL 8D LRDTC 22MM SM 29X13MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.215	SUP	Custom 27803010		364.215  -  SPACER SPNL 8D LRDTC 22MM SM 29X15MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.217	SUP	Custom 27803010		364.217  -  SPACER SPNL 8D LRDTC 22MM SM 29X17MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.311	SUP	Custom 27803010		364.311  -  SPACER SPNL 15D LRDTC 22MM SM 29X11MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.313	SUP	Custom 27803010		364.313  -  SPACER SPNL 15D LRDTC 22MM SM 29X13MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.315	SUP	Custom 27803010		364.315  -  SPACER SPNL 15D LRDTC 22MM SM 29X15MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.317	SUP	Custom 27803010		364.317  -  SPACER SPNL 15D LRDTC 22MM SM 29X17MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.409	SUP	Custom 27803010		364.409  -  SPACER SPNL 0D 24MM MED 35X9MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.411	SUP	Custom 27803010		364.411  -  SPACER SPNL 0D 24MM MED 35X11MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.413	SUP	Custom 27803010		364.413  -  SPACER SPNL 0D 24MM MED 35X13MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.415	SUP	Custom 27803010		364.415  -  SPACER SPNL 0D 24MM MED 35X15MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.417	SUP	Custom 27803010		364.417  -  SPACER SPNL 0D 24MM MED 35X17MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.419	SUP	Custom 27803010		364.419  -  SPACER SPNL 0D 24MM MED 35X19MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.421	SUP	Custom 27803010		364.421  -  SPACER SPNL 0D 24MM MED 35X21MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.509	SUP	Custom 27803010		364.509  -  SPACER SPNL 8D LRDTC 24MM MED 35X9MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.511	SUP	Custom 27803010		364.511  -  SPACER SPNL 8D LRDTC 24MM MED 35X11MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.513	SUP	Custom 27803010		364.513  -  SPACER SPNL 8D LRDTC 24MM MED 35X13MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.515	SUP	Custom 27803010		364.515  -  SPACER SPNL 8D LRDTC 24MM MED 35X15MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.517	SUP	Custom 27803010		364.517  -  SPACER SPNL 8D LRDTC 24MM MED 35X17MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.519	SUP	Custom 27803010		364.519  -  SPACER SPNL 8D LRDTC 24MM MED 35X19MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.521	SUP	Custom 27803010		364.521  -  SPACER SPNL 8D LRDTC 24MM MED 35X21MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.611	SUP	Custom 27803010		364.611  -  SPACER SPNL 15D LRDTC 24MM MED 35X11MM NS LF CNTNTL PEEK	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.613	SUP	Custom 27803010		364.613  -  SPACER SPNL 15D LRDTC 24MM MED 35X13MM NS LF CNTNTL PEEK	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.615	SUP	Custom 27803010		364.615  -  SPACER SPNL 15D LRDTC 24MM MED 35X15MM NS LF CNTNTL PEEK	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.617	SUP	Custom 27803010		364.617  -  SPACER SPNL 15D LRDTC 24MM MED 35X17MM NS LF CNTNTL PEEK	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.619	SUP	Custom 27803010		364.619  -  SPACER SPNL 15D LRDTC 24MM MED 35X19MM NS LF CNTNTL PEEK	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.621	SUP	Custom 27803010		364.621  -  SPACER SPNL 15D LRDTC 24MM MED 35X21MM NS LF CNTNTL PEEK	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.711	SUP	Custom 27803010		364.711  -  SPACER SPNL 8D LRDTC 28MM LG 39X11MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.713	SUP	Custom 27803010		364.713  -  SPACER SPNL 8D LRDTC 28MM LG 39X13MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.715	SUP	Custom 27803010		364.715  -  SPACER SPNL 8D LRDTC 28MM LG 39X15MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.717	SUP	Custom 27803010		364.717  -  SPACER SPNL 8D LRDTC 28MM LG 39X17MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.719	SUP	Custom 27803010		364.719  -  SPACER SPNL 8D LRDTC 28MM LG 39X19MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.721	SUP	Custom 27803010		364.721  -  SPACER SPNL 8D LRDTC 28MM LG 39X21MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.759	SUP	Custom 27803010		"364.759  -  CONTINENTAL ALIF SPACER, LARGE 5 DEG, 9MM"	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.813	SUP	Custom 27803010		364.813  -  SPACER SPNL 15D LRDTC 28MM LG 39X13MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.815	SUP	Custom 27803010		364.815  -  SPACER SPNL 15D LRDTC 28MM LG 39X15MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.817	SUP	Custom 27803010		364.817  -  SPACER SPNL 15D LRDTC 28MM LG 39X17MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.819	SUP	Custom 27803010		364.819  -  SPACER SPNL 15D LRDTC 28MM LG 39X19MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
364.821	SUP	Custom 27803010		364.821  -  SPACER SPNL 15D LRDTC 28MM LG 39X21MM NS LF CNTNTL PEEK ALIF	BOTH IP/OP	"$13,642.50 "	"$10,095.45"	$0.00	"$10,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,843.10"	$0.00	$0.00	$0.00	$0.00	"$6,821.25"	"$10,804.86"	"$10,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.005	SUP	Custom 27803010		365.005  -  SPACER SPNL 11MM SM PRLL 12X5MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.006	SUP	Custom 27803010		365.006  -  SPACER SPNL 11MM SM PRLL 12X6MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.007	SUP	Custom 27803010		365.007  -  SPACER SPNL 11MM SM PRLL 12X7MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.008	SUP	Custom 27803010		365.008  -  SPACER SPNL 11MM SM PRLL 12X8MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.009	SUP	Custom 27803010		365.009  -  SPACER SPNL 11MM SM PRLL 12X9MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.01	SUP	Custom 27803010		365.010  -  SPACER SPNL 11MM SM PRLL 12X10MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.011	SUP	Custom 27803010		365.011  -  SPACER SPNL 11MM SM PRLL 12X11MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.012	SUP	Custom 27803010		365.012  -  SPACER SPNL 11MM SM PRLL 12X12MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.045	SUP	Custom 27803010		365.045  -  SPACER SPNL 15MM 2XL PRLL 18X5MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.046	SUP	Custom 27803010		365.046  -  SPACER SPNL 15MM 2XL PRLL 18X6MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.047	SUP	Custom 27803010		365.047  -  SPACER SPNL 15MM 2XL PRLL 18X7MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.048	SUP	Custom 27803010		365.048  -  SPACER SPNL 15MM 2XL PRLL 18X8MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.049	SUP	Custom 27803010		365.049  -  SPACER SPNL 15MM 2XL PRLL 18X9MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.05	SUP	Custom 27803010		365.050  -  SPACER SPNL 15MM 2XL PRLL 18X10MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.051	SUP	Custom 27803010		365.051  -  SPACER SPNL 15MM 2XL PRLL 18X11MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.052	SUP	Custom 27803010		365.052  -  SPACER SPNL 15MM 2XL PRLL 18X12MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.065	SUP	Custom 27803010		365.065  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X5MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.066	SUP	Custom 27803010		365.066  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X6MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.067	SUP	Custom 27803010		365.067  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X7MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.068	SUP	Custom 27803010		365.068  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X8MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.069	SUP	Custom 27803010		365.069  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X9MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.07	SUP	Custom 27803010		365.070  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X10MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.071	SUP	Custom 27803010		365.071  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X11MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.072	SUP	Custom 27803010		365.072  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X12MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.105	SUP	Custom 27803010		365.105  -  SPACER SPNL 7D LRDTC 11MM SM 12X5MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.106	SUP	Custom 27803010		365.106  -  SPACER SPNL 7D LRDTC 11MM SM 12X6MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.107	SUP	Custom 27803010		365.107  -  SPACER SPNL 7D LRDTC 11MM SM 12X7MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.108	SUP	Custom 27803010		365.108  -  SPACER SPNL 7D LRDTC 11MM SM 12X8MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.109	SUP	Custom 27803010		365.109  -  SPACER SPNL 7D LRDTC 11MM SM 12X9MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.11	SUP	Custom 27803010		365.110  -  SPACER SPNL 7D LRDTC 11MM SM 12X10MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.111	SUP	Custom 27803010		365.111  -  SPACER SPNL 7D LRDTC 11MM SM 12X11MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.112	SUP	Custom 27803010		365.112  -  SPACER SPNL 7D LRDTC 11MM SM 12X12MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.305	SUP	Custom 27803010		365.305  -  SPACER SPNL 12MM LG PRLL 14X5MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.306	SUP	Custom 27803010		365.306  -  SPACER SPNL 12MM LG PRLL 14X6MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.307	SUP	Custom 27803010		365.307  -  SPACER SPNL 12MM LG PRLL 14X7MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.308	SUP	Custom 27803010		365.308  -  SPACER SPNL 12MM LG PRLL 14X8MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.309	SUP	Custom 27803010		365.309  -  SPACER SPNL 12MM LG PRLL 14X9MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.31	SUP	Custom 27803010		365.310  -  SPACER SPNL 12MM LG PRLL 14X10MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.311	SUP	Custom 27803010		365.311  -  SPACER SPNL 12MM LG PRLL 14X11MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.312	SUP	Custom 27803010		365.312  -  SPACER SPNL 12MM LG PRLL 14X12MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.405	SUP	Custom 27803010		365.405  -  SPACER SPNL 7D LRDTC 12MM LG 14X5MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.406	SUP	Custom 27803010		365.406  -  SPACER SPNL 7D LRDTC 12MM LG 14X6MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.407	SUP	Custom 27803010		365.407  -  SPACER SPNL 7D LRDTC 12MM LG 14X7MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.408	SUP	Custom 27803010		365.408  -  SPACER SPNL 7D LRDTC 12MM LG 14X8MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.409	SUP	Custom 27803010		365.409  -  SPACER SPNL 7D LRDTC 12MM LG 14X9MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.41	SUP	Custom 27803010		365.410  -  SPACER SPNL 7D LRDTC 12MM LG 14X10MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.411	SUP	Custom 27803010		365.411  -  SPACER SPNL 7D LRDTC 12MM LG 14X11MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.412	SUP	Custom 27803010		365.412  -  SPACER SPNL 7D LRDTC 12MM LG 14X12MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.705	SUP	Custom 27803010		365.705  -  SPACER SPNL 7D LRDTC 14MM XL 16X5MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.706	SUP	Custom 27803010		365.706  -  SPACER SPNL 7D LRDTC 14MM XL 16X6MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.707	SUP	Custom 27803010		365.707  -  SPACER SPNL 7D LRDTC 14MM XL 16X7MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.708	SUP	Custom 27803010		365.708  -  SPACER SPNL 7D LRDTC 14MM XL 16X8MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.709	SUP	Custom 27803010		365.709  -  SPACER SPNL 7D LRDTC 14MM XL 16X9MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.71	SUP	Custom 27803010		365.710  -  SPACER SPNL 7D LRDTC 14MM XL 16X10MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.711	SUP	Custom 27803010		365.711  -  SPACER SPNL 7D LRDTC 14MM XL 16X11MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.712	SUP	Custom 27803010		365.712  -  SPACER SPNL 7D LRDTC 14MM XL 16X12MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.805	SUP	Custom 27803010		365.805  -  SPACER SPNL 7D LRDTC 14MM XL 16X5MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.806	SUP	Custom 27803010		365.806  -  SPACER SPNL 7D LRDTC 14MM XL 16X6MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.807	SUP	Custom 27803010		365.807  -  SPACER SPNL 7D LRDTC 14MM XL 16X7MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.808	SUP	Custom 27803010		365.808  -  SPACER SPNL 7D LRDTC 14MM XL 16X8MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.809	SUP	Custom 27803010		365.809  -  SPACER SPNL 7D LRDTC 14MM XL 16X9MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.81	SUP	Custom 27803010		365.810  -  SPACER SPNL 7D LRDTC 14MM XL 16X10MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.811	SUP	Custom 27803010		365.811  -  SPACER SPNL 7D LRDTC 14MM XL 16X11MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
365.812	SUP	Custom 27803010		365.812  -  SPACER SPNL 7D LRDTC 14MM XL 16X12MM NS LF CLN PEEK ACDF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.207	SUP	Custom 27803010		368.207  -  SPACER SPNL SM 28X10X7MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.208	SUP	Custom 27803010		368.208  -  SPACER SPNL SM 28X10X8MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.209	SUP	Custom 27803010		368.209  -  SPACER SPNL SM 28X10X9MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.21	SUP	Custom 27803010		368.210  -  SPACER SPNL SM 28X10X10MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.211	SUP	Custom 27803010		368.211  -  SPACER SPNL SM 28X10X11MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.212	SUP	Custom 27803010		368.212  -  SPACER SPNL SM 28X10X12MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.213	SUP	Custom 27803010		368.213  -  SPACER SPNL SM 28X10X13MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.215	SUP	Custom 27803010		368.215  -  SPACER SPNL SM 28X10X15MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.217	SUP	Custom 27803010		368.217  -  SPACER SPNL SM 28X10X17MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.307	SUP	Custom 27803010		368.307  -  SPACER SPNL LG 33X11X7MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.308	SUP	Custom 27803010		368.308  -  SPACER SPNL LG 33X11X8MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.309	SUP	Custom 27803010		368.309  -  SPACER SPNL LG 33X11X9MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.31	SUP	Custom 27803010		368.310  -  SPACER SPNL LG 33X11X10MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.311	SUP	Custom 27803010		368.311  -  SPACER SPNL LG 33X11X11MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.312	SUP	Custom 27803010		368.312  -  SPACER SPNL LG 33X11X12MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.313	SUP	Custom 27803010		368.313  -  SPACER SPNL LG 33X11X13MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.315	SUP	Custom 27803010		368.315  -  SPACER SPNL LG 33X11X15MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
368.317	SUP	Custom 27803010		368.317  -  SPACER SPNL LG 33X11X17MM NS SGNTR PEEK TLIF	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.008	SUP	Custom 27803010		"375.008  -  TRANSCONTINENTAL LLIF SPACER, SMALL, 0 DEG, 8MM"	BOTH IP/OP	"$19,642.50 "	"$14,535.45"	$0.00	"$15,714.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,093.50"	$0.00	$0.00	$0.00	$0.00	"$9,821.25"	"$15,556.86"	"$15,714.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.009	SUP	Custom 27803010		375.009  -  SPACER SPNL 0D SM 45X18X9MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.011	SUP	Custom 27803010		375.011  -  SPACER SPNL 0D SM 45X18X11MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.013	SUP	Custom 27803010		375.013  -  SPACER SPNL 0D SM 45X18X13MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.015	SUP	Custom 27803010		375.015  -  SPACER SPNL 0D SM 45X18X15MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.017	SUP	Custom 27803010		375.017  -  SPACER SPNL 0D SM 45X18X17MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.019	SUP	Custom 27803010		375.019  -  SPACER SPNL 0D SM 45X18X19MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.021	SUP	Custom 27803010		375.021  -  SPACER SPNL 0D SM 45X18X21MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.109	SUP	Custom 27803010		375.109  -  SPACER SPNL 6D LRDTC SM 45X18X9MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.111	SUP	Custom 27803010		375.111  -  SPACER SPNL 6D LRDTC SM 45X18X11MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.113	SUP	Custom 27803010		375.113  -  SPACER SPNL 6D LRDTC SM 45X18X13MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.115	SUP	Custom 27803010		375.115  -  SPACER SPNL 6D LRDTC SM 45X18X15MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.117	SUP	Custom 27803010		375.117  -  SPACER SPNL 6D LRDTC SM 45X18X17MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.119	SUP	Custom 27803010		375.119  -  SPACER SPNL 6D LRDTC SM 45X18X19MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.121	SUP	Custom 27803010		375.121  -  SPACER SPNL 6D LRDTC SM 45X18X21MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.209	SUP	Custom 27803010		375.209  -  SPACER SPNL 0D MED 50X18X9MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.211	SUP	Custom 27803010		375.211  -  SPACER SPNL 0D MED 50X18X11MM NS LF TRANSCONTINENTAL PEEK	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.213	SUP	Custom 27803010		375.213  -  SPACER SPNL 0D MED 50X18X13MM NS LF TRANSCONTINENTAL PEEK	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.215	SUP	Custom 27803010		375.215  -  SPACER SPNL 0D MED 50X18X15MM NS LF TRANSCONTINENTAL PEEK	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.217	SUP	Custom 27803010		375.217  -  SPACER SPNL 0D MED 50X18X17MM NS LF TRANSCONTINENTAL PEEK	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.219	SUP	Custom 27803010		375.219  -  SPACER SPNL 0D MED 50X18X19MM NS LF TRANSCONTINENTAL PEEK	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.221	SUP	Custom 27803010		375.221  -  SPACER SPNL 0D MED 50X18X21MM NS LF TRANSCONTINENTAL PEEK	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.309	SUP	Custom 27803010		375.309  -  SPACER SPNL 6D LRDTC MED 50X18X9MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.311	SUP	Custom 27803010		375.311  -  SPACER SPNL 6D LRDTC MED 50X18X11MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.313	SUP	Custom 27803010		375.313  -  SPACER SPNL 6D LRDTC MED 50X18X13MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.315	SUP	Custom 27803010		375.315  -  SPACER SPNL 6D LRDTC MED 50X18X15MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.317	SUP	Custom 27803010		375.317  -  SPACER SPNL 6D LRDTC MED 50X18X17MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.319	SUP	Custom 27803010		375.319  -  SPACER SPNL 6D LRDTC MED 50X18X19MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.321	SUP	Custom 27803010		375.321  -  SPACER SPNL 6D LRDTC MED 50X18X21MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.409	SUP	Custom 27803010		375.409  -  SPACER SPNL 0D LG 55X18X9MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.411	SUP	Custom 27803010		375.411  -  SPACER SPNL 0D LG 55X18X11MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.413	SUP	Custom 27803010		375.413  -  SPACER SPNL 0D LG 55X18X13MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.415	SUP	Custom 27803010		375.415  -  SPACER SPNL 0D LG 55X18X15MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.417	SUP	Custom 27803010		375.417  -  SPACER SPNL 0D LG 55X18X17MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.419	SUP	Custom 27803010		375.419  -  SPACER SPNL 0D LG 55X18X19MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.421	SUP	Custom 27803010		375.421  -  SPACER SPNL 0D LG 55X18X21MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.509	SUP	Custom 27803010		375.509  -  SPACER SPNL 6D LRDTC LG 55X18X9MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.511	SUP	Custom 27803010		375.511  -  SPACER SPNL 6D LRDTC LG 55X18X11MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.513	SUP	Custom 27803010		375.513  -  SPACER SPNL 6D LRDTC LG 55X18X13MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.515	SUP	Custom 27803010		375.515  -  SPACER SPNL 6D LRDTC LG 55X18X15MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.517	SUP	Custom 27803010		375.517  -  SPACER SPNL 6D LRDTC LG 55X18X17MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.519	SUP	Custom 27803010		375.519  -  SPACER SPNL 6D LRDTC LG 55X18X19MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.521	SUP	Custom 27803010		375.521  -  SPACER SPNL 6D LRDTC LG 55X18X21MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.609	SUP	Custom 27803010		375.609  -  SPACER SPNL 0D XL 60X18X9MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.611	SUP	Custom 27803010		375.611  -  SPACER SPNL 0D XL 60X18X11MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.613	SUP	Custom 27803010		375.613  -  SPACER SPNL 0D XL 60X18X13MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.615	SUP	Custom 27803010		375.615  -  SPACER SPNL 0D XL 60X18X15MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.617	SUP	Custom 27803010		375.617  -  SPACER SPNL 0D XL 60X18X17MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.619	SUP	Custom 27803010		375.619  -  SPACER SPNL 0D XL 60X18X19MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.621	SUP	Custom 27803010		375.621  -  SPACER SPNL 0D XL 60X18X21MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.709	SUP	Custom 27803010		375.709  -  SPACER SPNL 6D LRDTC XL 60X18X9MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.711	SUP	Custom 27803010		375.711  -  SPACER SPNL 6D LRDTC XL 60X18X11MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.713	SUP	Custom 27803010		375.713  -  SPACER SPNL 6D LRDTC XL 60X18X13MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.715	SUP	Custom 27803010		375.715  -  SPACER SPNL 6D LRDTC XL 60X18X15MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.717	SUP	Custom 27803010		375.717  -  SPACER SPNL 6D LRDTC XL 60X18X17MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.719	SUP	Custom 27803010		375.719  -  SPACER SPNL 6D LRDTC XL 60X18X19MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.721	SUP	Custom 27803010		375.721  -  SPACER SPNL 6D LRDTC XL 60X18X21MM NS LF TRANSCONTINENTAL	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.809	SUP	Custom 27803010		375.809  -  SPACER SPNL 0D XS 40X18X9MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.811	SUP	Custom 27803010		375.811  -  SPACER SPNL 0D XS 40X18X11MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.813	SUP	Custom 27803010		375.813  -  SPACER SPNL 0D XS 40X18X13MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.815	SUP	Custom 27803010		375.815  -  SPACER SPNL 0D XS 40X18X15MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375.817	SUP	Custom 27803010		375.817  -  SPACER SPNL 0D XS 40X18X17MM NS LF TRANSCONTINENTAL PEEK LAT	BOTH IP/OP	"$21,065.00 "	"$15,588.10"	$0.00	"$16,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,389.95"	$0.00	$0.00	$0.00	$0.00	"$10,532.50"	"$16,683.48"	"$16,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.111	SUP	Custom 27803010		"376.111  -  INDEPENDENCE SPACER, SMALL, 8&DEG, 11MM"	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.113	SUP	Custom 27803010		376.113  -  SPACER SPNL 8D LRDTC 24MM SM 30X13MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.115	SUP	Custom 27803010		376.115  -  SPACER SPNL 8D LRDTC 24MM SM 30X15MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.117	SUP	Custom 27803010		376.117  -  SPACER SPNL 8D LRDTC 24MM SM 30X17MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.211	SUP	Custom 27803010		376.211  -  SPACER SPNL 15D LRDTC 24MM SM 30X11MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.213	SUP	Custom 27803010		376.213  -  SPACER SPNL 15D LRDTC 24MM SM 30X13MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.215	SUP	Custom 27803010		376.215  -  SPACER SPNL 15D LRDTC 24MM SM 30X15MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.217	SUP	Custom 27803010		376.217  -  SPACER SPNL 15D LRDTC 24MM SM 30X17MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.411	SUP	Custom 27803010		"376.411  -  INDEPENDENCE SPACER, MEDIUM, 8&DEG, 11MM"	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.413	SUP	Custom 27803010		376.413  -  SPACER SPNL 8D LRDTC 26MM MED 34X13MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.415	SUP	Custom 27803010		"376.415  -  INDEPENDENCE SPACER, MEDIUM, 8&DEG, 15MM"	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.417	SUP	Custom 27803010		376.417  -  SPACER SPNL 8D LRDTC 26MM MED 34X17MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.419	SUP	Custom 27803010		376.419  -  SPACER SPNL 8D LRDTC 26MM MED 34X19MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.421	SUP	Custom 27803010		376.421  -  SPACER SPNL 8D LRDTC 26MM MED 34X21MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.511	SUP	Custom 27803010		376.511  -  SPACER SPNL 15D LRDTC 26MM MED 24X11MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.513	SUP	Custom 27803010		376.513  -  SPACER SPNL 15D LRDTC 26MM MED 34X13MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.515	SUP	Custom 27803010		376.515  -  SPACER SPNL 15D LRDTC 26MM MED 34X15MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.517	SUP	Custom 27803010		376.517  -  SPACER SPNL 15D LRDTC 26MM MED 34X17MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.519	SUP	Custom 27803010		376.519  -  SPACER SPNL 15D LRDTC 26MM MED 34X19MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.521	SUP	Custom 27803010		376.521  -  SPACER SPNL 15D LRDTC 26MM MED 34X21MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.711	SUP	Custom 27803010		376.711  -  SPACER SPNL 8D LRDTC 29MM LG 39X11MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.713	SUP	Custom 27803010		376.713  -  SPACER SPNL 8D LRDTC 29MM LG 39X13MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.715	SUP	Custom 27803010		376.715  -  SPACER SPNL 8D LRDTC 29MM LG 39X15MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.717	SUP	Custom 27803010		376.717  -  SPACER SPNL 8D LRDTC 29MM LG 39X17MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.719	SUP	Custom 27803010		376.719  -  SPACER SPNL 8D LRDTC 29MM LG 39X19MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.721	SUP	Custom 27803010		376.721  -  SPACER SPNL 8D LRDTC 29MM LG 39X21MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.813	SUP	Custom 27803010		376.813  -  SPACER SPNL 15D LRDTC 29MM LG 39X13MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.815	SUP	Custom 27803010		"376.815  -  INDEPENDENCE SPACER, LARGE, 15&DEG, 15MM"	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.817	SUP	Custom 27803010		376.817  -  SPACER SPNL 15D LRDTC 29MM LG 39X17MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.819	SUP	Custom 27803010		376.819  -  SPACER SPNL 15D LRDTC 29MM LG 39X19MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
376.821	SUP	Custom 27803010		376.821  -  SPACER SPNL 15D LRDTC 29MM LG 39X21MM NS LF INDPD PLT PEEK	BOTH IP/OP	"$25,250.00 "	"$18,685.00"	$0.00	"$20,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,262.10"	$0.00	$0.00	$0.00	$0.00	"$12,625.00"	"$19,998.00"	"$20,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.006	SUP	Custom 27803010		384.006  -  SPACER SPNL 0D 12MM 14X6MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.007	SUP	Custom 27803010		384.007  -  SPACER SPNL 0D 12MM 14X7MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.008	SUP	Custom 27803010		384.008  -  SPACER SPNL 0D 12MM 14X8MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.009	SUP	Custom 27803010		384.009  -  SPACER SPNL 0D 12MM 14X9MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.01	SUP	Custom 27803010		384.010  -  SPACER SPNL 0D 12MM 14X10MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.011	SUP	Custom 27803010		384.011  -  SPACER SPNL 0D 12MM 14X11MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.012	SUP	Custom 27803010		384.012  -  SPACER SPNL 0D 12MM 14X12MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.106	SUP	Custom 27803010		384.106  -  SPACER SPNL 7D LRDTC 12MM 14X6MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.107	SUP	Custom 27803010		384.107  -  SPACER SPNL 7D LRDTC 12MM 14X7MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.108	SUP	Custom 27803010		384.108  -  SPACER SPNL 7D LRDTC 12MM 14X8MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.109	SUP	Custom 27803010		384.109  -  SPACER SPNL 7D LRDTC 12MM 14X9MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.11	SUP	Custom 27803010		384.110  -  SPACER SPNL 7D LRDTC 12MM 14X10MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.111	SUP	Custom 27803010		384.111  -  SPACER SPNL 7D LRDTC 12MM 14X11MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.112	SUP	Custom 27803010		384.112  -  SPACER SPNL 7D LRDTC 12MM 14X12MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.206	SUP	Custom 27803010		384.206  -  SPACER SPNL 0D 14MM 16X6MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.207	SUP	Custom 27803010		384.207  -  SPACER SPNL 0D 14MM 16X7MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.208	SUP	Custom 27803010		384.208  -  SPACER SPNL 0D 14MM 16X8MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.209	SUP	Custom 27803010		384.209  -  SPACER SPNL 0D 14MM 16X9MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.21	SUP	Custom 27803010		384.210  -  SPACER SPNL 0D 14MM 16X10MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.211	SUP	Custom 27803010		384.211  -  SPACER SPNL 0D 14MM 16X14MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.212	SUP	Custom 27803010		384.212  -  SPACER SPNL 0D 14MM 16X12MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.306	SUP	Custom 27803010		384.306  -  SPACER SPNL 7D LRDTC 14MM 16X6MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.307	SUP	Custom 27803010		384.307  -  SPACER SPNL 7D LRDTC 14MM 16X7MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.308	SUP	Custom 27803010		384.308  -  SPACER SPNL 7D LRDTC 14MM 16X8MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.309	SUP	Custom 27803010		384.309  -  SPACER SPNL 7D LRDTC 14MM 16X9MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.31	SUP	Custom 27803010		384.310  -  SPACER SPNL 7D LRDTC 14MM 16X10MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.311	SUP	Custom 27803010		384.311  -  SPACER SPNL 7D LRDTC 14MM 16X11MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.312	SUP	Custom 27803010		384.312  -  SPACER SPNL 7D LRDTC 14MM 16X12MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.406	SUP	Custom 27803010		384.406  -  SPACER SPNL 0D 15MM 18X6MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.407	SUP	Custom 27803010		384.407  -  SPACER SPNL 0D 15MM 18X7MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.408	SUP	Custom 27803010		384.408  -  SPACER SPNL 0D 15MM 18X8MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.409	SUP	Custom 27803010		384.409  -  SPACER SPNL 0D 15MM 18X9MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.41	SUP	Custom 27803010		384.410  -  SPACER SPNL 0D 15MM 18X10MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.411	SUP	Custom 27803010		384.411  -  SPACER SPNL 0D 15MM 18X11MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.412	SUP	Custom 27803010		384.412  -  SPACER SPNL 0D 15MM 18X12MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.506	SUP	Custom 27803010		384.506  -  SPACER SPNL 7D LRDTC 15MM 18X6MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.507	SUP	Custom 27803010		384.507  -  SPACER SPNL 7D LRDTC 15MM 18X7MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.508	SUP	Custom 27803010		384.508  -  SPACER SPNL 7D LRDTC 15MM 18X8MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.509	SUP	Custom 27803010		384.509  -  SPACER SPNL 7D LRDTC 15MM 18X9MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.51	SUP	Custom 27803010		384.510  -  SPACER SPNL 7D LRDTC 15MM 18X10MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.511	SUP	Custom 27803010		384.511  -  SPACER SPNL 7D LRDTC 15MM 18X11MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384.512	SUP	Custom 27803010		384.512  -  SPACER SPNL 7D LRDTC 15MM 18X12MM NS LF COALITION PEEK ACDF	BOTH IP/OP	"$12,052.50 "	"$8,918.85"	$0.00	"$9,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,511.74"	$0.00	$0.00	$0.00	$0.00	"$6,026.25"	"$9,545.58"	"$9,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
387.21	SUP	Custom 27203010		387.21  -  BIT DRILL THORPE	BOTH IP/OP	$375.75 	$278.06	$0.00	$300.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.88	$278.88	$0.00	$0.00	$78.31	$0.00	$0.00	$0.00	$0.00	$187.88	$297.59	$300.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
387.604	SUP	Custom 27203010		387.604  -  BIT DRILL 3MM QC STOP	BOTH IP/OP	$444.50 	$328.93	$0.00	$355.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$329.91	$329.91	$0.00	$0.00	$92.63	$0.00	$0.00	$0.00	$0.00	$222.25	$352.04	$355.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
388.174	SUP	Custom 27203010		388.174  -  BIT DRILL 91MM 1.5MM STOP 4-12MM NONSTRL	BOTH IP/OP	$224.00 	$165.76	$0.00	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.25	$166.25	$0.00	$0.00	$46.68	$0.00	$0.00	$0.00	$0.00	$112.00	$177.41	$179.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
388.175	SUP	Custom 27203010		388.175  -  BIT DRILL 91MM STOP ARCH 1.5MM NONSTRL QUICK COUPLING	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$0.00	$0.00	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
388.177	SUP	Custom 27203010		388.177  -  BIT DRILL 91MM 10MM STOP 1.5MM NONSTRL	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$0.00	$0.00	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
388.178	SUP	Custom 27203010		388.178  -  BIT DRILL 91MM 1.5MM 12MM STOP GUIDE NONSTRL	BOTH IP/OP	$224.00 	$165.76	$0.00	$179.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.25	$166.25	$0.00	$0.00	$46.68	$0.00	$0.00	$0.00	$0.00	$112.00	$177.41	$179.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
388.394	SUP	Custom 27203010		388.394  -  BIT DRL 65MM 2.4MM NS QC STP	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
388.868	SUP	HCPCS C1713		388.868  -  TRIAL SPNL 3.5MM ROD	BOTH IP/OP	$470.00 	$347.80	$0.00	$376.00	$211.50	$211.50	$0.00	$0.00	$0.00	$97.96	$348.83	$348.83	$0.00	$0.00	$97.95	$0.00	$278.01	$278.01	$0.00	$235.00	$372.24	$376.00	$0.00		$0.00	$73.56	$0.00	$0.00	$74.82	$0.00	$0.00	$0.00	$0.00	$0.00
388.906	SUP	HCPCS C1713		388.906  -  TEMPLATE ROD 150MM NS COAT 5.5MM ROD	BOTH IP/OP	$447.50 	$331.15	$0.00	$358.00	$201.38	$201.38	$0.00	$0.00	$0.00	$93.27	$332.13	$332.13	$0.00	$0.00	$93.26	$0.00	$264.70	$264.70	$0.00	$223.75	$354.42	$358.00	$0.00		$0.00	$70.03	$0.00	$0.00	$71.24	$0.00	$0.00	$0.00	$0.00	$0.00
388.907	SUP	Custom 27203010		388.907  -  TEMPLATE ROD 500MM NS COAT 5/5.5MM ROD	BOTH IP/OP	$740.00 	$547.60	$0.00	$592.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.23	$549.23	$0.00	$0.00	$154.22	$0.00	$0.00	$0.00	$0.00	$370.00	$586.08	$592.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.002	SUP	Custom 27203010		390.002  -  CLAMP EXFIX LARGE 6 POSITION MULTIPIN MR CONDITIONAL NONSTRL	BOTH IP/OP	"$1,205.30 "	$891.92	$0.00	$936.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$894.57	$894.57	$0.00	$0.00	$251.18	$0.00	$0.00	$0.00	$0.00	$585.09	$926.78	$936.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.003	SUP	HCPCS C1713		390.003  -  ROD EXFIX ATTCH NONSTRL LARGE MULTIPIN CLMP	BOTH IP/OP	$675.05 	$499.54	$0.00	$524.32	$294.93	$294.93	$0.00	$0.00	$0.00	$140.70	$501.02	$501.02	$0.00	$0.00	$140.68	$0.00	$399.29	$399.29	$0.00	$327.70	$519.08	$524.32	$0.00		$0.00	$99.58	$0.00	$0.00	$104.34	$0.00	$0.00	$0.00	$0.00	$0.00
390.004	SUP	Custom 27203010		390.004  -  CLAMP EXFIX LARGE 4 POSITION MULTIPIN MR CONDITIONAL NONSTRL	BOTH IP/OP	"$1,128.43 "	$835.04	$0.00	$876.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$837.52	$837.52	$0.00	$0.00	$235.16	$0.00	$0.00	$0.00	$0.00	$547.78	$867.68	$876.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.005	SUP	Custom 27203010		390.005  -  CLAMP EXFIX LARGE COMBO NONSTRL	BOTH IP/OP	"$1,053.80 "	$779.81	$0.00	$818.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$782.13	$782.13	$0.00	$0.00	$219.61	$0.00	$0.00	$0.00	$0.00	$511.55	$810.30	$818.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.006	SUP	Custom 27203010		390.006  -  CLIP XTRNFX NS DYN MR CONDITIONAL LG CMBN CLP	BOTH IP/OP	$167.10 	$123.65	$0.00	$129.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.02	$124.02	$0.00	$0.00	$34.82	$0.00	$0.00	$0.00	$0.00	$81.11	$128.49	$129.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.007	SUP	Custom 27203010		390.007  -  CLAMP EXFIX TUBE TO TUBE MR CONDITIONAL NONSTRL	BOTH IP/OP	"$1,088.33 "	$805.36	$0.00	$845.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$807.75	$807.75	$0.00	$0.00	$226.81	$0.00	$0.00	$0.00	$0.00	$528.31	$836.85	$845.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.008	SUP	Custom 27203010		390.008  -  CLAMP EXFIX LARGE OPEN ADJUSTABLE NONSTRL	BOTH IP/OP	$873.33 	$646.26	$0.00	$678.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$648.18	$648.18	$0.00	$0.00	$182.00	$0.00	$0.00	$0.00	$0.00	$423.95	$671.54	$678.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.009	SUP	Custom 27203010		390.009  -  CLAMP EXFIX LARGE 4 POSITION PIN NONSTRL LARGE EXFIX	BOTH IP/OP	$729.63 	$539.93	$0.00	$566.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.53	$541.53	$0.00	$0.00	$152.05	$0.00	$0.00	$0.00	$0.00	$354.19	$561.04	$566.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.01	SUP	Custom 27203010		390.010  -  CLAMP EXFIX LARGE 6 POSITION PIN NONSTRL	BOTH IP/OP	$727.85 	$538.61	$0.00	$582.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$540.21	$540.21	$0.00	$0.00	$151.68	$0.00	$0.00	$0.00	$0.00	$363.93	$576.46	$582.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.011	SUP	Custom 27203010		390.011  -  POST EXFIX STR 11MM OUTRIGGER NONSTRL	BOTH IP/OP	$197.18 	$145.91	$0.00	$153.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.34	$146.34	$0.00	$0.00	$41.09	$0.00	$0.00	$0.00	$0.00	$95.71	$151.61	$153.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.012	SUP	Custom 27203010		390.012  -  POST EXFIX 30D 11MM OUTRIGGER MR SAFE NONSTRL	BOTH IP/OP	$197.18 	$145.91	$0.00	$153.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.34	$146.34	$0.00	$0.00	$41.09	$0.00	$0.00	$0.00	$0.00	$95.71	$151.61	$153.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.013	SUP	Custom 27203010		390.013  -  POST EXFIX 90D 11MM OUTRIGGER NONSTRL	BOTH IP/OP	$217.23 	$160.75	$0.00	$168.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.22	$161.22	$0.00	$0.00	$45.27	$0.00	$0.00	$0.00	$0.00	$105.45	$167.03	$168.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.026	SUP	Custom 27203010		390.026  -  CLAMP EXFIX MEDIUM 4 POSISTION PIN MR SAFE NONSTRL	BOTH IP/OP	$689.53 	$510.25	$0.00	$535.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$511.77	$511.77	$0.00	$0.00	$143.70	$0.00	$0.00	$0.00	$0.00	$334.73	$530.20	$535.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.027	SUP	Custom 27203010		390.027  -  CLAMP EXFIX MEDIUM 6 POSISTION PIN MR SAFE NONSTRL	BOTH IP/OP	$707.35 	$523.44	$0.00	$549.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.00	$525.00	$0.00	$0.00	$147.41	$0.00	$0.00	$0.00	$0.00	$343.38	$543.91	$549.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.028	SUP	Custom 27203010		390.028  -  POST XTRNFX STRG 8MM NS OTRGR MR CONDITIONAL	BOTH IP/OP	$187.15 	$138.49	$0.00	$145.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.90	$138.90	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$90.85	$143.91	$145.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.029	SUP	Custom 27203010		390.029  -  POST XTRNFX 30D 8MM NS OTRGR MR CONDITIONAL	BOTH IP/OP	$187.15 	$138.49	$0.00	$145.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.90	$138.90	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$90.85	$143.91	$145.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.03	SUP	Custom 27203010		390.030  -  POST XTRNFX 90D 8MM NS OTRGR MR CONDITIONAL	BOTH IP/OP	$199.00 	$147.26	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.70	$147.70	$0.00	$0.00	$41.47	$0.00	$0.00	$0.00	$0.00	$99.50	$157.61	$159.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.031	SUP	Custom 27203010		390.031  -  CLAMP EXFIX MEDIUM COMBO SELF HOLDING CLIP ON NONSTRL	BOTH IP/OP	$857.75 	$634.74	$0.00	$666.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$636.62	$636.62	$0.00	$0.00	$178.76	$0.00	$0.00	$0.00	$0.00	$416.38	$659.54	$666.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.032	SUP	Custom 27203010		390.032  -  CLIP XTRNFX NS DYN MR CONDITIONAL MED CMBN CLP	BOTH IP/OP	$186.03 	$137.66	$0.00	$144.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.07	$138.07	$0.00	$0.00	$38.77	$0.00	$0.00	$0.00	$0.00	$90.30	$143.04	$144.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.033	SUP	Custom 27203010		390.033  -  CLAMP EXFIX MEDIUM 4 POSISTION MULTIPIN MR SAFE NONSTRL	BOTH IP/OP	"$1,038.20 "	$768.27	$0.00	$806.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$770.55	$770.55	$0.00	$0.00	$216.36	$0.00	$0.00	$0.00	$0.00	$503.98	$798.30	$806.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.034	SUP	Custom 27203010		390.034  -  CLAMP EXFIX MEDIUM MULTIPIN ROD ATTCH MRI SAFE NONSTRL	BOTH IP/OP	$595.95 	$441.00	$0.00	$462.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$442.31	$442.31	$0.00	$0.00	$124.20	$0.00	$0.00	$0.00	$0.00	$289.30	$458.25	$462.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.035	SUP	Custom 27203010		390.035  -  CLAMP EXFIX MEDIUM OPEN ADJUSTABLE NONSTRL	BOTH IP/OP	$707.35 	$523.44	$0.00	$549.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.00	$525.00	$0.00	$0.00	$147.41	$0.00	$0.00	$0.00	$0.00	$343.38	$543.91	$549.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.036	SUP	Custom 27203010		390.036  -  CLAMP EXFIX MEDIUM 6 POSISTION MULTIPIN MR SAFE NONSTRL	BOTH IP/OP	"$1,129.55 "	$835.87	$0.00	$877.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$838.35	$838.35	$0.00	$0.00	$235.40	$0.00	$0.00	$0.00	$0.00	$548.33	$868.55	$877.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.037	SUP	Custom 27203010		390.037  -  CLAMP EXFIX MEDIUM 8-11MM COMBO MR SAFE NONSTRL	BOTH IP/OP	$986.95 	$730.34	$0.00	$766.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.51	$732.51	$0.00	$0.00	$205.68	$0.00	$0.00	$0.00	$0.00	$479.10	$758.89	$766.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.041	SUP	Custom 27203010		390.041  -  CLAMP EXFIX SMALL COMBO NONSTRL	BOTH IP/OP	$553.63 	$409.69	$0.00	$430.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.90	$410.90	$0.00	$0.00	$115.38	$0.00	$0.00	$0.00	$0.00	$268.75	$425.70	$430.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.042	SUP	Custom 27203010		390.042  -  CLAMP EXFIX SM ADJ NONSPANNING MRI SAFE SM EXFIX NONSTRL	BOTH IP/OP	$955.33 	$706.94	$0.00	$764.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$709.04	$709.04	$0.00	$0.00	$199.09	$0.00	$0.00	$0.00	$0.00	$477.66	$756.62	$764.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.101	SUP	Custom 27203010		BASKET SPEC RTRVL 120CM 2.4FR 12MM STON 4WR SHTH 0TP NTNL	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.50	$392.04	$396.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.12	SUP	HCPCS C1713		390.120  -  PIN POSITIONING 40MM TITANIUM CRANIAL NONSTRL EXTERNAL	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$175.50	$175.50	$0.00	$0.00	$0.00	$81.29	$289.46	$289.46	$0.00	$0.00	$81.28	$0.00	$230.69	$230.69	$0.00	$195.00	$308.88	$312.00	$0.00		$0.00	$61.04	$0.00	$0.00	$62.09	$0.00	$0.00	$0.00	$0.00	$0.00
390.122	SUP	Custom 27203010		390.122  -  HOLDER IMPLANT 40MM MOUNT PIN TITANIUM CRANIAL NONSTRL	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.124	SUP	Custom 27803010		390.124  -  PIN FIX 50MM MOUNT MIDFAC NONSTRL EXTERNAL MIDFAC DISTRCT	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.126	SUP	Custom 27203010		390.126  -  HOLDER IMPLANT 40MM MOUNT PIN TITANIUM MIDFAC	BOTH IP/OP	$677.50 	$501.35	$0.00	$542.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.84	$502.84	$0.00	$0.00	$141.19	$0.00	$0.00	$0.00	$0.00	$338.75	$536.58	$542.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390.128	SUP	Custom 27203010		390.128  -  PIN SKULL 50MM SLFDRILL CRANIUM NONSTRL	BOTH IP/OP	$677.50 	$501.35	$0.00	$542.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.84	$502.84	$0.00	$0.00	$141.19	$0.00	$0.00	$0.00	$0.00	$338.75	$536.58	$542.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
392.177	SUP	Custom 27203010		392.177  -  CAP PROTECTIVE CLEAR NONSTRL 1MM 1.25MM K WIRES	BOTH IP/OP	$4.82 	$3.57	$0.00	$3.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.58	$3.58	$0.00	$0.00	$1.00	$0.00	$0.00	$0.00	$0.00	$2.34	$3.71	$3.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
392.178	SUP	Custom 27203010		392.178  -  CAP PROTECTIVE NONSTRL 1.6 MM KWIRE WIRE	BOTH IP/OP	$4.82 	$3.57	$0.00	$3.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.58	$3.58	$0.00	$0.00	$1.00	$0.00	$0.00	$0.00	$0.00	$2.34	$3.71	$3.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
392.179	SUP	Custom 27203010		392.179  -  CAP PROTECTIVE NONSTRL 2 MM KWIRE WIRE	BOTH IP/OP	$4.54 	$3.36	$0.00	$3.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.37	$3.37	$0.00	$0.00	$0.95	$0.00	$0.00	$0.00	$0.00	$2.27	$3.60	$3.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
392.18	SUP	Custom 27203010		392.18  -  CAP PROTECTIVE NONSTRL 1.8-2 MM KWIRE WIRE	BOTH IP/OP	$3.93 	$2.91	$0.00	$3.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.91	$2.91	$0.00	$0.00	$0.82	$0.00	$0.00	$0.00	$0.00	$1.91	$3.02	$3.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
392.24	SUP	Custom 27203010		392.24  -  CAP PROTECTIVE NONSTRL 2.5 MM KWIRE WIRE	BOTH IP/OP	$4.82 	$3.57	$0.00	$3.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.58	$3.58	$0.00	$0.00	$1.00	$0.00	$0.00	$0.00	$0.00	$2.34	$3.71	$3.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
392.961	SUP	HCPCS C1713		392.961  -  FIXATOR XTRNFX LG ADJ RADL DIST	BOTH IP/OP	"$6,189.08 "	"$4,579.92"	$0.00	"$4,807.06"	"$2,703.97"	"$2,703.97"	$0.00	$0.00	$0.00	"$1,289.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,289.80"	$0.00	"$3,051.21"	"$3,051.21"	$0.00	"$3,004.41"	"$4,758.99"	"$4,807.06"	$0.00		$0.00	$912.99	$0.00	$0.00	$956.60	$0.00	$0.00	$0.00	$0.00	$0.00
393.43	SUP	Custom 27203010		393.43  -  NUT XTRNFX NS RING TO ROD SPRG LD LG XTRNFXTR	BOTH IP/OP	$75.75 	$56.06	$0.00	$58.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.22	$56.22	$0.00	$0.00	$15.79	$0.00	$0.00	$0.00	$0.00	$36.78	$58.25	$58.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.436	SUP	Custom 27203010		393.436  -  CLAMP EXFIX RING TO ROD NONSTRL HYBRID EXFIX	BOTH IP/OP	"$1,444.78 "	"$1,069.14"	$0.00	"$1,122.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,072.31"	"$1,072.31"	$0.00	$0.00	$301.09	$0.00	$0.00	$0.00	$0.00	$701.35	"$1,110.94"	"$1,122.16"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.464	SUP	Custom 27203010		393.464  -  CLAMP EXFIX ADJUSTABLE WIRE PIN NONSTRL HYBRID EXFIX	BOTH IP/OP	"$1,289.95 "	$954.56	$0.00	"$1,001.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$957.40	$957.40	$0.00	$0.00	$268.83	$0.00	$0.00	$0.00	$0.00	$626.19	$991.88	"$1,001.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.64	SUP	Custom 27203010		393.64  -  CLAMP EXFIX ADJUSTABLE NONSTRL 4/6 MM SCHANZ SCREW LARGE	BOTH IP/OP	$650.55 	$481.41	$0.00	$505.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.84	$482.84	$0.00	$0.00	$135.57	$0.00	$0.00	$0.00	$0.00	$315.80	$500.23	$505.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.66	SUP	Custom 27203010		393.66  -  CLAMP EXFIX TRNSVRS NONSTRL 4-6 MM SCHANZ SCREW LARGE EXFIX	BOTH IP/OP	"$1,088.33 "	$805.36	$0.00	$845.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$807.75	$807.75	$0.00	$0.00	$226.81	$0.00	$0.00	$0.00	$0.00	$528.31	$836.85	$845.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.69	SUP	Custom 27203010		393.69  -  CLAMP EXFIX OPEN NONSTRL PIN INSERTION CONNECT	BOTH IP/OP	$387.65 	$286.86	$0.00	$301.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.71	$287.71	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$188.18	$298.07	$301.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.721	SUP	Custom 27203010		393.721  -  RING EXFIX FULL 205MM FULL RING NONSTRL HYBRID FIXATOR	BOTH IP/OP	$969.13 	$717.16	$0.00	$752.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$719.28	$719.28	$0.00	$0.00	$201.97	$0.00	$0.00	$0.00	$0.00	$470.45	$745.19	$752.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.722	SUP	Custom 27203010		393.722  -  RING EXFIX .75 205MM .75 RING NONSTRL HYBRID FIXATOR	BOTH IP/OP	$894.50 	$661.93	$0.00	$694.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$663.90	$663.90	$0.00	$0.00	$186.41	$0.00	$0.00	$0.00	$0.00	$434.23	$687.81	$694.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.731	SUP	Custom 27203010		393.731  -  RING EXFIX FULL 115MM FULL RING NONSTRL HYBRID FIXATOR	BOTH IP/OP	$732.98 	$542.41	$0.00	$569.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$544.01	$544.01	$0.00	$0.00	$152.75	$0.00	$0.00	$0.00	$0.00	$355.81	$563.61	$569.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.732	SUP	Custom 27203010		393.732  -  RING EXFIX .75 115MM .75 RING NONSTRL HYBRID FIXATOR	BOTH IP/OP	$658.35 	$487.18	$0.00	$511.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$488.63	$488.63	$0.00	$0.00	$137.20	$0.00	$0.00	$0.00	$0.00	$319.59	$506.23	$511.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.734	SUP	Custom 27203010		393.734  -  RING EXFIX .75 140MM NONSTRL HYBRID FIXATOR	BOTH IP/OP	$719.60 	$532.50	$0.00	$558.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$534.09	$534.09	$0.00	$0.00	$149.96	$0.00	$0.00	$0.00	$0.00	$349.33	$553.33	$558.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.735	SUP	Custom 27203010		393.735  -  RING EXFIX FULL 165MM FULL RING NONSTRL HYBRID FIXATOR	BOTH IP/OP	$831.00 	$614.94	$0.00	$645.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$616.77	$616.77	$0.00	$0.00	$173.18	$0.00	$0.00	$0.00	$0.00	$403.40	$638.99	$645.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.736	SUP	Custom 27203010		393.736  -  RING EXFIX .75 165MM .75 RING NONSTRL HYBRID FIXATOR	BOTH IP/OP	$755.25 	$558.89	$0.00	$586.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$560.55	$560.55	$0.00	$0.00	$157.39	$0.00	$0.00	$0.00	$0.00	$366.63	$580.73	$586.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.737	SUP	Custom 27203010		393.737  -  RING EXFIX .25 165MM .25 RING NONSTRL HYBRID FIXATOR	BOTH IP/OP	$607.10 	$449.25	$0.00	$471.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$450.59	$450.59	$0.00	$0.00	$126.52	$0.00	$0.00	$0.00	$0.00	$294.71	$466.83	$471.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
393.75	SUP	Custom 27203010		393.75  -  CLAMP EXFIX LARGE UNIVERSAL ADJUSTABLE NONSTRL LARGE EXFIX	BOTH IP/OP	"$1,033.93 "	$765.11	$0.00	$827.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$767.38	$767.38	$0.00	$0.00	$215.47	$0.00	$0.00	$0.00	$0.00	$516.96	$818.87	$827.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.05	SUP	Custom 27203010		394.050  -  FIXATOR XTRNFX NS ADJ RADL DIST	BOTH IP/OP	"$2,949.25 "	"$2,182.45"	$0.00	"$2,359.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,188.93"	"$2,188.93"	$0.00	$0.00	$614.62	$0.00	$0.00	$0.00	$0.00	"$1,474.63"	"$2,335.81"	"$2,359.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.055	SUP	Custom 27203010		394.055  -  FIXATOR XTRNFX HNG ELB UNSTBL FX	BOTH IP/OP	"$2,315.90 "	"$1,713.77"	$0.00	"$1,798.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.86"	"$1,718.86"	$0.00	$0.00	$482.63	$0.00	$0.00	$0.00	$0.00	"$1,124.23"	"$1,780.77"	"$1,798.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.46	SUP	Custom 27203010		394.46  -  SLEEVE DISTRCT 105MM HOLD	BOTH IP/OP	$517.98 	$383.31	$0.00	$402.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$384.44	$384.44	$0.00	$0.00	$107.95	$0.00	$0.00	$0.00	$0.00	$251.45	$398.30	$402.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.79	SUP	Custom 27203010		394.79  -  ROD EXFIX 180D CURVE 11MM 850MM CARFBR NONSTRL LARGE EXFIX	BOTH IP/OP	"$1,230.90 "	$910.87	$0.00	$956.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$913.57	$913.57	$0.00	$0.00	$256.52	$0.00	$0.00	$0.00	$0.00	$597.53	$946.48	$956.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.791	SUP	Custom 27203010		394.791  -  ROD EXFIX 45D 11MM 207MM CVD SPAN ANGLED CARFBR NONSTRL	BOTH IP/OP	$950.20 	$703.15	$0.00	$738.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$705.24	$705.24	$0.00	$0.00	$198.02	$0.00	$0.00	$0.00	$0.00	$461.26	$730.64	$738.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.792	SUP	Custom 27203010		394.792  -  ROD EXFIX 90D 11MM 382MM CVD SPAN ANGLED CARFBR NONSTRL	BOTH IP/OP	"$1,044.88 "	$773.21	$0.00	$811.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$775.51	$775.51	$0.00	$0.00	$217.75	$0.00	$0.00	$0.00	$0.00	$507.23	$803.44	$811.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.793	SUP	Custom 27203010		394.793  -  ROD EXFIX 135D 11MM 499MM CVD SPAN ANGLED CARFBR NONSTRL	BOTH IP/OP	"$1,140.68 "	$844.10	$0.00	$885.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$846.61	$846.61	$0.00	$0.00	$237.72	$0.00	$0.00	$0.00	$0.00	$553.73	$877.10	$885.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.8	SUP	Custom 27203010		394.80  -  ROD EXFIX 100MM 11MM SM CARFBR LG EXFIX	BOTH IP/OP	$360.93 	$267.09	$0.00	$267.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$267.88	$267.88	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$159.65	$252.89	$255.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.81	SUP	Custom 27203010		394.81  -  ROD EXFIX 11MM 125MM MR CONDITIONAL CARFBR NONSTRL	BOTH IP/OP	$360.93 	$267.09	$0.00	$280.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$267.88	$267.88	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$175.20	$277.52	$280.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.82	SUP	Custom 27203010		394.82  -  ROD EXFIX 11MM 150MM RADIOLUCENT MR CONDITIONAL CARFBR	BOTH IP/OP	$360.93 	$267.09	$0.00	$280.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$267.88	$267.88	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$175.20	$277.52	$280.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.83	SUP	Custom 27203010		394.83  -  ROD EXFIX 11MM 200MM RADIOLUCENT MR CONDITIONAL CARFBR	BOTH IP/OP	$360.93 	$267.09	$0.00	$280.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$267.88	$267.88	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$175.20	$277.52	$280.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.84	SUP	Custom 27203010		394.84  -  ROD EXFIX 11MM 250MM CARFBR NONSTRL	BOTH IP/OP	$387.65 	$286.86	$0.00	$301.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.71	$287.71	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$188.18	$298.07	$301.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.85	SUP	Custom 27203010		394.85  -  ROD EXFIX 11MM 300MM MR CONDITIONAL CARFBR NONSTRL	BOTH IP/OP	$387.65 	$286.86	$0.00	$301.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.71	$287.71	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$188.18	$298.07	$301.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.86	SUP	Custom 27203010		394.86  -  ROD EXFIX 11MM 350MM RADIOLUCENT MR CONDITIONAL CARFBR	BOTH IP/OP	$387.65 	$286.86	$0.00	$301.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.71	$287.71	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$188.18	$298.07	$301.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.87	SUP	Custom 27203010		394.87  -  ROD EXFIX 11MM 400MM MR CONDITIONAL CARFBR NONSTRL	BOTH IP/OP	$425.53 	$314.89	$0.00	$330.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.82	$315.82	$0.00	$0.00	$88.68	$0.00	$0.00	$0.00	$0.00	$206.56	$327.20	$330.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.88	SUP	Custom 27203010		394.88  -  ROD EXFIX 11MM 450MM MR CONDITIONAL CARFBR NONSTRL	BOTH IP/OP	$425.53 	$314.89	$0.00	$330.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.82	$315.82	$0.00	$0.00	$88.68	$0.00	$0.00	$0.00	$0.00	$206.56	$327.20	$330.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.89	SUP	Custom 27203010		394.89  -  ROD EXFIX 11MM 500MM CARFBR NONSTRL LARGE EXFIX	BOTH IP/OP	$425.53 	$314.89	$0.00	$330.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.82	$315.82	$0.00	$0.00	$88.68	$0.00	$0.00	$0.00	$0.00	$206.56	$327.20	$330.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.9	SUP	Custom 27203010		394.90  -  ROD EXFIX 11MM 550MM RADIOLUCENT CARFBR NONSTRL	BOTH IP/OP	$446.65 	$330.52	$0.00	$357.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.50	$331.50	$0.00	$0.00	$93.08	$0.00	$0.00	$0.00	$0.00	$223.33	$353.75	$357.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.91	SUP	Custom 27203010		394.91  -  ROD EXFIX 11MM 600MM CARFBR NONSTRL LARGE EXFIX	BOTH IP/OP	$460.05 	$340.44	$0.00	$357.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.45	$341.45	$0.00	$0.00	$95.87	$0.00	$0.00	$0.00	$0.00	$223.33	$353.75	$357.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.92	SUP	Custom 27203010		394.92  -  ROD EXFIX 11MM 650MM CARFBR NONSTRL LARGE EXFIX	BOTH IP/OP	$460.05 	$340.44	$0.00	$357.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.45	$341.45	$0.00	$0.00	$95.87	$0.00	$0.00	$0.00	$0.00	$223.33	$353.75	$357.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.97	SUP	Custom 27203010		394.97  -  CAP PROTECTIVE NONSTRL 11 MM CARFBR ROD	BOTH IP/OP	$2.39 	$1.77	$0.00	$1.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.77	$1.77	$0.00	$0.00	$0.50	$0.00	$0.00	$0.00	$0.00	$1.19	$1.89	$1.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.99	SUP	Custom 27203010		394.99  -  CAP PROTECTIVE BLACK NONSTRL 4MM CARFBR ROD	BOTH IP/OP	$4.82 	$3.57	$0.00	$3.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.58	$3.58	$0.00	$0.00	$1.00	$0.00	$0.00	$0.00	$0.00	$2.34	$3.71	$3.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.991	SUP	Custom 27203010		394.991  -  CAP PROTECTIVE YELLOW NONSTRL 4MM FIX PIN	BOTH IP/OP	$57.85 	$42.81	$0.00	$46.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.94	$42.94	$0.00	$0.00	$12.06	$0.00	$0.00	$0.00	$0.00	$28.93	$45.82	$46.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.992	SUP	Custom 27203010		394.992  -  CAP PROTECTIVE WHITE NONSTRL 4.5MM FIX PIN	BOTH IP/OP	$5.96 	$4.41	$0.00	$4.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.42	$4.42	$0.00	$0.00	$1.24	$0.00	$0.00	$0.00	$0.00	$2.89	$4.59	$4.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
394.994	SUP	Custom 27203010		394.994  -  CAP PROTECTIVE GREEN NONSTRL 6MM FIX PIN	BOTH IP/OP	$5.96 	$4.41	$0.00	$4.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.42	$4.42	$0.00	$0.00	$1.24	$0.00	$0.00	$0.00	$0.00	$2.89	$4.59	$4.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.103	SUP	Custom 27203010		395.103  -  BAR EXFIX ANGLED 3MM CONNCTNG ROD STAINLESS STEEL NONSTRL	BOTH IP/OP	$83.55 	$61.83	$0.00	$64.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.01	$62.01	$0.00	$0.00	$17.41	$0.00	$0.00	$0.00	$0.00	$40.56	$64.25	$64.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.105	SUP	Custom 27203010		395.105  -  ROD EXFIX 3MM 25MM CONNCTNG RADIOLUCENT CARFBR NONSTRL MINI	BOTH IP/OP	$65.18 	$48.23	$0.00	$50.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.37	$48.37	$0.00	$0.00	$13.58	$0.00	$0.00	$0.00	$0.00	$31.64	$50.12	$50.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.107	SUP	Custom 27203010		395.107  -  ROD EXFIX 3MM 45MM CARFBR NONSTRL MINI EXFIX	BOTH IP/OP	$65.18 	$48.23	$0.00	$50.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.37	$48.37	$0.00	$0.00	$13.58	$0.00	$0.00	$0.00	$0.00	$31.64	$50.12	$50.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.109	SUP	Custom 27203010		395.109  -  ROD EXFIX 3MM 60MM CARFBR NONSTRL MINI EXFIX	BOTH IP/OP	$65.18 	$48.23	$0.00	$50.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.37	$48.37	$0.00	$0.00	$13.58	$0.00	$0.00	$0.00	$0.00	$31.64	$50.12	$50.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.111	SUP	Custom 27203010		395.111  -  ROD EXFIX 3MM 75MM CONNCTNG RADIOLUCENT CARFBR NONSTRL MINI	BOTH IP/OP	$65.18 	$48.23	$0.00	$50.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.37	$48.37	$0.00	$0.00	$13.58	$0.00	$0.00	$0.00	$0.00	$31.64	$50.12	$50.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.125	SUP	Custom 27203010		395.125  -  CLAMP EXFIX 1.25MM HOLD NONSTRL MINI EXFIX	BOTH IP/OP	"$1,142.90 "	$845.75	$0.00	$887.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$848.26	$848.26	$0.00	$0.00	$238.18	$0.00	$0.00	$0.00	$0.00	$554.81	$878.83	$887.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.126	SUP	Custom 27203010		395.126  -  CLAMP EXFIX 1.6MM HOLD NONSTRL 1.6MM K WIRE MINI EXFIX	BOTH IP/OP	"$1,142.90 "	$845.75	$0.00	$887.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$848.26	$848.26	$0.00	$0.00	$238.18	$0.00	$0.00	$0.00	$0.00	$554.81	$878.83	$887.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.133	SUP	Custom 27203010		395.133  -  CLAMP EXFIX 3MM CONNCTNG NONSTRL MINI EXFIX	BOTH IP/OP	"$1,062.70 "	$786.40	$0.00	$825.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$788.74	$788.74	$0.00	$0.00	$221.47	$0.00	$0.00	$0.00	$0.00	$515.88	$817.15	$825.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.134	SUP	Custom 27203010		395.134  -  CLAMP EXFIX 3X4MM CONNCTNG NONSTRL MINI EXFIX SMALL EXFIX	BOTH IP/OP	"$1,062.70 "	$786.40	$0.00	$825.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$788.74	$788.74	$0.00	$0.00	$221.47	$0.00	$0.00	$0.00	$0.00	$515.88	$817.15	$825.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.54	SUP	Custom 27803010		395.54  -  CLAMP XTRNFX 4MM 2.5MM NS OPN SEF	BOTH IP/OP	$521.33 	$385.78	$0.00	$404.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$386.93	$386.93	$0.00	$0.00	$108.64	$0.00	$0.00	$0.00	$0.00	$253.08	$400.87	$404.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.55	SUP	Custom 27803010		395.55  -  CLAMP XTRNFX 4MM NS OPN SEF 4MM SCHNZ SCR	BOTH IP/OP	$521.33 	$385.78	$0.00	$404.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$386.93	$386.93	$0.00	$0.00	$108.64	$0.00	$0.00	$0.00	$0.00	$253.08	$400.87	$404.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.56	SUP	Custom 27203010		395.56  -  CLAMP EXFIX SMALL 2.5MM 4MM NONSTRL SMALL EXFIX	BOTH IP/OP	$486.80 	$360.23	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.30	$361.30	$0.00	$0.00	$101.45	$0.00	$0.00	$0.00	$0.00	$236.31	$374.32	$378.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.57	SUP	Custom 27203010		395.57  -  CLAMP EXFIX 4MM 4MM NONSTRL 4MM SCHANZ SCREW CONNECT	BOTH IP/OP	$486.80 	$360.23	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.30	$361.30	$0.00	$0.00	$101.45	$0.00	$0.00	$0.00	$0.00	$236.31	$374.32	$378.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.575	SUP	Custom 27203010		395.575  -  CLAMP EXFIX MULTIVECTOR TITANIUM CARFBR RODS	BOTH IP/OP	"$2,157.50 "	"$1,596.55"	$0.00	"$1,726.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,601.30"	"$1,601.30"	$0.00	$0.00	$449.62	$0.00	$0.00	$0.00	$0.00	"$1,078.75"	"$1,708.74"	"$1,726.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.58	SUP	Custom 27203010		395.58  -  NUT XTRNFX NS SPRG LD	BOTH IP/OP	$54.85 	$40.59	$0.00	$42.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.71	$40.71	$0.00	$0.00	$11.43	$0.00	$0.00	$0.00	$0.00	$26.63	$42.17	$42.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.6	SUP	Custom 27203010		395.60  -  ROD EXFIX 4MM 60MM CARFBR NONSTRL	BOTH IP/OP	$59.48 	$44.02	$0.00	$47.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.14	$44.14	$0.00	$0.00	$12.39	$0.00	$0.00	$0.00	$0.00	$29.74	$47.11	$47.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.61	SUP	Custom 27203010		395.61  -  ROD EXFIX 4MM 80MM CARFBR NONSTRL SMALL EXFIX	BOTH IP/OP	$61.28 	$45.35	$0.00	$47.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.48	$45.48	$0.00	$0.00	$12.77	$0.00	$0.00	$0.00	$0.00	$29.74	$47.11	$47.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.62	SUP	Custom 27203010		395.62  -  ROD EXFIX 4MM 100MM CARFBR NONSTRL SMALL EXFIX	BOTH IP/OP	$61.28 	$45.35	$0.00	$47.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.48	$45.48	$0.00	$0.00	$12.77	$0.00	$0.00	$0.00	$0.00	$29.74	$47.11	$47.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.63	SUP	Custom 27203010		395.63  -  ROD EXFIX 4MM 120MM CARFBR NONSTRL SMALL EXFIX	BOTH IP/OP	$61.28 	$45.35	$0.00	$47.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.48	$45.48	$0.00	$0.00	$12.77	$0.00	$0.00	$0.00	$0.00	$29.74	$47.11	$47.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.64	SUP	Custom 27203010		395.64  -  ROD EXFIX 4MM 140MM CARFBR NONSTRL SMALL EXFIX	BOTH IP/OP	$84.65 	$62.64	$0.00	$65.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.83	$62.83	$0.00	$0.00	$17.64	$0.00	$0.00	$0.00	$0.00	$41.10	$65.10	$65.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.65	SUP	Custom 27203010		395.65  -  ROD EXFIX 4MM 160MM CARFBR NONSTRL SMALL EXFIX	BOTH IP/OP	$84.65 	$62.64	$0.00	$65.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.83	$62.83	$0.00	$0.00	$17.64	$0.00	$0.00	$0.00	$0.00	$41.10	$65.10	$65.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.66	SUP	Custom 27203010		395.66  -  ROD EXFIX 4MM 180MM CARFBR NONSTRL SMALL EXFIX	BOTH IP/OP	$84.65 	$62.64	$0.00	$65.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.83	$62.83	$0.00	$0.00	$17.64	$0.00	$0.00	$0.00	$0.00	$41.10	$65.10	$65.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.67	SUP	Custom 27203010		395.67  -  ROD EXFIX 4MM 200MM CARFBR NONSTRL	BOTH IP/OP	$84.65 	$62.64	$0.00	$65.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.83	$62.83	$0.00	$0.00	$17.64	$0.00	$0.00	$0.00	$0.00	$41.10	$65.10	$65.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.68	SUP	Custom 27203010		395.680  -  ROD EXFIX 60D CVD 4MM 78MM CARFBR NONSTRL	BOTH IP/OP	$274.70 	$203.28	$0.00	$219.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$203.88	$203.88	$0.00	$0.00	$57.25	$0.00	$0.00	$0.00	$0.00	$137.35	$217.56	$219.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.681	SUP	Custom 27203010		395.681  -  ROD EXFIX 90D 4MM 117MM CVD SPAN ANGLED CARFBR NONSTRL	BOTH IP/OP	$303.00 	$224.22	$0.00	$235.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.89	$224.89	$0.00	$0.00	$63.15	$0.00	$0.00	$0.00	$0.00	$147.09	$232.99	$235.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.682	SUP	Custom 27203010		395.682  -  ROD EXFIX 120D 4MM 156MM CVD SPAN ANGLED CARFBR NONSTRL	BOTH IP/OP	$324.15 	$239.87	$0.00	$251.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.58	$240.58	$0.00	$0.00	$67.55	$0.00	$0.00	$0.00	$0.00	$157.36	$249.27	$251.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.685	SUP	Custom 27203010		395.685  -  ROD EXFIX ANGLE 4MM 50X80MM T BAR RECYCLED CARFBR NONSTRL	BOTH IP/OP	$582.60 	$431.12	$0.00	$452.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$432.41	$432.41	$0.00	$0.00	$121.41	$0.00	$0.00	$0.00	$0.00	$282.81	$447.98	$452.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.686	SUP	Custom 27203010		395.686  -  ROD EXFIX ANGLE 4MM 120X80MM T BAR CARFBR NONSTRL	BOTH IP/OP	$582.60 	$431.12	$0.00	$452.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$432.41	$432.41	$0.00	$0.00	$121.41	$0.00	$0.00	$0.00	$0.00	$282.81	$447.98	$452.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.687	SUP	Custom 27203010		395.687  -  ROD EXFIX ANGLED 4MM 50X110MM T BAR ANGLED CARFBR NONSTRL	BOTH IP/OP	$582.60 	$431.12	$0.00	$452.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$432.41	$432.41	$0.00	$0.00	$121.41	$0.00	$0.00	$0.00	$0.00	$282.81	$447.98	$452.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.688	SUP	Custom 27203010		395.688  -  ROD EXFIX ANGLED 4MM 120X110MM T BAR ANGLED CARFBR NONSTRL	BOTH IP/OP	$582.60 	$431.12	$0.00	$452.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$432.41	$432.41	$0.00	$0.00	$121.41	$0.00	$0.00	$0.00	$0.00	$282.81	$447.98	$452.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.69	SUP	Custom 27203010		395.690  -  ROD EXFIX 45D 8MM 214MM CVD CARFBR NONSTRL	BOTH IP/OP	$597.00 	$441.78	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$443.09	$443.09	$0.00	$0.00	$124.41	$0.00	$0.00	$0.00	$0.00	$298.50	$472.82	$477.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.691	SUP	Custom 27203010		395.691  -  ROD EXFIX 90D 8MM 382MM CVD CARFBR NONSTRL	BOTH IP/OP	$614.90 	$455.03	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$456.38	$456.38	$0.00	$0.00	$128.15	$0.00	$0.00	$0.00	$0.00	$298.50	$472.82	$477.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.692	SUP	Custom 27203010		395.692  -  ROD EXFIX 135D 8MM 499MM CVD CARFBR NONSTRL	BOTH IP/OP	$579.60 	$428.90	$0.00	$463.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$430.18	$430.18	$0.00	$0.00	$120.79	$0.00	$0.00	$0.00	$0.00	$289.80	$459.04	$463.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.693	SUP	Custom 27203010		395.693  -  ROD EXFIX 180D 8MM 540MM CVD SPAN ANGLED CARFBR NONSTRL	BOTH IP/OP	$579.60 	$428.90	$0.00	$463.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$430.18	$430.18	$0.00	$0.00	$120.79	$0.00	$0.00	$0.00	$0.00	$289.80	$459.04	$463.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.7	SUP	Custom 27203010		395.70  -  BAR XTRNFX 4MM 60MM NS CNCT MRI SAFE SS METACARPUS PHALANX	BOTH IP/OP	$47.05 	$34.82	$0.00	$37.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.92	$34.92	$0.00	$0.00	$9.81	$0.00	$0.00	$0.00	$0.00	$23.53	$37.26	$37.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.71	SUP	Custom 27203010		395.71  -  BAR XTRNFX 4MM 80MM NS CNCT MRI SAFE SS METACARPUS PHALANX	BOTH IP/OP	$47.05 	$34.82	$0.00	$37.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.92	$34.92	$0.00	$0.00	$9.81	$0.00	$0.00	$0.00	$0.00	$23.53	$37.26	$37.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.72	SUP	Custom 27203010		395.72  -  BAR XTRNFX 4MM 100MM NS CNCT MRI SAFE SS METACARPUS PHALANX	BOTH IP/OP	$47.05 	$34.82	$0.00	$37.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.92	$34.92	$0.00	$0.00	$9.81	$0.00	$0.00	$0.00	$0.00	$23.53	$37.26	$37.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.73	SUP	Custom 27203010		395.73  -  BAR XTRNFX 4MM 120MM NS CNCT MRI SAFE SS METACARPUS PHALANX	BOTH IP/OP	$47.05 	$34.82	$0.00	$37.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.92	$34.92	$0.00	$0.00	$9.81	$0.00	$0.00	$0.00	$0.00	$23.53	$37.26	$37.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.74	SUP	Custom 27203010		395.74  -  BAR XTRNFX 4MM 140MM NS CNCT MRI SAFE SS METACARPUS PHALANX	BOTH IP/OP	$61.65 	$45.62	$0.00	$49.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.76	$45.76	$0.00	$0.00	$12.85	$0.00	$0.00	$0.00	$0.00	$30.83	$48.83	$49.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.75	SUP	Custom 27203010		395.75  -  BAR XTRNFX 4MM 160MM NS CNCT MRI SAFE SS METACARPUS PHALANX	BOTH IP/OP	$61.65 	$45.62	$0.00	$49.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.76	$45.76	$0.00	$0.00	$12.85	$0.00	$0.00	$0.00	$0.00	$30.83	$48.83	$49.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.76	SUP	Custom 27203010		395.76  -  BAR XTRNFX 4MM 180MM NS CNCT MRI SAFE SS METACARPUS PHALANX	BOTH IP/OP	$61.65 	$45.62	$0.00	$49.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.76	$45.76	$0.00	$0.00	$12.85	$0.00	$0.00	$0.00	$0.00	$30.83	$48.83	$49.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.77	SUP	Custom 27203010		395.77  -  BAR XTRNFX 4MM 200MM NS CNCT MRI SAFE SS METACARPUS PHALANX	BOTH IP/OP	$61.65 	$45.62	$0.00	$49.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.76	$45.76	$0.00	$0.00	$12.85	$0.00	$0.00	$0.00	$0.00	$30.83	$48.83	$49.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.779	SUP	Custom 27203010		395.779  -  ROD EXFIX MEDIUM 8MM 160MM CARFBR NONSTRL	BOTH IP/OP	$246.18 	$182.17	$0.00	$191.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.71	$182.71	$0.00	$0.00	$51.30	$0.00	$0.00	$0.00	$0.00	$119.50	$189.29	$191.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.78	SUP	Custom 27203010		395.78  -  BAR XTRNFX 4MM 220MM NS CNCT MRI SAFE SS METACARPUS PHALANX	BOTH IP/OP	$246.18 	$182.17	$0.00	$182.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.71	$182.71	$0.00	$0.00	$51.30	$0.00	$141.37	$141.37	$0.00	$38.06	$60.29	$60.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.78	SUP	HCPCS C1713		395.780  -  ROD EXFIX 120MM 8MM MED CARFBR MED EXFIX NONSTRL	BOTH IP/OP	$246.18 	$182.17	$0.00	$189.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.71	$182.71	$0.00	$0.00	$51.30	$0.00	$141.37	$141.37	$0.00	$38.06	$189.29	$60.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.782	SUP	Custom 27203010		395.782  -  ROD EXFIX 8MM 200MM CARFBR DISTAL RAD NONSTRL	BOTH IP/OP	$243.95 	$180.52	$0.00	$189.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.06	$181.06	$0.00	$0.00	$50.84	$0.00	$0.00	$0.00	$0.00	$118.43	$187.59	$189.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.784	SUP	Custom 27203010		395.784  -  ROD EXFIX 8MM 220MM CARFBR DISTAL RAD NONSTRL	BOTH IP/OP	$243.95 	$180.52	$0.00	$189.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.06	$181.06	$0.00	$0.00	$50.84	$0.00	$0.00	$0.00	$0.00	$118.43	$187.59	$189.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.786	SUP	Custom 27203010		395.786  -  ROD EXFIX 8MM 240MM CARFBR DISTAL RAD NONSTRL	BOTH IP/OP	$243.95 	$180.52	$0.00	$189.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.06	$181.06	$0.00	$0.00	$50.84	$0.00	$0.00	$0.00	$0.00	$118.43	$187.59	$189.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.788	SUP	Custom 27203010		395.788  -  ROD EXFIX 8MM 280MM CARFBR DISTAL RAD NONSTRL	BOTH IP/OP	$246.18 	$182.17	$0.00	$191.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.71	$182.71	$0.00	$0.00	$51.30	$0.00	$0.00	$0.00	$0.00	$119.50	$189.29	$191.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.79	SUP	Custom 27203010		395.79  -  BAR XTRNFX 4MM 240MM NS CNCT MRI SAFE SS METACARPUS PHALANX	BOTH IP/OP	$76.13 	$56.34	$0.00	$60.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.50	$56.50	$0.00	$0.00	$15.86	$0.00	$0.00	$0.00	$0.00	$38.06	$60.29	$60.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.792	SUP	Custom 27203010		395.792  -  ROD EXFIX MEDIUM 8MM 320MM CARFBR NONSTRL	BOTH IP/OP	$246.18 	$182.17	$0.00	$191.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.71	$182.71	$0.00	$0.00	$51.30	$0.00	$0.00	$0.00	$0.00	$119.50	$189.29	$191.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.796	SUP	Custom 27203010		395.796  -  ROD EXFIX 8MM 360MM CARFBR NONSTRL	BOTH IP/OP	$265.13 	$196.20	$0.00	$205.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.78	$196.78	$0.00	$0.00	$55.25	$0.00	$0.00	$0.00	$0.00	$128.70	$203.86	$205.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.797	SUP	Custom 27203010		395.797  -  ROD EXFIX MEDIUM 8MM 400MM CARFBR NONSTRL	BOTH IP/OP	$265.13 	$196.20	$0.00	$205.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.78	$196.78	$0.00	$0.00	$55.25	$0.00	$0.00	$0.00	$0.00	$128.70	$203.86	$205.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.798	SUP	Custom 27203010		395.798  -  ROD EXFIX 8MM 460MM CARFBR NONSTRL	BOTH IP/OP	$265.13 	$196.20	$0.00	$205.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.78	$196.78	$0.00	$0.00	$55.25	$0.00	$0.00	$0.00	$0.00	$128.70	$203.86	$205.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.8	SUP	Custom 27203010		395.80  -  BAR XTRNFX 4MM 250MM NS CNCT SS MN XTRNFXTR	BOTH IP/OP	$76.13 	$56.34	$0.00	$60.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.50	$56.50	$0.00	$0.00	$15.86	$0.00	$0.00	$0.00	$0.00	$38.06	$60.29	$60.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.81	SUP	Custom 27203010		395.81  -  BAR EXFIX 4MM 260MM CONNECT NONSTRL	BOTH IP/OP	$76.13 	$56.34	$0.00	$60.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.50	$56.50	$0.00	$0.00	$15.86	$0.00	$0.00	$0.00	$0.00	$38.06	$60.29	$60.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.82	SUP	Custom 27203010		395.82  -  BAR EXFIX 4MM 280MM CONNECT NONSTRL	BOTH IP/OP	$76.13 	$56.34	$0.00	$60.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.50	$56.50	$0.00	$0.00	$15.86	$0.00	$0.00	$0.00	$0.00	$38.06	$60.29	$60.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
395.83	SUP	Custom 27203010		395.83  -  BAR EXFIX 4MM 300MM CONNECT NONSTRL	BOTH IP/OP	$76.13 	$56.34	$0.00	$60.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.50	$56.50	$0.00	$0.00	$15.86	$0.00	$0.00	$0.00	$0.00	$38.06	$60.29	$60.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
397.283	SUP	Custom 27203010		397.283  -  BIT DRILL 1.8MM JLTCH NONSTRL	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
397.284	SUP	Custom 27203010		397.284  -  BIT DRILL 2.4MM JLTCH NONSTRL	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
397.342	SUP	Custom 27203010		397.342  -  BIT DRL 140MM 2.5MM 400MM NS JCHK CLBRT	BOTH IP/OP	$969.93 	$717.75	$0.00	$753.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$719.88	$719.88	$0.00	$0.00	$202.13	$0.00	$0.00	$0.00	$0.00	$470.84	$745.81	$753.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
397.343	SUP	Custom 27203010		397.343  -  BIT DRL 3.5MM 380MM NS JCHK	BOTH IP/OP	"$1,017.73 "	$753.12	$0.00	$790.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$755.36	$755.36	$0.00	$0.00	$212.09	$0.00	$0.00	$0.00	$0.00	$494.04	$782.56	$790.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
398.756	SUP	Custom 27203010		398.756  -  CLAMP SURG 206MM HOOK ARM BONE	BOTH IP/OP	"$5,084.40 "	"$3,762.46"	$0.00	"$3,949.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,773.64"	"$3,773.64"	$0.00	$0.00	"$1,059.59"	$0.00	$0.00	$0.00	$0.00	"$2,468.15"	"$3,909.55"	"$3,949.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400.006	SUP	HCPCS C1713		400.006  -  SCREW BONE STANDARD 1.5MM 3MM 6MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.007	SUP	HCPCS C1713		400.007  -  SCREW BONE STANDARD 1.5MM 3MM 7MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.008	SUP	HCPCS C1713		400.008  -  SCREW BONE STANDARD 1.5MM 3MM 8MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.009	SUP	HCPCS C1713		400.009  -  SCREW BONE STANDARD 1.5MM 3MM 9MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.01	SUP	HCPCS C1713		400.010  -  SCREW BONE STANDARD 1.5MM 3MM 10MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.011	SUP	HCPCS C1713		400.011  -  SCREW BONE STANDARD 1.5MM 3MM 11MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.012	SUP	HCPCS C1713		400.012  -  SCREW BONE STANDARD 1.5MM 3MM 12MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.014	SUP	HCPCS C1713		400.014  -  SCREW BONE STANDARD 1.5MM 3MM 14MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.016	SUP	HCPCS C1713		400.016  -  SCREW BONE STANDARD 1.5MM 3MM 16MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.018	SUP	HCPCS C1713		400.018  -  SCREW BONE STANDARD 1.5MM 3MM 18MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.02	SUP	HCPCS C1713		400.020  -  SCREW BONE STANDARD 1.5MM 3MM 20MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.022	SUP	HCPCS C1713		400.022  -  SCREW BONE 1.5MM 22MM TITANIUM CORTICAL NONSTRL MINI	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.024	SUP	HCPCS C1713		400.024  -  SCREW BONE STANDARD CRCIFRM 1.5MM 3MM 24MM TITANIUM CORTICAL	BOTH IP/OP	$52.88 	$39.13	$0.00	$42.30	$23.79	$23.79	$0.00	$0.00	$0.00	$11.02	$39.24	$39.24	$0.00	$0.00	$11.02	$0.00	$31.28	$31.28	$0.00	$26.44	$41.88	$42.30	$0.00		$0.00	$8.03	$0.00	$0.00	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00
400.19	SUP	HCPCS C1713		400.190  -  PIN FIX 1.8MM 12MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$212.90 	$157.55	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$44.37	$158.01	$158.01	$0.00	$0.00	$44.37	$0.00	$125.93	$125.93	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
400.191	SUP	Custom 27203010		400.191  -  PIN FIX 1.8MM 14MM T8 STARDRIVE RECESS BUTTRESS LCP TITANIUM	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400.192	SUP	Custom 27203010		400.192  -  PIN FIX 1.8MM 16MM T8 STARDRIVE RECESS BUTTRESS LCP TITANIUM	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400.193	SUP	Custom 27203010		400.193  -  PIN FIX 1.8MM 18MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400.194	SUP	HCPCS C1713		400.194  -  PIN FIX 1.8MM 20MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
400.195	SUP	Custom 27203010		400.195  -  PIN FIX 1.8MM 22MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400.196	SUP	HCPCS C1713		400.196  -  PIN FIX 1.8MM 24MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
400.197	SUP	Custom 27203010		400.197  -  PIN FIX 1.8MM 26MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400.198	SUP	HCPCS C1713		400.198  -  PIN FIX 1.8MM 28MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
400.199	SUP	Custom 27203010		400.199  -  PIN FIX 1.8MM 30MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400.406	SUP	HCPCS C1713		400.406  -  SCREW BONE GOLD 6MM 1MM CORT CRANFCL TI SLFTAP +DR RECESS	BOTH IP/OP	$157.50 	$116.55	$0.00	$126.00	$70.88	$70.88	$0.00	$0.00	$0.00	$32.83	$116.90	$116.90	$0.00	$0.00	$32.82	$0.00	$93.16	$93.16	$0.00	$78.75	$124.74	$126.00	$0.00		$0.00	$24.65	$0.00	$0.00	$25.07	$0.00	$0.00	$0.00	$0.00	$0.00
400.526	SUP	HCPCS C1713		400.526  -  SCREW BONE 1MM 1.6MM 6MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.527	SUP	HCPCS C1713		400.527  -  SCREW BONE 1MM 1.6MM 7MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.528	SUP	HCPCS C1713		400.528  -  SCREW BONE 1MM 1.6MM 8MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.529	SUP	HCPCS C1713		400.529  -  SCREW BONE 1MM 1.6MM 9MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.53	SUP	HCPCS C1713		400.530  -  SCREW BONE 1MM 1.6MM 10MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$133.05 	$98.46	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$27.73	$98.75	$98.75	$0.00	$0.00	$27.73	$0.00	$78.70	$78.70	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.531	SUP	HCPCS C1713		400.531  -  SCREW BONE 1MM 1.6MM 11MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.532	SUP	HCPCS C1713		400.532  -  SCREW BONE 1MM 1.6MM 12MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.533	SUP	HCPCS C1713		400.533  -  SCREW BONE 1MM 1.6MM 13MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.534	SUP	HCPCS C1713		400.534  -  SCREW BONE 1MM 1.6MM 14MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$137.05 	$101.42	$0.00	$106.44	$59.87	$59.87	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$66.53	$105.38	$106.44	$0.00		$0.00	$20.22	$0.00	$0.00	$21.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.686	SUP	HCPCS C1713		400.686  -  SCREW BONE 1.3MM 2.4MM 6MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.687	SUP	HCPCS C1713		400.687  -  SCREW BONE 1.3MM 2.4MM 7MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.688	SUP	HCPCS C1713		400.688  -  SCREW BONE 1.3MM 2.4MM 8MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.689	SUP	HCPCS C1713		400.689  -  SCREW BONE 1.3MM 2.4MM 9MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$27.80	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.69	SUP	HCPCS C1713		400.690  -  SCREW BONE 1.3MM 2.4MM 10MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$139.20 	$103.01	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.01	$103.31	$103.31	$0.00	$0.00	$29.01	$0.00	$82.34	$82.34	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.691	SUP	HCPCS C1713		400.691  -  SCREW BONE 1.3MM 2.4MM 11MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.692	SUP	HCPCS C1713		400.692  -  SCREW BONE 1.3MM 2.4MM 12MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.693	SUP	HCPCS C1713		400.693  -  SCREW BONE 1.3MM 2.4MM 13MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.694	SUP	HCPCS C1713		400.694  -  SCREW BONE 1.3MM 2.4MM 14MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.696	SUP	HCPCS C1713		400.696  -  SCREW BONE 1.3MM 2.4MM 16MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.698	SUP	HCPCS C1713		400.698  -  SCREW BONE 1.3MM 2.4MM 18MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$62.64	$62.64	$0.00	$0.00	$0.00	$29.88	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$84.81	$84.81	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$21.15	$0.00	$0.00	$22.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.806	SUP	HCPCS C1713		400.806  -  SCREW BONE 1.5MM 3MM 6MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.807	SUP	HCPCS C1713		400.807  -  SCREW BONE 1.5MM 3MM 7MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.808	SUP	HCPCS C1713		400.808  -  SCREW BONE 1.5MM 3MM 8MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.809	SUP	HCPCS C1713		400.809  -  SCREW BONE 1.5MM 3MM 9MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.81	SUP	HCPCS C1713		400.810  -  SCREW BONE 1.5MM 3MM 10MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$63.45 	$46.95	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.22	$47.09	$47.09	$0.00	$0.00	$13.22	$0.00	$37.53	$37.53	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.811	SUP	HCPCS C1713		400.811  -  SCREW BONE 1.5MM 3MM 11MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.812	SUP	HCPCS C1713		400.812  -  SCREW BONE 1.5MM 3MM 12MM SELF TAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.814	SUP	HCPCS C1713		400.814  -  SCREW BONE 1.5MM 3MM 14MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.816	SUP	HCPCS C1713		400.816  -  SCREW BONE 1.5MM 3MM 16MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.818	SUP	HCPCS C1713		400.818  -  SCREW BONE 1.5MM 3MM 18MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.82	SUP	HCPCS C1713		400.820  -  SCREW BONE 1.5MM 3MM 20MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$63.45 	$46.95	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.22	$47.09	$47.09	$0.00	$0.00	$13.22	$0.00	$37.53	$37.53	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.822	SUP	HCPCS C1713		400.822  -  SCREW BONE 1.5MM 3MM 22MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.824	SUP	HCPCS C1713		400.824  -  SCREW BONE 1.5MM 3MM 24MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.834	SUP	HCPCS C1713		400.834  -  SCREW BONE 4MM 1.5MM CORT CRANFCL TI SLFDRILL LP NONSTRL	BOTH IP/OP	$151.38 	$112.02	$0.00	$121.10	$68.12	$68.12	$0.00	$0.00	$0.00	$31.55	$112.35	$112.35	$0.00	$0.00	$31.55	$0.00	$89.54	$89.54	$0.00	$75.69	$119.89	$121.10	$0.00		$0.00	$23.69	$0.00	$0.00	$24.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.835	SUP	HCPCS C1713		400.835  -  SCREW BONE 5MM 1.5MM CORT CRANFCL TI SLFDRILL LP NONSTRL	BOTH IP/OP	$151.38 	$112.02	$0.00	$121.10	$68.12	$68.12	$0.00	$0.00	$0.00	$31.55	$112.35	$112.35	$0.00	$0.00	$31.55	$0.00	$89.54	$89.54	$0.00	$75.69	$119.89	$121.10	$0.00		$0.00	$23.69	$0.00	$0.00	$24.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.996	SUP	HCPCS C1713		400.996  -  SCREW BONE 1.4MM 15MM SLFDRILL WIRE FIX TITANIUM MIDFAC	BOTH IP/OP	$347.50 	$257.15	$0.00	$278.00	$156.38	$156.38	$0.00	$0.00	$0.00	$72.43	$257.91	$257.91	$0.00	$0.00	$72.42	$0.00	$205.55	$205.55	$0.00	$173.75	$275.22	$278.00	$0.00		$0.00	$54.38	$0.00	$0.00	$55.32	$0.00	$0.00	$0.00	$0.00	$0.00
400.997	SUP	HCPCS C1713		400.997  -  SCREW BONE 1.4MM 21MM SLFDRILL WIRE FIX TITANIUM MIDFAC	BOTH IP/OP	$347.50 	$257.15	$0.00	$278.00	$156.38	$156.38	$0.00	$0.00	$0.00	$72.43	$257.91	$257.91	$0.00	$0.00	$72.42	$0.00	$205.55	$205.55	$0.00	$173.75	$275.22	$278.00	$0.00		$0.00	$54.38	$0.00	$0.00	$55.32	$0.00	$0.00	$0.00	$0.00	$0.00
401.006	SUP	HCPCS C1713		401.006  -  SCREW BONE STANDARD 2MM 3.5MM 6MM CRCIFRM TITANIUM CORTICAL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.008	SUP	HCPCS C1713		401.008  -  SCREW BONE STANDARD 2MM 3.5MM 8MM CRCIFRM TITANIUM CORTICAL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.012	SUP	HCPCS C1713		401.012  -  SCREW BONE STANDARD 2MM 3.5MM 12MM CRCIFRM TITANIUM CORTICAL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.02	SUP	HCPCS C1713		401.020  -  SCREW BONE STANDARD 2MM 3.5MM 20MM CRCIFRM TITANIUM CORTICAL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.022	SUP	HCPCS C1713		401.022  -  SCREW BONE STANDARD 2MM 3.5MM 22MM CRCIFRM TITANIUM CORTICAL	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.024	SUP	HCPCS C1713		401.024  -  SCREW BONE STANDARD 2MM 3.5MM 24MM SLFTAP CRCIFRM RECESS	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.026	SUP	HCPCS C1713		401.026  -  SCREW BONE 2MM 26MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.028	SUP	HCPCS C1713		401.028  -  SCREW BONE 2MM 28MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.03	SUP	HCPCS C1713		401.030  -  SCREW BONE 2MM 30MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.032	SUP	HCPCS C1713		401.032  -  SCREW BONE 2MM 32MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.034	SUP	HCPCS C1713		401.034  -  SCREW BONE 2MM 34MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.036	SUP	HCPCS C1713		401.036  -  SCREW BONE 2MM 36MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.038	SUP	HCPCS C1713		401.038  -  SCREW BONE 2MM 38MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT	BOTH IP/OP	$52.20 	$38.63	$0.00	$41.76	$23.49	$23.49	$0.00	$0.00	$0.00	$10.88	$38.74	$38.74	$0.00	$0.00	$10.88	$0.00	$30.88	$30.88	$0.00	$26.10	$41.34	$41.76	$0.00		$0.00	$7.93	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$0.00
401.158	SUP	HCPCS C1713		401.158  -  SCREW BONE 8MM 2MM CORT CRANFCL TI SLFTAP FLUT TIP NONSTRL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
401.292	SUP	HCPCS C1713		401.292  -  SCREW BONE BLUE 6MM 2MM CRANFCL TI SLFTAP +DR RECESS LCK	BOTH IP/OP	"$1,091.25 "	$807.53	$0.00	$873.00	$491.06	$491.06	$0.00	$0.00	$0.00	$227.44	$809.93	$809.93	$0.00	$0.00	$227.42	$0.00	$645.47	$645.47	$0.00	$545.63	$864.27	$873.00	$0.00		$0.00	$170.78	$0.00	$0.00	$173.73	$0.00	$0.00	$0.00	$0.00	$0.00
401.295	SUP	HCPCS C1713		401.295  -  SCREW BONE BLUE 10MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
401.296	SUP	HCPCS C1713		401.296  -  SCREW BONE BLUE 12MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
401.297	SUP	HCPCS C1713		401.297  -  SCREW BONE BLUE 14MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
401.298	SUP	HCPCS C1713		401.298  -  SCREW BONE BLUE 16MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
401.305	SUP	HCPCS C1713		401.305  -  SCREW BONE 5MM 2.4MM CRNMXF TI ER CRCIFRM RECESS NONSTRL	BOTH IP/OP	$119.25 	$88.25	$0.00	$95.40	$53.66	$53.66	$0.00	$0.00	$0.00	$24.85	$88.51	$88.51	$0.00	$0.00	$24.85	$0.00	$70.54	$70.54	$0.00	$59.63	$94.45	$95.40	$0.00		$0.00	$18.66	$0.00	$0.00	$18.98	$0.00	$0.00	$0.00	$0.00	$0.00
401.508	SUP	HCPCS C1713		401.508  -  SCREW BONE 2.4MM 8MM TI CORT CRNMXF SLFTAP STRL GOLD	BOTH IP/OP	$169.88 	$125.71	$0.00	$135.90	$76.44	$76.44	$0.00	$0.00	$0.00	$35.41	$126.08	$126.08	$0.00	$0.00	$35.40	$0.00	$100.48	$100.48	$0.00	$84.94	$134.54	$135.90	$0.00		$0.00	$26.59	$0.00	$0.00	$27.04	$0.00	$0.00	$0.00	$0.00	$0.00
401.51	SUP	HCPCS C1713		401.510  -  SCREW BONE 2.4MM 10MM TI CORT CRNMXF MANDIB SLFTAP NONSTRL	BOTH IP/OP	$169.88 	$125.71	$0.00	$135.90	$76.44	$76.44	$0.00	$0.00	$0.00	$35.41	$126.08	$126.08	$0.00	$0.00	$35.40	$0.00	$100.48	$100.48	$0.00	$84.94	$134.54	$135.90	$0.00		$0.00	$26.59	$0.00	$0.00	$27.04	$0.00	$0.00	$0.00	$0.00	$0.00
401.516	SUP	HCPCS C1713		401.516  -  SCREW BONE 2.4MM 16MM TI CORT CRNMXF SLFTAP STRL GOLD	BOTH IP/OP	$169.88 	$125.71	$0.00	$135.90	$76.44	$76.44	$0.00	$0.00	$0.00	$35.41	$126.08	$126.08	$0.00	$0.00	$35.40	$0.00	$100.48	$100.48	$0.00	$84.94	$134.54	$135.90	$0.00		$0.00	$26.59	$0.00	$0.00	$27.04	$0.00	$0.00	$0.00	$0.00	$0.00
401.518	SUP	HCPCS C1713		401.518  -  SCREW BONE 2.4MM 18MM TI CORT CRNMXF MANDIB SLFTAP NONSTRL	BOTH IP/OP	$169.88 	$125.71	$0.00	$135.90	$76.44	$76.44	$0.00	$0.00	$0.00	$35.41	$126.08	$126.08	$0.00	$0.00	$35.40	$0.00	$100.48	$100.48	$0.00	$84.94	$134.54	$135.90	$0.00		$0.00	$26.59	$0.00	$0.00	$27.04	$0.00	$0.00	$0.00	$0.00	$0.00
401.612	SUP	HCPCS C1713		401.612  -  SCREW BONE 2.4MM 3.5MM 12MM SELF TAP SMALL CRCIFRM RECESS	BOTH IP/OP	$115.93 	$85.79	$0.00	$92.74	$52.17	$52.17	$0.00	$0.00	$0.00	$24.16	$86.04	$86.04	$0.00	$0.00	$24.16	$0.00	$68.57	$68.57	$0.00	$57.96	$91.82	$92.74	$0.00		$0.00	$18.14	$0.00	$0.00	$18.46	$0.00	$0.00	$0.00	$0.00	$0.00
401.614	SUP	HCPCS C1713		401.614  -  SCREW BONE SMALL 2.4MM 3.5MM 14MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$115.93 	$85.79	$0.00	$92.74	$52.17	$52.17	$0.00	$0.00	$0.00	$24.16	$86.04	$86.04	$0.00	$0.00	$24.16	$0.00	$68.57	$68.57	$0.00	$57.96	$91.82	$92.74	$0.00		$0.00	$18.14	$0.00	$0.00	$18.46	$0.00	$0.00	$0.00	$0.00	$0.00
401.616	SUP	HCPCS C1713		401.616  -  SCREW BONE SMALL 2.4MM 3.5MM 16MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$115.93 	$85.79	$0.00	$92.74	$52.17	$52.17	$0.00	$0.00	$0.00	$24.16	$86.04	$86.04	$0.00	$0.00	$24.16	$0.00	$68.57	$68.57	$0.00	$57.96	$91.82	$92.74	$0.00		$0.00	$18.14	$0.00	$0.00	$18.46	$0.00	$0.00	$0.00	$0.00	$0.00
401.618	SUP	HCPCS C1713		401.618  -  SCREW BONE SMALL 2.4MM 3.5MM 18MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$115.93 	$85.79	$0.00	$92.74	$52.17	$52.17	$0.00	$0.00	$0.00	$24.16	$86.04	$86.04	$0.00	$0.00	$24.16	$0.00	$68.57	$68.57	$0.00	$57.96	$91.82	$92.74	$0.00		$0.00	$18.14	$0.00	$0.00	$18.46	$0.00	$0.00	$0.00	$0.00	$0.00
401.62	SUP	HCPCS C1713		401.620  -  SCREW BONE 2.4MM 3.5MM 20MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$115.93 	$85.79	$0.00	$92.74	$52.17	$52.17	$0.00	$0.00	$0.00	$24.16	$86.04	$86.04	$0.00	$0.00	$24.16	$0.00	$68.57	$68.57	$0.00	$57.96	$91.82	$92.74	$0.00		$0.00	$18.14	$0.00	$0.00	$18.46	$0.00	$0.00	$0.00	$0.00	$0.00
401.622	SUP	HCPCS C1713		401.622  -  SCREW BONE SMALL 2.4MM 3.5MM 22MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$115.93 	$85.79	$0.00	$92.74	$52.17	$52.17	$0.00	$0.00	$0.00	$24.16	$86.04	$86.04	$0.00	$0.00	$24.16	$0.00	$68.57	$68.57	$0.00	$57.96	$91.82	$92.74	$0.00		$0.00	$18.14	$0.00	$0.00	$18.46	$0.00	$0.00	$0.00	$0.00	$0.00
401.624	SUP	HCPCS C1713		401.624  -  SCREW BONE SMALL 2.4MM 3.5MM 24MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$115.93 	$85.79	$0.00	$92.74	$52.17	$52.17	$0.00	$0.00	$0.00	$24.16	$86.04	$86.04	$0.00	$0.00	$24.16	$0.00	$68.57	$68.57	$0.00	$57.96	$91.82	$92.74	$0.00		$0.00	$18.14	$0.00	$0.00	$18.46	$0.00	$0.00	$0.00	$0.00	$0.00
401.626	SUP	HCPCS C1713		401.626  -  SCREW BONE SMALL 2.4MM 3.5MM 26MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$115.93 	$85.79	$0.00	$92.74	$52.17	$52.17	$0.00	$0.00	$0.00	$24.16	$86.04	$86.04	$0.00	$0.00	$24.16	$0.00	$68.57	$68.57	$0.00	$57.96	$91.82	$92.74	$0.00		$0.00	$18.14	$0.00	$0.00	$18.46	$0.00	$0.00	$0.00	$0.00	$0.00
401.628	SUP	HCPCS C1713		401.628  -  SCREW BONE SMALL 2.4MM 3.5MM 28MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$115.93 	$85.79	$0.00	$92.74	$52.17	$52.17	$0.00	$0.00	$0.00	$24.16	$86.04	$86.04	$0.00	$0.00	$24.16	$0.00	$68.57	$68.57	$0.00	$57.96	$91.82	$92.74	$0.00		$0.00	$18.14	$0.00	$0.00	$18.46	$0.00	$0.00	$0.00	$0.00	$0.00
401.63	SUP	HCPCS C1713		401.630  -  SCREW BONE SMALL 2.4MM 3.5MM 30MM SELF TAP CRCIFRM TITANIUM	BOTH IP/OP	$115.93 	$85.79	$0.00	$92.74	$52.17	$52.17	$0.00	$0.00	$0.00	$24.16	$86.04	$86.04	$0.00	$0.00	$24.16	$0.00	$68.57	$68.57	$0.00	$57.96	$91.82	$92.74	$0.00		$0.00	$18.14	$0.00	$0.00	$18.46	$0.00	$0.00	$0.00	$0.00	$0.00
401.756	SUP	HCPCS C1713		401.756  -  SCREW BONE 2.4MM 6MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.757	SUP	HCPCS C1713		401.757  -  SCREW BONE 2.4MM 7MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.758	SUP	HCPCS C1713		401.758  -  SCREW BONE 2.4MM 8MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.759	SUP	HCPCS C1713		401.759  -  SCREW BONE 2.4MM 9MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.76	SUP	HCPCS C1713		401.760  -  SCREW BONE 2.4MM 4MM 10MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$101.65 	$75.22	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.19	$75.44	$75.44	$0.00	$0.00	$21.18	$0.00	$60.13	$60.13	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.761	SUP	HCPCS C1713		401.761  -  SCREW BONE 2.4MM 11MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.762	SUP	HCPCS C1713		401.762  -  SCREW BONE 2.4MM 4MM 12MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.763	SUP	HCPCS C1713		401.763  -  SCREW BONE 2.4MM 13MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.764	SUP	HCPCS C1713		401.764  -  SCREW BONE 2.4MM 4MM 14MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.766	SUP	HCPCS C1713		401.766  -  SCREW BONE 2.4MM 4MM 16MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.768	SUP	HCPCS C1713		401.768  -  SCREW BONE 2.4MM 4MM 18MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.77	SUP	HCPCS C1713		401.770  -  SCREW BONE 2.4MM 20MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$101.65 	$75.22	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.19	$75.44	$75.44	$0.00	$0.00	$21.18	$0.00	$60.13	$60.13	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.772	SUP	HCPCS C1713		401.772  -  SCREW BONE 2.4MM 4MM 22MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.774	SUP	HCPCS C1713		401.774  -  SCREW BONE 2.4MM 4MM 24MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.776	SUP	HCPCS C1713		401.776  -  SCREW BONE 2.4MM 26MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.778	SUP	HCPCS C1713		401.778  -  SCREW BONE 2.4MM 28MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.78	SUP	HCPCS C1713		401.780  -  SCREW BONE 2.4MM 30MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$101.65 	$75.22	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.19	$75.44	$75.44	$0.00	$0.00	$21.18	$0.00	$60.13	$60.13	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.782	SUP	HCPCS C1713		401.782  -  SCREW BONE 2.4MM 4MM 32MM T8 STARDRIVE RECESS SELF TAP SELF	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.784	SUP	HCPCS C1713		401.784  -  SCREW BONE 2.4MM 4MM 34MM T8 STARDRIVE RECESS SELF TAP	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.786	SUP	HCPCS C1713		401.786  -  SCREW BONE 2.4MM 36MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.788	SUP	HCPCS C1713		401.788  -  SCREW BONE 2.4MM 4MM 38MM T8 STARDRIVE RECESS SELF TAP LCP	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.79	SUP	HCPCS C1713		401.790  -  SCREW BONE 2.4MM 40MM T8 STARDRIVE RECESS SLFTAP TITANIUM	BOTH IP/OP	$101.65 	$75.22	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.19	$75.44	$75.44	$0.00	$0.00	$21.18	$0.00	$60.13	$60.13	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
401.806	SUP	HCPCS C1713		401.806  -  SCREW BONE 2MM 3.5MM 6MM SELF TAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.808	SUP	HCPCS C1713		401.808  -  SCREW BONE 2MM 3.5MM 8MM SELF TAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.81	SUP	HCPCS C1713		401.810  -  SCREW BONE 2MM 3.5MM 10MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$63.13 	$46.72	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.16	$46.85	$46.85	$0.00	$0.00	$13.16	$0.00	$37.34	$37.34	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.812	SUP	HCPCS C1713		401.812  -  SCREW BONE 2MM 3.5MM 12MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.814	SUP	HCPCS C1713		401.814  -  SCREW BONE 2MM 3.5MM 14MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.816	SUP	HCPCS C1713		401.816  -  SCREW BONE 2MM 3.5MM 16MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.818	SUP	HCPCS C1713		401.818  -  SCREW BONE 2MM 3.5MM 18MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.82	SUP	HCPCS C1713		401.820  -  SCREW BONE 2MM 3.5MM 22MM SELF TAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$63.13 	$46.72	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.16	$46.85	$46.85	$0.00	$0.00	$13.16	$0.00	$37.34	$37.34	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.822	SUP	HCPCS C1713		401.822  -  SCREW BONE 2MM 3.5MM 22MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.824	SUP	HCPCS C1713		401.824  -  SCREW BONE 2MM 3.5MM 24MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.826	SUP	HCPCS C1713		401.826  -  SCREW BONE 2MM 3.5MM 26MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.828	SUP	HCPCS C1713		401.828  -  SCREW BONE 2MM 3.5MM 28MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.83	SUP	HCPCS C1713		401.830  -  SCREW BONE 2MM 3.5MM 30MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$63.13 	$46.72	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.16	$46.85	$46.85	$0.00	$0.00	$13.16	$0.00	$37.34	$37.34	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.832	SUP	HCPCS C1713		401.832  -  SCREW BONE 2MM 3.5MM 32MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.834	SUP	HCPCS C1713		401.834  -  SCREW BONE 2MM 3.5MM 34MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.836	SUP	HCPCS C1713		401.836  -  SCREW BONE 2MM 3.5MM 36MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.838	SUP	HCPCS C1713		401.838  -  SCREW BONE 2MM 3.5MM 38MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.876	SUP	HCPCS C1713		401.876  -  SCREW BONE 2MM 6MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.877	SUP	HCPCS C1713		401.877  -  SCREW BONE 2MM 7MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.878	SUP	HCPCS C1713		401.878  -  SCREW BONE 2MM 8MM SLFTAP LOCKING LCP TITANIUM CORTICAL	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.879	SUP	HCPCS C1713		401.879  -  SCREW BONE 2MM 9MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.88	SUP	HCPCS C1713		401.880  -  SCREW BONE 2MM 10MM SELF TAP STARDRIVE LCP TITANIUM SMALL	BOTH IP/OP	$208.80 	$154.51	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$43.52	$154.97	$154.97	$0.00	$0.00	$43.51	$0.00	$123.51	$123.51	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.881	SUP	HCPCS C1713		401.881  -  SCREW BONE 2MM 11MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.882	SUP	HCPCS C1713		401.882  -  SCREW BONE 2MM 12MM SELF TAP STARDRIVE LCP TITANIUM SMALL	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.883	SUP	HCPCS C1713		401.883  -  SCREW BONE 2MM 13MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.884	SUP	HCPCS C1713		401.884  -  SCREW BONE 2MM 14MM SELF TAP STARDRIVE LCP TITANIUM SMALL	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.886	SUP	HCPCS C1713		401.886  -  SCREW BONE 2MM 16MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.888	SUP	HCPCS C1713		401.888  -  SCREW BONE 2MM 18MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.89	SUP	HCPCS C1713		401.890  -  SCREW BONE T6 2MM 20MM SELF TAP LOCK LCP TITANIUM CORTICAL	BOTH IP/OP	$208.80 	$154.51	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$43.52	$154.97	$154.97	$0.00	$0.00	$43.51	$0.00	$123.51	$123.51	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.892	SUP	HCPCS C1713		401.892  -  SCREW BONE 2MM 22MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.894	SUP	HCPCS C1713		401.894  -  SCREW BONE 2MM 24MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.896	SUP	HCPCS C1713		401.896  -  SCREW BONE 2MM 26MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.898	SUP	HCPCS C1713		401.898  -  SCREW BONE 2MM 28MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.9	SUP	HCPCS C1713		401.900  -  SCREW BONE 2MM 30MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP	BOTH IP/OP	$208.80 	$154.51	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$43.52	$154.97	$154.97	$0.00	$0.00	$43.51	$0.00	$123.51	$123.51	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
401.962	SUP	Custom 27203010		401.962  -  PIN FIX 1.8MM 12MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL	BOTH IP/OP	$114.55 	$84.77	$0.00	$88.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.02	$85.02	$0.00	$0.00	$23.87	$0.00	$0.00	$0.00	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
401.964	SUP	Custom 27203010		401.964  -  PIN FIX 1.8MM 14MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL	BOTH IP/OP	$114.55 	$84.77	$0.00	$88.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.02	$85.02	$0.00	$0.00	$23.87	$0.00	$0.00	$0.00	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
401.966	SUP	Custom 27203010		401.966  -  PIN FIX 1.8MM 16MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL	BOTH IP/OP	$114.55 	$84.77	$0.00	$88.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.02	$85.02	$0.00	$0.00	$23.87	$0.00	$0.00	$0.00	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
401.968	SUP	Custom 27203010		401.968  -  PIN FIX 1.8MM 18MM BUTTRESS TITANIUM NONSTRL	BOTH IP/OP	$114.55 	$84.77	$0.00	$88.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.02	$85.02	$0.00	$0.00	$23.87	$0.00	$0.00	$0.00	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
401.97	SUP	Custom 27203010		401.970  -  PIN FIX 1.8MM 20MM BUTTRESS TITANIUM DISTAL RAD NONSTRL	BOTH IP/OP	$111.23 	$82.31	$0.00	$88.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.55	$82.55	$0.00	$0.00	$23.18	$0.00	$0.00	$0.00	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
401.972	SUP	Custom 27203010		401.972  -  PIN FIX 1.8MM 22MM BUTTRESS TITANIUM DISTAL RAD NONSTRL	BOTH IP/OP	$114.55 	$84.77	$0.00	$88.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.02	$85.02	$0.00	$0.00	$23.87	$0.00	$0.00	$0.00	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
401.974	SUP	Custom 27203010		401.974  -  PIN FIX 1.8MM 24MM BUTTRESS TITANIUM DISTAL RAD NONSTRL	BOTH IP/OP	$114.55 	$84.77	$0.00	$88.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.02	$85.02	$0.00	$0.00	$23.87	$0.00	$0.00	$0.00	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
401.976	SUP	Custom 27203010		401.976  -  PIN FIX 1.8MM 26MM BUTTRESS TITANIUM DISTAL RAD NONSTRL	BOTH IP/OP	$114.55 	$84.77	$0.00	$88.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.02	$85.02	$0.00	$0.00	$23.87	$0.00	$0.00	$0.00	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
401.978	SUP	Custom 27203010		401.978  -  PIN FIX 1.8MM 28MM BUTTRESS TITANIUM DISTAL RAD NONSTRL	BOTH IP/OP	$114.55 	$84.77	$0.00	$88.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.02	$85.02	$0.00	$0.00	$23.87	$0.00	$0.00	$0.00	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
401.98	SUP	Custom 27203010		401.980  -  PIN FIX 1.8MM 30MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL	BOTH IP/OP	$111.23 	$82.31	$0.00	$88.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.55	$82.55	$0.00	$0.00	$23.18	$0.00	$0.00	$0.00	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
402	SUP	Custom 27204646		402  -  TUNNELER SURG 2 SLEEVE DISPOSABLE	BOTH IP/OP	"$1,080.00 "	$799.20	$0.00	$864.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$801.58	$801.58	$0.00	$0.00	$225.07	$0.00	$0.00	$0.00	$0.00	$540.00	$855.36	$864.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
402.006	SUP	HCPCS C1713		402.006  -  SCREW BONE 2.5MM STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 6MM	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.008	SUP	HCPCS C1713		402.008  -  SCREW BONE STANDARD 2.7MM 5MM 8MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.01	SUP	HCPCS C1713		402.010  -  SCREW BONE STANDARD 4MM 2.7MM 10MM T8 STARDRIVE SLFTAP	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.012	SUP	HCPCS C1713		402.012  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 12MM SPHERICAL HEAD	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.014	SUP	HCPCS C1713		402.014  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 14MM SPHERICAL HEAD	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.016	SUP	HCPCS C1713		402.016  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 16MM SMALL HEXAGONAL	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.018	SUP	HCPCS C1713		402.018  -  SCREW BONE 2.7MM 18MM TITANIUM CORTICAL NONSTRL MINI	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.02	SUP	HCPCS C1713		402.020  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 20MM SPHERICAL HEAD	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.022	SUP	HCPCS C1713		402.022  -  SCREW BONE 2.5MM STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 22	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.024	SUP	HCPCS C1713		402.024  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 24MM SPHERICAL HEAD	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.026	SUP	HCPCS C1713		402.026  -  SCREW BONE 2.7MM 26MM TITANIUM CORTICAL NONSTRL MINI	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.028	SUP	HCPCS C1713		402.028  -  SCREW BONE STANDARD 2.7MM 5MM 28MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.03	SUP	HCPCS C1713		402.030  -  SCREW BONE STANDARD 2.7MM 5MM 30MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.032	SUP	HCPCS C1713		402.032  -  SCREW BONE STANDARD 2.7MM 5MM 32MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.034	SUP	HCPCS C1713		402.034  -  SCREW BONE 2.7MM 34MM TITANIUM CORTICAL NONSTRL MINI	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.036	SUP	HCPCS C1713		402.036  -  SCREW BONE 2.7MM 36MM TITANIUM CORTICAL NONSTRL MINI	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.038	SUP	HCPCS C1713		402.038  -  SCREW BONE 2.5MM 38MM TITANIUM CORTICAL NONSTRL MINI	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.04	SUP	HCPCS C1713		402.040  -  SCREW BONE 2.7MM 40MM TITANIUM CORTICAL NONSTRL MINI	BOTH IP/OP	$54.93 	$40.65	$0.00	$43.94	$24.72	$24.72	$0.00	$0.00	$0.00	$11.45	$40.77	$40.77	$0.00	$0.00	$11.45	$0.00	$32.49	$32.49	$0.00	$27.46	$43.50	$43.94	$0.00		$0.00	$8.35	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
402.208	SUP	HCPCS C1713		402.208  -  SCREW BONE 2.7MM 8MM SLFTAP T8 STARDRIVE RECESS LOCKING LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.21	SUP	HCPCS C1713		402.210  -  SCREW BONE 2.7MM 10MM T8 STARDRIVE RECESS SLFTAP LOCKING LCP	BOTH IP/OP	$215.63 	$159.57	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.212	SUP	HCPCS C1713		402.212  -  SCREW BONE 2.7MM 12MM T8 STARDRIVE RECESS SELF TAP LOCK	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.214	SUP	HCPCS C1713		402.214  -  SCREW BONE 2.7MM 14MM T8 STARDRIVE RECESS SELF TAP LOCK LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.216	SUP	HCPCS C1713		402.216  -  SCREW BONE T8 2.7MM 16MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.218	SUP	HCPCS C1713		402.218  -  SCREW BONE T8 2.7MM 18MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.22	SUP	HCPCS C1713		402.220  -  SCREW BONE T8 2.7MM 20MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$215.63 	$159.57	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.222	SUP	HCPCS C1713		402.222  -  SCREW BONE 2.7MM 22MM T8 STARDRIVE RECESS SELF TAP LOCK LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.224	SUP	HCPCS C1713		402.224  -  SCREW BONE 2.7MM 24MM CANN SELF TAP LOCK STARDRIVE RECESS	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.226	SUP	HCPCS C1713		402.226  -  SCREW BONE 2.7MM 26MM CANN SELF TAP LOCK STARDRIVE RECESS	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.228	SUP	HCPCS C1713		402.228  -  SCREW BONE 2.7MM 28MM CANN SELF TAP LOCK STARDRIVE RECESS	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.23	SUP	HCPCS C1713		402.230  -  SCREW BONE 2.7MM 30MM SELF TAP LOCK T8 LCP STARDRIVE	BOTH IP/OP	$215.63 	$159.57	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.232	SUP	HCPCS C1713		402.232  -  SCREW BONE 2.7MM 32MM CANN SELF TAP LOCK STARDRIVE RECESS	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.234	SUP	HCPCS C1713		402.234  -  SCREW BONE 2.7MM 34MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.236	SUP	HCPCS C1713		402.236  -  SCREW BONE 2.7MM 36MM CANN SELF TAP LOCK STARDRIVE RECESS	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.238	SUP	HCPCS C1713		402.238  -  SCREW BONE 2.7MM 38MM SLFTAP LOCKING T8 STARDRIVE RECESS LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.24	SUP	HCPCS C1713		402.240  -  SCREW BONE 2.7MM 40MM SELF TAP LOCK T8 LCP STARDRIVE	BOTH IP/OP	$215.63 	$159.57	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.242	SUP	HCPCS C1713		402.242  -  SCREW BONE 2.7MM 42MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.244	SUP	HCPCS C1713		402.244  -  SCREW BONE 2.7MM 44MM SLFTAP LOCKING T8 STARDRIVE RECESS LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.246	SUP	HCPCS C1713		402.246  -  SCREW BONE 2.7MM 46MM SLFTAP LOCKING T8 STARDRIVE RECESS LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.248	SUP	HCPCS C1713		402.248  -  SCREW BONE 2.7MM 48MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.25	SUP	HCPCS C1713		402.250  -  SCREW BONE 2MM 50MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP	BOTH IP/OP	$215.63 	$159.57	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.255	SUP	HCPCS C1713		402.255  -  SCREW BONE 2.7MM 55MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$222.10 	$164.35	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$46.29	$164.84	$164.84	$0.00	$0.00	$46.29	$0.00	$131.37	$131.37	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.26	SUP	HCPCS C1713		402.260  -  SCREW BONE 2MM 60MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP	BOTH IP/OP	$215.63 	$159.57	$0.00	$172.50	$97.03	$97.03	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$107.81	$170.78	$172.50	$0.00		$0.00	$32.76	$0.00	$0.00	$34.33	$0.00	$0.00	$0.00	$0.00	$0.00
402.608	SUP	HCPCS C1713		402.608  -  SCREW BONE 3MM 4MM 1.2MM 8MM 4MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.609	SUP	HCPCS C1713		402.609  -  SCREW BONE 3MM 4MM 1.2MM 9MM 4MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.61	SUP	HCPCS C1713		402.610  -  SCREW BONE 3MM 4MM 1.2MM 10MM 4MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.611	SUP	HCPCS C1713		402.611  -  SCREW BONE 3MM 4MM 1.2MM 11MM 4MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.612	SUP	HCPCS C1713		402.612  -  SCREW BONE 3MM 4MM 1.2MM 12MM 4MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.613	SUP	HCPCS C1713		402.613  -  SCREW BONE 3MM 4MM 1.2MM 13MM 4MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.614	SUP	HCPCS C1713		402.614  -  SCREW BONE SHORT THREAD 3MM 14MM 4MM CANN SELF DRILL SELF	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.615	SUP	HCPCS C1713		402.615  -  SCREW BONE 3MM 4MM 1.2MM 15MM 4MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.616	SUP	HCPCS C1713		402.616  -  SCREW BONE 3MM 4MM 1.2MM 16MM 4MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.617	SUP	HCPCS C1713		402.617  -  SCREW BONE 3MM 4MM 1.2MM 17MM 4MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.618	SUP	HCPCS C1713		402.618  -  SCREW BONE 3MM 4MM 1.2MM 18MM 5MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.619	SUP	HCPCS C1713		402.619  -  SCREW BONE 3MM 4MM 1.2MM 19MM 5MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.62	SUP	HCPCS C1713		402.620  -  SCREW BONE 3MM 4MM 1.2MM 20MM 5MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.621	SUP	HCPCS C1713		402.621  -  SCREW BONE 3MM 4MM 1.2MM 21MM 5MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.622	SUP	HCPCS C1713		402.622  -  SCREW BONE 3MM 4MM 1.2MM 22MM 5MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.623	SUP	HCPCS C1713		402.623  -  SCREW BONE 3MM 4MM 1.2MM 23MM 5MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.624	SUP	HCPCS C1713		402.624  -  SCREW BONE 3MM 4MM 1.2MM 24MM 6MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.625	SUP	HCPCS C1713		402.625  -  SCREW BONE 3MM 4MM 1.2MM 25MM 6MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.626	SUP	HCPCS C1713		402.626  -  SCREW BONE 3MM 4MM 1.2MM 26MM 6MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.627	SUP	HCPCS C1713		402.627  -  SCREW BONE 3MM 4MM 1.2MM 27MM 6MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.628	SUP	HCPCS C1713		402.628  -  SCREW BONE 3MM 4MM 1.2MM 28MM 6MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.629	SUP	HCPCS C1713		402.629  -  SCREW BONE 3MM 4MM 1.2MM 29MM 6MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.63	SUP	HCPCS C1713		402.630  -  SCREW BONE 3MM 4MM 1.2MM 30MM 6MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.632	SUP	HCPCS C1713		402.632  -  SCREW BONE 3MM 4MM 1.2MM 32MM 6MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.634	SUP	HCPCS C1713		402.634  -  SCREW BONE 3MM 4MM 1.2MM 34MM 7MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.636	SUP	HCPCS C1713		402.636  -  SCREW BONE 3MM 4MM 1.2MM 36MM 7MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.638	SUP	HCPCS C1713		402.638  -  SCREW BONE 3MM 4MM 1.2MM 38MM 8MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.64	SUP	HCPCS C1713		402.640  -  SCREW BONE 3MM 4MM 1.2MM 40MM 8MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.714	SUP	HCPCS C1713		402.714  -  SCREW BONE 3MM 4MM 1.2MM 14MM 6MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.715	SUP	HCPCS C1713		402.715  -  SCREW BONE LNGTHRD 3MM 15MM CANN LOCK STARDRIVE RECESS	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.716	SUP	HCPCS C1713		402.716  -  SCREW BONE 3MM 4MM 1.2MM 16MM 7MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.717	SUP	HCPCS C1713		402.717  -  SCREW BONE 3MM 4MM 1.2MM 17MM 8MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.718	SUP	HCPCS C1713		402.718  -  SCREW BONE 3MM 4MM 1.2MM 18MM 8MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.719	SUP	HCPCS C1713		402.719  -  SCREW BONE 3MM 4MM 1.2MM 19MM 9MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.72	SUP	HCPCS C1713		402.720  -  SCREW BONE 3MM 4MM 1.2MM 20MM 9MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.721	SUP	HCPCS C1713		402.721  -  SCREW BONE 3MM 4MM 1.2MM 21MM 9MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.722	SUP	HCPCS C1713		402.722  -  SCREW BONE 3MM 4MM 1.2MM 22MM 10MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.723	SUP	HCPCS C1713		402.723  -  SCREW BONE 3MM 4MM 1.2MM 23MM 10MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.724	SUP	HCPCS C1713		402.724  -  SCREW BONE 3MM 4MM 1.2MM 24MM 10MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.725	SUP	HCPCS C1713		402.725  -  SCREW BONE 3MM 4MM 1.2MM 25MM 10MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.726	SUP	HCPCS C1713		402.726  -  SCREW BONE 3MM 4MM 1.2MM 26MM 12MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.727	SUP	HCPCS C1713		402.727  -  SCREW BONE 3MM 4MM 1.2MM 27MM 12MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.728	SUP	HCPCS C1713		402.728  -  SCREW BONE 3MM 4MM 1.2MM 28MM 12MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.729	SUP	HCPCS C1713		402.729  -  SCREW BONE 3MM 4MM 1.2MM 29MM 12MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.73	SUP	HCPCS C1713		402.730  -  SCREW BONE 3MM 4MM 1.2MM 30MM 14MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.732	SUP	HCPCS C1713		402.732  -  SCREW BONE 3MM 4MM 1.2MM 32MM 14MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.734	SUP	HCPCS C1713		402.734  -  SCREW BONE 3MM 4MM 1.2MM 34MM 16MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.736	SUP	HCPCS C1713		402.736  -  SCREW BONE 3MM 4MM 1.2MM 36MM 16MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.738	SUP	HCPCS C1713		402.738  -  SCREW BONE 3MM 4MM 1.2MM 38MM 18MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$372.50 	$275.65	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.74	SUP	HCPCS C1713		402.740  -  SCREW BONE 3MM 4MM 1.2MM 40MM 18MM CANN TITANIUM SMALL BONE	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$54.95	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
402.806	SUP	HCPCS C1713		402.806  -  SCREW BONE FULTHD 2.7MM 5MM 6MM SELF TAP SPHERICAL HEAD	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.808	SUP	HCPCS C1713		402.808  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 8MM SELF TAP	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.81	SUP	HCPCS C1713		402.810  -  SCREW BONE 2.7MM 5MM 10MM SELF TAP SPHERICAL HEAD SMALL	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.812	SUP	HCPCS C1713		402.812  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 12MM SELF TAP	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.814	SUP	HCPCS C1713		402.814  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 14MM SELF TAP	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.816	SUP	HCPCS C1713		402.816  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 16MM SELF TAP	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.818	SUP	HCPCS C1713		402.818  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 18MM SELF TAP	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.82	SUP	HCPCS C1713		402.820  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 20MM SELF TAP	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.822	SUP	HCPCS C1713		402.822  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 22MM SELF TAP	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.824	SUP	HCPCS C1713		402.824  -  SCREW BONE FULTHD 2.7MM 5MM 24MM SELF TAP SPHERICAL HEAD	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.826	SUP	HCPCS C1713		402.826  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 26MM SELF TAP	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.828	SUP	HCPCS C1713		402.828  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 28MM SELF TAP	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.83	SUP	HCPCS C1713		402.830  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 30MM SELF TAP	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.832	SUP	HCPCS C1713		402.832  -  SCREW BONE FULTHD 2.7MM 5MM 32MM SELF TAP HEXAGONAL SOCKET	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.834	SUP	HCPCS C1713		402.834  -  SCREW BONE FULTHD 2.7MM 5MM 34MM SELF TAP SPHERICAL HEAD	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.836	SUP	HCPCS C1713		402.836  -  SCREW BONE FULTHD 2.7MM 5MM 36MM SELF TAP SPHERICAL HEAD	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.838	SUP	HCPCS C1713		402.838  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 38MM SELF TAP	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.84	SUP	HCPCS C1713		402.840  -  SCREW BONE 2.7MM 40MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.845	SUP	HCPCS C1713		402.845  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 45MM SELF TAP	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.85	SUP	HCPCS C1713		402.850  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 50MM SELF TAP	BOTH IP/OP	$59.70 	$44.18	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.44	$44.31	$44.31	$0.00	$0.00	$12.44	$0.00	$35.31	$35.31	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.855	SUP	HCPCS C1713		402.855  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 55MM SELF TAP	BOTH IP/OP	$61.48 	$45.50	$0.00	$47.76	$26.87	$26.87	$0.00	$0.00	$0.00	$12.81	$45.63	$45.63	$0.00	$0.00	$12.81	$0.00	$36.36	$36.36	$0.00	$29.85	$47.28	$47.76	$0.00		$0.00	$9.07	$0.00	$0.00	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00
402.87	SUP	HCPCS C1713		402.870  -  SCREW BONE T8 2.7MM 10MM SELF TAP STARDRIVE LCP TITANIUM RAD	BOTH IP/OP	$68.90 	$50.99	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.36	$51.14	$51.14	$0.00	$0.00	$14.36	$0.00	$40.75	$40.75	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.872	SUP	HCPCS C1713		402.872  -  SCREW BONE T8 2.7MM 12MM SELF TAP STARDRIVE LCP TITANIUM RAD	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.874	SUP	HCPCS C1713		402.874  -  SCREW BONE T8 2.7MM 14MM SELF TAP STARDRIVE LCP TITANIUM RAD	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.876	SUP	HCPCS C1713		402.876  -  SCREW BONE T8 2.7MM 16MM SELF TAP STARDRIVE LCP TITANIUM RAD	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.878	SUP	HCPCS C1713		402.878  -  SCREW BONE T8 2.7MM 18MM SELF TAP STARDRIVE LCP TITANIUM RAD	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.88	SUP	HCPCS C1713		402.880  -  SCREW BONE T8 2.7MM 20MM SELF TAP STARDRIVE LCP TITANIUM RAD	BOTH IP/OP	$68.90 	$50.99	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.36	$51.14	$51.14	$0.00	$0.00	$14.36	$0.00	$40.75	$40.75	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.882	SUP	HCPCS C1713		402.882  -  SCREW BONE 2.7MM 22MM T8 STARDRIVE RECESS SLFTAP LCP	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.884	SUP	HCPCS C1713		402.884  -  SCREW BONE 2.7MM 24MM T8 STARDRIVE RECESS SLFTAP LCP	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.886	SUP	HCPCS C1713		402.886  -  SCREW BONE 2.7MM 26MM T8 STARDRIVE RECESS SLFTAP LCP	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.888	SUP	HCPCS C1713		402.888  -  SCREW BONE 2.7MM 28MM T8 STARDRIVE RECESS SLFTAP LCP	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.89	SUP	HCPCS C1713		402.890  -  SCREW BONE 2.7MM 30MM T8 STARDRIVE SELF TAP LCP TITANIUM RAD	BOTH IP/OP	$68.90 	$50.99	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.36	$51.14	$51.14	$0.00	$0.00	$14.36	$0.00	$40.75	$40.75	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.892	SUP	HCPCS C1713		402.892  -  SCREW BONE 2.7MM 32MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.894	SUP	HCPCS C1713		402.894  -  SCREW BONE 2.7MM 34MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.896	SUP	HCPCS C1713		402.896  -  SCREW BONE 2.7MM 36MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.898	SUP	HCPCS C1713		402.898  -  SCREW BONE 2.7MM 38MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.9	SUP	HCPCS C1713		402.900  -  SCREW BONE 2.7MM 5MM 40MM SLFTAP T8 STARDRIVE RECESS LCP	BOTH IP/OP	$68.90 	$50.99	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.36	$51.14	$51.14	$0.00	$0.00	$14.36	$0.00	$40.75	$40.75	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.962	SUP	HCPCS C1713		402.962  -  SCREW BONE 2.7MM 42MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.963	SUP	HCPCS C1713		402.963  -  SCREW BONE 2.7MM 44MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.965	SUP	HCPCS C1713		402.965  -  SCREW BONE T8 2.7MM 46MM SELF TAP STARDRIVE LCP TITANIUM RAD	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.966	SUP	HCPCS C1713		402.966  -  SCREW BONE T8 2.7MM 48MM SELF TAP STARDRIVE LCP TITANIUM RAD	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.967	SUP	HCPCS C1713		402.967  -  SCREW BONE 2.7MM 50MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.968	SUP	HCPCS C1713		402.968  -  SCREW BONE 2.7MM 55MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
402.969	SUP	HCPCS C1713		402.969  -  SCREW BONE 2.7MM 60MM SLFTAP LCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
404.01	SUP	HCPCS C1713		404.010  -  SCREW BONE STANDARD 3.5MM 6MM 10MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.012	SUP	HCPCS C1713		404.012  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 12MM SELF TAP SOCKET	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.014	SUP	HCPCS C1713		404.014  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 14MM SELF TAP SOCKET	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.016	SUP	HCPCS C1713		404.016  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 16MM SELF TAP SOCKET	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.018	SUP	HCPCS C1713		404.018  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 18MM SELF TAP SOCKET	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
404.02	SUP	HCPCS C1713		404.020  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 20MM SELF TAP SOCKET	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
404.022	SUP	HCPCS C1713		404.022  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 22MM SELF TAP SOCKET	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
404.024	SUP	HCPCS C1713		404.024  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 24MM SELF TAP SOCKET	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
404.026	SUP	HCPCS C1713		404.026  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 26MM SELF TAP SOCKET	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
404.028	SUP	HCPCS C1713		404.028  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 28MM SELF TAP SOCKET	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$12.43	$12.43	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.20	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
404.03	SUP	HCPCS C1713		404.030  -  SCREW BONE STANDARD SMALL HEXAGON 3.5MM 6MM 30MM SOCKET	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.032	SUP	HCPCS C1713		404.032  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 32MM SELF TAP SOCKET	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.034	SUP	HCPCS C1713		404.034  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 34MM SELF TAP SOCKET	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.036	SUP	HCPCS C1713		404.036  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 36MM SELF TAP SOCKET	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.038	SUP	HCPCS C1713		404.038  -  SCREW BONE STANDARD 3.5MM 6MM 38MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.04	SUP	HCPCS C1713		404.040  -  SCREW BONE STANDARD 3.5MM 6MM 40MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.045	SUP	HCPCS C1713		404.045  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 45MM SELF TAP SOCKET	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.05	SUP	HCPCS C1713		404.050  -  SCREW BONE STANDARD 3.5MM 6MM 50MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.055	SUP	HCPCS C1713		404.055  -  SCREW BONE 2.5MM STANDARD 3.5MM 6MM 55MM SMALL HEXAGONAL	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.06	SUP	HCPCS C1713		404.060  -  SCREW BONE 2.5MM STANDARD 3.5MM 6MM 60MM SMALL HEXAGONAL	BOTH IP/OP	$26.83 	$19.85	$0.00	$21.46	$12.07	$12.07	$0.00	$0.00	$0.00	$5.59	$19.91	$19.91	$0.00	$0.00	$5.59	$0.00	$15.87	$15.87	$0.00	$13.41	$21.25	$21.46	$0.00		$0.00	$4.20	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$0.00
404.216	SUP	HCPCS C1713		404.216  -  SCREW BONE HEXAGON SPHERE 3.5MM 16MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$33.73 	$24.96	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$7.03	$25.03	$25.03	$0.00	$0.00	$7.03	$0.00	$19.95	$19.95	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
404.218	SUP	HCPCS C1713		404.218  -  SCREW BONE HEXAGON SPHERE 3.5MM 18MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$33.73 	$24.96	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$7.03	$25.03	$25.03	$0.00	$0.00	$7.03	$0.00	$19.95	$19.95	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
404.22	SUP	HCPCS C1713		404.220  -  SCREW BONE HEXAGON SPHERE 3.5MM 20MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
404.222	SUP	HCPCS C1713		404.222  -  SCREW BONE HEXAGON SPHERE 3.5MM 22MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
404.224	SUP	HCPCS C1713		404.224  -  SCREW BONE HEXAGON SPHERE 3.5MM 24MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
404.226	SUP	HCPCS C1713		404.226  -  SCREW BONE HEXAGON SPHERE 3.5MM 26MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
404.228	SUP	HCPCS C1713		404.228  -  SCREW BONE HEXAGON SPHERE 3.5MM 28MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$33.73 	$24.96	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$7.03	$25.03	$25.03	$0.00	$0.00	$7.03	$0.00	$19.95	$19.95	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
404.23	SUP	HCPCS C1713		404.230  -  SCREW BONE PTHRD 3.5MM 6MM 30MM 10MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$32.75 	$24.24	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$6.83	$24.31	$24.31	$0.00	$0.00	$6.83	$0.00	$19.37	$19.37	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
404.232	SUP	HCPCS C1713		404.232  -  SCREW BONE HEXAGON SPHERE 3.5MM 32MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$33.73 	$24.96	$0.00	$26.20	$14.74	$14.74	$0.00	$0.00	$0.00	$7.03	$25.03	$25.03	$0.00	$0.00	$7.03	$0.00	$19.95	$19.95	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$4.98	$0.00	$0.00	$5.21	$0.00	$0.00	$0.00	$0.00	$0.00
404.234	SUP	HCPCS C1713		404.234  -  SCREW BONE HEXAGON SPHERE 3.5MM 34MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$31.80 	$23.53	$0.00	$25.44	$14.31	$14.31	$0.00	$0.00	$0.00	$6.63	$23.60	$23.60	$0.00	$0.00	$6.63	$0.00	$18.81	$18.81	$0.00	$15.90	$25.19	$25.44	$0.00		$0.00	$4.98	$0.00	$0.00	$5.06	$0.00	$0.00	$0.00	$0.00	$0.00
404.236	SUP	HCPCS C1713		404.236  -  SCREW BONE HEXAGON SPHERE 3.5MM 36MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$31.80 	$23.53	$0.00	$25.44	$14.31	$14.31	$0.00	$0.00	$0.00	$6.63	$23.60	$23.60	$0.00	$0.00	$6.63	$0.00	$18.81	$18.81	$0.00	$15.90	$25.19	$25.44	$0.00		$0.00	$4.98	$0.00	$0.00	$5.06	$0.00	$0.00	$0.00	$0.00	$0.00
404.238	SUP	HCPCS C1713		404.238  -  SCREW BONE HEXAGON SPHERE 3.5MM 38MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$31.80 	$23.53	$0.00	$25.44	$14.31	$14.31	$0.00	$0.00	$0.00	$6.63	$23.60	$23.60	$0.00	$0.00	$6.63	$0.00	$18.81	$18.81	$0.00	$15.90	$25.19	$25.44	$0.00		$0.00	$4.98	$0.00	$0.00	$5.06	$0.00	$0.00	$0.00	$0.00	$0.00
404.24	SUP	HCPCS C1713		404.240  -  SCREW BONE HEXAGON SPHERE 3.5MM 40MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$31.80 	$23.53	$0.00	$25.44	$14.31	$14.31	$0.00	$0.00	$0.00	$6.63	$23.60	$23.60	$0.00	$0.00	$6.63	$0.00	$18.81	$18.81	$0.00	$15.90	$25.19	$25.44	$0.00		$0.00	$4.98	$0.00	$0.00	$5.06	$0.00	$0.00	$0.00	$0.00	$0.00
404.245	SUP	HCPCS C1713		404.245  -  SCREW BONE HEXAGON SPHERE 3.5MM 45MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$31.80 	$23.53	$0.00	$25.44	$14.31	$14.31	$0.00	$0.00	$0.00	$6.63	$23.60	$23.60	$0.00	$0.00	$6.63	$0.00	$18.81	$18.81	$0.00	$15.90	$25.19	$25.44	$0.00		$0.00	$4.98	$0.00	$0.00	$5.06	$0.00	$0.00	$0.00	$0.00	$0.00
404.25	SUP	HCPCS C1713		404.250  -  SCREW BONE HEXAGON SPHERE 3.5MM 50MM SELF TAP SOCKET LC-DCP	BOTH IP/OP	$31.80 	$23.53	$0.00	$25.44	$14.31	$14.31	$0.00	$0.00	$0.00	$6.63	$23.60	$23.60	$0.00	$0.00	$6.63	$0.00	$18.81	$18.81	$0.00	$15.90	$25.19	$25.44	$0.00		$0.00	$4.98	$0.00	$0.00	$5.06	$0.00	$0.00	$0.00	$0.00	$0.00
404.81	SUP	HCPCS C1713		404.810  -  SCREW BONE FULTHD 3.5MM 6MM 10MM SLFTAP HEXAGONAL RECESS LCP	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.812	SUP	HCPCS C1713		404.812  -  SCREW BONE FULTHD 3.5MM 6MM 12MM SELF TAP HEXAGONAL RECESS	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.814	SUP	HCPCS C1713		404.814  -  SCREW BONE FULTHD 3.5MM 6MM 14MM SELF TAP HEXAGONAL RECESS	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.816	SUP	HCPCS C1713		404.816  -  SCREW BONE FULTHD 3.5MM 6MM 16MM SELF TAP HEXAGONAL RECESS	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$9.70	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.818	SUP	HCPCS C1713		404.818  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 18MM SELF TAP SOCKET LCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.82	SUP	HCPCS C1713		404.820  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 20MM SELF TAP SOCKET LCP	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$9.70	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.822	SUP	HCPCS C1713		404.822  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 22MM SELF TAP SOCKET LCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.824	SUP	HCPCS C1713		404.824  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 24MM SELF TAP SOCKET LCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.826	SUP	HCPCS C1713		404.826  -  SCREW BONE FULTHD 3.5MM 6MM 26MM SELF TAP HEXAGONAL RECESS	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.828	SUP	HCPCS C1713		404.828  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 28MM SELF TAP SOCKET LCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.83	SUP	HCPCS C1713		404.830  -  SCREW BONE FULTHD 3.5MM 6MM 30MM SLFTAP HEXAGONAL RECESS LCP	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.832	SUP	HCPCS C1713		404.832  -  SCREW BONE FULTHD 3.5MM 6MM 32MM SELF TAP HEXAGONAL RECESS	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.834	SUP	HCPCS C1713		404.834  -  SCREW BONE FULTHD 3.5MM 6MM 34MM SELF TAP HEXAGONAL RECESS	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.836	SUP	HCPCS C1713		404.836  -  SCREW BONE FULTHD 3.5MM 6MM 36MM SELF TAP HEXAGONAL RECESS	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.838	SUP	HCPCS C1713		404.838  -  SCREW BONE FULTHD 3.5MM 6MM 38MM SELF TAP HEXAGONAL RECESS	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.84	SUP	HCPCS C1713		404.840  -  SCREW BONE HEXAGON 3.5MM 40MM SLFTAP SMALL RECESS LCP	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.845	SUP	HCPCS C1713		404.845  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 45MM SELF TAP SOCKET LCP	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.85	SUP	HCPCS C1713		404.850  -  SCREW BONE FULTHD 3.5MM 6MM 50MM SELF TAP HEXAGONAL RECESS	BOTH IP/OP	$38.55 	$28.53	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.03	$28.61	$28.61	$0.00	$0.00	$8.03	$0.00	$22.80	$22.80	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
404.855	SUP	HCPCS C1713		404.855  -  SCREW BONE FULTHD 3.5MM 6MM 55MM SELF TAP HEXAGONAL RECESS	BOTH IP/OP	$39.70 	$29.38	$0.00	$30.84	$17.35	$17.35	$0.00	$0.00	$0.00	$8.27	$29.47	$29.47	$0.00	$0.00	$8.27	$0.00	$23.48	$23.48	$0.00	$19.28	$30.53	$30.84	$0.00		$0.00	$5.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$0.00
406.01	SUP	HCPCS C1713		406.010  -  SCREW BONE FULTHD 4MM 10MM LCP TITANIUM CANCELLOUS CLAVICLE	BOTH IP/OP	$31.73 	$23.48	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.012	SUP	HCPCS C1713		406.012  -  SCREW BONE FULTHD HEXAGON 4MM 12MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.014	SUP	HCPCS C1713		406.014  -  SCREW BONE FULTHD HEXAGON 4MM 14MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.016	SUP	HCPCS C1713		406.016  -  SCREW BONE FULTHD HEXAGON 4MM 16MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.018	SUP	HCPCS C1713		406.018  -  SCREW BONE FULTHD HEXAGON 4MM 18MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$7.42	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.02	SUP	HCPCS C1713		406.020  -  SCREW BONE FULTHD HEXAGON 4MM 20MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$31.73 	$23.48	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$7.42	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.022	SUP	HCPCS C1713		406.022  -  SCREW BONE FULTHD 4MM 6MM 22MM 9MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.024	SUP	HCPCS C1713		406.024  -  SCREW BONE FULTHD 4MM 6MM 24MM 10MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.026	SUP	HCPCS C1713		406.026  -  SCREW BONE FULTHD HEXAGON 4MM 26MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$7.42	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.028	SUP	HCPCS C1713		406.028  -  SCREW BONE FULTHD HEXAGON 4MM 28MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$7.42	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.03	SUP	HCPCS C1713		406.030  -  SCREW BONE FULTHD 4MM 6MM 30MM LC-DCP TITANIUM TIBIA	BOTH IP/OP	$31.73 	$23.48	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.032	SUP	HCPCS C1713		406.032  -  SCREW BONE FULTHD HEXAGON 4MM 32MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$30.80 	$22.79	$0.00	$24.64	$13.86	$13.86	$0.00	$0.00	$0.00	$6.42	$22.86	$22.86	$0.00	$0.00	$6.42	$0.00	$18.22	$18.22	$0.00	$15.40	$24.39	$24.64	$0.00		$0.00	$4.82	$0.00	$0.00	$4.90	$0.00	$0.00	$0.00	$0.00	$0.00
406.035	SUP	HCPCS C1713		406.035  -  SCREW BONE FULTHD HEXAGON 4MM 35MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.04	SUP	HCPCS C1713		406.040  -  SCREW BONE FULTHD SMALL HEXAGON 4MM 6MM 40MM SOCKET TITANIUM	BOTH IP/OP	$31.73 	$23.48	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$7.42	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.045	SUP	HCPCS C1713		406.045  -  SCREW BONE FULTHD 4MM 6MM 45MM 15MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.05	SUP	HCPCS C1713		406.050  -  SCREW BONE FULTHD HEXAGON 4MM 50MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$31.73 	$23.48	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$4.82	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.055	SUP	HCPCS C1713		406.055  -  SCREW BONE FULTHD 4MM 6MM 55MM 15MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$32.68 	$24.18	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.81	$24.25	$24.25	$0.00	$0.00	$6.81	$0.00	$19.33	$19.33	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$7.42	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.06	SUP	HCPCS C1713		406.060  -  SCREW BONE FULTHD 4MM 6MM 60MM 15MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$31.73 	$23.48	$0.00	$25.38	$14.28	$14.28	$0.00	$0.00	$0.00	$6.61	$23.55	$23.55	$0.00	$0.00	$6.61	$0.00	$18.77	$18.77	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$7.42	$0.00	$0.00	$5.05	$0.00	$0.00	$0.00	$0.00	$0.00
406.065	SUP	HCPCS C1713		406.065  -  SCREW BONE FULTHD 4MM 65MM LC-DCP TITANIUM TIBIA CANCELLOUS	BOTH IP/OP	$35.83 	$26.51	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.47	$26.59	$26.59	$0.00	$0.00	$7.47	$0.00	$21.19	$21.19	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
406.07	SUP	HCPCS C1713		406.070  -  SCREW BONE FULTHD 4MM 70MM LCP TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$34.80 	$25.75	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.25	$25.83	$25.83	$0.00	$0.00	$7.25	$0.00	$20.58	$20.58	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
406.075	SUP	HCPCS C1713		406.075  -  SCREW BONE FULTHD 4MM 75MM LC-DCP TITANIUM TIBIA CANCELLOUS	BOTH IP/OP	$35.83 	$26.51	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.47	$26.59	$26.59	$0.00	$0.00	$7.47	$0.00	$21.19	$21.19	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
406.08	SUP	HCPCS C1713		406.080  -  SCREW BONE FULTHD 4MM 80MM LCP TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$34.80 	$25.75	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.25	$25.83	$25.83	$0.00	$0.00	$7.25	$0.00	$20.58	$20.58	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
406.085	SUP	HCPCS C1713		406.085  -  SCREW BONE FULTHD 4MM 85MM LC-DCP TITANIUM TIBIA CANCELLOUS	BOTH IP/OP	$35.83 	$26.51	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.47	$26.59	$26.59	$0.00	$0.00	$7.47	$0.00	$21.19	$21.19	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
406.09	SUP	HCPCS C1713		406.090  -  SCREW BONE FULTHD 4MM 90MM LCP TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$34.80 	$25.75	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.25	$25.83	$25.83	$0.00	$0.00	$7.25	$0.00	$20.58	$20.58	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
406.095	SUP	HCPCS C1713		406.095  -  SCREW BONE FULTHD 4MM 95MM LC-DCP TITANIUM TIBIA CANCELLOUS	BOTH IP/OP	$35.83 	$26.51	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.47	$26.59	$26.59	$0.00	$0.00	$7.47	$0.00	$21.19	$21.19	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
406.1	SUP	HCPCS C1713		406.100  -  SCREW BONE FULTHD 4MM 100MM LC-DCP TITANIUM TIBIA CANCELLOUS	BOTH IP/OP	$34.80 	$25.75	$0.00	$27.84	$15.66	$15.66	$0.00	$0.00	$0.00	$7.25	$25.83	$25.83	$0.00	$0.00	$7.25	$0.00	$20.58	$20.58	$0.00	$17.40	$27.56	$27.84	$0.00		$0.00	$5.29	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$0.00
406.104	SUP	HCPCS C1713		406.104  -  SCREW BONE LOCK STARDRIVE AXON TITANIUM SPN NONSTRL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
407.01	SUP	HCPCS C1713		407.010  -  SCREW BONE PTHRD HEXAGON 4MM 10MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$30.03 	$22.22	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.012	SUP	HCPCS C1713		407.012  -  SCREW BONE PTHRD HEXAGON 4MM 12MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.014	SUP	HCPCS C1713		407.014  -  SCREW BONE PTHRD HEXAGON 4MM 14MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.016	SUP	HCPCS C1713		407.016  -  SCREW BONE PTHRD 4MM 6MM 16MM 6MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.018	SUP	HCPCS C1713		407.018  -  SCREW BONE PTHRD 4MM 6MM 18MM 7MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.02	SUP	HCPCS C1713		407.020  -  SCREW BONE PTHRD HEXAGON 4MM 20MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$30.03 	$22.22	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.022	SUP	HCPCS C1713		407.022  -  SCREW BONE PTHRD 4MM 6MM 22MM 9MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.024	SUP	HCPCS C1713		407.024  -  SCREW BONE PTHRD 4MM 6MM 24MM 10MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.026	SUP	HCPCS C1713		407.026  -  SCREW BONE PTHRD 4MM 6MM 26MM 12MM SMALL HEXAGONAL SOCKET	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.028	SUP	HCPCS C1713		407.028  -  SCREW BONE PTHRD 4MM 6MM 28MM 14MM HEXAGONAL SOCKET LC-DCP	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.03	SUP	HCPCS C1713		407.030  -  SCREW BONE PTHRD HEXAGON 4MM 30MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$30.03 	$22.22	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.035	SUP	HCPCS C1713		407.035  -  SCREW BONE PTHRD HEXAGON 4MM 35MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$7.42	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.04	SUP	HCPCS C1713		407.040  -  SCREW BONE PTHRD HEXAGON 4MM 40MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$30.03 	$22.22	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.045	SUP	HCPCS C1713		407.045  -  SCREW BONE PTHRD HEXAGON 4MM 45MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.05	SUP	HCPCS C1713		407.050  -  SCREW BONE PTHRD HEXAGON 4MM 50MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$30.03 	$22.22	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.055	SUP	HCPCS C1713		407.055  -  SCREW BONE PTHRD HEXAGON 4MM 55MM SOCKET LC-DCP TITANIUM	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.45	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$18.29	$18.29	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.06	SUP	HCPCS C1713		407.060  -  SCREW BONE 4MM 60MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS	BOTH IP/OP	$30.03 	$22.22	$0.00	$24.02	$13.51	$13.51	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.02	$0.00		$0.00	$4.56	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
407.065	SUP	HCPCS C1713		407.065  -  SCREW BONE 4MM 65MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS	BOTH IP/OP	$35.15 	$26.01	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.33	$26.09	$26.09	$0.00	$0.00	$7.33	$0.00	$20.79	$20.79	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
407.07	SUP	HCPCS C1713		407.070  -  SCREW BONE PTHRD 4MM 70MM LCP TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$34.13 	$25.26	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.11	$25.33	$25.33	$0.00	$0.00	$7.11	$0.00	$20.18	$20.18	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
407.075	SUP	HCPCS C1713		407.075  -  SCREW BONE 4MM 75MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS	BOTH IP/OP	$35.15 	$26.01	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.33	$26.09	$26.09	$0.00	$0.00	$7.33	$0.00	$20.79	$20.79	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
407.08	SUP	HCPCS C1713		407.080  -  SCREW BONE PTHRD 4MM 80MM LCP TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$34.13 	$25.26	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.11	$25.33	$25.33	$0.00	$0.00	$7.11	$0.00	$20.18	$20.18	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
407.085	SUP	HCPCS C1713		407.085  -  SCREW BONE 4MM 85MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS	BOTH IP/OP	$35.15 	$26.01	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.33	$26.09	$26.09	$0.00	$0.00	$7.33	$0.00	$20.79	$20.79	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
407.09	SUP	HCPCS C1713		407.090  -  SCREW BONE PTHRD 4MM 90MM LCP TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$34.13 	$25.26	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.11	$25.33	$25.33	$0.00	$0.00	$7.11	$0.00	$20.18	$20.18	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
407.095	SUP	HCPCS C1713		407.095  -  SCREW BONE 4MM 95MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS	BOTH IP/OP	$35.15 	$26.01	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.33	$26.09	$26.09	$0.00	$0.00	$7.33	$0.00	$20.79	$20.79	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
407.1	SUP	HCPCS C1713		407.100  -  SCREW BONE PTHRD 4MM 100MM LCP TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$34.13 	$25.26	$0.00	$27.30	$15.36	$15.36	$0.00	$0.00	$0.00	$7.11	$25.33	$25.33	$0.00	$0.00	$7.11	$0.00	$20.18	$20.18	$0.00	$17.06	$27.03	$27.30	$0.00		$0.00	$5.18	$0.00	$0.00	$5.43	$0.00	$0.00	$0.00	$0.00	$0.00
407.61	SUP	HCPCS C1713		407.610  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 10MM SELF DRILL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.612	SUP	HCPCS C1713		407.612  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 12MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.614	SUP	HCPCS C1713		407.614  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 14MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.616	SUP	HCPCS C1713		407.616  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 16MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.618	SUP	HCPCS C1713		407.618  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 18MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.62	SUP	HCPCS C1713		407.620  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 20MM SELF DRILL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.622	SUP	HCPCS C1713		407.622  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 22MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.624	SUP	HCPCS C1713		407.624  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 24MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.626	SUP	HCPCS C1713		407.626  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 26MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.628	SUP	HCPCS C1713		407.628  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 28MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$73.99	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.63	SUP	HCPCS C1713		407.630  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 30MM SELF DRILL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.632	SUP	HCPCS C1713		407.632  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 32MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.634	SUP	HCPCS C1713		407.634  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 34MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.636	SUP	HCPCS C1713		407.636  -  SCREW BONE SHORT THREAD 4MM 5MM 36MM CANN HEXAGONAL SOCKET	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.638	SUP	HCPCS C1713		407.638  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 38MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.64	SUP	HCPCS C1713		407.640  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 40MM SELF DRILL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.642	SUP	HCPCS C1713		407.642  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 42MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.644	SUP	HCPCS C1713		407.644  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 44MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.646	SUP	HCPCS C1713		407.646  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 46MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.648	SUP	HCPCS C1713		407.648  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 48MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.65	SUP	HCPCS C1713		407.650  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 50MM SELF DRILL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$73.99	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.652	SUP	HCPCS C1713		407.652  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 52MM SELF DRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.654	SUP	HCPCS C1713		407.654  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 54MM SELF DRILL	BOTH IP/OP	$380.95 	$281.90	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$79.40	$282.74	$282.74	$0.00	$0.00	$79.39	$0.00	$225.33	$225.33	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.656	SUP	HCPCS C1713		407.656  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 56MM SELF DRILL	BOTH IP/OP	$380.95 	$281.90	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$79.40	$282.74	$282.74	$0.00	$0.00	$79.39	$0.00	$225.33	$225.33	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.658	SUP	HCPCS C1713		407.658  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 58MM SELF DRILL	BOTH IP/OP	$380.95 	$281.90	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$79.40	$282.74	$282.74	$0.00	$0.00	$79.39	$0.00	$225.33	$225.33	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.66	SUP	HCPCS C1713		407.660  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 60MM SELF DRILL	BOTH IP/OP	$369.85 	$273.69	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$77.09	$274.50	$274.50	$0.00	$0.00	$77.08	$0.00	$218.77	$218.77	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.664	SUP	HCPCS C1713		407.664  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 64MM SELF DRILL	BOTH IP/OP	$380.95 	$281.90	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$79.40	$282.74	$282.74	$0.00	$0.00	$79.39	$0.00	$225.33	$225.33	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.668	SUP	HCPCS C1713		407.668  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 68MM SELF DRILL	BOTH IP/OP	$380.95 	$281.90	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$79.40	$282.74	$282.74	$0.00	$0.00	$79.39	$0.00	$225.33	$225.33	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.672	SUP	HCPCS C1713		407.672  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 72MM SELF DRILL	BOTH IP/OP	$380.95 	$281.90	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$79.40	$282.74	$282.74	$0.00	$0.00	$79.39	$0.00	$225.33	$225.33	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.716	SUP	HCPCS C1713		407.716  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 16MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.718	SUP	HCPCS C1713		407.718  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 18MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.72	SUP	HCPCS C1713		407.720  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 20MM CANN TITANIUM SMALL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.722	SUP	HCPCS C1713		407.722  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 22MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.724	SUP	HCPCS C1713		407.724  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 24MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.726	SUP	HCPCS C1713		407.726  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 26MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.728	SUP	HCPCS C1713		407.728  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 28MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.73	SUP	HCPCS C1713		407.730  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 30MM CANN TITANIUM SMALL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.732	SUP	HCPCS C1713		407.732  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 32MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.734	SUP	HCPCS C1713		407.734  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 34MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.736	SUP	HCPCS C1713		407.736  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 36MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.738	SUP	HCPCS C1713		407.738  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 38MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.74	SUP	HCPCS C1713		407.740  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 40MM CANN TITANIUM SMALL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.742	SUP	HCPCS C1713		407.742  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 42MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.744	SUP	HCPCS C1713		407.744  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 44MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.746	SUP	HCPCS C1713		407.746  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 46MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.748	SUP	HCPCS C1713		407.748  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 48MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.75	SUP	HCPCS C1713		407.750  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 50MM CANN TITANIUM SMALL	BOTH IP/OP	$357.58 	$264.61	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$74.53	$265.39	$265.39	$0.00	$0.00	$74.52	$0.00	$211.51	$211.51	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.752	SUP	HCPCS C1713		407.752  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 52MM CANN TITANIUM SMALL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
407.754	SUP	HCPCS C1713		407.754  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 54MM CANN TITANIUM SMALL	BOTH IP/OP	$380.95 	$281.90	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$79.40	$282.74	$282.74	$0.00	$0.00	$79.39	$0.00	$225.33	$225.33	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.756	SUP	HCPCS C1713		407.756  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 56MM CANN TITANIUM SMALL	BOTH IP/OP	$380.95 	$281.90	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$79.40	$282.74	$282.74	$0.00	$0.00	$79.39	$0.00	$225.33	$225.33	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.758	SUP	HCPCS C1713		407.758  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 58MM CANN TITANIUM SMALL	BOTH IP/OP	$380.95 	$281.90	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$79.40	$282.74	$282.74	$0.00	$0.00	$79.39	$0.00	$225.33	$225.33	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.76	SUP	HCPCS C1713		407.760  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 60MM CANN TITANIUM SMALL	BOTH IP/OP	$369.85 	$273.69	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$77.09	$274.50	$274.50	$0.00	$0.00	$77.08	$0.00	$218.77	$218.77	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.764	SUP	HCPCS C1713		407.764  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 64MM CANN TITANIUM SMALL	BOTH IP/OP	$380.95 	$281.90	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$79.40	$282.74	$282.74	$0.00	$0.00	$79.39	$0.00	$225.33	$225.33	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.768	SUP	HCPCS C1713		407.768  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 68MM CANN TITANIUM SMALL	BOTH IP/OP	$380.95 	$281.90	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$79.40	$282.74	$282.74	$0.00	$0.00	$79.39	$0.00	$225.33	$225.33	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
407.772	SUP	HCPCS C1713		407.772  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 72MM CANN TITANIUM SMALL	BOTH IP/OP	$380.95 	$281.90	$0.00	$295.88	$166.43	$166.43	$0.00	$0.00	$0.00	$79.40	$282.74	$282.74	$0.00	$0.00	$79.39	$0.00	$225.33	$225.33	$0.00	$184.93	$292.92	$295.88	$0.00		$0.00	$56.20	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00
408.401	SUP	HCPCS C1713		408.401  -  SCREW BONE 6.5MM 30MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.402	SUP	HCPCS C1713		408.402  -  SCREW BONE 6.5MM 35MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.403	SUP	HCPCS C1713		408.403  -  SCREW BONE 6.5MM 40MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.404	SUP	HCPCS C1713		408.404  -  SCREW BONE 6.5MM 45MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.405	SUP	HCPCS C1713		408.405  -  SCREW BONE 6.5MM 50MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.406	SUP	HCPCS C1713		408.406  -  SCREW BONE 6.5MM 55MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.407	SUP	HCPCS C1713		408.407  -  SCREW BONE 6.5MM 7.9MM 2.9MM 60MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.408	SUP	HCPCS C1713		408.408  -  SCREW BONE 6.5MM 7.9MM 2.9MM 65MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.409	SUP	HCPCS C1713		408.409  -  SCREW BONE 6.5MM 7.9MM 2.9MM 70MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.41	SUP	HCPCS C1713		408.410  -  SCREW BONE 6.5MM 7.9MM 2.9MM 75MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.411	SUP	HCPCS C1713		408.411  -  SCREW BONE 6.5MM 7.9MM 2.9MM 80MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.412	SUP	HCPCS C1713		408.412  -  SCREW BONE 6.5MM 7.9MM 2.9MM 85MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.413	SUP	HCPCS C1713		408.413  -  SCREW BONE 6.5MM 7.9MM 2.9MM 90MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.414	SUP	HCPCS C1713		408.414  -  SCREW BONE 6.5MM 7.9MM 2.9MM 95MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.415	SUP	HCPCS C1713		408.415  -  SCREW BONE 6.5MM 7.9MM 2.9MM 100MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.416	SUP	HCPCS C1713		408.416  -  SCREW BONE 6.5MM 7.9MM 2.9MM 105MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.417	SUP	HCPCS C1713		408.417  -  SCREW BONE 6.5MM 7.9MM 2.9MM 110MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.418	SUP	HCPCS C1713		408.418  -  SCREW BONE 6.5MM 7.9MM 2.9MM 115MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.419	SUP	HCPCS C1713		408.419  -  SCREW BONE 6.5MM 7.9MM 2.9MM 120MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.42	SUP	HCPCS C1713		408.420  -  SCREW BONE 6.5MM 7.9MM 2.9MM 125MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.421	SUP	HCPCS C1713		408.421  -  SCREW BONE 6.5MM 7.9MM 2.9MM 130MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.422	SUP	HCPCS C1713		408.422  -  SCREW BONE 6.5MM 7.9MM 2.9MM 135MM 16MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.423	SUP	HCPCS C1713		408.423  -  SCREW BONE 6.5MM 140MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.424	SUP	HCPCS C1713		408.424  -  SCREW BONE 6.5MM 145MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.425	SUP	HCPCS C1713		408.425  -  SCREW BONE 6.5MM 150MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.426	SUP	HCPCS C1713		408.426  -  SCREW BONE 6.5MM 160MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.427	SUP	HCPCS C1713		408.427  -  SCREW BONE 6.5MM 170MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.428	SUP	HCPCS C1713		408.428  -  SCREW BONE 6.5MM 180MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.431	SUP	HCPCS C1713		408.431  -  SCREW BONE 6.5MM 45MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.432	SUP	HCPCS C1713		408.432  -  SCREW BONE 6.5MM 50MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.433	SUP	HCPCS C1713		408.433  -  SCREW BONE 6.5MM 55MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.434	SUP	HCPCS C1713		408.434  -  SCREW BONE 6.5MM 7.9MM 2.9MM 60MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.435	SUP	HCPCS C1713		408.435  -  SCREW BONE 6.5MM 7.9MM 2.9MM 65MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.436	SUP	HCPCS C1713		408.436  -  SCREW BONE 6.5MM 7.9MM 2.9MM 70MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.437	SUP	HCPCS C1713		408.437  -  SCREW BONE 6.5MM 7.9MM 2.9MM 75MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.438	SUP	HCPCS C1713		408.438  -  SCREW BONE 6.5MM 7.9MM 2.9MM 80MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.439	SUP	HCPCS C1713		408.439  -  SCREW BONE 6.5MM 7.9MM 2.9MM 85MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.44	SUP	HCPCS C1713		408.440  -  SCREW BONE 6.5MM 7.9MM 2.9MM 90MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.441	SUP	HCPCS C1713		408.441  -  SCREW BONE 6.5MM 7.9MM 2.9MM 95MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.442	SUP	HCPCS C1713		408.442  -  SCREW BONE 6.5MM 7.9MM 2.9MM 100MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.443	SUP	HCPCS C1713		408.443  -  SCREW BONE 6.5MM 7.9MM 2.9MM 105MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.444	SUP	HCPCS C1713		408.444  -  SCREW BONE 6.5MM 7.9MM 2.9MM 110MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.445	SUP	HCPCS C1713		408.445  -  SCREW BONE 6.5MM 7.9MM 2.9MM 115MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.446	SUP	HCPCS C1713		408.446  -  SCREW BONE 6.5MM 7.9MM 2.9MM 120MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.447	SUP	HCPCS C1713		408.447  -  SCREW BONE 6.5MM 7.9MM 2.9MM 125MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.448	SUP	HCPCS C1713		408.448  -  SCREW BONE 6.5MM 7.9MM 2.9MM 130MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.449	SUP	HCPCS C1713		408.449  -  SCREW BONE 6.5MM 7.9MM 2.9MM 135MM 32MM CANN TITANIUM LARGE	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.45	SUP	HCPCS C1713		408.450  -  SCREW BONE 6.5MM 140MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.451	SUP	HCPCS C1713		408.451  -  SCREW BONE 6.5MM 145MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.452	SUP	HCPCS C1713		408.452  -  SCREW BONE 6.5MM 150MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.453	SUP	HCPCS C1713		408.453  -  SCREW BONE 6.5MM 160MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.454	SUP	HCPCS C1713		408.454  -  SCREW BONE 6.5MM 170MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.455	SUP	HCPCS C1713		408.455  -  SCREW BONE 6.5MM 180MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.46	SUP	HCPCS C1713		408.460  -  SCREW BONE FULTHD 6.5MM 20MM CANN TITANIUM FEMUR TIBIA ANKLE	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.461	SUP	HCPCS C1713		408.461  -  SCREW BONE FULTHD 6.5MM 25MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.462	SUP	HCPCS C1713		408.462  -  SCREW BONE FULTHD 6.5MM 30MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.463	SUP	HCPCS C1713		408.463  -  SCREW BONE FULTHD 6.5MM 35MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.464	SUP	HCPCS C1713		408.464  -  SCREW BONE FULTHD 6.5MM 40MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.465	SUP	HCPCS C1713		408.465  -  SCREW BONE 6.5MM 45MM FULTHRD TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.466	SUP	HCPCS C1713		408.466  -  SCREW BONE FULTHD 6.5MM 50MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.467	SUP	HCPCS C1713		408.467  -  SCREW BONE FULTHD 6.5MM 55MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.468	SUP	HCPCS C1713		408.468  -  SCREW BONE FULTHD 6.5MM 60MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.469	SUP	HCPCS C1713		408.469  -  SCREW BONE FULTHD 6.5MM 65MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.47	SUP	HCPCS C1713		408.470  -  SCREW BONE FULTHD 6.5MM 70MM CANN TITANIUM FEMUR TIBIA ANKLE	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.471	SUP	HCPCS C1713		408.471  -  SCREW BONE FULTHD 6.5MM 75MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.472	SUP	HCPCS C1713		408.472  -  SCREW BONE FULTHD 6.5MM 80MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.473	SUP	HCPCS C1713		408.473  -  SCREW BONE FULTHD 6.5MM 85MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.474	SUP	HCPCS C1713		408.474  -  SCREW BONE FULTHD 6.5MM 90MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.475	SUP	HCPCS C1713		408.475  -  SCREW BONE FULTHD 6.5MM 95MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.476	SUP	HCPCS C1713		408.476  -  SCREW BONE FULTHD 6.5MM 100MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.477	SUP	HCPCS C1713		408.477  -  SCREW BONE FULTHD 6.5MM 105MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.478	SUP	HCPCS C1713		408.478  -  SCREW BONE FULTHD 6.5MM 110MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.479	SUP	HCPCS C1713		408.479  -  SCREW BONE FULTHD 6.5MM 115MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.48	SUP	HCPCS C1713		408.480  -  SCREW BONE FULTHD 6.5MM 120MM CANN TITANIUM FEMUR TIBIA	BOTH IP/OP	$472.20 	$349.43	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$98.42	$350.47	$350.47	$0.00	$0.00	$98.41	$0.00	$279.31	$279.31	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.481	SUP	HCPCS C1713		408.481  -  SCREW BONE FULTHD 6.5MM 125MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.482	SUP	HCPCS C1713		408.482  -  SCREW BONE FULTHD 6.5MM 130MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
408.483	SUP	HCPCS C1713		408.483  -  SCREW BONE 6.5MM 140MM CANN FULTHD TITANIUM ORTHOPEDIC	BOTH IP/OP	$501.83 	$371.35	$0.00	$389.78	$219.25	$219.25	$0.00	$0.00	$0.00	$104.59	$372.45	$372.45	$0.00	$0.00	$104.58	$0.00	$296.83	$296.83	$0.00	$243.61	$385.89	$389.78	$0.00		$0.00	$74.03	$0.00	$0.00	$77.57	$0.00	$0.00	$0.00	$0.00	$0.00
408.484	SUP	HCPCS C1713		408.484  -  SCREW BONE FULTHD 6.5MM 150MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$501.83 	$371.35	$0.00	$389.78	$219.25	$219.25	$0.00	$0.00	$0.00	$104.59	$372.45	$372.45	$0.00	$0.00	$104.58	$0.00	$296.83	$296.83	$0.00	$243.61	$385.89	$389.78	$0.00		$0.00	$74.03	$0.00	$0.00	$77.57	$0.00	$0.00	$0.00	$0.00	$0.00
408.485	SUP	HCPCS C1713		408.485  -  SCREW BONE FULTHD 6.5MM 160MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$501.83 	$371.35	$0.00	$389.78	$219.25	$219.25	$0.00	$0.00	$0.00	$104.59	$372.45	$372.45	$0.00	$0.00	$104.58	$0.00	$296.83	$296.83	$0.00	$243.61	$385.89	$389.78	$0.00		$0.00	$74.03	$0.00	$0.00	$77.57	$0.00	$0.00	$0.00	$0.00	$0.00
408.486	SUP	HCPCS C1713		408.486  -  SCREW BONE FULTHD 6.5MM 170MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$501.83 	$371.35	$0.00	$389.78	$219.25	$219.25	$0.00	$0.00	$0.00	$104.59	$372.45	$372.45	$0.00	$0.00	$104.58	$0.00	$296.83	$296.83	$0.00	$243.61	$385.89	$389.78	$0.00		$0.00	$74.03	$0.00	$0.00	$77.57	$0.00	$0.00	$0.00	$0.00	$0.00
408.487	SUP	HCPCS C1713		408.487  -  SCREW BONE FULTHD 6.5MM 180MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$501.83 	$371.35	$0.00	$389.78	$219.25	$219.25	$0.00	$0.00	$0.00	$104.59	$372.45	$372.45	$0.00	$0.00	$104.58	$0.00	$296.83	$296.83	$0.00	$243.61	$385.89	$389.78	$0.00		$0.00	$74.03	$0.00	$0.00	$77.57	$0.00	$0.00	$0.00	$0.00	$0.00
408.83	SUP	HCPCS C1713		408.830  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 30MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.835	SUP	HCPCS C1713		408.835  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 35MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.84	SUP	HCPCS C1713		408.840  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 40MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.845	SUP	HCPCS C1713		408.845  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 45MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.85	SUP	HCPCS C1713		408.850  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 50MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.855	SUP	HCPCS C1713		408.855  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 55MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.86	SUP	HCPCS C1713		408.860  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 60MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.865	SUP	HCPCS C1713		408.865  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 65MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.87	SUP	HCPCS C1713		408.870  -  SCREW BONE 7.3MM 8.2MM 2.9MM 70MM 16MM CANN SELF TAP SELF	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.875	SUP	HCPCS C1713		408.875  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 75MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.88	SUP	HCPCS C1713		408.880  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 80MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.885	SUP	HCPCS C1713		408.885  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 85MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.89	SUP	HCPCS C1713		408.890  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 90MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.895	SUP	HCPCS C1713		408.895  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 95MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.9	SUP	HCPCS C1713		408.900  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 100MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.905	SUP	HCPCS C1713		408.905  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 105MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.91	SUP	HCPCS C1713		408.910  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 110MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.915	SUP	HCPCS C1713		408.915  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 115MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.92	SUP	HCPCS C1713		408.920  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 120MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.925	SUP	HCPCS C1713		408.925  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 125MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.93	SUP	HCPCS C1713		408.930  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 130MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.935	SUP	HCPCS C1713		408.935  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 135MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.94	SUP	HCPCS C1713		408.940  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 140MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.945	SUP	HCPCS C1713		408.945  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 145MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
408.95	SUP	HCPCS C1713		408.950  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 150MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.62	SUP	HCPCS C1713		409.620  -  SCREW BONE FULTHD 7.3MM 20MM CANN TITANIUM FEMUR TIBIA ANKLE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.625	SUP	HCPCS C1713		409.625  -  SCREW BONE FULTHD 7.3MM 25MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.63	SUP	HCPCS C1713		409.630  -  SCREW BONE FULTHD 7.3MM 30MM CANN TITANIUM FEMUR TIBIA ANKLE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.635	SUP	HCPCS C1713		409.635  -  SCREW BONE FULTHD 7.3MM 35MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.64	SUP	HCPCS C1713		409.640  -  SCREW BONE FULTHD 7.3MM 40MM CANN TITANIUM FEMUR TIBIA ANKLE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.645	SUP	HCPCS C1713		409.645  -  SCREW BONE FULTHD 7.3MM 45MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.65	SUP	HCPCS C1713		409.650  -  SCREW BONE FULTHD 7.3MM 50MM CANN TITANIUM FEMUR TIBIA ANKLE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.655	SUP	HCPCS C1713		409.655  -  SCREW BONE FULTHD 7.3MM 55MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.66	SUP	HCPCS C1713		409.660  -  SCREW BONE FULTHD 7.3MM 60MM CANN TITANIUM FEMUR TIBIA ANKLE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.665	SUP	HCPCS C1713		409.665  -  SCREW BONE FULTHD 7.3MM 65MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.67	SUP	HCPCS C1713		409.670  -  SCREW BONE FULTHD 7.3MM 70MM CANN TITANIUM FEMUR TIBIA ANKLE	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.675	SUP	HCPCS C1713		409.675  -  SCREW BONE FULTHD 7.3MM 8MM 2.9MM 75MM CANN SELF DRILL GOLD	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.68	SUP	HCPCS C1713		409.680  -  SCREW BONE FULTHD 7.3MM 8.2MM 80MM CANN SLFDRILL SLFTAP	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.685	SUP	HCPCS C1713		409.685  -  SCREW BONE FULTHD 7.3MM 85MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.69	SUP	HCPCS C1713		409.690  -  SCREW BONE FULTHD 7.3MM 8MM 2.9MM 90MM CANN SELF DRILL GOLD	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.695	SUP	HCPCS C1713		409.695  -  SCREW BONE FULTHD 7.3MM 8MM 2.9MM 95MM CANN SELF DRILL GOLD	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.7	SUP	HCPCS C1713		409.700  -  SCREW BONE FULTHD 7.3MM 100MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.705	SUP	HCPCS C1713		409.705  -  SCREW BONE FULTHD 7.3MM 105MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.71	SUP	HCPCS C1713		409.710  -  SCREW BONE FULTHD 7.3MM 110MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.715	SUP	HCPCS C1713		409.715  -  SCREW BONE FULTHD 7.3MM 115MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.72	SUP	HCPCS C1713		409.720  -  SCREW BONE FULTHD 7.3MM 120MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.725	SUP	HCPCS C1713		409.725  -  SCREW BONE FULTHD 7.3MM 125MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.73	SUP	HCPCS C1713		409.730  -  SCREW BONE FULTHD 7.3MM 130MM CANN TITANIUM ORTHOPEDIC	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.845	SUP	HCPCS C1713		409.845  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 45MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.85	SUP	HCPCS C1713		409.850  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 50MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.855	SUP	HCPCS C1713		409.855  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 55MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.86	SUP	HCPCS C1713		409.860  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 60MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.865	SUP	HCPCS C1713		409.865  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 65MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.87	SUP	HCPCS C1713		409.870  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 70MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.875	SUP	HCPCS C1713		409.875  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 75MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.88	SUP	HCPCS C1713		409.880  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 80MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.885	SUP	HCPCS C1713		409.885  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 85MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.89	SUP	HCPCS C1713		409.890  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 90MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.895	SUP	HCPCS C1713		409.895  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 95MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.9	SUP	HCPCS C1713		409.900  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 100MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.905	SUP	HCPCS C1713		409.905  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 105MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.91	SUP	HCPCS C1713		409.910  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 110MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.915	SUP	HCPCS C1713		409.915  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 115MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.92	SUP	HCPCS C1713		409.920  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 120MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.925	SUP	HCPCS C1713		409.925  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 125MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.93	SUP	HCPCS C1713		409.930  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 130MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.935	SUP	HCPCS C1713		409.935  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 135MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.94	SUP	HCPCS C1713		409.940  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 140MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.945	SUP	HCPCS C1713		409.945  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 145MM	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
409.95	SUP	HCPCS C1713		409.950  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 150MM	BOTH IP/OP	$469.48 	$347.42	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$97.85	$348.44	$348.44	$0.00	$0.00	$97.84	$0.00	$277.69	$277.69	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
412.101	SUP	HCPCS C1713		412.101  -  SCREW BONE T15 FULTHD 3.5MM 10MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.102	SUP	HCPCS C1713		412.102  -  SCREW BONE T15 FULTHD 3.5MM 12MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.103	SUP	HCPCS C1713		412.103  -  SCREW BONE T15 FULTHD 3.5MM 14MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.104	SUP	HCPCS C1713		412.104  -  SCREW BONE T15 FULTHD 3.5MM 16MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.105	SUP	HCPCS C1713		412.105  -  SCREW BONE 3.5MM 5MM 18MM SELF TAP LOCK T15 STARDRIVE RECESS	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.106	SUP	HCPCS C1713		412.106  -  SCREW BONE T15 FULTHD 3.5MM 20MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.107	SUP	HCPCS C1713		412.107  -  SCREW BONE T15 FULTHD 3.5MM 22MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.108	SUP	HCPCS C1713		412.108  -  SCREW BONE 3.5MM 24MM SELF TAP LOCK STARDRIVE CONICAL HEAD	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.109	SUP	HCPCS C1713		412.109  -  SCREW BONE T15 FULTHD 3.5MM 26MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.11	SUP	HCPCS C1713		412.110  -  SCREW BONE T15 FULTHD 3.5MM 28MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$227.93 	$168.67	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.111	SUP	HCPCS C1713		412.111  -  SCREW BONE T15 FULTHD 3.5MM 30MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.112	SUP	HCPCS C1713		412.112  -  SCREW BONE T15 FULTHD 3.5MM 32MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.113	SUP	HCPCS C1713		412.113  -  SCREW BONE T15 FULTHD 3.5MM 34MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.114	SUP	HCPCS C1713		412.114  -  SCREW BONE T15 FULTHD 3.5MM 35MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.115	SUP	HCPCS C1713		412.115  -  SCREW BONE T15 FULTHD 3.5MM 36MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$44.32	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.116	SUP	HCPCS C1713		412.116  -  SCREW BONE T15 FULTHD 3.5MM 38MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.117	SUP	HCPCS C1713		412.117  -  SCREW BONE T15 FULTHD 3.5MM 40MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.118	SUP	HCPCS C1713		412.118  -  SCREW BONE T15 FULTHD 3.5MM 42MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.119	SUP	HCPCS C1713		412.119  -  SCREW BONE T15 FULTHD 3.5MM 45MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.12	SUP	HCPCS C1713		412.120  -  SCREW BONE T15 FULTHD 3.5MM 48MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$227.93 	$168.67	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.121	SUP	HCPCS C1713		412.121  -  SCREW BONE T15 FULTHD 3.5MM 50MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.122	SUP	HCPCS C1713		412.122  -  SCREW BONE T15 FULTHD 3.5MM 52MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.123	SUP	HCPCS C1713		412.123  -  SCREW BONE T15 FULTHD 3.5MM 55MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.124	SUP	HCPCS C1713		412.124  -  SCREW BONE T15 FULTHD 3.5MM 60MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.125	SUP	HCPCS C1713		412.125  -  SCREW BONE 3.5MM 65MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.126	SUP	HCPCS C1713		412.126  -  SCREW BONE T15 FULTHD 3.5MM 70MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.127	SUP	HCPCS C1713		412.127  -  SCREW BONE T15 FULTHD 3.5MM 75MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.128	SUP	HCPCS C1713		412.128  -  SCREW BONE T15 FULTHD 3.5MM 80MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.129	SUP	HCPCS C1713		412.129  -  SCREW BONE 3.5MM 85MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.13	SUP	HCPCS C1713		412.130  -  SCREW BONE 3.5MM 90MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$227.93 	$168.67	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.131	SUP	HCPCS C1713		412.131  -  SCREW BONE 3.5MM 95MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.134	SUP	HCPCS C1713		412.134  -  SCREW BONE T15 FULTHD 3.5MM 44MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.136	SUP	HCPCS C1713		412.136  -  SCREW BONE T15 FULTHD 3.5MM 46MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
412.201	SUP	HCPCS C1713		412.201  -  SCREW BONE T25 5MM 14MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.202	SUP	HCPCS C1713		412.202  -  SCREW BONE T25 5MM 16MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.203	SUP	HCPCS C1713		412.203  -  SCREW BONE T25 5MM 18MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.204	SUP	HCPCS C1713		412.204  -  SCREW BONE T25 5MM 20MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.205	SUP	HCPCS C1713		412.205  -  SCREW BONE T25 5MM 22MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.206	SUP	HCPCS C1713		412.206  -  SCREW BONE T25 5MM 24MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.207	SUP	HCPCS C1713		412.207  -  SCREW BONE T25 5MM 26MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.208	SUP	HCPCS C1713		412.208  -  SCREW BONE T25 5MM 28MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.209	SUP	HCPCS C1713		412.209  -  SCREW BONE T25 5MM 30MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.21	SUP	HCPCS C1713		412.210  -  SCREW BONE T25 5MM 32MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$266.13 	$196.94	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$55.47	$197.52	$197.52	$0.00	$0.00	$55.46	$0.00	$157.41	$157.41	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.211	SUP	HCPCS C1713		412.211  -  SCREW BONE T25 5MM 34MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.212	SUP	HCPCS C1713		412.212  -  SCREW BONE T25 5MM 36MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.213	SUP	HCPCS C1713		412.213  -  SCREW BONE T25 5MM 38MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.214	SUP	HCPCS C1713		412.214  -  SCREW BONE T25 5MM 40MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.215	SUP	HCPCS C1713		412.215  -  SCREW BONE 5MM 6.6MM 42MM LOCK T25 STARDRIVE RECESS LCP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.216	SUP	HCPCS C1713		412.216  -  SCREW BONE 5MM 44MM LOCKING SLFTAP T25 STARDRIVE RECESS LCP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.217	SUP	HCPCS C1713		412.217  -  SCREW BONE T25 5MM 46MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.218	SUP	HCPCS C1713		412.218  -  SCREW BONE 5MM 6.6MM 48MM LOCK SELF TAP T25 STARDRIVE LCP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.219	SUP	HCPCS C1713		412.219  -  SCREW BONE T25 5MM 50MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.22	SUP	HCPCS C1713		412.220  -  SCREW BONE T25 5MM 55MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$266.13 	$196.94	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$55.47	$197.52	$197.52	$0.00	$0.00	$55.46	$0.00	$157.41	$157.41	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.221	SUP	HCPCS C1713		412.221  -  SCREW BONE 5MM 60MM LOCKING SLFTAP T25 STARDRIVE RECESS LCP	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.222	SUP	HCPCS C1713		412.222  -  SCREW BONE T25 5MM 65MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.223	SUP	HCPCS C1713		412.223  -  SCREW BONE T25 5MM 70MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.224	SUP	HCPCS C1713		412.224  -  SCREW BONE T25 5MM 75MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.225	SUP	HCPCS C1713		412.225  -  SCREW BONE T25 5MM 80MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.226	SUP	HCPCS C1713		412.226  -  SCREW BONE T25 5MM 85MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.227	SUP	HCPCS C1713		412.227  -  SCREW BONE T25 5MM 90MM SELF TAP STARDRIVE LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
412.251	SUP	HCPCS C1713		412.251  -  SCREW BONE 5MM 51MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.252	SUP	HCPCS C1713		412.252  -  SCREW BONE 5MM 52MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.253	SUP	HCPCS C1713		412.253  -  SCREW BONE 5MM 53MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.254	SUP	HCPCS C1713		412.254  -  SCREW BONE 5MM 54MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.255	SUP	HCPCS C1713		412.255  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.256	SUP	HCPCS C1713		412.256  -  SCREW BONE 5MM 56MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.257	SUP	HCPCS C1713		412.257  -  SCREW BONE 5MM 40MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.258	SUP	HCPCS C1713		412.258  -  SCREW BONE 5MM 45MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.259	SUP	HCPCS C1713		412.259  -  SCREW BONE 5MM 50MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.26	SUP	HCPCS C1713		412.260  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.261	SUP	HCPCS C1713		412.261  -  SCREW BONE 5MM 60MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.262	SUP	HCPCS C1713		412.262  -  SCREW BONE 5MM 65MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.263	SUP	HCPCS C1713		412.263  -  SCREW BONE 5MM 70MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.264	SUP	HCPCS C1713		412.264  -  SCREW BONE 5MM 75MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.265	SUP	HCPCS C1713		412.265  -  SCREW BONE 5MM 80MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.266	SUP	HCPCS C1713		412.266  -  SCREW BONE 5MM 85MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.267	SUP	HCPCS C1713		412.267  -  SCREW BONE 5MM 90MM SLFDRILL LOCKING STARDRIVE RECESS LISS	BOTH IP/OP	$385.58 	$285.33	$0.00	$308.46	$173.51	$173.51	$0.00	$0.00	$0.00	$80.36	$286.17	$286.17	$0.00	$0.00	$80.35	$0.00	$228.07	$228.07	$0.00	$192.79	$305.38	$308.46	$0.00		$0.00	$60.34	$0.00	$0.00	$61.38	$0.00	$0.00	$0.00	$0.00	$0.00
412.317	SUP	HCPCS C1713		412.317  -  SCREW BONE FULTHD 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.319	SUP	HCPCS C1713		412.319  -  SCREW BONE FULTHD 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.321	SUP	HCPCS C1713		412.321  -  SCREW BONE FULTHD 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.323	SUP	HCPCS C1713		412.323  -  SCREW BONE FULTHD 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.324	SUP	HCPCS C1713		412.324  -  SCREW BONE FULTHD 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.325	SUP	HCPCS C1713		412.325  -  SCREW BONE FULTHD 3.5MM 65MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.326	SUP	HCPCS C1713		412.326  -  SCREW BONE FULTHD 3.5MM 70MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.327	SUP	HCPCS C1713		412.327  -  SCREW BONE FULTHD 3.5MM 75MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.328	SUP	HCPCS C1713		412.328  -  SCREW BONE FULTHD 3.5MM 80MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
412.329	SUP	HCPCS C1713		412.329  -  SCREW BONE FULTHD 3.5MM 85MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
412.33	SUP	HCPCS C1713		412.330  -  SCREW BONE FULTHD 3.5MM 90MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$249.75 	$184.82	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$52.05	$185.36	$185.36	$0.00	$0.00	$52.05	$0.00	$147.73	$147.73	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
412.331	SUP	HCPCS C1713		412.331  -  SCREW BONE FULTHD 3.5MM 95MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
412.417	SUP	HCPCS C1713		412.417  -  SCREW BONE 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.419	SUP	HCPCS C1713		412.419  -  SCREW BONE 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.421	SUP	HCPCS C1713		412.421  -  SCREW BONE 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.423	SUP	HCPCS C1713		412.423  -  SCREW BONE 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.424	SUP	HCPCS C1713		412.424  -  SCREW BONE 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$264.28 	$195.57	$0.00	$205.26	$115.46	$115.46	$0.00	$0.00	$0.00	$55.08	$196.14	$196.14	$0.00	$0.00	$55.07	$0.00	$156.32	$156.32	$0.00	$128.29	$203.21	$205.26	$0.00		$0.00	$38.98	$0.00	$0.00	$40.85	$0.00	$0.00	$0.00	$0.00	$0.00
412.425	SUP	HCPCS C1713		412.425  -  SCREW BONE 3.5MM 65MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
412.426	SUP	HCPCS C1713		412.426  -  SCREW BONE 3.5MM 70MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
412.427	SUP	HCPCS C1713		412.427  -  SCREW BONE 3.5MM 75MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
412.428	SUP	HCPCS C1713		412.428  -  SCREW BONE 3.5MM 80MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
412.429	SUP	HCPCS C1713		412.429  -  SCREW BONE 3.5MM 85MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
412.43	SUP	HCPCS C1713		412.430  -  SCREW BONE PTHRD 3.5MM 90MM SLFTAP CONICAL STARDRIVE RECESS	BOTH IP/OP	$249.75 	$184.82	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$52.05	$185.36	$185.36	$0.00	$0.00	$52.05	$0.00	$147.73	$147.73	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
412.431	SUP	HCPCS C1713		412.431  -  SCREW BONE 3.5MM 95MM SLFTAP CONICAL STARDRIVE RECESS PTHRD	BOTH IP/OP	$257.25 	$190.37	$0.00	$199.80	$112.39	$112.39	$0.00	$0.00	$0.00	$53.62	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$152.16	$152.16	$0.00	$124.88	$197.80	$199.80	$0.00		$0.00	$37.95	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$0.00
412.806	SUP	HCPCS C1713		412.806  -  SCREW BONE 2.4MM 6MM T8 STARDRIVE RECESS SLFTAP LOCKING	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.807	SUP	HCPCS C1713		412.807  -  SCREW BONE 2.4MM 7MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.808	SUP	HCPCS C1713		412.808  -  SCREW BONE 2.4MM 8MM T8 STARDRIVE RECESS SLFTAP LOCKING	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.809	SUP	HCPCS C1713		412.809  -  SCREW BONE 2.4MM 9MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.81	SUP	HCPCS C1713		412.810  -  SCREW BONE T8 CONE 2.4MM 10MM SELF TAP THREAD STARDRIVE LCP	BOTH IP/OP	$212.90 	$157.55	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$44.37	$158.01	$158.01	$0.00	$0.00	$44.37	$0.00	$125.93	$125.93	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.811	SUP	HCPCS C1713		412.811  -  SCREW BONE T8 CONE 2.4MM 11MM SELF TAP THREAD STARDRIVE LCP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.812	SUP	HCPCS C1713		412.812  -  SCREW BONE T8 CONE 2.4MM 12MM SELF TAP THREAD STARDRIVE LCP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.813	SUP	HCPCS C1713		412.813  -  SCREW BONE 2.4MM 13MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.814	SUP	HCPCS C1713		412.814  -  SCREW BONE T8 CONE 2.4MM 14MM SELF TAP THREAD STARDRIVE LCP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.816	SUP	HCPCS C1713		412.816  -  SCREW BONE T8 CONE 2.4MM 16MM SELF TAP THREAD STARDRIVE LCP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.818	SUP	HCPCS C1713		412.818  -  SCREW BONE T8 CONE 2.4MM 18MM SELF TAP THREAD STARDRIVE LCP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.82	SUP	HCPCS C1713		412.820  -  SCREW BONE T8 CONE 2.4MM 20MM SELF TAP THREAD STARDRIVE LCP	BOTH IP/OP	$212.90 	$157.55	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$44.37	$158.01	$158.01	$0.00	$0.00	$44.37	$0.00	$125.93	$125.93	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.822	SUP	HCPCS C1713		412.822  -  SCREW BONE T8 CONE 2.4MM 22MM SELF TAP THREAD STARDRIVE LCP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.824	SUP	HCPCS C1713		412.824  -  SCREW BONE T8 CONE 2.4MM 24MM SELF TAP THREAD STARDRIVE LCP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.826	SUP	HCPCS C1713		412.826  -  SCREW BONE 2.4MM 1.9MM 26MM T8 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.828	SUP	HCPCS C1713		412.828  -  SCREW BONE 2.4MM 28MM T8 STARDRIVE RECESS SLFTAP LOCKING	BOTH IP/OP	$219.30 	$162.28	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$45.71	$162.76	$162.76	$0.00	$0.00	$45.70	$0.00	$129.72	$129.72	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
412.83	SUP	HCPCS C1713		412.830  -  SCREW BONE 2.4MM 30MM T8 STARDRIVE RECESS SLFTAP LOCKING	BOTH IP/OP	$212.90 	$157.55	$0.00	$170.32	$95.81	$95.81	$0.00	$0.00	$0.00	$44.37	$158.01	$158.01	$0.00	$0.00	$44.37	$0.00	$125.93	$125.93	$0.00	$106.45	$168.62	$170.32	$0.00		$0.00	$32.35	$0.00	$0.00	$33.89	$0.00	$0.00	$0.00	$0.00	$0.00
413.309	SUP	HCPCS C1776		413.309  -  SPACER TIBIAL 2MM 5MM 5MM TOMOFIX CHRONOS TITANIUM KNEE	BOTH IP/OP	$182.75 	$135.24	$0.00	$141.94	$79.84	$79.84	$0.00	$0.00	$0.00	$38.09	$135.64	$135.64	$0.00	$0.00	$38.09	$0.00	$108.10	$108.10	$0.00	$88.71	$140.52	$141.94	$0.00		$0.00	$26.96	$0.00	$0.00	$28.25	$0.00	$0.00	$0.00	$0.00	$0.00
413.324	SUP	HCPCS C1713		413.324  -  SCREW BONE 5MM 24MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.326	SUP	HCPCS C1713		413.326  -  SCREW BONE 5MM 26MM SLFTAP LOCKING HEAD TITANIUM NONSTRL	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.328	SUP	HCPCS C1713		413.328  -  SCREW BONE 5MM 28MM LOCKING SLFTAP HEX DRIVE TITANIUM FEMUR	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.33	SUP	HCPCS C1713		413.330  -  SCREW BONE 5MM 30MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM	BOTH IP/OP	$390.33 	$288.84	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$81.35	$289.70	$289.70	$0.00	$0.00	$81.34	$0.00	$230.88	$230.88	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.332	SUP	HCPCS C1713		413.332  -  SCREW BONE 5MM 32MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.334	SUP	HCPCS C1713		413.334  -  SCREW BONE 5MM 34MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.336	SUP	HCPCS C1713		413.336  -  SCREW BONE 5MM 36MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.338	SUP	HCPCS C1713		413.338  -  SCREW BONE 5MM 38MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM SPN	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.34	SUP	HCPCS C1713		413.340  -  SCREW BONE 5MM 40MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$390.33 	$288.84	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$81.35	$289.70	$289.70	$0.00	$0.00	$81.34	$0.00	$230.88	$230.88	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.342	SUP	HCPCS C1713		413.342  -  SCREW BONE 5MM 42MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.344	SUP	HCPCS C1713		413.344  -  SCREW BONE 5MM 44MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.346	SUP	HCPCS C1713		413.346  -  SCREW BONE 5MM 46MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.348	SUP	HCPCS C1713		413.348  -  SCREW BONE 5MM 48MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.35	SUP	HCPCS C1713		413.350  -  SCREW BONE 5MM 50MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$390.33 	$288.84	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$81.35	$289.70	$289.70	$0.00	$0.00	$81.34	$0.00	$230.88	$230.88	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.355	SUP	HCPCS C1713		413.355  -  SCREW BONE 5MM 55MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.36	SUP	HCPCS C1713		413.360  -  SCREW BONE 5MM 60MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$390.33 	$288.84	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$81.35	$289.70	$289.70	$0.00	$0.00	$81.34	$0.00	$230.88	$230.88	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.365	SUP	HCPCS C1713		413.365  -  SCREW BONE 5MM 65MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.37	SUP	HCPCS C1713		413.370  -  SCREW BONE 5MM 70MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$390.33 	$288.84	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$81.35	$289.70	$289.70	$0.00	$0.00	$81.34	$0.00	$230.88	$230.88	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.375	SUP	HCPCS C1713		413.375  -  SCREW BONE 5MM 75MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.38	SUP	HCPCS C1713		413.380  -  SCREW BONE 5MM 80MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$390.33 	$288.84	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$81.35	$289.70	$289.70	$0.00	$0.00	$81.34	$0.00	$230.88	$230.88	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.385	SUP	HCPCS C1713		413.385  -  SCREW BONE 5MM 85MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.39	SUP	HCPCS C1713		413.390  -  SCREW BONE 5MM 90MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$390.33 	$288.84	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$81.35	$289.70	$289.70	$0.00	$0.00	$81.34	$0.00	$230.88	$230.88	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.414	SUP	HCPCS C1713		413.414  -  SCREW BONE 5MM 14MM SLFDRILL LOCKING LISS TITANIUM FEMUR	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.418	SUP	HCPCS C1713		413.418  -  SCREW BONE 5MM 18MM SLFDRILL LOCKING LISS TITANIUM FEMUR	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.422	SUP	HCPCS C1713		413.422  -  SCREW BONE 5MM 22MM SLFDRILL LOCKING LISS TITANIUM FEMUR	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.426	SUP	HCPCS C1713		413.426  -  SCREW BONE 5MM 26MM SELF TAP LOCK HEAD TOMOFIX TITANIUM	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
413.43	SUP	HCPCS C1713		413.430  -  SCREW BONE 5MM 30MM SLFDRILL LOCKING LISS TITANIUM FEMUR	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.435	SUP	HCPCS C1713		413.435  -  SCREW BONE 5MM 35MM SLFDRILL LOCKING LISS TITANIUM FEMUR	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.44	SUP	HCPCS C1713		413.440  -  SCREW BONE 5MM 40MM SLFDRILL LOCKING LISS TITANIUM FEMUR	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.445	SUP	HCPCS C1713		413.445  -  SCREW BONE 5MM 45MM SLFDRILL LOCKING LISS TITANIUM FEMUR	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.45	SUP	HCPCS C1713		413.450  -  SCREW BONE 5MM 50MM SLFDRILL LOCKING LISS TITANIUM FEMUR	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.455	SUP	HCPCS C1713		413.455  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING LISS TITANIUM FEMUR	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.46	SUP	HCPCS C1713		413.460  -  SCREW BONE 5MM 60MM SLFDRILL LOCKING LISS TITANIUM FEMUR	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.465	SUP	HCPCS C1713		413.465  -  SCREW BONE 5MM 65MM SLFDRILL LOCKING LISS TITANIUM FEMUR	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.47	SUP	HCPCS C1713		413.470  -  SCREW BONE 5MM 70MM SLFDRILL LOCKING LISS TITANIUM FEMUR	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.475	SUP	HCPCS C1713		413.475  -  SCREW BONE 5MM 75MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.48	SUP	HCPCS C1713		413.480  -  SCREW BONE 5MM 80MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.485	SUP	HCPCS C1713		413.485  -  SCREW BONE 5MM 85MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
413.49	SUP	HCPCS C1713		413.490  -  SCREW BONE 5MM 90MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL	BOTH IP/OP	$378.95 	$280.42	$0.00	$303.16	$170.53	$170.53	$0.00	$0.00	$0.00	$78.98	$281.26	$281.26	$0.00	$0.00	$78.97	$0.00	$224.15	$224.15	$0.00	$189.48	$300.13	$303.16	$0.00		$0.00	$59.31	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.014	SUP	HCPCS C1713		414.014  -  SCREW BONE 4.5MM 14MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.016	SUP	HCPCS C1713		414.016  -  SCREW BONE 4.5MM 8MM 16MM HEXAGONAL SOCKET LC-DCP TITANIUM	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.018	SUP	HCPCS C1713		414.018  -  SCREW BONE 4.5MM 18MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.02	SUP	HCPCS C1713		414.020  -  SCREW BONE STANDARD 4.5MM 8MM 20MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.022	SUP	HCPCS C1713		414.022  -  SCREW BONE 4.5MM 8MM 22MM HEXAGONAL SOCKET LC-DCP TITANIUM	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.024	SUP	HCPCS C1713		414.024  -  SCREW BONE 4.5MM 24MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.026	SUP	HCPCS C1713		414.026  -  SCREW BONE 4.5MM 26MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.028	SUP	HCPCS C1713		414.028  -  SCREW BONE 4.5MM 28MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.03	SUP	HCPCS C1713		414.030  -  SCREW BONE 4.5MM 30MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$29.68 	$21.96	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.19	$22.02	$22.02	$0.00	$0.00	$6.18	$0.00	$17.55	$17.55	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.032	SUP	HCPCS C1713		414.032  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 32MM LARGE HEXAGONAL	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.034	SUP	HCPCS C1713		414.034  -  SCREW BONE 4.5MM 34MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.036	SUP	HCPCS C1713		414.036  -  SCREW BONE STANDARD 4.5MM 8MM 14MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.038	SUP	HCPCS C1713		414.038  -  SCREW BONE 4.5MM 38MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.04	SUP	HCPCS C1713		414.040  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 26MM LARGE HEXAGONAL	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.042	SUP	HCPCS C1713		414.042  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 42MM LARGE HEXAGONAL	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.044	SUP	HCPCS C1713		414.044  -  SCREW BONE 3MM STANDARD 4.5MM 8MM 44X3.5MM HEXAGONAL SOCKET	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.046	SUP	HCPCS C1713		414.046  -  SCREW BONE 4.5MM 46MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.048	SUP	HCPCS C1713		414.048  -  SCREW BONE 4.5MM 48MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.05	SUP	HCPCS C1713		414.050  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 50MM LARGE HEXAGONAL	BOTH IP/OP	$29.68 	$21.96	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.19	$22.02	$22.02	$0.00	$0.00	$6.18	$0.00	$17.55	$17.55	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.052	SUP	HCPCS C1713		414.052  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 52MM LARGE HEXAGONAL	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.054	SUP	HCPCS C1713		414.054  -  SCREW BONE 4.5MM 54MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.056	SUP	HCPCS C1713		414.056  -  SCREW BONE 4.5MM 56MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.058	SUP	HCPCS C1713		414.058  -  SCREW BONE STANDARD LARGE HEXAGON 4.5MM 8MM 14MM SOCKET	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.06	SUP	HCPCS C1713		414.060  -  SCREW BONE 4.5MM 60MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$29.68 	$21.96	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.19	$22.02	$22.02	$0.00	$0.00	$6.18	$0.00	$17.55	$17.55	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.062	SUP	HCPCS C1713		414.062  -  SCREW BONE 4.5MM 62MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.064	SUP	HCPCS C1713		414.064  -  SCREW BONE 4.5MM 64MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.066	SUP	HCPCS C1713		414.066  -  SCREW BONE 4.5MM 66MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.068	SUP	HCPCS C1713		414.068  -  SCREW BONE 4.5MM 68MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$30.55 	$22.61	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.37	$22.67	$22.67	$0.00	$0.00	$6.37	$0.00	$18.07	$18.07	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.07	SUP	HCPCS C1713		414.070  -  SCREW BONE STANDARD 4.5MM 8MM 70MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$29.68 	$21.96	$0.00	$23.74	$13.35	$13.35	$0.00	$0.00	$0.00	$6.19	$22.02	$22.02	$0.00	$0.00	$6.18	$0.00	$17.55	$17.55	$0.00	$14.84	$23.51	$23.74	$0.00		$0.00	$4.51	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
414.072	SUP	HCPCS C1713		414.072  -  SCREW BONE 4.5MM 72MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$12.96	$12.96	$0.00	$0.00	$0.00	$6.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$17.04	$17.04	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
414.076	SUP	HCPCS C1713		414.076  -  SCREW BONE 4.5MM 76MM SLFTAP LC-DCP TITANIUM CORTICAL	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.08	SUP	HCPCS C1713		414.080  -  SCREW BONE 4.5MM 80MM LC DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.085	SUP	HCPCS C1713		414.085  -  SCREW BONE 3.5MM 85MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.09	SUP	HCPCS C1713		414.090  -  SCREW BONE 4.5MM 90MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.095	SUP	HCPCS C1713		414.095  -  SCREW BONE 4.5MM 95MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.1	SUP	HCPCS C1713		414.100  -  SCREW BONE 4.5MM 100MM LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.105	SUP	HCPCS C1713		414.105  -  SCREW BONE 4.5MM 105MM LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.11	SUP	HCPCS C1713		414.110  -  SCREW BONE 4.5MM 110MM LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.115	SUP	HCPCS C1713		414.115  -  SCREW BONE 4.5MM 115MM LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.12	SUP	HCPCS C1713		414.120  -  SCREW BONE 4.5MM 120MM LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.125	SUP	HCPCS C1713		414.125  -  SCREW BONE 4.5MM 125MM LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.13	SUP	HCPCS C1713		414.130  -  SCREW BONE 4.5MM 130MM LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.135	SUP	HCPCS C1713		414.135  -  SCREW BONE 4.5MM 135MM LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.14	SUP	HCPCS C1713		414.140  -  SCREW BONE 4.5MM 140MM LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$46.70 	$34.56	$0.00	$37.36	$21.02	$21.02	$0.00	$0.00	$0.00	$9.73	$34.66	$34.66	$0.00	$0.00	$9.73	$0.00	$27.62	$27.62	$0.00	$23.35	$36.99	$37.36	$0.00		$0.00	$7.31	$0.00	$0.00	$7.43	$0.00	$0.00	$0.00	$0.00	$0.00
414.222	SUP	HCPCS C1713		414.222  -  SCREW BONE 4.5MM 22MM SHAFT LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
414.224	SUP	HCPCS C1713		414.224  -  SCREW BONE 4.5MM 24CM SHAFT LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
414.226	SUP	HCPCS C1713		414.226  -  SCREW BONE 4.5MM 26MM SHAFT LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
414.228	SUP	HCPCS C1713		414.228  -  SCREW BONE 4.5MM 28MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
414.23	SUP	HCPCS C1713		414.230  -  SCREW BONE 4.5MM 30MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
414.232	SUP	HCPCS C1713		414.232  -  SCREW BONE 4.5MM 32MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL	BOTH IP/OP	$31.03 	$22.96	$0.00	$24.82	$13.96	$13.96	$0.00	$0.00	$0.00	$6.47	$23.03	$23.03	$0.00	$0.00	$6.47	$0.00	$18.35	$18.35	$0.00	$15.51	$24.58	$24.82	$0.00		$0.00	$4.71	$0.00	$0.00	$4.94	$0.00	$0.00	$0.00	$0.00	$0.00
414.234	SUP	HCPCS C1713		414.234  -  SCREW BONE 4.5MM 34MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL	BOTH IP/OP	$31.03 	$22.96	$0.00	$24.82	$13.96	$13.96	$0.00	$0.00	$0.00	$6.47	$23.03	$23.03	$0.00	$0.00	$6.47	$0.00	$18.35	$18.35	$0.00	$15.51	$24.58	$24.82	$0.00		$0.00	$4.71	$0.00	$0.00	$4.94	$0.00	$0.00	$0.00	$0.00	$0.00
414.236	SUP	HCPCS C1713		414.236  -  SCREW BONE 4.5MM 36MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL	BOTH IP/OP	$31.03 	$22.96	$0.00	$24.82	$13.96	$13.96	$0.00	$0.00	$0.00	$6.47	$23.03	$23.03	$0.00	$0.00	$6.47	$0.00	$18.35	$18.35	$0.00	$15.51	$24.58	$24.82	$0.00		$0.00	$4.71	$0.00	$0.00	$4.94	$0.00	$0.00	$0.00	$0.00	$0.00
414.238	SUP	HCPCS C1713		414.238  -  SCREW BONE 4.5MM 38MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
414.24	SUP	HCPCS C1713		414.240  -  SCREW BONE 3.5MM 40MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$13.56	$13.56	$0.00	$0.00	$0.00	$6.28	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$17.82	$17.82	$0.00	$15.06	$23.86	$24.10	$0.00		$0.00	$4.71	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$0.00
414.242	SUP	HCPCS C1713		414.242  -  SCREW BONE 4.5MM 42MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.244	SUP	HCPCS C1713		414.244  -  SCREW BONE 4.5MM 44MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.246	SUP	HCPCS C1713		414.246  -  SCREW BONE 4.5MM 46MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL	BOTH IP/OP	$34.45 	$25.49	$0.00	$27.56	$15.50	$15.50	$0.00	$0.00	$0.00	$7.18	$25.57	$25.57	$0.00	$0.00	$7.18	$0.00	$20.38	$20.38	$0.00	$17.23	$27.28	$27.56	$0.00		$0.00	$5.23	$0.00	$0.00	$5.48	$0.00	$0.00	$0.00	$0.00	$0.00
414.248	SUP	HCPCS C1713		414.248  -  SCREW BONE 4.5MM 48MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL	BOTH IP/OP	$34.45 	$25.49	$0.00	$27.56	$15.50	$15.50	$0.00	$0.00	$0.00	$7.18	$25.57	$25.57	$0.00	$0.00	$7.18	$0.00	$20.38	$20.38	$0.00	$17.23	$27.28	$27.56	$0.00		$0.00	$5.23	$0.00	$0.00	$5.48	$0.00	$0.00	$0.00	$0.00	$0.00
414.25	SUP	HCPCS C1713		414.250  -  SCREW BONE 4.5MM 50MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.252	SUP	HCPCS C1713		414.252  -  SCREW BONE 4.5MM 52MM SHAFT LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$34.45 	$25.49	$0.00	$27.56	$15.50	$15.50	$0.00	$0.00	$0.00	$7.18	$25.57	$25.57	$0.00	$0.00	$7.18	$0.00	$20.38	$20.38	$0.00	$17.23	$27.28	$27.56	$0.00		$0.00	$5.23	$0.00	$0.00	$5.48	$0.00	$0.00	$0.00	$0.00	$0.00
414.254	SUP	HCPCS C1713		414.254  -  SCREW BONE 4.5MM 54MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.256	SUP	HCPCS C1713		414.256  -  SCREW BONE 4.5MM 56MM SHAFT LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$34.45 	$25.49	$0.00	$27.56	$15.50	$15.50	$0.00	$0.00	$0.00	$7.18	$25.57	$25.57	$0.00	$0.00	$7.18	$0.00	$20.38	$20.38	$0.00	$17.23	$27.28	$27.56	$0.00		$0.00	$5.23	$0.00	$0.00	$5.48	$0.00	$0.00	$0.00	$0.00	$0.00
414.258	SUP	HCPCS C1713		414.258  -  SCREW BONE 4.5MM 58MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.26	SUP	HCPCS C1713		414.260  -  SCREW BONE 4.5MM 60MM SHAFT LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.264	SUP	HCPCS C1713		414.264  -  SCREW BONE 4.5MM 64MM 20MM PTTHRD SHAFT LC-DCP TITANIUM	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.268	SUP	HCPCS C1713		414.268  -  SCREW BONE 4.5MM 68MM SHAFT LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.272	SUP	HCPCS C1713		414.272  -  SCREW BONE 4.5MM 72MM SHAFT LCP TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$33.45 	$24.75	$0.00	$26.76	$15.05	$15.05	$0.00	$0.00	$0.00	$6.97	$24.83	$24.83	$0.00	$0.00	$6.97	$0.00	$19.79	$19.79	$0.00	$16.73	$26.49	$26.76	$0.00		$0.00	$5.23	$0.00	$0.00	$5.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.276	SUP	HCPCS C1713		414.276  -  SCREW BONE 4.5MM 76MM SHAFT LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.28	SUP	HCPCS C1713		414.280  -  SCREW BONE 4.5MM 80MM SHAFT LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.285	SUP	HCPCS C1713		414.285  -  SCREW BONE 4.5MM 85MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.29	SUP	HCPCS C1713		414.290  -  SCREW BONE 4.5MM 90MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.295	SUP	HCPCS C1713		414.295  -  SCREW BONE 4.5MM 95MM SHAFT LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.3	SUP	HCPCS C1713		414.300  -  SCREW BONE 4.5MM 100MM SHAFT LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.305	SUP	HCPCS C1713		414.305  -  SCREW BONE 4.5MM 105MM SHAFT LC-DCP TITANIUM SHAFT NONSTRL	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.31	SUP	HCPCS C1713		414.310  -  SCREW BONE 4.5MM 110MM SHAAFT LC-DCP TITANIUM CORTICAL	BOTH IP/OP	$39.75 	$29.42	$0.00	$31.80	$17.89	$17.89	$0.00	$0.00	$0.00	$8.28	$29.50	$29.50	$0.00	$0.00	$8.28	$0.00	$23.51	$23.51	$0.00	$19.88	$31.48	$31.80	$0.00		$0.00	$6.22	$0.00	$0.00	$6.33	$0.00	$0.00	$0.00	$0.00	$0.00
414.52	SUP	HCPCS C1713		414.520  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.522	SUP	HCPCS C1713		414.522  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 22MM CANN LARGE HEXAGONAL	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.524	SUP	HCPCS C1713		414.524  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.526	SUP	HCPCS C1713		414.526  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 26MM CANN LARGE HEXAGONAL	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.528	SUP	HCPCS C1713		414.528  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 28MM CANN LARGE HEXAGONAL	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.53	SUP	HCPCS C1713		414.530  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.532	SUP	HCPCS C1713		414.532  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.534	SUP	HCPCS C1713		414.534  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.536	SUP	HCPCS C1713		414.536  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.538	SUP	HCPCS C1713		414.538  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.54	SUP	HCPCS C1713		414.540  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.542	SUP	HCPCS C1713		414.542  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 42MM CANN LARGE HEXAGONAL	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.544	SUP	HCPCS C1713		414.544  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.546	SUP	HCPCS C1713		414.546  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.548	SUP	HCPCS C1713		414.548  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.55	SUP	HCPCS C1713		414.550  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.552	SUP	HCPCS C1713		414.552  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 52MM CANN LARGE HEXAGONAL	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.554	SUP	HCPCS C1713		414.554  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.556	SUP	HCPCS C1713		414.556  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.56	SUP	HCPCS C1713		414.560  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 60MM CANN LARGE HEXAGONAL	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.564	SUP	HCPCS C1713		414.564  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.568	SUP	HCPCS C1713		414.568  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.572	SUP	HCPCS C1713		414.572  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM	BOTH IP/OP	$376.73 	$278.78	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$78.52	$279.61	$279.61	$0.00	$0.00	$78.51	$0.00	$222.83	$222.83	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$55.57	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
414.576	SUP	HCPCS C1713		414.576  -  SCREW BONE PTHRD 4.5MM 76MM CANN TITANIUM NONSTRL	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.58	SUP	HCPCS C1713		414.580  -  SCREW BONE PTHRD 4.5MM 80MM CANN TITANIUM NONSTRL	BOTH IP/OP	$376.68 	$278.74	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$78.51	$279.57	$279.57	$0.00	$0.00	$78.50	$0.00	$222.80	$222.80	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.72	SUP	HCPCS C1713		414.720  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 20MM CANN TITANIUM	BOTH IP/OP	$376.68 	$278.74	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$78.51	$279.57	$279.57	$0.00	$0.00	$78.50	$0.00	$222.80	$222.80	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.722	SUP	HCPCS C1713		414.722  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 22MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.724	SUP	HCPCS C1713		414.724  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 24MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.726	SUP	HCPCS C1713		414.726  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 26MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.728	SUP	HCPCS C1713		414.728  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 28MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.73	SUP	HCPCS C1713		414.730  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 30MM CANN TITANIUM	BOTH IP/OP	$376.68 	$278.74	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$78.51	$279.57	$279.57	$0.00	$0.00	$78.50	$0.00	$222.80	$222.80	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.732	SUP	HCPCS C1713		414.732  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 32MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.734	SUP	HCPCS C1713		414.734  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 34MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.736	SUP	HCPCS C1713		414.736  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 36MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.738	SUP	HCPCS C1713		414.738  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 38MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.74	SUP	HCPCS C1713		414.740  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 40MM CANN TITANIUM	BOTH IP/OP	$376.68 	$278.74	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$78.51	$279.57	$279.57	$0.00	$0.00	$78.50	$0.00	$222.80	$222.80	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.742	SUP	HCPCS C1713		414.742  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 42MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.744	SUP	HCPCS C1713		414.744  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 44MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.746	SUP	HCPCS C1713		414.746  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 46MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.748	SUP	HCPCS C1713		414.748  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 48MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.75	SUP	HCPCS C1713		414.750  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 50MM CANN TITANIUM	BOTH IP/OP	$376.68 	$278.74	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$78.51	$279.57	$279.57	$0.00	$0.00	$78.50	$0.00	$222.80	$222.80	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.752	SUP	HCPCS C1713		414.752  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 52MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.754	SUP	HCPCS C1713		414.754  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 54MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.756	SUP	HCPCS C1713		414.756  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 56MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.76	SUP	HCPCS C1713		414.760  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 60MM CANN TITANIUM	BOTH IP/OP	$376.68 	$278.74	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$78.51	$279.57	$279.57	$0.00	$0.00	$78.50	$0.00	$222.80	$222.80	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.764	SUP	HCPCS C1713		414.764  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 64MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.768	SUP	HCPCS C1713		414.768  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 68MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.772	SUP	HCPCS C1713		414.772  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 72MM CANN TITANIUM	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.776	SUP	HCPCS C1713		414.776  -  SCREW BONE FULTHD 4.5MM 76MM CANN TITANIUM NONSTRL	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.777	SUP	HCPCS C1713		414.777  -  SCREW BONE FULTHD 4.5MM 77MM CANN TITANIUM NONSTRL	BOTH IP/OP	$387.98 	$287.11	$0.00	$301.34	$169.50	$169.50	$0.00	$0.00	$0.00	$80.86	$287.96	$287.96	$0.00	$0.00	$80.85	$0.00	$229.49	$229.49	$0.00	$188.34	$298.33	$301.34	$0.00		$0.00	$57.23	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
414.814	SUP	HCPCS C1713		414.814  -  SCREW BONE 4.5MM 8MM 14MM LARGE HEXAGONAL SOCKET SELF TAP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.816	SUP	HCPCS C1713		414.816  -  SCREW BONE 4.5MM 8MM 16MM LARGE HEXAGONAL SOCKET SELF TAP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.818	SUP	HCPCS C1713		414.818  -  SCREW BONE 4.5MM 8MM 18MM HEXAGONAL SOCKET SELF TAP TIP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.82	SUP	HCPCS C1713		414.820  -  SCREW BONE 4.5MM 8MM 20MM LARGE HEXAGONAL SOCKET SELF TAP	BOTH IP/OP	$38.88 	$28.77	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$22.99	$22.99	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.822	SUP	HCPCS C1713		414.822  -  SCREW BONE 4.5MM 8MM 22MM HEXAGONAL SOCKET SELF TAP TIP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.824	SUP	HCPCS C1713		414.824  -  SCREW BONE 4.5MM 8MM 24MM HEXAGONAL SOCKET SELF TAP TIP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.826	SUP	HCPCS C1713		414.826  -  SCREW BONE 4.5MM 8MM 26MM HEXAGONAL SOCKET SELF TAP LC-DCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.828	SUP	HCPCS C1713		414.828  -  SCREW BONE 4.5MM 8MM 28MM HEXAGONAL SOCKET SELF TAP LC-DCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.83	SUP	HCPCS C1713		414.830  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 30MM SELF TAP SOCKET	BOTH IP/OP	$38.88 	$28.77	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$22.99	$22.99	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.832	SUP	HCPCS C1713		414.832  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 32MM SELF TAP SOCKET	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.834	SUP	HCPCS C1713		414.834  -  SCREW BONE 4.5MM 8MM 34MM HEXAGONAL SOCKET SELF TAP LC-DCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.836	SUP	HCPCS C1713		414.836  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 36MM SELF TAP SOCKET	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.838	SUP	HCPCS C1713		414.838  -  SCREW BONE 4.5MM 8MM 38MM HEXAGONAL SOCKET SELF TAP LC-DCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.84	SUP	HCPCS C1713		414.840  -  SCREW BONE 4.5MM 8MM 40MM HEXAGONAL SOCKET SELF TAP LC-DCP	BOTH IP/OP	$38.88 	$28.77	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$22.99	$22.99	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.842	SUP	HCPCS C1713		414.842  -  SCREW BONE 4.5MM 8MM 42MM HEXAGONAL SOCKET SELF TAP LC-DCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.844	SUP	HCPCS C1713		414.844  -  SCREW BONE 4.5MM 8MM 44MM HEXAGONAL SOCKET SELF TAP LC-DCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.846	SUP	HCPCS C1713		414.846  -  SCREW BONE 4.5MM 8MM 46MM HEXAGONAL SOCKET SELF TAP LC-DCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.848	SUP	HCPCS C1713		414.848  -  SCREW BONE 4.5MM 48MM SELF TAP LCP TITANIUM CORTEX LARGE	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.85	SUP	HCPCS C1713		414.850  -  SCREW BONE 4.5MM 50MM SELF TAP LCP TITANIUM CORTEX LARGE	BOTH IP/OP	$38.88 	$28.77	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$22.99	$22.99	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.852	SUP	HCPCS C1713		414.852  -  SCREW BONE 4.5MM 52MM SELF TAP LCP TITANIUM CORTEX LARGE	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.854	SUP	HCPCS C1713		414.854  -  SCREW BONE 4.5MM 54MM SELF TAP LCP TITANIUM CORTEX LARGE	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.856	SUP	HCPCS C1713		414.856  -  SCREW BONE 4.5MM 56MM SELF TAP LCP TITANIUM CORTEX LARGE	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.858	SUP	HCPCS C1713		414.858  -  SCREW BONE 4.5MM 58MM SELF TAP LCP TITANIUM CORTEX LARGE	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.86	SUP	HCPCS C1713		414.860  -  SCREW BONE 4.5MM 8MM 60MM HEXAGONAL SOCKET SELF TAP LC-DCP	BOTH IP/OP	$38.88 	$28.77	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$22.99	$22.99	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.862	SUP	HCPCS C1713		414.862  -  SCREW BONE 4.5MM 62MM SELF TAP LCP TITANIUM CORTEX LARGE	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.864	SUP	HCPCS C1713		414.864  -  SCREW BONE 4.5MM 64MM SELF TAP LCP TITANIUM CORTEX LARGE	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.866	SUP	HCPCS C1713		414.866  -  SCREW BONE 4.5MM 8MM 66MM HEXAGONAL SOCKET SELF TAP LC-DCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.868	SUP	HCPCS C1713		414.868  -  SCREW BONE 4.5MM 8MM 68MM HEXAGONAL SOCKET SELF TAP LC-DCP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.87	SUP	HCPCS C1713		414.870  -  SCREW BONE 4.5MM 70MM SELF TAP LCP TITANIUM CORTEX LARGE	BOTH IP/OP	$38.88 	$28.77	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$22.99	$22.99	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.872	SUP	HCPCS C1713		414.872  -  SCREW BONE 4.5MM 8MM 72MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$40.05 	$29.64	$0.00	$31.10	$17.49	$17.49	$0.00	$0.00	$0.00	$8.35	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$23.69	$23.69	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$5.91	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
414.876	SUP	HCPCS C1713		414.876  -  SCREW BONE 4.5MM 8MM 76MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$63.95 	$47.32	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$13.33	$47.46	$47.46	$0.00	$0.00	$13.33	$0.00	$37.83	$37.83	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.88	SUP	HCPCS C1713		414.880  -  SCREW BONE 4.5MM 8MM 80MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$62.08 	$45.94	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$12.94	$46.07	$46.07	$0.00	$0.00	$12.94	$0.00	$36.72	$36.72	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.885	SUP	HCPCS C1713		414.885  -  SCREW BONE 4.5MM 8MM 85MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$63.95 	$47.32	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$13.33	$47.46	$47.46	$0.00	$0.00	$13.33	$0.00	$37.83	$37.83	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.89	SUP	HCPCS C1713		414.890  -  SCREW BONE 4.5MM 8MM 90MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$62.08 	$45.94	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$12.94	$46.07	$46.07	$0.00	$0.00	$12.94	$0.00	$36.72	$36.72	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.895	SUP	HCPCS C1713		414.895  -  SCREW BONE 4.5MM 8MM 95MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$63.95 	$47.32	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$13.33	$47.46	$47.46	$0.00	$0.00	$13.33	$0.00	$37.83	$37.83	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.9	SUP	HCPCS C1713		414.900  -  SCREW BONE 4.5MM 8MM 100MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$62.08 	$45.94	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$12.94	$46.07	$46.07	$0.00	$0.00	$12.94	$0.00	$36.72	$36.72	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.905	SUP	HCPCS C1713		414.905  -  SCREW BONE 4.5MM 8MM 105MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$63.95 	$47.32	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$13.33	$47.46	$47.46	$0.00	$0.00	$13.33	$0.00	$37.83	$37.83	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.91	SUP	HCPCS C1713		414.910  -  SCREW BONE 4.5MM 8MM 110MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$62.08 	$45.94	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$12.94	$46.07	$46.07	$0.00	$0.00	$12.94	$0.00	$36.72	$36.72	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.915	SUP	HCPCS C1713		414.915  -  SCREW BONE 4.5MM 8MM 115MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$63.95 	$47.32	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$13.33	$47.46	$47.46	$0.00	$0.00	$13.33	$0.00	$37.83	$37.83	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.92	SUP	HCPCS C1713		414.920  -  SCREW BONE 4.5MM 8MM 120MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$62.08 	$45.94	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$12.94	$46.07	$46.07	$0.00	$0.00	$12.94	$0.00	$36.72	$36.72	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.925	SUP	HCPCS C1713		414.925  -  SCREW BONE 4.5MM 8MM 125MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$63.95 	$47.32	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$13.33	$47.46	$47.46	$0.00	$0.00	$13.33	$0.00	$37.83	$37.83	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.93	SUP	HCPCS C1713		414.930  -  SCREW BONE 4.5MM 8MM 130MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$62.08 	$45.94	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$12.94	$46.07	$46.07	$0.00	$0.00	$12.94	$0.00	$36.72	$36.72	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.935	SUP	HCPCS C1713		414.935  -  SCREW BONE 4.5MM 8MM 135MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$63.95 	$47.32	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$13.33	$47.46	$47.46	$0.00	$0.00	$13.33	$0.00	$37.83	$37.83	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.94	SUP	HCPCS C1713		414.940  -  SCREW BONE 4.5MM 8MM 140MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$62.08 	$45.94	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$12.94	$46.07	$46.07	$0.00	$0.00	$12.94	$0.00	$36.72	$36.72	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
414.945	SUP	HCPCS C1713		414.945  -  SCREW BONE 4.5MM 8MM 145MM LARGE HEXAGONAL SOCKET SLFTAP	BOTH IP/OP	$63.95 	$47.32	$0.00	$49.66	$27.93	$27.93	$0.00	$0.00	$0.00	$13.33	$47.46	$47.46	$0.00	$0.00	$13.33	$0.00	$37.83	$37.83	$0.00	$31.04	$49.17	$49.66	$0.00		$0.00	$9.43	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$0.00
416.03	SUP	HCPCS C1713		416.030  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 30MM 16MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
416.035	SUP	HCPCS C1713		416.035  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 35MM 16MM SOCKET LC-DCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
416.04	SUP	HCPCS C1713		416.040  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 40MM 16MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
416.045	SUP	HCPCS C1713		416.045  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 45MM 16MM SOCKET LC-DCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
416.05	SUP	HCPCS C1713		416.050  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 50MM 16MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
416.055	SUP	HCPCS C1713		416.055  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 55MM 16MM SOCKET LC-DCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
416.06	SUP	HCPCS C1713		416.060  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 60MM 16MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
416.065	SUP	HCPCS C1713		416.065  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 65MM 16MM SOCKET LC-DCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
416.07	SUP	HCPCS C1713		416.070  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 70MM 16MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
416.075	SUP	HCPCS C1713		416.075  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 75MM 16MM SOCKET LC-DCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
416.08	SUP	HCPCS C1713		416.080  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 80MM 16MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
416.085	SUP	HCPCS C1713		416.085  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 85MM 16MM SOCKET LC-DCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
416.09	SUP	HCPCS C1713		416.090  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 90MM 16MM SOCKET LC-DCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
416.095	SUP	HCPCS C1713		416.095  -  SCREW BONE 6.5MM 8MM 95MM 16MM THREAD LARGE HEXAGONAL SOCKET	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
416.1	SUP	HCPCS C1713		416.100  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 100MM 16MM SOCKET LC-DCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
416.105	SUP	HCPCS C1713		416.105  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 105MM 16MM SOCKET LC-DCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
416.11	SUP	HCPCS C1713		416.110  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 110MM 16MM SOCKET LC-DCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
416.115	SUP	HCPCS C1713		416.115  -  SCREW BONE 6.5MM 115MM 16MM LC-DCP TITANIUM CANCELLOUS	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
416.12	SUP	HCPCS C1713		416.120  -  SCREW BONE 6.5MM 120MM 16MM THREAD LC-DCP TITANIUM	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
417.045	SUP	HCPCS C1713		417.045  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 45MM 32MM SOCKET LC-DCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
417.05	SUP	HCPCS C1713		417.050  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 50MM 32MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
417.055	SUP	HCPCS C1713		417.055  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 55MM 32MM SOCKET LC-DCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
417.06	SUP	HCPCS C1713		417.060  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 60MM 32MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
417.065	SUP	HCPCS C1713		417.065  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 65MM 32MM SOCKET LC-DCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
417.07	SUP	HCPCS C1713		417.070  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 70MM 32MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
417.075	SUP	HCPCS C1713		417.075  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 75MM 32MM SOCKET LC-DCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
417.08	SUP	HCPCS C1713		417.080  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 80MM 32MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
417.085	SUP	HCPCS C1713		417.085  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 85MM 32MM SOCKET LC-DCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
417.09	SUP	HCPCS C1713		417.090  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 90MM 32MM SOCKET LC-DCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
417.095	SUP	HCPCS C1713		417.095  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 95MM 32MM SOCKET LC-DCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
417.1	SUP	HCPCS C1713		417.100  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 100MM 32MM SOCKET LC-DCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
417.105	SUP	HCPCS C1713		417.105  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 105MM 32MM SOCKET LC-DCP	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
417.11	SUP	HCPCS C1713		417.110  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 110MM 32MM SOCKET LC-DCP	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
417.115	SUP	HCPCS C1713		417.115  -  SCREW BONE PTHRD 6.5MM 8MM 115MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
417.12	SUP	HCPCS C1713		417.120  -  SCREW BONE PTHRD 6.5MM 8MM 120MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
417.125	SUP	HCPCS C1713		417.125  -  SCREW BONE PTHRD 6.5MM 8MM 125MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
417.13	SUP	HCPCS C1713		417.130  -  SCREW BONE PTHRD 6.5MM 8MM 130MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
417.135	SUP	HCPCS C1713		417.135  -  SCREW BONE PTHRD 6.5MM 8MM 135MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
417.14	SUP	HCPCS C1713		417.140  -  SCREW BONE PTHRD 6.5MM 8MM 140MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
417.145	SUP	HCPCS C1713		417.145  -  SCREW BONE PTHRD 6.5MM 8MM 145MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$82.23 	$60.85	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$17.14	$61.03	$61.03	$0.00	$0.00	$17.14	$0.00	$48.64	$48.64	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
417.15	SUP	HCPCS C1713		417.150  -  SCREW BONE PTHRD 6.5MM 8MM 150MM 32MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$79.83 	$59.07	$0.00	$63.86	$35.92	$35.92	$0.00	$0.00	$0.00	$16.64	$59.25	$59.25	$0.00	$0.00	$16.64	$0.00	$47.22	$47.22	$0.00	$39.91	$63.23	$63.86	$0.00		$0.00	$12.13	$0.00	$0.00	$12.71	$0.00	$0.00	$0.00	$0.00	$0.00
418.009	SUP	HCPCS C1713		418.009  -  SCREW BONE 6.5MM 60MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.01	SUP	HCPCS C1713		418.010  -  SCREW BONE FULTHD 6.5MM 4MM 65MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$266.13 	$196.94	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$55.47	$197.52	$197.52	$0.00	$0.00	$55.46	$0.00	$157.41	$157.41	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.011	SUP	HCPCS C1713		418.011  -  SCREW BONE 6.5MM 70MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.012	SUP	HCPCS C1713		418.012  -  SCREW BONE 6.5MM 75MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.013	SUP	HCPCS C1713		418.013  -  SCREW BONE 6.5MM 80MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.014	SUP	HCPCS C1713		418.014  -  SCREW BONE 6.5MM 85MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.015	SUP	HCPCS C1713		418.015  -  SCREW BONE 6.5MM 90MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.016	SUP	HCPCS C1713		418.016  -  SCREW BONE 6.5MM 95MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.017	SUP	HCPCS C1713		418.017  -  SCREW BONE 6.5MM 100MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.018	SUP	HCPCS C1713		418.018  -  SCREW BONE 6.5MM 105MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.019	SUP	HCPCS C1713		418.019  -  SCREW BONE 6.5MM 110MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.025	SUP	HCPCS C1713		418.025  -  SCREW BONE 6.5MM 8MM 25MM HEXAGONAL SOCKET LC-DCP TITANIUM	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
418.03	SUP	HCPCS C1713		418.030  -  SCREW BONE 6.5MM 8MM 30MM HEXAGONAL SOCKET LC-DCP TITANIUM	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
418.035	SUP	HCPCS C1713		418.035  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 35MM SOCKET LC-DCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
418.04	SUP	HCPCS C1713		418.040  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 40MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
418.045	SUP	HCPCS C1713		418.045  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 45MM SOCKET LC-DCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
418.05	SUP	HCPCS C1713		418.050  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 50MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
418.055	SUP	HCPCS C1713		418.055  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 55MM SOCKET LC-DCP	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
418.06	SUP	HCPCS C1713		418.060  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 60MM SOCKET LC-DCP	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
418.065	SUP	HCPCS C1713		418.065  -  SCREW BONE FULTHD 6.5MM 8MM 65MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
418.07	SUP	HCPCS C1713		418.070  -  SCREW BONE FULTHD 6.5MM 8MM 70MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
418.075	SUP	HCPCS C1713		418.075  -  SCREW BONE FULTHD 6.5MM 8MM 75MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$61.13 	$45.24	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.74	$45.37	$45.37	$0.00	$0.00	$12.74	$0.00	$36.16	$36.16	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
418.08	SUP	HCPCS C1713		418.080  -  SCREW BONE FULTHD 6.5MM 8MM 80MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$59.35 	$43.92	$0.00	$47.48	$26.71	$26.71	$0.00	$0.00	$0.00	$12.37	$44.05	$44.05	$0.00	$0.00	$12.37	$0.00	$35.11	$35.11	$0.00	$29.68	$47.01	$47.48	$0.00		$0.00	$9.02	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$0.00
418.085	SUP	HCPCS C1713		418.085  -  SCREW BONE FULTHD 6.5MM 8MM 85MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
418.09	SUP	HCPCS C1713		418.090  -  SCREW BONE FULTHD 6.5MM 8MM 90MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
418.095	SUP	HCPCS C1713		418.095  -  SCREW BONE FULTHD 6.5MM 8MM 95MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
418.1	SUP	HCPCS C1713		418.100  -  SCREW BONE FULTHD 6.5MM 8MM 100MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
418.105	SUP	HCPCS C1713		418.105  -  SCREW BONE FULTHD 6.5MM 8MM 105MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$66.08 	$48.90	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.77	$49.04	$49.04	$0.00	$0.00	$13.77	$0.00	$39.08	$39.08	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
418.11	SUP	HCPCS C1713		418.110  -  SCREW BONE FULTHD 6.5MM 8MM 110MM LARGE HEXAGONAL SOCKET	BOTH IP/OP	$64.15 	$47.47	$0.00	$51.32	$28.87	$28.87	$0.00	$0.00	$0.00	$13.37	$47.61	$47.61	$0.00	$0.00	$13.37	$0.00	$37.94	$37.94	$0.00	$32.08	$50.81	$51.32	$0.00		$0.00	$9.75	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$0.00
418.215	SUP	HCPCS C1713		418.215  -  SCREW BONE FULTHD 6.5MM 115MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.22	SUP	HCPCS C1713		418.220  -  SCREW BONE FULTHD 6.5MM 4MM 120MM TITANIUM CANCELLOUS	BOTH IP/OP	$266.13 	$196.94	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$55.47	$197.52	$197.52	$0.00	$0.00	$55.46	$0.00	$157.41	$157.41	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.225	SUP	HCPCS C1713		418.225  -  SCREW BONE FULTHD 6.5MM 125MM TITANIUM CANCELLOUS NONSTRL	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
418.23	SUP	HCPCS C1713		418.230  -  SCREW BONE FULTHD 6.5MM 4MM 130MM TITANIUM CANCELLOUS	BOTH IP/OP	$266.13 	$196.94	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$55.47	$197.52	$197.52	$0.00	$0.00	$55.46	$0.00	$157.41	$157.41	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
419.89	SUP	Custom 27803010		419.89  -  WASHER ORTHOPEDIC THREAD TITANIUM NONSTRL 3 MM CANN SCREWS	BOTH IP/OP	$258.65 	$191.40	$0.00	$200.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.97	$191.97	$0.00	$0.00	$53.90	$0.00	$0.00	$0.00	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
419.91	SUP	Custom 27803010		419.91  -  WASHER ORTHOPEDIC 10MM TITANIUM NONSTRL 4.5MM CANN SCREW	BOTH IP/OP	$55.85 	$41.33	$0.00	$43.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.45	$41.45	$0.00	$0.00	$11.64	$0.00	$0.00	$0.00	$0.00	$27.11	$42.95	$43.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
419.96	SUP	Custom 27803010		419.96  -  NUT ORTHOPEDIC LC-DCP TITANIUM NONSTRL 4.5 MM CORTICAL SCREW	BOTH IP/OP	$55.85 	$41.33	$0.00	$43.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.45	$41.45	$0.00	$0.00	$11.64	$0.00	$0.00	$0.00	$0.00	$27.11	$42.95	$43.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
419.972	SUP	Custom 27803010		419.972  -  WASHER ORTHOPEDIC 6.5MM CANN TITANIUM NONSTRL 3MM SCREWS	BOTH IP/OP	$54.83 	$40.57	$0.00	$42.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.69	$40.69	$0.00	$0.00	$11.43	$0.00	$0.00	$0.00	$0.00	$26.61	$42.16	$42.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
419.98	SUP	Custom 27803010		419.98  -  WASHER ORTHOPEDIC 7MM TITANIUM PROXIMAL TIBIA NONSTRL 4MM	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$0.00	$0.00	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
419.99	SUP	Custom 27803010		419.99  -  WASHER ORTHOPEDIC 13MM TITANIUM FEMUR NONSTRL 6.5/7.3MM CANN	BOTH IP/OP	$52.70 	$39.00	$0.00	$40.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.11	$39.11	$0.00	$0.00	$10.98	$0.00	$0.00	$0.00	$0.00	$25.59	$40.53	$40.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
420	SUP	HCPCS C1713		420.00  -  PLATE BONE 40X29MM CRANFCL TI MESH 1MM SCR NONSTRL	BOTH IP/OP	"$2,607.75 "	"$1,929.74"	$0.00	"$2,086.20"	"$1,173.49"	"$1,173.49"	$0.00	$0.00	$0.00	$543.52	"$1,935.47"	"$1,935.47"	$0.00	$0.00	$543.46	$0.00	"$1,285.62"	"$1,285.62"	$0.00	"$1,303.88"	"$2,065.34"	"$2,086.20"	$0.00		$0.00	$408.11	$0.00	$0.00	$415.15	$0.00	$0.00	$0.00	$0.00	$0.00
420.01	SUP	HCPCS C1713		420.01  -  PLATE BONE 30X6MM CRANFCL TI 16 HOLE STRUT 1MM SCR NONSTRL	BOTH IP/OP	"$1,131.75 "	$837.50	$0.00	$905.40	$509.29	$509.29	$0.00	$0.00	$0.00	$235.88	$839.98	$839.98	$0.00	$0.00	$235.86	$0.00	$669.43	$669.43	$0.00	$565.88	$896.35	$905.40	$0.00		$0.00	$177.12	$0.00	$0.00	$180.17	$0.00	$0.00	$0.00	$0.00	$0.00
420.02	SUP	HCPCS C1713		420.02  -  PLATE BONE 42X38X.4MM CRANFCL TI MESH 1MM SCR NONSTRL	BOTH IP/OP	"$3,145.50 "	"$2,327.67"	$0.00	"$2,516.40"	"$1,415.48"	"$1,415.48"	$0.00	$0.00	$0.00	$655.60	"$2,334.59"	"$2,334.59"	$0.00	$0.00	$655.52	$0.00	"$1,550.73"	"$1,550.73"	$0.00	"$1,572.75"	"$2,491.24"	"$2,516.40"	$0.00		$0.00	$492.27	$0.00	$0.00	$500.76	$0.00	$0.00	$0.00	$0.00	$0.00
420.031	SUP	HCPCS C1713		420.031  -  PLATE BONE 50X50MM MIC CRANFCL TI MESH 1MM SCR NONSTRL	BOTH IP/OP	"$3,746.25 "	"$2,772.23"	$0.00	"$2,997.00"	"$1,685.81"	"$1,685.81"	$0.00	$0.00	$0.00	$780.81	"$2,780.47"	"$2,780.47"	$0.00	$0.00	$780.72	$0.00	"$1,846.90"	"$1,846.90"	$0.00	"$1,873.13"	"$2,967.03"	"$2,997.00"	$0.00		$0.00	$586.29	$0.00	$0.00	$596.40	$0.00	$0.00	$0.00	$0.00	$0.00
420.04	SUP	HCPCS C1713		420.04  -  PLATE BONE 42X6X.4MM CRANFCL TI 22 HOLE STRUT 1MM SCR	BOTH IP/OP	"$1,271.25 "	$940.73	$0.00	"$1,017.00"	$572.06	$572.06	$0.00	$0.00	$0.00	$264.96	$943.52	$943.52	$0.00	$0.00	$264.93	$0.00	$751.94	$751.94	$0.00	$635.63	"$1,006.83"	"$1,017.00"	$0.00		$0.00	$198.95	$0.00	$0.00	$202.38	$0.00	$0.00	$0.00	$0.00	$0.00
420.05	SUP	HCPCS C1713		420.05  -  PLATE BONE 100X50X.4MM CRANFCL TI MESH 1MM SCR NONSTRL	BOTH IP/OP	"$3,746.25 "	"$2,772.23"	$0.00	"$2,997.00"	"$1,685.81"	"$1,685.81"	$0.00	$0.00	$0.00	$780.81	"$2,780.47"	"$2,780.47"	$0.00	$0.00	$780.72	$0.00	"$1,846.90"	"$1,846.90"	$0.00	"$1,873.13"	"$2,967.03"	"$2,997.00"	$0.00		$0.00	$586.29	$0.00	$0.00	$596.40	$0.00	$0.00	$0.00	$0.00	$0.00
420.06	SUP	HCPCS C1713		420.06  -  PLATE BONE 100X100X.4MM CRANFCL TI MESH 1MM SCR NONSTRL	BOTH IP/OP	"$5,346.00 "	"$3,956.04"	$0.00	"$4,276.80"	"$2,405.70"	"$2,405.70"	$0.00	$0.00	$0.00	"$1,114.24"	"$3,967.80"	"$3,967.80"	$0.00	$0.00	"$1,114.11"	$0.00	"$2,635.58"	"$2,635.58"	$0.00	"$2,673.00"	"$4,234.03"	"$4,276.80"	$0.00		$0.00	$836.65	$0.00	$0.00	$851.08	$0.00	$0.00	$0.00	$0.00	$0.00
420.07	SUP	HCPCS C1713		420.070  -  PLATE BONE 100X100X.1MM CRANFCL TI MESH SCRN 1MM SCR NONSTRL	BOTH IP/OP	"$2,691.00 "	"$1,991.34"	$0.00	"$2,152.80"	"$1,210.95"	"$1,210.95"	$0.00	$0.00	$0.00	$560.87	"$1,997.26"	"$1,997.26"	$0.00	$0.00	$560.80	$0.00	"$1,326.66"	"$1,326.66"	$0.00	"$1,345.50"	"$2,131.27"	"$2,152.80"	$0.00		$0.00	$421.14	$0.00	$0.00	$428.41	$0.00	$0.00	$0.00	$0.00	$0.00
420.071	SUP	HCPCS C1713		420.071  -  PLATE BONE 100X100MM CRANFCL TI MESH 1/1.5MM SCR NONSTRL	BOTH IP/OP	"$4,603.50 "	"$3,406.59"	$0.00	"$3,682.80"	"$2,071.58"	"$2,071.58"	$0.00	$0.00	$0.00	$959.48	"$3,416.72"	"$3,416.72"	$0.00	$0.00	$959.37	$0.00	"$2,269.53"	"$2,269.53"	$0.00	"$2,301.75"	"$3,645.97"	"$3,682.80"	$0.00		$0.00	$720.45	$0.00	$0.00	$732.88	$0.00	$0.00	$0.00	$0.00	$0.00
420.1	SUP	HCPCS C1713		420.10  -  PLATE BONE 100MM CRNMXF TI 34 HOLE ADP 1MM SCR NONSTRL	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$627.75	$627.75	$0.00	$0.00	$0.00	$290.75	"$1,035.37"	"$1,035.37"	$0.00	$0.00	$290.72	$0.00	$825.14	$825.14	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00		$0.00	$218.32	$0.00	$0.00	$222.08	$0.00	$0.00	$0.00	$0.00	$0.00
420.21	SUP	HCPCS C1713		420.21  -  PLATE BONE ORBTL RIM TI 11 HOLE 1 MM SCR NONSTRL	BOTH IP/OP	$616.50 	$456.21	$0.00	$493.20	$277.43	$277.43	$0.00	$0.00	$0.00	$128.49	$457.57	$457.57	$0.00	$0.00	$128.48	$0.00	$364.66	$364.66	$0.00	$308.25	$488.27	$493.20	$0.00		$0.00	$96.48	$0.00	$0.00	$98.15	$0.00	$0.00	$0.00	$0.00	$0.00
420.302	SUP	HCPCS C1713		420.302  -  PLATE BONE .2MM ORBTL RIM TI MESH 1MM SCR NONSTRL	BOTH IP/OP	"$2,889.00 "	"$2,137.86"	$0.00	"$2,311.20"	"$1,300.05"	"$1,300.05"	$0.00	$0.00	$0.00	$602.14	"$2,144.22"	"$2,144.22"	$0.00	$0.00	$602.07	$0.00	"$1,424.28"	"$1,424.28"	$0.00	"$1,444.50"	"$2,288.09"	"$2,311.20"	$0.00		$0.00	$452.13	$0.00	$0.00	$459.93	$0.00	$0.00	$0.00	$0.00	$0.00
420.303	SUP	HCPCS C1713		420.303  -  PLATE BONE .3MM ORBTL RIM TI MESH 1MM SCR NONSTRL	BOTH IP/OP	"$2,889.00 "	"$2,137.86"	$0.00	"$2,311.20"	"$1,300.05"	"$1,300.05"	$0.00	$0.00	$0.00	$602.14	"$2,144.22"	"$2,144.22"	$0.00	$0.00	$602.07	$0.00	"$1,424.28"	"$1,424.28"	$0.00	"$1,444.50"	"$2,288.09"	"$2,311.20"	$0.00		$0.00	$452.13	$0.00	$0.00	$459.93	$0.00	$0.00	$0.00	$0.00	$0.00
420.304	SUP	HCPCS C1713		420.304  -  PLATE BONE .4MM ORBTL RIM TI MESH 1MM SCR NONSTRL	BOTH IP/OP	"$2,889.00 "	"$2,137.86"	$0.00	"$2,311.20"	"$1,300.05"	"$1,300.05"	$0.00	$0.00	$0.00	$602.14	"$2,144.22"	"$2,144.22"	$0.00	$0.00	$602.07	$0.00	"$1,424.28"	"$1,424.28"	$0.00	"$1,444.50"	"$2,288.09"	"$2,311.20"	$0.00		$0.00	$452.13	$0.00	$0.00	$459.93	$0.00	$0.00	$0.00	$0.00	$0.00
420.4	SUP	HCPCS C1713		420.40  -  PLATE BONE UNV ORBTL FLR TI 1MM SCR NONSTRL	BOTH IP/OP	"$2,772.00 "	"$2,051.28"	$0.00	"$2,217.60"	"$1,247.40"	"$1,247.40"	$0.00	$0.00	$0.00	$577.75	"$2,057.38"	"$2,057.38"	$0.00	$0.00	$577.68	$0.00	"$1,366.60"	"$1,366.60"	$0.00	"$1,386.00"	"$2,195.42"	"$2,217.60"	$0.00		$0.00	$433.82	$0.00	$0.00	$441.30	$0.00	$0.00	$0.00	$0.00	$0.00
420.401	SUP	HCPCS C1713		420.401  -  PLATE SM .3MM TI 1MM SCR ANTM BONE ORBTL FLR NONSTRL	BOTH IP/OP	"$2,772.00 "	"$2,051.28"	$0.00	"$2,217.60"	"$1,247.40"	"$1,247.40"	$0.00	$0.00	$0.00	$577.75	"$2,057.38"	"$2,057.38"	$0.00	$0.00	$577.68	$0.00	"$1,366.60"	"$1,366.60"	$0.00	"$1,386.00"	"$2,195.42"	"$2,217.60"	$0.00		$0.00	$433.82	$0.00	$0.00	$441.30	$0.00	$0.00	$0.00	$0.00	$0.00
420.402	SUP	HCPCS C1713		420.402  -  PLATE BONE LG ORBTL FLR TI ANTM 1MM SCR NONSTRL	BOTH IP/OP	"$2,772.00 "	"$2,051.28"	$0.00	"$2,217.60"	"$1,247.40"	"$1,247.40"	$0.00	$0.00	$0.00	$577.75	"$2,057.38"	"$2,057.38"	$0.00	$0.00	$577.68	$0.00	"$1,366.60"	"$1,366.60"	$0.00	"$1,386.00"	"$2,195.42"	"$2,217.60"	$0.00		$0.00	$433.82	$0.00	$0.00	$441.30	$0.00	$0.00	$0.00	$0.00	$0.00
420.403	SUP	HCPCS C1713		420.403  -  PLATE BONE MED ORBTL FLR TI ANTM 1MM SCR NONSTRL	BOTH IP/OP	"$2,772.00 "	"$2,051.28"	$0.00	"$2,217.60"	"$1,247.40"	"$1,247.40"	$0.00	$0.00	$0.00	$577.75	"$2,057.38"	"$2,057.38"	$0.00	$0.00	$577.68	$0.00	"$1,366.60"	"$1,366.60"	$0.00	"$1,386.00"	"$2,195.42"	"$2,217.60"	$0.00		$0.00	$433.82	$0.00	$0.00	$441.30	$0.00	$0.00	$0.00	$0.00	$0.00
420.44	SUP	HCPCS C1713		420.44  -  PLATE BONE MIC LEFT MDL WL CRANFCL TI 1MM SCR NONSTRL	BOTH IP/OP	"$2,772.00 "	"$2,051.28"	$0.00	"$2,217.60"	"$1,247.40"	"$1,247.40"	$0.00	$0.00	$0.00	$577.75	"$2,057.38"	"$2,057.38"	$0.00	$0.00	$577.68	$0.00	"$1,366.60"	"$1,366.60"	$0.00	"$1,386.00"	"$2,195.42"	"$2,217.60"	$0.00		$0.00	$433.82	$0.00	$0.00	$441.30	$0.00	$0.00	$0.00	$0.00	$0.00
420.45	SUP	HCPCS C1713		420.45  -  PLATE BONE MIC RIGHT MDL WL CRANFCL TI 1MM SCR NONSTRL	BOTH IP/OP	"$2,772.00 "	"$2,051.28"	$0.00	"$2,217.60"	"$1,247.40"	"$1,247.40"	$0.00	$0.00	$0.00	$577.75	"$2,057.38"	"$2,057.38"	$0.00	$0.00	$577.68	$0.00	"$1,366.60"	"$1,366.60"	$0.00	"$1,386.00"	"$2,195.42"	"$2,217.60"	$0.00		$0.00	$433.82	$0.00	$0.00	$441.30	$0.00	$0.00	$0.00	$0.00	$0.00
420.54	SUP	HCPCS C1713		420.54  -  PLATE TI 1 MM SCR L BONE LEFT ORTH NONSTRL	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
420.55	SUP	HCPCS C1713		420.55  -  SET BONE RIGHT TI 5 HL SHFT 4 BASE 1 MM SCR NONSTRL	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
420.62	SUP	HCPCS C1713		420.62  -  PLATE BONE CRANFCL TI 9 HOLE Y 1 MM SCR NONSTRL	BOTH IP/OP	$558.00 	$412.92	$0.00	$446.40	$251.10	$251.10	$0.00	$0.00	$0.00	$116.30	$414.15	$414.15	$0.00	$0.00	$116.29	$0.00	$330.06	$330.06	$0.00	$279.00	$441.94	$446.40	$0.00		$0.00	$87.33	$0.00	$0.00	$88.83	$0.00	$0.00	$0.00	$0.00	$0.00
420.63	SUP	HCPCS C1713		420.63  -  PLATE BONE CRANFCL TI 13 HOLE Y 1 MM SCR NONSTRL	BOTH IP/OP	$558.00 	$412.92	$0.00	$446.40	$251.10	$251.10	$0.00	$0.00	$0.00	$116.30	$414.15	$414.15	$0.00	$0.00	$116.29	$0.00	$330.06	$330.06	$0.00	$279.00	$441.94	$446.40	$0.00		$0.00	$87.33	$0.00	$0.00	$88.83	$0.00	$0.00	$0.00	$0.00	$0.00
420.631	SUP	HCPCS C1713		420.631  -  PLATE BONE CRANFCL TI 18 HOLE Y 1 MM SCR NONSTRL	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$231.86	$231.86	$0.00	$0.00	$0.00	$107.39	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$304.77	$304.77	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$80.64	$0.00	$0.00	$82.03	$0.00	$0.00	$0.00	$0.00	$0.00
420.68	SUP	HCPCS C1713		420.68  -  PLATE BONE CRANFCL TI 1X2 HOLE 2 Y 1 MM SCR NONSTRL	BOTH IP/OP	$591.75 	$437.90	$0.00	$473.40	$266.29	$266.29	$0.00	$0.00	$0.00	$123.34	$439.20	$439.20	$0.00	$0.00	$123.32	$0.00	$350.02	$350.02	$0.00	$295.88	$468.67	$473.40	$0.00		$0.00	$92.61	$0.00	$0.00	$94.21	$0.00	$0.00	$0.00	$0.00	$0.00
420.7	SUP	HCPCS C1713		420.70  -  PLATE TI 1 MM SCR 5X5 HOLE T BONE ORTH NONSTRL	BOTH IP/OP	$558.00 	$412.92	$0.00	$446.40	$251.10	$251.10	$0.00	$0.00	$0.00	$116.30	$414.15	$414.15	$0.00	$0.00	$116.29	$0.00	$330.06	$330.06	$0.00	$279.00	$441.94	$446.40	$0.00		$0.00	$87.33	$0.00	$0.00	$88.83	$0.00	$0.00	$0.00	$0.00	$0.00
420.71	SUP	HCPCS C1713		420.71  -  PLATE BONE CRANFCL TI 12 HOLE T 1 MM SCR NONSTRL	BOTH IP/OP	$591.75 	$437.90	$0.00	$473.40	$266.29	$266.29	$0.00	$0.00	$0.00	$123.34	$439.20	$439.20	$0.00	$0.00	$123.32	$0.00	$350.02	$350.02	$0.00	$295.88	$468.67	$473.40	$0.00		$0.00	$92.61	$0.00	$0.00	$94.21	$0.00	$0.00	$0.00	$0.00	$0.00
420.81	SUP	HCPCS C1713		420.81  -  SCREW BONE CORT CRANFCL TI 5 HOLE X NONSTRL	BOTH IP/OP	$499.50 	$369.63	$0.00	$399.60	$224.78	$224.78	$0.00	$0.00	$0.00	$104.11	$370.73	$370.73	$0.00	$0.00	$104.10	$0.00	$295.45	$295.45	$0.00	$249.75	$395.60	$399.60	$0.00		$0.00	$78.17	$0.00	$0.00	$79.52	$0.00	$0.00	$0.00	$0.00	$0.00
420.84	SUP	HCPCS C1713		420.84  -  PLATE BONE CRANFCL TI 6 HOLE H 1 MM SCR NONSTRL	BOTH IP/OP	$528.75 	$391.28	$0.00	$423.00	$237.94	$237.94	$0.00	$0.00	$0.00	$110.20	$392.44	$392.44	$0.00	$0.00	$110.19	$0.00	$312.76	$312.76	$0.00	$264.38	$418.77	$423.00	$0.00		$0.00	$82.75	$0.00	$0.00	$84.18	$0.00	$0.00	$0.00	$0.00	$0.00
420.85	SUP	HCPCS C1713		420.85  -  PLATE BONE CRANFCL TI 11 HOLE H 1 MM SCR NONSTRL	BOTH IP/OP	$591.75 	$437.90	$0.00	$473.40	$266.29	$266.29	$0.00	$0.00	$0.00	$123.34	$439.20	$439.20	$0.00	$0.00	$123.32	$0.00	$350.02	$350.02	$0.00	$295.88	$468.67	$473.40	$0.00		$0.00	$92.61	$0.00	$0.00	$94.21	$0.00	$0.00	$0.00	$0.00	$0.00
420.9	SUP	Custom 27803010		420.900  -  BURR SURG 12MM HOLE COVER	BOTH IP/OP	$504.00 	$372.96	$0.00	$403.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.07	$374.07	$0.00	$0.00	$105.03	$0.00	$0.00	$0.00	$0.00	$252.00	$399.17	$403.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
420.91	SUP	Custom 27803010		420.91  -  COVER BUR HOLE 17MM CRANFCL TI 6 HOLE 1MM SCR NONSTRL	BOTH IP/OP	$504.00 	$372.96	$0.00	$403.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.07	$374.07	$0.00	$0.00	$105.03	$0.00	$0.00	$0.00	$0.00	$252.00	$399.17	$403.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
421.001	SUP	HCPCS C1713		421.001  -  PLATE BONE 53X38MM CRANFCL TI MESH MALBLE 1.3MM SCR NONSTRL	BOTH IP/OP	"$3,467.25 "	"$2,565.77"	$0.00	"$2,773.80"	"$1,560.26"	"$1,560.26"	$0.00	$0.00	$0.00	$722.66	"$2,573.39"	"$2,573.39"	$0.00	$0.00	$722.57	$0.00	"$1,709.35"	"$1,709.35"	$0.00	"$1,733.63"	"$2,746.06"	"$2,773.80"	$0.00		$0.00	$542.62	$0.00	$0.00	$551.99	$0.00	$0.00	$0.00	$0.00	$0.00
421.002	SUP	HCPCS C1713		421.002  -  PLATE BONE TMPR TI MESH MALBLE 1.3 MM SCR NONSTRL	BOTH IP/OP	"$1,851.75 "	"$1,370.30"	$0.00	"$1,481.40"	$833.29	$833.29	$0.00	$0.00	$0.00	$385.95	"$1,374.37"	"$1,374.37"	$0.00	$0.00	$385.90	$0.00	"$1,095.31"	"$1,095.31"	$0.00	$925.88	"$1,466.59"	"$1,481.40"	$0.00		$0.00	$289.80	$0.00	$0.00	$294.80	$0.00	$0.00	$0.00	$0.00	$0.00
421.003	SUP	HCPCS C1713		421.003  -  PLATE BONE CRANIAL TI 8 HOLE CONTUR STRUT 1.3 MM SCR NONSTRL	BOTH IP/OP	"$1,365.75 "	"$1,010.66"	$0.00	"$1,092.60"	$614.59	$614.59	$0.00	$0.00	$0.00	$284.66	"$1,013.66"	"$1,013.66"	$0.00	$0.00	$284.62	$0.00	$807.84	$807.84	$0.00	$682.88	"$1,081.67"	"$1,092.60"	$0.00		$0.00	$213.74	$0.00	$0.00	$217.43	$0.00	$0.00	$0.00	$0.00	$0.00
421.004	SUP	HCPCS C1713		421.004  -  PLATE BONE NONSTRL TEAL 45X38MM CRANFCL TI CONTUR MESH	BOTH IP/OP	"$3,584.25 "	"$2,652.35"	$0.00	"$2,867.40"	"$1,612.91"	"$1,612.91"	$0.00	$0.00	$0.00	$747.05	"$2,660.23"	"$2,660.23"	$0.00	$0.00	$746.96	$0.00	"$1,767.04"	"$1,767.04"	$0.00	"$1,792.13"	"$2,838.73"	"$2,867.40"	$0.00		$0.00	$560.94	$0.00	$0.00	$570.61	$0.00	$0.00	$0.00	$0.00	$0.00
421.005	SUP	HCPCS C1713		421.005  -  PLATE BN RECT 45X38X.6MM NS CNTR MESH RGD TI CRNFCL 1.3MM	BOTH IP/OP	"$3,584.25 "	"$2,652.35"	$0.00	"$2,867.40"	"$1,612.91"	"$1,612.91"	$0.00	$0.00	$0.00	$747.05	"$2,660.23"	"$2,660.23"	$0.00	$0.00	$746.96	$0.00	"$1,767.04"	"$1,767.04"	$0.00	"$1,792.13"	"$2,838.73"	"$2,867.40"	$0.00		$0.00	$560.94	$0.00	$0.00	$570.61	$0.00	$0.00	$0.00	$0.00	$0.00
421.006	SUP	HCPCS C1713		421.006  -  PLATE BONE 100X100MM CRANFCL TI 5 HOLE MESH MALBLE 1.3MM SCR	BOTH IP/OP	"$5,379.75 "	"$3,981.02"	$0.00	"$4,303.80"	"$2,420.89"	"$2,420.89"	$0.00	$0.00	$0.00	"$1,121.27"	"$3,992.85"	"$3,992.85"	$0.00	$0.00	"$1,121.14"	$0.00	"$2,652.22"	"$2,652.22"	$0.00	"$2,689.88"	"$4,260.76"	"$4,303.80"	$0.00		$0.00	$841.93	$0.00	$0.00	$856.46	$0.00	$0.00	$0.00	$0.00	$0.00
421.007	SUP	HCPCS C1713		421.007  -  PLATE BONE NONSTRL TEAL 100X100MM CRANFCL TI CONTUR MESH	BOTH IP/OP	"$5,595.75 "	"$4,140.86"	$0.00	"$4,476.60"	"$2,518.09"	"$2,518.09"	$0.00	$0.00	$0.00	"$1,166.29"	"$4,153.17"	"$4,153.17"	$0.00	$0.00	"$1,166.15"	$0.00	"$2,758.70"	"$2,758.70"	$0.00	"$2,797.88"	"$4,431.83"	"$4,476.60"	$0.00		$0.00	$875.73	$0.00	$0.00	$890.84	$0.00	$0.00	$0.00	$0.00	$0.00
421.008	SUP	HCPCS C1713		421.008  -  PLATE BN RECT 100X100X.6MM NS CNTR MESH RGD TI CRNFCL 1.3MM	BOTH IP/OP	"$5,595.75 "	"$4,140.86"	$0.00	"$4,476.60"	"$2,518.09"	"$2,518.09"	$0.00	$0.00	$0.00	"$1,166.29"	"$4,153.17"	"$4,153.17"	$0.00	$0.00	"$1,166.15"	$0.00	"$2,758.70"	"$2,758.70"	$0.00	"$2,797.88"	"$4,431.83"	"$4,476.60"	$0.00		$0.00	$875.73	$0.00	$0.00	$890.84	$0.00	$0.00	$0.00	$0.00	$0.00
421.009	SUP	HCPCS C1713		421.009  -  PLATE BONE NONSTRL GOLD 200X200MM CRANFCL TI CONTUR MESH RGD	BOTH IP/OP	"$22,304.25 "	"$16,505.15"	$0.00	"$17,843.40"	"$10,036.91"	"$10,036.91"	$0.00	$0.00	$0.00	"$4,648.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,648.21"	$0.00	"$10,996.00"	"$10,996.00"	$0.00	"$11,152.13"	"$17,664.97"	"$17,843.40"	$0.00		$0.00	"$3,490.62"	$0.00	$0.00	"$3,550.84"	$0.00	$0.00	$0.00	$0.00	$0.00
421.01	SUP	HCPCS C1713		421.010  -  PLATE BN 95X3.3X.5MM NS 24 HL ADP TI CRNFCL 1.3MM CORT SCR	BOTH IP/OP	"$1,446.75 "	"$1,070.60"	$0.00	"$1,157.40"	$651.04	$651.04	$0.00	$0.00	$0.00	$301.54	"$1,073.78"	"$1,073.78"	$0.00	$0.00	$301.50	$0.00	$855.75	$855.75	$0.00	$723.38	"$1,145.83"	"$1,157.40"	$0.00		$0.00	$226.42	$0.00	$0.00	$230.32	$0.00	$0.00	$0.00	$0.00	$0.00
421.011	SUP	HCPCS C1713		421.011  -  PLATE BONE NONSTRL TEAL CRANFCL TI CONTUR MESH MALBLE SM ARC	BOTH IP/OP	"$1,851.75 "	"$1,370.30"	$0.00	"$1,481.40"	$833.29	$833.29	$0.00	$0.00	$0.00	$385.95	"$1,374.37"	"$1,374.37"	$0.00	$0.00	$385.90	$0.00	"$1,095.31"	"$1,095.31"	$0.00	$925.88	"$1,466.59"	"$1,481.40"	$0.00		$0.00	$289.80	$0.00	$0.00	$294.80	$0.00	$0.00	$0.00	$0.00	$0.00
421.012	SUP	HCPCS C1713		421.012  -  PLATE BONE NONSTRL TEAL CRANFCL TI CONTUR MESH MALBLE LG ARC	BOTH IP/OP	"$2,893.50 "	"$2,141.19"	$0.00	"$2,314.80"	"$1,302.08"	"$1,302.08"	$0.00	$0.00	$0.00	$603.08	"$2,147.56"	"$2,147.56"	$0.00	$0.00	$603.01	$0.00	"$1,426.50"	"$1,426.50"	$0.00	"$1,446.75"	"$2,291.65"	"$2,314.80"	$0.00		$0.00	$452.83	$0.00	$0.00	$460.65	$0.00	$0.00	$0.00	$0.00	$0.00
421.013	SUP	HCPCS C1713		421.013  -  PLATE BONE 1.3MM SCR GOLD CRANFCL TI CONTUR MESH RGD SM ARC	BOTH IP/OP	"$1,851.75 "	"$1,370.30"	$0.00	"$1,481.40"	$833.29	$833.29	$0.00	$0.00	$0.00	$385.95	"$1,374.37"	"$1,374.37"	$0.00	$0.00	$385.90	$0.00	"$1,095.31"	"$1,095.31"	$0.00	$925.88	"$1,466.59"	"$1,481.40"	$0.00		$0.00	$289.80	$0.00	$0.00	$294.80	$0.00	$0.00	$0.00	$0.00	$0.00
421.014	SUP	HCPCS C1713		421.014  -  PLATE BONE 1.3MM SCR GOLD CRANFCL TI CONTUR MESH RGD LG ARC	BOTH IP/OP	"$2,893.50 "	"$2,141.19"	$0.00	"$2,314.80"	"$1,302.08"	"$1,302.08"	$0.00	$0.00	$0.00	$603.08	"$2,147.56"	"$2,147.56"	$0.00	$0.00	$603.01	$0.00	"$1,426.50"	"$1,426.50"	$0.00	"$1,446.75"	"$2,291.65"	"$2,314.80"	$0.00		$0.00	$452.83	$0.00	$0.00	$460.65	$0.00	$0.00	$0.00	$0.00	$0.00
421.015	SUP	HCPCS C1713		421.015  -  PLATE BONE RND CONTUR MESH MALBLE 1.3MM SCR TEAL 30MM	BOTH IP/OP	"$1,851.75 "	"$1,370.30"	$0.00	"$1,481.40"	$833.29	$833.29	$0.00	$0.00	$0.00	$385.95	"$1,374.37"	"$1,374.37"	$0.00	$0.00	$385.90	$0.00	"$1,095.31"	"$1,095.31"	$0.00	$925.88	"$1,466.59"	"$1,481.40"	$0.00		$0.00	$289.80	$0.00	$0.00	$294.80	$0.00	$0.00	$0.00	$0.00	$0.00
421.016	SUP	HCPCS C1713		421.016  -  PLATE BONE RND CONTUR MESH MALBLE 1.3MM SCR TEAL 70MM	BOTH IP/OP	"$3,845.25 "	"$2,845.49"	$0.00	"$3,076.20"	"$1,730.36"	"$1,730.36"	$0.00	$0.00	$0.00	$801.45	"$2,853.94"	"$2,853.94"	$0.00	$0.00	$801.35	$0.00	"$1,895.71"	"$1,895.71"	$0.00	"$1,922.63"	"$3,045.44"	"$3,076.20"	$0.00		$0.00	$601.78	$0.00	$0.00	$612.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.017	SUP	HCPCS C1713		421.017  -  PLATE BONE RND CONTUR MESH MALBLE 1.3MM SCR TEAL 100MM	BOTH IP/OP	"$5,334.75 "	"$3,947.72"	$0.00	"$4,267.80"	"$2,400.64"	"$2,400.64"	$0.00	$0.00	$0.00	"$1,111.90"	"$3,959.45"	"$3,959.45"	$0.00	$0.00	"$1,111.76"	$0.00	"$2,630.03"	"$2,630.03"	$0.00	"$2,667.38"	"$4,225.12"	"$4,267.80"	$0.00		$0.00	$834.89	$0.00	$0.00	$849.29	$0.00	$0.00	$0.00	$0.00	$0.00
421.018	SUP	HCPCS C1713		421.018  -  PLATE BONE NONSTRL GOLD 30MM CRANFCL TI CONTUR MESH RGD RND	BOTH IP/OP	"$1,851.75 "	"$1,370.30"	$0.00	"$1,481.40"	$833.29	$833.29	$0.00	$0.00	$0.00	$385.95	"$1,374.37"	"$1,374.37"	$0.00	$0.00	$385.90	$0.00	"$1,095.31"	"$1,095.31"	$0.00	$925.88	"$1,466.59"	"$1,481.40"	$0.00		$0.00	$289.80	$0.00	$0.00	$294.80	$0.00	$0.00	$0.00	$0.00	$0.00
421.019	SUP	HCPCS C1713		421.019  -  PLATE BONE NONSTRL GOLD 70MM CRANFCL TI CONTUR MESH RGD RND	BOTH IP/OP	"$3,845.25 "	"$2,845.49"	$0.00	"$3,076.20"	"$1,730.36"	"$1,730.36"	$0.00	$0.00	$0.00	$801.45	"$2,853.94"	"$2,853.94"	$0.00	$0.00	$801.35	$0.00	"$1,895.71"	"$1,895.71"	$0.00	"$1,922.63"	"$3,045.44"	"$3,076.20"	$0.00		$0.00	$601.78	$0.00	$0.00	$612.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.02	SUP	HCPCS C1713		421.020  -  PLATE BONE NONSTRL GOLD 100MM CRANFCL TI CONTUR MESH RGD RND	BOTH IP/OP	"$5,334.75 "	"$3,947.72"	$0.00	"$4,267.80"	"$2,400.64"	"$2,400.64"	$0.00	$0.00	$0.00	"$1,111.90"	"$3,959.45"	"$3,959.45"	$0.00	$0.00	"$1,111.76"	$0.00	"$2,630.03"	"$2,630.03"	$0.00	"$2,667.38"	"$4,225.12"	"$4,267.80"	$0.00		$0.00	$834.89	$0.00	$0.00	$849.29	$0.00	$0.00	$0.00	$0.00	$0.00
421.021	SUP	HCPCS C1713		421.021  -  PLATE BN 35X3.3X.5MM NS 9 HL TI CRNFCL ORBT RIM 1.3MM CORT	BOTH IP/OP	$576.00 	$426.24	$0.00	$460.80	$259.20	$259.20	$0.00	$0.00	$0.00	$120.05	$427.51	$427.51	$0.00	$0.00	$120.04	$0.00	$340.70	$340.70	$0.00	$288.00	$456.19	$460.80	$0.00		$0.00	$90.14	$0.00	$0.00	$91.70	$0.00	$0.00	$0.00	$0.00	$0.00
421.022	SUP	HCPCS C1713		421.022  -  PLATE BONE 13MM THK.5MM CRANIAL TI 2 HOLE STR 1.3MM SCR	BOTH IP/OP	$101.25 	$74.93	$0.00	$81.00	$45.56	$45.56	$0.00	$0.00	$0.00	$21.10	$75.15	$75.15	$0.00	$0.00	$21.10	$0.00	$59.89	$59.89	$0.00	$50.63	$80.19	$81.00	$0.00		$0.00	$15.85	$0.00	$0.00	$16.12	$0.00	$0.00	$0.00	$0.00	$0.00
421.024	SUP	HCPCS C1713		421.024  -  PLATE BONE 21MM CRANFCL TI 4 HOLE STR 1.3MM SCR NONSTRL	BOTH IP/OP	$139.50 	$103.23	$0.00	$111.60	$62.78	$62.78	$0.00	$0.00	$0.00	$29.08	$103.54	$103.54	$0.00	$0.00	$29.07	$0.00	$82.51	$82.51	$0.00	$69.75	$110.48	$111.60	$0.00		$0.00	$21.83	$0.00	$0.00	$22.21	$0.00	$0.00	$0.00	$0.00	$0.00
421.034	SUP	Custom 27803010		421.034  -  COVER BUR HOLE 17MM CRANIAL TI 5 HOLE SHNT 1.3MM SCR NONSTRL	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$0.00	$0.00	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
421.04	SUP	HCPCS C1713		421.040  -  PLATE BONE UNV ORBTL FLR TI 1.3MM SCR NONSTRL	BOTH IP/OP	"$2,531.25 "	"$1,873.13"	$0.00	"$2,025.00"	"$1,139.06"	"$1,139.06"	$0.00	$0.00	$0.00	$527.58	"$1,878.69"	"$1,878.69"	$0.00	$0.00	$527.51	$0.00	"$1,247.91"	"$1,247.91"	$0.00	"$1,265.63"	"$2,004.75"	"$2,025.00"	$0.00		$0.00	$396.14	$0.00	$0.00	$402.98	$0.00	$0.00	$0.00	$0.00	$0.00
421.043	SUP	HCPCS C1713		421.043  -  PLATE BONE MED ORBTL FLR TI ANTM 1.3MM SCR NONSTRL	BOTH IP/OP	"$2,553.75 "	"$1,889.78"	$0.00	"$2,043.00"	"$1,149.19"	"$1,149.19"	$0.00	$0.00	$0.00	$532.27	"$1,895.39"	"$1,895.39"	$0.00	$0.00	$532.20	$0.00	"$1,259.00"	"$1,259.00"	$0.00	"$1,276.88"	"$2,022.57"	"$2,043.00"	$0.00		$0.00	$399.66	$0.00	$0.00	$406.56	$0.00	$0.00	$0.00	$0.00	$0.00
421.044	SUP	HCPCS C1713		421.044  -  PLATE BONE LEFT MDL WL ORBTL FLR TI 1.3 MM SCR NONSTRL	BOTH IP/OP	"$2,531.25 "	"$1,873.13"	$0.00	"$2,025.00"	"$1,139.06"	"$1,139.06"	$0.00	$0.00	$0.00	$527.58	"$1,878.69"	"$1,878.69"	$0.00	$0.00	$527.51	$0.00	"$1,247.91"	"$1,247.91"	$0.00	"$1,265.63"	"$2,004.75"	"$2,025.00"	$0.00		$0.00	$396.14	$0.00	$0.00	$402.98	$0.00	$0.00	$0.00	$0.00	$0.00
421.045	SUP	HCPCS C1713		421.045  -  PLATE BONE RIGHT MDL WL ORBTL FLR TI 1.3 MM SCR NONSTRL	BOTH IP/OP	"$2,531.25 "	"$1,873.13"	$0.00	"$2,025.00"	"$1,139.06"	"$1,139.06"	$0.00	$0.00	$0.00	$527.58	"$1,878.69"	"$1,878.69"	$0.00	$0.00	$527.51	$0.00	"$1,247.91"	"$1,247.91"	$0.00	"$1,265.63"	"$2,004.75"	"$2,025.00"	$0.00		$0.00	$396.14	$0.00	$0.00	$402.98	$0.00	$0.00	$0.00	$0.00	$0.00
421.048	SUP	HCPCS C1713		421.048  -  PLATE BN SM .3MM NS ANTM TI ORBT FLR 1.3MM CORT SCR	BOTH IP/OP	"$2,553.75 "	"$1,889.78"	$0.00	"$2,043.00"	"$1,149.19"	"$1,149.19"	$0.00	$0.00	$0.00	$532.27	"$1,895.39"	"$1,895.39"	$0.00	$0.00	$532.20	$0.00	"$1,259.00"	"$1,259.00"	$0.00	"$1,276.88"	"$2,022.57"	"$2,043.00"	$0.00		$0.00	$399.66	$0.00	$0.00	$406.56	$0.00	$0.00	$0.00	$0.00	$0.00
421.049	SUP	HCPCS C1713		421.049  -  PLATE BN LG .3MM NS ANTM TI ORBT FLR 1.3MM CORT SCR	BOTH IP/OP	"$2,553.75 "	"$1,889.78"	$0.00	"$2,043.00"	"$1,149.19"	"$1,149.19"	$0.00	$0.00	$0.00	$532.27	"$1,895.39"	"$1,895.39"	$0.00	$0.00	$532.20	$0.00	"$1,259.00"	"$1,259.00"	$0.00	"$1,276.88"	"$2,022.57"	"$2,043.00"	$0.00		$0.00	$399.66	$0.00	$0.00	$406.56	$0.00	$0.00	$0.00	$0.00	$0.00
421.05	SUP	HCPCS C1713		421.050  -  PLATE BN 100D 9MM SPC L OB L 20X11X.5MM NS 3 HL BS 3 HL SHFT	BOTH IP/OP	$576.00 	$426.24	$0.00	$460.80	$259.20	$259.20	$0.00	$0.00	$0.00	$120.05	$427.51	$427.51	$0.00	$0.00	$120.04	$0.00	$340.70	$340.70	$0.00	$288.00	$456.19	$460.80	$0.00		$0.00	$90.14	$0.00	$0.00	$91.70	$0.00	$0.00	$0.00	$0.00	$0.00
421.051	SUP	HCPCS C1713		421.051  -  PLATE BN 100D 9MM SPC L OB R 20X11X.5MM NS 3 HL BS 3 HL SHFT	BOTH IP/OP	$576.00 	$426.24	$0.00	$460.80	$259.20	$259.20	$0.00	$0.00	$0.00	$120.05	$427.51	$427.51	$0.00	$0.00	$120.04	$0.00	$340.70	$340.70	$0.00	$288.00	$456.19	$460.80	$0.00		$0.00	$90.14	$0.00	$0.00	$91.70	$0.00	$0.00	$0.00	$0.00	$0.00
421.052	SUP	HCPCS C1713		421.052  -  PLATE BN 100D 5MM SPC L OB L 20X11X.5MM NS 3 HL BS 4 HL SHFT	BOTH IP/OP	$576.00 	$426.24	$0.00	$460.80	$259.20	$259.20	$0.00	$0.00	$0.00	$120.05	$427.51	$427.51	$0.00	$0.00	$120.04	$0.00	$340.70	$340.70	$0.00	$288.00	$456.19	$460.80	$0.00		$0.00	$90.14	$0.00	$0.00	$91.70	$0.00	$0.00	$0.00	$0.00	$0.00
421.053	SUP	HCPCS C1713		421.053  -  PLATE BN 100D 5MM SPC L OB R 20X11X.5MM NS 3 HL BS 4 HL SHFT	BOTH IP/OP	$576.00 	$426.24	$0.00	$460.80	$259.20	$259.20	$0.00	$0.00	$0.00	$120.05	$427.51	$427.51	$0.00	$0.00	$120.04	$0.00	$340.70	$340.70	$0.00	$288.00	$456.19	$460.80	$0.00		$0.00	$90.14	$0.00	$0.00	$91.70	$0.00	$0.00	$0.00	$0.00	$0.00
421.061	SUP	HCPCS C1713		421.061  -  PLATE BN Y 20X10X.5MM NS 5 HL TI CRNFCL 1.3MM CORT SCR	BOTH IP/OP	$522.00 	$386.28	$0.00	$417.60	$234.90	$234.90	$0.00	$0.00	$0.00	$108.80	$387.43	$387.43	$0.00	$0.00	$108.78	$0.00	$308.76	$308.76	$0.00	$261.00	$413.42	$417.60	$0.00		$0.00	$81.69	$0.00	$0.00	$83.10	$0.00	$0.00	$0.00	$0.00	$0.00
421.067	SUP	HCPCS C1713		421.067  -  PLATE BONE 22MM CRANFCL TI 6 HOLE DBL Y 1.3MM SCR NONSTRL	BOTH IP/OP	$571.50 	$422.91	$0.00	$457.20	$257.18	$257.18	$0.00	$0.00	$0.00	$119.11	$424.17	$424.17	$0.00	$0.00	$119.10	$0.00	$338.04	$338.04	$0.00	$285.75	$452.63	$457.20	$0.00		$0.00	$89.44	$0.00	$0.00	$90.98	$0.00	$0.00	$0.00	$0.00	$0.00
421.068	SUP	HCPCS C1713		421.068  -  PLATE BN 6MM SPC 2Y 15X9X.5MM NS 2 HL SHFT 1 HL ARM TI	BOTH IP/OP	$571.50 	$422.91	$0.00	$457.20	$257.18	$257.18	$0.00	$0.00	$0.00	$119.11	$424.17	$424.17	$0.00	$0.00	$119.10	$0.00	$338.04	$338.04	$0.00	$285.75	$452.63	$457.20	$0.00		$0.00	$89.44	$0.00	$0.00	$90.98	$0.00	$0.00	$0.00	$0.00	$0.00
421.069	SUP	HCPCS C1713		421.069  -  PLATE BONE 18MM CRANFCL TI 6 HOLE 2Y 1.3MM SCR NONSTRL	BOTH IP/OP	$571.50 	$422.91	$0.00	$457.20	$257.18	$257.18	$0.00	$0.00	$0.00	$119.11	$424.17	$424.17	$0.00	$0.00	$119.10	$0.00	$338.04	$338.04	$0.00	$285.75	$452.63	$457.20	$0.00		$0.00	$89.44	$0.00	$0.00	$90.98	$0.00	$0.00	$0.00	$0.00	$0.00
421.071	SUP	HCPCS C1713		421.071  -  PLATE BONE CRANFCL TI 7 HOLE T 1.3 MM SCR NONSTRL	BOTH IP/OP	$576.00 	$426.24	$0.00	$460.80	$259.20	$259.20	$0.00	$0.00	$0.00	$120.05	$427.51	$427.51	$0.00	$0.00	$120.04	$0.00	$340.70	$340.70	$0.00	$288.00	$456.19	$460.80	$0.00		$0.00	$90.14	$0.00	$0.00	$91.70	$0.00	$0.00	$0.00	$0.00	$0.00
421.072	SUP	HCPCS C1713		421.072  -  PLATE RIGHT MAXL T 1.3MM SCR BONE TI 14MM NONSTRL	BOTH IP/OP	$729.00 	$539.46	$0.00	$583.20	$328.05	$328.05	$0.00	$0.00	$0.00	$151.94	$541.06	$541.06	$0.00	$0.00	$151.92	$0.00	$431.20	$431.20	$0.00	$364.50	$577.37	$583.20	$0.00		$0.00	$114.09	$0.00	$0.00	$116.06	$0.00	$0.00	$0.00	$0.00	$0.00
421.073	SUP	HCPCS C1713		421.073  -  PLATE LEFT MAXL T 1.3MM SCR BONE TI 14MM NONSTRL	BOTH IP/OP	$729.00 	$539.46	$0.00	$583.20	$328.05	$328.05	$0.00	$0.00	$0.00	$151.94	$541.06	$541.06	$0.00	$0.00	$151.92	$0.00	$431.20	$431.20	$0.00	$364.50	$577.37	$583.20	$0.00		$0.00	$114.09	$0.00	$0.00	$116.06	$0.00	$0.00	$0.00	$0.00	$0.00
421.074	SUP	HCPCS C1713		421.074  -  PLATE RIGHT MAXL T 1.3MM SCR BONE TI 8MM NONSTRL	BOTH IP/OP	$729.00 	$539.46	$0.00	$583.20	$328.05	$328.05	$0.00	$0.00	$0.00	$151.94	$541.06	$541.06	$0.00	$0.00	$151.92	$0.00	$431.20	$431.20	$0.00	$364.50	$577.37	$583.20	$0.00		$0.00	$114.09	$0.00	$0.00	$116.06	$0.00	$0.00	$0.00	$0.00	$0.00
421.075	SUP	HCPCS C1713		421.075  -  PLATE LEFT MAXL T 1.3MM SCR BONE TI 8MM NONSTRL	BOTH IP/OP	$729.00 	$539.46	$0.00	$583.20	$328.05	$328.05	$0.00	$0.00	$0.00	$151.94	$541.06	$541.06	$0.00	$0.00	$151.92	$0.00	$431.20	$431.20	$0.00	$364.50	$577.37	$583.20	$0.00		$0.00	$114.09	$0.00	$0.00	$116.06	$0.00	$0.00	$0.00	$0.00	$0.00
421.076	SUP	HCPCS C1713		421.076  -  PLATE RIGHT MAXL T 1.3MM SCR BONE TI 10MM NONSTRL	BOTH IP/OP	$729.00 	$539.46	$0.00	$583.20	$328.05	$328.05	$0.00	$0.00	$0.00	$151.94	$541.06	$541.06	$0.00	$0.00	$151.92	$0.00	$431.20	$431.20	$0.00	$364.50	$577.37	$583.20	$0.00		$0.00	$114.09	$0.00	$0.00	$116.06	$0.00	$0.00	$0.00	$0.00	$0.00
421.077	SUP	HCPCS C1713		421.077  -  PLATE LEFT MAXL T 1.3MM SCR BONE TI 10MM NONSTRL	BOTH IP/OP	$729.00 	$539.46	$0.00	$583.20	$328.05	$328.05	$0.00	$0.00	$0.00	$151.94	$541.06	$541.06	$0.00	$0.00	$151.92	$0.00	$431.20	$431.20	$0.00	$364.50	$577.37	$583.20	$0.00		$0.00	$114.09	$0.00	$0.00	$116.06	$0.00	$0.00	$0.00	$0.00	$0.00
421.078	SUP	HCPCS C1713		421.078  -  PLATE RIGHT MAXL T 1.3MM SCR BONE TI 12MM NONSTRL	BOTH IP/OP	$729.00 	$539.46	$0.00	$583.20	$328.05	$328.05	$0.00	$0.00	$0.00	$151.94	$541.06	$541.06	$0.00	$0.00	$151.92	$0.00	$431.20	$431.20	$0.00	$364.50	$577.37	$583.20	$0.00		$0.00	$114.09	$0.00	$0.00	$116.06	$0.00	$0.00	$0.00	$0.00	$0.00
421.079	SUP	HCPCS C1713		421.079  -  PLATE LEFT MAXL T 1.3MM SCR BONE TI 12MM NONSTRL	BOTH IP/OP	$729.00 	$539.46	$0.00	$583.20	$328.05	$328.05	$0.00	$0.00	$0.00	$151.94	$541.06	$541.06	$0.00	$0.00	$151.92	$0.00	$431.20	$431.20	$0.00	$364.50	$577.37	$583.20	$0.00		$0.00	$114.09	$0.00	$0.00	$116.06	$0.00	$0.00	$0.00	$0.00	$0.00
421.08	SUP	HCPCS C1713		421.080  -  PLATE BN T 43X8X.5MM NS 2X9 HL STRUT TI CRNFCL 1.3MM CORT	BOTH IP/OP	"$1,190.25 "	$880.79	$0.00	$952.20	$535.61	$535.61	$0.00	$0.00	$0.00	$248.08	$883.40	$883.40	$0.00	$0.00	$248.05	$0.00	$704.03	$704.03	$0.00	$595.13	$942.68	$952.20	$0.00		$0.00	$186.27	$0.00	$0.00	$189.49	$0.00	$0.00	$0.00	$0.00	$0.00
421.081	SUP	HCPCS C1713		421.081  -  PLATE BONE CRANFCL TI 4 HOLE X 1.3 MM SCR NONSTRL	BOTH IP/OP	$522.00 	$386.28	$0.00	$417.60	$234.90	$234.90	$0.00	$0.00	$0.00	$108.80	$387.43	$387.43	$0.00	$0.00	$108.78	$0.00	$308.76	$308.76	$0.00	$261.00	$413.42	$417.60	$0.00		$0.00	$81.69	$0.00	$0.00	$83.10	$0.00	$0.00	$0.00	$0.00	$0.00
421.082	SUP	HCPCS C1713		421.082  -  PLATE MAXL T STR 1.3MM SCR BONE TI 8MM NONSTRL	BOTH IP/OP	$729.00 	$539.46	$0.00	$583.20	$328.05	$328.05	$0.00	$0.00	$0.00	$151.94	$541.06	$541.06	$0.00	$0.00	$151.92	$0.00	$431.20	$431.20	$0.00	$364.50	$577.37	$583.20	$0.00		$0.00	$114.09	$0.00	$0.00	$116.06	$0.00	$0.00	$0.00	$0.00	$0.00
421.083	SUP	HCPCS C1713		421.083  -  PLATE MAXL T STR 1.3MM SCR BONE TI 10MM NONSTRL	BOTH IP/OP	$729.00 	$539.46	$0.00	$583.20	$328.05	$328.05	$0.00	$0.00	$0.00	$151.94	$541.06	$541.06	$0.00	$0.00	$151.92	$0.00	$431.20	$431.20	$0.00	$364.50	$577.37	$583.20	$0.00		$0.00	$114.09	$0.00	$0.00	$116.06	$0.00	$0.00	$0.00	$0.00	$0.00
421.084	SUP	HCPCS C1713		421.084  -  PLATE MAXL T STR 1.3MM SCR BONE TI 12MM NONSTRL	BOTH IP/OP	$729.00 	$539.46	$0.00	$583.20	$328.05	$328.05	$0.00	$0.00	$0.00	$151.94	$541.06	$541.06	$0.00	$0.00	$151.92	$0.00	$431.20	$431.20	$0.00	$364.50	$577.37	$583.20	$0.00		$0.00	$114.09	$0.00	$0.00	$116.06	$0.00	$0.00	$0.00	$0.00	$0.00
421.085	SUP	HCPCS C1713		421.085  -  PLATE BONE CRANFCL TI 11 HOLE H 1.3 MM SCR NONSTRL	BOTH IP/OP	$609.75 	$451.22	$0.00	$487.80	$274.39	$274.39	$0.00	$0.00	$0.00	$127.09	$452.56	$452.56	$0.00	$0.00	$127.07	$0.00	$360.67	$360.67	$0.00	$304.88	$482.92	$487.80	$0.00		$0.00	$95.43	$0.00	$0.00	$97.07	$0.00	$0.00	$0.00	$0.00	$0.00
421.086	SUP	HCPCS C1713		421.086  -  PLATE MAXL T STR 1.3MM SCR BONE TI 14MM NONSTRL	BOTH IP/OP	$729.00 	$539.46	$0.00	$583.20	$328.05	$328.05	$0.00	$0.00	$0.00	$151.94	$541.06	$541.06	$0.00	$0.00	$151.92	$0.00	$431.20	$431.20	$0.00	$364.50	$577.37	$583.20	$0.00		$0.00	$114.09	$0.00	$0.00	$116.06	$0.00	$0.00	$0.00	$0.00	$0.00
421.09	SUP	Custom 27803010		421.090  -  COVER BUR HOLE 12MM CRANFCL TI 6 HOLE 1.3MM SCR NONSTRL	BOTH IP/OP	$632.25 	$467.87	$0.00	$505.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$469.26	$469.26	$0.00	$0.00	$131.76	$0.00	$0.00	$0.00	$0.00	$316.13	$500.74	$505.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
421.091	SUP	Custom 27803010		421.091  -  COVER BUR HOLE 17MM CRANFCL TI 6 HOLE 1.3MM SCR NONSTRL	BOTH IP/OP	$632.25 	$467.87	$0.00	$505.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$469.26	$469.26	$0.00	$0.00	$131.76	$0.00	$0.00	$0.00	$0.00	$316.13	$500.74	$505.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
421.092	SUP	Custom 27803010		421.092  -  COVER BUR HOLE 15MM CRANFCL TI 6 HOLE 1.3MM SCR NONSTRL	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$0.00	$0.00	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
421.093	SUP	Custom 27803010		421.093  -  COVER BUR HOLE 24MM CRANFCL TI 6 HOLE 1.3MM SCR NONSTRL	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$0.00	$0.00	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
421.095	SUP	HCPCS C1713		421.095  -  PLATE BN BX 13X8MM NS 4 HL TI CRNFCL 1.3MM SCR	BOTH IP/OP	$510.75 	$377.96	$0.00	$408.60	$229.84	$229.84	$0.00	$0.00	$0.00	$106.45	$379.08	$379.08	$0.00	$0.00	$106.44	$0.00	$302.11	$302.11	$0.00	$255.38	$404.51	$408.60	$0.00		$0.00	$79.93	$0.00	$0.00	$81.31	$0.00	$0.00	$0.00	$0.00	$0.00
421.096	SUP	HCPCS C1713		421.096  -  PLATE BONE 13X13MM CRANFCL TI 4 HOLE BOX 1.3MM SCR NONSTRL	BOTH IP/OP	$510.75 	$377.96	$0.00	$408.60	$229.84	$229.84	$0.00	$0.00	$0.00	$106.45	$379.08	$379.08	$0.00	$0.00	$106.44	$0.00	$302.11	$302.11	$0.00	$255.38	$404.51	$408.60	$0.00		$0.00	$79.93	$0.00	$0.00	$81.31	$0.00	$0.00	$0.00	$0.00	$0.00
421.099	SUP	HCPCS C1713		421.099  -  PLATE BONE 100X100MM CRANFCL TI MESH SCRN 1.3MM SCR NONSTRL	BOTH IP/OP	"$2,819.25 "	"$2,086.25"	$0.00	"$2,255.40"	"$1,268.66"	"$1,268.66"	$0.00	$0.00	$0.00	$587.60	"$2,092.45"	"$2,092.45"	$0.00	$0.00	$587.53	$0.00	"$1,389.89"	"$1,389.89"	$0.00	"$1,409.63"	"$2,232.85"	"$2,255.40"	$0.00		$0.00	$441.21	$0.00	$0.00	$448.82	$0.00	$0.00	$0.00	$0.00	$0.00
421.302	SUP	HCPCS C1713		421.302  -  PLATE BONE .2MM ORBTL FLR TI MESH 1.3MM SCR NONSTRL	BOTH IP/OP	"$2,668.50 "	"$1,974.69"	$0.00	"$2,134.80"	"$1,200.83"	"$1,200.83"	$0.00	$0.00	$0.00	$556.18	"$1,980.56"	"$1,980.56"	$0.00	$0.00	$556.12	$0.00	"$1,315.57"	"$1,315.57"	$0.00	"$1,334.25"	"$2,113.45"	"$2,134.80"	$0.00		$0.00	$417.62	$0.00	$0.00	$424.83	$0.00	$0.00	$0.00	$0.00	$0.00
421.303	SUP	HCPCS C1713		421.303  -  PLATE BONE .3MM ORBTL FLR TI MESH 1.3MM SCR NONSTRL	BOTH IP/OP	"$2,668.50 "	"$1,974.69"	$0.00	"$2,134.80"	"$1,200.83"	"$1,200.83"	$0.00	$0.00	$0.00	$556.18	"$1,980.56"	"$1,980.56"	$0.00	$0.00	$556.12	$0.00	"$1,315.57"	"$1,315.57"	$0.00	"$1,334.25"	"$2,113.45"	"$2,134.80"	$0.00		$0.00	$417.62	$0.00	$0.00	$424.83	$0.00	$0.00	$0.00	$0.00	$0.00
421.304	SUP	HCPCS C1713		421.304  -  PLATE BN .4MM AU NS 3 ROW SCR HL MESH MLBL TI ORBT 1.3MM SCR	BOTH IP/OP	"$2,668.50 "	"$1,974.69"	$0.00	"$2,134.80"	"$1,200.83"	"$1,200.83"	$0.00	$0.00	$0.00	$556.18	"$1,980.56"	"$1,980.56"	$0.00	$0.00	$556.12	$0.00	"$1,315.57"	"$1,315.57"	$0.00	"$1,334.25"	"$2,113.45"	"$2,134.80"	$0.00		$0.00	$417.62	$0.00	$0.00	$424.83	$0.00	$0.00	$0.00	$0.00	$0.00
421.306	SUP	HCPCS C1713		421.306  -  PLATE BN STRG 23MM NS 6 HL LOPRFL PRECONTOUR RECON TI HND	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
421.312	SUP	HCPCS C1713		421.312  -  PLATE BN STRG 47MM NS 12 HL LOPRFL PRECONTOUR RECON TI HND	BOTH IP/OP	$465.28 	$344.31	$0.00	$361.38	$203.28	$203.28	$0.00	$0.00	$0.00	$96.97	$345.33	$345.33	$0.00	$0.00	$96.96	$0.00	$275.21	$275.21	$0.00	$225.86	$357.77	$361.38	$0.00		$0.00	$68.64	$0.00	$0.00	$71.91	$0.00	$0.00	$0.00	$0.00	$0.00
421.32	SUP	HCPCS C1713		421.320  -  PLATE BONE H 19MMX.5MM 8 HOLE EXTENDED TITANIUM RIGHT HAND	BOTH IP/OP	$431.25 	$319.13	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$89.88	$320.07	$320.07	$0.00	$0.00	$89.87	$0.00	$255.08	$255.08	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
421.321	SUP	HCPCS C1713		421.321  -  PLATE BONE H 8 HOLE EXTEND PRECONTOUR LP TITANIUM HAND LEFT	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
421.333	SUP	HCPCS C1713		421.333  -  PLATE BONE T 32MM 3X8 HOLE PRECONTOUR LP TITANIUM HAND	BOTH IP/OP	$425.93 	$315.19	$0.00	$330.82	$186.09	$186.09	$0.00	$0.00	$0.00	$88.77	$316.12	$316.12	$0.00	$0.00	$88.76	$0.00	$251.93	$251.93	$0.00	$206.76	$327.52	$330.82	$0.00		$0.00	$62.83	$0.00	$0.00	$65.83	$0.00	$0.00	$0.00	$0.00	$0.00
421.334	SUP	HCPCS C1713		421.334  -  PLATE BONE T 32MM 4X8 HOLE PRECONTOUR LP TITANIUM HAND	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
421.335	SUP	HCPCS C1713		421.335  -  PLATE BONE Y 3X8 HOLE PRECONTOUR LP TITANIUM HAND NONSTRL	BOTH IP/OP	$425.93 	$315.19	$0.00	$330.82	$186.09	$186.09	$0.00	$0.00	$0.00	$88.77	$316.12	$316.12	$0.00	$0.00	$88.76	$0.00	$251.93	$251.93	$0.00	$206.76	$327.52	$330.82	$0.00		$0.00	$62.83	$0.00	$0.00	$65.83	$0.00	$0.00	$0.00	$0.00	$0.00
421.5	SUP	HCPCS C1713		421.500  -  PLATE BONE MED TMPR TI CONTUR MESH MALBLE LP NONSTRL	BOTH IP/OP	"$2,083.50 "	"$1,541.79"	$0.00	"$1,666.80"	$937.58	$937.58	$0.00	$0.00	$0.00	$434.25	"$1,546.37"	"$1,546.37"	$0.00	$0.00	$434.20	$0.00	"$1,232.39"	"$1,232.39"	$0.00	"$1,041.75"	"$1,650.13"	"$1,666.80"	$0.00		$0.00	$326.07	$0.00	$0.00	$331.69	$0.00	$0.00	$0.00	$0.00	$0.00
421.501	SUP	HCPCS C1713		421.501  -  PLATE BONE CRANFCL TI 8 HOLE MALBLE CONTUR MESH LP NONSTRL	BOTH IP/OP	"$1,572.75 "	"$1,163.84"	$0.00	"$1,258.20"	$707.74	$707.74	$0.00	$0.00	$0.00	$327.80	"$1,167.30"	"$1,167.30"	$0.00	$0.00	$327.76	$0.00	$930.28	$930.28	$0.00	$786.38	"$1,245.62"	"$1,258.20"	$0.00		$0.00	$246.14	$0.00	$0.00	$250.38	$0.00	$0.00	$0.00	$0.00	$0.00
421.502	SUP	HCPCS C1713		421.502  -  PLATE BONE CRANFCL TI 2 HOLE STR LP NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.503	SUP	HCPCS C1713		421.503  -  PLATE BONE 9MM CRANFCL TI 2 HOLE STR LP NONSTRL	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$56.19	$56.19	$0.00	$0.00	$0.00	$26.03	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$73.86	$73.86	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$19.54	$0.00	$0.00	$19.88	$0.00	$0.00	$0.00	$0.00	$0.00
421.504	SUP	HCPCS C1713		421.504  -  PLATE BONE CRANFCL TI 4 HOLE STR LP NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.505	SUP	HCPCS C1713		421.505  -  PLATE BONE ORBTL RIM TI 12 HOLE CVD LP NONSTRL	BOTH IP/OP	$783.00 	$579.42	$0.00	$626.40	$352.35	$352.35	$0.00	$0.00	$0.00	$163.20	$581.14	$581.14	$0.00	$0.00	$163.18	$0.00	$463.14	$463.14	$0.00	$391.50	$620.14	$626.40	$0.00		$0.00	$122.54	$0.00	$0.00	$124.65	$0.00	$0.00	$0.00	$0.00	$0.00
421.506	SUP	HCPCS C1713		421.506  -  PLATE BONE CRANFCL TI 2X3 HOLE L RIGHT OBLQ LP NONSTRL	BOTH IP/OP	$654.75 	$484.52	$0.00	$523.80	$294.64	$294.64	$0.00	$0.00	$0.00	$136.47	$485.96	$485.96	$0.00	$0.00	$136.45	$0.00	$387.28	$387.28	$0.00	$327.38	$518.56	$523.80	$0.00		$0.00	$102.47	$0.00	$0.00	$104.24	$0.00	$0.00	$0.00	$0.00	$0.00
421.507	SUP	HCPCS C1713		421.507  -  PLATE BONE CRANFCL TI 2X3 HOLE L LEFT OBLQ LP NONSTRL	BOTH IP/OP	$654.75 	$484.52	$0.00	$523.80	$294.64	$294.64	$0.00	$0.00	$0.00	$136.47	$485.96	$485.96	$0.00	$0.00	$136.45	$0.00	$387.28	$387.28	$0.00	$327.38	$518.56	$523.80	$0.00		$0.00	$102.47	$0.00	$0.00	$104.24	$0.00	$0.00	$0.00	$0.00	$0.00
421.508	SUP	HCPCS C1713		421.508  -  PLATE BONE CRANFCL TI 3X4 HOLE L RIGHT OBLQ LP NONSTRL	BOTH IP/OP	$654.75 	$484.52	$0.00	$523.80	$294.64	$294.64	$0.00	$0.00	$0.00	$136.47	$485.96	$485.96	$0.00	$0.00	$136.45	$0.00	$387.28	$387.28	$0.00	$327.38	$518.56	$523.80	$0.00		$0.00	$102.47	$0.00	$0.00	$104.24	$0.00	$0.00	$0.00	$0.00	$0.00
421.509	SUP	HCPCS C1713		421.509  -  PLATE BONE CRANFCL TI 3X4 HOLE L LEFT OBLQ LP NONSTRL	BOTH IP/OP	$654.75 	$484.52	$0.00	$523.80	$294.64	$294.64	$0.00	$0.00	$0.00	$136.47	$485.96	$485.96	$0.00	$0.00	$136.45	$0.00	$387.28	$387.28	$0.00	$327.38	$518.56	$523.80	$0.00		$0.00	$102.47	$0.00	$0.00	$104.24	$0.00	$0.00	$0.00	$0.00	$0.00
421.51	SUP	HCPCS C1713		421.510  -  PLATE BN X .5MM NS 4 HL LOPRFL TI CRNMXF NEURO SYS	BOTH IP/OP	$636.75 	$471.20	$0.00	$509.40	$286.54	$286.54	$0.00	$0.00	$0.00	$132.71	$472.60	$472.60	$0.00	$0.00	$132.70	$0.00	$376.64	$376.64	$0.00	$318.38	$504.31	$509.40	$0.00		$0.00	$99.65	$0.00	$0.00	$101.37	$0.00	$0.00	$0.00	$0.00	$0.00
421.511	SUP	HCPCS C1713		421.511  -  PLATE BONE 14X14MM CRANFCL TI 4 HOLE BOX LP NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.512	SUP	HCPCS C1713		421.512  -  PLATE BONE 16X16MM CRANFCL TI 4 HOLE BOX LP NONSTRL	BOTH IP/OP	$636.75 	$471.20	$0.00	$509.40	$286.54	$286.54	$0.00	$0.00	$0.00	$132.71	$472.60	$472.60	$0.00	$0.00	$132.70	$0.00	$376.64	$376.64	$0.00	$318.38	$504.31	$509.40	$0.00		$0.00	$99.65	$0.00	$0.00	$101.37	$0.00	$0.00	$0.00	$0.00	$0.00
421.515	SUP	HCPCS C1713		421.515  -  PLATE BONE 15MM CRANFCL TI 5 HOLE Y LP NONSTRL	BOTH IP/OP	$636.75 	$471.20	$0.00	$509.40	$286.54	$286.54	$0.00	$0.00	$0.00	$132.71	$472.60	$472.60	$0.00	$0.00	$132.70	$0.00	$376.64	$376.64	$0.00	$318.38	$504.31	$509.40	$0.00		$0.00	$99.65	$0.00	$0.00	$101.37	$0.00	$0.00	$0.00	$0.00	$0.00
421.516	SUP	HCPCS C1713		421.516  -  PLATE BONE 18MM CRANFCL TI 6 HOLE 2Y LP NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.517	SUP	HCPCS C1713		421.517  -  PLATE BONE 21MM TI 6 HOLE DBL Y LP	BOTH IP/OP	$636.75 	$471.20	$0.00	$509.40	$286.54	$286.54	$0.00	$0.00	$0.00	$132.71	$472.60	$472.60	$0.00	$0.00	$132.70	$0.00	$376.64	$376.64	$0.00	$318.38	$504.31	$509.40	$0.00		$0.00	$99.65	$0.00	$0.00	$101.37	$0.00	$0.00	$0.00	$0.00	$0.00
421.518	SUP	HCPCS C1713		421.518  -  PLATE BN .5MM NS 5 HL LOPRFL ADP TI CRNMXF NEURO SYS	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.519	SUP	HCPCS C1713		421.519  -  PLATE BN .5MM NS 7 HL LOPRFL ADP TI CRNMXF NEURO SYS	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.52	SUP	HCPCS C1713		421.520  -  PLATE BN .5MM NS 20 HL LOPRFL ADP TI CRNMXF NEURO SYS	BOTH IP/OP	"$1,413.00 "	"$1,045.62"	$0.00	"$1,130.40"	$635.85	$635.85	$0.00	$0.00	$0.00	$294.50	"$1,048.73"	"$1,048.73"	$0.00	$0.00	$294.47	$0.00	$835.79	$835.79	$0.00	$706.50	"$1,119.10"	"$1,130.40"	$0.00		$0.00	$221.13	$0.00	$0.00	$224.95	$0.00	$0.00	$0.00	$0.00	$0.00
421.521	SUP	HCPCS C1713		421.521  -  PLATE BONE 16X10MM CRANFCL TI 4 HOLE BOX LP NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.522	SUP	HCPCS C1713		421.522  -  PLATE BN .5MM NS 6 HL LOPRFL STRUT TI CRNMXF NEURO SYS	BOTH IP/OP	"$1,109.25 "	$820.85	$0.00	$887.40	$499.16	$499.16	$0.00	$0.00	$0.00	$231.20	$823.29	$823.29	$0.00	$0.00	$231.17	$0.00	$656.12	$656.12	$0.00	$554.63	$878.53	$887.40	$0.00		$0.00	$173.60	$0.00	$0.00	$176.59	$0.00	$0.00	$0.00	$0.00	$0.00
421.523	SUP	HCPCS C1713		421.523  -  PLATE BN .5MM NS 8 HL LOPRFL STRUT TI CRNMXF NEURO SYS	BOTH IP/OP	"$1,572.75 "	"$1,163.84"	$0.00	"$1,258.20"	$707.74	$707.74	$0.00	$0.00	$0.00	$327.80	"$1,167.30"	"$1,167.30"	$0.00	$0.00	$327.76	$0.00	$930.28	$930.28	$0.00	$786.38	"$1,245.62"	"$1,258.20"	$0.00		$0.00	$246.14	$0.00	$0.00	$250.38	$0.00	$0.00	$0.00	$0.00	$0.00
421.525	SUP	Custom 27803010		421.525  -  COVER BUR HOLE 12MM CRANFCL TI LP NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.00	$0.00	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
421.526	SUP	Custom 27803010		421.526  -  COVER BUR HOLE 15MM CRANFCL TI LP NONSTRL	BOTH IP/OP	$661.50 	$489.51	$0.00	$529.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$490.97	$490.97	$0.00	$0.00	$137.86	$0.00	$0.00	$0.00	$0.00	$330.75	$523.91	$529.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
421.527	SUP	Custom 27803010		421.527  -  COVER BUR HOLE 17MM CRANFCL TI LP NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.00	$0.00	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
421.528	SUP	Custom 27803010		421.528  -  COVER BUR HOLE 24MM CRANFCL TI LP NONSTRL	BOTH IP/OP	$661.50 	$489.51	$0.00	$529.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$490.97	$490.97	$0.00	$0.00	$137.86	$0.00	$0.00	$0.00	$0.00	$330.75	$523.91	$529.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
421.531	SUP	HCPCS C1713		421.531  -  PLATE BONE 45X38MM CRANFCL TI CONTUR MESH MALBLE LP NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.532	SUP	HCPCS C1713		421.532  -  PLATE THK.6MM 45X38MM TI CONTUR MESH RGD BONE NONSTRL SLVR	BOTH IP/OP	"$3,620.25 "	"$2,678.99"	$0.00	"$2,896.20"	"$1,629.11"	"$1,629.11"	$0.00	$0.00	$0.00	$754.55	"$2,686.95"	"$2,686.95"	$0.00	$0.00	$754.46	$0.00	"$1,784.78"	"$1,784.78"	$0.00	"$1,810.13"	"$2,867.24"	"$2,896.20"	$0.00		$0.00	$566.57	$0.00	$0.00	$576.34	$0.00	$0.00	$0.00	$0.00	$0.00
421.533	SUP	HCPCS C1713		421.533  -  PLATE BONE 100X100MM CRANFCL TI CONTUR MESH MALBLE LP	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.534	SUP	HCPCS C1713		421.534  -  PLATE BONE 100X100MM CRANFCL TI CONTUR MESH RGD LP NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.535	SUP	HCPCS C1713		421.535  -  PLATE BONE 200X200MM CRANFCL TI CONTUR MESH RGD LP NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
421.536	SUP	HCPCS C1713		421.536  -  PLATE BONE CRANFCL TI CONTUR MESH MALBLE LP SM ARC NONSTRL	BOTH IP/OP	"$2,083.50 "	"$1,541.79"	$0.00	"$1,666.80"	$937.58	$937.58	$0.00	$0.00	$0.00	$434.25	"$1,546.37"	"$1,546.37"	$0.00	$0.00	$434.20	$0.00	"$1,232.39"	"$1,232.39"	$0.00	"$1,041.75"	"$1,650.13"	"$1,666.80"	$0.00		$0.00	$326.07	$0.00	$0.00	$331.69	$0.00	$0.00	$0.00	$0.00	$0.00
421.537	SUP	HCPCS C1713		421.537  -  PLATE BONE CRANFCL TI CONTUR MESH MALBLE LP LG ARC NONSTRL	BOTH IP/OP	"$3,244.50 "	"$2,400.93"	$0.00	"$2,595.60"	"$1,460.03"	"$1,460.03"	$0.00	$0.00	$0.00	$676.23	"$2,408.07"	"$2,408.07"	$0.00	$0.00	$676.15	$0.00	"$1,599.54"	"$1,599.54"	$0.00	"$1,622.25"	"$2,569.64"	"$2,595.60"	$0.00		$0.00	$507.76	$0.00	$0.00	$516.52	$0.00	$0.00	$0.00	$0.00	$0.00
421.538	SUP	HCPCS C1713		421.538  -  PLATE BONE CRANFCL TI CONTUR MESH RGD LP SM ARC NONSTRL	BOTH IP/OP	"$2,083.50 "	"$1,541.79"	$0.00	"$1,666.80"	$937.58	$937.58	$0.00	$0.00	$0.00	$434.25	"$1,546.37"	"$1,546.37"	$0.00	$0.00	$434.20	$0.00	"$1,232.39"	"$1,232.39"	$0.00	"$1,041.75"	"$1,650.13"	"$1,666.80"	$0.00		$0.00	$326.07	$0.00	$0.00	$331.69	$0.00	$0.00	$0.00	$0.00	$0.00
421.539	SUP	HCPCS C1713		421.539  -  PLATE BONE CRANFCL TI CONTUR MESH RGD LP LG ARC NONSTRL	BOTH IP/OP	"$3,244.50 "	"$2,400.93"	$0.00	"$2,595.60"	"$1,460.03"	"$1,460.03"	$0.00	$0.00	$0.00	$676.23	"$2,408.07"	"$2,408.07"	$0.00	$0.00	$676.15	$0.00	"$1,599.54"	"$1,599.54"	$0.00	"$1,622.25"	"$2,569.64"	"$2,595.60"	$0.00		$0.00	$507.76	$0.00	$0.00	$516.52	$0.00	$0.00	$0.00	$0.00	$0.00
421.54	SUP	HCPCS C1713		421.540  -  PLATE BONE 30MM CRANFCL TI CONTUR MESH MALBLE LP NONSTRL	BOTH IP/OP	"$2,083.50 "	"$1,541.79"	$0.00	"$1,666.80"	$937.58	$937.58	$0.00	$0.00	$0.00	$434.25	"$1,546.37"	"$1,546.37"	$0.00	$0.00	$434.20	$0.00	"$1,232.39"	"$1,232.39"	$0.00	"$1,041.75"	"$1,650.13"	"$1,666.80"	$0.00		$0.00	$326.07	$0.00	$0.00	$331.69	$0.00	$0.00	$0.00	$0.00	$0.00
421.541	SUP	HCPCS C1713		421.541  -  PLATE BONE 70MM CRANFCL TI CONTUR MESH MALBLE LP NONSTRL	BOTH IP/OP	"$4,311.00 "	"$3,190.14"	$0.00	"$3,448.80"	"$1,939.95"	"$1,939.95"	$0.00	$0.00	$0.00	$898.52	"$3,199.62"	"$3,199.62"	$0.00	$0.00	$898.41	$0.00	"$2,125.32"	"$2,125.32"	$0.00	"$2,155.50"	"$3,414.31"	"$3,448.80"	$0.00		$0.00	$674.67	$0.00	$0.00	$686.31	$0.00	$0.00	$0.00	$0.00	$0.00
421.542	SUP	HCPCS C1713		421.542  -  PLATE BONE 100MM CRANFCL TI CONTUR MESH MALBLE LP NONSTRL	BOTH IP/OP	"$5,373.00 "	"$3,976.02"	$0.00	"$4,298.40"	"$2,417.85"	"$2,417.85"	$0.00	$0.00	$0.00	"$1,119.87"	"$3,987.84"	"$3,987.84"	$0.00	$0.00	"$1,119.73"	$0.00	"$2,648.89"	"$2,648.89"	$0.00	"$2,686.50"	"$4,255.42"	"$4,298.40"	$0.00		$0.00	$840.87	$0.00	$0.00	$855.38	$0.00	$0.00	$0.00	$0.00	$0.00
421.543	SUP	HCPCS C1713		421.543  -  PLATE TI LP CONTUR MESH RGD BONE 30MM NEURO NONSTRL	BOTH IP/OP	"$2,083.50 "	"$1,541.79"	$0.00	"$1,666.80"	$937.58	$937.58	$0.00	$0.00	$0.00	$434.25	"$1,546.37"	"$1,546.37"	$0.00	$0.00	$434.20	$0.00	"$1,232.39"	"$1,232.39"	$0.00	"$1,041.75"	"$1,650.13"	"$1,666.80"	$0.00		$0.00	$326.07	$0.00	$0.00	$331.69	$0.00	$0.00	$0.00	$0.00	$0.00
421.544	SUP	HCPCS C1713		421.544  -  PLATE BONE 70MM CRANFCL TI CONTUR MESH RGD LP NONSTRL	BOTH IP/OP	"$4,311.00 "	"$3,190.14"	$0.00	"$3,448.80"	"$1,939.95"	"$1,939.95"	$0.00	$0.00	$0.00	$898.52	"$3,199.62"	"$3,199.62"	$0.00	$0.00	$898.41	$0.00	"$2,125.32"	"$2,125.32"	$0.00	"$2,155.50"	"$3,414.31"	"$3,448.80"	$0.00		$0.00	$674.67	$0.00	$0.00	$686.31	$0.00	$0.00	$0.00	$0.00	$0.00
421.545	SUP	HCPCS C1713		421.545  -  PLATE BONE 100MM TI CONTUR MESH MALBLE LP RND	BOTH IP/OP	"$5,373.00 "	"$3,976.02"	$0.00	"$4,298.40"	"$2,417.85"	"$2,417.85"	$0.00	$0.00	$0.00	"$1,119.87"	"$3,987.84"	"$3,987.84"	$0.00	$0.00	"$1,119.73"	$0.00	"$2,648.89"	"$2,648.89"	$0.00	"$2,686.50"	"$4,255.42"	"$4,298.40"	$0.00		$0.00	$840.87	$0.00	$0.00	$855.38	$0.00	$0.00	$0.00	$0.00	$0.00
421.546	SUP	HCPCS C1713		421.546  -  PLATE BN THK.4MM LG BLU NS CNTR MESH LOPRFL TI CRNL MSTD	BOTH IP/OP	"$2,522.25 "	"$1,866.47"	$0.00	"$2,017.80"	"$1,135.01"	"$1,135.01"	$0.00	$0.00	$0.00	$525.70	"$1,872.01"	"$1,872.01"	$0.00	$0.00	$525.64	$0.00	"$1,243.47"	"$1,243.47"	$0.00	"$1,261.13"	"$1,997.62"	"$2,017.80"	$0.00		$0.00	$394.73	$0.00	$0.00	$401.54	$0.00	$0.00	$0.00	$0.00	$0.00
421.547	SUP	HCPCS C1713		421.547  -  PLATE MED .4MM MSTD CONTUR MESH MALBLE LP BONE TI	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
421.553	SUP	Custom 27803010		421.553  -  COVER BUR HOLE 15MM TI SHNT NEURO LP NONSTRL	BOTH IP/OP	$661.50 	$489.51	$0.00	$529.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$490.97	$490.97	$0.00	$0.00	$137.86	$0.00	$0.00	$0.00	$0.00	$330.75	$523.91	$529.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
421.554	SUP	Custom 27803010		421.554  -  COVER BUR HOLE 17MM CRANFCL TI LP SHNT NONSTRL	BOTH IP/OP	$661.50 	$489.51	$0.00	$529.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$490.97	$490.97	$0.00	$0.00	$137.86	$0.00	$0.00	$0.00	$0.00	$330.75	$523.91	$529.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
422.02	SUP	HCPCS C1713		422.02  -  PLATE BONE 39X12X1MM 2 HOLE SEMITUBULAR LC-DCP TITANIUM	BOTH IP/OP	$125.55 	$92.91	$0.00	$100.44	$56.50	$56.50	$0.00	$0.00	$0.00	$26.17	$93.18	$93.18	$0.00	$0.00	$26.16	$0.00	$74.26	$74.26	$0.00	$62.78	$99.44	$100.44	$0.00		$0.00	$19.08	$0.00	$0.00	$19.99	$0.00	$0.00	$0.00	$0.00	$0.00
422.03	SUP	HCPCS C1713		422.03  -  PLATE BONE 55X12X1MM 3 HOLE SEMITUBULAR LC-DCP TITANIUM	BOTH IP/OP	$133.75 	$98.98	$0.00	$107.00	$60.19	$60.19	$0.00	$0.00	$0.00	$27.88	$99.27	$99.27	$0.00	$0.00	$27.87	$0.00	$79.11	$79.11	$0.00	$66.88	$105.93	$107.00	$0.00		$0.00	$20.32	$0.00	$0.00	$21.29	$0.00	$0.00	$0.00	$0.00	$0.00
422.04	SUP	HCPCS C1713		422.04  -  PLATE BONE 71X12X1MM 4 HOLE SEMITUBULAR LC-DCP TITANIUM	BOTH IP/OP	$144.68 	$107.06	$0.00	$115.74	$65.10	$65.10	$0.00	$0.00	$0.00	$30.15	$107.38	$107.38	$0.00	$0.00	$30.15	$0.00	$85.58	$85.58	$0.00	$72.34	$114.59	$115.74	$0.00		$0.00	$21.98	$0.00	$0.00	$23.03	$0.00	$0.00	$0.00	$0.00	$0.00
422.05	SUP	HCPCS C1713		422.05  -  PLATE BONE 87X12X1MM 5 HOLE SEMITUBULAR LC-DCP TITANIUM	BOTH IP/OP	$152.85 	$113.11	$0.00	$122.28	$68.78	$68.78	$0.00	$0.00	$0.00	$31.86	$113.45	$113.45	$0.00	$0.00	$31.85	$0.00	$90.41	$90.41	$0.00	$76.43	$121.06	$122.28	$0.00		$0.00	$23.22	$0.00	$0.00	$24.33	$0.00	$0.00	$0.00	$0.00	$0.00
422.06	SUP	HCPCS C1713		422.06  -  PLATE BONE 103X12X1MM 6 HOLE SEMITUBULAR LC-DCP TITANIUM	BOTH IP/OP	$162.40 	$120.18	$0.00	$129.92	$73.08	$73.08	$0.00	$0.00	$0.00	$33.85	$120.53	$120.53	$0.00	$0.00	$33.84	$0.00	$96.06	$96.06	$0.00	$81.20	$128.62	$129.92	$0.00		$0.00	$24.68	$0.00	$0.00	$25.85	$0.00	$0.00	$0.00	$0.00	$0.00
422.07	SUP	HCPCS C1713		422.07  -  PLATE BONE 119X12X1MM 7 HOLE SEMITUBULAR LC-DCP TITANIUM	BOTH IP/OP	$174.30 	$128.98	$0.00	$135.38	$76.15	$76.15	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$84.61	$134.03	$135.38	$0.00		$0.00	$25.71	$0.00	$0.00	$26.94	$0.00	$0.00	$0.00	$0.00	$0.00
422.08	SUP	HCPCS C1713		422.08  -  PLATE BONE 135X12X1MM 8 HOLE SEMITUBULAR LC-DCP TITANIUM	BOTH IP/OP	$184.25 	$136.35	$0.00	$147.40	$82.91	$82.91	$0.00	$0.00	$0.00	$38.40	$136.75	$136.75	$0.00	$0.00	$38.40	$0.00	$108.98	$108.98	$0.00	$92.13	$145.93	$147.40	$0.00		$0.00	$27.99	$0.00	$0.00	$29.33	$0.00	$0.00	$0.00	$0.00	$0.00
422.09	SUP	HCPCS C1713		422.09  -  PLATE BONE 151X12X1MM 9 HOLE SEMITUBULAR LC-DCP TITANIUM	BOTH IP/OP	$206.08 	$152.50	$0.00	$164.86	$92.73	$92.73	$0.00	$0.00	$0.00	$42.95	$152.95	$152.95	$0.00	$0.00	$42.95	$0.00	$121.89	$121.89	$0.00	$103.04	$163.22	$164.86	$0.00		$0.00	$31.31	$0.00	$0.00	$32.81	$0.00	$0.00	$0.00	$0.00	$0.00
422.1	SUP	HCPCS C1713		422.10  -  PLATE BONE 167X12X1MM 10 HOLE SEMITUBULAR LC-DCP TITANIUM	BOTH IP/OP	$207.45 	$153.51	$0.00	$165.96	$93.35	$93.35	$0.00	$0.00	$0.00	$43.24	$153.97	$153.97	$0.00	$0.00	$43.23	$0.00	$122.71	$122.71	$0.00	$103.73	$164.30	$165.96	$0.00		$0.00	$31.52	$0.00	$0.00	$33.03	$0.00	$0.00	$0.00	$0.00	$0.00
422.11	SUP	HCPCS C1713		422.11  -  PLATE BONE 183X12X1MM 11 HOLE SEMITUBULAR LC-DCP TITANIUM	BOTH IP/OP	$222.45 	$164.61	$0.00	$177.96	$100.10	$100.10	$0.00	$0.00	$0.00	$46.36	$165.10	$165.10	$0.00	$0.00	$46.36	$0.00	$131.58	$131.58	$0.00	$111.23	$176.18	$177.96	$0.00		$0.00	$33.80	$0.00	$0.00	$35.41	$0.00	$0.00	$0.00	$0.00	$0.00
422.12	SUP	HCPCS C1713		422.12  -  PLATE BONE LARGE 183MM 12 HOLE SEMITUBULAR LC-DCP TITANIUM	BOTH IP/OP	$227.93 	$168.67	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$47.51	$169.17	$169.17	$0.00	$0.00	$47.50	$0.00	$134.82	$134.82	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
422.22	SUP	HCPCS C1713		422.220  -  PLATE BONE 140MM 5 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,913.75 "	"$2,156.18"	$0.00	"$2,331.00"	"$1,311.19"	"$1,311.19"	$0.00	$0.00	$0.00	$607.30	"$2,162.59"	"$2,162.59"	$0.00	$0.00	$607.23	$0.00	"$1,436.48"	"$1,436.48"	$0.00	"$1,456.88"	"$2,307.69"	"$2,331.00"	$0.00		$0.00	$442.72	$0.00	$0.00	$463.87	$0.00	$0.00	$0.00	$0.00	$0.00
422.221	SUP	HCPCS C1713		422.221  -  PLATE BONE 140MM 5 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$3,001.15 "	"$2,220.85"	$0.00	"$2,331.00"	"$1,311.19"	"$1,311.19"	$0.00	$0.00	$0.00	$625.51	"$2,227.45"	"$2,227.45"	$0.00	$0.00	$625.44	$0.00	"$1,479.57"	"$1,479.57"	$0.00	"$1,456.88"	"$2,307.69"	"$2,331.00"	$0.00		$0.00	$442.72	$0.00	$0.00	$463.87	$0.00	$0.00	$0.00	$0.00	$0.00
422.222	SUP	HCPCS C1713		422.222  -  PLATE BONE 180MM 7 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$3,061.60 "	"$2,265.58"	$0.00	"$2,377.94"	"$1,337.59"	"$1,337.59"	$0.00	$0.00	$0.00	$638.11	"$2,272.32"	"$2,272.32"	$0.00	$0.00	$638.04	$0.00	"$1,509.37"	"$1,509.37"	$0.00	"$1,486.21"	"$2,354.16"	"$2,377.94"	$0.00		$0.00	$451.64	$0.00	$0.00	$473.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.223	SUP	HCPCS C1713		422.223  -  PLATE BONE 180MM 7 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$3,061.60 "	"$2,265.58"	$0.00	"$2,377.94"	"$1,337.59"	"$1,337.59"	$0.00	$0.00	$0.00	$638.11	"$2,272.32"	"$2,272.32"	$0.00	$0.00	$638.04	$0.00	"$1,509.37"	"$1,509.37"	$0.00	"$1,486.21"	"$2,354.16"	"$2,377.94"	$0.00		$0.00	$451.64	$0.00	$0.00	$473.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.224	SUP	HCPCS C1713		422.224  -  PLATE BONE 220MM 9 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$3,124.85 "	"$2,312.39"	$0.00	"$2,427.08"	"$1,365.23"	"$1,365.23"	$0.00	$0.00	$0.00	$651.30	"$2,319.26"	"$2,319.26"	$0.00	$0.00	$651.22	$0.00	"$1,540.55"	"$1,540.55"	$0.00	"$1,516.93"	"$2,402.81"	"$2,427.08"	$0.00		$0.00	$460.97	$0.00	$0.00	$482.99	$0.00	$0.00	$0.00	$0.00	$0.00
422.225	SUP	HCPCS C1713		422.225  -  PLATE BONE 220MM 9 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$3,124.85 "	"$2,312.39"	$0.00	"$2,427.08"	"$1,365.23"	"$1,365.23"	$0.00	$0.00	$0.00	$651.30	"$2,319.26"	"$2,319.26"	$0.00	$0.00	$651.22	$0.00	"$1,540.55"	"$1,540.55"	$0.00	"$1,516.93"	"$2,402.81"	"$2,427.08"	$0.00		$0.00	$460.97	$0.00	$0.00	$482.99	$0.00	$0.00	$0.00	$0.00	$0.00
422.226	SUP	HCPCS C1713		422.226  -  PLATE BONE 260MM 11 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$3,185.30 "	"$2,357.12"	$0.00	"$2,474.02"	"$1,391.64"	"$1,391.64"	$0.00	$0.00	$0.00	$663.90	"$2,364.13"	"$2,364.13"	$0.00	$0.00	$663.82	$0.00	"$1,570.35"	"$1,570.35"	$0.00	"$1,546.26"	"$2,449.28"	"$2,474.02"	$0.00		$0.00	$469.88	$0.00	$0.00	$492.33	$0.00	$0.00	$0.00	$0.00	$0.00
422.227	SUP	HCPCS C1713		422.227  -  PLATE BONE 260MM 11 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$3,185.30 "	"$2,357.12"	$0.00	"$2,474.02"	"$1,391.64"	"$1,391.64"	$0.00	$0.00	$0.00	$663.90	"$2,364.13"	"$2,364.13"	$0.00	$0.00	$663.82	$0.00	"$1,570.35"	"$1,570.35"	$0.00	"$1,546.26"	"$2,449.28"	"$2,474.02"	$0.00		$0.00	$469.88	$0.00	$0.00	$492.33	$0.00	$0.00	$0.00	$0.00	$0.00
422.228	SUP	HCPCS C1713		422.228  -  PLATE BONE 300MM 13 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$3,248.55 "	"$2,403.93"	$0.00	"$2,523.14"	"$1,419.27"	"$1,419.27"	$0.00	$0.00	$0.00	$677.08	"$2,411.07"	"$2,411.07"	$0.00	$0.00	$677.00	$0.00	"$1,601.54"	"$1,601.54"	$0.00	"$1,576.96"	"$2,497.91"	"$2,523.14"	$0.00		$0.00	$479.21	$0.00	$0.00	$502.10	$0.00	$0.00	$0.00	$0.00	$0.00
422.229	SUP	HCPCS C1713		422.229  -  PLATE BONE 300MM 13 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$3,248.55 "	"$2,403.93"	$0.00	"$2,523.14"	"$1,419.27"	"$1,419.27"	$0.00	$0.00	$0.00	$677.08	"$2,411.07"	"$2,411.07"	$0.00	$0.00	$677.00	$0.00	"$1,601.54"	"$1,601.54"	$0.00	"$1,576.96"	"$2,497.91"	"$2,523.14"	$0.00		$0.00	$479.21	$0.00	$0.00	$502.10	$0.00	$0.00	$0.00	$0.00	$0.00
422.25	SUP	HCPCS C1713		422.250  -  PLATE BONE 156MM 5 HOLE LCP TITANIUM FEMUR RIGHT DISTAL	BOTH IP/OP	"$2,763.63 "	"$2,045.09"	$0.00	"$2,210.90"	"$1,243.63"	"$1,243.63"	$0.00	$0.00	$0.00	$576.01	"$2,051.16"	"$2,051.16"	$0.00	$0.00	$575.94	$0.00	"$1,362.47"	"$1,362.47"	$0.00	"$1,381.81"	"$2,188.79"	"$2,210.90"	$0.00		$0.00	$419.91	$0.00	$0.00	$439.97	$0.00	$0.00	$0.00	$0.00	$0.00
422.251	SUP	HCPCS C1713		422.251  -  PLATE BONE 156MM 5 HOLE LCP TITANIUM FEMUR LEFT DISTAL	BOTH IP/OP	"$2,846.53 "	"$2,106.43"	$0.00	"$2,210.90"	"$1,243.63"	"$1,243.63"	$0.00	$0.00	$0.00	$593.29	"$2,112.69"	"$2,112.69"	$0.00	$0.00	$593.22	$0.00	"$1,403.34"	"$1,403.34"	$0.00	"$1,381.81"	"$2,188.79"	"$2,210.90"	$0.00		$0.00	$419.91	$0.00	$0.00	$439.97	$0.00	$0.00	$0.00	$0.00	$0.00
422.252	SUP	HCPCS C1713		422.252  -  PLATE BONE 196MM 7 HOLE LCP TITANIUM FEMUR RIGHT DISTAL	BOTH IP/OP	"$2,904.15 "	"$2,149.07"	$0.00	"$2,255.66"	"$1,268.81"	"$1,268.81"	$0.00	$0.00	$0.00	$605.30	"$2,155.46"	"$2,155.46"	$0.00	$0.00	$605.22	$0.00	"$1,431.75"	"$1,431.75"	$0.00	"$1,409.79"	"$2,233.11"	"$2,255.66"	$0.00		$0.00	$428.41	$0.00	$0.00	$448.88	$0.00	$0.00	$0.00	$0.00	$0.00
422.253	SUP	HCPCS C1713		422.253  -  PLATE BONE 196MM 7 HOLE LCP TITANIUM FEMUR LEFT DISTAL	BOTH IP/OP	"$2,904.15 "	"$2,149.07"	$0.00	"$2,255.66"	"$1,268.81"	"$1,268.81"	$0.00	$0.00	$0.00	$605.30	"$2,155.46"	"$2,155.46"	$0.00	$0.00	$605.22	$0.00	"$1,431.75"	"$1,431.75"	$0.00	"$1,409.79"	"$2,233.11"	"$2,255.66"	$0.00		$0.00	$428.41	$0.00	$0.00	$448.88	$0.00	$0.00	$0.00	$0.00	$0.00
422.254	SUP	HCPCS C1713		422.254  -  PLATE BONE 236MM 9 HOLE LCP TITANIUM FEMUR RIGHT DISTAL	BOTH IP/OP	"$2,964.60 "	"$2,193.80"	$0.00	"$2,302.60"	"$1,295.21"	"$1,295.21"	$0.00	$0.00	$0.00	$617.90	"$2,200.33"	"$2,200.33"	$0.00	$0.00	$617.82	$0.00	"$1,461.55"	"$1,461.55"	$0.00	"$1,439.13"	"$2,279.57"	"$2,302.60"	$0.00		$0.00	$437.33	$0.00	$0.00	$458.22	$0.00	$0.00	$0.00	$0.00	$0.00
422.255	SUP	HCPCS C1713		422.255  -  PLATE BONE 236MM 9 HOLE LCP TITANIUM FEMUR LEFT DISTAL	BOTH IP/OP	"$2,964.60 "	"$2,193.80"	$0.00	"$2,302.60"	"$1,295.21"	"$1,295.21"	$0.00	$0.00	$0.00	$617.90	"$2,200.33"	"$2,200.33"	$0.00	$0.00	$617.82	$0.00	"$1,461.55"	"$1,461.55"	$0.00	"$1,439.13"	"$2,279.57"	"$2,302.60"	$0.00		$0.00	$437.33	$0.00	$0.00	$458.22	$0.00	$0.00	$0.00	$0.00	$0.00
422.256	SUP	HCPCS C1713		422.256  -  PLATE BONE 276MM 11 HOLE LCP TITANIUM FEMUR RIGHT DISTAL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,347.38"	"$1,320.40"	"$1,320.40"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,467.11"	"$2,323.91"	"$2,347.38"	$0.00		$0.00	$445.83	$0.00	$0.00	$467.13	$0.00	$0.00	$0.00	$0.00	$0.00
422.257	SUP	HCPCS C1713		422.257  -  PLATE BONE 276MM 11 HOLE LCP TITANIUM FEMUR LEFT DISTAL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,347.38"	"$1,320.40"	"$1,320.40"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,467.11"	"$2,323.91"	"$2,347.38"	$0.00		$0.00	$445.83	$0.00	$0.00	$467.13	$0.00	$0.00	$0.00	$0.00	$0.00
422.258	SUP	HCPCS C1713		422.258  -  PLATE BONE 316MM 13 HOLE LCP TITANIUM FEMUR RIGHT DISTAL	BOTH IP/OP	"$3,081.28 "	"$2,280.15"	$0.00	"$2,393.22"	"$1,346.19"	"$1,346.19"	$0.00	$0.00	$0.00	$642.21	"$2,286.92"	"$2,286.92"	$0.00	$0.00	$642.14	$0.00	"$1,519.07"	"$1,519.07"	$0.00	"$1,495.76"	"$2,369.29"	"$2,393.22"	$0.00		$0.00	$454.54	$0.00	$0.00	$476.25	$0.00	$0.00	$0.00	$0.00	$0.00
422.259	SUP	HCPCS C1713		422.259  -  PLATE BONE 316MM 13 HOLE LCP TITANIUM FEMUR LEFT DISTAL	BOTH IP/OP	"$3,081.28 "	"$2,280.15"	$0.00	"$2,393.22"	"$1,346.19"	"$1,346.19"	$0.00	$0.00	$0.00	$642.21	"$2,286.92"	"$2,286.92"	$0.00	$0.00	$642.14	$0.00	"$1,519.07"	"$1,519.07"	$0.00	"$1,495.76"	"$2,369.29"	"$2,393.22"	$0.00		$0.00	$454.54	$0.00	$0.00	$476.25	$0.00	$0.00	$0.00	$0.00	$0.00
422.3	SUP	HCPCS C1713		422.300  -  PLATE BONE 140MM 5 HOLE LISS TITANIUM RIGHT PROXIMAL TIBIA	BOTH IP/OP	"$3,003.83 "	"$2,222.83"	$0.00	"$2,403.06"	"$1,351.72"	"$1,351.72"	$0.00	$0.00	$0.00	$626.07	"$2,229.44"	"$2,229.44"	$0.00	$0.00	$626.00	$0.00	"$1,480.89"	"$1,480.89"	$0.00	"$1,501.91"	"$2,379.03"	"$2,403.06"	$0.00		$0.00	$456.40	$0.00	$0.00	$478.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.301	SUP	HCPCS C1713		422.301  -  PLATE BONE 140MM 5 HOLE LISS TITANIUM LEFT PROXIMAL TIBIA	BOTH IP/OP	"$3,093.93 "	"$2,289.51"	$0.00	"$2,403.06"	"$1,351.72"	"$1,351.72"	$0.00	$0.00	$0.00	$644.85	"$2,296.31"	"$2,296.31"	$0.00	$0.00	$644.77	$0.00	"$1,525.31"	"$1,525.31"	$0.00	"$1,501.91"	"$2,379.03"	"$2,403.06"	$0.00		$0.00	$456.40	$0.00	$0.00	$478.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.304	SUP	HCPCS C1713		422.304  -  PLATE BONE 3.5MM 220MM 9 HOLE LISS TITANIUM RIGHT PROXIMAL	BOTH IP/OP	"$3,093.93 "	"$2,289.51"	$0.00	"$2,403.06"	"$1,351.72"	"$1,351.72"	$0.00	$0.00	$0.00	$644.85	"$2,296.31"	"$2,296.31"	$0.00	$0.00	$644.77	$0.00	"$1,525.31"	"$1,525.31"	$0.00	"$1,501.91"	"$2,379.03"	"$2,403.06"	$0.00		$0.00	$456.40	$0.00	$0.00	$478.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.305	SUP	HCPCS C1713		422.305  -  PLATE BONE 220MM 9 HOLE LISS TITANIUM LEFT PROXIMAL TIBIA	BOTH IP/OP	"$3,093.93 "	"$2,289.51"	$0.00	"$2,403.06"	"$1,351.72"	"$1,351.72"	$0.00	$0.00	$0.00	$644.85	"$2,296.31"	"$2,296.31"	$0.00	$0.00	$644.77	$0.00	"$1,525.31"	"$1,525.31"	$0.00	"$1,501.91"	"$2,379.03"	"$2,403.06"	$0.00		$0.00	$456.40	$0.00	$0.00	$478.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.308	SUP	HCPCS C1713		422.308  -  PLATE BONE 300MM 13 HOLE LISS TITANIUM RIGHT PROXIMAL TIBIA	BOTH IP/OP	"$3,093.93 "	"$2,289.51"	$0.00	"$2,403.06"	"$1,351.72"	"$1,351.72"	$0.00	$0.00	$0.00	$644.85	"$2,296.31"	"$2,296.31"	$0.00	$0.00	$644.77	$0.00	"$1,525.31"	"$1,525.31"	$0.00	"$1,501.91"	"$2,379.03"	"$2,403.06"	$0.00		$0.00	$456.40	$0.00	$0.00	$478.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.309	SUP	HCPCS C1713		422.309  -  PLATE BONE 300MM 13 HOLE LISS TITANIUM LEFT PROXIMAL TIBIA	BOTH IP/OP	"$3,093.93 "	"$2,289.51"	$0.00	"$2,403.06"	"$1,351.72"	"$1,351.72"	$0.00	$0.00	$0.00	$644.85	"$2,296.31"	"$2,296.31"	$0.00	$0.00	$644.77	$0.00	"$1,525.31"	"$1,525.31"	$0.00	"$1,501.91"	"$2,379.03"	"$2,403.06"	$0.00		$0.00	$456.40	$0.00	$0.00	$478.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.34	SUP	HCPCS C1713		422.340  -  PLATE BONE 156MM 5 HOLE LISS TITANIUM FEMUR RIGHT DISTAL	BOTH IP/OP	"$3,003.83 "	"$2,222.83"	$0.00	"$2,403.06"	"$1,351.72"	"$1,351.72"	$0.00	$0.00	$0.00	$626.07	"$2,229.44"	"$2,229.44"	$0.00	$0.00	$626.00	$0.00	"$1,480.89"	"$1,480.89"	$0.00	"$1,501.91"	"$2,379.03"	"$2,403.06"	$0.00		$0.00	$456.40	$0.00	$0.00	$478.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.341	SUP	HCPCS C1713		422.341  -  PLATE BN 156MM NS LISS 5 HL TI FEM LT DIST 5MM LCK SCR	BOTH IP/OP	"$3,093.93 "	"$2,289.51"	$0.00	"$2,403.06"	"$1,351.72"	"$1,351.72"	$0.00	$0.00	$0.00	$644.85	"$2,296.31"	"$2,296.31"	$0.00	$0.00	$644.77	$0.00	"$1,525.31"	"$1,525.31"	$0.00	"$1,501.91"	"$2,379.03"	"$2,403.06"	$0.00		$0.00	$456.40	$0.00	$0.00	$478.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.344	SUP	HCPCS C1713		422.344  -  PLATE BN 236MM NS LISS 9 HL TI FEM RT DIST 5MM LCK SCR	BOTH IP/OP	"$3,093.93 "	"$2,289.51"	$0.00	"$2,403.06"	"$1,351.72"	"$1,351.72"	$0.00	$0.00	$0.00	$644.85	"$2,296.31"	"$2,296.31"	$0.00	$0.00	$644.77	$0.00	"$1,525.31"	"$1,525.31"	$0.00	"$1,501.91"	"$2,379.03"	"$2,403.06"	$0.00		$0.00	$456.40	$0.00	$0.00	$478.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.345	SUP	HCPCS C1713		422.345  -  PLATE BN 236MM NS LISS 9 HL TI FEM LT DIST 5MM LCK SCR	BOTH IP/OP	"$3,093.93 "	"$2,289.51"	$0.00	"$2,403.06"	"$1,351.72"	"$1,351.72"	$0.00	$0.00	$0.00	$644.85	"$2,296.31"	"$2,296.31"	$0.00	$0.00	$644.77	$0.00	"$1,525.31"	"$1,525.31"	$0.00	"$1,501.91"	"$2,379.03"	"$2,403.06"	$0.00		$0.00	$456.40	$0.00	$0.00	$478.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.348	SUP	HCPCS C1713		422.348  -  PLATE BN 316MM NS LISS 13 HL TI FEM RT DIST 5MM LCK SCR	BOTH IP/OP	"$3,093.93 "	"$2,289.51"	$0.00	"$2,403.06"	"$1,351.72"	"$1,351.72"	$0.00	$0.00	$0.00	$644.85	"$2,296.31"	"$2,296.31"	$0.00	$0.00	$644.77	$0.00	"$1,525.31"	"$1,525.31"	$0.00	"$1,501.91"	"$2,379.03"	"$2,403.06"	$0.00		$0.00	$456.40	$0.00	$0.00	$478.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.349	SUP	HCPCS C1713		422.349  -  PLATE BN 316MM NS LISS 13 HL TI FEM LT DIST 5MM LCK SCR	BOTH IP/OP	"$3,093.93 "	"$2,289.51"	$0.00	"$2,403.06"	"$1,351.72"	"$1,351.72"	$0.00	$0.00	$0.00	$644.85	"$2,296.31"	"$2,296.31"	$0.00	$0.00	$644.77	$0.00	"$1,525.31"	"$1,525.31"	$0.00	"$1,501.91"	"$2,379.03"	"$2,403.06"	$0.00		$0.00	$456.40	$0.00	$0.00	$478.21	$0.00	$0.00	$0.00	$0.00	$0.00
422.39	SUP	Custom 27203010		422.390  -  INSERT SCR HL 5MM LISS TI FEM	BOTH IP/OP	$176.05 	$130.28	$0.00	$140.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.66	$130.66	$0.00	$0.00	$36.69	$0.00	$0.00	$0.00	$0.00	$88.03	$139.43	$140.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
422.391	SUP	HCPCS C1713		422.391  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 18MM SELF DRILL	BOTH IP/OP	$395.00 	$292.30	$0.00	$306.80	$172.58	$172.58	$0.00	$0.00	$0.00	$82.33	$293.17	$293.17	$0.00	$0.00	$82.32	$0.00	$233.64	$233.64	$0.00	$191.75	$303.73	$306.80	$0.00		$0.00	$58.27	$0.00	$0.00	$61.05	$0.00	$0.00	$0.00	$0.00	$0.00
422.392	SUP	HCPCS C1713		422.392  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 26MM SELF DRILL	BOTH IP/OP	$395.00 	$292.30	$0.00	$306.80	$172.58	$172.58	$0.00	$0.00	$0.00	$82.33	$293.17	$293.17	$0.00	$0.00	$82.32	$0.00	$233.64	$233.64	$0.00	$191.75	$303.73	$306.80	$0.00		$0.00	$58.27	$0.00	$0.00	$61.05	$0.00	$0.00	$0.00	$0.00	$0.00
422.393	SUP	HCPCS C1713		422.393  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 40MM SELF DRILL	BOTH IP/OP	$395.00 	$292.30	$0.00	$306.80	$172.58	$172.58	$0.00	$0.00	$0.00	$82.33	$293.17	$293.17	$0.00	$0.00	$82.32	$0.00	$233.64	$233.64	$0.00	$191.75	$303.73	$306.80	$0.00		$0.00	$58.27	$0.00	$0.00	$61.05	$0.00	$0.00	$0.00	$0.00	$0.00
422.394	SUP	HCPCS C1713		422.394  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 55MM SELF DRILL	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
422.395	SUP	HCPCS C1713		422.395  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 65MM SELF DRILL	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
422.396	SUP	HCPCS C1713		422.396  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 75MM SELF DRILL	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
422.397	SUP	HCPCS C1713		422.397  -  SCREW BONE 3.5MM 5MM 4.4MM 85MM SLFDRILL LOCKING THREADED	BOTH IP/OP	$402.03 	$297.50	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$83.79	$298.38	$298.38	$0.00	$0.00	$83.78	$0.00	$237.80	$237.80	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
422.402	SUP	HCPCS C1713		422.402  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 14MM SELF DRILL LCP	BOTH IP/OP	$409.05 	$302.70	$0.00	$317.72	$178.72	$178.72	$0.00	$0.00	$0.00	$85.26	$303.60	$303.60	$0.00	$0.00	$85.25	$0.00	$241.95	$241.95	$0.00	$198.58	$314.54	$317.72	$0.00		$0.00	$60.34	$0.00	$0.00	$63.23	$0.00	$0.00	$0.00	$0.00	$0.00
422.404	SUP	HCPCS C1713		422.404  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 18MM SELF DRILL LCP	BOTH IP/OP	$409.05 	$302.70	$0.00	$317.72	$178.72	$178.72	$0.00	$0.00	$0.00	$85.26	$303.60	$303.60	$0.00	$0.00	$85.25	$0.00	$241.95	$241.95	$0.00	$198.58	$314.54	$317.72	$0.00		$0.00	$60.34	$0.00	$0.00	$63.23	$0.00	$0.00	$0.00	$0.00	$0.00
422.578	SUP	Custom 27803010		422.578  -  NUT ORTHOPEDIC 5MM TITANIUM TIBIA PROXIMAL MEDIAL NONSTRL	BOTH IP/OP	$303.63 	$224.69	$0.00	$235.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.35	$225.35	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$147.39	$233.47	$235.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
423.406	SUP	HCPCS C1713		423.406  -  PLATE BONE 86MM 6 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5	BOTH IP/OP	"$1,720.58 "	"$1,273.23"	$0.00	"$1,336.36"	$751.70	$751.70	$0.00	$0.00	$0.00	$358.61	"$1,277.01"	"$1,277.01"	$0.00	$0.00	$358.57	$0.00	"$1,017.72"	"$1,017.72"	$0.00	$835.23	"$1,323.00"	"$1,336.36"	$0.00		$0.00	$253.81	$0.00	$0.00	$265.94	$0.00	$0.00	$0.00	$0.00	$0.00
423.407	SUP	HCPCS C1713		423.407  -  PLATE BONE 99MM 7 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5	BOTH IP/OP	"$1,752.90 "	"$1,297.15"	$0.00	"$1,361.48"	$765.83	$765.83	$0.00	$0.00	$0.00	$365.35	"$1,301.00"	"$1,301.00"	$0.00	$0.00	$365.30	$0.00	"$1,036.84"	"$1,036.84"	$0.00	$850.93	"$1,347.87"	"$1,361.48"	$0.00		$0.00	$258.58	$0.00	$0.00	$270.93	$0.00	$0.00	$0.00	$0.00	$0.00
423.408	SUP	HCPCS C1713		423.408  -  PLATE BONE 112MM 8 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5	BOTH IP/OP	"$1,778.20 "	"$1,315.87"	$0.00	"$1,381.12"	$776.88	$776.88	$0.00	$0.00	$0.00	$370.62	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$370.58	$0.00	"$1,051.81"	"$1,051.81"	$0.00	$863.20	"$1,367.31"	"$1,381.12"	$0.00		$0.00	$262.31	$0.00	$0.00	$274.84	$0.00	$0.00	$0.00	$0.00	$0.00
423.409	SUP	HCPCS C1713		423.409  -  PLATE BONE 125MM 9 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5	BOTH IP/OP	"$1,807.73 "	"$1,337.72"	$0.00	"$1,404.06"	$789.78	$789.78	$0.00	$0.00	$0.00	$376.78	"$1,341.69"	"$1,341.69"	$0.00	$0.00	$376.73	$0.00	"$1,069.27"	"$1,069.27"	$0.00	$877.54	"$1,390.02"	"$1,404.06"	$0.00		$0.00	$266.67	$0.00	$0.00	$279.41	$0.00	$0.00	$0.00	$0.00	$0.00
423.41	SUP	HCPCS C1713		423.410  -  PLATE BONE 138MM 10 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$1,783.73 "	"$1,319.96"	$0.00	"$1,426.98"	$802.68	$802.68	$0.00	$0.00	$0.00	$371.77	"$1,323.88"	"$1,323.88"	$0.00	$0.00	$371.73	$0.00	"$1,055.07"	"$1,055.07"	$0.00	$891.86	"$1,412.71"	"$1,426.98"	$0.00		$0.00	$271.02	$0.00	$0.00	$283.97	$0.00	$0.00	$0.00	$0.00	$0.00
423.411	SUP	HCPCS C1713		423.411  -  PLATE BONE 151MM 11 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$1,868.18 "	"$1,382.45"	$0.00	"$1,451.00"	$816.19	$816.19	$0.00	$0.00	$0.00	$389.37	"$1,386.56"	"$1,386.56"	$0.00	$0.00	$389.33	$0.00	"$1,105.03"	"$1,105.03"	$0.00	$906.88	"$1,436.49"	"$1,451.00"	$0.00		$0.00	$275.58	$0.00	$0.00	$288.75	$0.00	$0.00	$0.00	$0.00	$0.00
423.412	SUP	HCPCS C1713		423.412  -  PLATE BONE 164MM 12 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$2,410.78 "	"$1,783.98"	$0.00	"$1,872.44"	"$1,053.25"	"$1,053.25"	$0.00	$0.00	$0.00	$502.47	"$1,789.28"	"$1,789.28"	$0.00	$0.00	$502.41	$0.00	"$1,425.97"	"$1,425.97"	$0.00	"$1,170.28"	"$1,853.72"	"$1,872.44"	$0.00		$0.00	$355.63	$0.00	$0.00	$372.62	$0.00	$0.00	$0.00	$0.00	$0.00
423.414	SUP	HCPCS C1713		423.414  -  PLATE BONE 190MM 14 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$2,489.48 "	"$1,842.22"	$0.00	"$1,933.58"	"$1,087.64"	"$1,087.64"	$0.00	$0.00	$0.00	$518.87	"$1,847.69"	"$1,847.69"	$0.00	$0.00	$518.81	$0.00	"$1,472.52"	"$1,472.52"	$0.00	"$1,208.49"	"$1,914.25"	"$1,933.58"	$0.00		$0.00	$367.24	$0.00	$0.00	$384.78	$0.00	$0.00	$0.00	$0.00	$0.00
423.416	SUP	HCPCS C1713		423.416  -  PLATE BONE 216MM 16 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$2,542.90 "	"$1,881.75"	$0.00	"$1,975.06"	"$1,110.97"	"$1,110.97"	$0.00	$0.00	$0.00	$530.00	"$1,887.34"	"$1,887.34"	$0.00	$0.00	$529.94	$0.00	"$1,253.65"	"$1,253.65"	$0.00	"$1,234.41"	"$1,955.31"	"$1,975.06"	$0.00		$0.00	$375.12	$0.00	$0.00	$393.04	$0.00	$0.00	$0.00	$0.00	$0.00
423.418	SUP	HCPCS C1713		423.418  -  PLATE BONE 242MM 18 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$2,489.48 "	"$1,842.22"	$0.00	"$1,933.58"	"$1,087.64"	"$1,087.64"	$0.00	$0.00	$0.00	$518.87	"$1,847.69"	"$1,847.69"	$0.00	$0.00	$518.81	$0.00	"$1,472.52"	"$1,472.52"	$0.00	"$1,208.49"	"$1,914.25"	"$1,933.58"	$0.00		$0.00	$367.24	$0.00	$0.00	$384.78	$0.00	$0.00	$0.00	$0.00	$0.00
423.52	SUP	HCPCS C1713		423.52  -  PLATE BONE 25X11X3.3MM 2 HOLE LC-DCP TITANIUM CLAVICLE	BOTH IP/OP	$218.63 	$161.79	$0.00	$174.90	$98.38	$98.38	$0.00	$0.00	$0.00	$45.57	$162.26	$162.26	$0.00	$0.00	$45.56	$0.00	$129.32	$129.32	$0.00	$109.31	$173.15	$174.90	$0.00		$0.00	$34.21	$0.00	$0.00	$34.81	$0.00	$0.00	$0.00	$0.00	$0.00
423.521	SUP	HCPCS C1713		423.521  -  PLATE BONE 33MM 2 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5MM	BOTH IP/OP	$490.58 	$363.03	$0.00	$381.04	$214.34	$214.34	$0.00	$0.00	$0.00	$102.25	$364.10	$364.10	$0.00	$0.00	$102.24	$0.00	$290.18	$290.18	$0.00	$238.15	$377.23	$381.04	$0.00		$0.00	$72.37	$0.00	$0.00	$75.83	$0.00	$0.00	$0.00	$0.00	$0.00
423.53	SUP	HCPCS C1713		423.53  -  PLATE BONE 38X11X3.3MM 3 HOLE LC-DCP TITANIUM CLAVICLE	BOTH IP/OP	$222.60 	$164.72	$0.00	$178.08	$100.17	$100.17	$0.00	$0.00	$0.00	$46.40	$165.21	$165.21	$0.00	$0.00	$46.39	$0.00	$131.67	$131.67	$0.00	$111.30	$176.30	$178.08	$0.00		$0.00	$34.84	$0.00	$0.00	$35.44	$0.00	$0.00	$0.00	$0.00	$0.00
423.531	SUP	HCPCS C1713		423.531  -  PLATE BONE 46MM 3 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5MM	BOTH IP/OP	$510.28 	$377.61	$0.00	$396.32	$222.93	$222.93	$0.00	$0.00	$0.00	$106.35	$378.73	$378.73	$0.00	$0.00	$106.34	$0.00	$301.83	$301.83	$0.00	$247.70	$392.36	$396.32	$0.00		$0.00	$75.27	$0.00	$0.00	$78.87	$0.00	$0.00	$0.00	$0.00	$0.00
423.54	SUP	HCPCS C1713		423.54  -  PLATE BONE 3.5MM 51X11X3.3MM 4 HOLE LC-DCP TITANIUM CLAVICLE	BOTH IP/OP	$229.23 	$169.63	$0.00	$183.38	$103.15	$103.15	$0.00	$0.00	$0.00	$47.78	$170.13	$170.13	$0.00	$0.00	$47.77	$0.00	$135.59	$135.59	$0.00	$114.61	$181.55	$183.38	$0.00		$0.00	$35.87	$0.00	$0.00	$36.49	$0.00	$0.00	$0.00	$0.00	$0.00
423.541	SUP	HCPCS C1713		423.541  -  PLATE BONE 59MM 4 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5MM	BOTH IP/OP	$532.75 	$394.24	$0.00	$413.80	$232.76	$232.76	$0.00	$0.00	$0.00	$111.04	$395.41	$395.41	$0.00	$0.00	$111.03	$0.00	$315.12	$315.12	$0.00	$258.63	$409.66	$413.80	$0.00		$0.00	$78.59	$0.00	$0.00	$82.35	$0.00	$0.00	$0.00	$0.00	$0.00
423.55	SUP	HCPCS C1713		423.55  -  PLATE BONE 64X11X3.3MM 5 HOLE LC-DCP TITANIUM CLAVICLE	BOTH IP/OP	$241.15 	$178.45	$0.00	$192.92	$108.52	$108.52	$0.00	$0.00	$0.00	$50.26	$178.98	$178.98	$0.00	$0.00	$50.26	$0.00	$142.64	$142.64	$0.00	$120.58	$190.99	$192.92	$0.00		$0.00	$37.74	$0.00	$0.00	$38.39	$0.00	$0.00	$0.00	$0.00	$0.00
423.551	SUP	HCPCS C1713		423.551  -  PLATE BONE 72X11X3.4MM 5 HOLE LCP TITANIUM HUMERUS RAD ULNA	BOTH IP/OP	$549.63 	$406.73	$0.00	$426.90	$240.13	$240.13	$0.00	$0.00	$0.00	$114.56	$407.93	$407.93	$0.00	$0.00	$114.54	$0.00	$325.10	$325.10	$0.00	$266.81	$422.63	$426.90	$0.00		$0.00	$81.08	$0.00	$0.00	$84.95	$0.00	$0.00	$0.00	$0.00	$0.00
423.56	SUP	HCPCS C1713		423.56  -  PLATE BONE 77X11X3.3MM 6 HOLE LC-DCP TITANIUM CLAVICLE	BOTH IP/OP	$258.38 	$191.20	$0.00	$206.70	$116.27	$116.27	$0.00	$0.00	$0.00	$53.85	$191.77	$191.77	$0.00	$0.00	$53.85	$0.00	$152.83	$152.83	$0.00	$129.19	$204.64	$206.70	$0.00		$0.00	$40.44	$0.00	$0.00	$41.13	$0.00	$0.00	$0.00	$0.00	$0.00
423.561	SUP	HCPCS C1713		423.561  -  PLATE BONE 85X11X3.4MM 6 HOLE LCP TITANIUM HUMERUS RAD ULNA	BOTH IP/OP	$584.78 	$432.74	$0.00	$454.18	$255.48	$255.48	$0.00	$0.00	$0.00	$121.88	$434.02	$434.02	$0.00	$0.00	$121.87	$0.00	$345.89	$345.89	$0.00	$283.86	$449.64	$454.18	$0.00		$0.00	$86.26	$0.00	$0.00	$90.38	$0.00	$0.00	$0.00	$0.00	$0.00
423.57	SUP	HCPCS C1713		423.57  -  PLATE BN 90X11X3.3MM NS LC DCP 7 HL TI 3.5MM SCR SM FRAG SET	BOTH IP/OP	$267.65 	$198.06	$0.00	$214.12	$120.44	$120.44	$0.00	$0.00	$0.00	$55.78	$198.65	$198.65	$0.00	$0.00	$55.78	$0.00	$158.31	$158.31	$0.00	$133.83	$211.98	$214.12	$0.00		$0.00	$41.89	$0.00	$0.00	$42.61	$0.00	$0.00	$0.00	$0.00	$0.00
423.571	SUP	HCPCS C1713		423.571  -  PLATE BN 98X11X3.4MM NS LCP CMBN 7 HL LMT CNTCT TPR END TI	BOTH IP/OP	$608.68 	$450.42	$0.00	$472.74	$265.92	$265.92	$0.00	$0.00	$0.00	$126.86	$451.76	$451.76	$0.00	$0.00	$126.85	$0.00	$360.03	$360.03	$0.00	$295.46	$468.02	$472.74	$0.00		$0.00	$89.79	$0.00	$0.00	$94.08	$0.00	$0.00	$0.00	$0.00	$0.00
423.58	SUP	HCPCS C1713		423.58  -  PLATE BONE SMALL 103X11X3.3MM 8 HOLE LC-DCP TITANIUM	BOTH IP/OP	$282.23 	$208.85	$0.00	$225.78	$127.00	$127.00	$0.00	$0.00	$0.00	$58.82	$209.47	$209.47	$0.00	$0.00	$58.82	$0.00	$166.94	$166.94	$0.00	$141.11	$223.53	$225.78	$0.00		$0.00	$44.17	$0.00	$0.00	$44.93	$0.00	$0.00	$0.00	$0.00	$0.00
423.581	SUP	HCPCS C1713		423.581  -  PLATE BN 111X11X3.4MM NS LCP CMBN 8 HL LMT CNTCT TPR END TI	BOTH IP/OP	$639.60 	$473.30	$0.00	$496.76	$279.43	$279.43	$0.00	$0.00	$0.00	$133.31	$474.71	$474.71	$0.00	$0.00	$133.29	$0.00	$378.32	$378.32	$0.00	$310.48	$491.79	$496.76	$0.00		$0.00	$94.35	$0.00	$0.00	$98.86	$0.00	$0.00	$0.00	$0.00	$0.00
423.59	SUP	HCPCS C1713		423.59  -  PLATE BN 116X11X3.3MM NS LC DCP 9 HL TI 3.5MM SCR SM FRAG	BOTH IP/OP	$304.75 	$225.52	$0.00	$243.80	$137.14	$137.14	$0.00	$0.00	$0.00	$63.52	$226.19	$226.19	$0.00	$0.00	$63.51	$0.00	$180.26	$180.26	$0.00	$152.38	$241.36	$243.80	$0.00		$0.00	$47.69	$0.00	$0.00	$48.52	$0.00	$0.00	$0.00	$0.00	$0.00
423.591	SUP	HCPCS C1713		423.591  -  PLATE BONE 124X11X3.4MM 9 HOLE LCP TITANIUM HUMERUS RAD ULNA	BOTH IP/OP	$664.90 	$492.03	$0.00	$516.42	$290.49	$290.49	$0.00	$0.00	$0.00	$138.58	$493.49	$493.49	$0.00	$0.00	$138.57	$0.00	$393.29	$393.29	$0.00	$322.76	$511.26	$516.42	$0.00		$0.00	$98.08	$0.00	$0.00	$102.77	$0.00	$0.00	$0.00	$0.00	$0.00
423.6	SUP	HCPCS C1713		423.60  -  PLATE BONE 129X11X3.3MM 10 HOLE LC-DCP TITANIUM DISTAL TIBIA	BOTH IP/OP	$308.73 	$228.46	$0.00	$246.98	$138.93	$138.93	$0.00	$0.00	$0.00	$64.35	$229.14	$229.14	$0.00	$0.00	$64.34	$0.00	$182.61	$182.61	$0.00	$154.36	$244.51	$246.98	$0.00		$0.00	$48.32	$0.00	$0.00	$49.15	$0.00	$0.00	$0.00	$0.00	$0.00
423.601	SUP	HCPCS C1713		423.601  -  PLATE BONE 137X11X3.4MM 10 HOLE LCP TITANIUM HUMERUS RAD	BOTH IP/OP	$685.98 	$507.63	$0.00	$532.80	$299.70	$299.70	$0.00	$0.00	$0.00	$142.97	$509.13	$509.13	$0.00	$0.00	$142.96	$0.00	$405.75	$405.75	$0.00	$333.00	$527.47	$532.80	$0.00		$0.00	$101.19	$0.00	$0.00	$106.03	$0.00	$0.00	$0.00	$0.00	$0.00
423.61	SUP	HCPCS C1713		423.61  -  PLATE BONE 142X11X3.3MM 11 HOLE LC-DCP TITANIUM CLAVICLE	BOTH IP/OP	$324.63 	$240.23	$0.00	$259.70	$146.08	$146.08	$0.00	$0.00	$0.00	$67.66	$240.94	$240.94	$0.00	$0.00	$67.65	$0.00	$192.02	$192.02	$0.00	$162.31	$257.11	$259.70	$0.00		$0.00	$50.80	$0.00	$0.00	$51.68	$0.00	$0.00	$0.00	$0.00	$0.00
423.611	SUP	HCPCS C1713		423.611  -  PLATE BONE 150MM 11 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5	BOTH IP/OP	$736.58 	$545.07	$0.00	$572.10	$321.81	$321.81	$0.00	$0.00	$0.00	$153.52	$546.69	$546.69	$0.00	$0.00	$153.50	$0.00	$435.68	$435.68	$0.00	$357.56	$566.38	$572.10	$0.00		$0.00	$108.66	$0.00	$0.00	$113.85	$0.00	$0.00	$0.00	$0.00	$0.00
423.62	SUP	HCPCS C1713		423.62  -  PLATE BONE 3.5MM 155X11X3.3MM 12 HOLE LC-DCP TITANIUM	BOTH IP/OP	$347.15 	$256.89	$0.00	$277.72	$156.22	$156.22	$0.00	$0.00	$0.00	$72.35	$257.65	$257.65	$0.00	$0.00	$72.35	$0.00	$205.34	$205.34	$0.00	$173.58	$274.94	$277.72	$0.00		$0.00	$54.33	$0.00	$0.00	$55.27	$0.00	$0.00	$0.00	$0.00	$0.00
423.621	SUP	HCPCS C1713		423.621  -  PLATE BONE 163X11X3.4MM 12 HOLE LCP TITANIUM HUMERUS RAD	BOTH IP/OP	$756.28 	$559.65	$0.00	$587.38	$330.40	$330.40	$0.00	$0.00	$0.00	$157.63	$561.31	$561.31	$0.00	$0.00	$157.61	$0.00	$447.34	$447.34	$0.00	$367.11	$581.51	$587.38	$0.00		$0.00	$111.56	$0.00	$0.00	$116.89	$0.00	$0.00	$0.00	$0.00	$0.00
423.631	SUP	HCPCS C1713		423.631  -  PLATE BONE 176MM 13 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5	BOTH IP/OP	$898.25 	$664.71	$0.00	$697.66	$392.43	$392.43	$0.00	$0.00	$0.00	$187.22	$666.68	$666.68	$0.00	$0.00	$187.20	$0.00	$531.31	$531.31	$0.00	$436.04	$690.69	$697.66	$0.00		$0.00	$132.50	$0.00	$0.00	$138.83	$0.00	$0.00	$0.00	$0.00	$0.00
423.64	SUP	HCPCS C1713		423.64  -  PLATE BONE 181X11X3.3MM 14 HOLE LC-DCP TITANIUM CLAVICLE	BOTH IP/OP	$642.63 	$475.55	$0.00	$514.10	$289.18	$289.18	$0.00	$0.00	$0.00	$133.94	$476.96	$476.96	$0.00	$0.00	$133.92	$0.00	$380.11	$380.11	$0.00	$321.31	$508.96	$514.10	$0.00		$0.00	$100.57	$0.00	$0.00	$102.31	$0.00	$0.00	$0.00	$0.00	$0.00
423.641	SUP	HCPCS C1713		423.641  -  PLATE BONE 189X11X3.4MM 14 HOLE LCP TITANIUM HUMERUS RAD	BOTH IP/OP	"$1,134.40 "	$839.46	$0.00	$881.08	$495.61	$495.61	$0.00	$0.00	$0.00	$236.44	$841.95	$841.95	$0.00	$0.00	$236.41	$0.00	$671.00	$671.00	$0.00	$550.68	$872.27	$881.08	$0.00		$0.00	$167.34	$0.00	$0.00	$175.33	$0.00	$0.00	$0.00	$0.00	$0.00
423.65	SUP	HCPCS C1713		423.65  -  PLATE BONE 195X11X3.3MM 15 HOLE LC-DCP TITANIUM CLAVICLE	BOTH IP/OP	$673.10 	$498.09	$0.00	$538.48	$302.90	$302.90	$0.00	$0.00	$0.00	$140.29	$499.57	$499.57	$0.00	$0.00	$140.27	$0.00	$398.14	$398.14	$0.00	$336.55	$533.10	$538.48	$0.00		$0.00	$105.34	$0.00	$0.00	$107.16	$0.00	$0.00	$0.00	$0.00	$0.00
423.651	SUP	HCPCS C1713		423.651  -  PLATE BONE 202MM 15 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5	BOTH IP/OP	"$1,214.53 "	$898.75	$0.00	$943.32	$530.62	$530.62	$0.00	$0.00	$0.00	$253.14	$901.42	$901.42	$0.00	$0.00	$253.11	$0.00	$718.39	$718.39	$0.00	$589.58	$933.89	$943.32	$0.00		$0.00	$179.16	$0.00	$0.00	$187.72	$0.00	$0.00	$0.00	$0.00	$0.00
423.66	SUP	HCPCS C1713		423.66  -  PLATE BONE 207X11X3.3MM 16 HOLE LC-DCP TITANIUM CLAVICLE	BOTH IP/OP	$738.03 	$546.14	$0.00	$590.42	$332.11	$332.11	$0.00	$0.00	$0.00	$153.82	$547.76	$547.76	$0.00	$0.00	$153.80	$0.00	$436.54	$436.54	$0.00	$369.01	$584.52	$590.42	$0.00		$0.00	$115.50	$0.00	$0.00	$117.49	$0.00	$0.00	$0.00	$0.00	$0.00
423.661	SUP	HCPCS C1713		423.661  -  PLATE BONE 215MM 16 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5	BOTH IP/OP	"$1,270.75 "	$940.36	$0.00	$986.98	$555.18	$555.18	$0.00	$0.00	$0.00	$264.86	$943.15	$943.15	$0.00	$0.00	$264.82	$0.00	$751.65	$751.65	$0.00	$616.86	$977.11	$986.98	$0.00		$0.00	$187.46	$0.00	$0.00	$196.41	$0.00	$0.00	$0.00	$0.00	$0.00
423.671	SUP	HCPCS C1713		423.671  -  PLATE BONE 241MM 18 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5	BOTH IP/OP	"$1,425.38 "	"$1,054.78"	$0.00	"$1,107.08"	$622.73	$622.73	$0.00	$0.00	$0.00	$297.08	"$1,057.91"	"$1,057.91"	$0.00	$0.00	$297.05	$0.00	$843.11	$843.11	$0.00	$691.93	"$1,096.01"	"$1,107.08"	$0.00		$0.00	$210.27	$0.00	$0.00	$220.31	$0.00	$0.00	$0.00	$0.00	$0.00
423.68	SUP	HCPCS C1713		423.68  -  PLATE BONE 233X11X3.3MM 18 HOLE LC-DCP TITANIUM CLAVICLE	BOTH IP/OP	$825.48 	$610.86	$0.00	$660.38	$371.46	$371.46	$0.00	$0.00	$0.00	$172.05	$612.67	$612.67	$0.00	$0.00	$172.03	$0.00	$488.27	$488.27	$0.00	$412.74	$653.78	$660.38	$0.00		$0.00	$129.19	$0.00	$0.00	$131.42	$0.00	$0.00	$0.00	$0.00	$0.00
423.681	SUP	HCPCS C1713		423.681  -  PLATE BONE 267MM 20 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5	BOTH IP/OP	"$1,582.80 "	"$1,171.27"	$0.00	"$1,229.36"	$691.52	$691.52	$0.00	$0.00	$0.00	$329.90	"$1,174.75"	"$1,174.75"	$0.00	$0.00	$329.86	$0.00	$936.23	$936.23	$0.00	$768.35	"$1,217.07"	"$1,229.36"	$0.00		$0.00	$233.49	$0.00	$0.00	$244.64	$0.00	$0.00	$0.00	$0.00	$0.00
423.691	SUP	HCPCS C1713		423.691  -  PLATE BONE 293MM 22 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5	BOTH IP/OP	"$1,584.23 "	"$1,172.33"	$0.00	"$1,230.46"	$692.13	$692.13	$0.00	$0.00	$0.00	$330.19	"$1,175.81"	"$1,175.81"	$0.00	$0.00	$330.15	$0.00	$937.07	$937.07	$0.00	$769.04	"$1,218.16"	"$1,230.46"	$0.00		$0.00	$233.70	$0.00	$0.00	$244.86	$0.00	$0.00	$0.00	$0.00	$0.00
423.7	SUP	HCPCS C1713		423.70  -  PLATE BONE 259X11X3.3MM 20 HOLE LC-DCP TITANIUM CLAVICLE	BOTH IP/OP	$914.25 	$676.55	$0.00	$731.40	$411.41	$411.41	$0.00	$0.00	$0.00	$190.55	$678.56	$678.56	$0.00	$0.00	$190.53	$0.00	$540.78	$540.78	$0.00	$457.13	$724.09	$731.40	$0.00		$0.00	$143.08	$0.00	$0.00	$145.55	$0.00	$0.00	$0.00	$0.00	$0.00
424.519	SUP	Custom 27803010		"424.519  -  5.5MM SS STRAIGHT ROD, HEX-END, 300MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
424.52	SUP	Custom 27803010		"424.520  -  5.5MM SS STRAIGHT ROD, HEX-END, 400MM"	BOTH IP/OP	$320.73 	$237.34	$0.00	$396.00	$144.33	$144.33	$0.00	$0.00	$0.00	$66.85	$238.04	$238.04	$0.00	$0.00	$66.84	$0.00	$189.71	$189.71	$0.00	$160.36	$396.00	$256.58	$0.00		$0.00	$48.73	$0.00	$0.00	$51.06	$0.00	$0.00	$0.00	$0.00	$0.00
424.52	SUP	HCPCS C1713		424.52  -  PLATE BONE NARROW 34X13.5X4.2MM 2 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$320.73 	$237.34	$0.00	$256.58	$144.33	$144.33	$0.00	$0.00	$0.00	$66.85	$238.04	$238.04	$0.00	$0.00	$66.84	$0.00	$189.71	$189.71	$0.00	$160.36	$254.02	$256.58	$0.00		$0.00	$48.73	$0.00	$0.00	$51.06	$0.00	$0.00	$0.00	$0.00	$0.00
424.521	SUP	Custom 27803010		424.521  -  PLATE BONE NARROW 44MM 2 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$588.98 	$435.85	$0.00	$457.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$437.14	$437.14	$0.00	$0.00	$122.74	$0.00	$0.00	$0.00	$0.00	$285.91	$452.89	$457.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
424.53	SUP	HCPCS C1713		424.53  -  PLATE BONE NARROW 52X13.5X4.2MM 3 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$320.73 	$237.34	$0.00	$256.58	$144.33	$144.33	$0.00	$0.00	$0.00	$66.85	$238.04	$238.04	$0.00	$0.00	$66.84	$0.00	$189.71	$189.71	$0.00	$160.36	$254.02	$256.58	$0.00		$0.00	$48.73	$0.00	$0.00	$51.06	$0.00	$0.00	$0.00	$0.00	$0.00
424.531	SUP	HCPCS C1713		424.531  -  PLATE BONE NARROW 62MM 3 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$596.03 	$441.06	$0.00	$462.92	$260.39	$260.39	$0.00	$0.00	$0.00	$124.23	$442.37	$442.37	$0.00	$0.00	$124.21	$0.00	$352.55	$352.55	$0.00	$289.33	$458.29	$462.92	$0.00		$0.00	$87.92	$0.00	$0.00	$92.12	$0.00	$0.00	$0.00	$0.00	$0.00
424.54	SUP	HCPCS C1713		424.54  -  PLATE BONE NARROW 70X13.5X4.2MM 4 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$320.73 	$237.34	$0.00	$256.58	$144.33	$144.33	$0.00	$0.00	$0.00	$66.85	$238.04	$238.04	$0.00	$0.00	$66.84	$0.00	$189.71	$189.71	$0.00	$160.36	$254.02	$256.58	$0.00		$0.00	$48.73	$0.00	$0.00	$51.06	$0.00	$0.00	$0.00	$0.00	$0.00
424.541	SUP	HCPCS C1713		424.541  -  PLATE BONE NARROW 80MM 4 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
424.55	SUP	HCPCS C1713		424.55  -  PLATE BONE NARROW 88X13.5X4.2MM 5 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$320.73 	$237.34	$0.00	$256.58	$144.33	$144.33	$0.00	$0.00	$0.00	$66.85	$238.04	$238.04	$0.00	$0.00	$66.84	$0.00	$189.71	$189.71	$0.00	$160.36	$254.02	$256.58	$0.00		$0.00	$48.73	$0.00	$0.00	$51.06	$0.00	$0.00	$0.00	$0.00	$0.00
424.551	SUP	HCPCS C1713		424.551  -  PLATE BONE NARROW 98MM 5 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$694.40 	$513.86	$0.00	$539.34	$303.38	$303.38	$0.00	$0.00	$0.00	$144.73	$515.38	$515.38	$0.00	$0.00	$144.71	$0.00	$410.74	$410.74	$0.00	$337.09	$533.95	$539.34	$0.00		$0.00	$102.44	$0.00	$0.00	$107.33	$0.00	$0.00	$0.00	$0.00	$0.00
424.56	SUP	HCPCS C1713		424.56  -  PLATE BONE NARROW 106X13.5X4.2MM 6 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$360.30 	$266.62	$0.00	$288.24	$162.14	$162.14	$0.00	$0.00	$0.00	$75.10	$267.41	$267.41	$0.00	$0.00	$75.09	$0.00	$213.12	$213.12	$0.00	$180.15	$285.36	$288.24	$0.00		$0.00	$54.74	$0.00	$0.00	$57.36	$0.00	$0.00	$0.00	$0.00	$0.00
424.561	SUP	HCPCS C1713		424.561  -  PLATE BONE NARROW 116MM 6 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
424.57	SUP	HCPCS C1713		424.57  -  PLATE BONE NARROW 124X13.5X4.2MM 7 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$349.80 	$258.85	$0.00	$279.84	$157.41	$157.41	$0.00	$0.00	$0.00	$72.91	$259.62	$259.62	$0.00	$0.00	$72.90	$0.00	$206.91	$206.91	$0.00	$174.90	$277.04	$279.84	$0.00		$0.00	$54.74	$0.00	$0.00	$55.69	$0.00	$0.00	$0.00	$0.00	$0.00
424.571	SUP	HCPCS C1713		424.571  -  PLATE BONE NARROW 134MM 7 HOLE LCP TITANIUM ORTHOPEDIC 4.5MM	BOTH IP/OP	$850.45 	$629.33	$0.00	$660.54	$371.55	$371.55	$0.00	$0.00	$0.00	$177.26	$631.20	$631.20	$0.00	$0.00	$177.23	$0.00	$503.04	$503.04	$0.00	$412.84	$653.94	$660.54	$0.00		$0.00	$125.45	$0.00	$0.00	$131.45	$0.00	$0.00	$0.00	$0.00	$0.00
424.58	SUP	HCPCS C1713		424.58  -  PLATE BONE NARROW 4.5MM 142X13.5X4.2MM 8 HOLE LC-DCP	BOTH IP/OP	$371.10 	$274.61	$0.00	$288.24	$162.14	$162.14	$0.00	$0.00	$0.00	$77.35	$275.43	$275.43	$0.00	$0.00	$77.34	$0.00	$219.51	$219.51	$0.00	$180.15	$285.36	$288.24	$0.00		$0.00	$54.74	$0.00	$0.00	$57.36	$0.00	$0.00	$0.00	$0.00	$0.00
424.581	SUP	HCPCS C1713		424.581  -  PLATE BONE NARROW 152MM 8 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$899.65 	$665.74	$0.00	$698.76	$393.05	$393.05	$0.00	$0.00	$0.00	$187.51	$667.72	$667.72	$0.00	$0.00	$187.49	$0.00	$532.14	$532.14	$0.00	$436.73	$691.77	$698.76	$0.00		$0.00	$132.71	$0.00	$0.00	$139.05	$0.00	$0.00	$0.00	$0.00	$0.00
424.59	SUP	HCPCS C1713		424.59  -  PLATE BONE NARROW 160X13.5X4.2MM 9 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$350.75 	$259.56	$0.00	$280.60	$157.84	$157.84	$0.00	$0.00	$0.00	$73.11	$260.33	$260.33	$0.00	$0.00	$73.10	$0.00	$207.47	$207.47	$0.00	$175.38	$277.79	$280.60	$0.00		$0.00	$53.29	$0.00	$0.00	$55.84	$0.00	$0.00	$0.00	$0.00	$0.00
424.591	SUP	HCPCS C1713		424.591  -  PLATE BONE NARROW 170MM 9 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$941.83 	$696.95	$0.00	$731.50	$411.47	$411.47	$0.00	$0.00	$0.00	$196.30	$699.02	$699.02	$0.00	$0.00	$196.28	$0.00	$557.09	$557.09	$0.00	$457.19	$724.19	$731.50	$0.00		$0.00	$138.93	$0.00	$0.00	$145.57	$0.00	$0.00	$0.00	$0.00	$0.00
424.6	SUP	HCPCS C1713		424.60  -  PLATE BONE NARROW 4.5MM 178X13.5X4.2MM 10 HOLE LC-DCP	BOTH IP/OP	$454.45 	$336.29	$0.00	$363.56	$204.50	$204.50	$0.00	$0.00	$0.00	$94.72	$337.29	$337.29	$0.00	$0.00	$94.71	$0.00	$268.81	$268.81	$0.00	$227.23	$359.92	$363.56	$0.00		$0.00	$69.05	$0.00	$0.00	$72.35	$0.00	$0.00	$0.00	$0.00	$0.00
424.601	SUP	HCPCS C1713		424.601  -  PLATE BONE NARROW 188MM 10 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,023.35 "	$757.28	$0.00	$794.84	$447.10	$447.10	$0.00	$0.00	$0.00	$213.29	$759.53	$759.53	$0.00	$0.00	$213.27	$0.00	$605.31	$605.31	$0.00	$496.78	$786.89	$794.84	$0.00		$0.00	$150.96	$0.00	$0.00	$158.17	$0.00	$0.00	$0.00	$0.00	$0.00
424.61	SUP	HCPCS C1713		424.61  -  PLATE BONE NARROW 4.5MM 206MM 11 HOLE LCP TITANIUM NONSTRL	BOTH IP/OP	$468.10 	$346.39	$0.00	$374.48	$210.65	$210.65	$0.00	$0.00	$0.00	$97.56	$347.42	$347.42	$0.00	$0.00	$97.55	$0.00	$276.88	$276.88	$0.00	$234.05	$370.74	$374.48	$0.00		$0.00	$71.13	$0.00	$0.00	$74.52	$0.00	$0.00	$0.00	$0.00	$0.00
424.611	SUP	HCPCS C1713		424.611  -  PLATE BONE NARROW 206MM 11 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,102.08 "	$815.54	$0.00	$855.98	$481.49	$481.49	$0.00	$0.00	$0.00	$229.70	$817.96	$817.96	$0.00	$0.00	$229.67	$0.00	$651.88	$651.88	$0.00	$534.99	$847.42	$855.98	$0.00		$0.00	$162.57	$0.00	$0.00	$170.34	$0.00	$0.00	$0.00	$0.00	$0.00
424.62	SUP	HCPCS C1713		424.62  -  PLATE BONE NARROW 214X13.5X4.2MM 12 HOLE LC-DCP TITANIUM	BOTH IP/OP	$441.23 	$326.51	$0.00	$352.98	$198.55	$198.55	$0.00	$0.00	$0.00	$91.96	$327.48	$327.48	$0.00	$0.00	$91.95	$0.00	$260.98	$260.98	$0.00	$220.61	$349.45	$352.98	$0.00		$0.00	$69.05	$0.00	$0.00	$70.24	$0.00	$0.00	$0.00	$0.00	$0.00
424.621	SUP	HCPCS C1713		424.621  -  PLATE BONE NARROW 224MM 12 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$920.38	$517.71	$517.71	$0.00	$0.00	$0.00	$246.98	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$700.93	$700.93	$0.00	$575.24	$911.18	$920.38	$0.00		$0.00	$174.81	$0.00	$0.00	$183.16	$0.00	$0.00	$0.00	$0.00	$0.00
424.63	SUP	HCPCS C1713		424.63  -  PLATE BONE NARROW 232X13.5X4.2MM 13 HOLE LC-DCP TITANIUM	BOTH IP/OP	$544.53 	$402.95	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$113.49	$404.15	$404.15	$0.00	$0.00	$113.48	$0.00	$322.09	$322.09	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
424.631	SUP	HCPCS C1713		424.631  -  PLATE BONE NARROW 242MM 13 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,265.13 "	$936.20	$0.00	$982.62	$552.72	$552.72	$0.00	$0.00	$0.00	$263.68	$938.98	$938.98	$0.00	$0.00	$263.65	$0.00	$748.32	$748.32	$0.00	$614.14	$972.80	$982.62	$0.00		$0.00	$186.63	$0.00	$0.00	$195.54	$0.00	$0.00	$0.00	$0.00	$0.00
424.64	SUP	HCPCS C1713		424.64  -  PLATE BONE NARROW 4.5MM 250X13.5X4.2MM 14 HOLE LC-DCP	BOTH IP/OP	$545.40 	$403.60	$0.00	$423.62	$238.29	$238.29	$0.00	$0.00	$0.00	$113.67	$404.80	$404.80	$0.00	$0.00	$113.66	$0.00	$322.60	$322.60	$0.00	$264.76	$419.39	$423.62	$0.00		$0.00	$80.46	$0.00	$0.00	$84.30	$0.00	$0.00	$0.00	$0.00	$0.00
424.641	SUP	HCPCS C1713		424.641  -  PLATE BONE NARROW 260MM 14 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,328.38 "	$983.00	$0.00	"$1,031.76"	$580.37	$580.37	$0.00	$0.00	$0.00	$276.87	$985.92	$985.92	$0.00	$0.00	$276.83	$0.00	$785.73	$785.73	$0.00	$644.85	"$1,021.44"	"$1,031.76"	$0.00		$0.00	$195.96	$0.00	$0.00	$205.32	$0.00	$0.00	$0.00	$0.00	$0.00
424.65	SUP	HCPCS C1713		424.65  -  PLATE BONE NARROW 4.5MM 268MM 15 HOLE LC-DCP TITANIUM	BOTH IP/OP	$544.53 	$402.95	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$113.49	$404.15	$404.15	$0.00	$0.00	$113.48	$0.00	$322.09	$322.09	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
424.651	SUP	HCPCS C1713		424.651  -  PLATE BONE NARROW 278MM 15 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,445.05 "	"$1,069.34"	$0.00	"$1,122.38"	$631.34	$631.34	$0.00	$0.00	$0.00	$301.18	"$1,072.52"	"$1,072.52"	$0.00	$0.00	$301.15	$0.00	$854.75	$854.75	$0.00	$701.49	"$1,111.16"	"$1,122.38"	$0.00		$0.00	$213.17	$0.00	$0.00	$223.35	$0.00	$0.00	$0.00	$0.00	$0.00
424.66	SUP	HCPCS C1713		424.66  -  PLATE BONE NARROW 4.5MM 286MM 16 HOLE LC-DCP TITANIUM	BOTH IP/OP	$544.53 	$402.95	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$113.49	$404.15	$404.15	$0.00	$0.00	$113.48	$0.00	$322.09	$322.09	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
424.661	SUP	HCPCS C1713		424.661  -  PLATE BONE NARROW 296MM 16 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,553.30 "	"$1,149.44"	$0.00	"$1,206.44"	$678.62	$678.62	$0.00	$0.00	$0.00	$323.75	"$1,152.86"	"$1,152.86"	$0.00	$0.00	$323.71	$0.00	$918.78	$918.78	$0.00	$754.03	"$1,194.38"	"$1,206.44"	$0.00		$0.00	$229.14	$0.00	$0.00	$240.08	$0.00	$0.00	$0.00	$0.00	$0.00
424.67	SUP	HCPCS C1713		424.67  -  PLATE BONE NARROW 4.5MM 305MM 17 HOLE LC-DCP TITANIUM	BOTH IP/OP	$799.75 	$591.82	$0.00	$639.80	$359.89	$359.89	$0.00	$0.00	$0.00	$166.69	$593.57	$593.57	$0.00	$0.00	$166.67	$0.00	$473.05	$473.05	$0.00	$399.88	$633.40	$639.80	$0.00		$0.00	$121.51	$0.00	$0.00	$127.32	$0.00	$0.00	$0.00	$0.00	$0.00
424.68	SUP	HCPCS C1713		424.68  -  PLATE BONE NARROW 4.5MM 323MM 18 HOLE LC-DCP TITANIUM	BOTH IP/OP	$799.75 	$591.82	$0.00	$639.80	$359.89	$359.89	$0.00	$0.00	$0.00	$166.69	$593.57	$593.57	$0.00	$0.00	$166.67	$0.00	$473.05	$473.05	$0.00	$399.88	$633.40	$639.80	$0.00		$0.00	$121.51	$0.00	$0.00	$127.32	$0.00	$0.00	$0.00	$0.00	$0.00
424.681	SUP	HCPCS C1713		424.681  -  PLATE BONE NARROW 332MM 18 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,824.60 "	"$1,350.20"	$0.00	"$1,417.16"	$797.15	$797.15	$0.00	$0.00	$0.00	$380.29	"$1,354.22"	"$1,354.22"	$0.00	$0.00	$380.25	$0.00	"$1,079.25"	"$1,079.25"	$0.00	$885.73	"$1,402.99"	"$1,417.16"	$0.00		$0.00	$269.16	$0.00	$0.00	$282.01	$0.00	$0.00	$0.00	$0.00	$0.00
424.7	SUP	HCPCS C1713		424.70  -  PLATE BONE NARROW 358X13.5X4.2MM 20 HOLE LC-DCP TITANIUM	BOTH IP/OP	"$1,123.20 "	$831.17	$0.00	$898.56	$505.44	$505.44	$0.00	$0.00	$0.00	$234.10	$833.64	$833.64	$0.00	$0.00	$234.07	$0.00	$664.37	$664.37	$0.00	$561.60	$889.57	$898.56	$0.00		$0.00	$170.66	$0.00	$0.00	$178.81	$0.00	$0.00	$0.00	$0.00	$0.00
424.701	SUP	HCPCS C1713		424.701  -  PLATE BONE NARROW 368MM 20 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$2,319.40 "	"$1,716.36"	$0.00	"$1,801.48"	"$1,013.33"	"$1,013.33"	$0.00	$0.00	$0.00	$483.42	"$1,721.46"	"$1,721.46"	$0.00	$0.00	$483.36	$0.00	"$1,371.93"	"$1,371.93"	$0.00	"$1,125.93"	"$1,783.47"	"$1,801.48"	$0.00		$0.00	$342.15	$0.00	$0.00	$358.49	$0.00	$0.00	$0.00	$0.00	$0.00
424.72	SUP	HCPCS C1713		424.72  -  PLATE BONE NARROW 394MM 22 HOLE LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,209.18 "	$894.79	$0.00	$967.34	$544.13	$544.13	$0.00	$0.00	$0.00	$252.02	$897.45	$897.45	$0.00	$0.00	$251.99	$0.00	$715.23	$715.23	$0.00	$604.59	$957.67	$967.34	$0.00		$0.00	$183.72	$0.00	$0.00	$192.50	$0.00	$0.00	$0.00	$0.00	$0.00
424.721	SUP	HCPCS C1713		424.721  -  PLATE BONE NARROW 404MM 22 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$2,533.05 "	"$1,874.46"	$0.00	"$1,967.42"	"$1,106.67"	"$1,106.67"	$0.00	$0.00	$0.00	$527.95	"$1,880.03"	"$1,880.03"	$0.00	$0.00	$527.89	$0.00	"$1,248.79"	"$1,248.79"	$0.00	"$1,229.64"	"$1,947.75"	"$1,967.42"	$0.00		$0.00	$373.67	$0.00	$0.00	$391.52	$0.00	$0.00	$0.00	$0.00	$0.00
424.753	SUP	HCPCS C1713		424.753  -  PLATE BONE 118MM 3/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$1,778.20 "	"$1,315.87"	$0.00	"$1,381.12"	$776.88	$776.88	$0.00	$0.00	$0.00	$370.62	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$370.58	$0.00	"$1,051.81"	"$1,051.81"	$0.00	$863.20	"$1,367.31"	"$1,381.12"	$0.00		$0.00	$262.31	$0.00	$0.00	$274.84	$0.00	$0.00	$0.00	$0.00	$0.00
424.754	SUP	HCPCS C1713		424.754  -  PLATE BONE 136MM 4/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$1,807.73 "	"$1,337.72"	$0.00	"$1,404.06"	$789.78	$789.78	$0.00	$0.00	$0.00	$376.78	"$1,341.69"	"$1,341.69"	$0.00	$0.00	$376.73	$0.00	"$1,069.27"	"$1,069.27"	$0.00	$877.54	"$1,390.02"	"$1,404.06"	$0.00		$0.00	$266.67	$0.00	$0.00	$279.41	$0.00	$0.00	$0.00	$0.00	$0.00
424.755	SUP	HCPCS C1713		424.755  -  PLATE BONE 154MM 5/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$1,837.25 "	"$1,359.57"	$0.00	"$1,426.98"	$802.68	$802.68	$0.00	$0.00	$0.00	$382.93	"$1,363.61"	"$1,363.61"	$0.00	$0.00	$382.88	$0.00	"$1,086.73"	"$1,086.73"	$0.00	$891.86	"$1,412.71"	"$1,426.98"	$0.00		$0.00	$271.02	$0.00	$0.00	$283.97	$0.00	$0.00	$0.00	$0.00	$0.00
424.756	SUP	HCPCS C1713		424.756  -  PLATE BONE 172MM 6/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$1,868.18 "	"$1,382.45"	$0.00	"$1,451.00"	$816.19	$816.19	$0.00	$0.00	$0.00	$389.37	"$1,386.56"	"$1,386.56"	$0.00	$0.00	$389.33	$0.00	"$1,105.03"	"$1,105.03"	$0.00	$906.88	"$1,436.49"	"$1,451.00"	$0.00		$0.00	$275.58	$0.00	$0.00	$288.75	$0.00	$0.00	$0.00	$0.00	$0.00
424.757	SUP	HCPCS C1713		424.757  -  PLATE BONE 190MM 7/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$2,410.78 "	"$1,783.98"	$0.00	"$1,872.44"	"$1,053.25"	"$1,053.25"	$0.00	$0.00	$0.00	$502.47	"$1,789.28"	"$1,789.28"	$0.00	$0.00	$502.41	$0.00	"$1,425.97"	"$1,425.97"	$0.00	"$1,170.28"	"$1,853.72"	"$1,872.44"	$0.00		$0.00	$355.63	$0.00	$0.00	$372.62	$0.00	$0.00	$0.00	$0.00	$0.00
424.758	SUP	HCPCS C1713		424.758  -  PLATE BONE 208MM 8/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$2,436.08 "	"$1,802.70"	$0.00	"$1,892.08"	"$1,064.30"	"$1,064.30"	$0.00	$0.00	$0.00	$507.74	"$1,808.05"	"$1,808.05"	$0.00	$0.00	$507.68	$0.00	"$1,440.94"	"$1,440.94"	$0.00	"$1,182.55"	"$1,873.16"	"$1,892.08"	$0.00		$0.00	$359.36	$0.00	$0.00	$376.52	$0.00	$0.00	$0.00	$0.00	$0.00
424.759	SUP	HCPCS C1713		424.759  -  PLATE BONE 226MM 9/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$2,489.48 "	"$1,842.22"	$0.00	"$1,933.58"	"$1,087.64"	"$1,087.64"	$0.00	$0.00	$0.00	$518.87	"$1,847.69"	"$1,847.69"	$0.00	$0.00	$518.81	$0.00	"$1,472.52"	"$1,472.52"	$0.00	"$1,208.49"	"$1,914.25"	"$1,933.58"	$0.00		$0.00	$367.24	$0.00	$0.00	$384.78	$0.00	$0.00	$0.00	$0.00	$0.00
424.761	SUP	HCPCS C1713		424.761  -  PLATE BONE 262MM 11/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$2,542.90 "	"$1,881.75"	$0.00	"$1,975.06"	"$1,110.97"	"$1,110.97"	$0.00	$0.00	$0.00	$530.00	"$1,887.34"	"$1,887.34"	$0.00	$0.00	$529.94	$0.00	"$1,253.65"	"$1,253.65"	$0.00	"$1,234.41"	"$1,955.31"	"$1,975.06"	$0.00		$0.00	$375.12	$0.00	$0.00	$393.04	$0.00	$0.00	$0.00	$0.00	$0.00
424.763	SUP	HCPCS C1713		424.763  -  PLATE BONE 298MM 13/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$2,590.70 "	"$1,917.12"	$0.00	"$2,012.18"	"$1,131.85"	"$1,131.85"	$0.00	$0.00	$0.00	$539.97	"$1,922.82"	"$1,922.82"	$0.00	$0.00	$539.90	$0.00	"$1,277.22"	"$1,277.22"	$0.00	"$1,257.61"	"$1,992.06"	"$2,012.18"	$0.00		$0.00	$382.17	$0.00	$0.00	$400.42	$0.00	$0.00	$0.00	$0.00	$0.00
424.765	SUP	HCPCS C1713		424.765  -  PLATE BONE 334MM 15/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL	BOTH IP/OP	"$2,708.78 "	"$2,004.50"	$0.00	"$2,103.90"	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$0.00	$564.58	"$2,010.45"	"$2,010.45"	$0.00	$0.00	$564.51	$0.00	"$1,335.43"	"$1,335.43"	$0.00	"$1,314.94"	"$2,082.86"	"$2,103.90"	$0.00		$0.00	$399.59	$0.00	$0.00	$418.68	$0.00	$0.00	$0.00	$0.00	$0.00
426.56	SUP	HCPCS C1713		426.56  -  PLATE BONE BROAD 106X17.5X5.2MM 6 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$488.58 	$361.55	$0.00	$390.86	$219.86	$219.86	$0.00	$0.00	$0.00	$101.83	$362.62	$362.62	$0.00	$0.00	$101.82	$0.00	$288.99	$288.99	$0.00	$244.29	$386.96	$390.86	$0.00		$0.00	$74.24	$0.00	$0.00	$77.78	$0.00	$0.00	$0.00	$0.00	$0.00
426.561	SUP	HCPCS C1713		426.561  -  PLATE BONE BROAD 116MM 6 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$784.38 	$580.44	$0.00	$609.22	$342.69	$342.69	$0.00	$0.00	$0.00	$163.48	$582.16	$582.16	$0.00	$0.00	$163.46	$0.00	$463.96	$463.96	$0.00	$380.76	$603.13	$609.22	$0.00		$0.00	$115.71	$0.00	$0.00	$121.23	$0.00	$0.00	$0.00	$0.00	$0.00
426.57	SUP	HCPCS C1713		426.57  -  PLATE BONE BROAD 124X17.5X5.2MM 7 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$529.53 	$391.85	$0.00	$423.62	$238.29	$238.29	$0.00	$0.00	$0.00	$110.37	$393.01	$393.01	$0.00	$0.00	$110.35	$0.00	$313.21	$313.21	$0.00	$264.76	$419.39	$423.62	$0.00		$0.00	$80.46	$0.00	$0.00	$84.30	$0.00	$0.00	$0.00	$0.00	$0.00
426.571	SUP	HCPCS C1713		426.571  -  PLATE BONE BROAD 134MM 7 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$833.58 	$616.85	$0.00	$647.44	$364.19	$364.19	$0.00	$0.00	$0.00	$173.74	$618.68	$618.68	$0.00	$0.00	$173.72	$0.00	$493.06	$493.06	$0.00	$404.65	$640.97	$647.44	$0.00		$0.00	$122.97	$0.00	$0.00	$128.84	$0.00	$0.00	$0.00	$0.00	$0.00
426.58	SUP	HCPCS C1713		426.58  -  PLATE BONE BROAD 3.5MM 142X17.5X5.2MM 8 HOLE LC-DCP TITANIUM	BOTH IP/OP	$588.20 	$435.27	$0.00	$470.56	$264.69	$264.69	$0.00	$0.00	$0.00	$122.60	$436.56	$436.56	$0.00	$0.00	$122.58	$0.00	$347.92	$347.92	$0.00	$294.10	$465.85	$470.56	$0.00		$0.00	$89.37	$0.00	$0.00	$93.64	$0.00	$0.00	$0.00	$0.00	$0.00
426.581	SUP	HCPCS C1713		426.581  -  PLATE BONE BROAD 152MM 8 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,019.13 "	$754.16	$0.00	$791.56	$445.25	$445.25	$0.00	$0.00	$0.00	$212.41	$756.39	$756.39	$0.00	$0.00	$212.39	$0.00	$602.81	$602.81	$0.00	$494.73	$783.64	$791.56	$0.00		$0.00	$150.34	$0.00	$0.00	$157.52	$0.00	$0.00	$0.00	$0.00	$0.00
426.59	SUP	HCPCS C1713		426.59  -  PLATE BONE BROAD 160X17.5X5.2MM 9 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$605.85 	$448.33	$0.00	$470.56	$264.69	$264.69	$0.00	$0.00	$0.00	$126.27	$449.66	$449.66	$0.00	$0.00	$126.26	$0.00	$358.36	$358.36	$0.00	$294.10	$465.85	$470.56	$0.00		$0.00	$89.37	$0.00	$0.00	$93.64	$0.00	$0.00	$0.00	$0.00	$0.00
426.591	SUP	HCPCS C1713		426.591  -  PLATE BONE BROAD 170MM 9 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,102.08 "	$815.54	$0.00	$855.98	$481.49	$481.49	$0.00	$0.00	$0.00	$229.70	$817.96	$817.96	$0.00	$0.00	$229.67	$0.00	$651.88	$651.88	$0.00	$534.99	$847.42	$855.98	$0.00		$0.00	$162.57	$0.00	$0.00	$170.34	$0.00	$0.00	$0.00	$0.00	$0.00
426.6	SUP	HCPCS C1713		426.60  -  PLATE BONE BROAD 178X17.5X5.2MM 10 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$588.20 	$435.27	$0.00	$470.56	$264.69	$264.69	$0.00	$0.00	$0.00	$122.60	$436.56	$436.56	$0.00	$0.00	$122.58	$0.00	$347.92	$347.92	$0.00	$294.10	$465.85	$470.56	$0.00		$0.00	$89.37	$0.00	$0.00	$93.64	$0.00	$0.00	$0.00	$0.00	$0.00
426.601	SUP	HCPCS C1713		426.601  -  PLATE BONE BROAD 188MM 10 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$920.38	$517.71	$517.71	$0.00	$0.00	$0.00	$246.98	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$700.93	$700.93	$0.00	$575.24	$911.18	$920.38	$0.00		$0.00	$174.81	$0.00	$0.00	$183.16	$0.00	$0.00	$0.00	$0.00	$0.00
426.61	SUP	HCPCS C1713		426.61  -  PLATE BONE BROAD 196X17.5X5.2MM 11 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$615.50 	$455.47	$0.00	$492.40	$276.98	$276.98	$0.00	$0.00	$0.00	$128.29	$456.82	$456.82	$0.00	$0.00	$128.27	$0.00	$364.07	$364.07	$0.00	$307.75	$487.48	$492.40	$0.00		$0.00	$93.52	$0.00	$0.00	$97.99	$0.00	$0.00	$0.00	$0.00	$0.00
426.611	SUP	HCPCS C1713		426.611  -  PLATE BONE BROAD 206MM 11 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,262.30 "	$934.10	$0.00	$980.44	$551.50	$551.50	$0.00	$0.00	$0.00	$263.09	$936.88	$936.88	$0.00	$0.00	$263.06	$0.00	$746.65	$746.65	$0.00	$612.78	$970.64	$980.44	$0.00		$0.00	$186.21	$0.00	$0.00	$195.11	$0.00	$0.00	$0.00	$0.00	$0.00
426.62	SUP	HCPCS C1713		426.62  -  PLATE BONE BROAD 214X17.5X5.2MM 12 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$633.98 	$469.15	$0.00	$492.40	$276.98	$276.98	$0.00	$0.00	$0.00	$132.14	$470.54	$470.54	$0.00	$0.00	$132.12	$0.00	$375.00	$375.00	$0.00	$307.75	$487.48	$492.40	$0.00		$0.00	$93.52	$0.00	$0.00	$97.99	$0.00	$0.00	$0.00	$0.00	$0.00
426.621	SUP	HCPCS C1713		426.621  -  PLATE BONE BROAD 224MM 12 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,339.63 "	$991.33	$0.00	"$1,040.48"	$585.27	$585.27	$0.00	$0.00	$0.00	$279.21	$994.27	$994.27	$0.00	$0.00	$279.18	$0.00	$792.39	$792.39	$0.00	$650.30	"$1,030.08"	"$1,040.48"	$0.00		$0.00	$197.62	$0.00	$0.00	$207.06	$0.00	$0.00	$0.00	$0.00	$0.00
426.622	SUP	HCPCS C1713		426.622  -  PLATE BONE BROAD 229MM 12 HOLE CVD LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,339.63 "	$991.33	$0.00	"$1,040.48"	$585.27	$585.27	$0.00	$0.00	$0.00	$279.21	$994.27	$994.27	$0.00	$0.00	$279.18	$0.00	$792.39	$792.39	$0.00	$650.30	"$1,030.08"	"$1,040.48"	$0.00		$0.00	$197.62	$0.00	$0.00	$207.06	$0.00	$0.00	$0.00	$0.00	$0.00
426.632	SUP	HCPCS C1713		426.632  -  PLATE BONE BROAD 247MM 13 HOLE CVD LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,419.75 "	"$1,050.62"	$0.00	"$1,102.72"	$620.28	$620.28	$0.00	$0.00	$0.00	$295.91	"$1,053.74"	"$1,053.74"	$0.00	$0.00	$295.88	$0.00	$839.78	$839.78	$0.00	$689.20	"$1,091.69"	"$1,102.72"	$0.00		$0.00	$209.44	$0.00	$0.00	$219.44	$0.00	$0.00	$0.00	$0.00	$0.00
426.64	SUP	HCPCS C1713		426.64  -  PLATE BONE BROAD 4.5MM 250X17.5X5.2MM 14 HOLE LC-DCP	BOTH IP/OP	$614.80 	$454.95	$0.00	$491.84	$276.66	$276.66	$0.00	$0.00	$0.00	$128.14	$456.30	$456.30	$0.00	$0.00	$128.12	$0.00	$363.65	$363.65	$0.00	$307.40	$486.92	$491.84	$0.00		$0.00	$96.22	$0.00	$0.00	$97.88	$0.00	$0.00	$0.00	$0.00	$0.00
426.641	SUP	HCPCS C1713		426.641  -  PLATE BONE BROAD 260MM 14 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,491.45 "	"$1,103.67"	$0.00	"$1,158.40"	$651.60	$651.60	$0.00	$0.00	$0.00	$310.86	"$1,106.95"	"$1,106.95"	$0.00	$0.00	$310.82	$0.00	$882.19	$882.19	$0.00	$724.00	"$1,146.82"	"$1,158.40"	$0.00		$0.00	$220.01	$0.00	$0.00	$230.52	$0.00	$0.00	$0.00	$0.00	$0.00
426.642	SUP	HCPCS C1713		426.642  -  PLATE BONE BROAD CVD 265MM 14 HOLE LCP TITANIUM ANKLE	BOTH IP/OP	"$1,491.45 "	"$1,103.67"	$0.00	"$1,158.40"	$651.60	$651.60	$0.00	$0.00	$0.00	$310.86	"$1,106.95"	"$1,106.95"	$0.00	$0.00	$310.82	$0.00	$882.19	$882.19	$0.00	$724.00	"$1,146.82"	"$1,158.40"	$0.00		$0.00	$220.01	$0.00	$0.00	$230.52	$0.00	$0.00	$0.00	$0.00	$0.00
426.652	SUP	HCPCS C1713		426.652  -  PLATE BONE BROAD 282MM 15 HOLE CVD LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,655.90 "	"$1,225.37"	$0.00	"$1,286.14"	$723.45	$723.45	$0.00	$0.00	$0.00	$345.13	"$1,229.01"	"$1,229.01"	$0.00	$0.00	$345.09	$0.00	$979.46	$979.46	$0.00	$803.84	"$1,273.28"	"$1,286.14"	$0.00		$0.00	$244.27	$0.00	$0.00	$255.94	$0.00	$0.00	$0.00	$0.00	$0.00
426.66	SUP	HCPCS C1713		426.66  -  PLATE BONE BROAD 286X17.5X5.2MM 16 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	$696.03 	$515.06	$0.00	$556.82	$313.21	$313.21	$0.00	$0.00	$0.00	$145.07	$516.59	$516.59	$0.00	$0.00	$145.05	$0.00	$411.70	$411.70	$0.00	$348.01	$551.26	$556.82	$0.00		$0.00	$105.75	$0.00	$0.00	$110.81	$0.00	$0.00	$0.00	$0.00	$0.00
426.661	SUP	HCPCS C1713		426.661  -  PLATE BONE BROAD 296MM 16 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,811.95 "	"$1,340.84"	$0.00	"$1,407.34"	$791.63	$791.63	$0.00	$0.00	$0.00	$377.66	"$1,344.83"	"$1,344.83"	$0.00	$0.00	$377.61	$0.00	"$1,071.77"	"$1,071.77"	$0.00	$879.59	"$1,393.27"	"$1,407.34"	$0.00		$0.00	$267.29	$0.00	$0.00	$280.06	$0.00	$0.00	$0.00	$0.00	$0.00
426.662	SUP	HCPCS C1713		426.662  -  PLATE BONE BROAD 300MM 16 HOLE CVD LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,811.95 "	"$1,340.84"	$0.00	"$1,407.34"	$791.63	$791.63	$0.00	$0.00	$0.00	$377.66	"$1,344.83"	"$1,344.83"	$0.00	$0.00	$377.61	$0.00	"$1,071.77"	"$1,071.77"	$0.00	$879.59	"$1,393.27"	"$1,407.34"	$0.00		$0.00	$267.29	$0.00	$0.00	$280.06	$0.00	$0.00	$0.00	$0.00	$0.00
426.672	SUP	HCPCS C1713		426.672  -  PLATE BONE BROAD 318MM 17 HOLE CVD LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,897.68 "	"$1,404.28"	$0.00	"$1,473.94"	$829.09	$829.09	$0.00	$0.00	$0.00	$395.52	"$1,408.45"	"$1,408.45"	$0.00	$0.00	$395.48	$0.00	"$1,122.47"	"$1,122.47"	$0.00	$921.21	"$1,459.20"	"$1,473.94"	$0.00		$0.00	$279.94	$0.00	$0.00	$293.31	$0.00	$0.00	$0.00	$0.00	$0.00
426.68	SUP	HCPCS C1713		426.68  -  PLATE BONE BROAD 4.5MM 322X17.5X5.2MM 18 HOLE LC-DCP	BOTH IP/OP	$788.60 	$583.56	$0.00	$612.50	$344.53	$344.53	$0.00	$0.00	$0.00	$164.36	$585.30	$585.30	$0.00	$0.00	$164.34	$0.00	$466.46	$466.46	$0.00	$382.81	$606.38	$612.50	$0.00		$0.00	$116.33	$0.00	$0.00	$121.89	$0.00	$0.00	$0.00	$0.00	$0.00
426.681	SUP	HCPCS C1713		426.681  -  PLATE BONE BROAD 332MM 18 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$2,132.43 "	"$1,578.00"	$0.00	"$1,656.26"	$931.65	$931.65	$0.00	$0.00	$0.00	$444.45	"$1,582.69"	"$1,582.69"	$0.00	$0.00	$444.40	$0.00	"$1,261.33"	"$1,261.33"	$0.00	"$1,035.16"	"$1,639.70"	"$1,656.26"	$0.00		$0.00	$314.57	$0.00	$0.00	$329.60	$0.00	$0.00	$0.00	$0.00	$0.00
426.682	SUP	HCPCS C1713		426.682  -  PLATE BONE BROAD 336MM 18 HOLE CVD LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$2,067.78 "	"$1,530.16"	$0.00	"$1,606.04"	$903.40	$903.40	$0.00	$0.00	$0.00	$430.98	"$1,534.70"	"$1,534.70"	$0.00	$0.00	$430.92	$0.00	"$1,223.09"	"$1,223.09"	$0.00	"$1,003.78"	"$1,589.98"	"$1,606.04"	$0.00		$0.00	$305.03	$0.00	$0.00	$319.60	$0.00	$0.00	$0.00	$0.00	$0.00
426.7	SUP	HCPCS C1713		426.70  -  PLATE BONE BROAD 358X17.5X5.2MM 20 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	"$1,123.20 "	$831.17	$0.00	$898.56	$505.44	$505.44	$0.00	$0.00	$0.00	$234.10	$833.64	$833.64	$0.00	$0.00	$234.07	$0.00	$664.37	$664.37	$0.00	$561.60	$889.57	$898.56	$0.00		$0.00	$170.66	$0.00	$0.00	$178.81	$0.00	$0.00	$0.00	$0.00	$0.00
426.701	SUP	HCPCS C1713		426.701  -  PLATE BONE BROAD 368MM 20 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$2,355.95 "	"$1,743.40"	$0.00	"$1,829.86"	"$1,029.30"	"$1,029.30"	$0.00	$0.00	$0.00	$491.04	"$1,748.59"	"$1,748.59"	$0.00	$0.00	$490.98	$0.00	"$1,393.54"	"$1,393.54"	$0.00	"$1,143.66"	"$1,811.57"	"$1,829.86"	$0.00		$0.00	$347.54	$0.00	$0.00	$364.14	$0.00	$0.00	$0.00	$0.00	$0.00
426.72	SUP	HCPCS C1713		426.72  -  PLATE BONE BROAD 394X17.5X5.2MM 22 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	"$1,209.18 "	$894.79	$0.00	$967.34	$544.13	$544.13	$0.00	$0.00	$0.00	$252.02	$897.45	$897.45	$0.00	$0.00	$251.99	$0.00	$715.23	$715.23	$0.00	$604.59	$957.67	$967.34	$0.00		$0.00	$183.72	$0.00	$0.00	$192.50	$0.00	$0.00	$0.00	$0.00	$0.00
426.721	SUP	HCPCS C1713		426.721  -  PLATE BONE BROAD 404MM 22 HOLE LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$2,582.25 "	"$1,910.87"	$0.00	"$2,005.64"	"$1,128.17"	"$1,128.17"	$0.00	$0.00	$0.00	$538.21	"$1,916.55"	"$1,916.55"	$0.00	$0.00	$538.14	$0.00	"$1,273.05"	"$1,273.05"	$0.00	"$1,253.53"	"$1,985.58"	"$2,005.64"	$0.00		$0.00	$380.92	$0.00	$0.00	$399.12	$0.00	$0.00	$0.00	$0.00	$0.00
426.74	SUP	HCPCS C1713		426.74  -  PLATE BONE BROAD 430X17.5X5.2MM 24 HOLE LC-DCP TITANIUM LONG	BOTH IP/OP	"$1,295.15 "	$958.41	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$269.94	$961.26	$961.26	$0.00	$0.00	$269.91	$0.00	$766.08	$766.08	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
429.331	SUP	HCPCS C1713		429.331  -  PLATE BONE 56MM 3 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	$775.95 	$574.20	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$161.73	$575.91	$575.91	$0.00	$0.00	$161.71	$0.00	$458.97	$458.97	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
429.341	SUP	HCPCS C1713		429.341  -  PLATE BONE 75MM 4 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	$812.50 	$601.25	$0.00	$631.06	$354.97	$354.97	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$394.41	$624.75	$631.06	$0.00		$0.00	$119.86	$0.00	$0.00	$125.58	$0.00	$0.00	$0.00	$0.00	$0.00
429.351	SUP	HCPCS C1713		429.351  -  PLATE BONE 94MM 5 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	$878.55 	$650.13	$0.00	$682.38	$383.84	$383.84	$0.00	$0.00	$0.00	$183.11	$652.06	$652.06	$0.00	$0.00	$183.09	$0.00	$519.66	$519.66	$0.00	$426.49	$675.56	$682.38	$0.00		$0.00	$129.60	$0.00	$0.00	$135.79	$0.00	$0.00	$0.00	$0.00	$0.00
429.361	SUP	HCPCS C1713		429.361  -  PLATE BONE 113MM 6 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	$937.60 	$693.82	$0.00	$728.24	$409.64	$409.64	$0.00	$0.00	$0.00	$195.42	$695.89	$695.89	$0.00	$0.00	$195.40	$0.00	$554.59	$554.59	$0.00	$455.15	$720.96	$728.24	$0.00		$0.00	$138.31	$0.00	$0.00	$144.92	$0.00	$0.00	$0.00	$0.00	$0.00
429.371	SUP	HCPCS C1713		429.371  -  PLATE BONE 132MM 7 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	$981.18 	$726.07	$0.00	$762.08	$428.67	$428.67	$0.00	$0.00	$0.00	$204.50	$728.23	$728.23	$0.00	$0.00	$204.48	$0.00	$580.37	$580.37	$0.00	$476.30	$754.46	$762.08	$0.00		$0.00	$144.74	$0.00	$0.00	$151.65	$0.00	$0.00	$0.00	$0.00	$0.00
429.381	SUP	HCPCS C1713		429.381  -  PLATE BONE 151MM 8 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,031.78 "	$763.52	$0.00	$801.38	$450.78	$450.78	$0.00	$0.00	$0.00	$215.05	$765.78	$765.78	$0.00	$0.00	$215.02	$0.00	$610.29	$610.29	$0.00	$500.86	$793.37	$801.38	$0.00		$0.00	$152.20	$0.00	$0.00	$159.47	$0.00	$0.00	$0.00	$0.00	$0.00
429.391	SUP	HCPCS C1713		429.391  -  PLATE BONE 170MM 9 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,104.88 "	$817.61	$0.00	$858.16	$482.72	$482.72	$0.00	$0.00	$0.00	$230.28	$820.04	$820.04	$0.00	$0.00	$230.26	$0.00	$653.53	$653.53	$0.00	$536.35	$849.58	$858.16	$0.00		$0.00	$162.99	$0.00	$0.00	$170.77	$0.00	$0.00	$0.00	$0.00	$0.00
429.401	SUP	HCPCS C1713		429.401  -  PLATE BONE 189MM 10 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,158.30 "	$857.14	$0.00	$899.64	$506.05	$506.05	$0.00	$0.00	$0.00	$241.42	$859.69	$859.69	$0.00	$0.00	$241.39	$0.00	$685.13	$685.13	$0.00	$562.28	$890.64	$899.64	$0.00		$0.00	$170.87	$0.00	$0.00	$179.03	$0.00	$0.00	$0.00	$0.00	$0.00
429.411	SUP	HCPCS C1713		429.411  -  PLATE BONE 208MM 11 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,196.25 "	$885.23	$0.00	$929.12	$522.63	$522.63	$0.00	$0.00	$0.00	$249.33	$887.86	$887.86	$0.00	$0.00	$249.30	$0.00	$707.58	$707.58	$0.00	$580.70	$919.83	$929.12	$0.00		$0.00	$176.47	$0.00	$0.00	$184.89	$0.00	$0.00	$0.00	$0.00	$0.00
429.421	SUP	HCPCS C1713		429.421  -  PLATE BONE 227MM 12 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,253.88 "	$927.87	$0.00	$973.88	$547.81	$547.81	$0.00	$0.00	$0.00	$261.34	$930.63	$930.63	$0.00	$0.00	$261.31	$0.00	$741.67	$741.67	$0.00	$608.68	$964.14	$973.88	$0.00		$0.00	$184.97	$0.00	$0.00	$193.80	$0.00	$0.00	$0.00	$0.00	$0.00
429.431	SUP	HCPCS C1713		429.431  -  PLATE BONE 246MM 13 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,334.00 "	$987.16	$0.00	"$1,036.12"	$582.82	$582.82	$0.00	$0.00	$0.00	$278.04	$990.09	$990.09	$0.00	$0.00	$278.01	$0.00	$789.06	$789.06	$0.00	$647.58	"$1,025.76"	"$1,036.12"	$0.00		$0.00	$196.79	$0.00	$0.00	$206.19	$0.00	$0.00	$0.00	$0.00	$0.00
429.441	SUP	HCPCS C1713		429.441  -  PLATE BONE 265MM 14 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,370.55 "	"$1,014.21"	$0.00	"$1,064.50"	$598.78	$598.78	$0.00	$0.00	$0.00	$285.66	"$1,017.22"	"$1,017.22"	$0.00	$0.00	$285.62	$0.00	$810.68	$810.68	$0.00	$665.31	"$1,053.86"	"$1,064.50"	$0.00		$0.00	$202.18	$0.00	$0.00	$211.84	$0.00	$0.00	$0.00	$0.00	$0.00
429.451	SUP	HCPCS C1713		429.451  -  PLATE BONE 284MM 15 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,428.18 "	"$1,056.85"	$0.00	"$1,109.26"	$623.96	$623.96	$0.00	$0.00	$0.00	$297.67	"$1,059.99"	"$1,059.99"	$0.00	$0.00	$297.63	$0.00	$844.77	$844.77	$0.00	$693.29	"$1,098.17"	"$1,109.26"	$0.00		$0.00	$210.68	$0.00	$0.00	$220.74	$0.00	$0.00	$0.00	$0.00	$0.00
429.461	SUP	HCPCS C1713		429.461  -  PLATE BONE 303MM 16 HOLE STR RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,466.13 "	"$1,084.94"	$0.00	"$1,138.74"	$640.54	$640.54	$0.00	$0.00	$0.00	$305.58	"$1,088.16"	"$1,088.16"	$0.00	$0.00	$305.54	$0.00	$867.21	$867.21	$0.00	$711.71	"$1,127.36"	"$1,138.74"	$0.00		$0.00	$216.28	$0.00	$0.00	$226.61	$0.00	$0.00	$0.00	$0.00	$0.00
432.006	SUP	HCPCS C1713		432.006  -  PLATE BONE 90D 30MM 10 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,929.20 "	"$1,427.61"	$0.00	"$1,543.36"	$868.14	$868.14	$0.00	$0.00	$0.00	$402.09	"$1,431.85"	"$1,431.85"	$0.00	$0.00	$402.05	$0.00	"$1,141.12"	"$1,141.12"	$0.00	$964.60	"$1,527.93"	"$1,543.36"	$0.00		$0.00	$301.92	$0.00	$0.00	$307.13	$0.00	$0.00	$0.00	$0.00	$0.00
432.007	SUP	HCPCS C1713		432.007  -  PLATE BONE 90D 35MM 10 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,929.20 "	"$1,427.61"	$0.00	"$1,543.36"	$868.14	$868.14	$0.00	$0.00	$0.00	$402.09	"$1,431.85"	"$1,431.85"	$0.00	$0.00	$402.05	$0.00	"$1,141.12"	"$1,141.12"	$0.00	$964.60	"$1,527.93"	"$1,543.36"	$0.00		$0.00	$301.92	$0.00	$0.00	$307.13	$0.00	$0.00	$0.00	$0.00	$0.00
432.008	SUP	HCPCS C1713		432.008  -  PLATE BONE 90D 40MM 10 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,929.20 "	"$1,427.61"	$0.00	"$1,543.36"	$868.14	$868.14	$0.00	$0.00	$0.00	$402.09	"$1,431.85"	"$1,431.85"	$0.00	$0.00	$402.05	$0.00	"$1,141.12"	"$1,141.12"	$0.00	$964.60	"$1,527.93"	"$1,543.36"	$0.00		$0.00	$301.92	$0.00	$0.00	$307.13	$0.00	$0.00	$0.00	$0.00	$0.00
432.009	SUP	HCPCS C1713		432.009  -  PLATE BONE 90D 45MM 10 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,929.20 "	"$1,427.61"	$0.00	"$1,543.36"	$868.14	$868.14	$0.00	$0.00	$0.00	$402.09	"$1,431.85"	"$1,431.85"	$0.00	$0.00	$402.05	$0.00	"$1,141.12"	"$1,141.12"	$0.00	$964.60	"$1,527.93"	"$1,543.36"	$0.00		$0.00	$301.92	$0.00	$0.00	$307.13	$0.00	$0.00	$0.00	$0.00	$0.00
432.046	SUP	HCPCS C1713		432.046  -  PLATE BONE 90D 30MM 4 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,538.33 "	"$1,138.36"	$0.00	"$1,230.66"	$692.25	$692.25	$0.00	$0.00	$0.00	$320.63	"$1,141.74"	"$1,141.74"	$0.00	$0.00	$320.59	$0.00	$909.92	$909.92	$0.00	$769.16	"$1,218.36"	"$1,230.66"	$0.00		$0.00	$240.75	$0.00	$0.00	$244.90	$0.00	$0.00	$0.00	$0.00	$0.00
432.047	SUP	HCPCS C1713		432.047  -  PLATE BONE 90D 35MM 4 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,538.33 "	"$1,138.36"	$0.00	"$1,230.66"	$692.25	$692.25	$0.00	$0.00	$0.00	$320.63	"$1,141.74"	"$1,141.74"	$0.00	$0.00	$320.59	$0.00	$909.92	$909.92	$0.00	$769.16	"$1,218.36"	"$1,230.66"	$0.00		$0.00	$240.75	$0.00	$0.00	$244.90	$0.00	$0.00	$0.00	$0.00	$0.00
432.048	SUP	HCPCS C1713		432.048  -  PLATE BONE 90D 40MM 4 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,538.33 "	"$1,138.36"	$0.00	"$1,230.66"	$692.25	$692.25	$0.00	$0.00	$0.00	$320.63	"$1,141.74"	"$1,141.74"	$0.00	$0.00	$320.59	$0.00	$909.92	$909.92	$0.00	$769.16	"$1,218.36"	"$1,230.66"	$0.00		$0.00	$240.75	$0.00	$0.00	$244.90	$0.00	$0.00	$0.00	$0.00	$0.00
432.049	SUP	HCPCS C1713		432.049  -  PLATE BONE 90D 45MM 4 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,538.33 "	"$1,138.36"	$0.00	"$1,230.66"	$692.25	$692.25	$0.00	$0.00	$0.00	$320.63	"$1,141.74"	"$1,141.74"	$0.00	$0.00	$320.59	$0.00	$909.92	$909.92	$0.00	$769.16	"$1,218.36"	"$1,230.66"	$0.00		$0.00	$240.75	$0.00	$0.00	$244.90	$0.00	$0.00	$0.00	$0.00	$0.00
432.056	SUP	HCPCS C1713		432.056  -  PLATE BONE 90D 30MM 5 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,625.78 "	"$1,203.08"	$0.00	"$1,300.62"	$731.60	$731.60	$0.00	$0.00	$0.00	$338.85	"$1,206.65"	"$1,206.65"	$0.00	$0.00	$338.81	$0.00	$961.65	$961.65	$0.00	$812.89	"$1,287.62"	"$1,300.62"	$0.00		$0.00	$254.43	$0.00	$0.00	$258.82	$0.00	$0.00	$0.00	$0.00	$0.00
432.057	SUP	HCPCS C1713		432.057  -  PLATE BONE 90D 35MM 5 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,625.78 "	"$1,203.08"	$0.00	"$1,300.62"	$731.60	$731.60	$0.00	$0.00	$0.00	$338.85	"$1,206.65"	"$1,206.65"	$0.00	$0.00	$338.81	$0.00	$961.65	$961.65	$0.00	$812.89	"$1,287.62"	"$1,300.62"	$0.00		$0.00	$254.43	$0.00	$0.00	$258.82	$0.00	$0.00	$0.00	$0.00	$0.00
432.058	SUP	HCPCS C1713		432.058  -  PLATE BONE 90D 40MM 5 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,625.78 "	"$1,203.08"	$0.00	"$1,300.62"	$731.60	$731.60	$0.00	$0.00	$0.00	$338.85	"$1,206.65"	"$1,206.65"	$0.00	$0.00	$338.81	$0.00	$961.65	$961.65	$0.00	$812.89	"$1,287.62"	"$1,300.62"	$0.00		$0.00	$254.43	$0.00	$0.00	$258.82	$0.00	$0.00	$0.00	$0.00	$0.00
432.059	SUP	HCPCS C1713		432.059  -  PLATE BONE 90D 45MM 5 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,625.78 "	"$1,203.08"	$0.00	"$1,300.62"	$731.60	$731.60	$0.00	$0.00	$0.00	$338.85	"$1,206.65"	"$1,206.65"	$0.00	$0.00	$338.81	$0.00	$961.65	$961.65	$0.00	$812.89	"$1,287.62"	"$1,300.62"	$0.00		$0.00	$254.43	$0.00	$0.00	$258.82	$0.00	$0.00	$0.00	$0.00	$0.00
432.066	SUP	HCPCS C1713		432.066  -  PLATE BONE 90D 30MM 6 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,696.00 "	"$1,255.04"	$0.00	"$1,356.80"	$763.20	$763.20	$0.00	$0.00	$0.00	$353.49	"$1,258.77"	"$1,258.77"	$0.00	$0.00	$353.45	$0.00	"$1,003.18"	"$1,003.18"	$0.00	$848.00	"$1,343.23"	"$1,356.80"	$0.00		$0.00	$265.42	$0.00	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00
432.067	SUP	HCPCS C1713		432.067  -  PLATE BONE 90D 35MM 6 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,696.00 "	"$1,255.04"	$0.00	"$1,356.80"	$763.20	$763.20	$0.00	$0.00	$0.00	$353.49	"$1,258.77"	"$1,258.77"	$0.00	$0.00	$353.45	$0.00	"$1,003.18"	"$1,003.18"	$0.00	$848.00	"$1,343.23"	"$1,356.80"	$0.00		$0.00	$265.42	$0.00	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00
432.068	SUP	HCPCS C1713		432.068  -  PLATE BONE 90D 40MM 6 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,696.00 "	"$1,255.04"	$0.00	"$1,356.80"	$763.20	$763.20	$0.00	$0.00	$0.00	$353.49	"$1,258.77"	"$1,258.77"	$0.00	$0.00	$353.45	$0.00	"$1,003.18"	"$1,003.18"	$0.00	$848.00	"$1,343.23"	"$1,356.80"	$0.00		$0.00	$265.42	$0.00	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00
432.069	SUP	HCPCS C1713		432.069  -  PLATE BONE 90D 45MM 6 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,696.00 "	"$1,255.04"	$0.00	"$1,356.80"	$763.20	$763.20	$0.00	$0.00	$0.00	$353.49	"$1,258.77"	"$1,258.77"	$0.00	$0.00	$353.45	$0.00	"$1,003.18"	"$1,003.18"	$0.00	$848.00	"$1,343.23"	"$1,356.80"	$0.00		$0.00	$265.42	$0.00	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00
432.086	SUP	HCPCS C1713		432.086  -  PLATE BONE 90D 30MM 8 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,819.23 "	"$1,346.23"	$0.00	"$1,455.38"	$818.65	$818.65	$0.00	$0.00	$0.00	$379.17	"$1,350.23"	"$1,350.23"	$0.00	$0.00	$379.13	$0.00	"$1,076.07"	"$1,076.07"	$0.00	$909.61	"$1,440.83"	"$1,455.38"	$0.00		$0.00	$284.71	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
432.087	SUP	HCPCS C1713		432.087  -  PLATE BONE 90D 106MM 35MM 8 HOLE CANN ANGLED TITANIUM	BOTH IP/OP	"$1,819.23 "	"$1,346.23"	$0.00	"$1,455.38"	$818.65	$818.65	$0.00	$0.00	$0.00	$379.17	"$1,350.23"	"$1,350.23"	$0.00	$0.00	$379.13	$0.00	"$1,076.07"	"$1,076.07"	$0.00	$909.61	"$1,440.83"	"$1,455.38"	$0.00		$0.00	$284.71	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
432.088	SUP	HCPCS C1713		432.088  -  PLATE BONE 90D 40MM 8 HOLE CANN LC ANGLE BLADE TITANIUM	BOTH IP/OP	"$1,819.23 "	"$1,346.23"	$0.00	"$1,455.38"	$818.65	$818.65	$0.00	$0.00	$0.00	$379.17	"$1,350.23"	"$1,350.23"	$0.00	$0.00	$379.13	$0.00	"$1,076.07"	"$1,076.07"	$0.00	$909.61	"$1,440.83"	"$1,455.38"	$0.00		$0.00	$284.71	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
432.089	SUP	HCPCS C1713		432.089  -  PLATE BONE 90D 45MM 8 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,819.23 "	"$1,346.23"	$0.00	"$1,455.38"	$818.65	$818.65	$0.00	$0.00	$0.00	$379.17	"$1,350.23"	"$1,350.23"	$0.00	$0.00	$379.13	$0.00	"$1,076.07"	"$1,076.07"	$0.00	$909.61	"$1,440.83"	"$1,455.38"	$0.00		$0.00	$284.71	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
433	SUP	Custom 27203010		433  -  CUTTER 433 WIRE MODIFIED W/CARBIDE	BOTH IP/OP	"$1,126.25 "	$833.43	$0.00	$901.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$835.90	$835.90	$0.00	$0.00	$234.71	$0.00	$0.00	$0.00	$0.00	$563.13	$891.99	$901.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
436.502	SUP	HCPCS C1713		436.502  -  PLATE BONE 86MM 2 HOLE LCP TITANIUM RIGHT OLECRANON NONSTRL	BOTH IP/OP	"$1,700.90 "	"$1,258.67"	$0.00	"$1,321.08"	$743.11	$743.11	$0.00	$0.00	$0.00	$354.51	"$1,262.41"	"$1,262.41"	$0.00	$0.00	$354.47	$0.00	"$1,006.08"	"$1,006.08"	$0.00	$825.68	"$1,307.87"	"$1,321.08"	$0.00		$0.00	$250.91	$0.00	$0.00	$262.89	$0.00	$0.00	$0.00	$0.00	$0.00
436.503	SUP	HCPCS C1713		436.503  -  PLATE BONE 86MM 2 HOLE LCP TITANIUM LEFT OLECRANON NONSTRL	BOTH IP/OP	"$1,700.90 "	"$1,258.67"	$0.00	"$1,321.08"	$743.11	$743.11	$0.00	$0.00	$0.00	$354.51	"$1,262.41"	"$1,262.41"	$0.00	$0.00	$354.47	$0.00	"$1,006.08"	"$1,006.08"	$0.00	$825.68	"$1,307.87"	"$1,321.08"	$0.00		$0.00	$250.91	$0.00	$0.00	$262.89	$0.00	$0.00	$0.00	$0.00	$0.00
436.506	SUP	HCPCS C1713		436.506  -  PLATE BONE 138MM 6 HOLE LCP TITANIUM RIGHT OLECRANON NONSTRL	BOTH IP/OP	"$1,831.63 "	"$1,355.41"	$0.00	"$1,422.62"	$800.22	$800.22	$0.00	$0.00	$0.00	$381.76	"$1,359.43"	"$1,359.43"	$0.00	$0.00	$381.71	$0.00	"$1,083.41"	"$1,083.41"	$0.00	$889.14	"$1,408.40"	"$1,422.62"	$0.00		$0.00	$270.19	$0.00	$0.00	$283.10	$0.00	$0.00	$0.00	$0.00	$0.00
436.507	SUP	HCPCS C1713		436.507  -  PLATE BONE 138MM 6 HOLE LCP TITANIUM LEFT OLECRANON NONSTRL	BOTH IP/OP	"$1,865.35 "	"$1,380.36"	$0.00	"$1,448.82"	$814.96	$814.96	$0.00	$0.00	$0.00	$388.79	"$1,384.46"	"$1,384.46"	$0.00	$0.00	$388.74	$0.00	"$1,103.35"	"$1,103.35"	$0.00	$905.51	"$1,434.34"	"$1,448.82"	$0.00		$0.00	$275.17	$0.00	$0.00	$288.32	$0.00	$0.00	$0.00	$0.00	$0.00
436.51	SUP	HCPCS C1713		436.510  -  PLATE BONE 189MM 10 HOLE LCP TITANIUM RIGHT OLECRANON ELBOW	BOTH IP/OP	"$1,918.85 "	"$1,419.95"	$0.00	"$1,535.08"	$863.48	$863.48	$0.00	$0.00	$0.00	$399.94	"$1,424.17"	"$1,424.17"	$0.00	$0.00	$399.89	$0.00	"$1,135.00"	"$1,135.00"	$0.00	$959.43	"$1,519.73"	"$1,535.08"	$0.00		$0.00	$291.55	$0.00	$0.00	$305.48	$0.00	$0.00	$0.00	$0.00	$0.00
436.511	SUP	HCPCS C1713		436.511  -  PLATE BONE 189MM 10 HOLE LCP TITANIUM LEFT OLECRANON ELBOW	BOTH IP/OP	"$1,976.40 "	"$1,462.54"	$0.00	"$1,535.08"	$863.48	$863.48	$0.00	$0.00	$0.00	$411.93	"$1,466.88"	"$1,466.88"	$0.00	$0.00	$411.88	$0.00	"$1,169.04"	"$1,169.04"	$0.00	$959.43	"$1,519.73"	"$1,535.08"	$0.00		$0.00	$291.55	$0.00	$0.00	$305.48	$0.00	$0.00	$0.00	$0.00	$0.00
436.512	SUP	HCPCS C1713		436.512  -  PLATE BONE 215MM 12 HOLE LCP TITANIUM RIGHT OLECRANON ELBOW	BOTH IP/OP	"$2,012.95 "	"$1,489.58"	$0.00	"$1,563.46"	$879.45	$879.45	$0.00	$0.00	$0.00	$419.55	"$1,494.01"	"$1,494.01"	$0.00	$0.00	$419.50	$0.00	"$1,190.66"	"$1,190.66"	$0.00	$977.16	"$1,547.83"	"$1,563.46"	$0.00		$0.00	$296.94	$0.00	$0.00	$311.13	$0.00	$0.00	$0.00	$0.00	$0.00
436.513	SUP	HCPCS C1713		436.513  -  PLATE BONE 215MM 13 HOLE LCP TITANIUM LEFT OLECRANON ELBOW	BOTH IP/OP	"$2,012.95 "	"$1,489.58"	$0.00	"$1,563.46"	$879.45	$879.45	$0.00	$0.00	$0.00	$419.55	"$1,494.01"	"$1,494.01"	$0.00	$0.00	$419.50	$0.00	"$1,190.66"	"$1,190.66"	$0.00	$977.16	"$1,547.83"	"$1,563.46"	$0.00		$0.00	$296.94	$0.00	$0.00	$311.13	$0.00	$0.00	$0.00	$0.00	$0.00
437.2	SUP	HCPCS C1713		437.20  -  PLATE BONE 95D 50MM 12 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,268.03 "	$938.34	$0.00	"$1,014.42"	$570.61	$570.61	$0.00	$0.00	$0.00	$264.29	$941.13	$941.13	$0.00	$0.00	$264.26	$0.00	$750.04	$750.04	$0.00	$634.01	"$1,004.28"	"$1,014.42"	$0.00		$0.00	$198.45	$0.00	$0.00	$201.87	$0.00	$0.00	$0.00	$0.00	$0.00
437.22	SUP	HCPCS C1713		437.22  -  PLATE BONE 95D 204MM 60MM 12 HOLE DCP TITANIUM CONDYLE	BOTH IP/OP	"$1,268.03 "	$938.34	$0.00	"$1,014.42"	$570.61	$570.61	$0.00	$0.00	$0.00	$264.29	$941.13	$941.13	$0.00	$0.00	$264.26	$0.00	$750.04	$750.04	$0.00	$634.01	"$1,004.28"	"$1,014.42"	$0.00		$0.00	$198.45	$0.00	$0.00	$201.87	$0.00	$0.00	$0.00	$0.00	$0.00
437.24	SUP	HCPCS C1713		437.24  -  PLATE BONE 95D 70MM 12 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,268.03 "	$938.34	$0.00	"$1,014.42"	$570.61	$570.61	$0.00	$0.00	$0.00	$264.29	$941.13	$941.13	$0.00	$0.00	$264.26	$0.00	$750.04	$750.04	$0.00	$634.01	"$1,004.28"	"$1,014.42"	$0.00		$0.00	$198.45	$0.00	$0.00	$201.87	$0.00	$0.00	$0.00	$0.00	$0.00
437.26	SUP	HCPCS C1713		437.26  -  PLATE BONE 95D 204MM 80MM 12 HOLE DCP TITANIUM CONDYLE	BOTH IP/OP	"$1,268.03 "	$938.34	$0.00	"$1,014.42"	$570.61	$570.61	$0.00	$0.00	$0.00	$264.29	$941.13	$941.13	$0.00	$0.00	$264.26	$0.00	$750.04	$750.04	$0.00	$634.01	"$1,004.28"	"$1,014.42"	$0.00		$0.00	$198.45	$0.00	$0.00	$201.87	$0.00	$0.00	$0.00	$0.00	$0.00
437.5	SUP	HCPCS C1713		437.50  -  PLATE BONE 95D 50MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,045.43 "	$773.62	$0.00	$836.34	$470.44	$470.44	$0.00	$0.00	$0.00	$217.89	$775.91	$775.91	$0.00	$0.00	$217.87	$0.00	$618.37	$618.37	$0.00	$522.71	$827.98	$836.34	$0.00		$0.00	$163.61	$0.00	$0.00	$166.43	$0.00	$0.00	$0.00	$0.00	$0.00
437.52	SUP	HCPCS C1713		437.52  -  PLATE BONE 95D 60MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,045.43 "	$773.62	$0.00	$836.34	$470.44	$470.44	$0.00	$0.00	$0.00	$217.89	$775.91	$775.91	$0.00	$0.00	$217.87	$0.00	$618.37	$618.37	$0.00	$522.71	$827.98	$836.34	$0.00		$0.00	$163.61	$0.00	$0.00	$166.43	$0.00	$0.00	$0.00	$0.00	$0.00
437.54	SUP	HCPCS C1713		437.54  -  PLATE BONE 95D 70MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,045.43 "	$773.62	$0.00	$836.34	$470.44	$470.44	$0.00	$0.00	$0.00	$217.89	$775.91	$775.91	$0.00	$0.00	$217.87	$0.00	$618.37	$618.37	$0.00	$522.71	$827.98	$836.34	$0.00		$0.00	$163.61	$0.00	$0.00	$166.43	$0.00	$0.00	$0.00	$0.00	$0.00
437.56	SUP	HCPCS C1713		437.56  -  PLATE BONE 95D 80MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,045.43 "	$773.62	$0.00	$836.34	$470.44	$470.44	$0.00	$0.00	$0.00	$217.89	$775.91	$775.91	$0.00	$0.00	$217.87	$0.00	$618.37	$618.37	$0.00	$522.71	$827.98	$836.34	$0.00		$0.00	$163.61	$0.00	$0.00	$166.43	$0.00	$0.00	$0.00	$0.00	$0.00
437.7	SUP	HCPCS C1713		437.70  -  PLATE BONE 95D 50MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,093.13 "	$808.92	$0.00	$874.50	$491.91	$491.91	$0.00	$0.00	$0.00	$227.83	$811.32	$811.32	$0.00	$0.00	$227.81	$0.00	$646.58	$646.58	$0.00	$546.56	$865.76	$874.50	$0.00		$0.00	$171.07	$0.00	$0.00	$174.03	$0.00	$0.00	$0.00	$0.00	$0.00
437.72	SUP	HCPCS C1713		437.72  -  PLATE BONE 95D 60MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,093.13 "	$808.92	$0.00	$874.50	$491.91	$491.91	$0.00	$0.00	$0.00	$227.83	$811.32	$811.32	$0.00	$0.00	$227.81	$0.00	$646.58	$646.58	$0.00	$546.56	$865.76	$874.50	$0.00		$0.00	$171.07	$0.00	$0.00	$174.03	$0.00	$0.00	$0.00	$0.00	$0.00
437.74	SUP	HCPCS C1713		437.74  -  PLATE BONE 95D 70MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,093.13 "	$808.92	$0.00	$874.50	$491.91	$491.91	$0.00	$0.00	$0.00	$227.83	$811.32	$811.32	$0.00	$0.00	$227.81	$0.00	$646.58	$646.58	$0.00	$546.56	$865.76	$874.50	$0.00		$0.00	$171.07	$0.00	$0.00	$174.03	$0.00	$0.00	$0.00	$0.00	$0.00
437.76	SUP	HCPCS C1713		437.76  -  PLATE BONE 95D 80MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,093.13 "	$808.92	$0.00	$874.50	$491.91	$491.91	$0.00	$0.00	$0.00	$227.83	$811.32	$811.32	$0.00	$0.00	$227.81	$0.00	$646.58	$646.58	$0.00	$546.56	$865.76	$874.50	$0.00		$0.00	$171.07	$0.00	$0.00	$174.03	$0.00	$0.00	$0.00	$0.00	$0.00
437.9	SUP	HCPCS C1713		437.90  -  PLATE BONE 95D 50MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,147.45 "	$849.11	$0.00	$917.96	$516.35	$516.35	$0.00	$0.00	$0.00	$239.16	$851.64	$851.64	$0.00	$0.00	$239.13	$0.00	$678.72	$678.72	$0.00	$573.73	$908.78	$917.96	$0.00		$0.00	$179.58	$0.00	$0.00	$182.67	$0.00	$0.00	$0.00	$0.00	$0.00
437.92	SUP	HCPCS C1713		437.92  -  PLATE BONE 95D 60MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,147.45 "	$849.11	$0.00	$917.96	$516.35	$516.35	$0.00	$0.00	$0.00	$239.16	$851.64	$851.64	$0.00	$0.00	$239.13	$0.00	$678.72	$678.72	$0.00	$573.73	$908.78	$917.96	$0.00		$0.00	$179.58	$0.00	$0.00	$182.67	$0.00	$0.00	$0.00	$0.00	$0.00
437.94	SUP	HCPCS C1713		437.94  -  PLATE BONE 95D 70MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,164.68 "	$861.86	$0.00	$931.74	$524.10	$524.10	$0.00	$0.00	$0.00	$242.75	$864.42	$864.42	$0.00	$0.00	$242.72	$0.00	$688.91	$688.91	$0.00	$582.34	$922.43	$931.74	$0.00		$0.00	$182.27	$0.00	$0.00	$185.42	$0.00	$0.00	$0.00	$0.00	$0.00
437.96	SUP	HCPCS C1713		437.96  -  PLATE BONE 95D 80MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL	BOTH IP/OP	"$1,164.68 "	$861.86	$0.00	$931.74	$524.10	$524.10	$0.00	$0.00	$0.00	$242.75	$864.42	$864.42	$0.00	$0.00	$242.72	$0.00	$688.91	$688.91	$0.00	$582.34	$922.43	$931.74	$0.00		$0.00	$182.27	$0.00	$0.00	$185.42	$0.00	$0.00	$0.00	$0.00	$0.00
438.24	SUP	HCPCS C1713		438.24  -  PLATE BONE 130D 70MM 12 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,276.05 "	$944.28	$0.00	"$1,020.84"	$574.22	$574.22	$0.00	$0.00	$0.00	$265.96	$947.08	$947.08	$0.00	$0.00	$265.93	$0.00	$754.78	$754.78	$0.00	$638.03	"$1,010.63"	"$1,020.84"	$0.00		$0.00	$193.88	$0.00	$0.00	$203.15	$0.00	$0.00	$0.00	$0.00	$0.00
438.26	SUP	HCPCS C1713		438.26  -  PLATE BONE 130D 80MM 12 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,276.05 "	$944.28	$0.00	"$1,020.84"	$574.22	$574.22	$0.00	$0.00	$0.00	$265.96	$947.08	$947.08	$0.00	$0.00	$265.93	$0.00	$754.78	$754.78	$0.00	$638.03	"$1,010.63"	"$1,020.84"	$0.00		$0.00	$193.88	$0.00	$0.00	$203.15	$0.00	$0.00	$0.00	$0.00	$0.00
438.28	SUP	HCPCS C1713		438.28  -  PLATE BONE 130D 90MM 12 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,276.05 "	$944.28	$0.00	"$1,020.84"	$574.22	$574.22	$0.00	$0.00	$0.00	$265.96	$947.08	$947.08	$0.00	$0.00	$265.93	$0.00	$754.78	$754.78	$0.00	$638.03	"$1,010.63"	"$1,020.84"	$0.00		$0.00	$193.88	$0.00	$0.00	$203.15	$0.00	$0.00	$0.00	$0.00	$0.00
438.36	SUP	HCPCS C1713		438.36  -  PLATE BONE 130D 50MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$943.05 	$697.86	$0.00	$754.44	$424.37	$424.37	$0.00	$0.00	$0.00	$196.56	$699.93	$699.93	$0.00	$0.00	$196.53	$0.00	$557.81	$557.81	$0.00	$471.53	$746.90	$754.44	$0.00		$0.00	$143.29	$0.00	$0.00	$150.13	$0.00	$0.00	$0.00	$0.00	$0.00
438.38	SUP	HCPCS C1713		438.38  -  PLATE BONE 130D 60MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$943.05 	$697.86	$0.00	$754.44	$424.37	$424.37	$0.00	$0.00	$0.00	$196.56	$699.93	$699.93	$0.00	$0.00	$196.53	$0.00	$557.81	$557.81	$0.00	$471.53	$746.90	$754.44	$0.00		$0.00	$143.29	$0.00	$0.00	$150.13	$0.00	$0.00	$0.00	$0.00	$0.00
438.4	SUP	HCPCS C1713		438.40  -  PLATE BONE 130D 100MM 4 HOLE ANGLE BLADE DCP TITANIUM	BOTH IP/OP	$943.05 	$697.86	$0.00	$754.44	$424.37	$424.37	$0.00	$0.00	$0.00	$196.56	$699.93	$699.93	$0.00	$0.00	$196.53	$0.00	$557.81	$557.81	$0.00	$471.53	$746.90	$754.44	$0.00		$0.00	$143.29	$0.00	$0.00	$150.13	$0.00	$0.00	$0.00	$0.00	$0.00
438.41	SUP	HCPCS C1713		438.41  -  PLATE BONE 130D 105MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$943.05 	$697.86	$0.00	$754.44	$424.37	$424.37	$0.00	$0.00	$0.00	$196.56	$699.93	$699.93	$0.00	$0.00	$196.53	$0.00	$557.81	$557.81	$0.00	$471.53	$746.90	$754.44	$0.00		$0.00	$143.29	$0.00	$0.00	$150.13	$0.00	$0.00	$0.00	$0.00	$0.00
438.42	SUP	HCPCS C1713		438.42  -  PLATE BONE 130D 110MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$943.05 	$697.86	$0.00	$754.44	$424.37	$424.37	$0.00	$0.00	$0.00	$196.56	$699.93	$699.93	$0.00	$0.00	$196.53	$0.00	$557.81	$557.81	$0.00	$471.53	$746.90	$754.44	$0.00		$0.00	$143.29	$0.00	$0.00	$150.13	$0.00	$0.00	$0.00	$0.00	$0.00
438.44	SUP	HCPCS C1713		438.44  -  PLATE BONE 130D 70MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$943.05 	$697.86	$0.00	$754.44	$424.37	$424.37	$0.00	$0.00	$0.00	$196.56	$699.93	$699.93	$0.00	$0.00	$196.53	$0.00	$557.81	$557.81	$0.00	$471.53	$746.90	$754.44	$0.00		$0.00	$143.29	$0.00	$0.00	$150.13	$0.00	$0.00	$0.00	$0.00	$0.00
438.45	SUP	HCPCS C1713		438.45  -  PLATE BONE 130D 75MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$943.05 	$697.86	$0.00	$754.44	$424.37	$424.37	$0.00	$0.00	$0.00	$196.56	$699.93	$699.93	$0.00	$0.00	$196.53	$0.00	$557.81	$557.81	$0.00	$471.53	$746.90	$754.44	$0.00		$0.00	$143.29	$0.00	$0.00	$150.13	$0.00	$0.00	$0.00	$0.00	$0.00
438.46	SUP	HCPCS C1713		438.46  -  PLATE BONE 130D 80MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$943.05 	$697.86	$0.00	$754.44	$424.37	$424.37	$0.00	$0.00	$0.00	$196.56	$699.93	$699.93	$0.00	$0.00	$196.53	$0.00	$557.81	$557.81	$0.00	$471.53	$746.90	$754.44	$0.00		$0.00	$143.29	$0.00	$0.00	$150.13	$0.00	$0.00	$0.00	$0.00	$0.00
438.47	SUP	HCPCS C1713		438.47  -  PLATE BONE 130D 85MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$943.05 	$697.86	$0.00	$754.44	$424.37	$424.37	$0.00	$0.00	$0.00	$196.56	$699.93	$699.93	$0.00	$0.00	$196.53	$0.00	$557.81	$557.81	$0.00	$471.53	$746.90	$754.44	$0.00		$0.00	$143.29	$0.00	$0.00	$150.13	$0.00	$0.00	$0.00	$0.00	$0.00
438.48	SUP	HCPCS C1713		438.48  -  PLATE BONE 130D 90MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$943.05 	$697.86	$0.00	$754.44	$424.37	$424.37	$0.00	$0.00	$0.00	$196.56	$699.93	$699.93	$0.00	$0.00	$196.53	$0.00	$557.81	$557.81	$0.00	$471.53	$746.90	$754.44	$0.00		$0.00	$143.29	$0.00	$0.00	$150.13	$0.00	$0.00	$0.00	$0.00	$0.00
438.49	SUP	HCPCS C1713		438.49  -  PLATE BONE 130D 95MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$943.05 	$697.86	$0.00	$754.44	$424.37	$424.37	$0.00	$0.00	$0.00	$196.56	$699.93	$699.93	$0.00	$0.00	$196.53	$0.00	$557.81	$557.81	$0.00	$471.53	$746.90	$754.44	$0.00		$0.00	$143.29	$0.00	$0.00	$150.13	$0.00	$0.00	$0.00	$0.00	$0.00
438.6	SUP	HCPCS C1713		438.60  -  PLATE BONE 130D 50MM 6 HOLE ANGLE BLADE DCP TITANIUM NONSTRL	BOTH IP/OP	"$1,007.18 "	$745.31	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$209.92	$747.53	$747.53	$0.00	$0.00	$209.90	$0.00	$595.74	$595.74	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
438.62	SUP	HCPCS C1713		438.62  -  PLATE BONE 130D 60MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,007.18 "	$745.31	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$209.92	$747.53	$747.53	$0.00	$0.00	$209.90	$0.00	$595.74	$595.74	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
438.64	SUP	HCPCS C1713		438.64  -  PLATE BONE 130D 70MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,007.18 "	$745.31	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$209.92	$747.53	$747.53	$0.00	$0.00	$209.90	$0.00	$595.74	$595.74	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
438.66	SUP	HCPCS C1713		438.66  -  PLATE BONE 130D 80MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,007.18 "	$745.31	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$209.92	$747.53	$747.53	$0.00	$0.00	$209.90	$0.00	$595.74	$595.74	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
438.68	SUP	HCPCS C1713		438.68  -  PLATE BLADE 130D 90MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,007.18 "	$745.31	$0.00	$805.74	$453.23	$453.23	$0.00	$0.00	$0.00	$209.92	$747.53	$747.53	$0.00	$0.00	$209.90	$0.00	$595.74	$595.74	$0.00	$503.59	$797.69	$805.74	$0.00		$0.00	$153.03	$0.00	$0.00	$160.34	$0.00	$0.00	$0.00	$0.00	$0.00
438.7	SUP	HCPCS C1713		438.700  -  PLATE BONE 116MM 4 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,530.75 "	"$1,872.76"	$0.00	"$2,024.60"	"$1,138.84"	"$1,138.84"	$0.00	$0.00	$0.00	$527.47	"$1,878.32"	"$1,878.32"	$0.00	$0.00	$527.41	$0.00	"$1,247.66"	"$1,247.66"	$0.00	"$1,265.38"	"$2,004.35"	"$2,024.60"	$0.00		$0.00	$396.06	$0.00	$0.00	$402.90	$0.00	$0.00	$0.00	$0.00	$0.00
438.701	SUP	HCPCS C1713		438.701  -  PLATE 116MM TI 3.5MM SCR 4 HOLE W/O TAB LCP BONE LEFT DISTAL	BOTH IP/OP	"$3,294.20 "	"$2,437.71"	$0.00	"$2,635.36"	"$1,482.39"	"$1,482.39"	$0.00	$0.00	$0.00	$686.59	"$2,444.96"	"$2,444.96"	$0.00	$0.00	$686.51	$0.00	"$1,624.04"	"$1,624.04"	$0.00	"$1,647.10"	"$2,609.01"	"$2,635.36"	$0.00		$0.00	$515.54	$0.00	$0.00	$524.44	$0.00	$0.00	$0.00	$0.00	$0.00
438.703	SUP	HCPCS C1713		438.703  -  PLATE 142MM TI 3.5MM SCR 6 HOLE W/O TAB LCP BONE LEFT DISTAL	BOTH IP/OP	"$3,234.43 "	"$2,393.48"	$0.00	"$2,587.54"	"$1,455.49"	"$1,455.49"	$0.00	$0.00	$0.00	$674.14	"$2,400.59"	"$2,400.59"	$0.00	$0.00	$674.05	$0.00	"$1,594.57"	"$1,594.57"	$0.00	"$1,617.21"	"$2,561.67"	"$2,587.54"	$0.00		$0.00	$506.19	$0.00	$0.00	$514.92	$0.00	$0.00	$0.00	$0.00	$0.00
438.705	SUP	HCPCS C1713		438.705  -  PLATE 168MM TI 3.5MM SCR 8 HOLE W/O TAB LCP BONE LEFT DISTAL	BOTH IP/OP	"$3,266.13 "	"$2,416.94"	$0.00	"$2,612.90"	"$1,469.76"	"$1,469.76"	$0.00	$0.00	$0.00	$680.74	"$2,424.12"	"$2,424.12"	$0.00	$0.00	$680.66	$0.00	"$1,610.20"	"$1,610.20"	$0.00	"$1,633.06"	"$2,586.77"	"$2,612.90"	$0.00		$0.00	$511.15	$0.00	$0.00	$519.97	$0.00	$0.00	$0.00	$0.00	$0.00
438.706	SUP	HCPCS C1713		438.706  -  PLATE 194MM TI 3.5MM SCR 10 HOLE W/O TAB LCP BONE RIGHT	BOTH IP/OP	"$3,399.05 "	"$2,515.30"	$0.00	"$2,719.24"	"$1,529.57"	"$1,529.57"	$0.00	$0.00	$0.00	$708.45	"$2,522.77"	"$2,522.77"	$0.00	$0.00	$708.36	$0.00	"$1,675.73"	"$1,675.73"	$0.00	"$1,699.53"	"$2,692.05"	"$2,719.24"	$0.00		$0.00	$531.95	$0.00	$0.00	$541.13	$0.00	$0.00	$0.00	$0.00	$0.00
438.708	SUP	HCPCS C1713		438.708  -  PLATE BONE 220MM 12 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,640.73 "	"$1,954.14"	$0.00	"$2,112.58"	"$1,188.33"	"$1,188.33"	$0.00	$0.00	$0.00	$550.39	"$1,959.95"	"$1,959.95"	$0.00	$0.00	$550.33	$0.00	"$1,301.88"	"$1,301.88"	$0.00	"$1,320.36"	"$2,091.46"	"$2,112.58"	$0.00		$0.00	$413.27	$0.00	$0.00	$420.40	$0.00	$0.00	$0.00	$0.00	$0.00
438.71	SUP	HCPCS C1713		438.710  -  PLATE BONE 246MM 14 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,675.18 "	"$1,979.63"	$0.00	"$2,140.14"	"$1,203.83"	"$1,203.83"	$0.00	$0.00	$0.00	$557.57	"$1,985.51"	"$1,985.51"	$0.00	$0.00	$557.51	$0.00	"$1,318.86"	"$1,318.86"	$0.00	"$1,337.59"	"$2,118.74"	"$2,140.14"	$0.00		$0.00	$418.66	$0.00	$0.00	$425.89	$0.00	$0.00	$0.00	$0.00	$0.00
438.711	SUP	HCPCS C1713		438.711  -  PLATE BONE 246MM 14 HOLE W/O TAB LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$2,756.00 "	"$2,039.44"	$0.00	"$2,204.80"	"$1,240.20"	"$1,240.20"	$0.00	$0.00	$0.00	$574.42	"$2,045.50"	"$2,045.50"	$0.00	$0.00	$574.35	$0.00	"$1,358.71"	"$1,358.71"	$0.00	"$1,378.00"	"$2,182.75"	"$2,204.80"	$0.00		$0.00	$431.31	$0.00	$0.00	$438.76	$0.00	$0.00	$0.00	$0.00	$0.00
438.94	SUP	HCPCS C1713		438.94  -  PLATE BONE 130D 70MM 9 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,110.90 "	$822.07	$0.00	$888.72	$499.91	$499.91	$0.00	$0.00	$0.00	$231.54	$824.51	$824.51	$0.00	$0.00	$231.51	$0.00	$657.10	$657.10	$0.00	$555.45	$879.83	$888.72	$0.00		$0.00	$168.79	$0.00	$0.00	$176.86	$0.00	$0.00	$0.00	$0.00	$0.00
438.96	SUP	HCPCS C1713		438.96  -  PLATE BONE 130D 80MM 9 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
438.98	SUP	HCPCS C1713		438.98  -  PLATE BONE 130D 90MM 9 HOLE ANGLED DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$1,110.90 "	$822.07	$0.00	$888.72	$499.91	$499.91	$0.00	$0.00	$0.00	$231.54	$824.51	$824.51	$0.00	$0.00	$231.51	$0.00	$657.10	$657.10	$0.00	$555.45	$879.83	$888.72	$0.00		$0.00	$168.79	$0.00	$0.00	$176.86	$0.00	$0.00	$0.00	$0.00	$0.00
439.2	SUP	HCPCS C1713		439.20  -  PLATE 90D 10MM DSPL 50MM TI OSTMY DCP BONE ADLT ORTH NONSTRL	BOTH IP/OP	"$1,290.98 "	$955.33	$0.00	"$1,032.78"	$580.94	$580.94	$0.00	$0.00	$0.00	$269.07	$958.16	$958.16	$0.00	$0.00	$269.04	$0.00	$763.61	$763.61	$0.00	$645.49	"$1,022.46"	"$1,032.78"	$0.00		$0.00	$202.04	$0.00	$0.00	$205.52	$0.00	$0.00	$0.00	$0.00	$0.00
439.21	SUP	HCPCS C1713		439.21  -  PLATE BONE 90D 10MM DISPLACEMENT 55MM ANGLED DCP TITANIUM	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.22	SUP	HCPCS C1713		439.22  -  PLATE BONE 90D 10MM DISPLACEMENT 60MM DCP TITANIUM ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.23	SUP	HCPCS C1713		439.23  -  PLATE BONE 90D 10MM DISPLACEMENT 65MM ANGLED DCP TITANIUM	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.24	SUP	HCPCS C1713		439.24  -  PLATE BONE 90D 10MM DISPLACEMENT 70MM DCP TITANIUM ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.25	SUP	HCPCS C1713		439.25  -  PLATE BONE 90D 10MM DISPLACEMENT 75MM DCP TITANIUM ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.28	SUP	HCPCS C1713		439.28  -  PLATE BONE 90D 10MM DISPLACEMENT 40MM DCP TITANIUM ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.32	SUP	HCPCS C1713		439.32  -  PLATE BONE 100D 10MM DISPLACEMENT 60MM DCP TITANIUM ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.43	SUP	HCPCS C1713		439.43  -  PLATE BONE 110D 65MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.45	SUP	HCPCS C1713		439.45  -  PLATE BONE 110D 75MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL	BOTH IP/OP	"$1,110.90 "	$822.07	$0.00	$888.72	$499.91	$499.91	$0.00	$0.00	$0.00	$231.54	$824.51	$824.51	$0.00	$0.00	$231.51	$0.00	$657.10	$657.10	$0.00	$555.45	$879.83	$888.72	$0.00		$0.00	$168.79	$0.00	$0.00	$176.86	$0.00	$0.00	$0.00	$0.00	$0.00
439.47	SUP	HCPCS C1713		439.47  -  PLATE BONE 110D 85MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.53	SUP	HCPCS C1713		439.53  -  PLATE BONE 120D 65MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.55	SUP	HCPCS C1713		439.55  -  PLATE BONE 120D 75MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.57	SUP	HCPCS C1713		439.57  -  PLATE BONE 120D 85MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.6	SUP	HCPCS C1713		439.60  -  PLATE BONE 90D 20MM DISPLACEMENT 50MM 20MM DCP TITANIUM	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.61	SUP	HCPCS C1713		439.61  -  PLATE BONE 90D 20MM 55MM DCP TITANIUM ADULT ORTHOPEDIC	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.62	SUP	HCPCS C1713		439.62  -  PLATE BN 90D 20MM DSPL 60MM NS DCP TI ADLT OSTM	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.63	SUP	HCPCS C1713		439.63  -  PLATE BONE 90D 20MM DISPLACEMENT 65MM DCP TITANIUM ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.64	SUP	HCPCS C1713		439.64  -  PLATE BONE 90D 20MM DISPLACEMENT 70MM DCP TITANIUM ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.65	SUP	HCPCS C1713		439.65  -  PLATE BONE 90D 20MM 75MM ANGLED DCP STAINLESS STEEL ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.7	SUP	HCPCS C1713		439.70  -  PLATE BONE 90D 15MM DISPLACEMENT 50MM DCP TITANIUM ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.71	SUP	HCPCS C1713		439.71  -  PLATE BONE 90D 15MM DISPLACEMENT 55MM ANGLED DCP TITANIUM	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.72	SUP	HCPCS C1713		439.72  -  PLATE BONE 90D 15MM DISPLACEMENT 60MM DCP TITANIUM ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.73	SUP	HCPCS C1713		439.73  -  PLATE BONE 90D 15MM DISPLACEMENT 65MM DCP TITANIUM ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.74	SUP	HCPCS C1713		439.74  -  PLATE BONE 90D 15MM 70MM DCP TITANIUM ADULT ORTHOPEDIC	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.76	SUP	HCPCS C1713		439.76  -  PLATE BONE 90D 15MM DISPLACEMENT 80MM DCP TITANIUM ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.78	SUP	HCPCS C1713		439.78  -  PLATE BONE 90D 15MM DISPLACEMENT 40MM DCP TITANIUM ADULT	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.8	SUP	HCPCS C1713		439.80  -  PLATE BONE 130D 100MM DCP TITANIUM ADULT NONSTRL OSTMY	BOTH IP/OP	"$1,110.90 "	$822.07	$0.00	$888.72	$499.91	$499.91	$0.00	$0.00	$0.00	$231.54	$824.51	$824.51	$0.00	$0.00	$231.51	$0.00	$657.10	$657.10	$0.00	$555.45	$879.83	$888.72	$0.00		$0.00	$168.79	$0.00	$0.00	$176.86	$0.00	$0.00	$0.00	$0.00	$0.00
439.81	SUP	HCPCS C1713		439.81  -  PLATE BONE 130D 105MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.82	SUP	HCPCS C1713		439.82  -  PLATE BONE 130D 110MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.83	SUP	HCPCS C1713		439.83  -  PLATE BONE 130D 65MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.84	SUP	HCPCS C1713		439.84  -  PLATE BONE 130D 70MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.85	SUP	HCPCS C1713		439.85  -  PLATE BONE 130D 75MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.86	SUP	HCPCS C1713		439.86  -  PLATE BONE 130D 80MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.87	SUP	HCPCS C1713		439.87  -  PLATE BONE 130D 85MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.88	SUP	HCPCS C1713		439.88  -  PLATE BONE 130D 90MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.89	SUP	HCPCS C1713		439.89  -  PLATE BONE 130D 95MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL	BOTH IP/OP	"$1,078.55 "	$798.13	$0.00	$862.84	$485.35	$485.35	$0.00	$0.00	$0.00	$224.80	$800.50	$800.50	$0.00	$0.00	$224.77	$0.00	$637.96	$637.96	$0.00	$539.28	$854.21	$862.84	$0.00		$0.00	$168.79	$0.00	$0.00	$171.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.934	SUP	HCPCS C1713		439.934  -  PLATE BONE 81MM 4 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,663.78 "	"$1,971.20"	$0.00	"$2,068.96"	"$1,163.79"	"$1,163.79"	$0.00	$0.00	$0.00	$555.20	"$1,977.05"	"$1,977.05"	$0.00	$0.00	$555.13	$0.00	"$1,313.24"	"$1,313.24"	$0.00	"$1,293.10"	"$2,048.27"	"$2,068.96"	$0.00		$0.00	$392.95	$0.00	$0.00	$411.72	$0.00	$0.00	$0.00	$0.00	$0.00
439.935	SUP	HCPCS C1713		439.935  -  PLATE BONE 81MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,663.78 "	"$1,971.20"	$0.00	"$2,068.96"	"$1,163.79"	"$1,163.79"	$0.00	$0.00	$0.00	$555.20	"$1,977.05"	"$1,977.05"	$0.00	$0.00	$555.13	$0.00	"$1,313.24"	"$1,313.24"	$0.00	"$1,293.10"	"$2,048.27"	"$2,068.96"	$0.00		$0.00	$392.95	$0.00	$0.00	$411.72	$0.00	$0.00	$0.00	$0.00	$0.00
439.936	SUP	HCPCS C1713		439.936  -  PLATE BONE 107MM 6 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,696.13 "	"$1,995.14"	$0.00	"$2,094.08"	"$1,177.92"	"$1,177.92"	$0.00	$0.00	$0.00	$561.94	"$2,001.06"	"$2,001.06"	$0.00	$0.00	$561.87	$0.00	"$1,329.19"	"$1,329.19"	$0.00	"$1,308.80"	"$2,073.14"	"$2,094.08"	$0.00		$0.00	$397.72	$0.00	$0.00	$416.72	$0.00	$0.00	$0.00	$0.00	$0.00
439.937	SUP	HCPCS C1713		439.937  -  PLATE BONE 107MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,696.13 "	"$1,995.14"	$0.00	"$2,094.08"	"$1,177.92"	"$1,177.92"	$0.00	$0.00	$0.00	$561.94	"$2,001.06"	"$2,001.06"	$0.00	$0.00	$561.87	$0.00	"$1,329.19"	"$1,329.19"	$0.00	"$1,308.80"	"$2,073.14"	"$2,094.08"	$0.00		$0.00	$397.72	$0.00	$0.00	$416.72	$0.00	$0.00	$0.00	$0.00	$0.00
439.938	SUP	HCPCS C1713		439.938  -  PLATE BONE 133MM 8 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,727.05 "	"$2,018.02"	$0.00	"$2,118.10"	"$1,191.43"	"$1,191.43"	$0.00	$0.00	$0.00	$568.39	"$2,024.02"	"$2,024.02"	$0.00	$0.00	$568.32	$0.00	"$1,344.44"	"$1,344.44"	$0.00	"$1,323.81"	"$2,096.92"	"$2,118.10"	$0.00		$0.00	$402.28	$0.00	$0.00	$421.50	$0.00	$0.00	$0.00	$0.00	$0.00
439.939	SUP	HCPCS C1713		439.939  -  PLATE BONE 133MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,727.05 "	"$2,018.02"	$0.00	"$2,118.10"	"$1,191.43"	"$1,191.43"	$0.00	$0.00	$0.00	$568.39	"$2,024.02"	"$2,024.02"	$0.00	$0.00	$568.32	$0.00	"$1,344.44"	"$1,344.44"	$0.00	"$1,323.81"	"$2,096.92"	"$2,118.10"	$0.00		$0.00	$402.28	$0.00	$0.00	$421.50	$0.00	$0.00	$0.00	$0.00	$0.00
439.94	SUP	HCPCS C1713		439.940  -  PLATE BONE 159MM 10 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,676.28 "	"$1,980.45"	$0.00	"$2,141.02"	"$1,204.32"	"$1,204.32"	$0.00	$0.00	$0.00	$557.80	"$1,986.33"	"$1,986.33"	$0.00	$0.00	$557.74	$0.00	"$1,319.40"	"$1,319.40"	$0.00	"$1,338.14"	"$2,119.61"	"$2,141.02"	$0.00		$0.00	$406.64	$0.00	$0.00	$426.06	$0.00	$0.00	$0.00	$0.00	$0.00
439.941	SUP	HCPCS C1713		439.941  -  PLATE BONE 159MM 10 HOLE TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,756.58 "	"$2,039.87"	$0.00	"$2,141.02"	"$1,204.32"	"$1,204.32"	$0.00	$0.00	$0.00	$574.54	"$2,045.93"	"$2,045.93"	$0.00	$0.00	$574.47	$0.00	"$1,358.99"	"$1,358.99"	$0.00	"$1,338.14"	"$2,119.61"	"$2,141.02"	$0.00		$0.00	$406.64	$0.00	$0.00	$426.06	$0.00	$0.00	$0.00	$0.00	$0.00
439.942	SUP	HCPCS C1713		439.942  -  PLATE BONE 185MM 12 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,793.10 "	"$2,066.89"	$0.00	"$2,169.40"	"$1,220.29"	"$1,220.29"	$0.00	$0.00	$0.00	$582.15	"$2,073.04"	"$2,073.04"	$0.00	$0.00	$582.08	$0.00	"$1,377.00"	"$1,377.00"	$0.00	"$1,355.88"	"$2,147.71"	"$2,169.40"	$0.00		$0.00	$412.03	$0.00	$0.00	$431.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.943	SUP	HCPCS C1713		439.943  -  PLATE BONE 185MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,793.10 "	"$2,066.89"	$0.00	"$2,169.40"	"$1,220.29"	"$1,220.29"	$0.00	$0.00	$0.00	$582.15	"$2,073.04"	"$2,073.04"	$0.00	$0.00	$582.08	$0.00	"$1,377.00"	"$1,377.00"	$0.00	"$1,355.88"	"$2,147.71"	"$2,169.40"	$0.00		$0.00	$412.03	$0.00	$0.00	$431.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.944	SUP	HCPCS C1713		439.944  -  PLATE BONE 211MM 14 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,822.63 "	"$2,088.75"	$0.00	"$2,192.34"	"$1,233.19"	"$1,233.19"	$0.00	$0.00	$0.00	$588.31	"$2,094.95"	"$2,094.95"	$0.00	$0.00	$588.24	$0.00	"$1,391.55"	"$1,391.55"	$0.00	"$1,370.21"	"$2,170.42"	"$2,192.34"	$0.00		$0.00	$416.38	$0.00	$0.00	$436.28	$0.00	$0.00	$0.00	$0.00	$0.00
439.945	SUP	HCPCS C1713		439.945  -  PLATE BONE 211MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,822.63 "	"$2,088.75"	$0.00	"$2,192.34"	"$1,233.19"	"$1,233.19"	$0.00	$0.00	$0.00	$588.31	"$2,094.95"	"$2,094.95"	$0.00	$0.00	$588.24	$0.00	"$1,391.55"	"$1,391.55"	$0.00	"$1,370.21"	"$2,170.42"	"$2,192.34"	$0.00		$0.00	$416.38	$0.00	$0.00	$436.28	$0.00	$0.00	$0.00	$0.00	$0.00
439.946	SUP	HCPCS C1713		439.946  -  PLATE BONE 237MM 16 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,922.43 "	"$2,162.60"	$0.00	"$2,269.86"	"$1,276.80"	"$1,276.80"	$0.00	$0.00	$0.00	$609.11	"$2,169.02"	"$2,169.02"	$0.00	$0.00	$609.03	$0.00	"$1,440.76"	"$1,440.76"	$0.00	"$1,418.66"	"$2,247.17"	"$2,269.86"	$0.00		$0.00	$431.11	$0.00	$0.00	$451.70	$0.00	$0.00	$0.00	$0.00	$0.00
439.947	SUP	HCPCS C1713		439.947  -  PLATE BONE 237MM 16 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,922.43 "	"$2,162.60"	$0.00	"$2,269.86"	"$1,276.80"	"$1,276.80"	$0.00	$0.00	$0.00	$609.11	"$2,169.02"	"$2,169.02"	$0.00	$0.00	$609.03	$0.00	"$1,440.76"	"$1,440.76"	$0.00	"$1,418.66"	"$2,247.17"	"$2,269.86"	$0.00		$0.00	$431.11	$0.00	$0.00	$451.70	$0.00	$0.00	$0.00	$0.00	$0.00
439.954	SUP	HCPCS C1713		439.954  -  PLATE BONE 94MM 4 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,655.35 "	"$1,964.96"	$0.00	"$2,062.42"	"$1,160.11"	"$1,160.11"	$0.00	$0.00	$0.00	$553.44	"$1,970.80"	"$1,970.80"	$0.00	$0.00	$553.37	$0.00	"$1,309.09"	"$1,309.09"	$0.00	"$1,289.01"	"$2,041.80"	"$2,062.42"	$0.00		$0.00	$391.71	$0.00	$0.00	$410.42	$0.00	$0.00	$0.00	$0.00	$0.00
439.955	SUP	HCPCS C1713		439.955  -  PLATE BONE 94MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,655.35 "	"$1,964.96"	$0.00	"$2,062.42"	"$1,160.11"	"$1,160.11"	$0.00	$0.00	$0.00	$553.44	"$1,970.80"	"$1,970.80"	$0.00	$0.00	$553.37	$0.00	"$1,309.09"	"$1,309.09"	$0.00	"$1,289.01"	"$2,041.80"	"$2,062.42"	$0.00		$0.00	$391.71	$0.00	$0.00	$410.42	$0.00	$0.00	$0.00	$0.00	$0.00
439.956	SUP	HCPCS C1713		439.956  -  PLATE BONE 119MM 6 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,690.50 "	"$1,990.97"	$0.00	"$2,089.70"	"$1,175.46"	"$1,175.46"	$0.00	$0.00	$0.00	$560.77	"$1,996.89"	"$1,996.89"	$0.00	$0.00	$560.70	$0.00	"$1,326.42"	"$1,326.42"	$0.00	"$1,306.06"	"$2,068.81"	"$2,089.70"	$0.00		$0.00	$396.89	$0.00	$0.00	$415.85	$0.00	$0.00	$0.00	$0.00	$0.00
439.957	SUP	HCPCS C1713		439.957  -  PLATE BONE 119MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,690.50 "	"$1,990.97"	$0.00	"$2,089.70"	"$1,175.46"	"$1,175.46"	$0.00	$0.00	$0.00	$560.77	"$1,996.89"	"$1,996.89"	$0.00	$0.00	$560.70	$0.00	"$1,326.42"	"$1,326.42"	$0.00	"$1,306.06"	"$2,068.81"	"$2,089.70"	$0.00		$0.00	$396.89	$0.00	$0.00	$415.85	$0.00	$0.00	$0.00	$0.00	$0.00
439.958	SUP	HCPCS C1713		439.958  -  PLATE BONE 145MM 8 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,722.83 "	"$2,014.89"	$0.00	"$2,114.82"	"$1,189.59"	"$1,189.59"	$0.00	$0.00	$0.00	$567.50	"$2,020.88"	"$2,020.88"	$0.00	$0.00	$567.44	$0.00	"$1,342.35"	"$1,342.35"	$0.00	"$1,321.76"	"$2,093.68"	"$2,114.82"	$0.00		$0.00	$401.66	$0.00	$0.00	$420.85	$0.00	$0.00	$0.00	$0.00	$0.00
439.959	SUP	HCPCS C1713		439.959  -  PLATE BONE 145MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,722.83 "	"$2,014.89"	$0.00	"$2,114.82"	"$1,189.59"	"$1,189.59"	$0.00	$0.00	$0.00	$567.50	"$2,020.88"	"$2,020.88"	$0.00	$0.00	$567.44	$0.00	"$1,342.35"	"$1,342.35"	$0.00	"$1,321.76"	"$2,093.68"	"$2,114.82"	$0.00		$0.00	$401.66	$0.00	$0.00	$420.85	$0.00	$0.00	$0.00	$0.00	$0.00
439.96	SUP	HCPCS C1713		439.960  -  PLATE BONE 171MM 10 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,673.55 "	"$1,978.43"	$0.00	"$2,138.84"	"$1,203.10"	"$1,203.10"	$0.00	$0.00	$0.00	$557.23	"$1,984.31"	"$1,984.31"	$0.00	$0.00	$557.17	$0.00	"$1,318.06"	"$1,318.06"	$0.00	"$1,336.78"	"$2,117.45"	"$2,138.84"	$0.00		$0.00	$406.22	$0.00	$0.00	$425.63	$0.00	$0.00	$0.00	$0.00	$0.00
439.961	SUP	HCPCS C1713		439.961  -  PLATE BONE 171MM 10 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,753.75 "	"$2,037.78"	$0.00	"$2,138.84"	"$1,203.10"	"$1,203.10"	$0.00	$0.00	$0.00	$573.95	"$2,043.83"	"$2,043.83"	$0.00	$0.00	$573.88	$0.00	"$1,357.60"	"$1,357.60"	$0.00	"$1,336.78"	"$2,117.45"	"$2,138.84"	$0.00		$0.00	$406.22	$0.00	$0.00	$425.63	$0.00	$0.00	$0.00	$0.00	$0.00
439.962	SUP	HCPCS C1713		439.962  -  PLATE BONE 197MM 12 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,783.28 "	"$2,059.63"	$0.00	"$2,161.76"	"$1,215.99"	"$1,215.99"	$0.00	$0.00	$0.00	$580.10	"$2,065.75"	"$2,065.75"	$0.00	$0.00	$580.03	$0.00	"$1,372.15"	"$1,372.15"	$0.00	"$1,351.10"	"$2,140.14"	"$2,161.76"	$0.00		$0.00	$410.58	$0.00	$0.00	$430.19	$0.00	$0.00	$0.00	$0.00	$0.00
439.963	SUP	HCPCS C1713		439.963  -  PLATE BONE 197MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,783.28 "	"$2,059.63"	$0.00	"$2,161.76"	"$1,215.99"	"$1,215.99"	$0.00	$0.00	$0.00	$580.10	"$2,065.75"	"$2,065.75"	$0.00	$0.00	$580.03	$0.00	"$1,372.15"	"$1,372.15"	$0.00	"$1,351.10"	"$2,140.14"	"$2,161.76"	$0.00		$0.00	$410.58	$0.00	$0.00	$430.19	$0.00	$0.00	$0.00	$0.00	$0.00
439.964	SUP	HCPCS C1713		439.964  -  PLATE BONE 223MM 14 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,817.00 "	"$2,084.58"	$0.00	"$2,187.96"	"$1,230.73"	"$1,230.73"	$0.00	$0.00	$0.00	$587.13	"$2,090.78"	"$2,090.78"	$0.00	$0.00	$587.06	$0.00	"$1,388.78"	"$1,388.78"	$0.00	"$1,367.48"	"$2,166.08"	"$2,187.96"	$0.00		$0.00	$415.55	$0.00	$0.00	$435.40	$0.00	$0.00	$0.00	$0.00	$0.00
439.965	SUP	HCPCS C1713		439.965  -  PLATE BONE 223MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,817.00 "	"$2,084.58"	$0.00	"$2,187.96"	"$1,230.73"	"$1,230.73"	$0.00	$0.00	$0.00	$587.13	"$2,090.78"	"$2,090.78"	$0.00	$0.00	$587.06	$0.00	"$1,388.78"	"$1,388.78"	$0.00	"$1,367.48"	"$2,166.08"	"$2,187.96"	$0.00		$0.00	$415.55	$0.00	$0.00	$435.40	$0.00	$0.00	$0.00	$0.00	$0.00
439.966	SUP	HCPCS C1713		439.966  -  PLATE BONE 249MM 16 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,915.40 "	"$2,157.40"	$0.00	"$2,264.40"	"$1,273.73"	"$1,273.73"	$0.00	$0.00	$0.00	$607.64	"$2,163.81"	"$2,163.81"	$0.00	$0.00	$607.57	$0.00	"$1,437.29"	"$1,437.29"	$0.00	"$1,415.25"	"$2,241.76"	"$2,264.40"	$0.00		$0.00	$430.07	$0.00	$0.00	$450.62	$0.00	$0.00	$0.00	$0.00	$0.00
439.967	SUP	HCPCS C1713		439.967  -  PLATE BONE 249MM 16 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,915.40 "	"$2,157.40"	$0.00	"$2,264.40"	"$1,273.73"	"$1,273.73"	$0.00	$0.00	$0.00	$607.64	"$2,163.81"	"$2,163.81"	$0.00	$0.00	$607.57	$0.00	"$1,437.29"	"$1,437.29"	$0.00	"$1,415.25"	"$2,241.76"	"$2,264.40"	$0.00		$0.00	$430.07	$0.00	$0.00	$450.62	$0.00	$0.00	$0.00	$0.00	$0.00
439.968	SUP	HCPCS C1713		439.968  -  PLATE BONE 275MM 18 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$3,019.43 "	"$2,234.38"	$0.00	"$2,345.18"	"$1,319.16"	"$1,319.16"	$0.00	$0.00	$0.00	$629.32	"$2,241.02"	"$2,241.02"	$0.00	$0.00	$629.25	$0.00	"$1,488.58"	"$1,488.58"	$0.00	"$1,465.74"	"$2,321.73"	"$2,345.18"	$0.00		$0.00	$445.41	$0.00	$0.00	$466.69	$0.00	$0.00	$0.00	$0.00	$0.00
439.969	SUP	HCPCS C1713		439.969  -  PLATE BONE 275MM 18 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$3,110.80 "	"$2,301.99"	$0.00	"$2,416.16"	"$1,359.09"	"$1,359.09"	$0.00	$0.00	$0.00	$648.37	"$2,308.84"	"$2,308.84"	$0.00	$0.00	$648.29	$0.00	"$1,533.62"	"$1,533.62"	$0.00	"$1,510.10"	"$2,392.00"	"$2,416.16"	$0.00		$0.00	$458.89	$0.00	$0.00	$480.82	$0.00	$0.00	$0.00	$0.00	$0.00
439.97	SUP	HCPCS C1713		439.970  -  PLATE BONE 301MM 20 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$3,028.38 "	"$2,241.00"	$0.00	"$2,422.70"	"$1,362.77"	"$1,362.77"	$0.00	$0.00	$0.00	$631.19	"$2,247.66"	"$2,247.66"	$0.00	$0.00	$631.11	$0.00	"$1,492.99"	"$1,492.99"	$0.00	"$1,514.19"	"$2,398.48"	"$2,422.70"	$0.00		$0.00	$460.14	$0.00	$0.00	$482.12	$0.00	$0.00	$0.00	$0.00	$0.00
439.971	SUP	HCPCS C1713		439.971  -  PLATE BONE 301MM 20 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$3,119.23 "	"$2,308.23"	$0.00	"$2,422.70"	"$1,362.77"	"$1,362.77"	$0.00	$0.00	$0.00	$650.12	"$2,315.09"	"$2,315.09"	$0.00	$0.00	$650.05	$0.00	"$1,537.78"	"$1,537.78"	$0.00	"$1,514.19"	"$2,398.48"	"$2,422.70"	$0.00		$0.00	$460.14	$0.00	$0.00	$482.12	$0.00	$0.00	$0.00	$0.00	$0.00
439.984	SUP	HCPCS C1713		439.984  -  PLATE BONE 106MM 4 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,665.20 "	"$1,972.25"	$0.00	"$2,070.06"	"$1,164.41"	"$1,164.41"	$0.00	$0.00	$0.00	$555.49	"$1,978.11"	"$1,978.11"	$0.00	$0.00	$555.43	$0.00	"$1,313.94"	"$1,313.94"	$0.00	"$1,293.79"	"$2,049.36"	"$2,070.06"	$0.00		$0.00	$393.16	$0.00	$0.00	$411.94	$0.00	$0.00	$0.00	$0.00	$0.00
439.985	SUP	HCPCS C1713		439.985  -  PLATE BONE 106MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,665.20 "	"$1,972.25"	$0.00	"$2,070.06"	"$1,164.41"	"$1,164.41"	$0.00	$0.00	$0.00	$555.49	"$1,978.11"	"$1,978.11"	$0.00	$0.00	$555.43	$0.00	"$1,313.94"	"$1,313.94"	$0.00	"$1,293.79"	"$2,049.36"	"$2,070.06"	$0.00		$0.00	$393.16	$0.00	$0.00	$411.94	$0.00	$0.00	$0.00	$0.00	$0.00
439.986	SUP	HCPCS C1713		439.986  -  PLATE BONE 142MM 6 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,697.53 "	"$1,996.17"	$0.00	"$2,095.16"	"$1,178.53"	"$1,178.53"	$0.00	$0.00	$0.00	$562.23	"$2,002.10"	"$2,002.10"	$0.00	$0.00	$562.16	$0.00	"$1,329.88"	"$1,329.88"	$0.00	"$1,309.48"	"$2,074.21"	"$2,095.16"	$0.00		$0.00	$397.93	$0.00	$0.00	$416.94	$0.00	$0.00	$0.00	$0.00	$0.00
439.987	SUP	HCPCS C1713		439.987  -  PLATE BONE 142MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,697.53 "	"$1,996.17"	$0.00	"$2,095.16"	"$1,178.53"	"$1,178.53"	$0.00	$0.00	$0.00	$562.23	"$2,002.10"	"$2,002.10"	$0.00	$0.00	$562.16	$0.00	"$1,329.88"	"$1,329.88"	$0.00	"$1,309.48"	"$2,074.21"	"$2,095.16"	$0.00		$0.00	$397.93	$0.00	$0.00	$416.94	$0.00	$0.00	$0.00	$0.00	$0.00
439.988	SUP	HCPCS C1713		439.988  -  PLATE BONE 178MM 8 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,728.45 "	"$2,019.05"	$0.00	"$2,119.18"	"$1,192.04"	"$1,192.04"	$0.00	$0.00	$0.00	$568.68	"$2,025.06"	"$2,025.06"	$0.00	$0.00	$568.61	$0.00	"$1,345.13"	"$1,345.13"	$0.00	"$1,324.49"	"$2,097.99"	"$2,119.18"	$0.00		$0.00	$402.49	$0.00	$0.00	$421.72	$0.00	$0.00	$0.00	$0.00	$0.00
439.989	SUP	HCPCS C1713		439.989  -  PLATE BONE 178MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,728.45 "	"$2,019.05"	$0.00	"$2,119.18"	"$1,192.04"	"$1,192.04"	$0.00	$0.00	$0.00	$568.68	"$2,025.06"	"$2,025.06"	$0.00	$0.00	$568.61	$0.00	"$1,345.13"	"$1,345.13"	$0.00	"$1,324.49"	"$2,097.99"	"$2,119.18"	$0.00		$0.00	$402.49	$0.00	$0.00	$421.72	$0.00	$0.00	$0.00	$0.00	$0.00
439.99	SUP	HCPCS C1713		439.990  -  PLATE BONE 214MM 10 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,677.65 "	"$1,981.46"	$0.00	"$2,142.12"	"$1,204.94"	"$1,204.94"	$0.00	$0.00	$0.00	$558.09	"$1,987.35"	"$1,987.35"	$0.00	$0.00	$558.02	$0.00	"$1,320.08"	"$1,320.08"	$0.00	"$1,338.83"	"$2,120.70"	"$2,142.12"	$0.00		$0.00	$406.85	$0.00	$0.00	$426.28	$0.00	$0.00	$0.00	$0.00	$0.00
439.991	SUP	HCPCS C1713		439.991  -  PLATE BONE 214MM 10 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,757.98 "	"$2,040.91"	$0.00	"$2,142.12"	"$1,204.94"	"$1,204.94"	$0.00	$0.00	$0.00	$574.83	"$2,046.97"	"$2,046.97"	$0.00	$0.00	$574.76	$0.00	"$1,359.68"	"$1,359.68"	$0.00	"$1,338.83"	"$2,120.70"	"$2,142.12"	$0.00		$0.00	$406.85	$0.00	$0.00	$426.28	$0.00	$0.00	$0.00	$0.00	$0.00
439.992	SUP	HCPCS C1713		439.992  -  PLATE BONE 250MM 12 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,793.10 "	"$2,066.89"	$0.00	"$2,169.40"	"$1,220.29"	"$1,220.29"	$0.00	$0.00	$0.00	$582.15	"$2,073.04"	"$2,073.04"	$0.00	$0.00	$582.08	$0.00	"$1,377.00"	"$1,377.00"	$0.00	"$1,355.88"	"$2,147.71"	"$2,169.40"	$0.00		$0.00	$412.03	$0.00	$0.00	$431.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.993	SUP	HCPCS C1713		439.993  -  PLATE BONE 250MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,793.10 "	"$2,066.89"	$0.00	"$2,169.40"	"$1,220.29"	"$1,220.29"	$0.00	$0.00	$0.00	$582.15	"$2,073.04"	"$2,073.04"	$0.00	$0.00	$582.08	$0.00	"$1,377.00"	"$1,377.00"	$0.00	"$1,355.88"	"$2,147.71"	"$2,169.40"	$0.00		$0.00	$412.03	$0.00	$0.00	$431.71	$0.00	$0.00	$0.00	$0.00	$0.00
439.994	SUP	HCPCS C1713		439.994  -  PLATE BONE 286MM 14 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,822.63 "	"$2,088.75"	$0.00	"$2,192.34"	"$1,233.19"	"$1,233.19"	$0.00	$0.00	$0.00	$588.31	"$2,094.95"	"$2,094.95"	$0.00	$0.00	$588.24	$0.00	"$1,391.55"	"$1,391.55"	$0.00	"$1,370.21"	"$2,170.42"	"$2,192.34"	$0.00		$0.00	$416.38	$0.00	$0.00	$436.28	$0.00	$0.00	$0.00	$0.00	$0.00
439.995	SUP	HCPCS C1713		439.995  -  PLATE BONE 286MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,822.63 "	"$2,088.75"	$0.00	"$2,192.34"	"$1,233.19"	"$1,233.19"	$0.00	$0.00	$0.00	$588.31	"$2,094.95"	"$2,094.95"	$0.00	$0.00	$588.24	$0.00	"$1,391.55"	"$1,391.55"	$0.00	"$1,370.21"	"$2,170.42"	"$2,192.34"	$0.00		$0.00	$416.38	$0.00	$0.00	$436.28	$0.00	$0.00	$0.00	$0.00	$0.00
439.996	SUP	HCPCS C1713		439.996  -  PLATE BONE 322MM 16 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL	BOTH IP/OP	"$2,850.75 "	"$2,109.56"	$0.00	"$2,214.18"	"$1,245.48"	"$1,245.48"	$0.00	$0.00	$0.00	$594.17	"$2,115.83"	"$2,115.83"	$0.00	$0.00	$594.10	$0.00	"$1,405.42"	"$1,405.42"	$0.00	"$1,383.86"	"$2,192.04"	"$2,214.18"	$0.00		$0.00	$420.53	$0.00	$0.00	$440.62	$0.00	$0.00	$0.00	$0.00	$0.00
439.997	SUP	HCPCS C1713		439.997  -  PLATE BONE 322MM 16 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,850.75 "	"$2,109.56"	$0.00	"$2,214.18"	"$1,245.48"	"$1,245.48"	$0.00	$0.00	$0.00	$594.17	"$2,115.83"	"$2,115.83"	$0.00	$0.00	$594.10	$0.00	"$1,405.42"	"$1,405.42"	$0.00	"$1,383.86"	"$2,192.04"	"$2,214.18"	$0.00		$0.00	$420.53	$0.00	$0.00	$440.62	$0.00	$0.00	$0.00	$0.00	$0.00
440.036	SUP	HCPCS C1713		440.036  -  PLATE BONE 82MM 4 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,666.60 "	"$1,973.28"	$0.00	"$2,071.14"	"$1,165.02"	"$1,165.02"	$0.00	$0.00	$0.00	$555.79	"$1,979.15"	"$1,979.15"	$0.00	$0.00	$555.72	$0.00	"$1,314.63"	"$1,314.63"	$0.00	"$1,294.46"	"$2,050.43"	"$2,071.14"	$0.00		$0.00	$393.37	$0.00	$0.00	$412.16	$0.00	$0.00	$0.00	$0.00	$0.00
440.037	SUP	HCPCS C1713		440.037  -  PLATE BONE 82MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,666.60 "	"$1,973.28"	$0.00	"$2,071.14"	"$1,165.02"	"$1,165.02"	$0.00	$0.00	$0.00	$555.79	"$1,979.15"	"$1,979.15"	$0.00	$0.00	$555.72	$0.00	"$1,314.63"	"$1,314.63"	$0.00	"$1,294.46"	"$2,050.43"	"$2,071.14"	$0.00		$0.00	$393.37	$0.00	$0.00	$412.16	$0.00	$0.00	$0.00	$0.00	$0.00
440.038	SUP	HCPCS C1713		440.038  -  PLATE BONE 118MM 6 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,698.93 "	"$1,997.21"	$0.00	"$2,096.26"	"$1,179.15"	"$1,179.15"	$0.00	$0.00	$0.00	$562.52	"$2,003.14"	"$2,003.14"	$0.00	$0.00	$562.46	$0.00	"$1,330.57"	"$1,330.57"	$0.00	"$1,310.16"	"$2,075.30"	"$2,096.26"	$0.00		$0.00	$398.14	$0.00	$0.00	$417.16	$0.00	$0.00	$0.00	$0.00	$0.00
440.039	SUP	HCPCS C1713		440.039  -  PLATE BONE 118MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,698.93 "	"$1,997.21"	$0.00	"$2,096.26"	"$1,179.15"	"$1,179.15"	$0.00	$0.00	$0.00	$562.52	"$2,003.14"	"$2,003.14"	$0.00	$0.00	$562.46	$0.00	"$1,330.57"	"$1,330.57"	$0.00	"$1,310.16"	"$2,075.30"	"$2,096.26"	$0.00		$0.00	$398.14	$0.00	$0.00	$417.16	$0.00	$0.00	$0.00	$0.00	$0.00
440.04	SUP	HCPCS C1713		440.040  -  PLATE BONE 154MM 8 HOLE LCP TITANIUM RIGHT PROXIMAL TIBIA	BOTH IP/OP	"$2,650.35 "	"$1,961.26"	$0.00	"$2,120.28"	"$1,192.66"	"$1,192.66"	$0.00	$0.00	$0.00	$552.40	"$1,967.09"	"$1,967.09"	$0.00	$0.00	$552.33	$0.00	"$1,306.62"	"$1,306.62"	$0.00	"$1,325.18"	"$2,099.08"	"$2,120.28"	$0.00		$0.00	$402.70	$0.00	$0.00	$421.94	$0.00	$0.00	$0.00	$0.00	$0.00
440.041	SUP	HCPCS C1713		440.041  -  PLATE BONE 154MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,729.85 "	"$2,020.09"	$0.00	"$2,120.28"	"$1,192.66"	"$1,192.66"	$0.00	$0.00	$0.00	$568.97	"$2,026.09"	"$2,026.09"	$0.00	$0.00	$568.90	$0.00	"$1,345.82"	"$1,345.82"	$0.00	"$1,325.18"	"$2,099.08"	"$2,120.28"	$0.00		$0.00	$402.70	$0.00	$0.00	$421.94	$0.00	$0.00	$0.00	$0.00	$0.00
440.042	SUP	HCPCS C1713		440.042  -  PLATE BONE 190MM 10 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,759.38 "	"$2,041.94"	$0.00	"$2,143.20"	"$1,205.55"	"$1,205.55"	$0.00	$0.00	$0.00	$575.12	"$2,048.01"	"$2,048.01"	$0.00	$0.00	$575.05	$0.00	"$1,360.37"	"$1,360.37"	$0.00	"$1,339.50"	"$2,121.77"	"$2,143.20"	$0.00		$0.00	$407.05	$0.00	$0.00	$426.50	$0.00	$0.00	$0.00	$0.00	$0.00
440.043	SUP	HCPCS C1713		440.043  -  PLATE BONE 190MM 10 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,759.38 "	"$2,041.94"	$0.00	"$2,143.20"	"$1,205.55"	"$1,205.55"	$0.00	$0.00	$0.00	$575.12	"$2,048.01"	"$2,048.01"	$0.00	$0.00	$575.05	$0.00	"$1,360.37"	"$1,360.37"	$0.00	"$1,339.50"	"$2,121.77"	"$2,143.20"	$0.00		$0.00	$407.05	$0.00	$0.00	$426.50	$0.00	$0.00	$0.00	$0.00	$0.00
440.044	SUP	HCPCS C1713		440.044  -  PLATE BONE 226MM 12 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,791.70 "	"$2,065.86"	$0.00	"$2,168.32"	"$1,219.68"	"$1,219.68"	$0.00	$0.00	$0.00	$581.86	"$2,072.00"	"$2,072.00"	$0.00	$0.00	$581.79	$0.00	"$1,376.31"	"$1,376.31"	$0.00	"$1,355.20"	"$2,146.64"	"$2,168.32"	$0.00		$0.00	$411.82	$0.00	$0.00	$431.50	$0.00	$0.00	$0.00	$0.00	$0.00
440.045	SUP	HCPCS C1713		440.045  -  PLATE BONE 226MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,791.70 "	"$2,065.86"	$0.00	"$2,168.32"	"$1,219.68"	"$1,219.68"	$0.00	$0.00	$0.00	$581.86	"$2,072.00"	"$2,072.00"	$0.00	$0.00	$581.79	$0.00	"$1,376.31"	"$1,376.31"	$0.00	"$1,355.20"	"$2,146.64"	"$2,168.32"	$0.00		$0.00	$411.82	$0.00	$0.00	$431.50	$0.00	$0.00	$0.00	$0.00	$0.00
440.046	SUP	HCPCS C1713		440.046  -  PLATE BONE 262MM 14 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL	BOTH IP/OP	"$2,821.23 "	"$2,087.71"	$0.00	"$2,191.24"	"$1,232.57"	"$1,232.57"	$0.00	$0.00	$0.00	$588.01	"$2,093.91"	"$2,093.91"	$0.00	$0.00	$587.94	$0.00	"$1,390.86"	"$1,390.86"	$0.00	"$1,369.53"	"$2,169.33"	"$2,191.24"	$0.00		$0.00	$416.18	$0.00	$0.00	$436.06	$0.00	$0.00	$0.00	$0.00	$0.00
440.047	SUP	HCPCS C1713		440.047  -  PLATE BONE 262MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL	BOTH IP/OP	"$2,821.23 "	"$2,087.71"	$0.00	"$2,191.24"	"$1,232.57"	"$1,232.57"	$0.00	$0.00	$0.00	$588.01	"$2,093.91"	"$2,093.91"	$0.00	$0.00	$587.94	$0.00	"$1,390.86"	"$1,390.86"	$0.00	"$1,369.53"	"$2,169.33"	"$2,191.24"	$0.00		$0.00	$416.18	$0.00	$0.00	$436.06	$0.00	$0.00	$0.00	$0.00	$0.00
440.05	SUP	HCPCS C1713		440.05  -  PLATE BONE 5 HOLE SPOON LC-DCP TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$626.43 	$463.56	$0.00	$501.14	$281.89	$281.89	$0.00	$0.00	$0.00	$130.56	$464.93	$464.93	$0.00	$0.00	$130.55	$0.00	$370.53	$370.53	$0.00	$313.21	$496.13	$501.14	$0.00		$0.00	$95.18	$0.00	$0.00	$99.73	$0.00	$0.00	$0.00	$0.00	$0.00
440.06	SUP	HCPCS C1713		440.06  -  PLATE BONE SPOON 6 HOLE LC DCP TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$668.73 	$494.86	$0.00	$534.98	$300.93	$300.93	$0.00	$0.00	$0.00	$139.38	$496.33	$496.33	$0.00	$0.00	$139.36	$0.00	$395.55	$395.55	$0.00	$334.36	$529.63	$534.98	$0.00		$0.00	$101.61	$0.00	$0.00	$106.46	$0.00	$0.00	$0.00	$0.00	$0.00
440.13	SUP	HCPCS C1713		440.13  -  PLATE BONE T 68MM 3 HOLE LC-DCP TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$504.95 	$373.66	$0.00	$403.96	$227.23	$227.23	$0.00	$0.00	$0.00	$105.24	$374.77	$374.77	$0.00	$0.00	$105.23	$0.00	$298.68	$298.68	$0.00	$252.48	$399.92	$403.96	$0.00		$0.00	$76.72	$0.00	$0.00	$80.39	$0.00	$0.00	$0.00	$0.00	$0.00
440.14	SUP	HCPCS C1713		440.14  -  PLATE BONE T 84MM 4 HOLE LC-DCP TITANIUM HUMERUS TIBIAL	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$247.50	$247.50	$0.00	$0.00	$0.00	$114.63	$408.21	$408.21	$0.00	$0.00	$114.62	$0.00	$325.33	$325.33	$0.00	$275.00	$435.60	$440.00	$0.00		$0.00	$83.57	$0.00	$0.00	$87.56	$0.00	$0.00	$0.00	$0.00	$0.00
440.141	SUP	HCPCS C1713		440.141  -  PLATE BONE 83MM 4 HOLE T LCP TITANIUM ORTHOPEDIC NONSTRL 4.5	BOTH IP/OP	"$1,137.20 "	$841.53	$0.00	$883.26	$496.83	$496.83	$0.00	$0.00	$0.00	$237.02	$844.03	$844.03	$0.00	$0.00	$236.99	$0.00	$672.65	$672.65	$0.00	$552.04	$874.43	$883.26	$0.00		$0.00	$167.76	$0.00	$0.00	$175.77	$0.00	$0.00	$0.00	$0.00	$0.00
440.15	SUP	HCPCS C1713		440.15  -  PLATE BONE T 100MM 5 HOLE LC-DCP TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$577.30 	$427.20	$0.00	$461.84	$259.79	$259.79	$0.00	$0.00	$0.00	$120.32	$428.47	$428.47	$0.00	$0.00	$120.31	$0.00	$341.47	$341.47	$0.00	$288.65	$457.22	$461.84	$0.00		$0.00	$87.71	$0.00	$0.00	$91.91	$0.00	$0.00	$0.00	$0.00	$0.00
440.16	SUP	HCPCS C1713		440.16  -  PLATE BONE T 116MM 6 HOLE LC-DCP TITANIUM HUMERUS TIBIAL	BOTH IP/OP	$656.45 	$485.77	$0.00	$525.16	$295.40	$295.40	$0.00	$0.00	$0.00	$136.82	$487.22	$487.22	$0.00	$0.00	$136.80	$0.00	$388.29	$388.29	$0.00	$328.23	$519.91	$525.16	$0.00		$0.00	$99.74	$0.00	$0.00	$104.51	$0.00	$0.00	$0.00	$0.00	$0.00
440.161	SUP	HCPCS C1713		440.161  -  PLATE BONE 115MM 6 HOLE T LCP TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	"$1,304.48 "	$965.32	$0.00	"$1,013.20"	$569.93	$569.93	$0.00	$0.00	$0.00	$271.89	$968.18	$968.18	$0.00	$0.00	$271.85	$0.00	$771.60	$771.60	$0.00	$633.25	"$1,003.07"	"$1,013.20"	$0.00		$0.00	$192.43	$0.00	$0.00	$201.63	$0.00	$0.00	$0.00	$0.00	$0.00
440.18	SUP	HCPCS C1713		440.18  -  PLATE BONE T 148MM 8 HOLE LC-DCP TITANIUM HUMERUS TIBIAL	BOTH IP/OP	$865.25 	$640.29	$0.00	$692.20	$389.36	$389.36	$0.00	$0.00	$0.00	$180.34	$642.19	$642.19	$0.00	$0.00	$180.32	$0.00	$511.80	$511.80	$0.00	$432.63	$685.28	$692.20	$0.00		$0.00	$131.47	$0.00	$0.00	$137.75	$0.00	$0.00	$0.00	$0.00	$0.00
440.181	SUP	HCPCS C1713		440.181  -  PLATE BONE 147MM 8 HOLE T LCP TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	"$1,505.50 "	"$1,114.07"	$0.00	"$1,169.32"	$657.74	$657.74	$0.00	$0.00	$0.00	$313.78	"$1,117.38"	"$1,117.38"	$0.00	$0.00	$313.75	$0.00	$890.50	$890.50	$0.00	$730.83	"$1,157.63"	"$1,169.32"	$0.00		$0.00	$222.09	$0.00	$0.00	$232.69	$0.00	$0.00	$0.00	$0.00	$0.00
440.34	SUP	HCPCS C1713		440.34  -  PLATE BONE T BUTTRESS 80MM 4 HOLE LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$839.33 	$621.10	$0.00	$671.46	$377.70	$377.70	$0.00	$0.00	$0.00	$174.94	$622.95	$622.95	$0.00	$0.00	$174.92	$0.00	$496.46	$496.46	$0.00	$419.66	$664.75	$671.46	$0.00		$0.00	$127.53	$0.00	$0.00	$133.62	$0.00	$0.00	$0.00	$0.00	$0.00
440.35	SUP	HCPCS C1713		440.35  -  PLATE BONE T BUTTRESS 96MM 5 HOLE LC-DCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$883.00 	$653.42	$0.00	$706.40	$397.35	$397.35	$0.00	$0.00	$0.00	$184.04	$655.36	$655.36	$0.00	$0.00	$184.02	$0.00	$522.29	$522.29	$0.00	$441.50	$699.34	$706.40	$0.00		$0.00	$134.16	$0.00	$0.00	$140.57	$0.00	$0.00	$0.00	$0.00	$0.00
440.36	SUP	HCPCS C1713		440.36  -  PLATE BONE T BUTTRESS 112MM 6 HOLE LC-DCP TITANIUM	BOTH IP/OP	$913.03 	$675.64	$0.00	$730.42	$410.86	$410.86	$0.00	$0.00	$0.00	$190.30	$677.65	$677.65	$0.00	$0.00	$190.27	$0.00	$540.05	$540.05	$0.00	$456.51	$723.12	$730.42	$0.00		$0.00	$138.73	$0.00	$0.00	$145.35	$0.00	$0.00	$0.00	$0.00	$0.00
440.44	SUP	HCPCS C1713		440.44  -  PLATE BN ANG LT L BTRS 86X14X3.8MM NS LC DCP 4 HL SHFT TI	BOTH IP/OP	$756.28 	$559.65	$0.00	$587.38	$330.40	$330.40	$0.00	$0.00	$0.00	$157.63	$561.31	$561.31	$0.00	$0.00	$157.61	$0.00	$447.34	$447.34	$0.00	$367.11	$581.51	$587.38	$0.00		$0.00	$111.56	$0.00	$0.00	$116.89	$0.00	$0.00	$0.00	$0.00	$0.00
440.515	SUP	HCPCS C1713		440.515  -  PLATE BONE 130MM 5 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD	BOTH IP/OP	"$1,396.15 "	"$1,033.15"	$0.00	"$1,116.92"	$628.27	$628.27	$0.00	$0.00	$0.00	$290.99	"$1,036.22"	"$1,036.22"	$0.00	$0.00	$290.96	$0.00	$825.82	$825.82	$0.00	$698.08	"$1,105.75"	"$1,116.92"	$0.00		$0.00	$212.13	$0.00	$0.00	$222.27	$0.00	$0.00	$0.00	$0.00	$0.00
440.517	SUP	HCPCS C1713		440.517  -  PLATE BONE 166MM 7 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD	BOTH IP/OP	"$1,495.78 "	"$1,106.88"	$0.00	"$1,196.62"	$673.10	$673.10	$0.00	$0.00	$0.00	$311.76	"$1,110.16"	"$1,110.16"	$0.00	$0.00	$311.72	$0.00	$884.75	$884.75	$0.00	$747.89	"$1,184.66"	"$1,196.62"	$0.00		$0.00	$227.27	$0.00	$0.00	$238.13	$0.00	$0.00	$0.00	$0.00	$0.00
440.519	SUP	HCPCS C1713		440.519  -  PLATE BONE 202MM 9 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD	BOTH IP/OP	"$1,604.95 "	"$1,187.66"	$0.00	"$1,283.96"	$722.23	$722.23	$0.00	$0.00	$0.00	$334.51	"$1,191.19"	"$1,191.19"	$0.00	$0.00	$334.47	$0.00	$949.33	$949.33	$0.00	$802.48	"$1,271.12"	"$1,283.96"	$0.00		$0.00	$243.86	$0.00	$0.00	$255.51	$0.00	$0.00	$0.00	$0.00	$0.00
440.521	SUP	HCPCS C1713		440.521  -  PLATE BONE 238MM 11 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL	BOTH IP/OP	"$1,708.68 "	"$1,264.42"	$0.00	"$1,366.94"	$768.90	$768.90	$0.00	$0.00	$0.00	$356.13	"$1,268.18"	"$1,268.18"	$0.00	$0.00	$356.09	$0.00	"$1,010.68"	"$1,010.68"	$0.00	$854.34	"$1,353.27"	"$1,366.94"	$0.00		$0.00	$259.62	$0.00	$0.00	$272.02	$0.00	$0.00	$0.00	$0.00	$0.00
440.523	SUP	HCPCS C1713		440.523  -  PLATE BONE 274MM 13 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL	BOTH IP/OP	"$1,776.90 "	"$1,314.91"	$0.00	"$1,421.52"	$799.61	$799.61	$0.00	$0.00	$0.00	$370.35	"$1,318.82"	"$1,318.82"	$0.00	$0.00	$370.31	$0.00	"$1,051.04"	"$1,051.04"	$0.00	$888.45	"$1,407.30"	"$1,421.52"	$0.00		$0.00	$269.99	$0.00	$0.00	$282.88	$0.00	$0.00	$0.00	$0.00	$0.00
440.525	SUP	HCPCS C1713		440.525  -  PLATE BONE 130MM 5 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD	BOTH IP/OP	"$1,396.15 "	"$1,033.15"	$0.00	"$1,116.92"	$628.27	$628.27	$0.00	$0.00	$0.00	$290.99	"$1,036.22"	"$1,036.22"	$0.00	$0.00	$290.96	$0.00	$825.82	$825.82	$0.00	$698.08	"$1,105.75"	"$1,116.92"	$0.00		$0.00	$212.13	$0.00	$0.00	$222.27	$0.00	$0.00	$0.00	$0.00	$0.00
440.527	SUP	HCPCS C1713		440.527  -  PLATE BONE 166MM 7 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD	BOTH IP/OP	"$1,495.78 "	"$1,106.88"	$0.00	"$1,196.62"	$673.10	$673.10	$0.00	$0.00	$0.00	$311.76	"$1,110.16"	"$1,110.16"	$0.00	$0.00	$311.72	$0.00	$884.75	$884.75	$0.00	$747.89	"$1,184.66"	"$1,196.62"	$0.00		$0.00	$227.27	$0.00	$0.00	$238.13	$0.00	$0.00	$0.00	$0.00	$0.00
440.529	SUP	HCPCS C1713		440.529  -  PLATE BONE 202MM 9 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD	BOTH IP/OP	"$1,604.95 "	"$1,187.66"	$0.00	"$1,283.96"	$722.23	$722.23	$0.00	$0.00	$0.00	$334.51	"$1,191.19"	"$1,191.19"	$0.00	$0.00	$334.47	$0.00	$949.33	$949.33	$0.00	$802.48	"$1,271.12"	"$1,283.96"	$0.00		$0.00	$243.86	$0.00	$0.00	$255.51	$0.00	$0.00	$0.00	$0.00	$0.00
440.531	SUP	HCPCS C1713		440.531  -  PLATE BONE 238MM 11 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL	BOTH IP/OP	"$1,708.68 "	"$1,264.42"	$0.00	"$1,366.94"	$768.90	$768.90	$0.00	$0.00	$0.00	$356.13	"$1,268.18"	"$1,268.18"	$0.00	$0.00	$356.09	$0.00	"$1,010.68"	"$1,010.68"	$0.00	$854.34	"$1,353.27"	"$1,366.94"	$0.00		$0.00	$259.62	$0.00	$0.00	$272.02	$0.00	$0.00	$0.00	$0.00	$0.00
440.533	SUP	HCPCS C1713		440.533  -  PLATE BONE 274MM 13 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL	BOTH IP/OP	"$1,776.90 "	"$1,314.91"	$0.00	"$1,421.52"	$799.61	$799.61	$0.00	$0.00	$0.00	$370.35	"$1,318.82"	"$1,318.82"	$0.00	$0.00	$370.31	$0.00	"$1,051.04"	"$1,051.04"	$0.00	$888.45	"$1,407.30"	"$1,421.52"	$0.00		$0.00	$269.99	$0.00	$0.00	$282.88	$0.00	$0.00	$0.00	$0.00	$0.00
440.54	SUP	HCPCS C1713		440.54  -  PLATE BN ANG RT L BTRS 86X14X3.8MM NS LC DCP 4 HL SHFT TI	BOTH IP/OP	$754.70 	$558.48	$0.00	$603.76	$339.62	$339.62	$0.00	$0.00	$0.00	$157.30	$560.14	$560.14	$0.00	$0.00	$157.28	$0.00	$446.41	$446.41	$0.00	$377.35	$597.72	$603.76	$0.00		$0.00	$114.67	$0.00	$0.00	$120.15	$0.00	$0.00	$0.00	$0.00	$0.00
440.547	SUP	HCPCS C1713		440.547  -  PLATE BONE 177MM 7 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE	BOTH IP/OP	"$1,695.03 "	"$1,254.32"	$0.00	"$1,356.02"	$762.76	$762.76	$0.00	$0.00	$0.00	$353.29	"$1,258.05"	"$1,258.05"	$0.00	$0.00	$353.24	$0.00	"$1,002.61"	"$1,002.61"	$0.00	$847.51	"$1,342.46"	"$1,356.02"	$0.00		$0.00	$257.54	$0.00	$0.00	$269.85	$0.00	$0.00	$0.00	$0.00	$0.00
440.549	SUP	HCPCS C1713		440.549  -  PLATE BONE 213MM 9 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE	BOTH IP/OP	"$1,744.15 "	"$1,290.67"	$0.00	"$1,395.32"	$784.87	$784.87	$0.00	$0.00	$0.00	$363.52	"$1,294.51"	"$1,294.51"	$0.00	$0.00	$363.48	$0.00	"$1,031.66"	"$1,031.66"	$0.00	$872.08	"$1,381.37"	"$1,395.32"	$0.00		$0.00	$265.01	$0.00	$0.00	$277.67	$0.00	$0.00	$0.00	$0.00	$0.00
440.551	SUP	HCPCS C1713		440.551  -  PLATE BONE 249MM 11 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE	BOTH IP/OP	"$1,786.45 "	"$1,321.97"	$0.00	"$1,429.16"	$803.90	$803.90	$0.00	$0.00	$0.00	$372.34	"$1,325.90"	"$1,325.90"	$0.00	$0.00	$372.30	$0.00	"$1,056.69"	"$1,056.69"	$0.00	$893.23	"$1,414.87"	"$1,429.16"	$0.00		$0.00	$271.44	$0.00	$0.00	$284.40	$0.00	$0.00	$0.00	$0.00	$0.00
440.553	SUP	HCPCS C1713		440.553  -  PLATE BONE 285MM 13 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE	BOTH IP/OP	"$1,845.15 "	"$1,365.41"	$0.00	"$1,476.12"	$830.32	$830.32	$0.00	$0.00	$0.00	$384.58	"$1,369.47"	"$1,369.47"	$0.00	$0.00	$384.53	$0.00	"$1,091.41"	"$1,091.41"	$0.00	$922.58	"$1,461.36"	"$1,476.12"	$0.00		$0.00	$280.35	$0.00	$0.00	$293.75	$0.00	$0.00	$0.00	$0.00	$0.00
440.555	SUP	HCPCS C1713		440.555  -  PLATE BONE 321MM 11 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE	BOTH IP/OP	"$1,918.85 "	"$1,419.95"	$0.00	"$1,535.08"	$863.48	$863.48	$0.00	$0.00	$0.00	$399.94	"$1,424.17"	"$1,424.17"	$0.00	$0.00	$399.89	$0.00	"$1,135.00"	"$1,135.00"	$0.00	$959.43	"$1,519.73"	"$1,535.08"	$0.00		$0.00	$291.55	$0.00	$0.00	$305.48	$0.00	$0.00	$0.00	$0.00	$0.00
440.567	SUP	HCPCS C1713		440.567  -  PLATE BONE 177MM 7 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE	BOTH IP/OP	"$1,695.03 "	"$1,254.32"	$0.00	"$1,356.02"	$762.76	$762.76	$0.00	$0.00	$0.00	$353.29	"$1,258.05"	"$1,258.05"	$0.00	$0.00	$353.24	$0.00	"$1,002.61"	"$1,002.61"	$0.00	$847.51	"$1,342.46"	"$1,356.02"	$0.00		$0.00	$257.54	$0.00	$0.00	$269.85	$0.00	$0.00	$0.00	$0.00	$0.00
440.569	SUP	HCPCS C1713		440.569  -  PLATE BONE 213MM 9 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE	BOTH IP/OP	"$1,696.38 "	"$1,255.32"	$0.00	"$1,357.10"	$763.37	$763.37	$0.00	$0.00	$0.00	$353.57	"$1,259.05"	"$1,259.05"	$0.00	$0.00	$353.52	$0.00	"$1,003.41"	"$1,003.41"	$0.00	$848.19	"$1,343.53"	"$1,357.10"	$0.00		$0.00	$257.75	$0.00	$0.00	$270.06	$0.00	$0.00	$0.00	$0.00	$0.00
440.571	SUP	HCPCS C1713		440.571  -  PLATE BONE 249MM 11 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE	BOTH IP/OP	"$1,786.45 "	"$1,321.97"	$0.00	"$1,429.16"	$803.90	$803.90	$0.00	$0.00	$0.00	$372.34	"$1,325.90"	"$1,325.90"	$0.00	$0.00	$372.30	$0.00	"$1,056.69"	"$1,056.69"	$0.00	$893.23	"$1,414.87"	"$1,429.16"	$0.00		$0.00	$271.44	$0.00	$0.00	$284.40	$0.00	$0.00	$0.00	$0.00	$0.00
440.573	SUP	HCPCS C1713		440.573  -  PLATE BONE 285MM 13 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE	BOTH IP/OP	"$1,791.40 "	"$1,325.64"	$0.00	"$1,433.12"	$806.13	$806.13	$0.00	$0.00	$0.00	$373.37	"$1,329.58"	"$1,329.58"	$0.00	$0.00	$373.33	$0.00	"$1,059.61"	"$1,059.61"	$0.00	$895.70	"$1,418.79"	"$1,433.12"	$0.00		$0.00	$280.35	$0.00	$0.00	$285.19	$0.00	$0.00	$0.00	$0.00	$0.00
440.575	SUP	HCPCS C1713		440.575  -  PLATE BONE 321MM 15 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE	BOTH IP/OP	"$1,862.95 "	"$1,378.58"	$0.00	"$1,490.36"	$838.33	$838.33	$0.00	$0.00	$0.00	$388.29	"$1,382.68"	"$1,382.68"	$0.00	$0.00	$388.24	$0.00	"$1,101.93"	"$1,101.93"	$0.00	$931.48	"$1,475.46"	"$1,490.36"	$0.00		$0.00	$291.55	$0.00	$0.00	$296.58	$0.00	$0.00	$0.00	$0.00	$0.00
440.831	SUP	HCPCS C1713		440.831  -  PLATE BONE SMALL 4 HOLE HIGH TOMOFIX TITANIUM TIBIAL MEDIAL	BOTH IP/OP	"$2,445.90 "	"$1,809.97"	$0.00	"$1,899.74"	"$1,068.60"	"$1,068.60"	$0.00	$0.00	$0.00	$509.79	"$1,815.35"	"$1,815.35"	$0.00	$0.00	$509.73	$0.00	"$1,446.75"	"$1,446.75"	$0.00	"$1,187.34"	"$1,880.75"	"$1,899.74"	$0.00		$0.00	$360.81	$0.00	$0.00	$378.05	$0.00	$0.00	$0.00	$0.00	$0.00
440.834	SUP	HCPCS C1713		440.834  -  PLATE BONE 4 HOLE HIGH TOMOFIX TITANIUM TIBIAL MEDIAL	BOTH IP/OP	"$2,445.90 "	"$1,809.97"	$0.00	"$1,899.74"	"$1,068.60"	"$1,068.60"	$0.00	$0.00	$0.00	$509.79	"$1,815.35"	"$1,815.35"	$0.00	$0.00	$509.73	$0.00	"$1,446.75"	"$1,446.75"	$0.00	"$1,187.34"	"$1,880.75"	"$1,899.74"	$0.00		$0.00	$360.81	$0.00	$0.00	$378.05	$0.00	$0.00	$0.00	$0.00	$0.00
440.843	SUP	HCPCS C1713		440.843  -  PLATE BONE 3 HOLE TOMOFIX TITANIUM TIBIA RIGHT LATERAL	BOTH IP/OP	"$2,445.90 "	"$1,809.97"	$0.00	"$1,899.74"	"$1,068.60"	"$1,068.60"	$0.00	$0.00	$0.00	$509.79	"$1,815.35"	"$1,815.35"	$0.00	$0.00	$509.73	$0.00	"$1,446.75"	"$1,446.75"	$0.00	"$1,187.34"	"$1,880.75"	"$1,899.74"	$0.00		$0.00	$360.81	$0.00	$0.00	$378.05	$0.00	$0.00	$0.00	$0.00	$0.00
440.853	SUP	HCPCS C1713		440.853  -  PLATE BONE 3 HOLE TOMOFIX TITANIUM TIBIA LEFT LATERAL	BOTH IP/OP	"$2,445.90 "	"$1,809.97"	$0.00	"$1,899.74"	"$1,068.60"	"$1,068.60"	$0.00	$0.00	$0.00	$509.79	"$1,815.35"	"$1,815.35"	$0.00	$0.00	$509.73	$0.00	"$1,446.75"	"$1,446.75"	$0.00	"$1,187.34"	"$1,880.75"	"$1,899.74"	$0.00		$0.00	$360.81	$0.00	$0.00	$378.05	$0.00	$0.00	$0.00	$0.00	$0.00
440.864	SUP	HCPCS C1713		440.864  -  PLATE BONE 4 HOLE TOMOFIX TITANIUM FEMUR RIGHT DISTAL	BOTH IP/OP	"$2,445.90 "	"$1,809.97"	$0.00	"$1,899.74"	"$1,068.60"	"$1,068.60"	$0.00	$0.00	$0.00	$509.79	"$1,815.35"	"$1,815.35"	$0.00	$0.00	$509.73	$0.00	"$1,446.75"	"$1,446.75"	$0.00	"$1,187.34"	"$1,880.75"	"$1,899.74"	$0.00		$0.00	$360.81	$0.00	$0.00	$378.05	$0.00	$0.00	$0.00	$0.00	$0.00
440.874	SUP	HCPCS C1713		440.874  -  PLATE BONE 4 HOLE TOMOFIX TITANIUM FEMUR LEFT DISTAL LATERAL	BOTH IP/OP	"$2,445.90 "	"$1,809.97"	$0.00	"$1,899.74"	"$1,068.60"	"$1,068.60"	$0.00	$0.00	$0.00	$509.79	"$1,815.35"	"$1,815.35"	$0.00	$0.00	$509.73	$0.00	"$1,446.75"	"$1,446.75"	$0.00	"$1,187.34"	"$1,880.75"	"$1,899.74"	$0.00		$0.00	$360.81	$0.00	$0.00	$378.05	$0.00	$0.00	$0.00	$0.00	$0.00
440.885	SUP	HCPCS C1713		440.885  -  PLATE BONE 121MM 4 HOLE TOMOFIX TITANIUM RIGHT MEDIAL DISTAL	BOTH IP/OP	"$2,305.50 "	"$1,706.07"	$0.00	"$1,844.40"	"$1,037.48"	"$1,037.48"	$0.00	$0.00	$0.00	$480.52	"$1,711.14"	"$1,711.14"	$0.00	$0.00	$480.47	$0.00	"$1,363.70"	"$1,363.70"	$0.00	"$1,152.75"	"$1,825.96"	"$1,844.40"	$0.00		$0.00	$360.81	$0.00	$0.00	$367.04	$0.00	$0.00	$0.00	$0.00	$0.00
440.895	SUP	HCPCS C1713		440.895  -  PLATE BONE 121MM 4 HOLE TOMOFIX TITANIUM LEFT MEDIAL DISTAL	BOTH IP/OP	"$2,305.50 "	"$1,706.07"	$0.00	"$1,844.40"	"$1,037.48"	"$1,037.48"	$0.00	$0.00	$0.00	$480.52	"$1,711.14"	"$1,711.14"	$0.00	$0.00	$480.47	$0.00	"$1,363.70"	"$1,363.70"	$0.00	"$1,152.75"	"$1,825.96"	"$1,844.40"	$0.00		$0.00	$360.81	$0.00	$0.00	$367.04	$0.00	$0.00	$0.00	$0.00	$0.00
441.031	SUP	HCPCS C1713		441.031  -  PLATE BONE T OBLIQUE RIGHT 52X10X1.5MM 3 HOLE HEAD 3 HOLE	BOTH IP/OP	$684.58 	$506.59	$0.00	$531.70	$299.08	$299.08	$0.00	$0.00	$0.00	$142.68	$508.09	$508.09	$0.00	$0.00	$142.67	$0.00	$404.93	$404.93	$0.00	$332.31	$526.39	$531.70	$0.00		$0.00	$100.99	$0.00	$0.00	$105.81	$0.00	$0.00	$0.00	$0.00	$0.00
441.041	SUP	HCPCS C1713		441.041  -  PLATE BONE T OBLIQUE RIGHT 63X10X1.5MM 3 HOLE HEAD 4 HOLE	BOTH IP/OP	$716.90 	$530.51	$0.00	$556.82	$313.21	$313.21	$0.00	$0.00	$0.00	$149.42	$532.08	$532.08	$0.00	$0.00	$149.40	$0.00	$424.05	$424.05	$0.00	$348.01	$551.26	$556.82	$0.00		$0.00	$105.75	$0.00	$0.00	$110.81	$0.00	$0.00	$0.00	$0.00	$0.00
441.051	SUP	HCPCS C1713		441.051  -  PLATE BONE T OBLIQUE RIGHT 74X10X1.5MM 3 HOLE HEAD 5 HOLE	BOTH IP/OP	$747.83 	$553.39	$0.00	$580.84	$326.72	$326.72	$0.00	$0.00	$0.00	$155.87	$555.04	$555.04	$0.00	$0.00	$155.85	$0.00	$442.34	$442.34	$0.00	$363.03	$575.03	$580.84	$0.00		$0.00	$110.32	$0.00	$0.00	$115.59	$0.00	$0.00	$0.00	$0.00	$0.00
441.061	SUP	HCPCS C1713		441.061  -  PLATE BONE 85MM 3 HOLE HEAD 6 HOLE SHAFT T OBLIQUE RIGHT LCP	BOTH IP/OP	$802.65 	$593.96	$0.00	$623.42	$350.67	$350.67	$0.00	$0.00	$0.00	$167.29	$595.73	$595.73	$0.00	$0.00	$167.27	$0.00	$474.77	$474.77	$0.00	$389.64	$617.19	$623.42	$0.00		$0.00	$118.40	$0.00	$0.00	$124.06	$0.00	$0.00	$0.00	$0.00	$0.00
441.062	SUP	HCPCS C1713		441.062  -  PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE	BOTH IP/OP	"$1,307.78 "	$967.76	$0.00	"$1,046.22"	$588.50	$588.50	$0.00	$0.00	$0.00	$272.57	$970.63	$970.63	$0.00	$0.00	$272.54	$0.00	$773.55	$773.55	$0.00	$653.89	"$1,035.76"	"$1,046.22"	$0.00		$0.00	$204.67	$0.00	$0.00	$208.20	$0.00	$0.00	$0.00	$0.00	$0.00
441.063	SUP	HCPCS C1713		441.063  -  PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,307.78 "	$967.76	$0.00	"$1,046.22"	$588.50	$588.50	$0.00	$0.00	$0.00	$272.57	$970.63	$970.63	$0.00	$0.00	$272.54	$0.00	$773.55	$773.55	$0.00	$653.89	"$1,035.76"	"$1,046.22"	$0.00		$0.00	$204.67	$0.00	$0.00	$208.20	$0.00	$0.00	$0.00	$0.00	$0.00
441.064	SUP	HCPCS C1713		441.064  -  PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE	BOTH IP/OP	"$1,307.78 "	$967.76	$0.00	"$1,046.22"	$588.50	$588.50	$0.00	$0.00	$0.00	$272.57	$970.63	$970.63	$0.00	$0.00	$272.54	$0.00	$773.55	$773.55	$0.00	$653.89	"$1,035.76"	"$1,046.22"	$0.00		$0.00	$204.67	$0.00	$0.00	$208.20	$0.00	$0.00	$0.00	$0.00	$0.00
441.065	SUP	HCPCS C1713		441.065  -  PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,307.78 "	$967.76	$0.00	"$1,046.22"	$588.50	$588.50	$0.00	$0.00	$0.00	$272.57	$970.63	$970.63	$0.00	$0.00	$272.54	$0.00	$773.55	$773.55	$0.00	$653.89	"$1,035.76"	"$1,046.22"	$0.00		$0.00	$204.67	$0.00	$0.00	$208.20	$0.00	$0.00	$0.00	$0.00	$0.00
441.066	SUP	HCPCS C1713		441.066  -  PLATE BONE 15MM 8 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE	BOTH IP/OP	"$1,403.18 "	"$1,038.35"	$0.00	"$1,122.54"	$631.43	$631.43	$0.00	$0.00	$0.00	$292.46	"$1,041.44"	"$1,041.44"	$0.00	$0.00	$292.42	$0.00	$829.98	$829.98	$0.00	$701.59	"$1,111.32"	"$1,122.54"	$0.00		$0.00	$219.60	$0.00	$0.00	$223.39	$0.00	$0.00	$0.00	$0.00	$0.00
441.067	SUP	HCPCS C1713		441.067  -  PLATE BONE 15MM 8 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,403.18 "	"$1,038.35"	$0.00	"$1,122.54"	$631.43	$631.43	$0.00	$0.00	$0.00	$292.46	"$1,041.44"	"$1,041.44"	$0.00	$0.00	$292.42	$0.00	$829.98	$829.98	$0.00	$701.59	"$1,111.32"	"$1,122.54"	$0.00		$0.00	$219.60	$0.00	$0.00	$223.39	$0.00	$0.00	$0.00	$0.00	$0.00
441.068	SUP	HCPCS C1713		441.068  -  PLATE BN 18MM 3.5MM 77MM NS 8 HL HK TI CLVCL RT 3.5MM 4MM	BOTH IP/OP	"$1,403.18 "	"$1,038.35"	$0.00	"$1,122.54"	$631.43	$631.43	$0.00	$0.00	$0.00	$292.46	"$1,041.44"	"$1,041.44"	$0.00	$0.00	$292.42	$0.00	$829.98	$829.98	$0.00	$701.59	"$1,111.32"	"$1,122.54"	$0.00		$0.00	$219.60	$0.00	$0.00	$223.39	$0.00	$0.00	$0.00	$0.00	$0.00
441.069	SUP	HCPCS C1713		441.069  -  PLATE BONE 18MM 77MM 8 HOLE HOOK TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,403.18 "	"$1,038.35"	$0.00	"$1,122.54"	$631.43	$631.43	$0.00	$0.00	$0.00	$292.46	"$1,041.44"	"$1,041.44"	$0.00	$0.00	$292.42	$0.00	$829.98	$829.98	$0.00	$701.59	"$1,111.32"	"$1,122.54"	$0.00		$0.00	$219.60	$0.00	$0.00	$223.39	$0.00	$0.00	$0.00	$0.00	$0.00
441.071	SUP	HCPCS C1713		441.071  -  PLATE BONE T RIGHT OBLIQUE 96MM 7 HOLE SHAFT 3 HOLE HEAD LCP	BOTH IP/OP	$812.50 	$601.25	$0.00	$631.06	$354.97	$354.97	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$394.41	$624.75	$631.06	$0.00		$0.00	$119.86	$0.00	$0.00	$125.58	$0.00	$0.00	$0.00	$0.00	$0.00
441.081	SUP	HCPCS C1713		441.081  -  PLATE BONE 107MM 3X8 HOLE T OBLIQUE RIGHT LCP TITANIUM	BOTH IP/OP	$882.78 	$653.26	$0.00	$685.66	$385.68	$385.68	$0.00	$0.00	$0.00	$183.99	$655.20	$655.20	$0.00	$0.00	$183.97	$0.00	$522.16	$522.16	$0.00	$428.54	$678.81	$685.66	$0.00		$0.00	$130.22	$0.00	$0.00	$136.45	$0.00	$0.00	$0.00	$0.00	$0.00
441.13	SUP	HCPCS C1713		441.13  -  PLATE BONE T RIGHT ANG 50X10X1.2MM 3X3 HOLE LC-DCP TITANIUM	BOTH IP/OP	$232.00 	$171.68	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$48.35	$172.19	$172.19	$0.00	$0.00	$48.35	$0.00	$137.23	$137.23	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
441.131	SUP	HCPCS C1713		441.131  -  PLATE BONE T RIGHT ANG 50X10X1.5MM 3 HOLE HEAD 3 HOLE SHAFT	BOTH IP/OP	$611.48 	$452.50	$0.00	$474.94	$267.15	$267.15	$0.00	$0.00	$0.00	$127.45	$453.84	$453.84	$0.00	$0.00	$127.43	$0.00	$361.69	$361.69	$0.00	$296.84	$470.19	$474.94	$0.00		$0.00	$90.20	$0.00	$0.00	$94.51	$0.00	$0.00	$0.00	$0.00	$0.00
441.132	SUP	HCPCS C1713		441.132  -  PLATE BONE 50MM 4 HEAD HOLE 3 SHAFT HOLE T RIGHT ANG LCP	BOTH IP/OP	$629.75 	$466.02	$0.00	$489.12	$275.13	$275.13	$0.00	$0.00	$0.00	$131.26	$467.40	$467.40	$0.00	$0.00	$131.24	$0.00	$372.50	$372.50	$0.00	$305.70	$484.23	$489.12	$0.00		$0.00	$92.90	$0.00	$0.00	$97.33	$0.00	$0.00	$0.00	$0.00	$0.00
441.14	SUP	HCPCS C1713		441.14  -  PLATE BONE 3.5MM 56MM T 4 HEAD HOLE 4 SHAFT HOLE RIGHT ANG	BOTH IP/OP	$240.20 	$177.75	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$50.06	$178.28	$178.28	$0.00	$0.00	$50.06	$0.00	$142.08	$142.08	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
441.141	SUP	HCPCS C1713		441.141  -  PLATE BONE T RIGHT ANG 56X11X1.5MM 4 HOLE HEAD 4 HOLE SHAFT	BOTH IP/OP	$631.15 	$467.05	$0.00	$490.22	$275.75	$275.75	$0.00	$0.00	$0.00	$131.55	$468.44	$468.44	$0.00	$0.00	$131.53	$0.00	$373.33	$373.33	$0.00	$306.39	$485.32	$490.22	$0.00		$0.00	$93.11	$0.00	$0.00	$97.55	$0.00	$0.00	$0.00	$0.00	$0.00
441.142	SUP	HCPCS C1713		441.142  -  PLATE BONE 57MM 3 HOLE HEAD 4 HOLE SHAFT T RIGHT ANG LCP	BOTH IP/OP	$650.83 	$481.61	$0.00	$505.50	$284.34	$284.34	$0.00	$0.00	$0.00	$135.65	$483.04	$483.04	$0.00	$0.00	$135.63	$0.00	$384.96	$384.96	$0.00	$315.94	$500.45	$505.50	$0.00		$0.00	$96.01	$0.00	$0.00	$100.59	$0.00	$0.00	$0.00	$0.00	$0.00
441.15	SUP	HCPCS C1713		441.15  -  PLATE BONE T RIGHT ANG 67X10X1.2MM 3X5 HOLE LC-DCP TITANIUM	BOTH IP/OP	$266.13 	$196.94	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$55.47	$197.52	$197.52	$0.00	$0.00	$55.46	$0.00	$157.41	$157.41	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
441.151	SUP	HCPCS C1713		441.151  -  PLATE BONE T RIGHT ANG 67X10X1.5MM 3 HOLE HEAD 5 HOLE SHAFT	BOTH IP/OP	$694.40 	$513.86	$0.00	$539.34	$303.38	$303.38	$0.00	$0.00	$0.00	$144.73	$515.38	$515.38	$0.00	$0.00	$144.71	$0.00	$410.74	$410.74	$0.00	$337.09	$533.95	$539.34	$0.00		$0.00	$102.44	$0.00	$0.00	$107.33	$0.00	$0.00	$0.00	$0.00	$0.00
441.152	SUP	HCPCS C1713		441.152  -  PLATE BONE 67MM 4 HEAD HOLE 5 SHAFT HOLE T RIGHT ANG LCP	BOTH IP/OP	$715.50 	$529.47	$0.00	$555.72	$312.59	$312.59	$0.00	$0.00	$0.00	$149.13	$531.04	$531.04	$0.00	$0.00	$149.11	$0.00	$423.22	$423.22	$0.00	$347.33	$550.16	$555.72	$0.00		$0.00	$105.55	$0.00	$0.00	$110.59	$0.00	$0.00	$0.00	$0.00	$0.00
441.16	SUP	HCPCS C1713		441.16  -  PLATE BONE T RIGHT ANG 78X10X1.2MM 4X6 HOLE LC-DCP TITANIUM	BOTH IP/OP	$302.10 	$223.55	$0.00	$241.68	$135.95	$135.95	$0.00	$0.00	$0.00	$62.97	$224.22	$224.22	$0.00	$0.00	$62.96	$0.00	$178.69	$178.69	$0.00	$151.05	$239.26	$241.68	$0.00		$0.00	$47.28	$0.00	$0.00	$48.09	$0.00	$0.00	$0.00	$0.00	$0.00
441.161	SUP	HCPCS C1713		441.161  -  PLATE BONE T RIGHT ANG 78X11X1.5MM 4 HOLE HEAD 6 HOLE SHAFT	BOTH IP/OP	$809.68 	$599.16	$0.00	$628.88	$353.75	$353.75	$0.00	$0.00	$0.00	$168.76	$600.94	$600.94	$0.00	$0.00	$168.74	$0.00	$478.92	$478.92	$0.00	$393.05	$622.59	$628.88	$0.00		$0.00	$119.44	$0.00	$0.00	$125.15	$0.00	$0.00	$0.00	$0.00	$0.00
441.162	SUP	HCPCS C1713		441.162  -  PLATE BONE 77MM 3 HOLE HEAD 6 HOLE SHAFT T RIGHT ANG LCP	BOTH IP/OP	$830.78 	$614.78	$0.00	$645.26	$362.96	$362.96	$0.00	$0.00	$0.00	$173.15	$616.60	$616.60	$0.00	$0.00	$173.13	$0.00	$491.40	$491.40	$0.00	$403.29	$638.81	$645.26	$0.00		$0.00	$122.55	$0.00	$0.00	$128.41	$0.00	$0.00	$0.00	$0.00	$0.00
441.171	SUP	HCPCS C1713		441.171  -  PLATE BONE T RIGHT ANG 87X10X1.5MM 3 HOLE HEAD 7 HOLE SHAFT	BOTH IP/OP	"$1,014.90 "	$751.03	$0.00	$788.28	$443.41	$443.41	$0.00	$0.00	$0.00	$211.53	$753.26	$753.26	$0.00	$0.00	$211.51	$0.00	$600.31	$600.31	$0.00	$492.68	$780.40	$788.28	$0.00		$0.00	$149.72	$0.00	$0.00	$156.87	$0.00	$0.00	$0.00	$0.00	$0.00
441.172	SUP	HCPCS C1713		441.172  -  PLATE BONE 89MM 4 HOLE HEAD 7 HOLE SHAFT T RIGHT ANG LCP	BOTH IP/OP	"$1,041.63 "	$770.81	$0.00	$809.02	$455.07	$455.07	$0.00	$0.00	$0.00	$217.10	$773.09	$773.09	$0.00	$0.00	$217.07	$0.00	$616.12	$616.12	$0.00	$505.64	$800.93	$809.02	$0.00		$0.00	$153.66	$0.00	$0.00	$160.99	$0.00	$0.00	$0.00	$0.00	$0.00
441.181	SUP	HCPCS C1713		441.181  -  PLATE BONE 97MM 3 HOLE HEAD 8 HOLE SHAFT T RIGHT ANG LCP	BOTH IP/OP	"$1,214.53 "	$898.75	$0.00	$943.32	$530.62	$530.62	$0.00	$0.00	$0.00	$253.14	$901.42	$901.42	$0.00	$0.00	$253.11	$0.00	$718.39	$718.39	$0.00	$589.58	$933.89	$943.32	$0.00		$0.00	$179.16	$0.00	$0.00	$187.72	$0.00	$0.00	$0.00	$0.00	$0.00
441.182	SUP	HCPCS C1713		441.182  -  PLATE BONE 100MM 4 HOLE HEAD 8 HOLE SHAFT T RIGHT ANG LCP	BOTH IP/OP	"$1,210.30 "	$895.62	$0.00	$940.04	$528.77	$528.77	$0.00	$0.00	$0.00	$252.26	$898.28	$898.28	$0.00	$0.00	$252.23	$0.00	$715.89	$715.89	$0.00	$587.53	$930.64	$940.04	$0.00		$0.00	$178.54	$0.00	$0.00	$187.07	$0.00	$0.00	$0.00	$0.00	$0.00
441.23	SUP	HCPCS C1713		441.23  -  PLATE BONE T OBLIQUE 53X10X1.2MM 3X3 HOLE LC-DCP TITANIUM	BOTH IP/OP	$398.50 	$294.89	$0.00	$318.80	$179.33	$179.33	$0.00	$0.00	$0.00	$83.06	$295.77	$295.77	$0.00	$0.00	$83.05	$0.00	$235.71	$235.71	$0.00	$199.25	$315.61	$318.80	$0.00		$0.00	$60.55	$0.00	$0.00	$63.44	$0.00	$0.00	$0.00	$0.00	$0.00
441.24	SUP	HCPCS C1713		441.24  -  PLATE BONE T OBLIQUE 63X10X1.2MM 3X4 HOLE LC-DCP TITANIUM	BOTH IP/OP	$423.08 	$313.08	$0.00	$338.46	$190.38	$190.38	$0.00	$0.00	$0.00	$88.18	$314.01	$314.01	$0.00	$0.00	$88.17	$0.00	$250.25	$250.25	$0.00	$211.54	$335.08	$338.46	$0.00		$0.00	$64.28	$0.00	$0.00	$67.35	$0.00	$0.00	$0.00	$0.00	$0.00
441.25	SUP	HCPCS C1713		441.25  -  PLATE BN T OBLQ 75X10X1.5MM LC DCP 3 HLE/HD 5 HL SHFT TI 3.5	BOTH IP/OP	$435.35 	$322.16	$0.00	$348.28	$195.91	$195.91	$0.00	$0.00	$0.00	$90.74	$323.12	$323.12	$0.00	$0.00	$90.73	$0.00	$257.51	$257.51	$0.00	$217.68	$344.80	$348.28	$0.00		$0.00	$66.15	$0.00	$0.00	$69.31	$0.00	$0.00	$0.00	$0.00	$0.00
441.262	SUP	HCPCS C1713		441.262  -  PLATE BONE 55MM 3 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT	BOTH IP/OP	"$1,790.85 "	"$1,325.23"	$0.00	"$1,390.96"	$782.42	$782.42	$0.00	$0.00	$0.00	$373.26	"$1,329.17"	"$1,329.17"	$0.00	$0.00	$373.21	$0.00	"$1,059.29"	"$1,059.29"	$0.00	$869.35	"$1,377.05"	"$1,390.96"	$0.00		$0.00	$264.18	$0.00	$0.00	$276.80	$0.00	$0.00	$0.00	$0.00	$0.00
441.263	SUP	HCPCS C1713		441.263  -  PLATE BONE 55MM 3 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT	BOTH IP/OP	"$1,790.85 "	"$1,325.23"	$0.00	"$1,390.96"	$782.42	$782.42	$0.00	$0.00	$0.00	$373.26	"$1,329.17"	"$1,329.17"	$0.00	$0.00	$373.21	$0.00	"$1,059.29"	"$1,059.29"	$0.00	$869.35	"$1,377.05"	"$1,390.96"	$0.00		$0.00	$264.18	$0.00	$0.00	$276.80	$0.00	$0.00	$0.00	$0.00	$0.00
441.264	SUP	HCPCS C1713		441.264  -  PLATE BONE 5 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT DISTAL	BOTH IP/OP	"$1,986.25 "	"$1,469.83"	$0.00	"$1,542.72"	$867.78	$867.78	$0.00	$0.00	$0.00	$413.98	"$1,474.19"	"$1,474.19"	$0.00	$0.00	$413.93	$0.00	"$1,174.87"	"$1,174.87"	$0.00	$964.20	"$1,527.29"	"$1,542.72"	$0.00		$0.00	$293.00	$0.00	$0.00	$307.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.265	SUP	HCPCS C1713		441.265  -  PLATE BONE 5 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT DISTAL	BOTH IP/OP	"$1,986.25 "	"$1,469.83"	$0.00	"$1,542.72"	$867.78	$867.78	$0.00	$0.00	$0.00	$413.98	"$1,474.19"	"$1,474.19"	$0.00	$0.00	$413.93	$0.00	"$1,174.87"	"$1,174.87"	$0.00	$964.20	"$1,527.29"	"$1,542.72"	$0.00		$0.00	$293.00	$0.00	$0.00	$307.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.266	SUP	HCPCS C1713		441.266  -  PLATE BONE 116MM 7 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT	BOTH IP/OP	"$2,184.45 "	"$1,616.49"	$0.00	"$1,696.66"	$954.37	$954.37	$0.00	$0.00	$0.00	$455.29	"$1,621.30"	"$1,621.30"	$0.00	$0.00	$455.24	$0.00	"$1,292.10"	"$1,292.10"	$0.00	"$1,060.41"	"$1,679.70"	"$1,696.66"	$0.00		$0.00	$322.24	$0.00	$0.00	$337.64	$0.00	$0.00	$0.00	$0.00	$0.00
441.267	SUP	HCPCS C1713		441.267  -  PLATE BONE 116MM 7 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT	BOTH IP/OP	"$2,184.45 "	"$1,616.49"	$0.00	"$1,696.66"	$954.37	$954.37	$0.00	$0.00	$0.00	$455.29	"$1,621.30"	"$1,621.30"	$0.00	$0.00	$455.24	$0.00	"$1,292.10"	"$1,292.10"	$0.00	"$1,060.41"	"$1,679.70"	"$1,696.66"	$0.00		$0.00	$322.24	$0.00	$0.00	$337.64	$0.00	$0.00	$0.00	$0.00	$0.00
441.268	SUP	HCPCS C1713		441.268  -  PLATE BONE 9 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT DISTAL	BOTH IP/OP	"$2,358.75 "	"$1,745.48"	$0.00	"$1,832.04"	"$1,030.52"	"$1,030.52"	$0.00	$0.00	$0.00	$491.62	"$1,750.66"	"$1,750.66"	$0.00	$0.00	$491.56	$0.00	"$1,395.20"	"$1,395.20"	$0.00	"$1,145.03"	"$1,813.72"	"$1,832.04"	$0.00		$0.00	$347.95	$0.00	$0.00	$364.58	$0.00	$0.00	$0.00	$0.00	$0.00
441.269	SUP	HCPCS C1713		441.269  -  PLATE BONE 9 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT DISTAL	BOTH IP/OP	"$2,358.75 "	"$1,745.48"	$0.00	"$1,832.04"	"$1,030.52"	"$1,030.52"	$0.00	$0.00	$0.00	$491.62	"$1,750.66"	"$1,750.66"	$0.00	$0.00	$491.56	$0.00	"$1,395.20"	"$1,395.20"	$0.00	"$1,145.03"	"$1,813.72"	"$1,832.04"	$0.00		$0.00	$347.95	$0.00	$0.00	$364.58	$0.00	$0.00	$0.00	$0.00	$0.00
441.272	SUP	HCPCS C1713		441.272  -  PLATE BONE 55MM 3 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS	BOTH IP/OP	"$2,053.73 "	"$1,519.76"	$0.00	"$1,595.12"	$897.26	$897.26	$0.00	$0.00	$0.00	$428.05	"$1,524.27"	"$1,524.27"	$0.00	$0.00	$428.00	$0.00	"$1,214.78"	"$1,214.78"	$0.00	$996.95	"$1,579.17"	"$1,595.12"	$0.00		$0.00	$302.96	$0.00	$0.00	$317.43	$0.00	$0.00	$0.00	$0.00	$0.00
441.273	SUP	HCPCS C1713		441.273  -  PLATE BONE 3 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT	BOTH IP/OP	"$2,053.73 "	"$1,519.76"	$0.00	"$1,595.12"	$897.26	$897.26	$0.00	$0.00	$0.00	$428.05	"$1,524.27"	"$1,524.27"	$0.00	$0.00	$428.00	$0.00	"$1,214.78"	"$1,214.78"	$0.00	$996.95	"$1,579.17"	"$1,595.12"	$0.00		$0.00	$302.96	$0.00	$0.00	$317.43	$0.00	$0.00	$0.00	$0.00	$0.00
441.274	SUP	HCPCS C1713		441.274  -  PLATE BONE 5 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS RIGHT	BOTH IP/OP	"$2,239.28 "	"$1,657.07"	$0.00	"$1,739.24"	$978.32	$978.32	$0.00	$0.00	$0.00	$466.72	"$1,661.99"	"$1,661.99"	$0.00	$0.00	$466.66	$0.00	"$1,324.53"	"$1,324.53"	$0.00	"$1,087.03"	"$1,721.85"	"$1,739.24"	$0.00		$0.00	$330.33	$0.00	$0.00	$346.11	$0.00	$0.00	$0.00	$0.00	$0.00
441.275	SUP	HCPCS C1713		441.275  -  PLATE BONE 5 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT	BOTH IP/OP	"$2,239.28 "	"$1,657.07"	$0.00	"$1,739.24"	$978.32	$978.32	$0.00	$0.00	$0.00	$466.72	"$1,661.99"	"$1,661.99"	$0.00	$0.00	$466.66	$0.00	"$1,324.53"	"$1,324.53"	$0.00	"$1,087.03"	"$1,721.85"	"$1,739.24"	$0.00		$0.00	$330.33	$0.00	$0.00	$346.11	$0.00	$0.00	$0.00	$0.00	$0.00
441.276	SUP	HCPCS C1713		441.276  -  PLATE BONE 116MM 7 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS	BOTH IP/OP	"$2,426.23 "	"$1,795.41"	$0.00	"$1,884.44"	"$1,060.00"	"$1,060.00"	$0.00	$0.00	$0.00	$505.69	"$1,800.74"	"$1,800.74"	$0.00	$0.00	$505.63	$0.00	"$1,435.11"	"$1,435.11"	$0.00	"$1,177.78"	"$1,865.60"	"$1,884.44"	$0.00		$0.00	$357.91	$0.00	$0.00	$375.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.277	SUP	HCPCS C1713		441.277  -  PLATE BONE 7 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT	BOTH IP/OP	"$2,426.23 "	"$1,795.41"	$0.00	"$1,884.44"	"$1,060.00"	"$1,060.00"	$0.00	$0.00	$0.00	$505.69	"$1,800.74"	"$1,800.74"	$0.00	$0.00	$505.63	$0.00	"$1,435.11"	"$1,435.11"	$0.00	"$1,177.78"	"$1,865.60"	"$1,884.44"	$0.00		$0.00	$357.91	$0.00	$0.00	$375.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.278	SUP	HCPCS C1713		441.278  -  PLATE BONE 9 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS RIGHT	BOTH IP/OP	"$2,632.85 "	"$1,948.31"	$0.00	"$2,044.94"	"$1,150.28"	"$1,150.28"	$0.00	$0.00	$0.00	$548.75	"$1,954.10"	"$1,954.10"	$0.00	$0.00	$548.69	$0.00	"$1,298.00"	"$1,298.00"	$0.00	"$1,278.09"	"$2,024.49"	"$2,044.94"	$0.00		$0.00	$388.39	$0.00	$0.00	$406.94	$0.00	$0.00	$0.00	$0.00	$0.00
441.279	SUP	HCPCS C1713		441.279  -  PLATE BONE 9 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT	BOTH IP/OP	"$2,632.85 "	"$1,948.31"	$0.00	"$2,044.94"	"$1,150.28"	"$1,150.28"	$0.00	$0.00	$0.00	$548.75	"$1,954.10"	"$1,954.10"	$0.00	$0.00	$548.69	$0.00	"$1,298.00"	"$1,298.00"	$0.00	"$1,278.09"	"$2,024.49"	"$2,044.94"	$0.00		$0.00	$388.39	$0.00	$0.00	$406.94	$0.00	$0.00	$0.00	$0.00	$0.00
441.282	SUP	HCPCS C1713		441.282  -  PLATE BONE 3 HOLE LCP TITANIUM HUMERUS RIGHT MEDIAL DISTAL	BOTH IP/OP	"$1,790.85 "	"$1,325.23"	$0.00	"$1,390.96"	$782.42	$782.42	$0.00	$0.00	$0.00	$373.26	"$1,329.17"	"$1,329.17"	$0.00	$0.00	$373.21	$0.00	"$1,059.29"	"$1,059.29"	$0.00	$869.35	"$1,377.05"	"$1,390.96"	$0.00		$0.00	$264.18	$0.00	$0.00	$276.80	$0.00	$0.00	$0.00	$0.00	$0.00
441.283	SUP	HCPCS C1713		441.283  -  PLATE BONE 58MM 3 HOLE LCP TITANIUM HUMERUS LEFT DISTAL	BOTH IP/OP	"$1,790.85 "	"$1,325.23"	$0.00	"$1,390.96"	$782.42	$782.42	$0.00	$0.00	$0.00	$373.26	"$1,329.17"	"$1,329.17"	$0.00	$0.00	$373.21	$0.00	"$1,059.29"	"$1,059.29"	$0.00	$869.35	"$1,377.05"	"$1,390.96"	$0.00		$0.00	$264.18	$0.00	$0.00	$276.80	$0.00	$0.00	$0.00	$0.00	$0.00
441.284	SUP	HCPCS C1713		441.284  -  PLATE BONE 5 HOLE LCP TITANIUM HUMERUS RIGHT DISTAL MEDIAL	BOTH IP/OP	"$1,986.25 "	"$1,469.83"	$0.00	"$1,542.72"	$867.78	$867.78	$0.00	$0.00	$0.00	$413.98	"$1,474.19"	"$1,474.19"	$0.00	$0.00	$413.93	$0.00	"$1,174.87"	"$1,174.87"	$0.00	$964.20	"$1,527.29"	"$1,542.72"	$0.00		$0.00	$293.00	$0.00	$0.00	$307.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.285	SUP	HCPCS C1713		441.285  -  PLATE BONE 83MM 5 HOLE LCP TITANIUM HUMERUS LEFT DISTAL	BOTH IP/OP	"$1,986.25 "	"$1,469.83"	$0.00	"$1,542.72"	$867.78	$867.78	$0.00	$0.00	$0.00	$413.98	"$1,474.19"	"$1,474.19"	$0.00	$0.00	$413.93	$0.00	"$1,174.87"	"$1,174.87"	$0.00	$964.20	"$1,527.29"	"$1,542.72"	$0.00		$0.00	$293.00	$0.00	$0.00	$307.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.286	SUP	HCPCS C1713		441.286  -  PLATE BONE 110MM 7 HOLE LCP TITANIUM HUMERUS RIGHT DISTAL	BOTH IP/OP	"$2,184.45 "	"$1,616.49"	$0.00	"$1,696.66"	$954.37	$954.37	$0.00	$0.00	$0.00	$455.29	"$1,621.30"	"$1,621.30"	$0.00	$0.00	$455.24	$0.00	"$1,292.10"	"$1,292.10"	$0.00	"$1,060.41"	"$1,679.70"	"$1,696.66"	$0.00		$0.00	$322.24	$0.00	$0.00	$337.64	$0.00	$0.00	$0.00	$0.00	$0.00
441.287	SUP	HCPCS C1713		441.287  -  PLATE BN 110X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT	BOTH IP/OP	"$2,184.45 "	"$1,616.49"	$0.00	"$1,696.66"	$954.37	$954.37	$0.00	$0.00	$0.00	$455.29	"$1,621.30"	"$1,621.30"	$0.00	$0.00	$455.24	$0.00	"$1,292.10"	"$1,292.10"	$0.00	"$1,060.41"	"$1,679.70"	"$1,696.66"	$0.00		$0.00	$322.24	$0.00	$0.00	$337.64	$0.00	$0.00	$0.00	$0.00	$0.00
441.288	SUP	HCPCS C1713		441.288  -  PLATE BONE 9 HOLE LCP TITANIUM HUMERUS RIGHT MEDIAL DISTAL	BOTH IP/OP	"$2,358.75 "	"$1,745.48"	$0.00	"$1,832.04"	"$1,030.52"	"$1,030.52"	$0.00	$0.00	$0.00	$491.62	"$1,750.66"	"$1,750.66"	$0.00	$0.00	$491.56	$0.00	"$1,395.20"	"$1,395.20"	$0.00	"$1,145.03"	"$1,813.72"	"$1,832.04"	$0.00		$0.00	$347.95	$0.00	$0.00	$364.58	$0.00	$0.00	$0.00	$0.00	$0.00
441.289	SUP	HCPCS C1713		441.289  -  PLATE BONE 136MM 9 HOLE LCP TITANIUM HUMERUS LEFT DISTAL	BOTH IP/OP	"$2,358.75 "	"$1,745.48"	$0.00	"$1,832.04"	"$1,030.52"	"$1,030.52"	$0.00	$0.00	$0.00	$491.62	"$1,750.66"	"$1,750.66"	$0.00	$0.00	$491.56	$0.00	"$1,395.20"	"$1,395.20"	$0.00	"$1,145.03"	"$1,813.72"	"$1,832.04"	$0.00		$0.00	$347.95	$0.00	$0.00	$364.58	$0.00	$0.00	$0.00	$0.00	$0.00
441.3	SUP	HCPCS C1713		441.300  -  PLATE BONE 14 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT DISTAL	BOTH IP/OP	"$2,355.55 "	"$1,743.11"	$0.00	"$1,884.44"	"$1,060.00"	"$1,060.00"	$0.00	$0.00	$0.00	$490.96	"$1,748.29"	"$1,748.29"	$0.00	$0.00	$490.90	$0.00	"$1,393.31"	"$1,393.31"	$0.00	"$1,177.78"	"$1,865.60"	"$1,884.44"	$0.00		$0.00	$357.91	$0.00	$0.00	$375.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.301	SUP	HCPCS C1713		441.301  -  PLATE BONE 14 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT DISTAL	BOTH IP/OP	"$2,426.23 "	"$1,795.41"	$0.00	"$1,884.44"	"$1,060.00"	"$1,060.00"	$0.00	$0.00	$0.00	$505.69	"$1,800.74"	"$1,800.74"	$0.00	$0.00	$505.63	$0.00	"$1,435.11"	"$1,435.11"	$0.00	"$1,177.78"	"$1,865.60"	"$1,884.44"	$0.00		$0.00	$357.91	$0.00	$0.00	$375.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.302	SUP	HCPCS C1713		441.302  -  PLATE BONE 14 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS	BOTH IP/OP	"$2,565.40 "	"$1,898.40"	$0.00	"$1,992.54"	"$1,120.80"	"$1,120.80"	$0.00	$0.00	$0.00	$534.69	"$1,904.04"	"$1,904.04"	$0.00	$0.00	$534.63	$0.00	"$1,264.74"	"$1,264.74"	$0.00	"$1,245.34"	"$1,972.62"	"$1,992.54"	$0.00		$0.00	$378.44	$0.00	$0.00	$396.52	$0.00	$0.00	$0.00	$0.00	$0.00
441.303	SUP	HCPCS C1713		441.303  -  PLATE BONE 14 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT	BOTH IP/OP	"$2,565.40 "	"$1,898.40"	$0.00	"$1,992.54"	"$1,120.80"	"$1,120.80"	$0.00	$0.00	$0.00	$534.69	"$1,904.04"	"$1,904.04"	$0.00	$0.00	$534.63	$0.00	"$1,264.74"	"$1,264.74"	$0.00	"$1,245.34"	"$1,972.62"	"$1,992.54"	$0.00		$0.00	$378.44	$0.00	$0.00	$396.52	$0.00	$0.00	$0.00	$0.00	$0.00
441.304	SUP	HCPCS C1713		441.304  -  PLATE BONE 14 HOLE LCP TITANIUM HUMERUS RIGHT MEDIAL DISTAL	BOTH IP/OP	"$2,426.23 "	"$1,795.41"	$0.00	"$1,884.44"	"$1,060.00"	"$1,060.00"	$0.00	$0.00	$0.00	$505.69	"$1,800.74"	"$1,800.74"	$0.00	$0.00	$505.63	$0.00	"$1,435.11"	"$1,435.11"	$0.00	"$1,177.78"	"$1,865.60"	"$1,884.44"	$0.00		$0.00	$357.91	$0.00	$0.00	$375.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.305	SUP	HCPCS C1713		441.305  -  PLATE BONE 14 HOLE LCP TITANIUM HUMERUS LEFT DISTAL MEDIAL	BOTH IP/OP	"$2,426.23 "	"$1,795.41"	$0.00	"$1,884.44"	"$1,060.00"	"$1,060.00"	$0.00	$0.00	$0.00	$505.69	"$1,800.74"	"$1,800.74"	$0.00	$0.00	$505.63	$0.00	"$1,435.11"	"$1,435.11"	$0.00	"$1,177.78"	"$1,865.60"	"$1,884.44"	$0.00		$0.00	$357.91	$0.00	$0.00	$375.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.32	SUP	HCPCS C1713		441.32  -  PLATE BONE 25X9X1MM 2 HOLE 1/3 TUBULAR COLLAR LC-DCP	BOTH IP/OP	$108.25 	$80.11	$0.00	$84.06	$47.28	$47.28	$0.00	$0.00	$0.00	$22.56	$80.34	$80.34	$0.00	$0.00	$22.56	$0.00	$64.03	$64.03	$0.00	$52.54	$83.22	$84.06	$0.00		$0.00	$15.97	$0.00	$0.00	$16.73	$0.00	$0.00	$0.00	$0.00	$0.00
441.33	SUP	HCPCS C1713		441.33  -  PLATE BONE 1/3 TUBULAR 37X9X1MM .5MM 3 HOLE COLLAR LC-DCP	BOTH IP/OP	$111.05 	$82.18	$0.00	$86.26	$48.52	$48.52	$0.00	$0.00	$0.00	$23.15	$82.42	$82.42	$0.00	$0.00	$23.14	$0.00	$65.69	$65.69	$0.00	$53.91	$85.40	$86.26	$0.00		$0.00	$16.38	$0.00	$0.00	$17.17	$0.00	$0.00	$0.00	$0.00	$0.00
441.331	SUP	HCPCS C1713		441.331  -  PLATE BONE 33MM 3 HOLE 1/3 TUBULAR COLLAR LCP TITANIUM	BOTH IP/OP	$274.10 	$202.83	$0.00	$212.90	$119.76	$119.76	$0.00	$0.00	$0.00	$57.13	$203.44	$203.44	$0.00	$0.00	$57.12	$0.00	$162.13	$162.13	$0.00	$133.06	$210.77	$212.90	$0.00		$0.00	$40.44	$0.00	$0.00	$42.37	$0.00	$0.00	$0.00	$0.00	$0.00
441.34	SUP	HCPCS C1713		441.34  -  PLATE BONE 1/3 TUBULAR 49X9X1MM .5MM 4 HOLE COLLAR LC-DCP	BOTH IP/OP	$130.73 	$96.74	$0.00	$101.54	$57.12	$57.12	$0.00	$0.00	$0.00	$27.25	$97.02	$97.02	$0.00	$0.00	$27.24	$0.00	$77.32	$77.32	$0.00	$63.46	$100.53	$101.54	$0.00		$0.00	$19.28	$0.00	$0.00	$20.21	$0.00	$0.00	$0.00	$0.00	$0.00
441.341	SUP	HCPCS C1713		441.341  -  PLATE BONE 45MM 4 HOLE 1/3 TUBULAR COLLAR LCP TITANIUM	BOTH IP/OP	$316.28 	$234.05	$0.00	$245.66	$138.18	$138.18	$0.00	$0.00	$0.00	$65.92	$234.74	$234.74	$0.00	$0.00	$65.91	$0.00	$187.08	$187.08	$0.00	$153.54	$243.21	$245.66	$0.00		$0.00	$46.66	$0.00	$0.00	$48.89	$0.00	$0.00	$0.00	$0.00	$0.00
441.35	SUP	HCPCS C1713		441.35  -  PLATE BONE 61X9X1MM 5 HOLE 1/3 TUBULAR COLLAR LC-DCP	BOTH IP/OP	$130.73 	$96.74	$0.00	$101.54	$57.12	$57.12	$0.00	$0.00	$0.00	$27.25	$97.02	$97.02	$0.00	$0.00	$27.24	$0.00	$77.32	$77.32	$0.00	$63.46	$100.53	$101.54	$0.00		$0.00	$19.28	$0.00	$0.00	$20.21	$0.00	$0.00	$0.00	$0.00	$0.00
441.351	SUP	HCPCS C1713		441.351  -  PLATE BONE 1/3 TUBULAR 57X9X1MM 5 HOLE COLLAR LCP TITANIUM	BOTH IP/OP	$316.28 	$234.05	$0.00	$245.66	$138.18	$138.18	$0.00	$0.00	$0.00	$65.92	$234.74	$234.74	$0.00	$0.00	$65.91	$0.00	$187.08	$187.08	$0.00	$153.54	$243.21	$245.66	$0.00		$0.00	$61.59	$0.00	$0.00	$48.89	$0.00	$0.00	$0.00	$0.00	$0.00
441.36	SUP	HCPCS C1713		441.36  -  PLATE BN 1/3 TBLR 12MM 73X9X1MM NS .5MM 6 HL COLR TI 3.5MM	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$59.25	$59.25	$0.00	$0.00	$0.00	$28.27	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$80.22	$80.22	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$20.01	$0.00	$0.00	$20.96	$0.00	$0.00	$0.00	$0.00	$0.00
441.361	SUP	HCPCS C1713		441.361  -  PLATE BN 1/3 TBLR 12MM 69X9X1MM NS .7MM LCP 6 HL COLR TI	BOTH IP/OP	$316.28 	$234.05	$0.00	$245.66	$138.18	$138.18	$0.00	$0.00	$0.00	$65.92	$234.74	$234.74	$0.00	$0.00	$65.91	$0.00	$187.08	$187.08	$0.00	$153.54	$243.21	$245.66	$0.00		$0.00	$46.66	$0.00	$0.00	$48.89	$0.00	$0.00	$0.00	$0.00	$0.00
441.37	SUP	HCPCS C1713		441.37  -  PLATE BN 1/3 TBLR 12MM 85X9X1MM NS .5MM 7 HL COLR TI 3.5MM	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$59.25	$59.25	$0.00	$0.00	$0.00	$28.27	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$80.22	$80.22	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$20.01	$0.00	$0.00	$20.96	$0.00	$0.00	$0.00	$0.00	$0.00
441.371	SUP	HCPCS C1713		441.371  -  PLATE BN 1/3 TBLR 12MM 81X9X1MM NS .7MM LCP 7 HL COLR TI	BOTH IP/OP	$323.30 	$239.24	$0.00	$251.12	$141.26	$141.26	$0.00	$0.00	$0.00	$67.38	$239.95	$239.95	$0.00	$0.00	$67.38	$0.00	$191.23	$191.23	$0.00	$156.95	$248.61	$251.12	$0.00		$0.00	$47.69	$0.00	$0.00	$49.97	$0.00	$0.00	$0.00	$0.00	$0.00
441.38	SUP	HCPCS C1713		441.38  -  PLATE BN 1/3 TBLR 12MM 97X9X1MM NS .5MM 8 HL COLR TI 3.5MM	BOTH IP/OP	$140.58 	$104.03	$0.00	$109.18	$61.41	$61.41	$0.00	$0.00	$0.00	$29.30	$104.33	$104.33	$0.00	$0.00	$29.30	$0.00	$83.15	$83.15	$0.00	$68.24	$108.09	$109.18	$0.00		$0.00	$20.74	$0.00	$0.00	$21.73	$0.00	$0.00	$0.00	$0.00	$0.00
441.381	SUP	HCPCS C1713		441.381  -  PLATE BN 1/3 TBLR 12MM 93X9X1MM NS .7MM LCP 8 HL COLR TI	BOTH IP/OP	$340.18 	$251.73	$0.00	$264.22	$148.62	$148.62	$0.00	$0.00	$0.00	$70.90	$252.48	$252.48	$0.00	$0.00	$70.89	$0.00	$201.21	$201.21	$0.00	$165.14	$261.58	$264.22	$0.00		$0.00	$50.18	$0.00	$0.00	$52.58	$0.00	$0.00	$0.00	$0.00	$0.00
441.39	SUP	HCPCS C1713		441.39  -  PLATE BONE 109X9X1MM 9 HOLE 1/3 TUBULAR COLLAR LC-DCP	BOTH IP/OP	$140.58 	$104.03	$0.00	$109.18	$61.41	$61.41	$0.00	$0.00	$0.00	$29.30	$104.33	$104.33	$0.00	$0.00	$29.30	$0.00	$83.15	$83.15	$0.00	$68.24	$108.09	$109.18	$0.00		$0.00	$20.74	$0.00	$0.00	$21.73	$0.00	$0.00	$0.00	$0.00	$0.00
441.391	SUP	HCPCS C1713		441.391  -  PLATE BONE 105MM 9 HOLE 1/3 TUBULAR COLLAR LCP TITANIUM	BOTH IP/OP	$357.05 	$264.22	$0.00	$277.32	$155.99	$155.99	$0.00	$0.00	$0.00	$74.42	$265.00	$265.00	$0.00	$0.00	$74.41	$0.00	$211.20	$211.20	$0.00	$173.33	$274.55	$277.32	$0.00		$0.00	$52.67	$0.00	$0.00	$55.19	$0.00	$0.00	$0.00	$0.00	$0.00
441.4	SUP	HCPCS C1713		441.40  -  PLATE BONE 121X9X1MM 10 HOLE 1/3 TUBULAR COLLAR LC-DCP	BOTH IP/OP	$136.48 	$101.00	$0.00	$109.18	$61.41	$61.41	$0.00	$0.00	$0.00	$28.44	$101.29	$101.29	$0.00	$0.00	$28.44	$0.00	$80.72	$80.72	$0.00	$68.24	$108.09	$109.18	$0.00		$0.00	$20.74	$0.00	$0.00	$21.73	$0.00	$0.00	$0.00	$0.00	$0.00
441.401	SUP	HCPCS C1713		441.401  -  PLATE BONE 1/3 TUBULAR 12MM 117X9X1MM 10 HOLE COLLAR LCP	BOTH IP/OP	$345.80 	$255.89	$0.00	$268.58	$151.08	$151.08	$0.00	$0.00	$0.00	$72.07	$256.65	$256.65	$0.00	$0.00	$72.06	$0.00	$204.54	$204.54	$0.00	$167.86	$265.90	$268.58	$0.00		$0.00	$51.01	$0.00	$0.00	$53.45	$0.00	$0.00	$0.00	$0.00	$0.00
441.42	SUP	HCPCS C1713		441.42  -  PLATE BONE 145X9X1MM 12 HOLE 1/3 TUBULAR COLLAR TITANIUM RAD	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
441.421	SUP	HCPCS C1713		441.421  -  PLATE BONE 1/3 TUBULAR 12MM 141X9X1MM 12 HOLE COLLAR LCP	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
441.44	SUP	HCPCS C1713		441.440  -  PLATE BONE 80MM 5 HOLE LCP TITANIUM TIBIA RIGHT DISTAL	BOTH IP/OP	"$2,774.53 "	"$2,053.15"	$0.00	"$2,219.62"	"$1,248.54"	"$1,248.54"	$0.00	$0.00	$0.00	$578.28	"$2,059.25"	"$2,059.25"	$0.00	$0.00	$578.21	$0.00	"$1,367.84"	"$1,367.84"	$0.00	"$1,387.26"	"$2,197.43"	"$2,219.62"	$0.00		$0.00	$421.57	$0.00	$0.00	$441.70	$0.00	$0.00	$0.00	$0.00	$0.00
441.441	SUP	HCPCS C1713		441.441  -  PLATE BONE 80MM 5 HOLE LCP TITANIUM TIBIA LEFT DISTAL ANTLAT	BOTH IP/OP	"$2,857.78 "	"$2,114.76"	$0.00	"$2,219.62"	"$1,248.54"	"$1,248.54"	$0.00	$0.00	$0.00	$595.63	"$2,121.04"	"$2,121.04"	$0.00	$0.00	$595.56	$0.00	"$1,408.88"	"$1,408.88"	$0.00	"$1,387.26"	"$2,197.43"	"$2,219.62"	$0.00		$0.00	$421.57	$0.00	$0.00	$441.70	$0.00	$0.00	$0.00	$0.00	$0.00
441.442	SUP	HCPCS C1713		441.442  -  PLATE BONE 106MM 7 HOLE LCP TITANIUM TIBIA RIGHT DISTAL	BOTH IP/OP	"$2,890.10 "	"$2,138.67"	$0.00	"$2,244.74"	"$1,262.67"	"$1,262.67"	$0.00	$0.00	$0.00	$602.37	"$2,145.03"	"$2,145.03"	$0.00	$0.00	$602.30	$0.00	"$1,424.82"	"$1,424.82"	$0.00	"$1,402.96"	"$2,222.30"	"$2,244.74"	$0.00		$0.00	$426.34	$0.00	$0.00	$446.70	$0.00	$0.00	$0.00	$0.00	$0.00
441.443	SUP	HCPCS C1713		441.443  -  PLATE BONE 106MM 7 HOLE LCP TITANIUM TIBIA LEFT DISTAL	BOTH IP/OP	"$2,890.10 "	"$2,138.67"	$0.00	"$2,244.74"	"$1,262.67"	"$1,262.67"	$0.00	$0.00	$0.00	$602.37	"$2,145.03"	"$2,145.03"	$0.00	$0.00	$602.30	$0.00	"$1,424.82"	"$1,424.82"	$0.00	"$1,402.96"	"$2,222.30"	"$2,244.74"	$0.00		$0.00	$426.34	$0.00	$0.00	$446.70	$0.00	$0.00	$0.00	$0.00	$0.00
441.444	SUP	HCPCS C1713		441.444  -  PLATE BONE 132MM 9 HOLE LCP TITANIUM TIBIA RIGHT DISTAL	BOTH IP/OP	"$2,919.63 "	"$2,160.53"	$0.00	"$2,267.66"	"$1,275.56"	"$1,275.56"	$0.00	$0.00	$0.00	$608.52	"$2,166.95"	"$2,166.95"	$0.00	$0.00	$608.45	$0.00	"$1,439.38"	"$1,439.38"	$0.00	"$1,417.29"	"$2,244.99"	"$2,267.66"	$0.00		$0.00	$430.69	$0.00	$0.00	$451.26	$0.00	$0.00	$0.00	$0.00	$0.00
441.445	SUP	HCPCS C1713		441.445  -  PLATE BONE 132MM 9 HOLE LCP TITANIUM TIBIA LEFT DISTAL	BOTH IP/OP	"$2,919.63 "	"$2,160.53"	$0.00	"$2,267.66"	"$1,275.56"	"$1,275.56"	$0.00	$0.00	$0.00	$608.52	"$2,166.95"	"$2,166.95"	$0.00	$0.00	$608.45	$0.00	"$1,439.38"	"$1,439.38"	$0.00	"$1,417.29"	"$2,244.99"	"$2,267.66"	$0.00		$0.00	$430.69	$0.00	$0.00	$451.26	$0.00	$0.00	$0.00	$0.00	$0.00
441.446	SUP	HCPCS C1713		441.446  -  PLATE BONE 158MM 11 HOLE LCP TITANIUM TIBIA RIGHT DISTAL	BOTH IP/OP	"$2,947.73 "	"$2,181.32"	$0.00	"$2,289.50"	"$1,287.84"	"$1,287.84"	$0.00	$0.00	$0.00	$614.38	"$2,187.80"	"$2,187.80"	$0.00	$0.00	$614.31	$0.00	"$1,453.23"	"$1,453.23"	$0.00	"$1,430.94"	"$2,266.61"	"$2,289.50"	$0.00		$0.00	$434.84	$0.00	$0.00	$455.61	$0.00	$0.00	$0.00	$0.00	$0.00
441.447	SUP	HCPCS C1713		441.447  -  PLATE BONE 158MM 11 HOLE LCP TITANIUM TIBIA LEFT DISTAL	BOTH IP/OP	"$2,947.73 "	"$2,181.32"	$0.00	"$2,289.50"	"$1,287.84"	"$1,287.84"	$0.00	$0.00	$0.00	$614.38	"$2,187.80"	"$2,187.80"	$0.00	$0.00	$614.31	$0.00	"$1,453.23"	"$1,453.23"	$0.00	"$1,430.94"	"$2,266.61"	"$2,289.50"	$0.00		$0.00	$434.84	$0.00	$0.00	$455.61	$0.00	$0.00	$0.00	$0.00	$0.00
441.448	SUP	HCPCS C1713		441.448  -  PLATE BONE 184MM 13 HOLE LCP TITANIUM TIBIA RIGHT DISTAL	BOTH IP/OP	"$2,980.08 "	"$2,205.26"	$0.00	"$2,314.62"	"$1,301.97"	"$1,301.97"	$0.00	$0.00	$0.00	$621.12	"$2,211.81"	"$2,211.81"	$0.00	$0.00	$621.05	$0.00	"$1,469.18"	"$1,469.18"	$0.00	"$1,446.64"	"$2,291.48"	"$2,314.62"	$0.00		$0.00	$439.61	$0.00	$0.00	$460.61	$0.00	$0.00	$0.00	$0.00	$0.00
441.449	SUP	HCPCS C1713		441.449  -  PLATE BONE 184MM 13 HOLE LCP TITANIUM TIBIA LEFT DISTAL	BOTH IP/OP	"$2,980.08 "	"$2,205.26"	$0.00	"$2,314.62"	"$1,301.97"	"$1,301.97"	$0.00	$0.00	$0.00	$621.12	"$2,211.81"	"$2,211.81"	$0.00	$0.00	$621.05	$0.00	"$1,469.18"	"$1,469.18"	$0.00	"$1,446.64"	"$2,291.48"	"$2,314.62"	$0.00		$0.00	$439.61	$0.00	$0.00	$460.61	$0.00	$0.00	$0.00	$0.00	$0.00
441.45	SUP	HCPCS C1713		441.450  -  PLATE BONE 210MM 15 HOLE LCP TITANIUM TIBIA RIGHT DISTAL	BOTH IP/OP	"$2,931.48 "	"$2,169.30"	$0.00	"$2,345.18"	"$1,319.16"	"$1,319.16"	$0.00	$0.00	$0.00	$610.99	"$2,175.74"	"$2,175.74"	$0.00	$0.00	$610.92	$0.00	"$1,445.22"	"$1,445.22"	$0.00	"$1,465.74"	"$2,321.73"	"$2,345.18"	$0.00		$0.00	$445.41	$0.00	$0.00	$466.69	$0.00	$0.00	$0.00	$0.00	$0.00
441.451	SUP	HCPCS C1713		441.451  -  PLATE BONE 210MM 15 HOLE LCP TITANIUM TIBIA LEFT DISTAL	BOTH IP/OP	"$3,019.43 "	"$2,234.38"	$0.00	"$2,345.18"	"$1,319.16"	"$1,319.16"	$0.00	$0.00	$0.00	$629.32	"$2,241.02"	"$2,241.02"	$0.00	$0.00	$629.25	$0.00	"$1,488.58"	"$1,488.58"	$0.00	"$1,465.74"	"$2,321.73"	"$2,345.18"	$0.00		$0.00	$445.41	$0.00	$0.00	$466.69	$0.00	$0.00	$0.00	$0.00	$0.00
441.452	SUP	HCPCS C1713		441.452  -  PLATE BONE 236MM 17 HOLE LCP TITANIUM TIBIA RIGHT DISTAL	BOTH IP/OP	"$3,047.55 "	"$2,255.19"	$0.00	"$2,367.02"	"$1,331.45"	"$1,331.45"	$0.00	$0.00	$0.00	$635.19	"$2,261.89"	"$2,261.89"	$0.00	$0.00	$635.11	$0.00	"$1,502.44"	"$1,502.44"	$0.00	"$1,479.39"	"$2,343.35"	"$2,367.02"	$0.00		$0.00	$449.56	$0.00	$0.00	$471.04	$0.00	$0.00	$0.00	$0.00	$0.00
441.453	SUP	HCPCS C1713		441.453  -  PLATE BONE 236MM 17 HOLE LCP TITANIUM TIBIA LEFT DISTAL	BOTH IP/OP	"$3,047.55 "	"$2,255.19"	$0.00	"$2,367.02"	"$1,331.45"	"$1,331.45"	$0.00	$0.00	$0.00	$635.19	"$2,261.89"	"$2,261.89"	$0.00	$0.00	$635.11	$0.00	"$1,502.44"	"$1,502.44"	$0.00	"$1,479.39"	"$2,343.35"	"$2,367.02"	$0.00		$0.00	$449.56	$0.00	$0.00	$471.04	$0.00	$0.00	$0.00	$0.00	$0.00
441.454	SUP	HCPCS C1713		441.454  -  PLATE BONE 262MM 19 HOLE LCP TITANIUM TIBIA RIGHT DISTAL	BOTH IP/OP	"$3,071.45 "	"$2,272.87"	$0.00	"$2,385.58"	"$1,341.89"	"$1,341.89"	$0.00	$0.00	$0.00	$640.17	"$2,279.63"	"$2,279.63"	$0.00	$0.00	$640.09	$0.00	"$1,514.22"	"$1,514.22"	$0.00	"$1,490.99"	"$2,361.73"	"$2,385.58"	$0.00		$0.00	$453.09	$0.00	$0.00	$474.73	$0.00	$0.00	$0.00	$0.00	$0.00
441.455	SUP	HCPCS C1713		441.455  -  PLATE BONE 262MM 19 HOLE LCP TITANIUM TIBIA LEFT DISTAL	BOTH IP/OP	"$3,071.45 "	"$2,272.87"	$0.00	"$2,385.58"	"$1,341.89"	"$1,341.89"	$0.00	$0.00	$0.00	$640.17	"$2,279.63"	"$2,279.63"	$0.00	$0.00	$640.09	$0.00	"$1,514.22"	"$1,514.22"	$0.00	"$1,490.99"	"$2,361.73"	"$2,385.58"	$0.00		$0.00	$453.09	$0.00	$0.00	$474.73	$0.00	$0.00	$0.00	$0.00	$0.00
441.456	SUP	HCPCS C1713		441.456  -  PLATE BONE 288MM 21 HOLE LCP TITANIUM TIBIA RIGHT DISTAL	BOTH IP/OP	"$3,100.95 "	"$2,294.70"	$0.00	"$2,408.52"	"$1,354.79"	"$1,354.79"	$0.00	$0.00	$0.00	$646.32	"$2,301.53"	"$2,301.53"	$0.00	$0.00	$646.24	$0.00	"$1,528.77"	"$1,528.77"	$0.00	"$1,505.33"	"$2,384.43"	"$2,408.52"	$0.00		$0.00	$457.44	$0.00	$0.00	$479.30	$0.00	$0.00	$0.00	$0.00	$0.00
441.457	SUP	HCPCS C1713		441.457  -  PLATE BONE 288MM 21 HOLE LCP TITANIUM TIBIA LEFT DISTAL	BOTH IP/OP	"$3,100.95 "	"$2,294.70"	$0.00	"$2,408.52"	"$1,354.79"	"$1,354.79"	$0.00	$0.00	$0.00	$646.32	"$2,301.53"	"$2,301.53"	$0.00	$0.00	$646.24	$0.00	"$1,528.77"	"$1,528.77"	$0.00	"$1,505.33"	"$2,384.43"	"$2,408.52"	$0.00		$0.00	$457.44	$0.00	$0.00	$479.30	$0.00	$0.00	$0.00	$0.00	$0.00
441.61	SUP	HCPCS C1713		441.61  -  PLATE BONE 60MMX1.2MM LC-DCP TITANIUM CALCANEUS NONSTRL	BOTH IP/OP	$992.18 	$734.21	$0.00	$793.74	$446.48	$446.48	$0.00	$0.00	$0.00	$206.79	$736.39	$736.39	$0.00	$0.00	$206.77	$0.00	$586.87	$586.87	$0.00	$496.09	$785.81	$793.74	$0.00		$0.00	$150.75	$0.00	$0.00	$157.95	$0.00	$0.00	$0.00	$0.00	$0.00
441.62	SUP	HCPCS C1713		441.62  -  PLATE BONE 70MMX1.2MM LC-DCP TITANIUM CALCANEUS NONSTRL	BOTH IP/OP	"$1,015.38 "	$751.38	$0.00	$812.30	$456.92	$456.92	$0.00	$0.00	$0.00	$211.63	$753.61	$753.61	$0.00	$0.00	$211.60	$0.00	$600.59	$600.59	$0.00	$507.69	$804.18	$812.30	$0.00		$0.00	$154.28	$0.00	$0.00	$161.65	$0.00	$0.00	$0.00	$0.00	$0.00
441.65	SUP	HCPCS C1713		441.65  -  PLATE BONE Y 87MMX2MM LC-DCP TITANIUM CALCANEUS NONSTRL	BOTH IP/OP	"$1,015.38 "	$751.38	$0.00	$812.30	$456.92	$456.92	$0.00	$0.00	$0.00	$211.63	$753.61	$753.61	$0.00	$0.00	$211.60	$0.00	$600.59	$600.59	$0.00	$507.69	$804.18	$812.30	$0.00		$0.00	$154.28	$0.00	$0.00	$161.65	$0.00	$0.00	$0.00	$0.00	$0.00
441.68	SUP	HCPCS C1713		441.680  -  PLATE BONE 2.4MM 34MM IMPLANT RIM 2 HOLE LCP TITANIUM RADIAL	BOTH IP/OP	"$1,112.28 "	$823.09	$0.00	$889.82	$500.52	$500.52	$0.00	$0.00	$0.00	$231.83	$825.53	$825.53	$0.00	$0.00	$231.80	$0.00	$657.91	$657.91	$0.00	$556.14	$880.93	$889.82	$0.00		$0.00	$169.00	$0.00	$0.00	$177.07	$0.00	$0.00	$0.00	$0.00	$0.00
441.681	SUP	HCPCS C1713		441.681  -  PLATE BONE 2.4MM 34MM IMPLANT RIM 2 HOLE LCP TITANIUM RADIAL	BOTH IP/OP	"$1,145.65 "	$847.78	$0.00	$889.82	$500.52	$500.52	$0.00	$0.00	$0.00	$238.78	$850.30	$850.30	$0.00	$0.00	$238.75	$0.00	$677.65	$677.65	$0.00	$556.14	$880.93	$889.82	$0.00		$0.00	$169.00	$0.00	$0.00	$177.07	$0.00	$0.00	$0.00	$0.00	$0.00
441.682	SUP	HCPCS C1713		441.682  -  PLATE BONE 2.4MM 46MM IMPLANT RIM 3 HOLE LCP TITANIUM RADIAL	BOTH IP/OP	"$1,177.98 "	$871.71	$0.00	$914.92	$514.64	$514.64	$0.00	$0.00	$0.00	$245.52	$874.29	$874.29	$0.00	$0.00	$245.49	$0.00	$696.77	$696.77	$0.00	$571.83	$905.77	$914.92	$0.00		$0.00	$173.77	$0.00	$0.00	$182.07	$0.00	$0.00	$0.00	$0.00	$0.00
441.683	SUP	HCPCS C1713		441.683  -  PLATE BONE 2.4MM 46MM IMPLANT RIM 3 HOLE LCP TITANIUM RADIAL	BOTH IP/OP	"$1,177.98 "	$871.71	$0.00	$914.92	$514.64	$514.64	$0.00	$0.00	$0.00	$245.52	$874.29	$874.29	$0.00	$0.00	$245.49	$0.00	$696.77	$696.77	$0.00	$571.83	$905.77	$914.92	$0.00		$0.00	$173.77	$0.00	$0.00	$182.07	$0.00	$0.00	$0.00	$0.00	$0.00
441.684	SUP	HCPCS C1713		441.684  -  PLATE BONE 2.4MM 56MM IMPLANT RIM 4 HOLE LCP TITANIUM RADIAL	BOTH IP/OP	"$1,199.05 "	$887.30	$0.00	$931.30	$523.86	$523.86	$0.00	$0.00	$0.00	$249.91	$889.93	$889.93	$0.00	$0.00	$249.88	$0.00	$709.24	$709.24	$0.00	$582.06	$921.99	$931.30	$0.00		$0.00	$176.88	$0.00	$0.00	$185.33	$0.00	$0.00	$0.00	$0.00	$0.00
441.685	SUP	HCPCS C1713		441.685  -  PLATE BONE 2.4MM 56MM IMPLANT RIM 4 HOLE LCP TITANIUM RADIAL	BOTH IP/OP	"$1,199.05 "	$887.30	$0.00	$931.30	$523.86	$523.86	$0.00	$0.00	$0.00	$249.91	$889.93	$889.93	$0.00	$0.00	$249.88	$0.00	$709.24	$709.24	$0.00	$582.06	$921.99	$931.30	$0.00		$0.00	$176.88	$0.00	$0.00	$185.33	$0.00	$0.00	$0.00	$0.00	$0.00
441.69	SUP	HCPCS C1713		441.690  -  PLATE BONE 2.4MM 28MM IMPLANT 2 HOLE LCP TITANIUM RADIAL	BOTH IP/OP	"$1,112.28 "	$823.09	$0.00	$889.82	$500.52	$500.52	$0.00	$0.00	$0.00	$231.83	$825.53	$825.53	$0.00	$0.00	$231.80	$0.00	$657.91	$657.91	$0.00	$556.14	$880.93	$889.82	$0.00		$0.00	$169.00	$0.00	$0.00	$177.07	$0.00	$0.00	$0.00	$0.00	$0.00
441.691	SUP	HCPCS C1713		441.691  -  PLATE BONE 2.4MM 40MM IMPLANT 3 HOLE LCP TITANIUM RADIAL	BOTH IP/OP	"$1,177.98 "	$871.71	$0.00	$914.92	$514.64	$514.64	$0.00	$0.00	$0.00	$245.52	$874.29	$874.29	$0.00	$0.00	$245.49	$0.00	$696.77	$696.77	$0.00	$571.83	$905.77	$914.92	$0.00		$0.00	$173.77	$0.00	$0.00	$182.07	$0.00	$0.00	$0.00	$0.00	$0.00
441.692	SUP	HCPCS C1713		441.692  -  PLATE BONE 2.4MM 50MM IMPLANT 4 HOLE LCP TITANIUM RADIAL	BOTH IP/OP	"$1,200.45 "	$888.33	$0.00	$932.40	$524.48	$524.48	$0.00	$0.00	$0.00	$250.20	$890.97	$890.97	$0.00	$0.00	$250.17	$0.00	$710.07	$710.07	$0.00	$582.75	$923.08	$932.40	$0.00		$0.00	$177.09	$0.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00
441.83	SUP	HCPCS C1713		441.83  -  PLATE BONE CLOVERLEAF 88X15X2MM 3 HOLE THIN BLADE LP HEAD	BOTH IP/OP	$570.48 	$422.16	$0.00	$456.38	$256.71	$256.71	$0.00	$0.00	$0.00	$118.90	$423.41	$423.41	$0.00	$0.00	$118.89	$0.00	$337.44	$337.44	$0.00	$285.24	$451.82	$456.38	$0.00		$0.00	$86.68	$0.00	$0.00	$90.82	$0.00	$0.00	$0.00	$0.00	$0.00
441.84	SUP	HCPCS C1713		441.84  -  PLATE BONE CLOVERLEAF 104X15X2MM 4 HOLE THIN BLADE LP HEAD	BOTH IP/OP	$610.05 	$451.44	$0.00	$488.04	$274.52	$274.52	$0.00	$0.00	$0.00	$127.15	$452.78	$452.78	$0.00	$0.00	$127.13	$0.00	$360.84	$360.84	$0.00	$305.03	$483.16	$488.04	$0.00		$0.00	$92.69	$0.00	$0.00	$97.12	$0.00	$0.00	$0.00	$0.00	$0.00
441.85	SUP	HCPCS C1713		441.85  -  PLATE BONE CLOVERLEAF 120X15X2MM 5 HOLE THIN BLADE LP HEAD	BOTH IP/OP	$768.35 	$568.58	$0.00	$614.68	$345.76	$345.76	$0.00	$0.00	$0.00	$160.14	$570.27	$570.27	$0.00	$0.00	$160.12	$0.00	$454.48	$454.48	$0.00	$384.18	$608.53	$614.68	$0.00		$0.00	$116.75	$0.00	$0.00	$122.32	$0.00	$0.00	$0.00	$0.00	$0.00
441.86	SUP	HCPCS C1713		441.86  -  PLATE BONE CLOVERLEAF 136X15X2MM 6 HOLE THIN BLADE LP HEAD	BOTH IP/OP	$833.85 	$617.05	$0.00	$667.08	$375.23	$375.23	$0.00	$0.00	$0.00	$173.80	$618.88	$618.88	$0.00	$0.00	$173.77	$0.00	$493.22	$493.22	$0.00	$416.93	$660.41	$667.08	$0.00		$0.00	$126.70	$0.00	$0.00	$132.75	$0.00	$0.00	$0.00	$0.00	$0.00
441.87	SUP	HCPCS C1713		441.87  -  PLATE BONE CLOVERLEAF 152X15X2MM 7 HOLE THIN BLADE LP HEAD	BOTH IP/OP	$898.00 	$664.52	$0.00	$718.40	$404.10	$404.10	$0.00	$0.00	$0.00	$187.17	$666.50	$666.50	$0.00	$0.00	$187.14	$0.00	$531.17	$531.17	$0.00	$449.00	$711.22	$718.40	$0.00		$0.00	$136.44	$0.00	$0.00	$142.96	$0.00	$0.00	$0.00	$0.00	$0.00
441.88	SUP	HCPCS C1713		441.88  -  PLATE BONE CLOVERLEAF 168X15X2MM 8 HOLE THIN BLADE LP HEAD	BOTH IP/OP	$953.95 	$705.92	$0.00	$763.16	$429.28	$429.28	$0.00	$0.00	$0.00	$198.83	$708.02	$708.02	$0.00	$0.00	$198.80	$0.00	$564.26	$564.26	$0.00	$476.98	$755.53	$763.16	$0.00		$0.00	$144.95	$0.00	$0.00	$151.87	$0.00	$0.00	$0.00	$0.00	$0.00
441.89	SUP	HCPCS C1713		441.89  -  PLATE BONE CLOVERLEAF 200X15X2MM 10 HOLE THIN BLADE LP HEAD	BOTH IP/OP	"$1,030.38 "	$762.48	$0.00	$824.30	$463.67	$463.67	$0.00	$0.00	$0.00	$214.76	$764.74	$764.74	$0.00	$0.00	$214.73	$0.00	$609.47	$609.47	$0.00	$515.19	$816.06	$824.30	$0.00		$0.00	$156.56	$0.00	$0.00	$164.04	$0.00	$0.00	$0.00	$0.00	$0.00
441.901	SUP	HCPCS C1713		441.901  -  PLATE BN STD 90X12X2.5MM NS LCP CMBN PHLS 3 HL SHFT LCK CMPR	BOTH IP/OP	"$2,954.78 "	"$2,186.54"	$0.00	"$2,294.96"	"$1,290.92"	"$1,290.92"	$0.00	$0.00	$0.00	$615.85	"$2,193.03"	"$2,193.03"	$0.00	$0.00	$615.78	$0.00	"$1,456.70"	"$1,456.70"	$0.00	"$1,434.35"	"$2,272.01"	"$2,294.96"	$0.00		$0.00	$435.88	$0.00	$0.00	$456.70	$0.00	$0.00	$0.00	$0.00	$0.00
441.903	SUP	HCPCS C1713		441.903  -  PLATE BONE STANDARD 114X12X2.5MM 6 HOLE HEAD 5 HOLE SHAFT	BOTH IP/OP	"$3,047.55 "	"$2,255.19"	$0.00	"$2,367.02"	"$1,331.45"	"$1,331.45"	$0.00	$0.00	$0.00	$635.19	"$2,261.89"	"$2,261.89"	$0.00	$0.00	$635.11	$0.00	"$1,502.44"	"$1,502.44"	$0.00	"$1,479.39"	"$2,343.35"	"$2,367.02"	$0.00		$0.00	$449.56	$0.00	$0.00	$471.04	$0.00	$0.00	$0.00	$0.00	$0.00
441.918	SUP	HCPCS C1713		441.918  -  PLATE BONE LONG 142MM 5 HOLE LOCKING LCP TITANIUM HUMERUS	BOTH IP/OP	"$3,077.05 "	"$2,277.02"	$0.00	"$2,389.96"	"$1,344.35"	"$1,344.35"	$0.00	$0.00	$0.00	$641.33	"$2,283.79"	"$2,283.79"	$0.00	$0.00	$641.26	$0.00	"$1,516.99"	"$1,516.99"	$0.00	"$1,493.73"	"$2,366.06"	"$2,389.96"	$0.00		$0.00	$453.92	$0.00	$0.00	$475.60	$0.00	$0.00	$0.00	$0.00	$0.00
441.919	SUP	HCPCS C1713		441.919  -  PLATE BONE LONG 160MM 6 HOLE LOCKING LCP TITANIUM HUMERUS	BOTH IP/OP	"$3,197.95 "	"$2,366.48"	$0.00	"$2,483.84"	"$1,397.16"	"$1,397.16"	$0.00	$0.00	$0.00	$666.53	"$2,373.52"	"$2,373.52"	$0.00	$0.00	$666.45	$0.00	"$1,576.59"	"$1,576.59"	$0.00	"$1,552.40"	"$2,459.00"	"$2,483.84"	$0.00		$0.00	$471.75	$0.00	$0.00	$494.28	$0.00	$0.00	$0.00	$0.00	$0.00
441.921	SUP	HCPCS C1713		441.921  -  PLATE BN 196X12X3.7MM NS LCP CMBN PHLS LNG 8 HL SHFT LCK	BOTH IP/OP	"$3,321.65 "	"$2,458.02"	$0.00	"$2,579.92"	"$1,451.21"	"$1,451.21"	$0.00	$0.00	$0.00	$692.31	"$2,465.33"	"$2,465.33"	$0.00	$0.00	$692.23	$0.00	"$1,637.57"	"$1,637.57"	$0.00	"$1,612.45"	"$2,554.12"	"$2,579.92"	$0.00		$0.00	$490.00	$0.00	$0.00	$513.40	$0.00	$0.00	$0.00	$0.00	$0.00
441.923	SUP	HCPCS C1713		441.923  -  PLATE BONE 3.5MM 232MM 10 HOLE LCP TITANIUM HUMERUS PROXIMAL	BOTH IP/OP	"$3,445.35 "	"$2,549.56"	$0.00	"$2,676.00"	"$1,505.25"	"$1,505.25"	$0.00	$0.00	$0.00	$718.10	"$2,557.14"	"$2,557.14"	$0.00	$0.00	$718.01	$0.00	"$1,698.56"	"$1,698.56"	$0.00	"$1,672.50"	"$2,649.24"	"$2,676.00"	$0.00		$0.00	$508.25	$0.00	$0.00	$532.52	$0.00	$0.00	$0.00	$0.00	$0.00
441.925	SUP	HCPCS C1713		441.925  -  PLATE BONE LONG 268MM 12 HOLE LOCKING LCP TITANIUM HUMERUS	BOTH IP/OP	"$3,564.83 "	"$2,637.97"	$0.00	"$2,768.80"	"$1,557.45"	"$1,557.45"	$0.00	$0.00	$0.00	$743.00	"$2,645.81"	"$2,645.81"	$0.00	$0.00	$742.91	$0.00	"$1,757.46"	"$1,757.46"	$0.00	"$1,730.50"	"$2,741.11"	"$2,768.80"	$0.00		$0.00	$525.87	$0.00	$0.00	$550.99	$0.00	$0.00	$0.00	$0.00	$0.00
441.931	SUP	HCPCS C1713		441.931  -  PLATE BONE T OBLIQUE LEFT 52X10X1.5MM 3 HOLE HEAD 3 HOLE	BOTH IP/OP	$721.13 	$533.64	$0.00	$560.10	$315.06	$315.06	$0.00	$0.00	$0.00	$150.30	$535.22	$535.22	$0.00	$0.00	$150.28	$0.00	$426.55	$426.55	$0.00	$350.06	$554.50	$560.10	$0.00		$0.00	$106.38	$0.00	$0.00	$111.46	$0.00	$0.00	$0.00	$0.00	$0.00
441.941	SUP	HCPCS C1713		441.941  -  PLATE BONE T OBLIQUE LEFT 63X10X1.5MM 3 HOLE HEAD 4 HOLE	BOTH IP/OP	$756.28 	$559.65	$0.00	$587.38	$330.40	$330.40	$0.00	$0.00	$0.00	$157.63	$561.31	$561.31	$0.00	$0.00	$157.61	$0.00	$447.34	$447.34	$0.00	$367.11	$581.51	$587.38	$0.00		$0.00	$111.56	$0.00	$0.00	$116.89	$0.00	$0.00	$0.00	$0.00	$0.00
441.951	SUP	HCPCS C1713		441.951  -  PLATE BONE T OBLIQUE LEFT 74X10X1.5MM 3 HOLE HEAD 5 HOLE	BOTH IP/OP	$788.60 	$583.56	$0.00	$612.50	$344.53	$344.53	$0.00	$0.00	$0.00	$164.36	$585.30	$585.30	$0.00	$0.00	$164.34	$0.00	$466.46	$466.46	$0.00	$382.81	$606.38	$612.50	$0.00		$0.00	$116.33	$0.00	$0.00	$121.89	$0.00	$0.00	$0.00	$0.00	$0.00
441.961	SUP	HCPCS C1713		441.961  -  PLATE BONE 85MM 3 HOLE HEAD 6 HOLE SHAFT T OBLIQUE LEFT LCP	BOTH IP/OP	$820.93 	$607.49	$0.00	$637.62	$358.66	$358.66	$0.00	$0.00	$0.00	$171.10	$609.29	$609.29	$0.00	$0.00	$171.08	$0.00	$485.58	$485.58	$0.00	$398.51	$631.25	$637.62	$0.00		$0.00	$121.10	$0.00	$0.00	$126.89	$0.00	$0.00	$0.00	$0.00	$0.00
441.971	SUP	HCPCS C1713		441.971  -  PLATE BONE T OBLIQUE 96X10X1.5MM 3 HOLE HEAD 7 HOLE SHAFT	BOTH IP/OP	$854.65 	$632.44	$0.00	$663.82	$373.40	$373.40	$0.00	$0.00	$0.00	$178.13	$634.32	$634.32	$0.00	$0.00	$178.11	$0.00	$505.53	$505.53	$0.00	$414.89	$657.19	$663.82	$0.00		$0.00	$126.08	$0.00	$0.00	$132.10	$0.00	$0.00	$0.00	$0.00	$0.00
441.981	SUP	HCPCS C1713		441.981  -  PLATE BONE 107MM 8 SHAFT HOLE 3 HOLE HEAD T OBLIQUE LEFT LCP	BOTH IP/OP	$901.05 	$666.78	$0.00	$699.84	$393.66	$393.66	$0.00	$0.00	$0.00	$187.80	$668.76	$668.76	$0.00	$0.00	$187.78	$0.00	$532.97	$532.97	$0.00	$437.40	$692.84	$699.84	$0.00		$0.00	$132.92	$0.00	$0.00	$139.27	$0.00	$0.00	$0.00	$0.00	$0.00
442.03	SUP	HCPCS C1713		442.03  -  PLATE BONE 23X7X1MM .3MM 3 HOLE .25 TUBULAR COLLAR TITANIUM	BOTH IP/OP	$146.03 	$108.06	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$30.44	$108.38	$108.38	$0.00	$0.00	$30.43	$0.00	$86.37	$86.37	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
442.04	SUP	HCPCS C1713		442.04  -  PLATE BONE 31X7X1MM .3MM 4 HOLE .25 TUBULAR COLLAR TITANIUM	BOTH IP/OP	$156.03 	$115.46	$0.00	$121.18	$68.16	$68.16	$0.00	$0.00	$0.00	$32.52	$115.80	$115.80	$0.00	$0.00	$32.52	$0.00	$92.29	$92.29	$0.00	$75.74	$119.97	$121.18	$0.00		$0.00	$23.02	$0.00	$0.00	$24.11	$0.00	$0.00	$0.00	$0.00	$0.00
442.05	SUP	HCPCS C1713		442.05  -  PLATE BONE 39X7X1MM .3MM 5 HOLE .25 TUBULAR COLLAR TITANIUM	BOTH IP/OP	$161.05 	$119.18	$0.00	$128.84	$72.47	$72.47	$0.00	$0.00	$0.00	$33.57	$119.53	$119.53	$0.00	$0.00	$33.56	$0.00	$95.26	$95.26	$0.00	$80.53	$127.55	$128.84	$0.00		$0.00	$24.47	$0.00	$0.00	$25.64	$0.00	$0.00	$0.00	$0.00	$0.00
442.06	SUP	HCPCS C1713		442.06  -  PLATE BONE 47X7X1MM .3MM 6 HOLE .25 TUBULAR COLLAR TITANIUM	BOTH IP/OP	$179.93 	$133.15	$0.00	$139.76	$78.62	$78.62	$0.00	$0.00	$0.00	$37.50	$133.54	$133.54	$0.00	$0.00	$37.50	$0.00	$106.43	$106.43	$0.00	$87.35	$138.36	$139.76	$0.00		$0.00	$26.54	$0.00	$0.00	$27.81	$0.00	$0.00	$0.00	$0.00	$0.00
442.07	SUP	HCPCS C1713		442.07  -  PLATE BONE 55X7X1MM .3MM 7 HOLE .25 TUBULAR COLLAR TITANIUM	BOTH IP/OP	$196.80 	$145.63	$0.00	$152.86	$85.98	$85.98	$0.00	$0.00	$0.00	$41.02	$146.06	$146.06	$0.00	$0.00	$41.01	$0.00	$116.41	$116.41	$0.00	$95.54	$151.34	$152.86	$0.00		$0.00	$29.03	$0.00	$0.00	$30.42	$0.00	$0.00	$0.00	$0.00	$0.00
442.08	SUP	HCPCS C1713		442.08  -  PLATE BONE 63X7X1MM .3MM 8 HOLE .25 TUBULAR COLLAR TITANIUM	BOTH IP/OP	$199.25 	$147.45	$0.00	$159.40	$89.66	$89.66	$0.00	$0.00	$0.00	$41.53	$147.88	$147.88	$0.00	$0.00	$41.52	$0.00	$117.86	$117.86	$0.00	$99.63	$157.81	$159.40	$0.00		$0.00	$30.27	$0.00	$0.00	$31.72	$0.00	$0.00	$0.00	$0.00	$0.00
442.33	SUP	HCPCS C1713		442.33  -  PLATE BONE L LEFT OBLIQUE 34X7X1MM 3 HOLE CNTOUR TITANIUM	BOTH IP/OP	$113.28 	$83.83	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$23.61	$84.07	$84.07	$0.00	$0.00	$23.61	$0.00	$67.00	$67.00	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
442.34	SUP	HCPCS C1713		442.34  -  PLATE BONE L RIGHT OBLIQUE 34X7X1MM 3 HOLE CNTOUR TITANIUM	BOTH IP/OP	$113.28 	$83.83	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$23.61	$84.07	$84.07	$0.00	$0.00	$23.61	$0.00	$67.00	$67.00	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
442.41	SUP	HCPCS C1713		442.41  -  PLATE BN T 32X7X1.2MM 3 HL TI 2.7MM SCR	BOTH IP/OP	$113.28 	$83.83	$0.00	$90.62	$50.97	$50.97	$0.00	$0.00	$0.00	$23.61	$84.07	$84.07	$0.00	$0.00	$23.61	$0.00	$67.00	$67.00	$0.00	$56.64	$89.72	$90.62	$0.00		$0.00	$17.21	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
442.472	SUP	HCPCS C1713		442.472  -  PLATE BN TI RDS RT DIST DRSL	BOTH IP/OP	"$1,854.48 "	"$1,372.32"	$0.00	"$1,483.58"	$834.51	$834.51	$0.00	$0.00	$0.00	$386.52	"$1,376.39"	"$1,376.39"	$0.00	$0.00	$386.47	$0.00	"$1,096.92"	"$1,096.92"	$0.00	$927.24	"$1,468.75"	"$1,483.58"	$0.00		$0.00	$290.23	$0.00	$0.00	$295.23	$0.00	$0.00	$0.00	$0.00	$0.00
442.473	SUP	HCPCS C1713		442.473  -  PLATE BN TI RDS RT DIST VOLR	BOTH IP/OP	"$1,530.63 "	"$1,132.67"	$0.00	"$1,224.50"	$688.78	$688.78	$0.00	$0.00	$0.00	$319.02	"$1,136.03"	"$1,136.03"	$0.00	$0.00	$318.98	$0.00	$905.36	$905.36	$0.00	$765.31	"$1,212.26"	"$1,224.50"	$0.00		$0.00	$239.54	$0.00	$0.00	$243.68	$0.00	$0.00	$0.00	$0.00	$0.00
442.477	SUP	HCPCS C1713		442.477  -  PLATE BONE 40MM 3X3 HOLE LCP TITANIUM DISTAL RAD NONSTRL 2.4	BOTH IP/OP	$877.15 	$649.09	$0.00	$681.28	$383.22	$383.22	$0.00	$0.00	$0.00	$182.82	$651.02	$651.02	$0.00	$0.00	$182.80	$0.00	$518.83	$518.83	$0.00	$425.80	$674.47	$681.28	$0.00		$0.00	$129.39	$0.00	$0.00	$135.57	$0.00	$0.00	$0.00	$0.00	$0.00
442.478	SUP	HCPCS C1713		442.478  -  PLATE BONE 49MM 3X4 HOLE LCP TITANIUM DISTAL RAD NONSTRL 2.4	BOTH IP/OP	$913.70 	$676.14	$0.00	$709.68	$399.20	$399.20	$0.00	$0.00	$0.00	$190.44	$678.15	$678.15	$0.00	$0.00	$190.42	$0.00	$540.45	$540.45	$0.00	$443.55	$702.58	$709.68	$0.00		$0.00	$134.79	$0.00	$0.00	$141.23	$0.00	$0.00	$0.00	$0.00	$0.00
442.479	SUP	HCPCS C1713		442.479  -  PLATE BONE STR 48MM 5 HOLE LCP TITANIUM DISTAL RAD NONSTRL	BOTH IP/OP	$832.18 	$615.81	$0.00	$646.34	$363.57	$363.57	$0.00	$0.00	$0.00	$173.45	$617.64	$617.64	$0.00	$0.00	$173.43	$0.00	$492.23	$492.23	$0.00	$403.96	$639.88	$646.34	$0.00		$0.00	$122.76	$0.00	$0.00	$128.62	$0.00	$0.00	$0.00	$0.00	$0.00
442.482	SUP	HCPCS C1713		442.482  -  PLATE BN TI RDS LT DIST DRSL	BOTH IP/OP	"$1,854.48 "	"$1,372.32"	$0.00	"$1,483.58"	$834.51	$834.51	$0.00	$0.00	$0.00	$386.52	"$1,376.39"	"$1,376.39"	$0.00	$0.00	$386.47	$0.00	"$1,096.92"	"$1,096.92"	$0.00	$927.24	"$1,468.75"	"$1,483.58"	$0.00		$0.00	$290.23	$0.00	$0.00	$295.23	$0.00	$0.00	$0.00	$0.00	$0.00
442.483	SUP	HCPCS C1713		442.483  -  PLATE BN TI RDS LT DIST VOLR	BOTH IP/OP	"$1,530.63 "	"$1,132.67"	$0.00	"$1,224.50"	$688.78	$688.78	$0.00	$0.00	$0.00	$319.02	"$1,136.03"	"$1,136.03"	$0.00	$0.00	$318.98	$0.00	$905.36	$905.36	$0.00	$765.31	"$1,212.26"	"$1,224.50"	$0.00		$0.00	$239.54	$0.00	$0.00	$243.68	$0.00	$0.00	$0.00	$0.00	$0.00
442.49	SUP	HCPCS C1713		442.490  -  PLATE BONE STR 57MM 6 HOLE LCP TITANIUM DISTAL RAD NONSTRL	BOTH IP/OP	$851.60 	$630.18	$0.00	$681.28	$383.22	$383.22	$0.00	$0.00	$0.00	$177.49	$632.06	$632.06	$0.00	$0.00	$177.47	$0.00	$503.72	$503.72	$0.00	$425.80	$674.47	$681.28	$0.00		$0.00	$129.39	$0.00	$0.00	$135.57	$0.00	$0.00	$0.00	$0.00	$0.00
442.491	SUP	HCPCS C1713		442.491  -  PLATE BN 43MM LCP 5 HLE/HD 3 HL SHFT TI RDS LT DIST VOLR 2.4	BOTH IP/OP	"$1,536.43 "	"$1,136.96"	$0.00	"$1,193.34"	$671.25	$671.25	$0.00	$0.00	$0.00	$320.23	"$1,140.33"	"$1,140.33"	$0.00	$0.00	$320.19	$0.00	$908.80	$908.80	$0.00	$745.84	"$1,181.41"	"$1,193.34"	$0.00		$0.00	$226.65	$0.00	$0.00	$237.47	$0.00	$0.00	$0.00	$0.00	$0.00
442.492	SUP	HCPCS C1713		442.492  -  PLATE BONE 61MM 5X5 HOLE LCP TITANIUM LEFT DISTAL VOLAR RAD	BOTH IP/OP	"$1,626.38 "	"$1,203.52"	$0.00	"$1,263.22"	$710.56	$710.56	$0.00	$0.00	$0.00	$338.98	"$1,207.10"	"$1,207.10"	$0.00	$0.00	$338.94	$0.00	$962.00	$962.00	$0.00	$789.51	"$1,250.59"	"$1,263.22"	$0.00		$0.00	$239.92	$0.00	$0.00	$251.38	$0.00	$0.00	$0.00	$0.00	$0.00
442.493	SUP	HCPCS C1713		442.493  -  PLATE BONE 43MM 5 HOLE HEAD 3 HOLE SHAFT LCP TITANIUM RAD	BOTH IP/OP	"$1,536.43 "	"$1,136.96"	$0.00	"$1,193.34"	$671.25	$671.25	$0.00	$0.00	$0.00	$320.23	"$1,140.33"	"$1,140.33"	$0.00	$0.00	$320.19	$0.00	$908.80	$908.80	$0.00	$745.84	"$1,181.41"	"$1,193.34"	$0.00		$0.00	$226.65	$0.00	$0.00	$237.47	$0.00	$0.00	$0.00	$0.00	$0.00
442.494	SUP	HCPCS C1713		442.494  -  PLATE BONE 61MM 5 HOLE HEAD 5 HOLE SHAFT LCP TITANIUM RAD	BOTH IP/OP	"$1,626.38 "	"$1,203.52"	$0.00	"$1,263.22"	$710.56	$710.56	$0.00	$0.00	$0.00	$338.98	"$1,207.10"	"$1,207.10"	$0.00	$0.00	$338.94	$0.00	$962.00	$962.00	$0.00	$789.51	"$1,250.59"	"$1,263.22"	$0.00		$0.00	$239.92	$0.00	$0.00	$251.38	$0.00	$0.00	$0.00	$0.00	$0.00
442.5	SUP	HCPCS C1713		442.500  -  PLATE BONE -90D L 40MM 2X3 HOLE LCP TITANIUM DISTAL RAD	BOTH IP/OP	$822.95 	$608.98	$0.00	$658.36	$370.33	$370.33	$0.00	$0.00	$0.00	$171.52	$610.79	$610.79	$0.00	$0.00	$171.50	$0.00	$486.77	$486.77	$0.00	$411.48	$651.78	$658.36	$0.00		$0.00	$125.04	$0.00	$0.00	$131.01	$0.00	$0.00	$0.00	$0.00	$0.00
442.501	SUP	HCPCS C1713		442.501  -  PLATE BONE -90D L 49MM 2X4 HOLE LCP TITANIUM DISTAL RAD	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
442.502	SUP	HCPCS C1713		442.502  -  PLATE BONE 90D L 40MM 2X3 HOLE LCP TITANIUM DISTAL RAD	BOTH IP/OP	$847.63 	$627.25	$0.00	$658.36	$370.33	$370.33	$0.00	$0.00	$0.00	$176.67	$629.11	$629.11	$0.00	$0.00	$176.65	$0.00	$501.37	$501.37	$0.00	$411.48	$651.78	$658.36	$0.00		$0.00	$125.04	$0.00	$0.00	$131.01	$0.00	$0.00	$0.00	$0.00	$0.00
442.503	SUP	HCPCS C1713		442.503  -  PLATE BONE 90D L 49MM 2X4 HOLE LCP TITANIUM DISTAL RAD	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
442.504	SUP	HCPCS C1713		442.504  -  PLATE BONE 90D L 40MM 3X3 HOLE LCP TITANIUM DISTAL RAD	BOTH IP/OP	$847.63 	$627.25	$0.00	$658.36	$370.33	$370.33	$0.00	$0.00	$0.00	$176.67	$629.11	$629.11	$0.00	$0.00	$176.65	$0.00	$501.37	$501.37	$0.00	$411.48	$651.78	$658.36	$0.00		$0.00	$125.04	$0.00	$0.00	$131.01	$0.00	$0.00	$0.00	$0.00	$0.00
442.505	SUP	HCPCS C1713		442.505  -  PLATE BONE 90D L 49MM 3X4 HOLE LCP TITANIUM DISTAL RAD	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
442.506	SUP	HCPCS C1713		442.506  -  PLATE BONE -90D L 40MM 3X3 HOLE LCP TITANIUM DISTAL RAD	BOTH IP/OP	$847.63 	$627.25	$0.00	$658.36	$370.33	$370.33	$0.00	$0.00	$0.00	$176.67	$629.11	$629.11	$0.00	$0.00	$176.65	$0.00	$501.37	$501.37	$0.00	$411.48	$651.78	$658.36	$0.00		$0.00	$125.04	$0.00	$0.00	$131.01	$0.00	$0.00	$0.00	$0.00	$0.00
442.507	SUP	HCPCS C1713		442.507  -  PLATE BONE -90D L 49MM 3X4 HOLE LCP TITANIUM DISTAL RAD	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
442.508	SUP	HCPCS C1713		442.508  -  PLATE BONE +20D L 43MM 3X3 HOLE LCP TITANIUM DISTAL RAD	BOTH IP/OP	$847.63 	$627.25	$0.00	$658.36	$370.33	$370.33	$0.00	$0.00	$0.00	$176.67	$629.11	$629.11	$0.00	$0.00	$176.65	$0.00	$501.37	$501.37	$0.00	$411.48	$651.78	$658.36	$0.00		$0.00	$125.04	$0.00	$0.00	$131.01	$0.00	$0.00	$0.00	$0.00	$0.00
442.509	SUP	HCPCS C1713		442.509  -  PLATE BONE +20D L 52MM 3X4 HOLE LCP TITANIUM DISTAL RAD	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
442.51	SUP	HCPCS C1713		442.51  -  PLATE BN STD BND NS 8 HL FSN TI WRST 2.7/3.5MM CORT SCR	BOTH IP/OP	"$1,973.43 "	"$1,460.34"	$0.00	"$1,578.74"	$888.04	$888.04	$0.00	$0.00	$0.00	$411.31	"$1,464.68"	"$1,464.68"	$0.00	$0.00	$411.26	$0.00	"$1,167.28"	"$1,167.28"	$0.00	$986.71	"$1,562.96"	"$1,578.74"	$0.00		$0.00	$299.85	$0.00	$0.00	$314.17	$0.00	$0.00	$0.00	$0.00	$0.00
442.511	SUP	HCPCS C1713		442.511  -  PLATE BONE -20D L 43MM 3X3 HOLE LCP TITANIUM DISTAL RAD	BOTH IP/OP	$847.63 	$627.25	$0.00	$658.36	$370.33	$370.33	$0.00	$0.00	$0.00	$176.67	$629.11	$629.11	$0.00	$0.00	$176.65	$0.00	$501.37	$501.37	$0.00	$411.48	$651.78	$658.36	$0.00		$0.00	$125.04	$0.00	$0.00	$131.01	$0.00	$0.00	$0.00	$0.00	$0.00
442.512	SUP	HCPCS C1713		442.512  -  PLATE BONE -20D L 52MM 3X4 HOLE LCP TITANIUM DISTAL RAD	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
442.52	SUP	HCPCS C1713		442.52  -  PLATE BN SHRT BND NS 8 HL FSN TI WRST 2.7/3.5MM CORT SCR	BOTH IP/OP	"$1,973.43 "	"$1,460.34"	$0.00	"$1,578.74"	$888.04	$888.04	$0.00	$0.00	$0.00	$411.31	"$1,464.68"	"$1,464.68"	$0.00	$0.00	$411.26	$0.00	"$1,167.28"	"$1,167.28"	$0.00	$986.71	"$1,562.96"	"$1,578.74"	$0.00		$0.00	$299.85	$0.00	$0.00	$314.17	$0.00	$0.00	$0.00	$0.00	$0.00
442.53	SUP	HCPCS C1713		442.53  -  PLATE BN STRG NS 9 HL FSN TI WRST 2.7/3.5MM CORT SCR	BOTH IP/OP	"$1,973.43 "	"$1,460.34"	$0.00	"$1,578.74"	$888.04	$888.04	$0.00	$0.00	$0.00	$411.31	"$1,464.68"	"$1,464.68"	$0.00	$0.00	$411.26	$0.00	"$1,167.28"	"$1,167.28"	$0.00	$986.71	"$1,562.96"	"$1,578.74"	$0.00		$0.00	$299.85	$0.00	$0.00	$314.17	$0.00	$0.00	$0.00	$0.00	$0.00
442.61	SUP	HCPCS C1713		442.61  -  PLATE BN 57X7X1.5MM NS 7 HL TI CNDRL LT 2.7MM SCR	BOTH IP/OP	$608.68 	$450.42	$0.00	$486.94	$273.90	$273.90	$0.00	$0.00	$0.00	$126.86	$451.76	$451.76	$0.00	$0.00	$126.85	$0.00	$360.03	$360.03	$0.00	$304.34	$482.07	$486.94	$0.00		$0.00	$92.48	$0.00	$0.00	$96.90	$0.00	$0.00	$0.00	$0.00	$0.00
442.62	SUP	HCPCS C1713		442.62  -  PLATE BN 57X7X1.5MM NS 7 HL TI CNDRL RT 2.7MM SCR	BOTH IP/OP	$608.68 	$450.42	$0.00	$486.94	$273.90	$273.90	$0.00	$0.00	$0.00	$126.86	$451.76	$451.76	$0.00	$0.00	$126.85	$0.00	$360.03	$360.03	$0.00	$304.34	$482.07	$486.94	$0.00		$0.00	$92.48	$0.00	$0.00	$96.90	$0.00	$0.00	$0.00	$0.00	$0.00
443.054	SUP	HCPCS C1713		443.054  -  PLATE BONE 22X5X1MM 4 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL 2	BOTH IP/OP	$408.05 	$301.96	$0.00	$326.44	$183.62	$183.62	$0.00	$0.00	$0.00	$85.05	$302.85	$302.85	$0.00	$0.00	$85.04	$0.00	$241.36	$241.36	$0.00	$204.03	$323.18	$326.44	$0.00		$0.00	$62.00	$0.00	$0.00	$64.96	$0.00	$0.00	$0.00	$0.00	$0.00
443.055	SUP	HCPCS C1713		443.055  -  PLATE BONE 27X5X1MM 5 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL 2	BOTH IP/OP	$450.38 	$333.28	$0.00	$360.30	$202.67	$202.67	$0.00	$0.00	$0.00	$93.87	$334.27	$334.27	$0.00	$0.00	$93.86	$0.00	$266.40	$266.40	$0.00	$225.19	$356.70	$360.30	$0.00		$0.00	$68.43	$0.00	$0.00	$71.70	$0.00	$0.00	$0.00	$0.00	$0.00
443.056	SUP	HCPCS C1713		443.056  -  PLATE BONE 32X5X1MM 6 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL 2	BOTH IP/OP	$491.30 	$363.56	$0.00	$393.04	$221.09	$221.09	$0.00	$0.00	$0.00	$102.40	$364.64	$364.64	$0.00	$0.00	$102.39	$0.00	$290.60	$290.60	$0.00	$245.65	$389.11	$393.04	$0.00		$0.00	$74.65	$0.00	$0.00	$78.21	$0.00	$0.00	$0.00	$0.00	$0.00
443.057	SUP	HCPCS C1713		443.057  -  PLATE BONE 37X5X1.5MM 7 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$532.25 	$393.87	$0.00	$425.80	$239.51	$239.51	$0.00	$0.00	$0.00	$110.93	$395.04	$395.04	$0.00	$0.00	$110.92	$0.00	$314.83	$314.83	$0.00	$266.13	$421.54	$425.80	$0.00		$0.00	$80.87	$0.00	$0.00	$84.73	$0.00	$0.00	$0.00	$0.00	$0.00
443.058	SUP	HCPCS C1713		443.058  -  PLATE BONE 42X5X1.5MM 8 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL	BOTH IP/OP	$571.83 	$423.15	$0.00	$457.46	$257.32	$257.32	$0.00	$0.00	$0.00	$119.18	$424.41	$424.41	$0.00	$0.00	$119.17	$0.00	$338.23	$338.23	$0.00	$285.91	$452.89	$457.46	$0.00		$0.00	$86.88	$0.00	$0.00	$91.03	$0.00	$0.00	$0.00	$0.00	$0.00
443.178	SUP	HCPCS C1713		443.178  -  PLATE 31MM TI 2MM SCR 2 BND ARCH BONE SPNL NONSTRL	BOTH IP/OP	"$1,342.25 "	$993.27	$0.00	"$1,073.80"	$604.01	$604.01	$0.00	$0.00	$0.00	$279.76	$996.22	$996.22	$0.00	$0.00	$279.72	$0.00	$793.94	$793.94	$0.00	$671.13	"$1,063.06"	"$1,073.80"	$0.00		$0.00	$210.06	$0.00	$0.00	$213.69	$0.00	$0.00	$0.00	$0.00	$0.00
443.18	SUP	HCPCS C1713		443.180  -  PLATE MINI 10MM SPC 33MM TI 2MM SCR 2 BND ARCH BONE SPNL	BOTH IP/OP	"$1,342.25 "	$993.27	$0.00	"$1,073.80"	$604.01	$604.01	$0.00	$0.00	$0.00	$279.76	$996.22	$996.22	$0.00	$0.00	$279.72	$0.00	$793.94	$793.94	$0.00	$671.13	"$1,063.06"	"$1,073.80"	$0.00		$0.00	$210.06	$0.00	$0.00	$213.69	$0.00	$0.00	$0.00	$0.00	$0.00
443.182	SUP	HCPCS C1713		443.182  -  PLATE MINI 12MM SPC 35MM TI 2MM SCR 2 BND ARCH BONE SPNL	BOTH IP/OP	"$1,342.25 "	$993.27	$0.00	"$1,073.80"	$604.01	$604.01	$0.00	$0.00	$0.00	$279.76	$996.22	$996.22	$0.00	$0.00	$279.72	$0.00	$793.94	$793.94	$0.00	$671.13	"$1,063.06"	"$1,073.80"	$0.00		$0.00	$210.06	$0.00	$0.00	$213.69	$0.00	$0.00	$0.00	$0.00	$0.00
443.19	SUP	HCPCS C1713		443.19  -  PLATE BN STRG 100X5X1MM NS 20 HL TI 2MM SCR	BOTH IP/OP	$458.55 	$339.33	$0.00	$366.84	$206.35	$206.35	$0.00	$0.00	$0.00	$95.57	$340.34	$340.34	$0.00	$0.00	$95.56	$0.00	$271.23	$271.23	$0.00	$229.28	$363.17	$366.84	$0.00		$0.00	$69.67	$0.00	$0.00	$73.00	$0.00	$0.00	$0.00	$0.00	$0.00
443.23	SUP	HCPCS C1713		443.23  -  PLATE BN T 50X5X1.2MM NS 3 HLE/HD 9 HL SHFT TI 2MM SCR	BOTH IP/OP	$390.33 	$288.84	$0.00	$312.26	$175.65	$175.65	$0.00	$0.00	$0.00	$81.35	$289.70	$289.70	$0.00	$0.00	$81.34	$0.00	$230.88	$230.88	$0.00	$195.16	$309.14	$312.26	$0.00		$0.00	$59.31	$0.00	$0.00	$62.14	$0.00	$0.00	$0.00	$0.00	$0.00
443.24	SUP	HCPCS C1713		443.24  -  PLATE BN T 50X5X1.2MM NS 4 HLE/HD 9 HL SHFT TI 2MM SCR	BOTH IP/OP	$421.70 	$312.06	$0.00	$337.36	$189.77	$189.77	$0.00	$0.00	$0.00	$87.89	$312.99	$312.99	$0.00	$0.00	$87.88	$0.00	$249.44	$249.44	$0.00	$210.85	$333.99	$337.36	$0.00		$0.00	$64.08	$0.00	$0.00	$67.13	$0.00	$0.00	$0.00	$0.00	$0.00
443.44	SUP	HCPCS C1713		443.44  -  PLATE BN 22X5X.9MM NS DCP 4 HL TI ZYG 2MM CORT SCR	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
443.45	SUP	HCPCS C1713		443.45  -  PLATE BN 27X5X.9MM NS DCP 5 HL TI ZYG 2MM SCR	BOTH IP/OP	$578.25 	$427.91	$0.00	$462.60	$260.21	$260.21	$0.00	$0.00	$0.00	$120.52	$429.18	$429.18	$0.00	$0.00	$120.51	$0.00	$342.03	$342.03	$0.00	$289.13	$457.97	$462.60	$0.00		$0.00	$90.50	$0.00	$0.00	$92.06	$0.00	$0.00	$0.00	$0.00	$0.00
443.46	SUP	HCPCS C1713		443.46  -  PLATE BN 32X5X.9MM NS DCP 6 HL TI ZYG 2MM SCR	BOTH IP/OP	$621.00 	$459.54	$0.00	$496.80	$279.45	$279.45	$0.00	$0.00	$0.00	$129.43	$460.91	$460.91	$0.00	$0.00	$129.42	$0.00	$367.32	$367.32	$0.00	$310.50	$491.83	$496.80	$0.00		$0.00	$97.19	$0.00	$0.00	$98.86	$0.00	$0.00	$0.00	$0.00	$0.00
443.48	SUP	HCPCS C1713		443.48  -  PLATE BONE H 12X11MM 4 HOLE TITANIUM CONDYLE NONSTRL 2MM	BOTH IP/OP	$398.50 	$294.89	$0.00	$318.80	$179.33	$179.33	$0.00	$0.00	$0.00	$83.06	$295.77	$295.77	$0.00	$0.00	$83.05	$0.00	$235.71	$235.71	$0.00	$199.25	$315.61	$318.80	$0.00		$0.00	$60.55	$0.00	$0.00	$63.44	$0.00	$0.00	$0.00	$0.00	$0.00
443.54	SUP	HCPCS C1713		443.54  -  PLATE BONE 22MM DCP MINI CRANFCL TI 4 HOLE 2MM SCR NONSTRL	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$283.50	$283.50	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$98.60	$0.00	$0.00	$100.30	$0.00	$0.00	$0.00	$0.00	$0.00
443.55	SUP	HCPCS C1713		443.55  -  PLATE BONE 27MM DCP MINI CRANFCL TI 5 HOLE 2MM SCR NONSTRL	BOTH IP/OP	$695.25 	$514.49	$0.00	$556.20	$312.86	$312.86	$0.00	$0.00	$0.00	$144.91	$516.01	$516.01	$0.00	$0.00	$144.89	$0.00	$411.24	$411.24	$0.00	$347.63	$550.64	$556.20	$0.00		$0.00	$108.81	$0.00	$0.00	$110.68	$0.00	$0.00	$0.00	$0.00	$0.00
443.56	SUP	HCPCS C1713		443.56  -  PLATE BONE 32MM DCP MINI CRANFCL TI 6 HOLE 2MM SCR NONSTRL	BOTH IP/OP	$760.50 	$562.77	$0.00	$608.40	$342.23	$342.23	$0.00	$0.00	$0.00	$158.51	$564.44	$564.44	$0.00	$0.00	$158.49	$0.00	$449.84	$449.84	$0.00	$380.25	$602.32	$608.40	$0.00		$0.00	$119.02	$0.00	$0.00	$121.07	$0.00	$0.00	$0.00	$0.00	$0.00
443.57	SUP	HCPCS C1713		443.57  -  PLATE BONE 37MM DCP MINI CRANFCL TI 7 HOLE 2MM SCR NONSTRL	BOTH IP/OP	$816.75 	$604.40	$0.00	$653.40	$367.54	$367.54	$0.00	$0.00	$0.00	$170.23	$606.19	$606.19	$0.00	$0.00	$170.21	$0.00	$483.11	$483.11	$0.00	$408.38	$646.87	$653.40	$0.00		$0.00	$127.82	$0.00	$0.00	$130.03	$0.00	$0.00	$0.00	$0.00	$0.00
443.58	SUP	HCPCS C1713		443.58  -  PLATE BONE 42MM DCP MINI CRANFCL TI 8 HOLE 2MM SCR NONSTRL	BOTH IP/OP	$884.25 	$654.35	$0.00	$707.40	$397.91	$397.91	$0.00	$0.00	$0.00	$184.30	$656.29	$656.29	$0.00	$0.00	$184.28	$0.00	$523.03	$523.03	$0.00	$442.13	$700.33	$707.40	$0.00		$0.00	$138.39	$0.00	$0.00	$140.77	$0.00	$0.00	$0.00	$0.00	$0.00
443.61	SUP	HCPCS C1713		443.61  -  PLATE BN 39X5X1.2MM NS 7 HL TI CNDRL LT 2MM SCR	BOTH IP/OP	$551.35 	$408.00	$0.00	$441.08	$248.11	$248.11	$0.00	$0.00	$0.00	$114.92	$409.21	$409.21	$0.00	$0.00	$114.90	$0.00	$326.12	$326.12	$0.00	$275.68	$436.67	$441.08	$0.00		$0.00	$83.77	$0.00	$0.00	$87.77	$0.00	$0.00	$0.00	$0.00	$0.00
443.62	SUP	HCPCS C1713		443.62  -  PLATE BN 39X5X1.2MM NS 7 HL TI CNDRL RT 2MM SCR	BOTH IP/OP	$551.35 	$408.00	$0.00	$441.08	$248.11	$248.11	$0.00	$0.00	$0.00	$114.92	$409.21	$409.21	$0.00	$0.00	$114.90	$0.00	$326.12	$326.12	$0.00	$275.68	$436.67	$441.08	$0.00		$0.00	$83.77	$0.00	$0.00	$87.77	$0.00	$0.00	$0.00	$0.00	$0.00
444.002	SUP	HCPCS C1713		444.002  -  PLATE BONE 2.7MM 20X8X2MM 2 HOLE DCP TITANIUM FT NONSTRL 2.7	BOTH IP/OP	$474.35 	$351.02	$0.00	$379.48	$213.46	$213.46	$0.00	$0.00	$0.00	$98.87	$352.06	$352.06	$0.00	$0.00	$98.85	$0.00	$280.58	$280.58	$0.00	$237.18	$375.69	$379.48	$0.00		$0.00	$74.24	$0.00	$0.00	$75.52	$0.00	$0.00	$0.00	$0.00	$0.00
444.004	SUP	HCPCS C1713		444.004  -  PLATE BONE 36X8X2MM 4 HOLE DCP TITANIUM FT NONSTRL 2.7MM	BOTH IP/OP	$593.60 	$439.26	$0.00	$474.88	$267.12	$267.12	$0.00	$0.00	$0.00	$123.72	$440.57	$440.57	$0.00	$0.00	$123.71	$0.00	$351.11	$351.11	$0.00	$296.80	$470.13	$474.88	$0.00		$0.00	$92.90	$0.00	$0.00	$94.50	$0.00	$0.00	$0.00	$0.00	$0.00
444.005	SUP	HCPCS C1713		444.005  -  PLATE BONE 44X8X2MM 5 HOLE DCP TITANIUM FT NONSTRL 2.7MM	BOTH IP/OP	$669.13 	$495.16	$0.00	$535.30	$301.11	$301.11	$0.00	$0.00	$0.00	$139.46	$496.62	$496.62	$0.00	$0.00	$139.45	$0.00	$395.79	$395.79	$0.00	$334.56	$529.95	$535.30	$0.00		$0.00	$104.72	$0.00	$0.00	$106.52	$0.00	$0.00	$0.00	$0.00	$0.00
444.006	SUP	HCPCS C1713		444.006  -  PLATE BONE 2.7MM 52X8X2MM 6 HOLE DCP TITANIUM FT NONSTRL 2.7	BOTH IP/OP	$716.83 	$530.45	$0.00	$573.46	$322.57	$322.57	$0.00	$0.00	$0.00	$149.40	$532.03	$532.03	$0.00	$0.00	$149.39	$0.00	$424.00	$424.00	$0.00	$358.41	$567.73	$573.46	$0.00		$0.00	$112.18	$0.00	$0.00	$114.12	$0.00	$0.00	$0.00	$0.00	$0.00
444.007	SUP	HCPCS C1713		444.007  -  PLATE BONE 60X8X2.5MM 7 HOLE DCP TITANIUM FT NONSTRL 2.7MM	BOTH IP/OP	$797.65 	$590.26	$0.00	$638.12	$358.94	$358.94	$0.00	$0.00	$0.00	$166.25	$592.02	$592.02	$0.00	$0.00	$166.23	$0.00	$471.81	$471.81	$0.00	$398.83	$631.74	$638.12	$0.00		$0.00	$124.83	$0.00	$0.00	$126.99	$0.00	$0.00	$0.00	$0.00	$0.00
444.008	SUP	HCPCS C1713		444.008  -  PLATE BONE 68X8X2.5MM 8 HOLE DCP TITANIUM FT NONSTRL 2.7MM	BOTH IP/OP	$836.08 	$618.70	$0.00	$668.86	$376.23	$376.23	$0.00	$0.00	$0.00	$174.26	$620.53	$620.53	$0.00	$0.00	$174.24	$0.00	$494.54	$494.54	$0.00	$418.04	$662.18	$668.86	$0.00		$0.00	$130.85	$0.00	$0.00	$133.10	$0.00	$0.00	$0.00	$0.00	$0.00
444.009	SUP	HCPCS C1713		444.009  -  PLATE BONE 2.7MM 76X8X2.5MM 9 HOLE DCP TITANIUM FT NONSTRL	BOTH IP/OP	$910.28 	$673.61	$0.00	$728.22	$409.62	$409.62	$0.00	$0.00	$0.00	$189.72	$675.61	$675.61	$0.00	$0.00	$189.70	$0.00	$538.43	$538.43	$0.00	$455.14	$720.94	$728.22	$0.00		$0.00	$142.46	$0.00	$0.00	$144.92	$0.00	$0.00	$0.00	$0.00	$0.00
444.01	SUP	HCPCS C1713		444.010  -  PLATE BONE 2.7MM 84X8X2.5MM 10 HOLE DCP TITANIUM FT NONSTRL	BOTH IP/OP	$985.80 	$729.49	$0.00	$788.64	$443.61	$443.61	$0.00	$0.00	$0.00	$205.47	$731.66	$731.66	$0.00	$0.00	$205.44	$0.00	$583.10	$583.10	$0.00	$492.90	$780.75	$788.64	$0.00		$0.00	$154.28	$0.00	$0.00	$156.94	$0.00	$0.00	$0.00	$0.00	$0.00
444.012	SUP	HCPCS C1713		444.012  -  PLATE BONE 2.7MM 100X8X2.5MM 12 HOLE DCP TITANIUM FT NONSTRL	BOTH IP/OP	"$1,094.45 "	$809.89	$0.00	$875.56	$492.50	$492.50	$0.00	$0.00	$0.00	$228.11	$812.30	$812.30	$0.00	$0.00	$228.08	$0.00	$647.37	$647.37	$0.00	$547.23	$866.80	$875.56	$0.00		$0.00	$171.28	$0.00	$0.00	$174.24	$0.00	$0.00	$0.00	$0.00	$0.00
444.022	SUP	HCPCS C1713		444.022  -  PLATE BONE 1.5MM 26X8X2.5MM 2 HOLE DCP TITANIUM FT NONSTRL	BOTH IP/OP	$494.23 	$365.73	$0.00	$395.38	$222.40	$222.40	$0.00	$0.00	$0.00	$103.01	$366.81	$366.81	$0.00	$0.00	$103.00	$0.00	$292.33	$292.33	$0.00	$247.11	$391.43	$395.38	$0.00		$0.00	$77.35	$0.00	$0.00	$78.68	$0.00	$0.00	$0.00	$0.00	$0.00
445	SUP	HCPCS C1713		445.00  -  PLATE BONE 3.5MM 118MM 10 HOLE RECONSTRUCTION LC-DCP	BOTH IP/OP	$941.68 	$696.84	$0.00	$753.34	$423.75	$423.75	$0.00	$0.00	$0.00	$196.27	$698.91	$698.91	$0.00	$0.00	$196.25	$0.00	$557.00	$557.00	$0.00	$470.84	$745.81	$753.34	$0.00		$0.00	$143.08	$0.00	$0.00	$149.91	$0.00	$0.00	$0.00	$0.00	$0.00
445.01	SUP	HCPCS C1713		445.01  -  PLATE BN 130MM NS 11 HL RECON TI 3.5MM SCR	BOTH IP/OP	$962.15 	$711.99	$0.00	$769.72	$432.97	$432.97	$0.00	$0.00	$0.00	$200.54	$714.11	$714.11	$0.00	$0.00	$200.51	$0.00	$569.11	$569.11	$0.00	$481.08	$762.02	$769.72	$0.00		$0.00	$146.19	$0.00	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$0.00
445.041	SUP	HCPCS C1713		445.041  -  PLATE BONE 56MM 4 HOLE RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	$818.13 	$605.42	$0.00	$635.42	$357.42	$357.42	$0.00	$0.00	$0.00	$170.52	$607.21	$607.21	$0.00	$0.00	$170.50	$0.00	$483.92	$483.92	$0.00	$397.14	$629.07	$635.42	$0.00		$0.00	$120.68	$0.00	$0.00	$126.45	$0.00	$0.00	$0.00	$0.00	$0.00
445.051	SUP	HCPCS C1713		445.051  -  PLATE BN 70X10.1X3.5MM NS LCP CMBN 5 HL RECON TI 3.5MM SCR	BOTH IP/OP	$823.73 	$609.56	$0.00	$639.80	$359.89	$359.89	$0.00	$0.00	$0.00	$171.68	$611.37	$611.37	$0.00	$0.00	$171.66	$0.00	$487.23	$487.23	$0.00	$399.88	$633.40	$639.80	$0.00		$0.00	$121.51	$0.00	$0.00	$127.32	$0.00	$0.00	$0.00	$0.00	$0.00
445.061	SUP	HCPCS C1713		445.061  -  PLATE BN 84X10.1X3.5MM NS LCP CMBN 6 HL RECON TI 3.5MM SCR	BOTH IP/OP	$953.05 	$705.26	$0.00	$740.24	$416.39	$416.39	$0.00	$0.00	$0.00	$198.64	$707.35	$707.35	$0.00	$0.00	$198.62	$0.00	$563.73	$563.73	$0.00	$462.65	$732.84	$740.24	$0.00		$0.00	$140.59	$0.00	$0.00	$147.31	$0.00	$0.00	$0.00	$0.00	$0.00
445.071	SUP	HCPCS C1713		445.071  -  PLATE BONE 98X10.1X3.5MM 7 HOLE LCP TITANIUM CLAVICLE	BOTH IP/OP	"$1,002.25 "	$741.67	$0.00	$778.46	$437.88	$437.88	$0.00	$0.00	$0.00	$208.89	$743.87	$743.87	$0.00	$0.00	$208.87	$0.00	$592.83	$592.83	$0.00	$486.54	$770.68	$778.46	$0.00		$0.00	$147.85	$0.00	$0.00	$154.91	$0.00	$0.00	$0.00	$0.00	$0.00
445.081	SUP	HCPCS C1713		445.081  -  PLATE BN 112X10.1X3.5MM NS LCP CMBN 8 HL RECON TI 3.5MM SCR	BOTH IP/OP	"$1,045.83 "	$773.91	$0.00	$812.30	$456.92	$456.92	$0.00	$0.00	$0.00	$217.98	$776.21	$776.21	$0.00	$0.00	$217.95	$0.00	$618.61	$618.61	$0.00	$507.69	$804.18	$812.30	$0.00		$0.00	$154.28	$0.00	$0.00	$161.65	$0.00	$0.00	$0.00	$0.00	$0.00
445.091	SUP	HCPCS C1713		445.091  -  PLATE BONE 126MM 9 HOLE RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,100.65 "	$814.48	$0.00	$854.88	$480.87	$480.87	$0.00	$0.00	$0.00	$229.40	$816.90	$816.90	$0.00	$0.00	$229.38	$0.00	$651.03	$651.03	$0.00	$534.30	$846.33	$854.88	$0.00		$0.00	$162.36	$0.00	$0.00	$170.12	$0.00	$0.00	$0.00	$0.00	$0.00
445.101	SUP	HCPCS C1713		445.101  -  PLATE BONE 140X10.1X3.5MM 10 HOLE LCP TITANIUM CLAVICLE	BOTH IP/OP	"$1,082.38 "	$800.96	$0.00	$840.68	$472.88	$472.88	$0.00	$0.00	$0.00	$225.59	$803.34	$803.34	$0.00	$0.00	$225.57	$0.00	$640.22	$640.22	$0.00	$525.43	$832.27	$840.68	$0.00		$0.00	$159.67	$0.00	$0.00	$167.30	$0.00	$0.00	$0.00	$0.00	$0.00
445.111	SUP	HCPCS C1713		445.111  -  PLATE BONE 154MM 11 HOLE RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,172.35 "	$867.54	$0.00	$910.56	$512.19	$512.19	$0.00	$0.00	$0.00	$244.35	$870.12	$870.12	$0.00	$0.00	$244.32	$0.00	$693.45	$693.45	$0.00	$569.10	$901.45	$910.56	$0.00		$0.00	$172.94	$0.00	$0.00	$181.20	$0.00	$0.00	$0.00	$0.00	$0.00
445.121	SUP	HCPCS C1713		445.121  -  PLATE BONE 168X10.1X3.5MM 12 HOLE LCP TITANIUM CLAVICLE	BOTH IP/OP	"$1,176.58 "	$870.67	$0.00	$913.84	$514.04	$514.04	$0.00	$0.00	$0.00	$245.23	$873.25	$873.25	$0.00	$0.00	$245.20	$0.00	$695.94	$695.94	$0.00	$571.15	$904.70	$913.84	$0.00		$0.00	$173.56	$0.00	$0.00	$181.85	$0.00	$0.00	$0.00	$0.00	$0.00
445.131	SUP	HCPCS C1713		445.131  -  PLATE BONE 182MM 13 HOLE RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,273.55 "	$942.43	$0.00	$989.18	$556.41	$556.41	$0.00	$0.00	$0.00	$265.44	$945.23	$945.23	$0.00	$0.00	$265.41	$0.00	$753.30	$753.30	$0.00	$618.24	$979.29	$989.18	$0.00		$0.00	$187.87	$0.00	$0.00	$196.85	$0.00	$0.00	$0.00	$0.00	$0.00
445.141	SUP	HCPCS C1713		445.141  -  PLATE BONE 196MM 14 HOLE RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,322.75 "	$978.84	$0.00	"$1,027.38"	$577.90	$577.90	$0.00	$0.00	$0.00	$275.69	$981.75	$981.75	$0.00	$0.00	$275.66	$0.00	$782.41	$782.41	$0.00	$642.11	"$1,017.11"	"$1,027.38"	$0.00		$0.00	$195.13	$0.00	$0.00	$204.45	$0.00	$0.00	$0.00	$0.00	$0.00
445.15	SUP	HCPCS C1713		445.15  -  PLATE BONE 58MM 5 HOLE RECONSTRUCTION LC-DCP TITANIUM	BOTH IP/OP	$716.50 	$530.21	$0.00	$573.20	$322.43	$322.43	$0.00	$0.00	$0.00	$149.34	$531.79	$531.79	$0.00	$0.00	$149.32	$0.00	$423.81	$423.81	$0.00	$358.25	$567.47	$573.20	$0.00		$0.00	$108.87	$0.00	$0.00	$114.07	$0.00	$0.00	$0.00	$0.00	$0.00
445.16	SUP	HCPCS C1713		445.16  -  PLATE BONE 70MM 6 HOLE RECONSTRUCTION LC-DCP TITANIUM	BOTH IP/OP	$825.68 	$611.00	$0.00	$660.54	$371.55	$371.55	$0.00	$0.00	$0.00	$172.09	$612.82	$612.82	$0.00	$0.00	$172.07	$0.00	$488.39	$488.39	$0.00	$412.84	$653.94	$660.54	$0.00		$0.00	$125.45	$0.00	$0.00	$131.45	$0.00	$0.00	$0.00	$0.00	$0.00
445.161	SUP	HCPCS C1713		445.161  -  PLATE BONE 224MM 16 HOLE RECONSTRUCTION LCP TITANIUM	BOTH IP/OP	"$1,433.80 "	"$1,061.01"	$0.00	"$1,113.64"	$626.42	$626.42	$0.00	$0.00	$0.00	$298.84	"$1,064.17"	"$1,064.17"	$0.00	$0.00	$298.80	$0.00	$848.09	$848.09	$0.00	$696.03	"$1,102.50"	"$1,113.64"	$0.00		$0.00	$211.51	$0.00	$0.00	$221.61	$0.00	$0.00	$0.00	$0.00	$0.00
445.17	SUP	HCPCS C1713		445.17  -  PLATE BONE 82MM 7 HOLE RECONSTRUCTION LC-DCP TITANIUM	BOTH IP/OP	$848.88 	$628.17	$0.00	$679.10	$381.99	$381.99	$0.00	$0.00	$0.00	$176.93	$630.04	$630.04	$0.00	$0.00	$176.91	$0.00	$502.11	$502.11	$0.00	$424.44	$672.31	$679.10	$0.00		$0.00	$128.98	$0.00	$0.00	$135.14	$0.00	$0.00	$0.00	$0.00	$0.00
445.18	SUP	HCPCS C1713		445.18  -  PLATE BONE 94MM 8 HOLE RECONSTRUCTION LC-DCP TITANIUM	BOTH IP/OP	$899.38 	$665.54	$0.00	$719.50	$404.72	$404.72	$0.00	$0.00	$0.00	$187.45	$667.52	$667.52	$0.00	$0.00	$187.43	$0.00	$531.98	$531.98	$0.00	$449.69	$712.31	$719.50	$0.00		$0.00	$136.65	$0.00	$0.00	$143.18	$0.00	$0.00	$0.00	$0.00	$0.00
445.181	SUP	HCPCS C1713		445.181  -  PLATE BN 252X10.1X3.5MM NS LCP CMBN 18 HL RECON TI 3.5MM SCR	BOTH IP/OP	"$1,501.28 "	"$1,110.95"	$0.00	"$1,166.04"	$655.90	$655.90	$0.00	$0.00	$0.00	$312.90	"$1,114.25"	"$1,114.25"	$0.00	$0.00	$312.87	$0.00	$888.00	$888.00	$0.00	$728.78	"$1,154.38"	"$1,166.04"	$0.00		$0.00	$221.46	$0.00	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00
445.19	SUP	HCPCS C1713		445.19  -  PLATE BONE 106MM 9 HOLE RECONSTRUCTION LC-DCP TITANIUM	BOTH IP/OP	$926.68 	$685.74	$0.00	$741.34	$417.00	$417.00	$0.00	$0.00	$0.00	$193.14	$687.78	$687.78	$0.00	$0.00	$193.12	$0.00	$548.13	$548.13	$0.00	$463.34	$733.93	$741.34	$0.00		$0.00	$140.80	$0.00	$0.00	$147.53	$0.00	$0.00	$0.00	$0.00	$0.00
445.201	SUP	HCPCS C1713		445.201  -  PLATE BN 280X10.1X3.5MM NS LCP CMBN 20 HL RECON TI 3.5MM SCR	BOTH IP/OP	"$1,823.18 "	"$1,349.15"	$0.00	"$1,416.06"	$796.53	$796.53	$0.00	$0.00	$0.00	$380.00	"$1,353.16"	"$1,353.16"	$0.00	$0.00	$379.95	$0.00	"$1,078.41"	"$1,078.41"	$0.00	$885.04	"$1,401.90"	"$1,416.06"	$0.00		$0.00	$268.95	$0.00	$0.00	$281.80	$0.00	$0.00	$0.00	$0.00	$0.00
445.221	SUP	HCPCS C1713		445.221  -  PLATE BONE 308MM 22 HOLE RECONSTRUCTION LCP TITANIUM NONSTRL	BOTH IP/OP	"$1,858.33 "	"$1,375.16"	$0.00	"$1,443.36"	$811.89	$811.89	$0.00	$0.00	$0.00	$387.32	"$1,379.25"	"$1,379.25"	$0.00	$0.00	$387.27	$0.00	"$1,099.20"	"$1,099.20"	$0.00	$902.10	"$1,428.93"	"$1,443.36"	$0.00		$0.00	$274.13	$0.00	$0.00	$287.23	$0.00	$0.00	$0.00	$0.00	$0.00
446.014	SUP	HCPCS C1713		446.014  -  PLATE BN RECT 45X38X.4MM NS CNTR MESH MLBL TI CRNFCL 1.5MM	BOTH IP/OP	"$3,413.25 "	"$2,525.81"	$0.00	"$2,730.60"	"$1,535.96"	"$1,535.96"	$0.00	$0.00	$0.00	$711.41	"$2,533.31"	"$2,533.31"	$0.00	$0.00	$711.32	$0.00	"$1,682.73"	"$1,682.73"	$0.00	"$1,706.63"	"$2,703.29"	"$2,730.60"	$0.00		$0.00	$534.17	$0.00	$0.00	$543.39	$0.00	$0.00	$0.00	$0.00	$0.00
446.015	SUP	HCPCS C1713		446.015  -  PLATE BN RECT 45X38X.6MM NS CNTR MESH RGD TI CRNFCL 1.5MM	BOTH IP/OP	"$3,413.25 "	"$2,525.81"	$0.00	"$2,730.60"	"$1,535.96"	"$1,535.96"	$0.00	$0.00	$0.00	$711.41	"$2,533.31"	"$2,533.31"	$0.00	$0.00	$711.32	$0.00	"$1,682.73"	"$1,682.73"	$0.00	"$1,706.63"	"$2,703.29"	"$2,730.60"	$0.00		$0.00	$534.17	$0.00	$0.00	$543.39	$0.00	$0.00	$0.00	$0.00	$0.00
446.017	SUP	HCPCS C1713		446.017  -  PLATE BN RECT 100X100X.3MM NS CNTR MESH MLBL TI CRNFCL 1.5MM	BOTH IP/OP	"$5,334.75 "	"$3,947.72"	$0.00	"$4,267.80"	"$2,400.64"	"$2,400.64"	$0.00	$0.00	$0.00	"$1,111.90"	"$3,959.45"	"$3,959.45"	$0.00	$0.00	"$1,111.76"	$0.00	"$2,630.03"	"$2,630.03"	$0.00	"$2,667.38"	"$4,225.12"	"$4,267.80"	$0.00		$0.00	$834.89	$0.00	$0.00	$849.29	$0.00	$0.00	$0.00	$0.00	$0.00
446.018	SUP	HCPCS C1713		446.018  -  PLATE BN RECT 100X100X.6MM NS CNTR MESH RGD TI CRNFCL 1.5MM	BOTH IP/OP	"$5,334.75 "	"$3,947.72"	$0.00	"$4,267.80"	"$2,400.64"	"$2,400.64"	$0.00	$0.00	$0.00	"$1,111.90"	"$3,959.45"	"$3,959.45"	$0.00	$0.00	"$1,111.76"	$0.00	"$2,630.03"	"$2,630.03"	$0.00	"$2,667.38"	"$4,225.12"	"$4,267.80"	$0.00		$0.00	$834.89	$0.00	$0.00	$849.29	$0.00	$0.00	$0.00	$0.00	$0.00
446.019	SUP	HCPCS C1713		446.019  -  PLATE BONE NONSTRL GOLD 200X200MM CRANFCL TI CONTUR MESH RGD	BOTH IP/OP	"$19,163.25 "	"$14,180.81"	$0.00	"$15,330.60"	"$8,623.46"	"$8,623.46"	$0.00	$0.00	$0.00	"$3,994.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,993.62"	$0.00	"$9,447.48"	"$9,447.48"	$0.00	"$9,581.63"	"$15,177.29"	"$15,330.60"	$0.00		$0.00	"$2,999.05"	$0.00	$0.00	"$3,050.79"	$0.00	$0.00	$0.00	$0.00	$0.00
446.02	SUP	HCPCS C1713		446.020  -  PLATE BONE CRANIAL TI 2 HOLE STR 1.5 MM SCR NONSTRL	BOTH IP/OP	$105.75 	$78.26	$0.00	$84.60	$47.59	$47.59	$0.00	$0.00	$0.00	$22.04	$78.49	$78.49	$0.00	$0.00	$22.04	$0.00	$62.55	$62.55	$0.00	$52.88	$83.75	$84.60	$0.00		$0.00	$16.55	$0.00	$0.00	$16.84	$0.00	$0.00	$0.00	$0.00	$0.00
446.024	SUP	HCPCS C1713		446.024  -  PLATE BONE 25MM CRANFCL TI 4 HOLE STR LP 1.5MM SCR NONSTRL	BOTH IP/OP	$144.00 	$106.56	$0.00	$115.20	$64.80	$64.80	$0.00	$0.00	$0.00	$30.01	$106.88	$106.88	$0.00	$0.00	$30.01	$0.00	$85.18	$85.18	$0.00	$72.00	$114.05	$115.20	$0.00		$0.00	$22.54	$0.00	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$0.00
446.031	SUP	HCPCS C1713		446.031  -  PLATE BN STRG 29X3.8X.8MM NS PRO-PK 6 HL LOPRFL PRECONTOUR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
446.032	SUP	HCPCS C1713		446.032  -  PLATE BN STRG 59X3.8X.8MM NS PRO-PK 12 HL LOPRFL PRECONTOUR	BOTH IP/OP	$465.28 	$344.31	$0.00	$361.38	$203.28	$203.28	$0.00	$0.00	$0.00	$96.97	$345.33	$345.33	$0.00	$0.00	$96.96	$0.00	$275.21	$275.21	$0.00	$225.86	$357.77	$361.38	$0.00		$0.00	$68.64	$0.00	$0.00	$71.91	$0.00	$0.00	$0.00	$0.00	$0.00
446.033	SUP	HCPCS C1713		446.033  -  PLATE BONE NONSTRL TEAL CRANFCL TI CONTUR MESH MALBLE SM ARC	BOTH IP/OP	"$1,768.50 "	"$1,308.69"	$0.00	"$1,414.80"	$795.83	$795.83	$0.00	$0.00	$0.00	$368.60	"$1,312.58"	"$1,312.58"	$0.00	$0.00	$368.56	$0.00	"$1,046.07"	"$1,046.07"	$0.00	$884.25	"$1,400.65"	"$1,414.80"	$0.00		$0.00	$276.77	$0.00	$0.00	$281.55	$0.00	$0.00	$0.00	$0.00	$0.00
446.034	SUP	HCPCS C1713		446.034  -  PLATE BONE NONSTRL TEAL CRANFCL TI CONTUR MESH MALBLE LG ARC	BOTH IP/OP	"$2,754.00 "	"$2,037.96"	$0.00	"$2,203.20"	"$1,239.30"	"$1,239.30"	$0.00	$0.00	$0.00	$574.00	"$2,044.02"	"$2,044.02"	$0.00	$0.00	$573.93	$0.00	"$1,357.72"	"$1,357.72"	$0.00	"$1,377.00"	"$2,181.17"	"$2,203.20"	$0.00		$0.00	$431.00	$0.00	$0.00	$438.44	$0.00	$0.00	$0.00	$0.00	$0.00
446.035	SUP	HCPCS C1713		446.035  -  PLATE BONE 1.5MM SCR GOLD CRANFCL TI CONTUR MESH RGD SM ARC	BOTH IP/OP	"$1,768.50 "	"$1,308.69"	$0.00	"$1,414.80"	$795.83	$795.83	$0.00	$0.00	$0.00	$368.60	"$1,312.58"	"$1,312.58"	$0.00	$0.00	$368.56	$0.00	"$1,046.07"	"$1,046.07"	$0.00	$884.25	"$1,400.65"	"$1,414.80"	$0.00		$0.00	$276.77	$0.00	$0.00	$281.55	$0.00	$0.00	$0.00	$0.00	$0.00
446.036	SUP	HCPCS C1713		446.036  -  PLATE BONE 1.5MM SCR GOLD CRANFCL TI CONTUR MESH RGD LG ARC	BOTH IP/OP	"$2,754.00 "	"$2,037.96"	$0.00	"$2,203.20"	"$1,239.30"	"$1,239.30"	$0.00	$0.00	$0.00	$574.00	"$2,044.02"	"$2,044.02"	$0.00	$0.00	$573.93	$0.00	"$1,357.72"	"$1,357.72"	$0.00	"$1,377.00"	"$2,181.17"	"$2,203.20"	$0.00		$0.00	$431.00	$0.00	$0.00	$438.44	$0.00	$0.00	$0.00	$0.00	$0.00
446.04	SUP	HCPCS C1713		446.040  -  PLATE 0MM RIGHT MAXL PREBNT OFFST ORTHGNAT 1.5MM SCR BONE TI	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.041	SUP	HCPCS C1713		446.041  -  PLATE LEFT MAXL PREBNT 1.5MM SCR BONE TI 0MM NONSTRL	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.042	SUP	HCPCS C1713		446.042  -  PLATE BN 3MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.043	SUP	HCPCS C1713		446.043  -  PLATE BN 3MM PREBNT 27.1X.9MM NS TI MXL LT 1.5MM CORT SCR	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.044	SUP	HCPCS C1713		446.044  -  PLATE BN 5MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.045	SUP	HCPCS C1713		446.045  -  PLATE BN 5MM PREBNT 27.1X.9MM NS TI MXL LT 1.5MM CORT SCR	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.046	SUP	HCPCS C1713		446.046  -  PLATE BN 7MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.047	SUP	HCPCS C1713		446.047  -  PLATE LEFT MAXL PREBNT 1.5MM SCR BONE TI 7MM NONSTRL	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.048	SUP	HCPCS C1713		446.048  -  PLATE BN 9MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.049	SUP	HCPCS C1713		446.049  -  PLATE BN 9MM PREBNT 27.1X.9MM NS TI MXL LT 1.5MM CORT SCR	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.05	SUP	HCPCS C1713		446.050  -  PLATE BONE CONTUR MESH MALBLE 1.5MM SCR TEAL 30MM CRANFCL TI	BOTH IP/OP	"$1,768.50 "	"$1,308.69"	$0.00	"$1,414.80"	$795.83	$795.83	$0.00	$0.00	$0.00	$368.60	"$1,312.58"	"$1,312.58"	$0.00	$0.00	$368.56	$0.00	"$1,046.07"	"$1,046.07"	$0.00	$884.25	"$1,400.65"	"$1,414.80"	$0.00		$0.00	$276.77	$0.00	$0.00	$281.55	$0.00	$0.00	$0.00	$0.00	$0.00
446.051	SUP	HCPCS C1713		446.051  -  PLATE BONE CONTUR MESH MALBLE 1.5MM SCR TEAL 70MM CRANFCL TI	BOTH IP/OP	"$3,665.25 "	"$2,712.29"	$0.00	"$2,932.20"	"$1,649.36"	"$1,649.36"	$0.00	$0.00	$0.00	$763.93	"$2,720.35"	"$2,720.35"	$0.00	$0.00	$763.84	$0.00	"$1,806.97"	"$1,806.97"	$0.00	"$1,832.63"	"$2,902.88"	"$2,932.20"	$0.00		$0.00	$573.61	$0.00	$0.00	$583.51	$0.00	$0.00	$0.00	$0.00	$0.00
446.052	SUP	HCPCS C1713		446.052  -  PLATE BONE CONTUR MESH MALBLE 1.5MM SCR TEAL 100MM CRANFCL	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
446.053	SUP	HCPCS C1713		446.053  -  PLATE BONE NONSTRL GOLD 30MM CRANFCL TI CONTUR MESH RGD 1.5	BOTH IP/OP	"$1,966.50 "	"$1,455.21"	$0.00	"$1,573.20"	$884.93	$884.93	$0.00	$0.00	$0.00	$409.87	"$1,459.54"	"$1,459.54"	$0.00	$0.00	$409.82	$0.00	"$1,163.18"	"$1,163.18"	$0.00	$983.25	"$1,557.47"	"$1,573.20"	$0.00		$0.00	$307.76	$0.00	$0.00	$313.07	$0.00	$0.00	$0.00	$0.00	$0.00
446.054	SUP	HCPCS C1713		446.054  -  PLATE BONE NONSTRL GOLD 70MM CRANFCL TI CONTUR MESH RGD 1.5	BOTH IP/OP	"$4,070.25 "	"$3,011.99"	$0.00	"$3,256.20"	"$1,831.61"	"$1,831.61"	$0.00	$0.00	$0.00	$848.34	"$3,020.94"	"$3,020.94"	$0.00	$0.00	$848.24	$0.00	"$2,006.63"	"$2,006.63"	$0.00	"$2,035.13"	"$3,223.64"	"$3,256.20"	$0.00		$0.00	$636.99	$0.00	$0.00	$647.98	$0.00	$0.00	$0.00	$0.00	$0.00
446.055	SUP	HCPCS C1713		446.055  -  PLATE BONE NONSTRL GOLD 100MM CRANFCL TI CONTUR MESH RGD 1.5	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
446.06	SUP	HCPCS C1713		446.060  -  PLATE 11MM ADV RIGHT MAXL PREBNT 1.5MM SCR BONE TI NONSTRL	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.061	SUP	HCPCS C1713		446.061  -  PLATE LEFT MAXL PREBNT 1.5MM SCR BONE TI 11MM NONSTRL	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.09	SUP	HCPCS C1713		446.090  -  PLATE MANDIB 4X7 HOLE T 1.5 MM SCR BONE TI NONSTRL	BOTH IP/OP	$625.50 	$462.87	$0.00	$500.40	$281.48	$281.48	$0.00	$0.00	$0.00	$130.37	$464.25	$464.25	$0.00	$0.00	$130.35	$0.00	$369.98	$369.98	$0.00	$312.75	$495.40	$500.40	$0.00		$0.00	$97.89	$0.00	$0.00	$99.58	$0.00	$0.00	$0.00	$0.00	$0.00
446.091	SUP	HCPCS C1713		446.091  -  PLATE MANDIB 4X7 HOLE T MALBLE 1.5 MM SCR BONE TI NONSTRL	BOTH IP/OP	$553.50 	$409.59	$0.00	$442.80	$249.08	$249.08	$0.00	$0.00	$0.00	$115.36	$410.81	$410.81	$0.00	$0.00	$115.35	$0.00	$327.40	$327.40	$0.00	$276.75	$438.37	$442.80	$0.00		$0.00	$86.62	$0.00	$0.00	$88.12	$0.00	$0.00	$0.00	$0.00	$0.00
446.096	SUP	HCPCS C1713		446.096  -  PLATE BONE 14X14MM CRANFCL TI 4 HOLE BOX 1.5MM SCR NONSTRL	BOTH IP/OP	$553.50 	$409.59	$0.00	$442.80	$249.08	$249.08	$0.00	$0.00	$0.00	$115.36	$410.81	$410.81	$0.00	$0.00	$115.35	$0.00	$327.40	$327.40	$0.00	$276.75	$438.37	$442.80	$0.00		$0.00	$86.62	$0.00	$0.00	$88.12	$0.00	$0.00	$0.00	$0.00	$0.00
446.097	SUP	HCPCS C1713		446.097  -  PLATE BONE 16X16MM CRANFCL TI 4 HOLE BOX 1.5MM SCR NONSTRL	BOTH IP/OP	$553.50 	$409.59	$0.00	$442.80	$249.08	$249.08	$0.00	$0.00	$0.00	$115.36	$410.81	$410.81	$0.00	$0.00	$115.35	$0.00	$327.40	$327.40	$0.00	$276.75	$438.37	$442.80	$0.00		$0.00	$86.62	$0.00	$0.00	$88.12	$0.00	$0.00	$0.00	$0.00	$0.00
446.1	SUP	HCPCS C1713		446.10  -  PLATE 4.5MM HOLE SPC 90MM TI 1.5MM SCR 20 HOLE ADP BONE	BOTH IP/OP	$859.50 	$636.03	$0.00	$687.60	$386.78	$386.78	$0.00	$0.00	$0.00	$179.14	$637.92	$637.92	$0.00	$0.00	$179.12	$0.00	$508.39	$508.39	$0.00	$429.75	$680.72	$687.60	$0.00		$0.00	$134.51	$0.00	$0.00	$136.83	$0.00	$0.00	$0.00	$0.00	$0.00
446.101	SUP	HCPCS C1713		446.101  -  PLATE BONE 90MM CRANFCL TI 20 HOLE ADP LP 1.5MM SCR NONSTRL	BOTH IP/OP	$819.00 	$606.06	$0.00	$655.20	$368.55	$368.55	$0.00	$0.00	$0.00	$170.70	$607.86	$607.86	$0.00	$0.00	$170.68	$0.00	$484.44	$484.44	$0.00	$409.50	$648.65	$655.20	$0.00		$0.00	$128.17	$0.00	$0.00	$130.38	$0.00	$0.00	$0.00	$0.00	$0.00
446.154	SUP	HCPCS C1713		446.154  -  1.5MM TI 90Ř L-PLATE 17MM 2X2 HOLES LOW-PROFILE/LEFT	BOTH IP/OP	$459.00 	$339.66	$0.00	$367.20	$206.55	$206.55	$0.00	$0.00	$0.00	$95.67	$340.67	$340.67	$0.00	$0.00	$95.66	$0.00	$271.50	$271.50	$0.00	$229.50	$363.53	$367.20	$0.00		$0.00	$71.83	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$0.00
446.155	SUP	HCPCS C1713		446.155  -  1.5MM TI 90Ř L-PLATE 17MM 2X2 HOLES LOW-PROFILE/RIGHT	BOTH IP/OP	$459.00 	$339.66	$0.00	$367.20	$206.55	$206.55	$0.00	$0.00	$0.00	$95.67	$340.67	$340.67	$0.00	$0.00	$95.66	$0.00	$271.50	$271.50	$0.00	$229.50	$363.53	$367.20	$0.00		$0.00	$71.83	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$0.00
446.156	SUP	HCPCS C1713		446.156  -  1.5MM TI 90Ř L-PLATE 19MM 2X2 HOLES LOW-PROFILE/LEFT	BOTH IP/OP	$459.00 	$339.66	$0.00	$367.20	$206.55	$206.55	$0.00	$0.00	$0.00	$95.67	$340.67	$340.67	$0.00	$0.00	$95.66	$0.00	$271.50	$271.50	$0.00	$229.50	$363.53	$367.20	$0.00		$0.00	$71.83	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$0.00
446.157	SUP	HCPCS C1713		446.157  -  1.5MM TI 90Ř L-PLATE 19MM 2X2 HOLES LOW-PROFILE/RIGHT	BOTH IP/OP	$459.00 	$339.66	$0.00	$367.20	$206.55	$206.55	$0.00	$0.00	$0.00	$95.67	$340.67	$340.67	$0.00	$0.00	$95.66	$0.00	$271.50	$271.50	$0.00	$229.50	$363.53	$367.20	$0.00		$0.00	$71.83	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$0.00
446.158	SUP	HCPCS C1713		446.158  -  1.5MM TI 90Ř L-PLATE 23MM 2X2 HOLES LOW-PROFILE/LEFT	BOTH IP/OP	$459.00 	$339.66	$0.00	$367.20	$206.55	$206.55	$0.00	$0.00	$0.00	$95.67	$340.67	$340.67	$0.00	$0.00	$95.66	$0.00	$271.50	$271.50	$0.00	$229.50	$363.53	$367.20	$0.00		$0.00	$71.83	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$0.00
446.159	SUP	HCPCS C1713		446.159  -  1.5MM TI 90Ř L-PLATE 23MM 2X2 HOLES LOW-PROFILE/RIGHT	BOTH IP/OP	$459.00 	$339.66	$0.00	$367.20	$206.55	$206.55	$0.00	$0.00	$0.00	$95.67	$340.67	$340.67	$0.00	$0.00	$95.66	$0.00	$271.50	$271.50	$0.00	$229.50	$363.53	$367.20	$0.00		$0.00	$71.83	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$0.00
446.18	SUP	HCPCS C1713		446.18  -  PLATE BONE ORBTL RIM TI 8 HOLE RGD 1.5 MM SCR NONSTRL	BOTH IP/OP	$684.00 	$506.16	$0.00	$547.20	$307.80	$307.80	$0.00	$0.00	$0.00	$142.56	$507.66	$507.66	$0.00	$0.00	$142.55	$0.00	$404.59	$404.59	$0.00	$342.00	$541.73	$547.20	$0.00		$0.00	$107.05	$0.00	$0.00	$108.89	$0.00	$0.00	$0.00	$0.00	$0.00
446.19	SUP	HCPCS C1713		446.19  -  PLATE BN STRG 100X3.8X.8MM NS 20 HL TI 1.5MM SCR	BOTH IP/OP	$451.23 	$333.91	$0.00	$350.46	$197.13	$197.13	$0.00	$0.00	$0.00	$94.05	$334.90	$334.90	$0.00	$0.00	$94.04	$0.00	$266.90	$266.90	$0.00	$219.04	$346.96	$350.46	$0.00		$0.00	$66.56	$0.00	$0.00	$69.74	$0.00	$0.00	$0.00	$0.00	$0.00
446.2	SUP	HCPCS C1713		446.20  -  PLATE BN 41MM NS 10 HL TI ORBT RIM 1.5MM SCR	BOTH IP/OP	$722.25 	$534.47	$0.00	$577.80	$325.01	$325.01	$0.00	$0.00	$0.00	$150.53	$536.05	$536.05	$0.00	$0.00	$150.52	$0.00	$427.21	$427.21	$0.00	$361.13	$572.02	$577.80	$0.00		$0.00	$113.03	$0.00	$0.00	$114.98	$0.00	$0.00	$0.00	$0.00	$0.00
446.22	SUP	HCPCS C1713		446.22  -  PLATE BN 49MM NS 12 HL TI ORBT RIM 1.5MM SCR	BOTH IP/OP	$776.25 	$574.43	$0.00	$621.00	$349.31	$349.31	$0.00	$0.00	$0.00	$161.79	$576.13	$576.13	$0.00	$0.00	$161.77	$0.00	$459.15	$459.15	$0.00	$388.13	$614.79	$621.00	$0.00		$0.00	$121.48	$0.00	$0.00	$123.58	$0.00	$0.00	$0.00	$0.00	$0.00
446.23	SUP	HCPCS C1713		446.23  -  PLATE BONE T 1.5MM 50MM 3X9 HOLE LCP TITANIUM CONDYLE	BOTH IP/OP	$390.78 	$289.18	$0.00	$303.52	$170.73	$170.73	$0.00	$0.00	$0.00	$81.45	$290.03	$290.03	$0.00	$0.00	$81.44	$0.00	$231.14	$231.14	$0.00	$189.70	$300.48	$303.52	$0.00		$0.00	$57.65	$0.00	$0.00	$60.40	$0.00	$0.00	$0.00	$0.00	$0.00
446.233	SUP	HCPCS C1713		446.233  -  PLATE BN T 44X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$425.93 	$315.19	$0.00	$330.82	$186.09	$186.09	$0.00	$0.00	$0.00	$88.77	$316.12	$316.12	$0.00	$0.00	$88.76	$0.00	$251.93	$251.93	$0.00	$206.76	$327.52	$330.82	$0.00		$0.00	$62.83	$0.00	$0.00	$65.83	$0.00	$0.00	$0.00	$0.00	$0.00
446.234	SUP	HCPCS C1713		446.234  -  PLATE BN T 44X4X1MM NS PRO-PK 4 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
446.24	SUP	HCPCS C1713		446.24  -  PLATE BN T 50X4X1MM NS 4 HLE/HD 9 HL SHFT TI 1.5MM SCR	BOTH IP/OP	$425.93 	$315.19	$0.00	$330.82	$186.09	$186.09	$0.00	$0.00	$0.00	$88.77	$316.12	$316.12	$0.00	$0.00	$88.76	$0.00	$251.93	$251.93	$0.00	$206.76	$327.52	$330.82	$0.00		$0.00	$62.83	$0.00	$0.00	$65.83	$0.00	$0.00	$0.00	$0.00	$0.00
446.4	SUP	HCPCS C1713		446.40  -  PLATE BONE UNV ORBTL FLR TI 1.5MM SCR NONSTRL	BOTH IP/OP	"$2,772.00 "	"$2,051.28"	$0.00	"$2,217.60"	"$1,247.40"	"$1,247.40"	$0.00	$0.00	$0.00	$577.75	"$2,057.38"	"$2,057.38"	$0.00	$0.00	$577.68	$0.00	"$1,366.60"	"$1,366.60"	$0.00	"$1,386.00"	"$2,195.42"	"$2,217.60"	$0.00		$0.00	$433.82	$0.00	$0.00	$441.30	$0.00	$0.00	$0.00	$0.00	$0.00
446.44	SUP	HCPCS C1713		446.44  -  PLATE BONE LEFT MDL WL CRANFCL TI 1.5 MM SCR NONSTRL	BOTH IP/OP	"$2,457.00 "	"$1,818.18"	$0.00	"$1,965.60"	"$1,105.65"	"$1,105.65"	$0.00	$0.00	$0.00	$512.10	"$1,823.59"	"$1,823.59"	$0.00	$0.00	$512.04	$0.00	"$1,453.32"	"$1,453.32"	$0.00	"$1,228.50"	"$1,945.94"	"$1,965.60"	$0.00		$0.00	$384.52	$0.00	$0.00	$391.15	$0.00	$0.00	$0.00	$0.00	$0.00
446.45	SUP	HCPCS C1713		446.45  -  PLATE BONE RIGHT MDL WL CRANFCL TI 1.5 MM SCR NONSTRL	BOTH IP/OP	"$2,457.00 "	"$1,818.18"	$0.00	"$1,965.60"	"$1,105.65"	"$1,105.65"	$0.00	$0.00	$0.00	$512.10	"$1,823.59"	"$1,823.59"	$0.00	$0.00	$512.04	$0.00	"$1,453.32"	"$1,453.32"	$0.00	"$1,228.50"	"$1,945.94"	"$1,965.60"	$0.00		$0.00	$384.52	$0.00	$0.00	$391.15	$0.00	$0.00	$0.00	$0.00	$0.00
446.48	SUP	HCPCS C1713		446.48  -  PLATE BONE H 1.5MM 6MM 4 HOLE TITANIUM HAND NONSTRL 1.5MM	BOTH IP/OP	$399.23 	$295.43	$0.00	$310.08	$174.42	$174.42	$0.00	$0.00	$0.00	$83.21	$296.30	$296.30	$0.00	$0.00	$83.20	$0.00	$236.14	$236.14	$0.00	$193.80	$306.98	$310.08	$0.00		$0.00	$58.89	$0.00	$0.00	$61.71	$0.00	$0.00	$0.00	$0.00	$0.00
446.482	SUP	HCPCS C1713		446.482  -  PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR TI RT	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
446.483	SUP	HCPCS C1713		446.483  -  PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR TI LT	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
446.5	SUP	HCPCS C1713		446.50  -  PLATE BN OB L L NS 2X3 HL RGD TI CRNFCL 1.5MM SCR	BOTH IP/OP	$616.50 	$456.21	$0.00	$493.20	$277.43	$277.43	$0.00	$0.00	$0.00	$128.49	$457.57	$457.57	$0.00	$0.00	$128.48	$0.00	$364.66	$364.66	$0.00	$308.25	$488.27	$493.20	$0.00		$0.00	$96.48	$0.00	$0.00	$98.15	$0.00	$0.00	$0.00	$0.00	$0.00
446.504	SUP	HCPCS C1713		446.504  -  PLATE RIGHT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 22MM NONSTRL	BOTH IP/OP	$596.25 	$441.23	$0.00	$477.00	$268.31	$268.31	$0.00	$0.00	$0.00	$124.27	$442.54	$442.54	$0.00	$0.00	$124.26	$0.00	$352.68	$352.68	$0.00	$298.13	$472.23	$477.00	$0.00		$0.00	$93.31	$0.00	$0.00	$94.92	$0.00	$0.00	$0.00	$0.00	$0.00
446.505	SUP	HCPCS C1713		446.505  -  PLATE LEFT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 22MM NONSTRL	BOTH IP/OP	$596.25 	$441.23	$0.00	$477.00	$268.31	$268.31	$0.00	$0.00	$0.00	$124.27	$442.54	$442.54	$0.00	$0.00	$124.26	$0.00	$352.68	$352.68	$0.00	$298.13	$472.23	$477.00	$0.00		$0.00	$93.31	$0.00	$0.00	$94.92	$0.00	$0.00	$0.00	$0.00	$0.00
446.506	SUP	HCPCS C1713		446.506  -  PLATE RIGHT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 24MM NONSTRL	BOTH IP/OP	$596.25 	$441.23	$0.00	$477.00	$268.31	$268.31	$0.00	$0.00	$0.00	$124.27	$442.54	$442.54	$0.00	$0.00	$124.26	$0.00	$352.68	$352.68	$0.00	$298.13	$472.23	$477.00	$0.00		$0.00	$93.31	$0.00	$0.00	$94.92	$0.00	$0.00	$0.00	$0.00	$0.00
446.507	SUP	HCPCS C1713		446.507  -  PLATE LEFT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 24MM NONSTRL	BOTH IP/OP	$596.25 	$441.23	$0.00	$477.00	$268.31	$268.31	$0.00	$0.00	$0.00	$124.27	$442.54	$442.54	$0.00	$0.00	$124.26	$0.00	$352.68	$352.68	$0.00	$298.13	$472.23	$477.00	$0.00		$0.00	$93.31	$0.00	$0.00	$94.92	$0.00	$0.00	$0.00	$0.00	$0.00
446.508	SUP	HCPCS C1713		446.508  -  PLATE RIGHT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 26MM NONSTRL	BOTH IP/OP	$596.25 	$441.23	$0.00	$477.00	$268.31	$268.31	$0.00	$0.00	$0.00	$124.27	$442.54	$442.54	$0.00	$0.00	$124.26	$0.00	$352.68	$352.68	$0.00	$298.13	$472.23	$477.00	$0.00		$0.00	$93.31	$0.00	$0.00	$94.92	$0.00	$0.00	$0.00	$0.00	$0.00
446.509	SUP	HCPCS C1713		446.509  -  PLATE LEFT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 26MM NONSTRL	BOTH IP/OP	$596.25 	$441.23	$0.00	$477.00	$268.31	$268.31	$0.00	$0.00	$0.00	$124.27	$442.54	$442.54	$0.00	$0.00	$124.26	$0.00	$352.68	$352.68	$0.00	$298.13	$472.23	$477.00	$0.00		$0.00	$93.31	$0.00	$0.00	$94.92	$0.00	$0.00	$0.00	$0.00	$0.00
446.51	SUP	HCPCS C1713		446.51  -  PLATE BN OB R L NS 2X3 HL RGD TI CRNFCL 1.5MM SCR	BOTH IP/OP	$616.50 	$456.21	$0.00	$493.20	$277.43	$277.43	$0.00	$0.00	$0.00	$128.49	$457.57	$457.57	$0.00	$0.00	$128.48	$0.00	$364.66	$364.66	$0.00	$308.25	$488.27	$493.20	$0.00		$0.00	$96.48	$0.00	$0.00	$98.15	$0.00	$0.00	$0.00	$0.00	$0.00
446.515	SUP	HCPCS C1713		446.515  -  PLATE BONE TEAL 22MM 100D CRANFCL TI 5 HOLE L RIGHT OBLQ	BOTH IP/OP	$636.75 	$471.20	$0.00	$509.40	$286.54	$286.54	$0.00	$0.00	$0.00	$132.71	$472.60	$472.60	$0.00	$0.00	$132.70	$0.00	$376.64	$376.64	$0.00	$318.38	$504.31	$509.40	$0.00		$0.00	$99.65	$0.00	$0.00	$101.37	$0.00	$0.00	$0.00	$0.00	$0.00
446.516	SUP	HCPCS C1713		446.516  -  PLATE BONE TEAL 22MM 100D CRANFCL TI 5 HOLE L LEFT OBLQ	BOTH IP/OP	$636.75 	$471.20	$0.00	$509.40	$286.54	$286.54	$0.00	$0.00	$0.00	$132.71	$472.60	$472.60	$0.00	$0.00	$132.70	$0.00	$376.64	$376.64	$0.00	$318.38	$504.31	$509.40	$0.00		$0.00	$99.65	$0.00	$0.00	$101.37	$0.00	$0.00	$0.00	$0.00	$0.00
446.52	SUP	HCPCS C1713		446.52  -  PLATE BN OB L L 3X4 HL TI CRNFCL 1.5MM SCR	BOTH IP/OP	$652.50 	$482.85	$0.00	$522.00	$293.63	$293.63	$0.00	$0.00	$0.00	$136.00	$484.29	$484.29	$0.00	$0.00	$135.98	$0.00	$385.95	$385.95	$0.00	$326.25	$516.78	$522.00	$0.00		$0.00	$102.12	$0.00	$0.00	$103.88	$0.00	$0.00	$0.00	$0.00	$0.00
446.527	SUP	HCPCS C1713		446.527  -  PLATE BONE TEAL 27MM 100D CRANFCL TI 7 HOLE L LEFT OBLQ	BOTH IP/OP	$666.00 	$492.84	$0.00	$532.80	$299.70	$299.70	$0.00	$0.00	$0.00	$138.81	$494.31	$494.31	$0.00	$0.00	$138.79	$0.00	$393.94	$393.94	$0.00	$333.00	$527.47	$532.80	$0.00		$0.00	$104.23	$0.00	$0.00	$106.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.53	SUP	HCPCS C1713		446.53  -  PLATE BN OB R L NS 3X4 HL RGD TI CRNFCL 1.5MM SCR	BOTH IP/OP	$652.50 	$482.85	$0.00	$522.00	$293.63	$293.63	$0.00	$0.00	$0.00	$136.00	$484.29	$484.29	$0.00	$0.00	$135.98	$0.00	$385.95	$385.95	$0.00	$326.25	$516.78	$522.00	$0.00		$0.00	$102.12	$0.00	$0.00	$103.88	$0.00	$0.00	$0.00	$0.00	$0.00
446.537	SUP	HCPCS C1713		446.537  -  PLATE BONE TEAL 27MM 100D CRANFCL TI 7 HOLE L RIGHT OBLQ	BOTH IP/OP	$666.00 	$492.84	$0.00	$532.80	$299.70	$299.70	$0.00	$0.00	$0.00	$138.81	$494.31	$494.31	$0.00	$0.00	$138.79	$0.00	$393.94	$393.94	$0.00	$333.00	$527.47	$532.80	$0.00		$0.00	$104.23	$0.00	$0.00	$106.03	$0.00	$0.00	$0.00	$0.00	$0.00
446.538	SUP	HCPCS C1713		446.538  -  PLATE BONE TEAL ORBTL RIM TI 8 HOLE MALBLE 1.5MM SCR NONSTRL	BOTH IP/OP	$607.50 	$449.55	$0.00	$486.00	$273.38	$273.38	$0.00	$0.00	$0.00	$126.62	$450.89	$450.89	$0.00	$0.00	$126.60	$0.00	$359.34	$359.34	$0.00	$303.75	$481.14	$486.00	$0.00		$0.00	$95.07	$0.00	$0.00	$96.71	$0.00	$0.00	$0.00	$0.00	$0.00
446.54	SUP	HCPCS C1713		446.540  -  PLATE BONE TEAL ORBTL RIM TI 10 HOLE MALBLE 1.5MM SCR	BOTH IP/OP	$641.25 	$474.53	$0.00	$513.00	$288.56	$288.56	$0.00	$0.00	$0.00	$133.65	$475.94	$475.94	$0.00	$0.00	$133.64	$0.00	$379.30	$379.30	$0.00	$320.63	$507.87	$513.00	$0.00		$0.00	$100.36	$0.00	$0.00	$102.09	$0.00	$0.00	$0.00	$0.00	$0.00
446.542	SUP	HCPCS C1713		446.542  -  PLATE BONE TEAL ORBTL RIM TI 12 HOLE MALBLE 1.5MM SCR	BOTH IP/OP	$690.75 	$511.16	$0.00	$552.60	$310.84	$310.84	$0.00	$0.00	$0.00	$143.97	$512.67	$512.67	$0.00	$0.00	$143.95	$0.00	$408.58	$408.58	$0.00	$345.38	$547.07	$552.60	$0.00		$0.00	$108.10	$0.00	$0.00	$109.97	$0.00	$0.00	$0.00	$0.00	$0.00
446.61	SUP	HCPCS C1713		446.61  -  PLATE BN 36X3.5X.9MM NS 7 HL TI CNDYL LT 1.5MM SCR MDLR HND	BOTH IP/OP	$616.50 	$456.21	$0.00	$493.20	$277.43	$277.43	$0.00	$0.00	$0.00	$128.49	$457.57	$457.57	$0.00	$0.00	$128.48	$0.00	$364.66	$364.66	$0.00	$308.25	$488.27	$493.20	$0.00		$0.00	$96.48	$0.00	$0.00	$98.15	$0.00	$0.00	$0.00	$0.00	$0.00
446.611	SUP	HCPCS C1713		446.611  -  PLATE BONE CRANFCL TI 5 HOLE Y LP 1.5 MM SCR NONSTRL	BOTH IP/OP	$616.50 	$456.21	$0.00	$493.20	$277.43	$277.43	$0.00	$0.00	$0.00	$128.49	$457.57	$457.57	$0.00	$0.00	$128.48	$0.00	$364.66	$364.66	$0.00	$308.25	$488.27	$493.20	$0.00		$0.00	$96.48	$0.00	$0.00	$98.15	$0.00	$0.00	$0.00	$0.00	$0.00
446.612	SUP	HCPCS C1713		446.612  -  PLATE BN Y 46X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$425.93 	$315.19	$0.00	$330.82	$186.09	$186.09	$0.00	$0.00	$0.00	$88.77	$316.12	$316.12	$0.00	$0.00	$88.76	$0.00	$251.93	$251.93	$0.00	$206.76	$327.52	$330.82	$0.00		$0.00	$62.83	$0.00	$0.00	$65.83	$0.00	$0.00	$0.00	$0.00	$0.00
446.614	SUP	HCPCS C1713		446.614  -  PLATE BN 2Y 18MM 6 HL TI CRNFCL 1.5MM SCR	BOTH IP/OP	$616.50 	$456.21	$0.00	$493.20	$277.43	$277.43	$0.00	$0.00	$0.00	$128.49	$457.57	$457.57	$0.00	$0.00	$128.48	$0.00	$364.66	$364.66	$0.00	$308.25	$488.27	$493.20	$0.00		$0.00	$96.48	$0.00	$0.00	$98.15	$0.00	$0.00	$0.00	$0.00	$0.00
446.615	SUP	HCPCS C1713		446.615  -  PLATE BN 2Y 21MM 6 HL TI CRNFCL 1.5MM SCR	BOTH IP/OP	$616.50 	$456.21	$0.00	$493.20	$277.43	$277.43	$0.00	$0.00	$0.00	$128.49	$457.57	$457.57	$0.00	$0.00	$128.48	$0.00	$364.66	$364.66	$0.00	$308.25	$488.27	$493.20	$0.00		$0.00	$96.48	$0.00	$0.00	$98.15	$0.00	$0.00	$0.00	$0.00	$0.00
446.63	SUP	HCPCS C1713		446.63  -  PLATE BONE 36X3.5X.9MM 7 HOLE SLFTAP LCP TITANIUM LEFT	BOTH IP/OP	$539.78 	$399.44	$0.00	$419.26	$235.83	$235.83	$0.00	$0.00	$0.00	$112.50	$400.62	$400.62	$0.00	$0.00	$112.49	$0.00	$319.28	$319.28	$0.00	$262.04	$415.07	$419.26	$0.00		$0.00	$79.63	$0.00	$0.00	$83.43	$0.00	$0.00	$0.00	$0.00	$0.00
446.64	SUP	HCPCS C1713		446.64  -  PLATE BONE 36X3.5X.9MM 7 HOLE SLFTAP LCP TITANIUM RIGHT	BOTH IP/OP	$539.78 	$399.44	$0.00	$419.26	$235.83	$235.83	$0.00	$0.00	$0.00	$112.50	$400.62	$400.62	$0.00	$0.00	$112.49	$0.00	$319.28	$319.28	$0.00	$262.04	$415.07	$419.26	$0.00		$0.00	$79.63	$0.00	$0.00	$83.43	$0.00	$0.00	$0.00	$0.00	$0.00
446.642	SUP	HCPCS C1713		446.642  -  PLATE 2MM MAXL 5X3 HOLE T 1.5MM SCR BONE TI NONSTRL	BOTH IP/OP	$821.25 	$607.73	$0.00	$657.00	$369.56	$369.56	$0.00	$0.00	$0.00	$171.17	$609.53	$609.53	$0.00	$0.00	$171.15	$0.00	$485.77	$485.77	$0.00	$410.63	$650.43	$657.00	$0.00		$0.00	$128.53	$0.00	$0.00	$130.74	$0.00	$0.00	$0.00	$0.00	$0.00
446.644	SUP	HCPCS C1713		446.644  -  PLATE 4MM MAXL 5X3 HOLE T 1.5MM SCR BONE TI NONSTRL	BOTH IP/OP	$821.25 	$607.73	$0.00	$657.00	$369.56	$369.56	$0.00	$0.00	$0.00	$171.17	$609.53	$609.53	$0.00	$0.00	$171.15	$0.00	$485.77	$485.77	$0.00	$410.63	$650.43	$657.00	$0.00		$0.00	$128.53	$0.00	$0.00	$130.74	$0.00	$0.00	$0.00	$0.00	$0.00
446.646	SUP	HCPCS C1713		446.646  -  PLATE 6MM MAXL 5X3 HOLE T 1.5MM SCR BONE TI NONSTRL	BOTH IP/OP	$821.25 	$607.73	$0.00	$657.00	$369.56	$369.56	$0.00	$0.00	$0.00	$171.17	$609.53	$609.53	$0.00	$0.00	$171.15	$0.00	$485.77	$485.77	$0.00	$410.63	$650.43	$657.00	$0.00		$0.00	$128.53	$0.00	$0.00	$130.74	$0.00	$0.00	$0.00	$0.00	$0.00
446.782	SUP	HCPCS C1713		446.782  -  PLATE SHRT MAXFACL 2X2 HOLE L RIGHT OBLQ MALBLE 1.5MM SCR	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$255.15	$255.15	$0.00	$0.00	$0.00	$118.18	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$335.38	$335.38	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$88.74	$0.00	$0.00	$90.27	$0.00	$0.00	$0.00	$0.00	$0.00
446.783	SUP	HCPCS C1713		446.783  -  PLATE SHRT MAXFACL 2X2 HOLE L LEFT OBLQ MALBLE 1.5MM SCR	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$255.15	$255.15	$0.00	$0.00	$0.00	$118.18	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$335.38	$335.38	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$88.74	$0.00	$0.00	$90.27	$0.00	$0.00	$0.00	$0.00	$0.00
446.784	SUP	HCPCS C1713		446.784  -  PLATE LNG MAXFACL 2X2 HOLE L RIGHT OBLQ MALBLE 1.5MM SCR	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$255.15	$255.15	$0.00	$0.00	$0.00	$118.18	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$335.38	$335.38	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$88.74	$0.00	$0.00	$90.27	$0.00	$0.00	$0.00	$0.00	$0.00
446.785	SUP	HCPCS C1713		446.785  -  PLATE LNG MAXFACL 2X2 HOLE L LEFT OBLQ MALBLE 1.5MM SCR BONE	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$255.15	$255.15	$0.00	$0.00	$0.00	$118.18	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$335.38	$335.38	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$88.74	$0.00	$0.00	$90.27	$0.00	$0.00	$0.00	$0.00	$0.00
446.786	SUP	HCPCS C1713		446.786  -  PLATE SHRT RIGHT MAXFACL Z MALBLE 1.5MM SCR BONE TI NONSTRL	BOTH IP/OP	$580.50 	$429.57	$0.00	$464.40	$261.23	$261.23	$0.00	$0.00	$0.00	$120.99	$430.85	$430.85	$0.00	$0.00	$120.98	$0.00	$343.37	$343.37	$0.00	$290.25	$459.76	$464.40	$0.00		$0.00	$90.85	$0.00	$0.00	$92.42	$0.00	$0.00	$0.00	$0.00	$0.00
446.787	SUP	HCPCS C1713		446.787  -  PLATE SHRT LEFT MAXFACL Z MALBLE 1.5MM SCR BONE TI NONSTRL	BOTH IP/OP	$580.50 	$429.57	$0.00	$464.40	$261.23	$261.23	$0.00	$0.00	$0.00	$120.99	$430.85	$430.85	$0.00	$0.00	$120.98	$0.00	$343.37	$343.37	$0.00	$290.25	$459.76	$464.40	$0.00		$0.00	$90.85	$0.00	$0.00	$92.42	$0.00	$0.00	$0.00	$0.00	$0.00
446.788	SUP	HCPCS C1713		446.788  -  PLATE LNG RIGHT MAXFACL Z MALBLE 1.5MM SCR BONE TI NONSTRL	BOTH IP/OP	$580.50 	$429.57	$0.00	$464.40	$261.23	$261.23	$0.00	$0.00	$0.00	$120.99	$430.85	$430.85	$0.00	$0.00	$120.98	$0.00	$343.37	$343.37	$0.00	$290.25	$459.76	$464.40	$0.00		$0.00	$90.85	$0.00	$0.00	$92.42	$0.00	$0.00	$0.00	$0.00	$0.00
446.789	SUP	HCPCS C1713		446.789  -  PLATE LNG LEFT MAXFACL Z MALBLE 1.5MM SCR BONE TI NONSTRL	BOTH IP/OP	$580.50 	$429.57	$0.00	$464.40	$261.23	$261.23	$0.00	$0.00	$0.00	$120.99	$430.85	$430.85	$0.00	$0.00	$120.98	$0.00	$343.37	$343.37	$0.00	$290.25	$459.76	$464.40	$0.00		$0.00	$90.85	$0.00	$0.00	$92.42	$0.00	$0.00	$0.00	$0.00	$0.00
446.792	SUP	HCPCS C1713		446.792  -  PLATE SHRT TI 1.5MM SCR L OBLQ 2X2 HOLE BONE RIGHT NONSTRL	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$255.15	$255.15	$0.00	$0.00	$0.00	$118.18	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$335.38	$335.38	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$88.74	$0.00	$0.00	$90.27	$0.00	$0.00	$0.00	$0.00	$0.00
446.793	SUP	HCPCS C1713		446.793  -  PLATE SHRT 1.5MM TI 1.5MM SCR L OBLQ 2X2 HOLE BONE LEFT	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$255.15	$255.15	$0.00	$0.00	$0.00	$118.18	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$335.38	$335.38	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$88.74	$0.00	$0.00	$90.27	$0.00	$0.00	$0.00	$0.00	$0.00
446.794	SUP	HCPCS C1713		446.794  -  PLATE 1.5MM TI 1.5MM SCR 2X2 HOLE L RIGHT OBLQ BONE NONSTRL	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$255.15	$255.15	$0.00	$0.00	$0.00	$118.18	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$335.38	$335.38	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$88.74	$0.00	$0.00	$90.27	$0.00	$0.00	$0.00	$0.00	$0.00
446.795	SUP	HCPCS C1713		446.795  -  PLATE TI 1.5 MM SCR 2X2 HOLE L LEFT OBLQ BONE NONSTRL	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$255.15	$255.15	$0.00	$0.00	$0.00	$118.18	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$335.38	$335.38	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$88.74	$0.00	$0.00	$90.27	$0.00	$0.00	$0.00	$0.00	$0.00
446.796	SUP	HCPCS C1713		446.796  -  PLATE SHRT TI 1.5MM SCR Z BONE RIGHT NONSTRL	BOTH IP/OP	$654.75 	$484.52	$0.00	$523.80	$294.64	$294.64	$0.00	$0.00	$0.00	$136.47	$485.96	$485.96	$0.00	$0.00	$136.45	$0.00	$387.28	$387.28	$0.00	$327.38	$518.56	$523.80	$0.00		$0.00	$102.47	$0.00	$0.00	$104.24	$0.00	$0.00	$0.00	$0.00	$0.00
446.797	SUP	HCPCS C1713		446.797  -  PLATE SHRT TI 1.5MM SCR Z BONE LEFT NONSTRL	BOTH IP/OP	$654.75 	$484.52	$0.00	$523.80	$294.64	$294.64	$0.00	$0.00	$0.00	$136.47	$485.96	$485.96	$0.00	$0.00	$136.45	$0.00	$387.28	$387.28	$0.00	$327.38	$518.56	$523.80	$0.00		$0.00	$102.47	$0.00	$0.00	$104.24	$0.00	$0.00	$0.00	$0.00	$0.00
446.798	SUP	HCPCS C1713		446.798  -  PLATE LNG TI 1.5MM SCR Z BONE RIGHT NONSTRL	BOTH IP/OP	$654.75 	$484.52	$0.00	$523.80	$294.64	$294.64	$0.00	$0.00	$0.00	$136.47	$485.96	$485.96	$0.00	$0.00	$136.45	$0.00	$387.28	$387.28	$0.00	$327.38	$518.56	$523.80	$0.00		$0.00	$102.47	$0.00	$0.00	$104.24	$0.00	$0.00	$0.00	$0.00	$0.00
446.799	SUP	HCPCS C1713		446.799  -  PLATE LNG TI 1.5MM SCR Z BONE LEFT NONSTRL	BOTH IP/OP	$654.75 	$484.52	$0.00	$523.80	$294.64	$294.64	$0.00	$0.00	$0.00	$136.47	$485.96	$485.96	$0.00	$0.00	$136.45	$0.00	$387.28	$387.28	$0.00	$327.38	$518.56	$523.80	$0.00		$0.00	$102.47	$0.00	$0.00	$104.24	$0.00	$0.00	$0.00	$0.00	$0.00
446.81	SUP	HCPCS C1713		446.81  -  PLATE BONE CRNMXF TI 4 HOLE X 1.5 MM SCR NONSTRL	BOTH IP/OP	$616.50 	$456.21	$0.00	$493.20	$277.43	$277.43	$0.00	$0.00	$0.00	$128.49	$457.57	$457.57	$0.00	$0.00	$128.48	$0.00	$364.66	$364.66	$0.00	$308.25	$488.27	$493.20	$0.00		$0.00	$96.48	$0.00	$0.00	$98.15	$0.00	$0.00	$0.00	$0.00	$0.00
446.811	SUP	HCPCS C1713		446.811  -  PLATE BONE CRANFCL TI 4 HOLE X LP 1.5 MM SCR NONSTRL	BOTH IP/OP	$616.50 	$456.21	$0.00	$493.20	$277.43	$277.43	$0.00	$0.00	$0.00	$128.49	$457.57	$457.57	$0.00	$0.00	$128.48	$0.00	$364.66	$364.66	$0.00	$308.25	$488.27	$493.20	$0.00		$0.00	$96.48	$0.00	$0.00	$98.15	$0.00	$0.00	$0.00	$0.00	$0.00
446.9	SUP	HCPCS C1713		446.900  -  PLATE BONE 12MM CRANFCL TI 6 HOLE 1.5MM SCR NONSTRL	BOTH IP/OP	$573.75 	$424.58	$0.00	$459.00	$258.19	$258.19	$0.00	$0.00	$0.00	$119.58	$425.84	$425.84	$0.00	$0.00	$119.57	$0.00	$339.37	$339.37	$0.00	$286.88	$454.41	$459.00	$0.00		$0.00	$89.79	$0.00	$0.00	$91.34	$0.00	$0.00	$0.00	$0.00	$0.00
446.901	SUP	Custom 27803010		446.901  -  COVER BUR HOLE 15MM CRANFCL TI 6 HOLE 1.5MM SCR NONSTRL	BOTH IP/OP	$573.75 	$424.58	$0.00	$459.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$425.84	$425.84	$0.00	$0.00	$119.57	$0.00	$0.00	$0.00	$0.00	$286.88	$454.41	$459.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
446.902	SUP	Custom 27803010		446.902  -  COVER BUR HOLE 24MM CRANFCL TI 6 HOLE 1.5MM SCR NONSTRL	BOTH IP/OP	$573.75 	$424.58	$0.00	$459.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$425.84	$425.84	$0.00	$0.00	$119.57	$0.00	$0.00	$0.00	$0.00	$286.88	$454.41	$459.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
446.91	SUP	Custom 27803010		446.91  -  COVER BUR HOLE 17MM CRANFCL TI 6 HOLE 1.5MM SCR NONSTRL	BOTH IP/OP	$573.75 	$424.58	$0.00	$459.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$425.84	$425.84	$0.00	$0.00	$119.57	$0.00	$0.00	$0.00	$0.00	$286.88	$454.41	$459.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
446.911	SUP	Custom 27803010		446.911  -  CLIP CRNL SPRG TI LT 1.5 MM BUR HL	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$0.00	$0.00	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
446.912	SUP	Custom 27803010		446.912  -  CLIP CRNL SPRG TI RT 1.5 MM BUR HL	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$0.00	$0.00	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
446.913	SUP	Custom 27803010		446.913  -  CLIP CRNL SPRG TI 1.5 MM BUR HL	BOTH IP/OP	$436.50 	$323.01	$0.00	$349.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$323.97	$323.97	$0.00	$0.00	$90.97	$0.00	$0.00	$0.00	$0.00	$218.25	$345.71	$349.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
446.916	SUP	HCPCS C1713		446.916  -  PLATE BONE 16X10MM CRANFCL TI 4 HOLE 1.5MM SCR NONSTRL	BOTH IP/OP	$533.25 	$394.61	$0.00	$426.60	$239.96	$239.96	$0.00	$0.00	$0.00	$111.14	$395.78	$395.78	$0.00	$0.00	$111.13	$0.00	$315.42	$315.42	$0.00	$266.63	$422.33	$426.60	$0.00		$0.00	$83.45	$0.00	$0.00	$84.89	$0.00	$0.00	$0.00	$0.00	$0.00
446.917	SUP	HCPCS C1713		446.917  -  PLATE CHIN 2 BND 1.5MM SCR BONE TI 4MM NONSTRL	BOTH IP/OP	$794.25 	$587.75	$0.00	$635.40	$357.41	$357.41	$0.00	$0.00	$0.00	$165.54	$589.49	$589.49	$0.00	$0.00	$165.52	$0.00	$469.80	$469.80	$0.00	$397.13	$629.05	$635.40	$0.00		$0.00	$124.30	$0.00	$0.00	$126.44	$0.00	$0.00	$0.00	$0.00	$0.00
446.918	SUP	HCPCS C1713		446.918  -  PLATE CHIN 2 BND 1.5MM SCR BONE TI 6MM NONSTRL	BOTH IP/OP	$794.25 	$587.75	$0.00	$635.40	$357.41	$357.41	$0.00	$0.00	$0.00	$165.54	$589.49	$589.49	$0.00	$0.00	$165.52	$0.00	$469.80	$469.80	$0.00	$397.13	$629.05	$635.40	$0.00		$0.00	$124.30	$0.00	$0.00	$126.44	$0.00	$0.00	$0.00	$0.00	$0.00
446.919	SUP	HCPCS C1713		446.919  -  PLATE CHIN 2 BND 1.5MM SCR BONE TI 8MM NONSTRL	BOTH IP/OP	$794.25 	$587.75	$0.00	$635.40	$357.41	$357.41	$0.00	$0.00	$0.00	$165.54	$589.49	$589.49	$0.00	$0.00	$165.52	$0.00	$469.80	$469.80	$0.00	$397.13	$629.05	$635.40	$0.00		$0.00	$124.30	$0.00	$0.00	$126.44	$0.00	$0.00	$0.00	$0.00	$0.00
446.92	SUP	HCPCS C1713		446.920  -  PLATE CHIN 2 BND 1.5MM SCR BONE TI 10MM NONSTRL	BOTH IP/OP	$794.25 	$587.75	$0.00	$635.40	$357.41	$357.41	$0.00	$0.00	$0.00	$165.54	$589.49	$589.49	$0.00	$0.00	$165.52	$0.00	$469.80	$469.80	$0.00	$397.13	$629.05	$635.40	$0.00		$0.00	$124.30	$0.00	$0.00	$126.44	$0.00	$0.00	$0.00	$0.00	$0.00
446.923	SUP	Custom 27803010		446.923  -  COVER BUR HOLE 15MM CRANIAL TI 5 HOLE SHNT 1.5MM SCR NONSTRL	BOTH IP/OP	$573.75 	$424.58	$0.00	$459.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$425.84	$425.84	$0.00	$0.00	$119.57	$0.00	$0.00	$0.00	$0.00	$286.88	$454.41	$459.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
447.007	SUP	Custom 27803010		447.007  -  FTPLT BONE ZYG TI 3 HOLE NONSTRL	BOTH IP/OP	$499.50 	$369.63	$0.00	$399.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$370.73	$370.73	$0.00	$0.00	$104.10	$0.00	$0.00	$0.00	$0.00	$249.75	$395.60	$399.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
447.008	SUP	HCPCS C1713		447.008  -  PLATE 6MM MAXFACL 6 HOLE CVD LP BONE NONSTRL	BOTH IP/OP	$726.75 	$537.80	$0.00	$581.40	$327.04	$327.04	$0.00	$0.00	$0.00	$151.47	$539.39	$539.39	$0.00	$0.00	$151.45	$0.00	$429.87	$429.87	$0.00	$363.38	$575.59	$581.40	$0.00		$0.00	$113.74	$0.00	$0.00	$115.70	$0.00	$0.00	$0.00	$0.00	$0.00
447.009	SUP	HCPCS C1713		447.009  -  PLATE 10MM TI 2MM SCR 6 HOLE SGTL SPLT CVD LP BONE NONSTRL	BOTH IP/OP	$726.75 	$537.80	$0.00	$581.40	$327.04	$327.04	$0.00	$0.00	$0.00	$151.47	$539.39	$539.39	$0.00	$0.00	$151.45	$0.00	$429.87	$429.87	$0.00	$363.38	$575.59	$581.40	$0.00		$0.00	$113.74	$0.00	$0.00	$115.70	$0.00	$0.00	$0.00	$0.00	$0.00
447.01	SUP	HCPCS C1713		447.010  -  PLATE MAXFACL 6 HOLE CVD SGTL SPLT 2MM SCR BONE TI 6MM	BOTH IP/OP	$726.75 	$537.80	$0.00	$581.40	$327.04	$327.04	$0.00	$0.00	$0.00	$151.47	$539.39	$539.39	$0.00	$0.00	$151.45	$0.00	$429.87	$429.87	$0.00	$363.38	$575.59	$581.40	$0.00		$0.00	$113.74	$0.00	$0.00	$115.70	$0.00	$0.00	$0.00	$0.00	$0.00
447.011	SUP	HCPCS C1713		447.011  -  PLATE MAXFACL 6 HOLE CVD SGTL SPLT 2MM SCR BONE TI 10MM	BOTH IP/OP	$726.75 	$537.80	$0.00	$581.40	$327.04	$327.04	$0.00	$0.00	$0.00	$151.47	$539.39	$539.39	$0.00	$0.00	$151.45	$0.00	$429.87	$429.87	$0.00	$363.38	$575.59	$581.40	$0.00		$0.00	$113.74	$0.00	$0.00	$115.70	$0.00	$0.00	$0.00	$0.00	$0.00
447.013	SUP	HCPCS C1713		447.013  -  PLATE BONE 65MM CRANFCL TI 13 HOLE ADP 2MM SCR NONSTRL	BOTH IP/OP	$805.50 	$596.07	$0.00	$644.40	$362.48	$362.48	$0.00	$0.00	$0.00	$167.89	$597.84	$597.84	$0.00	$0.00	$167.87	$0.00	$476.45	$476.45	$0.00	$402.75	$637.96	$644.40	$0.00		$0.00	$126.06	$0.00	$0.00	$128.24	$0.00	$0.00	$0.00	$0.00	$0.00
447.03	SUP	HCPCS C1713		447.030  -  PLATE 14MM MAXFACL 6 HOLE CVD 2MM SCR BILAT SGTL SPLT OSTMY	BOTH IP/OP	$783.00 	$579.42	$0.00	$626.40	$352.35	$352.35	$0.00	$0.00	$0.00	$163.20	$581.14	$581.14	$0.00	$0.00	$163.18	$0.00	$463.14	$463.14	$0.00	$391.50	$620.14	$626.40	$0.00		$0.00	$122.54	$0.00	$0.00	$124.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.031	SUP	HCPCS C1713		447.031  -  PLATE BN STRG 35X5X1.2MM NS PRO-PK 6 HL LOPRFL PRECONTOUR	BOTH IP/OP	$404.85 	$299.59	$0.00	$314.44	$176.87	$176.87	$0.00	$0.00	$0.00	$84.38	$300.48	$300.48	$0.00	$0.00	$84.37	$0.00	$239.47	$239.47	$0.00	$196.53	$311.30	$314.44	$0.00		$0.00	$59.72	$0.00	$0.00	$62.57	$0.00	$0.00	$0.00	$0.00	$0.00
447.032	SUP	HCPCS C1713		447.032  -  PLATE BN STRG 71X5X1.2MM NS PRO-PK 12 HL LOPRFL PRECONTOUR	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
447.033	SUP	HCPCS C1713		447.033  -  PLATE 2MM 4MM MAXFACL 6 HOLE BAR CVD LP SGTL SPLT 2MM SCR	BOTH IP/OP	$783.00 	$579.42	$0.00	$626.40	$352.35	$352.35	$0.00	$0.00	$0.00	$163.20	$581.14	$581.14	$0.00	$0.00	$163.18	$0.00	$463.14	$463.14	$0.00	$391.50	$620.14	$626.40	$0.00		$0.00	$122.54	$0.00	$0.00	$124.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.034	SUP	HCPCS C1713		447.034  -  PLATE 8MM MAXFACL 6 HOLE CVD LP 2MM SCR BILAT SGTL SPLT	BOTH IP/OP	$783.00 	$579.42	$0.00	$626.40	$352.35	$352.35	$0.00	$0.00	$0.00	$163.20	$581.14	$581.14	$0.00	$0.00	$163.18	$0.00	$463.14	$463.14	$0.00	$391.50	$620.14	$626.40	$0.00		$0.00	$122.54	$0.00	$0.00	$124.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.035	SUP	HCPCS C1713		447.035  -  PLATE BN CRV 4MMX1.25MM NS 6 HL SGTL SPLT TI CRNFCL 2MM SCR	BOTH IP/OP	$783.00 	$579.42	$0.00	$626.40	$352.35	$352.35	$0.00	$0.00	$0.00	$163.20	$581.14	$581.14	$0.00	$0.00	$163.18	$0.00	$463.14	$463.14	$0.00	$391.50	$620.14	$626.40	$0.00		$0.00	$122.54	$0.00	$0.00	$124.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.036	SUP	HCPCS C1713		447.036  -  PLATE BN CRV 12MMX1.25MM NS 6 HL SGTL SPLT TI CRNFCL 2MM SCR	BOTH IP/OP	$783.00 	$579.42	$0.00	$626.40	$352.35	$352.35	$0.00	$0.00	$0.00	$163.20	$581.14	$581.14	$0.00	$0.00	$163.18	$0.00	$463.14	$463.14	$0.00	$391.50	$620.14	$626.40	$0.00		$0.00	$122.54	$0.00	$0.00	$124.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.037	SUP	HCPCS C1713		447.037  -  PLATE 12MM MAXFACL 6 HOLE CVD LP 2MM SCR BILAT SGTL SPLT	BOTH IP/OP	$783.00 	$579.42	$0.00	$626.40	$352.35	$352.35	$0.00	$0.00	$0.00	$163.20	$581.14	$581.14	$0.00	$0.00	$163.18	$0.00	$463.14	$463.14	$0.00	$391.50	$620.14	$626.40	$0.00		$0.00	$122.54	$0.00	$0.00	$124.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.038	SUP	HCPCS C1713		447.038  -  PLATE BN CRV 8MMX1.25MM NS 6 HL SGTL SPLT TI CRNFCL 2MM SCR	BOTH IP/OP	$783.00 	$579.42	$0.00	$626.40	$352.35	$352.35	$0.00	$0.00	$0.00	$163.20	$581.14	$581.14	$0.00	$0.00	$163.18	$0.00	$463.14	$463.14	$0.00	$391.50	$620.14	$626.40	$0.00		$0.00	$122.54	$0.00	$0.00	$124.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.039	SUP	HCPCS C1713		447.039  -  PLATE 16MM MAXFACL 6 HOLE CVD 2MM SCR BILAT SGTL SPLT OSTMY	BOTH IP/OP	$783.00 	$579.42	$0.00	$626.40	$352.35	$352.35	$0.00	$0.00	$0.00	$163.20	$581.14	$581.14	$0.00	$0.00	$163.18	$0.00	$463.14	$463.14	$0.00	$391.50	$620.14	$626.40	$0.00		$0.00	$122.54	$0.00	$0.00	$124.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.04	SUP	HCPCS C1713		447.040  -  PLATE 25MM MAXL RIGHT 3X3 HOLE L 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$231.86	$231.86	$0.00	$0.00	$0.00	$107.39	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$304.77	$304.77	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$80.64	$0.00	$0.00	$82.03	$0.00	$0.00	$0.00	$0.00	$0.00
447.041	SUP	HCPCS C1713		447.041  -  PLATE BN L 25X4.8X.9MM NS 15MM 3 HL SHFT 3 HL BS TI MXL LT 2	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$231.86	$231.86	$0.00	$0.00	$0.00	$107.39	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$304.77	$304.77	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$80.64	$0.00	$0.00	$82.03	$0.00	$0.00	$0.00	$0.00	$0.00
447.042	SUP	HCPCS C1713		447.042  -  PLATE RIGHT MAXL 3X3 HOLE L 2MM SCR BONE TI 27MM NONSTRL	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$231.86	$231.86	$0.00	$0.00	$0.00	$107.39	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$304.77	$304.77	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$80.64	$0.00	$0.00	$82.03	$0.00	$0.00	$0.00	$0.00	$0.00
447.043	SUP	HCPCS C1713		447.043  -  PLATE LEFT MAXL 3X3 HOLE L 2MM SCR BONE TI 27MM NONSTRL	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$231.86	$231.86	$0.00	$0.00	$0.00	$107.39	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$304.77	$304.77	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$80.64	$0.00	$0.00	$82.03	$0.00	$0.00	$0.00	$0.00	$0.00
447.044	SUP	HCPCS C1713		447.044  -  PLATE RIGHT MAXL 3X3 HOLE L 2MM SCR BONE TI 29MM NONSTRL	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$231.86	$231.86	$0.00	$0.00	$0.00	$107.39	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$304.77	$304.77	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$80.64	$0.00	$0.00	$82.03	$0.00	$0.00	$0.00	$0.00	$0.00
447.045	SUP	HCPCS C1713		447.045  -  PLATE LEFT MAXL 3X3 HOLE L 2MM SCR BONE TI 29MM NONSTRL	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$231.86	$231.86	$0.00	$0.00	$0.00	$107.39	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$304.77	$304.77	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$80.64	$0.00	$0.00	$82.03	$0.00	$0.00	$0.00	$0.00	$0.00
447.046	SUP	HCPCS C1713		447.046  -  PLATE BN MN NAR 4.8X1MM 4 HL LCK MLBL TI MNDB 2MM SCR	BOTH IP/OP	$843.75 	$624.38	$0.00	$675.00	$379.69	$379.69	$0.00	$0.00	$0.00	$175.86	$626.23	$626.23	$0.00	$0.00	$175.84	$0.00	$499.08	$499.08	$0.00	$421.88	$668.25	$675.00	$0.00		$0.00	$132.05	$0.00	$0.00	$134.33	$0.00	$0.00	$0.00	$0.00	$0.00
447.047	SUP	HCPCS C1713		447.047  -  PLATE BN MN NAR 4.8X1MM 6 HL LCK MLBL TI MNDB 2MM SCR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.048	SUP	HCPCS C1713		447.048  -  PLATE BN MN NAR 4.8X1MM 4 HL LCK MLBL TI MNDB 2MM SCR	BOTH IP/OP	$843.75 	$624.38	$0.00	$675.00	$379.69	$379.69	$0.00	$0.00	$0.00	$175.86	$626.23	$626.23	$0.00	$0.00	$175.84	$0.00	$499.08	$499.08	$0.00	$421.88	$668.25	$675.00	$0.00		$0.00	$132.05	$0.00	$0.00	$134.33	$0.00	$0.00	$0.00	$0.00	$0.00
447.049	SUP	HCPCS C1713		447.049  -  PLATE BN MN NAR 4.8X1MM 6 HL LCK TI MNDB 2MM SCR	BOTH IP/OP	$918.00 	$679.32	$0.00	$734.40	$413.10	$413.10	$0.00	$0.00	$0.00	$191.33	$681.34	$681.34	$0.00	$0.00	$191.31	$0.00	$543.00	$543.00	$0.00	$459.00	$727.06	$734.40	$0.00		$0.00	$143.67	$0.00	$0.00	$146.15	$0.00	$0.00	$0.00	$0.00	$0.00
447.05	SUP	HCPCS C1713		447.050  -  PLATE MINI 1MM MANDIB 12 HOLE LCK ADP 2MM SCR BONE TI	BOTH IP/OP	"$1,500.75 "	"$1,110.56"	$0.00	"$1,200.60"	$675.34	$675.34	$0.00	$0.00	$0.00	$312.79	"$1,113.86"	"$1,113.86"	$0.00	$0.00	$312.76	$0.00	$887.69	$887.69	$0.00	$750.38	"$1,188.59"	"$1,200.60"	$0.00		$0.00	$234.87	$0.00	$0.00	$238.92	$0.00	$0.00	$0.00	$0.00	$0.00
447.051	SUP	HCPCS C1713		447.051  -  PLATE BN MN 4.8X1MM 20 HL LCK ADP TI MNDB 2MM SCR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.053	SUP	HCPCS C1713		447.053  -  PLATE BN MN 4.8X1MM 4 HL LCK TNSNBND TI MNDB 2MM SCR	BOTH IP/OP	"$1,055.25 "	$780.89	$0.00	$844.20	$474.86	$474.86	$0.00	$0.00	$0.00	$219.94	$783.21	$783.21	$0.00	$0.00	$219.91	$0.00	$624.18	$624.18	$0.00	$527.63	$835.76	$844.20	$0.00		$0.00	$165.15	$0.00	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00
447.055	SUP	HCPCS C1713		447.055  -  PLATE BN MN BRD 4.8X1.3MM 4 HL LCK TI MNDB 2MM SCR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.057	SUP	HCPCS C1713		447.057  -  PLATE BN MN BRD CRV 4.8X1.3MM 4 HL LCK TI MNDB 2MM SCR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.07	SUP	HCPCS C1713		447.070  -  PLATE SM 15MMX.9MM TI 2MM SCR 4 HOLE STR OFFST PURE BONE 3MM	BOTH IP/OP	$571.50 	$422.91	$0.00	$457.20	$257.18	$257.18	$0.00	$0.00	$0.00	$119.11	$424.17	$424.17	$0.00	$0.00	$119.10	$0.00	$338.04	$338.04	$0.00	$285.75	$452.63	$457.20	$0.00		$0.00	$89.44	$0.00	$0.00	$90.98	$0.00	$0.00	$0.00	$0.00	$0.00
447.071	SUP	HCPCS C1713		447.071  -  PLATE CHIN 4 HOLE STR 2MM SCR BONE TI 5MM NONSTRL	BOTH IP/OP	$600.75 	$444.56	$0.00	$480.60	$270.34	$270.34	$0.00	$0.00	$0.00	$125.21	$445.88	$445.88	$0.00	$0.00	$125.20	$0.00	$355.34	$355.34	$0.00	$300.38	$475.79	$480.60	$0.00		$0.00	$94.02	$0.00	$0.00	$95.64	$0.00	$0.00	$0.00	$0.00	$0.00
447.072	SUP	HCPCS C1713		447.072  -  PLATE CHIN 4 HOLE STR 2MM SCR BONE TI 8MM NONSTRL	BOTH IP/OP	$632.25 	$467.87	$0.00	$505.80	$284.51	$284.51	$0.00	$0.00	$0.00	$131.78	$469.26	$469.26	$0.00	$0.00	$131.76	$0.00	$373.98	$373.98	$0.00	$316.13	$500.74	$505.80	$0.00		$0.00	$98.95	$0.00	$0.00	$100.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.073	SUP	HCPCS C1713		447.073  -  PLATE CHIN 5 HOLE 2 BND 2MM SCR BONE TI 4MM NONSTRL	BOTH IP/OP	$708.75 	$524.48	$0.00	$567.00	$318.94	$318.94	$0.00	$0.00	$0.00	$147.72	$526.03	$526.03	$0.00	$0.00	$147.70	$0.00	$419.23	$419.23	$0.00	$354.38	$561.33	$567.00	$0.00		$0.00	$110.92	$0.00	$0.00	$112.83	$0.00	$0.00	$0.00	$0.00	$0.00
447.074	SUP	HCPCS C1713		447.074  -  PLATE 6MM CHIN 5 HOLE 2 BND 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$708.75 	$524.48	$0.00	$567.00	$318.94	$318.94	$0.00	$0.00	$0.00	$147.72	$526.03	$526.03	$0.00	$0.00	$147.70	$0.00	$419.23	$419.23	$0.00	$354.38	$561.33	$567.00	$0.00		$0.00	$110.92	$0.00	$0.00	$112.83	$0.00	$0.00	$0.00	$0.00	$0.00
447.075	SUP	HCPCS C1713		447.075  -  PLATE CHIN 5 HOLE 2 BND 2MM SCR BONE TI 8MM NONSTRL	BOTH IP/OP	$747.00 	$552.78	$0.00	$597.60	$336.15	$336.15	$0.00	$0.00	$0.00	$155.69	$554.42	$554.42	$0.00	$0.00	$155.67	$0.00	$441.85	$441.85	$0.00	$373.50	$591.62	$597.60	$0.00		$0.00	$116.91	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$0.00
447.076	SUP	HCPCS C1713		447.076  -  PLATE CHIN 5 HOLE 2 BND 2MM SCR BONE TI 10MM NONSTRL	BOTH IP/OP	$747.00 	$552.78	$0.00	$597.60	$336.15	$336.15	$0.00	$0.00	$0.00	$155.69	$554.42	$554.42	$0.00	$0.00	$155.67	$0.00	$441.85	$441.85	$0.00	$373.50	$591.62	$597.60	$0.00		$0.00	$116.91	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$0.00
447.077	SUP	HCPCS C1713		447.077  -  PLATE CHIN 5 HOLE 1 BND 2MM SCR BONE TI 3-5MM NONSTRL	BOTH IP/OP	$708.75 	$524.48	$0.00	$567.00	$318.94	$318.94	$0.00	$0.00	$0.00	$147.72	$526.03	$526.03	$0.00	$0.00	$147.70	$0.00	$419.23	$419.23	$0.00	$354.38	$561.33	$567.00	$0.00		$0.00	$110.92	$0.00	$0.00	$112.83	$0.00	$0.00	$0.00	$0.00	$0.00
447.078	SUP	HCPCS C1713		447.078  -  PLATE CHIN 5 HOLE 1 BND 2MM SCR BONE TI 6-8MM NONSTRL	BOTH IP/OP	$708.75 	$524.48	$0.00	$567.00	$318.94	$318.94	$0.00	$0.00	$0.00	$147.72	$526.03	$526.03	$0.00	$0.00	$147.70	$0.00	$419.23	$419.23	$0.00	$354.38	$561.33	$567.00	$0.00		$0.00	$110.92	$0.00	$0.00	$112.83	$0.00	$0.00	$0.00	$0.00	$0.00
447.079	SUP	HCPCS C1713		447.079  -  PLATE CHIN 5 HOLE 1 BND 2MM SCR BONE TI 9-11MM NONSTRL	BOTH IP/OP	$708.75 	$524.48	$0.00	$567.00	$318.94	$318.94	$0.00	$0.00	$0.00	$147.72	$526.03	$526.03	$0.00	$0.00	$147.70	$0.00	$419.23	$419.23	$0.00	$354.38	$561.33	$567.00	$0.00		$0.00	$110.92	$0.00	$0.00	$112.83	$0.00	$0.00	$0.00	$0.00	$0.00
447.082	SUP	HCPCS C1713		447.082  -  PLATE MAXFACL 8 HOLE STRUT 2 MM SCR BILAT SGTL SPLT OSTMY	BOTH IP/OP	$942.75 	$697.64	$0.00	$754.20	$424.24	$424.24	$0.00	$0.00	$0.00	$196.49	$699.71	$699.71	$0.00	$0.00	$196.47	$0.00	$557.64	$557.64	$0.00	$471.38	$746.66	$754.20	$0.00		$0.00	$147.54	$0.00	$0.00	$150.09	$0.00	$0.00	$0.00	$0.00	$0.00
447.083	SUP	HCPCS C1713		447.083  -  PLATE -90D 38MM MAXFACL 10 HOLE CVD SGTL SPLT CURVE 2MM SCR	BOTH IP/OP	$828.00 	$612.72	$0.00	$662.40	$372.60	$372.60	$0.00	$0.00	$0.00	$172.58	$614.54	$614.54	$0.00	$0.00	$172.56	$0.00	$489.76	$489.76	$0.00	$414.00	$655.78	$662.40	$0.00		$0.00	$129.58	$0.00	$0.00	$131.82	$0.00	$0.00	$0.00	$0.00	$0.00
447.084	SUP	HCPCS C1713		447.084  -  PLATE 30MM MAXFACL 4 HOLE STR 2MM SCR BILAT SGTL SPLT OSTMY	BOTH IP/OP	$828.00 	$612.72	$0.00	$662.40	$372.60	$372.60	$0.00	$0.00	$0.00	$172.58	$614.54	$614.54	$0.00	$0.00	$172.56	$0.00	$489.76	$489.76	$0.00	$414.00	$655.78	$662.40	$0.00		$0.00	$129.58	$0.00	$0.00	$131.82	$0.00	$0.00	$0.00	$0.00	$0.00
447.088	SUP	HCPCS C1713		447.088  -  PLATE MAXFACL 8 HOLE CVD 2 MM SCR BILAT SGTL SPLT OSTMY BONE	BOTH IP/OP	$828.00 	$612.72	$0.00	$662.40	$372.60	$372.60	$0.00	$0.00	$0.00	$172.58	$614.54	$614.54	$0.00	$0.00	$172.56	$0.00	$489.76	$489.76	$0.00	$414.00	$655.78	$662.40	$0.00		$0.00	$129.58	$0.00	$0.00	$131.82	$0.00	$0.00	$0.00	$0.00	$0.00
447.1	SUP	HCPCS C1713		447.10  -  PLATE 100MM MIDFAC 20 HOLE ADOPTION 2MM SCR BONE TI NONSTRL	BOTH IP/OP	"$1,059.75 "	$784.22	$0.00	$847.80	$476.89	$476.89	$0.00	$0.00	$0.00	$220.88	$786.55	$786.55	$0.00	$0.00	$220.85	$0.00	$626.84	$626.84	$0.00	$529.88	$839.32	$847.80	$0.00		$0.00	$165.85	$0.00	$0.00	$168.71	$0.00	$0.00	$0.00	$0.00	$0.00
447.101	SUP	HCPCS C1713		447.101  -  PLATE MANDIB 6 HOLE INTMD LCK 2 MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.102	SUP	HCPCS C1713		447.102  -  PLATE MANDIB 12 HOLE INTMD LCK 2 MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.103	SUP	HCPCS C1713		447.103  -  PLATE LG MANDIB 3X3 HOLE LCK STR 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.104	SUP	HCPCS C1713		447.104  -  PLATE LG MANDIB 6 HOLE LCK STR 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.105	SUP	HCPCS C1713		447.105  -  PLATE BN 8MM SPC LG 95X6.5X1.5MM NS 12 HL LCK LOPRFL TI MNDB	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.106	SUP	HCPCS C1713		447.106  -  PLATE LG MANDIB 20 HOLE LCK STR 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.108	SUP	HCPCS C1713		447.108  -  PLATE LG MANDIB 6X21 HOLE LCK RIGHT ANG 2MM SCR BONE TI	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.109	SUP	HCPCS C1713		447.109  -  PLATE LG MANDIB 6X21 HOLE LCK LEFT ANG 2MM SCR BONE TI	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.114	SUP	HCPCS C1713		447.114  -  PLATE 33MM MAXFACL 4 HOLE ADJ SLDR 2MM SCR BILAT SGTL SPLT	BOTH IP/OP	"$1,064.25 "	$787.55	$0.00	$851.40	$478.91	$478.91	$0.00	$0.00	$0.00	$221.82	$789.89	$789.89	$0.00	$0.00	$221.79	$0.00	$629.50	$629.50	$0.00	$532.13	$842.89	$851.40	$0.00		$0.00	$166.56	$0.00	$0.00	$169.43	$0.00	$0.00	$0.00	$0.00	$0.00
447.116	SUP	HCPCS C1713		447.116  -  PLATE 40MM MAXFACL 4 HOLE ADJ SLDR 2MM SCR BILAT SGTL SPLT	BOTH IP/OP	"$1,064.25 "	$787.55	$0.00	$851.40	$478.91	$478.91	$0.00	$0.00	$0.00	$221.82	$789.89	$789.89	$0.00	$0.00	$221.79	$0.00	$629.50	$629.50	$0.00	$532.13	$842.89	$851.40	$0.00		$0.00	$166.56	$0.00	$0.00	$169.43	$0.00	$0.00	$0.00	$0.00	$0.00
447.117	SUP	HCPCS C1713		447.117  -  PLATE LG MANDIB 3X3 HOLE LCK CRSNT 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.118	SUP	HCPCS C1713		447.118  -  PLATE LG MANDIB 3X3 HOLE LCK ANG 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.119	SUP	HCPCS C1713		447.119  -  PLATE LG MANDIB 4X4 HOLE LCK ANG 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.14	SUP	HCPCS C1713		447.140  -  PLATE BONE 24MM CRANFCL TI 3X3 HOLE T 2MM SCR NONSTRL	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$247.05	$247.05	$0.00	$0.00	$0.00	$114.43	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$324.73	$324.73	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$85.92	$0.00	$0.00	$87.40	$0.00	$0.00	$0.00	$0.00	$0.00
447.141	SUP	HCPCS C1713		447.141  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 4MM NONSTRL	BOTH IP/OP	$618.75 	$457.88	$0.00	$495.00	$278.44	$278.44	$0.00	$0.00	$0.00	$128.96	$459.24	$459.24	$0.00	$0.00	$128.95	$0.00	$365.99	$365.99	$0.00	$309.38	$490.05	$495.00	$0.00		$0.00	$96.83	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
447.142	SUP	HCPCS C1713		447.142  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 6MM NONSTRL	BOTH IP/OP	$618.75 	$457.88	$0.00	$495.00	$278.44	$278.44	$0.00	$0.00	$0.00	$128.96	$459.24	$459.24	$0.00	$0.00	$128.95	$0.00	$365.99	$365.99	$0.00	$309.38	$490.05	$495.00	$0.00		$0.00	$96.83	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
447.143	SUP	HCPCS C1713		447.143  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 8MM NONSTRL	BOTH IP/OP	$618.75 	$457.88	$0.00	$495.00	$278.44	$278.44	$0.00	$0.00	$0.00	$128.96	$459.24	$459.24	$0.00	$0.00	$128.95	$0.00	$365.99	$365.99	$0.00	$309.38	$490.05	$495.00	$0.00		$0.00	$96.83	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
447.144	SUP	HCPCS C1713		447.144  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 10MM NONSTRL	BOTH IP/OP	$618.75 	$457.88	$0.00	$495.00	$278.44	$278.44	$0.00	$0.00	$0.00	$128.96	$459.24	$459.24	$0.00	$0.00	$128.95	$0.00	$365.99	$365.99	$0.00	$309.38	$490.05	$495.00	$0.00		$0.00	$96.83	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
447.145	SUP	HCPCS C1713		447.145  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 12MM NONSTRL	BOTH IP/OP	$618.75 	$457.88	$0.00	$495.00	$278.44	$278.44	$0.00	$0.00	$0.00	$128.96	$459.24	$459.24	$0.00	$0.00	$128.95	$0.00	$365.99	$365.99	$0.00	$309.38	$490.05	$495.00	$0.00		$0.00	$96.83	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
447.146	SUP	HCPCS C1713		447.146  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 6MM NONSTRL	BOTH IP/OP	$677.25 	$501.17	$0.00	$541.80	$304.76	$304.76	$0.00	$0.00	$0.00	$141.16	$502.65	$502.65	$0.00	$0.00	$141.14	$0.00	$400.59	$400.59	$0.00	$338.63	$536.38	$541.80	$0.00		$0.00	$105.99	$0.00	$0.00	$107.82	$0.00	$0.00	$0.00	$0.00	$0.00
447.147	SUP	HCPCS C1713		447.147  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 6MM NONSTRL	BOTH IP/OP	$677.25 	$501.17	$0.00	$541.80	$304.76	$304.76	$0.00	$0.00	$0.00	$141.16	$502.65	$502.65	$0.00	$0.00	$141.14	$0.00	$400.59	$400.59	$0.00	$338.63	$536.38	$541.80	$0.00		$0.00	$105.99	$0.00	$0.00	$107.82	$0.00	$0.00	$0.00	$0.00	$0.00
447.148	SUP	HCPCS C1713		447.148  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 8MM NONSTRL	BOTH IP/OP	$677.25 	$501.17	$0.00	$541.80	$304.76	$304.76	$0.00	$0.00	$0.00	$141.16	$502.65	$502.65	$0.00	$0.00	$141.14	$0.00	$400.59	$400.59	$0.00	$338.63	$536.38	$541.80	$0.00		$0.00	$105.99	$0.00	$0.00	$107.82	$0.00	$0.00	$0.00	$0.00	$0.00
447.149	SUP	HCPCS C1713		447.149  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 8MM NONSTRL	BOTH IP/OP	$677.25 	$501.17	$0.00	$541.80	$304.76	$304.76	$0.00	$0.00	$0.00	$141.16	$502.65	$502.65	$0.00	$0.00	$141.14	$0.00	$400.59	$400.59	$0.00	$338.63	$536.38	$541.80	$0.00		$0.00	$105.99	$0.00	$0.00	$107.82	$0.00	$0.00	$0.00	$0.00	$0.00
447.15	SUP	HCPCS C1713		447.150  -  PLATE RIGHT CHIN 4 HOLE 2 BND 2MM SCR BONE TI 10MM NONSTRL	BOTH IP/OP	$677.25 	$501.17	$0.00	$541.80	$304.76	$304.76	$0.00	$0.00	$0.00	$141.16	$502.65	$502.65	$0.00	$0.00	$141.14	$0.00	$400.59	$400.59	$0.00	$338.63	$536.38	$541.80	$0.00		$0.00	$105.99	$0.00	$0.00	$107.82	$0.00	$0.00	$0.00	$0.00	$0.00
447.151	SUP	HCPCS C1713		447.151  -  PLATE LEFT CHIN 4 HOLE 2 BND 2MM SCR BONE TI 10MM NONSTRL	BOTH IP/OP	$677.25 	$501.17	$0.00	$541.80	$304.76	$304.76	$0.00	$0.00	$0.00	$141.16	$502.65	$502.65	$0.00	$0.00	$141.14	$0.00	$400.59	$400.59	$0.00	$338.63	$536.38	$541.80	$0.00		$0.00	$105.99	$0.00	$0.00	$107.82	$0.00	$0.00	$0.00	$0.00	$0.00
447.152	SUP	HCPCS C1713		447.152  -  PLATE BONE 24MM CRANFCL TI 4 HOLE STR 2MM SCR NONSTRL	BOTH IP/OP	$612.00 	$452.88	$0.00	$489.60	$275.40	$275.40	$0.00	$0.00	$0.00	$127.56	$454.23	$454.23	$0.00	$0.00	$127.54	$0.00	$362.00	$362.00	$0.00	$306.00	$484.70	$489.60	$0.00		$0.00	$95.78	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$0.00
447.153	SUP	HCPCS C1713		447.153  -  PLATE BONE 30MM CRANFCL TI 4 HOLE STR 2MM SCR NONSTRL	BOTH IP/OP	$612.00 	$452.88	$0.00	$489.60	$275.40	$275.40	$0.00	$0.00	$0.00	$127.56	$454.23	$454.23	$0.00	$0.00	$127.54	$0.00	$362.00	$362.00	$0.00	$306.00	$484.70	$489.60	$0.00		$0.00	$95.78	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$0.00
447.154	SUP	HCPCS C1713		447.154  -  PLATE BONE 17MM 90D RIGHT CRNMXF TI 2X2 HOLE L LP 2MM SCR	BOTH IP/OP	$517.50 	$382.95	$0.00	$414.00	$232.88	$232.88	$0.00	$0.00	$0.00	$107.86	$384.09	$384.09	$0.00	$0.00	$107.85	$0.00	$306.10	$306.10	$0.00	$258.75	$409.86	$414.00	$0.00		$0.00	$80.99	$0.00	$0.00	$82.39	$0.00	$0.00	$0.00	$0.00	$0.00
447.155	SUP	HCPCS C1713		447.155  -  PLATE BONE 17MM 90D LEFT CRNMXF TI 2X2 HOLE L LP 2MM SCR	BOTH IP/OP	$517.50 	$382.95	$0.00	$414.00	$232.88	$232.88	$0.00	$0.00	$0.00	$107.86	$384.09	$384.09	$0.00	$0.00	$107.85	$0.00	$306.10	$306.10	$0.00	$258.75	$409.86	$414.00	$0.00		$0.00	$80.99	$0.00	$0.00	$82.39	$0.00	$0.00	$0.00	$0.00	$0.00
447.156	SUP	HCPCS C1713		447.156  -  PLATE BONE 19MM 90D RIGHT CRNMXF TI 2X2 HOLE L LP 2MM SCR	BOTH IP/OP	$517.50 	$382.95	$0.00	$414.00	$232.88	$232.88	$0.00	$0.00	$0.00	$107.86	$384.09	$384.09	$0.00	$0.00	$107.85	$0.00	$306.10	$306.10	$0.00	$258.75	$409.86	$414.00	$0.00		$0.00	$80.99	$0.00	$0.00	$82.39	$0.00	$0.00	$0.00	$0.00	$0.00
447.157	SUP	HCPCS C1713		447.157  -  PLATE BONE 19MM 90D LEFT CRNMXF TI 2X2 HOLE L LP 2MM SCR	BOTH IP/OP	$517.50 	$382.95	$0.00	$414.00	$232.88	$232.88	$0.00	$0.00	$0.00	$107.86	$384.09	$384.09	$0.00	$0.00	$107.85	$0.00	$306.10	$306.10	$0.00	$258.75	$409.86	$414.00	$0.00		$0.00	$80.99	$0.00	$0.00	$82.39	$0.00	$0.00	$0.00	$0.00	$0.00
447.158	SUP	HCPCS C1713		447.158  -  PLATE BONE 23MM 90D RIGHT CRNMXF TI 2X2 HOLE L LP 2MM SCR	BOTH IP/OP	$517.50 	$382.95	$0.00	$414.00	$232.88	$232.88	$0.00	$0.00	$0.00	$107.86	$384.09	$384.09	$0.00	$0.00	$107.85	$0.00	$306.10	$306.10	$0.00	$258.75	$409.86	$414.00	$0.00		$0.00	$80.99	$0.00	$0.00	$82.39	$0.00	$0.00	$0.00	$0.00	$0.00
447.159	SUP	HCPCS C1713		447.159  -  PLATE BONE 23MM 90D LEFT CRNMXF TI 2X2 HOLE L LP 2MM SCR	BOTH IP/OP	$517.50 	$382.95	$0.00	$414.00	$232.88	$232.88	$0.00	$0.00	$0.00	$107.86	$384.09	$384.09	$0.00	$0.00	$107.85	$0.00	$306.10	$306.10	$0.00	$258.75	$409.86	$414.00	$0.00		$0.00	$80.99	$0.00	$0.00	$82.39	$0.00	$0.00	$0.00	$0.00	$0.00
447.18	SUP	HCPCS C1713		447.18  -  PLATE BONE ORBTL RIM TI 8 HOLE 2 MM SCR NONSTRL	BOTH IP/OP	$528.75 	$391.28	$0.00	$423.00	$237.94	$237.94	$0.00	$0.00	$0.00	$110.20	$392.44	$392.44	$0.00	$0.00	$110.19	$0.00	$312.76	$312.76	$0.00	$264.38	$418.77	$423.00	$0.00		$0.00	$82.75	$0.00	$0.00	$84.18	$0.00	$0.00	$0.00	$0.00	$0.00
447.184	SUP	HCPCS C1713		447.184  -  2.0MM TI SAGITTAL SPLIT PLATE STRAIGHT LOW-PROFILE/4 H/22MM	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$308.81	$308.81	$0.00	$0.00	$0.00	$143.03	$509.33	$509.33	$0.00	$0.00	$143.01	$0.00	$405.92	$405.92	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$107.40	$0.00	$0.00	$109.25	$0.00	$0.00	$0.00	$0.00	$0.00
447.185	SUP	HCPCS C1713		447.185  -  2.0MM TI SAGITTAL SPLIT PLATE STRAIGHT LOW-PROFILE/4 H/29MM	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$308.81	$308.81	$0.00	$0.00	$0.00	$143.03	$509.33	$509.33	$0.00	$0.00	$143.01	$0.00	$405.92	$405.92	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$107.40	$0.00	$0.00	$109.25	$0.00	$0.00	$0.00	$0.00	$0.00
447.186	SUP	HCPCS C1713		447.186  -  2.0MM TI SAGITTAL SPLIT PLATE STRAIGHT LOW-PROFILE/4 H/36MM	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$308.81	$308.81	$0.00	$0.00	$0.00	$143.03	$509.33	$509.33	$0.00	$0.00	$143.01	$0.00	$405.92	$405.92	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$107.40	$0.00	$0.00	$109.25	$0.00	$0.00	$0.00	$0.00	$0.00
447.2	SUP	HCPCS C1713		447.20  -  PLATE BONE ORBTL RIM TI 10 HOLE 2 MM SCR NONSTRL	BOTH IP/OP	$558.00 	$412.92	$0.00	$446.40	$251.10	$251.10	$0.00	$0.00	$0.00	$116.30	$414.15	$414.15	$0.00	$0.00	$116.29	$0.00	$330.06	$330.06	$0.00	$279.00	$441.94	$446.40	$0.00		$0.00	$87.33	$0.00	$0.00	$88.83	$0.00	$0.00	$0.00	$0.00	$0.00
447.204	SUP	HCPCS C1713		447.204  -  PLATE 1.3MM MANDIB 4 HOLE INTMD LCK CMPR 2MM SCR BONE TI	BOTH IP/OP	$816.75 	$604.40	$0.00	$653.40	$367.54	$367.54	$0.00	$0.00	$0.00	$170.23	$606.19	$606.19	$0.00	$0.00	$170.21	$0.00	$483.11	$483.11	$0.00	$408.38	$646.87	$653.40	$0.00		$0.00	$127.82	$0.00	$0.00	$130.03	$0.00	$0.00	$0.00	$0.00	$0.00
447.205	SUP	HCPCS C1713		447.205  -  PLATE 1.3MM MANDIB 5 HOLE INTMD LCK CMPR 2MM SCR BONE TI	BOTH IP/OP	$888.75 	$657.68	$0.00	$711.00	$399.94	$399.94	$0.00	$0.00	$0.00	$185.24	$659.63	$659.63	$0.00	$0.00	$185.22	$0.00	$525.70	$525.70	$0.00	$444.38	$703.89	$711.00	$0.00		$0.00	$139.09	$0.00	$0.00	$141.49	$0.00	$0.00	$0.00	$0.00	$0.00
447.206	SUP	HCPCS C1713		447.206  -  PLATE 1.3MM MANDIB 6 HOLE INTMD LCK CMPR 2MM SCR BONE TI	BOTH IP/OP	$958.50 	$709.29	$0.00	$766.80	$431.33	$431.33	$0.00	$0.00	$0.00	$199.78	$711.40	$711.40	$0.00	$0.00	$199.75	$0.00	$566.95	$566.95	$0.00	$479.25	$759.13	$766.80	$0.00		$0.00	$150.01	$0.00	$0.00	$152.59	$0.00	$0.00	$0.00	$0.00	$0.00
447.208	SUP	HCPCS C1713		447.208  -  PLATE 1.3MM MANDIB 8 HOLE INTMD LCK CMPR 2MM SCR BONE TI	BOTH IP/OP	"$1,084.50 "	$802.53	$0.00	$867.60	$488.03	$488.03	$0.00	$0.00	$0.00	$226.04	$804.92	$804.92	$0.00	$0.00	$226.01	$0.00	$641.48	$641.48	$0.00	$542.25	$858.92	$867.60	$0.00		$0.00	$169.72	$0.00	$0.00	$172.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.21	SUP	HCPCS C1713		447.210  -  PLATE 1.3MM MANDIB 6 HOLE INTMD LCK ANG CMPR 2MM SCR BONE TI	BOTH IP/OP	"$1,208.25 "	$894.11	$0.00	$966.60	$543.71	$543.71	$0.00	$0.00	$0.00	$251.83	$896.76	$896.76	$0.00	$0.00	$251.80	$0.00	$714.68	$714.68	$0.00	$604.13	$956.93	$966.60	$0.00		$0.00	$189.09	$0.00	$0.00	$192.35	$0.00	$0.00	$0.00	$0.00	$0.00
447.212	SUP	HCPCS C1713		447.212  -  PLATE 1.3MM MANDIB 8 HOLE INTMD LCK ANG CMPR 2MM SCR BONE TI	BOTH IP/OP	"$1,300.50 "	$962.37	$0.00	"$1,040.40"	$585.23	$585.23	$0.00	$0.00	$0.00	$271.06	$965.23	$965.23	$0.00	$0.00	$271.02	$0.00	$769.25	$769.25	$0.00	$650.25	"$1,030.00"	"$1,040.40"	$0.00		$0.00	$203.53	$0.00	$0.00	$207.04	$0.00	$0.00	$0.00	$0.00	$0.00
447.215	SUP	HCPCS C1713		447.215  -  PLATE 1.3MM MANDIB 5 HOLE INTMD LCK CRSNT 2MM SCR BONE TI	BOTH IP/OP	"$1,084.50 "	$802.53	$0.00	$867.60	$488.03	$488.03	$0.00	$0.00	$0.00	$226.04	$804.92	$804.92	$0.00	$0.00	$226.01	$0.00	$641.48	$641.48	$0.00	$542.25	$858.92	$867.60	$0.00		$0.00	$169.72	$0.00	$0.00	$172.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.217	SUP	HCPCS C1713		447.217  -  PLATE 1.3MM MANDIB 7 HOLE INTMD LCK CRSNT 2MM SCR BONE TI	BOTH IP/OP	"$1,154.25 "	$854.15	$0.00	$923.40	$519.41	$519.41	$0.00	$0.00	$0.00	$240.57	$856.68	$856.68	$0.00	$0.00	$240.55	$0.00	$682.74	$682.74	$0.00	$577.13	$914.17	$923.40	$0.00		$0.00	$180.64	$0.00	$0.00	$183.76	$0.00	$0.00	$0.00	$0.00	$0.00
447.22	SUP	HCPCS C1713		447.22  -  PLATE BONE ORBTL RIM CRNMXF TI 12 HOLE CVD 2 MM SCR NONSTRL	BOTH IP/OP	$589.50 	$436.23	$0.00	$471.60	$265.28	$265.28	$0.00	$0.00	$0.00	$122.87	$437.53	$437.53	$0.00	$0.00	$122.85	$0.00	$348.69	$348.69	$0.00	$294.75	$466.88	$471.60	$0.00		$0.00	$92.26	$0.00	$0.00	$93.85	$0.00	$0.00	$0.00	$0.00	$0.00
447.232	SUP	HCPCS C1713		447.232  -  PLATE BN T 53X5X1.2MM NS PRO-PK 2 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$83.00	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
447.233	SUP	HCPCS C1713		447.233  -  PLATE BN T 53X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
447.244	SUP	HCPCS C1713		447.244  -  PLATE BONE 25MM CRANFCL TI 3X4 HOLE T 2MM SCR NONSTRL	BOTH IP/OP	$517.50 	$382.95	$0.00	$414.00	$232.88	$232.88	$0.00	$0.00	$0.00	$107.86	$384.09	$384.09	$0.00	$0.00	$107.85	$0.00	$306.10	$306.10	$0.00	$258.75	$409.86	$414.00	$0.00		$0.00	$80.99	$0.00	$0.00	$82.39	$0.00	$0.00	$0.00	$0.00	$0.00
447.304	SUP	HCPCS C1713		447.304  -  PLATE MINI 1MM RIGHT MANDIB 4 HOLE LCK TNSNBND PREBNT 2MM	BOTH IP/OP	$987.75 	$730.94	$0.00	$790.20	$444.49	$444.49	$0.00	$0.00	$0.00	$205.87	$733.11	$733.11	$0.00	$0.00	$205.85	$0.00	$584.25	$584.25	$0.00	$493.88	$782.30	$790.20	$0.00		$0.00	$154.58	$0.00	$0.00	$157.25	$0.00	$0.00	$0.00	$0.00	$0.00
447.305	SUP	HCPCS C1713		447.305  -  PLATE MINI 1MM LEFT MANDIB 4 HOLE LCK TNSNBND PREBNT 2MM SCR	BOTH IP/OP	$987.75 	$730.94	$0.00	$790.20	$444.49	$444.49	$0.00	$0.00	$0.00	$205.87	$733.11	$733.11	$0.00	$0.00	$205.85	$0.00	$584.25	$584.25	$0.00	$493.88	$782.30	$790.20	$0.00		$0.00	$154.58	$0.00	$0.00	$157.25	$0.00	$0.00	$0.00	$0.00	$0.00
447.308	SUP	HCPCS C1713		447.308  -  PLATE 2 W MINI 1MM MANDIB 12 HOLE LCK MALBLE 2MM SCR BONE TI	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
447.309	SUP	HCPCS C1713		447.309  -  PLATE 2 W MINI 1MM MANDIB 9 HOLE LCK MALBLE 2MM SCR BONE TI	BOTH IP/OP	$949.50 	$702.63	$0.00	$759.60	$427.28	$427.28	$0.00	$0.00	$0.00	$197.90	$704.72	$704.72	$0.00	$0.00	$197.88	$0.00	$561.63	$561.63	$0.00	$474.75	$752.00	$759.60	$0.00		$0.00	$148.60	$0.00	$0.00	$151.16	$0.00	$0.00	$0.00	$0.00	$0.00
447.31	SUP	HCPCS C1713		447.310  -  PLATE MINI 1MM MANDIB 4 HOLE LCK BOX MALBLE 2MM SCR BONE TI	BOTH IP/OP	$663.75 	$491.18	$0.00	$531.00	$298.69	$298.69	$0.00	$0.00	$0.00	$138.34	$492.64	$492.64	$0.00	$0.00	$138.33	$0.00	$392.61	$392.61	$0.00	$331.88	$525.69	$531.00	$0.00		$0.00	$103.88	$0.00	$0.00	$105.67	$0.00	$0.00	$0.00	$0.00	$0.00
447.312	SUP	HCPCS C1713		447.312  -  PLATE MINI 1MM MANDIB 8 HOLE LCK STRUT MALBLE 2MM SCR BONE	BOTH IP/OP	"$1,300.50 "	$962.37	$0.00	"$1,040.40"	$585.23	$585.23	$0.00	$0.00	$0.00	$271.06	$965.23	$965.23	$0.00	$0.00	$271.02	$0.00	$769.25	$769.25	$0.00	$650.25	"$1,030.00"	"$1,040.40"	$0.00		$0.00	$203.53	$0.00	$0.00	$207.04	$0.00	$0.00	$0.00	$0.00	$0.00
447.315	SUP	HCPCS C1713		447.315  -  PLATE MINI 1MM MANDIB 8 HOLE LCK CVD STRUT MALBLE 2MM SCR	BOTH IP/OP	"$1,300.50 "	$962.37	$0.00	"$1,040.40"	$585.23	$585.23	$0.00	$0.00	$0.00	$271.06	$965.23	$965.23	$0.00	$0.00	$271.02	$0.00	$769.25	$769.25	$0.00	$650.25	"$1,030.00"	"$1,040.40"	$0.00		$0.00	$203.53	$0.00	$0.00	$207.04	$0.00	$0.00	$0.00	$0.00	$0.00
447.317	SUP	HCPCS C1713		447.317  -  PLATE MINI 1MM MANDIB 6 HOLE LCK 2Y MALBLE 2MM SCR BONE TI	BOTH IP/OP	$679.50 	$502.83	$0.00	$543.60	$305.78	$305.78	$0.00	$0.00	$0.00	$141.62	$504.32	$504.32	$0.00	$0.00	$141.61	$0.00	$401.92	$401.92	$0.00	$339.75	$538.16	$543.60	$0.00		$0.00	$106.34	$0.00	$0.00	$108.18	$0.00	$0.00	$0.00	$0.00	$0.00
447.318	SUP	HCPCS C1713		447.318  -  PLATE MINI 1MM RIGHT MANDIB 5 HOLE LCK L MALBLE 2MM SCR BONE	BOTH IP/OP	$627.75 	$464.54	$0.00	$502.20	$282.49	$282.49	$0.00	$0.00	$0.00	$130.84	$465.92	$465.92	$0.00	$0.00	$130.82	$0.00	$371.31	$371.31	$0.00	$313.88	$497.18	$502.20	$0.00		$0.00	$98.24	$0.00	$0.00	$99.94	$0.00	$0.00	$0.00	$0.00	$0.00
447.319	SUP	HCPCS C1713		447.319  -  PLATE MINI 1MM LEFT MANDIB 5 HOLE LCK L MALBLE 2MM SCR BONE	BOTH IP/OP	$627.75 	$464.54	$0.00	$502.20	$282.49	$282.49	$0.00	$0.00	$0.00	$130.84	$465.92	$465.92	$0.00	$0.00	$130.82	$0.00	$371.31	$371.31	$0.00	$313.88	$497.18	$502.20	$0.00		$0.00	$98.24	$0.00	$0.00	$99.94	$0.00	$0.00	$0.00	$0.00	$0.00
447.344	SUP	HCPCS C1713		447.344  -  PLATE BONE 31MM 4 HOLE LP LCP TITANIUM SMALL BONE CORTICAL	BOTH IP/OP	$459.65 	$340.14	$0.00	$357.02	$200.82	$200.82	$0.00	$0.00	$0.00	$95.80	$341.15	$341.15	$0.00	$0.00	$95.79	$0.00	$271.88	$271.88	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$67.81	$0.00	$0.00	$71.05	$0.00	$0.00	$0.00	$0.00	$0.00
447.345	SUP	HCPCS C1713		447.345  -  PLATE BONE 38MM 5 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM	BOTH IP/OP	$459.65 	$340.14	$0.00	$357.02	$200.82	$200.82	$0.00	$0.00	$0.00	$95.80	$341.15	$341.15	$0.00	$0.00	$95.79	$0.00	$271.88	$271.88	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$67.81	$0.00	$0.00	$71.05	$0.00	$0.00	$0.00	$0.00	$0.00
447.346	SUP	HCPCS C1713		447.346  -  PLATE BONE 45MM 6 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM	BOTH IP/OP	$459.65 	$340.14	$0.00	$357.02	$200.82	$200.82	$0.00	$0.00	$0.00	$95.80	$341.15	$341.15	$0.00	$0.00	$95.79	$0.00	$271.88	$271.88	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$67.81	$0.00	$0.00	$71.05	$0.00	$0.00	$0.00	$0.00	$0.00
447.347	SUP	HCPCS C1713		447.347  -  PLATE BONE 52MM 7 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM	BOTH IP/OP	$459.65 	$340.14	$0.00	$357.02	$200.82	$200.82	$0.00	$0.00	$0.00	$95.80	$341.15	$341.15	$0.00	$0.00	$95.79	$0.00	$271.88	$271.88	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$67.81	$0.00	$0.00	$71.05	$0.00	$0.00	$0.00	$0.00	$0.00
447.348	SUP	HCPCS C1713		447.348  -  PLATE BONE 59MM 8 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM	BOTH IP/OP	$459.65 	$340.14	$0.00	$357.02	$200.82	$200.82	$0.00	$0.00	$0.00	$95.80	$341.15	$341.15	$0.00	$0.00	$95.79	$0.00	$271.88	$271.88	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$67.81	$0.00	$0.00	$71.05	$0.00	$0.00	$0.00	$0.00	$0.00
447.349	SUP	HCPCS C1713		447.349  -  PLATE BONE 7 HOLE LCP TITANIUM CONDYLE NONSTRL 2 MM SCREWS	BOTH IP/OP	"$1,446.45 "	"$1,070.37"	$0.00	"$1,123.46"	$631.95	$631.95	$0.00	$0.00	$0.00	$301.48	"$1,073.56"	"$1,073.56"	$0.00	$0.00	$301.44	$0.00	$855.58	$855.58	$0.00	$702.16	"$1,112.23"	"$1,123.46"	$0.00		$0.00	$213.38	$0.00	$0.00	$223.57	$0.00	$0.00	$0.00	$0.00	$0.00
447.35	SUP	HCPCS C1713		447.350  -  PLATE BONE Y 55MM 3X7 HOLE LCP TITANIUM SMALL BONE NONSTRL 2	BOTH IP/OP	$788.83 	$583.73	$0.00	$631.06	$354.97	$354.97	$0.00	$0.00	$0.00	$164.41	$585.47	$585.47	$0.00	$0.00	$164.39	$0.00	$466.59	$466.59	$0.00	$394.41	$624.75	$631.06	$0.00		$0.00	$119.86	$0.00	$0.00	$125.58	$0.00	$0.00	$0.00	$0.00	$0.00
447.351	SUP	HCPCS C1713		447.351  -  PLATE BONE 2 HOLE HEAD 7 HOLE SHAFT T LCP TITANIUM	BOTH IP/OP	$812.50 	$601.25	$0.00	$631.06	$354.97	$354.97	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$394.41	$624.75	$631.06	$0.00		$0.00	$119.86	$0.00	$0.00	$125.58	$0.00	$0.00	$0.00	$0.00	$0.00
447.36	SUP	HCPCS C1713		447.360  -  PLATE BONE 73MM 10 HOLE LCP TITANIUM SMALL BONE NONSTRL 2MM	BOTH IP/OP	$446.28 	$330.25	$0.00	$357.02	$200.82	$200.82	$0.00	$0.00	$0.00	$93.01	$331.23	$331.23	$0.00	$0.00	$93.00	$0.00	$263.97	$263.97	$0.00	$223.14	$353.45	$357.02	$0.00		$0.00	$67.81	$0.00	$0.00	$71.05	$0.00	$0.00	$0.00	$0.00	$0.00
447.362	SUP	HCPCS C1713		447.362  -  PLATE BONE 81MM 12 HOLE ADAPTION LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$777.35 	$575.24	$0.00	$603.76	$339.62	$339.62	$0.00	$0.00	$0.00	$162.02	$576.95	$576.95	$0.00	$0.00	$162.00	$0.00	$459.80	$459.80	$0.00	$377.35	$597.72	$603.76	$0.00		$0.00	$114.67	$0.00	$0.00	$120.15	$0.00	$0.00	$0.00	$0.00	$0.00
447.364	SUP	HCPCS C1713		447.364  -  PLATE BONE 84MM 10 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
447.366	SUP	HCPCS C1713		447.366  -  PLATE BONE 88MM 12 HOLE ADAPTION LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	$856.08 	$633.50	$0.00	$664.90	$374.01	$374.01	$0.00	$0.00	$0.00	$178.43	$635.38	$635.38	$0.00	$0.00	$178.41	$0.00	$506.37	$506.37	$0.00	$415.56	$658.25	$664.90	$0.00		$0.00	$126.28	$0.00	$0.00	$132.32	$0.00	$0.00	$0.00	$0.00	$0.00
447.37	SUP	HCPCS C1713		447.370  -  PLATE BONE 97MM 12 HOLE ADAPTION LCP TITANIUM SMALL BONE	BOTH IP/OP	$831.13 	$615.04	$0.00	$664.90	$374.01	$374.01	$0.00	$0.00	$0.00	$173.23	$616.86	$616.86	$0.00	$0.00	$173.21	$0.00	$491.61	$491.61	$0.00	$415.56	$658.25	$664.90	$0.00		$0.00	$126.28	$0.00	$0.00	$132.32	$0.00	$0.00	$0.00	$0.00	$0.00
447.372	SUP	HCPCS C1713		447.372  -  PLATE BONE 76MM 8 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.7MM	BOTH IP/OP	$775.95 	$574.20	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$161.73	$575.91	$575.91	$0.00	$0.00	$161.71	$0.00	$458.97	$458.97	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
447.374	SUP	HCPCS C1713		447.374  -  PLATE BN 94MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH TI 2.7	BOTH IP/OP	$775.95 	$574.20	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$161.73	$575.91	$575.91	$0.00	$0.00	$161.71	$0.00	$458.97	$458.97	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
447.375	SUP	HCPCS C1713		447.375  -  PLATE BONE 44MM 5 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
447.377	SUP	HCPCS C1713		447.377  -  PLATE BONE 60MM 7 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
447.38	SUP	HCPCS C1713		447.38  -  PLATE BONE 193MM BRD SPC CRANFCL TI 30 HOLE ADP 2MM SCR	BOTH IP/OP	"$1,156.50 "	$855.81	$0.00	$925.20	$520.43	$520.43	$0.00	$0.00	$0.00	$241.04	$858.35	$858.35	$0.00	$0.00	$241.01	$0.00	$684.07	$684.07	$0.00	$578.25	$915.95	$925.20	$0.00		$0.00	$180.99	$0.00	$0.00	$184.11	$0.00	$0.00	$0.00	$0.00	$0.00
447.404	SUP	HCPCS C1713		447.404  -  PLATE LG 1.5MM MANDIB 4X20X4 HOLE LCK 2 ANG 2MM SCR BONE TI	BOTH IP/OP	"$4,916.25 "	"$3,638.03"	$0.00	"$3,933.00"	"$2,212.31"	"$2,212.31"	$0.00	$0.00	$0.00	"$1,024.67"	"$3,648.84"	"$3,648.84"	$0.00	$0.00	"$1,024.55"	$0.00	"$2,423.71"	"$2,423.71"	$0.00	"$2,458.13"	"$3,893.67"	"$3,933.00"	$0.00		$0.00	$769.39	$0.00	$0.00	$782.67	$0.00	$0.00	$0.00	$0.00	$0.00
447.405	SUP	HCPCS C1713		447.405  -  PLATE LG 1.5MM MANDIB 5X22X5 HOLE LCK 2 ANG 2MM SCR BONE TI	BOTH IP/OP	"$5,190.75 "	"$3,841.16"	$0.00	"$4,152.60"	"$2,335.84"	"$2,335.84"	$0.00	$0.00	$0.00	"$1,081.88"	"$3,852.57"	"$3,852.57"	$0.00	$0.00	"$1,081.75"	$0.00	"$2,559.04"	"$2,559.04"	$0.00	"$2,595.38"	"$4,111.07"	"$4,152.60"	$0.00		$0.00	$812.35	$0.00	$0.00	$826.37	$0.00	$0.00	$0.00	$0.00	$0.00
447.406	SUP	HCPCS C1713		447.406  -  PLATE LG 1.5MM MANDIB 6X24X6 HOLE LCK 2 ANG 2MM SCR BONE TI	BOTH IP/OP	"$5,474.25 "	"$4,050.95"	$0.00	"$4,379.40"	"$2,463.41"	"$2,463.41"	$0.00	$0.00	$0.00	"$1,140.97"	"$4,062.99"	"$4,062.99"	$0.00	$0.00	"$1,140.83"	$0.00	"$2,698.81"	"$2,698.81"	$0.00	"$2,737.13"	"$4,335.61"	"$4,379.40"	$0.00		$0.00	$856.72	$0.00	$0.00	$871.50	$0.00	$0.00	$0.00	$0.00	$0.00
447.412	SUP	HCPCS C1713		447.412  -  PLATE 2MM MANDIB 12 HOLE X LCK STR 2MM SCR BONE TI NONSTRL	BOTH IP/OP	"$1,953.00 "	"$1,445.22"	$0.00	"$1,562.40"	$878.85	$878.85	$0.00	$0.00	$0.00	$407.05	"$1,449.52"	"$1,449.52"	$0.00	$0.00	$407.01	$0.00	"$1,155.20"	"$1,155.20"	$0.00	$976.50	"$1,546.78"	"$1,562.40"	$0.00		$0.00	$305.64	$0.00	$0.00	$310.92	$0.00	$0.00	$0.00	$0.00	$0.00
447.42	SUP	HCPCS C1713		447.420  -  PLATE 2MM MANDIB 20 HOLE X LCK STR 2MM SCR BONE TI NONSTRL	BOTH IP/OP	"$2,697.75 "	"$1,996.34"	$0.00	"$2,158.20"	"$1,213.99"	"$1,213.99"	$0.00	$0.00	$0.00	$562.28	"$2,002.27"	"$2,002.27"	$0.00	$0.00	$562.21	$0.00	"$1,329.99"	"$1,329.99"	$0.00	"$1,348.88"	"$2,136.62"	"$2,158.20"	$0.00		$0.00	$422.20	$0.00	$0.00	$429.48	$0.00	$0.00	$0.00	$0.00	$0.00
447.422	SUP	HCPCS C1713		447.422  -  PLATE 2MM MANDIB 6X21 HOLE X LCK RIGHT ANG 2MM SCR BONE TI	BOTH IP/OP	"$4,459.50 "	"$3,300.03"	$0.00	"$3,567.60"	"$2,006.78"	"$2,006.78"	$0.00	$0.00	$0.00	$929.47	"$3,309.84"	"$3,309.84"	$0.00	$0.00	$929.36	$0.00	"$2,198.53"	"$2,198.53"	$0.00	"$2,229.75"	"$3,531.92"	"$3,567.60"	$0.00		$0.00	$697.91	$0.00	$0.00	$709.95	$0.00	$0.00	$0.00	$0.00	$0.00
447.423	SUP	HCPCS C1713		447.423  -  PLATE MANDIB 6X21 HOLE X LCK LEFT ANG 2 MM SCR BONE TI	BOTH IP/OP	"$4,459.50 "	"$3,300.03"	$0.00	"$3,567.60"	"$2,006.78"	"$2,006.78"	$0.00	$0.00	$0.00	$929.47	"$3,309.84"	"$3,309.84"	$0.00	$0.00	$929.36	$0.00	"$2,198.53"	"$2,198.53"	$0.00	"$2,229.75"	"$3,531.92"	"$3,567.60"	$0.00		$0.00	$697.91	$0.00	$0.00	$709.95	$0.00	$0.00	$0.00	$0.00	$0.00
447.424	SUP	HCPCS C1713		447.424  -  PLATE 2MM MANDIB 4X20X4 HOLE X LCK 2 ANG 2MM SCR BONE TI	BOTH IP/OP	"$5,154.75 "	"$3,814.52"	$0.00	"$4,123.80"	"$2,319.64"	"$2,319.64"	$0.00	$0.00	$0.00	"$1,074.38"	"$3,825.86"	"$3,825.86"	$0.00	$0.00	"$1,074.25"	$0.00	"$2,541.29"	"$2,541.29"	$0.00	"$2,577.38"	"$4,082.56"	"$4,123.80"	$0.00		$0.00	$806.72	$0.00	$0.00	$820.64	$0.00	$0.00	$0.00	$0.00	$0.00
447.425	SUP	HCPCS C1713		447.425  -  PLATE 2MM MANDIB 5X22X5 HOLE X LCK 2 ANG 2MM SCR BONE TI	BOTH IP/OP	"$5,447.25 "	"$4,030.97"	$0.00	"$4,357.80"	"$2,451.26"	"$2,451.26"	$0.00	$0.00	$0.00	"$1,135.34"	"$4,042.95"	"$4,042.95"	$0.00	$0.00	"$1,135.21"	$0.00	"$2,685.49"	"$2,685.49"	$0.00	"$2,723.63"	"$4,314.22"	"$4,357.80"	$0.00		$0.00	$852.49	$0.00	$0.00	$867.20	$0.00	$0.00	$0.00	$0.00	$0.00
447.426	SUP	HCPCS C1713		447.426  -  PLATE 2MM MANDIB 6X24X6 HOLE X LCK 2 ANG 2MM SCR BONE TI	BOTH IP/OP	"$5,735.25 "	"$4,244.09"	$0.00	"$4,588.20"	"$2,580.86"	"$2,580.86"	$0.00	$0.00	$0.00	"$1,195.37"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.23"	$0.00	"$2,827.48"	"$2,827.48"	$0.00	"$2,867.63"	"$4,542.32"	"$4,588.20"	$0.00		$0.00	$897.57	$0.00	$0.00	$913.05	$0.00	$0.00	$0.00	$0.00	$0.00
447.5	SUP	HCPCS C1713		447.50  -  PLATE BN 5MM SPC OB L L 25X10X.9MM NS 4.8MM 2 HL BS 3 HL	BOTH IP/OP	$558.00 	$412.92	$0.00	$446.40	$251.10	$251.10	$0.00	$0.00	$0.00	$116.30	$414.15	$414.15	$0.00	$0.00	$116.29	$0.00	$330.06	$330.06	$0.00	$279.00	$441.94	$446.40	$0.00		$0.00	$87.33	$0.00	$0.00	$88.83	$0.00	$0.00	$0.00	$0.00	$0.00
447.51	SUP	HCPCS C1713		447.51  -  PLATE 100D TI 2MM SCR 3 HOLE RIGHT OBLQ BONE ORTH NONSTRL	BOTH IP/OP	$558.00 	$412.92	$0.00	$446.40	$251.10	$251.10	$0.00	$0.00	$0.00	$116.30	$414.15	$414.15	$0.00	$0.00	$116.29	$0.00	$330.06	$330.06	$0.00	$279.00	$441.94	$446.40	$0.00		$0.00	$87.33	$0.00	$0.00	$88.83	$0.00	$0.00	$0.00	$0.00	$0.00
447.515	SUP	HCPCS C1713		447.515  -  PLATE BONE 100D CRANFCL TI 2X3 HOLE L RIGHT OBLQ MALBLE 2MM	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$247.05	$247.05	$0.00	$0.00	$0.00	$114.43	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$324.73	$324.73	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$85.92	$0.00	$0.00	$87.40	$0.00	$0.00	$0.00	$0.00	$0.00
447.516	SUP	HCPCS C1713		447.516  -  PLATE BONE 100D CRANFCL TI 2X3 HOLE L LEFT OBLQ MALBLE 2MM	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$247.05	$247.05	$0.00	$0.00	$0.00	$114.43	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$324.73	$324.73	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$85.92	$0.00	$0.00	$87.40	$0.00	$0.00	$0.00	$0.00	$0.00
447.52	SUP	HCPCS C1713		447.52  -  PLATE BN 5MM SPC OB L L 31X15X.9MM NS 4.8MM 3 HL BS 4 HL	BOTH IP/OP	$587.25 	$434.57	$0.00	$469.80	$264.26	$264.26	$0.00	$0.00	$0.00	$122.40	$435.86	$435.86	$0.00	$0.00	$122.38	$0.00	$347.36	$347.36	$0.00	$293.63	$465.10	$469.80	$0.00		$0.00	$91.90	$0.00	$0.00	$93.49	$0.00	$0.00	$0.00	$0.00	$0.00
447.521	SUP	HCPCS C1713		447.521  -  PLATE BONE 100D CRANFCL TI 4X3 HOLE L RIGHT OBLQ NO BAR 2MM	BOTH IP/OP	$481.50 	$356.31	$0.00	$385.20	$216.68	$216.68	$0.00	$0.00	$0.00	$100.36	$357.37	$357.37	$0.00	$0.00	$100.34	$0.00	$284.81	$284.81	$0.00	$240.75	$381.35	$385.20	$0.00		$0.00	$75.35	$0.00	$0.00	$76.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.522	SUP	HCPCS C1713		447.522  -  PLATE BONE 100D CRANFCL TI 4X3 HOLE L LEFT OBLQ NO BAR 2MM	BOTH IP/OP	$481.50 	$356.31	$0.00	$385.20	$216.68	$216.68	$0.00	$0.00	$0.00	$100.36	$357.37	$357.37	$0.00	$0.00	$100.34	$0.00	$284.81	$284.81	$0.00	$240.75	$381.35	$385.20	$0.00		$0.00	$75.35	$0.00	$0.00	$76.65	$0.00	$0.00	$0.00	$0.00	$0.00
447.524	SUP	HCPCS C1713		447.524  -  PLATE BONE 20MM 90D RIGHT CRNMXF TI 2X2 HOLE L 2MM SCR	BOTH IP/OP	$488.25 	$361.31	$0.00	$390.60	$219.71	$219.71	$0.00	$0.00	$0.00	$101.76	$362.38	$362.38	$0.00	$0.00	$101.75	$0.00	$288.80	$288.80	$0.00	$244.13	$386.69	$390.60	$0.00		$0.00	$76.41	$0.00	$0.00	$77.73	$0.00	$0.00	$0.00	$0.00	$0.00
447.525	SUP	HCPCS C1713		447.525  -  PLATE BONE 20MM 90D LEFT CRNMXF TI 2X2 HOLE L 2MM SCR	BOTH IP/OP	$488.25 	$361.31	$0.00	$390.60	$219.71	$219.71	$0.00	$0.00	$0.00	$101.76	$362.38	$362.38	$0.00	$0.00	$101.75	$0.00	$288.80	$288.80	$0.00	$244.13	$386.69	$390.60	$0.00		$0.00	$76.41	$0.00	$0.00	$77.73	$0.00	$0.00	$0.00	$0.00	$0.00
447.527	SUP	HCPCS C1713		447.527  -  PLATE BONE 100D CRANFCL TI 3X4 HOLE L LEFT OBLQ MALBLE 2MM	BOTH IP/OP	$576.00 	$426.24	$0.00	$460.80	$259.20	$259.20	$0.00	$0.00	$0.00	$120.05	$427.51	$427.51	$0.00	$0.00	$120.04	$0.00	$340.70	$340.70	$0.00	$288.00	$456.19	$460.80	$0.00		$0.00	$90.14	$0.00	$0.00	$91.70	$0.00	$0.00	$0.00	$0.00	$0.00
447.53	SUP	HCPCS C1713		447.53  -  PLATE BN 5MM SPC OB R L 31X15X.9MM NS 4.8MM 3 HL BS 4 HL	BOTH IP/OP	$587.25 	$434.57	$0.00	$469.80	$264.26	$264.26	$0.00	$0.00	$0.00	$122.40	$435.86	$435.86	$0.00	$0.00	$122.38	$0.00	$347.36	$347.36	$0.00	$293.63	$465.10	$469.80	$0.00		$0.00	$91.90	$0.00	$0.00	$93.49	$0.00	$0.00	$0.00	$0.00	$0.00
447.537	SUP	HCPCS C1713		447.537  -  PLATE BONE 100D CRANFCL TI 3X4 HOLE L RIGHT OBLQ MALBLE 2MM	BOTH IP/OP	$576.00 	$426.24	$0.00	$460.80	$259.20	$259.20	$0.00	$0.00	$0.00	$120.05	$427.51	$427.51	$0.00	$0.00	$120.04	$0.00	$340.70	$340.70	$0.00	$288.00	$456.19	$460.80	$0.00		$0.00	$90.14	$0.00	$0.00	$91.70	$0.00	$0.00	$0.00	$0.00	$0.00
447.54	SUP	HCPCS C1713		447.54  -  PLATE BN 5MM SPC OB L L 41X20X.9MM NS 4.8MM 4 HL BS 6 HL	BOTH IP/OP	$641.25 	$474.53	$0.00	$513.00	$288.56	$288.56	$0.00	$0.00	$0.00	$133.65	$475.94	$475.94	$0.00	$0.00	$133.64	$0.00	$379.30	$379.30	$0.00	$320.63	$507.87	$513.00	$0.00		$0.00	$100.36	$0.00	$0.00	$102.09	$0.00	$0.00	$0.00	$0.00	$0.00
447.546	SUP	HCPCS C1713		447.546  -  PLATE SHRT MAXFACL 2X2 HOLE L RIGHT OBLQ MALBLE 2MM SCR BONE	BOTH IP/OP	$429.75 	$318.02	$0.00	$343.80	$193.39	$193.39	$0.00	$0.00	$0.00	$89.57	$318.96	$318.96	$0.00	$0.00	$89.56	$0.00	$254.20	$254.20	$0.00	$214.88	$340.36	$343.80	$0.00		$0.00	$67.26	$0.00	$0.00	$68.42	$0.00	$0.00	$0.00	$0.00	$0.00
447.547	SUP	HCPCS C1713		447.547  -  PLATE SHRT MAXFACL 2X2 HOLE L LEFT OBLQ MALBLE 2MM SCR BONE	BOTH IP/OP	$429.75 	$318.02	$0.00	$343.80	$193.39	$193.39	$0.00	$0.00	$0.00	$89.57	$318.96	$318.96	$0.00	$0.00	$89.56	$0.00	$254.20	$254.20	$0.00	$214.88	$340.36	$343.80	$0.00		$0.00	$67.26	$0.00	$0.00	$68.42	$0.00	$0.00	$0.00	$0.00	$0.00
447.548	SUP	HCPCS C1713		447.548  -  PLATE LNG MAXFACL 2X2 HOLE L RIGHT OBLQ MALBLE 2MM SCR BONE	BOTH IP/OP	$486.00 	$359.64	$0.00	$388.80	$218.70	$218.70	$0.00	$0.00	$0.00	$101.29	$360.71	$360.71	$0.00	$0.00	$101.28	$0.00	$287.47	$287.47	$0.00	$243.00	$384.91	$388.80	$0.00		$0.00	$76.06	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$0.00
447.549	SUP	HCPCS C1713		447.549  -  PLATE LNG MAXFACL 2X2 HOLE L LEFT OBLQ MALBLE 2MM SCR BONE	BOTH IP/OP	$486.00 	$359.64	$0.00	$388.80	$218.70	$218.70	$0.00	$0.00	$0.00	$101.29	$360.71	$360.71	$0.00	$0.00	$101.28	$0.00	$287.47	$287.47	$0.00	$243.00	$384.91	$388.80	$0.00		$0.00	$76.06	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$0.00
447.55	SUP	HCPCS C1713		447.55  -  PLATE BN 5MM SPC OB R L 41X20X.9MM NS 4.8MM 4 HL BS 6 HL	BOTH IP/OP	$641.25 	$474.53	$0.00	$513.00	$288.56	$288.56	$0.00	$0.00	$0.00	$133.65	$475.94	$475.94	$0.00	$0.00	$133.64	$0.00	$379.30	$379.30	$0.00	$320.63	$507.87	$513.00	$0.00		$0.00	$100.36	$0.00	$0.00	$102.09	$0.00	$0.00	$0.00	$0.00	$0.00
447.556	SUP	HCPCS C1713		447.556  -  PLATE SHRT TI 2MM SCR L 2X2 HOLE BONE LEFT OBLQ NONSTRL	BOTH IP/OP	$486.00 	$359.64	$0.00	$388.80	$218.70	$218.70	$0.00	$0.00	$0.00	$101.29	$360.71	$360.71	$0.00	$0.00	$101.28	$0.00	$287.47	$287.47	$0.00	$243.00	$384.91	$388.80	$0.00		$0.00	$76.06	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$0.00
447.557	SUP	HCPCS C1713		447.557  -  PLATE SHRT TI 2MM SCR L OBLQ 2X2 HOLE BONE LEFT NONSTRL	BOTH IP/OP	$486.00 	$359.64	$0.00	$388.80	$218.70	$218.70	$0.00	$0.00	$0.00	$101.29	$360.71	$360.71	$0.00	$0.00	$101.28	$0.00	$287.47	$287.47	$0.00	$243.00	$384.91	$388.80	$0.00		$0.00	$76.06	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$0.00
447.558	SUP	HCPCS C1713		447.558  -  PLATE LNG TI 2MM SCR L OBLQ 2X2 HOLE BONE RIGHT NONSTRL	BOTH IP/OP	$486.00 	$359.64	$0.00	$388.80	$218.70	$218.70	$0.00	$0.00	$0.00	$101.29	$360.71	$360.71	$0.00	$0.00	$101.28	$0.00	$287.47	$287.47	$0.00	$243.00	$384.91	$388.80	$0.00		$0.00	$76.06	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$0.00
447.559	SUP	HCPCS C1713		447.559  -  PLATE LNG TI 2MM SCR L OBLQ 2X2 HOLE BONE LEFT NONSTRL	BOTH IP/OP	$486.00 	$359.64	$0.00	$388.80	$218.70	$218.70	$0.00	$0.00	$0.00	$101.29	$360.71	$360.71	$0.00	$0.00	$101.28	$0.00	$287.47	$287.47	$0.00	$243.00	$384.91	$388.80	$0.00		$0.00	$76.06	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$0.00
447.562	SUP	HCPCS C1713		447.562  -  PLATE SHRT TI 2MM SCR Z BONE RIGHT NONSTRL	BOTH IP/OP	$551.25 	$407.93	$0.00	$441.00	$248.06	$248.06	$0.00	$0.00	$0.00	$114.89	$409.14	$409.14	$0.00	$0.00	$114.88	$0.00	$326.06	$326.06	$0.00	$275.63	$436.59	$441.00	$0.00		$0.00	$86.27	$0.00	$0.00	$87.76	$0.00	$0.00	$0.00	$0.00	$0.00
447.563	SUP	HCPCS C1713		447.563  -  PLATE SHRT TI 2MM SCR Z BONE LEFT NONSTRL	BOTH IP/OP	$551.25 	$407.93	$0.00	$441.00	$248.06	$248.06	$0.00	$0.00	$0.00	$114.89	$409.14	$409.14	$0.00	$0.00	$114.88	$0.00	$326.06	$326.06	$0.00	$275.63	$436.59	$441.00	$0.00		$0.00	$86.27	$0.00	$0.00	$87.76	$0.00	$0.00	$0.00	$0.00	$0.00
447.564	SUP	HCPCS C1713		447.564  -  PLATE LNG TI 2MM SCR Z BONE RIGHT NONSTRL	BOTH IP/OP	$551.25 	$407.93	$0.00	$441.00	$248.06	$248.06	$0.00	$0.00	$0.00	$114.89	$409.14	$409.14	$0.00	$0.00	$114.88	$0.00	$326.06	$326.06	$0.00	$275.63	$436.59	$441.00	$0.00		$0.00	$86.27	$0.00	$0.00	$87.76	$0.00	$0.00	$0.00	$0.00	$0.00
447.565	SUP	HCPCS C1713		447.565  -  PLATE LNG TI 2MM SCR Z BONE LEFT NONSTRL	BOTH IP/OP	$551.25 	$407.93	$0.00	$441.00	$248.06	$248.06	$0.00	$0.00	$0.00	$114.89	$409.14	$409.14	$0.00	$0.00	$114.88	$0.00	$326.06	$326.06	$0.00	$275.63	$436.59	$441.00	$0.00		$0.00	$86.27	$0.00	$0.00	$87.76	$0.00	$0.00	$0.00	$0.00	$0.00
447.572	SUP	HCPCS C1713		447.572  -  PLATE SHRT RIGHT MAXFACL Z MALBLE 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$551.25 	$407.93	$0.00	$441.00	$248.06	$248.06	$0.00	$0.00	$0.00	$114.89	$409.14	$409.14	$0.00	$0.00	$114.88	$0.00	$326.06	$326.06	$0.00	$275.63	$436.59	$441.00	$0.00		$0.00	$86.27	$0.00	$0.00	$87.76	$0.00	$0.00	$0.00	$0.00	$0.00
447.573	SUP	HCPCS C1713		447.573  -  PLATE SHRT LEFT MAXFACL Z MALBLE 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$551.25 	$407.93	$0.00	$441.00	$248.06	$248.06	$0.00	$0.00	$0.00	$114.89	$409.14	$409.14	$0.00	$0.00	$114.88	$0.00	$326.06	$326.06	$0.00	$275.63	$436.59	$441.00	$0.00		$0.00	$86.27	$0.00	$0.00	$87.76	$0.00	$0.00	$0.00	$0.00	$0.00
447.574	SUP	HCPCS C1713		447.574  -  PLATE LNG RIGHT MAXFACL Z MALBLE 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$551.25 	$407.93	$0.00	$441.00	$248.06	$248.06	$0.00	$0.00	$0.00	$114.89	$409.14	$409.14	$0.00	$0.00	$114.88	$0.00	$326.06	$326.06	$0.00	$275.63	$436.59	$441.00	$0.00		$0.00	$86.27	$0.00	$0.00	$87.76	$0.00	$0.00	$0.00	$0.00	$0.00
447.575	SUP	HCPCS C1713		447.575  -  PLATE LNG LEFT MAXFACL Z MALBLE 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$551.25 	$407.93	$0.00	$441.00	$248.06	$248.06	$0.00	$0.00	$0.00	$114.89	$409.14	$409.14	$0.00	$0.00	$114.88	$0.00	$326.06	$326.06	$0.00	$275.63	$436.59	$441.00	$0.00		$0.00	$86.27	$0.00	$0.00	$87.76	$0.00	$0.00	$0.00	$0.00	$0.00
447.61	SUP	HCPCS C1713		447.61  -  PLATE BONE CRNMXF TI 5 HOLE Y 2 MM SCR NONSTRL	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$255.15	$255.15	$0.00	$0.00	$0.00	$118.18	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$335.38	$335.38	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$88.74	$0.00	$0.00	$90.27	$0.00	$0.00	$0.00	$0.00	$0.00
447.612	SUP	HCPCS C1713		447.612  -  PLATE BN Y 48X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$483.55 	$357.83	$0.00	$375.58	$211.26	$211.26	$0.00	$0.00	$0.00	$100.78	$358.89	$358.89	$0.00	$0.00	$100.77	$0.00	$286.02	$286.02	$0.00	$234.74	$371.83	$375.58	$0.00		$0.00	$71.33	$0.00	$0.00	$74.74	$0.00	$0.00	$0.00	$0.00	$0.00
447.615	SUP	HCPCS C1713		447.615  -  PLATE BONE 3 HOLE HEAD 7 HOLE SHAFT T LCP TITANIUM	BOTH IP/OP	$812.50 	$601.25	$0.00	$631.06	$354.97	$354.97	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$394.41	$624.75	$631.06	$0.00		$0.00	$119.86	$0.00	$0.00	$125.58	$0.00	$0.00	$0.00	$0.00	$0.00
447.62	SUP	HCPCS C1713		447.62  -  PLATE BN Y 32X19X.9MM NS 4.8MM 2 HLE/HD 4 HL SHFT 2 ARM TI	BOTH IP/OP	$580.50 	$429.57	$0.00	$464.40	$261.23	$261.23	$0.00	$0.00	$0.00	$120.99	$430.85	$430.85	$0.00	$0.00	$120.98	$0.00	$343.37	$343.37	$0.00	$290.25	$459.76	$464.40	$0.00		$0.00	$90.85	$0.00	$0.00	$92.42	$0.00	$0.00	$0.00	$0.00	$0.00
447.63	SUP	HCPCS C1713		447.630  -  PLATE BONE CRANFCL TI 7 HOLE Y 2 MM SCR NONSTRL	BOTH IP/OP	$490.50 	$362.97	$0.00	$392.40	$220.73	$220.73	$0.00	$0.00	$0.00	$102.23	$364.05	$364.05	$0.00	$0.00	$102.22	$0.00	$290.13	$290.13	$0.00	$245.25	$388.48	$392.40	$0.00		$0.00	$76.76	$0.00	$0.00	$78.09	$0.00	$0.00	$0.00	$0.00	$0.00
447.68	SUP	HCPCS C1713		447.68  -  PLATE BONE CRANFCL TI 8 HOLE 2 Y 2 MM SCR NONSTRL	BOTH IP/OP	$600.75 	$444.56	$0.00	$480.60	$270.34	$270.34	$0.00	$0.00	$0.00	$125.21	$445.88	$445.88	$0.00	$0.00	$125.20	$0.00	$355.34	$355.34	$0.00	$300.38	$475.79	$480.60	$0.00		$0.00	$94.02	$0.00	$0.00	$95.64	$0.00	$0.00	$0.00	$0.00	$0.00
447.681	SUP	HCPCS C1713		447.681  -  PLATE TI 2 MM SCR 8 HOLE Y BONE NONSTRL	BOTH IP/OP	$600.75 	$444.56	$0.00	$480.60	$270.34	$270.34	$0.00	$0.00	$0.00	$125.21	$445.88	$445.88	$0.00	$0.00	$125.20	$0.00	$355.34	$355.34	$0.00	$300.38	$475.79	$480.60	$0.00		$0.00	$94.02	$0.00	$0.00	$95.64	$0.00	$0.00	$0.00	$0.00	$0.00
447.702	SUP	HCPCS C1713		447.702  -  PLATE BONE SMALL 24X18MM X LOCKING TITANIUM FT NONSTRL	BOTH IP/OP	"$1,439.43 "	"$1,065.18"	$0.00	"$1,118.00"	$628.88	$628.88	$0.00	$0.00	$0.00	$300.01	"$1,068.34"	"$1,068.34"	$0.00	$0.00	$299.98	$0.00	$851.42	$851.42	$0.00	$698.75	"$1,106.82"	"$1,118.00"	$0.00		$0.00	$212.34	$0.00	$0.00	$222.48	$0.00	$0.00	$0.00	$0.00	$0.00
447.704	SUP	HCPCS C1713		447.704  -  PLATE BONE MEDIUM 30X20MM X LOCKING TITANIUM FT NONSTRL	BOTH IP/OP	"$1,457.70 "	"$1,078.70"	$0.00	"$1,132.20"	$636.86	$636.86	$0.00	$0.00	$0.00	$303.82	"$1,081.90"	"$1,081.90"	$0.00	$0.00	$303.78	$0.00	$862.23	$862.23	$0.00	$707.63	"$1,120.88"	"$1,132.20"	$0.00		$0.00	$215.03	$0.00	$0.00	$225.31	$0.00	$0.00	$0.00	$0.00	$0.00
447.706	SUP	HCPCS C1713		447.706  -  PLATE BONE LARGE 36X20MM X LOCKING TITANIUM FT NONSTRL	BOTH IP/OP	"$1,477.38 "	"$1,093.26"	$0.00	"$1,147.48"	$645.46	$645.46	$0.00	$0.00	$0.00	$307.92	"$1,096.51"	"$1,096.51"	$0.00	$0.00	$307.88	$0.00	$873.87	$873.87	$0.00	$717.18	"$1,136.01"	"$1,147.48"	$0.00		$0.00	$217.94	$0.00	$0.00	$228.35	$0.00	$0.00	$0.00	$0.00	$0.00
447.71	SUP	HCPCS C1713		447.710  -  PLATE BN STRG 17X6X1.6MM NS 2 HL LCK RND THRD HL TI HND/MDFT	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$306.45	$306.45	$0.00	$0.00	$0.00	$141.94	$505.44	$505.44	$0.00	$0.00	$141.92	$0.00	$402.81	$402.81	$0.00	$340.50	$539.35	$544.80	$0.00		$0.00	$103.47	$0.00	$0.00	$108.42	$0.00	$0.00	$0.00	$0.00	$0.00
447.711	SUP	HCPCS C1713		447.711  -  PLATE BONE XS 22X14MM X LOCKING TITANIUM NONSTRL 2.4/2.7MM	BOTH IP/OP	"$1,460.53 "	"$1,080.79"	$0.00	"$1,134.38"	$638.09	$638.09	$0.00	$0.00	$0.00	$304.41	"$1,084.00"	"$1,084.00"	$0.00	$0.00	$304.37	$0.00	$863.90	$863.90	$0.00	$708.99	"$1,123.04"	"$1,134.38"	$0.00		$0.00	$215.45	$0.00	$0.00	$225.74	$0.00	$0.00	$0.00	$0.00	$0.00
447.81	SUP	HCPCS C1713		447.81  -  PLATE BN 13MM SPC X 18X18X.9MM NS 4.8MM 4 HL TI CRNFCL 2MM	BOTH IP/OP	$528.75 	$391.28	$0.00	$423.00	$237.94	$237.94	$0.00	$0.00	$0.00	$110.20	$392.44	$392.44	$0.00	$0.00	$110.19	$0.00	$312.76	$312.76	$0.00	$264.38	$418.77	$423.00	$0.00		$0.00	$82.75	$0.00	$0.00	$84.18	$0.00	$0.00	$0.00	$0.00	$0.00
447.811	SUP	HCPCS C1713		447.811  -  PLATE BONE CRANFCL TI 4 HOLE X MALBLE 2 MM SCR NONSTRL	BOTH IP/OP	$432.00 	$319.68	$0.00	$345.60	$194.40	$194.40	$0.00	$0.00	$0.00	$90.04	$320.63	$320.63	$0.00	$0.00	$90.03	$0.00	$255.53	$255.53	$0.00	$216.00	$342.14	$345.60	$0.00		$0.00	$67.61	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
447.85	SUP	HCPCS C1713		447.85  -  PLATE BONE CRANFCL TI 9 HOLE H 2 MM SCR NONSTRL	BOTH IP/OP	$594.00 	$439.56	$0.00	$475.20	$267.30	$267.30	$0.00	$0.00	$0.00	$123.80	$440.87	$440.87	$0.00	$0.00	$123.79	$0.00	$351.35	$351.35	$0.00	$297.00	$470.45	$475.20	$0.00		$0.00	$92.96	$0.00	$0.00	$94.56	$0.00	$0.00	$0.00	$0.00	$0.00
447.86	SUP	HCPCS C1713		447.86  -  PLATE BONE CRANFCL TI 8 HOLE H 2 MM SCR NONSTRL	BOTH IP/OP	$594.00 	$439.56	$0.00	$475.20	$267.30	$267.30	$0.00	$0.00	$0.00	$123.80	$440.87	$440.87	$0.00	$0.00	$123.79	$0.00	$351.35	$351.35	$0.00	$297.00	$470.45	$475.20	$0.00		$0.00	$92.96	$0.00	$0.00	$94.56	$0.00	$0.00	$0.00	$0.00	$0.00
447.915	SUP	HCPCS C1713		447.915  -  PLATE BONE 13X13MM CRANFCL TI 4 HOLE BOX 2MM SCR NONSTRL	BOTH IP/OP	$474.75 	$351.32	$0.00	$379.80	$213.64	$213.64	$0.00	$0.00	$0.00	$98.95	$352.36	$352.36	$0.00	$0.00	$98.94	$0.00	$280.81	$280.81	$0.00	$237.38	$376.00	$379.80	$0.00		$0.00	$74.30	$0.00	$0.00	$75.58	$0.00	$0.00	$0.00	$0.00	$0.00
449.004	SUP	HCPCS C1713		449.004  -  PLATE BN NAR STRG 29X4.8X1MM NS 4 HL LOPRFL TI MNDB 2MM SCR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.006	SUP	HCPCS C1713		449.006  -  PLATE BN NAR STRG 42X4.8X1MM NS 6 HL LOPRFL TI MNDB 2MM SCR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.008	SUP	HCPCS C1713		449.008  -  PLATE NAR 55MM MANDIB 8 HOLE STR 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.014	SUP	HCPCS C1713		449.014  -  PLATE BN CRV NAR 29X4.8X1MM NS 4 HL LOPRFL TI MNDB 2MM SCR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.016	SUP	HCPCS C1713		449.016  -  PLATE BN CRV NAR 41X4.8X1MM NS 6 HL LOPRFL TI MNDB 2MM SCR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.017	SUP	HCPCS C1713		449.017  -  PLATE NAR MANDIB 6 HOLE STRUT 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.018	SUP	HCPCS C1713		449.018  -  PLATE MANDIB 8 HOLE CVD STRUT 2 MM SCR BONE TI NONSTRL	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
449.02	SUP	HCPCS C1713		449.020  -  PLATE 119MM MANDIB 20 HOLE ADP 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.021	SUP	HCPCS C1713		449.021  -  PLATE BONE 100MM CRANFCL TI 2X20 HOLE 2 ADP 2MM SCR BILAT	BOTH IP/OP	"$1,496.25 "	"$1,107.23"	$0.00	"$1,197.00"	$673.31	$673.31	$0.00	$0.00	$0.00	$311.86	"$1,110.52"	"$1,110.52"	$0.00	$0.00	$311.82	$0.00	$885.03	$885.03	$0.00	$748.13	"$1,185.03"	"$1,197.00"	$0.00		$0.00	$234.16	$0.00	$0.00	$238.20	$0.00	$0.00	$0.00	$0.00	$0.00
449.024	SUP	HCPCS C1713		449.024  -  PLATE BN BRD STRG 29X4.8X1.25MM NS 4 HL LOPRFL TI MNDB 2MM	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.025	SUP	HCPCS C1713		449.025  -  PLATE BN BRD CRV 29X4.8X1.25MM NS 4 HL LOPRFL TI MNDB 2MM	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.026	SUP	HCPCS C1713		449.026  -  PLATE BN BRD STRG 42X4.8X1.25MM NS 6 HL LOPRFL TI MNDB 2MM	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.027	SUP	HCPCS C1713		449.027  -  PLATE BN BRD CRV 41X4.8X1.25MM NS 6 HL LOPRFL TI MNDB 2MM	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.028	SUP	HCPCS C1713		449.028  -  PLATE BN BRD STRG 55X4.8X1.25MM NS 8 HL LOPRFL TI MNDB 2MM	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.032	SUP	HCPCS C1713		449.032  -  PLATE 21MM MANDIB 4X4 HOLE ANG 2MM SCR BONE DCP TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.034	SUP	HCPCS C1713		449.034  -  PLATE BN 30X5X1.25MM NS DCP 4 HL LOPRFL TI MNDB 2MM SCR MDLR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.035	SUP	HCPCS C1713		449.035  -  PLATE BN 32X5X1.25MM NS DCP 5 HL LOPRFL TI MNDB 2MM SCR MDLR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.036	SUP	HCPCS C1713		449.036  -  PLATE BN 42X5X1.25MM NS DCP 6 HL LOPRFL TI MNDB 2MM SCR MDLR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.037	SUP	HCPCS C1713		449.037  -  PLATE 48MM MANDIB 7 HOLE 2MM SCR BONE DCP TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.038	SUP	HCPCS C1713		449.038  -  PLATE 54MM MANDIB 8 HOLE 2MM SCR BONE DCP TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.04	SUP	HCPCS C1713		449.04  -  PLATE 22MM MANDIB 4 HOLE STR TNSNBND 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$857.25 	$634.37	$0.00	$685.80	$385.76	$385.76	$0.00	$0.00	$0.00	$178.67	$636.25	$636.25	$0.00	$0.00	$178.65	$0.00	$507.06	$507.06	$0.00	$428.63	$678.94	$685.80	$0.00		$0.00	$134.16	$0.00	$0.00	$136.47	$0.00	$0.00	$0.00	$0.00	$0.00
449.05	SUP	HCPCS C1713		449.05  -  PLATE 25MM MANDIB 4 HOLE STR TNSNBND 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.06	SUP	HCPCS C1713		449.06  -  PLATE 35MM MANDIB 6 HOLE STR TNSNBND 2MM SCR BONE TI NONSTRL	BOTH IP/OP	$954.00 	$705.96	$0.00	$763.20	$429.30	$429.30	$0.00	$0.00	$0.00	$198.84	$708.06	$708.06	$0.00	$0.00	$198.81	$0.00	$564.29	$564.29	$0.00	$477.00	$755.57	$763.20	$0.00		$0.00	$149.30	$0.00	$0.00	$151.88	$0.00	$0.00	$0.00	$0.00	$0.00
449.1	SUP	HCPCS C1713		449.100  -  PLATE 26MM MANDIB 4 HOLE CMPR TNSNBND 2.4MM SCR BONE LC DCP	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.11	SUP	HCPCS C1713		449.110  -  PLATE 36MM MANDIB 6 HOLE CMPR TNSNBND 2.4MM SCR BONE LC DCP	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.14	SUP	HCPCS C1713		449.14  -  PLATE BN 35X6.5X1.65MM NS LC DCP 4 HL TI MNDB 2.4MM SCR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.15	SUP	HCPCS C1713		449.15  -  PLATE BN 39X6.5X1.65MM NS LC DCP 5 HL TI MNDB 2.4MM SCR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.16	SUP	HCPCS C1713		449.16  -  PLATE BN 51X6.5X1.65MM NS LC DCP 6 HL TI MNDB 2.4MM SCR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.234	SUP	HCPCS C1713		449.234  -  PLATE 35MM MANDIB 4 HOLE ECNTRC 2.4MM SCR BONE LC DCP TI	BOTH IP/OP	"$1,359.00 "	"$1,005.66"	$0.00	"$1,087.20"	$611.55	$611.55	$0.00	$0.00	$0.00	$283.25	"$1,008.65"	"$1,008.65"	$0.00	$0.00	$283.22	$0.00	$803.85	$803.85	$0.00	$679.50	"$1,076.33"	"$1,087.20"	$0.00		$0.00	$212.68	$0.00	$0.00	$216.35	$0.00	$0.00	$0.00	$0.00	$0.00
449.236	SUP	HCPCS C1713		449.236  -  PLATE 6 HOLE ECNTRC 2.4 MM SCR BONE LC DCP TI NONSTRL	BOTH IP/OP	"$1,638.00 "	"$1,212.12"	$0.00	"$1,310.40"	$737.10	$737.10	$0.00	$0.00	$0.00	$341.40	"$1,215.72"	"$1,215.72"	$0.00	$0.00	$341.36	$0.00	$968.88	$968.88	$0.00	$819.00	"$1,297.30"	"$1,310.40"	$0.00		$0.00	$256.35	$0.00	$0.00	$260.77	$0.00	$0.00	$0.00	$0.00	$0.00
449.24	SUP	HCPCS C1713		449.24  -  PLATE 35X6.5X2MM MANDIB 4 HOLE CRSNT 2.4MM SCR BONE LC DCP	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.25	SUP	HCPCS C1713		449.250  -  PLATE 38MM MANDIB 5 HOLE CRSNT 2.4MM SCR BONE LC DCP TI	BOTH IP/OP	"$1,458.00 "	"$1,078.92"	$0.00	"$1,166.40"	$656.10	$656.10	$0.00	$0.00	$0.00	$303.88	"$1,082.13"	"$1,082.13"	$0.00	$0.00	$303.85	$0.00	$862.41	$862.41	$0.00	$729.00	"$1,154.74"	"$1,166.40"	$0.00		$0.00	$228.18	$0.00	$0.00	$232.11	$0.00	$0.00	$0.00	$0.00	$0.00
449.26	SUP	HCPCS C1713		449.26  -  PLATE 50MM TI 2.4MM SCR 6 HOLE CRSNT LC DCP BONE MANDIB	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.38	SUP	HCPCS C1713		449.38  -  PLATE UNV 64MM MANDIB 8 HOLE 2.4MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.4	SUP	HCPCS C1713		449.40  -  PLATE UNV 80MM MANDIB 10 HOLE STR 2.4MM SCR BONE TI NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.412	SUP	HCPCS C1713		449.412  -  PLATE MAXFACL 12 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$759.38	$759.38	$0.00	$0.00	$0.00	$351.72	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$998.16	$998.16	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$264.09	$0.00	$0.00	$268.65	$0.00	$0.00	$0.00	$0.00	$0.00
449.416	SUP	HCPCS C1713		449.416  -  PLATE MAXFACL 16 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL	BOTH IP/OP	"$2,310.75 "	"$1,709.96"	$0.00	"$1,848.60"	"$1,039.84"	"$1,039.84"	$0.00	$0.00	$0.00	$481.62	"$1,715.04"	"$1,715.04"	$0.00	$0.00	$481.56	$0.00	"$1,366.81"	"$1,366.81"	$0.00	"$1,155.38"	"$1,830.11"	"$1,848.60"	$0.00		$0.00	$361.63	$0.00	$0.00	$367.87	$0.00	$0.00	$0.00	$0.00	$0.00
449.418	SUP	HCPCS C1713		449.418  -  PLATE MAXFACL 18 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL	BOTH IP/OP	"$2,623.50 "	"$1,941.39"	$0.00	"$2,098.80"	"$1,180.58"	"$1,180.58"	$0.00	$0.00	$0.00	$546.80	"$1,947.16"	"$1,947.16"	$0.00	$0.00	$546.74	$0.00	"$1,293.39"	"$1,293.39"	$0.00	"$1,311.75"	"$2,077.81"	"$2,098.80"	$0.00		$0.00	$410.58	$0.00	$0.00	$417.66	$0.00	$0.00	$0.00	$0.00	$0.00
449.42	SUP	HCPCS C1713		449.420  -  PLATE MAXFACL 20 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL	BOTH IP/OP	"$2,938.50 "	"$2,174.49"	$0.00	"$2,350.80"	"$1,322.33"	"$1,322.33"	$0.00	$0.00	$0.00	$612.46	"$2,180.95"	"$2,180.95"	$0.00	$0.00	$612.38	$0.00	"$1,448.68"	"$1,448.68"	$0.00	"$1,469.25"	"$2,327.29"	"$2,350.80"	$0.00		$0.00	$459.88	$0.00	$0.00	$467.81	$0.00	$0.00	$0.00	$0.00	$0.00
449.422	SUP	HCPCS C1713		449.422  -  PLATE MAXFACL 22 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL	BOTH IP/OP	"$2,938.50 "	"$2,174.49"	$0.00	"$2,350.80"	"$1,322.33"	"$1,322.33"	$0.00	$0.00	$0.00	$612.46	"$2,180.95"	"$2,180.95"	$0.00	$0.00	$612.38	$0.00	"$1,448.68"	"$1,448.68"	$0.00	"$1,469.25"	"$2,327.29"	"$2,350.80"	$0.00		$0.00	$459.88	$0.00	$0.00	$467.81	$0.00	$0.00	$0.00	$0.00	$0.00
449.424	SUP	HCPCS C1713		449.424  -  PLATE MAXFACL 24 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL	BOTH IP/OP	"$2,938.50 "	"$2,174.49"	$0.00	"$2,350.80"	"$1,322.33"	"$1,322.33"	$0.00	$0.00	$0.00	$612.46	"$2,180.95"	"$2,180.95"	$0.00	$0.00	$612.38	$0.00	"$1,448.68"	"$1,448.68"	$0.00	"$1,469.25"	"$2,327.29"	"$2,350.80"	$0.00		$0.00	$459.88	$0.00	$0.00	$467.81	$0.00	$0.00	$0.00	$0.00	$0.00
449.44	SUP	HCPCS C1713		449.440  -  PLATE MAXFACL 4X8 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$2,938.50 "	"$2,174.49"	$0.00	"$2,350.80"	"$1,322.33"	"$1,322.33"	$0.00	$0.00	$0.00	$612.46	"$2,180.95"	"$2,180.95"	$0.00	$0.00	$612.38	$0.00	"$1,448.68"	"$1,448.68"	$0.00	"$1,469.25"	"$2,327.29"	"$2,350.80"	$0.00		$0.00	$459.88	$0.00	$0.00	$467.81	$0.00	$0.00	$0.00	$0.00	$0.00
449.441	SUP	HCPCS C1713		449.441  -  PLATE MAXFACL 4X8 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$2,938.50 "	"$2,174.49"	$0.00	"$2,350.80"	"$1,322.33"	"$1,322.33"	$0.00	$0.00	$0.00	$612.46	"$2,180.95"	"$2,180.95"	$0.00	$0.00	$612.38	$0.00	"$1,448.68"	"$1,448.68"	$0.00	"$1,469.25"	"$2,327.29"	"$2,350.80"	$0.00		$0.00	$459.88	$0.00	$0.00	$467.81	$0.00	$0.00	$0.00	$0.00	$0.00
449.442	SUP	HCPCS C1713		449.442  -  PLATE MAXFACL 4X16 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$3,343.50 "	"$2,474.19"	$0.00	"$2,674.80"	"$1,504.58"	"$1,504.58"	$0.00	$0.00	$0.00	$696.87	"$2,481.55"	"$2,481.55"	$0.00	$0.00	$696.79	$0.00	"$1,648.35"	"$1,648.35"	$0.00	"$1,671.75"	"$2,648.05"	"$2,674.80"	$0.00		$0.00	$523.26	$0.00	$0.00	$532.29	$0.00	$0.00	$0.00	$0.00	$0.00
449.443	SUP	HCPCS C1713		449.443  -  PLATE MAXFACL 4X16 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$3,343.50 "	"$2,474.19"	$0.00	"$2,674.80"	"$1,504.58"	"$1,504.58"	$0.00	$0.00	$0.00	$696.87	"$2,481.55"	"$2,481.55"	$0.00	$0.00	$696.79	$0.00	"$1,648.35"	"$1,648.35"	$0.00	"$1,671.75"	"$2,648.05"	"$2,674.80"	$0.00		$0.00	$523.26	$0.00	$0.00	$532.29	$0.00	$0.00	$0.00	$0.00	$0.00
449.444	SUP	HCPCS C1713		449.444  -  PLATE MAXFACL 5X17 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$3,660.75 "	"$2,708.96"	$0.00	"$2,928.60"	"$1,647.34"	"$1,647.34"	$0.00	$0.00	$0.00	$762.99	"$2,717.01"	"$2,717.01"	$0.00	$0.00	$762.90	$0.00	"$1,804.75"	"$1,804.75"	$0.00	"$1,830.38"	"$2,899.31"	"$2,928.60"	$0.00		$0.00	$572.91	$0.00	$0.00	$582.79	$0.00	$0.00	$0.00	$0.00	$0.00
449.445	SUP	HCPCS C1713		449.445  -  PLATE MAXFACL 5X17 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$3,660.75 "	"$2,708.96"	$0.00	"$2,928.60"	"$1,647.34"	"$1,647.34"	$0.00	$0.00	$0.00	$762.99	"$2,717.01"	"$2,717.01"	$0.00	$0.00	$762.90	$0.00	"$1,804.75"	"$1,804.75"	$0.00	"$1,830.38"	"$2,899.31"	"$2,928.60"	$0.00		$0.00	$572.91	$0.00	$0.00	$582.79	$0.00	$0.00	$0.00	$0.00	$0.00
449.446	SUP	HCPCS C1713		449.446  -  PLATE MAXFACL 6X18 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$4,027.50 "	"$2,980.35"	$0.00	"$3,222.00"	"$1,812.38"	"$1,812.38"	$0.00	$0.00	$0.00	$839.43	"$2,989.21"	"$2,989.21"	$0.00	$0.00	$839.33	$0.00	"$1,985.56"	"$1,985.56"	$0.00	"$2,013.75"	"$3,189.78"	"$3,222.00"	$0.00		$0.00	$630.30	$0.00	$0.00	$641.18	$0.00	$0.00	$0.00	$0.00	$0.00
449.447	SUP	HCPCS C1713		449.447  -  PLATE MAXFACL 6X18 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$4,027.50 "	"$2,980.35"	$0.00	"$3,222.00"	"$1,812.38"	"$1,812.38"	$0.00	$0.00	$0.00	$839.43	"$2,989.21"	"$2,989.21"	$0.00	$0.00	$839.33	$0.00	"$1,985.56"	"$1,985.56"	$0.00	"$2,013.75"	"$3,189.78"	"$3,222.00"	$0.00		$0.00	$630.30	$0.00	$0.00	$641.18	$0.00	$0.00	$0.00	$0.00	$0.00
449.448	SUP	HCPCS C1713		449.448  -  PLATE MAXFACL 6X21 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$4,401.00 "	"$3,256.74"	$0.00	"$3,520.80"	"$1,980.45"	"$1,980.45"	$0.00	$0.00	$0.00	$917.28	"$3,266.42"	"$3,266.42"	$0.00	$0.00	$917.17	$0.00	"$2,169.69"	"$2,169.69"	$0.00	"$2,200.50"	"$3,485.59"	"$3,520.80"	$0.00		$0.00	$688.76	$0.00	$0.00	$700.64	$0.00	$0.00	$0.00	$0.00	$0.00
449.449	SUP	HCPCS C1713		449.449  -  PLATE MAXFACL 6X21 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$4,401.00 "	"$3,256.74"	$0.00	"$3,520.80"	"$1,980.45"	"$1,980.45"	$0.00	$0.00	$0.00	$917.28	"$3,266.42"	"$3,266.42"	$0.00	$0.00	$917.17	$0.00	"$2,169.69"	"$2,169.69"	$0.00	"$2,200.50"	"$3,485.59"	"$3,520.80"	$0.00		$0.00	$688.76	$0.00	$0.00	$700.64	$0.00	$0.00	$0.00	$0.00	$0.00
449.45	SUP	HCPCS C1713		449.450  -  PLATE MAXFACL 4X20X4 HOLE 2 ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$7,537.50 "	"$5,577.75"	$0.00	"$6,030.00"	"$3,391.88"	"$3,391.88"	$0.00	$0.00	$0.00	"$1,571.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,570.82"	$0.00	"$3,715.99"	"$3,715.99"	$0.00	"$3,768.75"	"$5,969.70"	"$6,030.00"	$0.00		$0.00	"$1,179.62"	$0.00	$0.00	"$1,199.97"	$0.00	$0.00	$0.00	$0.00	$0.00
449.451	SUP	HCPCS C1713		449.451  -  PLATE MAXFACL 5X22X5 HOLE 2 ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$7,850.25 "	"$5,809.19"	$0.00	"$6,280.20"	"$3,532.61"	"$3,532.61"	$0.00	$0.00	$0.00	"$1,636.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,635.99"	$0.00	"$3,870.17"	"$3,870.17"	$0.00	"$3,925.13"	"$6,217.40"	"$6,280.20"	$0.00		$0.00	"$1,228.56"	$0.00	$0.00	"$1,249.76"	$0.00	$0.00	$0.00	$0.00	$0.00
449.452	SUP	HCPCS C1713		449.452  -  PLATE MAXFACL 6X24X6 HOLE 2 ANG MCVSC 2.4 MM SCR BONE TI	BOTH IP/OP	"$9,411.75 "	"$6,964.70"	$0.00	"$7,529.40"	"$4,235.29"	"$4,235.29"	$0.00	$0.00	$0.00	"$1,961.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.41"	$0.00	"$4,639.99"	"$4,639.99"	$0.00	"$4,705.88"	"$7,454.11"	"$7,529.40"	$0.00		$0.00	"$1,472.94"	$0.00	$0.00	"$1,498.35"	$0.00	$0.00	$0.00	$0.00	$0.00
449.612	SUP	HCPCS C1713		449.612  -  PLATE 96MM MANDIB 12 HOLE LCK STR RECON 2.4/3MM SCR BONE TI	BOTH IP/OP	"$2,301.75 "	"$1,703.30"	$0.00	"$1,841.40"	"$1,035.79"	"$1,035.79"	$0.00	$0.00	$0.00	$479.74	"$1,708.36"	"$1,708.36"	$0.00	$0.00	$479.68	$0.00	"$1,361.49"	"$1,361.49"	$0.00	"$1,150.88"	"$1,822.99"	"$1,841.40"	$0.00		$0.00	$360.22	$0.00	$0.00	$366.44	$0.00	$0.00	$0.00	$0.00	$0.00
449.615	SUP	HCPCS C1713		449.615  -  PLATE BONE 3 HOLE HEAD 7 HOLE SHAFT T LCP TITANIUM	BOTH IP/OP	"$1,350.88 "	$999.65	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$281.56	"$1,002.62"	"$1,002.62"	$0.00	$0.00	$281.52	$0.00	$799.04	$799.04	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
449.62	SUP	HCPCS C1713		449.62  -  PLATE 95MM MANDIB 12 HOLE STR LCK RECON 2.4MM SCR BONE TI	BOTH IP/OP	"$2,220.75 "	"$1,643.36"	$0.00	"$1,776.60"	$999.34	$999.34	$0.00	$0.00	$0.00	$462.86	"$1,648.24"	"$1,648.24"	$0.00	$0.00	$462.80	$0.00	"$1,313.57"	"$1,313.57"	$0.00	"$1,110.38"	"$1,758.83"	"$1,776.60"	$0.00		$0.00	$347.55	$0.00	$0.00	$353.54	$0.00	$0.00	$0.00	$0.00	$0.00
449.621	SUP	HCPCS C1713		449.621  -  PLATE BN STRG 160X8X2.5MM NS 20 HL LCK RECON TI MNDB 2.4/3MM	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.632	SUP	HCPCS C1713		449.632  -  PLATE 214MM MANDIB 6X23 HOLE LEFT ANG LCK RECON 2.4MM SCR	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.633	SUP	HCPCS C1713		449.633  -  PLATE BN ANG 214X44X2.4MM NS 44MM 6 HLE/HD 23 HL SHFT LOPRFL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.636	SUP	HCPCS C1713		449.636  -  PLATE MANDIB 4X20X4 HOLE LCK 2 ANG RECON 2.4/3 MM SCR BONE	BOTH IP/OP	"$5,553.00 "	"$4,109.22"	$0.00	"$4,442.40"	"$2,498.85"	"$2,498.85"	$0.00	$0.00	$0.00	"$1,157.38"	"$4,121.44"	"$4,121.44"	$0.00	$0.00	"$1,157.25"	$0.00	"$2,737.63"	"$2,737.63"	$0.00	"$2,776.50"	"$4,397.98"	"$4,442.40"	$0.00		$0.00	$869.04	$0.00	$0.00	$884.04	$0.00	$0.00	$0.00	$0.00	$0.00
449.637	SUP	HCPCS C1713		449.637  -  PLATE MANDIB 5X22X5 HOLE LCK 2 ANG RECON 2.4/3 MM SCR BONE	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.638	SUP	HCPCS C1713		449.638  -  PLATE MANDIB 6X24X6 HOLE LCK 2 ANG RECON 2.4/3 MM SCR BONE	BOTH IP/OP	"$6,187.50 "	"$4,578.75"	$0.00	"$4,950.00"	"$2,784.38"	"$2,784.38"	$0.00	$0.00	$0.00	"$1,289.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,289.48"	$0.00	"$3,050.44"	"$3,050.44"	$0.00	"$3,093.75"	"$4,900.50"	"$4,950.00"	$0.00		$0.00	$968.34	$0.00	$0.00	$985.05	$0.00	$0.00	$0.00	$0.00	$0.00
449.644	SUP	HCPCS C1713		449.644  -  PLATE RIGHT CNDYLR HEAD MANDIB 3X16 HOLE LCK RECON 2.4 MM	BOTH IP/OP	"$9,706.50 "	"$7,182.81"	$0.00	"$7,765.20"	"$4,367.93"	"$4,367.93"	$0.00	$0.00	$0.00	"$2,023.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,022.83"	$0.00	"$4,785.30"	"$4,785.30"	$0.00	"$4,853.25"	"$7,687.55"	"$7,765.20"	$0.00		$0.00	"$1,519.07"	$0.00	$0.00	"$1,545.27"	$0.00	$0.00	$0.00	$0.00	$0.00
449.645	SUP	HCPCS C1713		449.645  -  PLATE LEFT CNDYLR HEAD MANDIB 3X16 HOLE LCK RECON 2.4 MM SCR	BOTH IP/OP	"$9,706.50 "	"$7,182.81"	$0.00	"$7,765.20"	"$4,367.93"	"$4,367.93"	$0.00	$0.00	$0.00	"$2,023.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,022.83"	$0.00	"$4,785.30"	"$4,785.30"	$0.00	"$4,853.25"	"$7,687.55"	"$7,765.20"	$0.00		$0.00	"$1,519.07"	$0.00	$0.00	"$1,545.27"	$0.00	$0.00	$0.00	$0.00	$0.00
449.646	SUP	HCPCS C1713		449.646  -  PLATE RIGHT CNDYLR HEAD MANDIB 4X18 HOLE LCK RECON 2.4 MM	BOTH IP/OP	"$10,248.75 "	"$7,584.08"	$0.00	"$8,199.00"	"$4,611.94"	"$4,611.94"	$0.00	$0.00	$0.00	"$2,136.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,135.84"	$0.00	"$5,052.63"	"$5,052.63"	$0.00	"$5,124.38"	"$8,117.01"	"$8,199.00"	$0.00		$0.00	"$1,603.93"	$0.00	$0.00	"$1,631.60"	$0.00	$0.00	$0.00	$0.00	$0.00
449.647	SUP	HCPCS C1713		449.647  -  PLATE LEFT CNDYLR HEAD MANDIB 4X18 HOLE LCK RECON 2.4 MM SCR	BOTH IP/OP	"$10,248.75 "	"$7,584.08"	$0.00	"$8,199.00"	"$4,611.94"	"$4,611.94"	$0.00	$0.00	$0.00	"$2,136.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,135.84"	$0.00	"$5,052.63"	"$5,052.63"	$0.00	"$5,124.38"	"$8,117.01"	"$8,199.00"	$0.00		$0.00	"$1,603.93"	$0.00	$0.00	"$1,631.60"	$0.00	$0.00	$0.00	$0.00	$0.00
449.648	SUP	HCPCS C1713		449.648  -  PLATE TI 2.4 MM SCR 5X20 HOLE LCK RECON LCP BONE RIGHT	BOTH IP/OP	"$10,782.00 "	"$7,978.68"	$0.00	"$8,625.60"	"$4,851.90"	"$4,851.90"	$0.00	$0.00	$0.00	"$2,247.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,246.97"	$0.00	"$5,315.53"	"$5,315.53"	$0.00	"$5,391.00"	"$8,539.34"	"$8,625.60"	$0.00		$0.00	"$1,687.38"	$0.00	$0.00	"$1,716.49"	$0.00	$0.00	$0.00	$0.00	$0.00
449.649	SUP	HCPCS C1713		449.649  -  PLATE LEFT CNDYLR HEAD MANDIB 5X20 HOLE LCK RECON 2.4 MM SCR	BOTH IP/OP	"$10,782.00 "	"$7,978.68"	$0.00	"$8,625.60"	"$4,851.90"	"$4,851.90"	$0.00	$0.00	$0.00	"$2,247.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,246.97"	$0.00	"$5,315.53"	"$5,315.53"	$0.00	"$5,391.00"	"$8,539.34"	"$8,625.60"	$0.00		$0.00	"$1,687.38"	$0.00	$0.00	"$1,716.49"	$0.00	$0.00	$0.00	$0.00	$0.00
449.651	SUP	HCPCS C1713		449.651  -  PLATE MANDIB 3X3 HOLE LCK CRSNT ANG RECON 2.4/3 MM SCR BONE	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.652	SUP	HCPCS C1713		449.652  -  PLATE MANDIB 3X3 HOLE LCK ANG RECON 2.4/3 MM SCR BONE TI	BOTH IP/OP	"$2,756.25 "	"$2,039.63"	$0.00	"$2,205.00"	"$1,240.31"	"$1,240.31"	$0.00	$0.00	$0.00	$574.47	"$2,045.69"	"$2,045.69"	$0.00	$0.00	$574.40	$0.00	"$1,358.83"	"$1,358.83"	$0.00	"$1,378.13"	"$2,182.95"	"$2,205.00"	$0.00		$0.00	$431.35	$0.00	$0.00	$438.80	$0.00	$0.00	$0.00	$0.00	$0.00
449.653	SUP	HCPCS C1713		449.653  -  PLATE MANDIB 4X4 HOLE LCK ANG RECON 2.4/3 MM SCR BONE TI	BOTH IP/OP	"$2,972.25 "	"$2,199.47"	$0.00	"$2,377.80"	"$1,337.51"	"$1,337.51"	$0.00	$0.00	$0.00	$619.49	"$2,206.00"	"$2,206.00"	$0.00	$0.00	$619.42	$0.00	"$1,465.32"	"$1,465.32"	$0.00	"$1,486.13"	"$2,354.02"	"$2,377.80"	$0.00		$0.00	$465.16	$0.00	$0.00	$473.18	$0.00	$0.00	$0.00	$0.00	$0.00
449.654	SUP	HCPCS C1713		449.654  -  PLATE MANDIB 5X8 HOLE LCK LEFT ANG RECON 2.4/3 MM SCR BONE	BOTH IP/OP	"$3,242.25 "	"$2,399.27"	$0.00	"$2,593.80"	"$1,459.01"	"$1,459.01"	$0.00	$0.00	$0.00	$675.77	"$2,406.40"	"$2,406.40"	$0.00	$0.00	$675.68	$0.00	"$1,598.43"	"$1,598.43"	$0.00	"$1,621.13"	"$2,567.86"	"$2,593.80"	$0.00		$0.00	$507.41	$0.00	$0.00	$516.17	$0.00	$0.00	$0.00	$0.00	$0.00
449.655	SUP	HCPCS C1713		449.655  -  PLATE MANDIB 5X8 HOLE LCK RIGHT ANG RECON 2.4/3 MM SCR BONE	BOTH IP/OP	"$3,242.25 "	"$2,399.27"	$0.00	"$2,593.80"	"$1,459.01"	"$1,459.01"	$0.00	$0.00	$0.00	$675.77	"$2,406.40"	"$2,406.40"	$0.00	$0.00	$675.68	$0.00	"$1,598.43"	"$1,598.43"	$0.00	"$1,621.13"	"$2,567.86"	"$2,593.80"	$0.00		$0.00	$507.41	$0.00	$0.00	$516.17	$0.00	$0.00	$0.00	$0.00	$0.00
449.669	SUP	HCPCS C1713		449.669  -  PLATE BONE 3 HOLE HEAD 7 HOLE SHAFT Y LCP TITANIUM	BOTH IP/OP	"$1,350.88 "	$999.65	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$281.56	"$1,002.62"	"$1,002.62"	$0.00	$0.00	$281.52	$0.00	$799.04	$799.04	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
449.67	SUP	HCPCS C1713		449.670  -  PLATE BONE T 58MM 2X7 HOLE LCP TITANIUM CONDYLE NONSTRL 2.4	BOTH IP/OP	"$1,311.53 "	$970.53	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$273.35	$973.41	$973.41	$0.00	$0.00	$273.32	$0.00	$775.77	$775.77	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
449.674	SUP	HCPCS C1713		449.674  -  PLATE BONE 36MM 4 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
449.676	SUP	HCPCS C1713		449.676  -  PLATE BONE 52MM 6 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
449.678	SUP	HCPCS C1713		449.678  -  PLATE BONE 68MM 8 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$321.20	$321.20	$0.00	$0.00	$0.00	$153.23	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$434.86	$434.86	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$108.45	$0.00	$0.00	$113.63	$0.00	$0.00	$0.00	$0.00	$0.00
449.679	SUP	HCPCS C1713		449.679  -  PLATE BONE 7 HOLE LCP TITANIUM CONDYLE NONSTRL 2.4 MM SCREW	BOTH IP/OP	"$1,103.48 "	$816.58	$0.00	$857.06	$482.10	$482.10	$0.00	$0.00	$0.00	$229.99	$819.00	$819.00	$0.00	$0.00	$229.96	$0.00	$652.71	$652.71	$0.00	$535.66	$848.49	$857.06	$0.00		$0.00	$162.78	$0.00	$0.00	$170.55	$0.00	$0.00	$0.00	$0.00	$0.00
449.68	SUP	HCPCS C1713		449.680  -  PLATE BONE 40MM 4 HOLE LCP TITANIUM CONDYLE NONSTRL 2.7MM	BOTH IP/OP	$753.35 	$557.48	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$157.02	$559.14	$559.14	$0.00	$0.00	$157.00	$0.00	$445.61	$445.61	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
449.681	SUP	HCPCS C1713		449.681  -  PLATE BONE 49MM 5 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.7MM	BOTH IP/OP	$775.95 	$574.20	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$161.73	$575.91	$575.91	$0.00	$0.00	$161.71	$0.00	$458.97	$458.97	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
449.682	SUP	HCPCS C1713		449.682  -  PLATE BONE 6 HOLE LCP TITANIUM CONDYLE NONSTRL 2.4 MM SCREW	BOTH IP/OP	$775.95 	$574.20	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$161.73	$575.91	$575.91	$0.00	$0.00	$161.71	$0.00	$458.97	$458.97	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
449.683	SUP	HCPCS C1713		449.683  -  PLATE BONE 67MM 7 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.7MM	BOTH IP/OP	$775.95 	$574.20	$0.00	$602.68	$339.01	$339.01	$0.00	$0.00	$0.00	$161.73	$575.91	$575.91	$0.00	$0.00	$161.71	$0.00	$458.97	$458.97	$0.00	$376.68	$596.65	$602.68	$0.00		$0.00	$114.46	$0.00	$0.00	$119.93	$0.00	$0.00	$0.00	$0.00	$0.00
449.684	SUP	HCPCS C1713		449.684  -  PLATE BONE 7 HOLE LCP TITANIUM CONDYLE NONSTRL 2.7 MM SCREWS	BOTH IP/OP	"$1,203.28 "	$890.43	$0.00	$934.58	$525.70	$525.70	$0.00	$0.00	$0.00	$250.79	$893.07	$893.07	$0.00	$0.00	$250.76	$0.00	$711.74	$711.74	$0.00	$584.11	$925.24	$934.58	$0.00		$0.00	$177.50	$0.00	$0.00	$185.98	$0.00	$0.00	$0.00	$0.00	$0.00
449.685	SUP	HCPCS C1713		449.685  -  PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT T LCP TITANIUM	BOTH IP/OP	"$1,350.88 "	$999.65	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$281.56	"$1,002.62"	"$1,002.62"	$0.00	$0.00	$281.52	$0.00	$799.04	$799.04	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
449.686	SUP	HCPCS C1713		449.686  -  PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT L RIGHT OBLIQUE LCP	BOTH IP/OP	$736.58 	$545.07	$0.00	$572.10	$321.81	$321.81	$0.00	$0.00	$0.00	$153.52	$546.69	$546.69	$0.00	$0.00	$153.50	$0.00	$435.68	$435.68	$0.00	$357.56	$566.38	$572.10	$0.00		$0.00	$108.66	$0.00	$0.00	$113.85	$0.00	$0.00	$0.00	$0.00	$0.00
449.687	SUP	HCPCS C1713		449.687  -  PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT L LEFT OBLIQUE LCP	BOTH IP/OP	$736.58 	$545.07	$0.00	$572.10	$321.81	$321.81	$0.00	$0.00	$0.00	$153.52	$546.69	$546.69	$0.00	$0.00	$153.50	$0.00	$435.68	$435.68	$0.00	$357.56	$566.38	$572.10	$0.00		$0.00	$108.66	$0.00	$0.00	$113.85	$0.00	$0.00	$0.00	$0.00	$0.00
449.688	SUP	HCPCS C1713		449.688  -  PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT L LCP TITANIUM RIGHT	BOTH IP/OP	$736.58 	$545.07	$0.00	$572.10	$321.81	$321.81	$0.00	$0.00	$0.00	$153.52	$546.69	$546.69	$0.00	$0.00	$153.50	$0.00	$435.68	$435.68	$0.00	$357.56	$566.38	$572.10	$0.00		$0.00	$108.66	$0.00	$0.00	$113.85	$0.00	$0.00	$0.00	$0.00	$0.00
449.689	SUP	HCPCS C1713		449.689  -  PLATE BONE 2.7MM 2 HOLE HEAD 3 HOLE SHAFT LCP TITANIUM LEFT	BOTH IP/OP	$736.58 	$545.07	$0.00	$572.10	$321.81	$321.81	$0.00	$0.00	$0.00	$153.52	$546.69	$546.69	$0.00	$0.00	$153.50	$0.00	$435.68	$435.68	$0.00	$357.56	$566.38	$572.10	$0.00		$0.00	$108.66	$0.00	$0.00	$113.85	$0.00	$0.00	$0.00	$0.00	$0.00
449.69	SUP	HCPCS C1713		449.690  -  PLATE BONE 31MM 5 HOLE LOCKING TITANIUM HIND MIDFT NONSTRL	BOTH IP/OP	"$1,454.83 "	"$1,076.57"	$0.00	"$1,163.86"	$654.67	$654.67	$0.00	$0.00	$0.00	$303.22	"$1,079.77"	"$1,079.77"	$0.00	$0.00	$303.19	$0.00	$860.53	$860.53	$0.00	$727.41	"$1,152.23"	"$1,163.86"	$0.00		$0.00	$221.05	$0.00	$0.00	$231.61	$0.00	$0.00	$0.00	$0.00	$0.00
449.691	SUP	HCPCS C1713		449.691  -  PLATE BONE 45MM 8 HOLE LOCKING TITANIUM HIND MIDFT NONSTRL	BOTH IP/OP	"$1,529.40 "	"$1,131.76"	$0.00	"$1,187.88"	$668.18	$668.18	$0.00	$0.00	$0.00	$318.77	"$1,135.12"	"$1,135.12"	$0.00	$0.00	$318.73	$0.00	$904.64	$904.64	$0.00	$742.43	"$1,176.00"	"$1,187.88"	$0.00		$0.00	$225.61	$0.00	$0.00	$236.39	$0.00	$0.00	$0.00	$0.00	$0.00
449.697	SUP	HCPCS C1713		449.697  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT T LCP TITANIUM	BOTH IP/OP	"$1,350.88 "	$999.65	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$281.56	"$1,002.62"	"$1,002.62"	$0.00	$0.00	$281.52	$0.00	$799.04	$799.04	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
449.698	SUP	HCPCS C1713		449.698  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L RIGHT OBLIQUE LCP	BOTH IP/OP	$760.48 	$562.76	$0.00	$590.66	$332.25	$332.25	$0.00	$0.00	$0.00	$158.50	$564.42	$564.42	$0.00	$0.00	$158.48	$0.00	$449.82	$449.82	$0.00	$369.16	$584.76	$590.66	$0.00		$0.00	$112.18	$0.00	$0.00	$117.54	$0.00	$0.00	$0.00	$0.00	$0.00
449.699	SUP	HCPCS C1713		449.699  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L LEFT OBLIQUE LCP	BOTH IP/OP	$760.48 	$562.76	$0.00	$590.66	$332.25	$332.25	$0.00	$0.00	$0.00	$158.50	$564.42	$564.42	$0.00	$0.00	$158.48	$0.00	$449.82	$449.82	$0.00	$369.16	$584.76	$590.66	$0.00		$0.00	$112.18	$0.00	$0.00	$117.54	$0.00	$0.00	$0.00	$0.00	$0.00
449.7	SUP	HCPCS C1713		449.70  -  PLATE MANDIB 20 HOLE STR RECON 2.4 MM SCR BONE TI NONSTRL	BOTH IP/OP	"$3,154.50 "	"$2,334.33"	$0.00	"$2,523.60"	"$1,419.53"	"$1,419.53"	$0.00	$0.00	$0.00	$657.48	"$2,341.27"	"$2,341.27"	$0.00	$0.00	$657.40	$0.00	"$1,555.17"	"$1,555.17"	$0.00	"$1,577.25"	"$2,498.36"	"$2,523.60"	$0.00		$0.00	$493.68	$0.00	$0.00	$502.20	$0.00	$0.00	$0.00	$0.00	$0.00
449.701	SUP	HCPCS C1713		449.701  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L LCP TITANIUM RIGHT	BOTH IP/OP	$760.48 	$562.76	$0.00	$590.66	$332.25	$332.25	$0.00	$0.00	$0.00	$158.50	$564.42	$564.42	$0.00	$0.00	$158.48	$0.00	$449.82	$449.82	$0.00	$369.16	$584.76	$590.66	$0.00		$0.00	$112.18	$0.00	$0.00	$117.54	$0.00	$0.00	$0.00	$0.00	$0.00
449.702	SUP	HCPCS C1713		449.702  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L LCP TITANIUM LEFT	BOTH IP/OP	$760.48 	$562.76	$0.00	$590.66	$332.25	$332.25	$0.00	$0.00	$0.00	$158.50	$564.42	$564.42	$0.00	$0.00	$158.48	$0.00	$449.82	$449.82	$0.00	$369.16	$584.76	$590.66	$0.00		$0.00	$112.18	$0.00	$0.00	$117.54	$0.00	$0.00	$0.00	$0.00	$0.00
449.82	SUP	HCPCS C1713		449.82  -  PLATE UNV 26MM CRNMXF 3X3 HOLE ANG 2.4MM SCR FRAC BONE TI	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.84	SUP	HCPCS C1713		449.84  -  PLATE UNV 32MM MANDIB 4X4 HOLE ANG FRAC 2.4MM SCR BONE TI	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
449.87	SUP	HCPCS C1713		449.87  -  PLATE 97X47MM MANDIB 5X13 HOLE ANG RECON 2.4MM SCR BONE TI	BOTH IP/OP	"$3,471.75 "	"$2,569.10"	$0.00	"$2,777.40"	"$1,562.29"	"$1,562.29"	$0.00	$0.00	$0.00	$723.60	"$2,576.73"	"$2,576.73"	$0.00	$0.00	$723.51	$0.00	"$1,711.57"	"$1,711.57"	$0.00	"$1,735.88"	"$2,749.63"	"$2,777.40"	$0.00		$0.00	$543.33	$0.00	$0.00	$552.70	$0.00	$0.00	$0.00	$0.00	$0.00
449.88	SUP	HCPCS C1713		449.88  -  PLATE MANDIB ANG RECON 2.4 MM SCR BONE TI NONSTRL	BOTH IP/OP	"$3,471.75 "	"$2,569.10"	$0.00	"$2,777.40"	"$1,562.29"	"$1,562.29"	$0.00	$0.00	$0.00	$723.60	"$2,576.73"	"$2,576.73"	$0.00	$0.00	$723.51	$0.00	"$1,711.57"	"$1,711.57"	$0.00	"$1,735.88"	"$2,749.63"	"$2,777.40"	$0.00		$0.00	$543.33	$0.00	$0.00	$552.70	$0.00	$0.00	$0.00	$0.00	$0.00
449.906	SUP	HCPCS C1713		449.906  -  PLATE BN STRG 36X6.3X1.25MM NS 6 HL LOPRFL PRECONTOUR CUT TO	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
449.912	SUP	HCPCS C1713		449.912  -  PLATE BN STRG 72X6.3X1.25MM NS 12 HL LOPRFL PRECONTOUR CUT	BOTH IP/OP	$522.93 	$386.97	$0.00	$406.14	$228.45	$228.45	$0.00	$0.00	$0.00	$108.99	$388.11	$388.11	$0.00	$0.00	$108.98	$0.00	$309.31	$309.31	$0.00	$253.84	$402.08	$406.14	$0.00		$0.00	$77.14	$0.00	$0.00	$80.82	$0.00	$0.00	$0.00	$0.00	$0.00
449.913	SUP	HCPCS C1713		449.913  -  PLATE BN T 54X6.3X1.25MM NS 2 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$497.63 	$368.25	$0.00	$386.50	$217.41	$217.41	$0.00	$0.00	$0.00	$103.72	$369.34	$369.34	$0.00	$0.00	$103.71	$0.00	$294.35	$294.35	$0.00	$241.56	$382.64	$386.50	$0.00		$0.00	$73.41	$0.00	$0.00	$76.91	$0.00	$0.00	$0.00	$0.00	$0.00
449.914	SUP	HCPCS C1713		449.914  -  PLATE BN T 54X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$531.35 	$393.20	$0.00	$412.70	$232.14	$232.14	$0.00	$0.00	$0.00	$110.75	$394.37	$394.37	$0.00	$0.00	$110.73	$0.00	$314.29	$314.29	$0.00	$257.94	$408.58	$412.70	$0.00		$0.00	$78.38	$0.00	$0.00	$82.13	$0.00	$0.00	$0.00	$0.00	$0.00
449.915	SUP	HCPCS C1713		449.915  -  PLATE BN Y 56X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL	BOTH IP/OP	$514.48 	$380.72	$0.00	$399.60	$224.78	$224.78	$0.00	$0.00	$0.00	$107.23	$381.84	$381.84	$0.00	$0.00	$107.22	$0.00	$304.31	$304.31	$0.00	$249.75	$395.60	$399.60	$0.00		$0.00	$75.89	$0.00	$0.00	$79.52	$0.00	$0.00	$0.00	$0.00	$0.00
449.916	SUP	HCPCS C1713		449.916  -  PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH	BOTH IP/OP	$580.55 	$429.61	$0.00	$450.92	$253.64	$253.64	$0.00	$0.00	$0.00	$121.00	$430.88	$430.88	$0.00	$0.00	$120.99	$0.00	$343.40	$343.40	$0.00	$281.83	$446.41	$450.92	$0.00		$0.00	$85.64	$0.00	$0.00	$89.73	$0.00	$0.00	$0.00	$0.00	$0.00
449.917	SUP	HCPCS C1713		449.917  -  PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH	BOTH IP/OP	$580.55 	$429.61	$0.00	$450.92	$253.64	$253.64	$0.00	$0.00	$0.00	$121.00	$430.88	$430.88	$0.00	$0.00	$120.99	$0.00	$343.40	$343.40	$0.00	$281.83	$446.41	$450.92	$0.00		$0.00	$85.64	$0.00	$0.00	$89.73	$0.00	$0.00	$0.00	$0.00	$0.00
449.924	SUP	HCPCS C1713		449.924  -  PLATE BN 31X6.5X1.6MM NS LC DCP 4 HL LOPRFL PRECONTOUR CUT	BOTH IP/OP	$618.50 	$457.69	$0.00	$480.40	$270.23	$270.23	$0.00	$0.00	$0.00	$128.91	$459.05	$459.05	$0.00	$0.00	$128.90	$0.00	$365.84	$365.84	$0.00	$300.25	$475.60	$480.40	$0.00		$0.00	$91.24	$0.00	$0.00	$95.60	$0.00	$0.00	$0.00	$0.00	$0.00
449.926	SUP	HCPCS C1713		449.926  -  PLATE BN 47X6.5X1.6MM NS LC DCP 6 HL LOPRFL PRECONTOUR CUT	BOTH IP/OP	$695.83 	$514.91	$0.00	$540.44	$304.00	$304.00	$0.00	$0.00	$0.00	$145.03	$516.44	$516.44	$0.00	$0.00	$145.01	$0.00	$411.58	$411.58	$0.00	$337.78	$535.04	$540.44	$0.00		$0.00	$102.64	$0.00	$0.00	$107.55	$0.00	$0.00	$0.00	$0.00	$0.00
449.928	SUP	HCPCS C1713		449.928  -  PLATE BN 63X6.5X1.6MM NS LC DCP 8 HL LOPRFL PRECONTOUR CUT	BOTH IP/OP	$750.65 	$555.48	$0.00	$583.02	$327.95	$327.95	$0.00	$0.00	$0.00	$156.45	$557.13	$557.13	$0.00	$0.00	$156.44	$0.00	$444.01	$444.01	$0.00	$364.39	$577.19	$583.02	$0.00		$0.00	$141.20	$0.00	$0.00	$116.02	$0.00	$0.00	$0.00	$0.00	$0.00
449.931	SUP	HCPCS C1713		449.931  -  PLATE BN 24X5.5X1.25MM NS LC DCP 4 HL LOPRFL PRECONTOUR TI	BOTH IP/OP	$444.20 	$328.71	$0.00	$345.00	$194.06	$194.06	$0.00	$0.00	$0.00	$92.58	$329.69	$329.69	$0.00	$0.00	$92.57	$0.00	$262.74	$262.74	$0.00	$215.63	$341.55	$345.00	$0.00		$0.00	$65.53	$0.00	$0.00	$68.66	$0.00	$0.00	$0.00	$0.00	$0.00
449.936	SUP	HCPCS C1713		449.936  -  PLATE BN 36X5.5X1.25MM NS LC DCP 6 HL LOPRFL PRECONTOUR TI	BOTH IP/OP	$522.93 	$386.97	$0.00	$406.14	$228.45	$228.45	$0.00	$0.00	$0.00	$108.99	$388.11	$388.11	$0.00	$0.00	$108.98	$0.00	$309.31	$309.31	$0.00	$253.84	$402.08	$406.14	$0.00		$0.00	$77.14	$0.00	$0.00	$80.82	$0.00	$0.00	$0.00	$0.00	$0.00
449.938	SUP	HCPCS C1713		449.938  -  PLATE BN 48X5.5X1.25MM NS LC DCP 8 HL LOPRFL PRECONTOUR TI	BOTH IP/OP	$594.60 	$440.00	$0.00	$461.84	$259.79	$259.79	$0.00	$0.00	$0.00	$123.93	$441.31	$441.31	$0.00	$0.00	$123.91	$0.00	$351.71	$351.71	$0.00	$288.65	$457.22	$461.84	$0.00		$0.00	$87.71	$0.00	$0.00	$91.91	$0.00	$0.00	$0.00	$0.00	$0.00
450.101	SUP	HCPCS C1713		450.101  -  PLATE BONE 90MM CRANFCL TI 20 HOLE ADP MALBLE 1.5MM SCR	BOTH IP/OP	$819.00 	$606.06	$0.00	$655.20	$368.55	$368.55	$0.00	$0.00	$0.00	$170.70	$607.86	$607.86	$0.00	$0.00	$170.68	$0.00	$484.44	$484.44	$0.00	$409.50	$648.65	$655.20	$0.00		$0.00	$128.17	$0.00	$0.00	$130.38	$0.00	$0.00	$0.00	$0.00	$0.00
450.611	SUP	HCPCS C1713		450.611  -  PLATE BONE CRANFCL TI 5 HOLE Y MALBLE 1.5 MM SCR NONSTRL	BOTH IP/OP	$567.00 	$419.58	$0.00	$453.60	$255.15	$255.15	$0.00	$0.00	$0.00	$118.18	$420.83	$420.83	$0.00	$0.00	$118.16	$0.00	$335.38	$335.38	$0.00	$283.50	$449.06	$453.60	$0.00		$0.00	$88.74	$0.00	$0.00	$90.27	$0.00	$0.00	$0.00	$0.00	$0.00
450.861	SUP	HCPCS C1713		450.861  -  SCREW BONE FULTHD 6MM 45MM SELF TAP LOCKING HEXAGONAL RECESS	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.862	SUP	HCPCS C1713		450.862  -  SCREW BONE 6MM 50MM LOCKING HEXAGONAL RECESS AQUA TITANIUM	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.863	SUP	HCPCS C1713		450.863  -  SCREW BONE 6MM 55MM LOCKING HEXAGONAL RECESS AQUA TITANIUM	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.864	SUP	HCPCS C1713		450.864  -  SCREW BONE 6MM 60MM LOCKING HEXAGONAL RECESS AQUA TITANIUM	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.865	SUP	HCPCS C1713		450.865  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 65MM 2 LEAD	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.866	SUP	HCPCS C1713		450.866  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 70MM 2 LEAD	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.867	SUP	HCPCS C1713		450.867  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 75MM 2 LEAD	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.868	SUP	HCPCS C1713		450.868  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 80MM 2 LEAD	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.869	SUP	HCPCS C1713		450.869  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 85MM 2 LEAD	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.87	SUP	HCPCS C1713		450.870  -  SCREW BONE 6MM 90MM LOCKING HEXAGONAL RECESS AQUA TITANIUM	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.871	SUP	HCPCS C1713		450.871  -  SCREW BONE 6MM 95MM LOCKING HEXAGONAL RECESS AQUA TITANIUM	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.872	SUP	HCPCS C1713		450.872  -  SCREW BONE 6MM 100MM LOCKING HEXAGONAL RECESS AQUA TITANIUM	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.873	SUP	HCPCS C1713		450.873  -  SCREW BONE 3.5MM FULTHD 6MM 8MM 30MM 2 LEAD THREAD LOCKING	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.874	SUP	HCPCS C1713		450.874  -  SCREW BONE FULTHD 6MM 4.8MM 35MM 2 LEAD THREAD LOCKING	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
450.875	SUP	HCPCS C1713		450.875  -  SCREW BONE FULTHD 6MM 4.8MM 40MM 2 LEAD THREAD LOCKING	BOTH IP/OP	$361.65 	$267.62	$0.00	$289.32	$162.74	$162.74	$0.00	$0.00	$0.00	$75.38	$268.42	$268.42	$0.00	$0.00	$75.37	$0.00	$213.92	$213.92	$0.00	$180.83	$286.43	$289.32	$0.00		$0.00	$57.02	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
451.101	SUP	HCPCS C1713		451.101  -  PLATE BONE 100MM CRANFCL TI 20 HOLE ADP MALBLE 1.5MM SCR	BOTH IP/OP	"$1,017.00 "	$752.58	$0.00	$813.60	$457.65	$457.65	$0.00	$0.00	$0.00	$211.97	$754.82	$754.82	$0.00	$0.00	$211.94	$0.00	$601.56	$601.56	$0.00	$508.50	$805.46	$813.60	$0.00		$0.00	$159.16	$0.00	$0.00	$161.91	$0.00	$0.00	$0.00	$0.00	$0.00
451.611	SUP	HCPCS C1713		451.611  -  PLATE BONE CRANFCL TI 5 HOLE Y MALBLE 2 MM SCR NONSTRL	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
457.07	SUP	HCPCS C1713		457.070  -  SCREW BONE 5MM 70MM TI FEM SLFTAP SHFT NONSTRL GOLD	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$233.25	$233.25	$0.00	$0.00	$0.00	$108.03	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$306.59	$306.59	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$81.12	$0.00	$0.00	$82.52	$0.00	$0.00	$0.00	$0.00	$0.00
457.075	SUP	HCPCS C1713		457.075  -  SCREW BONE 5MM 75MM TI CANC SHFT NONSTRL GOLD IM NAIL	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$233.25	$233.25	$0.00	$0.00	$0.00	$108.03	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$306.59	$306.59	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$81.12	$0.00	$0.00	$82.52	$0.00	$0.00	$0.00	$0.00	$0.00
457.08	SUP	HCPCS C1713		457.080  -  SCREW BONE 5MM 80MM TI FEM SHFT NONSTRL GOLD	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$233.25	$233.25	$0.00	$0.00	$0.00	$108.03	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$306.59	$306.59	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$81.12	$0.00	$0.00	$82.52	$0.00	$0.00	$0.00	$0.00	$0.00
457.085	SUP	HCPCS C1713		457.085  -  SCREW BONE 5MM 85MM TI FEM SHFT NONSTRL GOLD	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$233.25	$233.25	$0.00	$0.00	$0.00	$108.03	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$306.59	$306.59	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$81.12	$0.00	$0.00	$82.52	$0.00	$0.00	$0.00	$0.00	$0.00
457.09	SUP	HCPCS C1713		457.090  -  SCREW BONE 5MM 90MM TI FEM SHFT NONSTRL GOLD	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$233.25	$233.25	$0.00	$0.00	$0.00	$108.03	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$306.59	$306.59	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$81.12	$0.00	$0.00	$82.52	$0.00	$0.00	$0.00	$0.00	$0.00
457.095	SUP	HCPCS C1713		457.095  -  SCREW BONE 5MM 95MM TI FEM SHFT NONSTRL GOLD	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$233.25	$233.25	$0.00	$0.00	$0.00	$108.03	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$306.59	$306.59	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$81.12	$0.00	$0.00	$82.52	$0.00	$0.00	$0.00	$0.00	$0.00
457.1	SUP	HCPCS C1713		457.100  -  SCREW BONE 5MM 100MM 16MM TI FEM SLFTAP SHFT FRN CUT FLUT	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$233.25	$233.25	$0.00	$0.00	$0.00	$108.03	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$306.59	$306.59	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$81.12	$0.00	$0.00	$82.52	$0.00	$0.00	$0.00	$0.00	$0.00
457.105	SUP	HCPCS C1713		457.105  -  SCREW BONE 5MM 105MM TI FEM SHFT NONSTRL GOLD	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$233.25	$233.25	$0.00	$0.00	$0.00	$108.03	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$306.59	$306.59	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$81.12	$0.00	$0.00	$82.52	$0.00	$0.00	$0.00	$0.00	$0.00
457.11	SUP	HCPCS C1713		457.110  -  SCREW BONE 5MM 110MM TI FEM SLFTAP SHFT FRN CUT FLUT STRL	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$233.25	$233.25	$0.00	$0.00	$0.00	$108.03	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$306.59	$306.59	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$81.12	$0.00	$0.00	$82.52	$0.00	$0.00	$0.00	$0.00	$0.00
457.115	SUP	HCPCS C1713		457.115  -  SCREW BONE 5MM 115MM TI FEM SHFT NONSTRL GOLD	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$233.25	$233.25	$0.00	$0.00	$0.00	$108.03	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$306.59	$306.59	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$81.12	$0.00	$0.00	$82.52	$0.00	$0.00	$0.00	$0.00	$0.00
457.12	SUP	HCPCS C1713		457.120  -  SCREW BONE GOLD 120MM 5MM FEM TI SLFTAP SHFT FRN CUT FLUT	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$233.25	$233.25	$0.00	$0.00	$0.00	$108.03	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$306.59	$306.59	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$81.12	$0.00	$0.00	$82.52	$0.00	$0.00	$0.00	$0.00	$0.00
457.125	SUP	HCPCS C1713		457.125  -  SCREW BONE 5MM 125MM TI FEM SLFTAP SHFT FRN CUT FLUT STRL	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$233.25	$233.25	$0.00	$0.00	$0.00	$108.03	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$306.59	$306.59	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$81.12	$0.00	$0.00	$82.52	$0.00	$0.00	$0.00	$0.00	$0.00
458.818	SUP	HCPCS C1713		458.818  -  SCREW BONE 4MM 3.3MM 18MM SELF CUTTING TROCAR TIP LOCKING	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.82	SUP	HCPCS C1713		458.820  -  SCREW BONE TROCAR 4MM 8MM 20MM 2 LEAD THREAD LOCKING SLFTAP	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.822	SUP	HCPCS C1713		458.822  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 22MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.824	SUP	HCPCS C1713		458.824  -  SCREW BONE 4MM 3.3MM 24MM SELF CUTTING TROCAR TIP LOCKING	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.826	SUP	HCPCS C1713		458.826  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 26MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.828	SUP	HCPCS C1713		458.828  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 28MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.83	SUP	HCPCS C1713		458.830  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 30MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.832	SUP	HCPCS C1713		458.832  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 32MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.834	SUP	HCPCS C1713		458.834  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 34MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.836	SUP	HCPCS C1713		458.836  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 36MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.838	SUP	HCPCS C1713		458.838  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 38MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.84	SUP	HCPCS C1713		458.840  -  SCREW BONE HEXAGON TROCAR 4MM 3.3MM 40MM SELF CUT LOCK	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.842	SUP	HCPCS C1713		458.842  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 42MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.844	SUP	HCPCS C1713		458.844  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 44MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.846	SUP	HCPCS C1713		458.846  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 46MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.848	SUP	HCPCS C1713		458.848  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 48MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.85	SUP	HCPCS C1713		458.850  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 50MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.852	SUP	HCPCS C1713		458.852  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 52MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.854	SUP	HCPCS C1713		458.854  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 54MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.856	SUP	HCPCS C1713		458.856  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 56MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.858	SUP	HCPCS C1713		458.858  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 58MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.86	SUP	HCPCS C1713		458.860  -  SCREW BONE TROCAR 4MM 8MM 60MM 2 LEAD THREAD LOCKING SLFTAP	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.862	SUP	HCPCS C1713		458.862  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 62MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.864	SUP	HCPCS C1713		458.864  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 64MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.866	SUP	HCPCS C1713		458.866  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 66MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.868	SUP	HCPCS C1713		458.868  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 68MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.87	SUP	HCPCS C1713		458.870  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 70MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.872	SUP	HCPCS C1713		458.872  -  SCREW BONE TROCAR FULTHD 4MM 8MM 72MM 2 LEAD THREAD LOCKING	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.874	SUP	HCPCS C1713		458.874  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 74MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.876	SUP	HCPCS C1713		458.876  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 76MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.878	SUP	HCPCS C1713		458.878  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 78MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.88	SUP	HCPCS C1713		458.880  -  SCREW BONE TROCAR 4MM 8MM 80MM 2 LEAD THREAD SLFTAP	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.926	SUP	HCPCS C1713		458.926  -  SCREW BONE 5MM 26MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.928	SUP	HCPCS C1713		458.928  -  SCREW BONE NONSTRL IM NAIL 5MM 28MM NLEX TI DISTAL FEM/TIB	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.93	SUP	HCPCS C1713		458.930  -  SCREW BONE NONSTRL 5MM 30MM NLEX TI DISTAL FEM/TIB LCK HEX	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.932	SUP	HCPCS C1713		458.932  -  SCREW BONE NONSTRL IM NAIL 5MM 32MM NLEX TI DISTAL FEM/TIB	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.934	SUP	HCPCS C1713		458.934  -  SCREW BONE NONSTRL IM NAIL 5MM 34MM NLEX TI DISTAL FEM/TIB	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.936	SUP	HCPCS C1713		458.936  -  SCREW BONE NONSTRL IM NAIL 5MM 36MM NLEX TI DISTAL FEM/TIB	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
458.938	SUP	HCPCS C1713		458.938  -  SCREW BONE 5MM 38MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
458.94	SUP	HCPCS C1713		458.940  -  SCREW BONE 5MM 40MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
458.942	SUP	HCPCS C1713		458.942  -  SCREW BONE 5MM 42MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
458.944	SUP	HCPCS C1713		458.944  -  SCREW BONE 5MM 44MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
458.946	SUP	HCPCS C1713		458.946  -  SCREW BONE 5MM 46MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
458.948	SUP	HCPCS C1713		458.948  -  SCREW BONE 5MM 48MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
458.95	SUP	HCPCS C1713		458.950  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 5MM 8MM 50MM 2 LEAD	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
458.952	SUP	HCPCS C1713		458.952  -  SCREW BONE 5MM 52MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$307.65 	$227.66	$0.00	$316.66	$178.12	$178.12	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$197.91	$243.66	$316.66	$0.00		$0.00	$48.15	$0.00	$0.00	$63.02	$0.00	$0.00	$0.00	$0.00	$0.00
458.954	SUP	HCPCS C1713		458.954  -  SCREW BONE NONSTRL CANN IM NAIL 5MM 54MM NLEX TI DISTAL	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
458.956	SUP	HCPCS C1713		458.956  -  SCREW BONE NONSTRL IM NAIL 5MM 56MM NLEX TI DISTAL FEM/TIB	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.958	SUP	HCPCS C1713		458.958  -  SCREW BONE NONSTRL IM NAIL 5MM 58MM NLEX TI DISTAL FEM/TIB	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
458.96	SUP	HCPCS C1713		458.960  -  SCREW BONE NONSTRL IM NAIL 5MM 60MM NLEX TI DISTAL FEM/TIB	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
458.964	SUP	HCPCS C1713		458.964  -  SCREW BONE 5MM 64MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
458.968	SUP	HCPCS C1713		458.968  -  SCREW BONE NONSTRL CANN IM NAIL 5MM 68MM NLEX TI DISTAL	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.972	SUP	HCPCS C1713		458.972  -  SCREW BONE 5MM 72MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.976	SUP	HCPCS C1713		458.976  -  SCREW BONE 5MM 76MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.98	SUP	HCPCS C1713		458.980  -  SCREW BONE NONSTRL CANN IM NAIL 5MM 80MM NLEX TI DISTAL	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.985	SUP	HCPCS C1713		458.985  -  SCREW BONE 5MM 85MM TI ALLOY LCK SLFTAP NONSTRL	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.99	SUP	HCPCS C1713		458.990  -  SCREW BONE 5MM 90MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.995	SUP	HCPCS C1713		458.995  -  SCREW BONE 5MM 95MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
458.999	SUP	HCPCS C1713		458.999  -  SCREW BONE 5MM 100MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
459.68	SUP	HCPCS C1713		459.68  -  BOLT LOCKING HEXAGON 4.9MM 8MM 68MM SELF TAP SELF CUT TROCAR	BOTH IP/OP	$328.90 	$243.39	$0.00	$263.12	$148.01	$148.01	$0.00	$0.00	$0.00	$68.55	$244.11	$244.11	$0.00	$0.00	$68.54	$0.00	$194.54	$194.54	$0.00	$164.45	$260.49	$263.12	$0.00		$0.00	$51.86	$0.00	$0.00	$52.36	$0.00	$0.00	$0.00	$0.00	$0.00
460	SUP	Custom 27203010		460  -  DRESSING GZE 12X12IN LF QUIKCLOT TRAUMAPAD 3 PLY NWVN FLXB	BOTH IP/OP	$145.58 	$107.73	$0.00	$116.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.79	$115.30	$116.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
460.022	SUP	HCPCS C1713		460.022  -  PIN FIX EMERGENCY RELEASE TITANIUM STERNUM NONSTRL	BOTH IP/OP	$226.25 	$167.43	$0.00	$181.00	$101.81	$101.81	$0.00	$0.00	$0.00	$47.16	$167.92	$167.92	$0.00	$0.00	$47.15	$0.00	$133.83	$133.83	$0.00	$113.13	$179.19	$181.00	$0.00		$0.00	$35.41	$0.00	$0.00	$36.02	$0.00	$0.00	$0.00	$0.00	$0.00
460.023	SUP	HCPCS C1713		460.023  -  PLATE BONE STR 20 HOLE LOCKING TITANIUM STERNUM NONSTRL 2.4	BOTH IP/OP	"$5,407.50 "	"$4,001.55"	$0.00	"$4,326.00"	"$2,433.38"	"$2,433.38"	$0.00	$0.00	$0.00	"$1,127.06"	"$4,013.45"	"$4,013.45"	$0.00	$0.00	"$1,126.92"	$0.00	"$2,665.90"	"$2,665.90"	$0.00	"$2,703.75"	"$4,282.74"	"$4,326.00"	$0.00		$0.00	$846.27	$0.00	$0.00	$860.87	$0.00	$0.00	$0.00	$0.00	$0.00
460.027	SUP	HCPCS C1713		460.027  -  PLATE BONE H SMALL 8 HOLE LOCKING TITANIUM MANUBRIUM STERNUM	BOTH IP/OP	"$2,380.00 "	"$1,761.20"	$0.00	"$1,904.00"	"$1,071.00"	"$1,071.00"	$0.00	$0.00	$0.00	$496.05	"$1,766.44"	"$1,766.44"	$0.00	$0.00	$495.99	$0.00	"$1,407.77"	"$1,407.77"	$0.00	"$1,190.00"	"$1,884.96"	"$1,904.00"	$0.00		$0.00	$372.47	$0.00	$0.00	$378.90	$0.00	$0.00	$0.00	$0.00	$0.00
460.028	SUP	HCPCS C1713		460.028  -  PLATE BONE H LARGE 8 HOLE LOCKING TITANIUM MANUBRIUM STERNUM	BOTH IP/OP	"$2,380.00 "	"$1,761.20"	$0.00	"$1,904.00"	"$1,071.00"	"$1,071.00"	$0.00	$0.00	$0.00	$496.05	"$1,766.44"	"$1,766.44"	$0.00	$0.00	$495.99	$0.00	"$1,407.77"	"$1,407.77"	$0.00	"$1,190.00"	"$1,884.96"	"$1,904.00"	$0.00		$0.00	$372.47	$0.00	$0.00	$378.90	$0.00	$0.00	$0.00	$0.00	$0.00
460.035	SUP	HCPCS C1713		460.035  -  PLATE BONE STAR 6 HOLE LOCKING TITANIUM STERNUM NONSTRL	BOTH IP/OP	"$2,260.00 "	"$1,672.40"	$0.00	"$1,808.00"	"$1,017.00"	"$1,017.00"	$0.00	$0.00	$0.00	$471.04	"$1,677.37"	"$1,677.37"	$0.00	$0.00	$470.98	$0.00	"$1,336.79"	"$1,336.79"	$0.00	"$1,130.00"	"$1,789.92"	"$1,808.00"	$0.00		$0.00	$353.69	$0.00	$0.00	$359.79	$0.00	$0.00	$0.00	$0.00	$0.00
460.036	SUP	HCPCS C1713		460.036  -  PLATE BONE STAR 12 HOLE LOCKING TITANIUM STERNUM NONSTRL	BOTH IP/OP	"$2,827.50 "	"$2,092.35"	$0.00	"$2,262.00"	"$1,272.38"	"$1,272.38"	$0.00	$0.00	$0.00	$589.32	"$2,098.57"	"$2,098.57"	$0.00	$0.00	$589.25	$0.00	"$1,393.96"	"$1,393.96"	$0.00	"$1,413.75"	"$2,239.38"	"$2,262.00"	$0.00		$0.00	$442.50	$0.00	$0.00	$450.14	$0.00	$0.00	$0.00	$0.00	$0.00
460.037	SUP	HCPCS C1713		460.037  -  PLATE BONE X 10 HOLE LOCKING TITANIUM STERNUM NONSTRL	BOTH IP/OP	"$2,492.50 "	"$1,844.45"	$0.00	"$1,994.00"	"$1,121.63"	"$1,121.63"	$0.00	$0.00	$0.00	$519.50	"$1,849.93"	"$1,849.93"	$0.00	$0.00	$519.44	$0.00	"$1,474.31"	"$1,474.31"	$0.00	"$1,246.25"	"$1,974.06"	"$1,994.00"	$0.00		$0.00	$390.08	$0.00	$0.00	$396.81	$0.00	$0.00	$0.00	$0.00	$0.00
460.038	SUP	HCPCS C1713		460.038  -  PLATE BONE 2T 14 HOLE LOCKING TITANIUM STERNUM NONSTRL	BOTH IP/OP	"$2,825.00 "	"$2,090.50"	$0.00	"$2,260.00"	"$1,271.25"	"$1,271.25"	$0.00	$0.00	$0.00	$588.80	"$2,096.72"	"$2,096.72"	$0.00	$0.00	$588.73	$0.00	"$1,392.73"	"$1,392.73"	$0.00	"$1,412.50"	"$2,237.40"	"$2,260.00"	$0.00		$0.00	$442.11	$0.00	$0.00	$449.74	$0.00	$0.00	$0.00	$0.00	$0.00
460.039	SUP	HCPCS C1713		460.039  -  PLATE BONE ANGLED 12 HOLE LOCKING TITANIUM STERNUM NONSTRL	BOTH IP/OP	"$3,817.50 "	"$2,824.95"	$0.00	"$3,054.00"	"$1,717.88"	"$1,717.88"	$0.00	$0.00	$0.00	$795.66	"$2,833.35"	"$2,833.35"	$0.00	$0.00	$795.57	$0.00	"$1,882.03"	"$1,882.03"	$0.00	"$1,908.75"	"$3,023.46"	"$3,054.00"	$0.00		$0.00	$597.44	$0.00	$0.00	$607.75	$0.00	$0.00	$0.00	$0.00	$0.00
460.04	SUP	HCPCS C1713		460.040  -  PLATE BONE X 10 HOLE LOCKING TITANIUM STERNUM NONSTRL	BOTH IP/OP	"$2,492.50 "	"$1,844.45"	$0.00	"$1,994.00"	"$1,121.63"	"$1,121.63"	$0.00	$0.00	$0.00	$519.50	"$1,849.93"	"$1,849.93"	$0.00	$0.00	$519.44	$0.00	"$1,474.31"	"$1,474.31"	$0.00	"$1,246.25"	"$1,974.06"	"$1,994.00"	$0.00		$0.00	$390.08	$0.00	$0.00	$396.81	$0.00	$0.00	$0.00	$0.00	$0.00
460.045	SUP	HCPCS C1713		460.045  -  PLATE BONE STR 8 HOLE LOCKING TITANIUM STERNUM NONSTRL	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	"$1,224.00"	"$1,224.00"	$0.00	$0.00	$0.00	$566.92	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	"$1,340.96"	"$1,340.96"	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$425.68	$0.00	$0.00	$433.02	$0.00	$0.00	$0.00	$0.00	$0.00
460.046	SUP	HCPCS C1713		460.046  -  PLATE BONE STR 13 HOLE LOCKING TITANIUM STERNUM NONSTRL	BOTH IP/OP	"$2,825.00 "	"$2,090.50"	$0.00	"$2,260.00"	"$1,271.25"	"$1,271.25"	$0.00	$0.00	$0.00	$588.80	"$2,096.72"	"$2,096.72"	$0.00	$0.00	$588.73	$0.00	"$1,392.73"	"$1,392.73"	$0.00	"$1,412.50"	"$2,237.40"	"$2,260.00"	$0.00		$0.00	$442.11	$0.00	$0.00	$449.74	$0.00	$0.00	$0.00	$0.00	$0.00
461	SUP	Custom 27203010		461  -  DRESSING GAUZE 4YDX3IN ROLL HEMOSTATIC QUIKCLOT	BOTH IP/OP	$99.72 	$73.79	$0.00	$80.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.01	$74.01	$0.00	$0.00	$20.78	$0.00	$0.00	$0.00	$0.00	$50.61	$1.35	$80.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
462.64	SUP	HCPCS C1713		462.640  -  BLADE IM NAIL GOLD 40MM HUM TI SPRL SLD NONSTRL	BOTH IP/OP	"$1,253.08 "	$927.28	$0.00	"$1,002.46"	$563.88	$563.88	$0.00	$0.00	$0.00	$261.17	$930.03	$930.03	$0.00	$0.00	$261.14	$0.00	$741.19	$741.19	$0.00	$626.54	$992.44	"$1,002.46"	$0.00		$0.00	$196.11	$0.00	$0.00	$199.49	$0.00	$0.00	$0.00	$0.00	$0.00
462.644	SUP	HCPCS C1713		462.644  -  BLADE IM FIX GOLD 44CM HUM TI SPRL NONSTRL	BOTH IP/OP	"$1,253.08 "	$927.28	$0.00	"$1,002.46"	$563.88	$563.88	$0.00	$0.00	$0.00	$261.17	$930.03	$930.03	$0.00	$0.00	$261.14	$0.00	$741.19	$741.19	$0.00	$626.54	$992.44	"$1,002.46"	$0.00		$0.00	$196.11	$0.00	$0.00	$199.49	$0.00	$0.00	$0.00	$0.00	$0.00
476	SUP	Custom 27803010		00476  -  TUBE NG 45IN 10FR SDPRT WT STY FLXFL PU PED STRL	BOTH IP/OP	$22.88 	$16.93	$0.00	$18.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.98	$16.98	$0.00	$0.00	$4.77	$0.00	$0.00	$0.00	$0.00	$11.44	$18.12	$18.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
482.823	SUP	HCPCS C1713		482.823  -  PLATE BONE 17X10X.7MM 7 HOLE BUTTON OVAL TITANIUM ORTHOPEDIC	BOTH IP/OP	$721.13 	$533.64	$0.00	$560.10	$315.06	$315.06	$0.00	$0.00	$0.00	$150.30	$535.22	$535.22	$0.00	$0.00	$150.28	$0.00	$426.55	$426.55	$0.00	$350.06	$554.50	$560.10	$0.00		$0.00	$106.38	$0.00	$0.00	$111.46	$0.00	$0.00	$0.00	$0.00	$0.00
487.931	SUP	Custom 27803010		487.931  -  DISTRACTOR SURG MULTI VECTOR BODY TITANIUM MANDIB NONSTRL	BOTH IP/OP	"$12,302.50 "	"$9,103.85"	$0.00	"$9,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,563.84"	$0.00	$0.00	$0.00	$0.00	"$6,151.25"	"$9,743.58"	"$9,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.933	SUP	Custom 27803010		487.933  -  DISTRACTOR SURG 15MM MULTI VECTOR ARM TITANIUM MANDIB	BOTH IP/OP	$797.50 	$590.15	$0.00	$638.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$591.90	$591.90	$0.00	$0.00	$166.20	$0.00	$0.00	$0.00	$0.00	$398.75	$631.62	$638.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.934	SUP	Custom 27803010		487.934  -  DISTRACTOR SURG 25MM MULTI VECTOR ARM TITANIUM MANDIB	BOTH IP/OP	$797.50 	$590.15	$0.00	$638.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$591.90	$591.90	$0.00	$0.00	$166.20	$0.00	$0.00	$0.00	$0.00	$398.75	$631.62	$638.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.935	SUP	Custom 27803010		487.935  -  DISTRACTOR SURG 35MM MULTI VECTOR ARM TITANIUM MANDIB	BOTH IP/OP	$797.50 	$590.15	$0.00	$638.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$591.90	$591.90	$0.00	$0.00	$166.20	$0.00	$0.00	$0.00	$0.00	$398.75	$631.62	$638.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.937	SUP	Custom 27803010		487.937  -  DISTRACTOR SURG NUT LINEAR ACTIVATION TITANIUM MANDIB	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.938	SUP	Custom 27803010		487.938  -  DISTRACTOR SURG MULTI VECTOR PIN HOLDING CLMP TITANIUM	BOTH IP/OP	"$2,622.50 "	"$1,940.65"	$0.00	"$2,098.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,946.42"	"$1,946.42"	$0.00	$0.00	$546.53	$0.00	$0.00	$0.00	$0.00	"$1,311.25"	"$2,077.02"	"$2,098.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.939	SUP	Custom 27803010		487.939  -  DISTRACTOR SURG MULTI VECTOR PIN HOLDING BODY TITANIUM	BOTH IP/OP	"$2,622.50 "	"$1,940.65"	$0.00	"$2,098.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,946.42"	"$1,946.42"	$0.00	$0.00	$546.53	$0.00	$0.00	$0.00	$0.00	"$1,311.25"	"$2,077.02"	"$2,098.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.94	SUP	Custom 27203010		487.940  -  CLAMP EXFIX UNIVERSAL PIN HOLDING TITANIUM MULTI VECTOR	BOTH IP/OP	"$2,622.50 "	"$1,940.65"	$0.00	"$2,098.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,946.42"	"$1,946.42"	$0.00	$0.00	$546.53	$0.00	$0.00	$0.00	$0.00	"$1,311.25"	"$2,077.02"	"$2,098.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.941	SUP	Custom 27203010		487.941  -  CLAMP EXFIX BODY PIN HOLDING MULTIVECTOR DISTRCT BLUE	BOTH IP/OP	"$2,622.50 "	"$1,940.65"	$0.00	"$2,098.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,946.42"	"$1,946.42"	$0.00	$0.00	$546.53	$0.00	$0.00	$0.00	$0.00	"$1,311.25"	"$2,077.02"	"$2,098.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.942	SUP	Custom 27203010		487.942  -  CLAMP EXFIX RAMUS PIN HOLDING MULTIVECTOR DISTRCT GOLD	BOTH IP/OP	"$2,622.50 "	"$1,940.65"	$0.00	"$2,098.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,946.42"	"$1,946.42"	$0.00	$0.00	$546.53	$0.00	$0.00	$0.00	$0.00	"$1,311.25"	"$2,077.02"	"$2,098.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.96	SUP	HCPCS C1713		487.960  -  PLATE 1.6MM MAXL ASMBLY BONE TI	BOTH IP/OP	"$1,838.25 "	"$1,360.31"	$0.00	"$1,470.60"	$827.21	$827.21	$0.00	$0.00	$0.00	$383.14	"$1,364.35"	"$1,364.35"	$0.00	$0.00	$383.09	$0.00	"$1,087.32"	"$1,087.32"	$0.00	$919.13	"$1,455.89"	"$1,470.60"	$0.00		$0.00	$287.69	$0.00	$0.00	$292.65	$0.00	$0.00	$0.00	$0.00	$0.00
487.962	SUP	Custom 27803010		487.962  -  FOOTPLATE BONE 20MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB	BOTH IP/OP	"$16,635.00 "	"$12,309.90"	$0.00	"$13,308.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,466.73"	$0.00	$0.00	$0.00	$0.00	"$8,317.50"	"$13,174.92"	"$13,308.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.963	SUP	Custom 27803010		487.963  -  FOOTPLATE BONE 20MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB	BOTH IP/OP	"$16,635.00 "	"$12,309.90"	$0.00	"$13,308.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,466.73"	$0.00	$0.00	$0.00	$0.00	"$8,317.50"	"$13,174.92"	"$13,308.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.964	SUP	Custom 27803010		487.964  -  FOOTPLATE BONE 30MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB	BOTH IP/OP	"$16,635.00 "	"$12,309.90"	$0.00	"$13,308.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,466.73"	$0.00	$0.00	$0.00	$0.00	"$8,317.50"	"$13,174.92"	"$13,308.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.965	SUP	Custom 27803010		487.965  -  FOOTPLATE BONE 30MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB	BOTH IP/OP	"$16,635.00 "	"$12,309.90"	$0.00	"$13,308.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,466.73"	$0.00	$0.00	$0.00	$0.00	"$8,317.50"	"$13,174.92"	"$13,308.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.966	SUP	Custom 27803010		487.966  -  DISTRACTOR SURG MULTI VECTOR ASMBLY TITANIUM RIGHT MANDIB	BOTH IP/OP	"$19,727.50 "	"$14,598.35"	$0.00	"$15,782.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,111.21"	$0.00	$0.00	$0.00	$0.00	"$9,863.75"	"$15,624.18"	"$15,782.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.967	SUP	Custom 27803010		487.967  -  DISTRACTOR SURG MULTI VECTOR ASMBLY TITANIUM MANDIB LEFT	BOTH IP/OP	"$19,727.50 "	"$14,598.35"	$0.00	"$15,782.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,111.21"	$0.00	$0.00	$0.00	$0.00	"$9,863.75"	"$15,624.18"	"$15,782.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.971	SUP	Custom 27803010		487.971  -  DISTRACTOR SURG 45MM MULTI VECTOR ARM TITANIUM MANDIB	BOTH IP/OP	$797.50 	$590.15	$0.00	$638.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$591.90	$591.90	$0.00	$0.00	$166.20	$0.00	$0.00	$0.00	$0.00	$398.75	$631.62	$638.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.973	SUP	Custom 27803010		487.973  -  DISTRACTOR SURG 55MM MULTI VECTOR ARM TITANIUM MANDIB	BOTH IP/OP	$797.50 	$590.15	$0.00	$638.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$591.90	$591.90	$0.00	$0.00	$166.20	$0.00	$0.00	$0.00	$0.00	$398.75	$631.62	$638.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.974	SUP	Custom 27803010		487.974  -  DISTRACTOR SURG 1 VECTOR TITANIUM MANDIB RIGHT NONSTRL	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$512.12	$512.12	$0.00	$0.00	$143.80	$0.00	$0.00	$0.00	$0.00	$345.00	$546.48	$552.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.975	SUP	Custom 27803010		487.975  -  DISTRACTOR SURG 1 VECTOR TITANIUM MANDIB LEFT NONSTRL	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$512.12	$512.12	$0.00	$0.00	$143.80	$0.00	$0.00	$0.00	$0.00	$345.00	$546.48	$552.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.976	SUP	Custom 27803010		487.976  -  DISTRACTOR SURG 65MM MULTI VECTOR ARM TITANIUM MANDIB	BOTH IP/OP	$797.50 	$590.15	$0.00	$638.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$591.90	$591.90	$0.00	$0.00	$166.20	$0.00	$0.00	$0.00	$0.00	$398.75	$631.62	$638.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.977	SUP	Custom 27803010		487.977  -  DISTRACTOR SURG 75MM MULTI VECTOR ARM TITANIUM MANDIB	BOTH IP/OP	$797.50 	$590.15	$0.00	$638.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$591.90	$591.90	$0.00	$0.00	$166.20	$0.00	$0.00	$0.00	$0.00	$398.75	$631.62	$638.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.978	SUP	Custom 27803010		487.978  -  DISTRACTOR SURG 85MM MULTI VECTOR ARM TITANIUM MANDIB	BOTH IP/OP	$797.50 	$590.15	$0.00	$638.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$591.90	$591.90	$0.00	$0.00	$166.20	$0.00	$0.00	$0.00	$0.00	$398.75	$631.62	$638.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.98	SUP	Custom 27803010		487.980  -  DISTRACTOR SURG 7MM NUT HEXAGONAL TITANIUM MIDFAC NONSTRL	BOTH IP/OP	$347.50 	$257.15	$0.00	$278.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.91	$257.91	$0.00	$0.00	$72.42	$0.00	$0.00	$0.00	$0.00	$173.75	$275.22	$278.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.982	SUP	Custom 27803010		487.982  -  DISTRACTOR SURG 40MM ASMBLY TITANIUM MIDFAC NONSTRL	BOTH IP/OP	"$13,747.50 "	"$10,173.15"	$0.00	"$10,998.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.98"	$0.00	$0.00	$0.00	$0.00	"$6,873.75"	"$10,888.02"	"$10,998.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.984	SUP	Custom 27803010		487.984  -  FOOTPLATE BONE ELEVATE TITANIUM RIGHT ANTERIOR MIDFAC	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	$0.00	$0.00	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.985	SUP	Custom 27803010		487.985  -  FOOTPLATE BONE ELEVATE TITANIUM LEFT ANTERIOR MIDFAC NONSTRL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	$0.00	$0.00	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.986	SUP	Custom 27803010		487.986  -  FOOTPLATE BONE LP SYMMETRICAL TITANIUM ANTERIOR MIDFAC	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	$0.00	$0.00	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.987	SUP	Custom 27803010		487.987  -  FOOTPLATE BONE ELEVATED SYMMETRICAL TITANIUM ANTERIOR MIDFAC	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	$0.00	$0.00	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.988	SUP	Custom 27803010		487.988  -  FOOTPLATE BONE MESH TITANIUM ANTERIOR MIDFAC NONSTRL MIDFAC	BOTH IP/OP	"$1,542.50 "	"$1,141.45"	$0.00	"$1,234.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,144.84"	"$1,144.84"	$0.00	$0.00	$321.46	$0.00	$0.00	$0.00	$0.00	$771.25	"$1,221.66"	"$1,234.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.989	SUP	Custom 27803010		487.989  -  FOOTPLATE BONE BUTTRESS TITANIUM ANTERIOR MIDFAC NONSTRL	BOTH IP/OP	"$1,542.50 "	"$1,141.45"	$0.00	"$1,234.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,144.84"	"$1,144.84"	$0.00	$0.00	$321.46	$0.00	$0.00	$0.00	$0.00	$771.25	"$1,221.66"	"$1,234.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.99	SUP	Custom 27803010		487.990  -  FOOTPLATE BONE 1 VECTOR TITANIUM MIDFAC POSTERIOR NONSTRL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	$0.00	$0.00	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.992	SUP	Custom 27803010		487.992  -  DISTRACTOR SURG 20MM RIGID EXTN TITANIUM MIDFAC NONSTRL	BOTH IP/OP	"$1,252.50 "	$926.85	$0.00	"$1,002.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$929.61	$929.61	$0.00	$0.00	$261.02	$0.00	$0.00	$0.00	$0.00	$626.25	$991.98	"$1,002.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.993	SUP	Custom 27803010		487.993  -  DISTRACTOR SURG 20MM UNIVERSAL JOINT EXTN TITANIUM	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.994	SUP	Custom 27803010		487.994  -  DISTRACTOR SURG 40MM FLEXIBLE CABLE EXTN TITANIUM MIDFAC	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
487.995	SUP	HCPCS C1713		487.995  -  SCREW EXTERNAL DISTRCT EXTERNAL MIDFAC DISTRCT SYSTEM	BOTH IP/OP	$365.00 	$270.10	$0.00	$292.00	$164.25	$164.25	$0.00	$0.00	$0.00	$76.08	$270.90	$270.90	$0.00	$0.00	$76.07	$0.00	$215.90	$215.90	$0.00	$182.50	$289.08	$292.00	$0.00		$0.00	$57.12	$0.00	$0.00	$58.11	$0.00	$0.00	$0.00	$0.00	$0.00
488.066	SUP	HCPCS C1713		488.066  -  SCREW BONE 1.6MM MACHINE TITANIUM CRANIAL NONSTRL	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
488.074	SUP	Custom 27803010		488.074  -  DISTRACTOR SURG 8MM STR PLATE TITANIUM ALVEOLAR NONSTRL	BOTH IP/OP	"$2,595.00 "	"$1,920.30"	$0.00	"$2,076.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,926.01"	"$1,926.01"	$0.00	$0.00	$540.80	$0.00	$0.00	$0.00	$0.00	"$1,297.50"	"$2,055.24"	"$2,076.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
488.075	SUP	Custom 27803010		488.075  -  BODY DISTRCT 12MM STR PLATE TITANIUM ALVEOLAR NONSTRL	BOTH IP/OP	"$2,595.00 "	"$1,920.30"	$0.00	"$2,076.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,926.01"	"$1,926.01"	$0.00	$0.00	$540.80	$0.00	$0.00	$0.00	$0.00	"$1,297.50"	"$2,055.24"	"$2,076.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
488.076	SUP	Custom 27803010		488.076  -  BODY DISTRCT 16MM STR PLATE TITANIUM ALVEOLAR NONSTRL	BOTH IP/OP	"$2,595.00 "	"$1,920.30"	$0.00	"$2,076.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,926.01"	"$1,926.01"	$0.00	$0.00	$540.80	$0.00	$0.00	$0.00	$0.00	"$1,297.50"	"$2,055.24"	"$2,076.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
488.75	SUP	HCPCS C1713		488.750  -  SCREW BONE 4.35MM 25MM TI CANC CERV SPN BTRS LCK XPD HEAD	BOTH IP/OP	$547.75 	$405.34	$0.00	$438.20	$246.49	$246.49	$0.00	$0.00	$0.00	$114.16	$406.54	$406.54	$0.00	$0.00	$114.15	$0.00	$323.99	$323.99	$0.00	$273.88	$433.82	$438.20	$0.00		$0.00	$85.72	$0.00	$0.00	$87.20	$0.00	$0.00	$0.00	$0.00	$0.00
488.915	SUP	HCPCS C1713		488.915  -  PLATE 30MM TI 2 HOLE LCK BTRS BONE SPNL NONSTRL	BOTH IP/OP	"$1,232.00 "	$911.68	$0.00	$985.60	$554.40	$554.40	$0.00	$0.00	$0.00	$256.78	$914.39	$914.39	$0.00	$0.00	$256.75	$0.00	$728.73	$728.73	$0.00	$616.00	$975.74	$985.60	$0.00		$0.00	$192.81	$0.00	$0.00	$196.13	$0.00	$0.00	$0.00	$0.00	$0.00
492.08	SUP	Custom 27203010		492.08  -  WIRE FX .8MM 70MM NS KRSH TROC PNT TI	BOTH IP/OP	$19.12 	$14.15	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.19	$14.19	$0.00	$0.00	$3.98	$0.00	$0.00	$0.00	$0.00	$9.28	$14.70	$14.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
492.1	SUP	Custom 27203010		492.10  -  WIRE FX 1MM 150MM NS KRSH TROC PNT TI	BOTH IP/OP	$18.56 	$13.73	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.78	$13.78	$0.00	$0.00	$3.87	$0.00	$0.00	$0.00	$0.00	$9.28	$14.70	$14.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
492.12	SUP	Custom 27203010		492.12  -  WIRE FX 1.25MM 150MM NS KRSH TROC PNT TI	BOTH IP/OP	$19.12 	$14.15	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.19	$14.19	$0.00	$0.00	$3.98	$0.00	$0.00	$0.00	$0.00	$9.28	$14.70	$14.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
492.16	SUP	Custom 27203010		492.16  -  WIRE FX 1.6MM 150MM NS KRSH TROC PNT TI	BOTH IP/OP	$19.12 	$14.15	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.19	$14.19	$0.00	$0.00	$3.98	$0.00	$0.00	$0.00	$0.00	$9.28	$14.70	$14.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
492.18	SUP	Custom 27203010		492.18  -  WIRE FX 1.6MM 285MM NS KRSH TROC PNT TI	BOTH IP/OP	$23.05 	$17.06	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.11	$17.11	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$11.19	$17.72	$17.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
492.2	SUP	Custom 27203010		492.20  -  WIRE FX 2MM 150MM NS KRSH TROC PNT TI	BOTH IP/OP	$18.56 	$13.73	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.78	$13.78	$0.00	$0.00	$3.87	$0.00	$0.00	$0.00	$0.00	$9.28	$14.70	$14.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
492.21	SUP	Custom 27203010		492.21  -  WIRE FX 2MM 285MM NS KRSH TROC PNT TI	BOTH IP/OP	$23.05 	$17.06	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.11	$17.11	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$11.19	$17.72	$17.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
492.25	SUP	Custom 27203010		492.25  -  WIRE FX 2.5MM 150MM NS KRSH TROC PNT TI	BOTH IP/OP	$19.12 	$14.15	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.19	$14.19	$0.00	$0.00	$3.98	$0.00	$0.00	$0.00	$0.00	$9.28	$14.70	$14.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
492.26	SUP	Custom 27203010		492.26  -  WIRE FX 2.5MM 285MM NS KRSH TROC PNT TI	BOTH IP/OP	$23.05 	$17.06	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.11	$17.11	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$11.19	$17.72	$17.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
492.3	SUP	Custom 27203010		492.30  -  WIRE FX 3MM 150MM NS KRSH TROC PNT TI	BOTH IP/OP	$18.56 	$13.73	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.78	$13.78	$0.00	$0.00	$3.87	$0.00	$0.00	$0.00	$0.00	$9.28	$14.70	$14.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
492.31	SUP	Custom 27203010		492.31  -  WIRE FX 3MM 285MM NS KRSH TROC PNT TI	BOTH IP/OP	$23.05 	$17.06	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.11	$17.11	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$11.19	$17.72	$17.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
494.769	SUP	HCPCS C1713		494.769  -  SCREW BONE 4/2.5MM 80MM 20MM SLFDRILL REINFORCED BONE ANCHOR	BOTH IP/OP	$249.53 	$184.65	$0.00	$193.80	$109.01	$109.01	$0.00	$0.00	$0.00	$52.01	$185.20	$185.20	$0.00	$0.00	$52.00	$0.00	$147.59	$147.59	$0.00	$121.13	$191.86	$193.80	$0.00		$0.00	$36.81	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$0.00
494.771	SUP	HCPCS C1713		494.771  -  SCREW XTRNFX 4MM 3MM 80MM NS 20MM SCHNZ SLF DRL MR	BOTH IP/OP	$278.48 	$206.08	$0.00	$216.30	$121.67	$121.67	$0.00	$0.00	$0.00	$58.04	$206.68	$206.68	$0.00	$0.00	$58.03	$0.00	$164.72	$164.72	$0.00	$135.19	$214.14	$216.30	$0.00		$0.00	$41.08	$0.00	$0.00	$43.04	$0.00	$0.00	$0.00	$0.00	$0.00
494.772	SUP	HCPCS C1713		494.772  -  SCREW BONE 4/3MM 100MM 20MM SLFDRILL SCHANZ TITANIUM	BOTH IP/OP	$278.48 	$206.08	$0.00	$216.30	$121.67	$121.67	$0.00	$0.00	$0.00	$58.04	$206.68	$206.68	$0.00	$0.00	$58.03	$0.00	$164.72	$164.72	$0.00	$135.19	$214.14	$216.30	$0.00		$0.00	$41.08	$0.00	$0.00	$43.04	$0.00	$0.00	$0.00	$0.00	$0.00
494.774	SUP	HCPCS C1713		494.774  -  SCREW BONE 4MM 60MM 20MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC	BOTH IP/OP	$278.48 	$206.08	$0.00	$216.30	$121.67	$121.67	$0.00	$0.00	$0.00	$58.04	$206.68	$206.68	$0.00	$0.00	$58.03	$0.00	$164.72	$164.72	$0.00	$135.19	$214.14	$216.30	$0.00		$0.00	$41.08	$0.00	$0.00	$43.04	$0.00	$0.00	$0.00	$0.00	$0.00
494.775	SUP	HCPCS C1713		494.775  -  PIN HALF 4MM 80MM 20MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC	BOTH IP/OP	$278.48 	$206.08	$0.00	$216.30	$121.67	$121.67	$0.00	$0.00	$0.00	$58.04	$206.68	$206.68	$0.00	$0.00	$58.03	$0.00	$164.72	$164.72	$0.00	$135.19	$214.14	$216.30	$0.00		$0.00	$41.08	$0.00	$0.00	$43.04	$0.00	$0.00	$0.00	$0.00	$0.00
494.776	SUP	HCPCS C1713		494.776  -  SCREW FIX 4MM 100MM 30MM SELF DRILL REINFORCE SYMMETRICAL	BOTH IP/OP	$278.48 	$206.08	$0.00	$216.30	$121.67	$121.67	$0.00	$0.00	$0.00	$58.04	$206.68	$206.68	$0.00	$0.00	$58.03	$0.00	$164.72	$164.72	$0.00	$135.19	$214.14	$216.30	$0.00		$0.00	$41.08	$0.00	$0.00	$43.04	$0.00	$0.00	$0.00	$0.00	$0.00
494.777	SUP	HCPCS C1713		494.777  -  SCREW BONE 4MM 125MM 40MM SLFDRILL SCHANZ TITANIUM	BOTH IP/OP	$278.48 	$206.08	$0.00	$216.30	$121.67	$121.67	$0.00	$0.00	$0.00	$58.04	$206.68	$206.68	$0.00	$0.00	$58.03	$0.00	$164.72	$164.72	$0.00	$135.19	$214.14	$216.30	$0.00		$0.00	$41.08	$0.00	$0.00	$43.04	$0.00	$0.00	$0.00	$0.00	$0.00
494.778	SUP	HCPCS C1713		494.778  -  SCREW BONE 4MM 150MM 40MM SLFDRILL SCHANZ TITANIUM	BOTH IP/OP	$278.48 	$206.08	$0.00	$216.30	$121.67	$121.67	$0.00	$0.00	$0.00	$58.04	$206.68	$206.68	$0.00	$0.00	$58.03	$0.00	$164.72	$164.72	$0.00	$135.19	$214.14	$216.30	$0.00		$0.00	$41.08	$0.00	$0.00	$43.04	$0.00	$0.00	$0.00	$0.00	$0.00
494.779	SUP	HCPCS C1713		494.779  -  PIN HALF 4MM 175MM 40MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC	BOTH IP/OP	$278.48 	$206.08	$0.00	$216.30	$121.67	$121.67	$0.00	$0.00	$0.00	$58.04	$206.68	$206.68	$0.00	$0.00	$58.03	$0.00	$164.72	$164.72	$0.00	$135.19	$214.14	$216.30	$0.00		$0.00	$41.08	$0.00	$0.00	$43.04	$0.00	$0.00	$0.00	$0.00	$0.00
494.782	SUP	HCPCS C1713		494.782  -  PIN HALF 5MM 100MM 30MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC	BOTH IP/OP	$320.83 	$237.41	$0.00	$249.18	$140.16	$140.16	$0.00	$0.00	$0.00	$66.87	$238.12	$238.12	$0.00	$0.00	$66.86	$0.00	$189.77	$189.77	$0.00	$155.74	$246.69	$249.18	$0.00		$0.00	$47.33	$0.00	$0.00	$49.59	$0.00	$0.00	$0.00	$0.00	$0.00
494.783	SUP	HCPCS C1713		494.783  -  PIN HALF 5MM 125MM 40MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC	BOTH IP/OP	$320.83 	$237.41	$0.00	$249.18	$140.16	$140.16	$0.00	$0.00	$0.00	$66.87	$238.12	$238.12	$0.00	$0.00	$66.86	$0.00	$189.77	$189.77	$0.00	$155.74	$246.69	$249.18	$0.00		$0.00	$47.33	$0.00	$0.00	$49.59	$0.00	$0.00	$0.00	$0.00	$0.00
494.784	SUP	HCPCS C1713		494.784  -  SCREW XTRNFX 5MM 150MM NS 60MM SCHNZ SLF DRL TI HIP CNDYL LG	BOTH IP/OP	$320.83 	$237.41	$0.00	$249.18	$140.16	$140.16	$0.00	$0.00	$0.00	$66.87	$238.12	$238.12	$0.00	$0.00	$66.86	$0.00	$189.77	$189.77	$0.00	$155.74	$246.69	$249.18	$0.00		$0.00	$47.33	$0.00	$0.00	$49.59	$0.00	$0.00	$0.00	$0.00	$0.00
494.785	SUP	HCPCS C1713		494.785  -  SCREW XTRNFX 5MM 175MM NS 60MM SCHNZ SLF DRL MR CONDITIONAL	BOTH IP/OP	$320.83 	$237.41	$0.00	$249.18	$140.16	$140.16	$0.00	$0.00	$0.00	$66.87	$238.12	$238.12	$0.00	$0.00	$66.86	$0.00	$189.77	$189.77	$0.00	$155.74	$246.69	$249.18	$0.00		$0.00	$47.33	$0.00	$0.00	$49.59	$0.00	$0.00	$0.00	$0.00	$0.00
494.786	SUP	HCPCS C1713		494.786  -  SCREW XTRNFX 5MM 200MM NS 80MM SCHNZ SLF DRL TI HIP CNDYL LG	BOTH IP/OP	$320.83 	$237.41	$0.00	$249.18	$140.16	$140.16	$0.00	$0.00	$0.00	$66.87	$238.12	$238.12	$0.00	$0.00	$66.86	$0.00	$189.77	$189.77	$0.00	$155.74	$246.69	$249.18	$0.00		$0.00	$47.33	$0.00	$0.00	$49.59	$0.00	$0.00	$0.00	$0.00	$0.00
494.788	SUP	HCPCS C1713		494.788  -  PIN HALF 5MM 250MM 80MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC	BOTH IP/OP	$320.83 	$237.41	$0.00	$249.18	$140.16	$140.16	$0.00	$0.00	$0.00	$66.87	$238.12	$238.12	$0.00	$0.00	$66.86	$0.00	$189.77	$189.77	$0.00	$155.74	$246.69	$249.18	$0.00		$0.00	$47.33	$0.00	$0.00	$49.59	$0.00	$0.00	$0.00	$0.00	$0.00
494.792	SUP	HCPCS C1713		494.792  -  SCREW BONE 6MM 100MM 30MM SLFDRILL SCHANZ TITANIUM	BOTH IP/OP	$341.98 	$253.07	$0.00	$265.62	$149.41	$149.41	$0.00	$0.00	$0.00	$71.28	$253.81	$253.81	$0.00	$0.00	$71.27	$0.00	$202.28	$202.28	$0.00	$166.01	$262.97	$265.62	$0.00		$0.00	$50.45	$0.00	$0.00	$52.86	$0.00	$0.00	$0.00	$0.00	$0.00
494.793	SUP	HCPCS C1713		494.793  -  PIN HALF 6MM 125MM 40MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC	BOTH IP/OP	$341.98 	$253.07	$0.00	$265.62	$149.41	$149.41	$0.00	$0.00	$0.00	$71.28	$253.81	$253.81	$0.00	$0.00	$71.27	$0.00	$202.28	$202.28	$0.00	$166.01	$262.97	$265.62	$0.00		$0.00	$50.45	$0.00	$0.00	$52.86	$0.00	$0.00	$0.00	$0.00	$0.00
494.794	SUP	HCPCS C1713		494.794  -  SCREW BONE 6MM 150MM 60MM SLFDRILL SCHANZ TITANIUM	BOTH IP/OP	$341.98 	$253.07	$0.00	$265.62	$149.41	$149.41	$0.00	$0.00	$0.00	$71.28	$253.81	$253.81	$0.00	$0.00	$71.27	$0.00	$202.28	$202.28	$0.00	$166.01	$262.97	$265.62	$0.00		$0.00	$50.45	$0.00	$0.00	$52.86	$0.00	$0.00	$0.00	$0.00	$0.00
494.795	SUP	HCPCS C1713		494.795  -  PIN HALF 6MM 175MM 60MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC	BOTH IP/OP	$341.98 	$253.07	$0.00	$265.62	$149.41	$149.41	$0.00	$0.00	$0.00	$71.28	$253.81	$253.81	$0.00	$0.00	$71.27	$0.00	$202.28	$202.28	$0.00	$166.01	$262.97	$265.62	$0.00		$0.00	$50.45	$0.00	$0.00	$52.86	$0.00	$0.00	$0.00	$0.00	$0.00
494.796	SUP	HCPCS C1713		494.796  -  SCREW BONE 6MM 200MM 80MM SLFDRILL SCHANZ TITANIUM	BOTH IP/OP	$341.98 	$253.07	$0.00	$265.62	$149.41	$149.41	$0.00	$0.00	$0.00	$71.28	$253.81	$253.81	$0.00	$0.00	$71.27	$0.00	$202.28	$202.28	$0.00	$166.01	$262.97	$265.62	$0.00		$0.00	$50.45	$0.00	$0.00	$52.86	$0.00	$0.00	$0.00	$0.00	$0.00
494.798	SUP	HCPCS C1713		494.798  -  PIN HALF 6MM 250MM 80MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC	BOTH IP/OP	$341.98 	$253.07	$0.00	$265.62	$149.41	$149.41	$0.00	$0.00	$0.00	$71.28	$253.81	$253.81	$0.00	$0.00	$71.27	$0.00	$202.28	$202.28	$0.00	$166.01	$262.97	$265.62	$0.00		$0.00	$50.45	$0.00	$0.00	$52.86	$0.00	$0.00	$0.00	$0.00	$0.00
495.372	SUP	HCPCS C1713		495.372  -  CAGE SPNL OBLNG 22X17X12MM NS SNMSH TI VERT BD REPL	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
495.394	SUP	HCPCS C1713		495.394  -  RING SPNL 5D OBLNG 22MM 17MM 22X17MM NS SNMSH PRFT ALAT	BOTH IP/OP	$830.00 	$614.20	$0.00	$664.00	$373.50	$373.50	$0.00	$0.00	$0.00	$172.99	$616.03	$616.03	$0.00	$0.00	$172.97	$0.00	$490.95	$490.95	$0.00	$415.00	$657.36	$664.00	$0.00		$0.00	$129.90	$0.00	$0.00	$132.14	$0.00	$0.00	$0.00	$0.00	$0.00
497.674	SUP	HCPCS C1713		497.674  -  SCREW TI 14MM 2.4MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
497.676	SUP	HCPCS C1713		497.676  -  SCREW TI 16MM 2.4MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
497.678	SUP	HCPCS C1713		497.678  -  SCREW TI 18MM 2.4MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
497.78	SUP	HCPCS C1713		497.78  -  SCREW BN 1.8MM 5MM LCK TI SPNE	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
497.797	SUP	Custom 27803010		497.797  -  TRNCON ROD 35-41MM 6MM CLICKX PANGEA USS UNV SPNL TI LP	BOTH IP/OP	"$2,432.50 "	"$1,800.05"	$0.00	"$1,946.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,805.40"	"$1,805.40"	$0.00	$0.00	$506.93	$0.00	$0.00	$0.00	$0.00	"$1,216.25"	"$1,926.54"	"$1,946.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
498.104	SUP	HCPCS C1713		498.104  -  ROD SPNL 100MM 6MM USS TI HRD NONSTRL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
498.105	SUP	HCPCS C1713		498.105  -  ROD SPNL 125MM 6MM USS TI HRD NONSTRL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
498.106	SUP	HCPCS C1713		498.106  -  ROD SPNL 150MM 6MM USS TI HRD NONSTRL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
498.108	SUP	HCPCS C1713		498.108  -  ROD SPNL 200MM 6MM USS TI HRD NONSTRL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
498.116	SUP	HCPCS C1713		498.116  -  ROD SPNL 400MM 6MM USS TI HRD NONSTRL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
498.12	SUP	HCPCS C1713		498.120  -  BAR SPNL 80MM 3.5MM USS TI CONCTR TRNSVRS NONSTRL	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$129.94	$129.94	$0.00	$0.00	$0.00	$60.18	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$170.80	$170.80	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$45.19	$0.00	$0.00	$45.97	$0.00	$0.00	$0.00	$0.00	$0.00
498.125	SUP	HCPCS C1713		498.125  -  CONNECTOR ROD STR 3.5MM 120MM SET UPPER BAR USS TITANIUM SPN	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
498.136	SUP	HCPCS C1713		498.136  -  ROD SPNL 40MM 3.5MM AXON TI CVD NONSTRL	BOTH IP/OP	$353.50 	$261.59	$0.00	$282.80	$159.08	$159.08	$0.00	$0.00	$0.00	$73.68	$262.37	$262.37	$0.00	$0.00	$73.67	$0.00	$209.10	$209.10	$0.00	$176.75	$279.97	$282.80	$0.00		$0.00	$55.32	$0.00	$0.00	$56.28	$0.00	$0.00	$0.00	$0.00	$0.00
498.137	SUP	HCPCS C1713		498.137  -  ROD SPINAL CURVE 3.5MM 80MM PREBENT AXON TITANIUM NONSTRL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
498.141	SUP	HCPCS C1713		498.141  -  ROD SPNL 65MM 6MM USS TI SFT CVD NONSTRL	BOTH IP/OP	$483.00 	$357.42	$0.00	$386.40	$217.35	$217.35	$0.00	$0.00	$0.00	$100.67	$358.48	$358.48	$0.00	$0.00	$100.66	$0.00	$285.69	$285.69	$0.00	$241.50	$382.54	$386.40	$0.00		$0.00	$75.59	$0.00	$0.00	$76.89	$0.00	$0.00	$0.00	$0.00	$0.00
500	SUP	Custom 27203010		LYPHOCHEK ANEMIA CONTROL	BOTH IP/OP	$257.50 	$190.55	$0.00	$206.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$128.75	$203.94	$206.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
510.01	SUP	HCPCS C1713		"510.010  -  4.0MM FIXED SCREW SELF-DRILLING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.012	SUP	HCPCS C1713		"510.012  -  4.0MM FIXED SCREW SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.014	SUP	HCPCS C1713		"510.014  -  4.0MM FIXED SCREW SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.016	SUP	HCPCS C1713		"510.016  -  4.0MM FIXED SCREW SELF-DRILLING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.03	SUP	HCPCS C1713		"510.030  -  4.0MM FIXED SCREW SELF-TAPPING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.032	SUP	HCPCS C1713		"510.032  -  4.0MM FIXED SCREW SELF-TAPPING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.034	SUP	HCPCS C1713		"510.034  -  4.0MM FIXED SCREW SELF-TAPPING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.036	SUP	HCPCS C1713		"510.036  -  4.0MM FIXED SCREW SELF-TAPPING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.038	SUP	HCPCS C1713		"510.038  -  4.0MM FIXED SCREW SELF-TAPPING, 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.04	SUP	HCPCS C1713		"510.040  -  4.0MM FIXED SCREW SELF-TAPPING, 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.512	SUP	HCPCS C1713		"510.512  -  4.5MM FIXED SCREW SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.514	SUP	HCPCS C1713		"510.514  -  4.5MM FIXED SCREW SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.516	SUP	HCPCS C1713		"510.516  -  4.5MM FIXED SCREW SELF-DRILLING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.53	SUP	HCPCS C1713		"510.530  -  4.5MM FIXED SCREW SELF-TAPPING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.532	SUP	HCPCS C1713		"510.532  -  4.5MM FIXED SCREW SELF-TAPPING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.534	SUP	HCPCS C1713		"510.534  -  4.5MM FIXED SCREW SELF-TAPPING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.536	SUP	HCPCS C1713		"510.536  -  4.5MM FIXED SCREW SELF-TAPPING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.538	SUP	HCPCS C1713		"510.538  -  4.5MM FIXED SCREW SELF-TAPPING, 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.54	SUP	HCPCS C1713		"510.540  -  4.5MM FIXED SCREW SELF-TAPPING, 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.61	SUP	HCPCS C1713		"510.610  -  4.0MM STANDARD SCREW FIXED SELF-DRILLING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.612	SUP	HCPCS C1713		"510.612  -  4.0MM STANDARD SCREW FIXED SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.614	SUP	HCPCS C1713		"510.614  -  4.0MM STANDARD SCREW FIXED SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.616	SUP	HCPCS C1713		"510.616  -  4.0MM STANDARD SCREW FIXED SELF-DRILLING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.71	SUP	HCPCS C1713		"510.710  -  4.5MM STANDARD SCREW FIXED SELF-DRILLING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.712	SUP	HCPCS C1713		"510.712  -  4.5MM STANDARD SCREW FIXED SELF-DRILLING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.714	SUP	HCPCS C1713		"510.714  -  4.5MM STANDARD SCREW FIXED SELF-DRILLING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.716	SUP	HCPCS C1713		"510.716  -  4.5MM STANDARD SCREW FIXED SELF-DRILLING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.81	SUP	HCPCS C1713		"510.810  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.812	SUP	HCPCS C1713		"510.812  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.814	SUP	HCPCS C1713		"510.814  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.816	SUP	HCPCS C1713		"510.816  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.818	SUP	HCPCS C1713		"510.818  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.82	SUP	HCPCS C1713		"510.820  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.91	SUP	HCPCS C1713		"510.910  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 10MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.912	SUP	HCPCS C1713		"510.912  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 12MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.914	SUP	HCPCS C1713		"510.914  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 14MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.916	SUP	HCPCS C1713		"510.916  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 16MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.918	SUP	HCPCS C1713		"510.918  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 18MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
510.92	SUP	HCPCS C1713		"510.920  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 20MM"	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
511.411	SUP	Custom 27203010		511.411  -  BIT DRILL 2MM 150MM BRAD POINT 3 FLUTED NONSTRL	BOTH IP/OP	$501.80 	$371.33	$0.00	$389.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.44	$372.44	$0.00	$0.00	$104.58	$0.00	$0.00	$0.00	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
511.412	SUP	Custom 27203010		511.412  -  BIT DRILL 2.5MM 150MM BRAD POINT 3 FLUTED NONSTRL	BOTH IP/OP	$501.80 	$371.33	$0.00	$389.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.44	$372.44	$0.00	$0.00	$104.58	$0.00	$0.00	$0.00	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
511.413	SUP	Custom 27203010		511.413  -  BIT DRILL 2.7MM 150MM QUICK COUPLING BRAD POINT 3 FLUTED	BOTH IP/OP	$501.80 	$371.33	$0.00	$389.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.44	$372.44	$0.00	$0.00	$104.58	$0.00	$0.00	$0.00	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
511.414	SUP	Custom 27203010		511.414  -  BIT DRILL 3 FLUTE 3.2MM 122MM QUICK COUPLING BRAD POINT	BOTH IP/OP	$501.80 	$371.33	$0.00	$389.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.44	$372.44	$0.00	$0.00	$104.58	$0.00	$0.00	$0.00	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
511.415	SUP	Custom 27203010		511.415  -  BIT DRILL 3.5MM 150MM QUICK COUPLING BRAD POINT 3 FLUTED	BOTH IP/OP	$501.80 	$371.33	$0.00	$389.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.44	$372.44	$0.00	$0.00	$104.58	$0.00	$0.00	$0.00	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
511.416	SUP	Custom 27203010		511.416  -  BIT DRILL 3.6MM 150MM 3 FLUTED QUICK COUPLING BRAD POINT	BOTH IP/OP	$501.80 	$371.33	$0.00	$389.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.44	$372.44	$0.00	$0.00	$104.58	$0.00	$0.00	$0.00	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
511.417	SUP	Custom 27203010		511.417  -  BIT DRILL 4MM 150MM 3 FLUTED QUICK COUPLING BRAD POINT	BOTH IP/OP	$501.80 	$371.33	$0.00	$389.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.44	$372.44	$0.00	$0.00	$104.58	$0.00	$0.00	$0.00	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
511.418	SUP	Custom 27203010		511.418  -  BIT DRILL 4.5MM 150MM QUICK COUPLING BRAD POINT 3 FLUTED	BOTH IP/OP	$501.80 	$371.33	$0.00	$389.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.44	$372.44	$0.00	$0.00	$104.58	$0.00	$0.00	$0.00	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
511.431	SUP	Custom 27203010		511.431  -  BIT DRILL 3.2MM 105MM BRAD POINT 3 FLUTE NONSTRL	BOTH IP/OP	$501.80 	$371.33	$0.00	$389.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.44	$372.44	$0.00	$0.00	$104.58	$0.00	$0.00	$0.00	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
511.432	SUP	Custom 27203010		511.432  -  BIT DRILL 4MM 105MM BRAD POINT 3 FLUTED NONSTRL	BOTH IP/OP	$501.80 	$371.33	$0.00	$389.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.44	$372.44	$0.00	$0.00	$104.58	$0.00	$0.00	$0.00	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
513.01	SUP	Custom 27203010		513.01  -  BIT DRILL MINI 1.1MM 28MM QUICK COUPLING NONSTRL	BOTH IP/OP	$124.55 	$92.17	$0.00	$99.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.44	$92.44	$0.00	$0.00	$25.96	$0.00	$0.00	$0.00	$0.00	$62.28	$98.64	$99.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
513.03	SUP	Custom 27203010		513.03  -  BIT DRILL MINI 1.1MM 45MM QUICK COUPLING NONSTRL	BOTH IP/OP	$124.55 	$92.17	$0.00	$99.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.44	$92.44	$0.00	$0.00	$25.96	$0.00	$0.00	$0.00	$0.00	$62.28	$98.64	$99.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
513.05	SUP	Custom 27203010		513.05  -  BIT DRILL MINI 3MM 28MM QUICK COUPLING NONSTRL	BOTH IP/OP	$124.55 	$92.17	$0.00	$99.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.44	$92.44	$0.00	$0.00	$25.96	$0.00	$0.00	$0.00	$0.00	$62.28	$98.64	$99.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
513.08	SUP	Custom 27203010		513.08  -  BIT DRILL MINI 1.5MM 52MM QUICK COUPLING NONSTRL	BOTH IP/OP	$124.55 	$92.17	$0.00	$99.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.44	$92.44	$0.00	$0.00	$25.96	$0.00	$0.00	$0.00	$0.00	$62.28	$98.64	$99.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
513.1	SUP	Custom 27203010		513.10  -  BIT DRILL MINI 2MM 28MM QUICK COUPLING NONSTRL	BOTH IP/OP	$124.55 	$92.17	$0.00	$99.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.44	$92.44	$0.00	$0.00	$25.96	$0.00	$0.00	$0.00	$0.00	$62.28	$98.64	$99.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
513.13	SUP	Custom 27203010		513.13  -  BIT DRILL MINI 2MM 52MM QUICK COUPLING NONSTRL	BOTH IP/OP	$124.55 	$92.17	$0.00	$99.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.44	$92.44	$0.00	$0.00	$25.96	$0.00	$0.00	$0.00	$0.00	$62.28	$98.64	$99.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
513.14	SUP	Custom 27203010		513.14  -  BIT DRILL MINI 2MM 67MM QUICK COUPLING NONSTRL	BOTH IP/OP	$124.55 	$92.17	$0.00	$99.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.44	$92.44	$0.00	$0.00	$25.96	$0.00	$0.00	$0.00	$0.00	$62.28	$98.64	$99.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
513.17	SUP	Custom 27203010		513.17  -  BIT DRILL MINI 2.7MM 28MM QUICK COUPLING NONSTRL	BOTH IP/OP	$124.55 	$92.17	$0.00	$99.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.44	$92.44	$0.00	$0.00	$25.96	$0.00	$0.00	$0.00	$0.00	$62.28	$98.64	$99.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
513.19	SUP	Custom 27203010		513.19  -  BIT DRILL MINI 2.7MM 67MM QUICK COUPLING NONSTRL	BOTH IP/OP	$124.55 	$92.17	$0.00	$99.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.44	$92.44	$0.00	$0.00	$25.96	$0.00	$0.00	$0.00	$0.00	$62.28	$98.64	$99.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.001	SUP	Custom 27803010		"524.001  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 4, 300MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.002	SUP	Custom 27803010		"524.002  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 4, 400MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.003	SUP	Custom 27803010		"524.003  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 4, 500MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.004	SUP	Custom 27803010		"524.004  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 2, 300MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.005	SUP	Custom 27803010		"524.005  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 2, 400MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.006	SUP	Custom 27803010		"524.006  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 2, 500MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.007	SUP	Custom 27803010		"524.007  -  5.5MM STRAIGHT ROD, HEX-END W/STOP, 500MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.008	SUP	Custom 27803010		"524.008  -  5.5MM STRAIGHT ROD, HEX-END W/STOP, CP, GRADE 4, 500MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.009	SUP	Custom 27803010		"524.009  -  5.5MM STRAIGHT ROD, HEX-END W/STOP, CP, GRADE 2, 500MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.051	SUP	HCPCS C1713		"524.051  -  5.0MM REVERE REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.052	SUP	HCPCS C1713		"524.052  -  5.0MM REVERE REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.053	SUP	HCPCS C1713		"524.053  -  5.0MM REVERE REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.054	SUP	HCPCS C1713		"524.054  -  5.0MM REVERE REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.055	SUP	HCPCS C1713		"524.055  -  5.0MM REVERE REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.056	SUP	HCPCS C1713		"524.056  -  5.0MM REVERE REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.057	SUP	HCPCS C1713		"524.057  -  5.0MM REVERE REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.071	SUP	HCPCS C1713		"524.071  -  7.5MM REVERE REDUCTION SCREW, 70MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.072	SUP	HCPCS C1713		"524.072  -  7.5MM REVERE REDUCTION SCREW, 75MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.073	SUP	HCPCS C1713		"524.073  -  7.5MM REVERE REDUCTION SCREW, 80MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.074	SUP	HCPCS C1713		"524.074  -  7.5MM REVERE REDUCTION SCREW, 85MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.075	SUP	HCPCS C1713		"524.075  -  7.5MM REVERE REDUCTION SCREW, 90MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.081	SUP	HCPCS C1713		"524.081  -  8.5MM REVERE REDUCTION SCREW, 70MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.082	SUP	HCPCS C1713		"524.082  -  8.5MM REVERE REDUCTION SCREW, 75MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.083	SUP	HCPCS C1713		"524.083  -  8.5MM REVERE REDUCTION SCREW, 80MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.084	SUP	HCPCS C1713		"524.084  -  8.5MM REVERE REDUCTION SCREW, 85MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.085	SUP	HCPCS C1713		"524.085  -  8.5MM REVERE REDUCTION SCREW, 90MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.2	SUP	HCPCS C1713		"524.200  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 20MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.201	SUP	HCPCS C1713		"524.201  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.202	SUP	HCPCS C1713		"524.202  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.203	SUP	HCPCS C1713		"524.203  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.204	SUP	HCPCS C1713		"524.204  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.241	SUP	HCPCS C1713		"524.241  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.242	SUP	HCPCS C1713		"524.242  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.243	SUP	HCPCS C1713		"524.243  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.244	SUP	HCPCS C1713		"524.244  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.245	SUP	HCPCS C1713		"524.245  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.252	SUP	HCPCS C1713		"524.252  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.253	SUP	HCPCS C1713		"524.253  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.254	SUP	HCPCS C1713		"524.254  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.255	SUP	HCPCS C1713		"524.255  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.256	SUP	HCPCS C1713		"524.256  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.257	SUP	HCPCS C1713		"524.257  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.258	SUP	HCPCS C1713		"524.258  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.259	SUP	HCPCS C1713		"524.259  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.262	SUP	HCPCS C1713		"524.262  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.263	SUP	HCPCS C1713		"524.263  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.264	SUP	HCPCS C1713		"524.264  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.265	SUP	HCPCS C1713		"524.265  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.266	SUP	HCPCS C1713		"524.266  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.267	SUP	HCPCS C1713		"524.267  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.268	SUP	HCPCS C1713		"524.268  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.269	SUP	HCPCS C1713		"524.269  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.272	SUP	HCPCS C1713		"524.272  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.273	SUP	HCPCS C1713		"524.273  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.274	SUP	HCPCS C1713		"524.274  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.275	SUP	HCPCS C1713		"524.275  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.276	SUP	HCPCS C1713		"524.276  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.277	SUP	HCPCS C1713		"524.277  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.278	SUP	HCPCS C1713		"524.278  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.279	SUP	HCPCS C1713		"524.279  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.282	SUP	HCPCS C1713		"524.282  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.283	SUP	HCPCS C1713		"524.283  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.284	SUP	HCPCS C1713		"524.284  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.285	SUP	HCPCS C1713		"524.285  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.286	SUP	HCPCS C1713		"524.286  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.287	SUP	HCPCS C1713		"524.287  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.288	SUP	HCPCS C1713		"524.288  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.289	SUP	HCPCS C1713		"524.289  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.341	SUP	HCPCS C1713		"524.341  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.342	SUP	HCPCS C1713		"524.342  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.343	SUP	HCPCS C1713		"524.343  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.344	SUP	HCPCS C1713		"524.344  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.345	SUP	HCPCS C1713		"524.345  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.346	SUP	HCPCS C1713		"524.346  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.347	SUP	HCPCS C1713		"524.347  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.351	SUP	HCPCS C1713		"524.351  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.352	SUP	HCPCS C1713		"524.352  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.353	SUP	HCPCS C1713		"524.353  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.354	SUP	HCPCS C1713		"524.354  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.355	SUP	HCPCS C1713		"524.355  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.356	SUP	HCPCS C1713		"524.356  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.357	SUP	HCPCS C1713		"524.357  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.361	SUP	HCPCS C1713		"524.361  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.362	SUP	HCPCS C1713		"524.362  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.363	SUP	HCPCS C1713		"524.363  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.364	SUP	HCPCS C1713		"524.364  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.365	SUP	HCPCS C1713		"524.365  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.366	SUP	HCPCS C1713		"524.366  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.367	SUP	HCPCS C1713		"524.367  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.371	SUP	HCPCS C1713		"524.371  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.372	SUP	HCPCS C1713		"524.372  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.373	SUP	HCPCS C1713		"524.373  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.374	SUP	HCPCS C1713		"524.374  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.375	SUP	HCPCS C1713		"524.375  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.376	SUP	HCPCS C1713		"524.376  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.377	SUP	HCPCS C1713		"524.377  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.441	SUP	HCPCS C1713		"524.441  -  4.5MM REVERE REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.442	SUP	HCPCS C1713		"524.442  -  4.5MM REVERE REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.443	SUP	HCPCS C1713		"524.443  -  4.5MM REVERE REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.444	SUP	HCPCS C1713		"524.444  -  4.5MM REVERE REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.445	SUP	HCPCS C1713		"524.445  -  4.5MM REVERE REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.451	SUP	HCPCS C1713		"524.451  -  5.5MM REVERE REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.452	SUP	HCPCS C1713		"524.452  -  5.5MM REVERE REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.453	SUP	HCPCS C1713		"524.453  -  5.5MM REVERE REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.454	SUP	HCPCS C1713		"524.454  -  5.5MM REVERE REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.455	SUP	HCPCS C1713		"524.455  -  5.5MM REVERE REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.456	SUP	HCPCS C1713		"524.456  -  5.5MM REVERE REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.457	SUP	HCPCS C1713		"524.457  -  5.5MM REVERE REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.461	SUP	HCPCS C1713		"524.461  -  6.5MM REVERE REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.462	SUP	HCPCS C1713		"524.462  -  6.5MM REVERE REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.463	SUP	HCPCS C1713		"524.463  -  6.5MM REVERE REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.464	SUP	HCPCS C1713		"524.464  -  6.5MM REVERE REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.465	SUP	HCPCS C1713		"524.465  -  6.5MM REVERE REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.466	SUP	HCPCS C1713		"524.466  -  6.5MM REVERE REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.467	SUP	HCPCS C1713		"524.467  -  6.5MM REVERE REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.468	SUP	HCPCS C1713		"524.468  -  6.5MM REVERE REDUCTION SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.469	SUP	HCPCS C1713		"524.469  -  6.5MM REVERE REDUCTION SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.471	SUP	HCPCS C1713		"524.471  -  7.5MM REVERE REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.472	SUP	HCPCS C1713		"524.472  -  7.5MM REVERE REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.473	SUP	HCPCS C1713		"524.473  -  7.5MM REVERE REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.474	SUP	HCPCS C1713		"524.474  -  7.5MM REVERE REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.475	SUP	HCPCS C1713		"524.475  -  7.5MM REVERE REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.476	SUP	HCPCS C1713		"524.476  -  7.5MM REVERE REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.477	SUP	HCPCS C1713		"524.477  -  7.5MM REVERE REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.478	SUP	HCPCS C1713		"524.478  -  7.5MM REVERE REDUCTION SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.479	SUP	HCPCS C1713		"524.479  -  7.5MM REVERE REDUCTION SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.481	SUP	HCPCS C1713		"524.481  -  8.5MM REVERE REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.482	SUP	HCPCS C1713		"524.482  -  8.5MM REVERE REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.483	SUP	HCPCS C1713		"524.483  -  8.5MM REVERE REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.484	SUP	HCPCS C1713		"524.484  -  8.5MM REVERE REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.485	SUP	HCPCS C1713		"524.485  -  8.5MM REVERE REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.486	SUP	HCPCS C1713		"524.486  -  8.5MM REVERE REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.487	SUP	HCPCS C1713		"524.487  -  8.5MM REVERE REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.488	SUP	HCPCS C1713		"524.488  -  8.5MM REVERE REDUCTION SCREW, 60MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.489	SUP	HCPCS C1713		"524.489  -  8.5MM REVERE REDUCTION SCREW, 65MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.51	SUP	Custom 27803010		"524.510  -  5.5MM STRAIGHT ROD, HEX-END, 100MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.512	SUP	Custom 27803010		"524.512  -  5.5MM STRAIGHT ROD, HEX-END, 125MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.515	SUP	Custom 27803010		"524.515  -  5.5MM STRAIGHT ROD, HEX-END, 150MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.517	SUP	Custom 27803010		"524.517  -  5.5MM STRAIGHT ROD, HEX-END, 200MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.519	SUP	Custom 27803010		"524.519  -  5.5MM STRAIGHT ROD, HEX-END, 300MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.52	SUP	Custom 27803010		"524.520  -  5.5MM STRAIGHT ROD, HEX-END, 400MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.521	SUP	Custom 27803010		"524.521  -  5.5MM STRAIGHT ROD, HEX-END, 500MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
524.641	SUP	HCPCS C1713		"524.641  -  REVERE 4.5MM UNIPLANAR SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.642	SUP	HCPCS C1713		"524.642  -  REVERE 4.5MM UNIPLANAR SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.643	SUP	HCPCS C1713		"524.643  -  REVERE 4.5MM UNIPLANAR SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.644	SUP	HCPCS C1713		"524.644  -  REVERE 4.5MM UNIPLANAR SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.645	SUP	HCPCS C1713		"524.645  -  REVERE 4.5MM UNIPLANAR SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.646	SUP	HCPCS C1713		"524.646  -  REVERE 4.5MM UNIPLANAR SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.647	SUP	HCPCS C1713		"524.647  -  REVERE 4.5MM UNIPLANAR SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.651	SUP	HCPCS C1713		"524.651  -  REVERE 5.0MM UNIPLANAR SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.652	SUP	HCPCS C1713		"524.652  -  REVERE 5.0MM UNIPLANAR SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.653	SUP	HCPCS C1713		"524.653  -  REVERE 5.0MM UNIPLANAR SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.654	SUP	HCPCS C1713		"524.654  -  REVERE 5.0MM UNIPLANAR SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.655	SUP	HCPCS C1713		"524.655  -  REVERE 5.0MM UNIPLANAR SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.656	SUP	HCPCS C1713		"524.656  -  REVERE 5.0MM UNIPLANAR SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.657	SUP	HCPCS C1713		"524.657  -  REVERE 5.0MM UNIPLANAR SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.661	SUP	HCPCS C1713		"524.661  -  REVERE 5.5MM UNIPLANAR SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.662	SUP	HCPCS C1713		"524.662  -  REVERE 5.5MM UNIPLANAR SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.663	SUP	HCPCS C1713		"524.663  -  REVERE 5.5MM UNIPLANAR SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.664	SUP	HCPCS C1713		"524.664  -  REVERE 5.5MM UNIPLANAR SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.665	SUP	HCPCS C1713		"524.665  -  REVERE 5.5MM UNIPLANAR SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.666	SUP	HCPCS C1713		"524.666  -  REVERE 5.5MM UNIPLANAR SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.667	SUP	HCPCS C1713		"524.667  -  REVERE 5.5MM UNIPLANAR SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.671	SUP	HCPCS C1713		"524.671  -  REVERE 6.5MM UNIPLANAR SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.672	SUP	HCPCS C1713		"524.672  -  REVERE 6.5MM UNIPLANAR SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.673	SUP	HCPCS C1713		"524.673  -  REVERE 6.5MM UNIPLANAR SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.674	SUP	HCPCS C1713		"524.674  -  REVERE 6.5MM UNIPLANAR SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.675	SUP	HCPCS C1713		"524.675  -  REVERE 6.5MM UNIPLANAR SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.676	SUP	HCPCS C1713		"524.676  -  REVERE 6.5MM UNIPLANAR SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.677	SUP	HCPCS C1713		"524.677  -  REVERE 6.5MM UNIPLANAR SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.851	SUP	HCPCS C1713		"524.851  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 25MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.852	SUP	HCPCS C1713		"524.852  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 30MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.853	SUP	HCPCS C1713		"524.853  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 35MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.854	SUP	HCPCS C1713		"524.854  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 40MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.855	SUP	HCPCS C1713		"524.855  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.856	SUP	HCPCS C1713		"524.856  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.857	SUP	HCPCS C1713		"524.857  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 55MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.871	SUP	HCPCS C1713		"524.871  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 70MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.872	SUP	HCPCS C1713		"524.872  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 75MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.873	SUP	HCPCS C1713		"524.873  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 80MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.874	SUP	HCPCS C1713		"524.874  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 85MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.875	SUP	HCPCS C1713		"524.875  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 90MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.881	SUP	HCPCS C1713		"524.881  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 70MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.882	SUP	HCPCS C1713		"524.882  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 75MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.883	SUP	HCPCS C1713		"524.883  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 80MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.884	SUP	HCPCS C1713		"524.884  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 85MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
524.885	SUP	HCPCS C1713		"524.885  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 90MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
553	SUP	Custom 27203010		CONTROL HGB A2 LYPHCHK LVL 2 1ML EPHRS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
610.514	SUP	Custom 27803010		610.514  -  BIT DRILL 4MM SM STOP	BOTH IP/OP	$672.50 	$497.65	$0.00	$538.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$499.13	$499.13	$0.00	$0.00	$140.15	$0.00	$0.00	$0.00	$0.00	$336.25	$532.62	$538.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
610.712	SUP	Custom 27100030		610.712  -  BIT DRILL 12MM SPNL	BOTH IP/OP	$672.50 	$497.65	$0.00	$538.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$499.13	$499.13	$0.00	$0.00	$140.15	$0.00	$0.00	$0.00	$0.00	$336.25	$532.62	$538.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
610.714	SUP	Custom 27100030		610.714  -  BIT DRILL 14MM SPNL	BOTH IP/OP	$672.50 	$497.65	$0.00	$538.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$499.13	$499.13	$0.00	$0.00	$140.15	$0.00	$0.00	$0.00	$0.00	$336.25	$532.62	$538.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
615.104	SUP	Custom 27100030		615.104  -  BIT DRILL 2.4MM PRTX CT 3.5MM SCR NONSTRL	BOTH IP/OP	"$1,060.00 "	$784.40	$0.00	$848.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$786.73	$786.73	$0.00	$0.00	$220.90	$0.00	$0.00	$0.00	$0.00	$530.00	$839.52	$848.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
615.107	SUP	Custom 27100030		615.107  -  TAP SPNL PRTX CT 3.5-4 MM SCR	BOTH IP/OP	$967.50 	$715.95	$0.00	$774.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$0.00	$0.00	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
615.301	SUP	HCPCS C1713		615.301  -  TMPLT ROD 240MM	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$0.00	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
618.6	SUP	Custom 27203010		618.60  -  LENS OPHTHALMIC GRIESHABER MACULA ASPHERIC VITREORETINAL SUR	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$0.00	$0.00	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
624.214	SUP	Custom 27100030		624.214  -  TAP 4.5MM SURG SPNL REVERE	BOTH IP/OP	$880.00 	$651.20	$0.00	$704.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$653.14	$653.14	$0.00	$0.00	$183.39	$0.00	$0.00	$0.00	$0.00	$440.00	$696.96	$704.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
624.215	SUP	Custom 27100030		624.215  -  TAP 5.5MM SURG SPNL REVERE	BOTH IP/OP	$880.00 	$651.20	$0.00	$704.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$653.14	$653.14	$0.00	$0.00	$183.39	$0.00	$0.00	$0.00	$0.00	$440.00	$696.96	$704.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
624.216	SUP	Custom 27100030		624.216  -  TAP 6.5MM SURG SPNL REVERE	BOTH IP/OP	$880.00 	$651.20	$0.00	$704.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$653.14	$653.14	$0.00	$0.00	$183.39	$0.00	$0.00	$0.00	$0.00	$440.00	$696.96	$704.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.414	SUP	Custom 27803010		"632.414  -  22MM PORT, BEVELED, 40MM"	BOTH IP/OP	$902.50 	$667.85	$0.00	$722.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$669.84	$669.84	$0.00	$0.00	$188.08	$0.00	$0.00	$0.00	$0.00	$451.25	$714.78	$722.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.415	SUP	Custom 27803010		"632.415  -  22MM PORT, BEVELED, 50MM"	BOTH IP/OP	$902.50 	$667.85	$0.00	$722.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$669.84	$669.84	$0.00	$0.00	$188.08	$0.00	$0.00	$0.00	$0.00	$451.25	$714.78	$722.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.416	SUP	Custom 27803010		"632.416  -  22MM PORT, BEVELED, 60MM"	BOTH IP/OP	$902.50 	$667.85	$0.00	$722.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$669.84	$669.84	$0.00	$0.00	$188.08	$0.00	$0.00	$0.00	$0.00	$451.25	$714.78	$722.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.417	SUP	Custom 27803010		"632.417  -  22MM PORT, BEVELED, 70MM"	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	$828.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.18	$768.18	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	$517.50	$819.72	$828.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.418	SUP	Custom 27803010		"632.418  -  22MM PORT, BEVELED, 80MM"	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	$828.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.18	$768.18	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	$517.50	$819.72	$828.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.419	SUP	Custom 27803010		"632.419  -  22MM PORT, BEVELED, 90MM"	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	$828.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.18	$768.18	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	$517.50	$819.72	$828.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.42	SUP	Custom 27803010		"632.420  -  22MM PORT, BEVELED, 100MM"	BOTH IP/OP	"$1,220.00 "	$902.80	$0.00	$976.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$905.48	$905.48	$0.00	$0.00	$254.25	$0.00	$0.00	$0.00	$0.00	$610.00	$966.24	$976.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.421	SUP	Custom 27803010		"632.421  -  22MM PORT, BEVELED, 110MM"	BOTH IP/OP	"$1,220.00 "	$902.80	$0.00	$976.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$905.48	$905.48	$0.00	$0.00	$254.25	$0.00	$0.00	$0.00	$0.00	$610.00	$966.24	$976.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.422	SUP	Custom 27803010		"632.422  -  22MM PORT, BEVELED, 120MM"	BOTH IP/OP	"$1,220.00 "	$902.80	$0.00	$976.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$905.48	$905.48	$0.00	$0.00	$254.25	$0.00	$0.00	$0.00	$0.00	$610.00	$966.24	$976.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.424	SUP	Custom 27803010		"632.424  -  22MM PORT, STRAIGHT, 40MM"	BOTH IP/OP	$835.00 	$617.90	$0.00	$668.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$619.74	$619.74	$0.00	$0.00	$174.01	$0.00	$0.00	$0.00	$0.00	$417.50	$661.32	$668.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.425	SUP	Custom 27803010		"632.425  -  22MM PORT, STRAIGHT, 50MM"	BOTH IP/OP	$835.00 	$617.90	$0.00	$668.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$619.74	$619.74	$0.00	$0.00	$174.01	$0.00	$0.00	$0.00	$0.00	$417.50	$661.32	$668.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.426	SUP	Custom 27803010		"632.426  -  22MM PORT, STRAIGHT, 60MM"	BOTH IP/OP	$835.00 	$617.90	$0.00	$668.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$619.74	$619.74	$0.00	$0.00	$174.01	$0.00	$0.00	$0.00	$0.00	$417.50	$661.32	$668.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.427	SUP	Custom 27803010		"632.427  -  22MM PORT, STRAIGHT, 70MM"	BOTH IP/OP	$942.50 	$697.45	$0.00	$754.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$699.52	$699.52	$0.00	$0.00	$196.42	$0.00	$0.00	$0.00	$0.00	$471.25	$746.46	$754.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.428	SUP	Custom 27803010		"632.428  -  22MM PORT, STRAIGHT, 80MM"	BOTH IP/OP	$942.50 	$697.45	$0.00	$754.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$699.52	$699.52	$0.00	$0.00	$196.42	$0.00	$0.00	$0.00	$0.00	$471.25	$746.46	$754.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.429	SUP	Custom 27803010		"632.429  -  22MM PORT, STRAIGHT, 90MM"	BOTH IP/OP	$942.50 	$697.45	$0.00	$754.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$699.52	$699.52	$0.00	$0.00	$196.42	$0.00	$0.00	$0.00	$0.00	$471.25	$746.46	$754.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.43	SUP	Custom 27803010		632.430  -  SET SPNL 22MM 100MM STRG PORT	BOTH IP/OP	"$1,140.00 "	$843.60	$0.00	$912.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$846.11	$846.11	$0.00	$0.00	$237.58	$0.00	$0.00	$0.00	$0.00	$570.00	$902.88	$912.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.431	SUP	Custom 27803010		"632.431  -  22MM PORT, STRAIGHT, 110MM"	BOTH IP/OP	"$1,140.00 "	$843.60	$0.00	$912.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$846.11	$846.11	$0.00	$0.00	$237.58	$0.00	$0.00	$0.00	$0.00	$570.00	$902.88	$912.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.432	SUP	Custom 27803010		"632.432  -  22MM PORT, STRAIGHT, 120MM"	BOTH IP/OP	"$1,140.00 "	$843.60	$0.00	$912.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$846.11	$846.11	$0.00	$0.00	$237.58	$0.00	$0.00	$0.00	$0.00	$570.00	$902.88	$912.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.434	SUP	Custom 27803010		"632.434  -  19MM PORT, BEVELED, 40MM"	BOTH IP/OP	$902.50 	$667.85	$0.00	$722.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$669.84	$669.84	$0.00	$0.00	$188.08	$0.00	$0.00	$0.00	$0.00	$451.25	$714.78	$722.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.435	SUP	Custom 27803010		"632.435  -  19MM PORT, BEVELED, 50MM"	BOTH IP/OP	$902.50 	$667.85	$0.00	$722.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$669.84	$669.84	$0.00	$0.00	$188.08	$0.00	$0.00	$0.00	$0.00	$451.25	$714.78	$722.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.436	SUP	Custom 27803010		632.436  -  SPACER SPNL 60MMX19MM BVL PORT PEEK INTRBD FS	BOTH IP/OP	$902.50 	$667.85	$0.00	$722.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$669.84	$669.84	$0.00	$0.00	$188.08	$0.00	$0.00	$0.00	$0.00	$451.25	$714.78	$722.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.437	SUP	Custom 27803010		632.437  -  SPACER SPNL 70MMX19MM BVL PORT PEEK INTRBD FS	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	$828.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.18	$768.18	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	$517.50	$819.72	$828.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.438	SUP	Custom 27803010		"632.438  -  19MM PORT, BEVELED, 80MM"	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	$828.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.18	$768.18	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	$517.50	$819.72	$828.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.439	SUP	Custom 27803010		"632.439  -  19MM PORT, BEVELED, 90MM"	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	$828.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.18	$768.18	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	$517.50	$819.72	$828.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.44	SUP	Custom 27803010		"632.440  -  19MM PORT, BEVELED, 100MM"	BOTH IP/OP	"$1,220.00 "	$902.80	$0.00	$976.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$905.48	$905.48	$0.00	$0.00	$254.25	$0.00	$0.00	$0.00	$0.00	$610.00	$966.24	$976.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.441	SUP	Custom 27803010		"632.441  -  19MM PORT, BEVELED, 110MM"	BOTH IP/OP	"$1,220.00 "	$902.80	$0.00	$976.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$905.48	$905.48	$0.00	$0.00	$254.25	$0.00	$0.00	$0.00	$0.00	$610.00	$966.24	$976.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.442	SUP	Custom 27803010		"632.442  -  19MM PORT, BEVELED, 120MM"	BOTH IP/OP	"$1,220.00 "	$902.80	$0.00	$976.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$905.48	$905.48	$0.00	$0.00	$254.25	$0.00	$0.00	$0.00	$0.00	$610.00	$966.24	$976.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.444	SUP	Custom 27803010		632.444  -  SPACER SPNL 19MMX40MM PEEK INTRBD FS	BOTH IP/OP	$835.00 	$617.90	$0.00	$668.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$619.74	$619.74	$0.00	$0.00	$174.01	$0.00	$0.00	$0.00	$0.00	$417.50	$661.32	$668.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.445	SUP	Custom 27803010		632.445  -  SPACER SPNL 50MMX19MM STRG PORT PEEK INTRBD FS	BOTH IP/OP	$835.00 	$617.90	$0.00	$668.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$619.74	$619.74	$0.00	$0.00	$174.01	$0.00	$0.00	$0.00	$0.00	$417.50	$661.32	$668.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.446	SUP	Custom 27803010		"632.446  -  19MM PORT, STRAIGHT, 60MM"	BOTH IP/OP	$835.00 	$617.90	$0.00	$668.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$619.74	$619.74	$0.00	$0.00	$174.01	$0.00	$0.00	$0.00	$0.00	$417.50	$661.32	$668.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.447	SUP	Custom 27803010		"632.447  -  19MM PORT, STRAIGHT, 70MM"	BOTH IP/OP	$942.50 	$697.45	$0.00	$754.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$699.52	$699.52	$0.00	$0.00	$196.42	$0.00	$0.00	$0.00	$0.00	$471.25	$746.46	$754.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.448	SUP	Custom 27803010		"632.448  -  19MM PORT, STRAIGHT, 80MM"	BOTH IP/OP	$942.50 	$697.45	$0.00	$754.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$699.52	$699.52	$0.00	$0.00	$196.42	$0.00	$0.00	$0.00	$0.00	$471.25	$746.46	$754.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.449	SUP	Custom 27803010		"632.449  -  19MM PORT, STRAIGHT, 90MM"	BOTH IP/OP	$942.50 	$697.45	$0.00	$754.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$699.52	$699.52	$0.00	$0.00	$196.42	$0.00	$0.00	$0.00	$0.00	$471.25	$746.46	$754.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.45	SUP	Custom 27803010		"632.450  -  19MM PORT, STRAIGHT, 100MM"	BOTH IP/OP	"$1,140.00 "	$843.60	$0.00	$912.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$846.11	$846.11	$0.00	$0.00	$237.58	$0.00	$0.00	$0.00	$0.00	$570.00	$902.88	$912.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.451	SUP	Custom 27803010		"632.451  -  19MM PORT, STRAIGHT, 110MM"	BOTH IP/OP	"$1,140.00 "	$843.60	$0.00	$912.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$846.11	$846.11	$0.00	$0.00	$237.58	$0.00	$0.00	$0.00	$0.00	$570.00	$902.88	$912.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.452	SUP	Custom 27803010		"632.452  -  19MM PORT, STRAIGHT, 120MM"	BOTH IP/OP	"$1,140.00 "	$843.60	$0.00	$912.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$846.11	$846.11	$0.00	$0.00	$237.58	$0.00	$0.00	$0.00	$0.00	$570.00	$902.88	$912.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.454	SUP	Custom 27803010		"632.454  -  26MM PORT, BEVELED, 40MM"	BOTH IP/OP	"$1,167.50 "	$863.95	$0.00	$934.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$866.52	$866.52	$0.00	$0.00	$243.31	$0.00	$0.00	$0.00	$0.00	$583.75	$924.66	$934.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.455	SUP	Custom 27803010		"632.455  -  26MM PORT, BEVELED, 50MM"	BOTH IP/OP	"$1,167.50 "	$863.95	$0.00	$934.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$866.52	$866.52	$0.00	$0.00	$243.31	$0.00	$0.00	$0.00	$0.00	$583.75	$924.66	$934.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.456	SUP	Custom 27803010		"632.456  -  26MM PORT, BEVELED, 60MM"	BOTH IP/OP	"$1,167.50 "	$863.95	$0.00	$934.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$866.52	$866.52	$0.00	$0.00	$243.31	$0.00	$0.00	$0.00	$0.00	$583.75	$924.66	$934.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.457	SUP	Custom 27803010		"632.457  -  26MM PORT, BEVELED, 70MM"	BOTH IP/OP	"$1,272.50 "	$941.65	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.45	$944.45	$0.00	$0.00	$265.19	$0.00	$0.00	$0.00	$0.00	$636.25	"$1,007.82"	"$1,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.458	SUP	Custom 27803010		"632.458  -  26MM PORT, BEVELED, 80MM"	BOTH IP/OP	"$1,272.50 "	$941.65	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.45	$944.45	$0.00	$0.00	$265.19	$0.00	$0.00	$0.00	$0.00	$636.25	"$1,007.82"	"$1,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.459	SUP	Custom 27803010		"632.459  -  26MM PORT, BEVELED, 90MM"	BOTH IP/OP	"$1,272.50 "	$941.65	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.45	$944.45	$0.00	$0.00	$265.19	$0.00	$0.00	$0.00	$0.00	$636.25	"$1,007.82"	"$1,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.46	SUP	Custom 27803010		"632.460  -  26MM PORT, BEVELED, 100MM"	BOTH IP/OP	"$1,380.00 "	"$1,021.20"	$0.00	"$1,104.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.24"	"$1,024.24"	$0.00	$0.00	$287.59	$0.00	$0.00	$0.00	$0.00	$690.00	"$1,092.96"	"$1,104.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.461	SUP	Custom 27803010		"632.461  -  26MM PORT, BEVELED, 110MM"	BOTH IP/OP	"$1,380.00 "	"$1,021.20"	$0.00	"$1,104.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.24"	"$1,024.24"	$0.00	$0.00	$287.59	$0.00	$0.00	$0.00	$0.00	$690.00	"$1,092.96"	"$1,104.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.462	SUP	Custom 27803010		"632.462  -  26MM PORT, BEVELED, 120MM"	BOTH IP/OP	"$1,380.00 "	"$1,021.20"	$0.00	"$1,104.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.24"	"$1,024.24"	$0.00	$0.00	$287.59	$0.00	$0.00	$0.00	$0.00	$690.00	"$1,092.96"	"$1,104.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.464	SUP	Custom 27803010		"632.464  -  26MM PORT, STRAIGHT, 40MM"	BOTH IP/OP	"$1,140.00 "	$843.60	$0.00	$912.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$846.11	$846.11	$0.00	$0.00	$237.58	$0.00	$0.00	$0.00	$0.00	$570.00	$902.88	$912.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.465	SUP	Custom 27803010		"632.465  -  26MM PORT, STRAIGHT, 50MM"	BOTH IP/OP	"$1,140.00 "	$843.60	$0.00	$912.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$846.11	$846.11	$0.00	$0.00	$237.58	$0.00	$0.00	$0.00	$0.00	$570.00	$902.88	$912.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.466	SUP	Custom 27803010		632.466  -  SPACER SPNL TBLR 60MMX26MM PEEK INTRBD FS	BOTH IP/OP	"$1,140.00 "	$843.60	$0.00	$912.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$846.11	$846.11	$0.00	$0.00	$237.58	$0.00	$0.00	$0.00	$0.00	$570.00	$902.88	$912.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.467	SUP	Custom 27803010		632.467  -  SPACER SPNL TBLR 70MMX26MM PEEK INTRBD FS	BOTH IP/OP	"$1,272.50 "	$941.65	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.45	$944.45	$0.00	$0.00	$265.19	$0.00	$0.00	$0.00	$0.00	$636.25	"$1,007.82"	"$1,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.468	SUP	Custom 27803010		632.468  -  SPACER SPNL TBLR 80MMX26MM PEEK INTRBD FS	BOTH IP/OP	"$1,272.50 "	$941.65	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.45	$944.45	$0.00	$0.00	$265.19	$0.00	$0.00	$0.00	$0.00	$636.25	"$1,007.82"	"$1,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.469	SUP	Custom 27803010		"632.469  -  26MM PORT, STRAIGHT, 90MM"	BOTH IP/OP	"$1,272.50 "	$941.65	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.45	$944.45	$0.00	$0.00	$265.19	$0.00	$0.00	$0.00	$0.00	$636.25	"$1,007.82"	"$1,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.47	SUP	Custom 27803010		"632.470  -  26MM PORT, STRAIGHT, 100MM"	BOTH IP/OP	"$1,380.00 "	"$1,021.20"	$0.00	"$1,104.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.24"	"$1,024.24"	$0.00	$0.00	$287.59	$0.00	$0.00	$0.00	$0.00	$690.00	"$1,092.96"	"$1,104.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.471	SUP	Custom 27803010		"632.471  -  26MM PORT, STRAIGHT, 110MM"	BOTH IP/OP	"$1,380.00 "	"$1,021.20"	$0.00	"$1,104.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.24"	"$1,024.24"	$0.00	$0.00	$287.59	$0.00	$0.00	$0.00	$0.00	$690.00	"$1,092.96"	"$1,104.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.472	SUP	Custom 27803010		"632.472  -  26MM PORT, STRAIGHT, 120MM"	BOTH IP/OP	"$1,380.00 "	"$1,021.20"	$0.00	"$1,104.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.24"	"$1,024.24"	$0.00	$0.00	$287.59	$0.00	$0.00	$0.00	$0.00	$690.00	"$1,092.96"	"$1,104.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
648.216	SUP	Custom 27203010		648.216  -  BIT DRILL FIX 2.4MM BONE CORRIDOR	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
650.012	SUP	HCPCS C1713		650.012  -  HOLDER IMPLANT TEMPORARY FIX SCREW SPN	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
650.112	SUP	Custom 27203010		650.112  -  BIT DRL 12MM STRL REUSE	BOTH IP/OP	$672.50 	$497.65	$0.00	$538.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$499.13	$499.13	$0.00	$0.00	$140.15	$0.00	$0.00	$0.00	$0.00	$336.25	$532.62	$538.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
650.114	SUP	Custom 27100030		650.114  -  BIT DRL 14MM STRL REUSE	BOTH IP/OP	$672.50 	$497.65	$0.00	$538.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$499.13	$499.13	$0.00	$0.00	$140.15	$0.00	$0.00	$0.00	$0.00	$336.25	$532.62	$538.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
650.116	SUP	Custom 27203010		650.116  -  BIT DRL 16MM STRL REUSE	BOTH IP/OP	$672.50 	$497.65	$0.00	$538.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$499.13	$499.13	$0.00	$0.00	$140.15	$0.00	$0.00	$0.00	$0.00	$336.25	$532.62	$538.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
682.104	SUP	Custom 27203010		682.104  -  BIT DRILL 2.4MM 3.5MM SCR ELLI	BOTH IP/OP	$950.00 	$703.00	$0.00	$760.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$705.09	$705.09	$0.00	$0.00	$197.98	$0.00	$0.00	$0.00	$0.00	$475.00	$752.40	$760.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
682.105	SUP	Custom 27203010		682.105  -  BIT DRILL 4 MM TITANIUM SCREW	BOTH IP/OP	$950.00 	$703.00	$0.00	$760.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$705.09	$705.09	$0.00	$0.00	$197.98	$0.00	$0.00	$0.00	$0.00	$475.00	$752.40	$760.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
682.107	SUP	Custom 27203010		682.107  -  TAP SURG TITANIUM SPN 4 MM SCREW	BOTH IP/OP	$950.00 	$703.00	$0.00	$760.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$705.09	$705.09	$0.00	$0.00	$197.98	$0.00	$0.00	$0.00	$0.00	$475.00	$752.40	$760.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
685.005	SUP	HCPCS C1769		685.005  -  GUIDEWIRE ORTHOPEDIC 500MM BLUNT SPN	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$156.11	$156.11	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
746	SUP	Custom 27203010		REAGENT ANALY STA ST FNCT PRTN S CLOT BS ASY 1ML	BOTH IP/OP	$594.95 	$440.26	$0.00	$475.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$297.48	$471.20	$475.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
751	SUP	Custom 27203010		CONTROL CHM 3ML LVL 1 ASY MLANLT LQCHK	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
752	SUP	Custom 27203010		CONTROL CHM 3ML LVL 2 ASY MLANLT LQCHK	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
804	SUP	HCPCS C1713		804  -  SCREW 804 2.2MM X-DRV 4MM 6PK	BOTH IP/OP	$97.75 	$72.34	$0.00	$78.20	$43.99	$43.99	$0.00	$0.00	$0.00	$20.37	$72.55	$72.55	$0.00	$0.00	$20.37	$0.00	$57.82	$57.82	$0.00	$48.88	$77.42	$78.20	$0.00		$0.00	$15.30	$0.00	$0.00	$15.56	$0.00	$0.00	$0.00	$0.00	$0.00
805	SUP	HCPCS C1713		805  -  SCREW 805 2.2MM X-DRV 5MM 6	BOTH IP/OP	$98.10 	$72.59	$0.00	$78.48	$44.15	$44.15	$0.00	$0.00	$0.00	$20.45	$72.81	$72.81	$0.00	$0.00	$20.44	$0.00	$58.03	$58.03	$0.00	$49.05	$77.70	$78.48	$0.00		$0.00	$15.35	$0.00	$0.00	$15.62	$0.00	$0.00	$0.00	$0.00	$0.00
807	SUP	HCPCS C1713		807  -  SCREW 807 2.2MM X-DRV 7MM 6	BOTH IP/OP	$97.75 	$72.34	$0.00	$78.20	$43.99	$43.99	$0.00	$0.00	$0.00	$20.37	$72.55	$72.55	$0.00	$0.00	$20.37	$0.00	$57.82	$57.82	$0.00	$48.88	$77.42	$78.20	$0.00		$0.00	$15.30	$0.00	$0.00	$15.56	$0.00	$0.00	$0.00	$0.00	$0.00
835.105	SUP	Custom 27804086		"835.105  -  MAINTAIN CERVICAL ALLOGRAFT, 5MM PARALLEL"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.106	SUP	Custom 27804086		"835.106  -  MAINTAIN CERVICAL ALLOGRAFT, 6MM PARALLEL"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.107	SUP	Custom 27804086		"835.107  -  MAINTAIN CERVICAL ALLOGRAFT, 7MM PARALLEL"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.108	SUP	Custom 27804086		"835.108  -  MAINTAIN CERVICAL ALLOGRAFT, 8MM PARALLEL"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.109	SUP	Custom 27804086		"835.109  -  MAINTAIN CERVICAL ALLOGRAFT, 9MM PARALLEL"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.11	SUP	Custom 27804086		"835.110  -  MAINTAIN CERVICAL ALLOGRAFT, 10MM PARALLEL"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.111	SUP	Custom 27804086		"835.111  -  MAINTAIN CERVICAL ALLOGRAFT, 11MM PARALLEL"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.112	SUP	Custom 27804086		"835.112  -  MAINTAIN CERVICAL ALLOGRAFT, 12MM PARALLEL"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.205	SUP	Custom 27804086		"835.205  -  MAINTAIN CERVICAL ALLOGRAFT, 5MM LORDOTIC"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.206	SUP	Custom 27804086		"835.206  -  MAINTAIN CERVICAL ALLOGRAFT, 6MM LORDOTIC"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.207	SUP	Custom 27804086		"835.207  -  MAINTAIN CERVICAL ALLOGRAFT, 7MM LORDOTIC"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.208	SUP	Custom 27804086		"835.208  -  MAINTAIN CERVICAL ALLOGRAFT, 8MM LORDOTIC"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.209	SUP	Custom 27804086		"835.209  -  MAINTAIN CERVICAL ALLOGRAFT, 9MM LORDOTIC"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.21	SUP	Custom 27804086		"835.210  -  MAINTAIN CERVICAL ALLOGRAFT, 10MM LORDOTIC"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.211	SUP	Custom 27804086		"835.211  -  MAINTAIN CERVICAL ALLOGRAFT, 11MM LORDOTIC"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
835.212	SUP	Custom 27804086		"835.212  -  MAINTAIN CERVICAL ALLOGRAFT, 12MM LORDOTIC"	BOTH IP/OP	"$3,460.00 "	"$2,560.40"	$0.00	"$2,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,568.01"	"$2,568.01"	$0.00	$0.00	$721.06	$0.00	$0.00	$0.00	$0.00	"$1,730.00"	"$2,740.32"	"$2,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
846	SUP	Custom 27011340		846  -  ELECTRODE PATIENT RETURN THK1/8IN 36X20IN 2 CORD MEGA SOFT	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,771.40"	$0.00	$0.00	$0.00	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
876	SUP	Custom 27203010		BLANKET 64X25IN MXTHR L HPR/HPO NWVN DISP WRM	BOTH IP/OP	$30.93 	$22.89	$0.00	$24.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.95	$22.95	$0.00	$0.00	$6.44	$0.00	$0.00	$0.00	$0.00	$15.46	$24.50	$24.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
876.853	SUP	HCPCS C1713		876.853  -  SCREW BONE 4.5MM 13MM ATLNTS TI CANC ANT CERV SPNE SLFTAP VA	BOTH IP/OP	"$1,202.95 "	$890.18	$0.00	$962.36	$541.33	$541.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$601.48	$952.74	$962.36	$0.00		$0.00	$188.26	$0.00	$0.00	$191.51	$0.00	$0.00	$0.00	$0.00	$0.00
900.601	SUP	Custom 27203010		900.601  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM DRILL TIP NONSTRL 3.5MM	BOTH IP/OP	$80.83 	$59.81	$0.00	$62.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.99	$59.99	$0.00	$0.00	$16.84	$0.00	$0.00	$0.00	$0.00	$39.23	$62.13	$62.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900.721	SUP	HCPCS C1769		900.721  -  GUIDEWIRE ORTHOPEDIC 1.25MM 150MM NONTHREADED COBALT NONSTRL	BOTH IP/OP	$52.35 	$38.74	$0.00	$40.66	$27.60	$27.60	$0.00	$0.00	$0.00	$10.91	$38.85	$38.85	$0.00	$0.00	$10.91	$0.00	$30.97	$30.97	$0.00	$25.41	$40.26	$40.66	$0.00		$0.00	$7.72	$0.00	$0.00	$8.09	$0.00	$0.00	$0.00	$0.00	$0.00
900.722	SUP	HCPCS C1769		900.722  -  GUIDEWIRE ORTHOPEDIC 1.25MM 150MM THREAD NONSTRL 3.5MM CANN	BOTH IP/OP	$55.50 	$41.07	$0.00	$43.12	$29.27	$29.27	$0.00	$0.00	$0.00	$11.57	$41.19	$41.19	$0.00	$0.00	$11.57	$0.00	$32.83	$32.83	$0.00	$26.95	$42.69	$43.12	$0.00		$0.00	$8.19	$0.00	$0.00	$8.58	$0.00	$0.00	$0.00	$0.00	$0.00
900.723	SUP	HCPCS C1769		900.723  -  GUIDEWIRE ORTHOPEDIC SPADE 2.5MM 230MM THREAD LCP DHHS	BOTH IP/OP	$90.65 	$67.08	$0.00	$70.42	$47.80	$47.80	$0.00	$0.00	$0.00	$18.89	$67.28	$67.28	$0.00	$0.00	$18.89	$0.00	$53.62	$53.62	$0.00	$44.01	$69.72	$70.42	$0.00		$0.00	$13.37	$0.00	$0.00	$14.01	$0.00	$0.00	$0.00	$0.00	$0.00
900.726	SUP	HCPCS C1769		900.726  -  GUIDEWIRE ORTHOPEDIC 2.8MM 450MM 300MM TROCAR POINT THREADED	BOTH IP/OP	$147.60 	$109.22	$0.00	$114.64	$77.81	$77.81	$0.00	$0.00	$0.00	$30.76	$109.55	$109.55	$0.00	$0.00	$30.76	$0.00	$87.31	$87.31	$0.00	$71.65	$113.49	$114.64	$0.00		$0.00	$21.77	$0.00	$0.00	$22.81	$0.00	$0.00	$0.00	$0.00	$0.00
910.011	SUP	HCPCS C1713		910.011  -  ASSURE SCREW RACK INSERT FOR 4.0MM STANDARD SELF-DRILLING SC	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.012	SUP	HCPCS C1713		910.012  -  ASSURE SCREW RACK INSERT FOR 4.5MM STANDARD SELF-DRILLING SC	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.013	SUP	HCPCS C1713		910.013  -  ASSURE SCREW RACK INSERT FOR 4.0MM STANDARD SELF-TAPPING SCR	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.014	SUP	HCPCS C1713		910.014  -  ASSURE SCREW RACK INSERT FOR 4.5MM STANDARD SELF-TAPPING SCR	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.021	SUP	HCPCS C1713		910.021  -  ASSURE SCREW RACK INSERT FOR 4.0MM RIGID SELF-DRILLING SCREW	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.022	SUP	HCPCS C1713		910.022  -  ASSURE SCREW RACK INSERT FOR 4.5MM RIGID SELF-DRILLING SCREW	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.023	SUP	HCPCS C1713		910.023  -  ASSURE SCREW RACK INSERT FOR 4.0MM RIGID SELF-TAPPING SCREWS	BOTH IP/OP	$530.00 	$392.20	$0.00	$424.00	$238.50	$238.50	$0.00	$0.00	$0.00	$110.47	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$313.50	$313.50	$0.00	$265.00	$419.76	$424.00	$0.00		$0.00	$82.95	$0.00	$0.00	$84.38	$0.00	$0.00	$0.00	$0.00	$0.00
910.024	SUP	HCPCS C1713		910.024  -  ASSURE SCREW RACK INSERT FOR 4.5MM RIGID SELF-TAPPING SCREWS	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.03	SUP	HCPCS C1713		910.030  -  ASSURE SCREW RACK INSERT FOR AUXILLARY SCREWS	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.511	SUP	HCPCS C1713		910.511  -  ASSURE SCREW RACK INSERT FOR 4.0MM STANDARD FIXED SELF-DRILL	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.512	SUP	HCPCS C1713		910.512  -  ASSURE SCREW RACK INSERT FOR 4.5MM STANDARD FIXED SELF-DRILL	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.513	SUP	HCPCS C1713		910.513  -  ASSURE SCREW RACK INSERT FOR 4.0MM STANDARD FIXED SELF-TAPPI	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.514	SUP	HCPCS C1713		910.514  -  ASSURE SCREW RACK INSERT FOR 4.5MM STANDARD FIXED SELF-TAPPI	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.521	SUP	HCPCS C1713		910.521  -  ASSURE SCREW RACK INSERT FOR 4.0MM FIXED SELF-DRILLING SCREW	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.522	SUP	HCPCS C1713		910.522  -  ASSURE SCREW RACK INSERT FOR 4.5MM FIXED SELF-DRILLING SCREW	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.523	SUP	HCPCS C1713		910.523  -  ASSURE SCREW RACK INSERT FOR 4.0MM FIXED SELF-TAPPING SCREWS	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.524	SUP	HCPCS C1713		910.524  -  ASSURE SCREW RACK INSERT FOR 4.5MM FIXED SELF-TAPPING SCREWS	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
910.525	SUP	HCPCS C1713		910.525  -  ASSURE SCREW RACK INSERT FOR AUXILIARY FIXED SCREWS	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
917.002	SUP	HCPCS C1713		"917.002  -  ASSURE TRANSLATIONAL CERVICAL PLATE IMPLANT MODULE FOR 1,2 A"	BOTH IP/OP	"$2,120.00 "	"$1,568.80"	$0.00	"$1,696.00"	$954.00	$954.00	$0.00	$0.00	$0.00	$441.86	"$1,573.46"	"$1,573.46"	$0.00	$0.00	$441.81	$0.00	"$1,253.98"	"$1,253.98"	$0.00	"$1,060.00"	"$1,679.04"	"$1,696.00"	$0.00		$0.00	$331.78	$0.00	$0.00	$337.50	$0.00	$0.00	$0.00	$0.00	$0.00
917.004	SUP	HCPCS C1713		917.004  -  ASSURE TRANSLATIONAL CERVICAL PLATE IMPLANT MODULE FOR 4-LEV	BOTH IP/OP	"$1,962.50 "	"$1,452.25"	$0.00	"$1,570.00"	$883.13	$883.13	$0.00	$0.00	$0.00	$409.03	"$1,456.57"	"$1,456.57"	$0.00	$0.00	$408.99	$0.00	"$1,160.82"	"$1,160.82"	$0.00	$981.25	"$1,554.30"	"$1,570.00"	$0.00		$0.00	$307.13	$0.00	$0.00	$312.43	$0.00	$0.00	$0.00	$0.00	$0.00
929.007	SUP	HCPCS C1713		929.007  -  GATEWAY/CITADEL BONE SCREW MODULE	BOTH IP/OP	"$3,180.00 "	"$2,353.20"	$0.00	"$2,544.00"	"$1,431.00"	"$1,431.00"	$0.00	$0.00	$0.00	$662.79	"$2,360.20"	"$2,360.20"	$0.00	$0.00	$662.71	$0.00	"$1,567.74"	"$1,567.74"	$0.00	"$1,590.00"	"$2,518.56"	"$2,544.00"	$0.00		$0.00	$497.67	$0.00	$0.00	$506.26	$0.00	$0.00	$0.00	$0.00	$0.00
992	SUP	HCPCS C1713		992  -  KIT ARTHRO FIX TRNFX2 SCR CANN DILAT ROTR CUF STRL DISP	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
1001	SUP	Custom 27203010		KIT MYCTST M TB AMPLF DIR 50 TST	BOTH IP/OP	"$3,090.00 "	"$2,286.60"	$0.00	"$2,472.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,545.00"	"$2,447.28"	"$2,472.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1006	SUP	Custom 27203010		1006  -  PROBE VITRTM LGC VRST ATIOP ANT OCCUTOME STRL DISP	BOTH IP/OP	$413.33 	$305.86	$0.00	$330.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.77	$306.77	$0.00	$0.00	$86.14	$0.00	$0.00	$0.00	$0.00	$206.66	$327.36	$330.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1028	SUP	HCPCS C2628		1028  -  CATHETER BLNOCC FLOCONTROL	BOTH IP/OP	"$6,987.50 "	"$5,170.75"	$0.00	"$5,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,456.37"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.20"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,493.75"	"$5,534.10"	"$5,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1041	SUP	Custom 27203010		MASK O2 VNYL ADLT ELNG UNDCHN MED CONCEN TBG 7FT	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1049	SUP	Custom 27203010		01049  -  MASK O2 VNYL ADLT UNDCHN STY MED CONCEN W/O TBG LATEX FREE	BOTH IP/OP	$1.04 	$0.77	$0.00	$0.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.52	$0.82	$0.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1151	SUP	Custom 27203010		1151  -  MANIPULATOR SURG UT INJECTOR 4.5MM DISP	BOTH IP/OP	$55.70 	$41.22	$0.00	$41.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.34	$41.34	$0.00	$0.00	$11.61	$0.00	$0.00	$0.00	$0.00	$25.52	$40.42	$40.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1201	SUP	Custom 27803010		1201  -  CLIP INTERNAL SMALL CHEVRON TRIANGLE WIDE LIGATE CROSS	BOTH IP/OP	$4.58 	$3.39	$0.00	$3.66	$2.06	$2.06	$0.00	$0.00	$0.00	$0.95	$3.40	$3.40	$0.00	$0.00	$0.95	$0.00	$2.71	$2.71	$0.00	$2.29	$0.83	$3.66	$0.00		$0.00	$0.72	$0.00	$0.00	$0.73	$0.00	$0.00	$0.00	$0.00	$0.00
1201	SUP	HCPCS C1760		001201  -  CLIP SM INTNL HRZN TI ENDSCP LIGAT STRL DISP LATEX FREE	BOTH IP/OP	$4.58 	$3.39	$0.00	$3.66	$2.06	$2.06	$0.00	$0.00	$0.00	$0.95	$3.40	$3.40	$0.00	$0.00	$0.95	$0.00	$2.71	$2.71	$0.00	$2.29	$3.63	$3.66	$0.00		$0.00	$0.72	$0.00	$0.00	$0.73	$0.00	$0.00	$0.00	$0.00	$0.00
1266	SUP	Custom 27203010		REAGENT THYGL AB IMMUN	BOTH IP/OP	$621.35 	$459.80	$0.00	$497.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.68	$492.11	$497.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1273	SUP	Custom 27203010		KIT IMMUN TST THR MICROSOMAL AB	BOTH IP/OP	$621.35 	$459.80	$0.00	$497.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.68	$492.11	$497.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1435	SUP	Custom 27203010		1435  -  BANDAGE COMPRESSION A TUBULAR 10MR MULTPUR ELAST COMFORTABLE	BOTH IP/OP	$39.80 	$29.45	$0.00	$34.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.54	$29.54	$0.00	$0.00	$8.29	$0.00	$0.00	$0.00	$0.00	$21.34	$33.80	$34.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1438	SUP	Custom 27203010		1438  -  BANDAGE COMPRESSION F LARGE KNEE MEDIUM THIGH TUBULAR 10MR	BOTH IP/OP	$89.85 	$66.49	$0.00	$69.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.69	$66.69	$0.00	$0.00	$18.72	$0.00	$0.00	$0.00	$0.00	$43.30	$68.60	$69.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1441	SUP	Custom 27203010		1441  -  BANDAGE COMPRESSION K 10MR TUBULAR MULTPUR COMFORTABLE	BOTH IP/OP	$136.15 	$100.75	$0.00	$116.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.05	$101.05	$0.00	$0.00	$28.37	$0.00	$0.00	$0.00	$0.00	$72.99	$115.62	$116.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1443	SUP	Custom 27203010		1443  -  BANDAGE COMPRESSION C MEDIUM ARM SMALL ANKLE TUBULAR 10MR	BOTH IP/OP	$57.43 	$42.50	$0.00	$49.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.62	$42.62	$0.00	$0.00	$11.97	$0.00	$0.00	$0.00	$0.00	$30.78	$48.76	$49.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1534	SUP	Custom 27203010		1534  -  SYSTEM GSTRC LAV 34FR NS ESLV TUBE RADOPQ STRP EASI-LOK ADPR	BOTH IP/OP	$365.14 	$270.20	$0.00	$292.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.01	$271.01	$0.00	$0.00	$76.10	$0.00	$0.00	$0.00	$0.00	$182.57	$289.19	$292.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1537	SUP	Custom 27203010		1537  -  FORCEPS BIOPSY COLD	BOTH IP/OP	$34.78 	$25.74	$0.00	$27.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.81	$25.81	$0.00	$0.00	$7.25	$0.00	$0.00	$0.00	$0.00	$17.39	$27.55	$27.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1651	SUP	Custom 27203010		SENSOR NEO LNOP FNGR TOE OXM ADH OPTC PRB DISP	BOTH IP/OP	$641.70 	$474.86	$0.00	$513.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.85	$508.23	$513.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1791	SUP	Custom 27203010		REAGENT CT GC AP CMB 2 DTCT KT 1200 TST ANALY	BOTH IP/OP	$64.38 	$47.64	$0.00	$51.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.19	$50.99	$51.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1798	SUP	Custom 27203010		SENSOR NEO LNOP NEO-L OXM ADH DISP	BOTH IP/OP	$31.05 	$22.98	$0.00	$24.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.53	$24.59	$24.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1800	SUP	Custom 27203010		SENSOR INF LNOP GRT TOE THB OXM ADH STRAP INF-L	BOTH IP/OP	$31.05 	$22.98	$0.00	$24.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.53	$24.59	$24.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1863	SUP	Custom 27203010		SENSOR ADLT LNCS DCI OXM ADH CBL NSTRL LF DISP	BOTH IP/OP	$457.20 	$338.33	$0.00	$365.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.60	$362.10	$365.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1892	SUP	Custom 27011340		1892  -  SET PRSS MONITR COMBITRANS	BOTH IP/OP	$113.75 	$84.18	$0.00	$91.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.43	$84.43	$0.00	$0.00	$23.71	$0.00	$0.00	$0.00	$0.00	$56.88	$90.09	$91.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1895	SUP	Custom 27203010		SENSOR REUSABLE TIP CLIP EAR LNOP TC-I	BOTH IP/OP	$457.20 	$338.33	$0.00	$365.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.60	$362.10	$365.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1896	SUP	Custom 27203010		SENSOR REUSABLE FOREHEAD LNOP TF-I	BOTH IP/OP	$572.50 	$423.65	$0.00	$458.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.25	$453.42	$458.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1904	SUP	Custom 27203010		ENFACARE LIPIL POWDER 12.8OZ	BOTH IP/OP	$190.00 	$140.60	$0.00	$152.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.00	$150.48	$152.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1951	SUP	Custom 27203010		1951  -  HEMOSTAT ABSORBABLE 14X2IN ORIGINAL FLEXIBLE SHEER WEAVE	BOTH IP/OP	$136.04 	$100.67	$0.00	$108.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.97	$100.97	$0.00	$0.00	$28.35	$0.00	$0.00	$0.00	$0.00	$68.02	$107.74	$108.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1974	SUP	Custom 27203010		1974  -  SPONGE ABSORBABLE THK10MM 100 12.5X8CM HEMOSTAT SURGIFOAM	BOTH IP/OP	$48.96 	$36.23	$0.00	$73.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.34	$36.34	$0.00	$0.00	$10.20	$0.00	$0.00	$0.00	$0.00	$45.84	$72.62	$73.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1985	SUP	Custom 27203010		1985  -  AGENT HMST STRL LF INSTAT ABS MCFIB CLGN 1GM DISP	BOTH IP/OP	$108.73 	$80.46	$0.00	$86.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.00	$73.00	$0.00	$0.00	$20.50	$0.00	$0.00	$0.00	$0.00	$41.04	$86.11	$65.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2056	SUP	Custom 27203010		2056  -  APL BRCHTX 5-6CM VAR TRY MAMST 8MM BRST	BOTH IP/OP	"$6,875.00 "	"$5,087.50"	$0.00	"$5,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,432.75"	$0.00	$0.00	$0.00	$0.00	"$3,437.50"	"$5,445.00"	"$5,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2083	SUP	Custom 27203010		2083  -  HEMOSTAT ABS 4X4IN NWVN BCTRCD SRGCL SNOW CLU FBRC	BOTH IP/OP	$286.01 	$211.65	$0.00	$228.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.28	$212.28	$0.00	$0.00	$59.60	$0.00	$0.00	$0.00	$0.00	$143.01	$226.52	$228.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2161	SUP	Custom 27203010		STRIP UA MLSTX 10 SG 9 PRMTR SG REAGENT 100 TST	BOTH IP/OP	$81.00 	$59.94	$0.00	$64.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.50	$64.15	$64.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2200	SUP	Custom 27803010		2200  -  CLIP INTERNAL MEDIUM CHEVRON HEART TRNSVRS GROOVE LIGATE	BOTH IP/OP	$6.90 	$5.11	$0.00	$5.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.45	$5.46	$5.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2406	SUP	Custom 27203010		STAIN DVD MRKNG 2OZ REFL BTL SET AST HISTOLGY	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2456	SUP	Custom 27203010		2456  -  APL BRCHTX 4-5CM VAR TRY MAMST 8MM BRST	BOTH IP/OP	"$1,219.18 "	$902.19	$0.00	"$5,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$904.87	$904.87	$0.00	$0.00	$254.08	$0.00	$0.00	$0.00	$0.00	"$3,437.50"	"$5,445.00"	"$5,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2550	SUP	Custom 27203010		2550  -  BAG DRAIN INLINE SELF FILL OASIS 600ML STERILE ATRIUM ATS	BOTH IP/OP	$57.10 	$42.25	$0.00	$45.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.38	$42.38	$0.00	$0.00	$11.90	$0.00	$0.00	$0.00	$0.00	$28.55	$45.22	$45.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2649	SUP	Custom 27203010		CUFF CLASSIC LRG ADLT LNG 2 TB ROSE WHT SCREW CONNECTOR	BOTH IP/OP	$36.25 	$26.83	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.13	$28.71	$29.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2816	SUP	Custom 27203010		RESTRAINT XTRMT PSY LMB WRST ANKL FOAM HLDR QRLSE SGL STRAP	BOTH IP/OP	$35.25 	$26.09	$0.00	$28.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.63	$27.92	$28.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2845	SUP	Custom 27203010		KIT MYCTST ACPRB M AVIUM CULT ID 20 TST	BOTH IP/OP	$708.13 	$524.02	$0.00	$566.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.06	$560.84	$566.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2855	SUP	Custom 27203010		KIT MYCTST ACPRB MYCB KS 2 CULT ID 20 TST	BOTH IP/OP	$708.33 	$524.16	$0.00	$566.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.16	$561.00	$566.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2860	SUP	Custom 27203010		KIT MYCTST ACPRB M TB CULT ID 20 TST	BOTH IP/OP	$708.13 	$524.02	$0.00	$566.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.06	$560.84	$566.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2910	SUP	Custom 27203010		KIT MYCTST ACPRB HISTOPLASMA CAPSULATUM CULT ID 20 TST	BOTH IP/OP	$708.33 	$524.16	$0.00	$566.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.16	$561.00	$566.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2994	SUP	Custom 27203010		2994  -  AGENT HMST STRL SURGIFLO KT MTRX THRMB	BOTH IP/OP	$650.86 	$481.64	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.07	$483.07	$0.00	$0.00	$135.64	$0.00	$0.00	$0.00	$0.00	$325.43	$515.48	$520.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3037	SUP	HCPCS C1787		3037  -  PROGRAMMER NRSTM 5L 22X10X4CM INTSTM 240X640 PIXELS PT SLIM	BOTH IP/OP	"$2,975.00 "	"$2,201.50"	$0.00	"$2,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,487.50"	"$2,356.20"	"$2,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3048	SUP	HCPCS C1729		CATHETER IV 14GA 1.25IN RADIOPQ SFSHLD ORNG PCTV TFLN STRL	BOTH IP/OP	$3.88 	$2.87	$0.00	$3.10	$2.10	$2.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.94	$3.07	$3.10	$0.00		$0.00	$0.61	$0.00	$0.00	$0.62	$0.00	$0.00	$0.00	$0.00	$0.00
3050	SUP	HCPCS C1729		CATHETER IV 22GA 1IN RADIOPQ SFSHLD BLUE PCTV TFLN STRL LF	BOTH IP/OP	$3.88 	$2.87	$0.00	$3.10	$2.10	$2.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.94	$3.07	$3.10	$0.00		$0.00	$0.61	$0.00	$0.00	$0.62	$0.00	$0.00	$0.00	$0.00	$0.00
3053	SUP	HCPCS C1729		CATHETER IV 24GA .75IN RADIOPQ SFSHLD YLW PCTV TFLN STRL LF	BOTH IP/OP	$3.88 	$2.87	$0.00	$3.10	$2.10	$2.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.94	$3.07	$3.10	$0.00		$0.00	$0.61	$0.00	$0.00	$0.62	$0.00	$0.00	$0.00	$0.00	$0.00
3055	SUP	HCPCS C1729		CATHETER IV 18GA 1.25IN RADIOPQ SFSHLD GRN PCTV TFLN STRL LF	BOTH IP/OP	$3.88 	$2.87	$0.00	$3.10	$2.10	$2.10	$0.00	$0.00	$0.00	$0.81	$2.88	$2.88	$0.00	$0.00	$0.81	$0.00	$2.29	$2.29	$0.00	$1.94	$3.07	$3.10	$0.00		$0.00	$0.61	$0.00	$0.00	$0.62	$0.00	$0.00	$0.00	$0.00	$0.00
3056	SUP	HCPCS C1729		CATHETER IV 20GA 1.25IN RADIOPQ SFSHLD PNK PCTV+PLUS TFLN	BOTH IP/OP	$3.88 	$2.87	$0.00	$3.10	$2.10	$2.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.94	$3.07	$3.10	$0.00		$0.00	$0.61	$0.00	$0.00	$0.62	$0.00	$0.00	$0.00	$0.00	$0.00
3057	SUP	HCPCS C1729		CATHETER IV 20GA 1IN RADIOPQ SFSHLD PNK PCTV+ TFLN STRL LF	BOTH IP/OP	$3.88 	$2.87	$0.00	$3.10	$2.10	$2.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.94	$3.07	$3.10	$0.00		$0.00	$0.61	$0.00	$0.00	$0.62	$0.00	$0.00	$0.00	$0.00	$0.00
3110	SUP	Custom 27203010		03110  -  WRENCH SURG 5MM ALN	BOTH IP/OP	$26.90 	$19.91	$0.00	$254.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.97	$19.97	$0.00	$0.00	$5.61	$0.00	$0.00	$0.00	$0.00	$158.75	$251.46	$254.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3125	SUP	Custom 27203010		03125  -  WRENCH SURG T BONE SCR	BOTH IP/OP	"$1,108.70 "	$820.44	$0.00	$822.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$822.88	$822.88	$0.00	$0.00	$231.05	$0.00	$0.00	$0.00	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3396	SUP	HCPCS C1729		CATHETER IV 20GA 1.25IN RADIOPQ SFSHLD PNK ACV J TFLN STRL	BOTH IP/OP	$3.93 	$2.91	$0.00	$3.14	$2.13	$2.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.96	$3.11	$3.14	$0.00		$0.00	$0.61	$0.00	$0.00	$0.62	$0.00	$0.00	$0.00	$0.00	$0.00
3423	SUP	Custom 27203010		3423  -  DRILL SRG SM SHRT 3.5MM STRL LF EVOS AO QCK CNCT OVR DISP	BOTH IP/OP	$258.36 	$191.19	$0.00	$254.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.35	$254.35	$0.00	$0.00	$71.42	$0.00	$0.00	$0.00	$0.00	$155.55	$204.62	$248.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3570	SUP	HCPCS C1729		CATHETER URTH KNGRD 24FR FOLEY 2W SIL 5ML LTX	BOTH IP/OP	$2.23 	$1.65	$0.00	$1.78	$1.21	$1.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.11	$1.77	$1.78	$0.00		$0.00	$0.35	$0.00	$0.00	$0.35	$0.00	$0.00	$0.00	$0.00	$0.00
3573	SUP	HCPCS C1729		CATHETER URTH KNGRD 26FR FOLEY 2W SIL 5ML LTX	BOTH IP/OP	$2.20 	$1.63	$0.00	$1.76	$1.19	$1.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.10	$1.74	$1.76	$0.00		$0.00	$0.34	$0.00	$0.00	$0.35	$0.00	$0.00	$0.00	$0.00	$0.00
3902	SUP	Custom 27203010		3902  -  KIT TISS CLSR 2ML EVICEL SLNT FBRN	BOTH IP/OP	$525.98 	$389.23	$0.00	$420.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$390.38	$390.38	$0.00	$0.00	$109.61	$0.00	$0.00	$0.00	$0.00	$262.99	$416.58	$420.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4001	SUP	Custom 27203010		4001  -  RETAINER INTNL ORG SURGIFISH RADOPQ	BOTH IP/OP	$53.75 	$39.78	$0.00	$43.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.89	$39.89	$0.00	$0.00	$11.20	$0.00	$0.00	$0.00	$0.00	$26.88	$42.57	$43.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4022	SUP	Custom 27203010		REUSABLE CLIPS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4030	SUP	Custom 27203010		4030  -  DRESSING HMST 12X12IN STRL LF QUIKCLOT TRAUMAPAD CNTRL+ 3	BOTH IP/OP	$145.58 	$107.73	$0.00	$544.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.16	$8.16	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$544.08	$8.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4073	SUP	Custom 27203010		BLADE LRNSCP 3 MCNTSH	BOTH IP/OP	$41.35 	$30.60	$0.00	$33.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.68	$32.75	$33.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4074	SUP	Custom 27203010		BLADE LRNSCP 4 MCNTSH	BOTH IP/OP	$41.35 	$30.60	$0.00	$33.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.68	$32.75	$33.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4080	SUP	Custom 27203010		BLADE LRNSCP 0 STD MLLR SS	BOTH IP/OP	$41.35 	$30.60	$0.00	$33.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.68	$32.75	$33.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4082	SUP	Custom 27203010		BLADE LRNSCP 2 STN MLLR REUSE	BOTH IP/OP	$37.55 	$27.79	$0.00	$30.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.78	$29.74	$30.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4083	SUP	Custom 27203010		BLADE LRNSCP 3 STD WINCONSIN	BOTH IP/OP	$41.35 	$30.60	$0.00	$33.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.68	$32.75	$33.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4200	SUP	Custom 27803010		004200  -  CLIP INTERNAL LARGE ANGLE RIGHT RING HANDLE LIGATE	BOTH IP/OP	$2.36 	$1.75	$0.00	$1.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.75	$1.75	$0.00	$0.00	$0.49	$0.00	$0.00	$0.00	$0.00	$1.18	$1.87	$1.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4259	SUP	Custom 27203010		04259  -  RESERVOIR ATF XRES B BLD COL DISP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4273	SUP	Custom 27203010		04273  -  KIT ATSBWL .25IN X ANCOAG ASP LN SCT ASMB TBG PVC DISP	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.11	$37.11	$0.00	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$25.00	$39.60	$40.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4275	SUP	Custom 27203010		04275  -  RESERVOIR ATF 120UM BTM OULET GRS FLTR BLUTSAMMEL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4350	SUP	HCPCS C1765		4350  -  BRR ADH ABS PLVC INTCD 4X3IN STRL	BOTH IP/OP	$753.34 	$557.47	$0.00	$602.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$559.13	$559.13	$0.00	$0.00	$157.00	$0.00	$0.00	$0.00	$0.00	$376.67	$596.65	$602.67	$0.00		$0.00	$117.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4353	SUP	Custom 27803010		4353  -  IMPLANT FACIAL PATIENT SPECIFIC	BOTH IP/OP	"$7,000.00 "	"$5,180.00"	$0.00	"$5,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,458.80"	$0.00	$0.00	$0.00	$0.00	"$3,500.00"	"$5,544.00"	"$5,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4400	SUP	Custom 27803010		4400  -  RING ANLPLS 28MM MTRL C-E CL TI	BOTH IP/OP	"$6,552.50 "	"$4,848.85"	$0.00	"$5,242.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.54"	$0.00	$0.00	$0.00	$0.00	"$3,276.25"	"$5,189.58"	"$5,242.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4450	SUP	Custom 27803010		4450  -  RING ANLPLS 24-40MM MTRL C-E PH	BOTH IP/OP	"$3,295.00 "	"$2,438.30"	$0.00	"$2,609.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.51	$137.51	$0.00	$0.00	$38.61	$0.00	$0.00	$0.00	$0.00	$84.00	"$2,609.64"	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4672	SUP	Custom 27803010		004672  -  DEVICE VENTRICULAR ASSIST 12FR MICROAXIAL PUMP IMPELLA 2.5L	BOTH IP/OP	"$62,500.00 "	"$46,250.00"	$0.00	"$50,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$13,025.00"	$0.00	$0.00	$0.00	$0.00	"$31,250.00"	"$49,500.00"	"$50,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4823	SUP	HCPCS C1713		4823.000  -  BLOCKER SPNL XIA 3 TI	BOTH IP/OP	$459.38 	$339.94	$0.00	$367.50	$206.72	$206.72	$0.00	$0.00	$0.00	$95.75	$340.95	$340.95	$0.00	$0.00	$95.73	$0.00	$271.72	$271.72	$0.00	$229.69	$363.83	$367.50	$0.00		$0.00	$71.89	$0.00	$0.00	$73.13	$0.00	$0.00	$0.00	$0.00	$0.00
5065	SUP	Custom 27203010		5065  -  COVER COMPRESSION MEDIUM 12- IN RIGID SOLE VENT HOLE DORSUM	BOTH IP/OP	$172.30 	$127.50	$0.00	$137.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.88	$127.88	$0.00	$0.00	$35.91	$0.00	$0.00	$0.00	$0.00	$86.15	$136.46	$137.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5571	SUP	HCPCS C1887		5571  -  HANDLE LRNSCP MED STD RUSCH DLPHN REUSE	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$946.00	$642.10	$642.10	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$591.25	$936.54	$946.00	$0.00		$0.00	$185.06	$0.00	$0.00	$188.25	$0.00	$0.00	$0.00	$0.00	$0.00
5897	SUP	Custom 27203010		5897  -  CUFF CMPR REG KDL SCD EXP BLDR FT	BOTH IP/OP	$80.68 	$59.70	$0.00	$60.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.72	$53.72	$0.00	$0.00	$15.08	$0.00	$0.00	$0.00	$0.00	$36.73	$60.76	$58.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5898	SUP	Custom 27203010		5898  -  SLEEVE CMPR LG SCD EXP ANEMB CUF FT	BOTH IP/OP	$74.55 	$55.17	$0.00	$60.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.72	$53.72	$0.00	$0.00	$15.08	$0.00	$0.00	$0.00	$0.00	$36.73	$60.76	$58.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6057	SUP	HCPCS C1765		6057  -  STYLET LEAD .014IN KT BALL TIP BLUE KNOB	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$15.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6081	SUP	Custom 27203010		6081  -  FILTER LEEP SMOKE EVACUATOR PRE	BOTH IP/OP	$28.90 	$21.39	$0.00	$23.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.45	$22.89	$23.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6091	SUP	HCPCS C1765		6091  -  STYLET LEAD .014IN KT JTP BALL TIP XTD TPR GRY KNOB	BOTH IP/OP	$100.00 	$74.00	$0.00	$79.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.72	$31.72	$0.00	$0.00	$8.91	$0.00	$0.00	$0.00	$0.00	$19.38	$79.20	$31.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6092	SUP	Custom 27203010		6092  -  PAPER RCD 110MM EKG THRM CARELINK	BOTH IP/OP	$250.00 	$185.00	$0.00	$198.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$198.00	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6122	SUP	Custom 27203010		6122  -  MOUTHWASH ORAL 1.5OZ LF RNS ANSEP 0.05% CPC CL	BOTH IP/OP	$86.43 	$63.96	$0.00	$69.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.15	$64.15	$0.00	$0.00	$18.01	$0.00	$0.00	$0.00	$0.00	$43.21	$68.45	$69.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6177	SUP	Custom 27203010		6177  -  SLEEVE PACEMAKER RADIO FREQUENCY HEAD WAND COVER STERILE	BOTH IP/OP	$23.75 	$17.58	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.63	$17.63	$0.00	$0.00	$4.95	$0.00	$0.00	$0.00	$0.00	$11.88	$18.81	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6196	SUP	HCPCS C1729		6196  -  CATHETER 7FR 100CM PIGTAIL	BOTH IP/OP	$2.50 	$1.85	$0.00	$2.00	$1.36	$1.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$1.98	$2.00	$0.00		$0.00	$0.39	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
6215	SUP	Custom 27203010		6215  -  CATHETER GD 6FR ATN GW PU CS VNGR	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.71	$170.71	$0.00	$0.00	$47.93	$0.00	$0.00	$0.00	$0.00	$115.00	$182.16	$184.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6314	SUP	Custom 27803010		6314  -  GRAFT SYNTH TISSUE 91X56X4MM SMOOTH EXTERIOR SURFACE	BOTH IP/OP	"$2,988.60 "	"$2,211.56"	$0.00	"$3,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,218.14"	"$2,218.14"	$0.00	$0.00	$622.82	$0.00	$0.00	$0.00	$0.00	"$2,371.25"	"$3,756.06"	"$3,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6316	SUP	Custom 27803010		6316  -  IMPLANT ORBTL 14MM SPHERE BIOCOMPATIBLE POROUS MEDPOR	BOTH IP/OP	"$1,265.18 "	$936.23	$0.00	"$1,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$939.01	$939.01	$0.00	$0.00	$263.66	$0.00	$0.00	$0.00	$0.00	$752.50	"$1,191.96"	"$1,204.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6317	SUP	Custom 27803010		6317  -  IMPLANT ORBTL 20MM SPHERE BIOCOMPATIBLE POROUS MEDPOR	BOTH IP/OP	"$1,265.18 "	$936.23	$0.00	"$1,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$939.01	$939.01	$0.00	$0.00	$263.66	$0.00	$0.00	$0.00	$0.00	$752.50	"$1,191.96"	"$1,204.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6322	SUP	Custom 27803010		6322  -  SPHERE EYE 22MM THK.45MM 42MMX41MMX1MM STRL PE POR MEDPOR	BOTH IP/OP	"$1,505.00 "	"$1,113.70"	$0.00	"$1,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,117.01"	"$1,117.01"	$0.00	$0.00	$313.64	$0.00	$0.00	$0.00	$0.00	$752.50	"$1,191.96"	"$1,204.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6326	SUP	Custom 27803010		6326  -  IMPLANT ORBTL 16MM SPHERE BIOCOMPATIBLE POROUS MEDPOR	BOTH IP/OP	"$1,265.18 "	$936.23	$0.00	"$1,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$939.01	$939.01	$0.00	$0.00	$263.66	$0.00	$0.00	$0.00	$0.00	$752.50	"$1,191.96"	"$1,204.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6327	SUP	Custom 27803010		6327  -  IMPLANT ORBTL ROUND 18MM SPHERE BIOCOMPATIBLE POROUS MEDPOR	BOTH IP/OP	"$1,265.18 "	$936.23	$0.00	"$1,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$939.01	$939.01	$0.00	$0.00	$263.66	$0.00	$0.00	$0.00	$0.00	$752.50	"$1,191.96"	"$1,204.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6330	SUP	Custom 27803010		6330  -  GRAFT SYNTH TISSUE 50X38X1.5MM SHEET POROUS MEDPOR	BOTH IP/OP	$911.05 	$674.18	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$676.18	$676.18	$0.00	$0.00	$189.86	$0.00	$0.00	$0.00	$0.00	$651.25	"$1,031.58"	"$1,042.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6331	SUP	Custom 27803010		6331  -  GRAFT SYNTH TISSUE 76X50X1.5MM SHEET POROUS MEDPOR	BOTH IP/OP	"$1,224.65 "	$906.24	$0.00	"$1,386.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.76	$49.76	$0.00	$0.00	$13.97	$0.00	$0.00	$0.00	$0.00	$28.50	"$1,386.00"	$45.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6332	SUP	Custom 27803010		6332  -  GRAFT SYNTH TISSUE 38X13X3MM BLOCK POROUS MEDPOR	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6333	SUP	Custom 27803010		6333  -  GRAFT SYNTH TISSUE 38X13X6MM BLOCK POROUS MEDPOR	BOTH IP/OP	"$1,460.25 "	"$1,080.59"	$0.00	"$1,318.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,083.80"	"$1,083.80"	$0.00	$0.00	$304.32	$0.00	$0.00	$0.00	$0.00	$823.75	"$1,304.82"	"$1,318.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6334	SUP	Custom 27803010		6334  -  GRAFT SYNTH TISSUE 38X13X9.5MM BLOCK POROUS MEDPOR	BOTH IP/OP	"$1,940.00 "	"$1,435.60"	$0.00	"$1,552.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,439.87"	"$1,439.87"	$0.00	$0.00	$404.30	$0.00	$0.00	$0.00	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6335	SUP	Custom 27803010		6335  -  GRAFT SYNTH TISSUE 50X25X3MM BLOCK POROUS MEDPOR	BOTH IP/OP	"$1,730.63 "	"$1,280.67"	$0.00	"$1,940.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.47"	"$1,284.47"	$0.00	$0.00	$360.66	$0.00	$0.00	$0.00	$0.00	"$1,212.50"	"$1,920.60"	"$1,940.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6336	SUP	Custom 27803010		6336  -  GRAFT SYNTH TISSUE CNTOUR 25X50X6MM BLOCK MEDPOR	BOTH IP/OP	"$1,905.00 "	"$1,409.70"	$0.00	"$2,134.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,413.89"	"$1,413.89"	$0.00	$0.00	$397.00	$0.00	$0.00	$0.00	$0.00	"$1,333.75"	"$2,112.66"	"$2,134.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6337	SUP	Custom 27803010		6337  -  GRAFT SYNTH TISSUE 50X25X9.5MM BLOCK POROUS MEDPOR	BOTH IP/OP	"$3,155.00 "	"$2,334.70"	$0.00	"$2,524.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,341.64"	"$2,341.64"	$0.00	$0.00	$657.50	$0.00	$0.00	$0.00	$0.00	"$1,577.50"	"$2,498.76"	"$2,524.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6338	SUP	Custom 27803010		6338  -  GRAFT SYNTH TISSUE 63X38X3MM BLOCK POROUS MEDPOR POLYETHLENE	BOTH IP/OP	"$3,155.00 "	"$2,334.70"	$0.00	"$2,524.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,341.64"	"$2,341.64"	$0.00	$0.00	$657.50	$0.00	$0.00	$0.00	$0.00	"$1,577.50"	"$2,498.76"	"$2,524.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6339	SUP	Custom 27803010		6339  -  GRAFT SYNTH TISSUE CNTOUR 38X63X6MM BLOCK MEDPOR	BOTH IP/OP	"$3,395.00 "	"$2,512.30"	$0.00	"$2,716.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,519.77"	"$2,519.77"	$0.00	$0.00	$707.52	$0.00	$0.00	$0.00	$0.00	"$1,697.50"	"$2,688.84"	"$2,716.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6340	SUP	Custom 27803010		6340  -  GRAFT SNTH TISS CNTR 38X63X9.5MM STRL MDPR BLCK PE POR	BOTH IP/OP	"$3,642.50 "	"$2,695.45"	$0.00	"$2,914.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,703.46"	"$2,703.46"	$0.00	$0.00	$759.10	$0.00	$0.00	$0.00	$0.00	"$1,821.25"	"$2,884.86"	"$2,914.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6351	SUP	Custom 27803010		6351  -  GRAFT SYNTH TISSUE MEDPOR 178X127MM SHEET POROUS	BOTH IP/OP	"$5,350.00 "	"$3,959.00"	$0.00	"$4,280.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,970.77"	"$3,970.77"	$0.00	$0.00	"$1,114.94"	$0.00	$0.00	$0.00	$0.00	"$2,675.00"	"$4,237.20"	"$4,280.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6550	SUP	Custom 27203010		KIT OC TTHT SWB PRXMNT SOL MOIST LF	BOTH IP/OP	$13.45 	$9.95	$0.00	$10.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.73	$10.65	$10.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6640	SUP	HCPCS C1729		6640  -  SYSTEM DRN 7FR 15ML STRL LF TLS EVACUATE TUBE RADOPQ CATH	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$57.02	$57.02	$0.00	$0.00	$0.00	$21.88	$77.93	$77.93	$0.00	$0.00	$21.88	$0.00	$62.11	$62.11	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$16.43	$0.00	$0.00	$16.72	$0.00	$0.00	$0.00	$0.00	$0.00
6650	SUP	HCPCS C1729		6650  -  SYSTEM DRAIN 10FR EVACUATE TUBE RADIOPQ RESERVOIR LATEX FREE	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$57.02	$57.02	$0.00	$0.00	$0.00	$21.88	$77.93	$77.93	$0.00	$0.00	$21.88	$0.00	$62.11	$62.11	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$16.43	$0.00	$0.00	$16.72	$0.00	$0.00	$0.00	$0.00	$0.00
7120	SUP	HCPCS C1895		7120  -  LEAD DFBR 7FR DURATA ECRDL STRD ELUT TRUE BIPOL ACT FIX	BOTH IP/OP	"$10,500.00 "	"$7,770.00"	$0.00	"$8,400.00"	"$4,725.00"	"$4,725.00"	$0.00	$0.00	$0.00	"$2,188.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,188.20"	$0.00	"$5,176.50"	"$5,176.50"	$0.00	"$5,250.00"	"$8,316.00"	"$8,400.00"	$0.00		$0.00	"$1,643.25"	$0.00	$0.00	"$1,671.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7122	SUP	HCPCS C1898		7122  -  LEAD PCNG ECRDL BIPOL ACT FIX XTD-RETRAC HLX TIP DURATA	BOTH IP/OP	"$10,500.00 "	"$7,770.00"	$0.00	"$8,400.00"	"$4,725.00"	"$4,725.00"	$0.00	$0.00	$0.00	"$2,188.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,188.20"	$0.00	"$5,176.50"	"$5,176.50"	$0.00	"$5,250.00"	"$8,316.00"	"$8,400.00"	$0.00		$0.00	"$1,643.25"	$0.00	$0.00	"$1,671.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7207	SUP	Custom 27803010		7207  -  IMPLANT ORBTL CONE FLAT 16MM MULTPUR ANTERIOR SURFACE MEDPOR	BOTH IP/OP	"$1,153.66 "	$853.71	$0.00	$922.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$856.24	$856.24	$0.00	$0.00	$240.42	$0.00	$0.00	$0.00	$0.00	$576.83	$913.70	$922.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7208	SUP	Custom 27803010		7208  -  SAW SURG SAGITTAL SYSTEM 7	BOTH IP/OP	"$1,153.66 "	$853.71	$0.00	$922.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$856.24	$856.24	$0.00	$0.00	$240.42	$0.00	$0.00	$0.00	$0.00	$576.83	$913.70	$922.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7209	SUP	Custom 27803010		7209  -  IMPLANT ORBTL CONE FLAT 20MM MULTPUR ANTERIOR SURFACE MEDPOR	BOTH IP/OP	"$1,153.66 "	$853.71	$0.00	$922.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$856.24	$856.24	$0.00	$0.00	$240.42	$0.00	$0.00	$0.00	$0.00	$576.83	$913.70	$922.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7210	SUP	Custom 27803010		7210  -  GRAFT SYNTH TISSUE ULTRATHIN 50X38X.85MM SHEET POROUS MEDPOR	BOTH IP/OP	$943.40 	$698.12	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$700.19	$700.19	$0.00	$0.00	$196.60	$0.00	$0.00	$0.00	$0.00	$651.25	"$1,031.58"	"$1,042.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7212	SUP	Custom 27803010		7212  -  GRAFT SYNTH TISSUE ULTRATHIN 76X50X.85MM SHEET SMOOTH	BOTH IP/OP	$53.20 	$39.37	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.49	$39.49	$0.00	$0.00	$11.09	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7214	SUP	Custom 27803010		7214  -  GRAFT SYNTH TISSUE ULTRATHIN 127X76X.85MM SHEET SMOOTH	BOTH IP/OP	$53.20 	$39.37	$0.00	"$2,688.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.49	$39.49	$0.00	$0.00	$11.09	$0.00	$0.00	$0.00	$0.00	"$1,680.00"	"$2,661.12"	"$2,688.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7216	SUP	Custom 27803010		7216  -  MEDPOR ULTRA THIN SHEET - 127MM X 178MM X 0.85MM	BOTH IP/OP	"$3,710.00 "	"$2,745.40"	$0.00	"$2,968.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,753.56"	"$2,753.56"	$0.00	$0.00	$773.16	$0.00	$0.00	$0.00	$0.00	"$1,855.00"	"$2,938.32"	"$2,968.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7222	SUP	Custom 27803010		7222  -  IMPLANT ORBTL CONICAL FLAT ANTERIOR SURFACE CHANNELS POROUS	BOTH IP/OP	"$1,417.05 "	"$1,048.62"	$0.00	"$1,223.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.47	$861.47	$0.00	$0.00	$241.89	$0.00	$0.00	$0.00	$0.00	$526.69	"$1,223.64"	$842.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7223	SUP	Custom 27803010		7223  -  IMPLANT ORBTL CONICAL FLAT ANTERIOR SURFACE CHANNELS POROUS	BOTH IP/OP	"$1,459.35 "	"$1,079.92"	$0.00	"$1,274.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,083.13"	"$1,083.13"	$0.00	$0.00	$304.13	$0.00	$0.00	$0.00	$0.00	$796.25	"$1,261.26"	"$1,274.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7341	SUP	Custom 27203010		STAIN BLUING SOL SGNTR 1GL HPRFR WKG SOL HMTL	BOTH IP/OP	$368.78 	$272.90	$0.00	$295.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.39	$292.07	$295.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7511	SUP	Custom 27803010		7511  -  COVER BURR HOLE 5MM 15X3MM SUPERIOR FLANGE POROUS MEDPOR	BOTH IP/OP	$672.00 	$497.28	$0.00	$856.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$498.76	$498.76	$0.00	$0.00	$140.04	$0.00	$0.00	$0.00	$0.00	$535.00	$847.44	$856.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7512	SUP	Custom 27803010		7512  -  COVER BURR HOLE 29X17X7MM 3PK CRANIOMAXILLOFACIAL	BOTH IP/OP	$672.00 	$497.28	$0.00	$856.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$498.76	$498.76	$0.00	$0.00	$140.04	$0.00	$0.00	$0.00	$0.00	$535.00	$847.44	$856.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7514	SUP	Custom 27803010		7514  -  BURR HOLE DISC - 14MM X 16MM	BOTH IP/OP	$340.00 	$251.60	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.35	$252.35	$0.00	$0.00	$70.86	$0.00	$0.00	$0.00	$0.00	$170.00	$269.28	$272.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7516	SUP	Custom 27803010		7516  -  GRAFT SYNTH TISSUE SMALL 53X5MM DESIGN A LATEX FREE MEDPOR	BOTH IP/OP	$777.43 	$575.30	$0.00	$862.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$577.00	$577.00	$0.00	$0.00	$162.02	$0.00	$0.00	$0.00	$0.00	$538.75	$853.38	$862.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7517	SUP	Custom 27803010		7517  -  GRAFT SYNTH TISSUE LARGE 66X8MM IMPLANT DESIGN A POROUS	BOTH IP/OP	$777.43 	$575.30	$0.00	$862.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$577.00	$577.00	$0.00	$0.00	$162.02	$0.00	$0.00	$0.00	$0.00	$538.75	$853.38	$862.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7518	SUP	Custom 27803010		7518  -  GRAFT SYNTH TISSUE LARGE 67X6.5MM IMPLANT DESIGN B POROUS	BOTH IP/OP	$777.43 	$575.30	$0.00	$862.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$577.00	$577.00	$0.00	$0.00	$162.02	$0.00	$0.00	$0.00	$0.00	$538.75	$853.38	$862.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7520	SUP	Custom 27803010		7520  -  GRAFT SYNTH TISSUE SMALL 65X37X5MM IMPLANT 1 PIECE DESIGN	BOTH IP/OP	$960.58 	$710.83	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.94	$712.94	$0.00	$0.00	$200.18	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7521	SUP	Custom 27803010		7521  -  GRAFT SYNTH TISSUE MEDIUM 65X37X7MM IMPLANT 1 PIECE DESIGN	BOTH IP/OP	$960.58 	$710.83	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.94	$712.94	$0.00	$0.00	$200.18	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7522	SUP	Custom 27803010		7522  -  GRAFT SYNTH TISSUE LARGE 65X37X10MM IMPLANT 1 PIECE DESIGN	BOTH IP/OP	$960.58 	$710.83	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.94	$712.94	$0.00	$0.00	$200.18	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7525	SUP	Custom 27803010		7525  -  EAR BASE - LEFT - 28MM X 55MM X 13MM	BOTH IP/OP	"$2,404.00 "	"$1,778.96"	$0.00	"$1,923.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,784.25"	"$1,784.25"	$0.00	$0.00	$500.99	$0.00	$0.00	$0.00	$0.00	"$1,202.00"	"$1,903.97"	"$1,923.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7526	SUP	Custom 27803010		7526  -  GRAFT SYNTH TISSUE LARGE 65X32X16MM BASE RECONSTRUCTION	BOTH IP/OP	"$2,454.38 "	"$1,816.24"	$0.00	"$2,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,821.64"	"$1,821.64"	$0.00	$0.00	$511.49	$0.00	$0.00	$0.00	$0.00	"$1,683.75"	"$2,667.06"	"$2,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7527	SUP	Custom 27803010		7527  -  GRAFT SYNTH TISSUE LARGE 65X32X16MM LATEX FREE EAR LEFT	BOTH IP/OP	"$2,454.38 "	"$1,816.24"	$0.00	"$2,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,821.64"	"$1,821.64"	$0.00	$0.00	$511.49	$0.00	$0.00	$0.00	$0.00	"$1,683.75"	"$2,667.06"	"$2,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7535	SUP	Custom 27803010		7535  -  GRAFT SYNTH TISSUE 47X37X3MM 6.5X3X3MM LATERAL AUGMENTATION	BOTH IP/OP	"$1,333.13 "	$986.52	$0.00	"$1,494.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$989.45	$989.45	$0.00	$0.00	$277.82	$0.00	$0.00	$0.00	$0.00	$933.75	"$1,479.06"	"$1,494.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7536	SUP	Custom 27803010		7536  -  GRAFT SYNTH TISSUE ANGLE 47X37X3MM AUGMENTATION ONLAY MEDPOR	BOTH IP/OP	"$1,333.13 "	$986.52	$0.00	"$1,479.06"	$9.90	$9.90	$0.00	$0.00	$0.00	$0.00	$989.45	$989.45	$0.00	$0.00	$277.82	$0.00	$0.00	$0.00	$0.00	$11.00	"$1,479.06"	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7538	SUP	Custom 27803010		7538  -  GRAFT SYNTH TISSUE ANGLE 79X32X5MM E-5 INFERIOR RIDGE MEDPOR	BOTH IP/OP	"$1,333.13 "	$986.52	$0.00	"$1,494.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$989.45	$989.45	$0.00	$0.00	$277.82	$0.00	$0.00	$0.00	$0.00	$933.75	"$1,479.06"	"$1,494.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7539	SUP	Custom 27803010		7539  -  GRAFT SYNTH TISSUE 79X32X10MM IMPLANT RAMUS INFERIOR RIDGE	BOTH IP/OP	"$1,333.13 "	$986.52	$0.00	"$1,494.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$989.45	$989.45	$0.00	$0.00	$277.82	$0.00	$0.00	$0.00	$0.00	$933.75	"$1,479.06"	"$1,494.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541	SUP	Custom 27803010		7541  -  GRAFT SYNTH TISSUE ANGLE 79X32X4MM ES-5 INFERIOR RIDGE	BOTH IP/OP	"$1,333.13 "	$986.52	$0.00	"$1,494.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$989.45	$989.45	$0.00	$0.00	$277.82	$0.00	$0.00	$0.00	$0.00	$933.75	"$1,479.06"	"$1,494.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7542	SUP	Custom 27803010		7542  -  GRAFT SYNTH TISSUE ANGLE 5MM 5MM 79MMX32MM 4MMX5MM RAMUS	BOTH IP/OP	"$1,333.13 "	$986.52	$0.00	"$1,494.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$989.45	$989.45	$0.00	$0.00	$277.82	$0.00	$0.00	$0.00	$0.00	$933.75	"$1,479.06"	"$1,494.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7543	SUP	Custom 27803010		7543  -  GRAFT SYNTH TISSUE 79X32X10MM IMPLANT RAMUS INFERIOR RIDGE	BOTH IP/OP	"$1,333.13 "	$986.52	$0.00	"$1,494.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$989.45	$989.45	$0.00	$0.00	$277.82	$0.00	$0.00	$0.00	$0.00	$933.75	"$1,479.06"	"$1,494.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7544	SUP	Custom 27803010		7544  -  GRAFT SYNTH TISSUE 79X32X10MM IMPLANT RAMUS INFERIOR RIDGE	BOTH IP/OP	"$1,333.13 "	$986.52	$0.00	"$1,494.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$989.45	$989.45	$0.00	$0.00	$277.82	$0.00	$0.00	$0.00	$0.00	$933.75	"$1,479.06"	"$1,494.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7594	SUP	Custom 27203010		REAGENT ANTI-FYB GMA CLN 5ML MNCLN BLOOD BANK	BOTH IP/OP	"$1,347.50 "	$997.15	$0.00	"$1,078.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.11"	"$1,000.11"	$0.00	$0.00	$280.82	$0.00	$0.00	$0.00	$0.00	$673.75	"$1,067.22"	"$1,078.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7730	SUP	Custom 27203010		7730  -  ADHESIVE OSTOMY MEDIUM SPRAY CAN REMAIN FLEXIBLE SILICONE	BOTH IP/OP	$607.98 	$449.91	$0.00	$451.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$451.24	$451.24	$0.00	$0.00	$126.70	$0.00	$0.00	$0.00	$0.00	$19.69	$31.19	$31.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7828	SUP	HCPCS C1768		007828  -  FABRIC CARDIO 4X4IN SVG THK.61MM FLMN	BOTH IP/OP	$254.37 	$188.23	$0.00	$203.49	$114.46	$114.46	$0.00	$0.00	$0.00	$53.02	$188.79	$188.79	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.18	$201.46	$203.49	$0.00		$0.00	$39.81	$0.00	$0.00	$40.49	$0.00	$0.00	$0.00	$0.00	$0.00
7836	SUP	HCPCS C1768		7836  -  FELT CARDIO 10X10CM THK1.65MM PTFE	BOTH IP/OP	$210.00 	$155.40	$0.00	$254.62	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$254.62	$254.62	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
7836	SUP	HCPCS C1768		007836  -  FELT CARDIO THK1.65MM 4X4IN PTFE STERILE	BOTH IP/OP	$210.00 	$155.40	$0.00	$254.62	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$254.62	$254.62	$0.00	$105.00	$174.60	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
7837	SUP	HCPCS C1768		007837  -  FELT CARDIO 15X15CM THK1.65MM PTFE PTCH	BOTH IP/OP	$295.55 	$218.71	$0.00	$236.44	$133.00	$133.00	$0.00	$0.00	$0.00	$61.60	$219.36	$219.36	$0.00	$0.00	$61.59	$0.00	$174.82	$174.82	$0.00	$147.78	$234.08	$236.44	$0.00		$0.00	$46.25	$0.00	$0.00	$47.05	$0.00	$0.00	$0.00	$0.00	$0.00
8101	SUP	Custom 27203010		REAGENT METHNL ISOPRPNL FLX 100 1GL ABST DEHYDRANT BTL	BOTH IP/OP	$40.60 	$30.04	$0.00	$32.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.30	$32.16	$32.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8185	SUP	HCPCS C1769		8185  -  GUIDEWIRE VASC STRG 185CM PRIMEWIRE PSTG+ PRSS	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$916.31	$916.31	$0.00	$0.00	$0.00	$351.72	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$998.16	$998.16	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$264.09	$0.00	$0.00	$268.65	$0.00	$0.00	$0.00	$0.00	$0.00
8305	SUP	Custom 27803010		8305  -  GRAFT SNTH TISS TRMPT 50X38X1MM STRL MDPR BRR SHT HDPE NPOR	BOTH IP/OP	"$1,319.50 "	$976.43	$0.00	"$1,616.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$979.33	$979.33	$0.00	$0.00	$274.98	$0.00	$0.00	$0.00	$0.00	"$1,010.00"	"$1,599.84"	"$1,616.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8312	SUP	Custom 27803010		8312  -  GRAFT SYNTH TISSUE REGULAR 76X50X1MM IMPLANT RECTANGULAR	BOTH IP/OP	"$1,288.00 "	$953.12	$0.00	"$1,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.95	$955.95	$0.00	$0.00	$268.42	$0.00	$0.00	$0.00	$0.00	$888.75	"$1,407.78"	"$1,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8313	SUP	Custom 27803010		8313  -  GRAFT SYNTH TISSUE SMALL ROUND 47X45X3MM 2 PIECE DESIGN	BOTH IP/OP	"$1,016.40 "	$752.14	$0.00	"$1,130.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$754.37	$754.37	$0.00	$0.00	$211.82	$0.00	$0.00	$0.00	$0.00	$706.25	"$1,118.70"	"$1,130.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8314	SUP	Custom 27803010		8314  -  GRAFT SYNTH TISSUE MEDIUM ROUND 47X45X5MM 2 PIECE DESIGN	BOTH IP/OP	"$1,016.40 "	$752.14	$0.00	"$1,130.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$754.37	$754.37	$0.00	$0.00	$211.82	$0.00	$0.00	$0.00	$0.00	$706.25	"$1,118.70"	"$1,130.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8315	SUP	Custom 27803010		8315  -  IMPLANT CHIN LG RND 47X45X7MM STRL MDPR RZ 2 PC DSGN NTCH	BOTH IP/OP	"$1,016.40 "	$752.14	$0.00	"$1,130.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$754.37	$754.37	$0.00	$0.00	$211.82	$0.00	$0.00	$0.00	$0.00	$706.25	"$1,118.70"	"$1,130.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8316	SUP	Custom 27803010		8316  -  GRAFT SYNTH TISSUE 3MM ROUND EXTEND RZ CHIN	BOTH IP/OP	"$1,016.40 "	$752.14	$0.00	"$1,130.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$754.37	$754.37	$0.00	$0.00	$211.82	$0.00	$0.00	$0.00	$0.00	$706.25	"$1,118.70"	"$1,130.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8317	SUP	Custom 27803010		8317  -  IMPLANT CHIN MED SQ 47X45X5MM STRL MDPR RZ 2 PC DSGN NTCH	BOTH IP/OP	"$1,016.40 "	$752.14	$0.00	"$1,130.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$754.37	$754.37	$0.00	$0.00	$211.82	$0.00	$0.00	$0.00	$0.00	$706.25	"$1,118.70"	"$1,130.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8318	SUP	Custom 27803010		8318  -  IMPLANT CHIN LG SQ 47X45X7MM STRL MDPR RZ 2 PC DSGN NTCH TAB	BOTH IP/OP	"$1,016.40 "	$752.14	$0.00	"$1,130.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$754.37	$754.37	$0.00	$0.00	$211.82	$0.00	$0.00	$0.00	$0.00	$706.25	"$1,118.70"	"$1,130.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8319	SUP	Custom 27803010		8319  -  IMPLANT CHIN 45X41X4MM MGG 2 PC	BOTH IP/OP	"$1,075.25 "	$795.69	$0.00	$972.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$798.05	$798.05	$0.00	$0.00	$224.08	$0.00	$0.00	$0.00	$0.00	$607.50	$962.28	$972.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8320	SUP	Custom 27803010		8320  -  GRAFT SNTH TISS SM 56X33X5MM STRL MDPR IMPL 2 PC PRJ TPR WNG	BOTH IP/OP	$893.75 	$661.38	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$663.34	$663.34	$0.00	$0.00	$186.26	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8321	SUP	Custom 27803010		8321  -  GRAFT SYNTH TISSUE 56X36X7MM IMPLANT 2 PIECE MEDIUM	BOTH IP/OP	$893.75 	$661.38	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$663.34	$663.34	$0.00	$0.00	$186.26	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8322	SUP	Custom 27803010		8322  -  GRAFT SYNTH TISSUE 56X36X7MM IMPLANT 2 PIECE LARGE	BOTH IP/OP	$893.75 	$661.38	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$663.34	$663.34	$0.00	$0.00	$186.26	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8328	SUP	Custom 27803010		8328  -  GRAFT SYNTH TISSUE 62X37MM IMPLANT HELICAL RIM POROUS MEDPOR	BOTH IP/OP	"$1,225.63 "	$906.97	$0.00	"$1,448.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$909.66	$909.66	$0.00	$0.00	$255.42	$0.00	$0.00	$0.00	$0.00	$905.00	"$1,433.52"	"$1,448.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8329	SUP	Custom 27803010		8329  -  GRAFT SYNTH TISSUE 62X37MM HELICAL RIM POROUS MEDPOR	BOTH IP/OP	"$1,225.63 "	$906.97	$0.00	"$1,448.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$909.66	$909.66	$0.00	$0.00	$255.42	$0.00	$0.00	$0.00	$0.00	$905.00	"$1,433.52"	"$1,448.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8330	SUP	Custom 27803010		8330  -  GRAFT SYNTH TISSUE 60X30MM IMPLANT EXTENDED BASE POROUS	BOTH IP/OP	"$2,262.60 "	"$1,674.32"	$0.00	"$2,654.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,679.30"	"$1,679.30"	$0.00	$0.00	$471.53	$0.00	$0.00	$0.00	$0.00	"$1,658.75"	"$2,627.46"	"$2,654.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8331	SUP	Custom 27803010		8331  -  GRAFT SYNTH TISSUE 60X30MM BASE EXTENDED POROUS MEDPOR	BOTH IP/OP	"$2,262.60 "	"$1,674.32"	$0.00	"$2,654.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,679.30"	"$1,679.30"	$0.00	$0.00	$471.53	$0.00	$0.00	$0.00	$0.00	"$1,658.75"	"$2,627.46"	"$2,654.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8340	SUP	Custom 27803010		8340  -  GRAFT SYNTH TISSUE SMALL 60X25X5MM IMPLANT GENIOPLASTY WEDGE	BOTH IP/OP	$984.70 	$728.68	$0.00	"$1,192.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$730.84	$730.84	$0.00	$0.00	$205.21	$0.00	$0.00	$0.00	$0.00	$745.00	"$1,180.08"	"$1,192.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8341	SUP	Custom 27803010		8341  -  GRAFT SYNTH TISSUE MEDIUM 60X25X7.5MM IMPLANT GENIOPLASTY	BOTH IP/OP	$984.70 	$728.68	$0.00	"$1,192.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$730.84	$730.84	$0.00	$0.00	$205.21	$0.00	$0.00	$0.00	$0.00	$745.00	"$1,180.08"	"$1,192.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8342	SUP	Custom 27803010		8342  -  GENIOPLASTY WEDGE - LARGE - 60MM X 25MM X 10MM	BOTH IP/OP	"$1,096.00 "	$811.04	$0.00	$876.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$813.45	$813.45	$0.00	$0.00	$228.41	$0.00	$0.00	$0.00	$0.00	$548.00	$868.03	$876.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8438	SUP	Custom 27803010		8438  -  GRAFT SYNTH TISSUE MICROTHIN 50X30X.4MM SHEET MEDPOR	BOTH IP/OP	$961.35 	$711.40	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$713.51	$713.51	$0.00	$0.00	$200.35	$0.00	$0.00	$0.00	$0.00	$651.25	"$1,031.58"	"$1,042.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8536	SUP	Custom 27203010		8536  -  NEEDLE SUT ULTHN STRL HI-FI 2 ARM SS MNSCL	BOTH IP/OP	$116.80 	$86.43	$0.00	$93.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.69	$86.69	$0.00	$0.00	$24.34	$0.00	$0.00	$0.00	$0.00	$58.40	$92.51	$93.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8570	SUP	Custom 27203010		8570  -  NEEDLE SUT BLU STRL ZN SPC II REPR EYLT NTNL MNSCS	BOTH IP/OP	$64.38 	$47.64	$0.00	$51.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.78	$47.78	$0.00	$0.00	$13.42	$0.00	$0.00	$0.00	$0.00	$32.19	$50.99	$51.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8662	SUP	Custom 27803010		8662  -  GRAFT SYNTH TISSUE MICROTHIN 76X127MM SHEET POROUS MEDPOR	BOTH IP/OP	"$2,242.40 "	"$1,659.38"	$0.00	"$2,370.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,664.31"	"$1,664.31"	$0.00	$0.00	$467.32	$0.00	$0.00	$0.00	$0.00	"$1,481.25"	"$2,346.30"	"$2,370.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8703	SUP	Custom 27803010		8703  -  SPHERE - 21MM	BOTH IP/OP	"$1,071.20 "	$792.69	$0.00	$856.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$795.04	$795.04	$0.00	$0.00	$223.24	$0.00	$0.00	$0.00	$0.00	$535.60	$848.39	$856.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8704	SUP	Custom 27803010		8704  -  SPHERE - 23MM	BOTH IP/OP	"$1,071.20 "	$792.69	$0.00	$856.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$795.04	$795.04	$0.00	$0.00	$223.24	$0.00	$0.00	$0.00	$0.00	$535.60	$848.39	$856.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8800	SUP	Custom 27203010		8800  -  KIT ARTHRO FIX PNACL ACL STRL DISP	BOTH IP/OP	$319.30 	$236.28	$0.00	$255.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.98	$236.98	$0.00	$0.00	$66.54	$0.00	$0.00	$0.00	$0.00	$159.65	$252.89	$255.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8814	SUP	Custom 27011340		08814  -  BRACE ORTH 30.5- IN 17-27IN TSCP BRIDGETECH ROM HNG PRMR TRM	BOTH IP/OP	$185.10 	$136.97	$0.00	$162.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.38	$137.38	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$101.60	$160.93	$162.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9019	SUP	Custom 27803010		9019  -  VAD 9019 18MM CONVERTIBLE	BOTH IP/OP	$888.25 	$657.31	$0.00	$710.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$659.26	$659.26	$0.00	$0.00	$185.11	$0.00	$0.00	$0.00	$0.00	$444.13	$703.49	$710.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9025	SUP	Custom 27803010		9025  -  CATH 9025 VENT STD XTRA LENGTH MARK IMP	BOTH IP/OP	$356.25 	$263.63	$0.00	$285.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.41	$264.41	$0.00	$0.00	$74.24	$0.00	$0.00	$0.00	$0.00	$178.13	$282.15	$285.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9031	SUP	Custom 27203010		9031  -  DEVICE BRCHTX CVTY EVAL TRGT MAMST BRST	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$0.00	$0.00	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9032	SUP	Custom 27803010		9032  -  VENT 9032 QUICK RELEASE INTRODUCER	BOTH IP/OP	$270.75 	$200.36	$0.00	$216.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.95	$200.95	$0.00	$0.00	$56.42	$0.00	$0.00	$0.00	$0.00	$135.38	$214.43	$216.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9041	SUP	Custom 27203010		CONNECTOR TBG FMALE LUER LOCK LOCK PLG IV	BOTH IP/OP	$157.50 	$116.55	$0.00	$126.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$78.75	$124.74	$126.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9053	SUP	Custom 27203010		9053  -  VAD 9053 12MM CONVT W/INLET CONN	BOTH IP/OP	$888.25 	$657.31	$0.00	$710.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$659.26	$659.26	$0.00	$0.00	$185.11	$0.00	$0.00	$0.00	$0.00	$444.13	$703.49	$710.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9073	SUP	Custom 27203010		9073  -  STOCKINETTE ORTHOPEDIC 25YDX3IN HIGH ABSORBENT KNIT LATEX	BOTH IP/OP	$28.80 	$21.31	$0.00	$23.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.38	$21.38	$0.00	$0.00	$6.00	$0.00	$0.00	$0.00	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9094	SUP	Custom 27203010		9094  -  STIMULATOR NRV STRL LF CKPNT LCTR DISP	BOTH IP/OP	"$1,565.00 "	"$1,158.10"	$0.00	"$1,252.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,161.54"	"$1,161.54"	$0.00	$0.00	$326.15	$0.00	$0.00	$0.00	$0.00	$782.50	"$1,239.48"	"$1,252.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9207	SUP	HCPCS C1729		CATHETER XTRN MED XTD WR MALE	BOTH IP/OP	$3.00 	$2.22	$0.00	$2.40	$1.63	$1.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.50	$2.38	$2.40	$0.00		$0.00	$0.47	$0.00	$0.00	$0.48	$0.00	$0.00	$0.00	$0.00	$0.00
9209	SUP	HCPCS C1729		CATHETER XTRN 36MM LG XTD WR LTX MALE	BOTH IP/OP	$3.00 	$2.22	$0.00	$2.40	$1.63	$1.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.50	$2.38	$2.40	$0.00		$0.00	$0.47	$0.00	$0.00	$0.48	$0.00	$0.00	$0.00	$0.00	$0.00
9305	SUP	Custom 27803010		9305  -  GRAFT SYNTH TISSUE TRUMPET 50X30X1.6MM SHEET BARRIER MEDPOR	BOTH IP/OP	"$1,380.00 "	"$1,021.20"	$0.00	"$1,616.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.24"	"$1,024.24"	$0.00	$0.00	$287.59	$0.00	$0.00	$0.00	$0.00	"$1,010.00"	"$1,599.84"	"$1,616.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9312	SUP	Custom 27803010		9312  -  GRAFT SYNTH TISSUE RECTANGLE 76X50X1.6MM IMPLANT NONPOROUS	BOTH IP/OP	"$1,277.70 "	$945.50	$0.00	"$1,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$948.31	$948.31	$0.00	$0.00	$266.27	$0.00	$0.00	$0.00	$0.00	$888.75	"$1,407.78"	"$1,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9429	SUP	Custom 27803010		9429  -  GRAFT SYNTH TISSUE 43X18MM FLANGE MEDPOR POLYETHYLENE POROUS	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9430	SUP	Custom 27803010		9430  -  GRAFT SYNTH TISSUE INFERIOR ORBTL RIM RIGHT	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,037.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$0.00	$0.00	$0.00	$3.79	"$1,037.52"	$6.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9500	SUP	HCPCS C1769		9500  -  GUIDEWIRE VASC 3CM COMBOWIRE XT FLXB SHFT DPLR PTFE HDRPHB	BOTH IP/OP	$1.40 	$1.04	$0.00	"$2,178.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	"$2,178.00"	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9501	SUP	Custom 27803010		9501  -  GRAFT SYNTH TISSUE SUPER PETITE 50X19X3MM IMPLANT TAPERED	BOTH IP/OP	$893.75 	$661.38	$0.00	"$1,037.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$663.34	$663.34	$0.00	$0.00	$186.26	$0.00	$0.00	$0.00	$0.00	$41.65	"$1,037.52"	$66.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9502	SUP	Custom 27803010		9502  -  GRAFT SYNTH TISSUE SUPER PETITE 50X19X3MM IMPLANT TAPERED	BOTH IP/OP	$893.75 	$661.38	$0.00	"$1,037.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.87	$131.87	$0.00	$0.00	$37.03	$0.00	$0.00	$0.00	$0.00	$50.40	"$1,037.52"	$80.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9503	SUP	Custom 27803010		9503  -  GRAFT SYNTH TISSUE PETITE 50X19X5MM IMPLANT POROUS MEDPOR	BOTH IP/OP	$893.75 	$661.38	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$663.34	$663.34	$0.00	$0.00	$186.26	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9504	SUP	Custom 27803010		9504  -  GRAFT SYNTH TISSUE PETITE 50X19X5MM IMPLANT TAPERED POROUS	BOTH IP/OP	$893.75 	$661.38	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$663.34	$663.34	$0.00	$0.00	$186.26	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9513	SUP	Custom 27803010		9513  -  GRAFT SYNTH TISSUE SMALL CNTOUR 45X24X3MM TRIM AUGMENTATION	BOTH IP/OP	$935.63 	$692.37	$0.00	"$1,047.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$396.78	$396.78	$0.00	$0.00	$111.41	$0.00	$0.00	$0.00	$0.00	$222.60	"$1,047.42"	$356.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9514	SUP	Custom 27803010		9514  -  GRAFT SYNTH TISSUE SMALL 45X24X3MM EXTEND DESIGN MEDPOR	BOTH IP/OP	$935.63 	$692.37	$0.00	"$1,058.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$694.42	$694.42	$0.00	$0.00	$194.98	$0.00	$0.00	$0.00	$0.00	$661.25	"$1,047.42"	"$1,058.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9515	SUP	Custom 27803010		9515  -  GRAFT SYNTH TISSUE MEDIUM CNTOUR 50X26X4MM EXTEND MEDPOR	BOTH IP/OP	$935.63 	$692.37	$0.00	"$1,058.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$694.42	$694.42	$0.00	$0.00	$194.98	$0.00	$0.00	$0.00	$0.00	$661.25	"$1,047.42"	"$1,058.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9516	SUP	Custom 27803010		9516  -  GRAFT SNTH TISS MED 50X26X4MM STRL LF MDPR XTD CNTR PE POR	BOTH IP/OP	$935.63 	$692.37	$0.00	"$1,047.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.63	$6.63	$0.00	$0.00	$1.86	$0.00	$0.00	$0.00	$0.00	$4.05	"$1,047.42"	$6.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9517	SUP	Custom 27803010		9517  -  GRAFT SNTH TISS LG 55X27X5MM STRL MDPR XTD CNTR POR PE	BOTH IP/OP	$935.63 	$692.37	$0.00	"$1,058.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$694.42	$694.42	$0.00	$0.00	$194.98	$0.00	$0.00	$0.00	$0.00	$661.25	"$1,047.42"	"$1,058.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9518	SUP	Custom 27803010		9518  -  GRAFT SYNTH TISSUE LARGE 55X27X5MM EXTEND SHAPE MEDPOR	BOTH IP/OP	$935.63 	$692.37	$0.00	"$1,058.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$694.42	$694.42	$0.00	$0.00	$194.98	$0.00	$0.00	$0.00	$0.00	$661.25	"$1,047.42"	"$1,058.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9519	SUP	Custom 27803010		9519  -  GRAFT SYNTH TISSUE PARANASAL CRESCENT PETITE 28X26X4.5MM	BOTH IP/OP	$925.58 	$684.93	$0.00	"$1,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$686.96	$686.96	$0.00	$0.00	$192.89	$0.00	$0.00	$0.00	$0.00	$680.00	"$1,077.12"	"$1,088.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9520	SUP	Custom 27803010		9520  -  GRAFT SYNTH TISSUE PARANASAL CRESCENT PETITE 28X26X4.5MM	BOTH IP/OP	$925.58 	$684.93	$0.00	"$1,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$686.96	$686.96	$0.00	$0.00	$192.89	$0.00	$0.00	$0.00	$0.00	$680.00	"$1,077.12"	"$1,088.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9521	SUP	Custom 27803010		9521  -  GRAFT SYNTH TISSUE SMALL 70X70X10MM SMOOTH FLEXIBLE AUGMENT	BOTH IP/OP	"$2,869.60 "	"$2,123.50"	$0.00	"$3,644.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,129.82"	"$2,129.82"	$0.00	$0.00	$598.02	$0.00	$0.00	$0.00	$0.00	"$2,277.50"	"$3,607.56"	"$3,644.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9522	SUP	Custom 27803010		9522  -  GRAFT SYNTH TISSUE MEDIUM 88X86X15MM SMOOTH FLEXIBLE AUGMENT	BOTH IP/OP	"$2,988.60 "	"$2,211.56"	$0.00	"$3,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,218.14"	"$2,218.14"	$0.00	$0.00	$622.82	$0.00	$0.00	$0.00	$0.00	"$2,371.25"	"$3,756.06"	"$3,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9523	SUP	Custom 27803010		9523  -  GRAFT SYNTH TISSUE LARGE 98X95X18MM SMOOTH FLEXIBLE AUGMENT	BOTH IP/OP	"$3,102.50 "	"$2,295.85"	$0.00	"$3,898.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.06	$62.06	$0.00	$0.00	$17.42	$0.00	$0.00	$0.00	$0.00	$37.91	"$3,898.62"	$60.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9524	SUP	Custom 27803010		9524  -  GRAFT SYNTH TISSUE THK6MM 107MMX97 GRID CNTOUR MEDPOR	BOTH IP/OP	"$7,350.80 "	"$5,439.59"	$0.00	"$9,542.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,531.91"	$0.00	$0.00	$0.00	$0.00	"$5,963.75"	"$9,446.58"	"$9,542.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9525	SUP	Custom 27803010		9525  -  GRAFT SYNTH TISSUE PARANASAL CRESCENT LARGE 30X28X7MM	BOTH IP/OP	$925.58 	$684.93	$0.00	"$1,077.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.43	$5.43	$0.00	$0.00	$1.53	$0.00	$0.00	$0.00	$0.00	$44.31	"$1,077.12"	$70.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9526	SUP	Custom 27803010		9526  -  GRAFT SYNTH TISSUE PARANASAL CRESCENT LARGE 30X28X7MM	BOTH IP/OP	$925.58 	$684.93	$0.00	"$1,077.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.14	$103.14	$0.00	$0.00	$28.96	$0.00	$0.00	$0.00	$0.00	$63.00	"$1,077.12"	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9527	SUP	Custom 27803010		9527  -  GRAFT SYNTH TISSUE 38X50X.85MM 1 CHANNEL SHEET MICROPLATE	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.00	$0.00	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9530	SUP	Custom 27203010		9530  -  SLEEVE COMPRESSION MEDIUM ANTIEMBOLISM ADJUSTABLE CLOSURE	BOTH IP/OP	$45.71 	$33.83	$0.00	$36.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.89	$36.20	$35.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9531	SUP	Custom 27803010		9531  -  GRAFT SYNTH TISSUE 52X40X2.3MM IMPLANT MINIPLATE CHANNEL	BOTH IP/OP	"$1,766.23 "	"$1,307.01"	$0.00	"$2,336.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,310.89"	"$1,310.89"	$0.00	$0.00	$368.08	$0.00	$0.00	$0.00	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9532	SUP	Custom 27803010		9532  -  GRAFT SNTH TISS 52X40X2.3MM BRR MDPR MCPLT CHNL SHT PE	BOTH IP/OP	"$1,766.23 "	"$1,307.01"	$0.00	"$2,336.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,310.89"	"$1,310.89"	$0.00	$0.00	$368.08	$0.00	$0.00	$0.00	$0.00	"$1,460.00"	"$2,312.64"	"$2,336.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9533	SUP	Custom 27803010		9533  -  GRAFT SYNTH TISSUE 1.1MM SMALL 70X13X2MM ONLAY ARCH SHAPE	BOTH IP/OP	$843.60 	$624.26	$0.00	$942.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$626.12	$626.12	$0.00	$0.00	$175.81	$0.00	$0.00	$0.00	$0.00	$588.75	$932.58	$942.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9534	SUP	Custom 27803010		9534  -  GRAFT SYNTH TISSUE MEDIUM 70X15X2MM NASAL ARCH POROUS MEDPOR	BOTH IP/OP	$843.60 	$624.26	$0.00	$942.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$626.12	$626.12	$0.00	$0.00	$175.81	$0.00	$0.00	$0.00	$0.00	$588.75	$932.58	$942.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9535	SUP	Custom 27803010		9535  -  GRAFT SYNTH TISSUE LARGE 70X17X2MM NASAL ARCH ONLAY POROUS	BOTH IP/OP	$843.60 	$624.26	$0.00	$942.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$626.12	$626.12	$0.00	$0.00	$175.81	$0.00	$0.00	$0.00	$0.00	$588.75	$932.58	$942.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9536	SUP	Custom 27803010		9536  -  GRAFT SYNTH TISSUE 40X9X1.1MM NASAL SHEET POROUS MEDPOR	BOTH IP/OP	$406.00 	$300.44	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.33	$301.33	$0.00	$0.00	$84.61	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9537	SUP	HCPCS C1763		9537  -  TISSUE SYNTH PE POR MEDPOR ORBTL RIM	BOTH IP/OP	$950.00 	$703.00	$0.00	$760.00	$427.50	$427.50	$0.00	$0.00	$0.00	$198.00	$705.09	$705.09	$0.00	$0.00	$197.98	$0.00	$561.93	$561.93	$0.00	$475.00	$752.40	$760.00	$0.00		$0.00	$148.68	$0.00	$0.00	$151.24	$0.00	$0.00	$0.00	$0.00	$0.00
9539	SUP	Custom 27803010		9539  -  GRAFT SYNTH TISSUE 47X40X6.3MM EXTEND MEDPOR POLYETHYLENE	BOTH IP/OP	"$1,371.58 "	"$1,014.97"	$0.00	"$1,552.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,017.98"	"$1,017.98"	$0.00	$0.00	$285.84	$0.00	$0.00	$0.00	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9540	SUP	Custom 27803010		9540  -  GRAFT SNTH TISS 47X40X6.3MM STRL MDPR XTD PE POR CRNMXF RT	BOTH IP/OP	"$1,371.58 "	"$1,014.97"	$0.00	"$1,552.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,017.98"	"$1,017.98"	$0.00	$0.00	$285.84	$0.00	$0.00	$0.00	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9541	SUP	Custom 27803010		9541  -  GRAFT SYNTH TISSUE REGULAR 31X22X7MM ENOPHTHALMOS WEDGE	BOTH IP/OP	"$1,215.00 "	$899.10	$0.00	"$1,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.77	$901.77	$0.00	$0.00	$253.21	$0.00	$0.00	$0.00	$0.00	$853.75	"$1,352.34"	"$1,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9542	SUP	Custom 27803010		9542  -  GRAFT SYNTH TISSUE REGULAR 31X22X7MM WEDGE ENOPHTHALMOS	BOTH IP/OP	"$1,215.00 "	$899.10	$0.00	"$1,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.77	$901.77	$0.00	$0.00	$253.21	$0.00	$0.00	$0.00	$0.00	$853.75	"$1,352.34"	"$1,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9543	SUP	Custom 27803010		9543  -  GRAFT SYNTH TISSUE LARGE 40X28X7.5MM ENOPHTHALMOS WEDGE	BOTH IP/OP	"$1,215.00 "	$899.10	$0.00	"$1,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.77	$901.77	$0.00	$0.00	$253.21	$0.00	$0.00	$0.00	$0.00	$853.75	"$1,352.34"	"$1,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9544	SUP	Custom 27803010		9544  -  GRAFT SYNTH TISSUE LARGE 40X28X7.5MM ENOPHTHALMOS WEDGE	BOTH IP/OP	"$1,215.00 "	$899.10	$0.00	"$1,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.77	$901.77	$0.00	$0.00	$253.21	$0.00	$0.00	$0.00	$0.00	$853.75	"$1,352.34"	"$1,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9545	SUP	Custom 27203010		9545  -  SLEEVE SMALL SCD EXPRESS THIGH LENGTH	BOTH IP/OP	$99.10 	$73.33	$0.00	$79.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.55	$78.49	$79.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9548	SUP	Custom 27803010		9548  -  CONFORMER OCULAR MEDIUM 24X21X5.3MM NONVENT LATEX FREE ACRYL	BOTH IP/OP	$120.25 	$88.99	$0.00	$142.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.25	$89.25	$0.00	$0.00	$25.06	$0.00	$0.00	$0.00	$0.00	$88.75	$140.58	$142.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9553	SUP	Custom 27803010		9553  -  GRAFT SYNTH TISSUE REGULAR SHELL 38X21X17MM 2 INSERT	BOTH IP/OP	"$1,130.00 "	$836.20	$0.00	"$1,242.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$838.69	$838.69	$0.00	$0.00	$235.49	$0.00	$0.00	$0.00	$0.00	$776.25	"$1,229.58"	"$1,242.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9554	SUP	Custom 27803010		9554  -  GRAFT SYNTH TISSUE LARGE 40X20X18MM NASAL SHELL 2 INSERTS	BOTH IP/OP	$190.13 	$140.70	$0.00	"$1,242.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.11	$141.11	$0.00	$0.00	$39.62	$0.00	$0.00	$0.00	$0.00	$776.25	"$1,229.58"	"$1,242.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9555	SUP	Custom 27203010		CURETTE 4MM FLXLP ADLT EAR FLXB OVL CUP SURG POLYPRO DISP	BOTH IP/OP	$2.13 	$1.58	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.06	$1.69	$1.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9562	SUP	Custom 27803010		9562  -  SHEET SNTH 50X38X3MM MDPR NEURO	BOTH IP/OP	"$2,214.05 "	"$1,638.40"	$0.00	"$2,688.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,643.27"	"$1,643.27"	$0.00	$0.00	$461.41	$0.00	$0.00	$0.00	$0.00	"$1,680.00"	"$2,661.12"	"$2,688.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9568	SUP	Custom 27803010		9568  -  GRAFT SNTH TISS 108X75MM STRL MDPR IMPL INFR 2/3 ORBT POR PE	BOTH IP/OP	"$7,026.50 "	"$5,199.61"	$0.00	"$9,128.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,464.32"	$0.00	$0.00	$0.00	$0.00	"$5,705.00"	"$9,036.72"	"$9,128.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9570	SUP	Custom 27803010		9570  -  GRAFT SNTH TISS 93X75MM STRL MDPR IMPL CMPLT POR PE CRNMXF	BOTH IP/OP	"$8,342.75 "	"$6,173.64"	$0.00	"$10,838.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,738.63"	$0.00	$0.00	$0.00	$0.00	"$6,773.75"	"$10,729.62"	"$10,838.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9580	SUP	Custom 27203010		09580  -  DEVICE EXFIX OPTRM ELB TRGT DISC	BOTH IP/OP	$572.50 	$423.65	$0.00	$458.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.91	$424.91	$0.00	$0.00	$119.31	$0.00	$0.00	$0.00	$0.00	$286.25	$453.42	$458.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9595	SUP	HCPCS C1769		09595  -  WIRE .062IN KWIRE TRGT ORTH NONSTRL	BOTH IP/OP	$257.50 	$190.55	$0.00	$206.00	$139.82	$139.82	$0.00	$0.00	$0.00	$0.00	$191.12	$191.12	$0.00	$0.00	$53.66	$0.00	$0.00	$0.00	$0.00	$128.75	$203.94	$206.00	$0.00		$0.00	$40.30	$0.00	$0.00	$40.99	$0.00	$0.00	$0.00	$0.00	$0.00
9600	SUP	Custom 27203010		09600  -  FXTR EXFIX OPTRM PROX ELB CMPNT	BOTH IP/OP	"$11,645.00 "	"$8,617.30"	$0.00	"$9,316.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,426.82"	$0.00	$0.00	$0.00	$0.00	"$5,822.50"	"$9,222.84"	"$9,316.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9610	SUP	Custom 27803010		09610  -  CMPNT EXFIX OPTRM RIGHT DISTAL	BOTH IP/OP	"$5,727.50 "	"$4,238.35"	$0.00	"$4,536.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.25	$52.25	$0.00	$0.00	$14.67	$0.00	$0.00	$0.00	$0.00	$23.94	"$4,536.18"	$38.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9780	SUP	Custom 27203010		9780  -  DEVICE DRN C400LB 10-24FR STRL LF INVACARE I-FIT ATCH DEV	BOTH IP/OP	$51.01 	$37.75	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.42	$40.40	$39.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9857	SUP	Custom 27803010		9857  -  SHEET SNTH SM CNTR 78X61X18MM STRL FLXBLK TF2 MDPR CRNMXF LT	BOTH IP/OP	"$3,042.25 "	"$2,251.27"	$0.00	"$3,634.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,257.96"	"$2,257.96"	$0.00	$0.00	$634.00	$0.00	$0.00	$0.00	$0.00	"$2,271.25"	"$3,597.66"	"$3,634.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9858	SUP	Custom 27803010		9858  -  GRAFT SYNTH TISSUE SMALL CNTOUR 78X61X18MM FLEXBLOCK TF2	BOTH IP/OP	"$3,042.25 "	"$2,251.27"	$0.00	"$3,634.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,257.96"	"$2,257.96"	$0.00	$0.00	$634.00	$0.00	$0.00	$0.00	$0.00	"$2,271.25"	"$3,597.66"	"$3,634.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9859	SUP	Custom 27803010		9859  -  GRAFT SYNTH TISSUE MEDIUM CNTOUR 93X74X20MM FLEXBLOCK MEDPOR	BOTH IP/OP	"$3,041.35 "	"$2,250.60"	$0.00	"$3,763.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.98	$202.98	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$124.13	"$3,763.98"	$198.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9860	SUP	Custom 27803010		9860  -  GRAFT SYNTH TISSUE MEDIUM CNTOUR 93X74X20MM FLEXBLOCK MEDPOR	BOTH IP/OP	"$3,041.35 "	"$2,250.60"	$0.00	"$3,802.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,257.29"	"$2,257.29"	$0.00	$0.00	$633.82	$0.00	$0.00	$0.00	$0.00	"$2,376.25"	"$3,763.98"	"$3,802.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9861	SUP	Custom 27803010		9861  -  GRAFT SYNTH TISSUE LARGE IMPLANT CNTOUR POROUS MEDPOR	BOTH IP/OP	"$3,170.50 "	"$2,346.17"	$0.00	"$3,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,353.15"	"$2,353.15"	$0.00	$0.00	$660.73	$0.00	$0.00	$0.00	$0.00	"$2,486.25"	"$3,938.22"	"$3,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9862	SUP	Custom 27803010		9862  -  GRAFT SYNTH TISSUE LARGE IMPLANT POROUS MEDPOR FLEXBLOCK TF2	BOTH IP/OP	"$3,170.50 "	"$2,346.17"	$0.00	"$3,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,353.15"	"$2,353.15"	$0.00	$0.00	$660.73	$0.00	$0.00	$0.00	$0.00	"$2,486.25"	"$3,938.22"	"$3,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9864	SUP	Custom 27803010		9864  -  GRAFT SYNTH TISSUE 44X43X6MM MEDPOR POLYETHYLENE POROUS	BOTH IP/OP	"$2,026.38 "	"$1,499.52"	$0.00	"$2,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,503.98"	"$1,503.98"	$0.00	$0.00	$422.30	$0.00	$0.00	$0.00	$0.00	"$1,757.50"	"$2,783.88"	"$2,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9865	SUP	Custom 27803010		9865  -  GRAFT SYNTH TISSUE 44X43X6MM MEDPOR POLYETHYLENE POROUS LEFT	BOTH IP/OP	"$2,026.38 "	"$1,499.52"	$0.00	"$2,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,503.98"	"$1,503.98"	$0.00	$0.00	$422.30	$0.00	$0.00	$0.00	$0.00	"$1,757.50"	"$2,783.88"	"$2,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9866	SUP	Custom 27803010		9866  -  IMPLANT ORBTL 16MM SMALL ROUND MOTILITY 2 CHANNEL 4 ANTERIOR	BOTH IP/OP	"$1,273.05 "	$942.06	$0.00	"$1,274.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.86	$944.86	$0.00	$0.00	$265.30	$0.00	$0.00	$0.00	$0.00	$796.25	"$1,261.26"	"$1,274.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9867	SUP	Custom 27803010		9867  -  IMPLANT ORBTL 18MM MEDIUM ROUND MOTILITY 2 CHANNEL 4	BOTH IP/OP	"$1,592.50 "	"$1,178.45"	$0.00	"$1,274.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,181.95"	"$1,181.95"	$0.00	$0.00	$331.88	$0.00	$0.00	$0.00	$0.00	$796.25	"$1,261.26"	"$1,274.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9868	SUP	Custom 27803010		9868  -  IMPLANT ORBTL 20MM LARGE ROUND MOTILITY 2 CHANNEL 4 ANTERIOR	BOTH IP/OP	"$1,592.50 "	"$1,178.45"	$0.00	"$1,274.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,181.95"	"$1,181.95"	$0.00	$0.00	$331.88	$0.00	$0.00	$0.00	$0.00	$796.25	"$1,261.26"	"$1,274.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9952	SUP	Custom 27803010		9952  -  SET SZR MALAR	BOTH IP/OP	$521.25 	$385.73	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$386.87	$386.87	$0.00	$0.00	$108.63	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9955	SUP	Custom 27803010		9955  -  GRAFT SYNTH TISSUE SMALL 65X35X3MM IMPLANT ANGLED WRAPAROUND	BOTH IP/OP	"$1,510.88 "	"$1,118.05"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,121.37"	"$1,121.37"	$0.00	$0.00	$314.87	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9956	SUP	Custom 27803010		9956  -  GRAFT SYNTH TISSUE SMALL ANGLE RIGHT 65X35X3MM WRAPAROUND	BOTH IP/OP	"$1,420.08 "	"$1,050.86"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,053.98"	"$1,053.98"	$0.00	$0.00	$295.94	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9957	SUP	Custom 27803010		9957  -  GRAFT SYNTH TISSUE MEDIUM 65X35X7MM IMPLANT ANGLED	BOTH IP/OP	"$1,420.08 "	"$1,050.86"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,053.98"	"$1,053.98"	$0.00	$0.00	$295.94	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9958	SUP	Custom 27803010		9958  -  GRAFT SYNTH TISSUE MEDIUM 65X35X7MM IMPLANT ANGLED	BOTH IP/OP	"$1,420.08 "	"$1,050.86"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,053.98"	"$1,053.98"	$0.00	$0.00	$295.94	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9959	SUP	Custom 27803010		9959  -  GRAFT SYNTH TISSUE LARGE 65X35X11MM IMPLANT ANGLED	BOTH IP/OP	"$1,420.08 "	"$1,050.86"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,053.98"	"$1,053.98"	$0.00	$0.00	$295.94	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9960	SUP	Custom 27803010		9960  -  GRAFT SYNTH TISSUE LARGE 65X35X11MM IMPLANT ANGLED	BOTH IP/OP	"$1,420.08 "	"$1,050.86"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,053.98"	"$1,053.98"	$0.00	$0.00	$295.94	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10004	SUP	HCPCS C1713		010004  -  PLATE BONE 4 HOLE UTILITY SPN	BOTH IP/OP	$26.25 	$19.43	$0.00	$21.00	$11.81	$11.81	$0.00	$0.00	$0.00	$5.47	$19.48	$19.48	$0.00	$0.00	$5.47	$0.00	$15.53	$15.53	$0.00	$13.13	$20.79	$21.00	$0.00		$0.00	$4.11	$0.00	$0.00	$4.18	$0.00	$0.00	$0.00	$0.00	$0.00
10014	SUP	HCPCS C1713		010014  -  PLATE BONE 4MM STANDARD STR 14 HOLE TIMESH TITANIUM CRANIAL	BOTH IP/OP	$490.88 	$363.25	$0.00	$388.78	$0.00	$0.00	$0.00	$0.00	$0.00	$102.31	$364.33	$364.33	$0.00	$0.00	$102.30	$0.00	$290.35	$290.35	$0.00	$86.63	$388.78	$138.60	$0.00		$0.00	$0.00	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$0.00
10015	SUP	HCPCS C1713		10015  -  SPACER ALLOGRAFT 8D NARROW LORDOTIC WEDGE PYRAMIDAL TEETH	BOTH IP/OP	"$10,725.00 "	"$7,936.50"	$0.00	"$8,580.00"	"$4,826.25"	"$4,826.25"	$0.00	$0.00	$0.00	"$2,235.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,235.09"	$0.00	"$5,287.43"	"$5,287.43"	$0.00	"$5,362.50"	"$8,494.20"	"$8,580.00"	$0.00		$0.00	"$1,678.46"	$0.00	$0.00	"$1,707.42"	$0.00	$0.00	$0.00	$0.00	$0.00
10016	SUP	HCPCS C1713		010016  -  PLATE BONE 3MM STANDARD STR 14 HOLE TIMESH TITANIUM CRANIAL	BOTH IP/OP	$490.88 	$363.25	$0.00	$392.70	$220.89	$220.89	$0.00	$0.00	$0.00	$102.31	$364.33	$364.33	$0.00	$0.00	$102.30	$0.00	$290.35	$290.35	$0.00	$245.44	$388.78	$392.70	$0.00		$0.00	$76.82	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$0.00
10019	SUP	HCPCS C1713		10019  -  SPACER ALLOGRAFT 8D NARROW PYRAMID LORDOTIC WEDGE 23-27MMX19	BOTH IP/OP	"$10,725.00 "	"$7,936.50"	$0.00	"$8,580.00"	"$4,826.25"	"$4,826.25"	$0.00	$0.00	$0.00	"$2,235.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,235.09"	$0.00	"$5,287.43"	"$5,287.43"	$0.00	"$5,362.50"	"$8,494.20"	"$8,580.00"	$0.00		$0.00	"$1,678.46"	$0.00	$0.00	"$1,707.42"	$0.00	$0.00	$0.00	$0.00	$0.00
10040	SUP	HCPCS C1713		010040  -  SCREW 010040 X-DRV 1.0MM 4MM 6	BOTH IP/OP	$105.19 	$77.84	$0.00	$84.15	$47.33	$47.33	$0.00	$0.00	$0.00	$21.92	$78.07	$78.07	$0.00	$0.00	$21.92	$0.00	$62.22	$62.22	$0.00	$52.59	$83.31	$84.15	$0.00		$0.00	$16.46	$0.00	$0.00	$16.75	$0.00	$0.00	$0.00	$0.00	$0.00
10060	SUP	HCPCS C1713		010060  -  SCREW 010060 X-DRV 1.0MM 6MM 6	BOTH IP/OP	$106.60 	$78.88	$0.00	$85.28	$47.97	$47.97	$0.00	$0.00	$0.00	$22.22	$79.12	$79.12	$0.00	$0.00	$22.22	$0.00	$63.06	$63.06	$0.00	$53.30	$84.43	$85.28	$0.00		$0.00	$16.68	$0.00	$0.00	$16.97	$0.00	$0.00	$0.00	$0.00	$0.00
10237	SUP	Custom 27203010		10237  -  KIT GASTROSTOMY 11 .035IN J LP 18FR 22FR INTROD NEEDLE FEED	BOTH IP/OP	$584.88 	$432.81	$0.00	$467.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$434.09	$434.09	$0.00	$0.00	$121.89	$0.00	$0.00	$0.00	$0.00	$292.44	$438.37	$467.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10241	SUP	HCPCS C1713		010241  -  CATHETER ANGIOGRAPHIC STR PIGTAIL CURVE 6FR 110CM 6 SIDEHOLE	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
10242	SUP	HCPCS C1713		010242  -  CATHETER ANGIOGRAPHIC 145D VAN TASSEL ANGLED PIGTAIL CURVE 6	BOTH IP/OP	$388.88 	$287.77	$0.00	$311.10	$174.99	$174.99	$0.00	$0.00	$0.00	$81.05	$288.62	$288.62	$0.00	$0.00	$81.04	$0.00	$230.02	$230.02	$0.00	$194.44	$307.99	$311.10	$0.00		$0.00	$60.86	$0.00	$0.00	$61.91	$0.00	$0.00	$0.00	$0.00	$0.00
10250	SUP	Custom 27203010		10250  -  KIT GASTROSTOMY 12FR INTROD LAPSCOP MIC-KEY	BOTH IP/OP	$584.88 	$432.81	$0.00	$467.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$434.09	$434.09	$0.00	$0.00	$121.89	$0.00	$0.00	$0.00	$0.00	$292.44	$463.22	$467.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10354	SUP	Custom 27203010		FUNNEL CNTRF FLTR CRD SL CAP SMPL CHMBR .4ML CYFNL CYTSPN	BOTH IP/OP	$207.05 	$153.22	$0.00	$165.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.53	$163.98	$165.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10355	SUP	Custom 27203010		FUNNEL CNTRF SGL FLTR CRD SL CAP .4ML CYFNL DISP WHT	BOTH IP/OP	$3.00 	$2.22	$0.00	$2.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.50	$2.38	$2.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10400	SUP	Custom 27203010		REAGENT NEIS HMPHLS API ID CRD ANALY	BOTH IP/OP	$9.80 	$7.25	$0.00	$7.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.90	$7.76	$7.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12110	SUP	HCPCS C1887		12110  -  CATHETER PERFUSION 10IN VENT DLP PVC PEDIATRIC 10FR	BOTH IP/OP	$1.25 	$0.93	$0.00	$919.56	$624.15	$624.15	$0.00	$0.00	$0.00	$0.00	$0.93	$0.93	$0.00	$0.00	$0.26	$0.00	$0.00	$0.00	$0.00	$574.73	$910.36	$919.56	$0.00		$0.00	$179.89	$0.00	$0.00	$182.99	$0.00	$0.00	$0.00	$0.00	$0.00
13030	SUP	HCPCS C1713		013030  -  SCREW 013030 X-DRV RESCUE 3MM 6PK	BOTH IP/OP	$99.52 	$73.64	$0.00	$79.62	$44.78	$44.78	$0.00	$0.00	$0.00	$20.74	$73.86	$73.86	$0.00	$0.00	$20.74	$0.00	$58.87	$58.87	$0.00	$49.76	$78.82	$79.62	$0.00		$0.00	$15.58	$0.00	$0.00	$15.84	$0.00	$0.00	$0.00	$0.00	$0.00
13050	SUP	HCPCS C1713		013050  -  SCREW 013050 X-DRV RESCUE 5MM 6PK	BOTH IP/OP	$105.19 	$77.84	$0.00	$84.15	$47.33	$47.33	$0.00	$0.00	$0.00	$21.92	$78.07	$78.07	$0.00	$0.00	$21.92	$0.00	$62.22	$62.22	$0.00	$52.59	$83.31	$84.15	$0.00		$0.00	$16.46	$0.00	$0.00	$16.75	$0.00	$0.00	$0.00	$0.00	$0.00
13186	SUP	HCPCS C1713		"13186  -  ENDOBUTTON FIXATION BUTTON, 4X 12MM"	BOTH IP/OP	$452.40 	$334.78	$0.00	$361.92	$203.58	$203.58	$0.00	$0.00	$0.00	$94.29	$335.77	$335.77	$0.00	$0.00	$94.28	$0.00	$267.59	$267.59	$0.00	$226.20	$358.30	$361.92	$0.00		$0.00	$70.80	$0.00	$0.00	$72.02	$0.00	$0.00	$0.00	$0.00	$0.00
14000	SUP	Custom 27203010		14000  -  SET CRDPLG .25IN 15IN DLP MLT 4 LG ADPR SLIP CNCT	BOTH IP/OP	$49.48 	$36.62	$0.00	$39.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.74	$39.19	$39.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14070	SUP	Custom 27203010		14070  -  SYSTEM 8 1/8-11.75IN OST C2000- ML MAXI DRAIN PORT	BOTH IP/OP	$42.70 	$31.60	$0.00	$104.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.69	$31.69	$0.00	$0.00	$8.90	$0.00	$0.00	$0.00	$0.00	$65.01	$102.98	$104.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15030	SUP	HCPCS C1713		015030  -  SCREW BN 1.5MM 3MM TIMESH XDR TI CRNM	BOTH IP/OP	$92.44 	$68.41	$0.00	$73.95	$41.60	$41.60	$0.00	$0.00	$0.00	$19.27	$68.61	$68.61	$0.00	$0.00	$19.26	$0.00	$54.68	$54.68	$0.00	$46.22	$73.21	$73.95	$0.00		$0.00	$14.47	$0.00	$0.00	$14.72	$0.00	$0.00	$0.00	$0.00	$0.00
15031	SUP	HCPCS C1713		015031  -  SCREW 015031 SELF TAPPING 1.5X3MM 1	BOTH IP/OP	$104.13 	$77.06	$0.00	$83.30	$46.86	$46.86	$0.00	$0.00	$0.00	$21.70	$77.28	$77.28	$0.00	$0.00	$21.70	$0.00	$61.59	$61.59	$0.00	$52.06	$82.47	$83.30	$0.00		$0.00	$16.30	$0.00	$0.00	$16.58	$0.00	$0.00	$0.00	$0.00	$0.00
15040	SUP	HCPCS C1713		015040  -  PLATE BN STRG 4MM TIMESH 1 HLE/HD 1 HL SHFT TI CRNM 1.5MM	BOTH IP/OP	$99.17 	$73.39	$0.00	$79.33	$44.63	$44.63	$0.00	$0.00	$0.00	$20.67	$73.60	$73.60	$0.00	$0.00	$20.67	$0.00	$58.66	$58.66	$0.00	$49.58	$78.54	$79.33	$0.00		$0.00	$15.52	$0.00	$0.00	$15.79	$0.00	$0.00	$0.00	$0.00	$0.00
15041	SUP	HCPCS C1713		015041  -  SCREW 015041 SELF TAPPING 1.5X4MM 1	BOTH IP/OP	$106.25 	$78.63	$0.00	$85.00	$47.81	$47.81	$0.00	$0.00	$0.00	$22.15	$78.86	$78.86	$0.00	$0.00	$22.14	$0.00	$62.85	$62.85	$0.00	$53.13	$84.15	$85.00	$0.00		$0.00	$16.63	$0.00	$0.00	$16.92	$0.00	$0.00	$0.00	$0.00	$0.00
15050	SUP	HCPCS C1713		015050  -  SCREW 015050 X-DRV 1.5MM 5MM 6	BOTH IP/OP	$97.75 	$72.34	$0.00	$78.20	$43.99	$43.99	$0.00	$0.00	$0.00	$20.37	$72.55	$72.55	$0.00	$0.00	$20.37	$0.00	$57.82	$57.82	$0.00	$48.88	$77.42	$78.20	$0.00		$0.00	$15.30	$0.00	$0.00	$15.56	$0.00	$0.00	$0.00	$0.00	$0.00
15051	SUP	HCPCS C1713		015051  -  SCREW 015051 SELF TAPPING 1.5X5MM 1	BOTH IP/OP	$104.13 	$77.06	$0.00	$83.30	$46.86	$46.86	$0.00	$0.00	$0.00	$21.70	$77.28	$77.28	$0.00	$0.00	$21.70	$0.00	$61.59	$61.59	$0.00	$52.06	$82.47	$83.30	$0.00		$0.00	$16.30	$0.00	$0.00	$16.58	$0.00	$0.00	$0.00	$0.00	$0.00
15060	SUP	HCPCS C1713		015060  -  SCREW 015060 X-DRV 1.5MM 6MM 6	BOTH IP/OP	$97.75 	$72.34	$0.00	$78.20	$43.99	$43.99	$0.00	$0.00	$0.00	$20.37	$72.55	$72.55	$0.00	$0.00	$20.37	$0.00	$57.82	$57.82	$0.00	$48.88	$77.42	$78.20	$0.00		$0.00	$15.30	$0.00	$0.00	$15.56	$0.00	$0.00	$0.00	$0.00	$0.00
15070	SUP	HCPCS C1713		015070  -  SCREW 015070 X DRV 1.5MM 7MM 6	BOTH IP/OP	$99.52 	$73.64	$0.00	$79.62	$44.78	$44.78	$0.00	$0.00	$0.00	$20.74	$73.86	$73.86	$0.00	$0.00	$20.74	$0.00	$58.87	$58.87	$0.00	$49.76	$78.82	$79.62	$0.00		$0.00	$15.58	$0.00	$0.00	$15.84	$0.00	$0.00	$0.00	$0.00	$0.00
15080	SUP	HCPCS C1713		015080  -  SCREW 015080 X-DRV 1.5MM 8MM 6	BOTH IP/OP	$97.75 	$72.34	$0.00	$78.20	$43.99	$43.99	$0.00	$0.00	$0.00	$20.37	$72.55	$72.55	$0.00	$0.00	$20.37	$0.00	$57.82	$57.82	$0.00	$48.88	$77.42	$78.20	$0.00		$0.00	$15.30	$0.00	$0.00	$15.56	$0.00	$0.00	$0.00	$0.00	$0.00
15090	SUP	HCPCS C1713		015090  -  SCREW BN 1.5MM 9MM XDR	BOTH IP/OP	$99.52 	$73.64	$0.00	$79.62	$44.78	$44.78	$0.00	$0.00	$0.00	$20.74	$73.86	$73.86	$0.00	$0.00	$20.74	$0.00	$58.87	$58.87	$0.00	$49.76	$78.82	$79.62	$0.00		$0.00	$15.58	$0.00	$0.00	$15.84	$0.00	$0.00	$0.00	$0.00	$0.00
15110	SUP	HCPCS C1713		015110  -  SCREW 015110 X-DRV 1.5MM 11MM 6	BOTH IP/OP	$97.75 	$72.34	$0.00	$78.20	$43.99	$43.99	$0.00	$0.00	$0.00	$20.37	$72.55	$72.55	$0.00	$0.00	$20.37	$0.00	$57.82	$57.82	$0.00	$48.88	$77.42	$78.20	$0.00		$0.00	$15.30	$0.00	$0.00	$15.56	$0.00	$0.00	$0.00	$0.00	$0.00
15170	SUP	Custom 27203010		015170  -  STAPLER INTNL 57MMX.17MM LACTOMER ABS STPL SQZ	BOTH IP/OP	"$1,226.30 "	$907.46	$0.00	$981.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$910.16	$910.16	$0.00	$0.00	$255.56	$0.00	$0.00	$0.00	$0.00	$613.15	$971.23	$981.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15850	SUP	HCPCS C1758		0015850  -  BAG DRN 9.5IN 19OZ STRL LTX 2 ADJ BELT ADPR NTR RBR BILE	BOTH IP/OP	$253.80 	$187.81	$0.00	$203.04	$137.81	$137.81	$0.00	$0.00	$0.00	$52.90	$188.37	$188.37	$0.00	$0.00	$52.89	$0.00	$150.12	$150.12	$0.00	$126.90	$201.01	$203.04	$0.00		$0.00	$39.72	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
17061	SUP	Custom 27203010		PUMP BRST 1 HND FLEXSHIELD	BOTH IP/OP	$55.15 	$40.81	$0.00	$44.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.58	$43.68	$44.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17130	SUP	HCPCS C1713		017130  -  PLATE BN CRV .6MM SLVR TRAUMAONE 10 HL TI ORBT FLR 1.5MM SCR	BOTH IP/OP	$540.00 	$399.60	$0.00	$432.00	$243.00	$243.00	$0.00	$0.00	$0.00	$112.55	$400.79	$400.79	$0.00	$0.00	$112.54	$0.00	$319.41	$319.41	$0.00	$270.00	$427.68	$432.00	$0.00		$0.00	$84.51	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$0.00
17152	SUP	Custom 27203010		KIT BRSTPMP 1 HND DUAL HYGIENIKIT	BOTH IP/OP	$92.10 	$68.15	$0.00	$73.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.05	$72.94	$73.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17207	SUP	HCPCS C1762		017207  -  GRAFT BONE CORT CNC SPCR ANT CERV INTRBD FS 7MM	BOTH IP/OP	"$2,967.50 "	"$2,195.95"	$0.00	"$2,374.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$618.50	"$2,202.48"	"$2,202.48"	$0.00	$0.00	$618.43	$0.00	"$1,462.98"	"$1,462.98"	$0.00	"$1,483.75"	"$2,350.26"	"$2,374.00"	$0.00		$0.00	$464.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17208	SUP	HCPCS C1789		017208  -  SPACER ALGRF 5D LRDTC OVL 12X14X8MM FRZDR MNLTH LG CNTR LUM	BOTH IP/OP	"$2,637.50 "	"$1,951.75"	$0.00	"$2,110.00"	"$1,186.88"	"$1,186.88"	$0.00	$0.00	$0.00	$549.72	"$1,957.55"	"$1,957.55"	$0.00	$0.00	$549.66	$0.00	"$1,300.29"	"$1,300.29"	$0.00	"$1,318.75"	"$2,088.90"	"$2,110.00"	$0.00		$0.00	$412.77	$0.00	$0.00	$419.89	$0.00	$0.00	$0.00	$0.00	$0.00
17251	SUP	HCPCS C1769		17251  -  PLATINUM PLUS GUIDEWIRE .014X300CM WIRE	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$190.05	$190.05	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
17614	SUP	Custom 27203010		17614  -  STAPLER INTNL 55X4.8MM TI ENDSCP LNR CTR SQZ HNDL STRL LF	BOTH IP/OP	$493.05 	$364.86	$0.00	$394.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$365.94	$365.94	$0.00	$0.00	$102.75	$0.00	$0.00	$0.00	$0.00	$246.52	$390.50	$394.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18030	SUP	HCPCS C1713		018030  -  SCREW 018030 X-DRV RESCUE 3MM 6PK	BOTH IP/OP	$91.73 	$67.88	$0.00	$73.38	$41.28	$41.28	$0.00	$0.00	$0.00	$19.12	$68.08	$68.08	$0.00	$0.00	$19.12	$0.00	$54.26	$54.26	$0.00	$45.86	$72.65	$73.38	$0.00		$0.00	$14.36	$0.00	$0.00	$14.60	$0.00	$0.00	$0.00	$0.00	$0.00
18031	SUP	HCPCS C1713		018031  -  SCREW 018031 CRUCIATE RESCUE 1.8X3MM 1	BOTH IP/OP	$97.75 	$72.34	$0.00	"$1,102.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,102.32"	"$1,102.32"	$0.00	$0.00	$309.52	$0.00	$57.82	$57.82	$0.00	$688.13	$77.42	"$1,101.01"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18050	SUP	HCPCS C1713		018050  -  SCREW 018050 X-DRV RESCUE 5MM 6PK	BOTH IP/OP	$91.73 	$67.88	$0.00	$73.38	$41.28	$41.28	$0.00	$0.00	$0.00	$19.12	$68.08	$68.08	$0.00	$0.00	$19.12	$0.00	$54.26	$54.26	$0.00	$45.86	$72.65	$73.38	$0.00		$0.00	$14.36	$0.00	$0.00	$14.60	$0.00	$0.00	$0.00	$0.00	$0.00
18051	SUP	HCPCS C1713		018051  -  SCREW 018051 CRUCIATE RESCUE 1.8X5MM 1	BOTH IP/OP	$97.75 	$72.34	$0.00	$78.20	$43.99	$43.99	$0.00	$0.00	$0.00	$20.37	$72.55	$72.55	$0.00	$0.00	$20.37	$0.00	$57.82	$57.82	$0.00	$48.88	$77.42	$78.20	$0.00		$0.00	$15.30	$0.00	$0.00	$15.56	$0.00	$0.00	$0.00	$0.00	$0.00
19004	SUP	Custom 27203010		19004  -  KIT COLOSTOMY/ILEOSTOMY 2.25- IN 2.75IN 12IN 2 PIECE DRAIN	BOTH IP/OP	$34.71 	$25.69	$0.00	$27.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.36	$27.49	$27.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19006	SUP	Custom 27203010		19006  -  KIT OSTOMY 0-3.5IN 4IN 12IN 2 PIECE DRAIN LOCK N ROLL	BOTH IP/OP	$46.72 	$34.57	$0.00	$37.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.67	$34.67	$0.00	$0.00	$9.74	$0.00	$0.00	$0.00	$0.00	$23.36	$37.00	$37.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19203	SUP	Custom 27203010		19203  -  KIT UROSTOMY CUT TO FIT 1.75- IN 2.25IN 9IN 2 PIECE BELT TAB	BOTH IP/OP	$52.03 	$38.50	$0.00	$38.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.62	$38.62	$0.00	$0.00	$10.84	$0.00	$0.00	$0.00	$0.00	$4.21	$6.68	$6.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20012	SUP	Custom 27203010		20012  -  CANNULA PRFSN 12GA 5.5IN DLP ANTGRD STD TIP INTRO VNT LN	BOTH IP/OP	$2.28 	$1.69	$0.00	$1.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.69	$1.69	$0.00	$0.00	$0.48	$0.00	$0.00	$0.00	$0.00	$1.14	$1.81	$1.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20028	SUP	Custom 27803010		20028  -  VAD 20028 BH 12MM W/INT VENT 5.5CM	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20033	SUP	HCPCS C1788		20033  -  PORT 20033 3-WAY CONN W/O SILICONE	BOTH IP/OP	$565.25 	$418.29	$0.00	$452.20	$254.36	$254.36	$0.00	$0.00	$0.00	$117.81	$419.53	$419.53	$0.00	$0.00	$117.80	$0.00	$334.35	$334.35	$0.00	$282.63	$447.68	$452.20	$0.00		$0.00	$88.46	$0.00	$0.00	$89.99	$0.00	$0.00	$0.00	$0.00	$0.00
20034	SUP	Custom 27203010		20034  -  KIT 20034 EDM VENTRICULAR 35CM	BOTH IP/OP	$712.80 	$527.47	$0.00	$570.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$529.04	$529.04	$0.00	$0.00	$148.55	$0.00	$0.00	$0.00	$0.00	$356.40	$564.54	$570.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20046	SUP	Custom 27803010		20046  -  CATH 20046 VENT LARGE 23CM	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20116	SUP	HCPCS C1758		020116  -  CATH URET 6FR 70CM .038IN OP-EN	BOTH IP/OP	$21.38 	$15.82	$0.00	$17.10	$11.61	$11.61	$0.00	$0.00	$0.00	$4.46	$15.86	$15.86	$0.00	$0.00	$4.45	$0.00	$12.64	$12.64	$0.00	$10.69	$16.93	$17.10	$0.00		$0.00	$3.35	$0.00	$0.00	$3.40	$0.00	$0.00	$0.00	$0.00	$0.00
20141	SUP	Custom 27203010		20141  -  DRESSING BURN 5X4IN ANTIMICROBIAL FAST ACT BARRIER CONTROL	BOTH IP/OP	$39.92 	$29.54	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.96	$31.62	$31.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20201	SUP	Custom 27203010		20201  -  DRESSING BURN ANBCTRL FAST ACT VRSTL NCRSTLN SLVR 8X4IN STRL	BOTH IP/OP	$121.69 	$90.05	$0.00	$97.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.32	$90.32	$0.00	$0.00	$25.36	$0.00	$0.00	$0.00	$0.00	$60.85	$96.38	$97.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20230	SUP	Custom 27203010		REAGENT .85% SAL API 5ML ANALY	BOTH IP/OP	$160.88 	$119.05	$0.00	$128.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.44	$127.42	$128.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20301	SUP	Custom 27203010		FORMULA  ENFAMIL  AR  RTU	BOTH IP/OP	$176.40 	$130.54	$0.00	$141.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.20	$139.71	$141.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20401	SUP	Custom 27203010		20401  -  DRESSING BRN 16X16IN STRL LF ACTCT ANBCTRL FST ACT BRR CNTRL	BOTH IP/OP	$156.26 	$115.63	$0.00	$126.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$115.97	$115.97	$0.00	$0.00	$32.56	$0.00	$0.00	$0.00	$0.00	$79.30	$125.61	$126.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20421	SUP	Custom 27203010		MATTRESS PT 16X10IN TRNWRMR PVC PORT NELCTR HEAT SRC INF	BOTH IP/OP	$57.78 	$42.76	$0.00	$46.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.88	$42.88	$0.00	$0.00	$12.04	$0.00	$0.00	$0.00	$0.00	$28.89	$45.76	$46.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20934	SUP	Custom 27203010		020934  -  BAG OST GTCH SNTH UNV 4IN 14-14.5IN 2 PC DRAIN SRFT FLNG TPE	BOTH IP/OP	$81.06 	$59.98	$0.00	$64.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.16	$60.16	$0.00	$0.00	$16.89	$0.00	$0.00	$0.00	$0.00	$40.53	$64.20	$64.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21004	SUP	Custom 27803010		21004  -  CATH 21004 PERT SML OPEN END W/SLITS	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.24	$310.24	$0.00	$0.00	$87.11	$0.00	$0.00	$0.00	$0.00	$209.00	$331.06	$334.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21029	SUP	Custom 27803010		21029  -  INLET 21029 V A D 12MM W/BOTTOM INLET	BOTH IP/OP	"$1,082.60 "	$801.12	$0.00	$803.51	$0.00	$0.00	$0.00	$0.00	$0.00	$225.64	$803.51	$803.51	$0.00	$0.00	$225.61	$0.00	$640.36	$640.36	$0.00	$465.50	$737.35	$744.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21038	SUP	HCPCS C1769		21038  -  GUIDEWIRE 21038 TEFLON COATED 100CM	BOTH IP/OP	$213.75 	$158.18	$0.00	$171.00	$116.07	$116.07	$0.00	$0.00	$0.00	$44.55	$158.65	$158.65	$0.00	$0.00	$44.55	$0.00	$126.43	$126.43	$0.00	$106.88	$169.29	$171.00	$0.00		$0.00	$33.45	$0.00	$0.00	$34.03	$0.00	$0.00	$0.00	$0.00	$0.00
21066	SUP	Custom 27803010		21066  -  CONNECTOR 21066 LUMBOPERITONEAL STRT CSF	BOTH IP/OP	$178.13 	$131.82	$0.00	$142.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.20	$132.20	$0.00	$0.00	$37.12	$0.00	$0.00	$0.00	$0.00	$89.06	$141.08	$142.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22013	SUP	Custom 27803010		22013  -  CATH 22013 PER SML OPEN 90CM NO SLIT	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.24	$310.24	$0.00	$0.00	$87.11	$0.00	$0.00	$0.00	$0.00	$209.00	$331.06	$334.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22014	SUP	Custom 27803010		22014  -  CATH 22014 PER STD OPEN 96CM NO SLIT	BOTH IP/OP	$967.50 	$715.95	$0.00	$718.08	$0.00	$0.00	$0.00	$0.00	$0.00	$201.65	$718.08	$718.08	$0.00	$0.00	$201.63	$0.00	$572.28	$572.28	$0.00	$209.00	$331.06	$334.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22039	SUP	Custom 27803010		22039  -  VAD 22039 12MM	BOTH IP/OP	$888.25 	$657.31	$0.00	$710.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$659.26	$659.26	$0.00	$0.00	$185.11	$0.00	$0.00	$0.00	$0.00	$444.13	$703.49	$710.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22063	SUP	Custom 27803010		22063  -  CONNECTOR 22063 STEPDOWN W/TUBING STD	BOTH IP/OP	"$1,596.58 "	"$1,181.47"	$0.00	"$1,184.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$332.77	"$1,184.98"	"$1,184.98"	$0.00	$0.00	$332.73	$0.00	$944.37	$944.37	$0.00	$102.13	$161.77	$163.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22104	SUP	Custom 27803010		22104  -  VAD 22104 NEONATE RES W/BOTTOM INLET	BOTH IP/OP	$888.25 	$657.31	$0.00	$710.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$659.26	$659.26	$0.00	$0.00	$185.11	$0.00	$0.00	$0.00	$0.00	$444.13	$703.49	$710.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22150	SUP	Custom 27203010		22150  -  DEVICE BLWR/MSTR STRL LF CLRVW TUBE SET N180 N185	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$0.00	$0.00	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22355	SUP	HCPCS C1713		22355  -  ROD OST 64MM STRL LF LOOP DISP SFN 70MM FLNG	BOTH IP/OP	$3.65 	$2.70	$0.00	$2.96	$1.66	$1.66	$0.00	$0.00	$0.00	$0.76	$2.71	$2.71	$0.00	$0.00	$0.76	$0.00	$2.16	$2.16	$0.00	$1.85	$2.93	$2.96	$0.00		$0.00	$0.58	$0.00	$0.00	$0.59	$0.00	$0.00	$0.00	$0.00	$0.00
22356	SUP	HCPCS C1713		22356  -  ROD OST 90MM STRL LF SFN CNVTC LOOP DISP 4IN FLNG SKN BRR	BOTH IP/OP	$37.00 	$27.38	$0.00	$29.60	$16.65	$16.65	$0.00	$0.00	$0.00	$7.71	$27.46	$27.46	$0.00	$0.00	$7.71	$0.00	$21.88	$21.88	$0.00	$18.50	$29.30	$29.60	$0.00		$0.00	$5.79	$0.00	$0.00	$5.89	$0.00	$0.00	$0.00	$0.00	$0.00
23014	SUP	Custom 27203010		23014  -  KIT 23014 EDM VENTRICULAR	BOTH IP/OP	$326.40 	$241.54	$0.00	$261.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.25	$242.25	$0.00	$0.00	$68.02	$0.00	$0.00	$0.00	$0.00	$163.20	$258.51	$261.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23021	SUP	Custom 27803010		23021  -  CONNECTOR 23021 LUERLOCK TO FIT 1.5MM ID	BOTH IP/OP	$153.60 	$113.66	$0.00	$122.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.00	$114.00	$0.00	$0.00	$32.01	$0.00	$0.00	$0.00	$0.00	$76.80	$121.65	$122.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23045	SUP	Custom 27203010		23045  -  EDM 23045 PATIENT LINE 91CM W/FEM LR	BOTH IP/OP	$177.60 	$131.42	$0.00	$142.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.81	$131.81	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$88.80	$140.66	$142.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23047	SUP	Custom 27803010		23047  -  CATH 23047 PERIT STD OE W/SLITS 120	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.24	$310.24	$0.00	$0.00	$87.11	$0.00	$0.00	$0.00	$0.00	$209.00	$331.06	$334.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23067	SUP	HCPCS C2619		23067  -  ADAPTER 23067 PREIMPLANT TEST SNAP ASSY	BOTH IP/OP	$225.63 	$166.97	$0.00	$180.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.46	$167.46	$0.00	$0.00	$47.02	$0.00	$0.00	$0.00	$0.00	$112.81	$178.70	$180.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23069	SUP	Custom 27803010		23069  -  SHUNT 23069 L-P K-TUBE W/PROX TIP	BOTH IP/OP	"$2,272.88 "	"$1,681.93"	$0.00	"$1,818.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,686.93"	"$1,686.93"	$0.00	$0.00	$473.67	$0.00	$0.00	$0.00	$0.00	"$1,136.44"	"$1,800.12"	"$1,818.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23075	SUP	Custom 27803010		23075  -  CATHETER 23075 VENTRICULAR POLYURETHANE	BOTH IP/OP	"$3,479.38 "	"$2,574.74"	$0.00	"$2,783.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,582.39"	"$2,582.39"	$0.00	$0.00	$725.10	$0.00	$0.00	$0.00	$0.00	"$1,739.69"	"$2,755.67"	"$2,783.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23076	SUP	Custom 27803010		23076  -  CATHETER 23076 PERITITONEAL POLYURETHANE	BOTH IP/OP	"$2,470.00 "	"$1,827.80"	$0.00	"$1,976.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,833.23"	"$1,833.23"	$0.00	$0.00	$514.75	$0.00	$0.00	$0.00	$0.00	"$1,235.00"	"$1,956.24"	"$1,976.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23092	SUP	HCPCS C1750		23092  -  CATHETER DLYS STD 120CM STRL BA IMPRG OP-EN WL SLT	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$188.10	$188.10	$0.00	$0.00	$0.00	$87.12	$310.24	$310.24	$0.00	$0.00	$87.11	$0.00	$247.25	$247.25	$0.00	$209.00	$331.06	$334.40	$0.00		$0.00	$65.42	$0.00	$0.00	$66.55	$0.00	$0.00	$0.00	$0.00	$0.00
23093	SUP	Custom 27803010		23093  -  VALVE 23093 CONT. REG. LOW-LOW	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24010	SUP	Custom 27803010		24010  -  CATHETER 24010 C/P STD 120CM	BOTH IP/OP	$410.88 	$304.05	$0.00	$328.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$304.95	$304.95	$0.00	$0.00	$85.63	$0.00	$0.00	$0.00	$0.00	$205.44	$325.42	$328.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24048	SUP	Custom 27803010		24048  -  VALVE 24048 DELTA RGL PL 0.5	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24052	SUP	Custom 27203010		24052  -  KIT 24052 VENTRICULOSTOMY RES 18MM	BOTH IP/OP	$693.50 	$513.19	$0.00	$554.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$514.72	$514.72	$0.00	$0.00	$144.53	$0.00	$0.00	$0.00	$0.00	$346.75	$549.25	$554.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24053	SUP	Custom 27803010		24053  -  CHAMBER 24053 DELTA	BOTH IP/OP	"$2,690.88 "	"$1,991.25"	$0.00	"$5,472.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,997.17"	"$1,997.17"	$0.00	$0.00	$560.78	$0.00	$0.00	$0.00	$0.00	"$1,345.44"	"$2,131.18"	"$2,152.70"	$0.00		$0.00	"$5,472.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24084	SUP	Custom 27803010		24084  -  RESVR 24084 12MM W INLET AND OUTLET CONN	BOTH IP/OP	$888.25 	$657.31	$0.00	$710.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$659.26	$659.26	$0.00	$0.00	$185.11	$0.00	$0.00	$0.00	$0.00	$444.13	$703.49	$710.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24085	SUP	Custom 27803010		24085  -  DOME 24085 SNAP VENTRIC W/15CM TUBE	BOTH IP/OP	$605.63 	$448.17	$0.00	$484.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.49	$449.49	$0.00	$0.00	$126.21	$0.00	$0.00	$0.00	$0.00	$302.81	$479.66	$484.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24094	SUP	Custom 27803010		24094  -  CATH 24094 VENT STD INCL SNAP BASE	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24114	SUP	Custom 27803010		24114  -  CONNECTOR SHNT .7MM CSF LL INTGR PLG	BOTH IP/OP	$187.20 	$138.53	$0.00	$149.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.94	$138.94	$0.00	$0.00	$39.01	$0.00	$0.00	$0.00	$0.00	$93.60	$148.26	$149.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24146	SUP	Custom 27203010		24146  -  EDMS 24146 BECKER NO Y-SITE	BOTH IP/OP	$547.20 	$404.93	$0.00	$437.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$406.13	$406.13	$0.00	$0.00	$114.04	$0.00	$0.00	$0.00	$0.00	$273.60	$433.38	$437.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24147	SUP	Custom 27803010		24147  -  VALVE 24147 DELTA SML PL 0.5	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24148	SUP	Custom 27803010		24148  -  CATH 24148 C/P STD 110CM NO MARKERS	BOTH IP/OP	$410.88 	$304.05	$0.00	$328.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$304.95	$304.95	$0.00	$0.00	$85.63	$0.00	$0.00	$0.00	$0.00	$205.44	$325.42	$328.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24154	SUP	Custom 27803010		24154  -  CATH 24154 VENT STD TRNS W/STRIPE	BOTH IP/OP	$356.25 	$263.63	$0.00	$285.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.41	$264.41	$0.00	$0.00	$74.24	$0.00	$0.00	$0.00	$0.00	$178.13	$282.15	$285.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24605	SUP	HCPCS C1758		024605  -  CATH URET 4.8FR 8FR 70CM CONE TIP MCK	BOTH IP/OP	$28.54 	$21.12	$0.00	$34.38	$15.50	$15.50	$0.00	$0.00	$0.00	$5.95	$21.18	$21.18	$0.00	$0.00	$5.95	$0.00	$34.38	$34.38	$0.00	$14.27	$22.60	$22.83	$0.00		$0.00	$4.47	$0.00	$0.00	$4.54	$0.00	$0.00	$0.00	$0.00	$0.00
24605	SUP	HCPCS C1758		24605  -  CATH URET 4.8FR 8FR 70CM CONE TIP MCK	BOTH IP/OP	$28.54 	$21.12	$0.00	$34.38	$15.50	$15.50	$0.00	$0.00	$0.00	$5.95	$21.18	$21.18	$0.00	$0.00	$5.95	$0.00	$34.38	$34.38	$0.00	$14.27	$23.44	$22.83	$0.00		$0.00	$4.47	$0.00	$0.00	$4.54	$0.00	$0.00	$0.00	$0.00	$0.00
24712	SUP	Custom 27803010		24712  -  TUBE VNT T FIRM FLNG 1.14MM 9.5MM 12MM GOODE SFT SIL EAR	BOTH IP/OP	$56.75 	$42.00	$0.00	$45.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.12	$42.12	$0.00	$0.00	$11.83	$0.00	$0.00	$0.00	$0.00	$28.38	$44.95	$45.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25020	SUP	Custom 27203010		OTOSCOPE 3.5V DX SPCLA HAL LGHT WA LEN FBROP SL SYS EXAM	BOTH IP/OP	$177.50 	$131.35	$0.00	$142.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.75	$140.58	$142.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25024	SUP	Custom 27803010		25024  -  CATH 25024 PERIT STD TRNS W/STRPE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,298.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$209.00	$331.06	$334.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25027	SUP	Custom 27803010		25027  -  CONNECTOR 25027 STRT STAINLESS STEEL IMP	BOTH IP/OP	$204.25 	$151.15	$0.00	$163.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.59	$151.59	$0.00	$0.00	$42.57	$0.00	$0.00	$0.00	$0.00	$102.13	$161.77	$163.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25030	SUP	Custom 27203010		25030  -  KIT 25030 EDM 46115 46124 46126	BOTH IP/OP	$513.60 	$380.06	$0.00	$410.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$381.19	$381.19	$0.00	$0.00	$107.03	$0.00	$0.00	$0.00	$0.00	$256.80	$406.77	$410.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25068	SUP	Custom 27203010		25068  -  KIT 25068 EDM 46124 46126	BOTH IP/OP	$290.40 	$214.90	$0.00	$232.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.53	$215.53	$0.00	$0.00	$60.52	$0.00	$0.00	$0.00	$0.00	$145.20	$230.00	$232.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25077	SUP	Custom 27803010		25077  -  TAB FX 1.5MM SIL	BOTH IP/OP	"$3,601.78 "	"$2,665.32"	$0.00	"$2,673.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$750.70	"$2,673.24"	"$2,673.24"	$0.00	$0.00	$750.61	$0.00	"$1,775.68"	"$1,775.68"	$0.00	$106.88	$169.29	$171.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25104	SUP	Custom 27803010		25104  -  CATHETER 25104 CP STD TRANS RAD STRP 90	BOTH IP/OP	$410.88 	$304.05	$0.00	$328.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$304.95	$304.95	$0.00	$0.00	$85.63	$0.00	$0.00	$0.00	$0.00	$205.44	$325.42	$328.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25115	SUP	Custom 27203010		REAGENT HBSAG EVOLIS BRCD ANALY	BOTH IP/OP	$496.25 	$367.23	$0.00	$397.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.13	$393.03	$397.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25120	SUP	Custom 27203010		25120  -  EDMS II 25120 BECKER W/1-WAY VALVE	BOTH IP/OP	$628.13 	$464.82	$0.00	"$2,062.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$466.19	$466.19	$0.00	$0.00	$130.90	$0.00	"$2,062.90"	"$2,062.90"	$0.00	$14.56	$471.40	$23.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25123	SUP	HCPCS C1894		25123  -  TROCAR 25123 WITH PROTECTOR SHEATH	BOTH IP/OP	$237.60 	$175.82	$0.00	$190.08	$129.02	$129.02	$0.00	$0.00	$0.00	$49.52	$176.35	$176.35	$0.00	$0.00	$49.52	$0.00	$140.54	$140.54	$0.00	$118.80	$188.18	$190.08	$0.00		$0.00	$37.18	$0.00	$0.00	$37.83	$0.00	$0.00	$0.00	$0.00	$0.00
25173	SUP	Custom 27203010		KIT IMMUN TST MCPLT EIA RBLA IGG 96 TST	BOTH IP/OP	$356.13 	$263.54	$0.00	$284.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.06	$282.05	$284.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25175	SUP	Custom 27203010		KIT IMMUN TST EIA TOXOPLASMA IGG 96 TST	BOTH IP/OP	$356.13 	$263.54	$0.00	$284.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.06	$282.05	$284.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25177	SUP	Custom 27203010		REAGENT CMV IGG AXSYM EIA 96 TST ANALY	BOTH IP/OP	$356.93 	$264.13	$0.00	$285.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.46	$282.69	$285.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25220	SUP	Custom 27203010		CONTROL ANTI HBS IGM MONOLISA EIA IMMUN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25280	SUP	Custom 27203010		KIT IMMUN TST MONOLISA BRCD SEQ ANTI HBS	BOTH IP/OP	$552.50 	$408.85	$0.00	$442.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.25	$437.58	$442.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25506	SUP	Custom 27203010		025506  -  STENT URET 6FR 125CM 2 PGTL CURVE URTSCP SET DRETLER BLUE	BOTH IP/OP	$109.68 	$81.16	$0.00	$87.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.40	$81.40	$0.00	$0.00	$22.86	$0.00	$0.00	$0.00	$0.00	$54.84	$86.87	$87.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26040	SUP	Custom 27203010		26040  -  KIT 26040 BECKER EDMS II	BOTH IP/OP	$31.43 	$23.26	$0.00	$660.48	$0.00	$0.00	$0.00	$0.00	$0.00	$6.55	$23.32	$23.32	$0.00	$0.00	$6.55	$0.00	$18.59	$18.59	$0.00	$412.80	$653.88	$660.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26054	SUP	HCPCS C1726		26054  -  DILAT VASC 4FR 20CM HYDPHI DECREASED FRCTN RADIOPQ STRL DISP	BOTH IP/OP	$26.25 	$19.43	$0.00	$21.00	$14.25	$14.25	$0.00	$0.00	$0.00	$5.47	$19.48	$19.48	$0.00	$0.00	$5.47	$0.00	$15.53	$15.53	$0.00	$13.13	$20.79	$21.00	$0.00		$0.00	$4.11	$0.00	$0.00	$4.18	$0.00	$0.00	$0.00	$0.00	$0.00
26057	SUP	Custom 27203010		26057  -  EDM 26021 CATH VENT STD TRANS 25CM	BOTH IP/OP	$364.80 	$269.95	$0.00	$291.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.75	$270.75	$0.00	$0.00	$76.02	$0.00	$0.00	$0.00	$0.00	$182.40	$288.92	$291.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26075	SUP	Custom 27803010		26075  -  RES 26075 VENT BH V-CATH W/7.5MM HLS	BOTH IP/OP	"$1,444.00 "	"$1,068.56"	$0.00	"$1,155.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,071.74"	"$1,071.74"	$0.00	$0.00	$300.93	$0.00	$0.00	$0.00	$0.00	$722.00	"$1,143.65"	"$1,155.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26174	SUP	Custom 27203010		CONTROL ANTI HBC IGM MONOLISA EIA IMMUN	BOTH IP/OP	"$1,612.50 "	"$1,193.25"	$0.00	"$1,290.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$806.25	"$1,277.10"	"$1,290.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26186	SUP	Custom 27203010		CONTROL ANTI-HBC HBV MONOLISA EIA 192 TST IMMUN	BOTH IP/OP	"$1,387.50 "	"$1,026.75"	$0.00	"$1,110.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$693.75	"$1,098.90"	"$1,110.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26189	SUP	Custom 27203010		KIT IMMUN TST MONOLISA BRCD ANTI HAV	BOTH IP/OP	$496.25 	$367.23	$0.00	$397.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.13	$393.03	$397.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27010	SUP	Custom 27803010		27010  -  CATH 27010 CSF-PERIT TRANS XTRA LM	BOTH IP/OP	$600.88 	$444.65	$0.00	$480.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.97	$445.97	$0.00	$0.00	$125.22	$0.00	$0.00	$0.00	$0.00	$300.44	$475.90	$480.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27051	SUP	Custom 27803010		27051  -  VAD 27051 6MM BH UNITIZED CONV.	BOTH IP/OP	$605.63 	$448.17	$0.00	$484.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.49	$449.49	$0.00	$0.00	$126.21	$0.00	$0.00	$0.00	$0.00	$302.81	$479.66	$484.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27081	SUP	Custom 27803010		27081  -  SHUNT 27081 DELTA ASSY RGL PL 0.5	BOTH IP/OP	"$3,462.75 "	"$2,562.44"	$0.00	"$2,770.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,570.05"	"$2,570.05"	$0.00	$0.00	$721.64	$0.00	$0.00	$0.00	$0.00	"$1,731.38"	"$2,742.50"	"$2,770.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27102	SUP	Custom 27803010		27102  -  VALVE 27102 CONTOURED SML LOW LOW	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27106	SUP	Custom 27803010		27106  -  BASE 27106 SNAP ASSY W/LARGER ID	BOTH IP/OP	$275.50 	$203.87	$0.00	$220.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.48	$204.48	$0.00	$0.00	$57.41	$0.00	$0.00	$0.00	$0.00	$137.75	$218.20	$220.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27156	SUP	Custom 27803010		27156  -  CATH 27156 VENT 1.3X2.5 FXTN COLLAR	BOTH IP/OP	$336.00 	$248.64	$0.00	$268.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.38	$249.38	$0.00	$0.00	$70.02	$0.00	$0.00	$0.00	$0.00	$168.00	$266.11	$268.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27165	SUP	Custom 27803010		27165  -  CATH 27165 VENT INNERVISION 1.5X2.8	BOTH IP/OP	$505.88 	$374.35	$0.00	$404.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$375.46	$375.46	$0.00	$0.00	$105.42	$0.00	$0.00	$0.00	$0.00	$252.94	$400.66	$404.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27211	SUP	Custom 27803010		27211  -  CATH 27211 VENT SLOTTED 16CM	BOTH IP/OP	$472.63 	$349.75	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$350.78	$350.78	$0.00	$0.00	$98.50	$0.00	$0.00	$0.00	$0.00	$236.31	$374.32	$378.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27240	SUP	Custom 27803010		27240  -  CATHETER DRN 15CM STRL LF INNERVISION DISP	BOTH IP/OP	$505.88 	$374.35	$0.00	$404.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$375.46	$375.46	$0.00	$0.00	$105.42	$0.00	$0.00	$0.00	$0.00	$252.94	$400.66	$404.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27251	SUP	Custom 27803010		27251  -  CATH 27251 VENT SML 8MM OF HOLE	BOTH IP/OP	$356.25 	$263.63	$0.00	$285.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.41	$264.41	$0.00	$0.00	$74.24	$0.00	$0.00	$0.00	$0.00	$178.13	$282.15	$285.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27274	SUP	Custom 27203010		27274  -  KIT 27274 VENTRICULOSTOMY RES UNIT	BOTH IP/OP	$821.75 	$608.10	$0.00	$657.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$609.90	$609.90	$0.00	$0.00	$171.25	$0.00	$0.00	$0.00	$0.00	$410.88	$650.83	$657.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27297	SUP	Custom 27203010		27297  -  KIT 27297 EDM DRAINAG VENT CATH	BOTH IP/OP	$806.40 	$596.74	$0.00	$645.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$598.51	$598.51	$0.00	$0.00	$168.05	$0.00	$0.00	$0.00	$0.00	$403.20	$638.67	$645.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27298	SUP	HCPCS C1753		27298  -  V-CATH 27298 INNERVISION W/ SNAP BASE	BOTH IP/OP	$665.00 	$492.10	$0.00	$532.00	$361.10	$361.10	$0.00	$0.00	$0.00	$138.60	$493.56	$493.56	$0.00	$0.00	$138.59	$0.00	$393.35	$393.35	$0.00	$332.50	$526.68	$532.00	$0.00		$0.00	$104.07	$0.00	$0.00	$105.87	$0.00	$0.00	$0.00	$0.00	$0.00
27302	SUP	Custom 27203010		27302  -  DRAIN 27302 EDM LUMBAR W/120 GRAD CH	BOTH IP/OP	$808.80 	$598.51	$0.00	$647.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$600.29	$600.29	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$404.40	$640.57	$647.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27303	SUP	Custom 27203010		27303  -  KIT 27303 EDM LUMBAR DRAINAGE OPEN	BOTH IP/OP	$705.60 	$522.14	$0.00	$564.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$523.70	$523.70	$0.00	$0.00	$147.05	$0.00	$0.00	$0.00	$0.00	$352.80	$558.84	$564.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27304	SUP	Custom 27203010		27304  -  KIT 27304 EDM LUMBAR DRAINAGE CLOSED	BOTH IP/OP	$684.00 	$506.16	$0.00	$547.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.66	$507.66	$0.00	$0.00	$142.55	$0.00	$0.00	$0.00	$0.00	$342.00	$541.73	$547.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27327	SUP	Custom 27803010		27327  -  CATH 27327 VENT STD EXTR TRANSLUC 23CM	BOTH IP/OP	$876.38 	$648.52	$0.00	$701.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$650.45	$650.45	$0.00	$0.00	$182.64	$0.00	$0.00	$0.00	$0.00	$438.19	$694.09	$701.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27328	SUP	HCPCS C1750		27328  -  PCATH 27328 EXTRACTED 90 CM	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$598.50	$598.50	$0.00	$0.00	$0.00	$277.21	$987.13	$987.13	$0.00	$0.00	$277.17	$0.00	$786.70	$786.70	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00		$0.00	$208.15	$0.00	$0.00	$211.74	$0.00	$0.00	$0.00	$0.00	$0.00
27384	SUP	Custom 27803010		27384  -  CATH 27384 EDM VENT 20CM W/TROCAR	BOTH IP/OP	$396.00 	$293.04	$0.00	$316.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$293.91	$293.91	$0.00	$0.00	$82.53	$0.00	$0.00	$0.00	$0.00	$198.00	$313.63	$316.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27497	SUP	Custom 27803010		27497  -  SHUNT 27497 DELTA ASSY SMALL BG 0.5	BOTH IP/OP	"$4,949.50 "	"$3,662.63"	$0.00	"$3,959.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,673.52"	"$3,673.52"	$0.00	$0.00	"$1,031.48"	$0.00	$0.00	$0.00	$0.00	"$2,474.75"	"$3,920.00"	"$3,959.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27498	SUP	Custom 27803010		27498  -  SHUNT 27498 DELTA ASSY REG BG 0.5	BOTH IP/OP	"$4,949.50 "	"$3,662.63"	$0.00	"$3,959.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,673.52"	"$3,673.52"	$0.00	$0.00	"$1,031.48"	$0.00	$0.00	$0.00	$0.00	"$2,474.75"	"$3,920.00"	"$3,959.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27510	SUP	Custom 27203010		27510  -  EDMS 27510 BECKER W/ Y-SITE EURO	BOTH IP/OP	$520.80 	$385.39	$0.00	$416.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$386.54	$386.54	$0.00	$0.00	$108.53	$0.00	$0.00	$0.00	$0.00	$260.40	$412.47	$416.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27536	SUP	Custom 27803010		27536  -  CATHETER 27536 PERIT W/BIOGLIDE 8 SLITS	BOTH IP/OP	$543.88 	$402.47	$0.00	$435.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$403.66	$403.66	$0.00	$0.00	$113.34	$0.00	$0.00	$0.00	$0.00	$271.94	$430.75	$435.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27548	SUP	Custom 27803010		27548  -  CATH 27548 PERIT STD OE TRANS BS 120CM	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.24	$310.24	$0.00	$0.00	$87.11	$0.00	$0.00	$0.00	$0.00	$209.00	$331.06	$334.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27579	SUP	Custom 27203010		27579  -  EDMS 27579 EXACTA W/ PATIENT LINE Y-PORT	BOTH IP/OP	$412.80 	$305.47	$0.00	$330.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.38	$306.38	$0.00	$0.00	$86.03	$0.00	$0.00	$0.00	$0.00	$206.40	$326.94	$330.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27581	SUP	Custom 27203010		27581  -  KIT 27581 EXACTA W/EDM VCATH 35CM	BOTH IP/OP	$777.60 	$575.42	$0.00	$622.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$577.13	$577.13	$0.00	$0.00	$162.05	$0.00	$0.00	$0.00	$0.00	$388.80	$615.86	$622.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27600	SUP	Custom 27803010		27600  -  CATH 27600 VENT INNERVISION SLOTTED 15CM	BOTH IP/OP	$665.00 	$492.10	$0.00	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.56	$493.56	$0.00	$0.00	$138.59	$0.00	$0.00	$0.00	$0.00	$332.50	$526.68	$532.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27613	SUP	Custom 27203010		27613  -  LASER 27613 EXACTA W/SCREW ASSY	BOTH IP/OP	"$1,024.80 "	$758.35	$0.00	$819.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$760.61	$760.61	$0.00	$0.00	$213.57	$0.00	$0.00	$0.00	$0.00	$512.40	$811.64	$819.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27617	SUP	Custom 27203010		27617  -  TUBE 27617 TRANS W/STRPE STR CONN	BOTH IP/OP	$539.13 	$398.96	$0.00	$431.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$400.14	$400.14	$0.00	$0.00	$112.35	$0.00	$0.00	$0.00	$0.00	$269.56	$426.99	$431.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27623	SUP	Custom 27803010		27623  -  CATH 27623 INNERV15CM XTRA HOLES 2CM	BOTH IP/OP	$662.63 	$490.35	$0.00	$530.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$491.80	$491.80	$0.00	$0.00	$138.09	$0.00	$0.00	$0.00	$0.00	$331.31	$524.80	$530.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27628	SUP	Custom 27203010		27628  -  KIT 27628 CSF-VENT RES BH VCATH 15CM	BOTH IP/OP	$836.00 	$618.64	$0.00	$668.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$620.48	$620.48	$0.00	$0.00	$174.22	$0.00	$0.00	$0.00	$0.00	$418.00	$662.11	$668.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27629	SUP	HCPCS C1729		27629  -  PCATH 27629 90 TRANS W/STRIPE NO SLT	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$226.97	$226.97	$0.00	$0.00	$0.00	$87.12	$310.24	$310.24	$0.00	$0.00	$87.11	$0.00	$247.25	$247.25	$0.00	$209.00	$331.06	$334.40	$0.00		$0.00	$65.42	$0.00	$0.00	$66.55	$0.00	$0.00	$0.00	$0.00	$0.00
27636	SUP	Custom 27203010		27636  -  EDM 27636 EXACTA W/BRAIDED CORD LOCK	BOTH IP/OP	$446.40 	$330.34	$0.00	$353.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.20	$20.20	$0.00	$0.00	$5.67	$0.00	$0.00	$0.00	$0.00	$12.34	$353.55	$19.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27637	SUP	Custom 27203010		27637  -  EDM 27637 VCATH TRANS OD 4.9MM W/TROC	BOTH IP/OP	$554.40 	$410.26	$0.00	$443.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$411.48	$411.48	$0.00	$0.00	$115.54	$0.00	$0.00	$0.00	$0.00	$277.20	$439.08	$443.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27654	SUP	Custom 27203010		27654  -  BAG 27654 EXACTA W/DRAINPORT GLUED ON	BOTH IP/OP	$336.00 	$248.64	$0.00	$268.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.38	$249.38	$0.00	$0.00	$70.02	$0.00	$0.00	$0.00	$0.00	$168.00	$266.11	$268.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27659	SUP	Custom 27203010		27659  -  EDM 27659 V/CATHETER 20CM LENGTH MARKER	BOTH IP/OP	$436.80 	$323.23	$0.00	$345.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$0.00	$0.00	$1.25	$0.00	$0.00	$0.00	$0.00	$3.00	$345.95	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27664	SUP	Custom 27803010		27664  -  RES 27664 CSF-VENT 12MM CONV BTTM INLET	BOTH IP/OP	$888.25 	$657.31	$0.00	$710.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$659.26	$659.26	$0.00	$0.00	$185.11	$0.00	$0.00	$0.00	$0.00	$444.13	$703.49	$710.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27666	SUP	Custom 27203010		27666  -  EDM 27666 EXCTA W GLUE STPCK GR PT LN	BOTH IP/OP	$400.80 	$296.59	$0.00	$320.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$297.47	$297.47	$0.00	$0.00	$83.53	$0.00	$0.00	$0.00	$0.00	$200.40	$317.43	$320.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27673	SUP	Custom 27203010		27673  -  KIT 27673 EXACTA W/EDM VCATH BIOGL 35CM	BOTH IP/OP	$859.20 	$635.81	$0.00	$687.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$637.70	$637.70	$0.00	$0.00	$179.06	$0.00	$0.00	$0.00	$0.00	$429.60	$680.49	$687.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27695	SUP	Custom 27803010		27695  -  CATH 27695 EDM VENT TRANS W/STRIPE 35CM	BOTH IP/OP	$451.20 	$333.89	$0.00	$357.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$334.88	$334.88	$0.00	$0.00	$94.03	$0.00	$0.00	$0.00	$0.00	$3.86	$357.35	$6.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27702	SUP	Custom 27203010		27702  -  EDMS 27702 EURO BECKER II GR PT LN	BOTH IP/OP	$556.80 	$412.03	$0.00	$445.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.26	$413.26	$0.00	$0.00	$116.04	$0.00	$0.00	$0.00	$0.00	$278.40	$440.99	$445.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27703	SUP	HCPCS C1729		27703  -  CATHETER DRN LG 35CM STRL LL CNCT LGTH MRKNG VNTRC	BOTH IP/OP	$424.80 	$314.35	$0.00	$339.84	$230.67	$230.67	$0.00	$0.00	$0.00	$88.54	$315.29	$315.29	$0.00	$0.00	$88.53	$0.00	$251.27	$251.27	$0.00	$212.40	$336.44	$339.84	$0.00		$0.00	$66.48	$0.00	$0.00	$67.63	$0.00	$0.00	$0.00	$0.00	$0.00
27705	SUP	Custom 27803010		27705  -  CATH 27705 EDM NUM LNGTHMARK BIO 35CM	BOTH IP/OP	$460.80 	$340.99	$0.00	$368.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.01	$342.01	$0.00	$0.00	$96.03	$0.00	$0.00	$0.00	$0.00	$230.40	$364.95	$368.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27710	SUP	Custom 27803010		27710  -  CATH 27710 EDM NUM LNGTHMRK BIO 35CM	BOTH IP/OP	$492.00 	$364.08	$0.00	$393.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$365.16	$365.16	$0.00	$0.00	$102.53	$0.00	$0.00	$0.00	$0.00	$246.00	$389.66	$393.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27725	SUP	Custom 27803010		27725  -  CATH 27725 VENT 8MM HLS NUM LM 23CM	BOTH IP/OP	$356.25 	$263.63	$0.00	$285.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.41	$264.41	$0.00	$0.00	$74.24	$0.00	$0.00	$0.00	$0.00	$178.13	$282.15	$285.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27726	SUP	Custom 27803010		27726  -  CATH 27726 VENT 8MM HLS NUM LM 23CM BIO	BOTH IP/OP	$513.00 	$379.62	$0.00	$410.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.75	$380.75	$0.00	$0.00	$106.91	$0.00	$0.00	$0.00	$0.00	$256.50	$406.30	$410.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27732	SUP	Custom 27203010		27732  -  EDM 27732 EXACTA W/NDL-LS INJ. ST W/CAP	BOTH IP/OP	$472.80 	$349.87	$0.00	$378.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$350.91	$350.91	$0.00	$0.00	$98.53	$0.00	$0.00	$0.00	$0.00	$236.40	$374.46	$378.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27739	SUP	Custom 27803010		27739  -  SHUNT 27739 STRATA NSC SNAP SML 120CM	BOTH IP/OP	"$10,361.15 "	"$7,667.25"	$0.00	"$8,288.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,159.26"	$0.00	$0.00	$0.00	$0.00	"$5,180.58"	"$8,206.03"	"$8,288.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27740	SUP	Custom 27803010		27740  -  SHUNT 27740 STRATA NSC SNAP REG 120CM	BOTH IP/OP	"$10,361.15 "	"$7,667.25"	$0.00	"$8,288.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,159.26"	$0.00	$0.00	$0.00	$0.00	"$5,180.58"	"$8,206.03"	"$8,288.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27771	SUP	Custom 27803010		27771  -  CATH 27771 VENTR EDM STD W/L-MARKERS	BOTH IP/OP	$374.40 	$277.06	$0.00	$299.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$277.88	$277.88	$0.00	$0.00	$78.02	$0.00	$0.00	$0.00	$0.00	$187.20	$296.52	$299.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27779	SUP	Custom 27203010		27779  -  EDMS 27779 BECKER BC NDLESS BOND CONN	BOTH IP/OP	$549.60 	$406.70	$0.00	$439.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.91	$407.91	$0.00	$0.00	$114.54	$0.00	$0.00	$0.00	$0.00	$274.80	$435.28	$439.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27781	SUP	Custom 27803010		27781  -  CATH 27781 INNERV 3 SETS FLOW HLS 23CM	BOTH IP/OP	$840.75 	$622.16	$0.00	$672.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$624.00	$624.00	$0.00	$0.00	$175.21	$0.00	$0.00	$0.00	$0.00	$420.38	$665.87	$672.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27785	SUP	Custom 27203010		27785  -  EDMS 27785 EXACTA 50ML BC NDLESS INJ	BOTH IP/OP	$475.20 	$351.65	$0.00	$380.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.69	$352.69	$0.00	$0.00	$99.03	$0.00	$0.00	$0.00	$0.00	$237.60	$376.36	$380.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27786	SUP	Custom 27803010		27786  -  SHUNT 27786 STRATA NSC UNI-KIT SML BIOGL	BOTH IP/OP	"$10,114.40 "	"$7,484.66"	$0.00	"$8,010.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,107.84"	$0.00	$0.00	$0.00	$0.00	"$1,136.00"	"$8,010.60"	$908.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27787	SUP	Custom 27803010		27787  -  SHUNT 27787 STRATA NSC UNI-KIT REG BIOGL	BOTH IP/OP	"$10,114.40 "	"$7,484.66"	$0.00	"$8,091.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,107.84"	$0.00	$0.00	$0.00	$0.00	"$5,057.20"	"$8,010.60"	"$8,091.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27788	SUP	Custom 27803010		27788  -  SHUNT 27788 STRATA NSC SNAP ASSY SM BG	BOTH IP/OP	"$11,202.45 "	"$8,289.81"	$0.00	"$8,961.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,334.59"	$0.00	$0.00	$0.00	$0.00	"$5,601.23"	"$8,872.34"	"$8,961.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27789	SUP	Custom 27803010		27789  -  SHUNT 27789 STRATA NSC SNAP ASSY RG BG	BOTH IP/OP	"$11,202.45 "	"$8,289.81"	$0.00	"$8,961.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,334.59"	$0.00	$0.00	$0.00	$0.00	"$5,601.23"	"$8,872.34"	"$8,961.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27794	SUP	Custom 27803010		27794  -  NSC 27794 N/A STRATA SNAPSHNT NO FLANGE	BOTH IP/OP	"$10,361.15 "	"$7,667.25"	$0.00	"$8,288.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,159.26"	$0.00	$0.00	$0.00	$0.00	"$5,180.58"	"$8,206.03"	"$8,288.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27795	SUP	Custom 27203010		27795  -  EDMS 27795 EXACTA 100ML CATH	BOTH IP/OP	$775.20 	$573.65	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.35	$575.35	$0.00	$0.00	$161.55	$0.00	$0.00	$0.00	$0.00	$387.60	$613.96	$620.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27811	SUP	Custom 27203010		27811  -  EDMS 27811 BECKER GRN PL VCATH	BOTH IP/OP	$792.00 	$586.08	$0.00	$633.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$587.82	$587.82	$0.00	$0.00	$165.05	$0.00	$0.00	$0.00	$0.00	$396.00	$627.26	$633.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27812	SUP	Custom 27803010		27812  -  VALVE 27812 STRATA II SM EXTRACTED	BOTH IP/OP	"$10,144.95 "	"$7,507.26"	$0.00	"$8,115.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,114.21"	$0.00	$0.00	$0.00	$0.00	"$5,072.48"	"$8,034.80"	"$8,115.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27814	SUP	Custom 27803010		27814  -  SHUNT 27814 STRATA II ASSY SML	BOTH IP/OP	"$10,770.05 "	"$7,969.84"	$0.00	"$8,616.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,244.48"	$0.00	$0.00	$0.00	$0.00	"$5,385.03"	"$8,529.88"	"$8,616.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27815	SUP	Custom 27803010		27815  -  SHUNT 27815 STRATA II ASSY REG	BOTH IP/OP	"$10,770.05 "	"$7,969.84"	$0.00	"$8,616.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,244.48"	$0.00	$0.00	$0.00	$0.00	"$5,385.03"	"$8,529.88"	"$8,616.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27816	SUP	Custom 27803010		27816  -  SHUNT 27816 SNAP STRATA II SMALL	BOTH IP/OP	"$11,167.20 "	"$8,263.73"	$0.00	"$8,933.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,327.24"	$0.00	$0.00	$0.00	$0.00	"$5,583.60"	"$8,844.42"	"$8,933.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27817	SUP	Custom 27803010		27817  -  SHUNT 27817 SNAP STRATA II REG	BOTH IP/OP	"$11,167.20 "	"$8,263.73"	$0.00	"$8,933.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,327.24"	$0.00	$0.00	$0.00	$0.00	"$5,583.60"	"$8,844.42"	"$8,933.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27818	SUP	Custom 27803010		27818  -  SHUNT 27818 STRATA II SML BIO	BOTH IP/OP	"$11,418.65 "	"$8,449.80"	$0.00	"$9,134.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,379.65"	$0.00	$0.00	$0.00	$0.00	"$5,709.33"	"$9,043.57"	"$9,134.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27819	SUP	Custom 27803010		27819  -  SHUNT 27819 STRATA II REG BIO	BOTH IP/OP	"$11,418.65 "	"$8,449.80"	$0.00	"$9,134.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,379.65"	$0.00	$0.00	$0.00	$0.00	"$5,709.33"	"$9,043.57"	"$9,134.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27820	SUP	Custom 27203010		27820  -  KIT 27820 UNI STRATA II SM V 11 PCATH90	BOTH IP/OP	"$10,915.75 "	"$8,077.66"	$0.00	"$8,732.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,274.84"	$0.00	$0.00	$0.00	$0.00	"$5,457.88"	"$8,645.27"	"$8,732.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27821	SUP	Custom 27203010		27821  -  KIT 27821 UNI STRATA II REG V13 PCATH90	BOTH IP/OP	"$10,915.75 "	"$8,077.66"	$0.00	"$8,732.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,274.84"	$0.00	$0.00	$0.00	$0.00	"$5,457.88"	"$8,645.27"	"$8,732.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27822	SUP	Custom 27803010		27822  -  SHUNT 27822 STRATA II SNP ASSY SM BIO	BOTH IP/OP	"$12,003.80 "	"$8,882.81"	$0.00	"$9,603.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,501.59"	$0.00	$0.00	$0.00	$0.00	"$6,001.90"	"$9,507.01"	"$9,603.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27823	SUP	Custom 27803010		27823  -  SHUNT 27823 STRATA II ASSY SNP REG BIO	BOTH IP/OP	"$12,003.80 "	"$8,882.81"	$0.00	"$9,603.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,501.59"	$0.00	$0.00	$0.00	$0.00	"$6,001.90"	"$9,507.01"	"$9,603.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27824	SUP	Custom 27803010		27824  -  SHUNT 27824 UNI STRATA II SM BIO	BOTH IP/OP	"$11,385.75 "	"$8,425.46"	$0.00	"$9,108.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,372.79"	$0.00	$0.00	$0.00	$0.00	"$5,692.88"	"$9,017.51"	"$9,108.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27825	SUP	Custom 27803010		27825  -  SHUNT 27825 STRATA II UNI REG BIO	BOTH IP/OP	"$11,385.75 "	"$8,425.46"	$0.00	"$9,108.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,372.79"	$0.00	$0.00	$0.00	$0.00	"$5,692.88"	"$9,017.51"	"$9,108.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27827	SUP	Custom 27803010		27827  -  VALVE 27827 STRATA II REG EXTRACTED	BOTH IP/OP	"$10,144.95 "	"$7,507.26"	$0.00	"$8,115.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,114.21"	$0.00	$0.00	$0.00	$0.00	"$5,072.48"	"$8,034.80"	"$8,115.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27828	SUP	Custom 27803010		27828  -  VALVE 27828 STRATA II SML INLET BUTTON	BOTH IP/OP	"$10,953.35 "	"$8,105.48"	$0.00	"$8,762.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,282.68"	$0.00	$0.00	$0.00	$0.00	"$5,476.68"	"$8,675.05"	"$8,762.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27829	SUP	Custom 27803010		27829  -  VALVE 27829 STRATA II REG INLET BUTTON	BOTH IP/OP	"$10,953.35 "	"$8,105.48"	$0.00	"$8,762.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,282.68"	$0.00	$0.00	$0.00	$0.00	"$5,476.68"	"$8,675.05"	"$8,762.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27830	SUP	Custom 27803010		27830  -  SHUNT 27830 SNAP STRATA II SML BLUNT	BOTH IP/OP	"$11,167.20 "	"$8,263.73"	$0.00	"$8,933.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,327.24"	$0.00	$0.00	$0.00	$0.00	"$5,583.60"	"$8,844.42"	"$8,933.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27831	SUP	Custom 27803010		27831  -  SHUNT 27831 SNAP STRATA II REG BLUNT P/C	BOTH IP/OP	"$11,167.20 "	"$8,263.73"	$0.00	"$8,933.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,327.24"	$0.00	$0.00	$0.00	$0.00	"$5,583.60"	"$8,844.42"	"$8,933.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27832	SUP	Custom 27803010		27832  -  VALVE 27832 SNAP STRATA II REG BLUNT	BOTH IP/OP	"$10,156.70 "	"$7,515.96"	$0.00	"$8,125.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,116.66"	$0.00	$0.00	$0.00	$0.00	"$5,078.35"	"$8,044.11"	"$8,125.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27842	SUP	Custom 27803010		27842  -  CATHETER 27842 EDMS VENTRICULAR STD 28CM	BOTH IP/OP	$297.60 	$220.22	$0.00	$238.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.88	$220.88	$0.00	$0.00	$62.02	$0.00	$0.00	$0.00	$0.00	$148.80	$235.70	$238.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27843	SUP	Custom 27803010		27843  -  CATHETER 27843 VENTRICULAR STD 15CM	BOTH IP/OP	$410.88 	$304.05	$0.00	$328.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$304.95	$304.95	$0.00	$0.00	$85.63	$0.00	$0.00	$0.00	$0.00	$205.44	$325.42	$328.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27848	SUP	Custom 27203010		27848  -  KIT 27848 STRATA II SHUNT SML PCATH 90CM	BOTH IP/OP	"$10,770.05 "	"$7,969.84"	$0.00	"$8,616.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,244.48"	$0.00	$0.00	$0.00	$0.00	"$5,385.03"	"$8,529.88"	"$8,616.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27852	SUP	Custom 27803010		27852  -  CATHETER 27852 VENT PLIANT FIX COL 15CM	BOTH IP/OP	$522.50 	$386.65	$0.00	$418.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$387.80	$387.80	$0.00	$0.00	$108.89	$0.00	$0.00	$0.00	$0.00	$261.25	$413.82	$418.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27853	SUP	Custom 27803010		27853  -  CATHETER 27853 OPUS VENT 23CM BIOGLIDE	BOTH IP/OP	$605.63 	$448.17	$0.00	$484.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.49	$449.49	$0.00	$0.00	$126.21	$0.00	$0.00	$0.00	$0.00	$302.81	$479.66	$484.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27855	SUP	Custom 27203010		27855  -  EDMS 27855 EXACTA VCATH W/NLESS INJ/STES	BOTH IP/OP	$688.80 	$509.71	$0.00	"$1,163.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,163.80"	"$1,163.80"	$0.00	$0.00	$326.78	$0.00	$0.00	$0.00	$0.00	$684.81	$545.53	"$1,095.69"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27857	SUP	Custom 27803010		27857  -  PCATH 27857 STD TRANSL NOSLIT 130CM	BOTH IP/OP	$418.00 	$309.32	$0.00	$331.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.95	$12.95	$0.00	$0.00	$3.64	$0.00	$0.00	$0.00	$0.00	$7.92	$331.06	$12.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27861	SUP	Custom 27203010		27861  -  EDMS 27861 EXACTA 50ML ANTIRFLUX GRNPL	BOTH IP/OP	$470.40 	$348.10	$0.00	$376.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$349.13	$349.13	$0.00	$0.00	$98.03	$0.00	$0.00	$0.00	$0.00	$235.20	$372.56	$376.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27864	SUP	Custom 27803010		27864  -  SHUNT 27864 STRATA II REGULAR 120CM	BOTH IP/OP	"$10,838.20 "	"$8,020.27"	$0.00	"$8,670.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,258.68"	$0.00	$0.00	$0.00	$0.00	"$5,419.10"	"$8,583.85"	"$8,670.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27867	SUP	Custom 27803010		27867  -  SHUNT 27867 STRATA II SMALL PCATH 130CM	BOTH IP/OP	"$10,770.05 "	"$7,969.84"	$0.00	"$8,616.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,244.48"	$0.00	$0.00	$0.00	$0.00	"$5,385.03"	"$8,529.88"	"$8,616.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27868	SUP	Custom 27803010		27868  -  SHUNT 27868 STRATA NSC SMALL PCATH 130CM	BOTH IP/OP	"$9,458.75 "	"$6,999.48"	$0.00	"$7,567.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,971.20"	$0.00	$0.00	$0.00	$0.00	"$4,729.38"	"$7,491.33"	"$7,567.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27873	SUP	Custom 27203010		27873  -  EDMS 27873 BECKR W/SC BLW DC W/NLESS INJ	BOTH IP/OP	$496.80 	$367.63	$0.00	$397.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$368.72	$368.72	$0.00	$0.00	$103.53	$0.00	$0.00	$0.00	$0.00	$248.40	$393.47	$397.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27875	SUP	Custom 27803010		27875  -  SHUNT 27875 CSF SNAP VCATH 15CM	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27888	SUP	Custom 27803010		27888  -  SHNT 27888 STRATA II SNAP ASSY REG PCATH	BOTH IP/OP	"$10,915.75 "	"$8,077.66"	$0.00	"$8,732.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,274.84"	$0.00	$0.00	$0.00	$0.00	"$5,457.88"	"$8,645.27"	"$8,732.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27889	SUP	Custom 27803010		27889  -  RESERVOIR 27889 VENT SNAP EXT FLANGE	BOTH IP/OP	$731.50 	$541.31	$0.00	$585.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$542.92	$542.92	$0.00	$0.00	$152.44	$0.00	$0.00	$0.00	$0.00	$365.75	$579.35	$585.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27903	SUP	Custom 27803010		27903  -  ASSY 27903 STRATA II SM CP CATHETER	BOTH IP/OP	"$9,949.90 "	"$7,362.93"	$0.00	"$7,959.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,073.56"	$0.00	$0.00	$0.00	$0.00	"$4,974.95"	"$7,880.32"	"$7,959.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27922	SUP	Custom 27803010		27922  -  SHUNT 27922 STRATA II REG W/INTEG V/RES	BOTH IP/OP	"$11,432.75 "	"$8,460.24"	$0.00	"$9,146.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,382.59"	$0.00	$0.00	$0.00	$0.00	"$5,716.38"	"$9,054.74"	"$9,146.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27923	SUP	Custom 27803010		27923  -  SHUNT 27923 STRATA II SML W/INTEG V/RES	BOTH IP/OP	"$11,432.75 "	"$8,460.24"	$0.00	"$9,146.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,382.59"	$0.00	$0.00	$0.00	$0.00	"$5,716.38"	"$9,054.74"	"$9,146.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27924	SUP	Custom 27803010		27924  -  SHUNT 27924 STRATA NSC REG W/INTG V/RES	BOTH IP/OP	"$10,624.35 "	"$7,862.02"	$0.00	"$8,499.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,214.11"	$0.00	$0.00	$0.00	$0.00	"$5,312.18"	"$8,414.49"	"$8,499.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27925	SUP	Custom 27803010		27925  -  SHUNT 27925 STRATA NSC SML W/INTEG V/RES	BOTH IP/OP	"$10,624.35 "	"$7,862.02"	$0.00	"$8,499.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,214.11"	$0.00	$0.00	$0.00	$0.00	"$5,312.18"	"$8,414.49"	"$8,499.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27926	SUP	Custom 27803010		27926  -  SHUNT 27926 STRATA II REG W/VRES INNERVN	BOTH IP/OP	"$11,900.40 "	"$8,806.30"	$0.00	"$9,520.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,480.04"	$0.00	$0.00	$0.00	$0.00	"$5,950.20"	"$9,425.12"	"$9,520.32"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27927	SUP	Custom 27803010		27927  -  SHUNT 27927 STRATA II SML W/VRES INNERVN	BOTH IP/OP	"$11,900.40 "	"$8,806.30"	$0.00	"$9,520.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,480.04"	$0.00	$0.00	$0.00	$0.00	"$5,950.20"	"$9,425.12"	"$9,520.32"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27929	SUP	Custom 27803010		27929  -  CATHETER 27929 CARDIAC PERIT SML EXTRCTD	BOTH IP/OP	"$1,330.00 "	$984.20	$0.00	"$1,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.13	$987.13	$0.00	$0.00	$277.17	$0.00	$0.00	$0.00	$0.00	$665.00	"$1,053.36"	"$1,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27930	SUP	Custom 27803010		27930  -  CATHETER 27930 VENTRICULAR SML EXTRACTD	BOTH IP/OP	$876.38 	$648.52	$0.00	$701.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$650.45	$650.45	$0.00	$0.00	$182.64	$0.00	$0.00	$0.00	$0.00	$438.19	$694.09	$701.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27931	SUP	Custom 27203010		27931  -  EDMS 27931 BECKER GS TUBING SMARTSITES	BOTH IP/OP	$556.80 	$412.03	$0.00	$445.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.26	$413.26	$0.00	$0.00	$116.04	$0.00	$0.00	$0.00	$0.00	$278.40	$440.99	$445.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27932	SUP	Custom 27803010		27932  -  VALVE 27932 STRATA NSC SML EXTRACTED	BOTH IP/OP	"$8,781.95 "	"$6,498.64"	$0.00	"$7,025.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,830.16"	$0.00	$0.00	$0.00	$0.00	"$4,390.98"	"$6,955.30"	"$7,025.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27933	SUP	Custom 27803010		27933  -  VALVE 27933 STRATA NSC REG EXTRACTED	BOTH IP/OP	"$8,781.95 "	"$6,498.64"	$0.00	"$7,025.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,830.16"	$0.00	$0.00	$0.00	$0.00	"$4,390.98"	"$6,955.30"	"$7,025.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28707	SUP	Custom 27203010		SET RTRCTR OCTOBASE HLD INS SUTURE DISP	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29400	SUP	Custom 27203010		STABILIZER SURG OCT4 DUAL VAC TUBE REINF ARM CARD	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30011	SUP	HCPCS C1776		30011  -  STEM ULNAR 41X6.2MM PLASMA SPRAY EASE OF INSERTION REDUCE	BOTH IP/OP	"$7,947.50 "	"$5,881.15"	$0.00	"$6,358.00"	"$3,576.38"	"$3,576.38"	$0.00	$0.00	$0.00	"$1,656.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,656.26"	$0.00	"$3,918.12"	"$3,918.12"	$0.00	"$3,973.75"	"$6,294.42"	"$6,358.00"	$0.00		$0.00	"$1,243.78"	$0.00	$0.00	"$1,265.24"	$0.00	$0.00	$0.00	$0.00	$0.00
30121	SUP	HCPCS C1776		30121  -  STEM ULNAR LATITUDE MEDIUM STANDARD LEFT ELBOW	BOTH IP/OP	"$7,946.75 "	"$5,880.60"	$0.00	"$6,357.40"	"$3,576.04"	"$3,576.04"	$0.00	$0.00	$0.00	"$1,656.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,656.10"	$0.00	"$3,917.75"	"$3,917.75"	$0.00	"$3,973.38"	"$6,293.83"	"$6,357.40"	$0.00		$0.00	"$1,243.67"	$0.00	$0.00	"$1,265.12"	$0.00	$0.00	$0.00	$0.00	$0.00
30303	SUP	HCPCS C1776		30303  -  STEM HUMERAL 90X7.7MM LATITUDE EV 6.5MM 4MM SMALL BOW	BOTH IP/OP	"$8,915.00 "	"$6,597.10"	$0.00	"$7,132.00"	"$4,011.75"	"$4,011.75"	$0.00	$0.00	$0.00	"$1,858.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,857.89"	$0.00	"$4,395.10"	"$4,395.10"	$0.00	"$4,457.50"	"$7,060.68"	"$7,132.00"	$0.00		$0.00	"$1,395.20"	$0.00	$0.00	"$1,419.27"	$0.00	$0.00	$0.00	$0.00	$0.00
30397	SUP	Custom 27203010		KIT C. DIFF A B ELISA MCBLTST 50ML 96 TST	BOTH IP/OP	$923.30 	$683.24	$0.00	$738.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$461.65	$731.25	$738.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30405	SUP	Custom 27203010		KIT PARASTST G LMBLA ELISA MCPLT POS NEG CNTRL	BOTH IP/OP	$910.28 	$673.61	$0.00	$728.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$455.14	$720.94	$728.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30406	SUP	Custom 27203010		KIT MYCTST CRPSP ELISA 96 TST	BOTH IP/OP	$883.75 	$653.98	$0.00	$707.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$441.88	$699.93	$707.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30418	SUP	Custom 27203010		030418  -  RELOAD STPLR UNV STRG 12MM 30MMX2.5MM WHT STRL LF EGIA 6 ROW	BOTH IP/OP	$223.20 	$165.17	$0.00	$178.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.66	$165.66	$0.00	$0.00	$46.51	$0.00	$0.00	$0.00	$0.00	$111.60	$176.77	$178.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30419	SUP	Custom 27203010		030419  -  RELOAD STPLR UNV STRG 12MM 30MMX3.5MM BLU STRL LF EGIA 6 ROW	BOTH IP/OP	$223.20 	$165.17	$0.00	$178.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.66	$165.66	$0.00	$0.00	$46.51	$0.00	$0.00	$0.00	$0.00	$111.60	$176.77	$178.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30422	SUP	Custom 27203010		030422  -  RELOAD STPLR UNV STRG 12MM 45MMX3.5MM BLU STRL LF EGIA 6 ROW	BOTH IP/OP	$230.33 	$170.44	$0.00	$184.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$115.16	$182.42	$184.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30423	SUP	Custom 27203010		030423  -  RELOAD STPLR UNV 45X4.8MM EGIA 2 TI THKTIS ENDSCP LNR CTR	BOTH IP/OP	$228.04 	$168.75	$0.00	$182.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.25	$169.25	$0.00	$0.00	$47.52	$0.00	$0.00	$0.00	$0.00	$114.02	$180.61	$182.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30425	SUP	Custom 27203010		030425  -  RELOAD STPLR UNV 45X2.5MM EGIA 2 TI VASC ENDSCP LNR CTR STRG	BOTH IP/OP	$228.04 	$168.75	$0.00	$182.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.25	$169.25	$0.00	$0.00	$47.52	$0.00	$0.00	$0.00	$0.00	$114.02	$180.61	$182.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30449	SUP	Custom 27203010		030449  -  RELOAD STPLR 12X4MM TI UNV LD UN STRL LATEX FREE DISP EGIA	BOTH IP/OP	$253.34 	$187.47	$0.00	$202.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.03	$188.03	$0.00	$0.00	$52.80	$0.00	$0.00	$0.00	$0.00	$126.67	$200.65	$202.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30454	SUP	Custom 27203010		030454  -  RELOAD STPLR UNV 12MM 45MMX2.5MM WHT STRL LF EGIA ROTC 6 ROW	BOTH IP/OP	$386.78 	$286.22	$0.00	$317.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.06	$287.06	$0.00	$0.00	$80.60	$0.00	$0.00	$0.00	$0.00	$198.40	$314.26	$317.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30455	SUP	Custom 27203010		030455  -  RELOAD STPLR UNV 12MM 45MMX3.5MM BLU STRL LF EGIA ROTC 6 ROW	BOTH IP/OP	$396.79 	$293.62	$0.00	$317.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$294.50	$294.50	$0.00	$0.00	$82.69	$0.00	$0.00	$0.00	$0.00	$198.39	$314.26	$317.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30456	SUP	Custom 27203010		RELOAD STPLR 45X4.8MM EGIA RT TI THKTIS LNR CTR LAPSCOP STRL	BOTH IP/OP	$425.65 	$314.98	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.33	$337.11	$333.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30456	SUP	Custom 27203010		030456  -  RELOAD STPLR UNV 12MM 45MMX4.8MM GRN STRL LF EGIA ROTC 6 ROW	BOTH IP/OP	$416.66 	$308.33	$0.00	$333.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.33	$329.99	$333.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30500	SUP	HCPCS C1729		CATHETER SCT 5FR GRAD STRG CNTRL VLV SF-T-VAC PED STRL LF	BOTH IP/OP	$0.88 	$0.65	$0.00	$0.70	$0.48	$0.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.44	$0.70	$0.70	$0.00		$0.00	$0.14	$0.00	$0.00	$0.14	$0.00	$0.00	$0.00	$0.00	$0.00
30688	SUP	HCPCS C1729		CATHETER SCT 6FR GRAD STRG SF-T-VAC PED STRL LF	BOTH IP/OP	$0.88 	$0.65	$0.00	$0.70	$0.48	$0.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.44	$0.70	$0.70	$0.00		$0.00	$0.14	$0.00	$0.00	$0.14	$0.00	$0.00	$0.00	$0.00	$0.00
30888	SUP	HCPCS C1729		CATHETER SCT 8FR CNTRL VLV STRG SF-T-VAC STRL LF DISP	BOTH IP/OP	$0.80 	$0.59	$0.00	$0.64	$0.43	$0.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.40	$0.63	$0.64	$0.00		$0.00	$0.13	$0.00	$0.00	$0.13	$0.00	$0.00	$0.00	$0.00	$0.00
30935	SUP	Custom 25003010		ANTIBODY CD68/MACRPH MAB MRKR HAM56 LAB	BOTH IP/OP	$353.15 	$261.33	$0.00	$282.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.58	$279.69	$282.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31000	SUP	HCPCS C1729		CATHETER SCT 10FR CNTRL VLV STRG SF-T-VAC STRL LF	BOTH IP/OP	$0.63 	$0.47	$0.00	$0.50	$0.34	$0.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.31	$0.50	$0.50	$0.00		$0.00	$0.10	$0.00	$0.00	$0.10	$0.00	$0.00	$0.00	$0.00	$0.00
31031	SUP	Custom 27203010		31031  -  BIT DRILL 145MM 3.2MM QC NONSTRL	BOTH IP/OP	$152.70 	$113.00	$0.00	$122.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$113.33	$113.33	$0.00	$0.00	$31.82	$0.00	$0.00	$0.00	$0.00	$76.35	$120.94	$122.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31035	SUP	Custom 27203010		31035  -  BIT DRILL 110MM 3.5MM QC CANN NONSTRL	BOTH IP/OP	$149.30 	$110.48	$0.00	$119.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$110.81	$110.81	$0.00	$0.00	$31.11	$0.00	$0.00	$0.00	$0.00	$74.65	$118.25	$119.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31100	SUP	Custom 27203010		31100  -  SHUNT CV 1MM 14MM STRL CLRVW BLB TPR TIP RADOPQ SIL INTRCOR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31113	SUP	Custom 27203010		KIT ORTH HCV BRCD SEQ VIR TST 3ML	BOTH IP/OP	$732.50 	$542.05	$0.00	$586.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$366.25	$580.14	$586.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31150	SUP	Custom 27203010		31150  -  SHUNT CV 1.5MM 14MM STRL CLRVW RADOPQ BLB TPR TIP SFT SIL	BOTH IP/OP	$207.50 	$153.55	$0.00	$166.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.01	$154.01	$0.00	$0.00	$43.24	$0.00	$0.00	$0.00	$0.00	$103.75	$164.34	$166.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31175	SUP	Custom 27203010		31175  -  SHUNT CV 1.75MM 14MM STRL CLRVW BLB INTRCOR ARTMY	BOTH IP/OP	$207.50 	$153.55	$0.00	$166.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.01	$154.01	$0.00	$0.00	$43.24	$0.00	$0.00	$0.00	$0.00	$103.75	$164.34	$166.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31200	SUP	Custom 27203010		31200  -  SHUNT CV 2MM 14MM STRL CLRVW RADOPQ BLB TPR TIP SFT SIL	BOTH IP/OP	$207.50 	$153.55	$0.00	$166.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.01	$154.01	$0.00	$0.00	$43.24	$0.00	$0.00	$0.00	$0.00	$103.75	$164.34	$166.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31250	SUP	Custom 27203010		31250  -  SHUNT CV 2.5MM 14MM STRL 14MM CLRVW BLB TPR TIP RADOPQ SIL	BOTH IP/OP	$207.50 	$153.55	$0.00	$166.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.01	$154.01	$0.00	$0.00	$43.24	$0.00	$0.00	$0.00	$0.00	$103.75	$164.34	$166.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31553.91	SUP	Custom 27203010		HANDLE SCP 3FT CORD HAL LGHT ILUM SYS ANOSCP SGSCP KLNSPC	BOTH IP/OP	$191.73 	$141.88	$0.00	$153.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.86	$151.85	$153.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31592	SUP	Custom 27203010		31592  -  BIT DRILL 230MM 2.5MM 3 FLT QC NONSTRL	BOTH IP/OP	$451.00 	$333.74	$0.00	$360.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$334.73	$334.73	$0.00	$0.00	$93.99	$0.00	$0.00	$0.00	$0.00	$225.50	$357.19	$360.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32508	SUP	Custom 27203010		KIT IMMUN TST WBLOT ANTI-HIV-1 40 TST	BOTH IP/OP	"$3,010.00 "	"$2,227.40"	$0.00	"$2,408.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,505.00"	"$2,383.92"	"$2,408.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32588	SUP	Custom 27203010		KIT IMMUN TST EIA ANTI-HIV 1 2	BOTH IP/OP	"$1,527.50 "	"$1,130.35"	$0.00	"$1,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$763.75	"$1,209.78"	"$1,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32591	SUP	Custom 27203010		KIT GN HBSAG VIR TST 480 TST	BOTH IP/OP	"$1,457.50 "	"$1,078.55"	$0.00	"$1,166.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$728.75	"$1,154.34"	"$1,166.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32594	SUP	Custom 27203010		KIT IMMUN TST CNFRM ASY HBSAG 25 TST	BOTH IP/OP	$580.00 	$429.20	$0.00	$464.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.00	$459.36	$464.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33000	SUP	Custom 27203010		REAGENT VIT B2 ACCES 50ML 100 TST ANALY	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33005	SUP	Custom 27203010		CALIBRATOR CHM 4ML VL VIT B2 ACCES	BOTH IP/OP	$264.45 	$195.69	$0.00	$211.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.23	$209.44	$211.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33020	SUP	Custom 27203010		REAGENT FRRTN ACCES 100 TST ANALY	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33025	SUP	Custom 27203010		CALIBRATOR CHM 4ML VL FRRTN ACCES	BOTH IP/OP	$44.08 	$32.62	$0.00	$35.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.04	$34.91	$35.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33138	SUP	Custom 27203010		FORMULA NUTRITIONAL ENFAMIL IRON FORTIFIED POWDER	BOTH IP/OP	$30.30 	$22.42	$0.00	$24.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.15	$24.00	$24.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33200	SUP	Custom 27203010		REAGENT CEA ACCES 100 TST ANALY	BOTH IP/OP	$595.00 	$440.30	$0.00	$476.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$297.50	$471.24	$476.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33205	SUP	Custom 27203010		CALIBRATOR CEA ACCES 50 TST IMMUN	BOTH IP/OP	$161.25 	$119.33	$0.00	$129.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.63	$127.71	$129.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33206	SUP	Custom 27203010		REAGENT CEA DILU ACCES 4ML ANALY	BOTH IP/OP	$153.75 	$113.78	$0.00	$123.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.88	$121.77	$123.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33211	SUP	Custom 27203010		REAGENT AFP ACCES 300 TST ANALY	BOTH IP/OP	"$1,597.50 "	"$1,182.15"	$0.00	"$1,278.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$798.75	"$1,265.22"	"$1,278.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33410	SUP	Custom 27203010		REAGENT INSN ACCES SYN ULSNS 50 TST ANALY	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33415	SUP	Custom 27203010		CALIBRATOR INSN ACCES SYN SET 2ML IMMUN	BOTH IP/OP	$264.45 	$195.69	$0.00	$211.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.23	$209.44	$211.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33500	SUP	Custom 27203010		REAGENT TL BHCG ACCES 100 TST ANALY	BOTH IP/OP	$141.88 	$104.99	$0.00	$113.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.94	$112.37	$113.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33505	SUP	Custom 27203010		CALIBRATOR TL BHCG ACCES 4ML IMMUN	BOTH IP/OP	$26.88 	$19.89	$0.00	$21.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.44	$21.29	$21.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33510	SUP	Custom 27203010		REAGENT LH ACCES 50 TST ANALY	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33515	SUP	Custom 27203010		CALIBRATOR LH ACCES 4ML IMMUN	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33520	SUP	Custom 27203010		REAGENT FSH ACCES 50 TST ANALY	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33525	SUP	Custom 27203010		CALIBRATOR FSH ACCES 4ML IMMUN	BOTH IP/OP	$264.45 	$195.69	$0.00	$211.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.23	$209.44	$211.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33530	SUP	Custom 27203010		REAGENT PRLCTN ACCES 50 TST ANALY	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33535	SUP	Custom 27203010		CALIBRATOR PRLCTN ACCES 50 TST IMMUN	BOTH IP/OP	$264.45 	$195.69	$0.00	$211.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.23	$209.44	$211.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33540	SUP	Custom 27203010		REAGENT E2 ACCES 100 TST ANALY	BOTH IP/OP	$501.25 	$370.93	$0.00	$401.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.63	$396.99	$401.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33545	SUP	Custom 27203010		CALIBRATOR E2 ACCES 2.5ML IMMUN	BOTH IP/OP	$264.45 	$195.69	$0.00	$211.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.23	$209.44	$211.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33546	SUP	Custom 27203010		REAGENT E2 DILU ACCES VL 4ML ANALY	BOTH IP/OP	$91.25 	$67.53	$0.00	$73.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.63	$72.27	$73.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33560	SUP	Custom 27203010		REAGENT T ACCES 50 TST ANALY	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33565	SUP	Custom 27203010		CALIBRATOR T ACCES 2.5ML IMMUN	BOTH IP/OP	$264.45 	$195.69	$0.00	$211.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.23	$209.44	$211.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33600	SUP	Custom 27203010		REAGENT CORTSL ACCES 100 TST ANALY	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33605	SUP	Custom 27203010		CALIBRATOR CORTSL ACCES 50 TST IMMUN	BOTH IP/OP	$264.45 	$195.69	$0.00	$211.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.23	$209.44	$211.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33606	SUP	Custom 27203010		CALIBRATOR CORTSL DILU ACCES 4ML IMMUN	BOTH IP/OP	$74.83 	$55.37	$0.00	$59.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.41	$59.27	$59.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33800	SUP	Custom 27203010		REAGENT TL T4 ACCES 50 TST ANALY	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33805	SUP	Custom 27203010		CALIBRATOR TL T4 ACCES 4ML IMMUN	BOTH IP/OP	$264.45 	$195.69	$0.00	$211.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.23	$209.44	$211.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33815	SUP	Custom 27203010		CALIBRATOR T UPTK ACCES 1ML IMMUN	BOTH IP/OP	$45.63 	$33.77	$0.00	$36.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.81	$36.14	$36.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33820	SUP	Custom 27203010		REAGENT TSH ACCES HYPERSENSITIVE 100 TST ANALY	BOTH IP/OP	$1.83 	$1.35	$0.00	$1.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.91	$1.45	$1.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33821	SUP	Custom 27203010		FORMULA NUTRITIONAL NUTRAMIGEN 1LB POWDER CAN	BOTH IP/OP	$56.68 	$41.94	$0.00	$45.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.34	$44.89	$45.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33825	SUP	Custom 27203010		CALIBRATOR TSH ACCES HYPERSENSITIVE VL 4ML IMMUN	BOTH IP/OP	$264.45 	$195.69	$0.00	$211.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.23	$209.44	$211.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33835	SUP	Custom 27203010		CALIBRATOR TL T3 ACCES 50 TST IMMUN	BOTH IP/OP	$264.45 	$195.69	$0.00	$211.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.23	$209.44	$211.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33880	SUP	Custom 27203010		REAGENT FR T4 ACCES 100 TST ANALY	BOTH IP/OP	$267.50 	$197.95	$0.00	$214.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.75	$211.86	$214.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33885	SUP	Custom 27203010		CALIBRATOR FR T4 ACCES 2.5ML IMMUN	BOTH IP/OP	$45.63 	$33.77	$0.00	$36.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.81	$36.14	$36.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35402	SUP	HCPCS C1729		CATHETER SCT 14FR CNTRL VLV 2 GLOVE WO SOL MINI TRY SF-T-VAC	BOTH IP/OP	$1.18 	$0.87	$0.00	$0.94	$0.64	$0.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.59	$0.93	$0.94	$0.00		$0.00	$0.18	$0.00	$0.00	$0.19	$0.00	$0.00	$0.00	$0.00	$0.00
36179	SUP	HCPCS C1769		36179  -  NEEDLE 5CM 18GA GUIDEWIRE PRC RNL FSCA 10MM	BOTH IP/OP	$82.45 	$61.01	$0.00	$65.96	$44.77	$44.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.23	$65.30	$65.96	$0.00		$0.00	$12.90	$0.00	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$0.00
36721	SUP	Custom 27203010		FORMULA NUTRITIONAL PREGESTIMIL 1LB POWDER CAN	BOTH IP/OP	$42.50 	$31.45	$0.00	$34.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.25	$33.66	$34.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
36826	SUP	HCPCS C1729		CATHETER SCT 8FR CNTRL VLV COIL GRAD 2 GLOVE PPUP BSIN	BOTH IP/OP	$1.43 	$1.06	$0.00	$1.14	$0.77	$0.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.71	$1.13	$1.14	$0.00		$0.00	$0.22	$0.00	$0.00	$0.23	$0.00	$0.00	$0.00	$0.00	$0.00
37024	SUP	HCPCS C1729		CATHETER SCT 10FR CNTRL VLV COIL 2 GLOVE PPUP BSIN KT	BOTH IP/OP	$1.28 	$0.95	$0.00	$1.02	$0.69	$0.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.64	$1.01	$1.02	$0.00		$0.00	$0.20	$0.00	$0.00	$0.20	$0.00	$0.00	$0.00	$0.00	$0.00
37092	SUP	HCPCS C1787		37092  -  PROGRAMMER NRSTM STRL ACTIVA PT ANTNA XTRN TELEM DP BRN STM	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37200	SUP	Custom 27203010		REAGENT PSA ACCES HYBRITECH 100 TST ANALY	BOTH IP/OP	$915.00 	$677.10	$0.00	$732.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$457.50	$724.68	$732.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37205	SUP	Custom 27203010		CALIBRATOR PSA ACCES HYBRITECH VL 2.5ML IMMUN	BOTH IP/OP	$264.45 	$195.69	$0.00	$211.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.23	$209.44	$211.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37206	SUP	Custom 27203010		REAGENT PSA DILU ACCES HYBRITECH 14ML ANALY	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37970	SUP	Custom 27203010		0037970  -  DEVICE IRR EFL DISP	BOTH IP/OP	$96.75 	$71.60	$0.00	$102.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.81	$71.81	$0.00	$0.00	$20.16	$0.00	$0.00	$0.00	$0.00	$63.75	$100.98	$102.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38005	SUP	Custom 27803010		038005  -  FILLER BONE VOID DBX DEMINERALIZED BONE MATRIX .5 CC ALLOGRA	BOTH IP/OP	$243.25 	$180.01	$0.00	$194.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.54	$180.54	$0.00	$0.00	$50.69	$0.00	$0.00	$0.00	$0.00	$121.63	$192.65	$194.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38010	SUP	HCPCS C1713		38010  -  FILLER BONE VOID ALLOGRAFT PUTTY FREEZE DRIED DBX	BOTH IP/OP	$432.25 	$319.87	$0.00	$345.80	$194.51	$194.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.13	$342.34	$345.80	$0.00		$0.00	$67.65	$0.00	$0.00	$68.81	$0.00	$0.00	$0.00	$0.00	$0.00
38025	SUP	HCPCS C1713		038025  -  FILLER BONE VOID ALLOGRAFT FREEZE DRY PUTTY DBX 2.5CC	BOTH IP/OP	$935.00 	$691.90	$0.00	$748.00	$420.75	$420.75	$0.00	$0.00	$0.00	$194.88	$693.96	$693.96	$0.00	$0.00	$194.85	$0.00	$553.05	$553.05	$0.00	$467.50	$740.52	$748.00	$0.00		$0.00	$146.33	$0.00	$0.00	$148.85	$0.00	$0.00	$0.00	$0.00	$0.00
38050	SUP	HCPCS C1713		038050  -  FILLER BONE VOID ALLOGRAFT FREEZE DRY PUTTY DBX 5ML	BOTH IP/OP	"$1,725.50 "	"$1,276.87"	$0.00	"$1,380.40"	$776.48	$776.48	$0.00	$0.00	$0.00	$359.64	"$1,280.67"	"$1,280.67"	$0.00	$0.00	$359.59	$0.00	"$1,020.63"	"$1,020.63"	$0.00	$862.75	"$1,366.60"	"$1,380.40"	$0.00		$0.00	$270.04	$0.00	$0.00	$274.70	$0.00	$0.00	$0.00	$0.00	$0.00
38100	SUP	Custom 27803010		038100  -  FILLER BONE VOID ALLOGRAFT FREEZE DRY PUTTY DBX 10ML	BOTH IP/OP	"$2,652.00 "	"$1,962.48"	$0.00	"$2,100.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.81	$87.81	$0.00	$0.00	$24.66	$0.00	$0.00	$0.00	$0.00	$53.64	"$2,100.38"	$85.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41101	SUP	HCPCS C1729		41101  -  CATHETER DRN STD 4FR 23CM STRL LF INPT TS CSF IMPREGNATE	BOTH IP/OP	$356.25 	$263.63	$0.00	$285.00	$193.44	$193.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.13	$282.15	$285.00	$0.00		$0.00	$55.75	$0.00	$0.00	$56.72	$0.00	$0.00	$0.00	$0.00	$0.00
41103	SUP	Custom 27803010		41103  -  CATH 41103 CSF-VENT STANDARD PLIANT	BOTH IP/OP	$356.25 	$263.63	$0.00	$285.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.41	$264.41	$0.00	$0.00	$74.24	$0.00	$0.00	$0.00	$0.00	$178.13	$282.15	$285.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41115	SUP	Custom 27803010		41115  -  CATH 41115 CSF-VENT STD TRANSLUCENT	BOTH IP/OP	$356.25 	$263.63	$0.00	$285.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.41	$264.41	$0.00	$0.00	$74.24	$0.00	$0.00	$0.00	$0.00	$178.13	$282.15	$285.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41207	SUP	Custom 27803010		41207  -  CATH 41207 CSF-VENT SMALL BAR IMP	BOTH IP/OP	$356.25 	$263.63	$0.00	$285.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.41	$264.41	$0.00	$0.00	$74.24	$0.00	$0.00	$0.00	$0.00	$178.13	$282.15	$285.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41308	SUP	Custom 27803010		41308  -  CATH 41308 CSF-VENT FLANGED SMALL	BOTH IP/OP	"$1,368.00 "	"$1,012.32"	$0.00	"$1,094.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,015.33"	"$1,015.33"	$0.00	$0.00	$285.09	$0.00	$0.00	$0.00	$0.00	$684.00	"$1,083.46"	"$1,094.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41404	SUP	Custom 27803010		41404  -  CATHETER 41404 CSF-VENT STD W/SNAP 4CM	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41405	SUP	Custom 27803010		41405  -  CATHETER 41405 CSF-VENT STD W/SNAP 5CM	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41406	SUP	Custom 27803010		41406  -  CATHETER 41406 CSF-VENT STD W/SNAP 6CM	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41407	SUP	Custom 27803010		41407  -  CATHETER 41407 CSF-VENT STD W/SNAP 7CM	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41408	SUP	Custom 27803010		41408  -  CATHETER DRN STD 8CM STRL LF CSF SNP SHNT VNTRC DISP	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41409	SUP	Custom 27803010		41409  -  CATHETER DRN STD 9CM STRL LF CSF SNP SHNT VNTRC DISP	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41501	SUP	Custom 27803010		41501  -  CATH 41501 OPUS VENTRICULAR SM 23CM	BOTH IP/OP	$465.50 	$344.47	$0.00	$372.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.49	$345.49	$0.00	$0.00	$97.01	$0.00	$0.00	$0.00	$0.00	$232.75	$368.68	$372.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41503	SUP	Custom 27803010		41503  -  CATH 41503 OPUS VENTRICULAR STD 23CM	BOTH IP/OP	$465.50 	$344.47	$0.00	$372.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.49	$345.49	$0.00	$0.00	$97.01	$0.00	$0.00	$0.00	$0.00	$232.75	$368.68	$372.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41701	SUP	Custom 27803010		41701  -  CATHETER 41701 RIVULET VENTRICULAR	BOTH IP/OP	$619.88 	$458.71	$0.00	$495.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$460.07	$460.07	$0.00	$0.00	$129.18	$0.00	$0.00	$0.00	$0.00	$309.94	$490.94	$495.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41704	SUP	Custom 27803010		41704  -  CATHETER 41704 RIVULET VENT SNAP 4CM	BOTH IP/OP	$790.88 	$585.25	$0.00	$632.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$586.99	$586.99	$0.00	$0.00	$164.82	$0.00	$0.00	$0.00	$0.00	$395.44	$626.38	$632.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41705	SUP	Custom 27803010		41705  -  CATHETER 41705 RIVULET VENT SNAP 5CM	BOTH IP/OP	$790.88 	$585.25	$0.00	$632.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$586.99	$586.99	$0.00	$0.00	$164.82	$0.00	$0.00	$0.00	$0.00	$395.44	$626.38	$632.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41707	SUP	Custom 27803010		41707  -  CATHETER 41707 RIVULET VENT SNAP 7CM	BOTH IP/OP	$790.88 	$585.25	$0.00	$632.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$586.99	$586.99	$0.00	$0.00	$164.82	$0.00	$0.00	$0.00	$0.00	$395.44	$626.38	$632.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41709	SUP	Custom 27803010		41709  -  CATHETER 41709 RIVULET VENT SNAP 9CM	BOTH IP/OP	$790.88 	$585.25	$0.00	$632.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$586.99	$586.99	$0.00	$0.00	$164.82	$0.00	$0.00	$0.00	$0.00	$395.44	$626.38	$632.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42102	SUP	Custom 27803010		42102  -  VALVE 42102 STANDARD LOW	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42104	SUP	Custom 27803010		42104  -  VALVE 42104 STANDARD MEDIUM	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42106	SUP	Custom 27803010		42106  -  VALVE 42106 STANDARD HIGH	BOTH IP/OP	"$1,655.38 "	"$1,224.98"	$0.00	"$1,324.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,228.62"	"$1,228.62"	$0.00	$0.00	$344.98	$0.00	$0.00	$0.00	$0.00	$827.69	"$1,311.06"	"$1,324.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42312	SUP	Custom 27803010		42312  -  VALVE 42312 SM CONTOURED LOW PRES IMP	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42314	SUP	Custom 27803010		42314  -  VALVE 42314 SM CONTOURED MED PRESS IMP	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42316	SUP	Custom 27803010		42316  -  VALVE 42316 SM CONTOURED HIGH PRESS IMP	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42322	SUP	Custom 27803010		42322  -  VALVE SHNT REG STRL DLT CNTR LP CSF	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42324	SUP	Custom 27803010		42324  -  VALVE SHNT REG CNTR 32X18X7.5MM STRL LF 14MM DLT PS MDCL CSF	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42326	SUP	Custom 27803010		42326  -  VALVE SHNT REG STRL DLT CNTR HI-PRS IMPRG CSF	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42335	SUP	Custom 27803010		42335  -  VALVE 42335 STRATA NSC BURR HOLE	BOTH IP/OP	"$9,038.10 "	"$6,688.19"	$0.00	"$7,230.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,883.54"	$0.00	$0.00	$0.00	$0.00	"$4,519.05"	"$7,158.18"	"$7,230.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42355	SUP	Custom 27803010		42355  -  VALVE 42355 FP STRATA NSC SMALL	BOTH IP/OP	"$9,038.10 "	"$6,688.19"	$0.00	"$7,230.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,883.54"	$0.00	$0.00	$0.00	$0.00	"$4,519.05"	"$7,158.18"	"$7,230.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42365	SUP	Custom 27803010		42365  -  VALVE 42365 FP STRATA NSC REGULAR	BOTH IP/OP	"$9,038.10 "	"$6,688.19"	$0.00	"$7,230.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,883.54"	$0.00	$0.00	$0.00	$0.00	"$4,519.05"	"$7,158.18"	"$7,230.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42410	SUP	Custom 27803010		42410  -  VALVE 42410 ULTRA SMALL LOW-LOW	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42412	SUP	Custom 27803010		42412  -  VALVE 42412 ULTRA SMALL LOW PRESS IMP	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42414	SUP	Custom 27803010		42414  -  VALVE 42414 ULTRA SMALL MEDIUM PRESS IMP	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42532	SUP	Custom 27803010		42532  -  VALVE 42532 BURR HOLE 12MM LOW PRESS IMP	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42534	SUP	Custom 27803010		42534  -  VALVE 42534 BURR HOLE 12MM MED PRESS IMP	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42536	SUP	Custom 27803010		42536  -  VALVE 42536 BURR HOLE 12MM HI PRESS IMP	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42542	SUP	Custom 27803010		42542  -  VALVE 42542 BURR HOLE 16 MM LOW IMP	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42544	SUP	Custom 27803010		42544  -  VALVE 42544 BURR HOLE 16MM MED PRESS IMP	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42546	SUP	Custom 27803010		42546  -  VALVE 42546 BURR HOLE 16MM HI PRESS IMP	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42812	SUP	Custom 27803010		42812  -  VALVE 42812 DELTA SMALL LEVEL I	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42813	SUP	Custom 27803010		42813  -  VALVE 42813 DELTA SMALL LEVEL 1.5	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42814	SUP	Custom 27803010		42814  -  VALVE 42814 DELTA SMALL LEVEL II	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42822	SUP	Custom 27803010		42822  -  VALVE SHNT DLT REG CSF PRFRM LVL 1 STRL	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42823	SUP	Custom 27803010		42823  -  VALVE SHNT DLT REG CSF PRFRM LVL 1.5 CHRNC SYSTOLIC STRL	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42824	SUP	HCPCS C1877		42824  -  VALVE SHNT DLT REG CSF PRFRM LVL 2 STRL	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	"$1,627.71"	"$1,627.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$566.08	$0.00	$0.00	$575.85	$0.00	$0.00	$0.00	$0.00	$0.00
42830	SUP	Custom 27803010		42830  -  VALVE 42830 DELTA BURR HOLE 12MM LEV 0.5	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42832	SUP	Custom 27803010		42832  -  VALVE 42832 DELTA BURR HOLE 12MM LEVEL 1	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42833	SUP	Custom 27803010		42833  -  VALVE 42833DELTA BURR HOLE 12MM LEV 1.5	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42834	SUP	Custom 27803010		42834  -  VALVE 42834 DELTA BURR HOLE 12 MM LEVEL	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42836	SUP	Custom 27803010		42836  -  VALVE 42836 STRATA II BURR HOLE	BOTH IP/OP	"$9,839.45 "	"$7,281.19"	$0.00	"$7,871.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,050.54"	$0.00	$0.00	$0.00	$0.00	"$4,919.73"	"$7,792.84"	"$7,871.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42840	SUP	Custom 27803010		42840  -  VALVE 42840 DELTA BURR HOLE 16MM LEV 0.5	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42842	SUP	Custom 27803010		42842  -  VALVE 42842 DELTA BURR HOLE 16MM LEVEL 1	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42843	SUP	Custom 27803010		42843  -  VALVE 42843 DELTA BURR HOLE 16 MM LEV 1.	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42844	SUP	Custom 27803010		42844  -  VALVE 42844 DELTA BURR HOLE 16 MM LEVEL	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42856	SUP	Custom 27803010		42856  -  VALVE 42856 FP-STRATA 2 SMALL	BOTH IP/OP	"$9,839.45 "	"$7,281.19"	$0.00	"$7,871.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,050.54"	$0.00	$0.00	$0.00	$0.00	"$4,919.73"	"$7,792.84"	"$7,871.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42866	SUP	Custom 27803010		42866  -  VALVE 42866 FP-STRATA 2 REGULAR	BOTH IP/OP	"$9,839.45 "	"$7,281.19"	$0.00	"$7,871.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,050.54"	$0.00	$0.00	$0.00	$0.00	"$4,919.73"	"$7,792.84"	"$7,871.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43103	SUP	HCPCS C1750		43103  -  CATHETER PERITONEAL STANDARD 90CM IMPREGNATE BARIUM CARDIAC	BOTH IP/OP	$410.88 	$304.05	$0.00	$328.70	$184.89	$184.89	$0.00	$0.00	$0.00	$85.64	$304.95	$304.95	$0.00	$0.00	$85.63	$0.00	$243.03	$243.03	$0.00	$205.44	$325.42	$328.70	$0.00		$0.00	$64.30	$0.00	$0.00	$65.41	$0.00	$0.00	$0.00	$0.00	$0.00
43105	SUP	HCPCS C1713		43105  -  SUB BNGFT GRFTN DBM PTTY JAR 5ML	BOTH IP/OP	"$2,162.50 "	"$1,600.25"	$0.00	"$1,605.01"	$630.00	$630.00	$0.00	$0.00	$0.00	$450.72	"$1,605.01"	"$1,605.01"	$0.00	$0.00	$450.67	$0.00	"$1,279.12"	"$1,279.12"	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00		$0.00	$219.10	$0.00	$0.00	$222.88	$0.00	$0.00	$0.00	$0.00	$0.00
43110	SUP	Custom 27804086		43110  -  FILLER BN VOID 10ML GRFTN ALGRF PTTY JR DBM	BOTH IP/OP	"$2,418.00 "	"$1,789.32"	$0.00	"$1,934.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,794.64"	"$1,794.64"	$0.00	$0.00	$503.91	$0.00	$0.00	$0.00	$0.00	"$1,209.00"	"$1,915.06"	"$1,934.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43111	SUP	Custom 27803010		43111  -  CATH 43111 C/P STANDARD TRANSLUCENT	BOTH IP/OP	$410.88 	$304.05	$0.00	$328.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$304.95	$304.95	$0.00	$0.00	$85.63	$0.00	$0.00	$0.00	$0.00	$205.44	$325.42	$328.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43209	SUP	Custom 27803010		43209  -  CATH 43209 C/P SMALL BAR IMP	BOTH IP/OP	$410.88 	$304.05	$0.00	$328.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$304.95	$304.95	$0.00	$0.00	$85.63	$0.00	$0.00	$0.00	$0.00	$205.44	$325.42	$328.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43418	SUP	Custom 27803010		43418  -  CATH 43418 CARDIAC CATH REDUCED TIP 58CM	BOTH IP/OP	$534.38 	$395.44	$0.00	$427.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$396.61	$396.61	$0.00	$0.00	$111.36	$0.00	$0.00	$0.00	$0.00	$267.19	$423.23	$427.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43522	SUP	Custom 27803010		43522  -  CATH 43522 C/P CATH OPEN END W/SLITS STD	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.24	$310.24	$0.00	$0.00	$87.11	$0.00	$0.00	$0.00	$0.00	$209.00	$331.06	$334.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43551	SUP	Custom 27803010		43551  -  CATH 43551 C/P STD PLIANT BAR IMP	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.24	$310.24	$0.00	$0.00	$87.11	$0.00	$0.00	$0.00	$0.00	$209.00	$331.06	$334.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43555	SUP	Custom 27803010		43555  -  CATHETER 43555 PERITONEAL SMALL LUMEN	BOTH IP/OP	$593.75 	$439.38	$0.00	$475.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$440.68	$440.68	$0.00	$0.00	$123.74	$0.00	$0.00	$0.00	$0.00	$296.88	$470.25	$475.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11-Jan	SUP	HCPCS C1713		JAN-11  -  PLATE BONE SM RIGHT ORBTL FLR MESH CNTOUR ANTM EZ	BOTH IP/OP	"$4,677.50 "	"$3,461.35"	$0.00	"$3,742.00"	"$2,104.88"	"$2,104.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,338.75"	"$3,704.58"	"$3,742.00"	$0.00		$0.00	$732.03	$0.00	$0.00	$744.66	$0.00	$0.00	$0.00	$0.00	$0.00
44000	SUP	Custom 27803010		44000  -  INLET 44000 VENTRICULAR PORT BOTTOM	BOTH IP/OP	$959.50 	$710.03	$0.00	$767.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.14	$712.14	$0.00	$0.00	$199.96	$0.00	$0.00	$0.00	$0.00	$479.75	$759.92	$767.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44010	SUP	Custom 27803010		44010  -  INLET 44010 VENTRICULAR PORT SIDE	BOTH IP/OP	$959.50 	$710.03	$0.00	$767.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.14	$712.14	$0.00	$0.00	$199.96	$0.00	$0.00	$0.00	$0.00	$479.75	$759.92	$767.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44100	SUP	Custom 27803010		44100  -  RESERVOIR 44100 VENT. 12MM CONVERT 20MM	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44101	SUP	Custom 27803010		44101  -  RESERVOIR DRN SM RT ANG 2.1MM 1.2MM 3CM .1ML STRL LF 12MM	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44103	SUP	Custom 27803010		44103  -  RESERVOIR DRN SM 28MM 2.1MM 1.2MM 23CM 1.1ML CSF SD INLT	BOTH IP/OP	$931.00 	$688.94	$0.00	$744.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$690.99	$690.99	$0.00	$0.00	$194.02	$0.00	$0.00	$0.00	$0.00	$465.50	$737.35	$744.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44104	SUP	Custom 27803010		44104  -  RESERVOIR 44104 VENT. INLET BOTTOM	BOTH IP/OP	$931.00 	$688.94	$0.00	$744.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$690.99	$690.99	$0.00	$0.00	$194.02	$0.00	$0.00	$0.00	$0.00	$465.50	$737.35	$744.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44105	SUP	Custom 27803010		44105  -  SUB BNGFT GRFTN DBM CRNCH JAR 5ML	BOTH IP/OP	$931.00 	$688.94	$0.00	$744.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$690.99	$690.99	$0.00	$0.00	$194.02	$0.00	$0.00	$0.00	$0.00	$465.50	$737.35	$744.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44108	SUP	Custom 27803010		44108  -  RESERVOIR DRN SM 2.1MM 1.2MM 90CM 2.4ML STRL LF 30MM CSF	BOTH IP/OP	"$1,503.38 "	"$1,112.50"	$0.00	"$1,202.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,115.80"	"$1,115.80"	$0.00	$0.00	$313.30	$0.00	$0.00	$0.00	$0.00	$751.69	"$1,190.68"	"$1,202.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44111	SUP	Custom 27803010		44111  -  RESERVOIR 44111 VENT. BURR HOLE	BOTH IP/OP	$931.00 	$688.94	$0.00	$744.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$690.99	$690.99	$0.00	$0.00	$194.02	$0.00	$0.00	$0.00	$0.00	$465.50	$737.35	$744.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44113	SUP	Custom 27803010		44113  -  RESERVOIR SHNT 12MM STRL DLT CSF BUR HL	BOTH IP/OP	$931.00 	$688.94	$0.00	$744.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$690.99	$690.99	$0.00	$0.00	$194.02	$0.00	$0.00	$0.00	$0.00	$465.50	$737.35	$744.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44150	SUP	HCPCS C1713		44150  -  SUB BNGFT GRFTN SM DFCT DBM OTHBLND JAR 10ML	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,700.00"	"$1,518.75"	"$1,518.75"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,687.50"	"$2,673.00"	"$2,700.00"	$0.00		$0.00	$528.19	$0.00	$0.00	$537.30	$0.00	$0.00	$0.00	$0.00	$0.00
44200	SUP	Custom 27803010		44200  -  RES 44200 VENTRICULOSTOMY BH 6MM REG IMP	BOTH IP/OP	$403.75 	$298.78	$0.00	$323.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$299.66	$299.66	$0.00	$0.00	$84.14	$0.00	$0.00	$0.00	$0.00	$201.88	$319.77	$323.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44201	SUP	Custom 27803010		44201  -  KIT VNCLSTM REG 6MM STRL BUR HL CSF	BOTH IP/OP	$714.88 	$529.01	$0.00	$571.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$530.58	$530.58	$0.00	$0.00	$148.98	$0.00	$0.00	$0.00	$0.00	$357.44	$566.18	$571.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44210	SUP	Custom 27803010		44210  -  RESERVOIR VNCLSTM SHLW 6MM CSF BUR HL	BOTH IP/OP	$403.75 	$298.78	$0.00	$323.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$299.66	$299.66	$0.00	$0.00	$84.14	$0.00	$0.00	$0.00	$0.00	$201.88	$319.77	$323.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44211	SUP	Custom 27803010		44211  -  KIT VNCLSTM REG 6MM STRL CSF BUR HL SHLW D	BOTH IP/OP	$714.88 	$529.01	$0.00	$571.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$530.58	$530.58	$0.00	$0.00	$148.98	$0.00	$0.00	$0.00	$0.00	$357.44	$566.18	$571.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-21	SUP	Custom 27803010		6-2021  -  CAGE SPNL 20MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF	BOTH IP/OP	"$7,813.35 "	"$5,781.88"	$0.00	"$6,250.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,628.30"	$0.00	$0.00	$0.00	$0.00	"$3,906.68"	"$6,188.17"	"$6,250.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jul-21	SUP	Custom 27803010		7-2021  -  DEVICE FSN 20MM 21MM RYTFC	BOTH IP/OP	"$6,615.95 "	"$4,895.80"	$0.00	"$5,292.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,378.76"	$0.00	$0.00	$0.00	$0.00	"$3,307.98"	"$5,239.83"	"$5,292.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44405	SUP	Custom 27803010		44405  -  CATHETER 44405 LUMBAR CLOSED TIP	BOTH IP/OP	"$1,472.50 "	"$1,089.65"	$0.00	"$1,178.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,092.89"	"$1,092.89"	$0.00	$0.00	$306.87	$0.00	$0.00	$0.00	$0.00	$736.25	"$1,166.22"	"$1,178.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44406	SUP	Custom 27803010		44406  -  CATHETER 44406 LUMBAR OPEN TIP	BOTH IP/OP	"$1,472.50 "	"$1,089.65"	$0.00	"$1,178.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,092.89"	"$1,092.89"	$0.00	$0.00	$306.87	$0.00	$0.00	$0.00	$0.00	$736.25	"$1,166.22"	"$1,178.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44410	SUP	Custom 27803010		44410  -  SYSTEM CATH C14-24CM 2O 20GA 14GA 84CM PS MDCL CNCT 3 FX TAB	BOTH IP/OP	"$1,686.25 "	"$1,247.83"	$0.00	"$1,349.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,251.53"	"$1,251.53"	$0.00	$0.00	$351.41	$0.00	$0.00	$0.00	$0.00	$843.13	"$1,335.51"	"$1,349.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44420	SUP	Custom 27803010		44420  -  SHUNT 44420 STRATA KIT NSC LP	BOTH IP/OP	"$11,247.10 "	"$8,322.85"	$0.00	"$8,997.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.90"	$0.00	$0.00	$0.00	$0.00	"$5,623.55"	"$8,907.70"	"$8,997.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44421	SUP	Custom 27203010		44421  -  KIT 44421 STRATA NSC LP OPEN LUMBAR	BOTH IP/OP	"$11,247.10 "	"$8,322.85"	$0.00	"$8,997.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.90"	$0.00	$0.00	$0.00	$0.00	"$5,623.55"	"$8,907.70"	"$8,997.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44430	SUP	Custom 27803010		44430  -  SHUNT 44430 STRATA KIT NSC LP ASSY	BOTH IP/OP	"$11,646.60 "	"$8,618.48"	$0.00	"$9,317.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,427.15"	$0.00	$0.00	$0.00	$0.00	"$5,823.30"	"$9,224.11"	"$9,317.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44465	SUP	Custom 27803010		44465  -  VALVE 44465 STRATA NSC LP	BOTH IP/OP	"$9,677.30 "	"$7,161.20"	$0.00	"$7,741.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.75"	$0.00	$0.00	$0.00	$0.00	"$4,838.65"	"$7,664.42"	"$7,741.84"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44513	SUP	Custom 27803010		44513  -  RES 44513 CSF-LUMBOPERITONEAL 20MM	BOTH IP/OP	$824.13 	$609.86	$0.00	$659.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.67	$611.67	$0.00	$0.00	$171.75	$0.00	$0.00	$0.00	$0.00	$412.06	$652.71	$659.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44515	SUP	Custom 27803010		44515  -  RES 44515 CSF-LUMBOPERITONEAL 30MM	BOTH IP/OP	$824.13 	$609.86	$0.00	$659.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.67	$611.67	$0.00	$0.00	$171.75	$0.00	$0.00	$0.00	$0.00	$412.06	$652.71	$659.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44520	SUP	Custom 27803010		44520  -  SHUNT NS 87CM STRL LMBPRTNL CATH T CSF	BOTH IP/OP	"$1,835.88 "	"$1,358.55"	$0.00	"$1,468.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,362.59"	"$1,362.59"	$0.00	$0.00	$382.60	$0.00	$0.00	$0.00	$0.00	$917.94	"$1,454.02"	"$1,468.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45001	SUP	Custom 27804086		45001  -  GRAFT BN 1ML GRFTN + PST SYR DBM	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45005	SUP	Custom 27804086		45005  -  CANNULA LAPSCP 10MM DL PK DP50-0116-006	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$0.00	$0.00	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45010	SUP	Custom 27804086		45010  -  GRAFT BN 10ML GRFTN + PST SYR DBM	BOTH IP/OP	"$2,170.00 "	"$1,605.80"	$0.00	"$1,736.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,610.57"	"$1,610.57"	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	"$1,085.00"	"$1,718.64"	"$1,736.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45103	SUP	Custom 27803010		45103  -  CONNECTOR SHNT STRG STRL ACFL CSF RADOPQ CATH PLS	BOTH IP/OP	$178.13 	$131.82	$0.00	$142.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.20	$132.20	$0.00	$0.00	$37.12	$0.00	$0.00	$0.00	$0.00	$89.06	$141.08	$142.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45104	SUP	Custom 27803010		45104  -  CONNECTOR SHNT RT ANG STRL ACFL CSF CATH PLS	BOTH IP/OP	$178.13 	$131.82	$0.00	$142.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.20	$132.20	$0.00	$0.00	$37.12	$0.00	$0.00	$0.00	$0.00	$89.06	$141.08	$142.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45105	SUP	Custom 27803010		45105  -  CONNECTOR SHNT STRL ACFL CSF CATH 3W PLS	BOTH IP/OP	$565.25 	$418.29	$0.00	$452.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$419.53	$419.53	$0.00	$0.00	$117.80	$0.00	$0.00	$0.00	$0.00	$282.63	$447.68	$452.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45402	SUP	Custom 27203010		45402  -  TOOL 45402 SNAP ASSEMBLY	BOTH IP/OP	$729.13 	$539.56	$0.00	$583.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.16	$541.16	$0.00	$0.00	$151.95	$0.00	$0.00	$0.00	$0.00	$364.56	$577.47	$583.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45792	SUP	HCPCS C1758		45792  -  CATHETER URET 5FR 70CM .038IN TPR TIP OP-EN RT	BOTH IP/OP	$24.50 	$18.13	$0.00	$19.60	$13.30	$13.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.25	$19.40	$19.60	$0.00		$0.00	$3.83	$0.00	$0.00	$3.90	$0.00	$0.00	$0.00	$0.00	$0.00
45806	SUP	Custom 27203010		45806  -  KIT 45806 STRATA VARIOUS	BOTH IP/OP	"$8,922.95 "	"$6,602.98"	$0.00	"$7,138.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,859.54"	$0.00	$0.00	$0.00	$0.00	"$4,461.48"	"$7,066.98"	"$7,138.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45807	SUP	Custom 27203010		45807  -  CARD 45807 SMART STRATA	BOTH IP/OP	$169.20 	$125.21	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.58	$125.58	$0.00	$0.00	$35.26	$0.00	$0.00	$0.00	$0.00	$84.60	$134.01	$135.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45808	SUP	Custom 27203010		45808  -  CARD 45808 SMART STRATA NSC	BOTH IP/OP	$232.65 	$172.16	$0.00	$186.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.67	$172.67	$0.00	$0.00	$48.48	$0.00	$0.00	$0.00	$0.00	$116.33	$184.26	$186.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45809	SUP	Custom 27203010		45809  -  TOOL 45809 STRATAVARIUS ADJUSTMENT	BOTH IP/OP	$491.63 	$363.81	$0.00	$393.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$364.88	$364.88	$0.00	$0.00	$102.45	$0.00	$0.00	$0.00	$0.00	$245.81	$389.37	$393.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46012	SUP	Custom 27803010		46012  -  KIT 46012 SHUNT UNITIZED SMALL LOW	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46014	SUP	Custom 27803010		46014  -  KIT 46014 SHUNT UNITIZED SMALL MED	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46016	SUP	Custom 27803010		46016  -  KIT 46016 SHUNT UNITIZED SMALL HIGH	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46022	SUP	Custom 27803010		46022  -  KIT 46022 SHUNT UNITIZED REG LOW	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46024	SUP	Custom 27803010		46024  -  KIT 46024 SHUNT UNITIZED REG MED	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46026	SUP	Custom 27803010		46026  -  KIT 46026 SHUNT UNITIZED REG HIGH	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46070	SUP	Custom 27803010		46070  -  SHNT 46070 FP UNI STRATA NSC SML 8CM	BOTH IP/OP	"$10,112.05 "	"$7,482.92"	$0.00	"$8,089.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,107.35"	$0.00	$0.00	$0.00	$0.00	"$5,056.03"	"$8,008.74"	"$8,089.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46075	SUP	Custom 27803010		46075  -  SHNT 46075 FP UNI STRATA NSC SM 11.5	BOTH IP/OP	"$10,112.05 "	"$7,482.92"	$0.00	"$8,089.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,107.35"	$0.00	$0.00	$0.00	$0.00	"$5,056.03"	"$8,008.74"	"$8,089.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46080	SUP	Custom 27803010		46080  -  SHNT 46080 FP UNI STRATA NSC REG 11	BOTH IP/OP	"$10,112.05 "	"$7,482.92"	$0.00	"$8,089.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,107.35"	$0.00	$0.00	$0.00	$0.00	"$5,056.03"	"$8,008.74"	"$8,089.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46085	SUP	Custom 27803010		46085  -  SHNT 46085 FP UNI STRATA NSC RG 13.5	BOTH IP/OP	"$10,112.05 "	"$7,482.92"	$0.00	"$8,089.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,107.35"	$0.00	$0.00	$0.00	$0.00	"$5,056.03"	"$8,008.74"	"$8,089.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46115	SUP	HCPCS C1729		46115  -  CATHETER DRN 20CM CLR STRL LF BCKR EDMS BA IMPRG SIL VNTRC	BOTH IP/OP	$268.80 	$198.91	$0.00	$215.04	$145.96	$145.96	$0.00	$0.00	$0.00	$56.02	$199.50	$199.50	$0.00	$0.00	$56.02	$0.00	$159.00	$159.00	$0.00	$134.40	$212.89	$215.04	$0.00		$0.00	$42.07	$0.00	$0.00	$42.79	$0.00	$0.00	$0.00	$0.00	$0.00
46118	SUP	HCPCS C1729		46118  -  CATHETER XTRN DRN 2.8MM 1.5MM 35CM 700ML STRL LF 15CM EDM	BOTH IP/OP	$403.20 	$298.37	$0.00	$322.56	$218.94	$218.94	$0.00	$0.00	$0.00	$84.04	$299.26	$299.26	$0.00	$0.00	$84.03	$0.00	$238.49	$238.49	$0.00	$201.60	$319.33	$322.56	$0.00		$0.00	$63.10	$0.00	$0.00	$64.19	$0.00	$0.00	$0.00	$0.00	$0.00
46126	SUP	Custom 27203010		46126  -  EDMS 46126 PATIENT CONN LINE ASSY	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.69	$124.69	$0.00	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46129	SUP	Custom 27203010		46129  -  EDMS III 46129 BECKER	BOTH IP/OP	$508.80 	$376.51	$0.00	$407.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$377.63	$377.63	$0.00	$0.00	$106.03	$0.00	$0.00	$0.00	$0.00	$254.40	$402.97	$407.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46135	SUP	HCPCS C1713		46135  -  CLAMP 46135 QUICK ATTACH POLE	BOTH IP/OP	"$1,120.80 "	$829.39	$0.00	$896.64	$504.36	$504.36	$0.00	$0.00	$0.00	$233.60	$831.86	$831.86	$0.00	$0.00	$233.57	$0.00	$662.95	$662.95	$0.00	$560.40	$887.67	$896.64	$0.00		$0.00	$175.41	$0.00	$0.00	$178.43	$0.00	$0.00	$0.00	$0.00	$0.00
46137	SUP	HCPCS C1713		46137  -  CLMP 46137 QUICK ATTACH POLE W/LAS	BOTH IP/OP	"$1,293.60 "	$957.26	$0.00	"$1,034.88"	$582.12	$582.12	$0.00	$0.00	$0.00	$269.62	$960.11	$960.11	$0.00	$0.00	$269.59	$0.00	$765.16	$765.16	$0.00	$646.80	"$1,024.53"	"$1,034.88"	$0.00		$0.00	$202.45	$0.00	$0.00	$205.94	$0.00	$0.00	$0.00	$0.00	$0.00
46141	SUP	Custom 27203010		46141  -  KIT 46141 EDM VEN DRAINAGE 5PK	BOTH IP/OP	$751.20 	$555.89	$0.00	$600.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$557.54	$557.54	$0.00	$0.00	$156.55	$0.00	$0.00	$0.00	$0.00	$375.60	$594.95	$600.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46154	SUP	Custom 27203010		46154  -  KIT 46154 VNTRC EURO	BOTH IP/OP	$784.80 	$580.75	$0.00	$627.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$582.48	$582.48	$0.00	$0.00	$163.55	$0.00	$0.00	$0.00	$0.00	$392.40	$621.56	$627.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-26	SUP	Custom 27803010		6-2026  -  CAGE SPNL 20MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF	BOTH IP/OP	"$7,813.35 "	"$5,781.88"	$0.00	"$6,250.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,628.30"	$0.00	$0.00	$0.00	$0.00	"$3,906.68"	"$6,188.17"	"$6,250.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46220	SUP	Custom 27803010		46220  -  KIT 46220 SHUNT ULTRA SMALL 4CM LL	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46222	SUP	Custom 27803010		46222  -  KIT 46222 SHUNT ULTRA SMALL 4CM LOW	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46224	SUP	Custom 27803010		46224  -  SHUNT 46224 KIT ULTRA SMALL 4CM MED IMP	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46240	SUP	Custom 27803010		46240  -  KIT 46240 SHUNT ULTRA SMALL 6CM LL	BOTH IP/OP	"$3,080.38 "	"$2,279.48"	$0.00	"$2,464.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,286.25"	"$2,286.25"	$0.00	$0.00	$641.95	$0.00	$0.00	$0.00	$0.00	"$1,540.19"	"$2,439.66"	"$2,464.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46242	SUP	Custom 27803010		46242  -  KIT 46242 SHUNT ULTRA SMALL 6CM LOW	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46244	SUP	Custom 27803010		46244  -  KIT 46244 SHUNT ULTRA SMALL 6CM MED	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46418	SUP	Custom 27803010		46418  -  CATHETER 46418 EDM LUMBAR 24CM OPEN	BOTH IP/OP	$391.20 	$289.49	$0.00	$312.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.35	$290.35	$0.00	$0.00	$81.53	$0.00	$0.00	$0.00	$0.00	$195.60	$309.83	$312.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46419	SUP	HCPCS C1729		46419  -  CATHETER XTRN DRN 80CM STRL EDM CLS TIP BA IMPRG SIL LMBR	BOTH IP/OP	$566.40 	$419.14	$0.00	$453.12	$307.56	$307.56	$0.00	$0.00	$0.00	$118.05	$420.38	$420.38	$0.00	$0.00	$118.04	$0.00	$335.03	$335.03	$0.00	$283.20	$448.59	$453.12	$0.00		$0.00	$88.64	$0.00	$0.00	$90.17	$0.00	$0.00	$0.00	$0.00	$0.00
46420	SUP	Custom 27803010		46420  -  CATH 46420 EDM LUMBAR 80CM/OPEN TIP	BOTH IP/OP	$544.80 	$403.15	$0.00	$435.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$404.35	$404.35	$0.00	$0.00	$113.54	$0.00	$0.00	$0.00	$0.00	$272.40	$431.48	$435.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46430	SUP	Custom 27203010		46430  -  BAGS 46430 EDM DRAINAGE 10-PACK BOX	BOTH IP/OP	$88.08 	$65.18	$0.00	$70.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.37	$65.37	$0.00	$0.00	$18.36	$0.00	$0.00	$0.00	$0.00	$44.04	$69.76	$70.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46440	SUP	Custom 27203010		46440  -  KIT XTRN DRN 35CM 700ML BE2 MNTR LMBR	BOTH IP/OP	$767.52 	$567.96	$0.00	$614.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$569.65	$569.65	$0.00	$0.00	$159.95	$0.00	$0.00	$0.00	$0.00	$383.76	$607.88	$614.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46441	SUP	Custom 27203010		46441  -  KIT 46441 EDM LUMBAR DRAINAGE 5PK	BOTH IP/OP	$629.76 	$466.02	$0.00	$503.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$467.41	$467.41	$0.00	$0.00	$131.24	$0.00	$0.00	$0.00	$0.00	$314.88	$498.77	$503.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46442	SUP	Custom 27203010		46442  -  KIT 46442 EDM LUMBAR DRN CLS TIP 5PK	BOTH IP/OP	$629.76 	$466.02	$0.00	$503.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$467.41	$467.41	$0.00	$0.00	$131.24	$0.00	$0.00	$0.00	$0.00	$314.88	$498.77	$503.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46540	SUP	Custom 27803010		46540  -  SHUNT 46540 CSF SNAP ASSY BUTTON LOW LOW	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46542	SUP	Custom 27803010		46542  -  SHUNT NS CSF ASMB SNP BTN LP	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46544	SUP	Custom 27803010		46544  -  SHUNT NS CSF ASMB SNP BTN MED PRSS	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46560	SUP	Custom 27803010		46560  -  SHUNT 46560 CSF SNAP ASSY US LOW LOW	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46562	SUP	Custom 27803010		46562  -  SHUNT 46562 CSF SNAP ASSY US LOW	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46564	SUP	Custom 27803010		46564  -  SHUNT 46564 CSF SNAP ASSY US MEDIUM	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46622	SUP	Custom 27803010		46622  -  SHUNT 46622 CSF ASSY SMALL LOW CONT C/P	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46624	SUP	Custom 27803010		46624  -  SHUNT 46624 CSF ASSY SMALL MED CONT C/P	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46626	SUP	Custom 27803010		46626  -  SHUNT 46626 CSF ASSY SMALL HIGH CONT C/P	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46635	SUP	Custom 27803010		46635  -  SHUNT 46635 STRATA NSC BURR HOLE	BOTH IP/OP	"$9,458.75 "	"$6,999.48"	$0.00	"$7,567.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,971.20"	$0.00	$0.00	$0.00	$0.00	"$4,729.38"	"$7,491.33"	"$7,567.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46642	SUP	Custom 27803010		46642  -  SHUNT 46642 ASSY REG LOW C/P-90CM	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46644	SUP	Custom 27803010		46644  -  SHUNT 46644 ASSY REG MED C/P-90CM	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46646	SUP	Custom 27803010		46646  -  SHUNT 46646 ASSY REG HIGH C/P-90CM	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46655	SUP	Custom 27803010		46655  -  ASSY 46655 FP SHUNT STRATA NSC SMALL	BOTH IP/OP	"$9,458.75 "	"$6,999.48"	$0.00	"$7,567.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,971.20"	$0.00	$0.00	$0.00	$0.00	"$4,729.38"	"$7,491.33"	"$7,567.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46665	SUP	Custom 27803010		46665  -  ASSY 46665 FP SHUNT STRATA NSC REG	BOTH IP/OP	"$9,458.75 "	"$6,999.48"	$0.00	"$7,567.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,971.20"	$0.00	$0.00	$0.00	$0.00	"$4,729.38"	"$7,491.33"	"$7,567.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46700	SUP	Custom 27203010		46700  -  SYSTEM 46700 EXACTA DISP. DRAINAGE	BOTH IP/OP	$398.40 	$294.82	$0.00	$318.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.69	$295.69	$0.00	$0.00	$83.03	$0.00	$0.00	$0.00	$0.00	$199.20	$315.53	$318.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46705	SUP	Custom 27203010		46705  -  SYSTEM 46705 EXACTA DRAINAGE 100ML	BOTH IP/OP	$432.00 	$319.68	$0.00	$345.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.63	$320.63	$0.00	$0.00	$90.03	$0.00	$0.00	$0.00	$0.00	$216.00	$342.14	$345.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46710	SUP	Custom 27203010		46710  -  BAG 46710 EXACTA DRAINAGE	BOTH IP/OP	$110.40 	$81.70	$0.00	$88.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.94	$81.94	$0.00	$0.00	$23.01	$0.00	$0.00	$0.00	$0.00	$55.20	$87.44	$88.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46711	SUP	Custom 27203010		46711  -  ASSY 46711 EXACTA POLE CLAMP W/LASER	BOTH IP/OP	"$1,281.60 "	$948.38	$0.00	"$1,025.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$951.20	$951.20	$0.00	$0.00	$267.09	$0.00	$0.00	$0.00	$0.00	$640.80	"$1,015.03"	"$1,025.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46712	SUP	Custom 27203010		46712  -  BAG 46712 EXACTA DRAINAGE 10 PK	BOTH IP/OP	$88.08 	$65.18	$0.00	$70.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.37	$65.37	$0.00	$0.00	$18.36	$0.00	$0.00	$0.00	$0.00	$44.04	$69.76	$70.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46713	SUP	Custom 27203010		46713  -  ASSY 46713 EXACTA POLE CLAMP NO LASER	BOTH IP/OP	"$1,142.40 "	$845.38	$0.00	$913.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$847.89	$847.89	$0.00	$0.00	$238.08	$0.00	$0.00	$0.00	$0.00	$571.20	$904.78	$913.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46715	SUP	HCPCS C1713		46715  -  CLAMP 46715 EXACTA PL NEG 25CM W/LSR	BOTH IP/OP	"$1,399.20 "	"$1,035.41"	$0.00	"$1,119.36"	$629.64	$629.64	$0.00	$0.00	$0.00	$291.63	"$1,038.49"	"$1,038.49"	$0.00	$0.00	$291.59	$0.00	$827.63	$827.63	$0.00	$699.60	"$1,108.17"	"$1,119.36"	$0.00		$0.00	$218.97	$0.00	$0.00	$222.75	$0.00	$0.00	$0.00	$0.00	$0.00
46717	SUP	HCPCS C1713		46717  -  CLAMP 46717 EXACTA POLE -25CM W/O LSR	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
46812	SUP	Custom 27803010		46812  -  ASSY 46812 DELTA SHUNT SMALL PL 1	BOTH IP/OP	"$4,134.88 "	"$3,059.81"	$0.00	"$3,307.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,068.90"	"$3,068.90"	$0.00	$0.00	$861.71	$0.00	$0.00	$0.00	$0.00	"$2,067.44"	"$3,274.82"	"$3,307.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46813	SUP	Custom 27803010		46813  -  ASSY 46813 DELTA SHUNT SM LEV 1.5	BOTH IP/OP	"$4,134.88 "	"$3,059.81"	$0.00	"$3,307.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,068.90"	"$3,068.90"	$0.00	$0.00	$861.71	$0.00	$0.00	$0.00	$0.00	"$2,067.44"	"$3,274.82"	"$3,307.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46814	SUP	Custom 27803010		46814  -  ASSY 46814 DELTA SHUNT SMALL P/L 2	BOTH IP/OP	"$4,134.88 "	"$3,059.81"	$0.00	"$3,307.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,068.90"	"$3,068.90"	$0.00	$0.00	$861.71	$0.00	$0.00	$0.00	$0.00	"$2,067.44"	"$3,274.82"	"$3,307.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46822	SUP	Custom 27803010		46822  -  ASSY 46822 DELTA SHUNT REG P/L 1	BOTH IP/OP	"$4,134.88 "	"$3,059.81"	$0.00	"$3,307.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,068.90"	"$3,068.90"	$0.00	$0.00	$861.71	$0.00	$0.00	$0.00	$0.00	"$2,067.44"	"$3,274.82"	"$3,307.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46823	SUP	Custom 27803010		46823  -  ASSY 46823 DELTA SHUNT REG LEV 1.5	BOTH IP/OP	"$4,134.88 "	"$3,059.81"	$0.00	"$3,307.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,068.90"	"$3,068.90"	$0.00	$0.00	$861.71	$0.00	$0.00	$0.00	$0.00	"$2,067.44"	"$3,274.82"	"$3,307.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46824	SUP	Custom 27803010		46824  -  ASSY 46824 DELTA SHUNT REG P/L 2	BOTH IP/OP	"$4,134.88 "	"$3,059.81"	$0.00	"$3,307.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,068.90"	"$3,068.90"	$0.00	$0.00	$861.71	$0.00	$0.00	$0.00	$0.00	"$2,067.44"	"$3,274.82"	"$3,307.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46832	SUP	Custom 27803010		46832  -  SHUNT 46832 NEONATAL DELTA SNAP L 1	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46833	SUP	Custom 27803010		46833  -  SHUNT 46833 NEONATAL DELTA SNAP 1.5	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46834	SUP	Custom 27803010		46834  -  SHUNT 46834 NEONATAL DELTA SNAP L 2	BOTH IP/OP	"$5,191.75 "	"$3,841.90"	$0.00	"$4,153.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,853.32"	"$3,853.32"	$0.00	$0.00	"$1,081.96"	$0.00	$0.00	$0.00	$0.00	"$2,595.88"	"$4,111.87"	"$4,153.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46836	SUP	Custom 27803010		46836  -  SHUNT 46836 STRATA II BURR HOLE	BOTH IP/OP	"$10,302.40 "	"$7,623.78"	$0.00	"$8,241.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,147.02"	$0.00	$0.00	$0.00	$0.00	"$5,151.20"	"$8,159.50"	"$8,241.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46856	SUP	Custom 27803010		46856  -  ASSY 46856 FP-STRATA 2 SHUNT SML	BOTH IP/OP	"$10,302.40 "	"$7,623.78"	$0.00	"$8,241.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,147.02"	$0.00	$0.00	$0.00	$0.00	"$5,151.20"	"$8,159.50"	"$8,241.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46866	SUP	Custom 27803010		46866  -  ASSY 46866 FP-STRATA 2 SHUNT REG	BOTH IP/OP	"$10,302.40 "	"$7,623.78"	$0.00	"$8,241.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,147.02"	$0.00	$0.00	$0.00	$0.00	"$5,151.20"	"$8,159.50"	"$8,241.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46871	SUP	Custom 27803010		46871  -  SHUNT 46871 FP-STRATA UNI SML 8	BOTH IP/OP	"$10,915.75 "	"$8,077.66"	$0.00	"$8,732.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,274.84"	$0.00	$0.00	$0.00	$0.00	"$5,457.88"	"$8,645.27"	"$8,732.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46876	SUP	Custom 27803010		46876  -  UNISHUNT 46876 FP STRATA SM 11.5	BOTH IP/OP	"$10,915.75 "	"$8,077.66"	$0.00	"$8,732.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,274.84"	$0.00	$0.00	$0.00	$0.00	"$5,457.88"	"$8,645.27"	"$8,732.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46881	SUP	Custom 27803010		46881  -  SHUNT 46881 FP-STRATA UNI REG 11	BOTH IP/OP	"$10,915.75 "	"$8,077.66"	$0.00	"$8,732.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,274.84"	$0.00	$0.00	$0.00	$0.00	"$5,457.88"	"$8,645.27"	"$8,732.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46886	SUP	Custom 27803010		46886  -  SHUNT 46886 FP-STRATA UNI REG 13.5	BOTH IP/OP	"$10,915.75 "	"$8,077.66"	$0.00	"$8,732.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,274.84"	$0.00	$0.00	$0.00	$0.00	"$5,457.88"	"$8,645.27"	"$8,732.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46911	SUP	Custom 27203010		46911  -  BAG 46911 DRAINAGE DEHP-FREE 1PK	BOTH IP/OP	$110.40 	$81.70	$0.00	$88.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.94	$81.94	$0.00	$0.00	$23.01	$0.00	$0.00	$0.00	$0.00	$55.20	$87.44	$88.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46912	SUP	Custom 27203010		46912  -  BAG 46912 DRAINAGE DEHP-FREE 10PK	BOTH IP/OP	$88.08 	$65.18	$0.00	$70.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.37	$65.37	$0.00	$0.00	$18.36	$0.00	$0.00	$0.00	$0.00	$44.04	$69.76	$70.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46913	SUP	Custom 27203010		46913  -  EDMS 46913 DUET INTERLINK SITES	BOTH IP/OP	$566.40 	$419.14	$0.00	$453.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$420.38	$420.38	$0.00	$0.00	$118.04	$0.00	$0.00	$0.00	$0.00	$283.20	$448.59	$453.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46914	SUP	Custom 27203010		46914  -  EDMS 46914 DUET BLUECORE SITES	BOTH IP/OP	$566.40 	$419.14	$0.00	$453.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$420.38	$420.38	$0.00	$0.00	$118.04	$0.00	$0.00	$0.00	$0.00	$283.20	$448.59	$453.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46915	SUP	Custom 27203010		46915  -  EDMS 46915 DUET INTERLINK WITH VCATH	BOTH IP/OP	$960.00 	$710.40	$0.00	$768.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.51	$712.51	$0.00	$0.00	$200.06	$0.00	$0.00	$0.00	$0.00	$480.00	$760.32	$768.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46916	SUP	Custom 27203010		46916  -  EDMS 46916 DUET BLUECORE WITH VCATH	BOTH IP/OP	$960.00 	$710.40	$0.00	$768.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.51	$712.51	$0.00	$0.00	$200.06	$0.00	$0.00	$0.00	$0.00	$480.00	$760.32	$768.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46917	SUP	Custom 27203010		46917  -  SYSTEM XTRN DRN 60IN DUET LCATH INTLNK CLS SYS XTRN VNTRC	BOTH IP/OP	"$1,104.00 "	$816.96	$0.00	$883.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$819.39	$819.39	$0.00	$0.00	$230.07	$0.00	$0.00	$0.00	$0.00	$552.00	$874.37	$883.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46918	SUP	Custom 27203010		46918  -  LEVEL LSR NS LF CLRST REUSE XTRN DRN MNTR SYS	BOTH IP/OP	$211.20 	$156.29	$0.00	$168.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.75	$156.75	$0.00	$0.00	$44.01	$0.00	$0.00	$0.00	$0.00	$105.60	$167.27	$168.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47032	SUP	Custom 27203010		47032  -  NEEDLE AMNIO 15CM 20GA ECHTP SDPRT DISP	BOTH IP/OP	$43.13 	$31.92	$0.00	$34.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.56	$34.16	$34.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48270	SUP	Custom 27203010		0048270  -  TUBING SCT 100FT 9/32IN PLST NCDTV ECON INTGR BLSTR CONCTR	BOTH IP/OP	$13.52 	$10.00	$0.00	$10.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.03	$10.03	$0.00	$0.00	$2.82	$0.00	$0.00	$0.00	$0.00	$6.76	$10.71	$10.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48403	SUP	Custom 27203010		48403  -  PASSER 48403 L/P SUBCUT CATH 38CM	BOTH IP/OP	"$2,766.88 "	"$2,047.49"	$0.00	"$2,213.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,053.57"	"$2,053.57"	$0.00	$0.00	$576.62	$0.00	$0.00	$0.00	$0.00	"$1,383.44"	"$2,191.37"	"$2,213.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48405	SUP	Custom 27203010		48405  -  PASSER 48405 CATH V/P SUBCUT 60CM	BOTH IP/OP	"$2,914.13 "	"$2,156.46"	$0.00	"$2,331.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,162.86"	"$2,162.86"	$0.00	$0.00	$607.30	$0.00	$0.00	$0.00	$0.00	"$1,457.06"	"$2,307.99"	"$2,331.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48407	SUP	Custom 27203010		48407  -  PASSER 48407 CATHETER 38CM DISP.	BOTH IP/OP	$344.38 	$254.84	$0.00	$275.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$255.60	$255.60	$0.00	$0.00	$71.77	$0.00	$0.00	$0.00	$0.00	$172.19	$272.75	$275.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48409	SUP	Custom 27203010		48409  -  PASSER 48409 60CM DISP. CATHETER	BOTH IP/OP	$368.13 	$272.42	$0.00	$294.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$273.22	$273.22	$0.00	$0.00	$76.72	$0.00	$0.00	$0.00	$0.00	$184.06	$291.56	$294.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50120	SUP	Custom 27803010		50120  -  CLIP LGT MED LG VESOCCLUDE SMTR 6 CRTDG TI	BOTH IP/OP	$9.38 	$6.94	$0.00	$7.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.96	$6.96	$0.00	$0.00	$1.95	$0.00	$0.00	$0.00	$0.00	$4.69	$7.43	$7.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50190	SUP	Custom 27203010		KIT GSTRM 18FR INTROD BR-MLR TFSTNR DILAT	BOTH IP/OP	$414.50 	$306.73	$0.00	$331.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.25	$328.28	$331.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50318	SUP	Custom 27803010		50318  -  CATHETER 50318 EVD ANTIBIOTIC PK 5 NCE	BOTH IP/OP	"$3,600.00 "	"$2,664.00"	$0.00	"$2,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,671.92"	"$2,671.92"	$0.00	$0.00	$750.24	$0.00	$0.00	$0.00	$0.00	"$1,800.00"	"$2,851.20"	"$2,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50823	SUP	Custom 27203010		50823  -  INFLATION SYSTEM	BOTH IP/OP	$55.15 	$40.81	$0.00	$44.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.93	$40.93	$0.00	$0.00	$11.49	$0.00	$0.00	$0.00	$0.00	$27.58	$43.68	$44.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
52021	SUP	HCPCS Q4108		52021  -  DRESSING WND 2X2IN MTRX BVN CLGN	BOTH IP/OP	"$1,205.92 "	$892.38	$0.00	"$1,096.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$895.03	$895.03	$0.00	$0.00	$41.87	$0.00	$0.00	$0.00	$0.00	$685.18	"$1,085.33"	"$1,096.29"	$0.00		$0.00	$39.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
53130	SUP	Custom 27203010		53130  -  RETAINER SEPRONET 3 25YDX7/8IN ELAST TBLR NT DRSG NYL RBR	BOTH IP/OP	$67.92 	$50.26	$0.00	$54.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.96	$53.79	$54.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
53660	SUP	HCPCS C1725		53660  -  CATH BALDILAT .038IN 7FR 80CM 4.5CM ILC FEM POPLT ART TPR	BOTH IP/OP	$37.50 	$27.75	$0.00	$30.00	$20.36	$20.36	$0.00	$0.00	$0.00	$7.82	$27.83	$27.83	$0.00	$0.00	$7.82	$0.00	$22.18	$22.18	$0.00	$18.75	$29.70	$30.00	$0.00		$0.00	$5.87	$0.00	$0.00	$5.97	$0.00	$0.00	$0.00	$0.00	$0.00
54051	SUP	HCPCS Q4108		54051  -  DRESSING WND 5X4IN STRL BVN CLGN GAG DISP	BOTH IP/OP	"$8,046.58 "	"$5,954.47"	$0.00	"$7,315.06"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,972.17"	"$5,972.17"	$0.00	$0.00	$41.87	$0.00	$0.00	$0.00	$0.00	"$4,571.91"	"$7,241.91"	"$7,315.06"	$0.00		$0.00	$39.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
56030	SUP	HCPCS C1729		"056030  -  URETHRAL CATHETERS, BARDEX, ROBINSON MODEL, LATEX 30FR"	BOTH IP/OP	$7.03 	$5.20	$0.00	$5.62	$3.81	$3.81	$0.00	$0.00	$0.00	$1.46	$5.21	$5.21	$0.00	$0.00	$1.46	$0.00	$4.16	$4.16	$0.00	$3.51	$5.57	$5.62	$0.00		$0.00	$1.10	$0.00	$0.00	$1.12	$0.00	$0.00	$0.00	$0.00	$0.00
57760	SUP	Custom 27203010		FORMULA NUTRITIONAL SIMILAC 24 CAL IRON FORTIFIED	BOTH IP/OP	$26.03 	$19.26	$0.00	$20.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.01	$20.62	$20.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
58025	SUP	Custom 27803010		58025  -  FILLER BONE VOID ALLOGRAFT FREEZE DRY MIX DBX 2.5CC	BOTH IP/OP	"$1,156.00 "	$855.44	$0.00	$924.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.98	$857.98	$0.00	$0.00	$240.91	$0.00	$0.00	$0.00	$0.00	$578.00	$915.55	$924.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
58050	SUP	HCPCS C1713		58050  -  FILLER BONE VOID ALLOGRAFT FREEZE DRIED MIX DBX 5ML	BOTH IP/OP	"$2,091.00 "	"$1,547.34"	$0.00	"$1,672.80"	$940.95	$940.95	$0.00	$0.00	$0.00	$435.82	"$1,551.94"	"$1,551.94"	$0.00	$0.00	$435.76	$0.00	"$1,236.83"	"$1,236.83"	$0.00	"$1,045.50"	"$1,656.07"	"$1,672.80"	$0.00		$0.00	$327.24	$0.00	$0.00	$332.89	$0.00	$0.00	$0.00	$0.00	$0.00
58200	SUP	HCPCS C1713		58200  -  FILLER BONE VOID ALLOGRAFT MIX FREEZE DRIED DBX	BOTH IP/OP	"$9,475.00 "	"$7,011.50"	$0.00	"$7,580.00"	"$4,263.75"	"$4,263.75"	$0.00	$0.00	$0.00	"$1,974.83"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,974.59"	$0.00	"$4,671.18"	"$4,671.18"	$0.00	"$4,737.50"	"$7,504.20"	"$7,580.00"	$0.00		$0.00	"$1,482.84"	$0.00	$0.00	"$1,508.42"	$0.00	$0.00	$0.00	$0.00	$0.00
60011	SUP	HCPCS C2625		60011  -  IMPLANT NASAL 370 MCG MINI 4MM 16MM STEROID RELEASE ZIP TIE	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,850.00"	"$1,040.63"	"$1,040.63"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,156.25"	"$1,831.50"	"$1,850.00"	$0.00		$0.00	$361.91	$0.00	$0.00	$368.15	$0.00	$0.00	$0.00	$0.00	$0.00
61000	SUP	Custom 27203010		TUBING PRSS DSPL SET STPCK 45IN REST HRT DISP	BOTH IP/OP	$37.50 	$27.75	$0.00	$30.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.75	$29.70	$30.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61621	SUP	Custom 27803010		61621  -  CAGE SPNL 16MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF	BOTH IP/OP	"$8,031.25 "	"$5,943.13"	$0.00	"$6,425.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,673.71"	$0.00	$0.00	$0.00	$0.00	"$4,015.63"	"$6,360.75"	"$6,425.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62100	SUP	Custom 27803010		62100  -  PATCH DURA 2X2IN STRL DUREPAIR RSRB BVN CLGN MTRX CRNL DRPLS	BOTH IP/OP	$996.40 	$737.34	$0.00	$797.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$739.53	$739.53	$0.00	$0.00	$207.65	$0.00	$0.00	$0.00	$0.00	$498.20	$789.15	$797.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62105	SUP	Custom 27803010		62105  -  PATCH DURA 3X3IN DUREPAIR CRANIAL BVN CLGN MTRX RESORB DRPLS	BOTH IP/OP	"$1,816.55 "	"$1,344.25"	$0.00	"$1,453.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,348.24"	"$1,348.24"	$0.00	$0.00	$378.57	$0.00	$0.00	$0.00	$0.00	$908.28	"$1,438.71"	"$1,453.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62106	SUP	Custom 27803010		62106  -  DURA 62106 SUBSTITUTE DUREPAIR 1X3IN NCE	BOTH IP/OP	$822.50 	$608.65	$0.00	$658.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.46	$610.46	$0.00	$0.00	$171.41	$0.00	$0.00	$0.00	$0.00	$411.25	$651.42	$658.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62110	SUP	Custom 27803010		62110  -  PATCH DURA 5X4IN DUREPAIR CRANIAL BVN CLGN MTRX RESORB DRPLS	BOTH IP/OP	"$3,520.30 "	"$2,605.02"	$0.00	"$2,816.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,612.77"	"$2,612.77"	$0.00	$0.00	$733.63	$0.00	$0.00	$0.00	$0.00	"$1,760.15"	"$2,788.08"	"$2,816.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62111	SUP	Custom 27803010		62111  -  DURA 62111 SUBSTITUTE DUREPAIR 1X1IN NCE	BOTH IP/OP	$392.45 	$290.41	$0.00	$313.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$291.28	$291.28	$0.00	$0.00	$81.79	$0.00	$0.00	$0.00	$0.00	$196.23	$310.82	$313.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62158	SUP	Custom 27803010		62158  -  DURA 62158 SUBSTITUTE DUREPAIR 5X8IN NCE	BOTH IP/OP	"$8,742.00 "	"$6,469.08"	$0.00	"$6,993.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,821.83"	$0.00	$0.00	$0.00	$0.00	"$4,371.00"	"$6,923.66"	"$6,993.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
64018	SUP	HCPCS C1729		064018  -  CATHETER NEPHROSTOMY 18FR 2 EYE DRAIN LATEX PEZZER STERILE	BOTH IP/OP	$43.23 	$31.99	$0.00	$34.58	$23.47	$23.47	$0.00	$0.00	$0.00	$9.01	$32.08	$32.08	$0.00	$0.00	$9.01	$0.00	$25.57	$25.57	$0.00	$21.61	$34.24	$34.58	$0.00		$0.00	$6.76	$0.00	$0.00	$6.88	$0.00	$0.00	$0.00	$0.00	$0.00
64024	SUP	HCPCS C1729		064024  -  CATH NPHSTM 24FR PEZ DRAIN 2 EYE STRL LATEX DISP	BOTH IP/OP	$43.23 	$31.99	$0.00	$34.58	$23.47	$23.47	$0.00	$0.00	$0.00	$9.01	$32.08	$32.08	$0.00	$0.00	$9.01	$0.00	$25.57	$25.57	$0.00	$21.61	$34.24	$34.58	$0.00		$0.00	$6.76	$0.00	$0.00	$6.88	$0.00	$0.00	$0.00	$0.00	$0.00
64026	SUP	HCPCS C1729		064026  -  CATH NPHSTM 26FR PEZ DRAIN 2 EYE STRL LATEX DISP	BOTH IP/OP	$43.23 	$31.99	$0.00	$34.58	$23.47	$23.47	$0.00	$0.00	$0.00	$9.01	$32.08	$32.08	$0.00	$0.00	$9.01	$0.00	$25.57	$25.57	$0.00	$21.61	$34.24	$34.58	$0.00		$0.00	$6.76	$0.00	$0.00	$6.88	$0.00	$0.00	$0.00	$0.00	$0.00
64030	SUP	HCPCS C1729		064030  -  CATHETER NEPHROSTOMY 30FR 2 EYE DRAIN LATEX PEZZER STERILE	BOTH IP/OP	$43.23 	$31.99	$0.00	$34.58	$23.47	$23.47	$0.00	$0.00	$0.00	$9.01	$32.08	$32.08	$0.00	$0.00	$9.01	$0.00	$25.57	$25.57	$0.00	$21.61	$34.24	$34.58	$0.00		$0.00	$6.76	$0.00	$0.00	$6.88	$0.00	$0.00	$0.00	$0.00	$0.00
64036	SUP	HCPCS C1729		064036  -  CATHETER URTH 36FR STRL LTX PEZ 2 EYE DRN PROPORTIONATE HD	BOTH IP/OP	$2.84 	$2.10	$0.00	$2.27	$1.54	$1.54	$0.00	$0.00	$0.00	$0.59	$2.11	$2.11	$0.00	$0.00	$0.59	$0.00	$1.68	$1.68	$0.00	$1.42	$2.25	$2.27	$0.00		$0.00	$0.44	$0.00	$0.00	$0.45	$0.00	$0.00	$0.00	$0.00	$0.00
64331	SUP	Custom 27203010		BRACE ORTH LEFT ANKL FT SWED AFO PE FRDM MALE	BOTH IP/OP	$76.88 	$56.89	$0.00	$61.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.44	$60.89	$61.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
67910	SUP	Custom 27203010		0067910  -  BRUSH FEMORAL CANAL SUCTION IRRIGATION LATEX SIMPULSE PLUS	BOTH IP/OP	$165.48 	$122.46	$0.00	$122.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.82	$122.82	$0.00	$0.00	$34.49	$0.00	$0.00	$0.00	$0.00	$46.53	$73.70	$74.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68128	SUP	Custom 27203010		68128  -  CANNULA PERFUSION 3/8IN CONCTR 28FR 12-15IN 1 STAGE MALBLE	BOTH IP/OP	$786.79 	$582.22	$0.00	$717.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$583.95	$583.95	$0.00	$0.00	$163.97	$0.00	$0.00	$0.00	$0.00	$448.63	$710.62	$717.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68250	SUP	Custom 27803010		68250  -  GRAFT SFT TIS 1.5X1.5CM TTPLST PRICRD ALGRF PRC STRL	BOTH IP/OP	$637.50 	$471.75	$0.00	$510.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$473.15	$473.15	$0.00	$0.00	$132.86	$0.00	$0.00	$0.00	$0.00	$318.75	$504.90	$510.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68333	SUP	Custom 27803010		68333  -  GRAFT SFT TIS .8X.5CM STRL TTPLST LOPRFL SCLR	BOTH IP/OP	$725.00 	$536.50	$0.00	$580.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$0.00	$0.00	$0.00	$362.50	$574.20	$580.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70011	SUP	HCPCS C2625		70011  -  STENT NSL 370 MCG PROPEL MOMETASONE FUROATE	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,850.00"	"$1,040.63"	"$1,040.63"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,156.25"	"$1,831.50"	"$1,850.00"	$0.00		$0.00	$361.91	$0.00	$0.00	$368.15	$0.00	$0.00	$0.00	$0.00	$0.00
71221	SUP	Custom 27803010		71221  -  CAGE SPNL STD 12MM 21MM RYTFC THRD CNCT TI PLIF	BOTH IP/OP	"$7,087.75 "	"$5,244.94"	$0.00	"$5,670.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,477.09"	$0.00	$0.00	$0.00	$0.00	"$3,543.88"	"$5,613.50"	"$5,670.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71226	SUP	Custom 27803010		71226  -  CAGE SPNL STD 12MM 26MM RYTFC THRD CNCT TI PLIF	BOTH IP/OP	"$7,087.75 "	"$5,244.94"	$0.00	"$5,670.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,477.09"	$0.00	$0.00	$0.00	$0.00	"$3,543.88"	"$5,613.50"	"$5,670.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71310	SUP	Custom 27203010		TRAY SPCLA BLK UNV CHRGR	BOTH IP/OP	$69.05 	$51.10	$0.00	$55.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.53	$54.69	$55.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71421	SUP	Custom 27803010		71421  -  CAGE SPNL STD 14MM 21MM RYTFC THRD CNCT TI PLIF	BOTH IP/OP	"$7,087.75 "	"$5,244.94"	$0.00	"$5,670.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,477.09"	$0.00	$0.00	$0.00	$0.00	"$3,543.88"	"$5,613.50"	"$5,670.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71426	SUP	Custom 27803010		71426  -  CAGE SPNL STD 14MM 26MM RYTFC THRD CNCT TI PLIF	BOTH IP/OP	"$7,087.75 "	"$5,244.94"	$0.00	"$5,670.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,477.09"	$0.00	$0.00	$0.00	$0.00	"$3,543.88"	"$5,613.50"	"$5,670.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71621	SUP	Custom 27803010		71621  -  CAGE SPNL STD 16MM 21MM RYTFC THRD CNCT TI PLIF	BOTH IP/OP	"$7,087.75 "	"$5,244.94"	$0.00	"$5,670.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,477.09"	$0.00	$0.00	$0.00	$0.00	"$3,543.88"	"$5,613.50"	"$5,670.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71626	SUP	Custom 27803010		71626  -  CAGE SPNL STD 16MM 26MM RYTFC THRD CNCT TI PLIF	BOTH IP/OP	"$7,087.75 "	"$5,244.94"	$0.00	"$5,670.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,477.09"	$0.00	$0.00	$0.00	$0.00	"$3,543.88"	"$5,613.50"	"$5,670.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71821	SUP	Custom 27803010		71821  -  CAGE SPNL STD 18MM 21MM RYTFC THRD CNCT TI PLIF	BOTH IP/OP	"$7,087.75 "	"$5,244.94"	$0.00	"$5,670.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,477.09"	$0.00	$0.00	$0.00	$0.00	"$3,543.88"	"$5,613.50"	"$5,670.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71826	SUP	Custom 27803010		71826  -  CAGE SPNL STD 18MM 26MM RYTFC THRD CNCT TI PLIF	BOTH IP/OP	"$7,087.75 "	"$5,244.94"	$0.00	"$5,670.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,477.09"	$0.00	$0.00	$0.00	$0.00	"$3,543.88"	"$5,613.50"	"$5,670.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72026	SUP	Custom 27803010		72026  -  CAGE SPNL STD 20MM 26MM RYTFC THRD CNCT TI PLIF	BOTH IP/OP	"$6,615.95 "	"$4,895.80"	$0.00	"$5,292.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,378.76"	$0.00	$0.00	$0.00	$0.00	"$3,307.98"	"$5,239.83"	"$5,292.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72228	SUP	Custom 27203010		72228  -  DRAIN INCISION FULL FLUTE ROUND 15FR 3/16IN CHANNEL RADIOPQ	BOTH IP/OP	$34.44 	$25.49	$0.00	$27.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.56	$25.56	$0.00	$0.00	$7.18	$0.00	$0.00	$0.00	$0.00	$17.22	$27.28	$27.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72230	SUP	Custom 27203010		072230  -  DRAIN 19FR HUBLESS FULL FLUTED	BOTH IP/OP	$43.68 	$32.32	$0.00	$34.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.42	$32.42	$0.00	$0.00	$9.10	$0.00	$0.00	$0.00	$0.00	$21.84	$34.59	$34.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72335	SUP	Custom 27203010		72335  -  SPLINT ORTHOPEDIC LP 35X3IN PRECUT PAD WATER REPELLENT LATEX	BOTH IP/OP	$23.68 	$17.52	$0.00	$32.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.57	$17.57	$0.00	$0.00	$4.93	$0.00	$0.00	$0.00	$0.00	$12.02	$32.08	$19.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72430	SUP	Custom 27203010		72430  -  SPLINT ORTH 30X4IN CNFRM PCUT FELT PD HPOAL H2O RPLNT FBGLS	BOTH IP/OP	$26.74 	$19.79	$0.00	$21.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.37	$21.18	$21.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72495	SUP	Custom 27203010		CONTROL ANTI HAV IGM MONOLISA EIA IMMUN	BOTH IP/OP	"$1,612.50 "	"$1,193.25"	$0.00	"$1,290.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$806.25	"$1,277.10"	"$1,290.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72496	SUP	Custom 27203010		CONTROL ANTI-HAV IGM IGG HAV MONOLISA EIA 192 TST IMMUN	BOTH IP/OP	"$1,387.50 "	"$1,026.75"	$0.00	"$1,110.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$693.75	"$1,098.90"	"$1,110.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72530	SUP	Custom 27203010		72530  -  SPLINT ORTH 30X5IN PCUT FELT PD FBGLS SCTCHCST CNFRM	BOTH IP/OP	$31.37 	$23.21	$0.00	$25.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.28	$23.28	$0.00	$0.00	$6.54	$0.00	$0.00	$0.00	$0.00	$15.69	$24.85	$25.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75000	SUP	HCPCS C1726		075000  -  SET DILAT 30CM 6-30FR AMPTZ RNL TFE 16CM	BOTH IP/OP	$495.85 	$366.93	$0.00	$396.68	$269.25	$269.25	$0.00	$0.00	$0.00	$103.35	$368.02	$368.02	$0.00	$0.00	$103.34	$0.00	$293.30	$293.30	$0.00	$247.93	$392.71	$396.68	$0.00		$0.00	$77.60	$0.00	$0.00	$78.94	$0.00	$0.00	$0.00	$0.00	$0.00
76430	SUP	Custom 27203010		76430  -  SPLINT ORTHOPEDIC 30X4IN CONFORMABLE MOLDABLE LIGHTWEIGHT 3M	BOTH IP/OP	$72.14 	$53.38	$0.00	$53.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.54	$53.54	$0.00	$0.00	$15.03	$0.00	$0.00	$0.00	$0.00	$14.11	$37.46	$22.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
78710	SUP	HCPCS C1713		SPACER MDI ARCHB+ MED VLV HLD CHMBR HNDHLD CMFSL MASK PED	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$18.81	$18.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
78810	SUP	Custom 27203010		TRANSILLUMINATOR EXAM TRNSFM ON/OFF SWH LF DISP KLNSPC VAG	BOTH IP/OP	$326.83 	$241.85	$0.00	$261.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.41	$258.85	$261.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79910	SUP	Custom 27203010		TRANSILLUMINATOR EXAM CRDLS CHRG STTN DISP KLNSPC VAG SPCLM	BOTH IP/OP	$461.70 	$341.66	$0.00	$369.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.85	$365.67	$369.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80010	SUP	Custom 27803010		80010  -  IMPLANT ORBTL 18MM SPHERE SMOOTH SUTURE TUNNELS POROUS	BOTH IP/OP	"$1,630.13 "	"$1,206.30"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,209.88"	"$1,209.88"	$0.00	$0.00	$339.72	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80018	SUP	Custom 27203010		80018  -  IMPLANT ORBTL 18MM CONICAL MULTPUR SMOOTH SUTURE TUNNELS	BOTH IP/OP	"$1,912.50 "	"$1,415.25"	$0.00	"$1,530.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,419.46"	"$1,419.46"	$0.00	$0.00	$398.57	$0.00	$0.00	$0.00	$0.00	$956.25	"$1,514.70"	"$1,530.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80022	SUP	Custom 27803010		80022  -  QUAD MOTILITY IMPLANT - EXTRA LARGE (APPROX. 22MM VOLUME)	BOTH IP/OP	"$1,188.06 "	$879.16	$0.00	$950.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.78	$881.78	$0.00	$0.00	$247.59	$0.00	$0.00	$0.00	$0.00	$594.03	$940.94	$950.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80026	SUP	Custom 27803010		80026  -  IMPLANT ORBTL CONICAL CONICAL FLAT ANTERIOR SURFACE CHANNELS	BOTH IP/OP	"$1,188.06 "	$879.16	$0.00	$950.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.78	$881.78	$0.00	$0.00	$247.59	$0.00	$0.00	$0.00	$0.00	$594.03	$940.94	$950.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80036	SUP	Custom 27803010		80036  -  SPHERE EYE 16MM MDPR+	BOTH IP/OP	"$1,277.20 "	$945.13	$0.00	"$1,021.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$947.94	$947.94	$0.00	$0.00	$266.17	$0.00	$0.00	$0.00	$0.00	$638.60	"$1,011.54"	"$1,021.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80038	SUP	Custom 27803010		80038  -  IMPLANT ORBTL STANDARD SPHERE 18MM MEDPOR PLUS BIOACTIVE	BOTH IP/OP	"$1,742.50 "	"$1,289.45"	$0.00	"$1,394.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,293.28"	"$1,293.28"	$0.00	$0.00	$363.14	$0.00	$0.00	$0.00	$0.00	$871.25	"$1,380.06"	"$1,394.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80040	SUP	Custom 27803010		80040  -  SPHERE EYE 20MM MDPR+	BOTH IP/OP	"$1,277.20 "	$945.13	$0.00	"$1,021.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$947.94	$947.94	$0.00	$0.00	$266.17	$0.00	$0.00	$0.00	$0.00	$638.60	"$1,011.54"	"$1,021.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80042	SUP	Custom 27803010		80042  -  MEDPOR PLUS - 22MM	BOTH IP/OP	"$1,277.20 "	$945.13	$0.00	"$1,021.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$947.94	$947.94	$0.00	$0.00	$266.17	$0.00	$0.00	$0.00	$0.00	$638.60	"$1,011.54"	"$1,021.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80046	SUP	Custom 27803010		80046  -  MEDPOR PLUS SST - 16MM	BOTH IP/OP	"$1,483.20 "	"$1,097.57"	$0.00	"$1,186.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,100.83"	"$1,100.83"	$0.00	$0.00	$309.10	$0.00	$0.00	$0.00	$0.00	$741.60	"$1,174.69"	"$1,186.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80048	SUP	Custom 27803010		80048  -  MEDPOR PLUS SST - 18MM	BOTH IP/OP	$26.00 	$19.24	$0.00	"$1,174.69"	$15.07	$15.07	$8.46	$8.46	$4.23	$4.23	$12.85	$12.85	$12.36	$8.46	$12.52	$5.50	$0.00	$0.00	$8.88	$23.66	"$1,174.69"	$24.00	$12.27		$12.27	$0.00	$8.46	$8.46	$9.34	$8.46	$0.00	$0.00	$0.00	$0.00
80050	SUP	Custom 27803010		80050  -  MEDPOR PLUS SST - 20MM	BOTH IP/OP	"$1,483.20 "	"$1,097.57"	$0.00	"$1,186.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,100.83"	"$1,100.83"	$0.00	$0.00	$309.10	$0.00	$0.00	$0.00	$0.00	$741.60	"$1,174.69"	"$1,186.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80052	SUP	Custom 27803010		80052  -  KIT RETRIEVER 18MM 20X4MM 32MM MICROCATHETER FLEXCELL TREVO	BOTH IP/OP	"$13,641.25 "	"$10,094.53"	$0.00	"$10,913.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,842.84"	$0.00	$0.00	$0.00	$0.00	"$6,820.63"	"$10,803.87"	"$10,913.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80056	SUP	Custom 27803010		80056  -  MEDPOR PLUS SST EZ - 16MM	BOTH IP/OP	"$1,483.20 "	"$1,097.57"	$0.00	"$1,186.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,100.83"	"$1,100.83"	$0.00	$0.00	$309.10	$0.00	$0.00	$0.00	$0.00	$741.60	"$1,174.69"	"$1,186.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80058	SUP	Custom 27803010		80058  -  SPHERE EYE 18MM SST EZ	BOTH IP/OP	"$1,483.20 "	"$1,097.57"	$0.00	"$1,186.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,100.83"	"$1,100.83"	$0.00	$0.00	$309.10	$0.00	$0.00	$0.00	$0.00	$741.60	"$1,174.69"	"$1,186.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80060	SUP	Custom 27803010		80060  -  MEDPOR PLUS SST EZ - 20MM	BOTH IP/OP	"$1,483.20 "	"$1,097.57"	$0.00	"$1,186.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,100.83"	"$1,100.83"	$0.00	$0.00	$309.10	$0.00	$0.00	$0.00	$0.00	$741.60	"$1,174.69"	"$1,186.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80062	SUP	Custom 27803010		80062  -  IMPLANT ORBTL ROUND 22MM SPHERE SMOOTH SURFACE SUTURE	BOTH IP/OP	"$2,052.50 "	"$1,518.85"	$0.00	"$1,642.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,523.37"	"$1,523.37"	$0.00	$0.00	$427.74	$0.00	$0.00	$0.00	$0.00	"$1,026.25"	"$1,625.58"	"$1,642.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80400	SUP	HCPCS C1751		0080400  -  DRAIN INCISION 15X5/8IN 3 LUMEN ANTIBACTERIAL FILTER SUMP	BOTH IP/OP	$55.90 	$41.37	$0.00	$44.72	$30.35	$30.35	$0.00	$0.00	$0.00	$11.65	$41.49	$41.49	$0.00	$0.00	$11.65	$0.00	$33.06	$33.06	$0.00	$27.95	$44.27	$44.72	$0.00		$0.00	$8.75	$0.00	$0.00	$8.90	$0.00	$0.00	$0.00	$0.00	$0.00
80710	SUP	HCPCS C1713		SPACER MDI ARCHB+ LG VLV HLD CHMBR HNDHLD CMFSL MASK PED	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$14.63	$14.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$5.09	$0.00	$0.00	$5.17	$0.00	$0.00	$0.00	$0.00	$0.00
81001	SUP	Custom 27803010		81001  -  IMPLANT ORBT 40X40X8.45MM STRL MDPR ONLAY PE POR LT CRNMXF	BOTH IP/OP	$10.00 	$7.40	$0.00	"$1,536.48"	$5.65	$5.65	$3.17	$3.17	$1.59	$1.58	$4.82	$4.82	$4.63	$3.17	$4.68	$2.06	$0.00	$0.00	$3.33	$8.86	"$1,536.48"	$8.80	$4.60		$4.60	$4.99	$3.17	$3.17	$3.49	$3.17	$0.00	$0.00	$0.00	$0.00
81002	SUP	Custom 27803010		81002  -  GRAFT SYNTH TISSUE 40X40MM ONLAY MEDPOR POLYETHYLENE POROUS	BOTH IP/OP	"$1,371.58 "	"$1,014.97"	$0.00	"$1,552.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,017.98"	"$1,017.98"	$0.00	$0.00	$285.84	$0.00	$0.00	$0.00	$0.00	$970.00	"$1,536.48"	"$1,552.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81007	SUP	Custom 27803010		81007  -  GRAFT SYNTH TISSUE 33X45MM IMPLANT POROUS MEDPOR	BOTH IP/OP	"$1,387.50 "	"$1,026.75"	$0.00	"$1,110.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,029.80"	"$1,029.80"	$0.00	$0.00	$289.16	$0.00	$0.00	$0.00	$0.00	$693.75	"$1,098.90"	"$1,110.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81008	SUP	Custom 27803010		81008  -  GRAFT SYNTH TISSUE 45X33MM IMPLANT POROUS MEDPOR	BOTH IP/OP	"$1,387.50 "	"$1,026.75"	$0.00	"$1,110.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,029.80"	"$1,029.80"	$0.00	$0.00	$289.16	$0.00	$0.00	$0.00	$0.00	$693.75	"$1,098.90"	"$1,110.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81013	SUP	Custom 27803010		81013  -  GRAFT SYNTH TISSUE 30MM 38X33X.8MM IMPLANT ORBITO-ZYGOMATIC	BOTH IP/OP	"$1,984.15 "	"$1,468.27"	$0.00	"$2,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,472.64"	"$1,472.64"	$0.00	$0.00	$413.50	$0.00	$0.00	$0.00	$0.00	"$1,520.00"	"$2,407.68"	"$2,432.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81014	SUP	Custom 27803010		81014  -  IMPLANT ORBT 38X33X.8MM TRM OFF THE SHLF MDPR RT	BOTH IP/OP	"$1,984.15 "	"$1,468.27"	$0.00	"$2,432.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,472.64"	"$1,472.64"	$0.00	$0.00	$413.50	$0.00	$0.00	$0.00	$0.00	"$1,520.00"	"$2,407.68"	"$2,432.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81020	SUP	Custom 27803010		81020  -  MESH CRANIAL 76X50X.85MM EMBED SHEET MEDPOR TITAN MEDPOR	BOTH IP/OP	"$2,677.50 "	"$1,981.35"	$0.00	"$2,962.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,987.24"	"$1,987.24"	$0.00	$0.00	$557.99	$0.00	$0.00	$0.00	$0.00	"$1,851.25"	"$2,932.38"	"$2,962.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81021	SUP	Custom 27803010		81021  -  PLATE BONE 38X50X.85MM MESH EMBEDDED POROUS MEDPOR TITAN MTM	BOTH IP/OP	"$1,958.10 "	"$1,448.99"	$0.00	"$2,370.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,453.30"	"$1,453.30"	$0.00	$0.00	$408.07	$0.00	$0.00	$0.00	$0.00	"$1,481.25"	"$2,346.30"	"$2,370.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81022	SUP	Custom 27803010		81022  -  PLATE BONE 38X50X1.5MM MESH EMBEDDED POROUS MEDPOR TITAN MTM	BOTH IP/OP	"$1,958.10 "	"$1,448.99"	$0.00	"$2,370.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,453.30"	"$1,453.30"	$0.00	$0.00	$408.07	$0.00	$0.00	$0.00	$0.00	"$1,481.25"	"$2,346.30"	"$2,370.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81023	SUP	Custom 27803010		81023  -  PLATE BONE 76X50X1.5MM MESH EMBEDDED POROUS MEDPOR TITAN MTM	BOTH IP/OP	"$2,447.23 "	"$1,810.95"	$0.00	"$2,962.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,816.33"	"$1,816.33"	$0.00	$0.00	$510.00	$0.00	$0.00	$0.00	$0.00	"$1,851.25"	"$2,932.38"	"$2,962.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81024	SUP	Custom 27803010		81024  -  PLATE BONE 38X50X.6MM MESH EMBEDDED NONPOROUS BARRIER	BOTH IP/OP	"$2,301.50 "	"$1,703.11"	$0.00	"$2,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.17"	"$1,708.17"	$0.00	$0.00	$479.63	$0.00	$0.00	$0.00	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81025	SUP	Custom 27803010		81025  -  MESH CRANIAL 76X50X.6MM EMBED SHEET MEDPOR TITAN BARRIER	BOTH IP/OP	$26.00 	$19.24	$0.00	"$3,346.20"	$11.26	$11.26	$8.61	$8.61	$4.31	$3.87	$9.61	$9.61	$9.24	$8.61	$9.36	$5.60	$0.00	$0.00	$9.04	$17.68	"$3,346.20"	$24.00	$12.48		$12.48	$9.97	$8.61	$8.61	$6.98	$8.61	$0.00	$0.00	$0.00	$0.00
81026	SUP	Custom 27803010		81026  -  MESH CRANIAL 38X50X1MM EMBED SHEET SOLID MEDPOR TITAN DOUBLE	BOTH IP/OP	"$2,301.50 "	"$1,703.11"	$0.00	"$2,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.17"	"$1,708.17"	$0.00	$0.00	$479.63	$0.00	$0.00	$0.00	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81027	SUP	Custom 27803010		81027  -  MESH CRANIAL 76X50X1MM EMBED SHEET SOLID MEDPOR TITAN DOUBLE	BOTH IP/OP	"$2,790.63 "	"$2,065.07"	$0.00	"$3,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,071.20"	"$2,071.20"	$0.00	$0.00	$581.57	$0.00	$0.00	$0.00	$0.00	"$2,112.50"	"$3,346.20"	"$3,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81028	SUP	Custom 27803010		81028  -  PLATE BONE 50X38X1.6MM SHEET SOLID SURFACE MTB POLYETHYLENE	BOTH IP/OP	"$2,301.50 "	"$1,703.11"	$0.00	"$2,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.17"	"$1,708.17"	$0.00	$0.00	$479.63	$0.00	$0.00	$0.00	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81029	SUP	Custom 27803010		81029  -  PLATE BONE 76X50X1.6MM MESH EMBEDDED NONPOROUS BARRIER	BOTH IP/OP	"$2,790.63 "	"$2,065.07"	$0.00	"$3,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,071.20"	"$2,071.20"	$0.00	$0.00	$581.57	$0.00	$0.00	$0.00	$0.00	"$2,112.50"	"$3,346.20"	"$3,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81030	SUP	Custom 27803010		81030  -  GRAFT SYNTH TISSUE 41X42X.85MM MESH EMBED MEDPOR TITAN	BOTH IP/OP	"$2,099.93 "	"$1,553.95"	$0.00	"$2,324.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,558.56"	"$1,558.56"	$0.00	$0.00	$437.62	$0.00	$0.00	$0.00	$0.00	"$1,452.50"	"$2,300.76"	"$2,324.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81031	SUP	Custom 27803010		81031  -  PLATE BN 42X41X1MM STRL MDPR TN MTB MESH EMBED XTN TI PE	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$2,734.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	$0.00	$0.00	$0.00	"$1,708.75"	"$2,706.66"	"$2,734.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81032	SUP	Custom 27803010		81032  -  PLATE BONE 42X41X1MM MESH EMBED EXTN MEDPOR TITAN MTB	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$2,734.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	$0.00	$0.00	$0.00	"$1,708.75"	"$2,706.66"	"$2,734.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81033	SUP	Custom 27803010		81033  -  PLATE BONE 42X41X.6MM MESH EMBED EXTN MEDPOR TITAN DOUBLE	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$2,734.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	$0.00	$0.00	$0.00	"$1,708.75"	"$2,706.66"	"$2,734.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81034	SUP	Custom 27803010		81034  -  GRAFT SYNTH TISSUE 41X42X.85MM MESH EMBED MEDPOR TITAN MAX	BOTH IP/OP	"$2,099.93 "	"$1,553.95"	$0.00	"$2,324.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,558.56"	"$1,558.56"	$0.00	$0.00	$437.62	$0.00	$0.00	$0.00	$0.00	"$1,452.50"	"$2,300.76"	"$2,324.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81035	SUP	Custom 27803010		81035  -  PLATE BONE 42X41X1MM MESH EMBED EXTN MEDPOR TITAN BARRIER	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$2,734.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	$0.00	$0.00	$0.00	"$1,708.75"	"$2,706.66"	"$2,734.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81036	SUP	Custom 27803010		81036  -  PLATE BONE THK1MM 42X41X1MM MESH EMBEDDED EXTENSIONS POROUS	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$2,734.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	$0.00	$0.00	$0.00	"$1,708.75"	"$2,706.66"	"$2,734.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81037	SUP	Custom 27803010		81037  -  PLATE BONE THIN PROFILE 130X130X3MM RADIOPQ MEDPOR TITANIUM	BOTH IP/OP	"$15,775.50 "	"$11,673.87"	$0.00	"$20,298.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,287.61"	$0.00	$0.00	$0.00	$0.00	"$12,686.25"	"$20,095.02"	"$20,298.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81038	SUP	Custom 27803010		81038  -  PLATE BONE 130X130X3MM MESH EMBEDDED POROUS MEDPOR TITAN	BOTH IP/OP	"$15,775.50 "	"$11,673.87"	$0.00	"$20,298.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,287.61"	$0.00	$0.00	$0.00	$0.00	"$12,686.25"	"$20,095.02"	"$20,298.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81040	SUP	Custom 27803010		81040  -  PLATE BONE 76X100X1.5MM MESH EMBEDDED SHEET POROUS MEDPOR	BOTH IP/OP	"$5,756.90 "	"$4,260.11"	$0.00	"$6,514.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,199.74"	$0.00	$0.00	$0.00	$0.00	"$4,071.25"	"$6,448.86"	"$6,514.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81050	SUP	HCPCS C1713		81050  -  PLATE BONE FAN MTB CRANFCL	BOTH IP/OP	"$2,546.25 "	"$1,884.23"	$0.00	"$2,874.00"	"$1,616.63"	"$1,616.63"	$0.00	$0.00	$0.00	$530.70	"$1,889.83"	"$1,889.83"	$0.00	$0.00	$530.64	$0.00	"$1,255.30"	"$1,255.30"	$0.00	"$1,796.25"	"$2,845.26"	"$2,874.00"	$0.00		$0.00	$562.23	$0.00	$0.00	$571.93	$0.00	$0.00	$0.00	$0.00	$0.00
81060	SUP	Custom 27803010		81060  -  IMPLANT MANDIB 30X15X.25MM BIOCOMPATIBLE SPACE MAINTENANCE	BOTH IP/OP	$477.50 	$353.35	$0.00	$382.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.40	$354.40	$0.00	$0.00	$99.51	$0.00	$0.00	$0.00	$0.00	$238.75	$378.18	$382.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81061	SUP	Custom 27803010		81061  -  IMPLANT MANDIB 30X25X.25MM BIOCOMPATIBLE SPACE MAINTENANCE	BOTH IP/OP	$720.00 	$532.80	$0.00	$576.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$534.38	$534.38	$0.00	$0.00	$150.05	$0.00	$0.00	$0.00	$0.00	$360.00	$570.24	$576.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81062	SUP	Custom 27803010		81062  -  GRAFT SYNTH TISSUE ULTRATHIN 35X45X.25IN SHEET CONTAINMENT	BOTH IP/OP	$957.50 	$708.55	$0.00	$766.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$710.66	$710.66	$0.00	$0.00	$199.54	$0.00	$0.00	$0.00	$0.00	$478.75	$758.34	$766.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81063	SUP	Custom 27803010		81063  -  IMPLANT MANDIB 30X15X.35MM BIOCOMPATIBLE SPACE MAINTENANCE	BOTH IP/OP	$348.43 	$257.84	$0.00	$382.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.60	$258.60	$0.00	$0.00	$72.61	$0.00	$0.00	$0.00	$0.00	$238.75	$378.18	$382.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81064	SUP	Custom 27803010		81064  -  IMPLANT MANDIB 30X25X.35MM BIOCOMPATIBLE SPACE MAINTENANCE	BOTH IP/OP	$527.45 	$390.31	$0.00	$576.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$391.47	$391.47	$0.00	$0.00	$109.92	$0.00	$0.00	$0.00	$0.00	$360.00	$570.24	$576.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81065	SUP	Custom 27803010		81065  -  IMPLANT MANDIB 45X35X.35MM BIOCOMPATIBLE SPACE MAINTENANCE	BOTH IP/OP	$702.63 	$519.95	$0.00	$766.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$521.49	$521.49	$0.00	$0.00	$146.43	$0.00	$0.00	$0.00	$0.00	$478.75	$758.34	$766.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81066	SUP	Custom 27803010		81066  -  IMPLANT MANDIB 30X15X.45MM BIOCOMPATIBLE SPACE MAINTENANCE	BOTH IP/OP	$477.50 	$353.35	$0.00	$382.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.40	$354.40	$0.00	$0.00	$99.51	$0.00	$0.00	$0.00	$0.00	$238.75	$378.18	$382.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81067	SUP	Custom 27803010		81067  -  IMPLANT MANDIB 30X25X.45MM BIOCOMPATIBLE SPACE MAINTENANCE	BOTH IP/OP	$526.88 	$389.89	$0.00	$576.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$391.05	$391.05	$0.00	$0.00	$109.80	$0.00	$0.00	$0.00	$0.00	$360.00	$570.24	$576.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81068	SUP	Custom 27803010		81068  -  IMPLANT MANDIB 35X45X.45MM BIOCOMPATIBLE SPACE MAINTENANCE	BOTH IP/OP	$701.25 	$518.93	$0.00	$766.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$520.47	$520.47	$0.00	$0.00	$146.14	$0.00	$0.00	$0.00	$0.00	$478.75	$758.34	$766.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81200	SUP	Custom 27803010		81200  -  ROD SPNL 5.5MM 50MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81201	SUP	Custom 27803010		81201  -  ROD SPNL 5.5MM 60MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81202	SUP	Custom 27803010		81202  -  ROD SPNL 5.5MM 70MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81203	SUP	Custom 27803010		81203  -  ROD SPNL 5.5MM 80MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81204	SUP	Custom 27803010		81204  -  ROD SPNL 5.5MM 90MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81205	SUP	Custom 27803010		81205  -  ROD SPNL 5.5MM 100MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81206	SUP	Custom 27803010		81206  -  ROD SPNL 5.5MM 110MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81207	SUP	Custom 27803010		81207  -  ROD SPNL 5.5MM 120MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81208	SUP	Custom 27803010		81208  -  ROD SPNL 5.5MM 140MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81210	SUP	Custom 27803010		81210  -  ROD SPNL 5.5MM 160MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81211	SUP	Custom 27803010		81211  -  ROD SPNL 5.5MM 180MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81212	SUP	Custom 27803010		81212  -  ROD SPNL 5.5MM 220MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81213	SUP	Custom 27803010		81213  -  ROD SPNL 5.5MM 240MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81214	SUP	Custom 27803010		81214  -  ROD SPNL 5.5MM 260MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81215	SUP	Custom 27803010		81215  -  ROD SPNL 5.5MM 280MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81216	SUP	Custom 27803010		81216  -  ROD SPNL 5.5MM 300MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81217	SUP	Custom 27803010		81217  -  ROD SPNL 5.5MM 320MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81218	SUP	Custom 27803010		81218  -  ROD SPNL 5.5MM 340MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81219	SUP	Custom 27803010		81219  -  ROD SPNL 5.5MM 360MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81220	SUP	Custom 27803010		81220  -  ROD SPNL 5.5MM 380MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81906	SUP	Custom 27203010		REAGENT SBSTR ACCES 130ML ANALY	BOTH IP/OP	$461.25 	$341.33	$0.00	$369.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.63	$365.31	$369.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81908	SUP	Custom 27203010		REAGENT SMPL DILU A ANALY	BOTH IP/OP	$74.83 	$55.37	$0.00	$59.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.41	$59.27	$59.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81910	SUP	Custom 27203010		REAGENT SYS CHK SOL ACCES 4ML ANALY	BOTH IP/OP	$95.33 	$70.54	$0.00	$76.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.66	$75.50	$76.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82000	SUP	Custom 27803010		82000  -  GRAFT SYNTH TISSUE THK4MM HEMISPHERE CNTOUR POROUS MEDPOR	BOTH IP/OP	"$14,542.50 "	"$10,761.45"	$0.00	"$11,634.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,271.25"	"$11,517.66"	"$11,634.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82001	SUP	Custom 27803010		82001  -  GRAFT SYNTH TISSUE HEMISPHERE 170X124X4.5MM OFF THE SHELF	BOTH IP/OP	"$8,921.60 "	"$6,601.98"	$0.00	"$11,634.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,859.26"	$0.00	$0.00	$0.00	$0.00	"$7,271.25"	"$11,517.66"	"$11,634.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82006	SUP	Custom 27803010		82006  -  GRAFT SYNTH TISSUE DOME 180X150X6MM PRESHAPED POROUS MEDPOR	BOTH IP/OP	"$15,460.00 "	"$11,440.40"	$0.00	"$12,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,221.86"	$0.00	$0.00	$0.00	$0.00	"$7,730.00"	"$12,244.32"	"$12,368.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82007	SUP	Custom 27803010		82007  -  GRAFT SNTH TISS LG 20X2.5X2.5MM STRL MDPR TSI TAB NPOR POST	BOTH IP/OP	"$1,108.25 "	$820.11	$0.00	"$1,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$822.54	$822.54	$0.00	$0.00	$230.96	$0.00	$0.00	$0.00	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82008	SUP	Custom 27803010		82008  -  GRAFT SYNTH TISSUE LARGE 40X40X2.5MM .73MM 3 TABS NONPOROUS	BOTH IP/OP	"$1,268.75 "	$938.88	$0.00	"$1,578.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$941.67	$941.67	$0.00	$0.00	$264.41	$0.00	$0.00	$0.00	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82011	SUP	Custom 27803010		82011  -  GRAFT SYNTH TISSUE TRIANGLE 102X3.6X4MM 102X10X6MM IMPLANT	BOTH IP/OP	$672.00 	$497.28	$0.00	$810.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$498.76	$498.76	$0.00	$0.00	$140.04	$0.00	$0.00	$0.00	$0.00	$506.25	$801.90	$810.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82013	SUP	Custom 27803010		82013  -  GRAFT SYNTH TISSUE .6MM V SHAPE 30X10X6MM IMPLANT CRANIOTOMY	BOTH IP/OP	$880.00 	$651.20	$0.00	$810.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$653.14	$653.14	$0.00	$0.00	$183.39	$0.00	$0.00	$0.00	$0.00	$506.25	$801.90	$810.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82014	SUP	Custom 27803010		82014  -  GRAFT SYNTH TISSUE SMALL 36X45X1MM IMPLANT POROUS MEDPOR	BOTH IP/OP	"$1,521.50 "	"$1,125.91"	$0.00	"$1,856.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,129.26"	"$1,129.26"	$0.00	$0.00	$317.08	$0.00	$0.00	$0.00	$0.00	"$1,160.00"	"$1,837.44"	"$1,856.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82015	SUP	Custom 27803010		82015  -  GRAFT SYNTH TISSUE 58X56X1.5MM IMPLANT POROUS MEDPOR	BOTH IP/OP	"$1,974.38 "	"$1,461.04"	$0.00	"$2,566.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,465.38"	"$1,465.38"	$0.00	$0.00	$411.46	$0.00	$0.00	$0.00	$0.00	"$1,603.75"	"$2,540.34"	"$2,566.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82016	SUP	Custom 27803010		82016  -  GRAFT SYNTH TISSUE 58X56X1.5MM IMPLANT POROUS MEDPOR	BOTH IP/OP	"$1,974.38 "	"$1,461.04"	$0.00	"$2,566.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,465.38"	"$1,465.38"	$0.00	$0.00	$411.46	$0.00	$0.00	$0.00	$0.00	"$1,603.75"	"$2,540.34"	"$2,566.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82019	SUP	Custom 27803010		82019  -  PLATE BONE CURVE 48X38X.85MM MESH EMBED PRESHAPE MEDPOR	BOTH IP/OP	"$2,728.38 "	"$2,019.00"	$0.00	"$3,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$568.59	$0.00	$0.00	$0.00	$0.00	"$2,215.00"	"$3,508.56"	"$3,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82020	SUP	Custom 27803010		82020  -  PLATE BONE CURVE 48X38X1MM MESH EMBEDDED PCVD NONPOROUS	BOTH IP/OP	"$2,859.75 "	"$2,116.22"	$0.00	"$4,012.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,122.51"	"$2,122.51"	$0.00	$0.00	$595.97	$0.00	$0.00	$0.00	$0.00	"$2,507.50"	"$3,971.88"	"$4,012.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82022	SUP	Custom 27803010		82022  -  FLEXBLOCK IMPLANT - BARRIER 56MM X 91MM X 4MM	BOTH IP/OP	"$3,712.00 "	"$2,746.88"	$0.00	"$2,969.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,755.05"	"$2,755.05"	$0.00	$0.00	$773.58	$0.00	$0.00	$0.00	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82030	SUP	Custom 27803010		82030  -  PLATE BONE 96X61X1.5MM IMPLANT POROUS MEDPOR TITAN TITANIUM	BOTH IP/OP	"$5,756.83 "	"$4,260.05"	$0.00	"$6,962.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,199.72"	$0.00	$0.00	$0.00	$0.00	"$4,351.25"	"$6,892.38"	"$6,962.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82301	SUP	HCPCS B4088		082301  -  TUBE JJNSTM 60IN 9-18FR PU COMPAT STPT FEED NSL STRL	BOTH IP/OP	$466.09 	$344.91	$0.00	$369.14	$9.90	$9.90	$0.00	$0.00	$0.00	$7.07	$16.33	$16.33	$0.00	$0.00	$3.31	$0.00	$0.00	$0.00	$0.00	$11.00	$369.14	$17.60	$13.20		$13.20	$3.29	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$0.00
83003	SUP	Custom 27803010		83003  -  GRAFT SYNTH TISSUE 47X28X3MM MEDPOR POLYETHYLENE POROUS	BOTH IP/OP	"$1,025.43 "	$758.82	$0.00	"$1,126.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$761.07	$761.07	$0.00	$0.00	$213.70	$0.00	$0.00	$0.00	$0.00	$703.75	"$1,114.74"	"$1,126.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
83004	SUP	Custom 27803010		83004  -  GRAFT SYNTH TISSUE 47X28X3MM MEDPOR POLYETHYLENE POROUS	BOTH IP/OP	"$1,025.43 "	$758.82	$0.00	"$1,126.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$761.07	$761.07	$0.00	$0.00	$213.70	$0.00	$0.00	$0.00	$0.00	$703.75	"$1,114.74"	"$1,126.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
83007	SUP	Custom 27803010		83007  -  GRAFT SNTH TISS 60X40X4MM STRL MDPR IMPL CNTR SHL-TY DSGN	BOTH IP/OP	"$1,025.43 "	$758.82	$0.00	"$1,126.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$761.07	$761.07	$0.00	$0.00	$213.70	$0.00	$0.00	$0.00	$0.00	$703.75	"$1,114.74"	"$1,126.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
83008	SUP	Custom 27803010		83008  -  GRAFT SNTH TISS 60X40MM STRL MDPR IMPL CNTR SHL-TY DSGN POR	BOTH IP/OP	"$1,025.43 "	$758.82	$0.00	"$1,126.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$761.07	$761.07	$0.00	$0.00	$213.70	$0.00	$0.00	$0.00	$0.00	$703.75	"$1,114.74"	"$1,126.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
83020	SUP	Custom 27803010		83020  -  GRAFT SYNTH TISSUE MICROTHIN 38X50X.25MM SHEET POROUS MEDPOR	BOTH IP/OP	$961.35 	$711.40	$0.00	"$1,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$713.51	$713.51	$0.00	$0.00	$200.35	$0.00	$0.00	$0.00	$0.00	$660.00	"$1,045.44"	"$1,056.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
83021	SUP	Custom 27803010		83021  -  GRAFT SYNTH TISSUE MICROTHIN 76X50X.25MM SHEET POROUS MEDPOR	BOTH IP/OP	"$1,777.50 "	"$1,315.35"	$0.00	"$1,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,319.26"	"$1,319.26"	$0.00	$0.00	$370.43	$0.00	$0.00	$0.00	$0.00	$888.75	"$1,407.78"	"$1,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
83022	SUP	Custom 27803010		83022  -  GRAFT SNTH 38X50X.35MM STRL OFF THE SHLF FTHR EDG SMTH TRNS	BOTH IP/OP	$949.03 	$702.28	$0.00	"$1,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$704.37	$704.37	$0.00	$0.00	$197.78	$0.00	$0.00	$0.00	$0.00	$660.00	"$1,045.44"	"$1,056.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
83023	SUP	Custom 27803010		83023  -  GRAFT SYNTH TISSUE MICROTHIN 76X50X.35MM SHEET POROUS MEDPOR	BOTH IP/OP	"$1,777.50 "	"$1,315.35"	$0.00	"$1,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,319.26"	"$1,319.26"	$0.00	$0.00	$370.43	$0.00	$0.00	$0.00	$0.00	$888.75	"$1,407.78"	"$1,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
83029	SUP	Custom 27803010		83029  -  GRAFT SYNTH TISSUE MICROTHIN 50X38X.45MM SHEET POROUS MEDPOR	BOTH IP/OP	$949.03 	$702.28	$0.00	"$1,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$704.37	$704.37	$0.00	$0.00	$197.78	$0.00	$0.00	$0.00	$0.00	$660.00	"$1,045.44"	"$1,056.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
83030	SUP	Custom 27803010		83030  -  GRAFT SYNTH TISSUE MICROTHIN 76X50X.45MM SHEET MEDPOR POROUS	BOTH IP/OP	"$1,276.28 "	$944.45	$0.00	"$1,422.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$947.25	$947.25	$0.00	$0.00	$265.98	$0.00	$0.00	$0.00	$0.00	$888.75	"$1,407.78"	"$1,422.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84000	SUP	Custom 27803010		84000  -  GRAFT SYNTH TISSUE PETITE 45X4X4MM IMPLANT TAPERED PROFILE	BOTH IP/OP	$650.63 	$481.47	$0.00	$750.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.89	$482.89	$0.00	$0.00	$135.59	$0.00	$0.00	$0.00	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84001	SUP	Custom 27803010		84001  -  GRAFT SYNTH TISSUE PETITE 55X4X4MM IMPLANT TAPERED PROFILE	BOTH IP/OP	$650.63 	$481.47	$0.00	$750.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.89	$482.89	$0.00	$0.00	$135.59	$0.00	$0.00	$0.00	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84002	SUP	Custom 27803010		84002  -  GRAFT SYNTH TISSUE PETITE 45X5X5MM IMPLANT TAPERED PROFILE	BOTH IP/OP	$650.63 	$481.47	$0.00	$750.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.89	$482.89	$0.00	$0.00	$135.59	$0.00	$0.00	$0.00	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84003	SUP	Custom 27803010		84003  -  GRAFT SYNTH TISSUE PETITE 55X5X5MM IMPLANT TAPERED PROFILE	BOTH IP/OP	$650.63 	$481.47	$0.00	$750.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.89	$482.89	$0.00	$0.00	$135.59	$0.00	$0.00	$0.00	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84004	SUP	Custom 27803010		84004  -  GRAFT SYNTH TISSUE PETITE 55X9X6MM IMPLANT TAPERED PROFILE	BOTH IP/OP	$650.63 	$481.47	$0.00	$750.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.89	$482.89	$0.00	$0.00	$135.59	$0.00	$0.00	$0.00	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84006	SUP	Custom 27803010		84006  -  IMPLANT FACIAL THIN SHELL NASAL DORSAL	BOTH IP/OP	"$1,130.00 "	$836.20	$0.00	"$1,242.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$838.69	$838.69	$0.00	$0.00	$235.49	$0.00	$0.00	$0.00	$0.00	$776.25	"$1,229.58"	"$1,242.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84008	SUP	Custom 27803010		84008  -  NASAL DARTT IMPLANT - 40M X 4MM X 1.4MM	BOTH IP/OP	$884.00 	$654.16	$0.00	$707.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$656.10	$656.10	$0.00	$0.00	$184.23	$0.00	$0.00	$0.00	$0.00	$442.00	$700.13	$707.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84010	SUP	Custom 27803010		84010  -  IMPLANT FACIAL 37X22X.5MM TIP TOP MEDPOR NASAL	BOTH IP/OP	$900.90 	$666.67	$0.00	$982.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$668.65	$668.65	$0.00	$0.00	$187.75	$0.00	$0.00	$0.00	$0.00	$613.75	$972.18	$982.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84012	SUP	Custom 27803010		84012  -  GRAFT SYNTH TISSUE 41X9X3MM ONLAY POROUS MEDPOR POLYETHYLENE	BOTH IP/OP	$777.43 	$575.30	$0.00	$862.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$577.00	$577.00	$0.00	$0.00	$162.02	$0.00	$0.00	$0.00	$0.00	$538.75	$853.38	$862.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84129	SUP	Custom 27803010		84129  -  GRAFT SYNTH TISSUE SMALL 59X34X19.5MM IMPLANT S-SHAPE 1	BOTH IP/OP	"$4,354.13 "	"$3,222.06"	$0.00	"$4,222.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,231.63"	"$3,231.63"	$0.00	$0.00	$907.40	$0.00	$0.00	$0.00	$0.00	"$2,638.75"	"$4,179.78"	"$4,222.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84130	SUP	Custom 27803010		84130  -  S EAR - SMALL - RIGHT - 59MM X 34MM X 19.5	BOTH IP/OP	"$3,886.00 "	"$2,875.64"	$0.00	"$3,108.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,884.19"	"$2,884.19"	$0.00	$0.00	$809.84	$0.00	$0.00	$0.00	$0.00	"$1,943.00"	"$3,077.71"	"$3,108.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84131	SUP	Custom 27803010		84131  -  PROS OSS MED 62X36X20.5MM LEFT EAR S	BOTH IP/OP	"$3,886.00 "	"$2,875.64"	$0.00	"$3,108.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,884.19"	"$2,884.19"	$0.00	$0.00	$809.84	$0.00	$0.00	$0.00	$0.00	"$1,943.00"	"$3,077.71"	"$3,108.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84132	SUP	Custom 27803010		84132  -  S EAR - MEDIUM - RIGHT - 62MM X 36MM X 20.5MM	BOTH IP/OP	$15.00 	$11.10	$0.00	"$3,108.80"	$0.00	$0.00	$4.76	$4.76	$2.38	$2.30	$6.97	$6.97	$0.00	$4.76	$6.79	$3.09	$0.00	$0.00	$0.00	"$1,943.00"	"$3,077.71"	"$3,108.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84133	SUP	Custom 27803010		84133  -  S EAR - LARGE - LEFT - 65MM X 37MM X 21.5MM	BOTH IP/OP	"$3,886.00 "	"$2,875.64"	$0.00	"$3,108.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,884.19"	"$2,884.19"	$0.00	$0.00	$809.84	$0.00	$0.00	$0.00	$0.00	"$1,943.00"	"$3,077.71"	"$3,108.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84134	SUP	Custom 27803010		84134  -  S EAR - LARGE - RIGHT - 65MM X 37MM X 21.5MM	BOTH IP/OP	"$4,004.00 "	"$2,962.96"	$0.00	"$3,203.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,971.77"	"$2,971.77"	$0.00	$0.00	$834.43	$0.00	$0.00	$0.00	$0.00	"$2,002.00"	"$3,171.17"	"$3,203.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84505	SUP	Custom 27803010		84505  -  CONNECTOR 84505 CD CL DOM 7.7MM	BOTH IP/OP	"$1,991.25 "	"$1,473.53"	$0.00	"$1,593.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,477.91"	"$1,477.91"	$0.00	$0.00	$414.98	$0.00	$0.00	$0.00	$0.00	$995.63	"$1,577.07"	"$1,593.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
85040	SUP	Custom 27203010		85040  -  APPLICATOR FBRTP 6IN FOAM CTTN POLYPRO CSTM OVR 1IN 3/8IN	BOTH IP/OP	$151.63 	$112.21	$0.00	$121.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.54	$112.54	$0.00	$0.00	$31.60	$0.00	$0.00	$0.00	$0.00	$75.81	$120.09	$121.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
85201	SUP	HCPCS C1768		85201  -  GRAFT HEMASHIELD GRAFT? 20X10MM X 40L962.45	BOTH IP/OP	"$1,688.05 "	"$1,249.16"	$0.00	"$1,350.44"	$759.62	$759.62	$0.00	$0.00	$0.00	$351.83	"$1,252.87"	"$1,252.87"	$0.00	$0.00	$351.79	$0.00	$998.48	$998.48	$0.00	$844.03	"$1,336.94"	"$1,350.44"	$0.00		$0.00	$264.18	$0.00	$0.00	$268.74	$0.00	$0.00	$0.00	$0.00	$0.00
85412	SUP	HCPCS C1876		85412  -  STENT TRCHBR 6MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO	BOTH IP/OP	"$6,125.00 "	"$4,532.50"	$0.00	"$4,900.00"	"$2,756.25"	"$2,756.25"	$0.00	$0.00	$0.00	"$1,276.60"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,276.45"	$0.00	"$3,019.63"	"$3,019.63"	$0.00	"$3,062.50"	"$4,851.00"	"$4,900.00"	$0.00		$0.00	$958.56	$0.00	$0.00	$975.10	$0.00	$0.00	$0.00	$0.00	$0.00
85414	SUP	HCPCS C1876		85414  -  STENT TRCHBR 7MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO	BOTH IP/OP	"$6,115.63 "	"$4,525.57"	$0.00	"$4,892.50"	"$2,752.03"	"$2,752.03"	$0.00	$0.00	$0.00	"$1,274.65"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,274.50"	$0.00	"$3,015.00"	"$3,015.00"	$0.00	"$3,057.81"	"$4,843.58"	"$4,892.50"	$0.00		$0.00	$957.10	$0.00	$0.00	$973.61	$0.00	$0.00	$0.00	$0.00	$0.00
85415	SUP	HCPCS C1876		85415  -  STENT TRCHBR 7MM 7FR 59MM STRL 120CM ICAST CVR CATH INTRO SS	BOTH IP/OP	"$6,590.63 "	"$4,877.07"	$0.00	"$5,272.50"	"$2,965.78"	"$2,965.78"	$0.00	$0.00	$0.00	"$1,373.65"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.49"	$0.00	"$3,249.18"	"$3,249.18"	$0.00	"$3,295.31"	"$5,219.78"	"$5,272.50"	$0.00		$0.00	"$1,031.43"	$0.00	$0.00	"$1,049.23"	$0.00	$0.00	$0.00	$0.00	$0.00
85416	SUP	HCPCS C1876		85416  -  STENT TRCHBR 8MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO SS	BOTH IP/OP	"$6,115.63 "	"$4,525.57"	$0.00	"$4,892.50"	"$2,752.03"	"$2,752.03"	$0.00	$0.00	$0.00	"$1,274.65"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,274.50"	$0.00	"$3,015.00"	"$3,015.00"	$0.00	"$3,057.81"	"$4,843.58"	"$4,892.50"	$0.00		$0.00	$957.10	$0.00	$0.00	$973.61	$0.00	$0.00	$0.00	$0.00	$0.00
85417	SUP	HCPCS C1876		85417  -  STENT TRCHBR 8MM 7FR 59MM STRL 120CM ICAST CVR CATH INTRO SS	BOTH IP/OP	"$6,590.63 "	"$4,877.07"	$0.00	"$5,272.50"	"$2,965.78"	"$2,965.78"	$0.00	$0.00	$0.00	"$1,373.65"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.49"	$0.00	"$3,249.18"	"$3,249.18"	$0.00	"$3,295.31"	"$5,219.78"	"$5,272.50"	$0.00		$0.00	"$1,031.43"	$0.00	$0.00	"$1,049.23"	$0.00	$0.00	$0.00	$0.00	$0.00
85418	SUP	HCPCS C1876		85418  -  STENT TRCHBR 9MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO	BOTH IP/OP	"$6,115.63 "	"$4,525.57"	$0.00	"$4,892.50"	"$2,752.03"	"$2,752.03"	$0.00	$0.00	$0.00	"$1,274.65"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,274.50"	$0.00	"$3,015.00"	"$3,015.00"	$0.00	"$3,057.81"	"$4,843.58"	"$4,892.50"	$0.00		$0.00	$957.10	$0.00	$0.00	$973.61	$0.00	$0.00	$0.00	$0.00	$0.00
85419	SUP	HCPCS C1876		85419  -  STENT TRCHBR 9MM 7FR 59MM STRL 120CM ICAST CVR CATH INTRO SS	BOTH IP/OP	"$6,590.63 "	"$4,877.07"	$0.00	"$5,272.50"	"$2,965.78"	"$2,965.78"	$0.00	$0.00	$0.00	"$1,373.65"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.49"	$0.00	"$3,249.18"	"$3,249.18"	$0.00	"$3,295.31"	"$5,219.78"	"$5,272.50"	$0.00		$0.00	"$1,031.43"	$0.00	$0.00	"$1,049.23"	$0.00	$0.00	$0.00	$0.00	$0.00
85424	SUP	HCPCS C1876		85424  -  STENT TRCHBR 10MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO	BOTH IP/OP	"$6,115.63 "	"$4,525.57"	$0.00	"$4,892.50"	"$2,752.03"	"$2,752.03"	$0.00	$0.00	$0.00	"$1,274.65"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,274.50"	$0.00	"$3,015.00"	"$3,015.00"	$0.00	"$3,057.81"	"$4,843.58"	"$4,892.50"	$0.00		$0.00	$957.10	$0.00	$0.00	$973.61	$0.00	$0.00	$0.00	$0.00	$0.00
85426	SUP	HCPCS C1768		85426  -  STENT COVERED  12MMX38MMX120CM	BOTH IP/OP	"$6,125.00 "	"$4,532.50"	$0.00	"$4,900.00"	"$2,756.25"	"$2,756.25"	$0.00	$0.00	$0.00	"$1,276.60"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,276.45"	$0.00	"$3,019.63"	"$3,019.63"	$0.00	"$3,062.50"	"$4,851.00"	"$4,900.00"	$0.00		$0.00	$958.56	$0.00	$0.00	$975.10	$0.00	$0.00	$0.00	$0.00	$0.00
85450	SUP	HCPCS C1876		85450  -  STENT TRCHBR 5MM 6FR 16MM 120CM ICAST CVR ULT LO CX PRFL PWR	BOTH IP/OP	"$5,723.75 "	"$4,235.58"	$0.00	"$4,579.00"	"$2,575.69"	"$2,575.69"	$0.00	$0.00	$0.00	"$1,192.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,192.83"	$0.00	"$2,821.81"	"$2,821.81"	$0.00	"$2,861.88"	"$4,533.21"	"$4,579.00"	$0.00		$0.00	$895.77	$0.00	$0.00	$911.22	$0.00	$0.00	$0.00	$0.00	$0.00
85451	SUP	HCPCS C1876		85451  -  STENT TRCHBR 5MM 6FR 22MM STRL 120CM ICAST CVR CATH INTRO SS	BOTH IP/OP	"$6,287.50 "	"$4,652.75"	$0.00	"$5,030.00"	"$2,829.38"	"$2,829.38"	$0.00	$0.00	$0.00	"$1,310.47"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,310.32"	$0.00	"$3,099.74"	"$3,099.74"	$0.00	"$3,143.75"	"$4,979.70"	"$5,030.00"	$0.00		$0.00	$983.99	$0.00	$0.00	"$1,000.97"	$0.00	$0.00	$0.00	$0.00	$0.00
85785	SUP	HCPCS C1733		85785  -  SET TBG 260CM CL PNT 2W CMUNC IRR PMP CATH	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
86000	SUP	Custom 27803010		86000  -  IMPLANT CHIN CNTR LF 2 PC	BOTH IP/OP	"$1,005.00 "	$743.70	$0.00	"$1,126.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$745.91	$745.91	$0.00	$0.00	$209.44	$0.00	$0.00	$0.00	$0.00	$703.75	"$1,114.74"	"$1,126.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86001	SUP	Custom 27803010		86001  -  GRAFT SYNTH TISSUE CNTOUR CONCAVE TAPER 74X42X5MM 2 PIECE	BOTH IP/OP	"$1,005.00 "	$743.70	$0.00	"$1,126.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$745.91	$745.91	$0.00	$0.00	$209.44	$0.00	$0.00	$0.00	$0.00	$703.75	"$1,114.74"	"$1,126.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86002	SUP	Custom 27803010		86002  -  IMPLANT CHIN CNTR TPR 78X50X7MM STRL MDPR 2 PC PE POR	BOTH IP/OP	"$1,005.00 "	$743.70	$0.00	"$1,126.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$745.91	$745.91	$0.00	$0.00	$209.44	$0.00	$0.00	$0.00	$0.00	$703.75	"$1,114.74"	"$1,126.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86003	SUP	Custom 27803010		86003  -  GRAFT SYNTH TISSUE CNTOUR TAPER 80X55X9MM 2 PIECE GRADUAL	BOTH IP/OP	"$1,005.00 "	$743.70	$0.00	"$1,126.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$745.91	$745.91	$0.00	$0.00	$209.44	$0.00	$0.00	$0.00	$0.00	$703.75	"$1,114.74"	"$1,126.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86010	SUP	Custom 27803010		86010  -  GRAFT SNTH TISS SM 3D 40X25X4MM STRL MDPR BTN MXLFCL CHIN	BOTH IP/OP	$848.00 	$627.52	$0.00	$942.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$629.39	$629.39	$0.00	$0.00	$176.72	$0.00	$0.00	$0.00	$0.00	$588.75	$932.58	$942.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86011	SUP	Custom 27803010		86011  -  GRAFT SNTH TISS MED 3D 47.5X37.5X5.5MM STRL MDPR BTN MXLFCL	BOTH IP/OP	$848.00 	$627.52	$0.00	$942.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$629.39	$629.39	$0.00	$0.00	$176.72	$0.00	$0.00	$0.00	$0.00	$588.75	$932.58	$942.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86012	SUP	HCPCS C2627		CATHETER SPBC MLCT 12FR 4 WNG DRAIN STRL LTX DISP AMBR	BOTH IP/OP	$165.15 	$122.21	$0.00	$122.57	$20.73	$20.73	$0.00	$0.00	$0.00	$34.42	$122.57	$122.57	$0.00	$0.00	$34.42	$0.00	$97.69	$97.69	$0.00	$19.09	$30.25	$30.55	$0.00		$0.00	$5.98	$0.00	$0.00	$6.08	$0.00	$0.00	$0.00	$0.00	$0.00
86014	SUP	HCPCS C1729		086014  -  CATHETER SUPRAPUBIC 14FR 4 WING DRAIN LATEX MALECOT STERILE	BOTH IP/OP	$24.90 	$18.43	$0.00	$19.92	$13.52	$13.52	$0.00	$0.00	$0.00	$5.19	$18.48	$18.48	$0.00	$0.00	$5.19	$0.00	$14.73	$14.73	$0.00	$12.45	$19.72	$19.92	$0.00		$0.00	$3.90	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$0.00
86016	SUP	HCPCS C1729		086016  -  CATHETER NPHSTM 16FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP	BOTH IP/OP	$24.90 	$18.43	$0.00	$19.92	$13.52	$13.52	$0.00	$0.00	$0.00	$5.19	$18.48	$18.48	$0.00	$0.00	$5.19	$0.00	$14.73	$14.73	$0.00	$12.45	$19.72	$19.92	$0.00		$0.00	$3.90	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$0.00
86018	SUP	HCPCS C1751		086018  -  CATHETER NPHSTM 18FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP	BOTH IP/OP	$24.90 	$18.43	$0.00	$19.92	$13.52	$13.52	$0.00	$0.00	$0.00	$5.19	$18.48	$18.48	$0.00	$0.00	$5.19	$0.00	$14.73	$14.73	$0.00	$12.45	$19.72	$19.92	$0.00		$0.00	$3.90	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$0.00
86020	SUP	HCPCS C1729		086020  -  CATH NPHSTM AMBR 20FR MLCT DRAIN 4 WNG STRL LATEX DISP	BOTH IP/OP	$284.70 	$210.68	$0.00	$294.48	$199.88	$199.88	$0.00	$0.00	$0.00	$59.34	$211.30	$211.30	$0.00	$0.00	$59.33	$0.00	$168.40	$168.40	$0.00	$184.05	$291.54	$294.48	$0.00		$0.00	$57.61	$0.00	$0.00	$58.60	$0.00	$0.00	$0.00	$0.00	$0.00
86022	SUP	HCPCS C1729		086022  -  CATHETER NPHSTM 22FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP	BOTH IP/OP	$24.90 	$18.43	$0.00	$19.92	$13.52	$13.52	$0.00	$0.00	$0.00	$5.19	$18.48	$18.48	$0.00	$0.00	$5.19	$0.00	$14.73	$14.73	$0.00	$12.45	$19.72	$19.92	$0.00		$0.00	$3.90	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$0.00
86024	SUP	HCPCS C1729		086024  -  CATHETER NPHSTM 24FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP	BOTH IP/OP	$24.90 	$18.43	$0.00	$19.92	$13.52	$13.52	$0.00	$0.00	$0.00	$5.19	$18.48	$18.48	$0.00	$0.00	$5.19	$0.00	$14.73	$14.73	$0.00	$12.45	$19.72	$19.92	$0.00		$0.00	$3.90	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$0.00
86026	SUP	HCPCS C1729		086026  -  CATHETER NPHSTM 26FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP	BOTH IP/OP	$24.90 	$18.43	$0.00	$19.92	$13.52	$13.52	$0.00	$0.00	$0.00	$5.19	$18.48	$18.48	$0.00	$0.00	$5.19	$0.00	$14.73	$14.73	$0.00	$12.45	$19.72	$19.92	$0.00		$0.00	$3.90	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$0.00
86028	SUP	HCPCS C1729		086028  -  CATHETER NPHSTM 28FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP	BOTH IP/OP	$24.90 	$18.43	$0.00	$19.92	$13.52	$13.52	$0.00	$0.00	$0.00	$5.19	$18.48	$18.48	$0.00	$0.00	$5.19	$0.00	$14.73	$14.73	$0.00	$12.45	$19.72	$19.92	$0.00		$0.00	$3.90	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$0.00
86030	SUP	HCPCS C1729		086030  -  CATHETER NPHSTM 30FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP	BOTH IP/OP	$24.90 	$18.43	$0.00	$19.92	$13.52	$13.52	$0.00	$0.00	$0.00	$5.19	$18.48	$18.48	$0.00	$0.00	$5.19	$0.00	$14.73	$14.73	$0.00	$12.45	$19.72	$19.92	$0.00		$0.00	$3.90	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$0.00
86032	SUP	HCPCS C1729		086032  -  CATHETER NPHSTM 32FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP	BOTH IP/OP	$24.90 	$18.43	$0.00	$19.92	$13.52	$13.52	$0.00	$0.00	$0.00	$5.19	$18.48	$18.48	$0.00	$0.00	$5.19	$0.00	$14.73	$14.73	$0.00	$12.45	$19.72	$19.92	$0.00		$0.00	$3.90	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$0.00
86034	SUP	HCPCS C1729		086034  -  CATHETER NPHSTM 34FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP	BOTH IP/OP	$24.90 	$18.43	$0.00	$19.92	$13.52	$13.52	$0.00	$0.00	$0.00	$5.19	$18.48	$18.48	$0.00	$0.00	$5.19	$0.00	$14.73	$14.73	$0.00	$12.45	$19.72	$19.92	$0.00		$0.00	$3.90	$0.00	$0.00	$3.96	$0.00	$0.00	$0.00	$0.00	$0.00
86036	SUP	HCPCS C1729		086036  -  CATHETER NPHSTM 36FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP	BOTH IP/OP	$4.15 	$3.07	$0.00	$3.32	$2.25	$2.25	$0.00	$0.00	$0.00	$0.86	$3.08	$3.08	$0.00	$0.00	$0.86	$0.00	$2.45	$2.45	$0.00	$2.08	$3.29	$3.32	$0.00		$0.00	$0.65	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
86038	SUP	HCPCS C1751		086038  -  CATHETER NPHSTM 38FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP	BOTH IP/OP	$24.90 	$18.43	$0.00	$49.08	$33.31	$33.31	$0.00	$0.00	$0.00	$5.19	$18.48	$18.48	$0.00	$0.00	$5.19	$0.00	$14.73	$14.73	$0.00	$30.68	$48.59	$49.08	$0.00		$0.00	$9.60	$0.00	$0.00	$9.77	$0.00	$0.00	$0.00	$0.00	$0.00
86202	SUP	Custom 27203010		86202  -  TUBE ENDOTRAC 6MM CUF MRPH EYE OR R STRL LATEX FREE DISP	BOTH IP/OP	$41.37 	$30.61	$0.00	$30.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.71	$30.71	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$6.13	$9.71	$9.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86203	SUP	Custom 27203010		86203  -  TUBE ENDOTRAC 6.5MM CUF MRPH EYE PREFRM CURVE OR R STRL	BOTH IP/OP	$12.26 	$9.07	$0.00	$9.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.10	$9.10	$0.00	$0.00	$2.55	$0.00	$0.00	$0.00	$0.00	$6.13	$9.71	$9.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86207	SUP	Custom 27203010		86207  -  TUBE ORAL/TRACHEAL RAE 8.5MM CUFFED MURPHY TIP PREFORMED PVC	BOTH IP/OP	$14.41 	$10.66	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.70	$10.70	$0.00	$0.00	$3.00	$0.00	$0.00	$0.00	$0.00	$7.21	$11.41	$11.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86207	SUP	Custom 27203010		086207  -  TUBE ORAL/TRACHEAL RAE 8.5MM CUFFED MURPHY TIP PREFORMED PVC	BOTH IP/OP	$14.41 	$10.66	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.70	$10.70	$0.00	$0.00	$3.00	$0.00	$0.00	$0.00	$0.00	$7.21	$11.41	$11.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86228	SUP	Custom 27203010		86228  -  TUBE ENDOTRAC 22FR 5.5MM STD NSL/ORL UNCUF MRPH EYE RADIOPQ	BOTH IP/OP	$25.12 	$18.59	$0.00	$26.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.65	$18.65	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$16.33	$25.87	$26.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86266	SUP	Custom 27203010		86266  -  TUBE ENDOTRAC 4.5MM UNCUF MRPH EYE OR R	BOTH IP/OP	$87.85 	$65.01	$0.00	$70.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.20	$65.20	$0.00	$0.00	$18.31	$0.00	$0.00	$0.00	$0.00	$43.92	$69.58	$70.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86287	SUP	Custom 27203010		86287  -  TUBE NASOTRACHEAL RAE 21FR 5MM UNCUFFED MURPHY EYE	BOTH IP/OP	$6.57 	$4.86	$0.00	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.88	$4.88	$0.00	$0.00	$1.37	$0.00	$0.00	$0.00	$0.00	$4.24	$6.72	$6.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86311	SUP	HCPCS C1757		86311  -  CATHETER  THROMBECTOMY PROGREAT PRELUMEN	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86395	SUP	Custom 27203010		86395  -  TUBE ET 7.9MM 5.5MM STRL SHLY LSRFLX 2 CUF MRPH EYE SS	BOTH IP/OP	$114.75 	$84.92	$0.00	$91.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.17	$85.17	$0.00	$0.00	$23.91	$0.00	$0.00	$0.00	$0.00	$57.38	$90.88	$91.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86397	SUP	Custom 27203010		86397  -  TUBE ET MGL CRV 7MM 4.5MM STRL LF LSRFLX MALLINCKRODT 2 CUF	BOTH IP/OP	$114.75 	$84.92	$0.00	$91.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.17	$85.17	$0.00	$0.00	$23.91	$0.00	$0.00	$0.00	$0.00	$57.38	$90.88	$91.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86548	SUP	Custom 27203010		86548  -  TUBE ENDOTRAC 6MM CUFF REINFORCE MURPHY EYE PVC SILICONE	BOTH IP/OP	$45.30 	$33.52	$0.00	$36.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.65	$35.88	$36.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86551	SUP	Custom 27203010		86551  -  TUBE ENDOTRAC 7.5MM NSL/ORL CUF MRPH EYE REINF SIL SS STRL	BOTH IP/OP	$44.63 	$33.03	$0.00	$40.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.12	$33.12	$0.00	$0.00	$9.30	$0.00	$0.00	$0.00	$0.00	$25.29	$40.07	$40.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86552	SUP	Custom 27203010		86552  -  TUBE ENDOTRAC 8MM CUF REINF STRL	BOTH IP/OP	$44.63 	$33.03	$0.00	$250.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.12	$33.12	$0.00	$0.00	$9.30	$0.00	$0.00	$0.00	$0.00	$156.47	$247.84	$250.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
86700	SUP	HCPCS C1753		86700  -  CATH US .018IN 3.4FR 135CM INTVASC NONUNIFORM ROT DSTRTN VSN	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$916.31	$916.31	$0.00	$0.00	$0.00	$351.72	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$998.16	$998.16	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$264.09	$0.00	$0.00	$268.65	$0.00	$0.00	$0.00	$0.00	$0.00
87003	SUP	Custom 27803010		87003  -  GRAFT SYNTH TISSUE 26X25X2.5MM IMPLANT POROUS MEDPOR IMORI	BOTH IP/OP	$935.63 	$692.37	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$694.42	$694.42	$0.00	$0.00	$194.98	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87004	SUP	Custom 27803010		87004  -  GRAFT SYNTH TISSUE 26X25X2.5MM IMPLANT POROUS MEDPOR IMORI	BOTH IP/OP	$935.63 	$692.37	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$694.42	$694.42	$0.00	$0.00	$194.98	$0.00	$0.00	$0.00	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87118	SUP	Custom 27203010		SLIDE KOVA 2 GLSTC 4 WELL WO GRID UA	BOTH IP/OP	$241.95 	$179.04	$0.00	$193.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.98	$191.62	$193.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88000	SUP	HCPCS B4088		88000  -  TUBE JJNSTM 55IN 28FR 12FR SIL CMPCT BLN RADIOPQ STRP ADPR	BOTH IP/OP	$263.90 	$195.29	$0.00	$211.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.87	$195.87	$0.00	$0.00	$55.00	$0.00	$0.00	$0.00	$0.00	$131.95	$209.01	$211.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88037	SUP	Custom 27803010		88037  -  GRAFT SYNTH TISSUE 59X29X7MM IMPLANT CNTOUR ANGLED POROUS	BOTH IP/OP	"$1,353.75 "	"$1,001.78"	$0.00	"$1,518.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,004.75"	"$1,004.75"	$0.00	$0.00	$282.12	$0.00	$0.00	$0.00	$0.00	$948.75	"$1,502.82"	"$1,518.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88038	SUP	Custom 27803010		88038  -  GRAFT SYNTH TISSUE 59X29X7MM IMPLANT CNTOUR ANGLED POROUS	BOTH IP/OP	"$1,353.75 "	"$1,001.78"	$0.00	"$1,518.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,004.75"	"$1,004.75"	$0.00	$0.00	$282.12	$0.00	$0.00	$0.00	$0.00	$948.75	"$1,502.82"	"$1,518.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88051	SUP	Custom 27803010		88051  -  GRAFT SYNTH TISSUE 79X37X5MM IMPLANT RAMUS INFERIOR RIDGE	BOTH IP/OP	"$1,867.50 "	"$1,381.95"	$0.00	"$1,494.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.06"	"$1,386.06"	$0.00	$0.00	$389.19	$0.00	$0.00	$0.00	$0.00	$933.75	"$1,479.06"	"$1,494.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88052	SUP	Custom 27803010		88052  -  GRAFT SYNTH TISSUE 79X37X5MM IMPLANT RAMUS INFERIOR RIDGE	BOTH IP/OP	"$1,867.50 "	"$1,381.95"	$0.00	"$1,494.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.06"	"$1,386.06"	$0.00	$0.00	$389.19	$0.00	$0.00	$0.00	$0.00	$933.75	"$1,479.06"	"$1,494.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88053	SUP	Custom 27803010		88053  -  GRAFT SYNTH TISSUE ANGLE LARGE 57X40X4MM AUGMENTATION	BOTH IP/OP	"$1,333.13 "	$986.52	$0.00	"$1,494.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$989.45	$989.45	$0.00	$0.00	$277.82	$0.00	$0.00	$0.00	$0.00	$933.75	"$1,479.06"	"$1,494.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88054	SUP	Custom 27803010		88054  -  MANDIBLE ANGLE LARGE - RIGHT-57MM X 40MM X 4MM X 10MM X 4MM	BOTH IP/OP	"$1,380.00 "	"$1,021.20"	$0.00	"$1,104.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.24"	"$1,024.24"	$0.00	$0.00	$287.59	$0.00	$0.00	$0.00	$0.00	$690.00	"$1,092.96"	"$1,104.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88710	SUP	HCPCS C1713		SPACER MDI ARCHB+ SM VLV HLD CHMBR HNDHLD CMFSL MASK PED	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$18.81	$18.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
88900	SUP	HCPCS C1725		88900  -  CATH US .038IN 8.2FR 90CM INTVASC PULBCK SLED REV	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	"$1,153.88"	"$1,153.88"	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
88901	SUP	HCPCS C1753		88901  -  CATHETER ULTRASOUND .035IN 8.5FR 90CM 100CM OTW RADIOPQ	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,357.50"	"$1,357.50"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
89007	SUP	HCPCS C2617		089007  -  STENT URETERAL 7FR 90CM LUBRICIOUS GWIRE LATEX FREE STERILE	BOTH IP/OP	$213.05 	$157.66	$0.00	$170.44	$95.87	$95.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.53	$168.74	$170.44	$0.00		$0.00	$33.34	$0.00	$0.00	$33.92	$0.00	$0.00	$0.00	$0.00	$0.00
89008	SUP	HCPCS C2617		089008  -  STENT URETERAL 8FR 90CM LUBRICIOUS GWIRE LATEX FREE STERILE	BOTH IP/OP	$213.05 	$157.66	$0.00	$170.44	$95.87	$95.87	$0.00	$0.00	$0.00	$44.40	$158.13	$158.13	$0.00	$0.00	$44.40	$0.00	$126.02	$126.02	$0.00	$106.53	$168.74	$170.44	$0.00		$0.00	$33.34	$0.00	$0.00	$33.92	$0.00	$0.00	$0.00	$0.00	$0.00
89020	SUP	HCPCS C1763		89020  -  TISSUE SYNTH PE POR MEDPOR IMPL CSTM CRANIAL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$0.00	$937.91	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	"$2,218.50"	"$2,218.50"	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$704.25	$0.00	$0.00	$716.40	$0.00	$0.00	$0.00	$0.00	$0.00
89104	SUP	HCPCS C1713		89104  -  SCREW 89104 CD THR PLUG	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
89223	SUP	Custom 27803010		89223  -  IMPLANT SOFT TISSUE FLAT 4X1X1CM MOIST TOUGH FLEXIBLE SHEET	BOTH IP/OP	$861.00 	$637.14	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$639.03	$639.03	$0.00	$0.00	$179.43	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89224	SUP	Custom 27803010		89224  -  IMPLANT SOFT TISSUE THK1MM FLAT 5X2CM MOIST TOUGH FLEXIBLE	BOTH IP/OP	"$1,742.50 "	"$1,289.45"	$0.00	"$1,814.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,293.28"	"$1,293.28"	$0.00	$0.00	$363.14	$0.00	$0.00	$0.00	$0.00	"$1,133.75"	"$1,795.86"	"$1,814.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89225	SUP	Custom 27803010		89225  -  IMPLANT SOFT TISSUE 8X3X1CM MOIST TOUGH FLEXIBLE FLAT SHEET	BOTH IP/OP	"$2,109.45 "	"$1,560.99"	$0.00	"$2,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,565.63"	"$1,565.63"	$0.00	$0.00	$439.61	$0.00	$0.00	$0.00	$0.00	"$1,371.25"	"$2,172.06"	"$2,194.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89612	SUP	Custom 27203010		TIP PIP 1100UL EPNDF CNDCT	BOTH IP/OP	"$3,545.00 "	"$2,623.30"	$0.00	"$2,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,772.50"	"$2,807.64"	"$2,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89894	SUP	Custom 27203010		WASHER PIP KT	BOTH IP/OP	$547.50 	$405.15	$0.00	$438.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$273.75	$433.62	$438.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90001	SUP	Custom 27203010		090001  -  NEEDLE ENDSCP 35CM 23GA 8MM URTH CSCP INJEC PRC WMS	BOTH IP/OP	$48.50 	$35.89	$0.00	$38.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.00	$36.00	$0.00	$0.00	$10.11	$0.00	$0.00	$0.00	$0.00	$24.25	$38.41	$38.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90044	SUP	HCPCS C1887		90044  -  CATHETER ANGIO 3-2.4FR 150CM MRC 1 LUM RADOPQ	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$644.81	$644.81	$0.00	$0.00	$0.00	$247.50	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$702.41	$702.41	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$185.84	$0.00	$0.00	$189.05	$0.00	$0.00	$0.00	$0.00	$0.00
90051	SUP	Custom 27203010		90051  -  CATHETER URETHRAL 16FR FOLEY TEMPERATURE SENSOR LATEX FREE	BOTH IP/OP	$3.93 	$2.91	$0.00	$20.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.91	$2.91	$0.00	$0.00	$0.82	$0.00	$0.00	$0.00	$0.00	$12.88	$3.11	$20.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90071	SUP	Custom 27203010		090071  -  NEEDLE FASCIAL INCISING 10MM	BOTH IP/OP	$76.95 	$56.94	$0.00	$61.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.11	$57.11	$0.00	$0.00	$16.04	$0.00	$0.00	$0.00	$0.00	$38.48	$60.94	$61.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90071	SUP	Custom 27203010		90071  -  NEEDLE 5CM 18GA GWIRE PRC RNL FSCA 10MM	BOTH IP/OP	$76.95 	$56.94	$0.00	$65.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.11	$57.11	$0.00	$0.00	$16.04	$0.00	$0.00	$0.00	$0.00	$38.48	$65.30	$61.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90073	SUP	HCPCS C1887		CATHETER GUID .038IN 8FR 5.9FR 95CM BLN SIL MRC	BOTH IP/OP	"$2,187.50 "	"$1,618.75"	$0.00	"$1,750.00"	"$1,187.81"	"$1,187.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,093.75"	"$1,732.50"	"$1,750.00"	$0.00		$0.00	$342.34	$0.00	$0.00	$348.25	$0.00	$0.00	$0.00	$0.00	$0.00
90074	SUP	HCPCS C1887		CATHETER BALLOON GUIDE CONCENTRIC 9F 95CM	BOTH IP/OP	"$2,187.50 "	"$1,618.75"	$0.00	"$1,750.00"	"$1,187.81"	"$1,187.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,093.75"	"$1,732.50"	"$1,750.00"	$0.00		$0.00	$342.34	$0.00	$0.00	$348.25	$0.00	$0.00	$0.00	$0.00	$0.00
90076	SUP	HCPCS C1887		CATHETER BALLOON GUIDE CONCENTRIC 8F 80CM	BOTH IP/OP	"$2,187.50 "	"$1,618.75"	$0.00	"$1,750.00"	"$1,187.81"	"$1,187.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,093.75"	"$1,732.50"	"$1,750.00"	$0.00		$0.00	$342.34	$0.00	$0.00	$348.25	$0.00	$0.00	$0.00	$0.00	$0.00
90077	SUP	HCPCS C1887		CATHETER BALLOON GUIDE 9F 80CM	BOTH IP/OP	"$2,187.50 "	"$1,618.75"	$0.00	"$1,750.00"	"$1,187.81"	"$1,187.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,093.75"	"$1,732.50"	"$1,750.00"	$0.00		$0.00	$342.34	$0.00	$0.00	$348.25	$0.00	$0.00	$0.00	$0.00	$0.00
90110	SUP	HCPCS C1757		90110  -  CATHETER THRMB CRKSCR 2MM 180CM 5MM MRC V RTRV V2 FIRM NTNL	BOTH IP/OP	"$7,987.50 "	"$5,910.75"	$0.00	"$6,390.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,664.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,664.60"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,993.75"	"$6,326.10"	"$6,390.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90111	SUP	HCPCS C1757		90111  -  CATHETER THRMB CRKSCR 2.5MM 180CM 6MM MRC V RETREIEVER V2.5	BOTH IP/OP	"$7,987.50 "	"$5,910.75"	$0.00	"$6,390.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,664.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,664.60"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,993.75"	"$6,326.10"	"$6,390.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90112	SUP	HCPCS C1757		90112  -  CATHETER THRMB CRKSCR 2.5MM 180CM 6MM MRC V RETREIVER V2.5	BOTH IP/OP	"$7,987.50 "	"$5,910.75"	$0.00	"$6,390.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,664.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,664.60"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,993.75"	"$6,326.10"	"$6,390.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90113	SUP	HCPCS C1757		90113  -  CATHETER THRMB CRKSCR 3MM 180CM 7MM MRC V RTRV V3 SFT NTNL	BOTH IP/OP	"$7,987.50 "	"$5,910.75"	$0.00	"$6,390.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,664.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,664.60"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,993.75"	"$6,326.10"	"$6,390.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90120	SUP	HCPCS C1757		90120  -  CATHETER THRMB 3.9FR .038IN 125CM DAC 1 LUM BRAID RADOPQ LL	BOTH IP/OP	"$2,700.15 "	"$1,998.11"	$0.00	"$2,160.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$562.78	"$2,004.05"	"$2,004.05"	$0.00	$0.00	$562.71	$0.00	"$1,597.14"	"$1,597.14"	$0.00	"$1,350.08"	"$2,138.52"	"$2,160.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90121	SUP	HCPCS C1887		CATHETER THROMBECTOMY DAC 038 - 136CM	BOTH IP/OP	"$2,487.50 "	"$1,840.75"	$0.00	"$1,990.00"	"$1,350.71"	"$1,350.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$389.29	$0.00	$0.00	$396.01	$0.00	$0.00	$0.00	$0.00	$0.00
90131	SUP	HCPCS C1887		CATHETER DISTAL ACCESS DAC 057 - 125CM	BOTH IP/OP	"$2,487.50 "	"$1,840.75"	$0.00	"$1,990.00"	"$1,350.71"	"$1,350.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$389.29	$0.00	$0.00	$396.01	$0.00	$0.00	$0.00	$0.00	$0.00
90160	SUP	HCPCS C1757		90160  -  CATHETER THRMB 4.3FR .044IN 115CM DAC 1 LUM BRAID RADOPQ LL	BOTH IP/OP	"$2,700.15 "	"$1,998.11"	$0.00	"$2,160.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$562.78	"$2,004.05"	"$2,004.05"	$0.00	$0.00	$562.71	$0.00	"$1,597.14"	"$1,597.14"	$0.00	"$1,350.08"	"$2,138.52"	"$2,160.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90161	SUP	HCPCS C1757		90161  -  CATHETER THROMBECTOMY DAC® 044 0.044IN / 130CM RADIOPQ SHAFT	BOTH IP/OP	"$2,573.25 "	"$1,904.21"	$0.00	"$2,058.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$536.33	"$1,909.87"	"$1,909.87"	$0.00	$0.00	$536.27	$0.00	"$1,522.08"	"$1,522.08"	$0.00	"$1,286.63"	"$2,038.01"	"$2,058.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90162	SUP	HCPCS C1757		90162  -  CATHETER THRMB 4.3FR .044IN 136CM DAC 1 LUM BRAID RADOPQ LL	BOTH IP/OP	"$2,700.15 "	"$1,998.11"	$0.00	"$2,160.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$562.78	"$2,004.05"	"$2,004.05"	$0.00	$0.00	$562.71	$0.00	"$1,597.14"	"$1,597.14"	$0.00	"$1,350.08"	"$2,138.52"	"$2,160.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90170	SUP	HCPCS C1757		90170  -  CATHETER THRMB 6.3FR .07IN 105CM DAC 1 LUM BRD RADOPQ LL HUB	BOTH IP/OP	"$2,700.15 "	"$1,998.11"	$0.00	"$2,160.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$562.78	"$2,004.05"	"$2,004.05"	$0.00	$0.00	$562.71	$0.00	"$1,597.14"	"$1,597.14"	$0.00	"$1,350.08"	"$2,138.52"	"$2,160.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90171	SUP	HCPCS C1757		90171  -  CATHETER THRMB 6.3FR .07IN 120CM DAC 1 LUM BRD RADOPQ LL HUB	BOTH IP/OP	"$2,700.15 "	"$1,998.11"	$0.00	"$2,160.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,350.08"	"$2,138.52"	"$2,160.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90182	SUP	Custom 27203010		90182  -  RETRIEVER ESCP 4MM 20MM TREVO XP PROVUE	BOTH IP/OP	"$13,116.25 "	"$9,706.03"	$0.00	"$10,493.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,733.43"	$0.00	$0.00	$0.00	$0.00	"$6,558.13"	"$10,388.07"	"$10,493.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90183	SUP	Custom 27203010		90183  -  RETRIEVER ESCP 3MM 20MM TREVO XP PROVUE	BOTH IP/OP	"$13,116.25 "	"$9,706.03"	$0.00	"$10,493.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,733.43"	$0.00	$0.00	$0.00	$0.00	"$6,558.13"	"$10,388.07"	"$10,493.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90231	SUP	HCPCS C1757		90231  -  CATHETER INFS MIC 18FR TREVO PRO NRVSC	BOTH IP/OP	"$1,703.75 "	"$1,260.78"	$0.00	"$1,363.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$355.10	"$1,264.52"	"$1,264.52"	$0.00	$0.00	$355.06	$0.00	"$1,007.77"	"$1,007.77"	$0.00	$851.88	"$1,349.37"	"$1,363.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90603	SUP	Custom 27203010		90603  -  DRESSING TRANSPARENT 8X8IN ABSORBENT NONADHESIVE	BOTH IP/OP	$28.88 	$21.37	$0.00	$23.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.44	$21.44	$0.00	$0.00	$6.02	$0.00	$0.00	$0.00	$0.00	$14.44	$22.87	$23.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90605	SUP	Custom 27203010		90605  -  DRESSING FOAM 24X4IN NONADHESIVE HIGH FLUID HANDLE	BOTH IP/OP	$49.61 	$36.71	$0.00	$39.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.82	$36.82	$0.00	$0.00	$10.34	$0.00	$0.00	$0.00	$0.00	$24.80	$39.29	$39.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90730	SUP	HCPCS C1757		90730  -  CATHETER THRMB 5.2FR .057IN 115CM DAC 1 LUM BRAID RADOPQ LL	BOTH IP/OP	"$2,700.15 "	"$1,998.11"	$0.00	"$2,160.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$562.78	"$2,004.05"	"$2,004.05"	$0.00	$0.00	$562.71	$0.00	"$1,597.14"	"$1,597.14"	$0.00	"$1,350.08"	"$2,138.52"	"$2,160.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90760	SUP	HCPCS C1757		90760  -  CATHETER THRMB 4.3FR .044IN 130CM DAC 1 LUM BRAID RADOPQ LL	BOTH IP/OP	"$2,573.25 "	"$1,904.21"	$0.00	"$2,058.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,286.63"	"$2,038.01"	"$2,058.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90805	SUP	Custom 27203010		90805  -  DRESSING TRANSPARENT LARGE SQUARE 8INX7 7/8IN 6INX5 7/8IN	BOTH IP/OP	$24.44 	$18.09	$0.00	$19.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.14	$18.14	$0.00	$0.00	$5.09	$0.00	$0.00	$0.00	$0.00	$12.22	$19.36	$19.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91101	SUP	Custom 27203010		91101  -  CATHETER NEUROSURGICAL ANTIBIOTIC IMPREGNATED ARES VENTRICLE	BOTH IP/OP	$770.00 	$569.80	$0.00	$616.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$571.49	$571.49	$0.00	$0.00	$160.47	$0.00	$0.00	$0.00	$0.00	$385.00	$609.84	$616.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91265	SUP	Custom 27203010		91265  -  FLAT VENOUS 2 STAGE CANNULA MC2	BOTH IP/OP	$78.68 	$58.22	$0.00	$68.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.40	$58.40	$0.00	$0.00	$16.40	$0.00	$0.00	$0.00	$0.00	$43.04	$68.18	$68.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91503	SUP	Custom 27803010		91503  -  CATH 91503 BIOGLIDE VENT 23CM CLOSED IMP	BOTH IP/OP	$513.00 	$379.62	$0.00	$410.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.75	$380.75	$0.00	$0.00	$106.91	$0.00	$0.00	$0.00	$0.00	$256.50	$406.30	$410.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92001	SUP	Custom 27203010		092001  -  CLIP INTNL ANG RT 15MM STRL LF LDS LNR CTR PWR SF LKOUT	BOTH IP/OP	$387.15 	$286.49	$0.00	$309.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.34	$287.34	$0.00	$0.00	$80.68	$0.00	$0.00	$0.00	$0.00	$193.58	$306.62	$309.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100	SUP	Custom 27203010		0092100  -  TUBE ESPH 20FR 8IN NS LTX 1.5IN BLKMR BLN SPCL NTR RBR ADLT	BOTH IP/OP	$758.28 	$561.13	$0.00	$562.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.79	$562.79	$0.00	$0.00	$158.02	$0.00	$0.00	$0.00	$0.00	$182.94	$289.78	$292.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92100	SUP	Custom 27203010		TUBE NG 8IN 20FR 3 LUM BLN RADIOPQ STRP BLKMR ADLT NSTRL LTX	BOTH IP/OP	$758.28 	$561.13	$0.00	$704.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.79	$562.79	$0.00	$0.00	$158.02	$0.00	$0.00	$0.00	$0.00	$182.94	$704.23	$292.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92312	SUP	Custom 27803010		92312  -  VALVE 92312 CSF CONTRD SML LOW BIO	BOTH IP/OP	"$2,681.38 "	"$1,984.22"	$0.00	"$2,145.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,990.12"	"$1,990.12"	$0.00	$0.00	$558.80	$0.00	$0.00	$0.00	$0.00	"$1,340.69"	"$2,123.65"	"$2,145.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92314	SUP	Custom 27803010		92314  -  VALVE 92314 CSF CONT SML MED BIO	BOTH IP/OP	"$2,681.38 "	"$1,984.22"	$0.00	"$2,145.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,990.12"	"$1,990.12"	$0.00	$0.00	$558.80	$0.00	$0.00	$0.00	$0.00	"$1,340.69"	"$2,123.65"	"$2,145.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92316	SUP	Custom 27803010		92316  -  VALVE 92316 CSF CONT SML HIGH BIO	BOTH IP/OP	"$3,018.63 "	"$2,233.79"	$0.00	"$2,414.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,240.42"	"$2,240.42"	$0.00	$0.00	$629.08	$0.00	$0.00	$0.00	$0.00	"$1,509.31"	"$2,390.75"	"$2,414.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92322	SUP	Custom 27803010		92322  -  VALVE 92322 CSF CONT REG LOW BIO	BOTH IP/OP	"$2,681.38 "	"$1,984.22"	$0.00	"$2,145.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,990.12"	"$1,990.12"	$0.00	$0.00	$558.80	$0.00	$0.00	$0.00	$0.00	"$1,340.69"	"$2,123.65"	"$2,145.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92324	SUP	Custom 27803010		92324  -  VALVE 92324 CSF CONT REG MED BIO	BOTH IP/OP	"$2,681.38 "	"$1,984.22"	$0.00	"$2,145.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,990.12"	"$1,990.12"	$0.00	$0.00	$558.80	$0.00	$0.00	$0.00	$0.00	"$1,340.69"	"$2,123.65"	"$2,145.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92326	SUP	Custom 27803010		92326  -  VALVE 92326 CSF CONT REG HIGH BIO	BOTH IP/OP	"$2,681.38 "	"$1,984.22"	$0.00	"$2,145.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,990.12"	"$1,990.12"	$0.00	$0.00	$558.80	$0.00	$0.00	$0.00	$0.00	"$1,340.69"	"$2,123.65"	"$2,145.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92355	SUP	Custom 27803010		92355  -  VALVE 92355 STRATA NSC SML BIOGLIDE	BOTH IP/OP	"$9,501.05 "	"$7,030.78"	$0.00	"$7,600.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,980.02"	$0.00	$0.00	$0.00	$0.00	"$4,750.53"	"$7,524.83"	"$7,600.84"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92365	SUP	Custom 27803010		92365  -  VALVE 92365 STRATA NSC REG BIOGLIDE	BOTH IP/OP	"$9,501.05 "	"$7,030.78"	$0.00	"$7,600.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,980.02"	$0.00	$0.00	$0.00	$0.00	"$4,750.53"	"$7,524.83"	"$7,600.84"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92812	SUP	Custom 27803010		92812  -  VALVE 92812 BIOGLIDE DELTA SM 1.0	BOTH IP/OP	"$4,358.13 "	"$3,225.02"	$0.00	"$3,486.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,234.60"	"$3,234.60"	$0.00	$0.00	$908.23	$0.00	$0.00	$0.00	$0.00	"$2,179.06"	"$3,451.64"	"$3,486.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92813	SUP	Custom 27803010		92813  -  VALVE 92813 BIOGLIDE DELTA SM 1.5	BOTH IP/OP	"$4,358.13 "	"$3,225.02"	$0.00	"$3,486.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,234.60"	"$3,234.60"	$0.00	$0.00	$908.23	$0.00	$0.00	$0.00	$0.00	"$2,179.06"	"$3,451.64"	"$3,486.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92814	SUP	Custom 27803010		92814  -  VALVE 92814 BIOGLIDE DELTA SM 2.0	BOTH IP/OP	"$4,358.13 "	"$3,225.02"	$0.00	"$3,486.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,234.60"	"$3,234.60"	$0.00	$0.00	$908.23	$0.00	$0.00	$0.00	$0.00	"$2,179.06"	"$3,451.64"	"$3,486.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92822	SUP	Custom 27803010		92822  -  VALVE 92822 BIOGLIDE DELTA REG. 1.0	BOTH IP/OP	"$4,358.13 "	"$3,225.02"	$0.00	"$3,486.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,234.60"	"$3,234.60"	$0.00	$0.00	$908.23	$0.00	$0.00	$0.00	$0.00	"$2,179.06"	"$3,451.64"	"$3,486.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92823	SUP	Custom 27803010		92823  -  VALVE 92823 BIOGLIDE DELTA REG. 1.5	BOTH IP/OP	"$4,358.13 "	"$3,225.02"	$0.00	"$3,486.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,234.60"	"$3,234.60"	$0.00	$0.00	$908.23	$0.00	$0.00	$0.00	$0.00	"$2,179.06"	"$3,451.64"	"$3,486.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92824	SUP	Custom 27803010		92824  -  VALVE 92824 BIOGLIDE DELTA REG. 2.0	BOTH IP/OP	"$4,358.13 "	"$3,225.02"	$0.00	"$3,486.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,234.60"	"$3,234.60"	$0.00	$0.00	$908.23	$0.00	$0.00	$0.00	$0.00	"$2,179.06"	"$3,451.64"	"$3,486.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92830	SUP	Custom 27803010		92830  -  VALVE 92830 DELTA BH 12MM PL 0.5 BIOGLID	BOTH IP/OP	"$4,612.25 "	"$3,413.07"	$0.00	"$3,689.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,423.21"	"$3,423.21"	$0.00	$0.00	$961.19	$0.00	$0.00	$0.00	$0.00	"$2,306.13"	"$3,652.90"	"$3,689.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92833	SUP	Custom 27803010		92833  -  VALVE 92833 BIOGLIDE DELTA BH 12 1.5	BOTH IP/OP	"$3,904.50 "	"$2,889.33"	$0.00	"$3,123.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,897.92"	"$2,897.92"	$0.00	$0.00	$813.70	$0.00	$0.00	$0.00	$0.00	"$1,952.25"	"$3,092.36"	"$3,123.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92834	SUP	Custom 27803010		92834  -  VALVE 92834 BIOGLIDE DELTA BH 12 2.0	BOTH IP/OP	"$4,612.25 "	"$3,413.07"	$0.00	"$3,689.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,423.21"	"$3,423.21"	$0.00	$0.00	$961.19	$0.00	$0.00	$0.00	$0.00	"$2,306.13"	"$3,652.90"	"$3,689.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92840	SUP	Custom 27803010		92840  -  VALVE 92840 DELTA BH 16MM PL 0.5 BIOGLID	BOTH IP/OP	"$3,904.50 "	"$2,889.33"	$0.00	"$3,123.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,897.92"	"$2,897.92"	$0.00	$0.00	$813.70	$0.00	$0.00	$0.00	$0.00	"$1,952.25"	"$3,092.36"	"$3,123.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92842	SUP	Custom 27803010		92842  -  VALVE 92842 BIOGLIDE DELTA BH 16 1.0	BOTH IP/OP	"$3,904.50 "	"$2,889.33"	$0.00	"$3,123.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,897.92"	"$2,897.92"	$0.00	$0.00	$813.70	$0.00	$0.00	$0.00	$0.00	"$1,952.25"	"$3,092.36"	"$3,123.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92843	SUP	Custom 27803010		92843  -  VALVE 92843 BIOGLIDE DELTA BH 16 1.5	BOTH IP/OP	"$3,904.50 "	"$2,889.33"	$0.00	"$3,123.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,897.92"	"$2,897.92"	$0.00	$0.00	$813.70	$0.00	$0.00	$0.00	$0.00	"$1,952.25"	"$3,092.36"	"$3,123.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92844	SUP	Custom 27803010		92844  -  VALVE 92844 BIOGLIDE DELTA BH 16 2.0	BOTH IP/OP	"$3,904.50 "	"$2,889.33"	$0.00	"$3,123.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,897.92"	"$2,897.92"	$0.00	$0.00	$813.70	$0.00	$0.00	$0.00	$0.00	"$1,952.25"	"$3,092.36"	"$3,123.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92856	SUP	Custom 27803010		92856  -  VALVE 92856 FP STRATA 2 SML BG	BOTH IP/OP	"$10,337.65 "	"$7,649.86"	$0.00	"$8,270.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,154.37"	$0.00	$0.00	$0.00	$0.00	"$5,168.83"	"$8,187.42"	"$8,270.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92866	SUP	Custom 27803010		92866  -  VALVE 92866 FP STRATA 2 REG BG	BOTH IP/OP	"$10,337.65 "	"$7,649.86"	$0.00	"$8,270.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,154.37"	$0.00	$0.00	$0.00	$0.00	"$5,168.83"	"$8,187.42"	"$8,270.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93092	SUP	Custom 27203010		93092  -  CATHETER NEUROSURGICAL 120CM ANTIBIOTIC IMPREGNATED ARES	BOTH IP/OP	$770.00 	$569.80	$0.00	$616.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$571.49	$571.49	$0.00	$0.00	$160.47	$0.00	$0.00	$0.00	$0.00	$385.00	$609.84	$616.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93320	SUP	HCPCS C1769		93320  -  WIRE 35-180 COONS	BOTH IP/OP	$60.75 	$44.96	$0.00	$48.60	$32.99	$32.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.38	$48.11	$48.60	$0.00		$0.00	$9.51	$0.00	$0.00	$9.67	$0.00	$0.00	$0.00	$0.00	$0.00
93522	SUP	Custom 27803010		93522  -  CATHETER 93522 BIOGLIDE PERITONEAL	BOTH IP/OP	$543.88 	$402.47	$0.00	$435.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$403.66	$403.66	$0.00	$0.00	$113.34	$0.00	$0.00	$0.00	$0.00	$271.94	$430.75	$435.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94965	SUP	Custom 27203010		94965  -  DLP RETROGRADE CORONARY PERFUSION CANNULA 15 FR	BOTH IP/OP	$199.49 	$147.62	$0.00	$174.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.06	$148.06	$0.00	$0.00	$41.57	$0.00	$0.00	$0.00	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95001	SUP	Custom 27203010		95001  -  KIT CATH STRL LF ARES ANBTC	BOTH IP/OP	$336.88 	$249.29	$0.00	"$1,080.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.03	$250.03	$0.00	$0.00	$70.20	$0.00	$0.00	$0.00	$0.00	$675.00	"$1,069.20"	"$1,080.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95201	SUP	Custom 27203010		PUMP CNTRF BPMP BPX80 STRL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96115	SUP	Custom 27803010		96115  -  CATH 96115 BIOGLIDE EDM VENT 20 CM	BOTH IP/OP	$458.40 	$339.22	$0.00	$366.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.22	$340.22	$0.00	$0.00	$95.53	$0.00	$0.00	$0.00	$0.00	$229.20	$363.05	$366.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96118	SUP	Custom 27803010		96118  -  CATH 96118 BIOGLIDE EDM VENT 35 CM	BOTH IP/OP	$549.60 	$406.70	$0.00	$439.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.91	$407.91	$0.00	$0.00	$114.54	$0.00	$0.00	$0.00	$0.00	$274.80	$435.28	$439.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96655	SUP	Custom 27803010		96655  -  SHUNT 96655 STRATA NSC ASSY SML BIOGLIDE	BOTH IP/OP	"$9,921.70 "	"$7,342.06"	$0.00	"$7,937.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,067.68"	$0.00	$0.00	$0.00	$0.00	"$4,960.85"	"$7,857.99"	"$7,937.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96665	SUP	Custom 27803010		96665  -  SHUNT 96665 STRATA NSC ASSY REG BIOGLIDE	BOTH IP/OP	"$9,921.70 "	"$7,342.06"	$0.00	"$7,937.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,067.68"	$0.00	$0.00	$0.00	$0.00	"$4,960.85"	"$7,857.99"	"$7,937.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96812	SUP	Custom 27803010		96812  -  SHUNT 96812 DELTA ASSY SMALL P/L 1.0 BIO	BOTH IP/OP	"$4,949.50 "	"$3,662.63"	$0.00	"$3,959.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,673.52"	"$3,673.52"	$0.00	$0.00	"$1,031.48"	$0.00	$0.00	$0.00	$0.00	"$2,474.75"	"$3,920.00"	"$3,959.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96813	SUP	Custom 27803010		96813  -  SHUNT 96813 DELTA ASSY SMALL P/L 1.5 BIO	BOTH IP/OP	"$4,949.50 "	"$3,662.63"	$0.00	"$3,959.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,673.52"	"$3,673.52"	$0.00	$0.00	"$1,031.48"	$0.00	$0.00	$0.00	$0.00	"$2,474.75"	"$3,920.00"	"$3,959.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96814	SUP	Custom 27803010		96814  -  SHUNT 96814 DELTA ASSY SMALL P/L 2.0 BIO	BOTH IP/OP	"$4,949.50 "	"$3,662.63"	$0.00	"$3,959.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,673.52"	"$3,673.52"	$0.00	$0.00	"$1,031.48"	$0.00	$0.00	$0.00	$0.00	"$2,474.75"	"$3,920.00"	"$3,959.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96822	SUP	Custom 27803010		96822  -  SHUNT 96822 DELTA ASSY REG P/L 1.0 BIO	BOTH IP/OP	"$4,949.50 "	"$3,662.63"	$0.00	"$3,959.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,673.52"	"$3,673.52"	$0.00	$0.00	"$1,031.48"	$0.00	$0.00	$0.00	$0.00	"$2,474.75"	"$3,920.00"	"$3,959.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96823	SUP	Custom 27803010		96823  -  SHUNT 96823 DELTA ASSY REG P/L 1.5 BIO	BOTH IP/OP	"$4,949.50 "	"$3,662.63"	$0.00	"$3,959.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,673.52"	"$3,673.52"	$0.00	$0.00	"$1,031.48"	$0.00	$0.00	$0.00	$0.00	"$2,474.75"	"$3,920.00"	"$3,959.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96824	SUP	Custom 27803010		96824  -  SHUNT 96824 DELTA ASSY REG P/L 2.0 BIO	BOTH IP/OP	"$5,569.38 "	"$4,121.34"	$0.00	"$4,455.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,133.59"	"$4,133.59"	$0.00	$0.00	"$1,160.66"	$0.00	$0.00	$0.00	$0.00	"$2,784.69"	"$4,410.95"	"$4,455.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97021	SUP	Custom 27203010		KIT OC KIMVENT SLF CLEAN Y CONNCTR SCT HNDL	BOTH IP/OP	$38.04 	$28.15	$0.00	$30.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.02	$30.13	$30.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98200	SUP	Custom 27203010		TRIAGE BIOSITE BNP REAGENT 2/PK	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98201	SUP	Custom 27203010		CONTROL BNP TRG BKMN SYS IMMUN	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98202	SUP	Custom 27203010		CALIBRATOR CHM BKMN SYS VRFR BNP TRG 98202	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
98433	SUP	HCPCS C1894		98433  -  KIT GASTROSTOMY 22FR 18GA DILAT INTROD NEEDLE HEMOSTAT LATEX	BOTH IP/OP	$531.70 	$393.46	$0.00	$425.36	$288.71	$288.71	$0.00	$0.00	$0.00	$110.82	$394.63	$394.63	$0.00	$0.00	$110.81	$0.00	$314.50	$314.50	$0.00	$265.85	$421.11	$425.36	$0.00		$0.00	$83.21	$0.00	$0.00	$84.65	$0.00	$0.00	$0.00	$0.00	$0.00
99102	SUP	Custom 27803010		99102  -  CATH 99102 INNERVISION BIOGLIDE	BOTH IP/OP	$729.13 	$539.56	$0.00	$583.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.16	$541.16	$0.00	$0.00	$151.95	$0.00	$0.00	$0.00	$0.00	$364.56	$577.47	$583.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99800	SUP	Custom 27203010		0099800  -  DRAIN INCS 10FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY	BOTH IP/OP	$34.88 	$25.81	$0.00	$27.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.88	$25.88	$0.00	$0.00	$7.27	$0.00	$0.00	$0.00	$0.00	$17.44	$27.62	$27.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99810	SUP	HCPCS C1729		0099810  -  DRAIN INCS 12FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY	BOTH IP/OP	$28.78 	$21.30	$0.00	$23.02	$15.62	$15.62	$0.00	$0.00	$0.00	$6.00	$21.36	$21.36	$0.00	$0.00	$6.00	$0.00	$17.02	$17.02	$0.00	$14.39	$22.79	$23.02	$0.00		$0.00	$4.50	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
99820	SUP	Custom 27203010		99820  -  TUBES T 14FR	BOTH IP/OP	$31.68 	$23.44	$0.00	$25.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.51	$23.51	$0.00	$0.00	$6.60	$0.00	$0.00	$0.00	$0.00	$15.84	$25.09	$25.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99830	SUP	Custom 27203010		99830  -  DRAIN INCS 16FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY	BOTH IP/OP	$173.25 	$128.21	$0.00	$138.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.63	$137.21	$138.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99840	SUP	HCPCS C1729		0099840  -  DRAIN INCS 18FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY	BOTH IP/OP	$28.78 	$21.30	$0.00	$23.02	$15.62	$15.62	$0.00	$0.00	$0.00	$6.00	$21.36	$21.36	$0.00	$0.00	$6.00	$0.00	$17.02	$17.02	$0.00	$14.39	$22.79	$23.02	$0.00		$0.00	$4.50	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
100100	SUP	Custom 27011340		100100  -  ROD XTRNFX LG 100MM ILZ TLSCP BSC SET SS AL PED FEM	BOTH IP/OP	"$1,686.40 "	"$1,247.94"	$0.00	"$1,349.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,251.65"	"$1,251.65"	$0.00	$0.00	$351.45	$0.00	$0.00	$0.00	$0.00	$843.20	"$1,335.63"	"$1,349.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100101	SUP	Custom 27011340		100101  -  ROD XTRNFX LG 150MM ILZ TLSCP SYS	BOTH IP/OP	"$1,686.40 "	"$1,247.94"	$0.00	"$1,349.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,251.65"	"$1,251.65"	$0.00	$0.00	$351.45	$0.00	$0.00	$0.00	$0.00	$843.20	"$1,335.63"	"$1,349.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100102	SUP	Custom 27011340		100102  -  ROD XTRNFX LG 200MM ILZ TLSCP	BOTH IP/OP	"$2,048.50 "	"$1,515.89"	$0.00	"$1,638.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,520.40"	"$1,520.40"	$0.00	$0.00	$426.91	$0.00	$0.00	$0.00	$0.00	"$1,024.25"	"$1,622.41"	"$1,638.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100103	SUP	Custom 27011340		100103  -  ROD XTRNFX LG 250MM ILZ CIRC TLSCP SS AL	BOTH IP/OP	"$2,048.50 "	"$1,515.89"	$0.00	"$1,638.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,520.40"	"$1,520.40"	$0.00	$0.00	$426.91	$0.00	$0.00	$0.00	$0.00	"$1,024.25"	"$1,622.41"	"$1,638.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100104	SUP	Custom 27011340		100104  -  ROD XTRNFX 60MM ILZ GRAD TLSCP SYS SS AL	BOTH IP/OP	"$3,145.00 "	"$2,327.30"	$0.00	"$2,516.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,334.22"	"$2,334.22"	$0.00	$0.00	$655.42	$0.00	$0.00	$0.00	$0.00	"$1,572.50"	"$2,490.84"	"$2,516.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100105	SUP	Custom 27011340		100105  -  ROD XTRNFX LG 100MM ILZ TLSCP GRAD DLX SET ADLT TIB	BOTH IP/OP	"$3,145.00 "	"$2,327.30"	$0.00	"$2,516.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,334.22"	"$2,334.22"	$0.00	$0.00	$655.42	$0.00	$0.00	$0.00	$0.00	"$1,572.50"	"$2,490.84"	"$2,516.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100106	SUP	Custom 27011340		100106  -  ROD XTRNFX 150MM ILZ GRAD TLSCP SYS SS AL	BOTH IP/OP	"$4,615.50 "	"$3,415.47"	$0.00	"$3,692.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,425.62"	"$3,425.62"	$0.00	$0.00	$961.87	$0.00	$0.00	$0.00	$0.00	"$2,307.75"	"$3,655.48"	"$3,692.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100107	SUP	Custom 27011340		100107  -  ROD XTRNFX 200MM ILZ GRAD TLSCP SYS SS AL	BOTH IP/OP	"$4,615.50 "	"$3,415.47"	$0.00	"$3,692.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,425.62"	"$3,425.62"	$0.00	$0.00	$961.87	$0.00	$0.00	$0.00	$0.00	"$2,307.75"	"$3,655.48"	"$3,692.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100108	SUP	Custom 27011340		100108  -  ROD XTRNFX 250MM ILZ GRAD TLSCP AL SS	BOTH IP/OP	"$4,615.50 "	"$3,415.47"	$0.00	"$3,692.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,425.62"	"$3,425.62"	$0.00	$0.00	$961.87	$0.00	$0.00	$0.00	$0.00	"$2,307.75"	"$3,655.48"	"$3,692.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100200	SUP	Custom 27011340		100200  -  WIRE XTRNFX ILZ BSC SET BCKL DTCH ADLT FEM SS RING	BOTH IP/OP	$826.20 	$611.39	$0.00	$660.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$613.21	$613.21	$0.00	$0.00	$172.18	$0.00	$0.00	$0.00	$0.00	$413.10	$654.35	$660.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100241	SUP	Custom 27011340		100241  -  DEVICE XTRNFX ILZ WRE FX BCKL CIRC SM BN FXTR	BOTH IP/OP	"$1,768.00 "	"$1,308.32"	$0.00	"$1,414.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,312.21"	"$1,312.21"	$0.00	$0.00	$368.45	$0.00	$0.00	$0.00	$0.00	$884.00	"$1,400.26"	"$1,414.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100250	SUP	Custom 27203010		100250  -  DEVICE XTRNFX ILZ WRE FX BCKL CIRC COMP RING	BOTH IP/OP	$911.20 	$674.29	$0.00	$728.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$676.29	$676.29	$0.00	$0.00	$189.89	$0.00	$0.00	$0.00	$0.00	$455.60	$721.67	$728.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100301	SUP	Custom 27011340		100301  -  CLAMP XTRNFX ILZ 1 HL PIN	BOTH IP/OP	$892.50 	$660.45	$0.00	$714.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$662.41	$662.41	$0.00	$0.00	$186.00	$0.00	$0.00	$0.00	$0.00	$446.25	$706.86	$714.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100302	SUP	Custom 27011340		100302  -  CLAMP XTRNFX ILZ 2 HL PIN	BOTH IP/OP	$892.50 	$660.45	$0.00	$714.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$662.41	$662.41	$0.00	$0.00	$186.00	$0.00	$0.00	$0.00	$0.00	$446.25	$706.86	$714.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100303	SUP	Custom 27011340		100303  -  CLAMP XTRNFX ILZ 3 HL PIN	BOTH IP/OP	$892.50 	$660.45	$0.00	$714.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$662.41	$662.41	$0.00	$0.00	$186.00	$0.00	$0.00	$0.00	$0.00	$446.25	$706.86	$714.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100304	SUP	Custom 27011340		100304  -  CLAMP XTRNFX ILZ 4 HL PIN	BOTH IP/OP	"$1,251.20 "	$925.89	$0.00	"$1,000.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$928.64	$928.64	$0.00	$0.00	$260.75	$0.00	$0.00	$0.00	$0.00	$625.60	$990.95	"$1,000.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100305	SUP	Custom 27011340		100305  -  CLAMP XTRNFX ILZ 5 HL PIN	BOTH IP/OP	"$1,251.20 "	$925.89	$0.00	"$1,000.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.60	$990.95	"$1,000.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100400	SUP	Custom 27011340		100400  -  PLATE XTRNFX LNG 155MM 8 HL CNCT	BOTH IP/OP	$974.10 	$720.83	$0.00	$779.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$722.98	$722.98	$0.00	$0.00	$203.00	$0.00	$0.00	$0.00	$0.00	$487.05	$771.49	$779.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100401	SUP	Custom 27011340		100401  -  PLATE XTRNFX LNG 235MM ILZ 12 HL CNCT	BOTH IP/OP	$974.10 	$720.83	$0.00	$779.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$722.98	$722.98	$0.00	$0.00	$203.00	$0.00	$0.00	$0.00	$0.00	$487.05	$771.49	$779.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100402	SUP	Custom 27011340		100402  -  PLATE XTRNFX LNG 355MM ILZ 17 HL CNCT SYS	BOTH IP/OP	"$1,184.90 "	$876.83	$0.00	$947.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.43	$879.43	$0.00	$0.00	$246.93	$0.00	$0.00	$0.00	$0.00	$592.45	$938.44	$947.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100409	SUP	Custom 27011340		100409  -  PLATE XTRNFX LNG 72MM ILZ 5 HL SM BN FXTR SET	BOTH IP/OP	$873.80 	$646.61	$0.00	$699.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$648.53	$648.53	$0.00	$0.00	$182.10	$0.00	$0.00	$0.00	$0.00	$436.90	$692.05	$699.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100412	SUP	Custom 27011340		100412  -  PLATE XTRNFX LNG 102MM ILZ 7 HL SM BN FXTR SET	BOTH IP/OP	$958.80 	$709.51	$0.00	$767.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$711.62	$711.62	$0.00	$0.00	$199.81	$0.00	$0.00	$0.00	$0.00	$479.40	$759.37	$767.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100415	SUP	Custom 27011340		100415  -  PLATE XTRNFX LNG 72MM ILZ 9 HL SM BN FXTR SET	BOTH IP/OP	"$1,014.90 "	$751.03	$0.00	$811.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$753.26	$753.26	$0.00	$0.00	$211.51	$0.00	$0.00	$0.00	$0.00	$507.45	$803.80	$811.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100418	SUP	Custom 27011340		100418  -  PLATE XTRNFX LNG 162MM ILZ 11 HL SM BN FXTR SET	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$816.42	$816.42	$0.00	$0.00	$229.24	$0.00	$0.00	$0.00	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100420	SUP	Custom 27011340		100420  -  PLATE XTRNFX LNG 155MM ILZ 8 HL CNCT CIRC COMP CFBR EPOXY	BOTH IP/OP	"$1,214.00 "	$898.36	$0.00	$971.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.03	$901.03	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$607.00	$961.49	$971.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100421	SUP	Custom 27011340		100421  -  PLATE XTRNFX LNG 235MM ILZ 12 HL CNCT CIRC COMP CFBR EPOXY	BOTH IP/OP	"$1,214.00 "	$898.36	$0.00	$971.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.03	$901.03	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$607.00	$961.49	$971.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100422	SUP	Custom 27011340		100422  -  PLATE XTRNFX LNG 335MM ILZ 17 HL CNCT CIRC COMP CFBR EPOXY	BOTH IP/OP	"$1,354.00 "	"$1,001.96"	$0.00	"$1,083.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,004.94"	"$1,004.94"	$0.00	$0.00	$282.17	$0.00	$0.00	$0.00	$0.00	$677.00	"$1,072.37"	"$1,083.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100500	SUP	Custom 27011340		100500  -  PLATE XTRNFX 135MM ILZ 5 HL CNCT THRD END	BOTH IP/OP	"$1,079.50 "	$798.83	$0.00	$863.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$801.20	$801.20	$0.00	$0.00	$224.97	$0.00	$0.00	$0.00	$0.00	$539.75	$854.96	$863.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100501	SUP	Custom 27011340		100501  -  PLATE XTRNFX 175MM ILZ 7 HL CNCT SYS THRD END	BOTH IP/OP	"$1,079.50 "	$798.83	$0.00	$863.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$801.20	$801.20	$0.00	$0.00	$224.97	$0.00	$0.00	$0.00	$0.00	$539.75	$854.96	$863.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100502	SUP	Custom 27011340		100502  -  PLATE XTRNFX 215MM ILZ 9 HL CNCT CIRC THRD END	BOTH IP/OP	"$1,380.40 "	"$1,021.50"	$0.00	"$1,104.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.53"	"$1,024.53"	$0.00	$0.00	$287.68	$0.00	$0.00	$0.00	$0.00	$690.20	"$1,093.28"	"$1,104.32"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100503	SUP	Custom 27011340		100503  -  PLATE XTRNFX 255MM ILZ 11 HL CNCT THRD END SS ADLT TIB	BOTH IP/OP	"$1,416.00 "	"$1,047.84"	$0.00	"$1,132.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.00	"$1,121.47"	"$1,132.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100550	SUP	HCPCS C1713		100550  -  BOLT XTRNFX 8MM ILZ CNCT SS ADLT	BOTH IP/OP	$16.15 	$11.95	$0.00	$12.92	$7.27	$7.27	$0.00	$0.00	$0.00	$3.37	$11.99	$11.99	$0.00	$0.00	$3.37	$0.00	$9.55	$9.55	$0.00	$8.08	$12.79	$12.92	$0.00		$0.00	$2.53	$0.00	$0.00	$2.57	$0.00	$0.00	$0.00	$0.00	$0.00
100600	SUP	Custom 27203010		100600  -  BOLT XTRNFX ILZ CNN WRE FEM	BOTH IP/OP	$143.83 	$106.43	$0.00	$115.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.75	$106.75	$0.00	$0.00	$29.97	$0.00	$0.00	$0.00	$0.00	$71.91	$113.91	$115.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100601	SUP	Custom 27011340		100601  -  BOLT XTRNFX ILZ CNN WRE CIRC THRD HD	BOTH IP/OP	$223.20 	$165.17	$0.00	$178.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.66	$165.66	$0.00	$0.00	$46.51	$0.00	$0.00	$0.00	$0.00	$111.60	$176.77	$178.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100613	SUP	Custom 27011340		100613  -  BOLT XTRNFX 3MM ILZ .5 PIN CIRC	BOTH IP/OP	$740.00 	$547.60	$0.00	$592.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.23	$549.23	$0.00	$0.00	$154.22	$0.00	$0.00	$0.00	$0.00	$370.00	$586.08	$592.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100614	SUP	Custom 27011340		100614  -  BOLT XTRNFX 4MM ILZ .5 PIN CIRC	BOTH IP/OP	$740.00 	$547.60	$0.00	$592.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.23	$549.23	$0.00	$0.00	$154.22	$0.00	$0.00	$0.00	$0.00	$370.00	$586.08	$592.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100615	SUP	Custom 27011340		100615  -  BOLT XTRNFX CRC 5MM ILZ HLF PIN	BOTH IP/OP	$672.00 	$497.28	$0.00	$537.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$498.76	$498.76	$0.00	$0.00	$140.04	$0.00	$0.00	$0.00	$0.00	$336.00	$532.22	$537.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100616	SUP	Custom 27011340		100616  -  BOLT XTRNFX CRC 6MM ILZ HLF PIN	BOTH IP/OP	$740.00 	$547.60	$0.00	$592.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$370.00	$586.08	$592.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
100700	SUP	HCPCS C1713		100700  -  BOLT XTRNFX ILZ SLOT WRE BSC SET FEM	BOTH IP/OP	$161.85 	$119.77	$0.00	$129.48	$72.83	$72.83	$0.00	$0.00	$0.00	$33.73	$120.13	$120.13	$0.00	$0.00	$33.73	$0.00	$95.73	$95.73	$0.00	$80.93	$128.19	$129.48	$0.00		$0.00	$25.33	$0.00	$0.00	$25.77	$0.00	$0.00	$0.00	$0.00	$0.00
100819	SUP	HCPCS C1713		100819  -  PLATE XTRNFX SHRT 27MM 2 HL CNCT CIRC SM BN	BOTH IP/OP	$484.50 	$358.53	$0.00	$387.60	$218.03	$218.03	$0.00	$0.00	$0.00	$100.98	$359.60	$359.60	$0.00	$0.00	$100.97	$0.00	$286.58	$286.58	$0.00	$242.25	$383.72	$387.60	$0.00		$0.00	$75.82	$0.00	$0.00	$77.13	$0.00	$0.00	$0.00	$0.00	$0.00
100822	SUP	HCPCS C1713		100822  -  PLATE XTRNFX SHRT 37MM 3 HL CNCT CIRC SM BN	BOTH IP/OP	$564.40 	$417.66	$0.00	$451.52	$253.98	$253.98	$0.00	$0.00	$0.00	$117.64	$418.90	$418.90	$0.00	$0.00	$117.62	$0.00	$333.84	$333.84	$0.00	$282.20	$447.00	$451.52	$0.00		$0.00	$88.33	$0.00	$0.00	$89.85	$0.00	$0.00	$0.00	$0.00	$0.00
100825	SUP	HCPCS C1713		100825  -  PLATE XTRNFX SHRT 47MM 4 HL CNCT CIRC SM BN	BOTH IP/OP	$600.10 	$444.07	$0.00	$480.08	$270.05	$270.05	$0.00	$0.00	$0.00	$125.08	$445.39	$445.39	$0.00	$0.00	$125.06	$0.00	$354.96	$354.96	$0.00	$300.05	$475.28	$480.08	$0.00		$0.00	$93.92	$0.00	$0.00	$95.54	$0.00	$0.00	$0.00	$0.00	$0.00
100882	SUP	HCPCS C1713		100882  -  SPACER XTRNFX 20MM SM BN FXTR	BOTH IP/OP	$511.70 	$378.66	$0.00	$409.36	$230.27	$230.27	$0.00	$0.00	$0.00	$106.65	$379.78	$379.78	$0.00	$0.00	$106.64	$0.00	$302.67	$302.67	$0.00	$255.85	$405.27	$409.36	$0.00		$0.00	$80.08	$0.00	$0.00	$81.46	$0.00	$0.00	$0.00	$0.00	$0.00
100883	SUP	HCPCS C1713		100883  -  SPACER XTRNFX 30MM SM BN FXTR	BOTH IP/OP	$511.70 	$378.66	$0.00	$409.36	$230.27	$230.27	$0.00	$0.00	$0.00	$106.65	$379.78	$379.78	$0.00	$0.00	$106.64	$0.00	$302.67	$302.67	$0.00	$255.85	$405.27	$409.36	$0.00		$0.00	$80.08	$0.00	$0.00	$81.46	$0.00	$0.00	$0.00	$0.00	$0.00
101010	SUP	HCPCS Q4116		101010  -  GRAFT SKIN 14X5CM ALLOGRAFT NON MESHED ALLODERM ACELLULAR	BOTH IP/OP	$1.39 	$1.03	$0.00	$1.11	$0.63	$0.63	$0.00	$0.00	$0.00	$0.29	$1.03	$1.03	$0.00	$0.00	$0.29	$0.00	$0.82	$0.82	$0.00	$0.70	$1.10	$1.11	$0.00		$0.00	$0.22	$0.00	$0.00	$0.22	$0.00	$0.00	$0.00	$0.00	$0.00
101020	SUP	HCPCS Q4116		101020  -  GRAFT SKIN 12X5CM ALLOGRAFT NON MESHED ALLODERM ACELLULAR	BOTH IP/OP	$1.63 	$1.21	$0.00	$1.30	$0.73	$0.73	$0.00	$0.00	$0.00	$0.34	$1.21	$1.21	$0.00	$0.00	$0.34	$0.00	$0.96	$0.96	$0.00	$0.81	$1.29	$1.30	$0.00		$0.00	$0.25	$0.00	$0.00	$0.26	$0.00	$0.00	$0.00	$0.00	$0.00
101400	SUP	Custom 27011340		101400  -  POST EXFIX ILZ SS 2 HOLE MALE	BOTH IP/OP	$409.70 	$303.18	$0.00	$327.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$304.08	$304.08	$0.00	$0.00	$85.38	$0.00	$0.00	$0.00	$0.00	$204.85	$324.48	$327.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101401	SUP	Custom 27011340		101401  -  POST EXFIX ILZ TIB 3 HOLE MALE PED	BOTH IP/OP	$428.40 	$317.02	$0.00	$342.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.96	$317.96	$0.00	$0.00	$89.28	$0.00	$0.00	$0.00	$0.00	$214.20	$339.29	$342.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101510	SUP	HCPCS Q4116		101510  -  GRAFT SKIN 36X5MM ALLOGRAFT MESHED ALLODERM ACELLULAR DERMIS	BOTH IP/OP	$0.54 	$0.40	$0.00	$0.43	$0.24	$0.24	$0.00	$0.00	$0.00	$0.11	$0.40	$0.40	$0.00	$0.00	$0.11	$0.00	$0.32	$0.32	$0.00	$0.27	$0.43	$0.43	$0.00		$0.00	$0.08	$0.00	$0.00	$0.09	$0.00	$0.00	$0.00	$0.00	$0.00
101520	SUP	HCPCS Q4116		101520  -  GRAFT SKIN 14.5X4CM ALLOGRAFT MESHED ALLODERM ACELLULAR	BOTH IP/OP	$1.68 	$1.24	$0.00	$1.34	$0.76	$0.76	$0.00	$0.00	$0.00	$0.35	$1.25	$1.25	$0.00	$0.00	$0.35	$0.00	$0.99	$0.99	$0.00	$0.84	$1.33	$1.34	$0.00		$0.00	$0.26	$0.00	$0.00	$0.27	$0.00	$0.00	$0.00	$0.00	$0.00
101602	SUP	Custom 27011340		101602  -  HINGE XTRNFX ILZ M CNCT LOPRFL SS TIB	BOTH IP/OP	$367.20 	$271.73	$0.00	$293.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.54	$272.54	$0.00	$0.00	$76.52	$0.00	$0.00	$0.00	$0.00	$183.60	$290.82	$293.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
101804	SUP	HCPCS C1713		101804  -  PLATE XTRNFX SHRT 85MM ILZ 7 HL CNCT TIB	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
101805	SUP	HCPCS C1713		101805  -  PLATE XTRNFX SHRT 95MM ILZ 8 HL CNCT TIB	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
101806	SUP	HCPCS C1713		101806  -  PLATE XTRNFX SHRT 105MM ILZ 9 HL CNCT  TIB	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
101807	SUP	HCPCS C1713		101807  -  PLATE XTRNFX SHRT 115MM ILZ 10 HL CNCT CIRC	BOTH IP/OP	$642.60 	$475.52	$0.00	$514.08	$289.17	$289.17	$0.00	$0.00	$0.00	$133.93	$476.94	$476.94	$0.00	$0.00	$133.92	$0.00	$380.10	$380.10	$0.00	$321.30	$508.94	$514.08	$0.00		$0.00	$100.57	$0.00	$0.00	$102.30	$0.00	$0.00	$0.00	$0.00	$0.00
101900	SUP	HCPCS C1713		101900  -  PLATE BN 45MM 2 HL TWST ORTH	BOTH IP/OP	$364.00 	$269.36	$0.00	$291.20	$163.80	$163.80	$0.00	$0.00	$0.00	$75.87	$270.16	$270.16	$0.00	$0.00	$75.86	$0.00	$215.31	$215.31	$0.00	$182.00	$288.29	$291.20	$0.00		$0.00	$56.97	$0.00	$0.00	$57.95	$0.00	$0.00	$0.00	$0.00	$0.00
101901	SUP	HCPCS C1713		101901  -  PLATE XTRNFX 65MM ILZ 3 HL TWST DLX SET ADLT TIB	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
101902	SUP	HCPCS C1713		101902  -  PLATE XTRNFX 85MM ILZ 3 HL TWST DLX SET ADLT	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
102000	SUP	HCPCS C1713		102000  -  PLATE XTRNFX ILZ 3 HL CRV CIRC	BOTH IP/OP	$623.90 	$461.69	$0.00	$499.12	$280.76	$280.76	$0.00	$0.00	$0.00	$130.04	$463.06	$463.06	$0.00	$0.00	$130.02	$0.00	$369.04	$369.04	$0.00	$311.95	$494.13	$499.12	$0.00		$0.00	$97.64	$0.00	$0.00	$99.32	$0.00	$0.00	$0.00	$0.00	$0.00
102003	SUP	HCPCS Q4116		102003  -  MATRIX TISSUE THICK 2X1CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$177.50 	$131.35	$0.00	$219.00	$123.19	$123.19	$0.00	$0.00	$0.00	$37.00	$131.74	$131.74	$0.00	$0.00	$36.99	$0.00	$104.99	$104.99	$0.00	$136.88	$216.81	$219.00	$0.00		$0.00	$42.84	$0.00	$0.00	$43.58	$0.00	$0.00	$0.00	$0.00	$0.00
102007	SUP	HCPCS Q4116		102007  -  MATRIX TISSUE THIN 4X1CM ALLOGRAFT REGENERATIVE FREEZE DRIED	BOTH IP/OP	$148.13 	$109.62	$0.00	$184.00	$103.50	$103.50	$0.00	$0.00	$0.00	$30.87	$109.94	$109.94	$0.00	$0.00	$30.87	$0.00	$87.62	$87.62	$0.00	$115.00	$182.16	$184.00	$0.00		$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
102009	SUP	HCPCS Q4116		102009  -  GRAFT SKIN 4X2CM ALLOGRAFT ALLODERM ACELLULAR DERMIS	BOTH IP/OP	$65.00 	$48.10	$0.00	$80.75	$45.42	$45.42	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$50.47	$79.94	$80.75	$0.00		$0.00	$15.80	$0.00	$0.00	$16.07	$0.00	$0.00	$0.00	$0.00	$0.00
102010	SUP	HCPCS Q4116		102010  -  MATRIX TISSUE THIN 4X2CM ALLOGRAFT REGENERATIVE FREEZE DRIED	BOTH IP/OP	"$1,030.00 "	$762.20	$0.00	"$1,280.00"	$720.00	$720.00	$0.00	$0.00	$0.00	$214.68	$764.47	$764.47	$0.00	$0.00	$214.65	$0.00	$609.25	$609.25	$0.00	$800.00	"$1,267.20"	"$1,280.00"	$0.00		$0.00	$250.40	$0.00	$0.00	$254.72	$0.00	$0.00	$0.00	$0.00	$0.00
102012	SUP	HCPCS Q4116		102012  -  MATRIX TISSUE THICK 4X2CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$128.75 	$95.28	$0.00	$160.00	$90.00	$90.00	$0.00	$0.00	$0.00	$26.83	$95.56	$95.56	$0.00	$0.00	$26.83	$0.00	$76.16	$76.16	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
102016	SUP	HCPCS Q4116		102016  -  ALLODERM IMPLANTABLE	BOTH IP/OP	"$12,497.50 "	"$9,248.15"	$0.00	"$9,998.00"	"$5,623.88"	"$5,623.88"	$0.00	$0.00	$0.00	"$2,604.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,604.48"	$0.00	"$6,161.27"	"$6,161.27"	$0.00	"$6,248.75"	"$9,898.02"	"$9,998.00"	$0.00		$0.00	"$1,955.86"	$0.00	$0.00	"$1,989.60"	$0.00	$0.00	$0.00	$0.00	$0.00
102020	SUP	HCPCS Q4116		102020  -  MATRIX TISSUE MEDIUM 7X3CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$83.45 	$61.75	$0.00	$103.52	$58.23	$58.23	$0.00	$0.00	$0.00	$17.39	$61.94	$61.94	$0.00	$0.00	$17.39	$0.00	$49.36	$49.36	$0.00	$64.70	$102.48	$103.52	$0.00		$0.00	$20.25	$0.00	$0.00	$20.60	$0.00	$0.00	$0.00	$0.00	$0.00
102021	SUP	HCPCS Q4116		102021  -  MATRIX TISSUE THICK 7X3CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$83.45 	$61.75	$0.00	$103.52	$58.23	$58.23	$0.00	$0.00	$0.00	$17.39	$61.94	$61.94	$0.00	$0.00	$17.39	$0.00	$49.36	$49.36	$0.00	$64.70	$102.48	$103.52	$0.00		$0.00	$20.25	$0.00	$0.00	$20.60	$0.00	$0.00	$0.00	$0.00	$0.00
102031	SUP	HCPCS Q4116		102031  -  MATRIX TISSUE THIN 7X4CM ALLOGRAFT REGENERATIVE FREEZE DRIED	BOTH IP/OP	$32.59 	$24.12	$0.00	$40.50	$22.78	$22.78	$0.00	$0.00	$0.00	$6.79	$24.19	$24.19	$0.00	$0.00	$6.79	$0.00	$19.28	$19.28	$0.00	$25.31	$40.10	$40.50	$0.00		$0.00	$7.92	$0.00	$0.00	$8.06	$0.00	$0.00	$0.00	$0.00	$0.00
102033	SUP	HCPCS Q4116		102033  -  MATRIX TISSUE MEDIUM 7X4CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$64.73 	$47.90	$0.00	$80.43	$45.24	$45.24	$0.00	$0.00	$0.00	$13.49	$48.04	$48.04	$0.00	$0.00	$13.49	$0.00	$38.29	$38.29	$0.00	$50.27	$79.63	$80.43	$0.00		$0.00	$15.73	$0.00	$0.00	$16.01	$0.00	$0.00	$0.00	$0.00	$0.00
102034	SUP	HCPCS Q4116		102034  -  MATRIX TISSUE THICK 7X4CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$64.73 	$47.90	$0.00	$80.43	$45.24	$45.24	$0.00	$0.00	$0.00	$13.49	$48.04	$48.04	$0.00	$0.00	$13.49	$0.00	$38.29	$38.29	$0.00	$50.27	$79.63	$80.43	$0.00		$0.00	$15.73	$0.00	$0.00	$16.01	$0.00	$0.00	$0.00	$0.00	$0.00
102049	SUP	HCPCS Q4116		102049  -  MATRIX TISSUE MEDIUM 12X4CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$104.11 	$77.04	$0.00	$83.29	$46.85	$46.85	$0.00	$0.00	$0.00	$21.70	$77.27	$77.27	$0.00	$0.00	$21.70	$0.00	$61.58	$61.58	$0.00	$52.06	$82.46	$83.29	$0.00		$0.00	$16.29	$0.00	$0.00	$16.58	$0.00	$0.00	$0.00	$0.00	$0.00
102050	SUP	HCPCS Q4116		102050  -  MATRIX TISSUE THICK 12X4CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
102061	SUP	HCPCS Q4116		102061  -  MATRIX TISSUE MEDIUM 10X5CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$64.55 	$47.77	$0.00	$80.16	$45.09	$45.09	$0.00	$0.00	$0.00	$13.45	$47.91	$47.91	$0.00	$0.00	$13.45	$0.00	$38.18	$38.18	$0.00	$50.10	$79.36	$80.16	$0.00		$0.00	$15.68	$0.00	$0.00	$15.95	$0.00	$0.00	$0.00	$0.00	$0.00
102062	SUP	HCPCS Q4116		102062  -  MATRIX TISSUE THICK 10X5CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	"$3,227.50 "	"$2,388.35"	$0.00	"$4,008.00"	"$2,254.50"	"$2,254.50"	$0.00	$0.00	$0.00	$672.69	"$2,395.45"	"$2,395.45"	$0.00	$0.00	$672.61	$0.00	"$1,591.16"	"$1,591.16"	$0.00	"$2,505.00"	"$3,967.92"	"$4,008.00"	$0.00		$0.00	$784.07	$0.00	$0.00	$797.59	$0.00	$0.00	$0.00	$0.00	$0.00
102071	SUP	HCPCS Q4116		102071  -  MATRIX TISSUE MEDIUM 12X6CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$70.80 	$52.39	$0.00	$56.64	$31.86	$31.86	$0.00	$0.00	$0.00	$14.76	$52.55	$52.55	$0.00	$0.00	$14.75	$0.00	$41.88	$41.88	$0.00	$35.40	$56.07	$56.64	$0.00		$0.00	$11.08	$0.00	$0.00	$11.27	$0.00	$0.00	$0.00	$0.00	$0.00
102072	SUP	HCPCS Q4116		102072  -  MATRIX TISSUE THICK 12X6CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$188.80 	$139.71	$0.00	$140.13	$31.86	$31.86	$0.00	$0.00	$0.00	$0.00	$140.13	$140.13	$0.00	$0.00	$39.35	$0.00	$41.88	$41.88	$0.00	$35.40	$56.07	$56.64	$0.00		$0.00	$11.08	$0.00	$0.00	$11.27	$0.00	$0.00	$0.00	$0.00	$0.00
102081	SUP	HCPCS Q4116		102081  -  MATRIX TISSUE MEDIUM 16X4CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$78.09 	$57.79	$0.00	$62.47	$35.14	$35.14	$0.00	$0.00	$0.00	$16.28	$57.96	$57.96	$0.00	$0.00	$16.27	$0.00	$46.19	$46.19	$0.00	$39.04	$61.85	$62.47	$0.00		$0.00	$12.22	$0.00	$0.00	$12.43	$0.00	$0.00	$0.00	$0.00	$0.00
102082	SUP	HCPCS Q4116		102082  -  MATRIX TISSUE THICK 16X4CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$867.50 	$641.95	$0.00	$643.86	$35.14	$35.14	$0.00	$0.00	$0.00	$0.00	$643.86	$643.86	$0.00	$0.00	$180.79	$0.00	$46.19	$46.19	$0.00	$39.04	$61.85	$62.47	$0.00		$0.00	$12.22	$0.00	$0.00	$12.43	$0.00	$0.00	$0.00	$0.00	$0.00
102096	SUP	HCPCS Q4116		102096  -  MATRIX TISSUE THICK 12X8CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$78.10 	$57.79	$0.00	$62.48	$35.14	$35.14	$0.00	$0.00	$0.00	$16.28	$57.97	$57.97	$0.00	$0.00	$16.28	$0.00	$46.20	$46.20	$0.00	$39.05	$61.86	$62.48	$0.00		$0.00	$12.22	$0.00	$0.00	$12.43	$0.00	$0.00	$0.00	$0.00	$0.00
102102	SUP	Custom 27203010		102102 - WIRE XTRNFX 1.8MM 370MM NS ILZ BYNT PNT DLX SET SS TIB	BOTH IP/OP	$208.50 	$154.29	$0.00	$166.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.75	$154.75	$0.00	$0.00	$43.45	$0.00	$0.00	$0.00	$0.00	$104.25	$165.13	$166.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
102128	SUP	HCPCS Q4116		102128  -  MATRIX TISSUE THICK 16X8CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$78.11 	$57.80	$0.00	$62.48	$35.15	$35.15	$0.00	$0.00	$0.00	$16.28	$57.97	$57.97	$0.00	$0.00	$16.28	$0.00	$46.20	$46.20	$0.00	$39.05	$61.86	$62.48	$0.00		$0.00	$12.22	$0.00	$0.00	$12.43	$0.00	$0.00	$0.00	$0.00	$0.00
102132	SUP	HCPCS C1760		CLIP HLF PIN CIRC DISC ILZ EXFIXA 4	BOTH IP/OP	$4.65 	$3.44	$0.00	$3.72	$2.09	$2.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.33	$3.68	$3.72	$0.00		$0.00	$0.73	$0.00	$0.00	$0.74	$0.00	$0.00	$0.00	$0.00	$0.00
102144	SUP	HCPCS Q4116		102144  -  MATRIX TISSUE THICK 12X12CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$68.23 	$50.49	$0.00	$84.69	$47.64	$47.64	$0.00	$0.00	$0.00	$14.22	$50.64	$50.64	$0.00	$0.00	$14.22	$0.00	$40.36	$40.36	$0.00	$52.93	$83.85	$84.69	$0.00		$0.00	$16.57	$0.00	$0.00	$16.85	$0.00	$0.00	$0.00	$0.00	$0.00
102196	SUP	HCPCS Q4116		102196  -  MATRIX TISSUE THICK 16X6CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$78.10 	$57.79	$0.00	$62.48	$35.14	$35.14	$0.00	$0.00	$0.00	$16.28	$57.97	$57.97	$0.00	$0.00	$16.28	$0.00	$46.20	$46.20	$0.00	$39.05	$61.86	$62.48	$0.00		$0.00	$12.22	$0.00	$0.00	$12.43	$0.00	$0.00	$0.00	$0.00	$0.00
102302	SUP	HCPCS C1713		102302  -  SET XTRNFX 100MM ILZ THRD ROD ADLT TIB	BOTH IP/OP	$109.60 	$81.10	$0.00	$87.68	$49.32	$49.32	$0.00	$0.00	$0.00	$22.84	$81.35	$81.35	$0.00	$0.00	$22.84	$0.00	$64.83	$64.83	$0.00	$54.80	$86.80	$87.68	$0.00		$0.00	$17.15	$0.00	$0.00	$17.45	$0.00	$0.00	$0.00	$0.00	$0.00
102303	SUP	HCPCS C1713		102303  -  ROD EXFIX 120MM ILZ TIB THRD DLX SET ADLT	BOTH IP/OP	$109.60 	$81.10	$0.00	$87.68	$49.32	$49.32	$0.00	$0.00	$0.00	$22.84	$81.35	$81.35	$0.00	$0.00	$22.84	$0.00	$64.83	$64.83	$0.00	$54.80	$86.80	$87.68	$0.00		$0.00	$17.15	$0.00	$0.00	$17.45	$0.00	$0.00	$0.00	$0.00	$0.00
102304	SUP	HCPCS C1713		102304  -  ROD XTRNFX 150MM ILZ THRD DLX SET SS ADLT TIB	BOTH IP/OP	$109.60 	$81.10	$0.00	$87.68	$49.32	$49.32	$0.00	$0.00	$0.00	$22.84	$81.35	$81.35	$0.00	$0.00	$22.84	$0.00	$64.83	$64.83	$0.00	$54.80	$86.80	$87.68	$0.00		$0.00	$17.15	$0.00	$0.00	$17.45	$0.00	$0.00	$0.00	$0.00	$0.00
102320	SUP	HCPCS Q4116		102320  -  MATRIX TISSUE THICK 20X16CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$78.12 	$57.81	$0.00	$62.49	$35.15	$35.15	$0.00	$0.00	$0.00	$16.28	$57.98	$57.98	$0.00	$0.00	$16.28	$0.00	$46.21	$46.21	$0.00	$39.06	$61.87	$62.49	$0.00		$0.00	$12.23	$0.00	$0.00	$12.44	$0.00	$0.00	$0.00	$0.00	$0.00
102600	SUP	HCPCS C1713		102600  -  WASHER XTRNFX THK3MM 14MM ILZ SLT BSC SET ADLT FEM	BOTH IP/OP	$65.40 	$48.40	$0.00	$52.32	$29.43	$29.43	$0.00	$0.00	$0.00	$13.63	$48.54	$48.54	$0.00	$0.00	$13.63	$0.00	$38.68	$38.68	$0.00	$32.70	$51.80	$52.32	$0.00		$0.00	$10.24	$0.00	$0.00	$10.41	$0.00	$0.00	$0.00	$0.00	$0.00
102701	SUP	HCPCS C1713		102701  -  WASHER XTRNFX 2MM 14MM ILZ BSC SET ADLT TIB	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$13.50	$13.50	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
102706	SUP	HCPCS C1713		102706  -  WASHER XTRNFX THK2MM ILZ BOLT	BOTH IP/OP	$65.40 	$48.40	$0.00	$52.32	$29.43	$29.43	$0.00	$0.00	$0.00	$13.63	$48.54	$48.54	$0.00	$0.00	$13.63	$0.00	$38.68	$38.68	$0.00	$32.70	$51.80	$52.32	$0.00		$0.00	$10.24	$0.00	$0.00	$10.41	$0.00	$0.00	$0.00	$0.00	$0.00
102707	SUP	HCPCS C1713		102707  -  WASHER XTRNFX THK4MM ILZ BOLT	BOTH IP/OP	$65.40 	$48.40	$0.00	$52.32	$29.43	$29.43	$0.00	$0.00	$0.00	$13.63	$48.54	$48.54	$0.00	$0.00	$13.63	$0.00	$38.68	$38.68	$0.00	$32.70	$51.80	$52.32	$0.00		$0.00	$10.24	$0.00	$0.00	$10.41	$0.00	$0.00	$0.00	$0.00	$0.00
102715	SUP	HCPCS C1713		102715  -  WASHER XTRNFX THK1MM 1MM CIRC SM BN FXTR	BOTH IP/OP	$45.90 	$33.97	$0.00	$36.72	$20.66	$20.66	$0.00	$0.00	$0.00	$9.57	$34.07	$34.07	$0.00	$0.00	$9.57	$0.00	$27.15	$27.15	$0.00	$22.95	$36.35	$36.72	$0.00		$0.00	$7.18	$0.00	$0.00	$7.31	$0.00	$0.00	$0.00	$0.00	$0.00
102718	SUP	HCPCS C1713		102718  -  WASHER XTRNFX THK1.5MM 1.5MM CIRC SM BN FXTR	BOTH IP/OP	$45.90 	$33.97	$0.00	$36.72	$20.66	$20.66	$0.00	$0.00	$0.00	$9.57	$34.07	$34.07	$0.00	$0.00	$9.57	$0.00	$27.15	$27.15	$0.00	$22.95	$36.35	$36.72	$0.00		$0.00	$7.18	$0.00	$0.00	$7.31	$0.00	$0.00	$0.00	$0.00	$0.00
102721	SUP	HCPCS C1713		102721  -  WASHER XTRNFX THK3MM SLT SM BN FXTR	BOTH IP/OP	$86.30 	$63.86	$0.00	$69.04	$38.84	$38.84	$0.00	$0.00	$0.00	$17.99	$64.05	$64.05	$0.00	$0.00	$17.98	$0.00	$51.05	$51.05	$0.00	$43.15	$68.35	$69.04	$0.00		$0.00	$13.51	$0.00	$0.00	$13.74	$0.00	$0.00	$0.00	$0.00	$0.00
103044	SUP	Custom 27203010		103044  -  BIT DRL 2.7MM STRL ILZ SHNK CMPNT SET DISP RNCH SYS	BOTH IP/OP	"$1,023.40 "	$757.32	$0.00	$818.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$759.57	$759.57	$0.00	$0.00	$213.28	$0.00	$0.00	$0.00	$0.00	$511.70	$810.53	$818.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103045	SUP	Custom 27203010		103045  -  BIT DRL 3.8MM STRL ILZ SHNK CMPNT SET DISP RNCH SYS	BOTH IP/OP	"$1,023.40 "	$757.32	$0.00	$818.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$759.57	$759.57	$0.00	$0.00	$213.28	$0.00	$0.00	$0.00	$0.00	$511.70	$810.53	$818.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103201	SUP	HCPCS C1713		103201  -  BOLT XTRNFX UNV 16MM ILZ CMPS BSC SET CIRC CNCT HNG SS ADLT	BOTH IP/OP	$0.81 	$0.60	$0.00	$12.92	$7.27	$7.27	$0.00	$0.00	$0.00	$0.17	$0.60	$0.60	$0.00	$0.00	$0.17	$0.00	$0.48	$0.48	$0.00	$8.08	$12.79	$12.92	$0.00		$0.00	$2.53	$0.00	$0.00	$2.57	$0.00	$0.00	$0.00	$0.00	$0.00
103301	SUP	HCPCS C1713		103301  -  NUT XTRNFX THK5MM 10MM 6MM ILZ THRD INS HEX SS NYL	BOTH IP/OP	$77.20 	$57.13	$0.00	$61.76	$34.74	$34.74	$0.00	$0.00	$0.00	$16.09	$57.30	$57.30	$0.00	$0.00	$16.09	$0.00	$45.66	$45.66	$0.00	$38.60	$61.14	$61.76	$0.00		$0.00	$12.08	$0.00	$0.00	$12.29	$0.00	$0.00	$0.00	$0.00	$0.00
103313	SUP	HCPCS C1713		103313  -  NUT XTRNFX 3ANG SM BN FXTR	BOTH IP/OP	$409.70 	$303.18	$0.00	$327.76	$184.37	$184.37	$0.00	$0.00	$0.00	$85.39	$304.08	$304.08	$0.00	$0.00	$85.38	$0.00	$242.34	$242.34	$0.00	$204.85	$324.48	$327.76	$0.00		$0.00	$64.12	$0.00	$0.00	$65.22	$0.00	$0.00	$0.00	$0.00	$0.00
103406	SUP	HCPCS C1776		103406  -  SLEEVE XTRNFX 6MM ILZ CENTERING	BOTH IP/OP	$406.30 	$300.66	$0.00	$325.04	$182.84	$182.84	$0.00	$0.00	$0.00	$84.68	$301.56	$301.56	$0.00	$0.00	$84.67	$0.00	$240.33	$240.33	$0.00	$203.15	$321.79	$325.04	$0.00		$0.00	$63.59	$0.00	$0.00	$64.68	$0.00	$0.00	$0.00	$0.00	$0.00
103452	SUP	HCPCS C1713		103452  -  CUBE XTRNFX ILZ 2 HL SS RNCH SYS	BOTH IP/OP	$578.00 	$427.72	$0.00	$462.40	$260.10	$260.10	$0.00	$0.00	$0.00	$120.47	$428.99	$428.99	$0.00	$0.00	$120.46	$0.00	$341.89	$341.89	$0.00	$289.00	$457.78	$462.40	$0.00		$0.00	$90.46	$0.00	$0.00	$92.02	$0.00	$0.00	$0.00	$0.00	$0.00
103453	SUP	HCPCS C1713		103453  -  CUBE EXFIX UNIVERSAL 3 HOLE COMPONENT SET HINGE COMPASS	BOTH IP/OP	$668.00 	$494.32	$0.00	$534.40	$300.60	$300.60	$0.00	$0.00	$0.00	$139.23	$495.79	$495.79	$0.00	$0.00	$139.21	$0.00	$395.12	$395.12	$0.00	$334.00	$529.06	$534.40	$0.00		$0.00	$104.54	$0.00	$0.00	$106.35	$0.00	$0.00	$0.00	$0.00	$0.00
103454	SUP	Custom 27203010		103454  -  CUBE XTRNFX ILZ 4 HL SS RNCH SYS	BOTH IP/OP	$686.80 	$508.23	$0.00	$549.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$509.74	$509.74	$0.00	$0.00	$143.13	$0.00	$0.00	$0.00	$0.00	$343.40	$543.95	$549.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103455	SUP	HCPCS C1713		CUBE 5 HOLE CIRC EXFIXA RNCH SYS	BOTH IP/OP	$758.20 	$561.07	$0.00	$562.74	$217.09	$217.09	$0.00	$0.00	$0.00	$0.00	$562.74	$562.74	$0.00	$0.00	$158.01	$0.00	$0.00	$0.00	$0.00	$241.21	$382.08	$385.94	$0.00		$0.00	$75.50	$0.00	$0.00	$76.80	$0.00	$0.00	$0.00	$0.00	$0.00
106132	SUP	HCPCS C1713		106132  -  BLADE SW DMD 800X.64X.54MM	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
106133	SUP	HCPCS C1713		106133  -  SAW 0106133 DIAMOND 0.81 0.91MM X 800MM	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
108280	SUP	Custom 27203010		108280  -  DOPPLER VASC 8MHZ STRL PRB DISP	BOTH IP/OP	$374.38 	$277.04	$0.00	$299.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$277.86	$277.86	$0.00	$0.00	$78.02	$0.00	$0.00	$0.00	$0.00	$187.19	$296.51	$299.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-00	SUP	Custom 27803010		01-2200  -  HEAD FEMORAL MORSE TAPER LFIT HIP	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$1,436.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	$0.00	$0.00	$0.00	$897.50	"$1,421.64"	"$1,436.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-00	SUP	Custom 27803010		06-2200  -  HEAD FEM +0MM OFST CTPR 22MM STRL LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110021	SUP	Custom 27203010		110021  -  BIT DRL 6.3MM AMBI PRFR	BOTH IP/OP	$200.55 	$148.41	$0.00	$160.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.85	$148.85	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$100.28	$158.84	$160.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110107	SUP	HCPCS C1713		110107  -  SCREW SET CLLS FRM	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$49.95	$49.95	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00		$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
110242	SUP	Custom 27203010		110242  -  BIT DRL 2.7MM STRL COLE TWST RDLCNT	BOTH IP/OP	$635.63 	$470.37	$0.00	$508.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$471.76	$471.76	$0.00	$0.00	$132.46	$0.00	$0.00	$0.00	$0.00	$317.81	$503.42	$508.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110244	SUP	Custom 27203010		110244  -  BIT DRL 3.5MM STRL COLE TWST RDLCNT	BOTH IP/OP	$635.63 	$470.37	$0.00	$508.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$471.76	$471.76	$0.00	$0.00	$132.46	$0.00	$0.00	$0.00	$0.00	$317.81	$503.42	$508.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110245	SUP	Custom 27203010		110245  -  BIT DRL 4MM COLE RDLCNT	BOTH IP/OP	$635.63 	$470.37	$0.00	$508.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$471.76	$471.76	$0.00	$0.00	$132.46	$0.00	$0.00	$0.00	$0.00	$317.81	$503.42	$508.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110246	SUP	Custom 27203010		110246  -  BIT DRL 4.8MM COLE RDLCNT	BOTH IP/OP	$635.63 	$470.37	$0.00	$508.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$471.76	$471.76	$0.00	$0.00	$132.46	$0.00	$0.00	$0.00	$0.00	$317.81	$503.42	$508.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110300	SUP	HCPCS C1713		110300  -  SCREW 110300  BABY CD SELF BRKNG	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
110675	SUP	Custom 27203010		110675  -  PASSER SUT 6.1IN BLK STRL LF 3.6CM SWNSN WIRELOOP ATCL SS	BOTH IP/OP	$199.70 	$147.78	$0.00	$159.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.22	$148.22	$0.00	$0.00	$41.62	$0.00	$0.00	$0.00	$0.00	$99.85	$158.16	$159.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111250	SUP	HCPCS C1762		111250  -  GRAFT SOFT TISSUE 1-2MM 50MM ALLOGRAFT AXONAL REGENERATION	BOTH IP/OP	"$11,165.00 "	"$8,262.10"	$0.00	"$8,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,327.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,326.79"	$0.00	"$5,504.35"	"$5,504.35"	$0.00	"$5,062.50"	"$8,019.00"	"$8,100.00"	$0.00		$0.00	"$1,584.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-05	SUP	Custom 27803010		01-2205  -  HEAD FEMORAL +5MM 22MM MORSE TAPERED LFIT COCR HIP	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$1,436.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	$0.00	$0.00	$0.00	$897.50	"$1,421.64"	"$1,436.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-05	SUP	Custom 27803010		06-2205  -  HEAD FEM +5MM OFST CTPR 22MM STRL LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
111630	SUP	HCPCS C1713		111630  -  PIN FX SM DUNN-DAUTREY STRPR UNCMP	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
111640	SUP	HCPCS C1713		111640  -  PIN FX 4MM 170MM STRL KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
111650	SUP	HCPCS C1776		111650  -  KIT THR STRL FEM/TIB CKPNT KT KN	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$174.38	$174.38	$0.00	$0.00	$0.00	$80.76	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$229.21	$229.21	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$60.64	$0.00	$0.00	$61.69	$0.00	$0.00	$0.00	$0.00	$0.00
111651	SUP	HCPCS C1776		111651  -  COMPONENT FEM STRL TIB CKPNT KN	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$54.00	$54.00	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$0.00	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00		$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
111652	SUP	HCPCS C1776		111652  -  COMPONENT FEM STRL FEM CKPNT KN	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$92.25	$92.25	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
111655	SUP	HCPCS C1713		111655  -  SCREW BN STRL VA CORT	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$298.13	$298.13	$0.00	$0.00	$0.00	$138.08	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$391.87	$391.87	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$103.68	$0.00	$0.00	$105.47	$0.00	$0.00	$0.00	$0.00	$0.00
111670	SUP	HCPCS C1713		111670  -  PIN ORTH 3.2MM 80MM STRL KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
111680	SUP	HCPCS C1713		111680  -  PIN FX 4MM 80MM STRL KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-06	SUP	HCPCS C1713		1-2206  -  SPACER SPNL 6MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS	BOTH IP/OP	"$7,632.00 "	"$5,647.68"	$0.00	"$6,105.60"	"$3,434.40"	"$3,434.40"	$0.00	$0.00	$0.00	"$1,590.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,590.51"	$0.00	"$3,762.58"	"$3,762.58"	$0.00	"$3,816.00"	"$6,044.54"	"$6,105.60"	$0.00		$0.00	"$1,194.41"	$0.00	$0.00	"$1,215.01"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-08	SUP	HCPCS C1713		1-2208  -  SPACER SPNL 8MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS	BOTH IP/OP	"$7,632.00 "	"$5,647.68"	$0.00	"$6,105.60"	"$3,434.40"	"$3,434.40"	$0.00	$0.00	$0.00	"$1,590.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,590.51"	$0.00	"$3,762.58"	"$3,762.58"	$0.00	"$3,816.00"	"$6,044.54"	"$6,105.60"	$0.00		$0.00	"$1,194.41"	$0.00	$0.00	"$1,215.01"	$0.00	$0.00	$0.00	$0.00	$0.00
112640	SUP	HCPCS C1781		0112640  -  MESH SURG 4X1IN PATCH FLAT SHEET KNIT MARLEX GROIN HERN	BOTH IP/OP	$118.25 	$87.51	$0.00	$94.60	$53.21	$53.21	$0.00	$0.00	$0.00	$24.65	$87.77	$87.77	$0.00	$0.00	$24.64	$0.00	$69.94	$69.94	$0.00	$59.13	$93.65	$94.60	$0.00		$0.00	$18.51	$0.00	$0.00	$18.83	$0.00	$0.00	$0.00	$0.00	$0.00
112660	SUP	HCPCS C1781		112660  -  MESH HERN GROIN POLYPRO 14X10IN FLAT PTCH KNTD MRLX STRL	BOTH IP/OP	"$1,350.00 "	$999.00	$0.00	"$1,080.00"	$607.50	$607.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$675.00	"$1,069.20"	"$1,080.00"	$0.00		$0.00	$211.28	$0.00	$0.00	$214.92	$0.00	$0.00	$0.00	$0.00	$0.00
112727	SUP	Custom 27203010		112727  -  SCREW XTRNFX SPTL FRM HXFX SET SS	BOTH IP/OP	$33.83 	$25.03	$0.00	$27.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.10	$25.10	$0.00	$0.00	$7.05	$0.00	$0.00	$0.00	$0.00	$16.91	$26.79	$27.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
112960	SUP	HCPCS C1781		0112960  -  PLUG SURG MEDIUM TAPER 1.55X1.3IN MONOFILAMENT NONABSORBABLE	BOTH IP/OP	$725.75 	$537.06	$0.00	$589.31	$331.49	$331.49	$0.00	$0.00	$0.00	$151.26	$538.65	$538.65	$0.00	$0.00	$151.25	$0.00	$429.28	$429.28	$0.00	$368.32	$583.42	$589.31	$0.00		$0.00	$115.28	$0.00	$0.00	$117.27	$0.00	$0.00	$0.00	$0.00	$0.00
112970	SUP	HCPCS C1781		0112970  -  MESH SRG LG 1.9IN 1.6IN STRL BARD PRFX PLG MFL PLT EDG PP	BOTH IP/OP	$732.25 	$541.87	$0.00	"$2,118.08"	$334.46	$334.46	$0.00	$0.00	$0.00	$152.62	$543.48	$543.48	$0.00	$0.00	$152.60	$0.00	"$2,118.08"	"$2,118.08"	$0.00	$371.62	$588.64	$594.59	$0.00		$0.00	$116.32	$0.00	$0.00	$118.32	$0.00	$0.00	$0.00	$0.00	$0.00
112970	SUP	HCPCS C1781		112970  -  MESH SURG LARGE 1.9IN 1.6IN PLUG MONOFILAMENT PERFIX POLYPRO	BOTH IP/OP	$732.25 	$541.87	$0.00	"$2,706.86"	$334.46	$334.46	$0.00	$0.00	$0.00	$152.62	$543.48	$543.48	$0.00	$0.00	$152.60	$0.00	"$2,118.08"	"$2,118.08"	$0.00	$371.62	"$2,706.86"	$594.59	$0.00		$0.00	$116.32	$0.00	$0.00	$118.32	$0.00	$0.00	$0.00	$0.00	$0.00
112980	SUP	HCPCS C1781		0112980  -  MESH SURG XL 2X1.6IN NONABSORBABLE PLUG TAPERED MARLEX	BOTH IP/OP	$849.25 	$628.45	$0.00	$679.40	$382.16	$382.16	$0.00	$0.00	$0.00	$177.00	$630.31	$630.31	$0.00	$0.00	$176.98	$0.00	$502.33	$502.33	$0.00	$424.63	$672.61	$679.40	$0.00		$0.00	$132.91	$0.00	$0.00	$135.20	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-10	SUP	HCPCS C1713		1-2210  -  SPACER SPNL 10MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS	BOTH IP/OP	"$7,632.00 "	"$5,647.68"	$0.00	"$6,105.60"	"$3,434.40"	"$3,434.40"	$0.00	$0.00	$0.00	"$1,590.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,590.51"	$0.00	"$3,762.58"	"$3,762.58"	$0.00	"$3,816.00"	"$6,044.54"	"$6,105.60"	$0.00		$0.00	"$1,194.41"	$0.00	$0.00	"$1,215.01"	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-10	SUP	Custom 27803010		06-2210  -  HEAD FEM +10MM OFST CTPR 22MM STRL LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-12	SUP	HCPCS C1713		1-2212  -  SPACER SPNL 12MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS	BOTH IP/OP	"$7,632.00 "	"$5,647.68"	$0.00	"$6,105.60"	"$3,434.40"	"$3,434.40"	$0.00	$0.00	$0.00	"$1,590.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,590.51"	$0.00	"$3,762.58"	"$3,762.58"	$0.00	"$3,816.00"	"$6,044.54"	"$6,105.60"	$0.00		$0.00	"$1,194.41"	$0.00	$0.00	"$1,215.01"	$0.00	$0.00	$0.00	$0.00	$0.00
114153	SUP	HCPCS C1880		114153  -  CATHETER SCT KT 2 LUM COIL XTD LGTH	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$90.00	$90.00	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
114156	SUP	HCPCS C1788		114156  -  SET HMDIAL 33ML LF AQDX BLD CRCT UF-500	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-14	SUP	HCPCS C1713		1-2214  -  SPACER SPNL 14MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS	BOTH IP/OP	"$7,632.00 "	"$5,647.68"	$0.00	"$6,105.60"	"$3,434.40"	"$3,434.40"	$0.00	$0.00	$0.00	"$1,590.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,590.51"	$0.00	"$3,762.58"	"$3,762.58"	$0.00	"$3,816.00"	"$6,044.54"	"$6,105.60"	$0.00		$0.00	"$1,194.41"	$0.00	$0.00	"$1,215.01"	$0.00	$0.00	$0.00	$0.00	$0.00
116240	SUP	HCPCS C1713		116240  -  SCREW BN STRL CORT	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$298.13	$298.13	$0.00	$0.00	$0.00	$138.08	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$391.87	$391.87	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$103.68	$0.00	$0.00	$105.47	$0.00	$0.00	$0.00	$0.00	$0.00
120019	SUP	HCPCS C1713		120019  -  BUTTON SUT 19MM STRL LF HWSN 4 HL HD PE LGMNT DISP	BOTH IP/OP	$310.40 	$229.70	$0.00	$248.32	$139.68	$139.68	$0.00	$0.00	$0.00	$64.70	$230.38	$230.38	$0.00	$0.00	$64.69	$0.00	$183.60	$183.60	$0.00	$155.20	$245.84	$248.32	$0.00		$0.00	$48.58	$0.00	$0.00	$49.42	$0.00	$0.00	$0.00	$0.00	$0.00
121100	SUP	HCPCS C1713		121100  -  SCREW BN STD 12.7MM 9MM 55MM STRL 21MM AMBI CLS LG CMPR SS	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121101	SUP	HCPCS C1713		121101  -  SCREW BN STD 9MM .5MM 60MM CLS AMBI IMHS LG THRD HIP	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121102	SUP	HCPCS C1713		121102  -  SCREW BN STD 12.7MM 9MM 65MM STRL 21MM AMBI CLS LG CMPR SS	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121103	SUP	HCPCS C1713		121103  -  SCREW BN STD 9MM .5MM 70MM CLS AMBI IMHS LG THRD HIP	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121104	SUP	HCPCS C1713		121104  -  SCREW BN STD 12.7MM 9MM 75MM STRL 21MM AMBI IMHS CLS LG CMPR	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121105	SUP	HCPCS C1713		121105  -  SCREW BN STD 12.7MM 9MM 80MM STRL 21MM AMBI IMHS CLS LG CMPR	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121106	SUP	HCPCS C1713		121106  -  SCREW BN P/T 12.7MM 9MM 85MM 21MM AMBI CHS IMHS STD LG HIP	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121107	SUP	HCPCS C1713		121107  -  SCREW BN P/T 12.7MM 9MM 90MM 21MM AMBI CHS IMHS STD LG HIP	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121108	SUP	HCPCS C1713		121108  -  SCREW BN 12.7MM 9MM 95MM 21MM AMBI CHS STD LG SS HIP	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121109	SUP	HCPCS C1713		121109  -  SCREW BN STD 12.7MM 9MM 100MM STRL 21MM AMBI IMHS CLS LG	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121110	SUP	HCPCS C1713		121110  -  SCREW BN 12.7MM 9MM 105MM 21MM AMBI CHS STD LG SS HIP	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121111	SUP	HCPCS C1713		121111  -  SCREW BN STD .5IN 9MM 110MM 21MM IMHS LG HIP SP CNDL PLT	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121112	SUP	HCPCS C1713		121112  -  SCREW BN STD .5IN 9MM 115MM 21MM AMBI CLS IMHS LG	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121116	SUP	HCPCS C1713		121116  -  SCREW BN HEX 3.5MM 19MM AMBI IMHS CLS CMPR SS HIP SP CNDL IM	BOTH IP/OP	$199.40 	$147.56	$0.00	$159.52	$89.73	$89.73	$0.00	$0.00	$0.00	$41.56	$147.99	$147.99	$0.00	$0.00	$41.55	$0.00	$117.95	$117.95	$0.00	$99.70	$157.92	$159.52	$0.00		$0.00	$31.21	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
121117	SUP	HCPCS C1713		121117  -  SCREW BN HEX 3.5MM 28.5MM AMBI IMHS CLS CMPR SS HIP SP CNDL	BOTH IP/OP	$199.40 	$147.56	$0.00	$159.52	$89.73	$89.73	$0.00	$0.00	$0.00	$41.56	$147.99	$147.99	$0.00	$0.00	$41.55	$0.00	$117.95	$117.95	$0.00	$99.70	$157.92	$159.52	$0.00		$0.00	$31.21	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
121120	SUP	HCPCS C1713		121120  -  PLATE BN 130D STD BRL 60MM 38.1MM AMBI 2 HL SS HIP	BOTH IP/OP	"$1,081.50 "	$800.31	$0.00	$865.20	$486.68	$486.68	$0.00	$0.00	$0.00	$225.41	$802.69	$802.69	$0.00	$0.00	$225.38	$0.00	$639.71	$639.71	$0.00	$540.75	$856.55	$865.20	$0.00		$0.00	$169.25	$0.00	$0.00	$172.17	$0.00	$0.00	$0.00	$0.00	$0.00
121121	SUP	HCPCS C1713		121121  -  PLATE BN 135D STD BRL 60MM 38.1MM AMBI 2 HL CMPR SS HIP	BOTH IP/OP	"$1,081.50 "	$800.31	$0.00	$865.20	$486.68	$486.68	$0.00	$0.00	$0.00	$225.41	$802.69	$802.69	$0.00	$0.00	$225.38	$0.00	$639.71	$639.71	$0.00	$540.75	$856.55	$865.20	$0.00		$0.00	$169.25	$0.00	$0.00	$172.17	$0.00	$0.00	$0.00	$0.00	$0.00
121122	SUP	HCPCS C1713		121122  -  PLATE BN 140D STD BRL 60MM 38.1MM AMBI 2 HL CMPR SS HIP	BOTH IP/OP	"$1,081.50 "	$800.31	$0.00	$865.20	$486.68	$486.68	$0.00	$0.00	$0.00	$225.41	$802.69	$802.69	$0.00	$0.00	$225.38	$0.00	$639.71	$639.71	$0.00	$540.75	$856.55	$865.20	$0.00		$0.00	$169.25	$0.00	$0.00	$172.17	$0.00	$0.00	$0.00	$0.00	$0.00
121123	SUP	HCPCS C1713		121123  -  PLATE BN 145D STD BRL 60MM 38.1MM AMBI 2 HL SS HIP	BOTH IP/OP	"$1,081.50 "	$800.31	$0.00	$865.20	$486.68	$486.68	$0.00	$0.00	$0.00	$225.41	$802.69	$802.69	$0.00	$0.00	$225.38	$0.00	$639.71	$639.71	$0.00	$540.75	$856.55	$865.20	$0.00		$0.00	$169.25	$0.00	$0.00	$172.17	$0.00	$0.00	$0.00	$0.00	$0.00
121124	SUP	HCPCS C1713		121124  -  PLATE BN 150D STD BRL 60MM 38.1MM AMBI 2 HL CMPR SS HIP	BOTH IP/OP	"$1,081.50 "	$800.31	$0.00	$865.20	$486.68	$486.68	$0.00	$0.00	$0.00	$225.41	$802.69	$802.69	$0.00	$0.00	$225.38	$0.00	$639.71	$639.71	$0.00	$540.75	$856.55	$865.20	$0.00		$0.00	$169.25	$0.00	$0.00	$172.17	$0.00	$0.00	$0.00	$0.00	$0.00
121125	SUP	HCPCS C1713		121125  -  PLATE BN 130D STD BRL 80MM 38.1MM AMBI 3 HL CMPR SS HIP	BOTH IP/OP	"$1,113.00 "	$823.62	$0.00	$890.40	$500.85	$500.85	$0.00	$0.00	$0.00	$231.98	$826.07	$826.07	$0.00	$0.00	$231.95	$0.00	$658.34	$658.34	$0.00	$556.50	$881.50	$890.40	$0.00		$0.00	$174.18	$0.00	$0.00	$177.19	$0.00	$0.00	$0.00	$0.00	$0.00
121126	SUP	HCPCS C1713		121126  -  PLATE BN 135D STD BRL 80MM 38.1MM AMBI 3 HL CMPR SS HIP	BOTH IP/OP	"$1,113.00 "	$823.62	$0.00	$890.40	$500.85	$500.85	$0.00	$0.00	$0.00	$231.98	$826.07	$826.07	$0.00	$0.00	$231.95	$0.00	$658.34	$658.34	$0.00	$556.50	$881.50	$890.40	$0.00		$0.00	$174.18	$0.00	$0.00	$177.19	$0.00	$0.00	$0.00	$0.00	$0.00
121127	SUP	HCPCS C1713		121127  -  PLATE BN 140D STD BRL 80MM 38.1MM AMBI 3 HL CMPR HIP	BOTH IP/OP	"$1,113.00 "	$823.62	$0.00	$890.40	$500.85	$500.85	$0.00	$0.00	$0.00	$231.98	$826.07	$826.07	$0.00	$0.00	$231.95	$0.00	$658.34	$658.34	$0.00	$556.50	$881.50	$890.40	$0.00		$0.00	$174.18	$0.00	$0.00	$177.19	$0.00	$0.00	$0.00	$0.00	$0.00
121128	SUP	HCPCS C1713		121128  -  PLATE BN 145D STD BRL 80MM 38.1MM AMBI 3 HL CMPR HIP	BOTH IP/OP	"$1,113.00 "	$823.62	$0.00	$890.40	$500.85	$500.85	$0.00	$0.00	$0.00	$231.98	$826.07	$826.07	$0.00	$0.00	$231.95	$0.00	$658.34	$658.34	$0.00	$556.50	$881.50	$890.40	$0.00		$0.00	$174.18	$0.00	$0.00	$177.19	$0.00	$0.00	$0.00	$0.00	$0.00
121130	SUP	HCPCS C1713		121130  -  PLATE BN 130D STD BRL 100MM 38.1MM AMBI 4 HL CMPR SS HIP	BOTH IP/OP	"$1,113.00 "	$823.62	$0.00	$890.40	$500.85	$500.85	$0.00	$0.00	$0.00	$231.98	$826.07	$826.07	$0.00	$0.00	$231.95	$0.00	$658.34	$658.34	$0.00	$556.50	$881.50	$890.40	$0.00		$0.00	$174.18	$0.00	$0.00	$177.19	$0.00	$0.00	$0.00	$0.00	$0.00
121131	SUP	HCPCS C1713		121131  -  PLATE BN 135D STD BRL 135MM 38.1MM AMBI 4 HL CMPR SS HIP	BOTH IP/OP	"$1,113.00 "	$823.62	$0.00	$890.40	$500.85	$500.85	$0.00	$0.00	$0.00	$231.98	$826.07	$826.07	$0.00	$0.00	$231.95	$0.00	$658.34	$658.34	$0.00	$556.50	$881.50	$890.40	$0.00		$0.00	$174.18	$0.00	$0.00	$177.19	$0.00	$0.00	$0.00	$0.00	$0.00
121135	SUP	HCPCS C1713		121135  -  PLATE BN 130D STD BRL 120MM 38.1MM AMBI CHS 5 HL SS HIP	BOTH IP/OP	"$1,191.75 "	$881.90	$0.00	$953.40	$536.29	$536.29	$0.00	$0.00	$0.00	$248.39	$884.52	$884.52	$0.00	$0.00	$248.36	$0.00	$704.92	$704.92	$0.00	$595.88	$943.87	$953.40	$0.00		$0.00	$186.51	$0.00	$0.00	$189.73	$0.00	$0.00	$0.00	$0.00	$0.00
121137	SUP	HCPCS C1713		121137  -  PLATE BN 140D STD BRL 120MM 38.1MM AMBI 5 HL HIP	BOTH IP/OP	"$1,191.75 "	$881.90	$0.00	$953.40	$536.29	$536.29	$0.00	$0.00	$0.00	$248.39	$884.52	$884.52	$0.00	$0.00	$248.36	$0.00	$704.92	$704.92	$0.00	$595.88	$943.87	$953.40	$0.00		$0.00	$186.51	$0.00	$0.00	$189.73	$0.00	$0.00	$0.00	$0.00	$0.00
121138	SUP	HCPCS C1713		121138  -  PLATE BN 145D STD BRL 120MM 38.1MM AMBI 5 HL CMPR SS HIP	BOTH IP/OP	"$1,191.75 "	$881.90	$0.00	$953.40	$536.29	$536.29	$0.00	$0.00	$0.00	$248.39	$884.52	$884.52	$0.00	$0.00	$248.36	$0.00	$704.92	$704.92	$0.00	$595.88	$943.87	$953.40	$0.00		$0.00	$186.51	$0.00	$0.00	$189.73	$0.00	$0.00	$0.00	$0.00	$0.00
121139	SUP	HCPCS C1713		121139  -  PLATE BN 150D STD BRL 120MM 38.1MM AMBI 5 HL CMPR SS HIP	BOTH IP/OP	"$1,191.75 "	$881.90	$0.00	$953.40	$536.29	$536.29	$0.00	$0.00	$0.00	$248.39	$884.52	$884.52	$0.00	$0.00	$248.36	$0.00	$704.92	$704.92	$0.00	$595.88	$943.87	$953.40	$0.00		$0.00	$186.51	$0.00	$0.00	$189.73	$0.00	$0.00	$0.00	$0.00	$0.00
121141	SUP	HCPCS C1713		121141  -  PLATE BN 135D STD BRL 140MM 38.1MM AMBI 6 HL CMPR SS HIP	BOTH IP/OP	"$1,239.00 "	$916.86	$0.00	$991.20	$557.55	$557.55	$0.00	$0.00	$0.00	$258.24	$919.59	$919.59	$0.00	$0.00	$258.21	$0.00	$732.87	$732.87	$0.00	$619.50	$981.29	$991.20	$0.00		$0.00	$193.90	$0.00	$0.00	$197.25	$0.00	$0.00	$0.00	$0.00	$0.00
121143	SUP	HCPCS C1713		121143  -  PLATE BN 145D STD BRL 140MM 38.1MM AMBI 6 HL CMPR SS HIP	BOTH IP/OP	"$1,239.00 "	$916.86	$0.00	$991.20	$557.55	$557.55	$0.00	$0.00	$0.00	$258.24	$919.59	$919.59	$0.00	$0.00	$258.21	$0.00	$732.87	$732.87	$0.00	$619.50	$981.29	$991.20	$0.00		$0.00	$193.90	$0.00	$0.00	$197.25	$0.00	$0.00	$0.00	$0.00	$0.00
121144	SUP	HCPCS C1713		121144  -  PLATE BN 150D STD BRL 140MM 38.1MM AMBI 6 HL CMPR SS HIP	BOTH IP/OP	"$1,239.00 "	$916.86	$0.00	$991.20	$557.55	$557.55	$0.00	$0.00	$0.00	$258.24	$919.59	$919.59	$0.00	$0.00	$258.21	$0.00	$732.87	$732.87	$0.00	$619.50	$981.29	$991.20	$0.00		$0.00	$193.90	$0.00	$0.00	$197.25	$0.00	$0.00	$0.00	$0.00	$0.00
121145	SUP	HCPCS C1713		121145  -  PLATE BN 130D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP	BOTH IP/OP	"$1,501.50 "	"$1,111.11"	$0.00	"$1,201.20"	$675.68	$675.68	$0.00	$0.00	$0.00	$312.95	"$1,114.41"	"$1,114.41"	$0.00	$0.00	$312.91	$0.00	$888.14	$888.14	$0.00	$750.75	"$1,189.19"	"$1,201.20"	$0.00		$0.00	$234.98	$0.00	$0.00	$239.04	$0.00	$0.00	$0.00	$0.00	$0.00
121147	SUP	HCPCS C1713		121147  -  PLATE BN 140D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP	BOTH IP/OP	"$1,501.50 "	"$1,111.11"	$0.00	"$1,201.20"	$675.68	$675.68	$0.00	$0.00	$0.00	$312.95	"$1,114.41"	"$1,114.41"	$0.00	$0.00	$312.91	$0.00	$888.14	$888.14	$0.00	$750.75	"$1,189.19"	"$1,201.20"	$0.00		$0.00	$234.98	$0.00	$0.00	$239.04	$0.00	$0.00	$0.00	$0.00	$0.00
121148	SUP	HCPCS C1713		121148  -  PLATE BN 145D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP	BOTH IP/OP	"$1,501.50 "	"$1,111.11"	$0.00	"$1,201.20"	$675.68	$675.68	$0.00	$0.00	$0.00	$312.95	"$1,114.41"	"$1,114.41"	$0.00	$0.00	$312.91	$0.00	$888.14	$888.14	$0.00	$750.75	"$1,189.19"	"$1,201.20"	$0.00		$0.00	$234.98	$0.00	$0.00	$239.04	$0.00	$0.00	$0.00	$0.00	$0.00
121149	SUP	HCPCS C1713		121149  -  PLATE BN 150D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP	BOTH IP/OP	"$1,501.50 "	"$1,111.11"	$0.00	"$1,201.20"	$675.68	$675.68	$0.00	$0.00	$0.00	$312.95	"$1,114.41"	"$1,114.41"	$0.00	$0.00	$312.91	$0.00	$888.14	$888.14	$0.00	$750.75	"$1,189.19"	"$1,201.20"	$0.00		$0.00	$234.98	$0.00	$0.00	$239.04	$0.00	$0.00	$0.00	$0.00	$0.00
121150	SUP	HCPCS C1713		121150  -  PLATE BN 130D STD BRL 220MM 38.1MM AMBI 10 HL SS HIP	BOTH IP/OP	"$1,758.75 "	"$1,301.48"	$0.00	"$1,407.00"	$791.44	$791.44	$0.00	$0.00	$0.00	$366.57	"$1,305.34"	"$1,305.34"	$0.00	$0.00	$366.52	$0.00	"$1,040.30"	"$1,040.30"	$0.00	$879.38	"$1,392.93"	"$1,407.00"	$0.00		$0.00	$275.24	$0.00	$0.00	$279.99	$0.00	$0.00	$0.00	$0.00	$0.00
121152	SUP	HCPCS C1713		121152  -  PLATE BN 140D STD BRL 220MM 1.5IN AMBI 10 HL SS HIP	BOTH IP/OP	"$1,758.75 "	"$1,301.48"	$0.00	"$1,407.00"	$791.44	$791.44	$0.00	$0.00	$0.00	$366.57	"$1,305.34"	"$1,305.34"	$0.00	$0.00	$366.52	$0.00	"$1,040.30"	"$1,040.30"	$0.00	$879.38	"$1,392.93"	"$1,407.00"	$0.00		$0.00	$275.24	$0.00	$0.00	$279.99	$0.00	$0.00	$0.00	$0.00	$0.00
121153	SUP	HCPCS C1713		121153  -  PLATE BN 145D STD BRL 180MM 38.1MM AMBI 10 HL CMPR SS HIP	BOTH IP/OP	"$1,758.75 "	"$1,301.48"	$0.00	"$1,407.00"	$791.44	$791.44	$0.00	$0.00	$0.00	$366.57	"$1,305.34"	"$1,305.34"	$0.00	$0.00	$366.52	$0.00	"$1,040.30"	"$1,040.30"	$0.00	$879.38	"$1,392.93"	"$1,407.00"	$0.00		$0.00	$275.24	$0.00	$0.00	$279.99	$0.00	$0.00	$0.00	$0.00	$0.00
121154	SUP	HCPCS C1713		121154  -  PLATE BN 150D STD BRL 220MM 38.1MM AMBI 10 HL CMPR SS HIP	BOTH IP/OP	"$1,758.75 "	"$1,301.48"	$0.00	"$1,407.00"	$791.44	$791.44	$0.00	$0.00	$0.00	$366.57	"$1,305.34"	"$1,305.34"	$0.00	$0.00	$366.52	$0.00	"$1,040.30"	"$1,040.30"	$0.00	$879.38	"$1,392.93"	"$1,407.00"	$0.00		$0.00	$275.24	$0.00	$0.00	$279.99	$0.00	$0.00	$0.00	$0.00	$0.00
121156	SUP	HCPCS C1713		121156  -  PLATE BN 135D STD BRL 260MM 38.1MM AMBI 12 HL CMPR SS HIP	BOTH IP/OP	"$1,879.50 "	"$1,390.83"	$0.00	"$1,503.60"	$845.78	$845.78	$0.00	$0.00	$0.00	$391.73	"$1,394.96"	"$1,394.96"	$0.00	$0.00	$391.69	$0.00	"$1,111.72"	"$1,111.72"	$0.00	$939.75	"$1,488.56"	"$1,503.60"	$0.00		$0.00	$294.14	$0.00	$0.00	$299.22	$0.00	$0.00	$0.00	$0.00	$0.00
121158	SUP	HCPCS C1713		121158  -  PLATE BN 145D STD BRL 260MM 38.1MM AMBI 12 HL CMPR SS HIP	BOTH IP/OP	"$1,879.50 "	"$1,390.83"	$0.00	"$1,503.60"	$845.78	$845.78	$0.00	$0.00	$0.00	$391.73	"$1,394.96"	"$1,394.96"	$0.00	$0.00	$391.69	$0.00	"$1,111.72"	"$1,111.72"	$0.00	$939.75	"$1,488.56"	"$1,503.60"	$0.00		$0.00	$294.14	$0.00	$0.00	$299.22	$0.00	$0.00	$0.00	$0.00	$0.00
121159	SUP	HCPCS C1713		121159  -  PLATE BN 150D STD BRL 260MM 38.1MM AMBI 12 HL CMPR HIP	BOTH IP/OP	$889.35 	$658.12	$0.00	$711.48	$400.21	$400.21	$0.00	$0.00	$0.00	$185.36	$660.08	$660.08	$0.00	$0.00	$185.34	$0.00	$526.05	$526.05	$0.00	$444.68	$704.37	$711.48	$0.00		$0.00	$139.18	$0.00	$0.00	$141.58	$0.00	$0.00	$0.00	$0.00	$0.00
121161	SUP	HCPCS C1713		121161  -  PLATE BN 135D STD BRL 300MM 38.1MM AMBI 14 SLOT SS HIP	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
121165	SUP	HCPCS C1713		121165  -  PLATE BN 130D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP	BOTH IP/OP	"$1,212.75 "	$897.44	$0.00	$970.20	$545.74	$545.74	$0.00	$0.00	$0.00	$252.77	$900.10	$900.10	$0.00	$0.00	$252.74	$0.00	$717.34	$717.34	$0.00	$606.38	$960.50	$970.20	$0.00		$0.00	$189.80	$0.00	$0.00	$193.07	$0.00	$0.00	$0.00	$0.00	$0.00
121166	SUP	HCPCS C1713		121166  -  PLATE BN 135D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP	BOTH IP/OP	"$1,212.75 "	$897.44	$0.00	$970.20	$545.74	$545.74	$0.00	$0.00	$0.00	$252.77	$900.10	$900.10	$0.00	$0.00	$252.74	$0.00	$717.34	$717.34	$0.00	$606.38	$960.50	$970.20	$0.00		$0.00	$189.80	$0.00	$0.00	$193.07	$0.00	$0.00	$0.00	$0.00	$0.00
121167	SUP	HCPCS C1713		121167  -  PLATE BN 140D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP	BOTH IP/OP	"$1,212.75 "	$897.44	$0.00	$970.20	$545.74	$545.74	$0.00	$0.00	$0.00	$252.77	$900.10	$900.10	$0.00	$0.00	$252.74	$0.00	$717.34	$717.34	$0.00	$606.38	$960.50	$970.20	$0.00		$0.00	$189.80	$0.00	$0.00	$193.07	$0.00	$0.00	$0.00	$0.00	$0.00
121168	SUP	HCPCS C1713		121168  -  PLATE BN 145D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP	BOTH IP/OP	"$1,212.75 "	$897.44	$0.00	$970.20	$545.74	$545.74	$0.00	$0.00	$0.00	$252.77	$900.10	$900.10	$0.00	$0.00	$252.74	$0.00	$717.34	$717.34	$0.00	$606.38	$960.50	$970.20	$0.00		$0.00	$189.80	$0.00	$0.00	$193.07	$0.00	$0.00	$0.00	$0.00	$0.00
121169	SUP	HCPCS C1713		121169  -  PLATE BN 150D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP	BOTH IP/OP	"$1,212.75 "	$897.44	$0.00	$970.20	$545.74	$545.74	$0.00	$0.00	$0.00	$252.77	$900.10	$900.10	$0.00	$0.00	$252.74	$0.00	$717.34	$717.34	$0.00	$606.38	$960.50	$970.20	$0.00		$0.00	$189.80	$0.00	$0.00	$193.07	$0.00	$0.00	$0.00	$0.00	$0.00
121176	SUP	HCPCS C1713		121176  -  SCREW BN STD .5IN 9MM 130MM 21MM AMBI CLS IMHS LG	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121177	SUP	HCPCS C1713		121177  -  SCREW BN 12.7MM 9MM 135MM 21MM IMHS CP STD LG SS HIP IM NL	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121178	SUP	HCPCS C1713		121178  -  SCREW BN 12.7MM 9MM 140MM 21MM IMHS CP STD LG SS HIP IM NL	BOTH IP/OP	$726.60 	$537.68	$0.00	$581.28	$326.97	$326.97	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$363.30	$575.47	$581.28	$0.00		$0.00	$113.71	$0.00	$0.00	$115.67	$0.00	$0.00	$0.00	$0.00	$0.00
121181	SUP	HCPCS C1713		121181  -  SCREW BN 14.3MM 9MM 60MM 21MM SPLG HIP	BOTH IP/OP	$774.90 	$573.43	$0.00	$619.92	$348.71	$348.71	$0.00	$0.00	$0.00	$161.51	$575.13	$575.13	$0.00	$0.00	$161.49	$0.00	$458.35	$458.35	$0.00	$387.45	$613.72	$619.92	$0.00		$0.00	$121.27	$0.00	$0.00	$123.36	$0.00	$0.00	$0.00	$0.00	$0.00
121191	SUP	HCPCS C1713		121191  -  SCREW BN 9/16IN 9MM 110MM 21MM AMBI CLS SPLG	BOTH IP/OP	$774.90 	$573.43	$0.00	$619.92	$348.71	$348.71	$0.00	$0.00	$0.00	$161.51	$575.13	$575.13	$0.00	$0.00	$161.49	$0.00	$458.35	$458.35	$0.00	$387.45	$613.72	$619.92	$0.00		$0.00	$121.27	$0.00	$0.00	$123.36	$0.00	$0.00	$0.00	$0.00	$0.00
121192	SUP	HCPCS C1713		121192  -  SCREW BN 14.3MM 9MM 115MM STRL 21MM AMBI CLS SPLG CMPR SS	BOTH IP/OP	$774.90 	$573.43	$0.00	$619.92	$348.71	$348.71	$0.00	$0.00	$0.00	$161.51	$575.13	$575.13	$0.00	$0.00	$161.49	$0.00	$458.35	$458.35	$0.00	$387.45	$613.72	$619.92	$0.00		$0.00	$121.27	$0.00	$0.00	$123.36	$0.00	$0.00	$0.00	$0.00	$0.00
121193	SUP	HCPCS C1713		121193  -  SCREW BN 14.3MM 9MM 120MM STRL 21MM AMBI CLS SPLG CMPR SS	BOTH IP/OP	$774.90 	$573.43	$0.00	$619.92	$348.71	$348.71	$0.00	$0.00	$0.00	$161.51	$575.13	$575.13	$0.00	$0.00	$161.49	$0.00	$458.35	$458.35	$0.00	$387.45	$613.72	$619.92	$0.00		$0.00	$121.27	$0.00	$0.00	$123.36	$0.00	$0.00	$0.00	$0.00	$0.00
121194	SUP	HCPCS C1713		121194  -  SCREW BN 14.3MM 9MM 125MM STRL 21MM AMBI CLS SPLG CMPR SS	BOTH IP/OP	$774.90 	$573.43	$0.00	$619.92	$348.71	$348.71	$0.00	$0.00	$0.00	$161.51	$575.13	$575.13	$0.00	$0.00	$161.49	$0.00	$458.35	$458.35	$0.00	$387.45	$613.72	$619.92	$0.00		$0.00	$121.27	$0.00	$0.00	$123.36	$0.00	$0.00	$0.00	$0.00	$0.00
121195	SUP	HCPCS C1713		121195  -  SCREW BN 14.3MM 9MM 130MM 21MM CHS SPLG SS HIP	BOTH IP/OP	$774.90 	$573.43	$0.00	$619.92	$348.71	$348.71	$0.00	$0.00	$0.00	$161.51	$575.13	$575.13	$0.00	$0.00	$161.49	$0.00	$458.35	$458.35	$0.00	$387.45	$613.72	$619.92	$0.00		$0.00	$121.27	$0.00	$0.00	$123.36	$0.00	$0.00	$0.00	$0.00	$0.00
121196	SUP	HCPCS C1713		121196  -  SCREW BN 14.3MM 9MM 135MM 21MM CHS SPLG SS HIP	BOTH IP/OP	$774.90 	$573.43	$0.00	$619.92	$348.71	$348.71	$0.00	$0.00	$0.00	$161.51	$575.13	$575.13	$0.00	$0.00	$161.49	$0.00	$458.35	$458.35	$0.00	$387.45	$613.72	$619.92	$0.00		$0.00	$121.27	$0.00	$0.00	$123.36	$0.00	$0.00	$0.00	$0.00	$0.00
121197	SUP	HCPCS C1713		121197  -  SCREW BN 14.3MM 9MM 140MM 21MM CHS SPLG SS HIP	BOTH IP/OP	$774.90 	$573.43	$0.00	$619.92	$348.71	$348.71	$0.00	$0.00	$0.00	$161.51	$575.13	$575.13	$0.00	$0.00	$161.49	$0.00	$458.35	$458.35	$0.00	$387.45	$613.72	$619.92	$0.00		$0.00	$121.27	$0.00	$0.00	$123.36	$0.00	$0.00	$0.00	$0.00	$0.00
121198	SUP	HCPCS C1713		121198  -  PLATE BN 130D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP	BOTH IP/OP	"$1,165.50 "	$862.47	$0.00	$932.40	$524.48	$524.48	$0.00	$0.00	$0.00	$242.92	$865.03	$865.03	$0.00	$0.00	$242.89	$0.00	$689.39	$689.39	$0.00	$582.75	$923.08	$932.40	$0.00		$0.00	$182.40	$0.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00
121199	SUP	HCPCS C1713		121199  -  PLATE BN 135D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP	BOTH IP/OP	"$1,165.50 "	$862.47	$0.00	$932.40	$524.48	$524.48	$0.00	$0.00	$0.00	$242.92	$865.03	$865.03	$0.00	$0.00	$242.89	$0.00	$689.39	$689.39	$0.00	$582.75	$923.08	$932.40	$0.00		$0.00	$182.40	$0.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00
121200	SUP	HCPCS C1713		121200  -  PLATE BN 140D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP	BOTH IP/OP	"$1,165.50 "	$862.47	$0.00	$932.40	$524.48	$524.48	$0.00	$0.00	$0.00	$242.92	$865.03	$865.03	$0.00	$0.00	$242.89	$0.00	$689.39	$689.39	$0.00	$582.75	$923.08	$932.40	$0.00		$0.00	$182.40	$0.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00
121201	SUP	HCPCS C1713		121201  -  PLATE BN 145D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP	BOTH IP/OP	"$1,165.50 "	$862.47	$0.00	$932.40	$524.48	$524.48	$0.00	$0.00	$0.00	$242.92	$865.03	$865.03	$0.00	$0.00	$242.89	$0.00	$689.39	$689.39	$0.00	$582.75	$923.08	$932.40	$0.00		$0.00	$182.40	$0.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00
121202	SUP	HCPCS C1713		121202  -  PLATE BN 150D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP	BOTH IP/OP	"$1,165.50 "	$862.47	$0.00	$932.40	$524.48	$524.48	$0.00	$0.00	$0.00	$242.92	$865.03	$865.03	$0.00	$0.00	$242.89	$0.00	$689.39	$689.39	$0.00	$582.75	$923.08	$932.40	$0.00		$0.00	$182.40	$0.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00
121410	SUP	Custom 27203010		121410  -  DEVICE BIOP 10CM 14GA MNPTY 22MM INSTR AUTO STRL DISP	BOTH IP/OP	$176.32 	$130.48	$0.00	$141.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.16	$139.65	$141.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121625	SUP	HCPCS C1713		121625  -  SCREW BN 6.5MM 25MM STRL 16MM IMSC CNN SS SP CNDL	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121626	SUP	HCPCS C1713		121626  -  SCREW BN UNV 6.5MM 30MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121627	SUP	HCPCS C1713		121627  -  SCREW BN UNV 6.5MM 35MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121628	SUP	HCPCS C1713		121628  -  SCREW BN UNV 6.5MM 40MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121629	SUP	HCPCS C1713		121629  -  SCREW BN UNV 6.5MM 45MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121630	SUP	HCPCS C1713		121630  -  SCREW BN UNV 6.5MM 50MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121631	SUP	HCPCS C1713		121631  -  SCREW BN UNV 6.5MM 55MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121632	SUP	HCPCS C1713		121632  -  SCREW BN UNV 6.5MM 60MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121633	SUP	HCPCS C1713		121633  -  SCREW BN UNV 6.5MM 65MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121634	SUP	HCPCS C1713		121634  -  SCREW BN UNV 6.5MM 70MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121635	SUP	HCPCS C1713		121635  -  SCREW BN UNV 6.5MM 75MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121636	SUP	HCPCS C1713		121636  -  SCREW BN P/T 6.5MM 4.5MM 80MM STRL 20MM CNN SS HIP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121637	SUP	HCPCS C1713		121637  -  SCREW BN UNV 6.5MM 85MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121638	SUP	HCPCS C1713		121638  -  SCREW BN 6.5MM 90MM CNN MTPHSL	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121639	SUP	HCPCS C1713		121639  -  SCREW BN UNV 6.5MM 95MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121640	SUP	HCPCS C1713		121640  -  SCREW BN 6.5MM 100MM CNN SP CNDL	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121641	SUP	HCPCS C1713		121641  -  SCREW BN UNV 6.5MM 105MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121642	SUP	HCPCS C1713		121642  -  SCREW BN UNV 6.5MM 110MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121643	SUP	HCPCS C1713		121643  -  SCREW BN UNV 6.5MM 115MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121644	SUP	HCPCS C1713		121644  -  SCREW BN UNV 6.5MM 120MM STRL 20MM IMSC CNN CMPR SS HIP SP	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
121654	SUP	HCPCS C1713		121654  -  PIN FX 30MM CNN HIP	BOTH IP/OP	$761.25 	$563.33	$0.00	$609.00	$342.56	$342.56	$0.00	$0.00	$0.00	$158.66	$565.00	$565.00	$0.00	$0.00	$158.64	$0.00	$450.28	$450.28	$0.00	$380.63	$602.91	$609.00	$0.00		$0.00	$119.14	$0.00	$0.00	$121.19	$0.00	$0.00	$0.00	$0.00	$0.00
121655	SUP	HCPCS C1713		121655  -  PIN FX 35MM CNN HIP	BOTH IP/OP	$761.25 	$563.33	$0.00	$609.00	$342.56	$342.56	$0.00	$0.00	$0.00	$158.66	$565.00	$565.00	$0.00	$0.00	$158.64	$0.00	$450.28	$450.28	$0.00	$380.63	$602.91	$609.00	$0.00		$0.00	$119.14	$0.00	$0.00	$121.19	$0.00	$0.00	$0.00	$0.00	$0.00
121656	SUP	HCPCS C1713		121656  -  PIN FX 40MM CNN HIP	BOTH IP/OP	$761.25 	$563.33	$0.00	$609.00	$342.56	$342.56	$0.00	$0.00	$0.00	$158.66	$565.00	$565.00	$0.00	$0.00	$158.64	$0.00	$450.28	$450.28	$0.00	$380.63	$602.91	$609.00	$0.00		$0.00	$119.14	$0.00	$0.00	$121.19	$0.00	$0.00	$0.00	$0.00	$0.00
121657	SUP	HCPCS C1713		121657  -  PIN FX 45MM CNN HIP	BOTH IP/OP	$761.25 	$563.33	$0.00	$609.00	$342.56	$342.56	$0.00	$0.00	$0.00	$158.66	$565.00	$565.00	$0.00	$0.00	$158.64	$0.00	$450.28	$450.28	$0.00	$380.63	$602.91	$609.00	$0.00		$0.00	$119.14	$0.00	$0.00	$121.19	$0.00	$0.00	$0.00	$0.00	$0.00
121658	SUP	HCPCS C1713		121658  -  PIN FX 50MM CNN HIP	BOTH IP/OP	$761.25 	$563.33	$0.00	$609.00	$342.56	$342.56	$0.00	$0.00	$0.00	$158.66	$565.00	$565.00	$0.00	$0.00	$158.64	$0.00	$450.28	$450.28	$0.00	$380.63	$602.91	$609.00	$0.00		$0.00	$119.14	$0.00	$0.00	$121.19	$0.00	$0.00	$0.00	$0.00	$0.00
121659	SUP	HCPCS C1713		121659  -  PIN FX 55MM CNN HIP	BOTH IP/OP	$761.25 	$563.33	$0.00	$609.00	$342.56	$342.56	$0.00	$0.00	$0.00	$158.66	$565.00	$565.00	$0.00	$0.00	$158.64	$0.00	$450.28	$450.28	$0.00	$380.63	$602.91	$609.00	$0.00		$0.00	$119.14	$0.00	$0.00	$121.19	$0.00	$0.00	$0.00	$0.00	$0.00
121660	SUP	HCPCS C1713		121660  -  PIN FX 60MM CNN HIP	BOTH IP/OP	$700.35 	$518.26	$0.00	$560.28	$315.16	$315.16	$0.00	$0.00	$0.00	$145.97	$519.80	$519.80	$0.00	$0.00	$145.95	$0.00	$414.26	$414.26	$0.00	$350.18	$554.68	$560.28	$0.00		$0.00	$109.60	$0.00	$0.00	$111.50	$0.00	$0.00	$0.00	$0.00	$0.00
121661	SUP	HCPCS C1713		121661  -  PIN FX 65MM CNN HIP	BOTH IP/OP	$700.35 	$518.26	$0.00	$560.28	$315.16	$315.16	$0.00	$0.00	$0.00	$145.97	$519.80	$519.80	$0.00	$0.00	$145.95	$0.00	$414.26	$414.26	$0.00	$350.18	$554.68	$560.28	$0.00		$0.00	$109.60	$0.00	$0.00	$111.50	$0.00	$0.00	$0.00	$0.00	$0.00
121662	SUP	HCPCS C1713		121662  -  PIN FX 6.35MM 70MM 16MM CNN HIP	BOTH IP/OP	$700.35 	$518.26	$0.00	$560.28	$315.16	$315.16	$0.00	$0.00	$0.00	$145.97	$519.80	$519.80	$0.00	$0.00	$145.95	$0.00	$414.26	$414.26	$0.00	$350.18	$554.68	$560.28	$0.00		$0.00	$109.60	$0.00	$0.00	$111.50	$0.00	$0.00	$0.00	$0.00	$0.00
121663	SUP	HCPCS C1713		121663  -  PIN FX 75MM CNN HIP	BOTH IP/OP	$700.35 	$518.26	$0.00	$560.28	$315.16	$315.16	$0.00	$0.00	$0.00	$145.97	$519.80	$519.80	$0.00	$0.00	$145.95	$0.00	$414.26	$414.26	$0.00	$350.18	$554.68	$560.28	$0.00		$0.00	$109.60	$0.00	$0.00	$111.50	$0.00	$0.00	$0.00	$0.00	$0.00
121664	SUP	HCPCS C1713		121664  -  PIN FX 6.35MM 80MM 16MM CNN HIP	BOTH IP/OP	$700.35 	$518.26	$0.00	$560.28	$315.16	$315.16	$0.00	$0.00	$0.00	$145.97	$519.80	$519.80	$0.00	$0.00	$145.95	$0.00	$414.26	$414.26	$0.00	$350.18	$554.68	$560.28	$0.00		$0.00	$109.60	$0.00	$0.00	$111.50	$0.00	$0.00	$0.00	$0.00	$0.00
121665	SUP	HCPCS C1713		121665  -  PIN FX 6.35MM 85MM 16MM CNN HIP	BOTH IP/OP	$700.35 	$518.26	$0.00	$560.28	$315.16	$315.16	$0.00	$0.00	$0.00	$145.97	$519.80	$519.80	$0.00	$0.00	$145.95	$0.00	$414.26	$414.26	$0.00	$350.18	$554.68	$560.28	$0.00		$0.00	$109.60	$0.00	$0.00	$111.50	$0.00	$0.00	$0.00	$0.00	$0.00
121666	SUP	HCPCS C1713		121666  -  PIN FX 6.35MM 90MM 16MM CNN HIP	BOTH IP/OP	$700.35 	$518.26	$0.00	$560.28	$315.16	$315.16	$0.00	$0.00	$0.00	$145.97	$519.80	$519.80	$0.00	$0.00	$145.95	$0.00	$414.26	$414.26	$0.00	$350.18	$554.68	$560.28	$0.00		$0.00	$109.60	$0.00	$0.00	$111.50	$0.00	$0.00	$0.00	$0.00	$0.00
121667	SUP	HCPCS C1713		121667  -  PIN FX 6.35MM 95MM 16MM CNN HIP	BOTH IP/OP	$700.35 	$518.26	$0.00	$560.28	$315.16	$315.16	$0.00	$0.00	$0.00	$145.97	$519.80	$519.80	$0.00	$0.00	$145.95	$0.00	$414.26	$414.26	$0.00	$350.18	$554.68	$560.28	$0.00		$0.00	$109.60	$0.00	$0.00	$111.50	$0.00	$0.00	$0.00	$0.00	$0.00
121668	SUP	HCPCS C1713		121668  -  PIN FX 6.35MM 100MM 16MM CNN HIP	BOTH IP/OP	$700.35 	$518.26	$0.00	$560.28	$315.16	$315.16	$0.00	$0.00	$0.00	$145.97	$519.80	$519.80	$0.00	$0.00	$145.95	$0.00	$414.26	$414.26	$0.00	$350.18	$554.68	$560.28	$0.00		$0.00	$109.60	$0.00	$0.00	$111.50	$0.00	$0.00	$0.00	$0.00	$0.00
121669	SUP	HCPCS C1713		121669  -  PIN FX 105MM CNN HIP	BOTH IP/OP	$700.35 	$518.26	$0.00	$560.28	$315.16	$315.16	$0.00	$0.00	$0.00	$145.97	$519.80	$519.80	$0.00	$0.00	$145.95	$0.00	$414.26	$414.26	$0.00	$350.18	$554.68	$560.28	$0.00		$0.00	$109.60	$0.00	$0.00	$111.50	$0.00	$0.00	$0.00	$0.00	$0.00
121670	SUP	HCPCS C1713		121670  -  PIN FX 6.35MM 110MM 16MM CNN HIP	BOTH IP/OP	$700.35 	$518.26	$0.00	$560.28	$315.16	$315.16	$0.00	$0.00	$0.00	$145.97	$519.80	$519.80	$0.00	$0.00	$145.95	$0.00	$414.26	$414.26	$0.00	$350.18	$554.68	$560.28	$0.00		$0.00	$109.60	$0.00	$0.00	$111.50	$0.00	$0.00	$0.00	$0.00	$0.00
121671	SUP	HCPCS C1713		121671  -  PIN FX 6.35MM 115MM 16MM CNN HIP	BOTH IP/OP	$700.35 	$518.26	$0.00	$560.28	$315.16	$315.16	$0.00	$0.00	$0.00	$145.97	$519.80	$519.80	$0.00	$0.00	$145.95	$0.00	$414.26	$414.26	$0.00	$350.18	$554.68	$560.28	$0.00		$0.00	$109.60	$0.00	$0.00	$111.50	$0.00	$0.00	$0.00	$0.00	$0.00
121672	SUP	HCPCS C1713		121672  -  PIN FX 6.86MM 115MM STRL 16MM CNN HEX HD SS HIP	BOTH IP/OP	$761.25 	$563.33	$0.00	$609.00	$342.56	$342.56	$0.00	$0.00	$0.00	$158.66	$565.00	$565.00	$0.00	$0.00	$158.64	$0.00	$450.28	$450.28	$0.00	$380.63	$602.91	$609.00	$0.00		$0.00	$119.14	$0.00	$0.00	$121.19	$0.00	$0.00	$0.00	$0.00	$0.00
121673	SUP	HCPCS C1713		121673  -  PIN FX 125MM CNN HIP	BOTH IP/OP	$761.25 	$563.33	$0.00	$609.00	$342.56	$342.56	$0.00	$0.00	$0.00	$158.66	$565.00	$565.00	$0.00	$0.00	$158.64	$0.00	$450.28	$450.28	$0.00	$380.63	$602.91	$609.00	$0.00		$0.00	$119.14	$0.00	$0.00	$121.19	$0.00	$0.00	$0.00	$0.00	$0.00
121674	SUP	HCPCS C1713		121674  -  PIN FX 130MM CNN HIP	BOTH IP/OP	$761.25 	$563.33	$0.00	$609.00	$342.56	$342.56	$0.00	$0.00	$0.00	$158.66	$565.00	$565.00	$0.00	$0.00	$158.64	$0.00	$450.28	$450.28	$0.00	$380.63	$602.91	$609.00	$0.00		$0.00	$119.14	$0.00	$0.00	$121.19	$0.00	$0.00	$0.00	$0.00	$0.00
121675	SUP	HCPCS C1713		121675  -  PIN FX 135MM CNN HIP	BOTH IP/OP	$761.25 	$563.33	$0.00	$609.00	$342.56	$342.56	$0.00	$0.00	$0.00	$158.66	$565.00	$565.00	$0.00	$0.00	$158.64	$0.00	$450.28	$450.28	$0.00	$380.63	$602.91	$609.00	$0.00		$0.00	$119.14	$0.00	$0.00	$121.19	$0.00	$0.00	$0.00	$0.00	$0.00
121680	SUP	HCPCS C1713		121680  -  WASHER ORTH UNV 12.7MM 6.5MM 1MM STRL SET SS 6.5MM CNN SCR	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$71.10	$71.10	$0.00	$0.00	$0.00	$32.93	$117.27	$117.27	$0.00	$0.00	$32.93	$0.00	$93.46	$93.46	$0.00	$79.00	$125.14	$126.40	$0.00		$0.00	$24.73	$0.00	$0.00	$25.15	$0.00	$0.00	$0.00	$0.00	$0.00
121810	SUP	HCPCS C1713		121810  -  SCREW BN 2.5MM FLUT 4MM 6MM 10MM STRL 5MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121812	SUP	HCPCS C1713		121812  -  SCREW BN 2.5MM FLUT 4MM 6MM 12MM STRL 5MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121814	SUP	HCPCS C1713		121814  -  SCREW BN 2.5MM FLUT 4MM 6MM 14MM STRL 5MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121816	SUP	HCPCS C1713		121816  -  SCREW BN 2.5MM FLUT 4MM 6MM 16MM STRL 6MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121818	SUP	HCPCS C1713		121818  -  SCREW BN 2.5MM FLUT 4MM 6MM 18MM STRL 7MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121820	SUP	HCPCS C1713		121820  -  SCREW BN 2.5MM FLUT 4MM 6MM 20MM STRL 8MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121822	SUP	HCPCS C1713		121822  -  SCREW BN 2.5MM FLUT 4MM 6MM 22MM STRL 9MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121824	SUP	HCPCS C1713		121824  -  SCREW BN 2.5MM FLUT 4MM 6MM 24MM STRL 10MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121826	SUP	HCPCS C1713		121826  -  SCREW BN 2.5MM FLUT 4MM 6MM 26MM STRL 12MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121828	SUP	HCPCS C1713		121828  -  SCREW BN 2.5MM FLUT 4MM 6MM 28MM STRL 14MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121830	SUP	HCPCS C1713		121830  -  SCREW BN 2.5MM FLUT 4MM 6MM 30MM STRL 14MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121832	SUP	HCPCS C1713		121832  -  SCREW BN 2.5MM FLUT 4MM 6MM 32MM STRL 14MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121834	SUP	HCPCS C1713		121834  -  SCREW BN 2.5MM FLUT 4MM 6MM 34MM STRL 14MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121836	SUP	HCPCS C1713		121836  -  SCREW BN 2.5MM FLUT 4MM 6MM 36MM STRL 14MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121838	SUP	HCPCS C1713		121838  -  SCREW BN 2.5MM FLUT 4MM 6MM 38MM STRL 14MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121840	SUP	HCPCS C1713		121840  -  SCREW BN 2.5MM FLUT 4MM 6MM 40MM STRL 14MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121842	SUP	HCPCS C1713		121842  -  SCREW BN 2.5MM FLUT 4MM 6MM 42MM STRL 14MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121844	SUP	HCPCS C1713		121844  -  SCREW BN P/T 4MM 6MM 1.3MM 44MM STRL 2.9MM CNN ST SLF DRL	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121846	SUP	HCPCS C1713		121846  -  SCREW BN 2.5MM FLUT 4MM 6MM 46MM STRL 15MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121848	SUP	HCPCS C1713		121848  -  SCREW BN 2.5MM FLUT P/T 4MM 6MM 48MM STRL 15MM PRLC ST CNN	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121850	SUP	HCPCS C1713		121850  -  SCREW BN 2.5MM FLUT 4MM 6MM 50MM STRL 15MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121852	SUP	HCPCS C1713		121852  -  SCREW BN 2.5MM FLUT 4MM 6MM 52MM STRL 15MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121854	SUP	HCPCS C1713		121854  -  SCREW BN 2.5MM FLUT 4MM 6MM 54MM STRL 15MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$316.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.15	$146.15	$0.00	$0.00	$41.04	$0.00	$236.01	$236.01	$0.00	$80.86	$316.01	$129.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
121856	SUP	HCPCS C1713		121856  -  SCREW BN 2.5MM FLUT 4MM 6MM 56MM STRL 15MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121858	SUP	HCPCS C1713		121858  -  SCREW BN 2.5MM FLUT 4MM 6MM 58MM STRL 15MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121860	SUP	HCPCS C1713		121860  -  SCREW BN 2.5MM FLUT 4MM 6MM 60MM STRL 15MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121865	SUP	HCPCS C1713		121865  -  SCREW BN 2.5MM FLUT 4MM 6MM 65MM STRL 15MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121870	SUP	HCPCS C1713		121870  -  SCREW BN 2.5MM FLUT 4MM 6MM 70MM STRL 15MM PRLC ST CNN TROC	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
121905	SUP	HCPCS C1713		121905  -  NAIL IM 8MM 32CM RUS-TYLR DLT SS FEM	BOTH IP/OP	"$1,704.38 "	"$1,261.24"	$0.00	"$1,363.50"	$766.97	$766.97	$0.00	$0.00	$0.00	$355.23	"$1,264.99"	"$1,264.99"	$0.00	$0.00	$355.19	$0.00	"$1,008.14"	"$1,008.14"	$0.00	$852.19	"$1,349.87"	"$1,363.50"	$0.00		$0.00	$266.73	$0.00	$0.00	$271.34	$0.00	$0.00	$0.00	$0.00	$0.00
121906	SUP	HCPCS C1713		121906  -  NAIL IM 8MM 34CM RUS-TYLR DLT II FEM	BOTH IP/OP	"$1,704.38 "	"$1,261.24"	$0.00	"$1,363.50"	$766.97	$766.97	$0.00	$0.00	$0.00	$355.23	"$1,264.99"	"$1,264.99"	$0.00	$0.00	$355.19	$0.00	"$1,008.14"	"$1,008.14"	$0.00	$852.19	"$1,349.87"	"$1,363.50"	$0.00		$0.00	$266.73	$0.00	$0.00	$271.34	$0.00	$0.00	$0.00	$0.00	$0.00
121907	SUP	HCPCS C1713		121907  -  NAIL IM 8MM 36CM RUS-TYLR DLT II FEM	BOTH IP/OP	"$1,704.38 "	"$1,261.24"	$0.00	"$1,363.50"	$766.97	$766.97	$0.00	$0.00	$0.00	$355.23	"$1,264.99"	"$1,264.99"	$0.00	$0.00	$355.19	$0.00	"$1,008.14"	"$1,008.14"	$0.00	$852.19	"$1,349.87"	"$1,363.50"	$0.00		$0.00	$266.73	$0.00	$0.00	$271.34	$0.00	$0.00	$0.00	$0.00	$0.00
122034	SUP	HCPCS C1713		122034  -  NAIL IM 11MM 44CM RUS-TYLR DLT SS FEM	BOTH IP/OP	"$1,563.75 "	"$1,157.18"	$0.00	"$1,251.00"	$703.69	$703.69	$0.00	$0.00	$0.00	$325.92	"$1,160.62"	"$1,160.62"	$0.00	$0.00	$325.89	$0.00	$924.96	$924.96	$0.00	$781.88	"$1,238.49"	"$1,251.00"	$0.00		$0.00	$244.73	$0.00	$0.00	$248.95	$0.00	$0.00	$0.00	$0.00	$0.00
122153	SUP	HCPCS C1713		122153  -  NAIL IM 15MM 42CM RUS-TYLR INTLK SS FEM	BOTH IP/OP	"$2,711.25 "	"$2,006.33"	$0.00	"$2,169.00"	"$1,220.06"	"$1,220.06"	$0.00	$0.00	$0.00	$565.09	"$2,012.29"	"$2,012.29"	$0.00	$0.00	$565.02	$0.00	"$1,336.65"	"$1,336.65"	$0.00	"$1,355.63"	"$2,147.31"	"$2,169.00"	$0.00		$0.00	$424.31	$0.00	$0.00	$431.63	$0.00	$0.00	$0.00	$0.00	$0.00
122159	SUP	HCPCS C1713		122159  -  NAIL IM 16MM 40CM RUS-TYLR INTLK SS FEM	BOTH IP/OP	"$2,711.25 "	"$2,006.33"	$0.00	"$2,169.00"	"$1,220.06"	"$1,220.06"	$0.00	$0.00	$0.00	$565.09	"$2,012.29"	"$2,012.29"	$0.00	$0.00	$565.02	$0.00	"$1,336.65"	"$1,336.65"	$0.00	"$1,355.63"	"$2,147.31"	"$2,169.00"	$0.00		$0.00	$424.31	$0.00	$0.00	$431.63	$0.00	$0.00	$0.00	$0.00	$0.00
122202	SUP	HCPCS C1713		122202  -  NAIL IM 13MM 36CM RUS-TYLR INTLK SS TIB	BOTH IP/OP	"$3,150.00 "	"$2,331.00"	$0.00	"$2,520.00"	"$1,417.50"	"$1,417.50"	$0.00	$0.00	$0.00	$656.54	"$2,337.93"	"$2,337.93"	$0.00	$0.00	$656.46	$0.00	"$1,552.95"	"$1,552.95"	$0.00	"$1,575.00"	"$2,494.80"	"$2,520.00"	$0.00		$0.00	$492.98	$0.00	$0.00	$501.48	$0.00	$0.00	$0.00	$0.00	$0.00
122341	SUP	HCPCS C1713		122341  -  NAIL IM 10MM 38CM RUS-TYLR DLT INTLK RECON SS FEM RT	BOTH IP/OP	"$8,375.63 "	"$6,197.97"	$0.00	"$6,700.50"	"$3,769.03"	"$3,769.03"	$0.00	$0.00	$0.00	"$1,745.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,745.48"	$0.00	"$4,129.18"	"$4,129.18"	$0.00	"$4,187.81"	"$6,633.50"	"$6,700.50"	$0.00		$0.00	"$1,310.79"	$0.00	$0.00	"$1,333.40"	$0.00	$0.00	$0.00	$0.00	$0.00
122466	SUP	HCPCS C1713		122466  -  NAIL IM 8MM 30CM RUS-TYLR INTLK SS HUM	BOTH IP/OP	"$6,519.38 "	"$4,824.34"	$0.00	"$5,215.50"	"$2,933.72"	"$2,933.72"	$0.00	$0.00	$0.00	"$1,358.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,358.64"	$0.00	"$3,214.05"	"$3,214.05"	$0.00	"$3,259.69"	"$5,163.35"	"$5,215.50"	$0.00		$0.00	"$1,020.28"	$0.00	$0.00	"$1,037.88"	$0.00	$0.00	$0.00	$0.00	$0.00
122670	SUP	HCPCS C1713		122670  -  CAP END RECON FEM	BOTH IP/OP	$70.10 	$51.87	$0.00	$56.08	$31.55	$31.55	$0.00	$0.00	$0.00	$14.61	$52.03	$52.03	$0.00	$0.00	$14.61	$0.00	$41.46	$41.46	$0.00	$35.05	$55.52	$56.08	$0.00		$0.00	$10.97	$0.00	$0.00	$11.16	$0.00	$0.00	$0.00	$0.00	$0.00
122671	SUP	HCPCS C1713		122671  -  CAP END RUS-TYLR RUS-TYLR RECON NL	BOTH IP/OP	$66.83 	$49.45	$0.00	$53.46	$30.07	$30.07	$0.00	$0.00	$0.00	$13.93	$49.60	$49.60	$0.00	$0.00	$13.93	$0.00	$39.53	$39.53	$0.00	$33.41	$52.93	$53.46	$0.00		$0.00	$10.46	$0.00	$0.00	$10.64	$0.00	$0.00	$0.00	$0.00	$0.00
122700	SUP	HCPCS C1713		122700  -  PIN HLF UNV 4MM 20MM 20MM HXFX RN HNG KT CMPS TI ORTH XTRNFX	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122701	SUP	HCPCS C1713		122701  -  PIN HLF 4MM 25MM HXFX RN UNLAT TI ORTH XTRNFX SYS	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122703	SUP	HCPCS C1713		122703  -  PIN HLF 4MM 35MM HXFX TI ORTH	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122704	SUP	HCPCS C1713		122704  -  PIN HLF 4MM 40MM HXFX RN UNLAT TI ORTH XTRNFX SYS	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122705	SUP	HCPCS C1713		122705  -  PIN HLF 4MM 45MM HXFX TI ORTH	BOTH IP/OP	$469.20 	$347.21	$0.00	$375.36	$211.14	$211.14	$0.00	$0.00	$0.00	$97.79	$348.24	$348.24	$0.00	$0.00	$97.78	$0.00	$277.53	$277.53	$0.00	$234.60	$371.61	$375.36	$0.00		$0.00	$73.43	$0.00	$0.00	$74.70	$0.00	$0.00	$0.00	$0.00	$0.00
122706	SUP	HCPCS C1713		122706  -  PIN HLF 4MM 50MM HXFX TI	BOTH IP/OP	$561.00 	$415.14	$0.00	$448.80	$252.45	$252.45	$0.00	$0.00	$0.00	$116.93	$416.37	$416.37	$0.00	$0.00	$116.91	$0.00	$331.83	$331.83	$0.00	$280.50	$444.31	$448.80	$0.00		$0.00	$87.80	$0.00	$0.00	$89.31	$0.00	$0.00	$0.00	$0.00	$0.00
122707	SUP	HCPCS C1713		122707  -  PIN HLF P/T 5MM 20MM HXFX SET TI ORTH XTRNFX SYS	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122708	SUP	HCPCS C1713		122708  -  PIN HLF P/T 5MM 25MM 25MM HXFX TI ORTH XTRNFX SYS	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122709	SUP	HCPCS C1713		122709  -  PIN HLF P/T 5MM 30MM HXFX TI	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122710	SUP	HCPCS C1713		122710  -  PIN HLF P/T 5MM 35MM HXFX TI XTRNFX SYS	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122711	SUP	HCPCS C1713		122711  -  PIN HLF P/T 5MM 40MM HXFX TI XTRNFX SYS	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122712	SUP	HCPCS C1713		122712  -  PIN HLF 5MM 45MM HXFX RN TI ORTH XTRNFX SYS	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122714	SUP	HCPCS C1713		122714  -  PIN HLF 5MM 55MM HXFX RN UNLAT TI ORTH XTRNFX SYS	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122715	SUP	HCPCS C1713		122715  -  PIN HLF 5MM 60MM HXFX RN UNLAT TI ORTH XTRNFX SYS	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122716	SUP	HCPCS C1713		122716  -  PIN HLF 5MM 65MM HXFX RN UNLAT TI ORTH XTRNFX SYS	BOTH IP/OP	$533.80 	$395.01	$0.00	$427.04	$240.21	$240.21	$0.00	$0.00	$0.00	$111.26	$396.19	$396.19	$0.00	$0.00	$111.24	$0.00	$315.74	$315.74	$0.00	$266.90	$422.77	$427.04	$0.00		$0.00	$83.54	$0.00	$0.00	$84.98	$0.00	$0.00	$0.00	$0.00	$0.00
122717	SUP	HCPCS C1713		122717  -  PIN HLF 5MM 70MM HXFX TI ORTH	BOTH IP/OP	$394.40 	$291.86	$0.00	$315.52	$177.48	$177.48	$0.00	$0.00	$0.00	$82.20	$292.72	$292.72	$0.00	$0.00	$82.19	$0.00	$233.29	$233.29	$0.00	$197.20	$312.36	$315.52	$0.00		$0.00	$61.72	$0.00	$0.00	$62.79	$0.00	$0.00	$0.00	$0.00	$0.00
122718	SUP	HCPCS C1713		122718  -  PIN HLF 5MM 75MM HXFX TI ORTH	BOTH IP/OP	$561.00 	$415.14	$0.00	$448.80	$252.45	$252.45	$0.00	$0.00	$0.00	$116.93	$416.37	$416.37	$0.00	$0.00	$116.91	$0.00	$331.83	$331.83	$0.00	$280.50	$444.31	$448.80	$0.00		$0.00	$87.80	$0.00	$0.00	$89.31	$0.00	$0.00	$0.00	$0.00	$0.00
122719	SUP	HCPCS C1713		122719  -  PIN HLF 5MM 80MM HXFX TI	BOTH IP/OP	$561.00 	$415.14	$0.00	$448.80	$252.45	$252.45	$0.00	$0.00	$0.00	$116.93	$416.37	$416.37	$0.00	$0.00	$116.91	$0.00	$331.83	$331.83	$0.00	$280.50	$444.31	$448.80	$0.00		$0.00	$87.80	$0.00	$0.00	$89.31	$0.00	$0.00	$0.00	$0.00	$0.00
122720	SUP	HCPCS C1713		122720  -  PIN HLF 5MM 85MM HXFX TI ORTH	BOTH IP/OP	$472.60 	$349.72	$0.00	$378.08	$212.67	$212.67	$0.00	$0.00	$0.00	$98.50	$350.76	$350.76	$0.00	$0.00	$98.49	$0.00	$279.54	$279.54	$0.00	$236.30	$374.30	$378.08	$0.00		$0.00	$73.96	$0.00	$0.00	$75.24	$0.00	$0.00	$0.00	$0.00	$0.00
122721	SUP	HCPCS C1713		122721  -  PIN HLF 5MM 90MM HXFX TI ORTH	BOTH IP/OP	$561.00 	$415.14	$0.00	$448.80	$252.45	$252.45	$0.00	$0.00	$0.00	$116.93	$416.37	$416.37	$0.00	$0.00	$116.91	$0.00	$331.83	$331.83	$0.00	$280.50	$444.31	$448.80	$0.00		$0.00	$87.80	$0.00	$0.00	$89.31	$0.00	$0.00	$0.00	$0.00	$0.00
122725	SUP	HCPCS C1713		122725  -  PIN HLF 6MM 40MM 40MM HXFX RN UNLAT THRD TI ORTH XTRNFX SYS	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122727	SUP	HCPCS C1713		122727  -  PIN HLF 6MM 50MM HXFX RN UNLAT TI ORTH XTRNFX SYS	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122729	SUP	HCPCS C1713		122729  -  PIN HLF 6MM 60MM HXFX RN UNLAT TI ORTH XTRNFX SYS	BOTH IP/OP	$780.30 	$577.42	$0.00	$624.24	$351.14	$351.14	$0.00	$0.00	$0.00	$162.63	$579.14	$579.14	$0.00	$0.00	$162.61	$0.00	$461.55	$461.55	$0.00	$390.15	$618.00	$624.24	$0.00		$0.00	$122.12	$0.00	$0.00	$124.22	$0.00	$0.00	$0.00	$0.00	$0.00
122733	SUP	HCPCS C1713		122733  -  PIN HLF 6MM 80MM HXFX TI	BOTH IP/OP	$472.60 	$349.72	$0.00	$378.08	$212.67	$212.67	$0.00	$0.00	$0.00	$98.50	$350.76	$350.76	$0.00	$0.00	$98.49	$0.00	$279.54	$279.54	$0.00	$236.30	$374.30	$378.08	$0.00		$0.00	$73.96	$0.00	$0.00	$75.24	$0.00	$0.00	$0.00	$0.00	$0.00
122735	SUP	HCPCS C1713		122735  -  PIN FX HLF 6MM 90MM	BOTH IP/OP	$561.00 	$415.14	$0.00	$448.80	$252.45	$252.45	$0.00	$0.00	$0.00	$116.93	$416.37	$416.37	$0.00	$0.00	$116.91	$0.00	$331.83	$331.83	$0.00	$280.50	$444.31	$448.80	$0.00		$0.00	$87.80	$0.00	$0.00	$89.31	$0.00	$0.00	$0.00	$0.00	$0.00
122741	SUP	HCPCS C1713		122741  -  PIN HLF 4MM 25MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$499.80 	$369.85	$0.00	$399.84	$224.91	$224.91	$0.00	$0.00	$0.00	$104.17	$370.95	$370.95	$0.00	$0.00	$104.16	$0.00	$295.63	$295.63	$0.00	$249.90	$395.84	$399.84	$0.00		$0.00	$78.22	$0.00	$0.00	$79.57	$0.00	$0.00	$0.00	$0.00	$0.00
122742	SUP	HCPCS C1713		122742  -  PIN HLF 4MM 30MM HXFX SS ORTH	BOTH IP/OP	$282.20 	$208.83	$0.00	$225.76	$126.99	$126.99	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$141.10	$223.50	$225.76	$0.00		$0.00	$44.16	$0.00	$0.00	$44.93	$0.00	$0.00	$0.00	$0.00	$0.00
122743	SUP	HCPCS C1713		122743  -  PIN HLF 4MM 35MM HXFX SS ORTH	BOTH IP/OP	$282.20 	$208.83	$0.00	$225.76	$126.99	$126.99	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$141.10	$223.50	$225.76	$0.00		$0.00	$44.16	$0.00	$0.00	$44.93	$0.00	$0.00	$0.00	$0.00	$0.00
122744	SUP	HCPCS C1713		122744  -  PIN HLF 4MM 40MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$499.80 	$369.85	$0.00	$399.84	$224.91	$224.91	$0.00	$0.00	$0.00	$104.17	$370.95	$370.95	$0.00	$0.00	$104.16	$0.00	$295.63	$295.63	$0.00	$249.90	$395.84	$399.84	$0.00		$0.00	$78.22	$0.00	$0.00	$79.57	$0.00	$0.00	$0.00	$0.00	$0.00
122745	SUP	HCPCS C1713		122745  -  PIN HLF 4MM 45MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$499.80 	$369.85	$0.00	$399.84	$224.91	$224.91	$0.00	$0.00	$0.00	$104.17	$370.95	$370.95	$0.00	$0.00	$104.16	$0.00	$295.63	$295.63	$0.00	$249.90	$395.84	$399.84	$0.00		$0.00	$78.22	$0.00	$0.00	$79.57	$0.00	$0.00	$0.00	$0.00	$0.00
122746	SUP	HCPCS C1713		122746  -  PIN HLF 4MM 50MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$499.80 	$369.85	$0.00	$399.84	$224.91	$224.91	$0.00	$0.00	$0.00	$104.17	$370.95	$370.95	$0.00	$0.00	$104.16	$0.00	$295.63	$295.63	$0.00	$249.90	$395.84	$399.84	$0.00		$0.00	$78.22	$0.00	$0.00	$79.57	$0.00	$0.00	$0.00	$0.00	$0.00
122747	SUP	HCPCS C1713		122747  -  PIN HLF 5MM 20MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$567.80 	$420.17	$0.00	$454.24	$255.51	$255.51	$0.00	$0.00	$0.00	$118.34	$421.42	$421.42	$0.00	$0.00	$118.33	$0.00	$335.85	$335.85	$0.00	$283.90	$449.70	$454.24	$0.00		$0.00	$88.86	$0.00	$0.00	$90.39	$0.00	$0.00	$0.00	$0.00	$0.00
122748	SUP	HCPCS C1713		122748  -  PIN HLF 5MM 25MM 25MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$567.80 	$420.17	$0.00	$454.24	$255.51	$255.51	$0.00	$0.00	$0.00	$118.34	$421.42	$421.42	$0.00	$0.00	$118.33	$0.00	$335.85	$335.85	$0.00	$283.90	$449.70	$454.24	$0.00		$0.00	$88.86	$0.00	$0.00	$90.39	$0.00	$0.00	$0.00	$0.00	$0.00
122749	SUP	HCPCS C1713		122749  -  PIN HLF 5MM 30MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$567.80 	$420.17	$0.00	$454.24	$255.51	$255.51	$0.00	$0.00	$0.00	$118.34	$421.42	$421.42	$0.00	$0.00	$118.33	$0.00	$335.85	$335.85	$0.00	$283.90	$449.70	$454.24	$0.00		$0.00	$88.86	$0.00	$0.00	$90.39	$0.00	$0.00	$0.00	$0.00	$0.00
122750	SUP	HCPCS C1713		122750  -  PIN HLF 5MM 35MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$567.80 	$420.17	$0.00	$454.24	$255.51	$255.51	$0.00	$0.00	$0.00	$118.34	$421.42	$421.42	$0.00	$0.00	$118.33	$0.00	$335.85	$335.85	$0.00	$283.90	$449.70	$454.24	$0.00		$0.00	$88.86	$0.00	$0.00	$90.39	$0.00	$0.00	$0.00	$0.00	$0.00
122751	SUP	HCPCS C1713		122751  -  PIN HLF 5MM 40MM 40MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$567.80 	$420.17	$0.00	$454.24	$255.51	$255.51	$0.00	$0.00	$0.00	$118.34	$421.42	$421.42	$0.00	$0.00	$118.33	$0.00	$335.85	$335.85	$0.00	$283.90	$449.70	$454.24	$0.00		$0.00	$88.86	$0.00	$0.00	$90.39	$0.00	$0.00	$0.00	$0.00	$0.00
122752	SUP	HCPCS C1713		122752  -  PIN HLF 5MM 45MM 45MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$567.80 	$420.17	$0.00	$454.24	$255.51	$255.51	$0.00	$0.00	$0.00	$118.34	$421.42	$421.42	$0.00	$0.00	$118.33	$0.00	$335.85	$335.85	$0.00	$283.90	$449.70	$454.24	$0.00		$0.00	$88.86	$0.00	$0.00	$90.39	$0.00	$0.00	$0.00	$0.00	$0.00
122753	SUP	HCPCS C1713		122753  -  PIN HLF 5MM 50MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$567.80 	$420.17	$0.00	$454.24	$255.51	$255.51	$0.00	$0.00	$0.00	$118.34	$421.42	$421.42	$0.00	$0.00	$118.33	$0.00	$335.85	$335.85	$0.00	$283.90	$449.70	$454.24	$0.00		$0.00	$88.86	$0.00	$0.00	$90.39	$0.00	$0.00	$0.00	$0.00	$0.00
122754	SUP	HCPCS C1713		122754  -  PIN HLF 5MM 55MM HXFX SS ORTH	BOTH IP/OP	$340.00 	$251.60	$0.00	$272.00	$153.00	$153.00	$0.00	$0.00	$0.00	$70.86	$252.35	$252.35	$0.00	$0.00	$70.86	$0.00	$201.11	$201.11	$0.00	$170.00	$269.28	$272.00	$0.00		$0.00	$53.21	$0.00	$0.00	$54.13	$0.00	$0.00	$0.00	$0.00	$0.00
122755	SUP	HCPCS C1713		122755  -  PIN HLF 5MM 60MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$209.10 	$154.73	$0.00	$167.28	$94.10	$94.10	$0.00	$0.00	$0.00	$43.58	$155.19	$155.19	$0.00	$0.00	$43.58	$0.00	$123.68	$123.68	$0.00	$104.55	$165.61	$167.28	$0.00		$0.00	$32.72	$0.00	$0.00	$33.29	$0.00	$0.00	$0.00	$0.00	$0.00
122756	SUP	HCPCS C1713		122756  -  PIN HLF 5MM 65MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$499.80 	$369.85	$0.00	$399.84	$224.91	$224.91	$0.00	$0.00	$0.00	$104.17	$370.95	$370.95	$0.00	$0.00	$104.16	$0.00	$295.63	$295.63	$0.00	$249.90	$395.84	$399.84	$0.00		$0.00	$78.22	$0.00	$0.00	$79.57	$0.00	$0.00	$0.00	$0.00	$0.00
122757	SUP	HCPCS C1713		122757  -  PIN HLF 5MM 70MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$209.10 	$154.73	$0.00	$167.28	$94.10	$94.10	$0.00	$0.00	$0.00	$43.58	$155.19	$155.19	$0.00	$0.00	$43.58	$0.00	$123.68	$123.68	$0.00	$104.55	$165.61	$167.28	$0.00		$0.00	$32.72	$0.00	$0.00	$33.29	$0.00	$0.00	$0.00	$0.00	$0.00
122758	SUP	HCPCS C1713		122758  -  PIN HLF 5MM 75MM HXFX SS ORTH	BOTH IP/OP	$340.00 	$251.60	$0.00	$272.00	$153.00	$153.00	$0.00	$0.00	$0.00	$70.86	$252.35	$252.35	$0.00	$0.00	$70.86	$0.00	$201.11	$201.11	$0.00	$170.00	$269.28	$272.00	$0.00		$0.00	$53.21	$0.00	$0.00	$54.13	$0.00	$0.00	$0.00	$0.00	$0.00
122759	SUP	HCPCS C1713		122759  -  PIN HLF 5MM 80MM HXFX SS ORTH	BOTH IP/OP	$340.00 	$251.60	$0.00	$272.00	$153.00	$153.00	$0.00	$0.00	$0.00	$70.86	$252.35	$252.35	$0.00	$0.00	$70.86	$0.00	$201.11	$201.11	$0.00	$170.00	$269.28	$272.00	$0.00		$0.00	$53.21	$0.00	$0.00	$54.13	$0.00	$0.00	$0.00	$0.00	$0.00
122760	SUP	HCPCS C1713		122760  -  PIN HLF 5MM 85MM HXFX SS ORTH	BOTH IP/OP	$340.00 	$251.60	$0.00	$272.00	$153.00	$153.00	$0.00	$0.00	$0.00	$70.86	$252.35	$252.35	$0.00	$0.00	$70.86	$0.00	$201.11	$201.11	$0.00	$170.00	$269.28	$272.00	$0.00		$0.00	$53.21	$0.00	$0.00	$54.13	$0.00	$0.00	$0.00	$0.00	$0.00
122761	SUP	HCPCS C1713		122761  -  PIN HLF 5MM 90MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$209.10 	$154.73	$0.00	$167.28	$94.10	$94.10	$0.00	$0.00	$0.00	$43.58	$155.19	$155.19	$0.00	$0.00	$43.58	$0.00	$123.68	$123.68	$0.00	$104.55	$165.61	$167.28	$0.00		$0.00	$32.72	$0.00	$0.00	$33.29	$0.00	$0.00	$0.00	$0.00	$0.00
122765	SUP	HCPCS C1713		122765  -  PIN HLF 6MM 40MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$567.80 	$420.17	$0.00	$454.24	$255.51	$255.51	$0.00	$0.00	$0.00	$118.34	$421.42	$421.42	$0.00	$0.00	$118.33	$0.00	$335.85	$335.85	$0.00	$283.90	$449.70	$454.24	$0.00		$0.00	$88.86	$0.00	$0.00	$90.39	$0.00	$0.00	$0.00	$0.00	$0.00
122767	SUP	HCPCS C1713		122767  -  PIN HLF 6MM 50MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$567.80 	$420.17	$0.00	$454.24	$255.51	$255.51	$0.00	$0.00	$0.00	$118.34	$421.42	$421.42	$0.00	$0.00	$118.33	$0.00	$335.85	$335.85	$0.00	$283.90	$449.70	$454.24	$0.00		$0.00	$88.86	$0.00	$0.00	$90.39	$0.00	$0.00	$0.00	$0.00	$0.00
122769	SUP	HCPCS C1713		122769  -  PIN HLF 6MM 60MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$567.80 	$420.17	$0.00	$454.24	$255.51	$255.51	$0.00	$0.00	$0.00	$118.34	$421.42	$421.42	$0.00	$0.00	$118.33	$0.00	$335.85	$335.85	$0.00	$283.90	$449.70	$454.24	$0.00		$0.00	$88.86	$0.00	$0.00	$90.39	$0.00	$0.00	$0.00	$0.00	$0.00
122771	SUP	HCPCS C1713		122771  -  PIN HLF 6MM 70MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$499.80 	$369.85	$0.00	$399.84	$224.91	$224.91	$0.00	$0.00	$0.00	$104.17	$370.95	$370.95	$0.00	$0.00	$104.16	$0.00	$295.63	$295.63	$0.00	$249.90	$395.84	$399.84	$0.00		$0.00	$78.22	$0.00	$0.00	$79.57	$0.00	$0.00	$0.00	$0.00	$0.00
122773	SUP	HCPCS C1713		122773  -  PIN HLF 6MM 80MM HXFX SS ORTH	BOTH IP/OP	$282.20 	$208.83	$0.00	$225.76	$126.99	$126.99	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$141.10	$223.50	$225.76	$0.00		$0.00	$44.16	$0.00	$0.00	$44.93	$0.00	$0.00	$0.00	$0.00	$0.00
122775	SUP	HCPCS C1713		122775  -  PIN HLF 6MM 90MM HXFX UNLAT SS ORTH XTRNFX SYS	BOTH IP/OP	$499.80 	$369.85	$0.00	$399.84	$224.91	$224.91	$0.00	$0.00	$0.00	$104.17	$370.95	$370.95	$0.00	$0.00	$104.16	$0.00	$295.63	$295.63	$0.00	$249.90	$395.84	$399.84	$0.00		$0.00	$78.22	$0.00	$0.00	$79.57	$0.00	$0.00	$0.00	$0.00	$0.00
124120	SUP	HCPCS C1713		124120  -  PLATE BN 130D STD BRL 60MM 38.1MM CLS CHS 2 HL SS HIP	BOTH IP/OP	"$1,107.75 "	$819.74	$0.00	$886.20	$498.49	$498.49	$0.00	$0.00	$0.00	$230.88	$822.17	$822.17	$0.00	$0.00	$230.86	$0.00	$655.23	$655.23	$0.00	$553.88	$877.34	$886.20	$0.00		$0.00	$173.36	$0.00	$0.00	$176.35	$0.00	$0.00	$0.00	$0.00	$0.00
124121	SUP	HCPCS C1713		124121  -  PLATE BN 135D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP	BOTH IP/OP	"$1,107.75 "	$819.74	$0.00	$886.20	$498.49	$498.49	$0.00	$0.00	$0.00	$230.88	$822.17	$822.17	$0.00	$0.00	$230.86	$0.00	$655.23	$655.23	$0.00	$553.88	$877.34	$886.20	$0.00		$0.00	$173.36	$0.00	$0.00	$176.35	$0.00	$0.00	$0.00	$0.00	$0.00
124122	SUP	HCPCS C1713		124122  -  PLATE BN 140D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP	BOTH IP/OP	"$1,107.75 "	$819.74	$0.00	$886.20	$498.49	$498.49	$0.00	$0.00	$0.00	$230.88	$822.17	$822.17	$0.00	$0.00	$230.86	$0.00	$655.23	$655.23	$0.00	$553.88	$877.34	$886.20	$0.00		$0.00	$173.36	$0.00	$0.00	$176.35	$0.00	$0.00	$0.00	$0.00	$0.00
124123	SUP	HCPCS C1713		124123  -  PLATE BN 145D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP	BOTH IP/OP	"$1,107.75 "	$819.74	$0.00	$886.20	$498.49	$498.49	$0.00	$0.00	$0.00	$230.88	$822.17	$822.17	$0.00	$0.00	$230.86	$0.00	$655.23	$655.23	$0.00	$553.88	$877.34	$886.20	$0.00		$0.00	$173.36	$0.00	$0.00	$176.35	$0.00	$0.00	$0.00	$0.00	$0.00
124124	SUP	HCPCS C1713		124124  -  PLATE BN 150D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP	BOTH IP/OP	"$1,107.75 "	$819.74	$0.00	$886.20	$498.49	$498.49	$0.00	$0.00	$0.00	$230.88	$822.17	$822.17	$0.00	$0.00	$230.86	$0.00	$655.23	$655.23	$0.00	$553.88	$877.34	$886.20	$0.00		$0.00	$173.36	$0.00	$0.00	$176.35	$0.00	$0.00	$0.00	$0.00	$0.00
124125	SUP	HCPCS C1713		124125  -  PLATE BN 130D STD BRL 80MM 38.1MM CLS CHS 3 HL CMPR HIP	BOTH IP/OP	"$1,144.50 "	$846.93	$0.00	$915.60	$515.03	$515.03	$0.00	$0.00	$0.00	$238.54	$849.45	$849.45	$0.00	$0.00	$238.51	$0.00	$676.97	$676.97	$0.00	$572.25	$906.44	$915.60	$0.00		$0.00	$179.11	$0.00	$0.00	$182.20	$0.00	$0.00	$0.00	$0.00	$0.00
124126	SUP	HCPCS C1713		124126  -  PLATE BN 135D STD BRL 80MM 38.1MM CLS CHS 3 HL CMPR SS HIP	BOTH IP/OP	"$1,144.50 "	$846.93	$0.00	$915.60	$515.03	$515.03	$0.00	$0.00	$0.00	$238.54	$849.45	$849.45	$0.00	$0.00	$238.51	$0.00	$676.97	$676.97	$0.00	$572.25	$906.44	$915.60	$0.00		$0.00	$179.11	$0.00	$0.00	$182.20	$0.00	$0.00	$0.00	$0.00	$0.00
124127	SUP	HCPCS C1713		124127  -  PLATE BN 140D STD BRL 80MM 38.1MM CLS CHS 3 HL CMPR SS HIP	BOTH IP/OP	"$1,144.50 "	$846.93	$0.00	$915.60	$515.03	$515.03	$0.00	$0.00	$0.00	$238.54	$849.45	$849.45	$0.00	$0.00	$238.51	$0.00	$676.97	$676.97	$0.00	$572.25	$906.44	$915.60	$0.00		$0.00	$179.11	$0.00	$0.00	$182.20	$0.00	$0.00	$0.00	$0.00	$0.00
124128	SUP	HCPCS C1713		124128  -  PLATE BN 145D STD BRL 80MM 38.1MM CLS CHS 3 HL SS HIP	BOTH IP/OP	"$1,144.50 "	$846.93	$0.00	$915.60	$515.03	$515.03	$0.00	$0.00	$0.00	$238.54	$849.45	$849.45	$0.00	$0.00	$238.51	$0.00	$676.97	$676.97	$0.00	$572.25	$906.44	$915.60	$0.00		$0.00	$179.11	$0.00	$0.00	$182.20	$0.00	$0.00	$0.00	$0.00	$0.00
124129	SUP	HCPCS C1713		124129  -  PLATE BN 150D STD BRL 80MM 38.1MM CLS CHS 3 HL SS HIP	BOTH IP/OP	"$1,144.50 "	$846.93	$0.00	$915.60	$515.03	$515.03	$0.00	$0.00	$0.00	$238.54	$849.45	$849.45	$0.00	$0.00	$238.51	$0.00	$676.97	$676.97	$0.00	$572.25	$906.44	$915.60	$0.00		$0.00	$179.11	$0.00	$0.00	$182.20	$0.00	$0.00	$0.00	$0.00	$0.00
124130	SUP	HCPCS C1713		124130  -  PLATE BN 130D STD BRL 100MM 38.1MM CLS CHS 4 HL CMPR HIP	BOTH IP/OP	"$1,144.50 "	$846.93	$0.00	$915.60	$515.03	$515.03	$0.00	$0.00	$0.00	$238.54	$849.45	$849.45	$0.00	$0.00	$238.51	$0.00	$676.97	$676.97	$0.00	$572.25	$906.44	$915.60	$0.00		$0.00	$179.11	$0.00	$0.00	$182.20	$0.00	$0.00	$0.00	$0.00	$0.00
124131	SUP	HCPCS C1713		124131  -  PLATE BN 135D STD BRL 100MM 1.5MM CLS 4 HL HIP	BOTH IP/OP	"$1,144.50 "	$846.93	$0.00	$915.60	$515.03	$515.03	$0.00	$0.00	$0.00	$238.54	$849.45	$849.45	$0.00	$0.00	$238.51	$0.00	$676.97	$676.97	$0.00	$572.25	$906.44	$915.60	$0.00		$0.00	$179.11	$0.00	$0.00	$182.20	$0.00	$0.00	$0.00	$0.00	$0.00
124132	SUP	HCPCS C1713		124132  -  PLATE BN 140D STD BRL 100MM 38.1MM CLS CHS 4 HL CMPR HIP	BOTH IP/OP	"$1,144.50 "	$846.93	$0.00	$915.60	$515.03	$515.03	$0.00	$0.00	$0.00	$238.54	$849.45	$849.45	$0.00	$0.00	$238.51	$0.00	$676.97	$676.97	$0.00	$572.25	$906.44	$915.60	$0.00		$0.00	$179.11	$0.00	$0.00	$182.20	$0.00	$0.00	$0.00	$0.00	$0.00
124133	SUP	HCPCS C1713		124133  -  PLATE BN 145D STD BRL 100MM 38.1MM CLS CHS 4 HL CMPR HIP	BOTH IP/OP	"$1,144.50 "	$846.93	$0.00	$915.60	$515.03	$515.03	$0.00	$0.00	$0.00	$238.54	$849.45	$849.45	$0.00	$0.00	$238.51	$0.00	$676.97	$676.97	$0.00	$572.25	$906.44	$915.60	$0.00		$0.00	$179.11	$0.00	$0.00	$182.20	$0.00	$0.00	$0.00	$0.00	$0.00
124134	SUP	HCPCS C1713		124134  -  PLATE BN 150D STD BRL 100MM 38.1MM CLS CHS 4 HL SS HIP	BOTH IP/OP	"$1,144.50 "	$846.93	$0.00	$915.60	$515.03	$515.03	$0.00	$0.00	$0.00	$238.54	$849.45	$849.45	$0.00	$0.00	$238.51	$0.00	$676.97	$676.97	$0.00	$572.25	$906.44	$915.60	$0.00		$0.00	$179.11	$0.00	$0.00	$182.20	$0.00	$0.00	$0.00	$0.00	$0.00
124135	SUP	HCPCS C1713		124135  -  PLATE BN 130D STD BRL 120MM 38.1MM CLS CHS 5 HL CMPR SS HIP	BOTH IP/OP	"$1,223.25 "	$905.21	$0.00	$978.60	$550.46	$550.46	$0.00	$0.00	$0.00	$254.96	$907.90	$907.90	$0.00	$0.00	$254.93	$0.00	$723.55	$723.55	$0.00	$611.63	$968.81	$978.60	$0.00		$0.00	$191.44	$0.00	$0.00	$194.74	$0.00	$0.00	$0.00	$0.00	$0.00
124136	SUP	HCPCS C1713		124136  -  PLATE BN 135D STD BRL 120MM 1.5MM CLS 5 HL HIP	BOTH IP/OP	"$1,223.25 "	$905.21	$0.00	$978.60	$550.46	$550.46	$0.00	$0.00	$0.00	$254.96	$907.90	$907.90	$0.00	$0.00	$254.93	$0.00	$723.55	$723.55	$0.00	$611.63	$968.81	$978.60	$0.00		$0.00	$191.44	$0.00	$0.00	$194.74	$0.00	$0.00	$0.00	$0.00	$0.00
124137	SUP	HCPCS C1713		124137  -  PLATE BN 140D STD BRL 120MM 38.1MM CHS 5 HL CMPR SS HIP	BOTH IP/OP	"$1,223.25 "	$905.21	$0.00	$978.60	$550.46	$550.46	$0.00	$0.00	$0.00	$254.96	$907.90	$907.90	$0.00	$0.00	$254.93	$0.00	$723.55	$723.55	$0.00	$611.63	$968.81	$978.60	$0.00		$0.00	$191.44	$0.00	$0.00	$194.74	$0.00	$0.00	$0.00	$0.00	$0.00
124138	SUP	HCPCS C1713		124138  -  PLATE BN 145D STD BRL 120MM 38.1MM CLS CHS 5 HL SS HIP	BOTH IP/OP	"$1,223.25 "	$905.21	$0.00	$978.60	$550.46	$550.46	$0.00	$0.00	$0.00	$254.96	$907.90	$907.90	$0.00	$0.00	$254.93	$0.00	$723.55	$723.55	$0.00	$611.63	$968.81	$978.60	$0.00		$0.00	$191.44	$0.00	$0.00	$194.74	$0.00	$0.00	$0.00	$0.00	$0.00
124139	SUP	HCPCS C1713		124139  -  PLATE BN 150D STD BRL 120MM 38.1MM CLS CHS 5 HL SS HIP	BOTH IP/OP	"$1,223.25 "	$905.21	$0.00	$978.60	$550.46	$550.46	$0.00	$0.00	$0.00	$254.96	$907.90	$907.90	$0.00	$0.00	$254.93	$0.00	$723.55	$723.55	$0.00	$611.63	$968.81	$978.60	$0.00		$0.00	$191.44	$0.00	$0.00	$194.74	$0.00	$0.00	$0.00	$0.00	$0.00
124140	SUP	HCPCS C1713		124140  -  PLATE BN 130D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
124141	SUP	HCPCS C1713		124141  -  PLATE BN 135D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
124142	SUP	HCPCS C1713		124142  -  PLATE BN 140D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
124143	SUP	HCPCS C1713		124143  -  PLATE BN 145D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
124144	SUP	HCPCS C1713		124144  -  PLATE BN 150D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
124145	SUP	HCPCS C1713		124145  -  PLATE BN 130D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP	BOTH IP/OP	"$1,554.00 "	"$1,149.96"	$0.00	"$1,243.20"	$699.30	$699.30	$0.00	$0.00	$0.00	$323.89	"$1,153.38"	"$1,153.38"	$0.00	$0.00	$323.85	$0.00	$919.19	$919.19	$0.00	$777.00	"$1,230.77"	"$1,243.20"	$0.00		$0.00	$243.20	$0.00	$0.00	$247.40	$0.00	$0.00	$0.00	$0.00	$0.00
124146	SUP	HCPCS C1713		124146  -  PLATE BN 135D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP	BOTH IP/OP	"$1,554.00 "	"$1,149.96"	$0.00	"$1,243.20"	$699.30	$699.30	$0.00	$0.00	$0.00	$323.89	"$1,153.38"	"$1,153.38"	$0.00	$0.00	$323.85	$0.00	$919.19	$919.19	$0.00	$777.00	"$1,230.77"	"$1,243.20"	$0.00		$0.00	$243.20	$0.00	$0.00	$247.40	$0.00	$0.00	$0.00	$0.00	$0.00
124147	SUP	HCPCS C1713		124147  -  PLATE BN 140D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP	BOTH IP/OP	"$1,554.00 "	"$1,149.96"	$0.00	"$1,243.20"	$699.30	$699.30	$0.00	$0.00	$0.00	$323.89	"$1,153.38"	"$1,153.38"	$0.00	$0.00	$323.85	$0.00	$919.19	$919.19	$0.00	$777.00	"$1,230.77"	"$1,243.20"	$0.00		$0.00	$243.20	$0.00	$0.00	$247.40	$0.00	$0.00	$0.00	$0.00	$0.00
124148	SUP	HCPCS C1713		124148  -  PLATE BN 145D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP	BOTH IP/OP	"$1,554.00 "	"$1,149.96"	$0.00	"$1,243.20"	$699.30	$699.30	$0.00	$0.00	$0.00	$323.89	"$1,153.38"	"$1,153.38"	$0.00	$0.00	$323.85	$0.00	$919.19	$919.19	$0.00	$777.00	"$1,230.77"	"$1,243.20"	$0.00		$0.00	$243.20	$0.00	$0.00	$247.40	$0.00	$0.00	$0.00	$0.00	$0.00
124149	SUP	HCPCS C1713		124149  -  PLATE BN 150D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP	BOTH IP/OP	"$1,554.00 "	"$1,149.96"	$0.00	"$1,243.20"	$699.30	$699.30	$0.00	$0.00	$0.00	$323.89	"$1,153.38"	"$1,153.38"	$0.00	$0.00	$323.85	$0.00	$919.19	$919.19	$0.00	$777.00	"$1,230.77"	"$1,243.20"	$0.00		$0.00	$243.20	$0.00	$0.00	$247.40	$0.00	$0.00	$0.00	$0.00	$0.00
124150	SUP	HCPCS C1713		124150  -  PLATE BN 130D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP	BOTH IP/OP	"$1,811.25 "	"$1,340.33"	$0.00	"$1,449.00"	$815.06	$815.06	$0.00	$0.00	$0.00	$377.51	"$1,344.31"	"$1,344.31"	$0.00	$0.00	$377.46	$0.00	"$1,071.35"	"$1,071.35"	$0.00	$905.63	"$1,434.51"	"$1,449.00"	$0.00		$0.00	$283.46	$0.00	$0.00	$288.35	$0.00	$0.00	$0.00	$0.00	$0.00
124151	SUP	HCPCS C1713		124151  -  PLATE BN 135D STD BRL 220MM 38.1MM CHS 10 HL SS HIP	BOTH IP/OP	"$1,811.25 "	"$1,340.33"	$0.00	"$1,449.00"	$815.06	$815.06	$0.00	$0.00	$0.00	$377.51	"$1,344.31"	"$1,344.31"	$0.00	$0.00	$377.46	$0.00	"$1,071.35"	"$1,071.35"	$0.00	$905.63	"$1,434.51"	"$1,449.00"	$0.00		$0.00	$283.46	$0.00	$0.00	$288.35	$0.00	$0.00	$0.00	$0.00	$0.00
124152	SUP	HCPCS C1713		124152  -  PLATE BN 140D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP	BOTH IP/OP	"$1,811.25 "	"$1,340.33"	$0.00	"$1,449.00"	$815.06	$815.06	$0.00	$0.00	$0.00	$377.51	"$1,344.31"	"$1,344.31"	$0.00	$0.00	$377.46	$0.00	"$1,071.35"	"$1,071.35"	$0.00	$905.63	"$1,434.51"	"$1,449.00"	$0.00		$0.00	$283.46	$0.00	$0.00	$288.35	$0.00	$0.00	$0.00	$0.00	$0.00
124153	SUP	HCPCS C1713		124153  -  PLATE BN 145D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP	BOTH IP/OP	"$1,811.25 "	"$1,340.33"	$0.00	"$1,449.00"	$815.06	$815.06	$0.00	$0.00	$0.00	$377.51	"$1,344.31"	"$1,344.31"	$0.00	$0.00	$377.46	$0.00	"$1,071.35"	"$1,071.35"	$0.00	$905.63	"$1,434.51"	"$1,449.00"	$0.00		$0.00	$283.46	$0.00	$0.00	$288.35	$0.00	$0.00	$0.00	$0.00	$0.00
124154	SUP	HCPCS C1713		124154  -  PLATE BN 150D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP	BOTH IP/OP	"$1,811.25 "	"$1,340.33"	$0.00	"$1,449.00"	$815.06	$815.06	$0.00	$0.00	$0.00	$377.51	"$1,344.31"	"$1,344.31"	$0.00	$0.00	$377.46	$0.00	"$1,071.35"	"$1,071.35"	$0.00	$905.63	"$1,434.51"	"$1,449.00"	$0.00		$0.00	$283.46	$0.00	$0.00	$288.35	$0.00	$0.00	$0.00	$0.00	$0.00
124156	SUP	HCPCS C1713		124156  -  PLATE BN 135D STD BRL 260MM 38.1MM CLS CHS 12 HL CMPR HIP	BOTH IP/OP	"$1,937.25 "	"$1,433.57"	$0.00	"$1,549.80"	$871.76	$871.76	$0.00	$0.00	$0.00	$403.77	"$1,437.83"	"$1,437.83"	$0.00	$0.00	$403.72	$0.00	"$1,145.88"	"$1,145.88"	$0.00	$968.63	"$1,534.30"	"$1,549.80"	$0.00		$0.00	$303.18	$0.00	$0.00	$308.41	$0.00	$0.00	$0.00	$0.00	$0.00
124158	SUP	HCPCS C1713		124158  -  PLATE BN 145D STD BRL 260MM 38.1MM CLS CHS 12 HL SS HIP	BOTH IP/OP	"$1,937.25 "	"$1,433.57"	$0.00	"$1,549.80"	$871.76	$871.76	$0.00	$0.00	$0.00	$403.77	"$1,437.83"	"$1,437.83"	$0.00	$0.00	$403.72	$0.00	"$1,145.88"	"$1,145.88"	$0.00	$968.63	"$1,534.30"	"$1,549.80"	$0.00		$0.00	$303.18	$0.00	$0.00	$308.41	$0.00	$0.00	$0.00	$0.00	$0.00
124161	SUP	HCPCS C1713		124161  -  PLATE BN 135D STD BRL 300MM 38.1MM CLS CHS 14 HL CMPR HIP	BOTH IP/OP	"$2,294.25 "	"$1,697.75"	$0.00	"$1,835.40"	"$1,032.41"	"$1,032.41"	$0.00	$0.00	$0.00	$478.18	"$1,702.79"	"$1,702.79"	$0.00	$0.00	$478.12	$0.00	"$1,357.05"	"$1,357.05"	$0.00	"$1,147.13"	"$1,817.05"	"$1,835.40"	$0.00		$0.00	$359.05	$0.00	$0.00	$365.24	$0.00	$0.00	$0.00	$0.00	$0.00
124162	SUP	HCPCS C1713		124162  -  PLATE BN 140D STD BRL 300MM 38.1MM CLS CHS 14 HL SS HIP	BOTH IP/OP	"$2,160.00 "	"$1,598.40"	$0.00	"$1,728.00"	$972.00	$972.00	$0.00	$0.00	$0.00	$450.20	"$1,603.15"	"$1,603.15"	$0.00	$0.00	$450.14	$0.00	"$1,277.64"	"$1,277.64"	$0.00	"$1,080.00"	"$1,710.72"	"$1,728.00"	$0.00		$0.00	$338.04	$0.00	$0.00	$343.87	$0.00	$0.00	$0.00	$0.00	$0.00
124163	SUP	HCPCS C1713		124163  -  PLATE BN 145D STD BRL 300MM 38.1MM CLS CHS 14 HL SS HIP	BOTH IP/OP	"$2,294.25 "	"$1,697.75"	$0.00	"$1,835.40"	"$1,032.41"	"$1,032.41"	$0.00	$0.00	$0.00	$478.18	"$1,702.79"	"$1,702.79"	$0.00	$0.00	$478.12	$0.00	"$1,357.05"	"$1,357.05"	$0.00	"$1,147.13"	"$1,817.05"	"$1,835.40"	$0.00		$0.00	$359.05	$0.00	$0.00	$365.24	$0.00	$0.00	$0.00	$0.00	$0.00
124164	SUP	HCPCS C1713		124164  -  PLATE BN 150D STD BRL 300MM 38.1MM CLS CHS 14 HL SS HIP	BOTH IP/OP	"$1,386.00 "	"$1,025.64"	$0.00	"$1,108.80"	$623.70	$623.70	$0.00	$0.00	$0.00	$288.88	"$1,028.69"	"$1,028.69"	$0.00	$0.00	$288.84	$0.00	$819.82	$819.82	$0.00	$693.00	"$1,097.71"	"$1,108.80"	$0.00		$0.00	$216.91	$0.00	$0.00	$220.65	$0.00	$0.00	$0.00	$0.00	$0.00
124165	SUP	HCPCS C1713		124165  -  PLATE BN 130D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP	BOTH IP/OP	"$1,249.50 "	$924.63	$0.00	$999.60	$562.28	$562.28	$0.00	$0.00	$0.00	$260.43	$927.38	$927.38	$0.00	$0.00	$260.40	$0.00	$739.08	$739.08	$0.00	$624.75	$989.60	$999.60	$0.00		$0.00	$195.55	$0.00	$0.00	$198.92	$0.00	$0.00	$0.00	$0.00	$0.00
124166	SUP	HCPCS C1713		124166  -  PLATE BN 135D SHRT BRL 120MM 25.9MM CLS CHS 5 HL CMPR SS HIP	BOTH IP/OP	"$1,249.50 "	$924.63	$0.00	$999.60	$562.28	$562.28	$0.00	$0.00	$0.00	$260.43	$927.38	$927.38	$0.00	$0.00	$260.40	$0.00	$739.08	$739.08	$0.00	$624.75	$989.60	$999.60	$0.00		$0.00	$195.55	$0.00	$0.00	$198.92	$0.00	$0.00	$0.00	$0.00	$0.00
124167	SUP	HCPCS C1713		124167  -  PLATE BN 140D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP	BOTH IP/OP	"$1,249.50 "	$924.63	$0.00	$999.60	$562.28	$562.28	$0.00	$0.00	$0.00	$260.43	$927.38	$927.38	$0.00	$0.00	$260.40	$0.00	$739.08	$739.08	$0.00	$624.75	$989.60	$999.60	$0.00		$0.00	$195.55	$0.00	$0.00	$198.92	$0.00	$0.00	$0.00	$0.00	$0.00
124168	SUP	HCPCS C1713		124168  -  PLATE BN 145D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP	BOTH IP/OP	"$1,249.50 "	$924.63	$0.00	$999.60	$562.28	$562.28	$0.00	$0.00	$0.00	$260.43	$927.38	$927.38	$0.00	$0.00	$260.40	$0.00	$739.08	$739.08	$0.00	$624.75	$989.60	$999.60	$0.00		$0.00	$195.55	$0.00	$0.00	$198.92	$0.00	$0.00	$0.00	$0.00	$0.00
124169	SUP	HCPCS C1713		124169  -  PLATE BN 150D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP	BOTH IP/OP	"$1,249.50 "	$924.63	$0.00	$999.60	$562.28	$562.28	$0.00	$0.00	$0.00	$260.43	$927.38	$927.38	$0.00	$0.00	$260.40	$0.00	$739.08	$739.08	$0.00	$624.75	$989.60	$999.60	$0.00		$0.00	$195.55	$0.00	$0.00	$198.92	$0.00	$0.00	$0.00	$0.00	$0.00
124176	SUP	HCPCS C1713		124176  -  PLATE BN 130D SHRT BRL 100MM 25.4MM CLS CHS 4 HL CMPR HIP SP	BOTH IP/OP	"$1,197.00 "	$885.78	$0.00	$957.60	$538.65	$538.65	$0.00	$0.00	$0.00	$249.48	$888.41	$888.41	$0.00	$0.00	$249.45	$0.00	$708.03	$708.03	$0.00	$598.50	$948.02	$957.60	$0.00		$0.00	$187.33	$0.00	$0.00	$190.56	$0.00	$0.00	$0.00	$0.00	$0.00
124177	SUP	HCPCS C1713		124177  -  PLATE BN 135D SHRT BRL 100MM 1MM CLS 4 HL HIP	BOTH IP/OP	"$1,197.00 "	$885.78	$0.00	$957.60	$538.65	$538.65	$0.00	$0.00	$0.00	$249.48	$888.41	$888.41	$0.00	$0.00	$249.45	$0.00	$708.03	$708.03	$0.00	$598.50	$948.02	$957.60	$0.00		$0.00	$187.33	$0.00	$0.00	$190.56	$0.00	$0.00	$0.00	$0.00	$0.00
124178	SUP	HCPCS C1713		124178  -  PLATE BN 140D SHRT BRL 100MM CLS 4 SLOT CMPR	BOTH IP/OP	"$1,197.00 "	$885.78	$0.00	$957.60	$538.65	$538.65	$0.00	$0.00	$0.00	$249.48	$888.41	$888.41	$0.00	$0.00	$249.45	$0.00	$708.03	$708.03	$0.00	$598.50	$948.02	$957.60	$0.00		$0.00	$187.33	$0.00	$0.00	$190.56	$0.00	$0.00	$0.00	$0.00	$0.00
124179	SUP	HCPCS C1713		124179  -  PLATE BN 145D SHRT BRL 100MM 25.4MM CLS CHS 4 HL CMPR HIP SP	BOTH IP/OP	"$1,197.00 "	$885.78	$0.00	$957.60	$538.65	$538.65	$0.00	$0.00	$0.00	$249.48	$888.41	$888.41	$0.00	$0.00	$249.45	$0.00	$708.03	$708.03	$0.00	$598.50	$948.02	$957.60	$0.00		$0.00	$187.33	$0.00	$0.00	$190.56	$0.00	$0.00	$0.00	$0.00	$0.00
124180	SUP	HCPCS C1713		124180  -  PLATE BN 150D SHRT BRL 100MM 25.4MM CLS CHS 4 HL CMPR HIP SP	BOTH IP/OP	"$1,197.00 "	$885.78	$0.00	$957.60	$538.65	$538.65	$0.00	$0.00	$0.00	$249.48	$888.41	$888.41	$0.00	$0.00	$249.45	$0.00	$708.03	$708.03	$0.00	$598.50	$948.02	$957.60	$0.00		$0.00	$187.33	$0.00	$0.00	$190.56	$0.00	$0.00	$0.00	$0.00	$0.00
124810	SUP	HCPCS C1713		124810  -  PIN TRC 4MM 250MM 50MM FULL COVE PNT ORTH	BOTH IP/OP	$894.50 	$661.93	$0.00	$708.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.45	$4.45	$0.00	$0.00	$1.25	$0.00	$529.10	$529.10	$0.00	$3.00	$708.44	$4.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
124811	SUP	HCPCS C1713		124811  -  PIN TRC 4MM 150MM 60MM FULL COVE PNT ORTH	BOTH IP/OP	$894.50 	$661.93	$0.00	$715.60	$402.53	$402.53	$0.00	$0.00	$0.00	$186.44	$663.90	$663.90	$0.00	$0.00	$186.41	$0.00	$529.10	$529.10	$0.00	$447.25	$708.44	$715.60	$0.00		$0.00	$139.99	$0.00	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00
124820	SUP	HCPCS C1713		124820  -  PIN TRC 4MM 250MM 40MM FULL COVE PNT ORTH	BOTH IP/OP	$894.50 	$661.93	$0.00	$715.60	$402.53	$402.53	$0.00	$0.00	$0.00	$186.44	$663.90	$663.90	$0.00	$0.00	$186.41	$0.00	$529.10	$529.10	$0.00	$447.25	$708.44	$715.60	$0.00		$0.00	$139.99	$0.00	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00
124823	SUP	HCPCS C1713		124823  -  PIN TRC 4MM 300MM 40MM FULL COVE PNT ORTH	BOTH IP/OP	$894.50 	$661.93	$0.00	$715.60	$402.53	$402.53	$0.00	$0.00	$0.00	$186.44	$663.90	$663.90	$0.00	$0.00	$186.41	$0.00	$529.10	$529.10	$0.00	$447.25	$708.44	$715.60	$0.00		$0.00	$139.99	$0.00	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00
124824	SUP	HCPCS C1713		124824  -  PIN TRC 4MM 300MM 50MM FULL COVE PNT ORTH	BOTH IP/OP	$894.50 	$661.93	$0.00	$715.60	$402.53	$402.53	$0.00	$0.00	$0.00	$186.44	$663.90	$663.90	$0.00	$0.00	$186.41	$0.00	$529.10	$529.10	$0.00	$447.25	$708.44	$715.60	$0.00		$0.00	$139.99	$0.00	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00
124825	SUP	HCPCS C1713		124825  -  PIN TRC 4MM 250MM 40MM FULL COVE PNT ORTH	BOTH IP/OP	$894.50 	$661.93	$0.00	$715.60	$402.53	$402.53	$0.00	$0.00	$0.00	$186.44	$663.90	$663.90	$0.00	$0.00	$186.41	$0.00	$529.10	$529.10	$0.00	$447.25	$708.44	$715.60	$0.00		$0.00	$139.99	$0.00	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00
124826	SUP	HCPCS C1713		124826  -  PIN TRC 5MM 250MM 50MM FULL COVE PNT ORTH	BOTH IP/OP	$894.50 	$661.93	$0.00	$715.60	$402.53	$402.53	$0.00	$0.00	$0.00	$186.44	$663.90	$663.90	$0.00	$0.00	$186.41	$0.00	$529.10	$529.10	$0.00	$447.25	$708.44	$715.60	$0.00		$0.00	$139.99	$0.00	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00
124827	SUP	HCPCS C1713		124827  -  PIN TRC 5MM 250MM 60MM FULL COVE PNT ORTH	BOTH IP/OP	$894.50 	$661.93	$0.00	$715.60	$402.53	$402.53	$0.00	$0.00	$0.00	$186.44	$663.90	$663.90	$0.00	$0.00	$186.41	$0.00	$529.10	$529.10	$0.00	$447.25	$708.44	$715.60	$0.00		$0.00	$139.99	$0.00	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00
124828	SUP	HCPCS C1713		124828  -  PIN TRC 3MM 60MM 16MM HLF COVE PNT ORTH	BOTH IP/OP	$558.00 	$412.92	$0.00	$446.40	$251.10	$251.10	$0.00	$0.00	$0.00	$116.30	$414.15	$414.15	$0.00	$0.00	$116.29	$0.00	$330.06	$330.06	$0.00	$279.00	$441.94	$446.40	$0.00		$0.00	$87.33	$0.00	$0.00	$88.83	$0.00	$0.00	$0.00	$0.00	$0.00
124829	SUP	HCPCS C1713		124829  -  PIN TRC 3MM 60MM 22MM HLF COVE PNT	BOTH IP/OP	$558.00 	$412.92	$0.00	$446.40	$251.10	$251.10	$0.00	$0.00	$0.00	$116.30	$414.15	$414.15	$0.00	$0.00	$116.29	$0.00	$330.06	$330.06	$0.00	$279.00	$441.94	$446.40	$0.00		$0.00	$87.33	$0.00	$0.00	$88.83	$0.00	$0.00	$0.00	$0.00	$0.00
124830	SUP	HCPCS C1713		124830  -  PIN TRC 3MM 75MM 28MM HLF COVE PNT ORTH	BOTH IP/OP	$558.00 	$412.92	$0.00	$446.40	$251.10	$251.10	$0.00	$0.00	$0.00	$116.30	$414.15	$414.15	$0.00	$0.00	$116.29	$0.00	$330.06	$330.06	$0.00	$279.00	$441.94	$446.40	$0.00		$0.00	$87.33	$0.00	$0.00	$88.83	$0.00	$0.00	$0.00	$0.00	$0.00
124831	SUP	HCPCS C1713		124831  -  PIN TRC 4MM 150MM 50MM HLF COVE PNT ORTH	BOTH IP/OP	$770.00 	$569.80	$0.00	$616.00	$346.50	$346.50	$0.00	$0.00	$0.00	$160.49	$571.49	$571.49	$0.00	$0.00	$160.47	$0.00	$455.46	$455.46	$0.00	$385.00	$609.84	$616.00	$0.00		$0.00	$120.51	$0.00	$0.00	$122.58	$0.00	$0.00	$0.00	$0.00	$0.00
124833	SUP	HCPCS C1713		124833  -  PIN TRC 5MM 150MM 50MM HLF COVE PNT ORTH	BOTH IP/OP	$770.00 	$569.80	$0.00	$616.00	$346.50	$346.50	$0.00	$0.00	$0.00	$160.49	$571.49	$571.49	$0.00	$0.00	$160.47	$0.00	$455.46	$455.46	$0.00	$385.00	$609.84	$616.00	$0.00		$0.00	$120.51	$0.00	$0.00	$122.58	$0.00	$0.00	$0.00	$0.00	$0.00
124834	SUP	HCPCS C1713		124834  -  PIN TRC 5MM 200MM 35MM HLF COVE PNT ORTH	BOTH IP/OP	$614.00 	$454.36	$0.00	$491.20	$276.30	$276.30	$0.00	$0.00	$0.00	$127.97	$455.71	$455.71	$0.00	$0.00	$127.96	$0.00	$363.18	$363.18	$0.00	$307.00	$486.29	$491.20	$0.00		$0.00	$96.09	$0.00	$0.00	$97.75	$0.00	$0.00	$0.00	$0.00	$0.00
124835	SUP	HCPCS C1713		124835  -  PIN TRC 3MM 250MM 50MM HLF COVE PNT ORTH	BOTH IP/OP	$894.50 	$661.93	$0.00	$715.60	$402.53	$402.53	$0.00	$0.00	$0.00	$186.44	$663.90	$663.90	$0.00	$0.00	$186.41	$0.00	$529.10	$529.10	$0.00	$447.25	$708.44	$715.60	$0.00		$0.00	$139.99	$0.00	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00
124839	SUP	HCPCS C1713		124839  -  PIN HLF 5MM 150MM 40MM PDRLL ORTH	BOTH IP/OP	$614.00 	$454.36	$0.00	$491.20	$276.30	$276.30	$0.00	$0.00	$0.00	$127.97	$455.71	$455.71	$0.00	$0.00	$127.96	$0.00	$363.18	$363.18	$0.00	$307.00	$486.29	$491.20	$0.00		$0.00	$96.09	$0.00	$0.00	$97.75	$0.00	$0.00	$0.00	$0.00	$0.00
124840	SUP	HCPCS C1713		124840  -  PIN HLF 5MM 150MM 45MM PDRLL ORTH	BOTH IP/OP	$493.00 	$364.82	$0.00	$394.40	$221.85	$221.85	$0.00	$0.00	$0.00	$102.75	$365.90	$365.90	$0.00	$0.00	$102.74	$0.00	$291.61	$291.61	$0.00	$246.50	$390.46	$394.40	$0.00		$0.00	$77.15	$0.00	$0.00	$78.49	$0.00	$0.00	$0.00	$0.00	$0.00
124841	SUP	HCPCS C1713		124841  -  PIN HLF 5MM 150MM 50MM PDRLL ORTH	BOTH IP/OP	$493.00 	$364.82	$0.00	$394.40	$221.85	$221.85	$0.00	$0.00	$0.00	$102.75	$365.90	$365.90	$0.00	$0.00	$102.74	$0.00	$291.61	$291.61	$0.00	$246.50	$390.46	$394.40	$0.00		$0.00	$77.15	$0.00	$0.00	$78.49	$0.00	$0.00	$0.00	$0.00	$0.00
125037	SUP	Custom 27203010		125037  -  TUBE ENDBR 37FR 5.1MM BLU CLR SHLY B-CTH LT CUF RADOPQ SLT	BOTH IP/OP	$124.95 	$92.46	$0.00	$101.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$0.00	$0.00	$0.00	$63.41	$100.45	$101.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
125039	SUP	Custom 27203010		125039  -  TUBE ENDBR 39FR 5.3MM BLU CLR SHLY B-CTH LT CUF RADOPQ SLT	BOTH IP/OP	$298.25 	$220.71	$0.00	$101.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$0.00	$0.00	$0.00	$63.41	$100.45	$101.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
125195	SUP	HCPCS C1713		125195  -  SCREW BN SLT HD CMPR PED	BOTH IP/OP	$183.75 	$135.98	$0.00	$147.00	$82.69	$82.69	$0.00	$0.00	$0.00	$38.30	$136.38	$136.38	$0.00	$0.00	$38.29	$0.00	$108.69	$108.69	$0.00	$91.88	$145.53	$147.00	$0.00		$0.00	$28.76	$0.00	$0.00	$29.25	$0.00	$0.00	$0.00	$0.00	$0.00
125292	SUP	HCPCS C1713		125292  -  PLATE BN 100D 3 HL BRL INTMD SS HIP	BOTH IP/OP	$601.65 	$445.22	$0.00	$481.32	$270.74	$270.74	$0.00	$0.00	$0.00	$125.40	$446.54	$446.54	$0.00	$0.00	$125.38	$0.00	$355.88	$355.88	$0.00	$300.83	$476.51	$481.32	$0.00		$0.00	$94.16	$0.00	$0.00	$95.78	$0.00	$0.00	$0.00	$0.00	$0.00
125294	SUP	HCPCS C1713		125294  -  PLATE BN 130D 76.2MM 3 HL BRL INTMD SS HIP KY-LOK	BOTH IP/OP	$558.60 	$413.36	$0.00	$446.88	$251.37	$251.37	$0.00	$0.00	$0.00	$116.43	$414.59	$414.59	$0.00	$0.00	$116.41	$0.00	$330.41	$330.41	$0.00	$279.30	$442.41	$446.88	$0.00		$0.00	$87.42	$0.00	$0.00	$88.93	$0.00	$0.00	$0.00	$0.00	$0.00
125800	SUP	HCPCS C1713		125800  -  PIN HLF 4MM 150MM 35MM SKL TRX COVE PNT	BOTH IP/OP	$383.50 	$283.79	$0.00	$306.80	$172.58	$172.58	$0.00	$0.00	$0.00	$79.93	$284.63	$284.63	$0.00	$0.00	$79.92	$0.00	$226.84	$226.84	$0.00	$191.75	$303.73	$306.80	$0.00		$0.00	$60.02	$0.00	$0.00	$61.05	$0.00	$0.00	$0.00	$0.00	$0.00
125900	SUP	HCPCS C1713		125900  -  PIN TRC 4MM 300MM 60MM FULL COVE PNT ORTH	BOTH IP/OP	$894.50 	$661.93	$0.00	$715.60	$402.53	$402.53	$0.00	$0.00	$0.00	$186.44	$663.90	$663.90	$0.00	$0.00	$186.41	$0.00	$529.10	$529.10	$0.00	$447.25	$708.44	$715.60	$0.00		$0.00	$139.99	$0.00	$0.00	$142.40	$0.00	$0.00	$0.00	$0.00	$0.00
127016	SUP	HCPCS C1713		127016  -  SCREW BN 4.5MM 16MM IMHS ST HIP	BOTH IP/OP	$36.50 	$27.01	$0.00	$29.20	$16.43	$16.43	$0.00	$0.00	$0.00	$7.61	$27.09	$27.09	$0.00	$0.00	$7.61	$0.00	$21.59	$21.59	$0.00	$18.25	$28.91	$29.20	$0.00		$0.00	$5.71	$0.00	$0.00	$5.81	$0.00	$0.00	$0.00	$0.00	$0.00
127018	SUP	HCPCS C1713		127018  -  SCREW BN 4.5MM 18MM IMHS ST HIP	BOTH IP/OP	$36.50 	$27.01	$0.00	$29.20	$16.43	$16.43	$0.00	$0.00	$0.00	$7.61	$27.09	$27.09	$0.00	$0.00	$7.61	$0.00	$21.59	$21.59	$0.00	$18.25	$28.91	$29.20	$0.00		$0.00	$5.71	$0.00	$0.00	$5.81	$0.00	$0.00	$0.00	$0.00	$0.00
127020	SUP	HCPCS C1713		127020  -  SCREW BN 4.5MM 20MM IMHS ST HIP	BOTH IP/OP	$36.50 	$27.01	$0.00	$29.20	$16.43	$16.43	$0.00	$0.00	$0.00	$7.61	$27.09	$27.09	$0.00	$0.00	$7.61	$0.00	$21.59	$21.59	$0.00	$18.25	$28.91	$29.20	$0.00		$0.00	$5.71	$0.00	$0.00	$5.81	$0.00	$0.00	$0.00	$0.00	$0.00
127026	SUP	HCPCS C1713		127026  -  SCREW BN 4.5MM 26MM IMHS ST HIP	BOTH IP/OP	$36.50 	$27.01	$0.00	$29.20	$16.43	$16.43	$0.00	$0.00	$0.00	$7.61	$27.09	$27.09	$0.00	$0.00	$7.61	$0.00	$21.59	$21.59	$0.00	$18.25	$28.91	$29.20	$0.00		$0.00	$5.71	$0.00	$0.00	$5.81	$0.00	$0.00	$0.00	$0.00	$0.00
127032	SUP	HCPCS C1713		127032  -  SCREW BN 4.5MM 32MM IMHS ST HIP	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$17.55	$17.55	$0.00	$0.00	$0.00	$8.13	$28.95	$28.95	$0.00	$0.00	$8.13	$0.00	$23.07	$23.07	$0.00	$19.50	$30.89	$31.20	$0.00		$0.00	$6.10	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
127042	SUP	HCPCS C1713		127042  -  SCREW BN 4.5MM 8MM 42MM IMHS ST THRD HD CORT	BOTH IP/OP	$32.10 	$23.75	$0.00	$25.68	$14.45	$14.45	$0.00	$0.00	$0.00	$6.69	$23.82	$23.82	$0.00	$0.00	$6.69	$0.00	$18.99	$18.99	$0.00	$16.05	$25.42	$25.68	$0.00		$0.00	$5.02	$0.00	$0.00	$5.11	$0.00	$0.00	$0.00	$0.00	$0.00
127056	SUP	HCPCS C1713		127056  -  SCREW BN 4.5MM 56MM IMHS ST HIP	BOTH IP/OP	$39.00 	$28.86	$0.00	$31.20	$17.55	$17.55	$0.00	$0.00	$0.00	$8.13	$28.95	$28.95	$0.00	$0.00	$8.13	$0.00	$23.07	$23.07	$0.00	$19.50	$30.89	$31.20	$0.00		$0.00	$6.10	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$0.00
127060	SUP	HCPCS C1713		127060  -  SCREW BN 4.5MM 60MM IMHS ST SS HIP	BOTH IP/OP	$36.50 	$27.01	$0.00	$29.20	$16.43	$16.43	$0.00	$0.00	$0.00	$7.61	$27.09	$27.09	$0.00	$0.00	$7.61	$0.00	$21.59	$21.59	$0.00	$18.25	$28.91	$29.20	$0.00		$0.00	$5.71	$0.00	$0.00	$5.81	$0.00	$0.00	$0.00	$0.00	$0.00
127062	SUP	HCPCS C1713		127062  -  SCREW BN 4.5MM 62MM ST CORT	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$18.81	$18.81	$0.00	$0.00	$0.00	$8.71	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$24.72	$24.72	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
127820	SUP	HCPCS C1769		127820  -  WIRE FX .85MM 9IN NS KRSH THRD DMD PT 1 END RND TY E SS ORTH	BOTH IP/OP	$164.70 	$121.88	$0.00	$131.76	$89.43	$89.43	$0.00	$0.00	$0.00	$34.33	$122.24	$122.24	$0.00	$0.00	$34.32	$0.00	$97.42	$97.42	$0.00	$82.35	$130.44	$131.76	$0.00		$0.00	$25.78	$0.00	$0.00	$26.22	$0.00	$0.00	$0.00	$0.00	$0.00
127821	SUP	HCPCS C1769		127821  -  WIRE FX .035MM 9IN NS KRSH THRD DMD PT BOTH ENDS TY F SS	BOTH IP/OP	$164.70 	$121.88	$0.00	$131.76	$89.43	$89.43	$0.00	$0.00	$0.00	$34.33	$122.24	$122.24	$0.00	$0.00	$34.32	$0.00	$97.42	$97.42	$0.00	$82.35	$130.44	$131.76	$0.00		$0.00	$25.78	$0.00	$0.00	$26.22	$0.00	$0.00	$0.00	$0.00	$0.00
127840	SUP	HCPCS C1769		127840  -  WIRE FX 1.1MM 9IN NS KRSH THRD DMD PT 1 END RND TY E SS ORTH	BOTH IP/OP	$164.70 	$121.88	$0.00	$131.76	$89.43	$89.43	$0.00	$0.00	$0.00	$34.33	$122.24	$122.24	$0.00	$0.00	$34.32	$0.00	$97.42	$97.42	$0.00	$82.35	$130.44	$131.76	$0.00		$0.00	$25.78	$0.00	$0.00	$26.22	$0.00	$0.00	$0.00	$0.00	$0.00
127841	SUP	HCPCS C1769		127841  -  WIRE FX 1.1MM 9IN NS KRSH THRD DMD PT BOTH ENDS TY F SS	BOTH IP/OP	$164.70 	$121.88	$0.00	$131.76	$89.43	$89.43	$0.00	$0.00	$0.00	$34.33	$122.24	$122.24	$0.00	$0.00	$34.32	$0.00	$97.42	$97.42	$0.00	$82.35	$130.44	$131.76	$0.00		$0.00	$25.78	$0.00	$0.00	$26.22	$0.00	$0.00	$0.00	$0.00	$0.00
127860	SUP	HCPCS C1769		127860  -  WIRE FX 1.5MM 9IN NS KRSH THRD DMD PT 1 END RND TY E SS ORTH	BOTH IP/OP	$164.70 	$121.88	$0.00	$131.76	$89.43	$89.43	$0.00	$0.00	$0.00	$34.33	$122.24	$122.24	$0.00	$0.00	$34.32	$0.00	$97.42	$97.42	$0.00	$82.35	$130.44	$131.76	$0.00		$0.00	$25.78	$0.00	$0.00	$26.22	$0.00	$0.00	$0.00	$0.00	$0.00
127861	SUP	HCPCS C1769		127861  -  WIRE FX 1.5IN 9IN NS KRSH THRD F TY PNT SS ORTH	BOTH IP/OP	$164.70 	$121.88	$0.00	$131.76	$89.43	$89.43	$0.00	$0.00	$0.00	$34.33	$122.24	$122.24	$0.00	$0.00	$34.32	$0.00	$97.42	$97.42	$0.00	$82.35	$130.44	$131.76	$0.00		$0.00	$25.78	$0.00	$0.00	$26.22	$0.00	$0.00	$0.00	$0.00	$0.00
127874	SUP	HCPCS C1713		127874  -  PIN FX 1.9MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127877	SUP	HCPCS C1713		127877  -  PIN FX 1.9IN 9IN NS STNM SMTH TY D THRD SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127880	SUP	HCPCS C1713		127880  -  PIN FX 5/64IN 9IN NS STNM THRD SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127881	SUP	HCPCS C1713		127881  -  PIN FX 1.9IN 9IN NS STNM F PLN THRD SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127894	SUP	HCPCS C1713		127894  -  PIN FX 2.3MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127900	SUP	HCPCS C1713		127900  -  PIN FX 2.3IN 9IN NS STNM THRD TY E SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127901	SUP	HCPCS C1713		127901  -  PIN FX 2.3MM 9IN NS STNM 2 END DMD PT TY F SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127914	SUP	HCPCS C1713		127914  -  PIN FX 2.7MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127917	SUP	HCPCS C1713		127917  -  PIN FX 2.7MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127920	SUP	HCPCS C1713		127920  -  PIN FX 7/64IN 9IN NS STNM THRD SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127921	SUP	HCPCS C1713		127921  -  PIN FX 2.7IN 9IN NS STNM F PLN THRD SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127934	SUP	HCPCS C1713		127934  -  PIN FX 3.1MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127937	SUP	HCPCS C1713		127937  -  PIN FX 3.1MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127940	SUP	HCPCS C1713		127940  -  PIN FX 1/8IN 9IN NS STNM THRD SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127941	SUP	HCPCS C1713		127941  -  PIN FX 3.1IN 9IN NS STNM F PLN THRD SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127954	SUP	HCPCS C1713		127954  -  PIN FX 3.5MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127957	SUP	HCPCS C1713		127957  -  PIN FX 3.5MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127960	SUP	HCPCS C1713		127960  -  PIN FX 9/64IN 9IN NS STNM THRD SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127961	SUP	HCPCS C1713		127961  -  PIN FX 3.5MM 9IN NS STNM THRD DMD PT BOTH ENDS TY F SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127974	SUP	HCPCS C1713		127974  -  PIN FX 3.9MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127977	SUP	HCPCS C1713		127977  -  PIN FX 3.9MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127980	SUP	HCPCS C1713		127980  -  PIN FX 5/32IN 9IN NS STNM THRD SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127981	SUP	HCPCS C1713		127981  -  PIN FX 3.9IN 9IN NS STNM THRD TY F SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127994	SUP	HCPCS C1713		127994  -  PIN FX 4.7MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
127997	SUP	HCPCS C1713		127997  -  PIN FX 4.7MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
128000	SUP	HCPCS C1713		128000  -  PIN FX 3/16IN 9IN NS STNM THRD SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
128001	SUP	HCPCS C1713		128001  -  PIN FX 4.7MM 9IN NS STNM THRD DMD PT BOTH ENDS TY F SS ORTH	BOTH IP/OP	$170.40 	$126.10	$0.00	$136.32	$76.68	$76.68	$0.00	$0.00	$0.00	$35.52	$126.47	$126.47	$0.00	$0.00	$35.51	$0.00	$100.79	$100.79	$0.00	$85.20	$134.96	$136.32	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
128005	SUP	HCPCS C1769		128005  -  WIRE FX .028MM 4MM NS KRSH SMTH TROC PNT BOTH END TY A SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128007	SUP	HCPCS C1769		128007  -  WIRE FX .76IN 4IN NS KRSH PLN PNT TY A SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128010	SUP	HCPCS C1769		128010  -  WIRE FX .035IN 4IN STRL KRSH PLN 2 PNT TY A TROC SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128011	SUP	HCPCS C1769		128011  -  WIRE FX .85MM 4IN NS KRSH SMTH TROC PNT 1 END RND TY D SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128012	SUP	HCPCS C1769		128012  -  WIRE FX .035IN 9IN NS KRSH 1 DMD PT SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128017	SUP	HCPCS C1769		128017  -  WIRE FX .85IN 4IN NS KRSH PLN PNT TY A SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128020	SUP	HCPCS C1769		128020  -  WIRE FX .85MM 5IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128021	SUP	HCPCS C1769		128021  -  WIRE FX .035IN 7IN NS KRSH PLN PNT TY F SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128022	SUP	HCPCS C1769		128022  -  WIRE FX .85IN 9IN NS KRSH PLN PNT TY F SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128030	SUP	HCPCS C1769		128030  -  WIRE FX .045MM 4MM STRL KRSH TROC PNT BOTH END TY A SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128031	SUP	HCPCS C1769		128031  -  WIRE FX 1.1MM 4IN NS KRSH SMTH TROC PNT 1 END RND TY D SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128032	SUP	HCPCS C1769		128032  -  WIRE FX .045IN 9IN NS KRSH PLN PNT TY E SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128034	SUP	HCPCS C1769		128034  -  WIRE FX 1.1MM 12IN NS KRSH SMTH DMD PT 1 END RND TY E SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128037	SUP	HCPCS C1769		128037  -  WIRE FX .045IN 4IN NS KRSH SMTH TY A SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128040	SUP	HCPCS C1769		128040  -  WIRE FX 1.1MM 5IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128041	SUP	HCPCS C1769		128041  -  WIRE FX .045IN 7IN NS KRSH PLN PNT TY F SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128042	SUP	HCPCS C1769		128042  -  WIRE FX .045IN 9IN NS KRSH DMD PT 2 END SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128044	SUP	HCPCS C1769		128044  -  WIRE FX 1.1MM 12IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS	BOTH IP/OP	$49.40 	$36.56	$0.00	$39.52	$26.82	$26.82	$0.00	$0.00	$0.00	$10.30	$36.66	$36.66	$0.00	$0.00	$10.29	$0.00	$29.22	$29.22	$0.00	$24.70	$39.12	$39.52	$0.00		$0.00	$7.73	$0.00	$0.00	$7.86	$0.00	$0.00	$0.00	$0.00	$0.00
128050	SUP	HCPCS C1769		128050  -  WIRE FX .062IN 4IN NS KRSH PLN 2 PNT TY A TROC SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128051	SUP	HCPCS C1769		128051  -  WIRE FX 1.5MM 4IN NS KRSH SMTH TROC PNT 1 END RND TY D SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128052	SUP	HCPCS C1769		128052  -  WIRE FX .062IN 9IN NS KRSH PLN PNT TY E SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128054	SUP	HCPCS C1769		128054  -  WIRE FX 1.5MM 12IN NS KRSH SMTH DMD PT 1 END RND TY E SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128057	SUP	HCPCS C1769		128057  -  WIRE FX 1.5IN 4IN NS KRSH PLN PNT TY A SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128060	SUP	HCPCS C1769		128060  -  WIRE FX 1.5MM 5IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128061	SUP	HCPCS C1769		128061  -  WIRE FX .062IN 7IN NS KRSH PLN PNT TY F SS ORTH	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128062	SUP	HCPCS C1769		128062  -  WIRE FX 1.5IN 9IN NS KRSH PLN TY F SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128064	SUP	HCPCS C1769		128064  -  WIRE FX 1.5MM 12IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS	BOTH IP/OP	$78.70 	$58.24	$0.00	$62.96	$42.73	$42.73	$0.00	$0.00	$0.00	$16.40	$58.41	$58.41	$0.00	$0.00	$16.40	$0.00	$46.55	$46.55	$0.00	$39.35	$62.33	$62.96	$0.00		$0.00	$12.32	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$0.00
128076	SUP	HCPCS C1713		128076  -  PIN FX 1.9IN 9IN NS STNM 2 END DMD PT PLN TY A SS ORTH	BOTH IP/OP	$87.40 	$64.68	$0.00	$69.92	$39.33	$39.33	$0.00	$0.00	$0.00	$18.22	$64.87	$64.87	$0.00	$0.00	$18.21	$0.00	$51.70	$51.70	$0.00	$43.70	$69.22	$69.92	$0.00		$0.00	$13.68	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
128077	SUP	HCPCS C1713		128077  -  PIN FX 1.9MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS	BOTH IP/OP	$87.40 	$64.68	$0.00	$69.92	$39.33	$39.33	$0.00	$0.00	$0.00	$18.22	$64.87	$64.87	$0.00	$0.00	$18.21	$0.00	$51.70	$51.70	$0.00	$43.70	$69.22	$69.92	$0.00		$0.00	$13.68	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
128078	SUP	HCPCS C1713		128078  -  PIN FX 1.9MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH	BOTH IP/OP	$87.40 	$64.68	$0.00	$69.92	$39.33	$39.33	$0.00	$0.00	$0.00	$18.22	$64.87	$64.87	$0.00	$0.00	$18.21	$0.00	$51.70	$51.70	$0.00	$43.70	$69.22	$69.92	$0.00		$0.00	$13.68	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
128079	SUP	HCPCS C1713		128079  -  PIN FX 1.9MM 9IN NS STNM SMTH TROC PNT 1 END RND TY D SS	BOTH IP/OP	$87.40 	$64.68	$0.00	$69.92	$39.33	$39.33	$0.00	$0.00	$0.00	$18.22	$64.87	$64.87	$0.00	$0.00	$18.21	$0.00	$51.70	$51.70	$0.00	$43.70	$69.22	$69.92	$0.00		$0.00	$13.68	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
128080	SUP	HCPCS C1713		128080  -  PIN FX 1.9IN 9IN NS STNM SMTH TY E SS ORTH	BOTH IP/OP	$87.40 	$64.68	$0.00	$69.92	$39.33	$39.33	$0.00	$0.00	$0.00	$18.22	$64.87	$64.87	$0.00	$0.00	$18.21	$0.00	$51.70	$51.70	$0.00	$43.70	$69.22	$69.92	$0.00		$0.00	$13.68	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
128081	SUP	HCPCS C1713		128081  -  PIN FX 1.9IN 9IN NS STNM 2 END DMD PT TY F SS	BOTH IP/OP	$87.40 	$64.68	$0.00	$69.92	$39.33	$39.33	$0.00	$0.00	$0.00	$18.22	$64.87	$64.87	$0.00	$0.00	$18.21	$0.00	$51.70	$51.70	$0.00	$43.70	$69.22	$69.92	$0.00		$0.00	$13.68	$0.00	$0.00	$13.91	$0.00	$0.00	$0.00	$0.00	$0.00
128086	SUP	HCPCS C1713		128086  -  PIN FX 2.3IN 9IN NS STNM A PLN SS ORTH	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$42.75	$42.75	$0.00	$0.00	$0.00	$19.80	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
128087	SUP	HCPCS C1713		128087  -  PIN FX 2.3MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$42.75	$42.75	$0.00	$0.00	$0.00	$19.80	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
128088	SUP	HCPCS C1713		128088  -  PIN FX 2.3MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$42.75	$42.75	$0.00	$0.00	$0.00	$19.80	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
128089	SUP	HCPCS C1713		128089  -  PIN FX 3/32IN 9IN NS STNM TY D SS ORTH	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$42.75	$42.75	$0.00	$0.00	$0.00	$19.80	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
128090	SUP	HCPCS C1713		128090  -  PIN FX 2.3IN 9IN NS STNM SMTH TY E SS ORTH	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$42.75	$42.75	$0.00	$0.00	$0.00	$19.80	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
128091	SUP	HCPCS C1713		128091  -  PIN FX 2.3MM 9IN NS STNM 2 END DMD PT SMTH TY F SS	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$42.75	$42.75	$0.00	$0.00	$0.00	$19.80	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
128097	SUP	HCPCS C1713		128097  -  PIN FX 2.7MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$42.75	$42.75	$0.00	$0.00	$0.00	$19.80	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
128098	SUP	HCPCS C1713		128098  -  PIN FX 2.7MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$42.75	$42.75	$0.00	$0.00	$0.00	$19.80	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
128099	SUP	HCPCS C1713		128099  -  PIN FX 2.7MM 9IN NS STNM SMTH TROC PNT 1 END RND TY D SS	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$42.75	$42.75	$0.00	$0.00	$0.00	$19.80	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
128100	SUP	HCPCS C1713		128100  -  PIN FX 2.7IN 9IN NS STNM SMTH DMD PT RND END TY E SS ORTH	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$42.75	$42.75	$0.00	$0.00	$0.00	$19.80	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
128101	SUP	HCPCS C1713		128101  -  PIN FX 7/64IN 9IN NS STNM SMTH DMD PT BOTH ENDS TY F SS	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$42.75	$42.75	$0.00	$0.00	$0.00	$19.80	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
128106	SUP	HCPCS C1713		128106  -  PIN FX 3.1IN 9IN NS STNM A PLN SS ORTH	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$42.75	$42.75	$0.00	$0.00	$0.00	$19.80	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$56.19	$56.19	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
128107	SUP	HCPCS C1713		128107  -  PIN FX 3.1MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS	BOTH IP/OP	$102.70 	$76.00	$0.00	$82.16	$46.22	$46.22	$0.00	$0.00	$0.00	$21.41	$76.22	$76.22	$0.00	$0.00	$21.40	$0.00	$60.75	$60.75	$0.00	$51.35	$81.34	$82.16	$0.00		$0.00	$16.07	$0.00	$0.00	$16.35	$0.00	$0.00	$0.00	$0.00	$0.00
128108	SUP	HCPCS C1713		128108  -  PIN FX 3.1MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH	BOTH IP/OP	$102.70 	$76.00	$0.00	$82.16	$46.22	$46.22	$0.00	$0.00	$0.00	$21.41	$76.22	$76.22	$0.00	$0.00	$21.40	$0.00	$60.75	$60.75	$0.00	$51.35	$81.34	$82.16	$0.00		$0.00	$16.07	$0.00	$0.00	$16.35	$0.00	$0.00	$0.00	$0.00	$0.00
128109	SUP	HCPCS C1713		128109  -  PIN FX 3.1IN 9IN NS STNM PLN PNT TY D TROC RND END SS	BOTH IP/OP	$102.70 	$76.00	$0.00	$82.16	$46.22	$46.22	$0.00	$0.00	$0.00	$21.41	$76.22	$76.22	$0.00	$0.00	$21.40	$0.00	$60.75	$60.75	$0.00	$51.35	$81.34	$82.16	$0.00		$0.00	$16.07	$0.00	$0.00	$16.35	$0.00	$0.00	$0.00	$0.00	$0.00
128110	SUP	HCPCS C1713		128110  -  PIN FX 3.1IN 9IN NS STNM SMTH TY E SS ORTH	BOTH IP/OP	$102.70 	$76.00	$0.00	$82.16	$46.22	$46.22	$0.00	$0.00	$0.00	$21.41	$76.22	$76.22	$0.00	$0.00	$21.40	$0.00	$60.75	$60.75	$0.00	$51.35	$81.34	$82.16	$0.00		$0.00	$16.07	$0.00	$0.00	$16.35	$0.00	$0.00	$0.00	$0.00	$0.00
128111	SUP	HCPCS C1713		128111  -  PIN FX 3.1IN 9IN NS STNM F PLN SS	BOTH IP/OP	$102.70 	$76.00	$0.00	$82.16	$46.22	$46.22	$0.00	$0.00	$0.00	$21.41	$76.22	$76.22	$0.00	$0.00	$21.40	$0.00	$60.75	$60.75	$0.00	$51.35	$81.34	$82.16	$0.00		$0.00	$16.07	$0.00	$0.00	$16.35	$0.00	$0.00	$0.00	$0.00	$0.00
128116	SUP	HCPCS C1713		128116  -  PIN FX 3.5IN 9IN NS STNM A PLN SS ORTH	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$49.95	$49.95	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00		$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
128117	SUP	HCPCS C1713		128117  -  PIN FX 3.5IN 9IN NS STNM PLN PNT TY A SS	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$49.95	$49.95	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00		$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
128118	SUP	HCPCS C1713		128118  -  PIN FX 3.5MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$49.95	$49.95	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00		$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
128119	SUP	HCPCS C1713		128119  -  PIN FX 3.5IN 9IN NS STNM PLN PNT TY D TROC RND END SS	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$49.95	$49.95	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00		$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
128120	SUP	HCPCS C1713		128120  -  PIN FX 3.5MM 9IN NS STNM SMTH DMD PT 1 END RND TY E SS ORTH	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$49.95	$49.95	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00		$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
128121	SUP	HCPCS C1713		128121  -  PIN FX 3.5IN 9IN NS STNM F PLN SS	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$49.95	$49.95	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00		$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
128126	SUP	HCPCS C1713		128126  -  PIN FX 3.9IN 9IN NS STNM A PLN SS ORTH	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128127	SUP	HCPCS C1713		128127  -  PIN FX 3.9MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128128	SUP	HCPCS C1713		128128  -  PIN FX 3.9MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128129	SUP	HCPCS C1713		128129  -  PIN FX 5/32IN 9IN NS STNM TY D SS ORTH	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128130	SUP	HCPCS C1713		128130  -  PIN FX 3.9MM 9IN NS STNM SMTH DMD PT 1 END RND TY E SS ORTH	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128131	SUP	HCPCS C1713		128131  -  PIN FX 3.9IN 9IN NS STNM F PLN SS	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128136	SUP	HCPCS C1713		128136  -  PIN FX 4.7IN 9IN NS STNM PLN TY A SS ORTH	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128137	SUP	HCPCS C1713		128137  -  PIN FX 4.7IN 9IN NS STNM SMTH TROC PNT 1 END TY B SS ORTH	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128138	SUP	HCPCS C1713		128138  -  PIN FX 4.7MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128139	SUP	HCPCS C1713		128139  -  PIN FX 4.7MM 9IN NS STNM SMTH TROC PNT 1 END RND TY D SS	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128140	SUP	HCPCS C1713		128140  -  PIN FX 4.7IN 9IN NS STNM SMTH DMD PT BOTH ENDS TY E SS ORTH	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128141	SUP	HCPCS C1713		128141  -  PIN FX 4.7IN 9IN NS STNM F PLN SS	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128146	SUP	HCPCS C1713		128146  -  PIN FX 1.14MM 5IN SWNSN SS FNGR XTRNFX SYS	BOTH IP/OP	$76.00 	$56.24	$0.00	$60.80	$34.20	$34.20	$0.00	$0.00	$0.00	$15.84	$56.41	$56.41	$0.00	$0.00	$15.84	$0.00	$44.95	$44.95	$0.00	$38.00	$60.19	$60.80	$0.00		$0.00	$11.89	$0.00	$0.00	$12.10	$0.00	$0.00	$0.00	$0.00	$0.00
128162	SUP	HCPCS C1713		128162  -  PIN FX 5/32IN 11.5IN THRD ORTH K-DONK	BOTH IP/OP	$452.20 	$334.63	$0.00	$361.76	$203.49	$203.49	$0.00	$0.00	$0.00	$94.25	$335.62	$335.62	$0.00	$0.00	$94.24	$0.00	$267.48	$267.48	$0.00	$226.10	$358.14	$361.76	$0.00		$0.00	$70.77	$0.00	$0.00	$71.99	$0.00	$0.00	$0.00	$0.00	$0.00
128175	SUP	HCPCS C1713		128175  -  PIN FX TROC PNT 1 END ORTH K-DONK	BOTH IP/OP	$452.20 	$334.63	$0.00	$361.76	$203.49	$203.49	$0.00	$0.00	$0.00	$94.25	$335.62	$335.62	$0.00	$0.00	$94.24	$0.00	$267.48	$267.48	$0.00	$226.10	$358.14	$361.76	$0.00		$0.00	$70.77	$0.00	$0.00	$71.99	$0.00	$0.00	$0.00	$0.00	$0.00
128177	SUP	HCPCS C1713		128177  -  PIN FX 7/64IN 9IN TROC PNT 1 END ORTH K-DONK	BOTH IP/OP	$598.40 	$442.82	$0.00	$478.72	$269.28	$269.28	$0.00	$0.00	$0.00	$124.72	$444.13	$444.13	$0.00	$0.00	$124.71	$0.00	$353.95	$353.95	$0.00	$299.20	$473.93	$478.72	$0.00		$0.00	$93.65	$0.00	$0.00	$95.27	$0.00	$0.00	$0.00	$0.00	$0.00
128307	SUP	HCPCS C1713		128307  -  PIN FX .15IN 2.25IN KNWL SS ORTH	BOTH IP/OP	$418.95 	$310.02	$0.00	$335.16	$188.53	$188.53	$0.00	$0.00	$0.00	$87.32	$310.94	$310.94	$0.00	$0.00	$87.31	$0.00	$247.81	$247.81	$0.00	$209.48	$331.81	$335.16	$0.00		$0.00	$65.57	$0.00	$0.00	$66.70	$0.00	$0.00	$0.00	$0.00	$0.00
128310	SUP	HCPCS C1713		128310  -  PIN FX 5/32IN 3IN KNWL SS	BOTH IP/OP	$418.95 	$310.02	$0.00	$335.16	$188.53	$188.53	$0.00	$0.00	$0.00	$87.32	$310.94	$310.94	$0.00	$0.00	$87.31	$0.00	$247.81	$247.81	$0.00	$209.48	$331.81	$335.16	$0.00		$0.00	$65.57	$0.00	$0.00	$66.70	$0.00	$0.00	$0.00	$0.00	$0.00
128314	SUP	HCPCS C1713		128314  -  PIN FX 5/32IN 4IN KNWL SS	BOTH IP/OP	$418.95 	$310.02	$0.00	$335.16	$188.53	$188.53	$0.00	$0.00	$0.00	$87.32	$310.94	$310.94	$0.00	$0.00	$87.31	$0.00	$247.81	$247.81	$0.00	$209.48	$331.81	$335.16	$0.00		$0.00	$65.57	$0.00	$0.00	$66.70	$0.00	$0.00	$0.00	$0.00	$0.00
128408	SUP	HCPCS C1713		128408  -  PIN FX 5/32IN 6IN 1.5IN HAGIE ORTH	BOTH IP/OP	$319.20 	$236.21	$0.00	$255.36	$143.64	$143.64	$0.00	$0.00	$0.00	$66.53	$236.91	$236.91	$0.00	$0.00	$66.52	$0.00	$188.81	$188.81	$0.00	$159.60	$252.81	$255.36	$0.00		$0.00	$49.95	$0.00	$0.00	$50.82	$0.00	$0.00	$0.00	$0.00	$0.00
128416	SUP	HCPCS C1713		128416  -  PIN FX 3/16IN 6IN 1.25IN HAGIE ORTH	BOTH IP/OP	$319.20 	$236.21	$0.00	$255.36	$143.64	$143.64	$0.00	$0.00	$0.00	$66.53	$236.91	$236.91	$0.00	$0.00	$66.52	$0.00	$188.81	$188.81	$0.00	$159.60	$252.81	$255.36	$0.00		$0.00	$49.95	$0.00	$0.00	$50.82	$0.00	$0.00	$0.00	$0.00	$0.00
128418	SUP	HCPCS C1713		128418  -  PIN FX 3/16IN 6IN 1.5IN HAGIE ORTH	BOTH IP/OP	$319.20 	$236.21	$0.00	$255.36	$143.64	$143.64	$0.00	$0.00	$0.00	$66.53	$236.91	$236.91	$0.00	$0.00	$66.52	$0.00	$188.81	$188.81	$0.00	$159.60	$252.81	$255.36	$0.00		$0.00	$49.95	$0.00	$0.00	$50.82	$0.00	$0.00	$0.00	$0.00	$0.00
128436	SUP	HCPCS C1713		128436  -  PIN FX .25IN 6IN 1.25IN HAGIE ORTH	BOTH IP/OP	$319.20 	$236.21	$0.00	$255.36	$143.64	$143.64	$0.00	$0.00	$0.00	$66.53	$236.91	$236.91	$0.00	$0.00	$66.52	$0.00	$188.81	$188.81	$0.00	$159.60	$252.81	$255.36	$0.00		$0.00	$49.95	$0.00	$0.00	$50.82	$0.00	$0.00	$0.00	$0.00	$0.00
128518	SUP	HCPCS C1713		128518  -  PIN FX .89MM 2IN STRL INSTR ORTH XTRNFX SYS	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128520	SUP	HCPCS C1713		128520  -  PIN FX 1.1MM 2IN STRL INSTR ORTH XTRNFX SYS	BOTH IP/OP	$102.70 	$76.00	$0.00	$82.16	$46.22	$46.22	$0.00	$0.00	$0.00	$21.41	$76.22	$76.22	$0.00	$0.00	$21.40	$0.00	$60.75	$60.75	$0.00	$51.35	$81.34	$82.16	$0.00		$0.00	$16.07	$0.00	$0.00	$16.35	$0.00	$0.00	$0.00	$0.00	$0.00
128522	SUP	HCPCS C1713		128522  -  PIN FX 1.5MM 2IN STRL INSTR ORTH XTRNFX SYS	BOTH IP/OP	$124.00 	$91.76	$0.00	$99.20	$55.80	$55.80	$0.00	$0.00	$0.00	$25.84	$92.03	$92.03	$0.00	$0.00	$25.84	$0.00	$73.35	$73.35	$0.00	$62.00	$98.21	$99.20	$0.00		$0.00	$19.41	$0.00	$0.00	$19.74	$0.00	$0.00	$0.00	$0.00	$0.00
128551	SUP	HCPCS C1713		128551  -  PIN FX .062IN 5.8IN SML SS ORTH	BOTH IP/OP	$149.00 	$110.26	$0.00	$119.20	$67.05	$67.05	$0.00	$0.00	$0.00	$31.06	$110.59	$110.59	$0.00	$0.00	$31.05	$0.00	$88.13	$88.13	$0.00	$74.50	$118.01	$119.20	$0.00		$0.00	$23.32	$0.00	$0.00	$23.72	$0.00	$0.00	$0.00	$0.00	$0.00
128552	SUP	HCPCS C1713		128552  -  PIN FX .062IN 7.8IN SML SS ORTH	BOTH IP/OP	$119.00 	$88.06	$0.00	$95.20	$53.55	$53.55	$0.00	$0.00	$0.00	$24.80	$88.32	$88.32	$0.00	$0.00	$24.80	$0.00	$70.39	$70.39	$0.00	$59.50	$94.25	$95.20	$0.00		$0.00	$18.62	$0.00	$0.00	$18.94	$0.00	$0.00	$0.00	$0.00	$0.00
128553	SUP	HCPCS C1713		128553  -  PIN FX .062IN 1IN SML SS ORTH	BOTH IP/OP	$119.00 	$88.06	$0.00	$95.20	$53.55	$53.55	$0.00	$0.00	$0.00	$24.80	$88.32	$88.32	$0.00	$0.00	$24.80	$0.00	$70.39	$70.39	$0.00	$59.50	$94.25	$95.20	$0.00		$0.00	$18.62	$0.00	$0.00	$18.94	$0.00	$0.00	$0.00	$0.00	$0.00
128555	SUP	HCPCS C1713		128555  -  PIN FX .062IN 1.25IN SML SS ORTH	BOTH IP/OP	$119.00 	$88.06	$0.00	$95.20	$53.55	$53.55	$0.00	$0.00	$0.00	$24.80	$88.32	$88.32	$0.00	$0.00	$24.80	$0.00	$70.39	$70.39	$0.00	$59.50	$94.25	$95.20	$0.00		$0.00	$18.62	$0.00	$0.00	$18.94	$0.00	$0.00	$0.00	$0.00	$0.00
128607	SUP	HCPCS C1713		128607  -  STAPLE BN 12MM 12MM KRCKW HTO OFST COCR TIB LAT BLDE	BOTH IP/OP	$852.60 	$630.92	$0.00	$682.08	$383.67	$383.67	$0.00	$0.00	$0.00	$177.70	$632.80	$632.80	$0.00	$0.00	$177.68	$0.00	$504.31	$504.31	$0.00	$426.30	$675.26	$682.08	$0.00		$0.00	$133.43	$0.00	$0.00	$135.73	$0.00	$0.00	$0.00	$0.00	$0.00
128608	SUP	HCPCS C1713		128608  -  STAPLE BN 14MM 14MM KRCKW HTO OFST COCR TIB LAT BLDE	BOTH IP/OP	$852.60 	$630.92	$0.00	$682.08	$383.67	$383.67	$0.00	$0.00	$0.00	$177.70	$632.80	$632.80	$0.00	$0.00	$177.68	$0.00	$504.31	$504.31	$0.00	$426.30	$675.26	$682.08	$0.00		$0.00	$133.43	$0.00	$0.00	$135.73	$0.00	$0.00	$0.00	$0.00	$0.00
128609	SUP	HCPCS C1713		128609  -  STAPLE BN 16MM 16MM KRCKW HTO OFST COCR TIB LAT BLDE	BOTH IP/OP	$852.60 	$630.92	$0.00	$682.08	$383.67	$383.67	$0.00	$0.00	$0.00	$177.70	$632.80	$632.80	$0.00	$0.00	$177.68	$0.00	$504.31	$504.31	$0.00	$426.30	$675.26	$682.08	$0.00		$0.00	$133.43	$0.00	$0.00	$135.73	$0.00	$0.00	$0.00	$0.00	$0.00
128610	SUP	HCPCS C1713		128610  -  STAPLE BN 25X25MM BLK KRCKW HTO COCR TIB MDL MEDAL	BOTH IP/OP	$852.60 	$630.92	$0.00	$682.08	$383.67	$383.67	$0.00	$0.00	$0.00	$177.70	$632.80	$632.80	$0.00	$0.00	$177.68	$0.00	$504.31	$504.31	$0.00	$426.30	$675.26	$682.08	$0.00		$0.00	$133.43	$0.00	$0.00	$135.73	$0.00	$0.00	$0.00	$0.00	$0.00
128673	SUP	HCPCS C1713		128673  -  STAPLE BN 5MM OFST 26.5X23MM FX COCR OSTM	BOTH IP/OP	$680.40 	$503.50	$0.00	$544.32	$306.18	$306.18	$0.00	$0.00	$0.00	$141.81	$504.99	$504.99	$0.00	$0.00	$141.80	$0.00	$402.46	$402.46	$0.00	$340.20	$538.88	$544.32	$0.00		$0.00	$106.48	$0.00	$0.00	$108.32	$0.00	$0.00	$0.00	$0.00	$0.00
128674	SUP	HCPCS C1713		128674  -  STAPLE BN 10MM 21.5X23MM FX OFST COCR ORTH OSTM	BOTH IP/OP	$680.40 	$503.50	$0.00	$544.32	$306.18	$306.18	$0.00	$0.00	$0.00	$141.81	$504.99	$504.99	$0.00	$0.00	$141.80	$0.00	$402.46	$402.46	$0.00	$340.20	$538.88	$544.32	$0.00		$0.00	$106.48	$0.00	$0.00	$108.32	$0.00	$0.00	$0.00	$0.00	$0.00
128675	SUP	HCPCS C1713		128675  -  STAPLE BN 14MM 17.5X23MM FX COCR ORTH OSTM	BOTH IP/OP	$680.40 	$503.50	$0.00	$544.32	$306.18	$306.18	$0.00	$0.00	$0.00	$141.81	$504.99	$504.99	$0.00	$0.00	$141.80	$0.00	$402.46	$402.46	$0.00	$340.20	$538.88	$544.32	$0.00		$0.00	$106.48	$0.00	$0.00	$108.32	$0.00	$0.00	$0.00	$0.00	$0.00
128690	SUP	HCPCS C1713		128690  -  STAPLE BN XS 23.22X6.35MM SPK FX COCR	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128691	SUP	HCPCS C1713		128691  -  STAPLE BN XS 23.22X6.35MM WO SPK COCR ORTH	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128692	SUP	HCPCS C1713		128692  -  STAPLE BN SM SPK 23X12MM FX COCR	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128693	SUP	HCPCS C1713		128693  -  STAPLE BN SM REG 23.22X7.94MM FX COCR OSTM	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128695	SUP	HCPCS C1713		128695  -  STAPLE BN MED 23.22X11.11MM SPK COCR ORTH	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128696	SUP	HCPCS C1713		128696  -  STAPLE BN LG REG 23.22X14.29MM SPK COCR ORTH OSTM	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128697	SUP	HCPCS C1713		128697  -  STAPLE BN LG 23.22X14.29MM FX COCR OSTM	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128698	SUP	HCPCS C1713		128698  -  STAPLE BN SM 16X13MM TBL FX COCR	BOTH IP/OP	$655.20 	$484.85	$0.00	$524.16	$294.84	$294.84	$0.00	$0.00	$0.00	$136.56	$486.29	$486.29	$0.00	$0.00	$136.54	$0.00	$387.55	$387.55	$0.00	$327.60	$518.92	$524.16	$0.00		$0.00	$102.54	$0.00	$0.00	$104.31	$0.00	$0.00	$0.00	$0.00	$0.00
128699	SUP	HCPCS C1713		128699  -  STAPLE BN 16 MED 22X16MM TBL FX RTRCT COCR ORTH	BOTH IP/OP	$655.20 	$484.85	$0.00	$524.16	$294.84	$294.84	$0.00	$0.00	$0.00	$136.56	$486.29	$486.29	$0.00	$0.00	$136.54	$0.00	$387.55	$387.55	$0.00	$327.60	$518.92	$524.16	$0.00		$0.00	$102.54	$0.00	$0.00	$104.31	$0.00	$0.00	$0.00	$0.00	$0.00
128720	SUP	HCPCS C1713		128720  -  STAPLE BN XS 15X6.35MM FX SPK SHRT LG COCR	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128721	SUP	HCPCS C1713		128721  -  STAPLE BN XS 15X6.35MM WO SPK SHRT LG COCR ORTH	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128722	SUP	HCPCS C1713		128722  -  STAPLE BN SM 15X7.94MM SPK SHRT LG FX COCR	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128723	SUP	HCPCS C1713		128723  -  STAPLE BN SM 15X7.94MM WO SPK SHRT LG COCR ORTH	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128724	SUP	HCPCS C1713		128724  -  STAPLE BN MED 15X11.11MM SPK SHRT LG FX COCR	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128725	SUP	HCPCS C1713		128725  -  STAPLE BN MED 15X11.11MM WO SPK SHRT LG COCR ORTH	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128726	SUP	HCPCS C1713		128726  -  STAPLE BN LG 15X14.29MM SPK SHRT LG FX COCR	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
128727	SUP	HCPCS C1713		128727  -  STAPLE BN LG 15X14.29MM WO SPK SHRT LG COCR ORTH	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
131710	SUP	HCPCS Q4130		131710  -  DRESSING BIO 48X3IN EZ DERM MSH PRFR PRCN XENOGRAFT	BOTH IP/OP	$890.29 	$658.81	$0.00	$779.16	$0.00	$0.00	$0.00	$0.00	$0.00	$185.56	$660.77	$660.77	$0.00	$0.00	$185.54	$0.00	$526.61	$526.61	$0.00	$486.97	$771.37	$779.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
140100	SUP	Custom 27203010		KIT IMMUN TST AGLT SYS CRPTCOC NFRMNS AG LTX	BOTH IP/OP	$950.70 	$703.52	$0.00	$760.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$475.35	$752.95	$760.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
143080	SUP	HCPCS C1713		143080  -  PIN FX 3.2MM 80MM STRL	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
143090	SUP	HCPCS C1713		143090  -  PIN FX 3.2MM 90MM STRL PRM KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
143100	SUP	HCPCS C1713		143100  -  PIN FX 3.2MM 100MM STRL PRM KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
143110	SUP	HCPCS C1713		143110  -  PIN FX 3.2MM 110MM STRL	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
143120	SUP	HCPCS C1713		143120  -  PIN FX 3.2MM 120MM STRL PRM KN	BOTH IP/OP	$302.50 	$223.85	$0.00	"$1,082.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$676.47	$239.58	"$1,082.34"	$0.00		$0.00	$0.00	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
143130	SUP	HCPCS C1713		143130  -  PIN FX 3.2MM 130MM STRL PRM KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
143140	SUP	HCPCS C1713		143140  -  PIN FX 3.2MM 140MM STRL	BOTH IP/OP	$302.50 	$223.85	$0.00	$239.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.33	$16.33	$0.00	$0.00	$4.58	$0.00	$178.93	$178.93	$0.00	$11.00	$239.58	$17.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
144080	SUP	HCPCS C1713		144080  -  PIN FX 4MM 80MM NS KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
144090	SUP	HCPCS C1713		144090  -  PIN FX 4MM 90MM STRL PRM KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
144100	SUP	HCPCS C1713		144100  -  PIN FX 4MM 100MM STRL PRM KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
144110	SUP	HCPCS C1713		144110  -  PIN FX 4MM 110MM STRL	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
144120	SUP	HCPCS C1713		144120  -  PIN FX 4MM 1200MM STRL PRM KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
144130	SUP	HCPCS C1713		144130  -  PIN FX 4MM 130MM STRL PRM KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
144140	SUP	HCPCS C1713		144140  -  PIN FX 4MM 140MM STRL KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
144150	SUP	HCPCS C1713		144150  -  PIN FX 4MM 150MM STRL PRM KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
144160	SUP	HCPCS C1713		144160  -  PIN FX 4MM 160MM STRL PRM KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
144170	SUP	HCPCS C1713		144170  -  PIN FX 4MM 170MM STRL KN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
151435	SUP	Custom 27203010		RETAINER TBGRP A 33FTX1.5IN NTR ELAST TBLR DRSG LTX	BOTH IP/OP	$40.13 	$29.70	$0.00	$32.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.06	$31.78	$32.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151436	SUP	Custom 27203010		151436  -  RETAINER TBGRP B 33FTX2.5IN NTR ELAST TBLR DRSG LF	BOTH IP/OP	$52.92 	$39.16	$0.00	$42.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.27	$39.27	$0.00	$0.00	$11.03	$0.00	$0.00	$0.00	$0.00	$26.46	$41.91	$42.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151437	SUP	Custom 27203010		151437  -  RETAINER DRSG D 33FTX3IN NTR LF TBGRP ELC TBLR	BOTH IP/OP	$73.13 	$54.12	$0.00	$58.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.28	$54.28	$0.00	$0.00	$15.24	$0.00	$0.00	$0.00	$0.00	$36.57	$57.92	$58.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151440	SUP	Custom 27203010		151440  -  RETAINER TBGRP J 33FTX6.75IN NTR ELAST TBLR DRSG LTX	BOTH IP/OP	$55.61 	$41.15	$0.00	$44.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.27	$41.27	$0.00	$0.00	$11.59	$0.00	$0.00	$0.00	$0.00	$27.80	$44.04	$44.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151442	SUP	Custom 27203010		151442  -  RTNR TBGRP LG 10MR NTR ELAST TBLR DRSG LATEX	BOTH IP/OP	$605.00 	$447.70	$0.00	$484.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.03	$449.03	$0.00	$0.00	$126.08	$0.00	$0.00	$0.00	$0.00	$302.50	$479.16	$484.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
160821	SUP	Custom 27203010		160821  -  BURR SURG MICRO 14 FLUTE BARREL .24IN 2.13IN .41IN STAINLESS	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
163663	SUP	HCPCS C1776		163663  -  HEAD FEMORAL +3MM 28MM MODULAR TYPE 1 COCR HIP	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
165808	SUP	Custom 27203010		165808  -  CATHETER URETHRAL 8FR 2 WAY FOLEY LATEX FREE BARD SILICONE 3	BOTH IP/OP	$8.13 	$6.02	$0.00	$6.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.03	$6.03	$0.00	$0.00	$1.69	$0.00	$0.00	$0.00	$0.00	$4.06	$6.44	$6.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
165810	SUP	Custom 27203010		165810  -  CATHETER URETHRAL 10FR 2 WAY FOLEY LATEX FREE BARD SILICONE	BOTH IP/OP	$8.13 	$6.02	$0.00	$6.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.03	$6.03	$0.00	$0.00	$1.69	$0.00	$0.00	$0.00	$0.00	$4.06	$6.44	$6.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
165814	SUP	Custom 27203010		165814  -  CATHETER URTH 14FR 5CC STRL LF BARD 2W FL BLN UNCOAT SIL	BOTH IP/OP	$7.83 	$5.79	$0.00	$6.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.81	$5.81	$0.00	$0.00	$1.63	$0.00	$0.00	$0.00	$0.00	$3.91	$6.20	$6.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
165816	SUP	Custom 27203010		165816  -  CATHETER URTH 16FR 5CC STRL LF BARD 2W FL BLN UNCOAT SIL	BOTH IP/OP	$7.83 	$5.79	$0.00	$6.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.81	$5.81	$0.00	$0.00	$1.63	$0.00	$0.00	$0.00	$0.00	$3.91	$6.20	$6.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
165818	SUP	Custom 27203010		165818  -  CATHETER URTH 18FR 5CC STRL LF BARD 2W FL BLN UNCOAT SIL	BOTH IP/OP	$7.83 	$5.79	$0.00	$6.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.81	$5.81	$0.00	$0.00	$1.63	$0.00	$0.00	$0.00	$0.00	$3.91	$6.20	$6.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
165822	SUP	Custom 27203010		165822  -  CATHETER URETHRAL 22FR 2 WAY FOLEY LATEX FREE BARD SILICONE	BOTH IP/OP	$7.83 	$5.79	$0.00	$6.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.81	$5.81	$0.00	$0.00	$1.63	$0.00	$0.00	$0.00	$0.00	$3.91	$6.20	$6.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
170057	SUP	Custom 27803010		170057  -  RELOAD SUT AS 2-0 ES-9 48IN UD E STCH PLSRB 1 STCH LACTOMER	BOTH IP/OP	$620.10 	$458.87	$0.00	$496.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$460.24	$460.24	$0.00	$0.00	$129.23	$0.00	$0.00	$0.00	$0.00	$310.05	$491.12	$496.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
173016	SUP	Custom 27203010		173016  -  DEVICE SUTURING 10MM 15IN PUSH BUTTON GRIP HANDLE LATEX FREE	BOTH IP/OP	$284.40 	$210.46	$0.00	$230.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.08	$211.08	$0.00	$0.00	$59.27	$0.00	$0.00	$0.00	$0.00	$144.33	$228.63	$230.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
173019	SUP	Custom 27203010		173019  -  RETRACTOR LAPSCOP STANDARD LENGTH 5MM 45CM TROCAR ADAPTER	BOTH IP/OP	$50.43 	$37.32	$0.00	$40.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.43	$37.43	$0.00	$0.00	$10.51	$0.00	$0.00	$0.00	$0.00	$25.59	$40.53	$40.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
174001	SUP	Custom 27203010		174001  -  CLAMP LAPSCP STD 10MM 31CM GRN STRL E-BBCK ON OFF SWH RCHT	BOTH IP/OP	$176.91 	$130.91	$0.00	$141.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.46	$140.11	$141.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
174006	SUP	Custom 27203010		174006  -  STAPLER INTERNAL 35.5X5MM 30 HELICAL FASTENER LATEX FREE	BOTH IP/OP	$584.95 	$432.86	$0.00	$474.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$434.15	$434.15	$0.00	$0.00	$121.90	$0.00	$0.00	$0.00	$0.00	$296.86	$470.23	$474.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
175424	SUP	HCPCS C1768		175424  -  GRAFT CV 24MM 30CM HMSH PL WVN STRG	BOTH IP/OP	"$1,236.58 "	$915.07	$0.00	$989.26	$556.46	$556.46	$0.00	$0.00	$0.00	$257.73	$917.79	$917.79	$0.00	$0.00	$257.70	$0.00	$731.43	$731.43	$0.00	$618.29	$979.37	$989.26	$0.00		$0.00	$193.52	$0.00	$0.00	$196.86	$0.00	$0.00	$0.00	$0.00	$0.00
175428	SUP	HCPCS C1768		175428  -  GRAFT VASC 30CM 28MM HMSH GMCVL WVN STR	BOTH IP/OP	"$1,317.40 "	$974.88	$0.00	"$1,053.92"	$592.83	$592.83	$0.00	$0.00	$0.00	$274.58	$977.77	$977.77	$0.00	$0.00	$274.55	$0.00	$779.24	$779.24	$0.00	$658.70	"$1,043.38"	"$1,053.92"	$0.00		$0.00	$206.17	$0.00	$0.00	$209.73	$0.00	$0.00	$0.00	$0.00	$0.00
175432	SUP	HCPCS C1768		175432  -  GRAFT CV 32MM 30CM HMSH GMCVL WVN STRG	BOTH IP/OP	"$1,317.40 "	$974.88	$0.00	"$1,053.92"	$592.83	$592.83	$0.00	$0.00	$0.00	$274.58	$977.77	$977.77	$0.00	$0.00	$274.55	$0.00	$779.24	$779.24	$0.00	$658.70	"$1,043.38"	"$1,053.92"	$0.00		$0.00	$206.17	$0.00	$0.00	$209.73	$0.00	$0.00	$0.00	$0.00	$0.00
176605	SUP	Custom 27203010		176605  -  SCISSORS LAPSCP 5MM 31CM E SCZ MNPLR CAUT ADPR HK CRV JAW	BOTH IP/OP	$187.02 	$138.39	$0.00	$149.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.80	$138.80	$0.00	$0.00	$38.97	$0.00	$0.00	$0.00	$0.00	$93.51	$148.12	$149.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
176620	SUP	Custom 27203010		176620  -  APPLIER INTERNAL CLIP LARGE 5MM 11IN TROCAR SLEEVE ENDO CLIP	BOTH IP/OP	$373.88 	$276.67	$0.00	$299.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$277.49	$277.49	$0.00	$0.00	$77.92	$0.00	$0.00	$0.00	$0.00	$186.94	$296.11	$299.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
176643	SUP	Custom 27203010		176643  -  SHEARS MONOPOLAR STANDARD CURVE 5MM 31CM MONOPOLAR CAUTERY	BOTH IP/OP	$151.10 	$111.81	$0.00	$122.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.15	$112.15	$0.00	$0.00	$31.49	$0.00	$0.00	$0.00	$0.00	$76.68	$121.47	$122.69	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
176657	SUP	Custom 27203010		176657  -  APPLIER INTERNAL CLIP MEDIUM LARGE 10MM 10MM PISTOL GRIP	BOTH IP/OP	$206.08 	$152.50	$0.00	$167.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.95	$152.95	$0.00	$0.00	$42.95	$0.00	$0.00	$0.00	$0.00	$104.58	$165.66	$167.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
176816	SUP	Custom 27203010		176816  -  CATHETER URTH 16FR 30ML STRL LF BARD LBRSL 2W FL BLN SIL	BOTH IP/OP	$18.70 	$13.84	$0.00	$14.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.88	$13.88	$0.00	$0.00	$3.90	$0.00	$0.00	$0.00	$0.00	$9.35	$14.81	$14.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
177017	SUP	Custom 27203010		REAGENT ANALY QUICKCOMP FLUOROCHROME MNCLN LQ 50 TST	BOTH IP/OP	"$1,849.53 "	"$1,368.65"	$0.00	"$1,479.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.76	"$1,464.83"	"$1,479.62"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
179301	SUP	Custom 27203010		179301  -  TROCAR ENDSCP 10.5MM NONCONDUCTIVE SLEEVE THORACOPORT TEAL	BOTH IP/OP	$38.25 	$28.31	$0.00	$31.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.39	$28.39	$0.00	$0.00	$7.97	$0.00	$0.00	$0.00	$0.00	$19.41	$30.75	$31.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
179309	SUP	Custom 27203010		179309  -  TROCAR ENDSCP 12MM SOFT CONDUCTIVE SLEEVE OBTURATOR	BOTH IP/OP	$38.25 	$28.31	$0.00	$31.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.39	$28.39	$0.00	$0.00	$7.97	$0.00	$0.00	$0.00	$0.00	$19.41	$30.75	$31.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
180402	SUP	HCPCS C1776		180402  -  COMPONENT FEM 2 KN LT PTLFEM MULTICOMPARTMENTAL KN SYS	BOTH IP/OP	"$9,780.00 "	"$7,237.20"	$0.00	"$7,824.00"	"$4,401.00"	"$4,401.00"	$0.00	$0.00	$0.00	"$2,038.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,038.15"	$0.00	"$4,821.54"	"$4,821.54"	$0.00	"$4,890.00"	"$7,745.76"	"$7,824.00"	$0.00		$0.00	"$1,530.57"	$0.00	$0.00	"$1,556.98"	$0.00	$0.00	$0.00	$0.00	$0.00
180403	SUP	HCPCS C1776		180403  -  COMPONENT FEM 3 KN PTLFEM LT MCK SYS	BOTH IP/OP	"$9,780.00 "	"$7,237.20"	$0.00	"$7,824.00"	"$4,401.00"	"$4,401.00"	$0.00	$0.00	$0.00	"$2,038.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,038.15"	$0.00	"$4,821.54"	"$4,821.54"	$0.00	"$4,890.00"	"$7,745.76"	"$7,824.00"	$0.00		$0.00	"$1,530.57"	$0.00	$0.00	"$1,556.98"	$0.00	$0.00	$0.00	$0.00	$0.00
180404	SUP	HCPCS C1776		180404  -  COMPONENT FEM 4 KN PTLFEM LT MCK SYS	BOTH IP/OP	"$9,780.00 "	"$7,237.20"	$0.00	"$7,824.00"	"$4,401.00"	"$4,401.00"	$0.00	$0.00	$0.00	"$2,038.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,038.15"	$0.00	"$4,821.54"	"$4,821.54"	$0.00	"$4,890.00"	"$7,745.76"	"$7,824.00"	$0.00		$0.00	"$1,530.57"	$0.00	$0.00	"$1,556.98"	$0.00	$0.00	$0.00	$0.00	$0.00
180405	SUP	HCPCS C1776		180405  -  COMPONENT FEM 5 KN PTLFEM LT MCK SYS	BOTH IP/OP	"$9,780.00 "	"$7,237.20"	$0.00	"$7,824.00"	"$4,401.00"	"$4,401.00"	$0.00	$0.00	$0.00	"$2,038.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,038.15"	$0.00	"$4,821.54"	"$4,821.54"	$0.00	"$4,890.00"	"$7,745.76"	"$7,824.00"	$0.00		$0.00	"$1,530.57"	$0.00	$0.00	"$1,556.98"	$0.00	$0.00	$0.00	$0.00	$0.00
180406	SUP	HCPCS C1776		180406  -  COMPONENT FEM 6 KN LT PTLFEM MULTICOMPARTMENTAL KN SYS	BOTH IP/OP	"$9,780.00 "	"$7,237.20"	$0.00	"$7,824.00"	"$4,401.00"	"$4,401.00"	$0.00	$0.00	$0.00	"$2,038.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,038.15"	$0.00	"$4,821.54"	"$4,821.54"	$0.00	"$4,890.00"	"$7,745.76"	"$7,824.00"	$0.00		$0.00	"$1,530.57"	$0.00	$0.00	"$1,556.98"	$0.00	$0.00	$0.00	$0.00	$0.00
180407	SUP	HCPCS C1776		180407  -  COMPONENT FEM 7 KN PTLFEM LT MCK SYS	BOTH IP/OP	"$9,780.00 "	"$7,237.20"	$0.00	"$7,824.00"	"$4,401.00"	"$4,401.00"	$0.00	$0.00	$0.00	"$2,038.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,038.15"	$0.00	"$4,821.54"	"$4,821.54"	$0.00	"$4,890.00"	"$7,745.76"	"$7,824.00"	$0.00		$0.00	"$1,530.57"	$0.00	$0.00	"$1,556.98"	$0.00	$0.00	$0.00	$0.00	$0.00
180412	SUP	HCPCS C1776		180412  -  COMPONENT FEM 2 KN PTLFEM RT MCK SYS	BOTH IP/OP	"$9,780.00 "	"$7,237.20"	$0.00	"$7,824.00"	"$4,401.00"	"$4,401.00"	$0.00	$0.00	$0.00	"$2,038.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,038.15"	$0.00	"$4,821.54"	"$4,821.54"	$0.00	"$4,890.00"	"$7,745.76"	"$7,824.00"	$0.00		$0.00	"$1,530.57"	$0.00	$0.00	"$1,556.98"	$0.00	$0.00	$0.00	$0.00	$0.00
180413	SUP	HCPCS C1776		180413  -  COMPONENT FEM 3 KN RT PTLFEM MULTICOMPARTMENTAL KN SYS	BOTH IP/OP	"$9,780.00 "	"$7,237.20"	$0.00	"$7,824.00"	"$4,401.00"	"$4,401.00"	$0.00	$0.00	$0.00	"$2,038.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,038.15"	$0.00	"$4,821.54"	"$4,821.54"	$0.00	"$4,890.00"	"$7,745.76"	"$7,824.00"	$0.00		$0.00	"$1,530.57"	$0.00	$0.00	"$1,556.98"	$0.00	$0.00	$0.00	$0.00	$0.00
180414	SUP	HCPCS C1776		180414  -  COMPONENT FEM 4 KN PTLFEM RT MCK SYS	BOTH IP/OP	"$9,780.00 "	"$7,237.20"	$0.00	"$7,824.00"	"$4,401.00"	"$4,401.00"	$0.00	$0.00	$0.00	"$2,038.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,038.15"	$0.00	"$4,821.54"	"$4,821.54"	$0.00	"$4,890.00"	"$7,745.76"	"$7,824.00"	$0.00		$0.00	"$1,530.57"	$0.00	$0.00	"$1,556.98"	$0.00	$0.00	$0.00	$0.00	$0.00
180415	SUP	HCPCS C1776		180415  -  COMPONENT FEM 5 KN PTLFEM RT MCK SYS	BOTH IP/OP	"$9,780.00 "	"$7,237.20"	$0.00	"$7,824.00"	"$4,401.00"	"$4,401.00"	$0.00	$0.00	$0.00	"$2,038.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,038.15"	$0.00	"$4,821.54"	"$4,821.54"	$0.00	"$4,890.00"	"$7,745.76"	"$7,824.00"	$0.00		$0.00	"$1,530.57"	$0.00	$0.00	"$1,556.98"	$0.00	$0.00	$0.00	$0.00	$0.00
180416	SUP	HCPCS C1776		180416  -  COMPONENT FEM 6 KN PTLFEM RT MCK SYS	BOTH IP/OP	"$9,780.00 "	"$7,237.20"	$0.00	"$7,824.00"	"$4,401.00"	"$4,401.00"	$0.00	$0.00	$0.00	"$2,038.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,038.15"	$0.00	"$4,821.54"	"$4,821.54"	$0.00	"$4,890.00"	"$7,745.76"	"$7,824.00"	$0.00		$0.00	"$1,530.57"	$0.00	$0.00	"$1,556.98"	$0.00	$0.00	$0.00	$0.00	$0.00
180417	SUP	HCPCS C1776		180417  -  COMPONENT FEM 7 STD KN PTLFEM RT	BOTH IP/OP	"$9,780.00 "	"$7,237.20"	$0.00	"$7,824.00"	"$4,401.00"	"$4,401.00"	$0.00	$0.00	$0.00	"$2,038.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,038.15"	$0.00	"$4,821.54"	"$4,821.54"	$0.00	"$4,890.00"	"$7,745.76"	"$7,824.00"	$0.00		$0.00	"$1,530.57"	$0.00	$0.00	"$1,556.98"	$0.00	$0.00	$0.00	$0.00	$0.00
180502	SUP	HCPCS C1776		180502  -  COMPONENT FEM 2 KN LT MDL RL MCK SYS	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180503	SUP	HCPCS C1776		180503  -  COMPONENT FEM 3 KN LT MDL RL MCK SYS	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180504	SUP	HCPCS C1776		180504  -  COMPONENT FEM 4 KN LT MDL RL MCK SYS	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180505	SUP	HCPCS C1776		180505  -  COMPONENT FEM 5 KN LT MDL RL MCK SYS	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180506	SUP	HCPCS C1776		180506  -  COMPONENT FEM 6 KN LT MDL RL MCK SYS	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180507	SUP	HCPCS C1776		180507  -  COMPONENT FEM 7 KN LT MDL RL MCK SYS	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180512	SUP	HCPCS C1776		180512  -  COMPONENT FEM 2 KN RMLL MCK SYS	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180513	SUP	HCPCS C1776		180513  -  COMPONENT FEM 3 KN RMLL MCK SYS	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180514	SUP	HCPCS C1776		180514  -  COMPONENT FEM 4 KN RMLL MCK SYS	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180515	SUP	HCPCS C1776		180515  -  COMPONENT FEM 5 KN RMLL MCK SYS	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180516	SUP	HCPCS C1776		180516  -  COMPONENT FEM 6 KN RMLL MCK SYS	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180517	SUP	HCPCS C1776		180517  -  COMPONENT FEM 7 STRL RESTORIS MULTICOMPARTMENTAL KN RMLL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180518	SUP	HCPCS C1776		180518  -  COMPONENT FEM 8 STRL RESTORIS MULTICOMPARTMENTAL KN RMLL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
180601	SUP	HCPCS C1776		180601  -  BASEPLATE TIB 1 STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN LT	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180602	SUP	HCPCS C1776		180602  -  BASEPLATE TIB 2 KN LT MDL RL MCK SYS	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180603	SUP	HCPCS C1776		180603  -  BASEPLATE TIB 3 KN LT MDL RL MCK SYS	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180604	SUP	HCPCS C1776		180604  -  BASEPLATE TIB 4 KN LT MDL RL MCK SYS	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180605	SUP	HCPCS C1776		180605  -  BASEPLATE TIB 5 KN LT MDL RL MCK SYS	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180606	SUP	HCPCS C1776		180606  -  BASEPLATE TIB 6 KN LT MDL RL MCK SYS	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180607	SUP	HCPCS C1776		180607  -  BASEPLATE TIB 7 KN LT MDL RL MCK SYS	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180608	SUP	HCPCS C1776		180608  -  BASEPLATE TIB 8 STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN LT	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180612	SUP	HCPCS C1776		180612  -  BASEPLATE TIB 2 KN RMLL MCK SYS	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180613	SUP	HCPCS C1776		180613  -  BASEPLATE TIB 3 KN RMLL MCK SYS	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180614	SUP	HCPCS C1776		180614  -  BASEPLATE TIB 4 STRL RESTORIS KN RMLL MCK SYS	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180615	SUP	HCPCS C1776		180615  -  BASEPLATE TIB 5 STRL RESTORIS KN RMLL MCK SYS	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180616	SUP	HCPCS C1776		180616  -  BASEPLATE TIB 6 KN RMLL MCK SYS	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180617	SUP	HCPCS C1776		180617  -  BASEPLATE TIB 7 KN RMLL MCK SYS	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
180618	SUP	HCPCS C1776		180618  -  BASEPLATE TIB 8 STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
186140	SUP	HCPCS C1776		186140  -  LINER ACTB NTRL RESTORIS XLVE HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186240	SUP	HCPCS C1776		186240  -  LINER ACTB RESTORIS HW XLVE HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
200641	SUP	Custom 27805411		200641  -  GRAFT BONE CORNERSTONE CORTICAL L14 MM X W11 MM X H6 MM BLOC	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	$0.00	$0.00	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
200741	SUP	HCPCS C1713		200741  -  GRAFT BONE CRSTN SR CORT BLCK 14X11X7MM CERV SPNE	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
200744	SUP	Custom 27804086		200744  -  GRAFT BONE 14X14X7MM BLOCK CORNERSTONE SR CORTICAL CERV SPN	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	$0.00	$0.00	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
200841	SUP	HCPCS C1713		200841  -  GRAFT BONE CRSTN PSR CORT BLOCK 14X11X8MM CERV SPN	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
200941	SUP	Custom 27804086		200941  -  GRAFT BONE 14X11X9MM BLOCK FREEZE DRIED CORNERSTONE CORTICAL	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	$0.00	$0.00	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
201400	SUP	HCPCS C1713		201400  -  PIN HLF 4MM 120MM 30MM ILZ THRD ORTH	BOTH IP/OP	$422.00 	$312.28	$0.00	$337.60	$189.90	$189.90	$0.00	$0.00	$0.00	$87.96	$313.21	$313.21	$0.00	$0.00	$87.94	$0.00	$249.61	$249.61	$0.00	$211.00	$334.22	$337.60	$0.00		$0.00	$66.04	$0.00	$0.00	$67.18	$0.00	$0.00	$0.00	$0.00	$0.00
201401	SUP	HCPCS C1713		201401  -  PIN HLF 4MM 150MM 35MM ILZ THRD ORTH	BOTH IP/OP	$428.00 	$316.72	$0.00	$342.40	$192.60	$192.60	$0.00	$0.00	$0.00	$89.21	$317.66	$317.66	$0.00	$0.00	$89.20	$0.00	$253.16	$253.16	$0.00	$214.00	$338.98	$342.40	$0.00		$0.00	$66.98	$0.00	$0.00	$68.14	$0.00	$0.00	$0.00	$0.00	$0.00
201402	SUP	HCPCS C1713		201402  -  PIN HLF 4MM 180MM 40MM ILZ THRD ORTH	BOTH IP/OP	$448.00 	$331.52	$0.00	$358.40	$201.60	$201.60	$0.00	$0.00	$0.00	$93.37	$332.51	$332.51	$0.00	$0.00	$93.36	$0.00	$264.99	$264.99	$0.00	$224.00	$354.82	$358.40	$0.00		$0.00	$70.11	$0.00	$0.00	$71.32	$0.00	$0.00	$0.00	$0.00	$0.00
201502	SUP	HCPCS C1713		201502  -  PIN HLF 5MM 180MM 50MM ILZ THRD CNCL ORTH	BOTH IP/OP	$480.00 	$355.20	$0.00	$384.00	$216.00	$216.00	$0.00	$0.00	$0.00	$100.04	$356.26	$356.26	$0.00	$0.00	$100.03	$0.00	$283.92	$283.92	$0.00	$240.00	$380.16	$384.00	$0.00		$0.00	$75.12	$0.00	$0.00	$76.42	$0.00	$0.00	$0.00	$0.00	$0.00
201700	SUP	HCPCS C1713		201700  -  WASHER ORTH ILZ CNCL CPL	BOTH IP/OP	$128.80 	$95.31	$0.00	$103.04	$57.96	$57.96	$0.00	$0.00	$0.00	$26.85	$95.60	$95.60	$0.00	$0.00	$26.84	$0.00	$76.19	$76.19	$0.00	$64.40	$102.01	$103.04	$0.00		$0.00	$20.16	$0.00	$0.00	$20.50	$0.00	$0.00	$0.00	$0.00	$0.00
202050	SUP	Custom 27203010		202050  -  SEALANT DURA 5ML DURASEAL PG TRILYSINE AMINE	BOTH IP/OP	"$2,732.63 "	"$2,022.15"	$0.00	"$2,208.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,028.15"	"$2,028.15"	$0.00	$0.00	$569.48	$0.00	$0.00	$0.00	$0.00	"$1,380.47"	"$2,186.66"	"$2,208.75"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
204002	SUP	HCPCS Q4116		204002  -  GRAFT SKN STRATTICE 20 X 40	BOTH IP/OP	"$50,720.00 "	"$37,532.80"	$0.00	"$40,576.00"	"$22,824.00"	"$22,824.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$10,570.05"	$0.00	"$25,004.96"	"$25,004.96"	$0.00	"$25,360.00"	"$40,170.24"	"$40,576.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,074.62"	$0.00	$0.00	$0.00	$0.00	$0.00
205108	SUP	Custom 27203010		205108  -  DEVICE TISSUE CLOSURE 8CM EXTEND TIP APPLICATOR	BOTH IP/OP	"$2,830.10 "	"$2,094.27"	$0.00	"$2,264.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,100.50"	"$2,100.50"	$0.00	$0.00	$589.79	$0.00	$0.00	$0.00	$0.00	"$1,415.05"	"$2,241.44"	"$2,264.08"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
206010	SUP	Custom 27203010		206010  -  STONE BREAKER	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$0.00	$0.00	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
206020	SUP	Custom 27203010		206020  -  STONE BRAKER PROBE 20 MM	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$0.00	$0.00	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
206520	SUP	Custom 27203010		206520  -  SEALANT TISS CLSR 5ML STRL LF DURASEAL EXACT SPNE DISP	BOTH IP/OP	"$14,296.10 "	"$10,579.11"	$0.00	"$11,436.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,979.31"	$0.00	$0.00	$0.00	$0.00	"$7,148.05"	"$11,322.51"	"$11,436.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
208058	SUP	Custom 27203010		FORMULA 1QT MCT OIL SUPPL GLS BTL ADLT 7.7 CAL	BOTH IP/OP	$375.20 	$277.65	$0.00	$300.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.60	$297.16	$300.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210439	SUP	Custom 27203010		210439  -  BIT DRL LNG 2MM 127MM STRL TWST SS	BOTH IP/OP	$175.40 	$129.80	$0.00	$140.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.18	$130.18	$0.00	$0.00	$36.55	$0.00	$0.00	$0.00	$0.00	$87.70	$138.92	$140.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210440	SUP	Custom 27203010		210440  -  BIT DRL LNG 2.4MM 127MM STRL CUT SS	BOTH IP/OP	$175.40 	$129.80	$0.00	$140.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.18	$130.18	$0.00	$0.00	$36.55	$0.00	$0.00	$0.00	$0.00	$87.70	$138.92	$140.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210441	SUP	Custom 27203010		210441  -  BIT DRL LNG 2.7MM 127MM STRL TWST SS	BOTH IP/OP	$175.40 	$129.80	$0.00	$140.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.18	$130.18	$0.00	$0.00	$36.55	$0.00	$0.00	$0.00	$0.00	$87.70	$138.92	$140.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210442	SUP	Custom 27203010		210442  -  BIT DRL 3.2MM 127MM STRL TWST SS	BOTH IP/OP	$175.40 	$129.80	$0.00	$140.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.18	$130.18	$0.00	$0.00	$36.55	$0.00	$0.00	$0.00	$0.00	$87.70	$138.92	$140.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210444	SUP	Custom 27203010		210444  -  BIT DRL LNG 4MM 127MM STRL TWST SS	BOTH IP/OP	$132.30 	$97.90	$0.00	$105.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.19	$98.19	$0.00	$0.00	$27.57	$0.00	$0.00	$0.00	$0.00	$66.15	$104.78	$105.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210445	SUP	Custom 27203010		210445  -  BIT DRL LNG 4.3MM 127MM STRL CUT SS	BOTH IP/OP	$132.30 	$97.90	$0.00	$105.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.19	$98.19	$0.00	$0.00	$27.57	$0.00	$0.00	$0.00	$0.00	$66.15	$104.78	$105.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210446	SUP	Custom 27203010		210446  -  BIT DRL LNG 4.7MM 127MM TWST SS	BOTH IP/OP	$132.30 	$97.90	$0.00	$105.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.19	$98.19	$0.00	$0.00	$27.57	$0.00	$0.00	$0.00	$0.00	$66.15	$104.78	$105.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210447	SUP	Custom 27203010		210447  -  BIT DRL 5.5MM 127MM STRL TWST SS	BOTH IP/OP	$140.70 	$104.12	$0.00	$112.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$0.00	$0.00	$0.00	$70.35	$111.43	$112.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210448	SUP	Custom 27203010		210448  -  BIT DRL LNG 6.4MM 127MM STRL CUT SS	BOTH IP/OP	$132.30 	$97.90	$0.00	$105.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.19	$98.19	$0.00	$0.00	$27.57	$0.00	$0.00	$0.00	$0.00	$66.15	$104.78	$105.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210450	SUP	Custom 27203010		210450  -  BIT DRL 2.7MM 152.4MM STRL TWST SS	BOTH IP/OP	$157.50 	$116.55	$0.00	$126.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.90	$116.90	$0.00	$0.00	$32.82	$0.00	$0.00	$0.00	$0.00	$78.75	$124.74	$126.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210451	SUP	Custom 27203010		210451  -  BIT DRL LNG 3.5MM 152.4MM STRL TWST SS	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.71	$170.71	$0.00	$0.00	$47.93	$0.00	$0.00	$0.00	$0.00	$115.00	$182.16	$184.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210454	SUP	Custom 27203010		210454  -  BIT DRL 5/16MM STRL TWST SS	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$0.00	$0.00	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210455	SUP	Custom 27203010		210455  -  BIT DRL LG 9.5MM 127MM STRL TWST SS	BOTH IP/OP	$632.10 	$467.75	$0.00	$505.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$469.14	$469.14	$0.00	$0.00	$131.73	$0.00	$0.00	$0.00	$0.00	$316.05	$500.62	$505.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210458	SUP	Custom 27203010		210458  -  BIT DRL LG 11.1MM 127MM STRL TWST SS	BOTH IP/OP	$679.35 	$502.72	$0.00	$543.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$504.21	$504.21	$0.00	$0.00	$141.58	$0.00	$0.00	$0.00	$0.00	$339.68	$538.05	$543.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210461	SUP	Custom 27203010		210461  -  BIT DRL LG 12.7MM 127MM TWST	BOTH IP/OP	$679.35 	$502.72	$0.00	$543.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$504.21	$504.21	$0.00	$0.00	$141.58	$0.00	$0.00	$0.00	$0.00	$339.68	$538.05	$543.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210465	SUP	Custom 27203010		210465  -  BIT DRL 3.6MM 152.4MM STRL TWST SS	BOTH IP/OP	$217.35 	$160.84	$0.00	$173.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.32	$161.32	$0.00	$0.00	$45.30	$0.00	$0.00	$0.00	$0.00	$108.68	$172.14	$173.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210521	SUP	Custom 27203010		210521  -  FORCEP SPEC RTRVL 65CM 5.2FR 1 JAW ALGTR TOOTH FLXB SHFT	BOTH IP/OP	$707.35 	$523.44	$0.00	$565.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$353.68	$560.22	$565.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210550	SUP	Custom 27203010		210550  -  BIT DRL 2.4MM 127MM STRL TWST SUT HL SS	BOTH IP/OP	$166.95 	$123.54	$0.00	$133.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.91	$123.91	$0.00	$0.00	$34.79	$0.00	$0.00	$0.00	$0.00	$83.48	$132.22	$133.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210551	SUP	Custom 27203010		210551  -  BIT DRL 2.7MM 127MM STRL TWST SUT HL SS	BOTH IP/OP	$166.95 	$123.54	$0.00	$133.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.91	$123.91	$0.00	$0.00	$34.79	$0.00	$0.00	$0.00	$0.00	$83.48	$132.22	$133.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210552	SUP	Custom 27203010		210552  -  BIT DRL 3.1MM 127MM STRL TWST SUT HL SS	BOTH IP/OP	$164.85 	$121.99	$0.00	$131.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.35	$122.35	$0.00	$0.00	$34.35	$0.00	$0.00	$0.00	$0.00	$82.43	$130.56	$131.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
210554	SUP	Custom 27203010		210554  -  BIT DRL 3.9MM 127MM STRL TWST SUT HL	BOTH IP/OP	$164.85 	$121.99	$0.00	$131.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.35	$122.35	$0.00	$0.00	$34.35	$0.00	$0.00	$0.00	$0.00	$82.43	$130.56	$131.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
211250	SUP	HCPCS C1763		211250  -  GRAFT SOFT TISSUE 2-3MM 50MM ALLOGRAFT MULTIPLE CLEAN AVANCE	BOTH IP/OP	"$11,165.00 "	"$8,262.10"	$0.00	"$8,100.00"	"$4,556.25"	"$4,556.25"	$0.00	$0.00	$0.00	"$2,327.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,326.79"	$0.00	"$5,504.35"	"$5,504.35"	$0.00	"$5,062.50"	"$8,019.00"	"$8,100.00"	$0.00		$0.00	"$1,584.56"	$0.00	$0.00	"$1,611.90"	$0.00	$0.00	$0.00	$0.00	$0.00
212038	SUP	HCPCS C1713		212038  -  ANCHOR SUTURE OTHCRD	BOTH IP/OP	"$1,027.50 "	$760.35	$0.00	$822.00	$462.38	$462.38	$0.00	$0.00	$0.00	$214.16	$762.61	$762.61	$0.00	$0.00	$214.13	$0.00	$607.77	$607.77	$0.00	$513.75	$813.78	$822.00	$0.00		$0.00	$160.80	$0.00	$0.00	$163.58	$0.00	$0.00	$0.00	$0.00	$0.00
212133	SUP	HCPCS C1713		212133  -  ANCHOR SUTURE 0 OS-2 MINI QANCHR+ SFT TIS SHLDR ARTHRO TI	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
212525	SUP	Custom 27203010		STAIN MCBL GM CRYS VIOL WKG SOL BBL 250ML	BOTH IP/OP	$17.55 	$12.99	$0.00	$14.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.78	$13.90	$14.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
212843	SUP	HCPCS C1713		212843  -  ANCHOR SUT 3-0 V-4 MIC 1.3MM STRL LF QANCHR+ OTHCRD BABSR	BOTH IP/OP	"$1,480.00 "	"$1,095.20"	$0.00	"$1,098.46"	$450.00	$450.00	$0.00	$0.00	$0.00	$308.47	"$1,098.46"	"$1,098.46"	$0.00	$0.00	$308.43	$0.00	$875.42	$875.42	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
212865	SUP	HCPCS C1713		212865  -  ANCHOR SUT 3-0 V-4 MIC QAN+ ETH BIT	BOTH IP/OP	$740.00 	$547.60	$0.00	$592.00	$333.00	$333.00	$0.00	$0.00	$0.00	$154.23	$549.23	$549.23	$0.00	$0.00	$154.22	$0.00	$437.71	$437.71	$0.00	$370.00	$586.08	$592.00	$0.00		$0.00	$115.81	$0.00	$0.00	$117.81	$0.00	$0.00	$0.00	$0.00	$0.00
213352	SUP	Custom 27203010		REAGENT FLW CYMTR CTCHX FIXAT TRNSPT STOR 1ML	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
213524	SUP	HCPCS C1713		213524  -  PIN FX 3.2MM 110MM STRL LF BN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
213527	SUP	HCPCS C1713		213527  -  PIN FX 3.2MM 140MM STRL LF BN	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
219791	SUP	Custom 27203010		219791  -  MONTEFIORE 7FR X 100CM	BOTH IP/OP	$39.38 	$29.14	$0.00	$31.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.22	$29.22	$0.00	$0.00	$8.21	$0.00	$0.00	$0.00	$0.00	$19.69	$31.19	$31.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
221716	SUP	Custom 27203010		MEDIA CULT TSB TUBE MCFLS 5ML	BOTH IP/OP	$75.88 	$56.15	$0.00	$60.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.94	$60.10	$60.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
222000	SUP	Custom 27203010		222000  -  IMMOBILIZER ORTH UNV 18-24IN KNEE 2 CUF SLD TO  ADJ EXOFORM	BOTH IP/OP	$47.13 	$34.88	$0.00	$34.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.98	$34.98	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$21.29	$33.73	$34.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
222228	SUP	Custom 27203010		MEDIA CULT C DFC SLCT AGAR PLT BBL	BOTH IP/OP	$26.43 	$19.56	$0.00	$21.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.21	$20.93	$21.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
222820	SUP	HCPCS C1713		222820  -  SCREW BN 6MM FT 4MM 2.7MM 1.3MM 20MM STRL EXCEL ST FLUT CNN	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222822	SUP	HCPCS C1713		222822  -  SCREW BN FT FLUT 4MM 22MM STRL EXCEL ST CNN TROC SS HIP	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222824	SUP	HCPCS C1713		222824  -  SCREW BN 6MM FT 4MM 2.7MM 1.3MM 24MM STRL EXCEL ST FLUT CNN	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222826	SUP	HCPCS C1713		222826  -  SCREW BN FT FLUT 4MM 26MM STRL EXCEL ST CNN TROC SS HIP	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222828	SUP	HCPCS C1713		222828  -  SCREW BN FT FLUT 4MM 28MM STRL EXCEL ST CNN TROC SS HIP	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222830	SUP	HCPCS C1713		222830  -  SCREW BN FT FLUT 4MM 30MM STRL EXCEL ST CNN TROC SS HIP	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222835	SUP	HCPCS C1713		222835  -  SCREW BN FT FLUT 4MM 35MM STRL EXCEL ST CNN TROC SS HIP	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222840	SUP	HCPCS C1713		222840  -  SCREW BN 6MM FT 4MM 2.7MM 1.3MM 40MM STRL EXCEL ST FLUT CNN	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222845	SUP	HCPCS C1713		222845  -  SCREW BN FT FLUT 4MM 45MM STRL EXCEL ST CNN TROC SS HIP	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222850	SUP	HCPCS C1713		222850  -  SCREW BN FT FLUT 4MM 50MM STRL EXCEL ST CNN TROC SS HIP	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222855	SUP	HCPCS C1713		222855  -  SCREW BN FT FLUT 4MM 55MM STRL EXCEL ST CNN TROC SS HIP	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222860	SUP	HCPCS C1713		222860  -  SCREW BN FT FLUT 4MM 60MM STRL EXCEL ST CNN TROC SS HIP	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222865	SUP	HCPCS C1713		222865  -  SCREW BN FT FLUT 4MM 65MM STRL EXCEL ST CNN TROC SS HIP	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222870	SUP	HCPCS C1713		222870  -  SCREW BN FT FLUT 4MM 70MM STRL EXCEL ST CNN TROC SS HIP	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
222983	SUP	HCPCS C1713		222983  -  ANCHOR SUT 2 CP-2 2.4MM 8.8MM STRL G2QKAN + OTHCRD NDL NTNL	BOTH IP/OP	"$1,030.00 "	$762.20	$0.00	$824.00	$463.50	$463.50	$0.00	$0.00	$0.00	$214.68	$764.47	$764.47	$0.00	$0.00	$214.65	$0.00	$609.25	$609.25	$0.00	$515.00	$815.76	$824.00	$0.00		$0.00	$161.20	$0.00	$0.00	$163.98	$0.00	$0.00	$0.00	$0.00	$0.00
222984	SUP	HCPCS C1713		222984  -  ANCHOR SUT 2 CP-2 2.8MM 11.4MM STRL QANCHR+ OTHCRD NDL NTNL	BOTH IP/OP	"$1,712.50 "	"$1,267.25"	$0.00	"$1,271.02"	$470.25	$470.25	$0.00	$0.00	$0.00	$356.93	"$1,271.02"	"$1,271.02"	$0.00	$0.00	$356.89	$0.00	"$1,012.94"	"$1,012.94"	$0.00	$522.50	$827.64	$836.00	$0.00		$0.00	$163.54	$0.00	$0.00	$166.36	$0.00	$0.00	$0.00	$0.00	$0.00
223522	SUP	HCPCS C1713		223522  -  NAIL IM 3.5MM 22CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223524	SUP	HCPCS C1713		223524  -  NAIL IM 3.5MM 24CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223525	SUP	HCPCS C1713		223525  -  NAIL IM 3.5MM 25CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223526	SUP	HCPCS C1713		223526  -  NAIL IM 3.5MM 26CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223527	SUP	HCPCS C1713		223527  -  NAIL IM 3.5MM 27CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223528	SUP	HCPCS C1713		223528  -  NAIL IM 3.5MM 28CM ENDR ORTH	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223529	SUP	HCPCS C1713		223529  -  NAIL IM 3.5MM 29CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223530	SUP	HCPCS C1713		223530  -  NAIL IM 3.5MM 30CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223531	SUP	HCPCS C1713		223531  -  NAIL IM 3.5MM 31CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223532	SUP	HCPCS C1713		223532  -  NAIL IM 3.5MM 32CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223533	SUP	HCPCS C1713		223533  -  NAIL IM 3.5MM 33CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223534	SUP	HCPCS C1713		223534  -  NAIL IM 3.5MM 34CM ENDR ADLT ORTH	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223535	SUP	HCPCS C1713		223535  -  NAIL IM 3.5MM 35CM ENDR ORTH	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223536	SUP	HCPCS C1713		223536  -  NAIL IM 3.5MM 36CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223537	SUP	HCPCS C1713		223537  -  NAIL IM 3.5MM 37CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
223538	SUP	HCPCS C1713		223538  -  NAIL IM 3.5MM 38CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224022	SUP	HCPCS C1713		224022  -  NAIL IM 4MM 22CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224023	SUP	HCPCS C1713		224023  -  NAIL IM 4MM 23CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224024	SUP	HCPCS C1713		224024  -  NAIL IM 4MM 24CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224025	SUP	HCPCS C1713		224025  -  NAIL IM 4MM 25CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224026	SUP	HCPCS C1713		224026  -  NAIL IM 4MM 26CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224027	SUP	HCPCS C1713		224027  -  NAIL IM 4MM 27CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224028	SUP	HCPCS C1713		224028  -  NAIL IM 4MM 28CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224029	SUP	HCPCS C1713		224029  -  NAIL IM 4MM 29CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224030	SUP	HCPCS C1713		224030  -  NAIL IM 4MM 30CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224031	SUP	HCPCS C1713		224031  -  NAIL IM 4MM 31CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224032	SUP	HCPCS C1713		224032  -  NAIL IM 4MM 32CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224033	SUP	HCPCS C1713		224033  -  NAIL IM 4MM 33CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224034	SUP	HCPCS C1713		224034  -  NAIL IM 4MM 34CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224035	SUP	HCPCS C1713		224035  -  NAIL IM 4MM 35CM ENDR SS HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224037	SUP	HCPCS C1713		224037  -  NAIL IM 4MM 37CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224527	SUP	HCPCS C1713		224527  -  NAIL IM 4.5MM 27CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224532	SUP	HCPCS C1713		224532  -  NAIL IM 4.5MM 32CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224533	SUP	HCPCS C1713		224533  -  NAIL IM 4.5MM 33CM ENDR	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224534	SUP	HCPCS C1713		224534  -  NAIL IM 4.5MM 34CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224535	SUP	HCPCS C1713		224535  -  NAIL IM 4.5MM 35CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224536	SUP	HCPCS C1713		224536  -  NAIL IM 4.5MM 36CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224537	SUP	HCPCS C1713		224537  -  NAIL IM 4.5MM 37CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224538	SUP	HCPCS C1713		224538  -  NAIL IM 4.5MM 38CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224539	SUP	HCPCS C1713		224539  -  NAIL IM 4.5MM 39CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224540	SUP	HCPCS C1713		224540  -  NAIL IM 4.5MM 40CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224541	SUP	HCPCS C1713		224541  -  NAIL IM 4.5MM 41CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224542	SUP	HCPCS C1713		224542  -  NAIL IM 4.5MM 42CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224543	SUP	HCPCS C1713		224543  -  NAIL IM 4.5MM 43CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224544	SUP	HCPCS C1713		224544  -  NAIL IM 4.5MM 44CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224545	SUP	HCPCS C1713		224545  -  NAIL IM 4.5MM 45CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224546	SUP	HCPCS C1713		224546  -  NAIL IM 4.5MM 46CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224547	SUP	HCPCS C1713		224547  -  NAIL IM 4.5MM 47CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224548	SUP	HCPCS C1713		224548  -  NAIL IM 4.5MM 48CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
224549	SUP	HCPCS C1713		224549  -  NAIL IM 4.5MM 49CM ENDR HUM TIB	BOTH IP/OP	"$1,092.38 "	$808.36	$0.00	$873.90	$491.57	$491.57	$0.00	$0.00	$0.00	$227.68	$810.76	$810.76	$0.00	$0.00	$227.65	$0.00	$646.14	$646.14	$0.00	$546.19	$865.16	$873.90	$0.00		$0.00	$170.96	$0.00	$0.00	$173.91	$0.00	$0.00	$0.00	$0.00	$0.00
231554	SUP	Custom 25003010		DISK OPTOCHIN PNMC DIFF BD TXO SNS	BOTH IP/OP	$91.08 	$67.40	$0.00	$72.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.54	$72.14	$72.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
232447	SUP	HCPCS C1713		232447  -  SYSTEM FX STD RIGIDLOOP ADJ CORT	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
240765	SUP	Custom 27203010		REAGENT VDRL CRDLPN AG BUFF SAL DFC .5ML 60ML NTRPN VL SERO	BOTH IP/OP	$127.95 	$94.68	$0.00	$102.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.98	$101.34	$102.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-00	SUP	Custom 27803010		01-2600  -  HEAD FEMORAL MORSE TAPERED LFIT HIP	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$1,436.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	$0.00	$0.00	$0.00	$897.50	"$1,421.64"	"$1,436.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-00	SUP	Custom 27803010		06-2600  -  HEAD FEMORAL 0 26MM C TAPER LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-05	SUP	Custom 27803010		01-2605  -  HEAD FEMORAL +5MM 26MM MORSE TAPERED LFIT COCR HIP	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$1,436.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	$0.00	$0.00	$0.00	$897.50	"$1,421.64"	"$1,436.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-05	SUP	Custom 27803010		06-2605  -  HEAD FEMORAL +5MM 26MM C TAPER OFFST LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
258962	SUP	HCPCS C1769		258962  -  INTROD TUBE 24-28FR CGL BRHN 8 PERC HYDPHI INTROD SHLY DILAT	BOTH IP/OP	$843.75 	$624.38	$0.00	$675.00	$458.16	$458.16	$0.00	$0.00	$0.00	$175.86	$626.23	$626.23	$0.00	$0.00	$175.84	$0.00	$499.08	$499.08	$0.00	$421.88	$668.25	$675.00	$0.00		$0.00	$132.05	$0.00	$0.00	$134.33	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-10	SUP	Custom 27803010		01-2610  -  HEAD FEMORAL +10MM 26MM MORSE TAPERED LFIT COCR	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$1,436.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	$0.00	$0.00	$0.00	$897.50	"$1,421.64"	"$1,436.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-10	SUP	Custom 27803010		06-2610  -  HEAD FEMORAL +10MM 26MM C TAPER LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
261187	SUP	Custom 27203010		REAGENT MCBL DMACA INDL DRPR BBL .5ML	BOTH IP/OP	$1.33 	$0.98	$0.00	$1.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.66	$1.05	$1.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
261221	SUP	Custom 27203010		261221  -  PERFORATOR SURG 14MM 11MM 14X11MM CRANIUM ADULT STERILE	BOTH IP/OP	$735.05 	$543.94	$0.00	$588.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.55	$545.55	$0.00	$0.00	$153.18	$0.00	$0.00	$0.00	$0.00	$367.53	$582.16	$588.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
263567	SUP	HCPCS C1769		263567  -  SET INTROD 24-26-28FR CGL BRHN 6 PERC EZ-PASS HYDPHI COAT	BOTH IP/OP	$905.05 	$669.74	$0.00	$724.04	$491.44	$491.44	$0.00	$0.00	$0.00	$188.64	$671.73	$671.73	$0.00	$0.00	$188.61	$0.00	$535.34	$535.34	$0.00	$452.53	$716.80	$724.04	$0.00		$0.00	$141.64	$0.00	$0.00	$144.08	$0.00	$0.00	$0.00	$0.00	$0.00
265724	SUP	Custom 27203010		265724  -  CATHETER FOLEY 5CC 24FR	BOTH IP/OP	$4.60 	$3.40	$0.00	$3.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.41	$3.41	$0.00	$0.00	$0.96	$0.00	$0.00	$0.00	$0.00	$2.45	$3.87	$3.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
266720	SUP	Custom 27203010		266720  -  CATHETER URTH 20FR 30CC STRL LTX BARD 2W FL 2 OPPS EYE	BOTH IP/OP	$5.73 	$4.24	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.25	$4.25	$0.00	$0.00	$1.19	$0.00	$0.00	$0.00	$0.00	$2.86	$4.54	$4.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
266722	SUP	Custom 27203010		266722  -  CATHETER URTH 22FR 30CC STRL LTX BARD 2W FL 2 OPPS EYE	BOTH IP/OP	$5.73 	$4.24	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.25	$4.25	$0.00	$0.00	$1.19	$0.00	$0.00	$0.00	$0.00	$2.86	$4.54	$4.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
266728	SUP	Custom 27203010		266728  -  CATH URTH 28FR 2W 2 OPPS EYE FOLEY RND TIP SIL-EL 30ML STRL	BOTH IP/OP	$0.48 	$0.36	$0.00	$4.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.35	$0.35	$0.00	$0.00	$0.10	$0.00	$0.00	$0.00	$0.00	$3.09	$4.89	$4.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
268877	SUP	Custom 27203010		TUBE ACD SOL B 3ML YLW VCTNR CNV CLSR COLLECT	BOTH IP/OP	$0.65 	$0.48	$0.00	$0.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.33	$0.51	$0.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
272905	SUP	Custom 27203010		DEVICE MACV DISPENSTIRS RPR VDRL KT SERTST .05ML	BOTH IP/OP	$183.63 	$135.89	$0.00	$146.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.81	$145.43	$146.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
276081	SUP	Custom 27803010		276081  -  SHUNT 276081 UNI DSM VCATH23CM PCTH120CM	BOTH IP/OP	"$4,723.88 "	"$3,495.67"	$0.00	"$3,779.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,506.06"	"$3,506.06"	$0.00	$0.00	$984.46	$0.00	$0.00	$0.00	$0.00	"$2,361.94"	"$3,741.31"	"$3,779.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
276082	SUP	Custom 27803010		276082  -  SHUNT 276082 UNI DSM VCATH23CM PCTH120CM	BOTH IP/OP	"$4,723.88 "	"$3,495.67"	$0.00	"$3,779.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,506.06"	"$3,506.06"	$0.00	$0.00	$984.46	$0.00	$0.00	$0.00	$0.00	"$2,361.94"	"$3,741.31"	"$3,779.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
276084	SUP	Custom 27803010		276084  -  SHUNT 276084 UNI DSM VCATH23CM PCTH120CM	BOTH IP/OP	"$4,723.88 "	"$3,495.67"	$0.00	"$3,779.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,506.06"	"$3,506.06"	$0.00	$0.00	$984.46	$0.00	$0.00	$0.00	$0.00	"$2,361.94"	"$3,741.31"	"$3,779.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
276085	SUP	Custom 27803010		276085  -  SHUNT 276085 UNI DSM VCATH23CM PCTH120CM	BOTH IP/OP	"$4,723.88 "	"$3,495.67"	$0.00	"$3,779.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,506.06"	"$3,506.06"	$0.00	$0.00	$984.46	$0.00	$0.00	$0.00	$0.00	"$2,361.94"	"$3,741.31"	"$3,779.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
276124	SUP	Custom 27803010		276124  -  SHUNT 276124 UNIDLTA VCATH11 PCATH90 38+	BOTH IP/OP	"$4,251.25 "	"$3,145.93"	$0.00	"$3,401.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,155.28"	"$3,155.28"	$0.00	$0.00	$885.96	$0.00	$0.00	$0.00	$0.00	"$2,125.63"	"$3,366.99"	"$3,401.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
276125	SUP	Custom 27803010		276125  -  SHUNT 276125 UNIDLTA VCATH11 PCATH90 38+	BOTH IP/OP	"$4,251.25 "	"$3,145.93"	$0.00	"$3,401.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,155.28"	"$3,155.28"	$0.00	$0.00	$885.96	$0.00	$0.00	$0.00	$0.00	"$2,125.63"	"$3,366.99"	"$3,401.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
276201	SUP	Custom 27203010		276201  -  KIT 276201 SHNT SM BIO PCATH 90 VCATH 15	BOTH IP/OP	"$5,804.50 "	"$4,295.33"	$0.00	"$4,643.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,209.66"	$0.00	$0.00	$0.00	$0.00	"$2,902.25"	"$4,597.16"	"$4,643.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
276391	SUP	Custom 27203010		276391  -  KIT 276391 DREG VRES PCATH120 VCATH15	BOTH IP/OP	"$4,970.88 "	"$3,678.45"	$0.00	"$3,976.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,689.38"	"$3,689.38"	$0.00	$0.00	"$1,035.93"	$0.00	$0.00	$0.00	$0.00	"$2,485.44"	"$3,936.94"	"$3,976.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
276412	SUP	Custom 27803010		276412  -  SHUNT 276412 DSM PCATH130 STRP NOSLT	BOTH IP/OP	"$4,134.88 "	"$3,059.81"	$0.00	"$3,307.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,068.90"	"$3,068.90"	$0.00	$0.00	$861.71	$0.00	$0.00	$0.00	$0.00	"$2,067.44"	"$3,274.82"	"$3,307.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
276421	SUP	Custom 27803010		276421  -  SHUNT 276421 DREG PCATH130 STRP P/L 1.0	BOTH IP/OP	"$4,134.88 "	"$3,059.81"	$0.00	"$3,307.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,068.90"	"$3,068.90"	$0.00	$0.00	$861.71	$0.00	$0.00	$0.00	$0.00	"$2,067.44"	"$3,274.82"	"$3,307.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
276709	SUP	Custom 27203010		CONTROL RPR BBL MACV CRD 1.5ML IMMUN	BOTH IP/OP	$105.93 	$78.39	$0.00	$84.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.96	$83.90	$84.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
278801	SUP	Custom 27803010		278801  -  SHUNT 278801 DELTA SNP ASY BG SML PL 1.0	BOTH IP/OP	"$2,983.00 "	"$2,207.42"	$0.00	"$2,386.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,213.98"	"$2,213.98"	$0.00	$0.00	$621.66	$0.00	$0.00	$0.00	$0.00	"$1,491.50"	"$2,362.54"	"$2,386.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
278802	SUP	Custom 27803010		278802  -  SHUNT 278802 DELTA SNP ASY BG SML PL 2.0	BOTH IP/OP	"$2,983.00 "	"$2,207.42"	$0.00	"$2,386.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,213.98"	"$2,213.98"	$0.00	$0.00	$621.66	$0.00	$0.00	$0.00	$0.00	"$1,491.50"	"$2,362.54"	"$2,386.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
278805	SUP	Custom 27803010		278805  -  SHUNT 278805 DELTA SNP ASY BG SML PL 1.5	BOTH IP/OP	"$2,983.00 "	"$2,207.42"	$0.00	"$2,386.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,213.98"	"$2,213.98"	$0.00	$0.00	$621.66	$0.00	$0.00	$0.00	$0.00	"$1,491.50"	"$2,362.54"	"$2,386.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
281000	SUP	Custom 27203010		281000  -  DRESSING FOAM THIN 2X1.6IN SELF ADHERENT MOISTURE PROOF	BOTH IP/OP	$221.83 	$164.15	$0.00	$213.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.64	$164.64	$0.00	$0.00	$46.23	$0.00	$0.00	$0.00	$0.00	$133.36	$211.24	$213.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282400	SUP	Custom 27203010		282400  -  DRESSING FM 9.2X9.2IN MPLX BR ADH SAFETAC SIL SCRM	BOTH IP/OP	$26.69 	$19.75	$0.00	$21.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.81	$19.81	$0.00	$0.00	$5.56	$0.00	$0.00	$0.00	$0.00	$13.34	$21.14	$21.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
287300	SUP	Custom 27203010		287300  -  DRESSING FOAM 6X6IN ABSORBENT SELF ADHERENT WATERPROOF	BOTH IP/OP	$39.20 	$29.01	$0.00	$33.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.10	$29.10	$0.00	$0.00	$8.17	$0.00	$0.00	$0.00	$0.00	$21.24	$33.64	$33.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
287500	SUP	Custom 27203010		287500  -  DRESSING FOAM 20X8IN GENTLE ADHERENCE POLYURETHANE FOAM PAD	BOTH IP/OP	$154.14 	$114.06	$0.00	$133.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.41	$114.41	$0.00	$0.00	$32.12	$0.00	$0.00	$0.00	$0.00	$83.52	$132.30	$133.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-91	SUP	HCPCS C1713		01-2691  -  PLATE BONE RECONSTRUCTION ADD ON LEFT CNDYLR HEAD MANDIB 2.4	BOTH IP/OP	"$7,577.50 "	"$5,607.35"	$0.00	"$6,062.00"	"$3,409.88"	"$3,409.88"	$0.00	$0.00	$0.00	"$1,579.34"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,579.15"	$0.00	"$3,735.71"	"$3,735.71"	$0.00	"$3,788.75"	"$6,001.38"	"$6,062.00"	$0.00		$0.00	"$1,185.88"	$0.00	$0.00	"$1,206.34"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-92	SUP	HCPCS C1713		01-2692  -  PLATE BONE RECONSTRUCTION ADD ON RIGHT CNDYLR HEAD MANDIB	BOTH IP/OP	"$7,577.50 "	"$5,607.35"	$0.00	"$6,062.00"	"$3,409.88"	"$3,409.88"	$0.00	$0.00	$0.00	"$1,579.34"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,579.15"	$0.00	"$3,735.71"	"$3,735.71"	$0.00	"$3,788.75"	"$6,001.38"	"$6,062.00"	$0.00		$0.00	"$1,185.88"	$0.00	$0.00	"$1,206.34"	$0.00	$0.00	$0.00	$0.00	$0.00
290058	SUP	HCPCS C1713		290058  -  CAP PCTV 4MM RD STRL	BOTH IP/OP	$84.30 	$62.38	$0.00	$67.44	$37.94	$37.94	$0.00	$0.00	$0.00	$17.57	$62.57	$62.57	$0.00	$0.00	$17.57	$0.00	$49.86	$49.86	$0.00	$42.15	$66.77	$67.44	$0.00		$0.00	$13.19	$0.00	$0.00	$13.42	$0.00	$0.00	$0.00	$0.00	$0.00
290060	SUP	HCPCS C1713		290060  -  CAP PCTV 3MM GRN STRL	BOTH IP/OP	$83.70 	$61.94	$0.00	$66.96	$37.67	$37.67	$0.00	$0.00	$0.00	$17.45	$62.12	$62.12	$0.00	$0.00	$17.44	$0.00	$49.51	$49.51	$0.00	$41.85	$66.29	$66.96	$0.00		$0.00	$13.10	$0.00	$0.00	$13.33	$0.00	$0.00	$0.00	$0.00	$0.00
290061	SUP	HCPCS C1713		290061  -  CAP PROTECTIVE 5MM BLACK STERILE	BOTH IP/OP	$78.20 	$57.87	$0.00	$62.56	$35.19	$35.19	$0.00	$0.00	$0.00	$16.30	$58.04	$58.04	$0.00	$0.00	$16.30	$0.00	$46.26	$46.26	$0.00	$39.10	$61.93	$62.56	$0.00		$0.00	$12.24	$0.00	$0.00	$12.45	$0.00	$0.00	$0.00	$0.00	$0.00
293400	SUP	Custom 27203010		293400  -  DRESSING MPFRM THN 7X4IN ADH FLXB WTPRF SAFETAC TCH WND SIL	BOTH IP/OP	$17.62 	$13.04	$0.00	$14.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.81	$13.96	$14.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
295900	SUP	Custom 27203010		295900  -  DRESSING FOAM 12X4IN ABSORBENT NONADHERENT WATERPROOF	BOTH IP/OP	$376.13 	$278.34	$0.00	$300.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.17	$279.17	$0.00	$0.00	$78.39	$0.00	$0.00	$0.00	$0.00	$188.07	$297.89	$300.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
296348	SUP	Custom 27203010		MEDIA MYCL SAB-DEX EMNS AGAR GNTA BBL PLT DP FILL	BOTH IP/OP	$57.80 	$42.77	$0.00	$46.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.90	$45.78	$46.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
304206	SUP	HCPCS C1729		CATHETER IV 16GA 1.25IN RADIOPQ SFSHLD GRY PCTV TFLN STRL LF	BOTH IP/OP	$3.88 	$2.87	$0.00	$3.10	$2.10	$2.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.94	$3.07	$3.10	$0.00		$0.00	$0.61	$0.00	$0.00	$0.62	$0.00	$0.00	$0.00	$0.00	$0.00
310431	SUP	Custom 27203010		310431  -  BIT DRILL 180MM 4.3MM QC 5MM LCK SCR NONSTRL	BOTH IP/OP	$260.10 	$192.47	$0.00	$208.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$193.05	$193.05	$0.00	$0.00	$54.20	$0.00	$0.00	$0.00	$0.00	$130.05	$206.00	$208.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311270	SUP	HCPCS C1768		"311270  -  GRAFT, AVANCE NERVE, 3-4MM X 70MM"	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$11,800.00"	"$6,637.50"	"$6,637.50"	$0.00	$0.00	$0.00	"$3,356.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	"$7,939.77"	"$7,939.77"	$0.00	"$7,375.00"	"$11,682.00"	"$11,800.00"	$0.00		$0.00	"$2,308.38"	$0.00	$0.00	"$2,348.20"	$0.00	$0.00	$0.00	$0.00	$0.00
315804	SUP	Custom 27203010		315804  -  CANNU PRFSN 11.4IN 4MM CORON ART STR SLF INFL BLN LATEX FREE	BOTH IP/OP	$163.75 	$121.18	$0.00	$131.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.54	$121.54	$0.00	$0.00	$34.13	$0.00	$0.00	$0.00	$0.00	$81.88	$129.69	$131.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315805	SUP	Custom 27203010		315805  -  CANNULA PERFUSION 2.1MM STR 5MM 11.4IN SELF INFLATING	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315806	SUP	Custom 27203010		315806  -  CANNU PRFSN 11.4IN 6MM CORON ART 3MM STR SLF INFL BLN FMALE	BOTH IP/OP	$196.50 	$145.41	$0.00	$157.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.84	$145.84	$0.00	$0.00	$40.95	$0.00	$0.00	$0.00	$0.00	$98.25	$155.63	$157.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315807	SUP	Custom 27203010		315807  -  CANNU PRFSN 11.4IN 7MM CORON ART 3MM STR SLF INFL BLN FMALE	BOTH IP/OP	$163.75 	$121.18	$0.00	$131.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.54	$121.54	$0.00	$0.00	$34.13	$0.00	$0.00	$0.00	$0.00	$81.88	$129.69	$131.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
323020	SUP	Custom 27803010		323020  -  STENT LARYNGEAL SMALL 2 SUTURE BUTTON FLEXIBLE NONADHERENT	BOTH IP/OP	$300.00 	$222.00	$0.00	$222.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
323025	SUP	Custom 27803010		323025  -  STENT LARYNGEAL MEDIUM FLEXIBLE NONADHERENT INTEGRAL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
323030	SUP	Custom 27803010		323030  -  STENT LARYNGEAL LARGE FLEXIBLE NONADHERENT INTEGRAL	BOTH IP/OP	$300.00 	$222.00	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
325014	SUP	HCPCS C1713		325014  -  SCREW BN 4MM 14MM NS ASNS III P/T CNN SS	BOTH IP/OP	$242.25 	$179.27	$0.00	$179.80	$92.81	$92.81	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
325016	SUP	HCPCS C1713		325016  -  SCREW BONE 4MM 16MM ASNS 3 SS PTHRD FRARM CANN NONSTRL	BOTH IP/OP	$242.25 	$179.27	$0.00	$179.80	$86.63	$86.63	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$96.25	$152.46	$154.00	$0.00		$0.00	$30.13	$0.00	$0.00	$30.65	$0.00	$0.00	$0.00	$0.00	$0.00
325018	SUP	HCPCS C1713		325018  -  SCREW BN 4MM 18MM STRL ASNS III P/T IMPL SS	BOTH IP/OP	$242.25 	$179.27	$0.00	$179.80	$92.81	$92.81	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
325020	SUP	HCPCS C1713		325020  -  SCREW BONE 4MM 20MM ASNS 3 SS CANN NONSTRL	BOTH IP/OP	$242.25 	$179.27	$0.00	$179.80	$92.81	$92.81	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
325022	SUP	HCPCS C1713		325022  -  SCREW BONE 4MM 22MM ASNS 3 SS CANN NONSTRL	BOTH IP/OP	$242.25 	$179.27	$0.00	$179.80	$92.81	$92.81	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
325024	SUP	HCPCS C1713		325024  -  SCREW BONE 4MM 24MM ASNS 3 SS PTHRD FRARM CANN NONSTRL	BOTH IP/OP	$242.25 	$179.27	$0.00	$179.80	$86.63	$86.63	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$96.25	$152.46	$154.00	$0.00		$0.00	$30.13	$0.00	$0.00	$30.65	$0.00	$0.00	$0.00	$0.00	$0.00
325026	SUP	HCPCS C1713		325026  -  SCREW BN P/T 4MM 26MM STRL 9MM ASNS III ST SLF DRL CNN SS	BOTH IP/OP	$242.25 	$179.27	$0.00	$179.80	$92.81	$92.81	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
325028	SUP	HCPCS C1713		325028  -  SCREW BN 4MM 28MM STRL 9.5MM ASNS III CNN SS	BOTH IP/OP	$242.25 	$179.27	$0.00	$179.80	$92.81	$92.81	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
325030	SUP	HCPCS C1713		325030  -  SCREW BN P/T 4MM 30MM STRL ASNS III ST SLF DRL CNN SS HIP	BOTH IP/OP	$242.25 	$179.27	$0.00	$179.80	$92.81	$92.81	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
325032	SUP	HCPCS C1713		325032  -  SCREW BONE 4MM 32MM SS PTTHRD IMPL STRL	BOTH IP/OP	$242.25 	$179.27	$0.00	$179.80	$92.81	$92.81	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
325034	SUP	HCPCS C1713		325034  -  SCREW BONE 4MM 34MM SS PTTHRD IMPL STRL	BOTH IP/OP	$242.25 	$179.27	$0.00	$179.80	$92.81	$92.81	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
325036	SUP	HCPCS C1713		325036  -  SCREW BONE 4MM 36MM ASNS 3 SS PTHRD FEM HIP STRL	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
325038	SUP	HCPCS C1713		325038  -  SCREW BN P/T 4MM 38MM NS ASNS III ST SLF DRL LOPRFL HD CNN	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
325040	SUP	HCPCS C1713		325040  -  SCREW BONE 4MM 40MM ASNS 3 SS PTHRD HIP CANN SYS SLFTAP CUT	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
325042	SUP	HCPCS C1713		325042  -  SCREW BONE 4MM 42MM ASNS 3 SS ORTH CANN	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
325044	SUP	HCPCS C1713		325044  -  SCREW BONE 4MM 44MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
325046	SUP	HCPCS C1713		325046  -  SCREW BONE 4MM 46MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
325048	SUP	HCPCS C1713		325048  -  SCREW BN P/T 4MM 48MM NS ASNS III ST SLF DRL LOPRFL HD CNN	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
325050	SUP	HCPCS C1713		325050  -  SCREW BONE 4MM 50MM ASNS 3 SS PTHRD HIP CANN SLFTAP SLFDRILL	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
325055	SUP	HCPCS C1713		325055  -  SCREW BONE 4MM 55MM ASNS 3 SS PTHRD HIP CANN SLFTAP CUT STRL	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
325060	SUP	HCPCS C1713		325060  -  SCREW BONE 4MM 60MM ASNS 3 SS CANN NONSTRL	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
325065	SUP	HCPCS C1713		325065  -  SCREW BONE 4MM 65MM ASNS 3 SS HIP CANN NONSTRL	BOTH IP/OP	$274.55 	$203.17	$0.00	$228.80	$128.70	$128.70	$0.00	$0.00	$0.00	$57.22	$203.77	$203.77	$0.00	$0.00	$57.22	$0.00	$162.40	$162.40	$0.00	$143.00	$226.51	$228.80	$0.00		$0.00	$44.76	$0.00	$0.00	$45.53	$0.00	$0.00	$0.00	$0.00	$0.00
325070	SUP	HCPCS C1713		325070  -  SCREW BONE 4MM 70MM ASNS 3 SS PTHRD HIP CANN STRL	BOTH IP/OP	$274.55 	$203.17	$0.00	$228.80	$128.70	$128.70	$0.00	$0.00	$0.00	$57.22	$203.77	$203.77	$0.00	$0.00	$57.22	$0.00	$162.40	$162.40	$0.00	$143.00	$226.51	$228.80	$0.00		$0.00	$44.76	$0.00	$0.00	$45.53	$0.00	$0.00	$0.00	$0.00	$0.00
325420	SUP	HCPCS C1713		325420  -  SCREW BONE 5MM 20MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$266.25 	$197.03	$0.00	$197.61	$74.87	$74.87	$0.00	$0.00	$0.00	$55.49	$197.61	$197.61	$0.00	$0.00	$55.49	$0.00	$157.49	$157.49	$0.00	$83.19	$131.77	$133.10	$0.00		$0.00	$26.04	$0.00	$0.00	$26.49	$0.00	$0.00	$0.00	$0.00	$0.00
326260	SUP	HCPCS C1713		326260  -  SCREW BONE 6.5MM 60MM 40MM ASNS 3 SS ORTH CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-00	SUP	Custom 27803010		01-2800  -  HEAD FEM +0MM OFST MRS TPR 28MM STRL HIP	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$1,436.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	$0.00	$0.00	$0.00	$897.50	"$1,421.64"	"$1,436.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-00	SUP	Custom 27803010		06-2800  -  HEAD FEM +0MM OFST CTPR 28MM LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
330046	SUP	Custom 27203010		ADAPTER TBG Y 2 FMALE SCR TO 1 MALE BYNT	BOTH IP/OP	$29.70 	$21.98	$0.00	$23.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.85	$23.52	$23.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-05	SUP	HCPCS C1776		01-2805  -  HEAD FEM +5MM 28MM LFIT MRS TPR COCR HIP	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$1,436.00"	$807.75	$807.75	$0.00	$0.00	$0.00	$374.12	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	"$1,061.74"	"$1,061.74"	$0.00	$897.50	"$1,421.64"	"$1,436.00"	$0.00		$0.00	$280.92	$0.00	$0.00	$285.76	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-05	SUP	Custom 27803010		06-2805  -  HEAD FEM +5MM OFST CTPR 28MM LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
331822	SUP	HCPCS C1729		CATHETER CONTAMINATING GUARD AG-2000	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
332079	SUP	Custom 27203010		TRAY EPDRL 17GA 3.5IN NDL MTL TIP SYR FLTR PRFX TH SCHF	BOTH IP/OP	$720.00 	$532.80	$0.00	$576.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$534.38	$534.38	$0.00	$0.00	$150.05	$0.00	$0.00	$0.00	$0.00	$360.00	$570.24	$576.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-10	SUP	Custom 27803010		01-2810  -  HEAD FEM LFIT MRS TPR	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$1,436.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	$0.00	$0.00	$0.00	$897.50	"$1,421.64"	"$1,436.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-10	SUP	Custom 27803010		06-2810  -  HEAD FEM +10MM OFST CTPR 28MM LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
333676	SUP	Custom 27203010		NEEDLE NS STPLX D BVL INSL EXTN SET 15D 4.75IN 22GA	BOTH IP/OP	$127.50 	$94.35	$0.00	$102.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.75	$100.98	$102.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
333690	SUP	Custom 27203010		NEEDLE NS STPLX A INSL EXTN SET BVL 30D DIG/HNS11 STM 2IN 22	BOTH IP/OP	$23.45 	$17.35	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.73	$18.57	$18.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
334050	SUP	HCPCS C1900		334050  -  PHILOS DR SYSTEM	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,771.61"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,771.40"	$0.00	"$4,190.50"	"$4,190.50"	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00		$0.00	"$1,330.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
335903	SUP	HCPCS C1729		CATHETER IV 20GA 1.75IN RADIOPQ SFSHLD PNK ACV+ OCRILON STRL	BOTH IP/OP	$3.98 	$2.95	$0.00	$3.18	$2.16	$2.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.99	$3.15	$3.18	$0.00		$0.00	$0.62	$0.00	$0.00	$0.63	$0.00	$0.00	$0.00	$0.00	$0.00
338001	SUP	HCPCS C1729		CATHETER IV 22GA 1IN RADIOPQ SFSHLD BLUE ACV J TFLN STRL LF	BOTH IP/OP	$3.80 	$2.81	$0.00	$3.04	$2.06	$2.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.90	$3.01	$3.04	$0.00		$0.00	$0.59	$0.00	$0.00	$0.60	$0.00	$0.00	$0.00	$0.00	$0.00
338610	SUP	HCPCS C1713		338610  -  SCREW BONE 3.5MM 10MM AXSOS SS FULTHD CORT SLFTAP	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338612	SUP	HCPCS C1713		338612  -  SCREW BONE 3.5MM 12MM SS CORT SLFTAP	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338614	SUP	HCPCS C1713		338614  -  SCREW BONE 3.5MM 14MM AXSOS SS FULTHD CORT HUM HEX DRV	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338616	SUP	HCPCS C1713		338616  -  SCREW BONE 3.5MM 16MM SS CORT SLFTAP	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338618	SUP	HCPCS C1713		338618  -  SCREW BONE 3.5MM 2.5MM 18MM AXSOS SS CORT PROX HUM HEX DRV	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338620	SUP	HCPCS C1713		338620  -  SCREW BN 2.5MM 3.5MM 20MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338622	SUP	HCPCS C1713		338622  -  SCREW BN 2.5MM 3.5MM 22MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338624	SUP	HCPCS C1713		338624  -  SCREW BN 2.5MM 3.5MM 24MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338626	SUP	HCPCS C1713		338626  -  SCREW BN 2.5MM 3.5MM 26MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338628	SUP	HCPCS C1713		338628  -  SCREW BN 2.5MM 3.5MM 28MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338630	SUP	HCPCS C1713		338630  -  SCREW BN 2.5MM 3.5MM 30MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338632	SUP	HCPCS C1713		338632  -  SCREW BONE 3.5MM 32MM AXSOS SS 2.5MM PROX CORT HUM SLFTAP	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338634	SUP	HCPCS C1713		338634  -  SCREW BN 2.5MM 3.5MM 34MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338636	SUP	HCPCS C1713		338636  -  SCREW BONE 3.5MM 36MM AXSOS SS FULTHD CORT HUM HEX DRV	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338638	SUP	HCPCS C1713		338638  -  SCREW BN 2.5MM 3.5MM 38MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338640	SUP	HCPCS C1713		338640  -  SCREW BN 2.5MM 3.5MM 40MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338642	SUP	HCPCS C1713		338642  -  SCREW BONE 3.5MM 40MM AXSOS SS FULTHD CORT SLFTAP	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338644	SUP	HCPCS C1713		338644  -  SCREW BONE 3.5MM 44MM AXSOS SS FULTHD CORT HUM HEX DRV	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338645	SUP	HCPCS C1713		338645  -  SCREW BN 2.5MM 3.5MM 45MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338646	SUP	HCPCS C1713		338646  -  SCREW BONE 3.5MM 46MM SS CORT SLFTAP	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338648	SUP	HCPCS C1713		338648  -  SCREW BONE 3.5MM 48MM AXSOS SS FULTHD CORT HUM HEX DRV	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338650	SUP	HCPCS C1713		338650  -  SCREW BN 2.5MM 3.5MM 50MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338655	SUP	HCPCS C1713		338655  -  SCREW BN 2.5MM 3.5MM 55MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338660	SUP	HCPCS C1713		338660  -  SCREW BN 2.5MM 3.5MM 60MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338665	SUP	HCPCS C1713		338665  -  SCREW BN 2.5MM 3.5MM 65MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338670	SUP	HCPCS C1713		338670  -  SCREW BN 2.5MM 3.5MM 70MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$14.23	$14.23	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338675	SUP	HCPCS C1713		338675  -  SCREW BN 2.5MM 3.5MM 75MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338680	SUP	HCPCS C1713		338680  -  SCREW BN 2.5MM 3.5MM 80MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338685	SUP	HCPCS C1713		338685  -  SCREW BN 2.5MM 3.5MM 85MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338690	SUP	HCPCS C1713		338690  -  SCREW BN 2.5MM 3.5MM 90MM NS ST HEX SS CORT AXSOS SM FRAG	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338695	SUP	HCPCS C1713		338695  -  SCREW BONE 3.5MM 95MM CORT SLFTAP	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
338700	SUP	HCPCS C1713		338700  -  SCREW BN FT 3.5MM 100MM ST HEX SS CORT AXSOS SM FRAG SET	BOTH IP/OP	$43.20 	$31.97	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$9.00	$32.06	$32.06	$0.00	$0.00	$9.00	$0.00	$25.55	$25.55	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
338705	SUP	HCPCS C1713		338705  -  SCREW BONE 3.5MM 105MM CORT SLFTAP	BOTH IP/OP	$43.20 	$31.97	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$9.00	$32.06	$32.06	$0.00	$0.00	$9.00	$0.00	$25.55	$25.55	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
338710	SUP	HCPCS C1713		338710  -  SCREW BONE 3.5MM 110MM CORT SLFTAP	BOTH IP/OP	$43.20 	$31.97	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$9.00	$32.06	$32.06	$0.00	$0.00	$9.00	$0.00	$25.55	$25.55	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
338715	SUP	HCPCS C1713		338715  -  SCREW BONE 3.5MM 115MM SS CORT SLFTAP	BOTH IP/OP	$43.20 	$31.97	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$9.00	$32.06	$32.06	$0.00	$0.00	$9.00	$0.00	$25.55	$25.55	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
338720	SUP	HCPCS C1713		338720  -  SCREW BONE 3.5MM 120MM SS CORT SLFTAP	BOTH IP/OP	$43.20 	$31.97	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$9.00	$32.06	$32.06	$0.00	$0.00	$9.00	$0.00	$25.55	$25.55	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
340612	SUP	HCPCS C1713		340612  -  SCREW BONE 4.5MM 12MM CORT SLFTAP	BOTH IP/OP	$28.88 	$21.37	$0.00	$23.10	$12.99	$12.99	$0.00	$0.00	$0.00	$6.02	$21.43	$21.43	$0.00	$0.00	$6.02	$0.00	$17.08	$17.08	$0.00	$14.44	$22.87	$23.10	$0.00		$0.00	$4.52	$0.00	$0.00	$4.60	$0.00	$0.00	$0.00	$0.00	$0.00
340614	SUP	HCPCS C1713		340614  -  SCREW BONE 4.5MM 14MM CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340616	SUP	HCPCS C1713		340616  -  SCREW BONE 4.5MM 16MM ISO SS FULTHD CORT SLFTAP NONSTRL	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340618	SUP	HCPCS C1713		340618  -  SCREW BONE 4.5MM 18MM AXSOS SS CORT SLFTAP LCK HEX DRV	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340620	SUP	HCPCS C1713		340620  -  SCREW BONE 4.5MM 20MM SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340622	SUP	HCPCS C1713		340622  -  SCREW BONE 4.5MM 22MM SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340624	SUP	HCPCS C1713		340624  -  SCREW BONE 4.5MM 24MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340626	SUP	HCPCS C1713		340626  -  SCREW BONE 4.5MM 26MM AXSOS SS CORT SLFTAP LCK HEX DRV	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340628	SUP	HCPCS C1713		340628  -  SCREW BONE 4.5MM 28MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340630	SUP	HCPCS C1713		340630  -  SCREW BONE 4.5MM 30MM AXSOS SS CORT SLFTAP LCK HEX DRV	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340632	SUP	HCPCS C1713		340632  -  SCREW BONE 4.5MM 32MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340634	SUP	HCPCS C1713		340634  -  SCREW BONE 4.5MM 34MM SPS SS CORT SLFTAP BASIC FRAG SET	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340636	SUP	HCPCS C1713		340636  -  SCREW BONE 4.5MM 36MM AXSOS SS 3.5MM LAT DISTAL CORT FEM	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340638	SUP	HCPCS C1713		340638  -  SCREW BONE 4.5MM 38MM AXSOS SS 3.5MM LAT DISTAL CORT FEM	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340640	SUP	HCPCS C1713		340640  -  SCREW BONE 4.5MM 40MM AXSOS SS 3.5MM LAT DISTAL CORT FEM	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340642	SUP	HCPCS C1713		340642  -  SCREW BONE 4.5MM 42MM AXSOS SS CORT SLFTAP LCK HEX DRV	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340644	SUP	HCPCS C1713		340644  -  SCREW BONE 4.5MM 44MM AXSOS SS CORT SLFTAP LCK HEX DRV	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340646	SUP	HCPCS C1713		340646  -  SCREW BONE 4.5MM 46MM AXSOS SS CORT SLFTAP LCK HEX DRV	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340648	SUP	HCPCS C1713		340648  -  SCREW BONE 4.5MM 48MM AXSOS SS CORT SLFTAP LCK HEX DRV	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340650	SUP	HCPCS C1713		340650  -  SCREW BONE 4.5MM 50MM AXSOS SS CORT SLFTAP LCK HEX DRV	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340652	SUP	HCPCS C1713		340652  -  SCREW BONE 4.5MM 52MM AXSOS SS CORT SLFTAP LCK HEX DRV	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340654	SUP	HCPCS C1713		340654  -  SCREW BONE 4.5MM 54MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340656	SUP	HCPCS C1713		340656  -  SCREW BONE 4.5MM 56MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340658	SUP	HCPCS C1713		340658  -  SCREW BONE 4.5MM 58MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340660	SUP	HCPCS C1713		340660  -  SCREW BONE 4.5MM 60MM AXSOS SS CORT SLFTAP LCK HEX DRV	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340665	SUP	HCPCS C1713		340665  -  SCREW BONE 4.5MM 3.5MM 65MM AXSOS SS CORT HEX DRV SLFTAP LCK	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340670	SUP	HCPCS C1713		340670  -  SCREW BONE 4.5MM 70MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340675	SUP	HCPCS C1713		340675  -  SCREW BONE 4.5MM 75MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340680	SUP	HCPCS C1713		340680  -  SCREW BONE 4.5MM 80MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340685	SUP	HCPCS C1713		340685  -  SCREW BONE 4.5MM 85MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340690	SUP	HCPCS C1713		340690  -  SCREW BONE 4.5MM 90MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340695	SUP	HCPCS C1713		340695  -  SCREW BONE 4.5MM 95MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$36.18	$14.85	$14.85	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$5.16	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$0.00
340700	SUP	HCPCS C1713		340700  -  SCREW BONE 4.5MM 100MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$38.50	$21.66	$21.66	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
340705	SUP	HCPCS C1713		340705  -  SCREW BONE 4.5MM 105MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$38.50	$21.66	$21.66	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
340710	SUP	HCPCS C1713		340710  -  SCREW BONE 4.5MM 100MM AXSOS SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$38.50	$21.66	$21.66	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
340715	SUP	HCPCS C1713		340715  -  SCREW BONE 4.5MM 115MM SS CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$38.50	$21.66	$21.66	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
340720	SUP	HCPCS C1713		340720  -  SCREW BONE 4.5MM 120MM CORT	BOTH IP/OP	$48.75 	$36.08	$0.00	$38.50	$21.66	$21.66	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
340725	SUP	HCPCS C1713		340725  -  SCREW BONE 4.5MM 125MM ISO SS FULTHD CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$38.50	$21.66	$21.66	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
340730	SUP	HCPCS C1713		340730  -  SCREW BONE 4.5MM 130MM ISO SS FULTHD CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$38.50	$21.66	$21.66	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
340735	SUP	HCPCS C1713		340735  -  SCREW BONE 4.5MM 135MM ISO SS FULTHD CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$38.50	$21.66	$21.66	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
340740	SUP	HCPCS C1713		340740  -  SCREW BONE 4.5MM 140MM ISO SS FULTHD CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$38.50	$21.66	$21.66	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
340745	SUP	HCPCS C1713		340745  -  SCREW BONE 4.5MM 145MM ISO SS FULTHD CORT SLFTAP	BOTH IP/OP	$48.75 	$36.08	$0.00	$38.50	$21.66	$21.66	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
340750	SUP	HCPCS C1713		340750  -  SCREW BONE 4.5MM 150MM ISO SS CORT SLFTAP FULTHD	BOTH IP/OP	$48.75 	$36.08	$0.00	$38.50	$21.66	$21.66	$0.00	$0.00	$0.00	$10.16	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$28.84	$28.84	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
341025	SUP	HCPCS C1713		341025  -  SCREW BN 6.5MM 25MM 16MM P/T CANC	BOTH IP/OP	$52.25 	$38.67	$0.00	$41.80	$23.51	$23.51	$0.00	$0.00	$0.00	$10.89	$38.78	$38.78	$0.00	$0.00	$10.89	$0.00	$30.91	$30.91	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341030	SUP	HCPCS C1713		341030  -  SCREW BONE 6.5MM 30MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341035	SUP	HCPCS C1713		341035  -  SCREW BONE 6.5MM 35MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341040	SUP	HCPCS C1713		341040  -  SCREW BONE 6.5MM 40MM 16MM CANC PTHRD	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341045	SUP	HCPCS C1713		341045  -  SCREW BONE 6.5MM 45MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341050	SUP	HCPCS C1713		341050  -  SCREW BONE 6.5MM 50MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341055	SUP	HCPCS C1713		341055  -  SCREW BONE 6.5MM 55MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341060	SUP	HCPCS C1713		341060  -  SCREW BONE 6.5MM 60MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341065	SUP	HCPCS C1713		341065  -  SCREW BONE 6.5MM 65MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341070	SUP	HCPCS C1713		341070  -  SCREW BONE 6.5MM 70MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341075	SUP	HCPCS C1713		341075  -  SCREW BONE 6.5MM 75MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341080	SUP	HCPCS C1713		341080  -  SCREW BONE 6.5MM 80MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341085	SUP	HCPCS C1713		341085  -  SCREW BONE 6.5MM 85MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341090	SUP	HCPCS C1713		341090  -  SCREW BONE 6.5MM 90MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341095	SUP	HCPCS C1713		341095  -  SCREW BONE 6.5MM 95MM 16MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
341100	SUP	HCPCS C1713		341100  -  SCREW BONE 6.5MM 100MM 16MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
341105	SUP	HCPCS C1713		341105  -  SCREW BONE 6.5MM 105MM 16MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
341110	SUP	HCPCS C1713		341110  -  SCREW BONE 6.5MM 110MM 16MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
341115	SUP	HCPCS C1713		341115  -  SCREW BONE 6.5MM 115MM 16MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
341120	SUP	HCPCS C1713		341120  -  SCREW BONE 6.5MM 120MM 16MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
341125	SUP	HCPCS C1713		341125  -  SCREW BONE 6.5MM 125MM 16MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
341130	SUP	HCPCS C1713		341130  -  SCREW BONE 6.5MM 130MM 16MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
341140	SUP	HCPCS C1713		341140  -  SCREW BONE 6.5MM 140MM 16MM SS CANC SLFTAP FULTHD ISO	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
341824	SUP	HCPCS C1786		341824  -  PACEMAKER CRD THK6MM 53X39MM 11ML PH2 SR IMPL 1 CHMBR RR	BOTH IP/OP	"$8,000.00 "	"$5,920.00"	$0.00	"$6,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,667.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,667.20"	$0.00	"$3,944.00"	"$3,944.00"	$0.00	"$4,000.00"	"$6,336.00"	"$6,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
342040	SUP	HCPCS C1713		342040  -  SCREW BONE 6.5MM 40MM 32MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
342045	SUP	HCPCS C1713		342045  -  SCREW BONE 6.5MM 45MM 32MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
342050	SUP	HCPCS C1713		342050  -  SCREW BONE 6.5MM 50MM SS CANC PTTHRD	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
342055	SUP	HCPCS C1713		342055  -  SCREW BONE 6.5MM 55MM 32MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
342060	SUP	HCPCS C1713		342060  -  SCREW BONE 6.5MM 60MM 32MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
342065	SUP	HCPCS C1713		342065  -  SCREW BONE 6.5MM 65MM 32MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
342070	SUP	HCPCS C1713		342070  -  SCREW BONE 6.5MM 70MM 32MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
342075	SUP	HCPCS C1713		342075  -  SCREW BONE 6.5MM 75MM 32MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
342080	SUP	HCPCS C1713		342080  -  SCREW BONE 6.5MM 80MM 32MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
342085	SUP	HCPCS C1713		342085  -  SCREW BONE 6.5MM 85MM 32MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
342090	SUP	HCPCS C1713		342090  -  SCREW BONE 6.5MM 90MM 32MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
342095	SUP	HCPCS C1713		342095  -  SCREW BONE 6.5MM 95MM 32MM SS CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
342100	SUP	HCPCS C1713		342100  -  SCREW BONE 6.5MM 100MM 32MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
342105	SUP	HCPCS C1713		342105  -  SCREW BONE 6.5MM 105MM 32MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
342110	SUP	HCPCS C1713		342110  -  SCREW BONE 6.5MM 110MM 32MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
342115	SUP	HCPCS C1713		342115  -  SCREW BONE 6.5MM 115MM 32MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
342120	SUP	HCPCS C1713		342120  -  SCREW BONE 6.5MM 120MM 32MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
342125	SUP	HCPCS C1713		342125  -  SCREW BONE 6.5MM 125MM 32MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
342130	SUP	HCPCS C1713		342130  -  SCREW BONE 6.5MM 130MM 32MM SS CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
342140	SUP	HCPCS C1713		342140  -  SCREW BONE 6.5MM 140MM 32MM SS CANC	BOTH IP/OP	$61.88 	$45.79	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.90	$45.92	$45.92	$0.00	$0.00	$12.89	$0.00	$36.60	$36.60	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
343020	SUP	HCPCS C1713		343020  -  SCREW BONE 6.5MM 20MM SS FULTHD CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
343025	SUP	HCPCS C1713		343025  -  SCREW BONE 6.5MM 25MM SS FULTHD CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343030	SUP	HCPCS C1713		343030  -  SCREW BONE 6.5MM 30MM SS FULTHD CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343035	SUP	HCPCS C1713		343035  -  SCREW BONE 6.5MM 35MM SS FULTHD CANC LCK HEX DRV	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343040	SUP	HCPCS C1713		343040  -  SCREW BONE 6.5MM 40MM ISO TI FULTHD CANC NONSTRL	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343045	SUP	HCPCS C1713		343045  -  SCREW BONE 6.5MM 45MM SS FULTHD CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343050	SUP	HCPCS C1713		343050  -  SCREW BONE 6.5MM 50MM SS FULTHD CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343055	SUP	HCPCS C1713		343055  -  SCREW BONE 6.5MM 55MM SS FULTHD CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343060	SUP	HCPCS C1713		343060  -  SCREW BONE 6.5MM 60MM SS FULTHD CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343065	SUP	HCPCS C1713		343065  -  SCREW BONE 6.5MM 65MM SS FULTHD CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343070	SUP	HCPCS C1713		343070  -  SCREW BONE 6.5MM 70MM SS FULTHD CANC LCK HEX DRV	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343075	SUP	HCPCS C1713		343075  -  SCREW BONE 6.5MM 75MM SS FULTHD CANC LCK HEX DRV	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343080	SUP	HCPCS C1713		343080  -  SCREW BONE 6.5MM 80MM SS FULTHD CANC LCK HEX DRV	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343085	SUP	HCPCS C1713		343085  -  SCREW BONE 6.5MM 85MM SS FULTHD CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343090	SUP	HCPCS C1713		343090  -  SCREW BONE 6.5MM 90MM SS FULTHD CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343095	SUP	HCPCS C1713		343095  -  SCREW BONE 6.5MM 95MM SS FULTHD CANC	BOTH IP/OP	$57.00 	$42.18	$0.00	$42.31	$23.51	$23.51	$0.00	$0.00	$0.00	$11.88	$42.31	$42.31	$0.00	$0.00	$11.88	$0.00	$33.72	$33.72	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
343100	SUP	HCPCS C1713		343100  -  SCREW BONE 6.5MM 100MM SS FULTHD CANC	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
343105	SUP	HCPCS C1713		343105  -  SCREW BONE 6.5MM 105MM SS CANC FULTHRD	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
343110	SUP	HCPCS C1713		343110  -  SCREW BONE 6.5MM 110MM SS CANC FULTHRD	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
343115	SUP	HCPCS C1713		343115  -  SCREW BONE 6.5MM 115MM SS CANC FULTHRD	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
343120	SUP	HCPCS C1713		343120  -  SCREW BONE 6.5MM 120MM ISO SS CANC FULTHRD	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
343125	SUP	HCPCS C1713		343125  -  SCREW BONE 6.5MM 125MM ISO SS FULTHD CANC HIP NONSTRL	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
343130	SUP	HCPCS C1713		343130  -  SCREW BONE 6.5MM 130MM ISO SS FULTHD CANC HIP NONSTRL	BOTH IP/OP	$60.80 	$44.99	$0.00	$49.50	$27.84	$27.84	$0.00	$0.00	$0.00	$12.67	$45.13	$45.13	$0.00	$0.00	$12.67	$0.00	$35.96	$35.96	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
345410	SUP	HCPCS C1713		345410  -  SCREW BONE 4MM 10MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345412	SUP	HCPCS C1713		345412  -  SCREW BONE 4MM 12MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345414	SUP	HCPCS C1713		345414  -  SCREW BONE 4MM 14MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345416	SUP	HCPCS C1713		345416  -  SCREW BONE 4MM 16MM SS FULTHD CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345418	SUP	HCPCS C1713		345418  -  SCREW BONE 4MM 18MM SS FULTHD CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345420	SUP	HCPCS C1713		345420  -  SCREW BONE 4MM 20MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345422	SUP	HCPCS C1713		345422  -  SCREW BONE 4MM 22MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345424	SUP	HCPCS C1713		345424  -  SCREW BONE 4MM 24MM UNIFLEX SS FULTHD CANC IM NAIL	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345426	SUP	HCPCS C1713		345426  -  SCREW BONE 4MM 26MM UNIFLEX SS FULTHD CANC IM NAIL	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345428	SUP	HCPCS C1713		345428  -  SCREW BONE 4MM 28MM ISO SS FULTHD CANC NONSTRL	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345430	SUP	HCPCS C1713		345430  -  SCREW BONE 4MM 30MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345432	SUP	HCPCS C1713		345432  -  SCREW BONE 4MM 32MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345434	SUP	HCPCS C1713		345434  -  SCREW BONE 4MM 34MM UNIFLEX SS FULTHD CANC IM NAIL	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345436	SUP	HCPCS C1713		345436  -  SCREW BONE 4MM 36MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345438	SUP	HCPCS C1713		345438  -  SCREW BONE 4MM 38MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345440	SUP	HCPCS C1713		345440  -  SCREW BONE 4MM 40MM SS FULTHD CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345445	SUP	HCPCS C1713		345445  -  SCREW BONE 4MM 45MM AXSOS SS 2.5MM FULTHD PROX CANC HUM LCK	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345450	SUP	HCPCS C1713		345450  -  SCREW BONE 4MM 50MM SS FULTHD CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345455	SUP	HCPCS C1713		345455  -  SCREW BONE 4MM 55MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345460	SUP	HCPCS C1713		345460  -  SCREW BONE 4MM 60MM UNIFLEX SS FULTHD CANC IM NAIL	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345465	SUP	HCPCS C1713		345465  -  SCREW BONE 4MM 65MM AXSOS SS FULTHD CANC HEX DRV LCK	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345470	SUP	HCPCS C1713		345470  -  SCREW BONE 4MM 70MM ISO SS FULTHD CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345475	SUP	HCPCS C1713		345475  -  SCREW BONE 4MM 75MM SS FULTHD CANC	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$14.23	$14.23	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345480	SUP	HCPCS C1713		345480  -  SCREW BONE 4MM 80MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$14.23	$14.23	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345485	SUP	HCPCS C1713		345485  -  SCREW BONE 4MM 85MM SS FULTHD CANC	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$14.23	$14.23	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345490	SUP	HCPCS C1713		345490  -  SCREW BONE 4MM 90MM SS FULTHD CANC	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$14.23	$14.23	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345495	SUP	HCPCS C1713		345495  -  SCREW BONE 4MM 95MM ISO SS FULTHD CANC	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$14.23	$14.23	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345500	SUP	HCPCS C1713		345500  -  SCREW BONE 4MM 100MM ISO SS FULTHD CANC	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$14.23	$14.23	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345510	SUP	HCPCS C1713		345510  -  SCREW BONE 4MM 10MM 5MM SS CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345512	SUP	HCPCS C1713		345512  -  SCREW BONE 4MM 12MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345514	SUP	HCPCS C1713		345514  -  SCREW BONE 4MM 14MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345516	SUP	HCPCS C1713		345516  -  SCREW BONE 4MM 16MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345518	SUP	HCPCS C1758		345518  -  SCREW BONE 4MM 18MM UNIFLEX SS CANC PTTHRD IM NAIL	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$17.17	$17.17	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345520	SUP	HCPCS C1713		345520  -  SCREW BONE 4MM 20MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345522	SUP	HCPCS C1713		345522  -  SCREW BONE 4MM 22MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345524	SUP	HCPCS C1713		345524  -  SCREW BONE 4MM 24MM ISO SS PTHRD CANC PARTIL THRD SM FRAG	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345526	SUP	HCPCS C1713		345526  -  SCREW BONE 4MM 26MM SS CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345528	SUP	HCPCS C1713		345528  -  SCREW BONE 4MM 28MM UNIFLEX SS CANC PTHRD IM NAIL	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345530	SUP	HCPCS C1713		345530  -  SCREW BONE 4MM 30MM AXSOS SS PTHRD CANC PTHRD SM FRAG SET	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345532	SUP	HCPCS C1713		345532  -  SCREW BONE 4MM 32MM 14MM SS CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345534	SUP	HCPCS C1713		345534  -  SCREW BONE 4MM 34MM 14MM SS CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345536	SUP	HCPCS C1713		345536  -  SCREW BONE 4MM 36MM 14MM SS CANC PTHRD	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345538	SUP	HCPCS C1713		345538  -  SCREW BONE 4MM 38MM 14MM SS CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345540	SUP	HCPCS C1713		345540  -  SCREW BONE 4MM 40MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345545	SUP	HCPCS C1713		345545  -  SCREW BN 2.5MM P/T 4MM 45MM NS HEX SS CANC AXSOS SM FRAG SET	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345550	SUP	HCPCS C1713		345550  -  SCREW BONE 4MM 50MM AXSOS SS PTHRD CANC PTHRD SM FRAG SET	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345555	SUP	HCPCS C1713		345555  -  SCREW BONE 4MM 55MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345560	SUP	HCPCS C1713		345560  -  SCREW BONE 4MM 60MM 16MM SS CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345565	SUP	HCPCS C1713		345565  -  SCREW BONE 4MM 65MM SS CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345570	SUP	HCPCS C1713		345570  -  SCREW BONE 4MM 70MM 14MM SS CANC	BOTH IP/OP	$40.50 	$29.97	$0.00	$30.06	$14.23	$14.23	$0.00	$0.00	$0.00	$8.44	$30.06	$30.06	$0.00	$0.00	$8.44	$0.00	$23.96	$23.96	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345575	SUP	HCPCS C1713		345575  -  SCREW BONE 4MM 75MM SS CANC	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$14.23	$14.23	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345580	SUP	HCPCS C1713		345580  -  SCREW BONE 4MM 80MM SS CANC	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$14.23	$14.23	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345585	SUP	HCPCS C1713		345585  -  SCREW BONE 4MM 85MM 16MM ISO SS CANC	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$14.23	$14.23	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345590	SUP	HCPCS C1713		345590  -  SCREW BONE 4MM 90MM 16MM ISO SS CANC	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$14.23	$14.23	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345595	SUP	HCPCS C1713		345595  -  SCREW BONE 4MM 95MM AXSOS SS CANC LCK PTHRD	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$14.23	$14.23	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
345600	SUP	HCPCS C1713		345600  -  SCREW BONE 4MM 100MM 16MM ISO SS CANC	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$14.23	$14.23	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
348446	SUP	HCPCS C1900		348446  -  PHILOS II DR SYSTEM	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
350974	SUP	HCPCS C1895		350974  -  SETROX S 53 LEAD	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
353440	SUP	Custom 27203010		PUNCH 7IN 4MM STD TIP STRL LF DISP AOR	BOTH IP/OP	$335.90 	$248.57	$0.00	$372.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.30	$249.30	$0.00	$0.00	$70.00	$0.00	$0.00	$0.00	$0.00	$232.50	$368.28	$372.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
355149	SUP	HCPCS C1900		355149  -  COROX OTW 85 BP-S LEAD	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
356053	SUP	HCPCS C1900		356053  -  CYLOS VR SYSTEM WITH CLS AUTONOMIC RESPONSE	BOTH IP/OP	"$9,500.00 "	"$7,030.00"	$0.00	"$7,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,980.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,979.80"	$0.00	"$4,683.50"	"$4,683.50"	$0.00	"$4,750.00"	"$7,524.00"	"$7,600.00"	$0.00		$0.00	"$1,486.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
359654	SUP	HCPCS C1721		359654  -  LUMAX 340 DR-T HIGH ENERGY WITH HM MOBILE GSM	BOTH IP/OP	"$46,450.00 "	"$34,373.00"	$0.00	"$37,160.00"	"$20,902.50"	"$20,902.50"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,680.18"	$0.00	"$22,899.85"	"$22,899.85"	$0.00	"$23,225.00"	"$36,788.40"	"$37,160.00"	$0.00		$0.00	"$7,269.43"	$0.00	$0.00	"$7,394.84"	$0.00	$0.00	$0.00	$0.00	$0.00
359655	SUP	HCPCS C1721		359655  -  LUMAX 340 DR-T HIGH ENERGY SYSTEM WITH HM MOBILE GSM	BOTH IP/OP	"$56,450.00 "	"$41,773.00"	$0.00	"$45,160.00"	"$25,402.50"	"$25,402.50"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$11,764.18"	$0.00	"$27,829.85"	"$27,829.85"	$0.00	"$28,225.00"	"$44,708.40"	"$45,160.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
359656	SUP	HCPCS C1721		359656  -  LUMAX 340 DR-T HIGH ENERGY SYSTEM WITH HM LANDLINE	BOTH IP/OP	"$51,450.00 "	"$38,073.00"	$0.00	"$41,160.00"	"$23,152.50"	"$23,152.50"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$10,722.18"	$0.00	"$25,364.85"	"$25,364.85"	$0.00	"$25,725.00"	"$40,748.40"	"$41,160.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
359659	SUP	HCPCS C1882		359659  -  LUMAX 340 HF-T HIGH ENERGY SYSTEM WITH HM MOBILE GSM	BOTH IP/OP	"$72,600.00 "	"$53,724.00"	$0.00	"$58,080.00"	"$32,670.00"	"$32,670.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$15,129.84"	$0.00	"$35,791.80"	"$35,791.80"	$0.00	"$36,300.00"	"$57,499.20"	"$58,080.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
359662	SUP	HCPCS C1882		359662  -  LUMAX 340 HF-T HIGH ENERGY SYSTEM WITH HM LANDLINE	BOTH IP/OP	"$67,600.00 "	"$50,024.00"	$0.00	"$54,080.00"	"$30,420.00"	"$30,420.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$14,087.84"	$0.00	"$33,326.80"	"$33,326.80"	$0.00	"$33,800.00"	"$53,539.20"	"$54,080.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
359664	SUP	HCPCS C1786		359664  -  LUMAX 340 VR-T HIGH ENERGY WITH HM MOBILE GSM	BOTH IP/OP	"$42,700.00 "	"$31,598.00"	$0.00	"$34,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,899.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,898.68"	$0.00	"$21,051.10"	"$21,051.10"	$0.00	"$21,350.00"	"$33,818.40"	"$34,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
359665	SUP	HCPCS C1786		359665  -  LUMAX 340 VR-T HIGH ENERGY SYSTEM WITH HM MOBILE GSM	BOTH IP/OP	"$52,700.00 "	"$38,998.00"	$0.00	"$42,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$10,982.68"	$0.00	"$25,981.10"	"$25,981.10"	$0.00	"$26,350.00"	"$41,738.40"	"$42,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
359666	SUP	HCPCS C1874		359666  -  DFBR CRD LUMAX 340 VR-T AV 1 CHMBR RSYN THRP IMPLTABLE	BOTH IP/OP	"$47,700.00 "	"$35,298.00"	$0.00	"$38,160.00"	"$21,465.00"	"$21,465.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,940.68"	$0.00	"$23,516.10"	"$23,516.10"	$0.00	"$23,850.00"	"$37,778.40"	"$38,160.00"	$0.00		$0.00	"$7,465.05"	$0.00	$0.00	"$7,593.84"	$0.00	$0.00	$0.00	$0.00	$0.00
360101	SUP	Custom 27203010		360101  -  DEVICE SPEC RTRVL .018IN 10MM 10CM INTLK DTCH COIL	BOTH IP/OP	$455.50 	$337.07	$0.00	$364.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$338.07	$338.07	$0.00	$0.00	$94.93	$0.00	$0.00	$0.00	$0.00	$227.75	$360.76	$364.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-98	SUP	Custom 27803010		06-2898  -  HEAD FEM -3MM OFST CTPR 28MM LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
370001	SUP	Custom 27803010		370001  -  INSERT ACETAB 3MM HIP LCK	BOTH IP/OP	$71.20 	$52.69	$0.00	$59.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.84	$52.84	$0.00	$0.00	$14.84	$0.00	$0.00	$0.00	$0.00	$37.13	$58.81	$59.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
370002	SUP	Custom 27803010		370002  -  INSERT ACETAB 4MM SM BONE SS AXSOS PLT SYS	BOTH IP/OP	$78.40 	$58.02	$0.00	$59.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.19	$58.19	$0.00	$0.00	$16.34	$0.00	$0.00	$0.00	$0.00	$37.13	$58.81	$59.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
370003	SUP	Custom 27803010		370003  -  INSERT TIB LAT DISTAL FEM SS LCK AXSOS 5MM NONSTRL BASIC	BOTH IP/OP	$96.25 	$71.23	$0.00	$77.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.44	$71.44	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
370004	SUP	HCPCS C1713		370004  -  PLUG CABLE 4MM AXSOS SS SM FRAG	BOTH IP/OP	$78.40 	$58.02	$0.00	$59.40	$33.41	$33.41	$0.00	$0.00	$0.00	$16.34	$58.19	$58.19	$0.00	$0.00	$16.34	$0.00	$46.37	$46.37	$0.00	$37.13	$58.81	$59.40	$0.00		$0.00	$11.62	$0.00	$0.00	$11.82	$0.00	$0.00	$0.00	$0.00	$0.00
370005	SUP	HCPCS C1713		370005  -  PLUG CABLE 5MM AXSOS LAT DISTAL FEM SS NONSTRL	BOTH IP/OP	$102.40 	$75.78	$0.00	$76.00	$40.22	$40.22	$0.00	$0.00	$0.00	$21.34	$76.00	$76.00	$0.00	$0.00	$21.34	$0.00	$60.57	$60.57	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
370008	SUP	HCPCS C1713		370008  -  SCREW BONE 3MM 8MM ORTH LCK	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$27.51	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
370010	SUP	HCPCS C1713		370010  -  SCREW BONE 3MM 10MM ORTH LCK	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$27.51	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
370012	SUP	HCPCS C1713		370012  -  SCREW BONE 3MM 12MM AXSOS SS CORT T8 DRV LCK SLFTAP	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$27.51	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
370014	SUP	HCPCS C1713		370014  -  SCREW BONE 3MM 14MM AXSOS SS CORT T8 DRV LCK SLFTAP	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$27.51	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
370016	SUP	HCPCS C1713		370016  -  SCREW BONE 3MM 16MM AXSOS SS CORT T8 DRV LCK SLFTAP	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$27.51	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
370018	SUP	HCPCS C1713		370018  -  SCREW BONE 3MM 18MM AXSOS SS HUM FEM/TIB T8 DRV LCK SLFTAP	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$27.51	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
370020	SUP	HCPCS C1713		370020  -  SCREW BONE 3MM 20MM ORTH LCK	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$27.51	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
370022	SUP	HCPCS C1713		370022  -  SCREW BONE 3MM 22MM ORTH LCK	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$27.51	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
370024	SUP	HCPCS C1713		370024  -  SCREW BONE 3MM 24MM AXSOS SS CORT T8 DRV LCK SLFTAP	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$27.51	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
370026	SUP	HCPCS C1713		370026  -  SCREW BONE 3MM 26MM ORTH LCK	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$27.51	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
370028	SUP	HCPCS C1713		370028  -  SCREW BONE 3MM 28MM ORTH LCK	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$27.51	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
370030	SUP	HCPCS C1713		370030  -  SCREW BONE 3MM 30MM AXSOS SS CORT T8 DRV LCK SLFTAP	BOTH IP/OP	$132.00 	$97.68	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$27.51	$97.97	$97.97	$0.00	$0.00	$27.51	$0.00	$78.08	$78.08	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
370110	SUP	HCPCS C1713		370110  -  SCREW BONE 5MM 10MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$260.80 	$192.99	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$54.36	$193.57	$193.57	$0.00	$0.00	$54.35	$0.00	$154.26	$154.26	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
370112	SUP	HCPCS C1713		370112  -  SCREW BONE 5MM 12MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV	BOTH IP/OP	$260.80 	$192.99	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$54.36	$193.57	$193.57	$0.00	$0.00	$54.35	$0.00	$154.26	$154.26	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
370114	SUP	HCPCS C1713		370114  -  SCREW BONE 5MM 14MM AXSOS DISTAL LAT FEM SLFTAP LCK T20 DRV	BOTH IP/OP	$260.80 	$192.99	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$54.36	$193.57	$193.57	$0.00	$0.00	$54.35	$0.00	$154.26	$154.26	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
370116	SUP	HCPCS C1713		370116  -  SCREW BONE 5MM 16MM AXSOS SS HUM FEM/TIB SLFTAP LCK T20 DRV	BOTH IP/OP	$260.80 	$192.99	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$54.36	$193.57	$193.57	$0.00	$0.00	$54.35	$0.00	$154.26	$154.26	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
370118	SUP	HCPCS C1713		370118  -  SCREW BONE 5MM 18MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$260.80 	$192.99	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$54.36	$193.57	$193.57	$0.00	$0.00	$54.35	$0.00	$154.26	$154.26	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
370120	SUP	HCPCS C1713		370120  -  SCREW BONE 5MM 20MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$260.80 	$192.99	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$54.36	$193.57	$193.57	$0.00	$0.00	$54.35	$0.00	$154.26	$154.26	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
370314	SUP	HCPCS C1713		370314  -  SCREW BONE 5MM 14MM ORTH LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370316	SUP	HCPCS C1713		370316  -  SCREW BONE 5MM 16MM ORTH LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370318	SUP	HCPCS C1713		370318  -  SCREW BONE 5MM 18MM AXSOS SS HUM FEM/TIB SLFTAP LCK T20 DRV	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370320	SUP	HCPCS C1713		370320  -  SCREW BONE 5MM 20MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370322	SUP	HCPCS C1713		370322  -  SCREW BONE 5MM 22MM ORTH LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370324	SUP	HCPCS C1713		370324  -  SCREW BONE 5MM 24MM ORTH LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370326	SUP	HCPCS C1713		370326  -  SCREW BONE 5MM 26MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370328	SUP	HCPCS C1713		370328  -  SCREW BONE 5MM 28MM AXSOS SS LCK SLFTAP T20 DRV PLT SYS	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370330	SUP	HCPCS C1713		370330  -  SCREW BONE 5MM 30MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370332	SUP	HCPCS C1713		370332  -  SCREW BONE 5MM 32MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370334	SUP	HCPCS C1713		370334  -  SCREW BONE 5MM 34MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370336	SUP	HCPCS C1713		370336  -  SCREW BONE 5MM 36MM AXSOS SS HUM FEM/TIB T20 DRV SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370338	SUP	HCPCS C1713		370338  -  SCREW BONE 5MM 38MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370340	SUP	HCPCS C1713		370340  -  SCREW BONE 5MM 40MM AXSOS SS DISTAL LAT FEM LCK SLFTAP T20	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370342	SUP	HCPCS C1713		370342  -  SCREW BONE 5MM 42MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370344	SUP	HCPCS C1713		370344  -  SCREW BONE 5MM 44MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370346	SUP	HCPCS C1713		370346  -  SCREW BONE 5MM 46MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370348	SUP	HCPCS C1713		370348  -  SCREW BONE 5MM 48MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370350	SUP	HCPCS C1713		370350  -  SCREW BONE 5MM 50MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370355	SUP	HCPCS C1713		370355  -  SCREW BONE 5MM 55MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370360	SUP	HCPCS C1713		370360  -  SCREW BONE 5MM 60MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370365	SUP	HCPCS C1713		370365  -  SCREW BONE 5MM 65MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370370	SUP	HCPCS C1713		370370  -  SCREW BONE 5MM 70MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370375	SUP	HCPCS C1713		370375  -  SCREW BONE 5MM 75MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370380	SUP	HCPCS C1713		370380  -  SCREW BONE 5MM 80MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370385	SUP	HCPCS C1713		370385  -  SCREW BONE 5MM 85MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370390	SUP	HCPCS C1713		370390  -  SCREW BONE 5MM 90MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370395	SUP	HCPCS C1713		370395  -  SCREW BONE 5MM 95MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
370400	SUP	HCPCS C1713		370400  -  SCREW BONE 5MM 100MM ORTH LCK	BOTH IP/OP	$196.63 	$145.51	$0.00	$157.30	$88.48	$88.48	$0.00	$0.00	$0.00	$40.98	$145.94	$145.94	$0.00	$0.00	$40.98	$0.00	$116.30	$116.30	$0.00	$98.31	$155.73	$157.30	$0.00		$0.00	$30.77	$0.00	$0.00	$31.30	$0.00	$0.00	$0.00	$0.00	$0.00
370405	SUP	HCPCS C1713		370405  -  SCREW BONE 5MM 105MM ORTH LCK	BOTH IP/OP	$196.63 	$145.51	$0.00	$157.30	$88.48	$88.48	$0.00	$0.00	$0.00	$40.98	$145.94	$145.94	$0.00	$0.00	$40.98	$0.00	$116.30	$116.30	$0.00	$98.31	$155.73	$157.30	$0.00		$0.00	$30.77	$0.00	$0.00	$31.30	$0.00	$0.00	$0.00	$0.00	$0.00
370410	SUP	HCPCS C1713		370410  -  SCREW BONE 5MM 110MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$196.63 	$145.51	$0.00	$157.30	$88.48	$88.48	$0.00	$0.00	$0.00	$40.98	$145.94	$145.94	$0.00	$0.00	$40.98	$0.00	$116.30	$116.30	$0.00	$98.31	$155.73	$157.30	$0.00		$0.00	$30.77	$0.00	$0.00	$31.30	$0.00	$0.00	$0.00	$0.00	$0.00
370415	SUP	HCPCS C1713		370415  -  SCREW BONE 5MM 115MM ORTH LCK	BOTH IP/OP	$196.63 	$145.51	$0.00	$157.30	$88.48	$88.48	$0.00	$0.00	$0.00	$40.98	$145.94	$145.94	$0.00	$0.00	$40.98	$0.00	$116.30	$116.30	$0.00	$98.31	$155.73	$157.30	$0.00		$0.00	$30.77	$0.00	$0.00	$31.30	$0.00	$0.00	$0.00	$0.00	$0.00
370420	SUP	HCPCS C1713		370420  -  SCREW BONE 5MM 120MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$196.63 	$145.51	$0.00	$157.30	$88.48	$88.48	$0.00	$0.00	$0.00	$40.98	$145.94	$145.94	$0.00	$0.00	$40.98	$0.00	$116.30	$116.30	$0.00	$98.31	$155.73	$157.30	$0.00		$0.00	$30.77	$0.00	$0.00	$31.30	$0.00	$0.00	$0.00	$0.00	$0.00
370514	SUP	HCPCS C1713		370514  -  SCREW BONE 4MM 14MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370516	SUP	HCPCS C1713		370516  -  SCREW BONE 4MM 16MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370518	SUP	HCPCS C1713		370518  -  SCREW BONE 4MM 18MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370520	SUP	HCPCS C1713		370520  -  SCREW BONE 4MM 20MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370522	SUP	HCPCS C1713		370522  -  SCREW BONE 4MM 22MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370524	SUP	HCPCS C1713		370524  -  SCREW BONE 4MM 24MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370526	SUP	HCPCS C1713		370526  -  SCREW BONE 4MM 26MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370528	SUP	HCPCS C1713		370528  -  SCREW BONE 4MM 28MM AXSOS SS LCK SLFTAP T15 DRV	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370530	SUP	HCPCS C1713		370530  -  SCREW BONE 4MM 30MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370532	SUP	HCPCS C1713		370532  -  SCREW BONE 4MM 32MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370534	SUP	HCPCS C1713		370534  -  SCREW BONE 4MM 34MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370536	SUP	HCPCS C1713		370536  -  SCREW BONE 4MM 36MM AXSOS SS HUM FEM/TIB SLFTAP LCK T20 DRV	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370538	SUP	HCPCS C1713		370538  -  SCREW BONE 4MM 38MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370540	SUP	HCPCS C1713		370540  -  SCREW BONE 4MM 40MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370542	SUP	HCPCS C1713		370542  -  SCREW BONE 4MM 42MM AXSOS SS LCK SLFTAP T15 DRV	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370544	SUP	HCPCS C1713		370544  -  SCREW BONE 4MM 44MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370546	SUP	HCPCS C1713		370546  -  SCREW BONE 4MM 46MM AXSOS SS LCK SLFTAP T15 DRV	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370548	SUP	HCPCS C1713		370548  -  SCREW BONE 4MM 48MM AXSOS SS HUM FEM/TIB LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370550	SUP	HCPCS C1713		370550  -  SCREW BONE 4MM 50MM AXSOS SS LCK SLFTAP T15 DRV	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370555	SUP	HCPCS C1713		370555  -  SCREW BONE 4MM 55MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370560	SUP	HCPCS C1713		370560  -  SCREW BONE 4MM 60MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370565	SUP	HCPCS C1713		370565  -  SCREW BONE 4MM 65MM AXSOS SS HUM FEM/TIB SLFTAP LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370570	SUP	HCPCS C1713		370570  -  SCREW BONE 4MM 70MM AXSOS SS SLFTAP LCK T15 DRV NONSTRL	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370575	SUP	HCPCS C1713		370575  -  SCREW BONE 4MM 75MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370580	SUP	HCPCS C1713		370580  -  SCREW BONE 4MM 80MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370585	SUP	HCPCS C1713		370585  -  SCREW BONE 4MM 85MM AXSOS SS HUM FEM/TIB SLFTAP LCK T20 DRV	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370590	SUP	HCPCS C1713		370590  -  SCREW BONE 4MM 90MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370595	SUP	HCPCS C1713		370595  -  SCREW BONE 3.5MM 95MM AXSOS SS HUM FEM/TIB ST LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370600	SUP	HCPCS C1713		370600  -  SCREW BONE 4MM 100MM ORTH LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370605	SUP	HCPCS C1713		370605  -  SCREW BONE 4MM 105MM ORTH LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370610	SUP	HCPCS C1713		370610  -  SCREW BONE 4MM 110MM ORTH LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370615	SUP	HCPCS C1713		370615  -  SCREW BONE 4MM 115MM ORTH LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
370620	SUP	HCPCS C1713		370620  -  SCREW BONE 4MM 120MM ORTH LCK	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
371008	SUP	HCPCS C1713		371008  -  SCREW BONE 3MM 8MM AXSOS T8 DRV LCK SLFTAP	BOTH IP/OP	$123.20 	$91.17	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$25.68	$91.44	$91.44	$0.00	$0.00	$25.67	$0.00	$72.87	$72.87	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
371010	SUP	HCPCS C1713		371010  -  SCREW BONE 3MM 10MM AXSOS SS LCK SLFTAP T8 DRV	BOTH IP/OP	$123.20 	$91.17	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$25.68	$91.44	$91.44	$0.00	$0.00	$25.67	$0.00	$72.87	$72.87	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
371012	SUP	HCPCS C1713		371012  -  SCREW BONE 3MM 12MM AXSOS LCK	BOTH IP/OP	$123.20 	$91.17	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$25.68	$91.44	$91.44	$0.00	$0.00	$25.67	$0.00	$72.87	$72.87	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
371014	SUP	HCPCS C1713		371014  -  SCREW BONE 3MM 14MM AXSOS SS PERIART LCK SLFTAP T8 DRV	BOTH IP/OP	$123.20 	$91.17	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$25.68	$91.44	$91.44	$0.00	$0.00	$25.67	$0.00	$72.87	$72.87	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
371016	SUP	HCPCS C1713		371016  -  SCREW BONE 3MM 16MM AXSOS SS PERIART LCK SLFTAP T8 DRV	BOTH IP/OP	$123.20 	$91.17	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$25.68	$91.44	$91.44	$0.00	$0.00	$25.67	$0.00	$72.87	$72.87	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
371018	SUP	HCPCS C1713		371018  -  SCREW BONE 3MM 18MM AXSOS SS PERIART LCK SLFTAP T8 DRV	BOTH IP/OP	$123.20 	$91.17	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$25.68	$91.44	$91.44	$0.00	$0.00	$25.67	$0.00	$72.87	$72.87	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
371020	SUP	HCPCS C1713		371020  -  SCREW BONE 3MM 20MM AXSOS SS PERIART T8 DRV LCK SLFTAP	BOTH IP/OP	$123.20 	$91.17	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$25.68	$91.44	$91.44	$0.00	$0.00	$25.67	$0.00	$72.87	$72.87	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
371022	SUP	HCPCS C1713		371022  -  SCREW BONE 3MM 22MM AXSOS SS LCK SLFTAP T8 DRV	BOTH IP/OP	$123.20 	$91.17	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$25.68	$91.44	$91.44	$0.00	$0.00	$25.67	$0.00	$72.87	$72.87	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
371024	SUP	HCPCS C1713		371024  -  SCREW BONE 3MM 24MM AXSOS T8 DRV LCK SLFTAP	BOTH IP/OP	$123.20 	$91.17	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$25.68	$91.44	$91.44	$0.00	$0.00	$25.67	$0.00	$72.87	$72.87	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
371026	SUP	HCPCS C1713		371026  -  SCREW BONE 3MM 26MM AXSOS T8 DRV LCK SLFTAP	BOTH IP/OP	$123.20 	$91.17	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$25.68	$91.44	$91.44	$0.00	$0.00	$25.67	$0.00	$72.87	$72.87	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
371028	SUP	HCPCS C1713		371028  -  SCREW BONE 3MM 28MM AXSOS T8 DRV LCK SLFTAP	BOTH IP/OP	$123.20 	$91.17	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$25.68	$91.44	$91.44	$0.00	$0.00	$25.67	$0.00	$72.87	$72.87	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
371030	SUP	HCPCS C1713		371030  -  SCREW BONE 3MM 30MM AXSOS SS PERIART LCK SLFTAP T8 DRV	BOTH IP/OP	$123.20 	$91.17	$0.00	$105.60	$59.40	$59.40	$0.00	$0.00	$0.00	$25.68	$91.44	$91.44	$0.00	$0.00	$25.67	$0.00	$72.87	$72.87	$0.00	$66.00	$104.54	$105.60	$0.00		$0.00	$20.66	$0.00	$0.00	$21.01	$0.00	$0.00	$0.00	$0.00	$0.00
371314	SUP	HCPCS C1713		371314  -  LOCKING SCREW AXSOS 5.0MM / L14MM	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371316	SUP	HCPCS C1713		371316  -  LOCKING SCREW AXSOS 5.0MM / L16MM	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371318	SUP	HCPCS C1713		371318  -  SCREW BONE 5MM 18MM AXSOS SS LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371320	SUP	HCPCS C1713		371320  -  SCREW BONE 5MM 20MM AXSOS SS PERIART LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371322	SUP	HCPCS C1713		371322  -  LOCKING SCREW AXSOS 5.0MM / L22MM	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371324	SUP	HCPCS C1713		371324  -  SCREW BONE 5MM 24MM AXSOS SS PERIART LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371326	SUP	HCPCS C1713		371326  -  SCREW BONE 5MM 26MM AXSOS SS LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371328	SUP	HCPCS C1713		371328  -  SCREW BONE 5MM 28MM AXOS SS T20 DRV LCK SLFTAP NONSTRL	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371330	SUP	HCPCS C1713		371330  -  SCREW BONE 5MM 30MM AXSOS SS HUM FEM/TIB LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371332	SUP	HCPCS C1713		371332  -  SCREW BONE 5MM 32MM AXSOS SS HUM FEM/TIB LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371334	SUP	HCPCS C1713		371334  -  SCREW BONE 5MM 34MM AXSOS SS PERIART LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371336	SUP	HCPCS C1713		371336  -  LOCKING SCREW AXSOS 5.0MM / L36MM	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371338	SUP	HCPCS C1713		371338  -  SCREW BONE 5MM 38MM AXSOS SS PERIART LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371340	SUP	HCPCS C1713		371340  -  SCREW BONE 5MM 40MM AXSOS SS PERIART LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371342	SUP	HCPCS C1713		371342  -  SCREW BONE 5MM 42MM AXSOS SS HUM FEM/TIB LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371344	SUP	HCPCS C1713		371344  -  SCREW BONE 5MM 44MM AXSOS SS LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371346	SUP	HCPCS C1713		371346  -  SCREW BONE 5MM 46MM AXSOS SS LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371348	SUP	HCPCS C1713		371348  -  SCREW BONE 5MM 48MM AXSOS SS LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371350	SUP	HCPCS C1713		371350  -  SCREW BONE 5MM 50MM AXSOS SS PERIART LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371355	SUP	HCPCS C1713		371355  -  SCREW BONE 5MM 55MM AXSOS SS LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371360	SUP	HCPCS C1713		371360  -  SCREW BONE 5MM 60MM AXSOS SS PERIART LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371365	SUP	HCPCS C1713		371365  -  SCREW BONE 5MM 65MM AXSOS SS PERIART LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371370	SUP	HCPCS C1713		371370  -  SCREW BONE 5MM 70MM AXSOS SS PERIART LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371375	SUP	HCPCS C1713		371375  -  SCREW BONE 5MM 75MM AXSOS SS PERIART LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371380	SUP	HCPCS C1713		371380  -  SCREW BONE 5MM 80MM AXSOS SS PERIART LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371385	SUP	HCPCS C1713		371385  -  SCREW BONE 5MM 85MM AXSOS SS LCK	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371390	SUP	HCPCS C1713		371390  -  SCREW BONE 5MM 90MM AXSOS SS LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371395	SUP	HCPCS C1713		371395  -  SCREW BONE 5MM 95MM AXSOS SS PERIART LCK SLFTAP T20 DRV	BOTH IP/OP	$228.00 	$168.72	$0.00	$169.22	$94.05	$94.05	$0.00	$0.00	$0.00	$47.52	$169.22	$169.22	$0.00	$0.00	$47.52	$0.00	$134.86	$134.86	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
371514	SUP	HCPCS C1713		371514  -  SCREW BONE 4MM 14MM SS T15 SLFTAP LCK DRV	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371516	SUP	HCPCS C1713		371516  -  SCREW BONE 4MM 16MM SS LCK SLFTAP T15 DRV NONSTRL	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371518	SUP	HCPCS C1713		371518  -  SCREW BONE 4MM 18MM AXSOS SS LCK SLFTAP T15 DRV NONSTRL	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371520	SUP	HCPCS C1713		371520  -  SCREW BN T15 4MM 20MM NS ST LCK SS AXSOS SM FRAG SET XTRMT	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371522	SUP	HCPCS C1713		371522  -  SCREW BN T15 4MM 22MM NS ST LCK SS AXSOS SM FRAG SET XTRMT	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371524	SUP	HCPCS C1713		371524  -  SCREW BN T15 4MM 24MM NS ST LCK SS AXSOS SM FRAG SET XTRMT	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371526	SUP	HCPCS C1713		371526  -  SCREW BN T15 4MM 26MM NS ST LCK SS AXSOS SM FRAG SET XTRMT	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371528	SUP	HCPCS C1713		371528  -  SCREW BN T15 4MM 28MM NS ST LCK SS AXSOS SM FRAG SET XTRMT	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371530	SUP	HCPCS C1713		371530  -  SCREW BN T15 4MM 30MM NS ST LCK SS AXSOS SM FRAG SET XTRMT	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371532	SUP	HCPCS C1713		371532  -  SCREW BN T15 4MM 32MM NS ST LCK SS AXSOS SM FRAG SET XTRMT	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371534	SUP	HCPCS C1713		371534  -  SCREW BN T15 4MM 34MM NS ST LCK SS AXSOS SM FRAG SET XTRMT	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371536	SUP	HCPCS C1713		371536  -  SCREW BN T15 4MM 36MM NS ST LCK SS AXSOS SM FRAG SET XTRMT	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371538	SUP	HCPCS C1713		371538  -  SCREW BN T15 4MM 38MM NS ST LCK SS AXSOS SM FRAG SET XTRMT	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371540	SUP	HCPCS C1713		371540  -  SCREW BONE 4MM 40MM AXSOS SS PERIART LCK SLFTAP T15 DRV	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371542	SUP	HCPCS C1713		371542  -  SCREW BONE 4MM 42MM AXSOS SS PERIART LCK SLFTAP T15 DRV	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371544	SUP	HCPCS C1713		371544  -  SCREW BONE 4MM 44MM AXSOS SS PERIART LCK SLFTAP T15 DRV	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371546	SUP	HCPCS C1713		371546  -  SCREW BONE 4MM 46MM AXSOS SS PERIART LCK SLFTAP T15 DRV	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371548	SUP	HCPCS C1713		371548  -  SCREW BN T15 4MM 48MM NS ST LCK SS AXSOS SM FRAG SET XTRMT	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371550	SUP	HCPCS C1713		371550  -  SCREW BONE 4MM 50MM AXSOS SS HUM FEM/TIB LCK SLFTAP T15 DRV	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371555	SUP	HCPCS C1713		371555  -  SCREW BONE 4MM 55MM AXSOS SS PERIART LCK SLFTAP T15 DRV	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371560	SUP	HCPCS C1713		371560  -  SCREW BONE 4MM 60MM AXSOS SS PERIART LCK SLFTAP T15 DRV	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371565	SUP	HCPCS C1713		371565  -  SCREW BONE 4MM 65MM AXSOS SS LCK SLFTAP T15 DRV	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371570	SUP	HCPCS C1713		371570  -  SCREW BONE T15 4MM 70MM SELF TAP LOCK AXSOS STAINLESS STEEL	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371575	SUP	HCPCS C1713		371575  -  SCREW BONE 4MM 75MM AXSOS SS LCK SLFTAP T15 DRV	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371580	SUP	HCPCS C1713		371580  -  SCREW BONE 4MM 80MM AXSOS LCK	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371585	SUP	HCPCS C1713		371585  -  SCREW BONE 4MM 85MM AXSOS SS T15 SLFTAP LCK DRV	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371590	SUP	HCPCS C1713		371590  -  SCREW BONE 4MM 90MM AXSOS SS T15 DRV SLFTAP LCK	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
371595	SUP	HCPCS C1713		371595  -  LOCKING SCREW AXSOS 4.0MM / L95MM	BOTH IP/OP	$204.80 	$151.55	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$42.69	$152.00	$152.00	$0.00	$0.00	$42.68	$0.00	$121.14	$121.14	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
372615	SUP	HCPCS C1713		372615  -  SCALPEL SURG 15 1 HAND ACTIVATION LOCK RETRACTABLE SHIELD	BOTH IP/OP	$36.48 	$27.00	$0.00	$29.62	$16.66	$16.66	$0.00	$0.00	$0.00	$7.60	$27.07	$27.07	$0.00	$0.00	$7.60	$0.00	$21.57	$21.57	$0.00	$18.51	$29.32	$29.62	$0.00		$0.00	$5.79	$0.00	$0.00	$5.89	$0.00	$0.00	$0.00	$0.00	$0.00
373741	SUP	Custom 27203010		373741  -  KNIFE OPHTHALMIC 45D ANGLED 4.1MM BEVEL UP PHACO SLIT MATTE	BOTH IP/OP	$30.07 	$22.25	$0.00	$24.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.32	$22.32	$0.00	$0.00	$6.27	$0.00	$0.00	$0.00	$0.00	$15.03	$23.82	$24.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
373808	SUP	Custom 27203010		373808  -  SCALPEL SURG 2.5MM 2.5MM STR ROUND TIP CRESCENT OPHTHALMIC	BOTH IP/OP	$34.30 	$25.38	$0.00	$69.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.46	$25.46	$0.00	$0.00	$7.15	$0.00	$0.00	$0.00	$0.00	$16.90	$69.44	$27.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
378227	SUP	Custom 27203010		378227  -  KNIFE OPHTHALMIC 45D BEVEL 2.75MM BLADE MATTE FINISH SLIT BD	BOTH IP/OP	$35.63 	$26.37	$0.00	$28.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.44	$26.44	$0.00	$0.00	$7.42	$0.00	$0.00	$0.00	$0.00	$17.81	$28.22	$28.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
378230	SUP	Custom 27203010		378230  -  KNIFE OPHTHALMIC 45D BEVEL 3MM PHACO SLIT SAFETY MATTE	BOTH IP/OP	$35.63 	$26.37	$0.00	$28.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.44	$26.44	$0.00	$0.00	$7.42	$0.00	$0.00	$0.00	$0.00	$17.81	$28.22	$28.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
378231	SUP	Custom 27203010		378231  -  KNIFE OPHTHALMIC 20D .9MM 3MM SAFETY SIDEPORT RETRACTABLE	BOTH IP/OP	$48.69 	$36.03	$0.00	$103.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.13	$36.13	$0.00	$0.00	$10.15	$0.00	$0.00	$0.00	$0.00	$64.44	$102.07	$103.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
381112	SUP	HCPCS C1729		CATHETER IV 24GA .75IN RADIOPQ YLW ANGCTH TFLN STRL LF	BOTH IP/OP	$4.45 	$3.29	$0.00	$3.56	$2.42	$2.42	$0.00	$0.00	$0.00	$0.93	$3.30	$3.30	$0.00	$0.00	$0.93	$0.00	$2.63	$2.63	$0.00	$2.23	$3.52	$3.56	$0.00		$0.00	$0.70	$0.00	$0.00	$0.71	$0.00	$0.00	$0.00	$0.00	$0.00
381137	SUP	HCPCS C1729		CATHETER IV 20GA 1.88IN RADIOPQ PNK ANGCTH TFLN STRL LF	BOTH IP/OP	$9.18 	$6.79	$0.00	$7.34	$4.98	$4.98	$0.00	$0.00	$0.00	$1.91	$6.81	$6.81	$0.00	$0.00	$1.91	$0.00	$5.43	$5.43	$0.00	$4.59	$7.27	$7.34	$0.00		$0.00	$1.44	$0.00	$0.00	$1.46	$0.00	$0.00	$0.00	$0.00	$0.00
381144	SUP	HCPCS C1729		CATHETER IV 18GA 1.16IN RADIOPQ GRN ANGCTH TFLN STRL LF	BOTH IP/OP	$9.93 	$7.35	$0.00	$7.94	$5.39	$5.39	$0.00	$0.00	$0.00	$2.07	$7.37	$7.37	$0.00	$0.00	$2.07	$0.00	$5.87	$5.87	$0.00	$4.96	$7.86	$7.94	$0.00		$0.00	$1.55	$0.00	$0.00	$1.58	$0.00	$0.00	$0.00	$0.00	$0.00
381511	SUP	HCPCS C1729		CATHETER IV 24GA .56IN RADIOPQ SFSHLD WNG YLW INST-N ATGRD	BOTH IP/OP	$6.65 	$4.92	$0.00	$5.32	$3.61	$3.61	$0.00	$0.00	$0.00	$1.39	$4.94	$4.94	$0.00	$0.00	$1.39	$0.00	$3.93	$3.93	$0.00	$3.33	$5.27	$5.32	$0.00		$0.00	$1.04	$0.00	$0.00	$1.06	$0.00	$0.00	$0.00	$0.00	$0.00
381512	SUP	HCPCS C1729		CATHETER IV 24GA .75IN RADIOPQ SFSHLD WNG YLW INST-N ATGRD	BOTH IP/OP	$4.93 	$3.65	$0.00	$3.94	$2.67	$2.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.46	$3.90	$3.94	$0.00		$0.00	$0.77	$0.00	$0.00	$0.78	$0.00	$0.00	$0.00	$0.00	$0.00
381523	SUP	HCPCS C1729		CATHETER IV 22GA 1IN RADIOPQ SFSHLD WNG BLUE INST-N ATGRD	BOTH IP/OP	$4.78 	$3.54	$0.00	$3.82	$2.59	$2.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.39	$3.79	$3.82	$0.00		$0.00	$0.75	$0.00	$0.00	$0.76	$0.00	$0.00	$0.00	$0.00	$0.00
381533	SUP	HCPCS C1729		CATHETER IV 20GA 1IN RADIOPQ SFSHLD WNG PNK INST AGRD VLN	BOTH IP/OP	$4.53 	$3.35	$0.00	$3.62	$2.46	$2.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.26	$3.59	$3.62	$0.00		$0.00	$0.71	$0.00	$0.00	$0.72	$0.00	$0.00	$0.00	$0.00	$0.00
382259	SUP	HCPCS C1729		CATHETER IV 16GA 5.25IN RADIOPQ YLW ANGCTH TFLN STRL LF	BOTH IP/OP	$33.00 	$24.42	$0.00	$36.36	$15.46	$15.46	$0.00	$0.00	$0.00	$6.88	$24.49	$24.49	$0.00	$0.00	$6.88	$0.00	$36.36	$36.36	$0.00	$14.24	$22.56	$22.78	$0.00		$0.00	$4.46	$0.00	$0.00	$4.53	$0.00	$0.00	$0.00	$0.00	$0.00
382269	SUP	HCPCS C1729		CATHETER IV 14GA 5.25IN RADIOPQ SFSHLD ORNG ANGCTH TFLN STRL	BOTH IP/OP	$33.00 	$24.42	$0.00	$36.36	$15.46	$15.46	$0.00	$0.00	$0.00	$6.88	$24.49	$24.49	$0.00	$0.00	$6.88	$0.00	$36.36	$36.36	$0.00	$14.24	$22.56	$22.78	$0.00		$0.00	$4.46	$0.00	$0.00	$4.53	$0.00	$0.00	$0.00	$0.00	$0.00
382861	SUP	HCPCS C1898		"382861  -  PASSIVE FIXATION PACING LEAD, J-SHAPE, SILICONE INSULATION,"	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
382866	SUP	HCPCS C1898		"382866  -  PASSIVE FIXATION PACING LEAD, J-SHAPE, SILICONE INSULATION,"	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
382872	SUP	HCPCS C1898		"382872  -  PASSIVE FIXATION PACING LEAD, STRAIGHT, SILICONE INSULATION,"	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
382878	SUP	HCPCS C1898		"382878  -  PASSIVE FIXATION PACING LEAD, STRAIGHT, SILICONE INSULATION,"	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
382884	SUP	HCPCS C1898		382884  -  LEAD PCNG HLX 45CM SIL ATR TILDA	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
382889	SUP	HCPCS C1895		382889  -  LEAD PCNG HLX 53CM SIL ATR TILDA	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
382895	SUP	HCPCS C1895		382895  -  LEAD PCNG HLX 60CM SIL VNTRC TILDA	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
382903	SUP	HCPCS C1777		382903  -  LEAD PCNG 65CM VIGILA	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
382918	SUP	HCPCS C1721		"382918  -  PASSIVE FIXATION, DUAL COIL, SILICONE INSULATION, 65 CM, 18"	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
382924	SUP	HCPCS C1721		"382924  -  ACTIVE FIXATION, DUAL COIL, SILICONE INSULATION, 60 CM, 16 C"	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
382936	SUP	HCPCS C1721		"382936  -  ACTIVE FIXATION, DUAL COIL, SILICONE INSULATION, 65 CM, 18 C"	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
382961	SUP	HCPCS C1900		382961  -  LEFT VENTRICULAR LEAD WITH 3D PRE-SHAPED HELIX AT DISTAL END	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
382972	SUP	HCPCS C1900		382972  -  LEFT VENTRICULAR LEAD WITH PRE-SHAPED BEND AND THREAD FIXATI	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
383395	SUP	HCPCS C1900		"383395  -  LEFT VENTRICULAR LEAD WITH 2D PRE-SHAPED BEND AT DISTAL END,"	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
384021	SUP	HCPCS C1887		INTRODUCER CATH 26GA 1.9FR INTRST-N NEO	BOTH IP/OP	$96.18 	$71.17	$0.00	$76.94	$52.22	$52.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.09	$76.17	$76.94	$0.00		$0.00	$15.05	$0.00	$0.00	$15.31	$0.00	$0.00	$0.00	$0.00	$0.00
384232	SUP	HCPCS C1729		CATHETER CEN VEN 1.9FR 50CM 1 LUM PICC 1ST PICC SIL	BOTH IP/OP	$143.63 	$106.29	$0.00	$114.90	$77.99	$77.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.81	$113.75	$114.90	$0.00		$0.00	$22.48	$0.00	$0.00	$22.87	$0.00	$0.00	$0.00	$0.00	$0.00
384825	SUP	Custom 27203010		TRAY PRC DRSG SCSR TRNQT NEO	BOTH IP/OP	$110.10 	$81.47	$0.00	$88.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.05	$87.20	$88.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
386358	SUP	Custom 27203010		CALIBRATOR CA 125 ACCES OV MONITR VL 2.5ML IMMUN	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
386371	SUP	Custom 27203010		REAGENT CKMB ACCES 100 TST ANALY	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
386372	SUP	Custom 27203010		CALIBRATOR CHM SET CK-MB ACCES 6X2ML	BOTH IP/OP	$264.45 	$195.69	$0.00	$211.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.23	$209.44	$211.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
390016	SUP	HCPCS C1713		390016  -  WASHER 6.6MM CANN ASNS 3 ORTH SS 8IN 6.5/8MM SCR	BOTH IP/OP	$59.13 	$43.76	$0.00	$47.30	$26.61	$26.61	$0.00	$0.00	$0.00	$12.32	$43.88	$43.88	$0.00	$0.00	$12.32	$0.00	$34.97	$34.97	$0.00	$29.56	$46.83	$47.30	$0.00		$0.00	$9.25	$0.00	$0.00	$9.41	$0.00	$0.00	$0.00	$0.00	$0.00
390017	SUP	HCPCS C1713		390017  -  WASHER 5MM ASNS 3 ORTH SS 7MM CANN SCR	BOTH IP/OP	$46.75 	$34.60	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$9.74	$34.70	$34.70	$0.00	$0.00	$9.74	$0.00	$27.65	$27.65	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
390018	SUP	HCPCS C1713		390018  -  WASHER 8MM ASNS 3 ORTH SS 7MM CANN SCR	BOTH IP/OP	$46.75 	$34.60	$0.00	$39.60	$22.28	$22.28	$0.00	$0.00	$0.00	$9.74	$34.70	$34.70	$0.00	$0.00	$9.74	$0.00	$27.65	$27.65	$0.00	$24.75	$39.20	$39.60	$0.00		$0.00	$7.75	$0.00	$0.00	$7.88	$0.00	$0.00	$0.00	$0.00	$0.00
390019	SUP	HCPCS C1713		390019  -  WASHER 9MM ASNS 3 ORTH SS 8IN 3.5MM CANN SCR	BOTH IP/OP	$50.88 	$37.65	$0.00	$40.70	$22.89	$22.89	$0.00	$0.00	$0.00	$10.60	$37.76	$37.76	$0.00	$0.00	$10.60	$0.00	$30.09	$30.09	$0.00	$25.44	$40.30	$40.70	$0.00		$0.00	$7.96	$0.00	$0.00	$8.10	$0.00	$0.00	$0.00	$0.00	$0.00
390083	SUP	HCPCS C1713		390083  -  PIN HLD 5MM ORTH REDX 150MM	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
390084	SUP	HCPCS C1713		390084  -  PIN HLD 5MM ORTH REDX SS 180MM	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
390086	SUP	HCPCS C1713		390086  -  PIN HALF 150MM 6MM PLVC SS SLF CUT REDX	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
390087	SUP	HCPCS C1713		390087  -  PIN HLD 6MM ORTH REDX 180MM	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
390181	SUP	HCPCS C1713		390181  -  WIRE FX 2.5MM 285MM NS KRSH TROC PNT SS	BOTH IP/OP	$136.00 	$100.64	$0.00	$112.20	$63.11	$63.11	$0.00	$0.00	$0.00	$28.35	$100.94	$100.94	$0.00	$0.00	$28.34	$0.00	$80.44	$80.44	$0.00	$70.13	$111.08	$112.20	$0.00		$0.00	$21.95	$0.00	$0.00	$22.33	$0.00	$0.00	$0.00	$0.00	$0.00
390195	SUP	HCPCS C1713		390195  -  WIRE FX 3MM 285MM NS KRSH TROC PNT SS	BOTH IP/OP	$129.25 	$95.65	$0.00	$103.40	$58.16	$58.16	$0.00	$0.00	$0.00	$26.94	$95.93	$95.93	$0.00	$0.00	$26.94	$0.00	$76.45	$76.45	$0.00	$64.63	$102.37	$103.40	$0.00		$0.00	$20.23	$0.00	$0.00	$20.58	$0.00	$0.00	$0.00	$0.00	$0.00
397003	SUP	HCPCS C1713		397003  -  CEMENT BONE SLF SET INJ OSTCNDC HYDROSET BONE SUB VOID FILR	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$2,018.10"	"$1,135.18"	"$1,135.18"	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,261.31"	"$1,997.92"	"$2,018.10"	$0.00		$0.00	$394.79	$0.00	$0.00	$401.60	$0.00	$0.00	$0.00	$0.00	$0.00
397005	SUP	HCPCS C1713		397005  -  CEMENT BONE HYDROSET CALCIUM PHOS 5ML INJ SLF SET VOID FILR	BOTH IP/OP	"$3,285.00 "	"$2,430.90"	$0.00	"$3,236.40"	"$1,820.48"	"$1,820.48"	$0.00	$0.00	$0.00	$684.68	"$2,438.13"	"$2,438.13"	$0.00	$0.00	$684.59	$0.00	"$1,619.51"	"$1,619.51"	$0.00	"$2,022.75"	"$3,204.04"	"$3,236.40"	$0.00		$0.00	$633.12	$0.00	$0.00	$644.04	$0.00	$0.00	$0.00	$0.00	$0.00
397010	SUP	HCPCS C1713		397010  -  CEMENT BONE SLF SET INJ OSTCNDC HYDROSET BONE SUB VOID FILR	BOTH IP/OP	"$6,252.50 "	"$4,626.85"	$0.00	"$6,221.70"	"$3,499.71"	"$3,499.71"	$0.00	$0.00	$0.00	"$1,303.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,303.02"	$0.00	"$3,082.48"	"$3,082.48"	$0.00	"$3,888.56"	"$6,159.49"	"$6,221.70"	$0.00		$0.00	"$1,217.12"	$0.00	$0.00	"$1,238.12"	$0.00	$0.00	$0.00	$0.00	$0.00
397015	SUP	HCPCS C1713		397015  -  CEMENT BONE HYDROSET BONE SUB VOID FILR CALCIUM PHOS 15ML	BOTH IP/OP	"$8,970.94 "	"$6,638.50"	$0.00	"$8,928.00"	"$5,022.00"	"$5,022.00"	$0.00	$0.00	$0.00	"$1,869.77"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,869.54"	$0.00	"$4,422.67"	"$4,422.67"	$0.00	"$5,580.00"	"$8,838.72"	"$8,928.00"	$0.00		$0.00	"$1,746.54"	$0.00	$0.00	"$1,776.67"	$0.00	$0.00	$0.00	$0.00	$0.00
400077	SUP	Custom 27203010		400077  -  SEAL CNN 8MM DVNC EWRST DISP	BOTH IP/OP	$3.75 	$2.78	$0.00	$3.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.78	$2.78	$0.00	$0.00	$0.78	$0.00	$0.00	$0.00	$0.00	$1.88	$2.97	$3.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400180	SUP	Custom 27203010		400180  -  COVER ESCP TIP 8MM STD HOT SHR DVNC EWRST CAUT MNPLR DISP	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.11	$37.11	$0.00	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$25.00	$39.60	$40.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400427	SUP	Custom 27203010		400427  -  PACKING NSL 2.5X.9X2CM MRCL BRN SIN-PK STNG SLIM PRFL	BOTH IP/OP	$18.98 	$14.05	$0.00	$15.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.08	$14.08	$0.00	$0.00	$3.95	$0.00	$0.00	$0.00	$0.00	$9.49	$15.03	$15.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
401531	SUP	Custom 27203010		401531  -  BAG OST SFN MINI 1.75IN 5IN 2 SIDE COROVIN LATEX FREE DISP	BOTH IP/OP	$1.50 	$1.11	$0.00	$1.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.12	$1.12	$0.00	$0.00	$0.31	$0.00	$0.00	$0.00	$0.00	$0.75	$1.19	$1.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
401552	SUP	Custom 27203010		KIT 1.5IN UROS STD SRFT	BOTH IP/OP	$4.00 	$2.96	$0.00	$3.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.97	$2.97	$0.00	$0.00	$0.83	$0.00	$0.00	$0.00	$0.00	$2.00	$3.17	$3.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
402025	SUP	HCPCS Q4116		402025  -  MATRIX TISSUE THIN 7X4CM ALLOGRAFT REGENERATIVE FREEZE DRIED	BOTH IP/OP	$64.73 	$47.90	$0.00	$80.43	$45.24	$45.24	$0.00	$0.00	$0.00	$13.49	$48.04	$48.04	$0.00	$0.00	$13.49	$0.00	$38.29	$38.29	$0.00	$50.27	$79.63	$80.43	$0.00		$0.00	$15.73	$0.00	$0.00	$16.01	$0.00	$0.00	$0.00	$0.00	$0.00
402045	SUP	HCPCS Q4116		402045  -  MATRIX TISSUE THIN 12X4CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$64.58 	$47.79	$0.00	$80.13	$45.07	$45.07	$0.00	$0.00	$0.00	$13.46	$47.93	$47.93	$0.00	$0.00	$13.46	$0.00	$38.20	$38.20	$0.00	$50.08	$79.33	$80.13	$0.00		$0.00	$15.67	$0.00	$0.00	$15.94	$0.00	$0.00	$0.00	$0.00	$0.00
402432	SUP	Custom 27803010		402432  -  CEMENT BONE CO HV LG 40GM HVISC STRL	BOTH IP/OP	$292.50 	$216.45	$0.00	$234.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.09	$217.09	$0.00	$0.00	$60.96	$0.00	$0.00	$0.00	$0.00	$146.25	$231.66	$234.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
402433	SUP	Custom 27803010		402433  -  CEMENT BONE CBLT G-HV 40GM HVISC GNTA STRL	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$0.00	$0.00	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
403326	SUP	Custom 27203010		DRESSING DUODERM 4X4 SIGNAL	BOTH IP/OP	$6.60 	$4.88	$0.00	$5.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.90	$4.90	$0.00	$0.00	$1.38	$0.00	$0.00	$0.00	$0.00	$3.30	$5.23	$5.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
403711	SUP	Custom 27203010		403711  -  DRESSING WOUND RECTANGLE 10X8IN STRONGER GREATER ABSORBENCY	BOTH IP/OP	$82.33 	$60.92	$0.00	$65.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.10	$61.10	$0.00	$0.00	$17.16	$0.00	$0.00	$0.00	$0.00	$41.16	$65.21	$65.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
403771	SUP	Custom 27203010		403771  -  DRESSING HYDROCOLLOID RIBBON 18X.75IN STITCHBOND LATEX FREE	BOTH IP/OP	$29.96 	$22.17	$0.00	$23.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.98	$23.73	$23.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
405416	SUP	HCPCS C1892		405416  -  INTROD SHTH 9FR 14CM HMSTS GWIRE PLWY .038IN TRNSPT	BOTH IP/OP	"$9,500.00 "	"$7,030.00"	$0.00	"$4,688.23"	$4.34	$4.34	$0.00	$0.00	$0.00	"$1,980.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,979.80"	$0.00	"$4,688.23"	"$4,688.23"	$0.00	$4.00	$6.34	$6.40	$0.00		$0.00	$1.25	$0.00	$0.00	$1.27	$0.00	$0.00	$0.00	$0.00	$0.00
406136	SUP	HCPCS C1894		406136  -  INTROD CATH 12CM 14FR .038IN TRNSPT FSTCTH HMSTS	BOTH IP/OP	$42.75 	$31.64	$0.00	$34.20	$23.21	$23.21	$0.00	$0.00	$0.00	$8.91	$31.73	$31.73	$0.00	$0.00	$8.91	$0.00	$25.29	$25.29	$0.00	$21.38	$33.86	$34.20	$0.00		$0.00	$6.69	$0.00	$0.00	$6.81	$0.00	$0.00	$0.00	$0.00	$0.00
406701	SUP	HCPCS C1894		406701  -  INTRODUCER SHEATH .038IN STANDARD 6FR 12CM 50CM 2 DISTAL	BOTH IP/OP	$2.75 	$2.04	$0.00	$2.20	$1.49	$1.49	$0.00	$0.00	$0.00	$0.57	$2.04	$2.04	$0.00	$0.00	$0.57	$0.00	$1.63	$1.63	$0.00	$1.38	$2.18	$2.20	$0.00		$0.00	$0.43	$0.00	$0.00	$0.44	$0.00	$0.00	$0.00	$0.00	$0.00
407145	SUP	HCPCS C1785		407145  -  PACEMAKER CRD SM 48X40X6.5MM 10CC EDORA PROMRI 1 CHMBR RT	BOTH IP/OP	"$15,250.00 "	"$11,285.00"	$0.00	"$12,200.00"	"$6,862.50"	"$6,862.50"	$0.00	$0.00	$0.00	"$3,178.48"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,178.10"	$0.00	"$7,518.25"	"$7,518.25"	$0.00	"$7,625.00"	"$12,078.00"	"$12,200.00"	$0.00		$0.00	"$2,386.63"	$0.00	$0.00	"$2,427.80"	$0.00	$0.00	$0.00	$0.00	$0.00
407157	SUP	HCPCS C1786		407157  -  PACEMAKER CRD SM 48X40X6.5MM 10CC EDORA PROMRI 1 CHMBR RT	BOTH IP/OP	"$13,375.00 "	"$9,897.50"	$0.00	"$10,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,787.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,787.35"	$0.00	"$6,593.88"	"$6,593.88"	$0.00	"$6,687.50"	"$10,593.00"	"$10,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
410298	SUP	Custom 27803010		410298  -  STAPLER INTNL 14MM 45MM NS LF DVNC SI EWRST RPSB 50 FRNG	BOTH IP/OP	"$17,500.00 "	"$12,950.00"	$0.00	"$14,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,647.00"	$0.00	$0.00	$0.00	$0.00	"$8,750.00"	"$13,860.00"	"$14,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
410322	SUP	Custom 27203010		410322  -  TIP CAUT 8MM 1 DVNC SI EWRST VSL SLR DISP	BOTH IP/OP	"$8,925.00 "	"$6,604.50"	$0.00	"$7,140.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,859.97"	$0.00	$0.00	$0.00	$0.00	"$4,462.50"	"$7,068.60"	"$7,140.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
410370	SUP	Custom 27203010		410370  -  SHEATH LAPSCP 45MM STPLR	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.11	$37.11	$0.00	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$25.00	$39.60	$40.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
410500	SUP	Custom 27203010		410500  -  DRESSING HYDROCOLLOID TAPER 7.8X7.5IN ABSORBENT FLEXIBLE	BOTH IP/OP	$29.32 	$21.70	$0.00	$23.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.76	$21.76	$0.00	$0.00	$6.11	$0.00	$0.00	$0.00	$0.00	$14.88	$23.56	$23.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
410501	SUP	Custom 27203010		SACRAL DUODERM SIGNAL 7.8X8.77	BOTH IP/OP	$28.28 	$20.93	$0.00	$22.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.14	$22.40	$22.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
410614	SUP	Custom 27203010		410614  -  DRESSING FOAM 8X8IN GELLING LATEX FREE VERSIVA XC	BOTH IP/OP	$33.99 	$25.15	$0.00	$27.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.23	$25.23	$0.00	$0.00	$7.08	$0.00	$0.00	$0.00	$0.00	$16.99	$26.92	$27.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
411250	SUP	HCPCS C1762		411250  -  GRAFT SOFT TISSUE 4-5MM 50MM ALLOGRAFT NATURAL CONNECT	BOTH IP/OP	"$10,437.50 "	"$7,723.75"	$0.00	"$8,350.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,175.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,175.18"	$0.00	"$5,145.69"	"$5,145.69"	$0.00	"$5,218.75"	"$8,266.50"	"$8,350.00"	$0.00		$0.00	"$1,633.47"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
411270	SUP	HCPCS C1768		"411270  -  GRAFT, AVANCE NERVE, 4-5MM X 70MM"	BOTH IP/OP	"$16,105.00 "	"$11,917.70"	$0.00	"$11,800.00"	"$6,637.50"	"$6,637.50"	$0.00	$0.00	$0.00	"$3,356.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,356.28"	$0.00	"$7,939.77"	"$7,939.77"	$0.00	"$7,375.00"	"$11,682.00"	"$11,800.00"	$0.00		$0.00	"$2,308.38"	$0.00	$0.00	"$2,348.20"	$0.00	$0.00	$0.00	$0.00	$0.00
415807	SUP	Custom 27203010		415807  -  CANNULA PERFUSION 7MM 3MM 11.4IN BALLOON RIGHT ANGLED LATEX	BOTH IP/OP	$982.50 	$727.05	$0.00	$786.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$729.21	$729.21	$0.00	$0.00	$204.75	$0.00	$0.00	$0.00	$0.00	$491.25	$778.14	$786.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
417300	SUP	Custom 27803010		417300  -  SYSTEM BONE CMNT TRPL MX KIT 120GM OPTVC	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
419588	SUP	HCPCS C1898		419588  -  LEAD PACING 5FR 88CM UNIPOLAR DEPLOYABLE LOBES FIX IS-1	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,850.00"	"$1,603.13"	"$1,603.13"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,781.25"	"$2,821.50"	"$2,850.00"	$0.00		$0.00	$557.53	$0.00	$0.00	$567.15	$0.00	$0.00	$0.00	$0.00	$0.00
419678	SUP	HCPCS C1898		419678  -  LEAD PACING 2 CURVE 4FR 78CM BIPOL IS-1 ATTAIN ABILITY	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,850.00"	"$1,603.13"	"$1,603.13"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,781.25"	"$2,821.50"	"$2,850.00"	$0.00		$0.00	$557.53	$0.00	$0.00	$567.15	$0.00	$0.00	$0.00	$0.00	$0.00
419688	SUP	HCPCS C1898		419688  -  LEAD PACING 4FR 88CM OTW TRACKABILITY STEERABLE BIPOL	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,850.00"	"$1,603.13"	"$1,603.13"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,781.25"	"$2,821.50"	"$2,850.00"	$0.00		$0.00	$557.53	$0.00	$0.00	$567.15	$0.00	$0.00	$0.00	$0.00	$0.00
420006	SUP	Custom 27203010		420006  -  DRIVER NDL 0-30D LG 8MM 54.4CM 1CM S/SI EWRST	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
420024	SUP	Custom 27203010		420024  -  OBTURATOR LAPSCP LNG 8MM STRL DVNC S/SI EWRST DISP	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
420206	SUP	Custom 27203010		420206  -  SEAL ENDSCP INSTR 8.5-13MM S/SI EWRST CANNU HD SD	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
420290	SUP	Custom 27203010		420290  -  KIT ACC 8MM DVNC SI 3 ARM CAM CNN SL INST DRP DISP	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
420291	SUP	Custom 27203010		420291  -  KIT 8MM 4 ARM CAM CANNU SL INSTR DRP ACC DVNC SI	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	$0.00	$0.00	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
425304	SUP	HCPCS C1713		425304  -  PLATE  PELVIS  108MM RADIUS	BOTH IP/OP	$284.63 	$210.63	$0.00	$227.70	$128.08	$128.08	$0.00	$0.00	$0.00	$59.32	$211.25	$211.25	$0.00	$0.00	$59.32	$0.00	$168.36	$168.36	$0.00	$142.31	$225.43	$227.70	$0.00		$0.00	$44.54	$0.00	$0.00	$45.31	$0.00	$0.00	$0.00	$0.00	$0.00
425306	SUP	HCPCS C1713		425306  -  PLATE  PELVIS  108MM RADIUS	BOTH IP/OP	$361.63 	$267.61	$0.00	$289.30	$162.73	$162.73	$0.00	$0.00	$0.00	$75.37	$268.40	$268.40	$0.00	$0.00	$75.36	$0.00	$213.90	$213.90	$0.00	$180.81	$286.41	$289.30	$0.00		$0.00	$56.59	$0.00	$0.00	$57.57	$0.00	$0.00	$0.00	$0.00	$0.00
425308	SUP	HCPCS C1713		425308  -  PLATE  PELVIS  108MM RADIUS	BOTH IP/OP	$354.75 	$262.52	$0.00	$283.80	$159.64	$159.64	$0.00	$0.00	$0.00	$73.94	$263.30	$263.30	$0.00	$0.00	$73.93	$0.00	$209.83	$209.83	$0.00	$177.38	$280.96	$283.80	$0.00		$0.00	$55.52	$0.00	$0.00	$56.48	$0.00	$0.00	$0.00	$0.00	$0.00
425310	SUP	HCPCS C1713		425310  -  PLATE  PELVIS  108MM RADIUS	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
425312	SUP	HCPCS C1713		425312  -  PLATE  PELVIS  108MM RADIUS	BOTH IP/OP	$419.38 	$310.34	$0.00	$335.50	$188.72	$188.72	$0.00	$0.00	$0.00	$87.41	$311.26	$311.26	$0.00	$0.00	$87.40	$0.00	$248.06	$248.06	$0.00	$209.69	$332.15	$335.50	$0.00		$0.00	$65.63	$0.00	$0.00	$66.76	$0.00	$0.00	$0.00	$0.00	$0.00
425406	SUP	HCPCS C1713		425406  -  PLATE  PELVIS  88MM RADIUS	BOTH IP/OP	$328.63 	$243.19	$0.00	$262.90	$147.88	$147.88	$0.00	$0.00	$0.00	$68.49	$243.91	$243.91	$0.00	$0.00	$68.49	$0.00	$194.38	$194.38	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$51.43	$0.00	$0.00	$52.32	$0.00	$0.00	$0.00	$0.00	$0.00
425408	SUP	HCPCS C1713		425408  -  PLATE  PELVIS  88MM RADIUS	BOTH IP/OP	$349.25 	$258.45	$0.00	$279.40	$157.16	$157.16	$0.00	$0.00	$0.00	$72.79	$259.21	$259.21	$0.00	$0.00	$72.78	$0.00	$206.58	$206.58	$0.00	$174.63	$276.61	$279.40	$0.00		$0.00	$54.66	$0.00	$0.00	$55.60	$0.00	$0.00	$0.00	$0.00	$0.00
425410	SUP	HCPCS C1713		425410  -  PLATE  PELVIS  88MM RADIUS	BOTH IP/OP	$389.13 	$287.96	$0.00	$311.30	$175.11	$175.11	$0.00	$0.00	$0.00	$81.10	$288.81	$288.81	$0.00	$0.00	$81.09	$0.00	$230.17	$230.17	$0.00	$194.56	$308.19	$311.30	$0.00		$0.00	$60.90	$0.00	$0.00	$61.95	$0.00	$0.00	$0.00	$0.00	$0.00
425412	SUP	HCPCS C1713		425412  -  PLATE  PELVIS  88MM RADIUS	BOTH IP/OP	$419.38 	$310.34	$0.00	$335.50	$188.72	$188.72	$0.00	$0.00	$0.00	$87.41	$311.26	$311.26	$0.00	$0.00	$87.40	$0.00	$248.06	$248.06	$0.00	$209.69	$332.15	$335.50	$0.00		$0.00	$65.63	$0.00	$0.00	$66.76	$0.00	$0.00	$0.00	$0.00	$0.00
425504	SUP	HCPCS C1713		425504  -  PELVIC PLATE STRAIGHT 4H/64MM	BOTH IP/OP	$233.75 	$172.98	$0.00	$187.00	$105.19	$105.19	$0.00	$0.00	$0.00	$48.72	$173.49	$173.49	$0.00	$0.00	$48.71	$0.00	$138.26	$138.26	$0.00	$116.88	$185.13	$187.00	$0.00		$0.00	$36.58	$0.00	$0.00	$37.21	$0.00	$0.00	$0.00	$0.00	$0.00
425506	SUP	HCPCS C1713		425506  -  PLATE  PELVIS  STRAIGHT	BOTH IP/OP	$268.13 	$198.42	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$55.88	$199.00	$199.00	$0.00	$0.00	$55.88	$0.00	$158.60	$158.60	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
425509	SUP	HCPCS C1713		425509  -  PELVIC PLATE STRAIGHT 9H/154MM	BOTH IP/OP	$338.25 	$250.31	$0.00	$270.60	$152.21	$152.21	$0.00	$0.00	$0.00	$70.50	$251.05	$251.05	$0.00	$0.00	$70.49	$0.00	$200.07	$200.07	$0.00	$169.13	$267.89	$270.60	$0.00		$0.00	$52.94	$0.00	$0.00	$53.85	$0.00	$0.00	$0.00	$0.00	$0.00
425512	SUP	HCPCS C1713		425512  -  PLATE. PELVIS. STRAIGHT	BOTH IP/OP	$398.75 	$295.08	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$83.11	$295.95	$295.95	$0.00	$0.00	$83.10	$0.00	$235.86	$235.86	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
425602	SUP	HCPCS C1713		425602  -  PLATE 108MM RAD 26.5MM 2 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$383.63 	$283.89	$0.00	$306.90	$172.63	$172.63	$0.00	$0.00	$0.00	$79.96	$284.73	$284.73	$0.00	$0.00	$79.95	$0.00	$226.91	$226.91	$0.00	$191.81	$303.83	$306.90	$0.00		$0.00	$60.04	$0.00	$0.00	$61.07	$0.00	$0.00	$0.00	$0.00	$0.00
425603	SUP	HCPCS C1713		425603  -  PLATE 108MM RAD 42.5MM 3 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$426.25 	$315.43	$0.00	$341.00	$191.81	$191.81	$0.00	$0.00	$0.00	$88.84	$316.36	$316.36	$0.00	$0.00	$88.83	$0.00	$252.13	$252.13	$0.00	$213.13	$337.59	$341.00	$0.00		$0.00	$66.71	$0.00	$0.00	$67.86	$0.00	$0.00	$0.00	$0.00	$0.00
425604	SUP	HCPCS C1713		425604  -  PLATE 108MM RAD 58.5MM SS R108 4 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$726.60 	$537.68	$0.00	$539.28	$210.99	$210.99	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$234.44	$371.35	$375.10	$0.00		$0.00	$73.38	$0.00	$0.00	$74.64	$0.00	$0.00	$0.00	$0.00	$0.00
425605	SUP	HCPCS C1713		425605  -  PLATE 108MM 74.5MM 5 HOLE CVD BONE PLVC	BOTH IP/OP	$726.60 	$537.68	$0.00	$539.28	$230.79	$230.79	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$256.44	$406.20	$410.30	$0.00		$0.00	$80.26	$0.00	$0.00	$81.65	$0.00	$0.00	$0.00	$0.00	$0.00
425606	SUP	HCPCS C1713		425606  -  PLATE 108MM RAD 90.5MM SS 6 HOLE CVD MPS BONE PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$249.36	$249.36	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$277.06	$438.87	$443.30	$0.00		$0.00	$86.72	$0.00	$0.00	$88.22	$0.00	$0.00	$0.00	$0.00	$0.00
425607	SUP	HCPCS C1713		425607  -  PLATE 108MM 106.5MM 5 HOLE CVD BONE PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$259.88	$259.88	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$288.75	$457.38	$462.00	$0.00		$0.00	$90.38	$0.00	$0.00	$91.94	$0.00	$0.00	$0.00	$0.00	$0.00
425608	SUP	HCPCS C1713		425608  -  PLATE 108MM RAD 122.5MM SS 8 HOLE CVD MPS BONE PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$273.49	$273.49	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$303.88	$481.34	$486.20	$0.00		$0.00	$95.11	$0.00	$0.00	$96.75	$0.00	$0.00	$0.00	$0.00	$0.00
425609	SUP	HCPCS C1713		425609  -  PLATE 108MM RAD 138.5X10.5X2.5MM 9 HL SHFT CVD MATTA BONE	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$278.44	$278.44	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$309.38	$490.05	$495.00	$0.00		$0.00	$96.83	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
425610	SUP	HCPCS C1713		425610  -  PLATE BN CRV 154.5MM MPS 10 HL SS R108	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$288.34	$288.34	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$320.38	$507.47	$512.60	$0.00		$0.00	$100.28	$0.00	$0.00	$102.01	$0.00	$0.00	$0.00	$0.00	$0.00
425611	SUP	HCPCS C1713		425611  -  PLATE 108MM RAD 170.5X10.5X2.5MM 11 HL SHFT CVD MATTA BONE	BOTH IP/OP	$880.60 	$651.64	$0.00	$653.58	$292.05	$292.05	$0.00	$0.00	$0.00	$183.54	$653.58	$653.58	$0.00	$0.00	$183.52	$0.00	$520.87	$520.87	$0.00	$324.50	$514.01	$519.20	$0.00		$0.00	$101.57	$0.00	$0.00	$103.32	$0.00	$0.00	$0.00	$0.00	$0.00
425612	SUP	HCPCS C1713		425612  -  PLATE 186.5MM SS 12 HOLE CVD MPS BONE 108MM PLVC	BOTH IP/OP	$880.60 	$651.64	$0.00	$653.58	$301.95	$301.95	$0.00	$0.00	$0.00	$183.54	$653.58	$653.58	$0.00	$0.00	$183.52	$0.00	$520.87	$520.87	$0.00	$335.50	$531.43	$536.80	$0.00		$0.00	$105.01	$0.00	$0.00	$106.82	$0.00	$0.00	$0.00	$0.00	$0.00
425613	SUP	HCPCS C1713		425613  -  PLATE 108MM RAD 202.5X10.5X2.5MM 13 HL SHFT CVD MATTA BONE	BOTH IP/OP	$880.60 	$651.64	$0.00	$653.58	$312.47	$312.47	$0.00	$0.00	$0.00	$183.54	$653.58	$653.58	$0.00	$0.00	$183.52	$0.00	$520.87	$520.87	$0.00	$347.19	$549.95	$555.50	$0.00		$0.00	$108.67	$0.00	$0.00	$110.54	$0.00	$0.00	$0.00	$0.00	$0.00
425614	SUP	HCPCS C1713		425614  -  PLATE 218.5MM SS 14 HOLE CVD MPS BONE 108MM PLVC	BOTH IP/OP	$880.60 	$651.64	$0.00	$653.58	$335.98	$335.98	$0.00	$0.00	$0.00	$183.54	$653.58	$653.58	$0.00	$0.00	$183.52	$0.00	$520.87	$520.87	$0.00	$373.31	$591.33	$597.30	$0.00		$0.00	$116.85	$0.00	$0.00	$118.86	$0.00	$0.00	$0.00	$0.00	$0.00
425615	SUP	HCPCS C1713		425615  -  PLATE 108MM RAD 234.5X10.5X2.5MM 15 HL SHFT CVD MATTA BONE	BOTH IP/OP	$880.60 	$651.64	$0.00	$653.58	$350.21	$350.21	$0.00	$0.00	$0.00	$183.54	$653.58	$653.58	$0.00	$0.00	$183.52	$0.00	$520.87	$520.87	$0.00	$389.13	$616.37	$622.60	$0.00		$0.00	$121.80	$0.00	$0.00	$123.90	$0.00	$0.00	$0.00	$0.00	$0.00
425616	SUP	HCPCS C1713		425616  -  PLATE 108MM RAD 250.5MM 16 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$966.70 	$715.36	$0.00	$717.48	$360.11	$360.11	$0.00	$0.00	$0.00	$201.48	$717.48	$717.48	$0.00	$0.00	$201.46	$0.00	$571.80	$571.80	$0.00	$400.13	$633.80	$640.20	$0.00		$0.00	$125.24	$0.00	$0.00	$127.40	$0.00	$0.00	$0.00	$0.00	$0.00
425618	SUP	HCPCS C1713		425618  -  PLATE 108MM RAD 282.5X10.5X2.5MM 18 HL SHFT CVD MATTA BONE	BOTH IP/OP	$966.70 	$715.36	$0.00	$717.48	$389.19	$389.19	$0.00	$0.00	$0.00	$201.48	$717.48	$717.48	$0.00	$0.00	$201.46	$0.00	$571.80	$571.80	$0.00	$432.44	$684.98	$691.90	$0.00		$0.00	$135.35	$0.00	$0.00	$137.69	$0.00	$0.00	$0.00	$0.00	$0.00
425620	SUP	HCPCS C1713		425620  -  PLATE 108MM RAD 314.5X10.5X2.5MM 20 HL SHFT CVD MATTA BONE	BOTH IP/OP	"$1,012.00 "	$748.88	$0.00	$809.60	$455.40	$455.40	$0.00	$0.00	$0.00	$210.93	$751.11	$751.11	$0.00	$0.00	$210.90	$0.00	$598.60	$598.60	$0.00	$506.00	$801.50	$809.60	$0.00		$0.00	$158.38	$0.00	$0.00	$161.11	$0.00	$0.00	$0.00	$0.00	$0.00
425653	SUP	HCPCS C1713		425653  -  PLATE 88MM RAD 42.5MM 3 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$726.60 	$537.68	$0.00	$539.28	$191.81	$191.81	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$213.13	$337.59	$341.00	$0.00		$0.00	$66.71	$0.00	$0.00	$67.86	$0.00	$0.00	$0.00	$0.00	$0.00
425654	SUP	HCPCS C1713		425654  -  PLATE 88MM RAD 58.8MM SS 4 HOLE CVD MPS BONE PLVC	BOTH IP/OP	$726.60 	$537.68	$0.00	$539.28	$210.99	$210.99	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$234.44	$371.35	$375.10	$0.00		$0.00	$73.38	$0.00	$0.00	$74.64	$0.00	$0.00	$0.00	$0.00	$0.00
425655	SUP	HCPCS C1713		425655  -  PLATE BN 88MM RDS CRV 74.5MM NS MATTA 5 HL SS PLV	BOTH IP/OP	$726.60 	$537.68	$0.00	$539.28	$230.79	$230.79	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$256.44	$406.20	$410.30	$0.00		$0.00	$80.26	$0.00	$0.00	$81.65	$0.00	$0.00	$0.00	$0.00	$0.00
425656	SUP	HCPCS C1713		425656  -  PLATE 88MM RAD 90.5MM SS 6 HOLE CVD MPS BONE PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$249.36	$249.36	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$277.06	$438.87	$443.30	$0.00		$0.00	$86.72	$0.00	$0.00	$88.22	$0.00	$0.00	$0.00	$0.00	$0.00
425657	SUP	HCPCS C1713		425657  -  PLATE 88MM 106.5MM 7 HOLE CVD BONE PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$259.88	$259.88	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$288.75	$457.38	$462.00	$0.00		$0.00	$90.38	$0.00	$0.00	$91.94	$0.00	$0.00	$0.00	$0.00	$0.00
425658	SUP	HCPCS C1713		425658  -  PLATE 122.5MM SS 8 HOLE CVD BONE 88MM PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$273.49	$273.49	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$303.88	$481.34	$486.20	$0.00		$0.00	$95.11	$0.00	$0.00	$96.75	$0.00	$0.00	$0.00	$0.00	$0.00
425659	SUP	HCPCS C1713		425659  -  PLATE 88MM RAD 138.5MM 9 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$278.44	$278.44	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$309.38	$490.05	$495.00	$0.00		$0.00	$96.83	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
425660	SUP	HCPCS C1713		425660  -  PLATE 154.5MM SS 10 HOLE CVD MPS BONE 88MM PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$288.34	$288.34	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$320.38	$507.47	$512.60	$0.00		$0.00	$100.28	$0.00	$0.00	$102.01	$0.00	$0.00	$0.00	$0.00	$0.00
425661	SUP	HCPCS C1713		425661  -  PLATE 88MM RAD 170.5MM 11 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$880.60 	$651.64	$0.00	$653.58	$292.05	$292.05	$0.00	$0.00	$0.00	$183.54	$653.58	$653.58	$0.00	$0.00	$183.52	$0.00	$520.87	$520.87	$0.00	$324.50	$514.01	$519.20	$0.00		$0.00	$101.57	$0.00	$0.00	$103.32	$0.00	$0.00	$0.00	$0.00	$0.00
425662	SUP	HCPCS C1713		425662  -  PLATE 186.5MM SS 12 HOLE CVD MPS BONE 88MM PLVC	BOTH IP/OP	$880.60 	$651.64	$0.00	$653.58	$301.95	$301.95	$0.00	$0.00	$0.00	$183.54	$653.58	$653.58	$0.00	$0.00	$183.52	$0.00	$520.87	$520.87	$0.00	$335.50	$531.43	$536.80	$0.00		$0.00	$105.01	$0.00	$0.00	$106.82	$0.00	$0.00	$0.00	$0.00	$0.00
425663	SUP	HCPCS C1713		425663  -  PLATE 88MM RAD 202.5MM 13 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$880.60 	$651.64	$0.00	$653.58	$312.47	$312.47	$0.00	$0.00	$0.00	$183.54	$653.58	$653.58	$0.00	$0.00	$183.52	$0.00	$520.87	$520.87	$0.00	$347.19	$549.95	$555.50	$0.00		$0.00	$108.67	$0.00	$0.00	$110.54	$0.00	$0.00	$0.00	$0.00	$0.00
425664	SUP	HCPCS C1713		425664  -  PLATE 218.5MM SS 14 HOLE CVD MPS BONE 88MM PLVC	BOTH IP/OP	$880.60 	$651.64	$0.00	$653.58	$335.98	$335.98	$0.00	$0.00	$0.00	$183.54	$653.58	$653.58	$0.00	$0.00	$183.52	$0.00	$520.87	$520.87	$0.00	$373.31	$591.33	$597.30	$0.00		$0.00	$116.85	$0.00	$0.00	$118.86	$0.00	$0.00	$0.00	$0.00	$0.00
425665	SUP	HCPCS C1713		425665  -  PLATE 88MM RAD 234.5MM 15 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$880.60 	$651.64	$0.00	$653.58	$350.21	$350.21	$0.00	$0.00	$0.00	$183.54	$653.58	$653.58	$0.00	$0.00	$183.52	$0.00	$520.87	$520.87	$0.00	$389.13	$616.37	$622.60	$0.00		$0.00	$121.80	$0.00	$0.00	$123.90	$0.00	$0.00	$0.00	$0.00	$0.00
425666	SUP	HCPCS C1713		425666  -  PLATE 88MM RAD 250.5MM 16 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$880.60 	$651.64	$0.00	$653.58	$360.11	$360.11	$0.00	$0.00	$0.00	$183.54	$653.58	$653.58	$0.00	$0.00	$183.52	$0.00	$520.87	$520.87	$0.00	$400.13	$633.80	$640.20	$0.00		$0.00	$125.24	$0.00	$0.00	$127.40	$0.00	$0.00	$0.00	$0.00	$0.00
425667	SUP	HCPCS C1713		425667  -  PLATE 88MM RAD 266.5MM 17 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$833.25 	$616.61	$0.00	$666.60	$374.96	$374.96	$0.00	$0.00	$0.00	$173.67	$618.44	$618.44	$0.00	$0.00	$173.65	$0.00	$492.87	$492.87	$0.00	$416.63	$659.93	$666.60	$0.00		$0.00	$130.40	$0.00	$0.00	$132.65	$0.00	$0.00	$0.00	$0.00	$0.00
425668	SUP	HCPCS C1713		425668  -  PLATE 88MM RAD 282.5MM 18 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$880.60 	$651.64	$0.00	$691.90	$389.19	$389.19	$0.00	$0.00	$0.00	$183.54	$653.58	$653.58	$0.00	$0.00	$183.52	$0.00	$520.87	$520.87	$0.00	$432.44	$684.98	$691.90	$0.00		$0.00	$135.35	$0.00	$0.00	$137.69	$0.00	$0.00	$0.00	$0.00	$0.00
425670	SUP	HCPCS C1713		425670  -  PLATE 88MM RAD 314.5MM 20 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	$974.95 	$721.46	$0.00	$809.60	$455.40	$455.40	$0.00	$0.00	$0.00	$203.20	$723.61	$723.61	$0.00	$0.00	$203.18	$0.00	$576.68	$576.68	$0.00	$506.00	$801.50	$809.60	$0.00		$0.00	$158.38	$0.00	$0.00	$161.11	$0.00	$0.00	$0.00	$0.00	$0.00
425672	SUP	HCPCS C1713		425672  -  PLATE 88MM RAD 346.5MM 22 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	"$1,012.00 "	$748.88	$0.00	$809.60	$455.40	$455.40	$0.00	$0.00	$0.00	$210.93	$751.11	$751.11	$0.00	$0.00	$210.90	$0.00	$598.60	$598.60	$0.00	$506.00	$801.50	$809.60	$0.00		$0.00	$158.38	$0.00	$0.00	$161.11	$0.00	$0.00	$0.00	$0.00	$0.00
425674	SUP	HCPCS C1713		425674  -  PLATE 88MM RAD 378.5MM 24 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	"$1,012.00 "	$748.88	$0.00	$809.60	$455.40	$455.40	$0.00	$0.00	$0.00	$210.93	$751.11	$751.11	$0.00	$0.00	$210.90	$0.00	$598.60	$598.60	$0.00	$506.00	$801.50	$809.60	$0.00		$0.00	$158.38	$0.00	$0.00	$161.11	$0.00	$0.00	$0.00	$0.00	$0.00
425676	SUP	HCPCS C1713		425676  -  PLATE 88MM RAD 410.5MM 26 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	"$1,067.00 "	$789.58	$0.00	$853.60	$480.15	$480.15	$0.00	$0.00	$0.00	$222.39	$791.93	$791.93	$0.00	$0.00	$222.36	$0.00	$631.13	$631.13	$0.00	$533.50	$845.06	$853.60	$0.00		$0.00	$166.99	$0.00	$0.00	$169.87	$0.00	$0.00	$0.00	$0.00	$0.00
425678	SUP	HCPCS C1713		425678  -  PLATE 442.5MM 28 HOLE CVD BONE 88MM PLVC	BOTH IP/OP	"$1,067.00 "	$789.58	$0.00	$853.60	$480.15	$480.15	$0.00	$0.00	$0.00	$222.39	$791.93	$791.93	$0.00	$0.00	$222.36	$0.00	$631.13	$631.13	$0.00	$533.50	$845.06	$853.60	$0.00		$0.00	$166.99	$0.00	$0.00	$169.87	$0.00	$0.00	$0.00	$0.00	$0.00
425680	SUP	HCPCS C1713		425680  -  PLATE 88MM RAD 474.5MM 30 HOLE CVD MATTA BONE PLVC	BOTH IP/OP	"$1,067.00 "	$789.58	$0.00	$853.60	$480.15	$480.15	$0.00	$0.00	$0.00	$222.39	$791.93	$791.93	$0.00	$0.00	$222.36	$0.00	$631.13	$631.13	$0.00	$533.50	$845.06	$853.60	$0.00		$0.00	$166.99	$0.00	$0.00	$169.87	$0.00	$0.00	$0.00	$0.00	$0.00
425702	SUP	HCPCS C1713		425702  -  PLATE 26.5MMX10.5MMX2.5M SS 2 HOLE STR MATTA BONE PLVC	BOTH IP/OP	$659.40 	$487.96	$0.00	$489.41	$157.16	$157.16	$0.00	$0.00	$0.00	$137.44	$489.41	$489.41	$0.00	$0.00	$137.42	$0.00	$390.04	$390.04	$0.00	$174.63	$276.61	$279.40	$0.00		$0.00	$54.66	$0.00	$0.00	$55.60	$0.00	$0.00	$0.00	$0.00	$0.00
425703	SUP	HCPCS C1713		425703  -  PLATE 42.5MM SS 3 HOLE STR BONE PLVC	BOTH IP/OP	$659.40 	$487.96	$0.00	$489.41	$180.68	$180.68	$0.00	$0.00	$0.00	$137.44	$489.41	$489.41	$0.00	$0.00	$137.42	$0.00	$390.04	$390.04	$0.00	$200.75	$317.99	$321.20	$0.00		$0.00	$62.83	$0.00	$0.00	$63.92	$0.00	$0.00	$0.00	$0.00	$0.00
425704	SUP	HCPCS C1713		425704  -  PLATE 58.5MM SS 4 HOLE STR MPS BONE PLVC	BOTH IP/OP	$659.40 	$487.96	$0.00	$489.41	$189.96	$189.96	$0.00	$0.00	$0.00	$137.44	$489.41	$489.41	$0.00	$0.00	$137.42	$0.00	$390.04	$390.04	$0.00	$211.06	$334.33	$337.70	$0.00		$0.00	$66.06	$0.00	$0.00	$67.20	$0.00	$0.00	$0.00	$0.00	$0.00
425705	SUP	HCPCS C1713		425705  -  PLATE 74.5MM 5 HL SHFT STR MATTA BONE PLVC	BOTH IP/OP	$659.40 	$487.96	$0.00	$489.41	$198.62	$198.62	$0.00	$0.00	$0.00	$137.44	$489.41	$489.41	$0.00	$0.00	$137.42	$0.00	$390.04	$390.04	$0.00	$220.69	$349.57	$353.10	$0.00		$0.00	$69.08	$0.00	$0.00	$70.27	$0.00	$0.00	$0.00	$0.00	$0.00
425706	SUP	HCPCS C1713		425706  -  PLATE 90.5MM SS 6 HOLE STR MPS BONE PLVC	BOTH IP/OP	$726.60 	$537.68	$0.00	$539.28	$215.94	$215.94	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$239.94	$380.06	$383.90	$0.00		$0.00	$75.10	$0.00	$0.00	$76.40	$0.00	$0.00	$0.00	$0.00	$0.00
425707	SUP	HCPCS C1713		425707  -  PLATE 106.5MM 7 HL SHFT STR MATTA BONE PLVC	BOTH IP/OP	$726.60 	$537.68	$0.00	$539.28	$229.56	$229.56	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$255.06	$404.02	$408.10	$0.00		$0.00	$79.83	$0.00	$0.00	$81.21	$0.00	$0.00	$0.00	$0.00	$0.00
425708	SUP	HCPCS C1713		425708  -  PLATE 122.5MM SS 8 HOLE STR MPS BONE PLVC	BOTH IP/OP	$726.60 	$537.68	$0.00	$539.28	$243.79	$243.79	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$270.88	$429.07	$433.40	$0.00		$0.00	$84.78	$0.00	$0.00	$86.25	$0.00	$0.00	$0.00	$0.00	$0.00
425709	SUP	HCPCS C1713		425709  -  PLATE 138.5MM 9 HL SHFT STR MATTA BONE PLVC	BOTH IP/OP	$726.60 	$537.68	$0.00	$539.28	$252.45	$252.45	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$280.50	$444.31	$448.80	$0.00		$0.00	$87.80	$0.00	$0.00	$89.31	$0.00	$0.00	$0.00	$0.00	$0.00
425710	SUP	HCPCS C1713		425710  -  PLATE 154.5MM SS 10 HOLE STR MPS BONE PLVC	BOTH IP/OP	$726.60 	$537.68	$0.00	$539.28	$261.11	$261.11	$0.00	$0.00	$0.00	$151.44	$539.28	$539.28	$0.00	$0.00	$151.42	$0.00	$429.78	$429.78	$0.00	$290.13	$459.56	$464.20	$0.00		$0.00	$90.81	$0.00	$0.00	$92.38	$0.00	$0.00	$0.00	$0.00	$0.00
425711	SUP	HCPCS C1713		425711  -  PLATE 170.5MM 11 HL SHFT STR MATTA BONE PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$270.39	$270.39	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$300.44	$475.90	$480.70	$0.00		$0.00	$94.04	$0.00	$0.00	$95.66	$0.00	$0.00	$0.00	$0.00	$0.00
425712	SUP	HCPCS C1713		425712  -  PLATE 186.5MM SS 12 HOLE STR MATTA MPS BONE PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$279.68	$279.68	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$310.75	$492.23	$497.20	$0.00		$0.00	$97.26	$0.00	$0.00	$98.94	$0.00	$0.00	$0.00	$0.00	$0.00
425713	SUP	HCPCS C1713		425713  -  PLATE 202.5MM 13 HL SHFT STR MATTA BONE PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$288.96	$288.96	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$321.06	$508.57	$513.70	$0.00		$0.00	$100.49	$0.00	$0.00	$102.23	$0.00	$0.00	$0.00	$0.00	$0.00
425714	SUP	HCPCS C1713		425714  -  PLATE 218.5MM SS 14 HOLE STR MATTA BONE PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$297.62	$297.62	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$330.69	$523.81	$529.10	$0.00		$0.00	$103.51	$0.00	$0.00	$105.29	$0.00	$0.00	$0.00	$0.00	$0.00
425715	SUP	HCPCS C1713		425715  -  PLATE 234.5MM 15 HL SHFT STR MATTA BONE PLVC	BOTH IP/OP	$799.40 	$591.56	$0.00	$593.31	$306.28	$306.28	$0.00	$0.00	$0.00	$166.61	$593.31	$593.31	$0.00	$0.00	$166.59	$0.00	$472.85	$472.85	$0.00	$340.31	$539.06	$544.50	$0.00		$0.00	$106.52	$0.00	$0.00	$108.36	$0.00	$0.00	$0.00	$0.00	$0.00
425716	SUP	HCPCS C1713		425716  -  PLATE 250.5MMX10.5MMX2.5M SS 16 HOLE STR MATTA BONE PLVC	BOTH IP/OP	$877.80 	$649.57	$0.00	$651.50	$324.23	$324.23	$0.00	$0.00	$0.00	$182.96	$651.50	$651.50	$0.00	$0.00	$182.93	$0.00	$519.22	$519.22	$0.00	$360.25	$570.64	$576.40	$0.00		$0.00	$112.76	$0.00	$0.00	$114.70	$0.00	$0.00	$0.00	$0.00	$0.00
425718	SUP	HCPCS C1713		425718  -  PLATE 282.5MM 18 HL SHFT STR MATTA BONE PLVC	BOTH IP/OP	$877.80 	$649.57	$0.00	$651.50	$360.73	$360.73	$0.00	$0.00	$0.00	$182.96	$651.50	$651.50	$0.00	$0.00	$182.93	$0.00	$519.22	$519.22	$0.00	$400.81	$634.89	$641.30	$0.00		$0.00	$125.45	$0.00	$0.00	$127.62	$0.00	$0.00	$0.00	$0.00	$0.00
425720	SUP	HCPCS C1713		425720  -  PLATE 314.5MM 20 HL SHFT STR MATTA BONE PLVC	BOTH IP/OP	$902.00 	$667.48	$0.00	$721.60	$405.90	$405.90	$0.00	$0.00	$0.00	$188.00	$669.46	$669.46	$0.00	$0.00	$187.98	$0.00	$533.53	$533.53	$0.00	$451.00	$714.38	$721.60	$0.00		$0.00	$141.16	$0.00	$0.00	$143.60	$0.00	$0.00	$0.00	$0.00	$0.00
425752	SUP	HCPCS C1713		425752  -  PLATE 22.5MM 2 HOLE STR BONE ACETAB	BOTH IP/OP	$374.00 	$276.76	$0.00	$299.20	$168.30	$168.30	$0.00	$0.00	$0.00	$77.95	$277.58	$277.58	$0.00	$0.00	$77.94	$0.00	$221.22	$221.22	$0.00	$187.00	$296.21	$299.20	$0.00		$0.00	$58.53	$0.00	$0.00	$59.54	$0.00	$0.00	$0.00	$0.00	$0.00
425753	SUP	HCPCS C1713		425753  -  PLATE 34.5MM 3 HOLE STR BONE ACETAB	BOTH IP/OP	$762.30 	$564.10	$0.00	$565.78	$191.81	$191.81	$0.00	$0.00	$0.00	$158.88	$565.78	$565.78	$0.00	$0.00	$158.86	$0.00	$450.90	$450.90	$0.00	$213.13	$337.59	$341.00	$0.00		$0.00	$66.71	$0.00	$0.00	$67.86	$0.00	$0.00	$0.00	$0.00	$0.00
425754	SUP	HCPCS C1713		425754  -  PLATE 46.5MM SS 4 HOLE STR MPS BONE ACETAB	BOTH IP/OP	$762.30 	$564.10	$0.00	$565.78	$201.71	$201.71	$0.00	$0.00	$0.00	$158.88	$565.78	$565.78	$0.00	$0.00	$158.86	$0.00	$450.90	$450.90	$0.00	$224.13	$355.01	$358.60	$0.00		$0.00	$70.15	$0.00	$0.00	$71.36	$0.00	$0.00	$0.00	$0.00	$0.00
425755	SUP	HCPCS C1713		425755  -  PLATE 58.5MM 5 HOLE STR BONE ACETAB	BOTH IP/OP	$762.30 	$564.10	$0.00	$565.78	$210.99	$210.99	$0.00	$0.00	$0.00	$158.88	$565.78	$565.78	$0.00	$0.00	$158.86	$0.00	$450.90	$450.90	$0.00	$234.44	$371.35	$375.10	$0.00		$0.00	$73.38	$0.00	$0.00	$74.64	$0.00	$0.00	$0.00	$0.00	$0.00
425756	SUP	HCPCS C1713		425756  -  PLATE 70.5MM SS 6 HOLE STR MPS BONE ACETAB	BOTH IP/OP	$837.90 	$620.05	$0.00	$621.89	$230.79	$230.79	$0.00	$0.00	$0.00	$174.64	$621.89	$621.89	$0.00	$0.00	$174.62	$0.00	$495.62	$495.62	$0.00	$256.44	$406.20	$410.30	$0.00		$0.00	$80.26	$0.00	$0.00	$81.65	$0.00	$0.00	$0.00	$0.00	$0.00
425757	SUP	HCPCS C1713		425757  -  PLATE 82.5MM 7 HOLE STR BONE ACETAB	BOTH IP/OP	$837.90 	$620.05	$0.00	$621.89	$244.41	$244.41	$0.00	$0.00	$0.00	$174.64	$621.89	$621.89	$0.00	$0.00	$174.62	$0.00	$495.62	$495.62	$0.00	$271.56	$430.16	$434.50	$0.00		$0.00	$85.00	$0.00	$0.00	$86.47	$0.00	$0.00	$0.00	$0.00	$0.00
425758	SUP	HCPCS C1713		425758  -  PLATE 94.5MM SS 8 HOLE STR MPS BONE ACETAB	BOTH IP/OP	$837.90 	$620.05	$0.00	$621.89	$259.88	$259.88	$0.00	$0.00	$0.00	$174.64	$621.89	$621.89	$0.00	$0.00	$174.62	$0.00	$495.62	$495.62	$0.00	$288.75	$457.38	$462.00	$0.00		$0.00	$90.38	$0.00	$0.00	$91.94	$0.00	$0.00	$0.00	$0.00	$0.00
425759	SUP	HCPCS C1713		425759  -  PLATE 106.5MM 9 HOLE STR BONE ACETAB	BOTH IP/OP	$837.90 	$620.05	$0.00	$621.89	$269.16	$269.16	$0.00	$0.00	$0.00	$174.64	$621.89	$621.89	$0.00	$0.00	$174.62	$0.00	$495.62	$495.62	$0.00	$299.06	$473.72	$478.50	$0.00		$0.00	$93.61	$0.00	$0.00	$95.22	$0.00	$0.00	$0.00	$0.00	$0.00
425760	SUP	HCPCS C1713		425760  -  PLATE 118.5MM SS 10 HOLE STR MPS BONE ACETAB	BOTH IP/OP	$837.90 	$620.05	$0.00	$621.89	$278.44	$278.44	$0.00	$0.00	$0.00	$174.64	$621.89	$621.89	$0.00	$0.00	$174.62	$0.00	$495.62	$495.62	$0.00	$309.38	$490.05	$495.00	$0.00		$0.00	$96.83	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
425761	SUP	HCPCS C1713		425761  -  PLATE 130.5MM 11 HOLE STR BONE ACETAB	BOTH IP/OP	$924.70 	$684.28	$0.00	$686.31	$288.34	$288.34	$0.00	$0.00	$0.00	$192.73	$686.31	$686.31	$0.00	$0.00	$192.71	$0.00	$546.96	$546.96	$0.00	$320.38	$507.47	$512.60	$0.00		$0.00	$100.28	$0.00	$0.00	$102.01	$0.00	$0.00	$0.00	$0.00	$0.00
425762	SUP	HCPCS C1713		425762  -  PLATE 142.5MM SS 12 HOLE STR MATTA MPS BONE ACETAB	BOTH IP/OP	$924.70 	$684.28	$0.00	$686.31	$298.24	$298.24	$0.00	$0.00	$0.00	$192.73	$686.31	$686.31	$0.00	$0.00	$192.71	$0.00	$546.96	$546.96	$0.00	$331.38	$524.90	$530.20	$0.00		$0.00	$103.72	$0.00	$0.00	$105.51	$0.00	$0.00	$0.00	$0.00	$0.00
425763	SUP	HCPCS C1713		425763  -  PLATE 154.5MM 13 HOLE STR BONE ACETAB	BOTH IP/OP	$924.70 	$684.28	$0.00	$686.31	$306.90	$306.90	$0.00	$0.00	$0.00	$192.73	$686.31	$686.31	$0.00	$0.00	$192.71	$0.00	$546.96	$546.96	$0.00	$341.00	$540.14	$545.60	$0.00		$0.00	$106.73	$0.00	$0.00	$108.57	$0.00	$0.00	$0.00	$0.00	$0.00
425764	SUP	HCPCS C1713		425764  -  PLATE 166.5MM SS 14 HOLE STR MATTA MPS BONE ACETAB	BOTH IP/OP	$924.70 	$684.28	$0.00	$686.31	$316.80	$316.80	$0.00	$0.00	$0.00	$192.73	$686.31	$686.31	$0.00	$0.00	$192.71	$0.00	$546.96	$546.96	$0.00	$352.00	$557.57	$563.20	$0.00		$0.00	$110.18	$0.00	$0.00	$112.08	$0.00	$0.00	$0.00	$0.00	$0.00
425765	SUP	HCPCS C1713		425765  -  PLATE 178.5MM 15 HOLE STR BONE ACETAB	BOTH IP/OP	$924.70 	$684.28	$0.00	$686.31	$326.70	$326.70	$0.00	$0.00	$0.00	$192.73	$686.31	$686.31	$0.00	$0.00	$192.71	$0.00	$546.96	$546.96	$0.00	$363.00	$574.99	$580.80	$0.00		$0.00	$113.62	$0.00	$0.00	$115.58	$0.00	$0.00	$0.00	$0.00	$0.00
425766	SUP	HCPCS C1713		425766  -  PLATE 190.5MM SS 16 HOLE STR BONE ACETAB	BOTH IP/OP	"$1,014.30 "	$750.58	$0.00	$752.81	$345.26	$345.26	$0.00	$0.00	$0.00	$211.41	$752.81	$752.81	$0.00	$0.00	$211.38	$0.00	$599.96	$599.96	$0.00	$383.63	$607.66	$613.80	$0.00		$0.00	$120.07	$0.00	$0.00	$122.15	$0.00	$0.00	$0.00	$0.00	$0.00
425767	SUP	HCPCS C1713		425767  -  PLATE 202.5MM 17 HOLE STR BONE ACETAB	BOTH IP/OP	"$1,014.30 "	$750.58	$0.00	$752.81	$364.44	$364.44	$0.00	$0.00	$0.00	$211.41	$752.81	$752.81	$0.00	$0.00	$211.38	$0.00	$599.96	$599.96	$0.00	$404.94	$641.42	$647.90	$0.00		$0.00	$126.75	$0.00	$0.00	$128.93	$0.00	$0.00	$0.00	$0.00	$0.00
425768	SUP	HCPCS C1713		425768  -  PLATE 214.5MM 18 HOLE STR BONE ACETAB	BOTH IP/OP	"$1,014.30 "	$750.58	$0.00	$752.81	$383.01	$383.01	$0.00	$0.00	$0.00	$211.41	$752.81	$752.81	$0.00	$0.00	$211.38	$0.00	$599.96	$599.96	$0.00	$425.56	$674.09	$680.90	$0.00		$0.00	$133.20	$0.00	$0.00	$135.50	$0.00	$0.00	$0.00	$0.00	$0.00
425769	SUP	HCPCS C1713		425769  -  PLATE 226.5MM 19 HOLE STR BONE ACETAB	BOTH IP/OP	$961.13 	$711.24	$0.00	$768.90	$432.51	$432.51	$0.00	$0.00	$0.00	$200.32	$713.35	$713.35	$0.00	$0.00	$200.30	$0.00	$568.51	$568.51	$0.00	$480.56	$761.21	$768.90	$0.00		$0.00	$150.42	$0.00	$0.00	$153.01	$0.00	$0.00	$0.00	$0.00	$0.00
425770	SUP	HCPCS C1713		425770  -  PLATE 238.5MM 20 HOLE STR BONE ACETAB	BOTH IP/OP	"$1,014.30 "	$750.58	$0.00	$768.90	$432.51	$432.51	$0.00	$0.00	$0.00	$211.41	$752.81	$752.81	$0.00	$0.00	$211.38	$0.00	$599.96	$599.96	$0.00	$480.56	$761.21	$768.90	$0.00		$0.00	$150.42	$0.00	$0.00	$153.01	$0.00	$0.00	$0.00	$0.00	$0.00
425772	SUP	HCPCS C1713		425772  -  PLATE 262.5MM 22 HOLE STR BONE ACETAB	BOTH IP/OP	"$1,014.30 "	$750.58	$0.00	$768.90	$432.51	$432.51	$0.00	$0.00	$0.00	$211.41	$752.81	$752.81	$0.00	$0.00	$211.38	$0.00	$599.96	$599.96	$0.00	$480.56	$761.21	$768.90	$0.00		$0.00	$150.42	$0.00	$0.00	$153.01	$0.00	$0.00	$0.00	$0.00	$0.00
425774	SUP	HCPCS C1713		425774  -  PLATE 286.5MM 24 HOLE STR BONE ACETAB	BOTH IP/OP	$961.13 	$711.24	$0.00	$768.90	$432.51	$432.51	$0.00	$0.00	$0.00	$200.32	$713.35	$713.35	$0.00	$0.00	$200.30	$0.00	$568.51	$568.51	$0.00	$480.56	$761.21	$768.90	$0.00		$0.00	$150.42	$0.00	$0.00	$153.01	$0.00	$0.00	$0.00	$0.00	$0.00
425776	SUP	HCPCS C1713		425776  -  PLATE 310.5MM 26 HOLE STR BONE ACETAB	BOTH IP/OP	$961.13 	$711.24	$0.00	$768.90	$432.51	$432.51	$0.00	$0.00	$0.00	$200.32	$713.35	$713.35	$0.00	$0.00	$200.30	$0.00	$568.51	$568.51	$0.00	$480.56	$761.21	$768.90	$0.00		$0.00	$150.42	$0.00	$0.00	$153.01	$0.00	$0.00	$0.00	$0.00	$0.00
425778	SUP	HCPCS C1713		425778  -  PLATE 334.5MM 28 HOLE STR BONE ACETAB	BOTH IP/OP	$961.13 	$711.24	$0.00	$768.90	$432.51	$432.51	$0.00	$0.00	$0.00	$200.32	$713.35	$713.35	$0.00	$0.00	$200.30	$0.00	$568.51	$568.51	$0.00	$480.56	$761.21	$768.90	$0.00		$0.00	$150.42	$0.00	$0.00	$153.01	$0.00	$0.00	$0.00	$0.00	$0.00
425780	SUP	HCPCS C1713		425780  -  PLATE 358.5MM 30 HOLE STR BONE ACETAB	BOTH IP/OP	"$1,014.30 "	$750.58	$0.00	$768.90	$432.51	$432.51	$0.00	$0.00	$0.00	$211.41	$752.81	$752.81	$0.00	$0.00	$211.38	$0.00	$599.96	$599.96	$0.00	$480.56	$761.21	$768.90	$0.00		$0.00	$150.42	$0.00	$0.00	$153.01	$0.00	$0.00	$0.00	$0.00	$0.00
425794	SUP	HCPCS C1713		425794  -  PLATE BN 60.5MM MPS 4 HL SS R75	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$831.26	$458.49	$458.49	$0.00	$0.00	$0.00	$233.44	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$662.48	$662.48	$0.00	$509.44	$806.95	$815.10	$0.00		$0.00	$159.45	$0.00	$0.00	$162.20	$0.00	$0.00	$0.00	$0.00	$0.00
425796	SUP	HCPCS C1713		425796  -  PLATE BN 92.5MM MPS 6 HL SS R75	BOTH IP/OP	"$1,187.20 "	$878.53	$0.00	$881.14	$482.01	$482.01	$0.00	$0.00	$0.00	$247.44	$881.14	$881.14	$0.00	$0.00	$247.41	$0.00	$702.23	$702.23	$0.00	$535.56	$848.33	$856.90	$0.00		$0.00	$167.63	$0.00	$0.00	$170.52	$0.00	$0.00	$0.00	$0.00	$0.00
425798	SUP	HCPCS C1713		425798  -  PLATE 75MM RAD 124.5MM 8 HOLE BONE PUBIS SYMPHYSIS	BOTH IP/OP	"$1,122.00 "	$830.28	$0.00	$897.60	$504.90	$504.90	$0.00	$0.00	$0.00	$233.85	$832.75	$832.75	$0.00	$0.00	$233.82	$0.00	$663.66	$663.66	$0.00	$561.00	$888.62	$897.60	$0.00		$0.00	$175.59	$0.00	$0.00	$178.62	$0.00	$0.00	$0.00	$0.00	$0.00
427002	SUP	HCPCS C1713		427002  -  PLATE 32MM SS 4MM SCR SM FRAG 2 HOLE WST CMPR LCK AXSOS BONE	BOTH IP/OP	$182.40 	$134.98	$0.00	$143.00	$80.44	$80.44	$0.00	$0.00	$0.00	$38.02	$135.38	$135.38	$0.00	$0.00	$38.01	$0.00	$107.89	$107.89	$0.00	$89.38	$141.57	$143.00	$0.00		$0.00	$27.97	$0.00	$0.00	$28.46	$0.00	$0.00	$0.00	$0.00	$0.00
427003	SUP	HCPCS C1713		427003  -  PLATE 45MM SS 3 HOLE WST CMPR SM FRAG IMPL AXSOS BONE 4MM	BOTH IP/OP	$182.40 	$134.98	$0.00	$143.00	$80.44	$80.44	$0.00	$0.00	$0.00	$38.02	$135.38	$135.38	$0.00	$0.00	$38.01	$0.00	$107.89	$107.89	$0.00	$89.38	$141.57	$143.00	$0.00		$0.00	$27.97	$0.00	$0.00	$28.46	$0.00	$0.00	$0.00	$0.00	$0.00
427004	SUP	HCPCS C1713		427004  -  PLATE 58MM SS 4MM SCR SM FRAG 4 HOLE WST CMPR LCK AXSOS BONE	BOTH IP/OP	$182.40 	$134.98	$0.00	$154.00	$86.63	$86.63	$0.00	$0.00	$0.00	$38.02	$135.38	$135.38	$0.00	$0.00	$38.01	$0.00	$107.89	$107.89	$0.00	$96.25	$152.46	$154.00	$0.00		$0.00	$30.13	$0.00	$0.00	$30.65	$0.00	$0.00	$0.00	$0.00	$0.00
427005	SUP	HCPCS C1713		427005  -  PLATE BN 71MM NS AXSOS 5 HL LCK CMPR SS WST 4MM SCR SM FRAG	BOTH IP/OP	$233.60 	$172.86	$0.00	$181.50	$102.09	$102.09	$0.00	$0.00	$0.00	$48.69	$173.38	$173.38	$0.00	$0.00	$48.68	$0.00	$138.17	$138.17	$0.00	$113.44	$179.69	$181.50	$0.00		$0.00	$35.51	$0.00	$0.00	$36.12	$0.00	$0.00	$0.00	$0.00	$0.00
427006	SUP	HCPCS C1713		427006  -  PLATE BN 84MM NS AXSOS 6 HL LCK CMPR SS WST 4MM SCR SM FRAG	BOTH IP/OP	$233.60 	$172.86	$0.00	$181.50	$102.09	$102.09	$0.00	$0.00	$0.00	$48.69	$173.38	$173.38	$0.00	$0.00	$48.68	$0.00	$138.17	$138.17	$0.00	$113.44	$179.69	$181.50	$0.00		$0.00	$35.51	$0.00	$0.00	$36.12	$0.00	$0.00	$0.00	$0.00	$0.00
427007	SUP	HCPCS C1713		427007  -  PLATE BN 97MM NS AXSOS 7 HL LCK CMPR SS WST 4MM SCR SM FRAG	BOTH IP/OP	$233.60 	$172.86	$0.00	$181.50	$102.09	$102.09	$0.00	$0.00	$0.00	$48.69	$173.38	$173.38	$0.00	$0.00	$48.68	$0.00	$138.17	$138.17	$0.00	$113.44	$179.69	$181.50	$0.00		$0.00	$35.51	$0.00	$0.00	$36.12	$0.00	$0.00	$0.00	$0.00	$0.00
427008	SUP	HCPCS C1713		427008  -  PLATE 110MM SS 4MM SCR 8 HOLE WST CMPR SM FRAG IMPL AXSOS	BOTH IP/OP	$260.00 	$192.40	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$54.19	$192.97	$192.97	$0.00	$0.00	$54.18	$0.00	$153.79	$153.79	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
427009	SUP	HCPCS C1713		427009  -  PLATE 123MM SS 4MM SCR SM FRAG 29 HOLE WST CMPR LCK AXSOS	BOTH IP/OP	$260.00 	$192.40	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$54.19	$192.97	$192.97	$0.00	$0.00	$54.18	$0.00	$153.79	$153.79	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
427010	SUP	HCPCS C1713		427010  -  PLATE 4MM SCR NONSTRL 136MM SS 10 HOLE LCK CMPR WST SM FRAG	BOTH IP/OP	$260.00 	$192.40	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$54.19	$192.97	$192.97	$0.00	$0.00	$54.18	$0.00	$153.79	$153.79	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
427011	SUP	HCPCS C1713		427011  -  PLATE 149MM SS 4MM SCR SM FRAG 11 HOLE WST CMPR LCK AXSOS	BOTH IP/OP	$260.00 	$192.40	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$54.19	$192.97	$192.97	$0.00	$0.00	$54.18	$0.00	$153.79	$153.79	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
427012	SUP	HCPCS C1713		427012  -  PLATE BN 162MM NS AXSOS 12 HL LCK CMPR SS WST 4MM SCR SM	BOTH IP/OP	$260.00 	$192.40	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$54.19	$192.97	$192.97	$0.00	$0.00	$54.18	$0.00	$153.79	$153.79	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
427014	SUP	HCPCS C1713		427014  -  PLATE 188MM 14 HOLE CMPR WST LCK AXSOS BONE 4MM	BOTH IP/OP	$311.20 	$230.29	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$64.86	$230.97	$230.97	$0.00	$0.00	$64.85	$0.00	$184.07	$184.07	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
427016	SUP	HCPCS C1713		427016  -  PLATE 241MM SS 16 HOLE WST CMPR BONE 4MM STRL	BOTH IP/OP	$311.20 	$230.29	$0.00	$269.50	$151.59	$151.59	$0.00	$0.00	$0.00	$64.86	$230.97	$230.97	$0.00	$0.00	$64.85	$0.00	$184.07	$184.07	$0.00	$168.44	$266.81	$269.50	$0.00		$0.00	$52.72	$0.00	$0.00	$53.63	$0.00	$0.00	$0.00	$0.00	$0.00
427018	SUP	HCPCS C1713		427018  -  PLATE 240MM SS 4MM SCR SM FRAG 18 HOLE WST CMPR LCK AXSOS	BOTH IP/OP	$363.20 	$268.77	$0.00	$302.50	$170.16	$170.16	$0.00	$0.00	$0.00	$75.70	$269.57	$269.57	$0.00	$0.00	$75.69	$0.00	$214.83	$214.83	$0.00	$189.06	$299.48	$302.50	$0.00		$0.00	$59.18	$0.00	$0.00	$60.20	$0.00	$0.00	$0.00	$0.00	$0.00
427020	SUP	HCPCS C1713		427020  -  PLATE 266MM SS 4MM SCR SM FRAG 20 HOLE WST CMPR LCK AXSOS	BOTH IP/OP	$363.20 	$268.77	$0.00	$302.50	$170.16	$170.16	$0.00	$0.00	$0.00	$75.70	$269.57	$269.57	$0.00	$0.00	$75.69	$0.00	$214.83	$214.83	$0.00	$189.06	$299.48	$302.50	$0.00		$0.00	$59.18	$0.00	$0.00	$60.20	$0.00	$0.00	$0.00	$0.00	$0.00
427062	SUP	HCPCS C1713		427062  -  PLATE 24MM SS 3MM SCR SM FRAG 2 HOLE 1/3 TBLR LCK SYS AXSOS	BOTH IP/OP	$179.20 	$132.61	$0.00	$144.10	$81.06	$81.06	$0.00	$0.00	$0.00	$37.35	$133.00	$133.00	$0.00	$0.00	$37.35	$0.00	$106.00	$106.00	$0.00	$90.06	$142.66	$144.10	$0.00		$0.00	$28.19	$0.00	$0.00	$28.68	$0.00	$0.00	$0.00	$0.00	$0.00
427063	SUP	HCPCS C1713		427063  -  PLATE 37MM SS 3 HOLE 1/3 TBLR BONE 3MM	BOTH IP/OP	$190.40 	$140.90	$0.00	$151.80	$85.39	$85.39	$0.00	$0.00	$0.00	$39.68	$141.31	$141.31	$0.00	$0.00	$39.68	$0.00	$112.62	$112.62	$0.00	$94.88	$150.28	$151.80	$0.00		$0.00	$29.70	$0.00	$0.00	$30.21	$0.00	$0.00	$0.00	$0.00	$0.00
427064	SUP	HCPCS C1713		427064  -  PLATE 50MM SS 3MM SCR SM FRAG SET 4 HOLE 1/3 TBLR LCK AXSOS	BOTH IP/OP	$218.40 	$161.62	$0.00	$174.90	$98.38	$98.38	$0.00	$0.00	$0.00	$45.52	$162.10	$162.10	$0.00	$0.00	$45.51	$0.00	$129.18	$129.18	$0.00	$109.31	$173.15	$174.90	$0.00		$0.00	$34.21	$0.00	$0.00	$34.81	$0.00	$0.00	$0.00	$0.00	$0.00
427065	SUP	HCPCS C1713		427065  -  PLATE 3MM 63MM SS 5 HOLE 1/3 TBLR SM FRAG AXSOS BONE	BOTH IP/OP	$218.40 	$161.62	$0.00	$174.90	$98.38	$98.38	$0.00	$0.00	$0.00	$45.52	$162.10	$162.10	$0.00	$0.00	$45.51	$0.00	$129.18	$129.18	$0.00	$109.31	$173.15	$174.90	$0.00		$0.00	$34.21	$0.00	$0.00	$34.81	$0.00	$0.00	$0.00	$0.00	$0.00
427066	SUP	HCPCS C1713		427066  -  PLATE BN 1/3 TBLR 76MM NS AXSOS 6 HL LCK SS 3MM SCR SM FRAG	BOTH IP/OP	$218.40 	$161.62	$0.00	$162.10	$39.60	$39.60	$0.00	$0.00	$0.00	$45.52	$162.10	$162.10	$0.00	$0.00	$45.51	$0.00	$129.18	$129.18	$0.00	$44.00	$69.70	$70.40	$0.00		$0.00	$13.77	$0.00	$0.00	$14.01	$0.00	$0.00	$0.00	$0.00	$0.00
427067	SUP	HCPCS C1713		427067  -  PLATE 89MM SS 3MM SCR SM FRAG 7 HOLE 1/3 TBLR LCK AXSOS BONE	BOTH IP/OP	$223.20 	$165.17	$0.00	$179.30	$100.86	$100.86	$0.00	$0.00	$0.00	$46.52	$165.66	$165.66	$0.00	$0.00	$46.51	$0.00	$132.02	$132.02	$0.00	$112.06	$177.51	$179.30	$0.00		$0.00	$35.08	$0.00	$0.00	$35.68	$0.00	$0.00	$0.00	$0.00	$0.00
427068	SUP	HCPCS C1713		427068  -  PLATE BN 1/3 TBLR 102MM NS AXSOS 8 HL LCK SS 3MM SCR SM FRAG	BOTH IP/OP	$236.80 	$175.23	$0.00	$189.20	$106.43	$106.43	$0.00	$0.00	$0.00	$49.36	$175.75	$175.75	$0.00	$0.00	$49.35	$0.00	$140.07	$140.07	$0.00	$118.25	$187.31	$189.20	$0.00		$0.00	$37.01	$0.00	$0.00	$37.65	$0.00	$0.00	$0.00	$0.00	$0.00
427070	SUP	HCPCS C1713		427070  -  PLATE 3MM 128MM SS 10 HOLE 1/3 TBLR SM FRAG IMPL AXSOS BONE	BOTH IP/OP	$236.80 	$175.23	$0.00	$189.20	$106.43	$106.43	$0.00	$0.00	$0.00	$49.36	$175.75	$175.75	$0.00	$0.00	$49.35	$0.00	$140.07	$140.07	$0.00	$118.25	$187.31	$189.20	$0.00		$0.00	$37.01	$0.00	$0.00	$37.65	$0.00	$0.00	$0.00	$0.00	$0.00
427072	SUP	HCPCS C1713		427072  -  PLATE 154MM SS 3MM SCR SM FRAG 12 HOLE 1/3 TBLR LCK AXSOS	BOTH IP/OP	$243.20 	$179.97	$0.00	$194.70	$109.52	$109.52	$0.00	$0.00	$0.00	$50.69	$180.50	$180.50	$0.00	$0.00	$50.68	$0.00	$143.85	$143.85	$0.00	$121.69	$192.76	$194.70	$0.00		$0.00	$38.09	$0.00	$0.00	$38.75	$0.00	$0.00	$0.00	$0.00	$0.00
427074	SUP	HCPCS C1713		427074  -  PLATE 180MM SS 3MM SCR SM FRAG 14 HOLE 1/3 TBLR LCK AXSOS	BOTH IP/OP	$247.20 	$182.93	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.52	$183.47	$183.47	$0.00	$0.00	$51.52	$0.00	$146.22	$146.22	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
427102	SUP	HCPCS C1713		427102  -  PLATE NAR 43MM SS 5MM SCR BASIC FRAG 2 HOLE WST CMPR LCK	BOTH IP/OP	$245.60 	$181.74	$0.00	$182.28	$89.72	$89.72	$0.00	$0.00	$0.00	$51.19	$182.28	$182.28	$0.00	$0.00	$51.18	$0.00	$145.27	$145.27	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
427103	SUP	HCPCS C1713		427103  -  PLATE NAR 61MM SS 5MM SCR BASIC FRAG 3 HOLE WST CMPR LCK	BOTH IP/OP	$245.60 	$181.74	$0.00	$182.28	$89.72	$89.72	$0.00	$0.00	$0.00	$51.19	$182.28	$182.28	$0.00	$0.00	$51.18	$0.00	$145.27	$145.27	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
427104	SUP	HCPCS C1713		427104  -  PLATE NAR 79MM SS 5MM SCR BASIC FRAG 4 HOLE WST CMPR LCK	BOTH IP/OP	$245.60 	$181.74	$0.00	$182.28	$89.72	$89.72	$0.00	$0.00	$0.00	$51.19	$182.28	$182.28	$0.00	$0.00	$51.18	$0.00	$145.27	$145.27	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
427105	SUP	HCPCS C1713		427105  -  PLATE NAR 97MM SS 5MM SCR BASIC FRAG 5 HOLE WST CMPR LCK	BOTH IP/OP	$245.60 	$181.74	$0.00	$182.28	$89.72	$89.72	$0.00	$0.00	$0.00	$51.19	$182.28	$182.28	$0.00	$0.00	$51.18	$0.00	$145.27	$145.27	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
427106	SUP	HCPCS C1713		427106  -  PLATE NAR 115MM SS WST CMPR 6 HOLE BONE 5MM	BOTH IP/OP	$245.60 	$181.74	$0.00	$182.28	$89.72	$89.72	$0.00	$0.00	$0.00	$51.19	$182.28	$182.28	$0.00	$0.00	$51.18	$0.00	$145.27	$145.27	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
427107	SUP	HCPCS C1713		427107  -  PLATE NAR 133MM SS 7 HL SHFT CMPR WST BONE 5MM	BOTH IP/OP	$293.60 	$217.26	$0.00	$217.91	$114.47	$114.47	$0.00	$0.00	$0.00	$61.19	$217.91	$217.91	$0.00	$0.00	$61.19	$0.00	$173.66	$173.66	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
427108	SUP	HCPCS C1713		427108  -  PLATE BN NAR 151MM NS AXSOS 8 HL LCK CMPR SS WST 5MM SCR BSC	BOTH IP/OP	$293.60 	$217.26	$0.00	$217.91	$114.47	$114.47	$0.00	$0.00	$0.00	$61.19	$217.91	$217.91	$0.00	$0.00	$61.19	$0.00	$173.66	$173.66	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
427109	SUP	HCPCS C1713		427109  -  PLATE NAR 169MM SS BASIC FRAG SET 9 HOLE LCK CMPR AXSOS BONE	BOTH IP/OP	$293.60 	$217.26	$0.00	$217.91	$114.47	$114.47	$0.00	$0.00	$0.00	$61.19	$217.91	$217.91	$0.00	$0.00	$61.19	$0.00	$173.66	$173.66	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
427110	SUP	HCPCS C1713		427110  -  PLATE NAR 187MM SS 5MM SCR BASIC FRAG 10 HOLE WST CMPR LCK	BOTH IP/OP	$293.60 	$217.26	$0.00	$217.91	$114.47	$114.47	$0.00	$0.00	$0.00	$61.19	$217.91	$217.91	$0.00	$0.00	$61.19	$0.00	$173.66	$173.66	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
427112	SUP	HCPCS C1713		427112  -  PLATE NAR 223MM SS 5MM SCR BASIC FRAG 12 HOLE WST CMPR LCK	BOTH IP/OP	$351.20 	$259.89	$0.00	$260.66	$142.31	$142.31	$0.00	$0.00	$0.00	$73.20	$260.66	$260.66	$0.00	$0.00	$73.19	$0.00	$207.73	$207.73	$0.00	$158.13	$250.47	$253.00	$0.00		$0.00	$49.49	$0.00	$0.00	$50.35	$0.00	$0.00	$0.00	$0.00	$0.00
427114	SUP	HCPCS C1713		427114  -  PLATE BN NAR 259MM NS AXSOS 14 HL LCK CMPR SS WST 5MM SCR	BOTH IP/OP	$351.20 	$259.89	$0.00	$260.66	$142.31	$142.31	$0.00	$0.00	$0.00	$73.20	$260.66	$260.66	$0.00	$0.00	$73.19	$0.00	$207.73	$207.73	$0.00	$158.13	$250.47	$253.00	$0.00		$0.00	$49.49	$0.00	$0.00	$50.35	$0.00	$0.00	$0.00	$0.00	$0.00
427116	SUP	HCPCS C1713		427116  -  PLATE NAR NONSTRL 295MM SS 5MM SCR BASIC FRAG 16 HOLE WST	BOTH IP/OP	$378.40 	$280.02	$0.00	$297.00	$167.06	$167.06	$0.00	$0.00	$0.00	$78.87	$280.85	$280.85	$0.00	$0.00	$78.86	$0.00	$223.82	$223.82	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$58.10	$0.00	$0.00	$59.10	$0.00	$0.00	$0.00	$0.00	$0.00
427118	SUP	HCPCS C1713		427118  -  PLATE NAR NONSTRL 331MM SS 5MM SCR BASIC FRAG 18 HOLE WST	BOTH IP/OP	$418.40 	$309.62	$0.00	$357.50	$201.09	$201.09	$0.00	$0.00	$0.00	$87.21	$310.54	$310.54	$0.00	$0.00	$87.19	$0.00	$247.48	$247.48	$0.00	$223.44	$353.93	$357.50	$0.00		$0.00	$69.94	$0.00	$0.00	$71.14	$0.00	$0.00	$0.00	$0.00	$0.00
427120	SUP	HCPCS C1713		427120  -  PLATE NAR 367MM SS 5MM SCR BASIC FRAG 20 HOLE WST CMPR LCK	BOTH IP/OP	$636.00 	$470.64	$0.00	$472.04	$225.84	$225.84	$0.00	$0.00	$0.00	$132.56	$472.04	$472.04	$0.00	$0.00	$132.54	$0.00	$376.19	$376.19	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
427122	SUP	HCPCS C1713		427122  -  PLATE NAR NONSTRL 403MM SS 5MM SCR BASIC FRAG 22 HOLE WST	BOTH IP/OP	$636.00 	$470.64	$0.00	$472.04	$253.69	$253.69	$0.00	$0.00	$0.00	$132.56	$472.04	$472.04	$0.00	$0.00	$132.54	$0.00	$376.19	$376.19	$0.00	$281.88	$446.49	$451.00	$0.00		$0.00	$88.23	$0.00	$0.00	$89.75	$0.00	$0.00	$0.00	$0.00	$0.00
427136	SUP	HCPCS C1713		427136  -  PLATE BRD 119MM SS 5MM SCR BASIC FRAG SET 6 HOLE LCK CMPR	BOTH IP/OP	$340.80 	$252.19	$0.00	$252.94	$133.65	$133.65	$0.00	$0.00	$0.00	$71.03	$252.94	$252.94	$0.00	$0.00	$71.02	$0.00	$201.58	$201.58	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
427137	SUP	HCPCS C1713		427137  -  PLATE BRD 137MM SS 7 HL SHFT CMPR WST BONE 5MM	BOTH IP/OP	$358.40 	$265.22	$0.00	$266.20	$149.74	$149.74	$0.00	$0.00	$0.00	$74.70	$266.00	$266.00	$0.00	$0.00	$74.69	$0.00	$211.99	$211.99	$0.00	$166.38	$263.54	$266.20	$0.00		$0.00	$52.08	$0.00	$0.00	$52.97	$0.00	$0.00	$0.00	$0.00	$0.00
427138	SUP	HCPCS C1713		427138  -  PLATE BN BRD 155MM NS AXSOS 8 HL LCK CMPR SS WST 5MM SCR BSC	BOTH IP/OP	$380.80 	$281.79	$0.00	$282.63	$149.74	$149.74	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$166.38	$263.54	$266.20	$0.00		$0.00	$52.08	$0.00	$0.00	$52.97	$0.00	$0.00	$0.00	$0.00	$0.00
427139	SUP	HCPCS C1713		427139  -  PLATE BRD 173MM SS 5MM SCR BASIC FRAG 9 HOLE WST CMPR LCK	BOTH IP/OP	$380.80 	$281.79	$0.00	$282.63	$149.74	$149.74	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$166.38	$263.54	$266.20	$0.00		$0.00	$52.08	$0.00	$0.00	$52.97	$0.00	$0.00	$0.00	$0.00	$0.00
427140	SUP	HCPCS C1713		427140  -  PLATE BN BRD 191MM NS AXSOS 10 HL LCK CMPR SS WST 5MM SCR	BOTH IP/OP	$380.80 	$281.79	$0.00	$282.63	$149.74	$149.74	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$166.38	$263.54	$266.20	$0.00		$0.00	$52.08	$0.00	$0.00	$52.97	$0.00	$0.00	$0.00	$0.00	$0.00
427141	SUP	HCPCS C1713		427141  -  PLATE BRD 209MM SS 5MM SCR BASIC FRAG 11 HOLE WST CMPR LCK	BOTH IP/OP	$416.80 	$308.43	$0.00	$309.35	$167.06	$167.06	$0.00	$0.00	$0.00	$86.87	$309.35	$309.35	$0.00	$0.00	$86.86	$0.00	$246.54	$246.54	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$58.10	$0.00	$0.00	$59.10	$0.00	$0.00	$0.00	$0.00	$0.00
427142	SUP	HCPCS C1713		427142  -  PLATE BRD 227MM SS BASIC FRAG SET 12 HOLE LCK CMPR AXSOS	BOTH IP/OP	$416.80 	$308.43	$0.00	$309.35	$167.06	$167.06	$0.00	$0.00	$0.00	$86.87	$309.35	$309.35	$0.00	$0.00	$86.86	$0.00	$246.54	$246.54	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$58.10	$0.00	$0.00	$59.10	$0.00	$0.00	$0.00	$0.00	$0.00
427143	SUP	HCPCS C1713		427143  -  PLATE BRD 245MM SS 5MM SCR BASIC FRAG 13 HOLE WST CMPR LCK	BOTH IP/OP	$416.80 	$308.43	$0.00	$309.35	$167.06	$167.06	$0.00	$0.00	$0.00	$86.87	$309.35	$309.35	$0.00	$0.00	$86.86	$0.00	$246.54	$246.54	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$58.10	$0.00	$0.00	$59.10	$0.00	$0.00	$0.00	$0.00	$0.00
427144	SUP	HCPCS C1713		427144  -  PLATE BRD 263MM SS 5MM SCR BASIC FRAG 14 HOLE WST CMPR LCK	BOTH IP/OP	$416.80 	$308.43	$0.00	$309.35	$167.06	$167.06	$0.00	$0.00	$0.00	$86.87	$309.35	$309.35	$0.00	$0.00	$86.86	$0.00	$246.54	$246.54	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$58.10	$0.00	$0.00	$59.10	$0.00	$0.00	$0.00	$0.00	$0.00
427146	SUP	HCPCS C1713		427146  -  PLATE BRD 299MM SS 5MM SCR BASIC FRAG 16 HOLE WST CMPR LCK	BOTH IP/OP	$446.40 	$330.34	$0.00	$331.32	$183.15	$183.15	$0.00	$0.00	$0.00	$93.04	$331.32	$331.32	$0.00	$0.00	$93.03	$0.00	$264.05	$264.05	$0.00	$203.50	$322.34	$325.60	$0.00		$0.00	$63.70	$0.00	$0.00	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00
427148	SUP	HCPCS C1713		427148  -  PLATE BRD 335MM SS 5MM SCR BASIC FRAG 18 HOLE WST CMPR LCK	BOTH IP/OP	$446.40 	$330.34	$0.00	$400.40	$225.23	$225.23	$0.00	$0.00	$0.00	$93.04	$331.32	$331.32	$0.00	$0.00	$93.03	$0.00	$264.05	$264.05	$0.00	$250.25	$396.40	$400.40	$0.00		$0.00	$78.33	$0.00	$0.00	$79.68	$0.00	$0.00	$0.00	$0.00	$0.00
427150	SUP	HCPCS C1713		427150  -  PLATE BRD 371MM SS 5MM SCR BASIC FRAG 20 HOLE WST CMPR LCK	BOTH IP/OP	$597.60 	$442.22	$0.00	$447.70	$251.83	$251.83	$0.00	$0.00	$0.00	$124.55	$443.54	$443.54	$0.00	$0.00	$124.54	$0.00	$353.48	$353.48	$0.00	$279.81	$443.23	$447.70	$0.00		$0.00	$87.58	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$0.00
427152	SUP	HCPCS C1713		427152  -  PLATE BRD 407MM SS 5MM SCR BASIC FRAG 22 HOLE WST CMPR LCK	BOTH IP/OP	$597.60 	$442.22	$0.00	$495.00	$278.44	$278.44	$0.00	$0.00	$0.00	$124.55	$443.54	$443.54	$0.00	$0.00	$124.54	$0.00	$353.48	$353.48	$0.00	$309.38	$490.05	$495.00	$0.00		$0.00	$96.83	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
429688	SUP	HCPCS C1900		429688  -  LEAD PACING 2 CURVE 5.3FR 88CM BIPOL 2 ELECTRODE 2 FIX IS-1	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,850.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,781.25"	"$2,821.50"	"$2,850.00"	$0.00		$0.00	$557.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
430009	SUP	HCPCS C1713		430009  -  PLATE 117MM SS SM FRAG SET 9 HOLE WST CMPR SPS BONE ORTH	BOTH IP/OP	$204.00 	$150.96	$0.00	$180.40	$101.48	$101.48	$0.00	$0.00	$0.00	$42.52	$151.41	$151.41	$0.00	$0.00	$42.51	$0.00	$120.67	$120.67	$0.00	$112.75	$178.60	$180.40	$0.00		$0.00	$35.29	$0.00	$0.00	$35.90	$0.00	$0.00	$0.00	$0.00	$0.00
430012	SUP	HCPCS C1713		430012  -  PLATE 156X10.3X3.2MM SS 12 HOLE CMPR WST BONE ORTH	BOTH IP/OP	$287.25 	$212.57	$0.00	$213.20	$109.52	$109.52	$0.00	$0.00	$0.00	$59.87	$213.20	$213.20	$0.00	$0.00	$59.86	$0.00	$169.91	$169.91	$0.00	$121.69	$192.76	$194.70	$0.00		$0.00	$38.09	$0.00	$0.00	$38.75	$0.00	$0.00	$0.00	$0.00	$0.00
430014	SUP	HCPCS C1713		430014  -  PLATE 182MM SS SM FRAG SET 14 HOLE WST CMPR SPS BONE ORTH	BOTH IP/OP	$306.40 	$226.74	$0.00	$311.30	$175.11	$175.11	$0.00	$0.00	$0.00	$63.86	$227.41	$227.41	$0.00	$0.00	$63.85	$0.00	$181.24	$181.24	$0.00	$194.56	$308.19	$311.30	$0.00		$0.00	$60.90	$0.00	$0.00	$61.95	$0.00	$0.00	$0.00	$0.00	$0.00
430016	SUP	HCPCS C1713		430016  -  PLATE 208MM SS SM FRAG SET 16 HOLE WST CMPR SPS BONE ORTH	BOTH IP/OP	$509.60 	$377.10	$0.00	$485.10	$272.87	$272.87	$0.00	$0.00	$0.00	$106.21	$378.23	$378.23	$0.00	$0.00	$106.20	$0.00	$301.43	$301.43	$0.00	$303.19	$480.25	$485.10	$0.00		$0.00	$94.90	$0.00	$0.00	$96.53	$0.00	$0.00	$0.00	$0.00	$0.00
430018	SUP	HCPCS C1713		430018  -  PLATE 234X10.3X3.2MM SS 18 HOLE CMPR WST BONE ORTH	BOTH IP/OP	$612.00 	$452.88	$0.00	$553.30	$311.23	$311.23	$0.00	$0.00	$0.00	$127.56	$454.23	$454.23	$0.00	$0.00	$127.54	$0.00	$362.00	$362.00	$0.00	$345.81	$547.77	$553.30	$0.00		$0.00	$108.24	$0.00	$0.00	$110.11	$0.00	$0.00	$0.00	$0.00	$0.00
430055	SUP	HCPCS C1713		430055  -  PLATE STD 65MM SS 5 HOLE CMPR SPS BONE DISTAL ULN NONSTRL	BOTH IP/OP	$191.13 	$141.44	$0.00	$152.90	$86.01	$86.01	$0.00	$0.00	$0.00	$39.84	$141.85	$141.85	$0.00	$0.00	$39.83	$0.00	$113.05	$113.05	$0.00	$95.56	$151.37	$152.90	$0.00		$0.00	$29.91	$0.00	$0.00	$30.43	$0.00	$0.00	$0.00	$0.00	$0.00
430056	SUP	HCPCS C1713		430056  -  PLATE STD 78MM SS 6 HOLE CMPR BONE	BOTH IP/OP	$191.25 	$141.53	$0.00	$141.95	$71.78	$71.78	$0.00	$0.00	$0.00	$39.86	$141.95	$141.95	$0.00	$0.00	$39.86	$0.00	$113.12	$113.12	$0.00	$79.75	$126.32	$127.60	$0.00		$0.00	$24.96	$0.00	$0.00	$25.39	$0.00	$0.00	$0.00	$0.00	$0.00
430060	SUP	HCPCS C1713		430060  -  PLATE STD 130MM SS 10 HOLE CMPR SPS BONE DISTAL ULN NONSTRL	BOTH IP/OP	$191.25 	$141.53	$0.00	$141.95	$74.25	$74.25	$0.00	$0.00	$0.00	$39.86	$141.95	$141.95	$0.00	$0.00	$39.86	$0.00	$113.12	$113.12	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
431748	SUP	HCPCS C1785		431748  -  PACEMAKER CRD EDORA PROMRI CLS HOME MNTR DR-T	BOTH IP/OP	"$17,750.00 "	"$13,135.00"	$0.00	"$14,200.00"	"$7,987.50"	"$7,987.50"	$0.00	$0.00	$0.00	"$3,699.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,699.10"	$0.00	"$8,750.75"	"$8,750.75"	$0.00	"$8,875.00"	"$14,058.00"	"$14,200.00"	$0.00		$0.00	"$2,777.88"	$0.00	$0.00	"$2,825.80"	$0.00	$0.00	$0.00	$0.00	$0.00
431749	SUP	HCPCS C1786		431749  -  PACEMAKER CRD EDORA PROMRI CLS HOME MNTR SR-T	BOTH IP/OP	"$14,500.00 "	"$10,730.00"	$0.00	"$11,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,022.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,021.80"	$0.00	"$7,148.50"	"$7,148.50"	$0.00	"$7,250.00"	"$11,484.00"	"$11,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
432203	SUP	HCPCS C1713		432203  -  PLATE 46MM SS 4.5MM SCR 3 HOLE RECON SPS BONE DISTAL TIB	BOTH IP/OP	$312.80 	$231.47	$0.00	$259.60	$146.03	$146.03	$0.00	$0.00	$0.00	$65.20	$232.16	$232.16	$0.00	$0.00	$65.19	$0.00	$185.02	$185.02	$0.00	$162.25	$257.00	$259.60	$0.00		$0.00	$50.78	$0.00	$0.00	$51.66	$0.00	$0.00	$0.00	$0.00	$0.00
432204	SUP	HCPCS C1713		432204  -  PLATE 62MM SS 4.5MM SCR 4 HL SHFT RECON BONE	BOTH IP/OP	$358.40 	$265.22	$0.00	$299.20	$168.30	$168.30	$0.00	$0.00	$0.00	$74.70	$266.00	$266.00	$0.00	$0.00	$74.69	$0.00	$211.99	$211.99	$0.00	$187.00	$296.21	$299.20	$0.00		$0.00	$58.53	$0.00	$0.00	$59.54	$0.00	$0.00	$0.00	$0.00	$0.00
432205	SUP	HCPCS C1713		432205  -  PLATE 78MM SS 4.5MM SCR 5 HOLE RECON SPS BONE DISTAL TIB	BOTH IP/OP	$392.80 	$290.67	$0.00	$327.80	$184.39	$184.39	$0.00	$0.00	$0.00	$81.87	$291.54	$291.54	$0.00	$0.00	$81.86	$0.00	$232.34	$232.34	$0.00	$204.88	$324.52	$327.80	$0.00		$0.00	$64.13	$0.00	$0.00	$65.23	$0.00	$0.00	$0.00	$0.00	$0.00
432206	SUP	HCPCS C1713		432206  -  PLATE 94MM SS 4.5MM SCR 6 HL SHFT RECON BONE	BOTH IP/OP	$419.20 	$310.21	$0.00	$349.80	$196.76	$196.76	$0.00	$0.00	$0.00	$87.37	$311.13	$311.13	$0.00	$0.00	$87.36	$0.00	$247.96	$247.96	$0.00	$218.63	$346.30	$349.80	$0.00		$0.00	$68.43	$0.00	$0.00	$69.61	$0.00	$0.00	$0.00	$0.00	$0.00
432207	SUP	HCPCS C1713		432207  -  PLATE 110MM SS 4.5MM SCR 7 HOLE RECON SPS BONE DISTAL TIB	BOTH IP/OP	$436.00 	$322.64	$0.00	$364.10	$204.81	$204.81	$0.00	$0.00	$0.00	$90.87	$323.60	$323.60	$0.00	$0.00	$90.86	$0.00	$257.89	$257.89	$0.00	$227.56	$360.46	$364.10	$0.00		$0.00	$71.23	$0.00	$0.00	$72.46	$0.00	$0.00	$0.00	$0.00	$0.00
432208	SUP	HCPCS C1713		432208  -  PLATE 126MM SS 4.5MM SCR 8 HL SHFT RECON BONE	BOTH IP/OP	$454.40 	$336.26	$0.00	$385.00	$216.56	$216.56	$0.00	$0.00	$0.00	$94.71	$337.26	$337.26	$0.00	$0.00	$94.70	$0.00	$268.78	$268.78	$0.00	$240.63	$381.15	$385.00	$0.00		$0.00	$75.32	$0.00	$0.00	$76.62	$0.00	$0.00	$0.00	$0.00	$0.00
432209	SUP	HCPCS C1713		432209  -  PLATE 142MM SS 4.5MM SCR 9 HOLE RECON SPS BONE DISTAL TIB	BOTH IP/OP	$485.60 	$359.34	$0.00	$413.60	$232.65	$232.65	$0.00	$0.00	$0.00	$101.21	$360.41	$360.41	$0.00	$0.00	$101.20	$0.00	$287.23	$287.23	$0.00	$258.50	$409.46	$413.60	$0.00		$0.00	$80.91	$0.00	$0.00	$82.31	$0.00	$0.00	$0.00	$0.00	$0.00
432210	SUP	HCPCS C1713		432210  -  PLATE 158MM SS 4.5MM SCR 10 HOLE RECON BONE	BOTH IP/OP	$503.20 	$372.37	$0.00	$427.90	$240.69	$240.69	$0.00	$0.00	$0.00	$104.88	$373.48	$373.48	$0.00	$0.00	$104.87	$0.00	$297.64	$297.64	$0.00	$267.44	$423.62	$427.90	$0.00		$0.00	$83.71	$0.00	$0.00	$85.15	$0.00	$0.00	$0.00	$0.00	$0.00
432211	SUP	HCPCS C1713		432211  -  PLATE 174MM SS 4.5MM SCR 11 HOLE RECON SPS BONE DISTAL TIB	BOTH IP/OP	$529.50 	$391.83	$0.00	$409.20	$230.18	$230.18	$0.00	$0.00	$0.00	$110.36	$392.99	$392.99	$0.00	$0.00	$110.35	$0.00	$313.20	$313.20	$0.00	$255.75	$405.11	$409.20	$0.00		$0.00	$80.05	$0.00	$0.00	$81.43	$0.00	$0.00	$0.00	$0.00	$0.00
432212	SUP	HCPCS C1713		432212  -  PLATE 190MM SS 4.5MM SCR 12 HOLE RECON BONE	BOTH IP/OP	$566.40 	$419.14	$0.00	$469.70	$264.21	$264.21	$0.00	$0.00	$0.00	$118.05	$420.38	$420.38	$0.00	$0.00	$118.04	$0.00	$335.03	$335.03	$0.00	$293.56	$465.01	$469.70	$0.00		$0.00	$91.89	$0.00	$0.00	$93.47	$0.00	$0.00	$0.00	$0.00	$0.00
432213	SUP	HCPCS C1713		432213  -  PLATE 206MM SS 4.5MM SCR 13 HOLE RECON SPS BONE DISTAL TIB	BOTH IP/OP	$587.20 	$434.53	$0.00	$499.40	$280.91	$280.91	$0.00	$0.00	$0.00	$122.39	$435.82	$435.82	$0.00	$0.00	$122.37	$0.00	$347.33	$347.33	$0.00	$312.13	$494.41	$499.40	$0.00		$0.00	$97.70	$0.00	$0.00	$99.38	$0.00	$0.00	$0.00	$0.00	$0.00
432214	SUP	HCPCS C1713		432214  -  PLATE 222MM SS 4.5MM SCR 14 HL SHFT RECON BONE	BOTH IP/OP	$591.20 	$437.49	$0.00	$513.70	$288.96	$288.96	$0.00	$0.00	$0.00	$123.22	$438.79	$438.79	$0.00	$0.00	$123.21	$0.00	$349.69	$349.69	$0.00	$321.06	$508.57	$513.70	$0.00		$0.00	$100.49	$0.00	$0.00	$102.23	$0.00	$0.00	$0.00	$0.00	$0.00
432215	SUP	HCPCS C1713		432215  -  PLATE 238MM SS 4.5MM SCR 15 HOLE RECON SPS BONE DISTAL TIB	BOTH IP/OP	$592.00 	$438.08	$0.00	$486.20	$273.49	$273.49	$0.00	$0.00	$0.00	$123.39	$439.38	$439.38	$0.00	$0.00	$123.37	$0.00	$350.17	$350.17	$0.00	$303.88	$481.34	$486.20	$0.00		$0.00	$95.11	$0.00	$0.00	$96.75	$0.00	$0.00	$0.00	$0.00	$0.00
432216	SUP	HCPCS C1713		432216  -  PLATE 254MM SS 4.5MM SCR 16 HL SHFT RECON BONE	BOTH IP/OP	$625.60 	$462.94	$0.00	$548.90	$308.76	$308.76	$0.00	$0.00	$0.00	$130.39	$464.32	$464.32	$0.00	$0.00	$130.38	$0.00	$370.04	$370.04	$0.00	$343.06	$543.41	$548.90	$0.00		$0.00	$107.38	$0.00	$0.00	$109.23	$0.00	$0.00	$0.00	$0.00	$0.00
433165	SUP	Custom 27803010		433165  -  CEMENT BONE SIL 65MM 40GM TIB KNEE SPCR MLD STRL DISP	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	$0.00	$0.00	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
436003	SUP	HCPCS C1713		436003  -  PLATE 3 HOLE BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$1,174.40 "	$869.06	$0.00	$871.64	$464.06	$464.06	$0.00	$0.00	$0.00	$244.77	$871.64	$871.64	$0.00	$0.00	$244.74	$0.00	$694.66	$694.66	$0.00	$515.63	$816.75	$825.00	$0.00		$0.00	$161.39	$0.00	$0.00	$164.18	$0.00	$0.00	$0.00	$0.00	$0.00
436004	SUP	HCPCS C1713		436004  -  PLATE 4 HOLE BONE LEFT DISTAL VOLR RAD	BOTH IP/OP	"$1,174.40 "	$869.06	$0.00	$871.64	$464.06	$464.06	$0.00	$0.00	$0.00	$244.77	$871.64	$871.64	$0.00	$0.00	$244.74	$0.00	$694.66	$694.66	$0.00	$515.63	$816.75	$825.00	$0.00		$0.00	$161.39	$0.00	$0.00	$164.18	$0.00	$0.00	$0.00	$0.00	$0.00
436006	SUP	HCPCS C1713		436006  -  PLATE 6 HOLE BONE LEFT DISTAL VOLR RAD	BOTH IP/OP	"$1,031.25 "	$763.13	$0.00	$825.00	$464.06	$464.06	$0.00	$0.00	$0.00	$214.94	$765.39	$765.39	$0.00	$0.00	$214.91	$0.00	$609.98	$609.98	$0.00	$515.63	$816.75	$825.00	$0.00		$0.00	$161.39	$0.00	$0.00	$164.18	$0.00	$0.00	$0.00	$0.00	$0.00
436008	SUP	HCPCS C1713		436008  -  DISTAL VOLAR RADIUS  8 HOLE LT	BOTH IP/OP	"$1,031.25 "	$763.13	$0.00	$825.00	$464.06	$464.06	$0.00	$0.00	$0.00	$214.94	$765.39	$765.39	$0.00	$0.00	$214.91	$0.00	$609.98	$609.98	$0.00	$515.63	$816.75	$825.00	$0.00		$0.00	$161.39	$0.00	$0.00	$164.18	$0.00	$0.00	$0.00	$0.00	$0.00
436010	SUP	HCPCS C1713		436010  -  PLATE 10 HOLE BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$1,031.25 "	$763.13	$0.00	$825.00	$464.06	$464.06	$0.00	$0.00	$0.00	$214.94	$765.39	$765.39	$0.00	$0.00	$214.91	$0.00	$609.98	$609.98	$0.00	$515.63	$816.75	$825.00	$0.00		$0.00	$161.39	$0.00	$0.00	$164.18	$0.00	$0.00	$0.00	$0.00	$0.00
436023	SUP	HCPCS C1713		436023  -  PLATE 3 HOLE BONE RIGHT DISTAL VOLR RAD	BOTH IP/OP	"$1,174.40 "	$869.06	$0.00	$871.64	$464.06	$464.06	$0.00	$0.00	$0.00	$244.77	$871.64	$871.64	$0.00	$0.00	$244.74	$0.00	$694.66	$694.66	$0.00	$515.63	$816.75	$825.00	$0.00		$0.00	$161.39	$0.00	$0.00	$164.18	$0.00	$0.00	$0.00	$0.00	$0.00
436024	SUP	HCPCS C1713		436024  -  PLATE 4 HOLE BONE RIGHT DISTAL VOLR RAD	BOTH IP/OP	"$1,174.40 "	$869.06	$0.00	$871.64	$464.06	$464.06	$0.00	$0.00	$0.00	$244.77	$871.64	$871.64	$0.00	$0.00	$244.74	$0.00	$694.66	$694.66	$0.00	$515.63	$816.75	$825.00	$0.00		$0.00	$161.39	$0.00	$0.00	$164.18	$0.00	$0.00	$0.00	$0.00	$0.00
436026	SUP	HCPCS C1713		436026  -  PLATE 6 HOLE BONE RIGHT DISTAL VOLR RAD	BOTH IP/OP	"$1,031.25 "	$763.13	$0.00	$825.00	$464.06	$464.06	$0.00	$0.00	$0.00	$214.94	$765.39	$765.39	$0.00	$0.00	$214.91	$0.00	$609.98	$609.98	$0.00	$515.63	$816.75	$825.00	$0.00		$0.00	$161.39	$0.00	$0.00	$164.18	$0.00	$0.00	$0.00	$0.00	$0.00
436028	SUP	HCPCS C1713		436028  -  PLATE 8 HOLE BONE RIGHT DISTAL VOLR RADL	BOTH IP/OP	"$1,031.25 "	$763.13	$0.00	$825.00	$464.06	$464.06	$0.00	$0.00	$0.00	$214.94	$765.39	$765.39	$0.00	$0.00	$214.91	$0.00	$609.98	$609.98	$0.00	$515.63	$816.75	$825.00	$0.00		$0.00	$161.39	$0.00	$0.00	$164.18	$0.00	$0.00	$0.00	$0.00	$0.00
436030	SUP	HCPCS C1713		436030  -  PLATE 10 HOLE BONE RIGHT DISTAL VOLR RADL	BOTH IP/OP	"$1,031.25 "	$763.13	$0.00	$825.00	$464.06	$464.06	$0.00	$0.00	$0.00	$214.94	$765.39	$765.39	$0.00	$0.00	$214.91	$0.00	$609.98	$609.98	$0.00	$515.63	$816.75	$825.00	$0.00		$0.00	$161.39	$0.00	$0.00	$164.18	$0.00	$0.00	$0.00	$0.00	$0.00
436103	SUP	HCPCS C1713		436103  -  PLATE 86MM SS 5 HOLE BONE LEFT PROX LAT HUM	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
436105	SUP	HCPCS C1713		436105  -  PLATE 5 HOLE BONE LEFT PROX LAT HUM	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
436108	SUP	HCPCS C1713		436108  -  PLATE 150MM SS 8 HOLE BONE LEFT PROX LAT HUM	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
436123	SUP	HCPCS C1713		436123  -  PLATE 86MM SS 5 HOLE BONE RIGHT PROX LAT HUM	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
436125	SUP	HCPCS C1713		436125  -  PLATE 112MM SS 5 HOLE BONE RIGHT PROX LAT HUM	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
436128	SUP	HCPCS C1713		436128  -  PLATE 112MM 8 HOLE LCK BONE 4MM RIGHT PROX HUM PERIART TIB	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
436204	SUP	HCPCS C1713		436204  -  PLATE 94MM SS 4MM 3.5MM STD LCK SCR 4 SHFT HOLE AXSOS BONE	BOTH IP/OP	"$1,813.63 "	"$1,342.09"	$0.00	"$1,450.90"	$816.13	$816.13	$0.00	$0.00	$0.00	$378.00	"$1,346.07"	"$1,346.07"	$0.00	$0.00	$377.96	$0.00	"$1,072.76"	"$1,072.76"	$0.00	$906.81	"$1,436.39"	"$1,450.90"	$0.00		$0.00	$283.83	$0.00	$0.00	$288.73	$0.00	$0.00	$0.00	$0.00	$0.00
436206	SUP	HCPCS C1713		436206  -  PLATE 6 HOLE BONE LEFT DISTAL MDL TIB	BOTH IP/OP	"$1,813.63 "	"$1,342.09"	$0.00	"$1,450.90"	$816.13	$816.13	$0.00	$0.00	$0.00	$378.00	"$1,346.07"	"$1,346.07"	$0.00	$0.00	$377.96	$0.00	"$1,072.76"	"$1,072.76"	$0.00	$906.81	"$1,436.39"	"$1,450.90"	$0.00		$0.00	$283.83	$0.00	$0.00	$288.73	$0.00	$0.00	$0.00	$0.00	$0.00
436208	SUP	HCPCS C1713		436208  -  PLATE 8 HOLE BONE LEFT DISTAL MDL TIB	BOTH IP/OP	"$1,813.63 "	"$1,342.09"	$0.00	"$1,450.90"	$816.13	$816.13	$0.00	$0.00	$0.00	$378.00	"$1,346.07"	"$1,346.07"	$0.00	$0.00	$377.96	$0.00	"$1,072.76"	"$1,072.76"	$0.00	$906.81	"$1,436.39"	"$1,450.90"	$0.00		$0.00	$283.83	$0.00	$0.00	$288.73	$0.00	$0.00	$0.00	$0.00	$0.00
436210	SUP	HCPCS C1713		436210  -  PLATE 172MM SS 10 HOLE BONE LEFT DISTAL MDL TIB	BOTH IP/OP	"$1,813.63 "	"$1,342.09"	$0.00	"$1,450.90"	$816.13	$816.13	$0.00	$0.00	$0.00	$378.00	"$1,346.07"	"$1,346.07"	$0.00	$0.00	$377.96	$0.00	"$1,072.76"	"$1,072.76"	$0.00	$906.81	"$1,436.39"	"$1,450.90"	$0.00		$0.00	$283.83	$0.00	$0.00	$288.73	$0.00	$0.00	$0.00	$0.00	$0.00
436212	SUP	HCPCS C1713		436212  -  PLATE 198MM SS 12 HOLE BONE LEFT DISTAL MDL TIB	BOTH IP/OP	"$2,143.63 "	"$1,586.29"	$0.00	"$1,714.90"	$964.63	$964.63	$0.00	$0.00	$0.00	$446.79	"$1,591.00"	"$1,591.00"	$0.00	$0.00	$446.73	$0.00	"$1,267.95"	"$1,267.95"	$0.00	"$1,071.81"	"$1,697.75"	"$1,714.90"	$0.00		$0.00	$335.48	$0.00	$0.00	$341.27	$0.00	$0.00	$0.00	$0.00	$0.00
436214	SUP	HCPCS C1713		436214  -  PLATE 224MM SS 14 SHFT HOLE LCK BONE 4MM 3.5MM DISTAL MDL	BOTH IP/OP	"$2,143.63 "	"$1,586.29"	$0.00	"$1,714.90"	$964.63	$964.63	$0.00	$0.00	$0.00	$446.79	"$1,591.00"	"$1,591.00"	$0.00	$0.00	$446.73	$0.00	"$1,267.95"	"$1,267.95"	$0.00	"$1,071.81"	"$1,697.75"	"$1,714.90"	$0.00		$0.00	$335.48	$0.00	$0.00	$341.27	$0.00	$0.00	$0.00	$0.00	$0.00
436216	SUP	HCPCS C1713		436216  -  PLATE 250MM SS 16 HOLE BONE LEFT DISTAL MDL TIB	BOTH IP/OP	"$2,143.63 "	"$1,586.29"	$0.00	"$1,714.90"	$964.63	$964.63	$0.00	$0.00	$0.00	$446.79	"$1,591.00"	"$1,591.00"	$0.00	$0.00	$446.73	$0.00	"$1,267.95"	"$1,267.95"	$0.00	"$1,071.81"	"$1,697.75"	"$1,714.90"	$0.00		$0.00	$335.48	$0.00	$0.00	$341.27	$0.00	$0.00	$0.00	$0.00	$0.00
436224	SUP	HCPCS C1713		436224  -  PLATE 4 HOLE BONE RIGHT DISTAL MDL TIB	BOTH IP/OP	"$1,813.63 "	"$1,342.09"	$0.00	"$1,450.90"	$816.13	$816.13	$0.00	$0.00	$0.00	$378.00	"$1,346.07"	"$1,346.07"	$0.00	$0.00	$377.96	$0.00	"$1,072.76"	"$1,072.76"	$0.00	$906.81	"$1,436.39"	"$1,450.90"	$0.00		$0.00	$283.83	$0.00	$0.00	$288.73	$0.00	$0.00	$0.00	$0.00	$0.00
436226	SUP	HCPCS C1713		436226  -  PLATE 120MM SS 4MM 3.5MM STD LCK SCR 6 SHFT HOLE AXSOS BONE	BOTH IP/OP	"$1,813.63 "	"$1,342.09"	$0.00	"$1,450.90"	$816.13	$816.13	$0.00	$0.00	$0.00	$378.00	"$1,346.07"	"$1,346.07"	$0.00	$0.00	$377.96	$0.00	"$1,072.76"	"$1,072.76"	$0.00	$906.81	"$1,436.39"	"$1,450.90"	$0.00		$0.00	$283.83	$0.00	$0.00	$288.73	$0.00	$0.00	$0.00	$0.00	$0.00
436228	SUP	HCPCS C1713		436228  -  PLATE 8 HOLE BONE RIGHT DISTAL MDL TIB	BOTH IP/OP	"$1,813.63 "	"$1,342.09"	$0.00	"$1,450.90"	$816.13	$816.13	$0.00	$0.00	$0.00	$378.00	"$1,346.07"	"$1,346.07"	$0.00	$0.00	$377.96	$0.00	"$1,072.76"	"$1,072.76"	$0.00	$906.81	"$1,436.39"	"$1,450.90"	$0.00		$0.00	$283.83	$0.00	$0.00	$288.73	$0.00	$0.00	$0.00	$0.00	$0.00
436230	SUP	HCPCS C1713		436230  -  PLATE 172MM SS 10 HOLE BONE RIGHT DISTAL MDL TIB	BOTH IP/OP	"$1,813.63 "	"$1,342.09"	$0.00	"$1,450.90"	$816.13	$816.13	$0.00	$0.00	$0.00	$378.00	"$1,346.07"	"$1,346.07"	$0.00	$0.00	$377.96	$0.00	"$1,072.76"	"$1,072.76"	$0.00	$906.81	"$1,436.39"	"$1,450.90"	$0.00		$0.00	$283.83	$0.00	$0.00	$288.73	$0.00	$0.00	$0.00	$0.00	$0.00
436232	SUP	HCPCS C1713		436232  -  PLATE 198MM SS 12 SHFT HOLE LCK BONE 4MM 3.5MM DISTAL MDL	BOTH IP/OP	"$2,143.63 "	"$1,586.29"	$0.00	"$1,714.90"	$964.63	$964.63	$0.00	$0.00	$0.00	$446.79	"$1,591.00"	"$1,591.00"	$0.00	$0.00	$446.73	$0.00	"$1,267.95"	"$1,267.95"	$0.00	"$1,071.81"	"$1,697.75"	"$1,714.90"	$0.00		$0.00	$335.48	$0.00	$0.00	$341.27	$0.00	$0.00	$0.00	$0.00	$0.00
436234	SUP	HCPCS C1713		436234  -  PLATE 224MM SS 14 HL SHFT LCK IMPL AXSOS BONE RIGHT DISTAL	BOTH IP/OP	"$2,143.63 "	"$1,586.29"	$0.00	"$1,714.90"	$964.63	$964.63	$0.00	$0.00	$0.00	$446.79	"$1,591.00"	"$1,591.00"	$0.00	$0.00	$446.73	$0.00	"$1,267.95"	"$1,267.95"	$0.00	"$1,071.81"	"$1,697.75"	"$1,714.90"	$0.00		$0.00	$335.48	$0.00	$0.00	$341.27	$0.00	$0.00	$0.00	$0.00	$0.00
436236	SUP	HCPCS C1713		436236  -  PLATE 250MM SS 16 HL SHFT LCK IMPL AXSOS BONE RIGHT DISTAL	BOTH IP/OP	"$2,143.63 "	"$1,586.29"	$0.00	"$1,714.90"	$964.63	$964.63	$0.00	$0.00	$0.00	$446.79	"$1,591.00"	"$1,591.00"	$0.00	$0.00	$446.73	$0.00	"$1,267.95"	"$1,267.95"	$0.00	"$1,071.81"	"$1,697.75"	"$1,714.90"	$0.00		$0.00	$335.48	$0.00	$0.00	$341.27	$0.00	$0.00	$0.00	$0.00	$0.00
436302	SUP	HCPCS C1713		436302  -  PLATE 2 HOLE BONE LEFT PROX LAT TIB	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436304	SUP	HCPCS C1713		436304  -  PLATE 4 HOLE BONE LEFT PROX LAT TIB	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436306	SUP	HCPCS C1713		436306  -  PLATE 6 HOLE BONE LEFT PROX LAT TIB	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436308	SUP	HCPCS C1713		436308  -  PLATE 8 HOLE BONE LEFT PROX LAT TIB	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436310	SUP	HCPCS C1713		436310  -  PLATE 10 HOLE BONE LEFT PROX LAT TIB	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436312	SUP	HCPCS C1713		436312  -  PLATE 12 HOLE BONE LEFT PROX LAT TIB	BOTH IP/OP	"$1,874.13 "	"$1,386.86"	$0.00	"$1,499.30"	$843.36	$843.36	$0.00	$0.00	$0.00	$390.61	"$1,390.98"	"$1,390.98"	$0.00	$0.00	$390.57	$0.00	"$1,108.54"	"$1,108.54"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
436314	SUP	HCPCS C1713		436314  -  PLATE 14 HOLE BONE LEFT PROX LAT TIB	BOTH IP/OP	"$2,061.13 "	"$1,525.24"	$0.00	"$1,648.90"	$927.51	$927.51	$0.00	$0.00	$0.00	$429.59	"$1,529.77"	"$1,529.77"	$0.00	$0.00	$429.54	$0.00	"$1,219.16"	"$1,219.16"	$0.00	"$1,030.56"	"$1,632.41"	"$1,648.90"	$0.00		$0.00	$322.57	$0.00	$0.00	$328.13	$0.00	$0.00	$0.00	$0.00	$0.00
436322	SUP	HCPCS C1713		436322  -  PLATE 2 HOLE BONE RIGHT PROX LAT TIB	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436324	SUP	HCPCS C1713		436324  -  PLATE 4 HOLE BONE RIGHT PROX LAT TIB	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436326	SUP	HCPCS C1713		436326  -  PLATE 6 HOLE BONE RIGHT PROX LAT TIB	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436328	SUP	HCPCS C1713		436328  -  PLATE 8 HOLE BONE RIGHT PROX LAT TIB	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436330	SUP	HCPCS C1713		436330  -  PLATE 10 HOLE BONE RIGHT PROX LAT TIB	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436332	SUP	HCPCS C1713		436332  -  PLATE 12 HOLE BONE RIGHT PROX LAT TIB	BOTH IP/OP	"$2,061.13 "	"$1,525.24"	$0.00	"$1,648.90"	$927.51	$927.51	$0.00	$0.00	$0.00	$429.59	"$1,529.77"	"$1,529.77"	$0.00	$0.00	$429.54	$0.00	"$1,219.16"	"$1,219.16"	$0.00	"$1,030.56"	"$1,632.41"	"$1,648.90"	$0.00		$0.00	$322.57	$0.00	$0.00	$328.13	$0.00	$0.00	$0.00	$0.00	$0.00
436334	SUP	HCPCS C1713		436334  -  PLATE 14 HOLE BONE RIGHT PROX LAT TIB	BOTH IP/OP	"$1,874.13 "	"$1,386.86"	$0.00	"$1,499.30"	$843.36	$843.36	$0.00	$0.00	$0.00	$390.61	"$1,390.98"	"$1,390.98"	$0.00	$0.00	$390.57	$0.00	"$1,108.54"	"$1,108.54"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
436342	SUP	HCPCS C1713		436342  -  PLATE 95MM SS 3.5MM 4MM STD SCR 2 SHFT HOLE 5 LCK HOLE BONE	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436344	SUP	HCPCS C1713		436344  -  PLATE 121MM 4MM SCR 4 HOLE LCK AXSOS BONE LEFT PROX LAT	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436346	SUP	HCPCS C1713		436346  -  PLATE 147MM 6 HL SHFT LCK BONE LEFT PROX LAT TIB	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436348	SUP	HCPCS C1713		436348  -  PLATE 173MM SS 3.5MM 4MM STD SCR 8 SHFT HOLE 5 LCK HOLE BONE	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436350	SUP	HCPCS C1713		436350  -  PLATE 199MM 4MM SCR 10X5 HOLE LCK AXSOS BONE LEFT PROX LAT	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436352	SUP	HCPCS C1713		436352  -  PLATE 225MM 4MM SCR 12X5 HOLE LCK AXSOS BONE LEFT PROX LAT	BOTH IP/OP	"$2,061.13 "	"$1,525.24"	$0.00	"$1,648.90"	$927.51	$927.51	$0.00	$0.00	$0.00	$429.59	"$1,529.77"	"$1,529.77"	$0.00	$0.00	$429.54	$0.00	"$1,219.16"	"$1,219.16"	$0.00	"$1,030.56"	"$1,632.41"	"$1,648.90"	$0.00		$0.00	$322.57	$0.00	$0.00	$328.13	$0.00	$0.00	$0.00	$0.00	$0.00
436354	SUP	HCPCS C1713		436354  -  PLATE 251MM 15 HOLE LCK BONE 4MM RIGHT PROX LAT PERIART TIB	BOTH IP/OP	"$1,874.13 "	"$1,386.86"	$0.00	"$1,499.30"	$843.36	$843.36	$0.00	$0.00	$0.00	$390.61	"$1,390.98"	"$1,390.98"	$0.00	$0.00	$390.57	$0.00	"$1,108.54"	"$1,108.54"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
436362	SUP	HCPCS C1713		436362  -  PLATE 2 HOLE BONE RIGHT PROX TIB	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436364	SUP	HCPCS C1713		436364  -  PLATE 121MM 4MM SCR 4X5 HOLE LCK AXSOS BONE RIGHT PROX LAT	BOTH IP/OP	"$1,574.38 "	"$1,165.04"	$0.00	"$1,259.50"	$708.47	$708.47	$0.00	$0.00	$0.00	$328.14	"$1,168.50"	"$1,168.50"	$0.00	$0.00	$328.10	$0.00	$931.24	$931.24	$0.00	$787.19	"$1,246.91"	"$1,259.50"	$0.00		$0.00	$246.39	$0.00	$0.00	$250.64	$0.00	$0.00	$0.00	$0.00	$0.00
436366	SUP	HCPCS C1713		436366  -  PLATE 147MM 4MM SCR 6X5 HOLE LCK AXSOS BONE RIGHT PROX LAT	BOTH IP/OP	"$1,731.13 "	"$1,281.04"	$0.00	"$1,384.90"	$779.01	$779.01	$0.00	$0.00	$0.00	$360.81	"$1,284.84"	"$1,284.84"	$0.00	$0.00	$360.77	$0.00	"$1,023.96"	"$1,023.96"	$0.00	$865.56	"$1,371.05"	"$1,384.90"	$0.00		$0.00	$270.92	$0.00	$0.00	$275.60	$0.00	$0.00	$0.00	$0.00	$0.00
436368	SUP	HCPCS C1713		436368  -  PLATE 173MM 4MM SCR 8X5 HOLE LCK AXSOS BONE RIGHT PROX LAT	BOTH IP/OP	"$1,574.38 "	"$1,165.04"	$0.00	"$1,259.50"	$708.47	$708.47	$0.00	$0.00	$0.00	$328.14	"$1,168.50"	"$1,168.50"	$0.00	$0.00	$328.10	$0.00	$931.24	$931.24	$0.00	$787.19	"$1,246.91"	"$1,259.50"	$0.00		$0.00	$246.39	$0.00	$0.00	$250.64	$0.00	$0.00	$0.00	$0.00	$0.00
436370	SUP	HCPCS C1713		436370  -  PLATE 199MM 4MM SCR 10X5 HOLE LCK AXSOS BONE RIGHT PROX LAT	BOTH IP/OP	"$1,574.38 "	"$1,165.04"	$0.00	"$1,259.50"	$708.47	$708.47	$0.00	$0.00	$0.00	$328.14	"$1,168.50"	"$1,168.50"	$0.00	$0.00	$328.10	$0.00	$931.24	$931.24	$0.00	$787.19	"$1,246.91"	"$1,259.50"	$0.00		$0.00	$246.39	$0.00	$0.00	$250.64	$0.00	$0.00	$0.00	$0.00	$0.00
436372	SUP	HCPCS C1713		436372  -  PLATE 225MM 4MM SCR 12X5 HOLE LCK AXSOS BONE RIGHT PROX LAT	BOTH IP/OP	"$1,874.13 "	"$1,386.86"	$0.00	"$1,499.30"	$843.36	$843.36	$0.00	$0.00	$0.00	$390.61	"$1,390.98"	"$1,390.98"	$0.00	$0.00	$390.57	$0.00	"$1,108.54"	"$1,108.54"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
436374	SUP	HCPCS C1713		436374  -  PLATE 251MM 14 HL SHFT LCK BONE RIGHT PROX LAT MTPHSL TIB	BOTH IP/OP	"$1,874.13 "	"$1,386.86"	$0.00	"$1,499.30"	$843.36	$843.36	$0.00	$0.00	$0.00	$390.61	"$1,390.98"	"$1,390.98"	$0.00	$0.00	$390.57	$0.00	"$1,108.54"	"$1,108.54"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
436404	SUP	HCPCS C1713		436404  -  PLATE 4 HOLE BONE LEFT DISTAL ANT LAT TIB	BOTH IP/OP	"$2,308.63 "	"$1,708.39"	$0.00	"$1,846.90"	"$1,038.88"	"$1,038.88"	$0.00	$0.00	$0.00	$481.18	"$1,713.46"	"$1,713.46"	$0.00	$0.00	$481.12	$0.00	"$1,365.55"	"$1,365.55"	$0.00	"$1,154.31"	"$1,828.43"	"$1,846.90"	$0.00		$0.00	$361.30	$0.00	$0.00	$367.53	$0.00	$0.00	$0.00	$0.00	$0.00
436406	SUP	HCPCS C1713		436406  -  PLATE 123MM SS 6 HL SHFT LCK IMPL AXSOS BONE LEFT DISTAL	BOTH IP/OP	"$2,308.63 "	"$1,708.39"	$0.00	"$1,846.90"	"$1,038.88"	"$1,038.88"	$0.00	$0.00	$0.00	$481.18	"$1,713.46"	"$1,713.46"	$0.00	$0.00	$481.12	$0.00	"$1,365.55"	"$1,365.55"	$0.00	"$1,154.31"	"$1,828.43"	"$1,846.90"	$0.00		$0.00	$361.30	$0.00	$0.00	$367.53	$0.00	$0.00	$0.00	$0.00	$0.00
436408	SUP	HCPCS C1713		436408  -  PLATE 149MM SS 8 HL SHFT LCK IMPL AXSOS BONE LEFT DISTAL	BOTH IP/OP	"$2,308.63 "	"$1,708.39"	$0.00	"$1,846.90"	"$1,038.88"	"$1,038.88"	$0.00	$0.00	$0.00	$481.18	"$1,713.46"	"$1,713.46"	$0.00	$0.00	$481.12	$0.00	"$1,365.55"	"$1,365.55"	$0.00	"$1,154.31"	"$1,828.43"	"$1,846.90"	$0.00		$0.00	$361.30	$0.00	$0.00	$367.53	$0.00	$0.00	$0.00	$0.00	$0.00
436410	SUP	HCPCS C1713		436410  -  PLATE 10 HOLE BONE LEFT DISTAL ANTLAT TIB	BOTH IP/OP	"$2,308.63 "	"$1,708.39"	$0.00	"$1,846.90"	"$1,038.88"	"$1,038.88"	$0.00	$0.00	$0.00	$481.18	"$1,713.46"	"$1,713.46"	$0.00	$0.00	$481.12	$0.00	"$1,365.55"	"$1,365.55"	$0.00	"$1,154.31"	"$1,828.43"	"$1,846.90"	$0.00		$0.00	$361.30	$0.00	$0.00	$367.53	$0.00	$0.00	$0.00	$0.00	$0.00
436412	SUP	HCPCS C1713		436412  -  PLATE 12 HOLE BONE LEFT DISTAL ANTLAT TIB	BOTH IP/OP	"$2,638.63 "	"$1,952.59"	$0.00	"$2,110.90"	"$1,187.38"	"$1,187.38"	$0.00	$0.00	$0.00	$549.96	"$1,958.39"	"$1,958.39"	$0.00	$0.00	$549.89	$0.00	"$1,300.84"	"$1,300.84"	$0.00	"$1,319.31"	"$2,089.79"	"$2,110.90"	$0.00		$0.00	$412.94	$0.00	$0.00	$420.07	$0.00	$0.00	$0.00	$0.00	$0.00
436414	SUP	HCPCS C1713		436414  -  PLATE 14 HOLE BONE LEFT DISTAL ANT LAT TIB	BOTH IP/OP	"$2,638.63 "	"$1,952.59"	$0.00	"$2,110.90"	"$1,187.38"	"$1,187.38"	$0.00	$0.00	$0.00	$549.96	"$1,958.39"	"$1,958.39"	$0.00	$0.00	$549.89	$0.00	"$1,300.84"	"$1,300.84"	$0.00	"$1,319.31"	"$2,089.79"	"$2,110.90"	$0.00		$0.00	$412.94	$0.00	$0.00	$420.07	$0.00	$0.00	$0.00	$0.00	$0.00
436416	SUP	HCPCS C1713		436416  -  PLATE 16 HOLE BONE LEFT DISTAL ANTLAT TIB	BOTH IP/OP	"$2,638.63 "	"$1,952.59"	$0.00	"$2,110.90"	"$1,187.38"	"$1,187.38"	$0.00	$0.00	$0.00	$549.96	"$1,958.39"	"$1,958.39"	$0.00	$0.00	$549.89	$0.00	"$1,300.84"	"$1,300.84"	$0.00	"$1,319.31"	"$2,089.79"	"$2,110.90"	$0.00		$0.00	$412.94	$0.00	$0.00	$420.07	$0.00	$0.00	$0.00	$0.00	$0.00
436424	SUP	HCPCS C1713		436424  -  PLATE 4 HOLE BONE RIGHT DISTAL ANT LAT TIB	BOTH IP/OP	"$2,308.63 "	"$1,708.39"	$0.00	"$1,846.90"	"$1,038.88"	"$1,038.88"	$0.00	$0.00	$0.00	$481.18	"$1,713.46"	"$1,713.46"	$0.00	$0.00	$481.12	$0.00	"$1,365.55"	"$1,365.55"	$0.00	"$1,154.31"	"$1,828.43"	"$1,846.90"	$0.00		$0.00	$361.30	$0.00	$0.00	$367.53	$0.00	$0.00	$0.00	$0.00	$0.00
436426	SUP	HCPCS C1713		436426  -  PLATE 123MM SS 6 HL SHFT LCK IMPL AXSOS BONE RIGHT DISTAL	BOTH IP/OP	"$2,308.63 "	"$1,708.39"	$0.00	"$1,846.90"	"$1,038.88"	"$1,038.88"	$0.00	$0.00	$0.00	$481.18	"$1,713.46"	"$1,713.46"	$0.00	$0.00	$481.12	$0.00	"$1,365.55"	"$1,365.55"	$0.00	"$1,154.31"	"$1,828.43"	"$1,846.90"	$0.00		$0.00	$361.30	$0.00	$0.00	$367.53	$0.00	$0.00	$0.00	$0.00	$0.00
436428	SUP	HCPCS C1713		436428  -  PLATE 149MM SS 8 HL SHFT LCK IMPL AXSOS BONE RIGHT DISTAL	BOTH IP/OP	"$2,308.63 "	"$1,708.39"	$0.00	"$1,846.90"	"$1,038.88"	"$1,038.88"	$0.00	$0.00	$0.00	$481.18	"$1,713.46"	"$1,713.46"	$0.00	$0.00	$481.12	$0.00	"$1,365.55"	"$1,365.55"	$0.00	"$1,154.31"	"$1,828.43"	"$1,846.90"	$0.00		$0.00	$361.30	$0.00	$0.00	$367.53	$0.00	$0.00	$0.00	$0.00	$0.00
436430	SUP	HCPCS C1713		436430  -  PLATE 4 HOLE BONE RIGHT DISTAL ANT LAT TIB	BOTH IP/OP	"$2,308.63 "	"$1,708.39"	$0.00	"$1,846.90"	"$1,038.88"	"$1,038.88"	$0.00	$0.00	$0.00	$481.18	"$1,713.46"	"$1,713.46"	$0.00	$0.00	$481.12	$0.00	"$1,365.55"	"$1,365.55"	$0.00	"$1,154.31"	"$1,828.43"	"$1,846.90"	$0.00		$0.00	$361.30	$0.00	$0.00	$367.53	$0.00	$0.00	$0.00	$0.00	$0.00
436432	SUP	HCPCS C1713		436432  -  PLATE 12 HOLE BONE RIGHT DISTAL ANT LAT TIB	BOTH IP/OP	"$2,638.63 "	"$1,952.59"	$0.00	"$2,110.90"	"$1,187.38"	"$1,187.38"	$0.00	$0.00	$0.00	$549.96	"$1,958.39"	"$1,958.39"	$0.00	$0.00	$549.89	$0.00	"$1,300.84"	"$1,300.84"	$0.00	"$1,319.31"	"$2,089.79"	"$2,110.90"	$0.00		$0.00	$412.94	$0.00	$0.00	$420.07	$0.00	$0.00	$0.00	$0.00	$0.00
436434	SUP	HCPCS C1713		436434  -  PLATE 14 HOLE BONE RIGHT DISTAL ANT LAT TIB	BOTH IP/OP	"$2,638.63 "	"$1,952.59"	$0.00	"$2,110.90"	"$1,187.38"	"$1,187.38"	$0.00	$0.00	$0.00	$549.96	"$1,958.39"	"$1,958.39"	$0.00	$0.00	$549.89	$0.00	"$1,300.84"	"$1,300.84"	$0.00	"$1,319.31"	"$2,089.79"	"$2,110.90"	$0.00		$0.00	$412.94	$0.00	$0.00	$420.07	$0.00	$0.00	$0.00	$0.00	$0.00
436436	SUP	HCPCS C1713		436436  -  PLATE 16 HOLE BONE RIGHT DISTAL ANT LAT TIB	BOTH IP/OP	"$2,638.63 "	"$1,952.59"	$0.00	"$2,110.90"	"$1,187.38"	"$1,187.38"	$0.00	$0.00	$0.00	$549.96	"$1,958.39"	"$1,958.39"	$0.00	$0.00	$549.89	$0.00	"$1,300.84"	"$1,300.84"	$0.00	"$1,319.31"	"$2,089.79"	"$2,110.90"	$0.00		$0.00	$412.94	$0.00	$0.00	$420.07	$0.00	$0.00	$0.00	$0.00	$0.00
436504	SUP	HCPCS C1713		436504  -  PLATE 130MM SS 5MM SCR 4 HOLE LCK AXSOS BONE LEFT DISTAL LAT	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436506	SUP	HCPCS C1713		436506  -  PLATE 6 HOLE BONE LEFT DISTAL LAT FEM	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436508	SUP	HCPCS C1713		436508  -  PLATE 202MM SS 8 HL SHFT LCK IMPL AXSOS BONE LEFT DISTAL LAT	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436510	SUP	HCPCS C1713		436510  -  PLATE 238MM SS 5MM SCR 10 HOLE LCK AXSOS BONE LEFT DISTAL	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436512	SUP	HCPCS C1713		436512  -  PLATE 274MM SS 12 HL SHFT LCK AXSOS BONE LEFT DISTAL LAT FEM	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436514	SUP	HCPCS C1713		436514  -  PLATE 310MM SS 14 HL SHFT LCK IMPL AXSOS BONE LEFT DISTAL	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436516	SUP	HCPCS C1713		436516  -  PLATE 343MM SS 16 HL SHFT LCK AXSOS BONE LEFT DISTAL LAT FEM	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436524	SUP	HCPCS C1713		436524  -  PLATE 130MM SS 5MM/4.5MM/6.5MM SCR 4X5 HOLE LCK AXSOS BONE	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436526	SUP	HCPCS C1713		436526  -  PLATE 166MM SS 5MM/4.5MM/6.5MM SCR 6X5 HOLE LCK AXSOS BONE	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436528	SUP	HCPCS C1713		436528  -  PLATE 8 HOLE BONE RIGHT DISTAL LAT FEM	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436530	SUP	HCPCS C1713		436530  -  PLATE SS 10 SHFT HOLE 5 LCK HOLE BONE	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436532	SUP	HCPCS C1713		436532  -  PLATE 274MM SS 12X5 HOLE LCK AXSOS BONE RIGHT DISTAL LAT FEM	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436534	SUP	HCPCS C1713		436534  -  PLATE 14 HOLE BONE RIGHT DISTAL LAT FEM	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
436536	SUP	HCPCS C1713		436536  -  PLATE 343MM SS 16X5 HOLE LCK AXSOS BONE RIGHT DISTAL LAT FEM	BOTH IP/OP	"$1,930.50 "	"$1,428.57"	$0.00	"$1,544.40"	$868.73	$868.73	$0.00	$0.00	$0.00	$402.36	"$1,432.82"	"$1,432.82"	$0.00	$0.00	$402.32	$0.00	"$1,141.89"	"$1,141.89"	$0.00	$965.25	"$1,528.96"	"$1,544.40"	$0.00		$0.00	$302.12	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00
437103	SUP	HCPCS C1713		437103  -  PLATE BN 86MM NS AXSOS 3X7X 1 HL LCK SS HUM LT PROX 3.5/4MM	BOTH IP/OP	"$2,319.20 "	"$1,716.21"	$0.00	"$1,721.31"	$965.25	$965.25	$0.00	$0.00	$0.00	$483.38	"$1,721.31"	"$1,721.31"	$0.00	$0.00	$483.32	$0.00	"$1,371.81"	"$1,371.81"	$0.00	"$1,072.50"	"$1,698.84"	"$1,716.00"	$0.00		$0.00	$335.69	$0.00	$0.00	$341.48	$0.00	$0.00	$0.00	$0.00	$0.00
437105	SUP	HCPCS C1713		437105  -  PLATE BN 112MM NS AXSOS 5X7X 2 HL LCK SS HUM LT PROX 3.5/4MM	BOTH IP/OP	"$2,319.20 "	"$1,716.21"	$0.00	"$1,721.31"	$965.25	$965.25	$0.00	$0.00	$0.00	$483.38	"$1,721.31"	"$1,721.31"	$0.00	$0.00	$483.32	$0.00	"$1,371.81"	"$1,371.81"	$0.00	"$1,072.50"	"$1,698.84"	"$1,716.00"	$0.00		$0.00	$335.69	$0.00	$0.00	$341.48	$0.00	$0.00	$0.00	$0.00	$0.00
437108	SUP	HCPCS C1713		437108  -  PLATE 150MM 4MM SCR 8 SHFT HOLE LCK THRD BONE LEFT PROX	BOTH IP/OP	"$2,319.20 "	"$1,716.21"	$0.00	"$1,721.31"	$965.25	$965.25	$0.00	$0.00	$0.00	$483.38	"$1,721.31"	"$1,721.31"	$0.00	$0.00	$483.32	$0.00	"$1,371.81"	"$1,371.81"	$0.00	"$1,072.50"	"$1,698.84"	"$1,716.00"	$0.00		$0.00	$335.69	$0.00	$0.00	$341.48	$0.00	$0.00	$0.00	$0.00	$0.00
437123	SUP	HCPCS C1713		437123  -  PLATE BN 86MM NS AXSOS 3X7X 1 HL LCK SS HUM RT PROX 3.5/4MM	BOTH IP/OP	"$2,319.20 "	"$1,716.21"	$0.00	"$1,721.31"	$965.25	$965.25	$0.00	$0.00	$0.00	$483.38	"$1,721.31"	"$1,721.31"	$0.00	$0.00	$483.32	$0.00	"$1,371.81"	"$1,371.81"	$0.00	"$1,072.50"	"$1,698.84"	"$1,716.00"	$0.00		$0.00	$335.69	$0.00	$0.00	$341.48	$0.00	$0.00	$0.00	$0.00	$0.00
437125	SUP	HCPCS C1713		437125  -  PLATE BN 112MM NS AXSOS 5X7X 2 HL LCK SS HUM RT PROX 3.5/4MM	BOTH IP/OP	"$2,319.20 "	"$1,716.21"	$0.00	"$1,721.31"	$965.25	$965.25	$0.00	$0.00	$0.00	$483.38	"$1,721.31"	"$1,721.31"	$0.00	$0.00	$483.32	$0.00	"$1,371.81"	"$1,371.81"	$0.00	"$1,072.50"	"$1,698.84"	"$1,716.00"	$0.00		$0.00	$335.69	$0.00	$0.00	$341.48	$0.00	$0.00	$0.00	$0.00	$0.00
437128	SUP	HCPCS C1713		437128  -  PLATE BN 150MM NS AXSOS 8X7X 4 HL LCK SS HUM RT PROX 3.5/4MM	BOTH IP/OP	"$2,319.20 "	"$1,716.21"	$0.00	"$1,721.31"	$965.25	$965.25	$0.00	$0.00	$0.00	$483.38	"$1,721.31"	"$1,721.31"	$0.00	$0.00	$483.32	$0.00	"$1,371.81"	"$1,371.81"	$0.00	"$1,072.50"	"$1,698.84"	"$1,716.00"	$0.00		$0.00	$335.69	$0.00	$0.00	$341.48	$0.00	$0.00	$0.00	$0.00	$0.00
437204	SUP	HCPCS C1713		437204  -  PLATE BN 94MM NS AXSOS 4X4X 2 HL LCK SS TIB LT DIST MDL	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437206	SUP	HCPCS C1713		437206  -  PLATE BN 120MM NS AXSOS 6X4X 3 HL LCK SS TIB LT DIST MDL	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437208	SUP	HCPCS C1713		437208  -  PLATE BN 146MM NS AXSOS 8X4X 4 HL LCK SS TIB LT DIST MDL	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437210	SUP	HCPCS C1713		437210  -  PLATE 172MM 10X4X 5 HOLE LCK THRD SHFT HOLE SYS AXSOS BONE	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437212	SUP	HCPCS C1713		437212  -  PLATE 198MM 4MM SCR 12 SHFT HOLE LCK THRD BONE LEFT DISTAL	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437214	SUP	HCPCS C1713		437214  -  PLATE BN 224MM NS AXSOS 14X4X 7 HL LCK SS TIB LT DIST MDL	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437216	SUP	HCPCS C1713		437216  -  PLATE 16 HL SHFT BONE DISTAL MDL TIB	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437224	SUP	HCPCS C1713		437224  -  PLATE BN 94MM NS AXSOS 4X4X 2 HL LCK SS TIB RT DIST MDL	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437226	SUP	HCPCS C1713		437226  -  PLATE BN 120MM NS AXSOS 6X4X 3 HL LCK SS TIB RT DIST MDL	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437228	SUP	HCPCS C1713		437228  -  PLATE BN 146MM NS AXSOS 8X4X 4 HL SS TIB RT DIST MDL 4/3.5MM	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437230	SUP	HCPCS C1713		437230  -  PLATE BN 172MM NS AXSOS 10X4X 5 HL LCK SS TIB RT DIST MDL	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437232	SUP	HCPCS C1713		437232  -  PLATE BN 198MM NS AXSOS 12X4X 6 HL LCK SS TIB RT DIST MDL	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437234	SUP	HCPCS C1713		437234  -  PLATE SS 14 HOLE TOT STAB AXSOS BONE DISTAL MDL TIB	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437236	SUP	HCPCS C1713		437236  -  PLATE 250MM BONE RIGHT DISTAL MDL TIB	BOTH IP/OP	"$2,049.60 "	"$1,516.70"	$0.00	"$1,651.10"	$928.74	$928.74	$0.00	$0.00	$0.00	$427.19	"$1,521.21"	"$1,521.21"	$0.00	$0.00	$427.14	$0.00	"$1,212.34"	"$1,212.34"	$0.00	"$1,031.94"	"$1,634.59"	"$1,651.10"	$0.00		$0.00	$323.00	$0.00	$0.00	$328.57	$0.00	$0.00	$0.00	$0.00	$0.00
437302	SUP	HCPCS C1713		437302  -  PLATE BN 95MM NS AXSOS 2X5X 1 HL SS TIB LT PROX LAT 3.5/4MM	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437304	SUP	HCPCS C1713		437304  -  PLATE BN 121MM NS AXSOS 4X5X 2 HL SS TIB LT PROX LAT 3.5/4MM	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437306	SUP	HCPCS C1713		437306  -  PLATE BN 147MM NS AXSOS 6X5X 3 HL SS TIB LT PROX LAT 3.5/4MM	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437308	SUP	HCPCS C1713		437308  -  PLATE BN 173MM NS AXSOS 8X5X 4 HL SS TIB LT PROX LAT 3.5/4MM	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437310	SUP	HCPCS C1713		437310  -  PLATE BN 199MM NS AXSOS 10X5X 5 HL SS TIB LT PROX LAT 3.5/4	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437312	SUP	HCPCS C1713		437312  -  PLATE BN 225MM NS AXSOS 12X5X 6 HL SS TIB LT PROX LAT 3.5/4	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437314	SUP	HCPCS C1713		437314  -  PLATE 251MM 4MM SCR 14 SHFT HOLE LCK THRD BONE LEFT PROX LAT	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437322	SUP	HCPCS C1713		437322  -  PLATE BN 95MM NS AXSOS 2X5X 1 HL SS TIB RT PROX LAT 3.5/4MM	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437324	SUP	HCPCS C1713		437324  -  PLATE BN 121MM NS AXSOS 4X5X 2 HL SS TIB RT PROX LAT 3.5/4MM	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437326	SUP	HCPCS C1713		437326  -  PLATE BN 147MM NS AXSOS 6X5X 3 HL SS TIB RT PROX LAT 3.5/4MM	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437328	SUP	HCPCS C1713		437328  -  PLATE BN 173MM NS AXSOS 8X5X 4 HL SS TIB RT PROX LAT 3.5/4MM	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437330	SUP	HCPCS C1713		437330  -  PLATE BN 199MM NS AXSOS 10X5X 5 HL SS TIB RT PROX LAT 3.5/4	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437332	SUP	HCPCS C1713		437332  -  PLATE BN 225MM NS AXSOS 12X5X 6 HL SS TIB RT PROX LAT 3.5/4	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437334	SUP	HCPCS C1713		437334  -  PLATE 251MM 4MM SCR 14 SHFT HOLE LCK THRD BONE RIGHT PROX	BOTH IP/OP	"$2,025.60 "	"$1,498.94"	$0.00	"$1,503.40"	$843.36	$843.36	$0.00	$0.00	$0.00	$422.19	"$1,503.40"	"$1,503.40"	$0.00	$0.00	$422.14	$0.00	"$1,198.14"	"$1,198.14"	$0.00	$937.06	"$1,484.31"	"$1,499.30"	$0.00		$0.00	$293.30	$0.00	$0.00	$298.36	$0.00	$0.00	$0.00	$0.00	$0.00
437404	SUP	HCPCS C1713		437404  -  PLATE BN 95MM NS AXSOS 4X3X 2 HL SS TIB LT DIST ALAT 3.5/4MM	BOTH IP/OP	"$2,126.40 "	"$1,573.54"	$0.00	"$1,648.90"	$927.51	$927.51	$0.00	$0.00	$0.00	$443.19	"$1,578.21"	"$1,578.21"	$0.00	$0.00	$443.14	$0.00	"$1,257.77"	"$1,257.77"	$0.00	"$1,030.56"	"$1,632.41"	"$1,648.90"	$0.00		$0.00	$322.57	$0.00	$0.00	$328.13	$0.00	$0.00	$0.00	$0.00	$0.00
437406	SUP	HCPCS C1713		437406  -  PLATE BN 123MM NS AXSOS 6X3X 3 HL SS TIB LT DIST ALAT 3.5/4	BOTH IP/OP	"$2,126.40 "	"$1,573.54"	$0.00	"$1,648.90"	$927.51	$927.51	$0.00	$0.00	$0.00	$443.19	"$1,578.21"	"$1,578.21"	$0.00	$0.00	$443.14	$0.00	"$1,257.77"	"$1,257.77"	$0.00	"$1,030.56"	"$1,632.41"	"$1,648.90"	$0.00		$0.00	$322.57	$0.00	$0.00	$328.13	$0.00	$0.00	$0.00	$0.00	$0.00
437408	SUP	HCPCS C1713		437408  -  PLATE BN 149MM NS AXSOS 8X3X 4 HL SS TIB LT DIST ALAT 3.5/4	BOTH IP/OP	"$2,126.40 "	"$1,573.54"	$0.00	"$1,648.90"	$927.51	$927.51	$0.00	$0.00	$0.00	$443.19	"$1,578.21"	"$1,578.21"	$0.00	$0.00	$443.14	$0.00	"$1,257.77"	"$1,257.77"	$0.00	"$1,030.56"	"$1,632.41"	"$1,648.90"	$0.00		$0.00	$322.57	$0.00	$0.00	$328.13	$0.00	$0.00	$0.00	$0.00	$0.00
437410	SUP	HCPCS C1713		437410  -  PLATE BN 175MM NS AXSOS 10X3X 5 HL SS TIB LT DIST ALAT 3.5/4	BOTH IP/OP	"$2,126.40 "	"$1,573.54"	$0.00	"$1,648.90"	$927.51	$927.51	$0.00	$0.00	$0.00	$443.19	"$1,578.21"	"$1,578.21"	$0.00	$0.00	$443.14	$0.00	"$1,257.77"	"$1,257.77"	$0.00	"$1,030.56"	"$1,632.41"	"$1,648.90"	$0.00		$0.00	$322.57	$0.00	$0.00	$328.13	$0.00	$0.00	$0.00	$0.00	$0.00
437412	SUP	HCPCS C1713		437412  -  PLATE 12 HL SHFT BONE DISTAL ANTLAT TIB	BOTH IP/OP	"$2,232.00 "	"$1,651.68"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$465.20	"$1,656.59"	"$1,656.59"	$0.00	$0.00	$465.15	$0.00	"$1,320.23"	"$1,320.23"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437414	SUP	HCPCS C1713		437414  -  PLATE 14 HL SHFT BONE DISTAL ANTLAT TIB	BOTH IP/OP	"$2,232.00 "	"$1,651.68"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$465.20	"$1,656.59"	"$1,656.59"	$0.00	$0.00	$465.15	$0.00	"$1,320.23"	"$1,320.23"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437416	SUP	HCPCS C1713		437416  -  PLATE 16 HL SHFT BONE DISTAL ANTLAT TIB	BOTH IP/OP	"$2,232.00 "	"$1,651.68"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$465.20	"$1,656.59"	"$1,656.59"	$0.00	$0.00	$465.15	$0.00	"$1,320.23"	"$1,320.23"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437424	SUP	HCPCS C1713		437424  -  PLATE BN 95MM NS AXSOS 4X3X 2 HL SS TIB RT DIST ALAT 3.5/4MM	BOTH IP/OP	"$2,126.40 "	"$1,573.54"	$0.00	"$1,648.90"	$927.51	$927.51	$0.00	$0.00	$0.00	$443.19	"$1,578.21"	"$1,578.21"	$0.00	$0.00	$443.14	$0.00	"$1,257.77"	"$1,257.77"	$0.00	"$1,030.56"	"$1,632.41"	"$1,648.90"	$0.00		$0.00	$322.57	$0.00	$0.00	$328.13	$0.00	$0.00	$0.00	$0.00	$0.00
437426	SUP	HCPCS C1713		437426  -  PLATE 123MM SS RFLX BONE RIGHT ANTLAT TIB	BOTH IP/OP	"$2,126.40 "	"$1,573.54"	$0.00	"$1,648.90"	$927.51	$927.51	$0.00	$0.00	$0.00	$443.19	"$1,578.21"	"$1,578.21"	$0.00	$0.00	$443.14	$0.00	"$1,257.77"	"$1,257.77"	$0.00	"$1,030.56"	"$1,632.41"	"$1,648.90"	$0.00		$0.00	$322.57	$0.00	$0.00	$328.13	$0.00	$0.00	$0.00	$0.00	$0.00
437428	SUP	HCPCS C1713		437428  -  PLATE BN 149MM NS AXSOS 8X3X 4 HL SS TIB RT DIST ALAT 4/3.5	BOTH IP/OP	"$2,126.40 "	"$1,573.54"	$0.00	"$1,648.90"	$927.51	$927.51	$0.00	$0.00	$0.00	$443.19	"$1,578.21"	"$1,578.21"	$0.00	$0.00	$443.14	$0.00	"$1,257.77"	"$1,257.77"	$0.00	"$1,030.56"	"$1,632.41"	"$1,648.90"	$0.00		$0.00	$322.57	$0.00	$0.00	$328.13	$0.00	$0.00	$0.00	$0.00	$0.00
437430	SUP	HCPCS C1713		437430  -  PLATE 10 HL SHFT BONE DISTAL ANTLAT TIB	BOTH IP/OP	"$2,126.40 "	"$1,573.54"	$0.00	"$1,648.90"	$927.51	$927.51	$0.00	$0.00	$0.00	$443.19	"$1,578.21"	"$1,578.21"	$0.00	$0.00	$443.14	$0.00	"$1,257.77"	"$1,257.77"	$0.00	"$1,030.56"	"$1,632.41"	"$1,648.90"	$0.00		$0.00	$322.57	$0.00	$0.00	$328.13	$0.00	$0.00	$0.00	$0.00	$0.00
437432	SUP	HCPCS C1713		437432  -  PLATE 12 HL SHFT BONE DISTAL ANTLAT TIB	BOTH IP/OP	"$2,232.00 "	"$1,651.68"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$465.20	"$1,656.59"	"$1,656.59"	$0.00	$0.00	$465.15	$0.00	"$1,320.23"	"$1,320.23"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437434	SUP	HCPCS C1713		437434  -  PLATE BN 14 HL SHFT TIB RT ALAT DIST	BOTH IP/OP	"$2,232.00 "	"$1,651.68"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$465.20	"$1,656.59"	"$1,656.59"	$0.00	$0.00	$465.15	$0.00	"$1,320.23"	"$1,320.23"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437436	SUP	HCPCS C1713		437436  -  PLATE 16 HL SHFT BONE DISTAL ANTLAT TIB	BOTH IP/OP	"$2,232.00 "	"$1,651.68"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$465.20	"$1,656.59"	"$1,656.59"	$0.00	$0.00	$465.15	$0.00	"$1,320.23"	"$1,320.23"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437504	SUP	HCPCS C1713		437504  -  PLATE BN 130MM NS AXSOS 4X5X 2 HL SS FEM LT DIST LAT	BOTH IP/OP	"$2,439.20 "	"$1,805.01"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$508.39	"$1,810.37"	"$1,810.37"	$0.00	$0.00	$508.33	$0.00	"$1,442.79"	"$1,442.79"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437506	SUP	HCPCS C1713		437506  -  PLATE BN 166MM NS AXSOS 6X5X 3 HL SS FEM LT DIST LAT	BOTH IP/OP	"$2,439.20 "	"$1,805.01"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$508.39	"$1,810.37"	"$1,810.37"	$0.00	$0.00	$508.33	$0.00	"$1,442.79"	"$1,442.79"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437508	SUP	HCPCS C1713		437508  -  PLATE BN 202MM NS AXSOS 8X5X 4 HL SS FEM LT DIST LAT	BOTH IP/OP	"$2,449.60 "	"$1,812.70"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$510.56	"$1,818.09"	"$1,818.09"	$0.00	$0.00	$510.50	$0.00	"$1,448.94"	"$1,448.94"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437510	SUP	HCPCS C1713		437510  -  PLATE BN 238MM NS AXSOS 10X5X 5 HL SS FEM LT DIST LAT	BOTH IP/OP	"$2,449.60 "	"$1,812.70"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$510.56	"$1,818.09"	"$1,818.09"	$0.00	$0.00	$510.50	$0.00	"$1,448.94"	"$1,448.94"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437512	SUP	HCPCS C1713		437512  -  PLATE 12 HL SHFT BONE DISTAL LAT FEM	BOTH IP/OP	"$2,449.60 "	"$1,812.70"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$510.56	"$1,818.09"	"$1,818.09"	$0.00	$0.00	$510.50	$0.00	"$1,448.94"	"$1,448.94"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437514	SUP	HCPCS C1713		437514  -  PLATE BN 310MM NS AXSOS 10X5X 7 HL SS FEM LT DIST LAT	BOTH IP/OP	"$2,449.60 "	"$1,812.70"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$510.56	"$1,818.09"	"$1,818.09"	$0.00	$0.00	$510.50	$0.00	"$1,448.94"	"$1,448.94"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437516	SUP	HCPCS C1713		437516  -  PLATE BN 343MM NS AXSOS 16X5X 8 HL SS FEM LT DIST LAT	BOTH IP/OP	"$2,449.60 "	"$1,812.70"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$510.56	"$1,818.09"	"$1,818.09"	$0.00	$0.00	$510.50	$0.00	"$1,448.94"	"$1,448.94"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437524	SUP	HCPCS C1713		437524  -  PLATE BN 130MM NS AXSOS 4X5X 2 HL SS FEM RT DIST LAT	BOTH IP/OP	"$2,439.20 "	"$1,805.01"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$508.39	"$1,810.37"	"$1,810.37"	$0.00	$0.00	$508.33	$0.00	"$1,442.79"	"$1,442.79"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437526	SUP	HCPCS C1713		437526  -  PLATE BN 166MM NS AXSOS 6X5X 3 HL SS FEM RT DIST LAT	BOTH IP/OP	"$2,439.20 "	"$1,805.01"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$508.39	"$1,810.37"	"$1,810.37"	$0.00	$0.00	$508.33	$0.00	"$1,442.79"	"$1,442.79"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437528	SUP	HCPCS C1713		437528  -  PLATE BN 202MM NS AXSOS 8X5X 4 HL SS FEM RT DIST LAT	BOTH IP/OP	"$2,449.60 "	"$1,812.70"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$510.56	"$1,818.09"	"$1,818.09"	$0.00	$0.00	$510.50	$0.00	"$1,448.94"	"$1,448.94"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437530	SUP	HCPCS C1713		437530  -  PLATE BN 238MM NS AXSOS 10X5X 5 HL SS FEM RT DIST LAT	BOTH IP/OP	"$2,449.60 "	"$1,812.70"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$510.56	"$1,818.09"	"$1,818.09"	$0.00	$0.00	$510.50	$0.00	"$1,448.94"	"$1,448.94"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437532	SUP	HCPCS C1713		437532  -  PLATE BN 274MM NS AXSOS 12X5X 6 HL SS FEM RT DIST LAT	BOTH IP/OP	"$2,449.60 "	"$1,812.70"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$510.56	"$1,818.09"	"$1,818.09"	$0.00	$0.00	$510.50	$0.00	"$1,448.94"	"$1,448.94"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437534	SUP	HCPCS C1713		437534  -  PLATE 310MM 14 HL SHFT BONE RIGHT DISTAL LAT PERIART FEM	BOTH IP/OP	"$2,449.60 "	"$1,812.70"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$510.56	"$1,818.09"	"$1,818.09"	$0.00	$0.00	$510.50	$0.00	"$1,448.94"	"$1,448.94"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
437536	SUP	HCPCS C1713		437536  -  PLATE BN 343MM NS AXSOS 16X5X 8 HL SS FEM RT DIST LAT	BOTH IP/OP	"$2,449.60 "	"$1,812.70"	$0.00	"$1,885.40"	"$1,060.54"	"$1,060.54"	$0.00	$0.00	$0.00	$510.56	"$1,818.09"	"$1,818.09"	$0.00	$0.00	$510.50	$0.00	"$1,448.94"	"$1,448.94"	$0.00	"$1,178.38"	"$1,866.55"	"$1,885.40"	$0.00		$0.00	$368.83	$0.00	$0.00	$375.19	$0.00	$0.00	$0.00	$0.00	$0.00
439678	SUP	HCPCS C1900		439678  -  LEAD PACING STR 4FR 78CM 2 ELECTRODE TINES IS-1 ATTAIN	BOTH IP/OP	"$3,562.50 "	"$2,636.25"	$0.00	"$2,850.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,781.25"	"$2,821.50"	"$2,850.00"	$0.00		$0.00	$557.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
439688	SUP	HCPCS C1900		439688  -  LEAD PACING STR 4FR 88CM 2 ELECTRODE TINES IS-1 ATTAIN	BOTH IP/OP	"$3,562.50 "	"$2,636.25"	$0.00	"$2,850.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,781.25"	"$2,821.50"	"$2,850.00"	$0.00		$0.00	$557.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
440400	SUP	Custom 27203010		440400  -  DRESSING NSL THK1.5CM STD 4.5CM WHT STRL LF MRCL TMPN SPT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
446400	SUP	Custom 27203010		REAGENT IGG IMMAGE 300 TST ANALY	BOTH IP/OP	"$1,608.75 "	"$1,190.48"	$0.00	"$1,287.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.38	"$1,274.13"	"$1,287.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
447060	SUP	Custom 27203010		REAGENT WSH SOL IMMAGE 10L ANALY	BOTH IP/OP	$318.75 	$235.88	$0.00	$255.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.38	$252.45	$255.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
447600	SUP	Custom 27203010		REAGENT ALBM IMMAGE 150 TST ANALY	BOTH IP/OP	$811.25 	$600.33	$0.00	$649.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$405.63	$642.51	$649.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
447640	SUP	Custom 27203010		REAGENT DILU 1 IMMAGE 120ML ANALY	BOTH IP/OP	$328.13 	$242.82	$0.00	$262.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.06	$259.88	$262.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
447650	SUP	Custom 27203010		REAGENT BUFF 1 IMMAGE 120ML ANALY	BOTH IP/OP	$328.13 	$242.82	$0.00	$262.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.06	$259.88	$262.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
449560	SUP	Custom 27203010		CALIBRATOR ARY CHM SYS IMMUN	BOTH IP/OP	$806.25 	$596.63	$0.00	$645.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$403.13	$638.55	$645.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
449730	SUP	Custom 27203010		CALIBRATOR TRNFRN IMMAGE ARY LVL 3 3ML 360 SER IMMUN	BOTH IP/OP	$534.38 	$395.44	$0.00	$427.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$267.19	$423.23	$427.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
453547	SUP	HCPCS C1751		453547  -  CATHETER IV 26GA .75IN STRL LF ABCTH-T ISO CLR CD TFLN	BOTH IP/OP	$8.68 	$6.42	$0.00	$6.94	$3.90	$3.90	$0.00	$0.00	$0.00	$1.81	$6.44	$6.44	$0.00	$0.00	$1.81	$0.00	$5.13	$5.13	$0.00	$4.34	$6.87	$6.94	$0.00		$0.00	$1.36	$0.00	$0.00	$1.38	$0.00	$0.00	$0.00	$0.00	$0.00
465990	SUP	Custom 27203010		CONTROL NH3 ALC SYN LVL 1 4ML CX7/LX SER TOX	BOTH IP/OP	$107.50 	$79.55	$0.00	$86.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.75	$85.14	$86.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
465993	SUP	Custom 27203010		CONTROL NH3 ALC SYN LVL 2 4ML CX7/LX SER TOX	BOTH IP/OP	$107.50 	$79.55	$0.00	$86.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.75	$85.14	$86.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
465996	SUP	Custom 27203010		CONTROL NH3 ALC SYN LVL 3 4ML CX7/LX SER TOX	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.00	$340.56	$344.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
472620	SUP	CPT® Q4128		472620  -  GRAFT SKIN THK1.8+ MM ULTRATHICK 20X16CM ALLOGRAFT HYDRATE	BOTH IP/OP	"$21,021.00 "	"$15,555.54"	$0.00	"$16,816.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,380.78"	$0.00	$0.00	$0.00	$0.00	"$10,510.50"	"$16,648.63"	"$16,816.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-00	SUP	Custom 27803010		01-3200  -  HEAD FEMORAL +0MM 32MM MORSE TAPER LFIT COCR HIP	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$1,436.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	$0.00	$0.00	$0.00	$897.50	"$1,421.64"	"$1,436.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-00	SUP	Custom 27803010		06-3200  -  HEAD FEMORAL 0 32MM C TAPER LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
474976	SUP	Custom 27203010		CONTROL MUL-DRUG SYN LOW 10ML CX/LX SER TOX	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-05	SUP	Custom 27803010		01-3205  -  HEAD FEMORAL +5MM MORSE TAPER 32MM LFIT COCR HIP	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$1,436.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	$0.00	$0.00	$0.00	$897.50	"$1,421.64"	"$1,436.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-06	SUP	HCPCS C1713		1-3206  -  SPACER SPNL 6MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-08	SUP	HCPCS C1713		1-3208  -  SPACER SPNL 8MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-10	SUP	Custom 27803010		01-3210  -  HEAD FEMORAL 10MM MORSE TAPER 32MM MORSE TAPER LFIT HIP	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$4,144.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	"$4,144.90"	"$4,144.90"	$0.00	$897.50	"$1,421.64"	"$1,436.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-10	SUP	HCPCS C1713		1-3210  -  SPACER SPNL 10MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$6,658.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	"$4,144.90"	"$4,144.90"	$0.00	$897.50	"$6,658.74"	"$1,436.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-10	SUP	Custom 27803010		06-3210  -  HEAD FEM +10MM OFST CTPR 32MM STRL LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-12	SUP	HCPCS C1713		1-3212  -  SPACER SPNL 12MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-14	SUP	HCPCS C1713		1-3214  -  SPACER SPNL 14MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-16	SUP	HCPCS C1713		1-3216  -  SPACER SPNL 16MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
482047	SUP	HCPCS C1763		482047  -  IMPL URO PLVCL BCMPT VERSATILITY DRBLTY STRTH ACLR CLGN MTRX	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
502452	SUP	HCPCS C1769		502452  -  GUIDEWIRE VASC 3MM RDS J .025IN 260CM STRL LF 7CM CRDS EMRLD	BOTH IP/OP	$25.08 	$18.56	$0.00	$18.61	$12.26	$12.26	$0.00	$0.00	$0.00	$5.23	$18.61	$18.61	$0.00	$0.00	$5.23	$0.00	$14.83	$14.83	$0.00	$11.29	$17.88	$18.06	$0.00		$0.00	$3.53	$0.00	$0.00	$3.59	$0.00	$0.00	$0.00	$0.00	$0.00
502455	SUP	HCPCS C1769		502455  -  GUIDEWIRE VASC 3MM RDS J .035IN 260CM STRL LF 7CM CRDS EMRLD	BOTH IP/OP	$25.08 	$18.56	$0.00	$18.61	$12.26	$12.26	$0.00	$0.00	$0.00	$5.23	$18.61	$18.61	$0.00	$0.00	$5.23	$0.00	$14.83	$14.83	$0.00	$11.29	$17.88	$18.06	$0.00		$0.00	$3.53	$0.00	$0.00	$3.59	$0.00	$0.00	$0.00	$0.00	$0.00
502521	SUP	HCPCS C1769		502521  -  GUIDEWIRE VASC 3MM RDS J .035IN 150CM STRL LF 7CM CRDS EMRLD	BOTH IP/OP	$16.25 	$12.03	$0.00	$12.06	$7.85	$7.85	$0.00	$0.00	$0.00	$3.39	$12.06	$12.06	$0.00	$0.00	$3.39	$0.00	$9.61	$9.61	$0.00	$7.23	$11.44	$11.56	$0.00		$0.00	$2.26	$0.00	$0.00	$2.30	$0.00	$0.00	$0.00	$0.00	$0.00
502542	SUP	HCPCS C1769		502542  -  GUIDEWIRE VASC STRG .035IN 150CM STRL LF 7CM CRDS EMRLD FLXB	BOTH IP/OP	$16.25 	$12.03	$0.00	$12.06	$7.85	$7.85	$0.00	$0.00	$0.00	$3.39	$12.06	$12.06	$0.00	$0.00	$3.39	$0.00	$9.61	$9.61	$0.00	$7.23	$11.44	$11.56	$0.00		$0.00	$2.26	$0.00	$0.00	$2.30	$0.00	$0.00	$0.00	$0.00	$0.00
509748	SUP	Custom 27203010		DRUG ANBTC VITEK2 ETST DXYCL DC 256 B100	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.00	$546.48	$552.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
510422	SUP	HCPCS A4351		510422  -  CATHETER URETHRAL 22FR 16IN 2 STAGGERED EYE RADIOPQ LATEX	BOTH IP/OP	$10.58 	$7.83	$0.00	$8.46	$0.00	$0.00	$0.00	$0.00	$0.00	$2.20	$7.85	$7.85	$0.00	$0.00	$2.20	$0.00	$6.26	$6.26	$0.00	$5.29	$8.38	$8.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
510426	SUP	HCPCS C1729		510426  -  CATHETER URTH RBNSN 26FR RBR STRL LTX RD	BOTH IP/OP	$105.75 	$78.26	$0.00	$162.76	$110.47	$110.47	$0.00	$0.00	$0.00	$0.00	$78.49	$78.49	$0.00	$0.00	$22.04	$0.00	$0.00	$0.00	$0.00	$101.73	$161.13	$162.76	$0.00		$0.00	$31.84	$0.00	$0.00	$32.39	$0.00	$0.00	$0.00	$0.00	$0.00
510428	SUP	HCPCS C1758		510428  -  CATHETER URTH 28FR 16IN RD STRL LTX 2 STGR EYE RADOPQ RBR	BOTH IP/OP	$10.58 	$7.83	$0.00	$8.46	$5.74	$5.74	$0.00	$0.00	$0.00	$2.20	$7.85	$7.85	$0.00	$0.00	$2.20	$0.00	$6.26	$6.26	$0.00	$5.29	$8.38	$8.46	$0.00		$0.00	$1.65	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-99	SUP	Custom 27803010		01-3299  -  HEAD FEMORAL -5MM 32MM MORSE TAPER LFIT COCR HIP	BOTH IP/OP	"$1,795.00 "	"$1,328.30"	$0.00	"$1,436.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,332.25"	"$1,332.25"	$0.00	$0.00	$374.08	$0.00	$0.00	$0.00	$0.00	$897.50	"$1,421.64"	"$1,436.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-99	SUP	Custom 27203010		06-3299  -  HEAD FEM -5MM OFST CTPR 32MM STRL LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
511212	SUP	HCPCS C1898		"511212  -  IS-1, SILICONE, 54CM, V PLACEMENT"	BOTH IP/OP	$680.00 	$503.20	$0.00	"$1,067.66"	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	"$1,067.66"	"$1,067.66"	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
513658	SUP	Custom 27203010		STRIP IMPNM .002-32 MCG SNS	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.00	$546.48	$552.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
516001	SUP	HCPCS Q4130		0516001  -  MATRIX TISSUE 16X5CM RECONSTRUCTIVE STRATTICE PIG DERMIS	BOTH IP/OP	"$24,997.50 "	"$18,498.15"	$0.00	"$19,998.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,210.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,209.48"	$0.00	"$12,323.77"	"$12,323.77"	$0.00	"$12,498.75"	"$19,798.02"	"$19,998.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
520368	SUP	HCPCS C1713		520368  -  SCREW BN 2MM CMPR HEX SCKT	BOTH IP/OP	$38.40 	$28.42	$0.00	$30.72	$17.28	$17.28	$0.00	$0.00	$0.00	$8.00	$28.50	$28.50	$0.00	$0.00	$8.00	$0.00	$22.71	$22.71	$0.00	$19.20	$30.41	$30.72	$0.00		$0.00	$6.01	$0.00	$0.00	$6.11	$0.00	$0.00	$0.00	$0.00	$0.00
522022	SUP	HCPCS C1776		522022  -  HEAD FEM +0MM 11/13 TPR 22MM STRL SR COCR HIP MDLR SYS	BOTH IP/OP	"$3,187.50 "	"$2,358.75"	$0.00	"$2,550.00"	"$1,434.38"	"$1,434.38"	$0.00	$0.00	$0.00	$664.35	"$2,365.76"	"$2,365.76"	$0.00	$0.00	$664.28	$0.00	"$1,571.44"	"$1,571.44"	$0.00	"$1,593.75"	"$2,524.50"	"$2,550.00"	$0.00		$0.00	$498.84	$0.00	$0.00	$507.45	$0.00	$0.00	$0.00	$0.00	$0.00
525558	SUP	Custom 27203010		STRIP VNCMCN ETST SNS	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.00	$546.48	$552.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
528341	SUP	Custom 27203010		528341  -  PILLING SURGILUX H/L VAR. 10-75 MM	BOTH IP/OP	"$2,400.00 "	"$1,776.00"	$0.00	"$1,920.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,781.28"	"$1,781.28"	$0.00	$0.00	$500.16	$0.00	$0.00	$0.00	$0.00	"$1,200.00"	"$1,900.80"	"$1,920.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
531658	SUP	Custom 27203010		DISK ERTAPENEM SNS	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.00	$546.48	$552.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
532644	SUP	HCPCS C1725		532644  -  CATHETER ANGIO MP A2 CRV 6FR 125CM ST BRD ATRM SLCT 2 SH PU	BOTH IP/OP	$21.13 	$15.64	$0.00	$16.90	$11.47	$11.47	$0.00	$0.00	$0.00	$4.40	$15.68	$15.68	$0.00	$0.00	$4.40	$0.00	$12.50	$12.50	$0.00	$10.56	$16.73	$16.90	$0.00		$0.00	$3.31	$0.00	$0.00	$3.36	$0.00	$0.00	$0.00	$0.00	$0.00
533448	SUP	Custom 27203010		STRIP PLMXN ETST SNS	BOTH IP/OP	$785.00 	$580.90	$0.00	$628.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$392.50	$621.72	$628.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
533558	SUP	Custom 27203010		STRIP TIGECYCLINE 256 MCG ETST VK2 SNS F100	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.00	$546.48	$552.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
535058	SUP	Custom 27203010		STRIP DAPTOMYCIN .016-256 MCG ETST SNS	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.00	$546.48	$552.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
535070	SUP	Custom 27203010		535070  -  KIT TRACHEOSTOMY 9.6MM 7MM 82MM 2 DECK TRAY DILAT OBTURATOR	BOTH IP/OP	$677.00 	$500.98	$0.00	$502.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.47	$502.47	$0.00	$0.00	$141.09	$0.00	$0.00	$0.00	$0.00	$313.81	$497.08	$502.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
535080	SUP	Custom 27203010		535080  -  KIT TRCH 10.9MM 8MM 86MM STRL LTX PRFT PRTX 2 DECK TRY DIL	BOTH IP/OP	$677.00 	$500.98	$0.00	$502.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.47	$502.47	$0.00	$0.00	$141.09	$0.00	$0.00	$0.00	$0.00	$313.81	$497.08	$502.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
535090	SUP	Custom 27203010		535090  -  KIT TRACHEOSTOMY 12.3MM 9MM COMPLETE SET INNER CANNU	BOTH IP/OP	$677.00 	$500.98	$0.00	$502.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.47	$502.47	$0.00	$0.00	$141.09	$0.00	$0.00	$0.00	$0.00	$313.81	$497.08	$502.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540015	SUP	Custom 27203010		540015  -  DRILL SURG MICRO CORE	BOTH IP/OP	"$13,025.75 "	"$9,639.06"	$0.00	"$10,420.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,714.57"	$0.00	$0.00	$0.00	$0.00	"$6,512.88"	"$10,316.39"	"$10,420.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
544230	SUP	Custom 27803010		544230  -  CLIP INTNL MED LG CHEVRON HRT GRN STRL LF WECK HEM-O-LOK LGT	BOTH IP/OP	$86.61 	$64.09	$0.00	$69.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.28	$64.28	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$43.30	$68.60	$69.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
544240	SUP	Custom 27803010		544240  -  CLIP INTERNAL LARGE LIGATE CARTRIDGE LATEX FREE WECK	BOTH IP/OP	$86.61 	$64.09	$0.00	$69.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.28	$64.28	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$43.30	$68.60	$69.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
544250	SUP	Custom 27803010		544250  -  CLIP XL INTNL HEM-O-LOK PLMR LAPSCOP STRL DISP LATEX FREE	BOTH IP/OP	$81.75 	$60.50	$0.00	$65.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.67	$60.67	$0.00	$0.00	$17.04	$0.00	$0.00	$0.00	$0.00	$40.88	$64.75	$65.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
570624	SUP	HCPCS C1729		570624  -  CATH URTH SMPLS 24FR 16IN FOLEY 3W CVLR TIP 30ML STRL LATEX	BOTH IP/OP	$84.50 	$62.53	$0.00	$67.60	$45.88	$45.88	$0.00	$0.00	$0.00	$17.61	$62.72	$62.72	$0.00	$0.00	$17.61	$0.00	$49.98	$49.98	$0.00	$42.25	$66.92	$67.60	$0.00		$0.00	$13.22	$0.00	$0.00	$13.45	$0.00	$0.00	$0.00	$0.00	$0.00
573030	SUP	HCPCS C1725		573030  -  CATH BALDILAT .014IN 3MM 145CM 10MM OTW NC DRLN NC RPTR	BOTH IP/OP	$597.55 	$442.19	$0.00	$478.04	$324.47	$324.47	$0.00	$0.00	$0.00	$124.54	$443.50	$443.50	$0.00	$0.00	$124.53	$0.00	$353.45	$353.45	$0.00	$298.78	$473.26	$478.04	$0.00		$0.00	$93.52	$0.00	$0.00	$95.13	$0.00	$0.00	$0.00	$0.00	$0.00
585040	SUP	Custom 27203010		585040  -  CANNULA OPHTHALMIC 40D 1.1MM 25MM 8MM SMOOTH TIP AIR INJEC	BOTH IP/OP	$198.83 	$147.13	$0.00	$154.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.57	$147.57	$0.00	$0.00	$41.44	$0.00	$0.00	$0.00	$0.00	$96.51	$152.88	$154.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
585047	SUP	Custom 27203010		585047  -  CANNULA IRR 23GA .8IN .4IN .3MM STRL LF SMC ASP PORT THNWL	BOTH IP/OP	$172.77 	$127.85	$0.00	$128.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$128.23	$128.23	$0.00	$0.00	$36.01	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
585119	SUP	Custom 27203010		585119  -  CANNULA OPHTHALMIC 45D ULTRATHIN WALL BEVEL 20GA 4MM INFUS	BOTH IP/OP	$256.00 	$189.44	$0.00	$204.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$190.00	$190.00	$0.00	$0.00	$53.35	$0.00	$0.00	$0.00	$0.00	$128.00	$202.75	$204.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
585233	SUP	Custom 27203010		585233  -  UNIT IRRIGATION 14MM SQUEEGEE LASIK FLAP ROLLER SLEEVE BD	BOTH IP/OP	$59.80 	$44.25	$0.00	$47.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.90	$47.36	$47.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600040	SUP	HCPCS C1751		0600040  -  CATHETER CV 2 BRCH 2.7FR .9MM .5MM 71CM STRL LTX BRVC 1 LUM	BOTH IP/OP	$195.50 	$144.67	$0.00	$154.84	$0.00	$0.00	$0.00	$0.00	$0.00	$38.71	$137.85	$137.85	$0.00	$0.00	$9.33	$0.00	$115.64	$115.64	$0.00	$84.91	$154.84	$135.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600125	SUP	Custom 27203010		0600125  -  APPLICATOR ENDSCP FLSL BXTR NRFL COMP CANNU COMP	BOTH IP/OP	$133.00 	$98.42	$0.00	$133.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.72	$98.72	$0.00	$0.00	$27.72	$0.00	$0.00	$0.00	$0.00	$83.17	$131.73	$133.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600160	SUP	HCPCS C1751		0600160  -  CATHETER 9FR SINGLE LUMEN HICKMAN	BOTH IP/OP	$61.35 	$45.40	$0.00	$49.08	$33.31	$33.31	$0.00	$0.00	$0.00	$12.79	$45.53	$45.53	$0.00	$0.00	$12.79	$0.00	$36.29	$36.29	$0.00	$30.68	$48.59	$49.08	$0.00		$0.00	$9.60	$0.00	$0.00	$9.77	$0.00	$0.00	$0.00	$0.00	$0.00
600544	SUP	HCPCS C1751		0600544  -  KIT CATH 6.6FR 57CM STRL LF BRVC 1 LUM LOPRFL ADPR SIL PED	BOTH IP/OP	$371.13 	$274.64	$0.00	$293.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.24	$15.24	$0.00	$0.00	$4.28	$0.00	$219.52	$219.52	$0.00	$9.31	$293.93	$14.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600560	SUP	HCPCS C1751		0600560  -  CATHETER CEN VEN 9.6FR 3.2MM 1.6MM 90CM 1 LUMEN TISSUE	BOTH IP/OP	$395.00 	$292.30	$0.00	$312.84	$23.40	$23.40	$0.00	$0.00	$0.00	$1.05	$38.59	$38.59	$0.00	$0.00	$4.30	$0.00	$0.00	$0.00	$0.00	$26.00	$312.84	$41.60	$0.00		$0.00	$3.91	$0.00	$0.00	$3.73	$0.00	$0.00	$0.00	$0.00	$0.00
600600	SUP	HCPCS C1751		0600600  -  KIT CATH 9FR 54CM STRL LF HKMN PEEL-APART 2 LUM LOPRFL ADPR	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$192.77	$192.77	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
601600	SUP	HCPCS C1751		0601600  -  KIT CATH REPR 2.7FR .9MM .5MM 71CM .15ML WHT STRL LTX BRVC 1	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
601610	SUP	HCPCS C1751		0601610  -  KIT CATH REPR 4.2FR 1.4MM .7MM 71CM .3ML WHT STRL LF BRVC 1	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
601648	SUP	HCPCS C1713		601648  -  SCREW BONE PTHRD 5MM 48MM CANN LP HEAD REVERSE CUTTING FLUTE	BOTH IP/OP	$299.75 	$221.82	$0.00	$408.18	$229.60	$229.60	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$255.11	$404.10	$408.18	$0.00		$0.00	$79.85	$0.00	$0.00	$81.23	$0.00	$0.00	$0.00	$0.00	$0.00
602230	SUP	HCPCS C1788		0602230  -  PORT IMPLTABLE INFUS SBQ TI 9.6FR 1 LUM ATCH CATH PLAPRT	BOTH IP/OP	"$2,108.70 "	"$1,560.44"	$0.00	"$1,686.96"	$948.92	$948.92	$0.00	$0.00	$0.00	$439.51	"$1,565.08"	"$1,565.08"	$0.00	$0.00	$439.45	$0.00	"$1,247.30"	"$1,247.30"	$0.00	"$1,054.35"	"$1,670.09"	"$1,686.96"	$0.00		$0.00	$330.01	$0.00	$0.00	$335.71	$0.00	$0.00	$0.00	$0.00	$0.00
602645	SUP	HCPCS C1713		602645  -  SCREW BN 6.5MM 45MM STRL 20MM ASNS III ST SLFDRL CNN TI ORTH	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
602650	SUP	HCPCS C1713		602650  -  SCREW BN 6.5MM 50MM STRL 20MM ASNS III ST SLF DRL CNN TI HIP	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
602660	SUP	HCPCS C1713		602660  -  SCREW BN 6.5MM 60MM STRL 20MM ASNS III SLF DRL ST CNN TI LNG	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
602885	SUP	HCPCS C1713		602885  -  SCREW BN LOPRFL REVCT FLUT 6.5MM 85MM NS 40MM ASNS III CNN	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
603020	SUP	HCPCS Q4116		603020  -  MATRIX TISSUE INJECTABLE CYMETRA MAT ACELLULAR DERMIS 2ML	BOTH IP/OP	$373.75 	$276.58	$0.00	$299.00	$168.19	$168.19	$0.00	$0.00	$0.00	$77.90	$277.40	$277.40	$0.00	$0.00	$77.89	$0.00	$221.07	$221.07	$0.00	$186.88	$296.01	$299.00	$0.00		$0.00	$58.49	$0.00	$0.00	$59.50	$0.00	$0.00	$0.00	$0.00	$0.00
606008	SUP	HCPCS Q4130		0606008  -  MESH SURG 6X6MM STMA TISS HERN PTCH	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
606096	SUP	Custom 27203010		KIT IMMUN TST PRMR POS NEG CNTRL H PYLR IGG 96 TST	BOTH IP/OP	"$1,619.25 "	"$1,198.25"	$0.00	"$1,295.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$809.63	"$1,282.45"	"$1,295.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
606560	SUP	HCPCS C1751		0606560  -  KIT CATH 10FR 59CM STRL LF HKMN 3 LUM LOPRFL ADPR PLAPRT	BOTH IP/OP	$455.05 	$336.74	$0.00	$364.04	$247.09	$247.09	$0.00	$0.00	$0.00	$94.84	$337.74	$337.74	$0.00	$0.00	$94.83	$0.00	$269.16	$269.16	$0.00	$227.53	$360.40	$364.04	$0.00		$0.00	$71.22	$0.00	$0.00	$72.44	$0.00	$0.00	$0.00	$0.00	$0.00
608001	SUP	HCPCS Q4130		0608001  -  MATRIX TISS 8X6CM STRL STRATTICE RECON PRCN DERM	BOTH IP/OP	"$2,825.00 "	"$2,090.50"	$0.00	"$3,416.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$588.80	"$2,096.72"	"$2,096.72"	$0.00	$0.00	$588.73	$0.00	"$1,392.73"	"$1,392.73"	$0.00	"$2,135.00"	"$3,381.84"	"$3,416.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
609002	SUP	Custom 27803010		609002  -  TISSUE 609002 2MM FACET SHIM	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
609003	SUP	Custom 27803010		609003  -  TISSUE 609003 3MM FACET SHIM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
609004	SUP	HCPCS C1763		609004  -  GRAFT SFT SHIM 4 MM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
609404	SUP	HCPCS C1763		609404  -  GRAFT SFT TIS 10X8X4MM FACET	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
609604	SUP	HCPCS C1763		609604  -  GRAFT SFT TIS WDG 8X8X4MM LF	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
610008	SUP	HCPCS Q4130		0610008  -  MATRIX TISSUE 10X6CM RECONSTRUCTIVE STRATTICE PIG DERMIS	BOTH IP/OP	"$3,785.00 "	"$2,800.90"	$0.00	"$4,576.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$788.89	"$2,809.23"	"$2,809.23"	$0.00	$0.00	$788.79	$0.00	"$1,866.01"	"$1,866.01"	$0.00	"$2,860.00"	"$4,530.24"	"$4,576.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
610102	SUP	HCPCS C1894		INTRODUCER SHTH 6FR 16CM TRAW ADPR DILAT SET INDN SPNLK .038	BOTH IP/OP	$67.10 	$49.65	$0.00	$53.68	$36.44	$36.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.55	$53.14	$53.68	$0.00		$0.00	$10.50	$0.00	$0.00	$10.68	$0.00	$0.00	$0.00	$0.00	$0.00
610104	SUP	HCPCS C1894		INTRODUCER 8 FR TEAR AWAY	BOTH IP/OP	$70.40 	$52.10	$0.00	$56.32	$38.23	$38.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.20	$55.76	$56.32	$0.00		$0.00	$11.02	$0.00	$0.00	$11.21	$0.00	$0.00	$0.00	$0.00	$0.00
610106	SUP	HCPCS C1892		INTRODUCER SHTH 10FR 16CM TRAW DILAT SET ADPR INTRDN .038IN	BOTH IP/OP	$69.35 	$51.32	$0.00	$55.48	$37.66	$37.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.68	$54.93	$55.48	$0.00		$0.00	$10.85	$0.00	$0.00	$11.04	$0.00	$0.00	$0.00	$0.00	$0.00
610130	SUP	HCPCS C1760		610130  -  DEVICE CLSR 6FR .035IN 70CM STRL LF ANGSL VIP BONDEK-+ HMST	BOTH IP/OP	$840.00 	$621.60	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
610131	SUP	HCPCS C1760		610131  -  DEVICE CLSR 8FR ANGSL VIP VASC HMST STRL LATEX FREE DISP	BOTH IP/OP	$840.00 	$621.60	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
610400	SUP	Custom 27203010		CONNECTOR CATH 9.5FR Y SWVL LUER LOCK SDPRT SGL	BOTH IP/OP	$65.65 	$48.58	$0.00	$52.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.83	$51.99	$52.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
611125	SUP	HCPCS C1713		611125  -  SCREW BONE 8MM 125MM 25MM ASNS 3 TI ORTH SLFTAP SLFDRILL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
611130	SUP	HCPCS C1713		611130  -  SCREW BONE 8MM 130MM 25MM ASNS 3 TI ORTH SLFTAP SLFDRILL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
611335	SUP	HCPCS C1713		611335  -  SCREW BONE 8MM 135MM ASNS 3 TI FULTHRD CANN NONSTRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
611340	SUP	HCPCS C1713		611340  -  SCREW BONE 8MM 140MM ASNS 3 TI FULTHRD CANN NONSTRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
611345	SUP	HCPCS C1713		611345  -  SCREW BONE 8MM 145MM ASNS 3 TI FULTHRD CANN NONSTRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
611350	SUP	HCPCS C1713		611350  -  SCREW BONE 8MM 150MM ASNS 3 TI FULTHRD CANN NONSTRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
612601	SUP	HCPCS C1892		612601 - INTRODUCER SHTH 5FR 19CM 16CM TRAW ADPR DILAT SET INDN SPNLK	BOTH IP/OP	$60.88 	$45.05	$0.00	$48.70	$33.06	$33.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.44	$48.22	$48.70	$0.00		$0.00	$9.53	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
614508	SUP	HCPCS C1713		614508  -  SCREW BONE 2.7MM 8MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614510	SUP	HCPCS C1713		614510  -  SCREW BONE 2.7MM 10MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614512	SUP	HCPCS C1713		614512  -  SCREW BONE 2.7MM 12MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614514	SUP	HCPCS C1713		614514  -  SCREW BONE 2.7MM 14MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614516	SUP	HCPCS C1713		614516  -  SCREW BONE 2.7MM 16MM LCK STRL	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614518	SUP	HCPCS C1713		614518  -  SCREW BONE 2.7MM 18MM LCK STRL	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614520	SUP	HCPCS C1713		614520  -  SCREW BONE 2.7MM 20MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614522	SUP	HCPCS C1713		614522  -  SCREW BONE 2.7MM 22MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614524	SUP	HCPCS C1713		614524  -  SCREW BONE 2.7MM 24MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614526	SUP	HCPCS C1713		614526  -  SCREW BONE 2.7MM 26MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614528	SUP	HCPCS C1713		614528  -  SCREW BONE 2.7MM 28MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614530	SUP	HCPCS C1713		614530  -  SCREW BONE 2.7MM 30MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614532	SUP	HCPCS C1713		614532  -  SCREW BONE 2.7MM 32MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614534	SUP	HCPCS C1713		614534  -  SCREW BONE 2.7MM 34MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614536	SUP	HCPCS C1713		614536  -  SCREW BONE 2.7MM 36MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614538	SUP	HCPCS C1713		614538  -  SCREW BONE 2.7MM 38MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614540	SUP	HCPCS C1713		614540  -  SCREW BONE 2.7MM 40MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614542	SUP	HCPCS C1713		614542  -  SCREW BONE 2.7MM 42MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$964.83 	$713.97	$0.00	$717.09	$111.38	$111.38	$0.00	$0.00	$0.00	$201.09	$716.09	$716.09	$0.00	$0.00	$201.07	$0.00	$717.09	$717.09	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614544	SUP	HCPCS C1713		614544  -  SCREW BONE 2.7MM 44MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614546	SUP	HCPCS C1713		614546  -  SCREW BONE 2.7MM 46MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614548	SUP	HCPCS C1713		614548  -  SCREW BONE 2.7MM 48MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614550	SUP	HCPCS C1713		614550  -  SCREW BONE 2.7MM 50MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614555	SUP	HCPCS C1713		614555  -  SCREW BONE 2.7MM 55MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614560	SUP	HCPCS C1713		614560  -  SCREW BONE 2.7MM 60MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614565	SUP	HCPCS C1713		614565  -  SCREW BONE 2.7MM 65MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614570	SUP	HCPCS C1713		614570  -  SCREW BONE 2.7MM 70MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
614608	SUP	HCPCS C1713		614608  -  SCREW BONE 3.5MM 8MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614610	SUP	HCPCS C1713		614610  -  SCREW BONE 3.5MM 10MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614612	SUP	HCPCS C1713		614612  -  SCREW BONE 3.5MM 12MM VARIAX SS ELB SLFTAP LCK	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614614	SUP	HCPCS C1713		614614  -  SCREW BONE 3.5MM 14MM VARIAX SS ELB SLFTAP LCK	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614616	SUP	HCPCS C1713		614616  -  SCREW BONE 3.5MM 16MM VARIAX SS ELB SLFTAP LCK	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614618	SUP	HCPCS C1713		614618  -  SCREW BONE 3.5MM 18MM VARIAX SS ELB SLFTAP LCK	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614620	SUP	HCPCS C1713		614620  -  SCREW BONE 3.5MM 20MM VARIAX SS ELB SLFTAP LCK	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614622	SUP	HCPCS C1713		614622  -  SCREW BONE 3.5MM 22MM VARIAX SS ELB SLFTAP LCK	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614624	SUP	HCPCS C1713		614624  -  SCREW BONE 3.5MM 24MM VARIAX SS ELB SLFTAP LCK	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614626	SUP	HCPCS C1713		614626  -  SCREW BONE 3.5MM 26MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614628	SUP	HCPCS C1713		614628  -  SCREW BONE 3.5MM 28MM VARIAX SS ELB SLFTAP LCK	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614630	SUP	HCPCS C1713		614630  -  SCREW BONE 3.5MM 30MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614632	SUP	HCPCS C1713		614632  -  SCREW BONE 3.5MM 32MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614634	SUP	HCPCS C1713		614634  -  SCREW BONE 3.5MM 42MM VARIAX TI ELB SLFTAP LCK NONSTRL	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614636	SUP	HCPCS C1713		614636  -  SCREW BONE 3.5MM 36MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614638	SUP	HCPCS C1713		614638  -  SCREW BONE 3.5MM 38MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614640	SUP	HCPCS C1713		614640  -  SCREW BONE 3.5MM 40MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614642	SUP	HCPCS C1713		614642  -  SCREW BONE 3.5MM 42MM VARIAX SS ELB SLFTAP LCK	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614644	SUP	HCPCS C1713		614644  -  SCREW BONE 3.5MM 44MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614646	SUP	HCPCS C1713		614646  -  SCREW BONE 3.5MM 46MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614648	SUP	HCPCS C1713		614648  -  SCREW BONE 3.5MM 48MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614650	SUP	HCPCS C1713		614650  -  SCREW BONE 3.5MM 50MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614655	SUP	HCPCS C1713		614655  -  SCREW BONE 3.5MM 55MM VARIAX LCK	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614660	SUP	HCPCS C1713		614660  -  SCREW BONE 3.5MM 60MM VARIAX SS ELB SLFTAP LCK	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614665	SUP	HCPCS C1713		614665  -  SCREW BONE 3.5MM 65MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614670	SUP	HCPCS C1713		614670  -  SCREW BONE 3.5MM 70MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
614708	SUP	HCPCS C1713		614708  -  SCREW BONE 2.7MM 8MM VARIAX TI ELB SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614710	SUP	HCPCS C1713		614710  -  SCREW BONE 2.7MM 10MM VARIAX TI ELB SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614712	SUP	HCPCS C1713		614712  -  SCREW BONE 2.7MM 12MM VARIAX TI ELB SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614714	SUP	HCPCS C1713		614714  -  SCREW BONE 2.7MM 14MM VARIAX TI ELB SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614716	SUP	HCPCS C1713		614716  -  SCREW BONE 2.7MM 16MM VARIAX TI ELB SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614718	SUP	HCPCS C1713		614718  -  SCREW BONE 2.7MM 18MM VARIAX SLFTAP	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614720	SUP	HCPCS C1713		614720  -  SCREW BONE 2.7MM 20MM VARIAX TI ELB SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614722	SUP	HCPCS C1713		614722  -  SCREW BONE 2.7MM 22MM VARIAX TI ELB SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614724	SUP	HCPCS C1713		614724  -  SCREW BONE 2.7MM 24MM VARIAX SLFTAP	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614726	SUP	HCPCS C1713		614726  -  SCREW BONE 2.7MM 26MM VARIAX TI ELB SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614728	SUP	HCPCS C1713		614728  -  SCREW BONE 2.7MM 28MM VARIAX TI ELB SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614730	SUP	HCPCS C1713		614730  -  SCREW BONE 2.7MM 30MM VARIAX TI ELB SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614732	SUP	HCPCS C1713		614732  -  SCREW BONE 2.7MM 32MM VARIAX TI ELB SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614734	SUP	HCPCS C1713		614734  -  SCREW BONE 2.7MM 34MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614736	SUP	HCPCS C1713		614736  -  SCREW BONE 2.7MM 36MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614738	SUP	HCPCS C1713		614738  -  SCREW BONE 2.7MM 38MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614740	SUP	HCPCS C1713		614740  -  SCREW BONE 2.7MM 40MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614742	SUP	HCPCS C1713		614742  -  SCREW BONE 2.7MM 42MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614744	SUP	HCPCS C1713		614744  -  SCREW BONE 2.7MM 44MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614746	SUP	HCPCS C1713		614746  -  SCREW BONE 2.7MM 46MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614748	SUP	HCPCS C1713		614748  -  SCREW BONE 2.7MM 48MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614750	SUP	HCPCS C1713		614750  -  SCREW BONE 2.7MM 50MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614755	SUP	HCPCS C1713		614755  -  SCREW BONE 2.7MM 55MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614760	SUP	HCPCS C1713		614760  -  SCREW BONE 2.7MM 60MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614765	SUP	HCPCS C1713		614765  -  SCREW BONE 2.7MM 65MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614770	SUP	HCPCS C1713		614770  -  SCREW BONE 2.7MM 70MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$111.30 	$82.36	$0.00	$85.80	$48.26	$48.26	$0.00	$0.00	$0.00	$23.20	$82.61	$82.61	$0.00	$0.00	$23.19	$0.00	$65.83	$65.83	$0.00	$53.63	$84.94	$85.80	$0.00		$0.00	$16.78	$0.00	$0.00	$17.07	$0.00	$0.00	$0.00	$0.00	$0.00
614808	SUP	HCPCS C1713		614808  -  SCREW BONE 3.5MM 8MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614810	SUP	HCPCS C1713		614810  -  SCREW BONE 3.5MM 10MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614812	SUP	HCPCS C1713		614812  -  SCREW BONE 3.5MM 12MM VARIAX TI ELB LCK SLFTAP PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614814	SUP	HCPCS C1713		614814  -  SCREW BONE 3.5MM 14MM VARIAX SS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614816	SUP	HCPCS C1713		614816  -  SCREW BONE 3.5MM 16MM VARIAX SS NLCKG	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614818	SUP	HCPCS C1713		614818  -  SCREW BONE 3.5MM 18MM VARIAX SS ELB SLFTAP LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614820	SUP	HCPCS C1713		614820  -  SCREW BONE 3.5MM 20MM VARIAX SS ELB SLFTAP LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614822	SUP	HCPCS C1713		614822  -  SCREW BONE 3.5MM 22MM VARIAX TI ELB SLFTAP LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614824	SUP	HCPCS C1713		614824  -  SCREW BONE 3.5MM 24MM VARIAX TI ELB SLFTAP LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614826	SUP	HCPCS C1713		614826  -  SCREW BONE 3.5MM 26MM VARIAX TI	BOTH IP/OP	"$1,941.50 "	"$1,436.71"	$0.00	"$1,553.20"	$873.68	$873.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$970.75	"$1,537.67"	"$1,553.20"	$0.00		$0.00	$303.84	$0.00	$0.00	$309.09	$0.00	$0.00	$0.00	$0.00	$0.00
614828	SUP	HCPCS C1713		614828  -  SCREW BONE 3.5MM 28MM VARIAX TI	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614830	SUP	HCPCS C1713		614830  -  SCREW BONE 3.5MM 30MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614832	SUP	HCPCS C1713		614832  -  SCREW BONE 3.5MM 32MM VARIAX TI ELB SLFTAP LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614834	SUP	HCPCS C1713		614834  -  SCREW BONE 3.5MM 34MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614836	SUP	HCPCS C1713		614836  -  SCREW BONE 3.5MM 36MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614838	SUP	HCPCS C1713		614838  -  SCREW BONE 3.5MM 38MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614840	SUP	HCPCS C1713		614840  -  SCREW BONE 3.5MM 40MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614842	SUP	HCPCS C1713		614842  -  SCREW BONE 3.5MM 42MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614844	SUP	HCPCS C1713		614844  -  SCREW BONE 3.5MM 44MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614846	SUP	HCPCS C1713		614846  -  SCREW BONE 3.5MM 46MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614848	SUP	HCPCS C1713		614848  -  SCREW BONE 3.5MM 48MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614850	SUP	HCPCS C1713		614850  -  SCREW BONE 3.5MM 50MM VARIAX NLCKG	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614855	SUP	HCPCS C1713		614855  -  SCREW BONE 3.5MM 55MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614860	SUP	HCPCS C1713		614860  -  SCREW BONE 3.5MM 60MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614865	SUP	HCPCS C1713		614865  -  SCREW BONE 3.5MM 65MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
614870	SUP	HCPCS C1713		614870  -  SCREW BONE 3.5MM 70MM VARIAX TI ELB SLFTAP LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
616002	SUP	HCPCS Q4130		0616002  -  MATRIX TISSUE 16X6CM RECONSTRUCTIVE STRATTICE PIG DERMIS	BOTH IP/OP	$58.88 	$43.57	$0.00	$71.19	$0.00	$0.00	$0.00	$0.00	$0.00	$12.27	$43.70	$43.70	$0.00	$0.00	$12.27	$0.00	$34.83	$34.83	$0.00	$44.49	$70.47	$71.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-00	SUP	Custom 27803010		06-3600  -  HEAD FEM +0MM OFST CTPR 36MM STRL LFIT ANTM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621552	SUP	HCPCS C1713		621552  -  PLATE LNG 50MM TI BONE CALCANEUS	BOTH IP/OP	$705.38 	$521.98	$0.00	$564.30	$317.42	$317.42	$0.00	$0.00	$0.00	$147.02	$523.53	$523.53	$0.00	$0.00	$147.00	$0.00	$417.23	$417.23	$0.00	$352.69	$558.66	$564.30	$0.00		$0.00	$110.39	$0.00	$0.00	$112.30	$0.00	$0.00	$0.00	$0.00	$0.00
621553	SUP	HCPCS C1713		621553  -  PLATE LNG 60MM TI BONE CALCANEUS	BOTH IP/OP	$705.38 	$521.98	$0.00	$564.30	$317.42	$317.42	$0.00	$0.00	$0.00	$147.02	$523.53	$523.53	$0.00	$0.00	$147.00	$0.00	$417.23	$417.23	$0.00	$352.69	$558.66	$564.30	$0.00		$0.00	$110.39	$0.00	$0.00	$112.30	$0.00	$0.00	$0.00	$0.00	$0.00
621554	SUP	HCPCS C1713		621554  -  PLATE LNG 70MM TI BONE CALCANEUS	BOTH IP/OP	$705.38 	$521.98	$0.00	$564.30	$317.42	$317.42	$0.00	$0.00	$0.00	$147.02	$523.53	$523.53	$0.00	$0.00	$147.00	$0.00	$417.23	$417.23	$0.00	$352.69	$558.66	$564.30	$0.00		$0.00	$110.39	$0.00	$0.00	$112.30	$0.00	$0.00	$0.00	$0.00	$0.00
621555	SUP	HCPCS C1713		621555  -  PLATE LNG 80MM TI BONE CALCANEUS	BOTH IP/OP	$541.75 	$400.90	$0.00	$433.40	$243.79	$243.79	$0.00	$0.00	$0.00	$112.91	$402.09	$402.09	$0.00	$0.00	$112.90	$0.00	$320.45	$320.45	$0.00	$270.88	$429.07	$433.40	$0.00		$0.00	$84.78	$0.00	$0.00	$86.25	$0.00	$0.00	$0.00	$0.00	$0.00
624519	SUP	Custom 27203010		CALIBRATOR CL S-CL KT 4.2ML HMTL	BOTH IP/OP	$78.85 	$58.35	$0.00	$63.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.43	$62.45	$63.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
626001	SUP	HCPCS C1713		626001  -  PLATE LNG 1 LVL RPS BONE SPNL	BOTH IP/OP	"$2,830.60 "	"$2,094.64"	$0.00	"$2,264.48"	"$1,273.77"	"$1,273.77"	$0.00	$0.00	$0.00	$589.97	"$2,100.87"	"$2,100.87"	$0.00	$0.00	$589.90	$0.00	"$1,395.49"	"$1,395.49"	$0.00	"$1,415.30"	"$2,241.84"	"$2,264.48"	$0.00		$0.00	$442.99	$0.00	$0.00	$450.63	$0.00	$0.00	$0.00	$0.00	$0.00
626002	SUP	HCPCS C1713		626002  -  PLATE LNG TI 2 LVL BONE ORTH	BOTH IP/OP	"$3,124.90 "	"$2,312.43"	$0.00	"$2,499.92"	"$1,406.21"	"$1,406.21"	$0.00	$0.00	$0.00	$651.31	"$2,319.30"	"$2,319.30"	$0.00	$0.00	$651.23	$0.00	"$1,540.58"	"$1,540.58"	$0.00	"$1,562.45"	"$2,474.92"	"$2,499.92"	$0.00		$0.00	$489.05	$0.00	$0.00	$497.48	$0.00	$0.00	$0.00	$0.00	$0.00
626011	SUP	HCPCS C1713		626011  -  PLATE SHRT 1 LVL RPS BONE SPNL	BOTH IP/OP	"$2,830.60 "	"$2,094.64"	$0.00	"$2,264.48"	"$1,273.77"	"$1,273.77"	$0.00	$0.00	$0.00	$589.97	"$2,100.87"	"$2,100.87"	$0.00	$0.00	$589.90	$0.00	"$1,395.49"	"$1,395.49"	$0.00	"$1,415.30"	"$2,241.84"	"$2,264.48"	$0.00		$0.00	$442.99	$0.00	$0.00	$450.63	$0.00	$0.00	$0.00	$0.00	$0.00
626300	SUP	Custom 27803010		626300  -  CONCTR ROD RPS FIX SPNL	BOTH IP/OP	"$2,122.93 "	"$1,570.97"	$0.00	"$1,698.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,575.63"	"$1,575.63"	$0.00	$0.00	$442.42	$0.00	$0.00	$0.00	$0.00	"$1,061.46"	"$1,681.36"	"$1,698.34"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
629004	SUP	HCPCS C1713		629004  -  PLATE BN 4 HL HUM DIST LAT	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$668.25	$668.25	$0.00	$0.00	$0.00	$309.51	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$878.38	$878.38	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$232.40	$0.00	$0.00	$236.41	$0.00	$0.00	$0.00	$0.00	$0.00
629006	SUP	HCPCS C1713		629006  -  PLATE BN 6 HL HUM LT DIST LAT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
629008	SUP	HCPCS C1713		629008  -  PLATE BN 8 HL HUM LT DIST LAT	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
629024	SUP	HCPCS C1713		629024  -  PLATE BN 4 HL HUM RT DIST LAT	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$668.25	$668.25	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$232.40	$0.00	$0.00	$236.41	$0.00	$0.00	$0.00	$0.00	$0.00
629026	SUP	HCPCS C1713		629026  -  PLATE BN 6 HL HUM RT DIST LAT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
629028	SUP	HCPCS C1713		629028  -  PLATE BN 8 HL HUM RT DIST LAT	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
629044	SUP	HCPCS C1713		629044  -  PLATE BN 4 HL HUM DP LAT	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$668.25	$668.25	$0.00	$0.00	$0.00	$309.51	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$878.38	$878.38	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$232.40	$0.00	$0.00	$236.41	$0.00	$0.00	$0.00	$0.00	$0.00
629046	SUP	HCPCS C1713		629046  -  PLATE BN 6 HL HUM L/L POST DIST	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
629048	SUP	HCPCS C1713		629048  -  PLATE BN 8 HL HUM L/L POST DIST	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$816.75	$816.75	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
629064	SUP	HCPCS C1713		629064  -  PLATE BN 4 HL HUM RL POST DIST	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$668.25	$668.25	$0.00	$0.00	$0.00	$309.51	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$878.38	$878.38	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$232.40	$0.00	$0.00	$236.41	$0.00	$0.00	$0.00	$0.00	$0.00
629066	SUP	HCPCS C1713		629066  -  PLATE BN 6 HL HUM RL POST DIST	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
629068	SUP	HCPCS C1713		629068  -  PLATE BN 8 HL HUM DP LAT	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
629084	SUP	HCPCS C1713		629084  -  PLATE BN XTD HUM DIST MDL	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$668.25	$668.25	$0.00	$0.00	$0.00	$309.51	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$878.38	$878.38	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$232.40	$0.00	$0.00	$236.41	$0.00	$0.00	$0.00	$0.00	$0.00
629086	SUP	HCPCS C1713		629086  -  PLATE BN 6 HL XTD HUM DIST MDL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
629088	SUP	HCPCS C1713		629088  -  PLATE BN XTD HUM DIST MDL	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
629104	SUP	HCPCS C1713		629104  -  PLATE BN 4 HL HUM MDL POST DIST	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$668.25	$668.25	$0.00	$0.00	$0.00	$309.51	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$878.38	$878.38	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$232.40	$0.00	$0.00	$236.41	$0.00	$0.00	$0.00	$0.00	$0.00
629106	SUP	HCPCS C1713		629106  -  DIST. POST. MED. HUM. PL. 6 HOLE / LEFT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
629108	SUP	HCPCS C1713		629108  -  PLATE BN 8 HL HUM MDL POST DIST	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
629124	SUP	HCPCS C1713		629124  -  PLATE BN 4 HL HUM MDL POST DIST	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$668.25	$668.25	$0.00	$0.00	$0.00	$309.51	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$878.38	$878.38	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$232.40	$0.00	$0.00	$236.41	$0.00	$0.00	$0.00	$0.00	$0.00
629126	SUP	HCPCS C1713		629126  -  PLATE BN 6 HL HUM MDL POST DIST	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
629128	SUP	HCPCS C1713		629128  -  PLATE BN 8 HL HUM MDL POST DIST	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
629144	SUP	HCPCS C1713		629144  -  PLATE BN 4 HL LT OLCRN	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$668.25	$668.25	$0.00	$0.00	$0.00	$309.51	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$878.38	$878.38	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$232.40	$0.00	$0.00	$236.41	$0.00	$0.00	$0.00	$0.00	$0.00
629146	SUP	HCPCS C1713		629146  -  PLATE BN 6 HL LT OLCRN	BOTH IP/OP	"$1,567.50 "	"$1,159.95"	$0.00	"$1,254.00"	$705.38	$705.38	$0.00	$0.00	$0.00	$326.71	"$1,163.40"	"$1,163.40"	$0.00	$0.00	$326.67	$0.00	$927.18	$927.18	$0.00	$783.75	"$1,241.46"	"$1,254.00"	$0.00		$0.00	$245.31	$0.00	$0.00	$249.55	$0.00	$0.00	$0.00	$0.00	$0.00
629148	SUP	HCPCS C1713		629148  -  PLATE BN 8 HL LT OLCRN	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
629164	SUP	HCPCS C1713		629164  -  OLECRANON PLATE 4 HOLE / RIGHT	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$668.25	$668.25	$0.00	$0.00	$0.00	$309.51	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$878.38	$878.38	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$232.40	$0.00	$0.00	$236.41	$0.00	$0.00	$0.00	$0.00	$0.00
629166	SUP	HCPCS C1713		629166  -  PLATE SS 6 HOLE LCK BONE OLCRN	BOTH IP/OP	"$1,567.50 "	"$1,159.95"	$0.00	"$1,254.00"	$705.38	$705.38	$0.00	$0.00	$0.00	$326.71	"$1,163.40"	"$1,163.40"	$0.00	$0.00	$326.67	$0.00	$927.18	$927.18	$0.00	$783.75	"$1,241.46"	"$1,254.00"	$0.00		$0.00	$245.31	$0.00	$0.00	$249.55	$0.00	$0.00	$0.00	$0.00	$0.00
629168	SUP	HCPCS C1713		629168  -  PLATE BN 8 HL RT OLCRN	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
629184	SUP	HCPCS C1713		629184  -  PLATE BN 4 HL HUM DIST MDL	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$668.25	$668.25	$0.00	$0.00	$0.00	$309.51	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$878.38	$878.38	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$232.40	$0.00	$0.00	$236.41	$0.00	$0.00	$0.00	$0.00	$0.00
629186	SUP	HCPCS C1713		629186  -  DIST. MED. HUM. PLATE 6 HOLE	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
629188	SUP	HCPCS C1713		629188  -  PLATE BN 8 HL HUM DIST MDL	BOTH IP/OP	"$1,815.00 "	"$1,343.10"	$0.00	"$1,452.00"	$816.75	$816.75	$0.00	$0.00	$0.00	$378.29	"$1,347.09"	"$1,347.09"	$0.00	$0.00	$378.25	$0.00	"$1,073.57"	"$1,073.57"	$0.00	$907.50	"$1,437.48"	"$1,452.00"	$0.00		$0.00	$284.05	$0.00	$0.00	$288.95	$0.00	$0.00	$0.00	$0.00	$0.00
629204	SUP	HCPCS C1713		629204  -  PLATE BN 109MM NS VARIAX 4 HL TI HUM LT DIST LAT	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$715.28	$715.28	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$794.75	"$1,258.88"	"$1,271.60"	$0.00		$0.00	$248.76	$0.00	$0.00	$253.05	$0.00	$0.00	$0.00	$0.00	$0.00
629206	SUP	HCPCS C1713		629206  -  PLATE BN 132MM NS VARIAX 6 HL TI HUM LT DIST LAT	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,412.40"	$794.48	$794.48	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$882.75	"$1,398.28"	"$1,412.40"	$0.00		$0.00	$276.30	$0.00	$0.00	$281.07	$0.00	$0.00	$0.00	$0.00	$0.00
629208	SUP	HCPCS C1713		629208  -  PLATE BN 156MM NS VARIAX 8 HL TI HUM LT DIST LAT	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$873.68	$873.68	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$970.75	"$1,537.67"	"$1,553.20"	$0.00		$0.00	$303.84	$0.00	$0.00	$309.09	$0.00	$0.00	$0.00	$0.00	$0.00
629224	SUP	HCPCS C1713		629224  -  PLATE BN 109MM NS VARIAX 4 HL TI HUM RT DIST LAT	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$715.28	$715.28	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$794.75	"$1,258.88"	"$1,271.60"	$0.00		$0.00	$248.76	$0.00	$0.00	$253.05	$0.00	$0.00	$0.00	$0.00	$0.00
629226	SUP	HCPCS C1713		629226  -  PLATE BN 132MM NS VARIAX 6 HL TI HUM RT DIST LAT	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,412.40"	$794.48	$794.48	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$882.75	"$1,398.28"	"$1,412.40"	$0.00		$0.00	$276.30	$0.00	$0.00	$281.07	$0.00	$0.00	$0.00	$0.00	$0.00
629228	SUP	HCPCS C1713		629228  -  PLATE BN 156MM NS VARIAX 8 HL TI HUM RT DIST LAT	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$873.68	$873.68	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$970.75	"$1,537.67"	"$1,553.20"	$0.00		$0.00	$303.84	$0.00	$0.00	$309.09	$0.00	$0.00	$0.00	$0.00	$0.00
629244	SUP	HCPCS C1713		629244  -  PLATE BN 105MM NS VARIAX 4 HL TI HUM LT P/L	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$715.28	$715.28	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$794.75	"$1,258.88"	"$1,271.60"	$0.00		$0.00	$248.76	$0.00	$0.00	$253.05	$0.00	$0.00	$0.00	$0.00	$0.00
629246	SUP	HCPCS C1713		629246  -  PLATE BN 128MM NS VARIAX 6 HL TI HUM LT P/L	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,412.40"	$794.48	$794.48	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$882.75	"$1,398.28"	"$1,412.40"	$0.00		$0.00	$276.30	$0.00	$0.00	$281.07	$0.00	$0.00	$0.00	$0.00	$0.00
629248	SUP	HCPCS C1713		629248  -  PLATE BN 150MM NS VARIAX 8 HL TI HUM LT P/L	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$873.68	$873.68	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$970.75	"$1,537.67"	"$1,553.20"	$0.00		$0.00	$303.84	$0.00	$0.00	$309.09	$0.00	$0.00	$0.00	$0.00	$0.00
629264	SUP	HCPCS C1713		629264  -  PLATE BN 105MM NS VARIAX 4 HL TI HUM RT P/L	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$715.28	$715.28	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$794.75	"$1,258.88"	"$1,271.60"	$0.00		$0.00	$248.76	$0.00	$0.00	$253.05	$0.00	$0.00	$0.00	$0.00	$0.00
629266	SUP	HCPCS C1713		629266  -  PLATE BN 128MM NS VARIAX 6 HL TI HUM RT P/L	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,412.40"	$794.48	$794.48	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$882.75	"$1,398.28"	"$1,412.40"	$0.00		$0.00	$276.30	$0.00	$0.00	$281.07	$0.00	$0.00	$0.00	$0.00	$0.00
629268	SUP	HCPCS C1713		629268  -  PLATE BN 150MM NS VARIAX 8 HL TI HUM RT P/L	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$873.68	$873.68	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$970.75	"$1,537.67"	"$1,553.20"	$0.00		$0.00	$303.84	$0.00	$0.00	$309.09	$0.00	$0.00	$0.00	$0.00	$0.00
629284	SUP	HCPCS C1713		629284  -  PLATE BN 96MM NS VARIAX 4 HL XTD TI HUM DIST MDL	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$715.28	$715.28	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$794.75	"$1,258.88"	"$1,271.60"	$0.00		$0.00	$248.76	$0.00	$0.00	$253.05	$0.00	$0.00	$0.00	$0.00	$0.00
629286	SUP	HCPCS C1713		629286  -  PLATE BN 120MM NS VARIAX 6 HL XTD TI HUM DIST MDL	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,412.40"	$794.48	$794.48	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$882.75	"$1,398.28"	"$1,412.40"	$0.00		$0.00	$276.30	$0.00	$0.00	$281.07	$0.00	$0.00	$0.00	$0.00	$0.00
629288	SUP	HCPCS C1713		629288  -  PLATE BN 143MM NS VARIAX 8 HL XTD TI HUM DIST MDL	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$873.68	$873.68	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$970.75	"$1,537.67"	"$1,553.20"	$0.00		$0.00	$303.84	$0.00	$0.00	$309.09	$0.00	$0.00	$0.00	$0.00	$0.00
629304	SUP	HCPCS C1713		629304  -  PLATE 104MM TI 4 SHFT HOLE VARIAX BONE LEFT POST MDL ELB	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$715.28	$715.28	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$794.75	"$1,258.88"	"$1,271.60"	$0.00		$0.00	$248.76	$0.00	$0.00	$253.05	$0.00	$0.00	$0.00	$0.00	$0.00
629306	SUP	HCPCS C1713		629306  -  PLATE 128MM TI 6 SHFT HOLE VARIAX BONE LEFT POST MDL ELB	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,412.40"	$794.48	$794.48	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$882.75	"$1,398.28"	"$1,412.40"	$0.00		$0.00	$276.30	$0.00	$0.00	$281.07	$0.00	$0.00	$0.00	$0.00	$0.00
629308	SUP	HCPCS C1713		629308  -  PLATE 151MM TI 8 SHFT HOLE VARIAX BONE LEFT POST MDL ELB	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$873.68	$873.68	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$970.75	"$1,537.67"	"$1,553.20"	$0.00		$0.00	$303.84	$0.00	$0.00	$309.09	$0.00	$0.00	$0.00	$0.00	$0.00
629324	SUP	HCPCS C1713		629324  -  PLATE 104MM TI 4 SHFT HOLE VARIAX BONE RIGHT POST MDL ELB	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$715.28	$715.28	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$794.75	"$1,258.88"	"$1,271.60"	$0.00		$0.00	$248.76	$0.00	$0.00	$253.05	$0.00	$0.00	$0.00	$0.00	$0.00
629326	SUP	HCPCS C1713		629326  -  PLATE 128MM TI 6 SHFT HOLE VARIAX BONE RIGHT POST MDL ELB	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,412.40"	$794.48	$794.48	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$882.75	"$1,398.28"	"$1,412.40"	$0.00		$0.00	$276.30	$0.00	$0.00	$281.07	$0.00	$0.00	$0.00	$0.00	$0.00
629328	SUP	HCPCS C1713		629328  -  PLATE 151MM TI 8 SHFT HOLE VARIAX BONE RIGHT POST MDL ELB	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$873.68	$873.68	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$970.75	"$1,537.67"	"$1,553.20"	$0.00		$0.00	$303.84	$0.00	$0.00	$309.09	$0.00	$0.00	$0.00	$0.00	$0.00
629344	SUP	HCPCS C1713		629344  -  PLATE BN 89MM NS VARIAX 4 HL TI OLCRN LT	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$715.28	$715.28	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$794.75	"$1,258.88"	"$1,271.60"	$0.00		$0.00	$248.76	$0.00	$0.00	$253.05	$0.00	$0.00	$0.00	$0.00	$0.00
629346	SUP	HCPCS C1713		629346  -  PLATE BN 113MM NS VARIAX 6 HL TI OLCRN LT	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$754.88	$754.88	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$838.75	"$1,328.58"	"$1,342.00"	$0.00		$0.00	$262.53	$0.00	$0.00	$267.06	$0.00	$0.00	$0.00	$0.00	$0.00
629348	SUP	HCPCS C1713		629348  -  PLATE BN 137MM NS VARIAX 8 HL TI OLCRN LT	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$794.48	$794.48	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$882.75	"$1,398.28"	"$1,412.40"	$0.00		$0.00	$276.30	$0.00	$0.00	$281.07	$0.00	$0.00	$0.00	$0.00	$0.00
629364	SUP	HCPCS C1713		629364  -  PLATE BN 89MM NS VARIAX 4 HL TI OLCRN RT	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$715.28	$715.28	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$794.75	"$1,258.88"	"$1,271.60"	$0.00		$0.00	$248.76	$0.00	$0.00	$253.05	$0.00	$0.00	$0.00	$0.00	$0.00
629366	SUP	HCPCS C1713		629366  -  PLATE BN 113MM NS VARIAX 6 HL TI OLCRN RT	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$754.88	$754.88	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$838.75	"$1,328.58"	"$1,342.00"	$0.00		$0.00	$262.53	$0.00	$0.00	$267.06	$0.00	$0.00	$0.00	$0.00	$0.00
629368	SUP	HCPCS C1713		629368  -  PLATE BN 137MM NS VARIAX 8 HL TI OLCRN RT	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$794.48	$794.48	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$882.75	"$1,398.28"	"$1,412.40"	$0.00		$0.00	$276.30	$0.00	$0.00	$281.07	$0.00	$0.00	$0.00	$0.00	$0.00
629384	SUP	HCPCS C1713		629384  -  PLATE BN 92MM NS VARIAX 4 HL TI HUM DIST MDL	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,387.17"	$715.28	$715.28	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$794.75	"$1,258.88"	"$1,271.60"	$0.00		$0.00	$248.76	$0.00	$0.00	$253.05	$0.00	$0.00	$0.00	$0.00	$0.00
629385	SUP	Custom 27203010		629385  -  STYLET LEAD STR BALL TAPER .016IN 85CM KIT EXTEND KNOB	BOTH IP/OP	$16.00 	$11.84	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$11.88	$0.00	$0.00	$3.33	$0.00	$0.00	$0.00	$0.00	$8.00	$12.67	$12.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
629386	SUP	HCPCS C1713		629386  -  PLATE BN 116MM NS VARIAX 6 HL TI HUM DIST MDL	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,412.40"	$794.48	$794.48	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$882.75	"$1,398.28"	"$1,412.40"	$0.00		$0.00	$276.30	$0.00	$0.00	$281.07	$0.00	$0.00	$0.00	$0.00	$0.00
629388	SUP	HCPCS C1713		629388  -  PLATE BN 139MM NS VARIAX 8 HL TI HUM DIST MDL	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$873.68	$873.68	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$970.75	"$1,537.67"	"$1,553.20"	$0.00		$0.00	$303.84	$0.00	$0.00	$309.09	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-25	SUP	Custom 27803010		06-3625  -  HEAD FEM +2.5MM OFST CTPR 36MM STRL LFIT ANTM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
631400	SUP	Custom 27203010		631400  -  PARTICLES EMBL TRFL KT LQ SYS NBCA 2GM	BOTH IP/OP	"$10,375.00 "	"$7,677.50"	$0.00	"$8,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,162.15"	$0.00	$0.00	$0.00	$0.00	"$5,187.50"	"$8,217.00"	"$8,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
631500	SUP	Custom 27203010		631500  -  PARTICLES EMBL TRFL KT LQ SYS NBCA 1GM	BOTH IP/OP	"$8,099.68 "	"$5,993.76"	$0.00	"$6,479.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,687.97"	$0.00	$0.00	$0.00	$0.00	"$4,049.84"	"$6,414.95"	"$6,479.74"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
633000	SUP	HCPCS C1884		COIL EMBL 2MM .014IN TRFL STRG PSH 2CM PLTN NRVSC	BOTH IP/OP	$172.50 	$127.65	$0.00	$138.00	$77.63	$77.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.25	$136.62	$138.00	$0.00		$0.00	$27.00	$0.00	$0.00	$27.46	$0.00	$0.00	$0.00	$0.00	$0.00
633340	SUP	HCPCS C1884		COIL EMBL 5MM TRFL PSH CMPLX SHP	BOTH IP/OP	$389.50 	$288.23	$0.00	$311.60	$175.28	$175.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.75	$308.48	$311.60	$0.00		$0.00	$60.96	$0.00	$0.00	$62.01	$0.00	$0.00	$0.00	$0.00	$0.00
633360	SUP	HCPCS C1884		COIL EMBL 60MM 7MM TRFL OCL PSH CMPLX SHP NYL	BOTH IP/OP	$389.50 	$288.23	$0.00	$311.60	$175.28	$175.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.75	$308.48	$311.60	$0.00		$0.00	$60.96	$0.00	$0.00	$62.01	$0.00	$0.00	$0.00	$0.00	$0.00
635002	SUP	Custom 27803010		635002  -  SYRINGE INFLAT/DEFLATION INDEFLATOR TRUFILL DCS II PLATINUM	BOTH IP/OP	$674.40 	$499.06	$0.00	$539.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.54	$500.54	$0.00	$0.00	$140.54	$0.00	$0.00	$0.00	$0.00	$337.20	$534.12	$539.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
636032	SUP	HCPCS C1713		636032  -  SPACER 636032 PERIMETER XS 10X13X12MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636053	SUP	HCPCS C1713		636053  -  SPACER 636053 PERIMETER XS 10X15X13MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636132	SUP	HCPCS C1713		636132  -  SPACER 636132 PERIMETER XS 11X13X12MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636153	SUP	HCPCS C1713		636153  -  SPACER 636153 PERIMETER XS 11X15X13MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636232	SUP	HCPCS C1713		636232  -  SPACER 636232 PERIMETER XS 12X13X12MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636253	SUP	HCPCS C1713		636253  -  SPACER 636253 PERIMETER XS 12X15X13MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636532	SUP	HCPCS C1713		636532  -  SPACER 636532 PERIMETER XS 5X13X12MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636553	SUP	HCPCS C1713		636553  -  SPACER 636553 PERIMETER XS 5X15X13MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636632	SUP	HCPCS C1713		636632  -  SPACER 636632 PERIMETER XS 6X13X12MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636653	SUP	HCPCS C1713		636653  -  SPACER 636653 PERIMETER XS 6X15X13MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636732	SUP	HCPCS C1713		636732  -  SPACER 636732 PERIMETER XS 7X13X12MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636753	SUP	HCPCS C1713		636753  -  SPACER 636753 PERIMETER XS 7X15X13MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636832	SUP	HCPCS C1713		636832  -  SPACER 636832 PERIMETER XS 8X13X12MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636853	SUP	HCPCS C1713		636853  -  SPACER 636853 PERIMETER XS 8X15X13MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636932	SUP	HCPCS C1713		636932  -  SPACER 636932 PERIMETER XS 9X13X12MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
636953	SUP	HCPCS C1713		636953  -  SPACER SPNL XS 15X13X9MM PRIMTR PEEK-OPTM LMBR INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-75	SUP	Custom 27803010		06-3675  -  HEAD FEM +7.5MM OFST CTPR 36MM STRL LFIT ANTM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
650038	SUP	Custom 27203010		CONTROL CHM LX SER LVL 1 2 HBA1C SYN VIGIL	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
653050	SUP	HCPCS C1762		653050  -  GRAFT BONE SHORT 5X2.5CM DEMINERALIZED BONE MATRIX	BOTH IP/OP	"$6,800.00 "	"$5,032.00"	$0.00	"$5,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,417.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,417.12"	$0.00	"$3,352.40"	"$3,352.40"	$0.00	"$3,400.00"	"$5,385.60"	"$5,440.00"	$0.00		$0.00	"$1,064.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
653100	SUP	HCPCS C1762		653100  -  GRAFT BONE BIO BOAT ALLOGRAFT DEMINERALIZED BONE MATRIX 20ML	BOTH IP/OP	"$10,975.00 "	"$8,121.50"	$0.00	"$8,780.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,287.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,287.19"	$0.00	"$5,410.68"	"$5,410.68"	$0.00	"$5,487.50"	"$8,692.20"	"$8,780.00"	$0.00		$0.00	"$1,717.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-97	SUP	Custom 27803010		06-3697  -  HEAD FEMORAL C TAPER LOW FRICTION HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-99	SUP	Custom 27803010		06-3699  -  HEAD FEMORAL -5 36MM C TAPER ANATOMIC LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663940	SUP	Custom 27203010		CALIBRATOR MLANLT IMMAGE ARY 1ML IMMUN	BOTH IP/OP	$543.75 	$402.38	$0.00	$435.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.88	$430.65	$435.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665040	SUP	Custom 27803010		665040  -  ROD SPINAL 6MM 40MM UNION DIAPASON TITANIUM THORACOLUMBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665050	SUP	Custom 27803010		665050  -  ROD SPINAL 6MM 50MM UNION DIAPASON TITANIUM THORACOLUMBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665060	SUP	Custom 27803010		665060  -  ROD SPINAL 6MM 60MM UNION DIAPASON TITANIUM THORACOLUMBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665070	SUP	Custom 27803010		665070  -  ROD SPINAL 6MM 70MM UNION TRIO THORACOLUMBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665080	SUP	Custom 27803010		665080  -  ROD SPINAL 6MM 80MM UNION DIAPASON TITANIUM THORACOLUMBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665090	SUP	Custom 27803010		665090  -  ROD SPINAL 6MM 90MM UNION TRIO THORACOLUMBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665100	SUP	Custom 27803010		665100  -  ROD SPINAL 6MM 100MM UNION DIAPASON TITANIUM THORACOLUMBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665110	SUP	Custom 27803010		665110  -  ROD SPINAL 6MM 110MM UNION DIAPASON TITANIUM THORACOLUMBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665120	SUP	Custom 27803010		665120  -  ROD SPINAL 6MM 120MM UNION DIAPASON OSS TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665130	SUP	Custom 27803010		665130  -  ROD SPINAL 6MM 130MM UNION DIAPASON TITANIUM THORACOLUMBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665140	SUP	Custom 27803010		665140  -  ROD SPINAL 6MM 140MM UNION TOP LOADING TRIO THORACOLUMBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665150	SUP	Custom 27803010		665150  -  ROD SPINAL 6MM 150MM UNION DIAPASON TITANIUM THORACOLUMBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665160	SUP	Custom 27803010		665160  -  ROD SPINAL 6MM 160MM UNION DIAPASON OSS TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665170	SUP	Custom 27803010		665170  -  ROD SPINAL 6MM 170MM UNION DIAPASON TITANIUM THORACOLUMBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665180	SUP	Custom 27803010		665180  -  ROD SPINAL 6MM 180MM UNION DIAPASON OSS TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665190	SUP	Custom 27803010		665190  -  ROD SPINAL 190MM UNION DIAPASON TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665200	SUP	Custom 27803010		665200  -  ROD SPINAL 6MM 200MM UNION DIAPASON TITANIUM PEDICLE	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665210	SUP	Custom 27803010		665210  -  ROD SPINAL 210MM UNION DIAPASON OSS TITANIUM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665250	SUP	Custom 27803010		665250  -  ROD SPINAL 250MM UNION DIAPASON OSS TITANIUM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665270	SUP	Custom 27803010		665270  -  ROD SPINAL 270MM UNION DIAPASON OSS TITANIUM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665300	SUP	Custom 27803010		665300  -  ROD SPINAL 300MM UNION DIAPASON OSS TITANIUM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665350	SUP	Custom 27803010		665350  -  ROD SPINAL 6MM 350MM UNION TRIO THORACOLUMBAR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665400	SUP	Custom 27803010		665400  -  ROD SPINAL 6MM 400MM UNION DIAPASON TITANIUM PEDICLE	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
665480	SUP	Custom 27803010		665480  -  ROD SPINAL 6MM 480MM UNION DIAPASON TITANIUM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
670001	SUP	HCPCS C1713		670001  -  SCREW BONE 6.7MM 35MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,675.90 "	"$1,240.17"	$0.00	"$1,340.72"	$754.16	$754.16	$0.00	$0.00	$0.00	$349.30	"$1,243.85"	"$1,243.85"	$0.00	$0.00	$349.26	$0.00	$991.29	$991.29	$0.00	$837.95	"$1,327.31"	"$1,340.72"	$0.00		$0.00	$262.28	$0.00	$0.00	$266.80	$0.00	$0.00	$0.00	$0.00	$0.00
670002	SUP	HCPCS C1713		670002  -  SCREW BONE 6.7MM 40MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,675.90 "	"$1,240.17"	$0.00	"$1,340.72"	$754.16	$754.16	$0.00	$0.00	$0.00	$349.30	"$1,243.85"	"$1,243.85"	$0.00	$0.00	$349.26	$0.00	$991.29	$991.29	$0.00	$837.95	"$1,327.31"	"$1,340.72"	$0.00		$0.00	$262.28	$0.00	$0.00	$266.80	$0.00	$0.00	$0.00	$0.00	$0.00
670003	SUP	HCPCS C1713		670003  -  SCREW BONE 6.7MM 45MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,675.90 "	"$1,240.17"	$0.00	"$1,340.72"	$754.16	$754.16	$0.00	$0.00	$0.00	$349.30	"$1,243.85"	"$1,243.85"	$0.00	$0.00	$349.26	$0.00	$991.29	$991.29	$0.00	$837.95	"$1,327.31"	"$1,340.72"	$0.00		$0.00	$262.28	$0.00	$0.00	$266.80	$0.00	$0.00	$0.00	$0.00	$0.00
670004	SUP	HCPCS C1713		670004  -  SCREW BONE 6.5MM 50MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,675.90 "	"$1,240.17"	$0.00	"$1,340.72"	$754.16	$754.16	$0.00	$0.00	$0.00	$349.30	"$1,243.85"	"$1,243.85"	$0.00	$0.00	$349.26	$0.00	$991.29	$991.29	$0.00	$837.95	"$1,327.31"	"$1,340.72"	$0.00		$0.00	$262.28	$0.00	$0.00	$266.80	$0.00	$0.00	$0.00	$0.00	$0.00
670005	SUP	HCPCS C1713		670005  -  SCREW BONE 7.5MM 35MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,675.90 "	"$1,240.17"	$0.00	"$1,340.72"	$754.16	$754.16	$0.00	$0.00	$0.00	$349.30	"$1,243.85"	"$1,243.85"	$0.00	$0.00	$349.26	$0.00	$991.29	$991.29	$0.00	$837.95	"$1,327.31"	"$1,340.72"	$0.00		$0.00	$262.28	$0.00	$0.00	$266.80	$0.00	$0.00	$0.00	$0.00	$0.00
670006	SUP	HCPCS C1713		670006  -  SCREW BONE 7.5MM 40MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,675.90 "	"$1,240.17"	$0.00	"$1,340.72"	$754.16	$754.16	$0.00	$0.00	$0.00	$349.30	"$1,243.85"	"$1,243.85"	$0.00	$0.00	$349.26	$0.00	$991.29	$991.29	$0.00	$837.95	"$1,327.31"	"$1,340.72"	$0.00		$0.00	$262.28	$0.00	$0.00	$266.80	$0.00	$0.00	$0.00	$0.00	$0.00
670007	SUP	HCPCS C1713		670007  -  SCREW BONE 7.5MM 45MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,675.90 "	"$1,240.17"	$0.00	"$1,340.72"	$754.16	$754.16	$0.00	$0.00	$0.00	$349.30	"$1,243.85"	"$1,243.85"	$0.00	$0.00	$349.26	$0.00	$991.29	$991.29	$0.00	$837.95	"$1,327.31"	"$1,340.72"	$0.00		$0.00	$262.28	$0.00	$0.00	$266.80	$0.00	$0.00	$0.00	$0.00	$0.00
670008	SUP	HCPCS C1713		670008  -  SCREW BONE 7.5MM 50MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,675.90 "	"$1,240.17"	$0.00	"$1,340.72"	$754.16	$754.16	$0.00	$0.00	$0.00	$349.30	"$1,243.85"	"$1,243.85"	$0.00	$0.00	$349.26	$0.00	$991.29	$991.29	$0.00	$837.95	"$1,327.31"	"$1,340.72"	$0.00		$0.00	$262.28	$0.00	$0.00	$266.80	$0.00	$0.00	$0.00	$0.00	$0.00
670009	SUP	HCPCS C1713		670009  -  SCREW BONE 7.5MM 55MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,675.90 "	"$1,240.17"	$0.00	"$1,340.72"	$754.16	$754.16	$0.00	$0.00	$0.00	$349.30	"$1,243.85"	"$1,243.85"	$0.00	$0.00	$349.26	$0.00	$991.29	$991.29	$0.00	$837.95	"$1,327.31"	"$1,340.72"	$0.00		$0.00	$262.28	$0.00	$0.00	$266.80	$0.00	$0.00	$0.00	$0.00	$0.00
670015	SUP	HCPCS C1713		670015  -  SCREW BONE 6.5MM 55MM OPUS SPNL CYLND	BOTH IP/OP	"$1,505.15 "	"$1,113.81"	$0.00	"$1,204.12"	$677.32	$677.32	$0.00	$0.00	$0.00	$313.71	"$1,117.12"	"$1,117.12"	$0.00	$0.00	$313.67	$0.00	$890.30	$890.30	$0.00	$752.58	"$1,192.08"	"$1,204.12"	$0.00		$0.00	$235.56	$0.00	$0.00	$239.62	$0.00	$0.00	$0.00	$0.00	$0.00
670062	SUP	HCPCS C1713		670062  -  SCREW BONE 5.5MM 35MM OPUS LNG SPNL HEX CONICAL	BOTH IP/OP	"$1,073.85 "	$794.65	$0.00	$859.08	$483.23	$483.23	$0.00	$0.00	$0.00	$223.82	$797.01	$797.01	$0.00	$0.00	$223.79	$0.00	$635.18	$635.18	$0.00	$536.93	$850.49	$859.08	$0.00		$0.00	$168.06	$0.00	$0.00	$170.96	$0.00	$0.00	$0.00	$0.00	$0.00
670063	SUP	HCPCS C1713		670063  -  SCREW BONE 5.5MM 40MM OPUS LNG SPNL HEX CONICAL	BOTH IP/OP	"$1,073.85 "	$794.65	$0.00	$859.08	$483.23	$483.23	$0.00	$0.00	$0.00	$223.82	$797.01	$797.01	$0.00	$0.00	$223.79	$0.00	$635.18	$635.18	$0.00	$536.93	$850.49	$859.08	$0.00		$0.00	$168.06	$0.00	$0.00	$170.96	$0.00	$0.00	$0.00	$0.00	$0.00
670071	SUP	HCPCS C1713		670071  -  SCREW BONE 6.5MM 35MM OPUS LNG SPNL HEX CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670072	SUP	HCPCS C1713		670072  -  SCREW BONE 6.5MM 40MM OPUS LNG SPNL HEX CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670073	SUP	HCPCS C1713		670073  -  SCREW BONE 6.5MM 45MM OPUS LNG SPNL HEX CONICAL	BOTH IP/OP	"$1,644.45 "	"$1,216.89"	$0.00	"$1,315.56"	$740.00	$740.00	$0.00	$0.00	$0.00	$342.74	"$1,220.51"	"$1,220.51"	$0.00	$0.00	$342.70	$0.00	$972.69	$972.69	$0.00	$822.23	"$1,302.40"	"$1,315.56"	$0.00		$0.00	$257.36	$0.00	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00
670074	SUP	HCPCS C1713		670074  -  SCREW BONE 6.5MM 50MM OPUS LNG SPNL HEX CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670075	SUP	HCPCS C1713		670075  -  SCREW BONE 6.5MM 55MM OPUS LNG SPNL HEX CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670081	SUP	HCPCS C1713		670081  -  SCREW BONE 7.5MM 35MM OPUS LNG SPNL HEX CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670082	SUP	HCPCS C1713		670082  -  SCREW BONE 7.5MM 40MM OPUS LNG SPNL HEX CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670083	SUP	HCPCS C1713		670083  -  SCREW BONE 7.5MM 45MM OPUS LNG SPNL HEX CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670084	SUP	HCPCS C1713		670084  -  SCREW BONE 7.5MM 50MM OPUS LNG SPNL HEX CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670086	SUP	HCPCS C1713		670086  -  SCREW BONE 7.5MM 55MM OPUS LNG SPNL HEX CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670102	SUP	HCPCS C1713		670102  -  SCREW BONE 8MM 40MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,026.65 "	$759.72	$0.00	$821.32	$461.99	$461.99	$0.00	$0.00	$0.00	$213.98	$761.98	$761.98	$0.00	$0.00	$213.95	$0.00	$607.26	$607.26	$0.00	$513.33	$813.11	$821.32	$0.00		$0.00	$160.67	$0.00	$0.00	$163.44	$0.00	$0.00	$0.00	$0.00	$0.00
670103	SUP	HCPCS C1713		670103  -  SCREW BONE 8MM 45MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,026.65 "	$759.72	$0.00	$821.32	$461.99	$461.99	$0.00	$0.00	$0.00	$213.98	$761.98	$761.98	$0.00	$0.00	$213.95	$0.00	$607.26	$607.26	$0.00	$513.33	$813.11	$821.32	$0.00		$0.00	$160.67	$0.00	$0.00	$163.44	$0.00	$0.00	$0.00	$0.00	$0.00
670111	SUP	HCPCS C1713		670111  -  SCREW BONE 9MM 35MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,062.58 "	$786.31	$0.00	$850.06	$478.16	$478.16	$0.00	$0.00	$0.00	$221.47	$788.64	$788.64	$0.00	$0.00	$221.44	$0.00	$628.51	$628.51	$0.00	$531.29	$841.56	$850.06	$0.00		$0.00	$166.29	$0.00	$0.00	$169.16	$0.00	$0.00	$0.00	$0.00	$0.00
670112	SUP	HCPCS C1713		670112  -  SCREW BONE 9MM 40MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,062.58 "	$786.31	$0.00	$850.06	$478.16	$478.16	$0.00	$0.00	$0.00	$221.47	$788.64	$788.64	$0.00	$0.00	$221.44	$0.00	$628.51	$628.51	$0.00	$531.29	$841.56	$850.06	$0.00		$0.00	$166.29	$0.00	$0.00	$169.16	$0.00	$0.00	$0.00	$0.00	$0.00
670113	SUP	HCPCS C1713		670113  -  SCREW BONE 9MM 45MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,062.58 "	$786.31	$0.00	$850.06	$478.16	$478.16	$0.00	$0.00	$0.00	$221.47	$788.64	$788.64	$0.00	$0.00	$221.44	$0.00	$628.51	$628.51	$0.00	$531.29	$841.56	$850.06	$0.00		$0.00	$166.29	$0.00	$0.00	$169.16	$0.00	$0.00	$0.00	$0.00	$0.00
670114	SUP	HCPCS C1713		670114  -  SCREW BONE 9MM 50MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,062.58 "	$786.31	$0.00	$850.06	$478.16	$478.16	$0.00	$0.00	$0.00	$221.47	$788.64	$788.64	$0.00	$0.00	$221.44	$0.00	$628.51	$628.51	$0.00	$531.29	$841.56	$850.06	$0.00		$0.00	$166.29	$0.00	$0.00	$169.16	$0.00	$0.00	$0.00	$0.00	$0.00
670115	SUP	HCPCS C1713		670115  -  SCREW BONE 9MM 55MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,062.58 "	$786.31	$0.00	$850.06	$478.16	$478.16	$0.00	$0.00	$0.00	$221.47	$788.64	$788.64	$0.00	$0.00	$221.44	$0.00	$628.51	$628.51	$0.00	$531.29	$841.56	$850.06	$0.00		$0.00	$166.29	$0.00	$0.00	$169.16	$0.00	$0.00	$0.00	$0.00	$0.00
670213	SUP	HCPCS C1713		670213  -  SCREW BONE 5.5MM 35MM OPUS SPNL SGTL DUAL CUT	BOTH IP/OP	"$1,505.15 "	"$1,113.81"	$0.00	"$1,204.12"	$677.32	$677.32	$0.00	$0.00	$0.00	$313.71	"$1,117.12"	"$1,117.12"	$0.00	$0.00	$313.67	$0.00	$890.30	$890.30	$0.00	$752.58	"$1,192.08"	"$1,204.12"	$0.00		$0.00	$235.56	$0.00	$0.00	$239.62	$0.00	$0.00	$0.00	$0.00	$0.00
670214	SUP	HCPCS C1713		670214  -  SCREW BONE 5.5MM 40MM OPUS SPNL CONICAL	BOTH IP/OP	"$1,675.90 "	"$1,240.17"	$0.00	"$1,340.72"	$754.16	$754.16	$0.00	$0.00	$0.00	$349.30	"$1,243.85"	"$1,243.85"	$0.00	$0.00	$349.26	$0.00	$991.29	$991.29	$0.00	$837.95	"$1,327.31"	"$1,340.72"	$0.00		$0.00	$262.28	$0.00	$0.00	$266.80	$0.00	$0.00	$0.00	$0.00	$0.00
670221	SUP	HCPCS C1713		670221  -  PLATE LNG 35MM 2 HOLE OPUS BONE SPNL	BOTH IP/OP	"$2,619.45 "	"$1,938.39"	$0.00	"$2,095.56"	"$1,178.75"	"$1,178.75"	$0.00	$0.00	$0.00	$545.96	"$1,944.16"	"$1,944.16"	$0.00	$0.00	$545.89	$0.00	"$1,291.39"	"$1,291.39"	$0.00	"$1,309.73"	"$2,074.60"	"$2,095.56"	$0.00		$0.00	$409.94	$0.00	$0.00	$417.02	$0.00	$0.00	$0.00	$0.00	$0.00
670222	SUP	HCPCS C1713		670222  -  PLATE SHRT 2 HOLE OPUS BONE SPNL	BOTH IP/OP	"$2,619.45 "	"$1,938.39"	$0.00	"$2,095.56"	"$1,178.75"	"$1,178.75"	$0.00	$0.00	$0.00	$545.96	"$1,944.16"	"$1,944.16"	$0.00	$0.00	$545.89	$0.00	"$1,291.39"	"$1,291.39"	$0.00	"$1,309.73"	"$2,074.60"	"$2,095.56"	$0.00		$0.00	$409.94	$0.00	$0.00	$417.02	$0.00	$0.00	$0.00	$0.00	$0.00
670223	SUP	HCPCS C1713		670223  -  PLATE LNG 3 HOLE OPUS BONE SPNL	BOTH IP/OP	"$2,772.18 "	"$2,051.41"	$0.00	"$2,217.74"	"$1,247.48"	"$1,247.48"	$0.00	$0.00	$0.00	$577.79	"$2,057.51"	"$2,057.51"	$0.00	$0.00	$577.72	$0.00	"$1,366.68"	"$1,366.68"	$0.00	"$1,386.09"	"$2,195.57"	"$2,217.74"	$0.00		$0.00	$433.85	$0.00	$0.00	$441.33	$0.00	$0.00	$0.00	$0.00	$0.00
670224	SUP	HCPCS C1713		670224  -  PLATE 90MM OPUS BONE SPNL	BOTH IP/OP	"$2,621.70 "	"$1,940.06"	$0.00	"$2,097.36"	"$1,179.77"	"$1,179.77"	$0.00	$0.00	$0.00	$546.43	"$1,945.83"	"$1,945.83"	$0.00	$0.00	$546.36	$0.00	"$1,292.50"	"$1,292.50"	$0.00	"$1,310.85"	"$2,076.39"	"$2,097.36"	$0.00		$0.00	$410.30	$0.00	$0.00	$417.37	$0.00	$0.00	$0.00	$0.00	$0.00
670225	SUP	HCPCS C1713		670225  -  PLATE 105MM OPUS BONE SPNL	BOTH IP/OP	"$2,495.88 "	"$1,846.95"	$0.00	"$1,996.70"	"$1,123.14"	"$1,123.14"	$0.00	$0.00	$0.00	$520.20	"$1,852.44"	"$1,852.44"	$0.00	$0.00	$520.14	$0.00	"$1,476.31"	"$1,476.31"	$0.00	"$1,247.94"	"$1,976.74"	"$1,996.70"	$0.00		$0.00	$390.60	$0.00	$0.00	$397.34	$0.00	$0.00	$0.00	$0.00	$0.00
670226	SUP	HCPCS C1713		670226  -  PLATE 120MM OPUS BONE SPNL	BOTH IP/OP	"$2,495.88 "	"$1,846.95"	$0.00	"$1,996.70"	"$1,123.14"	"$1,123.14"	$0.00	$0.00	$0.00	$520.20	"$1,852.44"	"$1,852.44"	$0.00	$0.00	$520.14	$0.00	"$1,476.31"	"$1,476.31"	$0.00	"$1,247.94"	"$1,976.74"	"$1,996.70"	$0.00		$0.00	$390.60	$0.00	$0.00	$397.34	$0.00	$0.00	$0.00	$0.00	$0.00
670282	SUP	Custom 27803010		670282  -  CONCTR ROD 35MM 5.5MM OPUS LONGTOP SPNL	BOTH IP/OP	"$1,121.03 "	$829.56	$0.00	$896.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$832.02	$832.02	$0.00	$0.00	$233.62	$0.00	$0.00	$0.00	$0.00	$560.51	$887.86	$896.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
670283	SUP	Custom 27803010		670283  -  CONCTR ROD 40MM 5.5MM OPUS LONGTOP SPNL	BOTH IP/OP	"$1,121.03 "	$829.56	$0.00	$896.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$832.02	$832.02	$0.00	$0.00	$233.62	$0.00	$0.00	$0.00	$0.00	$560.51	$887.86	$896.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
670301	SUP	HCPCS C1713		670301  -  SCREW BONE 6.5MM 35MM OPUS SPNL LNG TOP CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670302	SUP	HCPCS C1713		670302  -  SCREW BONE 6.5MM 40MM OPUS SPNL LNG TOP CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670303	SUP	HCPCS C1713		670303  -  SCREW BONE 6.5MM 45MM OPUS SPNL LNG TOP CONICAL	BOTH IP/OP	"$1,644.45 "	"$1,216.89"	$0.00	"$1,315.56"	$740.00	$740.00	$0.00	$0.00	$0.00	$342.74	"$1,220.51"	"$1,220.51"	$0.00	$0.00	$342.70	$0.00	$972.69	$972.69	$0.00	$822.23	"$1,302.40"	"$1,315.56"	$0.00		$0.00	$257.36	$0.00	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00
670304	SUP	HCPCS C1713		670304  -  SCREW BONE 6.5MM 50MM OPUS SPNL LNG TOP CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670305	SUP	HCPCS C1713		670305  -  SCREW BONE 6.5MM 55MM OPUS SPNL LNG TOP CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670311	SUP	HCPCS C1713		670311  -  SCREW BONE 7.5MM 35MM OPUS SPNL LNG TOP CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670312	SUP	HCPCS C1713		670312  -  SCREW BONE 7.5MM 40MM OPUS SPNL LNG TOP CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670313	SUP	HCPCS C1713		670313  -  SCREW BONE 7.5MM 45MM OPUS SPNL LNG TOP CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670314	SUP	HCPCS C1713		670314  -  SCREW BONE 7.5MM 50MM OPUS SPNL LNG TOP CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670315	SUP	HCPCS C1713		670315  -  SCREW BONE 7.5MM 55MM OPUS SPNL LNG TOP CONICAL	BOTH IP/OP	"$1,565.80 "	"$1,158.69"	$0.00	"$1,252.64"	$704.61	$704.61	$0.00	$0.00	$0.00	$326.35	"$1,162.14"	"$1,162.14"	$0.00	$0.00	$326.31	$0.00	$926.17	$926.17	$0.00	$782.90	"$1,240.11"	"$1,252.64"	$0.00		$0.00	$245.05	$0.00	$0.00	$249.28	$0.00	$0.00	$0.00	$0.00	$0.00
670371	SUP	HCPCS C1713		670371  -  SCREW BONE 6.5MM 35MM OPUS SPNL LNG TOP LNG HEX CONICAL	BOTH IP/OP	"$1,073.85 "	$794.65	$0.00	$859.08	$483.23	$483.23	$0.00	$0.00	$0.00	$223.82	$797.01	$797.01	$0.00	$0.00	$223.79	$0.00	$635.18	$635.18	$0.00	$536.93	$850.49	$859.08	$0.00		$0.00	$168.06	$0.00	$0.00	$170.96	$0.00	$0.00	$0.00	$0.00	$0.00
670372	SUP	HCPCS C1713		670372  -  SCREW BONE 6.5MM 40MM OPUS SPNL LNG TOP LNG HEX CONICAL	BOTH IP/OP	"$1,073.85 "	$794.65	$0.00	$859.08	$483.23	$483.23	$0.00	$0.00	$0.00	$223.82	$797.01	$797.01	$0.00	$0.00	$223.79	$0.00	$635.18	$635.18	$0.00	$536.93	$850.49	$859.08	$0.00		$0.00	$168.06	$0.00	$0.00	$170.96	$0.00	$0.00	$0.00	$0.00	$0.00
670373	SUP	HCPCS C1713		670373  -  SCREW BONE 6.5MM 45MM OPUS SPNL LNG TOP LNG HEX CONICAL	BOTH IP/OP	"$1,073.85 "	$794.65	$0.00	$859.08	$483.23	$483.23	$0.00	$0.00	$0.00	$223.82	$797.01	$797.01	$0.00	$0.00	$223.79	$0.00	$635.18	$635.18	$0.00	$536.93	$850.49	$859.08	$0.00		$0.00	$168.06	$0.00	$0.00	$170.96	$0.00	$0.00	$0.00	$0.00	$0.00
670374	SUP	HCPCS C1713		670374  -  SCREW BONE 6.5MM 50MM OPUS SPNL LNG TOP LNG HEX CONICAL	BOTH IP/OP	"$1,073.85 "	$794.65	$0.00	$859.08	$483.23	$483.23	$0.00	$0.00	$0.00	$223.82	$797.01	$797.01	$0.00	$0.00	$223.79	$0.00	$635.18	$635.18	$0.00	$536.93	$850.49	$859.08	$0.00		$0.00	$168.06	$0.00	$0.00	$170.96	$0.00	$0.00	$0.00	$0.00	$0.00
670381	SUP	HCPCS C1713		670381  -  SCREW BONE 7.5MM 35MM OPUS SPNL LNG TOP LNG HEX CONICAL	BOTH IP/OP	"$1,073.85 "	$794.65	$0.00	$859.08	$483.23	$483.23	$0.00	$0.00	$0.00	$223.82	$797.01	$797.01	$0.00	$0.00	$223.79	$0.00	$635.18	$635.18	$0.00	$536.93	$850.49	$859.08	$0.00		$0.00	$168.06	$0.00	$0.00	$170.96	$0.00	$0.00	$0.00	$0.00	$0.00
670382	SUP	HCPCS C1713		670382  -  SCREW BONE 7.5MM 40MM OPUS SPNL LNG TOP LNG HEX CONICAL	BOTH IP/OP	"$1,073.85 "	$794.65	$0.00	$859.08	$483.23	$483.23	$0.00	$0.00	$0.00	$223.82	$797.01	$797.01	$0.00	$0.00	$223.79	$0.00	$635.18	$635.18	$0.00	$536.93	$850.49	$859.08	$0.00		$0.00	$168.06	$0.00	$0.00	$170.96	$0.00	$0.00	$0.00	$0.00	$0.00
670383	SUP	HCPCS C1713		670383  -  SCREW BONE 7.5MM 45MM OPUS SPNL LNG TOP LNG HEX CONICAL	BOTH IP/OP	"$1,073.85 "	$794.65	$0.00	$859.08	$483.23	$483.23	$0.00	$0.00	$0.00	$223.82	$797.01	$797.01	$0.00	$0.00	$223.79	$0.00	$635.18	$635.18	$0.00	$536.93	$850.49	$859.08	$0.00		$0.00	$168.06	$0.00	$0.00	$170.96	$0.00	$0.00	$0.00	$0.00	$0.00
670384	SUP	HCPCS C1713		670384  -  SCREW BONE 7.5MM 50MM OPUS SPNL LNG TOP LNG HEX CONICAL	BOTH IP/OP	"$1,073.85 "	$794.65	$0.00	$859.08	$483.23	$483.23	$0.00	$0.00	$0.00	$223.82	$797.01	$797.01	$0.00	$0.00	$223.79	$0.00	$635.18	$635.18	$0.00	$536.93	$850.49	$859.08	$0.00		$0.00	$168.06	$0.00	$0.00	$170.96	$0.00	$0.00	$0.00	$0.00	$0.00
670501	SUP	HCPCS C1713		670501  -  OPUS WASHER	BOTH IP/OP	$141.55 	$104.75	$0.00	$113.24	$63.70	$63.70	$0.00	$0.00	$0.00	$29.50	$105.06	$105.06	$0.00	$0.00	$29.50	$0.00	$83.73	$83.73	$0.00	$70.78	$112.11	$113.24	$0.00		$0.00	$22.15	$0.00	$0.00	$22.53	$0.00	$0.00	$0.00	$0.00	$0.00
670504	SUP	HCPCS C1713		670504  -  OPUS PLATE NUT	BOTH IP/OP	$141.55 	$104.75	$0.00	$113.24	$63.70	$63.70	$0.00	$0.00	$0.00	$29.50	$105.06	$105.06	$0.00	$0.00	$29.50	$0.00	$83.73	$83.73	$0.00	$70.78	$112.11	$113.24	$0.00		$0.00	$22.15	$0.00	$0.00	$22.53	$0.00	$0.00	$0.00	$0.00	$0.00
670600	SUP	Custom 27803010		670600  -  CONCTR ROD OPUS SPNL	BOTH IP/OP	"$1,062.58 "	$786.31	$0.00	$850.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$788.64	$788.64	$0.00	$0.00	$221.44	$0.00	$0.00	$0.00	$0.00	$531.29	$841.56	$850.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
670604	SUP	HCPCS C1713		670604  -  OPUS ROD NUT	BOTH IP/OP	$199.95 	$147.96	$0.00	$159.96	$89.98	$89.98	$0.00	$0.00	$0.00	$41.67	$148.40	$148.40	$0.00	$0.00	$41.67	$0.00	$118.27	$118.27	$0.00	$99.98	$158.36	$159.96	$0.00		$0.00	$31.29	$0.00	$0.00	$31.83	$0.00	$0.00	$0.00	$0.00	$0.00
670610	SUP	Custom 27803010		670610  -  CONCTR ROD OPUS OFFST SPNL	BOTH IP/OP	"$1,251.28 "	$925.95	$0.00	"$1,001.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$928.70	$928.70	$0.00	$0.00	$260.77	$0.00	$0.00	$0.00	$0.00	$625.64	$991.01	"$1,001.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671040	SUP	Custom 27803010		671040  -  ROD SPNL 40MM OPUS	BOTH IP/OP	$707.65 	$523.66	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.22	$525.22	$0.00	$0.00	$147.47	$0.00	$0.00	$0.00	$0.00	$353.83	$560.46	$566.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671050	SUP	Custom 27803010		671050  -  ROD SPNL 50MM OPUS	BOTH IP/OP	$707.65 	$523.66	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.22	$525.22	$0.00	$0.00	$147.47	$0.00	$0.00	$0.00	$0.00	$353.83	$560.46	$566.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671060	SUP	Custom 27803010		671060  -  ROD SPNL 60MM OPUS	BOTH IP/OP	$707.65 	$523.66	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.22	$525.22	$0.00	$0.00	$147.47	$0.00	$0.00	$0.00	$0.00	$353.83	$560.46	$566.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671070	SUP	Custom 27803010		671070  -  ROD SPNL 70MM OPUS	BOTH IP/OP	$707.65 	$523.66	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.22	$525.22	$0.00	$0.00	$147.47	$0.00	$0.00	$0.00	$0.00	$353.83	$560.46	$566.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671080	SUP	Custom 27803010		671080  -  ROD SPNL 80MM OPUS	BOTH IP/OP	$707.65 	$523.66	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.22	$525.22	$0.00	$0.00	$147.47	$0.00	$0.00	$0.00	$0.00	$353.83	$560.46	$566.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671090	SUP	Custom 27803010		671090  -  ROD SPNL 90MM OPUS	BOTH IP/OP	$707.65 	$523.66	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.22	$525.22	$0.00	$0.00	$147.47	$0.00	$0.00	$0.00	$0.00	$353.83	$560.46	$566.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671100	SUP	Custom 27803010		671100  -  ROD SPNL 100MM OPUS	BOTH IP/OP	$707.65 	$523.66	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.22	$525.22	$0.00	$0.00	$147.47	$0.00	$0.00	$0.00	$0.00	$353.83	$560.46	$566.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671110	SUP	Custom 27803010		671110  -  ROD SPNL 110MM OPUS	BOTH IP/OP	$707.65 	$523.66	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.22	$525.22	$0.00	$0.00	$147.47	$0.00	$0.00	$0.00	$0.00	$353.83	$560.46	$566.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671120	SUP	Custom 27803010		671120  -  ROD SPNL 120MM OPUS	BOTH IP/OP	$707.65 	$523.66	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.22	$525.22	$0.00	$0.00	$147.47	$0.00	$0.00	$0.00	$0.00	$353.83	$560.46	$566.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671140	SUP	Custom 27803010		671140  -  ROD SPNL 140MM OPUS	BOTH IP/OP	$458.30 	$339.14	$0.00	$366.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.15	$340.15	$0.00	$0.00	$95.51	$0.00	$0.00	$0.00	$0.00	$229.15	$362.97	$366.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671150	SUP	Custom 27803010		671150  -  ROD SPNL 150MM OPUS	BOTH IP/OP	$707.65 	$523.66	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.22	$525.22	$0.00	$0.00	$147.47	$0.00	$0.00	$0.00	$0.00	$353.83	$560.46	$566.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671180	SUP	Custom 27803010		671180  -  ROD SPNL 180MM OPUS	BOTH IP/OP	$707.65 	$523.66	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.22	$525.22	$0.00	$0.00	$147.47	$0.00	$0.00	$0.00	$0.00	$353.83	$560.46	$566.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671190	SUP	Custom 27803010		671190  -  ROD SPNL 190MM OPUS TI	BOTH IP/OP	$707.65 	$523.66	$0.00	$566.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.22	$525.22	$0.00	$0.00	$147.47	$0.00	$0.00	$0.00	$0.00	$353.83	$560.46	$566.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671210	SUP	Custom 27803010		671210  -  ROD SPNL 210MM OPUS	BOTH IP/OP	$669.48 	$495.42	$0.00	$535.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$496.88	$496.88	$0.00	$0.00	$139.52	$0.00	$0.00	$0.00	$0.00	$334.74	$530.23	$535.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671240	SUP	Custom 27803010		671240  -  ROD SPNL 240MM OPUS	BOTH IP/OP	$638.03 	$472.14	$0.00	$510.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$473.54	$473.54	$0.00	$0.00	$132.96	$0.00	$0.00	$0.00	$0.00	$319.01	$505.32	$510.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671270	SUP	Custom 27803010		671270  -  ROD SPNL 270MM OPUS	BOTH IP/OP	$638.03 	$472.14	$0.00	$510.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$473.54	$473.54	$0.00	$0.00	$132.96	$0.00	$0.00	$0.00	$0.00	$319.01	$505.32	$510.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671300	SUP	Custom 27803010		671300  -  ROD SPNL 300MM OPUS	BOTH IP/OP	$638.03 	$472.14	$0.00	$510.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$473.54	$473.54	$0.00	$0.00	$132.96	$0.00	$0.00	$0.00	$0.00	$319.01	$505.32	$510.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
671600	SUP	Custom 27803010		671600  -  ROD SPNL 600MM OPUS	BOTH IP/OP	$435.83 	$322.51	$0.00	$348.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$323.47	$323.47	$0.00	$0.00	$90.83	$0.00	$0.00	$0.00	$0.00	$217.91	$345.18	$348.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
695305	SUP	Custom 27803010		695305  -  CONCTR ROD DIAPASON OSS OFFST SPNL	BOTH IP/OP	$660.48 	$488.76	$0.00	$528.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$490.20	$490.20	$0.00	$0.00	$137.64	$0.00	$0.00	$0.00	$0.00	$330.24	$523.10	$528.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700351	SUP	Custom 27203010		700351  -  BIT DRILL 180MM 2.5MM CLBRT AO FIT STRL	BOTH IP/OP	$287.38 	$212.66	$0.00	$229.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.29	$213.29	$0.00	$0.00	$59.89	$0.00	$0.00	$0.00	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700353	SUP	Custom 27203010		700353  -  BIT DRILL 195MM 3.5MM SPS TWST CLBRT AO FIT NONSTRL	BOTH IP/OP	$287.38 	$212.66	$0.00	$229.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.29	$213.29	$0.00	$0.00	$59.89	$0.00	$0.00	$0.00	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700354	SUP	Custom 27203010		700354  -  DRILL TWST LNG 4.5MM 195MM STRL AO FIT	BOTH IP/OP	$287.38 	$212.66	$0.00	$229.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.29	$213.29	$0.00	$0.00	$59.89	$0.00	$0.00	$0.00	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700355	SUP	Custom 27203010		700355  -  BIT DRILL 230MM 2.5MM SPS TWST CLBRT AO FIT NONSTRL	BOTH IP/OP	$287.38 	$212.66	$0.00	$229.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.29	$213.29	$0.00	$0.00	$59.89	$0.00	$0.00	$0.00	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700356	SUP	Custom 27203010		700356  -  BIT DRILL 180MM 3.2MM CLBRT AO FIT NONSTRL	BOTH IP/OP	$287.38 	$212.66	$0.00	$229.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.29	$213.29	$0.00	$0.00	$59.89	$0.00	$0.00	$0.00	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700357	SUP	Custom 27203010		700357  -  BIT DRILL 230MM 3.2MM AXSOS STD TWST CLBRT AO FIT STRL	BOTH IP/OP	$287.38 	$212.66	$0.00	$229.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.29	$213.29	$0.00	$0.00	$59.89	$0.00	$0.00	$0.00	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700371	SUP	Custom 27203010		700371  -  BIT DRILL 2MM TWST AO FIT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700373	SUP	Custom 27203010		700373  -  BIT DRL 2.7MM OSTN TWST AO FIT	BOTH IP/OP	$196.63 	$145.51	$0.00	$157.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.94	$145.94	$0.00	$0.00	$40.98	$0.00	$0.00	$0.00	$0.00	$98.31	$155.73	$157.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700374	SUP	Custom 27203010		700374  -  3.2MM AO FIT.TWIST DRILL BIT	BOTH IP/OP	$162.25 	$120.07	$0.00	$129.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.42	$120.42	$0.00	$0.00	$33.81	$0.00	$0.00	$0.00	$0.00	$81.13	$128.50	$129.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700375	SUP	Custom 27203010		700375  -  BIT DRILL 3.5MM TWST AO FIT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700436	SUP	Custom 27203010		700436  -  TAP SRG OD2.7 MM CORT SCR	BOTH IP/OP	$178.75 	$132.28	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.67	$132.67	$0.00	$0.00	$37.25	$0.00	$0.00	$0.00	$0.00	$89.38	$141.57	$143.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700438	SUP	Custom 27203010		700438  -  TAP SRG OD4.5 MM CANC SCR	BOTH IP/OP	$178.75 	$132.28	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.67	$132.67	$0.00	$0.00	$37.25	$0.00	$0.00	$0.00	$0.00	$89.38	$141.57	$143.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700443	SUP	Custom 27203010		700443  -  TAP SRG OSTEO FIT OD4.5 MM SCR	BOTH IP/OP	$342.38 	$253.36	$0.00	$273.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.11	$254.11	$0.00	$0.00	$71.35	$0.00	$0.00	$0.00	$0.00	$171.19	$271.16	$273.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700447	SUP	Custom 27203010		700447  -  TAP FIT SURG 6.5 MM SCR	BOTH IP/OP	$515.63 	$381.57	$0.00	$412.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.70	$382.70	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$257.81	$408.38	$412.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700448	SUP	Custom 27203010		700448  -  TAP FIT SURG 6.5 MM SCR	BOTH IP/OP	$618.75 	$457.88	$0.00	$495.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$459.24	$459.24	$0.00	$0.00	$128.95	$0.00	$0.00	$0.00	$0.00	$309.38	$490.05	$495.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700708	SUP	Custom 27203010		700708  -  TAP LAG SCR SURG HIP OHS	BOTH IP/OP	"$2,014.38 "	"$1,490.64"	$0.00	"$1,611.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,495.07"	"$1,495.07"	$0.00	$0.00	$419.80	$0.00	$0.00	$0.00	$0.00	"$1,007.19"	"$1,595.39"	"$1,611.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
700721	SUP	Custom 27203010		700721  -  TAP SURG OCS LAG SCR	BOTH IP/OP	"$1,560.63 "	"$1,154.87"	$0.00	"$1,248.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,158.30"	"$1,158.30"	$0.00	$0.00	$325.23	$0.00	$0.00	$0.00	$0.00	$780.31	"$1,236.02"	"$1,248.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702346	SUP	Custom 27203010		702346  -  BIT DRL 3.5MM	BOTH IP/OP	$243.38 	$180.10	$0.00	$194.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.63	$180.63	$0.00	$0.00	$50.72	$0.00	$0.00	$0.00	$0.00	$121.69	$192.76	$194.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702347	SUP	Custom 27203010		702347  -  BIT DRILL 220MM 5MM TWST AO FIT STRL	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$171.45	$171.45	$0.00	$0.00	$48.14	$0.00	$0.00	$0.00	$0.00	$115.50	$182.95	$184.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702348	SUP	Custom 27203010		702348  -  DRILL TWST 1.5MM 3.5MM AO FIT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702350	SUP	Custom 27203010		702350  -  BIT DRILL 235MM 4.2MM STRL	BOTH IP/OP	$243.38 	$180.10	$0.00	$194.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.63	$180.63	$0.00	$0.00	$50.72	$0.00	$0.00	$0.00	$0.00	$121.69	$192.76	$194.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702446	SUP	Custom 27203010		702446  -  DRILL SRG 4MM NS CNN AO CPLNG TWST	BOTH IP/OP	$507.45 	$375.51	$0.00	$410.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$376.63	$376.63	$0.00	$0.00	$105.75	$0.00	$0.00	$0.00	$0.00	$256.44	$406.20	$410.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702447	SUP	Custom 27203010		702447  -  BIT DRILL 5MM CANN TWST AO	BOTH IP/OP	$551.38 	$408.02	$0.00	$441.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$409.23	$409.23	$0.00	$0.00	$114.91	$0.00	$0.00	$0.00	$0.00	$275.69	$436.69	$441.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702448	SUP	Custom 27203010		702448  -  BIT DRILL 150MM 1.4MM NONSTRL DISP	BOTH IP/OP	$305.25 	$225.89	$0.00	$244.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$226.56	$226.56	$0.00	$0.00	$63.61	$0.00	$0.00	$0.00	$0.00	$152.63	$241.76	$244.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702453	SUP	Custom 27203010		702453  -  BIT DRILL 150MM 2MM ASNS CANN STRL	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$0.00	$0.00	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702459	SUP	HCPCS C1769		702459  -  GWIRE ORTH 150MM 1.4MM ASNS 3 FEM HIP THRD STRL	BOTH IP/OP	$109.50 	$81.03	$0.00	$81.27	$34.34	$34.34	$0.00	$0.00	$0.00	$22.82	$81.27	$81.27	$0.00	$0.00	$22.82	$0.00	$64.77	$64.77	$0.00	$31.63	$50.09	$50.60	$0.00		$0.00	$9.90	$0.00	$0.00	$10.07	$0.00	$0.00	$0.00	$0.00	$0.00
702460	SUP	HCPCS C1769		702460  -  GWIRE ORTH 150MM 2MM ASNS 3 FEM HIP THRD 5MM NONSTRL DISP	BOTH IP/OP	$109.50 	$81.03	$0.00	$81.27	$33.60	$33.60	$0.00	$0.00	$0.00	$22.82	$81.27	$81.27	$0.00	$0.00	$22.82	$0.00	$64.77	$64.77	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
702461	SUP	HCPCS C1769		702461  -  GWIRE ORTH 300MM 3MM ASNS 3 FEM HIP THRD DISP	BOTH IP/OP	$61.88 	$45.79	$0.00	$49.50	$33.60	$33.60	$0.00	$0.00	$0.00	$12.90	$45.92	$45.92	$0.00	$0.00	$12.89	$0.00	$36.60	$36.60	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
702462	SUP	HCPCS C1769		702462  -  GWIRE ORTH 300MM 3.2MM ASNS 3 FEM HIP THRD CANN SCR SYS STRL	BOTH IP/OP	$75.63 	$55.97	$0.00	$60.50	$41.06	$41.06	$0.00	$0.00	$0.00	$15.76	$56.13	$56.13	$0.00	$0.00	$15.76	$0.00	$44.73	$44.73	$0.00	$37.81	$59.90	$60.50	$0.00		$0.00	$11.84	$0.00	$0.00	$12.04	$0.00	$0.00	$0.00	$0.00	$0.00
702463	SUP	HCPCS C1769		702463  -  GWIRE ORTH 300MM 3.2MM ASNS 3 FEM HIP THRD 5MM STRL DISP	BOTH IP/OP	$75.63 	$55.97	$0.00	$60.50	$41.06	$41.06	$0.00	$0.00	$0.00	$15.76	$56.13	$56.13	$0.00	$0.00	$15.76	$0.00	$44.73	$44.73	$0.00	$37.81	$59.90	$60.50	$0.00		$0.00	$11.84	$0.00	$0.00	$12.04	$0.00	$0.00	$0.00	$0.00	$0.00
702739	SUP	Custom 27203010		702739  -  BIT DRL 4MM 180MM AO FIT	BOTH IP/OP	$728.75 	$539.28	$0.00	$583.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$540.88	$540.88	$0.00	$0.00	$151.87	$0.00	$0.00	$0.00	$0.00	$364.38	$577.17	$583.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702741	SUP	Custom 27203010		702741  -  BIT DRILL 125MM 2.3MM AXSOS CLBRT NONSTRL	BOTH IP/OP	$174.63 	$129.23	$0.00	$139.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.61	$129.61	$0.00	$0.00	$36.39	$0.00	$0.00	$0.00	$0.00	$87.31	$138.31	$139.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702742	SUP	Custom 27203010		702742  -  BIT DRILL 289MM 4.3MM AXSOS CLBRT NONSTRL	BOTH IP/OP	$205.50 	$152.07	$0.00	$152.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.52	$152.52	$0.00	$0.00	$42.83	$0.00	$0.00	$0.00	$0.00	$83.88	$132.86	$134.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702743	SUP	Custom 27203010		702743  -  BIT DRILL 289MM 4.3MM AXSOS CLBRT STRL	BOTH IP/OP	$222.75 	$164.84	$0.00	$171.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$0.00	$0.00	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702771	SUP	Custom 27803010		702771  -  TAP 3MM 130MM SURG	BOTH IP/OP	$172.55 	$127.69	$0.00	$139.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$128.07	$128.07	$0.00	$0.00	$35.96	$0.00	$0.00	$0.00	$0.00	$87.31	$138.31	$139.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702772	SUP	Custom 27803010		702772  -  TAP 4MM 140MM LCK SURG	BOTH IP/OP	$207.63 	$153.65	$0.00	$166.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.10	$154.10	$0.00	$0.00	$43.27	$0.00	$0.00	$0.00	$0.00	$103.81	$164.44	$166.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702773	SUP	Custom 27803010		702773  -  TAP 5MM 140MM LCK SURG AXSOS	BOTH IP/OP	$236.50 	$175.01	$0.00	$189.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.53	$175.53	$0.00	$0.00	$49.29	$0.00	$0.00	$0.00	$0.00	$118.25	$187.31	$189.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702804	SUP	Custom 27803010		702804  -  TAP 3.5MM SURG AXSOS	BOTH IP/OP	$642.00 	$475.08	$0.00	$476.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$476.49	$476.49	$0.00	$0.00	$133.79	$0.00	$0.00	$0.00	$0.00	$140.25	$222.16	$224.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702806	SUP	Custom 27803010		702806  -  TAP 4.5MM 180MM AO FIT SURG	BOTH IP/OP	$730.50 	$540.57	$0.00	$542.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$542.18	$542.18	$0.00	$0.00	$152.24	$0.00	$0.00	$0.00	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702807	SUP	Custom 27803010		702807  -  TAP 6.5MM 180MM AO FIT SURG CORT	BOTH IP/OP	$819.00 	$606.06	$0.00	$607.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$607.86	$607.86	$0.00	$0.00	$170.68	$0.00	$0.00	$0.00	$0.00	$140.25	$222.16	$224.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702808	SUP	Custom 27803010		702808  -  TAP 4.5MM SHRT 145MM AO FIT SURG CORT	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$0.00	$0.00	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702809	SUP	Custom 27803010		702809  -  TAP 6.5MM SHRT 145MM AO FIT SURG CANC	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$0.00	$0.00	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702930	SUP	Custom 27203010		702930  -  FORCEP SURG PLVC REPST 2X1 JAW	BOTH IP/OP	"$2,457.13 "	"$1,818.28"	$0.00	"$1,965.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,823.68"	"$1,823.68"	$0.00	$0.00	$512.06	$0.00	$0.00	$0.00	$0.00	"$1,228.56"	"$1,946.05"	"$1,965.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702996	SUP	Custom 27203010		702996  -  BIT DRL 2.5MM 285MM AO CLBRT	BOTH IP/OP	$152.63 	$112.95	$0.00	$122.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$113.28	$113.28	$0.00	$0.00	$31.81	$0.00	$0.00	$0.00	$0.00	$76.31	$120.88	$122.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702997	SUP	Custom 27203010		702997  -  BIT DRILL 285MM 3.1MM CLBRT	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$0.00	$0.00	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703176	SUP	Custom 27203010		703176  -  BIT DRILL 325MM 4.2MM AO STRL	BOTH IP/OP	$243.38 	$180.10	$0.00	$194.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.63	$180.63	$0.00	$0.00	$50.72	$0.00	$0.00	$0.00	$0.00	$121.69	$192.76	$194.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703178	SUP	Custom 27203010		703178  -  BIT DRILL 4.2MM TROCAR PNT AO STRL	BOTH IP/OP	$243.38 	$180.10	$0.00	$194.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.63	$180.63	$0.00	$0.00	$50.72	$0.00	$0.00	$0.00	$0.00	$121.69	$192.76	$194.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703541	SUP	Custom 27203010		703541  -  BIT DRILL 310MM 4.3MM CLBRT AO FIT	BOTH IP/OP	$331.38 	$245.22	$0.00	$265.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$245.95	$245.95	$0.00	$0.00	$69.06	$0.00	$0.00	$0.00	$0.00	$165.69	$262.45	$265.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703542	SUP	Custom 27203010		703542  -  BIT DRILL 310MM 3.2MM CLBRT AO FIT	BOTH IP/OP	$320.38 	$237.08	$0.00	$256.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$237.78	$237.78	$0.00	$0.00	$66.77	$0.00	$0.00	$0.00	$0.00	$160.19	$253.74	$256.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703543	SUP	Custom 27203010		703543  -  SET ORTH 4.5MM AO	BOTH IP/OP	$336.88 	$249.29	$0.00	$269.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.03	$250.03	$0.00	$0.00	$70.20	$0.00	$0.00	$0.00	$0.00	$168.44	$266.81	$269.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703551	SUP	Custom 27803010		703551  -  TAP 4.5MM 295MM AO FIT SURG CORT AXSOS	BOTH IP/OP	$475.75 	$352.06	$0.00	$380.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$353.10	$353.10	$0.00	$0.00	$99.15	$0.00	$0.00	$0.00	$0.00	$237.88	$376.79	$380.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703553	SUP	Custom 27803010		703553  -  TAP 6.5MM 295MM AO FIT SURG CANC AXSOS	BOTH IP/OP	$490.45 	$362.93	$0.00	$392.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$364.01	$364.01	$0.00	$0.00	$102.21	$0.00	$0.00	$0.00	$0.00	$245.44	$388.78	$392.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703554	SUP	Custom 27803010		703554  -  TAP 5MM 295MM LCK SURG	BOTH IP/OP	$489.50 	$362.23	$0.00	$391.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$363.31	$363.31	$0.00	$0.00	$102.01	$0.00	$0.00	$0.00	$0.00	$244.75	$387.68	$391.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703561	SUP	HCPCS C1713		703561  -  WIRE FX 2MM 315MM KRSH DRL TIP	BOTH IP/OP	$108.63 	$80.39	$0.00	$86.90	$48.88	$48.88	$0.00	$0.00	$0.00	$22.64	$80.62	$80.62	$0.00	$0.00	$22.64	$0.00	$64.25	$64.25	$0.00	$54.31	$86.03	$86.90	$0.00		$0.00	$17.00	$0.00	$0.00	$17.29	$0.00	$0.00	$0.00	$0.00	$0.00
703574	SUP	HCPCS C1713		703574  -  TAP BN LCK SPHRCL TIP 4 MM SCR	BOTH IP/OP	$606.38 	$448.72	$0.00	$485.10	$272.87	$272.87	$0.00	$0.00	$0.00	$126.38	$450.05	$450.05	$0.00	$0.00	$126.37	$0.00	$358.67	$358.67	$0.00	$303.19	$480.25	$485.10	$0.00		$0.00	$94.90	$0.00	$0.00	$96.53	$0.00	$0.00	$0.00	$0.00	$0.00
703583	SUP	HCPCS C1713		703583  -  WIRE FX 2MM 285MM KRSH DRL TIP	BOTH IP/OP	$167.45 	$123.91	$0.00	$138.60	$77.96	$77.96	$0.00	$0.00	$0.00	$34.90	$124.28	$124.28	$0.00	$0.00	$34.90	$0.00	$99.05	$99.05	$0.00	$86.63	$137.21	$138.60	$0.00		$0.00	$27.11	$0.00	$0.00	$27.58	$0.00	$0.00	$0.00	$0.00	$0.00
703585	SUP	Custom 27203010		703585  -  BIT DRILL 3.1MM	BOTH IP/OP	$323.13 	$239.12	$0.00	$258.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.82	$239.82	$0.00	$0.00	$67.34	$0.00	$0.00	$0.00	$0.00	$161.56	$255.92	$258.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703586	SUP	Custom 27203010		703586  -  BIT DRL 2.5MM CLBRT AO	BOTH IP/OP	$323.13 	$239.12	$0.00	$258.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.82	$239.82	$0.00	$0.00	$67.34	$0.00	$0.00	$0.00	$0.00	$161.56	$255.92	$258.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703588	SUP	Custom 27803010		703588  -  TAP 3.5MM SURG CORT AXSOS	BOTH IP/OP	$575.45 	$425.83	$0.00	$460.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.10	$427.10	$0.00	$0.00	$119.92	$0.00	$0.00	$0.00	$0.00	$288.06	$456.29	$460.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703589	SUP	Custom 27803010		703589  -  TAP SURG AXSOS 4 MM CANC SCR	BOTH IP/OP	$575.45 	$425.83	$0.00	$460.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.10	$427.10	$0.00	$0.00	$119.92	$0.00	$0.00	$0.00	$0.00	$288.06	$456.29	$460.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703590	SUP	Custom 27203010		703590  -  DRILL SURG SM AO 3.5MM	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703615	SUP	Custom 27203010		703615  -  BIT DRL 4.3MM 264MM CLBRT	BOTH IP/OP	$277.50 	$205.35	$0.00	$205.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$0.00	$0.00	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703616	SUP	Custom 27203010		703616  -  BIT DRL 3.1MM 205MM CLBRT	BOTH IP/OP	$259.50 	$192.03	$0.00	$192.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.60	$192.60	$0.00	$0.00	$54.08	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703617	SUP	Custom 27203010		703617  -  CALIBRATED DRILL BIT 03.1 X 285MM	BOTH IP/OP	$279.75 	$207.02	$0.00	$207.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.63	$207.63	$0.00	$0.00	$58.30	$0.00	$0.00	$0.00	$0.00	$103.81	$164.44	$166.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703618	SUP	Custom 27203010		703618  -  CALIBRATED DRILL BIT 04.3 X 315MM	BOTH IP/OP	$363.80 	$269.21	$0.00	$311.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.01	$270.01	$0.00	$0.00	$75.82	$0.00	$0.00	$0.00	$0.00	$194.56	$308.19	$311.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703701	SUP	Custom 27203010		703701  -  DRILL SURG AO CONNECT 2MM 2.7MM SCR	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703702	SUP	Custom 27203010		703702  -  DRILL SURG AO CONNECT 2.6MM 3.5MM SCR	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703703	SUP	Custom 27203010		703703  -  DRILL SURG OVR AO CONNECT 2.7 MM SCR	BOTH IP/OP	$232.90 	$172.35	$0.00	$187.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.86	$172.86	$0.00	$0.00	$48.54	$0.00	$0.00	$0.00	$0.00	$116.88	$185.13	$187.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703704	SUP	Custom 27203010		703704  -  BIT DRL 3.5MM STRL DISP	BOTH IP/OP	$232.90 	$172.35	$0.00	$187.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.86	$172.86	$0.00	$0.00	$48.54	$0.00	$0.00	$0.00	$0.00	$116.88	$185.13	$187.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703705	SUP	Custom 27803010		703705  -  TAP AO CONNECT SURG VARIAX 2.7 MM SCR NONSTRL	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703706	SUP	Custom 27803010		703706  -  TAP AO CONNECT SURG 3.5 MM SCR	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
704501	SUP	Custom 27203010		704501  -  DRILL SURG SHRT 246MM CANN JCB FIT HANSSON ADLT 6.7MM	BOTH IP/OP	$680.63 	$503.67	$0.00	$544.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$505.16	$505.16	$0.00	$0.00	$141.84	$0.00	$0.00	$0.00	$0.00	$340.31	$539.06	$544.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
704502	SUP	Custom 27203010		704502  -  DRILL SURG LNG 276MM CANN JCB FIT HANSSON ADLT 6.7MM	BOTH IP/OP	$680.63 	$503.67	$0.00	$544.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$505.16	$505.16	$0.00	$0.00	$141.84	$0.00	$0.00	$0.00	$0.00	$340.31	$539.06	$544.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
711050	SUP	Custom 27203010		00711050  -  DEVICE SPECIMEN RETRIEVAL STANDARD 2.5MM 230CM 6X3CM STRONG	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$0.00	$0.00	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
712001	SUP	Custom 27203010		712001  -  CLIP PMP IRR MDNXT	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.91	$103.91	$0.00	$0.00	$29.18	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
714080	SUP	Custom 27203010		REAGENT ANTI-LTTL C RH 4 BCLN 5ML MNCLN TUBE MCPLT BLOOD	BOTH IP/OP	$470.23 	$347.97	$0.00	$376.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.11	$372.42	$376.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
719101	SUP	Custom 27203010		REAGENT .8% RBC SRGSCRN 10ML AB SCRN BLOOD BANK	BOTH IP/OP	$80.35 	$59.46	$0.00	$64.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.18	$63.64	$64.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
721543	SUP	Custom 27203010		REAGENT ANALY CLTR CLEAN SOL 10L LH SER	BOTH IP/OP	$106.15 	$78.55	$0.00	$84.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.08	$84.07	$84.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
725230	SUP	Custom 27203010		REAGENT ANTI-FY LTTL B BLOOD BANK	BOTH IP/OP	"$1,350.63 "	$999.47	$0.00	"$1,080.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$675.31	"$1,069.70"	"$1,080.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
732420	SUP	HCPCS C1713		732420  -  SCREW BN 2.4MM 20MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
733008	SUP	HCPCS C1768		733008  -  GRAFT CARDIO STR 8MM 30CM SUTURE RETENTION UNIQUE	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
733010	SUP	HCPCS C1768		733010  -  GRAFT CV STRG 10MM 30CM GLWV SUT RTNT UNQ HYDROLYZABLE GELTN	BOTH IP/OP	"$1,202.25 "	$889.67	$0.00	$961.80	$541.01	$541.01	$0.00	$0.00	$0.00	$250.58	$892.31	$892.31	$0.00	$0.00	$250.55	$0.00	$711.13	$711.13	$0.00	$601.13	$952.18	$961.80	$0.00		$0.00	$188.15	$0.00	$0.00	$191.40	$0.00	$0.00	$0.00	$0.00	$0.00
733026	SUP	HCPCS C1768		733026  -  GRAFT CARDIO STR 26MM 30CM WOVEN VASCUTEK GELWEAVE THORAX	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
733028	SUP	HCPCS C1768		733028  -  GRAFT CARDIO STR 28MM 30CM SUTURE RETENTION UNIQUE	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
733030	SUP	HCPCS C1768		733030  -  GRAFT CARDIO STR 30MM 30CM SUTURE RETENTION UNIQUE	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
733032	SUP	HCPCS C1768		733032  -  GRAFT CARDIO STR 32MM 30CM SUTURE RETENTION UNIQUE	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
740026	SUP	Custom 27203010		740026  -  DEVICE PSTN STRL THE SEC AST 2 ADJ CLP BT FTBRD PLS KN DISP	BOTH IP/OP	$497.50 	$368.15	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$369.24	$369.24	$0.00	$0.00	$103.68	$0.00	$0.00	$0.00	$0.00	$248.75	$394.02	$398.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-00	SUP	Custom 27803010		06-4000  -  HEAD FEM +0MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-05	SUP	Custom 27803010		06-4005  -  HEAD FEM +5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4010	SUP	HCPCS C1713		03-11-4010  -  SCREW BONE 4MM 10MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4010	SUP	HCPCS C1713		03-12-4010  -  SCREW BONE 4MM 10MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-10	SUP	Custom 27803010		06-4010  -  HEAD FEMORAL +10 40MM C TAPER ANATOMIC OFFST LFIT COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4011	SUP	HCPCS C1713		03-11-4011  -  SCREW BONE 4MM 11MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4011	SUP	HCPCS C1713		03-12-4011  -  SCREW BONE 4MM 11MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4012	SUP	HCPCS C1713		03-11-4012  -  SCREW BONE 4MM 12MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4012	SUP	HCPCS C1713		03-12-4012  -  SCREW BONE 4MM 12MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4013	SUP	HCPCS C1713		03-11-4013  -  SCREW BONE 4MM 13MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4013	SUP	HCPCS C1713		03-12-4013  -  SCREW BONE 4MM 13MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4014	SUP	HCPCS C1713		03-11-4014  -  SCREW BONE 4MM 14MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4014	SUP	HCPCS C1713		03-12-4014  -  SCREW BONE 4MM 14MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4015	SUP	HCPCS C1713		03-11-4015  -  SCREW BONE 4MM 15MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4015	SUP	HCPCS C1713		03-12-4015  -  SCREW BONE 4MM 15MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4016	SUP	HCPCS C1713		03-11-4016  -  SCREW BONE 4MM 16MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4016	SUP	HCPCS C1713		03-12-4016  -  SCREW BONE 4MM 16MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4017	SUP	HCPCS C1713		03-11-4017  -  SCREW BONE 4MM 17MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4017	SUP	HCPCS C1713		03-12-4017  -  SCREW BONE 4MM 17MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4018	SUP	HCPCS C1713		03-11-4018  -  SCREW BONE 4MM 18MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4018	SUP	HCPCS C1713		03-12-4018  -  SCREW BONE 4MM 18MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
773997	SUP	Custom 27203010		CIRCUIT BRTHG HEAT WIRE 38IN	BOTH IP/OP	$299.35 	$221.52	$0.00	$239.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.68	$237.09	$239.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4019	SUP	HCPCS C1713		03-11-4019  -  SCREW BONE 4MM 19MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4019	SUP	HCPCS C1713		03-12-4019  -  SCREW BONE 4MM 19MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4020	SUP	HCPCS C1713		03-11-4020  -  SCREW BONE 4MM 20MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4020	SUP	HCPCS C1713		03-12-4020  -  SCREW BONE 4MM 20MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
775856	SUP	Custom 27203010		CIRCUIT BRTHG 3100B F AND P 850 VIASYS	BOTH IP/OP	$329.58 	$243.89	$0.00	$263.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.79	$261.03	$263.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-25	SUP	Custom 27803010		06-4025  -  HEAD FEM +2.5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-75	SUP	Custom 27803010		06-4075  -  HEAD FEM +7.5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
800070	SUP	Custom 27203010		800070  -  SLIDE INSTRUCTIONAL HMRHD THD SYS	BOTH IP/OP	"$1,307.50 "	$967.55	$0.00	"$1,046.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$970.43	$970.43	$0.00	$0.00	$272.48	$0.00	$0.00	$0.00	$0.00	$653.75	"$1,035.54"	"$1,046.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
800257	SUP	Custom 27203010		TIP ANALY PIP ALQ	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-97	SUP	Custom 27803010		06-4097  -  HEAD FEM -2.5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-99	SUP	Custom 27803010		06-4099  -  HEAD FEM -5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
807603	SUP	Custom 27203010		807603  -  FORCEPS BIPOL .5MM SMALL 8IN IRRIGATION DISPOSABLE	BOTH IP/OP	"$1,088.00 "	$805.12	$0.00	$870.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$807.51	$807.51	$0.00	$0.00	$226.74	$0.00	$0.00	$0.00	$0.00	$544.00	$861.70	$870.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
808006	SUP	HCPCS Q4130		0808006  -  MATRIX TISSUE 8X8CM RECONSTRUCTIVE STRATTICE PIG DERMIS	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$3,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$636.74	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	"$1,506.12"	"$1,506.12"	$0.00	"$2,308.75"	"$3,657.06"	"$3,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
810051	SUP	HCPCS C1771		810051  -  SLING GYN GNCR TVT OBT INTROD SYS DEV FMALE STRS URN INCNT	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$613.13	$613.13	$0.00	$0.00	$0.00	$283.98	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$805.92	$805.92	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$213.23	$0.00	$0.00	$216.91	$0.00	$0.00	$0.00	$0.00	$0.00
810061	SUP	HCPCS C1769		810061  -  GUIDE CATHETER 7FR 100CM RIGID TAPE TVT FMALE VAGINA	BOTH IP/OP	$347.63 	$257.25	$0.00	$278.10	$188.76	$188.76	$0.00	$0.00	$0.00	$72.45	$258.01	$258.01	$0.00	$0.00	$72.45	$0.00	$205.62	$205.62	$0.00	$173.81	$275.32	$278.10	$0.00		$0.00	$54.40	$0.00	$0.00	$55.34	$0.00	$0.00	$0.00	$0.00	$0.00
811558	SUP	Custom 27803010		811558  -  X-10 CROSSLINK	BOTH IP/OP	"$4,640.30 "	"$3,433.82"	$0.00	"$3,712.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,444.03"	"$3,444.03"	$0.00	$0.00	$967.04	$0.00	$0.00	$0.00	$0.00	"$2,320.15"	"$3,675.12"	"$3,712.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
815009	SUP	HCPCS Q4130		815009  -  MATRIX TISSUE 15X8CM RECONSTRUCTIVE STRATTICE PIG DERMIS	BOTH IP/OP	"$7,235.00 "	"$5,353.90"	$0.00	"$5,788.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,507.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,507.77"	$0.00	"$3,566.86"	"$3,566.86"	$0.00	"$3,617.50"	"$5,730.12"	"$5,788.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
816001	SUP	HCPCS Q4130		0816001  -  MATRIX TISSUE 16X8CM RECONSTRUCTIVE PLIABLE STRATTICE PIG	BOTH IP/OP	"$8,120.00 "	"$6,008.80"	$0.00	"$6,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,692.41"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,692.21"	$0.00	"$4,003.16"	"$4,003.16"	$0.00	"$4,060.00"	"$6,431.04"	"$6,496.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
816458	SUP	HCPCS C1713		816458  -  CROSSLINK X-10/58MM	BOTH IP/OP	"$4,640.30 "	"$3,433.82"	$0.00	"$3,712.24"	"$2,088.14"	"$2,088.14"	$0.00	$0.00	$0.00	$967.15	"$3,444.03"	"$3,444.03"	$0.00	$0.00	$967.04	$0.00	"$2,287.67"	"$2,287.67"	$0.00	"$2,320.15"	"$3,675.12"	"$3,712.24"	$0.00		$0.00	$726.21	$0.00	$0.00	$738.74	$0.00	$0.00	$0.00	$0.00	$0.00
821707	SUP	Custom 27203010		821707  -  KIT XTRN DRN CDMN CATH LMBR	BOTH IP/OP	$527.05 	$390.02	$0.00	$421.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$391.18	$391.18	$0.00	$0.00	$109.84	$0.00	$0.00	$0.00	$0.00	$263.53	$417.42	$421.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
821739	SUP	Custom 27803010		821739  -  SET VENTRICULAR DRAINAGE TRAUMACATH L35 CM OD10 FR ODSEC3.3	BOTH IP/OP	$271.95 	$201.24	$0.00	$217.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$135.98	$215.38	$217.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
821750	SUP	HCPCS C1729		821750  -  CATHETER EXTERNAL DRAIN LARGE 1.9MM LATEX FREE BACTISEAL EVD	BOTH IP/OP	"$1,241.73 "	$918.88	$0.00	$983.08	$667.27	$667.27	$0.00	$0.00	$0.00	$258.81	$921.61	$921.61	$0.00	$0.00	$258.78	$0.00	$734.48	$734.48	$0.00	$614.43	$973.25	$983.08	$0.00		$0.00	$192.32	$0.00	$0.00	$195.63	$0.00	$0.00	$0.00	$0.00	$0.00
858445	SUP	HCPCS C1713		858445  -  SCREW BONE 4.5MM 45MM FIX ANGLE CD HORIZON M8 STAINLESS	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858450	SUP	HCPCS C1713		858450  -  SCREW BONE 4.5MM 50MM FIX ANGLE CD HORIZON M8 STAINLESS	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
862309	SUP	Custom 27203010		862309  -  ELECTRODE MONOPOLAR 24.5FR 26FR HOOK BIPOL	BOTH IP/OP	$721.13 	$533.64	$0.00	$579.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$535.22	$535.22	$0.00	$0.00	$150.28	$0.00	$0.00	$0.00	$0.00	$362.38	$574.00	$579.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
873011	SUP	Custom 27203010		873011  -  SPRDR SURG DURA MATER	BOTH IP/OP	$398.08 	$294.58	$0.00	$318.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.45	$295.45	$0.00	$0.00	$82.96	$0.00	$0.00	$0.00	$0.00	$199.04	$315.28	$318.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
874002	SUP	Custom 27803010		874002  -  PIN DISTRACTION 10MM RELIANCE STERILE C	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$612.32	$612.32	$0.00	$0.00	$171.93	$0.00	$0.00	$0.00	$0.00	$412.50	$653.40	$660.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
898716	SUP	Custom 27203010		898716  -  TRAY CATH 16FR 350ML FOLEY URMTR LATEX	BOTH IP/OP	$40.06 	$29.64	$0.00	$32.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.73	$29.73	$0.00	$0.00	$8.35	$0.00	$0.00	$0.00	$0.00	$20.03	$31.73	$32.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900284	SUP	Custom 27203010		900284  -  SUTURE NABSB 2 KHC-5 BLU MXBRD BRAID	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900334	SUP	Custom 27203010		900334  -  SUTURE NABSB 2 C-2 BLU MXBRD BRAID	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900339	SUP	Custom 27203010		900339  -  DEVICE FX MAXFIRE REPR ZIPLOOP TCH MNSCS	BOTH IP/OP	"$1,085.00 "	$802.90	$0.00	$868.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$805.29	$805.29	$0.00	$0.00	$226.11	$0.00	$0.00	$0.00	$0.00	$542.50	$859.32	$868.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
901124	SUP	HCPCS C1894		901124  -  INTRO SHTH PRTNL	BOTH IP/OP	$777.50 	$575.35	$0.00	$622.00	$422.18	$422.18	$0.00	$0.00	$0.00	$162.05	$577.06	$577.06	$0.00	$0.00	$162.03	$0.00	$459.89	$459.89	$0.00	$388.75	$615.78	$622.00	$0.00		$0.00	$121.68	$0.00	$0.00	$123.78	$0.00	$0.00	$0.00	$0.00	$0.00
902916	SUP	Custom 27203010		902916  -  TRAY CATHETERIZATION 16FR URINE METER FOLEY STATLOCK LATEX	BOTH IP/OP	$38.29 	$28.33	$0.00	$30.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.15	$30.33	$30.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
904754	SUP	Custom 27803010		904754  -  DEVICE FX 7 50IN TOGGLELOC ZIPLOOP LNG LOOP XTD PE FEM	BOTH IP/OP	"$1,452.50 "	"$1,074.85"	$0.00	"$1,162.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,078.05"	"$1,078.05"	$0.00	$0.00	$302.70	$0.00	$0.00	$0.00	$0.00	$726.25	"$1,150.38"	"$1,162.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
905256	SUP	HCPCS C1713		905256  -  SCREW INTFR 9MM 25MM COMPOSITCP RND HD	BOTH IP/OP	"$1,122.50 "	$830.65	$0.00	$898.00	$505.13	$505.13	$0.00	$0.00	$0.00	$233.96	$833.12	$833.12	$0.00	$0.00	$233.93	$0.00	$663.96	$663.96	$0.00	$561.25	$889.02	$898.00	$0.00		$0.00	$175.67	$0.00	$0.00	$178.70	$0.00	$0.00	$0.00	$0.00	$0.00
905257	SUP	HCPCS C1713		905257  -  SCREW BABSR 9MM 30MM COMPOSITCP RND HD	BOTH IP/OP	"$1,122.50 "	$830.65	$0.00	$898.00	$505.13	$505.13	$0.00	$0.00	$0.00	$233.96	$833.12	$833.12	$0.00	$0.00	$233.93	$0.00	$663.96	$663.96	$0.00	$561.25	$889.02	$898.00	$0.00		$0.00	$175.67	$0.00	$0.00	$178.70	$0.00	$0.00	$0.00	$0.00	$0.00
905261	SUP	HCPCS C1713		905261  -  SCREW INTFR FT 10MM 30MM COMPOSITCP	BOTH IP/OP	"$1,122.50 "	$830.65	$0.00	$898.00	$505.13	$505.13	$0.00	$0.00	$0.00	$233.96	$833.12	$833.12	$0.00	$0.00	$233.93	$0.00	$663.96	$663.96	$0.00	$561.25	$889.02	$898.00	$0.00		$0.00	$175.67	$0.00	$0.00	$178.70	$0.00	$0.00	$0.00	$0.00	$0.00
905263	SUP	HCPCS C1713		905263  -  SCREW INTFR FT 11MM 30MM COMPOSITCP	BOTH IP/OP	"$1,122.50 "	$830.65	$0.00	$898.00	$505.13	$505.13	$0.00	$0.00	$0.00	$233.96	$833.12	$833.12	$0.00	$0.00	$233.93	$0.00	$663.96	$663.96	$0.00	$561.25	$889.02	$898.00	$0.00		$0.00	$175.67	$0.00	$0.00	$178.70	$0.00	$0.00	$0.00	$0.00	$0.00
905732	SUP	Custom 27203010		905732  -  CUTTER SRG 203MM MAXFIRE DISP	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
906520	SUP	Custom 27203010		BAG PPR THK1/6IN C50LB LG KRAFT BRL	BOTH IP/OP	$0.35 	$0.26	$0.00	$0.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.18	$0.28	$0.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
908469	SUP	HCPCS C1713		908469  -  WASHER ORTH SPK 16MM WSHRLC XTD TIP TI TIB	BOTH IP/OP	"$1,450.00 "	"$1,073.00"	$0.00	"$1,160.00"	$652.50	$652.50	$0.00	$0.00	$0.00	$302.22	"$1,076.19"	"$1,076.19"	$0.00	$0.00	$302.18	$0.00	$857.68	$857.68	$0.00	$725.00	"$1,148.40"	"$1,160.00"	$0.00		$0.00	$226.93	$0.00	$0.00	$230.84	$0.00	$0.00	$0.00	$0.00	$0.00
908846	SUP	HCPCS C1713		908846  -  SCREW BN 6MM 46MM STRL WSHRLC TI ACL/PCL CANC ASCP	BOTH IP/OP	$502.50 	$371.85	$0.00	$402.00	$226.13	$226.13	$0.00	$0.00	$0.00	$104.73	$372.96	$372.96	$0.00	$0.00	$104.72	$0.00	$297.23	$297.23	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$78.64	$0.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00
908850	SUP	HCPCS C1713		908850  -  SCREW BN 6MM 50MM STRL WSHRLC TI ACL/PCL CANC ASCP	BOTH IP/OP	$502.50 	$371.85	$0.00	$402.00	$226.13	$226.13	$0.00	$0.00	$0.00	$104.73	$372.96	$372.96	$0.00	$0.00	$104.72	$0.00	$297.23	$297.23	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$78.64	$0.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00
908860	SUP	HCPCS C1713		908860  -  SCREW BN 6MM 60MM STRL WSHRLC TI ACL/PCL CANC ASCP	BOTH IP/OP	$502.50 	$371.85	$0.00	$402.00	$226.13	$226.13	$0.00	$0.00	$0.00	$104.73	$372.96	$372.96	$0.00	$0.00	$104.72	$0.00	$297.23	$297.23	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$78.64	$0.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00
909848	SUP	Custom 27203010		909848  -  KIT ASCP FX TOGGLELOC ZIPLOOP	BOTH IP/OP	"$3,657.50 "	"$2,706.55"	$0.00	"$2,926.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,714.60"	"$2,714.60"	$0.00	$0.00	$762.22	$0.00	$0.00	$0.00	$0.00	"$1,828.75"	"$2,896.74"	"$2,926.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
912076	SUP	HCPCS C1713		912076  -  ANCHOR SUT JUGGERKNOT SFT TIS	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-00	SUP	Custom 27803010		06-4400  -  HEAD FEM +0MM OFST CTPR 44MM STRL LFIT ANTM COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-05	SUP	Custom 27803010		06-4405  -  HEAD FEM +5MM OFST CTPR 44MM STRL LFIT ANTM COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-10	SUP	Custom 27803010		06-4410  -  HEAD FEMORAL +10MM 44MM C TAPER LFIT COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
921031	SUP	HCPCS C9250		921031  -  SET SPRY 2 SPRY TIP CONCTR HOSE STRL FLTR TSMT DISP	BOTH IP/OP	$111.69 	$82.65	$0.00	$173.09	$59.25	$59.25	$156.84	$156.84	$111.69	$23.28	$82.90	$82.90	$0.00	$156.84	$23.28	$101.95	$66.07	$66.07	$173.09	$65.83	$104.27	$105.33	$131.66		$131.66	$20.60	$0.00	$0.00	$20.96	$164.85	$0.00	$0.00	$0.00	$0.00
Jun-25	SUP	Custom 27803010		06-4425  -  HEAD FEMORAL +2.5MM 44MM C TAPER LFIT COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
928950	SUP	HCPCS C1894		0928950  -  MICROMICROINTRUDUCER 7CM 5.0FR FLECURA GUIDEWIRE	BOTH IP/OP	$78.50 	$58.09	$0.00	$62.80	$42.63	$42.63	$0.00	$0.00	$0.00	$16.36	$58.26	$58.26	$0.00	$0.00	$16.36	$0.00	$46.43	$46.43	$0.00	$39.25	$62.17	$62.80	$0.00		$0.00	$12.29	$0.00	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$0.00
930740	SUP	Custom 27203010		KIT IMMUN TST ELISA ANTI-HCV 480 TST	BOTH IP/OP	"$7,582.50 "	"$5,611.05"	$0.00	"$6,066.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,791.25"	"$6,005.34"	"$6,066.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
933040	SUP	Custom 27203010		REAGENT ANTI-HCV ELISA STOP SOL 500ML ANALY	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-75	SUP	Custom 27803010		06-4475  -  HEAD FEMORAL +7.5MM 44MM C TAPER LFIT COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-97	SUP	Custom 27803010		06-4497  -  HEAD FEMORAL -2.5MM 44MM C TAPER LFIT COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jun-99	SUP	Custom 27803010		06-4499  -  HEAD FEMORAL -5MM 44MM C TAPER ANATOMIC LFIT V40 COCR	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4513	SUP	HCPCS C1713		03-11-4513  -  SCREW BONE 4.5MM 13MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4513	SUP	HCPCS C1713		03-12-4513  -  SCREW BONE 4.5MM 13MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4515	SUP	HCPCS C1713		03-11-4515  -  SCREW BONE 4.5MM 15MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4515	SUP	HCPCS C1713		03-12-4515  -  SCREW BONE 4.5MM 15MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/11/4517	SUP	HCPCS C1713		03-11-4517  -  SCREW BONE 4.5MM 17MM FIX ANGLE TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3/12/4517	SUP	HCPCS C1713		03-12-4517  -  SCREW BONE 4.5MM 17MM VAR ANG TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
982001	SUP	HCPCS Q4116		982001  -  GRAFT SKN XTHICK 1X1CM ALDRM	BOTH IP/OP	$140.00 	$103.60	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$29.18	$103.91	$103.91	$0.00	$0.00	$29.18	$0.00	$82.81	$82.81	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
982003	SUP	HCPCS Q4116		982003  -  GRAFT SKN 2X1CM ALDRM RGNRT ACLR DRML MTRX	BOTH IP/OP	$355.00 	$262.70	$0.00	$438.00	$246.38	$246.38	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$273.75	$433.62	$438.00	$0.00		$0.00	$85.68	$0.00	$0.00	$87.16	$0.00	$0.00	$0.00	$0.00	$0.00
982007	SUP	HCPCS Q4116		982007  -  MATRIX TISSUE XTHICK 4X1CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$148.13 	$109.62	$0.00	$184.00	$103.50	$103.50	$0.00	$0.00	$0.00	$30.87	$109.94	$109.94	$0.00	$0.00	$30.87	$0.00	$87.62	$87.62	$0.00	$115.00	$182.16	$184.00	$0.00		$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
982011	SUP	HCPCS Q4116		982011  -  MATRIX TISSUE XTHICK 4X2CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	"$1,030.00 "	$762.20	$0.00	"$1,280.00"	$720.00	$720.00	$0.00	$0.00	$0.00	$214.68	$764.47	$764.47	$0.00	$0.00	$214.65	$0.00	$609.25	$609.25	$0.00	$800.00	"$1,267.20"	"$1,280.00"	$0.00		$0.00	$250.40	$0.00	$0.00	$254.72	$0.00	$0.00	$0.00	$0.00	$0.00
982021	SUP	HCPCS Q4116		982021  -  MATRIX TISSUE XTHICK 7X3CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$83.45 	$61.75	$0.00	$103.52	$58.23	$58.23	$0.00	$0.00	$0.00	$17.39	$61.94	$61.94	$0.00	$0.00	$17.39	$0.00	$49.36	$49.36	$0.00	$64.70	$102.48	$103.52	$0.00		$0.00	$20.25	$0.00	$0.00	$20.60	$0.00	$0.00	$0.00	$0.00	$0.00
982024	SUP	HCPCS Q4116		982024  -  GRAFT SKN XTHICK 12X2CM ALDRM	BOTH IP/OP	"$1,507.50 "	"$1,115.55"	$0.00	"$1,870.00"	"$1,051.88"	"$1,051.88"	$0.00	$0.00	$0.00	$314.20	"$1,118.87"	"$1,118.87"	$0.00	$0.00	$314.16	$0.00	$891.69	$891.69	$0.00	"$1,168.75"	"$1,851.30"	"$1,870.00"	$0.00		$0.00	$365.82	$0.00	$0.00	$372.13	$0.00	$0.00	$0.00	$0.00	$0.00
982028	SUP	HCPCS Q4116		982028  -  MATRIX TISSUE XTHICK 7X4CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$64.73 	$47.90	$0.00	$80.43	$45.24	$45.24	$0.00	$0.00	$0.00	$13.49	$48.04	$48.04	$0.00	$0.00	$13.49	$0.00	$38.29	$38.29	$0.00	$50.27	$79.63	$80.43	$0.00		$0.00	$15.73	$0.00	$0.00	$16.01	$0.00	$0.00	$0.00	$0.00	$0.00
982048	SUP	HCPCS Q4116		982048  -  MATRIX TISSUE XTHICK 12X4CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
982060	SUP	HCPCS Q4116		982060  -  MATRIX TISSUE XTHICK 10CMX5CMX2.3-3.3MM ALLOGRAFT	BOTH IP/OP	$64.55 	$47.77	$0.00	$80.16	$45.09	$45.09	$0.00	$0.00	$0.00	$13.45	$47.91	$47.91	$0.00	$0.00	$13.45	$0.00	$38.18	$38.18	$0.00	$50.10	$79.36	$80.16	$0.00		$0.00	$15.68	$0.00	$0.00	$15.95	$0.00	$0.00	$0.00	$0.00	$0.00
982070	SUP	HCPCS Q4116		982070  -  MATRIX TISSUE XTHICK 12X6CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$70.80 	$52.39	$0.00	$56.64	$31.86	$31.86	$0.00	$0.00	$0.00	$14.76	$52.55	$52.55	$0.00	$0.00	$14.75	$0.00	$41.88	$41.88	$0.00	$35.40	$56.07	$56.64	$0.00		$0.00	$11.08	$0.00	$0.00	$11.27	$0.00	$0.00	$0.00	$0.00	$0.00
982080	SUP	HCPCS Q4116		982080  -  MATRIX TISSUE XTHICK 16X4CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$78.09 	$57.79	$0.00	$62.47	$35.14	$35.14	$0.00	$0.00	$0.00	$16.28	$57.96	$57.96	$0.00	$0.00	$16.27	$0.00	$46.19	$46.19	$0.00	$39.04	$61.85	$62.47	$0.00		$0.00	$12.22	$0.00	$0.00	$12.43	$0.00	$0.00	$0.00	$0.00	$0.00
982096	SUP	HCPCS Q4116		982096  -  MATRIX TISSUE XTHICK 12X8CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$78.10 	$57.79	$0.00	$62.48	$35.14	$35.14	$0.00	$0.00	$0.00	$16.28	$57.97	$57.97	$0.00	$0.00	$16.28	$0.00	$46.20	$46.20	$0.00	$39.05	$61.86	$62.48	$0.00		$0.00	$12.22	$0.00	$0.00	$12.43	$0.00	$0.00	$0.00	$0.00	$0.00
982108	SUP	HCPCS Q4116		982108  -  MATRIX TISSUE XTHICK 18X6CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$92.57 	$68.50	$0.00	$74.06	$41.66	$41.66	$0.00	$0.00	$0.00	$19.29	$68.71	$68.71	$0.00	$0.00	$19.29	$0.00	$54.75	$54.75	$0.00	$46.28	$73.32	$74.06	$0.00		$0.00	$14.49	$0.00	$0.00	$14.74	$0.00	$0.00	$0.00	$0.00	$0.00
982128	SUP	HCPCS Q4116		982128  -  MATRIX TISSUE XTHICK 16X8CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$78.11 	$57.80	$0.00	$62.48	$35.15	$35.15	$0.00	$0.00	$0.00	$16.28	$57.97	$57.97	$0.00	$0.00	$16.28	$0.00	$46.20	$46.20	$0.00	$39.05	$61.86	$62.48	$0.00		$0.00	$12.22	$0.00	$0.00	$12.43	$0.00	$0.00	$0.00	$0.00	$0.00
982144	SUP	HCPCS Q4116		982144  -  MATRIX TISSUE XTHICK 12X12CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$68.23 	$50.49	$0.00	$84.69	$47.64	$47.64	$0.00	$0.00	$0.00	$14.22	$50.64	$50.64	$0.00	$0.00	$14.22	$0.00	$40.36	$40.36	$0.00	$52.93	$83.85	$84.69	$0.00		$0.00	$16.57	$0.00	$0.00	$16.85	$0.00	$0.00	$0.00	$0.00	$0.00
982196	SUP	HCPCS Q4116		982196  -  MATRIX TISSUE XTHICK 16X6CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$78.10 	$57.79	$0.00	$62.48	$35.14	$35.14	$0.00	$0.00	$0.00	$16.28	$57.97	$57.97	$0.00	$0.00	$16.28	$0.00	$46.20	$46.20	$0.00	$39.05	$61.86	$62.48	$0.00		$0.00	$12.22	$0.00	$0.00	$12.43	$0.00	$0.00	$0.00	$0.00	$0.00
982320	SUP	HCPCS Q4116		982320  -  MATRIX TISSUE XTHICK 20X16CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$78.12 	$57.81	$0.00	$62.49	$35.15	$35.15	$0.00	$0.00	$0.00	$16.28	$57.98	$57.98	$0.00	$0.00	$16.28	$0.00	$46.21	$46.21	$0.00	$39.06	$61.87	$62.49	$0.00		$0.00	$12.23	$0.00	$0.00	$12.44	$0.00	$0.00	$0.00	$0.00	$0.00
983102	SUP	Custom 27203010		983102  -  COLLAR CERV CHLD SHRT CHIN REST TRCH OPN ADJ STRAP CNTCT	BOTH IP/OP	$67.45 	$49.91	$0.00	$53.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.73	$53.42	$53.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
983104	SUP	Custom 27203010		983104  -  COLLAR CERV CHLD REG ASPN CHIN REST TRCH OPN ADJ STRAP CNTCT	BOTH IP/OP	$70.54 	$52.20	$0.00	$60.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.36	$52.36	$0.00	$0.00	$14.70	$0.00	$0.00	$0.00	$0.00	$37.98	$60.17	$60.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
983106	SUP	Custom 27203010		983106  -  COLLAR CERV CHLD TOT CHIN REST TRCH OPN ADJ STRAP CNTCT CLSR	BOTH IP/OP	$81.85 	$60.57	$0.00	$60.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.75	$60.75	$0.00	$0.00	$17.06	$0.00	$0.00	$0.00	$0.00	$36.31	$57.52	$58.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
983112	SUP	Custom 27203010		983112  -  COLLAR CERV ADLT TLL CHIN REST TRCH OPN ADJ STRAP CNTCT CLSR	BOTH IP/OP	$65.80 	$48.69	$0.00	$52.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.90	$52.11	$52.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
983114	SUP	Custom 27203010		983114  -  COLLAR CERV ADLT XTALL CHIN REST TRCH OPN ADJ STRAP CNTCT	BOTH IP/OP	$69.50 	$51.43	$0.00	$112.86	$0.00	$0.00	$0.00	$0.00	$0.00	$112.86	$51.58	$51.58	$0.00	$0.00	$14.48	$0.00	$41.11	$41.11	$0.00	$32.90	$52.11	$52.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
983119	SUP	Custom 27203010		983119  -  COLLAR CERV ADLT LG BACK PNL PLST	BOTH IP/OP	$27.50 	$20.35	$0.00	$112.86	$0.00	$0.00	$0.00	$0.00	$0.00	$112.86	$20.41	$20.41	$0.00	$0.00	$5.73	$0.00	$16.27	$16.27	$0.00	$18.42	$29.19	$29.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
983190	SUP	Custom 27203010		983190  -  COLLAR IMMOB CERVICAL INFANT FOAM PAD TRACH OPEN FLEXIBLE TA	BOTH IP/OP	$65.80 	$48.69	$0.00	$52.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.90	$52.11	$52.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
983195	SUP	Custom 27203010		983195  -  COLLAR CERV INF REG CHIN REST TRCH OPN ADJ STRAP CNTCT CLSR	BOTH IP/OP	$81.85 	$60.57	$0.00	$112.86	$0.00	$0.00	$0.00	$0.00	$0.00	$112.86	$60.75	$60.75	$0.00	$0.00	$17.06	$0.00	$48.41	$48.41	$0.00	$36.14	$57.25	$57.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
992003	SUP	HCPCS Q4116		992003  -  MATRIX TISSUE THIN 2X1CM ALLOGRAFT REGENERATIVE FREEZE DRIED	BOTH IP/OP	$170.00 	$125.80	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$35.43	$126.17	$126.17	$0.00	$0.00	$35.43	$0.00	$100.56	$100.56	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
992128	SUP	HCPCS Q4116		992128  -  MATRIX TISSUE MEDIUM 16X8CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$78.11 	$57.80	$0.00	$62.48	$35.15	$35.15	$0.00	$0.00	$0.00	$16.28	$57.97	$57.97	$0.00	$0.00	$16.28	$0.00	$46.20	$46.20	$0.00	$39.05	$61.86	$62.48	$0.00		$0.00	$12.22	$0.00	$0.00	$12.43	$0.00	$0.00	$0.00	$0.00	$0.00
992196	SUP	HCPCS Q4116		992196  -  MATRIX TISSUE THIN 16X6CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	$78.10 	$57.79	$0.00	$62.48	$35.14	$35.14	$0.00	$0.00	$0.00	$16.28	$57.97	$57.97	$0.00	$0.00	$16.28	$0.00	$46.20	$46.20	$0.00	$39.05	$61.86	$62.48	$0.00		$0.00	$12.22	$0.00	$0.00	$12.43	$0.00	$0.00	$0.00	$0.00	$0.00
1001740	SUP	HCPCS C1769		1001740  -  GUIDEWIRE VASCULAR STR .014IN 190CM 3CM RADIOPQ HI-TORQUE	BOTH IP/OP	$177.50 	$131.35	$0.00	$142.00	$96.38	$96.38	$0.00	$0.00	$0.00	$37.00	$131.74	$131.74	$0.00	$0.00	$36.99	$0.00	$104.99	$104.99	$0.00	$88.75	$140.58	$142.00	$0.00		$0.00	$27.78	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$0.00
1001741	SUP	HCPCS C1769		1001741  -  GUIDEWIRE VASCULAR STR .014IN 300CM 3CM HI-TORQUE ALL STAR	BOTH IP/OP	$177.50 	$131.35	$0.00	$142.00	$96.38	$96.38	$0.00	$0.00	$0.00	$37.00	$131.74	$131.74	$0.00	$0.00	$36.99	$0.00	$104.99	$104.99	$0.00	$88.75	$140.58	$142.00	$0.00		$0.00	$27.78	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$0.00
1002005	SUP	Custom 27203010		1002005  -  NON STERILE DISPOSABLE DRILL BIT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004722	SUP	Custom 27804086		1004722  -  GRAFT BN 11X11X5MM TRD CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004723	SUP	Custom 27804086		1004723  -  GRAFT BN 11X11X6MM TRD CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004724	SUP	Custom 27804086		1004724  -  GRAFT BN 11X11X7MM TRD CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004725	SUP	Custom 27804086		1004725  -  GRAFT BN 11X11X8MM TRD CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004726	SUP	Custom 27804086		1004726  -  GRAFT BN 11X11X9MM TRD CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004727	SUP	Custom 27804086		1004727  -  GRAFT BN 11X11X10MM TRD CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004728	SUP	Custom 27804086		1004728  -  GRAFT BN 11X11X11IN ALGRF SPNE	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004732	SUP	Custom 27804086		1004732  -  GRAFT BN 14X11X5MM TRD CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004733	SUP	Custom 27804086		1004733  -  GRAFT BN 14X11X6MM TRD CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004734	SUP	Custom 27804086		1004734  -  GRAFT BN 7X11X14MM TRD CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004735	SUP	Custom 27804086		1004735  -  GRAFT BN 14X11X8MM TRD CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004736	SUP	Custom 27804086		1004736  -  GRAFT BN 14X11X9MM TRD CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004737	SUP	Custom 27804086		1004737  -  GRAFT BN 14X11X10MM TRD CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004772	SUP	Custom 27804086		1004772  -  GRAFT BN 20X9X8MM TRD PLIF	BOTH IP/OP	"$5,257.50 "	"$3,890.55"	$0.00	"$4,206.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,902.12"	"$3,902.12"	$0.00	$0.00	"$1,095.66"	$0.00	$0.00	$0.00	$0.00	"$2,628.75"	"$4,163.94"	"$4,206.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004773	SUP	Custom 27804086		1004773  -  GRAFT BN 20X9X10MM TRD PLIF ALGRF	BOTH IP/OP	"$5,257.50 "	"$3,890.55"	$0.00	"$4,206.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,902.12"	"$3,902.12"	$0.00	$0.00	"$1,095.66"	$0.00	$0.00	$0.00	$0.00	"$2,628.75"	"$4,163.94"	"$4,206.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004774	SUP	Custom 27804086		1004774  -  GRAFT BN 20X9X12MM TRD PLIF ALGRF	BOTH IP/OP	"$5,257.50 "	"$3,890.55"	$0.00	"$4,206.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,902.12"	"$3,902.12"	$0.00	$0.00	"$1,095.66"	$0.00	$0.00	$0.00	$0.00	"$2,628.75"	"$4,163.94"	"$4,206.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004775	SUP	Custom 27804086		1004775  -  GRAFT BN 20X9X14MM TRD PLIF	BOTH IP/OP	"$5,257.50 "	"$3,890.55"	$0.00	"$4,206.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,902.12"	"$3,902.12"	$0.00	$0.00	"$1,095.66"	$0.00	$0.00	$0.00	$0.00	"$2,628.75"	"$4,163.94"	"$4,206.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004782	SUP	Custom 27804086		1004782  -  GRAFT BN 20X11X8MM TRD TLIF	BOTH IP/OP	"$7,017.50 "	"$5,192.95"	$0.00	"$5,614.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,462.45"	$0.00	$0.00	$0.00	$0.00	"$3,508.75"	"$5,557.86"	"$5,614.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004783	SUP	Custom 27804086		1004783  -  GRAFT BN 20X11X10MM TRD TLIF	BOTH IP/OP	"$7,017.50 "	"$5,192.95"	$0.00	"$5,614.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,462.45"	$0.00	$0.00	$0.00	$0.00	"$3,508.75"	"$5,557.86"	"$5,614.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004784	SUP	Custom 27804086		1004784  -  GRAFT BN 20X11X12MM TRD TLIF	BOTH IP/OP	"$7,017.50 "	"$5,192.95"	$0.00	"$5,614.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,462.45"	$0.00	$0.00	$0.00	$0.00	"$3,508.75"	"$5,557.86"	"$5,614.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004785	SUP	Custom 27804086		1004785  -  GRAFT BN 20X11X14MM TRD TLIF	BOTH IP/OP	"$7,017.50 "	"$5,192.95"	$0.00	"$5,614.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,462.45"	$0.00	$0.00	$0.00	$0.00	"$3,508.75"	"$5,557.86"	"$5,614.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004792	SUP	Custom 27804086		1004792  -  GRAFT BN 25X9X8MM TRD PLIF ALGRF	BOTH IP/OP	"$5,257.50 "	"$3,890.55"	$0.00	"$4,206.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,902.12"	"$3,902.12"	$0.00	$0.00	"$1,095.66"	$0.00	$0.00	$0.00	$0.00	"$2,628.75"	"$4,163.94"	"$4,206.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004793	SUP	Custom 27804086		1004793  -  GRAFT BN 25X9X10MM TRD PLIF ALGRF	BOTH IP/OP	"$5,257.50 "	"$3,890.55"	$0.00	"$4,206.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,902.12"	"$3,902.12"	$0.00	$0.00	"$1,095.66"	$0.00	$0.00	$0.00	$0.00	"$2,628.75"	"$4,163.94"	"$4,206.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004794	SUP	Custom 27804086		1004794  -  GRAFT BN 25X9X12MM TRD PLIF	BOTH IP/OP	"$5,257.50 "	"$3,890.55"	$0.00	"$4,206.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,902.12"	"$3,902.12"	$0.00	$0.00	"$1,095.66"	$0.00	$0.00	$0.00	$0.00	"$2,628.75"	"$4,163.94"	"$4,206.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004795	SUP	Custom 27804086		1004795  -  GRAFT BN 25X9X14MM TRD PLIF	BOTH IP/OP	"$5,257.50 "	"$3,890.55"	$0.00	"$4,206.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,902.12"	"$3,902.12"	$0.00	$0.00	"$1,095.66"	$0.00	$0.00	$0.00	$0.00	"$2,628.75"	"$4,163.94"	"$4,206.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004802	SUP	Custom 27804086		1004802  -  GRAFT BN 25X11X8MM TRD TLIF	BOTH IP/OP	"$7,017.50 "	"$5,192.95"	$0.00	"$5,614.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,462.45"	$0.00	$0.00	$0.00	$0.00	"$3,508.75"	"$5,557.86"	"$5,614.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004803	SUP	Custom 27804086		1004803  -  GRAFT BN 25X11X10MM TLIF	BOTH IP/OP	"$7,017.50 "	"$5,192.95"	$0.00	"$5,614.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,462.45"	$0.00	$0.00	$0.00	$0.00	"$3,508.75"	"$5,557.86"	"$5,614.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004804	SUP	Custom 27804086		1004804  -  GRAFT BN 25X11X12MM TRD TLIF ALGRF	BOTH IP/OP	"$7,017.50 "	"$5,192.95"	$0.00	"$5,614.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,462.45"	$0.00	$0.00	$0.00	$0.00	"$3,508.75"	"$5,557.86"	"$5,614.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1004805	SUP	Custom 27804086		1004805  -  GRAFT BN 25X11X14MM TLIF	BOTH IP/OP	"$7,017.50 "	"$5,192.95"	$0.00	"$5,614.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,462.45"	$0.00	$0.00	$0.00	$0.00	"$3,508.75"	"$5,557.86"	"$5,614.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1005203	SUP	HCPCS C1769		1005203  -  GUIDEWIRE VASCULAR STR .014IN 300CM 5CM STEERABLE CORE TO	BOTH IP/OP	$207.50 	$153.55	$0.00	$166.00	$112.67	$112.67	$0.00	$0.00	$0.00	$43.25	$154.01	$154.01	$0.00	$0.00	$43.24	$0.00	$122.74	$122.74	$0.00	$103.75	$164.34	$166.00	$0.00		$0.00	$32.47	$0.00	$0.00	$33.03	$0.00	$0.00	$0.00	$0.00	$0.00
1005987	SUP	Custom 27203010		MASK F/F DISP W/HEADSTRP PED	BOTH IP/OP	$58.40 	$43.22	$0.00	$46.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.20	$46.25	$46.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007633	SUP	HCPCS C1713		1007633  -  MESH SRG 10X6MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007634	SUP	HCPCS C1713		1007634  -  MESH SRG 10X7MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007635	SUP	HCPCS C1713		1007635  -  MESH SRG 10X8MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007636	SUP	HCPCS C1713		1007636  -  MESH SRG 10X9MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007637	SUP	HCPCS C1713		1007637  -  MESH SRG 10X10MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007639	SUP	HCPCS C1713		1007639  -  MESH SRG 12X10MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007640	SUP	HCPCS C1713		1007640  -  MESH SRG 10X14MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007643	SUP	HCPCS C1713		1007643  -  MESH SRG 50X10MM SPNE	BOTH IP/OP	"$6,322.50 "	"$4,678.65"	$0.00	"$5,058.00"	"$2,845.13"	"$2,845.13"	$0.00	$0.00	$0.00	"$1,317.77"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,317.61"	$0.00	"$3,116.99"	"$3,116.99"	$0.00	"$3,161.25"	"$5,007.42"	"$5,058.00"	$0.00		$0.00	$989.47	$0.00	$0.00	"$1,006.54"	$0.00	$0.00	$0.00	$0.00	$0.00
1007653	SUP	HCPCS C1713		1007653  -  MESH SRG 12X6MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007654	SUP	HCPCS C1713		1007654  -  MESH SRG 12X7MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007655	SUP	HCPCS C1713		1007655  -  MESH SRG 12X8MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007656	SUP	HCPCS C1713		1007656  -  MESH SRG 12X9MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007657	SUP	HCPCS C1713		1007657  -  MESH SRG 10X12MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007659	SUP	HCPCS C1713		1007659  -  MESH SRG 12X12MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007660	SUP	HCPCS C1713		1007660  -  MESH SRG 12X14MM SPNE	BOTH IP/OP	"$2,617.50 "	"$1,936.95"	$0.00	"$2,094.00"	"$1,177.88"	"$1,177.88"	$0.00	$0.00	$0.00	$545.55	"$1,942.71"	"$1,942.71"	$0.00	$0.00	$545.49	$0.00	"$1,290.43"	"$1,290.43"	$0.00	"$1,308.75"	"$2,073.06"	"$2,094.00"	$0.00		$0.00	$409.64	$0.00	$0.00	$416.71	$0.00	$0.00	$0.00	$0.00	$0.00
1007663	SUP	HCPCS C1713		1007663  -  MESH SRG 50X12MM SPNE	BOTH IP/OP	"$7,227.50 "	"$5,348.35"	$0.00	"$5,782.00"	"$3,252.38"	"$3,252.38"	$0.00	$0.00	$0.00	"$1,506.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,506.21"	$0.00	"$3,563.16"	"$3,563.16"	$0.00	"$3,613.75"	"$5,724.18"	"$5,782.00"	$0.00		$0.00	"$1,131.10"	$0.00	$0.00	"$1,150.62"	$0.00	$0.00	$0.00	$0.00	$0.00
1007673	SUP	HCPCS C1713		1007673  -  MESH SRG 14X6MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007674	SUP	HCPCS C1713		1007674  -  MESH SRG 14X7MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007675	SUP	HCPCS C1713		1007675  -  MESH SRG 14X8MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007676	SUP	HCPCS C1713		1007676  -  MESH SRG 14X9MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007677	SUP	HCPCS C1713		1007677  -  MESH SRG 14X10MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007679	SUP	HCPCS C1713		1007679  -  MESH SRG 14X12MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007680	SUP	HCPCS C1713		1007680  -  MESH SRG 14X14MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007683	SUP	HCPCS C1713		1007683  -  MESH SRG 50X14MM TI SPNE	BOTH IP/OP	"$8,132.50 "	"$6,018.05"	$0.00	"$6,506.00"	"$3,659.63"	"$3,659.63"	$0.00	$0.00	$0.00	"$1,695.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,694.81"	$0.00	"$4,009.32"	"$4,009.32"	$0.00	"$4,066.25"	"$6,440.94"	"$6,506.00"	$0.00		$0.00	"$1,272.74"	$0.00	$0.00	"$1,294.69"	$0.00	$0.00	$0.00	$0.00	$0.00
1007693	SUP	HCPCS C1713		1007693  -  MESH SRG 16X6MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007694	SUP	HCPCS C1713		1007694  -  MESH SRG 16X7MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007695	SUP	HCPCS C1713		1007695  -  MESH SRG 16X8MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007696	SUP	HCPCS C1713		1007696  -  MESH SRG 16X9MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007697	SUP	HCPCS C1713		1007697  -  MESH SRG 16X10MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007699	SUP	HCPCS C1713		1007699  -  MESH SRG 16X12MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007700	SUP	HCPCS C1713		1007700  -  MESH SRG 16X14MM SPNE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
1007703	SUP	HCPCS C1713		1007703  -  CAGE SPNL 16MM 50MM MESH	BOTH IP/OP	"$8,132.50 "	"$6,018.05"	$0.00	"$6,506.00"	"$3,659.63"	"$3,659.63"	$0.00	$0.00	$0.00	"$1,695.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,694.81"	$0.00	"$4,009.32"	"$4,009.32"	$0.00	"$4,066.25"	"$6,440.94"	"$6,506.00"	$0.00		$0.00	"$1,272.74"	$0.00	$0.00	"$1,294.69"	$0.00	$0.00	$0.00	$0.00	$0.00
1007704	SUP	HCPCS C1713		1007704  -  MESH SRG 90X16MM SPNE	BOTH IP/OP	"$10,122.50 "	"$7,490.65"	$0.00	"$8,098.00"	"$4,555.13"	"$4,555.13"	$0.00	$0.00	$0.00	"$2,109.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,109.53"	$0.00	"$4,990.39"	"$4,990.39"	$0.00	"$5,061.25"	"$8,017.02"	"$8,098.00"	$0.00		$0.00	"$1,584.17"	$0.00	$0.00	"$1,611.50"	$0.00	$0.00	$0.00	$0.00	$0.00
1010008	SUP	HCPCS Q4130		1010008  -  SUBSTITUTE TISS 10X10CM STRATTICE MESH RECON TISS MTRX PRCN	BOTH IP/OP	"$6,825.00 "	"$5,050.50"	$0.00	"$5,460.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,422.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,422.33"	$0.00	"$3,364.73"	"$3,364.73"	$0.00	"$3,412.50"	"$5,405.40"	"$5,460.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1010020	SUP	Custom 27203010		1010020  -  AGENT HMST AVTN CLGN MCFIB FLUR 1GM STRL LATEX FREE DISP	BOTH IP/OP	$256.15 	$189.55	$0.00	$204.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$190.11	$190.11	$0.00	$0.00	$53.38	$0.00	$0.00	$0.00	$0.00	$128.08	$202.87	$204.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1010150	SUP	Custom 27203010		1010150  -  AGENT HEMOSTATIC 10MM 42CM 50X15X1MM PRELOAD APPLICATOR	BOTH IP/OP	$245.25 	$181.49	$0.00	$196.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.02	$182.02	$0.00	$0.00	$51.11	$0.00	$0.00	$0.00	$0.00	$122.63	$194.24	$196.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1011132	SUP	HCPCS C1713		1011132  -  MESH SRG 30X20MM SPNE	BOTH IP/OP	"$6,012.50 "	"$4,449.25"	$0.00	"$4,810.00"	"$2,705.63"	"$2,705.63"	$0.00	$0.00	$0.00	"$1,253.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,253.01"	$0.00	"$2,964.16"	"$2,964.16"	$0.00	"$3,006.25"	"$4,761.90"	"$4,810.00"	$0.00		$0.00	$940.96	$0.00	$0.00	$957.19	$0.00	$0.00	$0.00	$0.00	$0.00
1011134	SUP	HCPCS C1713		1011134  -  MESH SRG 60X20MM SPNE	BOTH IP/OP	"$8,495.00 "	"$6,286.30"	$0.00	"$6,796.00"	"$3,822.75"	"$3,822.75"	$0.00	$0.00	$0.00	"$1,770.57"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,770.36"	$0.00	"$4,188.04"	"$4,188.04"	$0.00	"$4,247.50"	"$6,728.04"	"$6,796.00"	$0.00		$0.00	"$1,329.47"	$0.00	$0.00	"$1,352.40"	$0.00	$0.00	$0.00	$0.00	$0.00
1011135	SUP	HCPCS C1713		1011135  -  MESH SRG 90X20MM SPNE	BOTH IP/OP	"$10,662.50 "	"$7,890.25"	$0.00	"$8,530.00"	"$4,798.13"	"$4,798.13"	$0.00	$0.00	$0.00	"$2,222.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,222.07"	$0.00	"$5,256.61"	"$5,256.61"	$0.00	"$5,331.25"	"$8,444.70"	"$8,530.00"	$0.00		$0.00	"$1,668.68"	$0.00	$0.00	"$1,697.47"	$0.00	$0.00	$0.00	$0.00	$0.00
1011152	SUP	HCPCS C1713		1011152  -  MESH SRG 30X24MM SPNE	BOTH IP/OP	"$6,012.50 "	"$4,449.25"	$0.00	"$4,810.00"	"$2,705.63"	"$2,705.63"	$0.00	$0.00	$0.00	"$1,253.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,253.01"	$0.00	"$2,964.16"	"$2,964.16"	$0.00	"$3,006.25"	"$4,761.90"	"$4,810.00"	$0.00		$0.00	$940.96	$0.00	$0.00	$957.19	$0.00	$0.00	$0.00	$0.00	$0.00
1011154	SUP	HCPCS C1713		1011154  -  MESH SRG 60X24MM SPNE	BOTH IP/OP	"$9,035.00 "	"$6,685.90"	$0.00	"$7,228.00"	"$4,065.75"	"$4,065.75"	$0.00	$0.00	$0.00	"$1,883.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,882.89"	$0.00	"$4,454.26"	"$4,454.26"	$0.00	"$4,517.50"	"$7,155.72"	"$7,228.00"	$0.00		$0.00	"$1,413.98"	$0.00	$0.00	"$1,438.37"	$0.00	$0.00	$0.00	$0.00	$0.00
1011155	SUP	HCPCS C1713		1011155  -  MESH SRG 90X24MM SPNE	BOTH IP/OP	"$11,207.50 "	"$8,293.55"	$0.00	"$8,966.00"	"$5,043.38"	"$5,043.38"	$0.00	$0.00	$0.00	"$2,335.92"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,335.64"	$0.00	"$5,525.30"	"$5,525.30"	$0.00	"$5,603.75"	"$8,876.34"	"$8,966.00"	$0.00		$0.00	"$1,753.97"	$0.00	$0.00	"$1,784.23"	$0.00	$0.00	$0.00	$0.00	$0.00
1012572	SUP	Custom 27203010		MASK CPAP LG ADLT HDGR FULL ADJ STRAP FRHD CLIP PRFMTRK LF	BOTH IP/OP	$65.20 	$48.25	$0.00	$52.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.60	$51.64	$52.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1012624	SUP	Custom 27203010		MASK CPAP MED ADLT HDGR FULL ADJ STRAP FRHD CLIP PRFMTRK LF	BOTH IP/OP	$65.20 	$48.25	$0.00	$52.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.60	$51.64	$52.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1016002	SUP	HCPCS Q4130		1016002  -  MATRIX TISSUE 16X10CM RECONSTRUCTIVE STRATTICE PIG DERMIS	BOTH IP/OP	$58.88 	$43.57	$0.00	$71.19	$0.00	$0.00	$0.00	$0.00	$0.00	$12.27	$43.70	$43.70	$0.00	$0.00	$12.27	$0.00	$34.82	$34.82	$0.00	$44.49	$70.47	$71.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1016692	SUP	Custom 27203010		MASK CPAP MED LG 2 FLP CSHN HDSTRP SIL CNTOUR DLX LF DISP	BOTH IP/OP	$37.53 	$27.77	$0.00	$30.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.76	$29.72	$30.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1025002	SUP	HCPCS Q4130		1025002  -  MATRIX TISSUE 25X10CM RECONSTRUCTIVE STRATTICE PIG DERMIS	BOTH IP/OP	"$14,720.00 "	"$10,892.80"	$0.00	"$17,796.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,068.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,067.65"	$0.00	"$7,256.96"	"$7,256.96"	$0.00	"$11,122.50"	"$17,618.04"	"$17,796.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1040014	SUP	Custom 27803010		1040014  -  TUBE VNT 1.14MM 3.6MM 1.3MM GRN POPE GRMT BVL FLRPLAS EAR	BOTH IP/OP	$44.25 	$32.75	$0.00	$35.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$0.00	$0.00	$0.00	$22.13	$35.05	$35.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1046742	SUP	Custom 27203010		PACIFIER NBN WTHMB PRMTR PUR	BOTH IP/OP	$7.40 	$5.48	$0.00	$5.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.70	$5.86	$5.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1050044	SUP	Custom 27203010		1050044  -  HYSTOCRYL BLUE FOIL POUCH 10X0.5ML	BOTH IP/OP	$487.50 	$360.75	$0.00	$361.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$24.38	$38.61	$39.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1112095	SUP	HCPCS C1713		1112095  -  PROSTHESIS OSS 90D RND 4MM 1.1MM 5MM FULL CNN SHFT OFF CNTR	BOTH IP/OP	$442.50 	$327.45	$0.00	$354.00	$199.13	$199.13	$0.00	$0.00	$0.00	$92.23	$328.42	$328.42	$0.00	$0.00	$92.22	$0.00	$261.74	$261.74	$0.00	$221.25	$350.46	$354.00	$0.00		$0.00	$69.25	$0.00	$0.00	$70.45	$0.00	$0.00	$0.00	$0.00	$0.00
1135510	SUP	HCPCS C1713		"1135510  -  RELINE MAS ROD, 100MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1151015	SUP	HCPCS C1781		1151015  -  GRAFT PRCN RECT 5.9X3.9IN STRL XENMATRIX AB NONCROSSLINK	BOTH IP/OP	"$11,445.00 "	"$8,469.30"	$0.00	"$9,156.00"	"$5,150.25"	"$5,150.25"	$0.00	$0.00	$0.00	"$2,385.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,385.14"	$0.00	"$5,642.39"	"$5,642.39"	$0.00	"$5,722.50"	"$9,064.44"	"$9,156.00"	$0.00		$0.00	"$1,791.14"	$0.00	$0.00	"$1,822.04"	$0.00	$0.00	$0.00	$0.00	$0.00
1151928	SUP	HCPCS C1781		1151928  -  GRAFT PRCN RECT 11X7.5IN STRL XENMATRIX AB RGNRT	BOTH IP/OP	"$22,877.00 "	"$16,928.98"	$0.00	"$18,301.60"	"$10,294.65"	"$10,294.65"	$0.00	$0.00	$0.00	"$4,768.14"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,767.57"	$0.00	"$11,278.36"	"$11,278.36"	$0.00	"$11,438.50"	"$18,118.58"	"$18,301.60"	$0.00		$0.00	"$3,580.25"	$0.00	$0.00	"$3,642.02"	$0.00	$0.00	$0.00	$0.00	$0.00
1161015	SUP	HCPCS C1781		1161015  -  GRAFT PIG THK1.8-2.5MM 5.9X3.9IN REGENERATIVE XENMATRIX	BOTH IP/OP	"$10,374.00 "	"$7,676.76"	$0.00	"$8,299.20"	"$4,668.30"	"$4,668.30"	$0.00	$0.00	$0.00	"$2,162.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,161.94"	$0.00	"$5,114.38"	"$5,114.38"	$0.00	"$5,187.00"	"$8,216.21"	"$8,299.20"	$0.00		$0.00	"$1,623.53"	$0.00	$0.00	"$1,651.54"	$0.00	$0.00	$0.00	$0.00	$0.00
1161520	SUP	HCPCS C1781		1161520  -  GRAFT PIG THK1.8-2.5MM 7.9X5.9IN REGENERATIVE XENMATRIX	BOTH IP/OP	"$20,748.00 "	"$15,353.52"	$0.00	"$16,598.40"	"$9,336.60"	"$9,336.60"	$0.00	$0.00	$0.00	"$4,324.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,323.88"	$0.00	"$10,228.76"	"$10,228.76"	$0.00	"$10,374.00"	"$16,432.42"	"$16,598.40"	$0.00		$0.00	"$3,247.06"	$0.00	$0.00	"$3,303.08"	$0.00	$0.00	$0.00	$0.00	$0.00
1161928	SUP	HCPCS C1781		1161928  -  GRAFT SURG 11X7.5IN REGENERATIVE XENMATRIX COLLAGEN MATRIX	BOTH IP/OP	"$35,479.60 "	"$26,254.90"	$0.00	"$28,383.68"	"$15,965.82"	"$15,965.82"	$0.00	$0.00	$0.00	"$7,394.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,393.95"	$0.00	"$17,491.44"	"$17,491.44"	$0.00	"$17,739.80"	"$28,099.84"	"$28,383.68"	$0.00		$0.00	"$5,552.56"	$0.00	$0.00	"$5,648.35"	$0.00	$0.00	$0.00	$0.00	$0.00
1190602	SUP	HCPCS C1781		1190602  -  PLUG SURG LARGE 1.9X1.5IN MONOFILAMENT MESH PLEATED EDGE	BOTH IP/OP	"$1,572.25 "	"$1,163.47"	$0.00	"$1,257.80"	$707.51	$707.51	$0.00	$0.00	$0.00	$327.70	"$1,166.92"	"$1,166.92"	$0.00	$0.00	$327.66	$0.00	$929.99	$929.99	$0.00	$786.13	"$1,245.22"	"$1,257.80"	$0.00		$0.00	$246.06	$0.00	$0.00	$250.30	$0.00	$0.00	$0.00	$0.00	$0.00
1190603	SUP	HCPCS C1781		1190603  -  PLUG SURG XL 1.6X1.3IN MESH MULTILAYER PHASIX	BOTH IP/OP	"$1,585.75 "	"$1,173.46"	$0.00	"$1,268.60"	$713.59	$713.59	$0.00	$0.00	$0.00	$330.51	"$1,176.94"	"$1,176.94"	$0.00	$0.00	$330.47	$0.00	$937.97	$937.97	$0.00	$792.88	"$1,255.91"	"$1,268.60"	$0.00		$0.00	$248.17	$0.00	$0.00	$252.45	$0.00	$0.00	$0.00	$0.00	$0.00
1203105	SUP	Custom 27203010		1203105  -  TUBE ENDBR 9FR STRL UNIBLOCKER ADLT	BOTH IP/OP	$347.50 	$257.15	$0.00	$278.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.91	$257.91	$0.00	$0.00	$72.42	$0.00	$0.00	$0.00	$0.00	$173.75	$275.22	$278.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1303346	SUP	Custom 27203010		1303346  -  SPONGE ABS HMST AGNT PWDR GELTN GLFM 50 STRL	BOTH IP/OP	$421.96 	$312.25	$0.00	$313.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$313.18	$313.18	$0.00	$0.00	$87.94	$0.00	$0.00	$0.00	$0.00	$144.21	$228.44	$230.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Oct-10	SUP	Custom 27203010		10-5510  -  DRESSING GZE 36X36IN STRL LF 1-+ 17 PLY W MESH 1 LYR	BOTH IP/OP	$37.32 	$27.62	$0.00	$27.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.70	$27.70	$0.00	$0.00	$7.78	$0.00	$0.00	$0.00	$0.00	$16.85	$26.68	$26.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6/11/5537	SUP	HCPCS C1776		5537-6/11  -  STEM HUMERAL 6 135MM PRESS FIT ANATOMIC TITANIUM NONSTRL	BOTH IP/OP	"$6,566.70 "	"$4,859.36"	$0.00	"$5,253.36"	"$2,955.02"	"$2,955.02"	$0.00	$0.00	$0.00	"$1,368.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,368.50"	$0.00	"$3,237.38"	"$3,237.38"	$0.00	"$3,283.35"	"$5,200.83"	"$5,253.36"	$0.00		$0.00	"$1,027.69"	$0.00	$0.00	"$1,045.42"	$0.00	$0.00	$0.00	$0.00	$0.00
8/12/5537	SUP	HCPCS C1776		5537-8/12  -  STEM HUMERAL 8 120MM PRESS FIT ANATOMIC SELF CENTERING EPOCA	BOTH IP/OP	"$6,566.70 "	"$4,859.36"	$0.00	"$5,253.36"	"$2,955.02"	"$2,955.02"	$0.00	$0.00	$0.00	"$1,368.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,368.50"	$0.00	"$3,237.38"	"$3,237.38"	$0.00	"$3,283.35"	"$5,200.83"	"$5,253.36"	$0.00		$0.00	"$1,027.69"	$0.00	$0.00	"$1,045.42"	$0.00	$0.00	$0.00	$0.00	$0.00
10/12/5537	SUP	HCPCS C1776		5537-10/12  -  STEM HUMERAL 10 125MM PRESS FIT ANATOMIC SELF CENTERING	BOTH IP/OP	"$6,566.70 "	"$4,859.36"	$0.00	"$5,253.36"	"$2,955.02"	"$2,955.02"	$0.00	$0.00	$0.00	"$1,368.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,368.50"	$0.00	"$3,237.38"	"$3,237.38"	$0.00	"$3,283.35"	"$5,200.83"	"$5,253.36"	$0.00		$0.00	"$1,027.69"	$0.00	$0.00	"$1,045.42"	$0.00	$0.00	$0.00	$0.00	$0.00
12/13/5537	SUP	HCPCS C1776		5537-12/13  -  STEM HUMERAL 12MM 130MM PRESS FIT TITANIUM NONSTRL	BOTH IP/OP	"$6,566.70 "	"$4,859.36"	$0.00	"$5,253.36"	"$2,955.02"	"$2,955.02"	$0.00	$0.00	$0.00	"$1,368.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,368.50"	$0.00	"$3,237.38"	"$3,237.38"	$0.00	"$3,283.35"	"$5,200.83"	"$5,253.36"	$0.00		$0.00	"$1,027.69"	$0.00	$0.00	"$1,045.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6/11/5540	SUP	HCPCS C1776		5540-6/11  -  STEM HUMERAL 6MM 115MM PRESS FIT TITANIUM HA STERILE	BOTH IP/OP	"$6,943.00 "	"$5,137.82"	$0.00	"$5,554.40"	"$3,124.35"	"$3,124.35"	$0.00	$0.00	$0.00	"$1,447.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,446.92"	$0.00	"$3,422.90"	"$3,422.90"	$0.00	"$3,471.50"	"$5,498.86"	"$5,554.40"	$0.00		$0.00	"$1,086.58"	$0.00	$0.00	"$1,105.33"	$0.00	$0.00	$0.00	$0.00	$0.00
8/12/5540	SUP	HCPCS C1776		5540-8/12  -  STEM HUMERAL 8MM 120MM PRESS FIT EPOCA TITANIUM HA SHOULDER	BOTH IP/OP	"$6,943.00 "	"$5,137.82"	$0.00	"$5,554.40"	"$3,124.35"	"$3,124.35"	$0.00	$0.00	$0.00	"$1,447.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,446.92"	$0.00	"$3,422.90"	"$3,422.90"	$0.00	"$3,471.50"	"$5,498.86"	"$5,554.40"	$0.00		$0.00	"$1,086.58"	$0.00	$0.00	"$1,105.33"	$0.00	$0.00	$0.00	$0.00	$0.00
10/12/5540	SUP	HCPCS C1776		5540-10/12  -  STEM HUMERAL 10 125MM PRESS FIT IMPLANT TITANIUM HA SHOULDER	BOTH IP/OP	"$6,943.00 "	"$5,137.82"	$0.00	"$5,554.40"	"$3,124.35"	"$3,124.35"	$0.00	$0.00	$0.00	"$1,447.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,446.92"	$0.00	"$3,422.90"	"$3,422.90"	$0.00	"$3,471.50"	"$5,498.86"	"$5,554.40"	$0.00		$0.00	"$1,086.58"	$0.00	$0.00	"$1,105.33"	$0.00	$0.00	$0.00	$0.00	$0.00
12/13/5540	SUP	HCPCS C1776		5540-12/13  -  STEM HUMERAL 12MM 130MM PRESS FIT TITANIUM HA STERILE	BOTH IP/OP	"$6,943.00 "	"$5,137.82"	$0.00	"$5,554.40"	"$3,124.35"	"$3,124.35"	$0.00	$0.00	$0.00	"$1,447.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,446.92"	$0.00	"$3,422.90"	"$3,422.90"	$0.00	"$3,471.50"	"$5,498.86"	"$5,554.40"	$0.00		$0.00	"$1,086.58"	$0.00	$0.00	"$1,105.33"	$0.00	$0.00	$0.00	$0.00	$0.00
6/11/5624	SUP	HCPCS C1776		5624-6/11  -  STEM HUMERAL 8MM 115MM CEMENT EPOCA COCR SHOULDER STERILE	BOTH IP/OP	"$5,769.05 "	"$4,269.10"	$0.00	"$4,615.24"	"$2,596.07"	"$2,596.07"	$0.00	$0.00	$0.00	"$1,202.41"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,202.27"	$0.00	"$2,844.14"	"$2,844.14"	$0.00	"$2,884.53"	"$4,569.09"	"$4,615.24"	$0.00		$0.00	$902.86	$0.00	$0.00	$918.43	$0.00	$0.00	$0.00	$0.00	$0.00
8/12/5624	SUP	HCPCS C1776		5624-8/12  -  STEM HUMERAL 8MM 120MM CEMENTED ANATOMIC SELF CENTERING	BOTH IP/OP	"$5,769.05 "	"$4,269.10"	$0.00	"$4,615.24"	"$2,596.07"	"$2,596.07"	$0.00	$0.00	$0.00	"$1,202.41"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,202.27"	$0.00	"$2,844.14"	"$2,844.14"	$0.00	"$2,884.53"	"$4,569.09"	"$4,615.24"	$0.00		$0.00	$902.86	$0.00	$0.00	$918.43	$0.00	$0.00	$0.00	$0.00	$0.00
10/12/5624	SUP	HCPCS C1776		5624-10/12  -  STEM HUMERAL 10 125MM CEMENTED ANATOMIC COCR STERILE	BOTH IP/OP	"$5,769.05 "	"$4,269.10"	$0.00	"$4,615.24"	"$2,596.07"	"$2,596.07"	$0.00	$0.00	$0.00	"$1,202.41"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,202.27"	$0.00	"$2,844.14"	"$2,844.14"	$0.00	"$2,884.53"	"$4,569.09"	"$4,615.24"	$0.00		$0.00	$902.86	$0.00	$0.00	$918.43	$0.00	$0.00	$0.00	$0.00	$0.00
12/13/5624	SUP	HCPCS C1776		5624-12/13  -  STEM HUMERAL 12 130MM CEMENTED ANATOMIC COCR STERILE	BOTH IP/OP	"$5,769.05 "	"$4,269.10"	$0.00	"$4,615.24"	"$2,596.07"	"$2,596.07"	$0.00	$0.00	$0.00	"$1,202.41"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,202.27"	$0.00	"$2,844.14"	"$2,844.14"	$0.00	"$2,884.53"	"$4,569.09"	"$4,615.24"	$0.00		$0.00	$902.86	$0.00	$0.00	$918.43	$0.00	$0.00	$0.00	$0.00	$0.00
1371120	SUP	Custom 27203010		PIPETTE TRNSF PE 6IN 5.8ML GRAD STRL	BOTH IP/OP	$0.30 	$0.22	$0.00	$0.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.15	$0.24	$0.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1372301	SUP	Custom 27203010		1372301  -  SET ADM 110IN 0.2 MH NVNT ADON	BOTH IP/OP	$38.38 	$28.40	$0.00	$30.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.48	$28.48	$0.00	$0.00	$8.00	$0.00	$0.00	$0.00	$0.00	$19.19	$30.40	$30.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1424571	SUP	HCPCS C1713		PLATE MCWL 96 WELL UBTM RGD PS DISP	BOTH IP/OP	$4.48 	$3.32	$0.00	$3.58	$2.01	$2.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.24	$3.55	$3.58	$0.00		$0.00	$0.70	$0.00	$0.00	$0.71	$0.00	$0.00	$0.00	$0.00	$0.00
1437374	SUP	Custom 27203010		BLADE HISTOLGY 130MM ACED SHRT SS TRM DISP	BOTH IP/OP	$539.75 	$399.42	$0.00	$431.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.88	$427.48	$431.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1500181	SUP	Custom 27203010		1500181  -  APL ENDSCP FLSL STRL DISP	BOTH IP/OP	$147.78 	$109.36	$0.00	$118.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.68	$109.68	$0.00	$0.00	$30.80	$0.00	$0.00	$0.00	$0.00	$73.89	$117.04	$118.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1501262	SUP	HCPCS C9250		1501262  -  KIT TISSUE CLOSURE 1 PREFILL SYRINGE PLUNGER 2 PULL STRAP	BOTH IP/OP	$385.60 	$285.34	$0.00	$481.28	$270.72	$270.72	$156.84	$156.84	$156.84	$80.37	$286.19	$286.19	$0.00	$156.84	$80.36	$101.95	$228.08	$228.08	$173.09	$300.80	$476.47	$481.28	$239.03		$239.03	$94.15	$0.00	$0.00	$95.77	$164.85	$0.00	$0.00	$0.00	$0.00
1501263	SUP	HCPCS C9250		1501263  -  KIT TISS CLSR 10ML 2 PCH FRZN SLNT SYRPLNG Y PC CONCTR TSSL	BOTH IP/OP	$946.28 	$700.25	$0.00	"$1,113.26"	$626.21	$626.21	$156.84	$156.84	$156.84	$197.23	$702.33	$702.33	$0.00	$156.84	$197.20	$101.95	$559.72	$559.72	$173.09	$695.79	"$1,102.13"	"$1,113.26"	$239.03		$239.03	$217.78	$0.00	$0.00	$221.54	$164.85	$0.00	$0.00	$0.00	$0.00
1518128	SUP	HCPCS Q4116		1518128  -  MATRIX TISS THK.4-1.6MM 128SQ CM MED RECT 16X8CM ALDRM SLCT	BOTH IP/OP	"$8,732.50 "	"$6,462.05"	$0.00	"$10,840.00"	"$6,097.50"	"$6,097.50"	$0.00	$0.00	$0.00	"$1,820.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,819.85"	$0.00	"$4,305.12"	"$4,305.12"	$0.00	"$6,775.00"	"$10,731.60"	"$10,840.00"	$0.00		$0.00	"$2,120.58"	$0.00	$0.00	"$2,157.16"	$0.00	$0.00	$0.00	$0.00	$0.00
1518320	SUP	HCPCS Q4116		1518320  -  MATRIX TISS THK.4-1.6MM 320SQ CM MED RECT 20X16CM ALDRM SLCT	BOTH IP/OP	"$21,832.50 "	"$16,156.05"	$0.00	"$27,100.00"	"$15,243.75"	"$15,243.75"	$0.00	$0.00	$0.00	"$4,550.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,549.89"	$0.00	"$10,763.42"	"$10,763.42"	$0.00	"$16,937.50"	"$26,829.00"	"$27,100.00"	$0.00		$0.00	"$5,301.44"	$0.00	$0.00	"$5,392.90"	$0.00	$0.00	$0.00	$0.00	$0.00
1518616	SUP	HCPCS Q4116		1518616  -  MATRIX TISSUE THICK 16X6CM ALLOGRAFT REGENERATIVE FREEZE	BOTH IP/OP	"$7,497.50 "	"$5,548.15"	$0.00	"$5,998.00"	"$3,373.88"	"$3,373.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,748.75"	"$5,938.02"	"$5,998.00"	$0.00		$0.00	"$1,173.36"	$0.00	$0.00	"$1,193.60"	$0.00	$0.00	$0.00	$0.00	$0.00
1520616	SUP	HCPCS Q4116		1520616  -  MATRIX TISS THK.4-1.6MM MED 16X6CM ALDRM SLCT ALGRF RGNRT	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$8,130.00"	"$4,573.13"	"$4,573.13"	$0.00	$0.00	$0.00	"$1,365.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	"$3,229.15"	"$3,229.15"	$0.00	"$5,081.25"	"$8,048.70"	"$8,130.00"	$0.00		$0.00	"$1,590.43"	$0.00	$0.00	"$1,617.87"	$0.00	$0.00	$0.00	$0.00	$0.00
1523901	SUP	Custom 27203010		1523901  -  SET IRRIGATION .28IN 85IN 4 LEAD 3Y CONCTR SIGHT CHAMBER	BOTH IP/OP	$385.75 	$285.46	$0.00	$308.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.30	$286.30	$0.00	$0.00	$80.39	$0.00	$0.00	$0.00	$0.00	$192.88	$305.51	$308.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1524055	SUP	Custom 27203010		1524055  -  SPLINT NSL WHT STRL LF DYLE II CMPR ANT TIP INTGR ARWY SIL	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$0.00	$0.00	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1525002	SUP	HCPCS Q4130		1525002  -  MATRIX TISSUE 25X15CM RECONSTRUCTIVE STRATTICE PIG DERMIS	BOTH IP/OP	"$22,080.00 "	"$16,339.20"	$0.00	"$26,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,602.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,601.47"	$0.00	"$10,885.44"	"$10,885.44"	$0.00	"$16,683.75"	"$26,427.06"	"$26,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1527005	SUP	Custom 27803010		1527005  -  SPLINT NSL THK.5MM STD REUT PREPUNCH HL FLRPLAS SPT	BOTH IP/OP	$74.50 	$55.13	$0.00	$59.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.29	$55.29	$0.00	$0.00	$15.53	$0.00	$0.00	$0.00	$0.00	$37.25	$59.00	$59.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1527010	SUP	HCPCS C1713		1527010  -  SPLINT 1527010 10PK PAIR REUTER LRG THIN	BOTH IP/OP	$100.00 	$74.00	$0.00	$74.22	$33.53	$33.53	$0.00	$0.00	$0.00	$20.84	$74.22	$74.22	$0.00	$0.00	$20.84	$0.00	$59.15	$59.15	$0.00	$37.25	$59.00	$59.60	$0.00		$0.00	$11.66	$0.00	$0.00	$11.86	$0.00	$0.00	$0.00	$0.00	$0.00
1527020	SUP	Custom 27803010		1527020  -  SPLINT 1527020 10PK PAIR REUTER LRG THK	BOTH IP/OP	$100.00 	$74.00	$0.00	$74.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.22	$74.22	$0.00	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$37.25	$59.00	$59.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1528120	SUP	Custom 27203010		1528120  -  SPLINT NASAL MEDIUM REGULAR 2.38X1.53IN EXTERNAL RUBBER FOAM	BOTH IP/OP	"$2,912.50 "	"$2,155.25"	$0.00	"$2,330.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,161.66"	"$2,161.66"	$0.00	$0.00	$606.97	$0.00	$0.00	$0.00	$0.00	"$1,456.25"	"$2,306.70"	"$2,330.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1528126	SUP	Custom 27203010		1528126  -  SPLINT NSL MED 2.38X1.53IN WHT STRL LF XTRN KT FM RBR SPT	BOTH IP/OP	$93.50 	$69.19	$0.00	$74.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.40	$69.40	$0.00	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$46.75	$74.05	$74.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1528136	SUP	Custom 27203010		1528136  -  SPLINT NSL LG KT XTRN LTWT STRNG WTR RS ADH FM AL SPT	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1528137	SUP	Custom 27203010		1528137  -  SPLINT NASAL LARGE 2.63INX1.73IN ADHERENT EXTERNAL STRONG	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1529010	SUP	Custom 27803010		1529010  -  SPLINT NSL MED 2.38X1.53IN WHT STRL LF THRMSPLNT KT XTRN	BOTH IP/OP	$7.80 	$5.77	$0.00	$462.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.79	$5.79	$0.00	$0.00	$1.63	$0.00	$0.00	$0.00	$0.00	$288.75	$457.38	$462.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1529020	SUP	Custom 27203010		1529020  -  SPLINT NSL LG 2.63INX1.73IN WHT STRL LF THRMSPLNT KT XTRN	BOTH IP/OP	$56.75 	$42.00	$0.00	$45.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.12	$42.12	$0.00	$0.00	$11.83	$0.00	$0.00	$0.00	$0.00	$28.38	$44.95	$45.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1608695	SUP	Custom 27203010		1608695  -  BURR SURG ROUND .157MM 2.13IN DIAMOND MEDIUM GRIT	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$0.00	$0.00	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1620002	SUP	HCPCS Q4130		1620002  -  MATRIX TISSUE 20X16CM RECONSTRUCTIVE STRATTICE PIG DERMIS	BOTH IP/OP	$58.88 	$43.57	$0.00	$71.19	$0.00	$0.00	$0.00	$0.00	$0.00	$12.27	$43.70	$43.70	$0.00	$0.00	$12.27	$0.00	$34.83	$34.83	$0.00	$44.49	$70.47	$71.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1664017	SUP	HCPCS C1713		1664017  -  SET SCREW 1664017 4.75 SOL PERC MULTI S	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
1677545	SUP	HCPCS C1713		1677545  -  SCREW BN 7.5MM 45MM NS PRCPT PA CR SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
1677550	SUP	HCPCS C1713		1677550  -  SCREW BN 7.5MM 50MM NS PRCPT PA CR SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
1801303	SUP	HCPCS C1713		1801303  -  ENDPLATE SPNL 3D MED NS INFIX TI THORLMBR ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
1801306	SUP	HCPCS C1713		1801306  -  ENDPLATE SPNL 6D MED NS INFIX TI THORLMBR ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
1803205	SUP	HCPCS C1776		1803205  -  DOME PTLR RND 38MM RSRFC KN MCK SYS	BOTH IP/OP	"$2,192.50 "	"$1,622.45"	$0.00	"$1,754.00"	$986.63	$986.63	$0.00	$0.00	$0.00	$456.97	"$1,627.27"	"$1,627.27"	$0.00	$0.00	$456.92	$0.00	"$1,296.86"	"$1,296.86"	$0.00	"$1,096.25"	"$1,736.46"	"$1,754.00"	$0.00		$0.00	$343.13	$0.00	$0.00	$349.05	$0.00	$0.00	$0.00	$0.00	$0.00
1804308	SUP	HCPCS C1713		1804308  -  STRUT SPNL MED 8MM BLU NS INFIX TI THORLMBR ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
1807052	SUP	HCPCS C1776		1807052  -  INSERT TIB 5 9MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
1807081	SUP	HCPCS C1776		1807081  -  INSERT TIB 8 8MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
1850300	SUP	HCPCS C1894		1850300  -  SHEATH ENDSCP CLEAN 170MM 4MM ESCRB 25D SIN LEN SYS STRL	BOTH IP/OP	$502.50 	$371.85	$0.00	$402.00	$272.86	$272.86	$0.00	$0.00	$0.00	$104.73	$372.96	$372.96	$0.00	$0.00	$104.72	$0.00	$297.23	$297.23	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$78.64	$0.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-33	SUP	HCPCS C1713		01-7033  -  PLATE 100D MED RIGHT MIDFAC 3X3 HOLE L 1.5MM SCR BONE TI	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$210.38	$210.38	$0.00	$0.00	$0.00	$97.44	$346.98	$346.98	$0.00	$0.00	$97.43	$0.00	$276.53	$276.53	$0.00	$233.75	$370.26	$374.00	$0.00		$0.00	$73.16	$0.00	$0.00	$74.43	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-38	SUP	HCPCS C1713		01-7038  -  PLATE BONE 1.5MM REGULAR L SILVER LEFT MIDFAC	BOTH IP/OP	$910.00 	$673.40	$0.00	$728.00	$409.50	$409.50	$0.00	$0.00	$0.00	$189.67	$675.40	$675.40	$0.00	$0.00	$189.64	$0.00	$538.27	$538.27	$0.00	$455.00	$720.72	$728.00	$0.00		$0.00	$142.42	$0.00	$0.00	$144.87	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-40	SUP	HCPCS C1713		01-7040  -  PLATE BONE REGULAR STR 16MMX.6MM 4 HOLE TRAUMAONE LORENZ	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-45	SUP	HCPCS C1713		01-7045  -  PLATE BONE MEDIUM STR 17MMX.6MM 4 HOLE SILVER TITANIUM	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-47	SUP	HCPCS C1713		01-7047  -  PLATE BONE LONG STR 4 HOLE GRADE II TRAUMAONE LORENZ SILVER	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-50	SUP	HCPCS C1713		01-7050  -  PLATE BONE REGULAR STR 6 HOLE TRAUMAONE LORENZ SILVER	BOTH IP/OP	$447.50 	$331.15	$0.00	$358.00	$201.38	$201.38	$0.00	$0.00	$0.00	$93.27	$332.13	$332.13	$0.00	$0.00	$93.26	$0.00	$264.70	$264.70	$0.00	$223.75	$354.42	$358.00	$0.00		$0.00	$70.03	$0.00	$0.00	$71.24	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-65	SUP	HCPCS C1713		01-7065  -  PLATE BONE MESH SIDE PROFILE PRECONTOUR 163X115X.3MM ULTRA	BOTH IP/OP	"$10,742.50 "	"$7,949.45"	$0.00	"$8,594.00"	"$4,834.13"	"$4,834.13"	$0.00	$0.00	$0.00	"$2,239.01"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,238.74"	$0.00	"$5,296.05"	"$5,296.05"	$0.00	"$5,371.25"	"$8,508.06"	"$8,594.00"	$0.00		$0.00	"$1,681.20"	$0.00	$0.00	"$1,710.21"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-66	SUP	HCPCS C1713		01-7066  -  PLATE BONE 16 HOLE STR LORENZ TITANIUM CRANIOMAXILLOFACIAL	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-92	SUP	HCPCS C1713		01-7092  -  PLATE BONE MED 2T CRNMXF TI 1.5MM SCR	BOTH IP/OP	$710.00 	$525.40	$0.00	$568.00	$319.50	$319.50	$0.00	$0.00	$0.00	$147.98	$526.96	$526.96	$0.00	$0.00	$147.96	$0.00	$419.97	$419.97	$0.00	$355.00	$562.32	$568.00	$0.00		$0.00	$111.12	$0.00	$0.00	$113.03	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-02	SUP	HCPCS C1713		01-7102  -  PLATE BONE LONG REGULAR Y 5 HOLE TRAUMAONE LORENZ SILVER	BOTH IP/OP	$840.00 	$621.60	$0.00	$672.00	$378.00	$378.00	$0.00	$0.00	$0.00	$175.08	$623.45	$623.45	$0.00	$0.00	$175.06	$0.00	$496.86	$496.86	$0.00	$420.00	$665.28	$672.00	$0.00		$0.00	$131.46	$0.00	$0.00	$133.73	$0.00	$0.00	$0.00	$0.00	$0.00
1900233	SUP	Custom 27203010		REAGENT XYLN SHDN 120ML SUB MOUNTANT HISTOLGY	BOTH IP/OP	$54.45 	$40.29	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.23	$43.12	$43.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-04	SUP	HCPCS C1713		01-7104  -  PLATE BONE XL Y 19MMX.6MM 5 HOLE LORENZ SILVER TITANIUM	BOTH IP/OP	$710.00 	$525.40	$0.00	$568.00	$319.50	$319.50	$0.00	$0.00	$0.00	$147.98	$526.96	$526.96	$0.00	$0.00	$147.96	$0.00	$419.97	$419.97	$0.00	$355.00	$562.32	$568.00	$0.00		$0.00	$111.12	$0.00	$0.00	$113.03	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-06	SUP	HCPCS C1713		01-7106  -  PLATE BONE SMALL PREFORM TITANIUM ORBTL FLOOR	BOTH IP/OP	"$3,112.50 "	"$2,303.25"	$0.00	"$2,490.00"	"$1,400.63"	"$1,400.63"	$0.00	$0.00	$0.00	$648.72	"$2,310.10"	"$2,310.10"	$0.00	$0.00	$648.65	$0.00	"$1,534.46"	"$1,534.46"	$0.00	"$1,556.25"	"$2,465.10"	"$2,490.00"	$0.00		$0.00	$487.11	$0.00	$0.00	$495.51	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-07	SUP	HCPCS C1713		01-7107  -  PLATE BONE MEDIUM .3MM PREFORM TRAUMAONE LORENZ GOLD	BOTH IP/OP	"$3,112.50 "	"$2,303.25"	$0.00	"$1,232,500.00"	"$1,400.63"	"$1,400.63"	$0.00	$0.00	$0.00	$648.72	"$2,310.10"	"$2,310.10"	$0.00	$0.00	$648.65	$0.00	"$1,232,500.00"	"$1,232,500.00"	$0.00	"$1,556.25"	"$2,465.10"	"$2,490.00"	$0.00		$0.00	$487.11	$0.00	$0.00	$495.51	$0.00	$0.00	$0.00	$0.00	$0.00
1901819	SUP	HCPCS C1713		1901819  -  PLATE BONE MED ORBTL FLR TI MESH	BOTH IP/OP	"$3,112.50 "	"$2,303.25"	$0.00	"$1,980,000.00"	"$1,400.63"	"$1,400.63"	$0.00	$0.00	$0.00	$648.72	"$2,310.10"	"$2,310.10"	$0.00	$0.00	$648.65	$0.00	"$1,232,500.00"	"$1,232,500.00"	$0.00	"$1,556.25"	"$1,980,000.00"	"$2,490.00"	$0.00		$0.00	$487.11	$0.00	$0.00	$495.51	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-08	SUP	HCPCS C1713		01-7108  -  PLATE BONE LARGE .3MM PREFORM TITANIUM ORBTL FLOOR STERILE	BOTH IP/OP	"$3,242.50 "	"$2,399.45"	$0.00	"$2,594.00"	"$1,459.13"	"$1,459.13"	$0.00	$0.00	$0.00	$675.82	"$2,406.58"	"$2,406.58"	$0.00	$0.00	$675.74	$0.00	"$1,598.55"	"$1,598.55"	$0.00	"$1,621.25"	"$2,568.06"	"$2,594.00"	$0.00		$0.00	$507.45	$0.00	$0.00	$516.21	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-09	SUP	HCPCS C1713		01-7109  -  PLATE BONE .3MM GRADE IV PREFORME TRAUMAONE LORENZ GOLD	BOTH IP/OP	"$2,835.00 "	"$2,097.90"	$0.00	"$2,268.00"	"$1,275.75"	"$1,275.75"	$0.00	$0.00	$0.00	$590.88	"$2,104.14"	"$2,104.14"	$0.00	$0.00	$590.81	$0.00	"$1,397.66"	"$1,397.66"	$0.00	"$1,417.50"	"$2,245.32"	"$2,268.00"	$0.00		$0.00	$443.68	$0.00	$0.00	$451.33	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-10	SUP	HCPCS C1713		01-7110  -  PLATE BN REG 2Y 6 HL TI MDFC 1.5MM SCR	BOTH IP/OP	$760.00 	$562.40	$0.00	$608.00	$342.00	$342.00	$0.00	$0.00	$0.00	$158.40	$564.07	$564.07	$0.00	$0.00	$158.38	$0.00	$449.54	$449.54	$0.00	$380.00	$601.92	$608.00	$0.00		$0.00	$118.94	$0.00	$0.00	$120.99	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-12	SUP	HCPCS C1713		01-7112  -  PLATE BONE LONG 6 HOLE 2Y TITANIUM MIDFAC 1.5MM SCREWS	BOTH IP/OP	$850.00 	$629.00	$0.00	$680.00	$382.50	$382.50	$0.00	$0.00	$0.00	$177.16	$630.87	$630.87	$0.00	$0.00	$177.14	$0.00	$502.78	$502.78	$0.00	$425.00	$673.20	$680.00	$0.00		$0.00	$133.03	$0.00	$0.00	$135.32	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-14	SUP	HCPCS C1713		01-7114  -  PLATE BONE XLONG 2Y TITANIUM CRANIOMAXILLOFACIAL 1.5MM SCREW	BOTH IP/OP	$745.00 	$551.30	$0.00	$596.00	$335.25	$335.25	$0.00	$0.00	$0.00	$155.28	$552.94	$552.94	$0.00	$0.00	$155.26	$0.00	$440.67	$440.67	$0.00	$372.50	$590.04	$596.00	$0.00		$0.00	$116.59	$0.00	$0.00	$118.60	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-20	SUP	HCPCS C1713		01-7120  -  PLATE BONE REGULAR X TITANIUM CRANIOMAXILLOFACIAL STERILE	BOTH IP/OP	$840.00 	$621.60	$0.00	$672.00	$378.00	$378.00	$0.00	$0.00	$0.00	$175.08	$623.45	$623.45	$0.00	$0.00	$175.06	$0.00	$496.86	$496.86	$0.00	$420.00	$665.28	$672.00	$0.00		$0.00	$131.46	$0.00	$0.00	$133.73	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-21	SUP	HCPCS C1713		01-7121  -  PLATE BONE 6 HOLE CVD TRAUMAONE GREEN ORBTL MIDFAC	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-22	SUP	HCPCS C1713		01-7122  -  PLATE BONE 18 HOLE CVD TRAUMAONE GREEN ORBTL MIDFAC	BOTH IP/OP	"$1,570.00 "	"$1,161.80"	$0.00	"$1,256.00"	$706.50	$706.50	$0.00	$0.00	$0.00	$327.23	"$1,165.25"	"$1,165.25"	$0.00	$0.00	$327.19	$0.00	$928.66	$928.66	$0.00	$785.00	"$1,243.44"	"$1,256.00"	$0.00		$0.00	$245.71	$0.00	$0.00	$249.94	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-23	SUP	HCPCS C1713		01-7123  -  PLATE BONE 4 HOLE CVD TRAUMAONE GREEN ORBTL MIDFAC	BOTH IP/OP	$932.50 	$690.05	$0.00	$746.00	$419.63	$419.63	$0.00	$0.00	$0.00	$194.36	$692.10	$692.10	$0.00	$0.00	$194.33	$0.00	$551.57	$551.57	$0.00	$466.25	$738.54	$746.00	$0.00		$0.00	$145.94	$0.00	$0.00	$148.45	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-26	SUP	HCPCS C1713		01-7126  -  PLATE BONE REGULAR CURVE 6 HOLE GRADE II TRAUMAONE LORENZ	BOTH IP/OP	$857.50 	$634.55	$0.00	$686.00	$385.88	$385.88	$0.00	$0.00	$0.00	$178.72	$636.44	$636.44	$0.00	$0.00	$178.70	$0.00	$507.21	$507.21	$0.00	$428.75	$679.14	$686.00	$0.00		$0.00	$134.20	$0.00	$0.00	$136.51	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-28	SUP	HCPCS C1713		01-7128  -  PLATE BONE REGULAR CURVE .6MM 8 HOLE TRAUMAONE LORENZ SILVER	BOTH IP/OP	$540.00 	$399.60	$0.00	$432.00	$243.00	$243.00	$0.00	$0.00	$0.00	$112.55	$400.79	$400.79	$0.00	$0.00	$112.54	$0.00	$319.41	$319.41	$0.00	$270.00	$427.68	$432.00	$0.00		$0.00	$84.51	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-30	SUP	HCPCS C1713		01-7130  -  PLATE BN CRV .6MM SLVR TRAUMAONE 10 HL TI ORBT FLR 1.5MM SCR	BOTH IP/OP	$540.00 	$399.60	$0.00	$432.00	$243.00	$243.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.00	$427.68	$432.00	$0.00		$0.00	$84.51	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-31	SUP	HCPCS C1713		01-7131  -  PLATE BN SQ 12MM LORENZ 4 HL NEURO 1.5MM SCR	BOTH IP/OP	$760.00 	$562.40	$0.00	$608.00	$342.00	$342.00	$0.00	$0.00	$0.00	$158.40	$564.07	$564.07	$0.00	$0.00	$158.38	$0.00	$449.54	$449.54	$0.00	$380.00	$601.92	$608.00	$0.00		$0.00	$118.94	$0.00	$0.00	$120.99	$0.00	$0.00	$0.00	$0.00	$0.00
1912000	SUP	HCPCS C1894		1912000  -  SHEATH ENDSCP CLEAN 0D 4MM LENS SOFTWARE CONTROL ENDO-SCRUB	BOTH IP/OP	$32.80 	$24.27	$0.00	$26.24	$17.81	$17.81	$0.00	$0.00	$0.00	$6.84	$24.34	$24.34	$0.00	$0.00	$6.84	$0.00	$19.40	$19.40	$0.00	$16.40	$25.98	$26.24	$0.00		$0.00	$5.13	$0.00	$0.00	$5.22	$0.00	$0.00	$0.00	$0.00	$0.00
1912010	SUP	HCPCS C1892		1912010  -  SHEATH ENDSCP CLEAN 4MM ESCRB2 30D SIN LEN STRL LATEX FREE	BOTH IP/OP	$27.50 	$20.35	$0.00	$22.00	$14.93	$14.93	$0.00	$0.00	$0.00	$5.73	$20.41	$20.41	$0.00	$0.00	$5.73	$0.00	$16.27	$16.27	$0.00	$13.75	$21.78	$22.00	$0.00		$0.00	$4.30	$0.00	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-36	SUP	HCPCS C1713		01-7136  -  PLATE BONE RECTANGLE 2X3 HOLE TRAUMAONE MATRIX SILVER	BOTH IP/OP	$950.00 	$703.00	$0.00	$760.00	$427.50	$427.50	$0.00	$0.00	$0.00	$198.00	$705.09	$705.09	$0.00	$0.00	$197.98	$0.00	$561.93	$561.93	$0.00	$475.00	$752.40	$760.00	$0.00		$0.00	$148.68	$0.00	$0.00	$151.24	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-37	SUP	HCPCS C1713		01-7137  -  PLATE BONE 2X4 HOLE RECTANGULAR LORENZ TITANIUM	BOTH IP/OP	$950.00 	$703.00	$0.00	$760.00	$427.50	$427.50	$0.00	$0.00	$0.00	$198.00	$705.09	$705.09	$0.00	$0.00	$197.98	$0.00	$561.93	$561.93	$0.00	$475.00	$752.40	$760.00	$0.00		$0.00	$148.68	$0.00	$0.00	$151.24	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-42	SUP	Custom 27203010		01-7142  -  DRILL TWIST 5MM STOP 1MM 50MM LORENZ MANDIB	BOTH IP/OP	$447.50 	$331.15	$0.00	$358.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$332.13	$332.13	$0.00	$0.00	$93.26	$0.00	$0.00	$0.00	$0.00	$223.75	$354.42	$358.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-44	SUP	Custom 27203010		01-7144  -  DRILL TWIST 1.1MM 50MM 7MM STOP LORENZ 1.5MM SCREW MIDAS REX	BOTH IP/OP	$447.50 	$331.15	$0.00	$358.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$332.13	$332.13	$0.00	$0.00	$93.26	$0.00	$0.00	$0.00	$0.00	$223.75	$354.42	$358.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-46	SUP	Custom 27203010		01-7146  -  DRILL TWIST 1.1MM 50MM 9MM STOP	BOTH IP/OP	$447.50 	$331.15	$0.00	$358.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$332.13	$332.13	$0.00	$0.00	$93.26	$0.00	$0.00	$0.00	$0.00	$223.75	$354.42	$358.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-48	SUP	Custom 27203010		01-7148  -  DRILL TWIST 1.1MM 50MM 15MM STOP	BOTH IP/OP	$447.50 	$331.15	$0.00	$358.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$332.13	$332.13	$0.00	$0.00	$93.26	$0.00	$0.00	$0.00	$0.00	$223.75	$354.42	$358.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924542	SUP	Custom 27803010		1924542  -  ROD SPNL 5.5MM 200MM SPRL R90D HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924543	SUP	Custom 27803010		1924543  -  ROD SPNL 5.5MM 400MM SPRL R90D HEX END	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924547	SUP	HCPCS C1713		1924547  -  SCREW BN 6.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$1,345.68 "	$995.80	$0.00	"$1,076.54"	$605.55	$605.55	$0.00	$0.00	$0.00	$280.47	$998.76	$998.76	$0.00	$0.00	$280.44	$0.00	$795.97	$795.97	$0.00	$672.84	"$1,065.78"	"$1,076.54"	$0.00		$0.00	$210.60	$0.00	$0.00	$214.23	$0.00	$0.00	$0.00	$0.00	$0.00
1924548	SUP	HCPCS C1713		1924548  -  SCREW BN 6.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$1,345.68 "	$995.80	$0.00	"$1,076.54"	$605.55	$605.55	$0.00	$0.00	$0.00	$280.47	$998.76	$998.76	$0.00	$0.00	$280.44	$0.00	$795.97	$795.97	$0.00	$672.84	"$1,065.78"	"$1,076.54"	$0.00		$0.00	$210.60	$0.00	$0.00	$214.23	$0.00	$0.00	$0.00	$0.00	$0.00
1924549	SUP	HCPCS C1713		1924549  -  SCREW BN 6.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$1,345.68 "	$995.80	$0.00	"$1,076.54"	$605.55	$605.55	$0.00	$0.00	$0.00	$280.47	$998.76	$998.76	$0.00	$0.00	$280.44	$0.00	$795.97	$795.97	$0.00	$672.84	"$1,065.78"	"$1,076.54"	$0.00		$0.00	$210.60	$0.00	$0.00	$214.23	$0.00	$0.00	$0.00	$0.00	$0.00
1924550	SUP	HCPCS C1713		1924550  -  SCREW BN 6.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$1,345.68 "	$995.80	$0.00	"$1,076.54"	$605.55	$605.55	$0.00	$0.00	$0.00	$280.47	$998.76	$998.76	$0.00	$0.00	$280.44	$0.00	$795.97	$795.97	$0.00	$672.84	"$1,065.78"	"$1,076.54"	$0.00		$0.00	$210.60	$0.00	$0.00	$214.23	$0.00	$0.00	$0.00	$0.00	$0.00
1924551	SUP	HCPCS C1713		1924551  -  SCREW BN 6.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$1,345.68 "	$995.80	$0.00	"$1,076.54"	$605.55	$605.55	$0.00	$0.00	$0.00	$280.47	$998.76	$998.76	$0.00	$0.00	$280.44	$0.00	$795.97	$795.97	$0.00	$672.84	"$1,065.78"	"$1,076.54"	$0.00		$0.00	$210.60	$0.00	$0.00	$214.23	$0.00	$0.00	$0.00	$0.00	$0.00
1924552	SUP	Custom 27803010		1924552  -  ROD SPNL 5.5MM 200MM SPRL R90D SCRL EYE TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924553	SUP	Custom 27803010		1924553  -  ROD SPNL 5.5MM 400MM SPRL R90D SCRL EYE TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924900	SUP	Custom 27803010		1924900  -  ROD SPNL 5.5MM 40MM SPRL R90D NONHEXAGONAL TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924901	SUP	Custom 27803010		1924901  -  ROD SPNL 5.5MM 50MM SPRL R90D NONHEXAGONAL TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924902	SUP	Custom 27803010		1924902  -  ROD SPNL 5.5MM 60MM SPRL R90D TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924903	SUP	Custom 27803010		1924903  -  ROD SPNL 5.5MM 70MM SPRL R90D NONHEXAGONAL TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924904	SUP	Custom 27803010		1924904  -  ROD SPNL 5.5MM 80MM SPRL R90D NONHEXAGONAL TI SPNE	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924905	SUP	Custom 27803010		1924905  -  ROD SPNL 5.5MM 90MM SPRL R90D NONHEXAGONAL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924906	SUP	Custom 27803010		1924906  -  ROD SPNL 5.5MM 100MM SPRL R90D NONHEXAGONAL TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924907	SUP	Custom 27803010		1924907  -  ROD SPNL 5.5MM 110MM SPRL R90D NONHEXAGONAL TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924908	SUP	Custom 27803010		1924908  -  ROD SPNL 5.5MM 120MM SPRL R90D NONHEXAGONAL TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924909	SUP	Custom 27803010		1924909  -  ROD SPNL 5.5MM 600MM SPRL R90D HEX TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-80	SUP	HCPCS C1713		01-7180  -  PLATE BN REG 80X53X.6MM SLVR LORENZ GRID MESH PNL TI CRNMXF	BOTH IP/OP	"$4,182.50 "	"$3,095.05"	$0.00	"$3,346.00"	"$1,882.13"	"$1,882.13"	$0.00	$0.00	$0.00	$871.74	"$3,104.25"	"$3,104.25"	$0.00	$0.00	$871.63	$0.00	"$2,061.97"	"$2,061.97"	$0.00	"$2,091.25"	"$3,312.54"	"$3,346.00"	$0.00		$0.00	$654.56	$0.00	$0.00	$665.85	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-82	SUP	HCPCS C1713		01-7182  -  PLATE BONE SMALL 85X53X.6MM GRID MESH PANEL LORENZ SILVER	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-85	SUP	HCPCS C1713		01-7185  -  PLATE BONE SMALL 85X53X.3MM GRID MESH PANEL LORENZ SILVER	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-49	SUP	HCPCS C1713		01-7249  -  PLATE BONE 100X100X.6MM CONTUR MESH LORENZ STERILE 1.5MM	BOTH IP/OP	"$6,692.50 "	"$4,952.45"	$0.00	"$5,354.00"	"$3,011.63"	"$3,011.63"	$0.00	$0.00	$0.00	"$1,394.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,394.72"	$0.00	"$3,299.40"	"$3,299.40"	$0.00	"$3,346.25"	"$5,300.46"	"$5,354.00"	$0.00		$0.00	"$1,047.38"	$0.00	$0.00	"$1,065.45"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-05	SUP	HCPCS C1713		01-7305  -  PLATE BONE LORENZ TITANIUM H.5 MM OD18.5 MM CRANIOMAXILLOFAC	BOTH IP/OP	$800.00 	$592.00	$0.00	$640.00	$360.00	$360.00	$0.00	$0.00	$0.00	$166.74	$593.76	$593.76	$0.00	$0.00	$166.72	$0.00	$473.20	$473.20	$0.00	$400.00	$633.60	$640.00	$0.00		$0.00	$125.20	$0.00	$0.00	$127.36	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-06	SUP	HCPCS C1713		01-7306  -  PLATE BONE 18.5MM .5MM BURR HOLE LORENZ TITANIUM	BOTH IP/OP	$800.00 	$592.00	$0.00	$640.00	$360.00	$360.00	$0.00	$0.00	$0.00	$166.74	$593.76	$593.76	$0.00	$0.00	$166.72	$0.00	$473.20	$473.20	$0.00	$400.00	$633.60	$640.00	$0.00		$0.00	$125.20	$0.00	$0.00	$127.36	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-08	SUP	HCPCS C1713		01-7308  -  PLATE BONE 18.5MM BURR HOLE TITANIUM MIDFAC 1.5MM SCREWS	BOTH IP/OP	$800.00 	$592.00	$0.00	$640.00	$360.00	$360.00	$0.00	$0.00	$0.00	$166.74	$593.76	$593.76	$0.00	$0.00	$166.72	$0.00	$473.20	$473.20	$0.00	$400.00	$633.60	$640.00	$0.00		$0.00	$125.20	$0.00	$0.00	$127.36	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-09	SUP	HCPCS C1713		01-7309  -  PLATE BONE 22MM .5MM BURR HOLE LORENZ TITANIUM	BOTH IP/OP	$800.00 	$592.00	$0.00	$640.00	$360.00	$360.00	$0.00	$0.00	$0.00	$166.74	$593.76	$593.76	$0.00	$0.00	$166.72	$0.00	$473.20	$473.20	$0.00	$400.00	$633.60	$640.00	$0.00		$0.00	$125.20	$0.00	$0.00	$127.36	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-40	SUP	HCPCS C1713		01-7340  -  PLATE BONE 1/1.5MM 85X50X.2MM HEXAGONAL PANEL LORENZ	BOTH IP/OP	"$4,022.50 "	"$2,976.65"	$0.00	"$3,218.00"	"$1,810.13"	"$1,810.13"	$0.00	$0.00	$0.00	$838.39	"$2,985.50"	"$2,985.50"	$0.00	$0.00	$838.29	$0.00	"$1,983.09"	"$1,983.09"	$0.00	"$2,011.25"	"$3,185.82"	"$3,218.00"	$0.00		$0.00	$629.52	$0.00	$0.00	$640.38	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-45	SUP	HCPCS C1713		01-7345  -  PLATE BONE MEDIUM 2 HOLE STR TITANIUM MIDFAC 1.5MM SCREWS	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$74.25	$74.25	$0.00	$0.00	$0.00	$34.39	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$97.60	$97.60	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-47	SUP	HCPCS C1713		01-7347  -  PLATE BONE LONG STR .6MM 2 HOLE TRAUMAONE LORENZ SILVER	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$74.25	$74.25	$0.00	$0.00	$0.00	$34.39	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$97.60	$97.60	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-51	SUP	HCPCS C1713		01-7351  -  PLATE BN 25MM LORENZ 6 HL GAP NEURO 1.5MM SCR	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-53	SUP	HCPCS C1713		01-7353  -  PLATE BONE MEDIUM 35MMX.5MM 6 HOLE GAP LORENZ TITANIUM	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-55	SUP	HCPCS C1713		01-7355  -  PLATE BN 45MMX.5MM LORENZ 6 HL GAP TI CRNM 1.5MM SCR	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
2010027	SUP	Custom 27203010		2010027  -  ELECTRODE EMG DMD STRL LF I-PAS III SPRINGLESS DISP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2010028	SUP	Custom 27203010		2010028  -  SET SPINAL INSULATED PEDICLE ACCES SYSTEM DIAMOND TIP I-PAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2010029	SUP	Custom 27203010		2010029  -  SET SPINAL INSULATED PEDICLE ACCES SYSTEM BEVELED TIP I-PAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2010036	SUP	Custom 27011340		2010036  -  STIMULATOR NRV STRL LF NVJJB DYNMC DISP	BOTH IP/OP	$182.50 	$135.05	$0.00	$146.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$135.45	$135.45	$0.00	$0.00	$38.03	$0.00	$0.00	$0.00	$0.00	$91.25	$144.54	$146.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2010037	SUP	Custom 27203010		2010037  -  ELECTRODE EMG BVL STRL LF I-PAS III SPRINGLESS DISP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2011202	SUP	Custom 27203010		2011202  -  RETRACTOR SRG SHTH NRV ROOT	BOTH IP/OP	"$1,205.00 "	$891.70	$0.00	$964.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$894.35	$894.35	$0.00	$0.00	$251.12	$0.00	$0.00	$0.00	$0.00	$602.50	$954.36	$964.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2012021	SUP	Custom 27011340		2012021  -  PROBE EMG STM HNDPC NV M5	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Oct-08	SUP	Custom 27203010		10-7408  -  BANDAGE COMPRESSION 7 TUBULAR 42-52IN 10YD ELAST DRESSING	BOTH IP/OP	$107.89 	$79.84	$0.00	$80.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.08	$80.08	$0.00	$0.00	$22.48	$0.00	$0.00	$0.00	$0.00	$14.65	$23.21	$23.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Oct-09	SUP	Custom 27203010		10-7409  -  RETAINER DRESSING 8 TUBULAR 52-58IN 10YD ELAST LATEX SAFE	BOTH IP/OP	$157.99 	$116.91	$0.00	$117.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.26	$117.26	$0.00	$0.00	$32.92	$0.00	$0.00	$0.00	$0.00	$19.98	$31.66	$31.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Oct-13	SUP	Custom 27203010		10-7413  -  RETAINER DRESSING 12 10YD ELAST LATEX SAFE STRETCHED TUBULAR	BOTH IP/OP	$65.24 	$48.28	$0.00	$52.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.42	$48.42	$0.00	$0.00	$13.60	$0.00	$0.00	$0.00	$0.00	$32.62	$51.67	$52.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2020000	SUP	HCPCS Q4130		2020000  -  SUB TISS 20X20CM STRATTICE PIG DRML MTRX FIRM PTCH RECON	BOTH IP/OP	$65.23 	$48.27	$0.00	$52.18	$0.00	$0.00	$0.00	$0.00	$0.00	$13.59	$48.41	$48.41	$0.00	$0.00	$13.59	$0.00	$38.58	$38.58	$0.00	$32.61	$51.66	$52.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2020002	SUP	HCPCS Q4130		2020002  -  MATRIX TISSUE 20X20CM RECONSTRUCTIVE STRATTICE PIG DERMIS	BOTH IP/OP	"$23,552.50 "	"$17,428.85"	$0.00	"$28,474.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,908.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,908.34"	$0.00	"$11,611.38"	"$11,611.38"	$0.00	"$17,796.25"	"$28,189.26"	"$28,474.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2025002	SUP	HCPCS Q4130		2025002  -  MATRIX TISSUE 25X20CM RECONSTRUCTIVE STRATTICE PIG DERMIS	BOTH IP/OP	"$29,440.00 "	"$21,785.60"	$0.00	"$35,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,136.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,135.30"	$0.00	"$14,513.92"	"$14,513.92"	$0.00	"$22,245.00"	"$35,236.08"	"$35,592.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2029950	SUP	Custom 27803010		2029950  -  KIT SPINAL DILAT XLIF NEUROVISION DISPOSABLE M5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2030365	SUP	Custom 27203010		STRIP ACCK CMFCRV GLUC CHMTEST	BOTH IP/OP	$60.20 	$44.55	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.10	$47.68	$48.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2040001	SUP	HCPCS C1713		2040001  -  DIGITIZER INST BENDINI ROD BNDRG ARY	BOTH IP/OP	"$5,660.00 "	"$4,188.40"	$0.00	"$4,528.00"	"$2,547.00"	"$2,547.00"	$0.00	$0.00	$0.00	"$1,179.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,179.54"	$0.00	"$2,790.38"	"$2,790.38"	$0.00	"$2,830.00"	"$4,482.72"	"$4,528.00"	$0.00		$0.00	$885.79	$0.00	$0.00	$901.07	$0.00	$0.00	$0.00	$0.00	$0.00
2078175	SUP	HCPCS C1769		2078175  -  GUIDEWIRE VASCULAR .014IN 300CM 3CM SHAPEABLE TIP STEERABLE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$203.63	$203.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
2110140	SUP	HCPCS C1713		2110140  -  SPACER SPNL 0D 40X20X8MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110145	SUP	HCPCS C1713		2110145  -  SPACER SPNL 0D 45X20X8MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110150	SUP	HCPCS C1713		2110150  -  SPACER SPNL 0D 50X20X8MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110155	SUP	HCPCS C1713		2110155  -  SPACER SPNL 0D 55X20X8MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110160	SUP	HCPCS C1713		2110160  -  SPACER SPNL 0D 60X20X8MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110240	SUP	HCPCS C1713		2110240  -  SPACER SPNL 0D 40X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110245	SUP	HCPCS C1713		2110245  -  SPACER SPNL 0D 45X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110250	SUP	HCPCS C1713		2110250  -  SPACER SPNL 0D 50X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110255	SUP	HCPCS C1713		2110255  -  SPACER SPNL 0D 55X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110260	SUP	HCPCS C1713		2110260  -  SPACER SPNL 0D 60X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110340	SUP	HCPCS C1713		2110340  -  SPACER SPNL 0D 40X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110345	SUP	HCPCS C1713		2110345  -  SPACER SPNL 0D 45X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110350	SUP	HCPCS C1713		2110350  -  SPACER SPNL 0D 50X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110355	SUP	HCPCS C1713		2110355  -  SPACER SPNL 0D 55X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110360	SUP	HCPCS C1713		2110360  -  SPACER SPNL 0D 60X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110440	SUP	HCPCS C1713		2110440  -  SPACER SPNL 0D 40X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110445	SUP	HCPCS C1713		2110445  -  SPACER SPNL 0D 45X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110450	SUP	HCPCS C1713		2110450  -  SPACER SPNL 0D 50X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110455	SUP	HCPCS C1713		2110455  -  SPACER SPNL 0D 55X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110460	SUP	HCPCS C1713		2110460  -  SPACER SPNL 0D 60X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110540	SUP	HCPCS C1713		2110540  -  SPACER SPNL 0D 40X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110545	SUP	HCPCS C1713		2110545  -  SPACER SPNL 0D 45X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110550	SUP	HCPCS C1713		2110550  -  SPACER SPNL 0D 50X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110555	SUP	HCPCS C1713		2110555  -  SPACER SPNL 0D 55X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2110560	SUP	HCPCS C1713		2110560  -  SPACER SPNL 0D 60X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111140	SUP	HCPCS C1713		2111140  -  SPACER SPNL 6D 40X20X8MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111145	SUP	HCPCS C1713		2111145  -  SPACER SPNL 6D 45X20X8MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111150	SUP	HCPCS C1713		2111150  -  SPACER SPNL 6D 50X20X8MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111155	SUP	HCPCS C1713		2111155  -  SPACER SPNL 6D 55X20X8MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111160	SUP	HCPCS C1713		2111160  -  SPACER SPNL 6D 60X20X8MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111240	SUP	HCPCS C1713		2111240  -  SPACER SPNL 6D 40X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111245	SUP	HCPCS C1713		2111245  -  SPACER SPNL 6D 45X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111250	SUP	HCPCS C1713		2111250  -  SPACER SPNL 6D 50X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111255	SUP	HCPCS C1713		2111255  -  SPACER SPNL 6D 55X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111260	SUP	HCPCS C1713		2111260  -  SPACER SPNL 6D 60X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111340	SUP	HCPCS C1713		2111340  -  SPACER SPNL 6D 40X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111345	SUP	HCPCS C1713		2111345  -  SPACER SPNL 6D 45X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111350	SUP	HCPCS C1713		2111350  -  SPACER SPNL 6D 50X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111355	SUP	HCPCS C1713		2111355  -  SPACER SPNL 6D 55X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111360	SUP	HCPCS C1713		2111360  -  SPACER SPNL 6D 60X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111440	SUP	HCPCS C1713		2111440  -  SPACER SPNL 6D 40X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111445	SUP	HCPCS C1713		2111445  -  SPACER SPNL 6D 45X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111450	SUP	HCPCS C1713		2111450  -  SPACER SPNL 6D 50X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111455	SUP	HCPCS C1713		2111455  -  SPACER SPNL 6D 55X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111460	SUP	HCPCS C1713		2111460  -  SPACER SPNL 6D 60X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111540	SUP	HCPCS C1713		2111540  -  SPACER SPNL 6D 40X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111545	SUP	HCPCS C1713		2111545  -  SPACER SPNL 6D 45X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111550	SUP	HCPCS C1713		2111550  -  SPACER SPNL 6D 50X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111555	SUP	HCPCS C1713		2111555  -  SPACER SPNL 6D 55X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2111560	SUP	HCPCS C1713		2111560  -  SPACER SPNL 6D 60X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112240	SUP	HCPCS C1713		2112240  -  SPACER SPNL 12D 40X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112245	SUP	HCPCS C1713		2112245  -  SPACER SPNL 12D 45X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112250	SUP	HCPCS C1713		2112250  -  SPACER SPNL 12D 50X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112255	SUP	HCPCS C1713		2112255  -  SPACER SPNL 12D 55X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112260	SUP	HCPCS C1713		2112260  -  SPACER SPNL 12D 60X20X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112340	SUP	HCPCS C1713		2112340  -  SPACER SPNL 12D 40X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112345	SUP	HCPCS C1713		2112345  -  SPACER SPNL 12D 45X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112350	SUP	HCPCS C1713		2112350  -  SPACER SPNL 12D 50X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112355	SUP	HCPCS C1713		2112355  -  SPACER SPNL 12D 55X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112360	SUP	HCPCS C1713		2112360  -  SPACER SPNL 12D 60X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112440	SUP	HCPCS C1713		2112440  -  SPACER SPNL 12D 40X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112445	SUP	HCPCS C1713		2112445  -  SPACER SPNL 12D 45X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112450	SUP	HCPCS C1713		2112450  -  SPACER SPNL 12D 50X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112455	SUP	HCPCS C1713		2112455  -  SPACER SPNL 12D 55X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112460	SUP	HCPCS C1713		2112460  -  SPACER SPNL 12D 60X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112540	SUP	HCPCS C1713		2112540  -  SPACER SPNL 12D 40X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112545	SUP	HCPCS C1713		2112545  -  SPACER SPNL 12D 45X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112550	SUP	HCPCS C1713		2112550  -  SPACER SPNL 12D 50X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112555	SUP	HCPCS C1713		2112555  -  SPACER SPNL 12D 55X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112560	SUP	HCPCS C1713		2112560  -  SPACER SPNL 12D 60X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112640	SUP	HCPCS C1713		2112640  -  SPACER SPNL 12D 40X20X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112645	SUP	HCPCS C1713		2112645  -  SPACER SPNL 12D 45X20X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112650	SUP	HCPCS C1713		2112650  -  SPACER SPNL 12D 50X20X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112655	SUP	HCPCS C1713		2112655  -  SPACER SPNL 12D 55X20X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2112660	SUP	HCPCS C1713		2112660  -  SPACER SPNL 12D 60X20X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113340	SUP	HCPCS C1713		2113340  -  SPACER SPNL 18D 40X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113345	SUP	HCPCS C1713		2113345  -  SPACER SPNL 18D 45X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113350	SUP	HCPCS C1713		2113350  -  SPACER SPNL 18D 50X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113355	SUP	HCPCS C1713		2113355  -  SPACER SPNL 18D 55X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113360	SUP	HCPCS C1713		2113360  -  SPACER SPNL 18D 60X20X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113440	SUP	HCPCS C1713		2113440  -  SPACER SPNL 18D 40X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113445	SUP	HCPCS C1713		2113445  -  SPACER SPNL 18D 45X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113450	SUP	HCPCS C1713		2113450  -  SPACER SPNL 18D 50X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113455	SUP	HCPCS C1713		2113455  -  SPACER SPNL 18D 55X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113460	SUP	HCPCS C1713		2113460  -  SPACER SPNL 18D 60X20X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113540	SUP	HCPCS C1713		2113540  -  SPACER SPNL 18D 40X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113545	SUP	HCPCS C1713		2113545  -  SPACER SPNL 18D 45X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113550	SUP	HCPCS C1713		2113550  -  SPACER SPNL 18D 50X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113555	SUP	HCPCS C1713		2113555  -  SPACER SPNL 18D 55X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113560	SUP	HCPCS C1713		2113560  -  SPACER SPNL 18D 60X20X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113640	SUP	HCPCS C1713		2113640  -  SPACER SPNL 18D 40X20X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113645	SUP	HCPCS C1713		2113645  -  SPACER SPNL 18D 45X20X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113650	SUP	HCPCS C1713		2113650  -  SPACER SPNL 18D 50X20X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113655	SUP	HCPCS C1713		2113655  -  SPACER SPNL 18D 55X20X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2113660	SUP	HCPCS C1713		2113660  -  SPACER SPNL 18D 60X20X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131240	SUP	HCPCS C1713		2131240  -  SPACER SPNL 6D 40X27X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131245	SUP	HCPCS C1713		2131245  -  SPACER SPNL 6D 45X27X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131250	SUP	HCPCS C1713		2131250  -  SPACER SPNL 6D 50X27X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131255	SUP	HCPCS C1713		2131255  -  SPACER SPNL 6D 55X27X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131260	SUP	HCPCS C1713		2131260  -  SPACER SPNL 6D 60X27X10MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131340	SUP	HCPCS C1713		2131340  -  SPACER SPNL 6D 40X27X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131345	SUP	HCPCS C1713		2131345  -  SPACER SPNL 6D 45X27X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131350	SUP	HCPCS C1713		2131350  -  SPACER SPNL 6D 50X27X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131355	SUP	HCPCS C1713		2131355  -  SPACER SPNL 6D 55X27X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131360	SUP	HCPCS C1713		2131360  -  SPACER SPNL 6D 60X27X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131440	SUP	HCPCS C1713		2131440  -  SPACER SPNL 6D 40X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131445	SUP	HCPCS C1713		2131445  -  SPACER SPNL 6D 45X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131450	SUP	HCPCS C1713		2131450  -  SPACER SPNL 6D 50X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131455	SUP	HCPCS C1713		2131455  -  SPACER SPNL 6D 55X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131460	SUP	HCPCS C1713		2131460  -  SPACER SPNL 6D 60X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131540	SUP	HCPCS C1713		2131540  -  SPACER SPNL 6D 40X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131545	SUP	HCPCS C1713		2131545  -  SPACER SPNL 6D 45X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131550	SUP	HCPCS C1713		2131550  -  SPACER SPNL 6D 50X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131555	SUP	HCPCS C1713		2131555  -  SPACER SPNL 6D 55X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2131560	SUP	HCPCS C1713		2131560  -  SPACER SPNL 6D 60X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132340	SUP	HCPCS C1713		2132340  -  SPACER SPNL 12D 40X27X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132345	SUP	HCPCS C1713		2132345  -  SPACER SPNL 12D 45X27X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132350	SUP	HCPCS C1713		2132350  -  SPACER SPNL 12D 50X27X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132355	SUP	HCPCS C1713		2132355  -  SPACER SPNL 12D 55X27X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132360	SUP	HCPCS C1713		2132360  -  SPACER SPNL 12D 60X27X12MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132440	SUP	HCPCS C1713		2132440  -  SPACER SPNL 12D 40X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132445	SUP	HCPCS C1713		2132445  -  SPACER SPNL 12D 45X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132450	SUP	HCPCS C1713		2132450  -  SPACER SPNL 12D 50X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132455	SUP	HCPCS C1713		2132455  -  SPACER SPNL 12D 55X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132460	SUP	HCPCS C1713		2132460  -  SPACER SPNL 12D 60X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132540	SUP	HCPCS C1713		2132540  -  SPACER SPNL 12D 40X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132545	SUP	HCPCS C1713		2132545  -  SPACER SPNL 12D 45X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132550	SUP	HCPCS C1713		2132550  -  SPACER SPNL 12D 50X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132555	SUP	HCPCS C1713		2132555  -  SPACER SPNL 12D 55X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132560	SUP	HCPCS C1713		2132560  -  SPACER SPNL 12D 60X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132640	SUP	HCPCS C1713		2132640  -  SPACER SPNL 12D 40X27X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132645	SUP	HCPCS C1713		2132645  -  SPACER SPNL 12D 45X27X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132650	SUP	HCPCS C1713		2132650  -  SPACER SPNL 12D 50X27X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132655	SUP	HCPCS C1713		2132655  -  SPACER SPNL 12D 55X27X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2132660	SUP	HCPCS C1713		2132660  -  SPACER SPNL 12D 60X27X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133440	SUP	HCPCS C1713		2133440  -  SPACER SPNL 18D 40X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133445	SUP	HCPCS C1713		2133445  -  SPACER SPNL 18D 45X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133450	SUP	HCPCS C1713		2133450  -  SPACER SPNL 18D 50X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133455	SUP	HCPCS C1713		2133455  -  SPACER SPNL 18D 55X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133460	SUP	HCPCS C1713		2133460  -  SPACER SPNL 18D 60X27X14MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133540	SUP	HCPCS C1713		2133540  -  SPACER SPNL 18D 40X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133545	SUP	HCPCS C1713		2133545  -  SPACER SPNL 18D 45X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133550	SUP	HCPCS C1713		2133550  -  SPACER SPNL 18D 50X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133555	SUP	HCPCS C1713		2133555  -  SPACER SPNL 18D 55X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133560	SUP	HCPCS C1713		2133560  -  SPACER SPNL 18D 60X27X16MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133640	SUP	HCPCS C1713		2133640  -  SPACER SPNL 18D 40X27X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133645	SUP	HCPCS C1713		2133645  -  SPACER SPNL 18D 45X27X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133650	SUP	HCPCS C1713		2133650  -  SPACER SPNL 18D 50X27X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133655	SUP	HCPCS C1713		2133655  -  SPACER SPNL 18D 55X27X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2133660	SUP	HCPCS C1713		2133660  -  SPACER SPNL 18D 60X27X18MM PIVOX LAT OLIF25	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2140001	SUP	HCPCS C1713		2140001  -  PLATE SPNL SM 2 HOLE OLIF25 STRL	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
2140002	SUP	HCPCS C1713		2140002  -  PLATE SPNL LG 2 HOLE OLIF25 STRL	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
2140120	SUP	HCPCS C1713		2140120  -  SCREW BONE 5.5MM 20MM LMBR SPN STRL	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
2140125	SUP	HCPCS C1713		2140125  -  SCREW BONE 5.5MM 25MM LMBR SPN STRL	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
2140130	SUP	HCPCS C1713		2140130  -  SCREW BONE 5.5MM 30MM LMBR SPN STRL	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
2140135	SUP	HCPCS C1713		2140135  -  SCREW BONE 5.5MM 35MM LMBR SPN STRL	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
2140140	SUP	HCPCS C1713		2140140  -  SCREW BONE 5.5MM 40MM LMBR SPN STRL	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
2140145	SUP	HCPCS C1713		2140145  -  SCREW BONE 5.5MM 45MM LMBR SPN STRL	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
2140150	SUP	HCPCS C1713		2140150  -  SCREW BONE 5.5MM 50MM LMBR SPN STRL	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
2150010	SUP	HCPCS C1713		2150010  -  PLATE SPNL 10MM DIVERGENCE-L OLIF51	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
2150012	SUP	HCPCS C1713		2150012  -  PLATE SPNL 12MM DIVERGENCE-L OLIF51	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
2150014	SUP	HCPCS C1713		2150014  -  PLATE SPNL 14MM DIVERGENCE-L OLIF51	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
2150016	SUP	HCPCS C1713		2150016  -  PLATE SPNL 16MM DIVERGENCE-L OLIF51	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
2150018	SUP	HCPCS C1713		2150018  -  PLATE SPNL 18MM DIVERGENCE-L OLIF51	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
2150020	SUP	HCPCS C1713		2150020  -  PLATE SPNL 20MM DIVERGENCE-L OLIF51	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
2150120	SUP	HCPCS C1713		2150120  -  SCREW BONE 20MM DIVERGENCE-L SPN	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
2150125	SUP	HCPCS C1713		2150125  -  SCREW BONE 25MM DIVERGENCE-L SPN	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
2150130	SUP	HCPCS C1713		2150130  -  SCREW BONE 6.5MM 30MM DIVERGENCE-L SPN	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
2150135	SUP	HCPCS C1713		2150135  -  SCREW BONE 6.5MM 35MM DIVERGENCE-L SPN	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
2150140	SUP	HCPCS C1713		2150140  -  SCREW BONE 6.5MM 40MM DIVERGENCE-L SPN	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
2151110	SUP	HCPCS C1713		2151110  -  CAGE SPNL 6D SM 32X25X10MM DIVERGENCE-L ANT OBLQ LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151112	SUP	HCPCS C1713		2151112  -  CAGE SPNL 32X25X12MM DIVERGENCE-L 6D SM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151114	SUP	HCPCS C1713		2151114  -  CAGE SPNL 6D SM 32X25X14MM DIVERGENCE-L ANT OBLQ LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151116	SUP	HCPCS C1713		2151116  -  CAGE SPNL 6D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151118	SUP	HCPCS C1713		2151118  -  CAGE SPNL 6D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151120	SUP	HCPCS C1713		2151120  -  CAGE SPNL 6D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151210	SUP	HCPCS C1713		2151210  -  CAGE SPNL 6D MED 37X29X10MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151212	SUP	HCPCS C1713		2151212  -  CAGE SPNL 6D MED 37X29X12MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151214	SUP	HCPCS C1713		2151214  -  CAGE SPNL 6D MED 37X29X14MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151216	SUP	HCPCS C1713		2151216  -  CAGE SPNL 6D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151218	SUP	HCPCS C1713		2151218  -  CAGE SPNL 6D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151220	SUP	HCPCS C1713		2151220  -  CAGE SPNL 6D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151310	SUP	HCPCS C1713		2151310  -  CAGE SPNL 6D LG 42X32X10MM DIVERGENCE-L ANT OBLQ LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151312	SUP	HCPCS C1713		2151312  -  CAGE SPNL 6D LG 42X32X12MM DIVERGENCE-L ANT OBLQ LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151314	SUP	HCPCS C1713		2151314  -  CAGE SPNL 6D LG 42X32X14MM DIVERGENCE-L ANT OBLQ LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151316	SUP	HCPCS C1713		2151316  -  CAGE SPNL 6D LG 42X32X16MM DIVERGENCE-L ANT OBLQ LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151318	SUP	HCPCS C1713		2151318  -  CAGE SPNL 6D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2151320	SUP	HCPCS C1713		2151320  -  CAGE SPNL 6D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152110	SUP	HCPCS C1713		2152110  -  CAGE SPNL 12D SM 32X25X10MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152112	SUP	HCPCS C1713		2152112  -  CAGE SPNL 12D SM 32X25X12MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152114	SUP	HCPCS C1713		2152114  -  CAGE SPNL 12D SM 32X25X14MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152116	SUP	HCPCS C1713		2152116  -  CAGE SPNL 12D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152118	SUP	HCPCS C1713		2152118  -  CAGE SPNL 12D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152120	SUP	HCPCS C1713		2152120  -  CAGE SPNL 12D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152210	SUP	HCPCS C1713		2152210  -  CAGE SPNL 12D MED 37X29X10MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152212	SUP	HCPCS C1713		2152212  -  CAGE SPNL 12D MED 37X29X12MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152214	SUP	HCPCS C1713		2152214  -  CAGE SPNL 12D MED 37X29X14MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152216	SUP	HCPCS C1713		2152216  -  CAGE SPNL 12D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152218	SUP	HCPCS C1713		2152218  -  CAGE SPNL 12D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152220	SUP	HCPCS C1713		2152220  -  CAGE SPNL 12D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152312	SUP	HCPCS C1713		2152312  -  CAGE SPNL 12D LG 42X32X12MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152314	SUP	HCPCS C1713		2152314  -  CAGE SPNL 12D LG 42X32X14MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152316	SUP	HCPCS C1713		2152316  -  CAGE SPNL 12D LG 42X32X16MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152318	SUP	HCPCS C1713		2152318  -  CAGE SPNL 12D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2152320	SUP	HCPCS C1713		2152320  -  CAGE SPNL 12D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2153112	SUP	HCPCS C1713		2153112  -  CAGE SPNL 18D SM 32X25X12MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2153114	SUP	HCPCS C1713		2153114  -  CAGE SPNL 18D SM 32X25X14MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2153116	SUP	HCPCS C1713		2153116  -  CAGE SPNL 18D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2153118	SUP	HCPCS C1713		2153118  -  CAGE SPNL 18D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2153120	SUP	HCPCS C1713		2153120  -  CAGE SPNL 18D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2153214	SUP	HCPCS C1713		2153214  -  CAGE SPNL 18D MED 37X29X14MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2153216	SUP	HCPCS C1713		2153216  -  CAGE SPNL 18D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2153218	SUP	HCPCS C1713		2153218  -  CAGE SPNL 18D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2153220	SUP	HCPCS C1713		2153220  -  CAGE SPNL 18D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2153316	SUP	HCPCS C1713		2153316  -  CAGE SPNL 18D LG 42X32X16MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2153318	SUP	HCPCS C1713		2153318  -  CAGE SPNL 18D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2153320	SUP	HCPCS C1713		2153320  -  CAGE SPNL 18D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2154116	SUP	HCPCS C1713		2154116  -  CAGE SPNL 24D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2154118	SUP	HCPCS C1713		2154118  -  CAGE SPNL 24D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2154120	SUP	HCPCS C1713		2154120  -  CAGE SPNL 24D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2154216	SUP	HCPCS C1713		2154216  -  CAGE SPNL 24D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2154218	SUP	HCPCS C1713		2154218  -  CAGE SPNL 24D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2154220	SUP	HCPCS C1713		2154220  -  CAGE SPNL 24D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2154318	SUP	HCPCS C1713		2154318  -  CAGE SPNL 24D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2154320	SUP	HCPCS C1713		2154320  -  CAGE SPNL 24D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2160010	SUP	HCPCS C1713		2160010  -  PLATE SPNL 10MM DIVERGENCE-L ALIF	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
2160012	SUP	HCPCS C1713		2160012  -  PLATE SPNL 12MM DIVERGENCE-L ALIF	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-11	SUP	HCPCS C1713		01-8611  -  PLATE BN SM MESH CNTR ANTM EZ MODIFICATION MN SHRP EDG RT	BOTH IP/OP	"$4,677.50 "	"$3,461.35"	$0.00	"$3,742.00"	"$2,104.88"	"$2,104.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,338.75"	"$3,704.58"	"$3,742.00"	$0.00		$0.00	$732.03	$0.00	$0.00	$744.66	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-12	SUP	HCPCS C1713		01-8612  -  PLATE BN LG MESH CNTR ANTM EZ MODIFICATION MN SHRP EDG LT	BOTH IP/OP	"$4,837.50 "	"$3,579.75"	$0.00	"$3,870.00"	"$2,176.88"	"$2,176.88"	$0.00	$0.00	$0.00	"$1,008.26"	"$3,590.39"	"$3,590.39"	$0.00	$0.00	"$1,008.14"	$0.00	"$2,384.89"	"$2,384.89"	$0.00	"$2,418.75"	"$3,831.30"	"$3,870.00"	$0.00		$0.00	$757.07	$0.00	$0.00	$770.13	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-36	SUP	HCPCS C1713		01-8636  -  PLATE BONE LONG 3X3 HOLE L RIGID DELTA GOLD LEFT	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-62	SUP	HCPCS C1713		01-8662  -  PLATE BONE 8 HOLE STR RIGID TRAUMAONE GOLD TITANIUM MIDFAC	BOTH IP/OP	$872.50 	$645.65	$0.00	$698.00	$392.63	$392.63	$0.00	$0.00	$0.00	$181.85	$647.57	$647.57	$0.00	$0.00	$181.83	$0.00	$516.08	$516.08	$0.00	$436.25	$691.02	$698.00	$0.00		$0.00	$136.55	$0.00	$0.00	$138.90	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-64	SUP	HCPCS C1713		01-8664  -  PLATE BONE 4 HOLE STR RIGID TRAUMAONE GOLD TITANIUM MIDFAC	BOTH IP/OP	$872.50 	$645.65	$0.00	$698.00	$392.63	$392.63	$0.00	$0.00	$0.00	$181.85	$647.57	$647.57	$0.00	$0.00	$181.83	$0.00	$516.08	$516.08	$0.00	$436.25	$691.02	$698.00	$0.00		$0.00	$136.55	$0.00	$0.00	$138.90	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-70	SUP	HCPCS C1713		01-8670  -  PLATE BONE LONG STR 20 HOLE RIGID SYSTEM LORENZ TRAUMAONE	BOTH IP/OP	"$1,510.00 "	"$1,117.40"	$0.00	"$1,208.00"	$679.50	$679.50	$0.00	$0.00	$0.00	$314.72	"$1,120.72"	"$1,120.72"	$0.00	$0.00	$314.68	$0.00	$893.17	$893.17	$0.00	$755.00	"$1,195.92"	"$1,208.00"	$0.00		$0.00	$236.32	$0.00	$0.00	$240.39	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-78	SUP	HCPCS C1713		01-8678  -  PLATE LEFT MIDFAC 2X2 HOLE L RGD 1.5MM SCR BONE LORENZ	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-79	SUP	HCPCS C1713		01-8679  -  PLATE RIGHT MIDFAC 2X2 HOLE L RGD 1.5MM SCR BONE LORENZ	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-80	SUP	HCPCS C1713		01-8680  -  PLATE BONE LONG 4X6 HOLE L RIGID TRAUMAONE GOLD TITANIUM	BOTH IP/OP	"$1,015.00 "	$751.10	$0.00	$812.00	$456.75	$456.75	$0.00	$0.00	$0.00	$211.55	$753.33	$753.33	$0.00	$0.00	$211.53	$0.00	$600.37	$600.37	$0.00	$507.50	$803.88	$812.00	$0.00		$0.00	$158.85	$0.00	$0.00	$161.59	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-81	SUP	HCPCS C1713		01-8681  -  PLATE BONE LONG 4X6 HOLE L RIGID TRAUMAONE GOLD TITANIUM	BOTH IP/OP	"$1,015.00 "	$751.10	$0.00	$812.00	$456.75	$456.75	$0.00	$0.00	$0.00	$211.55	$753.33	$753.33	$0.00	$0.00	$211.53	$0.00	$600.37	$600.37	$0.00	$507.50	$803.88	$812.00	$0.00		$0.00	$158.85	$0.00	$0.00	$161.59	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-89	SUP	HCPCS C1713		01-8689  -  PLATE BONE LONG 14 HOLE CVD RIGID TRAUMAONE GOLD TITANIUM	BOTH IP/OP	"$1,102.50 "	$815.85	$0.00	$882.00	$496.13	$496.13	$0.00	$0.00	$0.00	$229.79	$818.28	$818.28	$0.00	$0.00	$229.76	$0.00	$652.13	$652.13	$0.00	$551.25	$873.18	$882.00	$0.00		$0.00	$172.54	$0.00	$0.00	$175.52	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-92	SUP	Custom 27203010		01-9192  -  TW DRILL 1.5X50MM 5MM STP W/NT	BOTH IP/OP	$435.00 	$321.90	$0.00	$348.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$322.86	$322.86	$0.00	$0.00	$90.65	$0.00	$0.00	$0.00	$0.00	$217.50	$344.52	$348.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-93	SUP	Custom 27203010		01-9193  -  DRILL TWIST 1.5MM 50MM 7MM STOP TRAUMAONE	BOTH IP/OP	$435.00 	$321.90	$0.00	$348.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$322.86	$322.86	$0.00	$0.00	$90.65	$0.00	$0.00	$0.00	$0.00	$217.50	$344.52	$348.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-20	SUP	HCPCS C1781		01-9520  -  MESH SURG SMALL .6MM ETCHED LABEL ANATOMIC AESTHETIC	BOTH IP/OP	"$16,200.00 "	"$11,988.00"	$0.00	"$12,960.00"	"$7,290.00"	"$7,290.00"	$0.00	$0.00	$0.00	"$3,376.49"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,376.08"	$0.00	"$7,986.60"	"$7,986.60"	$0.00	"$8,100.00"	"$12,830.40"	"$12,960.00"	$0.00		$0.00	"$2,535.30"	$0.00	$0.00	"$2,579.04"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-21	SUP	HCPCS C1781		01-9521  -  MESH SURG SMALL .6MM ETCHED LABEL ANATOMIC AESTHETIC	BOTH IP/OP	"$18,900.00 "	"$13,986.00"	$0.00	"$15,120.00"	"$8,505.00"	"$8,505.00"	$0.00	$0.00	$0.00	"$3,939.23"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,938.76"	$0.00	"$9,317.70"	"$9,317.70"	$0.00	"$9,450.00"	"$14,968.80"	"$15,120.00"	$0.00		$0.00	"$2,957.85"	$0.00	$0.00	"$3,008.88"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-22	SUP	HCPCS C1781		01-9522  -  MESH SURG SMALL .6MM ETCHED LABEL ANATOMIC AESTHETIC	BOTH IP/OP	"$18,900.00 "	"$13,986.00"	$0.00	"$15,120.00"	"$8,505.00"	"$8,505.00"	$0.00	$0.00	$0.00	"$3,939.23"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,938.76"	$0.00	"$9,317.70"	"$9,317.70"	$0.00	"$9,450.00"	"$14,968.80"	"$15,120.00"	$0.00		$0.00	"$2,957.85"	$0.00	$0.00	"$3,008.88"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-23	SUP	HCPCS C1781		01-9523  -  MESH SURG LARGE .6MM ETCHED LABEL ANATOMIC AESTHETIC	BOTH IP/OP	"$21,060.00 "	"$15,584.40"	$0.00	"$16,848.00"	"$9,477.00"	"$9,477.00"	$0.00	$0.00	$0.00	"$4,389.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,388.90"	$0.00	"$10,382.58"	"$10,382.58"	$0.00	"$10,530.00"	"$16,679.52"	"$16,848.00"	$0.00		$0.00	"$3,295.89"	$0.00	$0.00	"$3,352.75"	$0.00	$0.00	$0.00	$0.00	$0.00
Jan-24	SUP	HCPCS C1781		01-9524  -  MESH SURG LARGE .6MM ETCHED LABEL ANATOMIC AESTHETIC	BOTH IP/OP	"$21,060.00 "	"$15,584.40"	$0.00	"$16,848.00"	"$9,477.00"	"$9,477.00"	$0.00	$0.00	$0.00	"$4,389.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,388.90"	$0.00	"$10,382.58"	"$10,382.58"	$0.00	"$10,530.00"	"$16,679.52"	"$16,848.00"	$0.00		$0.00	"$3,295.89"	$0.00	$0.00	"$3,352.75"	$0.00	$0.00	$0.00	$0.00	$0.00
2800724	SUP	HCPCS C1713		2800724  -  CAGE SPNL 0D 24MMX7MM STRL FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2800824	SUP	HCPCS C1713		2800824  -  CAGE SPNL 0D 24MMX8MM STRL FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2840924	SUP	HCPCS C1713		2840924  -  CAGE SPNL 4D 24MMX9MM STRL FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2841024	SUP	HCPCS C1713		2841024  -  CAGE SPNL 4D 24MMX10MM STRL FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2841124	SUP	HCPCS C1713		2841124  -  CAGE SPNL 4D 24MMX11MM STRL FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2841224	SUP	HCPCS C1713		2841224  -  CAGE SPNL 4D 24MMX12MM STRL FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2841324	SUP	HCPCS C1713		2841324  -  CAGE SPNL 4D 24MMX13MM STRL FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2841424	SUP	HCPCS C1713		2841424  -  CAGE SPNL 4D 24MMX14MM STRL FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2880924	SUP	HCPCS C1713		2880924  -  CAGE SPNL 8D 24MMX9MM FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2881024	SUP	HCPCS C1713		2881024  -  CAGE SPNL 8D 24MMX10MM FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2881124	SUP	HCPCS C1713		2881124  -  CAGE SPNL 8D 24MMX11MM FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2881224	SUP	HCPCS C1713		2881224  -  CAGE SPNL 8D 24MMX12MM FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2881324	SUP	HCPCS C1713		2881324  -  CAGE SPNL 8D 24MMX13MM FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2881424	SUP	HCPCS C1713		2881424  -  CAGE SPNL 8D 24MMX14MM FUSE TI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2920040	SUP	Custom 27803010		2920040  -  CAGE SPNL 0D 40X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920045	SUP	Custom 27803010		2920045  -  CAGE SPNL 0D 45X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920050	SUP	Custom 27803010		2920050  -  CAGE SPNL 0D 50X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920055	SUP	Custom 27803010		2920055  -  CAGE SPNL 0D 55X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920060	SUP	Custom 27803010		2920060  -  CAGE SPNL 0D 60X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920240	SUP	Custom 27803010		2920240  -  CAGE SPNL 0D 40X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920245	SUP	Custom 27803010		2920245  -  CAGE SPNL 0D 45X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920250	SUP	Custom 27803010		2920250  -  CAGE SPNL 0D 50X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920255	SUP	Custom 27803010		2920255  -  CAGE SPNL 0D 55X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920260	SUP	Custom 27803010		2920260  -  CAGE SPNL 0D 60X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920440	SUP	Custom 27803010		2920440  -  CAGE SPNL 0D 40X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920445	SUP	Custom 27803010		2920445  -  CAGE SPNL 0D 45X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920450	SUP	Custom 27803010		2920450  -  CAGE SPNL 0D 50X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920455	SUP	Custom 27803010		2920455  -  CAGE SPNL 0D 55X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920460	SUP	Custom 27803010		2920460  -  CAGE SPNL 0D 60X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920640	SUP	Custom 27803010		2920640  -  CAGE SPNL 0D 40X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920645	SUP	Custom 27803010		2920645  -  CAGE SPNL 0D 45X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920650	SUP	Custom 27803010		2920650  -  CAGE SPNL 0D 50X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920655	SUP	Custom 27803010		2920655  -  CAGE SPNL 0D 55X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920660	SUP	Custom 27803010		2920660  -  CAGE SPNL 0D 60X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920840	SUP	Custom 27803010		2920840  -  CAGE SPNL 0D 40X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920845	SUP	Custom 27803010		2920845  -  CAGE SPNL 0D 45X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920850	SUP	Custom 27803010		2920850  -  CAGE SPNL 0D 50X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920855	SUP	Custom 27803010		2920855  -  CAGE SPNL 0D 55X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2920860	SUP	Custom 27803010		2920860  -  CAGE SPNL 0D 60X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922040	SUP	Custom 27803010		2922040  -  CAGE SPNL 12D 40X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922045	SUP	Custom 27803010		2922045  -  CAGE SPNL 12D 45X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922050	SUP	Custom 27803010		2922050  -  CAGE SPNL 12D 50X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922055	SUP	Custom 27803010		2922055  -  CAGE SPNL 12D 55X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922060	SUP	Custom 27803010		2922060  -  CAGE SPNL 12D 60X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922240	SUP	Custom 27803010		2922240  -  CAGE SPNL 12D 40X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922245	SUP	Custom 27803010		2922245  -  CAGE SPNL 12D 45X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922250	SUP	Custom 27803010		2922250  -  CAGE SPNL 12D 50X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922255	SUP	Custom 27803010		2922255  -  CAGE SPNL 12D 55X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922260	SUP	Custom 27803010		2922260  -  CAGE SPNL 12D 60X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922440	SUP	Custom 27803010		2922440  -  CAGE SPNL 12D 40X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922445	SUP	Custom 27803010		2922445  -  CAGE SPNL 12D 45X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922450	SUP	Custom 27803010		2922450  -  CAGE SPNL 12D 50X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922455	SUP	Custom 27803010		2922455  -  CAGE SPNL 12D 55X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922460	SUP	Custom 27803010		2922460  -  CAGE SPNL 12D 60X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922640	SUP	Custom 27803010		2922640  -  CAGE SPNL 12D 40X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922645	SUP	Custom 27803010		2922645  -  CAGE SPNL 12D 45X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922650	SUP	Custom 27803010		2922650  -  CAGE SPNL 12D 50X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922655	SUP	Custom 27803010		2922655  -  CAGE SPNL 12D 55X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2922660	SUP	Custom 27803010		2922660  -  CAGE SPNL 12D 60X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926040	SUP	Custom 27803010		2926040  -  CAGE SPNL 6D 40X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926045	SUP	Custom 27803010		2926045  -  CAGE SPNL 6D 45X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926050	SUP	Custom 27803010		2926050  -  CAGE SPNL 6D 50X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926055	SUP	Custom 27803010		2926055  -  CAGE SPNL 6D 55X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926060	SUP	Custom 27803010		2926060  -  CAGE SPNL 6D 60X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926240	SUP	Custom 27803010		2926240  -  CAGE SPNL 6D 40X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926245	SUP	Custom 27803010		2926245  -  CAGE SPNL 6D 45X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926250	SUP	Custom 27803010		2926250  -  CAGE SPNL 6D 50X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926255	SUP	Custom 27803010		2926255  -  CAGE SPNL 6D 22X12X55MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926260	SUP	Custom 27803010		2926260  -  CAGE SPNL 6D 60X12X22MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926440	SUP	Custom 27803010		2926440  -  CAGE SPNL 6D 40X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926445	SUP	Custom 27803010		2926445  -  CAGE SPNL 6D 45X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926450	SUP	Custom 27803010		2926450  -  CAGE SPNL 6D 50X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926455	SUP	Custom 27803010		2926455  -  CAGE SPNL 6D 55X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926460	SUP	Custom 27803010		2926460  -  CAGE SPNL 6D 60X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926640	SUP	Custom 27803010		2926640  -  CAGE SPNL 6D 40X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926645	SUP	Custom 27803010		2926645  -  CAGE SPNL 6D 45X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926650	SUP	Custom 27803010		2926650  -  CAGE SPNL 6D 50X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926655	SUP	Custom 27803010		2926655  -  CAGE SPNL 6D 55X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926660	SUP	Custom 27803010		2926660  -  CAGE SPNL 6D 60X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926840	SUP	Custom 27803010		2926840  -  CAGE SPNL 6D 40X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926845	SUP	Custom 27803010		2926845  -  CAGE SPNL 6D 45X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926850	SUP	Custom 27803010		2926850  -  CAGE SPNL 6D 50X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926855	SUP	Custom 27803010		2926855  -  CAGE SPNL 6D 55X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2926860	SUP	Custom 27803010		2926860  -  CAGE SPNL 6D 60X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2960822	SUP	Custom 27803010		2960822  -  SPACER SPNL 22MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2960826	SUP	HCPCS C1713		2960826  -  SPACER SPNL 26MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2960832	SUP	Custom 27803010		2960832  -  SPACER SPNL 32MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2960836	SUP	Custom 27803010		2960836  -  SPACER SPNL 36MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2961022	SUP	Custom 27803010		2961022  -  SPACER SPNL 22MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2961026	SUP	HCPCS C1713		2961026  -  SPACER SPNL 26MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2961032	SUP	Custom 27803010		2961032  -  SPACER SPNL 32MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2961036	SUP	Custom 27803010		2961036  -  SPACER SPNL 36MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2961222	SUP	Custom 27803010		2961222  -  SPACER SPNL 22MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2961226	SUP	Custom 27803010		2961226  -  SPACER SPNL 26MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2961232	SUP	Custom 27803010		2961232  -  SPACER SPNL 32MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2961236	SUP	Custom 27803010		2961236  -  SPACER SPNL 36MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2961422	SUP	Custom 27803010		2961422  -  SPACER SPNL 22MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2961426	SUP	Custom 27803010		2961426  -  SPACER SPNL 26X14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2961432	SUP	Custom 27803010		2961432  -  SPACER SPNL 32MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2961436	SUP	Custom 27803010		2961436  -  SPACER SPNL 36X14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2962036	SUP	HCPCS C1713		2962036  -  SPACER SPNL 36MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2962040	SUP	HCPCS C1713		2962040  -  SPACER SPNL 40MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2962044	SUP	HCPCS C1713		2962044  -  SPACER SPNL 44MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2962236	SUP	HCPCS C1713		2962236  -  SPACER SPNL 36MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2962240	SUP	HCPCS C1713		2962240  -  SPACER SPNL 40MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2962244	SUP	HCPCS C1713		2962244  -  SPACER SPNL 44MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2962436	SUP	HCPCS C1713		2962436  -  SPACER SPNL 36MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2962440	SUP	HCPCS C1713		2962440  -  SPACER SPNL 40MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2962444	SUP	HCPCS C1713		2962444  -  SPACER SPNL 44MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2962836	SUP	HCPCS C1713		2962836  -  SPACER SPNL 36MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2962840	SUP	HCPCS C1713		2962840  -  SPACER SPNL 40MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2962844	SUP	HCPCS C1713		2962844  -  SPACER SPNL 44MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
2968040	SUP	Custom 27803010		2968040  -  CAGE SPNL 6D 40MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968045	SUP	Custom 27803010		2968045  -  CAGE SPNL 6D 45MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968050	SUP	Custom 27803010		2968050  -  CAGE SPNL 6D 50MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968055	SUP	Custom 27803010		2968055  -  CAGE SPNL 6D 55MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968060	SUP	Custom 27803010		2968060  -  CAGE SPNL 6D 60MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968240	SUP	Custom 27803010		2968240  -  CAGE SPNL 6D 40MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968245	SUP	Custom 27803010		2968245  -  CAGE SPNL 6D 45MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968250	SUP	Custom 27803010		2968250  -  CAGE SPNL 6D 50MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968255	SUP	Custom 27803010		2968255  -  CAGE SPNL 6D 55MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968260	SUP	Custom 27803010		2968260  -  CAGE SPNL 6D 60MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968440	SUP	Custom 27803010		2968440  -  CAGE SPNL 6D 40MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968445	SUP	Custom 27803010		2968445  -  CAGE SPNL 6D 45MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968450	SUP	Custom 27803010		2968450  -  CAGE SPNL 6D 50MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968455	SUP	Custom 27803010		2968455  -  CAGE SPNL 6D 55MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968460	SUP	Custom 27803010		2968460  -  CAGE SPNL 6D 60MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968640	SUP	Custom 27803010		2968640  -  CAGE SPNL 6D 40MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968645	SUP	Custom 27803010		2968645  -  CAGE SPNL 6D 45MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968650	SUP	Custom 27803010		2968650  -  CAGE SPNL 6D 50MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968655	SUP	Custom 27803010		2968655  -  CAGE SPNL 6D 55MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968660	SUP	Custom 27803010		2968660  -  CAGE SPNL 6D 60MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968840	SUP	Custom 27803010		2968840  -  CAGE SPNL 6D 40MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968845	SUP	Custom 27803010		2968845  -  CAGE SPNL 6D 45MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968850	SUP	Custom 27803010		2968850  -  CAGE SPNL 6D 50MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968855	SUP	Custom 27803010		2968855  -  CAGE SPNL 6D 55MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2968860	SUP	Custom 27803010		2968860  -  CAGE SPNL 6D 60MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969040	SUP	Custom 27803010		2969040  -  CAGE SPNL 0D 40MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969045	SUP	Custom 27803010		2969045  -  CAGE SPNL 0D 45MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969050	SUP	Custom 27803010		2969050  -  CAGE SPNL 0D 50MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969055	SUP	Custom 27803010		2969055  -  CAGE SPNL 0D 55MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969240	SUP	Custom 27803010		2969240  -  CAGE SPNL 0D 40MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969245	SUP	Custom 27803010		2969245  -  CAGE SPNL 0D 45MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969250	SUP	Custom 27803010		2969250  -  CAGE SPNL 0D 50MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969255	SUP	Custom 27803010		2969255  -  CAGE SPNL 0D 55MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969440	SUP	Custom 27803010		2969440  -  CAGE SPNL 0D 40MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969445	SUP	Custom 27803010		2969445  -  CAGE SPNL 0D 45MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969450	SUP	Custom 27803010		2969450  -  CAGE SPNL 0D 50MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969455	SUP	Custom 27803010		2969455  -  CAGE SPNL 0D 55MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969640	SUP	Custom 27803010		2969640  -  CAGE SPNL 0D 40MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969645	SUP	Custom 27803010		2969645  -  CAGE SPNL 0D 45MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969650	SUP	Custom 27803010		2969650  -  CAGE SPNL 0D 50MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969655	SUP	Custom 27803010		2969655  -  CAGE SPNL 0D 55MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969840	SUP	Custom 27803010		2969840  -  CAGE SPNL 0D 40MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969845	SUP	Custom 27803010		2969845  -  CAGE SPNL 0D 45MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969850	SUP	Custom 27803010		2969850  -  CAGE SPNL 0D 50MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2969855	SUP	Custom 27803010		2969855  -  CAGE SPNL 0D 55MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990622	SUP	HCPCS C1713		2990622  -  SPACER SPNL 22MMX6MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990626	SUP	HCPCS C1713		2990626  -  SPACER SPNL 26MMX6MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990722	SUP	HCPCS C1713		2990722  -  SPACER SPNL 22MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990726	SUP	HCPCS C1713		2990726  -  SPACER SPNL 26MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990732	SUP	HCPCS C1713		2990732  -  SPACER SPNL 32MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990736	SUP	HCPCS C1713		2990736  -  SPACER SPNL 36MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990822	SUP	Custom 27803010		2990822  -  SPACER SPNL 22MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990826	SUP	Custom 27803010		2990826  -  SPACER SPNL 26MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990832	SUP	Custom 27803010		2990832  -  SPACER SPNL 32MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990836	SUP	Custom 27803010		2990836  -  SPACER SPNL 36MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990922	SUP	HCPCS C1713		2990922  -  SPACER SPNL 22MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990926	SUP	HCPCS C1713		2990926  -  SPACER SPNL 26MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990932	SUP	HCPCS C1713		2990932  -  SPACER SPNL 32MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2990936	SUP	HCPCS C1713		2990936  -  SPACER SPNL 36MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991022	SUP	Custom 27803010		2991022  -  SPACER SPNL 22MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991026	SUP	Custom 27803010		2991026  -  SPACER SPNL 26MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991032	SUP	Custom 27803010		2991032  -  SPACER SPNL 32MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991036	SUP	Custom 27803010		2991036  -  SPACER SPNL 36MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991122	SUP	HCPCS C1713		2991122  -  SPACER SPNL 22MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991126	SUP	HCPCS C1713		2991126  -  SPACER SPNL 26MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991132	SUP	HCPCS C1713		2991132  -  SPACER SPNL 32MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991136	SUP	HCPCS C1713		2991136  -  SPACER SPNL 36MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991222	SUP	Custom 27803010		2991222  -  SPACER SPNL 22MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991226	SUP	Custom 27803010		2991226  -  SPACER SPNL 26MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991232	SUP	Custom 27803010		2991232  -  SPACER SPNL 32MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991236	SUP	Custom 27803010		2991236  -  SPACER SPNL 36MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991322	SUP	HCPCS C1713		2991322  -  SPACER SPNL 22MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991326	SUP	HCPCS C1713		2991326  -  SPACER SPNL 26MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991332	SUP	HCPCS C1713		2991332  -  SPACER SPNL 32MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991336	SUP	HCPCS C1713		2991336  -  SPACER SPNL 36MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991422	SUP	Custom 27803010		2991422  -  SPACER SPNL 22MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991426	SUP	Custom 27803010		2991426  -  SPACER SPNL 26MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991432	SUP	Custom 27803010		2991432  -  SPACER SPNL 32MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991436	SUP	Custom 27803010		2991436  -  SPACER SPNL 36MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991522	SUP	HCPCS C1713		2991522  -  SPACER SPNL 22MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991526	SUP	HCPCS C1713		2991526  -  SPACER SPNL 26MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991532	SUP	HCPCS C1713		2991532  -  SPACER SPNL 32MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991536	SUP	HCPCS C1713		2991536  -  SPACER SPNL 36MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991622	SUP	Custom 27803010		2991622  -  SPACER SPNL 22MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991626	SUP	Custom 27803010		2991626  -  SPACER SPNL 26MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991632	SUP	Custom 27803010		2991632  -  SPACER SPNL 32MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2991636	SUP	Custom 27803010		2991636  -  SPACER SPNL 36MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3001015	SUP	HCPCS C1713		3001015  -  PLATE BN 15MM ZEVO 1 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3001017	SUP	HCPCS C1713		3001017  -  PLATE BN 17MM ZEVO 1 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3001019	SUP	HCPCS C1713		3001019  -  PLATE BN 19MM ZEVO 1 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3001021	SUP	HCPCS C1713		3001021  -  PLATE BN 21MM ZEVO 1 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3001023	SUP	HCPCS C1713		3001023  -  PLATE BN 23MM ZEVO 1 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3001027	SUP	HCPCS C1713		3001027  -  PLATE 27MM TI LVL 1 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3001029	SUP	HCPCS C1713		3001029  -  PLATE 29MM TI LVL 1 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3001031	SUP	HCPCS C1713		3001031  -  PLATE 31MM TI LVL 1 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3002035	SUP	HCPCS C1713		3002035  -  PLATE BN 35MM ZEVO 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3002039	SUP	HCPCS C1713		3002039  -  PLATE BN 39MM ZEVO 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3002043	SUP	HCPCS C1713		3002043  -  PLATE 43MM TI LVL 2 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
3002045	SUP	HCPCS C1713		3002045  -  PLATE BN 45MM ZEVO 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
3002047	SUP	HCPCS C1713		3002047  -  PLATE 47MM TI LVL 2 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
3002048	SUP	HCPCS C1713		3002048  -  PLATE BN 48MM ZEVO 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
3002049	SUP	HCPCS C1713		3002049  -  PLATE 49MM TI LVL 2 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
3002051	SUP	HCPCS C1713		3002051  -  PLATE BN 51MM ZEVO 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
3002053	SUP	HCPCS C1713		3002053  -  PLATE 53MM TI LVL 2 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
3003047	SUP	HCPCS C1713		3003047  -  PLATE BN 47MM ZEVO 3 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
3003049	SUP	HCPCS C1713		3003049  -  PLATE 49MM TI LVL 3 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
3003055	SUP	HCPCS C1713		3003055  -  PLATE BN 55MM ZEVO LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
3003063	SUP	HCPCS C1713		3003063  -  PLATE BN 63MM ZEVO LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
3003065	SUP	HCPCS C1713		3003065  -  PLATE 65MM TI LVL 3 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
3003067	SUP	HCPCS C1713		3003067  -  PLATE 67MM TI LVL 3 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
3003068	SUP	HCPCS C1713		3003068  -  PLATE 68MM TI LVL 3 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
3003069	SUP	HCPCS C1713		3003069  -  PLATE 69MM TI LVL 3 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
3003071	SUP	HCPCS C1713		3003071  -  PLATE 71MM TI LVL 3 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
3003248	SUP	Custom 27203010		REAGENT PCR HOT SRT REAC MX LTCYCLR 96 TST	BOTH IP/OP	$597.50 	$442.15	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$298.75	$473.22	$478.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3004071	SUP	HCPCS C1713		3004071  -  PLATE 71MM TI LVL 4 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
3004073	SUP	HCPCS C1713		3004073  -  PLATE BN 73MM ZEVO 4 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
3004075	SUP	HCPCS C1713		3004075  -  PLATE BN 75MM ZEVO 4 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
3004077	SUP	HCPCS C1713		3004077  -  PLATE 77MM TI LVL 4 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
3004078	SUP	HCPCS C1713		3004078  -  PLATE BN 78MM ZEVO 4 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
3004079	SUP	HCPCS C1713		3004079  -  PLATE 79MM TI LVL 4 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
3004081	SUP	HCPCS C1713		3004081  -  PLATE 81MM TI LVL 4 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
3004083	SUP	HCPCS C1713		3004083  -  PLATE 83MM TI LVL 4 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
3004085	SUP	HCPCS C1713		3004085  -  PLATE 85MM TI LVL 4 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
3004086	SUP	HCPCS C1713		3004086  -  PLATE 86MM TI LVL 4 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
3004087	SUP	HCPCS C1713		3004087  -  PLATE 87MM TI LVL 4 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
3004089	SUP	HCPCS C1713		3004089  -  PLATE 89MM TI LVL 4 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
3005075	SUP	HCPCS C1713		3005075  -  PLATE 75MM TI LVL 5 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
3005077	SUP	HCPCS C1713		3005077  -  PLATE 77MM TI LVL 5 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
3005079	SUP	HCPCS C1713		3005079  -  PLATE 79MM TI LVL 5 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
3005081	SUP	HCPCS C1713		3005081  -  PLATE 81MM TI LVL 5 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
3005085	SUP	HCPCS C1713		3005085  -  PLATE 85MM TI LVL 5 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
3005090	SUP	HCPCS C1713		3005090  -  PLATE 90MM TI LVL 5 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
3005095	SUP	HCPCS C1713		3005095  -  PLATE 95MM TI LVL 5 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
3005100	SUP	HCPCS C1713		3005100  -  PLATE 100MM TI LVL 5 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
3005105	SUP	HCPCS C1713		3005105  -  PLATE 105MM TI LVL 5 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
3005108	SUP	HCPCS C1713		3005108  -  PLATE 108MM TI LVL 5 ZEVO BONE SPN CERV ANT	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
3034001	SUP	Custom 27203010		3034001  -  DRILL BIT 3034001 ADJUSTABLE STERILE	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$0.00	$0.00	$104.41	$0.00	$0.00	$0.00	$0.00	$250.50	$396.79	$400.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3101001	SUP	Custom 27203010		EARPLUG FOAM EAR NSE RDC BRL SHP PCTV EAR	BOTH IP/OP	$0.18 	$0.13	$0.00	$0.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.09	$0.14	$0.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3120211	SUP	HCPCS C1713		3120211  -  SCREW BN 4MM 11MM NS ATLNTS ST FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120212	SUP	HCPCS C1713		3120212  -  SCREW 3120212 4.0 X 12 SELF TAP FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120213	SUP	HCPCS C1713		3120213  -  SCREW 3120213 4.0 X 13 SELF TAP FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120214	SUP	HCPCS C1713		3120214  -  SCREW BONE 4MM 14MM ATLNTS TI ANT CERV SPN SLFTAP FIXANG	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120215	SUP	HCPCS C1713		3120215  -  SCREW BN 4MM 15MM NS ATLNTS ST FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120216	SUP	HCPCS C1713		3120216  -  SCREW 3120216 4.0 X 16 SELF TAP FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120217	SUP	HCPCS C1713		3120217  -  SCREW BN 4MM 17MM NS ATLNTS ST FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120218	SUP	HCPCS C1713		3120218  -  SCREW 3120218 4.0 X 18 SELF TAP FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120219	SUP	HCPCS C1713		3120219  -  SCREW 3120219 4.0 X 19 SELF TAP FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120220	SUP	HCPCS C1713		3120220  -  SCREW 3120220 4.0 X 20 SELF TAP FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120311	SUP	HCPCS C1713		3120311  -  SCREW BN 4MM 11MM NS ATLNTS ST VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120312	SUP	HCPCS C1713		3120312  -  SCREW 3120312 4.0 X 12 SELF TAP VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120313	SUP	HCPCS C1713		3120313  -  SCREW 3120313 4.0 X 13 SELF TAP VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120314	SUP	HCPCS C1713		3120314  -  SCREW BN 4MM 14MM NS ATLNTS ST VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120315	SUP	HCPCS C1713		3120315  -  SCREW BN 4MM 15MM NS ATLNTS ST VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120316	SUP	HCPCS C1713		3120316  -  SCREW BN 4MM 16MM NS ATLNTS ST VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120317	SUP	HCPCS C1713		3120317  -  SCREW BN 4MM 17MM NS ATLNTS ST VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120318	SUP	HCPCS C1713		3120318  -  SCREW 3120318 4.0 X 18 SELF TAP VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120319	SUP	HCPCS C1713		3120319  -  SCREW 3120319 4.0 X 19 SELF TAP VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120320	SUP	HCPCS C1713		3120320  -  SCREW 3120320 4.0 X 20 SELF TAP VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120411	SUP	HCPCS C1713		3120411  -  SCREW 3120411 4.0 X 11 SELF DRILL FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120412	SUP	HCPCS C1713		3120412  -  SCREW BN 4MM 12MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120413	SUP	HCPCS C1713		3120413  -  SCREW BN 4MM 13MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120414	SUP	HCPCS C1713		3120414  -  SCREW BN 4MM 14MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120415	SUP	HCPCS C1713		3120415  -  SCREW BN 4MM 15MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120416	SUP	HCPCS C1713		3120416  -  SCREW BN 4MM 16MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120417	SUP	HCPCS C1713		3120417  -  SCREW 3120417 4.0 X 17 SELF DRILL FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120419	SUP	HCPCS C1713		3120419  -  SCREW 3120419 4.0 X 19 SELF DRILL FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120420	SUP	HCPCS C1713		3120420  -  SCREW 3120420 4.0 X 20 SELF DRILL FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120511	SUP	HCPCS C1713		3120511  -  SCREW BN 4MM 11MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120512	SUP	HCPCS C1713		3120512  -  SCREW BN 4MM 12MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120513	SUP	HCPCS C1713		3120513  -  SCREW BN 4MM 13MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120514	SUP	HCPCS C1713		3120514  -  SCREW BN 4MM 14MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120515	SUP	HCPCS C1713		3120515  -  SCREW BN 4MM 15MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120516	SUP	HCPCS C1713		3120516  -  SCREW BN 4MM 16MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120517	SUP	HCPCS C1713		3120517  -  SCREW BN 4MM 17MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120518	SUP	HCPCS C1713		3120518  -  SCREW 3120518 4.0 X 18 SELF DRILL VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120519	SUP	HCPCS C1713		3120519  -  SCREW 3120519 4.0 X 19 SELF DRILL VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3120520	SUP	HCPCS C1713		3120520  -  SCREW 3120520 4.0 X 20 SELF DRILL VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125211	SUP	HCPCS C1713		3125211  -  SCREW 3125211 4.5 X 11 SELF TAP FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125213	SUP	HCPCS C1713		3125213  -  SCREW 3125213 4.5 X 13 SELF TAP FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125215	SUP	HCPCS C1713		3125215  -  SCREW 3125215 4.5 X 15 SELF TAP FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125217	SUP	HCPCS C1713		3125217  -  SCREW BN 4.5MM 17MM NS ATLNTS ST FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125311	SUP	HCPCS C1713		3125311  -  SCREW 3125311 4.5 X 11 SELF TAP VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125313	SUP	HCPCS C1713		3125313  -  SCREW 3125313 4.5 X 13 SELF TAP VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125315	SUP	HCPCS C1713		3125315  -  SCREW 3125315 4.5 X 15 SELF TAP VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125317	SUP	HCPCS C1713		3125317  -  SCREW 3125317 4.5 X 17 SELF TAP VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125411	SUP	HCPCS C1713		3125411  -  SCREW 3125411 4.5 X 11 SELF DRILL FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125413	SUP	HCPCS C1713		3125413  -  SCREW BN 4.5MM 13MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125415	SUP	HCPCS C1713		3125415  -  SCREW BN 4.5MM 15MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125417	SUP	HCPCS C1713		3125417  -  SCREW BN 4.5MM 17MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125511	SUP	HCPCS C1713		3125511  -  SCREW 3125511 4.5 X 11 SELF DRILL VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125513	SUP	HCPCS C1713		3125513  -  SCREW BN 4.5MM 13MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125515	SUP	HCPCS C1713		3125515  -  SCREW BN 4.5MM 15MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125517	SUP	HCPCS C1713		3125517  -  SCREW BN 4.5MM 17MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3125520	SUP	HCPCS C1713		3125520  -  SCREW 3125520 4.5 X 20 SELF DRILL VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
3155648	SUP	Custom 27203010		3155648  -  BURR SURG .8MM LOW FRICTION SLEEVE BEARING OTO-FLEX SKEETER	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$0.00	$0.00	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3200028	SUP	Custom 27203010		3200028  -  KIT SPNL MAXCESS SHIM FX	BOTH IP/OP	$920.00 	$680.80	$0.00	$736.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$682.82	$682.82	$0.00	$0.00	$191.73	$0.00	$0.00	$0.00	$0.00	$460.00	$728.64	$736.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3200060	SUP	Custom 27203010		3200060  -  KIT SPNL MAXCESS MOD STRL DISP	BOTH IP/OP	"$3,765.00 "	"$2,786.10"	$0.00	"$3,012.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,794.38"	"$2,794.38"	$0.00	$0.00	$784.63	$0.00	$0.00	$0.00	$0.00	"$1,882.50"	"$2,981.88"	"$3,012.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3230101	SUP	HCPCS C1713		3230101  -  WIRE FIX 13.5IN KWIRE SPN	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
3240060	SUP	Custom 27803010		3240060  -  RETRACTOR SURG MAXCESS 4 DISPOSABLE	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	$0.00	$0.00	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3240061	SUP	Custom 27203010		3240061  -  KIT SPNL MAXCESS4 SHIM DISP	BOTH IP/OP	"$2,957.50 "	"$2,188.55"	$0.00	"$2,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,195.06"	"$2,195.06"	$0.00	$0.00	$616.34	$0.00	$0.00	$0.00	$0.00	"$1,478.75"	"$2,342.34"	"$2,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3391208	SUP	HCPCS C1713		3391208  -  SPACER SPNL 4D SM 8MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3391210	SUP	HCPCS C1713		3391210  -  SPACER SPNL 4D SM 10MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3391212	SUP	HCPCS C1713		3391212  -  SPACER SPNL 4D SM 12MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3391214	SUP	HCPCS C1713		3391214  -  SPACER SPNL 4D SM 14MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3392308	SUP	Custom 27803010		3392308  -  SPACER SPNL 8D MED 8MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3392310	SUP	Custom 27803010		3392310  -  SPACER SPNL 8D MED 10MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3392312	SUP	Custom 27803010		3392312  -  SPACER SPNL 8D MED 12MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3392314	SUP	Custom 27803010		3392314  -  SPACER SPNL 8D MED 14MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3392316	SUP	Custom 27803010		3392316  -  SPACER SPNL 8D MED 16MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3392318	SUP	HCPCS C1713		3392318  -  SPACER SPNL 8D MED 18MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3392320	SUP	HCPCS C1713		3392320  -  SPACER SPNL 8D MED 20MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3393308	SUP	Custom 27803010		3393308  -  SPACER SPNL 8D LG 8MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3393310	SUP	Custom 27803010		3393310  -  SPACER SPNL 8D LG 10MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3393312	SUP	Custom 27803010		3393312  -  SPACER SPNL 8D LG 12MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3393314	SUP	Custom 27803010		3393314  -  SPACER SPNL 8D LG 14MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3393316	SUP	Custom 27803010		3393316  -  SPACER SPNL 8D LG 16MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3393318	SUP	HCPCS C1713		3393318  -  SPACER SPNL 8D LG 18MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3393320	SUP	HCPCS C1713		3393320  -  SPACER SPNL 8D LG 20MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3393412	SUP	Custom 27803010		3393412  -  SPACER SPNL 12D LG 12MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3393414	SUP	Custom 27803010		3393414  -  SPACER SPNL 12D LG 14MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3393416	SUP	Custom 27803010		3393416  -  SPACER SPNL 12D LG 16MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3393418	SUP	HCPCS C1713		3393418  -  SPACER SPNL 12D LG 18MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3393420	SUP	HCPCS C1713		3393420  -  SPACER SPNL 12D LG 20MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3394310	SUP	HCPCS C1713		3394310  -  SPACER SPNL 8D XL 8MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3394312	SUP	HCPCS C1713		3394312  -  SPACER SPNL 8D XL 12MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3394314	SUP	HCPCS C1713		3394314  -  SPACER SPNL 8D XL 14MM PRIMTR ADON PEEK-OPTM ALIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3400014	SUP	HCPCS C1713		3400014  -  SPACER SPNL TLIF HOOD SHIM	BOTH IP/OP	$920.00 	$680.80	$0.00	$736.00	$414.00	$414.00	$0.00	$0.00	$0.00	$191.75	$682.82	$682.82	$0.00	$0.00	$191.73	$0.00	$544.18	$544.18	$0.00	$460.00	$728.64	$736.00	$0.00		$0.00	$143.98	$0.00	$0.00	$146.46	$0.00	$0.00	$0.00	$0.00	$0.00
3400033	SUP	Custom 27203010		3400033  -  KIT SPNL MAS LGHT CBL SLFRET TLIF	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$0.00	$0.00	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3491208	SUP	HCPCS C1713		3491208  -  SPACER SPNL 4D LRDTC SM 8MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3491210	SUP	HCPCS C1713		3491210  -  SPACER SPNL 4D LRDTC SM 10MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3491212	SUP	HCPCS C1713		3491212  -  SPACER SPNL 4D LRDTC SM 12MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3491214	SUP	HCPCS C1713		3491214  -  SPACER SPNL 4D LRDTC SM 14MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3491216	SUP	HCPCS C1713		3491216  -  SPACER SPNL 4D LRDTC SM 16MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3491218	SUP	HCPCS C1713		3491218  -  SPACER SPNL 4D LRDTC SM 18MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3491220	SUP	HCPCS C1713		3491220  -  SPACER SPNL 4D LRDTC SM 20MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3492308	SUP	HCPCS C1713		3492308  -  SPACER SPNL 8D LRDTC MED 8MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3492310	SUP	HCPCS C1713		3492310  -  SPACER SPNL 8D LRDTC MED 10MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3492312	SUP	HCPCS C1713		3492312  -  SPACER SPNL 8D LRDTC MED 12MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3492314	SUP	HCPCS C1713		3492314  -  SPACER SPNL 8D LRDTC MED 14MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3492316	SUP	HCPCS C1713		3492316  -  SPACER SPNL 8D LRDTC MED 16MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3492318	SUP	HCPCS C1713		3492318  -  SPACER SPNL 8D LRDTC MED 18MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3492320	SUP	HCPCS C1713		3492320  -  SPACER SPNL 8D LRDTC MED 20MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493308	SUP	HCPCS C1713		3493308  -  SPACER SPNL 8D LRDTC LG 8MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493310	SUP	HCPCS C1713		3493310  -  SPACER SPNL 8D LRDTC LG 10MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493312	SUP	HCPCS C1713		3493312  -  SPACER SPNL 8D LRDTC LG 12MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493314	SUP	HCPCS C1713		3493314  -  SPACER SPNL 8D LRDTC LG 14MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493316	SUP	HCPCS C1713		3493316  -  SPACER SPNL 8D LRDTC LG 16MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493318	SUP	HCPCS C1713		3493318  -  SPACER SPNL 8D LRDTC LG 18MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493320	SUP	HCPCS C1713		3493320  -  SPACER SPNL 8D LRDTC LG 20MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493412	SUP	HCPCS C1713		3493412  -  SPACER SPNL 12D LRDTC LG 12MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493414	SUP	HCPCS C1713		3493414  -  SPACER SPNL 12D LRDTC LG 14MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493416	SUP	HCPCS C1713		3493416  -  SPACER SPNL 12D LRDTC LG 16MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493418	SUP	HCPCS C1713		3493418  -  SPACER SPNL 12D LRDTC LG 18MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493420	SUP	HCPCS C1713		3493420  -  SPACER SPNL 12D LRDTC LG 20MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493512	SUP	HCPCS C1713		3493512  -  SPACER SPNL 15D LRDTC LG 12MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493514	SUP	HCPCS C1713		3493514  -  SPACER SPNL 15D LRDTC LG 14MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493516	SUP	HCPCS C1713		3493516  -  SPACER SPNL 15D LRDTC LG 16MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493518	SUP	HCPCS C1713		3493518  -  SPACER SPNL 15D LRDTC LG 18MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3493520	SUP	HCPCS C1713		3493520  -  SPACER SPNL 15D LRDTC LG 20MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3494310	SUP	HCPCS C1713		3494310  -  SPACER SPNL 8D LRDTC XL 10MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3494312	SUP	HCPCS C1713		3494312  -  SPACER SPNL 8D LRDTC XL 12MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3494314	SUP	HCPCS C1713		3494314  -  SPACER SPNL 8D LRDTC XL 14MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3494316	SUP	HCPCS C1713		3494316  -  SPACER SPNL 8D LRDTC XL 16MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3494318	SUP	HCPCS C1713		3494318  -  SPACER SPNL 8D LRDTC XL 18MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3494320	SUP	HCPCS C1713		3494320  -  SPACER SPNL 8D LRDTC XL 20MM PRIMTR VERT BD REPL	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3547213	SUP	HCPCS C1789		3547213  -  EXPANDER TISS 450ML TAB MED HT STY 7200 CPX3 SLTX CNTOUR	BOTH IP/OP	"$3,312.50 "	"$2,451.25"	$0.00	"$2,650.00"	"$1,490.63"	"$1,490.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,656.25"	"$2,623.50"	"$2,650.00"	$0.00		$0.00	$518.41	$0.00	$0.00	$527.35	$0.00	$0.00	$0.00	$0.00	$0.00
3549213	SUP	HCPCS C1789		3549213  -  EXPANDER TISS P7CM CNTR PRFL MED HT 12.7X10.8CM 450ML CPX4	BOTH IP/OP	"$2,937.50 "	"$2,173.75"	$0.00	"$2,350.00"	"$1,321.88"	"$1,321.88"	$0.00	$0.00	$0.00	$612.25	"$2,180.21"	"$2,180.21"	$0.00	$0.00	$612.18	$0.00	"$1,448.19"	"$1,448.19"	$0.00	"$1,468.75"	"$2,326.50"	"$2,350.00"	$0.00		$0.00	$459.72	$0.00	$0.00	$467.65	$0.00	$0.00	$0.00	$0.00	$0.00
3549214	SUP	HCPCS C1789		3549214  -  EXPANDER TISS P7.4CM CNTR PRFL MED HT 13.5X11.7CM 550ML CPX4	BOTH IP/OP	"$2,937.50 "	"$2,173.75"	$0.00	"$2,350.00"	"$1,321.88"	"$1,321.88"	$0.00	$0.00	$0.00	$612.25	"$2,180.21"	"$2,180.21"	$0.00	$0.00	$612.18	$0.00	"$1,448.19"	"$1,448.19"	$0.00	"$1,468.75"	"$2,326.50"	"$2,350.00"	$0.00		$0.00	$459.72	$0.00	$0.00	$467.65	$0.00	$0.00	$0.00	$0.00	$0.00
3549215	SUP	HCPCS C1789		3549215  -  EXPANDER TISS P7.6CM CNTR PRFL MED HT 14.6X12.6CM 650ML CPX4	BOTH IP/OP	"$2,937.50 "	"$2,173.75"	$0.00	"$2,350.00"	"$1,321.88"	"$1,321.88"	$0.00	$0.00	$0.00	$612.25	"$2,180.21"	"$2,180.21"	$0.00	$0.00	$612.18	$0.00	"$1,448.19"	"$1,448.19"	$0.00	"$1,468.75"	"$2,326.50"	"$2,350.00"	$0.00		$0.00	$459.72	$0.00	$0.00	$467.65	$0.00	$0.00	$0.00	$0.00	$0.00
3549216	SUP	HCPCS C1789		3549216  -  EXPANDER TISS P8CM CNTR PRFL MED HT 15.6X13.3CM 800ML CPX4	BOTH IP/OP	"$2,937.50 "	"$2,173.75"	$0.00	"$2,350.00"	"$1,321.88"	"$1,321.88"	$0.00	$0.00	$0.00	$612.25	"$2,180.21"	"$2,180.21"	$0.00	$0.00	$612.18	$0.00	"$1,448.19"	"$1,448.19"	$0.00	"$1,468.75"	"$2,326.50"	"$2,350.00"	$0.00		$0.00	$459.72	$0.00	$0.00	$467.65	$0.00	$0.00	$0.00	$0.00	$0.00
3712039	SUP	Custom 27203010		PUNCH SURG 3.5MM UP BITE ANG CIRC CUT 160MM 45D	BOTH IP/OP	"$2,515.00 "	"$1,861.10"	$0.00	"$2,012.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,257.50"	"$1,991.88"	"$2,012.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3714231	SUP	Custom 27203010		PROBE SURG 208MM FRNTL OSTM SKR RT ANG 2 END BALL TIP	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3714284	SUP	Custom 27203010		CURETTE 5MM 2MM 75D CURVE CUP SURG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3756230	SUP	HCPCS C1713		03756230  -  SCREW SET BUTTRESS BLOCKER XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
3800750	SUP	HCPCS C1713		03800750  -  SCREW BONE 7.5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801530	SUP	HCPCS C1713		03801530  -  SCREW BONE 5.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801535	SUP	HCPCS C1713		03801535  -  SCREW BONE 5.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801540	SUP	HCPCS C1713		03801540  -  SCREW BONE 5.5MM 40MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801545	SUP	HCPCS C1713		03801545  -  SCREW BONE 5.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801550	SUP	HCPCS C1713		03801550  -  SCREW BONE 5.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801555	SUP	HCPCS C1713		03801555  -  SCREW BONE 5.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801630	SUP	HCPCS C1713		03801630  -  SCREW BONE 6.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801635	SUP	HCPCS C1713		03801635  -  SCREW BONE 6.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801640	SUP	HCPCS C1713		03801640  -  SCREW BONE 6.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801645	SUP	HCPCS C1713		03801645  -  SCREW BONE 6.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801650	SUP	HCPCS C1713		03801650  -  SCREW BONE 6.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801655	SUP	HCPCS C1713		03801655  -  SCREW BONE 6.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801660	SUP	HCPCS C1713		03801660  -  SCREW BONE 6.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801730	SUP	HCPCS C1713		03801730  -  SCREW BONE 7.5MM 30MM POLYAX XIA SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801735	SUP	HCPCS C1713		03801735  -  SCREW BONE 7.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801740	SUP	HCPCS C1713		03801740  -  SCREW BONE 7.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801745	SUP	HCPCS C1713		03801745  -  SCREW BONE 7.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801750	SUP	HCPCS C1713		03801750  -  SCREW BONE 7.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801755	SUP	HCPCS C1713		03801755  -  SCREW BONE 7.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801760	SUP	HCPCS C1713		03801760  -  SCREW BONE 7.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3801800	SUP	HCPCS C1713		03801800  -  SCREW BONE 8.5MM 100MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3801830	SUP	HCPCS C1713		03801830  -  SCREW BONE 8.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3801835	SUP	HCPCS C1713		03801835  -  SCREW BONE 8.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3801840	SUP	HCPCS C1713		03801840  -  SCREW BONE 8.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3801845	SUP	HCPCS C1713		03801845  -  SCREW BONE 8.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3801850	SUP	HCPCS C1713		03801850  -  SCREW BONE 8.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3801855	SUP	HCPCS C1713		03801855  -  SCREW BONE 8.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3801860	SUP	HCPCS C1713		03801860  -  SCREW BONE 8.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3801870	SUP	HCPCS C1713		03801870  -  SCREW BONE 8.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3801880	SUP	HCPCS C1713		03801880  -  SCREW BONE 8.5MM 80MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3801890	SUP	HCPCS C1713		03801890  -  SCREW BONE 8.5MM 90MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3801900	SUP	HCPCS C1713		03801900  -  SCREW BONE 9.5MM 100MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,162.50 "	$860.25	$0.00	$930.00	$523.13	$523.13	$0.00	$0.00	$0.00	$242.29	$862.81	$862.81	$0.00	$0.00	$242.27	$0.00	$687.62	$687.62	$0.00	$581.25	$920.70	$930.00	$0.00		$0.00	$181.93	$0.00	$0.00	$185.07	$0.00	$0.00	$0.00	$0.00	$0.00
3801960	SUP	HCPCS C1713		03801960  -  SCREW BONE 9.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,162.50 "	$860.25	$0.00	$930.00	$523.13	$523.13	$0.00	$0.00	$0.00	$242.29	$862.81	$862.81	$0.00	$0.00	$242.27	$0.00	$687.62	$687.62	$0.00	$581.25	$920.70	$930.00	$0.00		$0.00	$181.93	$0.00	$0.00	$185.07	$0.00	$0.00	$0.00	$0.00	$0.00
3801970	SUP	HCPCS C1713		03801970  -  SCREW BONE 9.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
3801980	SUP	HCPCS C1713		03801980  -  SCREW BONE 9.5MM 80MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$4,437.50 "	"$3,283.75"	$0.00	"$3,550.00"	"$1,996.88"	"$1,996.88"	$0.00	$0.00	$0.00	$924.89	"$3,293.51"	"$3,293.51"	$0.00	$0.00	$924.78	$0.00	"$2,187.69"	"$2,187.69"	$0.00	"$2,218.75"	"$3,514.50"	"$3,550.00"	$0.00		$0.00	$694.47	$0.00	$0.00	$706.45	$0.00	$0.00	$0.00	$0.00	$0.00
3801990	SUP	HCPCS C1713		03801990  -  SCREW BONE 9.5MM 90MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3802070	SUP	Custom 27803010		03802070  -  ROD SPNL 70MM 6MM XIA TI CENTRL POST	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3802110	SUP	Custom 27803010		03802110  -  ROD SPNL 110MM 6MM XIA TI CENTRL POST	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3802480	SUP	Custom 27803010		03802480  -  ROD SPNL 480MM 6MM XIA TI CENTRL POST	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3804025	SUP	Custom 27803010		03804025  -  CONNECTOR ROD XIA SPN I	BOTH IP/OP	$991.68 	$733.84	$0.00	$793.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$736.02	$736.02	$0.00	$0.00	$206.67	$0.00	$0.00	$0.00	$0.00	$495.84	$785.41	$793.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3804120	SUP	Custom 27803010		03804120  -  CONNECTOR ROD ADAPTER XIA SPN	BOTH IP/OP	$991.68 	$733.84	$0.00	$793.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$736.02	$736.02	$0.00	$0.00	$206.67	$0.00	$0.00	$0.00	$0.00	$495.84	$785.41	$793.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3805000	SUP	Custom 27803010		03805000  -  BLOCK SPINAL XIA TITANIUM SACRAL	BOTH IP/OP	"$4,082.50 "	"$3,021.05"	$0.00	"$3,266.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,030.03"	"$3,030.03"	$0.00	$0.00	$850.79	$0.00	$0.00	$0.00	$0.00	"$2,041.25"	"$3,233.34"	"$3,266.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3805001	SUP	Custom 27803010		03805001  -  CLAMP SPINAL ROD TO ROD PARALLEL XIA TITANIUM	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3805002	SUP	Custom 27803010		03805002  -  CLAMP SPINAL AXIAL XIA TITANIUM	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3805025	SUP	HCPCS C1713		03805025  -  SCREW BONE 6.5MM 25MM XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,400.00 "	"$1,776.00"	$0.00	"$1,920.00"	"$1,080.00"	"$1,080.00"	$0.00	$0.00	$0.00	$500.22	"$1,781.28"	"$1,781.28"	$0.00	$0.00	$500.16	$0.00	"$1,419.60"	"$1,419.60"	$0.00	"$1,200.00"	"$1,900.80"	"$1,920.00"	$0.00		$0.00	$375.60	$0.00	$0.00	$382.08	$0.00	$0.00	$0.00	$0.00	$0.00
3805030	SUP	HCPCS C1713		03805030  -  SCREW BONE 6.5MM 30MM XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,400.00 "	"$1,776.00"	$0.00	"$1,920.00"	"$1,080.00"	"$1,080.00"	$0.00	$0.00	$0.00	$500.22	"$1,781.28"	"$1,781.28"	$0.00	$0.00	$500.16	$0.00	"$1,419.60"	"$1,419.60"	$0.00	"$1,200.00"	"$1,900.80"	"$1,920.00"	$0.00		$0.00	$375.60	$0.00	$0.00	$382.08	$0.00	$0.00	$0.00	$0.00	$0.00
3805035	SUP	HCPCS C1713		03805035  -  SCREW BONE 6.5MM 35MM XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3806001	SUP	Custom 27803010		03806001  -  HOOK SPINAL LARGE XIA TITANIUM LAMINA	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3806002	SUP	Custom 27803010		03806002  -  HOOK SPINAL MEDIUM XIA TITANIUM LAMINA	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3806003	SUP	Custom 27803010		03806003  -  HOOK SPINAL SMALL XIA TITANIUM LMNR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3806006	SUP	Custom 27803010		03806006  -  HOOK SPINAL LEFT EXTEND BODY XIA TITANIUM LAMINA	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3806007	SUP	Custom 27803010		03806007  -  HOOK SPINAL RIGHT EXTEND BODY XIA TITANIUM LAMINA	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3806009	SUP	Custom 27803010		03806009  -  HOOK SPINAL LARGE ANGLE LEFT XIA TITANIUM LAMINA	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3806012	SUP	Custom 27803010		03806012  -  HOOK SPINAL SMALL XIA GOLD TITANIUM PEDICLE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820100	SUP	HCPCS C1713		03820100  -  WASHER SPINAL LP XIA II TITANIUM	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
3820101	SUP	Custom 27803010		03820101  -  CONCTR ROD XIA OFFST SCR TI THORLMBR SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820104	SUP	HCPCS C1713		03820104  -  STAPLE BONE 1 HOLE XIA TITANIUM SPN ANTERIOR	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
3820110	SUP	HCPCS C1713		03820110  -  STAPLE BONE SMALL 2 DIAPASON OSS XIA TITANIUM SPN CAUDAL	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
3820111	SUP	HCPCS C1713		03820111  -  STAPLE BONE SMALL 2 DIAPASON OSS XIA TITANIUM SPN ROSTRAL	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
3820112	SUP	HCPCS C1713		03820112  -  STAPLE BONE MEDIUM 2 DIAPASON OSS XIA TITANIUM SPN CAUDAL	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
3820113	SUP	HCPCS C1713		03820113  -  STAPLE BONE MEDIUM 2 DIAPASON OSS XIA TITANIUM SPN ROSTRAL	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
3820114	SUP	HCPCS C1713		03820114  -  STAPLE BONE LARGE 2 DIAPASON OSS XIA TITANIUM SPN CAUDAL	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
3820115	SUP	HCPCS C1713		03820115  -  STAPLE BONE LARGE 2 DIAPASON OSS XIA TITANIUM SPN ROSTRAL	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
3820120	SUP	HCPCS C1713		03820120  -  WASHER SPINAL 4.5MM LP XIA TITANIUM	BOTH IP/OP	$223.38 	$165.30	$0.00	$178.70	$100.52	$100.52	$0.00	$0.00	$0.00	$46.56	$165.79	$165.79	$0.00	$0.00	$46.55	$0.00	$132.13	$132.13	$0.00	$111.69	$176.92	$178.70	$0.00		$0.00	$34.96	$0.00	$0.00	$35.56	$0.00	$0.00	$0.00	$0.00	$0.00
3820124	SUP	HCPCS C1713		03820124  -  WASHER SPINAL 8.5MM LP XIA TITANIUM	BOTH IP/OP	$223.38 	$165.30	$0.00	$178.70	$100.52	$100.52	$0.00	$0.00	$0.00	$46.56	$165.79	$165.79	$0.00	$0.00	$46.55	$0.00	$132.13	$132.13	$0.00	$111.69	$176.92	$178.70	$0.00		$0.00	$34.96	$0.00	$0.00	$35.56	$0.00	$0.00	$0.00	$0.00	$0.00
3820130	SUP	Custom 27803010		03820130  -  CONNECTOR ROD 75D XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820131	SUP	Custom 27803010		03820131  -  CONNECTOR ROD 0D PLATE XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820132	SUP	Custom 27803010		03820132  -  CONNECTOR ROD 105D OFFST PLATE XIA TITANIUM SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820133	SUP	Custom 27803010		03820133  -  CONNECTOR ROD NEUTRAL 80MM OFFST XIA 3 TITANIUM STAINLESS	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820134	SUP	Custom 27803010		03820134  -  CONNECTOR ROD 0D SMALL XIA TITANIUM SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820135	SUP	Custom 27803010		03820135  -  CONNECTOR ROD 30D SMALL XIA TITANIUM SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820136	SUP	Custom 27803010		03820136  -  CONNECTOR ROD 0D LARGE XIA TITANIUM SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820137	SUP	Custom 27803010		03820137  -  CONNECTOR ROD 30D LARGE XIA TITANIUM SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820200	SUP	Custom 27803010		03820200  -  HOOK SPINAL SMALL STANDARD BLADE XIA TITANIUM LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820201	SUP	Custom 27803010		03820201  -  HOOK SPINAL SMALL NARROW XIA TITANIUM LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820202	SUP	Custom 27803010		03820202  -  HOOK SPINAL LARGE STANDARD BLADE XIA TITANIUM LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820203	SUP	Custom 27803010		03820203  -  HOOK SPINAL LARGE LEGENDARY BLADE XIA II TITANIUM LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820204	SUP	Custom 27803010		03820204  -  HOOK SPINAL EXTEND XIA TITANIUM LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820206	SUP	Custom 27803010		03820206  -  HOOK SPINAL RIGHT OFFST XIA TITANIUM LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820207	SUP	Custom 27803010		03820207  -  HOOK SPINAL LEFT OFFST XIA TITANIUM LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820208	SUP	Custom 27803010		03820208  -  HOOK SPINAL ANGLE BLADE XIA TITANIUM LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820210	SUP	Custom 27803010		03820210  -  HOOK SPINAL STANDARD BLADE XIA TITANIUM LMNR THORACIC	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820211	SUP	Custom 27803010		03820211  -  HOOK SPINAL SMALL NARROW BLADE XIA TITANIUM THORAX LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820212	SUP	Custom 27803010		03820212  -  HOOK SPINAL SMALL RIGHT OFFST XIA TITANIUM THORACOLUMBAR	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820213	SUP	Custom 27803010		03820213  -  HOOK SPINAL SMALL LEFT OFFST XIA TITANIUM THORACOLUMBAR	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820214	SUP	Custom 27803010		03820214  -  HOOK SPINAL LARGE RIGHT OFFST XIA TITANIUM THORAX LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820215	SUP	Custom 27803010		03820215  -  HOOK SPINAL LARGE LEFT OFFST XIA TITANIUM THORAX LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820220	SUP	Custom 27803010		03820220  -  HOOK SPINAL SMALL LOCK XIA TITANIUM PEDICLE	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820221	SUP	Custom 27803010		03820221  -  HOOK SPINAL LARGE XIA TITANIUM PEDICLE	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820230	SUP	Custom 27803010		03820230  -  HOOK SPINAL RIGHT OFFST XIA TITANIUM TRNSVRS PROCESS	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820231	SUP	Custom 27803010		03820231  -  HOOK SPINAL LEFT OFFST XIA II TITANIUM TRNSVRS PROCESS	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820240	SUP	Custom 27803010		03820240  -  HOOK SPINAL NARROW ANGLE REDUCE BLADE XIA TITANIUM LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820241	SUP	Custom 27803010		03820241  -  HOOK SPINAL WIDE ANGLE REDUCE BLADE XIA TITANIUM LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820242	SUP	Custom 27803010		03820242  -  HOOK SPINAL ANGLE REDUCE XIA TITANIUM LAMINA	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820243	SUP	Custom 27803010		03820243  -  HOOK SPINAL NARROW ANGLE REDUCE BLADE XIA TITANIUM THORAX	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820244	SUP	Custom 27803010		03820244  -  HOOK SPINAL LP RED BLADE XIA TITANIUM PEDIATRIC PEDICLE	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820425	SUP	HCPCS C1713		03820425  -  SCREW BONE 4.5MM 25MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820430	SUP	HCPCS C1713		03820430  -  SCREW BONE 4.5MM 30MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820435	SUP	HCPCS C1713		03820435  -  SCREW BONE 4.5MM 35MM MNOAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820440	SUP	HCPCS C1713		03820440  -  SCREW BONE 4.5MM 40MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820445	SUP	HCPCS C1713		03820445  -  SCREW BONE 4.5MM 45MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820525	SUP	HCPCS C1713		03820525  -  SCREW BONE 5.5MM 25MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820530	SUP	HCPCS C1713		03820530  -  SCREW BONE 5.5MM 30MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820535	SUP	HCPCS C1713		03820535  -  SCREW BONE 5.5MM 35MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820540	SUP	HCPCS C1713		03820540  -  SCREW BONE 5.5MM 40MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820545	SUP	HCPCS C1713		03820545  -  SCREW BONE 5.5MM 45MM XIA SPNL MNOAX	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820550	SUP	HCPCS C1713		03820550  -  SCREW BONE 5.5MM 50MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820555	SUP	HCPCS C1713		03820555  -  SCREW BONE 5.5MM 55MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820600	SUP	HCPCS C1713		03820600  -  SCREW BONE 6.5MM 100MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820630	SUP	HCPCS C1713		03820630  -  SCREW BONE 6.5MM 30MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820635	SUP	HCPCS C1713		03820635  -  SCREW BONE 6.5MM 35MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820640	SUP	HCPCS C1713		03820640  -  SCREW BONE 6.5MM 40MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820645	SUP	HCPCS C1713		03820645  -  SCREW BONE 6.5MM 45MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820650	SUP	HCPCS C1713		03820650  -  SCREW BONE 6.5MM 50MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820655	SUP	HCPCS C1713		03820655  -  SCREW BONE 6.5MM 55MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820660	SUP	HCPCS C1713		03820660  -  SCREW BONE 6.5MM 60MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820670	SUP	HCPCS C1713		03820670  -  SCREW BONE 6.5MM 70MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820680	SUP	HCPCS C1713		03820680  -  SCREW BONE 6.5MM 80MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820690	SUP	HCPCS C1713		03820690  -  SCREW BONE 6.5MM 90MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820700	SUP	HCPCS C1713		03820700  -  SCREW BONE 7.5MM 100MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820730	SUP	HCPCS C1713		03820730  -  SCREW BONE 7.5MM 30MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820735	SUP	HCPCS C1713		03820735  -  SCREW BONE 7.5MM 35MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820740	SUP	HCPCS C1713		03820740  -  SCREW BONE 7.5MM 40MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820745	SUP	HCPCS C1713		03820745  -  SCREW BONE 7.5MM 45MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820750	SUP	HCPCS C1713		03820750  -  SCREW BONE 7.5MM 50MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820755	SUP	HCPCS C1713		03820755  -  SCREW BONE 7.5MM 55MM XIA TI SPNL MNOAX	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820760	SUP	HCPCS C1713		03820760  -  SCREW BONE 7.5MM 60MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820770	SUP	HCPCS C1713		03820770  -  SCREW BONE 7.5MM 70MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820780	SUP	HCPCS C1713		03820780  -  SCREW BONE 7.5MM 80MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820790	SUP	HCPCS C1713		03820790  -  SCREW BONE 7.5MM 90MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820800	SUP	HCPCS C1713		03820800  -  SCREW BONE 8.5MM 100MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820830	SUP	HCPCS C1713		03820830  -  SCREW BONE 8.5MM 30MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820835	SUP	HCPCS C1713		03820835  -  SCREW BONE 8.5MM 35MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820840	SUP	HCPCS C1713		03820840  -  SCREW BONE 8.5MM 40MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820845	SUP	HCPCS C1713		03820845  -  SCREW BONE 8.5MM 45MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820850	SUP	HCPCS C1713		03820850  -  SCREW BONE 8.5MM 50MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820855	SUP	HCPCS C1713		03820855  -  SCREW BONE 8.5MM 55MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820860	SUP	HCPCS C1713		03820860  -  SCREW BONE 8.5MM 60MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820870	SUP	HCPCS C1713		03820870  -  SCREW BONE 8.5MM 70MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3820880	SUP	HCPCS C1713		03820880  -  SCREW BONE 8.5MM 80MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
3820890	SUP	HCPCS C1713		03820890  -  SCREW BONE 8.5MM 90MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820900	SUP	HCPCS C1713		03820900  -  SCREW BONE 9.5MM 100MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820960	SUP	HCPCS C1713		03820960  -  SCREW BONE 9.5MM 60MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820970	SUP	HCPCS C1713		03820970  -  SCREW BONE 9.5MM 70MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820980	SUP	HCPCS C1713		03820980  -  SCREW BONE 9.5MM 80MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3820990	SUP	HCPCS C1713		03820990  -  SCREW BONE 9.5MM 90MM MNOAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3821015	SUP	Custom 27803010		03821015  -  CONNECTOR ROD 15MM CROSSLINK XIA MAC TITANIUM THORACOLUMBAR	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	$0.00	$0.00	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3821016	SUP	Custom 27803010		03821016  -  CONNECTOR ROD 16MM MULTIAX CROSSLINK XIA MAC TITANIUM	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	$0.00	$0.00	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3821017	SUP	Custom 27803010		03821017  -  CONNECTOR ROD 17MM MULTIAX CROSSLINK XIA MAC TITANIUM	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	$0.00	$0.00	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3821018	SUP	Custom 27803010		03821018  -  CONNECTOR ROD 18MM MULTIAX CROSSLINK XIA MAC TITANIUM	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	$0.00	$0.00	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3821019	SUP	Custom 27803010		03821019  -  CONNECTOR ROD 19MM MULTIAX CROSSLINK XIA MAC TITANIUM	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	$0.00	$0.00	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3821020	SUP	Custom 27803010		03821020  -  CONNECTOR ROD 20MM MULTIAX CROSSLINK XIA MAC TITANIUM	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	$0.00	$0.00	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3821425	SUP	HCPCS C1713		03821425  -  SCREW BONE 4.5MM 25MM XIA TI THORLMBR SPN POLYAX	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
3821430	SUP	HCPCS C1713		03821430  -  SCREW BONE 4.5MM 30MM XIA TI THORLMBR SPN POLYAX	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
3821435	SUP	HCPCS C1713		03821435  -  SCREW BONE 4.5MM 35MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821440	SUP	HCPCS C1713		03821440  -  SCREW BONE 4.5MM 40MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821445	SUP	HCPCS C1713		03821445  -  SCREW BONE 4.5MM 45MM FIX XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821525	SUP	HCPCS C1713		03821525  -  SCREW BONE 5.5MM 25MM XIA TI SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
3821530	SUP	HCPCS C1713		03821530  -  SCREW BONE 5.5MM 30MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821535	SUP	HCPCS C1713		03821535  -  SCREW BONE 5.5MM 30MM XIA TI SPNL POLYAX LP	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
3821540	SUP	HCPCS C1713		03821540  -  SCREW BONE 5.5MM 40MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821545	SUP	HCPCS C1713		03821545  -  SCREW BONE 5.5MM 45MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821550	SUP	HCPCS C1713		03821550  -  SCREW BONE 5.5MM 50MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821555	SUP	HCPCS C1713		03821555  -  SCREW BONE 5.5MM 55MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821600	SUP	HCPCS C1713		03821600  -  SCREW BONE 6.5MM 100MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821630	SUP	HCPCS C1713		03821630  -  SCREW BONE 6.5MM 30MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821635	SUP	HCPCS C1713		03821635  -  SCREW BONE 6.5MM 35MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821640	SUP	HCPCS C1713		03821640  -  SCREW BONE 6.5MM 40MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821645	SUP	HCPCS C1713		03821645  -  SCREW BONE 6.5MM 45MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821650	SUP	HCPCS C1713		03821650  -  SCREW BONE 6.5MM 50MM XIA TI THORLMBR SPN POLYAX	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
3821650	SUP	HCPCS C1713		03821650  -  SCREW BONE 6.5MM 50MM XIA TI THORLMBR SPN POLYAX	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
3821655	SUP	HCPCS C1713		03821655  -  SCREW BONE 6.5MM 55MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821660	SUP	HCPCS C1713		03821660  -  SCREW BONE 6.5MM 60MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821670	SUP	HCPCS C1713		03821670  -  SCREW BONE 6.5MM 70MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3821680	SUP	HCPCS C1713		03821680  -  SCREW BONE 6.5MM 80MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3821690	SUP	HCPCS C1713		03821690  -  SCREW BONE 6.5MM 90MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3821700	SUP	HCPCS C1713		03821700  -  SCREW BONE 7.5MM 100MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3821730	SUP	HCPCS C1713		03821730  -  SCREW BONE 7.5MM 30MM POLYAX XIA SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3821735	SUP	HCPCS C1713		03821735  -  SCREW BONE 7.5MM 35MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3821740	SUP	HCPCS C1713		03821740  -  SCREW BONE 7.5MM 40MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3821745	SUP	HCPCS C1713		03821745  -  SCREW BONE 7.5MM 45MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3821750	SUP	HCPCS C1713		03821750  -  SCREW BONE 7.5MM 50MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3821755	SUP	HCPCS C1713		03821755  -  SCREW BONE 7.5MM 55MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3821760	SUP	HCPCS C1713		03821760  -  SCREW BONE 7.5MM 60MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3821770	SUP	HCPCS C1713		03821770  -  SCREW BONE 7.5MM 70MM POLYAX XIA II SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3821780	SUP	HCPCS C1713		03821780  -  SCREW BONE 7.5MM 80MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3821790	SUP	HCPCS C1713		03821790  -  SCREW BONE 7.5MM 90MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3822601	SUP	Custom 27803010		03822601  -  ROD SPINAL 6MM 600MM XIA VITALLIUM	BOTH IP/OP	"$2,356.58 "	"$1,743.87"	$0.00	"$1,885.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,749.05"	"$1,749.05"	$0.00	$0.00	$491.11	$0.00	$0.00	$0.00	$0.00	"$1,178.29"	"$1,866.41"	"$1,885.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3827201	SUP	Custom 27803010		03827201  -  HOOK SPINAL SMALL NARROW BLADE LMNR	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3827202	SUP	Custom 27803010		03827202  -  HOOK SPINAL LARGE STANDARD BLADE LMNR	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3827203	SUP	Custom 27803010		03827203  -  HOOK SPINAL LARGE NARROW BLADE LMNR	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3827211	SUP	Custom 27803010		03827211  -  HOOK SPINAL STANDARD BLADE LMNR	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3827220	SUP	Custom 27803010		03827220  -  HOOK SPINAL SMALL LONG ARM PEDICLE	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3828425	SUP	HCPCS C1713		03828425  -  SCREW BONE LONG ARM 4.5MM 25MM MNOAX XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828430	SUP	HCPCS C1713		03828430  -  SCREW BONE LONG ARM 4.5MM 30MM MNOAX XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828435	SUP	HCPCS C1713		03828435  -  SCREW BONE LONG ARM 4.5MM 35MM MNOAX XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828440	SUP	HCPCS C1713		03828440  -  SCREW BONE LONG ARM 4.5MM 40MM MNOAX XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828445	SUP	HCPCS C1713		03828445  -  SCREW BONE LONG ARM 4.5MM 45MM MNOAX XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828530	SUP	HCPCS C1713		03828530  -  SCREW BONE 5.5MM 30MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828535	SUP	HCPCS C1713		03828535  -  SCREW BONE 5.5MM 35MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828540	SUP	HCPCS C1713		03828540  -  SCREW BONE 5.5MM 40MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828545	SUP	HCPCS C1713		03828545  -  SCREW BONE 5.5MM 45MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828550	SUP	HCPCS C1713		03828550  -  SCREW BONE LONG ARM 5.5MM 50MM MNOAX XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828555	SUP	HCPCS C1713		03828555  -  SCREW BONE LONG ARM 5.5MM 55MM MNOAX XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828630	SUP	HCPCS C1713		03828630  -  SCREW BONE 6.5MM 30MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828635	SUP	HCPCS C1713		03828635  -  SCREW BONE 6.5MM 35MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828640	SUP	HCPCS C1713		03828640  -  SCREW BONE 6.5MM 40MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828645	SUP	HCPCS C1713		03828645  -  SCREW BONE 6.5MM 45MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828650	SUP	HCPCS C1713		03828650  -  SCREW BONE 6.5MM 50MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828655	SUP	HCPCS C1713		03828655  -  SCREW BONE 6.5MM 55MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828660	SUP	HCPCS C1713		03828660  -  SCREW BONE LONG ARM 6.5MM 60MM MNOAX XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828730	SUP	HCPCS C1713		03828730  -  SCREW BONE 7.5MM 30MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828735	SUP	HCPCS C1713		03828735  -  SCREW BONE 7.5MM 35MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828740	SUP	HCPCS C1713		03828740  -  SCREW BONE 7.5MM 40MM MNOAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828745	SUP	HCPCS C1713		03828745  -  SCREW BONE 7.5MM 45MM MNOAX REDX XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828750	SUP	HCPCS C1713		03828750  -  SCREW BONE 7.5MM 50MM MULTIAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828755	SUP	HCPCS C1713		03828755  -  SCREW BONE LONG ARM 7.5MM 55MM MNOAX XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3828760	SUP	HCPCS C1713		03828760  -  SCREW BONE LONG ARM 7.5MM 60MM MNOAX XIA TITANIUM SPN	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
3829425	SUP	HCPCS C1713		03829425  -  SCREW BONE LONG ARM 4.5MM 25MM POLYAX XIA TITANIUM SPN	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
3829430	SUP	HCPCS C1713		03829430  -  SCREW BONE LONG ARM 4.5MM 30MM POLYAX XIA TITANIUM SPN	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
3829435	SUP	HCPCS C1713		03829435  -  SCREW BONE LONG ARM 4.5MM 35MM POLYAX XIA TITANIUM SPN	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
3829440	SUP	HCPCS C1713		03829440  -  SCREW BONE LONG ARM 4.5MM 40MM POLYAX XIA TITANIUM SPN	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
3829445	SUP	HCPCS C1713		03829445  -  SCREW BONE LONG ARM 4.5MM 45MM POLYAX XIA TITANIUM SPN	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
3829530	SUP	HCPCS C1713		03829530  -  SCREW BONE 5.5MM 30MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
3829535	SUP	HCPCS C1713		03829535  -  SCREW BONE 5.5MM 35MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$371.25	$371.25	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$0.00	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$412.50	$653.40	$660.00	$0.00		$0.00	$129.11	$0.00	$0.00	$131.34	$0.00	$0.00	$0.00	$0.00	$0.00
3829540	SUP	HCPCS C1713		03829540  -  SCREW BONE 5.5MM 40MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829550	SUP	HCPCS C1713		03829550  -  SCREW BONE 5.5MM 50MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829555	SUP	HCPCS C1713		03829555  -  SCREW BONE LONG ARM 5.5MM 55MM POLYAX XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829630	SUP	HCPCS C1713		03829630  -  SCREW BONE 6.5MM 30MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829635	SUP	HCPCS C1713		03829635  -  SCREW BONE 6.5MM 35MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829640	SUP	HCPCS C1713		03829640  -  SCREW BONE 6.5MM 40MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829645	SUP	HCPCS C1713		03829645  -  SCREW BONE 6.5MM 45MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829650	SUP	HCPCS C1713		03829650  -  SCREW BONE 6.5MM 50MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829655	SUP	HCPCS C1713		03829655  -  SCREW BONE 6.5MM 55MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829660	SUP	HCPCS C1713		03829660  -  SCREW BONE LONG ARM 6.5MM 60MM POLYAX XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829730	SUP	HCPCS C1713		03829730  -  SCREW BONE 7.5MM 30MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829735	SUP	HCPCS C1713		03829735  -  SCREW BONE 7.5MM 35MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829740	SUP	HCPCS C1713		03829740  -  SCREW BONE 7.5MM 40MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829745	SUP	HCPCS C1713		03829745  -  SCREW BONE 7.5MM 45MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829750	SUP	HCPCS C1713		03829750  -  SCREW BONE 7.5MM 50MM POLYAX LONG ARM XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829755	SUP	HCPCS C1713		03829755  -  SCREW BONE LONG ARM 7.5MM 55MM POLYAX XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3829760	SUP	HCPCS C1713		03829760  -  SCREW BONE LONG ARM 7.5MM 60MM POLYAX XIA TITANIUM SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
3992206	SUP	HCPCS C1713		3992206  -  SPACER SPNL 0D 27MMX6MM STRL LF CPSTN CNTRL PEEK INTRBD FS	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3992207	SUP	HCPCS C1713		3992207  -  SPACER SPNL 22MMX7MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3992208	SUP	HCPCS C1713		3992208  -  SPACER SPNL 22MMX8MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3992209	SUP	HCPCS C1713		3992209  -  SPACER SPNL 22MMX9MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3992210	SUP	HCPCS C1713		3992210  -  SPACER SPNL 22MMX10MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3992211	SUP	HCPCS C1713		3992211  -  SPACER SPNL 22MMX11MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3992212	SUP	HCPCS C1713		3992212  -  SPACER SPNL 22MMX12MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3992213	SUP	HCPCS C1713		3992213  -  SPACER SPNL 22MMX13MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3992214	SUP	HCPCS C1713		3992214  -  SPACER SPNL 22MMX14MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3992215	SUP	HCPCS C1713		3992215  -  SPACER SPNL 22MMX15MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3992216	SUP	HCPCS C1713		3992216  -  SPACER SPNL 22MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
3992606	SUP	HCPCS C1713		3992606  -  SPACER SPNL 26MMX6MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3992607	SUP	HCPCS C1713		3992607  -  SPACER SPNL 26MMX7MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3992608	SUP	HCPCS C1713		3992608  -  SPACER SPNL 26MMX8MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3992609	SUP	HCPCS C1713		3992609  -  SPACER SPNL 26MMX9MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3992610	SUP	HCPCS C1713		3992610  -  SPACER SPNL 26MMX10MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3992611	SUP	HCPCS C1713		3992611  -  SPACER SPNL 26MMX11MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3992612	SUP	HCPCS C1713		3992612  -  SPACER SPNL 26MMX12MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3992613	SUP	HCPCS C1713		3992613  -  SPACER SPNL 26MMX13MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3992614	SUP	HCPCS C1713		3992614  -  SPACER SPNL 26X14MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3992615	SUP	HCPCS C1713		3992615  -  SPACER SPNL 26MMX15MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3992616	SUP	HCPCS C1713		3992616  -  SPACER SPNL 26MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3993207	SUP	HCPCS C1713		3993207  -  SPACER SPNL 32MMX7MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3993208	SUP	HCPCS C1713		3993208  -  SPACER SPNL 32MMX8MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3993209	SUP	HCPCS C1713		3993209  -  SPACER SPNL 32MMX9MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3993210	SUP	HCPCS C1713		3993210  -  SPACER SPNL 32MMX10MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3993211	SUP	HCPCS C1713		3993211  -  SPACER SPNL 32MMX11MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3993212	SUP	HCPCS C1713		3993212  -  SPACER SPNL 32MMX12MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3993213	SUP	HCPCS C1713		3993213  -  SPACER SPNL 32MMX13MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3993214	SUP	HCPCS C1713		3993214  -  SPACER SPNL 32MMX14MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3993215	SUP	HCPCS C1713		3993215  -  SPACER SPNL 32MMX15MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3993216	SUP	HCPCS C1713		3993216  -  SPACER SPNL 32MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
3993616	SUP	HCPCS C1713		3993616  -  SPACER SPNL 36MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4001122	SUP	HCPCS C1713		4001122  -  SPACER SPNL 6D 22MMX11MM STRL LF CPSTN CNTRL PEEK INTRBD FS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4001227	SUP	HCPCS C1713		4001227  -  SPACER SPNL 6D 27MMX12MM STRL LF CPSTN CNTRL PEEK INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
4001322	SUP	HCPCS C1713		4001322  -  SPACER SPNL 6D 22MMX13MM STRL LF CPSTN CNTRL PEEK INTRBD FS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4011022	SUP	HCPCS C1713		4011022  -  SPACER SPNL 12D 22MMX10MM STRL LF CPSTN CNTRL PEEK INTRBD FS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4011222	SUP	HCPCS C1713		4011222  -  SPACER SPNL 12D 22MMX12MM CPSTN CNTRL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4025900	SUP	Custom 27203010		VIAL ANALY CODA POLYPRO 5 REAGENT 23ML	BOTH IP/OP	$25.75 	$19.06	$0.00	$20.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.88	$20.39	$20.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4098545	SUP	HCPCS C1713		4098545  -  SCREW BONE CYLINDER 8.5MM 45MM OSS SPN	BOTH IP/OP	"$1,213.13 "	$897.72	$0.00	$970.50	$545.91	$545.91	$0.00	$0.00	$0.00	$252.85	$900.38	$900.38	$0.00	$0.00	$252.82	$0.00	$717.56	$717.56	$0.00	$606.56	$960.80	$970.50	$0.00		$0.00	$189.85	$0.00	$0.00	$193.13	$0.00	$0.00	$0.00	$0.00	$0.00
4098550	SUP	HCPCS C1713		4098550  -  SCREW BONE CYLINDER 8.5MM 50MM OSS SPN	BOTH IP/OP	"$1,213.13 "	$897.72	$0.00	$970.50	$545.91	$545.91	$0.00	$0.00	$0.00	$252.85	$900.38	$900.38	$0.00	$0.00	$252.82	$0.00	$717.56	$717.56	$0.00	$606.56	$960.80	$970.50	$0.00		$0.00	$189.85	$0.00	$0.00	$193.13	$0.00	$0.00	$0.00	$0.00	$0.00
4105535	SUP	HCPCS C1713		4105535  -  SCREW BONE 5.5MM 35MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4105540	SUP	HCPCS C1713		4105540  -  SCREW BONE 5.5MM 40MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4105545	SUP	HCPCS C1713		4105545  -  SCREW BONE 5.5MM 45MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4106535	SUP	HCPCS C1713		4106535  -  SCREW BONE 6.5MM 35MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4106540	SUP	HCPCS C1713		4106540  -  SCREW BONE 6.5MM 40MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4106550	SUP	HCPCS C1713		4106550  -  SCREW BONE 6.5MM 50MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4106555	SUP	HCPCS C1713		4106555  -  SCREW BONE 6.5MM 55MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4106560	SUP	HCPCS C1713		4106560  -  SCREW BONE 6.5MM 60MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4107017	SUP	Custom 27803010		4107017  -  CONNECTOR ROD 17MM MULTIAX CROSS XIA CROSSLINK TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4107020	SUP	Custom 27803010		4107020  -  CONNECTOR ROD 20MM MULTIAX CROSS XIA CROSSLINK TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4107023	SUP	Custom 27803010		4107023  -  CONNECTOR ROD 23MM CROSSLINK XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4107026	SUP	Custom 27803010		4107026  -  CONNECTOR ROD 26MM CROSSLINK XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4107029	SUP	Custom 27803010		4107029  -  CONNECTOR ROD 29-31MM MULTIAX CROSS XIA SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4107031	SUP	Custom 27803010		4107031  -  CONNECTOR ROD 31-34MM MULTIAX MAC CROSSLINK TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4107035	SUP	Custom 27803010		4107035  -  CONNECTOR ROD 35MM CROSSLINK XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4107038	SUP	Custom 27803010		4107038  -  CONNECTOR ROD 38-43MM MULTIAX CROSSLINK XIA TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4107042	SUP	Custom 27803010		4107042  -  CONNECTOR ROD 42-51MM MULTIAX CROSSLINK MAC SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4107050	SUP	Custom 27803010		4107050  -  CONNECTOR ROD 50-67MM MULTIAX CROSSLINK XIA TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4107066	SUP	Custom 27803010		4107066  -  CONNECTOR ROD 66-99MM MULTIAX CROSS XIA MAC TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4107535	SUP	HCPCS C1713		4107535  -  SCREW BONE 7.5MM 35MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4107545	SUP	HCPCS C1713		4107545  -  SCREW BONE 7.5MM 45MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4107555	SUP	HCPCS C1713		4107555  -  SCREW BONE 7.5MM 55MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4107560	SUP	HCPCS C1713		4107560  -  SCREW BONE 7.5MM 60MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4108535	SUP	HCPCS C1713		4108535  -  SCREW BONE 8.5MM 35MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4108540	SUP	HCPCS C1713		4108540  -  SCREW BONE 8.5MM 40MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4108560	SUP	HCPCS C1713		4108560  -  SCREW BONE 8.5MM 60MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4109040	SUP	HCPCS C1713		4109040  -  SCREW BONE 9MM 40MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4109045	SUP	HCPCS C1713		4109045  -  SCREW BONE 9MM 45MM OSS SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
4110101	SUP	Custom 27803010		4110101  -  HOOK SPINAL OSS LMNR THORACIC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4110102	SUP	Custom 27803010		4110102  -  HOOK SPINAL LONG OSS LMNR THORACIC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4110113	SUP	Custom 27803010		4110113  -  HOOK SPINAL SMALL OSS LMNR THORACIC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4110118	SUP	Custom 27803010		4110118  -  HOOK SPINAL LARGE OSS LMNR THORACIC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4110201	SUP	Custom 27803010		4110201  -  HOOK SPINAL CENTERED OSS TITANIUM LMNR LUMBAR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4110202	SUP	Custom 27803010		4110202  -  HOOK SPINAL LARGE OSS LMNR LUMBAR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4110203	SUP	Custom 27803010		4110203  -  HOOK SPINAL OSS RIGHT LMNR LUMBAR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4110204	SUP	Custom 27803010		4110204  -  HOOK SPINAL CENTERING OSS LEFT LMNR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4110223	SUP	Custom 27803010		4110223  -  HOOK SPINAL OSS RIGHT INFERIOR LMNR LUMBAR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4110224	SUP	Custom 27803010		4110224  -  HOOK SPINAL OSS LEFT INFERIOR LMNR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4110231	SUP	Custom 27803010		4110231  -  HOOK SPINAL SMALL LOWER RIGHT OFFST OSS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4110232	SUP	Custom 27803010		4110232  -  HOOK SPINAL SMALL LOWER LEFT OFFST OSS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4110302	SUP	Custom 27803010		4110302  -  HOOK SPINAL LONG BLADE OSS TITANIUM PEDICLE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4123010	SUP	Custom 27803010		4123010  -  RING SPNL OSS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4123021	SUP	HCPCS C1713		4123021  -  CAP SCR SPNL OSS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
4125303	SUP	Custom 27803010		4125303  -  RING SPNL OSS XL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4195103	SUP	HCPCS C1898		4195103  -  LEAD PACING 5FR 103CM UNIPOLAR DEPLOYABLE LOBES FIX IS-1	BOTH IP/OP	"$3,562.50 "	"$2,636.25"	$0.00	"$2,850.00"	"$1,603.13"	"$1,603.13"	$0.00	$0.00	$0.00	$742.51	"$2,644.09"	"$2,644.09"	$0.00	$0.00	$742.43	$0.00	"$1,756.31"	"$1,756.31"	$0.00	"$1,781.25"	"$2,821.50"	"$2,850.00"	$0.00		$0.00	$557.53	$0.00	$0.00	$567.15	$0.00	$0.00	$0.00	$0.00	$0.00
4200015	SUP	HCPCS C1762		4200015  -  GRAFT SOFT TISSUE DELIVERY UNCRIMPED	BOTH IP/OP	"$1,415.30 "	"$1,047.32"	$0.00	"$1,132.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$294.98	"$1,050.44"	"$1,050.44"	$0.00	$0.00	$294.95	$0.00	$837.15	$837.15	$0.00	$707.65	"$1,120.92"	"$1,132.24"	$0.00		$0.00	$221.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4210564	SUP	Custom 27803010		4210564  -  SPACER SPNL 14MM 16X5MM STRL PRVL STNDALN PEEK-OPTM CRV	BOTH IP/OP	"$5,775.00 "	"$4,273.50"	$0.00	"$4,620.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,203.51"	$0.00	$0.00	$0.00	$0.00	"$2,887.50"	"$4,573.80"	"$4,620.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4210664	SUP	Custom 27803010		4210664  -  SPACER SPNL 14MM 16X6MM STRL PRVL STNDALN PEEK-OPTM CRV	BOTH IP/OP	"$5,775.00 "	"$4,273.50"	$0.00	"$4,620.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,203.51"	$0.00	$0.00	$0.00	$0.00	"$2,887.50"	"$4,573.80"	"$4,620.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4210764	SUP	Custom 27803010		4210764  -  SPACER SPNL 14MM 16X7MM STRL PRVL STNDALN PEEK-OPTM CRV	BOTH IP/OP	"$5,775.00 "	"$4,273.50"	$0.00	"$4,620.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,203.51"	$0.00	$0.00	$0.00	$0.00	"$2,887.50"	"$4,573.80"	"$4,620.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4210864	SUP	Custom 27803010		4210864  -  SPACER SPNL 14MM 16X8MM STRL PRVL STNDALN PEEK-OPTM CRV	BOTH IP/OP	"$5,775.00 "	"$4,273.50"	$0.00	"$4,620.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,203.51"	$0.00	$0.00	$0.00	$0.00	"$2,887.50"	"$4,573.80"	"$4,620.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4210964	SUP	Custom 27803010		4210964  -  SPACER SPNL 14MM 16X9MM STRL PRVL STNDALN PEEK-OPTM CRV	BOTH IP/OP	"$5,775.00 "	"$4,273.50"	$0.00	"$4,620.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,203.51"	$0.00	$0.00	$0.00	$0.00	"$2,887.50"	"$4,573.80"	"$4,620.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240041	SUP	Custom 27803010		4240041  -  CAGE SPNL 11MM 14X10MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240064	SUP	Custom 27803010		4240064  -  CAGE SPNL 14MM 16X10MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240086	SUP	Custom 27803010		4240086  -  CAGE SPNL 16MM 18X10MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240141	SUP	Custom 27803010		4240141  -  CAGE SPNL 11MM 14X11MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240164	SUP	Custom 27803010		4240164  -  CAGE SPNL 14MM 16X11MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240186	SUP	Custom 27803010		4240186  -  CAGE SPNL 16MM 18X11MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240241	SUP	Custom 27803010		4240241  -  CAGE SPNL 11MM 14X12MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240264	SUP	Custom 27803010		4240264  -  CAGE SPNL 14MM 16X12MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240286	SUP	Custom 27803010		4240286  -  CAGE SPNL 16MM 18X12MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240341	SUP	Custom 27803010		4240341  -  CAGE SPNL 11MM 14X13MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240364	SUP	Custom 27803010		4240364  -  CAGE SPNL 14MM 16X13MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240386	SUP	Custom 27803010		4240386  -  CAGE SPNL 16MM 18X13MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240441	SUP	Custom 27803010		4240441  -  CAGE SPNL 11MM 14X14MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240464	SUP	Custom 27803010		4240464  -  CAGE SPNL 14MM 16X14MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240486	SUP	Custom 27803010		4240486  -  CAGE SPNL 16MM 18X14MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240541	SUP	Custom 27803010		4240541  -  CAGE SPNL 11MM 14X5MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240564	SUP	Custom 27803010		4240564  -  CAGE SPNL 14MM 16X5MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240586	SUP	Custom 27803010		4240586  -  CAGE SPNL 16MM 18X5MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240641	SUP	Custom 27803010		4240641  -  CAGE SPNL 11MM 14X6MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240664	SUP	Custom 27803010		4240664  -  CAGE SPNL 14MM 16X6MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240686	SUP	Custom 27803010		4240686  -  CAGE SPNL 16MM 18X6MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240741	SUP	Custom 27803010		4240741  -  CAGE SPNL 11MM 14X7MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240764	SUP	Custom 27803010		4240764  -  CAGE SPNL 14MM 16X7MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240786	SUP	Custom 27803010		4240786  -  CAGE SPNL 16MM 18X7MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240841	SUP	Custom 27803010		4240841  -  CAGE SPNL 11MM 14X8MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240864	SUP	Custom 27803010		4240864  -  CAGE SPNL 14MM 16X8MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240886	SUP	Custom 27803010		4240886  -  CAGE SPNL 16MM 18X8MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240941	SUP	Custom 27803010		4240941  -  CAGE SPNL 11MM 14X9MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240964	SUP	Custom 27803010		4240964  -  CAGE SPNL 14MM 16X9MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4240986	SUP	Custom 27803010		4240986  -  CAGE SPNL 16MM 18X9MM STRL ANTM RADOPQ PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4264606	SUP	Custom 27203010		4264606  -  KIT PRSS MONITR 84IN SFST 2 INLN BLD SMPL PORT TRNDCR KIT AN	BOTH IP/OP	$41.40 	$30.64	$0.00	$33.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.70	$32.79	$33.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4302208	SUP	HCPCS C1713		4302208  -  SPACER 4302208 TELAMON P VBS 0 22X8MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4302210	SUP	HCPCS C1713		4302210  -  SPACER 4302210 TELAMON P VBS 0 22X10MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4302212	SUP	HCPCS C1713		4302212  -  SPACER 4302212 TELAMON P VBS 0 22X12MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4302214	SUP	HCPCS C1713		4302214  -  SPACER 4302214 TELAMON P VBS 0 22X14MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4302608	SUP	HCPCS C1713		4302608  -  SPACER 4302608 TELAMON P VBS 0 26X8MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4302610	SUP	HCPCS C1713		4302610  -  SPACER 4302610 TELAMON P VBS 0 26X10MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4302612	SUP	HCPCS C1713		4302612  -  SPACER 4302612 TELAMON P VBS 0 26X12MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4302614	SUP	Custom 27803010		4302614  -  TELAMON-P 4302614 VBS 0 26 X 14MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4312513	SUP	Custom 27203010		STAIN MYCL DFC TB KMNO4 PK 250ML	BOTH IP/OP	$79.45 	$58.79	$0.00	$63.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.73	$62.92	$63.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4312514	SUP	Custom 27203010		STAIN MYCL DFC TB ARMN M BTL 250ML	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4312518	SUP	Custom 27203010		STAIN MYCL BBL TB CRBL FCHSN WKG SOL 250ML	BOTH IP/OP	$224.40 	$166.06	$0.00	$179.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.20	$177.72	$179.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4312526	SUP	Custom 27203010		STAIN MCBL GM CRYS VIOL WKG SOL BBL 1GL	BOTH IP/OP	$132.05 	$97.72	$0.00	$105.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.03	$104.58	$105.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4312531	SUP	Custom 27203010		STAIN MCBL GM SFRN WKG SOL DFC 250ML	BOTH IP/OP	$53.95 	$39.92	$0.00	$43.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.98	$42.73	$43.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4312532	SUP	Custom 27203010		STAIN MCBL GM SFRN REPL REAGENT BBL 1GL	BOTH IP/OP	$122.30 	$90.50	$0.00	$97.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.15	$96.86	$97.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4312542	SUP	Custom 27203010		STAIN MCBL GM IOD STAB DFC 250ML	BOTH IP/OP	$60.45 	$44.73	$0.00	$48.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.23	$47.88	$48.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4321039	SUP	Custom 27203010		MEDIA CULT TSI SLANT MCFLS	BOTH IP/OP	$121.63 	$90.01	$0.00	$97.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.81	$96.33	$97.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4321087	SUP	Custom 27203010		MEDIA CULT TSA SLANT BBL	BOTH IP/OP	$115.03 	$85.12	$0.00	$92.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.51	$91.10	$92.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4321283	SUP	Custom 27203010		MEDIA CULT TSA PLT BBL	BOTH IP/OP	$104.93 	$77.65	$0.00	$83.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.46	$83.10	$83.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4321326	SUP	Custom 27203010		MEDIA CULT OF BSL MED TUBE BBL 5ML	BOTH IP/OP	$39.93 	$29.55	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.96	$31.62	$31.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4321328	SUP	Custom 27203010		MEDIA CULT OF MED DEX TUBE BBL 5ML	BOTH IP/OP	$39.93 	$29.55	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.96	$31.62	$31.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4321388	SUP	Custom 27203010		MEDIA MYCL L-J MED BBL SLANT	BOTH IP/OP	$156.83 	$116.05	$0.00	$125.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$78.41	$124.21	$125.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4321739	SUP	Custom 27203010		MEDIA CULT CDC ANAER AGAR PEA 5% SB PLT BBL	BOTH IP/OP	$25.93 	$19.19	$0.00	$20.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.96	$20.54	$20.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4321826	SUP	Custom 27203010		MEDIA MYCL SAB EMNS DEX AGAR BBL SLANT	BOTH IP/OP	$1.78 	$1.32	$0.00	$1.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.89	$1.41	$1.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4328351	SUP	Custom 27203010		REAGENT MCBL ANSR SHIG FLEXNERI GRP B TYPE 1-6 LYPH 3ML	BOTH IP/OP	$272.00 	$201.28	$0.00	$217.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.00	$215.42	$217.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331107	SUP	Custom 27203010		STRIP X FCTR HMPHLS DIFF TAXO ID	BOTH IP/OP	$314.40 	$232.66	$0.00	$251.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.20	$249.00	$251.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331109	SUP	Custom 27203010		STRIP FCTR 5 DIFF TAXO ID	BOTH IP/OP	$278.90 	$206.39	$0.00	$223.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.45	$220.89	$223.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331264	SUP	Custom 25003010		DISK AMPCLN 10 MCG BD SNS DS SNS	BOTH IP/OP	$6.80 	$5.03	$0.00	$5.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.40	$5.39	$5.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331275	SUP	Custom 25003010		DISK CLNDMCN 2 MCG BD SNS DS SNS	BOTH IP/OP	$66.78 	$49.42	$0.00	$53.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.39	$52.89	$53.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331286	SUP	Custom 25003010		DISK DXYCL 30 MCG BD SNS DS SNS	BOTH IP/OP	$1.58 	$1.17	$0.00	$1.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.79	$1.25	$1.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331290	SUP	Custom 25003010		DISK EMYCIN 15 MCG SNSDC SNS	BOTH IP/OP	$6.80 	$5.03	$0.00	$5.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.40	$5.39	$5.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331299	SUP	Custom 25003010		DISK GNTA 10 MCG BD SNS DS SNS	BOTH IP/OP	$0.68 	$0.50	$0.00	$0.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.34	$0.54	$0.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331321	SUP	Custom 25003010		DISK PEN 10 UN SNSDC SNS	BOTH IP/OP	$6.80 	$5.03	$0.00	$5.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.40	$5.39	$5.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331344	SUP	Custom 25003010		DISK TTRCLN 30 MCG SNSDC SNS	BOTH IP/OP	$64.70 	$47.88	$0.00	$51.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.35	$51.24	$51.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331539	SUP	Custom 25003010		DISK SXT 23.75 MCG 1.25 MCG SNSDC SNS	BOTH IP/OP	$6.80 	$5.03	$0.00	$5.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.40	$5.39	$5.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331569	SUP	Custom 25003010		DISK TBR 10 MCG BD SNS DS SNS	BOTH IP/OP	$6.80 	$5.03	$0.00	$5.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.40	$5.39	$5.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331593	SUP	Custom 25003010		DISK CFZLN 30 MCG SNSDC SNS	BOTH IP/OP	$67.93 	$50.27	$0.00	$54.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.96	$53.80	$54.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331597	SUP	Custom 27203010		DISK AMK 30 MCG BD SNS DS SNS	BOTH IP/OP	$67.93 	$50.27	$0.00	$54.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.96	$53.80	$54.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331609	SUP	Custom 25003010		DISK PIPRCLN 100 MCG SNSDC SNS	BOTH IP/OP	$60.13 	$44.50	$0.00	$48.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.06	$47.62	$48.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331621	SUP	Custom 25003010		DISK CEFRXM 30 MCG BD SNS DS SNS	BOTH IP/OP	$60.13 	$44.50	$0.00	$48.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.06	$47.62	$48.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331633	SUP	Custom 25003010		DISK CFTZDM 30 MCG BD SNS DS SNS	BOTH IP/OP	$6.55 	$4.85	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.28	$5.19	$5.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331635	SUP	Custom 25003010		DISK CEFTRXN 30 MCG SNSDC SNS	BOTH IP/OP	$60.13 	$44.50	$0.00	$48.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.06	$47.62	$48.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331649	SUP	Custom 25003010		DISK TCR CLVLN 75 10 MCG SNSDC SNS	BOTH IP/OP	$66.78 	$49.42	$0.00	$53.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.39	$52.89	$53.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331658	SUP	Custom 25003010		DISK CIPRO 5 MCG BD SNS DS SNS	BOTH IP/OP	$6.80 	$5.03	$0.00	$5.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.40	$5.39	$5.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331696	SUP	Custom 25003010		DISK CEFEPIME 30 MCG BD SNS DS SNS	BOTH IP/OP	$6.80 	$5.03	$0.00	$5.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.40	$5.39	$5.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331704	SUP	Custom 25003010		DISK MRPNM 10 MCG BD SNS DS SNS	BOTH IP/OP	$0.68 	$0.50	$0.00	$0.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.34	$0.54	$0.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331752	SUP	Custom 25003010		DISK CFTXM CLVLN 30 10 MCG BD SNS DS SNS	BOTH IP/OP	$216.88 	$160.49	$0.00	$173.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.44	$171.77	$173.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4331754	SUP	Custom 25003010		DISK CFTZDM CLVLN 30 10 MCG BD SNS DS SNS	BOTH IP/OP	$56.13 	$41.54	$0.00	$44.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.06	$44.45	$44.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4332208	SUP	HCPCS C1713		4332208  -  SPACER SPNL 3D 22MMX8MM TLMN-PPEEK-OPTM END PC VERT BD REPL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4332210	SUP	HCPCS C1713		4332210  -  SPACER SPNL 3D 22MMX10MM TLMN-PPEEK-OPTM END PC VERT BD REPL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4332212	SUP	HCPCS C1713		4332212  -  SPACER 4332212 TELAMON P VBS 3 22X12MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4332214	SUP	HCPCS C1713		4332214  -  SPACER 4332214 TELAMON P VBS 3 22X14MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4332608	SUP	HCPCS C1713		4332608  -  SPACER 4332608 TELAMON P VBS 3 26X8MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4332610	SUP	HCPCS C1713		4332610  -  SPACER 4332610 TELAMON P VBS 3 26X10MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4332612	SUP	HCPCS C1713		4332612  -  SPACER SPNL 3D 26MMX12MM TLMN-PPEEK-OPTM END PC VERT BD REPL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4332614	SUP	HCPCS C1713		4332614  -  SPACER 4332614 TELAMON P VBS 3 26X14MM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
4340765	SUP	Custom 27203010		REAGENT VDRL AG BUFF SAL BBL .5ML 60ML SERO	BOTH IP/OP	$183.70 	$135.94	$0.00	$146.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$145.49	$146.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4340826	SUP	Custom 27203010		REAGENT MCBL COAG PLSM EDTA LYPH RBT BBL 15ML	BOTH IP/OP	$301.25 	$222.93	$0.00	$241.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.63	$238.59	$241.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4340983	SUP	Custom 27203010		REAGENT MCBL ANSR SLMNLA O GRP A GLYCERINATED DFC 3ML	BOTH IP/OP	$291.48 	$215.70	$0.00	$233.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.74	$230.85	$233.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4340984	SUP	Custom 27203010		REAGENT MCBL ANSR SLMNLA O GRP B GLYCERINATED DFC 3ML	BOTH IP/OP	$194.85 	$144.19	$0.00	$155.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.43	$154.32	$155.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4340985	SUP	Custom 27203010		REAGENT MCBL ANSR SLMNLA O GRP C1 GLYCERINATED DFC 3ML	BOTH IP/OP	$363.13 	$268.72	$0.00	$290.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.56	$287.60	$290.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4340986	SUP	Custom 27203010		REAGENT MCBL ANSR SLMNLA O GRP C2 GLYCERINATED DFC 3ML	BOTH IP/OP	$306.63 	$226.91	$0.00	$245.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$153.31	$242.85	$245.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4340987	SUP	Custom 27203010		REAGENT MCBL ANSR SLMNLA O GRP D GLYCERINATED DFC 3ML	BOTH IP/OP	$133.28 	$98.63	$0.00	$106.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.64	$105.56	$106.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4340988	SUP	Custom 27203010		REAGENT MCBL ANSR SLMNLA O GRP E GLYCERINATED DFC 3ML	BOTH IP/OP	$240.65 	$178.08	$0.00	$192.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.33	$190.59	$192.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4340993	SUP	Custom 27203010		REAGENT MCBL ANSR SLMNLA O PLVLNT A-1 6 GLYCERINATED DFC 3ML	BOTH IP/OP	$234.25 	$173.35	$0.00	$187.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.13	$185.53	$187.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4340994	SUP	Custom 27203010		REAGENT MCBL ANSR SLMNLA 6 GLYCERINATED DFC 3ML	BOTH IP/OP	$228.23 	$168.89	$0.00	$182.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.11	$180.76	$182.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4360130	SUP	HCPCS C1713		4360130  -  ENDCAP 4360130 13MM 0 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360135	SUP	HCPCS C1713		4360135  -  ENDCAP 4360135 13MM 15 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360138	SUP	HCPCS C1713		4360138  -  ENDCAP 4360138 13MM 8 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360160	SUP	HCPCS C1713		4360160  -  ENDCAP 4360160 16MM 0 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360165	SUP	HCPCS C1713		4360165  -  ENDCAP 4360165 16MM 15 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360168	SUP	HCPCS C1713		4360168  -  ENDCAP 4360168 16MM 8 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360200	SUP	HCPCS C1713		4360200  -  ENDCAP 4360200 20MM 0 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360205	SUP	HCPCS C1713		4360205  -  ENDCAP 4360205 20MM 15 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360208	SUP	HCPCS C1713		4360208  -  ENDCAP 4360208 20MM 8 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360220	SUP	HCPCS C1713		4360220  -  ENDCAP 4360220 22MM 0 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360225	SUP	HCPCS C1713		4360225  -  ENDCAP 4360225 22MM 15 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360228	SUP	HCPCS C1713		4360228  -  ENDCAP 4360228 22MM 8 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360250	SUP	HCPCS C1713		4360250  -  ENDCAP 4360250 25MM 0 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360255	SUP	HCPCS C1713		4360255  -  ENDCAP 4360255 25MM 15 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360258	SUP	HCPCS C1713		4360258  -  ENDCAP 4360258 25MM 8 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360300	SUP	HCPCS C1713		4360300  -  ENDCAP 4360300 30MM 0 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360305	SUP	HCPCS C1713		4360305  -  ENDCAP 4360305 30MM 15 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360308	SUP	HCPCS C1713		4360308  -  ENDCAP 4360308 30MM 8 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4360678	SUP	Custom 27203010		4360678  -  SYSTEM CULT SCHT GSPK EZ	BOTH IP/OP	$82.23 	$60.85	$0.00	$65.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.12	$65.13	$65.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4361130	SUP	HCPCS C1713		4361130  -  ENDCAP 4361130 13MM 0 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361135	SUP	HCPCS C1713		4361135  -  ENDCAP 4361135 13MM 15 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361138	SUP	HCPCS C1713		4361138  -  ENDCAP 4361138 13MM 8 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361160	SUP	HCPCS C1713		4361160  -  ENDCAP 4361160 16MM 0 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361165	SUP	HCPCS C1713		4361165  -  ENDCAP 4361165 16MM 15 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361168	SUP	HCPCS C1713		4361168  -  ENDCAP 4361168 16MM 8 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361200	SUP	HCPCS C1713		4361200  -  ENDCAP 4361200 20MM 0 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361205	SUP	HCPCS C1713		4361205  -  ENDCAP 4361205 20MM 15 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361208	SUP	HCPCS C1713		4361208  -  ENDCAP 4361208 20MM 8 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361220	SUP	HCPCS C1713		4361220  -  ENDCAP 4361220 22MM 0 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361225	SUP	HCPCS C1713		4361225  -  ENDCAP 4361225 22MM 15 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361228	SUP	HCPCS C1713		4361228  -  ENDCAP 4361228 22MM 8 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361250	SUP	HCPCS C1713		4361250  -  ENDCAP 4361250 25MM 0 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361255	SUP	HCPCS C1713		4361255  -  ENDCAP 4361255 25MM 15 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361258	SUP	HCPCS C1713		4361258  -  ENDCAP 4361258 25MM 8 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361300	SUP	HCPCS C1713		4361300  -  ENDCAP 4361300 30MM 0 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361305	SUP	HCPCS C1713		4361305  -  ENDCAP 4361305 30MM 15 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4361308	SUP	HCPCS C1713		4361308  -  ENDCAP 4361308 30MM 8 DEGREE STERILE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
4395872	SUP	Custom 27203010		MEDIA CULT CHOC AGAR SLANT MCFLS	BOTH IP/OP	$49.63 	$36.73	$0.00	$39.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.81	$39.31	$39.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4396266	SUP	Custom 27203010		MEDIA CULT T-H BROTH TUBE MYCFLS 5ML	BOTH IP/OP	$176.30 	$130.46	$0.00	$141.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.15	$139.63	$141.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4396348	SUP	Custom 27203010		MEDIA MYCL SAB-DEX EMNS AGAR GNTA BBL PLT DP FILL	BOTH IP/OP	$62.88 	$46.53	$0.00	$50.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.44	$49.80	$50.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4397222	SUP	Custom 27203010		MEDIA CULT TRSN AGAR PR TUBE BBL 20ML	BOTH IP/OP	$55.08 	$40.76	$0.00	$44.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.54	$43.62	$44.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4397224	SUP	Custom 27203010		MEDIA CULT XANTHINE AGAR PR TUBE BBL 20ML	BOTH IP/OP	$55.08 	$40.76	$0.00	$44.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.54	$43.62	$44.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4397231	SUP	Custom 27203010		MEDIA CULT LYSOZYME BROTH TUBE MCFLS 5ML	BOTH IP/OP	$62.83 	$46.49	$0.00	$50.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.41	$49.76	$50.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4397232	SUP	Custom 27203010		MEDIA CULT LYSOZYME CNTRL BROTH TUBE MCFLS 5ML	BOTH IP/OP	$56.98 	$42.17	$0.00	$45.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.49	$45.13	$45.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4397448	SUP	Custom 27203010		MEDIA MYCL MDBRK COHN 7H10 AGAR MCFLS SLANT	BOTH IP/OP	$53.98 	$39.95	$0.00	$43.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.99	$42.75	$43.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4397770	SUP	Custom 27203010		MEDIA MYCL SAB EMNS DEX AGAR GNTA SLANT	BOTH IP/OP	$759.05 	$561.70	$0.00	$607.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$379.53	$601.17	$607.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4397793	SUP	Custom 27203010		MEDIA CULT SKIRROWS MED PLT BBL	BOTH IP/OP	$60.70 	$44.92	$0.00	$48.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.35	$48.07	$48.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4397875	SUP	Custom 27203010		MEDIA MYCL BIRD SEED AGAR BBL PLT	BOTH IP/OP	$45.85 	$33.93	$0.00	$36.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.93	$36.31	$36.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4397880	SUP	Custom 27203010		MEDIA CULT BCYE SLCT AGAR PAV PLT BBL	BOTH IP/OP	$37.03 	$27.40	$0.00	$29.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.51	$29.33	$29.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4397886	SUP	Custom 27203010		MEDIA MYCL YST XTRT PHOS AGAR BBL PLT DP FILL	BOTH IP/OP	$26.43 	$19.56	$0.00	$21.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.21	$20.93	$21.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4484525	SUP	HCPCS C1713		4484525  -  SCREW BN 4.5MM 25MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4484530	SUP	HCPCS C1713		4484530  -  SCREW BN 4.5MM 30MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4484535	SUP	HCPCS C1713		4484535  -  SCREW BN 4.5MM 35MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4484540	SUP	HCPCS C1713		4484540  -  SCREW BN 4.5MM 40MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4484545	SUP	HCPCS C1713		4484545  -  SCREW BN 4.5MM 45MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4484550	SUP	HCPCS C1713		4484550  -  SCREW BN 4.5MM 50MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4484555	SUP	HCPCS C1713		4484555  -  SCREW BN 4.5MM 55MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4484560	SUP	HCPCS C1713		4484560  -  SCREW BN 4.5MM 60MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4484565	SUP	HCPCS C1713		4484565  -  SCREW BN 4.5MM 65MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4484570	SUP	HCPCS C1713		4484570  -  SCREW BN 4.5MM 70MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4484575	SUP	HCPCS C1713		4484575  -  SCREW BN 4.5MM 75MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4484580	SUP	HCPCS C1713		4484580  -  SCREW BN 4.5MM 80MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4485525	SUP	HCPCS C1713		4485525  -  SCREW BN 5.5MM 25MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4485530	SUP	HCPCS C1713		4485530  -  SCREW BN 5.5MM 30MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4485535	SUP	HCPCS C1713		4485535  -  SCREW BN 5.5MM 35MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4485540	SUP	HCPCS C1713		4485540  -  SCREW BN 5.5MM 40MM NS DBR III SPHERX CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4485545	SUP	HCPCS C1713		4485545  -  SCREW BN 5.5MM 45MM NS DBR III SPHERX CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4485550	SUP	HCPCS C1713		4485550  -  SCREW BN 5.5MM 50MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4485555	SUP	HCPCS C1713		4485555  -  SCREW BN 5.5MM 55MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4485560	SUP	HCPCS C1713		4485560  -  SCREW BN 5.5MM 60MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4485565	SUP	HCPCS C1713		4485565  -  SCREW BN 5.5MM 65MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4485570	SUP	HCPCS C1713		4485570  -  SCREW BN 5.5MM 70MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4485575	SUP	HCPCS C1713		4485575  -  SCREW BN 5.5MM 75MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4485580	SUP	HCPCS C1713		4485580  -  SCREW BN 5.5MM 80MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486510	SUP	HCPCS C1713		4486510  -  SCREW BN 6.5MM 100MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486511	SUP	HCPCS C1713		4486511  -  SCREW BN 6.5MM 105MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486512	SUP	HCPCS C1713		4486512  -  SCREW BN 6.5MM 110MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486513	SUP	HCPCS C1713		4486513  -  SCREW BN 6.5MM 115MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486514	SUP	HCPCS C1713		4486514  -  SCREW BN 6.5MM 120MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486525	SUP	HCPCS C1713		4486525  -  SCREW BN 6.5MM 25MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486530	SUP	HCPCS C1713		4486530  -  SCREW BN 6.5MM 30MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486535	SUP	HCPCS C1713		4486535  -  SCREW BN 6.5MM 35MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486540	SUP	HCPCS C1713		4486540  -  SCREW BN 6.5MM 40MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486545	SUP	HCPCS C1713		4486545  -  SCREW BN 6.5MM 45MM NS DBR III SPHERX CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486550	SUP	HCPCS C1713		4486550  -  SCREW BN 6.5MM 50MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486555	SUP	HCPCS C1713		4486555  -  SCREW BN 6.5MM 55MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486560	SUP	HCPCS C1713		4486560  -  SCREW BN 6.5MM 60MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486565	SUP	HCPCS C1713		4486565  -  SCREW BN 6.5MM 65MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486570	SUP	HCPCS C1713		4486570  -  SCREW BN 6.5MM 70MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486575	SUP	HCPCS C1713		4486575  -  SCREW BN 6.5MM 75MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486580	SUP	HCPCS C1713		4486580  -  SCREW BN 6.5MM 80MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486585	SUP	HCPCS C1713		4486585  -  SCREW BN 6.5MM 85MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486590	SUP	HCPCS C1713		4486590  -  SCREW BN 6.5MM 90MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4486595	SUP	HCPCS C1713		4486595  -  SCREW BN 6.5MM 95MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487510	SUP	HCPCS C1713		4487510  -  SCREW BN 7.5MM 100MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487511	SUP	HCPCS C1713		4487511  -  SCREW BN 7.5MM 105MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487512	SUP	HCPCS C1713		4487512  -  SCREW BN 7.5MM 110MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487513	SUP	HCPCS C1713		4487513  -  SCREW BN 7.5MM 115MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487514	SUP	HCPCS C1713		4487514  -  SCREW BN 7.5MM 120MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487525	SUP	HCPCS C1713		4487525  -  SCREW BN 7.5MM 25MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487530	SUP	HCPCS C1713		4487530  -  SCREW BN 7.5MM 30MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487535	SUP	HCPCS C1713		4487535  -  SCREW BN 7.5MM 35MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487540	SUP	HCPCS C1713		4487540  -  SCREW BN 7.5MM 40MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487545	SUP	HCPCS C1713		4487545  -  SCREW BN 7.5MM 45MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487550	SUP	HCPCS C1713		4487550  -  SCREW BN 7.5MM 50MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487555	SUP	HCPCS C1713		4487555  -  SCREW BN 7.5MM 55MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487560	SUP	HCPCS C1713		4487560  -  SCREW BN 7.5MM 60MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487565	SUP	HCPCS C1713		4487565  -  SCREW BN 7.5MM 65MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487570	SUP	HCPCS C1713		4487570  -  SCREW BN 7.5MM 70MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487575	SUP	HCPCS C1713		4487575  -  SCREW BN 7.5MM 75MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487580	SUP	HCPCS C1713		4487580  -  SCREW BN 7.5MM 80MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487585	SUP	HCPCS C1713		4487585  -  SCREW BN 7.5MM 85MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487590	SUP	HCPCS C1713		4487590  -  SCREW BN 7.5MM 90MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4487595	SUP	HCPCS C1713		4487595  -  SCREW BN 7.5MM 95MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488510	SUP	HCPCS C1713		4488510  -  SCREW BN 8.5MM 100MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488511	SUP	HCPCS C1713		4488511  -  SCREW BN 8.5MM 105MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488512	SUP	HCPCS C1713		4488512  -  SCREW BN 8.5MM 110MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488513	SUP	HCPCS C1713		4488513  -  SCREW BN 8.5MM 115MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488514	SUP	HCPCS C1713		4488514  -  SCREW BN 8.5MM 120MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488525	SUP	HCPCS C1713		4488525  -  SCREW BN 8.5MM 25MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488530	SUP	HCPCS C1713		4488530  -  SCREW BN 8.5MM 30MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488535	SUP	HCPCS C1713		4488535  -  SCREW BN 8.5MM 35MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488540	SUP	HCPCS C1713		4488540  -  SCREW BN 8.5MM 40MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488545	SUP	HCPCS C1713		4488545  -  SCREW BN 8.5MM 45MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488550	SUP	HCPCS C1713		4488550  -  SCREW BN 8.5MM 50MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488555	SUP	HCPCS C1713		4488555  -  SCREW BN 8.5MM 55MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488560	SUP	HCPCS C1713		4488560  -  SCREW BN 8.5MM 60MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488565	SUP	HCPCS C1713		4488565  -  SCREW BN 8.5MM 65MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488570	SUP	HCPCS C1713		4488570  -  SCREW BN 8.5MM 70MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488575	SUP	HCPCS C1713		4488575  -  SCREW BN 8.5MM 75MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488580	SUP	HCPCS C1713		4488580  -  SCREW BN 8.5MM 80MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488585	SUP	HCPCS C1713		4488585  -  SCREW BN 8.5MM 85MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488590	SUP	HCPCS C1713		4488590  -  SCREW BN 8.5MM 90MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4488595	SUP	HCPCS C1713		4488595  -  SCREW BN 8.5MM 95MM DBR III CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
4527020	SUP	Custom 27203010		4527020  -  BIT DRILL 2MM 102MM AO SHAFT	BOTH IP/OP	$306.30 	$226.66	$0.00	$245.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.34	$227.34	$0.00	$0.00	$63.83	$0.00	$0.00	$0.00	$0.00	$153.15	$242.59	$245.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4535020	SUP	Custom 27203010		4535020  -  BIT DRL 3.6MM RD YLW AO FIT 3.5MM VARIAX LCK PLT SYSTE	BOTH IP/OP	$306.30 	$226.66	$0.00	$245.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.34	$227.34	$0.00	$0.00	$63.83	$0.00	$0.00	$0.00	$0.00	$153.15	$242.59	$245.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4622801	SUP	Custom 27203010		MATTRESS HEAD SECTION /FA	BOTH IP/OP	"$1,264.83 "	$935.97	$0.00	"$1,011.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.41	"$1,001.75"	"$1,011.86"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4623002	SUP	Custom 27203010		MATTRESS FOOT SECTION /FA	BOTH IP/OP	"$1,015.35 "	$751.36	$0.00	$812.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.68	$804.16	$812.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920040	SUP	HCPCS C1713		4920040  -  CAGE SPNL 0D 40X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920045	SUP	HCPCS C1713		4920045  -  CAGE SPNL 0D 45X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920050	SUP	HCPCS C1713		4920050  -  CAGE SPNL 0D 50X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920055	SUP	HCPCS C1713		4920055  -  CAGE SPNL 0D 55X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920060	SUP	HCPCS C1713		4920060  -  CAGE SPNL 0D 60X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920240	SUP	HCPCS C1713		4920240  -  CAGE SPNL 0D 40X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920245	SUP	HCPCS C1713		4920245  -  CAGE SPNL 0D 45X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920250	SUP	HCPCS C1713		4920250  -  CAGE SPNL 0D 50X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920255	SUP	HCPCS C1713		4920255  -  CAGE SPNL 0D 55X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920260	SUP	HCPCS C1713		4920260  -  CAGE SPNL 0D 60X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920440	SUP	HCPCS C1713		4920440  -  CAGE SPNL 0D 40X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920445	SUP	HCPCS C1713		4920445  -  CAGE SPNL 0D 45X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920450	SUP	HCPCS C1713		4920450  -  CAGE SPNL 0D 50X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920455	SUP	HCPCS C1713		4920455  -  CAGE SPNL 0D 55X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920460	SUP	HCPCS C1713		4920460  -  CAGE SPNL 0D 60X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920640	SUP	HCPCS C1713		4920640  -  CAGE SPNL 0D 40X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920645	SUP	HCPCS C1713		4920645  -  CAGE SPNL 0D 45X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920650	SUP	HCPCS C1713		4920650  -  CAGE SPNL 0D 50X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920655	SUP	HCPCS C1713		4920655  -  CAGE SPNL 0D 55X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920660	SUP	HCPCS C1713		4920660  -  CAGE SPNL 0D 60X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920840	SUP	HCPCS C1713		4920840  -  CAGE SPNL 0D 40X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920845	SUP	HCPCS C1713		4920845  -  CAGE SPNL 0D 45X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920850	SUP	HCPCS C1713		4920850  -  CAGE SPNL 0D 50X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920855	SUP	HCPCS C1713		4920855  -  CAGE SPNL 0D 55X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4920860	SUP	HCPCS C1713		4920860  -  CAGE SPNL 0D 60X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922040	SUP	HCPCS C1713		4922040  -  CAGE SPNL 12D 40X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922045	SUP	HCPCS C1713		4922045  -  CAGE SPNL 12D 45X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922050	SUP	HCPCS C1713		4922050  -  CAGE SPNL 12D 50X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922055	SUP	HCPCS C1713		4922055  -  CAGE SPNL 12D 55X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922060	SUP	HCPCS C1713		4922060  -  CAGE SPNL 12D 60X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922240	SUP	HCPCS C1713		4922240  -  CAGE SPNL 12D 40X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922245	SUP	HCPCS C1713		4922245  -  CAGE SPNL 12D 45X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922250	SUP	HCPCS C1713		4922250  -  CAGE SPNL 12D 50X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922255	SUP	HCPCS C1713		4922255  -  CAGE SPNL 12D 55X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922260	SUP	HCPCS C1713		4922260  -  CAGE SPNL 12D 60X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922440	SUP	HCPCS C1713		4922440  -  CAGE SPNL 12D 40X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922445	SUP	HCPCS C1713		4922445  -  CAGE SPNL 12D 45X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922450	SUP	HCPCS C1713		4922450  -  CAGE SPNL 12D 50X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922455	SUP	HCPCS C1713		4922455  -  CAGE SPNL 12D 55X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922460	SUP	HCPCS C1713		4922460  -  CAGE SPNL 12D 60X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922640	SUP	HCPCS C1713		4922640  -  CAGE SPNL 12D 40X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922645	SUP	HCPCS C1713		4922645  -  CAGE SPNL 12D 45X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922650	SUP	HCPCS C1713		4922650  -  CAGE SPNL 12D 50X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922655	SUP	HCPCS C1713		4922655  -  CAGE SPNL 12D 55X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4922660	SUP	HCPCS C1713		4922660  -  CAGE SPNL 12D 60X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926040	SUP	HCPCS C1713		4926040  -  CAGE SPNL 6D 40X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926045	SUP	HCPCS C1713		4926045  -  CAGE SPNL 6D 45X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926050	SUP	HCPCS C1713		4926050  -  CAGE SPNL 6D 50X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926055	SUP	HCPCS C1713		4926055  -  CAGE SPNL 6D 55X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926060	SUP	HCPCS C1713		4926060  -  CAGE SPNL 6D 60X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926240	SUP	HCPCS C1713		4926240  -  CAGE SPNL 6D 40X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926245	SUP	HCPCS C1713		4926245  -  CAGE SPNL 6D 45X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926250	SUP	HCPCS C1713		4926250  -  CAGE SPNL 6D 50X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926255	SUP	HCPCS C1713		4926255  -  CAGE SPNL 6D 55X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926260	SUP	HCPCS C1713		4926260  -  CAGE SPNL 6D 60X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926440	SUP	HCPCS C1713		4926440  -  CAGE SPNL 6D 40X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926445	SUP	HCPCS C1713		4926445  -  CAGE SPNL 6D 45X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926450	SUP	HCPCS C1713		4926450  -  CAGE SPNL 6D 50X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926455	SUP	HCPCS C1713		4926455  -  CAGE SPNL 6D 55X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926460	SUP	HCPCS C1713		4926460  -  CAGE SPNL 6D 60X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926640	SUP	HCPCS C1713		4926640  -  CAGE SPNL 6D 40X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926645	SUP	HCPCS C1713		4926645  -  CAGE SPNL 6D 45X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926650	SUP	HCPCS C1713		4926650  -  CAGE SPNL 6D 50X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926655	SUP	HCPCS C1713		4926655  -  CAGE SPNL 6D 55X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926660	SUP	HCPCS C1713		4926660  -  CAGE SPNL 6D 60X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926840	SUP	HCPCS C1713		4926840  -  CAGE SPNL 6D 40X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926845	SUP	HCPCS C1713		4926845  -  CAGE SPNL 6D 45X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926850	SUP	HCPCS C1713		4926850  -  CAGE SPNL 6D 50X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926855	SUP	HCPCS C1713		4926855  -  CAGE SPNL 6D 55X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4926860	SUP	HCPCS C1713		4926860  -  CAGE SPNL 6D 60X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980040	SUP	HCPCS C1713		4980040  -  CAGE SPNL 0D 40X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980045	SUP	HCPCS C1713		4980045  -  CAGE SPNL 0D 45X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980050	SUP	HCPCS C1713		4980050  -  CAGE SPNL 0D 50X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980055	SUP	HCPCS C1713		4980055  -  CAGE SPNL 0D 55X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980240	SUP	HCPCS C1713		4980240  -  CAGE SPNL 0D 40X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980245	SUP	HCPCS C1713		4980245  -  CAGE SPNL 0D 45X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980250	SUP	HCPCS C1713		4980250  -  CAGE SPNL 0D 50X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980255	SUP	HCPCS C1713		4980255  -  CAGE SPNL 0D 55X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980440	SUP	HCPCS C1713		4980440  -  CAGE SPNL 0D 40X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980445	SUP	HCPCS C1713		4980445  -  CAGE SPNL 0D 45X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980450	SUP	HCPCS C1713		4980450  -  CAGE SPNL 0D 50X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980455	SUP	HCPCS C1713		4980455  -  CAGE SPNL 0D 55X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980640	SUP	HCPCS C1713		4980640  -  CAGE SPNL 0D 40X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980645	SUP	HCPCS C1713		4980645  -  CAGE SPNL 0D 45X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980650	SUP	HCPCS C1713		4980650  -  CAGE SPNL 0D 50X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980655	SUP	HCPCS C1713		4980655  -  CAGE SPNL 0D 55X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980840	SUP	HCPCS C1713		4980840  -  CAGE SPNL 0D 40X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980845	SUP	HCPCS C1713		4980845  -  CAGE SPNL 0D 45X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980850	SUP	HCPCS C1713		4980850  -  CAGE SPNL 0D 50X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4980855	SUP	HCPCS C1713		4980855  -  CAGE SPNL 0D 55X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986040	SUP	HCPCS C1713		4986040  -  CAGE SPNL 6D 40X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986045	SUP	HCPCS C1713		4986045  -  CAGE SPNL 6D 45X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986050	SUP	HCPCS C1713		4986050  -  CAGE SPNL 6D 50X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986055	SUP	HCPCS C1713		4986055  -  CAGE SPNL 6D 55X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986060	SUP	HCPCS C1713		4986060  -  CAGE SPNL 6D 60X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986240	SUP	HCPCS C1713		4986240  -  CAGE SPNL 6D 40X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986245	SUP	HCPCS C1713		4986245  -  CAGE SPNL 6D 45X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986250	SUP	HCPCS C1713		4986250  -  CAGE SPNL 6D 50X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986255	SUP	HCPCS C1713		4986255  -  CAGE SPNL 6D 55X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986260	SUP	HCPCS C1713		4986260  -  CAGE SPNL 6D 60X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986440	SUP	HCPCS C1713		4986440  -  CAGE SPNL 6D 40X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986445	SUP	HCPCS C1713		4986445  -  CAGE SPNL 6D 45X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986450	SUP	HCPCS C1713		4986450  -  CAGE SPNL 6D 50X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986455	SUP	HCPCS C1713		4986455  -  CAGE SPNL 6D 55X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986460	SUP	HCPCS C1713		4986460  -  CAGE SPNL 6D 60X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986640	SUP	HCPCS C1713		4986640  -  CAGE SPNL 6D 40X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986645	SUP	HCPCS C1713		4986645  -  CAGE SPNL 6D 45X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986650	SUP	HCPCS C1713		4986650  -  CAGE SPNL 6D 50X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986655	SUP	HCPCS C1713		4986655  -  CAGE SPNL 6D 55X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986660	SUP	HCPCS C1713		4986660  -  CAGE SPNL 6D 60X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986840	SUP	HCPCS C1713		4986840  -  CAGE SPNL 6D 40X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986845	SUP	HCPCS C1713		4986845  -  CAGE SPNL 6D 45X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986850	SUP	HCPCS C1713		4986850  -  CAGE SPNL 6D 50X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986855	SUP	HCPCS C1713		4986855  -  CAGE SPNL 6D 55X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
4986860	SUP	HCPCS C1713		4986860  -  CAGE SPNL 6D 60X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5010001	SUP	HCPCS C1788		5010001  -  DEVICE BX 6 PORT ASP BN MRW	BOTH IP/OP	$347.50 	$257.15	$0.00	$278.00	$156.38	$156.38	$0.00	$0.00	$0.00	$72.43	$257.91	$257.91	$0.00	$0.00	$72.42	$0.00	$205.55	$205.55	$0.00	$173.75	$275.22	$278.00	$0.00		$0.00	$54.38	$0.00	$0.00	$55.32	$0.00	$0.00	$0.00	$0.00	$0.00
5010005	SUP	Custom 27804086		5010005  -  SUBSTITUTE BNGF 5ML STRL FORMAGRAFT GRNL BVN CLGN MTRX TCP	BOTH IP/OP	"$1,990.00 "	"$1,472.60"	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,476.98"	"$1,476.98"	$0.00	$0.00	$414.72	$0.00	$0.00	$0.00	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5010008	SUP	Custom 27203010		5010008  -  NEEDLE SPNL 8IN ASP PORT	BOTH IP/OP	$347.50 	$257.15	$0.00	$278.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.91	$257.91	$0.00	$0.00	$72.42	$0.00	$0.00	$0.00	$0.00	$173.75	$275.22	$278.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5010010	SUP	Custom 27804086		5010010  -  SUBSTITUTE BNGF 10ML STRL FORMAGRAFT GRNL BVN CLGN MTRX	BOTH IP/OP	"$3,505.00 "	"$2,593.70"	$0.00	"$2,804.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,601.41"	"$2,601.41"	$0.00	$0.00	$730.44	$0.00	$0.00	$0.00	$0.00	"$1,752.50"	"$2,775.96"	"$2,804.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5010020	SUP	Custom 27804086		5010020  -  SUBSTITUTE BNGF 20ML STRL FORMAGRAFT GRNL BVN CLGN MTRX TCP	BOTH IP/OP	"$3,505.00 "	"$2,593.70"	$0.00	"$2,804.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,601.41"	"$2,601.41"	$0.00	$0.00	$730.44	$0.00	$0.00	$0.00	$0.00	"$1,752.50"	"$2,775.96"	"$2,804.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5010024	SUP	HCPCS C1884		5010024  -  FILTER CV .035IN LOPRFL CONE 9FR 70CM VNTC LP PROVEN DSGN	BOTH IP/OP	"$2,925.60 "	"$2,164.94"	$0.00	"$2,340.48"	"$1,316.52"	"$1,316.52"	$0.00	$0.00	$0.00	$609.77	"$2,171.38"	"$2,171.38"	$0.00	$0.00	$609.70	$0.00	"$1,442.32"	"$1,442.32"	$0.00	"$1,462.80"	"$2,317.08"	"$2,340.48"	$0.00		$0.00	$457.86	$0.00	$0.00	$465.76	$0.00	$0.00	$0.00	$0.00	$0.00
5010085	SUP	Custom 27804086		5010085  -  SUBSTITUTE BNGF SM STRL FORMAGRAFT BLCK BVN CLGN MTRX TCP	BOTH IP/OP	"$4,130.00 "	"$3,056.20"	$0.00	"$3,304.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,065.29"	"$3,065.29"	$0.00	$0.00	$860.69	$0.00	$0.00	$0.00	$0.00	"$2,065.00"	"$3,270.96"	"$3,304.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5010125	SUP	HCPCS C1713		5010125  -  SUBSTITUTE BNGF LG STRL FORMAGRAFT BLCK BVN CLGN MTRX TCP	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	"$2,008.13"	"$2,008.13"	$0.00	$0.00	$0.00	$930.10	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	"$2,200.01"	"$2,200.01"	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$698.38	$0.00	$0.00	$710.43	$0.00	$0.00	$0.00	$0.00	$0.00
5010205	SUP	Custom 27804086		5010205  -  SUBSTITUTE BNGF 5ML STRL FORMAGRAFT STRP BVN CLGN MTRX TCP	BOTH IP/OP	"$1,990.00 "	"$1,472.60"	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,476.98"	"$1,476.98"	$0.00	$0.00	$414.72	$0.00	$0.00	$0.00	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5013001	SUP	HCPCS C1762		5013001  -  GRAFT BONE OSTEOCEL PLUS CLLR BONE MTRX 1ML	BOTH IP/OP	"$1,222.50 "	$904.65	$0.00	$978.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.25	$968.22	$978.00	$0.00		$0.00	$191.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5013005	SUP	HCPCS C1762		5013005  -  GRAFT BONE OSTEOCEL PLUS CLLR BONE MTRX 5ML	BOTH IP/OP	"$5,632.50 "	"$4,168.05"	$0.00	"$4,506.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,816.25"	"$4,460.94"	"$4,506.00"	$0.00		$0.00	$881.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5013010	SUP	Custom 27804086		5013010  -  GRAFT BN 10ML OSTEOCEL + CLLR BN MTRX	BOTH IP/OP	"$9,625.00 "	"$7,122.50"	$0.00	"$7,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,005.85"	$0.00	$0.00	$0.00	$0.00	"$4,812.50"	"$7,623.00"	"$7,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5013015	SUP	HCPCS C1762		5013015  -  GRAFT BONE OSTEOCEL PLUS CLLR BONE MTRX 15ML	BOTH IP/OP	"$11,475.00 "	"$8,491.50"	$0.00	"$9,180.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,391.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,391.39"	$0.00	"$5,657.18"	"$5,657.18"	$0.00	"$5,737.50"	"$9,088.20"	"$9,180.00"	$0.00		$0.00	"$1,795.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5016001	SUP	HCPCS C1762		5016001  -  GRAFT BONE OSTEOCEL CLLR BONE MTRX 1ML	BOTH IP/OP	"$1,345.00 "	$995.30	$0.00	"$1,076.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$672.50	"$1,065.24"	"$1,076.00"	$0.00		$0.00	$210.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5016005	SUP	HCPCS C1762		5016005  -  GRAFT BONE OSTEOCEL CLLR BONE MTRX 5ML	BOTH IP/OP	"$6,195.00 "	"$4,584.30"	$0.00	"$4,956.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,097.50"	"$4,906.44"	"$4,956.00"	$0.00		$0.00	$969.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5016010	SUP	HCPCS C1762		5016010  -  GRAFT BONE OSTEOCEL CLLR BONE MTRX 10ML	BOTH IP/OP	"$10,652.50 "	"$7,882.85"	$0.00	"$8,522.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,326.25"	"$8,436.78"	"$8,522.00"	$0.00		$0.00	"$1,667.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5017905	SUP	HCPCS C1713		5017905  -  SCREW BN 1.7MM 5MM NS LEIBINGER UNV 2 SLF DRL XPN TI MDFC	BOTH IP/OP	$103.40 	$76.52	$0.00	$118.32	$66.56	$66.56	$0.00	$0.00	$0.00	$21.55	$76.74	$76.74	$0.00	$0.00	$21.55	$0.00	$61.16	$61.16	$0.00	$73.95	$117.14	$118.32	$0.00		$0.00	$23.15	$0.00	$0.00	$23.55	$0.00	$0.00	$0.00	$0.00	$0.00
5020001	SUP	HCPCS C1713		5020001  -  GRAFT BN SM STRL LF PROPEL ALGRF PTTY	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
5020005	SUP	HCPCS C1713		5020005  -  GRAFT BN MED STRL LF PROPEL ALGRF PTTY	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5020010	SUP	HCPCS C1713		5020010  -  GRAFT BN LG STRL LF PROPEL ALGRF PTTY	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5020404	SUP	HCPCS C1713		5020404  -  SCREW BN 2MM 4MM AU NS LEIBINGER UNV 2 ST XPN TI MXLFCL	BOTH IP/OP	$87.40 	$64.68	$0.00	$100.74	$56.67	$56.67	$0.00	$0.00	$0.00	$18.22	$64.87	$64.87	$0.00	$0.00	$18.21	$0.00	$51.70	$51.70	$0.00	$62.96	$99.74	$100.74	$0.00		$0.00	$19.71	$0.00	$0.00	$20.05	$0.00	$0.00	$0.00	$0.00	$0.00
5022105	SUP	HCPCS C1713		5022105  -  GRAFT BN MED PROPEL ALGRF DBM FBR	BOTH IP/OP	"$1,450.00 "	"$1,073.00"	$0.00	"$1,160.00"	$652.50	$652.50	$0.00	$0.00	$0.00	$302.22	"$1,076.19"	"$1,076.19"	$0.00	$0.00	$302.18	$0.00	$857.68	$857.68	$0.00	$725.00	"$1,148.40"	"$1,160.00"	$0.00		$0.00	$226.93	$0.00	$0.00	$230.84	$0.00	$0.00	$0.00	$0.00	$0.00
5022112	SUP	HCPCS C1713		5022112  -  GRAFT BN SM BOAT PROPEL ALGRF DBM FBR	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$731.25	$731.25	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
5022113	SUP	HCPCS C1713		5022113  -  GRAFT BN LG BOAT PROPEL ALGRF DBM FBR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
5030641	SUP	HCPCS C1713		5030641  -  CAGE SPNL 11MM 14MMX6MM STRL ANTM RADOPQ PTC CRV INTRBD FS	BOTH IP/OP	"$5,940.00 "	"$4,395.60"	$0.00	"$4,752.00"	"$2,673.00"	"$2,673.00"	$0.00	$0.00	$0.00	"$1,238.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,237.90"	$0.00	"$2,928.42"	"$2,928.42"	$0.00	"$2,970.00"	"$4,704.48"	"$4,752.00"	$0.00		$0.00	$929.61	$0.00	$0.00	$945.65	$0.00	$0.00	$0.00	$0.00	$0.00
5101302	SUP	HCPCS C1713		5101302  -  CAGE SPNL 12D 30X11X10MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5101308	SUP	HCPCS C1713		5101308  -  CAGE SPNL 8D 30X11X10MM NS LF CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5104308	SUP	HCPCS C1713		5104308  -  CAGE SPNL 8D 30MMX14MMX10 NS LF CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5109308	SUP	HCPCS C1713		5109308  -  CAGE SPNL 8D 30X10X9MM NS LF CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5111308	SUP	HCPCS C1713		5111308  -  CAGE SPNL 8D 30X11X11MM NS LF CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5119308	SUP	HCPCS C1713		5119308  -  CAGE SPNL 8D 30X11X9MM NS LF CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5121308	SUP	HCPCS C1713		5121308  -  CAGE SPNL 8D 30X12X11MM NS LF CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5129308	SUP	HCPCS C1713		5129308  -  CAGE SPNL 8D 30X12X9MM NS LF CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5149308	SUP	HCPCS C1713		5149308  -  CAGE SPNL 8D 30X14X9MM NS LF CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5161600	SUP	Custom 27803010		5161600  -  ENDCAP 16MM RND 0 DEG OD16 TI XCORE 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5161604	SUP	Custom 27803010		5161604  -  ENDCAP 16MM RND 4 DEG OD16 TI XCORE 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5161608	SUP	Custom 27803010		5161608  -  ENDCAP 16MM RND 8 DEG OD16 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5161612	SUP	Custom 27803010		5161612  -  ENDCAP 16MM RND 12 DEG XCORE 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5163000	SUP	Custom 27803010		5163000  -  ENDCAP OD16X16X30MM 0 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5163004	SUP	Custom 27803010		5163004  -  ENDCAP˙ OD16X16X30MM 4 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5163014	SUP	Custom 27803010		5163014  -  ENDCAP OD16X16X30MM -4 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5164000	SUP	Custom 27803010		5164000  -  ENDCAP OD16X16X40MM 0 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5164004	SUP	Custom 27803010		5164004  -  ENDCAP OD16X16X40MM 4 DEG TI XCORE TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5164014	SUP	Custom 27803010		5164014  -  ENDCAP OD16X16X40MM -4 DEG TI OD16 TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5181308	SUP	HCPCS C1713		5181308  -  CAGE SPNL 8D 30X11X8MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5181800	SUP	Custom 27803010		5181800  -  ENDCAP 18MM RND 0 DEG OD16 TI XCORE 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5181804	SUP	Custom 27803010		5181804  -  ENDCAP 18MM RND 4 DEG OD16 TI XCORE 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5181808	SUP	Custom 27803010		5181808  -  ENDCAP 18MM RND 8 DEG OD16 TI XCORE 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5181812	SUP	Custom 27803010		5181812  -  ENDCAP 18MM RND 12 DEG OD18 TI XCORE 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5189300	SUP	HCPCS C1713		5189300  -  CAGE SPNL 0D 30X9X8MM NS LF CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5189302	SUP	HCPCS C1713		5189302  -  CAGE SPNL 12D 30X9X8MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5191302	SUP	HCPCS C1713		5191302  -  CAGE SPNL 12D 30X11X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5191308	SUP	HCPCS C1713		5191308  -  CAGE SPNL 8D 30X11X9MM NS LF CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5199300	SUP	HCPCS C1713		5199300  -  CAGE SPNL 0D 30X9X9MM NS LF CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5199302	SUP	HCPCS C1713		5199302  -  CAGE SPNL 12D 30X9X9MM NS LF CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5289308	SUP	HCPCS C1713		5289308  -  CAGE SPNL 8D 30X9X8MM NS LF TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5300252	SUP	HCPCS C1713		5300252  -  CAGE SPNL 12D OBLQ 25X10X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5300254	SUP	HCPCS C1713		5300254  -  CAGE SPNL 4D OBLQ 25X10X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5300302	SUP	HCPCS C1713		5300302  -  CAGE SPNL 12D OBLQ 30X10X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5300304	SUP	HCPCS C1713		5300304  -  CAGE SPNL 4D OBLQ 30X10X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5300354	SUP	HCPCS C1713		5300354  -  CAGE SPNL 4D OBLQ 35X10X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5304252	SUP	HCPCS C1713		5304252  -  CAGE SPNL 12D OBLQ 25X10X14MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5304254	SUP	HCPCS C1713		5304254  -  CAGE SPNL 4D OBLQ 25X10X14MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5304302	SUP	HCPCS C1713		5304302  -  CAGE SPNL 12D OBLQ 30X10X14MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5304304	SUP	HCPCS C1713		5304304  -  CAGE SPNL 4D OBLQ 30X10X14MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5320252	SUP	HCPCS C1713		5320252  -  CAGE SPNL 12D OBLQ 25X12X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5320254	SUP	HCPCS C1713		5320254  -  CAGE SPNL 4D OBLQ 25X12X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5320302	SUP	HCPCS C1713		5320302  -  CAGE SPNL 12D OBLQ 30X12X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5320304	SUP	HCPCS C1713		5320304  -  CAGE SPNL 4D OBLQ 30X12X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5320354	SUP	HCPCS C1713		5320354  -  CAGE SPNL 4D OBLQ 35X12X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5324252	SUP	HCPCS C1713		5324252  -  CAGE SPNL 12D OBLQ 25X12X14MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5324254	SUP	HCPCS C1713		5324254  -  CAGE SPNL 4D OBLQ 25X12X14MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5324302	SUP	HCPCS C1713		5324302  -  CAGE SPNL 12D OBLQ 30X12X14MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5324304	SUP	HCPCS C1713		5324304  -  CAGE SPNL 4D OBLQ 30X12X14MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5340252	SUP	HCPCS C1713		5340252  -  CAGE SPNL 12D OBLQ 25X14X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5340254	SUP	HCPCS C1713		5340254  -  CAGE SPNL 4D OBLQ 25X14X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5340302	SUP	HCPCS C1713		5340302  -  CAGE SPNL 12D OBLQ 30X14X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5340304	SUP	HCPCS C1713		5340304  -  CAGE SPNL 4D OBLQ 30X14X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5340354	SUP	HCPCS C1713		5340354  -  CAGE SPNL 4D OBLQ 35X14X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5380252	SUP	HCPCS C1713		5380252  -  CAGE SPNL 12D OBLQ 25X8X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5380254	SUP	HCPCS C1713		5380254  -  CAGE SPNL 4D OBLQ 25X8X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5380302	SUP	HCPCS C1713		5380302  -  CAGE SPNL 12D OBLQ 30X8X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5380304	SUP	HCPCS C1713		5380304  -  CAGE SPNL 4D OBLQ 30X8X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5380354	SUP	HCPCS C1713		5380354  -  CAGE SPNL 4D OBLQ 35X8X10MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5384252	SUP	HCPCS C1713		5384252  -  CAGE SPNL 12D OBLQ 25X8X14MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5384254	SUP	HCPCS C1713		5384254  -  CAGE SPNL 4D OBLQ 25X8X14MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5384302	SUP	HCPCS C1713		5384302  -  CAGE SPNL 12D OBLQ 30X8X14MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5384304	SUP	HCPCS C1713		5384304  -  CAGE SPNL 4D OBLQ 30X8X14MM TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400250	SUP	HCPCS C1713		5400250  -  CAGE SPNL 0D OBLQ 25X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5400252	SUP	HCPCS C1713		5400252  -  CAGE SPNL 12D OBLQ 25X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5400254	SUP	HCPCS C1713		5400254  -  CAGE SPNL 4D OBLQ 25X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5400255	SUP	HCPCS C1713		5400255  -  CAGE SPNL 15D OBLQ 25X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400258	SUP	HCPCS C1713		5400258  -  CAGE SPNL 8D OBLQ 25X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400300	SUP	HCPCS C1713		5400300  -  CAGE SPNL 0D OBLQ 30X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5400302	SUP	HCPCS C1713		5400302  -  CAGE SPNL 12D OBLQ 30X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5400304	SUP	HCPCS C1713		5400304  -  CAGE SPNL 4D OBLQ 30X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5400305	SUP	HCPCS C1713		5400305  -  CAGE SPNL 15D OBLQ 30X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400308	SUP	HCPCS C1713		5400308  -  CAGE SPNL 8D OBLQ 30X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400350	SUP	HCPCS C1713		5400350  -  CAGE SPNL 0D OBLQ 35X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400352	SUP	HCPCS C1713		5400352  -  CAGE SPNL 12D OBLQ 35X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400354	SUP	HCPCS C1713		5400354  -  CAGE SPNL 4D OBLQ 35X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5400355	SUP	HCPCS C1713		5400355  -  CAGE SPNL 15D OBLQ 35X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400358	SUP	HCPCS C1713		5400358  -  CAGE SPNL 8D OBLQ 35X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400400	SUP	HCPCS C1713		5400400  -  CAGE SPNL 0D OBLQ 40X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400402	SUP	HCPCS C1713		5400402  -  CAGE SPNL 12D OBLQ 40X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400404	SUP	HCPCS C1713		5400404  -  CAGE SPNL 4D OBLQ 40X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400405	SUP	HCPCS C1713		5400405  -  CAGE SPNL 15D OBLQ 40X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5400408	SUP	HCPCS C1713		5400408  -  CAGE SPNL 8D OBLQ 40X10X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404250	SUP	HCPCS C1713		5404250  -  CAGE SPNL 0D OBLQ 25X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404252	SUP	HCPCS C1713		5404252  -  CAGE SPNL 12D OBLQ 25X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5404254	SUP	HCPCS C1713		5404254  -  CAGE SPNL 4D OBLQ 25X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5404255	SUP	HCPCS C1713		5404255  -  CAGE SPNL 15D OBLQ 25X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404258	SUP	HCPCS C1713		5404258  -  CAGE SPNL 8D OBLQ 25X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404300	SUP	HCPCS C1713		5404300  -  CAGE SPNL 0D OBLQ 30X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404302	SUP	HCPCS C1713		5404302  -  CAGE SPNL 12D OBLQ 30X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404304	SUP	HCPCS C1713		5404304  -  CAGE SPNL 4D OBLQ 30X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5404305	SUP	HCPCS C1713		5404305  -  CAGE SPNL 15D OBLQ 30X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404308	SUP	HCPCS C1713		5404308  -  CAGE SPNL 8D OBLQ 30X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404350	SUP	HCPCS C1713		5404350  -  CAGE SPNL 0D OBLQ 35X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404352	SUP	HCPCS C1713		5404352  -  CAGE SPNL 12D OBLQ 35X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404354	SUP	HCPCS C1713		5404354  -  CAGE SPNL 4D OBLQ 35X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404355	SUP	HCPCS C1713		5404355  -  CAGE SPNL 15D OBLQ 35X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404358	SUP	HCPCS C1713		5404358  -  CAGE SPNL 8D OBLQ 35X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404400	SUP	HCPCS C1713		5404400  -  CAGE SPNL 0D OBLQ 40X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404402	SUP	HCPCS C1713		5404402  -  CAGE SPNL 12D OBLQ 40X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404404	SUP	HCPCS C1713		5404404  -  CAGE SPNL 4D OBLQ 40X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404405	SUP	HCPCS C1713		5404405  -  CAGE SPNL 15D OBLQ 40X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5404408	SUP	HCPCS C1713		5404408  -  CAGE SPNL 8D OBLQ 40X14X10MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410250	SUP	HCPCS C1713		5410250  -  CAGE SPNL 0D OBLQ 25X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410252	SUP	HCPCS C1713		5410252  -  CAGE SPNL 12D OBLQ 25X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410254	SUP	HCPCS C1713		5410254  -  CAGE SPNL 4D OBLQ 25X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410255	SUP	HCPCS C1713		5410255  -  CAGE SPNL 15D OBLQ 25X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410258	SUP	HCPCS C1713		5410258  -  CAGE SPNL 8D OBLQ 25X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410300	SUP	HCPCS C1713		5410300  -  CAGE SPNL 0D OBLQ 30X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410302	SUP	HCPCS C1713		5410302  -  CAGE SPNL 12D OBLQ 30X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410304	SUP	HCPCS C1713		5410304  -  CAGE SPNL 4D OBLQ 30X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410305	SUP	HCPCS C1713		5410305  -  CAGE SPNL 15D OBLQ 30X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410308	SUP	HCPCS C1713		5410308  -  CAGE SPNL 8D OBLQ 30X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410350	SUP	HCPCS C1713		5410350  -  CAGE SPNL 0D OBLQ 35X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410352	SUP	HCPCS C1713		5410352  -  CAGE SPNL 12D OBLQ 35X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410354	SUP	HCPCS C1713		5410354  -  CAGE SPNL 4D OBLQ 35X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410355	SUP	HCPCS C1713		5410355  -  CAGE SPNL 15D OBLQ 35X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410358	SUP	HCPCS C1713		5410358  -  CAGE SPNL 8D OBLQ 35X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410400	SUP	HCPCS C1713		5410400  -  CAGE SPNL 0D OBLQ 40X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410402	SUP	HCPCS C1713		5410402  -  CAGE SPNL 12D OBLQ 40X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410404	SUP	HCPCS C1713		5410404  -  CAGE SPNL 4D OBLQ 40X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410405	SUP	HCPCS C1713		5410405  -  CAGE SPNL 15D OBLQ 40X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5410408	SUP	HCPCS C1713		5410408  -  CAGE SPNL 8D OBLQ 40X10X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414250	SUP	HCPCS C1713		5414250  -  CAGE SPNL 0D OBLQ 25X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414252	SUP	HCPCS C1713		5414252  -  CAGE SPNL 12D OBLQ 25X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414254	SUP	HCPCS C1713		5414254  -  CAGE SPNL 4D OBLQ 25X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414255	SUP	HCPCS C1713		5414255  -  CAGE SPNL 15D OBLQ 25X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414258	SUP	HCPCS C1713		5414258  -  CAGE SPNL 8D OBLQ 25X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414300	SUP	HCPCS C1713		5414300  -  CAGE SPNL 0D OBLQ 30X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414302	SUP	HCPCS C1713		5414302  -  CAGE SPNL 12D OBLQ 30X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414304	SUP	HCPCS C1713		5414304  -  CAGE SPNL 4D OBLQ 30X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414305	SUP	HCPCS C1713		5414305  -  CAGE SPNL 15D OBLQ 30X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414308	SUP	HCPCS C1713		5414308  -  CAGE SPNL 8D OBLQ 30X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414350	SUP	HCPCS C1713		5414350  -  CAGE SPNL 0D OBLQ 35X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414352	SUP	HCPCS C1713		5414352  -  CAGE SPNL 12D OBLQ 35X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414355	SUP	HCPCS C1713		5414355  -  CAGE SPNL 15D OBLQ 35X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414358	SUP	HCPCS C1713		5414358  -  CAGE SPNL 8D OBLQ 35X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414400	SUP	HCPCS C1713		5414400  -  CAGE SPNL 0D OBLQ 40X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414402	SUP	HCPCS C1713		5414402  -  CAGE SPNL 12D OBLQ 40X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414404	SUP	HCPCS C1713		5414404  -  CAGE SPNL 4D OBLQ 40X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414405	SUP	HCPCS C1713		5414405  -  CAGE SPNL 15D OBLQ 40X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5414408	SUP	HCPCS C1713		5414408  -  CAGE SPNL 8D OBLQ 40X14X11MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420250	SUP	HCPCS C1713		5420250  -  CAGE SPNL 0D OBLQ 25X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420252	SUP	HCPCS C1713		5420252  -  CAGE SPNL 12D OBLQ 25X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5420254	SUP	HCPCS C1713		5420254  -  CAGE SPNL 4D OBLQ 25X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5420255	SUP	HCPCS C1713		5420255  -  CAGE SPNL 15D OBLQ 25X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420258	SUP	HCPCS C1713		5420258  -  CAGE SPNL 8D OBLQ 25X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420300	SUP	HCPCS C1713		5420300  -  CAGE SPNL 0D OBLQ 30X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420302	SUP	HCPCS C1713		5420302  -  CAGE SPNL 12D OBLQ 30X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5420304	SUP	HCPCS C1713		5420304  -  CAGE SPNL 4D OBLQ 30X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5420305	SUP	HCPCS C1713		5420305  -  CAGE SPNL 15D OBLQ 30X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420308	SUP	HCPCS C1713		5420308  -  CAGE SPNL 8D OBLQ 30X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420350	SUP	HCPCS C1713		5420350  -  CAGE SPNL 0D OBLQ 35X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420352	SUP	HCPCS C1713		5420352  -  CAGE SPNL 12D OBLQ 35X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420354	SUP	HCPCS C1713		5420354  -  CAGE SPNL 4D OBLQ 35X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5420355	SUP	HCPCS C1713		5420355  -  CAGE SPNL 15D OBLQ 35X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420358	SUP	HCPCS C1713		5420358  -  CAGE SPNL 8D OBLQ 35X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420400	SUP	HCPCS C1713		5420400  -  CAGE SPNL 0D OBLQ 40X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420402	SUP	HCPCS C1713		5420402  -  CAGE SPNL 12D OBLQ 40X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420404	SUP	HCPCS C1713		5420404  -  CAGE SPNL 4D OBLQ 40X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420405	SUP	HCPCS C1713		5420405  -  CAGE SPNL 15D OBLQ 40X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5420408	SUP	HCPCS C1713		5420408  -  CAGE SPNL 8D OBLQ 40X10X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424250	SUP	HCPCS C1713		5424250  -  CAGE SPNL 0D OBLQ 25X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424252	SUP	HCPCS C1713		5424252  -  CAGE SPNL 12D OBLQ 25X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5424254	SUP	HCPCS C1713		5424254  -  CAGE SPNL 4D OBLQ 25X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5424255	SUP	HCPCS C1713		5424255  -  CAGE SPNL 15D OBLQ 25X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424258	SUP	HCPCS C1713		5424258  -  CAGE SPNL 8D OBLQ 25X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424300	SUP	HCPCS C1713		5424300  -  CAGE SPNL 0D OBLQ 30X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424302	SUP	HCPCS C1713		5424302  -  CAGE SPNL 12D OBLQ 30X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424304	SUP	HCPCS C1713		5424304  -  CAGE SPNL 4D OBLQ 30X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5424305	SUP	HCPCS C1713		5424305  -  CAGE SPNL 15D OBLQ 30X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424308	SUP	HCPCS C1713		5424308  -  CAGE SPNL 8D OBLQ 30X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424350	SUP	HCPCS C1713		5424350  -  CAGE SPNL 0D OBLQ 35X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424352	SUP	HCPCS C1713		5424352  -  CAGE SPNL 12D OBLQ 35X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424354	SUP	HCPCS C1713		5424354  -  CAGE SPNL 4D OBLQ 35X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424355	SUP	HCPCS C1713		5424355  -  CAGE SPNL 15D OBLQ 35X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424358	SUP	HCPCS C1713		5424358  -  CAGE SPNL 8D OBLQ 35X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424400	SUP	HCPCS C1713		5424400  -  CAGE SPNL 0D OBLQ 40X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424402	SUP	HCPCS C1713		5424402  -  CAGE SPNL 12D OBLQ 40X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424404	SUP	HCPCS C1713		5424404  -  CAGE SPNL 4D OBLQ 40X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424405	SUP	HCPCS C1713		5424405  -  CAGE SPNL 15D OBLQ 40X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5424408	SUP	HCPCS C1713		5424408  -  CAGE SPNL 8D OBLQ 40X14X12MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430250	SUP	HCPCS C1713		5430250  -  CAGE SPNL 0D OBLQ 25X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430252	SUP	HCPCS C1713		5430252  -  CAGE SPNL 12D OBLQ 25X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430254	SUP	HCPCS C1713		5430254  -  CAGE SPNL 4D OBLQ 25X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430255	SUP	HCPCS C1713		5430255  -  CAGE SPNL 15D OBLQ 25X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430258	SUP	HCPCS C1713		5430258  -  CAGE SPNL 8D OBLQ 25X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430300	SUP	HCPCS C1713		5430300  -  CAGE SPNL 0D OBLQ 30X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430302	SUP	HCPCS C1713		5430302  -  CAGE SPNL 12D OBLQ 30X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430304	SUP	HCPCS C1713		5430304  -  CAGE SPNL 4D OBLQ 30X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430305	SUP	HCPCS C1713		5430305  -  CAGE SPNL 15D OBLQ 30X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430308	SUP	HCPCS C1713		5430308  -  CAGE SPNL 8D OBLQ 30X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430350	SUP	HCPCS C1713		5430350  -  CAGE SPNL 0D OBLQ 35X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430352	SUP	HCPCS C1713		5430352  -  CAGE SPNL 12D OBLQ 35X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430354	SUP	HCPCS C1713		5430354  -  CAGE SPNL 4D OBLQ 35X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430355	SUP	HCPCS C1713		5430355  -  CAGE SPNL 15D OBLQ 35X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430358	SUP	HCPCS C1713		5430358  -  CAGE SPNL 8D OBLQ 35X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430400	SUP	HCPCS C1713		5430400  -  CAGE SPNL 0D OBLQ 40X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430402	SUP	HCPCS C1713		5430402  -  CAGE SPNL 12D OBLQ 40X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430404	SUP	HCPCS C1713		5430404  -  CAGE SPNL 4D OBLQ 40X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430405	SUP	HCPCS C1713		5430405  -  CAGE SPNL 15D OBLQ 40X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5430408	SUP	HCPCS C1713		5430408  -  CAGE SPNL 8D OBLQ 40X10X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434250	SUP	HCPCS C1713		5434250  -  CAGE SPNL 0D OBLQ 25X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434252	SUP	HCPCS C1713		5434252  -  CAGE SPNL 12D OBLQ 25X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434254	SUP	HCPCS C1713		5434254  -  CAGE SPNL 4D OBLQ 25X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434255	SUP	HCPCS C1713		5434255  -  CAGE SPNL 15D OBLQ 25X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434258	SUP	HCPCS C1713		5434258  -  CAGE SPNL 8D OBLQ 25X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434300	SUP	HCPCS C1713		5434300  -  CAGE SPNL 0D OBLQ 30X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434302	SUP	HCPCS C1713		5434302  -  CAGE SPNL 12D OBLQ 30X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434304	SUP	HCPCS C1713		5434304  -  CAGE SPNL 4D OBLQ 30X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434305	SUP	HCPCS C1713		5434305  -  CAGE SPNL 15D OBLQ 30X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434308	SUP	HCPCS C1713		5434308  -  CAGE SPNL 8D OBLQ 30X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434350	SUP	HCPCS C1713		5434350  -  CAGE SPNL 0D OBLQ 35X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434352	SUP	HCPCS C1713		5434352  -  CAGE SPNL 12D OBLQ 35X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434354	SUP	HCPCS C1713		5434354  -  CAGE SPNL 4D OBLQ 35X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434355	SUP	HCPCS C1713		5434355  -  CAGE SPNL 15D OBLQ 35X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434358	SUP	HCPCS C1713		5434358  -  CAGE SPNL 8D OBLQ 35X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434400	SUP	HCPCS C1713		5434400  -  CAGE SPNL 0D OBLQ 40X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434402	SUP	HCPCS C1713		5434402  -  CAGE SPNL 12D OBLQ 40X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434404	SUP	HCPCS C1713		5434404  -  CAGE SPNL 4D OBLQ 40X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434405	SUP	HCPCS C1713		5434405  -  CAGE SPNL 15D OBLQ 40X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5434408	SUP	HCPCS C1713		5434408  -  CAGE SPNL 8D OBLQ 40X14X13MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440030	SUP	HCPCS C1713		5440030  -  SET SCREW 5440030 4.75 TI NS BRK OFF	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
5440130	SUP	HCPCS C1713		5440130  -  SET SCREW 5440130 4.75 TI NS NON BRK OFF	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
5440230	SUP	HCPCS C1713		5440230  -  SET SCREW 5440230 4.75 TI NS RED BRK OFF	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
5440250	SUP	HCPCS C1713		5440250  -  CAGE SPNL 0D OBLQ 25X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440252	SUP	HCPCS C1713		5440252  -  CAGE SPNL 12D OBLQ 25X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5440254	SUP	HCPCS C1713		5440254  -  CAGE SPNL 4D OBLQ 25X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5440255	SUP	HCPCS C1713		5440255  -  CAGE SPNL 15D OBLQ 25X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440258	SUP	HCPCS C1713		5440258  -  CAGE SPNL 8D OBLQ 25X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440300	SUP	HCPCS C1713		5440300  -  CAGE SPNL 0D OBLQ 30X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440302	SUP	HCPCS C1713		5440302  -  CAGE SPNL 12D OBLQ 30X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5440304	SUP	HCPCS C1713		5440304  -  CAGE SPNL 4D OBLQ 30X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5440305	SUP	HCPCS C1713		5440305  -  CAGE SPNL 15D OBLQ 30X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440308	SUP	HCPCS C1713		5440308  -  CAGE SPNL 8D OBLQ 30X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440350	SUP	HCPCS C1713		5440350  -  CAGE SPNL 0D OBLQ 35X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440352	SUP	HCPCS C1713		5440352  -  CAGE SPNL 12D OBLQ 35X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440355	SUP	HCPCS C1713		5440355  -  CAGE SPNL 15D OBLQ 35X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440358	SUP	HCPCS C1713		5440358  -  CAGE SPNL 8D OBLQ 35X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440400	SUP	HCPCS C1713		5440400  -  CAGE SPNL 0D OBLQ 40X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440402	SUP	HCPCS C1713		5440402  -  CAGE SPNL 12D OBLQ 40X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440404	SUP	HCPCS C1713		5440404  -  CAGE SPNL 4D OBLQ 40X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440405	SUP	HCPCS C1713		5440405  -  CAGE SPNL 15D OBLQ 40X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440408	SUP	HCPCS C1713		5440408  -  CAGE SPNL 8D OBLQ 40X10X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5440430	SUP	HCPCS C1713		5440430  -  SCREW SET BREAKOFF SOLERA SEXTANT CD HORIZON TITANIUM SPN	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
5441101	SUP	HCPCS C1713		5441101  -  HOOK 5441101 4.75 TI NS PEDICLE  XSML	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441102	SUP	HCPCS C1713		5441102  -  HOOK 5441102 PEDICLE 4.75 SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441103	SUP	HCPCS C1713		5441103  -  HOOK 5441103 PEDICLE 4.75 MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441104	SUP	HCPCS C1713		5441104  -  HOOK 5441104 PEDICLE 4.75 LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441112	SUP	HCPCS C1713		5441112  -  HOOK 5441112 WIDE BLADE 4.75 SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441113	SUP	HCPCS C1713		5441113  -  HOOK 5441113 WIDE BLADE 4.75 MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441114	SUP	HCPCS C1713		5441114  -  HOOK 5441114 WIDE BLADE 4.75 LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441122	SUP	HCPCS C1713		5441122  -  HOOK 5441122 NARROW BLADE 4.75 SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441123	SUP	HCPCS C1713		5441123  -  HOOK 5441123 NARROW BLADE 4.75 MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441124	SUP	HCPCS C1713		5441124  -  HOOK 5441124 NARROW BLADE 4.75 LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441133	SUP	HCPCS C1713		5441133  -  HOOK 5441133 RAMP WIDE BLADE 4.75 MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441142	SUP	HCPCS C1713		5441142  -  HOOK 5441142 RMP NRW BLADE 4.75 SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441143	SUP	HCPCS C1713		5441143  -  HOOK 5441143 RMP NRW BLADE 4.75 MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441172	SUP	HCPCS C1713		5441172  -  HOOK 5441172 EXTENDED BODY 4.75 SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441173	SUP	HCPCS C1713		5441173  -  HOOK 5441173 EXTENDED BODY 4.75 MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441174	SUP	HCPCS C1713		5441174  -  HOOK 5441174 EXTENDED BODY 4.75 LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441196	SUP	HCPCS C1713		5441196  -  HOOK 5441196 4.75 TI NS OFFSET SML RT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441197	SUP	HCPCS C1713		5441197  -  HOOK 5441197 4.75 TI NS OFFSET SML LEFT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441198	SUP	HCPCS C1713		5441198  -  HOOK 5441198 OFFSET 4.75 RIGHT TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441199	SUP	HCPCS C1713		5441199  -  HOOK 5441199 OFFSET 4.75 LEFT TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441302	SUP	HCPCS C1713		5441302  -  HOOK 5441302 4.75 TI NS TAH PEDICLE SML	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441303	SUP	HCPCS C1713		5441303  -  HOOK 5441303 4.75 TI NS TAH PEDICLE MED	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441342	SUP	HCPCS C1713		5441342  -  HOOK 5441342 4.75 TI NS TAH TRAN PRO SML	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5441343	SUP	HCPCS C1713		5441343  -  HOOK 5441343 4.75 TI NS TAH TRAN PRO MED	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
5442016	SUP	HCPCS C1713		5442016  -  CROSSLINK 5442016 4.75 TI NS FIXED 16MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442019	SUP	HCPCS C1713		5442019  -  CROSSLINK 5442019 4.75 TI NS FIXED 19MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442022	SUP	HCPCS C1713		5442022  -  CROSSLINK 5442022 4.75 TI NS FIXED 22MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442025	SUP	HCPCS C1713		5442025  -  CROSSLINK 5442025 4.75 TI NS FIXED 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442028	SUP	HCPCS C1713		5442028  -  CROSSLINK 5442028 4.75 TI NS FIXED 28MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442031	SUP	HCPCS C1713		5442031  -  CROSSLINK 5442031 4.75 TI NS FIXED 31MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442034	SUP	HCPCS C1713		5442034  -  CROSSLINK 5442034 4.75 TI NS FIXED 34MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442037	SUP	HCPCS C1713		5442037  -  CROSSLINK 5442037 4.75 TI NS FIXED 37MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442130	SUP	HCPCS C1713		5442130  -  PLATE BN 30-32MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442132	SUP	HCPCS C1713		5442132  -  PLATE BN 32-37MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442136	SUP	HCPCS C1713		5442136  -  PLATE BN 36-38MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442138	SUP	HCPCS C1713		5442138  -  PLATE BN 38-42MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442141	SUP	HCPCS C1713		5442141  -  PLATE BN 41-48MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442144	SUP	HCPCS C1713		5442144  -  CROSSLINK 5442144 4.75X10 MLTSPN 44-54MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442147	SUP	HCPCS C1713		5442147  -  PLATE BN 47-60MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442152	SUP	HCPCS C1713		5442152  -  CROSSLINK 5442152 4.75X10 MLTSPN 52-70MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5442160	SUP	HCPCS C1713		5442160  -  CROSSLINK 5442160 4.75X10 MLTSPN 60-86MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
5443110	SUP	Custom 27803010		5443110  -  CONNECTOR 5443110 475/635 TI CL ILC 10MM	BOTH IP/OP	"$1,929.00 "	"$1,427.46"	$0.00	"$1,543.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,431.70"	"$1,431.70"	$0.00	$0.00	$402.00	$0.00	$0.00	$0.00	$0.00	$964.50	"$1,527.77"	"$1,543.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5443120	SUP	Custom 27803010		5443120  -  CONNECTOR 5443120 475/635 TI CL ILC 20MM	BOTH IP/OP	"$1,929.00 "	"$1,427.46"	$0.00	"$1,543.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,431.70"	"$1,431.70"	$0.00	$0.00	$402.00	$0.00	$0.00	$0.00	$0.00	$964.50	"$1,527.77"	"$1,543.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5443130	SUP	Custom 27803010		5443130  -  CONNECTOR 5443130 475/635 TI CL ILC 30MM	BOTH IP/OP	"$1,929.00 "	"$1,427.46"	$0.00	"$1,543.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,431.70"	"$1,431.70"	$0.00	$0.00	$402.00	$0.00	$0.00	$0.00	$0.00	$964.50	"$1,527.77"	"$1,543.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5443160	SUP	Custom 27803010		5443160  -  CONNECTOR 5443160 475/635 TI CL ILC 60MM	BOTH IP/OP	"$1,929.00 "	"$1,427.46"	$0.00	"$1,543.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,431.70"	"$1,431.70"	$0.00	$0.00	$402.00	$0.00	$0.00	$0.00	$0.00	$964.50	"$1,527.77"	"$1,543.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5444250	SUP	HCPCS C1713		5444250  -  CAGE SPNL 0D OBLQ 25X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444252	SUP	HCPCS C1713		5444252  -  CAGE SPNL 12D OBLQ 25X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444254	SUP	HCPCS C1713		5444254  -  CAGE SPNL 4D OBLQ 25X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444255	SUP	HCPCS C1713		5444255  -  CAGE SPNL 15D OBLQ 25X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444258	SUP	HCPCS C1713		5444258  -  CAGE SPNL 8D OBLQ 25X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444300	SUP	HCPCS C1713		5444300  -  CAGE SPNL 0D OBLQ 30X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444302	SUP	HCPCS C1713		5444302  -  CAGE SPNL 12D OBLQ 30X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444304	SUP	HCPCS C1713		5444304  -  CAGE SPNL 4D OBLQ 30X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444305	SUP	HCPCS C1713		5444305  -  CAGE SPNL 15D OBLQ 30X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444308	SUP	HCPCS C1713		5444308  -  CAGE SPNL 8D OBLQ 30X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444350	SUP	HCPCS C1713		5444350  -  CAGE SPNL 0D OBLQ 35X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444352	SUP	HCPCS C1713		5444352  -  CAGE SPNL 12D OBLQ 35X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444354	SUP	HCPCS C1713		5444354  -  CAGE SPNL 4D OBLQ 35X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444355	SUP	HCPCS C1713		5444355  -  CAGE SPNL 15D OBLQ 35X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444358	SUP	HCPCS C1713		5444358  -  CAGE SPNL 8D OBLQ 35X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444400	SUP	HCPCS C1713		5444400  -  CAGE SPNL 0D OBLQ 40X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444402	SUP	HCPCS C1713		5444402  -  CAGE SPNL 12D OBLQ 40X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444404	SUP	HCPCS C1713		5444404  -  CAGE SPNL 4D OBLQ 40X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444405	SUP	HCPCS C1713		5444405  -  CAGE SPNL 15D OBLQ 40X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5444408	SUP	HCPCS C1713		5444408  -  CAGE SPNL 8D OBLQ 40X14X14MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460250	SUP	HCPCS C1713		5460250  -  CAGE SPNL 0D OBLQ 25X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5460252	SUP	HCPCS C1713		5460252  -  CAGE SPNL 12D OBLQ 25X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460254	SUP	HCPCS C1713		5460254  -  CAGE SPNL 4D OBLQ 25X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5460255	SUP	HCPCS C1713		5460255  -  CAGE SPNL 15D OBLQ 25X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460258	SUP	HCPCS C1713		5460258  -  CAGE SPNL 8D OBLQ 25X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460300	SUP	HCPCS C1713		5460300  -  CAGE SPNL 0D OBLQ 30X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5460302	SUP	HCPCS C1713		5460302  -  CAGE SPNL 12D OBLQ 30X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460304	SUP	HCPCS C1713		5460304  -  CAGE SPNL 4D OBLQ 30X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5460305	SUP	HCPCS C1713		5460305  -  CAGE SPNL 15D OBLQ 30X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460308	SUP	HCPCS C1713		5460308  -  CAGE SPNL 8D OBLQ 30X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460350	SUP	HCPCS C1713		5460350  -  CAGE SPNL 0D OBLQ 35X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460352	SUP	HCPCS C1713		5460352  -  CAGE SPNL 12D OBLQ 35X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460354	SUP	HCPCS C1713		5460354  -  CAGE SPNL 4D OBLQ 35X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460355	SUP	HCPCS C1713		5460355  -  CAGE SPNL 15D OBLQ 35X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460358	SUP	HCPCS C1713		5460358  -  CAGE SPNL 8D OBLQ 35X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460400	SUP	HCPCS C1713		5460400  -  CAGE SPNL 0D OBLQ 40X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460402	SUP	HCPCS C1713		5460402  -  CAGE SPNL 12D OBLQ 40X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460404	SUP	HCPCS C1713		5460404  -  CAGE SPNL 4D OBLQ 40X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460405	SUP	HCPCS C1713		5460405  -  CAGE SPNL 15D OBLQ 40X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5460408	SUP	HCPCS C1713		5460408  -  CAGE SPNL 8D OBLQ 40X10X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464250	SUP	HCPCS C1713		5464250  -  CAGE SPNL 0D OBLQ 25X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464252	SUP	HCPCS C1713		5464252  -  CAGE SPNL 12D OBLQ 25X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464254	SUP	HCPCS C1713		5464254  -  CAGE SPNL 4D OBLQ 25X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464255	SUP	HCPCS C1713		5464255  -  CAGE SPNL 15D OBLQ 25X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464258	SUP	HCPCS C1713		5464258  -  CAGE SPNL 8D OBLQ 25X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464300	SUP	HCPCS C1713		5464300  -  CAGE SPNL 0D OBLQ 30X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464302	SUP	HCPCS C1713		5464302  -  CAGE SPNL 12D OBLQ 30X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464304	SUP	HCPCS C1713		5464304  -  CAGE SPNL 4D OBLQ 30X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464305	SUP	HCPCS C1713		5464305  -  CAGE SPNL 15D OBLQ 30X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464308	SUP	HCPCS C1713		5464308  -  CAGE SPNL 8D OBLQ 30X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464350	SUP	HCPCS C1713		5464350  -  CAGE SPNL 0D OBLQ 35X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464352	SUP	HCPCS C1713		5464352  -  CAGE SPNL 12D OBLQ 35X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464354	SUP	HCPCS C1713		5464354  -  CAGE SPNL 4D OBLQ 35X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464355	SUP	HCPCS C1713		5464355  -  CAGE SPNL 15D OBLQ 35X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464358	SUP	HCPCS C1713		5464358  -  CAGE SPNL 8D OBLQ 35X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464400	SUP	HCPCS C1713		5464400  -  CAGE SPNL 0D OBLQ 40X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464402	SUP	HCPCS C1713		5464402  -  CAGE SPNL 12D OBLQ 40X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464404	SUP	HCPCS C1713		5464404  -  CAGE SPNL 4D OBLQ 40X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464405	SUP	HCPCS C1713		5464405  -  CAGE SPNL 15D OBLQ 40X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5464408	SUP	HCPCS C1713		5464408  -  CAGE SPNL 8D OBLQ 40X14X6MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470250	SUP	HCPCS C1713		5470250  -  CAGE SPNL 0D OBLQ 25X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5470252	SUP	HCPCS C1713		5470252  -  CAGE SPNL 12D OBLQ 25X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470254	SUP	HCPCS C1713		5470254  -  CAGE SPNL 4D OBLQ 25X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470255	SUP	HCPCS C1713		5470255  -  CAGE SPNL 15D OBLQ 25X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470258	SUP	HCPCS C1713		5470258  -  CAGE SPNL 8D OBLQ 25X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470300	SUP	HCPCS C1713		5470300  -  CAGE SPNL 0D OBLQ 30X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5470302	SUP	HCPCS C1713		5470302  -  CAGE SPNL 12D OBLQ 30X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470304	SUP	HCPCS C1713		5470304  -  CAGE SPNL 4D OBLQ 30X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470305	SUP	HCPCS C1713		5470305  -  CAGE SPNL 15D OBLQ 30X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470308	SUP	HCPCS C1713		5470308  -  CAGE SPNL 8D OBLQ 30X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470350	SUP	HCPCS C1713		5470350  -  CAGE SPNL 0D OBLQ 35X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470352	SUP	HCPCS C1713		5470352  -  CAGE SPNL 12D OBLQ 35X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470354	SUP	HCPCS C1713		5470354  -  CAGE SPNL 4D OBLQ 35X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470355	SUP	HCPCS C1713		5470355  -  CAGE SPNL 15D OBLQ 35X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470358	SUP	HCPCS C1713		5470358  -  CAGE SPNL 8D OBLQ 35X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470400	SUP	HCPCS C1713		5470400  -  CAGE SPNL 0D OBLQ 40X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470402	SUP	HCPCS C1713		5470402  -  CAGE SPNL 12D OBLQ 40X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470404	SUP	HCPCS C1713		5470404  -  CAGE SPNL 4D OBLQ 40X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470405	SUP	HCPCS C1713		5470405  -  CAGE SPNL 15D OBLQ 40X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5470408	SUP	HCPCS C1713		5470408  -  CAGE SPNL 8D OBLQ 40X10X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474250	SUP	HCPCS C1713		5474250  -  CAGE SPNL 0D OBLQ 25X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474252	SUP	HCPCS C1713		5474252  -  CAGE SPNL 12D OBLQ 25X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474254	SUP	HCPCS C1713		5474254  -  CAGE SPNL 4D OBLQ 25X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474255	SUP	HCPCS C1713		5474255  -  CAGE SPNL 15D OBLQ 25X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474258	SUP	HCPCS C1713		5474258  -  CAGE SPNL 8D OBLQ 25X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474300	SUP	HCPCS C1713		5474300  -  CAGE SPNL 0D OBLQ 30X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474302	SUP	HCPCS C1713		5474302  -  CAGE SPNL 12D OBLQ 30X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474304	SUP	HCPCS C1713		5474304  -  CAGE SPNL 4D OBLQ 30X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474305	SUP	HCPCS C1713		5474305  -  CAGE SPNL 15D OBLQ 30X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474308	SUP	HCPCS C1713		5474308  -  CAGE SPNL 8D OBLQ 30X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474350	SUP	HCPCS C1713		5474350  -  CAGE SPNL 0D OBLQ 35X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474352	SUP	HCPCS C1713		5474352  -  CAGE SPNL 12D OBLQ 35X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474355	SUP	HCPCS C1713		5474355  -  CAGE SPNL 15D OBLQ 35X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474358	SUP	HCPCS C1713		5474358  -  CAGE SPNL 8D OBLQ 35X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474400	SUP	HCPCS C1713		5474400  -  CAGE SPNL 0D OBLQ 40X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474402	SUP	HCPCS C1713		5474402  -  CAGE SPNL 12D OBLQ 40X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474404	SUP	HCPCS C1713		5474404  -  CAGE SPNL 4D OBLQ 40X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474405	SUP	HCPCS C1713		5474405  -  CAGE SPNL 15D OBLQ 40X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5474408	SUP	HCPCS C1713		5474408  -  CAGE SPNL 8D OBLQ 40X14X7MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5475525	SUP	HCPCS C1713		5475525  -  SCREW BN 5.5MM 25MM NS CRNT FX ANG SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5475540	SUP	HCPCS C1713		5475540  -  SCREW BN 5.5MM 40MM NS CRNT FX ANG SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5475545	SUP	HCPCS C1713		5475545  -  SCREW BN 5.5MM 45MM NS CRNT FX ANG SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5475550	SUP	HCPCS C1713		5475550  -  SCREW BN 5.5MM 50MM NS CRNT FX ANG SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5475555	SUP	HCPCS C1713		5475555  -  SCREW BN 5.5MM 55MM NS CRNT FX ANG SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5475560	SUP	HCPCS C1713		5475560  -  SCREW BN 5.5MM 60MM NS CRNT FX ANG SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5475565	SUP	HCPCS C1713		5475565  -  SCREW BN 5.5MM 65MM CRNT XLIF FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5475570	SUP	HCPCS C1713		5475570  -  SCREW BN 5.5MM 70MM CRNT XLIF FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5476525	SUP	HCPCS C1713		5476525  -  SCREW BN 6.5MM 25MM CRNT XLIF FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5476540	SUP	HCPCS C1713		5476540  -  SCREW BN 6.5MM 40MM CRNT XLIF FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5476545	SUP	HCPCS C1713		5476545  -  SCREW BN 6.5MM 45MM CRNT XLIF FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5476550	SUP	HCPCS C1713		5476550  -  SCREW BN 6.5MM 50MM CRNT XLIF FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5476555	SUP	HCPCS C1713		5476555  -  SCREW BN 6.5MM 55MM FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5476560	SUP	HCPCS C1713		5476560  -  SCREW BN 6.5MM 60MM CRNT XLIF FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5476565	SUP	HCPCS C1713		5476565  -  SCREW BN 6.5MM 65MM CRNT XLIF FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5476570	SUP	HCPCS C1713		5476570  -  SCREW BN 6.5MM 70MM CRNT XLIF FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5480250	SUP	HCPCS C1713		5480250  -  CAGE SPNL 0D OBLQ 25X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5480252	SUP	HCPCS C1713		5480252  -  CAGE SPNL 12D OBLQ 25X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5480254	SUP	HCPCS C1713		5480254  -  CAGE SPNL 4D OBLQ 25X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5480255	SUP	HCPCS C1713		5480255  -  CAGE SPNL 15D OBLQ 25X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5480258	SUP	HCPCS C1713		5480258  -  CAGE SPNL 8D OBLQ 25X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5480300	SUP	HCPCS C1713		5480300  -  CAGE SPNL 0D OBLQ 30X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5480302	SUP	HCPCS C1713		5480302  -  CAGE SPNL 12D OBLQ 30X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5480304	SUP	HCPCS C1713		5480304  -  CAGE SPNL 4D OBLQ 30X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5480305	SUP	HCPCS C1713		5480305  -  CAGE SPNL 15D OBLQ 30X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5480308	SUP	HCPCS C1713		5480308  -  CAGE SPNL 8D OBLQ 30X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5480350	SUP	HCPCS C1713		5480350  -  CAGE SPNL 0D OBLQ 35X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5480352	SUP	HCPCS C1713		5480352  -  CAGE SPNL 12D OBLQ 35X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5480354	SUP	HCPCS C1713		5480354  -  CAGE SPNL 4D OBLQ 35X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5480355	SUP	HCPCS C1713		5480355  -  CAGE SPNL 15D OBLQ 35X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5480358	SUP	HCPCS C1713		5480358  -  CAGE SPNL 8D OBLQ 35X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5480400	SUP	HCPCS C1713		5480400  -  CAGE SPNL 0D OBLQ 40X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5480402	SUP	HCPCS C1713		5480402  -  CAGE SPNL 12D OBLQ 40X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5480404	SUP	HCPCS C1713		5480404  -  CAGE SPNL 4D OBLQ 40X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5480405	SUP	HCPCS C1713		5480405  -  CAGE SPNL 15D OBLQ 40X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5480408	SUP	HCPCS C1713		5480408  -  CAGE SPNL 8D OBLQ 40X10X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484250	SUP	HCPCS C1713		5484250  -  CAGE SPNL 0D OBLQ 25X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484252	SUP	HCPCS C1713		5484252  -  CAGE SPNL 12D OBLQ 25X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5484254	SUP	HCPCS C1713		5484254  -  CAGE SPNL 4D OBLQ 25X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5484258	SUP	HCPCS C1713		5484258  -  CAGE SPNL 8D OBLQ 25X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484300	SUP	HCPCS C1713		5484300  -  CAGE SPNL 0D OBLQ 30X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484350	SUP	HCPCS C1713		5484350  -  CAGE SPNL 0D OBLQ 35X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484352	SUP	HCPCS C1713		5484352  -  CAGE SPNL 12D OBLQ 35X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484354	SUP	HCPCS C1713		5484354  -  CAGE SPNL 4D OBLQ 35X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484355	SUP	HCPCS C1713		5484355  -  CAGE SPNL 15D OBLQ 35X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484358	SUP	HCPCS C1713		5484358  -  CAGE SPNL 8D OBLQ 35X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484400	SUP	HCPCS C1713		5484400  -  CAGE SPNL 0D OBLQ 40X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484402	SUP	HCPCS C1713		5484402  -  CAGE SPNL 12D OBLQ 40X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484404	SUP	HCPCS C1713		5484404  -  CAGE SPNL 4D OBLQ 40X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484405	SUP	HCPCS C1713		5484405  -  CAGE SPNL 15D OBLQ 40X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5484408	SUP	HCPCS C1713		5484408  -  CAGE SPNL 8D OBLQ 40X14X8MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5485525	SUP	HCPCS C1713		5485525  -  SCREW BONE 5.5MM 25MM VARIABLE COROENT XLF SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5485540	SUP	HCPCS C1713		5485540  -  SCREW BN 5.5MM 40MM NS CRNT VA SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5485545	SUP	HCPCS C1713		5485545  -  SCREW BN 5.5MM 45MM NS CRNT VA SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5485550	SUP	HCPCS C1713		5485550  -  SCREW BN 5.5MM 50MM CRNT XLF VA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5485555	SUP	HCPCS C1713		5485555  -  SCREW BN 5.5MM 55MM NS CRNT VA SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5485560	SUP	HCPCS C1713		5485560  -  SCREW BN 5.5MM 60MM NS CRNT VA SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5485565	SUP	HCPCS C1713		5485565  -  SCREW BN 5.5MM 65MM NS CRNT VA SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5485570	SUP	HCPCS C1713		5485570  -  SCREW BN 5.5MM 70MM CRNT XLF VAR SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5486525	SUP	HCPCS C1713		5486525  -  SCREW BN 6.5MM 25MM NS CRNT VA SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5486540	SUP	HCPCS C1713		5486540  -  SCREW BN 6.5MM 40MM NS CRNT VA SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5486545	SUP	HCPCS C1713		5486545  -  SCREW BN 6.5MM 45MM NS CRNT VA SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5486550	SUP	HCPCS C1713		5486550  -  SCREW BN 6.5MM 50MM NS CRNT VA SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5486555	SUP	HCPCS C1713		5486555  -  SCREW BN 6.5MM 55MM NS CRNT VA SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5486560	SUP	HCPCS C1713		5486560  -  SCREW BN 6.5MM 60MM NS CRNT VA SPNE XLF SYS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5486565	SUP	HCPCS C1713		5486565  -  SCREW BN 6.5MM 65MM CRNT XLF VAR SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5486570	SUP	HCPCS C1713		5486570  -  SCREW BN 6.5MM 70MM CRNT XLF VAR SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5490250	SUP	HCPCS C1713		5490250  -  CAGE SPNL 0D OBLQ 25X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5490252	SUP	HCPCS C1713		5490252  -  CAGE SPNL 12D OBLQ 25X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490254	SUP	HCPCS C1713		5490254  -  CAGE SPNL 4D OBLQ 25X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490255	SUP	HCPCS C1713		5490255  -  CAGE SPNL 15D OBLQ 25X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490258	SUP	HCPCS C1713		5490258  -  CAGE SPNL 8D OBLQ 25X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490300	SUP	HCPCS C1713		5490300  -  CAGE SPNL 0D OBLQ 30X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5490302	SUP	HCPCS C1713		5490302  -  CAGE SPNL 12D OBLQ 30X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490304	SUP	HCPCS C1713		5490304  -  CAGE SPNL 4D OBLQ 30X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490305	SUP	HCPCS C1713		5490305  -  CAGE SPNL 15D OBLQ 30X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490308	SUP	HCPCS C1713		5490308  -  CAGE SPNL 8D OBLQ 30X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490350	SUP	HCPCS C1713		5490350  -  CAGE SPNL 0D OBLQ 35X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490352	SUP	HCPCS C1713		5490352  -  CAGE SPNL 12D OBLQ 35X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490354	SUP	HCPCS C1713		5490354  -  CAGE SPNL 4D OBLQ 35X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490355	SUP	HCPCS C1713		5490355  -  CAGE SPNL 15D OBLQ 35X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490358	SUP	HCPCS C1713		5490358  -  CAGE SPNL 8D OBLQ 35X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490400	SUP	HCPCS C1713		5490400  -  CAGE SPNL 0D OBLQ 40X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490402	SUP	HCPCS C1713		5490402  -  CAGE SPNL 12D OBLQ 40X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490404	SUP	HCPCS C1713		5490404  -  CAGE SPNL 4D OBLQ 40X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490405	SUP	HCPCS C1713		5490405  -  CAGE SPNL 15D OBLQ 40X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5490408	SUP	HCPCS C1713		5490408  -  CAGE SPNL 8D OBLQ 40X10X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494250	SUP	HCPCS C1713		5494250  -  CAGE SPNL 0D OBLQ 25X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494252	SUP	HCPCS C1713		5494252  -  CAGE SPNL 12D OBLQ 25X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494254	SUP	HCPCS C1713		5494254  -  CAGE SPNL 4D OBLQ 25X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494255	SUP	HCPCS C1713		5494255  -  CAGE SPNL 15D OBLQ 25X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494258	SUP	HCPCS C1713		5494258  -  CAGE SPNL 8D OBLQ 25X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494300	SUP	HCPCS C1713		5494300  -  CAGE SPNL 0D OBLQ 30X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494302	SUP	HCPCS C1713		5494302  -  CAGE SPNL 12D OBLQ 30X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494304	SUP	HCPCS C1713		5494304  -  CAGE SPNL 4D OBLQ 30X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494305	SUP	HCPCS C1713		5494305  -  CAGE SPNL 15D OBLQ 30X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494308	SUP	HCPCS C1713		5494308  -  CAGE SPNL 8D OBLQ 30X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494350	SUP	HCPCS C1713		5494350  -  CAGE SPNL 0D OBLQ 35X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494352	SUP	HCPCS C1713		5494352  -  CAGE SPNL 12D OBLQ 35X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494354	SUP	HCPCS C1713		5494354  -  CAGE SPNL 4D OBLQ 35X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494355	SUP	HCPCS C1713		5494355  -  CAGE SPNL 15D OBLQ 35X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494358	SUP	HCPCS C1713		5494358  -  CAGE SPNL 8D OBLQ 35X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494400	SUP	HCPCS C1713		5494400  -  CAGE SPNL 0D OBLQ 40X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494402	SUP	HCPCS C1713		5494402  -  CAGE SPNL 12D OBLQ 40X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494404	SUP	HCPCS C1713		5494404  -  CAGE SPNL 4D OBLQ 40X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494405	SUP	HCPCS C1713		5494405  -  CAGE SPNL 15D OBLQ 40X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5494408	SUP	HCPCS C1713		5494408  -  CAGE SPNL 8D OBLQ 40X14X9MM NS LF CRNT TI TLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
5500302	SUP	HCPCS C1769		GUIDEWIRE VASC .035IN 150CM 3MM JTP FIX CORE PTFE	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$17.65	$17.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$5.09	$0.00	$0.00	$5.17	$0.00	$0.00	$0.00	$0.00	$0.00
5500801	SUP	HCPCS C1769		GUIDEWIRE VASC .035IN 150CM BNTSN STRG FIX CORE PTFE	BOTH IP/OP	$22.50 	$16.65	$0.00	$18.00	$12.22	$12.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.25	$17.82	$18.00	$0.00		$0.00	$3.52	$0.00	$0.00	$3.58	$0.00	$0.00	$0.00	$0.00	$0.00
5500803	SUP	Custom 27203010		GUIDEWIRE BENTSON .038 150CM	BOTH IP/OP	$30.00 	$22.20	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5501701	SUP	HCPCS C1769		GUIDEWIRE VASC .035IN 150CM 1.5MM RSN CURVE JTP FIX CORE	BOTH IP/OP	$22.50 	$16.65	$0.00	$18.00	$12.22	$12.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.25	$17.82	$18.00	$0.00		$0.00	$3.52	$0.00	$0.00	$3.58	$0.00	$0.00	$0.00	$0.00	$0.00
5513150	SUP	HCPCS C1894		5513150  -  INTRODUCER CATH 15FR 13CM ARGD VLV HMDIAL	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$133.04	$133.04	$0.00	$0.00	$0.00	$51.06	$181.84	$181.84	$0.00	$0.00	$51.06	$0.00	$144.92	$144.92	$0.00	$122.50	$194.04	$196.00	$0.00		$0.00	$38.34	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534010	SUP	HCPCS C1713		5534010  -  SPACER ALGRF 30X10X2MM EXTENSURE SPNE	BOTH IP/OP	"$5,577.50 "	"$4,127.35"	$0.00	"$4,462.00"	"$2,509.88"	"$2,509.88"	$0.00	$0.00	$0.00	"$1,162.49"	"$4,139.62"	"$4,139.62"	$0.00	$0.00	"$1,162.35"	$0.00	"$2,749.71"	"$2,749.71"	$0.00	"$2,788.75"	"$4,417.38"	"$4,462.00"	$0.00		$0.00	$872.88	$0.00	$0.00	$887.94	$0.00	$0.00	$0.00	$0.00	$0.00
5534012	SUP	HCPCS C1713		5534012  -  SPACER ALGRF 30X12X2MM EXTENSURE SPNE	BOTH IP/OP	"$5,577.50 "	"$4,127.35"	$0.00	"$4,462.00"	"$2,509.88"	"$2,509.88"	$0.00	$0.00	$0.00	"$1,162.49"	"$4,139.62"	"$4,139.62"	$0.00	$0.00	"$1,162.35"	$0.00	"$2,749.71"	"$2,749.71"	$0.00	"$2,788.75"	"$4,417.38"	"$4,462.00"	$0.00		$0.00	$872.88	$0.00	$0.00	$887.94	$0.00	$0.00	$0.00	$0.00	$0.00
5534014	SUP	HCPCS C1713		5534014  -  SPACER ALGRF 30X14X2MM EXTENSURE SPNE	BOTH IP/OP	"$5,577.50 "	"$4,127.35"	$0.00	"$4,462.00"	"$2,509.88"	"$2,509.88"	$0.00	$0.00	$0.00	"$1,162.49"	"$4,139.62"	"$4,139.62"	$0.00	$0.00	"$1,162.35"	$0.00	"$2,749.71"	"$2,749.71"	$0.00	"$2,788.75"	"$4,417.38"	"$4,462.00"	$0.00		$0.00	$872.88	$0.00	$0.00	$887.94	$0.00	$0.00	$0.00	$0.00	$0.00
5534018	SUP	HCPCS C1713		5534018  -  SPACER SPNL 30X18X2MM EXTENSURE ALGRF	BOTH IP/OP	"$5,577.50 "	"$4,127.35"	$0.00	"$4,462.00"	"$2,509.88"	"$2,509.88"	$0.00	$0.00	$0.00	"$1,162.49"	"$4,139.62"	"$4,139.62"	$0.00	$0.00	"$1,162.35"	$0.00	"$2,749.71"	"$2,749.71"	$0.00	"$2,788.75"	"$4,417.38"	"$4,462.00"	$0.00		$0.00	$872.88	$0.00	$0.00	$887.94	$0.00	$0.00	$0.00	$0.00	$0.00
5540030	SUP	HCPCS C1713		5540030  -  SCREW SET BREAK OFF CD HORIZON TITANIUM SPINAL NONSTRL 5.5	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
5540130	SUP	HCPCS C1713		5540130  -  SET SCREW 5540130  5.5/6.0 TI NS NON BO	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
5540230	SUP	HCPCS C1713		5540230  -  SET SCREW 5540230 5.5/6.0 TI NS RED BO	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
5540430	SUP	HCPCS C1713		5540430  -  SCREW SET SOLERA SEXTANT CD HORIZON TITANIUM 5.5-6MM NONSTRL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
5560001	SUP	Custom 27804086		5560001  -  GRAFT BN 13MMX5MM FACET DWL SPNE	BOTH IP/OP	"$3,177.50 "	"$2,351.35"	$0.00	"$2,542.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,358.34"	"$2,358.34"	$0.00	$0.00	$662.19	$0.00	$0.00	$0.00	$0.00	"$1,588.75"	"$2,516.58"	"$2,542.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5587000	SUP	HCPCS C1750		5587000  -  KIT CATH REPR REPL CNCT PU HMDIAL	BOTH IP/OP	$325.28 	$240.71	$0.00	$260.22	$146.37	$146.37	$0.00	$0.00	$0.00	$67.80	$241.42	$241.42	$0.00	$0.00	$67.79	$0.00	$192.40	$192.40	$0.00	$162.64	$257.62	$260.22	$0.00		$0.00	$50.91	$0.00	$0.00	$51.78	$0.00	$0.00	$0.00	$0.00	$0.00
5688000	SUP	Custom 27203010		5688000  -  TUNNELER SRG 30MM 8IN HMSPLT HMSPLT XK MLBL TPR	BOTH IP/OP	$61.25 	$45.33	$0.00	$49.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.46	$45.46	$0.00	$0.00	$12.76	$0.00	$0.00	$0.00	$0.00	$30.63	$48.51	$49.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5740105	SUP	Custom 27804086		5740105  -  GRAFT BN LRDTC 14X11X5MM SPNE	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5740106	SUP	Custom 27804086		5740106  -  GRAFT BONE 14X11X6MM ALLOGRAFT TRIAD CANCELLOUS CORTICAL SPN	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5740107	SUP	Custom 27804086		5740107  -  GRAFT BONE LORDOSIS 14X7X11MM ALLOGRAFT TRAID CANCELLOUS	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5740109	SUP	Custom 27804086		5740109  -  GRAFT BN LRDTC 14X11X9MM TRD ALGRF CORT CNC	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5740110	SUP	Custom 27804086		5740110  -  GRAFT BN LRDTC 14X11X10MM ALGRF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5750005	SUP	Custom 27804086		5750005  -  GRAFT BN 14X11X5MM TRD ALGRF SPNE CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5750007	SUP	HCPCS C1713		"5750007  -  TRIAD CR ALLOGRAFT, 7X 11X 14MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
5750010	SUP	Custom 27804086		5750010  -  GRAFT BN 14X11X10MM TRD ALGRF SPNE CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5950007	SUP	HCPCS C1781		5950007  -  PATCH SURG SMALL CIR 1.7IN STRAP VENTRALEX ST SEPRA	BOTH IP/OP	"$1,769.50 "	"$1,309.43"	$0.00	"$1,415.60"	$796.28	$796.28	$0.00	$0.00	$0.00	$368.81	"$1,313.32"	"$1,313.32"	$0.00	$0.00	$368.76	$0.00	"$1,046.66"	"$1,046.66"	$0.00	$884.75	"$1,401.44"	"$1,415.60"	$0.00		$0.00	$276.93	$0.00	$0.00	$281.70	$0.00	$0.00	$0.00	$0.00	$0.00
5950008	SUP	HCPCS C1781		5950008  -  PATCH SURG MEDIUM CIR 2.5IN STRAP VENTRALEX ST SEPRA	BOTH IP/OP	"$2,117.00 "	"$1,566.58"	$0.00	"$1,693.60"	$952.65	$952.65	$0.00	$0.00	$0.00	$441.24	"$1,571.24"	"$1,571.24"	$0.00	$0.00	$441.18	$0.00	"$1,252.21"	"$1,252.21"	$0.00	"$1,058.50"	"$1,676.66"	"$1,693.60"	$0.00		$0.00	$331.31	$0.00	$0.00	$337.03	$0.00	$0.00	$0.00	$0.00	$0.00
5950009	SUP	HCPCS C1781		5950009  -  PATCH SRG LG CRC 3.2IN STRL VNTRLX ST SEPRA SORBAFLEX SPRG	BOTH IP/OP	"$2,405.50 "	"$1,780.07"	$0.00	"$1,924.40"	"$1,082.48"	"$1,082.48"	$0.00	$0.00	$0.00	$501.37	"$1,785.36"	"$1,785.36"	$0.00	$0.00	$501.31	$0.00	"$1,422.85"	"$1,422.85"	$0.00	"$1,202.75"	"$1,905.16"	"$1,924.40"	$0.00		$0.00	$376.46	$0.00	$0.00	$382.96	$0.00	$0.00	$0.00	$0.00	$0.00
5950020	SUP	HCPCS C1781		5950020  -  PATCH SURG LARGE CIR 4.5IN SELF EXPAND VENTRIO ST SORBAFLEX	BOTH IP/OP	"$2,760.75 "	"$2,042.96"	$0.00	"$2,208.60"	"$1,242.34"	"$1,242.34"	$0.00	$0.00	$0.00	$575.41	"$2,049.03"	"$2,049.03"	$0.00	$0.00	$575.34	$0.00	"$1,361.05"	"$1,361.05"	$0.00	"$1,380.38"	"$2,186.51"	"$2,208.60"	$0.00		$0.00	$432.06	$0.00	$0.00	$439.51	$0.00	$0.00	$0.00	$0.00	$0.00
5950030	SUP	HCPCS C1781		5950030  -  PATCH SURG SMALL OVAL 4.7X3.1IN SELF EXPAND VENTRIO ST	BOTH IP/OP	"$1,213.38 "	$897.90	$0.00	$970.70	$546.02	$546.02	$0.00	$0.00	$0.00	$252.90	$900.57	$900.57	$0.00	$0.00	$252.87	$0.00	$717.71	$717.71	$0.00	$606.69	$961.00	$970.70	$0.00		$0.00	$189.89	$0.00	$0.00	$193.17	$0.00	$0.00	$0.00	$0.00	$0.00
5950040	SUP	HCPCS C1781		5950040  -  PATCH SURG MEDIUM OVAL 5.5X4.3IN SELF EXPAND VENTRIO ST	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
5950050	SUP	HCPCS C1781		5950050  -  PATCH SURG LARGE OVAL 7X5.4IN SELF EXPAND VENTRIO ST	BOTH IP/OP	"$4,550.25 "	"$3,367.19"	$0.00	"$3,640.20"	"$2,047.61"	"$2,047.61"	$0.00	$0.00	$0.00	$948.39	"$3,377.20"	"$3,377.20"	$0.00	$0.00	$948.27	$0.00	"$2,243.27"	"$2,243.27"	$0.00	"$2,275.13"	"$3,603.80"	"$3,640.20"	$0.00		$0.00	$712.11	$0.00	$0.00	$724.40	$0.00	$0.00	$0.00	$0.00	$0.00
5950070	SUP	HCPCS C1781		5950070  -  PATCH SURG XL CIR 9.7X7.7IN SELF EXPAND VENTRIO ST SORBAFLEX	BOTH IP/OP	"$6,143.00 "	"$4,545.82"	$0.00	"$4,914.40"	"$2,764.35"	"$2,764.35"	$0.00	$0.00	$0.00	"$1,280.35"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,280.20"	$0.00	"$3,028.50"	"$3,028.50"	$0.00	"$3,071.50"	"$4,865.26"	"$4,914.40"	$0.00		$0.00	$961.38	$0.00	$0.00	$977.97	$0.00	$0.00	$0.00	$0.00	$0.00
5950080	SUP	HCPCS C1781		5950080  -  PATCH SURG XL CIR 10.7X8.7IN SELF EXPAND VENTRIO ST	BOTH IP/OP	"$7,356.25 "	"$5,443.63"	$0.00	"$5,885.00"	"$3,310.31"	"$3,310.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,678.13"	"$5,826.15"	"$5,885.00"	$0.00		$0.00	"$1,151.25"	$0.00	$0.00	"$1,171.12"	$0.00	$0.00	$0.00	$0.00	$0.00
5960011	SUP	HCPCS C1713		5960011  -  SCREW SET UNIVERSAL END CAP SPN	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
5960033	SUP	HCPCS C1713		5960033  -  SCREW BN 12MM X-COR MN VBR LCK TI SPNE	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
5960034	SUP	HCPCS C1713		5960034  -  SCREW BONE 14MM X-CORE MINI VBR TI SPN LOCK	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
5960200	SUP	HCPCS C1713		5960200  -  END CAP SPNL PRLL 12MM 14MM NS X-COR MN	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5960400	SUP	HCPCS C1713		5960400  -  END CAP SPNL 16MM PRLL 14MM CORE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5962152	SUP	HCPCS C1713		5962152  -  CAGE SPNL 12MM 15-20MM NS LF X-COR MN XPD VERT BD REPL	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
5962172	SUP	Custom 27803010		5962172  -  CAGE SPNL 12MM 17-24MM NS LF X-COR MN XPD VERT BD REPL	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	$0.00	$0.00	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5962223	SUP	HCPCS C1713		5962223  -  CAGE SPNL 12MM 22-34MM NS LF X-COR MN	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
5962253	SUP	HCPCS C1713		5962253  -  CAGE SPNL 12MM 25-40MM NS LF X-COR MN	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
5962294	SUP	HCPCS C1713		5962294  -  CAGE SPNL 12MM 29-48MM NS LF X-COR MN	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
5962366	SUP	HCPCS C1713		5962366  -  CAGE SPNL 12MM 36-62MM NS LF X-COR MN	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
5962427	SUP	HCPCS C1713		5962427  -  CAGE SPNL 12MM 42-74MM NS LF X-COR MN	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
5962520	SUP	Custom 27803010		5962520  -  ENDCAP SPINAL 12MM 15MM PARALLEL TITANIUM 12MM CORE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	$0.00	$0.00	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5962521	SUP	Custom 27803010		5962521  -  ENDCAP SPINAL CONVEX 12MM 15X12MM TOP X-CORE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	$0.00	$0.00	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5962526	SUP	Custom 27803010		5962526  -  ENDCAP SPINAL 7D 12MM 15MM BOTTOM TITANIUM 12MM CORE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	$0.00	$0.00	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5962527	SUP	Custom 27803010		5962527  -  ENDCAP SPINAL 7D 12MM 15MM TOP TITANIUM 12MM CORE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	$0.00	$0.00	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5962740	SUP	HCPCS C1713		5962740  -  END CAP SPNL PRLL 12MM 17MM NS 14MM X-COR MN TI	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5962741	SUP	HCPCS C1713		5962741  -  END CAP SPNL 12MM 17MM NS 14MM X-COR MN CNTR TOP TI	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5962746	SUP	HCPCS C1713		5962746  -  END CAP SPNL 7D 12MM 17MM NS 14MM X-COR MN LRDTC BTM TI	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5962747	SUP	HCPCS C1713		5962747  -  END CAP SPNL 7D 12MM 17MM NS 14MM X-COR MN LRDTC TOP TI	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5963740	SUP	HCPCS C1713		5963740  -  END CAP SPNL ANG 14MM 17MM PRLL TOP TI 14MM COR	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5963745	SUP	HCPCS C1713		5963745  -  END CAP SPNL ANG 14MM 17MM PRLL BTM TI 14MM COR	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5963746	SUP	HCPCS C1713		5963746  -  END CAP SPNL 4D KYPHOTIC 14MM 17X14MM X-COR BTM	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5963747	SUP	HCPCS C1713		5963747  -  END CAP SPNL 4D KYPHOTIC 14MM 17X14MM X-COR TOP	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5963960	SUP	HCPCS C1713		5963960  -  END CAP SPNL ANG 16MM 19MM PRLL TOP TI 14MM COR	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5963965	SUP	HCPCS C1713		5963965  -  END CAP SPNL ANG 16MM 19MM PRLL BTM TI 14MM COR	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5963966	SUP	HCPCS C1713		5963966  -  END CAP SPNL 4D KYPHOTIC 14MM 19X16MM X-COR BTM	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5963967	SUP	HCPCS C1713		5963967  -  END CAP SPNL 4D KYPHOTIC 14MM 19X16MM X-COR TOP	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5964152	SUP	HCPCS C1713		5964152  -  CAGE SPNL 14MM 15-20MM NS LF X-COR MN	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
5964172	SUP	Custom 27803010		5964172  -  CAGE SPNL 14MM 17-24MM NS LF X-COR MN XPD VERT BD REPL	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	$0.00	$0.00	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5964223	SUP	HCPCS C1713		5964223  -  CAGE SPNL 14MM 22-34MM NS LF X-COR MN XPD VERT BD REPL	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
5964253	SUP	HCPCS C1713		5964253  -  CAGE SPNL 14MM 25-40MM NS LF X-COR MN	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
5964294	SUP	HCPCS C1713		5964294  -  CAGE SPNL 14MM 29-48MM NS LF X-COR MN	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
5964366	SUP	HCPCS C1713		5964366  -  CAGE SPNL 14MM 36-62MM NS LF X-COR MN	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
5964427	SUP	HCPCS C1713		5964427  -  CAGE SPNL 14MM 42-74MM NS LF X-COR MN	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
5964740	SUP	HCPCS C1713		5964740  -  END CAP SPNL PRLL 14MM 17MM NS 14MM X-COR MN TI	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5964741	SUP	HCPCS C1713		5964741  -  END CAP SPNL 14MM 17MM NS 14MM X-COR MN CNTR TOP TI	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5964746	SUP	HCPCS C1713		5964746  -  END CAP SPNL 7D LRDTC 14MM 17MM NS 14MM X-COR MN TI	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5964747	SUP	HCPCS C1713		5964747  -  END CAP SPNL 7D LRDTC 14MM 17MM NS 14MM X-COR MN TI	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5964960	SUP	HCPCS C1713		5964960  -  END CAP SPNL PRLL 14MM 19MM NS 14MM X-COR MN TI	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5964966	SUP	HCPCS C1713		5964966  -  END CAP SPNL 7D LRDTC 14MM 19MM NS 16MM X-COR MN TI	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5964967	SUP	HCPCS C1713		5964967  -  END CAP SPNL 7D LRDTC 14MM 19MM NS 16MM X-COR MN TI	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
5975730	SUP	HCPCS C1713		5975730  -  VUE POINT 435 X 30	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6014908	SUP	Custom 27203010		6014908  -  DRILL TWST 1.4MM 18MM 8MM WL	BOTH IP/OP	$760.00 	$562.40	$0.00	$608.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$564.07	$564.07	$0.00	$0.00	$158.38	$0.00	$0.00	$0.00	$0.00	$380.00	$601.92	$608.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6019135	SUP	Custom 27203010		6019135  -  DRILL TWST 1.9MM 115MM LF	BOTH IP/OP	$617.05 	$456.62	$0.00	$640.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$457.97	$457.97	$0.00	$0.00	$128.59	$0.00	$0.00	$0.00	$0.00	$400.00	$633.60	$640.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6046385	SUP	HCPCS C1713		"6046385  -  4.0 CANNULATED, 38MM"	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
6101045	SUP	HCPCS C1713		6101045  -  SPACER SPNL XL STD 45X18X10CM C-THRU PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101050	SUP	HCPCS C1713		6101050  -  CAGE SPNL XL 50X18X10MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101055	SUP	HCPCS C1713		6101055  -  CAGE SPNL XL STD 55X18X10MM CRNT CT4	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101060	SUP	HCPCS C1713		6101060  -  CAGE SPNL XL STD 60X18X10MM CRNT CT4	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101245	SUP	HCPCS C1713		6101245  -  SPACER SPNL 45X18X12MM CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101250	SUP	HCPCS C1713		6101250  -  CAGE SPNL XL CRNL TPR 50X18X12MM CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101255	SUP	HCPCS C1713		6101255  -  CAGE SPNL XL CRNL TPR 55X18X12MM CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101260	SUP	HCPCS C1713		6101260  -  CAGE SPNL XL CRNL TPR 60X18X12MM CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101445	SUP	HCPCS C1713		6101445  -  CAGE SPNL XL CRNL TPR 45X18X14MM CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101450	SUP	HCPCS C1713		6101450  -  CAGE SPNL XL CRNL TPR 50X18X14MM CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101455	SUP	HCPCS C1713		6101455  -  CAGE SPNL XL CRNL TPR 55X18X14MM CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101460	SUP	HCPCS C1713		6101460  -  CAGE SPNL XL CRNL TPR 60X18X14MM CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101645	SUP	HCPCS C1713		6101645  -  CAGE SPNL XL CRNL TPR 45X18X16MM CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101650	SUP	HCPCS C1713		6101650  -  CAGE SPNL XL CRNL TPR 50X18X16MM CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101655	SUP	HCPCS C1713		6101655  -  CAGE SPNL XL CRNL TPR 55X18X16MM CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6101660	SUP	HCPCS C1713		6101660  -  CAGE SPNL XL CRNL TPR 60X18X16MM CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111045	SUP	HCPCS C1713		6111045  -  CAGE SPNL 10D LRDTC 45X18X10MM CRNT XLIF PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111050	SUP	HCPCS C1713		6111050  -  CAGE SPNL 10D LRDTC 50X18X10MM CRNT XLIF PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111055	SUP	HCPCS C1713		6111055  -  CAGE SPNL 10D LRDTC 55X18X10MM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111060	SUP	HCPCS C1713		6111060  -  CAGE SPNL 10D LRDTC 60X18X10MM CRNT XLIF PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111245	SUP	HCPCS C1713		6111245  -  CAGE SPNL 10D LRDTC 45X18X12MM CRNT XLIF PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111250	SUP	HCPCS C1713		6111250  -  CAGE SPNL XL 10D 50X18X12MM CRNT COALITION PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111255	SUP	HCPCS C1713		6111255  -  CAGE SPNL 10D XL CRNL TPR 55X18X12MM CRNT PEEK-OPTM IM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111260	SUP	HCPCS C1713		6111260  -  SPACER SPNL 10D XL 60X18X12MM PEEK BCK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111445	SUP	HCPCS C1713		6111445  -  CAGE SPNL 10D XL CRNL TPR 45X18X14MM CRNT PEEK-OPTM IM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111450	SUP	HCPCS C1713		6111450  -  CAGE SPNL 10D XL CRNL TPR 50X18X14MM CRNT PEEK-OPTM IM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111455	SUP	HCPCS C1713		6111455  -  CAGE SPNL XL CRNL TPR 55X18X14MM CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111460	SUP	HCPCS C1713		6111460  -  CAGE SPNL 10D XL CRNL TPR 60X18X14MM CRNT PEEK-OPTM IM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111645	SUP	HCPCS C1713		6111645  -  CAGE SPNL 10D XL CRNL TPR 45X18X16MM CRNT PEEK-OPTM IM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111650	SUP	HCPCS C1713		6111650  -  CAGE SPNL 10D XL CRNL TPR 50X18X16MM CRNT PEEK-OPTM IM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111655	SUP	HCPCS C1713		6111655  -  CAGE SPNL 10D XL CRNL TPR 55X18X16MM CRNT PEEK-OPTM IM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6111660	SUP	HCPCS C1713		6111660  -  CAGE SPNL 10D XL CRNL TPR 60X18X16MM CRNT PEEK-OPTM IM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6160850	SUP	HCPCS C1713		6160850  -  CAGE SPNL XL W 50X22X8MM CRNT FX	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6160855	SUP	HCPCS C1713		6160855  -  CAGE SPNL XL W 55X22X8MM CRNT FX	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6160860	SUP	HCPCS C1713		6160860  -  CAGE SPNL XL W 60X22X8MM CRNT FX	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6161045	SUP	HCPCS C1713		6161045  -  CAGE SPNL XL 45X22X10MM NS LF CRNT W FTPRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6161050	SUP	HCPCS C1713		6161050  -  CAGE SPNL XL W 50X22X10MM CRNT FX	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6161055	SUP	HCPCS C1713		6161055  -  CAGE SPNL XL W 55X22X10MM CRNT FX	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6161060	SUP	HCPCS C1713		6161060  -  CAGE SPNL XL W 60X22X10MM CRNT FX	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6161255	SUP	HCPCS C1713		6161255  -  CAGE SPNL XL W 55X22X12MM CRNT FSN	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6161260	SUP	HCPCS C1713		6161260  -  CAGE SPNL XL W 60X22X12MM CRNT FSN	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6161450	SUP	HCPCS C1713		6161450  -  CAGE SPNL XL W 50X22X14MM CRNT FSN	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6161455	SUP	HCPCS C1713		6161455  -  CAGE SPNL XL W 55X22X14MM CRNT FSN	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6161460	SUP	HCPCS C1713		6161460  -  CAGE SPNL XL W 60X22X14MM CRNT FSN	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6170850	SUP	HCPCS C1713		6170850  -  CAGE SPNL XL W LRDTC 50X22X8MM CRNT FSN	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6170855	SUP	HCPCS C1713		6170855  -  CAGE SPNL XL LRDTC 55X22X8MM NS LF CRNT W FTPRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6170860	SUP	HCPCS C1713		6170860  -  CAGE SPNL XL LRDTC 60X22X8MM NS LF CRNT W FTPRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6171050	SUP	HCPCS C1713		6171050  -  SPACER SPNL XL W LRDTC 50X22X10MM CRNT FSN	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6171055	SUP	HCPCS C1713		6171055  -  CAGE SPNL XL LRDTC 55X22X10MM NS LF CRNT W FTPRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6171060	SUP	HCPCS C1713		6171060  -  CAGE SPNL XL LRDTC 60X22X10MM NS LF CRNT W FTPRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6171250	SUP	HCPCS C1713		6171250  -  CAGE SPNL XL W LRDTC 50X22X12MM CRNT FSN	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6171255	SUP	HCPCS C1713		6171255  -  CAGE SPNL XL LRDTC 55X22X12MM NS LF CRNT W FTPRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6171260	SUP	HCPCS C1713		6171260  -  CAGE SPNL XL LRDTC 60X22X12MM NS LF CRNT W FTPRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6171450	SUP	HCPCS C1713		6171450  -  CAGE SPNL XL W LRDTC 50X22X14MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6171455	SUP	HCPCS C1713		6171455  -  CAGE SPNL XL W LRDTC 55X22X14MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6171460	SUP	HCPCS C1713		6171460  -  CAGE SPNL XL W LRDTC 60X22X14MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6181800	SUP	Custom 27803010		6181800  -  ENDCAP 18MM RND 0 DEG OD18 TI XCORE 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6181804	SUP	Custom 27803010		6181804  -  ENDCAP 18MM RND 4 DEG OD18 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6181808	SUP	Custom 27803010		6181808  -  ENDCAP 18MM RND 8 DEG XCORE 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183000	SUP	Custom 27803010		6183000  -  ENDCAP OD18X18X30MM 0 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183004	SUP	Custom 27803010		6183004  -  ENDCAP OD18X18X30MM 4 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183008	SUP	Custom 27803010		6183008  -  ENDCAP OD18X18X30MM 8 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183014	SUP	Custom 27803010		6183014  -  ENDCAP OD18X18X30MM 4 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6184000	SUP	Custom 27803010		6184000  -  ENDCAP OD18X18X40MM 0 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6184004	SUP	Custom 27803010		6184004  -  ENDCAP OD18X18X40MM 4 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6184008	SUP	Custom 27803010		6184008  -  ENDCAP OD18X18X40MM 8 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6184014	SUP	Custom 27803010		6184014  -  ENDCAP OD18X18X40MM 4 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6185000	SUP	Custom 27803010		6185000  -  ENDCAP OD18X18X50MM 0 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6185004	SUP	Custom 27803010		6185004  -  ENDCAP OD18X18X50MM 4 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6185008	SUP	Custom 27803010		6185008  -  ENDCAP OD18X18X50MM 8 DEG TI XCORE TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6185014	SUP	Custom 27803010		6185014  -  ENDCAP OD18X18X50MM 4 DEG TI OD18 TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6200240	SUP	HCPCS C1713		6200240  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X2MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200245	SUP	HCPCS C1713		6200245  -  CAGE SPNL 20D XL 45X22X2MM CRNT PEEK	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200250	SUP	HCPCS C1713		6200250  -  CAGE SPNL 20D XL 50X22X2MM CRNT PEEK	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200255	SUP	HCPCS C1713		6200255  -  CAGE SPNL 20D XL 55X22X2MM CRNT PEEK	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200260	SUP	HCPCS C1713		6200260  -  CAGE SPNL 20D XL 60X22X2MM CRNT PEEK	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200265	SUP	HCPCS C1713		6200265  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X2MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200440	SUP	HCPCS C1713		6200440  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X4MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200445	SUP	HCPCS C1713		6200445  -  CAGE SPNL 20D XL 45X22X4MM CRNT PEEK	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200450	SUP	HCPCS C1713		6200450  -  CAGE SPNL 20D XL 50X22X4MM PEEK	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200455	SUP	HCPCS C1713		6200455  -  CAGE SPNL 20D XL 55X22X4MM PEEK	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200460	SUP	HCPCS C1713		6200460  -  CAGE SPNL 20D XL 60X22X4MM CRNT PEEK	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200465	SUP	HCPCS C1713		6200465  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X4MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200640	SUP	HCPCS C1713		6200640  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X6MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200645	SUP	HCPCS C1713		6200645  -  CAGE SPNL 20D XL 45X22X6MM CRNT PEEK	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200650	SUP	HCPCS C1713		6200650  -  CAGE SPNL 20D XL 50X22X6MM CRNT PEEK	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200655	SUP	HCPCS C1713		6200655  -  CAGE SPNL 20D XL HYPERLORDOTIC 55X22X6MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200660	SUP	HCPCS C1713		6200660  -  CAGE SPNL 20D XL HYPERLORDOTIC 60X22X6MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200665	SUP	HCPCS C1713		6200665  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X6MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200840	SUP	HCPCS C1713		6200840  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X8MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200845	SUP	HCPCS C1713		6200845  -  CAGE SPNL 20D XL HYPERLORDOTIC 45X22X8MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200850	SUP	HCPCS C1713		6200850  -  CAGE SPNL 20D XL HYPERLORDOTIC 50X22X8MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200855	SUP	HCPCS C1713		6200855  -  CAGE SPNL 20D XL HYPERLORDOTIC 55X22X8MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200860	SUP	HCPCS C1713		6200860  -  CAGE SPNL 20D XL HYPERLORDOTIC 60X22X8MM NS LF CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6200865	SUP	HCPCS C1713		6200865  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X8MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6201040	SUP	HCPCS C1713		6201040  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X10MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6201045	SUP	HCPCS C1713		6201045  -  CAGE SPNL 20D XL HYPERLORDOTIC 45X22X10MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6201050	SUP	HCPCS C1713		6201050  -  CAGE SPNL 20D XL HYPERLORDOTIC 50X22X10MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6201055	SUP	HCPCS C1713		6201055  -  CAGE SPNL 20D XL HYPERLORDOTIC 55X22X10MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6201060	SUP	HCPCS C1713		6201060  -  CAGE SPNL 20D XL HYPERLORDOTIC 60X22X10MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6201065	SUP	HCPCS C1713		6201065  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X10MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6208045	SUP	HCPCS C1713		6208045  -  CAGE SPNL XL XW 45X26X8MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6208050	SUP	HCPCS C1713		6208050  -  CAGE SPNL XL XW 50X26X8MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6208055	SUP	HCPCS C1713		6208055  -  CAGE SPNL XL XW 55X26X8MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6208060	SUP	HCPCS C1713		6208060  -  CAGE SPNL XL XW 60X26X8MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6208145	SUP	HCPCS C1713		6208145  -  CAGE SPNL 10D XL XW 45X26X8MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6208150	SUP	HCPCS C1713		6208150  -  CAGE SPNL 10D XL XW 50X26X8MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6208155	SUP	HCPCS C1713		6208155  -  CAGE SPNL 10D XL XW 55X26X8MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6208160	SUP	HCPCS C1713		6208160  -  CAGE SPNL 10D XL XW 60X26X8MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6210045	SUP	HCPCS C1713		6210045  -  CAGE SPNL XL XW 45X26X10MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6210050	SUP	HCPCS C1713		6210050  -  CAGE SPNL XL XW 50X26X10MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6210055	SUP	HCPCS C1713		6210055  -  CAGE SPNL XL XW 55X26X10MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6210060	SUP	HCPCS C1713		6210060  -  CAGE SPNL XL XW 60X26X10MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6210145	SUP	HCPCS C1713		6210145  -  CAGE SPNL 10D XL XW 45X26X10MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6210150	SUP	HCPCS C1713		6210150  -  CAGE SPNL 10D XL XW 50X26X10MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6210155	SUP	HCPCS C1713		6210155  -  CAGE SPNL 10D XL XW 55X26X10MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6212045	SUP	HCPCS C1713		6212045  -  CAGE SPNL XL XW 45X26X12MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6212050	SUP	HCPCS C1713		6212050  -  CAGE SPNL XL XW 50X26X12MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6212055	SUP	HCPCS C1713		6212055  -  CAGE SPNL XL XW 55X26X12MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6212060	SUP	HCPCS C1713		6212060  -  CAGE SPNL XL XW 60X26X12MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6212145	SUP	HCPCS C1713		6212145  -  CAGE SPNL 10D XL XW 45X26X12MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6212150	SUP	HCPCS C1713		6212150  -  CAGE SPNL 10D XL XW LRDTC 50X26X12MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6212155	SUP	HCPCS C1713		6212155  -  CAGE SPNL 10D XL XW LRDTC 55X26X12MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6212160	SUP	HCPCS C1713		6212160  -  CAGE SPNL 10D XL XW 60X26X12MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6214045	SUP	HCPCS C1713		6214045  -  CAGE SPNL XL XW 45X26X14MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6214050	SUP	HCPCS C1713		6214050  -  CAGE SPNL XL XW 50X26X14MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6214055	SUP	HCPCS C1713		6214055  -  CAGE SPNL XL XW 55X26X14MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6214060	SUP	HCPCS C1713		6214060  -  CAGE SPNL XL XW 60X26X14MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6214145	SUP	HCPCS C1713		6214145  -  CAGE SPNL 10D XL XW 45X26X14MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6214150	SUP	HCPCS C1713		6214150  -  CAGE SPNL 10D XL XW 50X26X14MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6214155	SUP	HCPCS C1713		6214155  -  CAGE SPNL 10D XL XW 55X26X14MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6214160	SUP	HCPCS C1713		6214160  -  CAGE SPNL 10D XL XW 60X26X14MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6216045	SUP	HCPCS C1713		6216045  -  CAGE SPNL XL XW 45X26X16MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6216050	SUP	HCPCS C1713		6216050  -  CAGE SPNL XL XW 50X26X16MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6216055	SUP	HCPCS C1713		6216055  -  CAGE SPNL XL XW 55X26X16MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6216060	SUP	HCPCS C1713		6216060  -  CAGE SPNL XL XW 60X26X16MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6216145	SUP	HCPCS C1713		6216145  -  CAGE SPNL 10D XL XW 45X26X16MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6216150	SUP	HCPCS C1713		6216150  -  CAGE SPNL 10D XL XW 50X26X16MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6216155	SUP	HCPCS C1713		6216155  -  CAGE SPNL 10D XL XW 55X26X16MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6216160	SUP	HCPCS C1713		6216160  -  CAGE SPNL 10D XL XW 60X26X16MM CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6222200	SUP	Custom 27803010		6222200  -  ENDCAP 22MM RND 0 DEG OD18 TI XCORE 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6222204	SUP	Custom 27803010		6222204  -  ENDCAP 22MM RND 4 DEG OD18 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6222208	SUP	Custom 27803010		6222208  -  ENDCAP 22MM RND 8 DEG XCORE 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6223000	SUP	Custom 27803010		6223000  -  ENDCAP OD18X22X30MM 0 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6223004	SUP	HCPCS C1713		6223004  -  END CAP SPNL 4D 18MM 30MM NS 22MM X-COR 2 TI	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	"$1,420.88"	"$1,420.88"	$0.00	$0.00	$0.00	$658.10	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	"$1,556.65"	"$1,556.65"	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$494.15	$0.00	$0.00	$502.67	$0.00	$0.00	$0.00	$0.00	$0.00
6223008	SUP	Custom 27803010		6223008  -  ENDCAP OD18X22X30MM 8 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6223012	SUP	Custom 27803010		6223012  -  ENDCAP OD18X22X30MM 12 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6224000	SUP	Custom 27803010		6224000  -  ENDCAP OD18X22X40MM 0 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6224004	SUP	Custom 27803010		6224004  -  ENDCAP OD18X22X40MM 4 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6224008	SUP	Custom 27803010		6224008  -  ENDCAP OD18X22X40MM 8 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6224012	SUP	Custom 27803010		6224012  -  ENDCAP OD18X22X40MM 12 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6225000	SUP	Custom 27803010		6225000  -  ENDCAP OD18X22X50MM 0 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6225004	SUP	Custom 27803010		6225004  -  ENDCAP OD18X22X50MM 4 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6225008	SUP	Custom 27803010		6225008  -  ENDCAP OD18X22X50MM 8 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6225012	SUP	Custom 27803010		6225012  -  ENDCAP OD18X22X50MM 12 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6226000	SUP	Custom 27803010		6226000  -  ENDCAP OD18X22X60MM 0 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6226004	SUP	Custom 27803010		6226004  -  ENDCAP OD18X22X60MM 4 DEG TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6226008	SUP	Custom 27803010		6226008  -  ENDCAP OD18X22X60MM 8 DEG TI XCORE TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6226012	SUP	Custom 27803010		6226012  -  ENDCAP OD18X22X60MM 12 DEG TI OD18 TI XCORE 2	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240041	SUP	Custom 27803010		6240041  -  SPACER SPNL 11MM 14X10MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240064	SUP	Custom 27803010		6240064  -  SPACER SPNL 6MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240086	SUP	Custom 27803010		6240086  -  SPACER SPNL 16MM 18X10MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240141	SUP	Custom 27803010		6240141  -  SPACER SPNL 11MM 14X11MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240164	SUP	Custom 27803010		6240164  -  SPACER SPNL 14MM 16X11MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240186	SUP	Custom 27803010		6240186  -  SPACER SPNL 16MM 18X11MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240241	SUP	Custom 27803010		6240241  -  SPACER SPNL 12MM 11X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240264	SUP	Custom 27803010		6240264  -  SPACER SPNL 14MM 16X12MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240286	SUP	Custom 27803010		6240286  -  SPACER SPNL 16MM 18X12MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240341	SUP	Custom 27803010		6240341  -  SPACER SPNL 13MM 11X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240364	SUP	Custom 27803010		6240364  -  SPACER SPNL 14MM 16X13MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240386	SUP	Custom 27803010		6240386  -  SPACER SPNL 16MM 18X13MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240441	SUP	Custom 27803010		6240441  -  SPACER SPNL 14MM 11X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240464	SUP	Custom 27803010		6240464  -  SPACER SPNL 14MM 16X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240486	SUP	Custom 27803010		6240486  -  SPACER SPNL 16MM 18X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240541	SUP	Custom 27803010		6240541  -  SPACER SPNL 11MM 14X5MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240564	SUP	Custom 27803010		6240564  -  SPACER SPNL 5MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240586	SUP	Custom 27803010		6240586  -  SPACER SPNL 16MM 18X5MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240641	SUP	Custom 27803010		6240641  -  SPACER SPNL 11MM 14X6MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240664	SUP	Custom 27803010		6240664  -  SPACER SPNL 6MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240686	SUP	Custom 27803010		6240686  -  SPACER SPNL 16MM 18X6MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240741	SUP	Custom 27803010		6240741  -  SPACER SPNL 11MM 14X7MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240764	SUP	Custom 27803010		6240764  -  SPACER SPNL 7MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240786	SUP	Custom 27803010		6240786  -  SPACER SPNL 16MM 18X7MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240841	SUP	HCPCS C1713		6240841  -  SPACER SPNL 11MM 14X8MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6240864	SUP	Custom 27803010		6240864  -  SPACER SPNL 8MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240886	SUP	Custom 27803010		6240886  -  SPACER SPNL 16MM 18X8MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240941	SUP	Custom 27803010		6240941  -  SPACER SPNL 11MM 14X9MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240964	SUP	Custom 27803010		6240964  -  SPACER SPNL 9MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6240986	SUP	Custom 27803010		6240986  -  SPACER SPNL 16MM 18X9MM VRTSTCK CRSTN PSR PEEK-OPTM CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6241041	SUP	HCPCS C1713		6241041  -  STRUT SPNL 11MM 14X5MM VRTSTCK HDRSRB PEEK-OPTM CRV	BOTH IP/OP	"$5,445.00 "	"$4,029.30"	$0.00	"$4,356.00"	"$2,450.25"	"$2,450.25"	$0.00	$0.00	$0.00	"$1,134.87"	"$4,041.28"	"$4,041.28"	$0.00	$0.00	"$1,134.74"	$0.00	"$2,684.39"	"$2,684.39"	$0.00	"$2,722.50"	"$4,312.44"	"$4,356.00"	$0.00		$0.00	$852.14	$0.00	$0.00	$866.84	$0.00	$0.00	$0.00	$0.00	$0.00
6241064	SUP	HCPCS C1713		6241064  -  STRUT SPNL 14MM 16X5MM VRTSTCK HDRSRB PEEK-OPTM CRV	BOTH IP/OP	"$5,445.00 "	"$4,029.30"	$0.00	"$4,356.00"	"$2,450.25"	"$2,450.25"	$0.00	$0.00	$0.00	"$1,134.87"	"$4,041.28"	"$4,041.28"	$0.00	$0.00	"$1,134.74"	$0.00	"$2,684.39"	"$2,684.39"	$0.00	"$2,722.50"	"$4,312.44"	"$4,356.00"	$0.00		$0.00	$852.14	$0.00	$0.00	$866.84	$0.00	$0.00	$0.00	$0.00	$0.00
6241086	SUP	HCPCS C1713		6241086  -  STRUT SPNL 16MM 18X5MM VRTSTCK HDRSRB PEEK-OPTM CRV	BOTH IP/OP	"$5,445.00 "	"$4,029.30"	$0.00	"$4,356.00"	"$2,450.25"	"$2,450.25"	$0.00	$0.00	$0.00	"$1,134.87"	"$4,041.28"	"$4,041.28"	$0.00	$0.00	"$1,134.74"	$0.00	"$2,684.39"	"$2,684.39"	$0.00	"$2,722.50"	"$4,312.44"	"$4,356.00"	$0.00		$0.00	$852.14	$0.00	$0.00	$866.84	$0.00	$0.00	$0.00	$0.00	$0.00
6242041	SUP	HCPCS C1713		6242041  -  STRUT SPNL 11MM 14X24MM VRTSTCK HDRSRB PEEK-OPTM CRV	BOTH IP/OP	"$5,445.00 "	"$4,029.30"	$0.00	"$4,356.00"	"$2,450.25"	"$2,450.25"	$0.00	$0.00	$0.00	"$1,134.87"	"$4,041.28"	"$4,041.28"	$0.00	$0.00	"$1,134.74"	$0.00	"$2,684.39"	"$2,684.39"	$0.00	"$2,722.50"	"$4,312.44"	"$4,356.00"	$0.00		$0.00	$852.14	$0.00	$0.00	$866.84	$0.00	$0.00	$0.00	$0.00	$0.00
6242064	SUP	HCPCS C1713		6242064  -  STRUT SPNL 14MM 16X24MM VRTSTCK HDRSRB PEEK-OPTM CRV	BOTH IP/OP	"$5,445.00 "	"$4,029.30"	$0.00	"$4,356.00"	"$2,450.25"	"$2,450.25"	$0.00	$0.00	$0.00	"$1,134.87"	"$4,041.28"	"$4,041.28"	$0.00	$0.00	"$1,134.74"	$0.00	"$2,684.39"	"$2,684.39"	$0.00	"$2,722.50"	"$4,312.44"	"$4,356.00"	$0.00		$0.00	$852.14	$0.00	$0.00	$866.84	$0.00	$0.00	$0.00	$0.00	$0.00
6242086	SUP	HCPCS C1713		6242086  -  STRUT SPNL 16MM 18X24MM VRTSTCK HDRSRB PEEK-OPTM CRV	BOTH IP/OP	"$5,445.00 "	"$4,029.30"	$0.00	"$4,356.00"	"$2,450.25"	"$2,450.25"	$0.00	$0.00	$0.00	"$1,134.87"	"$4,041.28"	"$4,041.28"	$0.00	$0.00	"$1,134.74"	$0.00	"$2,684.39"	"$2,684.39"	$0.00	"$2,722.50"	"$4,312.44"	"$4,356.00"	$0.00		$0.00	$852.14	$0.00	$0.00	$866.84	$0.00	$0.00	$0.00	$0.00	$0.00
6260535	SUP	HCPCS C1713		6260535  -  SCREW BONE 5MM 35MM RPS SPNL FIX	BOTH IP/OP	"$2,122.93 "	"$1,570.97"	$0.00	"$1,698.34"	$955.32	$955.32	$0.00	$0.00	$0.00	$442.47	"$1,575.63"	"$1,575.63"	$0.00	$0.00	$442.42	$0.00	"$1,255.71"	"$1,255.71"	$0.00	"$1,061.46"	"$1,681.36"	"$1,698.34"	$0.00		$0.00	$332.24	$0.00	$0.00	$337.97	$0.00	$0.00	$0.00	$0.00	$0.00
6260540	SUP	HCPCS C1713		6260540  -  SCREW BONE 5MM 40MM RPS SPNL FIX	BOTH IP/OP	"$2,122.93 "	"$1,570.97"	$0.00	"$1,698.34"	$955.32	$955.32	$0.00	$0.00	$0.00	$442.47	"$1,575.63"	"$1,575.63"	$0.00	$0.00	$442.42	$0.00	"$1,255.71"	"$1,255.71"	$0.00	"$1,061.46"	"$1,681.36"	"$1,698.34"	$0.00		$0.00	$332.24	$0.00	$0.00	$337.97	$0.00	$0.00	$0.00	$0.00	$0.00
6260555	SUP	HCPCS C1713		6260555  -  SCREW BONE 5MM 55MM RPS SPNL FIX	BOTH IP/OP	"$2,122.93 "	"$1,570.97"	$0.00	"$1,698.34"	$955.32	$955.32	$0.00	$0.00	$0.00	$442.47	"$1,575.63"	"$1,575.63"	$0.00	$0.00	$442.42	$0.00	"$1,255.71"	"$1,255.71"	$0.00	"$1,061.46"	"$1,681.36"	"$1,698.34"	$0.00		$0.00	$332.24	$0.00	$0.00	$337.97	$0.00	$0.00	$0.00	$0.00	$0.00
6260560	SUP	HCPCS C1713		6260560  -  SCREW BONE 5MM 60MM RPS SPNL FIX	BOTH IP/OP	"$2,122.93 "	"$1,570.97"	$0.00	"$1,698.34"	$955.32	$955.32	$0.00	$0.00	$0.00	$442.47	"$1,575.63"	"$1,575.63"	$0.00	$0.00	$442.42	$0.00	"$1,255.71"	"$1,255.71"	$0.00	"$1,061.46"	"$1,681.36"	"$1,698.34"	$0.00		$0.00	$332.24	$0.00	$0.00	$337.97	$0.00	$0.00	$0.00	$0.00	$0.00
6260625	SUP	HCPCS C1713		6260625  -  SCREW BONE 6MM 25MM TECHTONIX TI SPNL	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6260630	SUP	HCPCS C1713		6260630  -  SCREW BONE 6MM 30MM TECHTONIX SPNL	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6260635	SUP	HCPCS C1713		6260635  -  SCREW BONE 6MM 35MM TECHTONIX TI SPNL LP	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6260640	SUP	HCPCS C1713		6260640  -  SCREW BONE 6MM 40MM TECHTONIX TI SPNL LP	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6260645	SUP	HCPCS C1713		6260645  -  SCREW BONE 6MM 44MM TECHTONIX TI SPNL LP	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6260650	SUP	HCPCS C1713		6260650  -  SCREW BONE 6MM 50MM TECHTONIX TI SPNL LP	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6260655	SUP	HCPCS C1713		6260655  -  SCREW BONE 6MM 55MM TECHTONIX	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6260660	SUP	HCPCS C1713		6260660  -  SCREW BONE 6MM 60MM TECHTONIX	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6262525	SUP	HCPCS C1713		6262525  -  SCREW BONE 5MM 25MM TECHTONIX TI SPNL	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6262530	SUP	HCPCS C1713		6262530  -  SCREW BONE 5MM 30MM TECHTONIX	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6262535	SUP	HCPCS C1713		6262535  -  SCREW BONE 5MM 35MM TECHTONIX TI SPNL	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6262540	SUP	HCPCS C1713		6262540  -  SCREW BONE 5MM 40MM TECHTONIX SPNL	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6262545	SUP	HCPCS C1713		6262545  -  SCREW BONE 5MM 45MM TECHTONIX SPNL	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6262550	SUP	HCPCS C1713		6262550  -  SCREW BONE 5MM 50MM TECHTONIX SPNL	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6262555	SUP	HCPCS C1713		6262555  -  SCREW BONE 5MM 55MM TECHTONIX	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6262560	SUP	HCPCS C1713		6262560  -  SCREW BONE 5MM 60MM TECHTONIX	BOTH IP/OP	"$3,232.75 "	"$2,392.24"	$0.00	"$2,586.20"	"$1,454.74"	"$1,454.74"	$0.00	$0.00	$0.00	$673.79	"$2,399.35"	"$2,399.35"	$0.00	$0.00	$673.71	$0.00	"$1,593.75"	"$1,593.75"	$0.00	"$1,616.38"	"$2,560.34"	"$2,586.20"	$0.00		$0.00	$505.93	$0.00	$0.00	$514.65	$0.00	$0.00	$0.00	$0.00	$0.00
6262600	SUP	Custom 27803010		6262600  -  ENDCAP 26MM RND 0 DEG OD18 TI XCORE 2	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6262604	SUP	Custom 27803010		6262604  -  ENDCAP 26MM RND 4 DEG OD18	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6262608	SUP	Custom 27803010		6262608  -  ENDCAP 26MM RND 8 DEG	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6271044	SUP	HCPCS C1713		6271044  -  SPACER SPNL 11MM 11X44MM STRL LF VRTSTCK CRSTN PSR STRUT	BOTH IP/OP	"$4,992.00 "	"$3,694.08"	$0.00	"$3,993.60"	"$2,246.40"	"$2,246.40"	$0.00	$0.00	$0.00	"$1,040.46"	"$3,705.06"	"$3,705.06"	$0.00	$0.00	"$1,040.33"	$0.00	"$2,461.06"	"$2,461.06"	$0.00	"$2,496.00"	"$3,953.66"	"$3,993.60"	$0.00		$0.00	$781.25	$0.00	$0.00	$794.73	$0.00	$0.00	$0.00	$0.00	$0.00
6272044	SUP	Custom 27803010		6272044  -  SPACER SPNL 11MM 14X44MM STRL LF VRTSTCK CRSTN PSR STRUT	BOTH IP/OP	"$4,992.00 "	"$3,694.08"	$0.00	"$3,993.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,705.06"	"$3,705.06"	$0.00	$0.00	"$1,040.33"	$0.00	$0.00	$0.00	$0.00	"$2,496.00"	"$3,953.66"	"$3,993.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6273044	SUP	Custom 27803010		6273044  -  SPACER SPNL 14MM 14X44MM STRL LF VRTSTCK CRSTN PSR STRUT	BOTH IP/OP	"$4,992.00 "	"$3,694.08"	$0.00	"$3,993.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,705.06"	"$3,705.06"	$0.00	$0.00	"$1,040.33"	$0.00	$0.00	$0.00	$0.00	"$2,496.00"	"$3,953.66"	"$3,993.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6276011	SUP	HCPCS C1713		6276011  -  SPACER SPNL 11MM 11X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6276025	SUP	HCPCS C1713		6276025  -  SPACER SPNL 11MM 11X25MM STRL LF VRTSTCK CRSTN PSR STRUT	BOTH IP/OP	"$4,992.00 "	"$3,694.08"	$0.00	"$3,993.60"	"$2,246.40"	"$2,246.40"	$0.00	$0.00	$0.00	"$1,040.46"	"$3,705.06"	"$3,705.06"	$0.00	$0.00	"$1,040.33"	$0.00	"$2,461.06"	"$2,461.06"	$0.00	"$2,496.00"	"$3,953.66"	"$3,993.60"	$0.00		$0.00	$781.25	$0.00	$0.00	$794.73	$0.00	$0.00	$0.00	$0.00	$0.00
6276111	SUP	HCPCS C1713		6276111  -  SPACER SPNL 11MM 11X11MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6276211	SUP	HCPCS C1713		6276211  -  SPACER SPNL 12MM 11X12MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6276311	SUP	HCPCS C1713		6276311  -  SPACER SPNL 11MM 11X13MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6276411	SUP	HCPCS C1713		6276411  -  SPACER SPNL 11MM 11X4MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6276511	SUP	HCPCS C1713		6276511  -  SPACER SPNL 11MM 11X5MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6276611	SUP	HCPCS C1713		6276611  -  SPACER SPNL 11MM 11X6MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6276711	SUP	HCPCS C1713		6276711  -  SPACER SPNL 11MM 11X7MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6276811	SUP	HCPCS C1713		6276811  -  SPACER SPNL 11MM 11X8MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6276911	SUP	HCPCS C1713		6276911  -  SPACER SPNL 11MM 11X9MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6277006	SUP	HCPCS C1713		6277006  -  SPACER SPNL 11MM 14X6MM STRL LF VRTSTCK CRSTN PSR STRUT	BOTH IP/OP	"$4,992.00 "	"$3,694.08"	$0.00	"$3,993.60"	"$2,246.40"	"$2,246.40"	$0.00	$0.00	$0.00	"$1,040.46"	"$3,705.06"	"$3,705.06"	$0.00	$0.00	"$1,040.33"	$0.00	"$2,461.06"	"$2,461.06"	$0.00	"$2,496.00"	"$3,953.66"	"$3,993.60"	$0.00		$0.00	$781.25	$0.00	$0.00	$794.73	$0.00	$0.00	$0.00	$0.00	$0.00
6277025	SUP	Custom 27803010		6277025  -  SPACER SPNL 11MM 14X25MM STRL LF VRTSTCK CRSTN PSR STRUT	BOTH IP/OP	"$4,992.00 "	"$3,694.08"	$0.00	"$3,993.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,705.06"	"$3,705.06"	$0.00	$0.00	"$1,040.33"	$0.00	$0.00	$0.00	$0.00	"$2,496.00"	"$3,953.66"	"$3,993.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6277041	SUP	HCPCS C1713		6277041  -  SPACER SPNL 11MM 14X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6277141	SUP	HCPCS C1713		6277141  -  SPACER SPNL 11MM 14X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6277241	SUP	Custom 27803010		6277241  -  SPACER SPNL 11MM 14X12MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6277341	SUP	Custom 27803010		6277341  -  SPACER SPNL 11MM 14X13MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6277441	SUP	Custom 27803010		6277441  -  SPACER SPNL 11MM 14X4MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6277541	SUP	HCPCS C1713		6277541  -  SPACER SPNL 11MM 14X5MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6277641	SUP	HCPCS C1713		6277641  -  SPACER SPNL 11MM 14X6MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6277741	SUP	HCPCS C1713		6277741  -  SPACER SPNL 11MM 14X7MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6277841	SUP	HCPCS C1713		6277841  -  SPACER SPNL 11MM 14X8MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6277941	SUP	HCPCS C1713		6277941  -  SPACER SPNL 11MM 14X9MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6278006	SUP	Custom 27803010		6278006  -  SPACER SPNL 14MM 14X6MM STRL LF VRTSTCK CRSTN PSR STRUT	BOTH IP/OP	"$4,992.00 "	"$3,694.08"	$0.00	"$3,993.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,705.06"	"$3,705.06"	$0.00	$0.00	"$1,040.33"	$0.00	$0.00	$0.00	$0.00	"$2,496.00"	"$3,953.66"	"$3,993.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6278025	SUP	Custom 27803010		6278025  -  SPACER SPNL 14MM 14X25MM STRL LF VRTSTCK CRSTN PSR STRUT	BOTH IP/OP	"$4,992.00 "	"$3,694.08"	$0.00	"$3,993.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,705.06"	"$3,705.06"	$0.00	$0.00	"$1,040.33"	$0.00	$0.00	$0.00	$0.00	"$2,496.00"	"$3,953.66"	"$3,993.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6278044	SUP	Custom 27803010		6278044  -  SPACER SPNL 14MM 14X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6278144	SUP	Custom 27803010		6278144  -  SPACER SPNL 14MM 14X11MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6278244	SUP	Custom 27803010		6278244  -  SPACER SPNL 14MM 14X12MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6278344	SUP	Custom 27803010		6278344  -  SPACER SPNL 14MM 14X13MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6278444	SUP	Custom 27803010		6278444  -  SPACER SPNL 14MM 14X4MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6278544	SUP	Custom 27803010		6278544  -  SPACER SPNL 14MM 14X5MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6278644	SUP	Custom 27803010		6278644  -  SPACER SPNL 14MM 14X6MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6278744	SUP	Custom 27803010		6278744  -  SPACER SPNL 14MM 14X7MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6278844	SUP	Custom 27803010		6278844  -  SPACER SPNL 14MM 14X8MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6278944	SUP	Custom 27803010		6278944  -  SPACER SPNL 14MM 14X9MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6284011	SUP	HCPCS C1713		6284011  -  SPACER SPNL 11MM 11X10MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284041	SUP	HCPCS C1713		6284041  -  SPACER SPNL 11MM 14X10MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284044	SUP	HCPCS C1713		6284044  -  SPACER SPNL 14MM 14X10MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284111	SUP	HCPCS C1713		6284111  -  SPACER SPNL 11MM 11X11MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284141	SUP	HCPCS C1713		6284141  -  SPACER SPNL 11MM 14X11MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284144	SUP	HCPCS C1713		6284144  -  SPACER SPNL 14MM 14X11MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284211	SUP	HCPCS C1713		6284211  -  SPACER SPNL 11MM 11X12MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284241	SUP	HCPCS C1713		6284241  -  SPACER SPNL 11MM 14X12MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284244	SUP	HCPCS C1713		6284244  -  SPACER SPNL 14MM 14X12MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284311	SUP	HCPCS C1713		6284311  -  SPACER SPNL 11MM 11X13MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284511	SUP	HCPCS C1713		6284511  -  SPACER SPNL 11MM 11X5MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284541	SUP	HCPCS C1713		6284541  -  SPACER SPNL 11MM 14X5MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284544	SUP	HCPCS C1713		6284544  -  SPACER SPNL 14MM 14X5MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284611	SUP	HCPCS C1713		6284611  -  SPACER SPNL 11MM 11X6MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284641	SUP	HCPCS C1713		6284641  -  SPACER SPNL 11MM 14X6MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284644	SUP	HCPCS C1713		6284644  -  SPACER SPNL 14MM 14X6MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284711	SUP	HCPCS C1713		6284711  -  SPACER SPNL 11MM 11X7MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284741	SUP	HCPCS C1713		6284741  -  SPACER SPNL 11MM 14X7MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284744	SUP	HCPCS C1713		6284744  -  SPACER SPNL 14MM 14X7MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284811	SUP	HCPCS C1713		6284811  -  SPACER SPNL 11MM 11X8MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284841	SUP	HCPCS C1713		6284841  -  SPACER SPNL 11MM 14X8MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284844	SUP	HCPCS C1713		6284844  -  SPACER SPNL 14MM 14X8MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284911	SUP	HCPCS C1713		6284911  -  SPACER SPNL 11MM 11X9MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284941	SUP	HCPCS C1713		6284941  -  SPACER SPNL 11MM 14X9MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6284944	SUP	HCPCS C1713		6284944  -  SPACER SPNL 14MM 14X9MM CRSTN PSR PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6286011	SUP	HCPCS C1713		6286011  -  SPACER SPNL 11MM 11X10MM VRTSTCK CRSTN PSR LAT PORT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6286111	SUP	HCPCS C1713		6286111  -  SPACER SPNL 11MM 11X11MM VRTSTCK CRSTN PSR LAT PORT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6286211	SUP	HCPCS C1713		6286211  -  SPACER SPNL 11MM 11X12MM VRTSTCK CRSTN PSR LAT PORT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6286311	SUP	HCPCS C1713		6286311  -  SPACER SPNL 11MM 11X13MM VRTSTCK CRSTN PSR LAT PORT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6286511	SUP	HCPCS C1713		6286511  -  SPACER SPNL 11MM 11X5MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6286611	SUP	HCPCS C1713		6286611  -  SPACER SPNL 11MM 11X6MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6286711	SUP	HCPCS C1713		6286711  -  SPACER SPNL 11MM 11X7MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6286811	SUP	HCPCS C1713		6286811  -  SPACER SPNL 11MM 11X8MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6286911	SUP	HCPCS C1713		6286911  -  SPACER SPNL 11MM 11X9MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6287041	SUP	HCPCS C1713		6287041  -  SPACER SPNL 11MM 14X10MM VRTSTCK CRSTN PSR LAT PORT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6287141	SUP	HCPCS C1713		6287141  -  SPACER SPNL 11MM 14X11MM VRTSTCK CRSTN PSR LAT PORT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6287241	SUP	HCPCS C1713		6287241  -  SPACER SPNL 11MM 14X12MM VRTSTCK CRSTN PSR LAT PORT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6287341	SUP	HCPCS C1713		6287341  -  SPACER SPNL 11MM 14X13MM VRTSTCK CRSTN PSR LAT PORT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6287541	SUP	HCPCS C1713		6287541  -  SPACER SPNL 11MM 14X5MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6287641	SUP	HCPCS C1713		6287641  -  SPACER SPNL 11MM 14X6MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6287741	SUP	HCPCS C1713		6287741  -  SPACER SPNL 11MM 14X7MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6287841	SUP	HCPCS C1713		6287841  -  SPACER SPNL 11MM 14X8MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6287941	SUP	HCPCS C1713		6287941  -  SPACER SPNL 11MM 14X9MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6288044	SUP	HCPCS C1713		6288044  -  SPACER SPNL 14MM 14X10MM VRTSTCK CRSTN PSR LAT PORT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6288144	SUP	HCPCS C1713		6288144  -  SPACER SPNL 14MM 14X11MM VRTSTCK CRSTN PSR LAT PORT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6288244	SUP	HCPCS C1713		6288244  -  SPACER SPNL 14MM 14X12MM VRTSTCK CRSTN PSR LAT PORT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6288344	SUP	HCPCS C1713		6288344  -  SPACER SPNL 14MM 14X13MM VRTSTCK CRSTN PSR LAT PORT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6288544	SUP	HCPCS C1713		6288544  -  SPACER SPNL 14MM 14X5MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6288644	SUP	HCPCS C1713		6288644  -  SPACER SPNL 14MM 14X6MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6288744	SUP	HCPCS C1713		6288744  -  SPACER SPNL 14MM 14X7MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6288844	SUP	HCPCS C1713		6288844  -  SPACER SPNL 14MM 14X8MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6288944	SUP	HCPCS C1713		6288944  -  SPACER SPNL 14MM 14X9MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6300240	SUP	HCPCS C1713		6300240  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X2MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300245	SUP	HCPCS C1713		6300245  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X2MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300250	SUP	HCPCS C1713		6300250  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X2MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300255	SUP	HCPCS C1713		6300255  -  CAGE SPNL 30D XL HYPERLORDOTIC 55X22X2MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300260	SUP	HCPCS C1713		6300260  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X2MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300265	SUP	HCPCS C1713		6300265  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X2MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300440	SUP	HCPCS C1713		6300440  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X4MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300445	SUP	HCPCS C1713		6300445  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X4MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300450	SUP	HCPCS C1713		6300450  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X4MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300455	SUP	HCPCS C1713		6300455  -  CAGE SPNL 30D XL HYPERLORDOTIC 55X22X4MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300460	SUP	HCPCS C1713		6300460  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X4MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300465	SUP	HCPCS C1713		6300465  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X4MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300640	SUP	HCPCS C1713		6300640  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X6MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300645	SUP	HCPCS C1713		6300645  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X6MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300650	SUP	HCPCS C1713		6300650  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X6MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300655	SUP	HCPCS C1713		6300655  -  CAGE SPNL 30D LRDTC HI	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300660	SUP	HCPCS C1713		6300660  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X6MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300665	SUP	HCPCS C1713		6300665  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X6MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300840	SUP	HCPCS C1713		6300840  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X8MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300845	SUP	HCPCS C1713		6300845  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X8MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300850	SUP	HCPCS C1713		6300850  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X8MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300855	SUP	HCPCS C1713		6300855  -  CAGE SPNL 30D XL HYPERLORDOTIC 55X22X8MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300860	SUP	HCPCS C1713		6300860  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X8MM NS LF CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6300865	SUP	HCPCS C1713		6300865  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X8MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6301040	SUP	HCPCS C1713		6301040  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X10MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6301045	SUP	HCPCS C1713		6301045  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X10MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6301050	SUP	HCPCS C1713		6301050  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X10MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6301055	SUP	HCPCS C1713		6301055  -  CAGE SPNL 30D XL HYPERLORDOTIC 55X22X10MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6301060	SUP	HCPCS C1713		6301060  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X10MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6301065	SUP	HCPCS C1713		6301065  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X10MM CRNT	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6360032	SUP	HCPCS C1713		6360032  -  SPACER SPNL XS 13X12X10MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360053	SUP	HCPCS C1713		6360053  -  SPACER SPNL XS 15X13X10MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360132	SUP	HCPCS C1713		6360132  -  SPACER SPNL XS 13X12X11MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360153	SUP	HCPCS C1713		6360153  -  SPACER SPNL XS 15X13X11MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360232	SUP	HCPCS C1713		6360232  -  SPACER SPNL XS 13X12X12MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360253	SUP	HCPCS C1713		6360253  -  SPACER SPNL XS 15X13X12MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360532	SUP	HCPCS C1713		6360532  -  SPACER SPNL XS 13X12X5MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360553	SUP	HCPCS C1713		6360553  -  SPACER SPNL XS 15X13X5MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360632	SUP	HCPCS C1713		6360632  -  SPACER SPNL XS 13X12X6MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360653	SUP	HCPCS C1713		6360653  -  SPACER SPNL XS 15X6X3MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360732	SUP	HCPCS C1713		6360732  -  SPACER SPNL XS 13X12X7MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360753	SUP	HCPCS C1713		6360753  -  SPACER SPNL XS 15X13X7MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360832	SUP	HCPCS C1713		6360832  -  SPACER SPNL XS 13X12X8MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360853	SUP	HCPCS C1713		6360853  -  SPACER SPNL XS 15X13X8MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360932	SUP	HCPCS C1713		6360932  -  SPACER SPNL XS 13X12X9MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6360953	SUP	HCPCS C1713		6360953  -  SPACER SPNL XS 15X13X9MM PRIMTR C PEEK-OPTM CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6390206	SUP	Custom 27803010		6390206  -  CAGE SPNL CYL LRDTC TPR 6MM 12MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390207	SUP	Custom 27803010		6390207  -  CAGE SPNL CYL LRDTC TPR 7MM 12MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390208	SUP	Custom 27803010		6390208  -  CAGE SPNL CYL LRDTC TPR 8MM 12MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390209	SUP	Custom 27803010		6390209  -  CAGE SPNL CYL LRDTC TPR 9MM 12MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390210	SUP	Custom 27803010		6390210  -  CAGE SPNL CYL LRDTC TPR 10MM 12MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390211	SUP	Custom 27803010		6390211  -  CAGE SPNL CYL LRDTC TPR 11MM 12MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390212	SUP	Custom 27803010		6390212  -  CAGE SPNL CYL LRDTC TPR 12MM 12MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390406	SUP	Custom 27803010		6390406  -  CAGE SPNL CYL LRDTC TPR 6MM 14MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390407	SUP	Custom 27803010		6390407  -  CAGE SPNL CYL LRDTC TPR 7MM 14MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390408	SUP	Custom 27803010		6390408  -  CAGE SPNL CYL LRDTC TPR 8MM 14MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390409	SUP	Custom 27803010		6390409  -  CAGE SPNL CYL LRDTC TPR 9MM 14MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390410	SUP	Custom 27803010		6390410  -  CAGE SPNL CYL LRDTC TPR 10MM 14MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390411	SUP	Custom 27803010		6390411  -  CAGE SPNL CYL LRDTC TPR 11MM 14MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6390412	SUP	Custom 27803010		6390412  -  CAGE SPNL CYL LRDTC TPR 12MM 14MM AFF CLS CHMFR EDG MLT THR	BOTH IP/OP	"$6,988.50 "	"$5,171.49"	$0.00	"$5,590.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,456.40"	$0.00	$0.00	$0.00	$0.00	"$3,494.25"	"$5,534.89"	"$5,590.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6430530	SUP	HCPCS C1713		6430530  -  SCREW SET TI 4.75MM SPN PERC SOLERA CD HZN STRL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
6440530	SUP	HCPCS C1713		6440530  -  SET SCREW 6440530 4.75 SOLERA PERC TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
6470314	SUP	Custom 27203010		"6470314  -  BRYAN CERVICAL DISC, 14MM"	BOTH IP/OP	"$8,850.00 "	"$6,549.00"	$0.00	"$7,080.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,844.34"	$0.00	$0.00	$0.00	$0.00	"$4,425.00"	"$7,009.20"	"$7,080.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6470315	SUP	Custom 27803010		6470315  -  DISK SPINAL MOTION BRYAN 15MM CERV	BOTH IP/OP	"$8,850.00 "	"$6,549.00"	$0.00	"$7,080.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,844.34"	$0.00	$0.00	$0.00	$0.00	"$4,425.00"	"$7,009.20"	"$7,080.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6474024	SUP	HCPCS C1713		6474024  -  PIN DISTRACTION 14MM 3.5MM REUSABLE	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
6474176	SUP	Custom 27203010		6474176  -  BIT DRILL SPN	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6474524	SUP	Custom 27203010		6474524  -  BRYAN DISC CUTTER 14MM	BOTH IP/OP	"$1,350.00 "	$999.00	$0.00	"$1,080.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,001.97"	"$1,001.97"	$0.00	$0.00	$281.34	$0.00	$0.00	$0.00	$0.00	$675.00	"$1,069.20"	"$1,080.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6533131	SUP	HCPCS C1713		6533131  -  END CAP SPNL 0D 30X18MM VBR EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6533141	SUP	HCPCS C1713		6533141  -  END CAP SPNL 0D 40X18MM VBR EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6533151	SUP	HCPCS C1713		6533151  -  CAGE SPNL 0D 50X18MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6533231	SUP	HCPCS C1713		6533231  -  END CAP SPNL 4D 30X18MM VBR EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6533241	SUP	HCPCS C1713		6533241  -  CAGE SPNL 4D 40X18MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6533251	SUP	HCPCS C1713		6533251  -  END CAP SPNL 4D 50X18MM VBR EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6533331	SUP	HCPCS C1713		6533331  -  CAGE SPNL 8D 30X18MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6533341	SUP	HCPCS C1713		6533341  -  CAGE SPNL 8D 40X18MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6533351	SUP	HCPCS C1713		6533351  -  CAGE SPNL 8D 50X18MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6533431	SUP	HCPCS C1713		6533431  -  END CAP SPNL -4D 30X18MM VBR EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6533441	SUP	HCPCS C1713		6533441  -  CAGE SPNL -4D 40X18MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6533451	SUP	HCPCS C1713		6533451  -  CAGE SPNL -4D 50X18MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6535241	SUP	HCPCS C1713		6535241  -  CAGE SPNL 0D 40X22MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6535251	SUP	HCPCS C1713		6535251  -  CAGE SPNL 0D 50X22MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6535261	SUP	HCPCS C1713		6535261  -  CAGE SPNL 0D 60X22MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6535341	SUP	HCPCS C1713		6535341  -  CAGE SPNL 4D 40X22MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6535351	SUP	HCPCS C1713		6535351  -  CAGE SPNL 4D 50X22MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6535361	SUP	HCPCS C1713		6535361  -  CAGE SPNL 4D 60X22MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6535441	SUP	HCPCS C1713		6535441  -  CAGE SPNL 8D 40X22MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6535451	SUP	HCPCS C1713		6535451  -  CAGE SPNL 8D 50X22MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6535461	SUP	HCPCS C1713		6535461  -  CAGE SPNL 8D 60X22MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6535541	SUP	HCPCS C1713		6535541  -  CAGE SPNL 12D 40X22MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6535551	SUP	HCPCS C1713		6535551  -  CAGE SPNL 12D 50X22MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6535561	SUP	HCPCS C1713		6535561  -  CAGE SPNL 12D 60X22MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$3,740.00 "	"$2,767.60"	$0.00	"$2,992.00"	"$1,683.00"	"$1,683.00"	$0.00	$0.00	$0.00	$779.51	"$2,775.83"	"$2,775.83"	$0.00	$0.00	$779.42	$0.00	"$1,843.82"	"$1,843.82"	$0.00	"$1,870.00"	"$2,962.08"	"$2,992.00"	$0.00		$0.00	$585.31	$0.00	$0.00	$595.41	$0.00	$0.00	$0.00	$0.00	$0.00
6537124	SUP	HCPCS C1713		6537124  -  END CAP SPNL 0D RND 18MM 22MM VBR EXPANDABLE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	"$1,058.63"	"$1,058.63"	$0.00	$0.00	$0.00	$490.32	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	"$1,391.50"	"$1,391.50"	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$368.17	$0.00	$0.00	$374.52	$0.00	$0.00	$0.00	$0.00	$0.00
6537125	SUP	HCPCS C1713		6537125  -  CAGE SPNL 0D RND 18MM 26MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	"$1,058.63"	"$1,058.63"	$0.00	$0.00	$0.00	$490.32	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	"$1,391.50"	"$1,391.50"	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$368.17	$0.00	$0.00	$374.52	$0.00	$0.00	$0.00	$0.00	$0.00
6537134	SUP	HCPCS C1713		6537134  -  END CAP SPNL 8D RND 18MM 22MM VBR EXPANDABLE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	"$1,058.63"	"$1,058.63"	$0.00	$0.00	$0.00	$490.32	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	"$1,391.50"	"$1,391.50"	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$368.17	$0.00	$0.00	$374.52	$0.00	$0.00	$0.00	$0.00	$0.00
6537135	SUP	HCPCS C1713		6537135  -  CAGE SPNL 8D RND 18MM 26MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	"$1,058.63"	"$1,058.63"	$0.00	$0.00	$0.00	$490.32	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	"$1,391.50"	"$1,391.50"	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$368.17	$0.00	$0.00	$374.52	$0.00	$0.00	$0.00	$0.00	$0.00
6537225	SUP	HCPCS C1713		6537225  -  CAGE SPNL 0D RND 22MM 26MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	"$1,058.63"	"$1,058.63"	$0.00	$0.00	$0.00	$490.32	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	"$1,391.50"	"$1,391.50"	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$368.17	$0.00	$0.00	$374.52	$0.00	$0.00	$0.00	$0.00	$0.00
6537226	SUP	HCPCS C1713		6537226  -  CAGE SPNL 0D RND 22MM 30MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	"$1,058.63"	"$1,058.63"	$0.00	$0.00	$0.00	$490.32	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	"$1,391.50"	"$1,391.50"	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$368.17	$0.00	$0.00	$374.52	$0.00	$0.00	$0.00	$0.00	$0.00
6537235	SUP	HCPCS C1713		6537235  -  CAGE SPNL 8D RND 18MM 26MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	"$1,058.63"	"$1,058.63"	$0.00	$0.00	$0.00	$490.32	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	"$1,391.50"	"$1,391.50"	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$368.17	$0.00	$0.00	$374.52	$0.00	$0.00	$0.00	$0.00	$0.00
6537236	SUP	HCPCS C1713		6537236  -  CAGE SPNL 8D RND 22MM 30MM VBR ENDCP EXPANDABLE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	"$1,058.63"	"$1,058.63"	$0.00	$0.00	$0.00	$490.32	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	"$1,391.50"	"$1,391.50"	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$368.17	$0.00	$0.00	$374.52	$0.00	$0.00	$0.00	$0.00	$0.00
6539001	SUP	HCPCS C1713		6539001  -  SCREW BN SM VBR EXPANDABLE LCK SPNE	BOTH IP/OP	$620.00 	$458.80	$0.00	$496.00	$279.00	$279.00	$0.00	$0.00	$0.00	$129.22	$460.16	$460.16	$0.00	$0.00	$129.21	$0.00	$366.73	$366.73	$0.00	$310.00	$491.04	$496.00	$0.00		$0.00	$97.03	$0.00	$0.00	$98.70	$0.00	$0.00	$0.00	$0.00	$0.00
6539002	SUP	HCPCS C1713		6539002  -  SCREW BN LG VBR LCK EXPANDABLE SPNE	BOTH IP/OP	$620.00 	$458.80	$0.00	$496.00	$279.00	$279.00	$0.00	$0.00	$0.00	$129.22	$460.16	$460.16	$0.00	$0.00	$129.21	$0.00	$366.73	$366.73	$0.00	$310.00	$491.04	$496.00	$0.00		$0.00	$97.03	$0.00	$0.00	$98.70	$0.00	$0.00	$0.00	$0.00	$0.00
6540530	SUP	HCPCS C1713		6540530  -  SCREW SET 5.5/6MM NS LF CD HZN SOLERAL VYGR	BOTH IP/OP	$912.50 	$675.25	$0.00	$730.00	$410.63	$410.63	$0.00	$0.00	$0.00	$190.19	$677.26	$677.26	$0.00	$0.00	$190.17	$0.00	$539.74	$539.74	$0.00	$456.25	$722.70	$730.00	$0.00		$0.00	$142.81	$0.00	$0.00	$145.27	$0.00	$0.00	$0.00	$0.00	$0.00
6541019	SUP	HCPCS C1713		6541019  -  STAPLE 6541019 19MM ROSTRAL	BOTH IP/OP	"$2,932.13 "	"$2,169.78"	$0.00	"$2,345.70"	"$1,319.46"	"$1,319.46"	$0.00	$0.00	$0.00	$611.13	"$2,176.22"	"$2,176.22"	$0.00	$0.00	$611.05	$0.00	"$1,445.54"	"$1,445.54"	$0.00	"$1,466.06"	"$2,322.25"	"$2,345.70"	$0.00		$0.00	$458.88	$0.00	$0.00	$466.79	$0.00	$0.00	$0.00	$0.00	$0.00
6541021	SUP	HCPCS C1713		6541021  -  STAPLE 6541021 21MM ROSTRAL	BOTH IP/OP	"$2,932.13 "	"$2,169.78"	$0.00	"$2,345.70"	"$1,319.46"	"$1,319.46"	$0.00	$0.00	$0.00	$611.13	"$2,176.22"	"$2,176.22"	$0.00	$0.00	$611.05	$0.00	"$1,445.54"	"$1,445.54"	$0.00	"$1,466.06"	"$2,322.25"	"$2,345.70"	$0.00		$0.00	$458.88	$0.00	$0.00	$466.79	$0.00	$0.00	$0.00	$0.00	$0.00
6541023	SUP	HCPCS C1713		6541023  -  STAPLE 6541023 23MM ROSTRAL	BOTH IP/OP	"$2,932.13 "	"$2,169.78"	$0.00	"$2,345.70"	"$1,319.46"	"$1,319.46"	$0.00	$0.00	$0.00	$611.13	"$2,176.22"	"$2,176.22"	$0.00	$0.00	$611.05	$0.00	"$1,445.54"	"$1,445.54"	$0.00	"$1,466.06"	"$2,322.25"	"$2,345.70"	$0.00		$0.00	$458.88	$0.00	$0.00	$466.79	$0.00	$0.00	$0.00	$0.00	$0.00
6541025	SUP	HCPCS C1713		6541025  -  STAPLE 6541025 25MM ROSTRAL	BOTH IP/OP	"$2,932.13 "	"$2,169.78"	$0.00	"$2,345.70"	"$1,319.46"	"$1,319.46"	$0.00	$0.00	$0.00	$611.13	"$2,176.22"	"$2,176.22"	$0.00	$0.00	$611.05	$0.00	"$1,445.54"	"$1,445.54"	$0.00	"$1,466.06"	"$2,322.25"	"$2,345.70"	$0.00		$0.00	$458.88	$0.00	$0.00	$466.79	$0.00	$0.00	$0.00	$0.00	$0.00
6541119	SUP	HCPCS C1713		6541119  -  STAPLE 6541119 19MM CAUDAL	BOTH IP/OP	"$2,932.13 "	"$2,169.78"	$0.00	"$2,345.70"	"$1,319.46"	"$1,319.46"	$0.00	$0.00	$0.00	$611.13	"$2,176.22"	"$2,176.22"	$0.00	$0.00	$611.05	$0.00	"$1,445.54"	"$1,445.54"	$0.00	"$1,466.06"	"$2,322.25"	"$2,345.70"	$0.00		$0.00	$458.88	$0.00	$0.00	$466.79	$0.00	$0.00	$0.00	$0.00	$0.00
6541121	SUP	HCPCS C1713		6541121  -  STAPLE 6541121 21MM CAUDAL	BOTH IP/OP	"$2,932.13 "	"$2,169.78"	$0.00	"$2,345.70"	"$1,319.46"	"$1,319.46"	$0.00	$0.00	$0.00	$611.13	"$2,176.22"	"$2,176.22"	$0.00	$0.00	$611.05	$0.00	"$1,445.54"	"$1,445.54"	$0.00	"$1,466.06"	"$2,322.25"	"$2,345.70"	$0.00		$0.00	$458.88	$0.00	$0.00	$466.79	$0.00	$0.00	$0.00	$0.00	$0.00
6541123	SUP	HCPCS C1713		6541123  -  STAPLE 6541123 23MM CAUDAL	BOTH IP/OP	"$2,932.13 "	"$2,169.78"	$0.00	"$2,345.70"	"$1,319.46"	"$1,319.46"	$0.00	$0.00	$0.00	$611.13	"$2,176.22"	"$2,176.22"	$0.00	$0.00	$611.05	$0.00	"$1,445.54"	"$1,445.54"	$0.00	"$1,466.06"	"$2,322.25"	"$2,345.70"	$0.00		$0.00	$458.88	$0.00	$0.00	$466.79	$0.00	$0.00	$0.00	$0.00	$0.00
6541125	SUP	HCPCS C1713		6541125  -  STAPLE 6541125 25MM CAUDAL	BOTH IP/OP	"$2,932.13 "	"$2,169.78"	$0.00	"$2,345.70"	"$1,319.46"	"$1,319.46"	$0.00	$0.00	$0.00	$611.13	"$2,176.22"	"$2,176.22"	$0.00	$0.00	$611.05	$0.00	"$1,445.54"	"$1,445.54"	$0.00	"$1,466.06"	"$2,322.25"	"$2,345.70"	$0.00		$0.00	$458.88	$0.00	$0.00	$466.79	$0.00	$0.00	$0.00	$0.00	$0.00
6541213	SUP	HCPCS C1713		6541213  -  STAPLE 6541213 SINGLE 13MM	BOTH IP/OP	"$1,465.50 "	"$1,084.47"	$0.00	"$1,172.40"	$659.48	$659.48	$0.00	$0.00	$0.00	$305.45	"$1,087.69"	"$1,087.69"	$0.00	$0.00	$305.41	$0.00	$866.84	$866.84	$0.00	$732.75	"$1,160.68"	"$1,172.40"	$0.00		$0.00	$229.35	$0.00	$0.00	$233.31	$0.00	$0.00	$0.00	$0.00	$0.00
6541215	SUP	HCPCS C1713		6541215  -  STAPLE 6541215 SINGLE 15MM	BOTH IP/OP	"$1,465.50 "	"$1,084.47"	$0.00	"$1,172.40"	$659.48	$659.48	$0.00	$0.00	$0.00	$305.45	"$1,087.69"	"$1,087.69"	$0.00	$0.00	$305.41	$0.00	$866.84	$866.84	$0.00	$732.75	"$1,160.68"	"$1,172.40"	$0.00		$0.00	$229.35	$0.00	$0.00	$233.31	$0.00	$0.00	$0.00	$0.00	$0.00
6541217	SUP	HCPCS C1713		6541217  -  STAPLE 6541217 SINGLE 17MM	BOTH IP/OP	"$1,465.50 "	"$1,084.47"	$0.00	"$1,172.40"	$659.48	$659.48	$0.00	$0.00	$0.00	$305.45	"$1,087.69"	"$1,087.69"	$0.00	$0.00	$305.41	$0.00	$866.84	$866.84	$0.00	$732.75	"$1,160.68"	"$1,172.40"	$0.00		$0.00	$229.35	$0.00	$0.00	$233.31	$0.00	$0.00	$0.00	$0.00	$0.00
6543420	SUP	HCPCS C1713		6543420  -  SCREW 6543420 4.5MM FAS FOR 5.5 20MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543425	SUP	HCPCS C1713		6543425  -  SCREW 6543425 4.5MM FAS FOR 5.5 25MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543430	SUP	HCPCS C1713		6543430  -  SCREW 6543430 4.5MM FAS FOR 5.5 30MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543435	SUP	HCPCS C1713		6543435  -  SCREW 6543435 4.5MM FAS FOR 5.5 35MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543440	SUP	HCPCS C1713		6543440  -  SCREW 6543440 4.5MM FAS FOR 5.5 40MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543445	SUP	HCPCS C1713		6543445  -  SCREW 6543445 4.5MM FAS FOR 5.5 45MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543450	SUP	HCPCS C1713		6543450  -  SCREW 6543450 4.5MM FAS FOR 5.5 50MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543520	SUP	HCPCS C1713		6543520  -  SCREW 6543520 5.5MM FAS FOR 5.5 20MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543525	SUP	HCPCS C1713		6543525  -  SCREW 6543525 5.5MM FAS FOR 5.5 25MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543530	SUP	HCPCS C1713		6543530  -  SCREW 6543530 5.5MM FAS FOR 5.5 30MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543535	SUP	HCPCS C1713		6543535  -  SCREW 6543535 5.5MM FAS FOR 5.5 35MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543540	SUP	HCPCS C1713		6543540  -  SCREW 6543540 5.5MM FAS FOR 5.5 40MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543545	SUP	HCPCS C1713		6543545  -  SCREW 6543545 5.5MM FAS FOR 5.5 45MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543550	SUP	HCPCS C1713		6543550  -  SCREW 6543550 5.5MM FAS FOR 5.5 50MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543620	SUP	HCPCS C1713		6543620  -  SCREW 6543620 6.5MM FAS FOR 5.5 20MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543625	SUP	HCPCS C1713		6543625  -  SCREW 6543625 6.5MM FAS FOR 5.5 25MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543630	SUP	HCPCS C1713		6543630  -  SCREW 6543630 6.5MM FAS FOR 5.5 30MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543635	SUP	HCPCS C1713		6543635  -  SCREW 6543635 6.5MM FAS FOR 5.5 35MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543640	SUP	HCPCS C1713		6543640  -  SCREW 6543640 6.5MM FAS FOR 5.5 40MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543645	SUP	HCPCS C1713		6543645  -  SCREW 6543645 6.5MM FAS FOR 5.5 45MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543650	SUP	HCPCS C1713		6543650  -  SCREW 6543650 6.5MM FAS FOR 5.5 50MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543655	SUP	HCPCS C1713		6543655  -  SCREW 6543655 6.5MM FAS FOR 5.5 55MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543660	SUP	HCPCS C1713		6543660  -  SCREW 6543660 6.5MM FAS FOR 5.5 60MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543720	SUP	HCPCS C1713		6543720  -  SCREW 6543720 7.5MM FAS FOR 5.5 20MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543725	SUP	HCPCS C1713		6543725  -  SCREW 6543725 7.5MM FAS FOR 5.5 25MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543730	SUP	HCPCS C1713		6543730  -  SCREW 6543730 7.5MM FAS FOR 5.5 30MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543735	SUP	HCPCS C1713		6543735  -  SCREW 6543735 7.5MM FAS FOR 5.5 35MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543740	SUP	HCPCS C1713		6543740  -  SCREW 6543740 7.5MM FAS FOR 5.5 40MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543745	SUP	HCPCS C1713		6543745  -  SCREW 6543745 7.5MM FAS FOR 5.5 45MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543750	SUP	HCPCS C1713		6543750  -  SCREW 6543750 7.5MM FAS FOR 5.5 50MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543755	SUP	HCPCS C1713		6543755  -  SCREW 6543755 7.5MM FAS FOR 5.5 55MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543760	SUP	HCPCS C1713		6543760  -  SCREW 6543760 7.5MM FAS FOR 5.5 60MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543820	SUP	HCPCS C1713		6543820  -  SCREW 6543820 8.5MM FAS FOR 5.5 20MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543825	SUP	HCPCS C1713		6543825  -  SCREW 6543825 8.5MM FAS FOR 5.5 25MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543830	SUP	HCPCS C1713		6543830  -  SCREW 6543830 8.5MM FAS FOR 5.5 30MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543835	SUP	HCPCS C1713		6543835  -  SCREW 6543835 8.5MM FAS FOR 5.5 35MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543840	SUP	HCPCS C1713		6543840  -  SCREW 6543840 8.5MM FAS FOR 5.5 40MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543845	SUP	HCPCS C1713		6543845  -  SCREW 6543845 8.5MM FAS FOR 5.5 45MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543850	SUP	HCPCS C1713		6543850  -  SCREW 6543850 8.5MM FAS FOR 5.5 50MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543855	SUP	HCPCS C1713		6543855  -  SCREW 6543855 8.5MM FAS FOR 5.5 55MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6543860	SUP	HCPCS C1713		6543860  -  SCREW 6543860 8.5MM FAS FOR 5.5 60MM LG	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
6591011	SUP	HCPCS C1713		6591011  -  CAGE SPNL 18MM 20-22MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591012	SUP	HCPCS C1713		6591012  -  CAGE SPNL 18MM 21-25MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591013	SUP	HCPCS C1713		6591013  -  CAGE SPNL 18MM 24-31MM VBR COR XPD	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591014	SUP	HCPCS C1713		6591014  -  CAGE SPNL 18MM 28-40MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591015	SUP	HCPCS C1713		6591015  -  CAGE SPNL 18MM 35-52MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591016	SUP	HCPCS C1713		6591016  -  CAGE SPNL 18MM 41-65MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591017	SUP	HCPCS C1713		6591017  -  CAGE SPNL 18MM 47-75MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591021	SUP	HCPCS C1713		6591021  -  CAGE SPNL 22MM 20-22MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591022	SUP	HCPCS C1713		6591022  -  CAGE SPNL 22MM 21-25MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591023	SUP	HCPCS C1713		6591023  -  CAGE SPNL 22MM 24-31MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591024	SUP	HCPCS C1713		6591024  -  CAGE SPNL 22MM 28-40MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591025	SUP	HCPCS C1713		6591025  -  CAGE SPNL 22MM 35-52MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591026	SUP	HCPCS C1713		6591026  -  CAGE SPNL 22MM 41-65MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6591027	SUP	HCPCS C1713		6591027  -  CAGE SPNL 22MM 47-75MM VBR EXPANDABLE	BOTH IP/OP	"$11,245.00 "	"$8,321.30"	$0.00	"$8,996.00"	"$5,060.25"	"$5,060.25"	$0.00	$0.00	$0.00	"$2,343.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,343.46"	$0.00	"$5,543.79"	"$5,543.79"	$0.00	"$5,622.50"	"$8,906.04"	"$8,996.00"	$0.00		$0.00	"$1,759.84"	$0.00	$0.00	"$1,790.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6605359	SUP	Custom 27203010		CALIBRATOR FLW CYMTR FLW-CHK FLUOROSPHERES 10ML	BOTH IP/OP	$458.68 	$339.42	$0.00	$366.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.34	$363.27	$366.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6607007	SUP	Custom 27203010		CALIBRATOR FLW CYMTR FLW-SET FLUOROSPHERES 10ML	BOTH IP/OP	$458.68 	$339.42	$0.00	$366.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.34	$363.27	$366.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6607013	SUP	Custom 27203010		ANTIBODY CD45 CD4 CD8 CD3 CLONE B3821F4A SFCI12T4D11 SFCI21	BOTH IP/OP	$722.10 	$534.35	$0.00	$577.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.05	$571.90	$577.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6607023	SUP	Custom 27203010		CALIBRATOR FLW CYMTR CYTO-COMP HMN LYMPH LYPH 250 TST	BOTH IP/OP	$285.35 	$211.16	$0.00	$228.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.68	$226.00	$228.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6607077	SUP	Custom 27203010		CONTROL FLW CYMTR IMTRL POS 3ML 60 TST	BOTH IP/OP	$403.73 	$298.76	$0.00	$322.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.86	$319.75	$322.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6607098	SUP	Custom 27203010		CONTROL FLW CYMTR IMTRL LOW 3ML 60 TST	BOTH IP/OP	$403.73 	$298.76	$0.00	$322.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.86	$319.75	$322.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6608125	SUP	HCPCS C1713		6608125  -  CAGE SPNL 8D LG CNTR 25X11X8MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6608925	SUP	HCPCS C1713		6608925  -  CAGE SPNL 8D LG CNTR 25X9X8MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6609125	SUP	HCPCS C1713		6609125  -  CAGE SPNL LG 25X11X9MM CNTR PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6609925	SUP	HCPCS C1713		6609925  -  CAGE SPNL 8 25X9X9MM PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6610125	SUP	HCPCS C1713		6610125  -  CAGE SPNL 8D LG CNTR 25X11X10MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6610925	SUP	HCPCS C1713		6610925  -  CAGE SPNL 8D LG CNTR 25X10X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6611125	SUP	HCPCS C1713		6611125  -  SPACER SPNL LG 25X11X11MM CNTR PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6611925	SUP	Custom 27803010		6611925  -  CAGE SPNL 8D LG CNTR 25X9X11MM NS LF CRNT PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6612125	SUP	HCPCS C1713		6612125  -  CAGE SPNL 8D LG CNTR 25X12X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6612925	SUP	HCPCS C1713		6612925  -  CAGE SPNL 8D LG CNTR 25X12X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6613125	SUP	HCPCS C1713		6613125  -  SPACER SPNL 25X11X13MM PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6613925	SUP	HCPCS C1713		6613925  -  CAGE SPNL 8D LG CNTR 25X9X13MM NS LF CRNT PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6614125	SUP	HCPCS C1713		6614125  -  CAGE SPNL 8D LG CNTR 25X14X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6614925	SUP	HCPCS C1713		6614925  -  CAGE SPNL 8D LG CNTR 25X14X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6615125	SUP	HCPCS C1713		6615125  -  SPACER SPNL LG 25X11X15MM CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6615925	SUP	HCPCS C1713		6615925  -  CAGE SPNL 8D LG 25X9X15MM PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6616125	SUP	HCPCS C1713		6616125  -  CAGE SPNL LG 25X11X16MM PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6616925	SUP	HCPCS C1713		6616925  -  CAGE SPNL 8D LG 25X9X16MM PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6660725	SUP	HCPCS C1713		6660725  -  SPACER SPNL 6D 25X10X7MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6660730	SUP	HCPCS C1713		6660730  -  SPACER SPNL 6D 30X10X7MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6660736	SUP	HCPCS C1713		6660736  -  SPACER SPNL 6D 36X10X7MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6660825	SUP	HCPCS C1713		6660825  -  SPACER SPNL 6D 25X10X8MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6660830	SUP	HCPCS C1713		6660830  -  SPACER SPNL 6D 30X10X8MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6660836	SUP	HCPCS C1713		6660836  -  SPACER SPNL 6D 36X10X8MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6660925	SUP	HCPCS C1713		6660925  -  SPACER SPNL 6D 25X10X9MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6660930	SUP	HCPCS C1713		6660930  -  SPACER SPNL 6D 30X10X9MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6660936	SUP	HCPCS C1713		6660936  -  SPACER SPNL 6D 36X10X9MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661025	SUP	HCPCS C1713		6661025  -  SPACER SPNL 6D 25X10X10MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661030	SUP	HCPCS C1713		6661030  -  SPACER SPNL 6D 30X10X10MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661036	SUP	HCPCS C1713		6661036  -  SPACER SPNL 6D 36X10X10MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661125	SUP	HCPCS C1713		6661125  -  SPACER SPNL 6D 25X10X11MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661130	SUP	HCPCS C1713		6661130  -  SPACER SPNL 6D 30X10X11MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661136	SUP	HCPCS C1713		6661136  -  SPACER SPNL 6D 36X10X11MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661225	SUP	HCPCS C1713		6661225  -  SPACER SPNL 6D 25X10X12MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661230	SUP	HCPCS C1713		6661230  -  SPACER SPNL 6D 30X10X12MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661236	SUP	HCPCS C1713		6661236  -  SPACER SPNL 6D 36X10X12MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661325	SUP	HCPCS C1713		6661325  -  SPACER SPNL 6D 25X10X13MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661330	SUP	HCPCS C1713		6661330  -  SPACER SPNL 6D 30X10X13MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661336	SUP	HCPCS C1713		6661336  -  SPACER SPNL 6D 36X10X13MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661425	SUP	HCPCS C1713		6661425  -  SPACER SPNL 6D 25X10X14MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661430	SUP	HCPCS C1713		6661430  -  SPACER SPNL 6D 30X10X14MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661436	SUP	HCPCS C1713		6661436  -  SPACER SPNL 6D 36X10X14MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661525	SUP	HCPCS C1713		6661525  -  SPACER SPNL 6D 25X10X15MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661530	SUP	HCPCS C1713		6661530  -  SPACER SPNL 6D 30X10X15MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661536	SUP	HCPCS C1713		6661536  -  SPACER SPNL 6D 36X10X15MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661625	SUP	HCPCS C1713		6661625  -  SPACER SPNL 6D 25X10X16MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661630	SUP	HCPCS C1713		6661630  -  SPACER SPNL 6D 30X10X16MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6661636	SUP	HCPCS C1713		6661636  -  SPACER SPNL 6D 36X10X16MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6670725	SUP	HCPCS C1713		6670725  -  SPACER SPNL W 25X10X7MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6670730	SUP	HCPCS C1713		6670730  -  SPACER SPNL W 30X10X7MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6670736	SUP	HCPCS C1713		6670736  -  SPACER SPNL W 36X10X7MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6670825	SUP	HCPCS C1713		6670825  -  SPACER SPNL W 25X10X8MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6670830	SUP	HCPCS C1713		6670830  -  SPACER SPNL W 30X10X8MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6670836	SUP	HCPCS C1713		6670836  -  SPACER SPNL W 36X10X8MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6670925	SUP	HCPCS C1713		6670925  -  SPACER SPNL W 25X10X9MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6670930	SUP	HCPCS C1713		6670930  -  SPACER SPNL W 30X10X9MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6670936	SUP	HCPCS C1713		6670936  -  SPACER SPNL W 36X10X9MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671025	SUP	HCPCS C1713		6671025  -  SPACER SPNL W 25X10X10MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671030	SUP	HCPCS C1713		6671030  -  SPACER SPNL W 30X10X10MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671036	SUP	HCPCS C1713		6671036  -  SPACER SPNL W 36X10X10MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671125	SUP	HCPCS C1713		6671125  -  SPACER SPNL W 25X10X11MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671130	SUP	HCPCS C1713		6671130  -  SPACER SPNL W 30X10X11MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671136	SUP	HCPCS C1713		6671136  -  SPACER SPNL W 36X10X11MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671225	SUP	HCPCS C1713		6671225  -  SPACER SPNL W 25X10X12MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671230	SUP	HCPCS C1713		6671230  -  SPACER SPNL W 30X10X12MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671236	SUP	HCPCS C1713		6671236  -  SPACER SPNL W 36X10X12MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671325	SUP	HCPCS C1713		6671325  -  SPACER SPNL W 25X10X13MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671330	SUP	HCPCS C1713		6671330  -  SPACER SPNL W 30X10X13MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671336	SUP	HCPCS C1713		6671336  -  SPACER SPNL W 36X10X13MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671425	SUP	HCPCS C1713		6671425  -  SPACER SPNL W 25X10X14MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671430	SUP	HCPCS C1713		6671430  -  SPACER SPNL W 30X10X14MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671436	SUP	HCPCS C1713		6671436  -  SPACER SPNL W 36X10X14MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671525	SUP	HCPCS C1713		6671525  -  SPACER SPNL W 25X10X15MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671530	SUP	HCPCS C1713		6671530  -  SPACER SPNL W 30X10X15MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671536	SUP	HCPCS C1713		6671536  -  SPACER SPNL W 36X10X15MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671625	SUP	HCPCS C1713		6671625  -  SPACER SPNL W 25X10X16MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671630	SUP	HCPCS C1713		6671630  -  SPACER SPNL W 30X10X16MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6671636	SUP	HCPCS C1713		6671636  -  SPACER SPNL W 36X10X16MM STRL CRSNT TI	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
6708120	SUP	HCPCS C1713		6708120  -  CAGE SPNL 4D LG IMPCT 20X11X8MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6708126	SUP	Custom 27803010		6708126  -  CAGE SPNL 4D LG IMPCT 26X11X8MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6708132	SUP	HCPCS C1713		6708132  -  CAGE SPNL 4D LG IMPCT 32X11X8MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6708520	SUP	HCPCS C1713		6708520  -  SPACER SPNL 20X9X8MM CRNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6708820	SUP	HCPCS C1713		6708820  -  SPACER SPNL 8D LG 20X9X8MM CRNT THORLMBR INTRBD FS TPR PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6708926	SUP	Custom 27803010		6708926  -  CAGE SPNL 4D LG IMPCT 26X9X8MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6708932	SUP	HCPCS C1713		6708932  -  CAGE SPNL 4D LG IMPCT 32X9X8MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6709120	SUP	HCPCS C1713		6709120  -  CAGE SPNL 4D LG IMPCT 20X11X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6709126	SUP	HCPCS C1713		6709126  -  CAGE SPNL 4D LG IMPCT 26X11X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6709132	SUP	HCPCS C1713		6709132  -  CAGE SPNL 4D LG IMPCT 32X11X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6709920	SUP	HCPCS C1713		6709920  -  CAGE SPNL 4D LG IMPCT 20X9X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6709926	SUP	Custom 27803010		6709926  -  CAGE SPNL 4D LG IMPCT 26X9X9MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6709932	SUP	Custom 27803010		6709932  -  CAGE SPNL 4D LG IMPCT 32X9X9MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6710120	SUP	HCPCS C1713		6710120  -  CAGE SPNL 4D LG IMPCT 20X11X10MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6710126	SUP	HCPCS C1713		6710126  -  CAGE SPNL 4D LG IMPCT 26X11X10MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6710132	SUP	HCPCS C1713		6710132  -  CAGE SPNL 4D LG IMPCT 32X11X10MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6710520	SUP	HCPCS C1713		6710520  -  SPACER SPNL 20X10X9MM PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6710820	SUP	HCPCS C1713		6710820  -  SPACER SPNL 20X10X8MM CRNT THORLMBR INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6710920	SUP	HCPCS C1713		6710920  -  CAGE SPNL 20X10X9MM CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6710926	SUP	Custom 27803010		6710926  -  CAGE SPNL 4D LG IMPCT 26X9X10MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6710932	SUP	HCPCS C1713		6710932  -  CAGE SPNL 4D LG IMPCT 32X9X10MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6711120	SUP	HCPCS C1713		6711120  -  CAGE SPNL 4D LG IMPCT 20X11X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6711126	SUP	HCPCS C1713		6711126  -  CAGE SPNL 4D LG IMPCT 26X11X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6711132	SUP	HCPCS C1713		6711132  -  CAGE SPNL 4D LG IMPCT 32X11X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6711920	SUP	HCPCS C1713		6711920  -  CAGE SPNL 4D LG IMPCT 20X11X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6711926	SUP	HCPCS C1713		6711926  -  CAGE SPNL 4D LG IMPCT 26X11X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6711932	SUP	HCPCS C1713		6711932  -  CAGE SPNL 4D LG IMPCT 32X11X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712120	SUP	HCPCS C1713		6712120  -  CAGE SPNL 4D LG IMPCT 20X12X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712126	SUP	HCPCS C1713		6712126  -  CAGE SPNL 4D LG IMPCT 26X12X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712132	SUP	HCPCS C1713		6712132  -  CAGE SPNL 4D LG IMPCT 32X12X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712520	SUP	HCPCS C1713		6712520  -  SPACER SPNL 12MM 15MM INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712820	SUP	HCPCS C1713		6712820  -  CAGE SPNL 8D LG 20X9X12MM CRNT TPR PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712920	SUP	HCPCS C1713		6712920  -  CAGE SPNL 4D LG IMPCT 20X12X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712926	SUP	HCPCS C1713		6712926  -  CAGE SPNL 4D LG IMPCT 26X12X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712932	SUP	HCPCS C1713		6712932  -  CAGE SPNL 4D LG IMPCT 32X12X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6713120	SUP	HCPCS C1713		6713120  -  CAGE SPNL 4D LG IMPCT 20X13X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6713126	SUP	HCPCS C1713		6713126  -  CAGE SPNL 4D LG IMPCT 26X13X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6713132	SUP	HCPCS C1713		6713132  -  CAGE SPNL 4D LG IMPCT 32X13X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6713920	SUP	HCPCS C1713		6713920  -  CAGE SPNL 4D LG IMPCT 20X13X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6713926	SUP	HCPCS C1713		6713926  -  CAGE SPNL 4D LG IMPCT 26X13X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6713932	SUP	HCPCS C1713		6713932  -  CAGE SPNL 4D LG IMPCT 32X13X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6714120	SUP	HCPCS C1713		6714120  -  CAGE SPNL 4D LG IMPCT 20X14X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6714126	SUP	HCPCS C1713		6714126  -  CAGE SPNL 4D LG IMPCT 26X14X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6714132	SUP	HCPCS C1713		6714132  -  CAGE SPNL 4D LG IMPCT 32X14X11MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6714820	SUP	HCPCS C1713		6714820  -  SPACER SPNL 20X14X9MM INTRBD FS TPR PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6714920	SUP	HCPCS C1713		6714920  -  CAGE SPNL 4D LG IMPCT 20X14X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6714926	SUP	HCPCS C1713		6714926  -  CAGE SPNL 4D LG IMPCT 26X14X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6714932	SUP	HCPCS C1713		6714932  -  CAGE SPNL 4D LG IMPCT 32X14X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6733206	SUP	HCPCS C1713		6733206  -  CAGE SPNL 10D SM 16X19X6MM NS LF CRNT ACR RADOPQ	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
6733209	SUP	HCPCS C1713		6733209  -  CAGE SPNL 10D SM 16X19X9MM NS LF CRNT ACR RADOPQ	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
6736207	SUP	HCPCS C1713		6736207  -  CAGE SPNL 10D 7X17X14MM NS CRNT ACR TA SM INTLK RADOPQ	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
6790151	SUP	Custom 27203010		6790151  -  BIT DRL SM 12-16MM INTLK DISP B	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$0.00	$0.00	$0.00	$287.50	$455.40	$460.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6790152	SUP	Custom 27203010		6790152  -  TAP SRG 12MM TEMP SPNE DISP	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$0.00	$0.00	$0.00	$287.50	$455.40	$460.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6790225	SUP	HCPCS C1713		6790225  -  CAGE SPNL 5MM CRNT INTLK CRV	BOTH IP/OP	"$4,832.50 "	"$3,576.05"	$0.00	"$3,866.00"	"$2,174.63"	"$2,174.63"	$0.00	$0.00	$0.00	"$1,007.21"	"$3,586.68"	"$3,586.68"	$0.00	$0.00	"$1,007.09"	$0.00	"$2,382.42"	"$2,382.42"	$0.00	"$2,416.25"	"$3,827.34"	"$3,866.00"	$0.00		$0.00	$756.29	$0.00	$0.00	$769.33	$0.00	$0.00	$0.00	$0.00	$0.00
6790228	SUP	HCPCS C1713		6790228  -  CAGE SPNL 7D SM 17X14X8MM NS LF CRNT INTLK CRV	BOTH IP/OP	"$4,832.50 "	"$3,576.05"	$0.00	"$3,866.00"	"$2,174.63"	"$2,174.63"	$0.00	$0.00	$0.00	"$1,007.21"	"$3,586.68"	"$3,586.68"	$0.00	$0.00	"$1,007.09"	$0.00	"$2,382.42"	"$2,382.42"	$0.00	"$2,416.25"	"$3,827.34"	"$3,866.00"	$0.00		$0.00	$756.29	$0.00	$0.00	$769.33	$0.00	$0.00	$0.00	$0.00	$0.00
6790229	SUP	HCPCS C1713		6790229  -  CAGE SPNL 9MM CRNT INTLK CRV	BOTH IP/OP	"$4,832.50 "	"$3,576.05"	$0.00	"$3,866.00"	"$2,174.63"	"$2,174.63"	$0.00	$0.00	$0.00	"$1,007.21"	"$3,586.68"	"$3,586.68"	$0.00	$0.00	"$1,007.09"	$0.00	"$2,382.42"	"$2,382.42"	$0.00	"$2,416.25"	"$3,827.34"	"$3,866.00"	$0.00		$0.00	$756.29	$0.00	$0.00	$769.33	$0.00	$0.00	$0.00	$0.00	$0.00
6790230	SUP	HCPCS C1713		6790230  -  CAGE SPNL 10MM CRNT INTLK CRV	BOTH IP/OP	"$4,832.50 "	"$3,576.05"	$0.00	"$3,866.00"	"$2,174.63"	"$2,174.63"	$0.00	$0.00	$0.00	"$1,007.21"	"$3,586.68"	"$3,586.68"	$0.00	$0.00	"$1,007.09"	$0.00	"$2,382.42"	"$2,382.42"	$0.00	"$2,416.25"	"$3,827.34"	"$3,866.00"	$0.00		$0.00	$756.29	$0.00	$0.00	$769.33	$0.00	$0.00	$0.00	$0.00	$0.00
6790231	SUP	HCPCS C1713		6790231  -  CAGE SPNL 11MM CRNT INTLK CRV	BOTH IP/OP	"$4,832.50 "	"$3,576.05"	$0.00	"$3,866.00"	"$2,174.63"	"$2,174.63"	$0.00	$0.00	$0.00	"$1,007.21"	"$3,586.68"	"$3,586.68"	$0.00	$0.00	"$1,007.09"	$0.00	"$2,382.42"	"$2,382.42"	$0.00	"$2,416.25"	"$3,827.34"	"$3,866.00"	$0.00		$0.00	$756.29	$0.00	$0.00	$769.33	$0.00	$0.00	$0.00	$0.00	$0.00
6790232	SUP	HCPCS C1713		6790232  -  CAGE SPNL 12MM CRNT INTLK CRV	BOTH IP/OP	"$4,832.50 "	"$3,576.05"	$0.00	"$3,866.00"	"$2,174.63"	"$2,174.63"	$0.00	$0.00	$0.00	"$1,007.21"	"$3,586.68"	"$3,586.68"	$0.00	$0.00	"$1,007.09"	$0.00	"$2,382.42"	"$2,382.42"	$0.00	"$2,416.25"	"$3,827.34"	"$3,866.00"	$0.00		$0.00	$756.29	$0.00	$0.00	$769.33	$0.00	$0.00	$0.00	$0.00	$0.00
6791512	SUP	HCPCS C1713		6791512  -  SCREW BN 4MM 12MM CRNT SLF DRL SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791513	SUP	HCPCS C1713		6791513  -  SCREW BN 4MM 13MM CRNT SLF DRL SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791514	SUP	HCPCS C1713		6791514  -  SCREW BN 4MM 14MM CRNT SLF DRL SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791515	SUP	HCPCS C1713		6791515  -  SCREW BN 4MM 15MM CRNT SLF DRL SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791516	SUP	HCPCS C1713		6791516  -  SCREW BN 4MM 16MM CRNT SLF DRL SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791612	SUP	HCPCS C1713		6791612  -  SCREW BN 4.5MM 12MM CRNT SM INTLK SLF DRL SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791613	SUP	HCPCS C1713		6791613  -  SCREW BN 4.5MM 13MM CRNT SM INTLK SLF DRL SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791614	SUP	HCPCS C1713		6791614  -  SCREW BN 4.5MM 14MM CRNT SM INTLK SLF DRL SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791615	SUP	HCPCS C1713		6791615  -  SCREW BN 4.5MM 15MM CRNT SM INTLK SLF DRL SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791616	SUP	HCPCS C1713		6791616  -  SCREW BN 4.5MM 16MM CRNT SM INTLK SLF DRL SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791712	SUP	HCPCS C1713		6791712  -  SCREW BN 4MM 12MM SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791713	SUP	HCPCS C1713		6791713  -  SCREW BN 4MM 13MM RSC SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791714	SUP	HCPCS C1713		6791714  -  SCREW BN 4MM 14MM RSC SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791715	SUP	HCPCS C1713		6791715  -  SCREW BN 4MM 15MM SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791716	SUP	HCPCS C1713		6791716  -  SCREW BN 4MM 16MM SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791812	SUP	HCPCS C1713		6791812  -  SCREW BN 4.5MM 12MM RSC SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791813	SUP	HCPCS C1713		6791813  -  SCREW BN 4.5MM 13MM RSC SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791814	SUP	HCPCS C1713		6791814  -  SCREW BN 4.5MM 14MM RSC SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6791816	SUP	HCPCS C1713		6791816  -  SCREW BN 4.5MM 16MM RSC SPNE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
6805115	SUP	HCPCS C1713		6805115  -  CAGE SPNL SM 14X11X5MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6805714	SUP	HCPCS C1713		6805714  -  CAGE SPNL 5D SM LRDTC 14X11X5MM NS LF CRNT RDLCNT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6805815	SUP	HCPCS C1713		6805815  -  CAGE SPNL SM LRDTC + 15X13X5MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6806115	SUP	HCPCS C1713		6806115  -  CAGE SPNL SM 14X11X6MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6806714	SUP	HCPCS C1713		6806714  -  CAGE SPNL 5D SM LRDTC 14X11X6MM NS LF CRNT RDLCNT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6806815	SUP	Custom 27803010		6806815  -  CAGE SPNL SM LRDTC + 15X13X6MM NS LF CRNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6807115	SUP	HCPCS C1713		6807115  -  CAGE SPNL SM 14X11X7MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6807714	SUP	HCPCS C1713		6807714  -  CAGE SPNL 5D SM LRDTC 14X11X7MM NS LF CRNT RDLCNT PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6807815	SUP	HCPCS C1713		6807815  -  CAGE SPNL 5D SM LRDTC + 15X13X7MM NS LF CRNT RDLCNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6808115	SUP	HCPCS C1713		6808115  -  CAGE SPNL SM 14X11X8MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6808125	SUP	HCPCS C1713		6808125  -  SPACER SPNL 25X11X8MM CRNT THORLMBR INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6808130	SUP	HCPCS C1713		6808130  -  RESTRICTOR CMNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6808240	SUP	HCPCS C1713		6808240  -  SPACER SPNL XL W 40X22X8MM PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6808340	SUP	HCPCS C1713		6808340  -  SPACER SPNL XL 10 40X22X8MM PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6808815	SUP	Custom 27803010		6808815  -  CAGE SPNL SM LRDTC + 15X13X8MM NS LF CRNT PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6808925	SUP	HCPCS C1713		6808925  -  SPACER SPNL 25X9X8MM INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6808930	SUP	HCPCS C1713		6808930  -  SPACER SPNL 30X9X8MM INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6809115	SUP	HCPCS C1713		6809115  -  CAGE SPNL SM 14X11X9MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6809714	SUP	HCPCS C1713		6809714  -  CAGE SPNL 5D SM LRDTC 14X11X9MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6809925	SUP	HCPCS C1713		6809925  -  SPACER SPNL 25X9X9MM STRL CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6810115	SUP	HCPCS C1713		6810115  -  CAGE SPNL SM 14X11X10MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6810125	SUP	HCPCS C1713		6810125  -  SPACER SPNL 25X11X10MM STRL CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6810130	SUP	HCPCS C1713		6810130  -  SPACER SPNL 30INX11INX10MM STRL CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6810240	SUP	HCPCS C1713		6810240  -  SPACER SPNL XL W 40X22X10MM PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6810340	SUP	HCPCS C1713		6810340  -  SPACER SPNL 10D XL W LRDTC 40X22X10MM PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6810714	SUP	HCPCS C1713		6810714  -  CAGE SPNL 5D SM LRDTC 14X11X10MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6810815	SUP	HCPCS C1713		6810815  -  CAGE SPNL SM LRDTC + 15X13X10MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6810925	SUP	HCPCS C1713		6810925  -  SPACER SPNL NAR 25X10X9MM INTRBD FS PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6810930	SUP	HCPCS C1713		6810930  -  SPACER SPNL NAR 30X10X9MM INTRBD FS PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6811115	SUP	HCPCS C1713		6811115  -  CAGE SPNL SM 14X11X11MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6811714	SUP	HCPCS C1713		6811714  -  CAGE SPNL 5D SM LRDTC 14X11X11MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6811815	SUP	HCPCS C1713		6811815  -  CAGE SPNL SM LRDTC + 15X13X11MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6811925	SUP	HCPCS C1713		6811925  -  SPACER SPNL 25X11X9MM STRL CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6812115	SUP	HCPCS C1713		6812115  -  CAGE SPNL SM 14X11X11MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6812125	SUP	HCPCS C1713		6812125  -  SPACER SPNL LG 25X12X11MM CRNT THORLMBR INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6812130	SUP	HCPCS C1713		6812130  -  CAGE SPNL LG 30X12X10MM CRNT THORLMBR INTRBD FS RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6812240	SUP	HCPCS C1713		6812240  -  SPACER SPNL XL W 40X22X12MM PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6812340	SUP	HCPCS C1713		6812340  -  SPACER SPNL 10 XL W LRDTC 40X22X12MM PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6812714	SUP	HCPCS C1713		6812714  -  CAGE SPNL 5D SM LRDTC 14X11X11MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6812815	SUP	HCPCS C1713		6812815  -  CAGE SPNL SM LRDTC + 15X13X10MM NS LF CRNT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6812925	SUP	HCPCS C1713		6812925  -  SPACER SPNL 25X12X9MM CRNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6812930	SUP	HCPCS C1713		6812930  -  SPACER SPNL 30X12X9MM STRL CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6813815	SUP	HCPCS C1713		6813815  -  SPACER SPNL SM 15X13X13MM LOPRFL PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6813925	SUP	HCPCS C1713		6813925  -  SPACER SPNL LG NAR 25X13X9MM CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6814125	SUP	HCPCS C1713		6814125  -  SPACER SPNL LG 25X14X11MM CRNT THORLMBR INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6814130	SUP	HCPCS C1713		6814130  -  SPACER SPNL LG W 14X11X30MM CRNT LMBR INTRBD FS RDLCNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6814240	SUP	HCPCS C1713		6814240  -  SPACER SPNL XL W 40X22X14MM PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6814340	SUP	HCPCS C1713		6814340  -  SPACER SPNL 10D XL W LRDTC 40X22X14MM PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6814815	SUP	HCPCS C1713		6814815  -  SPACER SPNL SM 15X14X13MM LOPRFL PEEK-OPTM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6814925	SUP	HCPCS C1713		6814925  -  SPACER SPNL 25X14X9MM CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6814930	SUP	HCPCS C1713		6814930  -  CAGE SPNL LG NAR 30X9X14MM CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6816240	SUP	HCPCS C1713		6816240  -  SPACER SPNL XL W 40X22X16MM PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6816340	SUP	HCPCS C1713		6816340  -  SPACER SPNL 10D XL W LRDTC 40X22X16MM PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6850810	SUP	HCPCS C1713		6850810  -  SPACER SPNL GRN CRNT LMBR OBLQ	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6850811	SUP	HCPCS C1713		6850811  -  CAGE SPNL 5D LG 30X10X8MM CRNT OBLQ PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6850813	SUP	HCPCS C1713		6850813  -  CAGE SPNL LG 40X10X8MM GRN OBLQ PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6851012	SUP	HCPCS C1713		6851012  -  CAGE SPNL 5D LG 35X10X10MM CRNT OBLQ PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6851013	SUP	HCPCS C1713		6851013  -  CAGE SPNL 5D LG 40X10X10MM CRNT OBLQ PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6851211	SUP	HCPCS C1713		6851211  -  CAGE SPNL 30X12X10MM CRNT PEEK LRDTC 5	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6851212	SUP	HCPCS C1713		6851212  -  SPACER SPNL 5D LG 35X12X10MM CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6851213	SUP	HCPCS C1713		6851213  -  CAGE SPNL 5D LG 40X10X12MM CRNT OBLQ PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6851411	SUP	HCPCS C1713		6851411  -  SPACER SPNL 5D LG 30X14X10MM CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6851412	SUP	HCPCS C1713		6851412  -  CAGE SPNL 5D LG OBLQ 35X14X10MM CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6851413	SUP	Custom 27804086		6851413  -  GRAFT BN LG CRNT PEEK SPNE 5DE	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6860010	SUP	HCPCS C1713		6860010  -  SCREW BN 4MM 10MM PRMR ST TI CANC ANT CSPN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860011	SUP	HCPCS C1713		6860011  -  SCREW BN 4MM 11MM NS PRMR VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860012	SUP	HCPCS C1713		6860012  -  SCREW BN 4MM 12MM NS PRMR VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860013	SUP	HCPCS C1713		6860013  -  SCREW BN 4MM 13MM NS PRMR VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860014	SUP	HCPCS C1713		6860014  -  SCREW BN 4MM 14MM NS PRMR VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860015	SUP	HCPCS C1713		6860015  -  SCREW BN 4MM 15MM NS PRMR VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860016	SUP	HCPCS C1713		6860016  -  SCREW BN 4MM 16MM NS PRMR VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860017	SUP	HCPCS C1713		6860017  -  SCREW BN 4MM 17MM NS PRMR VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860018	SUP	HCPCS C1713		6860018  -  SCREW BN 4MM 18MM NS PRMR VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860019	SUP	HCPCS C1713		6860019  -  SCREW BN 4MM 19MM STRL PRMR ST TI CANC ANT CSPN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860020	SUP	HCPCS C1713		6860020  -  SCREW BN 4MM 20MM NS PRMR VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860053	SUP	HCPCS C1713		6860053  -  SCREW BN 4.5MM 13MM NS PRMR VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860055	SUP	HCPCS C1713		6860055  -  SCREW BN 4.5MM 15MM NS PRMR VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860057	SUP	HCPCS C1713		6860057  -  SCREW BN 4.5MM 17MM NS PRMR VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
6860123	SUP	HCPCS C1713		6860123  -  PLATE 6860123 23  MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6860125	SUP	HCPCS C1713		6860125  -  PLATE 6860125 25  MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6860127	SUP	HCPCS C1713		6860127  -  PLATE 6860127 27.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6860130	SUP	HCPCS C1713		6860130  -  PLATE 6860130 30 MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6860132	SUP	HCPCS C1713		6860132  -  PLATE 6860132 32.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6860135	SUP	HCPCS C1713		6860135  -  PLATE 6860135 35  MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6860137	SUP	HCPCS C1713		6860137  -  PLATE 6860137 37.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6860140	SUP	HCPCS C1713		6860140  -  PLATE 6860140 40  MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6860142	SUP	HCPCS C1713		6860142  -  PLATE 6860142 42.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6860145	SUP	HCPCS C1713		6860145  -  PLATE 6860145 45  MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6860147	SUP	HCPCS C1713		6860147  -  PLATE 6860147 47.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6860150	SUP	HCPCS C1713		6860150  -  PLATE 6860150 50  MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6860152	SUP	HCPCS C1713		6860152  -  PLATE 6860152 52.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6860155	SUP	HCPCS C1713		6860155  -  PLATE 6860155 55  MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6860157	SUP	HCPCS C1713		6860157  -  PLATE 6860157 57.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6860160	SUP	HCPCS C1713		6860160  -  PLATE 6860160 60  MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6860162	SUP	HCPCS C1713		6860162  -  PLATE 6860162 62.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6860165	SUP	HCPCS C1713		6860165  -  PLATE 6860165 65  MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6860167	SUP	HCPCS C1713		6860167  -  PLATE 6860167 67.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6860170	SUP	HCPCS C1713		6860170  -  PLATE 6860170 70  MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6860172	SUP	HCPCS C1713		6860172  -  PLATE 6860172 72.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6860175	SUP	HCPCS C1713		6860175  -  PLATE 6860175 75 MM ANT CERV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6860177	SUP	HCPCS C1713		6860177  -  PLATE 6860177 77 5MM ANT CERV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6860180	SUP	HCPCS C1713		6860180  -  PLATE 6860180 80 MM ANT CERV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6860182	SUP	HCPCS C1713		6860182  -  PLATE 6860182 82 5MM ANT CERV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6860185	SUP	HCPCS C1713		6860185  -  PLATE 6860185 85 MM ANT CERV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6860187	SUP	HCPCS C1713		6860187  -  PLATE 6860187 87 5MM ANT CERV	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6860190	SUP	HCPCS C1713		6860190  -  PLATE 6860190 90 MM ANT CERV	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6860195	SUP	HCPCS C1713		6860195  -  PLATE 6860195 95 MM ANT CERV	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6860200	SUP	HCPCS C1713		6860200  -  PLATE 6860200 100 MM ANT CERV	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6860205	SUP	HCPCS C1713		6860205  -  PLATE 6860205 105 MM ANT CERV	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6860210	SUP	HCPCS C1713		6860210  -  PLATE 6860210 110 MM ANT CERV	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6860405	SUP	Custom 27803010		6860405  -  PIN 6860405 PREMIER MIDLINE FIXATION	BOTH IP/OP	$177.00 	$130.98	$0.00	$141.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.37	$131.37	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$88.50	$140.18	$141.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6861130	SUP	HCPCS C1713		6861130  -  PLATE 6861130 30MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6861137	SUP	HCPCS C1713		6861137  -  PLATE 6861137 37.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6861150	SUP	HCPCS C1713		6861150  -  PLATE 6861150 50 MM ANT CERV PLATE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6861157	SUP	HCPCS C1713		6861157  -  PLATE 6861157 57.5 MM ANT CERV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6861165	SUP	HCPCS C1713		6861165  -  PLATE 6861165 65 MM ANT CERV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6861167	SUP	HCPCS C1713		6861167  -  PLATE 6861167 67.5 MM ANT CERV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6861175	SUP	HCPCS C1713		6861175  -  PLATE 6861175 75 MM ANT CERV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6861177	SUP	HCPCS C1713		6861177  -  PLATE 6861177 77.5 MM ANT CERV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6861182	SUP	HCPCS C1713		6861182  -  PLATE 6861182 82.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6861185	SUP	HCPCS C1713		6861185  -  PLATE 6861185 85MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6861200	SUP	HCPCS C1713		6861200  -  PLATE 6861200 100MM ANTERIOR CERVICAL	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6861223	SUP	HCPCS C1713		6861223  -  PLATE 6861223 23MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6861225	SUP	HCPCS C1713		6861225  -  PLATE 6861225 25MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6861227	SUP	HCPCS C1713		6861227  -  PLATE 6861227 27.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6861230	SUP	HCPCS C1713		6861230  -  PLATE 6861230 30MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6861232	SUP	HCPCS C1713		6861232  -  PLATE 6861232 32.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6861235	SUP	HCPCS C1713		6861235  -  PLATE 6861235 35MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6861237	SUP	HCPCS C1713		6861237  -  PLATE 6861237 37.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6861240	SUP	HCPCS C1713		6861240  -  PLATE 6861240 40 MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6861242	SUP	HCPCS C1713		6861242  -  PLATE 6861242 42.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6861245	SUP	HCPCS C1713		6861245  -  PLATE 6861245 45MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6861247	SUP	HCPCS C1713		6861247  -  PLATE 6861247 47.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6861250	SUP	HCPCS C1713		6861250  -  PLATE 6861250 50MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6861252	SUP	HCPCS C1713		6861252  -  PLATE 6861252 52.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6861255	SUP	HCPCS C1713		6861255  -  PLATE 6861255 55MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6861257	SUP	HCPCS C1713		6861257  -  PLATE 6861257 57.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6861260	SUP	HCPCS C1713		6861260  -  PLATE 6861260 60MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6861262	SUP	HCPCS C1713		6861262  -  PLATE 6861262 62.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6861265	SUP	HCPCS C1713		6861265  -  PLATE 6861265 65MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6861267	SUP	HCPCS C1713		6861267  -  PLATE 6861267 67.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
6861270	SUP	HCPCS C1713		6861270  -  PLATE 6861270 70MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6861272	SUP	HCPCS C1713		6861272  -  PLATE 6861272 72.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6861275	SUP	HCPCS C1713		6861275  -  PLATE 6861275 75MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6861277	SUP	HCPCS C1713		6861277  -  PLATE 6861277 77.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6861280	SUP	HCPCS C1713		6861280  -  PLATE 6861280 80MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6861282	SUP	HCPCS C1713		6861282  -  PLATE 6861282 82.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6861285	SUP	HCPCS C1713		6861285  -  PLATE 6861285 85MM FSP ANTERIOR CRV	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
6861287	SUP	HCPCS C1713		6861287  -  PLATE 6861287 87.5MM FSP ANTERIOR CRV	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6861290	SUP	HCPCS C1713		6861290  -  PLATE 6861290 90MM FSP ANTERIOR CRV	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6861295	SUP	HCPCS C1713		6861295  -  PLATE 6861295 95MM FSP ANTERIOR CRV	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6861300	SUP	HCPCS C1713		6861300  -  PLATE 6861300 100MM FSP ANTERIOR CRV	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6861305	SUP	HCPCS C1713		6861305  -  PLATE 6861305 105MM FSP ANTERIOR CRV	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6861310	SUP	HCPCS C1713		6861310  -  PLATE 6861310 110MM FSP ANTERIOR CRV	BOTH IP/OP	"$4,266.00 "	"$3,156.84"	$0.00	"$3,412.80"	"$1,919.70"	"$1,919.70"	$0.00	$0.00	$0.00	$889.14	"$3,166.23"	"$3,166.23"	$0.00	$0.00	$889.03	$0.00	"$2,103.14"	"$2,103.14"	$0.00	"$2,133.00"	"$3,378.67"	"$3,412.80"	$0.00		$0.00	$667.63	$0.00	$0.00	$679.15	$0.00	$0.00	$0.00	$0.00	$0.00
6900120	SUP	HCPCS C1713		6900120  -  ROD SPNL SHRT 3.2MM 120MM VRTX MX CNCT PNT TI RECON SYS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
6900240	SUP	HCPCS C1713		6900240  -  ROD SPNL 240MM 3.2MM VRTX STD TI PCVD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
6900241	SUP	Custom 27203010		6900241  -  INSTRUMENT 6900241 3.2MMX240MM ROD TMPLT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6900270	SUP	HCPCS C1713		6900270  -  ROD SPNL 100MM 3.2MM VRTX STD OCCPTL TI PCVD OCCPTL PLT	BOTH IP/OP	"$4,216.50 "	"$3,120.21"	$0.00	"$3,373.20"	"$1,897.43"	"$1,897.43"	$0.00	$0.00	$0.00	$878.82	"$3,129.49"	"$3,129.49"	$0.00	$0.00	$878.72	$0.00	"$2,078.73"	"$2,078.73"	$0.00	"$2,108.25"	"$3,339.47"	"$3,373.20"	$0.00		$0.00	$659.88	$0.00	$0.00	$671.27	$0.00	$0.00	$0.00	$0.00	$0.00
6900280	SUP	HCPCS C1713		6900280  -  ROD SPNL 200MM 3.2MM VRTX STD OCCPTL TI PCVD OCCPTL PLT	BOTH IP/OP	"$4,216.50 "	"$3,120.21"	$0.00	"$3,373.20"	"$1,897.43"	"$1,897.43"	$0.00	$0.00	$0.00	$878.82	"$3,129.49"	"$3,129.49"	$0.00	$0.00	$878.72	$0.00	"$2,078.73"	"$2,078.73"	$0.00	"$2,108.25"	"$3,339.47"	"$3,373.20"	$0.00		$0.00	$659.88	$0.00	$0.00	$671.27	$0.00	$0.00	$0.00	$0.00	$0.00
6900506	SUP	HCPCS C1713		6900506  -  SCREW BN 3.5MM 6MM NTR STRL VRTX MA VA TI SPNE THOR CANC	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900508	SUP	HCPCS C1713		6900508  -  SCREW BN 3.5MM 8MM NTR STRL VRTX MA VA TI SPNE THOR CANC	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900510	SUP	HCPCS C1713		6900510  -  SCREW BN 3.5MM 10MM NTR STRL VRTX MA VA TI SPNE THOR CANC	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900512	SUP	HCPCS C1713		6900512  -  SCREW 6900512 VAS CANCELLOUS 3.5X12MM TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900514	SUP	HCPCS C1713		6900514  -  SCREW 6900514 VAS CANCELLOUS 3.5X14MM TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900516	SUP	HCPCS C1713		6900516  -  SCREW 6900516 VAS CANCELLOUS 3.5X16MM TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900518	SUP	HCPCS C1713		6900518  -  SCREW 6900518 VAS CANCELLOUS 3.5X18MM TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900520	SUP	HCPCS C1713		6900520  -  SCREW 6900520 VAS CANCELLOUS 3.5X20MM TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900522	SUP	HCPCS C1713		6900522  -  SCREW BONE 3.5MM 22MM VRTX TI CANC THOR SPN MULTIAX STRL	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900524	SUP	HCPCS C1713		6900524  -  SCREW 6900524 CANCELLOUS 3.5MMX24MM TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900606	SUP	HCPCS C1713		6900606  -  SCREW BN 4MM 6MM NTR STRL VRTX MA VA TI SPNE THOR CANC	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900608	SUP	HCPCS C1713		6900608  -  SCREW BN 4MM 8MM NTR STRL VRTX MA VA TI SPNE THOR CANC	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900610	SUP	HCPCS C1713		6900610  -  SCREW BN 4MM 10MM NTR STRL VRTX MA VA TI SPNE THOR CANC	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900612	SUP	HCPCS C1713		6900612  -  SCREW 6900612 VAS CANCELLOUS 4.0X12MM TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900614	SUP	HCPCS C1713		6900614  -  SCREW 6900614 VAS CANCELLOUS 4.0X14MM TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900616	SUP	HCPCS C1713		6900616  -  SCREW 6900616 VAS CANCELLOUS 4.0X16MM TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900618	SUP	HCPCS C1713		6900618  -  SCREW 6900618 VAS CANCELLOUS 4.0X18MM TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900620	SUP	HCPCS C1713		6900620  -  SCREW 6900620 VAS CANCELLOUS 4.0X20MM TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900622	SUP	HCPCS C1713		6900622  -  BONE SCREW 6900622 4.0MMX22MM CANC TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900624	SUP	HCPCS C1713		6900624  -  BONE SCREW 6900624 4.0MMX24MM CANC TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900626	SUP	HCPCS C1713		6900626  -  BONE SCREW 6900626 4.0MMX26MM CORT TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6900628	SUP	HCPCS C1713		6900628  -  BONE SCREW 6900628 4.0MMX28MM CORT TI	BOTH IP/OP	$696.00 	$515.04	$0.00	$556.80	$313.20	$313.20	$0.00	$0.00	$0.00	$145.06	$516.57	$516.57	$0.00	$0.00	$145.05	$0.00	$411.68	$411.68	$0.00	$348.00	$551.23	$556.80	$0.00		$0.00	$108.92	$0.00	$0.00	$110.80	$0.00	$0.00	$0.00	$0.00	$0.00
6901000	SUP	Custom 27803010		6901000  -  CONNECTOR 6901000 SCREW	BOTH IP/OP	$963.38 	$712.90	$0.00	$770.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$715.02	$715.02	$0.00	$0.00	$200.77	$0.00	$0.00	$0.00	$0.00	$481.69	$763.00	$770.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6902130	SUP	Custom 27803010		6902130  -  CONNECTOR 6902130 LATERAL CLOSED 10MM	BOTH IP/OP	$963.38 	$712.90	$0.00	$770.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$715.02	$715.02	$0.00	$0.00	$200.77	$0.00	$0.00	$0.00	$0.00	$481.69	$763.00	$770.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6902131	SUP	Custom 27803010		6902131  -  CONNECTOR 6902131 13MM LATRL CONCTR CLSE	BOTH IP/OP	$963.38 	$712.90	$0.00	$770.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$715.02	$715.02	$0.00	$0.00	$200.77	$0.00	$0.00	$0.00	$0.00	$481.69	$763.00	$770.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6902135	SUP	Custom 27803010		6902135  -  CONNECTOR 6902135 LATERAL OPEN 10MM	BOTH IP/OP	$963.38 	$712.90	$0.00	$770.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$715.02	$715.02	$0.00	$0.00	$200.77	$0.00	$0.00	$0.00	$0.00	$481.69	$763.00	$770.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6902200	SUP	Custom 27803010		6902200  -  CONNECTOR 6902200 ROD 3.2-5.5 TI	BOTH IP/OP	"$1,389.00 "	"$1,027.86"	$0.00	"$1,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,030.92"	"$1,030.92"	$0.00	$0.00	$289.47	$0.00	$0.00	$0.00	$0.00	$694.50	"$1,100.09"	"$1,111.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6902220	SUP	Custom 27803010		6902220  -  CONNECTOR 6902220 ROD 3.2-4.5 TI	BOTH IP/OP	"$1,389.00 "	"$1,027.86"	$0.00	"$1,111.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,030.92"	"$1,030.92"	$0.00	$0.00	$289.47	$0.00	$0.00	$0.00	$0.00	$694.50	"$1,100.09"	"$1,111.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6902525	SUP	HCPCS C1713		6902525  -  CROSSLINK 6902525 CRSSLNK CONNECTOR CLIP	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6902530	SUP	HCPCS C1713		6902530  -  CROSSLINK 6902530 CRSSLNK CONNECTOR BAR	BOTH IP/OP	$276.00 	$204.24	$0.00	$220.80	$124.20	$124.20	$0.00	$0.00	$0.00	$57.53	$204.85	$204.85	$0.00	$0.00	$57.52	$0.00	$163.25	$163.25	$0.00	$138.00	$218.59	$220.80	$0.00		$0.00	$43.19	$0.00	$0.00	$43.94	$0.00	$0.00	$0.00	$0.00	$0.00
6904045	SUP	HCPCS C1713		6904045  -  HOOK 6904045 LAMINAR 4.5MM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
6904060	SUP	HCPCS C1713		6904060  -  HOOK 6904060 LAMINAR 6.0MM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
6904075	SUP	HCPCS C1713		6904075  -  HOOK 6904075 LAMINAR 7.5MM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
6904090	SUP	HCPCS C1713		6904090  -  HOOK 6904090 LAMINAR 9.0MM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
6908245	SUP	HCPCS C1713		6908245  -  CAGE SPNL XL W 45X22X8MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6908250	SUP	HCPCS C1713		6908250  -  CAGE SPNL XL W 50X22X8MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6908255	SUP	HCPCS C1713		6908255  -  CAGE SPNL XL W 55X22X8MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6908260	SUP	HCPCS C1713		6908260  -  CAGE SPNL XL W 60X22X8MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6908840	SUP	HCPCS C1713		6908840  -  SPACER SPNL XL 40X18X8MM CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6908845	SUP	HCPCS C1713		6908845  -  CAGE SPNL XL 45X18X8MM NS LF CRNT PEEK LMBR INTRBD FS	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6908850	SUP	HCPCS C1713		6908850  -  CAGE SPNL XL 50X18X8MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6908855	SUP	HCPCS C1713		6908855  -  CAGE SPNL XL 55X18X8MM NS LF CRNT PEEK LMBR INTRBD FS	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6908860	SUP	HCPCS C1713		6908860  -  CAGE SPNL XL 60X18X8MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6910245	SUP	HCPCS C1713		6910245  -  CAGE SPNL XL W 45X22X10MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6910250	SUP	HCPCS C1713		6910250  -  CAGE SPNL XL W 50X22X10MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6910255	SUP	Custom 27803010		6910255  -  CAGE SPNL XL W 55X22X10MM NS LF CRNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	$0.00	$0.00	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6910260	SUP	HCPCS C1713		6910260  -  CAGE SPNL XL W 60X22X10MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6910840	SUP	HCPCS C1713		6910840  -  SPACER SPNL XL 40X18X10MM CRNT THORLMBR INTRBD FS RDLCNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6910845	SUP	HCPCS C1713		6910845  -  CAGE SPNL XL 45X18X10MM NS LF CRNT RADOPQ PEEK TLIF	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6910850	SUP	HCPCS C1713		6910850  -  CAGE SPNL XL 50X18X10MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6910855	SUP	HCPCS C1713		6910855  -  CAGE SPNL XL 55X18X10MM NS LF CRNT RADOPQ PEEK TLIF	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6910860	SUP	HCPCS C1713		6910860  -  CAGE SPNL XL 60X18X10MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6912245	SUP	HCPCS C1713		6912245  -  CAGE SPNL XL W 45X22X12MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6912250	SUP	HCPCS C1713		6912250  -  CAGE SPNL XL W 50X22X12MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6912255	SUP	HCPCS C1713		6912255  -  CAGE SPNL XL W 55X22X12MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6912260	SUP	HCPCS C1713		6912260  -  CAGE SPNL XL W 60X22X12MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6912840	SUP	HCPCS C1713		6912840  -  SPACER SPNL XL 40X18X12MM CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6912845	SUP	HCPCS C1713		6912845  -  CAGE SPNL XL 45X18X12MM NS LF CRNT RADOPQ PEEK LMBR INTRBD	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6912850	SUP	HCPCS C1713		6912850  -  CAGE SPNL XL 50X18X12MM NS LF CRNT RADOPQ PEEK LMBR INTRBD	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6912855	SUP	Custom 27803010		6912855  -  CAGE SPNL XL 55X18X12MM NS LF CRNT RADOPQ PEEK LMBR INTRBD	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	$0.00	$0.00	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6912860	SUP	HCPCS C1713		6912860  -  CAGE SPNL XL 60X18X12MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6914245	SUP	HCPCS C1713		6914245  -  SPACER SPNL XL W 45X22X14MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6914250	SUP	HCPCS C1713		6914250  -  CAGE SPNL XL W 50X22X14MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6914255	SUP	HCPCS C1713		6914255  -  SPACER SPNL XL W 55X22X14MM CRNT LMBR INTRBD FS RDLCNT PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6914260	SUP	HCPCS C1713		6914260  -  CAGE SPNL XL 60X22X14MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6914840	SUP	HCPCS C1713		6914840  -  SPACER SPNL 40X18X14MM INTRBD FS GFT RSTRC	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6914845	SUP	HCPCS C1713		6914845  -  SPACER SPNL XL 45X18X14MM STRL CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6914850	SUP	HCPCS C1713		6914850  -  CAGE SPNL XL 50X18X14MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6914855	SUP	HCPCS C1713		6914855  -  CAGE SPNL XL 55X18X14MM NS LF CRNT PEEK LMBR INTRBD FS	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6914860	SUP	HCPCS C1713		6914860  -  CAGE SPNL 10D XL 60X18X14MM XLIF CRNT PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6916245	SUP	HCPCS C1713		6916245  -  SPACER SPNL XL W 45X22X16MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6916250	SUP	HCPCS C1713		6916250  -  CAGE SPNL XL W 50X22X16MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6916255	SUP	HCPCS C1713		6916255  -  SPACER SPNL XL W 55X22X16MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6916260	SUP	HCPCS C1713		6916260  -  SPACER SPNL XL W 60X22X16MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6916840	SUP	HCPCS C1713		6916840  -  SPACER SPNL XL 40X18X16MM CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6916845	SUP	HCPCS C1713		6916845  -  SPACER SPNL XL 45X18X16MM CRNT THORLMBR INTRBD FS PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6916850	SUP	HCPCS C1713		6916850  -  CAGE SPNL XL 50X18X16MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6916855	SUP	HCPCS C1713		6916855  -  SPACER SPNL XL 55X18X16MM CRNT THORLMBR INTRBD FS PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6916860	SUP	HCPCS C1713		6916860  -  SPACER SPNL 10D XL 60X18X16MM XLIF CRNT PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6920845	SUP	HCPCS C1713		6920845  -  CAGE SPNL XL W LRDTC 45X22X8MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6920855	SUP	HCPCS C1713		6920855  -  CAGE SPNL XL W LRDTC 55X22X8MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6920860	SUP	HCPCS C1713		6920860  -  CAGE SPNL XL W LRDTC 60X22X8MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921044	SUP	HCPCS C1713		6921044  -  CAGE SPNL 8D XL 24X34X10MM CRNT RND PEEK-OPTM	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6921045	SUP	HCPCS C1713		6921045  -  CAGE SPNL XL W LRDTC 45X22X10MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921050	SUP	HCPCS C1713		6921050  -  CAGE SPNL XL W LRDTC 50X22X10MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921055	SUP	HCPCS C1713		6921055  -  CAGE SPNL XL W LRDTC 55X22X10MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921088	SUP	HCPCS C1713		6921088  -  SPACER SPNL 8D XL 38X28X10MM CRNT PEEK-OPTM	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6921244	SUP	HCPCS C1713		6921244  -  SPACER SPNL XL 12X34X24MM CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6921245	SUP	HCPCS C1713		6921245  -  CAGE SPNL XL W LRDTC 45X22X12MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921255	SUP	HCPCS C1713		6921255  -  CAGE SPNL XL W LRDTC 55X22X12MM NS LF CRNT PEEK LMBR INTRBD	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921260	SUP	HCPCS C1713		6921260  -  CAGE SPNL XL W LRDTC 60X22X12MM NS LF CRNT	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921288	SUP	HCPCS C1713		6921288  -  CAGE SPNL 8D XL 28X38X12MM CRNT RND PEEK-OPTM	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6921444	SUP	HCPCS C1713		6921444  -  CAGE SPNL 8D XL 24X34X14MM CRNT RND PEEK-OPTM	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6921445	SUP	HCPCS C1713		6921445  -  SPACER SPNL 10D LRDTC XL W 45X22X14MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921450	SUP	HCPCS C1713		6921450  -  SPACER SPNL 10D LRDTC XL W 50X22X14MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921455	SUP	HCPCS C1713		6921455  -  SPACER SPNL 10D LRDTC XL W 55X22X14MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921460	SUP	HCPCS C1713		6921460  -  SPACER SPNL 10D LRDTC XL W 60X22X14MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921488	SUP	HCPCS C1713		6921488  -  SPACER SPNL 8D XL 38X28X114MM LMBR INTRBD FS RDLCNT PEEK	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6921644	SUP	HCPCS C1713		6921644  -  SPACER SPNL 8D XL 34X24X16MM CRNT PEEK	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6921645	SUP	HCPCS C1713		6921645  -  SPACER SPNL 10D LRDTC XL W 45X22X16MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921650	SUP	HCPCS C1713		6921650  -  SPACER SPNL 10D LRDTC XL W 50X22X16MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921655	SUP	HCPCS C1713		6921655  -  SPACER SPNL 10D LRDTC XL W 55X22X16MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921660	SUP	HCPCS C1713		6921660  -  SPACER SPNL 10D LRDTC XL W 60X22X16MM PEEK	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6921688	SUP	HCPCS C1713		6921688  -  SPACER SPNL 8D XL 38X28X16MM CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6921844	SUP	HCPCS C1713		6921844  -  SPACER SPNL 8D XL 34X24X18MM LMBR INTRBD FS RDLCNT PEEK-OPTM	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6921888	SUP	HCPCS C1713		6921888  -  SPACER SPNL 8D XL 38X28X18MM LMBR INTRBD FS RDLCNT PEEK	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6922044	SUP	HCPCS C1713		6922044  -  SPACER SPNL 8D XL 34X24X20MM LMBR INTRBD FS RDLCNT PEEK	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6922088	SUP	HCPCS C1713		6922088  -  SPACER SPNL 8D XL 38X28X20MM LMBR INTRBD FS RDLCNT PEEK	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6931288	SUP	HCPCS C1713		6931288  -  CAGE SPNL 15D XL 28X38X12MM CRNT RND PEEK-OPTM	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6931488	SUP	HCPCS C1713		6931488  -  CAGE SPNL 15D XL 28X38X14MM CRNT RND PEEK-OPTM	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6931688	SUP	HCPCS C1713		6931688  -  SPACER SPNL XL 38X28X16MM CRNT INTRBD FS PEEK	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6931888	SUP	HCPCS C1713		6931888  -  SPACER SPNL 15D XL 38X28X18MM CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6932088	SUP	HCPCS C1713		6932088  -  SPACER SPNL 15D XL 38X28X20MM TLIF RDLCNT PEEK-OPTM	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	"$6,750.00"	"$6,750.00"	$0.00	$0.00	$0.00	"$3,126.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	"$7,395.00"	"$7,395.00"	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	"$2,347.50"	$0.00	$0.00	"$2,388.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6940664	SUP	HCPCS C1713		6940664  -  GRAFT BN 16X14X6MM SPCR ANTM SPNE CRV	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
6940764	SUP	HCPCS C1713		6940764  -  SPACER ALGRF 16X14X7MM SPNE CRV	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
6940864	SUP	HCPCS C1713		6940864  -  SPACER ALGRF 16X14X8MM SPNE CRV	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
6940964	SUP	HCPCS C1713		6940964  -  SPACER ALGRF 16X14X9MM SPNE CRV	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
6941034	SUP	HCPCS C1713		6941034  -  CAGE SPNL 8D 34X24X10MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941038	SUP	HCPCS C1713		6941038  -  CAGE SPNL 8D 38X28X10MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941042	SUP	HCPCS C1713		6941042  -  CAGE SPNL 8D 42X30X10MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941234	SUP	HCPCS C1713		6941234  -  CAGE SPNL 8D 34X24X12MM NS LF BRIGADE TI	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941238	SUP	HCPCS C1713		6941238  -  CAGE SPNL 8D 38X28X12MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941242	SUP	HCPCS C1713		6941242  -  CAGE SPNL 8D 42X30X12MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941434	SUP	HCPCS C1713		6941434  -  CAGE SPNL 8D 34X24X14MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941438	SUP	HCPCS C1713		6941438  -  CAGE SPNL 8D 38X28X14MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941442	SUP	HCPCS C1713		6941442  -  CAGE SPNL 8D 42X30X14MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941634	SUP	HCPCS C1713		6941634  -  CAGE SPNL 8D 34X24X16MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941638	SUP	HCPCS C1713		6941638  -  CAGE SPNL 8D 38X28X16MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941642	SUP	HCPCS C1713		6941642  -  CAGE SPNL 8D 42X30X16MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941834	SUP	HCPCS C1713		6941834  -  CAGE SPNL 8D 34X24X18MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941838	SUP	HCPCS C1713		6941838  -  CAGE SPNL 8D 38X28X18MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6941842	SUP	HCPCS C1713		6941842  -  CAGE SPNL 8D 42X30X18MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6942034	SUP	HCPCS C1713		6942034  -  CAGE SPNL 8D 34X24X20MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6942038	SUP	HCPCS C1713		6942038  -  CAGE SPNL 8D 38X28X20MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6942042	SUP	HCPCS C1713		6942042  -  CAGE SPNL 8D 42X30X20MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6950305	SUP	HCPCS C1713		6950305  -  SCREW BN 3.5MM 5MM LGHT BLU NS VRTX MX 3 RLF NTCH ST TOP LD	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
6950315	SUP	HCPCS C1713		6950315  -  SCREW SET TI 15MM 3.5MM POST SPN M6 VRTX	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
6951034	SUP	HCPCS C1713		6951034  -  CAGE SPNL 12D 34X24X10MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6951234	SUP	HCPCS C1713		6951234  -  CAGE SPNL 12D 34X24X12MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6951238	SUP	HCPCS C1713		6951238  -  CAGE SPNL 12D 38X28X12MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6951242	SUP	HCPCS C1713		6951242  -  CAGE SPNL 12D 42X30X12MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6951434	SUP	HCPCS C1713		6951434  -  CAGE SPNL 12D 34X24X14MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6951438	SUP	HCPCS C1713		6951438  -  CAGE SPNL 12D 38X28X14MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6951442	SUP	HCPCS C1713		6951442  -  CAGE SPNL 12D 42X30X14MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6951634	SUP	HCPCS C1713		6951634  -  CAGE SPNL 12D 34X24X16MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6951638	SUP	HCPCS C1713		6951638  -  CAGE SPNL 12D 38X28X16MM NS LF BRIGADE TI	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6951642	SUP	HCPCS C1713		6951642  -  CAGE SPNL 12D 42X30X16MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6951834	SUP	HCPCS C1713		6951834  -  CAGE SPNL 12D 34X24X18MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6951838	SUP	HCPCS C1713		6951838  -  CAGE SPNL 12D 38X28X18MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6951842	SUP	HCPCS C1713		6951842  -  CAGE SPNL 12D 42X30X18MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6952034	SUP	HCPCS C1713		6952034  -  CAGE SPNL 12D 34X24X20MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6952038	SUP	HCPCS C1713		6952038  -  CAGE SPNL 12D 38X28X20MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6952042	SUP	HCPCS C1713		6952042  -  CAGE SPNL 12D 42X30X20MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6955240	SUP	Custom 27803010		6955240  -  CONCTR ROD 240MM 3.2MM VRTX MX THRD TI SPNL RECON SYS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6955245	SUP	HCPCS C1713		6955245  -  ROD SPNL 4.5MM 360MM VRTX MX THRD TI RECON SYS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
6955255	SUP	HCPCS C1713		6955255  -  ROD SPNL 5.5MM 360MM VRTX MX THRD TI OCPTL RECON SYS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
6955260	SUP	HCPCS C1713		6955260  -  ROD 6955260 3.2 X 100 PRECURVED OC TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
6955270	SUP	HCPCS C1713		6955270  -  ROD 6955270 3.2 X 200 PRECURVED OC TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
6955273	SUP	HCPCS C1713		6955273  -  PLATE 6955273 OCCIPITAL KEEL SMALL	BOTH IP/OP	"$6,735.00 "	"$4,983.90"	$0.00	"$5,388.00"	"$3,030.75"	"$3,030.75"	$0.00	$0.00	$0.00	"$1,403.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,403.57"	$0.00	"$3,320.36"	"$3,320.36"	$0.00	"$3,367.50"	"$5,334.12"	"$5,388.00"	$0.00		$0.00	"$1,054.03"	$0.00	$0.00	"$1,072.21"	$0.00	$0.00	$0.00	$0.00	$0.00
6955274	SUP	HCPCS C1713		6955274  -  PLATE 6955274 OCCIPITAL KEEL MEDIUM	BOTH IP/OP	"$6,735.00 "	"$4,983.90"	$0.00	"$5,388.00"	"$3,030.75"	"$3,030.75"	$0.00	$0.00	$0.00	"$1,403.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,403.57"	$0.00	"$3,320.36"	"$3,320.36"	$0.00	"$3,367.50"	"$5,334.12"	"$5,388.00"	$0.00		$0.00	"$1,054.03"	$0.00	$0.00	"$1,072.21"	$0.00	$0.00	$0.00	$0.00	$0.00
6955275	SUP	HCPCS C1713		6955275  -  PLATE 6955275 OCCIPITAL KEEL LARGE	BOTH IP/OP	"$6,735.00 "	"$4,983.90"	$0.00	"$5,388.00"	"$3,030.75"	"$3,030.75"	$0.00	$0.00	$0.00	"$1,403.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,403.57"	$0.00	"$3,320.36"	"$3,320.36"	$0.00	"$3,367.50"	"$5,334.12"	"$5,388.00"	$0.00		$0.00	"$1,054.03"	$0.00	$0.00	"$1,072.21"	$0.00	$0.00	$0.00	$0.00	$0.00
6955406	SUP	HCPCS C1713		6955406  -  BONE SCREW 6955406 4.0 X 6MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955408	SUP	HCPCS C1713		6955408  -  BONE SCREW 6955408 4.0 X 8MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955410	SUP	HCPCS C1713		6955410  -  BONE SCREW 6955410 4.0 X 10MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955412	SUP	HCPCS C1713		6955412  -  BONE SCREW 6955412 4.0 X 12MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955414	SUP	HCPCS C1713		6955414  -  BONE SCREW 6955414 4.0 X 14MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955416	SUP	HCPCS C1713		6955416  -  BONE SCREW 6955416 4.0 X 16MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955418	SUP	HCPCS C1713		6955418  -  BONE SCREW 6955418 4.0 X 18MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955506	SUP	HCPCS C1713		6955506  -  BONE SCREW 6955506 4.5 X 6MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955508	SUP	HCPCS C1713		6955508  -  BONE SCREW 6955508 4.5 X 8MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955510	SUP	HCPCS C1713		6955510  -  BONE SCREW 6955510 4.5 X 10MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955512	SUP	HCPCS C1713		6955512  -  BONE SCREW 6955512 4.5 X 12MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955514	SUP	HCPCS C1713		6955514  -  BONE SCREW 6955514 4.5 X 14MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955516	SUP	HCPCS C1713		6955516  -  BONE SCREW 6955516 4.5 X 16MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955518	SUP	HCPCS C1713		6955518  -  BONE SCREW 6955518 4.5 X 18MM CORTICAL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955520	SUP	HCPCS C1713		6955520  -  SCREW BONE 4.5MM 20MM TI CORT SPNL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955524	SUP	HCPCS C1713		6955524  -  SCREW BONE 4.5MM 24MM CORT SPNL	BOTH IP/OP	$694.88 	$514.21	$0.00	$555.90	$312.69	$312.69	$0.00	$0.00	$0.00	$144.83	$515.74	$515.74	$0.00	$0.00	$144.81	$0.00	$411.02	$411.02	$0.00	$347.44	$550.34	$555.90	$0.00		$0.00	$108.75	$0.00	$0.00	$110.62	$0.00	$0.00	$0.00	$0.00	$0.00
6955710	SUP	HCPCS C1713		6955710  -  SCREW BN 3.5MM 10MM GRN VRTX MX MA ST ROT SDL TI THOR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
6955712	SUP	HCPCS C1713		6955712  -  SCREW BN 3.5MM 12MM STRL VRTX MA TI THOR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
6955714	SUP	HCPCS C1713		6955714  -  SCREW BN 3.5MM 14MM GRN VRTX MX MA ST ROT SDL TI THOR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
6955718	SUP	HCPCS C1713		6955718  -  SCREW BN 3.5MM 18MM GRN VRTX MX MA ST ROT SDL TI THOR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
6955826	SUP	HCPCS C1713		6955826  -  SCREW BN 4MM 26MM BLU VRTX MX MA ST ROT SDL TI THOR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
6955830	SUP	HCPCS C1713		6955830  -  SCREW BN 4MM 30MM AU VRTX MX MA ST ROT SDL TI THOR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
6955926	SUP	HCPCS C1713		6955926  -  SCREW BN 4.5MM 26MM MAG VRTX MX MA ST ROT SDL TI THOR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
6955960	SUP	Custom 27803010		6955960  -  CONNECTOR 6955960 10MM LAT OFFSET OPEN	BOTH IP/OP	$970.50 	$718.17	$0.00	$776.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$720.31	$720.31	$0.00	$0.00	$202.25	$0.00	$0.00	$0.00	$0.00	$485.25	$768.64	$776.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6955965	SUP	Custom 27803010		6955965  -  CONNECTOR 6955965 13MM LAT OFFSET OPEN	BOTH IP/OP	$970.50 	$718.17	$0.00	$776.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$720.31	$720.31	$0.00	$0.00	$202.25	$0.00	$0.00	$0.00	$0.00	$485.25	$768.64	$776.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6955973	SUP	HCPCS C1713		6955973  -  HOOK SPNL 4.5MM NS VRTX MX TI LMN RECON SYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
6955974	SUP	HCPCS C1713		6955974  -  HOOK SPNL 6MM VRTX MX LMNR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
6956010	SUP	Custom 27203010		6956010  -  BIT DRL 2.4MM STRL VRTX DISP	BOTH IP/OP	$649.50 	$480.63	$0.00	$519.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.06	$482.06	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$324.75	$514.40	$519.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6956011	SUP	Custom 27203010		6956011  -  BIT DRILL 26-52MM 2.9MM VRTX MX STRL DISP	BOTH IP/OP	$649.50 	$480.63	$0.00	$519.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.06	$482.06	$0.00	$0.00	$135.36	$0.00	$0.00	$0.00	$0.00	$324.75	$514.40	$519.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6956035	SUP	HCPCS C1713		6956035  -  TAP 3.5MM 10-24MM SURG VRTX MX	BOTH IP/OP	$385.50 	$285.27	$0.00	$308.40	$173.48	$173.48	$0.00	$0.00	$0.00	$80.35	$286.12	$286.12	$0.00	$0.00	$80.34	$0.00	$228.02	$228.02	$0.00	$192.75	$305.32	$308.40	$0.00		$0.00	$60.33	$0.00	$0.00	$61.37	$0.00	$0.00	$0.00	$0.00	$0.00
6957314	SUP	HCPCS C1769		6957314  -  GWIRE ORTH 720MM SPN THRD	BOTH IP/OP	$261.00 	$193.14	$0.00	$208.80	$141.72	$141.72	$0.00	$0.00	$0.00	$54.40	$193.71	$193.71	$0.00	$0.00	$54.39	$0.00	$154.38	$154.38	$0.00	$130.50	$206.71	$208.80	$0.00		$0.00	$40.85	$0.00	$0.00	$41.55	$0.00	$0.00	$0.00	$0.00	$0.00
6957315	SUP	HCPCS C1769		6957315  -  GWIRE ORTH 3MM CANN	BOTH IP/OP	$261.00 	$193.14	$0.00	$208.80	$141.72	$141.72	$0.00	$0.00	$0.00	$54.40	$193.71	$193.71	$0.00	$0.00	$54.39	$0.00	$154.38	$154.38	$0.00	$130.50	$206.71	$208.80	$0.00		$0.00	$40.85	$0.00	$0.00	$41.55	$0.00	$0.00	$0.00	$0.00	$0.00
6958710	SUP	HCPCS C1713		6958710  -  SCREW BN 3.5MM 10MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958712	SUP	HCPCS C1713		6958712  -  SCREW BN 3.5MM 12MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958714	SUP	HCPCS C1713		6958714  -  SCREW BN 3.5MM 14MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958716	SUP	HCPCS C1713		6958716  -  SCREW BN 3.5MM 16MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958718	SUP	HCPCS C1713		6958718  -  SCREW BN 3.5MM 18MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958720	SUP	HCPCS C1713		6958720  -  SCREW BN 3.5MM 20MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958722	SUP	HCPCS C1713		6958722  -  SCREW BN 3.5MM 22MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958724	SUP	HCPCS C1713		6958724  -  SCREW BN 3.5MM 24MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958726	SUP	HCPCS C1713		6958726  -  SCREW BN 3.5MM 26MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958728	SUP	HCPCS C1713		6958728  -  SCREW BN 3.5MM 28MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958730	SUP	HCPCS C1713		6958730  -  SCREW BN 3.5MM 30MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958732	SUP	HCPCS C1713		6958732  -  SCREW BN 3.5MM 32MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958734	SUP	HCPCS C1713		6958734  -  SCREW BN 3.5MM 34MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958736	SUP	HCPCS C1713		6958736  -  SCREW BN 3.5MM 36MM GRN NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958738	SUP	HCPCS C1713		6958738  -  SCREW BN 3.5MM 38MM GRN NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958740	SUP	HCPCS C1713		6958740  -  SCREW BN 3.5MM 40MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958742	SUP	HCPCS C1713		6958742  -  SCREW BN 3.5MM 42MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958744	SUP	HCPCS C1713		6958744  -  SCREW BN 3.5MM 44MM GRN VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958746	SUP	HCPCS C1713		6958746  -  SCREW BN 3.5MM 46MM GRN VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958748	SUP	HCPCS C1713		6958748  -  SCREW BN 3.5MM 48MM GRN VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958750	SUP	HCPCS C1713		6958750  -  SCREW BN 3.5MM 50MM GRN VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958752	SUP	HCPCS C1713		6958752  -  SCREW BN 3.5MM 52MM GRN VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958810	SUP	HCPCS C1713		6958810  -  SCREW BN 4MM 10MM BLU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958812	SUP	HCPCS C1713		6958812  -  SCREW 6958812 4.0 X 12MM MAS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958814	SUP	HCPCS C1713		6958814  -  SCREW BN 4MM 14MM BLU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958816	SUP	HCPCS C1713		6958816  -  SCREW BN 4MM 16MM BLU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958818	SUP	HCPCS C1713		6958818  -  SCREW BN 4MM 18MM BLU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958820	SUP	HCPCS C1713		6958820  -  SCREW BN 4MM 20MM BLU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958822	SUP	HCPCS C1713		6958822  -  SCREW BN 4MM 22MM BLU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958824	SUP	HCPCS C1713		6958824  -  SCREW BN 4MM 24MM BLU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958826	SUP	HCPCS C1713		6958826  -  SCREW BN 4MM 26MM AU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958828	SUP	HCPCS C1713		6958828  -  SCREW BN 4MM 28MM AU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958830	SUP	HCPCS C1713		6958830  -  SCREW BN 4MM 30MM AU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958832	SUP	HCPCS C1713		6958832  -  SCREW BN 4MM 32MM AU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958834	SUP	HCPCS C1713		6958834  -  SCREW BN 4MM 34MM AU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958836	SUP	HCPCS C1713		6958836  -  SCREW BN 4MM 36MM AU VRTX MX MA ST ROT SDL TI THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958838	SUP	HCPCS C1713		6958838  -  SCREW BN 4MM 38MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958840	SUP	HCPCS C1713		6958840  -  SCREW BN 4MM 40MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958842	SUP	HCPCS C1713		6958842  -  SCREW BN 4MM 42MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958844	SUP	HCPCS C1713		6958844  -  SCREW BN 4MM 44MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958846	SUP	HCPCS C1713		6958846  -  SCREW BN 4MM 46MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958848	SUP	HCPCS C1713		6958848  -  SCREW BN 4MM 48MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958850	SUP	HCPCS C1713		6958850  -  SCREW BN 4MM 50MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958852	SUP	HCPCS C1713		6958852  -  SCREW BN 4MM 52MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958910	SUP	HCPCS C1713		6958910  -  SCREW BN 4.5MM 10MM MAG NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958912	SUP	HCPCS C1713		6958912  -  SCREW BN 4.5MM 12MM MAG NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958914	SUP	HCPCS C1713		6958914  -  SCREW BN 4.5MM 14MM MAG NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958916	SUP	HCPCS C1713		6958916  -  SCREW BN 4.5MM 16MM MAG NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958918	SUP	HCPCS C1713		6958918  -  SCREW BN 4.5MM 18MM MAG NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958920	SUP	HCPCS C1713		6958920  -  SCREW BN 4.5MM 20MM MAG NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958922	SUP	HCPCS C1713		6958922  -  SCREW BN 4.5MM 22MM MAG NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958924	SUP	HCPCS C1713		6958924  -  SCREW BN 4.5MM 24MM MAG NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958926	SUP	HCPCS C1713		6958926  -  SCREW BN 4.5MM 26MM MAG NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958928	SUP	HCPCS C1713		6958928  -  SCREW BN 4.5MM 28MM MAG NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958930	SUP	HCPCS C1713		6958930  -  SCREW BN 4.5MM 30MM MAG NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958932	SUP	HCPCS C1713		6958932  -  SCREW BN 4.5MM 32MM MAG NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958934	SUP	HCPCS C1713		6958934  -  SCREW BN 4.5MM 34MM MAG NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958936	SUP	HCPCS C1713		6958936  -  SCREW BN 4.5MM 36MM MAG NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958938	SUP	HCPCS C1713		6958938  -  SCREW BN 4.5MM 38MM MAG NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958940	SUP	HCPCS C1713		6958940  -  SCREW BN 4.5MM 40MM MAG NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958942	SUP	HCPCS C1713		6958942  -  SCREW BN 4.5MM 42MM MAG NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958944	SUP	HCPCS C1713		6958944  -  SCREW 6958944 4.5 X 44MM MAS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958946	SUP	HCPCS C1713		6958946  -  SCREW 6958946 4.5 X 46MM MAS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958948	SUP	HCPCS C1713		6958948  -  SCREW 6958948 4.5 X 48MM MAS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958950	SUP	HCPCS C1713		6958950  -  SCREW 6958950 4.5 X 50MM MAS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958952	SUP	HCPCS C1713		6958952  -  SCREW 6958952 4.5 X 52MM MAS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6959418	SUP	HCPCS C1713		6959418  -  SCREW BN 4MM 18MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959420	SUP	HCPCS C1713		6959420  -  SCREW BN 4MM 20MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959422	SUP	HCPCS C1713		6959422  -  SCREW BN 4MM 22MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959424	SUP	HCPCS C1713		6959424  -  SCREW BN 4MM 24MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959426	SUP	HCPCS C1713		6959426  -  SCREW BN 4MM 26MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959430	SUP	HCPCS C1713		6959430  -  SCREW BN 4MM 30MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959432	SUP	HCPCS C1713		6959432  -  SCREW BN 4MM 32MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959434	SUP	HCPCS C1713		6959434  -  SCREW BN 4MM 34MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959436	SUP	HCPCS C1713		6959436  -  SCREW BN 4MM 36MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959438	SUP	HCPCS C1713		6959438  -  SCREW BN 4MM 38MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959440	SUP	HCPCS C1713		6959440  -  SCREW BN 4MM 40MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959442	SUP	HCPCS C1713		6959442  -  SCREW BN 4MM 42MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959444	SUP	HCPCS C1713		6959444  -  SCREW BN 4MM 44MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959446	SUP	HCPCS C1713		6959446  -  SCREW BN 4MM 46MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959448	SUP	HCPCS C1713		6959448  -  SCREW BN 4MM 48MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959450	SUP	HCPCS C1713		6959450  -  SCREW BN 4MM 50MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959452	SUP	HCPCS C1713		6959452  -  SCREW BN 4MM 52MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959510	SUP	HCPCS C1713		6959510  -  SCREW BN 4.5MM 10MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959512	SUP	HCPCS C1713		6959512  -  SCREW BN 4.5MM 12MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959514	SUP	HCPCS C1713		6959514  -  SCREW BN 4.5MM 14MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959516	SUP	HCPCS C1713		6959516  -  SCREW BN 4.5MM 16MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959518	SUP	HCPCS C1713		6959518  -  SCREW BN 4.5MM 18MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959520	SUP	HCPCS C1713		6959520  -  SCREW BN 4.5MM 20MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959522	SUP	HCPCS C1713		6959522  -  SCREW BN 4.5MM 22MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959524	SUP	HCPCS C1713		6959524  -  SCREW BN 4.5MM 24MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959526	SUP	HCPCS C1713		6959526  -  SCREW BN 4.5MM 26MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959528	SUP	HCPCS C1713		6959528  -  SCREW BN 4.5MM 28MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959530	SUP	HCPCS C1713		6959530  -  SCREW BN 4.5MM 30MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959532	SUP	HCPCS C1713		6959532  -  SCREW BN 4.5MM 32MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959534	SUP	HCPCS C1713		6959534  -  SCREW BN 4.5MM 34MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959536	SUP	HCPCS C1713		6959536  -  SCREW BN 4.5MM 36MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959538	SUP	HCPCS C1713		6959538  -  SCREW BN 4.5MM 38MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959540	SUP	HCPCS C1713		6959540  -  SCREW BN 4.5MM 40MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959542	SUP	HCPCS C1713		6959542  -  SCREW BN 4.5MM 42MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959544	SUP	HCPCS C1713		6959544  -  SCREW BN 4.5MM 44MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959546	SUP	HCPCS C1713		6959546  -  SCREW BN 4.5MM 46MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959548	SUP	HCPCS C1713		6959548  -  SCREW BN 4.5MM 48MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959550	SUP	HCPCS C1713		6959550  -  SCREW BN 4.5MM 50MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959552	SUP	HCPCS C1713		6959552  -  SCREW BN 4.5MM 52MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959970	SUP	HCPCS C1713		6959970  -  PLATE 6959970 LP OC KEEL SMALL	BOTH IP/OP	"$7,095.00 "	"$5,250.30"	$0.00	"$5,676.00"	"$3,192.75"	"$3,192.75"	$0.00	$0.00	$0.00	"$1,478.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,478.60"	$0.00	"$3,497.84"	"$3,497.84"	$0.00	"$3,547.50"	"$5,619.24"	"$5,676.00"	$0.00		$0.00	"$1,110.37"	$0.00	$0.00	"$1,129.52"	$0.00	$0.00	$0.00	$0.00	$0.00
6959971	SUP	HCPCS C1713		6959971  -  PLATE 6959971 LP OC KEEL MEDIUM	BOTH IP/OP	"$7,095.00 "	"$5,250.30"	$0.00	"$5,676.00"	"$3,192.75"	"$3,192.75"	$0.00	$0.00	$0.00	"$1,478.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,478.60"	$0.00	"$3,497.84"	"$3,497.84"	$0.00	"$3,547.50"	"$5,619.24"	"$5,676.00"	$0.00		$0.00	"$1,110.37"	$0.00	$0.00	"$1,129.52"	$0.00	$0.00	$0.00	$0.00	$0.00
6959972	SUP	HCPCS C1713		6959972  -  PLATE 6959972 LP OC KEEL LARGE	BOTH IP/OP	"$7,095.00 "	"$5,250.30"	$0.00	"$5,676.00"	"$3,192.75"	"$3,192.75"	$0.00	$0.00	$0.00	"$1,478.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,478.60"	$0.00	"$3,497.84"	"$3,497.84"	$0.00	"$3,547.50"	"$5,619.24"	"$5,676.00"	$0.00		$0.00	"$1,110.37"	$0.00	$0.00	"$1,129.52"	$0.00	$0.00	$0.00	$0.00	$0.00
6960013	SUP	HCPCS C1713		6960013  -  SCREW 6960013 PRSTG BON FAST 4.0X13MM	BOTH IP/OP	$633.00 	$468.42	$0.00	$506.40	$284.85	$284.85	$0.00	$0.00	$0.00	$131.93	$469.81	$469.81	$0.00	$0.00	$131.92	$0.00	$374.42	$374.42	$0.00	$316.50	$501.34	$506.40	$0.00		$0.00	$99.06	$0.00	$0.00	$100.77	$0.00	$0.00	$0.00	$0.00	$0.00
6960015	SUP	HCPCS C1713		6960015  -  SCREW 6960015 PRSTG BONE FAST 4.0X15MM	BOTH IP/OP	$633.00 	$468.42	$0.00	$506.40	$284.85	$284.85	$0.00	$0.00	$0.00	$131.93	$469.81	$469.81	$0.00	$0.00	$131.92	$0.00	$374.42	$374.42	$0.00	$316.50	$501.34	$506.40	$0.00		$0.00	$99.06	$0.00	$0.00	$100.77	$0.00	$0.00	$0.00	$0.00	$0.00
6960113	SUP	HCPCS C1713		6960113  -  SCREW 6960113 PRSTG BONE FAST 4.5X13MM	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$364.50	$364.50	$0.00	$0.00	$0.00	$168.82	$601.18	$601.18	$0.00	$0.00	$168.80	$0.00	$479.12	$479.12	$0.00	$405.00	$641.52	$648.00	$0.00		$0.00	$126.77	$0.00	$0.00	$128.95	$0.00	$0.00	$0.00	$0.00	$0.00
6960120	SUP	HCPCS C1713		6960120  -  SCREW 6960120  LOCK	BOTH IP/OP	$268.50 	$198.69	$0.00	$214.80	$120.83	$120.83	$0.00	$0.00	$0.00	$55.96	$199.28	$199.28	$0.00	$0.00	$55.96	$0.00	$158.82	$158.82	$0.00	$134.25	$212.65	$214.80	$0.00		$0.00	$42.02	$0.00	$0.00	$42.75	$0.00	$0.00	$0.00	$0.00	$0.00
6961038	SUP	HCPCS C1713		6961038  -  CAGE SPNL 8D 38X32X10MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6961238	SUP	HCPCS C1713		6961238  -  CAGE SPNL 8D 38X32X12MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6961260	SUP	Custom 27803010		6961260  -  PRESTIGE ARTIFICIAL DISC 6X12MM	BOTH IP/OP	"$7,342.50 "	"$5,433.45"	$0.00	"$5,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,530.18"	$0.00	$0.00	$0.00	$0.00	"$3,671.25"	"$5,815.26"	"$5,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6961438	SUP	HCPCS C1713		6961438  -  CAGE SPNL 8D 38X32X14MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6961460	SUP	Custom 27203010		6961460  -  DISC 6961460 CERVICAL DISC 6MM X 14MM	BOTH IP/OP	"$7,342.50 "	"$5,433.45"	$0.00	"$5,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,530.18"	$0.00	$0.00	$0.00	$0.00	"$3,671.25"	"$5,815.26"	"$5,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6961470	SUP	Custom 27203010		6961470  -  DISC 6961470 PRESTIGE ARTIFICIAL 7X14MM	BOTH IP/OP	"$7,342.50 "	"$5,433.45"	$0.00	"$5,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,530.18"	$0.00	$0.00	$0.00	$0.00	"$3,671.25"	"$5,815.26"	"$5,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6961638	SUP	HCPCS C1713		6961638  -  CAGE SPNL 8D 38X32X16MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6961660	SUP	Custom 27203010		6961660  -  DISC 6961660 CERVICAL DISC 6MM X 16MM	BOTH IP/OP	"$7,342.50 "	"$5,433.45"	$0.00	"$5,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,530.18"	$0.00	$0.00	$0.00	$0.00	"$3,671.25"	"$5,815.26"	"$5,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6961670	SUP	Custom 27203010		6961670  -  DISC 6961670 CERVICAL DISC 7MM X 16MM	BOTH IP/OP	"$7,342.50 "	"$5,433.45"	$0.00	"$5,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,530.18"	$0.00	$0.00	$0.00	$0.00	"$3,671.25"	"$5,815.26"	"$5,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6961838	SUP	HCPCS C1713		6961838  -  CAGE SPNL 8D 38X32X18MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6961870	SUP	Custom 27203010		6961870  -  DISC 6961870 CERVICAL DISC 7MM X 18MM	BOTH IP/OP	"$7,342.50 "	"$5,433.45"	$0.00	"$5,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,530.18"	$0.00	$0.00	$0.00	$0.00	"$3,671.25"	"$5,815.26"	"$5,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6962038	SUP	HCPCS C1713		6962038  -  CAGE SPNL 8D 38X32X20MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6971238	SUP	HCPCS C1713		6971238  -  CAGE SPNL 12D 38X32X12MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6971250	SUP	HCPCS C1713		6971250  -  DISC ARTF 12MM 5MM CERV	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971260	SUP	HCPCS C1713		6971260  -  DISC ARTF 12MM 6MM CERV MTN	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971270	SUP	HCPCS C1713		6971270  -  DISC ARTF 12MM 7MM CERV MTN	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971438	SUP	HCPCS C1713		6971438  -  CAGE SPNL 12D 38X32X14MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6971450	SUP	HCPCS C1713		6971450  -  DISC ARTF 14MM 5MM CERV	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971460	SUP	HCPCS C1713		6971460  -  DISC ARTF 14MM 6MM CERV MTN	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971470	SUP	HCPCS C1713		6971470  -  DISC ARTF 14MM 7MM CERV MTN	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971480	SUP	HCPCS C1713		6971480  -  DISC ARTF 14MM 8MM CERV MTN	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971638	SUP	HCPCS C1713		6971638  -  CAGE SPNL 12D 38X32X16MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6971650	SUP	HCPCS C1713		6971650  -  DISC 6971650 CERVICAL 5MM X 16MM	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971660	SUP	HCPCS C1713		6971660  -  DISC ARTF 16MM 6MM CERV MTN	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971670	SUP	HCPCS C1713		6971670  -  DISC ARTF 16MM 7MM CERV MTN	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971680	SUP	HCPCS C1713		6971680  -  DISC ARTF 16MM 8MM CERV MTN	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971838	SUP	HCPCS C1713		6971838  -  CAGE SPNL 12D 38X32X18MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6971870	SUP	HCPCS C1713		6971870  -  DISC ARTF 18MM 7MM CERV MTN	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971880	SUP	HCPCS C1713		6971880  -  DISC ARTF 18MM 8MM CERV MTN	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972038	SUP	HCPCS C1713		6972038  -  CAGE SPNL 12D 38X32X20MM NS LF BRIGADE	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6972118	SUP	Custom 27203010		6972118  -  BIT DRL DMD 1.5MM STRL RAIL CTR DISP	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6972250	SUP	HCPCS C1713		6972250  -  DISC 6972250 PRESTIGE	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972260	SUP	HCPCS C1713		6972260  -  DISC INTVRTB 12MM 6MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972270	SUP	HCPCS C1713		6972270  -  DISC INTVRTB 12MM 7MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972450	SUP	HCPCS C1713		6972450  -  DISC INTVRTB 14MM 4MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972460	SUP	HCPCS C1713		6972460  -  DISC INTVRTB 14MM 6MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972470	SUP	HCPCS C1713		6972470  -  DISC INTVRTB 14MM 7MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972480	SUP	HCPCS C1713		6972480  -  DISC INTVRTB 14MM 8MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972650	SUP	HCPCS C1713		6972650  -  DISC INTVRTB 16MM 5MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972660	SUP	HCPCS C1713		6972660  -  DISC INTVRTB 16MM 6MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972670	SUP	HCPCS C1713		6972670  -  DISC INTVRTB 16MM 7MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972680	SUP	HCPCS C1713		6972680  -  DISC INTVRTB 16MM 8MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972860	SUP	HCPCS C1713		6972860  -  DISC INTVRTB 18MM 6MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972870	SUP	HCPCS C1713		6972870  -  DISC INTVRTB 18MM 7MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6972880	SUP	HCPCS C1713		6972880  -  DISC INTVRTB 18MM 8MM PSTG LP CERV SPN TI	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6980840	SUP	HCPCS C1713		6980840  -  SPACER SPNL 40X18X8MM LMBR INTRBD FS PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6980850	SUP	HCPCS C1713		6980850  -  CAGE SPNL 10D XL 50X18X8MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6980855	SUP	HCPCS C1713		6980855  -  CAGE SPNL 10D XL 55X18X8MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6980860	SUP	HCPCS C1713		6980860  -  CAGE SPNL 10D XL 60X18X8MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981040	SUP	HCPCS C1713		6981040  -  CAGE SPNL 40X18X10MM PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981045	SUP	Custom 27803010		6981045  -  CAGE SPNL 10D XL 45X18X10MM NS LF CRNT PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	$0.00	$0.00	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6981050	SUP	HCPCS C1713		6981050  -  CAGE SPNL 10D XL 50X18X10MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981055	SUP	HCPCS C1713		6981055  -  CAGE SPNL 10D XL 55X18X10MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981060	SUP	HCPCS C1713		6981060  -  CAGE SPNL 10D XL 60X18X10MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981240	SUP	HCPCS C1713		6981240  -  SPACER SPNL LRDTC XL 40X18X12MM CRNT PEEK LMBR INTRBD FS	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981245	SUP	Custom 27803010		6981245  -  CAGE SPNL 10D XL 45X18X12MM NS LF CRNT PEEK LMBR INTRBD FS	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	$0.00	$0.00	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6981250	SUP	HCPCS C1713		6981250  -  CAGE SPNL 10D XL 50X18X12MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981255	SUP	Custom 27803010		6981255  -  CAGE SPNL 10D XL 55X18X12MM NS LF CRNT PEEK LMBR INTRBD FS	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	$0.00	$0.00	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6981260	SUP	HCPCS C1713		6981260  -  CAGE SPNL 10D XL 60X18X12MM NS LF CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981440	SUP	HCPCS C1713		6981440  -  SPACER SPNL XL 40X18X14MM CRNT LMBR INTRBD FS PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981445	SUP	HCPCS C1713		6981445  -  CAGE SPNL 10D XL 45X18X14MM CRNT PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981455	SUP	HCPCS C1713		6981455  -  CAGE SPNL 55X18X14MM CRNT THORLMBR INTRBD FS RDLCNT PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981460	SUP	HCPCS C1713		6981460  -  CAGE SPNL 10D XL 60X18X14MM CRNT PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981640	SUP	HCPCS C1713		6981640  -  SPACER SPNL XL 40X18X16MM INTRBD FS PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981645	SUP	HCPCS C1713		6981645  -  CAGE SPNL 10D XL 45X18X16MM CRNT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981650	SUP	HCPCS C1713		6981650  -  CAGE SPNL 10D XL 50X18X16MM CRNT PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981655	SUP	HCPCS C1713		6981655  -  CAGE SPNL 55X18X16MM CRNT THORLMBR INTRBD FS PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6981660	SUP	HCPCS C1713		6981660  -  CAGE SPNL XL LRDTC 60X18X14MM CRNT PEEK	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6990625	SUP	HCPCS C1713		6990625  -  CAGE SPNL XL 25X16X6MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6990630	SUP	HCPCS C1713		6990630  -  CAGE SPNL XL 30X16X6MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6990635	SUP	HCPCS C1713		6990635  -  CAGE SPNL XL 35X16X6MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6990640	SUP	HCPCS C1713		6990640  -  CAGE SPNL XL 40X16X6MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6990825	SUP	HCPCS C1713		6990825  -  CAGE SPNL XL 25X16X8MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6990830	SUP	HCPCS C1713		6990830  -  CAGE SPNL XL 30X16X8MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6990835	SUP	HCPCS C1713		6990835  -  CAGE SPNL XL 35X16X8MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6990840	SUP	HCPCS C1713		6990840  -  CAGE SPNL XL 40X16X8MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6991025	SUP	HCPCS C1713		6991025  -  CAGE SPNL XL 25X16X10MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6991030	SUP	HCPCS C1713		6991030  -  CAGE SPNL XL 30X16X10MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6991035	SUP	HCPCS C1713		6991035  -  CAGE SPNL XL 35X16X10MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6991040	SUP	HCPCS C1713		6991040  -  CAGE SPNL XL 40X16X10MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6991225	SUP	HCPCS C1713		6991225  -  CAGE SPNL XL 25X16X12MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6991230	SUP	HCPCS C1713		6991230  -  CAGE SPNL XL 30X16X12MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6991235	SUP	HCPCS C1713		6991235  -  CAGE SPNL XL 35X16X12MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6991240	SUP	HCPCS C1713		6991240  -  CAGE SPNL XL 40X16X12MM NS LF CRNT THOR	BOTH IP/OP	"$13,000.00 "	"$9,620.00"	$0.00	"$10,400.00"	"$5,850.00"	"$5,850.00"	$0.00	$0.00	$0.00	"$2,709.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,709.20"	$0.00	"$6,409.00"	"$6,409.00"	$0.00	"$6,500.00"	"$10,296.00"	"$10,400.00"	$0.00		$0.00	"$2,034.50"	$0.00	$0.00	"$2,069.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7002500	SUP	HCPCS C1713		7002500  -  CROSSLINK SET SCREW	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7002525	SUP	HCPCS C1713		7002525  -  LINK SPNL XLNK VRTX SM TI PLT RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7002526	SUP	HCPCS C1713		7002526  -  PLATE BONE XLNK MED SPNL TI PLT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7002527	SUP	Custom 27803010		7002527  -  CONCTR ROD LG VRTX MX XLNK PLT TI SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7020500	SUP	HCPCS C1713		7020500  -  BONE SCREW 7020500 ILIAC 5.5X100 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020535	SUP	HCPCS C1713		7020535  -  BONE SCREW 7020535 ILIAC 5.5X35 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020540	SUP	HCPCS C1713		7020540  -  BONE SCREW 7020540 ILIAC 5.5X40 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020545	SUP	HCPCS C1713		7020545  -  BONE SCREW 7020545 ILIAC 5.5X45 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020550	SUP	HCPCS C1713		7020550  -  BONE SCREW 7020550 ILIAC 5.5X50 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020555	SUP	HCPCS C1713		7020555  -  BONE SCREW 7020555 ILIAC 5.5X55 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020560	SUP	HCPCS C1713		7020560  -  BONE SCREW 7020560 ILIAC 5.5X60 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020570	SUP	HCPCS C1713		7020570  -  BONE SCREW 7020570 ILIAC 5.5X70 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020580	SUP	HCPCS C1713		7020580  -  BONE SCREW 7020580 ILIAC 5.5X80 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020590	SUP	HCPCS C1713		7020590  -  BONE SCREW 7020590 ILIAC 5.5X90 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020600	SUP	HCPCS C1713		7020600  -  BONE SCREW 7020600 ILIAC 6.5X100 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020635	SUP	HCPCS C1713		7020635  -  BONE SCREW 7020635 ILIAC 6.5X35 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020640	SUP	HCPCS C1713		7020640  -  BONE SCREW 7020640 ILIAC 6.5X40 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020645	SUP	HCPCS C1713		7020645  -  BONE SCREW 7020645 ILIAC 6.5X45 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020650	SUP	HCPCS C1713		7020650  -  BONE SCREW 7020650 ILIAC 6.5X50 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020655	SUP	HCPCS C1713		7020655  -  BONE SCREW 7020655 ILIAC 6.5X55 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020660	SUP	HCPCS C1713		7020660  -  BONE SCREW 7020660 ILIAC 6.5X60 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020670	SUP	HCPCS C1713		7020670  -  BONE SCREW 7020670 ILIAC 6.5X70 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020680	SUP	HCPCS C1713		7020680  -  BONE SCREW 7020680 ILIAC 6.5X80 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020690	SUP	HCPCS C1713		7020690  -  BONE SCREW 7020690 ILIAC 6.5X90 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020700	SUP	HCPCS C1713		7020700  -  BONE SCREW 7020700 ILIAC 7.5X100 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020735	SUP	HCPCS C1713		7020735  -  BONE SCREW 7020735 ILIAC 7.5X35 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020740	SUP	HCPCS C1713		7020740  -  BONE SCREW 7020740 ILIAC 7.5X40 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020745	SUP	HCPCS C1713		7020745  -  BONE SCREW 7020745 ILIAC 7.5X45 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020750	SUP	HCPCS C1713		7020750  -  BONE SCREW 7020750 ILIAC 7.5X50 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020755	SUP	HCPCS C1713		7020755  -  BONE SCREW 7020755 ILIAC 7.5X55 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020760	SUP	HCPCS C1713		7020760  -  BONE SCREW 7020760 ILIAC 7.5X60 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020770	SUP	HCPCS C1713		7020770  -  BONE SCREW 7020770 ILIAC 7.5X70 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020780	SUP	HCPCS C1713		7020780  -  BONE SCREW 7020780 ILIAC 7.5X80 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020790	SUP	HCPCS C1713		7020790  -  BONE SCREW 7020790 ILIAC 7.5X90 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020800	SUP	HCPCS C1713		7020800  -  BONE SCREW 7020800 ILIAC 8.5X100 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020835	SUP	HCPCS C1713		7020835  -  BONE SCREW 7020835 ILIAC 8.5X35 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020840	SUP	HCPCS C1713		7020840  -  BONE SCREW 7020840 ILIAC 8.5X40 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020845	SUP	HCPCS C1713		7020845  -  BONE SCREW 7020845 ILIAC 8.5X45 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020850	SUP	HCPCS C1713		7020850  -  BONE SCREW 7020850 ILIAC 8.5X50 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020860	SUP	HCPCS C1713		7020860  -  BONE SCREW 7020860 ILIAC 8.5X60 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020870	SUP	HCPCS C1713		7020870  -  BONE SCREW 7020870 ILIAC 8.5X70 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020880	SUP	HCPCS C1713		7020880  -  BONE SCREW 7020880 ILIAC 8.5X80 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7020890	SUP	HCPCS C1713		7020890  -  BONE SCREW 7020890 ILIAC 8.5X90 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021210	SUP	Custom 27803010		7021210  -  CONCTR ROD 10MM 4.5/6.35MM CD HZN LGC CLOSE OFFST SS SPNL	BOTH IP/OP	"$1,730.18 "	"$1,280.33"	$0.00	"$1,384.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.14"	"$1,284.14"	$0.00	$0.00	$360.57	$0.00	$0.00	$0.00	$0.00	$865.09	"$1,370.30"	"$1,384.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7021220	SUP	Custom 27803010		7021220  -  CONCTR ROD 20MM 4.5/6.35MM CD HZN LGC CLOSE OFFST SS SPNL	BOTH IP/OP	"$1,730.18 "	"$1,280.33"	$0.00	"$1,384.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.14"	"$1,284.14"	$0.00	$0.00	$360.57	$0.00	$0.00	$0.00	$0.00	$865.09	"$1,370.30"	"$1,384.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7021230	SUP	Custom 27803010		7021230  -  CONCTR ROD 30MM 4.5/6.35MM CD HZN LGC CLOSE OFFST SS SPNL	BOTH IP/OP	"$1,730.18 "	"$1,280.33"	$0.00	"$1,384.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.14"	"$1,284.14"	$0.00	$0.00	$360.57	$0.00	$0.00	$0.00	$0.00	$865.09	"$1,370.30"	"$1,384.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7021310	SUP	Custom 27803010		7021310  -  CONNECTOR 7021310 5.5 6.35 CLS LAT 10 SS	BOTH IP/OP	"$1,730.18 "	"$1,280.33"	$0.00	"$1,384.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.14"	"$1,284.14"	$0.00	$0.00	$360.57	$0.00	$0.00	$0.00	$0.00	$865.09	"$1,370.30"	"$1,384.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7021320	SUP	Custom 27803010		7021320  -  CONNECTOR 7021320 5.5 6.35 CLS LAT 20 SS	BOTH IP/OP	"$1,730.18 "	"$1,280.33"	$0.00	"$1,384.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.14"	"$1,284.14"	$0.00	$0.00	$360.57	$0.00	$0.00	$0.00	$0.00	$865.09	"$1,370.30"	"$1,384.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7021330	SUP	Custom 27803010		7021330  -  CONNECTOR 7021330 5.5 6.35 CLS LAT 30 SS	BOTH IP/OP	"$1,730.18 "	"$1,280.33"	$0.00	"$1,384.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.14"	"$1,284.14"	$0.00	$0.00	$360.57	$0.00	$0.00	$0.00	$0.00	$865.09	"$1,370.30"	"$1,384.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7021360	SUP	Custom 27803010		7021360  -  CONCTR ROD 60MM 5.5/6.35MM CD HZN LGC CLOSE OFFST SS SPNL	BOTH IP/OP	"$1,730.18 "	"$1,280.33"	$0.00	"$1,384.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.14"	"$1,284.14"	$0.00	$0.00	$360.57	$0.00	$0.00	$0.00	$0.00	$865.09	"$1,370.30"	"$1,384.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7021410	SUP	Custom 27803010		7021410  -  CONNECTOR 7021410 6.35 6.35 CLS LT 10 SS	BOTH IP/OP	"$1,730.18 "	"$1,280.33"	$0.00	"$1,384.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.14"	"$1,284.14"	$0.00	$0.00	$360.57	$0.00	$0.00	$0.00	$0.00	$865.09	"$1,370.30"	"$1,384.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7021420	SUP	Custom 27803010		7021420  -  CONNECTOR 7021420 6.35 6.35 CLS LT 20 SS	BOTH IP/OP	"$1,730.18 "	"$1,280.33"	$0.00	"$1,384.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.14"	"$1,284.14"	$0.00	$0.00	$360.57	$0.00	$0.00	$0.00	$0.00	$865.09	"$1,370.30"	"$1,384.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7021430	SUP	Custom 27803010		7021430  -  CONNECTOR 7021430 6.35 6.35 CLS LT 30 SS	BOTH IP/OP	"$1,730.18 "	"$1,280.33"	$0.00	"$1,384.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.14"	"$1,284.14"	$0.00	$0.00	$360.57	$0.00	$0.00	$0.00	$0.00	$865.09	"$1,370.30"	"$1,384.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7021460	SUP	Custom 27803010		7021460  -  CONCTR ROD 60MM 6.35MM CD HZN LGC CLOSE OFFST SS SPNL LAT	BOTH IP/OP	"$1,730.18 "	"$1,280.33"	$0.00	"$1,384.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.14"	"$1,284.14"	$0.00	$0.00	$360.57	$0.00	$0.00	$0.00	$0.00	$865.09	"$1,370.30"	"$1,384.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7021600	SUP	HCPCS C1713		7021600  -  BONE SCREW 7021600 10 DEG ILC 6.5X100 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021635	SUP	HCPCS C1713		7021635  -  BONE SCREW 7021635 10 DEG ILC 6.5X35 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021640	SUP	HCPCS C1713		7021640  -  BONE SCREW 7021640 10 DEG ILC 6.5X40 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021645	SUP	HCPCS C1713		7021645  -  BONE SCREW 7021645 10 DEG ILC 6.5X45 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021650	SUP	HCPCS C1713		7021650  -  BONE SCREW 7021650 10 DEG ILC 6.5X50 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021655	SUP	HCPCS C1713		7021655  -  BONE SCREW 7021655 10 DEG ILC 6.5X55 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021660	SUP	HCPCS C1713		7021660  -  BONE SCREW 7021660 10 DEG ILC 6.5X60 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021670	SUP	HCPCS C1713		7021670  -  BONE SCREW 7021670 10 DEG ILC 6.5X70 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021680	SUP	HCPCS C1713		7021680  -  BONE SCREW 7021680 10 DEG ILC 6.5X80 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021690	SUP	HCPCS C1713		7021690  -  BONE SCREW 7021690 10 DEG ILC 6.5X90 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021700	SUP	HCPCS C1713		7021700  -  BONE SCREW 7021700 10 DEG ILC 7.5X100 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021735	SUP	HCPCS C1713		7021735  -  BONE SCREW 7021735 10 DEG ILC 7.5X35 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021740	SUP	HCPCS C1713		7021740  -  BONE SCREW 7021740 10 DEG ILC 7.5X40 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021745	SUP	HCPCS C1713		7021745  -  BONE SCREW 7021745 10 DEG ILC 7.5X45 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021750	SUP	HCPCS C1713		7021750  -  BONE SCREW 7021750 10 DEG ILC 7.5X50 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021755	SUP	HCPCS C1713		7021755  -  BONE SCREW 7021755 10 DEG ILC 7.5X55 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021760	SUP	HCPCS C1713		7021760  -  BONE SCREW 7021760 10 DEG ILC 7.5X60 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021770	SUP	HCPCS C1713		7021770  -  BONE SCREW 7021770 10 DEG ILC 7.5X70 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021780	SUP	HCPCS C1713		7021780  -  BONE SCREW 7021780 10 DEG ILC 7.5X80 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021790	SUP	HCPCS C1713		7021790  -  BONE SCREW 7021790 10 DEG ILC 7.5X90 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021800	SUP	HCPCS C1713		7021800  -  BONE SCREW 7021800 10 DEG ILC 8.5X100 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021835	SUP	HCPCS C1713		7021835  -  BONE SCREW 7021835 10 DEG ILC 8.5X35 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021840	SUP	HCPCS C1713		7021840  -  BONE SCREW 7021840 10 DEG ILC 8.5X40 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021845	SUP	HCPCS C1713		7021845  -  BONE SCREW 7021845 10 DEG ILC 8.5X45 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021850	SUP	HCPCS C1713		7021850  -  BONE SCREW 7021850 10 DEG ILC 8.5X50 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021855	SUP	HCPCS C1713		7021855  -  BONE SCREW 7021855 10 DEG ILC 8.5X55 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021860	SUP	HCPCS C1713		7021860  -  BONE SCREW 7021860 10 DEG ILC 8.5X60 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021870	SUP	HCPCS C1713		7021870  -  BONE SCREW 7021870 10 DEG ILC 8.5X70 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021880	SUP	HCPCS C1713		7021880  -  BONE SCREW 7021880 10 DEG ILC 8.5X80 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7021890	SUP	HCPCS C1713		7021890  -  BONE SCREW 7021890 10 DEG ILC 8.5X90 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022210	SUP	Custom 27803010		7022210  -  CONNECTOR 7022210 LAT CONN SS 4.5 12MM	BOTH IP/OP	"$1,981.85 "	"$1,466.57"	$0.00	"$1,585.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.93"	"$1,470.93"	$0.00	$0.00	$413.02	$0.00	$0.00	$0.00	$0.00	$990.93	"$1,569.63"	"$1,585.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7022230	SUP	Custom 27803010		7022230  -  CONNECTOR 7022230 LAT CONN SS 4.5 32MM	BOTH IP/OP	"$1,981.85 "	"$1,466.57"	$0.00	"$1,585.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.93"	"$1,470.93"	$0.00	$0.00	$413.02	$0.00	$0.00	$0.00	$0.00	$990.93	"$1,569.63"	"$1,585.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7022310	SUP	Custom 27803010		7022310  -  CONNECTOR 7022310 LAT CONN SS 5.5 12MM	BOTH IP/OP	"$1,981.85 "	"$1,466.57"	$0.00	"$1,585.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.93"	"$1,470.93"	$0.00	$0.00	$413.02	$0.00	$0.00	$0.00	$0.00	$990.93	"$1,569.63"	"$1,585.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7022330	SUP	Custom 27803010		7022330  -  CONNECTOR 7022330 LAT CONN SS 5.5 32MM	BOTH IP/OP	"$1,981.85 "	"$1,466.57"	$0.00	"$1,585.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.93"	"$1,470.93"	$0.00	$0.00	$413.02	$0.00	$0.00	$0.00	$0.00	$990.93	"$1,569.63"	"$1,585.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7022410	SUP	Custom 27803010		7022410  -  CONNECTOR 7022410 LAT CONN SS 6.35 12MM	BOTH IP/OP	"$1,981.85 "	"$1,466.57"	$0.00	"$1,585.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.93"	"$1,470.93"	$0.00	$0.00	$413.02	$0.00	$0.00	$0.00	$0.00	$990.93	"$1,569.63"	"$1,585.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7022430	SUP	Custom 27803010		7022430  -  CONNECTOR 7022430 LAT CONN SS 6.35 32MM	BOTH IP/OP	"$1,981.85 "	"$1,466.57"	$0.00	"$1,585.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.93"	"$1,470.93"	$0.00	$0.00	$413.02	$0.00	$0.00	$0.00	$0.00	$990.93	"$1,569.63"	"$1,585.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7022600	SUP	HCPCS C1713		7022600  -  BONE SCREW 7022600 20 DEG ILC 6.5X100 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022635	SUP	HCPCS C1713		7022635  -  BONE SCREW 7022635 20 DEG ILC 6.5X35 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022640	SUP	HCPCS C1713		7022640  -  BONE SCREW 7022640 20 DEG ILC 6.5X40 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022645	SUP	HCPCS C1713		7022645  -  BONE SCREW 7022645 20 DEG ILC 6.5X45 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022650	SUP	HCPCS C1713		7022650  -  BONE SCREW 7022650 20 DEG ILC 6.5X50 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022655	SUP	HCPCS C1713		7022655  -  BONE SCREW 7022655 20 DEG ILC 6.5X55 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022660	SUP	HCPCS C1713		7022660  -  BONE SCREW 7022660 20 DEG ILC 6.5X60 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022670	SUP	HCPCS C1713		7022670  -  BONE SCREW 7022670 20 DEG ILC 6.5X70 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022680	SUP	HCPCS C1713		7022680  -  BONE SCREW 7022680 20 DEG ILC 6.5X80 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022690	SUP	HCPCS C1713		7022690  -  BONE SCREW 7022690 20 DEG ILC 6.5X90 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022700	SUP	HCPCS C1713		7022700  -  BONE SCREW 7022700 20 DEG ILC 7.5X100 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022735	SUP	HCPCS C1713		7022735  -  BONE SCREW 7022735 20 DEG ILC 7.5X35 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022740	SUP	HCPCS C1713		7022740  -  BONE SCREW 7022740 20 DEG ILC 7.5X40 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022750	SUP	HCPCS C1713		7022750  -  BONE SCREW 7022750 20 DEG ILC 7.5X50 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022755	SUP	HCPCS C1713		7022755  -  BONE SCREW 7022755 20 DEG ILC 7.5X55 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022760	SUP	HCPCS C1713		7022760  -  BONE SCREW 7022760 20 DEG ILC 7.5X60 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022770	SUP	HCPCS C1713		7022770  -  BONE SCREW 7022770 20 DEG ILC 7.5X70 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022780	SUP	HCPCS C1713		7022780  -  BONE SCREW 7022780 20 DEG ILC 7.5X80 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022790	SUP	HCPCS C1713		7022790  -  BONE SCREW 7022790 20 DEG ILC 7.5X90 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022800	SUP	HCPCS C1713		7022800  -  BONE SCREW 7022800 20 DEG ILC 8.5X100 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022835	SUP	HCPCS C1713		7022835  -  BONE SCREW 7022835 20 DEG ILC 8.5X35 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022840	SUP	HCPCS C1713		7022840  -  BONE SCREW 7022840 20 DEG ILC 8.5X40 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022845	SUP	HCPCS C1713		7022845  -  BONE SCREW 7022845 20 DEG ILC 8.5X45 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022850	SUP	HCPCS C1713		7022850  -  BONE SCREW 7022850 20 DEG ILC 8.5X50 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022855	SUP	HCPCS C1713		7022855  -  BONE SCREW 7022855 20 DEG ILC 8.5X55 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022860	SUP	HCPCS C1713		7022860  -  BONE SCREW 7022860 20 DEG ILC 8.5X60 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022870	SUP	HCPCS C1713		7022870  -  BONE SCREW 7022870 20 DEG ILC 8.5X70 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022880	SUP	HCPCS C1713		7022880  -  BONE SCREW 7022880 20 DEG ILC 8.5X80 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7022890	SUP	HCPCS C1713		7022890  -  BONE SCREW 7022890 20 DEG ILC 8.5X90 SS	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7023130	SUP	Custom 27203010		7023130  -  CASE STERILIZATION ILIAC SCREW SET	BOTH IP/OP	$409.50 	$303.03	$0.00	$327.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$303.93	$303.93	$0.00	$0.00	$85.34	$0.00	$0.00	$0.00	$0.00	$204.75	$324.32	$327.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7024855	SUP	HCPCS C1713		7024855  -  SCREW SET SS .25IN 32 THRD SPN PDCL BRKOF CD HZN LGC 6.35MM	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7025855	SUP	HCPCS C1713		7025855  -  SET SCREW 7025855 1 4 32 BREAK OFF SS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7030500	SUP	HCPCS C1713		"7030500  -  PROXIMAL SCREW 5.5 X 100, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030550	SUP	HCPCS C1713		"7030550  -  PROXIMAL SCREW 5.5 X 50, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030555	SUP	HCPCS C1713		"7030555  -  PROXIMAL SCREW 5.5 X 55, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030560	SUP	HCPCS C1713		"7030560  -  PROXIMAL SCREW 5.5 X 60, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030570	SUP	HCPCS C1713		"7030570  -  PROXIMAL SCREW 5.5 X 70, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030580	SUP	HCPCS C1713		"7030580  -  PROXIMAL SCREW 5.5 X 80, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030590	SUP	HCPCS C1713		"7030590  -  PROXIMAL SCREW 5.5 X 90, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030600	SUP	HCPCS C1713		"7030600  -  PROXIMAL SCREW 6.5 X 100, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030655	SUP	HCPCS C1713		"7030655  -  PROXIMAL SCREW 6.5 X 55, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030680	SUP	HCPCS C1713		"7030680  -  PROXIMAL SCREW 6.5 X 80, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030690	SUP	HCPCS C1713		"7030690  -  PROXIMAL SCREW 6.5 X 90, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030750	SUP	HCPCS C1713		"7030750  -  PROXIMAL SCREW 7.5 X 50, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030755	SUP	HCPCS C1713		"7030755  -  PROXIMAL SCREW 7.5 X 55, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030850	SUP	HCPCS C1713		"7030850  -  PROXIMAL SCREW 8.5 X 50, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030855	SUP	HCPCS C1713		"7030855  -  PROXIMAL SCREW 8.5 X 55, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7030860	SUP	HCPCS C1713		"7030860  -  PROXIMAL SCREW 8.5 X 60, SS"	BOTH IP/OP	"$2,134.10 "	"$1,579.23"	$0.00	"$1,707.28"	$960.35	$960.35	$0.00	$0.00	$0.00	$444.80	"$1,583.93"	"$1,583.93"	$0.00	$0.00	$444.75	$0.00	"$1,262.32"	"$1,262.32"	$0.00	"$1,067.05"	"$1,690.21"	"$1,707.28"	$0.00		$0.00	$333.99	$0.00	$0.00	$339.75	$0.00	$0.00	$0.00	$0.00	$0.00
7040500	SUP	HCPCS C1713		7040500  -  BONE SCREW 7040500 ILIAC 5.5X100 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040535	SUP	HCPCS C1713		7040535  -  BONE SCREW 7040535 ILIAC 5.5X35 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040540	SUP	HCPCS C1713		7040540  -  BONE SCREW 7040540 ILIAC 5.5X40 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040545	SUP	HCPCS C1713		7040545  -  BONE SCREW 7040545 ILIAC 5.5X45 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040550	SUP	HCPCS C1713		7040550  -  BONE SCREW 7040550 ILIAC 5.5X50 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040555	SUP	HCPCS C1713		7040555  -  BONE SCREW 7040555 ILIAC 5.5X55 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040570	SUP	HCPCS C1713		7040570  -  BONE SCREW 7040570 ILIAC 5.5X70 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040580	SUP	HCPCS C1713		7040580  -  BONE SCREW 7040580 ILIAC 5.5X80 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040590	SUP	HCPCS C1713		7040590  -  BONE SCREW 7040590 ILIAC 5.5X90 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040600	SUP	HCPCS C1713		7040600  -  BONE SCREW 7040600 ILIAC 6.5X100 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040635	SUP	HCPCS C1713		7040635  -  BONE SCREW 7040635 ILIAC 6.5X35 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040640	SUP	HCPCS C1713		7040640  -  BONE SCREW 7040640 ILIAC 6.5X40 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040645	SUP	HCPCS C1713		7040645  -  BONE SCREW 7040645 ILIAC 6.5X45 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040650	SUP	HCPCS C1713		7040650  -  BONE SCREW 7040650 ILIAC 6.5X50 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040655	SUP	HCPCS C1713		7040655  -  BONE SCREW 7040655 ILIAC 6.5X55 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040660	SUP	HCPCS C1713		7040660  -  BONE SCREW 7040660 ILIAC 6.5X60 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040670	SUP	HCPCS C1713		7040670  -  BONE SCREW 7040670 ILIAC 6.5X70 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040680	SUP	HCPCS C1713		7040680  -  BONE SCREW 7040680 ILIAC 6.5X80 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040690	SUP	HCPCS C1713		7040690  -  BONE SCREW 7040690 ILIAC 6.5X90 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040700	SUP	HCPCS C1713		7040700  -  BONE SCREW 7040700 ILIAC 7.5X100 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040740	SUP	HCPCS C1713		7040740  -  BONE SCREW 7040740 ILIAC 7.5X40 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040745	SUP	HCPCS C1713		7040745  -  BONE SCREW 7040745 ILIAC 7.5X45 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040750	SUP	HCPCS C1713		7040750  -  BONE SCREW 7040750 ILIAC 7.5X50 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040755	SUP	HCPCS C1713		7040755  -  BONE SCREW 7040755 ILIAC 7.5X55 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040760	SUP	HCPCS C1713		7040760  -  BONE SCREW 7040760 ILIAC 7.5X60 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040770	SUP	HCPCS C1713		7040770  -  BONE SCREW 7040770 ILIAC 7.5X70 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040780	SUP	HCPCS C1713		7040780  -  BONE SCREW 7040780 ILIAC 7.5X80 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040790	SUP	HCPCS C1713		7040790  -  BONE SCREW 7040790 ILIAC 7.5X90 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040800	SUP	HCPCS C1713		7040800  -  BONE SCREW 7040800 ILIAC 8.5X100 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040835	SUP	HCPCS C1713		7040835  -  BONE SCREW 7040835 ILIAC 8.5X35 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040840	SUP	HCPCS C1713		7040840  -  BONE SCREW 7040840 ILIAC 8.5X40 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040845	SUP	HCPCS C1713		7040845  -  BONE SCREW 7040845 ILIAC 8.5X45 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040850	SUP	HCPCS C1713		7040850  -  BONE SCREW 7040850 ILIAC 8.5X50 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040860	SUP	HCPCS C1713		7040860  -  BONE SCREW 7040860 ILIAC 8.5X60 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040870	SUP	HCPCS C1713		7040870  -  BONE SCREW 7040870 ILIAC 8.5X70 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040880	SUP	HCPCS C1713		7040880  -  BONE SCREW 7040880 ILIAC 8.5X80 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7040890	SUP	HCPCS C1713		7040890  -  BONE SCREW 7040890 ILIAC 8.5X90 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041210	SUP	Custom 27803010		7041210  -  CONCTR ROD 10MM CD HZN LGC CLOSE OFFST TI LAT SPNL 4.5/6.35	BOTH IP/OP	"$1,843.63 "	"$1,364.29"	$0.00	"$1,474.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.34"	"$1,368.34"	$0.00	$0.00	$384.21	$0.00	$0.00	$0.00	$0.00	$921.81	"$1,460.15"	"$1,474.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7041220	SUP	Custom 27803010		7041220  -  CONECTOR 7041220 CLSLAT 20MM TI 4.5/6.35	BOTH IP/OP	"$1,843.63 "	"$1,364.29"	$0.00	"$1,474.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.34"	"$1,368.34"	$0.00	$0.00	$384.21	$0.00	$0.00	$0.00	$0.00	$921.81	"$1,460.15"	"$1,474.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7041230	SUP	Custom 27803010		7041230  -  CONECTOR 7041230 CLSLAT 30MM TI 4.5/6.35	BOTH IP/OP	"$1,843.63 "	"$1,364.29"	$0.00	"$1,474.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.34"	"$1,368.34"	$0.00	$0.00	$384.21	$0.00	$0.00	$0.00	$0.00	$921.81	"$1,460.15"	"$1,474.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7041310	SUP	Custom 27803010		7041310  -  CONNECTOR 7041310 5.5 6.35 CLS LAT 10 TI	BOTH IP/OP	"$1,843.63 "	"$1,364.29"	$0.00	"$1,474.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.34"	"$1,368.34"	$0.00	$0.00	$384.21	$0.00	$0.00	$0.00	$0.00	$921.81	"$1,460.15"	"$1,474.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7041320	SUP	Custom 27803010		7041320  -  CONCTR ROD 20MM CD HZN LGC CLOSE OFFST TI LAT SPNL 5.5/6.35	BOTH IP/OP	"$1,843.63 "	"$1,364.29"	$0.00	"$1,474.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.34"	"$1,368.34"	$0.00	$0.00	$384.21	$0.00	$0.00	$0.00	$0.00	$921.81	"$1,460.15"	"$1,474.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7041330	SUP	Custom 27803010		7041330  -  CONNECTOR 7041330 5.5 6.35 CLS LAT 30 TI	BOTH IP/OP	"$1,843.63 "	"$1,364.29"	$0.00	"$1,474.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.34"	"$1,368.34"	$0.00	$0.00	$384.21	$0.00	$0.00	$0.00	$0.00	$921.81	"$1,460.15"	"$1,474.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7041360	SUP	Custom 27803010		7041360  -  CONECTR 7041360 5.5/6.35 CLS LAT 60MM TI	BOTH IP/OP	"$1,843.63 "	"$1,364.29"	$0.00	"$1,474.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.34"	"$1,368.34"	$0.00	$0.00	$384.21	$0.00	$0.00	$0.00	$0.00	$921.81	"$1,460.15"	"$1,474.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7041410	SUP	Custom 27803010		7041410  -  CONNECTOR 7041410 6.35 6.35 CLS LT 10 TI	BOTH IP/OP	"$1,843.63 "	"$1,364.29"	$0.00	"$1,474.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.34"	"$1,368.34"	$0.00	$0.00	$384.21	$0.00	$0.00	$0.00	$0.00	$921.81	"$1,460.15"	"$1,474.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7041420	SUP	Custom 27803010		7041420  -  CONNECTOR 7041420 6.35 6.35 CLS LT 20 TI	BOTH IP/OP	"$1,843.63 "	"$1,364.29"	$0.00	"$1,474.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.34"	"$1,368.34"	$0.00	$0.00	$384.21	$0.00	$0.00	$0.00	$0.00	$921.81	"$1,460.15"	"$1,474.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7041430	SUP	Custom 27803010		7041430  -  CONNECTOR 7041430 6.35 6.35 CLS LT 30 TI	BOTH IP/OP	"$1,843.63 "	"$1,364.29"	$0.00	"$1,474.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.34"	"$1,368.34"	$0.00	$0.00	$384.21	$0.00	$0.00	$0.00	$0.00	$921.81	"$1,460.15"	"$1,474.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7041460	SUP	Custom 27803010		7041460  -  CONECTR 7041460 6.35/6.35 CLS LAT 60MMTI	BOTH IP/OP	"$1,843.63 "	"$1,364.29"	$0.00	"$1,474.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.34"	"$1,368.34"	$0.00	$0.00	$384.21	$0.00	$0.00	$0.00	$0.00	$921.81	"$1,460.15"	"$1,474.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7041600	SUP	HCPCS C1713		7041600  -  BONE SCREW 7041600 10 DEG ILC 6.5X100 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041635	SUP	HCPCS C1713		7041635  -  BONE SCREW 7041635 10 DEG ILC 6.5X35 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041640	SUP	HCPCS C1713		7041640  -  BONE SCREW 7041640 10 DEG ILC 6.5X40 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041645	SUP	HCPCS C1713		7041645  -  BONE SCREW 7041645 10 DEG ILC 6.5X45 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041650	SUP	HCPCS C1713		7041650  -  BONE SCREW 7041650 10 DEG ILC 6.5X50 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041655	SUP	HCPCS C1713		7041655  -  BONE SCREW 7041655 10 DEG ILC 6.5X55 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041660	SUP	HCPCS C1713		7041660  -  BONE SCREW 7041660 10 DEG ILC 6.5X60 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041670	SUP	HCPCS C1713		7041670  -  BONE SCREW 7041670 10 DEG ILC 6.5X70 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041680	SUP	HCPCS C1713		7041680  -  BONE SCREW 7041680 10 DEG ILC 6.5X80 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041690	SUP	HCPCS C1713		7041690  -  BONE SCREW 7041690 10 DEG ILC 6.5X90 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041700	SUP	HCPCS C1713		7041700  -  BONE SCREW 7041700 10 DEG ILC 7.5X100 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041735	SUP	HCPCS C1713		7041735  -  BONE SCREW 7041735 10 DEG ILC 7.5X35 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041740	SUP	HCPCS C1713		7041740  -  BONE SCREW 7041740 10 DEG ILC 7.5X40 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041745	SUP	HCPCS C1713		7041745  -  BONE SCREW 7041745 10 DEG ILC 7.5X45 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041750	SUP	HCPCS C1713		7041750  -  BONE SCREW 7041750 10 DEG ILC 7.5X50 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041755	SUP	HCPCS C1713		7041755  -  BONE SCREW 7041755 10 DEG ILC 7.5X55 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041760	SUP	HCPCS C1713		7041760  -  BONE SCREW 7041760 10 DEG ILC 7.5X60 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041770	SUP	HCPCS C1713		7041770  -  BONE SCREW 7041770 10 DEG ILC 7.5X70 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041780	SUP	HCPCS C1713		7041780  -  BONE SCREW 7041780 10 DEG ILC 7.5X80 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041790	SUP	HCPCS C1713		7041790  -  BONE SCREW 7041790 10 DEG ILC 7.5X90 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041800	SUP	HCPCS C1713		7041800  -  BONE SCREW 7041800 10 DEG ILC 8.5X100 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041835	SUP	HCPCS C1713		7041835  -  BONE SCREW 7041835 10 DEG ILC 8.5X35 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041840	SUP	HCPCS C1713		7041840  -  BONE SCREW 7041840 10 DEG ILC 8.5X40 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041845	SUP	HCPCS C1713		7041845  -  BONE SCREW 7041845 10 DEG ILC 8.5X45 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041850	SUP	HCPCS C1713		7041850  -  BONE SCREW 7041850 10 DEG ILC 8.5X50 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041855	SUP	HCPCS C1713		7041855  -  BONE SCREW 7041855 10 DEG ILC 8.5X55 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041860	SUP	HCPCS C1713		7041860  -  BONE SCREW 7041860 10 DEG ILC 8.5X60 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041870	SUP	HCPCS C1713		7041870  -  BONE SCREW 7041870 10 DEG ILC 8.5X70 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041880	SUP	HCPCS C1713		7041880  -  BONE SCREW 7041880 10 DEG ILC 8.5X80 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7041890	SUP	HCPCS C1713		7041890  -  BONE SCREW 7041890 10 DEG ILC 8.5X90 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042210	SUP	Custom 27803010		7042210  -  CONNECTOR 7042210 LAT CONN TI 4.5 12MM	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7042230	SUP	Custom 27803010		7042230  -  CONNECTOR 7042230 LAT CONN TI 4.5 32MM	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7042310	SUP	Custom 27803010		7042310  -  CONNECTOR 7042310 LAT CONN TI 5.5 12MM	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7042320	SUP	Custom 27803010		7042320  -  CONNECTOR 7042320 LAT CONN TI 5.5 22MM	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7042330	SUP	Custom 27803010		7042330  -  CONNECTOR 7042330 LAT CONN TI 5.5 32MM	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7042410	SUP	Custom 27803010		7042410  -  CONNECTOR 7042410 LAT CONN TI 6.35 12MM	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7042430	SUP	Custom 27803010		7042430  -  CONNECTOR 7042430 LAT CONN TI 6.35 32MM	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7042600	SUP	HCPCS C1713		7042600  -  BONE SCREW 7042600 20 DEG ILC 6.5X100 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042635	SUP	HCPCS C1713		7042635  -  BONE SCREW 7042635 20 DEG ILC 6.5X35 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042640	SUP	HCPCS C1713		7042640  -  BONE SCREW 7042640 20 DEG ILC 6.5X40 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042645	SUP	HCPCS C1713		7042645  -  BONE SCREW 7042645 20 DEG ILC 6.5X45 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042650	SUP	HCPCS C1713		7042650  -  BONE SCREW 7042650 20 DEG ILC 6.5X50 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042655	SUP	HCPCS C1713		7042655  -  BONE SCREW 7042655 20 DEG ILC 6.5X55 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042660	SUP	HCPCS C1713		7042660  -  BONE SCREW 7042660 20 DEG ILC 6.5X60 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042670	SUP	HCPCS C1713		7042670  -  BONE SCREW 7042670 20 DEG ILC 6.5X70 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042680	SUP	HCPCS C1713		7042680  -  BONE SCREW 7042680 20 DEG ILC 6.5X80 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042690	SUP	HCPCS C1713		7042690  -  BONE SCREW 7042690 20 DEG ILC 6.5X90 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042700	SUP	HCPCS C1713		7042700  -  BONE SCREW 7042700 20 DEG ILC 7.5X100 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042735	SUP	HCPCS C1713		7042735  -  BONE SCREW 7042735 20 DEG ILC 7.5X35 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042740	SUP	HCPCS C1713		7042740  -  BONE SCREW 7042740 20 DEG ILC 7.5X40 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042745	SUP	HCPCS C1713		7042745  -  BONE SCREW 7042745 20 DEG ILC 7.5X45 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042750	SUP	HCPCS C1713		7042750  -  BONE SCREW 7042750 20 DEG ILC 7.5X50 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042755	SUP	HCPCS C1713		7042755  -  BONE SCREW 7042755 20 DEG ILC 7.5X55 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042760	SUP	HCPCS C1713		7042760  -  BONE SCREW 7042760 20 DEG ILC 7.5X60 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042770	SUP	HCPCS C1713		7042770  -  BONE SCREW 7042770 20 DEG ILC 7.5X70 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042780	SUP	HCPCS C1713		7042780  -  BONE SCREW 7042780 20 DEG ILC 7.5X80 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042790	SUP	HCPCS C1713		7042790  -  BONE SCREW 7042790 20 DEG ILC 7.5X90 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042800	SUP	HCPCS C1713		7042800  -  BONE SCREW 7042800 20 DEG ILC 8.5X100 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042835	SUP	HCPCS C1713		7042835  -  BONE SCREW 7042835 20 DEG ILC 8.5X35 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042840	SUP	HCPCS C1713		7042840  -  BONE SCREW 7042840 20 DEG ILC 8.5X40 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042845	SUP	HCPCS C1713		7042845  -  BONE SCREW 7042845 20 DEG ILC 8.5X45 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042850	SUP	HCPCS C1713		7042850  -  BONE SCREW 7042850 20 DEG ILC 8.5X50 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042855	SUP	HCPCS C1713		7042855  -  BONE SCREW 7042855 20 DEG ILC 8.5X55 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042860	SUP	HCPCS C1713		7042860  -  BONE SCREW 7042860 20 DEG ILC 8.5X60 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042870	SUP	HCPCS C1713		7042870  -  BONE SCREW 7042870 20 DEG ILC 8.5X70 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042880	SUP	HCPCS C1713		7042880  -  BONE SCREW 7042880 20 DEG ILC 8.5X80 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7042890	SUP	HCPCS C1713		7042890  -  BONE SCREW 7042890 20 DEG ILC 8.5X90 TI	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7045855	SUP	HCPCS C1713		7045855  -  SET SCREW 7045855 1 4 32 BREAK OFF TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7049855	SUP	HCPCS C1713		7049855  -  SCREW 7049855 HEX BREAK OFF TI .25 32	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7050500	SUP	HCPCS C1713		"7050500  -  PROXIMAL SCREW 5.5 X 100, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050550	SUP	HCPCS C1713		"7050550  -  PROXIMAL SCREW 5.5 X 50, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050555	SUP	HCPCS C1713		"7050555  -  PROXIMAL SCREW 5.5 X 55, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050560	SUP	HCPCS C1713		"7050560  -  PROXIMAL SCREW 5.5 X 60, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050570	SUP	HCPCS C1713		"7050570  -  PROXIMAL SCREW 5.5 X 70, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050580	SUP	HCPCS C1713		"7050580  -  PROXIMAL SCREW 5.5 X 80, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050590	SUP	HCPCS C1713		"7050590  -  PROXIMAL SCREW 5.5 X 90, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050600	SUP	HCPCS C1713		"7050600  -  PROXIMAL SCREW 6.5 X 100, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050655	SUP	HCPCS C1713		"7050655  -  PROXIMAL SCREW 6.5 X 55, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050680	SUP	HCPCS C1713		"7050680  -  PROXIMAL SCREW 6.5 X 80, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050690	SUP	HCPCS C1713		"7050690  -  PROXIMAL SCREW 6.5 X 90, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050750	SUP	HCPCS C1713		"7050750  -  PROXIMAL SCREW 7.5 X 50, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050755	SUP	HCPCS C1713		"7050755  -  PROXIMAL SCREW 7.5 X 55, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050850	SUP	HCPCS C1713		"7050850  -  PROXIMAL SCREW 8.5 X 50, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050855	SUP	HCPCS C1713		"7050855  -  PROXIMAL SCREW 8.5 X 55, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7050860	SUP	HCPCS C1713		"7050860  -  PROXIMAL SCREW 8.5 X 60, TI"	BOTH IP/OP	"$2,273.50 "	"$1,682.39"	$0.00	"$1,818.80"	"$1,023.08"	"$1,023.08"	$0.00	$0.00	$0.00	$473.85	"$1,687.39"	"$1,687.39"	$0.00	$0.00	$473.80	$0.00	"$1,344.78"	"$1,344.78"	$0.00	"$1,136.75"	"$1,800.61"	"$1,818.80"	$0.00		$0.00	$355.80	$0.00	$0.00	$361.94	$0.00	$0.00	$0.00	$0.00	$0.00
7060300	SUP	Custom 27803010		7060300  -  TUBE ET 9MM 6MM STRL LSRSHLD II CUF WRP REFLC SIL AL FLRPLAS	BOTH IP/OP	$445.00 	$329.30	$0.00	$356.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$330.28	$330.28	$0.00	$0.00	$92.74	$0.00	$0.00	$0.00	$0.00	$222.50	$352.44	$356.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7060400	SUP	Custom 27803010		7060400  -  TUBE ET 10.5MM 7MM STRL LSRSHLD II CUF WRP REFLC SIL AL	BOTH IP/OP	$445.00 	$329.30	$0.00	$356.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$330.28	$330.28	$0.00	$0.00	$92.74	$0.00	$0.00	$0.00	$0.00	$222.50	$352.44	$356.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7060500	SUP	Custom 27803010		7060500  -  TUBE ET 11.5MM 8MM STRL LF LSRSHLD II DISP	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.72	$311.72	$0.00	$0.00	$87.53	$0.00	$0.00	$0.00	$0.00	$210.00	$332.64	$336.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7070501	SUP	Custom 27203010		7070501  -  DRILL SRG 4.5MM NS LF DISP MAS PLIF	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7070502	SUP	Custom 27203010		7070502  -  DRILL SRG 5MM DISP MAS PLIF	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7070503	SUP	Custom 27203010		7070503  -  DRILL SRG 5.5MM DISP MAS PLIF	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7080510	SUP	Custom 27203010		7080510  -  BIT DRL 11MM STRL DISP	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$0.00	$0.00	$104.41	$0.00	$0.00	$0.00	$0.00	$250.50	$396.79	$400.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7080513	SUP	Custom 27203010		7080513  -  BIT DRL 13MM STRL DISP	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$0.00	$0.00	$104.41	$0.00	$0.00	$0.00	$0.00	$250.50	$396.79	$400.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7096530	SUP	HCPCS C1713		7096530  -  SCREW BN 6.5MM 30MM MAS PLIF	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7110001	SUP	HCPCS C1713		7110001  -  SCREW LOCK DIA 16 CORE VBR 2	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
7110003	SUP	HCPCS C1713		7110003  -  SCREW LOCK  CORE DIA 18 DIA 22 XCORE 2 TI	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
7124540	SUP	HCPCS C1713		7124540  -  SCREW BN 4.5MM 40MM SPNE MAS PLIF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7125025	SUP	HCPCS C1713		7125025  -  SCREW BN 5MM 25MM NS MAS PA SPNE 3Z PLIF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7125035	SUP	HCPCS C1713		7125035  -  SCREW BN 5MM 35MM SPNE MAS PLIF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7125525	SUP	HCPCS C1713		7125525  -  SCREW BN 5.5MM 25MM SPNE MAS PLIF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7125535	SUP	HCPCS C1713		7125535  -  SCREW BN 5.5MM 35MM SPNE MAS PLIF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7135100	SUP	Custom 27203010		7135100  -  KIT AUTOTRANSFUSION BOWL SMALL ASMBLY LOW VOLUME CENTRIFUGE	BOTH IP/OP	"$1,378.93 "	"$1,020.41"	$0.00	"$1,103.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,023.44"	"$1,023.44"	$0.00	$0.00	$287.37	$0.00	$0.00	$0.00	$0.00	$689.46	"$1,092.11"	"$1,103.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7140208	SUP	HCPCS C1713		7140208  -  PLATE BN 8 NS DECADE 2 HL SPNE XLIF	BOTH IP/OP	"$9,005.00 "	"$6,663.70"	$0.00	"$7,204.00"	"$4,052.25"	"$4,052.25"	$0.00	$0.00	$0.00	"$1,876.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,876.64"	$0.00	"$4,439.47"	"$4,439.47"	$0.00	"$4,502.50"	"$7,131.96"	"$7,204.00"	$0.00		$0.00	"$1,409.28"	$0.00	$0.00	"$1,433.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7140210	SUP	HCPCS C1713		7140210  -  PLATE BN 10 NS DECADE 2 HL SPNE XLIF	BOTH IP/OP	"$9,005.00 "	"$6,663.70"	$0.00	"$7,204.00"	"$4,052.25"	"$4,052.25"	$0.00	$0.00	$0.00	"$1,876.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,876.64"	$0.00	"$4,439.47"	"$4,439.47"	$0.00	"$4,502.50"	"$7,131.96"	"$7,204.00"	$0.00		$0.00	"$1,409.28"	$0.00	$0.00	"$1,433.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7140212	SUP	HCPCS C1713		7140212  -  PLATE BN 12 NS DECADE 2 HL SPNE XLIF	BOTH IP/OP	"$9,005.00 "	"$6,663.70"	$0.00	"$7,204.00"	"$4,052.25"	"$4,052.25"	$0.00	$0.00	$0.00	"$1,876.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,876.64"	$0.00	"$4,439.47"	"$4,439.47"	$0.00	"$4,502.50"	"$7,131.96"	"$7,204.00"	$0.00		$0.00	"$1,409.28"	$0.00	$0.00	"$1,433.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7140214	SUP	HCPCS C1713		7140214  -  PLATE BN 14 NS DECADE 2 HL SPNE XLIF	BOTH IP/OP	"$9,005.00 "	"$6,663.70"	$0.00	"$7,204.00"	"$4,052.25"	"$4,052.25"	$0.00	$0.00	$0.00	"$1,876.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,876.64"	$0.00	"$4,439.47"	"$4,439.47"	$0.00	"$4,502.50"	"$7,131.96"	"$7,204.00"	$0.00		$0.00	"$1,409.28"	$0.00	$0.00	"$1,433.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7140216	SUP	HCPCS C1713		7140216  -  PLATE BN 16 NS DECADE 2 HL SPNE XLIF	BOTH IP/OP	"$9,005.00 "	"$6,663.70"	$0.00	"$7,204.00"	"$4,052.25"	"$4,052.25"	$0.00	$0.00	$0.00	"$1,876.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,876.64"	$0.00	"$4,439.47"	"$4,439.47"	$0.00	"$4,502.50"	"$7,131.96"	"$7,204.00"	$0.00		$0.00	"$1,409.28"	$0.00	$0.00	"$1,433.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7140218	SUP	HCPCS C1713		7140218  -  PLATE BN 18 NS DECADE 2 HL SPNE XLIF	BOTH IP/OP	"$9,005.00 "	"$6,663.70"	$0.00	"$7,204.00"	"$4,052.25"	"$4,052.25"	$0.00	$0.00	$0.00	"$1,876.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,876.64"	$0.00	"$4,439.47"	"$4,439.47"	$0.00	"$4,502.50"	"$7,131.96"	"$7,204.00"	$0.00		$0.00	"$1,409.28"	$0.00	$0.00	"$1,433.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7140408	SUP	HCPCS C1713		7140408  -  PLATE BN 8 NS DECADE 4 HL SPNE XLIF	BOTH IP/OP	"$9,642.50 "	"$7,135.45"	$0.00	"$7,714.00"	"$4,339.13"	"$4,339.13"	$0.00	$0.00	$0.00	"$2,009.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,009.50"	$0.00	"$4,753.75"	"$4,753.75"	$0.00	"$4,821.25"	"$7,636.86"	"$7,714.00"	$0.00		$0.00	"$1,509.05"	$0.00	$0.00	"$1,535.09"	$0.00	$0.00	$0.00	$0.00	$0.00
7140410	SUP	HCPCS C1713		7140410  -  PLATE BN 10 NS DECADE 4 HL SPNE XLIF	BOTH IP/OP	"$9,642.50 "	"$7,135.45"	$0.00	"$7,714.00"	"$4,339.13"	"$4,339.13"	$0.00	$0.00	$0.00	"$2,009.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,009.50"	$0.00	"$4,753.75"	"$4,753.75"	$0.00	"$4,821.25"	"$7,636.86"	"$7,714.00"	$0.00		$0.00	"$1,509.05"	$0.00	$0.00	"$1,535.09"	$0.00	$0.00	$0.00	$0.00	$0.00
7140412	SUP	HCPCS C1713		7140412  -  PLATE BN 12 NS DECADE 4 HL SPNE XLIF	BOTH IP/OP	"$9,642.50 "	"$7,135.45"	$0.00	"$7,714.00"	"$4,339.13"	"$4,339.13"	$0.00	$0.00	$0.00	"$2,009.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,009.50"	$0.00	"$4,753.75"	"$4,753.75"	$0.00	"$4,821.25"	"$7,636.86"	"$7,714.00"	$0.00		$0.00	"$1,509.05"	$0.00	$0.00	"$1,535.09"	$0.00	$0.00	$0.00	$0.00	$0.00
7140414	SUP	HCPCS C1713		7140414  -  PLATE BN 14 NS DECADE 4 HL SPNE XLIF	BOTH IP/OP	"$9,642.50 "	"$7,135.45"	$0.00	"$7,714.00"	"$4,339.13"	"$4,339.13"	$0.00	$0.00	$0.00	"$2,009.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,009.50"	$0.00	"$4,753.75"	"$4,753.75"	$0.00	"$4,821.25"	"$7,636.86"	"$7,714.00"	$0.00		$0.00	"$1,509.05"	$0.00	$0.00	"$1,535.09"	$0.00	$0.00	$0.00	$0.00	$0.00
7140416	SUP	HCPCS C1713		7140416  -  PLATE BN 16 NS DECADE 4 HL SPNE XLIF	BOTH IP/OP	"$9,642.50 "	"$7,135.45"	$0.00	"$7,714.00"	"$4,339.13"	"$4,339.13"	$0.00	$0.00	$0.00	"$2,009.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,009.50"	$0.00	"$4,753.75"	"$4,753.75"	$0.00	"$4,821.25"	"$7,636.86"	"$7,714.00"	$0.00		$0.00	"$1,509.05"	$0.00	$0.00	"$1,535.09"	$0.00	$0.00	$0.00	$0.00	$0.00
7140418	SUP	HCPCS C1713		7140418  -  PLATE BN 18 NS DECADE 4 HL SPNE XLIF	BOTH IP/OP	"$9,642.50 "	"$7,135.45"	$0.00	"$7,714.00"	"$4,339.13"	"$4,339.13"	$0.00	$0.00	$0.00	"$2,009.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,009.50"	$0.00	"$4,753.75"	"$4,753.75"	$0.00	"$4,821.25"	"$7,636.86"	"$7,714.00"	$0.00		$0.00	"$1,509.05"	$0.00	$0.00	"$1,535.09"	$0.00	$0.00	$0.00	$0.00	$0.00
7141112	SUP	Custom 27203010		7141112  -  GUIDE PIN ORTH 100MM DECADE SPNE XLIF	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7141113	SUP	HCPCS C1713		7141113  -  PIN FX DECADE SCR XLIF	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
7141230	SUP	HCPCS C1713		7141230  -  BOLT SPNL SM 5MM 30MM DECADE IMPACTABLE XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7141240	SUP	HCPCS C1713		7141240  -  BOLT SPNL SM 5MM 40MM DECADE IMPACTABLE XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7141250	SUP	HCPCS C1713		7141250  -  BOLT SPNL SM 5MM 50MM DECADE IMPACTABLE XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145030	SUP	HCPCS C1713		7145030  -  BOLT SPNL SM 5MM 30MM NS DECADE THRD PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145035	SUP	HCPCS C1713		7145035  -  BOLT SPNL SM 5MM 35MM NS DECADE THRD PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145040	SUP	HCPCS C1713		7145040  -  BOLT SPNL SM 5MM 40MM NS DECADE THRD PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145045	SUP	HCPCS C1713		7145045  -  BOLT SPNL SM 5MM 45MM NS DECADE THRD PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145050	SUP	HCPCS C1713		7145050  -  BOLT SPNL SM 5MM 50MM NS DECADE THRD PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145055	SUP	HCPCS C1713		7145055  -  BOLT SPNL SM 5MM 55MM NS DECADE THRD PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145060	SUP	HCPCS C1713		7145060  -  BOLT SPNL SM 5MM 60MM NS DECADE THRD PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145130	SUP	HCPCS C1713		7145130  -  BOLT SPNL SM 5.5MM 30MM NS DECADE THRD PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145140	SUP	HCPCS C1713		7145140  -  BOLT SPNL SM 5.5MM 40MM NS DECADE THRD PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145150	SUP	HCPCS C1713		7145150  -  BOLT SPNL SM 5.5MM 50MM NS DECADE THRD PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145525	SUP	HCPCS C1713		7145525  -  BOLT SPNL LG 5.5MM 25MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145530	SUP	HCPCS C1713		7145530  -  BOLT SPNL LG 5.5MM 30MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145535	SUP	HCPCS C1713		7145535  -  BOLT SPNL LG 5.5MM 35MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145540	SUP	HCPCS C1713		7145540  -  BOLT SPNL LG 5.5MM 40MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145545	SUP	HCPCS C1713		7145545  -  BOLT SPNL LG 5.5MM 45MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145550	SUP	HCPCS C1713		7145550  -  BOLT SPNL LG 5.5MM 50MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145555	SUP	HCPCS C1713		7145555  -  BOLT SPNL LG 5.5MM 55MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7145560	SUP	HCPCS C1713		7145560  -  BOLT SPNL LG 5.5MM 60MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7146525	SUP	HCPCS C1713		7146525  -  BOLT SPNL LG 6.5MM 25MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7146530	SUP	HCPCS C1713		7146530  -  BOLT SPNL LG 6.5MM 30MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7146535	SUP	HCPCS C1713		7146535  -  BOLT SPNL LG 6.5MM 35MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7146540	SUP	HCPCS C1713		7146540  -  BOLT SPNL LG 6.5MM 40MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7146545	SUP	HCPCS C1713		7146545  -  BOLT SPNL LG 6.5MM 45MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7146550	SUP	HCPCS C1713		7146550  -  BOLT SPNL LG 6.5MM 50MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7146555	SUP	HCPCS C1713		7146555  -  BOLT SPNL LG 6.5MM 55MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7146560	SUP	HCPCS C1713		7146560  -  BOLT SPNL LG 6.5MM 60MM NS DECADE PLT XLIF	BOTH IP/OP	"$2,407.50 "	"$1,781.55"	$0.00	"$1,926.00"	"$1,083.38"	"$1,083.38"	$0.00	$0.00	$0.00	$501.78	"$1,786.85"	"$1,786.85"	$0.00	$0.00	$501.72	$0.00	"$1,424.04"	"$1,424.04"	$0.00	"$1,203.75"	"$1,906.74"	"$1,926.00"	$0.00		$0.00	$376.77	$0.00	$0.00	$383.27	$0.00	$0.00	$0.00	$0.00	$0.00
7160012	SUP	Custom 27803010		7160012  -  CAGE SPNL 16MM 12MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7160014	SUP	Custom 27803010		7160014  -  CAGE SPNL 16MM 14MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7160022	SUP	Custom 27803010		7160022  -  CAGE SPNL 16MM 16-22MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7160025	SUP	Custom 27803010		7160025  -  CAGE SPNL 16MM 18-25MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7160035	SUP	Custom 27803010		7160035  -  CAGE SPNL 16MM 23-35MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7160041	SUP	Custom 27803010		7160041  -  CAGE SPNL 16MM 26-41MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7160049	SUP	Custom 27803010		7160049  -  CAGE SPNL 16MM 30-49MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7160063	SUP	Custom 27803010		7160063  -  CAGE SPNL 16MM 37-63MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7160075	SUP	Custom 27803010		7160075  -  CAGE SPNL 16MM 43-75MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7162000	SUP	HCPCS C1713		7162000  -  SCREW LOCK ENDCAP XCORE 2 TI	BOTH IP/OP	$620.00 	$458.80	$0.00	$496.00	$279.00	$279.00	$0.00	$0.00	$0.00	$129.22	$460.16	$460.16	$0.00	$0.00	$129.21	$0.00	$366.73	$366.73	$0.00	$310.00	$491.04	$496.00	$0.00		$0.00	$97.03	$0.00	$0.00	$98.70	$0.00	$0.00	$0.00	$0.00	$0.00
7164565	SUP	HCPCS C1713		7164565  -  5.0X 65MM SCREW	BOTH IP/OP	$648.00 	$479.52	$0.00	$518.40	$291.60	$291.60	$0.00	$0.00	$0.00	$135.06	$480.95	$480.95	$0.00	$0.00	$135.04	$0.00	$383.29	$383.29	$0.00	$324.00	$513.22	$518.40	$0.00		$0.00	$101.41	$0.00	$0.00	$103.16	$0.00	$0.00	$0.00	$0.00	$0.00
7180016	SUP	Custom 27803010		7180016  -  CAGE SPNL 18MM 16MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7180018	SUP	Custom 27803010		7180018  -  CAGE SPNL 18MM 18MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7180025	SUP	Custom 27803010		7180025  -  CAGE SPNL 18MM 20-25MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7180027	SUP	Custom 27803010		7180027  -  CAGE SPNL 18MM 21-27MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7180033	SUP	Custom 27803010		7180033  -  CAGE SPNL 18MM 24-33MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7180041	SUP	Custom 27803010		7180041  -  CAGE SPNL 18MM 28-41MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7180055	SUP	Custom 27803010		7180055  -  CAGE SPINAL 18X35-55MM X-CORE 2 TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7180067	SUP	Custom 27803010		7180067  -  CAGE SPNL 18MM 41-67MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7180079	SUP	Custom 27803010		7180079  -  CAGE SPNL 18MM 47-79MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7180121	SUP	Custom 27803010		7180121  -  CAGE SPNL 18MM 68-121MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7191525	SUP	HCPCS C1713		7191525  -  CDH 7191525 HA COATED  5.5X25	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191530	SUP	HCPCS C1713		7191530  -  CDH 7191530 HA COATED  5.5X30	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191535	SUP	HCPCS C1713		7191535  -  SCREW BN 5.5MM 35MM STRL CD HZN LGC MA HA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191540	SUP	HCPCS C1713		7191540  -  SCREW BN 5.5MM 40MM STRL CD HZN LGC MA HA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191545	SUP	HCPCS C1713		7191545  -  CDH 7191545 HA COATED  5.5X45	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191550	SUP	HCPCS C1713		7191550  -  CDH HA COATED MAS 5.5X50	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191555	SUP	HCPCS C1713		7191555  -  CDH HA COATED MAS 5.5X55	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191560	SUP	HCPCS C1713		7191560  -  CDH HA COATED MAS 5.5X60	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191625	SUP	HCPCS C1713		7191625  -  CDH HA COATED MAS 6.5X25	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191630	SUP	HCPCS C1713		7191630  -  CDH HA COATED MAS 6.5X30	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191635	SUP	HCPCS C1713		7191635  -  SCREW BN 6.5MM 35MM STRL CD HZN LGC MA HA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191640	SUP	HCPCS C1713		7191640  -  SCREW BN 6.5MM 40MM STRL CD HZN LGC MA HA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191645	SUP	HCPCS C1713		7191645  -  SCREW BN 6.5MM 45MM STRL CD HZN LGC MA HA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191650	SUP	HCPCS C1713		7191650  -  CDH HA COATED MAS 6.5X50	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191655	SUP	HCPCS C1713		7191655  -  CDH HA COATED MAS 6.5X55	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191660	SUP	HCPCS C1713		7191660  -  CDH HA COATED MAS 6.5X60	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191665	SUP	HCPCS C1713		7191665  -  CDH HA COATED MAS 6.5X65	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191725	SUP	HCPCS C1713		7191725  -  CDH HA COATED MAS 7.5X25	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191730	SUP	HCPCS C1713		7191730  -  CDH HA COATED MAS 7.5X30	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191735	SUP	HCPCS C1713		7191735  -  CDH 7191735 HA COATED  7.5X35	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191740	SUP	HCPCS C1713		7191740  -  SCREW BN 7.5MM 40MM STRL CD HZN LGC MA HA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191745	SUP	HCPCS C1713		7191745  -  SCREW 7191745 MULTI-AXIAL HA COATED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191750	SUP	HCPCS C1713		7191750  -  CDH HA COATED MAS 7.5X50	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191755	SUP	HCPCS C1713		7191755  -  CDH HA COATED MAS 7.5X55	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191760	SUP	HCPCS C1713		7191760  -  CDH HA COATED MAS 7.5X60	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191765	SUP	HCPCS C1713		7191765  -  SCREW 7191765 CDH HA COATED MA 7.5X65	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191770	SUP	HCPCS C1713		7191770  -  CDH HA COATED MAS 7.5X70	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191825	SUP	HCPCS C1713		7191825  -  CDH HA COATED MAS 8.5X25	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191830	SUP	HCPCS C1713		7191830  -  CDH HA COATED MAS 8.5X30	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191835	SUP	HCPCS C1713		7191835  -  CDH 7191835 HA COATED  8.5X35	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191840	SUP	HCPCS C1713		7191840  -  SCREW 7191840 MULTI-AXIAL HA COATED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191845	SUP	HCPCS C1713		7191845  -  SCREW 7191845 MULTI-AXIAL HA COATED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191850	SUP	HCPCS C1713		7191850  -  CDH HA COATED MAS 8.5X50	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191855	SUP	HCPCS C1713		7191855  -  CDH 7191855 HA COATED  8.5X55	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191860	SUP	HCPCS C1713		7191860  -  CDH HA COATED MAS 8.5X60	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7191865	SUP	HCPCS C1713		7191865  -  CDH HA COATED MAS 8.5X65	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7195535	SUP	HCPCS C1713		7195535  -  SCREW BN 5.5MM 35MM SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7195540	SUP	HCPCS C1713		7195540  -  SCREW BN 5.5MM 40MM 2 LD CNN SPNE PDCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7195545	SUP	HCPCS C1713		7195545  -  SCREW BN 5.5MM 45MM SPHERX II 2 LCK SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7195550	SUP	HCPCS C1713		7195550  -  SCREW BN 5.5MM 50MM 2 LD CNN SPNE PDCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7195555	SUP	HCPCS C1713		7195555  -  SCREW BN 5.5MM 55MM 2 LD CNN SPNE PDCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7196535	SUP	HCPCS C1713		7196535  -  SCREW BN 6.5MM 35MM SPHERX II SPNE DLS	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7196540	SUP	HCPCS C1713		7196540  -  SCREW BN 6.5MM 40MM SPHERX II 2 LCK SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7196545	SUP	HCPCS C1713		7196545  -  SCREW BN 6.5MM 45MM SPHERX II 2 SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7196550	SUP	HCPCS C1713		7196550  -  SCREW BN 6.5MM 50MM SPHERX II 2 LCK SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7196555	SUP	HCPCS C1713		7196555  -  SCREW BN 6.5MM 55MM SPHERX II 2 LCK SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7197535	SUP	HCPCS C1713		7197535  -  SCREW BN 7.5MM 40MM SPHERX II 2 LCK SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7197540	SUP	HCPCS C1713		7197540  -  SCREW BN 7.5MM 40MM SPHERX II 2 LCK SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7197545	SUP	HCPCS C1713		7197545  -  SCREW BN 7.5MM 45MM 2 LD SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7197550	SUP	HCPCS C1713		7197550  -  SCREW BN 7.5MM 50MM 2 LD SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7197555	SUP	HCPCS C1713		7197555  -  SCREW BN 7.5MM 55MM SPHERX II PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7200019	SUP	HCPCS C1713		7200019  -  PLATE BN 19MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7200021	SUP	HCPCS C1713		7200021  -  PLATE BN 21MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7200023	SUP	HCPCS C1713		7200023  -  PLATE BN 23MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7200025	SUP	HCPCS C1713		7200025  -  PLATE BN 25MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7200027	SUP	HCPCS C1713		7200027  -  PLATE BN 27.5MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7200030	SUP	HCPCS C1713		7200030  -  PLATE BN 30MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7200032	SUP	HCPCS C1713		7200032  -  PLATE 7200032 ATL VISION ELITE 32.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7200035	SUP	HCPCS C1713		7200035  -  PLATE BN 35MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7200037	SUP	HCPCS C1713		7200037  -  PLATE BN 37.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7200040	SUP	HCPCS C1713		7200040  -  PLATE BN 40MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7200042	SUP	HCPCS C1713		7200042  -  PLATE BN 42.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7200045	SUP	HCPCS C1713		7200045  -  PLATE BN 45MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7200047	SUP	HCPCS C1713		7200047  -  PLATE BN 47.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7200050	SUP	HCPCS C1713		7200050  -  PLATE 7200050 ATL VISION ELITE 50MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7200052	SUP	HCPCS C1713		7200052  -  PLATE BN 52.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200055	SUP	HCPCS C1713		7200055  -  PLATE BN 55MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200057	SUP	HCPCS C1713		7200057  -  PLATE BN 57.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200060	SUP	HCPCS C1713		7200060  -  PLATE BN 60MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200062	SUP	HCPCS C1713		7200062  -  PLATE BN 62.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200065	SUP	HCPCS C1713		7200065  -  PLATE BN 65MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200067	SUP	HCPCS C1713		7200067  -  PLATE BN 67.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200070	SUP	HCPCS C1713		7200070  -  PLATE 7200070 ATL VISION ELITE 70MM	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200072	SUP	HCPCS C1713		7200072  -  PLATE 7200072 ATL VISION ELITE 72.5MM	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200075	SUP	HCPCS C1713		7200075  -  PLATE 7200075 ATL VISION ELITE 75MM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7200077	SUP	HCPCS C1713		7200077  -  PLATE 7200077 ATL VISION ELITE 77.5MM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7200080	SUP	HCPCS C1713		7200080  -  PLATE BN 80MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7200082	SUP	HCPCS C1713		7200082  -  PLATE BN 82.5MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7200085	SUP	HCPCS C1713		7200085  -  PLATE 7200085 ATL VISION ELITE 85MM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7200087	SUP	HCPCS C1713		7200087  -  PLATE 7200087 ATL VISION ELITE 87.5MM	BOTH IP/OP	"$4,492.00 "	"$3,324.08"	$0.00	"$3,593.60"	"$2,021.40"	"$2,021.40"	$0.00	$0.00	$0.00	$936.25	"$3,333.96"	"$3,333.96"	$0.00	$0.00	$936.13	$0.00	"$2,214.56"	"$2,214.56"	$0.00	"$2,246.00"	"$3,557.66"	"$3,593.60"	$0.00		$0.00	$703.00	$0.00	$0.00	$715.13	$0.00	$0.00	$0.00	$0.00	$0.00
7200090	SUP	HCPCS C1713		7200090  -  PLATE 7200090 ATL VISION ELITE 90MM	BOTH IP/OP	"$4,492.00 "	"$3,324.08"	$0.00	"$3,593.60"	"$2,021.40"	"$2,021.40"	$0.00	$0.00	$0.00	$936.25	"$3,333.96"	"$3,333.96"	$0.00	$0.00	$936.13	$0.00	"$2,214.56"	"$2,214.56"	$0.00	"$2,246.00"	"$3,557.66"	"$3,593.60"	$0.00		$0.00	$703.00	$0.00	$0.00	$715.13	$0.00	$0.00	$0.00	$0.00	$0.00
7200095	SUP	HCPCS C1713		7200095  -  PLATE BN 95MM NS ATL VS ELT 5 LVL TI SPNE CRV ANT	BOTH IP/OP	"$4,492.00 "	"$3,324.08"	$0.00	"$3,593.60"	"$2,021.40"	"$2,021.40"	$0.00	$0.00	$0.00	$936.25	"$3,333.96"	"$3,333.96"	$0.00	$0.00	$936.13	$0.00	"$2,214.56"	"$2,214.56"	$0.00	"$2,246.00"	"$3,557.66"	"$3,593.60"	$0.00		$0.00	$703.00	$0.00	$0.00	$715.13	$0.00	$0.00	$0.00	$0.00	$0.00
7200100	SUP	HCPCS C1713		7200100  -  PLATE 7200100 ATL VISION ELITE 100MM	BOTH IP/OP	"$4,492.00 "	"$3,324.08"	$0.00	"$3,593.60"	"$2,021.40"	"$2,021.40"	$0.00	$0.00	$0.00	$936.25	"$3,333.96"	"$3,333.96"	$0.00	$0.00	$936.13	$0.00	"$2,214.56"	"$2,214.56"	$0.00	"$2,246.00"	"$3,557.66"	"$3,593.60"	$0.00		$0.00	$703.00	$0.00	$0.00	$715.13	$0.00	$0.00	$0.00	$0.00	$0.00
7200105	SUP	HCPCS C1713		7200105  -  PLATE 7200105 ATL VISION ELITE 105MM	BOTH IP/OP	"$4,492.00 "	"$3,324.08"	$0.00	"$3,593.60"	"$2,021.40"	"$2,021.40"	$0.00	$0.00	$0.00	$936.25	"$3,333.96"	"$3,333.96"	$0.00	$0.00	$936.13	$0.00	"$2,214.56"	"$2,214.56"	$0.00	"$2,246.00"	"$3,557.66"	"$3,593.60"	$0.00		$0.00	$703.00	$0.00	$0.00	$715.13	$0.00	$0.00	$0.00	$0.00	$0.00
7200110	SUP	HCPCS C1713		7200110  -  PLATE 7200110 ATL VISION ELITE 110MM	BOTH IP/OP	"$4,492.00 "	"$3,324.08"	$0.00	"$3,593.60"	"$2,021.40"	"$2,021.40"	$0.00	$0.00	$0.00	$936.25	"$3,333.96"	"$3,333.96"	$0.00	$0.00	$936.13	$0.00	"$2,214.56"	"$2,214.56"	$0.00	"$2,246.00"	"$3,557.66"	"$3,593.60"	$0.00		$0.00	$703.00	$0.00	$0.00	$715.13	$0.00	$0.00	$0.00	$0.00	$0.00
7200127	SUP	Custom 27203010		RESERVOIR REAGENT NTR CSTR PS MT CHNL PIPETTER 50ML STRL	BOTH IP/OP	$1.48 	$1.10	$0.00	$1.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.74	$1.17	$1.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200130	SUP	HCPCS C1713		7200130  -  PLATE 7200130 ATL VISION ELITE 30MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7200132	SUP	HCPCS C1713		7200132  -  PLATE BN 32.5MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7200145	SUP	HCPCS C1713		7200145  -  PLATE BN 45MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200147	SUP	HCPCS C1713		7200147  -  PLATE 7200147 ATL VISION ELITE 47.5MM	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200150	SUP	HCPCS C1713		7200150  -  PLATE BN 50MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200152	SUP	HCPCS C1713		7200152  -  PLATE BN 52.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7200155	SUP	HCPCS C1713		7200155  -  PLATE BN 55MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7200167	SUP	HCPCS C1713		7200167  -  PLATE 7200167 ATL VISION ELITE 67.5MM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7200170	SUP	HCPCS C1713		7200170  -  PLATE BN 70MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7200172	SUP	HCPCS C1713		7200172  -  PLATE BN 72.5MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7200180	SUP	HCPCS C1713		7200180  -  PLATE BN 80MM NS ATL VS ELT 5 LVL TI SPNE CRV ANT	BOTH IP/OP	"$4,492.00 "	"$3,324.08"	$0.00	"$3,593.60"	"$2,021.40"	"$2,021.40"	$0.00	$0.00	$0.00	$936.25	"$3,333.96"	"$3,333.96"	$0.00	$0.00	$936.13	$0.00	"$2,214.56"	"$2,214.56"	$0.00	"$2,246.00"	"$3,557.66"	"$3,593.60"	$0.00		$0.00	$703.00	$0.00	$0.00	$715.13	$0.00	$0.00	$0.00	$0.00	$0.00
7200182	SUP	HCPCS C1713		7200182  -  PLATE 7200182 ATL VISION ELITE 82.5MM	BOTH IP/OP	"$4,492.00 "	"$3,324.08"	$0.00	"$3,593.60"	"$2,021.40"	"$2,021.40"	$0.00	$0.00	$0.00	$936.25	"$3,333.96"	"$3,333.96"	$0.00	$0.00	$936.13	$0.00	"$2,214.56"	"$2,214.56"	$0.00	"$2,246.00"	"$3,557.66"	"$3,593.60"	$0.00		$0.00	$703.00	$0.00	$0.00	$715.13	$0.00	$0.00	$0.00	$0.00	$0.00
7200185	SUP	HCPCS C1713		7200185  -  PLATE BN 85MM NS ATL VS ELT 5 LVL TI SPNE CRV ANT	BOTH IP/OP	"$4,492.00 "	"$3,324.08"	$0.00	"$3,593.60"	"$2,021.40"	"$2,021.40"	$0.00	$0.00	$0.00	$936.25	"$3,333.96"	"$3,333.96"	$0.00	$0.00	$936.13	$0.00	"$2,214.56"	"$2,214.56"	$0.00	"$2,246.00"	"$3,557.66"	"$3,593.60"	$0.00		$0.00	$703.00	$0.00	$0.00	$715.13	$0.00	$0.00	$0.00	$0.00	$0.00
7200300	SUP	Custom 27203010		TIP PIP 1-200UL POLYPRO GRAD BVL RK NTR NSTRL	BOTH IP/OP	$0.13 	$0.10	$0.00	$0.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.06	$0.10	$0.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7200502	SUP	HCPCS C1713		7200502  -  WIRE FX LNG KRSH SS ORTH	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$88.88	$88.88	$0.00	$0.00	$0.00	$41.16	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$116.82	$116.82	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$30.91	$0.00	$0.00	$31.44	$0.00	$0.00	$0.00	$0.00	$0.00
7205345	SUP	Custom 27203010		7205345  -  DYONICS 4.5MM INCISOR PLUS BLSDE BX/6	BOTH IP/OP	$56.10 	$41.51	$0.00	$44.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.05	$44.43	$44.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7209984	SUP	Custom 27203010		7209984  -  CANNU ARTHRO 72MM OBT THRD CL-TRC STRL DISP 8.5MM LATEX FREE	BOTH IP/OP	$61.26 	$45.33	$0.00	$49.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.47	$45.47	$0.00	$0.00	$12.77	$0.00	$0.00	$0.00	$0.00	$30.63	$48.52	$49.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7209985	SUP	Custom 27203010		7209985  -  CANNU ENDSCP GRY 72MM OBT THRD CL-TRC CMPLT STRL DISP 7MM	BOTH IP/OP	$61.26 	$45.33	$0.00	$49.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.47	$45.47	$0.00	$0.00	$12.77	$0.00	$0.00	$0.00	$0.00	$30.63	$48.52	$49.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7217020	SUP	HCPCS C1713		7217020  -  ROD SPNL PREBNT 20MM	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217025	SUP	HCPCS C1713		7217025  -  ROD SPNL PREBNT 6MM 25MM SPHERX TI	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217030	SUP	HCPCS C1713		7217030  -  ROD SPNL PREBNT 6MM 30MM SPHERX DBR II TI	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217035	SUP	HCPCS C1713		7217035  -  ROD SPNL PREBNT 6MM 35MM TI	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217040	SUP	HCPCS C1713		7217040  -  ROD SPNL PREBNT 40MM SPHERX DBR II TI	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217045	SUP	HCPCS C1713		7217045  -  ROD SPNL PREBNT 45MM	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217050	SUP	HCPCS C1713		7217050  -  ROD SPNL PREBNT 6MM 50MM TI	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217055	SUP	HCPCS C1713		7217055  -  ROD SPNL PREBNT 55MM NS SPHERX DBR II TI	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217060	SUP	HCPCS C1713		7217060  -  ROD SPNL PREBNT 60MM SPHERX DBR II TI	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217065	SUP	HCPCS C1713		7217065  -  ROD SPNL PREBNT 65MM SPHERX DBR II TI	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217070	SUP	HCPCS C1713		7217070  -  ROD SPNL PREBNT 70MM SPHERX DBR II TI	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217075	SUP	HCPCS C1713		7217075  -  ROD SPNL PREBNT 75MM SPHERX DBR II TI	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217080	SUP	HCPCS C1713		7217080  -  ROD SPNL PREBNT 80MM SPHERX DBR II TI	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
7217085	SUP	HCPCS C1713		7217085  -  ROD SPNL PREBNT 85MM SPHERX DBR II	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$641.25	$641.25	$0.00	$0.00	$0.00	$297.01	"$1,057.64"	"$1,057.64"	$0.00	$0.00	$296.97	$0.00	$842.89	$842.89	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00		$0.00	$223.01	$0.00	$0.00	$226.86	$0.00	$0.00	$0.00	$0.00	$0.00
7217090	SUP	HCPCS C1713		7217090  -  ROD SPNL PREBNT 90MM SPHERX DBR II	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$641.25	$641.25	$0.00	$0.00	$0.00	$297.01	"$1,057.64"	"$1,057.64"	$0.00	$0.00	$296.97	$0.00	$842.89	$842.89	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00		$0.00	$223.01	$0.00	$0.00	$226.86	$0.00	$0.00	$0.00	$0.00	$0.00
7217095	SUP	HCPCS C1713		7217095  -  ROD SPNL PREBNT 95MM SPHERX DBR II	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$641.25	$641.25	$0.00	$0.00	$0.00	$297.01	"$1,057.64"	"$1,057.64"	$0.00	$0.00	$296.97	$0.00	$842.89	$842.89	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00		$0.00	$223.01	$0.00	$0.00	$226.86	$0.00	$0.00	$0.00	$0.00	$0.00
7217100	SUP	HCPCS C1713		7217100  -  ROD SPNL PREBNT 100MM SPHERX DBR II	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$641.25	$641.25	$0.00	$0.00	$0.00	$297.01	"$1,057.64"	"$1,057.64"	$0.00	$0.00	$296.97	$0.00	$842.89	$842.89	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00		$0.00	$223.01	$0.00	$0.00	$226.86	$0.00	$0.00	$0.00	$0.00	$0.00
7217105	SUP	HCPCS C1713		7217105  -  ROD SPNL PREBNT 105MM SPHERX DBR II	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$641.25	$641.25	$0.00	$0.00	$0.00	$297.01	"$1,057.64"	"$1,057.64"	$0.00	$0.00	$296.97	$0.00	$842.89	$842.89	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00		$0.00	$223.01	$0.00	$0.00	$226.86	$0.00	$0.00	$0.00	$0.00	$0.00
7217110	SUP	HCPCS C1713		7217110  -  ROD SPNL PREBNT 110MM SPHERX DBR II TI	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$641.25	$641.25	$0.00	$0.00	$0.00	$297.01	"$1,057.64"	"$1,057.64"	$0.00	$0.00	$296.97	$0.00	$842.89	$842.89	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00		$0.00	$223.01	$0.00	$0.00	$226.86	$0.00	$0.00	$0.00	$0.00	$0.00
7217120	SUP	HCPCS C1713		7217120  -  ROD SPNL PREBNT 120MM SPHERX DBR II TI	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$641.25	$641.25	$0.00	$0.00	$0.00	$297.01	"$1,057.64"	"$1,057.64"	$0.00	$0.00	$296.97	$0.00	$842.89	$842.89	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00		$0.00	$223.01	$0.00	$0.00	$226.86	$0.00	$0.00	$0.00	$0.00	$0.00
7217130	SUP	HCPCS C1713		7217130  -  ROD SPNL PREBNT 130MM SPHERX DBR II	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$641.25	$641.25	$0.00	$0.00	$0.00	$297.01	"$1,057.64"	"$1,057.64"	$0.00	$0.00	$296.97	$0.00	$842.89	$842.89	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00		$0.00	$223.01	$0.00	$0.00	$226.86	$0.00	$0.00	$0.00	$0.00	$0.00
7217140	SUP	HCPCS C1713		7217140  -  ROD SPNL PREBNT 140MM SPHERX II DBR	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$641.25	$641.25	$0.00	$0.00	$0.00	$297.01	"$1,057.64"	"$1,057.64"	$0.00	$0.00	$296.97	$0.00	$842.89	$842.89	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00		$0.00	$223.01	$0.00	$0.00	$226.86	$0.00	$0.00	$0.00	$0.00	$0.00
7217150	SUP	HCPCS C1713		7217150  -  ROD SPNL PREBNT 150MM SPHERX DBR II	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$641.25	$641.25	$0.00	$0.00	$0.00	$297.01	"$1,057.64"	"$1,057.64"	$0.00	$0.00	$296.97	$0.00	$842.89	$842.89	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00		$0.00	$223.01	$0.00	$0.00	$226.86	$0.00	$0.00	$0.00	$0.00	$0.00
7220016	SUP	Custom 27803010		7220016  -  CAGE SPNL 22MM 16MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7220018	SUP	Custom 27803010		7220018  -  CAGE SPNL 22MM 18MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7220025	SUP	Custom 27803010		7220025  -  CAGE SPNL 22MM 20-25MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7220027	SUP	Custom 27803010		7220027  -  CAGE SPINAL 22X21-27MM X-CORE 2 TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7220033	SUP	Custom 27803010		7220033  -  CAGE SPNL 22MM 24-33MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7220041	SUP	Custom 27803010		7220041  -  CAGE SPNL 22MM 28-41MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7220055	SUP	Custom 27803010		7220055  -  CAGE SPNL 22MM 35-55MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7220067	SUP	Custom 27803010		7220067  -  CAGE SPNL 22MM 41-67MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7220079	SUP	Custom 27803010		7220079  -  CAGE SPNL 22MM 47-79MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7220121	SUP	Custom 27803010		7220121  -  CAGE SPNL 22MM 68-121MM NS LF X-COR 2 XPD TI VERT BD REPL	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	$0.00	$0.00	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7220850	SUP	HCPCS C1713		7220850  -  SCREW SET 50MM 8.5MM SPNL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7222200	SUP	Custom 27803010		7222200  -  ENDCAP SPNL 22MM RND 0 DEG OD 22 XCORE 2 TI	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7222204	SUP	Custom 27803010		7222204  -  ENDCAP SPNL 22MM RND 4 DEG OD 22 XCORE 2 TI	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7222208	SUP	Custom 27803010		7222208  -  ENDCAP SPNL 22MM RND 8 DEG OD 22 XCORE 2 TI	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7222212	SUP	Custom 27803010		7222212  -  ENDCAP SPNL 22MM RND 12 DEG OD 22 XCORE 2 TI	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7224000	SUP	Custom 27803010		7224000  -  ENDCAP SPNL OD 22X22X40MM 0 DEG XCORE 2 TI	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7224004	SUP	Custom 27803010		7224004  -  ENDCAP SPNL OD 22X22X40MM 4 DEG XCORE 2 TI	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7224008	SUP	Custom 27803010		7224008  -  ENDCAP SPNL OD 22X22X40MM 8 DEG XCORE 2 TI	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7224012	SUP	Custom 27803010		7224012  -  ENDCAP SPNL OD 22X22X40MM 12 DEG XCORE 2 TI	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7225000	SUP	Custom 27803010		7225000  -  ENDCAP SPNL OD 22X22X50MM 0 DEG XCORE 2 TI	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7225004	SUP	Custom 27803010		7225004  -  ENDCAP SPNL OD 22X22X50MM 4 DEG XCORE 2 TI	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7225008	SUP	Custom 27803010		7225008  -  ENDCAP SPNL OD 22X22X50MM 8 DEG XCORE 2 TI	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7225012	SUP	Custom 27803010		7225012  -  ENDCAP SPNL OD 22X22X50MM 12 DEG XCORE 2 TI	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7226000	SUP	Custom 27803010		7226000  -  ENDCAP SPNL OD 22X22X60MM 0 DEG XCORE 2 TI	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7226004	SUP	Custom 27803010		7226004  -  ENDCAP SPNL OD 22X22X60MM 4 DEG XCORE 2 TI	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7226008	SUP	Custom 27803010		7226008  -  ENDCAP SPNL OD 22X22X60MM 8 DEG XCORE 2 TI	BOTH IP/OP	"$3,157.50 "	"$2,336.55"	$0.00	"$2,526.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,343.50"	"$2,343.50"	$0.00	$0.00	$658.02	$0.00	$0.00	$0.00	$0.00	"$1,578.75"	"$2,500.74"	"$2,526.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7240033	SUP	HCPCS C1713		7240033  -  TMPLT ROD 250MM	BOTH IP/OP	"$1,012.50 "	$749.25	$0.00	$810.00	$455.63	$455.63	$0.00	$0.00	$0.00	$211.03	$751.48	$751.48	$0.00	$0.00	$211.01	$0.00	$598.89	$598.89	$0.00	$506.25	$801.90	$810.00	$0.00		$0.00	$158.46	$0.00	$0.00	$161.19	$0.00	$0.00	$0.00	$0.00	$0.00
7240034	SUP	HCPCS C1713		7240034  -  TMPLT ROD 500MM SPHERX 2 TI	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$534.38	$534.38	$0.00	$0.00	$0.00	$247.50	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$702.41	$702.41	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$185.84	$0.00	$0.00	$189.05	$0.00	$0.00	$0.00	$0.00	$0.00
7241045	SUP	HCPCS C1713		7241045  -  CONNECTOR ROD 45-60MM SPHERX II TRNSV TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241055	SUP	HCPCS C1713		7241055  -  CONNECTOR ROD 55-81MM SPHERX II TRNSV TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241075	SUP	HCPCS C1713		7241075  -  CONNECTOR ROD 74-85MM SPHERX II TRNSV TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241100	SUP	HCPCS C1713		7241100  -  SCREW BN SM 1.5MM 10MM SPHERX DBR II LCK TI SPNE	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7241102	SUP	HCPCS C1713		7241102  -  HOOK SPNL SM SPHERX II TI PDCL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241103	SUP	HCPCS C1713		7241103  -  HOOK SPNL MED SPHERX II TI PDCL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241104	SUP	HCPCS C1713		7241104  -  HOOK SPNL 6MM SPHERX II NAR BLDE TI LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241105	SUP	HCPCS C1713		7241105  -  HOOK SPNL 8MM SPHERX II NAR BLDE TI LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241106	SUP	HCPCS C1713		7241106  -  HOOK SPNL 10MM SPHERX II NAR BLDE TI LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241107	SUP	HCPCS C1713		7241107  -  HOOK SPNL 6MM SPHERX II W BLDE ANG LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241108	SUP	HCPCS C1713		7241108  -  HOOK SPNL 8MM SPHERX II W BLDE ANG LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241109	SUP	HCPCS C1713		7241109  -  HOOK SPNL 10MM SPHERX II W BLDE ANG LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241110	SUP	HCPCS C1713		7241110  -  HOOK SPNL 6MM SPHERX II NAR BLDE ANG RDC TIP LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241111	SUP	HCPCS C1713		7241111  -  HOOK SPNL 8MM SPHERX II NAR BLDE ANG RDC TIP LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241112	SUP	HCPCS C1713		7241112  -  HOOK SPNL 10MM SPHERX II NAR BLDE ANG RDC TIP LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241113	SUP	HCPCS C1713		7241113  -  HOOK SPNL 6MM SPHERX II WA RDC TIP LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241114	SUP	HCPCS C1713		7241114  -  HOOK SPNL 8MM SPHERX II W BLDE ANG RDC TIP LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241115	SUP	HCPCS C1713		7241115  -  HOOK SPNL 10MM SPHERX II W BLDE ANG RDC TIP LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241116	SUP	HCPCS C1713		7241116  -  HOOK SPNL 6MM SPHERX II NAR BLDE DN ANG LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241117	SUP	HCPCS C1713		7241117  -  HOOK SPNL 8MM SPHERX II NAR BLDE DN ANG LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241118	SUP	HCPCS C1713		7241118  -  HOOK SPNL 10MM SPHERX II NAR BLDE DN ANG LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241119	SUP	HCPCS C1713		7241119  -  HOOK SPNL 6MM SPHERX II NAR BLDE ANG XTD LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241120	SUP	HCPCS C1713		7241120  -  HOOK SPNL 8MM SPHERX II NAR BLDE ANG XTD LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241121	SUP	HCPCS C1713		7241121  -  HOOK SPNL 45D SPHERX II NAR BLDE ANG	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241122	SUP	HCPCS C1713		7241122  -  HOOK SPNL SPHERX II NAR BLDE ANG RT OFST	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241123	SUP	HCPCS C1713		7241123  -  HOOK SPNL SPHERX II NAR BLDE ANG LT OFST	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241124	SUP	HCPCS C1713		7241124  -  HOOK SPNL SPHERX II NAR BLDE ANG RT OFST	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241125	SUP	HCPCS C1713		7241125  -  HOOK SPNL SPHERX II NAR BLDE ANG LT OFST	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241131	SUP	HCPCS C1713		7241131  -  HOOK SPNL 6MM SPHERX II ANG UP LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241132	SUP	HCPCS C1713		7241132  -  HOOK SPNL 8MM SPHERX II ANG UP LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241133	SUP	HCPCS C1713		7241133  -  HOOK SPNL 10MM SPHERX II ANG UP LMR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
7241200	SUP	HCPCS C1713		7241200  -  CONNECTOR ROD 20MM SPHERX II TRNSV FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241225	SUP	HCPCS C1713		7241225  -  CONNECTOR ROD 22MM SPHERX II TRNSV FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241250	SUP	HCPCS C1713		7241250  -  CONNECTOR ROD 25MM SPHERX II TRNSV FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241275	SUP	HCPCS C1713		7241275  -  CONNECTOR ROD 27MM SPHERX II TRNSV FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241300	SUP	HCPCS C1713		7241300  -  CONNECTOR ROD 30MM TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241325	SUP	HCPCS C1713		7241325  -  CONNECTOR ROD 32.5MM TRNSV FX SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241350	SUP	HCPCS C1713		7241350  -  CONNECTOR ROD 35MM SPHERX II TRNSV FA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241375	SUP	HCPCS C1713		7241375  -  CONNECTOR ROD 37.5MM SPHERX II TRNSV FA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241400	SUP	HCPCS C1713		7241400  -  CONNECTOR ROD 40MM SPHERX II TRNSV FA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241450	SUP	HCPCS C1713		7241450  -  CONNECTOR ROD 45MM SPHERX II TRNSV FA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241500	SUP	HCPCS C1713		7241500  -  CONNECTOR ROD 50MM SPHERX II TRNSV FA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241550	SUP	HCPCS C1713		7241550  -  CONNECTOR ROD 55MM SPHERX II TRNSV FA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7241600	SUP	HCPCS C1713		7241600  -  CONNECTOR ROD 60MM SPHERX II TRNSV FA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7242020	SUP	HCPCS C1713		7242020  -  ROD SPNL PREBNT 20MM SPHERX II	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242030	SUP	HCPCS C1713		7242030  -  ROD SPNL PREBNT 30MM SPHERX II	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242035	SUP	HCPCS C1713		7242035  -  ROD SPNL PREBNT 35MM SPHERX II	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242040	SUP	HCPCS C1713		7242040  -  ROD SPINAL 40MM PREBENT CONVENTIONAL SPHERX II	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242050	SUP	HCPCS C1713		7242050  -  ROD SPNL PREBNT 50MM SPHERX II	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242055	SUP	HCPCS C1713		7242055  -  ROD SPNL PREBNT 55MM NS SPHERX II MAS PLIF	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242060	SUP	HCPCS C1713		7242060  -  ROD SPNL PREBNT 60MM SPHERX II	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242065	SUP	HCPCS C1713		7242065  -  ROD SPNL PREBNT 65MM SPHERX II	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242070	SUP	HCPCS C1713		7242070  -  ROD SPNL PREBNT 70MM SPHERX II	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242075	SUP	HCPCS C1713		7242075  -  ROD SPINAL 75MM PREBENT CONVENTIONAL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242080	SUP	HCPCS C1713		7242080  -  ROD SPNL PREBNT 80MM NS SPHERX II MAS PLIF	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242085	SUP	HCPCS C1713		7242085  -  ROD SPNL PREBNT 85MM SPHERX II	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242095	SUP	HCPCS C1713		7242095  -  ROD SPNL PREBNT 95MM SPHERX II	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7242110	SUP	HCPCS C1713		7242110  -  ROD SPNL PREBNT 110MM SPHERX II	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7243045	SUP	HCPCS C1713		7243045  -  TRANSCONNECTOR ROD PREBNT 45-50MM ADJ ARCH SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7243050	SUP	HCPCS C1713		7243050  -  CONNECTOR ROD 50-60MM TRNSV SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7243060	SUP	HCPCS C1713		7243060  -  TRANSCONNECTOR ROD 60-70MM ADJ ARCH VAR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7243070	SUP	HCPCS C1713		7243070  -  CONNECTOR ROD 70-85MM VAR ADJ TRANSVRS	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7245525	SUP	HCPCS C1713		7245525  -  SCREW BN 5.5MM 25MM SPHERX DBR II PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7245530	SUP	HCPCS C1713		7245530  -  SCREW BN 5.5MM 30MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7245535	SUP	HCPCS C1713		7245535  -  SCREW BN 5.5MM 35MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7245540	SUP	HCPCS C1713		7245540  -  SCREW BN 5.5MM 40MM PA SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7245545	SUP	HCPCS C1713		7245545  -  SCREW BN 5.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7245550	SUP	HCPCS C1713		7245550  -  SCREW BN 5.5MM 50MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7245555	SUP	HCPCS C1713		7245555  -  SCREW BN 5.5MM 55MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7245560	SUP	HCPCS C1713		7245560  -  SCREW BN 5.5MM 60MM SPHERX II PA SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246510	SUP	HCPCS C1713		7246510  -  SCREW BN 6.5MM 100MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246525	SUP	HCPCS C1713		7246525  -  SCREW BN 6.5MM 25MM SPHERX II PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246530	SUP	HCPCS C1713		7246530  -  SCREW BN 6.5MM 30MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246535	SUP	HCPCS C1713		7246535  -  SCREW BN 6.5MM 35MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246540	SUP	HCPCS C1713		7246540  -  SCREW BN 6.5MM 40MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246545	SUP	HCPCS C1713		7246545  -  SCREW BN 6.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246550	SUP	HCPCS C1713		7246550  -  SCREW BN 6.5MM 50MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246555	SUP	HCPCS C1713		7246555  -  SCREW BN 6.5MM 55MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246560	SUP	HCPCS C1713		7246560  -  SCREW BN 6.5MM 60MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246565	SUP	HCPCS C1713		7246565  -  SCREW BN 6.5MM 65MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246570	SUP	HCPCS C1713		7246570  -  SCREW BN 6.5MM 70MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246575	SUP	HCPCS C1713		7246575  -  SCREW BN 6.5MM 75MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246580	SUP	HCPCS C1713		7246580  -  SCREW BN 6.5MM 80MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246585	SUP	HCPCS C1713		7246585  -  SCREW BN 6.5MM 85MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246590	SUP	HCPCS C1713		7246590  -  SCREW BN 6.5MM 90MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7246595	SUP	HCPCS C1713		7246595  -  SCREW BN 6.5MM 95MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247510	SUP	HCPCS C1713		7247510  -  SCREW BN 7.5MM 100MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247525	SUP	HCPCS C1713		7247525  -  SCREW BN 7.5MM 25MM SPHERX II PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247530	SUP	HCPCS C1713		7247530  -  SCREW BN 7.5MM 30MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247535	SUP	HCPCS C1713		7247535  -  SCREW BN 7.5MM 35MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247540	SUP	HCPCS C1713		7247540  -  SCREW BN 7.5MM 40MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247545	SUP	HCPCS C1713		7247545  -  SCREW BN 7.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247550	SUP	HCPCS C1713		7247550  -  SCREW BN 7.5MM 50MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247555	SUP	HCPCS C1713		7247555  -  SCREW BN 7.5MM 55MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247560	SUP	HCPCS C1713		7247560  -  SCREW BN 7.5MM 60MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247565	SUP	HCPCS C1713		7247565  -  SCREW BN 7.5MM 65MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247570	SUP	HCPCS C1713		7247570  -  SCREW BN 7.5MM 70MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247575	SUP	HCPCS C1713		7247575  -  SCREW BN 7.5MM 75MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247580	SUP	HCPCS C1713		7247580  -  SCREW BN 7.5MM 80MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247585	SUP	HCPCS C1713		7247585  -  SCREW BN 7.5MM 85MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247590	SUP	HCPCS C1713		7247590  -  SCREW BN 7.5MM 90MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7247595	SUP	HCPCS C1713		7247595  -  SCREW BN 7.5MM 95MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248025	SUP	HCPCS C1713		7248025  -  ROD SPNL 25MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248030	SUP	HCPCS C1713		7248030  -  ROD SPNL 30MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248035	SUP	HCPCS C1713		7248035  -  ROD SPNL 35MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248040	SUP	HCPCS C1713		7248040  -  ROD SPNL 40MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248045	SUP	HCPCS C1713		7248045  -  ROD SPNL 45MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248050	SUP	HCPCS C1713		7248050  -  ROD SPNL 50MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248055	SUP	HCPCS C1713		7248055  -  ROD SPNL 55MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248060	SUP	HCPCS C1713		7248060  -  ROD SPNL 60MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248065	SUP	HCPCS C1713		7248065  -  ROD SPNL 65MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248070	SUP	HCPCS C1713		7248070  -  ROD SPNL 70MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248075	SUP	HCPCS C1713		7248075  -  ROD SPNL 75MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248080	SUP	HCPCS C1713		7248080  -  ROD SPNL 80MM SPHERX DBR II THOR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248085	SUP	HCPCS C1713		7248085  -  ROD SPNL 85MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248090	SUP	HCPCS C1713		7248090  -  ROD SPNL 90MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248095	SUP	HCPCS C1713		7248095  -  ROD SPNL 95MM SPHERX II CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7248100	SUP	HCPCS C1713		7248100  -  ROD SPNL 100MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248105	SUP	HCPCS C1713		7248105  -  ROD SPNL 105MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248110	SUP	HCPCS C1713		7248110  -  ROD SPNL 110MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248115	SUP	HCPCS C1713		7248115  -  ROD SPNL 115MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248120	SUP	HCPCS C1713		7248120  -  ROD SPNL 120MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248125	SUP	HCPCS C1713		7248125  -  ROD SPNL 125MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248130	SUP	HCPCS C1713		7248130  -  ROD SPNL 130MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248135	SUP	HCPCS C1713		7248135  -  ROD SPNL 135MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248140	SUP	HCPCS C1713		7248140  -  ROD SPNL 140MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248145	SUP	HCPCS C1713		7248145  -  ROD SPNL 145MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248150	SUP	HCPCS C1713		7248150  -  ROD SPNL 150MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248300	SUP	HCPCS C1713		7248300  -  ROD SPNL 300MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248500	SUP	HCPCS C1713		7248500  -  ROD SPNL 500MM SPHERX II CNV	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7248510	SUP	HCPCS C1713		7248510  -  SCREW BN 8.5MM 100MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248525	SUP	HCPCS C1713		7248525  -  SCREW BN 8.5MM 25MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248530	SUP	HCPCS C1713		7248530  -  SCREW BN 8.5MM 30MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248535	SUP	HCPCS C1713		7248535  -  SCREW BN 8.5MM 35MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248540	SUP	HCPCS C1713		7248540  -  SCREW BN 8.5MM 40MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248545	SUP	HCPCS C1713		7248545  -  SCREW BN 8.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248550	SUP	HCPCS C1713		7248550  -  SCREW BN 8.5MM 50MM SPHERX DBR II PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248555	SUP	HCPCS C1713		7248555  -  SCREW BN 8.5MM 55MM PA SPNE PDCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248560	SUP	HCPCS C1713		7248560  -  SCREW BN 8.5MM 60MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248565	SUP	HCPCS C1713		7248565  -  SCREW BN 8.5MM 65MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248570	SUP	HCPCS C1713		7248570  -  SCREW BN 8.5MM 70MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248575	SUP	HCPCS C1713		7248575  -  SCREW BN 8.5MM 75MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248580	SUP	HCPCS C1713		7248580  -  SCREW BN 8.5MM 80MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248585	SUP	HCPCS C1713		7248585  -  SCREW BN 8.5MM 85MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248590	SUP	HCPCS C1713		7248590  -  SCREW BN 8.5MM 90MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7248595	SUP	HCPCS C1713		7248595  -  SCREW BN 8.5MM 95MM PA ILIUM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7249310	SUP	HCPCS C1713		7249310  -  CONNECTOR ROD OFST 100MM SPNE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
7249335	SUP	HCPCS C1713		7249335  -  CONNECTOR ROD OFST 35MM SPHERX II SPNE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
7249350	SUP	HCPCS C1713		7249350  -  CONNECTOR ROD OFST 50MM SPNE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
7251526	SUP	HCPCS C1713		7251526  -  STAPLE BN SM INFR ANT THOR SPNL	BOTH IP/OP	"$2,162.50 "	"$1,600.25"	$0.00	"$1,730.00"	$973.13	$973.13	$0.00	$0.00	$0.00	$450.72	"$1,605.01"	"$1,605.01"	$0.00	$0.00	$450.67	$0.00	"$1,279.12"	"$1,279.12"	$0.00	"$1,081.25"	"$1,712.70"	"$1,730.00"	$0.00		$0.00	$338.43	$0.00	$0.00	$344.27	$0.00	$0.00	$0.00	$0.00	$0.00
7251528	SUP	HCPCS C1713		7251528  -  STAPLE BN MED INFR ANT THOR SPNL	BOTH IP/OP	"$2,162.50 "	"$1,600.25"	$0.00	"$1,730.00"	$973.13	$973.13	$0.00	$0.00	$0.00	$450.72	"$1,605.01"	"$1,605.01"	$0.00	$0.00	$450.67	$0.00	"$1,279.12"	"$1,279.12"	$0.00	"$1,081.25"	"$1,712.70"	"$1,730.00"	$0.00		$0.00	$338.43	$0.00	$0.00	$344.27	$0.00	$0.00	$0.00	$0.00	$0.00
7251530	SUP	HCPCS C1713		7251530  -  STAPLE BN LG INFR ANT THOR SPNL	BOTH IP/OP	"$2,162.50 "	"$1,600.25"	$0.00	"$1,730.00"	$973.13	$973.13	$0.00	$0.00	$0.00	$450.72	"$1,605.01"	"$1,605.01"	$0.00	$0.00	$450.67	$0.00	"$1,279.12"	"$1,279.12"	$0.00	"$1,081.25"	"$1,712.70"	"$1,730.00"	$0.00		$0.00	$338.43	$0.00	$0.00	$344.27	$0.00	$0.00	$0.00	$0.00	$0.00
7251626	SUP	HCPCS C1713		7251626  -  STAPLE BN SM SUP ANT THOR SPNL	BOTH IP/OP	"$2,162.50 "	"$1,600.25"	$0.00	"$1,730.00"	$973.13	$973.13	$0.00	$0.00	$0.00	$450.72	"$1,605.01"	"$1,605.01"	$0.00	$0.00	$450.67	$0.00	"$1,279.12"	"$1,279.12"	$0.00	"$1,081.25"	"$1,712.70"	"$1,730.00"	$0.00		$0.00	$338.43	$0.00	$0.00	$344.27	$0.00	$0.00	$0.00	$0.00	$0.00
7251628	SUP	HCPCS C1713		7251628  -  STAPLE BN MED SUP ANT THOR SPNL	BOTH IP/OP	"$2,162.50 "	"$1,600.25"	$0.00	"$1,730.00"	$973.13	$973.13	$0.00	$0.00	$0.00	$450.72	"$1,605.01"	"$1,605.01"	$0.00	$0.00	$450.67	$0.00	"$1,279.12"	"$1,279.12"	$0.00	"$1,081.25"	"$1,712.70"	"$1,730.00"	$0.00		$0.00	$338.43	$0.00	$0.00	$344.27	$0.00	$0.00	$0.00	$0.00	$0.00
7251630	SUP	HCPCS C1713		7251630  -  STAPLE BN LG SUP ANT THOR SPNL	BOTH IP/OP	"$2,162.50 "	"$1,600.25"	$0.00	"$1,730.00"	$973.13	$973.13	$0.00	$0.00	$0.00	$450.72	"$1,605.01"	"$1,605.01"	$0.00	$0.00	$450.67	$0.00	"$1,279.12"	"$1,279.12"	$0.00	"$1,081.25"	"$1,712.70"	"$1,730.00"	$0.00		$0.00	$338.43	$0.00	$0.00	$344.27	$0.00	$0.00	$0.00	$0.00	$0.00
7253012	SUP	HCPCS C1713		7253012  -  STAPLE BN SM 1 HL	BOTH IP/OP	$947.50 	$701.15	$0.00	$758.00	$426.38	$426.38	$0.00	$0.00	$0.00	$197.48	$703.23	$703.23	$0.00	$0.00	$197.46	$0.00	$560.45	$560.45	$0.00	$473.75	$750.42	$758.00	$0.00		$0.00	$148.28	$0.00	$0.00	$150.84	$0.00	$0.00	$0.00	$0.00	$0.00
7253014	SUP	HCPCS C1713		7253014  -  STAPLE BN MED 1 HL	BOTH IP/OP	$947.50 	$701.15	$0.00	$758.00	$426.38	$426.38	$0.00	$0.00	$0.00	$197.48	$703.23	$703.23	$0.00	$0.00	$197.46	$0.00	$560.45	$560.45	$0.00	$473.75	$750.42	$758.00	$0.00		$0.00	$148.28	$0.00	$0.00	$150.84	$0.00	$0.00	$0.00	$0.00	$0.00
7253016	SUP	HCPCS C1713		7253016  -  STAPLE BN LG 1 HL	BOTH IP/OP	$947.50 	$701.15	$0.00	$758.00	$426.38	$426.38	$0.00	$0.00	$0.00	$197.48	$703.23	$703.23	$0.00	$0.00	$197.46	$0.00	$560.45	$560.45	$0.00	$473.75	$750.42	$758.00	$0.00		$0.00	$148.28	$0.00	$0.00	$150.84	$0.00	$0.00	$0.00	$0.00	$0.00
7253112	SUP	HCPCS C1713		7253112  -  WASHER SPNL SM	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$174.38	$174.38	$0.00	$0.00	$0.00	$80.76	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$229.21	$229.21	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$60.64	$0.00	$0.00	$61.69	$0.00	$0.00	$0.00	$0.00	$0.00
7253114	SUP	HCPCS C1713		7253114  -  WASHER SPNL MED	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$174.38	$174.38	$0.00	$0.00	$0.00	$80.76	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$229.21	$229.21	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$60.64	$0.00	$0.00	$61.69	$0.00	$0.00	$0.00	$0.00	$0.00
7253116	SUP	HCPCS C1713		7253116  -  WASHER SPNL LG	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$174.38	$174.38	$0.00	$0.00	$0.00	$80.76	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$229.21	$229.21	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$60.64	$0.00	$0.00	$61.69	$0.00	$0.00	$0.00	$0.00	$0.00
7254022	SUP	HCPCS C1713		7254022  -  CONNECTOR ROD 22MM SPHERX II FX SPNE ANT	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7254525	SUP	HCPCS C1713		7254525  -  SCREW BN 4.5MM 25MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7254530	SUP	HCPCS C1713		7254530  -  SCREW BN 4.5MM 30MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7254535	SUP	HCPCS C1713		7254535  -  SCREW BN 4.5MM 35MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7254540	SUP	HCPCS C1713		7254540  -  SCREW BN 4.5MM 40MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7254545	SUP	HCPCS C1713		7254545  -  SCREW BN 4.5MM 45MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7254550	SUP	HCPCS C1713		7254550  -  SCREW BN 4.5MM 50MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7255525	SUP	HCPCS C1713		7255525  -  SCREW BN 5.5MM 25MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7255530	SUP	HCPCS C1713		7255530  -  SCREW BN 5.5MM 30MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7255535	SUP	HCPCS C1713		7255535  -  SCREW BN 5.5MM 35MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7255540	SUP	HCPCS C1713		7255540  -  SCREW BN 5.5MM 40MM SPHERX DBR II FX ANG TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7255545	SUP	HCPCS C1713		7255545  -  SCREW BN 5.5MM 45MM SPHERX DBR II FX ANG TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7255550	SUP	HCPCS C1713		7255550  -  SCREW BN 5.5MM 50MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7255555	SUP	HCPCS C1713		7255555  -  SCREW BN 5.5MM 55MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7255560	SUP	HCPCS C1713		7255560  -  SCREW BN 5.5MM 60MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256012	SUP	HCPCS C1713		7256012  -  CONNECTOR ROD 12MM SPHERX II FX SPNE ANT	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256013	SUP	HCPCS C1713		7256013  -  CONNECTOR ROD 13MM SPHERX II FX SPNE ANT	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256014	SUP	HCPCS C1713		7256014  -  CONNECTOR ROD 14MM SPHERX II FX SPNE ANT	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256015	SUP	HCPCS C1713		7256015  -  CONNECTOR ROD 15MM SPHERX II FX SPNE ANT	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256016	SUP	HCPCS C1713		7256016  -  CONNECTOR ROD 16MM SPHERX II FX SPNE ANT	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256017	SUP	HCPCS C1713		7256017  -  CONNECTOR ROD 17MM SPHERX II FX SPNE ANT	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256018	SUP	HCPCS C1713		7256018  -  CONNECTOR ROD 18MM SPHERX II FX SPNE ANT	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256019	SUP	HCPCS C1713		7256019  -  CONNECTOR ROD 19MM TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256020	SUP	HCPCS C1713		7256020  -  CONNECTOR ROD 20MM TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256021	SUP	HCPCS C1713		7256021  -  CONNECTOR ROD 21MM SPHERX II FX SPNE ANT	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256530	SUP	HCPCS C1713		7256530  -  SCREW BN 6.5MM 30MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256535	SUP	HCPCS C1713		7256535  -  SCREW BN 6.5MM 35MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256540	SUP	HCPCS C1713		7256540  -  SCREW BN 6.5MM 40MM SPHERX DBR II FX ANG TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256545	SUP	HCPCS C1713		7256545  -  SCREW BN 6.5MM 45MM SPHERX II FX	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256550	SUP	HCPCS C1713		7256550  -  SCREW BN 6.5MM 50MM SPHERX DBR II FX ANG TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256555	SUP	HCPCS C1713		7256555  -  SCREW BN 6.5MM 55MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7256560	SUP	HCPCS C1713		7256560  -  SCREW BN 6.5MM 60MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7257530	SUP	HCPCS C1713		7257530  -  SCREW BN 7.5MM 30MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7257535	SUP	HCPCS C1713		7257535  -  SCREW BN 7.5MM 35MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7257540	SUP	HCPCS C1713		7257540  -  SCREW BN 7.5IN 40MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7257545	SUP	HCPCS C1713		7257545  -  SCREW BN 7.5MM 45MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7257550	SUP	HCPCS C1713		7257550  -  SCREW BN 7.5MM 50MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7257555	SUP	HCPCS C1713		7257555  -  SCREW BN 7.5MM 55MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7257560	SUP	HCPCS C1713		7257560  -  SCREW BN 7.5MM 60MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7258530	SUP	HCPCS C1713		7258530  -  SCREW BN 8.5MM 30MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7258535	SUP	HCPCS C1713		7258535  -  SCREW BN 8.5MM 35MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7258540	SUP	HCPCS C1713		7258540  -  SCREW BN 8.5MM 40MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7258545	SUP	HCPCS C1713		7258545  -  SCREW BN 8.5MM 45MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7258550	SUP	HCPCS C1713		7258550  -  SCREW BN 8.5MM 50MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7258555	SUP	HCPCS C1713		7258555  -  SCREW BN 8.5MM 55MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7258560	SUP	HCPCS C1713		7258560  -  SCREW BN 8.5MM 60MM SPHERX II FA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7262600	SUP	Custom 27803010		7262600  -  ENDCAP SPNL 26MM RND 0 DEG OD 22 XCORE 2 TI	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7262604	SUP	Custom 27803010		7262604  -  ENDCAP SPNL 26MM RND 4 DEG OD 22 XCORE 2 TI	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7262608	SUP	Custom 27803010		7262608  -  ENDCAP SPNL 26MM RND 8 DEG OD 22 XCORE 2 TI	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7262612	SUP	Custom 27803010		7262612  -  ENDCAP SPNL 26MM RND 12 DEG OD 22 XCORE 2 TI	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7265535	SUP	HCPCS C1713		7265535  -  SCREW BN 5.5MM 35MM RDC PA SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7265540	SUP	HCPCS C1713		7265540  -  SCREW BN 5.5MM 40MM PA RDC SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7265545	SUP	HCPCS C1713		7265545  -  SCREW BN 5.5MM 45MM PA RDC SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7265550	SUP	HCPCS C1713		7265550  -  SCREW BN 5.5MM 50MM SPHERX PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7265555	SUP	HCPCS C1713		7265555  -  SCREW BN 5.5MM 55MM SPHERX PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7266535	SUP	HCPCS C1713		7266535  -  SCREW BN 6.5MM 35MM SPHERX PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7266540	SUP	HCPCS C1713		7266540  -  SCREW BN 6.5MM 40MM SPHERX RDC SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7266545	SUP	HCPCS C1713		7266545  -  SCREW BN 6.5MM 45MM SPHERX II RDC PA SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7266550	SUP	HCPCS C1713		7266550  -  SCREW BN 6.5MM 50MM SPHERX PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7266555	SUP	HCPCS C1713		7266555  -  SCREW BN 6.5MM 55MM SPHERX PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7267535	SUP	HCPCS C1713		7267535  -  SCREW BN 7.5MM 35MM SPHERX PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7267540	SUP	HCPCS C1713		7267540  -  SCREW BN 7.5MM 40MM RDC PA SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7267545	SUP	HCPCS C1713		7267545  -  SCREW BN 7.5MM 45MM SPHERX PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7267550	SUP	HCPCS C1713		7267550  -  SCREW BN 7.5MM 50MM SPHERX PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7267555	SUP	HCPCS C1713		7267555  -  SCREW BN 7.5MM 55MM SPHERX PA SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7270100	SUP	HCPCS C1713		7270100  -  WIRE FX KRSH BVL TIP	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$90.00	$90.00	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
7270200	SUP	HCPCS C1713		7270200  -  WIRE FX KRSH THRD	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$90.00	$90.00	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
7270300	SUP	HCPCS C1713		7270300  -  WIRE FX XLNG KRSH THRD TIP	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$90.00	$90.00	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
7270411	SUP	HCPCS C1713		7270411  -  SPACER SPNL 11MM 11X4MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270441	SUP	HCPCS C1713		7270441  -  SPACER SPNL 11MM 14X4MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270444	SUP	HCPCS C1713		7270444  -  SPACER SPNL 14MM 14X4MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270511	SUP	HCPCS C1713		7270511  -  SPACER SPNL 11MM 11X5MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270541	SUP	HCPCS C1713		7270541  -  SPACER SPNL 11MM 14X5MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270544	SUP	HCPCS C1713		7270544  -  SPACER SPNL 14MM 14X5MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270611	SUP	HCPCS C1713		7270611  -  SPACER SPNL 11MM 11X6MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270641	SUP	HCPCS C1713		7270641  -  SPACER SPNL 11MM 14X6MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270644	SUP	HCPCS C1713		7270644  -  SPACER SPNL 14MM 14X6MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270711	SUP	HCPCS C1713		7270711  -  SPACER SPNL 11MM 11X7MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270741	SUP	HCPCS C1713		7270741  -  SPACER SPNL 11MM 14X7MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270744	SUP	HCPCS C1713		7270744  -  SPACER SPNL 14MM 14X7MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270811	SUP	HCPCS C1713		7270811  -  SPACER SPNL 11MM 11X8MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270841	SUP	HCPCS C1713		7270841  -  SPACER SPNL 11MM 14X8MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270844	SUP	HCPCS C1713		7270844  -  SPACER SPNL 14MM 14X8MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270911	SUP	HCPCS C1713		7270911  -  SPACER SPNL 11MM 11X9MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270941	SUP	HCPCS C1713		7270941  -  SPACER SPNL 11MM 14X9MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7270944	SUP	HCPCS C1713		7270944  -  SPACER SPNL 14MM 14X9MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7271011	SUP	HCPCS C1713		7271011  -  SPACER SPNL 11MM 11X10MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7271041	SUP	HCPCS C1713		7271041  -  SPACER SPNL 11MM 14X10MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7271044	SUP	HCPCS C1713		7271044  -  SPACER SPNL 14MM 14X10MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7271111	SUP	HCPCS C1713		7271111  -  SPACER SPNL 11MM 11X11MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7271141	SUP	HCPCS C1713		7271141  -  SPACER SPNL 11MM 14X11MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7271144	SUP	HCPCS C1713		7271144  -  SPACER SPNL 14MM 14X11MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7271211	SUP	HCPCS C1713		7271211  -  SPACER SPNL 11MM 11X12MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7271241	SUP	HCPCS C1713		7271241  -  SPACER SPNL 11MM 14X12MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7271244	SUP	HCPCS C1713		7271244  -  SPACER SPNL 14MM 14X12MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7271311	SUP	HCPCS C1713		7271311  -  SPACER SPNL 11MM 11X13MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7271341	SUP	HCPCS C1713		7271341  -  SPACER SPNL 11MM 14X13MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7271344	SUP	HCPCS C1713		7271344  -  SPACER SPNL 14MM 14X13MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7284525	SUP	HCPCS C1713		7284525  -  SCREW BN 4.5MM 25MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7284530	SUP	HCPCS C1713		7284530  -  SCREW BN 4.5MM 30MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7284535	SUP	HCPCS C1713		7284535  -  SCREW BN 4.5MM 35MM PA SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7284540	SUP	HCPCS C1713		7284540  -  SCREW BN 4.5MM 40MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7284545	SUP	HCPCS C1713		7284545  -  SCREW BN 4.5MM 45MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7284550	SUP	HCPCS C1713		7284550  -  SCREW BN 4.5MM 50MM SPHERX II PA TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7291025	SUP	HCPCS C1713		7291025  -  ROD SPNL 5.5MM 25MM SPHERX II TI	BOTH IP/OP	$782.50 	$579.05	$0.00	$626.00	$352.13	$352.13	$0.00	$0.00	$0.00	$163.09	$580.77	$580.77	$0.00	$0.00	$163.07	$0.00	$462.85	$462.85	$0.00	$391.25	$619.74	$626.00	$0.00		$0.00	$122.46	$0.00	$0.00	$124.57	$0.00	$0.00	$0.00	$0.00	$0.00
7291030	SUP	HCPCS C1713		7291030  -  ROD SPNL 5.5MM 30MM SPHERX II TI	BOTH IP/OP	$782.50 	$579.05	$0.00	$626.00	$352.13	$352.13	$0.00	$0.00	$0.00	$163.09	$580.77	$580.77	$0.00	$0.00	$163.07	$0.00	$462.85	$462.85	$0.00	$391.25	$619.74	$626.00	$0.00		$0.00	$122.46	$0.00	$0.00	$124.57	$0.00	$0.00	$0.00	$0.00	$0.00
7291035	SUP	HCPCS C1713		7291035  -  ROD SPNL 5.5MM 35MM 1 BALL	BOTH IP/OP	$782.50 	$579.05	$0.00	$626.00	$352.13	$352.13	$0.00	$0.00	$0.00	$163.09	$580.77	$580.77	$0.00	$0.00	$163.07	$0.00	$462.85	$462.85	$0.00	$391.25	$619.74	$626.00	$0.00		$0.00	$122.46	$0.00	$0.00	$124.57	$0.00	$0.00	$0.00	$0.00	$0.00
7291040	SUP	HCPCS C1713		7291040  -  ROD SPNL PREBNT 5.5MM 40MM SPHERX II 1 BALL	BOTH IP/OP	$782.50 	$579.05	$0.00	$626.00	$352.13	$352.13	$0.00	$0.00	$0.00	$163.09	$580.77	$580.77	$0.00	$0.00	$163.07	$0.00	$462.85	$462.85	$0.00	$391.25	$619.74	$626.00	$0.00		$0.00	$122.46	$0.00	$0.00	$124.57	$0.00	$0.00	$0.00	$0.00	$0.00
7291045	SUP	HCPCS C1713		7291045  -  ROD SPNL 5.5MM 45MM SPHERX II TI	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$387.00	$387.00	$0.00	$0.00	$0.00	$179.25	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$508.69	$508.69	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$134.59	$0.00	$0.00	$136.91	$0.00	$0.00	$0.00	$0.00	$0.00
7291050	SUP	HCPCS C1713		7291050  -  ROD SPNL 5.5MM 50MM SPHERX II TI	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$387.00	$387.00	$0.00	$0.00	$0.00	$179.25	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$508.69	$508.69	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$134.59	$0.00	$0.00	$136.91	$0.00	$0.00	$0.00	$0.00	$0.00
7291055	SUP	HCPCS C1713		7291055  -  ROD SPNL 5.5MM 55MM SPHERX II TI	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$387.00	$387.00	$0.00	$0.00	$0.00	$179.25	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$508.69	$508.69	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$134.59	$0.00	$0.00	$136.91	$0.00	$0.00	$0.00	$0.00	$0.00
7291060	SUP	HCPCS C1713		7291060  -  ROD SPNL 5.5MM 60MM SPHERX II TI	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$387.00	$387.00	$0.00	$0.00	$0.00	$179.25	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$508.69	$508.69	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$134.59	$0.00	$0.00	$136.91	$0.00	$0.00	$0.00	$0.00	$0.00
7291065	SUP	HCPCS C1713		7291065  -  ROD SPNL 5.5MM 65MM SPHERX II TI	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$387.00	$387.00	$0.00	$0.00	$0.00	$179.25	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$508.69	$508.69	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$134.59	$0.00	$0.00	$136.91	$0.00	$0.00	$0.00	$0.00	$0.00
7291070	SUP	HCPCS C1713		7291070  -  ROD SPNL 5.5MM 70MM SPHERX II TI	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$387.00	$387.00	$0.00	$0.00	$0.00	$179.25	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$508.69	$508.69	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$134.59	$0.00	$0.00	$136.91	$0.00	$0.00	$0.00	$0.00	$0.00
7291075	SUP	HCPCS C1713		7291075  -  ROD SPNL 5.5MM 75MM SPHERX II TI	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$387.00	$387.00	$0.00	$0.00	$0.00	$179.25	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$508.69	$508.69	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$134.59	$0.00	$0.00	$136.91	$0.00	$0.00	$0.00	$0.00	$0.00
7291080	SUP	HCPCS C1713		7291080  -  ROD SPNL 5.5MM 80MM SPHERX II TI	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$387.00	$387.00	$0.00	$0.00	$0.00	$179.25	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$508.69	$508.69	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$134.59	$0.00	$0.00	$136.91	$0.00	$0.00	$0.00	$0.00	$0.00
7291085	SUP	HCPCS C1713		7291085  -  ROD SPNL 5.5MM 85MM SPHERX II TI	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$387.00	$387.00	$0.00	$0.00	$0.00	$179.25	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$508.69	$508.69	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$134.59	$0.00	$0.00	$136.91	$0.00	$0.00	$0.00	$0.00	$0.00
7291090	SUP	HCPCS C1713		7291090  -  ROD SPNL 5.5MM 90MM SPHERX II TI	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$387.00	$387.00	$0.00	$0.00	$0.00	$179.25	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$508.69	$508.69	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$134.59	$0.00	$0.00	$136.91	$0.00	$0.00	$0.00	$0.00	$0.00
7291095	SUP	HCPCS C1713		7291095  -  ROD SPNL 5.5MM 95MM SPHERX II TI	BOTH IP/OP	$917.50 	$678.95	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$191.23	$680.97	$680.97	$0.00	$0.00	$191.21	$0.00	$542.70	$542.70	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
7291100	SUP	HCPCS C1713		7291100  -  ROD SPNL 5.5MM 100MM SPHERX II TI	BOTH IP/OP	$917.50 	$678.95	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$191.23	$680.97	$680.97	$0.00	$0.00	$191.21	$0.00	$542.70	$542.70	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
7291110	SUP	HCPCS C1713		7291110  -  ROD SPNL 5.5MM 110MM SPHERX II TI	BOTH IP/OP	$917.50 	$678.95	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$191.23	$680.97	$680.97	$0.00	$0.00	$191.21	$0.00	$542.70	$542.70	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
7291120	SUP	HCPCS C1713		7291120  -  ROD SPNL PREBNT 5.5MM 120MM SPHERX II TI	BOTH IP/OP	$917.50 	$678.95	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$191.23	$680.97	$680.97	$0.00	$0.00	$191.21	$0.00	$542.70	$542.70	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
7291130	SUP	HCPCS C1713		7291130  -  ROD SPNL 5.5MM 400MM SPHERX II TI	BOTH IP/OP	$917.50 	$678.95	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$191.23	$680.97	$680.97	$0.00	$0.00	$191.21	$0.00	$542.70	$542.70	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
7291140	SUP	HCPCS C1713		7291140  -  ROD SPNL PREBNT 5.5MM 140MM SPHERX II TI	BOTH IP/OP	$917.50 	$678.95	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$191.23	$680.97	$680.97	$0.00	$0.00	$191.21	$0.00	$542.70	$542.70	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
7291150	SUP	HCPCS C1713		7291150  -  ROD SPNL 150MM MAS PLIF	BOTH IP/OP	$917.50 	$678.95	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$191.23	$680.97	$680.97	$0.00	$0.00	$191.21	$0.00	$542.70	$542.70	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
7291160	SUP	HCPCS C1713		7291160  -  ROD SPNL PREBNT 5.5MM 160MM SPHERX II TI	BOTH IP/OP	$917.50 	$678.95	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$191.23	$680.97	$680.97	$0.00	$0.00	$191.21	$0.00	$542.70	$542.70	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
7291180	SUP	HCPCS C1713		7291180  -  ROD SPNL PREBNT 5.5MM 180MM SPHERX II TI	BOTH IP/OP	$917.50 	$678.95	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$191.23	$680.97	$680.97	$0.00	$0.00	$191.21	$0.00	$542.70	$542.70	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
7291200	SUP	HCPCS C1713		7291200  -  ROD SPNL PREBNT 5.5MM 200MM SPHERX II TI	BOTH IP/OP	$917.50 	$678.95	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$191.23	$680.97	$680.97	$0.00	$0.00	$191.21	$0.00	$542.70	$542.70	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
7291300	SUP	HCPCS C1713		7291300  -  ROD SPNL PREBNT 5.5MM 300MM SPHERX DBR II TI	BOTH IP/OP	$917.50 	$678.95	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$191.23	$680.97	$680.97	$0.00	$0.00	$191.21	$0.00	$542.70	$542.70	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
7291500	SUP	HCPCS C1713		7291500  -  ROD SPNL PREBNT 5.5MM 500MM SPHERX II TI	BOTH IP/OP	"$1,052.50 "	$778.85	$0.00	$842.00	$473.63	$473.63	$0.00	$0.00	$0.00	$219.37	$781.17	$781.17	$0.00	$0.00	$219.34	$0.00	$622.55	$622.55	$0.00	$526.25	$833.58	$842.00	$0.00		$0.00	$164.72	$0.00	$0.00	$167.56	$0.00	$0.00	$0.00	$0.00	$0.00
7292025	SUP	HCPCS C1713		7292025  -  ROD SPNL PREBNT 5.5MM 25MM SPHERX II TI	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7292030	SUP	HCPCS C1713		7292030  -  ROD SPNL PREBNT 5.5MM 30MM SPHERX II	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7292040	SUP	HCPCS C1713		7292040  -  ROD SPNL PREBNT 5.5MM 40MM SPHERX II TI	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7292050	SUP	HCPCS C1713		7292050  -  ROD SPNL PREBNT 5.5MM 50MM SPHERX II TI	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7292060	SUP	HCPCS C1713		7292060  -  ROD SPNL PREBNT 5.5MM 60MM SPHERX II TI	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7292065	SUP	HCPCS C1713		7292065  -  ROD SPNL PREBNT 5.5MM 65MM SPHERX II TI	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7292070	SUP	HCPCS C1713		7292070  -  ROD SPNL PREBNT 5.5MM 70MM SPHERX II	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7292080	SUP	HCPCS C1713		7292080  -  ROD SPNL PREBNT 5.5MM 80MM	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7292085	SUP	HCPCS C1713		7292085  -  ROD SPNL PREBNT 5.5MM 85MM	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7292090	SUP	HCPCS C1713		7292090  -  ROD SPNL PREBNT 5.5MM 90MM	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7292095	SUP	HCPCS C1713		7292095  -  ROD SPNL PREBNT 5.5MM 95MM	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7292100	SUP	HCPCS C1713		7292100  -  ROD SPNL PREBNT 5.5MM 100MM SPHERX II TI	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7292120	SUP	HCPCS C1713		7292120  -  ROD SPNL PREBNT 120MM SPHERX	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
7303000	SUP	Custom 27803010		7303000  -  ENDCAP SPNL 30MM RND 0 DEG OD 22 XCORE 2 TI	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7303004	SUP	Custom 27803010		7303004  -  ENDCAP SPNL 30MM RND 4 DEG OD 22 XCORE 2 TI	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7303008	SUP	Custom 27803010		7303008  -  ENDCAP SPNL 30MM RND 8 DEG OD 22 XCORE 2 TI	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7303012	SUP	Custom 27803010		7303012  -  ENDCAP SPNL 30MM RND 12 DEG OD 22 XCORE 2 TI	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7340000	SUP	HCPCS C1713		7340000  -  SET SCREW 7340000 BREAKOFF M6XI BUTTRESS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7340300	SUP	HCPCS C1713		7340300  -  ROD 7340300 3.5MM TI  300MM LENGTH	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7340500	SUP	HCPCS C1713		7340500  -  ROD 7340500 3.5MM TI  500MM LENGTH	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7341101	SUP	HCPCS C1713		7341101  -  HOOK 7341101 PEDICLE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7341111	SUP	HCPCS C1713		7341111  -  HOOK 7341111 SMALL LAMINIAR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7341112	SUP	HCPCS C1713		7341112  -  HOOK 7341112 MEDIUM LAMINIAR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7341113	SUP	HCPCS C1713		7341113  -  HOOK 7341113 LARGE LAMINIAR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7341142	SUP	HCPCS C1713		7341142  -  HOOK 7341142 RAMPED NARROW BLADE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7341171	SUP	HCPCS C1713		7341171  -  HOOK 7341171 EXTENDED BODY	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7342410	SUP	HCPCS C1713		7342410  -  SCREW 7342410 FAS 4.0 X 10MM FOR 3.5 ROD	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7342415	SUP	HCPCS C1713		7342415  -  SCREW 7342415 FAS 4.0 X 15MM FOR 3.5 ROD	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7342420	SUP	HCPCS C1713		7342420  -  SCREW 7342420 FAS 4.0 X 20MM FOR 3.5 ROD	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7342425	SUP	HCPCS C1713		7342425  -  SCREW 7342425 FAS 4.0 X 25MM FOR 3.5 ROD	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7342430	SUP	HCPCS C1713		7342430  -  SCREW 7342430 FAS 4.0 X 30MM FOR 3.5 ROD	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7342435	SUP	HCPCS C1713		7342435  -  FAS 4.0 X 35MM FOR 3.5 ROD	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7342440	SUP	HCPCS C1713		7342440  -  FAS 4.0 X 40MM FOR 3.5 ROD	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343310	SUP	HCPCS C1713		7343310  -  SCREW 7343310 3.5 X 10	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343315	SUP	HCPCS C1713		7343315  -  SCREW 7343315 3.5 X 15	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343320	SUP	HCPCS C1713		7343320  -  SCREW 7343320 3.5 X 20	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343325	SUP	HCPCS C1713		7343325  -  SCREW 7343325 3.5 X 25	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343330	SUP	HCPCS C1713		7343330  -  SCREW 7343330 3.5 X 30	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343415	SUP	HCPCS C1713		7343415  -  SCREW 7343415 4.5 X 15	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343420	SUP	HCPCS C1713		7343420  -  SCREW 7343420 4.5 X 20	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343425	SUP	HCPCS C1713		7343425  -  SCREW 7343425 4.5 X 25	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343430	SUP	HCPCS C1713		7343430  -  SCREW 7343430 4.5 X 30	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343435	SUP	HCPCS C1713		7343435  -  SCREW 7343435 4.5 X 35	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343440	SUP	HCPCS C1713		7343440  -  SCREW 7343440 4.5 X 40	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343520	SUP	HCPCS C1713		7343520  -  SCREW 7343520 5.5 X 20	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343525	SUP	HCPCS C1713		7343525  -  SCREW 7343525 5.5 X 25	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343530	SUP	HCPCS C1713		7343530  -  SCREW 7343530 5.5 X 30	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343535	SUP	HCPCS C1713		7343535  -  SCREW 7343535 5.5 X 35	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343540	SUP	HCPCS C1713		7343540  -  SCREW 7343540 5.5 X 40	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7343545	SUP	HCPCS C1713		7343545  -  SCREW 7343545 5.5 X 45	BOTH IP/OP	"$1,959.00 "	"$1,449.66"	$0.00	"$1,567.20"	$881.55	$881.55	$0.00	$0.00	$0.00	$408.30	"$1,453.97"	"$1,453.97"	$0.00	$0.00	$408.26	$0.00	"$1,158.75"	"$1,158.75"	$0.00	$979.50	"$1,551.53"	"$1,567.20"	$0.00		$0.00	$306.58	$0.00	$0.00	$311.87	$0.00	$0.00	$0.00	$0.00	$0.00
7360000	SUP	HCPCS C1713		7360000  -  SET SCREW 7360000 BRK OFF M6 BUTR PLG SS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7360300	SUP	HCPCS C1713		7360300  -  ROD 7360300 ROD 3.5MM DIA SS L 300	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7360500	SUP	HCPCS C1713		7360500  -  ROD 7360500 ROD 3.5MM DIA SS L 500	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7361101	SUP	HCPCS C1713		7361101  -  HOOK 7361101 PEDICLE HOOK 3.5MM DIA SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7361111	SUP	HCPCS C1713		7361111  -  HOOK 7361111 S LAMINAR HOOK 3.5MM DIA SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7361112	SUP	HCPCS C1713		7361112  -  HOOK 7361112 M LAMINAR HOOK 3.5MM DIA SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7361113	SUP	HCPCS C1713		7361113  -  HOOK 7361113 L LAMINAR HOOK 3.5MM DIA SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7361142	SUP	HCPCS C1713		7361142  -  HOOK 7361142 RMP NAR BLD HK 3.5MM DIA SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7361171	SUP	HCPCS C1713		7361171  -  HOOK 7361171 EXTD BODY HOOK 3.5MM DIA SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7362410	SUP	HCPCS C1713		"7362410  -  FAS 4.0 X 10MM FOR 3.5 ROD, SS"	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7362415	SUP	HCPCS C1713		"7362415  -  FAS 4.0 X 15MM FOR 3.5 ROD, SS"	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7362420	SUP	HCPCS C1713		"7362420  -  FAS 4.0 X 20MM FOR 3.5 ROD, SS"	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7362425	SUP	HCPCS C1713		"7362425  -  FAS 4.0 X 25MM FOR 3.5 ROD, SS"	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7362430	SUP	HCPCS C1713		"7362430  -  FAS 4.0 X 30MM FOR 3.5 ROD, SS"	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7362435	SUP	HCPCS C1713		"7362435  -  FAS 4.0 X 35MM FOR 3.5 ROD, SS"	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7362440	SUP	HCPCS C1713		"7362440  -  FAS 4.0 X 40MM FOR 3.5 ROD, SS"	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363310	SUP	HCPCS C1713		7363310  -  BONE SCREW 7363310 FAS 3.5 X 10 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363315	SUP	HCPCS C1713		7363315  -  BONE SCREW 7363315 FAS 3.5 X 15 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363320	SUP	HCPCS C1713		7363320  -  BONE SCREW 7363320 FAS 3.5 X 20 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363325	SUP	HCPCS C1713		7363325  -  BONE SCREW 7363325 FAS 3.5 X 25 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363330	SUP	HCPCS C1713		7363330  -  BONE SCREW 7363330 FAS 3.5 X 30 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363415	SUP	HCPCS C1713		7363415  -  BONE SCREW 7363415 FAS 4.5 X 15 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363420	SUP	HCPCS C1713		7363420  -  BONE SCREW 7363420 FAS 4.5 X 20 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363425	SUP	HCPCS C1713		7363425  -  BONE SCREW 7363425 FAS 4.5 X 25 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363430	SUP	HCPCS C1713		7363430  -  BONE SCREW 7363430 FAS 4.5 X 30 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363435	SUP	HCPCS C1713		7363435  -  BONE SCREW 7363435 FAS 4.5 X 35 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363440	SUP	HCPCS C1713		7363440  -  BONE SCREW 7363440 FAS 4.5 X 40 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363520	SUP	HCPCS C1713		7363520  -  BONE SCREW 7363520 FAS 5.5 X 20 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363525	SUP	HCPCS C1713		7363525  -  BONE SCREW 7363525 FAS 5.5 X 25 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363530	SUP	HCPCS C1713		7363530  -  BONE SCREW 7363530 FAS 5.5 X 30 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363535	SUP	HCPCS C1713		7363535  -  BONE SCREW 7363535 FAS 5.5 X 35 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363540	SUP	HCPCS C1713		7363540  -  BONE SCREW 7363540 FAS 5.5 X 40 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7363545	SUP	HCPCS C1713		7363545  -  BONE SCREW 7363545 FAS 5.5 X 45 SS	BOTH IP/OP	"$1,825.50 "	"$1,350.87"	$0.00	"$1,460.40"	$821.48	$821.48	$0.00	$0.00	$0.00	$380.48	"$1,354.89"	"$1,354.89"	$0.00	$0.00	$380.43	$0.00	"$1,079.78"	"$1,079.78"	$0.00	$912.75	"$1,445.80"	"$1,460.40"	$0.00		$0.00	$285.69	$0.00	$0.00	$290.62	$0.00	$0.00	$0.00	$0.00	$0.00
7370100	SUP	HCPCS C1713		7370100  -  SCREW BONE .5MM 10MM SPHERX DBR 2 TI SPNL LCK	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7375530	SUP	HCPCS C1713		7375530  -  SCREW BN 5.5MM 30MM SPHERX II PA CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7375535	SUP	HCPCS C1713		7375535  -  SCREW BN 5.5MM 35MM SPHERX DBR II PA CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7375540	SUP	HCPCS C1713		7375540  -  SCREW BN 5.5MM 40MM PA CNN CANC SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7375545	SUP	HCPCS C1713		7375545  -  SCREW BN 5.5MM 45MM PA CNN CANC SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7375550	SUP	HCPCS C1713		7375550  -  SCREW BN 5.5MM 50MM SPHERX DBR II PA CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7375555	SUP	HCPCS C1713		7375555  -  SCREW BN 5.5MM 55MM SPHERX DBR II PA CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7376530	SUP	HCPCS C1713		7376530  -  SCREW BN 6.5MM 30MM SPHERX DBR II PA CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7376535	SUP	HCPCS C1713		7376535  -  SCREW BN 6.5MM 35MM PA CANC SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7376540	SUP	HCPCS C1713		7376540  -  SCREW BN 6.5MM 40MM SPHERX DBR II PA CNN TI SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7376550	SUP	HCPCS C1713		7376550  -  SCREW BN 6.5MM 50MM SPHERX DBR II PA CNN TI SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7376555	SUP	HCPCS C1713		7376555  -  SCREW BN 6.5MM 55MM SPHERX DBR II PA CNN TI SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7377530	SUP	HCPCS C1713		7377530  -  SCREW BN 7.5MM 30MM SPHERX DBR II PA CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7377535	SUP	HCPCS C1713		7377535  -  SCREW BN 7.5MM 35MM SPHERX DBR II PA CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7377540	SUP	HCPCS C1713		7377540  -  SCREW BN 7.5MM 40MM SPHERX DBR II PA CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7377545	SUP	HCPCS C1713		7377545  -  SCREW BN 7.5MM 45MM SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7377550	SUP	HCPCS C1713		7377550  -  SCREW BN 7.5MM 50MM SPHERX DBR II PA CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7377555	SUP	HCPCS C1713		7377555  -  SCREW BN 7.5MM 55MM SPHERX DBR II PA CNN SPNE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
7401151	SUP	Custom 27203010		KIT CYTOBLOCK REPL REAGENT TISS FRAG CELL PREP CYTO	BOTH IP/OP	$65.18 	$48.23	$0.00	$52.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.59	$51.62	$52.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440020	SUP	HCPCS C1713		7440020  -  SET SCREW 7440020 BREAKOFF TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7440030	SUP	HCPCS C1713		7440030  -  SET SCREW 7440030 L 4.5 G4 TI BRK OFF	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7440100	SUP	HCPCS C1713		"7440100  -  SET SCREW, NON BREAK-OFF, TI"	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7440120	SUP	HCPCS C1713		"7440120  -  SET SCREW, NON BREAK-OFF, TI"	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7440122	SUP	HCPCS C1713		7440122  -  PLATE BN 22MM NS GRDNT + 1 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440124	SUP	HCPCS C1713		7440124  -  PLATE BN 24MM NS GRDNT + 1 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440126	SUP	HCPCS C1713		7440126  -  PLATE BN 26MM NS GRDNT + 1 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440128	SUP	HCPCS C1713		7440128  -  PLATE BN 28MM NS GRDNT + 1 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440130	SUP	HCPCS C1713		7440130  -  PLATE BN 30MM NS GRDNT + 1 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440132	SUP	HCPCS C1713		7440132  -  PLATE BN 32MM NS GRDNT + 1 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440134	SUP	HCPCS C1713		7440134  -  PLATE BN 34MM NS GRDNT + 1 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440136	SUP	HCPCS C1713		7440136  -  PLATE BN 36MM NS GRDNT + 1 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440236	SUP	HCPCS C1713		7440236  -  PLATE BN 36MM NS GRDNT + 2 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440238	SUP	HCPCS C1713		7440238  -  PLATE BN 38MM NS GRDNT + 2 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440240	SUP	HCPCS C1713		7440240  -  PLATE BN 40MM NS GRDNT + 2 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440242	SUP	HCPCS C1713		7440242  -  PLATE BN 42MM NS GRDNT + 2 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440244	SUP	HCPCS C1713		7440244  -  PLATE BN 44MM NS GRDNT + 2 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440246	SUP	HCPCS C1713		7440246  -  PLATE BN 46MM NS GRDNT + 2 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440248	SUP	HCPCS C1713		7440248  -  PLATE BN 48MM NS GRDNT + 2 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440250	SUP	HCPCS C1713		7440250  -  PLATE BN 50MM NS GRDNT + 2 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440252	SUP	HCPCS C1713		7440252  -  PLATE BN 52MM NS GRDNT + 2 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440254	SUP	HCPCS C1713		7440254  -  PLATE BN 54MM NS GRDNT + 2 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440354	SUP	HCPCS C1713		7440354  -  PLATE BN 54MM NS GRDNT + 3 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440356	SUP	HCPCS C1713		7440356  -  PLATE BN 56MM NS GRDNT + 3 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440358	SUP	HCPCS C1713		7440358  -  PLATE BN 58MM NS GRDNT + 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440360	SUP	HCPCS C1713		7440360  -  PLATE BN 60MM NS GRDNT + 3 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440362	SUP	HCPCS C1713		7440362  -  PLATE BN 62MM NS GRDNT + 3 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440364	SUP	HCPCS C1713		7440364  -  PLATE BN 64MM NS GRDNT + 3 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440366	SUP	HCPCS C1713		7440366  -  PLATE BN 66MM NS GRDNT + 3 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440368	SUP	HCPCS C1713		7440368  -  PLATE BN 68MM NS GRDNT + 3 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440468	SUP	HCPCS C1713		7440468  -  PLATE BN 68MM NS GRDNT + 4 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440470	SUP	HCPCS C1713		7440470  -  PLATE BN 70MM NS GRDNT + 4 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440474	SUP	HCPCS C1713		7440474  -  PLATE BN 74MM NS GRDNT + 4 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440478	SUP	HCPCS C1713		7440478  -  PLATE BN 78MM NS GRDNT + 4 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440482	SUP	HCPCS C1713		7440482  -  PLATE BN 82MM NS GRDNT + 4 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440486	SUP	HCPCS C1713		7440486  -  PLATE BN 86MM NS GRDNT + 4 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440490	SUP	HCPCS C1713		7440490  -  PLATE BN 90MM NS GRDNT + 4 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7440500	SUP	HCPCS C1713		7440500  -  PLATE BN RND HL CVR TI SPNE CRV ANT	BOTH IP/OP	$377.50 	$279.35	$0.00	$302.00	$169.88	$169.88	$0.00	$0.00	$0.00	$78.68	$280.18	$280.18	$0.00	$0.00	$78.67	$0.00	$223.29	$223.29	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$59.08	$0.00	$0.00	$60.10	$0.00	$0.00	$0.00	$0.00	$0.00
7440918	SUP	Custom 27203010		7440918  -  BIT DRL MN 10MM HLX ACP SPNE	BOTH IP/OP	$570.00 	$421.80	$0.00	$456.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$423.05	$423.05	$0.00	$0.00	$118.79	$0.00	$0.00	$0.00	$0.00	$285.00	$451.44	$456.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7441102	SUP	HCPCS C1713		7441102  -  HOOK 7441102 PEDICLE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7441112	SUP	HCPCS C1713		7441112  -  HOOK 7441112 WIDE BLADE SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7441113	SUP	HCPCS C1713		7441113  -  HOOK 7441113 WIDE BLADE MED TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7441114	SUP	HCPCS C1713		7441114  -  HOOK 7441114 WIDE BLADE LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7441122	SUP	HCPCS C1713		7441122  -  HOOK 7441122 NARROW BLADE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7441142	SUP	HCPCS C1713		7441142  -  HOOK 7441142 RAMPED THORACIC TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7441162	SUP	HCPCS C1713		7441162  -  HOOK 7441162 LUMBAR ANGLED BLADE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7441172	SUP	HCPCS C1713		7441172  -  HOOK 7441172 EXTENDED BODY TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7441198	SUP	HCPCS C1713		7441198  -  HOOK 7441198 OFFSET RT TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7441199	SUP	HCPCS C1713		7441199  -  HOOK 7441199 OFFSET LT TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7442420	SUP	HCPCS C1713		7442420  -  BONE SCREW 7442420 FXD ANGLE 4.0X20 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442425	SUP	HCPCS C1713		7442425  -  BONE SCREW 7442425 FXD ANGLE 4.0X25 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442430	SUP	HCPCS C1713		7442430  -  BONE SCREW 7442430 FXD ANGLE 4.0X30 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442435	SUP	HCPCS C1713		7442435  -  BONE SCREW 7442435 FXD ANGLE 4.0X35 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442440	SUP	HCPCS C1713		7442440  -  BONE SCREW 7442440 FXD ANGLE 4.0X40 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442525	SUP	HCPCS C1713		7442525  -  BONE SCREW 7442525 FXD ANGLE 5.0X25 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442528	SUP	HCPCS C1713		"7442528  -  SCREW, FIXED ANGLE,5.0X27.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442530	SUP	HCPCS C1713		7442530  -  BONE SCREW 7442530 FXD ANGLE 5.0X30 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442533	SUP	HCPCS C1713		"7442533  -  SCREW, FIXED ANGLE,5.0X32.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442535	SUP	HCPCS C1713		7442535  -  BONE SCREW 7442535 FXD ANGLE 5.0X35 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442538	SUP	HCPCS C1713		"7442538  -  SCREW, FIXED ANGLE,5.0X37.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442540	SUP	HCPCS C1713		7442540  -  BONE SCREW 7442540 FXD ANGLE 5.0X40 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442545	SUP	HCPCS C1713		7442545  -  BONE SCREW 7442545 FXD ANGLE 5.0X45 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442550	SUP	HCPCS C1713		7442550  -  BONE SCREW 7442550 FXD ANGLE 5.0X50 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442625	SUP	HCPCS C1713		7442625  -  BONE SCREW 7442625 FXD ANGLE6.0X25TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442628	SUP	HCPCS C1713		"7442628  -  SCREW, FIXED ANGLE,6.0X27.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442630	SUP	HCPCS C1713		7442630  -  BONE SCREW 7442630 FXD ANGLE6.0X30TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442633	SUP	HCPCS C1713		"7442633  -  SCREW, FIXED ANGLE,6.0X32.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442635	SUP	HCPCS C1713		7442635  -  BONE SCREW 7442635 FXD ANGLE6.0X35TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442638	SUP	HCPCS C1713		"7442638  -  SCREW, FIXED ANGLE,6.0X37.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442640	SUP	HCPCS C1713		7442640  -  BONE SCREW 7442640 FXD ANGLE6.0X40TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442645	SUP	HCPCS C1713		7442645  -  BONE SCREW 7442645 FXD ANGLE6.0X45TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7442650	SUP	HCPCS C1713		7442650  -  BONE SCREW 7442650 FXD ANGLE6.0X50TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443425	SUP	HCPCS C1713		7443425  -  BONE SCREW 7443425 FXD ANGLE 4.5X25 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443428	SUP	HCPCS C1713		"7443428  -  SCREW, FIXED ANGLE,4.5X27.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443430	SUP	HCPCS C1713		7443430  -  BONE SCREW 7443430 FXD ANGLE 4.5X30 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443433	SUP	HCPCS C1713		"7443433  -  SCREW, FIXED ANGLE,4.5X32.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443435	SUP	HCPCS C1713		7443435  -  BONE SCREW 7443435 FXD ANGLE 4.5X35 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443438	SUP	HCPCS C1713		"7443438  -  SCREW, FIXED ANGLE,4.5X37.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443440	SUP	HCPCS C1713		7443440  -  BONE SCREW 7443440 FXD ANGLE 4.5X40 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443445	SUP	HCPCS C1713		"7443445  -  SCREW, FIXED ANGLE, 4.5X45, TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443450	SUP	HCPCS C1713		"7443450  -  SCREW, FIXED ANGLE, 4.5X50, TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443525	SUP	HCPCS C1713		7443525  -  BONE SCREW 7443525 FXD ANGLE 5.5X25 TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443528	SUP	HCPCS C1713		"7443528  -  SCREW, FIXED ANGLE,5.5X27.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443530	SUP	HCPCS C1713		7443530  -  BONE SCREW 7443530 FXD ANGLE5.5X30TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443533	SUP	HCPCS C1713		"7443533  -  SCREW, FIXED ANGLE,5.5X32.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443535	SUP	HCPCS C1713		7443535  -  BONE SCREW 7443535 FXD ANGLE5.5X35TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443538	SUP	HCPCS C1713		"7443538  -  SCREW, FIXED ANGLE,5.5X37.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443540	SUP	HCPCS C1713		7443540  -  BONE SCREW 7443540 FXD ANGLE5.5X40TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443545	SUP	HCPCS C1713		7443545  -  BONE SCREW 7443545 FXD ANGLE5.5X45TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443550	SUP	HCPCS C1713		7443550  -  BONE SCREW 7443550 FXD ANGLE5.5X50TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443625	SUP	HCPCS C1713		7443625  -  BONE SCREW 7443625 FXD ANGLE6.5X25TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443628	SUP	HCPCS C1713		"7443628  -  SCREW, FIXED ANGLE,6.5X27.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443630	SUP	HCPCS C1713		7443630  -  BONE SCREW 7443630 FXD ANGLE6.5X30TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443633	SUP	HCPCS C1713		"7443633  -  SCREW, FIXED ANGLE,6.5X32.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443635	SUP	HCPCS C1713		7443635  -  BONE SCREW 7443635 FXD ANGLE6.5X35TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443638	SUP	HCPCS C1713		"7443638  -  SCREW, FIXED ANGLE,6.5X37.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443640	SUP	HCPCS C1713		7443640  -  BONE SCREW 7443640 FXD ANGLE6.5X40TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443645	SUP	HCPCS C1713		7443645  -  BONE SCREW 7443645 FXD ANGLE6.5X45TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443650	SUP	HCPCS C1713		7443650  -  BONE SCREW 7443650 FXD ANGLE6.5X50TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443655	SUP	HCPCS C1713		7443655  -  BONE SCREW 7443655 FXD ANGLE6.5X55TI	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443725	SUP	HCPCS C1713		"7443725  -  SCREW, FIXED ANGLE,7.5X25,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443728	SUP	HCPCS C1713		"7443728  -  SCREW, FIXED ANGLE,7.5X27.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443730	SUP	HCPCS C1713		"7443730  -  SCREW, FIXED ANGLE,7.5X30,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443733	SUP	HCPCS C1713		"7443733  -  SCREW, FIXED ANGLE,7.5X32.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443735	SUP	HCPCS C1713		"7443735  -  SCREW, FIXED ANGLE,7.5X35,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443738	SUP	HCPCS C1713		"7443738  -  SCREW, FIXED ANGLE,7.5X37.5,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443740	SUP	HCPCS C1713		"7443740  -  SCREW, FIXED ANGLE,7.5X40,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443745	SUP	HCPCS C1713		"7443745  -  SCREW, FIXED ANGLE,7.5X45,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443750	SUP	HCPCS C1713		"7443750  -  SCREW, FIXED ANGLE,7.5X50,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7443755	SUP	HCPCS C1713		"7443755  -  SCREW, FIXED ANGLE,7.5X55,TI"	BOTH IP/OP	"$1,864.50 "	"$1,379.73"	$0.00	"$1,491.60"	$839.03	$839.03	$0.00	$0.00	$0.00	$388.61	"$1,383.83"	"$1,383.83"	$0.00	$0.00	$388.56	$0.00	"$1,102.85"	"$1,102.85"	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$291.79	$0.00	$0.00	$296.83	$0.00	$0.00	$0.00	$0.00	$0.00
7450122	SUP	HCPCS C1713		7450122  -  PLATE BN 22MM GRDNT + 1 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450124	SUP	HCPCS C1713		7450124  -  PLATE BN 24MM GRDNT + 1 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450126	SUP	HCPCS C1713		7450126  -  PLATE BN 26MM GRDNT + 1 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450128	SUP	HCPCS C1713		7450128  -  PLATE BN 28MM GRDNT + 1 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450130	SUP	HCPCS C1713		7450130  -  PLATE BN 30MM GRDNT + 1 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450132	SUP	HCPCS C1713		7450132  -  PLATE BN 32MM GRDNT + 1 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450134	SUP	HCPCS C1713		7450134  -  PLATE BN 34MM GRDNT + 1 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450136	SUP	HCPCS C1713		7450136  -  PLATE BN 36MM GRDNT + 1 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450236	SUP	HCPCS C1713		7450236  -  PLATE BN 36MM GRDNT + 2 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450238	SUP	HCPCS C1713		7450238  -  PLATE BN 38MM GRDNT + 2 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450240	SUP	HCPCS C1713		7450240  -  PLATE BN 40MM GRDNT + 2 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450242	SUP	HCPCS C1713		7450242  -  PLATE BN 42MM GRDNT + 2 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450244	SUP	HCPCS C1713		7450244  -  PLATE BN 44MM GRDNT + 2 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450246	SUP	HCPCS C1713		7450246  -  PLATE BN 46MM GRDNT + 2 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450248	SUP	HCPCS C1713		7450248  -  PLATE BN 48MM GRDNT + 2 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450250	SUP	HCPCS C1713		7450250  -  PLATE BN 50MM GRDNT + LVL 2 FX ANG TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450252	SUP	HCPCS C1713		7450252  -  PLATE BN 52MM GRDNT + LVL 2 FX ANG TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450254	SUP	HCPCS C1713		7450254  -  PLATE BN 54MM GRDNT + 2 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7450354	SUP	HCPCS C1713		7450354  -  PLATE BN 54MM GRDNT + 3 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450356	SUP	HCPCS C1713		7450356  -  PLATE BN 56MM GRDNT + LVL 3 FX ANG TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450358	SUP	HCPCS C1713		7450358  -  PLATE BN 58MM GRDNT + 3 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450360	SUP	HCPCS C1713		7450360  -  PLATE BN 60MM GRDNT + 3 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450362	SUP	HCPCS C1713		7450362  -  PLATE BN 62MM GRDNT + 3 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450364	SUP	HCPCS C1713		7450364  -  PLATE BN 64MM GRDNT + 3 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450366	SUP	HCPCS C1713		7450366  -  PLATE BN 66MM GRDNT + 3 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450368	SUP	HCPCS C1713		7450368  -  PLATE BN 68MM GRDNT + 3 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450468	SUP	HCPCS C1713		7450468  -  PLATE BN 68MM GRDNT + 4 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450470	SUP	HCPCS C1713		7450470  -  PLATE BN 70MM GRDNT + 4 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450474	SUP	HCPCS C1713		7450474  -  PLATE BN 74MM GRDNT + 4 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450478	SUP	HCPCS C1713		7450478  -  PLATE BN 78MM GRDNT + 4 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450482	SUP	HCPCS C1713		7450482  -  PLATE BN 82MM GRDNT + 4 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450486	SUP	HCPCS C1713		7450486  -  PLATE BN 86MM GRDNT + 4 LVL FX SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450490	SUP	HCPCS C1713		7450490  -  PLATE BN 90MM GRDNT + LVL 4 FX ANG TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450500	SUP	HCPCS C1713		7450500  -  PLATE BN 100MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450505	SUP	HCPCS C1713		7450505  -  PLATE BN 105MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450510	SUP	HCPCS C1713		7450510  -  PLATE BN 110MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450595	SUP	HCPCS C1713		7450595  -  PLATE BN 95MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7450610	SUP	HCPCS C1713		7450610  -  SCREW BN 4MM 10MM NS GRDNT + FX ANG SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7450612	SUP	HCPCS C1713		7450612  -  SCREW BN 4MM 12MM NS GRDNT + FX ANG SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7450614	SUP	HCPCS C1713		7450614  -  SCREW BN 4MM 14MM NS GRDNT + FX ANG SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7450616	SUP	HCPCS C1713		7450616  -  SCREW BN 4MM FA ANT CSPN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7450710	SUP	HCPCS C1713		7450710  -  SCREW BN 4.5MM 10MM NS GRDNT + FX ANG SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7450712	SUP	HCPCS C1713		7450712  -  SCREW BN 4.5MM 12MM NS GRDNT + FX ANG SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7450714	SUP	HCPCS C1713		7450714  -  SCREW BN 4.5MM 14MM NS GRDNT + FX ANG SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7450716	SUP	HCPCS C1713		7450716  -  SCREW BN 4.5MM 16MM GRDNT + FA ANT CSPN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7450800	SUP	Custom 27803010		7450800  -  HOLDER IMPL VLCK TEMP FX TACK	BOTH IP/OP	$377.50 	$279.35	$0.00	$302.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.18	$280.18	$0.00	$0.00	$78.67	$0.00	$0.00	$0.00	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7451500	SUP	HCPCS C1713		7451500  -  PLATE BN NS GRDNT + SLOT HL CVR TI SPNE	BOTH IP/OP	$377.50 	$279.35	$0.00	$302.00	$169.88	$169.88	$0.00	$0.00	$0.00	$78.68	$280.18	$280.18	$0.00	$0.00	$78.67	$0.00	$223.29	$223.29	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$59.08	$0.00	$0.00	$60.10	$0.00	$0.00	$0.00	$0.00	$0.00
7451501	SUP	HCPCS C1713		7451501  -  PLATE BN NS GRDNT + RND HL CVR TI SPNE	BOTH IP/OP	$377.50 	$279.35	$0.00	$302.00	$169.88	$169.88	$0.00	$0.00	$0.00	$78.68	$280.18	$280.18	$0.00	$0.00	$78.67	$0.00	$223.29	$223.29	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$59.08	$0.00	$0.00	$60.10	$0.00	$0.00	$0.00	$0.00	$0.00
7460020	SUP	HCPCS C1713		7460020  -  SET SCREW 7460020 BREAK OFF SS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7460120	SUP	HCPCS C1713		"7460120  -  SET SCREW, NON BREAK-OFF, SS"	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7460500	SUP	HCPCS C1713		7460500  -  PLATE BN 100MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7460505	SUP	HCPCS C1713		7460505  -  PLATE BN 105MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7460510	SUP	HCPCS C1713		7460510  -  PLATE BN 110MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7460595	SUP	HCPCS C1713		7460595  -  PLATE BN 95MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7460610	SUP	HCPCS C1713		7460610  -  SCREW BN 4MM 10MM NS GRDNT + SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7460612	SUP	HCPCS C1713		7460612  -  SCREW BN 4MM 12MM NS GRDNT + SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7460614	SUP	HCPCS C1713		7460614  -  SCREW BN 4MM 14MM NS GRDNT + SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7460616	SUP	HCPCS C1713		7460616  -  SCREW BN 4MM 16MM GRDNT + VA TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7460710	SUP	HCPCS C1713		7460710  -  SCREW BN 4.5MM 10MM NS GRDNT + SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7460712	SUP	HCPCS C1713		7460712  -  SCREW BN 4.5MM 12MM NS GRDNT + SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7460714	SUP	HCPCS C1713		7460714  -  SCREW BN 4.5MM 14MM NS GRDNT + SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7460716	SUP	HCPCS C1713		7460716  -  SCREW BN 4.5MM 16MM GRDNT + VA ANT CSPN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7461102	SUP	HCPCS C1713		7461102  -  HOOK 7461102 PEDICLE SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7461112	SUP	HCPCS C1713		7461112  -  HOOK 7461112 WIDE BLADE SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7461113	SUP	HCPCS C1713		7461113  -  HOOK 7461113 WIDE BLADE MED SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7461114	SUP	HCPCS C1713		7461114  -  HOOK 7461114 WIDE BLADE LGE SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7461122	SUP	HCPCS C1713		7461122  -  HOOK 7461122 NARROW BLADE SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7461142	SUP	HCPCS C1713		7461142  -  HOOK 7461142 RAMPED THORACIC SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7461162	SUP	HCPCS C1713		7461162  -  HOOK 7461162 LUMBAR ANGLED BLADE SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7461172	SUP	HCPCS C1713		7461172  -  HOOK 7461172 EXTENDED BODY SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7461198	SUP	HCPCS C1713		7461198  -  HOOK 7461198 OFFSET RIGHT SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7461199	SUP	HCPCS C1713		7461199  -  HOOK 7461199 OFFSET LEFT SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7461500	SUP	HCPCS C1713		7461500  -  PLATE BN NS GRDNT + SLOT HL CVR TI SPNE	BOTH IP/OP	$377.50 	$279.35	$0.00	$302.00	$169.88	$169.88	$0.00	$0.00	$0.00	$78.68	$280.18	$280.18	$0.00	$0.00	$78.67	$0.00	$223.29	$223.29	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$59.08	$0.00	$0.00	$60.10	$0.00	$0.00	$0.00	$0.00	$0.00
7461501	SUP	HCPCS C1713		7461501  -  PLATE BN NS GRDNT + RND HL CVR TI SPNE	BOTH IP/OP	$377.50 	$279.35	$0.00	$302.00	$169.88	$169.88	$0.00	$0.00	$0.00	$78.68	$280.18	$280.18	$0.00	$0.00	$78.67	$0.00	$223.29	$223.29	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$59.08	$0.00	$0.00	$60.10	$0.00	$0.00	$0.00	$0.00	$0.00
7462420	SUP	HCPCS C1713		7462420  -  SCREW 7462420 FIXED ANGLE 4.0X20 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462425	SUP	HCPCS C1713		7462425  -  SCREW 7462425 FIXED ANGLE 4.0X25 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462430	SUP	HCPCS C1713		7462430  -  SCREW 7462430 FIXED ANGLE 4.0X30 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462435	SUP	HCPCS C1713		7462435  -  SCREW 7462435 FIXED ANGLE 4.0X35 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462440	SUP	HCPCS C1713		7462440  -  SCREW 7462440 FIXED ANGLE 4.0X40 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462525	SUP	HCPCS C1713		7462525  -  SCREW 7462525 FIXED ANGLE 5.0X25 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462528	SUP	HCPCS C1713		"7462528  -  SCREW, FIXED ANGLE,5.0X27.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462530	SUP	HCPCS C1713		7462530  -  SCREW 7462530 FIXED ANGLE 5.0X30 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462533	SUP	HCPCS C1713		"7462533  -  SCREW, FIXED ANGLE,5.0X32.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462535	SUP	HCPCS C1713		7462535  -  SCREW 7462535 FIXED ANGLE 5.0X35 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462538	SUP	HCPCS C1713		"7462538  -  SCREW, FIXED ANGLE,5.0X37.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462540	SUP	HCPCS C1713		7462540  -  SCREW 7462540 FIXED ANGLE 5.0X40 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462545	SUP	HCPCS C1713		7462545  -  SCREW 7462545 FIXED ANGLE 5.0X45 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462550	SUP	HCPCS C1713		7462550  -  SCREW 7462550 FIXED ANGLE 5.0X50 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462625	SUP	HCPCS C1713		7462625  -  SCREW 7462625 FIXED ANGLE 6.0X25 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462628	SUP	HCPCS C1713		"7462628  -  SCREW, FIXED ANGLE,6.0X27.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462630	SUP	HCPCS C1713		7462630  -  SCREW 7462630 FIXED ANGLE 6.0X30 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462633	SUP	HCPCS C1713		"7462633  -  SCREW, FIXED ANGLE,6.0X32.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462635	SUP	HCPCS C1713		7462635  -  SCREW 7462635 FIXED ANGLE 6.0X35 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462638	SUP	HCPCS C1713		"7462638  -  SCREW, FIXED ANGLE,6.0X37.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462640	SUP	HCPCS C1713		7462640  -  SCREW 7462640 FIXED ANGLE 6.0X40 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462645	SUP	HCPCS C1713		7462645  -  SCREW 7462645 FIXED ANGLE 6.0X45 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7462650	SUP	HCPCS C1713		7462650  -  SCREW 7462650 FIXED ANGLE 6.0X50 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463425	SUP	HCPCS C1713		7463425  -  SCREW 7463425 FIXED ANGLE 4.5X25 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463428	SUP	HCPCS C1713		"7463428  -  SCREW, FIXED ANGLE,4.5X27.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463430	SUP	HCPCS C1713		7463430  -  SCREW 7463430 FIXED ANGLE 4.5X30 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463433	SUP	HCPCS C1713		"7463433  -  SCREW, FIXED ANGLE,4.5X32.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463435	SUP	HCPCS C1713		7463435  -  SCREW 7463435 FIXED ANGLE 4.5X35 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463438	SUP	HCPCS C1713		"7463438  -  SCREW, FIXED ANGLE,4.5X37.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463440	SUP	HCPCS C1713		7463440  -  SCREW 7463440 FIXED ANGLE 4.5X40 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463445	SUP	HCPCS C1713		"7463445  -  SCREW, FIXED ANGLE, 4.5X45, SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463450	SUP	HCPCS C1713		"7463450  -  SCREW, FIXED ANGLE, 4.5X50, SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463525	SUP	HCPCS C1713		7463525  -  SCREW 7463525 FIXED ANGLE 5.5X25 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463528	SUP	HCPCS C1713		"7463528  -  SCREW, FIXED ANGLE,5.5X27.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463530	SUP	HCPCS C1713		7463530  -  SCREW 7463530 FIXED ANGLE 5.5X30 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463533	SUP	HCPCS C1713		"7463533  -  SCREW, FIXED ANGLE,5.5X32.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463535	SUP	HCPCS C1713		7463535  -  SCREW 7463535 FIXED ANGLE 5.5X35 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463538	SUP	HCPCS C1713		"7463538  -  SCREW, FIXED ANGLE,5.5X37.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463540	SUP	HCPCS C1713		7463540  -  SCREW 7463540 FIXED ANGLE 5.5X40 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463545	SUP	HCPCS C1713		7463545  -  SCREW 7463545 FIXED ANGLE 5.5X45 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463550	SUP	HCPCS C1713		7463550  -  SCREW 7463550 FIXED ANGLE 5.5X50 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463625	SUP	HCPCS C1713		7463625  -  SCREW 7463625 FIXED ANGLE 6.5X25 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463628	SUP	HCPCS C1713		"7463628  -  SCREW, FIXED ANGLE,6.5X27.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463630	SUP	HCPCS C1713		7463630  -  SCREW 7463630 FIXED ANGLE 6.5X30 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463633	SUP	HCPCS C1713		"7463633  -  SCREW, FIXED ANGLE,6.5X32.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463635	SUP	HCPCS C1713		7463635  -  SCREW 7463635 FIXED ANGLE 6.5X35 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463638	SUP	HCPCS C1713		"7463638  -  SCREW, FIXED ANGLE,6.5X37.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463640	SUP	HCPCS C1713		7463640  -  SCREW 7463640 FIXED ANGLE 6.5X40 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463645	SUP	HCPCS C1713		7463645  -  SCREW 7463645 FIXED ANGLE 6.5X45 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463650	SUP	HCPCS C1713		7463650  -  SCREW 7463650 FIXED ANGLE 6.5X50 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463655	SUP	HCPCS C1713		7463655  -  SCREW 7463655 FIXED ANGLE 6.5X55 SS	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463725	SUP	HCPCS C1713		"7463725  -  SCREW, FIXED ANGLE,7.5X25,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463728	SUP	HCPCS C1713		"7463728  -  SCREW, FIXED ANGLE,7.5X27.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463730	SUP	HCPCS C1713		"7463730  -  SCREW, FIXED ANGLE,7.5X30,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463733	SUP	HCPCS C1713		"7463733  -  SCREW, FIXED ANGLE,7.5X32.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463735	SUP	HCPCS C1713		"7463735  -  SCREW, FIXED ANGLE,7.5X35,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463738	SUP	HCPCS C1713		"7463738  -  SCREW, FIXED ANGLE,7.5X37.5,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463740	SUP	HCPCS C1713		"7463740  -  SCREW, FIXED ANGLE,7.5X40,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463745	SUP	HCPCS C1713		"7463745  -  SCREW, FIXED ANGLE,7.5X45,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463750	SUP	HCPCS C1713		"7463750  -  SCREW, FIXED ANGLE,7.5X50,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7463755	SUP	HCPCS C1713		"7463755  -  SCREW, FIXED ANGLE,7.5X55,SS"	BOTH IP/OP	"$1,666.50 "	"$1,233.21"	$0.00	"$1,333.20"	$749.93	$749.93	$0.00	$0.00	$0.00	$347.34	"$1,236.88"	"$1,236.88"	$0.00	$0.00	$347.30	$0.00	$985.73	$985.73	$0.00	$833.25	"$1,319.87"	"$1,333.20"	$0.00		$0.00	$260.81	$0.00	$0.00	$265.31	$0.00	$0.00	$0.00	$0.00	$0.00
7490122	SUP	HCPCS C1713		7490122  -  PLATE BN 22MM GRDNT + 1 LVL FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7490124	SUP	HCPCS C1713		7490124  -  PLATE BN 24MM GRDNT + 1 LVL FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7490126	SUP	HCPCS C1713		7490126  -  PLATE BN 26MM GRDNT + 1 LVL FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7490128	SUP	HCPCS C1713		7490128  -  PLATE BN 28MM GRDNT + 1 LVL FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7490236	SUP	HCPCS C1713		7490236  -  PLATE BN 36MM NS GRDNT + 2 LVL SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7490238	SUP	HCPCS C1713		7490238  -  PLATE BN 38MM NS GRDNT + 2 LVL SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7490240	SUP	HCPCS C1713		7490240  -  PLATE BN 40MM GRDNT + 2 LVL FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7490242	SUP	HCPCS C1713		7490242  -  PLATE BN 42MM GRDNT + 2 LVL FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7490244	SUP	HCPCS C1713		7490244  -  PLATE BN 44MM GRDNT + 2 LVL FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7490246	SUP	HCPCS C1713		7490246  -  PLATE BN 46MM GRDNT + 2 LVL FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7490248	SUP	HCPCS C1713		7490248  -  PLATE BN 48MM GRDNT + 2 LVL FX SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7490354	SUP	HCPCS C1713		7490354  -  PLATE BN 54MM GRDNT + 3 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7490356	SUP	HCPCS C1713		7490356  -  PLATE BN 56MM GRDNT + 3 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7490358	SUP	HCPCS C1713		7490358  -  PLATE BN 58MM GRDNT + 3 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7490360	SUP	HCPCS C1713		7490360  -  PLATE BN 60MM GRDNT + 3 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7490362	SUP	HCPCS C1713		7490362  -  PLATE BN 62MM GRDNT + 3 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7490364	SUP	HCPCS C1713		7490364  -  PLATE BN 64MM GRDNT + 3 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7490366	SUP	HCPCS C1713		7490366  -  PLATE BN 66MM GRDNT + 3 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7490468	SUP	HCPCS C1713		7490468  -  PLATE BN 68MM GRDNT + 4 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7490470	SUP	HCPCS C1713		7490470  -  PLATE BN 70MM GRDNT + 4 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7490474	SUP	HCPCS C1713		7490474  -  PLATE BN 74MM GRDNT + 4 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7490478	SUP	HCPCS C1713		7490478  -  PLATE BN 78MM GRDNT + 4 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7490482	SUP	HCPCS C1713		7490482  -  PLATE BN 82MM GRDNT + 4 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7490486	SUP	HCPCS C1713		7490486  -  PLATE BN 86MM GRDNT + 4 LVL FX SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7502073	SUP	HCPCS C1713		7502073  -  CAGE SPNL 20D HYPERLORDOTIC 34X6X24MM CRNT BRIGADE	BOTH IP/OP	"$18,375.00 "	"$13,597.50"	$0.00	"$14,700.00"	"$8,268.75"	"$8,268.75"	$0.00	$0.00	$0.00	"$3,829.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,829.35"	$0.00	"$9,058.88"	"$9,058.88"	$0.00	"$9,187.50"	"$14,553.00"	"$14,700.00"	$0.00		$0.00	"$2,875.69"	$0.00	$0.00	"$2,925.30"	$0.00	$0.00	$0.00	$0.00	$0.00
7502077	SUP	HCPCS C1713		7502077  -  CAGE SPNL 20D HYPERLORDOTIC 34X10X24MM NS BRIGADE	BOTH IP/OP	"$18,375.00 "	"$13,597.50"	$0.00	"$14,700.00"	"$8,268.75"	"$8,268.75"	$0.00	$0.00	$0.00	"$3,829.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,829.35"	$0.00	"$9,058.88"	"$9,058.88"	$0.00	"$9,187.50"	"$14,553.00"	"$14,700.00"	$0.00		$0.00	"$2,875.69"	$0.00	$0.00	"$2,925.30"	$0.00	$0.00	$0.00	$0.00	$0.00
7502100	SUP	HCPCS C1713		7502100  -  CAGE SPNL 20D HYPERLORDOTIC 38X28X6MM NS LF BRIGADE	BOTH IP/OP	"$18,375.00 "	"$13,597.50"	$0.00	"$14,700.00"	"$8,268.75"	"$8,268.75"	$0.00	$0.00	$0.00	"$3,829.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,829.35"	$0.00	"$9,058.88"	"$9,058.88"	$0.00	"$9,187.50"	"$14,553.00"	"$14,700.00"	$0.00		$0.00	"$2,875.69"	$0.00	$0.00	"$2,925.30"	$0.00	$0.00	$0.00	$0.00	$0.00
7502102	SUP	HCPCS C1713		7502102  -  CAGE SPNL 20D HYPERLORDOTIC 38X28X8MM NS LF BRIGADE	BOTH IP/OP	"$18,375.00 "	"$13,597.50"	$0.00	"$14,700.00"	"$8,268.75"	"$8,268.75"	$0.00	$0.00	$0.00	"$3,829.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,829.35"	$0.00	"$9,058.88"	"$9,058.88"	$0.00	"$9,187.50"	"$14,553.00"	"$14,700.00"	$0.00		$0.00	"$2,875.69"	$0.00	$0.00	"$2,925.30"	$0.00	$0.00	$0.00	$0.00	$0.00
7502104	SUP	HCPCS C1713		7502104  -  CAGE SPNL 20D HYPERLORDOTIC 38X28X10MM NS LF BRIGADE	BOTH IP/OP	"$18,375.00 "	"$13,597.50"	$0.00	"$14,700.00"	"$8,268.75"	"$8,268.75"	$0.00	$0.00	$0.00	"$3,829.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,829.35"	$0.00	"$9,058.88"	"$9,058.88"	$0.00	"$9,187.50"	"$14,553.00"	"$14,700.00"	$0.00		$0.00	"$2,875.69"	$0.00	$0.00	"$2,925.30"	$0.00	$0.00	$0.00	$0.00	$0.00
7502219	SUP	HCPCS C1713		7502219  -  CAGE SPNL 20D HYPERLORDOTIC 34X8X24MM CRNT BRIGADE	BOTH IP/OP	"$18,375.00 "	"$13,597.50"	$0.00	"$14,700.00"	"$8,268.75"	"$8,268.75"	$0.00	$0.00	$0.00	"$3,829.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,829.35"	$0.00	"$9,058.88"	"$9,058.88"	$0.00	"$9,187.50"	"$14,553.00"	"$14,700.00"	$0.00		$0.00	"$2,875.69"	$0.00	$0.00	"$2,925.30"	$0.00	$0.00	$0.00	$0.00	$0.00
7502221	SUP	HCPCS C1713		7502221  -  CAGE SPNL 30D HYPERLORDOTIC 34X10X24MM CRNT BRIGADE	BOTH IP/OP	"$18,375.00 "	"$13,597.50"	$0.00	"$14,700.00"	"$8,268.75"	"$8,268.75"	$0.00	$0.00	$0.00	"$3,829.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,829.35"	$0.00	"$9,058.88"	"$9,058.88"	$0.00	"$9,187.50"	"$14,553.00"	"$14,700.00"	$0.00		$0.00	"$2,875.69"	$0.00	$0.00	"$2,925.30"	$0.00	$0.00	$0.00	$0.00	$0.00
7502244	SUP	HCPCS C1713		7502244  -  CAGE SPNL 30D HYPERLORDOTIC 38X6X28MM CRNT BRIGADE	BOTH IP/OP	"$18,375.00 "	"$13,597.50"	$0.00	"$14,700.00"	"$8,268.75"	"$8,268.75"	$0.00	$0.00	$0.00	"$3,829.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,829.35"	$0.00	"$9,058.88"	"$9,058.88"	$0.00	"$9,187.50"	"$14,553.00"	"$14,700.00"	$0.00		$0.00	"$2,875.69"	$0.00	$0.00	"$2,925.30"	$0.00	$0.00	$0.00	$0.00	$0.00
7502246	SUP	HCPCS C1713		7502246  -  CAGE SPNL 30D HYPERLORDOTIC 38X28X8MM NS LF BRIGADE	BOTH IP/OP	"$18,375.00 "	"$13,597.50"	$0.00	"$14,700.00"	"$8,268.75"	"$8,268.75"	$0.00	$0.00	$0.00	"$3,829.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,829.35"	$0.00	"$9,058.88"	"$9,058.88"	$0.00	"$9,187.50"	"$14,553.00"	"$14,700.00"	$0.00		$0.00	"$2,875.69"	$0.00	$0.00	"$2,925.30"	$0.00	$0.00	$0.00	$0.00	$0.00
7502248	SUP	HCPCS C1713		7502248  -  CAGE SPNL 30D HYPERLORDOTIC 38X28X10MM NS LF BRIGADE	BOTH IP/OP	"$18,375.00 "	"$13,597.50"	$0.00	"$14,700.00"	"$8,268.75"	"$8,268.75"	$0.00	$0.00	$0.00	"$3,829.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,829.35"	$0.00	"$9,058.88"	"$9,058.88"	$0.00	"$9,187.50"	"$14,553.00"	"$14,700.00"	$0.00		$0.00	"$2,875.69"	$0.00	$0.00	"$2,925.30"	$0.00	$0.00	$0.00	$0.00	$0.00
7509145	SUP	Custom 27804086		7509145  -  GRAFT BN 5X1.75CM MAGNIFUSE DBM	BOTH IP/OP	"$6,875.00 "	"$5,087.50"	$0.00	"$5,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,432.75"	$0.00	$0.00	$0.00	$0.00	"$3,437.50"	"$5,445.00"	"$5,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7509211	SUP	Custom 27804086		7509211  -  GRAFT BN 10X1CM MAGNIFUSE DBM	BOTH IP/OP	"$6,500.00 "	"$4,810.00"	$0.00	"$5,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,354.60"	$0.00	$0.00	$0.00	$0.00	"$3,250.00"	"$5,148.00"	"$5,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7509215	SUP	Custom 27804086		7509215  -  GRAFT BN 5X1CM MAGNIFUSE DBM SPNE CRV POST	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	$0.00	$0.00	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7510001	SUP	HCPCS C1713		7510001  -  NUT LCK 5.5MM LAT PLT SPNE	BOTH IP/OP	$317.50 	$234.95	$0.00	$254.00	$142.88	$142.88	$0.00	$0.00	$0.00	$66.17	$235.65	$235.65	$0.00	$0.00	$66.17	$0.00	$187.80	$187.80	$0.00	$158.75	$251.46	$254.00	$0.00		$0.00	$49.69	$0.00	$0.00	$50.55	$0.00	$0.00	$0.00	$0.00	$0.00
7510050	SUP	HCPCS C1713		7510050  -  GRAFT BONE 2XS 12MM 20MM ABSORBABLE SPONGE STERILE WATER	BOTH IP/OP	"$2,387.50 "	"$1,766.75"	$0.00	"$1,910.00"	"$1,074.38"	"$1,074.38"	$0.00	$0.00	$0.00	$497.61	"$1,772.00"	"$1,772.00"	$0.00	$0.00	$497.56	$0.00	"$1,412.21"	"$1,412.21"	$0.00	"$1,193.75"	"$1,890.90"	"$1,910.00"	$0.00		$0.00	$373.64	$0.00	$0.00	$380.09	$0.00	$0.00	$0.00	$0.00	$0.00
7510100	SUP	HCPCS C1713		7510100  -  GRAFT BONE XS KIT INFUSE BOVINE COLLAGEN RHBMP-2 LUMBAR	BOTH IP/OP	"$4,762.50 "	"$3,524.25"	$0.00	"$3,810.00"	"$2,143.13"	"$2,143.13"	$0.00	$0.00	$0.00	$992.62	"$3,534.73"	"$3,534.73"	$0.00	$0.00	$992.51	$0.00	"$2,347.91"	"$2,347.91"	$0.00	"$2,381.25"	"$3,771.90"	"$3,810.00"	$0.00		$0.00	$745.33	$0.00	$0.00	$758.19	$0.00	$0.00	$0.00	$0.00	$0.00
7510200	SUP	HCPCS C1713		7510200  -  GRAFT BONE SMALL 14MM 23MM ABSORBABLE SPONGE STERILE WATER	BOTH IP/OP	"$9,512.50 "	"$7,039.25"	$0.00	"$7,610.00"	"$4,280.63"	"$4,280.63"	$0.00	$0.00	$0.00	"$1,982.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,982.41"	$0.00	"$4,689.66"	"$4,689.66"	$0.00	"$4,756.25"	"$7,533.90"	"$7,610.00"	$0.00		$0.00	"$1,488.71"	$0.00	$0.00	"$1,514.39"	$0.00	$0.00	$0.00	$0.00	$0.00
7510400	SUP	HCPCS C1713		7510400  -  GRAFT BONE MEDIUM 20GA 2X1IN VIAL ABSORBABLE COLLAGEN SPONGE	BOTH IP/OP	"$13,250.00 "	"$9,805.00"	$0.00	"$10,600.00"	"$5,962.50"	"$5,962.50"	$0.00	$0.00	$0.00	"$2,761.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,761.30"	$0.00	"$6,532.25"	"$6,532.25"	$0.00	"$6,625.00"	"$10,494.00"	"$10,600.00"	$0.00		$0.00	"$2,073.63"	$0.00	$0.00	"$2,109.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7510800	SUP	HCPCS C1713		7510800  -  GRAFT BONE LARGE II 18MM 26MM ABSORBABLE SPONGE STERILE	BOTH IP/OP	"$14,775.00 "	"$10,933.50"	$0.00	"$11,820.00"	"$6,648.75"	"$6,648.75"	$0.00	$0.00	$0.00	"$3,079.48"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,079.11"	$0.00	"$7,284.08"	"$7,284.08"	$0.00	"$7,387.50"	"$11,701.80"	"$11,820.00"	$0.00		$0.00	"$2,312.29"	$0.00	$0.00	"$2,352.18"	$0.00	$0.00	$0.00	$0.00	$0.00
7521006	SUP	HCPCS C1713		7521006  -  PLATE BN 6MM XLP 2 HL TI SPNE LAT	BOTH IP/OP	"$7,022.50 "	"$5,196.65"	$0.00	"$5,618.00"	"$3,160.13"	"$3,160.13"	$0.00	$0.00	$0.00	"$1,463.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,463.49"	$0.00	"$3,462.09"	"$3,462.09"	$0.00	"$3,511.25"	"$5,561.82"	"$5,618.00"	$0.00		$0.00	"$1,099.02"	$0.00	$0.00	"$1,117.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7521008	SUP	HCPCS C1713		7521008  -  PLATE BN 8MM XLP 2 HL TI SPNE LAT	BOTH IP/OP	"$7,022.50 "	"$5,196.65"	$0.00	"$5,618.00"	"$3,160.13"	"$3,160.13"	$0.00	$0.00	$0.00	"$1,463.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,463.49"	$0.00	"$3,462.09"	"$3,462.09"	$0.00	"$3,511.25"	"$5,561.82"	"$5,618.00"	$0.00		$0.00	"$1,099.02"	$0.00	$0.00	"$1,117.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7521012	SUP	HCPCS C1713		7521012  -  PLATE BN 12MM XLP 2 HL TI SPNE LAT	BOTH IP/OP	"$7,022.50 "	"$5,196.65"	$0.00	"$5,618.00"	"$3,160.13"	"$3,160.13"	$0.00	$0.00	$0.00	"$1,463.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,463.49"	$0.00	"$3,462.09"	"$3,462.09"	$0.00	"$3,511.25"	"$5,561.82"	"$5,618.00"	$0.00		$0.00	"$1,099.02"	$0.00	$0.00	"$1,117.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7521014	SUP	HCPCS C1713		7521014  -  PLATE BN 14MM XLP 2 HL TI SPNE LAT	BOTH IP/OP	"$7,022.50 "	"$5,196.65"	$0.00	"$5,618.00"	"$3,160.13"	"$3,160.13"	$0.00	$0.00	$0.00	"$1,463.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,463.49"	$0.00	"$3,462.09"	"$3,462.09"	$0.00	"$3,511.25"	"$5,561.82"	"$5,618.00"	$0.00		$0.00	"$1,099.02"	$0.00	$0.00	"$1,117.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7521016	SUP	HCPCS C1713		7521016  -  PLATE BN 16MM XLP 2 HL TI SPNE LAT	BOTH IP/OP	"$7,022.50 "	"$5,196.65"	$0.00	"$5,618.00"	"$3,160.13"	"$3,160.13"	$0.00	$0.00	$0.00	"$1,463.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,463.49"	$0.00	"$3,462.09"	"$3,462.09"	$0.00	"$3,511.25"	"$5,561.82"	"$5,618.00"	$0.00		$0.00	"$1,099.02"	$0.00	$0.00	"$1,117.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7533006	SUP	HCPCS C1713		7533006  -  PLATE BN 6MM XLP + 4 HL SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7533008	SUP	HCPCS C1713		7533008  -  PLATE BN 8MM XLP + 4 HL SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7533010	SUP	HCPCS C1713		7533010  -  PLATE BN 10MM XLP + 4 HL SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7533012	SUP	HCPCS C1713		7533012  -  PLATE BN 12MM XLP + 4 HL SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7533014	SUP	HCPCS C1713		7533014  -  PLATE BN 14MM XLP + 4 HL SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7533016	SUP	HCPCS C1713		7533016  -  PLATE BN 16MM XLP + 4 HL SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7534006	SUP	HCPCS C1713		7534006  -  PLATE BN 6MM XLP + 2X2 HL SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7534008	SUP	HCPCS C1713		7534008  -  PLATE BN 8MM XLP + 2X2 HL SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7534010	SUP	HCPCS C1713		7534010  -  PLATE BN 10MM XLP + 2X2 HL SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7534012	SUP	HCPCS C1713		7534012  -  PLATE BN 12MM XLP + 2X2 HL SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7534014	SUP	HCPCS C1713		7534014  -  PLATE BN 14MM XLP + 2X2 HL SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7534016	SUP	HCPCS C1713		7534016  -  PLATE BN 16MM XLP + 2X2 HL SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7539006	SUP	HCPCS C1713		7539006  -  PLATE BN ANG FAVORED 6MM XLP + SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7539008	SUP	HCPCS C1713		7539008  -  PLATE BN ANG FAVORED 8MM XLP + SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7539010	SUP	HCPCS C1713		7539010  -  PLATE BN ANG FAVORED 10MM XLP + SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7539012	SUP	HCPCS C1713		7539012  -  PLATE BN ANG FAVORED 12MM XLP + SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7539014	SUP	HCPCS C1713		7539014  -  PLATE BN ANG FAVORED 14MM XLP + SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7539016	SUP	HCPCS C1713		7539016  -  PLATE BN ANG FAVORED 16MM XLP + SPNE	BOTH IP/OP	"$7,887.50 "	"$5,836.75"	$0.00	"$6,310.00"	"$3,549.38"	"$3,549.38"	$0.00	$0.00	$0.00	"$1,643.95"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,643.76"	$0.00	"$3,888.54"	"$3,888.54"	$0.00	"$3,943.75"	"$6,246.90"	"$6,310.00"	$0.00		$0.00	"$1,234.39"	$0.00	$0.00	"$1,255.69"	$0.00	$0.00	$0.00	$0.00	$0.00
7540020	SUP	HCPCS C1713		7540020  -  SCREW BONE 20MM SPNL TI BRKOF	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7540120	SUP	HCPCS C1713		7540120  -  SET SCREW 7540120 NON BREAK OFF TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7540220	SUP	HCPCS C1713		7540220  -  SET SCREW 7540220 LEGACY 5.5 RED PLUG TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7541102	SUP	HCPCS C1713		7541102  -  HOOK 7541102 PEDICLE SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541103	SUP	HCPCS C1713		7541103  -  HOOK 7541103 PEDICLE MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541104	SUP	HCPCS C1713		7541104  -  HOOK 7541104 PEDICLE LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541112	SUP	HCPCS C1713		7541112  -  HOOK 7541112 WIDE BLADE SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541113	SUP	HCPCS C1713		7541113  -  HOOK 7541113 WIDE BLADE MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541114	SUP	HCPCS C1713		7541114  -  HOOK 7541114 WIDE BLADE LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541122	SUP	HCPCS C1713		7541122  -  HOOK 7541122 NARROW BLADE SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541123	SUP	HCPCS C1713		7541123  -  HOOK 7541123 NARROW BLADE MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541124	SUP	HCPCS C1713		7541124  -  HOOK 7541124 NARROW BLADE LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541133	SUP	HCPCS C1713		7541133  -  HOOK 7541133 RAMP WIDE BLADE MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541142	SUP	HCPCS C1713		7541142  -  HOOK 7541142 RAMP NARROW BLADE SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541143	SUP	HCPCS C1713		7541143  -  HOOK 7541143 RAMP NARROW BLADE MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541153	SUP	HCPCS C1713		7541153  -  HOOK 7541153 SUPRA LAM LUMBAR MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541162	SUP	HCPCS C1713		7541162  -  HOOK 7541162 LUMBAR ANG BLADE SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541163	SUP	HCPCS C1713		7541163  -  HOOK 7541163 LUMBAR ANG BLADE MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541172	SUP	HCPCS C1713		7541172  -  HOOK 7541172 EXTENDED BODY SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541173	SUP	HCPCS C1713		7541173  -  HOOK 7541173 EXTENDED BODY MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541174	SUP	HCPCS C1713		7541174  -  HOOK 7541174 EXTENDED BODY LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541188	SUP	HCPCS C1713		7541188  -  HOOK 7541188 THORACIC ANG BLADE RT TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541189	SUP	HCPCS C1713		7541189  -  HOOK 7541189 THORACIC ANG BLADE LT TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541198	SUP	HCPCS C1713		7541198  -  HOOK 7541198 OFFSET RT TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541199	SUP	HCPCS C1713		7541199  -  HOOK 7541199 OFFSET LT TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541203	SUP	HCPCS C1713		7541203  -  HOOK 7541203 PEDICLE WITH LIP MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541213	SUP	HCPCS C1713		7541213  -  HOOK 7541213 WIDE BLADEW LIP MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541223	SUP	HCPCS C1713		7541223  -  HOOK 7541223 NARROW BLADEW LIP MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541302	SUP	HCPCS C1713		"7541302  -  TAH PEDICLE HOOK - SMALL, TI"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541303	SUP	HCPCS C1713		"7541303  -  TAH PEDICLE HOOK - MEDIUM, TI"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541304	SUP	HCPCS C1713		"7541304  -  TAH PEDICLE HOOK - LARGE,TI"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541312	SUP	HCPCS C1713		"7541312  -  TAH SUPRA-LAMINAR HOOK -SM, TI"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541313	SUP	HCPCS C1713		"7541313  -  TAH SUPRA-LAMINAR HOOK -MD, TI"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541314	SUP	HCPCS C1713		"7541314  -  TAH SUPRA-LAMINAR HOOK-LG, TI"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541322	SUP	HCPCS C1713		"7541322  -  TAH INFRA-LAMINAR HOOK-SM, TI"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541323	SUP	HCPCS C1713		"7541323  -  TAH INFRA-LAMINAR HOOK-MD, TI"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541324	SUP	HCPCS C1713		"7541324  -  TAH INFRA-LAMINAR HOOK-LG, TI"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541342	SUP	HCPCS C1713		7541342  -  TAH TRANSVERSE PROCESS HOOK-SM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541343	SUP	HCPCS C1713		7541343  -  TAH TRANSVERSE PROCESS HOOK-MD	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7541344	SUP	HCPCS C1713		7541344  -  TAH TRANSVERSE PROCESS HOOK-TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7542420	SUP	HCPCS C1713		"7542420  -  SCREW, FIXED ANGLE, 4.0X20, TI"	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542425	SUP	HCPCS C1713		7542425  -  SCREW 7542425 FIXED ANGLE 4.0X25 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542430	SUP	HCPCS C1713		"7542430  -  SCREW, FIXED ANGLE, 4.0X30, TI"	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542435	SUP	HCPCS C1713		"7542435  -  SCREW, FIXED ANGLE, 4.0X35, TI"	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542440	SUP	HCPCS C1713		"7542440  -  SCREW, FIXED ANGLE, 4.0X40, TI"	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542445	SUP	HCPCS C1713		"7542445  -  SCREW, FIXED ANGLE, 4.0X45, TI"	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542450	SUP	HCPCS C1713		"7542450  -  SCREW, FIXED ANGLE, 4.0X50, TI"	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542455	SUP	HCPCS C1713		"7542455  -  SCREW, FIXED ANGLE, 4.0X55, TI"	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542520	SUP	HCPCS C1713		7542520  -  SCREW 7542520 FIXED ANGLE 5.0X20 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542525	SUP	HCPCS C1713		7542525  -  SCREW BN 5MM 25MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542530	SUP	HCPCS C1713		7542530  -  SCREW BN 5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542535	SUP	HCPCS C1713		7542535  -  SCREW BN 5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542540	SUP	HCPCS C1713		7542540  -  SCREW BN 5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542545	SUP	HCPCS C1713		7542545  -  SCREW BN 5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542550	SUP	HCPCS C1713		7542550  -  SCREW 7542550 FIXED ANGLE 5.0X50 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542555	SUP	HCPCS C1713		7542555  -  SCREW 7542555 FIXED ANGLE 5.0X55 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542625	SUP	HCPCS C1713		7542625  -  SCREW 7542625 FIXED ANGLE 6.0X25 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542630	SUP	HCPCS C1713		7542630  -  SCREW 7542630 FIXED ANGLE 6.0X30 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542635	SUP	HCPCS C1713		7542635  -  SCREW 7542635 FIXED ANGLE 6.0X35 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542640	SUP	HCPCS C1713		7542640  -  SCREW 7542640 FIXED ANGLE 6.0X40 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542645	SUP	HCPCS C1713		7542645  -  BONE SCREW 7542645 FIXED ANGLE 6.0X45 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542650	SUP	HCPCS C1713		7542650  -  SCREW 7542650 FIXED ANGLE 6.0X50 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542655	SUP	HCPCS C1713		7542655  -  SCREW 7542655 FIXED ANGLE 6.0X55 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7542660	SUP	HCPCS C1713		7542660  -  SCREW 7542660 FIXED ANGLE 6.0X60 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543420	SUP	HCPCS C1713		7543420  -  SCREW 7543420 FIXED ANGLE 4.5X20 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543425	SUP	HCPCS C1713		7543425  -  SCREW BN 4.5MM 25MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543430	SUP	HCPCS C1713		7543430  -  SCREW BN 4.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543435	SUP	HCPCS C1713		7543435  -  SCREW BN 4.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543440	SUP	HCPCS C1713		7543440  -  SCREW BN 4.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543445	SUP	HCPCS C1713		7543445  -  SCREW BN 4.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543450	SUP	HCPCS C1713		7543450  -  SCREW 7543450 FIXED ANGLE 4.5X50 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543455	SUP	HCPCS C1713		7543455  -  SCREW 7543455 FIXED ANGLE 4.5X55 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543525	SUP	HCPCS C1713		7543525  -  SCREW BN 5.5MM 25MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543530	SUP	HCPCS C1713		7543530  -  SCREW BN 5.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543535	SUP	HCPCS C1713		7543535  -  SCREW BN 5.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543540	SUP	HCPCS C1713		7543540  -  SCREW BN 5.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543545	SUP	HCPCS C1713		7543545  -  SCREW BN 5.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543550	SUP	HCPCS C1713		7543550  -  SCREW BN 5.5MM 50MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543555	SUP	HCPCS C1713		7543555  -  SCREW 7543555 FIXED ANGLE 5.5X55 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543560	SUP	HCPCS C1713		7543560  -  SCREW 7543560 FIXED ANGLE 5.5X60 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543625	SUP	HCPCS C1713		7543625  -  SCREW 7543625 FIXED ANGLE 6.5X25 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543630	SUP	HCPCS C1713		7543630  -  SCREW BN 6.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543635	SUP	HCPCS C1713		7543635  -  SCREW BN 6.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543640	SUP	HCPCS C1713		7543640  -  SCREW BN 6.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543645	SUP	HCPCS C1713		7543645  -  SCREW BN 6.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543650	SUP	HCPCS C1713		7543650  -  SCREW BN 6.5MM 50MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543655	SUP	HCPCS C1713		7543655  -  SCREW BN 6.5MM 55MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543660	SUP	HCPCS C1713		7543660  -  SCREW 7543660 FIXED ANGLE 6.5X60 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543725	SUP	HCPCS C1713		7543725  -  SCREW 7543725 FIXED ANGLE 7.5X25 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543730	SUP	HCPCS C1713		7543730  -  SCREW BN 7.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543735	SUP	HCPCS C1713		7543735  -  SCREW BN 7.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543740	SUP	HCPCS C1713		7543740  -  SCREW BN 7.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543745	SUP	HCPCS C1713		7543745  -  SCREW BN 7.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543750	SUP	HCPCS C1713		7543750  -  SCREW BN 7.5MM 50MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543755	SUP	HCPCS C1713		7543755  -  SCREW BN 7.5MM 55MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543760	SUP	HCPCS C1713		7543760  -  SCREW 7543760 FIXED ANGLE 7.5X60 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7543765	SUP	HCPCS C1713		7543765  -  SCREW 7543765 FIXED ANGLE 7.5X65 TI	BOTH IP/OP	"$1,896.00 "	"$1,403.04"	$0.00	"$1,516.80"	$853.20	$853.20	$0.00	$0.00	$0.00	$395.17	"$1,407.21"	"$1,407.21"	$0.00	$0.00	$395.13	$0.00	"$1,121.48"	"$1,121.48"	$0.00	$948.00	"$1,501.63"	"$1,516.80"	$0.00		$0.00	$296.72	$0.00	$0.00	$301.84	$0.00	$0.00	$0.00	$0.00	$0.00
7544035	SUP	HCPCS C1713		7544035  -  SCREW BN 4MM 35MM CD HZN LGC MA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7546999	SUP	Custom 27203010		REAGENT SOL A B C IMPRP KT 300 TST ANALY	BOTH IP/OP	$559.15 	$413.77	$0.00	$447.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.58	$442.85	$447.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7547053	SUP	Custom 27203010		CONTROL FLW CYMTR FLWCNT FLUOROSPHERES 20ML	BOTH IP/OP	$686.15 	$507.75	$0.00	$548.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.08	$543.43	$548.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7547116	SUP	Custom 27203010		CONTROL CLTR 5C 3PK DISK 3.3ML HMTL	BOTH IP/OP	$40.83 	$30.21	$0.00	$32.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.41	$32.34	$32.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7547125	SUP	Custom 27203010		CONTROL RETCYT CLTR RTC C GNS 3PK 3.3ML LH SER HMTL	BOTH IP/OP	$38.73 	$28.66	$0.00	$30.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.36	$30.67	$30.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7547178	SUP	Custom 27203010		STAIN WRTS GMS TRUCOLOR 2L SLD LH SER HMTL	BOTH IP/OP	$517.38 	$382.86	$0.00	$413.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.69	$409.76	$413.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7547181	SUP	Custom 27203010		STAIN WRTS GMS TRUCOLOR 2L SLD BUFF LH SER HMTL	BOTH IP/OP	$316.25 	$234.03	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.13	$250.47	$253.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7555025	SUP	HCPCS C1713		7555025  -  BOLT SPNL 5.5MM 25MM PLT	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7555030	SUP	HCPCS C1713		7555030  -  BOLT SPNL 5.5MM 30MM TI	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7555035	SUP	HCPCS C1713		7555035  -  BOLT SPNL 5MM 35MM TI	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7555040	SUP	HCPCS C1713		7555040  -  BOLT SPNL 5.5MM 40MM TI	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7555050	SUP	HCPCS C1713		7555050  -  BOLT SPNL 5.5MM 50MM TI	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7555055	SUP	HCPCS C1713		7555055  -  BOLT SPNL 5.5MM 55MM XLP	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7555060	SUP	HCPCS C1713		7555060  -  BOLT SPNL 5.5MM 60MM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7555065	SUP	HCPCS C1713		7555065  -  BOLT SPNL 5.5MM 65MM TI	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7560020	SUP	HCPCS C1713		7560020  -  SET SCREW 7560020 BREAK OFF SS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7560120	SUP	HCPCS C1713		7560120  -  SET SCREW 7560120 NON BREAK OFF SS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7560220	SUP	HCPCS C1713		7560220  -  SET SCREW 7560220 LEGACY 5.5 RED PLUG SS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7561102	SUP	HCPCS C1713		7561102  -  HOOK 7561102 PEDICLE SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561103	SUP	HCPCS C1713		7561103  -  HOOK 7561103 PEDICLE MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561104	SUP	HCPCS C1713		7561104  -  HOOK 7561104 PEDICLE LG SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561112	SUP	HCPCS C1713		7561112  -  HOOK 7561112 WIDE BLADE SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561113	SUP	HCPCS C1713		7561113  -  HOOK 7561113 WIDE BLADE MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561114	SUP	HCPCS C1713		7561114  -  HOOK 7561114 WIDE BLADE LG SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561122	SUP	HCPCS C1713		7561122  -  HOOK 7561122 NARROW BLADE SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561123	SUP	HCPCS C1713		7561123  -  HOOK 7561123 NARROW BLADE MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561124	SUP	HCPCS C1713		7561124  -  HOOK 7561124 NARROW BLADE LG SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561133	SUP	HCPCS C1713		7561133  -  HOOK SPNL MED CD HZN LGC RAMP W BLDE SS THOR 5.5MM ROD	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561142	SUP	HCPCS C1713		7561142  -  HOOK 7561142 RAMP NARROW BLADE SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561143	SUP	HCPCS C1713		7561143  -  HOOK 7561143 RAMP NARROW BLADE MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561153	SUP	HCPCS C1713		7561153  -  HOOK 7561153 SUPRA LAM LUMBAR MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561162	SUP	HCPCS C1713		7561162  -  HOOK 7561162 LUMBAR ANG BLADE SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561163	SUP	HCPCS C1713		7561163  -  HOOK 7561163 LUMBAR ANG BLADE MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561172	SUP	HCPCS C1713		7561172  -  HOOK 7561172 EXTENDED BODY SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561173	SUP	HCPCS C1713		7561173  -  HOOK 7561173 EXTENDED BODY MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561174	SUP	HCPCS C1713		7561174  -  HOOK 7561174 EXTENDED BODY LG SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561188	SUP	HCPCS C1713		7561188  -  HOOK 7561188 THORACIC ANG BLADE RT SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561189	SUP	HCPCS C1713		7561189  -  HOOK 7561189 THORACIC ANG BLADE LT SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561198	SUP	HCPCS C1713		7561198  -  HOOK 7561198 OFFSET RT SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561199	SUP	HCPCS C1713		7561199  -  HOOK 7561199 OFFSET LT SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561203	SUP	HCPCS C1713		7561203  -  HOOK 7561203 PEDICLE WITH LIP MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561213	SUP	HCPCS C1713		7561213  -  HOOK 7561213 WIDE BLADE W LIP MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7561223	SUP	HCPCS C1713		7561223  -  HOOK 7561223 NARROW BLADE W LIP MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7562420	SUP	HCPCS C1713		"7562420  -  SCREW, FIXED ANGLE, 4.0X20, SS"	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562425	SUP	HCPCS C1713		"7562425  -  SCREW, FIXED ANGLE, 4.0X25, SS"	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562430	SUP	HCPCS C1713		"7562430  -  SCREW, FIXED ANGLE, 4.0X30, SS"	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562435	SUP	HCPCS C1713		"7562435  -  SCREW, FIXED ANGLE, 4.0X35, SS"	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562440	SUP	HCPCS C1713		"7562440  -  SCREW, FIXED ANGLE, 4.0X40, SS"	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562445	SUP	HCPCS C1713		"7562445  -  SCREW, FIXED ANGLE, 4.0X45, SS"	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562450	SUP	HCPCS C1713		"7562450  -  SCREW, FIXED ANGLE, 4.0X50, SS"	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562455	SUP	HCPCS C1713		"7562455  -  SCREW, FIXED ANGLE, 4.0X55, SS"	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562520	SUP	HCPCS C1713		7562520  -  SCREW 7562520 FIXED ANGLE 5.0X20 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562525	SUP	HCPCS C1713		7562525  -  SCREW 7562525 FIXED ANGLE 5.0X25 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562530	SUP	HCPCS C1713		7562530  -  BONE SCREW 7562530 FIXED ANGLE 5X30 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562535	SUP	HCPCS C1713		7562535  -  SCREW 7562535 FIXED ANGLE 5.0X35 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562540	SUP	HCPCS C1713		7562540  -  SCREW 7562540 FIXED ANGLE 5.0X40 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562545	SUP	HCPCS C1713		7562545  -  SCREW 7562545 FIXED ANGLE 5.0X45 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562550	SUP	HCPCS C1713		7562550  -  SCREW 7562550 FIXED ANGLE 5.0X50 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562555	SUP	HCPCS C1713		7562555  -  SCREW 7562555 FIXED ANGLE 5.0X55 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562625	SUP	HCPCS C1713		7562625  -  SCREW 7562625 FIXED ANGLE 6.0X25 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562630	SUP	HCPCS C1713		7562630  -  SCREW 7562630 FIXED ANGLE 6.0X30 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562635	SUP	HCPCS C1713		7562635  -  SCREW 7562635 FIXED ANGLE 6.0X35 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562640	SUP	HCPCS C1713		7562640  -  SCREW 7562640 FIXED ANGLE 6.0X40 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562645	SUP	HCPCS C1713		7562645  -  SCREW 7562645 FIXED ANGLE 6.0X45 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562650	SUP	HCPCS C1713		7562650  -  SCREW 7562650 FIXED ANGLE 6.0X50 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562655	SUP	HCPCS C1713		7562655  -  SCREW 7562655 FIXED ANGLE 6.0X55 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7562660	SUP	HCPCS C1713		7562660  -  SCREW 7562660 FIXED ANGLE 6.0X60 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563420	SUP	HCPCS C1713		7563420  -  SCREW 7563420 FIXED ANGLE 4.5X20 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563425	SUP	HCPCS C1713		7563425  -  SCREW 7563425 FIXED ANGLE 4.5X25 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563430	SUP	HCPCS C1713		7563430  -  SCREW 7563430 FIXED ANGLE 4.5X30 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563435	SUP	HCPCS C1713		7563435  -  SCREW 7563435 FIXED ANGLE 4.5X35 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563440	SUP	HCPCS C1713		7563440  -  SCREW 7563440 FIXED ANGLE 4.5X40 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563445	SUP	HCPCS C1713		7563445  -  SCREW 7563445 FIXED ANGLE 4.5X45 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563450	SUP	HCPCS C1713		7563450  -  SCREW 7563450 FIXED ANGLE 4.5X50 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563455	SUP	HCPCS C1713		7563455  -  SCREW 7563455 FIXED ANGLE 4.5X55 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563525	SUP	HCPCS C1713		7563525  -  SCREW 7563525 FIXED ANGLE 5.5X25 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563530	SUP	HCPCS C1713		7563530  -  SCREW 7563530 FIXED ANGLE 5.5X30 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563535	SUP	HCPCS C1713		7563535  -  SCREW 7563535 FIXED ANGLE 5.5X35 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563540	SUP	HCPCS C1713		7563540  -  SCREW 7563540 FIXED ANGLE 5.5X40 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563545	SUP	HCPCS C1713		7563545  -  SCREW 7563545 FIXED ANGLE 5.5X45 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563550	SUP	HCPCS C1713		7563550  -  SCREW 7563550 FIXED ANGLE 5.5X50 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563555	SUP	HCPCS C1713		7563555  -  SCREW 7563555 FIXED ANGLE 5.5X55 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563560	SUP	HCPCS C1713		7563560  -  SCREW 7563560 FIXED ANGLE 5.5X60 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563625	SUP	HCPCS C1713		7563625  -  SCREW 7563625 FIXED ANGLE 6.5X25 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563630	SUP	HCPCS C1713		7563630  -  SCREW 7563630 FIXED ANGLE 6.5X30 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563635	SUP	HCPCS C1713		7563635  -  SCREW 7563635 FIXED ANGLE 6.5X35 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563640	SUP	HCPCS C1713		7563640  -  SCREW 7563640 FIXED ANGLE 6.5X40 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563645	SUP	HCPCS C1713		7563645  -  SCREW 7563645 FIXED ANGLE 6.5X45 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563650	SUP	HCPCS C1713		7563650  -  SCREW 7563650 FIXED ANGLE 6.5X50 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563655	SUP	HCPCS C1713		7563655  -  SCREW 7563655 FIXED ANGLE 6.5X55 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563660	SUP	HCPCS C1713		7563660  -  SCREW 7563660 FIXED ANGLE 6.5X60 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563725	SUP	HCPCS C1713		7563725  -  SCREW 7563725 FIXED ANGLE 7.5X25 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563730	SUP	HCPCS C1713		7563730  -  SCREW 7563730 FIXED ANGLE 7.5X30 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563735	SUP	HCPCS C1713		7563735  -  SCREW 7563735 FIXED ANGLE 7.5X35 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563740	SUP	HCPCS C1713		7563740  -  SCREW 7563740 FIXED ANGLE 7.5X40 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563745	SUP	HCPCS C1713		7563745  -  SCREW 7563745 FIXED ANGLE 7.5X45 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563750	SUP	HCPCS C1713		7563750  -  SCREW 7563750 FIXED ANGLE 7.5X50 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563755	SUP	HCPCS C1713		7563755  -  SCREW 7563755 FIXED ANGLE 7.5X55 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563760	SUP	HCPCS C1713		7563760  -  SCREW 7563760 FIXED ANGLE 7.5X60 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7563765	SUP	HCPCS C1713		7563765  -  SCREW 7563765 FIXED ANGLE 7.5X65 SS	BOTH IP/OP	"$2,036.15 "	"$1,506.75"	$0.00	"$1,628.92"	$916.27	$916.27	$0.00	$0.00	$0.00	$424.38	"$1,511.23"	"$1,511.23"	$0.00	$0.00	$424.33	$0.00	"$1,204.38"	"$1,204.38"	$0.00	"$1,018.08"	"$1,612.63"	"$1,628.92"	$0.00		$0.00	$318.66	$0.00	$0.00	$324.16	$0.00	$0.00	$0.00	$0.00	$0.00
7565025	SUP	HCPCS C1713		7565025  -  BOLT SPNL 6.5MM 25MM PLT	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7565030	SUP	HCPCS C1713		7565030  -  BOLT SPNL 6.5MM 30MM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7565035	SUP	HCPCS C1713		7565035  -  BOLT SPNL 6.5MM 35MM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7565040	SUP	HCPCS C1713		7565040  -  BOLT SPNL 6.5MM 40MM XLP	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7565045	SUP	HCPCS C1713		7565045  -  BOLT SPNL 6.5MM 45MM TI	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7565050	SUP	HCPCS C1713		7565050  -  BOLT SPNL 6.5MM 50MM TI	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7565055	SUP	HCPCS C1713		7565055  -  BOLT SPNL 6.5MM 55MM TI	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7565060	SUP	HCPCS C1713		7565060  -  BOLT SPNL 6.5MM 60MM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7565065	SUP	HCPCS C1713		7565065  -  BOLT SPNL 6.5MM 65MM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7570955	SUP	HCPCS C1713		7570955  -  SCREW SET CD HZN SXTNT II BRKOF SS SPNE PDCL ROD INS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7571030	SUP	HCPCS C1713		7571030  -  ROD 7571030 5.5MM STRAIGHT 30MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571035	SUP	HCPCS C1713		7571035  -  PLATE BN 35MM AFFIX II SPNE SPINOUS PRC	BOTH IP/OP	"$8,730.00 "	"$6,460.20"	$0.00	"$6,984.00"	"$3,928.50"	"$3,928.50"	$0.00	$0.00	$0.00	"$1,819.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,819.33"	$0.00	"$4,303.89"	"$4,303.89"	$0.00	"$4,365.00"	"$6,914.16"	"$6,984.00"	$0.00		$0.00	"$1,366.25"	$0.00	$0.00	"$1,389.82"	$0.00	$0.00	$0.00	$0.00	$0.00
7571040	SUP	HCPCS C1713		7571040  -  ROD 7571040 5.5MM STRAIGHT 40MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571045	SUP	HCPCS C1713		7571045  -  PLATE BN 45MM XLIF AFFIX XTRM SPNE	BOTH IP/OP	"$8,730.00 "	"$6,460.20"	$0.00	"$6,984.00"	"$3,928.50"	"$3,928.50"	$0.00	$0.00	$0.00	"$1,819.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,819.33"	$0.00	"$4,303.89"	"$4,303.89"	$0.00	"$4,365.00"	"$6,914.16"	"$6,984.00"	$0.00		$0.00	"$1,366.25"	$0.00	$0.00	"$1,389.82"	$0.00	$0.00	$0.00	$0.00	$0.00
7571050	SUP	HCPCS C1713		7571050  -  ROD 7571050 5.5MM STRAIGHT 50MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571055	SUP	HCPCS C1713		7571055  -  PLATE BN 55MM AFFIX II SPNE SPINOUS PRC	BOTH IP/OP	"$8,730.00 "	"$6,460.20"	$0.00	"$6,984.00"	"$3,928.50"	"$3,928.50"	$0.00	$0.00	$0.00	"$1,819.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,819.33"	$0.00	"$4,303.89"	"$4,303.89"	$0.00	"$4,365.00"	"$6,914.16"	"$6,984.00"	$0.00		$0.00	"$1,366.25"	$0.00	$0.00	"$1,389.82"	$0.00	$0.00	$0.00	$0.00	$0.00
7571060	SUP	HCPCS C1713		7571060  -  ROD 7571060 5.5MM STRAIGHT 60MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571070	SUP	HCPCS C1713		7571070  -  ROD 7571070 5.5MM STRAIGHT 70MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571080	SUP	HCPCS C1713		7571080  -  ROD 7571080 5.5MM STRAIGHT 80MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571090	SUP	HCPCS C1713		7571090  -  ROD 7571090 5.5MM STRAIGHT 90MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571100	SUP	HCPCS C1713		7571100  -  ROD 7571100 5.5MM STRAIGHT 100MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571110	SUP	HCPCS C1713		7571110  -  ROD 7571110 5.5MM STRAIGHT 110MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571120	SUP	HCPCS C1713		7571120  -  ROD 7571120 5.5MM STRAIGHT 120MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571130	SUP	HCPCS C1713		7571130  -  ROD 7571130 5.5MM STRAIGHT 130MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571140	SUP	HCPCS C1713		7571140  -  ROD 7571140 5.5MM STRAIGHT 140MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571150	SUP	HCPCS C1713		7571150  -  ROD 7571150 5.5MM STRAIGHT 150MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571160	SUP	HCPCS C1713		7571160  -  ROD 7571160 5.5MM STRAIGHT 160MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571170	SUP	HCPCS C1713		7571170  -  ROD 7571170 5.5MM STRAIGHT 170MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571180	SUP	HCPCS C1713		7571180  -  ROD 7571180 5.5MM STRAIGHT 180MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571190	SUP	HCPCS C1713		7571190  -  ROD 7571190 5.5MM STRAIGHT 190MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571200	SUP	HCPCS C1713		7571200  -  ROD 7571200 5.5MM STRAIGHT 200MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571210	SUP	HCPCS C1713		7571210  -  ROD 7571210 5.5MM STRAIGHT 210MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571220	SUP	HCPCS C1713		7571220  -  ROD 7571220 5.5MM STRAIGHT 220MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571230	SUP	HCPCS C1713		7571230  -  ROD 7571230 5.5MM STRAIGHT 230MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571240	SUP	HCPCS C1713		7571240  -  ROD 7571240 5.5MM STRAIGHT 240MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571250	SUP	HCPCS C1713		7571250  -  ROD 7571250 5.5MM STRAIGHT 250MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571260	SUP	HCPCS C1713		7571260  -  ROD 7571260 5.5MM STRAIGHT 260MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571270	SUP	HCPCS C1713		7571270  -  ROD 7571270 5.5MM STRAIGHT 270MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571280	SUP	HCPCS C1713		7571280  -  ROD 7571280 5.5MM STRAIGHT 280MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571290	SUP	HCPCS C1713		7571290  -  ROD 7571290 5.5MM STRAIGHT 290MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571300	SUP	HCPCS C1713		7571300  -  ROD 7571300 5.5MM STRAIGHT 300MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571310	SUP	HCPCS C1713		7571310  -  ROD 7571310 5.5MM STRAIGHT 310MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571320	SUP	HCPCS C1713		7571320  -  ROD 7571320 5.5MM STRAIGHT 320MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571330	SUP	HCPCS C1713		7571330  -  ROD 7571330 5.5MM STRAIGHT 330MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571340	SUP	HCPCS C1713		7571340  -  ROD 7571340 5.5MM STRAIGHT 340MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571350	SUP	HCPCS C1713		7571350  -  ROD 7571350 5.5MM STRAIGHT 350MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571360	SUP	HCPCS C1713		7571360  -  ROD 7571360 5.5MM STRAIGHT 360MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571370	SUP	HCPCS C1713		7571370  -  ROD 7571370 5.5MM STRAIGHT 370MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571380	SUP	HCPCS C1713		7571380  -  ROD 7571380 5.5MM STRAIGHT 380MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571390	SUP	HCPCS C1713		7571390  -  ROD 7571390 5.5MM STRAIGHT 390MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571400	SUP	HCPCS C1713		7571400  -  ROD 7571400 5.5MM STRAIGHT 400MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571410	SUP	HCPCS C1713		7571410  -  ROD 7571410 5.5MM STRAIGHT 410MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571420	SUP	HCPCS C1713		7571420  -  ROD 7571420 5.5MM STRAIGHT 420MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571430	SUP	HCPCS C1713		7571430  -  ROD 7571430 5.5MM STRAIGHT 430MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571440	SUP	HCPCS C1713		7571440  -  ROD 7571440 5.5MM STRAIGHT 440MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571450	SUP	HCPCS C1713		7571450  -  ROD 7571450 5.5MM STRAIGHT 450MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571460	SUP	HCPCS C1713		7571460  -  ROD 7571460 5.5MM STRAIGHT 460MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571470	SUP	HCPCS C1713		7571470  -  ROD 7571470 5.5MM STRAIGHT 470MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571480	SUP	HCPCS C1713		7571480  -  ROD 7571480 5.5MM STRAIGHT 480MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571490	SUP	HCPCS C1713		7571490  -  ROD 7571490 5.5MM STRAIGHT 490MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7571500	SUP	HCPCS C1713		7571500  -  ROD 7571500 5.5MM STRAIGHT 500MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7575535	SUP	HCPCS C1713		7575535  -  SCREW BN 5.5MM 35MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7575540	SUP	HCPCS C1713		7575540  -  SCREW BN 5.5MM 40MM CD HZN LGC MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7575545	SUP	HCPCS C1713		7575545  -  SCREW BN 5.5MM 45MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7575550	SUP	HCPCS C1713		7575550  -  SCREW BN 5.5MM 50MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7576309	SUP	Custom 27203010		7576309  -  INSTRUMENT 7576309 TALL REDUX NUT DR	BOTH IP/OP	$726.00 	$537.24	$0.00	$580.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$538.84	$538.84	$0.00	$0.00	$151.30	$0.00	$0.00	$0.00	$0.00	$363.00	$574.99	$580.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7576535	SUP	HCPCS C1713		7576535  -  SCREW BN 6.5MM 35MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7576540	SUP	HCPCS C1713		7576540  -  SCREW BN 6.5MM 40MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7576545	SUP	HCPCS C1713		7576545  -  SCREW BN 6.5MM 45MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7576550	SUP	HCPCS C1713		7576550  -  SCREW BN 6.5MM 50MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7576555	SUP	HCPCS C1713		7576555  -  SCREW BN 6.5MM 55MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7577025	SUP	HCPCS C1713		7577025  -  PLATE BN MN 25MM NS AFFIX II SPNE LMBR	BOTH IP/OP	"$9,162.50 "	"$6,780.25"	$0.00	"$7,330.00"	"$4,123.13"	"$4,123.13"	$0.00	$0.00	$0.00	"$1,909.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,909.47"	$0.00	"$4,517.11"	"$4,517.11"	$0.00	"$4,581.25"	"$7,256.70"	"$7,330.00"	$0.00		$0.00	"$1,433.93"	$0.00	$0.00	"$1,458.67"	$0.00	$0.00	$0.00	$0.00	$0.00
7577035	SUP	HCPCS C1713		7577035  -  PLATE BN 35MM NS AFFIX II SPNE LMBR	BOTH IP/OP	"$9,162.50 "	"$6,780.25"	$0.00	"$7,330.00"	"$4,123.13"	"$4,123.13"	$0.00	$0.00	$0.00	"$1,909.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,909.47"	$0.00	"$4,517.11"	"$4,517.11"	$0.00	"$4,581.25"	"$7,256.70"	"$7,330.00"	$0.00		$0.00	"$1,433.93"	$0.00	$0.00	"$1,458.67"	$0.00	$0.00	$0.00	$0.00	$0.00
7577045	SUP	HCPCS C1713		7577045  -  PLATE BN 45MM NS AFFIX II SPNE LMBR	BOTH IP/OP	"$9,162.50 "	"$6,780.25"	$0.00	"$7,330.00"	"$4,123.13"	"$4,123.13"	$0.00	$0.00	$0.00	"$1,909.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,909.47"	$0.00	"$4,517.11"	"$4,517.11"	$0.00	"$4,581.25"	"$7,256.70"	"$7,330.00"	$0.00		$0.00	"$1,433.93"	$0.00	$0.00	"$1,458.67"	$0.00	$0.00	$0.00	$0.00	$0.00
7577055	SUP	HCPCS C1713		7577055  -  PLATE BN 55MM NS AFFIX II SPNE LMBR	BOTH IP/OP	"$9,162.50 "	"$6,780.25"	$0.00	"$7,330.00"	"$4,123.13"	"$4,123.13"	$0.00	$0.00	$0.00	"$1,909.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,909.47"	$0.00	"$4,517.11"	"$4,517.11"	$0.00	"$4,581.25"	"$7,256.70"	"$7,330.00"	$0.00		$0.00	"$1,433.93"	$0.00	$0.00	"$1,458.67"	$0.00	$0.00	$0.00	$0.00	$0.00
7577530	SUP	HCPCS C1713		7577530  -  SCREW BN 7.5MM 30MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7577535	SUP	HCPCS C1713		7577535  -  SCREW BN 7.5MM 35MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7577540	SUP	HCPCS C1713		7577540  -  SCREW BN 7.5MM 40MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7577545	SUP	HCPCS C1713		7577545  -  SCREW BN 7.5MM 45MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$6,185.00 "	"$4,576.90"	$0.00	"$4,948.00"	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$0.00	"$1,289.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,288.95"	$0.00	"$3,049.21"	"$3,049.21"	$0.00	"$3,092.50"	"$4,898.52"	"$4,948.00"	$0.00		$0.00	$967.95	$0.00	$0.00	$984.65	$0.00	$0.00	$0.00	$0.00	$0.00
7600320	SUP	HCPCS C1713		7600320  -  SUB BNGFT CALCIUM PHOS CLGN 20ML MS GRFT VOID FILR MTRX	BOTH IP/OP	"$3,575.00 "	"$2,645.50"	$0.00	"$2,860.00"	"$1,608.75"	"$1,608.75"	$0.00	$0.00	$0.00	$745.12	"$2,653.37"	"$2,653.37"	$0.00	$0.00	$745.03	$0.00	"$1,762.48"	"$1,762.48"	$0.00	"$1,787.50"	"$2,831.40"	"$2,860.00"	$0.00		$0.00	$559.49	$0.00	$0.00	$569.14	$0.00	$0.00	$0.00	$0.00	$0.00
7640120	SUP	HCPCS C1713		7640120  -  SET SCREW 7640120 NON BREAK OFF  TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7640220	SUP	HCPCS C1713		7640220  -  SET SCREW 7640220 REDUCTION PLUG  TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7641102	SUP	HCPCS C1713		7641102  -  HOOK 7641102 L6.35 PEDICLE SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641103	SUP	HCPCS C1713		7641103  -  HOOK 7641103 L6.35 PEDICLE MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641104	SUP	HCPCS C1713		7641104  -  HOOK 7641104 L6.35 PEDICLE LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641112	SUP	HCPCS C1713		7641112  -  HOOK 7641112 L6.35 WIDE BLADE SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641113	SUP	HCPCS C1713		7641113  -  HOOK 7641113 L6.35 WIDE BLADE MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641114	SUP	HCPCS C1713		7641114  -  HOOK 7641114 L6.35 WIDE BLADE LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641122	SUP	HCPCS C1713		7641122  -  HOOK 7641122 L6.35 NARRW BLDE SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641123	SUP	HCPCS C1713		7641123  -  HOOK 7641123 L6.35 NARRW BLDE MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641124	SUP	HCPCS C1713		7641124  -  HOOK 7641124 L6.35 NARRW BLDE LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641133	SUP	HCPCS C1713		7641133  -  HOOK 7641133 RAMP WIDE BLADE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641142	SUP	HCPCS C1713		7641142  -  HOOK 7641142 RAMP NARROW BLADE SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641143	SUP	HCPCS C1713		7641143  -  HOOK 7641143 RAMP NARROW BLADE MED TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641162	SUP	HCPCS C1713		7641162  -  HOOK 7641162 LUMBAR ANG BLADE SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641163	SUP	HCPCS C1713		7641163  -  HOOK 7641163 LUMBAR ANG BLADE MED TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641173	SUP	HCPCS C1713		7641173  -  HOOK 7641173 EXTENDED BODY MED TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641174	SUP	HCPCS C1713		7641174  -  HOOK 7641174 EXTENDED BODY LARGE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641188	SUP	HCPCS C1713		7641188  -  HOOK 7641188 THORACIC ANG BLADE RT TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641189	SUP	HCPCS C1713		7641189  -  HOOK 7641189 THORACIC ANG BLADE LT TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641198	SUP	HCPCS C1713		7641198  -  HOOK 7641198 OFFSET RIGHT TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641199	SUP	HCPCS C1713		7641199  -  HOOK 7641199 OFFSET LEFT TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641202	SUP	HCPCS C1713		7641202  -  HOOK 7641202 PEDICLE WITH LIP SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641203	SUP	HCPCS C1713		7641203  -  HOOK 7641203 PEDICLE WITH LIP MED TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641204	SUP	HCPCS C1713		7641204  -  HOOK 7641204 PEDICLE WITH LIP LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641212	SUP	HCPCS C1713		7641212  -  HOOK 7641212 WIDE BLADE W SHELF SM T	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641213	SUP	HCPCS C1713		7641213  -  HOOK 7641213 WIDE BLADE W SHELF MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641214	SUP	HCPCS C1713		7641214  -  HOOK 7641214 WIDE BLADE W SHELF LG TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641222	SUP	HCPCS C1713		7641222  -  HOOK 7641222 NARROW BLADE W SHELF SM TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641223	SUP	HCPCS C1713		7641223  -  HOOK 7641223 NARROW BLADE W SHELF MD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7641224	SUP	HCPCS C1713		7641224  -  HOOK 7641224 NARROW BLADE W SHELF LG T	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7642420	SUP	HCPCS C1713		"7642420  -  SCREW, FIXED ANGLE, 4.0X20, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642425	SUP	HCPCS C1713		"7642425  -  SCREW, FIXED ANGLE, 4.0X25, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642430	SUP	HCPCS C1713		"7642430  -  SCREW, FIXED ANGLE, 4.0X30, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642435	SUP	HCPCS C1713		"7642435  -  SCREW, FIXED ANGLE, 4.0X35, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642440	SUP	HCPCS C1713		"7642440  -  SCREW, FIXED ANGLE, 4.0X40, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642445	SUP	HCPCS C1713		"7642445  -  SCREW, FIXED ANGLE, 4.0X45, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642450	SUP	HCPCS C1713		"7642450  -  SCREW, FIXED ANGLE, 4.0X50, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642455	SUP	HCPCS C1713		"7642455  -  SCREW, FIXED ANGLE, 4.0X55, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642520	SUP	HCPCS C1713		"7642520  -  SCREW, FIXED ANGLE, 5.0X20, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642525	SUP	HCPCS C1713		"7642525  -  SCREW, FIXED ANGLE, 5.0X25, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642530	SUP	HCPCS C1713		"7642530  -  SCREW, FIXED ANGLE, 5.0X30, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642535	SUP	HCPCS C1713		"7642535  -  SCREW, FIXED ANGLE, 5.0X35, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642540	SUP	HCPCS C1713		"7642540  -  SCREW, FIXED ANGLE, 5.0X40, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642545	SUP	HCPCS C1713		"7642545  -  SCREW, FIXED ANGLE, 5.0X45, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642550	SUP	HCPCS C1713		"7642550  -  SCREW, FIXED ANGLE, 5.0X50, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642555	SUP	HCPCS C1713		7642555  -  FIXED ANGLE 5.0X55 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642625	SUP	HCPCS C1713		"7642625  -  SCREW, FIXED ANGLE, 6.0X25, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642630	SUP	HCPCS C1713		"7642630  -  SCREW, FIXED ANGLE, 6.0X30, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642635	SUP	HCPCS C1713		"7642635  -  SCREW, FIXED ANGLE, 6.0X35, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642640	SUP	HCPCS C1713		"7642640  -  SCREW, FIXED ANGLE, 6.0X40, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642645	SUP	HCPCS C1713		"7642645  -  SCREW, FIXED ANGLE, 6.0X45, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642650	SUP	HCPCS C1713		"7642650  -  SCREW, FIXED ANGLE, 6.0X50, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642655	SUP	HCPCS C1713		"7642655  -  SCREW, FIXED ANGLE, 6.0X55, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7642660	SUP	HCPCS C1713		"7642660  -  SCREW, FIXED ANGLE, 6.0X60, TI"	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643420	SUP	HCPCS C1713		7643420  -  BONE SCREW 7643420 FXD ANGLE 4.5X20 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643425	SUP	HCPCS C1713		7643425  -  BONE SCREW 7643425 FXD ANGLE 4.5X25 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643430	SUP	HCPCS C1713		7643430  -  BONE SCREW 7643430 FXD ANGLE 4.5X30 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643435	SUP	HCPCS C1713		7643435  -  BONE SCREW 7643435 FXD ANGLE 4.5X35 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643440	SUP	HCPCS C1713		7643440  -  BONE SCREW 7643440 FXD ANGLE 4.5X40 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643445	SUP	HCPCS C1713		7643445  -  BONE SCREW 7643445 FXD ANGLE 4.5X45 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643450	SUP	HCPCS C1713		7643450  -  BONE SCREW 7643450 FXD ANGLE 4.5X50 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643455	SUP	HCPCS C1713		7643455  -  BONE SCREW 7643455 FXD ANGLE 4.5X55 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643525	SUP	HCPCS C1713		7643525  -  BONE SCREW 7643525 FXD ANGLE 5.5X25 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643530	SUP	HCPCS C1713		7643530  -  BONE SCREW 7643530 FXD ANGLE 5.5X30 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643535	SUP	HCPCS C1713		7643535  -  BONE SCREW 7643535 FXD ANGLE 5.5X35 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643540	SUP	HCPCS C1713		7643540  -  BONE SCREW 7643540 FXD ANGLE 5.5X40 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643545	SUP	HCPCS C1713		7643545  -  BONE SCREW 7643545 FXD ANGLE 5.5X45 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643550	SUP	HCPCS C1713		7643550  -  BONE SCREW 7643550 FXD ANGLE 5.5X50 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643555	SUP	HCPCS C1713		7643555  -  BONE SCREW 7643555 FXD ANGLE 5.5X55 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643560	SUP	HCPCS C1713		7643560  -  BONE SCREW 7643560 FXD ANGLE 5.5X60 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643625	SUP	HCPCS C1713		7643625  -  SCREW 7643625 FIXED ANGLE 6.5X25 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643630	SUP	HCPCS C1713		7643630  -  SCREW 7643630 FIXED ANGLE 6.5X30 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643635	SUP	HCPCS C1713		7643635  -  BONE SCREW 7643635 FXD ANGLE 6.5X35 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643640	SUP	HCPCS C1713		7643640  -  BONE SCREW 7643640 FXD ANGLE 6.5X40 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643645	SUP	HCPCS C1713		7643645  -  BONE SCREW 7643645 FXD ANGLE 6.5X45 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643650	SUP	HCPCS C1713		7643650  -  BONE SCREW 7643650 FXD ANGLE 6.5X50 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643655	SUP	HCPCS C1713		7643655  -  BONE SCREW 7643655 FXD ANGLE 6.5X55 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643660	SUP	HCPCS C1713		7643660  -  BONE SCREW 7643660 FXD ANGLE 6.5X60 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643665	SUP	HCPCS C1713		7643665  -  BONE SCREW 7643665 FXD ANGLE 6.5X65 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643670	SUP	HCPCS C1713		7643670  -  BONE SCREW 7643670 FXD ANGLE 6.5X70 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643725	SUP	HCPCS C1713		7643725  -  BONE SCREW 7643725 FXD ANGLE 7.5X25 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643730	SUP	HCPCS C1713		7643730  -  BONE SCREW 7643730 FXD ANGLE 7.5X30 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643735	SUP	HCPCS C1713		7643735  -  BONE SCREW 7643735 FXD ANGLE 7.5X35 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643740	SUP	HCPCS C1713		7643740  -  BONE SCREW 7643740 FXD ANGLE 7.5X40 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643745	SUP	HCPCS C1713		7643745  -  BONE SCREW 7643745 FXD ANGLE 7.5X45 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643750	SUP	HCPCS C1713		7643750  -  BONE SCREW 7643750 FXD ANGLE 7.5X50 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643755	SUP	HCPCS C1713		7643755  -  BONE SCREW 7643755 FXD ANGLE 7.5X55 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643760	SUP	HCPCS C1713		7643760  -  BONE SCREW 7643760 FXD ANGLE 7.5X60 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7643765	SUP	HCPCS C1713		7643765  -  BONE SCREW 7643765 FXD ANGLE 7.5X65 TI	BOTH IP/OP	"$1,933.50 "	"$1,430.79"	$0.00	"$1,546.80"	$870.08	$870.08	$0.00	$0.00	$0.00	$402.99	"$1,435.04"	"$1,435.04"	$0.00	$0.00	$402.94	$0.00	"$1,143.67"	"$1,143.67"	$0.00	$966.75	"$1,531.33"	"$1,546.80"	$0.00		$0.00	$302.59	$0.00	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00
7650008	SUP	HCPCS C1713		7650008  -  PLATE BONE SMALL 8MM TRADITIONAL SPN CERV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650009	SUP	HCPCS C1713		7650009  -  PLATE BONE MEDIUM 9.5MM TRADITIONAL SPN CERV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650011	SUP	HCPCS C1713		7650011  -  PLATE BONE LARGE 11MM TRADITIONAL SPN CERV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650012	SUP	HCPCS C1713		7650012  -  PLATE BN XL 12.5MM NS LVRG TRD SPNE CRV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650108	SUP	HCPCS C1713		7650108  -  PLATE BN SM 8MM NS LVRG TRD SPNE CRV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650109	SUP	HCPCS C1713		7650109  -  PLATE MED 9.5MM TRD BONE SPN CERV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650111	SUP	HCPCS C1713		7650111  -  PLATE BN LG 11MM NS LVRG TRD SPNE CRV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650112	SUP	HCPCS C1713		7650112  -  PLATE BN XL 12.5MM NS LVRG TRD SPNE CRV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650208	SUP	HCPCS C1713		7650208  -  PLATE BONE SMALL 8MM GRAFT SPN CERV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650209	SUP	HCPCS C1713		7650209  -  PLATE BONE MEDIUM 9.5MM GRAFT SPN CERV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650211	SUP	HCPCS C1713		7650211  -  PLATE BN LG 11MM NS LVRG GFT SPNE CRV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650212	SUP	HCPCS C1713		7650212  -  PLATE BN XL 12.5MM GFT SPNE CRV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650308	SUP	HCPCS C1713		7650308  -  PLATE BN SM 8MM NS LVRG GFT SPNE CRV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650309	SUP	HCPCS C1713		7650309  -  PLATE BN MED 9.5MM NS LVRG GFT SPNE CRV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650311	SUP	HCPCS C1713		7650311  -  PLATE BN LG 11MM NS LVRG GFT SPNE CRV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650312	SUP	HCPCS C1713		7650312  -  PLATE BN XL 12.5MM NS LVRG GFT SPNE CRV	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650408	SUP	HCPCS C1713		7650408  -  PLATE BN SM 8MM NS LVRG SPNE CRV LMN	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650409	SUP	HCPCS C1713		7650409  -  PLATE BN MED 9.5MM NS LVRG SPNE CRV LMN	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650411	SUP	HCPCS C1713		7650411  -  PLATE BN LG 11MM NS LVRG SPNE CRV LMN	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650412	SUP	HCPCS C1713		7650412  -  PLATE BN XL 12.5MM NS LVRG SPNE CRV LMN	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
7650505	SUP	HCPCS C1713		7650505  -  SCREW BONE 2.6MM 5MM LATERAL MASS CERV	BOTH IP/OP	$410.00 	$303.40	$0.00	$328.00	$184.50	$184.50	$0.00	$0.00	$0.00	$85.45	$304.30	$304.30	$0.00	$0.00	$85.44	$0.00	$242.52	$242.52	$0.00	$205.00	$324.72	$328.00	$0.00		$0.00	$64.17	$0.00	$0.00	$65.27	$0.00	$0.00	$0.00	$0.00	$0.00
7650506	SUP	HCPCS C1713		7650506  -  SCREW BONE 2.6MM 6MM LATERAL MASS SPN CERV	BOTH IP/OP	$410.00 	$303.40	$0.00	$328.00	$184.50	$184.50	$0.00	$0.00	$0.00	$85.45	$304.30	$304.30	$0.00	$0.00	$85.44	$0.00	$242.52	$242.52	$0.00	$205.00	$324.72	$328.00	$0.00		$0.00	$64.17	$0.00	$0.00	$65.27	$0.00	$0.00	$0.00	$0.00	$0.00
7650507	SUP	HCPCS C1713		7650507  -  SCREW BONE 2.6MM 7MM LATERAL MASS SPN CERV	BOTH IP/OP	$410.00 	$303.40	$0.00	$328.00	$184.50	$184.50	$0.00	$0.00	$0.00	$85.45	$304.30	$304.30	$0.00	$0.00	$85.44	$0.00	$242.52	$242.52	$0.00	$205.00	$324.72	$328.00	$0.00		$0.00	$64.17	$0.00	$0.00	$65.27	$0.00	$0.00	$0.00	$0.00	$0.00
7650508	SUP	HCPCS C1713		"7650508  -  LATERAL MASS SCREW, 2.6X8MM"	BOTH IP/OP	$410.00 	$303.40	$0.00	$328.00	$184.50	$184.50	$0.00	$0.00	$0.00	$85.45	$304.30	$304.30	$0.00	$0.00	$85.44	$0.00	$242.52	$242.52	$0.00	$205.00	$324.72	$328.00	$0.00		$0.00	$64.17	$0.00	$0.00	$65.27	$0.00	$0.00	$0.00	$0.00	$0.00
7650605	SUP	HCPCS C1713		7650605  -  SCREW BONE 3MM 5MM LATERAL MASS CERV	BOTH IP/OP	$410.00 	$303.40	$0.00	$328.00	$184.50	$184.50	$0.00	$0.00	$0.00	$85.45	$304.30	$304.30	$0.00	$0.00	$85.44	$0.00	$242.52	$242.52	$0.00	$205.00	$324.72	$328.00	$0.00		$0.00	$64.17	$0.00	$0.00	$65.27	$0.00	$0.00	$0.00	$0.00	$0.00
7650607	SUP	HCPCS C1713		7650607  -  SCREW BONE 3MM 7MM LATERAL MASS SPN CERV	BOTH IP/OP	$410.00 	$303.40	$0.00	$328.00	$184.50	$184.50	$0.00	$0.00	$0.00	$85.45	$304.30	$304.30	$0.00	$0.00	$85.44	$0.00	$242.52	$242.52	$0.00	$205.00	$324.72	$328.00	$0.00		$0.00	$64.17	$0.00	$0.00	$65.27	$0.00	$0.00	$0.00	$0.00	$0.00
7650608	SUP	HCPCS C1713		7650608  -  SCREW BN 3MM 8MM NS LVRG LAT MASS SPNE CRV	BOTH IP/OP	$410.00 	$303.40	$0.00	$328.00	$184.50	$184.50	$0.00	$0.00	$0.00	$85.45	$304.30	$304.30	$0.00	$0.00	$85.44	$0.00	$242.52	$242.52	$0.00	$205.00	$324.72	$328.00	$0.00		$0.00	$64.17	$0.00	$0.00	$65.27	$0.00	$0.00	$0.00	$0.00	$0.00
7650705	SUP	HCPCS C1713		7650705  -  SCREW BONE 2.6MM 5MM SPN CERV LAMINA	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$258.75	$258.75	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$287.50	$455.40	$460.00	$0.00		$0.00	$89.99	$0.00	$0.00	$91.54	$0.00	$0.00	$0.00	$0.00	$0.00
7650753	SUP	Custom 27203010		7650753  -  BIT DRILL 3MM SHAFT SPN DISPOSABLE	BOTH IP/OP	$615.00 	$455.10	$0.00	$492.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$456.45	$456.45	$0.00	$0.00	$128.17	$0.00	$0.00	$0.00	$0.00	$307.50	$487.08	$492.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7650755	SUP	Custom 27203010		7650755  -  BIT DRILL 5MM SHAFT SPN DISPOSABLE	BOTH IP/OP	$615.00 	$455.10	$0.00	$492.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$456.45	$456.45	$0.00	$0.00	$128.17	$0.00	$0.00	$0.00	$0.00	$307.50	$487.08	$492.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7650756	SUP	Custom 27203010		7650756  -  BIT DRILL 6MM SHAFT SPN DISPOSABLE	BOTH IP/OP	$615.00 	$455.10	$0.00	$492.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$456.45	$456.45	$0.00	$0.00	$128.17	$0.00	$0.00	$0.00	$0.00	$307.50	$487.08	$492.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7650757	SUP	Custom 27203010		7650757  -  BIT DRILL 7MM SHAFT DISPOSABLE LVG LFS	BOTH IP/OP	$615.00 	$455.10	$0.00	$492.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$456.45	$456.45	$0.00	$0.00	$128.17	$0.00	$0.00	$0.00	$0.00	$307.50	$487.08	$492.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7650758	SUP	Custom 27203010		"7650758  -  LAMINOPLASTY DRILL BIT, 8MM"	BOTH IP/OP	$615.00 	$455.10	$0.00	$492.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$456.45	$456.45	$0.00	$0.00	$128.17	$0.00	$0.00	$0.00	$0.00	$307.50	$487.08	$492.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7650805	SUP	HCPCS C1713		7650805  -  SCREW BONE 3MM 5MM LAMINA CERV SPN	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$258.75	$258.75	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$287.50	$455.40	$460.00	$0.00		$0.00	$89.99	$0.00	$0.00	$91.54	$0.00	$0.00	$0.00	$0.00	$0.00
7650811	SUP	HCPCS C1713		7650811  -  CAGE SPNL 11MM ALGRF XLIF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7650812	SUP	HCPCS C1713		7650812  -  CAGE SPNL 12.5MM ALGRF XLIF	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7660020	SUP	HCPCS C1713		7660020  -  SET SCREW 7660020 BREAK OFF  SS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7660120	SUP	HCPCS C1713		7660120  -  SET SCREW 7660120 NON BREAK OFF  SS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7660220	SUP	HCPCS C1713		7660220  -  SET SCREW 7660220 REDUCTION PLUG  SS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7661102	SUP	HCPCS C1713		7661102  -  HOOK 7661102 PEDICLE SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661103	SUP	HCPCS C1713		7661103  -  HOOK 7661103 PEDICLE MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661104	SUP	HCPCS C1713		7661104  -  HOOK 7661104 PEDICLE LG SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661112	SUP	HCPCS C1713		7661112  -  HOOK 7661112 WIDE BLADE SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661113	SUP	HCPCS C1713		7661113  -  HOOK 7661113 WIDE BLADE MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661114	SUP	HCPCS C1713		7661114  -  HOOK 7661114 WIDE BLADE LG SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661122	SUP	HCPCS C1713		7661122  -  HOOK 7661122 NARROW BLADE SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661123	SUP	HCPCS C1713		7661123  -  HOOK 7661123 NARROW BLADE MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661124	SUP	HCPCS C1713		7661124  -  HOOK 7661124 NARROW BLADE LG SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661133	SUP	HCPCS C1713		7661133  -  HOOK 7661133 RAMP WIDE BLADE MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661142	SUP	HCPCS C1713		7661142  -  HOOK 7661142 RAMP NARROW BLADE SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661143	SUP	HCPCS C1713		7661143  -  HOOK 7661143 RAMP NARROW BLADE MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661162	SUP	HCPCS C1713		7661162  -  HOOK 7661162 LUMBAR ANG BLADE SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661163	SUP	HCPCS C1713		7661163  -  HOOK 7661163 LUMBAR ANG BLADE MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661173	SUP	HCPCS C1713		7661173  -  HOOK 7661173 EXTENDED BODY MD SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661174	SUP	HCPCS C1713		7661174  -  HOOK 7661174 EXTENDED BODY LG SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661188	SUP	HCPCS C1713		7661188  -  HOOK 7661188 THORACIC ANG BLADE RT SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661189	SUP	HCPCS C1713		7661189  -  HOOK 7661189 THORACIC ANG BLADE LT SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661198	SUP	HCPCS C1713		7661198  -  HOOK 7661198 OFFSET RT SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661199	SUP	HCPCS C1713		7661199  -  HOOK 7661199 OFFSET LT SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661202	SUP	HCPCS C1713		7661202  -  HOOK 7661202 PEDICLE WITH LIP SM SS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661203	SUP	HCPCS C1713		"7661203  -  HOOK, PEDICLE WITH LIP, MD,SS"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661204	SUP	HCPCS C1713		"7661204  -  HOOK, PEDICLE WITH LIP, LG,SS"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661212	SUP	HCPCS C1713		"7661212  -  HOOK, WIDE BLADE W/LIP,SM,SS"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661213	SUP	HCPCS C1713		"7661213  -  HOOK, WIDE BLADE W/LIP,MD,SS"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661214	SUP	HCPCS C1713		"7661214  -  HOOK, WIDE BLADE W/LIP,LG,SS"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661222	SUP	HCPCS C1713		"7661222  -  HOOK, NARROW BLADE W/LIP,SM,SS"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661223	SUP	HCPCS C1713		"7661223  -  HOOK, NARROW BLADE W/LIP,MD,SS"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7661224	SUP	HCPCS C1713		"7661224  -  HOOK, NARROW BLADE W/LIP,LG,SS"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7662420	SUP	HCPCS C1713		"7662420  -  SCREW, FIXED ANGLE, 4.0X20, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662425	SUP	HCPCS C1713		"7662425  -  SCREW, FIXED ANGLE, 4.0X25, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662430	SUP	HCPCS C1713		"7662430  -  SCREW, FIXED ANGLE, 4.0X30, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662435	SUP	HCPCS C1713		"7662435  -  SCREW, FIXED ANGLE, 4.0X35, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662440	SUP	HCPCS C1713		"7662440  -  SCREW, FIXED ANGLE, 4.0X40, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662445	SUP	HCPCS C1713		"7662445  -  SCREW, FIXED ANGLE, 4.0X45, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662450	SUP	HCPCS C1713		"7662450  -  SCREW, FIXED ANGLE, 4.0X50, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662455	SUP	HCPCS C1713		"7662455  -  SCREW, FIXED ANGLE, 4.0X55, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662520	SUP	HCPCS C1713		"7662520  -  SCREW, FIXED ANGLE, 5.0X20, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662525	SUP	HCPCS C1713		"7662525  -  SCREW, FIXED ANGLE, 5.0X25, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662530	SUP	HCPCS C1713		"7662530  -  SCREW, FIXED ANGLE, 5.0X30, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662535	SUP	HCPCS C1713		"7662535  -  SCREW, FIXED ANGLE, 5.0X35, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662540	SUP	HCPCS C1713		"7662540  -  SCREW, FIXED ANGLE, 5.0X40, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662545	SUP	HCPCS C1713		"7662545  -  SCREW, FIXED ANGLE, 5.0X45, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662550	SUP	HCPCS C1713		"7662550  -  SCREW, FIXED ANGLE, 5.0X50, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662555	SUP	HCPCS C1713		"7662555  -  SCREW, FIXED ANGLE, 5.0X55, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662625	SUP	HCPCS C1713		"7662625  -  SCREW, FIXED ANGLE, 6.0X25, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662630	SUP	HCPCS C1713		"7662630  -  SCREW, FIXED ANGLE, 6.0X30, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662635	SUP	HCPCS C1713		"7662635  -  SCREW, FIXED ANGLE, 6.0X35, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662640	SUP	HCPCS C1713		"7662640  -  SCREW, FIXED ANGLE, 6.0X40, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662645	SUP	HCPCS C1713		"7662645  -  SCREW, FIXED ANGLE, 6.0X45, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662650	SUP	HCPCS C1713		"7662650  -  SCREW, FIXED ANGLE, 6.0X50, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662655	SUP	HCPCS C1713		"7662655  -  SCREW, FIXED ANGLE, 6.0X55, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7662660	SUP	HCPCS C1713		"7662660  -  SCREW, FIXED ANGLE, 6.0X60, SS"	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663420	SUP	HCPCS C1713		7663420  -  SCREW 7663420 FIXED ANGLE 4.5X20 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663425	SUP	HCPCS C1713		7663425  -  SCREW 7663425 FIXED ANGLE 4.5X25 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663430	SUP	HCPCS C1713		7663430  -  SCREW 7663430 FIXED ANGLE 4.5X30 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663435	SUP	HCPCS C1713		7663435  -  SCREW 7663435 FIXED ANGLE 4.5X35 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663440	SUP	HCPCS C1713		7663440  -  SCREW 7663440 FIXED ANGLE 4.5X40 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663445	SUP	HCPCS C1713		7663445  -  SCREW 7663445 FIXED ANGLE 4.5X45 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663450	SUP	HCPCS C1713		7663450  -  SCREW 7663450 FIXED ANGLE 4.5X50 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663455	SUP	HCPCS C1713		7663455  -  SCREW 7663455 FIXED ANGLE 4.5X55 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663525	SUP	HCPCS C1713		7663525  -  SCREW 7663525 FIXED ANGLE 5.5X25 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663530	SUP	HCPCS C1713		7663530  -  SCREW 7663530 FIXED ANGLE 5.5X30 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663535	SUP	HCPCS C1713		7663535  -  SCREW 7663535 FIXED ANGLE 5.5X35 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663540	SUP	HCPCS C1713		7663540  -  SCREW 7663540 FIXED ANGLE 5.5X40 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663545	SUP	HCPCS C1713		7663545  -  SCREW 7663545 FIXED ANGLE 5.5X45 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663550	SUP	HCPCS C1713		7663550  -  SCREW 7663550 FIXED ANGLE 5.5X50 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663555	SUP	HCPCS C1713		7663555  -  SCREW 7663555 FIXED ANGLE 5.5X55 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663560	SUP	HCPCS C1713		7663560  -  SCREW 7663560 FIXED ANGLE 5.5X60 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663625	SUP	HCPCS C1713		7663625  -  SCREW 7663625 FIXED ANGLE 6.5X25 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663630	SUP	HCPCS C1713		7663630  -  SCREW 7663630 FIXED ANGLE 6.5X30 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663635	SUP	HCPCS C1713		7663635  -  SCREW 7663635 FIXED ANGLE 6.5X35 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663640	SUP	HCPCS C1713		7663640  -  SCREW 7663640 FIXED ANGLE 6.5X40 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663645	SUP	HCPCS C1713		7663645  -  SCREW 7663645 FIXED ANGLE 6.5X45 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663650	SUP	HCPCS C1713		7663650  -  SCREW 7663650 FIXED ANGLE 6.5X50 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663655	SUP	HCPCS C1713		7663655  -  BONE SCREW 7663655 FIXED ANGLE 6.5X55 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663660	SUP	HCPCS C1713		7663660  -  SCREW 7663660 FIXED ANGLE 6.5X60 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663665	SUP	HCPCS C1713		7663665  -  SCREW 7663665 FIXED ANGLE 6.5X65 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663670	SUP	HCPCS C1713		7663670  -  SCREW 7663670 FIXED ANGLE 6.5X70 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663725	SUP	HCPCS C1713		7663725  -  SCREW 7663725 FIXED ANGLE 7.5X25 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663730	SUP	HCPCS C1713		7663730  -  SCREW 7663730 FIXED ANGLE 7.5X30 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663735	SUP	HCPCS C1713		7663735  -  SCREW 7663735 FIXED ANGLE 7.5X35 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663740	SUP	HCPCS C1713		7663740  -  SCREW 7663740 FIXED ANGLE 7.5X40 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663745	SUP	HCPCS C1713		7663745  -  SCREW 7663745 FIXED ANGLE 7.5X45 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663750	SUP	HCPCS C1713		7663750  -  SCREW 7663750 FIXED ANGLE 7.5X50 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663755	SUP	HCPCS C1713		7663755  -  SCREW 7663755 FIXED ANGLE 7.5X55 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663760	SUP	HCPCS C1713		7663760  -  SCREW 7663760 FIXED ANGLE 7.5X60 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7663765	SUP	HCPCS C1713		7663765  -  SCREW 7663765 FIXED ANGLE 7.5X65 SS	BOTH IP/OP	"$1,762.50 "	"$1,304.25"	$0.00	"$1,410.00"	$793.13	$793.13	$0.00	$0.00	$0.00	$367.35	"$1,308.13"	"$1,308.13"	$0.00	$0.00	$367.31	$0.00	"$1,042.52"	"$1,042.52"	$0.00	$881.25	"$1,395.90"	"$1,410.00"	$0.00		$0.00	$275.83	$0.00	$0.00	$280.59	$0.00	$0.00	$0.00	$0.00	$0.00
7670212	SUP	HCPCS C1713		7670212  -  12MM CASPAR PINS	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
7670214	SUP	HCPCS C1713		7670214  -  SCREW DSTRCT 14MM PCM SPNE	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
7680265	SUP	Custom 27803010		7680265  -  DISK SPNL SM 6.5MM PCM CRV	BOTH IP/OP	"$13,077.50 "	"$9,677.35"	$0.00	"$10,462.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,725.35"	$0.00	$0.00	$0.00	$0.00	"$6,538.75"	"$10,357.38"	"$10,462.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7680272	SUP	Custom 27803010		7680272  -  DISC INTVRTB 14MM SM 17X7.2MM STRL LF PCM ARTF SPNE CRV	BOTH IP/OP	"$13,077.50 "	"$9,677.35"	$0.00	"$10,462.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,725.35"	$0.00	$0.00	$0.00	$0.00	"$6,538.75"	"$10,357.38"	"$10,462.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7680280	SUP	Custom 27803010		7680280  -  DISK SPNL SM 8MM PCM CRV	BOTH IP/OP	"$13,077.50 "	"$9,677.35"	$0.00	"$10,462.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,725.35"	$0.00	$0.00	$0.00	$0.00	"$6,538.75"	"$10,357.38"	"$10,462.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7680372	SUP	Custom 27803010		7680372  -  DISK SPNL MED 7.2MM PCM CRV	BOTH IP/OP	"$13,077.50 "	"$9,677.35"	$0.00	"$10,462.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,725.35"	$0.00	$0.00	$0.00	$0.00	"$6,538.75"	"$10,357.38"	"$10,462.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7680380	SUP	Custom 27803010		7680380  -  DISK SPNL MED 8MM PCM CRV	BOTH IP/OP	"$13,077.50 "	"$9,677.35"	$0.00	"$10,462.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,725.35"	$0.00	$0.00	$0.00	$0.00	"$6,538.75"	"$10,357.38"	"$10,462.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7680465	SUP	Custom 27803010		7680465  -  DISK SPNL LG 6.5MM PCM CRV	BOTH IP/OP	"$13,077.50 "	"$9,677.35"	$0.00	"$10,462.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,725.35"	$0.00	$0.00	$0.00	$0.00	"$6,538.75"	"$10,357.38"	"$10,462.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7680472	SUP	Custom 27803010		7680472  -  DISK SPNL LG 7.2MM PCM CRV	BOTH IP/OP	"$13,077.50 "	"$9,677.35"	$0.00	"$10,462.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,725.35"	$0.00	$0.00	$0.00	$0.00	"$6,538.75"	"$10,357.38"	"$10,462.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7680480	SUP	Custom 27803010		7680480  -  DISK SPNL LG 8MM PCM CRV	BOTH IP/OP	"$13,077.50 "	"$9,677.35"	$0.00	"$10,462.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,725.35"	$0.00	$0.00	$0.00	$0.00	"$6,538.75"	"$10,357.38"	"$10,462.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7710635	SUP	HCPCS C1713		7710635  -  CAGE SPNL 6MM CRNT LO CX PRFL PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7710835	SUP	HCPCS C1713		7710835  -  CAGE SPNL 8MM CRNT LO CX PRFL PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7711055	SUP	HCPCS C1713		7711055  -  CAGE SPNL 10MM CRNT LO CX PRFL PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7711275	SUP	HCPCS C1713		7711275  -  CAGE SPNL 12MM CRNT LX	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7711495	SUP	HCPCS C1713		7711495  -  SPACER SPNL 14MM CRNT LX EXTENSURE	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7711615	SUP	HCPCS C1713		7711615  -  SPACER SPNL 16MM CRNT LX EXTENSURE	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7711835	SUP	HCPCS C1713		7711835  -  SPACER SPNL 18MM CRNT LX EXTENSURE	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7712055	SUP	HCPCS C1713		7712055  -  SPACER SPNL 20MM CRNT LX EXTENSURE LMBR INTRBD FS PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7713510	SUP	HCPCS C1713		7713510  -  SCREW BONE 3.5MM 10MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713511	SUP	HCPCS C1713		7713511  -  SCREW BONE 3.5MM 11MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713512	SUP	HCPCS C1713		7713512  -  SCREW BONE 3.5MM 12MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713514	SUP	HCPCS C1713		7713514  -  SCREW BONE 3.5MM 14MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713515	SUP	HCPCS C1713		7713515  -  SCREW BONE 3.5MM 15MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713516	SUP	HCPCS C1713		7713516  -  SCREW BONE 3.5MM 16MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713517	SUP	HCPCS C1713		7713517  -  SCREW BONE 3.5MM 17MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713518	SUP	HCPCS C1713		7713518  -  SCREW BONE 3.5MM 18MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713519	SUP	HCPCS C1713		7713519  -  SCREW BONE 3.5MM 19MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713520	SUP	HCPCS C1713		7713520  -  SCREW BONE 3.5MM 20MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713521	SUP	HCPCS C1713		7713521  -  SCREW BONE 3.5MM 21MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713522	SUP	HCPCS C1713		7713522  -  SCREW BONE 3.5MM 22MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713523	SUP	HCPCS C1713		7713523  -  SCREW BONE 3.5MM 23MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7713524	SUP	HCPCS C1713		7713524  -  SCREW BONE 3.5MM 24MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7714010	SUP	HCPCS C1713		7714010  -  SCREW BONE 4MM 10MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7714011	SUP	HCPCS C1713		7714011  -  SCREW BONE 4MM 11MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7714012	SUP	HCPCS C1713		7714012  -  SCREW BONE 4MM 12MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7714014	SUP	HCPCS C1713		7714014  -  SCREW BONE 4MM 14MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7714016	SUP	HCPCS C1713		7714016  -  SCREW BONE 4MM 16MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7714018	SUP	HCPCS C1713		7714018  -  SCREW BONE 4MM 18MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7714019	SUP	HCPCS C1713		7714019  -  SCREW BONE 4MM 19MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7714020	SUP	HCPCS C1713		7714020  -  SCREW BONE 4MM 20MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7714021	SUP	HCPCS C1713		7714021  -  SCREW BONE 4MM 21MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7714022	SUP	HCPCS C1713		7714022  -  SCREW BONE 4MM 22MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7714023	SUP	HCPCS C1713		7714023  -  SCREW BONE 4MM 23MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7714024	SUP	HCPCS C1713		7714024  -  SCREW BONE 4MM 24MM ZEVO TI SPN CERV ANT VAR SLF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723510	SUP	HCPCS C1713		7723510  -  SCREW BONE 3.5MM 10MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723511	SUP	HCPCS C1713		7723511  -  SCREW BONE 3.5MM 11MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723512	SUP	HCPCS C1713		7723512  -  SCREW BONE 3.5MM 12MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723514	SUP	HCPCS C1713		7723514  -  SCREW BN 3.5MM 14MM ZEVO VAR ST TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723515	SUP	HCPCS C1713		7723515  -  SCREW BN 3.5MM 15MM ZEVO VAR ST TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723516	SUP	HCPCS C1713		7723516  -  SCREW BONE 3.5MM 16MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723517	SUP	HCPCS C1713		7723517  -  SCREW BONE 3.5MM 17MM VARIABLE SELF TAP ZEVO TITANIUM SPN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723518	SUP	HCPCS C1713		7723518  -  SCREW BONE 3.5MM 18MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723519	SUP	HCPCS C1713		7723519  -  SCREW BONE 3.5MM 19MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723520	SUP	HCPCS C1713		7723520  -  SCREW BONE 3.5MM 20MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723521	SUP	HCPCS C1713		7723521  -  SCREW BONE 3.5MM 21MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723522	SUP	HCPCS C1713		7723522  -  SCREW BONE 3.5MM 22MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723523	SUP	HCPCS C1713		7723523  -  SCREW BONE 3.5MM 23MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7723524	SUP	HCPCS C1713		7723524  -  SCREW BONE 3.5MM 24MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724010	SUP	HCPCS C1713		7724010  -  SCREW BONE 4MM 10MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724011	SUP	HCPCS C1713		7724011  -  SCREW BONE 4MM 11MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724012	SUP	HCPCS C1713		7724012  -  SCREW BONE 4MM 12MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724014	SUP	HCPCS C1713		7724014  -  SCREW BONE 4MM 14MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724016	SUP	HCPCS C1713		7724016  -  SCREW BONE 4MM 16MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724017	SUP	HCPCS C1713		7724017  -  SCREW BN 4MM 17MM ZEVO VAR ST TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724018	SUP	HCPCS C1713		7724018  -  SCREW BONE 4MM 18MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724019	SUP	HCPCS C1713		7724019  -  SCREW BONE 4MM 19MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724020	SUP	HCPCS C1713		7724020  -  SCREW BONE 4MM 20MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724021	SUP	HCPCS C1713		7724021  -  SCREW BONE 4MM 21MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724022	SUP	HCPCS C1713		7724022  -  SCREW BONE 4MM 22MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724023	SUP	HCPCS C1713		7724023  -  SCREW BONE 4MM 23MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7724024	SUP	HCPCS C1713		7724024  -  SCREW BONE 4MM 24MM ZEVO TI SPN CERV ANT VAR ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7730016	SUP	Custom 27203010		7730016  -  BIT DRL 13MM STRL HLX ACP SPNE	BOTH IP/OP	$535.00 	$395.90	$0.00	$428.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$397.08	$397.08	$0.00	$0.00	$111.49	$0.00	$0.00	$0.00	$0.00	$267.50	$423.72	$428.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7732111	SUP	HCPCS C1713		7732111  -  SCREW BN 4MM 11MM NS HLX ACP SLF DRL FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7732113	SUP	HCPCS C1713		7732113  -  SCREW BN 4MM 13MM NS HLX-T SLF DRL FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7732115	SUP	HCPCS C1713		7732115  -  SCREW BN 4MM 15MM NS HLX-T SLF DRL FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7733111	SUP	HCPCS C1713		7733111  -  SCREW BN 4MM 11MM NS HLX ACP ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7733119	SUP	HCPCS C1713		7733119  -  SCREW BN 4MM 19MM NS HLX ACP ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7734111	SUP	HCPCS C1713		7734111  -  SCREW BN 4MM 11MM NS HLX-T ACP ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7734113	SUP	HCPCS C1713		7734113  -  SCREW BN 4MM 13MM NS HLX-T ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7734115	SUP	HCPCS C1713		7734115  -  SCREW BN 4MM 15MM NS HLX-T ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7734117	SUP	HCPCS C1713		7734117  -  SCREW BN 4MM 17MM NS HLX-T ACP ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7734119	SUP	HCPCS C1713		7734119  -  SCREW BN 4MM 19MM NS HLX-T ACP ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7735111	SUP	HCPCS C1713		7735111  -  SCREW BN 4.5MM 11MM HLX ACP VA ST SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7735113	SUP	HCPCS C1713		7735113  -  SCREW BN 4.5MM 13MM NS HLX-T ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7735115	SUP	HCPCS C1713		7735115  -  SCREW BN 4.5MM 15MM NS HLX-T ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7735117	SUP	HCPCS C1713		7735117  -  SCREW BN 4.5MM 17MM NS HLX ACP ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7735119	SUP	HCPCS C1713		7735119  -  SCREW BN 4.5MM 19MM NS HLX ACP ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7736113	SUP	HCPCS C1713		7736113  -  SCREW BN 4.5MM 13MM NS HLX-T ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7736115	SUP	HCPCS C1713		7736115  -  SCREW BN 4.5MM 15MM NS HLX-T ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7736117	SUP	HCPCS C1713		7736117  -  SCREW BN 4.5MM 17MM NS HLX ACP ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7737110	SUP	Custom 27203010		7737110  -  HOLDER IMPL NS HLX ACP TEMP TACK SPNE	BOTH IP/OP	$535.00 	$395.90	$0.00	$428.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$397.08	$397.08	$0.00	$0.00	$111.49	$0.00	$0.00	$0.00	$0.00	$267.50	$423.72	$428.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738120	SUP	HCPCS C1713		7738120  -  PLATE BN 20MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738122	SUP	HCPCS C1713		7738122  -  PLATE BN 22MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738124	SUP	HCPCS C1713		7738124  -  PLATE BN 24MM HLX ACP 1 LVL TI ANT CSPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738126	SUP	HCPCS C1713		7738126  -  PLATE BN 26MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738128	SUP	HCPCS C1713		7738128  -  PLATE BN 28MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738130	SUP	HCPCS C1713		7738130  -  PLATE BN 30MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738132	SUP	HCPCS C1713		7738132  -  PLATE BN 32MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738134	SUP	HCPCS C1713		7738134  -  PLATE BN 34MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738236	SUP	HCPCS C1713		7738236  -  PLATE BN 36MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738238	SUP	HCPCS C1713		7738238  -  PLATE BN 38MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738240	SUP	HCPCS C1713		7738240  -  PLATE BN 40MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738242	SUP	HCPCS C1713		7738242  -  PLATE BN 42MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738244	SUP	HCPCS C1713		7738244  -  PLATE BN 44MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738246	SUP	HCPCS C1713		7738246  -  PLATE BN 46MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738248	SUP	HCPCS C1713		7738248  -  PLATE BN 48MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738250	SUP	HCPCS C1713		7738250  -  PLATE BN 50MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738252	SUP	HCPCS C1713		7738252  -  PLATE BN 52MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738254	SUP	HCPCS C1713		7738254  -  PLATE BN 54MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7738356	SUP	HCPCS C1713		7738356  -  PLATE BN 56MM HLX LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738358	SUP	HCPCS C1713		7738358  -  PLATE BN 58MM HLX LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738360	SUP	HCPCS C1713		7738360  -  PLATE BN 60MM HLX LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738362	SUP	HCPCS C1713		7738362  -  PLATE BN 62MM HLX LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738364	SUP	HCPCS C1713		7738364  -  PLATE BN 64MM HLX LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738366	SUP	HCPCS C1713		7738366  -  PLATE BN 66MM HLX LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738368	SUP	HCPCS C1713		7738368  -  PLATE BN 68MM HLX LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738470	SUP	HCPCS C1713		7738470  -  PLATE BN 70MM HLX LVL 4 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738474	SUP	HCPCS C1713		7738474  -  PLATE BN 74MM HLX LVL 4 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738478	SUP	HCPCS C1713		7738478  -  PLATE BN 78MM HLX LVL 4 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738482	SUP	HCPCS C1713		7738482  -  PLATE BN 82MM HLX LVL 4 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738486	SUP	HCPCS C1713		7738486  -  PLATE BN 86MM HLX LVL 4 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738490	SUP	HCPCS C1713		7738490  -  PLATE BN 90MM HLX LVL 4 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738500	SUP	HCPCS C1713		7738500  -  PLATE BN 100MM HLX LVL 5 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738505	SUP	HCPCS C1713		7738505  -  PLATE BN 105MM HLX LVL 5 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738510	SUP	HCPCS C1713		7738510  -  PLATE BN 110MM HLX LVL 5 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7738595	SUP	HCPCS C1713		7738595  -  PLATE BN 95MM HLX LVL 5 TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7739111	SUP	HCPCS C1713		7739111  -  SCREW BN 4MM 11MM NS HLX ACP SLF DRL VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7739113	SUP	HCPCS C1713		7739113  -  SCREW BN 4MM 13MM NS HLX-T SLF DRL VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7739115	SUP	HCPCS C1713		7739115  -  SCREW BN 4MM 15MM NS HLX-T SLF DRL VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7739213	SUP	HCPCS C1713		7739213  -  SCREW BN 4MM 13MM NS HLX-T ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7739215	SUP	HCPCS C1713		7739215  -  SCREW BN 4MM 15MM NS HLX-T ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7739217	SUP	HCPCS C1713		7739217  -  SCREW BN 4MM 17MM NS HLX ACP ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7740120	SUP	HCPCS C1713		7740120  -  PLATE BN MN 20MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7740122	SUP	HCPCS C1713		7740122  -  PLATE BN MN 22MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7740124	SUP	HCPCS C1713		7740124  -  PLATE BN MN 24MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7740126	SUP	HCPCS C1713		7740126  -  PLATE BN MN 26MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7740128	SUP	HCPCS C1713		7740128  -  PLATE BN MN 28MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7740130	SUP	HCPCS C1713		7740130  -  PLATE BN MN 30MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7740132	SUP	HCPCS C1713		7740132  -  PLATE BN MN 32MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7740134	SUP	HCPCS C1713		7740134  -  PLATE BN MN 34MM HLX LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7740236	SUP	HCPCS C1713		7740236  -  PLATE BN MN 36MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7740238	SUP	HCPCS C1713		7740238  -  PLATE BN MN 38MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7740240	SUP	HCPCS C1713		7740240  -  PLATE BONE 40MM LEVEL 2 HELIX MINI TITANIUM SPN CERV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7740242	SUP	HCPCS C1713		7740242  -  PLATE BN MN 42MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7740244	SUP	HCPCS C1713		7740244  -  PLATE BN MN 44MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7740246	SUP	HCPCS C1713		7740246  -  PLATE BN MN 46MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7740248	SUP	HCPCS C1713		7740248  -  PLATE BN MN 48MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7740250	SUP	HCPCS C1713		7740250  -  PLATE BN MN 50MM HLX LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7741111	SUP	HCPCS C1713		7741111  -  SCREW BN HEX 4MM 11MM VA SLF DRL SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7741113	SUP	HCPCS C1713		7741113  -  SCREW BN HEX 4MM 13MM VA SLF DRL SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7741115	SUP	HCPCS C1713		7741115  -  SCREW BN HEX 4MM 15MM VA SLF DRL SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7742111	SUP	HCPCS C1713		7742111  -  SCREW BN 4MM 11MM FX ANG SLF DRL SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7742113	SUP	HCPCS C1713		7742113  -  SCREW BN 4MM 13MM FX ANG SLF DRL SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7742115	SUP	HCPCS C1713		7742115  -  SCREW BN 4MM 15MM FX ANG SLF DRL SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7746111	SUP	HCPCS C1713		7746111  -  SCREW BN 4.5MM 11MM FX ANG ST SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7746113	SUP	HCPCS C1713		7746113  -  SCREW BN 4.5MM 13MM FX ANG ST SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7746115	SUP	HCPCS C1713		7746115  -  SCREW BN 4.5MM 15MM FX ANG ST SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7747111	SUP	HCPCS C1713		7747111  -  SCREW BN 4MM 11MM FX ANG ST SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7747113	SUP	HCPCS C1713		7747113  -  SCREW BONE 13MM FIX ANGLE SELF TAP 4MM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7747115	SUP	HCPCS C1713		7747115  -  SCREW BN 4MM 15MM FX ANG ST SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7748111	SUP	HCPCS C1713		7748111  -  SCREW BN 4MM 11MM VA ST SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7748113	SUP	HCPCS C1713		7748113  -  SCREW BONE 13MM VAR ANG SELF TAP 4MM SPN CERV ANTERIOR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7748115	SUP	HCPCS C1713		7748115  -  SCREW BN 4MM 15MM VA ST SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7750010	SUP	HCPCS C1713		7750010  -  ROD 7750010 3.5MM ROD 120MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7750015	SUP	HCPCS C1713		7750015  -  ROD 7750015 3.5MM ROD 240MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7750020	SUP	HCPCS C1713		7750020  -  ROD 7750020 3.5MM ROD 300MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7750086	SUP	HCPCS C1713		7750086  -  ROD 7750086 3.5MM CHROMALOY PLUS 120MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7750087	SUP	HCPCS C1713		7750087  -  ROD 7750087 3.5MM CHROMALOY PLUS 240MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7750088	SUP	HCPCS C1713		7750088  -  ROD 7750088 3.5MM CHROMALOY PLUS 300MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7750346	SUP	Custom 27803010		7750346  -  CONNECTOR 7750346 DMNO3.5 4.0 TO 3.5 4.0	BOTH IP/OP	"$1,458.00 "	"$1,078.92"	$0.00	"$1,166.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,082.13"	"$1,082.13"	$0.00	$0.00	$303.85	$0.00	$0.00	$0.00	$0.00	$729.00	"$1,154.74"	"$1,166.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7750347	SUP	Custom 27803010		7750347  -  CONNECTOR 7750347 AX DOMNO3.5 4.0 TO 4.5	BOTH IP/OP	"$1,458.00 "	"$1,078.92"	$0.00	"$1,166.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,082.13"	"$1,082.13"	$0.00	$0.00	$303.85	$0.00	$0.00	$0.00	$0.00	$729.00	"$1,154.74"	"$1,166.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7750348	SUP	Custom 27803010		7750348  -  CONNECTOR 7750348 AX DOMNO3.5 4.0 TO 5.5	BOTH IP/OP	"$1,458.00 "	"$1,078.92"	$0.00	"$1,166.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,082.13"	"$1,082.13"	$0.00	$0.00	$303.85	$0.00	$0.00	$0.00	$0.00	$729.00	"$1,154.74"	"$1,166.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7750443	SUP	HCPCS C1713		"7750443  -  DOMINO 7750443 OFFSET 3.2,3.5 TO 3.2,3.5"	BOTH IP/OP	"$1,458.00 "	"$1,078.92"	$0.00	"$1,166.40"	$656.10	$656.10	$0.00	$0.00	$0.00	$303.88	"$1,082.13"	"$1,082.13"	$0.00	$0.00	$303.85	$0.00	$862.41	$862.41	$0.00	$729.00	"$1,154.74"	"$1,166.40"	$0.00		$0.00	$228.18	$0.00	$0.00	$232.11	$0.00	$0.00	$0.00	$0.00	$0.00
7750444	SUP	HCPCS C1713		7750444  -  DOMINO 7750444 OFSET 3.2-3.5 TO 4.5-4.75	BOTH IP/OP	"$1,458.00 "	"$1,078.92"	$0.00	"$1,166.40"	$656.10	$656.10	$0.00	$0.00	$0.00	$303.88	"$1,082.13"	"$1,082.13"	$0.00	$0.00	$303.85	$0.00	$862.41	$862.41	$0.00	$729.00	"$1,154.74"	"$1,166.40"	$0.00		$0.00	$228.18	$0.00	$0.00	$232.11	$0.00	$0.00	$0.00	$0.00	$0.00
7750445	SUP	HCPCS C1713		"7750445  -  DOMINO 7750445 OFFSET 3.2, 3.5 TO 5.5"	BOTH IP/OP	"$1,458.00 "	"$1,078.92"	$0.00	"$1,166.40"	$656.10	$656.10	$0.00	$0.00	$0.00	$303.88	"$1,082.13"	"$1,082.13"	$0.00	$0.00	$303.85	$0.00	$862.41	$862.41	$0.00	$729.00	"$1,154.74"	"$1,166.40"	$0.00		$0.00	$228.18	$0.00	$0.00	$232.11	$0.00	$0.00	$0.00	$0.00	$0.00
7750506	SUP	HCPCS C1713		7750506  -  SCREW BN 4.5MM 6MM VRTX SLCT TI SPNE OCPTL	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750508	SUP	HCPCS C1713		7750508  -  SCREW BN 4.5MM 8MM VRTX SLCT TI SPNE OCPTL	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750510	SUP	HCPCS C1713		7750510  -  SCREW BN 4.5MM 10MM VRTX TI SPNE CRV OCPTL CORT ANT	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750512	SUP	HCPCS C1713		7750512  -  SCREW BN 4.5MM 12MM VRTX SLCT TI SPNE OCPTL	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750514	SUP	HCPCS C1713		7750514  -  SCREW BN 4.5MM 14MM VRTX TI SPNE CRV OCPTL CORT ANT	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750516	SUP	HCPCS C1713		7750516  -  SCREW BN 4.5MM 16MM VRTX TI SPNE CRV OCPTL CORT ANT	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750518	SUP	HCPCS C1713		7750518  -  SCREW BN 4.5MM 18MM VRTX TI SPNE CRV OCPTL CORT ANT	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750606	SUP	HCPCS C1713		7750606  -  SCREW BN 5MM 6MM VRTX TI SPNE CRV OCPTL CORT ANT	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750608	SUP	HCPCS C1713		7750608  -  SCREW BONE 4MM 8MM CORT	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750610	SUP	HCPCS C1713		7750610  -  SCREW BN 5MM 10MM VRTX TI SPNE CRV OCPTL CORT ANT	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750612	SUP	HCPCS C1713		7750612  -  SCREW BN 5MM 12MM VRTX TI SPNE CRV OCPTL CORT ANT	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750614	SUP	HCPCS C1713		7750614  -  SCREW BN 5MM 14MM VRTX TI SPNE CRV OCPTL CORT ANT	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750616	SUP	HCPCS C1713		7750616  -  SCREW BN 5MM 16MM VRTX TI SPNE CRV OCPTL CORT ANT	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7750618	SUP	HCPCS C1713		7750618  -  SCREW BN 5MM 18MM VRTX TI SPNE CRV OCPTL CORT ANT	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$323.55	$323.55	$0.00	$0.00	$0.00	$149.86	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$425.29	$425.29	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$112.52	$0.00	$0.00	$114.46	$0.00	$0.00	$0.00	$0.00	$0.00
7751101	SUP	HCPCS C1713		7751101  -  POSTED SCREW CONNECTOR 7751101 SMALL	BOTH IP/OP	"$1,794.00 "	"$1,327.56"	$0.00	"$1,435.20"	$807.30	$807.30	$0.00	$0.00	$0.00	$373.91	"$1,331.51"	"$1,331.51"	$0.00	$0.00	$373.87	$0.00	"$1,061.15"	"$1,061.15"	$0.00	$897.00	"$1,420.85"	"$1,435.20"	$0.00		$0.00	$280.76	$0.00	$0.00	$285.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751103	SUP	HCPCS C1713		7751103  -  POSTED SCREW CONNECTOR 7751103 MEDIUM	BOTH IP/OP	"$1,794.00 "	"$1,327.56"	$0.00	"$1,435.20"	$807.30	$807.30	$0.00	$0.00	$0.00	$373.91	"$1,331.51"	"$1,331.51"	$0.00	$0.00	$373.87	$0.00	"$1,061.15"	"$1,061.15"	$0.00	$897.00	"$1,420.85"	"$1,435.20"	$0.00		$0.00	$280.76	$0.00	$0.00	$285.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751105	SUP	HCPCS C1713		7751105  -  POSTED SCREW CONNECTOR 7751105 LARGE	BOTH IP/OP	"$1,794.00 "	"$1,327.56"	$0.00	"$1,435.20"	$807.30	$807.30	$0.00	$0.00	$0.00	$373.91	"$1,331.51"	"$1,331.51"	$0.00	$0.00	$373.87	$0.00	"$1,061.15"	"$1,061.15"	$0.00	$897.00	"$1,420.85"	"$1,435.20"	$0.00		$0.00	$280.76	$0.00	$0.00	$285.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751110	SUP	Custom 27803010		7751110  -  CONNECTOR 7751110 OPEN CABLE CONN	BOTH IP/OP	"$1,155.00 "	$854.70	$0.00	$924.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.24	$857.24	$0.00	$0.00	$240.70	$0.00	$0.00	$0.00	$0.00	$577.50	$914.76	$924.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7751710	SUP	HCPCS C1713		7751710  -  SCREW 7751710 3.5 X 10MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751712	SUP	HCPCS C1713		7751712  -  SCREW 7751712 3.5 X 12MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751714	SUP	HCPCS C1713		7751714  -  SCREW 7751714 3.5 X 14MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751716	SUP	HCPCS C1713		7751716  -  SCREW 7751716 3.5 X 16MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751718	SUP	HCPCS C1713		7751718  -  SCREW 7751718 3.5 X 18MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751720	SUP	HCPCS C1713		7751720  -  SCREW 7751720 3.5 X 20MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751722	SUP	HCPCS C1713		7751722  -  SCREW 7751722 3.5 X 22MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751724	SUP	HCPCS C1713		7751724  -  SCREW 7751724 3.5 X 24MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751726	SUP	HCPCS C1713		7751726  -  SCREW 7751726 3.5 X 26MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751728	SUP	HCPCS C1713		7751728  -  SCREW 7751728 3.5 X 28MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751730	SUP	HCPCS C1713		7751730  -  SCREW 7751730 3.5 X 30MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751732	SUP	HCPCS C1713		7751732  -  SCREW 7751732 3.5 X 32MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751734	SUP	HCPCS C1713		7751734  -  SCREW 7751734 3.5 X 34MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751810	SUP	HCPCS C1713		7751810  -  SCREW 7751810 4.0 X 10MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751812	SUP	HCPCS C1713		7751812  -  SCREW 7751812 4.0 X 12MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751814	SUP	HCPCS C1713		7751814  -  SCREW 7751814 4.0 X 14MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751816	SUP	HCPCS C1713		7751816  -  SCREW 7751816 4.0 X 16MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751818	SUP	HCPCS C1713		7751818  -  SCREW 7751818 4.0 X 18MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751820	SUP	HCPCS C1713		7751820  -  SCREW 7751820 4.0 X 20MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751822	SUP	HCPCS C1713		7751822  -  SCREW 7751822 4.0 X 22MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751824	SUP	HCPCS C1713		7751824  -  SCREW 7751824 4.0 X 24MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751826	SUP	HCPCS C1713		7751826  -  SCREW 7751826 4.0 X 26MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751828	SUP	HCPCS C1713		7751828  -  SCREW 7751828 4.0 X 28MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751830	SUP	HCPCS C1713		7751830  -  SCREW 7751830 4.0 X 30MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751832	SUP	HCPCS C1713		7751832  -  SCREW 7751832 4.0 X 32MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751834	SUP	HCPCS C1713		7751834  -  SCREW 7751834 4.0 X 34MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751924	SUP	HCPCS C1713		7751924  -  SCREW 7751924 4.5 X 24MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751926	SUP	HCPCS C1713		7751926  -  SCREW 7751926 4.5 X 26MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751928	SUP	HCPCS C1713		7751928  -  SCREW 7751928 4.5 X 28MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751930	SUP	HCPCS C1713		7751930  -  SCREW 7751930 4.5 X 30MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751932	SUP	HCPCS C1713		7751932  -  SCREW 7751932 4.5 X 32MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751934	SUP	HCPCS C1713		7751934  -  SCREW 7751934 4.5 X 34MM POSTED	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7752510	SUP	HCPCS C1713		7752510  -  SET SCREW 7752510 CROSSLINK	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7752515	SUP	HCPCS C1713		7752515  -  SCREW 7752515 FLAT CONNECTOR SETSCREW	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7752525	SUP	HCPCS C1713		7752525  -  CROSSLINK 7752525 SMALL MAS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7752526	SUP	HCPCS C1713		7752526  -  CROSSLINK 7752526 MEDIUM MAS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7752527	SUP	HCPCS C1713		7752527  -  CROSSLINK 7752527 LARGE MAS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7752528	SUP	Custom 27803010		7752528  -  CONNECTOR 7752528 MAS CROSSLINK ROD	BOTH IP/OP	$719.00 	$532.06	$0.00	$575.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$533.64	$533.64	$0.00	$0.00	$149.84	$0.00	$0.00	$0.00	$0.00	$359.50	$569.45	$575.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7752529	SUP	HCPCS C1713		7752529  -  SCREW 7752529 MAS CROSSLINK LOCKING	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7752535	SUP	HCPCS C1713		7752535  -  CROSSLINK 7752535 SMALL ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7752536	SUP	HCPCS C1713		7752536  -  CROSSLINK 7752536 MEDIUM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7752537	SUP	HCPCS C1713		7752537  -  CROSSLINK 7752537 LARGE ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7753500	SUP	HCPCS C1713		7753500  -  SET SCREW 7753500 MAS CONNECTOR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7753520	SUP	HCPCS C1713		"7753520  -  SET SCREW 7753520 MAS EXT.,  LAT. CONN"	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7753730	SUP	HCPCS C1713		7753730  -  ROD SPINAL 30MM PRECUT VERTEX 3.5MM NONSTRL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7753740	SUP	HCPCS C1713		7753740  -  ROD SPNL 40MM 3.5MM VRTX PCUT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7753750	SUP	HCPCS C1713		7753750  -  ROD SPINAL 3.5MM 50MM PRECUT VERTEX NONSTRL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7753760	SUP	HCPCS C1713		7753760  -  ROD SPINAL 3.5MM 60MM PRECUT VERTEX SELECT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7753770	SUP	HCPCS C1713		7753770  -  ROD SPINAL 70MM PRECUT CCM PLUS 3.5MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7753780	SUP	HCPCS C1713		7753780  -  ROD SPINAL 80MM PRECUT TITANIUM 3.5MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7753806	SUP	HCPCS C1713		7753806  -  ROD SPINAL 420MM CCM PLUS STAINLESS STEEL 4.75MM 3.5MM	BOTH IP/OP	"$2,362.50 "	"$1,748.25"	$0.00	"$1,890.00"	"$1,063.13"	"$1,063.13"	$0.00	$0.00	$0.00	$492.40	"$1,753.45"	"$1,753.45"	$0.00	$0.00	$492.35	$0.00	"$1,397.42"	"$1,397.42"	$0.00	"$1,181.25"	"$1,871.10"	"$1,890.00"	$0.00		$0.00	$369.73	$0.00	$0.00	$376.11	$0.00	$0.00	$0.00	$0.00	$0.00
7753880	SUP	HCPCS C1713		7753880  -  ROD SPINAL 80MM PRECUT CCM PLUS 3.5MM	BOTH IP/OP	"$1,252.50 "	$926.85	$0.00	"$1,002.00"	$563.63	$563.63	$0.00	$0.00	$0.00	$261.05	$929.61	$929.61	$0.00	$0.00	$261.02	$0.00	$740.85	$740.85	$0.00	$626.25	$991.98	"$1,002.00"	$0.00		$0.00	$196.02	$0.00	$0.00	$199.40	$0.00	$0.00	$0.00	$0.00	$0.00
7753890	SUP	HCPCS C1713		7753890  -  ROD SPINAL 90MM PRECUT CCM PLUS 3.5MM	BOTH IP/OP	"$1,252.50 "	$926.85	$0.00	"$1,002.00"	$563.63	$563.63	$0.00	$0.00	$0.00	$261.05	$929.61	$929.61	$0.00	$0.00	$261.02	$0.00	$740.85	$740.85	$0.00	$626.25	$991.98	"$1,002.00"	$0.00		$0.00	$196.02	$0.00	$0.00	$199.40	$0.00	$0.00	$0.00	$0.00	$0.00
7753900	SUP	HCPCS C1713		7753900  -  ROD SPINAL 100MM PRECUT CCM PLUS 3.5MM	BOTH IP/OP	"$1,252.50 "	$926.85	$0.00	"$1,002.00"	$563.63	$563.63	$0.00	$0.00	$0.00	$261.05	$929.61	$929.61	$0.00	$0.00	$261.02	$0.00	$740.85	$740.85	$0.00	$626.25	$991.98	"$1,002.00"	$0.00		$0.00	$196.02	$0.00	$0.00	$199.40	$0.00	$0.00	$0.00	$0.00	$0.00
7754525	SUP	HCPCS C1713		7754525  -  SCREW BN 4.5MM 25MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7754530	SUP	HCPCS C1713		7754530  -  SCREW BN 4.5MM 35MM SHNK PPS SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7754535	SUP	HCPCS C1713		7754535  -  SCREW BN 4.5MM 35MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7754540	SUP	HCPCS C1713		7754540  -  SCREW BN 4.5MM 40MM HLX-REV ACP SHNK PLYP-PHENYLENE SLF SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7754545	SUP	HCPCS C1713		7754545  -  SCREW BN 4.5MM 45MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7754550	SUP	HCPCS C1713		7754550  -  SCREW BN 4.5MM 50MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7755120	SUP	HCPCS C1713		7755120  -  ROD SPNL 3.5MM HNG	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755122	SUP	HCPCS C1713		7755122  -  ROD SPNL 3.2/3.5MM 120MM HNG ADJ OCPTL	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
7755123	SUP	HCPCS C1713		7755123  -  ROD SPNL 3.5MM 3.2MM 220MM ADJ OCPTL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755124	SUP	HCPCS C1713		7755124  -  ROD SPNL 3.5MM 220MM STRL VRTX ADJ TI OCPTL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755217	SUP	HCPCS C1713		7755217  -  VERTEX SELECT PRE-CURVED OC ROD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755231	SUP	HCPCS C1713		7755231  -  ROD SPNL 3.5MM 100MM OCPTL PLT	BOTH IP/OP	"$4,426.50 "	"$3,275.61"	$0.00	"$3,541.20"	"$1,991.93"	"$1,991.93"	$0.00	$0.00	$0.00	$922.59	"$3,285.35"	"$3,285.35"	$0.00	$0.00	$922.48	$0.00	"$2,182.26"	"$2,182.26"	$0.00	"$2,213.25"	"$3,505.79"	"$3,541.20"	$0.00		$0.00	$692.75	$0.00	$0.00	$704.70	$0.00	$0.00	$0.00	$0.00	$0.00
7755232	SUP	HCPCS C1713		7755232  -  ROD SPNL 3.5MM 200MM PCRV PLT OCPTL	BOTH IP/OP	"$4,426.50 "	"$3,275.61"	$0.00	"$3,541.20"	"$1,991.93"	"$1,991.93"	$0.00	$0.00	$0.00	$922.59	"$3,285.35"	"$3,285.35"	$0.00	$0.00	$922.48	$0.00	"$2,182.26"	"$2,182.26"	$0.00	"$2,213.25"	"$3,505.79"	"$3,541.20"	$0.00		$0.00	$692.75	$0.00	$0.00	$704.70	$0.00	$0.00	$0.00	$0.00	$0.00
7755240	SUP	HCPCS C1713		7755240  -  ROD SPNL 3.5MM 240MM VRTX THRD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755245	SUP	HCPCS C1713		7755245  -  ROD THRD 4.5MM 360MM SPNE	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755247	SUP	HCPCS C1713		7755247  -  ROD SPNL 5.5MM 360MM VRTX THRD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755266	SUP	HCPCS C1713		7755266  -  ROD SPNL P/T 4.75MM 360MM CIRC	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755270	SUP	HCPCS C1713		7755270  -  ROD SPNL 3.5MM 100MM PCRV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755271	SUP	HCPCS C1713		7755271  -  ROD SPNL 3.5MM 200MM VRTX PCRV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755274	SUP	HCPCS C1713		7755274  -  ROD 7755274 3.5 PRECURV CHROMALOY PL 100	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755275	SUP	HCPCS C1713		7755275  -  ROD SPNL CRV 3.5MM 200MM NS CHROMALOY +	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755278	SUP	HCPCS C1713		7755278  -  PLATE BN 50MM NS VRTX SLCT ADJ SPNE OCPTL RECON SYS	BOTH IP/OP	"$8,085.00 "	"$5,982.90"	$0.00	"$6,468.00"	"$3,638.25"	"$3,638.25"	$0.00	$0.00	$0.00	"$1,685.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,684.91"	$0.00	"$3,985.91"	"$3,985.91"	$0.00	"$4,042.50"	"$6,403.32"	"$6,468.00"	$0.00		$0.00	"$1,265.30"	$0.00	$0.00	"$1,287.13"	$0.00	$0.00	$0.00	$0.00	$0.00
7755325	SUP	HCPCS C1713		7755325  -  CONNECTOR ROD SM LOPRFL SCR OCPTL SPNE	BOTH IP/OP	"$1,794.00 "	"$1,327.56"	$0.00	"$1,435.20"	$807.30	$807.30	$0.00	$0.00	$0.00	$373.91	"$1,331.51"	"$1,331.51"	$0.00	$0.00	$373.87	$0.00	"$1,061.15"	"$1,061.15"	$0.00	$897.00	"$1,420.85"	"$1,435.20"	$0.00		$0.00	$280.76	$0.00	$0.00	$285.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755327	SUP	HCPCS C1713		7755327  -  SCREW BN OFST 27MM CNCT SPNE OCPTL	BOTH IP/OP	"$1,794.00 "	"$1,327.56"	$0.00	"$1,435.20"	$807.30	$807.30	$0.00	$0.00	$0.00	$373.91	"$1,331.51"	"$1,331.51"	$0.00	$0.00	$373.87	$0.00	"$1,061.15"	"$1,061.15"	$0.00	$897.00	"$1,420.85"	"$1,435.20"	$0.00		$0.00	$280.76	$0.00	$0.00	$285.60	$0.00	$0.00	$0.00	$0.00	$0.00
7755530	SUP	HCPCS C1713		7755530  -  SCREW BN 5.5MM 30MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7755535	SUP	HCPCS C1713		7755535  -  SCREW BN 5.5MM 35MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7755540	SUP	HCPCS C1713		7755540  -  SCREW BN 5.5MM 40MM CNN TI SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7755545	SUP	HCPCS C1713		7755545  -  SCREW BN 5.5MM 45MM CNN TI SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7755550	SUP	HCPCS C1713		7755550  -  SCREW BN 5.5MM 50MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7755555	SUP	HCPCS C1713		7755555  -  SCREW BN 5.5MM 55MM HLX-REV ACP SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7756007	SUP	Custom 27203010		7756007  -  BIT DRILL 2.4MM	BOTH IP/OP	$660.00 	$488.40	$0.00	$528.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.85	$489.85	$0.00	$0.00	$137.54	$0.00	$0.00	$0.00	$0.00	$330.00	$522.72	$528.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756010	SUP	Custom 27203010		7756010  -  BIT DRL 2.4MM STRL VRTX SLCT DISP	BOTH IP/OP	$660.00 	$488.40	$0.00	$528.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.85	$489.85	$0.00	$0.00	$137.54	$0.00	$0.00	$0.00	$0.00	$330.00	$522.72	$528.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756035	SUP	Custom 27203010		7756035  -  TAP SURG INSTR 3.5MM	BOTH IP/OP	"$1,038.00 "	$768.12	$0.00	$830.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$770.40	$770.40	$0.00	$0.00	$216.32	$0.00	$0.00	$0.00	$0.00	$519.00	$822.10	$830.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756064	SUP	Custom 27803010		"7756064  -  LATERAL CONNECTOR 7756064 OPEN, 10MM"	BOTH IP/OP	"$1,077.00 "	$796.98	$0.00	$861.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$799.35	$799.35	$0.00	$0.00	$224.45	$0.00	$0.00	$0.00	$0.00	$538.50	$852.98	$861.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756066	SUP	Custom 27803010		"7756066  -  LATERAL CONNECTOR 7756066 OPEN, 13MM"	BOTH IP/OP	"$1,077.00 "	$796.98	$0.00	$861.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$799.35	$799.35	$0.00	$0.00	$224.45	$0.00	$0.00	$0.00	$0.00	$538.50	$852.98	$861.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756067	SUP	Custom 27803010		"7756067  -  LATERAL CONNECTOR 7756067 CLOSED, 10MM"	BOTH IP/OP	"$1,018.50 "	$753.69	$0.00	$814.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$755.93	$755.93	$0.00	$0.00	$212.26	$0.00	$0.00	$0.00	$0.00	$509.25	$806.65	$814.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756068	SUP	Custom 27803010		"7756068  -  LATERAL CONNECTOR 7756068 CLOSED, 13MM"	BOTH IP/OP	"$1,018.50 "	$753.69	$0.00	$814.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$755.93	$755.93	$0.00	$0.00	$212.26	$0.00	$0.00	$0.00	$0.00	$509.25	$806.65	$814.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756069	SUP	Custom 27803010		"7756069  -  MAS EXTENSION CONN. 7756069 3.2, 3.5MM"	BOTH IP/OP	"$1,077.00 "	$796.98	$0.00	$861.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$799.35	$799.35	$0.00	$0.00	$224.45	$0.00	$0.00	$0.00	$0.00	$538.50	$852.98	$861.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756071	SUP	Custom 27803010		7756071  -  CONNECTOR MAS EXT 7756071 4.5-4.75MM	BOTH IP/OP	"$1,077.00 "	$796.98	$0.00	$861.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$799.35	$799.35	$0.00	$0.00	$224.45	$0.00	$0.00	$0.00	$0.00	$538.50	$852.98	$861.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756072	SUP	Custom 27803010		7756072  -  MAS EXTENSION CONN. 7756072 5.5MM	BOTH IP/OP	"$1,077.00 "	$796.98	$0.00	$861.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$799.35	$799.35	$0.00	$0.00	$224.45	$0.00	$0.00	$0.00	$0.00	$538.50	$852.98	$861.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756073	SUP	HCPCS C1713		"7756073  -  HOOK 7756073 LAMINAR, 4.5MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756074	SUP	HCPCS C1713		"7756074  -  HOOK 7756074 LAMINAR, 6.0MM"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756131	SUP	Custom 27203010		7756131  -  DRILL BIT 7756131 3.2MM DRILL BIT	BOTH IP/OP	$676.50 	$500.61	$0.00	$541.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.10	$502.10	$0.00	$0.00	$140.98	$0.00	$0.00	$0.00	$0.00	$338.25	$535.79	$541.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756133	SUP	Custom 27203010		7756133  -  DRILL BIT 7756133 3.2MM DRILL BIT	BOTH IP/OP	$676.50 	$500.61	$0.00	$541.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.10	$502.10	$0.00	$0.00	$140.98	$0.00	$0.00	$0.00	$0.00	$338.25	$535.79	$541.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756300	SUP	Custom 27203010		7756300  -  TAP SPINAL VERTEX SELECT 3MM	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756530	SUP	HCPCS C1713		7756530  -  SCREW BN 6.5MM 30MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7756535	SUP	HCPCS C1713		7756535  -  SCREW BN 6.5MM 35MM CNN TI SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7756540	SUP	HCPCS C1713		7756540  -  SCREW BN 6.5MM 40MM CNN TI SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7756545	SUP	HCPCS C1713		7756545  -  SCREW BN 6.5MM 45MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7756550	SUP	HCPCS C1713		7756550  -  SCREW BN 6.5MM 50MM CNN TI SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7756555	SUP	HCPCS C1713		7756555  -  SCREW BN 6.5MM 55MM NEURO SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7757530	SUP	HCPCS C1713		7757530  -  SCREW BN 7.5MM 30MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7757535	SUP	HCPCS C1713		7757535  -  SCREW BN 7.5MM 35MM SHNK CNN SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7757540	SUP	HCPCS C1713		7757540  -  SCREW BN 7.5MM 40MM CNN TI SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7757545	SUP	HCPCS C1713		7757545  -  SCREW BN 7.5MM 45MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7757550	SUP	HCPCS C1713		7757550  -  SCREW BN 7.5MM 50MM SPHERX PPS CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7757555	SUP	HCPCS C1713		7757555  -  SCREW BN 7.5MM 55MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7758535	SUP	HCPCS C1713		7758535  -  SCREW BN 8.5MM 35MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7758540	SUP	HCPCS C1713		7758540  -  SCREW BN 8.5MM 40MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7758545	SUP	HCPCS C1713		7758545  -  SCREW BN 8.5MM 45MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7758550	SUP	HCPCS C1713		7758550  -  SCREW BN 8.5MM 50MM CNN SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7759970	SUP	HCPCS C1713		7759970  -  PLATE BN SM LOPRFL VRTX SLCT LCK SLCT SPNE OC	BOTH IP/OP	"$7,095.00 "	"$5,250.30"	$0.00	"$5,676.00"	"$3,192.75"	"$3,192.75"	$0.00	$0.00	$0.00	"$1,478.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,478.60"	$0.00	"$3,497.84"	"$3,497.84"	$0.00	"$3,547.50"	"$5,619.24"	"$5,676.00"	$0.00		$0.00	"$1,110.37"	$0.00	$0.00	"$1,129.52"	$0.00	$0.00	$0.00	$0.00	$0.00
7759971	SUP	HCPCS C1713		7759971  -  PLATE BN MED LOPRFL VRTX SLCT LCK SLCT SPNE OC	BOTH IP/OP	"$7,095.00 "	"$5,250.30"	$0.00	"$5,676.00"	"$3,192.75"	"$3,192.75"	$0.00	$0.00	$0.00	"$1,478.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,478.60"	$0.00	"$3,497.84"	"$3,497.84"	$0.00	"$3,547.50"	"$5,619.24"	"$5,676.00"	$0.00		$0.00	"$1,110.37"	$0.00	$0.00	"$1,129.52"	$0.00	$0.00	$0.00	$0.00	$0.00
7759972	SUP	HCPCS C1713		7759972  -  PLATE BN LG LOPRFL VRTX SLCT LCK SLCT SPNE OC	BOTH IP/OP	"$7,095.00 "	"$5,250.30"	$0.00	"$5,676.00"	"$3,192.75"	"$3,192.75"	$0.00	$0.00	$0.00	"$1,478.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,478.60"	$0.00	"$3,497.84"	"$3,497.84"	$0.00	"$3,547.50"	"$5,619.24"	"$5,676.00"	$0.00		$0.00	"$1,110.37"	$0.00	$0.00	"$1,129.52"	$0.00	$0.00	$0.00	$0.00	$0.00
7764525	SUP	HCPCS C1713		7764525  -  SCREW BN 4.5MM 25MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7764530	SUP	HCPCS C1713		7764530  -  SCREW BN 4.5MM 30MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7764535	SUP	HCPCS C1713		7764535  -  SCREW BN 4.5MM 35MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7764540	SUP	HCPCS C1713		7764540  -  SCREW BN 4.5MM 40MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7764545	SUP	HCPCS C1713		7764545  -  SCREW BN 4.5MM 45MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7765530	SUP	HCPCS C1713		7765530  -  SCREW BN 5.5MM 30MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7765535	SUP	HCPCS C1713		7765535  -  SCREW BN 5.5MM 35MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7765540	SUP	HCPCS C1713		7765540  -  SCREW BN 5.5MM 40MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7765545	SUP	HCPCS C1713		7765545  -  SCREW BN 5.5MM 45MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7765550	SUP	HCPCS C1713		7765550  -  SCREW BN 5.5MM 50MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7765555	SUP	HCPCS C1713		7765555  -  SCREW BN 5.5MM 55MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7765560	SUP	HCPCS C1713		7765560  -  SCREW BN 5.5MM 60MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7766530	SUP	HCPCS C1713		7766530  -  SCREW BN 6.5MM 30MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7766535	SUP	HCPCS C1713		7766535  -  SCREW BN 6.5MM 35MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7766540	SUP	HCPCS C1713		7766540  -  SCREW BN 6.5MM 40MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7766545	SUP	HCPCS C1713		7766545  -  SCREW BN 6.5MM 45MM TI SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7766550	SUP	HCPCS C1713		7766550  -  SCREW BN 6.5MM 50MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7766555	SUP	HCPCS C1713		7766555  -  SCREW BN 6.5MM 55MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7766560	SUP	HCPCS C1713		7766560  -  SCREW BN 6.5MM 60MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7767530	SUP	HCPCS C1713		7767530  -  SCREW BN 7.5MM 30MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7767535	SUP	HCPCS C1713		7767535  -  SCREW BN 7.5MM 35MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7767540	SUP	HCPCS C1713		7767540  -  SCREW BN 7.5MM 40MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7767545	SUP	HCPCS C1713		7767545  -  SCREW BN 7.5MM 45MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7767550	SUP	HCPCS C1713		7767550  -  SCREW BN 7.5MM 50MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7767555	SUP	HCPCS C1713		7767555  -  SCREW BN 7.5MM 55MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7767560	SUP	HCPCS C1713		7767560  -  SCREW BN 7.5MM 60MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7768535	SUP	HCPCS C1713		7768535  -  SCREW BN 8.5MM 35MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7768540	SUP	HCPCS C1713		7768540  -  SCREW BN 8.5MM 40MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7768545	SUP	HCPCS C1713		7768545  -  SCREW BN 8.5MM 45MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7768550	SUP	HCPCS C1713		7768550  -  SCREW BN 8.5MM 50MM NCLNLT SHNK SPNE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
7770723	SUP	HCPCS C1713		7770723  -  SPACER SPNL XLORDOTIC 23MMX7MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7770728	SUP	HCPCS C1713		7770728  -  SPACER SPNL XLORDOTIC 28MMX7MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7770732	SUP	HCPCS C1713		7770732  -  SPACER SPNL XLORDOTIC 32MMX7MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7770823	SUP	HCPCS C1713		7770823  -  SPACER SPNL STD 23MMX8MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7770828	SUP	HCPCS C1713		7770828  -  SPACER SPNL STD 28MMX8MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7770832	SUP	HCPCS C1713		7770832  -  SPACER SPNL STD 32MMX8MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7770923	SUP	HCPCS C1713		7770923  -  SPACER SPNL STD 23MMX9MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7770928	SUP	HCPCS C1713		7770928  -  SPACER SPNL STD 28MMX9MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7770932	SUP	HCPCS C1713		7770932  -  SPACER SPNL STD 32MMX9MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7771023	SUP	HCPCS C1713		7771023  -  SPACER SPNL STD 23MMX10MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7771028	SUP	HCPCS C1713		7771028  -  SPACER SPNL STD 28MMX10MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7771032	SUP	HCPCS C1713		7771032  -  SPACER SPNL STD 32MMX10MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7771123	SUP	HCPCS C1713		7771123  -  SPACER SPNL STD 23MMX11MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7771128	SUP	HCPCS C1713		7771128  -  SPACER SPNL STD 28MMX11MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7771132	SUP	HCPCS C1713		7771132  -  SPACER SPNL STD 32MMX11MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
7771174	SUP	Custom 27203010		7771174  -  SLEEVE SPNL SPHERX PRODUCTIVE PPS	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7772001	SUP	HCPCS C1713		7772001  -  SCREW BN TULIP LCK SPNE 6.25 MM ROD	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7781120	SUP	HCPCS C1713		7781120  -  PLATE BN 20MM NS HLX-T 1 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781122	SUP	HCPCS C1713		7781122  -  PLATE BN 22MM NS HLX-T 1 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781124	SUP	HCPCS C1713		7781124  -  PLATE BN 24MM NS HLX-T 1 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781126	SUP	HCPCS C1713		7781126  -  PLATE BN 26MM NS HLX-T 1 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781128	SUP	HCPCS C1713		7781128  -  PLATE BN 28MM NS HLX-T 1 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781130	SUP	HCPCS C1713		7781130  -  PLATE BN 30MM NS HLX-T 1 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781132	SUP	HCPCS C1713		7781132  -  PLATE BN 32MM NS HLX-T 1 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781134	SUP	HCPCS C1713		7781134  -  PLATE BN 34MM NS HLX-T 1 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781234	SUP	HCPCS C1713		7781234  -  PLATE BN 34MM NS HLX-T 2 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781236	SUP	HCPCS C1713		7781236  -  PLATE BN 36MM NS HLX-T 2 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781238	SUP	HCPCS C1713		7781238  -  PLATE BN 38MM NS HLX-T 2 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781240	SUP	HCPCS C1713		7781240  -  PLATE BN 40MM NS HLX-T 2 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781242	SUP	HCPCS C1713		7781242  -  PLATE BN 42MM NS HLX-T 2 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781244	SUP	HCPCS C1713		7781244  -  PLATE BN 44MM NS HLX-T 2 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781246	SUP	HCPCS C1713		7781246  -  PLATE BN 46MM NS HLX-T 2 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781248	SUP	HCPCS C1713		7781248  -  PLATE BN 48MM NS HLX-T 2 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781250	SUP	HCPCS C1713		7781250  -  PLATE BN 50MM NS HLX-T 2 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781252	SUP	HCPCS C1713		7781252  -  PLATE BN 52MM NS HLX-T 2 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781254	SUP	HCPCS C1713		7781254  -  PLATE BN 54MM NS HLX-T 2 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781354	SUP	HCPCS C1713		7781354  -  PLATE BN 54MM NS HLX-T 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781356	SUP	HCPCS C1713		7781356  -  PLATE BN 56MM NS HLX-T 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781358	SUP	HCPCS C1713		7781358  -  PLATE BN 58MM NS HLX-T 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781360	SUP	HCPCS C1713		7781360  -  PLATE BN 60MM NS HLX-T 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781362	SUP	HCPCS C1713		7781362  -  PLATE BN 62MM NS HLX-T 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781364	SUP	HCPCS C1713		7781364  -  PLATE BN 64MM NS HLX-T 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781366	SUP	HCPCS C1713		7781366  -  PLATE BN 66MM NS HLX-T 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781368	SUP	HCPCS C1713		7781368  -  PLATE BN 68MM NS HLX-T 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781470	SUP	HCPCS C1713		7781470  -  PLATE BN 70MM NS HLX-T 4 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781474	SUP	HCPCS C1713		7781474  -  PLATE BN 74MM NS HLX-T 4 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781478	SUP	HCPCS C1713		7781478  -  PLATE BN 78MM NS HLX-T 4 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781482	SUP	HCPCS C1713		7781482  -  PLATE BN 82MM NS HLX-T 4 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781486	SUP	HCPCS C1713		7781486  -  PLATE BN 86MM NS HLX-T 4 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781490	SUP	HCPCS C1713		7781490  -  PLATE BN 90MM NS HLX-T 4 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781501	SUP	HCPCS C1713		7781501  -  PLATE BN T 100MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781505	SUP	HCPCS C1713		7781505  -  PLATE BN T 105MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781510	SUP	HCPCS C1713		7781510  -  PLATE BN T 110MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7781595	SUP	HCPCS C1713		7781595  -  PLATE BN T 95MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7782001	SUP	HCPCS C1713		7782001  -  SCREW LCK 5.5MM SPHERX PPS SPNE	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7782300	SUP	HCPCS C1713		7782300  -  ROD SPNL 5.5MM 300MM STRL SPHERX XTN	BOTH IP/OP	"$1,540.00 "	"$1,139.60"	$0.00	"$1,232.00"	$693.00	$693.00	$0.00	$0.00	$0.00	$320.97	"$1,142.99"	"$1,142.99"	$0.00	$0.00	$320.94	$0.00	$910.91	$910.91	$0.00	$770.00	"$1,219.68"	"$1,232.00"	$0.00		$0.00	$241.01	$0.00	$0.00	$245.17	$0.00	$0.00	$0.00	$0.00	$0.00
7782500	SUP	HCPCS C1713		7782500  -  ROD SPNL 5.5MM 500MM SPHERX XTN	BOTH IP/OP	"$1,540.00 "	"$1,139.60"	$0.00	"$1,232.00"	$693.00	$693.00	$0.00	$0.00	$0.00	$320.97	"$1,142.99"	"$1,142.99"	$0.00	$0.00	$320.94	$0.00	$910.91	$910.91	$0.00	$770.00	"$1,219.68"	"$1,232.00"	$0.00		$0.00	$241.01	$0.00	$0.00	$245.17	$0.00	$0.00	$0.00	$0.00	$0.00
7783025	SUP	HCPCS C1713		7783025  -  ROD SPNL PREBNT 5.5MM 25MM SPHERX XTN	BOTH IP/OP	"$1,790.00 "	"$1,324.60"	$0.00	"$1,432.00"	$805.50	$805.50	$0.00	$0.00	$0.00	$373.08	"$1,328.54"	"$1,328.54"	$0.00	$0.00	$373.04	$0.00	"$1,058.79"	"$1,058.79"	$0.00	$895.00	"$1,417.68"	"$1,432.00"	$0.00		$0.00	$280.14	$0.00	$0.00	$284.97	$0.00	$0.00	$0.00	$0.00	$0.00
7783030	SUP	HCPCS C1713		7783030  -  ROD SPNL PREBNT 5.5MM 30MM SPHERX XTN	BOTH IP/OP	"$1,790.00 "	"$1,324.60"	$0.00	"$1,432.00"	$805.50	$805.50	$0.00	$0.00	$0.00	$373.08	"$1,328.54"	"$1,328.54"	$0.00	$0.00	$373.04	$0.00	"$1,058.79"	"$1,058.79"	$0.00	$895.00	"$1,417.68"	"$1,432.00"	$0.00		$0.00	$280.14	$0.00	$0.00	$284.97	$0.00	$0.00	$0.00	$0.00	$0.00
7783035	SUP	HCPCS C1713		7783035  -  ROD SPNL PREBNT 5.5MM 35MM SPHERX XTN	BOTH IP/OP	"$1,790.00 "	"$1,324.60"	$0.00	"$1,432.00"	$805.50	$805.50	$0.00	$0.00	$0.00	$373.08	"$1,328.54"	"$1,328.54"	$0.00	$0.00	$373.04	$0.00	"$1,058.79"	"$1,058.79"	$0.00	$895.00	"$1,417.68"	"$1,432.00"	$0.00		$0.00	$280.14	$0.00	$0.00	$284.97	$0.00	$0.00	$0.00	$0.00	$0.00
7783040	SUP	HCPCS C1713		7783040  -  ROD SPNL PREBNT 5.5MM 40MM SPHERX XTN	BOTH IP/OP	"$1,790.00 "	"$1,324.60"	$0.00	"$1,432.00"	$805.50	$805.50	$0.00	$0.00	$0.00	$373.08	"$1,328.54"	"$1,328.54"	$0.00	$0.00	$373.04	$0.00	"$1,058.79"	"$1,058.79"	$0.00	$895.00	"$1,417.68"	"$1,432.00"	$0.00		$0.00	$280.14	$0.00	$0.00	$284.97	$0.00	$0.00	$0.00	$0.00	$0.00
7783045	SUP	HCPCS C1713		7783045  -  ROD SPNL PREBNT 5.5MM 45MM SPHERX XTN	BOTH IP/OP	"$1,790.00 "	"$1,324.60"	$0.00	"$1,432.00"	$805.50	$805.50	$0.00	$0.00	$0.00	$373.08	"$1,328.54"	"$1,328.54"	$0.00	$0.00	$373.04	$0.00	"$1,058.79"	"$1,058.79"	$0.00	$895.00	"$1,417.68"	"$1,432.00"	$0.00		$0.00	$280.14	$0.00	$0.00	$284.97	$0.00	$0.00	$0.00	$0.00	$0.00
7783050	SUP	HCPCS C1713		7783050  -  ROD SPNL PREBNT 5.5MM 50MM SPHERX XTN	BOTH IP/OP	"$1,790.00 "	"$1,324.60"	$0.00	"$1,432.00"	$805.50	$805.50	$0.00	$0.00	$0.00	$373.08	"$1,328.54"	"$1,328.54"	$0.00	$0.00	$373.04	$0.00	"$1,058.79"	"$1,058.79"	$0.00	$895.00	"$1,417.68"	"$1,432.00"	$0.00		$0.00	$280.14	$0.00	$0.00	$284.97	$0.00	$0.00	$0.00	$0.00	$0.00
7783055	SUP	HCPCS C1713		7783055  -  ROD SPNL PREBNT 5.5MM 55MM SPHERX XTN	BOTH IP/OP	"$1,790.00 "	"$1,324.60"	$0.00	"$1,432.00"	$805.50	$805.50	$0.00	$0.00	$0.00	$373.08	"$1,328.54"	"$1,328.54"	$0.00	$0.00	$373.04	$0.00	"$1,058.79"	"$1,058.79"	$0.00	$895.00	"$1,417.68"	"$1,432.00"	$0.00		$0.00	$280.14	$0.00	$0.00	$284.97	$0.00	$0.00	$0.00	$0.00	$0.00
7783060	SUP	HCPCS C1713		7783060  -  ROD SPNL PREBNT 5.5MM 60MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783065	SUP	HCPCS C1713		7783065  -  ROD SPNL PREBNT 5.5MM 65MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783070	SUP	HCPCS C1713		7783070  -  ROD SPNL PREBNT 5.5MM 70MM SPHERX PPS XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783075	SUP	HCPCS C1713		7783075  -  ROD SPNL PREBNT 5.5MM 75MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783080	SUP	HCPCS C1713		7783080  -  ROD SPNL PREBNT 5.5MM 90MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783085	SUP	HCPCS C1713		7783085  -  ROD SPNL PREBNT 5.5MM 85MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783090	SUP	HCPCS C1713		7783090  -  ROD SPNL PREBNT 5.5MM 90MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783095	SUP	HCPCS C1713		7783095  -  ROD SPNL PREBNT 5.5MM 95MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783100	SUP	HCPCS C1713		7783100  -  ROD SPNL PREBNT 5.5MM 100MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783110	SUP	HCPCS C1713		7783110  -  ROD SPNL PREBNT 5.5MM 110MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783120	SUP	HCPCS C1713		7783120  -  ROD SPNL PREBNT 5.5MM 120MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783150	SUP	HCPCS C1713		7783150  -  ROD SPNL PREBNT 5.5MM 150MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783300	SUP	HCPCS C1713		7783300  -  ROD SPNL PREBNT 5.5MM 300MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7783500	SUP	HCPCS C1713		7783500  -  ROD SPNL PREBNT 5.5MM 500MM SPHERX XTN	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
7800015	SUP	HCPCS C1713		7800015  -  PIN FX HLX TEMP SLFCNTR TACK SPNE	BOTH IP/OP	$535.00 	$395.90	$0.00	$428.00	$240.75	$240.75	$0.00	$0.00	$0.00	$111.51	$397.08	$397.08	$0.00	$0.00	$111.49	$0.00	$316.45	$316.45	$0.00	$267.50	$423.72	$428.00	$0.00		$0.00	$83.73	$0.00	$0.00	$85.17	$0.00	$0.00	$0.00	$0.00	$0.00
7800120	SUP	HCPCS C1713		7800120  -  PLATE BONE 20MM LEVEL 1 HELIX T STAINLESS STEEL SPN CERV	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7800122	SUP	HCPCS C1713		7800122  -  PLATE BONE 22MM LEVEL 1 HELIX T STAINLESS STEEL SPN CERV	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7800124	SUP	HCPCS C1713		7800124  -  PLATE BN 24MM NS HLX R 1 LVL SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7800126	SUP	HCPCS C1713		7800126  -  PLATE BN 26MM NS HLX R 1 LVL SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7800128	SUP	HCPCS C1713		7800128  -  PLATE BN 28MM NS HLX R 1 LVL SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7800130	SUP	HCPCS C1713		7800130  -  PLATE BN 30MM NS HLX R 1 LVL SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7800132	SUP	HCPCS C1713		7800132  -  PLATE BN 32MM NS HLX R 1 LVL SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7800134	SUP	HCPCS C1713		7800134  -  PLATE BN 34MM NS HLX R 1 LVL SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7800232	SUP	HCPCS C1713		7800232  -  PLATE BN 32MM NS HLX R 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7800234	SUP	HCPCS C1713		7800234  -  PLATE BN 34MM NS HLX R 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7800236	SUP	HCPCS C1713		7800236  -  PLATE BN 36MM NS HLX R 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7800238	SUP	HCPCS C1713		7800238  -  PLATE BONE 38MM LEVEL 2 HELIX-REVOLUTION SPN CERV ANTERIOR	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7800240	SUP	HCPCS C1713		7800240  -  PLATE BONE 40MM LEVEL 1 HELIX-REVOLUTION SPN CERV ANTERIOR	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7800242	SUP	HCPCS C1713		7800242  -  PLATE BN 42MM NS HLX R 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7800244	SUP	HCPCS C1713		7800244  -  PLATE BN 44MM NS HLX R 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7800246	SUP	HCPCS C1713		7800246  -  PLATE BN 46MM NS HLX R 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7800248	SUP	HCPCS C1713		7800248  -  PLATE BN 48MM NS HLX R 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7800250	SUP	HCPCS C1713		7800250  -  PLATE BN 50MM NS HLX R 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7800252	SUP	HCPCS C1713		7800252  -  PLATE BN 52MM NS HLX R 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7800254	SUP	HCPCS C1713		7800254  -  PLATE BN 54MM NS HLX R 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
7800350	SUP	HCPCS C1713		7800350  -  PLATE BN 50MM NS HLX R 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7800352	SUP	HCPCS C1713		7800352  -  PLATE BN 52MM NS HLX R 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7800354	SUP	HCPCS C1713		7800354  -  PLATE BN 54MM NS HLX R 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7800356	SUP	HCPCS C1713		7800356  -  PLATE BN 56MM NS HLX R 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7800358	SUP	HCPCS C1713		7800358  -  PLATE BN 58MM NS HLX R 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7800360	SUP	HCPCS C1713		7800360  -  PLATE BN 60MM NS HLX R 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7800362	SUP	HCPCS C1713		7800362  -  PLATE BN 62MM NS HLX R 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7800364	SUP	HCPCS C1713		7800364  -  PLATE BN 64MM NS HLX R 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7800366	SUP	HCPCS C1713		7800366  -  PLATE BN 66MM NS HLX R 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7800368	SUP	HCPCS C1713		7800368  -  PLATE BN 68MM NS HLX R 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
7800466	SUP	HCPCS C1713		7800466  -  PLATE BN 66MM NS HLX R 4 LVL SPNE	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7800468	SUP	HCPCS C1713		7800468  -  PLATE BN 68MM NS HLX R 4 LVL SPNE	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7800470	SUP	HCPCS C1713		7800470  -  PLATE BN 70MM NS HLX R 4 LVL SPNE	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7800474	SUP	HCPCS C1713		7800474  -  PLATE BN 74MM NS HLX R 4 LVL SPNE	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7800478	SUP	HCPCS C1713		7800478  -  PLATE BN 78MM NS HLX R 4 LVL SPNE	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7800482	SUP	HCPCS C1713		7800482  -  PLATE BN 82MM NS HLX R 4 LVL SPNE	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7800486	SUP	HCPCS C1713		7800486  -  PLATE BN 86MM NS HLX R 4 LVL SPNE	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7800490	SUP	HCPCS C1713		7800490  -  PLATE BN 90MM NS HLX R 4 LVL SPNE	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7800500	SUP	HCPCS C1713		7800500  -  PLATE BN 100MM HLX-REV LVL 5 SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7800505	SUP	HCPCS C1713		7800505  -  PLATE BN 105MM HLX-REV LVL 5 SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7800510	SUP	HCPCS C1713		7800510  -  PLATE BN 110MM HLX-REV LVL 5 SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7800590	SUP	HCPCS C1713		7800590  -  PLATE BN 90MM HLX-REV LVL 5 SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7800595	SUP	HCPCS C1713		7800595  -  PLATE BN 95MM HLX-REV LVL 5 SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
7801111	SUP	HCPCS C1713		7801111  -  SCREW BN 4MM 11MM NS HLX R SLF DRL VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7801113	SUP	HCPCS C1713		7801113  -  SCREW BONE 13MM VAR ANG SELF DRILL HELIX-REVOLUTION ACP 4MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7801115	SUP	HCPCS C1713		7801115  -  SCREW BONE 15MM VAR ANG SELF DRILL HELIX-REVOLUTION ACP 4MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7801117	SUP	HCPCS C1713		7801117  -  SCREW BN 4MM 17MM HLX REV ACP SLF DRL VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7802211	SUP	HCPCS C1713		7802211  -  SCREW BN 4MM 11MM NS HLX R SLF DRL FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7802213	SUP	HCPCS C1713		7802213  -  SCREW BONE 13MM FIX ANGLE SELF DRILL HELIX-REVOLUTION ACP 4	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7802215	SUP	HCPCS C1713		7802215  -  SCREW BONE 15MM FIX ANGLE SELF DRILL HELIX-REVOLUTION ACP 4	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7803111	SUP	HCPCS C1713		7803111  -  SCREW BN 4MM 11MM NS HLX R ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7803113	SUP	HCPCS C1713		7803113  -  SCREW BONE 13MM VAR ANG SELF TAP HELIX-REVOLUTION ACP 4MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7803115	SUP	HCPCS C1713		7803115  -  SCREW BONE 15MM VAR ANG SELF TAP HELIX-REVOLUTION ACP 4MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7803117	SUP	HCPCS C1713		7803117  -  SCREW BN 4MM 17MM NS HLX R ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7803119	SUP	HCPCS C1713		7803119  -  SCREW BN 4MM 19MM NS HLX R ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7804211	SUP	HCPCS C1713		7804211  -  SCREW BN 4MM 11MM NS HLX R ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7804213	SUP	HCPCS C1713		7804213  -  SCREW BONE 13MM FIX ANGLE SELF TAP HELIX-REVOLUTION ACP 4MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7804215	SUP	HCPCS C1713		7804215  -  SCREW BN 4MM 15MM NS HLX R ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7804217	SUP	HCPCS C1713		7804217  -  SCREW BN 4MM 17MM NS HLX R ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7804219	SUP	HCPCS C1713		7804219  -  SCREW BN 4MM 19MM NS HLX R ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7805111	SUP	HCPCS C1713		7805111  -  SCREW BN 4.5MM 11MM NS HLX R ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7805113	SUP	HCPCS C1713		7805113  -  SCREW BN 4.5MM 13MM NS HLX R ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7805114	SUP	HCPCS C1713		7805114  -  SCREW BN 4.5MM 14MM VAR ST SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7805115	SUP	HCPCS C1713		7805115  -  SCREW BN 4.5MM 15MM NS HLX R ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7805117	SUP	HCPCS C1713		7805117  -  SCREW BN 4.5MM 17MM NS HLX R ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7805119	SUP	HCPCS C1713		7805119  -  SCREW BN 4.5MM 19MM NS HLX R ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7806211	SUP	HCPCS C1713		7806211  -  SCREW BN 4.5MM 11MM NS HLX R ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7806213	SUP	HCPCS C1713		7806213  -  SCREW BN 4.5MM 13MM NS HLX R ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7806215	SUP	HCPCS C1713		7806215  -  SCREW BONE 15MM FIX ANGLE SELF TAP HELIX-REVOLUTION ACP 4.5	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7806217	SUP	HCPCS C1713		7806217  -  SCREW BN 4.5MM 17MM NS HLX R ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7806219	SUP	HCPCS C1713		7806219  -  SCREW BN 4.5MM 19MM NS HLX R ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
7807110	SUP	Custom 27203010		7807110  -  PIN FIX TEMPORARY HELIX	BOTH IP/OP	$535.00 	$395.90	$0.00	$428.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$397.08	$397.08	$0.00	$0.00	$111.49	$0.00	$0.00	$0.00	$0.00	$267.50	$423.72	$428.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7812025	SUP	Custom 27203010		7812025  -  BIT DRILL 10MM	BOTH IP/OP	$535.00 	$395.90	$0.00	$428.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$397.08	$397.08	$0.00	$0.00	$111.49	$0.00	$0.00	$0.00	$0.00	$267.50	$423.72	$428.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7820015	SUP	HCPCS C1713		7820015  -  PLATE BONE 15MM FIX TRAVERSE SPN	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7820020	SUP	HCPCS C1713		7820020  -  PLATE BN 20MM FX TRAVERSE SPNE	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7820025	SUP	HCPCS C1713		7820025  -  PLATE BN 25MM FX TRAVERSE SPNE	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7820030	SUP	HCPCS C1713		7820030  -  PLATE BONE 30MM FIX TRAVERSE SPN	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7820040	SUP	HCPCS C1713		7820040  -  PLATE BONE 40MM FIX TRAVERSE SPN	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7820045	SUP	HCPCS C1713		7820045  -  PLATE BN 45MM NS TRAVERSE FX SPNE	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7820050	SUP	HCPCS C1713		7820050  -  PLATE BN 50MM NS TRAVERSE FX SPNE	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7820055	SUP	HCPCS C1713		7820055  -  PLATE BN 55MM NS TRAVERSE FX SPNE	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7820060	SUP	HCPCS C1713		7820060  -  PLATE BN 60MM NS TRAVERSE FX SPNE	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7820065	SUP	HCPCS C1713		7820065  -  PLATE BN 65MM NS TRAVERSE FX SPNE	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7820070	SUP	HCPCS C1713		7820070  -  PLATE BN 70MM NS TRAVERSE FX SPNE	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7820080	SUP	HCPCS C1713		7820080  -  PLATE BN 80MM NS TRAVERSE FX SPNE	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7820090	SUP	HCPCS C1713		7820090  -  PLATE BN 90MM NS TRAVERSE FX SPNE	BOTH IP/OP	"$10,232.50 "	"$7,572.05"	$0.00	"$8,186.00"	"$4,604.63"	"$4,604.63"	$0.00	$0.00	$0.00	"$2,132.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,132.45"	$0.00	"$5,044.62"	"$5,044.62"	$0.00	"$5,116.25"	"$8,104.14"	"$8,186.00"	$0.00		$0.00	"$1,601.39"	$0.00	$0.00	"$1,629.01"	$0.00	$0.00	$0.00	$0.00	$0.00
7821045	SUP	HCPCS C1713		7821045  -  PLATE BN 45MM NS TRAVERSE CMPR SPNE	BOTH IP/OP	"$11,560.00 "	"$8,554.40"	$0.00	"$9,248.00"	"$5,202.00"	"$5,202.00"	$0.00	$0.00	$0.00	"$2,409.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,409.10"	$0.00	"$5,699.08"	"$5,699.08"	$0.00	"$5,780.00"	"$9,155.52"	"$9,248.00"	$0.00		$0.00	"$1,809.14"	$0.00	$0.00	"$1,840.35"	$0.00	$0.00	$0.00	$0.00	$0.00
7821050	SUP	HCPCS C1713		7821050  -  PLATE BN 50MM NS TRAVERSE CMPR SPNE	BOTH IP/OP	"$11,560.00 "	"$8,554.40"	$0.00	"$9,248.00"	"$5,202.00"	"$5,202.00"	$0.00	$0.00	$0.00	"$2,409.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,409.10"	$0.00	"$5,699.08"	"$5,699.08"	$0.00	"$5,780.00"	"$9,155.52"	"$9,248.00"	$0.00		$0.00	"$1,809.14"	$0.00	$0.00	"$1,840.35"	$0.00	$0.00	$0.00	$0.00	$0.00
7821055	SUP	HCPCS C1713		7821055  -  PLATE BN 55MM NS TRAVERSE CMPR SPNE	BOTH IP/OP	"$11,560.00 "	"$8,554.40"	$0.00	"$9,248.00"	"$5,202.00"	"$5,202.00"	$0.00	$0.00	$0.00	"$2,409.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,409.10"	$0.00	"$5,699.08"	"$5,699.08"	$0.00	"$5,780.00"	"$9,155.52"	"$9,248.00"	$0.00		$0.00	"$1,809.14"	$0.00	$0.00	"$1,840.35"	$0.00	$0.00	$0.00	$0.00	$0.00
7821060	SUP	HCPCS C1713		7821060  -  PLATE BN 60MM NS TRAVERSE CMPR SPNE	BOTH IP/OP	"$11,560.00 "	"$8,554.40"	$0.00	"$9,248.00"	"$5,202.00"	"$5,202.00"	$0.00	$0.00	$0.00	"$2,409.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,409.10"	$0.00	"$5,699.08"	"$5,699.08"	$0.00	"$5,780.00"	"$9,155.52"	"$9,248.00"	$0.00		$0.00	"$1,809.14"	$0.00	$0.00	"$1,840.35"	$0.00	$0.00	$0.00	$0.00	$0.00
7821065	SUP	HCPCS C1713		7821065  -  PLATE BN 65MM NS TRAVERSE CMPR SPNE	BOTH IP/OP	"$11,560.00 "	"$8,554.40"	$0.00	"$9,248.00"	"$5,202.00"	"$5,202.00"	$0.00	$0.00	$0.00	"$2,409.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,409.10"	$0.00	"$5,699.08"	"$5,699.08"	$0.00	"$5,780.00"	"$9,155.52"	"$9,248.00"	$0.00		$0.00	"$1,809.14"	$0.00	$0.00	"$1,840.35"	$0.00	$0.00	$0.00	$0.00	$0.00
7821070	SUP	HCPCS C1713		7821070  -  PLATE BN 70MM NS TRAVERSE CMPR SPNE	BOTH IP/OP	"$11,560.00 "	"$8,554.40"	$0.00	"$9,248.00"	"$5,202.00"	"$5,202.00"	$0.00	$0.00	$0.00	"$2,409.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,409.10"	$0.00	"$5,699.08"	"$5,699.08"	$0.00	"$5,780.00"	"$9,155.52"	"$9,248.00"	$0.00		$0.00	"$1,809.14"	$0.00	$0.00	"$1,840.35"	$0.00	$0.00	$0.00	$0.00	$0.00
7821075	SUP	HCPCS C1713		7821075  -  PLATE BN 75MM NS TRAVERSE CMPR SPNE	BOTH IP/OP	"$11,560.00 "	"$8,554.40"	$0.00	"$9,248.00"	"$5,202.00"	"$5,202.00"	$0.00	$0.00	$0.00	"$2,409.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,409.10"	$0.00	"$5,699.08"	"$5,699.08"	$0.00	"$5,780.00"	"$9,155.52"	"$9,248.00"	$0.00		$0.00	"$1,809.14"	$0.00	$0.00	"$1,840.35"	$0.00	$0.00	$0.00	$0.00	$0.00
7821080	SUP	HCPCS C1713		7821080  -  PLATE BN 80MM NS TRAVERSE CMPR SPNE	BOTH IP/OP	"$11,560.00 "	"$8,554.40"	$0.00	"$9,248.00"	"$5,202.00"	"$5,202.00"	$0.00	$0.00	$0.00	"$2,409.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,409.10"	$0.00	"$5,699.08"	"$5,699.08"	$0.00	"$5,780.00"	"$9,155.52"	"$9,248.00"	$0.00		$0.00	"$1,809.14"	$0.00	$0.00	"$1,840.35"	$0.00	$0.00	$0.00	$0.00	$0.00
7821085	SUP	HCPCS C1713		7821085  -  PLATE BN 85MM NS TRAVERSE CMPR SPNE	BOTH IP/OP	"$11,560.00 "	"$8,554.40"	$0.00	"$9,248.00"	"$5,202.00"	"$5,202.00"	$0.00	$0.00	$0.00	"$2,409.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,409.10"	$0.00	"$5,699.08"	"$5,699.08"	$0.00	"$5,780.00"	"$9,155.52"	"$9,248.00"	$0.00		$0.00	"$1,809.14"	$0.00	$0.00	"$1,840.35"	$0.00	$0.00	$0.00	$0.00	$0.00
7821095	SUP	HCPCS C1713		7821095  -  PLATE BN 95MM NS TRAVERSE CMPR SPNE	BOTH IP/OP	"$11,560.00 "	"$8,554.40"	$0.00	"$9,248.00"	"$5,202.00"	"$5,202.00"	$0.00	$0.00	$0.00	"$2,409.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,409.10"	$0.00	"$5,699.08"	"$5,699.08"	$0.00	"$5,780.00"	"$9,155.52"	"$9,248.00"	$0.00		$0.00	"$1,809.14"	$0.00	$0.00	"$1,840.35"	$0.00	$0.00	$0.00	$0.00	$0.00
7821105	SUP	HCPCS C1713		7821105  -  PLATE BN 105MM NS TRAVERSE CMPR SPNE	BOTH IP/OP	"$11,560.00 "	"$8,554.40"	$0.00	"$9,248.00"	"$5,202.00"	"$5,202.00"	$0.00	$0.00	$0.00	"$2,409.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,409.10"	$0.00	"$5,699.08"	"$5,699.08"	$0.00	"$5,780.00"	"$9,155.52"	"$9,248.00"	$0.00		$0.00	"$1,809.14"	$0.00	$0.00	"$1,840.35"	$0.00	$0.00	$0.00	$0.00	$0.00
7822035	SUP	HCPCS C1713		7822035  -  PLATE BN 35MM NS TRAVERSE 2 BOLT SPNE	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7822040	SUP	HCPCS C1713		7822040  -  PLATE BN 40MM NS TRAVERSE 2 BOLT SPNE	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7822045	SUP	HCPCS C1713		7822045  -  PLATE BN 45MM NS TRAVERSE 2 BOLT SPNE	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7822050	SUP	HCPCS C1713		7822050  -  PLATE BN 50MM NS TRAVERSE 2 BOLT SPNE	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7822055	SUP	HCPCS C1713		7822055  -  PLATE BN 55MM NS TRAVERSE 2 BOLT SPNE	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7822060	SUP	HCPCS C1713		7822060  -  PLATE BONE 60MM 2 BOLT TRAVERSE SPN	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7822065	SUP	HCPCS C1713		7822065  -  PLATE BONE 65MM 2 BOLT TRAVERSE SPN	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7822070	SUP	HCPCS C1713		7822070  -  PLATE BN 70MM 2 BOLT TRAVERSE SPNE	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7822075	SUP	HCPCS C1713		7822075  -  PLATE BN 75MM 2 BOLT TRAVERSE SPNE	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7822080	SUP	HCPCS C1713		7822080  -  PLATE BN 80MM 2 BOLT TRAVERSE SPNE	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7822085	SUP	HCPCS C1713		7822085  -  PLATE BN 85MM 2 BOLT TRAVERSE SPNE	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7822095	SUP	HCPCS C1713		7822095  -  PLATE BN 95MM 2 BOLT TRAVERSE SPNE	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7822105	SUP	HCPCS C1713		7822105  -  PLATE BN 105MM 2 BOLT TRAVERSE SPNE	BOTH IP/OP	"$9,747.50 "	"$7,213.15"	$0.00	"$7,798.00"	"$4,386.38"	"$4,386.38"	$0.00	$0.00	$0.00	"$2,031.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.38"	$0.00	"$4,805.52"	"$4,805.52"	$0.00	"$4,873.75"	"$7,720.02"	"$7,798.00"	$0.00		$0.00	"$1,525.48"	$0.00	$0.00	"$1,551.80"	$0.00	$0.00	$0.00	$0.00	$0.00
7830002	SUP	HCPCS C1713		7830002  -  SCREW BONE NUT LOCKING TITANIUM SPN	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
7835525	SUP	HCPCS C1713		7835525  -  SCREW BONE 5.5MM 25MM ASMBLY TRAVERSE SPN	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7835530	SUP	HCPCS C1713		7835530  -  SCREW BONE 5.5MM 30MM TRAVERSE SPN	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7835535	SUP	HCPCS C1713		7835535  -  SCREW BONE 35MM TRAVERSE 5.5MM SPN	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7835540	SUP	HCPCS C1713		7835540  -  SCREW BN 5.5MM 40MM NS TRAVERSE SPNE	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7835545	SUP	HCPCS C1713		7835545  -  SCREW BN 5.5MM 45MM NS TRAVERSE SPNE	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7835550	SUP	HCPCS C1713		7835550  -  SCREW BONE 5.5MM 50MM TRAVERSE SPN	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7835555	SUP	HCPCS C1713		7835555  -  SCREW BN 5.5MM 55MM NS TRAVERSE SPNE	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7835560	SUP	HCPCS C1713		7835560  -  SCREW BN 5.5MM 60MM NS TRAVERSE SPNE	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7835565	SUP	HCPCS C1713		7835565  -  SCREW BN 5.5MM 65MM NS TRAVERSE SPNE	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7846525	SUP	HCPCS C1713		7846525  -  SCREW BN 6.5MM 25MM NS TRAVERSE SPNE	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7846530	SUP	HCPCS C1713		7846530  -  SCREW BONE 6.5MM 30MM TRAVERSE SPN	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7846535	SUP	HCPCS C1713		7846535  -  SCREW BN 6.5MM 35MM NS TRAVERSE SPNE	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7846540	SUP	HCPCS C1713		7846540  -  SCREW BN 6.5MM 40MM NS TRAVERSE SPNE	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7846545	SUP	HCPCS C1713		7846545  -  TRAVERSE 6.5X 45MM VARIABLE SCREW	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7846550	SUP	HCPCS C1713		7846550  -  TRAVERSE 6.5X 50MM VARIABLE SCREW	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7846555	SUP	HCPCS C1713		7846555  -  SCREW BN 6.5MM 55MM NS TRAVERSE SPNE	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7846560	SUP	HCPCS C1713		7846560  -  SCREW BN 6.5MM 60MM NS TRAVERSE SPNE	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7846565	SUP	HCPCS C1713		7846565  -  SCREW BN 6.5MM 65MM NS TRAVERSE SPNE	BOTH IP/OP	"$1,007.50 "	$745.55	$0.00	$806.00	$453.38	$453.38	$0.00	$0.00	$0.00	$209.99	$747.77	$747.77	$0.00	$0.00	$209.96	$0.00	$595.94	$595.94	$0.00	$503.75	$797.94	$806.00	$0.00		$0.00	$157.67	$0.00	$0.00	$160.39	$0.00	$0.00	$0.00	$0.00	$0.00
7856525	SUP	HCPCS C1713		7856525  -  BOLT SPNL 6.5MM 25MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7856530	SUP	HCPCS C1713		7856530  -  BOLT SPINAL 6.5MM 30MM	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7856535	SUP	HCPCS C1713		7856535  -  BOLT SPINAL 6.5MM 35MM	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7856540	SUP	HCPCS C1713		7856540  -  BOLT SPNL 6.5MM 40MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7856545	SUP	HCPCS C1713		7856545  -  BOLT SPINAL 6.5MM 45MM TITANIUM	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7856550	SUP	HCPCS C1713		7856550  -  BOLT SPINAL 6.5MM 50MM	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7856555	SUP	HCPCS C1713		7856555  -  BOLT SPNL 6.5MM 55MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7856560	SUP	HCPCS C1713		7856560  -  BOLT SPNL 6.5MM 60MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7856565	SUP	HCPCS C1713		7856565  -  BOLT SPNL 6.5MM 65MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7860845	SUP	HCPCS C1713		7860845  -  CAGE SPNL 45X18X8MM CRNT XLIF	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7860850	SUP	HCPCS C1713		7860850  -  CAGE SPNL XL 50X18X8MM NS LF CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7860855	SUP	HCPCS C1713		7860855  -  CAGE SPNL XL 55X18X8MM NS LF CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7860860	SUP	HCPCS C1713		7860860  -  CAGE SPNL 10D LRDTC 60X18X8MM CRNT XLIF PEEK-OPTM	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861045	SUP	HCPCS C1713		7861045  -  SPACER SPNL 45X18X10MM CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861050	SUP	HCPCS C1713		7861050  -  CAGE SPNL XL 50X18X10MM NS LF CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861055	SUP	HCPCS C1713		7861055  -  CAGE SPNL XL 55X18X10MM NS LF CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861060	SUP	HCPCS C1713		7861060  -  CAGE SPNL STD XL 60X10MM PLT FSN PEEK	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861245	SUP	HCPCS C1713		7861245  -  SPACER SPNL XL 45X18X12MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861250	SUP	HCPCS C1713		7861250  -  CAGE SPNL XL 50X12X12MM NS LF CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861255	SUP	HCPCS C1713		7861255  -  CAGE SPNL XL 55X12X12MM NS LF CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861260	SUP	HCPCS C1713		7861260  -  SPACER SPNL XL 60X18X12MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861445	SUP	HCPCS C1713		7861445  -  SPACER SPNL XL 45X18X14MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861450	SUP	HCPCS C1713		7861450  -  SPACER SPNL XL 50X18X14MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861455	SUP	HCPCS C1713		7861455  -  IMPLANT SPNL 55X18X14MM XLIF CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861460	SUP	HCPCS C1713		7861460  -  SPACER SPNL XL 60X18X14MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861645	SUP	HCPCS C1713		7861645  -  SPACER SPNL XL 45X18X16MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861650	SUP	HCPCS C1713		7861650  -  SPACER SPNL XL 50X18X16MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861655	SUP	HCPCS C1713		7861655  -  SPACER SPNL XL 55X18X16MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861660	SUP	HCPCS C1713		7861660  -  SPACER SPNL XL 60X18X16MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861845	SUP	HCPCS C1713		7861845  -  CAGE SPNL XL 45X18X18MM NS LF CRNT PEEK-OPTM 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861850	SUP	HCPCS C1713		7861850  -  CAGE SPNL 10D LRDTC 50X18X10MM CRNT XLIF PEEK-OPTM	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861855	SUP	HCPCS C1713		7861855  -  SPACER SPNL XL 55X18X18MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7861860	SUP	HCPCS C1713		7861860  -  CAGE SPNL 10D LRDTC 60X18X8MM CRNT XLIF PEEK-OPTM	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7867525	SUP	HCPCS C1713		7867525  -  BOLT SPNL 7.5MM 25MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7867530	SUP	HCPCS C1713		7867530  -  BOLT SPNL 7.5MM 30MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7867535	SUP	HCPCS C1713		7867535  -  BOLT SPNL 7.5MM 35MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7867540	SUP	HCPCS C1713		7867540  -  BOLT SPNL 7.5MM 40MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7867545	SUP	HCPCS C1713		7867545  -  BOLT SPNL 7.5MM 45MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7867550	SUP	HCPCS C1713		7867550  -  BOLT SPNL 7.5MM 50MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7867555	SUP	HCPCS C1713		7867555  -  BOLT SPNL 7.5MM 55MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7867560	SUP	HCPCS C1713		7867560  -  BOLT SPNL 7.5MM 60MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7867565	SUP	HCPCS C1713		7867565  -  BOLT SPNL 7.5MM 65MM NS TRAVERSE PLT	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
7870845	SUP	HCPCS C1713		7870845  -  SPACER SPNL 10D XL 45X18X8MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7870850	SUP	HCPCS C1713		7870850  -  CAGE SPNL 10D XL 50X18X8MM NS LF CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7870855	SUP	HCPCS C1713		7870855  -  CAGE SPNL 10D XL 55X18X8MM NS LF CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7870860	SUP	HCPCS C1713		7870860  -  CAGE SPNL 10D LRDTC 60X18X8MM CRNT XLIF PEEK-OPTM	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871055	SUP	HCPCS C1713		7871055  -  CAGE SPNL 10D XL 55X18X10MM NS LF CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871060	SUP	HCPCS C1713		7871060  -  CAGE SPNL 10D LRDTC 60X18X10MM CRNT XLIF PEEK-OPTM	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871245	SUP	HCPCS C1713		7871245  -  SPACER SPNL XL 45X18X12MM CRNT FSN	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871250	SUP	HCPCS C1713		7871250  -  CAGE SPNL 10D XL 50X18X10MM NS LF CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871255	SUP	HCPCS C1713		7871255  -  CAGE SPNL 10D XL 55X18X12MM NS LF CRNT	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871260	SUP	HCPCS C1713		7871260  -  CAGE SPNL 10D LRDTC 60X18X12MM CRNT XLIF PEEK-OPTM	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871445	SUP	HCPCS C1713		7871445  -  SPACER SPNL 10D XL 45X18X14MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871450	SUP	HCPCS C1713		7871450  -  SPACER SPNL 10D XL 50X18X14MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871455	SUP	HCPCS C1713		7871455  -  CAGE SPNL 10D LRDTC 55X18X14MM CRNT XLIF PEEK-OPTM	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871460	SUP	HCPCS C1713		7871460  -  CAGE SPNL 10D LRDTC 60X18X14MM CRNT XLIF PEEK-OPTM	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871645	SUP	HCPCS C1713		7871645  -  SPACER SPNL 10D XL 45X18X16MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871650	SUP	HCPCS C1713		7871650  -  SPACER SPNL 10D XL 50X18X16MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871655	SUP	HCPCS C1713		7871655  -  SPACER SPNL 10D XL 55X18X16MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871660	SUP	HCPCS C1713		7871660  -  SPACER SPNL 10D XL 60X18X16MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871845	SUP	HCPCS C1713		7871845  -  SPACER SPNL 10D XL 45X18X18MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871850	SUP	HCPCS C1713		7871850  -  SPACER SPNL 10D XL 50X18X18MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871855	SUP	HCPCS C1713		7871855  -  SPACER SPNL 10D XL 55X18X18MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7871860	SUP	HCPCS C1713		7871860  -  SPACER SPNL 10D XL 60X18X18MM CRNT 1ST LAT APRCH	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7875520	SUP	HCPCS C1713		7875520  -  SCREW BN 5.5MM 20MM HALO SPNE	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7875522	SUP	HCPCS C1713		7875522  -  SCREW BN 5.5MM 22MM HALO SPNE	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7875524	SUP	HCPCS C1713		7875524  -  SCREW BN 5.5MM 24MM HALO SPNE	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7875526	SUP	HCPCS C1713		7875526  -  SCREW BN 5.5MM 26MM HALO SPNE	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7875528	SUP	HCPCS C1713		7875528  -  SCREW BN 5.5MM 28MM HALO SPNE	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7875530	SUP	HCPCS C1713		7875530  -  SCREW BN 5.5MM 30MM HALO SPNE LMBR ANT	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7875532	SUP	HCPCS C1713		7875532  -  SCREW BN 5.5MM 32MM HALO SPNE LMBR ANT	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7875534	SUP	HCPCS C1713		7875534  -  SCREW BN 5.5MM 34MM HALO SPNE LMBR ANT	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7876520	SUP	HCPCS C1713		7876520  -  SCREW BN 6.5MM 20MM HALO SPNE LMBR ANT	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7876522	SUP	HCPCS C1713		7876522  -  SCREW BN 6.5MM 22MM HALO SPNE	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7876526	SUP	HCPCS C1713		7876526  -  SCREW BN 6.5MM 26MM HALO ANT LMBR SPNE PLT	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7876528	SUP	HCPCS C1713		7876528  -  SCREW BN 6.5MM 28MM HALO PLT ANT LMBR SPNE	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7876530	SUP	HCPCS C1713		7876530  -  SCREW BN 6.5MM 30MM HALO SPNE LMBR ANT	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7876532	SUP	HCPCS C1713		7876532  -  SCREW BN 6.5MM 32MM HALO SPNE LMBR ANT	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7876534	SUP	HCPCS C1713		7876534  -  SCREW BN 6.5MM 34MM HALO SPNE LMBR ANT	BOTH IP/OP	"$1,057.50 "	$782.55	$0.00	$846.00	$475.88	$475.88	$0.00	$0.00	$0.00	$220.41	$784.88	$784.88	$0.00	$0.00	$220.38	$0.00	$625.51	$625.51	$0.00	$528.75	$837.54	$846.00	$0.00		$0.00	$165.50	$0.00	$0.00	$168.35	$0.00	$0.00	$0.00	$0.00	$0.00
7890030	SUP	HCPCS C1713		7890030  -  PIN SKL HALO SLV ANT LMBR SPNE	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
7891032	SUP	HCPCS C1713		7891032  -  PLATE BN 32MM HALO TI SPNE LMBR ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7891034	SUP	HCPCS C1713		7891034  -  PLATE BN 34MM HALO TI SPNE LMBR ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7891036	SUP	HCPCS C1713		7891036  -  PLATE BN 36MM HALO TI SPNE LMBR ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7891038	SUP	HCPCS C1713		7891038  -  PLATE BN 38MM HALO TI SPNE LMBR ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7891040	SUP	HCPCS C1713		7891040  -  PLATE BN 40MM HALO TI SPNE LMBR ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7891042	SUP	HCPCS C1713		7891042  -  PLATE BN 42MM HALO TI SPNE LMBR ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7891044	SUP	HCPCS C1713		7891044  -  PLATE BN 44MM HALO TI SPNE LMBR ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7891046	SUP	HCPCS C1713		7891046  -  PLATE BN 46MM HALO TI SPNE LMBR ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7892032	SUP	HCPCS C1713		7892032  -  PLATE BN 32MM HALO TI SPNE SCRM ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7892034	SUP	HCPCS C1713		7892034  -  PLATE BN 34MM HALO TI SPNE SCRM ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7892038	SUP	HCPCS C1713		7892038  -  PLATE BN 38MM HALO TI SPNE SCRM ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7892042	SUP	HCPCS C1713		7892042  -  PLATE BN 42MM HALO TI SPNE SCRM ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7892044	SUP	HCPCS C1713		7892044  -  PLATE BN 44MM HALO TI SPNE SCRM ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7892046	SUP	HCPCS C1713		7892046  -  PLATE BN 46MM HALO TI SPNE SCRM ANT	BOTH IP/OP	"$8,407.50 "	"$6,221.55"	$0.00	"$6,726.00"	"$3,783.38"	"$3,783.38"	$0.00	$0.00	$0.00	"$1,752.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,752.12"	$0.00	"$4,144.90"	"$4,144.90"	$0.00	"$4,203.75"	"$6,658.74"	"$6,726.00"	$0.00		$0.00	"$1,315.77"	$0.00	$0.00	"$1,338.47"	$0.00	$0.00	$0.00	$0.00	$0.00
7892525	SUP	HCPCS C1713		7892525  -  SCREW 7892525 HA COATED NONCAN 5.5 X 25	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892530	SUP	HCPCS C1713		7892530  -  SCREW 7892530 HA COATED NONCAN 5.5 X 30	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892535	SUP	HCPCS C1713		7892535  -  SCREW 7892535 HA COATED NONCAN 5.5 X 35	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892540	SUP	HCPCS C1713		7892540  -  SCREW 7892540 HA COATED NONCAN 5.5 X 40	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892545	SUP	HCPCS C1713		7892545  -  SCREW 7892545 HA COATED NONCAN 5.5 X 45	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892550	SUP	HCPCS C1713		7892550  -  SCREW 7892550 HA COATED NONCAN 5.5 X 50	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892555	SUP	HCPCS C1713		7892555  -  SCREW 7892555 HA COATED NONCAN 5.5 X 55	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892560	SUP	HCPCS C1713		7892560  -  SCREW 7892560 HA COATED NONCANN 5.5X60	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892625	SUP	HCPCS C1713		7892625  -  SCREW 7892625 HA COATED NONCAN 6.5 X 25	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892630	SUP	HCPCS C1713		7892630  -  SCREW 7892630 HA COATED NONCAN 6.5 X 30	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892635	SUP	HCPCS C1713		7892635  -  SCREW 7892635 HA COATED NONCAN 6.5 X 35	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892640	SUP	HCPCS C1713		7892640  -  SCREW 7892640 HA COATED NONCAN 6.5 X 40	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892645	SUP	HCPCS C1713		7892645  -  SCREW 7892645 HA COATED NONCAN 6.5 X 45	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892650	SUP	HCPCS C1713		7892650  -  SCREW 7892650 HA COATED NONCAN 6.5 X 50	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892655	SUP	HCPCS C1713		7892655  -  SCREW 7892655 HA COATED NONCAN 6.5 X 55	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892660	SUP	HCPCS C1713		7892660  -  SCREW 7892660 HA COATED NONCAN 6.5 X 60	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892665	SUP	HCPCS C1713		7892665  -  SCREW 7892665 HA COATED NONCAN 6.5 X 65	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892725	SUP	HCPCS C1713		7892725  -  SCREW 7892725 HA COATED NONCAN 7.5 X 25	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892730	SUP	HCPCS C1713		7892730  -  SCREW 7892730 HA COATED NONCAN 7.5 X 30	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892735	SUP	HCPCS C1713		7892735  -  SCREW 7892735 HA COATED NONCAN 7.5 X 35	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892740	SUP	HCPCS C1713		7892740  -  SCREW BN 7.5MM 40MM STRL CD HZN LGC MA PEEK HA SPNE PDCL 5.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892745	SUP	HCPCS C1713		7892745  -  SCREW BN 7.5MM 45MM STRL CD HZN LGC MA PEEK HA SPNE PDCL 5.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892750	SUP	HCPCS C1713		7892750  -  SCREW 7892750 HA COATED NONCAN 7.5 X 50	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892755	SUP	HCPCS C1713		7892755  -  SCREW 7892755 HA COATED NONCAN 7.5 X 55	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892760	SUP	HCPCS C1713		7892760  -  SCREW 7892760 HA COATED NONCAN 7.5 X 60	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892765	SUP	HCPCS C1713		7892765  -  SCREW 7892765 HA COATED NONCAN 7.5 X 65	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892770	SUP	HCPCS C1713		7892770  -  SCREW 7892770 HA COATED NONCAN 7.5 X 70	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892825	SUP	HCPCS C1713		7892825  -  SCREW 7892825 HA COATED NONCAN 8.5 X 25	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892830	SUP	HCPCS C1713		7892830  -  SCREW 7892830 HA COATED NONCAN 8.5 X 30	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892835	SUP	HCPCS C1713		7892835  -  SCREW 7892835 HA COATED NONCAN 8.5 X 35	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892840	SUP	HCPCS C1713		7892840  -  SCREW 7892840 HA COATED NONCAN 8.5 X 40	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892845	SUP	HCPCS C1713		7892845  -  SCREW 7892845 HA COATED NONCAN 8.5 X 45	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892850	SUP	HCPCS C1713		7892850  -  SCREW 7892850 HA COATED NONCAN 8.5 X 50	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892855	SUP	HCPCS C1713		7892855  -  SCREW 7892855 HA COATED NONCAN 8.5 X 55	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892860	SUP	HCPCS C1713		7892860  -  SCREW 7892860 HA COATED NONCAN 8.5 X 60	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7892865	SUP	HCPCS C1713		7892865  -  SCREW 7892865 HA COATED NONCAN 8.5 X 65	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893025	SUP	HCPCS C1713		7893025  -  ROD 7893025 6.35MM X 25MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893030	SUP	HCPCS C1713		7893030  -  ROD 7893030 6.35MM X 30MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893035	SUP	HCPCS C1713		7893035  -  ROD 7893035 6.35MM X 35MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893040	SUP	HCPCS C1713		7893040  -  ROD 7893040 6.35MM X 40MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893045	SUP	HCPCS C1713		7893045  -  ROD 7893045 6.35MM X 45MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893050	SUP	HCPCS C1713		7893050  -  ROD 7893050 6.35MM X 50MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893055	SUP	HCPCS C1713		7893055  -  ROD 7893055 6.35MM X 55MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893060	SUP	HCPCS C1713		7893060  -  ROD SPNL 60MM 6.35MM PEEK	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893065	SUP	HCPCS C1713		7893065  -  ROD 7893065 6.35MM X 65MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893070	SUP	HCPCS C1713		7893070  -  ROD 7893070 6.35MM X 70MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893075	SUP	HCPCS C1713		7893075  -  ROD 7893075 6.35MM X 75MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893076	SUP	HCPCS C1713		7893076  -  PLATE BN 76MM HALO LVL 2 TI SPNE LMBR ANT	BOTH IP/OP	"$11,927.50 "	"$8,826.35"	$0.00	"$9,542.00"	"$5,367.38"	"$5,367.38"	$0.00	$0.00	$0.00	"$2,485.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,485.69"	$0.00	"$5,880.26"	"$5,880.26"	$0.00	"$5,963.75"	"$9,446.58"	"$9,542.00"	$0.00		$0.00	"$1,866.65"	$0.00	$0.00	"$1,898.86"	$0.00	$0.00	$0.00	$0.00	$0.00
7893080	SUP	HCPCS C1713		7893080  -  PLATE BN 80MM HALO LVL 2 TI SPNE LMBR ANT	BOTH IP/OP	"$11,927.50 "	"$8,826.35"	$0.00	"$9,542.00"	"$5,367.38"	"$5,367.38"	$0.00	$0.00	$0.00	"$2,485.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,485.69"	$0.00	"$5,880.26"	"$5,880.26"	$0.00	"$5,963.75"	"$9,446.58"	"$9,542.00"	$0.00		$0.00	"$1,866.65"	$0.00	$0.00	"$1,898.86"	$0.00	$0.00	$0.00	$0.00	$0.00
7893084	SUP	HCPCS C1713		7893084  -  PLATE BN 84MM HALO LVL 2 TI SPNE LMBR ANT	BOTH IP/OP	"$11,927.50 "	"$8,826.35"	$0.00	"$9,542.00"	"$5,367.38"	"$5,367.38"	$0.00	$0.00	$0.00	"$2,485.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,485.69"	$0.00	"$5,880.26"	"$5,880.26"	$0.00	"$5,963.75"	"$9,446.58"	"$9,542.00"	$0.00		$0.00	"$1,866.65"	$0.00	$0.00	"$1,898.86"	$0.00	$0.00	$0.00	$0.00	$0.00
7893085	SUP	HCPCS C1713		7893085  -  ROD 7893085 6.35MM X 85MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893088	SUP	HCPCS C1713		7893088  -  PLATE BN 88MM HALO LVL 2 TI SPNE LMBR ANT	BOTH IP/OP	"$11,927.50 "	"$8,826.35"	$0.00	"$9,542.00"	"$5,367.38"	"$5,367.38"	$0.00	$0.00	$0.00	"$2,485.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,485.69"	$0.00	"$5,880.26"	"$5,880.26"	$0.00	"$5,963.75"	"$9,446.58"	"$9,542.00"	$0.00		$0.00	"$1,866.65"	$0.00	$0.00	"$1,898.86"	$0.00	$0.00	$0.00	$0.00	$0.00
7893090	SUP	HCPCS C1713		7893090  -  ROD 7893090 6.35MM X 90MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893092	SUP	HCPCS C1713		7893092  -  PLATE BN 92MM HALO LVL 2 TI SPNE LMBR ANT	BOTH IP/OP	"$11,927.50 "	"$8,826.35"	$0.00	"$9,542.00"	"$5,367.38"	"$5,367.38"	$0.00	$0.00	$0.00	"$2,485.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,485.69"	$0.00	"$5,880.26"	"$5,880.26"	$0.00	"$5,963.75"	"$9,446.58"	"$9,542.00"	$0.00		$0.00	"$1,866.65"	$0.00	$0.00	"$1,898.86"	$0.00	$0.00	$0.00	$0.00	$0.00
7893095	SUP	HCPCS C1713		7893095  -  ROD 7893095 6.35MM X 95MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893096	SUP	HCPCS C1713		7893096  -  PLATE BN 96MM HALO LVL 2 TI SPNE LMBR ANT	BOTH IP/OP	"$11,927.50 "	"$8,826.35"	$0.00	"$9,542.00"	"$5,367.38"	"$5,367.38"	$0.00	$0.00	$0.00	"$2,485.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,485.69"	$0.00	"$5,880.26"	"$5,880.26"	$0.00	"$5,963.75"	"$9,446.58"	"$9,542.00"	$0.00		$0.00	"$1,866.65"	$0.00	$0.00	"$1,898.86"	$0.00	$0.00	$0.00	$0.00	$0.00
7893100	SUP	HCPCS C1713		7893100  -  PLATE BN 100MM HALO LVL 2 TI SPNE LMBR ANT	BOTH IP/OP	"$11,927.50 "	"$8,826.35"	$0.00	"$9,542.00"	"$5,367.38"	"$5,367.38"	$0.00	$0.00	$0.00	"$2,485.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,485.69"	$0.00	"$5,880.26"	"$5,880.26"	$0.00	"$5,963.75"	"$9,446.58"	"$9,542.00"	$0.00		$0.00	"$1,866.65"	$0.00	$0.00	"$1,898.86"	$0.00	$0.00	$0.00	$0.00	$0.00
7893105	SUP	HCPCS C1713		7893105  -  ROD 7893105 6.35MM X 105MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893110	SUP	HCPCS C1713		7893110  -  ROD 7893110 6.35MM X 110MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893115	SUP	HCPCS C1713		7893115  -  ROD 7893115 6.35MM X 115MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893120	SUP	HCPCS C1713		7893120  -  ROD 7893120 6.35MM X 120MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893125	SUP	HCPCS C1713		7893125  -  ROD 7893125 6.35MM X 125MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7893130	SUP	HCPCS C1713		7893130  -  ROD 7893130 6.35MM X 130MM PEEK ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
7894525	SUP	HCPCS C1713		7894525  -  SCREW 7894525 CDH PEEK 4.5X25 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7894530	SUP	HCPCS C1713		7894530  -  SCREW 7894530 CDH PEEK 4.5X30 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7894535	SUP	HCPCS C1713		7894535  -  SCREW 7894535 CDH PEEK 4.5X35 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7894540	SUP	HCPCS C1713		7894540  -  SCREW 7894540 CDH PEEK 4.5X40 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7894545	SUP	HCPCS C1713		7894545  -  SCREW 7894545 CDH PEEK 4.5X45 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7894550	SUP	HCPCS C1713		7894550  -  SCREW 7894550 CDH PEEK 4.5X50 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7895525	SUP	HCPCS C1713		7895525  -  SCREW 7895525 CDH PEEK 5.5X25 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7895530	SUP	HCPCS C1713		7895530  -  SCREW 7895530 CDH PEEK 5.5X30 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7895535	SUP	HCPCS C1713		7895535  -  SCREW 7895535 CDH PEEK 5.5X35 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7895540	SUP	HCPCS C1713		7895540  -  SCREW 7895540 CDH PEEK 5.5X40 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7895545	SUP	HCPCS C1713		7895545  -  SCREW BN 5.5MM 45MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7895550	SUP	HCPCS C1713		7895550  -  SCREW 7895550 CDH PEEK 5.5X50 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7895555	SUP	HCPCS C1713		7895555  -  SCREW 7895555 CDH PEEK 5.5X55 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7895560	SUP	HCPCS C1713		7895560  -  SCREW 7895560 CDH PEEK 5.5X60 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7896525	SUP	HCPCS C1713		7896525  -  SCREW 7896525 CDH PEEK 6.5X25 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7896530	SUP	HCPCS C1713		7896530  -  SCREW 7896530 CDH PEEK 6.5X30 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7896535	SUP	HCPCS C1713		7896535  -  SCREW BN 6.5MM 35MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7896540	SUP	HCPCS C1713		7896540  -  SCREW BN 6.5MM 40MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7896545	SUP	HCPCS C1713		7896545  -  SCREW BN 6.5MM 45MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7896550	SUP	HCPCS C1713		7896550  -  SCREW BN 6.5MM 50MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7896555	SUP	HCPCS C1713		7896555  -  SCREW 7896555 CDH PEEK 6.5X55 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7896560	SUP	HCPCS C1713		7896560  -  SCREW 7896560 CDH PEEK 6.5X60 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7896565	SUP	HCPCS C1713		7896565  -  SCREW 7896565 CDH PEEK 6.5X65 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7897530	SUP	HCPCS C1713		7897530  -  SCREW 7897530 CDH PEEK 7.5X30 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7897535	SUP	HCPCS C1713		7897535  -  SCREW 7897535 CDH PEEK 7.5X35 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7897540	SUP	HCPCS C1713		7897540  -  SCREW BONE 7.5MM 40MM CD HZN LGC PEEK SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7897545	SUP	HCPCS C1713		7897545  -  SCREW 7897545 CDH PEEK 7.5X45 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7897550	SUP	HCPCS C1713		7897550  -  SCREW 7897550 CDH PEEK 7.5X50 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7897555	SUP	HCPCS C1713		7897555  -  SCREW 7897555 CDH PEEK 7.5X55 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7897560	SUP	HCPCS C1713		7897560  -  SCREW 7897560 CDH PEEK 7.5X60 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7897565	SUP	HCPCS C1713		7897565  -  SCREW 7897565 CDH PEEK 7.5X65 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7897570	SUP	HCPCS C1713		7897570  -  SCREW 7897570 CDH PEEK 7.5X70 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7898530	SUP	HCPCS C1713		7898530  -  SCREW 7898530 CDH PEEK 8.5X30 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7898535	SUP	HCPCS C1713		7898535  -  SCREW 7898535 CDH PEEK 8.5X35 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7898540	SUP	HCPCS C1713		7898540  -  SCREW 7898540 CDH PEEK 8.5X40 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7898545	SUP	HCPCS C1713		7898545  -  SCREW 7898545 CDH PEEK 8.5X45 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7898550	SUP	HCPCS C1713		7898550  -  SCREW 7898550 CDH PEEK 8.5X50 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7898555	SUP	HCPCS C1713		7898555  -  SCREW 7898555 CDH PEEK 8.5X55 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7898560	SUP	HCPCS C1713		7898560  -  SCREW 7898560 CDH PEEK 8.5X60 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7898565	SUP	HCPCS C1713		7898565  -  SCREW 7898565 CDH PEEK 8.5X65 NON CANN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905310	SUP	HCPCS C1713		7905310  -  SCREW BONE 3.5MM 10MM TI SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905312	SUP	HCPCS C1713		7905312  -  SCREW BONE 3.5MM 12MM VUEPOINT POST CERV SPN MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905314	SUP	HCPCS C1713		7905314  -  SCREW BONE 3.5MM 14MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905316	SUP	HCPCS C1713		7905316  -  SCREW BONE 3.5MM 16MM VUEPOINT POST CERV SPN MULTIAX SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905318	SUP	HCPCS C1713		7905318  -  SCREW BONE 3.5MM 18MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905320	SUP	HCPCS C1713		7905320  -  SCREW BONE 3.5MM 20MM VUEPOINT POST CERV SPN MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905322	SUP	HCPCS C1713		7905322  -  SCREW BONE 3.5MM 22MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905324	SUP	HCPCS C1713		7905324  -  SCREW BONE 3.5MM 24MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905326	SUP	HCPCS C1713		7905326  -  SCREW BONE 3.5MM 26MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905328	SUP	HCPCS C1713		7905328  -  SCREW BONE 3.5MM 28MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905330	SUP	HCPCS C1713		7905330  -  SCREW BONE 3.5MM 30MM VUEPOINT POST CERV SPN MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905332	SUP	HCPCS C1713		7905332  -  SCREW BONE 3.5MM 32MM VUEPOINT POST CERV SPN MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905334	SUP	HCPCS C1713		7905334  -  SCREW BONE 34MM 3.5MM VUEPOINT POST CERV SPN MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905410	SUP	HCPCS C1713		7905410  -  SCREW BONE 4MM 10MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905412	SUP	HCPCS C1713		7905412  -  SCREW BONE 4MM 12MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905414	SUP	HCPCS C1713		7905414  -  SCREW BONE 4MM 14MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905416	SUP	HCPCS C1713		7905416  -  SCREW BONE 16MM 40MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905418	SUP	HCPCS C1713		7905418  -  SCREW BONE 4MM 18MM VUEPOINT TI POST CERV SPN MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905420	SUP	HCPCS C1713		7905420  -  SCREW BONE 24MM 40MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905422	SUP	HCPCS C1713		7905422  -  SCREW BONE 4MM 22MM POST CERV SPN MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905424	SUP	HCPCS C1713		7905424  -  SCREW BONE 4MM 24MM VUEPOINT POST CERV SPN MULTIAX SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905426	SUP	HCPCS C1713		7905426  -  SCREW BONE 4MM 26MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905428	SUP	HCPCS C1713		7905428  -  SCREW BONE 4MM 28MM VUEPOINT POST CERV SPN MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905430	SUP	HCPCS C1713		7905430  -  SCREW BONE 4MM 30MM VUEPOINT POST CERV SPN MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905432	SUP	HCPCS C1713		7905432  -  SCREW BONE 4MM 32MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905434	SUP	HCPCS C1713		7905434  -  SCREW BONE 4MM 34MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905436	SUP	HCPCS C1713		7905436  -  SCREW BONE 4MM 36MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905438	SUP	HCPCS C1713		7905438  -  SCREW BONE 4MM 38MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905440	SUP	HCPCS C1713		7905440  -  SCREW BONE 4MM 40MM VUEPOINT POST CERV SPN MULTIAX SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905510	SUP	HCPCS C1713		7905510  -  SCREW BONE 3.5MM 10MM VUEPOINT POST CERV SPN MULTIAX FAVORED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905512	SUP	HCPCS C1713		7905512  -  SCREW BONE 3.5MM 12MM TI SPNL FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905514	SUP	HCPCS C1713		7905514  -  SCREW BONE 3.5MM 14MM VUEPOINT POST CERV SPN MULTIAX FAVORED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905516	SUP	HCPCS C1713		7905516  -  SCREW BONE 3.5MM 16MM VUEPOINT POST CERV SPN MULTIAX FAVORED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905518	SUP	HCPCS C1713		7905518  -  SCREW BONE 3.5MM 18MM VUEPOINT POST CERV SPN MULTIAX FAVORED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905520	SUP	HCPCS C1713		7905520  -  SCREW BONE 3.5MM 20MM VUEPOINT POST CERV SPN MULTIAX FAVORED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905522	SUP	HCPCS C1713		7905522  -  SCREW BONE 22MM 35MM SPNL FAVORED ANG FULTHRD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905524	SUP	HCPCS C1713		7905524  -  SCREW BONE 3.5MM 24MM VUEPOINT POST CERV SPN MULTIAX FAVORED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905526	SUP	HCPCS C1713		7905526  -  SCREW BONE 3.5MM 26MM VUEPOINT POST CERV SPN MULTIAX FAVORED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905528	SUP	HCPCS C1713		7905528  -  SCREW BONE 3.5MM 28MM SPNL MULTIAX FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905530	SUP	HCPCS C1713		7905530  -  SCREW BONE 3.5MM 30MM SPNL MULTIAX FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905532	SUP	HCPCS C1713		7905532  -  SCREW BONE 3.5MM 32MM SPNL MULTIAX FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905534	SUP	HCPCS C1713		7905534  -  SCREW BONE 3.5MM 34MM VUEPOINT POST CERV SPN MULTIAX FAVORED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905610	SUP	HCPCS C1713		7905610  -  SCREW BONE 4MM 10MM TULIP SPNL ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905612	SUP	HCPCS C1713		7905612  -  SCREW BONE 4MM 12MM TI SPNL FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905614	SUP	HCPCS C1713		7905614  -  SCREW BONE 4MM 14MM TULIP SPNL ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905616	SUP	HCPCS C1713		7905616  -  SCREW BONE 4MM 20MM TULIP SPNL ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905618	SUP	HCPCS C1713		7905618  -  SCREW BONE 4MM 18MM TULIP SPNL ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905620	SUP	HCPCS C1713		7905620  -  SCREW BONE 4MM 20MM TULIP SPNL ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905622	SUP	HCPCS C1713		7905622  -  SCREW BONE 4MM 22MM TULIP SPNL ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905624	SUP	HCPCS C1713		7905624  -  SCREW BONE 4MM 24MM TULIP SPNL FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905626	SUP	HCPCS C1713		7905626  -  SCREW BONE 4MM 26MM TULIP SPNL FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905628	SUP	HCPCS C1713		7905628  -  SCREW BONE 4MM 28MM TULIP SPNL FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905630	SUP	HCPCS C1713		7905630  -  SCREW BONE 4MM 30MM VUEPOINT TULIP POST CERV SPN FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905632	SUP	HCPCS C1713		7905632  -  SCREW BONE 4MM 32MM TULIP SPNL FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905634	SUP	HCPCS C1713		7905634  -  SCREW BONE 4MM 34MM TULIP SPNL FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905636	SUP	HCPCS C1713		7905636  -  SCREW BONE 4MM 36MM TULIP SPNL FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905638	SUP	HCPCS C1713		7905638  -  SCREW BONE 4MM 38MM TULIP SPNL FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905640	SUP	HCPCS C1713		7905640  -  SCREW BONE 4MM 40MM TULIP SPNL FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905710	SUP	HCPCS C1713		7905710  -  SCREW BONE 4.5MM 10MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905712	SUP	HCPCS C1713		7905712  -  SCREW BONE 4.5MM 12MM VUEPOINT SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905714	SUP	HCPCS C1713		7905714  -  SCREW BONE 4.5MM 14MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905716	SUP	HCPCS C1713		7905716  -  SCREW BONE 4.5MM 16MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905718	SUP	HCPCS C1713		7905718  -  SCREW BONE 4.5MM 18MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905720	SUP	HCPCS C1713		7905720  -  SCREW BONE 4.5MM 20MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905722	SUP	HCPCS C1713		7905722  -  SCREW BONE 4.5MM 22MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905724	SUP	HCPCS C1713		7905724  -  SCREW BONE 4.5MM 24MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905726	SUP	HCPCS C1713		7905726  -  SCREW BONE 4.5MM 26MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905728	SUP	HCPCS C1713		7905728  -  SCREW BONE 4.5MM 28MM VUEPOINT POST CERV SPN SYS MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905730	SUP	HCPCS C1713		7905730  -  SCREW BONE 4.5MM 30MM VUEPOINT POST CERV SPN SYS MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905732	SUP	HCPCS C1713		7905732  -  SCREW BONE 4.5MM 32MM VUEPOINT POST CERV SPN SYS MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905734	SUP	HCPCS C1713		7905734  -  SCREW BONE 4.5MM 34MM VUEPOINT POST CERV SPN SYS MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905736	SUP	HCPCS C1713		7905736  -  SCREW BONE 4.5MM 36MM VUEPOINT POST CERV SPN SYS MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905738	SUP	HCPCS C1713		7905738  -  SCREW BONE 4.5MM 38MM VUEPOINT POST CERV SPN SYS MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905740	SUP	HCPCS C1713		7905740  -  SCREW BONE 4.5MM 40MM SPNL MULTIAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905824	SUP	HCPCS C1713		7905824  -  SCREW BONE 3.5MM 24MM SPNL FAVORED ANG PTTHRD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905826	SUP	HCPCS C1713		7905826  -  SCREW BONE 3.5MM 26MM SPNL PTTHRD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905828	SUP	HCPCS C1713		7905828  -  SCREW BONE 3.5MM 28MM VUEPOINT POST CERV SPN SYS FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905830	SUP	HCPCS C1713		7905830  -  SCREW BONE 3.5MM 30MM VUEPOINT TI POST CERV SPN FAVORED ANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905832	SUP	HCPCS C1713		7905832  -  SCREW BONE 3.5MM 32MM SPNL FAVORED ANG PTTHRD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905834	SUP	HCPCS C1713		7905834  -  SCREW BONE 3.5MM 14MM VUEPOINT POST CERV SPN FAVORED ANG SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7905836	SUP	HCPCS C1713		7905836  -  SCREW BONE 3.5MM 36MM VUEPOINT PTHRD POST CERV SPN FAVORED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906000	SUP	HCPCS C1713		7906000  -  SCREW SET 3.5MM POST CERV SPN LMNR HOOK TULIP SYS VUEPOINT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
7906005	SUP	Custom 27803010		7906005  -  HOOK SPNL 5MM LMNR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7906007	SUP	Custom 27803010		7906007  -  HOOK SPNL 7MM LMNR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7906008	SUP	HCPCS C1713		7906008  -  SCREW BONE 11MM VUEPOINT POST CERV SPN SYS OFFST CONCTR OPN	BOTH IP/OP	"$1,022.50 "	$756.65	$0.00	$818.00	$460.13	$460.13	$0.00	$0.00	$0.00	$213.11	$758.90	$758.90	$0.00	$0.00	$213.09	$0.00	$604.81	$604.81	$0.00	$511.25	$809.82	$818.00	$0.00		$0.00	$160.02	$0.00	$0.00	$162.78	$0.00	$0.00	$0.00	$0.00	$0.00
7906022	SUP	HCPCS C1713		7906022  -  SCREW BONE 25MM VUEPOINT LG POST CERV SPN SYS OFFST CONCTR	BOTH IP/OP	"$1,240.00 "	$917.60	$0.00	$992.00	$558.00	$558.00	$0.00	$0.00	$0.00	$258.45	$920.33	$920.33	$0.00	$0.00	$258.42	$0.00	$733.46	$733.46	$0.00	$620.00	$982.08	$992.00	$0.00		$0.00	$194.06	$0.00	$0.00	$197.41	$0.00	$0.00	$0.00	$0.00	$0.00
7906025	SUP	HCPCS C1713		7906025  -  CONCTR ROD ACUTE ANG OFFST	BOTH IP/OP	"$1,240.00 "	$917.60	$0.00	$992.00	$558.00	$558.00	$0.00	$0.00	$0.00	$258.45	$920.33	$920.33	$0.00	$0.00	$258.42	$0.00	$733.46	$733.46	$0.00	$620.00	$982.08	$992.00	$0.00		$0.00	$194.06	$0.00	$0.00	$197.41	$0.00	$0.00	$0.00	$0.00	$0.00
7906035	SUP	HCPCS C1713		7906035  -  CONCTR ROD 3.5MM INLN	BOTH IP/OP	"$1,830.00 "	"$1,354.20"	$0.00	"$1,464.00"	$823.50	$823.50	$0.00	$0.00	$0.00	$381.42	"$1,358.23"	"$1,358.23"	$0.00	$0.00	$381.37	$0.00	"$1,082.45"	"$1,082.45"	$0.00	$915.00	"$1,449.36"	"$1,464.00"	$0.00		$0.00	$286.40	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$0.00
7906045	SUP	HCPCS C1713		7906045  -  CONCTR ROD 3.5-4.5MM INLN	BOTH IP/OP	"$1,830.00 "	"$1,354.20"	$0.00	"$1,464.00"	$823.50	$823.50	$0.00	$0.00	$0.00	$381.42	"$1,358.23"	"$1,358.23"	$0.00	$0.00	$381.37	$0.00	"$1,082.45"	"$1,082.45"	$0.00	$915.00	"$1,449.36"	"$1,464.00"	$0.00		$0.00	$286.40	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$0.00
7906055	SUP	HCPCS C1713		7906055  -  CONCTR ROD 5.5MM 3.5MM INLN	BOTH IP/OP	"$1,830.00 "	"$1,354.20"	$0.00	"$1,464.00"	$823.50	$823.50	$0.00	$0.00	$0.00	$381.42	"$1,358.23"	"$1,358.23"	$0.00	$0.00	$381.37	$0.00	"$1,082.45"	"$1,082.45"	$0.00	$915.00	"$1,449.36"	"$1,464.00"	$0.00		$0.00	$286.40	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$0.00
7906065	SUP	HCPCS C1713		7906065  -  CONCTR ROD 6.5MM 3.5MM INLN	BOTH IP/OP	"$1,830.00 "	"$1,354.20"	$0.00	"$1,464.00"	$823.50	$823.50	$0.00	$0.00	$0.00	$381.42	"$1,358.23"	"$1,358.23"	$0.00	$0.00	$381.37	$0.00	"$1,082.45"	"$1,082.45"	$0.00	$915.00	"$1,449.36"	"$1,464.00"	$0.00		$0.00	$286.40	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$0.00
7906120	SUP	HCPCS C1713		7906120  -  CONCTR ROD 120MM 3.5MM VUEPOINT SYS POST CERV SPN	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7906126	SUP	HCPCS C1713		7906126  -  CONCTR ROD 26MM FIX CX SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906128	SUP	HCPCS C1713		7906128  -  CONCTR ROD 28MM CX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906130	SUP	HCPCS C1713		7906130  -  CONCTR ROD 30MM FIX CX SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906132	SUP	HCPCS C1713		7906132  -  CONCTR ROD 32MM FIX CX TI SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906134	SUP	HCPCS C1713		7906134  -  CONCTR ROD 34MM CX FIX SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906136	SUP	HCPCS C1713		7906136  -  CONCTR ROD 36MM CX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906138	SUP	HCPCS C1713		7906138  -  CONCTR ROD 38MM VUEPOINT FIX CX SYS POST CERV SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906140	SUP	HCPCS C1713		7906140  -  CONCTR ROD 40MM CX FIX SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906142	SUP	HCPCS C1713		7906142  -  CONCTR ROD 42MM XLNK SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906144	SUP	HCPCS C1713		7906144  -  CONCTR ROD 44MM VUEPOINT FIX CX SYS POST CERV SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906146	SUP	HCPCS C1713		7906146  -  CONCTR ROD 46MM VUEPOINT FIX CX SYS POST CERV SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906148	SUP	HCPCS C1713		7906148  -  CONCTR ROD 48MM VUEPOINT FIX CX SYS POST CERV SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906150	SUP	HCPCS C1713		7906150  -  CONCTR ROD 50MM VUEPOINT FIX CX SYS POST CERV SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
7906160	SUP	HCPCS C1713		7906160  -  CONCTR ROD 60MM 3.5MM VUEPOINT SYS POST CERV SPN	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7906240	SUP	HCPCS C1713		7906240  -  ROD SPNL 240MM 3.5MM	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
7906300	SUP	HCPCS C1713		7906300  -  ROD SPNL 45D PCVD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
7906302	SUP	Custom 27203010		7906302  -  CONCTR CORD EYLT OCCPTL	BOTH IP/OP	"$1,277.50 "	$945.35	$0.00	"$1,022.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$948.16	$948.16	$0.00	$0.00	$266.23	$0.00	$0.00	$0.00	$0.00	$638.75	"$1,011.78"	"$1,022.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7906306	SUP	HCPCS C1713		7906306  -  SCREW BONE 4.5MM 6MM VUEPOINT POST CERV SPN OCCPTL CORT SYS	BOTH IP/OP	$680.00 	$503.20	$0.00	$544.00	$306.00	$306.00	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$340.00	$538.56	$544.00	$0.00		$0.00	$106.42	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00
7906308	SUP	HCPCS C1713		7906308  -  SCREW BONE 4.5MM 8MM VUEPOINT POST CERV SPN OCCPTL CORT SYS	BOTH IP/OP	$680.00 	$503.20	$0.00	$544.00	$306.00	$306.00	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$340.00	$538.56	$544.00	$0.00		$0.00	$106.42	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00
7906310	SUP	HCPCS C1713		7906310  -  SCREW BONE 4.5MM 10MM VUEPOINT POST CERV SPN CORT OCCPTL SYS	BOTH IP/OP	$680.00 	$503.20	$0.00	$544.00	$306.00	$306.00	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$340.00	$538.56	$544.00	$0.00		$0.00	$106.42	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00
7906312	SUP	HCPCS C1713		7906312  -  SCREW BONE 4.5MM 12MM VUEPOINT POST CERV SPN CORT OCCPTL SYS	BOTH IP/OP	$680.00 	$503.20	$0.00	$544.00	$306.00	$306.00	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$340.00	$538.56	$544.00	$0.00		$0.00	$106.42	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00
7906314	SUP	HCPCS C1713		7906314  -  SCREW BONE 4.5MM 14MM VUEPOINT POST CERV SPN CORT OCCPTL SYS	BOTH IP/OP	$680.00 	$503.20	$0.00	$544.00	$306.00	$306.00	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$340.00	$538.56	$544.00	$0.00		$0.00	$106.42	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00
7906335	SUP	HCPCS C1713		7906335  -  PLATE 35MM KLD POST CERV SYS VUEPOINT BONE	BOTH IP/OP	"$6,355.00 "	"$4,702.70"	$0.00	"$5,084.00"	"$2,859.75"	"$2,859.75"	$0.00	$0.00	$0.00	"$1,324.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,324.38"	$0.00	"$3,133.02"	"$3,133.02"	$0.00	"$3,177.50"	"$5,033.16"	"$5,084.00"	$0.00		$0.00	$994.56	$0.00	$0.00	"$1,011.72"	$0.00	$0.00	$0.00	$0.00	$0.00
7906340	SUP	HCPCS C1713		7906340  -  PLATE 40MM KLD SYS VUEPOINT BONE POST CERV SPN	BOTH IP/OP	"$6,355.00 "	"$4,702.70"	$0.00	"$5,084.00"	"$2,859.75"	"$2,859.75"	$0.00	$0.00	$0.00	"$1,324.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,324.38"	$0.00	"$3,133.02"	"$3,133.02"	$0.00	"$3,177.50"	"$5,033.16"	"$5,084.00"	$0.00		$0.00	$994.56	$0.00	$0.00	"$1,011.72"	$0.00	$0.00	$0.00	$0.00	$0.00
7906345	SUP	HCPCS C1713		7906345  -  PLATE 45MM KLD BONE	BOTH IP/OP	"$6,355.00 "	"$4,702.70"	$0.00	"$5,084.00"	"$2,859.75"	"$2,859.75"	$0.00	$0.00	$0.00	"$1,324.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,324.38"	$0.00	"$3,133.02"	"$3,133.02"	$0.00	"$3,177.50"	"$5,033.16"	"$5,084.00"	$0.00		$0.00	$994.56	$0.00	$0.00	"$1,011.72"	$0.00	$0.00	$0.00	$0.00	$0.00
7906355	SUP	HCPCS C1713		7906355  -  ROD SPNL 3.5-5.5MM VUEPOINT TRNS	BOTH IP/OP	"$1,830.00 "	"$1,354.20"	$0.00	"$1,464.00"	$823.50	$823.50	$0.00	$0.00	$0.00	$381.42	"$1,358.23"	"$1,358.23"	$0.00	$0.00	$381.37	$0.00	"$1,082.45"	"$1,082.45"	$0.00	$915.00	"$1,449.36"	"$1,464.00"	$0.00		$0.00	$286.40	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$0.00
7906356	SUP	HCPCS C1713		7906356  -  SCREW BONE 5MM 6MM VUEPOINT POST CERV SPN OCCPTL CORT SYS	BOTH IP/OP	$680.00 	$503.20	$0.00	$544.00	$306.00	$306.00	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$340.00	$538.56	$544.00	$0.00		$0.00	$106.42	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00
7906358	SUP	HCPCS C1713		7906358  -  SCREW BONE 5MM 8MM VUEPOINT POST CERV SPN OCCPTL CORT SYS	BOTH IP/OP	$680.00 	$503.20	$0.00	$544.00	$306.00	$306.00	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$340.00	$538.56	$544.00	$0.00		$0.00	$106.42	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00
7906360	SUP	HCPCS C1713		7906360  -  SCREW BONE 5MM 10MM LEFT OCCPTL CORT	BOTH IP/OP	$680.00 	$503.20	$0.00	$544.00	$306.00	$306.00	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$340.00	$538.56	$544.00	$0.00		$0.00	$106.42	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00
7906362	SUP	HCPCS C1713		7906362  -  SCREW BONE 5MM 12MM VUEPOINT POST CERV SPN CORT OCCPTL SYS	BOTH IP/OP	$680.00 	$503.20	$0.00	$544.00	$306.00	$306.00	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$340.00	$538.56	$544.00	$0.00		$0.00	$106.42	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00
7906364	SUP	HCPCS C1713		7906364  -  SCREW BONE 5MM 14MM CORT OCCPTL	BOTH IP/OP	$680.00 	$503.20	$0.00	$544.00	$306.00	$306.00	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$340.00	$538.56	$544.00	$0.00		$0.00	$106.42	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00
7906435	SUP	HCPCS C1713		7906435  -  CONCTR ROD 35MM OFFST	BOTH IP/OP	"$1,830.00 "	"$1,354.20"	$0.00	"$1,464.00"	$823.50	$823.50	$0.00	$0.00	$0.00	$381.42	"$1,358.23"	"$1,358.23"	$0.00	$0.00	$381.37	$0.00	"$1,082.45"	"$1,082.45"	$0.00	$915.00	"$1,449.36"	"$1,464.00"	$0.00		$0.00	$286.40	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$0.00
7906445	SUP	HCPCS C1713		7906445  -  CONCTR ROD 4.5MM 3.5MM OFFST	BOTH IP/OP	"$1,830.00 "	"$1,354.20"	$0.00	"$1,464.00"	$823.50	$823.50	$0.00	$0.00	$0.00	$381.42	"$1,358.23"	"$1,358.23"	$0.00	$0.00	$381.37	$0.00	"$1,082.45"	"$1,082.45"	$0.00	$915.00	"$1,449.36"	"$1,464.00"	$0.00		$0.00	$286.40	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$0.00
7906455	SUP	HCPCS C1713		7906455  -  CONCTR ROD 5.5MM 3.5MM OFFST	BOTH IP/OP	"$1,830.00 "	"$1,354.20"	$0.00	"$1,464.00"	$823.50	$823.50	$0.00	$0.00	$0.00	$381.42	"$1,358.23"	"$1,358.23"	$0.00	$0.00	$381.37	$0.00	"$1,082.45"	"$1,082.45"	$0.00	$915.00	"$1,449.36"	"$1,464.00"	$0.00		$0.00	$286.40	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$0.00
7906465	SUP	HCPCS C1713		7906465  -  CONCTR ROD 6.25MM 3.5MM OFFST	BOTH IP/OP	"$1,830.00 "	"$1,354.20"	$0.00	"$1,464.00"	$823.50	$823.50	$0.00	$0.00	$0.00	$381.42	"$1,358.23"	"$1,358.23"	$0.00	$0.00	$381.37	$0.00	"$1,082.45"	"$1,082.45"	$0.00	$915.00	"$1,449.36"	"$1,464.00"	$0.00		$0.00	$286.40	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$0.00
7907010	SUP	Custom 27203010		7907010  -  BIT DRILL 2.05MM SYSTEM VUEPOINT POSTERIOR CERV SPN	BOTH IP/OP	$647.50 	$479.15	$0.00	$518.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$480.57	$480.57	$0.00	$0.00	$134.94	$0.00	$0.00	$0.00	$0.00	$323.75	$512.82	$518.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7907012	SUP	Custom 27203010		7907012  -  BIT DRILL 2.5MM	BOTH IP/OP	$647.50 	$479.15	$0.00	$518.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$480.57	$480.57	$0.00	$0.00	$134.94	$0.00	$0.00	$0.00	$0.00	$323.75	$512.82	$518.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7907220	SUP	HCPCS C1713		7907220  -  TEMPLATE SZ 120MM ROD	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$61.88	$61.88	$0.00	$0.00	$0.00	$28.66	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$81.33	$81.33	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$21.52	$0.00	$0.00	$21.89	$0.00	$0.00	$0.00	$0.00	$0.00
7907240	SUP	HCPCS C1713		7907240  -  TMPLT ROD 240MM VUEPOINT POST CERV SPN	BOTH IP/OP	$157.50 	$116.55	$0.00	$126.00	$70.88	$70.88	$0.00	$0.00	$0.00	$32.83	$116.90	$116.90	$0.00	$0.00	$32.82	$0.00	$93.16	$93.16	$0.00	$78.75	$124.74	$126.00	$0.00		$0.00	$24.65	$0.00	$0.00	$25.07	$0.00	$0.00	$0.00	$0.00	$0.00
7908300	SUP	HCPCS C1713		7908300  -  ROD SPNL VUEPOINT 45D COCR BNT	BOTH IP/OP	"$1,680.00 "	"$1,243.20"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$350.15	"$1,246.90"	"$1,246.90"	$0.00	$0.00	$350.11	$0.00	$993.72	$993.72	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$262.92	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
7908355	SUP	HCPCS C1713		7908355  -  ROD TRANSITION COCR 5.5 MM	BOTH IP/OP	"$3,150.00 "	"$2,331.00"	$0.00	"$2,520.00"	"$1,417.50"	"$1,417.50"	$0.00	$0.00	$0.00	$656.54	"$2,337.93"	"$2,337.93"	$0.00	$0.00	$656.46	$0.00	"$1,552.95"	"$1,552.95"	$0.00	"$1,575.00"	"$2,494.80"	"$2,520.00"	$0.00		$0.00	$492.98	$0.00	$0.00	$501.48	$0.00	$0.00	$0.00	$0.00	$0.00
7965520	SUP	HCPCS C1713		7965520  -  SCREW 7965520 5.5MM X 20MM SELF TAP	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7965525	SUP	HCPCS C1713		7965525  -  SCREW 7965525 5.5MM X 25MM SELF TAP	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7965530	SUP	HCPCS C1713		7965530  -  SCREW 7965530 5.5MM X 30MM SELF TAP	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7965535	SUP	HCPCS C1713		7965535  -  SCREW 7965535 5.5MM X 35MM SELF TAP	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7966020	SUP	HCPCS C1713		7966020  -  SCREW 7966020 6.0MM X 20MM SELF TAP	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7966025	SUP	HCPCS C1713		7966025  -  SCREW 7966025 6.0MM X 25MM SELF TAP	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7966030	SUP	HCPCS C1713		7966030  -  SCREW 7966030 6.0MM X 30MM SELF TAP	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7966035	SUP	HCPCS C1713		7966035  -  SCREW 7966035 6.0MM X 35MM SELF TAP	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7967210	SUP	HCPCS C1713		7967210  -  SPACER SPNL 12D SM 32X23X10MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7967212	SUP	HCPCS C1713		7967212  -  SPACER SPNL 12D SM 32X23X12MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7967214	SUP	HCPCS C1713		7967214  -  SPACER SPNL 12D SM 32X23X14MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7967216	SUP	HCPCS C1713		7967216  -  SPACER SPNL 12D SM 32X23X16MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7967218	SUP	HCPCS C1713		7967218  -  SPACER SPNL 12D SM 32X23X18MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7967220	SUP	HCPCS C1713		7967220  -  SPACER SPNL 12D SM 32X23X20MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7967810	SUP	HCPCS C1713		7967810  -  SPACER SPNL 8D SM 32X23X10MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7967812	SUP	HCPCS C1713		7967812  -  SPACER SPNL 8D SM 32X23X12MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7967814	SUP	HCPCS C1713		7967814  -  SPACER SPNL 8D SM 32X23X14MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7967816	SUP	HCPCS C1713		7967816  -  SPACER SPNL 8D SM 32X23X16MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7967818	SUP	HCPCS C1713		7967818  -  SPACER SPNL 8D SM 32X23X18MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7967820	SUP	HCPCS C1713		7967820  -  SPACER SPNL 8D SM 32X23X20MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7968210	SUP	HCPCS C1713		7968210  -  SPACER SPNL 12D MED 37X27X10MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7968212	SUP	HCPCS C1713		7968212  -  SPACER SPNL 12D MED 37X27X12MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7968214	SUP	HCPCS C1713		7968214  -  SPACER SPNL 12D MED 37X27X14MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7968216	SUP	HCPCS C1713		7968216  -  SPACER SPNL 12D MED 37X27X16MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7968218	SUP	HCPCS C1713		7968218  -  SPACER SPNL 12D MED 37X27X18MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7968220	SUP	HCPCS C1713		7968220  -  SPACER SPNL 12D MED 37X27X20MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7968810	SUP	HCPCS C1713		7968810  -  SPACER SPNL 8D MED 37X27X10MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7968812	SUP	HCPCS C1713		7968812  -  SPACER SPNL 8D MED 37X27X12MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7968814	SUP	HCPCS C1713		7968814  -  SPACER SPNL 8D MED 37X27X14MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7968816	SUP	HCPCS C1713		7968816  -  SPACER SPNL 8D MED 37X27X16MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7968818	SUP	HCPCS C1713		7968818  -  SPACER SPNL 8D MED 37X27X18MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7968820	SUP	HCPCS C1713		7968820  -  SPACER SPNL 8D MED 37X27X20MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7969210	SUP	HCPCS C1713		7969210  -  SPACER SPNL 12D LG 42X30X10MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7969212	SUP	HCPCS C1713		7969212  -  SPACER SPNL 12D LG 42X30X12MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7969214	SUP	HCPCS C1713		7969214  -  SPACER SPNL 12D LG 42X30X14MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7969216	SUP	HCPCS C1713		7969216  -  SPACER SPNL 12D LG 42X30X16MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7969218	SUP	HCPCS C1713		7969218  -  SPACER SPNL 12D LG 42X30X18MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7969220	SUP	HCPCS C1713		7969220  -  SPACER SPNL 12D LG 42X30X20MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7969810	SUP	HCPCS C1713		7969810  -  SPACER SPNL 8D LG 42X30X10MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7969812	SUP	HCPCS C1713		7969812  -  SPACER SPNL 8D LG 42X30X12MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7969814	SUP	HCPCS C1713		7969814  -  SPACER SPNL 8D LG 42X30X14MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7969816	SUP	HCPCS C1713		7969816  -  SPACER SPNL 8D LG 42X30X16MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7969818	SUP	HCPCS C1713		7969818  -  SPACER SPNL 8D LG 42X30X18MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7969820	SUP	HCPCS C1713		7969820  -  SPACER SPNL 8D LG 42X30X20MM STRL CRSNT SVRGN CVR PLT PEEK	BOTH IP/OP	"$14,190.00 "	"$10,500.60"	$0.00	"$11,352.00"	"$6,385.50"	"$6,385.50"	$0.00	$0.00	$0.00	"$2,957.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.20"	$0.00	"$6,995.67"	"$6,995.67"	$0.00	"$7,095.00"	"$11,238.48"	"$11,352.00"	$0.00		$0.00	"$2,220.74"	$0.00	$0.00	"$2,259.05"	$0.00	$0.00	$0.00	$0.00	$0.00
7975520	SUP	HCPCS C1713		7975520  -  SCREW 7975520 SOVEREIGN FA  5.5 X 20MM	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7975525	SUP	HCPCS C1713		7975525  -  SCREW 7975525 SOVEREIGN FA 5.5 X 25MM	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7975530	SUP	HCPCS C1713		7975530  -  SCREW 7975530 SOVEREIGN FA 5.5 X 30MM	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7975535	SUP	HCPCS C1713		7975535  -  SCREW 7975535 SOVEREIGN FA 5.5 X 35MM	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7976020	SUP	HCPCS C1713		7976020  -  SCREW 7976020 SOVEREIGN FA 6.0 X 20MM	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7976025	SUP	HCPCS C1713		7976025  -  SCREW 7976025 SOVEREIGN FA 6.0 X 25MM	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7976030	SUP	HCPCS C1713		7976030  -  SCREW 7976030 SOVEREIGN FA 6.0 X 30MM	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
7976035	SUP	HCPCS C1713		7976035  -  SCREW 7976035 SOVEREIGN FA 6.0 X 35MM	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
8001501	SUP	Custom 27203010		8001501  -  TRAY 8001501 CRANI FIX 1.5 MM ST	BOTH IP/OP	"$4,636.75 "	"$3,431.20"	$0.00	"$3,709.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,441.40"	"$3,441.40"	$0.00	$0.00	$966.30	$0.00	$0.00	$0.00	$0.00	"$2,318.38"	"$3,672.31"	"$3,709.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8001505	SUP	HCPCS C1713		8001505  -  CADDY 8001505 SCREW CRANI FIX 1.5MM ST	BOTH IP/OP	"$1,177.25 "	$871.17	$0.00	$941.80	$529.76	$529.76	$0.00	$0.00	$0.00	$245.37	$873.75	$873.75	$0.00	$0.00	$245.34	$0.00	$696.34	$696.34	$0.00	$588.63	$932.38	$941.80	$0.00		$0.00	$184.24	$0.00	$0.00	$187.42	$0.00	$0.00	$0.00	$0.00	$0.00
8001601	SUP	HCPCS C1713		8001601  -  CADDY 8001601 SCREW 1.6 SDS	BOTH IP/OP	$930.75 	$688.76	$0.00	$744.60	$418.84	$418.84	$0.00	$0.00	$0.00	$193.99	$690.80	$690.80	$0.00	$0.00	$193.97	$0.00	$550.54	$550.54	$0.00	$465.38	$737.15	$744.60	$0.00		$0.00	$145.66	$0.00	$0.00	$148.18	$0.00	$0.00	$0.00	$0.00	$0.00
8001602	SUP	Custom 27203010		8001602  -  TRAY 8001602 CRANI FIX 1.6MM SD	BOTH IP/OP	"$4,636.75 "	"$3,431.20"	$0.00	"$3,709.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,441.40"	"$3,441.40"	$0.00	$0.00	$966.30	$0.00	$0.00	$0.00	$0.00	"$2,318.38"	"$3,672.31"	"$3,709.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8001605	SUP	HCPCS C1713		8001605  -  CADDY 8001605 CRANI FIX SCRW 1.6MM SD	BOTH IP/OP	"$1,247.38 "	$923.06	$0.00	$997.90	$561.32	$561.32	$0.00	$0.00	$0.00	$259.98	$925.80	$925.80	$0.00	$0.00	$259.95	$0.00	$737.82	$737.82	$0.00	$623.69	$987.92	$997.90	$0.00		$0.00	$195.21	$0.00	$0.00	$198.58	$0.00	$0.00	$0.00	$0.00	$0.00
8001830	SUP	HCPCS C1713		8001830  -  SCREW BONE 1.8MM 3MM RSC TI SPNL	BOTH IP/OP	$119.35 	$88.32	$0.00	$95.48	$53.71	$53.71	$0.00	$0.00	$0.00	$24.88	$88.58	$88.58	$0.00	$0.00	$24.87	$0.00	$70.60	$70.60	$0.00	$59.68	$94.53	$95.48	$0.00		$0.00	$18.68	$0.00	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$0.00
8002635	SUP	HCPCS C1713		8002635  -  SCREW BONE 1.6MM 3.5MM TIMESH TI CRANIAL SLFDRILL STRL	BOTH IP/OP	$126.08 	$93.30	$0.00	$100.87	$56.74	$56.74	$0.00	$0.00	$0.00	$26.28	$93.58	$93.58	$0.00	$0.00	$26.28	$0.00	$74.58	$74.58	$0.00	$63.04	$99.86	$100.87	$0.00		$0.00	$19.73	$0.00	$0.00	$20.07	$0.00	$0.00	$0.00	$0.00	$0.00
8004200	SUP	Custom 27203010		8004200  -  BPD TRAY	BOTH IP/OP	$896.75 	$663.60	$0.00	$717.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$665.57	$665.57	$0.00	$0.00	$186.88	$0.00	$0.00	$0.00	$0.00	$448.38	$710.23	$717.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8009000	SUP	Custom 27803010		8009000  -  BASE 8009000 TRAY CRANI FIX 1.5/1.6MM	BOTH IP/OP	"$1,544.88 "	"$1,143.21"	$0.00	"$1,235.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,146.61"	"$1,146.61"	$0.00	$0.00	$321.95	$0.00	$0.00	$0.00	$0.00	$772.44	"$1,223.54"	"$1,235.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8009002	SUP	HCPCS C1713		8009002  -  CADDY 8009002 PLATE CRANI FIX 1.5/1.6MM	BOTH IP/OP	$773.50 	$572.39	$0.00	$618.80	$348.08	$348.08	$0.00	$0.00	$0.00	$161.22	$574.09	$574.09	$0.00	$0.00	$161.20	$0.00	$457.53	$457.53	$0.00	$386.75	$612.61	$618.80	$0.00		$0.00	$121.05	$0.00	$0.00	$123.14	$0.00	$0.00	$0.00	$0.00	$0.00
8009220	SUP	Custom 27803010		8009220  -  BASE 8009220 TRAY COMBO CRANI FIX SYS	BOTH IP/OP	$809.63 	$599.13	$0.00	$647.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$600.90	$600.90	$0.00	$0.00	$168.73	$0.00	$0.00	$0.00	$0.00	$404.81	$641.23	$647.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8010050	SUP	Custom 27203010		8010050  -  ELECTRODE EEG 2 NDL MNTR PK SPNE	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$0.00	$0.00	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8011830	SUP	HCPCS C1713		8011830  -  SCREW 8011830 RESCUE SDS 1.8X3MM 1	BOTH IP/OP	$140.25 	$103.79	$0.00	$112.20	$63.11	$63.11	$0.00	$0.00	$0.00	$29.23	$104.09	$104.09	$0.00	$0.00	$29.23	$0.00	$82.96	$82.96	$0.00	$70.13	$111.08	$112.20	$0.00		$0.00	$21.95	$0.00	$0.00	$22.33	$0.00	$0.00	$0.00	$0.00	$0.00
8011850	SUP	HCPCS C1713		8011850  -  SCREW 8011850 RESCUE SDS 1.8X5MM 1	BOTH IP/OP	$140.25 	$103.79	$0.00	$112.20	$63.11	$63.11	$0.00	$0.00	$0.00	$29.23	$104.09	$104.09	$0.00	$0.00	$29.23	$0.00	$82.96	$82.96	$0.00	$70.13	$111.08	$112.20	$0.00		$0.00	$21.95	$0.00	$0.00	$22.33	$0.00	$0.00	$0.00	$0.00	$0.00
8012635	SUP	HCPCS C1713		8012635  -  SCREW 8012635 CRUCIATE SDS 1.6X3.5MM 1	BOTH IP/OP	$142.38 	$105.36	$0.00	$113.90	$64.07	$64.07	$0.00	$0.00	$0.00	$29.67	$105.67	$105.67	$0.00	$0.00	$29.67	$0.00	$84.21	$84.21	$0.00	$71.19	$112.76	$113.90	$0.00		$0.00	$22.28	$0.00	$0.00	$22.67	$0.00	$0.00	$0.00	$0.00	$0.00
8012640	SUP	HCPCS C1713		8012640  -  SCREW 8012640 CRUCIATE SDS 1.6X4MM 1	BOTH IP/OP	$142.38 	$105.36	$0.00	$113.90	$64.07	$64.07	$0.00	$0.00	$0.00	$29.67	$105.67	$105.67	$0.00	$0.00	$29.67	$0.00	$84.21	$84.21	$0.00	$71.19	$112.76	$113.90	$0.00		$0.00	$22.28	$0.00	$0.00	$22.67	$0.00	$0.00	$0.00	$0.00	$0.00
8020016	SUP	Custom 27011340		8020016  -  PROBE EMG M5 MOD	BOTH IP/OP	"$3,377.50 "	"$2,499.35"	$0.00	"$2,702.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,506.78"	"$2,506.78"	$0.00	$0.00	$703.87	$0.00	$0.00	$0.00	$0.00	"$1,688.75"	"$2,674.98"	"$2,702.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8020018	SUP	Custom 27203010		8020018  -  ELECTRODE EMG SRFC MOD CLIP NVM5	BOTH IP/OP	"$3,377.50 "	"$2,499.35"	$0.00	"$2,702.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,506.78"	"$2,506.78"	$0.00	$0.00	$703.87	$0.00	$0.00	$0.00	$0.00	"$1,688.75"	"$2,674.98"	"$2,702.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8020020	SUP	Custom 27203010		8020020  -  ELECTRODE EMG NRVSN MOD CLIP PRB	BOTH IP/OP	"$4,140.00 "	"$3,063.60"	$0.00	"$3,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,072.71"	"$3,072.71"	$0.00	$0.00	$862.78	$0.00	$0.00	$0.00	$0.00	"$2,070.00"	"$3,278.88"	"$3,312.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8020021	SUP	Custom 27203010		8020021  -  ELECTRODE EMG MOD CLIP SHTH NVM5	BOTH IP/OP	"$3,367.50 "	"$2,491.95"	$0.00	"$2,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,499.36"	"$2,499.36"	$0.00	$0.00	$701.79	$0.00	$0.00	$0.00	$0.00	"$1,683.75"	"$2,667.06"	"$2,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8020029	SUP	Custom 27203010		8020029  -  KIT EMG XLIF NVM5	BOTH IP/OP	"$4,442.50 "	"$3,287.45"	$0.00	"$3,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,297.22"	"$3,297.22"	$0.00	$0.00	$925.82	$0.00	$0.00	$0.00	$0.00	"$2,221.25"	"$3,518.46"	"$3,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8020215	SUP	Custom 27203010		8020215  -  ELTRD EMG NRVSN MOD M5	BOTH IP/OP	"$3,572.50 "	"$2,643.65"	$0.00	"$2,858.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,651.51"	"$2,651.51"	$0.00	$0.00	$744.51	$0.00	$0.00	$0.00	$0.00	"$1,786.25"	"$2,829.42"	"$2,858.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8050015	SUP	Custom 27203010		8050015  -  ELECTRODE EMG 15MM NEEDLE MODULE PROBE NEUROVISION M5	BOTH IP/OP	"$2,687.50 "	"$1,988.75"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,994.66"	"$1,994.66"	$0.00	$0.00	$560.08	$0.00	$0.00	$0.00	$0.00	"$1,343.75"	"$2,128.50"	"$2,150.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8050016	SUP	Custom 27203010		8050016  -  MODULE EMG NDL PRB M5	BOTH IP/OP	"$3,377.50 "	"$2,499.35"	$0.00	"$2,702.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,506.78"	"$2,506.78"	$0.00	$0.00	$703.87	$0.00	$0.00	$0.00	$0.00	"$1,688.75"	"$2,674.98"	"$2,702.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8050018	SUP	Custom 27203010		8050018  -  MODULE SPNL M5 NDL EMG CLIP	BOTH IP/OP	"$3,377.50 "	"$2,499.35"	$0.00	"$2,702.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,506.78"	"$2,506.78"	$0.00	$0.00	$703.87	$0.00	$0.00	$0.00	$0.00	"$1,688.75"	"$2,674.98"	"$2,702.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8050020	SUP	Custom 27203010		8050020  -  ELECTRODE EMG 20MM NRVSN M5 NDL MOD PRB	BOTH IP/OP	"$4,140.00 "	"$3,063.60"	$0.00	"$3,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,072.71"	"$3,072.71"	$0.00	$0.00	$862.78	$0.00	$0.00	$0.00	$0.00	"$2,070.00"	"$3,278.88"	"$3,312.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8050021	SUP	Custom 27203010		8050021  -  MODULE SPNL M5 NDL EMG CLIP SHTH	BOTH IP/OP	"$3,367.50 "	"$2,491.95"	$0.00	"$2,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,499.36"	"$2,499.36"	$0.00	$0.00	$701.79	$0.00	$0.00	$0.00	$0.00	"$1,683.75"	"$2,667.06"	"$2,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8050029	SUP	Custom 27203010		8050029  -  MODULE SPNL M5 NDL EMG XLIF KT	BOTH IP/OP	"$4,442.50 "	"$3,287.45"	$0.00	"$3,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,297.22"	"$3,297.22"	$0.00	$0.00	$925.82	$0.00	$0.00	$0.00	$0.00	"$2,221.25"	"$3,518.46"	"$3,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8050215	SUP	Custom 27011340		8050215  -  ELECTRODE EMG 15MM NEEDLE MODULE PROBE NEUROVISION M5	BOTH IP/OP	"$3,572.50 "	"$2,643.65"	$0.00	"$2,858.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,651.51"	"$2,651.51"	$0.00	$0.00	$744.51	$0.00	$0.00	$0.00	$0.00	"$1,786.25"	"$2,829.42"	"$2,858.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8051100	SUP	HCPCS C1713		8051100  -  SCREW BONE 100MM TULIP TI LOCK CLOSE	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8052025	SUP	HCPCS C1713		8052025  -  ROD SPNL 25MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052030	SUP	HCPCS C1713		8052030  -  ROD SPNL 30MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052035	SUP	HCPCS C1713		8052035  -  ROD SPNL 35MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052040	SUP	HCPCS C1713		8052040  -  ROD SPNL 40MM 5.5MM ARMADA TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052045	SUP	HCPCS C1713		8052045  -  ROD SPNL 45MM 5.5MM ARMADA TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052050	SUP	HCPCS C1713		8052050  -  ROD SPNL 50MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052055	SUP	HCPCS C1713		8052055  -  ROD SPNL 55MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052060	SUP	HCPCS C1713		8052060  -  ROD SPNL 60MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052065	SUP	HCPCS C1713		8052065  -  ROD SPNL 65MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052070	SUP	HCPCS C1713		8052070  -  ROD SPNL 70MM 5.5MM PREBNT ARM15 CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052075	SUP	HCPCS C1713		8052075  -  ROD SPNL 75MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052080	SUP	HCPCS C1713		8052080  -  ROD SPNL 80MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052085	SUP	HCPCS C1713		8052085  -  ROD SPNL 85MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052090	SUP	HCPCS C1713		8052090  -  ROD SPNL 90MM 5.5MM PREBNT ARM15 CNV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052095	SUP	HCPCS C1713		8052095  -  ROD SPNL 95MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052100	SUP	HCPCS C1713		8052100  -  ROD SPNL 100MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052110	SUP	HCPCS C1713		8052110  -  ROD SPNL 110MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052120	SUP	HCPCS C1713		8052120  -  ROD SPNL 120MM 5.5MM TI PREBNT ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8052200	SUP	HCPCS C1713		8052200  -  ROD SPNL PREBNT 5.5MM 200MM ARMADA TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8060040	SUP	Custom 27011340		8060040  -  PLANER SRG NUVAMAP	BOTH IP/OP	"$2,990.00 "	"$2,212.60"	$0.00	"$2,392.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,219.18"	"$2,219.18"	$0.00	$0.00	$623.12	$0.00	$0.00	$0.00	$0.00	"$1,495.00"	"$2,368.08"	"$2,392.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8100845	SUP	HCPCS C1713		8100845  -  SCREW 8100845 BREAKOFF SET SCRW 10-32	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8100855	SUP	HCPCS C1713		8100855  -  SCREW 8100855  BREAKOFF SET 12 32	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8103500	SUP	HCPCS C1713		"8103500  -  SETSCREW, SS, FOR 3.5MM X10"	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8103513	SUP	HCPCS C1713		8103513  -  CROSSLINK 8103513 X10 FOR 3.5ROD L 13	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8103517	SUP	HCPCS C1713		8103517  -  CROSSLINK 8103517 X10 FOR 3.5ROD L 17	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8103521	SUP	HCPCS C1713		8103521  -  CROSSLINK 8103521 X10 FOR 3.5ROD L 21	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8103525	SUP	HCPCS C1713		8103525  -  CROSSLINK 8103525 X10 FOR 3.5ROD L 25	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8103529	SUP	HCPCS C1713		8103529  -  CROSSLINK 8103529 X10 FOR 3.5ROD L 29	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8103533	SUP	HCPCS C1713		8103533  -  CROSSLINK 8103533 X10 FOR 3.5ROD L 33	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8103537	SUP	HCPCS C1713		8103537  -  CROSSLINK 8103537 X10 FOR 3.5ROD L 37	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104516	SUP	HCPCS C1713		8104516  -  CROSSLINK 8104516 16MM X10 PLATE 4.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104519	SUP	HCPCS C1713		8104519  -  CROSSLINK 8104519 19MM X10 PLATE 4.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104522	SUP	HCPCS C1713		8104522  -  CROSSLINK 8104522 22MM X10 PLATE 4.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104525	SUP	HCPCS C1713		8104525  -  CROSSLINK 8104525 25MM X10 PLATE 4.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104528	SUP	HCPCS C1713		8104528  -  CROSSLINK 8104528 28MM X10 PLATE 4.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104531	SUP	HCPCS C1713		8104531  -  CROSSLINK 8104531 31MM X10 PLATE 4.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104534	SUP	HCPCS C1713		8104534  -  CROSSLINK 8104534 34MM X10 PLATE 4.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104537	SUP	HCPCS C1713		8104537  -  CROSSLINK 8104537 37MM X10 PLATE 4.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104540	SUP	HCPCS C1713		8104540  -  CROSSLINK 8104540 40MM X10 PLATE 4.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105516	SUP	HCPCS C1713		8105516  -  CROSSLINK 8105516 16MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105519	SUP	HCPCS C1713		8105519  -  CROSSLINK 8105519 19MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105522	SUP	HCPCS C1713		8105522  -  CROSSLINK 8105522 22MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105525	SUP	HCPCS C1713		8105525  -  CROSSLINK 8105525 25MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105527	SUP	HCPCS C1713		8105527  -  CROSSLINK 8105527 28MM FXD LP 5.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105528	SUP	HCPCS C1713		8105528  -  CROSSLINK 8105528 28TO30MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105530	SUP	HCPCS C1713		8105530  -  CROSSLINK 8105530 30TO34MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105531	SUP	HCPCS C1713		8105531  -  CROSSLINK 8105531 31MM FXD LP 5.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105534	SUP	HCPCS C1713		8105534  -  CROSSLINK 8105534 34TO36MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105536	SUP	HCPCS C1713		8105536  -  CROSSLINK 8105536 36TO39MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105539	SUP	HCPCS C1713		8105539  -  CROSSLINK 8105539 39TO45MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105545	SUP	HCPCS C1713		8105545  -  CROSSLINK 8105545 45TO58MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8105558	SUP	HCPCS C1713		8105558  -  CROSSLINK 8105558 58TO80MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106416	SUP	HCPCS C1713		8106416  -  CROSSLINK 8106416 16MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106419	SUP	HCPCS C1713		8106419  -  CROSSLINK 8106419 19MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106422	SUP	HCPCS C1713		8106422  -  CROSSLINK 8106422 22MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106425	SUP	HCPCS C1713		8106425  -  CROSSLINK 8106425 25MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106427	SUP	HCPCS C1713		8106427  -  CROSSLINK 8106427 28MM FXD LP 6.35 SS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106428	SUP	HCPCS C1713		8106428  -  CROSSLINK 8106428 28TO30MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106430	SUP	HCPCS C1713		8106430  -  CROSSLINK 8106430 30TO34MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106431	SUP	HCPCS C1713		8106431  -  CROSSLINK 8106431 31MM FXD LP 6.35 SS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106434	SUP	HCPCS C1713		8106434  -  CROSSLINK 8106434 34TO36MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106436	SUP	HCPCS C1713		8106436  -  CROSSLINK 8106436 36TO39MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106439	SUP	HCPCS C1713		8106439  -  CROSSLINK 8106439 39TO45MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106445	SUP	HCPCS C1713		8106445  -  CROSSLINK 8106445 45TO58MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8106458	SUP	HCPCS C1713		8106458  -  CROSSLINK 8106458 58TO80MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8110450	SUP	HCPCS C1713		8110450  -  SCREW 8110450 NA LP CROSSLINK SET  TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8110614	SUP	HCPCS C1713		8110614  -  PLATE 14MM TI FIX CD HZN ANTARES XLNK BONE SPNL	BOTH IP/OP	"$4,155.00 "	"$3,074.70"	$0.00	"$3,324.00"	"$1,869.75"	"$1,869.75"	$0.00	$0.00	$0.00	$866.01	"$3,083.84"	"$3,083.84"	$0.00	$0.00	$865.90	$0.00	"$2,048.42"	"$2,048.42"	$0.00	"$2,077.50"	"$3,290.76"	"$3,324.00"	$0.00		$0.00	$650.26	$0.00	$0.00	$661.48	$0.00	$0.00	$0.00	$0.00	$0.00
8110713	SUP	HCPCS C1713		8110713  -  CROSSLINK 8110713 ANTERIOR 13MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8110714	SUP	HCPCS C1713		8110714  -  CROSSLINK 8110714 ANTERIOR 14MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8110715	SUP	HCPCS C1713		8110715  -  CROSSLINK 8110715 ANTERIOR 15MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8110716	SUP	HCPCS C1713		8110716  -  CROSSLINK 8110716 ANTERIOR 16MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8110717	SUP	HCPCS C1713		8110717  -  CROSSLINK 8110717 ANTERIOR 17MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8110718	SUP	HCPCS C1713		8110718  -  CROSSLINK 8110718 ANTERIOR 18MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8110719	SUP	HCPCS C1713		8110719  -  CROSSLINK 8110719 ANTERIOR 19MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8110845	SUP	HCPCS C1713		8110845  -  SCREW 8110845 BREAKOFF SET SCREW 10-32TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8110855	SUP	HCPCS C1713		8110855  -  SCREW SET TI 12-32MM 5.5MM SPNL BRKOF X10 XLNK	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8113500	SUP	HCPCS C1713		"8113500  -  SETSCREW, TI, FOR 3.5MM X10"	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8113513	SUP	HCPCS C1713		8113513  -  CROSSLINK 8113513 X10 FOR 3.5ROD L 13	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8113517	SUP	HCPCS C1713		8113517  -  CROSSLINK 8113517 X10 FOR 3.5ROD L 17	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8113521	SUP	HCPCS C1713		8113521  -  CROSSLINK 8113521 X10 FOR 3.5ROD L 21	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8113525	SUP	HCPCS C1713		8113525  -  CROSSLINK 8113525 X10 FOR 3.5ROD L 25	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8113529	SUP	HCPCS C1713		8113529  -  CROSSLINK 8113529 X10 FOR 3.5ROD L 29	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8113533	SUP	HCPCS C1713		8113533  -  CROSSLINK 8113533 X10 FOR 3.5ROD L 33	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8113537	SUP	HCPCS C1713		8113537  -  CROSSLINK 8113537 X10 FOR 3.5ROD L 37	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114516	SUP	HCPCS C1713		8114516  -  CROSSLINK 8114516 16MM X10 PLATE 4.5 TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114519	SUP	HCPCS C1713		8114519  -  CROSSLINK 8114519 19MM X10 PLATE 4.5 TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114522	SUP	HCPCS C1713		8114522  -  CROSSLINK 8114522 22MM X10 PLATE 4.5 TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114525	SUP	HCPCS C1713		8114525  -  CROSSLINK 8114525 25MM X10 PLT 4.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114528	SUP	HCPCS C1713		8114528  -  CROSSLINK 8114528 28MM X10 PLATE 4.5 TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114531	SUP	HCPCS C1713		8114531  -  CROSSLINK 8114531 31MM X10 PLATE 4.5 TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114534	SUP	HCPCS C1713		8114534  -  CROSSLINK 8114534 34MM X10 PLATE 4.5 TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114537	SUP	HCPCS C1713		8114537  -  CROSSLINK 8114537 37MM X10 PLATE 4.5 TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114540	SUP	HCPCS C1713		8114540  -  CROSSLINK 8114540 40MM X10 PLATE 4.5 TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115516	SUP	HCPCS C1713		8115516  -  PLATE BN 16MM STRL LG X10 XLNK CD HZN LOPRFL FX TI SPNE 5.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115519	SUP	HCPCS C1713		8115519  -  PLATE BN 19MM STRL LG X10 XLNK CD HZN LOPRFL FX TI SPNE 5.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115522	SUP	HCPCS C1713		8115522  -  CROSSLINK 8115522 22MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115525	SUP	HCPCS C1713		8115525  -  PLATE BN 25MM STRL LG X10 XLNK CD HZN LOPRFL FX TI SPNE 5.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115527	SUP	HCPCS C1713		8115527  -  CROSSLINK 8115527 28MM FXD LP TI 5.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115528	SUP	HCPCS C1713		8115528  -  PLATE BN 28-30MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115530	SUP	HCPCS C1713		8115530  -  PLATE BN 30-34MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115531	SUP	HCPCS C1713		8115531  -  CROSSLINK 8115531 31MM FXD LP TI 5.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115534	SUP	HCPCS C1713		8115534  -  PLATE BN 34-36MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115536	SUP	HCPCS C1713		8115536  -  PLATE BN 36-39MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115539	SUP	HCPCS C1713		8115539  -  PLATE BN 39-45MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115545	SUP	HCPCS C1713		8115545  -  PLATE BN 45-58MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8115558	SUP	HCPCS C1713		8115558  -  PLATE BN 58-81MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116416	SUP	HCPCS C1713		8116416  -  CROSSLINK 8116416 16MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116419	SUP	HCPCS C1713		8116419  -  CROSSLINK 8116419 19MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116422	SUP	HCPCS C1713		8116422  -  CROSSLINK 8116422 22MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116425	SUP	HCPCS C1713		8116425  -  CROSSLINK 8116425 25MM X10 FIXED	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116427	SUP	HCPCS C1713		8116427  -  CROSSLINK 8116427 28MM FXD L P 6 35TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116428	SUP	HCPCS C1713		8116428  -  CROSSLINK 8116428 28 30MM X10  MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116430	SUP	HCPCS C1713		8116430  -  CROSSLINK 8116430 30 34MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116431	SUP	HCPCS C1713		8116431  -  CROSSLINK 8116431 31MM FXD LP TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116434	SUP	HCPCS C1713		8116434  -  PLATE 34-36MM TI 6.35MM ROD MLSPN X10 XLNK BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116436	SUP	HCPCS C1713		8116436  -  CROSSLINK 8116436 36 39MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116439	SUP	HCPCS C1713		8116439  -  CROSSLINK 8116439 39 45MM X10 MULTI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116445	SUP	HCPCS C1713		8116445  -  PLATE 45-57MM TI 6.35MM ROD MLSPN X10 XLNK BONE SPNL STRL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8116458	SUP	HCPCS C1713		8116458  -  PLATE 58-80MM TI 6.35MM SCR MULTIAX X10 XLNK BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8151100	SUP	HCPCS C1713		8151100  -  SCREW BONE SS SPNL LCK CLOSE HEAD	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$340.88	$340.88	$0.00	$0.00	$0.00	$157.88	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$448.06	$448.06	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$118.55	$0.00	$0.00	$120.59	$0.00	$0.00	$0.00	$0.00	$0.00
8162102	SUP	HCPCS C1713		8162102  -  STAPLE 8162102  2MM X 9MM TWO PRONG SMA	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
8162103	SUP	HCPCS C1713		8162103  -  STAPLE 8162103  3MM X 9MM TWO PRONG SMA	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
8162104	SUP	HCPCS C1713		8162104  -  STAPLE 8162104  4MM X 10MM 2PRONG SMA	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
8162106	SUP	HCPCS C1713		8162106  -  STAPLE 8162106  6MM X 11MM 2PRONG SMA	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
8162108	SUP	HCPCS C1713		8162108  -  STAPLE 8162108  8MM X 12MM 2PRONG SMA	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
8162110	SUP	HCPCS C1713		8162110  -  STAPLE 8162110  10MM X 13MM 2PRONG SMA	BOTH IP/OP	"$1,972.50 "	"$1,459.65"	$0.00	"$1,578.00"	$887.63	$887.63	$0.00	$0.00	$0.00	$411.12	"$1,463.99"	"$1,463.99"	$0.00	$0.00	$411.07	$0.00	"$1,166.73"	"$1,166.73"	$0.00	$986.25	"$1,562.22"	"$1,578.00"	$0.00		$0.00	$308.70	$0.00	$0.00	$314.02	$0.00	$0.00	$0.00	$0.00	$0.00
8164604	SUP	HCPCS C1713		8164604  -  STAPLE 8164604  4MM X 10MM 4 PRONG SMA	BOTH IP/OP	"$6,300.65 "	"$4,662.48"	$0.00	"$5,040.52"	"$2,835.29"	"$2,835.29"	$0.00	$0.00	$0.00	"$1,313.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,313.06"	$0.00	"$3,106.22"	"$3,106.22"	$0.00	"$3,150.33"	"$4,990.11"	"$5,040.52"	$0.00		$0.00	$986.05	$0.00	$0.00	"$1,003.06"	$0.00	$0.00	$0.00	$0.00	$0.00
8164605	SUP	HCPCS C1713		8164605  -  STAPLE BONE 4 PR 10X5MM SPNL SMA	BOTH IP/OP	"$6,300.65 "	"$4,662.48"	$0.00	"$5,040.52"	"$2,835.29"	"$2,835.29"	$0.00	$0.00	$0.00	"$1,313.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,313.06"	$0.00	"$3,106.22"	"$3,106.22"	$0.00	"$3,150.33"	"$4,990.11"	"$5,040.52"	$0.00		$0.00	$986.05	$0.00	$0.00	"$1,003.06"	$0.00	$0.00	$0.00	$0.00	$0.00
8164606	SUP	HCPCS C1713		8164606  -  STAPLE 8164606  6MM X 11MM 4 PRONG SMA	BOTH IP/OP	"$6,300.65 "	"$4,662.48"	$0.00	"$5,040.52"	"$2,835.29"	"$2,835.29"	$0.00	$0.00	$0.00	"$1,313.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,313.06"	$0.00	"$3,106.22"	"$3,106.22"	$0.00	"$3,150.33"	"$4,990.11"	"$5,040.52"	$0.00		$0.00	$986.05	$0.00	$0.00	"$1,003.06"	$0.00	$0.00	$0.00	$0.00	$0.00
8164608	SUP	HCPCS C1713		8164608  -  STAPLE 8164608  8MM X 12MM 4 PRONG SMA	BOTH IP/OP	"$6,300.65 "	"$4,662.48"	$0.00	"$5,040.52"	"$2,835.29"	"$2,835.29"	$0.00	$0.00	$0.00	"$1,313.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,313.06"	$0.00	"$3,106.22"	"$3,106.22"	$0.00	"$3,150.33"	"$4,990.11"	"$5,040.52"	$0.00		$0.00	$986.05	$0.00	$0.00	"$1,003.06"	$0.00	$0.00	$0.00	$0.00	$0.00
8164610	SUP	HCPCS C1713		8164610  -  STAPLE 8164610  10MM X 13MM 4 PRONG SMA	BOTH IP/OP	"$6,300.65 "	"$4,662.48"	$0.00	"$5,040.52"	"$2,835.29"	"$2,835.29"	$0.00	$0.00	$0.00	"$1,313.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,313.06"	$0.00	"$3,106.22"	"$3,106.22"	$0.00	"$3,150.33"	"$4,990.11"	"$5,040.52"	$0.00		$0.00	$986.05	$0.00	$0.00	"$1,003.06"	$0.00	$0.00	$0.00	$0.00	$0.00
8164612	SUP	HCPCS C1713		8164612  -  STAPLE 8164612 12MMX14MM 4PRNG SMA	BOTH IP/OP	"$6,300.65 "	"$4,662.48"	$0.00	"$5,040.52"	"$2,835.29"	"$2,835.29"	$0.00	$0.00	$0.00	"$1,313.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,313.06"	$0.00	"$3,106.22"	"$3,106.22"	$0.00	"$3,150.33"	"$4,990.11"	"$5,040.52"	$0.00		$0.00	$986.05	$0.00	$0.00	"$1,003.06"	$0.00	$0.00	$0.00	$0.00	$0.00
8164614	SUP	HCPCS C1713		8164614  -  STAPLE 8164614 14MMX15MM 4PRNG SMA	BOTH IP/OP	"$6,300.65 "	"$4,662.48"	$0.00	"$5,040.52"	"$2,835.29"	"$2,835.29"	$0.00	$0.00	$0.00	"$1,313.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,313.06"	$0.00	"$3,106.22"	"$3,106.22"	$0.00	"$3,150.33"	"$4,990.11"	"$5,040.52"	$0.00		$0.00	$986.05	$0.00	$0.00	"$1,003.06"	$0.00	$0.00	$0.00	$0.00	$0.00
8200001	SUP	HCPCS C1713		8200001  -  CLIP SPNL LG NUVASIVE INC	BOTH IP/OP	"$2,282.50 "	"$1,689.05"	$0.00	"$1,826.00"	"$1,027.13"	"$1,027.13"	$0.00	$0.00	$0.00	$475.73	"$1,694.07"	"$1,694.07"	$0.00	$0.00	$475.67	$0.00	"$1,350.10"	"$1,350.10"	$0.00	"$1,141.25"	"$1,807.74"	"$1,826.00"	$0.00		$0.00	$357.21	$0.00	$0.00	$363.37	$0.00	$0.00	$0.00	$0.00	$0.00
8200003	SUP	HCPCS C1769		8200003  -  WIRE FX KRSH MAXCESS MOD	BOTH IP/OP	"$1,857.50 "	"$1,374.55"	$0.00	"$1,486.00"	"$1,008.62"	"$1,008.62"	$0.00	$0.00	$0.00	$387.15	"$1,378.64"	"$1,378.64"	$0.00	$0.00	$387.10	$0.00	"$1,098.71"	"$1,098.71"	$0.00	$928.75	"$1,471.14"	"$1,486.00"	$0.00		$0.00	$290.70	$0.00	$0.00	$295.71	$0.00	$0.00	$0.00	$0.00	$0.00
8200010	SUP	Custom 27203010		8200010  -  KIT SPNL STRL MAXCESS SHIM DISP	BOTH IP/OP	"$3,572.50 "	"$2,643.65"	$0.00	"$2,858.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,651.51"	"$2,651.51"	$0.00	$0.00	$744.51	$0.00	$0.00	$0.00	$0.00	"$1,786.25"	"$2,829.42"	"$2,858.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8200011	SUP	Custom 27203010		8200011  -  KIT SPNL STRL MAXCESS MOD DISP	BOTH IP/OP	"$5,115.00 "	"$3,785.10"	$0.00	"$4,092.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,796.35"	"$3,796.35"	$0.00	$0.00	"$1,065.97"	$0.00	$0.00	$0.00	$0.00	"$2,557.50"	"$4,051.08"	"$4,092.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8200200	SUP	HCPCS C1713		8200200  -  SCREW BN MA MOD TLIF SPNE DISP	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
8200201	SUP	HCPCS C1713		8200201  -  SCREW BN MA HP SHIM LGHT CBL SPNE TLIF	BOTH IP/OP	"$4,662.50 "	"$3,450.25"	$0.00	"$3,730.00"	"$2,098.13"	"$2,098.13"	$0.00	$0.00	$0.00	$971.78	"$3,460.51"	"$3,460.51"	$0.00	$0.00	$971.67	$0.00	"$2,298.61"	"$2,298.61"	$0.00	"$2,331.25"	"$3,692.70"	"$3,730.00"	$0.00		$0.00	$729.68	$0.00	$0.00	$742.27	$0.00	$0.00	$0.00	$0.00	$0.00
8200202	SUP	HCPCS C1713		8200202  -  SCREW BN MA MOD TLIF HP SHIM SPNE	BOTH IP/OP	"$3,575.00 "	"$2,645.50"	$0.00	"$2,860.00"	"$1,608.75"	"$1,608.75"	$0.00	$0.00	$0.00	$745.12	"$2,653.37"	"$2,653.37"	$0.00	$0.00	$745.03	$0.00	"$1,762.48"	"$1,762.48"	$0.00	"$1,787.50"	"$2,831.40"	"$2,860.00"	$0.00		$0.00	$559.49	$0.00	$0.00	$569.14	$0.00	$0.00	$0.00	$0.00	$0.00
8203030	SUP	Custom 27203010		8203030  -  AIRWAY PHARYNGEAL 3 SMALL 15MM CONCTR NONINFLATABLE CUFF	BOTH IP/OP	$23.05 	$17.06	$0.00	$28.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.11	$17.11	$0.00	$0.00	$4.80	$0.00	$0.00	$0.00	$0.00	$17.54	$27.78	$28.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8227103	SUP	HCPCS C1898		8227103  -  ELECTRODE EMG 4MM 12MM 2MM 2 CHANNEL NEEDLE LANCET TIP	BOTH IP/OP	$227.50 	$168.35	$0.00	$182.00	$102.38	$102.38	$0.00	$0.00	$0.00	$47.42	$168.85	$168.85	$0.00	$0.00	$47.41	$0.00	$134.57	$134.57	$0.00	$113.75	$180.18	$182.00	$0.00		$0.00	$35.60	$0.00	$0.00	$36.22	$0.00	$0.00	$0.00	$0.00	$0.00
8229507	SUP	Custom 27203010		8229507  -  TUBE ENDOTRACHEAL NIM STAINLESS STEEL PVC OD10.5 MM ID7.0 MM	BOTH IP/OP	$960.00 	$710.40	$0.00	$768.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.51	$712.51	$0.00	$0.00	$200.06	$0.00	$0.00	$0.00	$0.00	$480.00	$760.32	$768.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8229706	SUP	Custom 27803010		8229706  -  TUBE ENDOTRAC STANDARD LP 8.2MM 6MM DEPH FREE NONREINFORCED	BOTH IP/OP	"$1,014.13 "	$750.46	$0.00	$739.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$685.70	$685.70	$0.00	$0.00	$192.54	$0.00	$0.00	$0.00	$0.00	$461.94	$731.71	$739.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8229707	SUP	Custom 27803010		8229707  -  TUBE ENDOTRAC STANDARD LP 8.2MM 6MM DEPH FREE NONREINFORCED	BOTH IP/OP	"$1,014.13 "	$750.46	$0.00	$739.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$685.70	$685.70	$0.00	$0.00	$192.54	$0.00	$0.00	$0.00	$0.00	$461.94	$731.71	$739.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8229708	SUP	Custom 27803010		8229708  -  TUBE ENDOTRAC STANDARD LP 10.7MM 8MM DEPH FREE NONREINFORCED	BOTH IP/OP	$852.63 	$630.95	$0.00	$682.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.82	$632.82	$0.00	$0.00	$177.69	$0.00	$0.00	$0.00	$0.00	$426.31	$675.28	$682.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8240001	SUP	Custom 27203010		8240001  -  KIT SPINAL 4 MAXCESS	BOTH IP/OP	"$2,385.00 "	"$1,764.90"	$0.00	"$1,908.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,770.15"	"$1,770.15"	$0.00	$0.00	$497.03	$0.00	$0.00	$0.00	$0.00	"$1,192.50"	"$1,888.92"	"$1,908.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8240060	SUP	Custom 27203010		8240060  -  MODULE SPNL 4 MAXCESS	BOTH IP/OP	"$5,850.25 "	"$4,329.19"	$0.00	"$4,680.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,219.19"	$0.00	$0.00	$0.00	$0.00	"$2,925.13"	"$4,633.40"	"$4,680.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8240061	SUP	Custom 27203010		8240061  -  MODULE SPNL 4 MAXCESS SHIM	BOTH IP/OP	"$4,695.25 "	"$3,474.49"	$0.00	"$3,756.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,484.81"	"$3,484.81"	$0.00	$0.00	$978.49	$0.00	$0.00	$0.00	$0.00	"$2,347.63"	"$3,718.64"	"$3,756.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8275525	SUP	HCPCS C1713		8275525  -  SCREW BN 5.5MM 25MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8275530	SUP	HCPCS C1713		8275530  -  SCREW BN 5.5MM 30MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8275535	SUP	HCPCS C1713		8275535  -  SCREW BN 5.5MM 35MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8275540	SUP	HCPCS C1713		8275540  -  SCREW BONE 5.5MM 40MM REDX TITANIUM SPN 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8275545	SUP	HCPCS C1713		8275545  -  SCREW BN 5.5MM 45MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8275550	SUP	HCPCS C1713		8275550  -  SCREW BN 5.5MM 50MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8275555	SUP	HCPCS C1713		8275555  -  SCREW BN 5.5MM 55MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8276530	SUP	HCPCS C1713		8276530  -  SCREW BN 6.5MM 30MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8276535	SUP	HCPCS C1713		8276535  -  SCREW BN 6.5MM 35MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8276545	SUP	HCPCS C1713		8276545  -  SCREW BN 6.5MM 45MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8276555	SUP	HCPCS C1713		8276555  -  SCREW BN 6.5MM 55MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8277530	SUP	HCPCS C1713		8277530  -  SCREW BN 7.5MM 30MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8277535	SUP	HCPCS C1713		8277535  -  SCREW BN 7.5MM 35MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8277540	SUP	HCPCS C1713		8277540  -  SCREW BN 7.5MM 40MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8277550	SUP	HCPCS C1713		8277550  -  SCREW BN 7.5MM 50MM RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$3,257.50 "	"$2,410.55"	$0.00	"$2,606.00"	"$1,465.88"	"$1,465.88"	$0.00	$0.00	$0.00	$678.94	"$2,417.72"	"$2,417.72"	$0.00	$0.00	$678.86	$0.00	"$1,605.95"	"$1,605.95"	$0.00	"$1,628.75"	"$2,579.94"	"$2,606.00"	$0.00		$0.00	$509.80	$0.00	$0.00	$518.59	$0.00	$0.00	$0.00	$0.00	$0.00
8281190	SUP	HCPCS C1713		8281190  -  SCREW 8281190 TSRH .25 32 LOCK NON BREAK	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8281246	SUP	HCPCS C1713		8281246  -  SCREW 8281246 SET 3BDL HEX TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8281248	SUP	HCPCS C1713		8281248  -  SET SCREW 8281248 0.25 32 FLSH BRK LK TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8350424	SUP	Custom 27203010		8350424  -  TAP SURG OSTEOGRIP 5.5MM	BOTH IP/OP	$790.50 	$584.97	$0.00	$632.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$586.71	$586.71	$0.00	$0.00	$164.74	$0.00	$0.00	$0.00	$0.00	$395.25	$626.08	$632.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8350426	SUP	Custom 27203010		8350426  -  TAP SURG OSTEOGRIP 6.5MM	BOTH IP/OP	$790.50 	$584.97	$0.00	$632.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$586.71	$586.71	$0.00	$0.00	$164.74	$0.00	$0.00	$0.00	$0.00	$395.25	$626.08	$632.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8351500	SUP	HCPCS C1713		8351500  -  SET SCREW 8351500 TSRH 3DX FLUSH BREAK	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8351502	SUP	HCPCS C1713		8351502  -  SET SCREW 8351502 TSRH 3DX NON-BREAK	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8351520	SUP	Custom 27803010		8351520  -  CONNECTOR 8351520 TSRH 3DX SMALL	BOTH IP/OP	"$2,316.75 "	"$1,714.40"	$0.00	"$1,853.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,719.49"	"$1,719.49"	$0.00	$0.00	$482.81	$0.00	$0.00	$0.00	$0.00	"$1,158.38"	"$1,834.87"	"$1,853.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8351521	SUP	Custom 27803010		8351521  -  CONNECTOR 8351521 TSRH 3DX MEDIUM	BOTH IP/OP	"$2,316.75 "	"$1,714.40"	$0.00	"$1,853.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,719.49"	"$1,719.49"	$0.00	$0.00	$482.81	$0.00	$0.00	$0.00	$0.00	"$1,158.38"	"$1,834.87"	"$1,853.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8351522	SUP	Custom 27803010		8351522  -  CONNECTOR 8351522 TSRH 3DX LARGE	BOTH IP/OP	"$2,316.75 "	"$1,714.40"	$0.00	"$1,853.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,719.49"	"$1,719.49"	$0.00	$0.00	$482.81	$0.00	$0.00	$0.00	$0.00	"$1,158.38"	"$1,834.87"	"$1,853.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8351523	SUP	Custom 27803010		8351523  -  CONNECTOR 8351523 TSRH 3DX 90 DEG OFFSET	BOTH IP/OP	"$2,316.75 "	"$1,714.40"	$0.00	"$1,853.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,719.49"	"$1,719.49"	$0.00	$0.00	$482.81	$0.00	$0.00	$0.00	$0.00	"$1,158.38"	"$1,834.87"	"$1,853.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8352200	SUP	HCPCS C1713		8352200  -  ROD 5.5MM USS 200MM	BOTH IP/OP	"$2,017.50 "	"$1,492.95"	$0.00	"$1,614.00"	$907.88	$907.88	$0.00	$0.00	$0.00	$420.50	"$1,497.39"	"$1,497.39"	$0.00	$0.00	$420.45	$0.00	"$1,193.35"	"$1,193.35"	$0.00	"$1,008.75"	"$1,597.86"	"$1,614.00"	$0.00		$0.00	$315.74	$0.00	$0.00	$321.19	$0.00	$0.00	$0.00	$0.00	$0.00
8352300	SUP	HCPCS C1713		8352300  -  ROD 5.5MM USS 300MM	BOTH IP/OP	"$2,275.00 "	"$1,683.50"	$0.00	"$1,820.00"	"$1,023.75"	"$1,023.75"	$0.00	$0.00	$0.00	$474.17	"$1,688.51"	"$1,688.51"	$0.00	$0.00	$474.11	$0.00	"$1,345.66"	"$1,345.66"	$0.00	"$1,137.50"	"$1,801.80"	"$1,820.00"	$0.00		$0.00	$356.04	$0.00	$0.00	$362.18	$0.00	$0.00	$0.00	$0.00	$0.00
8352500	SUP	HCPCS C1713		8352500  -  ROD 5.5MM USS 500MM	BOTH IP/OP	"$2,502.50 "	"$1,851.85"	$0.00	"$2,002.00"	"$1,126.13"	"$1,126.13"	$0.00	$0.00	$0.00	$521.58	"$1,857.36"	"$1,857.36"	$0.00	$0.00	$521.52	$0.00	"$1,233.73"	"$1,233.73"	$0.00	"$1,251.25"	"$1,981.98"	"$2,002.00"	$0.00		$0.00	$391.64	$0.00	$0.00	$398.40	$0.00	$0.00	$0.00	$0.00	$0.00
8352510	SUP	Custom 27803010		8352510  -  CONNECTOR 8352510 5.5 SLOTTED TI	BOTH IP/OP	"$2,031.00 "	"$1,502.94"	$0.00	"$1,624.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,507.41"	"$1,507.41"	$0.00	$0.00	$423.26	$0.00	$0.00	$0.00	$0.00	"$1,015.50"	"$1,608.55"	"$1,624.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8354525	SUP	HCPCS C1713		8354525  -  SCREW BONE 4.5MM 25MM SS SPNL LCK 5.5MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8354530	SUP	HCPCS C1713		8354530  -  SCREW BONE 4.5MM 30MM SS SPNL LCK 5.5MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8354535	SUP	HCPCS C1713		8354535  -  SCREW BONE 4.5MM 35MM SS SPNL LCK 5.5MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8354540	SUP	HCPCS C1713		8354540  -  SCREW BONE 4.5MM 40MM SS SPNL LCK 5.5MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8355530	SUP	HCPCS C1713		8355530  -  SCREW BONE 5.5MM 30MM SS SPNL LCK 5.5MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8355535	SUP	HCPCS C1713		8355535  -  SCREW BONE 5.5MM 35MM SS SPNL LCK 5.5MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8355540	SUP	HCPCS C1713		8355540  -  SCREW BONE 5.5MM 40MM SS SPNL LCK 5.5MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8355545	SUP	HCPCS C1713		8355545  -  SCREW BONE 5.5MM 45MM SS SPNL LCK 5.5MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8356535	SUP	HCPCS C1713		8356535  -  SCREW BONE 6.5MM 35MM SS SPNL LCK 5.5MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8356540	SUP	HCPCS C1713		8356540  -  SCREW BONE 6.5MM 40MM SS SPNL LCK 5.5MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8356545	SUP	HCPCS C1713		8356545  -  SCREW BONE 6.5MM 45MM SS SPNL LCK 5.5MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8364525	SUP	HCPCS C1713		8364525  -  SCREW BONE 4.5MM 25MM SPNL LCK 6.35MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8364530	SUP	HCPCS C1713		8364530  -  SCREW BONE 4.5MM 30MM SPNL LCK 6.35MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8364535	SUP	HCPCS C1713		8364535  -  SCREW BONE 4.5MM 35MM SPNL LCK 6.35MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8364540	SUP	HCPCS C1713		8364540  -  SCREW BONE 4.5MM 40MM SPNL LCK 6.35MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8364545	SUP	HCPCS C1713		8364545  -  SCREW BONE 4.5MM 45MM SPNL LCK 6.35MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8365530	SUP	HCPCS C1713		8365530  -  SCREW BONE 5.5MM 30MM SPNL LCK 6.35MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8365535	SUP	HCPCS C1713		8365535  -  SCREW BONE 5.5MM 35MM SPNL LCK 6.35MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8365540	SUP	HCPCS C1713		8365540  -  SCREW BONE 5.5MM 40MM SPNL LCK 6.35MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8365545	SUP	HCPCS C1713		8365545  -  SCREW BONE 5.5MM 45MM SPNL LCK 6.35MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8366535	SUP	HCPCS C1713		8366535  -  SCREW BONE 6.5MM 35MM SPNL LCK 6.35MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8366540	SUP	HCPCS C1713		8366540  -  SCREW BONE 6.5MM 40MM SPNL LCK 6.35MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8366545	SUP	HCPCS C1713		8366545  -  SCREW BONE 6.5MM 45MM SPNL LCK 6.35MM ROD	BOTH IP/OP	"$5,507.50 "	"$4,075.55"	$0.00	"$4,406.00"	"$2,478.38"	"$2,478.38"	$0.00	$0.00	$0.00	"$1,147.90"	"$4,087.67"	"$4,087.67"	$0.00	$0.00	"$1,147.76"	$0.00	"$2,715.20"	"$2,715.20"	$0.00	"$2,753.75"	"$4,361.94"	"$4,406.00"	$0.00		$0.00	$861.92	$0.00	$0.00	$876.79	$0.00	$0.00	$0.00	$0.00	$0.00
8367645	SUP	HCPCS C1713		8367645  -  BONE SCREW 8367645 EXTRACTOR 4.5MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367650	SUP	HCPCS C1713		8367650  -  BONE SCREW 8367650 EXTRACTPR 5.0MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367655	SUP	HCPCS C1713		8367655  -  BONE SCREW 8367655 EXTRACTOR 5.5MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367660	SUP	HCPCS C1713		8367660  -  BONE SCREW 8367660 EXTRACTOR 6.0MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367665	SUP	HCPCS C1713		8367665  -  BONE SCREW 8367665 EXTRACTOR 6.5MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367670	SUP	HCPCS C1713		8367670  -  BONE SCREW 8367670 EXTRACTOR 7.0MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367675	SUP	HCPCS C1713		8367675  -  BONE SCREW 8367675 EXTRACTOR 7.5MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367680	SUP	HCPCS C1713		8367680  -  BONE SCREW 8367680 EXTRACTOR 8.0MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367745	SUP	HCPCS C1713		8367745  -  BONE SCREW 8367745 TREPHINE 4.5MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367750	SUP	HCPCS C1713		8367750  -  BONE SCREW 8367750 TREPHINE 5.0MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367755	SUP	HCPCS C1713		8367755  -  BONE SCREW 8367755 TREPHINE 5.5MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367760	SUP	HCPCS C1713		8367760  -  BONE SCREW 8367760 TREPHINE 6.0MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367765	SUP	HCPCS C1713		8367765  -  BONE SCREW 8367765 TREPHINE 6.5MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367770	SUP	HCPCS C1713		8367770  -  BONE SCREW 8367770 TREPHINE 7.0MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367775	SUP	HCPCS C1713		8367775  -  BONE SCREW 8367775 TREPHINE 7.5MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8367780	SUP	HCPCS C1713		8367780  -  BONE SCREW 8367780 TREPHINE 8.0MM	BOTH IP/OP	"$1,138.50 "	$842.49	$0.00	$910.80	$512.33	$512.33	$0.00	$0.00	$0.00	$237.29	$844.99	$844.99	$0.00	$0.00	$237.26	$0.00	$673.42	$673.42	$0.00	$569.25	$901.69	$910.80	$0.00		$0.00	$178.18	$0.00	$0.00	$181.25	$0.00	$0.00	$0.00	$0.00	$0.00
8370030	SUP	HCPCS C1713		8370030  -  ROD 8370030 TSR2D PCUT BENT 3.0CMX5.5MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370035	SUP	HCPCS C1713		8370035  -  ROD 8370035 TSR2D PCUT BENT 3.5CMX5.5MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370040	SUP	HCPCS C1713		8370040  -  ROD 8370040 TSR2D PCUT BENT 4.0CMX5.5MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370045	SUP	HCPCS C1713		8370045  -  ROD SPNL 450MM 5.5MM TSRH3D TI PREBNT PCUT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370050	SUP	HCPCS C1713		8370050  -  ROD 8370050 TSR2D PCUT BENT 5.0CMX5.5MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370055	SUP	HCPCS C1713		8370055  -  ROD SPNL 550MM 5.5MM TSRH3D TI PREBNT PCUT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370060	SUP	HCPCS C1713		8370060  -  ROD 8370060 TSR2D PCUT BENT 6.0CMX5.5MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370065	SUP	HCPCS C1713		8370065  -  ROD 8370065 6.5CM X 5.5MM PRE-CUT/BENT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370070	SUP	HCPCS C1713		8370070  -  ROD 8370070 TSR2D PCUT BENT 7.0CMX5.5MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370080	SUP	HCPCS C1713		8370080  -  ROD 8370080 TSR2D PCUT BENT8.0CMX5.5MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370090	SUP	HCPCS C1713		8370090  -  ROD 8370090 TSR2D PCUT BENT 9.0CMX5.5MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370095	SUP	HCPCS C1713		8370095  -  ROD SPNL 950MM 5.5MM TSRH3D TI PREBNT PCUT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370100	SUP	HCPCS C1713		8370100  -  ROD 8370100 TSR2D PCUT BENT 10CMX5.5MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8370420	SUP	HCPCS C1713		8370420  -  SCREW 8370420 TSRH SHORT POST4.5X20 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8370425	SUP	HCPCS C1713		8370425  -  SCREW 8370425 TSRH SHORT POST4.5X25 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8370430	SUP	HCPCS C1713		8370430  -  SCREW 8370430 TSRH SHORT POST4.5X30 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8370435	SUP	HCPCS C1713		8370435  -  SCREW 8370435 TSRH SHORT POST4.5X35 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8370440	SUP	HCPCS C1713		8370440  -  SCREW 8370440 TSRH SHORT POST4.5X40 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8370445	SUP	HCPCS C1713		8370445  -  SCREW 8370445 TSRH SHORT POST4.5X45 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8370450	SUP	HCPCS C1713		8370450  -  SCREW 8370450 TSRH SHORT POST4.5X50 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8370455	SUP	HCPCS C1713		8370455  -  SCREW 8370455 TSRH SHORT POST4.5X55 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8371030	SUP	HCPCS C1713		8371030  -  ROD 8371030 TSR2D PCUT BENT 3.0CMX6.35	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8371035	SUP	HCPCS C1713		8371035  -  ROD 8371035 3.5CMX6.35 PRE CUT BENT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8371040	SUP	HCPCS C1713		8371040  -  ROD 8371040 TSR2D PCUT BENT 4.0CMX6.35	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8371050	SUP	HCPCS C1713		8371050  -  ROD 8371050 TSR2D PCUT BENT 5.0CMX6.35	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8371060	SUP	HCPCS C1713		8371060  -  ROD 8371060 TSR2D PCUT BENT 6.0CMX6.35	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8371070	SUP	HCPCS C1713		8371070  -  ROD 8371070 TSR2D PCUT BENT 7.0CMX6.35	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8371080	SUP	HCPCS C1713		8371080  -  ROD 8371080 TSR2D PCUT BENT 8.0CMX6.35	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8371090	SUP	HCPCS C1713		8371090  -  ROD 8371090 TSR2D PCUT BENT 9.0CMX6.35	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8371100	SUP	HCPCS C1713		8371100  -  ROD 8371100 TSR2D PCUT BENT 10.0CMX6.35	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8371530	SUP	HCPCS C1713		8371530  -  SCREW 8371530 TSR3D THRD 5.5X30MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371535	SUP	HCPCS C1713		8371535  -  SCREW 8371535 TSR3D THRD 5.5X35MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371540	SUP	HCPCS C1713		8371540  -  SCREW 8371540 TSR3D THRD 5.5X40MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371545	SUP	HCPCS C1713		8371545  -  SCREW 8371545 TSR3D THRD 5.5X45MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371550	SUP	HCPCS C1713		8371550  -  SCREW 8371550 TSR3D THRD 5.5X50MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371630	SUP	HCPCS C1713		8371630  -  SCREW 8371630 TSR3D THRD 6.5X30MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371635	SUP	HCPCS C1713		8371635  -  SCREW 8371635 TSR3D THRD 6.5X35MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371640	SUP	HCPCS C1713		8371640  -  SCREW 8371640 TSR3D THRD 6.5X40MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371645	SUP	HCPCS C1713		8371645  -  SCREW 8371645 TSR3D THRD 6.5X45MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371650	SUP	HCPCS C1713		8371650  -  SCREW 8371650 TSR3D THRD 6.5X50MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371655	SUP	HCPCS C1713		8371655  -  SCREW 8371655 TSR3D THRD 6.5X55MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371660	SUP	HCPCS C1713		8371660  -  SCREW 8371660 TSR3D THRD 6.5X60MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371730	SUP	HCPCS C1713		8371730  -  SCREW 8371730 TSR3D THRD 7.5X30MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371735	SUP	HCPCS C1713		8371735  -  SCREW 8371735 TSR3D THRD 7.5X35MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371740	SUP	HCPCS C1713		8371740  -  SCREW 8371740 TSR3D THRD 7.5X40MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371745	SUP	HCPCS C1713		8371745  -  SCREW 8371745 TSR3D THRD 7.5X45MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371750	SUP	HCPCS C1713		8371750  -  SCREW 8371750 TSR3D THRD 7.5X50MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371755	SUP	HCPCS C1713		8371755  -  SCREW 8371755 TSR3D THRD 7.5X55MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371760	SUP	HCPCS C1713		8371760  -  SCREW 8371760 TSR3D THRD 7.5X60MM TI	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371830	SUP	HCPCS C1713		8371830  -  SCREW 8371830 TSRH 3D 8 5MMX30MM THR PST	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371835	SUP	HCPCS C1713		8371835  -  SCREW 8371835 TSRH 3D 8 5MMX35MM THR PST	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371840	SUP	HCPCS C1713		8371840  -  SCREW 8371840 TSRH 3D 8 5MMX40MM THR PST	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371845	SUP	HCPCS C1713		8371845  -  SCREW 8371845 TSRH 3D 8 5MMX45MM THR PST	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371850	SUP	HCPCS C1713		8371850  -  SCREW 8371850 TSRH 3D 8 5MMX50MM THR PST	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371855	SUP	HCPCS C1713		8371855  -  SCREW 8371855 TSRH 3D 8 5MMX55MM THR PST	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8371860	SUP	HCPCS C1713		8371860  -  SCREW 8371860 TSRH 3D 8 5MMX60MM THR PST	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$535.95	$535.95	$0.00	$0.00	$0.00	$248.23	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$704.48	$704.48	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$186.39	$0.00	$0.00	$189.61	$0.00	$0.00	$0.00	$0.00	$0.00
8372520	SUP	HCPCS C1713		8372520  -  SCREW 8372520 TSR3D SHORT POST 5.5X20 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372525	SUP	HCPCS C1713		8372525  -  SCREW 8372525 TSR3D SHORT POST 5.5X25 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372530	SUP	HCPCS C1713		8372530  -  SCREW 8372530 TSR3D SHORT POST 5.5X30 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372535	SUP	HCPCS C1713		8372535  -  SCREW 8372535 TSR3D SHORT POST 5.5X35 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372540	SUP	HCPCS C1713		8372540  -  SCREW 8372540 TSR3D SHORT POST 5.5X40 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372545	SUP	HCPCS C1713		8372545  -  SCREW 8372545 TSR3D SHORT POST 5.5X45 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372550	SUP	HCPCS C1713		8372550  -  SCREW 8372550 TSR3D SHORT POST 5.5X50 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372555	SUP	HCPCS C1713		8372555  -  SCREW 8372555 TSR3D SHORT POST 5.5X55 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372620	SUP	HCPCS C1713		8372620  -  SCREW 8372620 TSR3D SHORT POST 6.5X20 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372625	SUP	HCPCS C1713		8372625  -  SCREW 8372625 TSR3D SHORT POST 6.5X25 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372630	SUP	HCPCS C1713		8372630  -  SCREW 8372630 TSR3D SHORT POST 6.5X30 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372635	SUP	HCPCS C1713		8372635  -  SCREW 8372635 TSR3D SHORT POST 6.5X35 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372640	SUP	HCPCS C1713		8372640  -  SCREW 8372640 TSR3D SHORT POST 6.5X40 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372645	SUP	HCPCS C1713		8372645  -  SCREW 8372645 TSR3D SHORT POST 6.5X45 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372650	SUP	HCPCS C1713		8372650  -  SCREW 8372650 TSR3D SHORT POST 6.5X50 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372655	SUP	HCPCS C1713		8372655  -  SCREW 8372655 TSR3D SHORT POST 6.5X55 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372660	SUP	HCPCS C1713		8372660  -  SCREW 8372660 TSR3D SHORT POST 6.5X60 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372720	SUP	HCPCS C1713		8372720  -  SCREW 8372720 TSR3D SHORT POST 7.5X20 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372725	SUP	HCPCS C1713		8372725  -  SCREW 8372725 TSR3D SHORT POST 7.5X25 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372730	SUP	HCPCS C1713		8372730  -  SCREW 8372730 TSR3D SHORT POST 7.5X30 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372735	SUP	HCPCS C1713		8372735  -  SCREW 8372735 TSR3D SHORT POST 7.5X35 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372740	SUP	HCPCS C1713		8372740  -  SCREW 8372740 TSR3D SHORT POST 7.5X40 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372745	SUP	HCPCS C1713		8372745  -  SCREW 8372745 TSR3D SHORT POST 7.5X45 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372750	SUP	HCPCS C1713		8372750  -  SCREW 8372750 TSR3D SHORT POST 7.5X50 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372755	SUP	HCPCS C1713		8372755  -  SCREW 8372755 TSR3D SHORT POST 7.5X55 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372760	SUP	HCPCS C1713		8372760  -  SCREW 8372760 TSR3D SHORT POST 7.5X60 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372820	SUP	HCPCS C1713		8372820  -  SCREW 8372820 TSR3D SHORT POST 8.5X20 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372825	SUP	HCPCS C1713		8372825  -  SCREW 8372825 TSR3D SHORT POST 8.5X25 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372830	SUP	HCPCS C1713		8372830  -  SCREW 8372830 TSR3D SHORT POST 8.5X30 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372835	SUP	HCPCS C1713		8372835  -  SCREW 8372835 TSR3D SHORT POST 8.5X35 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372840	SUP	HCPCS C1713		8372840  -  SCREW 8372840 TSR3D SHORT POST 8.5X40 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372845	SUP	HCPCS C1713		8372845  -  SCREW 8372845 TSR3D SHORT POST 8.5X45 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372850	SUP	HCPCS C1713		8372850  -  SCREW 8372850 TSR3D SHORT POST 8.5X50 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372855	SUP	HCPCS C1713		8372855  -  SCREW 8372855 TSR3D SHORT POST 8.5X55 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8372860	SUP	HCPCS C1713		8372860  -  SCREW 8372860 TSR3D SHORT POST 8.5X60 TI	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8373745	SUP	HCPCS C1713		8373745  -  SCREW BONE 7.5MM 45MM SCRL	BOTH IP/OP	"$1,122.00 "	$830.28	$0.00	$897.60	$504.90	$504.90	$0.00	$0.00	$0.00	$233.85	$832.75	$832.75	$0.00	$0.00	$233.82	$0.00	$663.66	$663.66	$0.00	$561.00	$888.62	$897.60	$0.00		$0.00	$175.59	$0.00	$0.00	$178.62	$0.00	$0.00	$0.00	$0.00	$0.00
8374535	SUP	HCPCS C1713		8374535  -  SCREW BONE 4.5MM 35MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8374540	SUP	HCPCS C1713		8374540  -  SCREW BONE 4.5MM 40MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8374545	SUP	HCPCS C1713		8374545  -  SCREW BONE 4.5MM 45MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8375530	SUP	HCPCS C1713		8375530  -  SCREW BONE 5.5MM 30MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8375535	SUP	HCPCS C1713		8375535  -  SCREW BONE 5.5MM 35MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8375540	SUP	HCPCS C1713		8375540  -  SCREW BONE 5.5MM 40MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8375545	SUP	HCPCS C1713		8375545  -  SCREW BONE 5.5MM 45MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8375550	SUP	HCPCS C1713		8375550  -  SCREW BONE 5.5MM 50MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8376520	SUP	HCPCS C1713		"8376520  -  MPA SHRT SCREW, 5.5MMX20MM, TI"	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376525	SUP	HCPCS C1713		"8376525  -  MPA SHRT SCREW, 5.5MMX25MM, TI"	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376530	SUP	HCPCS C1713		"8376530  -  MPA SHRT SCREW, 5.5MMX30MM, TI"	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376535	SUP	HCPCS C1713		8376535  -  SCREW 8376535 MPA SHRT 5 5MMX35MM TI	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376540	SUP	HCPCS C1713		8376540  -  SCREW BONE 6.5MM 40MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8376545	SUP	HCPCS C1713		8376545  -  SCREW BONE 6.5MM 45MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8376550	SUP	HCPCS C1713		8376550  -  SCREW BONE 6.5MM 50MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8376555	SUP	HCPCS C1713		8376555  -  SCREW BONE 6.5MM 55MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8376620	SUP	HCPCS C1713		"8376620  -  MPA SHRT SCREW, 6.5MMX20MM, TI"	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376625	SUP	HCPCS C1713		"8376625  -  MPA SHRT SCREW, 6.5MMX25MM, TI"	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376630	SUP	HCPCS C1713		"8376630  -  MPA SHRT SCREW, 6.5MMX30MM, TI"	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376635	SUP	HCPCS C1713		8376635  -  BONE SCREW 8376635 MPA SHRT 6.5MMX35MM	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376640	SUP	HCPCS C1713		8376640  -  SCREW 8376640 MPA SHRT 6 5MMX40MM TI	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376645	SUP	HCPCS C1713		8376645  -  SCREW 8376645 MPA SHRT 6 5MMX45MM TI	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376650	SUP	HCPCS C1713		8376650  -  SCREW 8376650 MPA SHRT 6 5MMX50MM TI	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376655	SUP	HCPCS C1713		"8376655  -  MPA SHRT SCREW, 6.5MMX55MM, TI"	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376660	SUP	HCPCS C1713		"8376660  -  MPA SHRT SCREW, 6.5MMX60MM, TI"	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376720	SUP	HCPCS C1713		"8376720  -  MPA SHRT SCREW, 7.5MMX20MM, TI"	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376725	SUP	HCPCS C1713		"8376725  -  MPA SHRT SCREW, 7.5MMX25MM, TI"	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376730	SUP	HCPCS C1713		"8376730  -  MPA SHRT SCREW, 7.5MMX30MM, TI"	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376735	SUP	HCPCS C1713		8376735  -  SCREW 8376735 MPA SHRT 7 5MMX35MM TI	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376740	SUP	HCPCS C1713		8376740  -  SCREW 8376740 MPA SHRT 7 5MMX40MM TI	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376745	SUP	HCPCS C1713		8376745  -  SCREW 8376745 MPA SHRT 7 5MMX45MM TI	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376750	SUP	HCPCS C1713		8376750  -  SCREW 8376750 MPA SHRT 7 5MMX50MM TI	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376755	SUP	HCPCS C1713		8376755  -  SCREW 8376755 MPA SHRT 7 5MMX55MM TI	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8376760	SUP	HCPCS C1713		8376760  -  SCREW 8376760 MPA SHRT 7 5MMX60MM TI	BOTH IP/OP	"$1,279.50 "	$946.83	$0.00	"$1,023.60"	$575.78	$575.78	$0.00	$0.00	$0.00	$266.68	$949.64	$949.64	$0.00	$0.00	$266.65	$0.00	$756.82	$756.82	$0.00	$639.75	"$1,013.36"	"$1,023.60"	$0.00		$0.00	$200.24	$0.00	$0.00	$203.70	$0.00	$0.00	$0.00	$0.00	$0.00
8377530	SUP	HCPCS C1713		8377530  -  BONE SCREW 8377530 MPA THRD 5.5X30 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377535	SUP	HCPCS C1713		8377535  -  BONE SCREW 8377535 MPA THRD 5.5X35 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377540	SUP	HCPCS C1713		8377540  -  SCREW BONE 7.5MM 40MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8377545	SUP	HCPCS C1713		8377545  -  SCREW BONE 7.5MM 45MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8377550	SUP	HCPCS C1713		8377550  -  SCREW BONE 7.5MM 50MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8377555	SUP	HCPCS C1713		8377555  -  SCREW BONE 7.5MM 55MM SPNL REDX 5.5MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8377630	SUP	HCPCS C1713		8377630  -  BONE SCREW 8377630 MPA THRD 6.5X30 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377635	SUP	HCPCS C1713		8377635  -  BONE SCREW 8377635 MPA THRD 6.5X35 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377640	SUP	HCPCS C1713		8377640  -  BONE SCREW 8377640 MPA THRD 6.5X40 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377645	SUP	HCPCS C1713		8377645  -  BONE SCREW 8377645 MPA THRD 6.5X45 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377650	SUP	HCPCS C1713		8377650  -  BONE SCREW 8377650 MPA THRD 6.5X50 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377655	SUP	HCPCS C1713		8377655  -  BONE SCREW 8377655 MPA THRD 6.5X55 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377660	SUP	HCPCS C1713		8377660  -  BONE SCREW 8377660 MPA THRD 6.5X60 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377730	SUP	HCPCS C1713		8377730  -  BONE SCREW 8377730 MPA THRD 7.5X30 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377735	SUP	HCPCS C1713		8377735  -  BONE SCREW 8377735 MPA THRD 7.5X35 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377740	SUP	HCPCS C1713		8377740  -  BONE SCREW 8377740 MPA THRD 7.5X40 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377745	SUP	HCPCS C1713		8377745  -  BONE SCREW 8377745 MPA THRD 7.5X45 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377750	SUP	HCPCS C1713		8377750  -  BONE SCREW 8377750 MPA THRD 7.5X50 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377755	SUP	HCPCS C1713		8377755  -  BONE SCREW 8377755 MPA THRD 7.5X55 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8377760	SUP	HCPCS C1713		8377760  -  BONE SCREW 8377760 MPA THRD 7.5X60 TI	BOTH IP/OP	"$1,549.50 "	"$1,146.63"	$0.00	"$1,239.60"	$697.28	$697.28	$0.00	$0.00	$0.00	$322.95	"$1,150.04"	"$1,150.04"	$0.00	$0.00	$322.92	$0.00	$916.53	$916.53	$0.00	$774.75	"$1,227.20"	"$1,239.60"	$0.00		$0.00	$242.50	$0.00	$0.00	$246.68	$0.00	$0.00	$0.00	$0.00	$0.00
8379120	SUP	Custom 27803010		8379120  -  CONNECTOR 8379120 5.5 TSRH 3D SML TI	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8379121	SUP	Custom 27803010		8379121  -  CONNECTOR 8379121 5.5 TSRH 3D MED TI	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8379122	SUP	Custom 27803010		8379122  -  CONNECTOR 8379122 5.5 TSRH 3D LRG TI	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8379124	SUP	Custom 27803010		8379124  -  CONNECTOR 8379124 90 DEG OFFSET 5.5 TI	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8379130	SUP	Custom 27803010		8379130  -  CONNECTOR ROD 8379130 6.35 TSRH 3D SM	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8379131	SUP	Custom 27803010		8379131  -  CONNECTOR 8379131 6.35 TSRH 3D MED TI	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8379132	SUP	Custom 27803010		8379132  -  CONNECTOR 8379132 6.35 TSRH 3D LRG TI	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8379134	SUP	Custom 27803010		8379134  -  CONNECTOR 8379134 90 DEG OSET 6.35 TI	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8379140	SUP	Custom 27803010		8379140  -  CONNECTOR 8379140 SM TRSH-3D 6.35MM TI	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8379141	SUP	Custom 27803010		8379141  -  CONNECTOR 8379141 6.35 TSRH-3D MED	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8379142	SUP	Custom 27803010		8379142  -  CONCTR ROD LG 6.35MM TSRH3D CLOSE OFFST TI POST PDCL	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8384535	SUP	HCPCS C1713		8384535  -  SCREW BONE 4.5MM 35MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8384540	SUP	HCPCS C1713		8384540  -  SCREW BONE 4.5MM 40MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8384545	SUP	HCPCS C1713		8384545  -  SCREW BONE 4.5MM 45MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8385040	SUP	HCPCS C1713		8385040  -  SCREW BONE 5MM 40MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8385045	SUP	HCPCS C1713		8385045  -  SCREW BONE 5MM 45MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8385050	SUP	HCPCS C1713		8385050  -  SCREW BONE 5MM 50MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8386535	SUP	HCPCS C1713		8386535  -  SCREW BONE 6.5MM 35MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8386540	SUP	HCPCS C1713		8386540  -  SCREW BONE 6.5MM 40MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8386545	SUP	HCPCS C1713		8386545  -  SCREW BONE 6.5MM 45MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8386550	SUP	HCPCS C1713		8386550  -  SCREW BONE 6.5MM 50MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8387540	SUP	HCPCS C1713		8387540  -  SCREW BONE 7.5MM 40MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8387545	SUP	HCPCS C1713		8387545  -  SCREW BONE 7.5MM 45MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8387550	SUP	HCPCS C1713		8387550  -  SCREW BONE 7.5MM 50MM SPNL REDX 6.35MM ROD	BOTH IP/OP	"$5,220.00 "	"$3,862.80"	$0.00	"$4,176.00"	"$2,349.00"	"$2,349.00"	$0.00	$0.00	$0.00	"$1,087.98"	"$3,874.28"	"$3,874.28"	$0.00	$0.00	"$1,087.85"	$0.00	"$2,573.46"	"$2,573.46"	$0.00	"$2,610.00"	"$4,134.24"	"$4,176.00"	$0.00		$0.00	$816.93	$0.00	$0.00	$831.02	$0.00	$0.00	$0.00	$0.00	$0.00
8436510	SUP	HCPCS C1713		8436510  -  SCREW BN 6.5MM 100MM SACROILIAC 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8436560	SUP	HCPCS C1713		8436560  -  SCREW BN 6.5MM 60MM SACROILIAC 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8436570	SUP	HCPCS C1713		8436570  -  SCREW BN 6.5MM 70MM SACROILIAC 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8436580	SUP	HCPCS C1713		8436580  -  SCREW BN 6.5MM 80MM SACROILIAC 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8436590	SUP	HCPCS C1713		8436590  -  SCREW BN 6.5MM 90MM SACROILIAC 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8437510	SUP	HCPCS C1713		8437510  -  SCREW BONE 7.5MM 100MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8437560	SUP	HCPCS C1713		8437560  -  SCREW BONE 7.5MM 60MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8437570	SUP	HCPCS C1713		8437570  -  SCREW BONE 7.5MM 70MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8437580	SUP	HCPCS C1713		8437580  -  SCREW BONE 7.5MM 80MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8437590	SUP	HCPCS C1713		8437590  -  SCREW BONE 7.5MM 90MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8438510	SUP	HCPCS C1713		8438510  -  SCREW BONE 8.5MM 100MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8438560	SUP	HCPCS C1713		8438560  -  SCREW BONE 8.5MM 60MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8438570	SUP	HCPCS C1713		8438570  -  SCREW BONE 8.5MM 70MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8438580	SUP	HCPCS C1713		8438580  -  SCREW BONE 8.5MM 80MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8438590	SUP	HCPCS C1713		8438590  -  SCREW BONE 8.5MM 90MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8439510	SUP	HCPCS C1713		8439510  -  SCREW BONE 9.5MM 100MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8439560	SUP	HCPCS C1713		8439560  -  SCREW BONE 9.5MM 60MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8439570	SUP	HCPCS C1713		8439570  -  SCREW BONE 9.5MM 70MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8439580	SUP	HCPCS C1713		8439580  -  SCREW BONE 9.5MM 80MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8439590	SUP	HCPCS C1713		8439590  -  SCREW BONE 9.5MM 90MM ILC 5.5MM ROD SLC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8446510	SUP	HCPCS C1713		8446510  -  SCREW BONE 6.5MM 100MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8446560	SUP	HCPCS C1713		8446560  -  SCREW BONE 6.5MM 60MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8446570	SUP	HCPCS C1713		8446570  -  SCREW BONE 6.5MM 70MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8446580	SUP	HCPCS C1713		8446580  -  SCREW BONE 6.5MM 80MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8446590	SUP	HCPCS C1713		8446590  -  SCREW BONE 6.5MM 90MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8447510	SUP	HCPCS C1713		8447510  -  SCREW BONE 7.5MM 100MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8447560	SUP	HCPCS C1713		8447560  -  SCREW BONE 7.5MM 60MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8447570	SUP	HCPCS C1713		8447570  -  SCREW BONE 7.5MM 70MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8447580	SUP	HCPCS C1713		8447580  -  SCREW BONE 7.5MM 80MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8447590	SUP	HCPCS C1713		8447590  -  SCREW BONE 7.5MM 90MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8448510	SUP	HCPCS C1713		8448510  -  SCREW BONE 8.5MM 100MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8448560	SUP	HCPCS C1713		8448560  -  SCREW BONE 8.5MM 60MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8448570	SUP	HCPCS C1713		8448570  -  SCREW BONE 8.5MM 70MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8448580	SUP	HCPCS C1713		8448580  -  SCREW BONE 8.5MM 80MM SPNL ILC	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8448590	SUP	HCPCS C1713		8448590  -  SCREW BONE 8.5MM 90MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8449510	SUP	HCPCS C1713		8449510  -  SCREW BONE 9.5MM 100MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8449560	SUP	HCPCS C1713		8449560  -  SCREW BONE 9.5MM 60MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8449570	SUP	HCPCS C1713		8449570  -  SCREW BONE 9.5MM 70MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8449580	SUP	HCPCS C1713		8449580  -  SCREW BONE 9.5MM 80MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8449590	SUP	HCPCS C1713		8449590  -  SCREW BONE 9.5MM 90MM ILC SLT 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8450120	SUP	HCPCS C1713		8450120  -  CONCTR ROD 20MM 5.5MM FIX CX TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450122	SUP	HCPCS C1713		8450122  -  CONCTR ROD 22MM 5.5MM FIX CX TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450125	SUP	HCPCS C1713		8450125  -  CONCTR ROD 25MM 5.5MM FIX CX TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450127	SUP	HCPCS C1713		8450127  -  CONCTR ROD 27.5MM BCN CX BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450130	SUP	HCPCS C1713		8450130  -  CONCTR ROD 30MM 5.5MM FIX CX TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450132	SUP	HCPCS C1713		8450132  -  CONCTR ROD 32.5MM 5.5MM ARMADA CX SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450135	SUP	HCPCS C1713		8450135  -  CONCTR ROD 35MM 5.5MM FIX CX TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450137	SUP	HCPCS C1713		8450137  -  CONCTR ROD 37MM 5.5MM FIX CX TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450140	SUP	HCPCS C1713		8450140  -  CONCTR ROD 40MM 5.5MM FIX CX TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450145	SUP	HCPCS C1713		8450145  -  CONCTR ROD 45MM 5.5MM FIX CX TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450150	SUP	HCPCS C1713		8450150  -  CONCTR ROD 50MM 5.5MM FIX CX TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450155	SUP	HCPCS C1713		8450155  -  CONCTR ROD 55MM 5.5MM FIX CX TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450160	SUP	HCPCS C1713		8450160  -  CONCTR ROD 60MM 5.5MM FIX CX TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450245	SUP	HCPCS C1713		8450245  -  TRNCON ROD 45-50MM ADJ ARCH	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450250	SUP	HCPCS C1713		8450250  -  CONCTR ROD 50-60MM ADJ TRNSVRS SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8450260	SUP	HCPCS C1713		8450260  -  TRNCON ROD 60-70MM ADJ ARCH	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8451188	SUP	HCPCS C1713		8451188  -  POSITIONING CLIP 8451188 5.5MM ROD	BOTH IP/OP	$37.50 	$27.75	$0.00	$30.00	$16.88	$16.88	$0.00	$0.00	$0.00	$7.82	$27.83	$27.83	$0.00	$0.00	$7.82	$0.00	$22.18	$22.18	$0.00	$18.75	$29.70	$30.00	$0.00		$0.00	$5.87	$0.00	$0.00	$5.97	$0.00	$0.00	$0.00	$0.00	$0.00
8451302	SUP	HCPCS C1713		8451302  -  CONNECTOR ROD 5.5MM INLN TI	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8451402	SUP	HCPCS C1713		8451402  -  CONCTR ROD 5.5MM T PRLL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8451530	SUP	HCPCS C1713		8451530  -  SCREW BONE 10.5MM 30MM POLYAX˙ 5.5MM TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8451535	SUP	HCPCS C1713		8451535  -  SCREW BONE 10.5MM 35MM POLYAX˙ 5.5MM TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8451540	SUP	HCPCS C1713		8451540  -  SCREW BONE 10.5MM 40MM POLYAX˙ 5.5MM TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8451545	SUP	HCPCS C1713		8451545  -  SCREW BONE 10.5MM 45MM POLYAX˙ 5.5MM TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8451550	SUP	HCPCS C1713		8451550  -  SCREW BONE 10.5MM 50MM POLYAX˙ 5.5MM TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8451555	SUP	HCPCS C1713		8451555  -  SCREW BONE 10.5MM 55MM POLYAX˙ 5.5MM TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8451602	SUP	HCPCS C1713		8451602  -  CONCTR ROD 5.5MM 4 HOLE TI ARM15	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8452004	SUP	HCPCS C1713		8452004  -  ROD LATERAL OFFSET	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	"$1,057.50"	"$1,057.50"	$0.00	$0.00	$0.00	$489.80	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	"$1,390.03"	"$1,390.03"	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$367.78	$0.00	$0.00	$374.12	$0.00	$0.00	$0.00	$0.00	$0.00
8452025	SUP	HCPCS C1713		8452025  -  ROD SPNL 25MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452030	SUP	HCPCS C1713		8452030  -  ROD SPNL 30MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452035	SUP	HCPCS C1713		8452035  -  ROD SPNL 35MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452040	SUP	HCPCS C1713		8452040  -  ROD SPNL 40MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452045	SUP	HCPCS C1713		8452045  -  ROD SPNL 45MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452050	SUP	HCPCS C1713		8452050  -  ROD SPNL 50MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452055	SUP	HCPCS C1713		8452055  -  ROD SPNL 55MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452060	SUP	HCPCS C1713		8452060  -  ROD SPNL 60MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452065	SUP	HCPCS C1713		8452065  -  ROD SPNL 65MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452070	SUP	HCPCS C1713		8452070  -  ROD SPNL 70MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452075	SUP	HCPCS C1713		8452075  -  ROD SPNL 5.5MM 75MM TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452080	SUP	HCPCS C1713		8452080  -  ROD SPNL 80MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452090	SUP	HCPCS C1713		8452090  -  ROD SPNL 90MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452100	SUP	HCPCS C1713		8452100  -  ROD SPNL 100MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452120	SUP	HCPCS C1713		8452120  -  ROD SPNL 120MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452140	SUP	HCPCS C1713		8452140  -  ROD SPNL 140MM 5.5MM TI ARM15	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452152	SUP	HCPCS C1713		8452152  -  ROD-ROD 5.5MM O -5.5MM O	BOTH IP/OP	"$3,530.00 "	"$2,612.20"	$0.00	"$2,824.00"	"$1,588.50"	"$1,588.50"	$0.00	$0.00	$0.00	$735.74	"$2,619.97"	"$2,619.97"	$0.00	$0.00	$735.65	$0.00	"$1,740.29"	"$1,740.29"	$0.00	"$1,765.00"	"$2,795.76"	"$2,824.00"	$0.00		$0.00	$552.45	$0.00	$0.00	$561.98	$0.00	$0.00	$0.00	$0.00	$0.00
8452156	SUP	HCPCS C1713		8452156  -  ROD-ROD 5.5MM O-6.35MM O	BOTH IP/OP	"$3,530.00 "	"$2,612.20"	$0.00	"$2,824.00"	"$1,588.50"	"$1,588.50"	$0.00	$0.00	$0.00	$735.74	"$2,619.97"	"$2,619.97"	$0.00	$0.00	$735.65	$0.00	"$1,740.29"	"$1,740.29"	$0.00	"$1,765.00"	"$2,795.76"	"$2,824.00"	$0.00		$0.00	$552.45	$0.00	$0.00	$561.98	$0.00	$0.00	$0.00	$0.00	$0.00
8452160	SUP	HCPCS C1713		8452160  -  ROD SPNL 160MM 5.5MM TI ARM15T	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452166	SUP	HCPCS C1713		8452166  -  ROD-ROD 6.35MM O-6.35MM O	BOTH IP/OP	"$3,530.00 "	"$2,612.20"	$0.00	"$2,824.00"	"$1,588.50"	"$1,588.50"	$0.00	$0.00	$0.00	$735.74	"$2,619.97"	"$2,619.97"	$0.00	$0.00	$735.65	$0.00	"$1,740.29"	"$1,740.29"	$0.00	"$1,765.00"	"$2,795.76"	"$2,824.00"	$0.00		$0.00	$552.45	$0.00	$0.00	$561.98	$0.00	$0.00	$0.00	$0.00	$0.00
8452200	SUP	HCPCS C1713		8452200  -  ROD SPNL 200MM 5.5MM ARMADA TI ARM15T	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452255	SUP	HCPCS C1713		8452255  -  ROD-ROD 5.5MM O-5.5MM OW	BOTH IP/OP	"$3,530.00 "	"$2,612.20"	$0.00	"$2,824.00"	"$1,588.50"	"$1,588.50"	$0.00	$0.00	$0.00	$735.74	"$2,619.97"	"$2,619.97"	$0.00	$0.00	$735.65	$0.00	"$1,740.29"	"$1,740.29"	$0.00	"$1,765.00"	"$2,795.76"	"$2,824.00"	$0.00		$0.00	$552.45	$0.00	$0.00	$561.98	$0.00	$0.00	$0.00	$0.00	$0.00
8452256	SUP	HCPCS C1713		8452256  -  ROD-ROD 5.5MM O-6.35MM OW	BOTH IP/OP	"$3,530.00 "	"$2,612.20"	$0.00	"$2,824.00"	"$1,588.50"	"$1,588.50"	$0.00	$0.00	$0.00	$735.74	"$2,619.97"	"$2,619.97"	$0.00	$0.00	$735.65	$0.00	"$1,740.29"	"$1,740.29"	$0.00	"$1,765.00"	"$2,795.76"	"$2,824.00"	$0.00		$0.00	$552.45	$0.00	$0.00	$561.98	$0.00	$0.00	$0.00	$0.00	$0.00
8452266	SUP	HCPCS C1713		8452266  -  ROD-ROD 6.35MM O-6.35MM OW	BOTH IP/OP	"$3,530.00 "	"$2,612.20"	$0.00	"$2,824.00"	"$1,588.50"	"$1,588.50"	$0.00	$0.00	$0.00	$735.74	"$2,619.97"	"$2,619.97"	$0.00	$0.00	$735.65	$0.00	"$1,740.29"	"$1,740.29"	$0.00	"$1,765.00"	"$2,795.76"	"$2,824.00"	$0.00		$0.00	$552.45	$0.00	$0.00	$561.98	$0.00	$0.00	$0.00	$0.00	$0.00
8452300	SUP	HCPCS C1713		8452300  -  ROD SPNL 300MM NS ARMADA ARM15T	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8452355	SUP	HCPCS C1713		8452355  -  ROD-ROD 90 DEG 5.5MM O-5.5MM C	BOTH IP/OP	"$3,845.00 "	"$2,845.30"	$0.00	"$3,076.00"	"$1,730.25"	"$1,730.25"	$0.00	$0.00	$0.00	$801.39	"$2,853.76"	"$2,853.76"	$0.00	$0.00	$801.30	$0.00	"$1,895.59"	"$1,895.59"	$0.00	"$1,922.50"	"$3,045.24"	"$3,076.00"	$0.00		$0.00	$601.74	$0.00	$0.00	$612.12	$0.00	$0.00	$0.00	$0.00	$0.00
8452356	SUP	HCPCS C1713		8452356  -  ROD-ROD 90 DEG 5.5MM O 6.35MM C	BOTH IP/OP	"$3,845.00 "	"$2,845.30"	$0.00	"$3,076.00"	"$1,730.25"	"$1,730.25"	$0.00	$0.00	$0.00	$801.39	"$2,853.76"	"$2,853.76"	$0.00	$0.00	$801.30	$0.00	"$1,895.59"	"$1,895.59"	$0.00	"$1,922.50"	"$3,045.24"	"$3,076.00"	$0.00		$0.00	$601.74	$0.00	$0.00	$612.12	$0.00	$0.00	$0.00	$0.00	$0.00
8452365	SUP	HCPCS C1713		8452365  -  ROD-ROD 90 DEG 6.35MM O 5.5MM C	BOTH IP/OP	"$3,845.00 "	"$2,845.30"	$0.00	"$3,076.00"	"$1,730.25"	"$1,730.25"	$0.00	$0.00	$0.00	$801.39	"$2,853.76"	"$2,853.76"	$0.00	$0.00	$801.30	$0.00	"$1,895.59"	"$1,895.59"	$0.00	"$1,922.50"	"$3,045.24"	"$3,076.00"	$0.00		$0.00	$601.74	$0.00	$0.00	$612.12	$0.00	$0.00	$0.00	$0.00	$0.00
8452366	SUP	HCPCS C1713		8452366  -  ROD-ROD 90 DEG 6.35MM O 6.35MM C	BOTH IP/OP	"$3,845.00 "	"$2,845.30"	$0.00	"$3,076.00"	"$1,730.25"	"$1,730.25"	$0.00	$0.00	$0.00	$801.39	"$2,853.76"	"$2,853.76"	$0.00	$0.00	$801.30	$0.00	"$1,895.59"	"$1,895.59"	$0.00	"$1,922.50"	"$3,045.24"	"$3,076.00"	$0.00		$0.00	$601.74	$0.00	$0.00	$612.12	$0.00	$0.00	$0.00	$0.00	$0.00
8452412	SUP	HCPCS C1713		8452412  -  ROD CONNECTOR LH 5.5MM 15 X 200MM	BOTH IP/OP	"$5,105.00 "	"$3,777.70"	$0.00	"$4,084.00"	"$2,297.25"	"$2,297.25"	$0.00	$0.00	$0.00	"$1,064.01"	"$3,788.93"	"$3,788.93"	$0.00	$0.00	"$1,063.88"	$0.00	"$2,516.77"	"$2,516.77"	$0.00	"$2,552.50"	"$4,043.16"	"$4,084.00"	$0.00		$0.00	$798.93	$0.00	$0.00	$812.72	$0.00	$0.00	$0.00	$0.00	$0.00
8452422	SUP	HCPCS C1713		8452422  -  ROD CONNECTOR LH 5.5MM 25 X 200MM	BOTH IP/OP	"$5,105.00 "	"$3,777.70"	$0.00	"$4,084.00"	"$2,297.25"	"$2,297.25"	$0.00	$0.00	$0.00	"$1,064.01"	"$3,788.93"	"$3,788.93"	$0.00	$0.00	"$1,063.88"	$0.00	"$2,516.77"	"$2,516.77"	$0.00	"$2,552.50"	"$4,043.16"	"$4,084.00"	$0.00		$0.00	$798.93	$0.00	$0.00	$812.72	$0.00	$0.00	$0.00	$0.00	$0.00
8452432	SUP	HCPCS C1713		8452432  -  ROD CONNECTOR LH 5.5MM 35 X 200MM	BOTH IP/OP	"$5,105.00 "	"$3,777.70"	$0.00	"$4,084.00"	"$2,297.25"	"$2,297.25"	$0.00	$0.00	$0.00	"$1,064.01"	"$3,788.93"	"$3,788.93"	$0.00	$0.00	"$1,063.88"	$0.00	"$2,516.77"	"$2,516.77"	$0.00	"$2,552.50"	"$4,043.16"	"$4,084.00"	$0.00		$0.00	$798.93	$0.00	$0.00	$812.72	$0.00	$0.00	$0.00	$0.00	$0.00
8452442	SUP	HCPCS C1713		8452442  -  ROD CONNECTOR LH 5.5MM 40 X 200MM	BOTH IP/OP	"$5,105.00 "	"$3,777.70"	$0.00	"$4,084.00"	"$2,297.25"	"$2,297.25"	$0.00	$0.00	$0.00	"$1,064.01"	"$3,788.93"	"$3,788.93"	$0.00	$0.00	"$1,063.88"	$0.00	"$2,516.77"	"$2,516.77"	$0.00	"$2,552.50"	"$4,043.16"	"$4,084.00"	$0.00		$0.00	$798.93	$0.00	$0.00	$812.72	$0.00	$0.00	$0.00	$0.00	$0.00
8452500	SUP	HCPCS C1713		8452500  -  ROD SPNL 500MM 5.5MM TI	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
8452512	SUP	HCPCS C1713		8452512  -  ROD CONNECTOR RH 5.5MM 15 X 200MM	BOTH IP/OP	"$5,105.00 "	"$3,777.70"	$0.00	"$4,084.00"	"$2,297.25"	"$2,297.25"	$0.00	$0.00	$0.00	"$1,064.01"	"$3,788.93"	"$3,788.93"	$0.00	$0.00	"$1,063.88"	$0.00	"$2,516.77"	"$2,516.77"	$0.00	"$2,552.50"	"$4,043.16"	"$4,084.00"	$0.00		$0.00	$798.93	$0.00	$0.00	$812.72	$0.00	$0.00	$0.00	$0.00	$0.00
8452522	SUP	HCPCS C1713		8452522  -  ROD CONNECTOR RH 5.5MM 25 X 200MM	BOTH IP/OP	"$5,105.00 "	"$3,777.70"	$0.00	"$4,084.00"	"$2,297.25"	"$2,297.25"	$0.00	$0.00	$0.00	"$1,064.01"	"$3,788.93"	"$3,788.93"	$0.00	$0.00	"$1,063.88"	$0.00	"$2,516.77"	"$2,516.77"	$0.00	"$2,552.50"	"$4,043.16"	"$4,084.00"	$0.00		$0.00	$798.93	$0.00	$0.00	$812.72	$0.00	$0.00	$0.00	$0.00	$0.00
8452532	SUP	HCPCS C1713		8452532  -  ROD CONNECTOR RH 5.5MM 35 X 200MM	BOTH IP/OP	"$5,105.00 "	"$3,777.70"	$0.00	"$4,084.00"	"$2,297.25"	"$2,297.25"	$0.00	$0.00	$0.00	"$1,064.01"	"$3,788.93"	"$3,788.93"	$0.00	$0.00	"$1,063.88"	$0.00	"$2,516.77"	"$2,516.77"	$0.00	"$2,552.50"	"$4,043.16"	"$4,084.00"	$0.00		$0.00	$798.93	$0.00	$0.00	$812.72	$0.00	$0.00	$0.00	$0.00	$0.00
8452542	SUP	HCPCS C1713		8452542  -  ROD CONNECTOR RH 5.5MM 40 X 200MM	BOTH IP/OP	"$5,105.00 "	"$3,777.70"	$0.00	"$4,084.00"	"$2,297.25"	"$2,297.25"	$0.00	$0.00	$0.00	"$1,064.01"	"$3,788.93"	"$3,788.93"	$0.00	$0.00	"$1,063.88"	$0.00	"$2,516.77"	"$2,516.77"	$0.00	"$2,552.50"	"$4,043.16"	"$4,084.00"	$0.00		$0.00	$798.93	$0.00	$0.00	$812.72	$0.00	$0.00	$0.00	$0.00	$0.00
8453101	SUP	Custom 27803010		8453101  -  HOOK SPNL 5.5MM SM PDCL TI	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8453102	SUP	Custom 27803010		8453102  -  HOOK SPNL 5.5MM MED PDCL TI	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8453112	SUP	Custom 27803010		8453112  -  HOOK SPNL 6MM 5.5MM LMNR TI RED	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8453113	SUP	Custom 27803010		8453113  -  HOOK SPNL 8MM 5.5MM LMNR TI RED	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8453114	SUP	Custom 27803010		8453114  -  HOOK SPNL 10MM 5.5MM LMNR RED	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8453121	SUP	Custom 27803010		8453121  -  HOOK SPNL 5.5MM RIGHT TI ANG	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8453122	SUP	Custom 27803010		8453122  -  HOOK SPNL 5.5MM LEFT TI ANG	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8453123	SUP	Custom 27803010		8453123  -  HOOK SPNL 5.5MM TI RIGHT OFFST	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8453124	SUP	Custom 27803010		8453124  -  HOOK SPNL 5.5MM TI LEFT OFFST	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8454025	SUP	HCPCS C1713		8454025  -  SCREW BONE 4MM 25MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8454030	SUP	HCPCS C1713		8454030  -  SCREW BONE 4MM 30MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8454035	SUP	HCPCS C1713		8454035  -  SCREW BONE 4MM 35MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8454040	SUP	HCPCS C1713		8454040  -  SCREW BONE 4MM 40MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8454045	SUP	HCPCS C1713		8454045  -  SCREW BONE 4MM 45MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8454402	SUP	HCPCS C1713		8454402  -  CONNECTOR ROD PARALLEL 5.5MM CLOSE TITANIUM SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8454404	SUP	HCPCS C1713		8454404  -  CONNECTOR ROD 5.5MM NS ARMADA PRLL SPNE ASF25T	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8454525	SUP	HCPCS C1713		8454525  -  SCREW BONE 4.5MM 25MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8454530	SUP	HCPCS C1713		8454530  -  SCREW BONE 4.5MM 30MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8454535	SUP	HCPCS C1713		8454535  -  SCREW BONE 4.5MM 35MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8454540	SUP	HCPCS C1713		8454540  -  SCREW BONE 40MM 4.5MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8454545	SUP	HCPCS C1713		8454545  -  SCREW BONE 45MM 4.5MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8454602	SUP	HCPCS C1713		8454602  -  CONNECTOR ROD 5.5MM 4 HOLE TITANIUM SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8454604	SUP	HCPCS C1713		8454604  -  CONNECTOR ROD 5.5MM NS ARMADA 4 HL PRLL SPNE ASF25T	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8455025	SUP	HCPCS C1713		8455025  -  SCREW BONE 5MM 25MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8455030	SUP	HCPCS C1713		8455030  -  SCREW BONE 5MM 30MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8455035	SUP	HCPCS C1713		8455035  -  SCREW BONE 5MM 35MM SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8455040	SUP	HCPCS C1713		8455040  -  SCREW BONE 5MM 40MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8455045	SUP	HCPCS C1713		8455045  -  SCREW BONE 5MM 45MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8455050	SUP	HCPCS C1713		8455050  -  SCREW BONE 5MM 50MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8455525	SUP	HCPCS C1713		8455525  -  SCREW BONE 5.5MM 25MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8455530	SUP	HCPCS C1713		8455530  -  SCREW BONE 5.5MM 30MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8455535	SUP	HCPCS C1713		8455535  -  SCREW BONE 5.5MM 35MM SPNL POLYAX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8455540	SUP	HCPCS C1713		8455540  -  SCREW BONE 5.5MM 40MM SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8455545	SUP	HCPCS C1713		8455545  -  SCREW BONE 5.5MM 45MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8455550	SUP	HCPCS C1713		8455550  -  SCREW BONE 5.5MM 50MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8455555	SUP	HCPCS C1713		8455555  -  SCREW BONE 5.5MM 55MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8456530	SUP	HCPCS C1713		8456530  -  SCREW BONE 6.5MM 30MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8456535	SUP	HCPCS C1713		8456535  -  SCREW BONE 6.5MM 35MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8456540	SUP	HCPCS C1713		8456540  -  SCREW BN 6.5MM 40MM NS ARMADA PA TI SPNE ARM15T	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8456545	SUP	HCPCS C1713		8456545  -  SCREW BN 6.5MM 45MM NS ARMADA PA TI SPNE ARM15T	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8456550	SUP	HCPCS C1713		8456550  -  SCREW BN 6.5MM 50MM NS ARMADA PA TI SPNE ARM15T	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8456555	SUP	HCPCS C1713		8456555  -  SCREW BN 6.5MM 55MM NS ARMADA PA TI SPNE ARM15T	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8456560	SUP	HCPCS C1713		8456560  -  SCREW BONE 6.5MM 60MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8457530	SUP	HCPCS C1713		8457530  -  SCREW BONE 7.5MM 30MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8457535	SUP	HCPCS C1713		8457535  -  SCREW BONE 7.5MM 35MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8457540	SUP	HCPCS C1713		8457540  -  SCREW BN 7.5MM 40MM NS ARMADA PA TI SPNE ARM15T	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8457545	SUP	HCPCS C1713		8457545  -  SCREW BN 7.5MM 45MM NS ARMADA PA TI SPNE ARM15T	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8457550	SUP	HCPCS C1713		8457550  -  SCREW BN 7.5MM 50MM NS ARMADA PA TI SPNE ARM15T	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8457555	SUP	HCPCS C1713		8457555  -  SCREW BN 7.5MM 55MM NS ARMADA PA TI SPNE ARM15T	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8457560	SUP	HCPCS C1713		8457560  -  SCREW BN 7.5MM 60MM NS ARMADA PA TI SPNE ARM15T	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8458530	SUP	HCPCS C1713		8458530  -  SCREW BONE 8.5MM 30MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8458535	SUP	HCPCS C1713		8458535  -  SCREW BONE 8.5MM 35MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8458540	SUP	HCPCS C1713		8458540  -  SCREW BONE 8.5MM 40MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8458545	SUP	HCPCS C1713		8458545  -  SCREW BONE 8.5MM 45MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8458550	SUP	HCPCS C1713		8458550  -  SCREW BN 8.5MM 50MM NS ARMADA PA TI SPNE ARM15T	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8459530	SUP	HCPCS C1713		8459530  -  SCREW BONE 9.5MM 30MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8459535	SUP	HCPCS C1713		8459535  -  SCREW BONE 9.5MM 35MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8459540	SUP	HCPCS C1713		8459540  -  SCREW BONE 9.5MM 40MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8459545	SUP	HCPCS C1713		8459545  -  SCREW BONE 9.5MM 45MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8459550	SUP	HCPCS C1713		8459550  -  SCREW BONE 9.5MM 50MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8459555	SUP	HCPCS C1713		8459555  -  SCREW BONE 9.5MM 55MM POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8461100	SUP	HCPCS C1713		8461100  -  SCREW BN 5.5MM 100MM NS ARMADA LCK OPN TULIP TI SPNE	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8461302	SUP	HCPCS C1713		8461302  -  CONNECTOR ROD 5.5MM 6.25MM INLN TI	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8461402	SUP	HCPCS C1713		8461402  -  CONCTR ROD 6.5/5.5MM PRLL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8461602	SUP	HCPCS C1713		8461602  -  CONCTR ROD 6.25/5.5MM 4 HOLE TI	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8464402	SUP	HCPCS C1713		8464402  -  CONNECTOR ROD PARALLEL 5.5MM 6.35MM CLOSE TITANIUM SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8464404	SUP	HCPCS C1713		8464404  -  CONNECTOR ROD 5.5-6.35MM NS ARMADA PRLL SPNE ASF26T	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8464602	SUP	HCPCS C1713		8464602  -  CONNECTOR ROD PARALLEL 5.5MM 6.35MM 4 HOLE TITANIUM SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8464604	SUP	HCPCS C1713		8464604  -  CONNECTOR ROD 5.5-6.35MM NS ARMADA 4 HL PRLL SPNE ASF26T	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8480511	SUP	HCPCS C1713		8480511  -  STAPLE 8480511   3 PRONG 12MM TI	BOTH IP/OP	$579.00 	$428.46	$0.00	$463.20	$260.55	$260.55	$0.00	$0.00	$0.00	$120.68	$429.73	$429.73	$0.00	$0.00	$120.66	$0.00	$342.48	$342.48	$0.00	$289.50	$458.57	$463.20	$0.00		$0.00	$90.61	$0.00	$0.00	$92.18	$0.00	$0.00	$0.00	$0.00	$0.00
8480512	SUP	HCPCS C1713		8480512  -  STAPLE 8480512 12MM TI	BOTH IP/OP	$579.00 	$428.46	$0.00	$463.20	$260.55	$260.55	$0.00	$0.00	$0.00	$120.68	$429.73	$429.73	$0.00	$0.00	$120.66	$0.00	$342.48	$342.48	$0.00	$289.50	$458.57	$463.20	$0.00		$0.00	$90.61	$0.00	$0.00	$92.18	$0.00	$0.00	$0.00	$0.00	$0.00
8481623	SUP	HCPCS C1713		8481623  -  SCREW 8481623 CANNULATED BONE 6.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481625	SUP	HCPCS C1713		8481625  -  SCREW 8481625 CANNULATED BONE 6.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481628	SUP	HCPCS C1713		8481628  -  SCREW 8481628 CANNULATED BONE 6.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481630	SUP	HCPCS C1713		8481630  -  SCREW 8481630 CANNULATED BONE 6.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481633	SUP	HCPCS C1713		8481633  -  SCREW 8481633 CANNULATED BONE 6.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481635	SUP	HCPCS C1713		8481635  -  SCREW 8481635 CANNULATED BONE 6.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481638	SUP	HCPCS C1713		8481638  -  SCREW 8481638 CANNULATED BONE 6.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481640	SUP	HCPCS C1713		8481640  -  SCREW 8481640 CANNULATED BONE 6.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481643	SUP	HCPCS C1713		8481643  -  SCREW 8481643 CANNULATED BONE 6.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481645	SUP	HCPCS C1713		8481645  -  SCREW 8481645 CANNULATED BONE 6.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481648	SUP	HCPCS C1713		8481648  -  BONE SCREW 8481648 6.5MM TI CANNULATED	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481650	SUP	HCPCS C1713		8481650  -  SCREW BONE 6.5MM 50MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481653	SUP	HCPCS C1713		8481653  -  SCREW BONE 6.5MM 53MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481655	SUP	HCPCS C1713		8481655  -  SCREW BONE 6.5MM 55MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481723	SUP	HCPCS C1713		8481723  -  SCREW BONE 7.5MM 48MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481725	SUP	HCPCS C1713		8481725  -  SCREW BONE 7.5MM 50MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481728	SUP	HCPCS C1713		8481728  -  SCREW BONE 7.5MM 53MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481730	SUP	HCPCS C1713		8481730  -  SCREW BONE 7.5MM 55MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481733	SUP	HCPCS C1713		8481733  -  SCREW 8481733 CANNULATED BONE 7.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481735	SUP	HCPCS C1713		8481735  -  SCREW 8481735 CANNULATED BONE 7.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481738	SUP	HCPCS C1713		8481738  -  SCREW 8481738 CANNULATED BONE 7.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481743	SUP	HCPCS C1713		8481743  -  SCREW 8481743 CANNULATED BONE 7.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481745	SUP	HCPCS C1713		8481745  -  SCREW 8481745 CANNULATED BONE 7.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481748	SUP	HCPCS C1713		8481748  -  SCREW BONE 7.5MM 48MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481750	SUP	HCPCS C1713		8481750  -  SCREW BONE 7.5MM 50MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481753	SUP	HCPCS C1713		8481753  -  SCREW BONE 7.5MM 53MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481755	SUP	HCPCS C1713		8481755  -  SCREW BONE 7.5MM 55MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481823	SUP	HCPCS C1713		8481823  -  SCREW BONE 8.5MM 23MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481825	SUP	HCPCS C1713		8481825  -  SCREW 8481825 CANNULATED BONE 8.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481828	SUP	HCPCS C1713		8481828  -  SCREW BONE 8.5MM 28MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481830	SUP	HCPCS C1713		8481830  -  SCREW 8481830 CANNULATED BONE 8.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481833	SUP	HCPCS C1713		8481833  -  SCREW BONE 8.5MM 33MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481835	SUP	HCPCS C1713		8481835  -  SCREW 8481835 CANNULATED BONE 8.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481838	SUP	HCPCS C1713		8481838  -  SCREW BONE 8.5MM 38MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481840	SUP	HCPCS C1713		8481840  -  SCREW 8481840 CANNULATED BONE 8.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481843	SUP	HCPCS C1713		8481843  -  SCREW BONE 8.5MM 43MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481845	SUP	HCPCS C1713		8481845  -  SCREW 8481845 CANNULATED BONE 8.5MM TI	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481848	SUP	HCPCS C1713		8481848  -  SCREW BONE 8.5MM 48MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481850	SUP	HCPCS C1713		8481850  -  SCREW BONE 8.5MM 50MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481853	SUP	HCPCS C1713		8481853  -  SCREW BONE 8.5MM 53MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481855	SUP	HCPCS C1713		8481855  -  SCREW BONE 8.5MM 55MM TI SPNL CANN	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
8481910	SUP	Custom 27203010		8481910  -  INSTRUMENT 8481910 6.5MM RM CAN TAP	BOTH IP/OP	$945.00 	$699.30	$0.00	$756.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$701.38	$701.38	$0.00	$0.00	$196.94	$0.00	$0.00	$0.00	$0.00	$472.50	$748.44	$756.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8481912	SUP	Custom 27203010		8481912  -  INSTRUMENT 8481912 7.5MM RM TP HNDL GRN	BOTH IP/OP	$945.00 	$699.30	$0.00	$756.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$701.38	$701.38	$0.00	$0.00	$196.94	$0.00	$0.00	$0.00	$0.00	$472.50	$748.44	$756.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8482623	SUP	HCPCS C1713		8482623  -  SCREW 8482623 CDH ECLIPSE 6.5X22.5MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482625	SUP	HCPCS C1713		8482625  -  SCREW 8482625 CDH ECLIPSE 6.5X25MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482628	SUP	HCPCS C1713		8482628  -  SCREW 8482628 CDH ECLIPSE 6.5X27.5MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482630	SUP	HCPCS C1713		8482630  -  SCREW 8482630 CDH ECLIPSE 6.5X30MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482633	SUP	HCPCS C1713		8482633  -  SCREW 8482633 CDH ECLIPSE 6.5X32.5MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482635	SUP	HCPCS C1713		8482635  -  SCREW 8482635 CDH ECLIPSE 6.5X35MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482638	SUP	HCPCS C1713		8482638  -  SCREW 8482638 CDH ECLIPSE 6.5X37.5MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482640	SUP	HCPCS C1713		8482640  -  SCREW 8482640 CDH ECLIPSE 6.5X40MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482643	SUP	HCPCS C1713		8482643  -  SCREW 8482643 CDH ECLIPSE 6.5X42.5MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482645	SUP	HCPCS C1713		8482645  -  SCREW 8482645 CDH ECLIPSE 6.5X45MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482648	SUP	HCPCS C1713		8482648  -  SCREW BONE 6.5MM 47.5MM ECLPS SPNL	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482650	SUP	HCPCS C1713		8482650  -  SCREW BONE 6.5MM 50MM ECLPS DBL HEX	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482653	SUP	HCPCS C1713		8482653  -  SCREW BONE 6.5MM 52.5MM ECLPS SPNL	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482655	SUP	HCPCS C1713		8482655  -  SCREW BONE 6.5MM 55MM ECLPS SPNL	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482723	SUP	HCPCS C1713		8482723  -  SCREW 8482723 CDH ECLIPSE 7.5X22.5MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482725	SUP	HCPCS C1713		8482725  -  SCREW 8482725 CDH ECLIPSE 7.5X25MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482728	SUP	HCPCS C1713		8482728  -  SCREW 8482728 CDH ECLIPSE 7.5X27.5MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482730	SUP	HCPCS C1713		8482730  -  SCREW 8482730 CDH ECLIPSE 7.5X30MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482733	SUP	HCPCS C1713		8482733  -  SCREW 8482733 CDH ECLIPSE 7.5X32.5MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482735	SUP	HCPCS C1713		8482735  -  SCREW 8482735 CDH ECLIPSE 7.5X35MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482738	SUP	HCPCS C1713		8482738  -  SCREW 8482738 CDH ECLIPSE 7.5X37.5MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482740	SUP	HCPCS C1713		8482740  -  SCREW 8482740 CDH ECLIPSE 7.5X40MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482743	SUP	HCPCS C1713		8482743  -  SCREW 8482743 CDH ECLIPSE 7.5X42.5MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482745	SUP	HCPCS C1713		8482745  -  SCREW 8482745 CDH ECLIPSE 7.5X45MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482748	SUP	HCPCS C1713		8482748  -  SCREW BONE 7.5MM 47.5MM ECLPS DBL HEX	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482750	SUP	HCPCS C1713		8482750  -  SCREW BONE 7.5MM 50MM ECLPS SPNL	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482753	SUP	HCPCS C1713		8482753  -  SCREW BONE 7.5MM 52.5MM ECLPS DBL HEX	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482755	SUP	HCPCS C1713		8482755  -  SCREW BONE 7.5MM 55MM ECLPS DBL HEX	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482823	SUP	HCPCS C1713		8482823  -  SCREW BONE 8.5MM 22.5MM ECLPS SPNL	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482825	SUP	HCPCS C1713		8482825  -  SCREW 8482825 CDH ECLIPSE 8.5X25MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482828	SUP	HCPCS C1713		8482828  -  SCREW BONE 8.5MM 27.5MM ECLPS DBL HEX	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482830	SUP	HCPCS C1713		8482830  -  SCREW 8482830 CDH ECLIPSE 8.5X30MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482833	SUP	HCPCS C1713		8482833  -  SCREW BONE 8.5MM 32.5MM ECLPS DBL HEX	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482835	SUP	HCPCS C1713		8482835  -  SCREW 8482835 CDH ECLIPSE 8.5X35MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482838	SUP	HCPCS C1713		8482838  -  SCREW BONE 8.5MM 37.5MM ECLPS SPNL	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482840	SUP	HCPCS C1713		8482840  -  SCREW 8482840 CDH ECLIPSE 8.5X40MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482843	SUP	HCPCS C1713		8482843  -  SCREW BONE 8.5MM 42.5MM ECLPS SPNL	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482845	SUP	HCPCS C1713		8482845  -  SCREW 8482845 CDH ECLIPSE 8.5X45MM	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482848	SUP	HCPCS C1713		8482848  -  SCREW BONE 8.5MM 47.5MM ECLPS DBL HEX	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482850	SUP	HCPCS C1713		8482850  -  SCREW BONE 8.5MM 50MM ECLPS SPNL	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482853	SUP	HCPCS C1713		8482853  -  SCREW BONE 8.5MM 52.5MM ECLPS SPNL	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8482855	SUP	HCPCS C1713		8482855  -  SCREW BONE 8.5MM 55MM ECLPS DBL HEX	BOTH IP/OP	"$2,890.50 "	"$2,138.97"	$0.00	"$2,312.40"	"$1,300.73"	"$1,300.73"	$0.00	$0.00	$0.00	$602.45	"$2,145.33"	"$2,145.33"	$0.00	$0.00	$602.38	$0.00	"$1,425.02"	"$1,425.02"	$0.00	"$1,445.25"	"$2,289.28"	"$2,312.40"	$0.00		$0.00	$452.36	$0.00	$0.00	$460.17	$0.00	$0.00	$0.00	$0.00	$0.00
8530000	SUP	HCPCS C1713		8530000  -  PLATE 8530000 TROUGH PLATE	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
8530008	SUP	HCPCS C1713		8530008  -  PLATE 8MM BONE SPN	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
8530408	SUP	HCPCS C1713		8530408  -  PLATE BN 8MM NS CENTERPIECE GFT SPNE	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
8530605	SUP	Custom 27203010		8530605  -  BIT DRL 1.9MM STRL 3 FLT DISP	BOTH IP/OP	$349.50 	$258.63	$0.00	$279.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.40	$259.40	$0.00	$0.00	$72.84	$0.00	$0.00	$0.00	$0.00	$174.75	$276.80	$279.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8536510	SUP	HCPCS C1713		8536510  -  SCREW ILIAC 6.5MM 100MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8536560	SUP	HCPCS C1713		8536560  -  SCREW ILIAC 6.5MM 60MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8536570	SUP	HCPCS C1713		8536570  -  SCREW ILIAC 6.5MM 70MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8536580	SUP	HCPCS C1713		8536580  -  SCREW ILIAC 6.5MM 80MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8536590	SUP	HCPCS C1713		8536590  -  SCREW ILIAC 6.5MM 90MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8537510	SUP	HCPCS C1713		8537510  -  SCREW ILIAC 7.5MM 100MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8537570	SUP	HCPCS C1713		8537570  -  SCREW ILIAC 7.5MM 70MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8537580	SUP	HCPCS C1713		8537580  -  SCREW ILIAC 7.5MM 80MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8537590	SUP	HCPCS C1713		8537590  -  SCREW ILIAC 7.5MM 90MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8538510	SUP	HCPCS C1713		8538510  -  SCREW ILIAC 8.5MM 100MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8538570	SUP	HCPCS C1713		8538570  -  SCREW ILIAC 8.5MM 70MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8538580	SUP	HCPCS C1713		8538580  -  SCREW ILIAC 8.5MM 80MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8538590	SUP	HCPCS C1713		8538590  -  SCREW ILIAC 8.5MM 90MM SC 5.5MM SS	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8540611	SUP	HCPCS C1713		8540611  -  CROSSLINK 8540611 11 MM ANTERIOR LPC TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8540612	SUP	HCPCS C1713		8540612  -  CROSSLINK 8540612 12 MM ANTERIOR LPC TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8540613	SUP	HCPCS C1713		8540613  -  CROSSLINK 8540613 13 MM ANTERIOR LPC TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8540614	SUP	HCPCS C1713		8540614  -  CROSSLINK 8540614 14 MM ANTERIOR LPC TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8540615	SUP	HCPCS C1713		8540615  -  CROSSLINK 8540615 15 MM ANTERIOR LPC TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8540616	SUP	HCPCS C1713		8540616  -  CROSSLINK 8540616 16 MM ANTERIOR LPC TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8540617	SUP	HCPCS C1713		8540617  -  CROSSLINK 8540617 17 MM ANTERIOR LPC TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8546796	SUP	Custom 27203010		REAGENT LYS SOL CLTR LYS S 5L MAXM/HMX/LH SER ANALY	BOTH IP/OP	$815.20 	$603.25	$0.00	$652.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.60	$645.64	$652.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8547008	SUP	Custom 27203010		REAGENT SHTH FLUID ISFLW 1.8L ANALY	BOTH IP/OP	$38.05 	$28.16	$0.00	$30.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.03	$30.14	$30.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8547194	SUP	Custom 27203010		REAGENT DILU CLTR ISOT CARBOY 20L LH700 SER ANALY	BOTH IP/OP	$64.33 	$47.60	$0.00	$51.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.16	$50.95	$51.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8547195	SUP	Custom 27203010		REAGENT DILU CLTR SCTR PK 20L LH700 SER ANALY	BOTH IP/OP	$354.18 	$262.09	$0.00	$283.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.09	$280.51	$283.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8547196	SUP	Custom 27203010		REAGENT RETCYT CLTR 20L LH700 SER ANALY	BOTH IP/OP	$419.10 	$310.13	$0.00	$335.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$209.55	$331.93	$335.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8548498	SUP	HCPCS C1713		8548498  -  STAPLE 8548498  19MM CAUDAL TI	BOTH IP/OP	"$2,518.50 "	"$1,863.69"	$0.00	"$2,014.80"	"$1,133.33"	"$1,133.33"	$0.00	$0.00	$0.00	$524.92	"$1,869.23"	"$1,869.23"	$0.00	$0.00	$524.86	$0.00	"$1,241.62"	"$1,241.62"	$0.00	"$1,259.25"	"$1,994.65"	"$2,014.80"	$0.00		$0.00	$394.15	$0.00	$0.00	$400.95	$0.00	$0.00	$0.00	$0.00	$0.00
8548499	SUP	HCPCS C1713		8548499  -  STAPLE 8548499  19MM ROSTRAL TI	BOTH IP/OP	"$2,518.50 "	"$1,863.69"	$0.00	"$2,014.80"	"$1,133.33"	"$1,133.33"	$0.00	$0.00	$0.00	$524.92	"$1,869.23"	"$1,869.23"	$0.00	$0.00	$524.86	$0.00	"$1,241.62"	"$1,241.62"	$0.00	"$1,259.25"	"$1,994.65"	"$2,014.80"	$0.00		$0.00	$394.15	$0.00	$0.00	$400.95	$0.00	$0.00	$0.00	$0.00	$0.00
8548500	SUP	HCPCS C1713		8548500  -  STAPLE 8548500  21 MM CAUDAL TI	BOTH IP/OP	"$2,518.50 "	"$1,863.69"	$0.00	"$2,014.80"	"$1,133.33"	"$1,133.33"	$0.00	$0.00	$0.00	$524.92	"$1,869.23"	"$1,869.23"	$0.00	$0.00	$524.86	$0.00	"$1,241.62"	"$1,241.62"	$0.00	"$1,259.25"	"$1,994.65"	"$2,014.80"	$0.00		$0.00	$394.15	$0.00	$0.00	$400.95	$0.00	$0.00	$0.00	$0.00	$0.00
8548501	SUP	HCPCS C1713		8548501  -  STAPLE 8548501  21 MM ROSTRAL TI	BOTH IP/OP	"$2,518.50 "	"$1,863.69"	$0.00	"$2,014.80"	"$1,133.33"	"$1,133.33"	$0.00	$0.00	$0.00	$524.92	"$1,869.23"	"$1,869.23"	$0.00	$0.00	$524.86	$0.00	"$1,241.62"	"$1,241.62"	$0.00	"$1,259.25"	"$1,994.65"	"$2,014.80"	$0.00		$0.00	$394.15	$0.00	$0.00	$400.95	$0.00	$0.00	$0.00	$0.00	$0.00
8549008	SUP	HCPCS C1713		8549008  -  CROSSLINK 8549008 16TI LPC FOR 4.5ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8549009	SUP	HCPCS C1713		8549009  -  CROSSLINK 8549009 19TI LPC FOR 4.5ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8549010	SUP	HCPCS C1713		8549010  -  CROSSLINK 8549010 22TI LPC FOR 4.5ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8549011	SUP	HCPCS C1713		8549011  -  CROSSLINK 8549011 25TI LPC FOR 4.5ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8549012	SUP	HCPCS C1713		8549012  -  CROSSLINK 8549012 29TI LPC FOR 4.5ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8549013	SUP	HCPCS C1713		8549013  -  CROSSLINK 8549013 32TI LPC FOR 4.5ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8549014	SUP	HCPCS C1713		8549014  -  CROSSLINK 8549014 35TI LPC FOR 4.5ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8549015	SUP	HCPCS C1713		8549015  -  CROSSLINK 8549015 38TI LPC FOR 4.5ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8549016	SUP	HCPCS C1713		8549016  -  CROSSLINK 8549016 4.5MM MLTSPAN LPC SM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8549017	SUP	HCPCS C1713		8549017  -  CROSSLINK 8549017 4.5MM MLTSPAN LPC MD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8549018	SUP	HCPCS C1713		8549018  -  CROSSLINK 8549018 4.5MM MLTSPAN LPC LG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8549300	SUP	Custom 27803010		8549300  -  CONNECTOR 8549300 4.5 4.5 OPEN DOMINO TI	BOTH IP/OP	"$1,831.18 "	"$1,355.07"	$0.00	"$1,464.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,359.10"	"$1,359.10"	$0.00	$0.00	$381.62	$0.00	$0.00	$0.00	$0.00	$915.59	"$1,450.29"	"$1,464.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8549301	SUP	Custom 27803010		8549301  -  CONNECTOR 8549301 4.5 5.5 OPEN DOMINO TI	BOTH IP/OP	"$1,831.18 "	"$1,355.07"	$0.00	"$1,464.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,359.10"	"$1,359.10"	$0.00	$0.00	$381.62	$0.00	$0.00	$0.00	$0.00	$915.59	"$1,450.29"	"$1,464.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8549305	SUP	Custom 27803010		8549305  -  CONNECTOR 8549305 4.5 MM DOMINO	BOTH IP/OP	"$1,831.18 "	"$1,355.07"	$0.00	"$1,464.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,359.10"	"$1,359.10"	$0.00	$0.00	$381.62	$0.00	$0.00	$0.00	$0.00	$915.59	"$1,450.29"	"$1,464.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8549306	SUP	Custom 27803010		8549306  -  CONNECTOR 8549306 4.5 MM 5.5MM DOMINO	BOTH IP/OP	"$1,831.18 "	"$1,355.07"	$0.00	"$1,464.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,359.10"	"$1,359.10"	$0.00	$0.00	$381.62	$0.00	$0.00	$0.00	$0.00	$915.59	"$1,450.29"	"$1,464.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8550120	SUP	HCPCS C1713		8550120  -  CONCTR ROD 20MM 5.5MM CX FIX SS	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$756.58	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	"$1,789.59"	"$1,789.59"	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
8550122	SUP	HCPCS C1713		8550122  -  CONCTR ROD 22.5MM 5.5MM CX FIX SS	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$756.58	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	"$1,789.59"	"$1,789.59"	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
8550125	SUP	HCPCS C1713		8550125  -  CONCTR ROD 25MM 5.5MM SS CX FIX	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$756.58	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	"$1,789.59"	"$1,789.59"	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
8550127	SUP	HCPCS C1713		8550127  -  CONCTR ROD 27.5MM 5.5MM SS CX FIX	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$756.58	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	"$1,789.59"	"$1,789.59"	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
8550130	SUP	HCPCS C1713		8550130  -  CONCTR ROD 30MM 5.5MM SS CX FIX	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$756.58	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	"$1,789.59"	"$1,789.59"	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
8550132	SUP	HCPCS C1713		8550132  -  CONCTR ROD 32.5MM 5.5MM SS CX FIX	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$756.58	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	"$1,789.59"	"$1,789.59"	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
8550135	SUP	HCPCS C1713		8550135  -  CONCTR ROD 35MM 5.5MM SS CX FIX	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$756.58	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	"$1,789.59"	"$1,789.59"	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
8550137	SUP	HCPCS C1713		8550137  -  CONCTR ROD 37.5MM 5.5MM SS CX FIX	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$756.58	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	"$1,789.59"	"$1,789.59"	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
8550140	SUP	HCPCS C1713		8550140  -  CONCTR ROD 40MM 5.5MM SS CX FIX	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$756.58	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	"$1,789.59"	"$1,789.59"	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
8550145	SUP	HCPCS C1713		8550145  -  CONCTR ROD 45MM 5.5MM SS CX FIX	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$756.58	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	"$1,789.59"	"$1,789.59"	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
8550150	SUP	HCPCS C1713		8550150  -  CONCTR ROD 50MM 5.5MM SS CX FIX	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$756.58	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	"$1,789.59"	"$1,789.59"	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
8550245	SUP	HCPCS C1713		8550245  -  CONCTR ROD 45-50MM 5.5MM SS CX	BOTH IP/OP	"$4,905.00 "	"$3,629.70"	$0.00	"$3,924.00"	"$2,207.25"	"$2,207.25"	$0.00	$0.00	$0.00	"$1,022.32"	"$3,640.49"	"$3,640.49"	$0.00	$0.00	"$1,022.20"	$0.00	"$2,418.17"	"$2,418.17"	$0.00	"$2,452.50"	"$3,884.76"	"$3,924.00"	$0.00		$0.00	$767.63	$0.00	$0.00	$780.88	$0.00	$0.00	$0.00	$0.00	$0.00
8550250	SUP	HCPCS C1713		8550250  -  CONCTR ROD 50-60MM 5.5MM SS CX	BOTH IP/OP	"$4,905.00 "	"$3,629.70"	$0.00	"$3,924.00"	"$2,207.25"	"$2,207.25"	$0.00	$0.00	$0.00	"$1,022.32"	"$3,640.49"	"$3,640.49"	$0.00	$0.00	"$1,022.20"	$0.00	"$2,418.17"	"$2,418.17"	$0.00	"$2,452.50"	"$3,884.76"	"$3,924.00"	$0.00		$0.00	$767.63	$0.00	$0.00	$780.88	$0.00	$0.00	$0.00	$0.00	$0.00
8550260	SUP	HCPCS C1713		8550260  -  CONCTR ROD 60-70MM 5.5MM SS CX	BOTH IP/OP	"$4,905.00 "	"$3,629.70"	$0.00	"$3,924.00"	"$2,207.25"	"$2,207.25"	$0.00	$0.00	$0.00	"$1,022.32"	"$3,640.49"	"$3,640.49"	$0.00	$0.00	"$1,022.20"	$0.00	"$2,418.17"	"$2,418.17"	$0.00	"$2,452.50"	"$3,884.76"	"$3,924.00"	$0.00		$0.00	$767.63	$0.00	$0.00	$780.88	$0.00	$0.00	$0.00	$0.00	$0.00
8550270	SUP	HCPCS C1713		8550270  -  CONCTR ROD 70-85MM 5.5MM SS CX	BOTH IP/OP	"$4,905.00 "	"$3,629.70"	$0.00	"$3,924.00"	"$2,207.25"	"$2,207.25"	$0.00	$0.00	$0.00	"$1,022.32"	"$3,640.49"	"$3,640.49"	$0.00	$0.00	"$1,022.20"	$0.00	"$2,418.17"	"$2,418.17"	$0.00	"$2,452.50"	"$3,884.76"	"$3,924.00"	$0.00		$0.00	$767.63	$0.00	$0.00	$780.88	$0.00	$0.00	$0.00	$0.00	$0.00
8550302	SUP	HCPCS C1713		8550302  -  CONCTR ROD 5.5MM SS INLN	BOTH IP/OP	"$2,880.00 "	"$2,131.20"	$0.00	"$2,304.00"	"$1,296.00"	"$1,296.00"	$0.00	$0.00	$0.00	$600.26	"$2,137.54"	"$2,137.54"	$0.00	$0.00	$600.19	$0.00	"$1,419.84"	"$1,419.84"	$0.00	"$1,440.00"	"$2,280.96"	"$2,304.00"	$0.00		$0.00	$450.72	$0.00	$0.00	$458.50	$0.00	$0.00	$0.00	$0.00	$0.00
8550402	SUP	HCPCS C1713		8550402  -  CONCTR ROD 5.5MM SS PRLL	BOTH IP/OP	"$2,880.00 "	"$2,131.20"	$0.00	"$2,304.00"	"$1,296.00"	"$1,296.00"	$0.00	$0.00	$0.00	$600.26	"$2,137.54"	"$2,137.54"	$0.00	$0.00	$600.19	$0.00	"$1,419.84"	"$1,419.84"	$0.00	"$1,440.00"	"$2,280.96"	"$2,304.00"	$0.00		$0.00	$450.72	$0.00	$0.00	$458.50	$0.00	$0.00	$0.00	$0.00	$0.00
8550602	SUP	HCPCS C1713		8550602  -  CONCTR ROD 5.5MM SS 4 HOLE	BOTH IP/OP	"$3,617.50 "	"$2,676.95"	$0.00	"$2,894.00"	"$1,627.88"	"$1,627.88"	$0.00	$0.00	$0.00	$753.98	"$2,684.91"	"$2,684.91"	$0.00	$0.00	$753.89	$0.00	"$1,783.43"	"$1,783.43"	$0.00	"$1,808.75"	"$2,865.06"	"$2,894.00"	$0.00		$0.00	$566.14	$0.00	$0.00	$575.91	$0.00	$0.00	$0.00	$0.00	$0.00
8552200	SUP	HCPCS C1713		8552200  -  ROD 5.5MM 200MM SS	BOTH IP/OP	"$1,295.00 "	$958.30	$0.00	"$1,036.00"	$582.75	$582.75	$0.00	$0.00	$0.00	$269.91	$961.15	$961.15	$0.00	$0.00	$269.88	$0.00	$765.99	$765.99	$0.00	$647.50	"$1,025.64"	"$1,036.00"	$0.00		$0.00	$202.67	$0.00	$0.00	$206.16	$0.00	$0.00	$0.00	$0.00	$0.00
8552300	SUP	HCPCS C1713		8552300  -  ROD 5.5MM 300MM SS	BOTH IP/OP	"$1,860.00 "	"$1,376.40"	$0.00	"$1,488.00"	$837.00	$837.00	$0.00	$0.00	$0.00	$387.67	"$1,380.49"	"$1,380.49"	$0.00	$0.00	$387.62	$0.00	"$1,100.19"	"$1,100.19"	$0.00	$930.00	"$1,473.12"	"$1,488.00"	$0.00		$0.00	$291.09	$0.00	$0.00	$296.11	$0.00	$0.00	$0.00	$0.00	$0.00
8552500	SUP	HCPCS C1713		8552500  -  ROD SPNL 500MM 5.5MM SS	BOTH IP/OP	"$1,922.50 "	"$1,422.65"	$0.00	"$1,538.00"	$865.13	$865.13	$0.00	$0.00	$0.00	$400.70	"$1,426.88"	"$1,426.88"	$0.00	$0.00	$400.65	$0.00	"$1,137.16"	"$1,137.16"	$0.00	$961.25	"$1,522.62"	"$1,538.00"	$0.00		$0.00	$300.87	$0.00	$0.00	$306.06	$0.00	$0.00	$0.00	$0.00	$0.00
8553101	SUP	Custom 27803010		8553101  -  HOOK SPNL 5.5MM SM PDCL SS	BOTH IP/OP	"$3,115.00 "	"$2,305.10"	$0.00	"$2,492.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,311.95"	"$2,311.95"	$0.00	$0.00	$649.17	$0.00	$0.00	$0.00	$0.00	"$1,557.50"	"$2,467.08"	"$2,492.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8553102	SUP	Custom 27803010		8553102  -  HOOK SPNL 5.5MM MED PDCL SS	BOTH IP/OP	"$3,115.00 "	"$2,305.10"	$0.00	"$2,492.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,311.95"	"$2,311.95"	$0.00	$0.00	$649.17	$0.00	$0.00	$0.00	$0.00	"$1,557.50"	"$2,467.08"	"$2,492.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8553112	SUP	Custom 27803010		8553112  -  HOOK SPNL 6MM LMNR SS RED 5.5MM ROD	BOTH IP/OP	"$3,115.00 "	"$2,305.10"	$0.00	"$2,492.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,311.95"	"$2,311.95"	$0.00	$0.00	$649.17	$0.00	$0.00	$0.00	$0.00	"$1,557.50"	"$2,467.08"	"$2,492.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8553113	SUP	Custom 27803010		8553113  -  HOOK SPNL 8MM LMNR SS RED 5.5MM ROD	BOTH IP/OP	"$3,115.00 "	"$2,305.10"	$0.00	"$2,492.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,311.95"	"$2,311.95"	$0.00	$0.00	$649.17	$0.00	$0.00	$0.00	$0.00	"$1,557.50"	"$2,467.08"	"$2,492.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8553114	SUP	Custom 27803010		8553114  -  HOOK SPNL 10MM LMNR SS RED 5.5MM ROD	BOTH IP/OP	"$3,115.00 "	"$2,305.10"	$0.00	"$2,492.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,311.95"	"$2,311.95"	$0.00	$0.00	$649.17	$0.00	$0.00	$0.00	$0.00	"$1,557.50"	"$2,467.08"	"$2,492.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8553121	SUP	Custom 27803010		8553121  -  HOOK SPNL SS RIGHT ANG 5.5 MM ROD	BOTH IP/OP	"$3,950.00 "	"$2,923.00"	$0.00	"$3,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,931.69"	"$2,931.69"	$0.00	$0.00	$823.18	$0.00	$0.00	$0.00	$0.00	"$1,975.00"	"$3,128.40"	"$3,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8553122	SUP	Custom 27803010		8553122  -  HOOK SPNL SS LEFT ANG 5.5 MM ROD	BOTH IP/OP	"$3,950.00 "	"$2,923.00"	$0.00	"$3,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,931.69"	"$2,931.69"	$0.00	$0.00	$823.18	$0.00	$0.00	$0.00	$0.00	"$1,975.00"	"$3,128.40"	"$3,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8553123	SUP	Custom 27803010		8553123  -  HOOK SPNL SS RIGHT OFFST 5.5 MM ROD	BOTH IP/OP	"$3,950.00 "	"$2,923.00"	$0.00	"$3,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,931.69"	"$2,931.69"	$0.00	$0.00	$823.18	$0.00	$0.00	$0.00	$0.00	"$1,975.00"	"$3,128.40"	"$3,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8553124	SUP	Custom 27803010		8553124  -  HOOK SPNL SS LEFT OFFST 5.5 MM ROD	BOTH IP/OP	"$3,950.00 "	"$2,923.00"	$0.00	"$3,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,931.69"	"$2,931.69"	$0.00	$0.00	$823.18	$0.00	$0.00	$0.00	$0.00	"$1,975.00"	"$3,128.40"	"$3,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8554025	SUP	HCPCS C1713		8554025  -  SCREW BONE 4MM 25MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8554030	SUP	HCPCS C1713		8554030  -  SCREW BONE 4MM 30MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8554035	SUP	HCPCS C1713		8554035  -  SCREW BONE 4MM 35MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8554040	SUP	HCPCS C1713		8554040  -  SCREW BONE 4MM 40MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8554525	SUP	HCPCS C1713		8554525  -  SCREW BONE 4.5MM 25MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8554530	SUP	HCPCS C1713		8554530  -  SCREW BONE 4.5MM 30MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8554535	SUP	HCPCS C1713		8554535  -  SCREW BONE 4.5MM 35MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8554540	SUP	HCPCS C1713		8554540  -  SCREW BONE 4.5MM 40MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8554545	SUP	HCPCS C1713		8554545  -  SCREW BONE 4.5MM 45MM SS SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8555025	SUP	HCPCS C1713		8555025  -  SCREW BONE 5MM 25MM SS SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8555030	SUP	HCPCS C1713		8555030  -  SCREW BONE 5MM 30MM SS SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8555035	SUP	HCPCS C1713		8555035  -  SCREW BONE 5MM 35MM SS SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8555040	SUP	HCPCS C1713		8555040  -  SCREW BONE 5MM 40MM SS SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8555045	SUP	HCPCS C1713		8555045  -  SCREW BONE 5MM 45MM SS SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8555530	SUP	HCPCS C1713		8555530  -  SCREW BONE 5.5MM 30MM SS SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8555535	SUP	HCPCS C1713		8555535  -  SCREW BONE 5.5MM 35MM SS SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8555540	SUP	HCPCS C1713		8555540  -  SCREW BONE 5.5MM 40MM SS SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8555545	SUP	HCPCS C1713		8555545  -  SCREW BONE 5.5MM 45MM SS SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8555550	SUP	HCPCS C1713		8555550  -  SCREW BONE 5.5MM 50MM SS SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8555555	SUP	HCPCS C1713		8555555  -  SCREW BONE 5.5MM 55MM SS SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8556535	SUP	HCPCS C1713		8556535  -  SCREW BONE 6.5MM 35MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8556540	SUP	HCPCS C1713		8556540  -  SCREW BONE 6.5MM 40MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8556545	SUP	HCPCS C1713		8556545  -  SCREW BONE 6.5MM 45MM SS SPNL	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8556550	SUP	HCPCS C1713		8556550  -  SCREW BONE 6.5MM 50MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8556555	SUP	HCPCS C1713		8556555  -  SCREW BONE 6.5MM 55MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8557535	SUP	HCPCS C1713		8557535  -  SCREW BONE 7.5MM 35MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8557540	SUP	HCPCS C1713		8557540  -  SCREW BONE 7.5MM 40MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8557545	SUP	HCPCS C1713		8557545  -  SCREW BONE 7.5MM 45MM SS SPNL	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8557550	SUP	HCPCS C1713		8557550  -  SCREW BONE 7.5MM 50MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8557555	SUP	HCPCS C1713		8557555  -  SCREW BONE 7.5MM 55MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8558540	SUP	HCPCS C1713		8558540  -  SCREW BONE 8.5MM 40MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8558545	SUP	HCPCS C1713		8558545  -  SCREW BONE 8.5MM 45MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8558550	SUP	HCPCS C1713		8558550  -  SCREW BONE 8.5MM 50MM SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8560302	SUP	HCPCS C1713		8560302  -  CONCTR ROD 6.35/5.5MM SS INLN	BOTH IP/OP	"$2,880.00 "	"$2,131.20"	$0.00	"$2,304.00"	"$1,296.00"	"$1,296.00"	$0.00	$0.00	$0.00	$600.26	"$2,137.54"	"$2,137.54"	$0.00	$0.00	$600.19	$0.00	"$1,419.84"	"$1,419.84"	$0.00	"$1,440.00"	"$2,280.96"	"$2,304.00"	$0.00		$0.00	$450.72	$0.00	$0.00	$458.50	$0.00	$0.00	$0.00	$0.00	$0.00
8560402	SUP	HCPCS C1713		8560402  -  CONCTR ROD 6.35/5.5MM SS PRLL	BOTH IP/OP	"$2,880.00 "	"$2,131.20"	$0.00	"$2,304.00"	"$1,296.00"	"$1,296.00"	$0.00	$0.00	$0.00	$600.26	"$2,137.54"	"$2,137.54"	$0.00	$0.00	$600.19	$0.00	"$1,419.84"	"$1,419.84"	$0.00	"$1,440.00"	"$2,280.96"	"$2,304.00"	$0.00		$0.00	$450.72	$0.00	$0.00	$458.50	$0.00	$0.00	$0.00	$0.00	$0.00
8560602	SUP	HCPCS C1713		8560602  -  CONCTR ROD 6.35/5.5MM SS 4 HOLE	BOTH IP/OP	"$3,617.50 "	"$2,676.95"	$0.00	"$2,894.00"	"$1,627.88"	"$1,627.88"	$0.00	$0.00	$0.00	$753.98	"$2,684.91"	"$2,684.91"	$0.00	$0.00	$753.89	$0.00	"$1,783.43"	"$1,783.43"	$0.00	"$1,808.75"	"$2,865.06"	"$2,894.00"	$0.00		$0.00	$566.14	$0.00	$0.00	$575.91	$0.00	$0.00	$0.00	$0.00	$0.00
8561100	SUP	HCPCS C1713		8561100  -  SCREW BONE ARMADA SPNL LCK	BOTH IP/OP	$910.00 	$673.40	$0.00	$728.00	$409.50	$409.50	$0.00	$0.00	$0.00	$189.67	$675.40	$675.40	$0.00	$0.00	$189.64	$0.00	$538.27	$538.27	$0.00	$455.00	$720.72	$728.00	$0.00		$0.00	$142.42	$0.00	$0.00	$144.87	$0.00	$0.00	$0.00	$0.00	$0.00
8561300	SUP	HCPCS C1713		8561300  -  CONCTR ROD ROD TO ROD LCK SCR SIDE SPNL	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$340.88	$340.88	$0.00	$0.00	$0.00	$157.88	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$448.06	$448.06	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$118.55	$0.00	$0.00	$120.59	$0.00	$0.00	$0.00	$0.00	$0.00
8562010	SUP	Custom 27203010		8562010  -  STIMULATOR NRV STD VRSTIM3 HNDHLD LCTR SUBDERMIS	BOTH IP/OP	$204.75 	$151.52	$0.00	$151.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.97	$151.97	$0.00	$0.00	$42.67	$0.00	$0.00	$0.00	$0.00	$92.00	$145.73	$147.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8562250	SUP	HCPCS C1713		8562250  -  ROD SPNL 250MM 6.35MM SS	BOTH IP/OP	"$1,860.00 "	"$1,376.40"	$0.00	"$1,488.00"	$837.00	$837.00	$0.00	$0.00	$0.00	$387.67	"$1,380.49"	"$1,380.49"	$0.00	$0.00	$387.62	$0.00	"$1,100.19"	"$1,100.19"	$0.00	$930.00	"$1,473.12"	"$1,488.00"	$0.00		$0.00	$291.09	$0.00	$0.00	$296.11	$0.00	$0.00	$0.00	$0.00	$0.00
8562500	SUP	HCPCS C1713		8562500  -  ROD SPNL 500MM 6.35MM SS	BOTH IP/OP	"$2,017.50 "	"$1,492.95"	$0.00	"$1,614.00"	$907.88	$907.88	$0.00	$0.00	$0.00	$420.50	"$1,497.39"	"$1,497.39"	$0.00	$0.00	$420.45	$0.00	"$1,193.35"	"$1,193.35"	$0.00	"$1,008.75"	"$1,597.86"	"$1,614.00"	$0.00		$0.00	$315.74	$0.00	$0.00	$321.19	$0.00	$0.00	$0.00	$0.00	$0.00
8564525	SUP	HCPCS C1713		8564525  -  SCREW BONE 4.5MM 25MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8564530	SUP	HCPCS C1713		8564530  -  SCREW BONE 4.5MM 30MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8564535	SUP	HCPCS C1713		8564535  -  SCREW BONE 4.5MM 35MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8564540	SUP	HCPCS C1713		8564540  -  SCREW BONE 4.5MM 40MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8564545	SUP	HCPCS C1713		8564545  -  SCREW BONE 4.5MM 45MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8565530	SUP	HCPCS C1713		8565530  -  SCREW BONE 5.5MM 30MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8565535	SUP	HCPCS C1713		8565535  -  SCREW BONE 5.5MM 35MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8565540	SUP	HCPCS C1713		8565540  -  SCREW BONE 5.5MM 40MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8565545	SUP	HCPCS C1713		8565545  -  SCREW BONE 5.5MM 45MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8565550	SUP	HCPCS C1713		8565550  -  SCREW BONE 5.5MM 50MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8565555	SUP	HCPCS C1713		8565555  -  SCREW BONE 5.5MM 55MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8566530	SUP	HCPCS C1713		8566530  -  SCREW BONE 6.5MM 30MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8566535	SUP	HCPCS C1713		8566535  -  SCREW BONE 6.5MM 35MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8566540	SUP	HCPCS C1713		8566540  -  SCREW BONE 6.5MM 40MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8566545	SUP	HCPCS C1713		8566545  -  SCREW BONE 6.5MM 45MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8566550	SUP	HCPCS C1713		8566550  -  SCREW BONE 6.5MM 50MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8566555	SUP	HCPCS C1713		8566555  -  SCREW BONE 6.5MM 55MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8567535	SUP	HCPCS C1713		8567535  -  SCREW BONE 7.5MM 35MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8567540	SUP	HCPCS C1713		8567540  -  SCREW BONE 7.5MM 40MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8567545	SUP	HCPCS C1713		8567545  -  SCREW BONE 7.5MM 45MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8567550	SUP	HCPCS C1713		8567550  -  SCREW BONE 7.5MM 50MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8567555	SUP	HCPCS C1713		8567555  -  SCREW BONE 7.5MM 55MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8568535	SUP	HCPCS C1713		8568535  -  SCREW BONE 8.5MM 35MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8568540	SUP	HCPCS C1713		8568540  -  SCREW BONE 8.5MM 40MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8568545	SUP	HCPCS C1713		8568545  -  SCREW BONE 8.5MM 45MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8568550	SUP	HCPCS C1713		8568550  -  SCREW BONE 8.5MM 50MM SPNL POLYAX 6.35MM ROD	BOTH IP/OP	"$4,607.50 "	"$3,409.55"	$0.00	"$3,686.00"	"$2,073.38"	"$2,073.38"	$0.00	$0.00	$0.00	$960.32	"$3,419.69"	"$3,419.69"	$0.00	$0.00	$960.20	$0.00	"$2,271.50"	"$2,271.50"	$0.00	"$2,303.75"	"$3,649.14"	"$3,686.00"	$0.00		$0.00	$721.07	$0.00	$0.00	$733.51	$0.00	$0.00	$0.00	$0.00	$0.00
8570611	SUP	HCPCS C1713		8570611  -  CROSSLINK 8570611 4.5MM DUAL ROD 11MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8570612	SUP	HCPCS C1713		8570612  -  CROSSLINK 8570612 4.5MM DUAL ROD 12MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8570613	SUP	HCPCS C1713		8570613  -  CROSSLINK 8570613 4.5MM DUAL ROD 13MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8570614	SUP	HCPCS C1713		8570614  -  CROSSLINK 8570614 4.5MM DUAL ROD 14MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8570615	SUP	HCPCS C1713		8570615  -  CROSSLINK 8570615 4.5MM DUAL ROD 15MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8570616	SUP	HCPCS C1713		8570616  -  CROSSLINK 8570616 4.5MM DUAL ROD 16MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8570617	SUP	HCPCS C1713		8570617  -  CROSSLINK 8570617 4.5MM DUAL ROD 17MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8576510	SUP	HCPCS C1713		8576510  -  SCREW BONE 6.5MM 80MM ILC SPNL 6.35MM ROD	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8576570	SUP	HCPCS C1713		8576570  -  SCREW BONE 6.5MM 70MM ILC SPNL 6.35MM ROD	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8576580	SUP	HCPCS C1713		8576580  -  SCREW BONE 6.5MM 80MM ILC SPNL 6.35MM ROD	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8576590	SUP	HCPCS C1713		8576590  -  SCREW BONE 6.5MM 90MM ILC SPNL 6.35MM ROD	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8577510	SUP	HCPCS C1713		8577510  -  SCREW BONE 7.5MM 100MM ILC SPNL 6.3MM	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8577570	SUP	HCPCS C1713		8577570  -  SCREW BONE 7.5MM 70MM ILC SPNL 6.35MM ROD	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8577580	SUP	HCPCS C1713		8577580  -  SCREW BONE 7.5MM 80MM ILC SPNL 6.35MM ROD	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8577590	SUP	HCPCS C1713		8577590  -  SCREW BONE 7.5MM 90MM ILC SPNL 6.35MM ROD	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8578510	SUP	HCPCS C1713		8578510  -  SCREW BONE 8.5MM 100MM ILC SPNL 6.3MM	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8578570	SUP	HCPCS C1713		8578570  -  SCREW BONE 8.5MM 70MM ILC SPNL 6.35MM ROD	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8578580	SUP	HCPCS C1713		8578580  -  SCREW BONE 8.5MM 80MM ILC SPNL 6.35MM ROD	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8578590	SUP	HCPCS C1713		8578590  -  SCREW BONE 8.5MM 90MM ILC SPNL 6.35MM ROD	BOTH IP/OP	"$5,602.50 "	"$4,145.85"	$0.00	"$4,482.00"	"$2,521.13"	"$2,521.13"	$0.00	$0.00	$0.00	"$1,167.70"	"$4,158.18"	"$4,158.18"	$0.00	$0.00	"$1,167.56"	$0.00	"$2,762.03"	"$2,762.03"	$0.00	"$2,801.25"	"$4,437.18"	"$4,482.00"	$0.00		$0.00	$876.79	$0.00	$0.00	$891.92	$0.00	$0.00	$0.00	$0.00	$0.00
8579008	SUP	HCPCS C1713		8579008  -  CROSSLINK 8579008 4.5 LP .625 16MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8579009	SUP	HCPCS C1713		8579009  -  CROSSLINK 8579009 4.5 LP .750 19MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8579010	SUP	HCPCS C1713		8579010  -  CROSSLINK 8579010 4.5 LP .875 22MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8579011	SUP	HCPCS C1713		8579011  -  CROSSLINK 8579011 4.5 LP 1.00 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8579012	SUP	HCPCS C1713		8579012  -  CROSSLINK 8579012 4.5 LP 1.12529MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8579013	SUP	HCPCS C1713		8579013  -  CROSSLINK 8579013 4.5 LP 1.25032MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8579014	SUP	HCPCS C1713		8579014  -  CROSSLINK 8579014 4.5 LP 1.37535MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8579015	SUP	HCPCS C1713		8579015  -  CROSSLINK 8579015 4.5 LP 1.50038MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8579016	SUP	HCPCS C1713		8579016  -  CROSSLINK 8579016 4.5 LP 1.55 1.75	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8579017	SUP	HCPCS C1713		8579017  -  CROSSLINK 8579017 4.5 LP 1.75 2.15	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8579018	SUP	HCPCS C1713		8579018  -  CROSSLINK 8579018 4.5 LP 2.15 2.95	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8579300	SUP	Custom 27803010		8579300  -  CONNECTOR 8579300 4.5 TO 4.5MM DOMINO	BOTH IP/OP	"$1,796.58 "	"$1,329.47"	$0.00	"$1,437.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,333.42"	"$1,333.42"	$0.00	$0.00	$374.41	$0.00	$0.00	$0.00	$0.00	$898.29	"$1,422.89"	"$1,437.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8579301	SUP	Custom 27803010		8579301  -  CONNECTOR 8579301 4.5 TO 5.5MM DOMINO	BOTH IP/OP	"$1,796.58 "	"$1,329.47"	$0.00	"$1,437.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,333.42"	"$1,333.42"	$0.00	$0.00	$374.41	$0.00	$0.00	$0.00	$0.00	$898.29	"$1,422.89"	"$1,437.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8580858	SUP	HCPCS C1713		"8580858  -  SET SCREW, BREAK-OFF, M8, SS"	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8590855	SUP	HCPCS C1713		8590855  -  SCREW SET TI 55MM SPNL BRKOF CLOSE HZNM8 5.5MM ROD	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8590858	SUP	HCPCS C1713		"8590858  -  SET SCREW, BREAK-OFF, M8, TI"	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8594520	SUP	HCPCS C1713		8594520  -  SCREW BN 4.5MM 20MM NS BRIGADE CRNT SPNE XLRF SYS	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
8594522	SUP	HCPCS C1713		8594522  -  SCREW BN 4.5MM 22.5MM NS BRIGADE CRNT SPNE XLRF SYS	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
8594525	SUP	HCPCS C1713		8594525  -  SCREW BONE 4.5MM 25MM POLYAX BRIGADE SPN	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
8594527	SUP	HCPCS C1713		8594527  -  SCREW BN 4.5MM 27.5MM NS BRIGADE CRNT SPNE XLRF SYS	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
8594530	SUP	HCPCS C1713		8594530  -  SCREW BN 4.5MM 30MM NS BRIGADE CRNT SPNE XLRF SYS	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
8594535	SUP	HCPCS C1713		8594535  -  SCREW BN 4.5MM 35MM NS BRIGADE CRNT SPNE XLRF SYS	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
8595520	SUP	HCPCS C1713		8595520  -  SCREW BN 5.5MM 20MM NS BRIGADE CRNT SPNE XLRF SYS	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
8595522	SUP	HCPCS C1713		8595522  -  SCREW BN 5.5MM 22.5MM NS BRIGADE CRNT SPNE XLRF SYS	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
8595525	SUP	HCPCS C1713		8595525  -  SCREW BN 5.5MM 25MM NS BRIGADE CRNT SPNE XLRF SYS	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
8595527	SUP	HCPCS C1713		8595527  -  SCREW BN 5.5MM 27.5MM NS BRIGADE CRNT SPNE XLRF SYS	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
8595530	SUP	HCPCS C1713		8595530  -  SCREW BN 5.5MM 30MM NS BRIGADE CRNT SPNE XLRF SYS	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
8595535	SUP	HCPCS C1713		8595535  -  SCREW BN 5.5MM 35MM NS BRIGADE CRNT SPNE XLRF SYS	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
8610425	SUP	HCPCS C1713		8610425  -  SCREW 8610425 CLRD 4.5MMX25MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610430	SUP	HCPCS C1713		8610430  -  SCREW 8610430 CLRD 4.5MMX30MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610435	SUP	HCPCS C1713		8610435  -  SCREW 8610435 CLRD 4.5MMX35MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610440	SUP	HCPCS C1713		8610440  -  SCREW 8610440 CLRD 4.5MMX40MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610445	SUP	HCPCS C1713		8610445  -  SCREW 8610445 CLRD  4.5MMX45MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610525	SUP	HCPCS C1713		8610525  -  SCREW 8610525 CLRD 5.5MMX25MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610530	SUP	HCPCS C1713		8610530  -  SCREW 8610530 CLRD 5.5MMX30MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610535	SUP	HCPCS C1713		8610535  -  SCREW 8610535 CLRD 5.5MMX35MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610540	SUP	HCPCS C1713		8610540  -  SCREW 8610540 CLRD 5.5MMX40MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610545	SUP	HCPCS C1713		8610545  -  SCREW 8610545 CLRD 5.5MMX45MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610550	SUP	HCPCS C1713		8610550  -  SCREW 8610550 CLRD 5.5MMX50MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610555	SUP	HCPCS C1713		8610555  -  SCREW 8610555 CLRD 5.5MMX55MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610630	SUP	HCPCS C1713		8610630  -  SCREW 8610630 CLRD 6.5MMX30MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610635	SUP	HCPCS C1713		8610635  -  SCREW 8610635 CLRD 6.5MMX35MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610640	SUP	HCPCS C1713		8610640  -  SCREW 8610640 CLRD 6.5MMX40MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610645	SUP	HCPCS C1713		8610645  -  SCREW 8610645 CLRD 6.5MMX45MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610650	SUP	HCPCS C1713		8610650  -  SCREW 8610650 CLRD 6.5MMX50MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610655	SUP	HCPCS C1713		8610655  -  SCREW 8610655 CLRD 6.5MMX55MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610735	SUP	HCPCS C1713		8610735  -  SCREW 8610735 CLRD 7.5MMX35MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610740	SUP	HCPCS C1713		8610740  -  SCREW 8610740 CLRD 7.5MMX40MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610745	SUP	HCPCS C1713		8610745  -  SCREW 8610745 CLRD 7.5MMX45MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8610750	SUP	HCPCS C1713		8610750  -  SCREW 8610750 CLRD 7.5MMX50MM	BOTH IP/OP	"$2,517.00 "	"$1,862.58"	$0.00	"$2,013.60"	"$1,132.65"	"$1,132.65"	$0.00	$0.00	$0.00	$524.61	"$1,868.12"	"$1,868.12"	$0.00	$0.00	$524.54	$0.00	"$1,240.88"	"$1,240.88"	$0.00	"$1,258.50"	"$1,993.46"	"$2,013.60"	$0.00		$0.00	$393.91	$0.00	$0.00	$400.71	$0.00	$0.00	$0.00	$0.00	$0.00
8611102	SUP	HCPCS C1713		8611102  -  HOOK 8611102 PEDICULAR SM GROOVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8611104	SUP	HCPCS C1713		8611104  -  HOOK 8611104 PEDICULAR LG GROOVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8611202	SUP	HCPCS C1713		8611202  -  HOOK 8611202 LAMINAR SM GROOVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8611203	SUP	HCPCS C1713		8611203  -  HOOK 8611203 LAM MEDIUM GROOVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8611204	SUP	HCPCS C1713		8611204  -  HOOK 8611204 LAMINAR LG GROOVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8611300	SUP	HCPCS C1713		8611300  -  STAPLE 8611300 PEDICULAR HK	BOTH IP/OP	$873.00 	$646.02	$0.00	$698.40	$392.85	$392.85	$0.00	$0.00	$0.00	$181.96	$647.94	$647.94	$0.00	$0.00	$181.93	$0.00	$516.38	$516.38	$0.00	$436.50	$691.42	$698.40	$0.00		$0.00	$136.62	$0.00	$0.00	$138.98	$0.00	$0.00	$0.00	$0.00	$0.00
8611402	SUP	HCPCS C1713		8611402  -  HOOK 8611402 CLOSED LAM THOR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8612055	SUP	HCPCS C1713		8612055  -  SCREW 8612055 CLRD ILIO SCARAL 7.0X55MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612060	SUP	HCPCS C1713		8612060  -  SCREW 8612060 CLRD ILIO SCARAL 7.0X60MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612065	SUP	HCPCS C1713		8612065  -  SCREW 8612065 CLRD ILIO SCARAL 7.0X65MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612070	SUP	HCPCS C1713		8612070  -  SCREW 8612070 CLRD ILIO SCARAL 7.0X70MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612075	SUP	HCPCS C1713		8612075  -  SCREW 8612075 CLRD ILIO SCARAL 7.0X75MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612080	SUP	HCPCS C1713		8612080  -  SCREW 8612080 CLRD ILIO SCARAL 7.0X80MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612230	SUP	HCPCS C1713		8612230  -  SCREW 8612230 CLRD SACRAL 6.5X30MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612235	SUP	HCPCS C1713		8612235  -  SCREW 8612235 CLRD SACRAL 6.5X35MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612240	SUP	HCPCS C1713		8612240  -  SCREW 8612240 CLRD SACRAL 6.5X40MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612245	SUP	HCPCS C1713		8612245  -  SCREW 8612245 CLRD SACRAL 6.5X45MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612250	SUP	HCPCS C1713		8612250  -  SCREW 8612250 CLRD SACRAL 6.5X50MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612255	SUP	HCPCS C1713		8612255  -  SCREW 8612255 CLRD SACRAL 6.5X55MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612260	SUP	HCPCS C1713		8612260  -  SCREW 8612260 CLRD SACRAL 6.5X60MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612265	SUP	HCPCS C1713		8612265  -  SCREW 8612265 CLRD SACRAL 6.5X65MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8612270	SUP	HCPCS C1713		8612270  -  SCREW 8612270 CLRD SACRAL 6.5X70MM	BOTH IP/OP	"$1,594.50 "	"$1,179.93"	$0.00	"$1,275.60"	$717.53	$717.53	$0.00	$0.00	$0.00	$332.33	"$1,183.44"	"$1,183.44"	$0.00	$0.00	$332.29	$0.00	$943.15	$943.15	$0.00	$797.25	"$1,262.84"	"$1,275.60"	$0.00		$0.00	$249.54	$0.00	$0.00	$253.84	$0.00	$0.00	$0.00	$0.00	$0.00
8613505	SUP	HCPCS C1713		8613505  -  ROD 8613505 CLRD 5.0X50MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613506	SUP	HCPCS C1713		8613506  -  ROD 8613506 CLRD 5.0X60MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613507	SUP	HCPCS C1713		8613507  -  ROD 8613507 CLRD 5.0X70MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613508	SUP	HCPCS C1713		8613508  -  ROD 8613508 CLRD 5.0X80MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613509	SUP	HCPCS C1713		8613509  -  ROD 8613509 CLRD 5.0X90MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613510	SUP	HCPCS C1713		8613510  -  ROD 8613510 CLRD 5.0X100MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613511	SUP	HCPCS C1713		8613511  -  ROD 8613511 CLRD 5.0X110MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613512	SUP	HCPCS C1713		8613512  -  ROD 8613512 CLRD 5.0X120MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613514	SUP	HCPCS C1713		8613514  -  ROD 8613514 CLRD 5.0X140MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613516	SUP	HCPCS C1713		8613516  -  ROD 8613516 CLRD 5.0X160MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613518	SUP	HCPCS C1713		8613518  -  ROD 8613518 CLRD 5.0X180MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613520	SUP	HCPCS C1713		8613520  -  ROD 8613520 CLRD 5.0X200MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613522	SUP	HCPCS C1713		8613522  -  ROD 8613522 CLRD 5.0X220MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613524	SUP	HCPCS C1713		8613524  -  ROD 8613524 CLRD 5.0X240MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613526	SUP	HCPCS C1713		8613526  -  ROD 8613526 CLRD 5.0X260MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613528	SUP	HCPCS C1713		8613528  -  ROD 8613528 CLRD 5.0X280MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613530	SUP	HCPCS C1713		8613530  -  ROD 8613530 CLRD 5.0X300MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613532	SUP	HCPCS C1713		8613532  -  ROD 8613532 CLRD 5.0X320MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613534	SUP	HCPCS C1713		8613534  -  ROD 8613534 CLRD 5.0X340MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613536	SUP	HCPCS C1713		8613536  -  ROD 8613536 CLRD 5.0X360MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613538	SUP	HCPCS C1713		8613538  -  ROD 8613538 CLRD 5.0X380MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613544	SUP	HCPCS C1713		8613544  -  ROD 8613544 CLRD 5.0X440MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8613560	SUP	HCPCS C1713		8613560  -  ROD 8613560 CLRD 5MM X 600MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8614100	SUP	Custom 27803010		8614100  -  CONNECTOR 8614100 CLAMP FOR 5MM ROD	BOTH IP/OP	"$1,255.50 "	$929.07	$0.00	"$1,004.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$931.83	$931.83	$0.00	$0.00	$261.65	$0.00	$0.00	$0.00	$0.00	$627.75	$994.36	"$1,004.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8614110	SUP	Custom 27803010		8614110  -  CONNECTOR 8614110 SACRAL ILIO PLATE	BOTH IP/OP	"$1,710.00 "	"$1,265.40"	$0.00	"$1,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,269.16"	"$1,269.16"	$0.00	$0.00	$356.36	$0.00	$0.00	$0.00	$0.00	$855.00	"$1,354.32"	"$1,368.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8614111	SUP	HCPCS C1713		8614111  -  SCREW 8614111  BREAK OFF NUT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8614120	SUP	HCPCS C1713		8614120  -  SCREW 8614120  BREAK OFF SET  XLINK	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8614200	SUP	Custom 27803010		8614200  -  CONNECTOR 8614200 OFFSET	BOTH IP/OP	"$1,870.50 "	"$1,384.17"	$0.00	"$1,496.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,388.29"	"$1,388.29"	$0.00	$0.00	$389.81	$0.00	$0.00	$0.00	$0.00	$935.25	"$1,481.44"	"$1,496.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8615400	SUP	Custom 27803010		8615400  -  CONNECTOR 8615400 5MM X 5MM AXIAL	BOTH IP/OP	"$2,631.50 "	"$1,947.31"	$0.00	"$2,105.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,953.10"	"$1,953.10"	$0.00	$0.00	$548.40	$0.00	$0.00	$0.00	$0.00	"$1,315.75"	"$2,084.15"	"$2,105.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8615405	SUP	HCPCS C1713		8615405  -  SCREW 8615405  BK OFF  AXIALLAT CLSD HK	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8615410	SUP	Custom 27803010		8615410  -  CONNECTOR 8615410 5MM X 5MM LATERAL	BOTH IP/OP	"$2,631.50 "	"$1,947.31"	$0.00	"$2,105.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,953.10"	"$1,953.10"	$0.00	$0.00	$548.40	$0.00	$0.00	$0.00	$0.00	"$1,315.75"	"$2,084.15"	"$2,105.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8615420	SUP	Custom 27803010		8615420  -  CONNECTOR 8615420 5MM X 5.5MM AXIAL	BOTH IP/OP	"$2,833.50 "	"$2,096.79"	$0.00	"$2,266.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,103.02"	"$2,103.02"	$0.00	$0.00	$590.50	$0.00	$0.00	$0.00	$0.00	"$1,416.75"	"$2,244.13"	"$2,266.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8615440	SUP	Custom 27803010		8615440  -  CONNECTOR 8615440 5MM X 7MM AXIAL	BOTH IP/OP	"$2,631.50 "	"$1,947.31"	$0.00	"$2,105.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,953.10"	"$1,953.10"	$0.00	$0.00	$548.40	$0.00	$0.00	$0.00	$0.00	"$1,315.75"	"$2,084.15"	"$2,105.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8616100	SUP	Custom 27203010		BLADE LRNSCP 1 MLLR IMRSB REUSE	BOTH IP/OP	$60.80 	$44.99	$0.00	$48.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.40	$48.15	$48.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8619110	SUP	HCPCS C1713		8619110  -  PLATE 8619110 RIGHT SACRAL	BOTH IP/OP	"$3,873.00 "	"$2,866.02"	$0.00	"$3,098.40"	"$1,742.85"	"$1,742.85"	$0.00	$0.00	$0.00	$807.23	"$2,874.54"	"$2,874.54"	$0.00	$0.00	$807.13	$0.00	"$1,909.39"	"$1,909.39"	$0.00	"$1,936.50"	"$3,067.42"	"$3,098.40"	$0.00		$0.00	$606.12	$0.00	$0.00	$616.58	$0.00	$0.00	$0.00	$0.00	$0.00
8619120	SUP	HCPCS C1713		8619120  -  PLATE 8619120 LEFT SACRAL	BOTH IP/OP	"$3,873.00 "	"$2,866.02"	$0.00	"$3,098.40"	"$1,742.85"	"$1,742.85"	$0.00	$0.00	$0.00	$807.23	"$2,874.54"	"$2,874.54"	$0.00	$0.00	$807.13	$0.00	"$1,909.39"	"$1,909.39"	$0.00	"$1,936.50"	"$3,067.42"	"$3,098.40"	$0.00		$0.00	$606.12	$0.00	$0.00	$616.58	$0.00	$0.00	$0.00	$0.00	$0.00
8619210	SUP	HCPCS C1713		8619210  -  PLATE 8619210 RIGHT ILLIO SACRAL	BOTH IP/OP	"$4,800.00 "	"$3,552.00"	$0.00	"$3,840.00"	"$2,160.00"	"$2,160.00"	$0.00	$0.00	$0.00	"$1,000.44"	"$3,562.56"	"$3,562.56"	$0.00	$0.00	"$1,000.32"	$0.00	"$2,366.40"	"$2,366.40"	$0.00	"$2,400.00"	"$3,801.60"	"$3,840.00"	$0.00		$0.00	$751.20	$0.00	$0.00	$764.16	$0.00	$0.00	$0.00	$0.00	$0.00
8619220	SUP	HCPCS C1713		8619220  -  PLATE 8619220 LEFT ILLIO SACRAL	BOTH IP/OP	"$4,800.00 "	"$3,552.00"	$0.00	"$3,840.00"	"$2,160.00"	"$2,160.00"	$0.00	$0.00	$0.00	"$1,000.44"	"$3,562.56"	"$3,562.56"	$0.00	$0.00	"$1,000.32"	$0.00	"$2,366.40"	"$2,366.40"	$0.00	"$2,400.00"	"$3,801.60"	"$3,840.00"	$0.00		$0.00	$751.20	$0.00	$0.00	$764.16	$0.00	$0.00	$0.00	$0.00	$0.00
8619300	SUP	HCPCS C1713		8619300  -  SCREW 8619300  SET  SAC LLIO SAC PLATE	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8619400	SUP	HCPCS C1713		8619400  -  STAPLE 8619400 ANTERIOR	BOTH IP/OP	$873.00 	$646.02	$0.00	$698.40	$392.85	$392.85	$0.00	$0.00	$0.00	$181.96	$647.94	$647.94	$0.00	$0.00	$181.93	$0.00	$516.38	$516.38	$0.00	$436.50	$691.42	$698.40	$0.00		$0.00	$136.62	$0.00	$0.00	$138.98	$0.00	$0.00	$0.00	$0.00	$0.00
8619654	SUP	HCPCS C1713		8619654  -  PLATE 8619654 INTERPEDICULAR 54MM	BOTH IP/OP	"$2,187.00 "	"$1,618.38"	$0.00	"$1,749.60"	$984.15	$984.15	$0.00	$0.00	$0.00	$455.83	"$1,623.19"	"$1,623.19"	$0.00	$0.00	$455.77	$0.00	"$1,293.61"	"$1,293.61"	$0.00	"$1,093.50"	"$1,732.10"	"$1,749.60"	$0.00		$0.00	$342.27	$0.00	$0.00	$348.17	$0.00	$0.00	$0.00	$0.00	$0.00
8624110	SUP	Custom 27803010		8624110  -  CONNECTOR 8624110 5.5MM ILIO SAC PLT	BOTH IP/OP	"$1,710.00 "	"$1,265.40"	$0.00	"$1,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,269.16"	"$1,269.16"	$0.00	$0.00	$356.36	$0.00	$0.00	$0.00	$0.00	$855.00	"$1,354.32"	"$1,368.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8630540	SUP	HCPCS C1713		8630540  -  SCREW 8630540 CLRD 5.5MMX40MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8630550	SUP	HCPCS C1713		8630550  -  SCREW 8630550 CLRD 5.5MMX50MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8630645	SUP	HCPCS C1713		8630645  -  SCREW 8630645 CLRD 6.5MMX45MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8630650	SUP	HCPCS C1713		8630650  -  SCREW 8630650 CLRD 6.5MMX50MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8631203	SUP	HCPCS C1713		8631203  -  HOOK 8631203 MEDIUM LAMINAR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8631300	SUP	HCPCS C1713		8631300  -  STAPLE 8631300	BOTH IP/OP	$988.50 	$731.49	$0.00	$790.80	$444.83	$444.83	$0.00	$0.00	$0.00	$206.03	$733.66	$733.66	$0.00	$0.00	$206.00	$0.00	$584.70	$584.70	$0.00	$494.25	$782.89	$790.80	$0.00		$0.00	$154.70	$0.00	$0.00	$157.37	$0.00	$0.00	$0.00	$0.00	$0.00
8631402	SUP	HCPCS C1713		8631402  -  HOOK 8631402 CLOSED LAMINAR THORACIC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8632050	SUP	HCPCS C1713		8632050  -  SCREW 8632050 CLRD ILIO SACRAL 7.0X50MM	BOTH IP/OP	"$1,811.63 "	"$1,340.61"	$0.00	"$1,449.30"	$815.23	$815.23	$0.00	$0.00	$0.00	$377.59	"$1,344.59"	"$1,344.59"	$0.00	$0.00	$377.54	$0.00	"$1,071.58"	"$1,071.58"	$0.00	$905.81	"$1,434.81"	"$1,449.30"	$0.00		$0.00	$283.52	$0.00	$0.00	$288.41	$0.00	$0.00	$0.00	$0.00	$0.00
8632055	SUP	HCPCS C1713		8632055  -  SCREW 8632055 CLRD ILIO SACRAL 7.0X55MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632060	SUP	HCPCS C1713		8632060  -  SCREW 8632060 CLRD ILIO SACRAL 7.0X60MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632065	SUP	HCPCS C1713		8632065  -  SCREW 8632065 CLRD ILIO SACRAL 7.0X65MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632070	SUP	HCPCS C1713		8632070  -  SCREW 8632070 CLRD ILIO SACRAL 7.0X70MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632075	SUP	HCPCS C1713		8632075  -  SCREW 8632075 CLRD ILIO SACRAL 7.0X75MM	BOTH IP/OP	"$1,811.63 "	"$1,340.61"	$0.00	"$1,449.30"	$815.23	$815.23	$0.00	$0.00	$0.00	$377.59	"$1,344.59"	"$1,344.59"	$0.00	$0.00	$377.54	$0.00	"$1,071.58"	"$1,071.58"	$0.00	$905.81	"$1,434.81"	"$1,449.30"	$0.00		$0.00	$283.52	$0.00	$0.00	$288.41	$0.00	$0.00	$0.00	$0.00	$0.00
8632080	SUP	HCPCS C1713		8632080  -  SCREW 8632080 CLRD ILIO SACRAL 7.0X80MM	BOTH IP/OP	"$1,811.63 "	"$1,340.61"	$0.00	"$1,449.30"	$815.23	$815.23	$0.00	$0.00	$0.00	$377.59	"$1,344.59"	"$1,344.59"	$0.00	$0.00	$377.54	$0.00	"$1,071.58"	"$1,071.58"	$0.00	$905.81	"$1,434.81"	"$1,449.30"	$0.00		$0.00	$283.52	$0.00	$0.00	$288.41	$0.00	$0.00	$0.00	$0.00	$0.00
8632230	SUP	HCPCS C1713		8632230  -  SCREW 8632230 CLRD SACRAL 6.5X30MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632235	SUP	HCPCS C1713		8632235  -  SCREW 8632235 CLRD SACRAL 6.5X35MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632240	SUP	HCPCS C1713		8632240  -  SCREW 8632240 CLRD SACRAL 6.5X40MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632245	SUP	HCPCS C1713		8632245  -  SCREW 8632245 CLRD SACRAL 6.5X45MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632250	SUP	HCPCS C1713		8632250  -  SCREW 8632250 CLRD SACRAL 6.5X50MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632255	SUP	HCPCS C1713		8632255  -  SCREW 8632255 CLRD SACRAL 6.5X55MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632260	SUP	HCPCS C1713		8632260  -  SCREW 8632260 CLRD SACRAL 6.5X60MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632265	SUP	HCPCS C1713		8632265  -  SCREW 8632265 CLRD SACRAL 6.5X65MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632270	SUP	HCPCS C1713		8632270  -  SCREW 8632270 CLRD SACRAL 6.5X70MM	BOTH IP/OP	"$1,821.23 "	"$1,347.71"	$0.00	"$1,456.98"	$819.55	$819.55	$0.00	$0.00	$0.00	$379.59	"$1,351.71"	"$1,351.71"	$0.00	$0.00	$379.54	$0.00	"$1,077.25"	"$1,077.25"	$0.00	$910.61	"$1,442.41"	"$1,456.98"	$0.00		$0.00	$285.02	$0.00	$0.00	$289.94	$0.00	$0.00	$0.00	$0.00	$0.00
8632330	SUP	HCPCS C1713		8632330  -  SCREW 8632330 CLRD SACRAL 7.0X30MM	BOTH IP/OP	"$1,811.63 "	"$1,340.61"	$0.00	"$1,449.30"	$815.23	$815.23	$0.00	$0.00	$0.00	$377.59	"$1,344.59"	"$1,344.59"	$0.00	$0.00	$377.54	$0.00	"$1,071.58"	"$1,071.58"	$0.00	$905.81	"$1,434.81"	"$1,449.30"	$0.00		$0.00	$283.52	$0.00	$0.00	$288.41	$0.00	$0.00	$0.00	$0.00	$0.00
8632335	SUP	HCPCS C1713		8632335  -  SCREW 8632335 CLRD SACRAL 7.0X35MM	BOTH IP/OP	"$1,811.63 "	"$1,340.61"	$0.00	"$1,449.30"	$815.23	$815.23	$0.00	$0.00	$0.00	$377.59	"$1,344.59"	"$1,344.59"	$0.00	$0.00	$377.54	$0.00	"$1,071.58"	"$1,071.58"	$0.00	$905.81	"$1,434.81"	"$1,449.30"	$0.00		$0.00	$283.52	$0.00	$0.00	$288.41	$0.00	$0.00	$0.00	$0.00	$0.00
8632340	SUP	HCPCS C1713		8632340  -  SCREW 8632340 CLRD SACRAL 7.0X40MM	BOTH IP/OP	"$1,811.63 "	"$1,340.61"	$0.00	"$1,449.30"	$815.23	$815.23	$0.00	$0.00	$0.00	$377.59	"$1,344.59"	"$1,344.59"	$0.00	$0.00	$377.54	$0.00	"$1,071.58"	"$1,071.58"	$0.00	$905.81	"$1,434.81"	"$1,449.30"	$0.00		$0.00	$283.52	$0.00	$0.00	$288.41	$0.00	$0.00	$0.00	$0.00	$0.00
8632345	SUP	HCPCS C1713		8632345  -  SCREW 8632345 CLRD SACRAL 7.0X45MM	BOTH IP/OP	"$1,811.63 "	"$1,340.61"	$0.00	"$1,449.30"	$815.23	$815.23	$0.00	$0.00	$0.00	$377.59	"$1,344.59"	"$1,344.59"	$0.00	$0.00	$377.54	$0.00	"$1,071.58"	"$1,071.58"	$0.00	$905.81	"$1,434.81"	"$1,449.30"	$0.00		$0.00	$283.52	$0.00	$0.00	$288.41	$0.00	$0.00	$0.00	$0.00	$0.00
8632350	SUP	HCPCS C1713		8632350  -  SCREW 8632350 CLRD SACRAL 7.0X50MM	BOTH IP/OP	"$1,811.63 "	"$1,340.61"	$0.00	"$1,449.30"	$815.23	$815.23	$0.00	$0.00	$0.00	$377.59	"$1,344.59"	"$1,344.59"	$0.00	$0.00	$377.54	$0.00	"$1,071.58"	"$1,071.58"	$0.00	$905.81	"$1,434.81"	"$1,449.30"	$0.00		$0.00	$283.52	$0.00	$0.00	$288.41	$0.00	$0.00	$0.00	$0.00	$0.00
8632355	SUP	HCPCS C1713		8632355  -  SCREW 8632355 CLRD SACRAL 7.0X55MM	BOTH IP/OP	"$1,811.63 "	"$1,340.61"	$0.00	"$1,449.30"	$815.23	$815.23	$0.00	$0.00	$0.00	$377.59	"$1,344.59"	"$1,344.59"	$0.00	$0.00	$377.54	$0.00	"$1,071.58"	"$1,071.58"	$0.00	$905.81	"$1,434.81"	"$1,449.30"	$0.00		$0.00	$283.52	$0.00	$0.00	$288.41	$0.00	$0.00	$0.00	$0.00	$0.00
8632360	SUP	HCPCS C1713		8632360  -  SCREW 8632360 CLRD SACRAL 7.0X60MM	BOTH IP/OP	"$1,811.63 "	"$1,340.61"	$0.00	"$1,449.30"	$815.23	$815.23	$0.00	$0.00	$0.00	$377.59	"$1,344.59"	"$1,344.59"	$0.00	$0.00	$377.54	$0.00	"$1,071.58"	"$1,071.58"	$0.00	$905.81	"$1,434.81"	"$1,449.30"	$0.00		$0.00	$283.52	$0.00	$0.00	$288.41	$0.00	$0.00	$0.00	$0.00	$0.00
8632365	SUP	HCPCS C1713		8632365  -  SCREW 8632365 CLRD SACRAL 7.0X65MM	BOTH IP/OP	"$1,811.63 "	"$1,340.61"	$0.00	"$1,449.30"	$815.23	$815.23	$0.00	$0.00	$0.00	$377.59	"$1,344.59"	"$1,344.59"	$0.00	$0.00	$377.54	$0.00	"$1,071.58"	"$1,071.58"	$0.00	$905.81	"$1,434.81"	"$1,449.30"	$0.00		$0.00	$283.52	$0.00	$0.00	$288.41	$0.00	$0.00	$0.00	$0.00	$0.00
8632370	SUP	HCPCS C1713		8632370  -  SCREW 8632370 CLRD SACRAL 7.0X70MM	BOTH IP/OP	"$1,811.63 "	"$1,340.61"	$0.00	"$1,449.30"	$815.23	$815.23	$0.00	$0.00	$0.00	$377.59	"$1,344.59"	"$1,344.59"	$0.00	$0.00	$377.54	$0.00	"$1,071.58"	"$1,071.58"	$0.00	$905.81	"$1,434.81"	"$1,449.30"	$0.00		$0.00	$283.52	$0.00	$0.00	$288.41	$0.00	$0.00	$0.00	$0.00	$0.00
8634100	SUP	Custom 27803010		8634100  -  CONNECTOR 8634100 CLAMP FOR 5MM ROD	BOTH IP/OP	"$1,453.50 "	"$1,075.59"	$0.00	"$1,162.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,078.79"	"$1,078.79"	$0.00	$0.00	$302.91	$0.00	$0.00	$0.00	$0.00	$726.75	"$1,151.17"	"$1,162.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8634110	SUP	Custom 27803010		8634110  -  CONNECTOR 8634110 SACRAL ILIO PLATE	BOTH IP/OP	"$1,935.50 "	"$1,432.27"	$0.00	"$1,548.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,436.53"	"$1,436.53"	$0.00	$0.00	$403.36	$0.00	$0.00	$0.00	$0.00	$967.75	"$1,532.92"	"$1,548.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8634111	SUP	HCPCS C1713		8634111  -  SCREW 8634111  BREAK OFF NUT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8634200	SUP	Custom 27803010		8634200  -  CONNECTOR 8634200 OFFSET CLAMP	BOTH IP/OP	"$1,935.50 "	"$1,432.27"	$0.00	"$1,548.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,436.53"	"$1,436.53"	$0.00	$0.00	$403.36	$0.00	$0.00	$0.00	$0.00	$967.75	"$1,532.92"	"$1,548.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8635400	SUP	Custom 27803010		8635400  -  CONNECTOR 8635400 5.5X5.5 LAT CLOSE CLMP	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	$0.00	$0.00	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8635405	SUP	HCPCS C1713		8635405  -  SCREW 8635405  BREAK OFF LOCKING	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8635430	SUP	Custom 27803010		8635430  -  CONNECTOR 8635430 LATERAL CLOSED	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	$0.00	$0.00	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8638102	SUP	HCPCS C1713		8638102  -  HOOK 8638102 PED SMALL GROOVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8638104	SUP	HCPCS C1713		8638104  -  HOOK 8638104 PED LARGE GROOVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8638110	SUP	HCPCS C1713		8638110  -  PLATE 8638110 RIGHT SACRAL	BOTH IP/OP	"$3,873.00 "	"$2,866.02"	$0.00	"$3,098.40"	"$1,742.85"	"$1,742.85"	$0.00	$0.00	$0.00	$807.23	"$2,874.54"	"$2,874.54"	$0.00	$0.00	$807.13	$0.00	"$1,909.39"	"$1,909.39"	$0.00	"$1,936.50"	"$3,067.42"	"$3,098.40"	$0.00		$0.00	$606.12	$0.00	$0.00	$616.58	$0.00	$0.00	$0.00	$0.00	$0.00
8638120	SUP	HCPCS C1713		8638120  -  PLATE 8638120 LEFT SACRAL	BOTH IP/OP	"$3,873.00 "	"$2,866.02"	$0.00	"$3,098.40"	"$1,742.85"	"$1,742.85"	$0.00	$0.00	$0.00	$807.23	"$2,874.54"	"$2,874.54"	$0.00	$0.00	$807.13	$0.00	"$1,909.39"	"$1,909.39"	$0.00	"$1,936.50"	"$3,067.42"	"$3,098.40"	$0.00		$0.00	$606.12	$0.00	$0.00	$616.58	$0.00	$0.00	$0.00	$0.00	$0.00
8638203	SUP	HCPCS C1713		8638203  -  HOOK 8638203 LAM MEDIUM GROOVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8638210	SUP	HCPCS C1713		8638210  -  PLATE 8638210 RIGHT LLIO SACRAL	BOTH IP/OP	"$4,938.00 "	"$3,654.12"	$0.00	"$3,950.40"	"$2,222.10"	"$2,222.10"	$0.00	$0.00	$0.00	"$1,029.20"	"$3,664.98"	"$3,664.98"	$0.00	$0.00	"$1,029.08"	$0.00	"$2,434.43"	"$2,434.43"	$0.00	"$2,469.00"	"$3,910.90"	"$3,950.40"	$0.00		$0.00	$772.80	$0.00	$0.00	$786.13	$0.00	$0.00	$0.00	$0.00	$0.00
8638220	SUP	HCPCS C1713		8638220  -  PLATE 8638220 LEFT ILIO SACRAL	BOTH IP/OP	"$4,938.00 "	"$3,654.12"	$0.00	"$3,950.40"	"$2,222.10"	"$2,222.10"	$0.00	$0.00	$0.00	"$1,029.20"	"$3,664.98"	"$3,664.98"	$0.00	$0.00	"$1,029.08"	$0.00	"$2,434.43"	"$2,434.43"	$0.00	"$2,469.00"	"$3,910.90"	"$3,950.40"	$0.00		$0.00	$772.80	$0.00	$0.00	$786.13	$0.00	$0.00	$0.00	$0.00	$0.00
8638425	SUP	HCPCS C1713		8638425  -  SCREW 8638425 PED D4.5MM L25MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638430	SUP	HCPCS C1713		8638430  -  SCREW 8638430 CLRD PED 4.5X30MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638435	SUP	HCPCS C1713		8638435  -  SCREW 8638435 CLRD PED 4.5X35MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638440	SUP	HCPCS C1713		8638440  -  BONE SCREW 8638440 PED D4.5MM L40MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638445	SUP	HCPCS C1713		8638445  -  SCREW 8638445 CLRD PED 4.5X45MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638525	SUP	HCPCS C1713		8638525  -  SCREW 8638525 CLRD PED 5.5X25MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638530	SUP	HCPCS C1713		8638530  -  SCREW 8638530 CLRD PED 5.5X30MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638535	SUP	HCPCS C1713		8638535  -  SCREW 8638535 CLRD PED 5.5X35MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638540	SUP	HCPCS C1713		8638540  -  SCREW 8638540 CLRD PED 5.5X40MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638545	SUP	HCPCS C1713		8638545  -  SCREW 8638545 CLRD PED 5.5X45MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638550	SUP	HCPCS C1713		8638550  -  SCREW 8638550 CLRD PED 5.5X50MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638555	SUP	HCPCS C1713		8638555  -  SCREW 8638555 CLRD PED 5.5X55MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638625	SUP	HCPCS C1713		8638625  -  SCREW 8638625 PED D6.5MM L25MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638630	SUP	HCPCS C1713		8638630  -  SCREW 8638630 CLRD PED 6.5X30MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638635	SUP	HCPCS C1713		8638635  -  SCREW BN 6.5MM 35MM CO2 SPNE PDCL	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638640	SUP	HCPCS C1713		8638640  -  SCREW BN 6.5MM 35MM CO2 SPNE PDCL	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638645	SUP	HCPCS C1713		8638645  -  SCREW 8638645 CLRD PED 6.5X45MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638650	SUP	HCPCS C1713		8638650  -  SCREW 8638650 CLRD PED 6.5X50MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638655	SUP	HCPCS C1713		8638655  -  SCREW 8638655 CLRD PED 6.5X55MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638660	SUP	HCPCS C1713		8638660  -  SCREW 8638660 PED D6.5MM L60MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638665	SUP	HCPCS C1713		8638665  -  SCREW 8638665 PED D6.5MM L65MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638725	SUP	HCPCS C1713		8638725  -  SCREW 8638725 PED D7.5MM L25MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638730	SUP	HCPCS C1713		8638730  -  BONE SCREW 8638730 PED D7.5MM L30MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638735	SUP	HCPCS C1713		8638735  -  SCREW 8638735 CLRD PED 7.5X35MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638740	SUP	HCPCS C1713		8638740  -  SCREW 8638740 CLRD PED 7.5X40MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638745	SUP	HCPCS C1713		8638745  -  SCREW 8638745 CLRD PED 7.5X45MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638750	SUP	HCPCS C1713		8638750  -  SCREW 8638750 CLRD PED 7.5X50MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638755	SUP	HCPCS C1713		8638755  -  BONE SCREW 8638755 PED SCRW D7.5MM L55MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638760	SUP	HCPCS C1713		8638760  -  SCREW 8638760 PED D7.5MM L60MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8638765	SUP	HCPCS C1713		8638765  -  SCREW 8638765 PED D7.5MM L65MM	BOTH IP/OP	"$2,818.50 "	"$2,085.69"	$0.00	"$2,254.80"	"$1,268.33"	"$1,268.33"	$0.00	$0.00	$0.00	$587.45	"$2,091.89"	"$2,091.89"	$0.00	$0.00	$587.38	$0.00	"$1,389.52"	"$1,389.52"	$0.00	"$1,409.25"	"$2,232.25"	"$2,254.80"	$0.00		$0.00	$441.10	$0.00	$0.00	$448.71	$0.00	$0.00	$0.00	$0.00	$0.00
8639300	SUP	HCPCS C1713		8639300  -  SCREW 8639300  L AND ILIO L  SET	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8639400	SUP	HCPCS C1713		8639400  -  STAPLE 8639400  ANTERIOR	BOTH IP/OP	$988.50 	$731.49	$0.00	$790.80	$444.83	$444.83	$0.00	$0.00	$0.00	$206.03	$733.66	$733.66	$0.00	$0.00	$206.00	$0.00	$584.70	$584.70	$0.00	$494.25	$782.89	$790.80	$0.00		$0.00	$154.70	$0.00	$0.00	$157.37	$0.00	$0.00	$0.00	$0.00	$0.00
8644525	SUP	HCPCS C1713		8644525  -  SCREW BN 4.5MM 25MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8644530	SUP	HCPCS C1713		8644530  -  SCREW BN 4.5MM 30MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8644535	SUP	HCPCS C1713		8644535  -  SCREW BN 4.5MM 35MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8644540	SUP	HCPCS C1713		8644540  -  SCREW BN 4.5MM 40MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8644545	SUP	HCPCS C1713		8644545  -  SCREW BN 4.5MM 45MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8645025	SUP	HCPCS C1713		8645025  -  SCREW BN 5MM 25MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8645030	SUP	HCPCS C1713		8645030  -  SCREW BN 5MM 30MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8645035	SUP	HCPCS C1713		8645035  -  SCREW BN 5MM 35MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8645040	SUP	HCPCS C1713		8645040  -  SCREW BN 5MM 40MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8645045	SUP	HCPCS C1713		8645045  -  SCREW BN 5MM 45MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8645050	SUP	HCPCS C1713		8645050  -  SCREW BN 6MM 55MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8646030	SUP	HCPCS C1713		8646030  -  SCREW BN 5MM 50MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8646035	SUP	HCPCS C1713		8646035  -  SCREW BN 6MM 30MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8646040	SUP	HCPCS C1713		8646040  -  SCREW BN 6MM 35MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8646045	SUP	HCPCS C1713		8646045  -  SCREW BN 6MM 40MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8646050	SUP	HCPCS C1713		8646050  -  SCREW BN 6MM 45MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8646055	SUP	HCPCS C1713		8646055  -  SCREW BN 6MM 50MM UNIPLANAR TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
8650520	SUP	HCPCS C1713		8650520  -  CONCTR ROD 20MM 5.5MM OFFST TI SPNL	BOTH IP/OP	"$1,655.00 "	"$1,224.70"	$0.00	"$1,324.00"	$744.75	$744.75	$0.00	$0.00	$0.00	$344.94	"$1,228.34"	"$1,228.34"	$0.00	$0.00	$344.90	$0.00	$978.93	$978.93	$0.00	$827.50	"$1,310.76"	"$1,324.00"	$0.00		$0.00	$259.01	$0.00	$0.00	$263.48	$0.00	$0.00	$0.00	$0.00	$0.00
8650530	SUP	HCPCS C1713		8650530  -  CONCTR ROD 30MM 4.5MM OFFST TI	BOTH IP/OP	"$1,655.00 "	"$1,224.70"	$0.00	"$1,324.00"	$744.75	$744.75	$0.00	$0.00	$0.00	$344.94	"$1,228.34"	"$1,228.34"	$0.00	$0.00	$344.90	$0.00	$978.93	$978.93	$0.00	$827.50	"$1,310.76"	"$1,324.00"	$0.00		$0.00	$259.01	$0.00	$0.00	$263.48	$0.00	$0.00	$0.00	$0.00	$0.00
8650560	SUP	HCPCS C1713		8650560  -  CONCTR ROD 60MM 4.5MM OFFST TI	BOTH IP/OP	"$1,655.00 "	"$1,224.70"	$0.00	"$1,324.00"	$744.75	$744.75	$0.00	$0.00	$0.00	$344.94	"$1,228.34"	"$1,228.34"	$0.00	$0.00	$344.90	$0.00	$978.93	$978.93	$0.00	$827.50	"$1,310.76"	"$1,324.00"	$0.00		$0.00	$259.01	$0.00	$0.00	$263.48	$0.00	$0.00	$0.00	$0.00	$0.00
8651520	SUP	HCPCS C1713		8651520  -  CONCTR ROD 5.5MM OFFST CLOSE TI	BOTH IP/OP	"$1,655.00 "	"$1,224.70"	$0.00	"$1,324.00"	$744.75	$744.75	$0.00	$0.00	$0.00	$344.94	"$1,228.34"	"$1,228.34"	$0.00	$0.00	$344.90	$0.00	$978.93	$978.93	$0.00	$827.50	"$1,310.76"	"$1,324.00"	$0.00		$0.00	$259.01	$0.00	$0.00	$263.48	$0.00	$0.00	$0.00	$0.00	$0.00
8651530	SUP	HCPCS C1713		8651530  -  CONCTR ROD 5.5MM OFFST CLOSE TI	BOTH IP/OP	"$1,655.00 "	"$1,224.70"	$0.00	"$1,324.00"	$744.75	$744.75	$0.00	$0.00	$0.00	$344.94	"$1,228.34"	"$1,228.34"	$0.00	$0.00	$344.90	$0.00	$978.93	$978.93	$0.00	$827.50	"$1,310.76"	"$1,324.00"	$0.00		$0.00	$259.01	$0.00	$0.00	$263.48	$0.00	$0.00	$0.00	$0.00	$0.00
8651560	SUP	HCPCS C1713		8651560  -  CONCTR ROD 5.5MM OFFST CLOSE TI	BOTH IP/OP	"$1,655.00 "	"$1,224.70"	$0.00	"$1,324.00"	$744.75	$744.75	$0.00	$0.00	$0.00	$344.94	"$1,228.34"	"$1,228.34"	$0.00	$0.00	$344.90	$0.00	$978.93	$978.93	$0.00	$827.50	"$1,310.76"	"$1,324.00"	$0.00		$0.00	$259.01	$0.00	$0.00	$263.48	$0.00	$0.00	$0.00	$0.00	$0.00
8664110	SUP	Custom 27803010		8664110  -  CONNECTOR 8664110 6.35MM SACRAL SS	BOTH IP/OP	"$1,710.00 "	"$1,265.40"	$0.00	"$1,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,269.16"	"$1,269.16"	$0.00	$0.00	$356.36	$0.00	$0.00	$0.00	$0.00	$855.00	"$1,354.32"	"$1,368.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8664111	SUP	HCPCS C1713		8664111  -  SET SCREW 8664111 FOR 6.35MM CONN SS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8670001	SUP	HCPCS C1769		8670001  -  GUIDEWIRE ORTHOPEDIC BLUNT INSTR SEXTANT TITANIUM SPN	BOTH IP/OP	$151.50 	$112.11	$0.00	$121.20	$82.26	$82.26	$0.00	$0.00	$0.00	$31.58	$112.44	$112.44	$0.00	$0.00	$31.57	$0.00	$89.61	$89.61	$0.00	$75.75	$119.99	$121.20	$0.00		$0.00	$23.71	$0.00	$0.00	$24.12	$0.00	$0.00	$0.00	$0.00	$0.00
8670002	SUP	HCPCS C1769		8670002  -  GUIDEWIRE ORTHOPEDIC SHARP CD HORIZON TITANIUM SPN	BOTH IP/OP	$151.50 	$112.11	$0.00	$121.20	$82.26	$82.26	$0.00	$0.00	$0.00	$31.58	$112.44	$112.44	$0.00	$0.00	$31.57	$0.00	$89.61	$89.61	$0.00	$75.75	$119.99	$121.20	$0.00		$0.00	$23.71	$0.00	$0.00	$24.12	$0.00	$0.00	$0.00	$0.00	$0.00
8672030	SUP	HCPCS C1713		8672030  -  ROD SPNL STD PREBNT CNTR 5.5MM 30MM SXTNT CD HZN TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672035	SUP	HCPCS C1713		8672035  -  ROD SPNL PREBNT 5.5MM 35MM SXTNT CD HZN TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672040	SUP	HCPCS C1713		8672040  -  ROD SPNL STD CNTR PREBNT 5.5MM 40MM CD HZN SXTNT PCUT TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672045	SUP	HCPCS C1713		8672045  -  ROD SPNL STD CNTR PREBNT 5.5MM 45MM CD HZN SXTNT PCUT TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672050	SUP	HCPCS C1713		8672050  -  ROD SPNL STD CNTR PREBNT 5.5MM 50MM CD HZN SXTNT PCUT TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672055	SUP	HCPCS C1713		8672055  -  ROD SPNL STD PREBNT PCUT CNTR 5.5MM 55MM SXTNT CD HZN TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672060	SUP	HCPCS C1713		8672060  -  ROD SPNL STD CNTR PREBNT 5.5MM 60MM CD HZN SXTNT PCUT TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672065	SUP	HCPCS C1713		8672065  -  ROD SPNL STD CNTR PREBNT 5.5MM 65MM CD HZN SXTNT PCUT TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672070	SUP	HCPCS C1713		8672070  -  ROD SPNL STD CNTR PREBNT 5.5MM 70MM CD HZN SXTNT PCUT TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672075	SUP	HCPCS C1713		8672075  -  ROD SPNL STD CNTR PREBNT 5.5MM 75MM CD HZN SXTNT PCUT TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672080	SUP	HCPCS C1713		8672080  -  ROD SPNL STD CNTR PREBNT 5.5MM 80MM CD HZN SXTNT PCUT TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672085	SUP	HCPCS C1713		8672085  -  ROD SPNL STD PREBNT PCUT CNTR 5.5MM 85MM SXTNT CD HZN TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672090	SUP	HCPCS C1713		8672090  -  ROD SPNL STD PREBNT CNTR 5.5MM 90MM SXTNT CD HZN TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672095	SUP	HCPCS C1713		8672095  -  ROD SPNL STD CNTR PREBNT 5.5MM 95MM CD HZN SXTNT PCUT TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8672100	SUP	HCPCS C1713		8672100  -  ROD SPNL STD CNTR PREBNT 5.5MM 100MM CD HZN SXTNT PCUT TI	BOTH IP/OP	"$2,072.50 "	"$1,533.65"	$0.00	"$1,658.00"	$932.63	$932.63	$0.00	$0.00	$0.00	$431.96	"$1,538.21"	"$1,538.21"	$0.00	$0.00	$431.91	$0.00	"$1,225.88"	"$1,225.88"	$0.00	"$1,036.25"	"$1,641.42"	"$1,658.00"	$0.00		$0.00	$324.35	$0.00	$0.00	$329.94	$0.00	$0.00	$0.00	$0.00	$0.00
8674110	SUP	Custom 27803010		8674110  -  CONNECTOR 8674110 6.35MM SACRAL TI	BOTH IP/OP	"$1,935.50 "	"$1,432.27"	$0.00	"$1,548.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,436.53"	"$1,436.53"	$0.00	$0.00	$403.36	$0.00	$0.00	$0.00	$0.00	$967.75	"$1,532.92"	"$1,548.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8674111	SUP	HCPCS C1713		8674111  -  SCREW 8674111  SET  FOR 6.35MM CONN TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8680853	SUP	HCPCS C1713		"8680853  -  M8 REDUCTION SCREW PLUG, SS"	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8688498	SUP	HCPCS C1713		8688498  -  STAPLE 8688498 19MM CAUDAL SS	BOTH IP/OP	"$2,173.50 "	"$1,608.39"	$0.00	"$1,738.80"	$978.08	$978.08	$0.00	$0.00	$0.00	$453.01	"$1,613.17"	"$1,613.17"	$0.00	$0.00	$452.96	$0.00	"$1,285.63"	"$1,285.63"	$0.00	"$1,086.75"	"$1,721.41"	"$1,738.80"	$0.00		$0.00	$340.15	$0.00	$0.00	$346.02	$0.00	$0.00	$0.00	$0.00	$0.00
8688499	SUP	HCPCS C1713		8688499  -  STAPLE 8688499 19MM ROSTRAL SS	BOTH IP/OP	"$2,173.50 "	"$1,608.39"	$0.00	"$1,738.80"	$978.08	$978.08	$0.00	$0.00	$0.00	$453.01	"$1,613.17"	"$1,613.17"	$0.00	$0.00	$452.96	$0.00	"$1,285.63"	"$1,285.63"	$0.00	"$1,086.75"	"$1,721.41"	"$1,738.80"	$0.00		$0.00	$340.15	$0.00	$0.00	$346.02	$0.00	$0.00	$0.00	$0.00	$0.00
8688500	SUP	HCPCS C1713		8688500  -  STAPLE 8688500 21MM CAUDAL SS	BOTH IP/OP	"$2,173.50 "	"$1,608.39"	$0.00	"$1,738.80"	$978.08	$978.08	$0.00	$0.00	$0.00	$453.01	"$1,613.17"	"$1,613.17"	$0.00	$0.00	$452.96	$0.00	"$1,285.63"	"$1,285.63"	$0.00	"$1,086.75"	"$1,721.41"	"$1,738.80"	$0.00		$0.00	$340.15	$0.00	$0.00	$346.02	$0.00	$0.00	$0.00	$0.00	$0.00
8688501	SUP	HCPCS C1713		8688501  -  STAPLE 8688501 21MM ROSTRAL SS	BOTH IP/OP	"$2,173.50 "	"$1,608.39"	$0.00	"$1,738.80"	$978.08	$978.08	$0.00	$0.00	$0.00	$453.01	"$1,613.17"	"$1,613.17"	$0.00	$0.00	$452.96	$0.00	"$1,285.63"	"$1,285.63"	$0.00	"$1,086.75"	"$1,721.41"	"$1,738.80"	$0.00		$0.00	$340.15	$0.00	$0.00	$346.02	$0.00	$0.00	$0.00	$0.00	$0.00
8690024	SUP	HCPCS C1713		8690024  -  ROD 8690024 5.5MM CCM ROD L 500MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8690030	SUP	HCPCS C1713		8690030  -  ROD SPNL PREBNT 5.5MM 30MM CD HZN TI CP	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690035	SUP	HCPCS C1713		"8690035  -  PRE-BENT ROD, 5.5X35, TI"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690040	SUP	HCPCS C1713		8690040  -  ROD SPNL PREBNT 5.5MM 40MM LGC CD HZN TI CP	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690045	SUP	HCPCS C1713		"8690045  -  PRE-BENT ROD, 5.5X45, TI"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690050	SUP	HCPCS C1713		8690050  -  ROD SPNL PCUT PREBNT 5.5MM 50MM LGC CD HZN TI CP	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690055	SUP	HCPCS C1713		8690055  -  ROD 8690055 PRE-BENT 5.5X55 TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690060	SUP	HCPCS C1713		8690060  -  ROD SPNL PREBNT 5.5MM 60MM CD HZN LGC CNTR POST TI THRX	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690065	SUP	HCPCS C1713		"8690065  -  PRE-BENT ROD, 5.5X65, TI"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690070	SUP	HCPCS C1713		8690070  -  ROD SPNL PREBNT 5.5MM 70MM CD HZN LGC CNTR POST TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690075	SUP	HCPCS C1713		"8690075  -  PRE-BENT ROD, 5.5X75, TI"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690080	SUP	HCPCS C1713		8690080  -  ROD SPNL 80MM 5.5MM CD HZN LGC TI PREBNT CP	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690085	SUP	HCPCS C1713		"8690085  -  PRE-BENT ROD, 5.5X85, TI"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690090	SUP	HCPCS C1713		8690090  -  ROD SPNL PREBNT 5.5MM 90MM CD HZN LGC CNTR POST TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690095	SUP	HCPCS C1713		"8690095  -  ROD 8690095, PRE-BENT 5.5X95, TI"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690100	SUP	HCPCS C1713		8690100  -  ROD SPNL PREBNT 5.5MM 100MM LGC CD HZN TI CP	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690105	SUP	HCPCS C1713		"8690105  -  PRE-BENT ROD, 5.5X105, TI"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690110	SUP	HCPCS C1713		8690110  -  ROD 8690110 CDH PBNT 5.5X110 TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690115	SUP	HCPCS C1713		"8690115  -  PRE-BENT ROD, 5.5X115, TI"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690120	SUP	HCPCS C1713		8690120  -  ROD 8690120 CDH PBNT 5.5X120 TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8690853	SUP	HCPCS C1713		8690853  -  SCREW 8690853  M8 REDUCTION PLUG TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8690878	SUP	HCPCS C1713		"8690878  -  SET SCREW, REDUCTION, M8, TI"	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8691530	SUP	HCPCS C1713		8691530  -  CDH M8 5.5 X 30 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691535	SUP	HCPCS C1713		8691535  -  CDH M8 5.5 X 35 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691540	SUP	HCPCS C1713		8691540  -  CDH M8 5.5 X 40 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691545	SUP	HCPCS C1713		8691545  -  CDH M8 5.5 X 45 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691550	SUP	HCPCS C1713		8691550  -  CDH M8 5.5 X 50 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691630	SUP	HCPCS C1713		8691630  -  CDH M8 6.5 X 30 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691635	SUP	HCPCS C1713		8691635  -  CDH M8 6.5 X 35 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691640	SUP	HCPCS C1713		8691640  -  CDH M8 6.5 X 40 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691645	SUP	HCPCS C1713		8691645  -  CDH M8 6.5 X 45 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691650	SUP	HCPCS C1713		8691650  -  CDH M8 6.5 X 50 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691655	SUP	HCPCS C1713		8691655  -  CDH M8 6.5 X 55 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691730	SUP	HCPCS C1713		8691730  -  CDH M8 7.5 X 30 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691735	SUP	HCPCS C1713		8691735  -  CDH M8 7.5 X 35 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691745	SUP	HCPCS C1713		8691745  -  CDH M8 7.5 X 45 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8691750	SUP	HCPCS C1713		8691750  -  CDH M8 7.5 X 50 RED FAS 5.5 TI	BOTH IP/OP	"$2,362.40 "	"$1,748.18"	$0.00	"$1,889.92"	"$1,063.08"	"$1,063.08"	$0.00	$0.00	$0.00	$492.38	"$1,753.37"	"$1,753.37"	$0.00	$0.00	$492.32	$0.00	"$1,397.36"	"$1,397.36"	$0.00	"$1,181.20"	"$1,871.02"	"$1,889.92"	$0.00		$0.00	$369.72	$0.00	$0.00	$376.09	$0.00	$0.00	$0.00	$0.00	$0.00
8692150	SUP	HCPCS C1713		"8692150  -  M8 RED. STD. RAMPED HOOK, TI"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8692152	SUP	HCPCS C1713		"8692152  -  M8 RED. NARROW RAMP HOOK, TI"	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8698501	SUP	HCPCS C1713		8698501  -  STAPLE BONE SM 2 ROD 21MM TI RSTRL SPN CD HZN ANTARES STRL	BOTH IP/OP	"$4,240.00 "	"$3,137.60"	$0.00	"$3,392.00"	"$1,908.00"	"$1,908.00"	$0.00	$0.00	$0.00	$883.72	"$3,146.93"	"$3,146.93"	$0.00	$0.00	$883.62	$0.00	"$2,090.32"	"$2,090.32"	$0.00	"$2,120.00"	"$3,358.08"	"$3,392.00"	$0.00		$0.00	$663.56	$0.00	$0.00	$675.01	$0.00	$0.00	$0.00	$0.00	$0.00
8698502	SUP	HCPCS C1713		8698502  -  STAPLE BONE MED 2 ROD TI CDL SPN CD HZN ANTARES	BOTH IP/OP	"$4,240.00 "	"$3,137.60"	$0.00	"$3,392.00"	"$1,908.00"	"$1,908.00"	$0.00	$0.00	$0.00	$883.72	"$3,146.93"	"$3,146.93"	$0.00	$0.00	$883.62	$0.00	"$2,090.32"	"$2,090.32"	$0.00	"$2,120.00"	"$3,358.08"	"$3,392.00"	$0.00		$0.00	$663.56	$0.00	$0.00	$675.01	$0.00	$0.00	$0.00	$0.00	$0.00
8699050	SUP	HCPCS C1713		"8699050  -  CDH 5.5X50 STRAIGHT ROD, TI CP"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8699055	SUP	HCPCS C1713		"8699055  -  CDH 5.5X55 STRAIGHT ROD, TI CP"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8699060	SUP	HCPCS C1713		"8699060  -  CDH 5.5X60 STRAIGHT ROD, TI CP"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8699065	SUP	HCPCS C1713		"8699065  -  CDH 5.5X65 STRAIGHT ROD, TI CP"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8699070	SUP	HCPCS C1713		"8699070  -  CDH 5.5X70 STRAIGHT ROD, TI CP"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8699075	SUP	HCPCS C1713		"8699075  -  CDH 5.5X75 STRAIGHT ROD, TI CP"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8699080	SUP	HCPCS C1713		"8699080  -  CDH 5.5X80 STRAIGHT ROD, TI CP"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8699085	SUP	HCPCS C1713		"8699085  -  CDH 5.5X85 STRAIGHT ROD, TI CP"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8699090	SUP	HCPCS C1713		"8699090  -  CDH 5.5X90 STRAIGHT ROD, TI CP"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8699095	SUP	HCPCS C1713		"8699095  -  CDH 5.5X95 STRAIGHT ROD, TI CP"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8699100	SUP	HCPCS C1713		"8699100  -  CDH 5.5X100 STRAIGHT ROD,TI CP"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8730006	SUP	Custom 27203010		"8730006  -  UCSS CANNULATED DRILL BIT, STERILE"	BOTH IP/OP	"$1,099.50 "	$813.63	$0.00	$879.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$816.05	$816.05	$0.00	$0.00	$229.14	$0.00	$0.00	$0.00	$0.00	$549.75	$870.80	$879.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8750520	SUP	HCPCS C1713		8750520  -  CONCTR ROD 20MM 5.5MM SS OFFST	BOTH IP/OP	"$2,482.50 "	"$1,837.05"	$0.00	"$1,986.00"	"$1,117.13"	"$1,117.13"	$0.00	$0.00	$0.00	$517.42	"$1,842.51"	"$1,842.51"	$0.00	$0.00	$517.35	$0.00	"$1,468.40"	"$1,468.40"	$0.00	"$1,241.25"	"$1,966.14"	"$1,986.00"	$0.00		$0.00	$388.51	$0.00	$0.00	$395.21	$0.00	$0.00	$0.00	$0.00	$0.00
8750530	SUP	HCPCS C1713		8750530  -  CONCTR ROD 30MM 5.5MM SS OFFST	BOTH IP/OP	"$2,482.50 "	"$1,837.05"	$0.00	"$1,986.00"	"$1,117.13"	"$1,117.13"	$0.00	$0.00	$0.00	$517.42	"$1,842.51"	"$1,842.51"	$0.00	$0.00	$517.35	$0.00	"$1,468.40"	"$1,468.40"	$0.00	"$1,241.25"	"$1,966.14"	"$1,986.00"	$0.00		$0.00	$388.51	$0.00	$0.00	$395.21	$0.00	$0.00	$0.00	$0.00	$0.00
8750560	SUP	HCPCS C1713		8750560  -  CONCTR ROD 60MM 5.5MM SS OFFST	BOTH IP/OP	"$2,482.50 "	"$1,837.05"	$0.00	"$1,986.00"	"$1,117.13"	"$1,117.13"	$0.00	$0.00	$0.00	$517.42	"$1,842.51"	"$1,842.51"	$0.00	$0.00	$517.35	$0.00	"$1,468.40"	"$1,468.40"	$0.00	"$1,241.25"	"$1,966.14"	"$1,986.00"	$0.00		$0.00	$388.51	$0.00	$0.00	$395.21	$0.00	$0.00	$0.00	$0.00	$0.00
8754025	SUP	HCPCS C1713		8754025  -  SCREW UNIPLANER 4.0MM 25MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8754030	SUP	HCPCS C1713		8754030  -  SCREW UNIPLANER 4.0MM 30MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8754035	SUP	HCPCS C1713		8754035  -  SCREW UNIPLANER 4.0MM 35MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8754040	SUP	HCPCS C1713		8754040  -  SCREW UNIPLANER 4.0MM 40MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8754045	SUP	HCPCS C1713		8754045  -  SCREW UNIPLANER 4.0MM 45MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8754525	SUP	HCPCS C1713		8754525  -  SCREW UNIPLANER 4.5MM 25MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8754530	SUP	HCPCS C1713		8754530  -  SCREW UNIPLANER 4.5MM 30MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8754535	SUP	HCPCS C1713		8754535  -  SCREW UNIPLANER 4.5MM 35MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8754540	SUP	HCPCS C1713		8754540  -  SCREW UNIPLANER 4.5MM 40MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8754545	SUP	HCPCS C1713		8754545  -  SCREW UNIPLANER 4.5MM 45MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8754550	SUP	HCPCS C1713		8754550  -  SCREW UNIPLANER 4.5MM 50MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755025	SUP	HCPCS C1713		8755025  -  SCREW UNIPLANER 5.0MM 25MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755030	SUP	HCPCS C1713		8755030  -  SCREW UNIPLANER 5.0MM 30MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755035	SUP	HCPCS C1713		8755035  -  SCREW UNIPLANER 5.0MM 35MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755040	SUP	HCPCS C1713		8755040  -  SCREW UNIPLANER 5.0MM 40MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755045	SUP	HCPCS C1713		8755045  -  SCREW UNIPLANER 5.0MM 45MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755050	SUP	HCPCS C1713		8755050  -  SCREW UNIPLANER 5.0MM 50MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755525	SUP	HCPCS C1713		8755525  -  SCREW UNIPLANER 5.5MM 25MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755530	SUP	HCPCS C1713		8755530  -  SCREW UNIPLANER 5.5MM 30MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755535	SUP	HCPCS C1713		8755535  -  SCREW UNIPLANER 5.5MM 35MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755540	SUP	HCPCS C1713		8755540  -  SCREW UNIPLANER 5.5MM 40MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755545	SUP	HCPCS C1713		8755545  -  SCREW UNIPLANER 5.5MM 45MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755550	SUP	HCPCS C1713		8755550  -  SCREW UNIPLANER 5.5MM 50MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755555	SUP	HCPCS C1713		8755555  -  SCREW UNIPLANER 5.5MM 55MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755560	SUP	HCPCS C1713		8755560  -  SCREW UNIPLANER 5.5MM 60MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8755565	SUP	HCPCS C1713		8755565  -  SCREW UNIPLANER 5.5MM 65MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8756025	SUP	HCPCS C1713		8756025  -  SCREW UNIPLANER 6.0MM 25MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8756030	SUP	HCPCS C1713		8756030  -  SCREW UNIPLANER 6.0MM 30MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8756035	SUP	HCPCS C1713		8756035  -  SCREW UNIPLANER 6.0MM 35MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8756040	SUP	HCPCS C1713		8756040  -  SCREW UNIPLANER 6.0MM 40MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8756045	SUP	HCPCS C1713		8756045  -  SCREW UNIPLANER 6.0MM 45MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8756050	SUP	HCPCS C1713		8756050  -  SCREW UNIPLANER 6.0MM 50MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8756055	SUP	HCPCS C1713		8756055  -  SCREW UNIPLANER 6.0MM 55MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8756060	SUP	HCPCS C1713		8756060  -  SCREW UNIPLANER 6.0MM 60MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8756065	SUP	HCPCS C1713		8756065  -  SCREW UNIPLANER 6.0MM 65MM 5.5MM SS	BOTH IP/OP	"$5,192.50 "	"$3,842.45"	$0.00	"$4,154.00"	"$2,336.63"	"$2,336.63"	$0.00	$0.00	$0.00	"$1,082.25"	"$3,853.87"	"$3,853.87"	$0.00	$0.00	"$1,082.12"	$0.00	"$2,559.90"	"$2,559.90"	$0.00	"$2,596.25"	"$4,112.46"	"$4,154.00"	$0.00		$0.00	$812.63	$0.00	$0.00	$826.65	$0.00	$0.00	$0.00	$0.00	$0.00
8780111	SUP	HCPCS C1713		8780111  -  SCREW BN 4MM 11MM ARCHON SLF DRL FX ANG SPNE DEGENERATIVE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780113	SUP	HCPCS C1713		8780113  -  SCREW BN 4MM 13MM ARCHON SLF DRL FX ANG SPNE DEGENERATIVE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780115	SUP	HCPCS C1713		8780115  -  SCREW BN 4MM 15MM ARCHON SLF DRL FX ANG SPNE DEGENERATIVE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780211	SUP	HCPCS C1713		8780211  -  SCREW BN 4MM 11MM NS ARCHON SLF DRL VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780213	SUP	HCPCS C1713		8780213  -  SCREW BN 4MM 13MM ARCHON SLF DRL VA SPNE DEGENERATIVE DISC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780215	SUP	HCPCS C1713		8780215  -  SCREW BN 4MM 15MM NS ARCHON SLF DRL VA SPNE DEGENERATIVE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780216	SUP	HCPCS C1713		8780216  -  SCREW BN 4MM 16MM SLF DRL VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780311	SUP	HCPCS C1713		8780311  -  SCREW BN 4MM 11MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780313	SUP	HCPCS C1713		8780313  -  SCREW BN 4MM 13MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780319	SUP	HCPCS C1713		8780319  -  SCREW BN 4MM 19MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780411	SUP	HCPCS C1713		8780411  -  SCREW BN 4MM 11MM NS ARCHON SLF DRL VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780511	SUP	HCPCS C1713		8780511  -  SCREW BN 4.5MM 11MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780515	SUP	HCPCS C1713		8780515  -  SCREW BN 4.5MM 15MM NS ARCHON ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780517	SUP	HCPCS C1713		8780517  -  SCREW BN 4.5MM 17MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780519	SUP	HCPCS C1713		8780519  -  SCREW BN 4.5MM 19MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780613	SUP	HCPCS C1713		8780613  -  SCREW BN 4.5MM 13MM NS ARCHON ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780617	SUP	HCPCS C1713		8780617  -  SCREW BN 4.5MM 17MM NS ARCHON SLF DRL VA SPNE DEGENERATIVE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780619	SUP	HCPCS C1713		8780619  -  SCREW BN 4.5MM 19MM NS ARCHON ST VA SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780711	SUP	HCPCS C1713		8780711  -  SCREW BN 4MM 11MM NS ARCHON SLF DRL FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780715	SUP	HCPCS C1713		8780715  -  SCREW BN 4MM 15MM NS ARCHON SLF DRL FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780811	SUP	HCPCS C1713		8780811  -  SCREW BN 4MM 11MM NS ARCHON ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780813	SUP	HCPCS C1713		8780813  -  SCREW BN 4MM 13MM NS ARCHON ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780815	SUP	HCPCS C1713		8780815  -  SCREW BN 4MM 15MM NS ARCHON ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780817	SUP	HCPCS C1713		8780817  -  SCREW BN 4MM 17MM NS ARCHON ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780819	SUP	HCPCS C1713		8780819  -  SCREW BN 4MM 19MM NS ARCHON ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780911	SUP	HCPCS C1713		8780911  -  SCREW BN 4.5MM 11MM NS ARCHON ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780913	SUP	HCPCS C1713		8780913  -  SCREW BN 4.5MM 13MM NS ARCHON ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780915	SUP	HCPCS C1713		8780915  -  SCREW BN 4.5MM 15MM NS ARCHON ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780917	SUP	HCPCS C1713		8780917  -  SCREW BN 4.5MM 17MM NS ARCHON SLF DRL FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8780919	SUP	HCPCS C1713		8780919  -  SCREW BN 4.5MM 19MM NS ARCHON ST FX ANG SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8787118	SUP	HCPCS C1713		8787118  -  ARCHON 18MM PLATE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8787120	SUP	HCPCS C1713		8787120  -  PLATE BN 20MM ARCHON 1 LVL SPNE DEGENERATIVE DISC	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8787128	SUP	HCPCS C1713		8787128  -  PLATE BN 28MM NS ARCHON 1 LVL SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8787130	SUP	HCPCS C1713		8787130  -  PLATE BN 30MM NS ARCHON 1 LVL SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8787132	SUP	HCPCS C1713		8787132  -  PLATE BN 32MM NS ARCHON 1 LVL SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8787234	SUP	HCPCS C1713		8787234  -  PLATE BN 34MM NS ARCHON 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8787236	SUP	HCPCS C1713		8787236  -  PLATE BN 36MM NS ARCHON 2 LVL SPNE DEGENERATIVE DISC	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8787238	SUP	HCPCS C1713		8787238  -  ARCHON 2 LEVEL PLATE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8787240	SUP	HCPCS C1713		"8787240  -  ARCHON LEVEL2, CERVICAL PLATE"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8787242	SUP	HCPCS C1713		8787242  -  PLATE BN 42MM ARCHON 2 LVL SPNE DEGENERATIVE DISC	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8787244	SUP	HCPCS C1713		"8787244  -  ARCHON PLATE, 2 LEVEL, 44MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8787246	SUP	HCPCS C1713		8787246  -  PLATE BN 46MM NS ARCHON 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8787248	SUP	HCPCS C1713		8787248  -  PLATE BN 48MM NS ARCHON 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8787250	SUP	HCPCS C1713		8787250  -  PLATE BN 50MM NS ARCHON 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8787252	SUP	HCPCS C1713		8787252  -  PLATE BN 52MM NS ARCHON 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8787254	SUP	HCPCS C1713		8787254  -  PLATE BN 54MM NS ARCHON 2 LVL SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8787350	SUP	HCPCS C1713		8787350  -  PLATE BN 50MM NS ARCHON 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8787352	SUP	HCPCS C1713		8787352  -  PLATE BN 52MM NS ARCHON 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8787356	SUP	HCPCS C1713		8787356  -  PLATE BN 56MM NS ARCHON 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8787364	SUP	HCPCS C1713		8787364  -  PLATE BN 64MM NS ARCHON 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8787366	SUP	HCPCS C1713		8787366  -  PLATE BN 66MM NS ARCHON 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8787368	SUP	HCPCS C1713		8787368  -  PLATE BN 68MM NS ARCHON 3 LVL SPNE	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8787468	SUP	HCPCS C1713		8787468  -  PLATE BN 68MM ARCHON 4 LVL SPNE DEGENERATIVE DISC	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
8787474	SUP	HCPCS C1713		8787474  -  PLATE BN 74MM ARCHON 4 LVL SPNE DEGENERATIVE DISC	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
8787486	SUP	HCPCS C1713		8787486  -  PLATE BN 86MM ARCHON 4 LVL SPNE DEGENERATIVE DISC	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
8787500	SUP	HCPCS C1713		8787500  -  PLATE BN 100MM ARCHON 5 LVL SPNE DEGENERATIVE DISC	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
8787510	SUP	HCPCS C1713		8787510  -  PLATE BN 110MM ARCHON 5 LVL SPNE DEGENERATIVE DISC	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
8792111	SUP	HCPCS C1713		8792111  -  SCREW 8792111 VAST CNCLLS 3.5X11MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792113	SUP	HCPCS C1713		8792113  -  SCREW 8792113 ZEPHIR VAST 3.5X13	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792115	SUP	HCPCS C1713		8792115  -  SCREW 8792115 ZEPHIR VAST 3.5X15	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792117	SUP	HCPCS C1713		8792117  -  SCREW 8792117 ZEPHIR VAST 3.5X17	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792711	SUP	HCPCS C1713		8792711  -  SCREW 8792711 VAST CNCLLS 4.0X11MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792713	SUP	HCPCS C1713		8792713  -  SCREW 8792713 VAST CNCLLS 4.0X13MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792715	SUP	HCPCS C1713		8792715  -  SCREW 8792715 VAST CNCLLS 4.0X15MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792717	SUP	HCPCS C1713		8792717  -  SCREW 8792717 VASD CNCLLS 4.0X17MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792811	SUP	HCPCS C1713		8792811  -  SCREW 8792811 VA SELF DRILLING 3.5X11MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792813	SUP	HCPCS C1713		8792813  -  SCREW 8792813 VA SELF DRILLING 3.5X13MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792815	SUP	HCPCS C1713		8792815  -  SCREW BN 3.5MM 15MM NS ZPHR VA SLF DRL TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792817	SUP	HCPCS C1713		8792817  -  SCREW 8792817 VA SELF DRILLING 3.5X17MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792911	SUP	HCPCS C1713		8792911  -  SCREW 8792911 VA SELF DRILLING 4.0X11MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792913	SUP	HCPCS C1713		8792913  -  SCREW 8792913 VA SELF DRILLING 4.0X13MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792915	SUP	HCPCS C1713		8792915  -  SCREW BN 4MM 15MM NS ZPHR VA SLF DRL TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8792917	SUP	HCPCS C1713		8792917  -  SCREW 8792917 VA SELF DRILLING 4.0X17MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
8799022	SUP	HCPCS C1713		8799022  -  PLATE 8799022 ANT CERV  22.5MM TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8799025	SUP	HCPCS C1713		8799025  -  PLATE 8799025 ANT CERV 25MM TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8799027	SUP	HCPCS C1713		8799027  -  PLATE 8799027 ANT CERV 27.5MM TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8799130	SUP	HCPCS C1713		8799130  -  PLATE 8799130 ZEPHIR 30MM TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8799132	SUP	HCPCS C1713		8799132  -  PLATE 8799132 ZEPHIR 32.5MM TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8799135	SUP	HCPCS C1713		8799135  -  PLATE 8799135 ZEPHIR 35MM TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8799137	SUP	HCPCS C1713		8799137  -  PLATE 8799137 ZEPHIR 37.5MM TI	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8799140	SUP	HCPCS C1713		8799140  -  PLATE 8799140 ZEPHIR  40MM TI	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8799142	SUP	HCPCS C1713		8799142  -  PLATE 8799142 ZEPHIR 42.5MM TI	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8799145	SUP	HCPCS C1713		8799145  -  PLATE 8799145 ZEPHIR 45MM TI	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8799147	SUP	HCPCS C1713		8799147  -  PLATE 8799147ZEPHIR 47.5MM TI	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8799150	SUP	HCPCS C1713		8799150  -  PLATE 8799150 ZEPHIR 50MM TI	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8799152	SUP	HCPCS C1713		8799152  -  PLATE 8799152 ZEPHIR 52.5MM TI	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799155	SUP	HCPCS C1713		8799155  -  PLATE 8799155 ZEPHIR 55MM TI	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799157	SUP	HCPCS C1713		8799157  -  PLATE 8799157 ZEPHIR 57.5MM TI	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799160	SUP	HCPCS C1713		8799160  -  PLATE 8799160 ZEPHIR 60MM TI	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799162	SUP	HCPCS C1713		8799162  -  PLATE 8799162 ZEPHIR 62.5MM TI	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799165	SUP	HCPCS C1713		8799165  -  PLATE 8799165 ZEPHIR 65MM TI	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799167	SUP	HCPCS C1713		8799167  -  PLATE 8799167 ZEPHIR 67.5MM TI	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799170	SUP	HCPCS C1713		8799170  -  PLATE 8799170 ZEPHIR 70MM TI	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799180	SUP	HCPCS C1713		8799180  -  PLATE 8799180 ZEPHIR KIT 22MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8799190	SUP	HCPCS C1713		8799190  -  PLATE 8799190 ZEPHIR KIT 25MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8799200	SUP	HCPCS C1713		8799200  -  PLATE 8799200 ZEPHIR KIT 27MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8799230	SUP	HCPCS C1713		"8799230  -  ZEPHIR DUAL SLOT PLATE, 30MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8799232	SUP	HCPCS C1713		"8799232  -  ZEPHIR DUAL SLOT PLATE, 32.5MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8799235	SUP	HCPCS C1713		"8799235  -  ZEPHIR DUAL SLOT PLATE, 35MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8799237	SUP	HCPCS C1713		"8799237  -  ZEPHIR DUAL SLOT PLATE, 37.5MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8799245	SUP	HCPCS C1713		"8799245  -  ZEPHIR DUAL SLOT PLATE, 45MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8799247	SUP	HCPCS C1713		"8799247  -  ZEPHIR DUAL SLOT PLATE, 47.5MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8799250	SUP	HCPCS C1713		"8799250  -  ZEPHIR DUAL SLOT PLATE, 50MM"	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8799252	SUP	HCPCS C1713		"8799252  -  ZEPHIR DUAL SLOT PLATE, 52.5MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799255	SUP	HCPCS C1713		"8799255  -  ZEPHIR DUAL SLOT PLATE, 55MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799257	SUP	HCPCS C1713		"8799257  -  ZEPHIR DUAL SLOT PLATE, 57.5MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799260	SUP	HCPCS C1713		"8799260  -  ZEPHIR DUAL SLOT PLATE, 60MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799262	SUP	HCPCS C1713		"8799262  -  ZEPHIR DUAL SLOT PLATE, 62.5MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799265	SUP	HCPCS C1713		"8799265  -  ZEPHIR DUAL SLOT PLATE, 65MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799267	SUP	HCPCS C1713		"8799267  -  ZEPHIR DUAL SLOT PLATE, 67.5MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8799270	SUP	HCPCS C1713		"8799270  -  ZEPHIR DUAL SLOT PLATE, 70MM"	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
8800000	SUP	HCPCS C1713		8800000  -  SCREW BONE SPNL MULTIAX LCK	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8801054	SUP	Custom 27203010		8801054  -  MARKER SRG STRL NDI 4 SPHR IN TRY STD MNT POST DISP	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8801068	SUP	HCPCS C1769		8801068  -  WIRE KWIRE SPNL THRD	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
8801269	SUP	HCPCS C1713		8801269  -  WIRE FX LNG PRCPT GSB MAS KRSH BVL TIP NTNL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
8804525	SUP	HCPCS C1713		8804525  -  SCREW BONE 4.5MM 25MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8804530	SUP	HCPCS C1713		8804530  -  SCREW BONE 4.5MM 30MM SPNL POLYAX	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
8804535	SUP	HCPCS C1713		8804535  -  SCREW BONE 4.5MM 35MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8804540	SUP	HCPCS C1713		8804540  -  SCREW BONE 4.5MM 40MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8804545	SUP	HCPCS C1713		8804545  -  SCREW BONE 4.5MM 45MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805530	SUP	HCPCS C1713		8805530  -  SCREW BONE 5.5MM 30MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805535	SUP	HCPCS C1713		8805535  -  SCREW BONE 5.5MM 35MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805540	SUP	HCPCS C1713		8805540  -  SCREW BONE 5.5MM 40MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805545	SUP	HCPCS C1713		8805545  -  SCREW BONE 5.5MM 45MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805550	SUP	HCPCS C1713		8805550  -  SCREW BONE 5.5MM 50MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805555	SUP	HCPCS C1713		8805555  -  SCREW BONE 5.5MM 55MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806530	SUP	HCPCS C1713		8806530  -  SCREW BONE 6.5MM 30MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806535	SUP	HCPCS C1713		8806535  -  SCREW BONE 6.5MM 35MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806540	SUP	HCPCS C1713		8806540  -  SCREW BONE 6.5MM 40MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806545	SUP	HCPCS C1713		8806545  -  SCREW BONE 6.5MM 45MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806550	SUP	HCPCS C1713		8806550  -  SCREW BONE 6.5MM 50MM MULTIAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806555	SUP	HCPCS C1713		8806555  -  SCREW BONE 6.5MM 55MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807500	SUP	HCPCS C1713		8807500  -  SCREW BONE 7.5MM 50MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807530	SUP	HCPCS C1713		8807530  -  SCREW BONE 7.5MM 30MM SPNL POLYAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807535	SUP	HCPCS C1713		8807535  -  SCREW BONE 7.5MM 35MM SPNL POLYAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807540	SUP	HCPCS C1713		8807540  -  SCREW BONE 7.5MM 40MM SPNL POLYAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807545	SUP	HCPCS C1713		8807545  -  SCREW BONE 7.5MM 45MM SPNL POLYAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807550	SUP	HCPCS C1713		8807550  -  SCREW BONE 7.5MM 50MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807555	SUP	HCPCS C1713		8807555  -  SCREW BONE 7.5MM 55MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807560	SUP	HCPCS C1713		8807560  -  SCREW BONE 7.5MM 60MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807570	SUP	HCPCS C1713		8807570  -  SCREW BONE 7.5MM 70MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807580	SUP	HCPCS C1713		8807580  -  SCREW BONE 7.5MM 80MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807590	SUP	HCPCS C1713		8807590  -  SCREW BONE 7.5MM 90MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808500	SUP	HCPCS C1713		8808500  -  SCREW BONE 8.5MM 100MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808535	SUP	HCPCS C1713		8808535  -  SCREW BONE 8.5MM 35MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808540	SUP	HCPCS C1713		8808540  -  SCREW BONE 8.5MM 40MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808545	SUP	HCPCS C1713		8808545  -  SCREW BONE 8.5MM 45MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808550	SUP	HCPCS C1713		8808550  -  SCREW BONE 8.5MM 50MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808555	SUP	HCPCS C1713		8808555  -  SCREW BONE 8.5MM 55MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808560	SUP	HCPCS C1713		8808560  -  SCREW BONE 8.5MM 60MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808570	SUP	HCPCS C1713		8808570  -  SCREW BONE 8.5MM 70MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808580	SUP	HCPCS C1713		8808580  -  SCREW BONE 8.5MM 80MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808590	SUP	HCPCS C1713		8808590  -  SCREW BONE 8.5MM 90MM SPNL MULTIAX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8824525	SUP	HCPCS C1713		8824525  -  SCREW BN 4.5MM 25MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8824530	SUP	HCPCS C1713		8824530  -  SCREW BN 4.5MM 30MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8824535	SUP	HCPCS C1713		8824535  -  SCREW BN 4.5MM 35MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8824540	SUP	HCPCS C1713		8824540  -  SCREW BN 4.5MM 40MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8824545	SUP	HCPCS C1713		8824545  -  SCREW BN 4.5MM 45MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8825530	SUP	HCPCS C1713		8825530  -  SCREW BN 7.5MM 35MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8825545	SUP	HCPCS C1713		8825545  -  SCREW BN 7.5MM 50MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8825550	SUP	HCPCS C1713		8825550  -  SCREW BN 7.5MM 55MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8825555	SUP	HCPCS C1713		8825555  -  SCREW BN 6.5MM 40MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8826530	SUP	HCPCS C1713		8826530  -  SCREW BN 6.5MM 45MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8826540	SUP	HCPCS C1713		8826540  -  SCREW BN 6.5MM 40MM NS PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8826550	SUP	HCPCS C1713		8826550  -  SCREW BN 5.5MM 30MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8826555	SUP	HCPCS C1713		8826555  -  SCREW BN 5.5MM 35MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8827500	SUP	HCPCS C1713		8827500  -  SCREW BN 7.5MM 100MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8827530	SUP	HCPCS C1713		8827530  -  SCREW BN 5.5MM 40MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8827535	SUP	HCPCS C1713		8827535  -  SCREW BN 5.5MM 45MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8827550	SUP	HCPCS C1713		8827550  -  SCREW BN 6.5MM 30MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8827555	SUP	HCPCS C1713		8827555  -  SCREW BN 6.5MM 35MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8827560	SUP	HCPCS C1713		8827560  -  SCREW BN 7.5MM 60MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8827570	SUP	HCPCS C1713		8827570  -  SCREW BN 7.5MM 70MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8827580	SUP	HCPCS C1713		8827580  -  SCREW BN 7.5MM 80MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8827590	SUP	HCPCS C1713		8827590  -  SCREW BN 7.5MM 90MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8828500	SUP	HCPCS C1713		8828500  -  SCREW BN 8.5MM 100MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8828535	SUP	HCPCS C1713		8828535  -  SCREW BN 8.5MM 35MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8828540	SUP	HCPCS C1713		8828540  -  SCREW BN 8.5MM 40MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8828545	SUP	HCPCS C1713		8828545  -  SCREW BN 8.5MM 45MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8828550	SUP	HCPCS C1713		8828550  -  SCREW BN 8.5MM 50MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8828555	SUP	HCPCS C1713		8828555  -  SCREW BN 8.5MM 55MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8828560	SUP	HCPCS C1713		8828560  -  SCREW BN 8.5MM 60MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8828570	SUP	HCPCS C1713		8828570  -  SCREW BN 8.5MM 70MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8828580	SUP	HCPCS C1713		8828580  -  SCREW BN 8.5MM 80MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8828590	SUP	HCPCS C1713		8828590  -  SCREW BN 8.5MM 90MM PRCPT RDC SPNE	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
8847020	SUP	HCPCS C1713		8847020  -  ROD SPNL 20MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847025	SUP	HCPCS C1713		8847025  -  ROD SPNL 25MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847030	SUP	HCPCS C1713		8847030  -  ROD SPNL 30MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847035	SUP	HCPCS C1713		8847035  -  ROD SPNL 35MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847040	SUP	HCPCS C1713		8847040  -  ROD SPNL 540MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847045	SUP	HCPCS C1713		8847045  -  ROD SPNL 45MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847050	SUP	HCPCS C1713		8847050  -  ROD SPNL 50MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847055	SUP	HCPCS C1713		8847055  -  ROD SPNL 55MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847060	SUP	HCPCS C1713		8847060  -  ROD SPNL 60MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847065	SUP	HCPCS C1713		8847065  -  ROD SPNL 65MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847070	SUP	HCPCS C1713		8847070  -  ROD SPNL 70MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847075	SUP	HCPCS C1713		8847075  -  ROD SPNL 75MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847080	SUP	HCPCS C1713		8847080  -  ROD SPNL 80MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847085	SUP	HCPCS C1713		8847085  -  ROD SPNL 85MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847090	SUP	HCPCS C1713		8847090  -  ROD SPNL 90MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847095	SUP	HCPCS C1713		8847095  -  ROD SPNL 95MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847100	SUP	HCPCS C1713		8847100  -  ROD SPNL 100MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847110	SUP	HCPCS C1713		8847110  -  ROD SPNL 110MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847120	SUP	HCPCS C1713		8847120  -  ROD SPNL 120MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847130	SUP	HCPCS C1713		8847130  -  ROD SPNL 130MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847140	SUP	HCPCS C1713		8847140  -  ROD SPNL 140MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847150	SUP	HCPCS C1713		8847150  -  ROD SPNL 150MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8847160	SUP	HCPCS C1713		8847160  -  ROD SPNL 160MM PRCPT PREBNT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848160	SUP	HCPCS C1713		8848160  -  ROD SPNL 160MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848170	SUP	HCPCS C1713		8848170  -  ROD SPNL 170MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848180	SUP	HCPCS C1713		8848180  -  ROD SPNL 180MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848190	SUP	HCPCS C1713		8848190  -  ROD SPNL 190MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848200	SUP	HCPCS C1713		8848200  -  ROD SPNL 200MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848210	SUP	HCPCS C1713		8848210  -  ROD SPNL 210MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848220	SUP	HCPCS C1713		8848220  -  ROD SPNL 220MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848230	SUP	HCPCS C1713		8848230  -  ROD SPNL 230MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848240	SUP	HCPCS C1713		8848240  -  ROD SPNL 240MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848250	SUP	HCPCS C1713		8848250  -  ROD SPNL 250MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848300	SUP	HCPCS C1713		8848300  -  ROD SPNL 300MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848500	SUP	HCPCS C1713		8848500  -  ROD SPNL 500MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8848600	SUP	HCPCS C1713		8848600  -  ROD SPNL 600MM PRCPT STRAIGHT TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8880823	SUP	HCPCS C1713		8880823  -  SPACER SPNL XLORDOTIC 23MMX8MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
8880828	SUP	HCPCS C1713		8880828  -  SPACER SPNL XLORDOTIC 28MMX8MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
8880832	SUP	HCPCS C1713		8880832  -  SPACER SPNL XLORDOTIC 32MMX8MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
8880923	SUP	HCPCS C1713		8880923  -  SPACER SPNL XLORDOTIC 23MMX9MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
8880928	SUP	HCPCS C1713		8880928  -  SPACER SPNL 28MMX9MM ELEV XLORDOTIC PEEK TI STRL	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
8880932	SUP	HCPCS C1713		8880932  -  SPACER SPNL XLORDOTIC 32MMX9MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
8881023	SUP	HCPCS C1713		8881023  -  SPACER SPNL XLORDOTIC 23MMX10MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
8881028	SUP	HCPCS C1713		8881028  -  SPACER SPNL XLORDOTIC 28MMX10MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
8881032	SUP	HCPCS C1713		8881032  -  SPACER SPNL XLORDOTIC 32MMX10MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
8881123	SUP	HCPCS C1713		8881123  -  SPACER SPNL XLORDOTIC 23MMX11MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
8881128	SUP	HCPCS C1713		8881128  -  SPACER SPNL XLORDOTIC 28MMX11MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
8881132	SUP	HCPCS C1713		8881132  -  SPACER SPNL XLORDOTIC 32MMX11MM STRL ELEV PEEK TI	BOTH IP/OP	"$11,698.50 "	"$8,656.89"	$0.00	"$9,358.80"	"$5,264.33"	"$5,264.33"	$0.00	$0.00	$0.00	"$2,438.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,437.97"	$0.00	"$5,767.36"	"$5,767.36"	$0.00	"$5,849.25"	"$9,265.21"	"$9,358.80"	$0.00		$0.00	"$1,830.82"	$0.00	$0.00	"$1,862.40"	$0.00	$0.00	$0.00	$0.00	$0.00
8896555	SUP	HCPCS C1713		8896555  -  SCREW BONE 6.5MM 55MM GSB PRCPT SPN MDLR CANN SHNK	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
8914000	SUP	HCPCS C1713		8914000  -  M4 BREAK-OFF SCREW	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8915008	SUP	HCPCS C1713		8915008  -  SPACER SPNL SM FLT 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915010	SUP	HCPCS C1713		8915010  -  SPACER SPNL SM FLT 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915012	SUP	HCPCS C1713		8915012  -  SPACER SPNL SM FLT 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915014	SUP	HCPCS C1713		8915014  -  SPACER SPNL SM FLT 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915016	SUP	HCPCS C1713		8915016  -  SPACER SPNL SM FLT 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915018	SUP	HCPCS C1713		8915018  -  SPACER SPNL SM FLT 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915020	SUP	HCPCS C1713		8915020  -  SPACER SPNL SM FLT 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915408	SUP	HCPCS C1713		8915408  -  SPACER SPNL SM LRDTC 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915410	SUP	HCPCS C1713		8915410  -  SPACER SPNL SM LRDTC 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915412	SUP	HCPCS C1713		8915412  -  SPACER SPNL SM LRDTC 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915414	SUP	HCPCS C1713		8915414  -  SPACER SPNL SM LRDTC 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915416	SUP	HCPCS C1713		8915416  -  SPACER SPNL SM LRDTC 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915418	SUP	HCPCS C1713		8915418  -  SPACER SPNL SM LRDTC 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915420	SUP	HCPCS C1713		8915420  -  SPACER SPNL SM LRDTC 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915805	SUP	HCPCS C1713		8915805  -  SPACER SPNL SM 5MM STRL VRTSTCK CENTERPIECE PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915810	SUP	HCPCS C1713		8915810  -  SPACER SPNL SM 10MM STRL VRTSTCK CENTERPIECE PEEK LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915820	SUP	HCPCS C1713		8915820  -  SPACER SPNL SM 20MM STRL VRTSTCK CENTERPIECE PEEK LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915830	SUP	HCPCS C1713		8915830  -  SPACER SPNL SM 30MM STRL VRTSTCK CENTERPIECE PEEK LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8915840	SUP	HCPCS C1713		8915840  -  SPACER SPNL SM 40MM STRL VRTSTCK CENTERPIECE PEEK LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916008	SUP	HCPCS C1713		8916008  -  SPACER SPNL LG FLT 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916010	SUP	HCPCS C1713		8916010  -  SPACER SPNL LG FLT 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916012	SUP	HCPCS C1713		8916012  -  SPACER SPNL LG FLT 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916014	SUP	HCPCS C1713		8916014  -  SPACER SPNL LG FLT 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916016	SUP	HCPCS C1713		8916016  -  SPACER SPNL LG FLT 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916018	SUP	HCPCS C1713		8916018  -  SPACER SPNL LG FLT 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916020	SUP	HCPCS C1713		8916020  -  SPACER SPNL LG FLT 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916408	SUP	HCPCS C1713		8916408  -  SPACER SPNL LG LRDTC 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916410	SUP	HCPCS C1713		8916410  -  SPACER SPNL LG LRDTC 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916412	SUP	HCPCS C1713		8916412  -  SPACER SPNL LG LRDTC 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916414	SUP	HCPCS C1713		8916414  -  SPACER SPNL LG LRDTC 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916416	SUP	HCPCS C1713		8916416  -  SPACER SPNL LG LRDTC 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916418	SUP	HCPCS C1713		8916418  -  SPACER SPNL LG LRDTC 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916420	SUP	HCPCS C1713		8916420  -  SPACER SPNL LG LRDTC 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916805	SUP	HCPCS C1713		8916805  -  SPACER SPNL LG 5MM STRL VRTSTCK CENTERPIECE PEEK LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916810	SUP	HCPCS C1713		8916810  -  SPACER SPNL LG 10MM STRL VRTSTCK CENTERPIECE PEEK LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916820	SUP	HCPCS C1713		8916820  -  SPACER SPNL LG 20MM STRL VRTSTCK CENTERPIECE PEEK LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916830	SUP	HCPCS C1713		8916830  -  SPACER SPNL LG 30MM STRL VRTSTCK CENTERPIECE PEEK LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8916840	SUP	HCPCS C1713		8916840  -  SPACER SPNL LG 40MM STRL VRTSTCK CENTERPIECE PEEK LMBR	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
8941420	SUP	Custom 27803010		8941420  -  CAGE SPNL 14MM 20X17MM LTCG TI LMBR TPR FSN DEV	BOTH IP/OP	"$7,226.25 "	"$5,347.43"	$0.00	"$5,781.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,505.95"	$0.00	$0.00	$0.00	$0.00	"$3,613.13"	"$5,723.19"	"$5,781.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941423	SUP	Custom 27803010		8941423  -  CAGE SPNL 14MM 23X17.5MM LTCG TI LMBR TPR FSN DEV	BOTH IP/OP	"$7,226.25 "	"$5,347.43"	$0.00	"$5,781.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,505.95"	$0.00	$0.00	$0.00	$0.00	"$3,613.13"	"$5,723.19"	"$5,781.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941620	SUP	Custom 27803010		8941620  -  CAGE SPNL 16MM 20X19MM LTCG TI LMBR TPR FSN DEV	BOTH IP/OP	"$7,226.25 "	"$5,347.43"	$0.00	"$5,781.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,505.95"	$0.00	$0.00	$0.00	$0.00	"$3,613.13"	"$5,723.19"	"$5,781.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941623	SUP	Custom 27803010		8941623  -  CAGE SPNL 16MM 23X19MM LTCG TI LMBR TPR FSN DEV	BOTH IP/OP	"$7,226.25 "	"$5,347.43"	$0.00	"$5,781.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,505.95"	$0.00	$0.00	$0.00	$0.00	"$3,613.13"	"$5,723.19"	"$5,781.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941626	SUP	Custom 27803010		8941626  -  CAGE SPNL 16MM 26X20MM LTCG TI LMBR TPR FSN DEV	BOTH IP/OP	"$7,226.25 "	"$5,347.43"	$0.00	"$5,781.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,505.95"	$0.00	$0.00	$0.00	$0.00	"$3,613.13"	"$5,723.19"	"$5,781.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941823	SUP	Custom 27803010		8941823  -  CAGE SPNL 18MM 23X21.5MM LTCG TI LMBR TPR FSN DEV	BOTH IP/OP	"$7,226.25 "	"$5,347.43"	$0.00	"$5,781.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,505.95"	$0.00	$0.00	$0.00	$0.00	"$3,613.13"	"$5,723.19"	"$5,781.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941826	SUP	Custom 27803010		8941826  -  CAGE SPNL 18MM 26X22MM LTCG TI LMBR TPR FSN DEV	BOTH IP/OP	"$7,226.25 "	"$5,347.43"	$0.00	"$5,781.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,505.95"	$0.00	$0.00	$0.00	$0.00	"$3,613.13"	"$5,723.19"	"$5,781.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8954025	SUP	HCPCS C1713		8954025  -  SCREW BONE 25MM 4MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8954030	SUP	HCPCS C1713		8954030  -  SCREW BONE 30MM 4MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8954035	SUP	HCPCS C1713		8954035  -  SCREW BONE 35MM 4MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8954525	SUP	HCPCS C1713		8954525  -  SCREW BONE 25MM 4.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8954530	SUP	HCPCS C1713		8954530  -  SCREW BONE 30MM 4.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8954535	SUP	HCPCS C1713		8954535  -  SCREW BONE 35MM 4.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8954540	SUP	HCPCS C1713		8954540  -  SCREW BONE 40MM 4.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8954545	SUP	HCPCS C1713		8954545  -  SCREW BONE 45MM 4.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8955530	SUP	HCPCS C1713		8955530  -  SCREW BONE 30MM 5.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8955535	SUP	HCPCS C1713		8955535  -  SCREW BONE 35MM 5.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8955540	SUP	HCPCS C1713		8955540  -  SCREW BONE 40MM 5.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8955545	SUP	HCPCS C1713		8955545  -  SCREW BONE 45MM 5.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8956535	SUP	HCPCS C1713		8956535  -  SCREW BONE 35MM 6.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8956540	SUP	HCPCS C1713		8956540  -  SCREW BONE 40MM 6.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8956545	SUP	HCPCS C1713		8956545  -  SCREW BONE 45MM 6.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8956550	SUP	HCPCS C1713		8956550  -  SCREW BONE 50MM 6.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8957535	SUP	HCPCS C1713		8957535  -  SCREW BONE 35MM 7.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8957540	SUP	HCPCS C1713		8957540  -  SCREW BONE 40MM 7.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8957545	SUP	HCPCS C1713		8957545  -  SCREW BONE 45MM 7.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8957550	SUP	HCPCS C1713		8957550  -  SCREW BONE 50MM 7.5MM SS FIX 5.5MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8964525	SUP	HCPCS C1713		8964525  -  SCREW BONE 4.5MM 25MM SS SPNL FIX 6.35MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8964530	SUP	HCPCS C1713		8964530  -  SCREW BONE 4.5MM 30MM SS SPNL FIX 6.35MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8964535	SUP	HCPCS C1713		8964535  -  SCREW BONE 4.5MM 35MM SS SPNL FIX 6.35MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8964540	SUP	HCPCS C1713		8964540  -  SCREW BONE 4.5MM 40MM SS SPNL FIX 6.35MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8964545	SUP	HCPCS C1713		8964545  -  SCREW BONE 4.5MM 45MM SS SPNL FIX 6.35MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8965530	SUP	HCPCS C1713		8965530  -  SCREW BONE 5.5MM 30MM SS SPNL FIX 6.35MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8965535	SUP	HCPCS C1713		8965535  -  SCREW BONE 5.5MM 35MM SS SPNL FIX 6.35MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8965540	SUP	HCPCS C1713		8965540  -  SCREW BONE 5.5MM 40MM SS SPNL FIX 6.35MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8965545	SUP	HCPCS C1713		8965545  -  SCREW BONE 5.5MM 45MM SS SPNL FIX 6.35MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8966535	SUP	HCPCS C1713		8966535  -  SCREW BONE 6.5MM 35MM SS SPNL FIX 6.35MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8966540	SUP	HCPCS C1713		8966540  -  SCREW BONE 6.5MM 40MM SS SPNL FIX 6.35MM ROD	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8966545	SUP	HCPCS C1713		8966545  -  SCREW BONE 6.5MM 6.35MM 45MM SS SPNL FIX	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8966550	SUP	HCPCS C1713		8966550  -  SCREW BONE 6.5MM 6.35MM 50MM SS SPNL FIX	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8967535	SUP	HCPCS C1713		8967535  -  SCREW BONE 7.5MM 6.35MM 35MM SS SPNL FIX	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8967540	SUP	HCPCS C1713		8967540  -  SCREW BONE 7.5MM 6.35MM 40MM SS SPNL FIX	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8967545	SUP	HCPCS C1713		8967545  -  SCREW BONE 7.5MM 6.35MM 45MM SS SPNL FIX	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8967550	SUP	HCPCS C1713		8967550  -  SCREW BONE 7.5MM 6.35MM 50MM SS SPNL FIX	BOTH IP/OP	"$2,802.50 "	"$2,073.85"	$0.00	"$2,242.00"	"$1,261.13"	"$1,261.13"	$0.00	$0.00	$0.00	$584.11	"$2,080.02"	"$2,080.02"	$0.00	$0.00	$584.04	$0.00	"$1,381.63"	"$1,381.63"	$0.00	"$1,401.25"	"$2,219.58"	"$2,242.00"	$0.00		$0.00	$438.59	$0.00	$0.00	$446.16	$0.00	$0.00	$0.00	$0.00	$0.00
8968625	SUP	HCPCS C1713		8968625  -  SCREW 8968625 PYRMD BONE FAS 6.5X25MM	BOTH IP/OP	$880.50 	$651.57	$0.00	$704.40	$396.23	$396.23	$0.00	$0.00	$0.00	$183.52	$653.51	$653.51	$0.00	$0.00	$183.50	$0.00	$520.82	$520.82	$0.00	$440.25	$697.36	$704.40	$0.00		$0.00	$137.80	$0.00	$0.00	$140.18	$0.00	$0.00	$0.00	$0.00	$0.00
8968630	SUP	HCPCS C1713		8968630  -  SCREW 8968630 PYRMD BONE FAS 6.5X30MM	BOTH IP/OP	$880.50 	$651.57	$0.00	$704.40	$396.23	$396.23	$0.00	$0.00	$0.00	$183.52	$653.51	$653.51	$0.00	$0.00	$183.50	$0.00	$520.82	$520.82	$0.00	$440.25	$697.36	$704.40	$0.00		$0.00	$137.80	$0.00	$0.00	$140.18	$0.00	$0.00	$0.00	$0.00	$0.00
8968635	SUP	HCPCS C1713		8968635  -  SCREW 8968635 PYRMD BONE FAS 6.5X35MM	BOTH IP/OP	$880.50 	$651.57	$0.00	$704.40	$396.23	$396.23	$0.00	$0.00	$0.00	$183.52	$653.51	$653.51	$0.00	$0.00	$183.50	$0.00	$520.82	$520.82	$0.00	$440.25	$697.36	$704.40	$0.00		$0.00	$137.80	$0.00	$0.00	$140.18	$0.00	$0.00	$0.00	$0.00	$0.00
8969117	SUP	HCPCS C1713		8969117  -  PLATE 8969117 PLATE 17MM	BOTH IP/OP	"$8,377.50 "	"$6,199.35"	$0.00	"$6,702.00"	"$3,769.88"	"$3,769.88"	$0.00	$0.00	$0.00	"$1,746.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,745.87"	$0.00	"$4,130.11"	"$4,130.11"	$0.00	"$4,188.75"	"$6,634.98"	"$6,702.00"	$0.00		$0.00	"$1,311.08"	$0.00	$0.00	"$1,333.70"	$0.00	$0.00	$0.00	$0.00	$0.00
8969119	SUP	HCPCS C1713		8969119  -  PLATE 8969119 PLATE 19MM	BOTH IP/OP	"$8,377.50 "	"$6,199.35"	$0.00	"$6,702.00"	"$3,769.88"	"$3,769.88"	$0.00	$0.00	$0.00	"$1,746.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,745.87"	$0.00	"$4,130.11"	"$4,130.11"	$0.00	"$4,188.75"	"$6,634.98"	"$6,702.00"	$0.00		$0.00	"$1,311.08"	$0.00	$0.00	"$1,333.70"	$0.00	$0.00	$0.00	$0.00	$0.00
8969121	SUP	HCPCS C1713		8969121  -  PLATE 8969121 PLATE 21MM	BOTH IP/OP	"$8,377.50 "	"$6,199.35"	$0.00	"$6,702.00"	"$3,769.88"	"$3,769.88"	$0.00	$0.00	$0.00	"$1,746.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,745.87"	$0.00	"$4,130.11"	"$4,130.11"	$0.00	"$4,188.75"	"$6,634.98"	"$6,702.00"	$0.00		$0.00	"$1,311.08"	$0.00	$0.00	"$1,333.70"	$0.00	$0.00	$0.00	$0.00	$0.00
8969123	SUP	HCPCS C1713		8969123  -  PLATE 8969123 PLATE 23MM	BOTH IP/OP	"$8,377.50 "	"$6,199.35"	$0.00	"$6,702.00"	"$3,769.88"	"$3,769.88"	$0.00	$0.00	$0.00	"$1,746.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,745.87"	$0.00	"$4,130.11"	"$4,130.11"	$0.00	"$4,188.75"	"$6,634.98"	"$6,702.00"	$0.00		$0.00	"$1,311.08"	$0.00	$0.00	"$1,333.70"	$0.00	$0.00	$0.00	$0.00	$0.00
8969125	SUP	HCPCS C1713		8969125  -  PLATE 8969125 PLATE 25MM	BOTH IP/OP	"$8,377.50 "	"$6,199.35"	$0.00	"$6,702.00"	"$3,769.88"	"$3,769.88"	$0.00	$0.00	$0.00	"$1,746.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,745.87"	$0.00	"$4,130.11"	"$4,130.11"	$0.00	"$4,188.75"	"$6,634.98"	"$6,702.00"	$0.00		$0.00	"$1,311.08"	$0.00	$0.00	"$1,333.70"	$0.00	$0.00	$0.00	$0.00	$0.00
8969127	SUP	HCPCS C1713		8969127  -  PLATE 8969127 PLATE 27MM	BOTH IP/OP	"$8,377.50 "	"$6,199.35"	$0.00	"$6,702.00"	"$3,769.88"	"$3,769.88"	$0.00	$0.00	$0.00	"$1,746.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,745.87"	$0.00	"$4,130.11"	"$4,130.11"	$0.00	"$4,188.75"	"$6,634.98"	"$6,702.00"	$0.00		$0.00	"$1,311.08"	$0.00	$0.00	"$1,333.70"	$0.00	$0.00	$0.00	$0.00	$0.00
8969201	SUP	HCPCS C1713		8969201  -  SET SCREW 8969201 LOCKING PLATE	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8969217	SUP	HCPCS C1713		8969217  -  PLATE 8969217 COVER PLATE 17MM	BOTH IP/OP	"$1,105.50 "	$818.07	$0.00	$884.40	$497.48	$497.48	$0.00	$0.00	$0.00	$230.41	$820.50	$820.50	$0.00	$0.00	$230.39	$0.00	$653.90	$653.90	$0.00	$552.75	$875.56	$884.40	$0.00		$0.00	$173.01	$0.00	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00
8969219	SUP	HCPCS C1713		8969219  -  PLATE 8969219 COVER PLATE 19MM	BOTH IP/OP	"$1,105.50 "	$818.07	$0.00	$884.40	$497.48	$497.48	$0.00	$0.00	$0.00	$230.41	$820.50	$820.50	$0.00	$0.00	$230.39	$0.00	$653.90	$653.90	$0.00	$552.75	$875.56	$884.40	$0.00		$0.00	$173.01	$0.00	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00
8969221	SUP	HCPCS C1713		8969221  -  PLATE 8969221 COVER PLATE 21MM	BOTH IP/OP	"$1,105.50 "	$818.07	$0.00	$884.40	$497.48	$497.48	$0.00	$0.00	$0.00	$230.41	$820.50	$820.50	$0.00	$0.00	$230.39	$0.00	$653.90	$653.90	$0.00	$552.75	$875.56	$884.40	$0.00		$0.00	$173.01	$0.00	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00
8969223	SUP	HCPCS C1713		8969223  -  PLATE 8969223 COVER PLATE 23MM	BOTH IP/OP	"$1,105.50 "	$818.07	$0.00	$884.40	$497.48	$497.48	$0.00	$0.00	$0.00	$230.41	$820.50	$820.50	$0.00	$0.00	$230.39	$0.00	$653.90	$653.90	$0.00	$552.75	$875.56	$884.40	$0.00		$0.00	$173.01	$0.00	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00
8969225	SUP	HCPCS C1713		8969225  -  PLATE 8969225 COVER PLATE 25MM	BOTH IP/OP	"$1,105.50 "	$818.07	$0.00	$884.40	$497.48	$497.48	$0.00	$0.00	$0.00	$230.41	$820.50	$820.50	$0.00	$0.00	$230.39	$0.00	$653.90	$653.90	$0.00	$552.75	$875.56	$884.40	$0.00		$0.00	$173.01	$0.00	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00
8969227	SUP	HCPCS C1713		8969227  -  PLATE 8969227 COVER PLATE 27MM	BOTH IP/OP	"$1,105.50 "	$818.07	$0.00	$884.40	$497.48	$497.48	$0.00	$0.00	$0.00	$230.41	$820.50	$820.50	$0.00	$0.00	$230.39	$0.00	$653.90	$653.90	$0.00	$552.75	$875.56	$884.40	$0.00		$0.00	$173.01	$0.00	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00
8970000	SUP	HCPCS C1713		8970000  -  SCREW LOCK 2 VUE POINT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8970240	SUP	HCPCS C1713		"8970240  -  VUE POINT II, ROD TEMPLATE"	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
8975310	SUP	HCPCS C1713		8975310  -  SCREW BN 3.5MM 10MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975312	SUP	HCPCS C1713		8975312  -  SCREW BN 3.5MM 12MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975314	SUP	HCPCS C1713		8975314  -  SCREW BN 3.5MM 14MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975318	SUP	HCPCS C1713		8975318  -  SCREW BN 3.5MM 18MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975320	SUP	HCPCS C1713		8975320  -  SCREW BN 3.5MM 20MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975322	SUP	HCPCS C1713		8975322  -  SCREW BN 3.5MM 22MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975324	SUP	HCPCS C1713		8975324  -  SCREW BN 3.5MM 24MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975326	SUP	HCPCS C1713		8975326  -  SCREW BN 3.5MM 26MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975328	SUP	HCPCS C1713		8975328  -  SCREW BN 3.5MM 28MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975330	SUP	HCPCS C1713		8975330  -  SCREW BN 3.5MM 30MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975332	SUP	HCPCS C1713		8975332  -  SCREW BN 3.5MM 32MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975334	SUP	HCPCS C1713		8975334  -  SCREW BN 3.5MM 34MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975410	SUP	HCPCS C1713		8975410  -  SCREW BN 4MM 10MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975412	SUP	HCPCS C1713		8975412  -  SCREW BN 4MM 12MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975414	SUP	HCPCS C1713		8975414  -  SCREW BN 4MM 14MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975416	SUP	HCPCS C1713		8975416  -  SCREW BN 4MM 16MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975418	SUP	HCPCS C1713		8975418  -  SCREW BN 4MM 18MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975420	SUP	HCPCS C1713		8975420  -  SCREW BN 4MM 20MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975422	SUP	HCPCS C1713		8975422  -  SCREW BN 4MM 22MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975424	SUP	HCPCS C1713		8975424  -  SCREW BN 4MM 24MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975426	SUP	HCPCS C1713		8975426  -  SCREW BN 4MM 26MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975428	SUP	HCPCS C1713		8975428  -  SCREW BN 4MM 28MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975430	SUP	HCPCS C1713		8975430  -  SCREW BN 4MM 30MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975432	SUP	HCPCS C1713		8975432  -  SCREW BN 4MM 32MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975434	SUP	HCPCS C1713		8975434  -  SCREW BN 4MM 34MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975436	SUP	HCPCS C1713		8975436  -  SCREW BN 4MM 36MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975438	SUP	HCPCS C1713		8975438  -  SCREW BN 4MM 38MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975440	SUP	HCPCS C1713		8975440  -  SCREW BN 4MM 40MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975510	SUP	HCPCS C1713		8975510  -  SCREW BONE 3.5MM 10MM FAVORED ANGLE SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975512	SUP	HCPCS C1713		8975512  -  SCREW BONE 2MM 12MM VUEPOINT POSTERIOR CERV SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975514	SUP	HCPCS C1713		8975514  -  SCREW BONE 3.5MM 14MM VUEPOINT SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975516	SUP	HCPCS C1713		8975516  -  SCREW BN 3.5MM 16MM VUEPOINT II FAVOR ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975518	SUP	HCPCS C1713		8975518  -  SCREW BN 3.5MM 18MM NS VUEPOINT II FAVORED ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975526	SUP	HCPCS C1713		8975526  -  SCREW BN 3.5MM 26MM NS VUEPOINT II FAVORED ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975528	SUP	HCPCS C1713		8975528  -  SCREW BN 3.5MM 28MM NS VUEPOINT II FAVORED ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975530	SUP	HCPCS C1713		8975530  -  SCREW BN 3.5MM 30MM NS VUEPOINT II FAVORED ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975532	SUP	HCPCS C1713		8975532  -  SCREW BN 3.5MM 32MM NS VUEPOINT II FAVORED ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975534	SUP	HCPCS C1713		8975534  -  SCREW BN 3.5MM 34MM NS VUEPOINT II FAVORED ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975618	SUP	HCPCS C1713		8975618  -  SCREW BN 4MM 18MM VUEPOINT II FAVOR ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975622	SUP	HCPCS C1713		"8975622  -  VUE POINT 2, 4.0X 22MM, FAVORED ANGLE"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975624	SUP	HCPCS C1713		8975624  -  VUE POINT 2 4.0X 24MM SCREW	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975636	SUP	HCPCS C1713		8975636  -  SCREW BN 4MM 36MM NS VUEPOINT II FAVORED ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975638	SUP	HCPCS C1713		8975638  -  SCREW BN 4MM 38MM NS VUEPOINT II FAVORED ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975640	SUP	HCPCS C1713		8975640  -  SCREW BN 4MM 40MM NS VUEPOINT II FAVORED ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975710	SUP	HCPCS C1713		8975710  -  SCREW BN 4.5MM 10MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975712	SUP	HCPCS C1713		8975712  -  SCREW BN 4.5MM 12MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975716	SUP	HCPCS C1713		8975716  -  SCREW BN 4.5MM 16MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975718	SUP	HCPCS C1713		8975718  -  SCREW BN 4.5MM 18MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975720	SUP	HCPCS C1713		8975720  -  VUE POINT 435 X 20	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975722	SUP	HCPCS C1713		8975722  -  SCREW BN 4.5MM 22MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975724	SUP	HCPCS C1713		8975724  -  SCREW BONE MULTIAX TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975726	SUP	HCPCS C1713		8975726  -  SCREW BN 4.5MM 26MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975728	SUP	HCPCS C1713		8975728  -  VUEPOINT 2 MULTI-AXIAL SCREW 4.5 X28	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975732	SUP	HCPCS C1713		"8975732  -  VUE POINT II, SCREW 4.5X32MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975734	SUP	HCPCS C1713		"8975734  -  VUE POINT II, SCREW 4.5X34MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975736	SUP	HCPCS C1713		"8975736  -  VUE POINT II, SCREW 4.5X36MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975738	SUP	HCPCS C1713		"8975738  -  VUE POINT II, SCREW 4.5X38MM"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975740	SUP	HCPCS C1713		8975740  -  SCREW BN 4.5MM 40MM NS VUEPOINT II MA SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975824	SUP	HCPCS C1713		8975824  -  SCREW BN P/T 3.5MM 24MM NS VUEPOINT II FAVORED ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975834	SUP	HCPCS C1713		8975834  -  SCREW BN P/T 3.5MM 34MM VUEPOINT II FAVOR ANG SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8975838	SUP	HCPCS C1713		"8975838  -  VUE POINT II, FA/PT SCREW 3.5X38"	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976006	SUP	HCPCS C1713		8976006  -  HOOK SPNL 6MM NS VUEPOINT II LMN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976008	SUP	HCPCS C1713		8976008  -  HOOK SPNL 8MM NS VUEPOINT II LMN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976011	SUP	HCPCS C1713		8976011  -  CONNECTOR ROD 11MM OFST VUEPOINT II OPN SPNE	BOTH IP/OP	"$1,095.00 "	$810.30	$0.00	$876.00	$492.75	$492.75	$0.00	$0.00	$0.00	$228.23	$812.71	$812.71	$0.00	$0.00	$228.20	$0.00	$647.69	$647.69	$0.00	$547.50	$867.24	$876.00	$0.00		$0.00	$171.37	$0.00	$0.00	$174.32	$0.00	$0.00	$0.00	$0.00	$0.00
8976025	SUP	HCPCS C1713		8976025  -  CONNECTOR ROD 25MM LNG OFST NS VUEPOINT II OPN SPNE	BOTH IP/OP	"$1,222.50 "	$904.65	$0.00	$978.00	$550.13	$550.13	$0.00	$0.00	$0.00	$254.80	$907.34	$907.34	$0.00	$0.00	$254.77	$0.00	$723.11	$723.11	$0.00	$611.25	$968.22	$978.00	$0.00		$0.00	$191.32	$0.00	$0.00	$194.62	$0.00	$0.00	$0.00	$0.00	$0.00
8976030	SUP	HCPCS C1713		8976030  -  CONNECTOR ROD 45D OFST NS VUEPOINT II SPNE	BOTH IP/OP	"$1,222.50 "	$904.65	$0.00	$978.00	$550.13	$550.13	$0.00	$0.00	$0.00	$254.80	$907.34	$907.34	$0.00	$0.00	$254.77	$0.00	$723.11	$723.11	$0.00	$611.25	$968.22	$978.00	$0.00		$0.00	$191.32	$0.00	$0.00	$194.62	$0.00	$0.00	$0.00	$0.00	$0.00
8976035	SUP	HCPCS C1713		8976035  -  CONNECTOR ROD 3.5MM NS VUEPOINT II INLN SPNE	BOTH IP/OP	"$1,867.50 "	"$1,381.95"	$0.00	"$1,494.00"	$840.38	$840.38	$0.00	$0.00	$0.00	$389.23	"$1,386.06"	"$1,386.06"	$0.00	$0.00	$389.19	$0.00	"$1,104.63"	"$1,104.63"	$0.00	$933.75	"$1,479.06"	"$1,494.00"	$0.00		$0.00	$292.26	$0.00	$0.00	$297.31	$0.00	$0.00	$0.00	$0.00	$0.00
8976055	SUP	HCPCS C1713		8976055  -  CONNECTOR ROD 3.5-5.5MM NS VUEPOINT II INLN SPNE	BOTH IP/OP	"$1,867.50 "	"$1,381.95"	$0.00	"$1,494.00"	$840.38	$840.38	$0.00	$0.00	$0.00	$389.23	"$1,386.06"	"$1,386.06"	$0.00	$0.00	$389.19	$0.00	"$1,104.63"	"$1,104.63"	$0.00	$933.75	"$1,479.06"	"$1,494.00"	$0.00		$0.00	$292.26	$0.00	$0.00	$297.31	$0.00	$0.00	$0.00	$0.00	$0.00
8976112	SUP	HCPCS C1713		8976112  -  ROD SPNL 3.5MM 120MM VUEPOINT II	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8976124	SUP	HCPCS C1713		8976124  -  ROD 240MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8976128	SUP	HCPCS C1713		8976128  -  CONNECTOR ROD 28MM NS VUEPOINT II FX CX SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976130	SUP	HCPCS C1713		8976130  -  CONNECTOR ROD 30MM NS VUEPOINT II FX CX SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976132	SUP	HCPCS C1713		8976132  -  VUE POINT 2 32MM FIXED CROSS CONN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976136	SUP	HCPCS C1713		8976136  -  CONNECTOR ROD 36MM NS VUEPOINT II FX CX SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976138	SUP	HCPCS C1713		8976138  -  CONNECTOR ROD 38MM VUEPOINT II CX STC SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976160	SUP	HCPCS C1713		8976160  -  VUE POINT II ROD 60MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976165	SUP	HCPCS C1713		8976165  -  CONNECTOR ROD NS VUEPOINT II X SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976180	SUP	HCPCS C1713		8976180  -  ROD SPNL 80MM NS VUEPOINT II PRECONTOUR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976240	SUP	HCPCS C1713		8976240  -  ROD SPNL 45D 240MM NS VUEPOINT II PRECURVE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976355	SUP	HCPCS C1713		"8976355  -  TRANSITION ROD, 3.5X 5.5MM"	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
8976406	SUP	HCPCS C1713		8976406  -  SCREW BN 4.5MM 6MM VUEPOINT II SPNE OCPTL CORT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
8976412	SUP	HCPCS C1713		8976412  -  SCREW BN 4.5MM 12MM NS VUEPOINT II SPNE OCPTL	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
8976414	SUP	HCPCS C1713		8976414  -  SCREW BN 4.5MM 14MM VUEPOINT II SPNE OCPTL CORT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
8976435	SUP	HCPCS C1713		8976435  -  CONNECTOR ROD OFST 3.5MM NS VUEPOINT II SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976455	SUP	HCPCS C1713		8976455  -  CONNECTOR ROD OFST 3.5-5.5MM NS VUEPOINT II SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8976506	SUP	HCPCS C1713		8976506  -  SCREW BN 5MM 6MM VUEPOINT II SPNE OCPTL CORT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
8976508	SUP	HCPCS C1713		8976508  -  SCREW BN 5MM 8MM VUEPOINT II SPNE OCPTL CORT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
8976510	SUP	HCPCS C1713		8976510  -  SCREW BN 5MM 10MM VUEPOINT II SPNE OCPTL CORT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
8976512	SUP	HCPCS C1713		8976512  -  SCREW BN 5MM 12MM VUEPOINT II SPNE OCPTL CORT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
8976514	SUP	HCPCS C1713		8976514  -  SCREW BN 5MM 14MM VUEPOINT II SPNE OCPTL CORT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
8977010	SUP	Custom 27203010		8977010  -  DRILL BIT VUE POINT 2 2.4MM	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8977035	SUP	HCPCS C1713		8977035  -  SCREW TAP VUE POINT 3.5MM	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$890.64	$320.63	$320.63	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
8977040	SUP	HCPCS C1713		8977040  -  SCREW TAP VUE POINT 4.0MM	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
9000027	SUP	Custom 27203010		9000027  -  SPIDER FLEX SERRATED GRASPER	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9000028	SUP	Custom 27203010		9000028  -  SPIDER FLEX MARYLAND DISSECTOR	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9000031	SUP	Custom 27203010		9000031  -  SPIDER FLEX MONOPOLAR HOOK	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9000240	SUP	HCPCS C1713		9000240  -  SCREW BONE 40MM CANN TITANIUM 12MM SACROILIAC	BOTH IP/OP	"$11,000.00 "	"$8,140.00"	$0.00	"$8,800.00"	"$4,950.00"	"$4,950.00"	$0.00	$0.00	$0.00	"$2,292.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,292.40"	$0.00	"$5,423.00"	"$5,423.00"	$0.00	"$5,500.00"	"$8,712.00"	"$8,800.00"	$0.00		$0.00	"$1,721.50"	$0.00	$0.00	"$1,751.20"	$0.00	$0.00	$0.00	$0.00	$0.00
9000250	SUP	HCPCS C1713		9000250  -  SCREW BONE 12MM 50MM TI SACROILIAC CANN	BOTH IP/OP	"$11,000.00 "	"$8,140.00"	$0.00	"$8,800.00"	"$4,950.00"	"$4,950.00"	$0.00	$0.00	$0.00	"$2,292.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,292.40"	$0.00	"$5,423.00"	"$5,423.00"	$0.00	"$5,500.00"	"$8,712.00"	"$8,800.00"	$0.00		$0.00	"$1,721.50"	$0.00	$0.00	"$1,751.20"	$0.00	$0.00	$0.00	$0.00	$0.00
9001635	SUP	HCPCS C1713		9001635  -  SCREW BONE 1.6MM 35MM TIMESH TI SPNL	BOTH IP/OP	$146.20 	$108.19	$0.00	$116.96	$65.79	$65.79	$0.00	$0.00	$0.00	$30.47	$108.51	$108.51	$0.00	$0.00	$30.47	$0.00	$86.48	$86.48	$0.00	$73.10	$115.79	$116.96	$0.00		$0.00	$22.88	$0.00	$0.00	$23.28	$0.00	$0.00	$0.00	$0.00	$0.00
9001640	SUP	HCPCS C1713		9001640  -  SCREW BONE 1.6MM 4MM TI SPNL SLFDRILL STRL	BOTH IP/OP	$731.00 	$540.94	$0.00	$584.80	$328.95	$328.95	$0.00	$0.00	$0.00	$152.36	$542.55	$542.55	$0.00	$0.00	$152.34	$0.00	$432.39	$432.39	$0.00	$365.50	$578.95	$584.80	$0.00		$0.00	$114.40	$0.00	$0.00	$116.38	$0.00	$0.00	$0.00	$0.00	$0.00
9002196	SUP	Custom 27203010		9002196  -  KIT NDL GD 21GA 96IN STRT US	BOTH IP/OP	$68.43 	$50.64	$0.00	$50.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.79	$50.79	$0.00	$0.00	$14.26	$0.00	$0.00	$0.00	$0.00	$26.75	$42.37	$42.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011221	SUP	Custom 27803010		9011221  -  CAGE SPNL 12MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011225	SUP	Custom 27803010		9011225  -  CAGE SPNL 12MM 25MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011420	SUP	Custom 27803010		9011420  -  CAGE SPNL 14MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011423	SUP	Custom 27803010		9011423  -  CAGE SPNL 14MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011426	SUP	Custom 27803010		9011426  -  CAGE SPNL 14MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011429	SUP	Custom 27803010		9011429  -  CAGE SPNL 14MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011620	SUP	Custom 27803010		9011620  -  CAGE SPNL 16MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011623	SUP	Custom 27803010		9011623  -  CAGE SPNL 16MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011626	SUP	Custom 27803010		9011626  -  CAGE SPNL 16MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011629	SUP	Custom 27803010		9011629  -  CAGE SPNL 16MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011635	SUP	HCPCS C1713		9011635  -  SCREW 9011635 TIMESH 1.6X3.5MM SDS OPT 1	BOTH IP/OP	$127.50 	$94.35	$0.00	$102.00	$57.38	$57.38	$0.00	$0.00	$0.00	$26.57	$94.63	$94.63	$0.00	$0.00	$26.57	$0.00	$75.42	$75.42	$0.00	$63.75	$100.98	$102.00	$0.00		$0.00	$19.95	$0.00	$0.00	$20.30	$0.00	$0.00	$0.00	$0.00	$0.00
9011640	SUP	HCPCS C1713		9011640  -  SCREW 9011640 TIMESH 1.6X4.0MM SDS OPT 1	BOTH IP/OP	$129.63 	$95.93	$0.00	$103.70	$58.33	$58.33	$0.00	$0.00	$0.00	$27.02	$96.21	$96.21	$0.00	$0.00	$27.01	$0.00	$76.67	$76.67	$0.00	$64.81	$102.67	$103.70	$0.00		$0.00	$20.29	$0.00	$0.00	$20.64	$0.00	$0.00	$0.00	$0.00	$0.00
9011820	SUP	Custom 27803010		9011820  -  CAGE SPNL 18MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011823	SUP	Custom 27803010		9011823  -  CAGE SPNL 18MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011826	SUP	Custom 27803010		9011826  -  CAGE SPNL 18MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9011829	SUP	Custom 27803010		9011829  -  CAGE SPNL 18MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9012020	SUP	Custom 27803010		9012020  -  CAGE SPNL 20MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9012023	SUP	Custom 27803010		9012023  -  CAGE SPNL 20MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9012026	SUP	Custom 27803010		9012026  -  CAGE SPNL 20MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9012029	SUP	Custom 27803010		9012029  -  CAGE SPNL 20MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9012220	SUP	Custom 27803010		9012220  -  CAGE SPNL 22MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9012223	SUP	Custom 27803010		9012223  -  CAGE SPNL 22MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9012226	SUP	Custom 27803010		9012226  -  CAGE SPNL 22MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9012229	SUP	Custom 27803010		9012229  -  CAGE SPNL 22MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9012420	SUP	Custom 27803010		9012420  -  CAGE SPNL 24MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9012423	SUP	Custom 27803010		9012423  -  CAGE SPNL 24MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9012426	SUP	Custom 27803010		9012426  -  CAGE SPNL 24MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9012429	SUP	Custom 27803010		9012429  -  CAGE SPNL 24MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9050012	SUP	HCPCS C1781		9050012  -  CAGE SPNL 12MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9050014	SUP	HCPCS C1781		9050014  -  CAGE SPNL 14MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9050016	SUP	HCPCS C1781		9050016  -  CAGE SPNL 16MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9050018	SUP	HCPCS C1781		9050018  -  CAGE SPNL 18MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9050020	SUP	HCPCS C1781		9050020  -  CAGE SPNL 20MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9050413	SUP	HCPCS C1781		9050413  -  CAGE SPNL OVOID 14X13X10MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9050414	SUP	HCPCS C1781		9050414  -  CAGE SPNL OVOID 14X14X10MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9050450	SUP	HCPCS C1781		9050450  -  MESH 9050450 PYRAMESH IMP 10MMX14MMX50MM	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9050513	SUP	HCPCS C1781		9050513  -  CAGE SPNL OVOID 17X13X13MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9050514	SUP	HCPCS C1781		9050514  -  CAGE SPNL OVOID 17X13X14MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9050700	SUP	Custom 27203010		9050700  -  INSTRUMENT 9050700 PYMSH END CAP INSERT	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	$0.00	$0.00	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9050713	SUP	HCPCS C1781		9050713  -  MESH 9050713  PYMSH IMPL 13MM END CAP	BOTH IP/OP	$858.00 	$634.92	$0.00	$686.40	$386.10	$386.10	$0.00	$0.00	$0.00	$178.83	$636.81	$636.81	$0.00	$0.00	$178.81	$0.00	$507.51	$507.51	$0.00	$429.00	$679.54	$686.40	$0.00		$0.00	$134.28	$0.00	$0.00	$136.59	$0.00	$0.00	$0.00	$0.00	$0.00
9050716	SUP	HCPCS C1781		9050716  -  MESH 9050716  PYMSH IMPL 16MM END CAP	BOTH IP/OP	$858.00 	$634.92	$0.00	$686.40	$386.10	$386.10	$0.00	$0.00	$0.00	$178.83	$636.81	$636.81	$0.00	$0.00	$178.81	$0.00	$507.51	$507.51	$0.00	$429.00	$679.54	$686.40	$0.00		$0.00	$134.28	$0.00	$0.00	$136.59	$0.00	$0.00	$0.00	$0.00	$0.00
9050719	SUP	HCPCS C1781		9050719  -  MESH 9050719  PYMSH IMPL 19MM END CAP	BOTH IP/OP	$858.00 	$634.92	$0.00	$686.40	$386.10	$386.10	$0.00	$0.00	$0.00	$178.83	$636.81	$636.81	$0.00	$0.00	$178.81	$0.00	$507.51	$507.51	$0.00	$429.00	$679.54	$686.40	$0.00		$0.00	$134.28	$0.00	$0.00	$136.59	$0.00	$0.00	$0.00	$0.00	$0.00
9050722	SUP	HCPCS C1781		9050722  -  MESH 9050722 PYMSH IMPL 22MM END CAP	BOTH IP/OP	$858.00 	$634.92	$0.00	$686.40	$386.10	$386.10	$0.00	$0.00	$0.00	$178.83	$636.81	$636.81	$0.00	$0.00	$178.81	$0.00	$507.51	$507.51	$0.00	$429.00	$679.54	$686.40	$0.00		$0.00	$134.28	$0.00	$0.00	$136.59	$0.00	$0.00	$0.00	$0.00	$0.00
9050725	SUP	HCPCS C1781		9050725  -  MESH 9050725 PYMSH IMPL 25MM END CAP	BOTH IP/OP	$858.00 	$634.92	$0.00	$686.40	$386.10	$386.10	$0.00	$0.00	$0.00	$178.83	$636.81	$636.81	$0.00	$0.00	$178.81	$0.00	$507.51	$507.51	$0.00	$429.00	$679.54	$686.40	$0.00		$0.00	$134.28	$0.00	$0.00	$136.59	$0.00	$0.00	$0.00	$0.00	$0.00
9050823	SUP	HCPCS C1781		9050823  -  CAGE SPNL OVOID 24X10X8MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9051009	SUP	HCPCS C1781		9051009  -  CAGE SPNL RND 10MM 9MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
9051011	SUP	HCPCS C1781		9051011  -  CAGE SPNL RND 10MM 10MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
9051013	SUP	HCPCS C1781		9051013  -  CAGE SPNL 13MMX10MM PRMSH LMBR INTRBD FS RND TI	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
9051014	SUP	HCPCS C1781		9051014  -  CAGE SPNL RND 10MM 14MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
9051023	SUP	HCPCS C1781		9051023  -  CAGE SPNL RND 10MM 23MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9051050	SUP	HCPCS C1781		9051050  -  CAGE SPNL RND 10MM 50MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9051223	SUP	HCPCS C1781		9051223  -  CAGE SPNL RND 12MM 23MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9051314	SUP	HCPCS C1781		9051314  -  CAGE SPNL RND 13MM 14MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
9051315	SUP	HCPCS C1781		9051315  -  CAGE SPNL RND 13MM 15MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
9051350	SUP	HCPCS C1781		9051350  -  MESH 9051350 PYRAMESH IMP 13MMX50MM RND	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9051423	SUP	HCPCS C1781		9051423  -  CAGE SPNL RND 14MM 23MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9051690	SUP	HCPCS C1781		9051690  -  CAGE SPNL RND 16MM 90MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9051710	SUP	HCPCS C1781		9051710  -  CAGE SPNL OVOID 22X17X10MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9051715	SUP	HCPCS C1781		9051715  -  CAGE SPNL OVOID 22X17X15MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9051730	SUP	HCPCS C1781		9051730  -  CAGE SPNL RND 22MM 30MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9051750	SUP	HCPCS C1781		9051750  -  CAGE SPNL OVOID 22X17X50MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9051770	SUP	HCPCS C1781		9051770  -  CAGE SPNL OVOID 22X17X70MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9051790	SUP	HCPCS C1781		9051790  -  CAGE SPNL OVOID 22X17X90MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9051915	SUP	HCPCS C1781		9051915  -  CAGE SPNL RND 15MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9051918	SUP	HCPCS C1781		9051918  -  CAGE SPNL RND 18MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9052205	SUP	HCPCS C1781		9052205  -  CAGE SPNL RND 22MM 15MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9052208	SUP	HCPCS C1781		9052208  -  MESH 9052208 PYRMSH IMPL 22MM AGL 13X18	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9052215	SUP	HCPCS C1781		9052215  -  MESH 9052215 PYRAMESH IMPLT 22MMX15MM RD	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9052230	SUP	HCPCS C1781		9052230  -  MESH 9052230 PYRAMESH IMPLT 22MMX30MM RD	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9052250	SUP	HCPCS C1781		9052250  -  CAGE SPNL RND 22MM 50MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9052270	SUP	HCPCS C1781		9052270  -  MESH 9052270  PYRM IMPLANT 22MMX70MM RND	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9052290	SUP	HCPCS C1781		9052290  -  MESH 9052290 PYRAMESH IMP 22MMX90MM RND	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9052315	SUP	HCPCS C1781		9052315  -  MESH 9052315 PYMSH IMPL 23X27 AGL 10X15	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9052318	SUP	HCPCS C1781		9052318  -  MESH 9052318 PYMSH IMPL 25X27 AGL 13X18	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9052518	SUP	HCPCS C1781		9052518  -  MESH 9052518 PYRMSH IMPL 25MM AGL 13X18	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9052815	SUP	HCPCS C1781		9052815  -  MESH 9052815 PYRAMESH IMP 22MMX28MMX15MM	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9052830	SUP	HCPCS C1781		9052830  -  MESH 9052830 PYRAMESH IMP 22MMX28MMX30MM	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9052850	SUP	HCPCS C1781		9052850  -  MESH SRG OVOID 50X28X22MM NS PRMSH CG TI	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9052870	SUP	HCPCS C1781		9052870  -  PYRAMESH IMPL 22MMX28MMX70MM	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9052890	SUP	HCPCS C1781		9052890  -  CAGE SPNL OVOID 28X22X90MM PRMSH HLW CNTR OP-EN TI LMBR	BOTH IP/OP	"$16,827.60 "	"$12,452.42"	$0.00	"$13,462.08"	"$7,572.42"	"$7,572.42"	$0.00	$0.00	$0.00	"$3,507.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,506.87"	$0.00	"$8,296.01"	"$8,296.01"	$0.00	"$8,413.80"	"$13,327.46"	"$13,462.08"	$0.00		$0.00	"$2,633.52"	$0.00	$0.00	"$2,678.95"	$0.00	$0.00	$0.00	$0.00	$0.00
9059104	SUP	Custom 27203010		9059104  -  DISPOSABLE 9059104 MESH CUTTER BLADE	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9098526	SUP	HCPCS C1713		9098526  -  SCREW BONE 4MM 26MM CORT SPNL	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098530	SUP	HCPCS C1713		9098530  -  SCREW BONE 4MM 30MM CORT SPNL	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098534	SUP	HCPCS C1713		9098534  -  SCREW BONE 4MM 34MM CORT SPNL	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098538	SUP	HCPCS C1713		9098538  -  SCREW BONE 4MM 38MM CORTEX SPN	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098540	SUP	HCPCS C1713		9098540  -  SCREW BONE 4MM 40MM CORTEX SPN	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098542	SUP	HCPCS C1713		9098542  -  SCREW BONE 4MM 42MM CORT SPNL	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098544	SUP	HCPCS C1713		9098544  -  SCREW BONE 4MM 44MM CORT SPNL	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098546	SUP	HCPCS C1713		9098546  -  SCREW BONE 4MM 46MM CORT SPNL	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098548	SUP	HCPCS C1713		9098548  -  SCREW BONE 4MM 48MM CORT SPNL	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098550	SUP	HCPCS C1713		9098550  -  SCREW BONE 4MM 50MM CORTEX SPN	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098552	SUP	HCPCS C1713		9098552  -  SCREW BONE 4MM 52MM CORT SPNL	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098554	SUP	HCPCS C1713		9098554  -  SCREW BONE 4MM 54MM CORT SPNL	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098556	SUP	HCPCS C1713		9098556  -  SCREW BONE 4MM 56MM CORT SPNL	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098558	SUP	HCPCS C1713		9098558  -  SCREW BONE 4MM 58MM CORT SPNL	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9098560	SUP	HCPCS C1713		9098560  -  SCREW BONE 4MM 60MM CORT SPNL	BOTH IP/OP	"$1,384.50 "	"$1,024.53"	$0.00	"$1,107.60"	$623.03	$623.03	$0.00	$0.00	$0.00	$288.56	"$1,027.58"	"$1,027.58"	$0.00	$0.00	$288.53	$0.00	$818.93	$818.93	$0.00	$692.25	"$1,096.52"	"$1,107.60"	$0.00		$0.00	$216.67	$0.00	$0.00	$220.41	$0.00	$0.00	$0.00	$0.00	$0.00
9164400	SUP	Custom 27803010		9164400  -  CONNECTOR 9164400 CDH 4.5 DOMINO	BOTH IP/OP	"$1,506.00 "	"$1,114.44"	$0.00	"$1,204.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,117.75"	"$1,117.75"	$0.00	$0.00	$313.85	$0.00	$0.00	$0.00	$0.00	$753.00	"$1,192.75"	"$1,204.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9192507	SUP	HCPCS C1713		9192507  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X7MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9192508	SUP	HCPCS C1713		9192508  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X8MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9192509	SUP	HCPCS C1713		9192509  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X9MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9192510	SUP	HCPCS C1713		9192510  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X10MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9192511	SUP	HCPCS C1713		9192511  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X11MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9192512	SUP	HCPCS C1713		9192512  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X12MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9192513	SUP	HCPCS C1713		9192513  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X13MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9192514	SUP	HCPCS C1713		9192514  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X14MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9192515	SUP	HCPCS C1713		9192515  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X15MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193007	SUP	HCPCS C1713		9193007  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X7MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193008	SUP	HCPCS C1713		9193008  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X8MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193009	SUP	HCPCS C1713		9193009  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X9MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193010	SUP	HCPCS C1713		9193010  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X10MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193011	SUP	HCPCS C1713		9193011  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X11MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193012	SUP	HCPCS C1713		9193012  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X12MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193013	SUP	HCPCS C1713		9193013  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X13MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193014	SUP	HCPCS C1713		9193014  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X14MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193015	SUP	HCPCS C1713		9193015  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X15MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193607	SUP	HCPCS C1713		9193607  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X7MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193608	SUP	HCPCS C1713		9193608  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X8MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193609	SUP	HCPCS C1713		9193609  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X9MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193610	SUP	HCPCS C1713		9193610  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X10MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193611	SUP	HCPCS C1713		9193611  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X11MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193612	SUP	HCPCS C1713		9193612  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X12MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193613	SUP	HCPCS C1713		9193613  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X13MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193614	SUP	HCPCS C1713		9193614  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X14MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9193615	SUP	HCPCS C1713		9193615  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X15MM VRTSTCK CRSNT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9206768	SUP	HCPCS C1713		9206768  -  PLATE BN 90D STD L 4MM 9 HL BAR CRNMXF LT	BOTH IP/OP	"$1,315.00 "	$973.10	$0.00	"$1,052.00"	$591.75	$591.75	$0.00	$0.00	$0.00	$274.08	$975.99	$975.99	$0.00	$0.00	$274.05	$0.00	$777.82	$777.82	$0.00	$657.50	"$1,041.48"	"$1,052.00"	$0.00		$0.00	$205.80	$0.00	$0.00	$209.35	$0.00	$0.00	$0.00	$0.00	$0.00
9240100	SUP	HCPCS C1713		9240100  -  PLATE 9240100 SPINOUS PROCESS	BOTH IP/OP	"$8,608.50 "	"$6,370.29"	$0.00	"$6,886.80"	"$3,873.83"	"$3,873.83"	$0.00	$0.00	$0.00	"$1,794.23"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,794.01"	$0.00	"$4,243.99"	"$4,243.99"	$0.00	"$4,304.25"	"$6,817.93"	"$6,886.80"	$0.00		$0.00	"$1,347.23"	$0.00	$0.00	"$1,370.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9240150	SUP	HCPCS C1713		9240150  -  SCREW 9240150 M4 BREAKOFFS	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
9240200	SUP	HCPCS C1713		9240200  -  PLATE  9240200 35MM SPIRE	BOTH IP/OP	"$8,608.50 "	"$6,370.29"	$0.00	"$6,886.80"	"$3,873.83"	"$3,873.83"	$0.00	$0.00	$0.00	"$1,794.23"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,794.01"	$0.00	"$4,243.99"	"$4,243.99"	$0.00	"$4,304.25"	"$6,817.93"	"$6,886.80"	$0.00		$0.00	"$1,347.23"	$0.00	$0.00	"$1,370.47"	$0.00	$0.00	$0.00	$0.00	$0.00
9255562	SUP	HCPCS C1713		9255562  -  PLATE BN 3D CRV 1.5MM 6X2 HL CRNMXF	BOTH IP/OP	"$1,965.00 "	"$1,454.10"	$0.00	"$1,572.00"	$884.25	$884.25	$0.00	$0.00	$0.00	$409.56	"$1,458.42"	"$1,458.42"	$0.00	$0.00	$409.51	$0.00	"$1,162.30"	"$1,162.30"	$0.00	$982.50	"$1,556.28"	"$1,572.00"	$0.00		$0.00	$307.52	$0.00	$0.00	$312.83	$0.00	$0.00	$0.00	$0.00	$0.00
9330000	SUP	HCPCS C1713		9330000  -  NUT LOCK VNTG SPNL TI LCK SCR SET STRL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
9330001	SUP	HCPCS C1713		9330001  -  STAPLE BONE 2 HOLE TI RSTRL VNTG STRL	BOTH IP/OP	"$2,805.00 "	"$2,075.70"	$0.00	"$2,244.00"	"$1,262.25"	"$1,262.25"	$0.00	$0.00	$0.00	$584.63	"$2,081.87"	"$2,081.87"	$0.00	$0.00	$584.56	$0.00	"$1,382.87"	"$1,382.87"	$0.00	"$1,402.50"	"$2,221.56"	"$2,244.00"	$0.00		$0.00	$438.98	$0.00	$0.00	$446.56	$0.00	$0.00	$0.00	$0.00	$0.00
9330002	SUP	HCPCS C1713		9330002  -  STAPLE BONE 2 HOLE TI CDL VNTG STRL	BOTH IP/OP	"$2,805.00 "	"$2,075.70"	$0.00	"$2,244.00"	"$1,262.25"	"$1,262.25"	$0.00	$0.00	$0.00	$584.63	"$2,081.87"	"$2,081.87"	$0.00	$0.00	$584.56	$0.00	"$1,382.87"	"$1,382.87"	$0.00	"$1,402.50"	"$2,221.56"	"$2,244.00"	$0.00		$0.00	$438.98	$0.00	$0.00	$446.56	$0.00	$0.00	$0.00	$0.00	$0.00
9330003	SUP	HCPCS C1713		9330003  -  STAPLE BONE 2 HOLE TI RSTRL VNTG STRL	BOTH IP/OP	"$2,805.00 "	"$2,075.70"	$0.00	"$2,244.00"	"$1,262.25"	"$1,262.25"	$0.00	$0.00	$0.00	$584.63	"$2,081.87"	"$2,081.87"	$0.00	$0.00	$584.56	$0.00	"$1,382.87"	"$1,382.87"	$0.00	"$1,402.50"	"$2,221.56"	"$2,244.00"	$0.00		$0.00	$438.98	$0.00	$0.00	$446.56	$0.00	$0.00	$0.00	$0.00	$0.00
9330004	SUP	HCPCS C1713		9330004  -  STAPLE BONE 2 HOLE TI CDL VNTG STRL	BOTH IP/OP	"$2,805.00 "	"$2,075.70"	$0.00	"$2,244.00"	"$1,262.25"	"$1,262.25"	$0.00	$0.00	$0.00	$584.63	"$2,081.87"	"$2,081.87"	$0.00	$0.00	$584.56	$0.00	"$1,382.87"	"$1,382.87"	$0.00	"$1,402.50"	"$2,221.56"	"$2,244.00"	$0.00		$0.00	$438.98	$0.00	$0.00	$446.56	$0.00	$0.00	$0.00	$0.00	$0.00
9330040	SUP	HCPCS C1713		9330040  -  PLATE 9330040 4CM ATL TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9330045	SUP	HCPCS C1713		9330045  -  PLATE 9330045 4 5CM ATL TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9330050	SUP	HCPCS C1713		9330050  -  PLATE 9330050 5CM ATL TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9330055	SUP	HCPCS C1713		9330055  -  PLATE 9330055 5 5CM ATL TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9330060	SUP	HCPCS C1713		9330060  -  PLATE BN 6CM VNTG SMTH TI SPNE THORLMBR ANT	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9330065	SUP	HCPCS C1713		9330065  -  PLATE 65MM TI LCK ATLNTS BONE ANT CERV SPN	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9330070	SUP	HCPCS C1713		9330070  -  PLATE 7CM TI LCK VNTG BONE LAT LMBR	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9330075	SUP	HCPCS C1713		9330075  -  PLATE 9330075 7 5CM ATL TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9330080	SUP	HCPCS C1713		9330080  -  PLATE 9330080 8CM ATL TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9330085	SUP	HCPCS C1713		9330085  -  PLATE 9330085 8 5CM ATL TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9330090	SUP	HCPCS C1713		9330090  -  PLATE 9330090 9CM ATL TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9330095	SUP	HCPCS C1713		9330095  -  PLATE 9330095 9 5CM ATL TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9330100	SUP	HCPCS C1713		9330100  -  PLATE 9330100 10CM ATL TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9331025	SUP	Custom 27803010		9331025  -  PLATE 25MM TI VNTG BONE ANT THORLMBR SPN STRL	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	$0.00	$0.00	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9331030	SUP	HCPCS C1713		9331030  -  PLATE 9331030 3CM THORACIC TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9331035	SUP	HCPCS C1713		9331035  -  PLATE 9331035 3 5CM THORACIC TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9331040	SUP	HCPCS C1713		9331040  -  PLATE 9331040 4CM THORACIC TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9331045	SUP	HCPCS C1713		9331045  -  PLATE 9331045 4 5CM THORACIC TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9331050	SUP	HCPCS C1713		9331050  -  PLATE 9331050 5CM THORACIC TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9331055	SUP	HCPCS C1713		9331055  -  PLATE BN 5.5CM VNTG SMTH TI SPNE THOR ANT	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9331060	SUP	HCPCS C1713		9331060  -  PLATE BN 6CM VNTG SMTH TI SPNE THOR ANT	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9331065	SUP	HCPCS C1713		9331065  -  PLATE 9331065 6 5CM THORACIC TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9331070	SUP	HCPCS C1713		9331070  -  PLATE 9331070 7CM THORACIC TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9331075	SUP	HCPCS C1713		9331075  -  PLATE 9331075 7CM THORACIC TI 5	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9331080	SUP	HCPCS C1713		9331080  -  PLATE 9331080 8CM THORACIC TI	BOTH IP/OP	"$6,778.50 "	"$5,016.09"	$0.00	"$5,422.80"	"$3,050.33"	"$3,050.33"	$0.00	$0.00	$0.00	"$1,412.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,412.64"	$0.00	"$3,341.80"	"$3,341.80"	$0.00	"$3,389.25"	"$5,368.57"	"$5,422.80"	$0.00		$0.00	"$1,060.84"	$0.00	$0.00	"$1,079.14"	$0.00	$0.00	$0.00	$0.00	$0.00
9335515	SUP	HCPCS C1713		9335515  -  SCREW 9335515 THORACIC 5.5X15MM TI	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9335520	SUP	HCPCS C1713		9335520  -  SCREW 9335520 THORACIC 5.5X20MM TI	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9335525	SUP	HCPCS C1713		9335525  -  SCREW 9335525 THORACIC 5.5X25MM TI	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9335530	SUP	HCPCS C1713		9335530  -  SCREW 9335530 THORACIC 5.5X30MM TI	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9335535	SUP	HCPCS C1713		9335535  -  SCREW BN 5.5MM 35MM NS VNTG ST INTNL HEX CLR CD CUT TI SPNE	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9335540	SUP	HCPCS C1713		9335540  -  SCREW BN 5.5MM 40MM NS VNTG ST INTNL HEX CLR CD CUT TI SPNE	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9335545	SUP	HCPCS C1713		9335545  -  SCREW 9335545 THORACIC 5.5X45MM TI	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9335550	SUP	HCPCS C1713		9335550  -  SCREW 9335550 THORACIC 5.5X50MM TI	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9336525	SUP	HCPCS C1713		9336525  -  SCREW BONE 6.5MM 25MM ATLNTS TI ANT CERV SPN	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9336530	SUP	HCPCS C1713		9336530  -  SCREW 9336530 FAST ATL 6.5X30MM TI	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9336535	SUP	HCPCS C1713		9336535  -  SCREW BONE 6.5MM 35MM ATLNTS TI ANT CERV SPN	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9336540	SUP	HCPCS C1713		9336540  -  SCREW BN 6.5MM 40MM NS ATLNTS VNTG FST CLSR TI SPNE CRV ANT	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9336545	SUP	HCPCS C1713		9336545  -  SCREW 9336545 FAST ATL 6.5X45MM TI	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9336550	SUP	HCPCS C1713		9336550  -  SCREW 9336550 FAST ATL 6.5X50MM TI	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9336555	SUP	HCPCS C1713		9336555  -  SCREW 9336555 FAST ATL 6.5X55MM TI	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9336560	SUP	HCPCS C1713		9336560  -  SCREW BONE 6.5MM 60MM ATLNTS TI ANT CERV SPN	BOTH IP/OP	"$1,305.00 "	$965.70	$0.00	"$1,044.00"	$587.25	$587.25	$0.00	$0.00	$0.00	$271.99	$968.57	$968.57	$0.00	$0.00	$271.96	$0.00	$771.91	$771.91	$0.00	$652.50	"$1,033.56"	"$1,044.00"	$0.00		$0.00	$204.23	$0.00	$0.00	$207.76	$0.00	$0.00	$0.00	$0.00	$0.00
9338020	SUP	HCPCS C1713		9338020  -  BOLT SPNL 20MM 8MM ANT	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338025	SUP	HCPCS C1713		9338025  -  BOLT SPNL 25MM 8MM VNTG TI	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338030	SUP	HCPCS C1713		9338030  -  BOLT SPNL 30MM 8MM ANT TI SGL	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338035	SUP	HCPCS C1713		9338035  -  SCREW BONE 8MM 35MM TI ANT SPN	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338040	SUP	HCPCS C1713		9338040  -  BOLT SPNL 40MM 8MM VNTG TI	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338045	SUP	HCPCS C1713		9338045  -  SCREW BONE 8MM 45MM TI ANT SPN	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338050	SUP	HCPCS C1713		9338050  -  BOLT SPNL 50MM 8MM TI	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338055	SUP	HCPCS C1713		9338055  -  BOLT SPNL 55MM 8MM TI	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338920	SUP	HCPCS C1713		9338920  -  BOLT SPNL 20MM 9MM TI	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338925	SUP	HCPCS C1713		9338925  -  BOLT SPNL 25MM 9MM TI	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338930	SUP	HCPCS C1713		9338930  -  BOLT SPNL 30MM 9MM TI	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338935	SUP	HCPCS C1713		9338935  -  BOLT SPNL 35MM 6MM TI	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338940	SUP	HCPCS C1713		9338940  -  BOLT SPNL 40MM 9MM SGL	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338945	SUP	HCPCS C1713		9338945  -  BOLT SPNL 45MM 9MM TI	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338950	SUP	HCPCS C1713		9338950  -  BOLT SPNL 50MM 9MM TI	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9338955	SUP	HCPCS C1713		9338955  -  BOLT SPNL 55MM 9MM TI	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9391316	SUP	HCPCS C1713		9391316  -  CAGE SPNL 13MM 16MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$9,968.75 "	"$7,376.88"	$0.00	"$7,975.00"	"$4,485.94"	"$4,485.94"	$0.00	$0.00	$0.00	"$2,077.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,077.49"	$0.00	"$4,914.59"	"$4,914.59"	$0.00	"$4,984.38"	"$7,895.25"	"$7,975.00"	$0.00		$0.00	"$1,560.11"	$0.00	$0.00	"$1,587.03"	$0.00	$0.00	$0.00	$0.00	$0.00
9391319	SUP	HCPCS C1713		9391319  -  CAGE SPNL 13MM 19MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$9,968.75 "	"$7,376.88"	$0.00	"$7,975.00"	"$4,485.94"	"$4,485.94"	$0.00	$0.00	$0.00	"$2,077.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,077.49"	$0.00	"$4,914.59"	"$4,914.59"	$0.00	"$4,984.38"	"$7,895.25"	"$7,975.00"	$0.00		$0.00	"$1,560.11"	$0.00	$0.00	"$1,587.03"	$0.00	$0.00	$0.00	$0.00	$0.00
9391322	SUP	HCPCS C1713		9391322  -  CAGE SPNL 13MM 22MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$9,968.75 "	"$7,376.88"	$0.00	"$7,975.00"	"$4,485.94"	"$4,485.94"	$0.00	$0.00	$0.00	"$2,077.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,077.49"	$0.00	"$4,914.59"	"$4,914.59"	$0.00	"$4,984.38"	"$7,895.25"	"$7,975.00"	$0.00		$0.00	"$1,560.11"	$0.00	$0.00	"$1,587.03"	$0.00	$0.00	$0.00	$0.00	$0.00
9391326	SUP	HCPCS C1713		9391326  -  CAGE SPNL 13MM 26MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$9,968.75 "	"$7,376.88"	$0.00	"$7,975.00"	"$4,485.94"	"$4,485.94"	$0.00	$0.00	$0.00	"$2,077.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,077.49"	$0.00	"$4,914.59"	"$4,914.59"	$0.00	"$4,984.38"	"$7,895.25"	"$7,975.00"	$0.00		$0.00	"$1,560.11"	$0.00	$0.00	"$1,587.03"	$0.00	$0.00	$0.00	$0.00	$0.00
9391332	SUP	HCPCS C1713		9391332  -  CAGE SPNL 13MM 32MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9391341	SUP	HCPCS C1713		9391341  -  CAGE SPNL 13MM 41MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9391617	SUP	HCPCS C1713		9391617  -  CAGE SPNL 16MM 17MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$9,968.75 "	"$7,376.88"	$0.00	"$7,975.00"	"$4,485.94"	"$4,485.94"	$0.00	$0.00	$0.00	"$2,077.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,077.49"	$0.00	"$4,914.59"	"$4,914.59"	$0.00	"$4,984.38"	"$7,895.25"	"$7,975.00"	$0.00		$0.00	"$1,560.11"	$0.00	$0.00	"$1,587.03"	$0.00	$0.00	$0.00	$0.00	$0.00
9391620	SUP	HCPCS C1713		9391620  -  CENTERPIECE 9391620 16 X 20MM 16B	BOTH IP/OP	"$9,968.75 "	"$7,376.88"	$0.00	"$7,975.00"	"$4,485.94"	"$4,485.94"	$0.00	$0.00	$0.00	"$2,077.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,077.49"	$0.00	"$4,914.59"	"$4,914.59"	$0.00	"$4,984.38"	"$7,895.25"	"$7,975.00"	$0.00		$0.00	"$1,560.11"	$0.00	$0.00	"$1,587.03"	$0.00	$0.00	$0.00	$0.00	$0.00
9391623	SUP	HCPCS C1713		9391623  -  CAGE SPNL 16MM 23MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$9,968.75 "	"$7,376.88"	$0.00	"$7,975.00"	"$4,485.94"	"$4,485.94"	$0.00	$0.00	$0.00	"$2,077.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,077.49"	$0.00	"$4,914.59"	"$4,914.59"	$0.00	"$4,984.38"	"$7,895.25"	"$7,975.00"	$0.00		$0.00	"$1,560.11"	$0.00	$0.00	"$1,587.03"	$0.00	$0.00	$0.00	$0.00	$0.00
9391628	SUP	HCPCS C1713		9391628  -  CAGE SPNL 16MM 28MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$9,968.75 "	"$7,376.88"	$0.00	"$7,975.00"	"$4,485.94"	"$4,485.94"	$0.00	$0.00	$0.00	"$2,077.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,077.49"	$0.00	"$4,914.59"	"$4,914.59"	$0.00	"$4,984.38"	"$7,895.25"	"$7,975.00"	$0.00		$0.00	"$1,560.11"	$0.00	$0.00	"$1,587.03"	$0.00	$0.00	$0.00	$0.00	$0.00
9391633	SUP	HCPCS C1713		9391633  -  CAGE SPNL 16MM 33MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9391641	SUP	HCPCS C1713		9391641  -  CAGE SPNL 16MM 41MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9391919	SUP	HCPCS C1713		9391919  -  CAGE SPNL 19MM 19MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9391923	SUP	HCPCS C1713		9391923  -  CAGE SPNL 19MM 23MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9391928	SUP	HCPCS C1713		9391928  -  CAGE SPNL 19MM 28MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9391936	SUP	HCPCS C1713		9391936  -  CAGE SPNL 19MM 36MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9391947	SUP	HCPCS C1713		9391947  -  CAGE SPNL 19MM 47MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$13,406.25 "	"$9,920.63"	$0.00	"$10,725.00"	"$6,032.81"	"$6,032.81"	$0.00	$0.00	$0.00	"$2,794.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,793.86"	$0.00	"$6,609.28"	"$6,609.28"	$0.00	"$6,703.13"	"$10,617.75"	"$10,725.00"	$0.00		$0.00	"$2,098.08"	$0.00	$0.00	"$2,134.28"	$0.00	$0.00	$0.00	$0.00	$0.00
9391969	SUP	HCPCS C1713		9391969  -  CAGE SPNL 19MM 69MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$13,406.25 "	"$9,920.63"	$0.00	"$10,725.00"	"$6,032.81"	"$6,032.81"	$0.00	$0.00	$0.00	"$2,794.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,793.86"	$0.00	"$6,609.28"	"$6,609.28"	$0.00	"$6,703.13"	"$10,617.75"	"$10,725.00"	$0.00		$0.00	"$2,098.08"	$0.00	$0.00	"$2,134.28"	$0.00	$0.00	$0.00	$0.00	$0.00
9392221	SUP	HCPCS C1713		9392221  -  CAGE SPNL 22MM 21MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9392225	SUP	HCPCS C1713		9392225  -  CAGE SPNL 22MM 25MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9392231	SUP	HCPCS C1713		9392231  -  CAGE SPNL 22MM 31MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9392237	SUP	HCPCS C1713		9392237  -  CAGE SPNL 22MM 37MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9392248	SUP	HCPCS C1713		9392248  -  CAGE SPNL 22MM 48MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$13,406.25 "	"$9,920.63"	$0.00	"$10,725.00"	"$6,032.81"	"$6,032.81"	$0.00	$0.00	$0.00	"$2,794.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,793.86"	$0.00	"$6,609.28"	"$6,609.28"	$0.00	"$6,703.13"	"$10,617.75"	"$10,725.00"	$0.00		$0.00	"$2,098.08"	$0.00	$0.00	"$2,134.28"	$0.00	$0.00	$0.00	$0.00	$0.00
9392268	SUP	HCPCS C1713		9392268  -  CAGE SPNL 22MM 68MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$13,406.25 "	"$9,920.63"	$0.00	"$10,725.00"	"$6,032.81"	"$6,032.81"	$0.00	$0.00	$0.00	"$2,794.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,793.86"	$0.00	"$6,609.28"	"$6,609.28"	$0.00	"$6,703.13"	"$10,617.75"	"$10,725.00"	$0.00		$0.00	"$2,098.08"	$0.00	$0.00	"$2,134.28"	$0.00	$0.00	$0.00	$0.00	$0.00
9392507	SUP	HCPCS C1713		9392507  -  SPACER SPNL 25MMX7MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9392508	SUP	HCPCS C1713		9392508  -  SPACER SPNL 25MMX8MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9392509	SUP	HCPCS C1713		9392509  -  SPACER SPNL 25MMX9MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9392510	SUP	HCPCS C1713		9392510  -  SPACER SPNL 25MMX10MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9392511	SUP	HCPCS C1713		9392511  -  SPACER SPNL 25MMX11MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9392512	SUP	HCPCS C1713		9392512  -  SPACER SPNL 25MMX12MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9392513	SUP	HCPCS C1713		9392513  -  SPACER SPNL 25MMX13MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9392514	SUP	HCPCS C1713		9392514  -  SPACER SPNL 25MMX14MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9392515	SUP	HCPCS C1713		9392515  -  SPACER SPNL 25MMX15MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9392521	SUP	HCPCS C1713		9392521  -  CAGE SPNL 25MM 21MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9392525	SUP	HCPCS C1713		9392525  -  CAGE SPNL 25MM 25MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9392531	SUP	HCPCS C1713		9392531  -  CAGE SPNL 25MM 31MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9392537	SUP	HCPCS C1713		9392537  -  CAGE SPNL 25MM 37MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$11,687.50 "	"$8,648.75"	$0.00	"$9,350.00"	"$5,259.38"	"$5,259.38"	$0.00	$0.00	$0.00	"$2,435.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,435.68"	$0.00	"$5,761.94"	"$5,761.94"	$0.00	"$5,843.75"	"$9,256.50"	"$9,350.00"	$0.00		$0.00	"$1,829.09"	$0.00	$0.00	"$1,860.65"	$0.00	$0.00	$0.00	$0.00	$0.00
9392548	SUP	HCPCS C1713		9392548  -  CAGE SPNL 25MM 48MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$13,406.25 "	"$9,920.63"	$0.00	"$10,725.00"	"$6,032.81"	"$6,032.81"	$0.00	$0.00	$0.00	"$2,794.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,793.86"	$0.00	"$6,609.28"	"$6,609.28"	$0.00	"$6,703.13"	"$10,617.75"	"$10,725.00"	$0.00		$0.00	"$2,098.08"	$0.00	$0.00	"$2,134.28"	$0.00	$0.00	$0.00	$0.00	$0.00
9392568	SUP	HCPCS C1713		9392568  -  CAGE SPNL 25MM 68MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR	BOTH IP/OP	"$13,406.25 "	"$9,920.63"	$0.00	"$10,725.00"	"$6,032.81"	"$6,032.81"	$0.00	$0.00	$0.00	"$2,794.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,793.86"	$0.00	"$6,609.28"	"$6,609.28"	$0.00	"$6,703.13"	"$10,617.75"	"$10,725.00"	$0.00		$0.00	"$2,098.08"	$0.00	$0.00	"$2,134.28"	$0.00	$0.00	$0.00	$0.00	$0.00
9393007	SUP	HCPCS C1713		9393007  -  SPACER SPNL 30MMX7MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393008	SUP	HCPCS C1713		9393008  -  SPACER SPNL 30MMX8MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393009	SUP	HCPCS C1713		9393009  -  SPACER SPNL 30MMX9MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393010	SUP	HCPCS C1713		9393010  -  SPACER SPNL 30MMX10MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393011	SUP	HCPCS C1713		9393011  -  SPACER SPNL 30MMX11MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393012	SUP	HCPCS C1713		9393012  -  SPACER SPNL 30MMX12MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393013	SUP	HCPCS C1713		9393013  -  SPACER SPNL 30MMX13MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393014	SUP	HCPCS C1713		9393014  -  SPACER SPNL 30MMX14MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393015	SUP	HCPCS C1713		9393015  -  SPACER SPNL 30MMX15MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393607	SUP	HCPCS C1713		9393607  -  SPACER SPNL 36MMX7MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393608	SUP	HCPCS C1713		9393608  -  SPACER SPNL 36MMX8MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393609	SUP	HCPCS C1713		9393609  -  SPACER SPNL 36MMX9MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393610	SUP	HCPCS C1713		9393610  -  SPACER SPNL 36MMX10MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393611	SUP	HCPCS C1713		9393611  -  SPACER SPNL 36MMX11MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393612	SUP	HCPCS C1713		9393612  -  SPACER SPNL 36MMX12MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393613	SUP	HCPCS C1713		9393613  -  SPACER SPNL 36MMX13MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393614	SUP	HCPCS C1713		9393614  -  SPACER SPNL 36MMX14MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9393615	SUP	HCPCS C1713		9393615  -  SPACER SPNL 36MMX15MM LF CRSNT PEEK-OPTM VERT BD REPL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
9401300	SUP	HCPCS C1713		9401300  -  END CAP 9401300 13MM 0 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9401304	SUP	HCPCS C1713		9401304  -  END CAP 9401304 13MM 4 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9401308	SUP	HCPCS C1713		9401308  -  END CAP 9401308 13MM 8 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9401315	SUP	HCPCS C1713		9401315  -  END CAP 9401315 13MM 15 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9401600	SUP	HCPCS C1713		9401600  -  END CAP 9401600 16MM 0 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9401604	SUP	HCPCS C1713		9401604  -  END CAP 9401604 16MM 4 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9401608	SUP	HCPCS C1713		9401608  -  END CAP 9401608 16MM 8 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9401615	SUP	HCPCS C1713		9401615  -  END CAP 9401615 16MM 15 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9401900	SUP	HCPCS C1713		9401900  -  END CAP 9401900 19MM 0 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9401904	SUP	HCPCS C1713		9401904  -  END CAP 9401904 19MM 4 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9401908	SUP	HCPCS C1713		9401908  -  END CAP 9401908 19MM 8 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9401915	SUP	HCPCS C1713		9401915  -  END CAP 9401915 19MM 15 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9402200	SUP	HCPCS C1713		9402200  -  END CAP 9402200 22MM 0 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9402204	SUP	HCPCS C1713		9402204  -  CAGE SPNL 4D 22MM T2 XVBR CENTERPIECE END CAP TI COCR NTNL	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9402208	SUP	HCPCS C1713		9402208  -  END CAP 9402208 22MM 8 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9402215	SUP	HCPCS C1713		9402215  -  END CAP 9402215 22MM 15 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9402500	SUP	HCPCS C1713		9402500  -  END CAP 9402500 25MM 0 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9402504	SUP	HCPCS C1713		9402504  -  CAGE SPNL 4D 25MM T2 XVBR CENTERPIECE END CAP TI COCR NTNL	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9402508	SUP	HCPCS C1713		9402508  -  END CAP 9402508 25MM 8 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9402515	SUP	HCPCS C1713		9402515  -  END CAP 9402515 25MM 15 DEGREE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
9450002	SUP	Custom 27203010		9450002  -  DISPOSABLE 9450002 ELECTRO LOW IMPED22MM	BOTH IP/OP	$669.00 	$495.06	$0.00	$535.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$496.53	$496.53	$0.00	$0.00	$139.42	$0.00	$0.00	$0.00	$0.00	$334.50	$529.85	$535.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9450003	SUP	Custom 27203010		9450003  -  DISPOSABLE 9450003 ELECTRO TWST PAIR 8CH	BOTH IP/OP	$936.00 	$692.64	$0.00	$748.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$694.70	$694.70	$0.00	$0.00	$195.06	$0.00	$0.00	$0.00	$0.00	$468.00	$741.31	$748.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9450019	SUP	Custom 27203010		9450019  -  DISPOSABLE 9450019 NIM PED PROBE THORAC	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9450020	SUP	Custom 27203010		9450020  -  NEEDLE SPNL STRL LF NIM-SPNE ACC PDCL DISP	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9450047	SUP	Custom 27203010		9450047  -  DISPOSABLE 9450047 NEW PED PROBE LMBR	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9450051	SUP	Custom 27203010		9450051  -  DISPOSABLE 9450051 NIM 2.3MM BLL TIP PRB	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560551	SUP	Custom 27203010		9560551  -  INSTRUMENT 9560551 METRX SHTHD KNF BLDE	BOTH IP/OP	$645.00 	$477.30	$0.00	$516.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.72	$478.72	$0.00	$0.00	$134.42	$0.00	$0.00	$0.00	$0.00	$322.50	$510.84	$516.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560658	SUP	Custom 27203010		9560658  -  INSTRUMENT 9560658 QUADRANT ILLUMIN SYS	BOTH IP/OP	"$1,207.50 "	$893.55	$0.00	$966.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$896.21	$896.21	$0.00	$0.00	$251.64	$0.00	$0.00	$0.00	$0.00	$603.75	$956.34	$966.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560659	SUP	Custom 27203010		9560659  -  KNIFE SRG BYNT STRL MTRX SPNE CRV ANT DISP DSCTMY	BOTH IP/OP	$781.50 	$578.31	$0.00	$625.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$580.03	$580.03	$0.00	$0.00	$162.86	$0.00	$0.00	$0.00	$0.00	$390.75	$618.95	$625.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560702	SUP	Custom 27203010		9560702  -  INSTRUMENT 9560702 RADIANCE ILLUMIN SYS	BOTH IP/OP	"$1,062.00 "	$785.88	$0.00	$849.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$788.22	$788.22	$0.00	$0.00	$221.32	$0.00	$0.00	$0.00	$0.00	$531.00	$841.10	$849.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560703	SUP	Custom 27203010		9560703  -  INSTRUMENT 9560703 DISP 22MMX3CM RTRCT	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560704	SUP	Custom 27203010		9560704  -  INSTRUMENT 9560704 DISP 22MMX4CM RTRCT	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560705	SUP	Custom 27203010		9560705  -  INSTRUMENT 9560705 DISP 22MMX5CM RTRCT	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560706	SUP	Custom 27203010		9560706  -  INSTRUMENT 9560706 DISP 22MMX6CM RTRCT	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560707	SUP	Custom 27203010		9560707  -  INSTRUMENT 9560707 DISP 22MMX7CM RTRCT	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560708	SUP	Custom 27203010		9560708  -  INSTRUMENT 9560708 DISP 22MMX8CM RTRCT	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560709	SUP	Custom 27203010		9560709  -  INSTRUMENT 9560709 DISP 22MMX9CM RTRCT	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560757	SUP	Custom 27203010		9560757  -  INSTRUMENT 9560757 RDINCEXILLUMIN SYS	BOTH IP/OP	"$1,290.00 "	$954.60	$0.00	"$1,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$957.44	$957.44	$0.00	$0.00	$268.84	$0.00	$0.00	$0.00	$0.00	$645.00	"$1,021.68"	"$1,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9560802	SUP	Custom 27803010		9560802  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$958.50 	$709.29	$0.00	$766.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$711.40	$711.40	$0.00	$0.00	$199.75	$0.00	$0.00	$0.00	$0.00	$479.25	$759.13	$766.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561424	SUP	Custom 27203010		9561424  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$921.00 	$681.54	$0.00	$736.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$683.57	$683.57	$0.00	$0.00	$191.94	$0.00	$0.00	$0.00	$0.00	$460.50	$729.43	$736.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561426	SUP	Custom 27203010		9561426  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$0.00	$0.00	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561427	SUP	Custom 27203010		9561427  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$0.00	$0.00	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561428	SUP	Custom 27203010		9561428  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$0.00	$0.00	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561523	SUP	Custom 27203010		9561523  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$5,940.00 "	"$4,395.60"	$0.00	"$4,752.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,237.90"	$0.00	$0.00	$0.00	$0.00	"$2,970.00"	"$4,704.48"	"$4,752.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561524	SUP	Custom 27203010		9561524  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$8,920.50 "	"$6,601.17"	$0.00	"$7,136.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,859.03"	$0.00	$0.00	$0.00	$0.00	"$4,460.25"	"$7,065.04"	"$7,136.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561525	SUP	Custom 27203010		9561525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,314.50 "	"$1,712.73"	$0.00	"$1,851.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,717.82"	"$1,717.82"	$0.00	$0.00	$482.34	$0.00	$0.00	$0.00	$0.00	"$1,157.25"	"$1,833.08"	"$1,851.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561526	SUP	Custom 27203010		9561526  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$252.00 	$186.48	$0.00	$201.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.03	$187.03	$0.00	$0.00	$52.52	$0.00	$0.00	$0.00	$0.00	$126.00	$199.58	$201.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561813	SUP	Custom 27203010		9561813  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561814	SUP	Custom 27203010		9561814  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561815	SUP	Custom 27203010		9561815  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561816	SUP	Custom 27203010		9561816  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561817	SUP	Custom 27203010		9561817  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561818	SUP	Custom 27203010		9561818  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9561819	SUP	Custom 27203010		9561819  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9562613	SUP	Custom 27203010		9562613  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9562614	SUP	Custom 27203010		9562614  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$631.50 	$467.31	$0.00	$505.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.70	$468.70	$0.00	$0.00	$131.60	$0.00	$0.00	$0.00	$0.00	$315.75	$500.15	$505.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9562615	SUP	Custom 27203010		9562615  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9562616	SUP	Custom 27203010		9562616  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9562617	SUP	Custom 27203010		9562617  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9562618	SUP	Custom 27203010		9562618  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9562619	SUP	Custom 27203010		9562619  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9569575	SUP	Custom 27203010		9569575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$153.64	$153.64	$0.00	$0.00	$43.14	$0.00	$0.00	$0.00	$0.00	$103.50	$163.94	$165.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9569813	SUP	Custom 27203010		9569813  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$505.44	$505.44	$0.00	$0.00	$141.92	$0.00	$0.00	$0.00	$0.00	$340.50	$539.35	$544.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9569814	SUP	Custom 27203010		9569814  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$505.44	$505.44	$0.00	$0.00	$141.92	$0.00	$0.00	$0.00	$0.00	$340.50	$539.35	$544.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9569815	SUP	Custom 27203010		9569815  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$505.44	$505.44	$0.00	$0.00	$141.92	$0.00	$0.00	$0.00	$0.00	$340.50	$539.35	$544.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9569816	SUP	Custom 27203010		9569816  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$505.44	$505.44	$0.00	$0.00	$141.92	$0.00	$0.00	$0.00	$0.00	$340.50	$539.35	$544.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9569817	SUP	Custom 27203010		9569817  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$505.44	$505.44	$0.00	$0.00	$141.92	$0.00	$0.00	$0.00	$0.00	$340.50	$539.35	$544.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9569818	SUP	Custom 27203010		9569818  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$505.44	$505.44	$0.00	$0.00	$141.92	$0.00	$0.00	$0.00	$0.00	$340.50	$539.35	$544.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9569819	SUP	Custom 27203010		9569819  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$681.00 	$503.94	$0.00	$544.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$505.44	$505.44	$0.00	$0.00	$141.92	$0.00	$0.00	$0.00	$0.00	$340.50	$539.35	$544.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9680050	SUP	Custom 27203010		9680050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,451.00 "	"$1,813.74"	$0.00	"$1,960.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,819.13"	"$1,819.13"	$0.00	$0.00	$510.79	$0.00	$0.00	$0.00	$0.00	"$1,225.50"	"$1,941.19"	"$1,960.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9680853	SUP	HCPCS C1713		9680853  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$153.90	$153.90	$0.00	$0.00	$0.00	$71.28	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$202.29	$202.29	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$53.52	$0.00	$0.00	$54.45	$0.00	$0.00	$0.00	$0.00	$0.00
9680854	SUP	HCPCS C1713		9680854  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
9680855	SUP	HCPCS C1713		9680855  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
9690030	SUP	HCPCS C1713		9690030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
9690040	SUP	HCPCS C1713		9690040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
9690050	SUP	HCPCS C1713		9690050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
9690060	SUP	HCPCS C1713		9690060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
9690070	SUP	HCPCS C1713		9690070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
9690080	SUP	HCPCS C1713		9690080  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
9690090	SUP	HCPCS C1713		9690090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
9690100	SUP	HCPCS C1713		9690100  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
9690110	SUP	HCPCS C1713		9690110  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
9690853	SUP	HCPCS C1713		9690853  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
9690854	SUP	HCPCS C1713		9690854  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
9690855	SUP	HCPCS C1713		9690855  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
9733065	SUP	Custom 27203010		9733065  -  SYSTEM GUIDANCE EXTERNAL TRAJECTORY KIT NAVIGUS	BOTH IP/OP	"$2,937.50 "	"$2,173.75"	$0.00	"$2,350.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,180.21"	"$2,180.21"	$0.00	$0.00	$612.18	$0.00	$0.00	$0.00	$0.00	"$1,468.75"	"$2,326.50"	"$2,350.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9733068	SUP	Custom 27203010		9733068  -  KIT BIOP NEEDLE PASSIVE NAVIGUS	BOTH IP/OP	"$1,562.50 "	"$1,156.25"	$0.00	"$1,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,159.69"	"$1,159.69"	$0.00	$0.00	$325.63	$0.00	$0.00	$0.00	$0.00	$781.25	"$1,237.50"	"$1,250.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9733497	SUP	Custom 27203010		9733497  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,642.50 "	"$1,215.45"	$0.00	"$1,314.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,219.06"	"$1,219.06"	$0.00	$0.00	$342.30	$0.00	$0.00	$0.00	$0.00	$821.25	"$1,300.86"	"$1,314.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9733498	SUP	Custom 27203010		9733498  -  KIT STRTC STRL LF NAVIGATE ACC SPNE PDCL DISP	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$0.00	$0.00	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9734887	SUP	Custom 27203010		9734887  -  TRACKER NVG STRL LF NINVS DISP	BOTH IP/OP	$542.50 	$401.45	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$402.64	$402.64	$0.00	$0.00	$113.06	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9735428	SUP	Custom 27203010		9735428  -  STYLET NVG STRL LF 2 COIL DISP	BOTH IP/OP	"$1,420.00 "	"$1,050.80"	$0.00	"$1,092.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,053.92"	"$1,053.92"	$0.00	$0.00	$295.93	$0.00	$0.00	$0.00	$0.00	$682.50	"$1,081.08"	"$1,092.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9790019	SUP	HCPCS C1713		9790019  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
9790021	SUP	HCPCS C1713		9790021  -  PLATE 21MM TI LCK VNTR BONE ANT CERV SPN STRL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
9790023	SUP	HCPCS C1713		9790023  -  PLATE BN 23MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
9790025	SUP	HCPCS C1713		9790025  -  PLATE BN 25MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
9790027	SUP	HCPCS C1713		9790027  -  PLATE BN 27.5MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
9790030	SUP	HCPCS C1713		9790030  -  PLATE BN 30MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
9790032	SUP	HCPCS C1713		9790032  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
9790035	SUP	HCPCS C1713		9790035  -  PLATE 35MM TI LCK VNTR BONE ANT CERV SPN STRL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
9790037	SUP	HCPCS C1713		9790037  -  PLATE 37.5MM TI LCK VNTR BONE ANT CERV SPN STRL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
9790040	SUP	HCPCS C1713		9790040  -  PLATE BN 40MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
9790042	SUP	HCPCS C1713		9790042  -  PLATE 42.5MM TI LCK VNTR BONE ANT CERV SPN STRL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
9790045	SUP	HCPCS C1713		9790045  -  PLATE BN 45MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
9790047	SUP	HCPCS C1713		9790047  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
9790050	SUP	HCPCS C1713		9790050  -  PLATE BN 50MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
9790052	SUP	HCPCS C1713		9790052  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
9790055	SUP	HCPCS C1713		9790055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
9790057	SUP	HCPCS C1713		9790057  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
9790060	SUP	HCPCS C1713		9790060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
9790062	SUP	HCPCS C1713		9790062  -  PLATE BN 62.5MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
9790065	SUP	HCPCS C1713		9790065  -  PLATE BN 65MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
9790067	SUP	HCPCS C1713		9790067  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
9790070	SUP	HCPCS C1713		9790070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
9790072	SUP	HCPCS C1713		9790072  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
9790075	SUP	HCPCS C1713		9790075  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
9790077	SUP	HCPCS C1713		9790077  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
9790080	SUP	HCPCS C1713		9790080  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
9790082	SUP	HCPCS C1713		9790082  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
9790085	SUP	HCPCS C1713		9790085  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
9790087	SUP	HCPCS C1713		9790087  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9790090	SUP	HCPCS C1713		9790090  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9790095	SUP	HCPCS C1713		9790095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9790100	SUP	HCPCS C1713		9790100  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9790105	SUP	HCPCS C1713		9790105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9790110	SUP	HCPCS C1713		9790110  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,525.50 "	"$3,348.87"	$0.00	"$3,620.40"	"$2,036.48"	"$2,036.48"	$0.00	$0.00	$0.00	$943.23	"$3,358.83"	"$3,358.83"	$0.00	$0.00	$943.11	$0.00	"$2,231.07"	"$2,231.07"	$0.00	"$2,262.75"	"$3,584.20"	"$3,620.40"	$0.00		$0.00	$708.24	$0.00	$0.00	$720.46	$0.00	$0.00	$0.00	$0.00	$0.00
9790211	SUP	HCPCS C1713		9790211  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790213	SUP	HCPCS C1713		9790213  -  SCREW BONE 4MM 13MM VNTR TI ANT CERV SPN SLFTAP FIXANG STRL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790215	SUP	HCPCS C1713		9790215  -  SCREW BN 4MM 15MM NS VNTR ST FX ANG TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790217	SUP	HCPCS C1713		9790217  -  SCREW BONE 4MM 17MM VNTR TI ANT CERV SPN SLFTAP FIXANG STRL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790219	SUP	HCPCS C1713		9790219  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790221	SUP	HCPCS C1713		9790221  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790223	SUP	HCPCS C1713		9790223  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790311	SUP	HCPCS C1713		9790311  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790312	SUP	HCPCS C1713		9790312  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790313	SUP	HCPCS C1713		9790313  -  SCREW BONE 4MM 13MM VNTR TI ANT CERV SPN SLFTAP VAR ANG STRL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790315	SUP	HCPCS C1713		9790315  -  SCREW BONE 4MM 15MM VNTR TI ANT CERV SPN SLFTAP VAR ANG STRL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790317	SUP	HCPCS C1713		9790317  -  SCREW BONE 4MM 15MM TI SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790319	SUP	HCPCS C1713		9790319  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790325	SUP	HCPCS C1713		9790325  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9790904	SUP	HCPCS C1713		9790904  -  PIN FIX PREFIXATION SPNL	BOTH IP/OP	$291.00 	$215.34	$0.00	$232.80	$130.95	$130.95	$0.00	$0.00	$0.00	$60.65	$215.98	$215.98	$0.00	$0.00	$60.64	$0.00	$172.13	$172.13	$0.00	$145.50	$230.47	$232.80	$0.00		$0.00	$45.54	$0.00	$0.00	$46.33	$0.00	$0.00	$0.00	$0.00	$0.00
9790915	SUP	Custom 27203010		9790915  -  BIT DRL 11MM STRL DISP	BOTH IP/OP	$718.50 	$531.69	$0.00	$574.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$533.27	$533.27	$0.00	$0.00	$149.74	$0.00	$0.00	$0.00	$0.00	$359.25	$569.05	$574.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9791030	SUP	HCPCS C1713		9791030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
9791150	SUP	HCPCS C1713		9791150  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
9791221	SUP	HCPCS C1713		9791221  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791222	SUP	HCPCS C1713		9791222  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791223	SUP	HCPCS C1713		9791223  -  SCREW BN 4MM 13MM NS VNTR SLF DRL FX ANG INTGR LCK TI SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791224	SUP	HCPCS C1713		9791224  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791225	SUP	HCPCS C1713		9791225  -  SCREW BN 4MM 15MM NS VNTR SLF DRL FX ANG INTGR LCK TI SPNE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791226	SUP	HCPCS C1713		9791226  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791227	SUP	HCPCS C1713		9791227  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791321	SUP	HCPCS C1713		9791321  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791322	SUP	HCPCS C1713		9791322  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791323	SUP	HCPCS C1713		9791323  -  SCREW BN 4MM 13MM NS VNTR SLF DRL VA INTGR LCK TI SPNE CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791324	SUP	HCPCS C1713		9791324  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791325	SUP	HCPCS C1713		9791325  -  SCREW BN 4MM 15MM NS VNTR SLF DRL VA INTGR LCK TI SPNE CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791326	SUP	HCPCS C1713		9791326  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9791327	SUP	HCPCS C1713		9791327  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795211	SUP	HCPCS C1713		9795211  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795213	SUP	HCPCS C1713		9795213  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795215	SUP	HCPCS C1713		9795215  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795217	SUP	HCPCS C1713		9795217  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795219	SUP	HCPCS C1713		9795219  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795221	SUP	HCPCS C1713		9795221  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795223	SUP	HCPCS C1713		9795223  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795225	SUP	HCPCS C1713		9795225  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795227	SUP	HCPCS C1713		9795227  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795229	SUP	HCPCS C1713		9795229  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795311	SUP	HCPCS C1713		9795311  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795313	SUP	HCPCS C1713		9795313  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795315	SUP	HCPCS C1713		9795315  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795317	SUP	HCPCS C1713		9795317  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795319	SUP	HCPCS C1713		9795319  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795321	SUP	HCPCS C1713		9795321  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795323	SUP	HCPCS C1713		9795323  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795325	SUP	HCPCS C1713		9795325  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795327	SUP	HCPCS C1713		9795327  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9795329	SUP	HCPCS C1713		9795329  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9873033	SUP	HCPCS C1713		9873033  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9873035	SUP	HCPCS C1713		9873035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9873037	SUP	HCPCS C1713		9873037  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9873039	SUP	HCPCS C1713		9873039  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9873041	SUP	HCPCS C1713		9873041  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9873133	SUP	HCPCS C1713		9873133  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9873135	SUP	HCPCS C1713		9873135  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9873137	SUP	HCPCS C1713		9873137  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9873139	SUP	HCPCS C1713		9873139  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9873141	SUP	HCPCS C1713		9873141  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9874035	SUP	HCPCS C1713		9874035  -  PLATE BN 35MM PRMD 4 HL SPNE LMBR ANT	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9874037	SUP	HCPCS C1713		9874037  -  PLATE BN 37MM PRMD 4 HL SPNE LMBR ANT	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9874039	SUP	HCPCS C1713		9874039  -  PLATE BN 39MM PRMD 4 HL SPNE LMBR ANT	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9874041	SUP	HCPCS C1713		9874041  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9874043	SUP	HCPCS C1713		9874043  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9874045	SUP	HCPCS C1713		9874045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$9,487.50 "	"$7,020.75"	$0.00	"$7,590.00"	"$4,269.38"	"$4,269.38"	$0.00	$0.00	$0.00	"$1,977.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,977.20"	$0.00	"$4,677.34"	"$4,677.34"	$0.00	"$4,743.75"	"$7,514.10"	"$7,590.00"	$0.00		$0.00	"$1,484.79"	$0.00	$0.00	"$1,510.41"	$0.00	$0.00	$0.00	$0.00	$0.00
9990700	SUP	Custom 27203010		KWIQ DIP	BOTH IP/OP	$223.78 	$165.60	$0.00	$179.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.89	$177.23	$179.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10000607	SUP	HCPCS C1713		10000607  -  WIRE FX RELINE MAS BLNT THRD NTNL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
10004354	SUP	Custom 27203010		MAX-FAST FOREHEAD SENSOR WITH HEADBAND	BOTH IP/OP	$117.73 	$87.12	$0.00	$94.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.87	$93.24	$94.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10055332	SUP	HCPCS C1713		10055332  -  RELINE FIXED CROSS CONN. 37.5MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
10055425	SUP	HCPCS C1713		10055425  -  CONNECTOR ROD 5.5MM 25-30MM RELINE CX ADJ LOPRFL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
10056425	SUP	HCPCS C1713		10056425  -  CONNECTOR ROD 5.5-6MM 25-30MM RELINE CX ADJ LOPRFL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
10612513	SUP	Custom 27203010		TIP PIP 1000UL DISP BLK	BOTH IP/OP	"$1,844.75 "	"$1,365.12"	$0.00	"$1,475.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$922.38	"$1,461.04"	"$1,475.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10719701	SUP	HCPCS C1725		CATHETER ANGIO .035IN 5FR 65CM C1 CURVE NBRD SFT RADIOPQ TIP	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20	$4.89	$4.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$1.41	$0.00	$0.00	$1.43	$0.00	$0.00	$0.00	$0.00	$0.00
10719702	SUP	HCPCS C1725		CATHETER ANGIO .035IN C2 CURVE 5FR 65CM 2 SH NBRD SFT	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20	$4.89	$4.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$1.41	$0.00	$0.00	$1.43	$0.00	$0.00	$0.00	$0.00	$0.00
10720401	SUP	HCPCS C1725		CATHETER ANGIO .038IN SOS OMNI1 CURVE 5FR 80CM NBRD SFT	BOTH IP/OP	$35.00 	$25.90	$0.00	$25.98	$12.76	$12.76	$0.00	$0.00	$0.00	$7.29	$25.98	$25.98	$0.00	$0.00	$7.29	$0.00	$20.70	$20.70	$0.00	$11.75	$18.61	$18.80	$0.00		$0.00	$3.68	$0.00	$0.00	$3.74	$0.00	$0.00	$0.00	$0.00	$0.00
10720405	SUP	HCPCS C1725		CATHETER ANGIO .038IN SOS OMNI2 CURVE 5FR 80CM NBRD SFT	BOTH IP/OP	$23.75 	$17.58	$0.00	$19.00	$12.90	$12.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$18.81	$19.00	$0.00		$0.00	$3.72	$0.00	$0.00	$3.78	$0.00	$0.00	$0.00	$0.00	$0.00
10722102	SUP	HCPCS C1725		CATHETER ANGIO .038IN BERN CURVE 5FR 100CM NBRD SFT RADIOPQ	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
10732101	SUP	HCPCS C1725		CATHETER ANGIO .038IN MIK CURVE 5FR 80CM NBRD SFT RADIOPQ	BOTH IP/OP	$23.75 	$17.58	$0.00	$19.00	$12.90	$12.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.88	$18.81	$19.00	$0.00		$0.00	$3.72	$0.00	$0.00	$3.78	$0.00	$0.00	$0.00	$0.00	$0.00
10800702	SUP	HCPCS C1769		SET CATH 20CM .035IN SCHN XL GUIDEWIRE INTROD NDL HMDIAL	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$133.04	$133.04	$0.00	$0.00	$0.00	$51.06	$181.84	$181.84	$0.00	$0.00	$51.06	$0.00	$144.92	$144.92	$0.00	$122.50	$194.04	$196.00	$0.00		$0.00	$38.34	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00
10802701	SUP	HCPCS C1769		SET CATH 15CM .035IN SIL SCHN XL GUIDEWIRE INTROD NDL FULL	BOTH IP/OP	$355.00 	$262.70	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$0.00	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
10802702	SUP	HCPCS C1769		SET CATH 20CM .035IN SIL SCHN XL GUIDEWIRE INTROD NDL FULL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
10802703	SUP	HCPCS C1752		10802703  -  SET CATH 24CM SCHN XL FULL HMDIAL	BOTH IP/OP	$355.00 	$262.70	$0.00	$654.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$0.00	$0.00	$0.00	$409.17	$648.13	$654.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11221000	SUP	Custom 27203010		11221000  -  COLLAR XTRIC MN PRFT AC SM CERV PLST ADJ PED	BOTH IP/OP	$74.37 	$55.03	$0.00	$59.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.18	$58.90	$59.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11355025	SUP	HCPCS C1713		11355025  -  ROD SPNL LRDTC 5.5MM 25MM NS RELINE TI MAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355030	SUP	HCPCS C1713		11355030  -  ROD SPNL LRDTC 5.5MM 30MM NS RELINE TI MAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355035	SUP	HCPCS C1713		11355035  -  ROD SPNL LRDTC 5.5MM 35MM NS RELINE TI MAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355045	SUP	HCPCS C1713		11355045  -  ROD SPNL LRDTC 5.5MM 45MM NS RELINE TI MAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355050	SUP	HCPCS C1713		11355050  -  ROD SPNL LRDTC 5.5MM 50MM NS RELINE TI MAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355055	SUP	HCPCS C1713		11355055  -  ROD SPNL LRDTC 5.5MM 55MM NS RELINE TI MAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355060	SUP	HCPCS C1713		11355060  -  ROD SPNL LRDTC 5.5MM 60MM NS RELINE TI MAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355070	SUP	HCPCS C1713		11355070  -  ROD SPNL LRDTC 5.5MM 70MM NS RELINE TI MAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355085	SUP	HCPCS C1713		11355085  -  RELINE ROD 85MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355090	SUP	HCPCS C1713		"11355090  -  RELINE ROD, 90MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355095	SUP	HCPCS C1713		11355095  -  ROD SPNL LRDTC 5.5MM 95MM NS RELINE TI MAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355110	SUP	HCPCS C1713		11355110  -  ROD SPNL LRDTC 5.5MM 110MM NS RELINE TI MAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355150	SUP	HCPCS C1713		11355150  -  ROD SPNL LRDTC 5.5MM 150MM NS RELINE TI MAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11355160	SUP	HCPCS C1713		11355160  -  ROD SPNL LRDTC 5.5MM 160MM NS RELINE TI MAS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
11403002	SUP	Custom 27203010		11403002  -  KIT PROCEDURE .035IN 21GA 65CM LONG ACCES GWIRE NEEDLE GOLD	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12401812	SUP	HCPCS C1757		12401812  -  CATHETER THROMBECTOMY 5FR 135CM 10CM OCCLUDING BALL WIRE	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12401813	SUP	HCPCS C1729		CATHETER INFUS 5FR 25MM 20CM SLT DSGN FLW THRU HUB OCL WIRE	BOTH IP/OP	$412.50 	$305.25	$0.00	$502.77	$223.99	$223.99	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$502.77	$502.77	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
12401816	SUP	HCPCS C1729		CATHETER INFUS 5FR 25MM 50CM CORON SLT DSGN FLW THRU HUB OCL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$223.99	$223.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
13010545	SUP	HCPCS C1713		13010545  -  SCREW BN 2S 10.5MM 45MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13014030	SUP	HCPCS C1713		13014030  -  SCREW BN 2S 4MM 30MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13014040	SUP	HCPCS C1713		13014040  -  SCREW BN 2S 4MM 40MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13014530	SUP	HCPCS C1713		13014530  -  SCREW BN 2S 4.5MM 30MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13014540	SUP	HCPCS C1713		13014540  -  SCREW BN 2S 4.5MM 40MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13015035	SUP	HCPCS C1713		13015035  -  SCREW BN 2S 5MM 35MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13015045	SUP	HCPCS C1713		13015045  -  SCREW BN 2S 5MM 45MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13015050	SUP	HCPCS C1713		13015050  -  SCREW BN 2S 5MM 50MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13015055	SUP	HCPCS C1713		13015055  -  SCREW BN 2S 5MM 55MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13015525	SUP	HCPCS C1713		13015525  -  SCREW BN 2S 5.5MM 25MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13015530	SUP	HCPCS C1713		13015530  -  SCREW BN 2S 5.5MM 30MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13015535	SUP	HCPCS C1713		13015535  -  SCREW BN 2S 5.5MM 35MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13015540	SUP	HCPCS C1713		13015540  -  SCREW BN 2S 5.5MM 40MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13015545	SUP	HCPCS C1713		13015545  -  SCREW BN 2S 5.5MM 45MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13015550	SUP	HCPCS C1713		13015550  -  SCREW BN 2S 5.5MM 50MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13015555	SUP	HCPCS C1713		13015555  -  SCREW BN 2S 5.5MM 55MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13016535	SUP	HCPCS C1713		13016535  -  SCREW BN 2S 6.5MM 35MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13016540	SUP	HCPCS C1713		13016540  -  SCREW BN 2S 6.5MM 40MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13016545	SUP	HCPCS C1713		13016545  -  SCREW BN 2S 6.5MM 45MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13016550	SUP	HCPCS C1713		13016550  -  SCREW BN 2S 6.5MM 50MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13016555	SUP	HCPCS C1713		13016555  -  SCREW BN 2S 6.5MM 55MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13017535	SUP	HCPCS C1713		13017535  -  SCREW BN 2S 7.5MM 35MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13017540	SUP	HCPCS C1713		13017540  -  SCREW BN 2S 7.5MM 40MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13017545	SUP	HCPCS C1713		13017545  -  SCREW BN 2S 7.5MM 45MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13017550	SUP	HCPCS C1713		13017550  -  SCREW BN 2S 7.5MM 50MM NS LF RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13017555	SUP	HCPCS C1713		13017555  -  SCREW BN 2S 7.5MM 55MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13018535	SUP	HCPCS C1713		13018535  -  SCREW BN 2S 8.5MM 35MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13018540	SUP	HCPCS C1713		13018540  -  SCREW BN 2S 8.5MM 40MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13018545	SUP	HCPCS C1713		13018545  -  SCREW BN 2S 8.5MM 45MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13018550	SUP	HCPCS C1713		13018550  -  SCREW BN 2S 8.5MM 50MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13018555	SUP	HCPCS C1713		13018555  -  SCREW BN 2S 8.5MM 55MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13018560	SUP	HCPCS C1713		13018560  -  SCREW BN 2S 8.5MM 60MM NS LF RELINE-O PA SPNE LLIAC	BOTH IP/OP	"$3,450.00 "	"$2,553.00"	$0.00	"$2,760.00"	"$1,552.50"	"$1,552.50"	$0.00	$0.00	$0.00	$719.07	"$2,560.59"	"$2,560.59"	$0.00	$0.00	$718.98	$0.00	"$1,700.85"	"$1,700.85"	$0.00	"$1,725.00"	"$2,732.40"	"$2,760.00"	$0.00		$0.00	$539.93	$0.00	$0.00	$549.24	$0.00	$0.00	$0.00	$0.00	$0.00
13018580	SUP	HCPCS C1713		13018580  -  SCREW BN 2S 8.5MM 80MM NS RELINE-O PA SPNE LLIAC	BOTH IP/OP	"$3,450.00 "	"$2,553.00"	$0.00	"$2,760.00"	"$1,552.50"	"$1,552.50"	$0.00	$0.00	$0.00	$719.07	"$2,560.59"	"$2,560.59"	$0.00	$0.00	$718.98	$0.00	"$1,700.85"	"$1,700.85"	$0.00	"$1,725.00"	"$2,732.40"	"$2,760.00"	$0.00		$0.00	$539.93	$0.00	$0.00	$549.24	$0.00	$0.00	$0.00	$0.00	$0.00
13019545	SUP	HCPCS C1713		13019545  -  SCREW BN 2S 9.5MM 45MM NS RELINE-O PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13025545	SUP	HCPCS C1713		13025545  -  SCREW BN 2S 5.5MM 45MM NS RELINE RELINEO RDC SPNE	BOTH IP/OP	"$3,580.00 "	"$2,649.20"	$0.00	"$2,864.00"	"$1,611.00"	"$1,611.00"	$0.00	$0.00	$0.00	$746.16	"$2,657.08"	"$2,657.08"	$0.00	$0.00	$746.07	$0.00	"$1,764.94"	"$1,764.94"	$0.00	"$1,790.00"	"$2,835.36"	"$2,864.00"	$0.00		$0.00	$560.27	$0.00	$0.00	$569.94	$0.00	$0.00	$0.00	$0.00	$0.00
13025555	SUP	HCPCS C1713		13025555  -  SCREW BN 2S 5.5MM 55MM NS RELINE RELINEO RDC SPNE	BOTH IP/OP	"$3,580.00 "	"$2,649.20"	$0.00	"$2,864.00"	"$1,611.00"	"$1,611.00"	$0.00	$0.00	$0.00	$746.16	"$2,657.08"	"$2,657.08"	$0.00	$0.00	$746.07	$0.00	"$1,764.94"	"$1,764.94"	$0.00	"$1,790.00"	"$2,835.36"	"$2,864.00"	$0.00		$0.00	$560.27	$0.00	$0.00	$569.94	$0.00	$0.00	$0.00	$0.00	$0.00
13026545	SUP	HCPCS C1713		13026545  -  SCREW BN 2S 6.5MM 45MM NS RELINE-O RDC SPNE	BOTH IP/OP	"$3,580.00 "	"$2,649.20"	$0.00	"$2,864.00"	"$1,611.00"	"$1,611.00"	$0.00	$0.00	$0.00	$746.16	"$2,657.08"	"$2,657.08"	$0.00	$0.00	$746.07	$0.00	"$1,764.94"	"$1,764.94"	$0.00	"$1,790.00"	"$2,835.36"	"$2,864.00"	$0.00		$0.00	$560.27	$0.00	$0.00	$569.94	$0.00	$0.00	$0.00	$0.00	$0.00
13037590	SUP	HCPCS C1713		13037590  -  SCREW BN 2S 7.5MM 90MM NS RELINE-O CLS PA SPNE ILC	BOTH IP/OP	"$3,450.00 "	"$2,553.00"	$0.00	"$2,760.00"	"$1,552.50"	"$1,552.50"	$0.00	$0.00	$0.00	$719.07	"$2,560.59"	"$2,560.59"	$0.00	$0.00	$718.98	$0.00	"$1,700.85"	"$1,700.85"	$0.00	"$1,725.00"	"$2,732.40"	"$2,760.00"	$0.00		$0.00	$539.93	$0.00	$0.00	$549.24	$0.00	$0.00	$0.00	$0.00	$0.00
13038560	SUP	HCPCS C1713		13038560  -  SCREW BN 2S 8.5MM 60MM NS RELINE-O CLS SPNE ILC	BOTH IP/OP	"$3,450.00 "	"$2,553.00"	$0.00	"$2,760.00"	"$1,552.50"	"$1,552.50"	$0.00	$0.00	$0.00	$719.07	"$2,560.59"	"$2,560.59"	$0.00	$0.00	$718.98	$0.00	"$1,700.85"	"$1,700.85"	$0.00	"$1,725.00"	"$2,732.40"	"$2,760.00"	$0.00		$0.00	$539.93	$0.00	$0.00	$549.24	$0.00	$0.00	$0.00	$0.00	$0.00
13038580	SUP	HCPCS C1713		13038580  -  SCREW BN 2S 8.5MM 80MM NS RELINE-O CLS SPNE ILC	BOTH IP/OP	"$3,450.00 "	"$2,553.00"	$0.00	"$2,760.00"	"$1,552.50"	"$1,552.50"	$0.00	$0.00	$0.00	$719.07	"$2,560.59"	"$2,560.59"	$0.00	$0.00	$718.98	$0.00	"$1,700.85"	"$1,700.85"	$0.00	"$1,725.00"	"$2,732.40"	"$2,760.00"	$0.00		$0.00	$539.93	$0.00	$0.00	$549.24	$0.00	$0.00	$0.00	$0.00	$0.00
13039510	SUP	HCPCS C1713		13039510  -  SCREW BN 2S 9.5MM 100MM NS RELINE-O CLS SPNE ILC	BOTH IP/OP	"$3,450.00 "	"$2,553.00"	$0.00	"$2,760.00"	"$1,552.50"	"$1,552.50"	$0.00	$0.00	$0.00	$719.07	"$2,560.59"	"$2,560.59"	$0.00	$0.00	$718.98	$0.00	"$1,700.85"	"$1,700.85"	$0.00	"$1,725.00"	"$2,732.40"	"$2,760.00"	$0.00		$0.00	$539.93	$0.00	$0.00	$549.24	$0.00	$0.00	$0.00	$0.00	$0.00
13114540	SUP	HCPCS C1713		13114540  -  SCREW BN 4.5MM 40MM NS RELINE-O PA TRC SPNE	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
13115540	SUP	HCPCS C1713		13115540  -  SCREW BN 5.5MM 40MM NS RELINE-O PA TRC SPNE	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
13115545	SUP	HCPCS C1713		13115545  -  SCREW BN 5.5MM 45MM NS RELINE-O PA TRC SPNE	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
13115550	SUP	HCPCS C1713		13115550  -  SCREW BN 5.5MM 50MM NS RELINE-O PA TRC SPNE	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
13115555	SUP	HCPCS C1713		13115555  -  SCREW BN 5.5MM 55MM NS RELINE-O PA TRC SPNE	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
13116545	SUP	HCPCS C1713		13116545  -  SCREW BN 6.5MM 45MM NS RELINE-O PA TRC SPNE	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
13116550	SUP	HCPCS C1713		13116550  -  SCREW BN 6.5MM 50MM NS RELINE-O PA TRC SPNE	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
13117550	SUP	HCPCS C1713		13117550  -  SCREW BN 7.5MM 50MM NS RELINE-O PA TRC SPNE	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
13117555	SUP	HCPCS C1713		13117555  -  SCREW BN 7.5MM 55MM NS RELINE-O PA TRC SPNE	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
13118555	SUP	HCPCS C1713		13118555  -  SCREW BN 8.5MM 55MM NS RELINE-O PA TRC SPNE	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
13210510	SUP	HCPCS C1713		13210510  -  SCREW BN 10.5MM 100MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210511	SUP	HCPCS C1713		13210511  -  SCREW BN 10.5MM 110MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210512	SUP	HCPCS C1713		13210512  -  SCREW BN 10.5MM 120MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210525	SUP	HCPCS C1713		13210525  -  SCREW BN 10.5MM 25MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210530	SUP	HCPCS C1713		13210530  -  SCREW BN 10.5MM 30MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210535	SUP	HCPCS C1713		13210535  -  SCREW BN 10.5MM 35MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210540	SUP	HCPCS C1713		13210540  -  SCREW BN 10.5MM 40MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210545	SUP	HCPCS C1713		13210545  -  SCREW BN 10.5MM 45MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210550	SUP	HCPCS C1713		13210550  -  SCREW BN 10.5MM 50MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210555	SUP	HCPCS C1713		13210555  -  SCREW BN 10.5MM 55MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210560	SUP	HCPCS C1713		13210560  -  SCREW BN 10.5MM 60MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210565	SUP	HCPCS C1713		13210565  -  SCREW BN 10.5MM 65MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210570	SUP	HCPCS C1713		13210570  -  SCREW BN 10.5MM 70MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210575	SUP	HCPCS C1713		13210575  -  SCREW BN 10.5MM 75MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210580	SUP	HCPCS C1713		13210580  -  SCREW BN 10.5MM 80MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210585	SUP	HCPCS C1713		13210585  -  SCREW BN 10.5MM 85MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210590	SUP	HCPCS C1713		13210590  -  SCREW BN 10.5MM 90MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13210595	SUP	HCPCS C1713		13210595  -  SCREW BN 10.5MM 95MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13211010	SUP	HCPCS C1713		13211010  -  SCREW BN 10MM 100MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13219545	SUP	HCPCS C1713		13219545  -  SCREW BN 9.5MM 45MM NS RELINE PA 2 FENESTRATE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13550000	SUP	HCPCS C1713		13550000  -  RELINE LOCK SCREW	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
13600000	SUP	HCPCS C1713		13600000  -  SCREW BN 6MM NS RELINE LCK OPN TULIP SPNE	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
14355030	SUP	HCPCS C1713		14355030  -  ROD SPNL LRDTC 5.5MM 30MM NS RELINE-O TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
14355035	SUP	HCPCS C1713		14355035  -  ROD SPNL LRDTC 5.5MM 35MM NS RELINE-O TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
14355045	SUP	HCPCS C1713		"14355045  -  RELINE ROD, 45MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
14355050	SUP	HCPCS C1713		14355050  -  ROD SPNL LRDTC 5.5MM 50MM NS RELINE-O TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
14355055	SUP	HCPCS C1713		14355055  -  ROD SPNL LRDTC 5.5MM 55MM NS RELINE-O TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
14355060	SUP	HCPCS C1713		14355060  -  ROD SPNL LRDTC 5.5MM 60MM NS RELINE-O TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
14910164	SUP	Custom 27203010		KIT IMMUN TST PRMR POS NEG CNTRL H PYLR IGG 96 TST	BOTH IP/OP	"$1,619.25 "	"$1,198.25"	$0.00	"$1,295.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$809.63	"$1,282.45"	"$1,295.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15355300	SUP	HCPCS C1713		"15355300  -  RELINE ROD, 300MM"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
16014520	SUP	HCPCS C1713		16014520  -  SCREW BN 4.5MM 20MM NS RELINE MAS PA SPNL 2C	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16015520	SUP	HCPCS C1713		16015520  -  SCREW BN 5.5MM 20MM NS RELINE MAS PA SPNL 2C	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16015540	SUP	HCPCS C1713		16015540  -  SCREW BN 2C 5.5MM 40MM NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16016520	SUP	HCPCS C1713		16016520  -  SCREW BN 6.5MM 20MM NS RELINE MAS PA SPNL 2C	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16016535	SUP	HCPCS C1713		16016535  -  SCREW BN 2C 6.5MM 35MM NS LF RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16016550	SUP	HCPCS C1713		16016550  -  SCREW BN 6.5MM 50MM RELINE POLYAX MA SPNE 2C	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16017540	SUP	HCPCS C1713		16017540  -  SCREW BN 2C 7.5MM 40MM NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16017545	SUP	HCPCS C1713		16017545  -  SCREW BN 2C 7.5MM 45MM NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16018510	SUP	HCPCS C1713		16018510  -  SCREW BN 2C 8.5MM 100MM NS RELINE PA SPNE ILC MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16018580	SUP	HCPCS C1713		16018580  -  SCREW BN 2C 8.5MM 80MM NS LF RELINE PA SPNE LLIAC MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16018590	SUP	HCPCS C1713		16018590  -  RELINE MAS SCREW 8.5X 90	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16024530	SUP	HCPCS C1713		16024530  -  SCREW BN 2C 4.5MM 30MM RD NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16024535	SUP	HCPCS C1713		16024535  -  SCREW BN 2C 4.5MM 35MM RD NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16024540	SUP	HCPCS C1713		16024540  -  SCREW BN 2C 4.5MM 40MM RD NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16024545	SUP	HCPCS C1713		16024545  -  SCREW BN 2C 4.5MM 45MM RD NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16025535	SUP	HCPCS C1713		16025535  -  SCREW BN 2C 5.5MM 35MM RD NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16026540	SUP	HCPCS C1713		16026540  -  SCREW BN 2C 6.5MM 40MM RD NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16026545	SUP	HCPCS C1713		"16026545  -  RELINE REDUCTIONSCREW, 6.5 X 45"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16026550	SUP	HCPCS C1713		"16026550  -  RELINE MAS REDUCTION SCREW, 6.5X 50"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16026555	SUP	HCPCS C1713		"16026555  -  RELINE MAS REDUCTION SCREW, 6.5X 55"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16027535	SUP	HCPCS C1713		16027535  -  SCREW BN 2C 7.5MM 35MM RD NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16027555	SUP	HCPCS C1713		"16027555  -  RELINE REDUCTION SCREW, 7.5X 55"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16028535	SUP	HCPCS C1713		16028535  -  SCREW BN 2C 8.5MM 35MM RD NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16028540	SUP	HCPCS C1713		16028540  -  SCREW BN 2C 8.5MM 40MM RD NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16028545	SUP	HCPCS C1713		16028545  -  SCREW BN 2C 8.5MM 45MM RD NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16028550	SUP	HCPCS C1713		16028550  -  SCREW BN 2C 8.5MM 50MM RD NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16028555	SUP	HCPCS C1713		16028555  -  SCREW BN 2C 8.5MM 55MM RD NS RELINE PA SPNE MAS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16084520	SUP	HCPCS C1713		16084520  -  SCREW BN T 4.5MM 20MM NS RELINE MAS MA SPNL 2C	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16085520	SUP	HCPCS C1713		16085520  -  SCREW BN T 5.5MM 20MM NS RELINE MAS MA SPNL 2C	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16086520	SUP	HCPCS C1713		16086520  -  SCREW BN T 5.5MM 20MM RELINE MAS MA SPNL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
16500311	SUP	HCPCS C1876		BALLOON WORKHOUSE  7-2/5/75	BOTH IP/OP	$2.50 	$1.85	$0.00	$2.00	$1.13	$1.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.25	$1.98	$2.00	$0.00		$0.00	$0.39	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
16500317	SUP	HCPCS C1725		CATHETER BALDILAT 5MM 100CM 2CM NC LOW PROFILE HI-PRS	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
16500412	SUP	HCPCS C1725		CATHETER BALDILAT 6FR 8MM 75CM 2CM NC LOW PROFILE HI-PRS	BOTH IP/OP	$320.00 	$236.80	$0.00	$256.00	$173.76	$173.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.00	$253.44	$256.00	$0.00		$0.00	$50.08	$0.00	$0.00	$50.94	$0.00	$0.00	$0.00	$0.00	$0.00
16500414	SUP	HCPCS C1725		CATHETER BALDILAT 6FR 6MM 75CM 4CM NC LOW PROFILE HI-PRS	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$169.69	$169.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
16500416	SUP	HCPCS C1725		CATHETER BALDILAT 6FR 8MM 75CM 4CM NC LOW PROFILE HI-PRS	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$169.69	$169.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
16500446	SUP	HCPCS C1725		CATHETER BALDILAT 7FR 10MM 75CM 4CM NC LOW PROFILE HI-PRS	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
16500448	SUP	HCPCS C1725		CATHETER BALDILAT 7FR 10MM 100CM 4CM NC LOW PROFILE HI-PRS	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
16701001	SUP	HCPCS C1876		STENT BILIARY OMNIFLEX 6FR X 75CM X 5MM X 15MM BALLOON EXPAN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
18600545	SUP	HCPCS C1713		18600545  -  SCREW ACTB	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$31.50	$31.50	$0.00	$0.00	$0.00	$14.59	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$41.41	$41.41	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
18600550	SUP	HCPCS C1713		18600550  -  SCREW ACTB	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$31.50	$31.50	$0.00	$0.00	$0.00	$14.59	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$41.41	$41.41	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
18600555	SUP	HCPCS C1713		18600555  -  SCREW ACTB	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$31.50	$31.50	$0.00	$0.00	$0.00	$14.59	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$41.41	$41.41	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
18600560	SUP	HCPCS C1713		18600560  -  SCREW ACTB	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$31.50	$31.50	$0.00	$0.00	$0.00	$14.59	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$41.41	$41.41	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
20585507	SUP	Custom 27203010		HEMOCONCENTRATOR PK RINSELESS TBG CONNCTR WST BAG PRFSN 1400	BOTH IP/OP	$655.10 	$484.77	$0.00	$524.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$327.55	$518.84	$524.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21074025	SUP	Custom 27203010		21074025  -  BIT DRILL 4MM 25MM STERILE	BOTH IP/OP	$367.50 	$271.95	$0.00	$294.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.76	$272.76	$0.00	$0.00	$76.59	$0.00	$0.00	$0.00	$0.00	$183.75	$291.06	$294.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21381338	SUP	Custom 27203010		TIP PIP 2.5ML EPNDF CMBTP PLUS 25UL INCR GRAD PLNG CYL STRL	BOTH IP/OP	$3.15 	$2.33	$0.00	$2.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.58	$2.49	$2.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22046341	SUP	Custom 27203010		REAGENT CLRT 3 1GL CLR AGNT HISTOLGY	BOTH IP/OP	$68.75 	$50.88	$0.00	$55.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.38	$54.45	$55.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22046344	SUP	Custom 27203010		REAGENT METHNL ISOPRPNL FLX 100 1GL ABST DEHYDRANT BTL	BOTH IP/OP	$40.60 	$30.04	$0.00	$32.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.30	$32.16	$32.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22046346	SUP	Custom 27203010		REAGENT METHNL ISOPRPNL FLX 95 1GL DEHYDRANT BTL HISTOLGY	BOTH IP/OP	$158.90 	$117.59	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.45	$125.85	$127.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22046348	SUP	Custom 27203010		REAGENT METHNL ISOPRPNL FLX 80 1GL DEHYDRANT BTL HISTOLGY	BOTH IP/OP	$169.55 	$125.47	$0.00	$135.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.78	$134.28	$135.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22046619	SUP	Custom 27203010		CONTROL OSMTR ACCUREF 2ML 290 SER	BOTH IP/OP	$116.03 	$85.86	$0.00	$92.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.01	$91.90	$92.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22266306	SUP	Custom 27203010		TIP PIP 5ML CMBTP PLUS EPPPENDORF INCRM NSTRL	BOTH IP/OP	$273.28 	$202.23	$0.00	$218.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.64	$216.44	$218.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22610135	SUP	Custom 27203010		CAP TUBE 12MM FLNG	BOTH IP/OP	$0.08 	$0.06	$0.00	$0.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.04	$0.06	$0.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23022523	SUP	Custom 27203010		AIR CMPR AERS DSTR EXTN TUBE O3 SAFE TRPL FLTR 11OZ 5IN SUP	BOTH IP/OP	$43.33 	$32.06	$0.00	$34.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.66	$34.32	$34.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23022524	SUP	Custom 27203010		FREEZER CRYGN SUP FRND FRZ-IT AERS TISS SPRY PE SNORKEL 11OZ	BOTH IP/OP	$35.83 	$26.51	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.91	$28.38	$28.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23030817	SUP	HCPCS C1783		23030817  -  DRAIN GLAUCOMA IMNPLANT BAERVELDT SILICONE ANTER CHAM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
23038384	SUP	Custom 27203010		CONTROL MLANLT MAS NRM VL 60ML UA	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23046581	SUP	Custom 27203010		CONTROL ESR ESRCHX LVL 1 2 9ML HMTL	BOTH IP/OP	$780.00 	$577.20	$0.00	$624.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$390.00	$617.76	$624.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23046595	SUP	Custom 27203010		KIT IMMUN TST CLRVW COMBO 2 CLIA COMPLEXITY WVD SER URN HCG	BOTH IP/OP	$108.25 	$80.11	$0.00	$86.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.13	$85.73	$86.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23255961	SUP	Custom 27203010		STAIN MCBL GM IOD PRTCL 500ML	BOTH IP/OP	$66.35 	$49.10	$0.00	$53.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.18	$52.55	$53.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23270181	SUP	Custom 27203010		STAIN MCBL GM IOD UNSTBL PRTCL 1GL	BOTH IP/OP	$324.78 	$240.34	$0.00	$259.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.39	$257.23	$259.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23285625	SUP	Custom 27203010		REAGENT SCKL SCRN SCKCHX BUFF PWDR HMTL	BOTH IP/OP	$8.53 	$6.31	$0.00	$6.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.26	$6.76	$6.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100101	SUP	Custom 27203010		30100101  -  BIT DRILL 16-24MM BIOTRAK STD CANN BIOTRACK	BOTH IP/OP	$650.00 	$481.00	$0.00	$525.60	$29.07	$29.07	$16.30	$16.30	$8.15	$8.15	$24.76	$24.76	$23.81	$16.30	$24.09	$10.60	$0.00	$0.00	$17.12	$45.56	$429.66	$525.60	$23.64		$23.64	$25.67	$16.30	$16.30	$17.97	$16.30	$0.00	$0.00	$0.00	$0.00
30100102	SUP	Custom 27203010		30100102  -  BIT DRILL BIOTRAK STD TAP	BOTH IP/OP	$791.00 	$585.34	$0.00	$625.60	$32.19	$32.19	$24.09	$24.09	$12.05	$10.84	$9.12	$9.12	$8.77	$24.09	$8.87	$15.66	$0.00	$0.00	$25.29	$16.78	$429.66	$625.60	$34.93		$34.93	$9.45	$24.09	$24.09	$6.62	$24.09	$0.00	$0.00	$0.00	$0.00
30100151	SUP	Custom 27203010		30100151  -  BIT DRL MN BIOTRAK	BOTH IP/OP	$510.00 	$377.40	$0.00	$429.66	$34.50	$34.50	$26.07	$26.07	$13.04	$11.73	$29.38	$29.38	$28.25	$26.07	$28.59	$16.95	$0.00	$0.00	$27.37	$54.08	$429.66	$371.20	$37.80		$37.80	$30.46	$26.07	$26.07	$21.33	$26.07	$0.00	$0.00	$0.00	$0.00
30100152	SUP	Custom 27203010		30100152  -  BIT DRL BIOTRAK TAP	BOTH IP/OP	$462.00 	$341.88	$0.00	$429.66	$34.50	$34.50	$26.07	$26.07	$13.04	$11.73	$29.38	$29.38	$28.25	$26.07	$28.59	$16.95	$0.00	$0.00	$27.37	$54.08	$429.66	$371.20	$37.80		$37.80	$30.46	$26.07	$26.07	$21.33	$26.07	$0.00	$0.00	$0.00	$0.00
30100153	SUP	Custom 27203010		30100153  -  DRIVER MINI BIOTRAK SURG	BOTH IP/OP	$176.00 	$130.24	$0.00	$429.66	$27.63	$27.63	$21.09	$21.09	$10.55	$9.49	$23.52	$23.52	$22.62	$21.09	$22.90	$13.71	$0.00	$0.00	$22.14	$43.30	$429.66	$140.80	$30.58		$30.58	$24.40	$21.09	$21.09	$17.08	$21.09	$0.00	$0.00	$0.00	$0.00
30100154	SUP	Custom 27203010		30100154  -  EJTR MINI BLADE BIOTRAK INDIV SET NONSTRL	BOTH IP/OP	$470.00 	$347.80	$0.00	$376.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.83	$348.83	$0.00	$0.00	$97.95	$0.00	$0.00	$0.00	$0.00	$235.00	$372.24	$376.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30100351	SUP	Custom 27203010		30100351  -  DRILL SRG BIOTRAK	BOTH IP/OP	$276.00 	$204.24	$0.00	$429.66	$37.85	$37.85	$21.23	$21.23	$10.62	$10.62	$32.25	$32.25	$31.01	$21.23	$31.36	$13.80	$0.00	$0.00	$22.29	$59.34	$429.66	$220.80	$30.78		$30.78	$33.42	$21.23	$21.23	$23.39	$21.23	$0.00	$0.00	$0.00	$0.00
31002701	SUP	Custom 27803010		31002701  -  VALVE MTRL 27MM 35MM 24MM 19MM 14MM MSC CNCH FLXB STNT	BOTH IP/OP	"$19,500.00 "	"$14,430.00"	$0.00	"$15,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,063.80"	$0.00	$0.00	$0.00	$0.00	"$9,750.00"	"$15,444.00"	"$15,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
37129000	SUP	Custom 27203010		FORMULA 237ML PTMN SUPPL CHOC	BOTH IP/OP	$7.28 	$5.39	$0.00	$5.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.64	$5.77	$5.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38204020	SUP	HCPCS C1713		038204020  -  SCREW BONE 4MM 20MM MULTIAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
38204025	SUP	HCPCS C1713		038204025  -  SCREW BONE 4MM 25MM MULTIAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
38204030	SUP	HCPCS C1713		038204030  -  SCREW BONE 4MM 30MM MULTIAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
38204035	SUP	HCPCS C1713		038204035  -  SCREW BONE 4MM 35MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
38204040	SUP	HCPCS C1713		038204040  -  SCREW BONE 4MM 40MM MULTIAX XIA II TITANIUM SPN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
38205025	SUP	HCPCS C1713		038205025  -  SCREW BONE 5MM 25MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
38205030	SUP	HCPCS C1713		038205030  -  SCREW BONE 5MM 30MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
38205035	SUP	HCPCS C1713		038205035  -  SCREW BONE 5MM 35MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
38205040	SUP	HCPCS C1713		038205040  -  SCREW BONE 5MM 40MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
38205045	SUP	HCPCS C1713		038205045  -  SCREW BONE 5MM 45MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
38214020	SUP	HCPCS C1713		038214020  -  SCREW BONE 4MM 20MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
38214025	SUP	HCPCS C1713		038214025  -  SCREW BONE 4MM 25MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
38214030	SUP	HCPCS C1713		038214030  -  SCREW BONE 4MM 30MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
38214035	SUP	HCPCS C1713		038214035  -  SCREW BONE 4MM 35MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
38214040	SUP	HCPCS C1713		038214040  -  SCREW BONE 4MM 40MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
38215025	SUP	HCPCS C1713		038215025  -  SCREW BONE 5MM 25MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
38215030	SUP	HCPCS C1713		038215030  -  SCREW BONE 5MM 30MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
38215035	SUP	HCPCS C1713		038215035  -  SCREW BONE 5MM 35MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
38215040	SUP	HCPCS C1713		038215040  -  SCREW BONE 5MM 40MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	"$2,581.88"	"$2,581.88"	$0.00	$0.00	$0.00	"$1,195.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	"$2,828.59"	"$2,828.59"	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$897.92	$0.00	$0.00	$913.41	$0.00	$0.00	$0.00	$0.00	$0.00
38215045	SUP	HCPCS C1713		038215045  -  SCREW BONE 5MM 45MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	"$2,581.88"	"$2,581.88"	$0.00	$0.00	$0.00	"$1,195.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	"$2,828.59"	"$2,828.59"	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$897.92	$0.00	$0.00	$913.41	$0.00	$0.00	$0.00	$0.00	$0.00
40036170	SUP	Custom 27803010		61421  -  SPACER SPNL 21MMX14MM RYTFC UNT	BOTH IP/OP	"$8,031.25 "	"$5,943.13"	$0.00	"$6,425.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,673.71"	$0.00	$0.00	$0.00	$0.00	"$4,015.63"	"$6,360.75"	"$6,425.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48030022	SUP	HCPCS C1713		48030022  -  PLATE BONE 22MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$8,793.48 "	"$6,507.18"	$0.00	"$7,034.78"	"$3,957.06"	"$3,957.06"	$0.00	$0.00	$0.00	"$1,832.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,832.56"	$0.00	"$4,335.18"	"$4,335.18"	$0.00	"$4,396.74"	"$6,964.44"	"$7,034.78"	$0.00		$0.00	"$1,376.18"	$0.00	$0.00	"$1,399.92"	$0.00	$0.00	$0.00	$0.00	$0.00
48030025	SUP	HCPCS C1713		48030025  -  PLATE BONE 25MM NONCOMPRESSION 1 LEVEL THORACIC	BOTH IP/OP	"$8,793.48 "	"$6,507.18"	$0.00	"$7,034.78"	"$3,957.06"	"$3,957.06"	$0.00	$0.00	$0.00	"$1,832.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,832.56"	$0.00	"$4,335.18"	"$4,335.18"	$0.00	"$4,396.74"	"$6,964.44"	"$7,034.78"	$0.00		$0.00	"$1,376.18"	$0.00	$0.00	"$1,399.92"	$0.00	$0.00	$0.00	$0.00	$0.00
48030028	SUP	HCPCS C1713		48030028  -  PLATE BONE 28MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$8,793.48 "	"$6,507.18"	$0.00	"$7,034.78"	"$3,957.06"	"$3,957.06"	$0.00	$0.00	$0.00	"$1,832.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,832.56"	$0.00	"$4,335.18"	"$4,335.18"	$0.00	"$4,396.74"	"$6,964.44"	"$7,034.78"	$0.00		$0.00	"$1,376.18"	$0.00	$0.00	"$1,399.92"	$0.00	$0.00	$0.00	$0.00	$0.00
48030031	SUP	HCPCS C1713		48030031  -  PLATE BONE 31MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$8,793.48 "	"$6,507.18"	$0.00	"$7,034.78"	"$3,957.06"	"$3,957.06"	$0.00	$0.00	$0.00	"$1,832.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,832.56"	$0.00	"$4,335.18"	"$4,335.18"	$0.00	"$4,396.74"	"$6,964.44"	"$7,034.78"	$0.00		$0.00	"$1,376.18"	$0.00	$0.00	"$1,399.92"	$0.00	$0.00	$0.00	$0.00	$0.00
48030034	SUP	HCPCS C1713		48030034  -  PLATE BONE 34MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$8,793.48 "	"$6,507.18"	$0.00	"$7,034.78"	"$3,957.06"	"$3,957.06"	$0.00	$0.00	$0.00	"$1,832.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,832.56"	$0.00	"$4,335.18"	"$4,335.18"	$0.00	"$4,396.74"	"$6,964.44"	"$7,034.78"	$0.00		$0.00	"$1,376.18"	$0.00	$0.00	"$1,399.92"	$0.00	$0.00	$0.00	$0.00	$0.00
48030037	SUP	HCPCS C1713		48030037  -  PLATE BONE 37MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$8,793.48 "	"$6,507.18"	$0.00	"$7,034.78"	"$3,957.06"	"$3,957.06"	$0.00	$0.00	$0.00	"$1,832.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,832.56"	$0.00	"$4,335.18"	"$4,335.18"	$0.00	"$4,396.74"	"$6,964.44"	"$7,034.78"	$0.00		$0.00	"$1,376.18"	$0.00	$0.00	"$1,399.92"	$0.00	$0.00	$0.00	$0.00	$0.00
48030040	SUP	HCPCS C1713		48030040  -  PLATE BONE 40MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$8,793.48 "	"$6,507.18"	$0.00	"$7,034.78"	"$3,957.06"	"$3,957.06"	$0.00	$0.00	$0.00	"$1,832.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,832.56"	$0.00	"$4,335.18"	"$4,335.18"	$0.00	"$4,396.74"	"$6,964.44"	"$7,034.78"	$0.00		$0.00	"$1,376.18"	$0.00	$0.00	"$1,399.92"	$0.00	$0.00	$0.00	$0.00	$0.00
48030225	SUP	HCPCS C1713		48030225  -  SCREW BONE 6.5MM 22MM COMPRESSION SPN THORACIC	BOTH IP/OP	"$1,008.65 "	$746.40	$0.00	$806.92	$453.89	$453.89	$0.00	$0.00	$0.00	$210.23	$748.62	$748.62	$0.00	$0.00	$210.20	$0.00	$596.62	$596.62	$0.00	$504.33	$798.85	$806.92	$0.00		$0.00	$157.85	$0.00	$0.00	$160.58	$0.00	$0.00	$0.00	$0.00	$0.00
48030265	SUP	HCPCS C1713		48030265  -  PLATE BONE 65MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48030271	SUP	HCPCS C1713		48030271  -  PLATE BONE 71MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48030277	SUP	HCPCS C1713		48030277  -  PLATE BONE 77MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48030283	SUP	HCPCS C1713		48030283  -  PLATE BONE 83MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48030289	SUP	HCPCS C1713		48030289  -  PLATE BONE 89MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48030350	SUP	HCPCS C1713		48030350  -  SCREW BONE 6MM 35MM COMPRESSION SPN THORACIC	BOTH IP/OP	"$1,008.65 "	$746.40	$0.00	$806.92	$453.89	$453.89	$0.00	$0.00	$0.00	$210.23	$748.62	$748.62	$0.00	$0.00	$210.20	$0.00	$596.62	$596.62	$0.00	$504.33	$798.85	$806.92	$0.00		$0.00	$157.85	$0.00	$0.00	$160.58	$0.00	$0.00	$0.00	$0.00	$0.00
48032040	SUP	HCPCS C1713		48032040  -  PLATE BONE 40MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48032044	SUP	HCPCS C1713		48032044  -  PLATE BONE 44MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48032048	SUP	HCPCS C1713		48032048  -  PLATE BONE 48MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48032052	SUP	HCPCS C1713		48032052  -  PLATE BONE 52MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48032056	SUP	HCPCS C1713		48032056  -  PLATE BONE 56MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48032060	SUP	HCPCS C1713		48032060  -  PLATE BONE 60MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48032064	SUP	HCPCS C1713		48032064  -  PLATE BONE 64MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48032068	SUP	HCPCS C1713		48032068  -  PLATE BONE 68MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48032072	SUP	HCPCS C1713		48032072  -  PLATE BONE 72MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48032076	SUP	HCPCS C1713		48032076  -  PLATE BONE 76MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$12,217.15 "	"$9,040.69"	$0.00	"$9,773.72"	"$5,497.72"	"$5,497.72"	$0.00	$0.00	$0.00	"$2,546.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,546.05"	$0.00	"$6,023.05"	"$6,023.05"	$0.00	"$6,108.58"	"$9,675.98"	"$9,773.72"	$0.00		$0.00	"$1,911.98"	$0.00	$0.00	"$1,944.97"	$0.00	$0.00	$0.00	$0.00	$0.00
48032080	SUP	HCPCS C1713		48032080  -  PLATE BONE 80MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$13,963.70 "	"$10,333.14"	$0.00	"$11,170.96"	"$6,283.67"	"$6,283.67"	$0.00	$0.00	$0.00	"$2,910.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.04"	$0.00	"$6,884.10"	"$6,884.10"	$0.00	"$6,981.85"	"$11,059.25"	"$11,170.96"	$0.00		$0.00	"$2,185.32"	$0.00	$0.00	"$2,223.02"	$0.00	$0.00	$0.00	$0.00	$0.00
48032084	SUP	HCPCS C1713		48032084  -  PLATE BONE 84MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$13,963.70 "	"$10,333.14"	$0.00	"$11,170.96"	"$6,283.67"	"$6,283.67"	$0.00	$0.00	$0.00	"$2,910.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.04"	$0.00	"$6,884.10"	"$6,884.10"	$0.00	"$6,981.85"	"$11,059.25"	"$11,170.96"	$0.00		$0.00	"$2,185.32"	$0.00	$0.00	"$2,223.02"	$0.00	$0.00	$0.00	$0.00	$0.00
48032088	SUP	HCPCS C1713		48032088  -  PLATE BONE 88MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$13,963.70 "	"$10,333.14"	$0.00	"$11,170.96"	"$6,283.67"	"$6,283.67"	$0.00	$0.00	$0.00	"$2,910.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.04"	$0.00	"$6,884.10"	"$6,884.10"	$0.00	"$6,981.85"	"$11,059.25"	"$11,170.96"	$0.00		$0.00	"$2,185.32"	$0.00	$0.00	"$2,223.02"	$0.00	$0.00	$0.00	$0.00	$0.00
48032092	SUP	HCPCS C1713		48032092  -  PLATE BONE 92MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$13,963.70 "	"$10,333.14"	$0.00	"$11,170.96"	"$6,283.67"	"$6,283.67"	$0.00	$0.00	$0.00	"$2,910.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.04"	$0.00	"$6,884.10"	"$6,884.10"	$0.00	"$6,981.85"	"$11,059.25"	"$11,170.96"	$0.00		$0.00	"$2,185.32"	$0.00	$0.00	"$2,223.02"	$0.00	$0.00	$0.00	$0.00	$0.00
48032096	SUP	HCPCS C1713		48032096  -  PLATE BONE 96MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$13,963.70 "	"$10,333.14"	$0.00	"$11,170.96"	"$6,283.67"	"$6,283.67"	$0.00	$0.00	$0.00	"$2,910.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.04"	$0.00	"$6,884.10"	"$6,884.10"	$0.00	"$6,981.85"	"$11,059.25"	"$11,170.96"	$0.00		$0.00	"$2,185.32"	$0.00	$0.00	"$2,223.02"	$0.00	$0.00	$0.00	$0.00	$0.00
48032100	SUP	HCPCS C1713		48032100  -  PLATE BONE 100MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$13,963.70 "	"$10,333.14"	$0.00	"$11,170.96"	"$6,283.67"	"$6,283.67"	$0.00	$0.00	$0.00	"$2,910.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.04"	$0.00	"$6,884.10"	"$6,884.10"	$0.00	"$6,981.85"	"$11,059.25"	"$11,170.96"	$0.00		$0.00	"$2,185.32"	$0.00	$0.00	"$2,223.02"	$0.00	$0.00	$0.00	$0.00	$0.00
48034525	SUP	HCPCS C1713		48034525  -  PLATE BONE 25MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$9,160.23 "	"$6,778.57"	$0.00	"$7,328.18"	"$4,122.10"	"$4,122.10"	$0.00	$0.00	$0.00	"$1,909.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,908.99"	$0.00	"$4,515.99"	"$4,515.99"	$0.00	"$4,580.11"	"$7,254.90"	"$7,328.18"	$0.00		$0.00	"$1,433.58"	$0.00	$0.00	"$1,458.31"	$0.00	$0.00	$0.00	$0.00	$0.00
48034528	SUP	HCPCS C1713		48034528  -  PLATE BONE 28MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$9,160.23 "	"$6,778.57"	$0.00	"$7,328.18"	"$4,122.10"	"$4,122.10"	$0.00	$0.00	$0.00	"$1,909.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,908.99"	$0.00	"$4,515.99"	"$4,515.99"	$0.00	"$4,580.11"	"$7,254.90"	"$7,328.18"	$0.00		$0.00	"$1,433.58"	$0.00	$0.00	"$1,458.31"	$0.00	$0.00	$0.00	$0.00	$0.00
48034531	SUP	HCPCS C1713		48034531  -  PLATE BONE 31MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$9,160.23 "	"$6,778.57"	$0.00	"$7,328.18"	"$4,122.10"	"$4,122.10"	$0.00	$0.00	$0.00	"$1,909.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,908.99"	$0.00	"$4,515.99"	"$4,515.99"	$0.00	"$4,580.11"	"$7,254.90"	"$7,328.18"	$0.00		$0.00	"$1,433.58"	$0.00	$0.00	"$1,458.31"	$0.00	$0.00	$0.00	$0.00	$0.00
48034534	SUP	HCPCS C1713		48034534  -  PLATE BONE 34MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$9,160.23 "	"$6,778.57"	$0.00	"$7,328.18"	"$4,122.10"	"$4,122.10"	$0.00	$0.00	$0.00	"$1,909.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,908.99"	$0.00	"$4,515.99"	"$4,515.99"	$0.00	"$4,580.11"	"$7,254.90"	"$7,328.18"	$0.00		$0.00	"$1,433.58"	$0.00	$0.00	"$1,458.31"	$0.00	$0.00	$0.00	$0.00	$0.00
48034537	SUP	HCPCS C1713		48034537  -  PLATE BONE 37MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR	BOTH IP/OP	"$9,160.23 "	"$6,778.57"	$0.00	"$7,328.18"	"$4,122.10"	"$4,122.10"	$0.00	$0.00	$0.00	"$1,909.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,908.99"	$0.00	"$4,515.99"	"$4,515.99"	$0.00	"$4,580.11"	"$7,254.90"	"$7,328.18"	$0.00		$0.00	"$1,433.58"	$0.00	$0.00	"$1,458.31"	$0.00	$0.00	$0.00	$0.00	$0.00
48035125	SUP	HCPCS C1713		48035125  -  PLATE BONE 25MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM	BOTH IP/OP	"$9,160.23 "	"$6,778.57"	$0.00	"$7,328.18"	"$4,122.10"	"$4,122.10"	$0.00	$0.00	$0.00	"$1,909.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,908.99"	$0.00	"$4,515.99"	"$4,515.99"	$0.00	"$4,580.11"	"$7,254.90"	"$7,328.18"	$0.00		$0.00	"$1,433.58"	$0.00	$0.00	"$1,458.31"	$0.00	$0.00	$0.00	$0.00	$0.00
48035128	SUP	HCPCS C1713		48035128  -  PLATE BONE 28MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM	BOTH IP/OP	"$9,160.23 "	"$6,778.57"	$0.00	"$7,328.18"	"$4,122.10"	"$4,122.10"	$0.00	$0.00	$0.00	"$1,909.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,908.99"	$0.00	"$4,515.99"	"$4,515.99"	$0.00	"$4,580.11"	"$7,254.90"	"$7,328.18"	$0.00		$0.00	"$1,433.58"	$0.00	$0.00	"$1,458.31"	$0.00	$0.00	$0.00	$0.00	$0.00
48035131	SUP	HCPCS C1713		48035131  -  PLATE BONE 31MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM	BOTH IP/OP	"$9,160.23 "	"$6,778.57"	$0.00	"$7,328.18"	"$4,122.10"	"$4,122.10"	$0.00	$0.00	$0.00	"$1,909.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,908.99"	$0.00	"$4,515.99"	"$4,515.99"	$0.00	"$4,580.11"	"$7,254.90"	"$7,328.18"	$0.00		$0.00	"$1,433.58"	$0.00	$0.00	"$1,458.31"	$0.00	$0.00	$0.00	$0.00	$0.00
48035134	SUP	HCPCS C1713		48035134  -  PLATE BONE 34MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM	BOTH IP/OP	"$9,160.23 "	"$6,778.57"	$0.00	"$7,328.18"	"$4,122.10"	"$4,122.10"	$0.00	$0.00	$0.00	"$1,909.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,908.99"	$0.00	"$4,515.99"	"$4,515.99"	$0.00	"$4,580.11"	"$7,254.90"	"$7,328.18"	$0.00		$0.00	"$1,433.58"	$0.00	$0.00	"$1,458.31"	$0.00	$0.00	$0.00	$0.00	$0.00
48035137	SUP	HCPCS C1713		48035137  -  PLATE BONE 37MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM	BOTH IP/OP	"$9,160.23 "	"$6,778.57"	$0.00	"$7,328.18"	"$4,122.10"	"$4,122.10"	$0.00	$0.00	$0.00	"$1,909.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,908.99"	$0.00	"$4,515.99"	"$4,515.99"	$0.00	"$4,580.11"	"$7,254.90"	"$7,328.18"	$0.00		$0.00	"$1,433.58"	$0.00	$0.00	"$1,458.31"	$0.00	$0.00	$0.00	$0.00	$0.00
48035225	SUP	HCPCS C1713		48035225  -  SCREW BONE 6.5MM 22MM COMPRESSION THORACIC SPN	BOTH IP/OP	"$1,008.65 "	$746.40	$0.00	$806.92	$453.89	$453.89	$0.00	$0.00	$0.00	$210.23	$748.62	$748.62	$0.00	$0.00	$210.20	$0.00	$596.62	$596.62	$0.00	$504.33	$798.85	$806.92	$0.00		$0.00	$157.85	$0.00	$0.00	$160.58	$0.00	$0.00	$0.00	$0.00	$0.00
48035350	SUP	HCPCS C1713		48035350  -  SCREW BONE 6.5MM 35MM COMPRESSION THORACIC SPN	BOTH IP/OP	"$1,008.65 "	$746.40	$0.00	$806.92	$453.89	$453.89	$0.00	$0.00	$0.00	$210.23	$748.62	$748.62	$0.00	$0.00	$210.20	$0.00	$596.62	$596.62	$0.00	$504.33	$798.85	$806.92	$0.00		$0.00	$157.85	$0.00	$0.00	$160.58	$0.00	$0.00	$0.00	$0.00	$0.00
48130000	SUP	Custom 27803010		48130000  -  SCREW SET BLOCKER XIA TITANIUM SPN 4.5 MM ROD	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130110	SUP	HCPCS C1713		48130110  -  STAPLE BONE SMALL 4.5MM 2 XIA TITANIUM SPN CAUDAL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130111	SUP	HCPCS C1713		48130111  -  STAPLE BONE SMALL 4.5MM 2 XIA TITANIUM SPN ROSTRAL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130112	SUP	HCPCS C1713		48130112  -  STAPLE BONE LARGE 4.5MM 2 XIA TITANIUM SPN CAUDAL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130113	SUP	HCPCS C1713		48130113  -  STAPLE BONE LARGE 4.5MM 2 XIA TITANIUM SPN ROSTRAL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130201	SUP	Custom 27803010		48130201  -  HOOK SPINAL SMALL XIA TITANIUM LMNR 4.5MM ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130202	SUP	Custom 27803010		48130202  -  HOOK SPINAL MEDIUM XIA TITANIUM LMNR 4.5MM ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130203	SUP	Custom 27803010		48130203  -  HOOK SPINAL LARGE XIA TITANIUM LMNR 4.5MM ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130204	SUP	Custom 27803010		48130204  -  HOOK SPINAL EXTEND XIA TITANIUM LMNR 4.5 MM ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130208	SUP	Custom 27803010		48130208  -  HOOK SPINAL ANGLED BLADE XIA TITANIUM LMNR 4.5 MM ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130210	SUP	Custom 27803010		48130210  -  HOOK SPINAL XIA TITANIUM LMNR THORACIC 4.5 MM ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130212	SUP	Custom 27803010		48130212  -  HOOK SPINAL RIGHT OFFST XIA TITANIUM LMNR THORACIC 4.5 MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130213	SUP	Custom 27803010		48130213  -  HOOK SPINAL LEFT OFFST XIA TITANIUM LMNR THORACIC 4.5 MM ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130214	SUP	Custom 27803010		48130214  -  HOOK SPINAL RIGHT OFFST XIA TITANIUM SUPRA LMNR 4.5 MM ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130215	SUP	Custom 27803010		48130215  -  HOOK SPINAL LEFT OFFST XIA TITANIUM SUPRA LMNR 4.5 MM ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130220	SUP	Custom 27803010		48130220  -  HOOK SPINAL SMALL XIA TITANIUM PEDICLE 4.5MM ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130221	SUP	Custom 27803010		48130221  -  HOOK SPINAL LARGE XIA TITANIUM PEDICLE 4.5MM ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130230	SUP	Custom 27803010		48130230  -  HOOK SPINAL RIGHT OFFST TRNSVRS PROCESS XIA TITANIUM 4.5 MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48130231	SUP	Custom 27803010		48130231  -  HOOK SPINAL LEFT OFFST TRNSVRS PROCESS XIA TITANIUM 4.5 MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48132040	SUP	HCPCS C1713		48132040  -  ROD SPNL STRG 4.5MM 40MM XIA HEX VIT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
48132090	SUP	HCPCS C1713		48132090  -  ROD SPNL STRG 4.5MM 90MM XIA HEX VIT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
48132100	SUP	HCPCS C1713		48132100  -  ROD SPNL STRG 4.5MM 100MM XIA HEX VIT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
48132601	SUP	HCPCS C1713		48132601  -  ROD SPINAL 4.5MM 600MM XIA VITALLIUM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
48133012	SUP	HCPCS C1713		48133012  -  SCREW BONE 4.5MM 12MM CONCTR MONOBLOCK XIA TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133013	SUP	HCPCS C1713		48133013  -  SCREW BONE 4.5MM 13MM CONCTR MONOBLOCK XIA TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133014	SUP	HCPCS C1713		48133014  -  SCREW BONE 4.5MM 14MM CONCTR MONOBLOCK XIA TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133015	SUP	Custom 27803010		48133015  -  CROSSLINK SPINAL 15MM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133016	SUP	HCPCS C1713		48133016  -  SCREW BONE 4.5MM 16MM CONCTR MONOBLOCK XIA TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133017	SUP	HCPCS C1713		48133017  -  SCREW BONE 4.5MM 17MM CONCTR MONOBLOCK XIA TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133018	SUP	HCPCS C1713		48133018  -  SCREW BONE 4.5MM 18MM CONCTR MONOBLOCK XIA TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133019	SUP	HCPCS C1713		48133019  -  CONNECTOR ROD 4.5MM 19MM MONOBLOCK CROSSLINK XIA SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133021	SUP	HCPCS C1713		48133021  -  SCREW BONE 4.5MM 21MM CONCTR MONOBLOCK XIA TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133023	SUP	HCPCS C1713		48133023  -  SCREW BONE 4.5MM 23MM CONCTR MONOBLOCK XIA TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133024	SUP	HCPCS C1713		48133024  -  SCREW BONE 4.5MM 24MM CONCTR MONOBLOCK XIA TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133200	SUP	Custom 27803010		48133200  -  ROD SPINAL 5.5MM 40MM XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133224	SUP	Custom 27803010		48133224  -  CONNECTOR ROD SMALL 24-30MM POLYAX CROSS XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133230	SUP	Custom 27803010		48133230  -  CONNECTOR ROD MEDIUM 30-36MM POLYAX CROSS XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133236	SUP	Custom 27803010		48133236  -  CONNECTOR ROD LARGE 36-45MM CROSSLINK XIA TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133245	SUP	Custom 27803010		48133245  -  CONNECTOR ROD LARGE 45-60MM POLYAX CROSS XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48133480	SUP	Custom 27803010		48133480  -  ROD SPINAL 4.5MM 480MM XIA TITANIUM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48134020	SUP	HCPCS C1713		48134020  -  SCREW BONE 4MM 20MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48134025	SUP	HCPCS C1713		48134025  -  SCREW BONE 4MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48134030	SUP	HCPCS C1713		48134030  -  SCREW BONE 4MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48134035	SUP	HCPCS C1713		48134035  -  SCREW BONE 4MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48134040	SUP	HCPCS C1713		48134040  -  SCREW BONE 4MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48134520	SUP	HCPCS C1713		48134520  -  SCREW BONE 4.5MM 20MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48134525	SUP	HCPCS C1713		48134525  -  SCREW BONE 4.5MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48134530	SUP	HCPCS C1713		48134530  -  SCREW BONE 4.5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48134535	SUP	HCPCS C1713		48134535  -  SCREW BONE 4.5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48134540	SUP	HCPCS C1713		48134540  -  SCREW BONE 4.5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48134545	SUP	HCPCS C1713		48134545  -  SCREW BONE 4.5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135000	SUP	Custom 27803010		48135000  -  CONNECTOR ROD 4.5MM 30MM ROD TO ROD XIA TITANIUM SPN	BOTH IP/OP	"$1,819.65 "	"$1,346.54"	$0.00	"$1,455.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,350.54"	"$1,350.54"	$0.00	$0.00	$379.22	$0.00	$0.00	$0.00	$0.00	$909.83	"$1,441.16"	"$1,455.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135000	SUP	Custom 27803010		0048135000  -  CONNECTOR ROD 4.5MM 30MM ROD TO ROD XIA TITANIUM SPN	BOTH IP/OP	"$1,819.65 "	"$1,346.54"	$0.00	"$1,455.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,350.54"	"$1,350.54"	$0.00	$0.00	$379.22	$0.00	$0.00	$0.00	$0.00	$909.83	"$1,441.16"	"$1,455.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135001	SUP	Custom 27803010		48135001  -  CONNECTOR ROD 4.5MM 60MM XIA SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135003	SUP	Custom 27803010		48135003  -  CONNECTOR ROD 4.5-5.5/6MM ROD TO ROD PARALLEL XIA SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135004	SUP	Custom 27803010		48135004  -  CONNECTOR ROD 4.5-6MM ROD TO ROD XIA SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135005	SUP	Custom 27803010		48135005  -  CONNECTOR ROD SMALL 4.5MM ROD TO ROD PARALLEL XIA SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135006	SUP	Custom 27803010		48135006  -  CONNECTOR ROD LARGE 4.5MM ROD TO ROD PARALLEL XIA SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135008	SUP	Custom 27803010		48135008  -  CONNECTOR ROD 4.5-5.5/6MM ROD TO ROD PARALLEL XIA SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135020	SUP	HCPCS C1713		48135020  -  SCREW BONE 5MM 20MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135025	SUP	HCPCS C1713		48135025  -  SCREW BONE 5MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135030	SUP	HCPCS C1713		48135030  -  SCREW BONE 5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135035	SUP	HCPCS C1713		48135035  -  SCREW BONE 5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135040	SUP	HCPCS C1713		48135040  -  SCREW BONE 5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135045	SUP	HCPCS C1713		48135045  -  SCREW BONE 5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135050	SUP	HCPCS C1713		48135050  -  SCREW BONE 5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135055	SUP	HCPCS C1713		48135055  -  SCREW BONE 5MM 55MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135060	SUP	HCPCS C1713		48135060  -  SCREW BONE 5MM 60MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135070	SUP	HCPCS C1713		48135070  -  SCREW BONE 5MM 70MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135080	SUP	HCPCS C1713		48135080  -  SCREW BONE 5MM 80MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135101	SUP	Custom 27803010		48135101  -  CONNECTOR ROD 4.5MM 30MM OFFST XIA TITANIUM SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135102	SUP	Custom 27803010		48135102  -  CONNECTOR ROD 4.5MM 70MM OFFST XIA SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135103	SUP	Custom 27803010		48135103  -  CONNECTOR ROD SMALL EXTEND XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$3,032.78 "	"$2,244.26"	$0.00	"$2,426.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,250.93"	"$2,250.93"	$0.00	$0.00	$632.03	$0.00	$0.00	$0.00	$0.00	"$1,516.39"	"$2,401.96"	"$2,426.22"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135104	SUP	Custom 27803010		48135104  -  CONNECTOR ROD LONG 4.5MM EXTEND XIA SPN	BOTH IP/OP	"$3,032.78 "	"$2,244.26"	$0.00	"$2,426.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,250.93"	"$2,250.93"	$0.00	$0.00	$632.03	$0.00	$0.00	$0.00	$0.00	"$1,516.39"	"$2,401.96"	"$2,426.22"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135105	SUP	Custom 27803010		48135105  -  CONNECTOR ROD STR XIA TITANIUM ILIAC SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135106	SUP	Custom 27803010		48135106  -  CONNECTOR ROD 15D 4.5MM STR XIA SPN ILIAC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135107	SUP	Custom 27803010		48135107  -  CONNECTOR ROD 25D 4.5MM STR XIA SPN ILIAC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135108	SUP	Custom 27803010		48135108  -  CONNECTOR ROD 35D 4.5MM STR XIA SPN ILIAC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135109	SUP	Custom 27803010		48135109  -  CONNECTOR ROD 45D 4.5MM STR XIA SPN ILIAC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48135520	SUP	HCPCS C1713		48135520  -  SCREW BONE 5.5MM 20MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135525	SUP	HCPCS C1713		48135525  -  SCREW BONE 5.5MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135530	SUP	HCPCS C1713		48135530  -  SCREW BONE 5.5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135535	SUP	HCPCS C1713		48135535  -  SCREW BONE 5.5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135540	SUP	HCPCS C1713		48135540  -  SCREW BONE 5.5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135545	SUP	HCPCS C1713		48135545  -  SCREW BONE 5.5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135550	SUP	HCPCS C1713		48135550  -  SCREW BONE 5.5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135555	SUP	HCPCS C1713		48135555  -  SCREW BONE 5.5MM 55MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135560	SUP	HCPCS C1713		48135560  -  SCREW BONE 5.5MM 60MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135570	SUP	HCPCS C1713		48135570  -  SCREW BONE 5.5MM 70MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48135580	SUP	HCPCS C1713		48135580  -  SCREW BONE 5.5MM 80MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136025	SUP	HCPCS C1713		48136025  -  SCREW BONE 6MM 25MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136030	SUP	HCPCS C1713		48136030  -  SCREW BONE 6MM 30MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136035	SUP	HCPCS C1713		48136035  -  SCREW BONE 6MM 35MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136040	SUP	HCPCS C1713		48136040  -  SCREW BONE 6MM 40MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136045	SUP	HCPCS C1713		48136045  -  SCREW BONE 6MM 45MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136050	SUP	HCPCS C1713		48136050  -  SCREW BONE 6MM 50MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136055	SUP	HCPCS C1713		48136055  -  SCREW BONE 6MM 55MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136060	SUP	HCPCS C1713		48136060  -  SCREW BONE 6MM 60MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136070	SUP	HCPCS C1713		48136070  -  SCREW BONE 6MM 70MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136080	SUP	HCPCS C1713		48136080  -  SCREW BONE 6MM 80MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136530	SUP	HCPCS C1713		48136530  -  SCREW BONE 6.5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136535	SUP	HCPCS C1713		48136535  -  SCREW BONE 6.5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136540	SUP	HCPCS C1713		48136540  -  SCREW BONE 6.5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136545	SUP	HCPCS C1713		48136545  -  SCREW BONE 6.5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136550	SUP	HCPCS C1713		48136550  -  SCREW BONE 6.5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136555	SUP	HCPCS C1713		48136555  -  SCREW BONE 6.5MM 55MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136560	SUP	HCPCS C1713		48136560  -  SCREW BONE 6.5MM 60MM MNOAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136570	SUP	HCPCS C1713		48136570  -  SCREW BONE 6.5MM 70MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48136580	SUP	HCPCS C1713		48136580  -  SCREW BONE 6.5MM 80MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137030	SUP	HCPCS C1713		48137030  -  SCREW BONE 7MM 30MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137035	SUP	HCPCS C1713		48137035  -  SCREW BONE 7MM 35MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137040	SUP	HCPCS C1713		48137040  -  SCREW BONE 7MM 40MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137045	SUP	HCPCS C1713		48137045  -  SCREW BONE 7MM 45MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137050	SUP	HCPCS C1713		48137050  -  SCREW BONE 7MM 50MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137060	SUP	HCPCS C1713		48137060  -  SCREW BONE 7MM 60MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137070	SUP	HCPCS C1713		48137070  -  SCREW BONE 7MM 70MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137080	SUP	HCPCS C1713		48137080  -  SCREW BONE 7MM 80MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137530	SUP	HCPCS C1713		48137530  -  SCREW BONE 7.5MM 30MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137535	SUP	HCPCS C1713		48137535  -  SCREW BONE 7.5MM 35MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137540	SUP	HCPCS C1713		48137540  -  SCREW BONE 7.5MM 40MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137545	SUP	HCPCS C1713		48137545  -  SCREW BONE 7.5MM 45MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137550	SUP	HCPCS C1713		48137550  -  SCREW BONE 7.5MM 50MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137555	SUP	HCPCS C1713		48137555  -  SCREW BONE 7.5MM 55MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137560	SUP	HCPCS C1713		48137560  -  SCREW BONE 7.5MM 60MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137570	SUP	HCPCS C1713		48137570  -  SCREW BONE 7.5MM 70MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48137580	SUP	HCPCS C1713		48137580  -  SCREW BONE 7.5MM 80MM MNOAX XIA SPN 4.5MM ROD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
48144020	SUP	HCPCS C1713		48144020  -  SCREW BONE 4MM 20MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48144025	SUP	HCPCS C1713		48144025  -  SCREW BONE 4MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48144030	SUP	HCPCS C1713		48144030  -  SCREW BONE 4MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48144035	SUP	HCPCS C1713		48144035  -  SCREW BONE 4MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48144040	SUP	HCPCS C1713		48144040  -  SCREW BONE 4MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48144520	SUP	HCPCS C1713		48144520  -  SCREW BONE 4.5MM 20MM POLYAX XIA SPN 4.5MM ROD	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48144525	SUP	HCPCS C1713		48144525  -  SCREW BONE 4.5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48144530	SUP	HCPCS C1713		48144530  -  SCREW BONE 4.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48144535	SUP	HCPCS C1713		48144535  -  SCREW BONE 4.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48144540	SUP	HCPCS C1713		48144540  -  SCREW BONE 4.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48144545	SUP	HCPCS C1713		48144545  -  SCREW BONE 4.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48144560	SUP	HCPCS C1713		48144560  -  SCREW BONE 4.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48144570	SUP	HCPCS C1713		48144570  -  SCREW BONE 4.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145020	SUP	HCPCS C1713		48145020  -  SCREW BONE 5MM 20MM POLYAX XIA SPN 4.5MM ROD	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145025	SUP	HCPCS C1713		48145025  -  SCREW BONE 5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145030	SUP	HCPCS C1713		48145030  -  SCREW BONE 5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145035	SUP	HCPCS C1713		48145035  -  SCREW BONE 5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145040	SUP	HCPCS C1713		48145040  -  SCREW BONE 5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145045	SUP	HCPCS C1713		48145045  -  SCREW BONE 5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145050	SUP	HCPCS C1713		48145050  -  SCREW BONE 5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145055	SUP	HCPCS C1713		48145055  -  SCREW BONE 5MM 55MM POLYAX XIA SPN 4.5MM ROD	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145060	SUP	HCPCS C1713		48145060  -  SCREW BONE 5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145070	SUP	HCPCS C1713		48145070  -  SCREW BONE 5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145080	SUP	HCPCS C1713		48145080  -  SCREW BONE 5MM 80MM POLYAX XIA SPN 4.5MM ROD	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145520	SUP	HCPCS C1713		48145520  -  SCREW BONE 5.5MM 20MM POLYAX XIA SPN 4.5MM ROD	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145525	SUP	HCPCS C1713		48145525  -  SCREW BONE 5.5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145530	SUP	HCPCS C1713		48145530  -  SCREW BONE 5.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145535	SUP	HCPCS C1713		48145535  -  SCREW BONE 5.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145540	SUP	HCPCS C1713		48145540  -  SCREW BONE 5.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145545	SUP	HCPCS C1713		48145545  -  SCREW BONE 5.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145550	SUP	HCPCS C1713		48145550  -  SCREW BONE 5.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145555	SUP	HCPCS C1713		48145555  -  SCREW BONE 5.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145560	SUP	HCPCS C1713		48145560  -  SCREW BONE 5.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145570	SUP	HCPCS C1713		48145570  -  SCREW BONE 5.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48145580	SUP	HCPCS C1713		48145580  -  SCREW BONE 5.5MM 80MM POLYAX XIA SPN 4.5MM ROD	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146025	SUP	HCPCS C1713		48146025  -  SCREW BONE 6MM 25MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146030	SUP	HCPCS C1713		48146030  -  SCREW BONE 6MM 30MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146035	SUP	HCPCS C1713		48146035  -  SCREW BONE 6MM 35MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146040	SUP	HCPCS C1713		48146040  -  SCREW BONE 6MM 40MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146045	SUP	HCPCS C1713		48146045  -  SCREW BONE 6MM 45MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146050	SUP	HCPCS C1713		48146050  -  SCREW BONE 6MM 50MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146055	SUP	HCPCS C1713		48146055  -  SCREW BONE 6MM 55MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146060	SUP	HCPCS C1713		48146060  -  SCREW BONE 6MM 60MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146070	SUP	HCPCS C1713		48146070  -  SCREW BONE 6MM 70MM POLYAX XIA SPN 4.5MM ROD	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146080	SUP	HCPCS C1713		48146080  -  SCREW BONE 6MM 80MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146530	SUP	HCPCS C1713		48146530  -  SCREW BONE 6.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146535	SUP	HCPCS C1713		48146535  -  SCREW BONE 6.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146540	SUP	HCPCS C1713		48146540  -  SCREW BONE 6.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146545	SUP	HCPCS C1713		48146545  -  SCREW BONE 6.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146550	SUP	HCPCS C1713		48146550  -  SCREW BONE 6.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146555	SUP	HCPCS C1713		48146555  -  SCREW BONE 6.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146560	SUP	HCPCS C1713		48146560  -  SCREW BONE 6.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146570	SUP	HCPCS C1713		48146570  -  SCREW BONE 6.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48146580	SUP	HCPCS C1713		48146580  -  SCREW BONE 6.5MM 80MM POLYAX XIA SPN 4.5MM ROD	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147030	SUP	HCPCS C1713		48147030  -  SCREW BONE 7MM 30MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147035	SUP	HCPCS C1713		48147035  -  SCREW BONE 7MM 35MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147040	SUP	HCPCS C1713		48147040  -  SCREW BONE 7MM 40MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147045	SUP	HCPCS C1713		48147045  -  SCREW BONE 7MM 45MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147050	SUP	HCPCS C1713		48147050  -  SCREW BONE 7MM 50MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147055	SUP	HCPCS C1713		48147055  -  SCREW BONE 7MM 55MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147060	SUP	HCPCS C1713		48147060  -  SCREW BONE 7MM 60MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147070	SUP	HCPCS C1713		48147070  -  SCREW BONE 7MM 70MM POLYAX XIA SPN 4.5MM ROD	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147080	SUP	HCPCS C1713		48147080  -  SCREW BONE 7MM 80MM POLYAX XIA SPN 4.5MM ROD	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147530	SUP	HCPCS C1713		48147530  -  SCREW BONE 7.5MM 30MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147535	SUP	HCPCS C1713		48147535  -  SCREW BONE 7.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147540	SUP	HCPCS C1713		48147540  -  SCREW BONE 7.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147545	SUP	HCPCS C1713		48147545  -  SCREW BONE 7.5MM 45MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147550	SUP	HCPCS C1713		48147550  -  SCREW BONE 7.5MM 50MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147555	SUP	HCPCS C1713		48147555  -  SCREW BONE 7.5MM 55MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147560	SUP	HCPCS C1713		48147560  -  SCREW BONE 7.5MM 60MM POLYAX XIA TITANIUM THORACOLUMBAR SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147570	SUP	HCPCS C1713		48147570  -  SCREW BONE 7.5MM 70MM POLYAX XIA SPN 4.5MM ROD	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48147580	SUP	HCPCS C1713		48147580  -  SCREW BONE 7.5MM 80MM POLYAX XIA SPN 4.5MM ROD	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48200000	SUP	HCPCS C1713		48200000  -  BLOCKER SPINAL BLOCKER TECHTONIX LUMBAR SACRAL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
48200005	SUP	Custom 27803010		48200005  -  BLOCKER SPINAL 4.5MM BLOCKER TECHTONIX LUMBAR SACRAL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48200022	SUP	HCPCS C1713		48200022  -  PLATE BONE 22MM LEVEL 2 TECHTONIX TITANIUM SPN	BOTH IP/OP	"$3,306.20 "	"$2,446.59"	$0.00	"$2,644.96"	"$1,487.79"	"$1,487.79"	$0.00	$0.00	$0.00	$689.09	"$2,453.86"	"$2,453.86"	$0.00	$0.00	$689.01	$0.00	"$1,629.96"	"$1,629.96"	$0.00	"$1,653.10"	"$2,618.51"	"$2,644.96"	$0.00		$0.00	$517.42	$0.00	$0.00	$526.35	$0.00	$0.00	$0.00	$0.00	$0.00
48202234	SUP	HCPCS C1713		48202234  -  PLATE BONE 22-34MM LEVEL 2 TECHTONIX TITANIUM SPN	BOTH IP/OP	"$3,306.20 "	"$2,446.59"	$0.00	"$2,644.96"	"$1,487.79"	"$1,487.79"	$0.00	$0.00	$0.00	$689.09	"$2,453.86"	"$2,453.86"	$0.00	$0.00	$689.01	$0.00	"$1,629.96"	"$1,629.96"	$0.00	"$1,653.10"	"$2,618.51"	"$2,644.96"	$0.00		$0.00	$517.42	$0.00	$0.00	$526.35	$0.00	$0.00	$0.00	$0.00	$0.00
48202840	SUP	HCPCS C1713		48202840  -  PLATE BONE 28-40MM LEVEL 2 TECHTONIX TITANIUM SPN	BOTH IP/OP	"$3,306.20 "	"$2,446.59"	$0.00	"$2,644.96"	"$1,487.79"	"$1,487.79"	$0.00	$0.00	$0.00	$689.09	"$2,453.86"	"$2,453.86"	$0.00	$0.00	$689.01	$0.00	"$1,629.96"	"$1,629.96"	$0.00	"$1,653.10"	"$2,618.51"	"$2,644.96"	$0.00		$0.00	$517.42	$0.00	$0.00	$526.35	$0.00	$0.00	$0.00	$0.00	$0.00
48204658	SUP	HCPCS C1713		48204658  -  PLATE BONE 46-58MM LEVEL 2 TECHTONIX TITANIUM SPN	BOTH IP/OP	"$3,729.85 "	"$2,760.09"	$0.00	"$2,983.88"	"$1,678.43"	"$1,678.43"	$0.00	$0.00	$0.00	$777.39	"$2,768.29"	"$2,768.29"	$0.00	$0.00	$777.30	$0.00	"$1,838.82"	"$1,838.82"	$0.00	"$1,864.93"	"$2,954.04"	"$2,983.88"	$0.00		$0.00	$583.72	$0.00	$0.00	$593.79	$0.00	$0.00	$0.00	$0.00	$0.00
48213017	SUP	Custom 27803010		48213017  -  CONNECTOR ROD 17MM MONOBLOCK MAC TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48213020	SUP	Custom 27803010		48213020  -  CONNECTOR ROD 20MM MONOBLOCK MAC TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48213023	SUP	Custom 27803010		48213023  -  CONNECTOR ROD 23MM MULTIAX CROSS XIA MAC TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48213026	SUP	Custom 27803010		48213026  -  CONNECTOR ROD 26MM MULTIAX CROSS XIA MAC TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48213029	SUP	Custom 27803010		48213029  -  CONNECTOR ROD 29-31MM CROSS MAC TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48213031	SUP	Custom 27803010		48213031  -  CONNECTOR ROD SMALL 31-35MM MAC TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48213035	SUP	Custom 27803010		48213035  -  CONNECTOR ROD SMALL 35-40MM MAC TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48213038	SUP	Custom 27803010		48213038  -  CONNECTOR ROD STANDARD 39-43MM MAC TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48213042	SUP	Custom 27803010		48213042  -  CONNECTOR ROD 42MM MULTIAX CROSSLINK MAC TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48213050	SUP	Custom 27803010		48213050  -  CONNECTOR ROD 50MM MULTIAX CROSSLINK MAC TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48213066	SUP	Custom 27803010		48213066  -  CONNECTOR ROD 67-99MM MULTIAX CROSS XIA MAC TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48218030	SUP	Custom 27803010		48218030  -  ROD SPINAL 3.5IN RAD PREBENT 30MM XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48218035	SUP	Custom 27803010		48218035  -  ROD SPINAL 6MM 35MM RAD XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48218040	SUP	Custom 27803010		48218040  -  ROD SPINAL 3.5IN 40MM XIA RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48218045	SUP	Custom 27803010		48218045  -  ROD SPINAL 4.25IN RAD 6MM 45MM RAD XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48218050	SUP	Custom 27803010		48218050  -  ROD SPINAL 4.25IN RAD 6MM 50MM CVD XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48218060	SUP	Custom 27803010		48218060  -  ROD SPINAL 4.25IN RAD 6MM 60MM CVD XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48218070	SUP	Custom 27803010		48218070  -  ROD SPINAL 6MM 70MM RAD XIA RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48218080	SUP	Custom 27803010		48218080  -  ROD SPINAL 5IN RAD 5IN 80MM XIA	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48218090	SUP	Custom 27803010		48218090  -  ROD SPINAL 5IN RAD PREBENT 90MM XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48219050	SUP	Custom 27803010		48219050  -  ROD SPNL 50MM 6MM XIA TI RAD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48219060	SUP	Custom 27803010		48219060  -  ROD SPNL 60MM XIA TI 2 RAD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48219070	SUP	Custom 27803010		48219070  -  ROD SPNL 70MM XIA MXTI 2 RAD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48219080	SUP	Custom 27803010		48219080  -  ROD SPNL 80MM XIA TI 2 RAD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220000	SUP	Custom 27803010		48220000  -  SCREW SET BUTTRESS THREAD BLOCKER XIA STAINLESS STEEL	BOTH IP/OP	"$2,400.00 "	"$1,776.00"	$0.00	"$1,920.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,781.28"	"$1,781.28"	$0.00	$0.00	$500.16	$0.00	$0.00	$0.00	$0.00	"$1,200.00"	"$1,900.80"	"$1,920.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220100	SUP	HCPCS C1713		48220100  -  WASHER SPINAL XIA STAINLESS STEEL THORACOLUMBAR SPN SCOLIOS	BOTH IP/OP	$202.18 	$149.61	$0.00	$161.74	$90.98	$90.98	$0.00	$0.00	$0.00	$42.14	$150.05	$150.05	$0.00	$0.00	$42.13	$0.00	$119.59	$119.59	$0.00	$101.09	$160.13	$161.74	$0.00		$0.00	$31.64	$0.00	$0.00	$32.19	$0.00	$0.00	$0.00	$0.00	$0.00
48220101	SUP	Custom 27803010		48220101  -  CONNECTOR ROD OFFST XIA STAINLESS STEEL SCOLIOS	BOTH IP/OP	$556.50 	$411.81	$0.00	$445.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.03	$413.03	$0.00	$0.00	$115.97	$0.00	$0.00	$0.00	$0.00	$278.25	$440.75	$445.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220102	SUP	Custom 27803010		48220102  -  CONNECTOR ROD AXIAL OFFST XIA STAINLESS STEEL THORACOLUMBAR	BOTH IP/OP	"$1,001.30 "	$740.96	$0.00	$801.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$743.16	$743.16	$0.00	$0.00	$208.67	$0.00	$0.00	$0.00	$0.00	$500.65	$793.03	$801.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220103	SUP	Custom 27803010		48220103  -  CONNECTOR ROD AXIAL OFFST XIA STAINLESS STEEL THORACOLUMBAR	BOTH IP/OP	"$1,001.30 "	$740.96	$0.00	$801.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$743.16	$743.16	$0.00	$0.00	$208.67	$0.00	$0.00	$0.00	$0.00	$500.65	$793.03	$801.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220104	SUP	HCPCS C1713		48220104  -  STAPLE BONE XIA STAINLESS STEEL THORACOLUMBAR SPN SCOLIOS	BOTH IP/OP	$223.38 	$165.30	$0.00	$178.70	$100.52	$100.52	$0.00	$0.00	$0.00	$46.56	$165.79	$165.79	$0.00	$0.00	$46.55	$0.00	$132.13	$132.13	$0.00	$111.69	$176.92	$178.70	$0.00		$0.00	$34.96	$0.00	$0.00	$35.56	$0.00	$0.00	$0.00	$0.00	$0.00
48220110	SUP	HCPCS C1713		48220110  -  STAPLE BONE SMALL 2 HOLE XIA STAINLESS STEEL ANTERIOR CAUDAL	BOTH IP/OP	"$2,133.55 "	"$1,578.83"	$0.00	"$1,706.84"	$960.10	$960.10	$0.00	$0.00	$0.00	$444.69	"$1,583.52"	"$1,583.52"	$0.00	$0.00	$444.63	$0.00	"$1,261.99"	"$1,261.99"	$0.00	"$1,066.78"	"$1,689.77"	"$1,706.84"	$0.00		$0.00	$333.90	$0.00	$0.00	$339.66	$0.00	$0.00	$0.00	$0.00	$0.00
48220111	SUP	HCPCS C1713		48220111  -  STAPLE BONE SMALL 2 HOLE XIA STAINLESS STEEL ANTERIOR	BOTH IP/OP	"$2,133.55 "	"$1,578.83"	$0.00	"$1,706.84"	$960.10	$960.10	$0.00	$0.00	$0.00	$444.69	"$1,583.52"	"$1,583.52"	$0.00	$0.00	$444.63	$0.00	"$1,261.99"	"$1,261.99"	$0.00	"$1,066.78"	"$1,689.77"	"$1,706.84"	$0.00		$0.00	$333.90	$0.00	$0.00	$339.66	$0.00	$0.00	$0.00	$0.00	$0.00
48220112	SUP	HCPCS C1713		48220112  -  STAPLE BONE MEDIUM 2 HOLE XIA STAINLESS STEEL ANTERIOR	BOTH IP/OP	"$2,133.55 "	"$1,578.83"	$0.00	"$1,706.84"	$960.10	$960.10	$0.00	$0.00	$0.00	$444.69	"$1,583.52"	"$1,583.52"	$0.00	$0.00	$444.63	$0.00	"$1,261.99"	"$1,261.99"	$0.00	"$1,066.78"	"$1,689.77"	"$1,706.84"	$0.00		$0.00	$333.90	$0.00	$0.00	$339.66	$0.00	$0.00	$0.00	$0.00	$0.00
48220113	SUP	HCPCS C1713		48220113  -  STAPLE BONE MEDIUM 2 HOLE XIA STAINLESS STEEL ANTERIOR	BOTH IP/OP	"$2,133.55 "	"$1,578.83"	$0.00	"$1,706.84"	$960.10	$960.10	$0.00	$0.00	$0.00	$444.69	"$1,583.52"	"$1,583.52"	$0.00	$0.00	$444.63	$0.00	"$1,261.99"	"$1,261.99"	$0.00	"$1,066.78"	"$1,689.77"	"$1,706.84"	$0.00		$0.00	$333.90	$0.00	$0.00	$339.66	$0.00	$0.00	$0.00	$0.00	$0.00
48220114	SUP	HCPCS C1713		48220114  -  STAPLE BONE LARGE 2 HOLE XIA STAINLESS STEEL ANTERIOR CAUDAL	BOTH IP/OP	"$2,133.55 "	"$1,578.83"	$0.00	"$1,706.84"	$960.10	$960.10	$0.00	$0.00	$0.00	$444.69	"$1,583.52"	"$1,583.52"	$0.00	$0.00	$444.63	$0.00	"$1,261.99"	"$1,261.99"	$0.00	"$1,066.78"	"$1,689.77"	"$1,706.84"	$0.00		$0.00	$333.90	$0.00	$0.00	$339.66	$0.00	$0.00	$0.00	$0.00	$0.00
48220115	SUP	HCPCS C1713		48220115  -  STAPLE BONE LARGE 2 HOLE XIA STAINLESS STEEL ANTERIOR	BOTH IP/OP	"$2,133.55 "	"$1,578.83"	$0.00	"$1,706.84"	$960.10	$960.10	$0.00	$0.00	$0.00	$444.69	"$1,583.52"	"$1,583.52"	$0.00	$0.00	$444.63	$0.00	"$1,261.99"	"$1,261.99"	$0.00	"$1,066.78"	"$1,689.77"	"$1,706.84"	$0.00		$0.00	$333.90	$0.00	$0.00	$339.66	$0.00	$0.00	$0.00	$0.00	$0.00
48220130	SUP	Custom 27803010		48220130  -  CONNECTOR ROD 75D OFFST XIA STAINLESS STEEL SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220131	SUP	Custom 27803010		48220131  -  CONNECTOR ROD OFFST STAINLESS STEEL SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220132	SUP	Custom 27803010		48220132  -  CONNECTOR ROD 105D OFFST XIA STAINLESS STEEL SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220133	SUP	Custom 27803010		48220133  -  CONNECTOR ROD NEUTRAL LONG OFFST XIA STAINLESS STEEL SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220134	SUP	Custom 27803010		48220134  -  CONNECTOR ROD 0D SMALL PARALLEL XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220135	SUP	Custom 27803010		48220135  -  CONNECTOR ROD 30D SMALL ROD TO ROD XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220136	SUP	Custom 27803010		48220136  -  CONNECTOR ROD 0D LARGE ROD TO ROD XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220137	SUP	Custom 27803010		48220137  -  CONNECTOR ROD 30D LARGE ROD TO ROD XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220200	SUP	Custom 27803010		48220200  -  HOOK SPINAL SMALL STANDARD LAMINATE XIA STAINLESS STEEL LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220201	SUP	Custom 27803010		48220201  -  HOOK SPINAL SMALL NARROW XIA STAINLESS STEEL LMNR SCOLIOS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220202	SUP	Custom 27803010		48220202  -  HOOK SPINAL LARGE STANDARD BLADE XIA STAINLESS STEEL LAMINA	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220203	SUP	Custom 27203010		48220203  -  HOOK SURG LARGE NARROW BLADE XIA STAINLESS STEEL SPINAL LMNR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220204	SUP	Custom 27803010		48220204  -  HOOK SPINAL EXTENDED BODY XIA STAINLESS STEEL LMNR SCOLIOS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220205	SUP	Custom 27803010		48220205  -  HOOK SPINAL ANGLED BLADE XIA STAINLESS STEEL LMNR THORACIC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220206	SUP	Custom 27803010		48220206  -  HOOK SPINAL OFFST XIA STAINLESS STEEL RIGHT LMNR SCOLIOS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220207	SUP	Custom 27803010		48220207  -  HOOK SPINAL OFFST XIA LEFT LMNR SCOLIOS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220208	SUP	Custom 27803010		48220208  -  HOOK SPINAL ANGLED BLADE XIA STAINLESS STEEL LMNR THORACIC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220210	SUP	Custom 27803010		48220210  -  HOOK SPINAL STANDARD BLADE XIA STAINLESS STEEL LMNR SCOLIOS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220211	SUP	Custom 27803010		48220211  -  HOOK SPINAL NARROW BLADE XIA STAINLESS STEEL LMNR THORACIC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220212	SUP	Custom 27803010		48220212  -  HOOK SPINAL SMALL RIGHT OFFST XIA STAINLESS STEEL LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220213	SUP	Custom 27803010		48220213  -  HOOK SPINAL SMALL LEFT OFFST XIA STAINLESS STEEL LMNR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220214	SUP	Custom 27803010		48220214  -  HOOK SPINAL LARGE STANDARD RIGHT OFFST XIA STAINLESS STEEL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220215	SUP	Custom 27803010		48220215  -  HOOK SPINAL LARGE LEFT OFFST XIA STAINLESS STEEL LMNR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220220	SUP	Custom 27803010		48220220  -  HOOK SPINAL SMALL XIA PEDICLE SCOLIOS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220221	SUP	Custom 27803010		48220221  -  HOOK SPINAL LARGE XIA PEDICLE SCOLIOS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220230	SUP	Custom 27803010		48220230  -  HOOK SPINAL STANDARD TRNSVRS PROCESS XIA STAINLESS STEEL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220231	SUP	Custom 27803010		48220231  -  HOOK SPINAL LEFT OFFST TRNSVRS PROCESS XIA STAINLESS STEEL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220240	SUP	Custom 27203010		48220240  -  HOOK RETRACTION WIDE LAMINA RBH	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220241	SUP	Custom 27803010		48220241  -  HOOK SPINAL WIDE BLADE RED XIA STAINLESS STEEL LMNR THORACIC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220242	SUP	Custom 27203010		48220242  -  HOOK RETRACTION ANGLED LP	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220243	SUP	Custom 27803010		48220243  -  HOOK SPINAL RED NARROW BLADE XIA TITANIUM LMNR THORACIC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220244	SUP	Custom 27803010		48220244  -  HOOK SPINAL RED BLADE XIA STAINLESS STEEL PEDICLE SCOLIOS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220317	SUP	Custom 27803010		48220317  -  CONNECTOR ROD 17MM CROSS XIA MAC STAINLESS STEEL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220319	SUP	Custom 27803010		48220319  -  CONNECTOR ROD 19MM MULTIAX CROSS XIA MAC STAINLESS STEEL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220321	SUP	Custom 27803010		48220321  -  CONNECTOR ROD 21MM MOMO TYPE XIA MAC STAINLESS STEEL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220323	SUP	Custom 27803010		48220323  -  CONNECTOR ROD 23MM MULTIAX CROSS XIA STAINLESS STEEL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220326	SUP	Custom 27803010		48220326  -  CONNECTOR ROD 26MM MOMO TYPE XIA MAC STAINLESS STEEL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220329	SUP	Custom 27803010		48220329  -  CONNECTOR ROD 29MM MULTIAX MONO XIA STAINLESS STEEL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220331	SUP	Custom 27803010		48220331  -  CROSSLINK SPINAL 31-34MM MULTIAX XIA STAINLESS STEEL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220335	SUP	Custom 27803010		48220335  -  CONNECTOR ROD SMALL 35-37MM MULTIAX CROSS XIA STAINLESS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220338	SUP	Custom 27803010		48220338  -  CROSSLINK SPINAL 38-43MM MULTIAX XIA STAINLESS STEEL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220342	SUP	Custom 27803010		48220342  -  CONNECTOR ROD 42-51MM MULTIAX CROSS XIA MAC STAINLESS STEEL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220350	SUP	Custom 27803010		48220350  -  CONNECTOR ROD 50-67MM CROSSLINK XIA SPN SCOLIOS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48220425	SUP	HCPCS C1713		48220425  -  SCREW BONE 4.5MM 25MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220430	SUP	HCPCS C1713		48220430  -  SCREW BONE 4.5MM 30MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220435	SUP	HCPCS C1713		48220435  -  SCREW BONE 4.5MM 35MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220440	SUP	HCPCS C1713		48220440  -  SCREW BONE 4.5MM 40MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220445	SUP	HCPCS C1713		48220445  -  SCREW BONE 4.5MM 45MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220525	SUP	HCPCS C1713		48220525  -  SCREW BONE 5.5MM 25MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220530	SUP	HCPCS C1713		48220530  -  SCREW BONE 5.5MM 30MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48220535	SUP	HCPCS C1713		48220535  -  SCREW BONE 5.5MM 35MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48220540	SUP	HCPCS C1713		48220540  -  SCREW BONE 5.5MM 40MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48220545	SUP	HCPCS C1713		48220545  -  SCREW BONE 5.5MM 45MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220550	SUP	HCPCS C1713		48220550  -  SCREW BONE 5.5MM 50MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220555	SUP	HCPCS C1713		48220555  -  SCREW BONE 5.5MM 55MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220600	SUP	HCPCS C1713		48220600  -  SCREW BONE 6.5MM 100MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220630	SUP	HCPCS C1713		48220630  -  SCREW BONE 6.5MM 30MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220635	SUP	HCPCS C1713		48220635  -  SCREW BONE 6.5MM 35MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48220640	SUP	HCPCS C1713		48220640  -  SCREW BONE 6.5MM 40MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48220645	SUP	HCPCS C1713		48220645  -  SCREW BONE 6.5MM 45MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48220650	SUP	HCPCS C1713		48220650  -  SCREW BONE 6.5MM 50MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220655	SUP	HCPCS C1713		48220655  -  SCREW BONE 6.5MM 55MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220660	SUP	HCPCS C1713		48220660  -  SCREW BONE 6.5MM 60MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220670	SUP	HCPCS C1713		48220670  -  SCREW BONE 6.5MM 70MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220680	SUP	HCPCS C1713		48220680  -  SCREW BONE 6.5MM 80MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220690	SUP	HCPCS C1713		48220690  -  SCREW BONE 6.5MM 90MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220700	SUP	HCPCS C1713		48220700  -  SCREW BONE 7.5MM 100MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220730	SUP	HCPCS C1713		48220730  -  SCREW BONE 7.5MM 30MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220735	SUP	HCPCS C1713		48220735  -  SCREW BONE 7.5MM 35MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220740	SUP	HCPCS C1713		48220740  -  SCREW BONE 7.5MM 40MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48220745	SUP	HCPCS C1713		48220745  -  SCREW BONE 7.5MM 45MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48220750	SUP	HCPCS C1713		48220750  -  SCREW BONE 7.5MM 50MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220755	SUP	HCPCS C1713		48220755  -  SCREW BONE 7.5MM 55MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220760	SUP	HCPCS C1713		48220760  -  SCREW BONE 7.5MM 60MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220770	SUP	HCPCS C1713		48220770  -  SCREW BONE 7.5MM 70MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220780	SUP	HCPCS C1713		48220780  -  SCREW BONE 7.5MM 80MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220790	SUP	HCPCS C1713		48220790  -  SCREW BONE 7.5MM 90MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220800	SUP	HCPCS C1713		48220800  -  SCREW BONE 8.5MM 100MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220830	SUP	HCPCS C1713		48220830  -  SCREW BONE 8.5MM 30MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220835	SUP	HCPCS C1713		48220835  -  SCREW BONE 8.5MM 35MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220840	SUP	HCPCS C1713		48220840  -  SCREW BONE 8.5MM 40MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220845	SUP	HCPCS C1713		48220845  -  SCREW BONE 8.5MM 45MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220850	SUP	HCPCS C1713		48220850  -  SCREW BONE 8.5MM 50MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220855	SUP	HCPCS C1713		48220855  -  SCREW BONE 8.5MM 55MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220860	SUP	HCPCS C1713		48220860  -  SCREW BONE 8.5MM 60MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220870	SUP	HCPCS C1713		48220870  -  SCREW BONE 8.5MM 70MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220880	SUP	HCPCS C1713		48220880  -  SCREW BONE 8.5MM 80MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220890	SUP	HCPCS C1713		48220890  -  SCREW BONE 8.5MM 90MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220900	SUP	HCPCS C1713		48220900  -  SCREW BONE 9.5MM 100MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220960	SUP	HCPCS C1713		48220960  -  SCREW BONE 9.5MM 60MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220970	SUP	HCPCS C1713		48220970  -  SCREW BONE 9.5MM 70MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220980	SUP	HCPCS C1713		48220980  -  SCREW BONE 9.5MM 80MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48220990	SUP	HCPCS C1713		48220990  -  SCREW BONE 9.5MM 90MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
48221015	SUP	Custom 27803010		48221015  -  CONNECTOR ROD 15MM MULTIAX CROSS XIA MAC STAINLESS STEEL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48221016	SUP	Custom 27803010		48221016  -  CONNECTOR ROD 16MM MULTIAX CROSS XIA MAC STAINLESS STEEL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48221017	SUP	Custom 27803010		48221017  -  CONNECTOR ROD 17MM MULTIAX CROSS XIA MAC STAINLESS STEEL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48221018	SUP	Custom 27803010		48221018  -  CONNECTOR ROD 18MM MULTIAX CROSS XIA MAC STAINLESS STEEL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48221019	SUP	Custom 27803010		48221019  -  CONNECTOR ROD 19MM MULTIAX CROSS XIA MAC STAINLESS STEEL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48221020	SUP	Custom 27803010		48221020  -  CONNECTOR ROD 20MM MULTIAX CROSS XIA MAC STAINLESS STEEL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48221425	SUP	HCPCS C1713		48221425  -  SCREW BONE 4.5MM 25MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
48221430	SUP	HCPCS C1713		48221430  -  SCREW BONE 4.5MM 30MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
48221435	SUP	HCPCS C1713		48221435  -  SCREW BONE 4.5MM 35MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
48221440	SUP	HCPCS C1713		48221440  -  SCREW BONE 4.5MM 40MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
48221445	SUP	HCPCS C1713		48221445  -  SCREW BONE 4.5MM 45MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	"$2,581.88"	"$2,581.88"	$0.00	$0.00	$0.00	"$1,195.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	"$2,828.59"	"$2,828.59"	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$897.92	$0.00	$0.00	$913.41	$0.00	$0.00	$0.00	$0.00	$0.00
48221525	SUP	HCPCS C1713		48221525  -  SCREW BONE 5.5MM 25MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	"$2,581.88"	"$2,581.88"	$0.00	$0.00	$0.00	"$1,195.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	"$2,828.59"	"$2,828.59"	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$897.92	$0.00	$0.00	$913.41	$0.00	$0.00	$0.00	$0.00	$0.00
48221530	SUP	HCPCS C1713		48221530  -  SCREW BONE 5.5MM 30MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	"$2,581.88"	"$2,581.88"	$0.00	$0.00	$0.00	"$1,195.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	"$2,828.59"	"$2,828.59"	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$897.92	$0.00	$0.00	$913.41	$0.00	$0.00	$0.00	$0.00	$0.00
48221535	SUP	HCPCS C1713		48221535  -  SCREW BONE 5.5MM 35MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	"$2,581.88"	"$2,581.88"	$0.00	$0.00	$0.00	"$1,195.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	"$2,828.59"	"$2,828.59"	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$897.92	$0.00	$0.00	$913.41	$0.00	$0.00	$0.00	$0.00	$0.00
48221540	SUP	HCPCS C1713		48221540  -  SCREW BONE 5.5MM 40MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	"$2,581.88"	"$2,581.88"	$0.00	$0.00	$0.00	"$1,195.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	"$2,828.59"	"$2,828.59"	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$897.92	$0.00	$0.00	$913.41	$0.00	$0.00	$0.00	$0.00	$0.00
48221545	SUP	HCPCS C1713		48221545  -  SCREW BONE 5.5MM 45MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221550	SUP	HCPCS C1713		48221550  -  SCREW BONE 5.5MM 50MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221555	SUP	HCPCS C1713		48221555  -  SCREW BONE 5.5MM 55MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221600	SUP	HCPCS C1713		48221600  -  SCREW BONE 6.5MM 100MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221630	SUP	HCPCS C1713		48221630  -  SCREW BONE 6.5MM 30MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221635	SUP	HCPCS C1713		48221635  -  SCREW BONE 6.5MM 35MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221640	SUP	HCPCS C1713		48221640  -  SCREW BONE 6.5MM 40MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221645	SUP	HCPCS C1713		48221645  -  SCREW BONE 6.5MM 45MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221650	SUP	HCPCS C1713		48221650  -  SCREW BONE 6.5MM 50MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221655	SUP	HCPCS C1713		48221655  -  SCREW BONE 6.5MM 55MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221660	SUP	HCPCS C1713		48221660  -  SCREW BONE 6.5MM 60MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221670	SUP	HCPCS C1713		48221670  -  SCREW BONE 6.5MM 70MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221680	SUP	HCPCS C1713		48221680  -  SCREW BONE 6.5MM 80MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221690	SUP	HCPCS C1713		48221690  -  SCREW BONE 6.5MM 90MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221700	SUP	HCPCS C1713		48221700  -  SCREW BONE 7.5MM 100MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221730	SUP	HCPCS C1713		48221730  -  SCREW BONE 7.5MM 30MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221735	SUP	HCPCS C1713		48221735  -  SCREW BONE 7.5MM 35MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221740	SUP	HCPCS C1713		48221740  -  SCREW BONE 7.5MM 40MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221745	SUP	HCPCS C1713		48221745  -  SCREW BONE 7.5MM 45MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221750	SUP	HCPCS C1713		48221750  -  SCREW BONE 7.5MM 50MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221755	SUP	HCPCS C1713		48221755  -  SCREW BONE 7.5MM 55MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221760	SUP	HCPCS C1713		48221760  -  SCREW BONE 7.5MM 60MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221770	SUP	HCPCS C1713		48221770  -  SCREW BONE 7.5MM 70MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221780	SUP	HCPCS C1713		48221780  -  SCREW BONE 7.5MM 80MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48221790	SUP	HCPCS C1713		48221790  -  SCREW BONE 7.5MM 90MM POLYAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
48222000	SUP	Custom 27803010		48222000  -  ROD SPINAL STANDARD 5.5MM 480MM XIA STAINLESS STEEL SCOLIOS	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48222001	SUP	Custom 27803010		48222001  -  ROD SPINAL STANDARD 5.5MM 480MM STIFF XIA STAINLESS STEEL	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48222003	SUP	Custom 27803010		48222003  -  ROD SPNL 5.5MM 480MM NS XIA STF HEX SS	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48222600	SUP	Custom 27803010		48222600  -  ROD SPINAL STANDARD 600MM XIA STAINLESS STEEL SCOLIOS	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48222601	SUP	Custom 27803010		48222601  -  ROD SPINAL 600MM STIFF XIA STAINLESS STEEL SCOLIOS	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48222603	SUP	Custom 27803010		48222603  -  ROD SPNL 5.5MM 600MM NS XIA STF HEX SS	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48223425	SUP	HCPCS C1713		48223425  -  SCREW BONE 4.5MM 25MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$6,800.00 "	"$5,032.00"	$0.00	"$5,440.00"	"$3,060.00"	"$3,060.00"	$0.00	$0.00	$0.00	"$1,417.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,417.12"	$0.00	"$3,352.40"	"$3,352.40"	$0.00	"$3,400.00"	"$5,385.60"	"$5,440.00"	$0.00		$0.00	"$1,064.20"	$0.00	$0.00	"$1,082.56"	$0.00	$0.00	$0.00	$0.00	$0.00
48223430	SUP	HCPCS C1713		48223430  -  SCREW BONE 4.5MM 30MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$10,975.00 "	"$8,121.50"	$0.00	"$8,780.00"	"$4,938.75"	"$4,938.75"	$0.00	$0.00	$0.00	"$2,287.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,287.19"	$0.00	"$5,410.68"	"$5,410.68"	$0.00	"$5,487.50"	"$8,692.20"	"$8,780.00"	$0.00		$0.00	"$1,717.59"	$0.00	$0.00	"$1,747.22"	$0.00	$0.00	$0.00	$0.00	$0.00
48223435	SUP	HCPCS C1713		48223435  -  SCREW BONE 4.5MM 35MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48223440	SUP	HCPCS C1713		48223440  -  SCREW BONE 4.5MM 40MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48223445	SUP	HCPCS C1713		48223445  -  SCREW BONE 4.5MM 45MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48223530	SUP	HCPCS C1713		48223530  -  SCREW BONE 5.5MM 30MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48223535	SUP	HCPCS C1713		48223535  -  SCREW BONE 5.5MM 35MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48223540	SUP	HCPCS C1713		48223540  -  SCREW BONE 5.5MM 40MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48223545	SUP	HCPCS C1713		48223545  -  SCREW BONE 5.5MM 45MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48223550	SUP	HCPCS C1713		48223550  -  SCREW BONE 5.5MM 50MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48223630	SUP	HCPCS C1713		48223630  -  SCREW BONE 6.5MM 30MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48223635	SUP	HCPCS C1713		48223635  -  SCREW BONE 6.5MM 35MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48223640	SUP	HCPCS C1713		48223640  -  SCREW BONE 6.5MM 40MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48223645	SUP	HCPCS C1713		48223645  -  SCREW BONE 6.5MM 45MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48223650	SUP	HCPCS C1713		48223650  -  SCREW BONE 6.5MM 50MM UNIPLNR XIA STAINLESS STEEL SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48227201	SUP	Custom 27803010		48227201  -  HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48227202	SUP	Custom 27803010		48227202  -  HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48227203	SUP	Custom 27803010		48227203  -  HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48227211	SUP	Custom 27803010		48227211  -  HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48227220	SUP	Custom 27803010		48227220  -  HOOK SPINAL REDX LONG ARM STAINLESS STEEL PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48228425	SUP	HCPCS C1713		48228425  -  SCREW BONE 4.5MM 25MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228430	SUP	HCPCS C1713		48228430  -  SCREW BONE 4.5MM 30MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228435	SUP	HCPCS C1713		48228435  -  SCREW BONE 4.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228440	SUP	HCPCS C1713		48228440  -  SCREW BONE 4.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228445	SUP	HCPCS C1713		48228445  -  SCREW BONE 4.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228530	SUP	HCPCS C1713		48228530  -  SCREW BONE 5.5MM 30MM REDX MNOAX LONG ARM STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228535	SUP	HCPCS C1713		48228535  -  SCREW BONE 5.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228540	SUP	HCPCS C1713		48228540  -  SCREW BONE 5.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228545	SUP	HCPCS C1713		48228545  -  SCREW BONE 5.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228550	SUP	HCPCS C1713		48228550  -  SCREW BONE 5.5MM 50MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228555	SUP	HCPCS C1713		48228555  -  SCREW BONE 5.5MM 55MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228630	SUP	HCPCS C1713		48228630  -  SCREW BONE 6.5MM 30MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228635	SUP	HCPCS C1713		48228635  -  SCREW BONE 6.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228640	SUP	HCPCS C1713		48228640  -  SCREW BONE 6.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228645	SUP	HCPCS C1713		48228645  -  SCREW BONE 6.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228650	SUP	HCPCS C1713		48228650  -  SCREW BONE 6.5MM 50MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	"$1,313.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	"$3,105.90"	"$3,105.90"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
48228655	SUP	HCPCS C1713		48228655  -  SCREW BONE 6.5MM 55MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
48228660	SUP	HCPCS C1713		48228660  -  SCREW BONE 6.5MM 60MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
48228730	SUP	HCPCS C1713		48228730  -  SCREW BONE 7.5MM 30MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
48228735	SUP	HCPCS C1713		48228735  -  SCREW BONE 7.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
48228740	SUP	HCPCS C1713		48228740  -  SCREW BONE 7.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
48228745	SUP	HCPCS C1713		48228745  -  SCREW BONE 7.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
48228750	SUP	HCPCS C1713		48228750  -  SCREW BONE 7.5MM 50MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
48228755	SUP	HCPCS C1713		48228755  -  SCREW BONE 7.5MM 55MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
48228760	SUP	HCPCS C1713		48228760  -  SCREW BONE 7.5MM 60MM REDX LONG ARM MNOAX STAINLESS STEEL	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
48229425	SUP	HCPCS C1713		48229425  -  SCREW BONE LONG ARM 4.5MM 25MM POLYAX REDX XIA STAINLESS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48229430	SUP	HCPCS C1713		48229430  -  SCREW BONE 4.5MM 30MM REDX LONG ARM POLYAX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229435	SUP	HCPCS C1713		48229435  -  SCREW BONE 4.5MM 35MM REDX LONG ARM POLYAX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229440	SUP	HCPCS C1713		48229440  -  SCREW BONE 4.5MM 40MM REDX LONG ARM POLYAX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229445	SUP	HCPCS C1713		48229445  -  SCREW BONE LONG ARM 4.5MM 45MM POLYAX REDX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229530	SUP	HCPCS C1713		48229530  -  SCREW BONE 5.5MM 30MM REDX LONG ARM POLYAX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229535	SUP	HCPCS C1713		48229535  -  SCREW BONE 5.5MM 35MM REDX LONG ARM POLYAX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229540	SUP	HCPCS C1713		48229540  -  SCREW BONE 5.5MM 40MM REDX LONG ARM POLYAX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229545	SUP	HCPCS C1713		48229545  -  SCREW BONE LONG ARM 5.5MM 45MM POLYAX REDX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229550	SUP	HCPCS C1713		48229550  -  SCREW BONE LONG ARM 5.5MM 50MM POLYAX REDX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229555	SUP	HCPCS C1713		48229555  -  SCREW BONE LONG ARM 5.5MM 55MM POLYAX REDX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229630	SUP	HCPCS C1713		48229630  -  SCREW BONE 6.5MM 30MM REDX LONG ARM POLYAX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229635	SUP	HCPCS C1713		48229635  -  SCREW BONE 6.5MM 35MM REDX LONG ARM POLYAX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229640	SUP	HCPCS C1713		48229640  -  SCREW BONE 6.5MM 40MM REDX LONG ARM POLYAX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229645	SUP	HCPCS C1713		48229645  -  SCREW BONE 6.5MM 45MM REDX LONG ARM POLYAX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229650	SUP	HCPCS C1713		48229650  -  SCREW BONE 6.5MM 50MM REDX LONG ARM POLYAX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229655	SUP	HCPCS C1713		48229655  -  SCREW BONE 6.5MM 55MM REDX LONG ARM POLYAX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229660	SUP	HCPCS C1713		48229660  -  SCREW BONE LONG ARM 6.5MM 60MM POLYAX REDX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229730	SUP	HCPCS C1713		48229730  -  SCREW BONE LONG ARM 7.5MM 30MM POLYAX REDX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229735	SUP	HCPCS C1713		48229735  -  SCREW BONE LONG ARM 7.5MM 35MM POLYAX REDX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229740	SUP	HCPCS C1713		48229740  -  SCREW BONE LONG ARM 7.5MM 40MM POLYAX REDX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229745	SUP	HCPCS C1713		48229745  -  SCREW BONE LONG ARM 7.5MM 45MM POLYAX REDX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229750	SUP	HCPCS C1713		48229750  -  SCREW BONE LONG ARM 7.5MM 50MM POLYAX REDX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229755	SUP	HCPCS C1713		48229755  -  SCREW BONE LONG ARM 7.5MM 55MM POLYAX REDX XIA STAINLESS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48229760	SUP	HCPCS C1713		48229760  -  BLOCKER SPNL XIA 3 TI SPNE	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
48230000	SUP	Custom 27803010		48230000  -  SCREW SET BLOCKER XIA 3 TITANIUM SPN	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230133	SUP	Custom 27803010		48230133  -  CONNECTOR ROD LARGE OFFST ILIAC PELVIC	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230138	SUP	Custom 27803010		48230138  -  CONNECTOR ROD SMALL REVISION OFFST ILIOSACRAL SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230139	SUP	Custom 27803010		48230139  -  CONNECTOR ROD LONG REVISION OFFST XIA 3 ILIOSACRAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230141	SUP	Custom 27803010		48230141  -  CONNECTOR ROD SMALL 7MM REVISION ROD TO ROD PARALLEL XIA 3	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230143	SUP	Custom 27803010		48230143  -  CONNECTOR ROD REVISION J HOOK OFFST ILIOSACRAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230144	SUP	Custom 27803010		48230144  -  CONNECTOR ROD REVISION OFFST ILIOSACRAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230201	SUP	Custom 27803010		48230201  -  HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230202	SUP	Custom 27803010		48230202  -  HOOK SPINAL LARGE XIA TITANIUM LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230203	SUP	Custom 27803010		48230203  -  HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230204	SUP	Custom 27803010		48230204  -  HOOK SPINAL EXTENDED BODY XIA TITANIUM LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230205	SUP	Custom 27803010		48230205  -  HOOK SPINAL EXTENDED BODY XIA 3 TITANIUM LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230206	SUP	Custom 27803010		48230206  -  HOOK SPINAL RIGHT OFFST XIA LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230207	SUP	Custom 27803010		48230207  -  HOOK SPINAL LEFT OFFST XIA LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230208	SUP	Custom 27803010		48230208  -  HOOK SPINAL ANGLED BLADE XIA TITANIUM LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230209	SUP	Custom 27803010		48230209  -  HOOK SPINAL ANGLED BLADE XIA TITANIUM LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230210	SUP	Custom 27803010		48230210  -  HOOK SPINAL OPEN XIA THORACIC	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230211	SUP	Custom 27803010		48230211  -  HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR THORACIC	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230212	SUP	Custom 27803010		48230212  -  HOOK SPINAL XIA RIGHT LMNR THORACIC	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230213	SUP	Custom 27803010		48230213  -  HOOK SPINAL XIA LEFT LMNR THORACIC	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230214	SUP	Custom 27803010		48230214  -  HOOK SPINAL LARGE OFFST XIA 3 TITANIUM RIGHT LMNR THORACIC	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230215	SUP	Custom 27803010		48230215  -  HOOK SPINAL LARGE OFFST XIA 3 TITANIUM LEFT LMNR THORACIC	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230216	SUP	Custom 27803010		48230216  -  HOOK SPINAL SMALL XIA TITANIUM LMNR THORACIC	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230217	SUP	Custom 27803010		48230217  -  HOOK SPNL XIA LG TI RIGHT OFFST	BOTH IP/OP	"$2,687.35 "	"$1,988.64"	$0.00	"$2,149.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,994.55"	"$1,994.55"	$0.00	$0.00	$560.04	$0.00	$0.00	$0.00	$0.00	"$1,343.68"	"$2,128.38"	"$2,149.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230218	SUP	Custom 27803010		48230218  -  HOOK SPNL XIA LG TI LEFT OFFST	BOTH IP/OP	"$2,687.35 "	"$1,988.64"	$0.00	"$2,149.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,994.55"	"$1,994.55"	$0.00	$0.00	$560.04	$0.00	$0.00	$0.00	$0.00	"$1,343.68"	"$2,128.38"	"$2,149.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230220	SUP	Custom 27803010		48230220  -  HOOK SPINAL SMALL XIA TITANIUM PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230221	SUP	Custom 27803010		48230221  -  HOOK SPINAL MEDIUM XIA TITANIUM PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230222	SUP	Custom 27803010		48230222  -  HOOK SPINAL LARGE XIA TITANIUM PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230230	SUP	HCPCS C1713		48230230  -  WIRE FIX SHARP CANN KWIRE SPN	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48230231	SUP	HCPCS C1713		48230231  -  WIRE FIX BLUNT KWIRE	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48230232	SUP	Custom 27803010		48230232  -  HOOK SPINAL TRNSVRS PROCESS XIA TITANIUM RIGHT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230233	SUP	Custom 27803010		48230233  -  HOOK SPINAL TRNSVRS PROCESS XIA TITANIUM LEFT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230240	SUP	Custom 27803010		48230240  -  HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230241	SUP	Custom 27803010		48230241  -  HOOK SPINAL XIA TITANIUM LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230250	SUP	Custom 27803010		48230250  -  HOOK SPINAL MEDIUM LMNR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230260	SUP	Custom 27803010		48230260  -  HOOK SPINAL REVISION ILIOSACRAL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48231535	SUP	HCPCS C1713		48231535  -  SCREW BONE 5.5MM 35MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231540	SUP	HCPCS C1713		48231540  -  SCREW BONE 5.5MM 40MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231545	SUP	HCPCS C1713		48231545  -  SCREW BONE 5.5MM 45MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231550	SUP	HCPCS C1713		48231550  -  SCREW BONE 5.5MM 50MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231630	SUP	HCPCS C1713		48231630  -  SCREW BONE 6.5MM 30MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231635	SUP	HCPCS C1713		48231635  -  SCREW BONE 6.5MM 35MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231640	SUP	HCPCS C1713		48231640  -  SCREW BONE 6.5MM 40MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231645	SUP	HCPCS C1713		48231645  -  SCREW BONE 6.5MM 45MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231650	SUP	HCPCS C1713		48231650  -  SCREW BONE 6.5MM 50MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231655	SUP	HCPCS C1713		48231655  -  SCREW BN 6.5MM 50MM XIA 3 PA TI SPNE THORLMBR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231730	SUP	HCPCS C1713		48231730  -  SCREW BONE 7.5MM 30MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231735	SUP	HCPCS C1713		48231735  -  SCREW BONE 7.5MM 35MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231740	SUP	HCPCS C1713		48231740  -  SCREW BONE 7.5MM 40MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231745	SUP	HCPCS C1713		48231745  -  SCREW BN 7.5MM 45MM XIA 3 PA TI SPNE THORLMBR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231750	SUP	HCPCS C1713		48231750  -  SCREW BONE 7.5MM 50MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48231755	SUP	HCPCS C1713		48231755  -  SCREW BN 7.5MM 50MM XIA CNN TI SPNE THORLMBR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
48232030	SUP	Custom 27803010		48232030  -  ROD SPINAL 6MM 30MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232040	SUP	Custom 27803010		48232040  -  ROD SPINAL 40MM XIA	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232050	SUP	Custom 27803010		48232050  -  ROD SPINAL 6MM 50MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232060	SUP	Custom 27803010		48232060  -  ROD SPINAL 6MM 60MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232070	SUP	Custom 27803010		48232070  -  ROD SPINAL 6MM 70MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232080	SUP	Custom 27803010		48232080  -  ROD SPINAL 6MM 80MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232090	SUP	Custom 27803010		48232090  -  ROD SPINAL 6MM 90MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232100	SUP	Custom 27803010		48232100  -  ROD SPINAL 6MM 100MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232110	SUP	Custom 27803010		48232110  -  ROD SPINAL 6MM 110MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232120	SUP	Custom 27803010		48232120  -  ROD SPINAL 6MM 120MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232130	SUP	Custom 27803010		48232130  -  ROD SPINAL 6MM 130MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232140	SUP	Custom 27803010		48232140  -  ROD SPINAL 6MM 140MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232150	SUP	Custom 27803010		48232150  -  ROD SPINAL 6MM 30MM XIA 3 TITANIUM RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232480	SUP	Custom 27803010		48232480  -  ROD SPINAL 6MM 480MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48232600	SUP	Custom 27803010		48232600  -  ROD SPINAL 6MM 600MM COMPRESSION XIA TITANIUM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233030	SUP	Custom 27803010		48233030  -  ROD SPINAL 6MM 30MM XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233040	SUP	Custom 27803010		48233040  -  ROD SPINAL 6MM 40MM XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233050	SUP	Custom 27803010		48233050  -  ROD SPINAL 6MM 50MM XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233060	SUP	Custom 27803010		48233060  -  ROD SPINAL 6MM 60MM XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233070	SUP	Custom 27803010		48233070  -  ROD SPINAL 6MM 70MM XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233080	SUP	Custom 27803010		48233080  -  ROD SPINAL 6MM 80MM XIA TITANIUM ALLOY	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233090	SUP	Custom 27803010		48233090  -  ROD SPINAL 6MM 90MM XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233100	SUP	Custom 27803010		48233100  -  ROD SPINAL 100MM STR DIAPASON XIA	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233110	SUP	Custom 27803010		48233110  -  ROD SPINAL 110MM STR DIAPASON XIA	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233120	SUP	Custom 27803010		48233120  -  ROD SPINAL 6MM 120MM XIA TITANIUM ALLOY	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233130	SUP	Custom 27803010		48233130  -  ROD SPINAL 6MM 13MM XIA TITANIUM ALLOY	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233140	SUP	Custom 27803010		48233140  -  ROD SPINAL 6MM 14MM XIA TITANIUM ALLOY	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233150	SUP	Custom 27803010		48233150  -  ROD SPINAL 6MM 15MM XIA TITANIUM ALLOY	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233420	SUP	HCPCS C1713		48233420  -  SCREW BONE 4.5MM 20MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233425	SUP	HCPCS C1713		48233425  -  SCREW BONE 4.5MM 25MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233430	SUP	HCPCS C1713		48233430  -  SCREW BONE 4.5MM 30MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233435	SUP	HCPCS C1713		48233435  -  SCREW BONE 4.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233440	SUP	HCPCS C1713		48233440  -  SCREW BONE 4.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233445	SUP	HCPCS C1713		48233445  -  SCREW BONE 4.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233480	SUP	HCPCS C1713		48233480  -  ROD SPINAL 6MM 480MM XIA 3	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
48233500	SUP	HCPCS C1713		48233500  -  SCREW SET M6 NS XIA 3 SPNE	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233520	SUP	HCPCS C1713		48233520  -  SCREW BONE 5.5MM 20MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233525	SUP	HCPCS C1713		48233525  -  SCREW BONE 5.5MM 25MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233530	SUP	HCPCS C1713		48233530  -  SCREW BONE 5.5MM 30MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233535	SUP	HCPCS C1713		48233535  -  SCREW BONE 5.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233540	SUP	HCPCS C1713		48233540  -  SCREW BONE 5.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233545	SUP	HCPCS C1713		48233545  -  SCREW BONE 5.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233550	SUP	HCPCS C1713		48233550  -  SCREW BONE 5.5MM 50MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233555	SUP	HCPCS C1713		48233555  -  SCREW BONE 5.5MM 55MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233600	SUP	Custom 27803010		48233600  -  ROD SPINAL 6MM 60MM XIA TITANIUM ALLOY	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48233625	SUP	HCPCS C1713		48233625  -  SCREW BONE 6.5MM 25MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233630	SUP	HCPCS C1713		48233630  -  SCREW BONE 6.5MM 30MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233635	SUP	HCPCS C1713		48233635  -  SCREW BONE 6.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233640	SUP	HCPCS C1713		48233640  -  SCREW BONE 6.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233645	SUP	HCPCS C1713		48233645  -  SCREW BONE 6.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233650	SUP	HCPCS C1713		48233650  -  SCREW BONE 6.5MM 50MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233655	SUP	HCPCS C1713		48233655  -  SCREW BONE 6.5MM 55MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233660	SUP	HCPCS C1713		48233660  -  SCREW BONE 6.5MM 60MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233730	SUP	HCPCS C1713		48233730  -  SCREW BONE 7.5MM 30MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233735	SUP	HCPCS C1713		48233735  -  SCREW BONE 7.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233740	SUP	HCPCS C1713		48233740  -  SCREW BONE 7.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233745	SUP	HCPCS C1713		48233745  -  SCREW BONE 7.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233750	SUP	HCPCS C1713		48233750  -  SCREW BONE 7.5MM 50MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233755	SUP	HCPCS C1713		48233755  -  SCREW BONE 7.5MM 55MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48233760	SUP	HCPCS C1713		48233760  -  SCREW BONE 7.5MM 60MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48235007	SUP	HCPCS C1713		48235007  -  SCREW BONE REVISION SPN ILIOSACRAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
48235008	SUP	Custom 27803010		48235008  -  CONNECTOR ROD REVISION ILIOSACRAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48235009	SUP	Custom 27803010		48235009  -  CONNECTOR ROD LARGE PARALLEL 11MM XIA 3 TITANIUM SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48235010	SUP	HCPCS C1713		48235010  -  SCREW BONE REVISION PARALLEL ILIOSACRAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
48235011	SUP	Custom 27803010		48235011  -  CONNECTOR ROD REVISION ROD TO ROD PARALLEL ILIOSACRAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48235012	SUP	Custom 27803010		48235012  -  CONNECTOR ROD REVISION ROD TO ROD ILIOSACRAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236014	SUP	Custom 27803010		48236014  -  CROSSLINK SPINAL 14MM MONOBLOCK XIA TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236015	SUP	Custom 27803010		48236015  -  CROSSLINK SPINAL 15MM MONOBLOCK XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236016	SUP	Custom 27803010		48236016  -  CROSSLINK SPINAL 16MM MONOBLOCK XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236017	SUP	Custom 27803010		48236017  -  CROSSLINK SPINAL 17MM MONOBLOCK XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236018	SUP	Custom 27803010		48236018  -  CROSSLINK SPINAL 18MM MONOBLOCK XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236019	SUP	Custom 27803010		48236019  -  CROSSLINK SPINAL 19MM MONOBLOCK XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236020	SUP	Custom 27803010		48236020  -  CROSSLINK SPINAL 20MM MONOBLOCK XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236022	SUP	Custom 27803010		48236022  -  CROSSLINK SPINAL 22MM MONOBLOCK XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236024	SUP	Custom 27803010		48236024  -  CROSSLINK SPINAL 24MM MONOBLOCK XIA TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236026	SUP	HCPCS C1713		48236026  -  SCREW BONE 26MM MONOBLOCK SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236028	SUP	Custom 27803010		48236028  -  CONNECTOR ROD 28-31MM MULTIAX CROSS XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236030	SUP	Custom 27803010		48236030  -  CONNECTOR ROD 35-44MM XIA 3 MA CX TI THORLMBR SPNE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236035	SUP	Custom 27803010		48236035  -  CONNECTOR ROD 35-44MM MULTIAX CROSS XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236043	SUP	Custom 27803010		48236043  -  CONNECTOR ROD 70-99MM XIA 3 MA CX TI THORLMBR SPNE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236053	SUP	Custom 27803010		48236053  -  CONNECTOR ROD 53-73MM MULTIAX CROSS XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236070	SUP	HCPCS C1713		48236070  -  CONNECTOR ROD 70-99MM MULTIAX CROSS XIA 3 TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48236540	SUP	HCPCS C1713		48236540  -  SCREW BONE 6.5MM 40MM REVISION ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48236550	SUP	HCPCS C1713		48236550  -  SCREW BONE 6.5MM 50MM REVISION ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48236560	SUP	HCPCS C1713		48236560  -  SCREW BONE 6.5MM 60MM REVISION ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48237105	SUP	Custom 27203010		48237105  -  NEEDLE BIOP 10GA 5IN JAMSHIDI	BOTH IP/OP	$73.55 	$54.43	$0.00	$58.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.59	$54.59	$0.00	$0.00	$15.33	$0.00	$0.00	$0.00	$0.00	$36.78	$58.25	$58.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48237110	SUP	Custom 27203010		48237110  -  BLADE SURG 10GA 9IN JAMSHIDI	BOTH IP/OP	$73.55 	$54.43	$0.00	$58.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.59	$54.59	$0.00	$0.00	$15.33	$0.00	$0.00	$0.00	$0.00	$36.78	$58.25	$58.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48237115	SUP	HCPCS C1713		48237115  -  WIRE FIX JAMSHIDI SPN	BOTH IP/OP	$73.55 	$54.43	$0.00	$58.84	$33.10	$33.10	$0.00	$0.00	$0.00	$15.33	$54.59	$54.59	$0.00	$0.00	$15.33	$0.00	$43.50	$43.50	$0.00	$36.78	$58.25	$58.84	$0.00		$0.00	$11.51	$0.00	$0.00	$11.71	$0.00	$0.00	$0.00	$0.00	$0.00
48237135	SUP	Custom 27203010		48237135  -  NEEDLE BIOP 13GA 5IN	BOTH IP/OP	$73.55 	$54.43	$0.00	$58.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.59	$54.59	$0.00	$0.00	$15.33	$0.00	$0.00	$0.00	$0.00	$36.78	$58.25	$58.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48237540	SUP	HCPCS C1713		48237540  -  SCREW BONE 7.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48237550	SUP	HCPCS C1713		48237550  -  SCREW BONE 7.5MM 50MM REVISION ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48237560	SUP	HCPCS C1713		48237560  -  SCREW BONE 7.5MM 60MM REVISION ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48238030	SUP	Custom 27803010		48238030  -  ROD SPINAL 6MM 30MM RADIOLUCENT XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48238035	SUP	Custom 27803010		48238035  -  ROD SPINAL 6MM 35MM RADIOLUCENT XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48238040	SUP	Custom 27803010		48238040  -  ROD SPINAL 6MM 40MM RADIOLUCENT XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48238045	SUP	Custom 27803010		48238045  -  ROD SPINAL 6MM 45MM RADIOLUCENT XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48238050	SUP	Custom 27803010		48238050  -  ROD SPINAL 6MM 50MM RADIOLUCENT XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48238060	SUP	Custom 27803010		48238060  -  ROD SPINAL 6MM 60MM RADIOLUCENT XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48238070	SUP	Custom 27803010		48238070  -  ROD SPINAL 6MM 70MM RADIOLUCENT XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48238080	SUP	Custom 27803010		48238080  -  ROD SPINAL 6MM 80MM RADIOLUCENT XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48238090	SUP	Custom 27803010		48238090  -  ROD SPINAL 6MM 90MM RADIOLUCENT XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48238100	SUP	Custom 27803010		48238100  -  ROD SPINAL 6MM 100MM XIA 3 TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48238110	SUP	Custom 27803010		48238110  -  ROD SPINAL 6MM 110MM XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48238120	SUP	Custom 27803010		48238120  -  ROD SPINAL 6MM 120MM XIA TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48238540	SUP	HCPCS C1713		48238540  -  SCREW BONE 8.5MM 40MM REVISION ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48238550	SUP	HCPCS C1713		48238550  -  SCREW BONE 8.5MM 50MM REVISION ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48238560	SUP	HCPCS C1713		48238560  -  SCREW BONE 8.5MM 60MM REVISION ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48239050	SUP	Custom 27803010		48239050  -  ROD SPNL 50MM XIA 2 BND	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48239060	SUP	Custom 27803010		48239060  -  ROD SPINAL 60MM MAX XIA	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48239070	SUP	Custom 27803010		48239070  -  ROD SPINAL 70MM XIA MAX	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48239080	SUP	Custom 27803010		48239080  -  ROD SPINAL 80MM XIA MAXL	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48239090	SUP	Custom 27803010		48239090  -  ROD SPINAL 90MM RAD MAX	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48239100	SUP	Custom 27803010		48239100  -  ROD SPINAL 100MM RAD XIA	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48239110	SUP	Custom 27803010		48239110  -  ROD SPINAL 110MM RAD XIA	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48239120	SUP	Custom 27803010		48239120  -  ROD SPINAL 120MM RAD XIA	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48239540	SUP	HCPCS C1713		48239540  -  SCREW BONE 9.5MM 40MM REVISION ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48239550	SUP	HCPCS C1713		48239550  -  SCREW BONE 9.5MM 50MM REVISION ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48239560	SUP	HCPCS C1713		48239560  -  SCREW BONE 9.5MM 60MM REVISION ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48250210	SUP	Custom 27203010		48250210  -  RETRACTOR FIBER OPTIC LUXOR	BOTH IP/OP	$597.13 	$441.88	$0.00	$477.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$443.19	$443.19	$0.00	$0.00	$124.44	$0.00	$0.00	$0.00	$0.00	$298.56	$472.93	$477.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48251040	SUP	Custom 27803010		48251040  -  SLEEVE RB 40MM LUXOR SIL	BOTH IP/OP	$906.95 	$671.14	$0.00	$725.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$673.14	$673.14	$0.00	$0.00	$189.01	$0.00	$0.00	$0.00	$0.00	$453.48	$718.30	$725.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48251050	SUP	Custom 27803010		48251050  -  SLEEVE RB 50MM LUXOR SIL	BOTH IP/OP	$906.95 	$671.14	$0.00	$725.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$673.14	$673.14	$0.00	$0.00	$189.01	$0.00	$0.00	$0.00	$0.00	$453.48	$718.30	$725.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48251060	SUP	Custom 27803010		48251060  -  SPREADER SURG OVAL 60MM SLEEVE LUXOR SILICONE THORACOLUMBAR	BOTH IP/OP	$906.95 	$671.14	$0.00	$725.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$673.14	$673.14	$0.00	$0.00	$189.01	$0.00	$0.00	$0.00	$0.00	$453.48	$718.30	$725.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48251070	SUP	Custom 27803010		48251070  -  SPREADER SURG OVAL 70MM SLEEVE LUXOR SILICONE SPN	BOTH IP/OP	$906.95 	$671.14	$0.00	$725.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$673.14	$673.14	$0.00	$0.00	$189.01	$0.00	$0.00	$0.00	$0.00	$453.48	$718.30	$725.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48251080	SUP	Custom 27803010		48251080  -  SPREADER SURG OVAL 80MM SLEEVE LUXOR SILICONE SPN	BOTH IP/OP	$906.95 	$671.14	$0.00	$725.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$673.14	$673.14	$0.00	$0.00	$189.01	$0.00	$0.00	$0.00	$0.00	$453.48	$718.30	$725.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48251090	SUP	Custom 27803010		48251090  -  SLEEVE RB 90MM LUXOR SIL	BOTH IP/OP	$906.95 	$671.14	$0.00	$725.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$673.14	$673.14	$0.00	$0.00	$189.01	$0.00	$0.00	$0.00	$0.00	$453.48	$718.30	$725.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48251105	SUP	Custom 27803010		48251105  -  SLEEVE RB 105MM LUXOR SIL	BOTH IP/OP	$906.95 	$671.14	$0.00	$725.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$673.14	$673.14	$0.00	$0.00	$189.01	$0.00	$0.00	$0.00	$0.00	$453.48	$718.30	$725.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48251120	SUP	Custom 27803010		48251120  -  SLEEVE RB 120MM LUXOR SIL	BOTH IP/OP	$906.95 	$671.14	$0.00	$725.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$673.14	$673.14	$0.00	$0.00	$189.01	$0.00	$0.00	$0.00	$0.00	$453.48	$718.30	$725.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48285425	SUP	HCPCS C1713		48285425  -  SCREW BONE 4.5MM 25MM CANN MANTIS SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285430	SUP	HCPCS C1713		48285430  -  SCREW BONE 4.5MM 30MM CANN MANTIS SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285435	SUP	HCPCS C1713		48285435  -  SCREW BONE 4.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285440	SUP	HCPCS C1713		48285440  -  SCREW BONE 4.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285445	SUP	HCPCS C1713		48285445  -  SCREW BONE 4.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285530	SUP	HCPCS C1713		48285530  -  SCREW BONE 5.5MM 30MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285535	SUP	HCPCS C1713		48285535  -  SCREW BONE 5.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285540	SUP	HCPCS C1713		48285540  -  SCREW BONE 5.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285545	SUP	HCPCS C1713		48285545  -  SCREW BONE 5.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285550	SUP	HCPCS C1713		48285550  -  SCREW BONE 5.5MM 50MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285555	SUP	HCPCS C1713		48285555  -  SCREW BONE 5.5MM 55MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285630	SUP	HCPCS C1713		48285630  -  SCREW BONE 6.5MM 30MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285635	SUP	HCPCS C1713		48285635  -  SCREW BONE 6.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285640	SUP	HCPCS C1713		48285640  -  SCREW BONE 6.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285645	SUP	HCPCS C1713		48285645  -  SCREW BONE 6.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285650	SUP	HCPCS C1713		48285650  -  SCREW BONE 6.5MM 50MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285655	SUP	HCPCS C1713		48285655  -  SCREW BONE 6.5MM 55MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285660	SUP	HCPCS C1713		48285660  -  SCREW BONE 6.5MM 60MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285730	SUP	HCPCS C1713		48285730  -  SCREW BONE 7.5MM 30MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285735	SUP	HCPCS C1713		48285735  -  SCREW BONE 7.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285740	SUP	HCPCS C1713		48285740  -  SCREW BONE 7.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285745	SUP	HCPCS C1713		48285745  -  SCREW BONE 7.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285750	SUP	HCPCS C1713		48285750  -  SCREW BONE 7.5MM 50MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285755	SUP	HCPCS C1713		48285755  -  SCREW BONE 7.5MM 55MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48285760	SUP	HCPCS C1713		48285760  -  SCREW BONE 7.5MM 60MM POLYAX CANN XIA MANTIS SPN PEDICLE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
48286030	SUP	Custom 27803010		48286030  -  ROD SPINAL 6MM 30MM RADIOPQ MANTIS PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48286035	SUP	Custom 27803010		48286035  -  ROD SPINAL 6MM 35MM RAD MANTIS TITANIUM PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48286040	SUP	Custom 27803010		48286040  -  ROD SPINAL 6MM 40MM RAD MANTIS TITANIUM PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48286045	SUP	Custom 27803010		48286045  -  ROD SPINAL 6MM 45MM RAD MANTIS TITANIUM PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48286050	SUP	Custom 27803010		48286050  -  ROD SPINAL 6MM 50MM RAD MANTIS TITANIUM PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48286060	SUP	Custom 27803010		48286060  -  ROD SPINAL 6MM 60MM RAD MANTIS TITANIUM PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48286070	SUP	Custom 27803010		48286070  -  ROD SPINAL 6MM 70MM RAD MANTIS TITANIUM PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48286080	SUP	Custom 27803010		48286080  -  ROD SPINAL 6MM 80MM RAD MANTIS TITANIUM PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48286090	SUP	Custom 27803010		48286090  -  ROD SPINAL 6MM 90MM RAD MANTIS TITANIUM PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48286100	SUP	Custom 27803010		48286100  -  ROD SPINAL 6MM 100MM RAD MANTIS TITANIUM PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48286110	SUP	Custom 27803010		48286110  -  ROD SPINAL 6MM 110MM RADIOPQ MANTIS PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48286120	SUP	Custom 27803010		48286120  -  ROD SPINAL 120MM CVD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48286130	SUP	Custom 27803010		48286130  -  ROD SPINAL 6MM 130MM RADIOPQ MANTIS PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48287050	SUP	Custom 27803010		48287050  -  ROD SPINAL 6MM 50MM RADIOPQ MANTIS PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48287060	SUP	Custom 27803010		48287060  -  ROD SPINAL 6MM 60MM RADIOPQ MANTIS PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48287070	SUP	Custom 27803010		48287070  -  ROD SPINAL 6MM 70MM RADIOPQ MANTIS PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48287080	SUP	Custom 27803010		48287080  -  ROD SPINAL 6MM 80MM RADIOPQ MANTIS PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48287090	SUP	Custom 27803010		48287090  -  ROD SPINAL 6MM 90MM RADIOPQ MANTIS PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48287100	SUP	Custom 27803010		48287100  -  ROD SPINAL 6MM 100MM RADIOPQ MANTIS PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48287110	SUP	Custom 27803010		48287110  -  ROD SPINAL 6MM 110MM RADIOPQ MANTIS PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48287120	SUP	Custom 27803010		48287120  -  ROD SPINAL 6MM 120MM RADIOPQ MANTIS PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48287130	SUP	Custom 27803010		48287130  -  ROD SPINAL 6MM 130MM RADIOPQ MANTIS PEDICLE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48287200	SUP	Custom 27803010		48287200  -  ROD SPINAL 6MM 200MM STR MANTIS PEDICLE	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48288030	SUP	Custom 27803010		48288030  -  ROD SPINAL STR 6MM 30MM MANTIS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48288040	SUP	Custom 27803010		48288040  -  ROD SPINAL STR 6MM 40MM MANTIS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48288050	SUP	Custom 27803010		48288050  -  ROD SPINAL 6MM 50MM STR MANTIS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48288060	SUP	Custom 27803010		48288060  -  ROD SPINAL 6MM 60MM STR MANTIS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48288070	SUP	Custom 27803010		48288070  -  ROD SPINAL STR 6MM 70MM MANTIS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48288080	SUP	Custom 27803010		48288080  -  ROD SPINAL STR 6MM 80MM MANTIS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48288090	SUP	Custom 27803010		48288090  -  ROD SPINAL 6MM 90MM STR MANTIS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48288100	SUP	Custom 27803010		48288100  -  ROD SPINAL 6MM 100MM STR MANTIS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48288110	SUP	Custom 27803010		48288110  -  ROD SPINAL STR 6MM 110MM MANTIS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48288120	SUP	Custom 27803010		48288120  -  ROD SPINAL 6MM 120MM STR MANTIS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48288130	SUP	Custom 27803010		48288130  -  ROD SPINAL 6MM 130MM STR MANTIS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48288480	SUP	Custom 27803010		48288480  -  ROD SPINAL 6MM 480MM STR MANTIS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48290220	SUP	Custom 27803010		48290220  -  END CAP SPNL 20D 22MM 18MM NS VLIFT TI LMBR INTRBD FS	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48290225	SUP	Custom 27803010		48290225  -  ENDCAP SPINAL 25D 22MM CLOSE	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48290230	SUP	Custom 27803010		48290230  -  ENDCAP SPINAL 30D 22MM CLOSE	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48291180	SUP	Custom 27803010		48291180  -  ENDCAP SPINAL 0D 18MM MODULAR OPEN SNAP EXTERIOR METAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48291183	SUP	Custom 27803010		48291183  -  ENDCAP SPINAL 3D 18MM MODULAR OPEN SNAP EXTERIOR METAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48291188	SUP	Custom 27803010		48291188  -  ENDCAP SPINAL 8D 18MM 118MM VLIFT	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48291220	SUP	Custom 27803010		48291220  -  ENDCAP SPINAL 0D 22MM MODULAR OPEN SNAP EXTERIOR METAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48291223	SUP	Custom 27803010		48291223  -  ENDCAP SPINAL 3D 22MM MODULAR OPEN SNAP EXTERIOR METAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48291228	SUP	Custom 27803010		48291228  -  ENDCAP SPINAL 8D 22MM MODULAR OPEN SNAP EXTERIOR METAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48291800	SUP	HCPCS C1781		48291800  -  EXTENSION STEM 18MM VLIFT	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
48291820	SUP	Custom 27803010		48291820  -  CAGE SPNL 18MM 20MM NS LF VLIFT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48291825	SUP	Custom 27803010		48291825  -  CAGE SPNL 18MM 25MM NS LF VLIFT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48291832	SUP	Custom 27803010		48291832  -  CAGE SPNL 18MM 32MM NS LF VLIFT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48292200	SUP	Custom 27803010		48292200  -  EXTENSION SPNL 22MM NS LF VLIFT TI LMBR INTRBD FS	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48292215	SUP	Custom 27803010		48292215  -  ENDCAP SPINAL 15D 22MM MODULAR OPEN SNAP EXTERIOR METAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48292225	SUP	Custom 27803010		48292225  -  CAGE SPNL 22MM 25MM NS LF VLIFT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48292232	SUP	Custom 27803010		48292232  -  CAGE SPNL 22MM 32MM NS LF VLIFT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48292237	SUP	Custom 27803010		48292237  -  CAGE SPNL 22MM 37MM NS LF VLIFT TI LMBR INTRBD FS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321060	SUP	Custom 27803010		48321060  -  CAGE SPNL 0D 12MM RECT 14X6MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321064	SUP	Custom 27803010		48321064  -  CAGE SPNL 4D 12MM RECT 14X6MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321068	SUP	Custom 27803010		48321068  -  CAGE SPNL 8D 12MM RECT 14X6MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321070	SUP	Custom 27803010		48321070  -  CAGE SPNL 0D 12MM RECT 14X7MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321074	SUP	Custom 27803010		48321074  -  CAGE SPNL 4D 12MM RECT 14X7MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321078	SUP	Custom 27803010		48321078  -  CAGE SPNL 8D 12MM RECT 14X7MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321080	SUP	Custom 27803010		48321080  -  CAGE SPNL 0D 12MM RECT 14X8MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321084	SUP	Custom 27803010		48321084  -  CAGE SPNL 4D 12MM RECT 14X8MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321088	SUP	Custom 27803010		48321088  -  CAGE SPNL 8D 12MM RECT 14X8MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321090	SUP	Custom 27803010		48321090  -  CAGE SPNL 0D 12MM RECT 14X9MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321094	SUP	Custom 27803010		48321094  -  CAGE SPNL 4D 12MM RECT 14X9MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321098	SUP	Custom 27803010		48321098  -  CAGE SPNL 8D 12MM RECT 14X9MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321100	SUP	Custom 27803010		48321100  -  CAGE SPNL 0D 12MM RECT 14X10MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321104	SUP	Custom 27803010		48321104  -  CAGE SPNL 4D 12MM RECT 14X10MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321108	SUP	Custom 27803010		48321108  -  CAGE SPNL 8D 12MM RECT 14X10MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321110	SUP	Custom 27803010		48321110  -  CAGE SPNL 0D 12MM RECT 14X11MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321114	SUP	Custom 27803010		48321114  -  CAGE SPNL 4D 12MM RECT 14X11MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321118	SUP	Custom 27803010		48321118  -  CAGE SPNL 8D 12MM RECT 14X11MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321120	SUP	Custom 27803010		48321120  -  CAGE SPNL 0D 12MM RECT 14X12MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321124	SUP	Custom 27803010		48321124  -  CAGE SPNL 4D 12MM RECT 14X12MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48321128	SUP	Custom 27803010		48321128  -  CAGE SPNL 8D 12MM RECT 14X12MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322040	SUP	Custom 27803010		48322040  -  SPACER SPNL 0D 12MM 14X4MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322044	SUP	Custom 27803010		48322044  -  SPACER SPNL 4D 12MM 14X4MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322050	SUP	Custom 27803010		48322050  -  SPACER SPNL 0D 12MM 14X5MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322054	SUP	Custom 27803010		48322054  -  SPACER SPNL 4D 12MM 14X5MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322060	SUP	Custom 27803010		48322060  -  SPACER SPNL 0D 12MM 14X6MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322064	SUP	Custom 27803010		48322064  -  SPACER SPNL 4D 12MM 14X6MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322070	SUP	Custom 27803010		48322070  -  SPACER SPNL 0D 12MM 14X7MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322074	SUP	Custom 27803010		48322074  -  SPACER SPNL 4D 12MM 14X7MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322080	SUP	Custom 27803010		48322080  -  SPACER SPNL 0D 12MM 14X8MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322084	SUP	Custom 27803010		48322084  -  SPACER SPNL 4D 12MM 14X8MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322090	SUP	Custom 27803010		48322090  -  SPACER SPNL 0D 12MM 14X9MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322094	SUP	Custom 27803010		48322094  -  SPACER SPNL 4D 12MM 14X9MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322100	SUP	Custom 27803010		48322100  -  SPACER SPNL 0D 12MM 14X10MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322104	SUP	Custom 27803010		48322104  -  SPACER SPNL 4D 12MM 14X10MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322110	SUP	Custom 27803010		48322110  -  SPACER SPNL 0D 12MM 14X11MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322114	SUP	Custom 27803010		48322114  -  SPACER SPNL 4D 12MM 14X11MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322120	SUP	Custom 27803010		48322120  -  SPACER SPNL 0D 12MM 14X12MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322124	SUP	Custom 27803010		48322124  -  SPACER SPNL 4D 12MM 14X12MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48322204	SUP	Custom 27803010		48322204  -  SPACER SPNL 4D 12MM 14X20MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323060	SUP	Custom 27803010		48323060  -  CAGE SPNL 0D 14MM RECT 16X6MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323064	SUP	Custom 27803010		48323064  -  CAGE SPNL 4D 14MM RECT 16X6MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323068	SUP	Custom 27803010		48323068  -  CAGE SPNL 8D 14MM RECT 16X6MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323070	SUP	Custom 27803010		48323070  -  CAGE SPNL 0D 14MM RECT 16X7MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323074	SUP	Custom 27803010		48323074  -  CAGE SPNL 4D 14MM RECT 16X7MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323078	SUP	Custom 27803010		48323078  -  CAGE SPNL 8D 14MM RECT 16X7MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323080	SUP	Custom 27803010		48323080  -  CAGE SPNL 0D 14MM RECT 16X8MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323084	SUP	Custom 27803010		48323084  -  CAGE SPNL 4D 14MM RECT 16X8MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323088	SUP	Custom 27803010		48323088  -  CAGE SPNL 8D 14MM RECT 16X8MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323090	SUP	Custom 27803010		48323090  -  CAGE SPNL 0D 14MM RECT 16X9MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323094	SUP	Custom 27803010		48323094  -  CAGE SPNL 4D 14MM RECT 16X9MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323098	SUP	Custom 27803010		48323098  -  CAGE SPNL 8D 14MM RECT 16X9MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323100	SUP	Custom 27803010		48323100  -  CAGE SPNL 0D 14MM RECT 16X10MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323104	SUP	Custom 27803010		48323104  -  CAGE SPNL 4D 14MM RECT 16X10MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323108	SUP	Custom 27803010		48323108  -  CAGE SPNL 8D 14MM RECT 16X10MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323110	SUP	Custom 27803010		48323110  -  CAGE SPNL 0D 14MM RECT 16X11MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323114	SUP	Custom 27803010		48323114  -  CAGE SPNL 4D 14MM RECT 16X11MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323118	SUP	Custom 27803010		48323118  -  CAGE SPNL 8D 14MM RECT 16X11MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323120	SUP	Custom 27803010		48323120  -  CAGE SPNL 0D 14MM RECT 16X12MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323124	SUP	Custom 27803010		48323124  -  CAGE SPNL 4D 14MM RECT 16X12MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48323128	SUP	Custom 27803010		48323128  -  CAGE SPNL 8D 14MM RECT 16X12MM NS LF AVS ANCH-C RADOPQ HLW	BOTH IP/OP	"$3,875.00 "	"$2,867.50"	$0.00	"$3,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,876.03"	"$2,876.03"	$0.00	$0.00	$807.55	$0.00	$0.00	$0.00	$0.00	"$1,937.50"	"$3,069.00"	"$3,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324040	SUP	Custom 27803010		48324040  -  SPACER SPNL 0D 14MM 16X4MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324044	SUP	Custom 27803010		48324044  -  SPACER SPNL 4D 14MM 16X4MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324050	SUP	Custom 27803010		48324050  -  SPACER SPNL 0D 14MM 16X5MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324054	SUP	Custom 27803010		48324054  -  SPACER SPNL 4D 14MM 16X5MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324060	SUP	Custom 27803010		48324060  -  SPACER SPNL 0D 14MM 16X6MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324064	SUP	Custom 27803010		48324064  -  SPACER SPNL 4D 14MM 16X6MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324070	SUP	Custom 27803010		48324070  -  SPACER SPNL 0D 14MM 16X7MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324074	SUP	Custom 27803010		48324074  -  SPACER SPNL 4D 14MM 16X7MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324080	SUP	Custom 27803010		48324080  -  SPACER SPNL 0D 14MM 16X8MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324084	SUP	Custom 27803010		48324084  -  SPACER SPNL 4D 14MM 16X8MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324090	SUP	Custom 27803010		48324090  -  SPACER SPNL 0D 14MM 16X9MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324094	SUP	Custom 27803010		48324094  -  SPACER SPNL 4D 14MM 16X9MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324100	SUP	Custom 27803010		48324100  -  SPACER SPNL 0D 14MM 16X10MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324104	SUP	Custom 27803010		48324104  -  SPACER SPNL 4D 14MM 16X10MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324110	SUP	Custom 27803010		48324110  -  SPACER SPNL 0D 14MM 16X11MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324114	SUP	Custom 27803010		48324114  -  SPACER SPNL 4D 14MM 16X11MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324120	SUP	Custom 27803010		48324120  -  SPACER SPNL 0D 14MM 16X12MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48324124	SUP	Custom 27803010		48324124  -  SPACER SPNL 4D 14MM 16X12MM AVS AS PEEK CRV INTRBD FS	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48325308	SUP	HCPCS C1713		48325308  -  SCREW BONE 3.5MM 8MM SPNL SLFTAP	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48325310	SUP	HCPCS C1713		48325310  -  SCREW BONE 3.5MM 10MM SELF TAP AVS ANCHOR-C TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48325312	SUP	HCPCS C1713		48325312  -  SCREW BONE 3.5MM 12MM SELF TAP AVS ANCHOR-C TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48325314	SUP	HCPCS C1713		48325314  -  SCREW BONE 3.5MM 14MM SPNL SLFTAP	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48325408	SUP	HCPCS C1713		48325408  -  SCREW BONE 4MM 8MM SPNL SLFTAP	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48325410	SUP	HCPCS C1713		48325410  -  SCREW BONE 4MM 10MM SELF TAP AVS ANCHOR-C TITANIUM SPN CERV	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48325412	SUP	HCPCS C1713		48325412  -  SCREW BONE 4MM 12MM SELF TAP AVS ANCHOR-C TITANIUM SPN CERV	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48325414	SUP	HCPCS C1713		48325414  -  ANCHOR-C  4.0 X 14MM SELF TAPPING SCREW	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48326084	SUP	Custom 27803010		48326084  -  SPACER SPNL 4D 28X22X8MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326088	SUP	Custom 27803010		48326088  -  SPACER SPNL 8D 28X22X8MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326104	SUP	Custom 27803010		48326104  -  SPACER SPNL 4D 28X22X10MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326108	SUP	Custom 27803010		48326108  -  SPACER SPNL 8D 28X22X10MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326122	SUP	Custom 27803010		48326122  -  SPACER SPNL 12D 28X22X12MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326124	SUP	Custom 27803010		48326124  -  SPACER SPNL 4D 28X22X12MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326126	SUP	Custom 27803010		48326126  -  SPACER SPNL 16D 28X22X12MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326128	SUP	Custom 27803010		48326128  -  SPACER SPNL 8D 28X22X12MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326142	SUP	Custom 27803010		48326142  -  SPACER SPNL 12D 28X22X14MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326144	SUP	Custom 27803010		48326144  -  SPACER SPNL 4D 28X22X14MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326146	SUP	Custom 27803010		48326146  -  SPACER SPNL 16D 28X22X14MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326148	SUP	Custom 27803010		48326148  -  SPACER SPNL 8D 28X22X14MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326162	SUP	Custom 27803010		48326162  -  SPACER SPNL 12D 28X22X16MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326164	SUP	Custom 27803010		48326164  -  SPACER SPNL 4D 28X22X16MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326166	SUP	Custom 27803010		48326166  -  SPACER SPNL 16D 28X22X16MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326168	SUP	Custom 27803010		48326168  -  SPACER SPNL 8D 28X22X16MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326182	SUP	Custom 27803010		48326182  -  SPACER SPNL 12D 28X22X18MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326184	SUP	Custom 27803010		48326184  -  SPACER SPNL 4D 28X22X18MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326186	SUP	Custom 27803010		48326186  -  SPACER SPNL 16D 28X22X18MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326188	SUP	Custom 27803010		48326188  -  SPACER SPNL 8D 28X22X18MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326202	SUP	Custom 27803010		48326202  -  SPACER SPNL 12D 28X22X20MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326204	SUP	Custom 27803010		48326204  -  SPACER SPNL 4D 28X22X20MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326206	SUP	Custom 27803010		48326206  -  SPACER SPNL 16D 22X28X20MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48326208	SUP	Custom 27803010		48326208  -  SPACER SPNL 8D 28X22X20MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328084	SUP	Custom 27803010		48328084  -  SPACER SPNL 4D 28X33X8MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328088	SUP	Custom 27803010		48328088  -  SPACER SPNL 8D 28X33X8MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328104	SUP	Custom 27803010		48328104  -  SPACER SPNL 4D 28X33X10MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328108	SUP	Custom 27803010		48328108  -  SPACER SPNL 8D 28X33X10MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328122	SUP	Custom 27803010		48328122  -  SPACER SPNL 12D 28X33X12MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328124	SUP	Custom 27803010		48328124  -  SPACER SPNL 4D 28X33X12MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328126	SUP	Custom 27803010		48328126  -  SPACER SPNL 16D 28X33X12MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328128	SUP	Custom 27803010		48328128  -  SPACER SPNL 8D 28X33X12MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328142	SUP	Custom 27803010		48328142  -  SPACER SPNL 12D 28X33X14MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328144	SUP	Custom 27803010		48328144  -  SPACER SPNL 4D 28X33X14MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328146	SUP	Custom 27803010		48328146  -  SPACER SPNL 16D 28X33X14MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328148	SUP	Custom 27803010		48328148  -  SPACER SPNL 8D 28X33X14MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328162	SUP	Custom 27803010		48328162  -  SPACER SPNL 12D 28X33X16MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328164	SUP	Custom 27803010		48328164  -  SPACER SPNL 4D 28X33X16MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328166	SUP	Custom 27803010		48328166  -  SPACER SPNL 16D 28X33X16MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328168	SUP	Custom 27803010		48328168  -  SPACER SPNL 8D 28X33X16MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328182	SUP	Custom 27803010		48328182  -  SPACER SPNL 12D 28X33X18MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328184	SUP	Custom 27803010		48328184  -  SPACER SPNL 4D 28X33X18MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328186	SUP	Custom 27803010		48328186  -  SPACER SPNL 16D 28X33X18MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328188	SUP	Custom 27803010		48328188  -  SPACER SPNL 8D 28X33X18MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328202	SUP	Custom 27803010		48328202  -  SPACER SPNL 12D 28X33X20MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328204	SUP	Custom 27803010		48328204  -  SPACER SPNL 4D 28X33X20MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328206	SUP	Custom 27803010		48328206  -  SPACER SPNL 16D 33X28X20MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328208	SUP	Custom 27803010		48328208  -  SPACER SPNL 8D 28X33X20MM AVS AL PEEK ALIF	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328908	SUP	Custom 27203010		48328908  -  BIT DRILL 2.3MM 8MM AVS ANCHOR-C	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328910	SUP	Custom 27203010		48328910  -  BIT DRILL 2.3MM 10MM AVS ANCHOR-C	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48328912	SUP	Custom 27203010		48328912  -  BIT DRILL 2.3MM 12MM AVS ANCHOR-C	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48335308	SUP	HCPCS C1713		48335308  -  ANCHOR-C  3.5 X 8MM SELF DRILLING SCREW	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48335310	SUP	HCPCS C1713		48335310  -  ANCHOR-C  3.5 X 10MM SELF DRILLING SCREW	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48335312	SUP	HCPCS C1713		48335312  -  SCREW BONE 3.5MM 12MM SPNL SLFDRILL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48335314	SUP	HCPCS C1713		48335314  -  SCREW BONE 3.5MM 14MM SPNL SLFDRILL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48335408	SUP	HCPCS C1713		48335408  -  SCREW BONE 4MM 8MM	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48335410	SUP	HCPCS C1713		48335410  -  ANCHOR-C  4.0 X 10MM SELF DRILLING SCREW	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48335412	SUP	HCPCS C1713		48335412  -  SCREW BONE 4MM 12MM SPNL SLFDRILL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48335414	SUP	HCPCS C1713		48335414  -  SCREW BONE 4MM 14MM SPNL SLFDRILL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48340074	SUP	Custom 27803010		48340074  -  SPACER SPNL 4D WDG 20X9X7MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340084	SUP	Custom 27803010		48340084  -  SPACER SPNL 4D WDG 20X9X8MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340090	SUP	Custom 27803010		48340090  -  SPACER SPNL 0D RECT 20X9X9MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340094	SUP	Custom 27803010		48340094  -  SPACER SPNL 4D WDG 20X9X9MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340098	SUP	Custom 27803010		48340098  -  SPACER SPNL 8D WDG 20X9X9MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340100	SUP	Custom 27803010		48340100  -  SPACER SPNL 0D RECT 20X9X10MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340104	SUP	Custom 27803010		48340104  -  SPACER SPNL 4D WDG 20X9X10MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340108	SUP	Custom 27803010		48340108  -  SPACER SPNL 8D WDG 20X9X10MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340110	SUP	Custom 27803010		48340110  -  SPACER SPNL 0D RECT 20X9X11MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340114	SUP	Custom 27803010		48340114  -  SPACER SPNL 4D WDG 20X9X11MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340118	SUP	Custom 27803010		48340118  -  SPACER SPNL 8D WDG 20X9X11MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340120	SUP	Custom 27803010		48340120  -  SPACER SPNL 0D RECT 20X9X12MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340124	SUP	Custom 27803010		48340124  -  SPACER SPNL 4D WDG 20X9X12MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340128	SUP	Custom 27803010		48340128  -  SPACER SPNL 8D WDG 20X9X12MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340130	SUP	Custom 27803010		48340130  -  SPACER SPNL 0D RECT 20X9X13MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340134	SUP	Custom 27803010		48340134  -  SPACER SPNL 4D WDG 20X9X13MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340138	SUP	Custom 27803010		48340138  -  SPACER SPNL 8D WDG 20X9X13MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340140	SUP	Custom 27803010		48340140  -  SPACER SPNL 0D RECT 20X9X14MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340144	SUP	Custom 27803010		48340144  -  SPACER SPNL 4D WDG 20X9X14MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340148	SUP	Custom 27803010		48340148  -  SPACER SPNL 8D WDG 20X9X14MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340150	SUP	Custom 27803010		48340150  -  SPACER SPNL 0D RECT 20X9X15MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340154	SUP	Custom 27803010		48340154  -  SPACER SPNL 4D WDG 20X9X15MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340158	SUP	Custom 27803010		48340158  -  SPACER SPNL 8D WDG 20X9X15MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340160	SUP	Custom 27803010		48340160  -  SPACER SPNL 0D RECT 20X9X16MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340164	SUP	Custom 27803010		48340164  -  SPACER SPNL 4D WDG 20X9X16MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48340168	SUP	Custom 27803010		48340168  -  SPACER SPNL 8D WDG 20X9X16MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345074	SUP	Custom 27803010		48345074  -  SPACER SPNL 4D WDG 25X8X7MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345084	SUP	Custom 27803010		48345084  -  SPACER SPNL 4D WDG 25X8X8MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345090	SUP	Custom 27803010		48345090  -  SPACER SPNL 0D RECT 25X8X9MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345094	SUP	Custom 27803010		48345094  -  SPACER SPNL 4D WDG 25X8X9MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345098	SUP	Custom 27803010		48345098  -  SPACER SPNL 8D WDG 25X8X9MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345100	SUP	Custom 27803010		48345100  -  SPACER SPNL 0D RECT 25X8X10MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345104	SUP	Custom 27803010		48345104  -  SPACER SPNL 4D WDG 25X8X10MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345108	SUP	Custom 27803010		48345108  -  SPACER SPNL 8D WDG 25X8X10MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345110	SUP	Custom 27803010		48345110  -  SPACER SPNL 0D RECT 25X8X11MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345114	SUP	Custom 27803010		48345114  -  SPACER SPNL 4D WDG 25X8X11MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345118	SUP	Custom 27803010		48345118  -  SPACER SPNL 8D WDG 25X8X11MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345120	SUP	Custom 27803010		48345120  -  SPACER SPNL 0D RECT 25X8X12MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345124	SUP	Custom 27803010		48345124  -  SPACER SPNL 4D WDG 25X8X12MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345128	SUP	Custom 27803010		48345128  -  SPACER SPNL 8D WDG 25X8X12MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345130	SUP	Custom 27803010		48345130  -  SPACER SPNL 0D RECT 25X8X13MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345134	SUP	Custom 27803010		48345134  -  SPACER SPNL 4D WDG 25X8X13MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345138	SUP	Custom 27803010		48345138  -  SPACER SPNL 8D WDG 25X8X13MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345140	SUP	Custom 27803010		48345140  -  SPACER SPNL 0D RECT 25X8X14MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345144	SUP	Custom 27803010		48345144  -  SPACER SPNL 4D WDG 25X8X14MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345148	SUP	Custom 27803010		48345148  -  SPACER SPNL 8D WDG 25X8X14MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345150	SUP	Custom 27803010		48345150  -  SPACER SPNL 0D RECT 25X8X15MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345154	SUP	Custom 27803010		48345154  -  SPACER SPNL 4D WDG 25X8X15MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345158	SUP	Custom 27803010		48345158  -  SPACER SPNL 8D WDG 25X8X15MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345160	SUP	Custom 27803010		48345160  -  SPACER SPNL 0D RECT 25X8X16MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345164	SUP	Custom 27803010		48345164  -  SPACER SPNL 4D WDG 25X8X16MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48345168	SUP	Custom 27803010		48345168  -  SPACER SPNL 8D WDG 25X8X16MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350060	SUP	Custom 27803010		48350060  -  SPACER SPNL 0D WDG NOSE 20X11X6MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350064	SUP	Custom 27803010		48350064  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X6MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350070	SUP	Custom 27803010		48350070  -  SPACER SPNL 0D WDG NOSE 20X11X7MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350074	SUP	Custom 27803010		48350074  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X7MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350080	SUP	Custom 27803010		48350080  -  SPACER SPNL 0D WDG NOSE 20X11X8MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350084	SUP	Custom 27803010		48350084  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X8MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350090	SUP	Custom 27803010		48350090  -  SPACER SPNL 0D RECT 20X11X9MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350094	SUP	Custom 27803010		48350094  -  SPACER SPNL 4D WDG 20X11X9MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350100	SUP	Custom 27803010		48350100  -  SPACER SPNL 0D RECT 20X11X10MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350104	SUP	Custom 27803010		48350104  -  SPACER SPNL 4D WDG 20X11X10MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350110	SUP	Custom 27803010		48350110  -  SPACER SPNL 0D RECT 20X11X11MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350114	SUP	Custom 27803010		48350114  -  SPACER SPNL 4D WDG 20X11X11MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350120	SUP	Custom 27803010		48350120  -  SPACER SPNL 0D RECT 20X11X12MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350124	SUP	Custom 27803010		48350124  -  SPACER SPNL 4D WDG 20X11X12MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350130	SUP	Custom 27803010		48350130  -  SPACER SPNL 0D RECT 20X11X13MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350134	SUP	Custom 27803010		48350134  -  SPACER SPNL 4D WDG 20X11X13MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350160	SUP	Custom 27803010		48350160  -  SPACER SPNL 0D RECT 20X11X16MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350164	SUP	Custom 27803010		48350164  -  SPACER SPNL 4D WDG 20X11X16MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350180	SUP	Custom 27803010		48350180  -  SPACER SPNL 0D RECT 20X11X18MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48350184	SUP	Custom 27803010		48350184  -  SPACER SPNL 4D WDG 20X11X18MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351060	SUP	Custom 27803010		48351060  -  SPACER SPNL 0D WDG NOSE 30X11X6MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351064	SUP	Custom 27803010		48351064  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X6MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351070	SUP	Custom 27803010		48351070  -  SPACER SPNL 0D WDG NOSE 30X11X7MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351074	SUP	Custom 27803010		48351074  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X7MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351080	SUP	Custom 27803010		48351080  -  SPACER SPNL 0D WDG NOSE 30X11X8MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351084	SUP	Custom 27803010		48351084  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X8MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351090	SUP	Custom 27803010		48351090  -  SPACER SPNL 0D WDG NOSE 30X11X9MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351094	SUP	Custom 27803010		48351094  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X9MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351100	SUP	Custom 27803010		48351100  -  SPACER SPNL 0D WDG NOSE 30X11X10MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351104	SUP	Custom 27803010		48351104  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X10MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351110	SUP	Custom 27803010		48351110  -  SPACER SPNL 0D WDG NOSE 30X11X11MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351114	SUP	Custom 27803010		48351114  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X11MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351120	SUP	Custom 27803010		48351120  -  SPACER SPNL 0D WDG NOSE 30X11X12MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351124	SUP	Custom 27803010		48351124  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X12MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351130	SUP	Custom 27803010		48351130  -  SPACER SPNL 0D WDG NOSE 30X11X13MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351134	SUP	Custom 27803010		48351134  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X13MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351140	SUP	Custom 27803010		48351140  -  SPACER SPNL 0D WDG NOSE 30X11X14MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48351144	SUP	Custom 27803010		48351144  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X14MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353060	SUP	HCPCS C1713		48353060  -  SPACER SPNL 0D WDG NOSE 33X11X6MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	"$2,475.00"	"$2,475.00"	$0.00	$0.00	$0.00	"$1,146.34"	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	"$2,711.50"	"$2,711.50"	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$860.75	$0.00	$0.00	$875.60	$0.00	$0.00	$0.00	$0.00	$0.00
48353064	SUP	Custom 27803010		48353064  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X6MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353070	SUP	Custom 27803010		48353070  -  SPACER SPNL 0D WDG NOSE 33X11X7MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353074	SUP	Custom 27803010		48353074  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X7MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353080	SUP	Custom 27803010		48353080  -  SPACER SPNL 0D WDG NOSE 33X11X8MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353084	SUP	Custom 27803010		48353084  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X8MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353090	SUP	Custom 27803010		48353090  -  SPACER SPNL 0D WDG NOSE 33X11X9MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353094	SUP	Custom 27803010		48353094  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X9MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353100	SUP	Custom 27803010		48353100  -  SPACER SPNL 0D WDG NOSE 33X11X10MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353104	SUP	Custom 27803010		48353104  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X10MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353110	SUP	Custom 27803010		48353110  -  SPACER SPNL 0D WDG NOSE 33X11X11MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353114	SUP	Custom 27803010		48353114  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X11MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353120	SUP	Custom 27803010		48353120  -  SPACER SPNL 0D WDG NOSE 33X11X12MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353124	SUP	Custom 27803010		48353124  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X12MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353130	SUP	Custom 27803010		48353130  -  SPACER SPNL 0D WDG NOSE 33X11X13MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353134	SUP	Custom 27803010		48353134  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X13MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353140	SUP	Custom 27803010		48353140  -  SPACER SPNL 0D WDG NOSE 33X11X14MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48353144	SUP	Custom 27803010		48353144  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X14MM AVS UNILIF HLW	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355060	SUP	Custom 27803010		48355060  -  SPACER SPNL 0D WDG NOSE 25X11X6MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355064	SUP	Custom 27803010		48355064  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X6MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355070	SUP	Custom 27803010		48355070  -  SPACER SPNL 0D WDG NOSE 25X11X7MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355074	SUP	Custom 27803010		48355074  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X7MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355080	SUP	Custom 27803010		48355080  -  SPACER SPNL 0D WDG NOSE 25X11X8MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355084	SUP	Custom 27803010		48355084  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X8MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355090	SUP	Custom 27803010		48355090  -  SPACER SPNL 0D RECT 25X11X9MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355094	SUP	Custom 27803010		48355094  -  SPACER SPNL 4D WDG 25X11X9MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355100	SUP	Custom 27803010		48355100  -  SPACER SPNL 0D RECT 25X11X10MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355104	SUP	Custom 27803010		48355104  -  SPACER SPNL 4D WDG 25X11X10MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355110	SUP	Custom 27803010		48355110  -  SPACER SPNL 0D RECT 25X11X11MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355114	SUP	Custom 27803010		48355114  -  SPACER SPNL 4D WDG 25X11X11MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355120	SUP	Custom 27803010		48355120  -  SPACER SPNL 0D RECT 25X11X12MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355124	SUP	Custom 27803010		48355124  -  SPACER SPNL 4D WDG 25X11X12MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355130	SUP	Custom 27803010		48355130  -  SPACER SPNL 0D RECT 25X11X13MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355134	SUP	Custom 27803010		48355134  -  SPACER SPNL 4D WDG 25X11X13MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355164	SUP	Custom 27803010		48355164  -  SPACER SPNL 4D WDG 25X11X16MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355180	SUP	Custom 27803010		48355180  -  SPACER SPNL 0D RECT 25X11X18MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48355184	SUP	Custom 27803010		48355184  -  SPACER SPNL 4D WDG 25X11X18MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370090	SUP	Custom 27803010		48370090  -  SPACER SPNL 0D PRLL 30X9MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370094	SUP	Custom 27803010		48370094  -  SPACER SPNL 4D WDG 30X9MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370100	SUP	Custom 27803010		48370100  -  SPACER SPNL 0D PRLL 30X10MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370104	SUP	Custom 27803010		48370104  -  SPACER SPNL 4D WDG 30X10MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370110	SUP	Custom 27803010		48370110  -  SPACER SPNL 0D PRLL 30X11MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370114	SUP	Custom 27803010		48370114  -  SPACER SPNL 4D WDG 30X11MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370120	SUP	Custom 27803010		48370120  -  SPACER SPNL 0D PRLL 30X12MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370124	SUP	Custom 27803010		48370124  -  SPACER SPNL 4D WDG 30X12MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370130	SUP	Custom 27803010		48370130  -  SPACER SPNL 0D PRLL 30X13MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370134	SUP	Custom 27803010		48370134  -  SPACER SPNL 4D WDG 30X13MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370140	SUP	Custom 27803010		48370140  -  SPACER SPNL 0D PRLL 30X14MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370144	SUP	Custom 27803010		48370144  -  SPACER SPNL 4D WDG 30X14MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370150	SUP	Custom 27803010		48370150  -  SPACER SPNL 0D PRLL 30X15MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370154	SUP	Custom 27803010		48370154  -  SPACER SPNL 4D WDG 30X15MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370160	SUP	Custom 27803010		48370160  -  SPACER SPNL 0D PRLL 30X16MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370164	SUP	Custom 27803010		48370164  -  SPACER SPNL 4D WDG 30X16MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370170	SUP	Custom 27803010		48370170  -  SPACER SPNL 0D PRLL 30X17MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370174	SUP	Custom 27803010		48370174  -  SPACER SPNL 4D WDG 30X17MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370180	SUP	Custom 27803010		48370180  -  SPACER SPNL 0D PRLL 30X18MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48370184	SUP	Custom 27803010		48370184  -  SPACER SPNL 4D WDG 30X18MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375070	SUP	Custom 27803010		48375070  -  SPACER SPNL 0D PRLL 25X7MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375074	SUP	Custom 27803010		48375074  -  SPACER SPNL 4D WDG 25X7MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375080	SUP	Custom 27803010		48375080  -  SPACER SPNL 0D PRLL 25X8MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375084	SUP	Custom 27803010		48375084  -  SPACER SPNL 4D WDG 25X8MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375090	SUP	Custom 27803010		48375090  -  SPACER SPNL 0D PRLL 25X9MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375094	SUP	Custom 27803010		48375094  -  SPACER SPNL 4D WDG 25X9MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375100	SUP	Custom 27803010		48375100  -  SPACER SPNL 0D PRLL 25X10MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375104	SUP	Custom 27803010		48375104  -  SPACER SPNL 4D WDG 25X10MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375110	SUP	Custom 27803010		48375110  -  SPACER SPNL 0D PRLL 25X11MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375114	SUP	Custom 27803010		48375114  -  SPACER SPNL 4D WDG 25X11MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375120	SUP	Custom 27803010		48375120  -  SPACER SPNL 0D PRLL 25X12MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375124	SUP	Custom 27803010		48375124  -  SPACER SPNL 4D WDG 25X12MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375130	SUP	Custom 27803010		48375130  -  SPACER SPNL 0D PRLL 25X13MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375134	SUP	Custom 27803010		48375134  -  SPACER SPNL 4D WDG 25X13MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375140	SUP	Custom 27803010		48375140  -  SPACER SPNL 0D PRLL 25X14MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48375144	SUP	Custom 27803010		48375144  -  SPACER SPNL 4D WDG 25X14MM AVS TL HLW PEEK TLIF	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390090	SUP	Custom 27803010		48390090  -  SPACER SPNL 0D WDG NOSE 20X11X9MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390094	SUP	Custom 27803010		48390094  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X9MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390101	SUP	Custom 27803010		48390101  -  SPACER SPNL 0D WDG NOSE 20X11X10MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390104	SUP	Custom 27803010		48390104  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X10MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390111	SUP	Custom 27803010		48390111  -  SPACER SPNL 0D WDG NOSE 20X11X11MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390114	SUP	Custom 27803010		48390114  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X11MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390120	SUP	Custom 27803010		48390120  -  SPACER SPNL 0D WDG NOSE 20X11X12MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390124	SUP	Custom 27803010		48390124  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X12MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390130	SUP	Custom 27803010		48390130  -  SPACER SPNL 0D WDG NOSE 20X11X13MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390134	SUP	Custom 27803010		48390134  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X13MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390140	SUP	Custom 27803010		48390140  -  SPACER SPNL 0D WDG NOSE 20X11X14MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390144	SUP	Custom 27803010		48390144  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X14MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390150	SUP	Custom 27803010		48390150  -  SPACER SPNL 0D WDG NOSE 20X11X15MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390154	SUP	Custom 27803010		48390154  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X15MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390160	SUP	Custom 27803010		48390160  -  SPACER SPNL 0D WDG NOSE 20X11X16MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390164	SUP	Custom 27803010		48390164  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X16MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48390180	SUP	Custom 27803010		48390180  -  SPACER SPNL 0D WDG NOSE 20X11X18MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395090	SUP	Custom 27803010		48395090  -  SPACER SPNL 0D WDG NOSE 25X11X9MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395094	SUP	Custom 27803010		48395094  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X9MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395100	SUP	Custom 27803010		48395100  -  SPACER SPNL 0D WDG NOSE 25X11X10MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395104	SUP	Custom 27803010		48395104  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X10MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395110	SUP	Custom 27803010		48395110  -  SPACER SPNL 0D WDG NOSE 25X11X11MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395114	SUP	Custom 27803010		48395114  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X11MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395120	SUP	Custom 27803010		48395120  -  SPACER SPNL 0D WDG NOSE 25X11X12MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395124	SUP	Custom 27803010		48395124  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X12MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395130	SUP	Custom 27803010		48395130  -  SPACER SPNL 0D WDG NOSE 25X11X13MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395134	SUP	Custom 27803010		48395134  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X13MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395140	SUP	Custom 27803010		48395140  -  SPACER SPNL 0D WDG NOSE 25X11X14MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395144	SUP	Custom 27803010		48395144  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X14MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395150	SUP	Custom 27803010		48395150  -  SPACER SPNL 0D WDG NOSE 25X11X15MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395154	SUP	Custom 27803010		48395154  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X15MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395160	SUP	Custom 27803010		48395160  -  SPACER SPNL 0D WDG NOSE 25X11X16MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395164	SUP	Custom 27803010		48395164  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X16MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395180	SUP	Custom 27803010		48395180  -  SPACER SPNL 0D WDG NOSE 25X11X18MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48395184	SUP	Custom 27803010		48395184  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X18MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480074	SUP	Custom 27803010		48480074  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X7MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480084	SUP	Custom 27803010		48480084  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X8MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480090	SUP	Custom 27803010		48480090  -  SPACER SPNL 0D WDG NOSE 20X9X9MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480094	SUP	Custom 27803010		48480094  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X9MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480100	SUP	Custom 27803010		48480100  -  SPACER SPNL 0D WDG NOSE 20X9X10MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480104	SUP	Custom 27803010		48480104  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X10MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480110	SUP	Custom 27803010		48480110  -  SPACER SPNL 0D WDG NOSE 20X9X11MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480114	SUP	Custom 27803010		48480114  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X11MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480120	SUP	Custom 27803010		48480120  -  SPACER SPNL 0D WDG NOSE 20X9X12MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480124	SUP	Custom 27803010		48480124  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X12MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480130	SUP	Custom 27803010		48480130  -  SPACER SPNL 0D WDG NOSE 20X9X13MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480134	SUP	Custom 27803010		48480134  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X13MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480140	SUP	Custom 27803010		48480140  -  SPACER SPNL 0D WDG NOSE 20X9X14MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480144	SUP	Custom 27803010		48480144  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X14MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480150	SUP	Custom 27803010		48480150  -  SPACER SPNL 0D WDG NOSE 20X9X15MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480154	SUP	Custom 27803010		48480154  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X15MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480160	SUP	Custom 27803010		48480160  -  SPACER SPNL 0D WDG NOSE 20X9X16MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48480164	SUP	Custom 27803010		48480164  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X16MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48482001	SUP	HCPCS C1713		48482001  -  SCREW BONE DIAPASON OSS LMBR SPN COMBO	BOTH IP/OP	$271.83 	$201.15	$0.00	$217.46	$122.32	$122.32	$0.00	$0.00	$0.00	$56.66	$201.75	$201.75	$0.00	$0.00	$56.65	$0.00	$160.78	$160.78	$0.00	$135.91	$215.29	$217.46	$0.00		$0.00	$42.54	$0.00	$0.00	$43.27	$0.00	$0.00	$0.00	$0.00	$0.00
48482010	SUP	HCPCS C1713		48482010  -  CAP IMPL DIAPASON OSS BLOCKER SPNE	BOTH IP/OP	$271.83 	$201.15	$0.00	$217.46	$122.32	$122.32	$0.00	$0.00	$0.00	$56.66	$201.75	$201.75	$0.00	$0.00	$56.65	$0.00	$160.78	$160.78	$0.00	$135.91	$215.29	$217.46	$0.00		$0.00	$42.54	$0.00	$0.00	$43.27	$0.00	$0.00	$0.00	$0.00	$0.00
48482020	SUP	HCPCS C1713		48482020  -  RING IMPL DIAPASON OSS BLOCKER SPNE	BOTH IP/OP	$271.83 	$201.15	$0.00	$217.46	$122.32	$122.32	$0.00	$0.00	$0.00	$56.66	$201.75	$201.75	$0.00	$0.00	$56.65	$0.00	$160.78	$160.78	$0.00	$135.91	$215.29	$217.46	$0.00		$0.00	$42.54	$0.00	$0.00	$43.27	$0.00	$0.00	$0.00	$0.00	$0.00
48485074	SUP	Custom 27803010		48485074  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X7MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485084	SUP	Custom 27803010		48485084  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X8MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485090	SUP	Custom 27803010		48485090  -  SPACER SPNL 0D WDG NOSE 25X8X9MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485094	SUP	Custom 27803010		48485094  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X9MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485100	SUP	Custom 27803010		48485100  -  SPACER SPNL 0D WDG NOSE 25X8X10MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485104	SUP	Custom 27803010		48485104  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X10MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485110	SUP	Custom 27803010		48485110  -  SPACER SPNL 0D WDG NOSE 25X8X11MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485114	SUP	Custom 27803010		48485114  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X11MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485120	SUP	Custom 27803010		48485120  -  SPACER SPNL 0D WDG NOSE 25X8X12MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485124	SUP	Custom 27803010		48485124  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X12MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485130	SUP	Custom 27803010		48485130  -  SPACER SPNL 0D WDG NOSE 25X8X13MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485134	SUP	Custom 27803010		48485134  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X13MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485140	SUP	Custom 27803010		48485140  -  SPACER SPNL 0D WDG NOSE 25X8X14MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485144	SUP	Custom 27803010		48485144  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X14MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485150	SUP	Custom 27803010		48485150  -  SPACER SPNL 0D WDG NOSE 25X8X15MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485154	SUP	Custom 27803010		48485154  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X15MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485160	SUP	Custom 27803010		48485160  -  SPACER SPNL 0D WDG NOSE 25X8X16MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485164	SUP	Custom 27803010		48485164  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X16MM AVS UNILIF HLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48485530	SUP	HCPCS C1713		48485530  -  SCREW BONE 5.5MM 30MM DIAPASON OSS THOR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48485535	SUP	HCPCS C1713		48485535  -  SCREW BONE 5.5MM 35MM DIAPASON OSS THOR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48485540	SUP	HCPCS C1713		48485540  -  SCREW BONE 5.5MM 40MM DIAPASON OSS THOR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48485545	SUP	HCPCS C1713		48485545  -  SCREW BONE 5.5MM 45MM DIAPASON OSS THOR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48485550	SUP	HCPCS C1713		48485550  -  SCREW BONE 5.5MM 50MM DIAPASON OSS THOR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48485555	SUP	HCPCS C1713		48485555  -  SCREW BONE 5.5MM 55MM DIAPASON OSS THOR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486730	SUP	HCPCS C1713		48486730  -  SCREW BONE 6.7MM 30MM DIAPASON OSS LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486735	SUP	HCPCS C1713		48486735  -  SCREW BONE 6.7MM 35MM DIAPASON OSS THOR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486740	SUP	HCPCS C1713		48486740  -  SCREW BONE 6.7MM 40MM DIAPASON OSS LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486745	SUP	HCPCS C1713		48486745  -  SCREW BONE 6.7MM 45MM DIAPASON OSS LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486750	SUP	HCPCS C1713		48486750  -  SCREW BONE 6.7MM 50MM DIAPASON OSS LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486755	SUP	HCPCS C1713		48486755  -  SCREW BONE 6.7MM 55MM DIAPASON OSS LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486760	SUP	HCPCS C1713		48486760  -  SCREW BONE 6.7MM 60MM DIAPASON OSS LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48487730	SUP	HCPCS C1713		48487730  -  SCREW BONE 7.7MM 30MM DIAPASON OSS TI LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48487735	SUP	HCPCS C1713		48487735  -  SCREW BONE 7.7MM 35MM DIAPASON OSS LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48487740	SUP	HCPCS C1713		48487740  -  SCREW BONE 7.7MM 40MM DIAPASON OSS LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48487745	SUP	HCPCS C1713		48487745  -  SCREW BONE 7.7MM 45MM DIAPASON OSS LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48487750	SUP	HCPCS C1713		48487750  -  SCREW BONE 7.7MM 50MM DIAPASON OSS LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48487755	SUP	HCPCS C1713		48487755  -  SCREW BONE 7.7MM 55MM DIAPASON OSS LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48487760	SUP	HCPCS C1713		48487760  -  SCREW BONE 7.7MM 60MM DIAPASON OSS LMBR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48488035	SUP	HCPCS C1713		48488035  -  SCREW BONE 8MM 35MM DIAPASON OSS SCRL SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48488040	SUP	HCPCS C1713		48488040  -  SCREW BONE 8MM 40MM DIAPASON OSS SCRL SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48488045	SUP	HCPCS C1713		48488045  -  SCREW BONE 8MM 45MM DIAPASON OSS SCRL SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48488050	SUP	HCPCS C1713		48488050  -  SCREW BONE 8MM 50MM DIAPASON OSS SCRL SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48488055	SUP	HCPCS C1713		48488055  -  SCREW BONE 8MM 55MM DIAPASON OSS SCRL SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48489040	SUP	HCPCS C1713		48489040  -  SCREW BONE 9MM 40MM DIAPASON OSS SCRL SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48489045	SUP	HCPCS C1713		48489045  -  SCREW BONE 9MM 45MM DIAPASON OSS SCRL SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48489050	SUP	HCPCS C1713		48489050  -  SCREW BONE 9MM 50MM DIAPASON OSS SCRL SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48489055	SUP	HCPCS C1713		48489055  -  SCREW BONE 9MM 55MM DIAPASON OSS TI SCRL SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48510410	SUP	Custom 27203010		48510410  -  PIN FIX STANDARD TEMPORARY NAIL REFLEX SPN	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48510420	SUP	Custom 27203010		48510420  -  PIN FIX LONG REFLEX HYBRID	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48510610	SUP	HCPCS C1729		48510610  -  BIT DRILL 10MM REFLEX HYBRID STERILE	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48510612	SUP	Custom 27203010		48510612  -  BIT DRILL 12MM REFLEX HYBRID SPN CERV ANTERIOR STERILE	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48510614	SUP	Custom 27203010		48510614  -  BIT DRILL 14MM REFLEX HYBRID SPN CERV ANTERIOR STERILE	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48510616	SUP	Custom 27203010		48510616  -  BIT DRILL 16MM REFLEX HYBRID SPN CERV ANTERIOR STERILE	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48510618	SUP	HCPCS C1729		48510618  -  BIT DRILL 18MM REFLEX HYBRID SPN CERV ANTERIOR STERILE	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48510620	SUP	HCPCS C1729		48510620  -  BIT DRILL 20MM	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$142.54	$142.54	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
48550260	SUP	HCPCS C1713		48550260  -  ROD SPNL 60MM 3.5MM OASYS TI	BOTH IP/OP	$480.48 	$355.56	$0.00	$384.38	$216.21	$216.21	$0.00	$0.00	$0.00	$100.14	$356.61	$356.61	$0.00	$0.00	$100.13	$0.00	$284.20	$284.20	$0.00	$240.24	$380.54	$384.38	$0.00		$0.00	$75.19	$0.00	$0.00	$76.49	$0.00	$0.00	$0.00	$0.00	$0.00
48551000	SUP	Custom 27803010		48551000  -  SCREW SET BUTTRESS THREAD BLOCKER OASYS TITANIUM	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551006	SUP	HCPCS C1713		48551006  -  SCREW SET OASYS SPN CONCTR	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48551040	SUP	HCPCS C1713		48551040  -  PLATE BONE 130D STR OASYS TITANIUM SPN THORACIC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
48551042	SUP	HCPCS C1713		48551042  -  PLATE BONE 100D STR OASYS TITANIUM SPN THORACIC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
48551044	SUP	HCPCS C1713		48551044  -  PLATE BONE SMALL OASYS TITANIUM SPN THORACIC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
48551045	SUP	HCPCS C1713		48551045  -  PLATE BONE MEDIUM OASYS TITANIUM SPN THORACIC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
48551046	SUP	HCPCS C1713		48551046  -  PLATE BONE LARGE OASYS TITANIUM SPN THORACIC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
48551047	SUP	HCPCS C1713		48551047  -  PLATE BONE LARGE LONG OASYS TITANIUM SPN THORACIC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
48551048	SUP	HCPCS C1713		48551048  -  PLATE BONE MINI OASYS TITANIUM SPN THORACIC OCCIPITOCERVICAL	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
48551049	SUP	Custom 27803010		48551049  -  HOOK SPINAL 3.5MM OASYS TITANIUM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551050	SUP	Custom 27803010		48551050  -  HOOK SPINAL SHORT 5MM OASYS TITANIUM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551053	SUP	Custom 27803010		48551053  -  HOOK SPINAL 6.5MM OASYS TITANIUM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551055	SUP	Custom 27803010		48551055  -  HOOK SPINAL STANDARD 8MM TALL OASYS TITANIUM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551060	SUP	Custom 27803010		48551060  -  HOOK SPINAL RIGHT OFFST OASYS TITANIUM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551065	SUP	Custom 27803010		48551065  -  HOOK SPINAL LEFT OFFST OASYS TITANIUM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551070	SUP	Custom 27803010		48551070  -  CONNECTOR ROD TRNSVRS POLYAX OASYS CROSSLINK SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551071	SUP	Custom 27803010		48551071  -  CONNECTOR ROD 60MM TRNSVRS SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551072	SUP	Custom 27803010		48551072  -  CONNECTOR ROD 40MM TRNSVRS SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551073	SUP	HCPCS C1713		48551073  -  PLATE BONE SMALL CROSS CONCTR OASYS SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551074	SUP	Custom 27203010		48551074  -  CONNECTOR ROD MEDIUM 32MM CROSS PLATE OASYS SPN NONSTRL 91	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551075	SUP	HCPCS C1713		48551075  -  PLATE BONE CROSS CONCTR OASYS TITANIUM SPN THORACIC	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551080	SUP	Custom 27803010		48551080  -  CONNECTOR ROD OFFST OASYS SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551081	SUP	Custom 27803010		48551081  -  CONNECTOR ROD 12MM CROSS PLATE OASYS CERV SPN NONSTRL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551084	SUP	Custom 27803010		48551084  -  CONNECTOR ROD 3.5-4.5MM AXIAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551085	SUP	Custom 27803010		48551085  -  CONNECTOR ROD 3.5/3.5MM AXIAL OASYS SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551086	SUP	Custom 27803010		48551086  -  CONNECTOR ROD 3.5/5.5MM AXIAL OASYS SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551087	SUP	Custom 27803010		48551087  -  CONNECTOR ROD 3.5/6MM AXIAL OASYS SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551088	SUP	Custom 27803010		48551088  -  CONNECTOR ROD 3.5/3.5MM ROD TO ROD OASYS SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551089	SUP	Custom 27803010		48551089  -  CONNECTOR ROD 3.5/5.5MM ROD TO ROD OASYS SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551090	SUP	Custom 27803010		48551090  -  CONNECTOR ROD 3.5MM 90MM POLYAX ROD TO ROD OASYS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551091	SUP	Custom 27803010		48551091  -  CONNECTOR ROD 3.5/4.5MM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551094	SUP	Custom 27803010		48551094  -  CONNECTOR ROD SADDLE SCREW OASYS SPN 3.5 MM ROD	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551240	SUP	Custom 27803010		48551240  -  ROD SPINAL 3.5MM 240MM OASYS	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48551350	SUP	Custom 27803010		48551350  -  ROD SPINAL 3.5MM 350MM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552025	SUP	Custom 27803010		48552025  -  ROD SPINAL 3.5MM 25MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552030	SUP	Custom 27803010		48552030  -  ROD SPINAL 3.5MM 30MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552040	SUP	Custom 27803010		48552040  -  ROD SPINAL 3.5MM 40MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552050	SUP	Custom 27803010		48552050  -  ROD SPINAL 3.5MM 50MM OASYS TITANIUM OCCIPITO CERVICO	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552060	SUP	Custom 27803010		48552060  -  ROD SPINAL 3.5MM 60MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552070	SUP	Custom 27803010		48552070  -  ROD SPINAL 3.5MM 70MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552080	SUP	Custom 27803010		48552080  -  ROD SPINAL 3.5MM 80MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552120	SUP	Custom 27803010		48552120  -  ROD SPINAL 3.5MM 120MM OASYS TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552240	SUP	Custom 27803010		48552240  -  ROD SPINAL 3.5MM 240MM OASYS TITANIUM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552310	SUP	HCPCS C1713		48552310  -  SCREW BONE 3.5MM 10MM BIAS ANGLE POLYAX OASYS SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552312	SUP	HCPCS C1713		48552312  -  SCREW BONE LP 3.5MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552314	SUP	HCPCS C1713		48552314  -  SCREW BONE LP 3.5MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552316	SUP	HCPCS C1713		48552316  -  SCREW BONE LP 3.5MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552318	SUP	HCPCS C1713		48552318  -  SCREW BONE LP 3.5MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552320	SUP	HCPCS C1713		48552320  -  SCREW BONE LP 3.5MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552322	SUP	HCPCS C1713		48552322  -  SCREW BONE LP 3.5MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552324	SUP	HCPCS C1713		48552324  -  SCREW BONE LP 3.5MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552326	SUP	HCPCS C1713		48552326  -  SCREW BONE LP 3.5MM 26MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552328	SUP	HCPCS C1713		48552328  -  SCREW BONE LP 3.5MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552330	SUP	HCPCS C1713		48552330  -  SCREW BONE LP 3.5MM 30MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552332	SUP	HCPCS C1713		48552332  -  SCREW BONE LP 3.5MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552334	SUP	HCPCS C1713		48552334  -  SCREW BONE LP 3.5MM 34MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552336	SUP	HCPCS C1713		48552336  -  SCREW BONE 3.5MM 36MM POLYAX OASYS SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552338	SUP	HCPCS C1713		48552338  -  SCREW BONE 3.5MM 38MM POLYAX OASYS SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552340	SUP	HCPCS C1713		48552340  -  SCREW BONE 3.5MM 40MM POLYAX OASYS SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552342	SUP	HCPCS C1713		48552342  -  SCREW BONE 3.5MM 42MM POLYAX OASYS SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552344	SUP	HCPCS C1713		48552344  -  SCREW BONE 3.5MM 44MM POLYAX OASYS SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552346	SUP	HCPCS C1713		48552346  -  SCREW BONE 3.5MM 46MM POLYAX OASYS SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552348	SUP	HCPCS C1713		48552348  -  SCREW BONE 3.5MM 48MM POLYAX OASYS SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552350	SUP	HCPCS C1713		48552350  -  SCREW BONE 3.5MM 50MM POLYAX OASYS SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552352	SUP	HCPCS C1713		48552352  -  SCREW BONE 3.5MM 52MM POLYAX OASYS SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552354	SUP	HCPCS C1713		48552354  -  SCREW BONE 3.5MM 54MM POLYAX OASYS SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552410	SUP	HCPCS C1713		48552410  -  SCREW BONE LP 4MM 10MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552412	SUP	HCPCS C1713		48552412  -  SCREW BONE LP 4MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552414	SUP	HCPCS C1713		48552414  -  SCREW BONE LP 4MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552416	SUP	HCPCS C1713		48552416  -  SCREW BONE LP 4MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552418	SUP	HCPCS C1713		48552418  -  SCREW BONE LP 4MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552420	SUP	HCPCS C1713		48552420  -  SCREW BONE LP 4MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552422	SUP	HCPCS C1713		48552422  -  SCREW BONE LP 4MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552424	SUP	HCPCS C1713		48552424  -  SCREW BONE LP 4MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552426	SUP	HCPCS C1713		48552426  -  SCREW BONE LP 4MM 26MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552428	SUP	HCPCS C1713		48552428  -  SCREW BONE LP 4MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552430	SUP	HCPCS C1713		48552430  -  SCREW BONE LP 4MM 30MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552432	SUP	HCPCS C1713		48552432  -  SCREW BONE LP 4MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552434	SUP	HCPCS C1713		48552434  -  SCREW BONE LP 4MM 34MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552436	SUP	HCPCS C1713		48552436  -  SCREW BONE LP 4MM 36MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552438	SUP	HCPCS C1713		48552438  -  SCREW BONE LP 4MM 38MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552440	SUP	HCPCS C1713		48552440  -  SCREW BONE LP 4MM 40MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552442	SUP	HCPCS C1713		48552442  -  SCREW BONE LP 4MM 42MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552446	SUP	HCPCS C1713		48552446  -  SCREW BONE LP 4MM 46MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48552450	SUP	HCPCS C1713		48552450  -  SCREW BONE LP 4MM 50MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48553600	SUP	Custom 27803010		48553600  -  ROD SPINAL 3.5-4.5MM 600MM TRANSITION OASYS TITANIUM	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48553602	SUP	Custom 27803010		48553602  -  ROD SPNL 3.5-4.5MM 600MM NS LF OASYS TRNS VIT	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48553604	SUP	Custom 27803010		48553604  -  ROD SPNL 3.5-5.5MM 600MM NS OASYS TRNS TI	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48553606	SUP	Custom 27803010		48553606  -  ROD SPINAL 3.5-5.5MM TRANSITION OASYS VITALLIUM	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48553608	SUP	Custom 27803010		48553608  -  ROD SPNL 3.5-6MM 600MM NS OASYS TRNS TI	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48553610	SUP	Custom 27803010		48553610  -  ROD SPINAL 3.5-6MM TRANSITION OASYS VITALLIUM	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48554306	SUP	HCPCS C1713		48554306  -  SCREW BONE LP 3.5MM 6MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554308	SUP	HCPCS C1713		48554308  -  SCREW BONE LP 3.5MM 8MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554310	SUP	HCPCS C1713		48554310  -  SCREW BONE LP 3.5MM 10MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554312	SUP	HCPCS C1713		48554312  -  SCREW BONE LP 3.5MM 12MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554314	SUP	HCPCS C1713		48554314  -  SCREW BONE LP 3.5MM 14MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554316	SUP	HCPCS C1713		48554316  -  SCREW BONE LP 3.5MM 16MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554406	SUP	HCPCS C1713		48554406  -  SCREW BONE LP 4MM 6MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554408	SUP	HCPCS C1713		48554408  -  SCREW BONE LP 4MM 8MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554410	SUP	HCPCS C1713		48554410  -  SCREW BONE LP 4MM 10MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554412	SUP	HCPCS C1713		48554412  -  SCREW BONE LP 4MM 12MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554414	SUP	HCPCS C1713		48554414  -  SCREW BONE LP 4MM 14MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554416	SUP	HCPCS C1713		48554416  -  SCREW BONE LP 4MM 16MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554506	SUP	HCPCS C1713		48554506  -  SCREW BONE LP 4.5MM 6MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554508	SUP	HCPCS C1713		48554508  -  SCREW BONE LP 4.5MM 8MM OASYS TITANIUM SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554510	SUP	HCPCS C1713		48554510  -  SCREW BONE 4.5MM 10MM OASYS SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554512	SUP	HCPCS C1713		48554512  -  SCREW BONE 4.5MM 12MM OASYS SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554514	SUP	HCPCS C1713		48554514  -  SCREW BONE 4.5MM 14MM OASYS SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48554516	SUP	HCPCS C1713		48554516  -  SCREW BONE 4.5MM 16MM OASYS SPN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
48555320	SUP	HCPCS C1713		48555320  -  SCREW BONE LP 3.5MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555322	SUP	HCPCS C1713		48555322  -  SCREW BONE LP 3.5MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555324	SUP	HCPCS C1713		48555324  -  SCREW BONE LP 3.5MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555328	SUP	HCPCS C1713		48555328  -  SCREW BONE LP 3.5MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555332	SUP	HCPCS C1713		48555332  -  SCREW BONE LP 3.5MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555336	SUP	HCPCS C1713		48555336  -  SCREW BONE LP 3.5MM 36MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555340	SUP	HCPCS C1713		48555340  -  SCREW BONE LP 3.5MM 40MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555420	SUP	HCPCS C1713		48555420  -  SCREW BONE LP 4MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555422	SUP	HCPCS C1713		48555422  -  SCREW BONE LP 4MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555424	SUP	HCPCS C1713		48555424  -  SCREW BONE LP 4MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555428	SUP	HCPCS C1713		48555428  -  SCREW BONE LP 4MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555432	SUP	HCPCS C1713		48555432  -  SCREW BONE LP 4MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555436	SUP	HCPCS C1713		48555436  -  SCREW BONE LP 4MM 36MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555440	SUP	HCPCS C1713		48555440  -  SCREW BONE LP 4MM 40MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555444	SUP	HCPCS C1713		48555444  -  SCREW BONE LP 4MM 44MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555448	SUP	HCPCS C1713		48555448  -  SCREW BONE LP 4MM 48MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48555452	SUP	HCPCS C1713		48555452  -  SCREW BONE LP 4MM 52MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48556322	SUP	HCPCS C1713		48556322  -  SCREW BONE LP 3.5MM 22MM BIAS ANGLE SMOOTH SHANK OASYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48556324	SUP	HCPCS C1713		48556324  -  SCREW BONE LP 3.5MM 24MM BIAS ANGLE SMOOTH SHANK OASYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48556326	SUP	HCPCS C1713		48556326  -  SCREW BONE LP 3.5MM 26MM BIAS ANGLE SMOOTH SHANK OASYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48556328	SUP	HCPCS C1713		48556328  -  SCREW BONE LP 3.5MM 28MM BIAS ANGLE SMOOTH SHANK OASYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48556330	SUP	HCPCS C1713		48556330  -  SCREW BONE LP 3.5MM 30MM BIAS ANGLE SMOOTH SHANK OASYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48556332	SUP	HCPCS C1713		48556332  -  SCREW BONE LP 3.5MM 32MM BIAS ANGLE SMOOTH SHANK OASYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48556334	SUP	HCPCS C1713		48556334  -  SCREW BONE LP 3.5MM 34MM BIAS ANGLE SMOOTH SHANK OASYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48556336	SUP	HCPCS C1713		48556336  -  SCREW BONE LP 3.5MM 36MM BIAS ANGLE SMOOTH SHANK OASYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48556338	SUP	HCPCS C1713		48556338  -  SCREW BONE LP 3.5MM 38MM BIAS ANGLE SMOOTH SHANK OASYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48556340	SUP	HCPCS C1713		48556340  -  SCREW BONE LP 3.5MM 40MM BIAS ANGLE SMOOTH SHANK OASYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557310	SUP	HCPCS C1713		48557310  -  SCREW BONE LP 3.5MM 10MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557312	SUP	HCPCS C1713		48557312  -  SCREW BONE LP 3.5MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557314	SUP	HCPCS C1713		48557314  -  SCREW BONE LP 3.5MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557316	SUP	HCPCS C1713		48557316  -  SCREW BONE LP 3.5MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557318	SUP	HCPCS C1713		48557318  -  SCREW BONE LP 3.5MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557320	SUP	HCPCS C1713		48557320  -  SCREW BONE LP 3.5MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557322	SUP	HCPCS C1713		48557322  -  SCREW BONE LP 3.5MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557324	SUP	HCPCS C1713		48557324  -  SCREW BONE LP 3.5MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557410	SUP	HCPCS C1713		48557410  -  SCREW BONE LP 4MM 10MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557412	SUP	HCPCS C1713		48557412  -  SCREW BONE LP 4MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557414	SUP	HCPCS C1713		48557414  -  SCREW BONE LP 4MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557416	SUP	HCPCS C1713		48557416  -  SCREW BONE LP 4MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557418	SUP	HCPCS C1713		48557418  -  SCREW BONE LP 4MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557420	SUP	HCPCS C1713		48557420  -  SCREW BONE LP 4MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557422	SUP	HCPCS C1713		48557422  -  SCREW BONE LP 4MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48557424	SUP	HCPCS C1713		48557424  -  SCREW BONE LP 4MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558310	SUP	HCPCS C1713		48558310  -  SCREW BONE LP 3.5MM 10MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558312	SUP	HCPCS C1713		48558312  -  SCREW BN 3.5MM 12MM FCHSA NS OASYS PA NONBIAS ANG TULIP HD	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558314	SUP	HCPCS C1713		48558314  -  SCREW BN 3.5MM 14MM FCHSA NS OASYS PA NONBIAS ANG TULIP HD	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558316	SUP	HCPCS C1713		48558316  -  SCREW BONE LP 3.5MM 16MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558318	SUP	HCPCS C1713		48558318  -  SCREW BONE LP 3.5MM 18MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558320	SUP	HCPCS C1713		48558320  -  SCREW BONE LP 3.5MM 20MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558410	SUP	HCPCS C1713		48558410  -  SCREW BONE LP 4MM 10MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558412	SUP	HCPCS C1713		48558412  -  SCREW BONE LP 4MM 12MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558414	SUP	HCPCS C1713		48558414  -  SCREW BONE LP 4MM 14MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558416	SUP	HCPCS C1713		48558416  -  SCREW BONE LP 4MM 16MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558418	SUP	HCPCS C1713		48558418  -  SCREW BONE LP 4MM 18MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558420	SUP	HCPCS C1713		48558420  -  SCREW BONE LP 4MM 20MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558520	SUP	HCPCS C1713		48558520  -  SCREW BONE LP 4.5MM 20MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558524	SUP	HCPCS C1713		48558524  -  SCREW BN 4.5MM 24MM FCHSA NS OASYS PA NONBIAS ANG TULIP HD	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558528	SUP	HCPCS C1713		48558528  -  SCREW BONE LP 4.5MM 28MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558532	SUP	HCPCS C1713		48558532  -  SCREW BONE LP 4.5MM 32MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558536	SUP	HCPCS C1713		48558536  -  SCREW BONE LP 4.5MM 36MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558540	SUP	HCPCS C1713		48558540  -  SCREW BONE LP 4.5MM 40MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558544	SUP	HCPCS C1713		48558544  -  SCREW BONE LP 4.5MM 44MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558548	SUP	HCPCS C1713		48558548  -  SCREW BONE LP 4.5MM 48MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48558552	SUP	HCPCS C1713		48558552  -  SCREW BONE LP 4.5MM 52MM POLYAX OASYS TITANIUM SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
48560314	SUP	Custom 27803010		48560314  -  TAP SPINAL 3.5MM DRILL BIT OASYS	BOTH IP/OP	$490.83 	$363.21	$0.00	$392.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$364.29	$364.29	$0.00	$0.00	$102.29	$0.00	$0.00	$0.00	$0.00	$245.41	$388.74	$392.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48560323	SUP	Custom 27203010		48560323  -  BIT DRL 2.5MM 3.5MM PA SCR	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48560414	SUP	HCPCS C1713		48560414  -  TAP SURG 4MM OASYS SPN 4MM SCREW	BOTH IP/OP	$490.83 	$363.21	$0.00	$392.66	$220.87	$220.87	$0.00	$0.00	$0.00	$102.30	$364.29	$364.29	$0.00	$0.00	$102.29	$0.00	$290.32	$290.32	$0.00	$245.41	$388.74	$392.66	$0.00		$0.00	$76.81	$0.00	$0.00	$78.14	$0.00	$0.00	$0.00	$0.00	$0.00
48560423	SUP	Custom 27203010		48560423  -  DRILL SURG 3MM OASYS SPN STERILE 4MM SCREW	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48560514	SUP	HCPCS C1713		48560514  -  TAP SPINAL 3.5MM OASYS SPN	BOTH IP/OP	$425.30 	$314.72	$0.00	$340.24	$191.39	$191.39	$0.00	$0.00	$0.00	$88.64	$315.66	$315.66	$0.00	$0.00	$88.63	$0.00	$251.56	$251.56	$0.00	$212.65	$336.84	$340.24	$0.00		$0.00	$66.56	$0.00	$0.00	$67.71	$0.00	$0.00	$0.00	$0.00	$0.00
48570114	SUP	Custom 27203010		48570114  -  BIT DRL 4MM ESCALATE LAMINOPLASTY	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48570116	SUP	Custom 27203010		48570116  -  DRILL SURG 6MM ESCALATE NONSTRL LAMINOPLASTY	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48570118	SUP	Custom 27203010		48570118  -  DRILL SURG 8MM ESCALATE NONSTRL LAMINOPLASTY	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48570204	SUP	HCPCS C1713		48570204  -  SCREW BONE 2MM 4MM SELF DRILL ESCALATE MAGENTA SPN CERV	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48570206	SUP	HCPCS C1713		48570206  -  SCREW BONE 2MM 6MM SELF DRILL ESCALATE MAGENTA SPN CERV	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48570208	SUP	HCPCS C1713		48570208  -  SCREW BONE 2MM 8MM SELF DRILL ESCALATE MAGENTA SPN CERV	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48570210	SUP	HCPCS C1713		48570210  -  ESCALATE 2.0 X 10MM SELF DRILLING SCREW	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48570240	SUP	HCPCS C1713		48570240  -  ESCALATE 2.4 X 10MM SELF TAPPING SCREW	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48570244	SUP	HCPCS C1713		48570244  -  ESCALATE 2.4 X 4MM SELF TAPPING SCREW	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48570246	SUP	HCPCS C1713		48570246  -  ESCALATE 2.4 X 6MM SELF TAPPING SCREW	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48570248	SUP	HCPCS C1713		48570248  -  ESCALATE 2.4 X 8MM SELF TAPPING SCREW	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48570300	SUP	HCPCS C1713		48570300  -  PLATE BONE 5MM EXPANDABLE ESCALATE TITANIUM SPN CERV NONSTRL	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
48570301	SUP	HCPCS C1713		48570301  -  PLATE BONE 5MM 2 HOLE BASE ESCALATE TITANIUM SPN CERV	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610112	SUP	HCPCS C1713		48610112  -  PLATE 12MM TI 1 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610114	SUP	HCPCS C1713		48610114  -  PLATE 14MM TI 1 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610116	SUP	HCPCS C1713		48610116  -  PLATE 16MM TI 1 LVL RFLX HB BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610118	SUP	HCPCS C1713		48610118  -  PLATE 18MM TI 1 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610120	SUP	HCPCS C1713		48610120  -  PLATE 20MM TI 1 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610122	SUP	HCPCS C1713		48610122  -  PLATE 22MM TI 1 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610224	SUP	HCPCS C1713		48610224  -  PLATE 24MM TI 2 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610226	SUP	HCPCS C1713		48610226  -  PLATE 26MM TI 2 LVL RFLX HB BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610228	SUP	HCPCS C1713		48610228  -  PLATE 28MM TI 2 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610230	SUP	HCPCS C1713		48610230  -  PLATE 30MM TI 2 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610232	SUP	HCPCS C1713		48610232  -  PLATE 32MM TI 2 LVL RFLX BONE ANT CERV	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610234	SUP	HCPCS C1713		48610234  -  PLATE 34MM TI 2 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610237	SUP	HCPCS C1713		48610237  -  PLATE 37MM TI 2 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610240	SUP	HCPCS C1713		48610240  -  PLATE 40MM TI 2 LVL RFLX HB BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610243	SUP	HCPCS C1713		48610243  -  PLATE 43MM TI 2 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610246	SUP	HCPCS C1713		48610246  -  PLATE 46MM 2 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48610339	SUP	HCPCS C1713		48610339  -  PLATE 39MM TI 3 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610342	SUP	HCPCS C1713		48610342  -  PLATE 42MM TI 3 LVL RFLX BONE ANT CERV	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610345	SUP	HCPCS C1713		48610345  -  PLATE 45MM TI 3 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610348	SUP	HCPCS C1713		48610348  -  PLATE 48MM 3 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610351	SUP	HCPCS C1713		48610351  -  PLATE 51MM TI 3 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610354	SUP	HCPCS C1713		48610354  -  PLATE 54MM TI 3 LVL RFLX HB BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610357	SUP	HCPCS C1713		48610357  -  PLATE 57MM TI 3 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610360	SUP	HCPCS C1713		48610360  -  PLATE 60MM TI 3 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610363	SUP	HCPCS C1713		48610363  -  PLATE 63MM TI 3 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610366	SUP	HCPCS C1713		48610366  -  PLATE 66MM TI 3 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610369	SUP	HCPCS C1713		48610369  -  PLATE 69MM TI 3 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610460	SUP	HCPCS C1713		48610460  -  PLATE 60MM TI 4 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610464	SUP	HCPCS C1713		48610464  -  PLATE 64MM TI 4 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610468	SUP	HCPCS C1713		48610468  -  PLATE 68MM TI 4 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610472	SUP	HCPCS C1713		48610472  -  PLATE 72MM TI 4 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610476	SUP	HCPCS C1713		48610476  -  PLATE 76MM TI 4 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610480	SUP	HCPCS C1713		48610480  -  PLATE 80MM TI 4 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48610484	SUP	HCPCS C1713		48610484  -  PLATE 84MM TI 4 LVL RFLX BONE ANT CERV SPN	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
48624010	SUP	HCPCS C1713		48624010  -  SCREW BONE 4MM 10MM RFLX HB TI ANT CERV SPN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48624012	SUP	HCPCS C1713		48624012  -  SCREW BONE 4MM 12MM RFLX TI ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48624014	SUP	HCPCS C1713		48624014  -  SCREW BONE 4MM 14MM RFLX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48624016	SUP	HCPCS C1713		48624016  -  SCREW BONE 4MM 16MM RFLX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48624018	SUP	HCPCS C1713		48624018  -  SCREW BONE 4MM 18MM RFLX TI ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48624020	SUP	HCPCS C1713		48624020  -  SCREW BONE 4MM 20MM RFLX TI ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48624022	SUP	HCPCS C1713		48624022  -  SCREW BONE 4MM 22MM RFLX TI ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48624512	SUP	HCPCS C1713		48624512  -  SCREW BONE 4.5MM 12MM RFLX TI ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48624514	SUP	HCPCS C1713		48624514  -  SCREW BONE 4.5MM 14MM RFLX TI ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48624516	SUP	HCPCS C1713		48624516  -  SCREW BONE 4.5MM 16MM RFLX TI ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48624518	SUP	HCPCS C1713		48624518  -  SCREW BONE 4.5MM 18MM RFLX TI ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48624520	SUP	HCPCS C1713		48624520  -  SCREW BONE 4.5MM 20MM RFLX TI ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48624522	SUP	HCPCS C1713		48624522  -  SCREW BONE 4.5MM 22MM RFLX TI ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48644010	SUP	HCPCS C1713		48644010  -  SCREW BONE 4MM 10MM RFLX HB TI SPNL SLFDRILL VAR ANG	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
48644012	SUP	HCPCS C1713		48644012  -  SCREW BONE 4MM 12MM VAR ANG SELF DRILL DYNATRAN REFLEX	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48644014	SUP	HCPCS C1713		48644014  -  SCREW BONE 4MM 14MM VAR ANG SELF DRILL DYNATRAN REFLEX	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48644016	SUP	HCPCS C1713		48644016  -  SCREW BONE 4MM 16MM VAR ANG SELF DRILL DYNATRAN REFLEX	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48644018	SUP	HCPCS C1713		48644018  -  SCREW BONE 4MM 18MM VAR ANG SELF DRILL DYNATRAN REFLEX	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48650228	SUP	HCPCS C1713		48650228  -  PLATE BN 28MM RFLX HB LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
48651112	SUP	HCPCS C1713		48651112  -  PLATE BONE 12MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651114	SUP	HCPCS C1713		48651114  -  PLATE BN 14MM NS RFLX HB LVL 1 TI SPNE CRV ANT	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651116	SUP	HCPCS C1713		48651116  -  PLATE BONE 16MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651118	SUP	HCPCS C1713		48651118  -  PLATE BONE 18MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651120	SUP	HCPCS C1713		48651120  -  PLATE BONE 20MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651122	SUP	HCPCS C1713		48651122  -  PLATE BONE 22MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651224	SUP	HCPCS C1713		48651224  -  PLATE BONE 24MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651226	SUP	HCPCS C1713		48651226  -  PLATE BONE 26MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651228	SUP	HCPCS C1713		48651228  -  PLATE BN 28MM NS RFLX HB LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651230	SUP	HCPCS C1713		48651230  -  PLATE BONE 30MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651232	SUP	HCPCS C1713		48651232  -  PLATE BN 32MM NS RFLX HB LVL 2 TI SPNE CRV ANT	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651234	SUP	HCPCS C1713		48651234  -  PLATE BONE 34MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651237	SUP	HCPCS C1713		48651237  -  PLATE BONE 37MM 6 HOLE LEVEL 2 REFLEX HYBRID TITANIUM SPN	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651240	SUP	HCPCS C1713		48651240  -  PLATE BONE 40MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651243	SUP	HCPCS C1713		48651243  -  PLATE BONE 43MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651246	SUP	HCPCS C1713		48651246  -  PLATE BONE 46MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48651339	SUP	HCPCS C1713		48651339  -  PLATE BONE 39MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651342	SUP	HCPCS C1713		48651342  -  PLATE BONE 42MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651345	SUP	HCPCS C1713		48651345  -  PLATE BONE 45MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651348	SUP	HCPCS C1713		48651348  -  PLATE BN 48MM NS RFLX HB LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651351	SUP	HCPCS C1713		48651351  -  PLATE BONE 51MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651354	SUP	HCPCS C1713		48651354  -  PLATE BONE 54MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651357	SUP	HCPCS C1713		48651357  -  PLATE BONE 57MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651360	SUP	HCPCS C1713		48651360  -  PLATE BN 60MM NS RFLX HB LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651363	SUP	HCPCS C1713		48651363  -  PLATE BN 63MM RFLX HB LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651366	SUP	HCPCS C1713		48651366  -  PLATE BN 66MM RFLX HB LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651369	SUP	HCPCS C1713		48651369  -  PLATE BN 69MM RFLX HB LVL 3 TI SPNE CRV ANT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651460	SUP	HCPCS C1713		48651460  -  PLATE BN 60MM NS RFLX HB LVL 4 TI SPNE CRV ANT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651464	SUP	HCPCS C1713		48651464  -  PLATE BONE 64MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651468	SUP	HCPCS C1713		48651468  -  PLATE BONE 68MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651472	SUP	HCPCS C1713		48651472  -  PLATE BONE 72MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651476	SUP	HCPCS C1713		48651476  -  PLATE BN 76MM RFLX HB LVL 4 TI SPNE CRV ANT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651480	SUP	HCPCS C1713		48651480  -  PLATE BN 80MM RFLX HB LVL 4 TI SPNE CRV ANT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651484	SUP	HCPCS C1713		48651484  -  PLATE BONE 84MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651488	SUP	HCPCS C1713		48651488  -  PLATE BONE 88MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651492	SUP	HCPCS C1713		48651492  -  PLATE BN 92MM LVL 4 SPNE CRV ANT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48651496	SUP	HCPCS C1713		48651496  -  PLATE BN 96MM LVL 4 SPNE CRV ANT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48654010	SUP	HCPCS C1713		48654010  -  SCREW BONE 4MM 10MM FIX ANGLE SELF DRILL DYNATRAN REFLEX	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48654012	SUP	HCPCS C1713		48654012  -  SCREW BONE 4MM 12MM FIX ANGLE SELF DRILL DYNATRAN REFLEX	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48654014	SUP	HCPCS C1713		48654014  -  SCREW BONE 4MM 14MM FIX ANGLE SELF DRILL DYNATRAN REFLEX	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48654016	SUP	HCPCS C1713		48654016  -  SCREW BONE 4MM 16MM FIX ANGLE SELF DRILL DYNATRAN REFLEX	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48654018	SUP	HCPCS C1713		48654018  -  SCREW BONE 4MM 18MM FIX ANGLE SELF DRILL DYNATRAN REFLEX	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48660112	SUP	HCPCS C1713		48660112  -  PLATE 12MM 1 LVL ZERO PRFL ACP BONE ANT CERV SPN	BOTH IP/OP	"$4,263.88 "	"$3,155.27"	$0.00	"$3,411.10"	"$1,918.74"	"$1,918.74"	$0.00	$0.00	$0.00	$888.70	"$3,164.65"	"$3,164.65"	$0.00	$0.00	$888.59	$0.00	"$2,102.09"	"$2,102.09"	$0.00	"$2,131.94"	"$3,376.99"	"$3,411.10"	$0.00		$0.00	$667.30	$0.00	$0.00	$678.81	$0.00	$0.00	$0.00	$0.00	$0.00
48660114	SUP	HCPCS C1713		48660114  -  PLATE 14MM 1 LVL BONE	BOTH IP/OP	"$4,263.88 "	"$3,155.27"	$0.00	"$3,411.10"	"$1,918.74"	"$1,918.74"	$0.00	$0.00	$0.00	$888.70	"$3,164.65"	"$3,164.65"	$0.00	$0.00	$888.59	$0.00	"$2,102.09"	"$2,102.09"	$0.00	"$2,131.94"	"$3,376.99"	"$3,411.10"	$0.00		$0.00	$667.30	$0.00	$0.00	$678.81	$0.00	$0.00	$0.00	$0.00	$0.00
48660116	SUP	HCPCS C1713		48660116  -  PLATE 16MM ZERO PRFL ACP BONE ANT CERV SPN	BOTH IP/OP	"$4,263.88 "	"$3,155.27"	$0.00	"$3,411.10"	"$1,918.74"	"$1,918.74"	$0.00	$0.00	$0.00	$888.70	"$3,164.65"	"$3,164.65"	$0.00	$0.00	$888.59	$0.00	"$2,102.09"	"$2,102.09"	$0.00	"$2,131.94"	"$3,376.99"	"$3,411.10"	$0.00		$0.00	$667.30	$0.00	$0.00	$678.81	$0.00	$0.00	$0.00	$0.00	$0.00
48660118	SUP	HCPCS C1713		48660118  -  PLATE 18MM 1 LVL BONE ANT CERV SPN	BOTH IP/OP	"$4,263.88 "	"$3,155.27"	$0.00	"$3,411.10"	"$1,918.74"	"$1,918.74"	$0.00	$0.00	$0.00	$888.70	"$3,164.65"	"$3,164.65"	$0.00	$0.00	$888.59	$0.00	"$2,102.09"	"$2,102.09"	$0.00	"$2,131.94"	"$3,376.99"	"$3,411.10"	$0.00		$0.00	$667.30	$0.00	$0.00	$678.81	$0.00	$0.00	$0.00	$0.00	$0.00
48660120	SUP	HCPCS C1713		48660120  -  PLATE 20MM 1 LVL ZERO PRFL ACP BONE	BOTH IP/OP	"$4,263.88 "	"$3,155.27"	$0.00	"$3,411.10"	"$1,918.74"	"$1,918.74"	$0.00	$0.00	$0.00	$888.70	"$3,164.65"	"$3,164.65"	$0.00	$0.00	$888.59	$0.00	"$2,102.09"	"$2,102.09"	$0.00	"$2,131.94"	"$3,376.99"	"$3,411.10"	$0.00		$0.00	$667.30	$0.00	$0.00	$678.81	$0.00	$0.00	$0.00	$0.00	$0.00
48660122	SUP	HCPCS C1713		48660122  -  PLATE 22MM 1 LVL ACP BONE ANT CERV SPN	BOTH IP/OP	"$4,263.88 "	"$3,155.27"	$0.00	"$3,411.10"	"$1,918.74"	"$1,918.74"	$0.00	$0.00	$0.00	$888.70	"$3,164.65"	"$3,164.65"	$0.00	$0.00	$888.59	$0.00	"$2,102.09"	"$2,102.09"	$0.00	"$2,131.94"	"$3,376.99"	"$3,411.10"	$0.00		$0.00	$667.30	$0.00	$0.00	$678.81	$0.00	$0.00	$0.00	$0.00	$0.00
48660124	SUP	HCPCS C1713		48660124  -  PLATE 24MM 1 LVL ACP BONE ANT CERV SPN	BOTH IP/OP	"$4,263.88 "	"$3,155.27"	$0.00	"$3,411.10"	"$1,918.74"	"$1,918.74"	$0.00	$0.00	$0.00	$888.70	"$3,164.65"	"$3,164.65"	$0.00	$0.00	$888.59	$0.00	"$2,102.09"	"$2,102.09"	$0.00	"$2,131.94"	"$3,376.99"	"$3,411.10"	$0.00		$0.00	$667.30	$0.00	$0.00	$678.81	$0.00	$0.00	$0.00	$0.00	$0.00
48660224	SUP	HCPCS C1713		48660224  -  PLATE 24MM 2 LVL ACP BONE ANT CERV SPN	BOTH IP/OP	"$4,477.28 "	"$3,313.19"	$0.00	"$3,581.82"	"$2,014.77"	"$2,014.77"	$0.00	$0.00	$0.00	$933.18	"$3,323.03"	"$3,323.03"	$0.00	$0.00	$933.06	$0.00	"$2,207.30"	"$2,207.30"	$0.00	"$2,238.64"	"$3,546.01"	"$3,581.82"	$0.00		$0.00	$700.69	$0.00	$0.00	$712.78	$0.00	$0.00	$0.00	$0.00	$0.00
48660226	SUP	HCPCS C1713		48660226  -  PLATE 26MM 2 LVL ACP BONE ANT CERV SPN	BOTH IP/OP	"$4,477.28 "	"$3,313.19"	$0.00	"$3,581.82"	"$2,014.77"	"$2,014.77"	$0.00	$0.00	$0.00	$933.18	"$3,323.03"	"$3,323.03"	$0.00	$0.00	$933.06	$0.00	"$2,207.30"	"$2,207.30"	$0.00	"$2,238.64"	"$3,546.01"	"$3,581.82"	$0.00		$0.00	$700.69	$0.00	$0.00	$712.78	$0.00	$0.00	$0.00	$0.00	$0.00
48660228	SUP	HCPCS C1713		48660228  -  PLATE 28MM 2 LVL ACP BONE ANT CERV SPN	BOTH IP/OP	"$4,477.28 "	"$3,313.19"	$0.00	"$3,581.82"	"$2,014.77"	"$2,014.77"	$0.00	$0.00	$0.00	$933.18	"$3,323.03"	"$3,323.03"	$0.00	$0.00	$933.06	$0.00	"$2,207.30"	"$2,207.30"	$0.00	"$2,238.64"	"$3,546.01"	"$3,581.82"	$0.00		$0.00	$700.69	$0.00	$0.00	$712.78	$0.00	$0.00	$0.00	$0.00	$0.00
48660230	SUP	HCPCS C1713		48660230  -  PLATE 30MM 2 LVL BONE SPNL	BOTH IP/OP	"$4,477.28 "	"$3,313.19"	$0.00	"$3,581.82"	"$2,014.77"	"$2,014.77"	$0.00	$0.00	$0.00	$933.18	"$3,323.03"	"$3,323.03"	$0.00	$0.00	$933.06	$0.00	"$2,207.30"	"$2,207.30"	$0.00	"$2,238.64"	"$3,546.01"	"$3,581.82"	$0.00		$0.00	$700.69	$0.00	$0.00	$712.78	$0.00	$0.00	$0.00	$0.00	$0.00
48660232	SUP	HCPCS C1713		48660232  -  PLATE 32MM 2 LVL ACP BONE	BOTH IP/OP	"$4,477.28 "	"$3,313.19"	$0.00	"$3,581.82"	"$2,014.77"	"$2,014.77"	$0.00	$0.00	$0.00	$933.18	"$3,323.03"	"$3,323.03"	$0.00	$0.00	$933.06	$0.00	"$2,207.30"	"$2,207.30"	$0.00	"$2,238.64"	"$3,546.01"	"$3,581.82"	$0.00		$0.00	$700.69	$0.00	$0.00	$712.78	$0.00	$0.00	$0.00	$0.00	$0.00
48660234	SUP	HCPCS C1713		48660234  -  PLATE 34MM 2 LVL BONE ANT CERV SPN	BOTH IP/OP	"$4,477.28 "	"$3,313.19"	$0.00	"$3,581.82"	"$2,014.77"	"$2,014.77"	$0.00	$0.00	$0.00	$933.18	"$3,323.03"	"$3,323.03"	$0.00	$0.00	$933.06	$0.00	"$2,207.30"	"$2,207.30"	$0.00	"$2,238.64"	"$3,546.01"	"$3,581.82"	$0.00		$0.00	$700.69	$0.00	$0.00	$712.78	$0.00	$0.00	$0.00	$0.00	$0.00
48660236	SUP	HCPCS C1713		48660236  -  PLATE 36MM 2 LVL ACP BONE	BOTH IP/OP	"$4,477.28 "	"$3,313.19"	$0.00	"$3,581.82"	"$2,014.77"	"$2,014.77"	$0.00	$0.00	$0.00	$933.18	"$3,323.03"	"$3,323.03"	$0.00	$0.00	$933.06	$0.00	"$2,207.30"	"$2,207.30"	$0.00	"$2,238.64"	"$3,546.01"	"$3,581.82"	$0.00		$0.00	$700.69	$0.00	$0.00	$712.78	$0.00	$0.00	$0.00	$0.00	$0.00
48660238	SUP	HCPCS C1713		48660238  -  PLATE 38MM 2 LVL ACP BONE ANT CERV SPN	BOTH IP/OP	"$4,477.28 "	"$3,313.19"	$0.00	"$3,581.82"	"$2,014.77"	"$2,014.77"	$0.00	$0.00	$0.00	$933.18	"$3,323.03"	"$3,323.03"	$0.00	$0.00	$933.06	$0.00	"$2,207.30"	"$2,207.30"	$0.00	"$2,238.64"	"$3,546.01"	"$3,581.82"	$0.00		$0.00	$700.69	$0.00	$0.00	$712.78	$0.00	$0.00	$0.00	$0.00	$0.00
48660240	SUP	HCPCS C1713		48660240  -  PLATE 40MM 2 LVL ACP BONE ANT CERV SPN	BOTH IP/OP	"$4,477.28 "	"$3,313.19"	$0.00	"$3,581.82"	"$2,014.77"	"$2,014.77"	$0.00	$0.00	$0.00	$933.18	"$3,323.03"	"$3,323.03"	$0.00	$0.00	$933.06	$0.00	"$2,207.30"	"$2,207.30"	$0.00	"$2,238.64"	"$3,546.01"	"$3,581.82"	$0.00		$0.00	$700.69	$0.00	$0.00	$712.78	$0.00	$0.00	$0.00	$0.00	$0.00
48660242	SUP	HCPCS C1713		48660242  -  PLATE 42MM 2 LVL ACP BONE ANT CERV SPN	BOTH IP/OP	"$4,477.28 "	"$3,313.19"	$0.00	"$3,581.82"	"$2,014.77"	"$2,014.77"	$0.00	$0.00	$0.00	$933.18	"$3,323.03"	"$3,323.03"	$0.00	$0.00	$933.06	$0.00	"$2,207.30"	"$2,207.30"	$0.00	"$2,238.64"	"$3,546.01"	"$3,581.82"	$0.00		$0.00	$700.69	$0.00	$0.00	$712.78	$0.00	$0.00	$0.00	$0.00	$0.00
48665030	SUP	HCPCS C1713		48665030  -  SCREW BN 5MM 30MM AVS ANCH-L ST SLF DRL 2 THRD LD CUT FLUT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
48667000	SUP	HCPCS C1713		48667000  -  ANCHOR-L LOCKING PLATE	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
48668142	SUP	HCPCS C1713		48668142  -  SPACER SPNL 12D RECT 28X40X14MM NS LF AVS ANCH-L RADOPQ HLW	BOTH IP/OP	"$9,375.00 "	"$6,937.50"	$0.00	"$7,500.00"	"$4,218.75"	"$4,218.75"	$0.00	$0.00	$0.00	"$1,953.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,953.75"	$0.00	"$4,621.88"	"$4,621.88"	$0.00	"$4,687.50"	"$7,425.00"	"$7,500.00"	$0.00		$0.00	"$1,467.19"	$0.00	$0.00	"$1,492.50"	$0.00	$0.00	$0.00	$0.00	$0.00
48674010	SUP	HCPCS C1713		48674010  -  SCREW BONE FLUTE 4MM 10MM FIX ANGLE SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48674012	SUP	HCPCS C1713		48674012  -  SCREW BONE FLUTE 4MM 12MM FIX ANGLE SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48674014	SUP	HCPCS C1713		48674014  -  SCREW BONE FLUTE 4MM 14MM FIX ANGLE SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48674016	SUP	HCPCS C1713		48674016  -  SCREW BONE FLUTE 4MM 16MM FIX ANGLE SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48674018	SUP	HCPCS C1713		48674018  -  SCREW BONE FLUTE 4MM 18MM FIX ANGLE SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48674020	SUP	HCPCS C1713		48674020  -  SCREW BONE FLUTE 4MM 20MM FIX ANGLE SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48674512	SUP	HCPCS C1713		48674512  -  SCREW BONE FLUTE 4.5MM 12MM FIX ANGLE SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48674514	SUP	HCPCS C1713		48674514  -  SCREW BONE FLUTE 4.5MM 14MM FIX ANGLE SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48674516	SUP	HCPCS C1713		48674516  -  SCREW BONE FLUTE 4.5MM 16MM FIX ANGLE SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48674518	SUP	HCPCS C1713		48674518  -  SCREW BONE FLUTE 4.5MM 18MM FIX ANGLE SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48674520	SUP	HCPCS C1713		48674520  -  SCREW BONE FLUTE 4.5MM 20MM FIX ANGLE SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48694010	SUP	HCPCS C1713		48694010  -  SCREW BONE FLUTE 4MM 10MM VAR ANG SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48694012	SUP	HCPCS C1713		48694012  -  SCREW BONE FLUTE 4MM 12MM VAR ANG SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48694014	SUP	HCPCS C1713		48694014  -  SCREW BONE FLUTE 4MM 14MM VAR ANG SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48694016	SUP	HCPCS C1713		48694016  -  SCREW BONE FLUTE 4MM 16MM VAR ANG SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48694018	SUP	HCPCS C1713		48694018  -  SCREW BONE FLUTE 4MM 18MM VAR ANG SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48694020	SUP	HCPCS C1713		48694020  -  SCREW BONE FLUTE 4MM 20MM VAR ANG SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48694512	SUP	HCPCS C1713		48694512  -  SCREW BONE FLUTE 4.5MM 12MM VAR ANG SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48694514	SUP	HCPCS C1713		48694514  -  SCREW BONE FLUTE 4.5MM 14MM VAR ANG SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48694516	SUP	HCPCS C1713		48694516  -  SCREW BONE FLUTE 4.5MM 16MM VAR ANG SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48694518	SUP	HCPCS C1713		48694518  -  SCREW BONE FLUTE 4.5MM 18MM VAR ANG SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48694520	SUP	HCPCS C1713		48694520  -  SCREW BONE FLUTE 4.5MM 20MM VAR ANG SELF TAP COLOR CODED	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48770410	SUP	Custom 27203010		48770410  -  PIN FIX TEMPORARY AVIATOR	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48770610	SUP	Custom 27203010		48770610  -  BIT DRILL 10MM AVTR	BOTH IP/OP	$656.90 	$486.11	$0.00	$525.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$487.55	$487.55	$0.00	$0.00	$136.90	$0.00	$0.00	$0.00	$0.00	$328.45	$520.26	$525.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48770612	SUP	Custom 27203010		48770612  -  BIT DRILL 12MM AVTR	BOTH IP/OP	$656.90 	$486.11	$0.00	$525.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$487.55	$487.55	$0.00	$0.00	$136.90	$0.00	$0.00	$0.00	$0.00	$328.45	$520.26	$525.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48770614	SUP	Custom 27203010		48770614  -  BIT DRILL 14MM AVTR	BOTH IP/OP	$656.90 	$486.11	$0.00	$525.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$487.55	$487.55	$0.00	$0.00	$136.90	$0.00	$0.00	$0.00	$0.00	$328.45	$520.26	$525.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48770616	SUP	Custom 27203010		48770616  -  BIT DRILL 16MM AVTR	BOTH IP/OP	$656.90 	$486.11	$0.00	$525.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$487.55	$487.55	$0.00	$0.00	$136.90	$0.00	$0.00	$0.00	$0.00	$328.45	$520.26	$525.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48771610	SUP	Custom 27203010		48771610  -  BIT DRILL 2.5MM 10MM AVIATOR	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48771612	SUP	Custom 27203010		48771612  -  BIT DRILL 2.5MM 12MM AVIATOR	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48771614	SUP	Custom 27203010		48771614  -  BIT DRILL 2.5MM 14MM AVIATOR	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48771616	SUP	Custom 27203010		48771616  -  BIT DRILL 2.5MM 16MM AVIATOR	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48811112	SUP	HCPCS C1713		48811112  -  PLATE BONE 12X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811114	SUP	HCPCS C1713		48811114  -  PLATE BONE 14X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811116	SUP	HCPCS C1713		48811116  -  PLATE BONE 16X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811118	SUP	HCPCS C1713		48811118  -  PLATE BONE 18X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811120	SUP	HCPCS C1713		48811120  -  PLATE BONE 20X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811122	SUP	HCPCS C1713		48811122  -  PLATE BONE 22X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811224	SUP	HCPCS C1713		48811224  -  PLATE BONE 24X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811226	SUP	HCPCS C1713		48811226  -  PLATE BONE 26X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811228	SUP	HCPCS C1713		48811228  -  PLATE BONE 28X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811230	SUP	HCPCS C1713		48811230  -  PLATE BONE 30X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811232	SUP	HCPCS C1713		48811232  -  PLATE BONE 32X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811234	SUP	HCPCS C1713		48811234  -  PLATE BONE 34X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811237	SUP	HCPCS C1713		48811237  -  PLATE BONE 37X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811240	SUP	HCPCS C1713		48811240  -  PLATE BONE 40X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811243	SUP	HCPCS C1713		48811243  -  PLATE BONE 43X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811246	SUP	HCPCS C1713		48811246  -  PLATE BONE 46X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
48811339	SUP	HCPCS C1713		48811339  -  PLATE BONE 39X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811342	SUP	HCPCS C1713		48811342  -  PLATE BONE 42X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811345	SUP	HCPCS C1713		48811345  -  PLATE BONE 45X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811348	SUP	HCPCS C1713		48811348  -  PLATE BONE 48X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811351	SUP	HCPCS C1713		48811351  -  PLATE BONE 51X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811354	SUP	HCPCS C1713		48811354  -  PLATE BONE 54X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811357	SUP	HCPCS C1713		48811357  -  PLATE BONE 57X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811360	SUP	HCPCS C1713		48811360  -  PLATE BONE 60X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811363	SUP	HCPCS C1713		48811363  -  PLATE BONE 63X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811366	SUP	HCPCS C1713		48811366  -  PLATE BONE 66MM LEVEL 3 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811369	SUP	HCPCS C1713		48811369  -  PLATE BONE 69MM LEVEL 3 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811456	SUP	HCPCS C1713		48811456  -  PLATE BONE 56MM LEVEL 4 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811460	SUP	HCPCS C1713		48811460  -  PLATE BONE 60MM LEVEL 4 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811464	SUP	HCPCS C1713		48811464  -  PLATE BONE 64MM LEVEL 4 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811468	SUP	HCPCS C1713		48811468  -  PLATE BONE 68MM LEVEL 4 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811472	SUP	HCPCS C1713		48811472  -  PLATE BONE 72MM LEVEL 4 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811476	SUP	HCPCS C1713		48811476  -  PLATE BONE 76MM LEVEL 4 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811480	SUP	HCPCS C1713		48811480  -  PLATE BONE 80MM LEVEL 4 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811484	SUP	HCPCS C1713		48811484  -  PLATE BONE 84MM LEVEL 4 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811488	SUP	HCPCS C1713		48811488  -  PLATE BONE 88MM LEVEL 4 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811492	SUP	HCPCS C1713		48811492  -  PLATE BONE 92MM LEVEL 4 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48811496	SUP	HCPCS C1713		48811496  -  PLATE BONE 96MM LEVEL 4 AVIATOR SPN CERV ANTERIOR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
48814010	SUP	HCPCS C1713		48814010  -  SCREW BONE 4MM 10MM VAR ANG SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48814012	SUP	HCPCS C1713		48814012  -  SCREW BONE 4MM 12MM VAR ANG SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48814014	SUP	HCPCS C1713		48814014  -  SCREW BONE 4MM 14MM VAR ANG SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48814016	SUP	HCPCS C1713		48814016  -  SCREW BONE 4MM 16MM VAR ANG SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48814018	SUP	HCPCS C1713		48814018  -  SCREW BONE 4MM 18MM VAR ANG SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48814512	SUP	HCPCS C1713		48814512  -  SCREW BONE 4.35MM 12MM VAR ANG SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48814514	SUP	HCPCS C1713		48814514  -  SCREW BONE 4.35MM 14MM VAR ANG SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48814516	SUP	HCPCS C1713		48814516  -  SCREW BONE 4.35MM 16MM VAR ANG SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48814518	SUP	HCPCS C1713		48814518  -  SCREW BONE 4.35MM 18MM VAR ANG SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48814520	SUP	HCPCS C1713		48814520  -  SCREW BONE 4.35MM 20MM VAR ANG SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48815540	SUP	HCPCS C1713		48815540  -  SCREW POLYAXIAL 5.5X40MM XIA CT	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	"$1,068.75"	"$1,068.75"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
48824010	SUP	HCPCS C1713		48824010  -  SCREW BONE 4MM 10MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48824012	SUP	HCPCS C1713		48824012  -  SCREW BONE 4MM 12MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48824014	SUP	HCPCS C1713		48824014  -  SCREW BONE 4MM 14MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48824016	SUP	HCPCS C1713		48824016  -  SCREW BONE 4MM 16MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48824018	SUP	HCPCS C1713		48824018  -  SCREW BONE 4MM 18MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48834010	SUP	HCPCS C1713		48834010  -  SCREW BONE 4MM 10MM FIX ANGLE SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48834012	SUP	HCPCS C1713		48834012  -  SCREW BONE 4MM 12MM FIX ANGLE SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48834014	SUP	HCPCS C1713		48834014  -  SCREW BONE 4MM 14MM FIX ANGLE SELF TAP AVIATOR SPN CERV	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48834016	SUP	HCPCS C1713		48834016  -  SCREW BONE 4MM 16MM FIX ANGLE SELF TAP AVIATOR TITANIUM SPN	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48834018	SUP	HCPCS C1713		48834018  -  SCREW BONE 4MM 18MM SPNL FIX SLFDRILL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48834512	SUP	HCPCS C1713		48834512  -  SCREW BONE 4.35MM 12MM FIX ANGLE SELF TAP AVIATOR TITANIUM	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48834514	SUP	HCPCS C1713		48834514  -  SCREW BN 4.35MM 14MM AVTR ST FA SPNE	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48834516	SUP	HCPCS C1713		48834516  -  SCREW BONE 4.35MM 16MM FIX ANGLE SELF TAP AVIATOR TITANIUM	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48834518	SUP	HCPCS C1713		48834518  -  SCREW BONE 4.35MM 18MM SELF TAP FIX ANGLE AVIATOR SPN CERV	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48834520	SUP	HCPCS C1713		48834520  -  SCREW BONE 4.35MM 20MM SELF TAP FIX ANGLE AVIATOR SPN CERV	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48844010	SUP	HCPCS C1713		48844010  -  SCREW BONE 4MM 10MM FIX ANGLE SELF DRILL AVIATOR TITANIUM	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48844012	SUP	HCPCS C1713		48844012  -  SCREW BONE 4MM 12MM FIX ANGLE SELF DRILL AVIATOR TITANIUM	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48844014	SUP	HCPCS C1713		48844014  -  SCREW BONE 4MM 14MM FIX ANGLE SELF DRILL AVIATOR TITANIUM	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48844016	SUP	HCPCS C1713		48844016  -  SCREW BONE 4MM 16MM FIX ANGLE SELF DRILL AVIATOR TITANIUM	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48844018	SUP	HCPCS C1713		48844018  -  SCREW BONE 4MM 18MM SELF DRILL FIX ANGLE AVIATOR SPN CERV	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
48850000	SUP	HCPCS C1713		48850000  -  BLOCKER SPNL CORT XIA	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
48857535	SUP	Custom 27203010		48857535  -  XIA CT 05.0mmX35mm TAP MARKER	BOTH IP/OP	$406.58 	$300.87	$0.00	$325.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.76	$301.76	$0.00	$0.00	$84.73	$0.00	$0.00	$0.00	$0.00	$203.29	$322.01	$325.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48858435	SUP	Custom 27203010		48858435  -  XIA CT 04.5mmX35mm TAP MARKER	BOTH IP/OP	$406.58 	$300.87	$0.00	$325.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.76	$301.76	$0.00	$0.00	$84.73	$0.00	$0.00	$0.00	$0.00	$203.29	$322.01	$325.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48858535	SUP	Custom 27203010		48858535  -  XIA CT 05.5mmX35mm TAP MARKER	BOTH IP/OP	$406.58 	$300.87	$0.00	$325.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.76	$301.76	$0.00	$0.00	$84.73	$0.00	$0.00	$0.00	$0.00	$203.29	$322.01	$325.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48900425	SUP	HCPCS C1713		48900425  -  SCREW BONE STANDARD POST 4.5MM 25MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900430	SUP	HCPCS C1713		48900430  -  SCREW BONE STANDARD POST 4.5MM 30MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900435	SUP	HCPCS C1713		48900435  -  SCREW BONE STANDARD POST 4.5MM 35MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900440	SUP	HCPCS C1713		48900440  -  SCREW BONE STANDARD POST 4.5MM 40MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900445	SUP	HCPCS C1713		48900445  -  SCREW BONE 4.5MM 45MM STANDARD POST TRIO SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48900450	SUP	HCPCS C1713		48900450  -  SCREW BONE 4.5MM 50MM STANDARD POST TRIO SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48900455	SUP	HCPCS C1713		48900455  -  SCREW BONE 4.5MM 55MM STANDARD POST TRIO SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48900525	SUP	HCPCS C1713		48900525  -  SCREW BONE STANDARD POST 5.5MM 25MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900530	SUP	HCPCS C1713		48900530  -  SCREW BONE STANDARD POST 5.5MM 30MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900535	SUP	HCPCS C1713		48900535  -  SCREW BONE STANDARD POST 5.5MM 35MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900540	SUP	HCPCS C1713		48900540  -  SCREW BONE STANDARD POST 5.5MM 40MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900545	SUP	HCPCS C1713		48900545  -  SCREW BONE STANDARD POST 5.5MM 45MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900550	SUP	HCPCS C1713		48900550  -  SCREW BONE STANDARD POST 5.5MM 50MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900555	SUP	HCPCS C1713		48900555  -  SCREW BONE 5.5MM 55MM STANDARD POST TRIO SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48900560	SUP	HCPCS C1713		48900560  -  SCREW BONE 5.5MM 60MM STANDARD POST TRIO SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
48900630	SUP	HCPCS C1713		48900630  -  SCREW BONE STANDARD POST 6.5MM 30MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900635	SUP	HCPCS C1713		48900635  -  SCREW BONE STANDARD POST 6.5MM 35MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900640	SUP	HCPCS C1713		48900640  -  SCREW BONE STANDARD POST 6.5MM 40MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900645	SUP	HCPCS C1713		48900645  -  SCREW BONE STANDARD POST 6.5MM 45MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900650	SUP	HCPCS C1713		48900650  -  SCREW BONE STANDARD POST 6.5MM 50MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900655	SUP	HCPCS C1713		48900655  -  SCREW BONE STANDARD POST 6.5MM 55MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900660	SUP	HCPCS C1713		48900660  -  SCREW BONE STANDARD POST 6.5MM 60MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900730	SUP	HCPCS C1713		48900730  -  SCREW BONE STANDARD POST 7.5MM 30MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900735	SUP	HCPCS C1713		48900735  -  SCREW BONE STANDARD POST 7.5MM 35MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900740	SUP	HCPCS C1713		48900740  -  SCREW BONE STANDARD POST 7.5MM 40MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900745	SUP	HCPCS C1713		48900745  -  SCREW BONE STANDARD POST 7.5MM 45MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900750	SUP	HCPCS C1713		48900750  -  SCREW BONE STANDARD POST 7.5MM 50MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900755	SUP	HCPCS C1713		48900755  -  SCREW BONE STANDARD POST 7.5MM 55MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900760	SUP	HCPCS C1713		48900760  -  SCREW BONE STANDARD POST 7.5MM 60MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900830	SUP	HCPCS C1713		48900830  -  SCREW BONE STANDARD POST 8.5MM 30MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900835	SUP	HCPCS C1713		48900835  -  SCREW BONE STANDARD POST 8.5MM 35MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900840	SUP	HCPCS C1713		48900840  -  SCREW BONE STANDARD POST 8.5MM 40MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900845	SUP	HCPCS C1713		48900845  -  SCREW BONE STANDARD POST 8.5MM 45MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900850	SUP	HCPCS C1713		48900850  -  SCREW BONE STANDARD POST 8.5MM 50MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900855	SUP	HCPCS C1713		48900855  -  SCREW BONE STANDARD POST 8.5MM 55MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48900860	SUP	HCPCS C1713		48900860  -  SCREW BONE STANDARD POST 8.5MM 60MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48901640	SUP	HCPCS C1713		48901640  -  SCREW BONE LONG POST 6.5MM 40MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48901645	SUP	HCPCS C1713		48901645  -  SCREW BONE LONG POST 6.5MM 45MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48901650	SUP	HCPCS C1713		48901650  -  SCREW BONE LONG POST 6.5MM 50MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48901740	SUP	HCPCS C1713		48901740  -  SCREW BONE LONG POST 7.5MM 40MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48901745	SUP	HCPCS C1713		48901745  -  SCREW BONE LONG POST 7.5MM 45MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48901750	SUP	HCPCS C1713		48901750  -  SCREW BONE LONG POST 7.5MM 50MM TITANIUM SPN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
48902015	SUP	Custom 27803010		48902015  -  CONNECTOR ROD SMALL OFFST UPGRADE TRIO SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48902025	SUP	Custom 27803010		48902025  -  CONNECTOR ROD MEDIUM LP SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48902035	SUP	Custom 27803010		48902035  -  CONNECTOR ROD LARGE LP OFFST SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48902040	SUP	Custom 27803010		48902040  -  CONNECTOR ROD 2 STEP LOCKING TITANIUM SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48902060	SUP	Custom 27803010		48902060  -  CONNECTOR ROD RIGHT OFFST BIASED SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48902070	SUP	Custom 27803010		48902070  -  CONNECTOR ROD LEFT BIASED OFFST TITANIUM SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48910530	SUP	HCPCS C1713		48910530  -  SCREW BONE 5.5MM 30MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910535	SUP	HCPCS C1713		48910535  -  SCREW BONE 5.5MM 35MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910540	SUP	HCPCS C1713		48910540  -  SCREW BONE 5.5MM 40MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910545	SUP	HCPCS C1713		48910545  -  SCREW BONE 5.5MM 45MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910550	SUP	HCPCS C1713		48910550  -  SCREW BONE 5.5MM 50MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910635	SUP	HCPCS C1713		48910635  -  SCREW BONE 6.5MM 35MM TI STD POST SPNL PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910640	SUP	HCPCS C1713		48910640  -  SCREW BONE 6.5MM 40MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910645	SUP	HCPCS C1713		48910645  -  SCREW BONE 6.5MM 45MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910655	SUP	HCPCS C1713		48910655  -  SCREW BONE 6.5MM 55MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910660	SUP	HCPCS C1713		48910660  -  SCREW BONE 6.5MM 60MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910730	SUP	HCPCS C1713		48910730  -  SCREW BONE 7.5MM 30MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910735	SUP	HCPCS C1713		48910735  -  SCREW BONE 7.5MM 35MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910740	SUP	HCPCS C1713		48910740  -  SCREW BONE 7.5MM 40MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910745	SUP	HCPCS C1713		48910745  -  SCREW BONE 7.5MM 45MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910755	SUP	HCPCS C1713		48910755  -  SCREW BONE 7.5MM 55MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910760	SUP	HCPCS C1713		48910760  -  SCREW BONE 7.5MM 60MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910830	SUP	HCPCS C1713		48910830  -  SCREW BONE 8.5MM 30MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910835	SUP	HCPCS C1713		48910835  -  SCREW BONE 8.5MM 35MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910840	SUP	HCPCS C1713		48910840  -  SCREW BONE 8.5MM 40MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910855	SUP	HCPCS C1713		48910855  -  SCREW BONE 8.5MM 55MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48910860	SUP	HCPCS C1713		48910860  -  SCREW BONE 8.5MM 60MM STD POST PS	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
48911640	SUP	HCPCS C1713		48911640  -  SCREW BONE 6.5MM 40MM LNG POST PS	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
48911645	SUP	HCPCS C1713		48911645  -  SCREW BONE 6.5MM 45MM LNG POST PS	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
48911650	SUP	HCPCS C1713		48911650  -  SCREW BONE 6.5MM 50MM LNG POST PS	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
48911740	SUP	HCPCS C1713		48911740  -  SCREW BONE 7.5MM 40MM LNG POST PS	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
48911745	SUP	HCPCS C1713		48911745  -  SCREW BONE 7.5MM 45MM LNG POST PS	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
48911750	SUP	HCPCS C1713		48911750  -  SCREW BONE 7.5MM 50MM LNG POST PS	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
48912035	SUP	HCPCS C1713		48912035  -  PLATE 35MM LRDTC STAB BONE POST	BOTH IP/OP	"$2,866.53 "	"$2,121.23"	$0.00	"$2,293.22"	"$1,289.94"	"$1,289.94"	$0.00	$0.00	$0.00	$597.46	"$2,127.53"	"$2,127.53"	$0.00	$0.00	$597.38	$0.00	"$1,413.20"	"$1,413.20"	$0.00	"$1,433.26"	"$2,270.29"	"$2,293.22"	$0.00		$0.00	$448.61	$0.00	$0.00	$456.35	$0.00	$0.00	$0.00	$0.00	$0.00
48912040	SUP	HCPCS C1713		48912040  -  PLATE 40MM LRDTC STAB BONE POST	BOTH IP/OP	"$2,866.53 "	"$2,121.23"	$0.00	"$2,293.22"	"$1,289.94"	"$1,289.94"	$0.00	$0.00	$0.00	$597.46	"$2,127.53"	"$2,127.53"	$0.00	$0.00	$597.38	$0.00	"$1,413.20"	"$1,413.20"	$0.00	"$1,433.26"	"$2,270.29"	"$2,293.22"	$0.00		$0.00	$448.61	$0.00	$0.00	$456.35	$0.00	$0.00	$0.00	$0.00	$0.00
48912060	SUP	HCPCS C1713		48912060  -  PLATE 60MM LRDTC STAB BONE POST	BOTH IP/OP	"$3,102.43 "	"$2,295.80"	$0.00	"$2,481.94"	"$1,396.09"	"$1,396.09"	$0.00	$0.00	$0.00	$646.62	"$2,302.62"	"$2,302.62"	$0.00	$0.00	$646.55	$0.00	"$1,529.50"	"$1,529.50"	$0.00	"$1,551.21"	"$2,457.12"	"$2,481.94"	$0.00		$0.00	$485.53	$0.00	$0.00	$493.91	$0.00	$0.00	$0.00	$0.00	$0.00
48912070	SUP	HCPCS C1713		48912070  -  PLATE 70MM POST STAB LRDTC BONE SPNL	BOTH IP/OP	"$3,102.43 "	"$2,295.80"	$0.00	"$2,481.94"	"$1,396.09"	"$1,396.09"	$0.00	$0.00	$0.00	$646.62	"$2,302.62"	"$2,302.62"	$0.00	$0.00	$646.55	$0.00	"$1,529.50"	"$1,529.50"	$0.00	"$1,551.21"	"$2,457.12"	"$2,481.94"	$0.00		$0.00	$485.53	$0.00	$0.00	$493.91	$0.00	$0.00	$0.00	$0.00	$0.00
48912080	SUP	HCPCS C1713		48912080  -  PLATE 80MM POST STAB LRDTC BONE SPNL	BOTH IP/OP	"$3,102.43 "	"$2,295.80"	$0.00	"$2,481.94"	"$1,396.09"	"$1,396.09"	$0.00	$0.00	$0.00	$646.62	"$2,302.62"	"$2,302.62"	$0.00	$0.00	$646.55	$0.00	"$1,529.50"	"$1,529.50"	$0.00	"$1,551.21"	"$2,457.12"	"$2,481.94"	$0.00		$0.00	$485.53	$0.00	$0.00	$493.91	$0.00	$0.00	$0.00	$0.00	$0.00
48912090	SUP	HCPCS C1713		48912090  -  PLATE 90MM POST STAB LRDTC BONE SPNL	BOTH IP/OP	"$3,102.43 "	"$2,295.80"	$0.00	"$2,481.94"	"$1,396.09"	"$1,396.09"	$0.00	$0.00	$0.00	$646.62	"$2,302.62"	"$2,302.62"	$0.00	$0.00	$646.55	$0.00	"$1,529.50"	"$1,529.50"	$0.00	"$1,551.21"	"$2,457.12"	"$2,481.94"	$0.00		$0.00	$485.53	$0.00	$0.00	$493.91	$0.00	$0.00	$0.00	$0.00	$0.00
48912105	SUP	HCPCS C1713		48912105  -  PLATE 105MM POST STAB LRDTC BONE SPNL	BOTH IP/OP	"$3,338.33 "	"$2,470.36"	$0.00	"$2,670.66"	"$1,502.25"	"$1,502.25"	$0.00	$0.00	$0.00	$695.79	"$2,477.70"	"$2,477.70"	$0.00	$0.00	$695.71	$0.00	"$1,645.79"	"$1,645.79"	$0.00	"$1,669.16"	"$2,643.96"	"$2,670.66"	$0.00		$0.00	$522.45	$0.00	$0.00	$531.46	$0.00	$0.00	$0.00	$0.00	$0.00
48912120	SUP	HCPCS C1713		48912120  -  PLATE 120MM POST STAB LRDTC BONE SPNL	BOTH IP/OP	"$3,338.33 "	"$2,470.36"	$0.00	"$2,670.66"	"$1,502.25"	"$1,502.25"	$0.00	$0.00	$0.00	$695.79	"$2,477.70"	"$2,477.70"	$0.00	$0.00	$695.71	$0.00	"$1,645.79"	"$1,645.79"	$0.00	"$1,669.16"	"$2,643.96"	"$2,670.66"	$0.00		$0.00	$522.45	$0.00	$0.00	$531.46	$0.00	$0.00	$0.00	$0.00	$0.00
48912510	SUP	Custom 27803010		48912510  -  NUT LOCK 9MM POST TI HEX STAB POST STAB	BOTH IP/OP	$294.28 	$217.77	$0.00	$235.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.41	$218.41	$0.00	$0.00	$61.33	$0.00	$0.00	$0.00	$0.00	$147.14	$233.07	$235.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48912520	SUP	HCPCS C1713		48912520  -  PLATE 20MM POST STAB POLYAX DOME BONE SPNL	BOTH IP/OP	$224.65 	$166.24	$0.00	$179.72	$101.09	$101.09	$0.00	$0.00	$0.00	$46.82	$166.74	$166.74	$0.00	$0.00	$46.82	$0.00	$132.88	$132.88	$0.00	$112.33	$177.92	$179.72	$0.00		$0.00	$35.16	$0.00	$0.00	$35.76	$0.00	$0.00	$0.00	$0.00	$0.00
48953112	SUP	Custom 27803010		48953112  -  CAGE SPNL 12D LRDTC 28X11X11MM STRL LF TRITANIUM PLIF	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	$0.00	$0.00	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48955106	SUP	Custom 27203010		48955106  -  CAGE SPNL 6D LRDTC 28X11X10MM STRL LF TRITANIUM PLIF	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	$0.00	$0.00	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48955126	SUP	HCPCS C1713		48955126  -  POSTERIOR LUMBAR CAGE 12MM X 28MM X 6 - 11MM	BOTH IP/OP	"$5,500.00 "	"$4,070.00"	$0.00	"$4,400.00"	"$2,475.00"	"$2,475.00"	$0.00	$0.00	$0.00	"$1,146.34"	"$4,082.10"	"$4,082.10"	$0.00	$0.00	"$1,146.20"	$0.00	"$2,711.50"	"$2,711.50"	$0.00	"$2,750.00"	"$4,356.00"	"$4,400.00"	$0.00		$0.00	$860.75	$0.00	$0.00	$875.60	$0.00	$0.00	$0.00	$0.00	$0.00
50506000	SUP	Custom 27011340		050506000  -  CONCTR PRFSN STR EQL 3/8INX3/8IN 3/8INX3/8IN STRL	BOTH IP/OP	$248.78 	$184.10	$0.00	$199.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.64	$184.64	$0.00	$0.00	$51.84	$0.00	$0.00	$0.00	$0.00	$124.39	$197.03	$199.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50516000	SUP	Custom 27011340		050516000  -  CONNECTOR PRFSN .25IN 3/8IN STRL RDCR	BOTH IP/OP	$281.50 	$208.31	$0.00	$225.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.93	$208.93	$0.00	$0.00	$58.66	$0.00	$0.00	$0.00	$0.00	$140.75	$222.95	$225.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50524000	SUP	Custom 27011340		050524000  -  CONNECTOR PRFSN .25IN X .25IN X .25IN STRL Y EQL	BOTH IP/OP	$11.28 	$8.35	$0.00	$9.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.37	$8.37	$0.00	$0.00	$2.35	$0.00	$0.00	$0.00	$0.00	$5.64	$8.93	$9.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50524000	SUP	Custom 27011340		50524000  -  CONNECTOR PERFUSION EQUAL Y STER 1/4 X 1/4IN	BOTH IP/OP	$11.28 	$8.35	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.37	$8.37	$0.00	$0.00	$2.35	$0.00	$0.00	$0.00	$0.00	$5.64	$10.10	$9.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50526000	SUP	Custom 27203010		CONNECTOR PRFSN Y EQL 3/8INX3/8INX3/8IN	BOTH IP/OP	$10.95 	$8.10	$0.00	$8.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.48	$8.67	$8.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50529000	SUP	Custom 27011340		050529000  -  CONCTR PRFSN RDC WYE .5X3/8IN STRL	BOTH IP/OP	$13.33 	$9.86	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.89	$9.89	$0.00	$0.00	$2.78	$0.00	$0.00	$0.00	$0.00	$11.19	$17.73	$17.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60060083	SUP	Custom 27203010		60060083  -  KIT PRSS MNTR CSTM TRNDCR RT HRT	BOTH IP/OP	$35.57 	$26.32	$0.00	$28.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.40	$26.40	$0.00	$0.00	$7.41	$0.00	$0.00	$0.00	$0.00	$17.78	$28.17	$28.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65305001	SUP	HCPCS C1762		65305001  -  GRAFT BONE DBM 10ML SPNL	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
66020016	SUP	Custom 27203010		66020016  -  BANDAGE COMPRESSION 7.25+ IN 4IN MULTILAYER HIGH WOUND	BOTH IP/OP	$21.65 	$16.02	$0.00	$17.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.07	$16.07	$0.00	$0.00	$4.51	$0.00	$0.00	$0.00	$0.00	$10.99	$17.40	$17.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
66800433	SUP	Custom 27203010		66800433  -  DRESSING BRN 16X16IN STRL LF ACTCT FLX 3 ANMC BRR FLXB SFT	BOTH IP/OP	$150.59 	$111.44	$0.00	$122.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.77	$111.77	$0.00	$0.00	$31.38	$0.00	$0.00	$0.00	$0.00	$76.42	$121.06	$122.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
66800434	SUP	Custom 27203010		66800434 -  DRESSING BURN 16X16IN ANTIBACTERIAL FAST ACT BARRIER CONTROL	BOTH IP/OP	$179.20 	$132.61	$0.00	$140.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.00	$133.00	$0.00	$0.00	$37.35	$0.00	$0.00	$0.00	$0.00	$87.81	$139.08	$140.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
67005200	SUP	HCPCS C1887		CATHETER GUID XB3 CURVE 6FR .070IN 100CM PTFE VSBR BLUE YLW	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
67005300	SUP	HCPCS C1887		CATHETER GUID XB3 CURVE 6FR .070IN 100CM SH PTFE VSBR BLUE	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
67005500	SUP	HCPCS C1887		CATHETER GUID XB3.5 CURVE 6FR .070IN 100CM SH PTFE VSBR BLUE	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
67011200	SUP	HCPCS C1887		CATHETER GUID AR2 CURVE 6FR .070IN 100CM PTFE VSBR BLUE YLW	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
68304060	SUP	Custom 27803010		68304060  -  ROD SPNL 60MM 4MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68304070	SUP	Custom 27803010		68304070  -  ROD SPNL 70MM 4MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68304080	SUP	Custom 27803010		68304080  -  ROD SPNL 80MM 4MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68304090	SUP	Custom 27803010		68304090  -  ROD SPNL 90MM 4MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68304100	SUP	Custom 27803010		68304100  -  ROD SPNL 100MM 4MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68304110	SUP	Custom 27803010		68304110  -  ROD SPNL 110MM 4MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68304120	SUP	Custom 27803010		68304120  -  ROD SPNL 120MM 4MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68304130	SUP	Custom 27803010		68304130  -  ROD SPNL 130MM 4MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68304140	SUP	Custom 27803010		68304140  -  ROD SPNL 140MM 4MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68304150	SUP	Custom 27803010		68304150  -  ROD SPNL 150MM 4MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68304160	SUP	Custom 27803010		68304160  -  ROD SPNL 160MM 4MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68306060	SUP	Custom 27803010		68306060  -  ROD SPNL 60MM 6MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68306070	SUP	Custom 27803010		68306070  -  ROD SPNL 70MM 6MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68306080	SUP	Custom 27803010		68306080  -  ROD SPNL 80MM 6MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68306090	SUP	Custom 27803010		68306090  -  ROD SPNL 90MM 6MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68306100	SUP	Custom 27803010		68306100  -  ROD SPNL 100MM 6MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68306110	SUP	Custom 27803010		68306110  -  ROD SPNL 110MM 6MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68306120	SUP	Custom 27803010		68306120  -  ROD SPNL 120MM 6MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68306130	SUP	Custom 27803010		68306130  -  ROD SPNL 130MM 6MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68306140	SUP	Custom 27803010		68306140  -  ROD SPNL 140MM 6MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68306150	SUP	Custom 27803010		68306150  -  ROD SPNL 150MM 6MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68306160	SUP	Custom 27803010		68306160  -  ROD SPNL 160MM 6MM CENTAUR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68415525	SUP	HCPCS C1713		68415525  -  SCREW BONE 5.5MM 25MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68415530	SUP	HCPCS C1713		68415530  -  SCREW BONE 5.5MM 30MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68415535	SUP	HCPCS C1713		68415535  -  SCREW BONE 5.5MM 35MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68415540	SUP	HCPCS C1713		68415540  -  SCREW BONE 5.5MM 40MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68415545	SUP	HCPCS C1713		68415545  -  SCREW BONE 5.5MM 45MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68415550	SUP	HCPCS C1713		68415550  -  SCREW BONE 5.5MM 50MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68415555	SUP	HCPCS C1713		68415555  -  SCREW BONE 5.5MM 55MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68417025	SUP	HCPCS C1713		68417025  -  SCREW BONE 7MM 25MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68417030	SUP	HCPCS C1713		68417030  -  SCREW BONE 30MM 7MM CENTAUR PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68417035	SUP	HCPCS C1713		68417035  -  SCREW BONE 7MM 35MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68417040	SUP	HCPCS C1713		68417040  -  SCREW BONE 7MM 40MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68417045	SUP	HCPCS C1713		68417045  -  SCREW BONE 7MM 45MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68417050	SUP	HCPCS C1713		68417050  -  SCREW BONE 7MM 50MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68417055	SUP	HCPCS C1713		68417055  -  SCREW BONE 7MM 55MM CENTAUR SPNL PLT	BOTH IP/OP	"$1,204.15 "	$891.07	$0.00	$963.32	$541.87	$541.87	$0.00	$0.00	$0.00	$250.97	$893.72	$893.72	$0.00	$0.00	$250.94	$0.00	$712.25	$712.25	$0.00	$602.08	$953.69	$963.32	$0.00		$0.00	$188.45	$0.00	$0.00	$191.70	$0.00	$0.00	$0.00	$0.00	$0.00
68420000	SUP	HCPCS C1713		68420000  -  PLATE SPRT CENTAUR BONE SPNL	BOTH IP/OP	$354.95 	$262.66	$0.00	$283.96	$159.73	$159.73	$0.00	$0.00	$0.00	$73.98	$263.44	$263.44	$0.00	$0.00	$73.97	$0.00	$209.95	$209.95	$0.00	$177.48	$281.12	$283.96	$0.00		$0.00	$55.55	$0.00	$0.00	$56.51	$0.00	$0.00	$0.00	$0.00	$0.00
68425525	SUP	HCPCS C1713		68425525  -  BOLT SPNL 25MM 5.5MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68425530	SUP	HCPCS C1713		68425530  -  BOLT SPNL 30MM 5.5MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68425535	SUP	HCPCS C1713		68425535  -  BOLT SPNL 35MM 5.5MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68425540	SUP	HCPCS C1713		68425540  -  BOLT SPNL 40MM 5.5MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68425545	SUP	HCPCS C1713		68425545  -  BOLT SPNL 45MM 5.5MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68425550	SUP	HCPCS C1713		68425550  -  BOLT SPNL 50MM 5.5MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68425555	SUP	HCPCS C1713		68425555  -  BOLT SPNL 55MM 5.5MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68427025	SUP	HCPCS C1713		68427025  -  BOLT SPNL 25MM 7MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68427030	SUP	HCPCS C1713		68427030  -  BOLT SPNL 30MM 7MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68427035	SUP	HCPCS C1713		68427035  -  BOLT SPNL 35MM 7MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68427040	SUP	HCPCS C1713		68427040  -  BOLT SPNL 40MM 7MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68427045	SUP	HCPCS C1713		68427045  -  BOLT SPNL 45MM 7MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68427050	SUP	HCPCS C1713		68427050  -  BOLT SPNL 50MM 7MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68427055	SUP	HCPCS C1713		68427055  -  BOLT SPNL 55MM 7MM CENTAUR	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$626.78	$626.78	$0.00	$0.00	$0.00	$290.30	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$823.87	$823.87	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$217.98	$0.00	$0.00	$221.74	$0.00	$0.00	$0.00	$0.00	$0.00
68430000	SUP	Custom 27803010		68430000  -  CONCTR ROD CENTAUR SET SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68435525	SUP	Custom 27803010		68435525  -  BOLT SPNL 25MM 5.5MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68435530	SUP	Custom 27803010		68435530  -  BOLT SPNL 30MM 5.5MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68435535	SUP	Custom 27803010		68435535  -  BOLT SPNL 35MM 5.5MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68435540	SUP	Custom 27803010		68435540  -  BOLT SPNL 40MM 5.5MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68435545	SUP	Custom 27803010		68435545  -  BOLT SPNL 45MM 5.5MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68435550	SUP	Custom 27803010		68435550  -  BOLT SPNL 50MM 5.5MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68435555	SUP	Custom 27803010		68435555  -  BOLT SPNL 55MM 5.5MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68437025	SUP	Custom 27803010		68437025  -  BOLT SPNL 25MM 7MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68437030	SUP	Custom 27803010		68437030  -  BOLT SPNL 30MM 7MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68437035	SUP	Custom 27803010		68437035  -  BOLT SPNL 35MM 7MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68437040	SUP	Custom 27803010		68437040  -  BOLT SPNL 40MM 7MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68437045	SUP	Custom 27803010		68437045  -  BOLT SPNL 45MM 7MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68437050	SUP	Custom 27803010		68437050  -  BOLT SPNL 50MM 7MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68437055	SUP	Custom 27803010		68437055  -  BOLT SPNL 55MM 7MM CENTAUR ROD	BOTH IP/OP	"$1,392.85 "	"$1,030.71"	$0.00	"$1,114.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.77"	"$1,033.77"	$0.00	$0.00	$290.27	$0.00	$0.00	$0.00	$0.00	$696.43	"$1,103.14"	"$1,114.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68470030	SUP	HCPCS C1713		68470030  -  PLATE 30MM STR CENTAUR BONE SPNL	BOTH IP/OP	"$6,274.48 "	"$4,643.12"	$0.00	"$5,019.58"	"$2,823.51"	"$2,823.51"	$0.00	$0.00	$0.00	"$1,307.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,307.60"	$0.00	"$3,093.32"	"$3,093.32"	$0.00	"$3,137.24"	"$4,969.39"	"$5,019.58"	$0.00		$0.00	$981.96	$0.00	$0.00	$998.90	$0.00	$0.00	$0.00	$0.00	$0.00
68470040	SUP	HCPCS C1713		68470040  -  PLATE 40MM STR CENTAUR BONE SPNL	BOTH IP/OP	"$6,274.48 "	"$4,643.12"	$0.00	"$5,019.58"	"$2,823.51"	"$2,823.51"	$0.00	$0.00	$0.00	"$1,307.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,307.60"	$0.00	"$3,093.32"	"$3,093.32"	$0.00	"$3,137.24"	"$4,969.39"	"$5,019.58"	$0.00		$0.00	$981.96	$0.00	$0.00	$998.90	$0.00	$0.00	$0.00	$0.00	$0.00
68470050	SUP	HCPCS C1713		68470050  -  PLATE 50MM STR CENTAUR BONE SPNL	BOTH IP/OP	"$6,723.78 "	"$4,975.60"	$0.00	"$5,379.02"	"$3,025.70"	"$3,025.70"	$0.00	$0.00	$0.00	"$1,401.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,401.23"	$0.00	"$3,314.82"	"$3,314.82"	$0.00	"$3,361.89"	"$5,325.23"	"$5,379.02"	$0.00		$0.00	"$1,052.27"	$0.00	$0.00	"$1,070.42"	$0.00	$0.00	$0.00	$0.00	$0.00
68470060	SUP	HCPCS C1713		68470060  -  PLATE 60MM STR CENTAUR BONE SPNL	BOTH IP/OP	"$6,723.78 "	"$4,975.60"	$0.00	"$5,379.02"	"$3,025.70"	"$3,025.70"	$0.00	$0.00	$0.00	"$1,401.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,401.23"	$0.00	"$3,314.82"	"$3,314.82"	$0.00	"$3,361.89"	"$5,325.23"	"$5,379.02"	$0.00		$0.00	"$1,052.27"	$0.00	$0.00	"$1,070.42"	$0.00	$0.00	$0.00	$0.00	$0.00
68470070	SUP	HCPCS C1713		68470070  -  PLATE 70MM STR CENTAUR BONE SPNL	BOTH IP/OP	"$7,006.85 "	"$5,185.07"	$0.00	"$5,605.48"	"$3,153.08"	"$3,153.08"	$0.00	$0.00	$0.00	"$1,460.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.23"	$0.00	"$3,454.38"	"$3,454.38"	$0.00	"$3,503.43"	"$5,549.43"	"$5,605.48"	$0.00		$0.00	"$1,096.57"	$0.00	$0.00	"$1,115.49"	$0.00	$0.00	$0.00	$0.00	$0.00
68470080	SUP	HCPCS C1713		68470080  -  PLATE 80MM STR CENTAUR BONE SPNL	BOTH IP/OP	"$7,006.85 "	"$5,185.07"	$0.00	"$5,605.48"	"$3,153.08"	"$3,153.08"	$0.00	$0.00	$0.00	"$1,460.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.23"	$0.00	"$3,454.38"	"$3,454.38"	$0.00	"$3,503.43"	"$5,549.43"	"$5,605.48"	$0.00		$0.00	"$1,096.57"	$0.00	$0.00	"$1,115.49"	$0.00	$0.00	$0.00	$0.00	$0.00
68470090	SUP	HCPCS C1713		68470090  -  PLATE 90MM STR CENTAUR BONE SPNL	BOTH IP/OP	"$7,465.13 "	"$5,524.20"	$0.00	"$5,972.10"	"$3,359.31"	"$3,359.31"	$0.00	$0.00	$0.00	"$1,555.92"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,555.73"	$0.00	"$3,680.31"	"$3,680.31"	$0.00	"$3,732.56"	"$5,912.38"	"$5,972.10"	$0.00		$0.00	"$1,168.29"	$0.00	$0.00	"$1,188.45"	$0.00	$0.00	$0.00	$0.00	$0.00
68480060	SUP	HCPCS C1713		68480060  -  PLATE 60MM LRDTC CENTAUR BONE SPNL	BOTH IP/OP	"$4,953.53 "	"$3,665.61"	$0.00	"$3,962.82"	"$2,229.09"	"$2,229.09"	$0.00	$0.00	$0.00	"$1,032.44"	"$3,676.51"	"$3,676.51"	$0.00	$0.00	"$1,032.31"	$0.00	"$2,442.09"	"$2,442.09"	$0.00	"$2,476.76"	"$3,923.20"	"$3,962.82"	$0.00		$0.00	$775.23	$0.00	$0.00	$788.60	$0.00	$0.00	$0.00	$0.00	$0.00
68480070	SUP	HCPCS C1713		68480070  -  PLATE 70MM LRDTC CENTAUR BONE SPNL	BOTH IP/OP	"$5,166.98 "	"$3,823.57"	$0.00	"$4,133.58"	"$2,325.14"	"$2,325.14"	$0.00	$0.00	$0.00	"$1,076.93"	"$3,834.93"	"$3,834.93"	$0.00	$0.00	"$1,076.80"	$0.00	"$2,547.32"	"$2,547.32"	$0.00	"$2,583.49"	"$4,092.25"	"$4,133.58"	$0.00		$0.00	$808.63	$0.00	$0.00	$822.58	$0.00	$0.00	$0.00	$0.00	$0.00
68480080	SUP	HCPCS C1713		68480080  -  PLATE 80MM LRDTC CENTAUR BONE SPNL	BOTH IP/OP	"$5,366.88 "	"$3,971.49"	$0.00	"$4,293.50"	"$2,415.09"	"$2,415.09"	$0.00	$0.00	$0.00	"$1,118.59"	"$3,983.29"	"$3,983.29"	$0.00	$0.00	"$1,118.46"	$0.00	"$2,645.87"	"$2,645.87"	$0.00	"$2,683.44"	"$4,250.57"	"$4,293.50"	$0.00		$0.00	$839.92	$0.00	$0.00	$854.41	$0.00	$0.00	$0.00	$0.00	$0.00
68480090	SUP	HCPCS C1713		68480090  -  PLATE 90MM LRDTC CENTAUR BONE SPNL	BOTH IP/OP	"$5,366.88 "	"$3,971.49"	$0.00	"$4,293.50"	"$2,415.09"	"$2,415.09"	$0.00	$0.00	$0.00	"$1,118.59"	"$3,983.29"	"$3,983.29"	$0.00	$0.00	"$1,118.46"	$0.00	"$2,645.87"	"$2,645.87"	$0.00	"$2,683.44"	"$4,250.57"	"$4,293.50"	$0.00		$0.00	$839.92	$0.00	$0.00	$854.41	$0.00	$0.00	$0.00	$0.00	$0.00
68490050	SUP	HCPCS C1713		68490050  -  PLATE 50MM KYPHOTIC CENTAUR BONE SPNL	BOTH IP/OP	"$6,818.15 "	"$5,045.43"	$0.00	"$5,454.52"	"$3,068.17"	"$3,068.17"	$0.00	$0.00	$0.00	"$1,421.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,420.90"	$0.00	"$3,361.35"	"$3,361.35"	$0.00	"$3,409.08"	"$5,399.97"	"$5,454.52"	$0.00		$0.00	"$1,067.04"	$0.00	$0.00	"$1,085.45"	$0.00	$0.00	$0.00	$0.00	$0.00
68490060	SUP	HCPCS C1713		68490060  -  PLATE 60MM KYPHOTIC CENTAUR BONE SPNL	BOTH IP/OP	"$7,112.45 "	"$5,263.21"	$0.00	"$5,689.96"	"$3,200.60"	"$3,200.60"	$0.00	$0.00	$0.00	"$1,482.41"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,482.23"	$0.00	"$3,506.44"	"$3,506.44"	$0.00	"$3,556.23"	"$5,633.06"	"$5,689.96"	$0.00		$0.00	"$1,113.10"	$0.00	$0.00	"$1,132.30"	$0.00	$0.00	$0.00	$0.00	$0.00
68490070	SUP	HCPCS C1713		68490070  -  PLATE 70MM KYPHOTIC CENTAUR BONE SPNL	BOTH IP/OP	"$7,395.48 "	"$5,472.66"	$0.00	"$5,916.38"	"$3,327.96"	"$3,327.96"	$0.00	$0.00	$0.00	"$1,541.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,541.22"	$0.00	"$3,645.97"	"$3,645.97"	$0.00	"$3,697.74"	"$5,857.22"	"$5,916.38"	$0.00		$0.00	"$1,157.39"	$0.00	$0.00	"$1,177.36"	$0.00	$0.00	$0.00	$0.00	$0.00
68490080	SUP	HCPCS C1713		68490080  -  PLATE 80MM KYPHOTIC CENTAUR BONE SPNL	BOTH IP/OP	"$7,831.35 "	"$5,795.20"	$0.00	"$6,265.08"	"$3,524.11"	"$3,524.11"	$0.00	$0.00	$0.00	"$1,632.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,632.05"	$0.00	"$3,860.86"	"$3,860.86"	$0.00	"$3,915.68"	"$6,202.43"	"$6,265.08"	$0.00		$0.00	"$1,225.61"	$0.00	$0.00	"$1,246.75"	$0.00	$0.00	$0.00	$0.00	$0.00
68490090	SUP	HCPCS C1713		68490090  -  PLATE 90MM KYPHOTIC CENTAUR BONE SPNL	BOTH IP/OP	"$8,386.20 "	"$6,205.79"	$0.00	"$6,708.96"	"$3,773.79"	"$3,773.79"	$0.00	$0.00	$0.00	"$1,747.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,747.68"	$0.00	"$4,134.40"	"$4,134.40"	$0.00	"$4,193.10"	"$6,641.87"	"$6,708.96"	$0.00		$0.00	"$1,312.44"	$0.00	$0.00	"$1,335.08"	$0.00	$0.00	$0.00	$0.00	$0.00
70000267	SUP	HCPCS C1894		612606 - INTRODUCER SHTH 9FR 16CM TRAW ADPR DILAT SET INDN SPNLK .035	BOTH IP/OP	$67.10 	$49.65	$0.00	$53.68	$36.44	$36.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.55	$53.14	$53.68	$0.00		$0.00	$10.50	$0.00	$0.00	$10.68	$0.00	$0.00	$0.00	$0.00	$0.00
70035009	SUP	Custom 27203010		70035009  -  STOPCOCK ANGIO 400 PSI NAMIC 3W ROT ADPR RT PORT	BOTH IP/OP	$2.80 	$2.07	$0.00	$2.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.08	$2.08	$0.00	$0.00	$0.58	$0.00	$0.00	$0.00	$0.00	$1.40	$2.22	$2.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70055017	SUP	Custom 27203010		70055017  -  STOPCOCK ANGIO 1050 PSI NAMIC 1 WY FX M LL	BOTH IP/OP	$161.28 	$119.35	$0.00	$129.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.70	$119.70	$0.00	$0.00	$33.61	$0.00	$0.00	$0.00	$0.00	$80.64	$127.73	$129.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70245550	SUP	HCPCS C1713		70245550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70245560	SUP	HCPCS C1713		70245560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70260500	SUP	HCPCS C1713		70260500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70260511	SUP	HCPCS C1713		70260511  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70260580	SUP	HCPCS C1713		70260580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70260590	SUP	HCPCS C1713		70260590  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70265530	SUP	HCPCS C1713		70265530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70265535	SUP	HCPCS C1713		70265535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70265540	SUP	HCPCS C1713		70265540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70265545	SUP	HCPCS C1713		70265545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70265550	SUP	HCPCS C1713		70265550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70265555	SUP	HCPCS C1713		70265555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70265560	SUP	HCPCS C1713		70265560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70266535	SUP	HCPCS C1713		70266535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70266540	SUP	HCPCS C1713		70266540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70266545	SUP	HCPCS C1713		70266545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70266550	SUP	HCPCS C1713		70266550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70266555	SUP	HCPCS C1713		70266555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70266560	SUP	HCPCS C1713		70266560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70266570	SUP	HCPCS C1713		70266570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70267500	SUP	HCPCS C1713		70267500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70267540	SUP	HCPCS C1713		70267540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70267545	SUP	HCPCS C1713		70267545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70267550	SUP	HCPCS C1713		70267550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70267555	SUP	HCPCS C1713		70267555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70267560	SUP	HCPCS C1713		70267560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70267570	SUP	HCPCS C1713		70267570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70267580	SUP	HCPCS C1713		70267580  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70267590	SUP	HCPCS C1713		70267590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70268500	SUP	HCPCS C1713		70268500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70268540	SUP	HCPCS C1713		70268540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70268545	SUP	HCPCS C1713		70268545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70268550	SUP	HCPCS C1713		70268550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70268555	SUP	HCPCS C1713		70268555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70268560	SUP	HCPCS C1713		70268560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70268570	SUP	HCPCS C1713		70268570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70268580	SUP	HCPCS C1713		70268580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70268590	SUP	HCPCS C1713		70268590  -  SCREW BN 8.5MM 90MM SOLERA CD HZN LGC MA CLS SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70269500	SUP	HCPCS C1713		70269500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70269511	SUP	HCPCS C1713		70269511  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70269580	SUP	HCPCS C1713		70269580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70269590	SUP	HCPCS C1713		70269590  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
70460500	SUP	HCPCS C1713		70460500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70460511	SUP	HCPCS C1713		70460511  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70460580	SUP	HCPCS C1713		70460580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70460590	SUP	HCPCS C1713		70460590  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70465530	SUP	HCPCS C1713		70465530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70465535	SUP	HCPCS C1713		70465535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70465540	SUP	HCPCS C1713		70465540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70465545	SUP	HCPCS C1713		70465545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70465550	SUP	HCPCS C1713		70465550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70465555	SUP	HCPCS C1713		70465555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70465560	SUP	HCPCS C1713		70465560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70466535	SUP	HCPCS C1713		70466535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70466540	SUP	HCPCS C1713		70466540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70466545	SUP	HCPCS C1713		70466545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70466550	SUP	HCPCS C1713		70466550  -  SCREW BN 6.5MM 50MM SOLERA CD HZN LGC MA CLS TI SPNE	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70466555	SUP	HCPCS C1713		70466555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70466560	SUP	HCPCS C1713		70466560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70466570	SUP	HCPCS C1713		70466570  -  SCREW BN 6.5MM 70MM SOLERA CD HZN LGC MA CLS TI SPNE	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70467500	SUP	HCPCS C1713		70467500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70467540	SUP	HCPCS C1713		70467540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70467545	SUP	HCPCS C1713		70467545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70467550	SUP	HCPCS C1713		70467550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70467555	SUP	HCPCS C1713		70467555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70467560	SUP	HCPCS C1713		70467560  -  SCREW BN 7.5MM 60MM SOLERA CD HZN LGC MA CLS TI SPNE	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70467570	SUP	HCPCS C1713		70467570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70467580	SUP	HCPCS C1713		70467580  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70467590	SUP	HCPCS C1713		70467590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70468500	SUP	HCPCS C1713		70468500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70468540	SUP	HCPCS C1713		70468540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70468545	SUP	HCPCS C1713		70468545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70468550	SUP	HCPCS C1713		70468550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70468555	SUP	HCPCS C1713		70468555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70468560	SUP	HCPCS C1713		70468560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70468570	SUP	HCPCS C1713		70468570  -  SCREW BN 8.5MM 70MM SOLERA CD HZN LGC MA CLS TI SPNE	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70468580	SUP	HCPCS C1713		70468580  -  SCREW BN 8.5MM 80MM SOLERA CD HZN LGC MA CLS TI SPNE	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70468590	SUP	HCPCS C1713		70468590  -  SCREW BN 8.5MM 90MM SOLERA CD HZN LGC MA CLS TI SPNE	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70469500	SUP	HCPCS C1713		70469500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70469511	SUP	HCPCS C1713		70469511  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70469580	SUP	HCPCS C1713		70469580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
70469590	SUP	HCPCS C1713		70469590  -  SCREW BN 9.5MM 90MM SOLERA CD HZN LGC MA CLS TI SPNE	BOTH IP/OP	"$3,091.50 "	"$2,287.71"	$0.00	"$2,473.20"	"$1,391.18"	"$1,391.18"	$0.00	$0.00	$0.00	$644.35	"$2,294.51"	"$2,294.51"	$0.00	$0.00	$644.27	$0.00	"$1,524.11"	"$1,524.11"	$0.00	"$1,545.75"	"$2,448.47"	"$2,473.20"	$0.00		$0.00	$483.82	$0.00	$0.00	$492.17	$0.00	$0.00	$0.00	$0.00	$0.00
71010705	SUP	HCPCS C1713		71010705  -  BOLT EXFIX ILZ RSN WIRE	BOTH IP/OP	$147.60 	$109.22	$0.00	$118.08	$66.42	$66.42	$0.00	$0.00	$0.00	$30.76	$109.55	$109.55	$0.00	$0.00	$30.76	$0.00	$87.31	$87.31	$0.00	$73.80	$116.90	$118.08	$0.00		$0.00	$23.10	$0.00	$0.00	$23.50	$0.00	$0.00	$0.00	$0.00	$0.00
71011002	SUP	HCPCS C1713		71011002  -  NUT XTRNFX ILZ QCK CNCT CIRC	BOTH IP/OP	$175.10 	$129.57	$0.00	$140.08	$78.80	$78.80	$0.00	$0.00	$0.00	$36.50	$129.96	$129.96	$0.00	$0.00	$36.49	$0.00	$103.57	$103.57	$0.00	$87.55	$138.68	$140.08	$0.00		$0.00	$27.40	$0.00	$0.00	$27.88	$0.00	$0.00	$0.00	$0.00	$0.00
71011550	SUP	HCPCS C1713		71011550  -  WASHER ORTH 7MM TI	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
71012000	SUP	HCPCS C1713		71012000  -  WASHER XTRNFX CNCL CPL SM BN FXTR	BOTH IP/OP	$192.00 	$142.08	$0.00	$153.60	$86.40	$86.40	$0.00	$0.00	$0.00	$40.02	$142.50	$142.50	$0.00	$0.00	$40.01	$0.00	$113.57	$113.57	$0.00	$96.00	$152.06	$153.60	$0.00		$0.00	$30.05	$0.00	$0.00	$30.57	$0.00	$0.00	$0.00	$0.00	$0.00
71012005	SUP	HCPCS C1713		71012005  -  NUT XTRNFX CIRC NYL SM BN FXTR	BOTH IP/OP	$29.70 	$21.98	$0.00	$23.76	$13.37	$13.37	$0.00	$0.00	$0.00	$6.19	$22.04	$22.04	$0.00	$0.00	$6.19	$0.00	$17.57	$17.57	$0.00	$14.85	$23.52	$23.76	$0.00		$0.00	$4.65	$0.00	$0.00	$4.73	$0.00	$0.00	$0.00	$0.00	$0.00
71012502	SUP	HCPCS C1713		71012502  -  PIN HLF 5MM 180MM ILZ SS ANKL/FT XTRNFXTR	BOTH IP/OP	$627.30 	$464.20	$0.00	$501.84	$282.29	$282.29	$0.00	$0.00	$0.00	$130.75	$465.58	$465.58	$0.00	$0.00	$130.73	$0.00	$371.05	$371.05	$0.00	$313.65	$496.82	$501.84	$0.00		$0.00	$98.17	$0.00	$0.00	$99.87	$0.00	$0.00	$0.00	$0.00	$0.00
71013000	SUP	Custom 27203010		71013000  -  BOLT XTRNFX LNG ILZ SLOT WRE	BOTH IP/OP	$178.50 	$132.09	$0.00	$142.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.48	$132.48	$0.00	$0.00	$37.20	$0.00	$0.00	$0.00	$0.00	$89.25	$141.37	$142.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71013204	SUP	HCPCS C1713		71013204  -  BOLT EXFIX ILIZAROV	BOTH IP/OP	$148.33 	$109.76	$0.00	$118.66	$66.75	$66.75	$0.00	$0.00	$0.00	$30.91	$110.09	$110.09	$0.00	$0.00	$30.91	$0.00	$87.73	$87.73	$0.00	$74.16	$117.48	$118.66	$0.00		$0.00	$23.21	$0.00	$0.00	$23.61	$0.00	$0.00	$0.00	$0.00	$0.00
71021027	SUP	HCPCS C1713		71021027  -  PIN HLF 6MM 45MM HXFX TI	BOTH IP/OP	$472.60 	$349.72	$0.00	$378.08	$212.67	$212.67	$0.00	$0.00	$0.00	$98.50	$350.76	$350.76	$0.00	$0.00	$98.49	$0.00	$279.54	$279.54	$0.00	$236.30	$374.30	$378.08	$0.00		$0.00	$73.96	$0.00	$0.00	$75.24	$0.00	$0.00	$0.00	$0.00	$0.00
71021029	SUP	HCPCS C1713		71021029  -  PIN HLF 6MM 55MM HXFX TI	BOTH IP/OP	$472.60 	$349.72	$0.00	$378.08	$212.67	$212.67	$0.00	$0.00	$0.00	$98.50	$350.76	$350.76	$0.00	$0.00	$98.49	$0.00	$279.54	$279.54	$0.00	$236.30	$374.30	$378.08	$0.00		$0.00	$73.96	$0.00	$0.00	$75.24	$0.00	$0.00	$0.00	$0.00	$0.00
71021031	SUP	HCPCS C1713		71021031  -  PIN HLF 6MM 65MM HXFX TI ORTH XTRNFX SYS	BOTH IP/OP	$719.10 	$532.13	$0.00	$575.28	$323.60	$323.60	$0.00	$0.00	$0.00	$149.88	$533.72	$533.72	$0.00	$0.00	$149.86	$0.00	$425.35	$425.35	$0.00	$359.55	$569.53	$575.28	$0.00		$0.00	$112.54	$0.00	$0.00	$114.48	$0.00	$0.00	$0.00	$0.00	$0.00
71021033	SUP	HCPCS C1713		71021033  -  PIN HLF 6MM 75MM HXFX TI ORTH XTRNFX SYS	BOTH IP/OP	$719.10 	$532.13	$0.00	$575.28	$323.60	$323.60	$0.00	$0.00	$0.00	$149.88	$533.72	$533.72	$0.00	$0.00	$149.86	$0.00	$425.35	$425.35	$0.00	$359.55	$569.53	$575.28	$0.00		$0.00	$112.54	$0.00	$0.00	$114.48	$0.00	$0.00	$0.00	$0.00	$0.00
71021035	SUP	HCPCS C1713		71021035  -  PIN HLF 6MM 85MM HXFX TI ORTH XTRNFX SYS	BOTH IP/OP	$719.10 	$532.13	$0.00	$575.28	$323.60	$323.60	$0.00	$0.00	$0.00	$149.88	$533.72	$533.72	$0.00	$0.00	$149.86	$0.00	$425.35	$425.35	$0.00	$359.55	$569.53	$575.28	$0.00		$0.00	$112.54	$0.00	$0.00	$114.48	$0.00	$0.00	$0.00	$0.00	$0.00
71021072	SUP	HCPCS C1713		71021072  -  PIN HLF 6MM 20MM HXFX SS ORTH XTRNFX SYS	BOTH IP/OP	$719.10 	$532.13	$0.00	$575.28	$323.60	$323.60	$0.00	$0.00	$0.00	$149.88	$533.72	$533.72	$0.00	$0.00	$149.86	$0.00	$425.35	$425.35	$0.00	$359.55	$569.53	$575.28	$0.00		$0.00	$112.54	$0.00	$0.00	$114.48	$0.00	$0.00	$0.00	$0.00	$0.00
71021073	SUP	HCPCS C1713		71021073  -  PIN HLF 6MM 25MM HXFX SS	BOTH IP/OP	$248.20 	$183.67	$0.00	$198.56	$111.69	$111.69	$0.00	$0.00	$0.00	$51.73	$184.21	$184.21	$0.00	$0.00	$51.72	$0.00	$146.81	$146.81	$0.00	$124.10	$196.57	$198.56	$0.00		$0.00	$38.84	$0.00	$0.00	$39.51	$0.00	$0.00	$0.00	$0.00	$0.00
71021074	SUP	HCPCS C1713		71021074  -  PIN HLF 6MM 30MM HXFX SS	BOTH IP/OP	$496.40 	$367.34	$0.00	$397.12	$223.38	$223.38	$0.00	$0.00	$0.00	$103.46	$368.43	$368.43	$0.00	$0.00	$103.45	$0.00	$293.62	$293.62	$0.00	$248.20	$393.15	$397.12	$0.00		$0.00	$77.69	$0.00	$0.00	$79.03	$0.00	$0.00	$0.00	$0.00	$0.00
71021075	SUP	HCPCS C1713		71021075  -  PIN HLF 6MM 35MM HXFX SS	BOTH IP/OP	$282.20 	$208.83	$0.00	$225.76	$126.99	$126.99	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$141.10	$223.50	$225.76	$0.00		$0.00	$44.16	$0.00	$0.00	$44.93	$0.00	$0.00	$0.00	$0.00	$0.00
71021077	SUP	HCPCS C1713		71021077  -  PIN HLF 6MM 45MM HXFX SS ORTH XTRNFX SYS	BOTH IP/OP	$719.10 	$532.13	$0.00	$575.28	$323.60	$323.60	$0.00	$0.00	$0.00	$149.88	$533.72	$533.72	$0.00	$0.00	$149.86	$0.00	$425.35	$425.35	$0.00	$359.55	$569.53	$575.28	$0.00		$0.00	$112.54	$0.00	$0.00	$114.48	$0.00	$0.00	$0.00	$0.00	$0.00
71021079	SUP	HCPCS C1713		71021079  -  PIN HLF 6MM 55MM HXFX SS	BOTH IP/OP	$282.20 	$208.83	$0.00	$225.76	$126.99	$126.99	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$141.10	$223.50	$225.76	$0.00		$0.00	$44.16	$0.00	$0.00	$44.93	$0.00	$0.00	$0.00	$0.00	$0.00
71021081	SUP	HCPCS C1713		71021081  -  PIN HLF 6MM 65MM HXFX SS ORTH XTRNFX SYS	BOTH IP/OP	$409.70 	$303.18	$0.00	$327.76	$184.37	$184.37	$0.00	$0.00	$0.00	$85.39	$304.08	$304.08	$0.00	$0.00	$85.38	$0.00	$242.34	$242.34	$0.00	$204.85	$324.48	$327.76	$0.00		$0.00	$64.12	$0.00	$0.00	$65.22	$0.00	$0.00	$0.00	$0.00	$0.00
71021083	SUP	HCPCS C1713		71021083  -  PIN HLF 6MM 75MM HXFX SS ORTH XTRNFX SYS	BOTH IP/OP	$409.70 	$303.18	$0.00	$327.76	$184.37	$184.37	$0.00	$0.00	$0.00	$85.39	$304.08	$304.08	$0.00	$0.00	$85.38	$0.00	$242.34	$242.34	$0.00	$204.85	$324.48	$327.76	$0.00		$0.00	$64.12	$0.00	$0.00	$65.22	$0.00	$0.00	$0.00	$0.00	$0.00
71021085	SUP	HCPCS C1713		71021085  -  PIN HLF 6MM 85MM HXFX SS ORTH XTRNFX SYS	BOTH IP/OP	$409.70 	$303.18	$0.00	$327.76	$184.37	$184.37	$0.00	$0.00	$0.00	$85.39	$304.08	$304.08	$0.00	$0.00	$85.38	$0.00	$242.34	$242.34	$0.00	$204.85	$324.48	$327.76	$0.00		$0.00	$64.12	$0.00	$0.00	$65.22	$0.00	$0.00	$0.00	$0.00	$0.00
71022001	SUP	HCPCS C1713		71022001  -  PIN FX 3MM 120MM 16MM COVE PNT ORTH	BOTH IP/OP	$533.80 	$395.01	$0.00	$427.04	$240.21	$240.21	$0.00	$0.00	$0.00	$111.26	$396.19	$396.19	$0.00	$0.00	$111.24	$0.00	$315.74	$315.74	$0.00	$266.90	$422.77	$427.04	$0.00		$0.00	$83.54	$0.00	$0.00	$84.98	$0.00	$0.00	$0.00	$0.00	$0.00
71022002	SUP	HCPCS C1713		71022002  -  PIN FX 3MM 120MM 22MM COVE PNT ORTH	BOTH IP/OP	$533.80 	$395.01	$0.00	$427.04	$240.21	$240.21	$0.00	$0.00	$0.00	$111.26	$396.19	$396.19	$0.00	$0.00	$111.24	$0.00	$315.74	$315.74	$0.00	$266.90	$422.77	$427.04	$0.00		$0.00	$83.54	$0.00	$0.00	$84.98	$0.00	$0.00	$0.00	$0.00	$0.00
71022003	SUP	HCPCS C1713		71022003  -  PIN HLF 3MM 28MM 28MM COVE PNT DIST RADL	BOTH IP/OP	$533.80 	$395.01	$0.00	$427.04	$240.21	$240.21	$0.00	$0.00	$0.00	$111.26	$396.19	$396.19	$0.00	$0.00	$111.24	$0.00	$315.74	$315.74	$0.00	$266.90	$422.77	$427.04	$0.00		$0.00	$83.54	$0.00	$0.00	$84.98	$0.00	$0.00	$0.00	$0.00	$0.00
71031033	SUP	HCPCS C1713		71031033  -  POSITIONER SRG 5MM HXFX CENTERING SLV PIN	BOTH IP/OP	$691.90 	$512.01	$0.00	$553.52	$311.36	$311.36	$0.00	$0.00	$0.00	$144.21	$513.53	$513.53	$0.00	$0.00	$144.19	$0.00	$409.26	$409.26	$0.00	$345.95	$547.98	$553.52	$0.00		$0.00	$108.28	$0.00	$0.00	$110.15	$0.00	$0.00	$0.00	$0.00	$0.00
71031034	SUP	HCPCS C1713		71031034  -  POSITIONER SRG 6MM HXFX CENTERING SLV PIN	BOTH IP/OP	$691.90 	$512.01	$0.00	$553.52	$311.36	$311.36	$0.00	$0.00	$0.00	$144.21	$513.53	$513.53	$0.00	$0.00	$144.19	$0.00	$409.26	$409.26	$0.00	$345.95	$547.98	$553.52	$0.00		$0.00	$108.28	$0.00	$0.00	$110.15	$0.00	$0.00	$0.00	$0.00	$0.00
71031040	SUP	Custom 27203010		71031040  -  GUIDE HXFX TROCAR SURG	BOTH IP/OP	"$5,262.50 "	"$3,894.25"	$0.00	"$4,210.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,905.83"	"$3,905.83"	$0.00	$0.00	"$1,096.71"	$0.00	$0.00	$0.00	$0.00	"$2,631.25"	"$4,167.90"	"$4,210.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71033019	SUP	Custom 27203010		71033019  -  BIT DRL 2MM DIST RDS SYS	BOTH IP/OP	$914.60 	$676.80	$0.00	$731.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$678.82	$678.82	$0.00	$0.00	$190.60	$0.00	$0.00	$0.00	$0.00	$457.30	$724.36	$731.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71053002	SUP	Custom 27203010		71053002  -  BIT DRL 2.8MM	BOTH IP/OP	"$1,106.70 "	$818.96	$0.00	$885.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$821.39	$821.39	$0.00	$0.00	$230.64	$0.00	$0.00	$0.00	$0.00	$553.35	$876.51	$885.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71053004	SUP	Custom 27203010		71053004  -  BIT DRL 4.8MM	BOTH IP/OP	"$1,106.70 "	$818.96	$0.00	$885.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$821.39	$821.39	$0.00	$0.00	$230.64	$0.00	$0.00	$0.00	$0.00	$553.35	$876.51	$885.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71053033	SUP	HCPCS C1713		71053033  -  WASHER XTRNFX 8MM CNTR BD LCK BOLT	BOTH IP/OP	$265.20 	$196.25	$0.00	$212.16	$119.34	$119.34	$0.00	$0.00	$0.00	$55.27	$196.83	$196.83	$0.00	$0.00	$55.27	$0.00	$156.87	$156.87	$0.00	$132.60	$210.04	$212.16	$0.00		$0.00	$41.50	$0.00	$0.00	$42.22	$0.00	$0.00	$0.00	$0.00	$0.00
71053101	SUP	HCPCS C1713		71053101  -  PIN HLF 3MM 10MM JTX TI ORTH XTRNFX SYS	BOTH IP/OP	$218.75 	$161.88	$0.00	$175.00	$98.44	$98.44	$0.00	$0.00	$0.00	$45.59	$162.36	$162.36	$0.00	$0.00	$45.59	$0.00	$129.39	$129.39	$0.00	$109.38	$173.25	$175.00	$0.00		$0.00	$34.23	$0.00	$0.00	$34.83	$0.00	$0.00	$0.00	$0.00	$0.00
71053151	SUP	HCPCS C1713		71053151  -  PIN HLF 3MM 15MM JTX TI ORTH XTRNFX SYS	BOTH IP/OP	$218.75 	$161.88	$0.00	$175.00	$98.44	$98.44	$0.00	$0.00	$0.00	$45.59	$162.36	$162.36	$0.00	$0.00	$45.59	$0.00	$129.39	$129.39	$0.00	$109.38	$173.25	$175.00	$0.00		$0.00	$34.23	$0.00	$0.00	$34.83	$0.00	$0.00	$0.00	$0.00	$0.00
71053201	SUP	HCPCS C1713		71053201  -  PIN HLF 3MM 20MM JTX TI ORTH XTRNFX SYS	BOTH IP/OP	$218.75 	$161.88	$0.00	$175.00	$98.44	$98.44	$0.00	$0.00	$0.00	$45.59	$162.36	$162.36	$0.00	$0.00	$45.59	$0.00	$129.39	$129.39	$0.00	$109.38	$173.25	$175.00	$0.00		$0.00	$34.23	$0.00	$0.00	$34.83	$0.00	$0.00	$0.00	$0.00	$0.00
71053251	SUP	HCPCS C1713		71053251  -  PIN HLF 3MM 25MM JTX TI ORTH XTRNFX SYS	BOTH IP/OP	$218.75 	$161.88	$0.00	$175.00	$98.44	$98.44	$0.00	$0.00	$0.00	$45.59	$162.36	$162.36	$0.00	$0.00	$45.59	$0.00	$129.39	$129.39	$0.00	$109.38	$173.25	$175.00	$0.00		$0.00	$34.23	$0.00	$0.00	$34.83	$0.00	$0.00	$0.00	$0.00	$0.00
71054151	SUP	HCPCS C1713		71054151  -  PIN HLF 4MM 15MM JTX TI ORTH XTRNFX SYS	BOTH IP/OP	$231.88 	$171.59	$0.00	$185.50	$104.34	$104.34	$0.00	$0.00	$0.00	$48.33	$172.10	$172.10	$0.00	$0.00	$48.32	$0.00	$137.15	$137.15	$0.00	$115.94	$183.65	$185.50	$0.00		$0.00	$36.29	$0.00	$0.00	$36.91	$0.00	$0.00	$0.00	$0.00	$0.00
71054201	SUP	HCPCS C1713		71054201  -  PIN HLF 4MM 20MM JTX TI ORTH XTRNFX SYS	BOTH IP/OP	$231.88 	$171.59	$0.00	$185.50	$104.34	$104.34	$0.00	$0.00	$0.00	$48.33	$172.10	$172.10	$0.00	$0.00	$48.32	$0.00	$137.15	$137.15	$0.00	$115.94	$183.65	$185.50	$0.00		$0.00	$36.29	$0.00	$0.00	$36.91	$0.00	$0.00	$0.00	$0.00	$0.00
71054251	SUP	HCPCS C1713		71054251  -  PIN HLF 4MM 25MM JTX TI ORTH XTRNFX SYS	BOTH IP/OP	$231.88 	$171.59	$0.00	$185.50	$104.34	$104.34	$0.00	$0.00	$0.00	$48.33	$172.10	$172.10	$0.00	$0.00	$48.32	$0.00	$137.15	$137.15	$0.00	$115.94	$183.65	$185.50	$0.00		$0.00	$36.29	$0.00	$0.00	$36.91	$0.00	$0.00	$0.00	$0.00	$0.00
71054301	SUP	HCPCS C1713		71054301  -  PIN HLF 4MM 30MM JTX TI ORTH XTRNFX SYS	BOTH IP/OP	$231.88 	$171.59	$0.00	$185.50	$104.34	$104.34	$0.00	$0.00	$0.00	$48.33	$172.10	$172.10	$0.00	$0.00	$48.32	$0.00	$137.15	$137.15	$0.00	$115.94	$183.65	$185.50	$0.00		$0.00	$36.29	$0.00	$0.00	$36.91	$0.00	$0.00	$0.00	$0.00	$0.00
71054351	SUP	HCPCS C1713		71054351  -  PIN HLF 4MM 35MM JTX TI ORTH XTRNFX SYS	BOTH IP/OP	$231.88 	$171.59	$0.00	$185.50	$104.34	$104.34	$0.00	$0.00	$0.00	$48.33	$172.10	$172.10	$0.00	$0.00	$48.32	$0.00	$137.15	$137.15	$0.00	$115.94	$183.65	$185.50	$0.00		$0.00	$36.29	$0.00	$0.00	$36.91	$0.00	$0.00	$0.00	$0.00	$0.00
71055020	SUP	HCPCS C1713		71055020  -  PIN HLF 5MM 20MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$121.13 	$89.64	$0.00	$96.90	$54.51	$54.51	$0.00	$0.00	$0.00	$25.25	$89.90	$89.90	$0.00	$0.00	$25.24	$0.00	$71.65	$71.65	$0.00	$60.56	$95.93	$96.90	$0.00		$0.00	$18.96	$0.00	$0.00	$19.28	$0.00	$0.00	$0.00	$0.00	$0.00
71055201	SUP	HCPCS C1713		71055201  -  PIN HLF SHRT 5MM 20MM JTX TI NTRD	BOTH IP/OP	$253.75 	$187.78	$0.00	$203.00	$114.19	$114.19	$0.00	$0.00	$0.00	$52.89	$188.33	$188.33	$0.00	$0.00	$52.88	$0.00	$150.09	$150.09	$0.00	$126.88	$200.97	$203.00	$0.00		$0.00	$39.71	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
71055251	SUP	HCPCS C1713		71055251  -  PIN HLF SHRT 5MM 25MM JTX TI NTRD	BOTH IP/OP	$253.75 	$187.78	$0.00	$203.00	$114.19	$114.19	$0.00	$0.00	$0.00	$52.89	$188.33	$188.33	$0.00	$0.00	$52.88	$0.00	$150.09	$150.09	$0.00	$126.88	$200.97	$203.00	$0.00		$0.00	$39.71	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
71055301	SUP	HCPCS C1713		71055301  -  PIN HLF SHRT 5MM 30MM TI	BOTH IP/OP	$253.75 	$187.78	$0.00	$203.00	$114.19	$114.19	$0.00	$0.00	$0.00	$52.89	$188.33	$188.33	$0.00	$0.00	$52.88	$0.00	$150.09	$150.09	$0.00	$126.88	$200.97	$203.00	$0.00		$0.00	$39.71	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
71055351	SUP	HCPCS C1713		71055351  -  PIN HLF SHRT 5MM 35MM TI	BOTH IP/OP	$253.75 	$187.78	$0.00	$203.00	$114.19	$114.19	$0.00	$0.00	$0.00	$52.89	$188.33	$188.33	$0.00	$0.00	$52.88	$0.00	$150.09	$150.09	$0.00	$126.88	$200.97	$203.00	$0.00		$0.00	$39.71	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
71055401	SUP	HCPCS C1713		71055401  -  PIN HLF SHRT 5MM 40MM TI	BOTH IP/OP	$253.75 	$187.78	$0.00	$203.00	$114.19	$114.19	$0.00	$0.00	$0.00	$52.89	$188.33	$188.33	$0.00	$0.00	$52.88	$0.00	$150.09	$150.09	$0.00	$126.88	$200.97	$203.00	$0.00		$0.00	$39.71	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
71055451	SUP	HCPCS C1713		71055451  -  PIN HLF SHRT 5MM 45MM TI	BOTH IP/OP	$253.75 	$187.78	$0.00	$203.00	$114.19	$114.19	$0.00	$0.00	$0.00	$52.89	$188.33	$188.33	$0.00	$0.00	$52.88	$0.00	$150.09	$150.09	$0.00	$126.88	$200.97	$203.00	$0.00		$0.00	$39.71	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
71055501	SUP	HCPCS C1713		71055501  -  PIN HLF SHRT 5MM 50MM TI	BOTH IP/OP	$253.75 	$187.78	$0.00	$203.00	$114.19	$114.19	$0.00	$0.00	$0.00	$52.89	$188.33	$188.33	$0.00	$0.00	$52.88	$0.00	$150.09	$150.09	$0.00	$126.88	$200.97	$203.00	$0.00		$0.00	$39.71	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
71055502	SUP	HCPCS C1713		71055502  -  PIN HLF LNG 5MM 50MM TI	BOTH IP/OP	$234.50 	$173.53	$0.00	$187.60	$105.53	$105.53	$0.00	$0.00	$0.00	$48.88	$174.05	$174.05	$0.00	$0.00	$48.87	$0.00	$138.71	$138.71	$0.00	$117.25	$185.72	$187.60	$0.00		$0.00	$36.70	$0.00	$0.00	$37.33	$0.00	$0.00	$0.00	$0.00	$0.00
71055503	SUP	HCPCS C1713		71055503  -  PIN HLF 5MM 50MM STRL TI	BOTH IP/OP	$718.38 	$531.60	$0.00	$574.70	$323.27	$323.27	$0.00	$0.00	$0.00	$149.73	$533.18	$533.18	$0.00	$0.00	$149.71	$0.00	$424.92	$424.92	$0.00	$359.19	$568.96	$574.70	$0.00		$0.00	$112.43	$0.00	$0.00	$114.37	$0.00	$0.00	$0.00	$0.00	$0.00
71055551	SUP	HCPCS C1713		71055551  -  PIN HLF SHRT 5MM 55MM TI	BOTH IP/OP	$253.75 	$187.78	$0.00	$203.00	$114.19	$114.19	$0.00	$0.00	$0.00	$52.89	$188.33	$188.33	$0.00	$0.00	$52.88	$0.00	$150.09	$150.09	$0.00	$126.88	$200.97	$203.00	$0.00		$0.00	$39.71	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
71055552	SUP	HCPCS C1713		71055552  -  PIN HLF LNG 5MM 55MM TI	BOTH IP/OP	$234.50 	$173.53	$0.00	$187.60	$105.53	$105.53	$0.00	$0.00	$0.00	$48.88	$174.05	$174.05	$0.00	$0.00	$48.87	$0.00	$138.71	$138.71	$0.00	$117.25	$185.72	$187.60	$0.00		$0.00	$36.70	$0.00	$0.00	$37.33	$0.00	$0.00	$0.00	$0.00	$0.00
71055601	SUP	HCPCS C1713		71055601  -  PIN HLF SHRT 5MM 60MM TI	BOTH IP/OP	$253.75 	$187.78	$0.00	$203.00	$114.19	$114.19	$0.00	$0.00	$0.00	$52.89	$188.33	$188.33	$0.00	$0.00	$52.88	$0.00	$150.09	$150.09	$0.00	$126.88	$200.97	$203.00	$0.00		$0.00	$39.71	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
71055602	SUP	HCPCS C1713		71055602  -  PIN HLF LNG 5MM 60MM TI	BOTH IP/OP	$234.50 	$173.53	$0.00	$187.60	$105.53	$105.53	$0.00	$0.00	$0.00	$48.88	$174.05	$174.05	$0.00	$0.00	$48.87	$0.00	$138.71	$138.71	$0.00	$117.25	$185.72	$187.60	$0.00		$0.00	$36.70	$0.00	$0.00	$37.33	$0.00	$0.00	$0.00	$0.00	$0.00
71055651	SUP	HCPCS C1713		71055651  -  PIN HLF SHRT 5MM 65MM TI	BOTH IP/OP	$253.75 	$187.78	$0.00	$203.00	$114.19	$114.19	$0.00	$0.00	$0.00	$52.89	$188.33	$188.33	$0.00	$0.00	$52.88	$0.00	$150.09	$150.09	$0.00	$126.88	$200.97	$203.00	$0.00		$0.00	$39.71	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
71055701	SUP	HCPCS C1713		71055701  -  PIN HLF SHRT 5MM 70MM TI	BOTH IP/OP	$253.75 	$187.78	$0.00	$203.00	$114.19	$114.19	$0.00	$0.00	$0.00	$52.89	$188.33	$188.33	$0.00	$0.00	$52.88	$0.00	$150.09	$150.09	$0.00	$126.88	$200.97	$203.00	$0.00		$0.00	$39.71	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
71055702	SUP	HCPCS C1713		71055702  -  PIN HLF LNG 5MM 70MM TI	BOTH IP/OP	$234.50 	$173.53	$0.00	$187.60	$105.53	$105.53	$0.00	$0.00	$0.00	$48.88	$174.05	$174.05	$0.00	$0.00	$48.87	$0.00	$138.71	$138.71	$0.00	$117.25	$185.72	$187.60	$0.00		$0.00	$36.70	$0.00	$0.00	$37.33	$0.00	$0.00	$0.00	$0.00	$0.00
71056208	SUP	HCPCS C1713		71056208  -  PIN HLF SHRT 6MM 20MM JTX TI NTRD	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$116.55	$116.55	$0.00	$0.00	$0.00	$53.98	$192.23	$192.23	$0.00	$0.00	$53.98	$0.00	$153.20	$153.20	$0.00	$129.50	$205.13	$207.20	$0.00		$0.00	$40.53	$0.00	$0.00	$41.23	$0.00	$0.00	$0.00	$0.00	$0.00
71056209	SUP	HCPCS C1713		71056209  -  PIN HLF LNG 20MM JTX TI ORTH	BOTH IP/OP	$248.50 	$183.89	$0.00	$198.80	$111.83	$111.83	$0.00	$0.00	$0.00	$51.79	$184.44	$184.44	$0.00	$0.00	$51.79	$0.00	$146.99	$146.99	$0.00	$124.25	$196.81	$198.80	$0.00		$0.00	$38.89	$0.00	$0.00	$39.56	$0.00	$0.00	$0.00	$0.00	$0.00
71056258	SUP	HCPCS C1713		71056258  -  PIN HLF SHRT 6MM 25MM JTX TI NTRD	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$116.55	$116.55	$0.00	$0.00	$0.00	$53.98	$192.23	$192.23	$0.00	$0.00	$53.98	$0.00	$153.20	$153.20	$0.00	$129.50	$205.13	$207.20	$0.00		$0.00	$40.53	$0.00	$0.00	$41.23	$0.00	$0.00	$0.00	$0.00	$0.00
71056308	SUP	HCPCS C1713		71056308  -  PIN HLF SHRT 6MM 30MM JTX TI NTRD	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$116.55	$116.55	$0.00	$0.00	$0.00	$53.98	$192.23	$192.23	$0.00	$0.00	$53.98	$0.00	$153.20	$153.20	$0.00	$129.50	$205.13	$207.20	$0.00		$0.00	$40.53	$0.00	$0.00	$41.23	$0.00	$0.00	$0.00	$0.00	$0.00
71056309	SUP	HCPCS C1713		71056309  -  PIN HLF LNG 30MM JTX TI ORTH	BOTH IP/OP	$248.50 	$183.89	$0.00	$198.80	$111.83	$111.83	$0.00	$0.00	$0.00	$51.79	$184.44	$184.44	$0.00	$0.00	$51.79	$0.00	$146.99	$146.99	$0.00	$124.25	$196.81	$198.80	$0.00		$0.00	$38.89	$0.00	$0.00	$39.56	$0.00	$0.00	$0.00	$0.00	$0.00
71056358	SUP	HCPCS C1713		71056358  -  PIN HLF SHRT 6MM 35MM JTX TI NTRD	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$116.55	$116.55	$0.00	$0.00	$0.00	$53.98	$192.23	$192.23	$0.00	$0.00	$53.98	$0.00	$153.20	$153.20	$0.00	$129.50	$205.13	$207.20	$0.00		$0.00	$40.53	$0.00	$0.00	$41.23	$0.00	$0.00	$0.00	$0.00	$0.00
71056408	SUP	HCPCS C1713		71056408  -  PIN HLF SHRT 6MM 40MM JTX TI NTRD	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$116.55	$116.55	$0.00	$0.00	$0.00	$53.98	$192.23	$192.23	$0.00	$0.00	$53.98	$0.00	$153.20	$153.20	$0.00	$129.50	$205.13	$207.20	$0.00		$0.00	$40.53	$0.00	$0.00	$41.23	$0.00	$0.00	$0.00	$0.00	$0.00
71056409	SUP	HCPCS C1713		71056409  -  PIN HLF LNG 40MM JTX TI ORTH	BOTH IP/OP	$248.50 	$183.89	$0.00	$198.80	$111.83	$111.83	$0.00	$0.00	$0.00	$51.79	$184.44	$184.44	$0.00	$0.00	$51.79	$0.00	$146.99	$146.99	$0.00	$124.25	$196.81	$198.80	$0.00		$0.00	$38.89	$0.00	$0.00	$39.56	$0.00	$0.00	$0.00	$0.00	$0.00
71056458	SUP	HCPCS C1713		71056458  -  PIN HLF SHRT 6MM 45MM JTX TI NTRD	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$116.55	$116.55	$0.00	$0.00	$0.00	$53.98	$192.23	$192.23	$0.00	$0.00	$53.98	$0.00	$153.20	$153.20	$0.00	$129.50	$205.13	$207.20	$0.00		$0.00	$40.53	$0.00	$0.00	$41.23	$0.00	$0.00	$0.00	$0.00	$0.00
71056459	SUP	HCPCS C1713		71056459  -  PIN HLF LNG 45MM JTX TI ORTH	BOTH IP/OP	$248.50 	$183.89	$0.00	$198.80	$111.83	$111.83	$0.00	$0.00	$0.00	$51.79	$184.44	$184.44	$0.00	$0.00	$51.79	$0.00	$146.99	$146.99	$0.00	$124.25	$196.81	$198.80	$0.00		$0.00	$38.89	$0.00	$0.00	$39.56	$0.00	$0.00	$0.00	$0.00	$0.00
71056508	SUP	HCPCS C1713		71056508  -  PIN HLF SHRT 6MM 50MM JTX TI NTRD	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$116.55	$116.55	$0.00	$0.00	$0.00	$53.98	$192.23	$192.23	$0.00	$0.00	$53.98	$0.00	$153.20	$153.20	$0.00	$129.50	$205.13	$207.20	$0.00		$0.00	$40.53	$0.00	$0.00	$41.23	$0.00	$0.00	$0.00	$0.00	$0.00
71056509	SUP	HCPCS C1713		71056509  -  PIN HLF LNG 50MM JTX TI ORTH	BOTH IP/OP	$260.75 	$192.96	$0.00	$208.60	$117.34	$117.34	$0.00	$0.00	$0.00	$54.35	$193.53	$193.53	$0.00	$0.00	$54.34	$0.00	$154.23	$154.23	$0.00	$130.38	$206.51	$208.60	$0.00		$0.00	$40.81	$0.00	$0.00	$41.51	$0.00	$0.00	$0.00	$0.00	$0.00
71056558	SUP	HCPCS C1713		71056558  -  PIN HLF SHRT 6MM 55MM JTX TI NTRD	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$116.55	$116.55	$0.00	$0.00	$0.00	$53.98	$192.23	$192.23	$0.00	$0.00	$53.98	$0.00	$153.20	$153.20	$0.00	$129.50	$205.13	$207.20	$0.00		$0.00	$40.53	$0.00	$0.00	$41.23	$0.00	$0.00	$0.00	$0.00	$0.00
71056608	SUP	HCPCS C1713		71056608  -  PIN HLF SHRT 6MM 60MM JTX TI NTRD	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$116.55	$116.55	$0.00	$0.00	$0.00	$53.98	$192.23	$192.23	$0.00	$0.00	$53.98	$0.00	$153.20	$153.20	$0.00	$129.50	$205.13	$207.20	$0.00		$0.00	$40.53	$0.00	$0.00	$41.23	$0.00	$0.00	$0.00	$0.00	$0.00
71056609	SUP	HCPCS C1713		71056609  -  PIN HLF 60MM JTX TI ORTH	BOTH IP/OP	$260.75 	$192.96	$0.00	$208.60	$117.34	$117.34	$0.00	$0.00	$0.00	$54.35	$193.53	$193.53	$0.00	$0.00	$54.34	$0.00	$154.23	$154.23	$0.00	$130.38	$206.51	$208.60	$0.00		$0.00	$40.81	$0.00	$0.00	$41.51	$0.00	$0.00	$0.00	$0.00	$0.00
71056658	SUP	HCPCS C1713		71056658  -  PIN HLF SHRT 6MM 65MM JTX TI NTRD	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$116.55	$116.55	$0.00	$0.00	$0.00	$53.98	$192.23	$192.23	$0.00	$0.00	$53.98	$0.00	$153.20	$153.20	$0.00	$129.50	$205.13	$207.20	$0.00		$0.00	$40.53	$0.00	$0.00	$41.23	$0.00	$0.00	$0.00	$0.00	$0.00
71056708	SUP	HCPCS C1713		71056708  -  PIN HLF SHRT 6MM 70MM JTX TI NTRD	BOTH IP/OP	$259.00 	$191.66	$0.00	$207.20	$116.55	$116.55	$0.00	$0.00	$0.00	$53.98	$192.23	$192.23	$0.00	$0.00	$53.98	$0.00	$153.20	$153.20	$0.00	$129.50	$205.13	$207.20	$0.00		$0.00	$40.53	$0.00	$0.00	$41.23	$0.00	$0.00	$0.00	$0.00	$0.00
71056709	SUP	HCPCS C1713		71056709  -  PIN HLF LNG 60MM JTX TI ORTH	BOTH IP/OP	$260.75 	$192.96	$0.00	$208.60	$117.34	$117.34	$0.00	$0.00	$0.00	$54.35	$193.53	$193.53	$0.00	$0.00	$54.34	$0.00	$154.23	$154.23	$0.00	$130.38	$206.51	$208.60	$0.00		$0.00	$40.81	$0.00	$0.00	$41.51	$0.00	$0.00	$0.00	$0.00	$0.00
71061001	SUP	HCPCS C1713		71061001  -  PIN FX 3.2MM 86MM TROC PNT 1 END ORTH	BOTH IP/OP	$494.00 	$365.56	$0.00	$395.20	$222.30	$222.30	$0.00	$0.00	$0.00	$102.96	$366.65	$366.65	$0.00	$0.00	$102.95	$0.00	$292.20	$292.20	$0.00	$247.00	$391.25	$395.20	$0.00		$0.00	$77.31	$0.00	$0.00	$78.64	$0.00	$0.00	$0.00	$0.00	$0.00
71062007	SUP	HCPCS C1713		71062007  -  CAP PCTV 5MM	BOTH IP/OP	$60.30 	$44.62	$0.00	$48.24	$27.14	$27.14	$0.00	$0.00	$0.00	$12.57	$44.75	$44.75	$0.00	$0.00	$12.57	$0.00	$35.67	$35.67	$0.00	$30.15	$47.76	$48.24	$0.00		$0.00	$9.44	$0.00	$0.00	$9.60	$0.00	$0.00	$0.00	$0.00	$0.00
71062008	SUP	HCPCS C1713		71062008  -  BAR XTRNFX JTX CAP	BOTH IP/OP	$69.10 	$51.13	$0.00	$55.28	$31.10	$31.10	$0.00	$0.00	$0.00	$14.40	$51.29	$51.29	$0.00	$0.00	$14.40	$0.00	$40.87	$40.87	$0.00	$34.55	$54.73	$55.28	$0.00		$0.00	$10.81	$0.00	$0.00	$11.00	$0.00	$0.00	$0.00	$0.00	$0.00
71062017	SUP	HCPCS C1713		71062017  -  CAP END 4MM JTX PIN ORTH XTRNFX SYS	BOTH IP/OP	$115.50 	$85.47	$0.00	$92.40	$51.98	$51.98	$0.00	$0.00	$0.00	$24.07	$85.72	$85.72	$0.00	$0.00	$24.07	$0.00	$68.32	$68.32	$0.00	$57.75	$91.48	$92.40	$0.00		$0.00	$18.08	$0.00	$0.00	$18.39	$0.00	$0.00	$0.00	$0.00	$0.00
71062200	SUP	HCPCS C1713		71062200  -  BAR XTRNFX 200MM NS JTX CFBR DISP	BOTH IP/OP	$400.75 	$296.56	$0.00	$320.60	$180.34	$180.34	$0.00	$0.00	$0.00	$83.53	$297.44	$297.44	$0.00	$0.00	$83.52	$0.00	$237.04	$237.04	$0.00	$200.38	$317.39	$320.60	$0.00		$0.00	$62.72	$0.00	$0.00	$63.80	$0.00	$0.00	$0.00	$0.00	$0.00
71062250	SUP	Custom 27203010		71062250  -  BAR XTRNFX 250MM NS JTX CFBR DISP	BOTH IP/OP	$430.50 	$318.57	$0.00	$344.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.52	$319.52	$0.00	$0.00	$89.72	$0.00	$0.00	$0.00	$0.00	$215.25	$340.96	$344.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71062300	SUP	HCPCS C1713		71062300  -  BAR XTRNFX 300MM NS JTX CFBR DISP	BOTH IP/OP	$430.50 	$318.57	$0.00	$344.40	$193.73	$193.73	$0.00	$0.00	$0.00	$89.73	$319.52	$319.52	$0.00	$0.00	$89.72	$0.00	$254.64	$254.64	$0.00	$215.25	$340.96	$344.40	$0.00		$0.00	$67.37	$0.00	$0.00	$68.54	$0.00	$0.00	$0.00	$0.00	$0.00
71062350	SUP	HCPCS C1713		71062350  -  BAR XTRNFX 350MM NS JTX CFBR DISP	BOTH IP/OP	$430.50 	$318.57	$0.00	$344.40	$193.73	$193.73	$0.00	$0.00	$0.00	$89.73	$319.52	$319.52	$0.00	$0.00	$89.72	$0.00	$254.64	$254.64	$0.00	$215.25	$340.96	$344.40	$0.00		$0.00	$67.37	$0.00	$0.00	$68.54	$0.00	$0.00	$0.00	$0.00	$0.00
71062400	SUP	HCPCS C1713		71062400  -  BAR XTRNFX 400MM NS JTX CFBR DISP	BOTH IP/OP	$474.25 	$350.95	$0.00	$379.40	$213.41	$213.41	$0.00	$0.00	$0.00	$98.85	$351.99	$351.99	$0.00	$0.00	$98.83	$0.00	$280.52	$280.52	$0.00	$237.13	$375.61	$379.40	$0.00		$0.00	$74.22	$0.00	$0.00	$75.50	$0.00	$0.00	$0.00	$0.00	$0.00
71063006	SUP	Custom 27203010		71063006  -  BIT DRL 3.5MM STRL JTX AO CNCT	BOTH IP/OP	$470.75 	$348.36	$0.00	$376.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$349.39	$349.39	$0.00	$0.00	$98.10	$0.00	$0.00	$0.00	$0.00	$235.38	$372.83	$376.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71063011	SUP	HCPCS C1769		71063011  -  GUIDEWIRE ESCP 1.6MM	BOTH IP/OP	"$1,876.88 "	"$1,388.89"	$0.00	"$1,501.50"	"$1,019.14"	"$1,019.14"	$0.00	$0.00	$0.00	$391.19	"$1,393.02"	"$1,393.02"	$0.00	$0.00	$391.14	$0.00	"$1,110.17"	"$1,110.17"	$0.00	$938.44	"$1,486.49"	"$1,501.50"	$0.00		$0.00	$293.73	$0.00	$0.00	$298.80	$0.00	$0.00	$0.00	$0.00	$0.00
71063028	SUP	Custom 27203010		71063028  -  BIT DRL 3.5MM STRL JTX GRAD STP SHRT HLF PIN	BOTH IP/OP	$413.88 	$306.27	$0.00	$331.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.18	$307.18	$0.00	$0.00	$86.25	$0.00	$0.00	$0.00	$0.00	$206.94	$327.79	$331.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71063152	SUP	HCPCS C1713		71063152  -  PIN XTRNFX SHRT 3MM 15MM JTX TI NTRD DIST RDS XTRNFX SYS	BOTH IP/OP	$317.63 	$235.05	$0.00	$254.10	$142.93	$142.93	$0.00	$0.00	$0.00	$66.20	$235.74	$235.74	$0.00	$0.00	$66.19	$0.00	$187.88	$187.88	$0.00	$158.81	$251.56	$254.10	$0.00		$0.00	$49.71	$0.00	$0.00	$50.57	$0.00	$0.00	$0.00	$0.00	$0.00
71063202	SUP	HCPCS C1713		71063202  -  PIN XTRNFX SHRT 3MM 20MM JTX TI NTRD DIST RDS XTRNFX SYS	BOTH IP/OP	$317.63 	$235.05	$0.00	$254.10	$142.93	$142.93	$0.00	$0.00	$0.00	$66.20	$235.74	$235.74	$0.00	$0.00	$66.19	$0.00	$187.88	$187.88	$0.00	$158.81	$251.56	$254.10	$0.00		$0.00	$49.71	$0.00	$0.00	$50.57	$0.00	$0.00	$0.00	$0.00	$0.00
71063203	SUP	Custom 27203010		71063203  -  BIT DRL SHRT 3MM STRL GRAD HLF PIN	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$0.00	$0.00	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71064151	SUP	HCPCS C1713		71064151  -  PIN HLF 4MM 95MM 15MM JTX SS DIST RDS FT XTRNFX SYS	BOTH IP/OP	$219.63 	$162.53	$0.00	$175.70	$98.83	$98.83	$0.00	$0.00	$0.00	$45.78	$163.01	$163.01	$0.00	$0.00	$45.77	$0.00	$129.91	$129.91	$0.00	$109.81	$173.95	$175.70	$0.00		$0.00	$34.37	$0.00	$0.00	$34.96	$0.00	$0.00	$0.00	$0.00	$0.00
71064158	SUP	HCPCS C1713		71064158  -  PIN HLF SHRT 4MM 15MM JTX TI NTRD XTRNFX SYS	BOTH IP/OP	$219.63 	$162.53	$0.00	$175.70	$98.83	$98.83	$0.00	$0.00	$0.00	$45.78	$163.01	$163.01	$0.00	$0.00	$45.77	$0.00	$129.91	$129.91	$0.00	$109.81	$173.95	$175.70	$0.00		$0.00	$34.37	$0.00	$0.00	$34.96	$0.00	$0.00	$0.00	$0.00	$0.00
71064201	SUP	HCPCS C1713		71064201  -  PIN HLF 4MM 20MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$219.63 	$162.53	$0.00	$175.70	$98.83	$98.83	$0.00	$0.00	$0.00	$45.78	$163.01	$163.01	$0.00	$0.00	$45.77	$0.00	$129.91	$129.91	$0.00	$109.81	$173.95	$175.70	$0.00		$0.00	$34.37	$0.00	$0.00	$34.96	$0.00	$0.00	$0.00	$0.00	$0.00
71064208	SUP	HCPCS C1713		71064208  -  PIN HLF SHRT 4MM 20MM JTX TI NTRD XTRNFX SYS	BOTH IP/OP	$219.63 	$162.53	$0.00	$175.70	$98.83	$98.83	$0.00	$0.00	$0.00	$45.78	$163.01	$163.01	$0.00	$0.00	$45.77	$0.00	$129.91	$129.91	$0.00	$109.81	$173.95	$175.70	$0.00		$0.00	$34.37	$0.00	$0.00	$34.96	$0.00	$0.00	$0.00	$0.00	$0.00
71064251	SUP	HCPCS C1713		71064251  -  PIN HLF 4MM 25MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$219.63 	$162.53	$0.00	$175.70	$98.83	$98.83	$0.00	$0.00	$0.00	$45.78	$163.01	$163.01	$0.00	$0.00	$45.77	$0.00	$129.91	$129.91	$0.00	$109.81	$173.95	$175.70	$0.00		$0.00	$34.37	$0.00	$0.00	$34.96	$0.00	$0.00	$0.00	$0.00	$0.00
71064258	SUP	HCPCS C1713		71064258  -  PIN HLF SHRT 4MM 25MM JTX TI NTRD XTRNFX SYS	BOTH IP/OP	$219.63 	$162.53	$0.00	$175.70	$98.83	$98.83	$0.00	$0.00	$0.00	$45.78	$163.01	$163.01	$0.00	$0.00	$45.77	$0.00	$129.91	$129.91	$0.00	$109.81	$173.95	$175.70	$0.00		$0.00	$34.37	$0.00	$0.00	$34.96	$0.00	$0.00	$0.00	$0.00	$0.00
71064301	SUP	HCPCS C1713		71064301  -  PIN HLF SHRT 4MM 30MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$219.63 	$162.53	$0.00	$175.70	$98.83	$98.83	$0.00	$0.00	$0.00	$45.78	$163.01	$163.01	$0.00	$0.00	$45.77	$0.00	$129.91	$129.91	$0.00	$109.81	$173.95	$175.70	$0.00		$0.00	$34.37	$0.00	$0.00	$34.96	$0.00	$0.00	$0.00	$0.00	$0.00
71064308	SUP	HCPCS C1713		71064308  -  PIN HALF SHORT 4MM 30MM JET-X TITANIUM NITRIDE ORTHOPEDIC	BOTH IP/OP	$219.63 	$162.53	$0.00	$175.70	$98.83	$98.83	$0.00	$0.00	$0.00	$45.78	$163.01	$163.01	$0.00	$0.00	$45.77	$0.00	$129.91	$129.91	$0.00	$109.81	$173.95	$175.70	$0.00		$0.00	$34.37	$0.00	$0.00	$34.96	$0.00	$0.00	$0.00	$0.00	$0.00
71064351	SUP	HCPCS C1713		71064351  -  PIN HLF 4MM 35MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$219.63 	$162.53	$0.00	$175.70	$98.83	$98.83	$0.00	$0.00	$0.00	$45.78	$163.01	$163.01	$0.00	$0.00	$45.77	$0.00	$129.91	$129.91	$0.00	$109.81	$173.95	$175.70	$0.00		$0.00	$34.37	$0.00	$0.00	$34.96	$0.00	$0.00	$0.00	$0.00	$0.00
71064358	SUP	HCPCS C1713		71064358  -  PIN HLF SHRT 4MM 35MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$219.63 	$162.53	$0.00	$175.70	$98.83	$98.83	$0.00	$0.00	$0.00	$45.78	$163.01	$163.01	$0.00	$0.00	$45.77	$0.00	$129.91	$129.91	$0.00	$109.81	$173.95	$175.70	$0.00		$0.00	$34.37	$0.00	$0.00	$34.96	$0.00	$0.00	$0.00	$0.00	$0.00
71065301	SUP	HCPCS C1713		71065301  -  PIN HLF 5MM 17.5CM 30MM JTX SS XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065302	SUP	HCPCS C1713		71065302  -  PIN HLF LNG 5MM 255MM 30MM JTX SS XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065304	SUP	HCPCS C1713		71065304  -  PIN HLF XSH 5MM 30MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065309	SUP	HCPCS C1713		71065309  -  PIN HLF LNG 5MM 30MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$138.60	$138.60	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
71065351	SUP	HCPCS C1713		71065351  -  PIN HLF 5MM 17.5CM 35MM JTX SS XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065352	SUP	HCPCS C1713		71065352  -  PIN HLF LNG 5MM 255MM 35MM JTX SS XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065354	SUP	HCPCS C1713		71065354  -  PIN HLF XSH 5MM 35MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065358	SUP	HCPCS C1713		71065358  -  PIN HLF SHRT 5MM 35MM JTX TI NTRD XTRNFX SYS	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$138.60	$138.60	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
71065359	SUP	HCPCS C1713		71065359  -  PIN HLF LNG 5MM 35MM JTX TI NTRD XTRNFX SYS	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$138.60	$138.60	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
71065400	SUP	HCPCS C1713		71065400  -  PIN HLF 5MM 40MM JTX CNN TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$392.00 	$290.08	$0.00	$313.60	$176.40	$176.40	$0.00	$0.00	$0.00	$81.70	$290.94	$290.94	$0.00	$0.00	$81.69	$0.00	$231.87	$231.87	$0.00	$196.00	$310.46	$313.60	$0.00		$0.00	$61.35	$0.00	$0.00	$62.41	$0.00	$0.00	$0.00	$0.00	$0.00
71065401	SUP	HCPCS C1713		71065401  -  PIN HLF 5MM 17.5CM 40MM JTX SS XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065402	SUP	HCPCS C1713		71065402  -  PIN HLF LNG 5MM 225MM 40MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065404	SUP	HCPCS C1713		71065404  -  PIN HLF XSH 5MM 40MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065407	SUP	HCPCS C1713		71065407  -  PIN HLF XSH 1.6MM 40MM 40MM JTX CNN TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$392.00 	$290.08	$0.00	$313.60	$176.40	$176.40	$0.00	$0.00	$0.00	$81.70	$290.94	$290.94	$0.00	$0.00	$81.69	$0.00	$231.87	$231.87	$0.00	$196.00	$310.46	$313.60	$0.00		$0.00	$61.35	$0.00	$0.00	$62.41	$0.00	$0.00	$0.00	$0.00	$0.00
71065408	SUP	HCPCS C1713		71065408  -  PIN HLF SHRT 5MM 40MM JTX TI NTRD XTRNFX SYS	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$138.60	$138.60	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
71065409	SUP	HCPCS C1713		71065409  -  PIN HLF LNG 5MM 40MM JTX TI NTRD XTRNFX SYS	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$138.60	$138.60	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
71065451	SUP	HCPCS C1713		71065451  -  PIN HLF 5MM 17.5CM 45MM JTX SS XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065452	SUP	HCPCS C1713		71065452  -  PIN HLF LNG 5MM 255MM 45MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065454	SUP	HCPCS C1713		71065454  -  PIN HLF XSH 5MM 45MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065458	SUP	HCPCS C1713		71065458  -  PIN HLF SHRT 5MM 45MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$138.60	$138.60	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
71065459	SUP	HCPCS C1713		71065459  -  PIN HLF LNG 5MM 45MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$138.60	$138.60	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
71065501	SUP	HCPCS C1713		71065501  -  PIN HLF SHRT 5MM 175MM 50MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065502	SUP	HCPCS C1713		71065502  -  PIN HLF LNG 5MM 255MM 50MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065508	SUP	HCPCS C1713		71065508  -  PIN HLF SHRT 5MM 50MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$233.63 	$172.89	$0.00	$186.90	$105.13	$105.13	$0.00	$0.00	$0.00	$48.69	$173.40	$173.40	$0.00	$0.00	$48.69	$0.00	$138.19	$138.19	$0.00	$116.81	$185.03	$186.90	$0.00		$0.00	$36.56	$0.00	$0.00	$37.19	$0.00	$0.00	$0.00	$0.00	$0.00
71065509	SUP	HCPCS C1713		71065509  -  PIN HLF LNG 5MM 50MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$233.63 	$172.89	$0.00	$186.90	$105.13	$105.13	$0.00	$0.00	$0.00	$48.69	$173.40	$173.40	$0.00	$0.00	$48.69	$0.00	$138.19	$138.19	$0.00	$116.81	$185.03	$186.90	$0.00		$0.00	$36.56	$0.00	$0.00	$37.19	$0.00	$0.00	$0.00	$0.00	$0.00
71065551	SUP	HCPCS C1713		71065551  -  PIN HLF SHRT 5MM 175MM 55MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065552	SUP	HCPCS C1713		71065552  -  PIN HLF LNG 5MM 255MM 55MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065558	SUP	HCPCS C1713		71065558  -  PIN HLF SHRT 5MM 55MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$233.63 	$172.89	$0.00	$186.90	$105.13	$105.13	$0.00	$0.00	$0.00	$48.69	$173.40	$173.40	$0.00	$0.00	$48.69	$0.00	$138.19	$138.19	$0.00	$116.81	$185.03	$186.90	$0.00		$0.00	$36.56	$0.00	$0.00	$37.19	$0.00	$0.00	$0.00	$0.00	$0.00
71065559	SUP	HCPCS C1713		71065559  -  PIN HLF LNG 5MM 55MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$233.63 	$172.89	$0.00	$186.90	$105.13	$105.13	$0.00	$0.00	$0.00	$48.69	$173.40	$173.40	$0.00	$0.00	$48.69	$0.00	$138.19	$138.19	$0.00	$116.81	$185.03	$186.90	$0.00		$0.00	$36.56	$0.00	$0.00	$37.19	$0.00	$0.00	$0.00	$0.00	$0.00
71065601	SUP	HCPCS C1713		71065601  -  PIN HLF SHRT 5MM 60MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065602	SUP	HCPCS C1713		71065602  -  PIN HLF LNG 5MM 60MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065608	SUP	HCPCS C1713		71065608  -  PIN HLF SHRT 5MM 60MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$233.63 	$172.89	$0.00	$186.90	$105.13	$105.13	$0.00	$0.00	$0.00	$48.69	$173.40	$173.40	$0.00	$0.00	$48.69	$0.00	$138.19	$138.19	$0.00	$116.81	$185.03	$186.90	$0.00		$0.00	$36.56	$0.00	$0.00	$37.19	$0.00	$0.00	$0.00	$0.00	$0.00
71065609	SUP	HCPCS C1713		71065609  -  PIN HLF LNG 5MM 60MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$233.63 	$172.89	$0.00	$186.90	$105.13	$105.13	$0.00	$0.00	$0.00	$48.69	$173.40	$173.40	$0.00	$0.00	$48.69	$0.00	$138.19	$138.19	$0.00	$116.81	$185.03	$186.90	$0.00		$0.00	$36.56	$0.00	$0.00	$37.19	$0.00	$0.00	$0.00	$0.00	$0.00
71065651	SUP	HCPCS C1713		71065651  -  PIN HLF SHRT 5MM 65MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065652	SUP	HCPCS C1713		71065652  -  PIN HLF LNG 5MM 65MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065658	SUP	HCPCS C1713		71065658  -  PIN HLF SHRT 5MM 65MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$233.63 	$172.89	$0.00	$186.90	$105.13	$105.13	$0.00	$0.00	$0.00	$48.69	$173.40	$173.40	$0.00	$0.00	$48.69	$0.00	$138.19	$138.19	$0.00	$116.81	$185.03	$186.90	$0.00		$0.00	$36.56	$0.00	$0.00	$37.19	$0.00	$0.00	$0.00	$0.00	$0.00
71065659	SUP	HCPCS C1713		71065659  -  PIN HLF LNG 5MM 65MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$230.13 	$170.30	$0.00	$184.10	$103.56	$103.56	$0.00	$0.00	$0.00	$47.96	$170.80	$170.80	$0.00	$0.00	$47.96	$0.00	$136.12	$136.12	$0.00	$115.06	$182.26	$184.10	$0.00		$0.00	$36.01	$0.00	$0.00	$36.64	$0.00	$0.00	$0.00	$0.00	$0.00
71065701	SUP	HCPCS C1713		71065701  -  PIN HLF SHRT 5MM 70MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065702	SUP	HCPCS C1713		71065702  -  PIN HLF LNG 5MM 70MM JTX SS ORTH XTRNFX SYS	BOTH IP/OP	$278.25 	$205.91	$0.00	$222.60	$125.21	$125.21	$0.00	$0.00	$0.00	$57.99	$206.52	$206.52	$0.00	$0.00	$57.99	$0.00	$164.58	$164.58	$0.00	$139.13	$220.37	$222.60	$0.00		$0.00	$43.55	$0.00	$0.00	$44.30	$0.00	$0.00	$0.00	$0.00	$0.00
71065708	SUP	HCPCS C1713		71065708  -  PIN HLF SHRT 5MM 70MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$233.63 	$172.89	$0.00	$186.90	$105.13	$105.13	$0.00	$0.00	$0.00	$48.69	$173.40	$173.40	$0.00	$0.00	$48.69	$0.00	$138.19	$138.19	$0.00	$116.81	$185.03	$186.90	$0.00		$0.00	$36.56	$0.00	$0.00	$37.19	$0.00	$0.00	$0.00	$0.00	$0.00
71065709	SUP	HCPCS C1713		71065709  -  PIN HLF LNG 5MM 70MM JTX TI NTRD ORTH XTRNFX SYS	BOTH IP/OP	$233.63 	$172.89	$0.00	$186.90	$105.13	$105.13	$0.00	$0.00	$0.00	$48.69	$173.40	$173.40	$0.00	$0.00	$48.69	$0.00	$138.19	$138.19	$0.00	$116.81	$185.03	$186.90	$0.00		$0.00	$36.56	$0.00	$0.00	$37.19	$0.00	$0.00	$0.00	$0.00	$0.00
71066409	SUP	HCPCS C1713		71066409  -  PIN FX LNG 6MM 40MM NS 160MM JTX SLF DRL ST TI NTRD	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$138.60	$138.60	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
71066459	SUP	HCPCS C1713		71066459  -  PIN HLF LNG 6MM 45MM JTX TI NTRD	BOTH IP/OP	$233.63 	$172.89	$0.00	$186.90	$105.13	$105.13	$0.00	$0.00	$0.00	$48.69	$173.40	$173.40	$0.00	$0.00	$48.69	$0.00	$138.19	$138.19	$0.00	$116.81	$185.03	$186.90	$0.00		$0.00	$36.56	$0.00	$0.00	$37.19	$0.00	$0.00	$0.00	$0.00	$0.00
71066509	SUP	HCPCS C1713		71066509  -  PIN HALF 50MM 6MM JTX LNG TI NTRD	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$138.60	$138.60	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
71066559	SUP	HCPCS C1713		71066559  -  PIN HLF LNG 6MM 55MM JTX TI NTRD	BOTH IP/OP	$233.63 	$172.89	$0.00	$186.90	$105.13	$105.13	$0.00	$0.00	$0.00	$48.69	$173.40	$173.40	$0.00	$0.00	$48.69	$0.00	$138.19	$138.19	$0.00	$116.81	$185.03	$186.90	$0.00		$0.00	$36.56	$0.00	$0.00	$37.19	$0.00	$0.00	$0.00	$0.00	$0.00
71067315	SUP	Custom 27203010		71067315  -  BIT DRL 2MM 3MM HLF PIN	BOTH IP/OP	$569.63 	$421.53	$0.00	$455.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$422.78	$422.78	$0.00	$0.00	$118.71	$0.00	$0.00	$0.00	$0.00	$284.81	$451.15	$455.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71067319	SUP	Custom 27203010		71067319  -  BIT DRILL LNG 5MM HALF PIN	BOTH IP/OP	$569.63 	$421.53	$0.00	$455.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$422.78	$422.78	$0.00	$0.00	$118.71	$0.00	$0.00	$0.00	$0.00	$284.81	$451.15	$455.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71067321	SUP	Custom 27203010		71067321  -  BIT DRILL 6 MM HALF PIN	BOTH IP/OP	$569.63 	$421.53	$0.00	$455.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$422.78	$422.78	$0.00	$0.00	$118.71	$0.00	$0.00	$0.00	$0.00	$284.81	$451.15	$455.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71067374	SUP	HCPCS C1713		71067374  -  CLAMP EXFIX 10.5MM 10.5MM QUICK CONNECT BAR TO BAR JET-X	BOTH IP/OP	"$1,015.00 "	$751.10	$0.00	$812.00	$456.75	$456.75	$0.00	$0.00	$0.00	$211.55	$753.33	$753.33	$0.00	$0.00	$211.53	$0.00	$600.37	$600.37	$0.00	$507.50	$803.88	$812.00	$0.00		$0.00	$158.85	$0.00	$0.00	$161.59	$0.00	$0.00	$0.00	$0.00	$0.00
71070113	SUP	HCPCS C1713		71070113  -  RING EXFIX CIR FULL 130MM TAYLOR SPATIAL FRAME	BOTH IP/OP	"$3,230.00 "	"$2,390.20"	$0.00	"$2,584.00"	"$1,453.50"	"$1,453.50"	$0.00	$0.00	$0.00	$673.21	"$2,397.31"	"$2,397.31"	$0.00	$0.00	$673.13	$0.00	"$1,592.39"	"$1,592.39"	$0.00	"$1,615.00"	"$2,558.16"	"$2,584.00"	$0.00		$0.00	$505.50	$0.00	$0.00	$514.22	$0.00	$0.00	$0.00	$0.00	$0.00
71070116	SUP	HCPCS C1713		71070116  -  RING EXFIX FULL 205MM ALUMINUM TAYLOR SPATIAL FRAME	BOTH IP/OP	"$3,230.00 "	"$2,390.20"	$0.00	"$2,584.00"	"$1,453.50"	"$1,453.50"	$0.00	$0.00	$0.00	$673.21	"$2,397.31"	"$2,397.31"	$0.00	$0.00	$673.13	$0.00	"$1,592.39"	"$1,592.39"	$0.00	"$1,615.00"	"$2,558.16"	"$2,584.00"	$0.00		$0.00	$505.50	$0.00	$0.00	$514.22	$0.00	$0.00	$0.00	$0.00	$0.00
71070117	SUP	Custom 27203010		71070117  -  RING EXFIX 230MM FULL RING CIRCULAR TAYLOR SPATIAL FRAME	BOTH IP/OP	"$3,230.00 "	"$2,390.20"	$0.00	"$2,584.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,397.31"	"$2,397.31"	$0.00	$0.00	$673.13	$0.00	$0.00	$0.00	$0.00	"$1,615.00"	"$2,558.16"	"$2,584.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71070124	SUP	Custom 27011340		71070124  -  RING EXFIX 155MM CIR HALF TLT SP	BOTH IP/OP	"$3,459.50 "	"$2,560.03"	$0.00	"$2,767.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,567.64"	"$2,567.64"	$0.00	$0.00	$720.96	$0.00	$0.00	$0.00	$0.00	"$1,729.75"	"$2,739.92"	"$2,767.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71070144	SUP	Custom 27011340		71070144  -  RING EXFIX 155MM LNG CIR FT TLT SP	BOTH IP/OP	"$4,080.00 "	"$3,019.20"	$0.00	"$3,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,028.18"	"$3,028.18"	$0.00	$0.00	$850.27	$0.00	$0.00	$0.00	$0.00	"$2,040.00"	"$3,231.36"	"$3,264.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71070272	SUP	HCPCS C1776		71070272  -  SLEEVE CENTERING 6MM	BOTH IP/OP	$406.30 	$300.66	$0.00	$325.04	$182.84	$182.84	$0.00	$0.00	$0.00	$84.68	$301.56	$301.56	$0.00	$0.00	$84.67	$0.00	$240.33	$240.33	$0.00	$203.15	$321.79	$325.04	$0.00		$0.00	$63.59	$0.00	$0.00	$64.68	$0.00	$0.00	$0.00	$0.00	$0.00
71070273	SUP	Custom 27011340		71070273  -  CUBE XTRNFX ILZ 1 HL POST RNCH SYS	BOTH IP/OP	$527.00 	$389.98	$0.00	$421.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$391.14	$391.14	$0.00	$0.00	$109.83	$0.00	$0.00	$0.00	$0.00	$263.50	$417.38	$421.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71070282	SUP	Custom 27011340		71070282  -  CONNECTOR EXFIX 30MM SHRT XTD	BOTH IP/OP	$406.30 	$300.66	$0.00	$325.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.56	$301.56	$0.00	$0.00	$84.67	$0.00	$0.00	$0.00	$0.00	$203.15	$321.79	$325.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71070283	SUP	Custom 27011340		71070283  -  CONNECTOR ROD 50MM LNG XTD	BOTH IP/OP	$406.30 	$300.66	$0.00	$325.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.56	$301.56	$0.00	$0.00	$84.67	$0.00	$0.00	$0.00	$0.00	$203.15	$321.79	$325.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71070284	SUP	HCPCS C1713		71070284  -  BOLT XTRNFX ILZ CMBN WRE	BOTH IP/OP	$191.20 	$141.49	$0.00	$152.96	$86.04	$86.04	$0.00	$0.00	$0.00	$39.85	$141.91	$141.91	$0.00	$0.00	$39.85	$0.00	$113.09	$113.09	$0.00	$95.60	$151.43	$152.96	$0.00		$0.00	$29.92	$0.00	$0.00	$30.44	$0.00	$0.00	$0.00	$0.00	$0.00
71070285	SUP	HCPCS C1713		71070285  -  NUT ORTH LNG RSN	BOTH IP/OP	$32.80 	$24.27	$0.00	$26.24	$14.76	$14.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.40	$25.98	$26.24	$0.00		$0.00	$5.13	$0.00	$0.00	$5.22	$0.00	$0.00	$0.00	$0.00	$0.00
71070286	SUP	HCPCS C1713		71070286  -  NUT ORTH 10MM	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$49.05	$49.05	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$0.00	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00		$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
71070290	SUP	HCPCS C1713		71070290  -  CAP PIN 6MM HALF HALF ORANGE	BOTH IP/OP	$80.33 	$59.44	$0.00	$64.26	$36.15	$36.15	$0.00	$0.00	$0.00	$16.74	$59.62	$59.62	$0.00	$0.00	$16.74	$0.00	$47.51	$47.51	$0.00	$40.16	$63.62	$64.26	$0.00		$0.00	$12.57	$0.00	$0.00	$12.79	$0.00	$0.00	$0.00	$0.00	$0.00
71070340	SUP	HCPCS C1713		71070340  -  KIT XTRNFX FST FX ID BAND STD STRUT	BOTH IP/OP	"$1,057.40 "	$782.48	$0.00	$845.92	$475.83	$475.83	$0.00	$0.00	$0.00	$220.39	$784.80	$784.80	$0.00	$0.00	$220.36	$0.00	$625.45	$625.45	$0.00	$528.70	$837.46	$845.92	$0.00		$0.00	$165.48	$0.00	$0.00	$168.34	$0.00	$0.00	$0.00	$0.00	$0.00
71070345	SUP	Custom 27203010		71070345  -  DRILL SURG SHORT 3.8MM STEP	BOTH IP/OP	"$1,072.70 "	$793.80	$0.00	$858.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$796.16	$796.16	$0.00	$0.00	$223.55	$0.00	$0.00	$0.00	$0.00	$536.35	$849.58	$858.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71070348	SUP	Custom 27203010		71070348  -  DRILL SURG LONG 3.8MM STEP	BOTH IP/OP	"$1,072.70 "	$793.80	$0.00	$858.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$796.16	$796.16	$0.00	$0.00	$223.55	$0.00	$0.00	$0.00	$0.00	$536.35	$849.58	$858.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71070365	SUP	Custom 27011340		71070365  -  RING EXFIX 180MM 155MM RCKR	BOTH IP/OP	"$2,592.50 "	"$1,918.45"	$0.00	"$2,074.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,924.15"	"$1,924.15"	$0.00	$0.00	$540.28	$0.00	$0.00	$0.00	$0.00	"$1,296.25"	"$2,053.26"	"$2,074.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71070515	SUP	HCPCS C1713		71070515  -  BOLT CNCT 12MM TLT SP	BOTH IP/OP	$25.00 	$18.50	$0.00	$20.00	$11.25	$11.25	$0.00	$0.00	$0.00	$5.21	$18.56	$18.56	$0.00	$0.00	$5.21	$0.00	$14.79	$14.79	$0.00	$12.50	$19.80	$20.00	$0.00		$0.00	$3.91	$0.00	$0.00	$3.98	$0.00	$0.00	$0.00	$0.00	$0.00
71070720	SUP	HCPCS C1713		71070720  -  STRUT EXFIX MEDIUM CIR 143-205MM FAST-FIX TAYLOR SPATIAL	BOTH IP/OP	"$3,332.00 "	"$2,465.68"	$0.00	"$2,665.60"	"$1,499.40"	"$1,499.40"	$0.00	$0.00	$0.00	$694.47	"$2,473.01"	"$2,473.01"	$0.00	$0.00	$694.39	$0.00	"$1,642.68"	"$1,642.68"	$0.00	"$1,666.00"	"$2,638.94"	"$2,665.60"	$0.00		$0.00	$521.46	$0.00	$0.00	$530.45	$0.00	$0.00	$0.00	$0.00	$0.00
71070730	SUP	HCPCS C1713		71070730  -  STRUT XTRNFX LNG 195-311MM FST FX TLT SP	BOTH IP/OP	"$3,332.00 "	"$2,465.68"	$0.00	"$2,665.60"	"$1,499.40"	"$1,499.40"	$0.00	$0.00	$0.00	$694.47	"$2,473.01"	"$2,473.01"	$0.00	$0.00	$694.39	$0.00	"$1,642.68"	"$1,642.68"	$0.00	"$1,666.00"	"$2,638.94"	"$2,665.60"	$0.00		$0.00	$521.46	$0.00	$0.00	$530.45	$0.00	$0.00	$0.00	$0.00	$0.00
71070800	SUP	HCPCS C1713		71070800  -  PIN HLF 6MM 150MM 20MM HA XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070801	SUP	HCPCS C1713		71070801  -  PIN HLF 6MM 200MM 20MM HA XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070802	SUP	HCPCS C1713		71070802  -  PIN HALF 6MM 150MM 25MM HA EXFIX SYSTEM	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070803	SUP	HCPCS C1713		71070803  -  PIN HALF 6MM 200MM 25MM HA ORTHOPEDIC EXFIX SYSTEM	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070804	SUP	HCPCS C1713		71070804  -  PIN HALF 6MM 150MM 30MM HA EXFIX SYSTEM	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070805	SUP	HCPCS C1713		71070805  -  PIN HLF 6MM 200MM 30MM HA ORTH XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070806	SUP	HCPCS C1713		71070806  -  PIN HALF 6MM 150MM 35MM HA EXFIX SYSTEM	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070808	SUP	HCPCS C1713		71070808  -  PIN HALF 6MM 150MM 40MM HA EXFIX SYSTEM	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070809	SUP	HCPCS C1713		71070809  -  PIN HALF 200MM 6MM HA 40MM EXFIX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070812	SUP	HCPCS C1713		71070812  -  PIN HLF 6MM 150MM 55MM HA XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070814	SUP	HCPCS C1713		71070814  -  PIN HLF 6MM 150MM 60MM HA XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070815	SUP	HCPCS C1713		71070815  -  PIN HLF 6MM 200MM 60MM HAP XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070816	SUP	HCPCS C1713		71070816  -  PIN HLF 6MM 150MM 65MM HA XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070817	SUP	HCPCS C1713		71070817  -  PIN HLF 6MM 200MM 65MM HAP XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070818	SUP	HCPCS C1713		71070818  -  PIN HLF 6MM 150MM 70MM HA XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070819	SUP	HCPCS C1713		71070819  -  PIN HLF 6MM 200MM 70MM HAP ORTH XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070820	SUP	HCPCS C1713		71070820  -  PIN HLF 6MM 200MM 80MM HA XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070821	SUP	HCPCS C1713		71070821  -  PIN HLF 6MM 200MM 90MM HAP ORTH XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070822	SUP	HCPCS C1713		71070822  -  PIN HLF 6MM 150MM 20MM HAP ORTH XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070823	SUP	HCPCS C1713		71070823  -  PIN HLF 4.5MM 150MM 10MM HA XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070824	SUP	HCPCS C1713		71070824  -  PIN HLF 4.5MM 150MM 20MM HA XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070825	SUP	HCPCS C1713		71070825  -  PIN HALF 4.5MM 150MM 30MM THREAD HA ORTHOPEDIC EXFIX SYSTEM	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070826	SUP	HCPCS C1713		71070826  -  PIN HALF 4.5MM 150MM 40MM THREAD HA ORTHOPEDIC EXFIX SYSTEM	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070827	SUP	HCPCS C1713		71070827  -  PIN HLF 4.5MM 150MM 50MM THRD HA ORTH XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070828	SUP	HCPCS C1713		71070828  -  PIN HLF 6MM 150MM 15MM HA ORTH XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070829	SUP	HCPCS C1713		71070829  -  PIN HLF 6MM 200MM 15MM HAP ORTH XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070835	SUP	HCPCS C1713		71070835  -  PIN HLF 6MM 150MM 45MM HA XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070836	SUP	HCPCS C1713		71070836  -  PIN HLF 6MM 200MM 45MM HAP XTRNFX SYS	BOTH IP/OP	$586.50 	$434.01	$0.00	$469.20	$263.93	$263.93	$0.00	$0.00	$0.00	$122.24	$435.30	$435.30	$0.00	$0.00	$122.23	$0.00	$346.91	$346.91	$0.00	$293.25	$464.51	$469.20	$0.00		$0.00	$91.79	$0.00	$0.00	$93.37	$0.00	$0.00	$0.00	$0.00	$0.00
71070844	SUP	Custom 27203010		71070844  -  BIT DRL LNG 4.8MM HA PIN	BOTH IP/OP	"$1,237.60 "	$915.82	$0.00	$990.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.55	$918.55	$0.00	$0.00	$257.92	$0.00	$0.00	$0.00	$0.00	$618.80	$980.18	$990.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71070845	SUP	Custom 27203010		71070845  -  BIT DRL 1.8MM 4.8MM CNN HA PIN	BOTH IP/OP	"$1,603.10 "	"$1,186.29"	$0.00	"$1,282.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,189.82"	"$1,189.82"	$0.00	$0.00	$334.09	$0.00	$0.00	$0.00	$0.00	$801.55	"$1,269.66"	"$1,282.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71070846	SUP	Custom 27203010		71070846  -  BIT DRL 1.5MM 3.8MM CNN HA PIN	BOTH IP/OP	"$1,603.10 "	"$1,186.29"	$0.00	"$1,282.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,189.82"	"$1,189.82"	$0.00	$0.00	$334.09	$0.00	$0.00	$0.00	$0.00	$801.55	"$1,269.66"	"$1,282.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71100045	SUP	HCPCS C1713		71100045  -  SCREW BN 6.5MM 45MM STRL 32MM CNN ORTH	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100050	SUP	HCPCS C1713		71100050  -  SCREW BN 6.5MM 8MM 3.5MM 50MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100055	SUP	HCPCS C1713		71100055  -  SCREW BN 6.5MM 8MM 3.5MM 55MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100060	SUP	HCPCS C1713		71100060  -  SCREW BN 6.5MM 8MM 3.5MM 60MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100065	SUP	HCPCS C1713		71100065  -  SCREW BN 6.5MM 8MM 3.5MM 65MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100070	SUP	HCPCS C1713		71100070  -  SCREW BN 6.5MM 8MM 3.5MM 70MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100075	SUP	HCPCS C1713		71100075  -  SCREW BN 6.5MM 8MM 3.5MM 75MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100080	SUP	HCPCS C1713		71100080  -  SCREW BN 6.5MM 8MM 3.5MM 80MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100085	SUP	HCPCS C1713		71100085  -  SCREW BN 6.5MM 8MM 3.5MM 85MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100090	SUP	HCPCS C1713		71100090  -  SCREW BN 6.5MM 8MM 3.5MM 90MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100095	SUP	HCPCS C1713		71100095  -  SCREW BN 6.5MM 8MM 3.5MM 95MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100100	SUP	HCPCS C1713		71100100  -  SCREW BN 6.5MM 8MM 3.5MM 100MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100105	SUP	HCPCS C1713		71100105  -  SCREW BN 6.5MM 105MM STRL 32MM CNN ORTH	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100110	SUP	HCPCS C1713		71100110  -  SCREW BN 6.5MM 8MM 3.5MM 110MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100115	SUP	HCPCS C1713		71100115  -  SCREW BN 6.5MM 115MM STRL 32MM CNN ORTH	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100120	SUP	HCPCS C1713		71100120  -  SCREW BN 6.5MM 8MM 3.5MM 120MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100125	SUP	HCPCS C1713		71100125  -  SCREW BN 6.5MM 125MM STRL 32MM CNN ORTH	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71100130	SUP	HCPCS C1713		71100130  -  SCREW BN 6.5MM 8MM 3.5MM 130MM STRL 32MM CNN SS HIP ACPT 2.4	BOTH IP/OP	$531.30 	$393.16	$0.00	$425.04	$239.09	$239.09	$0.00	$0.00	$0.00	$110.74	$394.33	$394.33	$0.00	$0.00	$110.72	$0.00	$314.26	$314.26	$0.00	$265.65	$420.79	$425.04	$0.00		$0.00	$83.15	$0.00	$0.00	$84.58	$0.00	$0.00	$0.00	$0.00	$0.00
71101000	SUP	HCPCS C1713		71101000  -  WASHER ORTH 8MM 4MM STRL TI	BOTH IP/OP	$187.70 	$138.90	$0.00	$150.16	$84.47	$84.47	$0.00	$0.00	$0.00	$39.12	$139.31	$139.31	$0.00	$0.00	$39.12	$0.00	$111.02	$111.02	$0.00	$93.85	$148.66	$150.16	$0.00		$0.00	$29.38	$0.00	$0.00	$29.88	$0.00	$0.00	$0.00	$0.00	$0.00
71101020	SUP	HCPCS C1713		71101020  -  SCREW BN 4MM 20MM STRL 8MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101022	SUP	HCPCS C1713		71101022  -  SCREW BN 4MM 22MM STRL 10MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101024	SUP	HCPCS C1713		71101024  -  SCREW BN 4MM 24MM STRL 12MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101026	SUP	HCPCS C1713		71101026  -  SCREW BN 4MM 26MM STRL 14MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101028	SUP	HCPCS C1713		71101028  -  SCREW BN 4MM 28MM STRL 14MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101030	SUP	HCPCS C1713		71101030  -  SCREW BN 4MM 30MM STRL 14MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101032	SUP	HCPCS C1713		71101032  -  SCREW BN 4MM 32MM STRL 14MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101034	SUP	HCPCS C1713		71101034  -  SCREW BN 4MM 34MM STRL 14MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101036	SUP	HCPCS C1713		71101036  -  SCREW BN 4MM 36MM STRL 14MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101038	SUP	HCPCS C1713		71101038  -  SCREW BN 4MM 38MM STRL 14MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101040	SUP	HCPCS C1713		71101040  -  SCREW BN 4MM 40MM STRL 14MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101042	SUP	HCPCS C1713		71101042  -  SCREW BN 4MM 42MM STRL 14MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101044	SUP	HCPCS C1713		71101044  -  SCREW BN 4MM 44MM STRL 15MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101046	SUP	HCPCS C1713		71101046  -  SCREW BN 4MM 46MM STRL 15MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101048	SUP	HCPCS C1713		71101048  -  SCREW BN 4MM 48MM STRL 15MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101050	SUP	HCPCS C1713		71101050  -  SCREW BN 4MM 50MM STRL 15MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101052	SUP	HCPCS C1713		71101052  -  SCREW BN 4MM 52MM STRL 15MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101054	SUP	HCPCS C1713		71101054  -  SCREW BN 4MM 54MM STRL 15MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101056	SUP	HCPCS C1713		71101056  -  SCREW BN 4MM 56MM STRL 15MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101058	SUP	HCPCS C1713		71101058  -  SCREW BN 4MM 58MM STRL 15MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101060	SUP	HCPCS C1713		71101060  -  SCREW BN 4MM 60MM STRL 15MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101065	SUP	HCPCS C1713		71101065  -  SCREW BN 4MM 65MM STRL 15MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101070	SUP	HCPCS C1713		71101070  -  SCREW BN 4MM 70MM STRL 15MM CNN TI ORTH	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71101401	SUP	HCPCS C1713		71101401  -  CAP PCTV 1.1 MM WRE	BOTH IP/OP	$30.70 	$22.72	$0.00	$24.56	$13.82	$13.82	$0.00	$0.00	$0.00	$6.40	$22.79	$22.79	$0.00	$0.00	$6.40	$0.00	$18.16	$18.16	$0.00	$15.35	$24.31	$24.56	$0.00		$0.00	$4.80	$0.00	$0.00	$4.89	$0.00	$0.00	$0.00	$0.00	$0.00
71101402	SUP	HCPCS C1713		71101402  -  CAP PCTV 1.25 MM WRE	BOTH IP/OP	$30.70 	$22.72	$0.00	$24.56	$13.82	$13.82	$0.00	$0.00	$0.00	$6.40	$22.79	$22.79	$0.00	$0.00	$6.40	$0.00	$18.16	$18.16	$0.00	$15.35	$24.31	$24.56	$0.00		$0.00	$4.80	$0.00	$0.00	$4.89	$0.00	$0.00	$0.00	$0.00	$0.00
71101403	SUP	HCPCS C1713		71101403  -  CAP PCTV 1.6 MM WRE	BOTH IP/OP	$30.70 	$22.72	$0.00	$24.56	$13.82	$13.82	$0.00	$0.00	$0.00	$6.40	$22.79	$22.79	$0.00	$0.00	$6.40	$0.00	$18.16	$18.16	$0.00	$15.35	$24.31	$24.56	$0.00		$0.00	$4.80	$0.00	$0.00	$4.89	$0.00	$0.00	$0.00	$0.00	$0.00
71101404	SUP	HCPCS C1713		71101404  -  CAP PCTV 2 MM WRE	BOTH IP/OP	$30.70 	$22.72	$0.00	$24.56	$13.82	$13.82	$0.00	$0.00	$0.00	$6.40	$22.79	$22.79	$0.00	$0.00	$6.40	$0.00	$18.16	$18.16	$0.00	$15.35	$24.31	$24.56	$0.00		$0.00	$4.80	$0.00	$0.00	$4.89	$0.00	$0.00	$0.00	$0.00	$0.00
71101501	SUP	Custom 27203010		71101501  -  WIRE FX 2MM 150MM DRL TIP	BOTH IP/OP	$145.50 	$107.67	$0.00	$116.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.99	$107.99	$0.00	$0.00	$30.32	$0.00	$0.00	$0.00	$0.00	$72.75	$115.24	$116.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71101502	SUP	Custom 27203010		71101502  -  WIRE FX FLUT 1.6MM 150MM VLP DRL TIP COCR	BOTH IP/OP	$105.63 	$78.17	$0.00	$84.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$78.39	$78.39	$0.00	$0.00	$22.01	$0.00	$0.00	$0.00	$0.00	$52.81	$83.66	$84.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71101691	SUP	HCPCS C1713		71101691  -  WASHER ORTH 21.7MM 12.7MM OBLNG SS	BOTH IP/OP	$109.20 	$80.81	$0.00	$87.36	$49.14	$49.14	$0.00	$0.00	$0.00	$22.76	$81.05	$81.05	$0.00	$0.00	$22.76	$0.00	$64.59	$64.59	$0.00	$54.60	$86.49	$87.36	$0.00		$0.00	$17.09	$0.00	$0.00	$17.38	$0.00	$0.00	$0.00	$0.00	$0.00
71101693	SUP	HCPCS C1713		71101693  -  WASHER ORTH 21.7MM BTRFLY SS	BOTH IP/OP	$103.33 	$76.46	$0.00	$82.66	$46.50	$46.50	$0.00	$0.00	$0.00	$21.54	$76.69	$76.69	$0.00	$0.00	$21.53	$0.00	$61.12	$61.12	$0.00	$51.66	$81.84	$82.66	$0.00		$0.00	$16.17	$0.00	$0.00	$16.45	$0.00	$0.00	$0.00	$0.00	$0.00
71102000	SUP	HCPCS C1713		71102000  -  WASHER ORTH 12.7MM 6.5MM 1MM TI	BOTH IP/OP	$242.40 	$179.38	$0.00	$193.92	$109.08	$109.08	$0.00	$0.00	$0.00	$50.52	$179.91	$179.91	$0.00	$0.00	$50.52	$0.00	$143.38	$143.38	$0.00	$121.20	$191.98	$193.92	$0.00		$0.00	$37.94	$0.00	$0.00	$38.59	$0.00	$0.00	$0.00	$0.00	$0.00
71102030	SUP	HCPCS C1713		71102030  -  PIN FX 30MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102035	SUP	HCPCS C1713		71102035  -  PIN FX 35MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102040	SUP	HCPCS C1713		71102040  -  PIN FX 40MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102045	SUP	HCPCS C1713		71102045  -  PIN FX 45MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102050	SUP	HCPCS C1713		71102050  -  PIN FX 50MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102055	SUP	HCPCS C1713		71102055  -  PIN FX 55MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102060	SUP	HCPCS C1713		71102060  -  PIN FX 60MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102065	SUP	HCPCS C1713		71102065  -  PIN FX 65MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102070	SUP	HCPCS C1713		71102070  -  PIN FX 70MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102075	SUP	HCPCS C1713		71102075  -  PIN FX 75MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102080	SUP	HCPCS C1713		71102080  -  PIN FX 80MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102085	SUP	HCPCS C1713		71102085  -  PIN FX 85MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102090	SUP	HCPCS C1713		71102090  -  PIN FX 90MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102095	SUP	HCPCS C1713		71102095  -  PIN FX 95MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102100	SUP	HCPCS C1713		71102100  -  PIN FX 100MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102105	SUP	HCPCS C1713		71102105  -  PIN FX 105MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102110	SUP	HCPCS C1713		71102110  -  PIN FX 110MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102115	SUP	HCPCS C1713		71102115  -  PIN FX 115MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102120	SUP	HCPCS C1713		71102120  -  PIN FX 120MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102125	SUP	HCPCS C1713		71102125  -  PIN FX 125MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102130	SUP	HCPCS C1713		71102130  -  PIN FX 130MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71102135	SUP	HCPCS C1713		71102135  -  PIN FX 135MM 16MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71103045	SUP	HCPCS C1713		71103045  -  PIN FX 45MM 32MM CNN TI HIP	BOTH IP/OP	$741.30 	$548.56	$0.00	$593.04	$333.59	$333.59	$0.00	$0.00	$0.00	$154.51	$550.19	$550.19	$0.00	$0.00	$154.49	$0.00	$438.48	$438.48	$0.00	$370.65	$587.11	$593.04	$0.00		$0.00	$116.01	$0.00	$0.00	$118.01	$0.00	$0.00	$0.00	$0.00	$0.00
71107030	SUP	HCPCS C1713		71107030  -  SCREW BN 7MM 30MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107035	SUP	HCPCS C1713		71107035  -  SCREW BN 7MM 35MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107040	SUP	HCPCS C1713		71107040  -  SCREW BN 7MM 40MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107045	SUP	HCPCS C1713		71107045  -  SCREW BN 7MM 45MM 16MM CNN P/T TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107050	SUP	HCPCS C1713		71107050  -  SCREW BN 7MM 50MM 16MM CNN P/T TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107055	SUP	HCPCS C1713		71107055  -  SCREW BN 7MM 55MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107060	SUP	HCPCS C1713		71107060  -  SCREW BN 7MM 60MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107065	SUP	HCPCS C1713		71107065  -  SCREW BN P/T 7MM 65MM STRL 16MM CNN TI	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107070	SUP	HCPCS C1713		71107070  -  SCREW BN P/T 7MM 70MM STRL 16MM CNN TI	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107075	SUP	HCPCS C1713		71107075  -  SCREW BN P/T 7MM 75MM STRL 16MM CNN TI	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107080	SUP	HCPCS C1713		71107080  -  SCREW BN P/T 7MM 80MM STRL 16MM CNN TI	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107085	SUP	HCPCS C1713		71107085  -  SCREW BN P/T 7MM 85MM STRL 16MM CNN TI SM BN LNG BN	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107090	SUP	HCPCS C1713		71107090  -  SCREW BN P/T 7MM 90MM STRL 16MM CNN TI	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107095	SUP	HCPCS C1713		71107095  -  SCREW BN P/T 7MM 95MM STRL 16MM CNN TI	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107100	SUP	HCPCS C1713		71107100  -  SCREW BN P/T 7MM 100MM STRL 16MM CNN TI	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107105	SUP	HCPCS C1713		71107105  -  SCREW BN P/T 7MM 105MM STRL 16MM CNN TI SM BN LNG BN	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107110	SUP	HCPCS C1713		71107110  -  SCREW BN 7MM 110MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107115	SUP	HCPCS C1713		71107115  -  SCREW BN 7MM 115MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107120	SUP	HCPCS C1713		71107120  -  SCREW BN 7MM 120MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107125	SUP	HCPCS C1713		71107125  -  SCREW BN 7MM 125MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107130	SUP	HCPCS C1713		71107130  -  SCREW BN 7MM 130MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107135	SUP	HCPCS C1713		71107135  -  SCREW BN 7MM 135MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107140	SUP	HCPCS C1713		71107140  -  SCREW BN 7MM 140MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107145	SUP	HCPCS C1713		71107145  -  SCREW BN 7MM 145MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71107150	SUP	HCPCS C1713		71107150  -  SCREW BN 7MM 150MM STRL 16MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108045	SUP	HCPCS C1713		71108045  -  SCREW BN 7MM 45MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108050	SUP	HCPCS C1713		71108050  -  SCREW BN 7MM 50MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108055	SUP	HCPCS C1713		71108055  -  SCREW BN 7MM 55MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108060	SUP	HCPCS C1713		71108060  -  SCREW BN 7MM 60MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108065	SUP	HCPCS C1713		71108065  -  SCREW BN 7MM 65MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108070	SUP	HCPCS C1713		71108070  -  SCREW BN 7MM 70MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108075	SUP	HCPCS C1713		71108075  -  SCREW BN P/T 7MM 75MM STRL 32MM CNN TI	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108080	SUP	HCPCS C1713		71108080  -  SCREW BN P/T 7MM 80MM STRL 32MM CNN TI	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108085	SUP	HCPCS C1713		71108085  -  SCREW BN 7MM 85MM 32MM CNN P/T TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108090	SUP	HCPCS C1713		71108090  -  SCREW BN P/T 7MM 90MM STRL 32MM CNN TI	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108095	SUP	HCPCS C1713		71108095  -  SCREW BN P/T 7MM 95MM STRL 32MM CNN TI	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108100	SUP	HCPCS C1713		71108100  -  SCREW BN P/T 7MM 100MM STRL 32MM CNN TI	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108105	SUP	HCPCS C1713		71108105  -  SCREW BN 7MM 105MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108110	SUP	HCPCS C1713		71108110  -  SCREW BN 7MM 110MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108115	SUP	HCPCS C1713		71108115  -  SCREW BN 7MM 115MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108120	SUP	HCPCS C1713		71108120  -  SCREW BN 7MM 120MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108125	SUP	HCPCS C1713		71108125  -  SCREW BN 7MM 125MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108130	SUP	HCPCS C1713		71108130  -  SCREW BN 7MM 130MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108135	SUP	HCPCS C1713		71108135  -  SCREW BN 7MM 135MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108140	SUP	HCPCS C1713		71108140  -  SCREW BN 7MM 140MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108145	SUP	HCPCS C1713		71108145  -  SCREW BN 7MM 145MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108150	SUP	HCPCS C1713		71108150  -  SCREW BN 7MM 150MM STRL 32MM CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71108670	SUP	HCPCS C1713		71108670  -  SCREW BN P/T 8MM 170MM 24MM CNN SS CANC	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$364.50	$364.50	$0.00	$0.00	$0.00	$168.82	$601.18	$601.18	$0.00	$0.00	$168.80	$0.00	$479.12	$479.12	$0.00	$405.00	$641.52	$648.00	$0.00		$0.00	$126.77	$0.00	$0.00	$128.95	$0.00	$0.00	$0.00	$0.00	$0.00
71109030	SUP	HCPCS C1713		71109030  -  SCREW BN FT 7MM 30MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109035	SUP	HCPCS C1713		71109035  -  SCREW BN FT 7MM 35MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109040	SUP	HCPCS C1713		71109040  -  SCREW BN FT 7MM 40MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109045	SUP	HCPCS C1713		71109045  -  SCREW BN FT 7MM 45MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109050	SUP	HCPCS C1713		71109050  -  SCREW BN FT 7MM 50MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109055	SUP	HCPCS C1713		71109055  -  SCREW BN FT 7MM 55MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109060	SUP	HCPCS C1713		71109060  -  SCREW BN FT 7MM 60MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109065	SUP	HCPCS C1713		71109065  -  SCREW BN FT 7MM 65MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109070	SUP	HCPCS C1713		71109070  -  SCREW BN FT 7MM 70MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109075	SUP	HCPCS C1713		71109075  -  SCREW BN FT 7MM 75MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109080	SUP	HCPCS C1713		71109080  -  SCREW BN FT 7MM 80MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109085	SUP	HCPCS C1713		71109085  -  SCREW BN FT 7MM 85MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109090	SUP	HCPCS C1713		71109090  -  SCREW BN FT 7MM 90MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109095	SUP	HCPCS C1713		71109095  -  SCREW BN FT 7MM 95MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109100	SUP	HCPCS C1713		71109100  -  SCREW BN FT 7MM 100MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109105	SUP	HCPCS C1713		71109105  -  SCREW BN FT 7MM 105MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109110	SUP	HCPCS C1713		71109110  -  SCREW BN FT 7MM 110MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109115	SUP	HCPCS C1713		71109115  -  SCREW BN 7MM 115MM STRL CNN FT TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109120	SUP	HCPCS C1713		71109120  -  SCREW BN 7MM 120MM STRL CNN FT TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109125	SUP	HCPCS C1713		71109125  -  SCREW BN FT 7MM 125MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109130	SUP	HCPCS C1713		71109130  -  SCREW BN FT 7MM 130MM STRL CNN TI ORTH	BOTH IP/OP	$519.75 	$384.62	$0.00	$415.80	$233.89	$233.89	$0.00	$0.00	$0.00	$108.33	$385.76	$385.76	$0.00	$0.00	$108.32	$0.00	$307.43	$307.43	$0.00	$259.88	$411.64	$415.80	$0.00		$0.00	$81.34	$0.00	$0.00	$82.74	$0.00	$0.00	$0.00	$0.00	$0.00
71110027	SUP	Custom 27203010		71110027  -  BIT DRL 4.5MM TWST	BOTH IP/OP	$143.85 	$106.45	$0.00	$115.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.77	$106.77	$0.00	$0.00	$29.98	$0.00	$0.00	$0.00	$0.00	$71.93	$113.93	$115.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71110045	SUP	Custom 27203010		71110045  -  BIT DRL 3.5MM TWST	BOTH IP/OP	$114.45 	$84.69	$0.00	$91.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.94	$84.94	$0.00	$0.00	$23.85	$0.00	$0.00	$0.00	$0.00	$57.23	$90.64	$91.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71116060	SUP	HCPCS C1713		71116060  -  PIN FX 3IN ORTH	BOTH IP/OP	"$1,459.50 "	"$1,080.03"	$0.00	"$1,167.60"	$656.78	$656.78	$0.00	$0.00	$0.00	$304.20	"$1,083.24"	"$1,083.24"	$0.00	$0.00	$304.16	$0.00	$863.29	$863.29	$0.00	$729.75	"$1,155.92"	"$1,167.60"	$0.00		$0.00	$228.41	$0.00	$0.00	$232.35	$0.00	$0.00	$0.00	$0.00	$0.00
71119005	SUP	HCPCS C1713		71119005  -  WASHER XTRNFX 12.7MM SLV 7MM CNN SCR	BOTH IP/OP	$308.70 	$228.44	$0.00	$246.96	$138.92	$138.92	$0.00	$0.00	$0.00	$64.34	$229.12	$229.12	$0.00	$0.00	$64.33	$0.00	$182.60	$182.60	$0.00	$154.35	$244.49	$246.96	$0.00		$0.00	$48.31	$0.00	$0.00	$49.15	$0.00	$0.00	$0.00	$0.00	$0.00
71119007	SUP	Custom 27203010		71119007  -  BIT DRL 4MM STRL CNN	BOTH IP/OP	$807.45 	$597.51	$0.00	$645.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.29	$599.29	$0.00	$0.00	$168.27	$0.00	$0.00	$0.00	$0.00	$403.73	$639.50	$645.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71119106	SUP	Custom 27203010		71119106  -  BIT DRL 5.2MM STRL CNN 7MM SCR	BOTH IP/OP	$940.80 	$696.19	$0.00	$752.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$698.26	$698.26	$0.00	$0.00	$196.06	$0.00	$0.00	$0.00	$0.00	$470.40	$745.11	$752.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71120006	SUP	HCPCS C1713		71120006  -  WASHER ORTH THK1MM 8MM 4MM STRL CNN SS 4MM CNN SCR	BOTH IP/OP	$121.90 	$90.21	$0.00	$97.52	$54.86	$54.86	$0.00	$0.00	$0.00	$25.41	$90.47	$90.47	$0.00	$0.00	$25.40	$0.00	$72.10	$72.10	$0.00	$60.95	$96.54	$97.52	$0.00		$0.00	$19.08	$0.00	$0.00	$19.41	$0.00	$0.00	$0.00	$0.00	$0.00
71123122	SUP	HCPCS C1713		71123122  -  PLATE BN 90D 55MM CHS 3 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123124	SUP	HCPCS C1713		71123124  -  PLATE BN 100D 55MM CHS 3 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123126	SUP	HCPCS C1713		71123126  -  PLATE BN 110D 55MM CHS 3 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123128	SUP	HCPCS C1713		71123128  -  PLATE BN 120D 55MM CHS 3 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123130	SUP	HCPCS C1713		71123130  -  PLATE BN 130D 55MM CHS 3 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123132	SUP	HCPCS C1713		71123132  -  PLATE BN 135D 55MM CHS 3 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123134	SUP	HCPCS C1713		71123134  -  PLATE BN 140D 55MM CHS 3 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123136	SUP	HCPCS C1713		71123136  -  PLATE BN 145D 55MM CHS 3 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123138	SUP	HCPCS C1713		71123138  -  PLATE BN 150D 55MM CHS 3 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123140	SUP	HCPCS C1713		71123140  -  PLATE BN 90D 76MM CHS 4 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123142	SUP	HCPCS C1713		71123142  -  PLATE BN 100D 76MM CHS 4 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123144	SUP	HCPCS C1713		71123144  -  PLATE BN 110D 76MM CHS 4 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123146	SUP	HCPCS C1713		71123146  -  PLATE BN 120D 76MM CHS 4 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123148	SUP	HCPCS C1713		71123148  -  PLATE BN 130D 76MM CHS 4 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123150	SUP	HCPCS C1713		71123150  -  PLATE BN 135D 76MM CHS 4 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123152	SUP	HCPCS C1713		71123152  -  PLATE BN 140D 76MM CHS 4 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123154	SUP	HCPCS C1713		71123154  -  PLATE BN 145D 76MM CHS 4 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123156	SUP	HCPCS C1713		71123156  -  PLATE BN 150D 76MM CHS 4 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123158	SUP	HCPCS C1713		71123158  -  PLATE BN 90D 102MM CHS 6 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123160	SUP	HCPCS C1713		71123160  -  PLATE BN 100D 102MM CHS 6 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123162	SUP	HCPCS C1713		71123162  -  PLATE BN 110D 102MM CHS 6 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123164	SUP	HCPCS C1713		71123164  -  PLATE BN 120D 102MM CHS 6 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123166	SUP	HCPCS C1713		71123166  -  PLATE BN 130D 102MM CHS 6 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123168	SUP	HCPCS C1713		71123168  -  PLATE BN 135D 102MM CHS 6 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123170	SUP	HCPCS C1713		71123170  -  PLATE BN 140D 102MM CHS 6 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123172	SUP	HCPCS C1713		71123172  -  PLATE BN 145D 102MM CHS 6 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123174	SUP	HCPCS C1713		71123174  -  PLATE BN 150D 102MM CHS 6 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123176	SUP	HCPCS C1713		71123176  -  PLATE BN 130D 127MM CHS 8 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123178	SUP	HCPCS C1713		71123178  -  PLATE BN 135D 127MM CHS 8 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123180	SUP	HCPCS C1713		71123180  -  PLATE BN 140D 127MM CHS 8 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123182	SUP	HCPCS C1713		71123182  -  PLATE BN 145D 127MM CHS 8 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123184	SUP	HCPCS C1713		71123184  -  PLATE BN 150D 127MM CHS 8 HL INTMD SS PED HIP	BOTH IP/OP	"$1,832.25 "	"$1,355.87"	$0.00	"$1,465.80"	$824.51	$824.51	$0.00	$0.00	$0.00	$381.89	"$1,359.90"	"$1,359.90"	$0.00	$0.00	$381.84	$0.00	"$1,083.78"	"$1,083.78"	$0.00	$916.13	"$1,451.14"	"$1,465.80"	$0.00		$0.00	$286.75	$0.00	$0.00	$291.69	$0.00	$0.00	$0.00	$0.00	$0.00
71123186	SUP	HCPCS C1713		71123186  -  SCREW BN 35MM CHS INTMD LG SS PED HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123187	SUP	HCPCS C1713		71123187  -  SCREW BN 40MM CHS INTMD LG SS PED HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123188	SUP	HCPCS C1713		71123188  -  SCREW BN 45MM CHS INTMD LG SS PED HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123189	SUP	HCPCS C1713		71123189  -  SCREW BN 50MM CHS INTMD LG SS PED HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123190	SUP	HCPCS C1713		71123190  -  SCREW BN 55MM CHS INTMD LG SS HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123191	SUP	HCPCS C1713		71123191  -  SCREW BN 60MM CHS INTMD LG SS HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123192	SUP	HCPCS C1713		71123192  -  SCREW BN 65MM CHS INTMD LG SS HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123193	SUP	HCPCS C1713		71123193  -  SCREW BN 70MM CHS INTMD LG SS PED HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123194	SUP	HCPCS C1713		71123194  -  SCREW BN 75MM CHS INTMD LG SS HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123195	SUP	HCPCS C1713		71123195  -  SCREW BN 80MM CHS INTMD LG SS HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123196	SUP	HCPCS C1713		71123196  -  SCREW BN 85MM CHS INTMD LG SS HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123197	SUP	HCPCS C1713		71123197  -  SCREW BN 90MM CHS INTMD LG SS HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123198	SUP	HCPCS C1713		71123198  -  SCREW BN 95MM CHS INTMD LG SS HIP	BOTH IP/OP	"$1,307.25 "	$967.37	$0.00	"$1,045.80"	$588.26	$588.26	$0.00	$0.00	$0.00	$272.46	$970.24	$970.24	$0.00	$0.00	$272.43	$0.00	$773.24	$773.24	$0.00	$653.63	"$1,035.34"	"$1,045.80"	$0.00		$0.00	$204.58	$0.00	$0.00	$208.11	$0.00	$0.00	$0.00	$0.00	$0.00
71123199	SUP	HCPCS C1713		71123199  -  SCREW BN 2.5MM CHS INTMD CMPR HEX HD SS PED HIP	BOTH IP/OP	$216.30 	$160.06	$0.00	$173.04	$97.34	$97.34	$0.00	$0.00	$0.00	$45.08	$160.54	$160.54	$0.00	$0.00	$45.08	$0.00	$127.94	$127.94	$0.00	$108.15	$171.31	$173.04	$0.00		$0.00	$33.85	$0.00	$0.00	$34.43	$0.00	$0.00	$0.00	$0.00	$0.00
71123228	SUP	HCPCS C1713		71123228  -  SCREW BN FT 2.7MM 28MM ST PED HIP	BOTH IP/OP	$40.70 	$30.12	$0.00	$32.56	$18.32	$18.32	$0.00	$0.00	$0.00	$8.48	$30.21	$30.21	$0.00	$0.00	$8.48	$0.00	$24.07	$24.07	$0.00	$20.35	$32.23	$32.56	$0.00		$0.00	$6.37	$0.00	$0.00	$6.48	$0.00	$0.00	$0.00	$0.00	$0.00
71123232	SUP	HCPCS C1713		71123232  -  SCREW BN 2.7MM 32MM ST HEX HD	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$18.81	$18.81	$0.00	$0.00	$0.00	$8.71	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$24.72	$24.72	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
71123234	SUP	HCPCS C1713		71123234  -  SCREW BN 2.7MM 34MM ST HEX HD	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$18.81	$18.81	$0.00	$0.00	$0.00	$8.71	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$24.72	$24.72	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
71123236	SUP	HCPCS C1713		71123236  -  SCREW BN 2.7MM 36MM ST HEX HD	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$18.81	$18.81	$0.00	$0.00	$0.00	$8.71	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$24.72	$24.72	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
71123238	SUP	HCPCS C1713		71123238  -  SCREW BN 2.7MM 38MM ST HEX HD	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$18.81	$18.81	$0.00	$0.00	$0.00	$8.71	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$24.72	$24.72	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
71123242	SUP	HCPCS C1713		71123242  -  PLATE BN 90D 50MM CHS 4 PROX HL SS PED HIP	BOTH IP/OP	"$2,394.00 "	"$1,771.56"	$0.00	"$1,915.20"	"$1,077.30"	"$1,077.30"	$0.00	$0.00	$0.00	$498.97	"$1,776.83"	"$1,776.83"	$0.00	$0.00	$498.91	$0.00	"$1,416.05"	"$1,416.05"	$0.00	"$1,197.00"	"$1,896.05"	"$1,915.20"	$0.00		$0.00	$374.66	$0.00	$0.00	$381.12	$0.00	$0.00	$0.00	$0.00	$0.00
71123244	SUP	HCPCS C1713		71123244  -  PLATE BN 100D .385IN CHS 4 PROX HL SS PED HIP	BOTH IP/OP	"$2,394.00 "	"$1,771.56"	$0.00	"$1,915.20"	"$1,077.30"	"$1,077.30"	$0.00	$0.00	$0.00	$498.97	"$1,776.83"	"$1,776.83"	$0.00	$0.00	$498.91	$0.00	"$1,416.05"	"$1,416.05"	$0.00	"$1,197.00"	"$1,896.05"	"$1,915.20"	$0.00		$0.00	$374.66	$0.00	$0.00	$381.12	$0.00	$0.00	$0.00	$0.00	$0.00
71123246	SUP	HCPCS C1713		71123246  -  PLATE BN 110D 50MM CHS 4 PROX HL SS PED HIP	BOTH IP/OP	"$2,394.00 "	"$1,771.56"	$0.00	"$1,915.20"	"$1,077.30"	"$1,077.30"	$0.00	$0.00	$0.00	$498.97	"$1,776.83"	"$1,776.83"	$0.00	$0.00	$498.91	$0.00	"$1,416.05"	"$1,416.05"	$0.00	"$1,197.00"	"$1,896.05"	"$1,915.20"	$0.00		$0.00	$374.66	$0.00	$0.00	$381.12	$0.00	$0.00	$0.00	$0.00	$0.00
71123248	SUP	HCPCS C1713		71123248  -  PLATE BN 120D 50MM CHS 4 PROX HL SS PED HIP	BOTH IP/OP	"$2,394.00 "	"$1,771.56"	$0.00	"$1,915.20"	"$1,077.30"	"$1,077.30"	$0.00	$0.00	$0.00	$498.97	"$1,776.83"	"$1,776.83"	$0.00	$0.00	$498.91	$0.00	"$1,416.05"	"$1,416.05"	$0.00	"$1,197.00"	"$1,896.05"	"$1,915.20"	$0.00		$0.00	$374.66	$0.00	$0.00	$381.12	$0.00	$0.00	$0.00	$0.00	$0.00
71123250	SUP	HCPCS C1713		71123250  -  PLATE BN 130D 50MM CHS 4 PROX HL SS PED HIP	BOTH IP/OP	"$2,394.00 "	"$1,771.56"	$0.00	"$1,915.20"	"$1,077.30"	"$1,077.30"	$0.00	$0.00	$0.00	$498.97	"$1,776.83"	"$1,776.83"	$0.00	$0.00	$498.91	$0.00	"$1,416.05"	"$1,416.05"	$0.00	"$1,197.00"	"$1,896.05"	"$1,915.20"	$0.00		$0.00	$374.66	$0.00	$0.00	$381.12	$0.00	$0.00	$0.00	$0.00	$0.00
71123252	SUP	HCPCS C1713		71123252  -  PLATE BN 140D 50MM CHS 4 PROX HL SS PED HIP	BOTH IP/OP	"$2,394.00 "	"$1,771.56"	$0.00	"$1,915.20"	"$1,077.30"	"$1,077.30"	$0.00	$0.00	$0.00	$498.97	"$1,776.83"	"$1,776.83"	$0.00	$0.00	$498.91	$0.00	"$1,416.05"	"$1,416.05"	$0.00	"$1,197.00"	"$1,896.05"	"$1,915.20"	$0.00		$0.00	$374.66	$0.00	$0.00	$381.12	$0.00	$0.00	$0.00	$0.00	$0.00
71123254	SUP	HCPCS C1713		71123254  -  SCREW BN 22MM CHS LG SS PED HIP	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71123256	SUP	HCPCS C1713		71123256  -  SCREW BN 25MM CHS LG SS PED HIP	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71123258	SUP	HCPCS C1713		71123258  -  SCREW BN 28MM CHS LG SS PED HIP	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71123260	SUP	HCPCS C1713		71123260  -  SCREW BN 31MM CHS LG SS PED HIP	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71123262	SUP	HCPCS C1713		71123262  -  SCREW BN 34MM CHS LG SS PED HIP	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71123264	SUP	HCPCS C1713		71123264  -  SCREW BN 37MM CHS LG SS PED HIP	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71123266	SUP	HCPCS C1713		71123266  -  SCREW BN 40MM CHS LG SS PED HIP	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71124002	SUP	HCPCS C1713		71124002  -  NAIL IM 4MM 22CM FRSGHT SET FRARM	BOTH IP/OP	"$6,380.00 "	"$4,721.20"	$0.00	"$5,104.00"	"$2,871.00"	"$2,871.00"	$0.00	$0.00	$0.00	"$1,329.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,329.59"	$0.00	"$3,145.34"	"$3,145.34"	$0.00	"$3,190.00"	"$5,052.96"	"$5,104.00"	$0.00		$0.00	$998.47	$0.00	$0.00	"$1,015.70"	$0.00	$0.00	$0.00	$0.00	$0.00
71124010	SUP	HCPCS C1713		71124010  -  SCREW BN 2.7MM 10MM UNICORTICAL	BOTH IP/OP	$373.40 	$276.32	$0.00	$298.72	$168.03	$168.03	$0.00	$0.00	$0.00	$77.83	$277.14	$277.14	$0.00	$0.00	$77.82	$0.00	$220.87	$220.87	$0.00	$186.70	$295.73	$298.72	$0.00		$0.00	$58.44	$0.00	$0.00	$59.45	$0.00	$0.00	$0.00	$0.00	$0.00
71126130	SUP	HCPCS C1713		71126130  -  PLATE BN 130D CLS 4 HL CMPR LOPRFL HIP	BOTH IP/OP	$715.05 	$529.14	$0.00	$572.04	$321.77	$321.77	$0.00	$0.00	$0.00	$149.03	$530.71	$530.71	$0.00	$0.00	$149.02	$0.00	$422.95	$422.95	$0.00	$357.53	$566.32	$572.04	$0.00		$0.00	$111.91	$0.00	$0.00	$113.84	$0.00	$0.00	$0.00	$0.00	$0.00
71126131	SUP	HCPCS C1713		71126131  -  PLATE BN 135D CLS LP 4 HL	BOTH IP/OP	$532.35 	$393.94	$0.00	$425.88	$239.56	$239.56	$0.00	$0.00	$0.00	$110.96	$395.11	$395.11	$0.00	$0.00	$110.94	$0.00	$314.89	$314.89	$0.00	$266.18	$421.62	$425.88	$0.00		$0.00	$83.31	$0.00	$0.00	$84.75	$0.00	$0.00	$0.00	$0.00	$0.00
71127030	SUP	HCPCS C1713		71127030  -  SCREW BN 7MM 30MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127035	SUP	HCPCS C1713		71127035  -  SCREW BN 7MM 35MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127040	SUP	HCPCS C1713		71127040  -  SCREW BN 7MM 40MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127045	SUP	HCPCS C1713		71127045  -  SCREW BN 7MM 45MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127050	SUP	HCPCS C1713		71127050  -  SCREW BN 7MM 50MM STRL 16MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127055	SUP	HCPCS C1713		71127055  -  SCREW BN 7MM 55MM STRL 16MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127060	SUP	HCPCS C1713		71127060  -  SCREW BN 7MM 60MM STRL 16MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127065	SUP	HCPCS C1713		71127065  -  SCREW BN 7MM 65MM STRL 16MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127070	SUP	HCPCS C1713		71127070  -  SCREW BN P/T TROC SPHR 7MM 5.2MM 70MM 16MM CNN SLFDRL ST HD	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127075	SUP	HCPCS C1713		71127075  -  SCREW BN 7MM 75MM STRL 16MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127080	SUP	HCPCS C1713		71127080  -  SCREW BN 7MM 80MM STRL 16MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127085	SUP	HCPCS C1713		71127085  -  SCREW BN 7MM 85MM STRL 16MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127090	SUP	HCPCS C1713		71127090  -  SCREW BN 7MM 90MM STRL 16MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127095	SUP	HCPCS C1713		71127095  -  SCREW BN 7MM 95MM STRL 16MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127100	SUP	HCPCS C1713		71127100  -  SCREW BN 7MM 100MM STRL 16MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127105	SUP	HCPCS C1713		71127105  -  SCREW BN 7MM 105MM STRL 16MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127110	SUP	HCPCS C1713		71127110  -  SCREW BN 7MM 110MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127115	SUP	HCPCS C1713		71127115  -  SCREW BN 7MM 115MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127120	SUP	HCPCS C1713		71127120  -  SCREW BN 7MM 120MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127125	SUP	HCPCS C1713		71127125  -  SCREW BN 7MM 125MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127130	SUP	HCPCS C1713		71127130  -  SCREW BN 7MM 130MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127135	SUP	HCPCS C1713		71127135  -  SCREW BN 7MM 135MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127140	SUP	HCPCS C1713		71127140  -  SCREW BN 7MM 140MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127145	SUP	HCPCS C1713		71127145  -  SCREW BN 7MM 145MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71127150	SUP	HCPCS C1713		71127150  -  SCREW BN 7MM 150MM STRL 16MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128045	SUP	HCPCS C1713		71128045  -  SCREW BN 7MM 45MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128050	SUP	HCPCS C1713		71128050  -  SCREW BN 7MM 50MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128055	SUP	HCPCS C1713		71128055  -  SCREW BN 7MM 55MM STRL 32MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128060	SUP	HCPCS C1713		71128060  -  SCREW BN 7MM 60MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128065	SUP	HCPCS C1713		71128065  -  SCREW BN 7MM 65MM STRL 32MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128070	SUP	HCPCS C1713		71128070  -  SCREW BN 7MM 70MM STRL 32MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128075	SUP	HCPCS C1713		71128075  -  SCREW BN 7MM 75MM STRL 32MM CNN SET SS ORTH IMPL	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128080	SUP	HCPCS C1713		71128080  -  SCREW BN 7MM 80MM STRL 32MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128085	SUP	HCPCS C1713		71128085  -  SCREW BN 7MM 85MM STRL 32MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128090	SUP	HCPCS C1713		71128090  -  SCREW BN 7MM 90MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128095	SUP	HCPCS C1713		71128095  -  SCREW BN 7MM 95MM STRL 32MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128100	SUP	HCPCS C1713		71128100  -  SCREW BN 7MM 100MM STRL 32MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128105	SUP	HCPCS C1713		71128105  -  SCREW BN 7MM 105MM STRL 32MM CNN SS CORT	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128110	SUP	HCPCS C1713		71128110  -  SCREW BN 7MM 110MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128115	SUP	HCPCS C1713		71128115  -  SCREW BN 7MM 115MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128120	SUP	HCPCS C1713		71128120  -  SCREW BN 7MM 120MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128125	SUP	HCPCS C1713		71128125  -  SCREW BN 7MM 125MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128130	SUP	HCPCS C1713		71128130  -  SCREW BN 7MM 130MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128135	SUP	HCPCS C1713		71128135  -  SCREW BN 7MM 135MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$467.25 	$345.77	$0.00	$373.80	$210.26	$210.26	$0.00	$0.00	$0.00	$97.39	$346.79	$346.79	$0.00	$0.00	$97.37	$0.00	$276.38	$276.38	$0.00	$233.63	$370.06	$373.80	$0.00		$0.00	$73.12	$0.00	$0.00	$74.39	$0.00	$0.00	$0.00	$0.00	$0.00
71128140	SUP	HCPCS C1713		71128140  -  SCREW BN 7MM 140MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128145	SUP	HCPCS C1713		71128145  -  SCREW BN 7MM 145MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$467.25 	$345.77	$0.00	$373.80	$210.26	$210.26	$0.00	$0.00	$0.00	$97.39	$346.79	$346.79	$0.00	$0.00	$97.37	$0.00	$276.38	$276.38	$0.00	$233.63	$370.06	$373.80	$0.00		$0.00	$73.12	$0.00	$0.00	$74.39	$0.00	$0.00	$0.00	$0.00	$0.00
71128150	SUP	HCPCS C1713		71128150  -  SCREW BN 7MM 150MM STRL 32MM CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71128690	SUP	HCPCS C1713		71128690  -  STAPLE BN SM 23X10.8MM SPK FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128691	SUP	HCPCS C1713		71128691  -  STAPLE BN SM 23X10.8MM FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128692	SUP	HCPCS C1713		71128692  -  STAPLE BN SM 23X12MM SPK FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128693	SUP	HCPCS C1713		71128693  -  STAPLE BN SM 23X12MM FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128694	SUP	HCPCS C1713		71128694  -  STAPLE BN MED 23X15MM SPK FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128695	SUP	HCPCS C1713		71128695  -  STAPLE BN MED 23X15MM FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128696	SUP	HCPCS C1713		71128696  -  STAPLE BN LG 23X18MM SPK FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128697	SUP	HCPCS C1713		71128697  -  STAPLE BN LG 23X18MM FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128698	SUP	HCPCS C1713		71128698  -  STAPLE BN SM 16X13MM TBL FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128699	SUP	HCPCS C1713		71128699  -  STAPLE BN MED 22X16MM TBL FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128720	SUP	HCPCS C1713		71128720  -  STAPLE BN SM 15X11MM SPK FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128721	SUP	HCPCS C1713		71128721  -  STAPLE BN SM 15X11MM FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128722	SUP	HCPCS C1713		71128722  -  STAPLE BN SM 15X12.5MM SPK FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128723	SUP	HCPCS C1713		71128723  -  STAPLE BN SM 23X12.5MM FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128724	SUP	HCPCS C1713		71128724  -  STAPLE BN SM 16X15MM SPK FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128725	SUP	HCPCS C1713		71128725  -  STAPLE BN SM 16X15MM FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128726	SUP	HCPCS C1713		71128726  -  STAPLE BN LG 19X15MM SPK FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71128727	SUP	HCPCS C1713		71128727  -  STAPLE BN LG 19X15MM FX	BOTH IP/OP	$507.15 	$375.29	$0.00	$405.72	$228.22	$228.22	$0.00	$0.00	$0.00	$105.70	$376.41	$376.41	$0.00	$0.00	$105.69	$0.00	$299.98	$299.98	$0.00	$253.58	$401.66	$405.72	$0.00		$0.00	$79.37	$0.00	$0.00	$80.74	$0.00	$0.00	$0.00	$0.00	$0.00
71129030	SUP	HCPCS C1713		71129030  -  SCREW BN FT 7MM 30MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129035	SUP	HCPCS C1713		71129035  -  SCREW BN FT 7MM 35MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129040	SUP	HCPCS C1713		71129040  -  SCREW BN FT 7MM 40MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129045	SUP	HCPCS C1713		71129045  -  SCREW BN FT 7MM 45MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129050	SUP	HCPCS C1713		71129050  -  SCREW BN FT 7MM 50MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129055	SUP	HCPCS C1713		71129055  -  SCREW BN FT 7MM 55MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129060	SUP	HCPCS C1713		71129060  -  SCREW BN FT 7MM 60MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129065	SUP	HCPCS C1713		71129065  -  SCREW BN FT 7MM 65MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129070	SUP	HCPCS C1713		71129070  -  SCREW BN FT 7MM 70MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129075	SUP	HCPCS C1713		71129075  -  SCREW BN FT 7MM 75MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129080	SUP	HCPCS C1713		71129080  -  SCREW BN FT 7MM 80MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129085	SUP	HCPCS C1713		71129085  -  SCREW BN FT 7MM 85MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129090	SUP	HCPCS C1713		71129090  -  SCREW BN FT 7MM 90MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129095	SUP	HCPCS C1713		71129095  -  SCREW BN FT 7MM 95MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129100	SUP	HCPCS C1713		71129100  -  SCREW BN FT 7MM 100MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129105	SUP	HCPCS C1713		71129105  -  SCREW BN FT 7MM 105MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129110	SUP	HCPCS C1713		71129110  -  SCREW BN FT 7MM 110MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129115	SUP	HCPCS C1713		71129115  -  SCREW BN FT 7MM 115MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129120	SUP	HCPCS C1713		71129120  -  SCREW BN FT 7MM 120MM STRL CNN SS ORTH	BOTH IP/OP	$467.25 	$345.77	$0.00	$373.80	$210.26	$210.26	$0.00	$0.00	$0.00	$97.39	$346.79	$346.79	$0.00	$0.00	$97.37	$0.00	$276.38	$276.38	$0.00	$233.63	$370.06	$373.80	$0.00		$0.00	$73.12	$0.00	$0.00	$74.39	$0.00	$0.00	$0.00	$0.00	$0.00
71129125	SUP	HCPCS C1713		71129125  -  SCREW BN FT 7MM 125MM STRL CNN SS ORTH	BOTH IP/OP	$467.25 	$345.77	$0.00	$373.80	$210.26	$210.26	$0.00	$0.00	$0.00	$97.39	$346.79	$346.79	$0.00	$0.00	$97.37	$0.00	$276.38	$276.38	$0.00	$233.63	$370.06	$373.80	$0.00		$0.00	$73.12	$0.00	$0.00	$74.39	$0.00	$0.00	$0.00	$0.00	$0.00
71129130	SUP	HCPCS C1713		71129130  -  SCREW BN FT 7MM 130MM STRL CNN SS ORTH	BOTH IP/OP	$487.20 	$360.53	$0.00	$389.76	$219.24	$219.24	$0.00	$0.00	$0.00	$101.54	$361.60	$361.60	$0.00	$0.00	$101.53	$0.00	$288.18	$288.18	$0.00	$243.60	$385.86	$389.76	$0.00		$0.00	$76.25	$0.00	$0.00	$77.56	$0.00	$0.00	$0.00	$0.00	$0.00
71129212	SUP	HCPCS C1713		71129212  -  SCREW BN 4.5MM 12MM AMBI CLS ST CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129214	SUP	HCPCS C1713		71129214  -  SCREW BN 4.5MM 3.2MM 14MM AMBI CLS ST SS CORT HIP PLT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129216	SUP	HCPCS C1713		71129216  -  SCREW BN 4.5MM 8MM 16MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129218	SUP	HCPCS C1713		71129218  -  SCREW BN 4.5MM 8MM 18MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129220	SUP	HCPCS C1713		71129220  -  SCREW BN 4.5MM 8MM 20MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129222	SUP	HCPCS C1713		71129222  -  SCREW BN 4.5MM 8MM 22MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129224	SUP	HCPCS C1713		71129224  -  SCREW BN 4.5MM 24MM CHS ST SS CORT HIP PLT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129226	SUP	HCPCS C1713		71129226  -  SCREW BN 4.5MM 26MM AMBI CLS ST SS CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129228	SUP	HCPCS C1713		71129228  -  SCREW BN 4.5MM 8MM 28MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129230	SUP	HCPCS C1713		71129230  -  SCREW BN 4.5MM 3.2MM 30MM ST SS CORT SP CNDL PLT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129232	SUP	HCPCS C1713		71129232  -  SCREW BN 4.5MM 8MM 32MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129234	SUP	HCPCS C1713		71129234  -  SCREW BN 4.5MM 34MM IMHS ST SS CORT IM NL	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129236	SUP	HCPCS C1713		71129236  -  SCREW BN 4.5MM 8MM 36MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129238	SUP	HCPCS C1713		71129238  -  SCREW BN 4.5MM 8MM 38MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129240	SUP	HCPCS C1713		71129240  -  SCREW BN 4.5MM 8MM 40MM ST HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129242	SUP	HCPCS C1713		71129242  -  SCREW BN 4.5MM 8MM 42MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129244	SUP	HCPCS C1713		71129244  -  SCREW BN 4.5MM 8MM 44MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129246	SUP	HCPCS C1713		71129246  -  SCREW BN 4.5MM 8MM 46MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129248	SUP	HCPCS C1713		71129248  -  SCREW BN 4.5MM 8MM 48MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129250	SUP	HCPCS C1713		71129250  -  SCREW BN 4.5MM 8MM 50MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129252	SUP	HCPCS C1713		71129252  -  SCREW BN 4.5MM 8MM 52MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129254	SUP	HCPCS C1713		71129254  -  SCREW BN 4.5MM 8MM 54MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129256	SUP	HCPCS C1713		71129256  -  SCREW BN 4.5MM 8MM 56MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129258	SUP	HCPCS C1713		71129258  -  SCREW BN 4.5MM 3.2MM 58MM AMBI CLS ST SS CORT HIP PLT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129260	SUP	HCPCS C1713		71129260  -  SCREW BN 4.5MM 8MM 60MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129262	SUP	HCPCS C1713		71129262  -  SCREW BN 4.5MM 3.2MM 62MM AMBI CLS ST SS CORT HIP PLT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71129264	SUP	HCPCS C1713		71129264  -  SCREW BN 4.5MM 8MM 64MM AMBI CLS ST SS HIP CORT	BOTH IP/OP	$54.13 	$40.06	$0.00	$43.30	$24.36	$24.36	$0.00	$0.00	$0.00	$11.28	$40.17	$40.17	$0.00	$0.00	$11.28	$0.00	$32.01	$32.01	$0.00	$27.06	$42.87	$43.30	$0.00		$0.00	$8.47	$0.00	$0.00	$8.62	$0.00	$0.00	$0.00	$0.00	$0.00
71130205	SUP	HCPCS C1713		71130205  -  PLATE BN 3.5MM 5 HL CMPR PRV FX 3.5MM SCR SM FRAG SET	BOTH IP/OP	$359.10 	$265.73	$0.00	$287.28	$161.60	$161.60	$0.00	$0.00	$0.00	$74.85	$266.52	$266.52	$0.00	$0.00	$74.84	$0.00	$212.41	$212.41	$0.00	$179.55	$284.41	$287.28	$0.00		$0.00	$56.20	$0.00	$0.00	$57.17	$0.00	$0.00	$0.00	$0.00	$0.00
71130206	SUP	HCPCS C1713		71130206  -  PLATE BN 3.5MM 6 HL CMPR PRV FX 3.5MM SCR SM FRAG SET	BOTH IP/OP	$378.00 	$279.72	$0.00	$302.40	$170.10	$170.10	$0.00	$0.00	$0.00	$78.78	$280.55	$280.55	$0.00	$0.00	$78.78	$0.00	$223.59	$223.59	$0.00	$189.00	$299.38	$302.40	$0.00		$0.00	$59.16	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$0.00
71130207	SUP	HCPCS C1713		71130207  -  PLATE BN 3.5MM 7 HL CMPR PRV FX 3.5MM SCR SM FRAG SET	BOTH IP/OP	$389.55 	$288.27	$0.00	$311.64	$175.30	$175.30	$0.00	$0.00	$0.00	$81.19	$289.12	$289.12	$0.00	$0.00	$81.18	$0.00	$230.42	$230.42	$0.00	$194.78	$308.52	$311.64	$0.00		$0.00	$60.96	$0.00	$0.00	$62.02	$0.00	$0.00	$0.00	$0.00	$0.00
71130208	SUP	HCPCS C1713		71130208  -  PLATE BN 3.5MM 8 HL CMPR PRV FX 3.5MM SCR SM FRAG SET	BOTH IP/OP	$411.60 	$304.58	$0.00	$329.28	$185.22	$185.22	$0.00	$0.00	$0.00	$85.79	$305.49	$305.49	$0.00	$0.00	$85.78	$0.00	$243.46	$243.46	$0.00	$205.80	$325.99	$329.28	$0.00		$0.00	$64.42	$0.00	$0.00	$65.53	$0.00	$0.00	$0.00	$0.00	$0.00
71130209	SUP	HCPCS C1713		71130209  -  PLATE BN 3.5MM 9 HL CMPR PRV FX 3.5MM SCR SM FRAG SET	BOTH IP/OP	$434.70 	$321.68	$0.00	$347.76	$195.62	$195.62	$0.00	$0.00	$0.00	$90.60	$322.63	$322.63	$0.00	$0.00	$90.59	$0.00	$257.13	$257.13	$0.00	$217.35	$344.28	$347.76	$0.00		$0.00	$68.03	$0.00	$0.00	$69.20	$0.00	$0.00	$0.00	$0.00	$0.00
71130210	SUP	HCPCS C1713		71130210  -  PLATE BN 3.5MM 10 HL CMPR PRV FX 3.5MM SCR SM FRAG SET	BOTH IP/OP	$442.05 	$327.12	$0.00	$353.64	$198.92	$198.92	$0.00	$0.00	$0.00	$92.13	$328.09	$328.09	$0.00	$0.00	$92.12	$0.00	$261.47	$261.47	$0.00	$221.03	$350.10	$353.64	$0.00		$0.00	$69.18	$0.00	$0.00	$70.37	$0.00	$0.00	$0.00	$0.00	$0.00
71130303	SUP	HCPCS C1713		71130303  -  PLATE BN 1/3 TBLR 3 HL COLR PRV FX SM FRAG SET	BOTH IP/OP	$190.05 	$140.64	$0.00	$152.04	$85.52	$85.52	$0.00	$0.00	$0.00	$39.61	$141.06	$141.06	$0.00	$0.00	$39.61	$0.00	$112.41	$112.41	$0.00	$95.03	$150.52	$152.04	$0.00		$0.00	$29.74	$0.00	$0.00	$30.26	$0.00	$0.00	$0.00	$0.00	$0.00
71130304	SUP	HCPCS C1713		71130304  -  PLATE BN 1/3 TBLR 4 HL COLR PRV FX SM FRAG SET	BOTH IP/OP	$204.75 	$151.52	$0.00	$163.80	$92.14	$92.14	$0.00	$0.00	$0.00	$42.68	$151.97	$151.97	$0.00	$0.00	$42.67	$0.00	$121.11	$121.11	$0.00	$102.38	$162.16	$163.80	$0.00		$0.00	$32.04	$0.00	$0.00	$32.60	$0.00	$0.00	$0.00	$0.00	$0.00
71130305	SUP	HCPCS C1713		71130305  -  PLATE BN 1/3 TBLR 5 HL COLR PRV FX SM FRAG SET	BOTH IP/OP	$218.40 	$161.62	$0.00	$174.72	$98.28	$98.28	$0.00	$0.00	$0.00	$45.52	$162.10	$162.10	$0.00	$0.00	$45.51	$0.00	$129.18	$129.18	$0.00	$109.20	$172.97	$174.72	$0.00		$0.00	$34.18	$0.00	$0.00	$34.77	$0.00	$0.00	$0.00	$0.00	$0.00
71130306	SUP	HCPCS C1713		71130306  -  PLATE BN 1/3 TBLR 6 HL COLR PRV FX SM FRAG SET	BOTH IP/OP	$211.05 	$156.18	$0.00	$168.84	$94.97	$94.97	$0.00	$0.00	$0.00	$43.99	$156.64	$156.64	$0.00	$0.00	$43.98	$0.00	$124.84	$124.84	$0.00	$105.53	$167.15	$168.84	$0.00		$0.00	$33.03	$0.00	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00
71130307	SUP	HCPCS C1713		71130307  -  PLATE BN 1/3 TBLR 7 HL COLR PRV FX SM FRAG SET	BOTH IP/OP	$227.85 	$168.61	$0.00	$182.28	$102.53	$102.53	$0.00	$0.00	$0.00	$47.49	$169.11	$169.11	$0.00	$0.00	$47.48	$0.00	$134.77	$134.77	$0.00	$113.93	$180.46	$182.28	$0.00		$0.00	$35.66	$0.00	$0.00	$36.27	$0.00	$0.00	$0.00	$0.00	$0.00
71130308	SUP	HCPCS C1713		71130308  -  PLATE BN 1/3 TBLR 8 HL COLR PRV FX SM FRAG SET	BOTH IP/OP	$235.20 	$174.05	$0.00	$188.16	$105.84	$105.84	$0.00	$0.00	$0.00	$49.02	$174.57	$174.57	$0.00	$0.00	$49.02	$0.00	$139.12	$139.12	$0.00	$117.60	$186.28	$188.16	$0.00		$0.00	$36.81	$0.00	$0.00	$37.44	$0.00	$0.00	$0.00	$0.00	$0.00
71130310	SUP	HCPCS C1713		71130310  -  PLATE BN 1/3 TBLR 10 HL COLR PRV FX SM FRAG SET	BOTH IP/OP	$246.75 	$182.60	$0.00	$197.40	$111.04	$111.04	$0.00	$0.00	$0.00	$51.43	$183.14	$183.14	$0.00	$0.00	$51.42	$0.00	$145.95	$145.95	$0.00	$123.38	$195.43	$197.40	$0.00		$0.00	$38.62	$0.00	$0.00	$39.28	$0.00	$0.00	$0.00	$0.00	$0.00
71130403	SUP	HCPCS C1713		71130403  -  PLATE BN T SM 3 HL PRV FX SM FRAG SET	BOTH IP/OP	$352.80 	$261.07	$0.00	$282.24	$158.76	$158.76	$0.00	$0.00	$0.00	$73.53	$261.85	$261.85	$0.00	$0.00	$73.52	$0.00	$208.68	$208.68	$0.00	$176.40	$279.42	$282.24	$0.00		$0.00	$55.21	$0.00	$0.00	$56.17	$0.00	$0.00	$0.00	$0.00	$0.00
71130404	SUP	HCPCS C1713		71130404  -  PLATE BN T SM 4 HL PRV FX SM FRAG SET	BOTH IP/OP	$360.15 	$266.51	$0.00	$288.12	$162.07	$162.07	$0.00	$0.00	$0.00	$75.06	$267.30	$267.30	$0.00	$0.00	$75.06	$0.00	$213.03	$213.03	$0.00	$180.08	$285.24	$288.12	$0.00		$0.00	$56.36	$0.00	$0.00	$57.34	$0.00	$0.00	$0.00	$0.00	$0.00
71130405	SUP	HCPCS C1713		71130405  -  PLATE BN T SM 5 HL PRV FX SM FRAG SET	BOTH IP/OP	$456.75 	$338.00	$0.00	$365.40	$205.54	$205.54	$0.00	$0.00	$0.00	$95.20	$339.00	$339.00	$0.00	$0.00	$95.19	$0.00	$270.17	$270.17	$0.00	$228.38	$361.75	$365.40	$0.00		$0.00	$71.48	$0.00	$0.00	$72.71	$0.00	$0.00	$0.00	$0.00	$0.00
71130503	SUP	HCPCS C1713		71130503  -  PLATE BN T OBLQ 3 HL PRV FX SM FRAG SET	BOTH IP/OP	$581.70 	$430.46	$0.00	$465.36	$261.77	$261.77	$0.00	$0.00	$0.00	$121.24	$431.74	$431.74	$0.00	$0.00	$121.23	$0.00	$344.08	$344.08	$0.00	$290.85	$460.71	$465.36	$0.00		$0.00	$91.04	$0.00	$0.00	$92.61	$0.00	$0.00	$0.00	$0.00	$0.00
71130504	SUP	HCPCS C1713		71130504  -  PLATE BN T OBLQ 4 HL PRV FX SM FRAG SET	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$283.50	$283.50	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$98.60	$0.00	$0.00	$100.30	$0.00	$0.00	$0.00	$0.00	$0.00
71130505	SUP	HCPCS C1713		71130505  -  PLATE BN T OBLQ 5 HL PRV FX SM FRAG SET	BOTH IP/OP	$640.50 	$473.97	$0.00	$512.40	$288.23	$288.23	$0.00	$0.00	$0.00	$133.50	$475.38	$475.38	$0.00	$0.00	$133.48	$0.00	$378.86	$378.86	$0.00	$320.25	$507.28	$512.40	$0.00		$0.00	$100.24	$0.00	$0.00	$101.97	$0.00	$0.00	$0.00	$0.00	$0.00
71130603	SUP	HCPCS C1713		71130603  -  PLATE BN CLVRLF 3 HL PRV FX SM FRAG SET	BOTH IP/OP	$819.00 	$606.06	$0.00	$655.20	$368.55	$368.55	$0.00	$0.00	$0.00	$170.70	$607.86	$607.86	$0.00	$0.00	$170.68	$0.00	$484.44	$484.44	$0.00	$409.50	$648.65	$655.20	$0.00		$0.00	$128.17	$0.00	$0.00	$130.38	$0.00	$0.00	$0.00	$0.00	$0.00
71130804	SUP	HCPCS C1713		71130804  -  PLATE BN L BTRS 4 HL PRV FX LT LG FRAG SET	BOTH IP/OP	$922.95 	$682.98	$0.00	$738.36	$415.33	$415.33	$0.00	$0.00	$0.00	$192.37	$685.01	$685.01	$0.00	$0.00	$192.34	$0.00	$545.92	$545.92	$0.00	$461.48	$730.98	$738.36	$0.00		$0.00	$144.44	$0.00	$0.00	$146.93	$0.00	$0.00	$0.00	$0.00	$0.00
71130904	SUP	HCPCS C1713		71130904  -  PLATE BN L BTRS 4 HL PRV FX RT LG FRAG SET	BOTH IP/OP	$922.95 	$682.98	$0.00	$738.36	$415.33	$415.33	$0.00	$0.00	$0.00	$192.37	$685.01	$685.01	$0.00	$0.00	$192.34	$0.00	$545.92	$545.92	$0.00	$461.48	$730.98	$738.36	$0.00		$0.00	$144.44	$0.00	$0.00	$146.93	$0.00	$0.00	$0.00	$0.00	$0.00
71131007	SUP	HCPCS C1713		71131007  -  PLATE BN BTRS 7 HL PRV FX TIBHD RL LG FRAG SET	BOTH IP/OP	"$1,974.00 "	"$1,460.76"	$0.00	"$1,579.20"	$888.30	$888.30	$0.00	$0.00	$0.00	$411.43	"$1,465.10"	"$1,465.10"	$0.00	$0.00	$411.38	$0.00	"$1,167.62"	"$1,167.62"	$0.00	$987.00	"$1,563.41"	"$1,579.20"	$0.00		$0.00	$308.93	$0.00	$0.00	$314.26	$0.00	$0.00	$0.00	$0.00	$0.00
71131009	SUP	HCPCS C1713		71131009  -  PLATE BN BTRS 9 HL PRV FX TIBHD RL LG FRAG SET	BOTH IP/OP	"$2,110.50 "	"$1,561.77"	$0.00	"$1,688.40"	$949.73	$949.73	$0.00	$0.00	$0.00	$439.88	"$1,566.41"	"$1,566.41"	$0.00	$0.00	$439.83	$0.00	"$1,248.36"	"$1,248.36"	$0.00	"$1,055.25"	"$1,671.52"	"$1,688.40"	$0.00		$0.00	$330.29	$0.00	$0.00	$335.99	$0.00	$0.00	$0.00	$0.00	$0.00
71131107	SUP	HCPCS C1713		71131107  -  PLATE BN BTRS 7 HL PRV FX TIBHD L/L LG FRAG SET	BOTH IP/OP	"$1,974.00 "	"$1,460.76"	$0.00	"$1,579.20"	$888.30	$888.30	$0.00	$0.00	$0.00	$411.43	"$1,465.10"	"$1,465.10"	$0.00	$0.00	$411.38	$0.00	"$1,167.62"	"$1,167.62"	$0.00	$987.00	"$1,563.41"	"$1,579.20"	$0.00		$0.00	$308.93	$0.00	$0.00	$314.26	$0.00	$0.00	$0.00	$0.00	$0.00
71131109	SUP	HCPCS C1713		71131109  -  PLATE BN BTRS 9 HL PRV FX TIBHD L/L LG FRAG SET	BOTH IP/OP	"$2,110.50 "	"$1,561.77"	$0.00	"$1,688.40"	$949.73	$949.73	$0.00	$0.00	$0.00	$439.88	"$1,566.41"	"$1,566.41"	$0.00	$0.00	$439.83	$0.00	"$1,248.36"	"$1,248.36"	$0.00	"$1,055.25"	"$1,671.52"	"$1,688.40"	$0.00		$0.00	$330.29	$0.00	$0.00	$335.99	$0.00	$0.00	$0.00	$0.00	$0.00
71131206	SUP	HCPCS C1713		71131206  -  PLATE BN 4.5MM BRD 6 HL PRV FX PERIART MTPHSL 4.5MM SCR LG	BOTH IP/OP	$703.50 	$520.59	$0.00	$562.80	$316.58	$316.58	$0.00	$0.00	$0.00	$146.63	$522.14	$522.14	$0.00	$0.00	$146.61	$0.00	$416.12	$416.12	$0.00	$351.75	$557.17	$562.80	$0.00		$0.00	$110.10	$0.00	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00
71131207	SUP	HCPCS C1713		71131207  -  PLATE BN 4.5MM BRD 7 HL PRV FX PERIART MTPHSL 4.5MM SCR LG	BOTH IP/OP	$703.50 	$520.59	$0.00	$562.80	$316.58	$316.58	$0.00	$0.00	$0.00	$146.63	$522.14	$522.14	$0.00	$0.00	$146.61	$0.00	$416.12	$416.12	$0.00	$351.75	$557.17	$562.80	$0.00		$0.00	$110.10	$0.00	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00
71131208	SUP	HCPCS C1713		71131208  -  PLATE BN 4.5MM BRD 8 HL PRV FX PERIART MTPHSL 4.5MM SCR LG	BOTH IP/OP	$875.70 	$648.02	$0.00	$700.56	$394.07	$394.07	$0.00	$0.00	$0.00	$182.52	$649.94	$649.94	$0.00	$0.00	$182.50	$0.00	$517.98	$517.98	$0.00	$437.85	$693.55	$700.56	$0.00		$0.00	$137.05	$0.00	$0.00	$139.41	$0.00	$0.00	$0.00	$0.00	$0.00
71131209	SUP	HCPCS C1713		71131209  -  PLATE BN 4.5MM BRD 9 HL PRV FX PERIART MTPHSL 4.5MM SCR LG	BOTH IP/OP	$875.70 	$648.02	$0.00	$700.56	$394.07	$394.07	$0.00	$0.00	$0.00	$182.52	$649.94	$649.94	$0.00	$0.00	$182.50	$0.00	$517.98	$517.98	$0.00	$437.85	$693.55	$700.56	$0.00		$0.00	$137.05	$0.00	$0.00	$139.41	$0.00	$0.00	$0.00	$0.00	$0.00
71131210	SUP	HCPCS C1713		71131210  -  PLATE BN 4.5MM BRD 10 HL PRV FX PERIART MTPHSL 4.5MM SCR LG	BOTH IP/OP	$875.70 	$648.02	$0.00	$700.56	$394.07	$394.07	$0.00	$0.00	$0.00	$182.52	$649.94	$649.94	$0.00	$0.00	$182.50	$0.00	$517.98	$517.98	$0.00	$437.85	$693.55	$700.56	$0.00		$0.00	$137.05	$0.00	$0.00	$139.41	$0.00	$0.00	$0.00	$0.00	$0.00
71131212	SUP	HCPCS C1713		71131212  -  PLATE BN 4.5MM BRD 12 HL PRV FX PERIART MTPHSL 4.5MM SCR LG	BOTH IP/OP	$939.75 	$695.42	$0.00	$751.80	$422.89	$422.89	$0.00	$0.00	$0.00	$195.87	$697.48	$697.48	$0.00	$0.00	$195.84	$0.00	$555.86	$555.86	$0.00	$469.88	$744.28	$751.80	$0.00		$0.00	$147.07	$0.00	$0.00	$149.61	$0.00	$0.00	$0.00	$0.00	$0.00
71131214	SUP	HCPCS C1713		71131214  -  PLATE BN 4.5MM BRD 14 HL PRV FX PERIART MTPHSL 4.5MM SCR LG	BOTH IP/OP	$939.75 	$695.42	$0.00	$751.80	$422.89	$422.89	$0.00	$0.00	$0.00	$195.87	$697.48	$697.48	$0.00	$0.00	$195.84	$0.00	$555.86	$555.86	$0.00	$469.88	$744.28	$751.80	$0.00		$0.00	$147.07	$0.00	$0.00	$149.61	$0.00	$0.00	$0.00	$0.00	$0.00
71131304	SUP	HCPCS C1713		71131304  -  PLATE BN SMTB 4 HL PRV FX LG FRAG SET	BOTH IP/OP	$190.05 	$140.64	$0.00	$152.04	$85.52	$85.52	$0.00	$0.00	$0.00	$39.61	$141.06	$141.06	$0.00	$0.00	$39.61	$0.00	$112.41	$112.41	$0.00	$95.03	$150.52	$152.04	$0.00		$0.00	$29.74	$0.00	$0.00	$30.26	$0.00	$0.00	$0.00	$0.00	$0.00
71131305	SUP	HCPCS C1713		71131305  -  PLATE BN SMTB 5 HL PRV FX LG FRAG SET	BOTH IP/OP	$192.15 	$142.19	$0.00	$153.72	$86.47	$86.47	$0.00	$0.00	$0.00	$40.05	$142.61	$142.61	$0.00	$0.00	$40.04	$0.00	$113.66	$113.66	$0.00	$96.08	$152.18	$153.72	$0.00		$0.00	$30.07	$0.00	$0.00	$30.59	$0.00	$0.00	$0.00	$0.00	$0.00
71131306	SUP	HCPCS C1713		71131306  -  PLATE BN SMTB 6 HL PRV FX LG FRAG SET	BOTH IP/OP	$211.05 	$156.18	$0.00	$168.84	$94.97	$94.97	$0.00	$0.00	$0.00	$43.99	$156.64	$156.64	$0.00	$0.00	$43.98	$0.00	$124.84	$124.84	$0.00	$105.53	$167.15	$168.84	$0.00		$0.00	$33.03	$0.00	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00
71131307	SUP	HCPCS C1713		71131307  -  PLATE BN SMTB 7 HL PRV FX LG FRAG SET	BOTH IP/OP	$223.65 	$165.50	$0.00	$178.92	$100.64	$100.64	$0.00	$0.00	$0.00	$46.61	$165.99	$165.99	$0.00	$0.00	$46.61	$0.00	$132.29	$132.29	$0.00	$111.83	$177.13	$178.92	$0.00		$0.00	$35.00	$0.00	$0.00	$35.61	$0.00	$0.00	$0.00	$0.00	$0.00
71131403	SUP	HCPCS C1713		71131403  -  PLATE BN NAR 3 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG	BOTH IP/OP	$473.55 	$350.43	$0.00	$378.84	$213.10	$213.10	$0.00	$0.00	$0.00	$98.70	$351.47	$351.47	$0.00	$0.00	$98.69	$0.00	$280.10	$280.10	$0.00	$236.78	$375.05	$378.84	$0.00		$0.00	$74.11	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
71131404	SUP	HCPCS C1713		71131404  -  PLATE BN NAR 4 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG	BOTH IP/OP	$473.55 	$350.43	$0.00	$378.84	$213.10	$213.10	$0.00	$0.00	$0.00	$98.70	$351.47	$351.47	$0.00	$0.00	$98.69	$0.00	$280.10	$280.10	$0.00	$236.78	$375.05	$378.84	$0.00		$0.00	$74.11	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
71131405	SUP	HCPCS C1713		71131405  -  PLATE BN NAR 5 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG	BOTH IP/OP	$473.55 	$350.43	$0.00	$378.84	$213.10	$213.10	$0.00	$0.00	$0.00	$98.70	$351.47	$351.47	$0.00	$0.00	$98.69	$0.00	$280.10	$280.10	$0.00	$236.78	$375.05	$378.84	$0.00		$0.00	$74.11	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
71131406	SUP	HCPCS C1713		71131406  -  PLATE BN NAR 6 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG	BOTH IP/OP	$441.00 	$326.34	$0.00	$352.80	$198.45	$198.45	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$220.50	$349.27	$352.80	$0.00		$0.00	$69.02	$0.00	$0.00	$70.21	$0.00	$0.00	$0.00	$0.00	$0.00
71131407	SUP	HCPCS C1713		71131407  -  PLATE BN NAR 7 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG	BOTH IP/OP	$526.05 	$389.28	$0.00	$420.84	$236.72	$236.72	$0.00	$0.00	$0.00	$109.64	$390.43	$390.43	$0.00	$0.00	$109.63	$0.00	$311.16	$311.16	$0.00	$263.03	$416.63	$420.84	$0.00		$0.00	$82.33	$0.00	$0.00	$83.75	$0.00	$0.00	$0.00	$0.00	$0.00
71131408	SUP	HCPCS C1713		71131408  -  PLATE BN NAR 8 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG	BOTH IP/OP	$441.00 	$326.34	$0.00	$352.80	$198.45	$198.45	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$220.50	$349.27	$352.80	$0.00		$0.00	$69.02	$0.00	$0.00	$70.21	$0.00	$0.00	$0.00	$0.00	$0.00
71131409	SUP	HCPCS C1713		71131409  -  PLATE BN NAR 9 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG	BOTH IP/OP	$441.00 	$326.34	$0.00	$352.80	$198.45	$198.45	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$220.50	$349.27	$352.80	$0.00		$0.00	$69.02	$0.00	$0.00	$70.21	$0.00	$0.00	$0.00	$0.00	$0.00
71131410	SUP	HCPCS C1713		71131410  -  PLATE BN NAR 10 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG	BOTH IP/OP	$570.15 	$421.91	$0.00	$456.12	$256.57	$256.57	$0.00	$0.00	$0.00	$118.83	$423.17	$423.17	$0.00	$0.00	$118.82	$0.00	$337.24	$337.24	$0.00	$285.08	$451.56	$456.12	$0.00		$0.00	$89.23	$0.00	$0.00	$90.77	$0.00	$0.00	$0.00	$0.00	$0.00
71131411	SUP	HCPCS C1713		71131411  -  PLATE BN NAR 11 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG	BOTH IP/OP	$696.15 	$515.15	$0.00	$556.92	$313.27	$313.27	$0.00	$0.00	$0.00	$145.10	$516.68	$516.68	$0.00	$0.00	$145.08	$0.00	$411.77	$411.77	$0.00	$348.08	$551.35	$556.92	$0.00		$0.00	$108.95	$0.00	$0.00	$110.83	$0.00	$0.00	$0.00	$0.00	$0.00
71131412	SUP	HCPCS C1713		71131412  -  PLATE BN NAR 12 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG	BOTH IP/OP	$696.15 	$515.15	$0.00	$556.92	$313.27	$313.27	$0.00	$0.00	$0.00	$145.10	$516.68	$516.68	$0.00	$0.00	$145.08	$0.00	$411.77	$411.77	$0.00	$348.08	$551.35	$556.92	$0.00		$0.00	$108.95	$0.00	$0.00	$110.83	$0.00	$0.00	$0.00	$0.00	$0.00
71131510	SUP	HCPCS C1713		71131510  -  PIN FX LG ST 2MM 61MM 10MM TRL SS	BOTH IP/OP	$221.55 	$163.95	$0.00	$177.24	$99.70	$99.70	$0.00	$0.00	$0.00	$46.18	$164.43	$164.43	$0.00	$0.00	$46.17	$0.00	$131.05	$131.05	$0.00	$110.78	$175.47	$177.24	$0.00		$0.00	$34.67	$0.00	$0.00	$35.27	$0.00	$0.00	$0.00	$0.00	$0.00
71131511	SUP	HCPCS C1713		71131511  -  PIN FX LG MED THRD 2MM 38MM 13MM TRL SS	BOTH IP/OP	$221.55 	$163.95	$0.00	$177.24	$99.70	$99.70	$0.00	$0.00	$0.00	$46.18	$164.43	$164.43	$0.00	$0.00	$46.17	$0.00	$131.05	$131.05	$0.00	$110.78	$175.47	$177.24	$0.00		$0.00	$34.67	$0.00	$0.00	$35.27	$0.00	$0.00	$0.00	$0.00	$0.00
71131512	SUP	HCPCS C1713		71131512  -  PIN FX LG L/T 2MM 61MM 23MM TRL SS	BOTH IP/OP	$235.20 	$174.05	$0.00	$188.16	$105.84	$105.84	$0.00	$0.00	$0.00	$49.02	$174.57	$174.57	$0.00	$0.00	$49.02	$0.00	$139.12	$139.12	$0.00	$117.60	$186.28	$188.16	$0.00		$0.00	$36.81	$0.00	$0.00	$37.44	$0.00	$0.00	$0.00	$0.00	$0.00
71131604	SUP	HCPCS C1713		71131604  -  PLATE BN T 4 HL PRV FX LG FRAG SET	BOTH IP/OP	$340.20 	$251.75	$0.00	$272.16	$153.09	$153.09	$0.00	$0.00	$0.00	$70.91	$252.50	$252.50	$0.00	$0.00	$70.90	$0.00	$201.23	$201.23	$0.00	$170.10	$269.44	$272.16	$0.00		$0.00	$53.24	$0.00	$0.00	$54.16	$0.00	$0.00	$0.00	$0.00	$0.00
71131606	SUP	HCPCS C1713		71131606  -  PLATE BN T 6 HL PRV FX LG FRAG SET	BOTH IP/OP	$376.95 	$278.94	$0.00	$301.56	$169.63	$169.63	$0.00	$0.00	$0.00	$78.57	$279.77	$279.77	$0.00	$0.00	$78.56	$0.00	$222.97	$222.97	$0.00	$188.48	$298.54	$301.56	$0.00		$0.00	$58.99	$0.00	$0.00	$60.01	$0.00	$0.00	$0.00	$0.00	$0.00
71131608	SUP	HCPCS C1713		71131608  -  PLATE BN T 8 HL PRV FX LG FRAG SET	BOTH IP/OP	"$1,118.25 "	$827.51	$0.00	$894.60	$503.21	$503.21	$0.00	$0.00	$0.00	$233.07	$829.97	$829.97	$0.00	$0.00	$233.04	$0.00	$661.44	$661.44	$0.00	$559.13	$885.65	$894.60	$0.00		$0.00	$175.01	$0.00	$0.00	$178.03	$0.00	$0.00	$0.00	$0.00	$0.00
71134016	SUP	Custom 27203010		71134016  -  BIT DRL 2MM TWST PED	BOTH IP/OP	$91.40 	$67.64	$0.00	$73.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.84	$67.84	$0.00	$0.00	$19.05	$0.00	$0.00	$0.00	$0.00	$45.70	$72.39	$73.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71134064	SUP	Custom 27203010		71134064  -  BIT DRL 2.7MM TWST PED	BOTH IP/OP	$95.70 	$70.82	$0.00	$76.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.03	$71.03	$0.00	$0.00	$19.94	$0.00	$0.00	$0.00	$0.00	$47.85	$75.79	$76.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71140003	SUP	HCPCS C1713		71140003  -  PLATE BN 45MM TC100 3 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	$798.00 	$590.52	$0.00	$638.40	$359.10	$359.10	$0.00	$0.00	$0.00	$166.32	$592.28	$592.28	$0.00	$0.00	$166.30	$0.00	$472.02	$472.02	$0.00	$399.00	$632.02	$638.40	$0.00		$0.00	$124.89	$0.00	$0.00	$127.04	$0.00	$0.00	$0.00	$0.00	$0.00
71140004	SUP	HCPCS C1713		71140004  -  PLATE BN 61MM TC100 4 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	$846.30 	$626.26	$0.00	$677.04	$380.84	$380.84	$0.00	$0.00	$0.00	$176.39	$628.12	$628.12	$0.00	$0.00	$176.37	$0.00	$500.59	$500.59	$0.00	$423.15	$670.27	$677.04	$0.00		$0.00	$132.45	$0.00	$0.00	$134.73	$0.00	$0.00	$0.00	$0.00	$0.00
71140005	SUP	HCPCS C1713		71140005  -  PLATE BN 77MM TC100 5 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	$910.35 	$673.66	$0.00	$728.28	$409.66	$409.66	$0.00	$0.00	$0.00	$189.74	$675.66	$675.66	$0.00	$0.00	$189.72	$0.00	$538.47	$538.47	$0.00	$455.18	$721.00	$728.28	$0.00		$0.00	$142.47	$0.00	$0.00	$144.93	$0.00	$0.00	$0.00	$0.00	$0.00
71140006	SUP	HCPCS C1713		71140006  -  PLATE BN 93MM TC100 6 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	$972.30 	$719.50	$0.00	$777.84	$437.54	$437.54	$0.00	$0.00	$0.00	$202.65	$721.64	$721.64	$0.00	$0.00	$202.63	$0.00	$575.12	$575.12	$0.00	$486.15	$770.06	$777.84	$0.00		$0.00	$152.16	$0.00	$0.00	$154.79	$0.00	$0.00	$0.00	$0.00	$0.00
71140007	SUP	HCPCS C1713		71140007  -  PLATE BN 109MM TC100 7 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	"$1,025.85 "	$759.13	$0.00	$820.68	$461.63	$461.63	$0.00	$0.00	$0.00	$213.81	$761.39	$761.39	$0.00	$0.00	$213.79	$0.00	$606.79	$606.79	$0.00	$512.93	$812.47	$820.68	$0.00		$0.00	$160.55	$0.00	$0.00	$163.32	$0.00	$0.00	$0.00	$0.00	$0.00
71140008	SUP	HCPCS C1713		71140008  -  PLATE BN 125MM TC100 8 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	"$1,302.00 "	$963.48	$0.00	"$1,041.60"	$585.90	$585.90	$0.00	$0.00	$0.00	$271.37	$966.34	$966.34	$0.00	$0.00	$271.34	$0.00	$770.13	$770.13	$0.00	$651.00	"$1,031.18"	"$1,041.60"	$0.00		$0.00	$203.76	$0.00	$0.00	$207.28	$0.00	$0.00	$0.00	$0.00	$0.00
71140009	SUP	HCPCS C1713		71140009  -  PLATE BN 141MM TC100 9 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	"$1,391.25 "	"$1,029.53"	$0.00	"$1,113.00"	$626.06	$626.06	$0.00	$0.00	$0.00	$289.97	"$1,032.59"	"$1,032.59"	$0.00	$0.00	$289.94	$0.00	$822.92	$822.92	$0.00	$695.63	"$1,101.87"	"$1,113.00"	$0.00		$0.00	$217.73	$0.00	$0.00	$221.49	$0.00	$0.00	$0.00	$0.00	$0.00
71140010	SUP	HCPCS C1713		71140010  -  PLATE BN 157MM TC100 10 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	"$1,464.75 "	"$1,083.92"	$0.00	"$1,171.80"	$659.14	$659.14	$0.00	$0.00	$0.00	$305.29	"$1,087.14"	"$1,087.14"	$0.00	$0.00	$305.25	$0.00	$866.40	$866.40	$0.00	$732.38	"$1,160.08"	"$1,171.80"	$0.00		$0.00	$229.23	$0.00	$0.00	$233.19	$0.00	$0.00	$0.00	$0.00	$0.00
71140011	SUP	HCPCS C1713		71140011  -  PLATE BN 173MM TC100 11 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	"$1,506.75 "	"$1,115.00"	$0.00	"$1,205.40"	$678.04	$678.04	$0.00	$0.00	$0.00	$314.04	"$1,118.31"	"$1,118.31"	$0.00	$0.00	$314.01	$0.00	$891.24	$891.24	$0.00	$753.38	"$1,193.35"	"$1,205.40"	$0.00		$0.00	$235.81	$0.00	$0.00	$239.87	$0.00	$0.00	$0.00	$0.00	$0.00
71140012	SUP	HCPCS C1713		71140012  -  PLATE BN 189MM TC100 12 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	"$1,302.00 "	$963.48	$0.00	"$1,041.60"	$585.90	$585.90	$0.00	$0.00	$0.00	$271.37	$966.34	$966.34	$0.00	$0.00	$271.34	$0.00	$770.13	$770.13	$0.00	$651.00	"$1,031.18"	"$1,041.60"	$0.00		$0.00	$203.76	$0.00	$0.00	$207.28	$0.00	$0.00	$0.00	$0.00	$0.00
71140013	SUP	HCPCS C1713		71140013  -  PLATE BN 205MM TC100 13 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	"$1,701.00 "	"$1,258.74"	$0.00	"$1,360.80"	$765.45	$765.45	$0.00	$0.00	$0.00	$354.53	"$1,262.48"	"$1,262.48"	$0.00	$0.00	$354.49	$0.00	"$1,006.14"	"$1,006.14"	$0.00	$850.50	"$1,347.19"	"$1,360.80"	$0.00		$0.00	$266.21	$0.00	$0.00	$270.80	$0.00	$0.00	$0.00	$0.00	$0.00
71140014	SUP	HCPCS C1713		71140014  -  PLATE BN 221MM TC100 14 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	"$1,422.75 "	"$1,052.84"	$0.00	"$1,138.20"	$640.24	$640.24	$0.00	$0.00	$0.00	$296.54	"$1,055.97"	"$1,055.97"	$0.00	$0.00	$296.50	$0.00	$841.56	$841.56	$0.00	$711.38	"$1,126.82"	"$1,138.20"	$0.00		$0.00	$222.66	$0.00	$0.00	$226.50	$0.00	$0.00	$0.00	$0.00	$0.00
71140015	SUP	HCPCS C1713		71140015  -  PLATE BN 237MM TC100 15 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	"$1,806.00 "	"$1,336.44"	$0.00	"$1,444.80"	$812.70	$812.70	$0.00	$0.00	$0.00	$376.42	"$1,340.41"	"$1,340.41"	$0.00	$0.00	$376.37	$0.00	"$1,068.25"	"$1,068.25"	$0.00	$903.00	"$1,430.35"	"$1,444.80"	$0.00		$0.00	$282.64	$0.00	$0.00	$287.52	$0.00	$0.00	$0.00	$0.00	$0.00
71140016	SUP	HCPCS C1713		71140016  -  PLATE BN 253MM TC100 16 HL RECON SS PLVC 4.5MM SCR	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,495.20"	$841.05	$841.05	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$934.50	"$1,480.25"	"$1,495.20"	$0.00		$0.00	$292.50	$0.00	$0.00	$297.54	$0.00	$0.00	$0.00	$0.00	$0.00
71140104	SUP	HCPCS C1713		71140104  -  PLATE BN 46MM TC100 4 HL RECON SS PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$875.70 	$648.02	$0.00	$700.56	$394.07	$394.07	$0.00	$0.00	$0.00	$182.52	$649.94	$649.94	$0.00	$0.00	$182.50	$0.00	$517.98	$517.98	$0.00	$437.85	$693.55	$700.56	$0.00		$0.00	$137.05	$0.00	$0.00	$139.41	$0.00	$0.00	$0.00	$0.00	$0.00
71140105	SUP	HCPCS C1713		71140105  -  PLATE BN 58MM TC100 5 HL RECON SS PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$812.70 	$601.40	$0.00	$650.16	$365.72	$365.72	$0.00	$0.00	$0.00	$169.39	$603.19	$603.19	$0.00	$0.00	$169.37	$0.00	$480.71	$480.71	$0.00	$406.35	$643.66	$650.16	$0.00		$0.00	$127.19	$0.00	$0.00	$129.38	$0.00	$0.00	$0.00	$0.00	$0.00
71140106	SUP	HCPCS C1713		71140106  -  PLATE BN 70MM TC100 6 HL RECON SS PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	"$1,022.70 "	$756.80	$0.00	$818.16	$460.22	$460.22	$0.00	$0.00	$0.00	$213.16	$759.05	$759.05	$0.00	$0.00	$213.13	$0.00	$604.93	$604.93	$0.00	$511.35	$809.98	$818.16	$0.00		$0.00	$160.05	$0.00	$0.00	$162.81	$0.00	$0.00	$0.00	$0.00	$0.00
71140107	SUP	HCPCS C1713		71140107  -  PLATE BN 82MM TC100 7 HL RECON SS PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$974.40 	$721.06	$0.00	$779.52	$438.48	$438.48	$0.00	$0.00	$0.00	$203.09	$723.20	$723.20	$0.00	$0.00	$203.06	$0.00	$576.36	$576.36	$0.00	$487.20	$771.72	$779.52	$0.00		$0.00	$152.49	$0.00	$0.00	$155.12	$0.00	$0.00	$0.00	$0.00	$0.00
71140108	SUP	HCPCS C1713		71140108  -  PLATE BN 94MM TC100 8 HL RECON SS PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	"$1,118.25 "	$827.51	$0.00	$894.60	$503.21	$503.21	$0.00	$0.00	$0.00	$233.07	$829.97	$829.97	$0.00	$0.00	$233.04	$0.00	$661.44	$661.44	$0.00	$559.13	$885.65	$894.60	$0.00		$0.00	$175.01	$0.00	$0.00	$178.03	$0.00	$0.00	$0.00	$0.00	$0.00
71140109	SUP	HCPCS C1713		71140109  -  PLATE BN 106MM TC100 9 HL RECON SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,050.00 "	$777.00	$0.00	$840.00	$472.50	$472.50	$0.00	$0.00	$0.00	$218.85	$779.31	$779.31	$0.00	$0.00	$218.82	$0.00	$621.08	$621.08	$0.00	$525.00	$831.60	$840.00	$0.00		$0.00	$164.33	$0.00	$0.00	$167.16	$0.00	$0.00	$0.00	$0.00	$0.00
71140110	SUP	HCPCS C1713		71140110  -  PLATE BN 118MM TC100 10 HL RECON SS PLVC 3.5MM SCR	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
71140111	SUP	HCPCS C1713		71140111  -  PLATE BN 130MM TC100 11 HL RECON SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,118.25 "	$827.51	$0.00	$894.60	$503.21	$503.21	$0.00	$0.00	$0.00	$233.07	$829.97	$829.97	$0.00	$0.00	$233.04	$0.00	$661.44	$661.44	$0.00	$559.13	$885.65	$894.60	$0.00		$0.00	$175.01	$0.00	$0.00	$178.03	$0.00	$0.00	$0.00	$0.00	$0.00
71140112	SUP	HCPCS C1713		71140112  -  PLATE BN 142MM TC100 12 HL RECON SS PLVC 3.5MM SCR	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71140113	SUP	HCPCS C1713		71140113  -  PLATE BN 154MM TC100 13 HL RECON SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,496.25 "	"$1,107.23"	$0.00	"$1,197.00"	$673.31	$673.31	$0.00	$0.00	$0.00	$311.86	"$1,110.52"	"$1,110.52"	$0.00	$0.00	$311.82	$0.00	$885.03	$885.03	$0.00	$748.13	"$1,185.03"	"$1,197.00"	$0.00		$0.00	$234.16	$0.00	$0.00	$238.20	$0.00	$0.00	$0.00	$0.00	$0.00
71140114	SUP	HCPCS C1713		71140114  -  PLATE BN 166MM TC100 14 HL RECON SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,380.75 "	"$1,021.76"	$0.00	"$1,104.60"	$621.34	$621.34	$0.00	$0.00	$0.00	$287.78	"$1,024.79"	"$1,024.79"	$0.00	$0.00	$287.75	$0.00	$816.71	$816.71	$0.00	$690.38	"$1,093.55"	"$1,104.60"	$0.00		$0.00	$216.09	$0.00	$0.00	$219.82	$0.00	$0.00	$0.00	$0.00	$0.00
71140115	SUP	HCPCS C1713		71140115  -  PLATE BN 178MM TC100 15 HL RECON SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,648.50 "	"$1,219.89"	$0.00	"$1,318.80"	$741.83	$741.83	$0.00	$0.00	$0.00	$343.59	"$1,223.52"	"$1,223.52"	$0.00	$0.00	$343.55	$0.00	$975.09	$975.09	$0.00	$824.25	"$1,305.61"	"$1,318.80"	$0.00		$0.00	$257.99	$0.00	$0.00	$262.44	$0.00	$0.00	$0.00	$0.00	$0.00
71140116	SUP	HCPCS C1713		71140116  -  PLATE BN 190MM TC100 16 HL RECON SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,407.00 "	"$1,041.18"	$0.00	"$1,125.60"	$633.15	$633.15	$0.00	$0.00	$0.00	$293.25	"$1,044.28"	"$1,044.28"	$0.00	$0.00	$293.22	$0.00	$832.24	$832.24	$0.00	$703.50	"$1,114.34"	"$1,125.60"	$0.00		$0.00	$220.20	$0.00	$0.00	$223.99	$0.00	$0.00	$0.00	$0.00	$0.00
71140118	SUP	HCPCS C1713		71140118  -  PLATE BN 214MM TC100 18 HL RECON SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,480.50 "	"$1,095.57"	$0.00	"$1,184.40"	$666.23	$666.23	$0.00	$0.00	$0.00	$308.57	"$1,098.83"	"$1,098.83"	$0.00	$0.00	$308.54	$0.00	$875.72	$875.72	$0.00	$740.25	"$1,172.56"	"$1,184.40"	$0.00		$0.00	$231.70	$0.00	$0.00	$235.70	$0.00	$0.00	$0.00	$0.00	$0.00
71140120	SUP	HCPCS C1713		71140120  -  PLATE BN 238MM TC100 20 HL RECON SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,800.75 "	"$1,332.56"	$0.00	"$1,440.60"	$810.34	$810.34	$0.00	$0.00	$0.00	$375.32	"$1,336.52"	"$1,336.52"	$0.00	$0.00	$375.28	$0.00	"$1,065.14"	"$1,065.14"	$0.00	$900.38	"$1,426.19"	"$1,440.60"	$0.00		$0.00	$281.82	$0.00	$0.00	$286.68	$0.00	$0.00	$0.00	$0.00	$0.00
71140122	SUP	HCPCS C1713		71140122  -  PLATE BN 263MM TC100 22 HL RECON SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,827.00"	"$1,027.69"	"$1,027.69"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,141.88"	"$1,808.73"	"$1,827.00"	$0.00		$0.00	$357.41	$0.00	$0.00	$363.57	$0.00	$0.00	$0.00	$0.00	$0.00
71140202	SUP	HCPCS C1713		71140202  -  PLATE BN 25MM TC100 2 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$296.10 	$219.11	$0.00	$236.88	$133.25	$133.25	$0.00	$0.00	$0.00	$61.71	$219.77	$219.77	$0.00	$0.00	$61.71	$0.00	$175.14	$175.14	$0.00	$148.05	$234.51	$236.88	$0.00		$0.00	$46.34	$0.00	$0.00	$47.14	$0.00	$0.00	$0.00	$0.00	$0.00
71140203	SUP	HCPCS C1713		71140203  -  PLATE BN 37MM TC100 3 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$309.75 	$229.22	$0.00	$247.80	$139.39	$139.39	$0.00	$0.00	$0.00	$64.56	$229.90	$229.90	$0.00	$0.00	$64.55	$0.00	$183.22	$183.22	$0.00	$154.88	$245.32	$247.80	$0.00		$0.00	$48.48	$0.00	$0.00	$49.31	$0.00	$0.00	$0.00	$0.00	$0.00
71140204	SUP	HCPCS C1713		71140204  -  PLATE BN 49MM TC100 4 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$316.05 	$233.88	$0.00	$252.84	$142.22	$142.22	$0.00	$0.00	$0.00	$65.87	$234.57	$234.57	$0.00	$0.00	$65.86	$0.00	$186.94	$186.94	$0.00	$158.03	$250.31	$252.84	$0.00		$0.00	$49.46	$0.00	$0.00	$50.32	$0.00	$0.00	$0.00	$0.00	$0.00
71140205	SUP	HCPCS C1713		71140205  -  PLATE BN 61MM TC100 5 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$345.45 	$255.63	$0.00	$276.36	$155.45	$155.45	$0.00	$0.00	$0.00	$72.00	$256.39	$256.39	$0.00	$0.00	$71.99	$0.00	$204.33	$204.33	$0.00	$172.73	$273.60	$276.36	$0.00		$0.00	$54.06	$0.00	$0.00	$55.00	$0.00	$0.00	$0.00	$0.00	$0.00
71140206	SUP	HCPCS C1713		71140206  -  PLATE BN 73MM TC100 6 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$361.20 	$267.29	$0.00	$288.96	$162.54	$162.54	$0.00	$0.00	$0.00	$75.28	$268.08	$268.08	$0.00	$0.00	$75.27	$0.00	$213.65	$213.65	$0.00	$180.60	$286.07	$288.96	$0.00		$0.00	$56.53	$0.00	$0.00	$57.50	$0.00	$0.00	$0.00	$0.00	$0.00
71140207	SUP	HCPCS C1713		71140207  -  PLATE BN 85MM TC100 7 HL CMPR SS PLVC 3.5MM SCR	BOTH IP/OP	$378.00 	$279.72	$0.00	$302.40	$170.10	$170.10	$0.00	$0.00	$0.00	$78.78	$280.55	$280.55	$0.00	$0.00	$78.78	$0.00	$223.59	$223.59	$0.00	$189.00	$299.38	$302.40	$0.00		$0.00	$59.16	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$0.00
71140208	SUP	HCPCS C1713		71140208  -  PLATE BN 97MM 8 HL HIP 3.5MM SCR SM FRAG SET	BOTH IP/OP	$405.30 	$299.92	$0.00	$324.24	$182.39	$182.39	$0.00	$0.00	$0.00	$84.47	$300.81	$300.81	$0.00	$0.00	$84.46	$0.00	$239.73	$239.73	$0.00	$202.65	$321.00	$324.24	$0.00		$0.00	$63.43	$0.00	$0.00	$64.52	$0.00	$0.00	$0.00	$0.00	$0.00
71140209	SUP	HCPCS C1713		71140209  -  PLATE BN 109MM TC100 9 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$414.75 	$306.92	$0.00	$331.80	$186.64	$186.64	$0.00	$0.00	$0.00	$86.44	$307.83	$307.83	$0.00	$0.00	$86.43	$0.00	$245.32	$245.32	$0.00	$207.38	$328.48	$331.80	$0.00		$0.00	$64.91	$0.00	$0.00	$66.03	$0.00	$0.00	$0.00	$0.00	$0.00
71140210	SUP	HCPCS C1713		71140210  -  PLATE BN 121MM TC100 10 HL CMPR SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	$426.30 	$315.46	$0.00	$341.04	$191.84	$191.84	$0.00	$0.00	$0.00	$88.85	$316.40	$316.40	$0.00	$0.00	$88.84	$0.00	$252.16	$252.16	$0.00	$213.15	$337.63	$341.04	$0.00		$0.00	$66.72	$0.00	$0.00	$67.87	$0.00	$0.00	$0.00	$0.00	$0.00
71140212	SUP	HCPCS C1713		71140212  -  PLATE BN 145MM TC100 12 HL CMPR SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	$473.55 	$350.43	$0.00	$378.84	$213.10	$213.10	$0.00	$0.00	$0.00	$98.70	$351.47	$351.47	$0.00	$0.00	$98.69	$0.00	$280.10	$280.10	$0.00	$236.78	$375.05	$378.84	$0.00		$0.00	$74.11	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
71140214	SUP	HCPCS C1713		71140214  -  PLATE BN 169MM TC100 14 HL CMPR SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	$889.35 	$658.12	$0.00	$711.48	$400.21	$400.21	$0.00	$0.00	$0.00	$185.36	$660.08	$660.08	$0.00	$0.00	$185.34	$0.00	$526.05	$526.05	$0.00	$444.68	$704.37	$711.48	$0.00		$0.00	$139.18	$0.00	$0.00	$141.58	$0.00	$0.00	$0.00	$0.00	$0.00
71140216	SUP	HCPCS C1713		71140216  -  PLATE BN 194MM TC100 16 HL CMPR SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,025.85 "	$759.13	$0.00	$820.68	$461.63	$461.63	$0.00	$0.00	$0.00	$213.81	$761.39	$761.39	$0.00	$0.00	$213.79	$0.00	$606.79	$606.79	$0.00	$512.93	$812.47	$820.68	$0.00		$0.00	$160.55	$0.00	$0.00	$163.32	$0.00	$0.00	$0.00	$0.00	$0.00
71140218	SUP	HCPCS C1713		71140218  -  PLATE BN 217MM TC100 18 HL CMPR SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,380.75 "	"$1,021.76"	$0.00	"$1,104.60"	$621.34	$621.34	$0.00	$0.00	$0.00	$287.78	"$1,024.79"	"$1,024.79"	$0.00	$0.00	$287.75	$0.00	$816.71	$816.71	$0.00	$690.38	"$1,093.55"	"$1,104.60"	$0.00		$0.00	$216.09	$0.00	$0.00	$219.82	$0.00	$0.00	$0.00	$0.00	$0.00
71140220	SUP	HCPCS C1713		71140220  -  PLATE BN 242MM TC100 20 HL CMPR SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,270.50 "	$940.17	$0.00	"$1,016.40"	$571.73	$571.73	$0.00	$0.00	$0.00	$264.80	$942.97	$942.97	$0.00	$0.00	$264.77	$0.00	$751.50	$751.50	$0.00	$635.25	"$1,006.24"	"$1,016.40"	$0.00		$0.00	$198.83	$0.00	$0.00	$202.26	$0.00	$0.00	$0.00	$0.00	$0.00
71140222	SUP	HCPCS C1713		71140222  -  PLATE BN 265MM TC100 22 HL CMPR SS PLVC 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,701.00 "	"$1,258.74"	$0.00	"$1,360.80"	$765.45	$765.45	$0.00	$0.00	$0.00	$354.53	"$1,262.48"	"$1,262.48"	$0.00	$0.00	$354.49	$0.00	"$1,006.14"	"$1,006.14"	$0.00	$850.50	"$1,347.19"	"$1,360.80"	$0.00		$0.00	$266.21	$0.00	$0.00	$270.80	$0.00	$0.00	$0.00	$0.00	$0.00
71140302	SUP	HCPCS C1713		71140302  -  PLATE BN 25MM TC100 2 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM	BOTH IP/OP	$169.05 	$125.10	$0.00	$135.24	$76.07	$76.07	$0.00	$0.00	$0.00	$35.23	$125.47	$125.47	$0.00	$0.00	$35.23	$0.00	$99.99	$99.99	$0.00	$84.53	$133.89	$135.24	$0.00		$0.00	$26.46	$0.00	$0.00	$26.91	$0.00	$0.00	$0.00	$0.00	$0.00
71140303	SUP	HCPCS C1713		71140303  -  PLATE BN 37MM TC100 3 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM	BOTH IP/OP	$143.85 	$106.45	$0.00	$115.08	$64.73	$64.73	$0.00	$0.00	$0.00	$29.98	$106.77	$106.77	$0.00	$0.00	$29.98	$0.00	$85.09	$85.09	$0.00	$71.93	$113.93	$115.08	$0.00		$0.00	$22.51	$0.00	$0.00	$22.90	$0.00	$0.00	$0.00	$0.00	$0.00
71140304	SUP	HCPCS C1713		71140304  -  PLATE BN 49MM TC100 4 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM	BOTH IP/OP	$169.05 	$125.10	$0.00	$135.24	$76.07	$76.07	$0.00	$0.00	$0.00	$35.23	$125.47	$125.47	$0.00	$0.00	$35.23	$0.00	$99.99	$99.99	$0.00	$84.53	$133.89	$135.24	$0.00		$0.00	$26.46	$0.00	$0.00	$26.91	$0.00	$0.00	$0.00	$0.00	$0.00
71140305	SUP	HCPCS C1713		71140305  -  PLATE BN 61MM TC100 5 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM	BOTH IP/OP	$211.05 	$156.18	$0.00	$168.84	$94.97	$94.97	$0.00	$0.00	$0.00	$43.99	$156.64	$156.64	$0.00	$0.00	$43.98	$0.00	$124.84	$124.84	$0.00	$105.53	$167.15	$168.84	$0.00		$0.00	$33.03	$0.00	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00
71140306	SUP	HCPCS C1713		71140306  -  PLATE BN 73MM TC100 6 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM	BOTH IP/OP	$175.35 	$129.76	$0.00	$140.28	$78.91	$78.91	$0.00	$0.00	$0.00	$36.55	$130.14	$130.14	$0.00	$0.00	$36.54	$0.00	$103.72	$103.72	$0.00	$87.68	$138.88	$140.28	$0.00		$0.00	$27.44	$0.00	$0.00	$27.92	$0.00	$0.00	$0.00	$0.00	$0.00
71140307	SUP	HCPCS C1713		71140307  -  PLATE BN 1/3 TBLR 85MM NS TC100 7 HL COLR SS PLVC 3.5MM SCR	BOTH IP/OP	$175.35 	$129.76	$0.00	$140.28	$78.91	$78.91	$0.00	$0.00	$0.00	$36.55	$130.14	$130.14	$0.00	$0.00	$36.54	$0.00	$103.72	$103.72	$0.00	$87.68	$138.88	$140.28	$0.00		$0.00	$27.44	$0.00	$0.00	$27.92	$0.00	$0.00	$0.00	$0.00	$0.00
71140308	SUP	HCPCS C1713		71140308  -  PLATE BN 97MM TC100 8 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM	BOTH IP/OP	$177.45 	$131.31	$0.00	$141.96	$79.85	$79.85	$0.00	$0.00	$0.00	$36.99	$131.70	$131.70	$0.00	$0.00	$36.98	$0.00	$104.96	$104.96	$0.00	$88.73	$140.54	$141.96	$0.00		$0.00	$27.77	$0.00	$0.00	$28.25	$0.00	$0.00	$0.00	$0.00	$0.00
71140309	SUP	HCPCS C1713		71140309  -  PLATE BN 109MM TC100 9 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM	BOTH IP/OP	$177.45 	$131.31	$0.00	$141.96	$79.85	$79.85	$0.00	$0.00	$0.00	$36.99	$131.70	$131.70	$0.00	$0.00	$36.98	$0.00	$104.96	$104.96	$0.00	$88.73	$140.54	$141.96	$0.00		$0.00	$27.77	$0.00	$0.00	$28.25	$0.00	$0.00	$0.00	$0.00	$0.00
71140310	SUP	HCPCS C1713		71140310  -  PLATE BN 121MM TC100 10 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR	BOTH IP/OP	$177.45 	$131.31	$0.00	$141.96	$79.85	$79.85	$0.00	$0.00	$0.00	$36.99	$131.70	$131.70	$0.00	$0.00	$36.98	$0.00	$104.96	$104.96	$0.00	$88.73	$140.54	$141.96	$0.00		$0.00	$27.77	$0.00	$0.00	$28.25	$0.00	$0.00	$0.00	$0.00	$0.00
71140312	SUP	HCPCS C1713		71140312  -  PLATE BN 145MM TC100 12 HL 1/3 TBLR COLR SS ORTH SM FRAG SET	BOTH IP/OP	$181.65 	$134.42	$0.00	$145.32	$81.74	$81.74	$0.00	$0.00	$0.00	$37.86	$134.82	$134.82	$0.00	$0.00	$37.86	$0.00	$107.45	$107.45	$0.00	$90.83	$143.87	$145.32	$0.00		$0.00	$28.43	$0.00	$0.00	$28.92	$0.00	$0.00	$0.00	$0.00	$0.00
71140403	SUP	HCPCS C1713		71140403  -  PLATE BN SM T RT ANG 50MM TC100 3X3 HL SS PLVC SM FRAG SET	BOTH IP/OP	$313.95 	$232.32	$0.00	$251.16	$141.28	$141.28	$0.00	$0.00	$0.00	$65.44	$233.01	$233.01	$0.00	$0.00	$65.43	$0.00	$185.70	$185.70	$0.00	$156.98	$248.65	$251.16	$0.00		$0.00	$49.13	$0.00	$0.00	$49.98	$0.00	$0.00	$0.00	$0.00	$0.00
71140404	SUP	HCPCS C1713		71140404  -  PLATE BN SM T RT ANG 50MM TC100 4X4 HL SS PLVC SM FRAG SET	BOTH IP/OP	$320.25 	$236.99	$0.00	$256.20	$144.11	$144.11	$0.00	$0.00	$0.00	$66.75	$237.69	$237.69	$0.00	$0.00	$66.74	$0.00	$189.43	$189.43	$0.00	$160.13	$253.64	$256.20	$0.00		$0.00	$50.12	$0.00	$0.00	$50.98	$0.00	$0.00	$0.00	$0.00	$0.00
71140405	SUP	HCPCS C1713		71140405  -  PLATE BN SM T RT ANG 50MM TC100 3X5 HL SS PLVC SM FRAG SET	BOTH IP/OP	$360.15 	$266.51	$0.00	$288.12	$162.07	$162.07	$0.00	$0.00	$0.00	$75.06	$267.30	$267.30	$0.00	$0.00	$75.06	$0.00	$213.03	$213.03	$0.00	$180.08	$285.24	$288.12	$0.00		$0.00	$56.36	$0.00	$0.00	$57.34	$0.00	$0.00	$0.00	$0.00	$0.00
71140406	SUP	HCPCS C1713		71140406  -  PLATE BN 78MM TC100 4 HLE/HD 6 HL SHFT T RT ANG SS ORTH SM	BOTH IP/OP	$414.75 	$306.92	$0.00	$331.80	$186.64	$186.64	$0.00	$0.00	$0.00	$86.44	$307.83	$307.83	$0.00	$0.00	$86.43	$0.00	$245.32	$245.32	$0.00	$207.38	$328.48	$331.80	$0.00		$0.00	$64.91	$0.00	$0.00	$66.03	$0.00	$0.00	$0.00	$0.00	$0.00
71140503	SUP	HCPCS C1713		71140503  -  PLATE BN SM T OBLQ 53MM TC100 3X3 HL SS PLVC SM FRAG SET	BOTH IP/OP	$563.85 	$417.25	$0.00	$451.08	$253.73	$253.73	$0.00	$0.00	$0.00	$117.52	$418.49	$418.49	$0.00	$0.00	$117.51	$0.00	$333.52	$333.52	$0.00	$281.93	$446.57	$451.08	$0.00		$0.00	$88.24	$0.00	$0.00	$89.76	$0.00	$0.00	$0.00	$0.00	$0.00
71140504	SUP	HCPCS C1713		71140504  -  PLATE BN SM T OBLQ 53MM TC100 3X4 HL SS PLVC SM FRAG SET	BOTH IP/OP	$588.00 	$435.12	$0.00	$470.40	$264.60	$264.60	$0.00	$0.00	$0.00	$122.55	$436.41	$436.41	$0.00	$0.00	$122.54	$0.00	$347.80	$347.80	$0.00	$294.00	$465.70	$470.40	$0.00		$0.00	$92.02	$0.00	$0.00	$93.61	$0.00	$0.00	$0.00	$0.00	$0.00
71140505	SUP	HCPCS C1713		71140505  -  PLATE BN SM T OBLQ 53MM TC100 3X5 HL SS PLVC SM FRAG SET	BOTH IP/OP	$609.00 	$450.66	$0.00	$487.20	$274.05	$274.05	$0.00	$0.00	$0.00	$126.93	$452.00	$452.00	$0.00	$0.00	$126.92	$0.00	$360.22	$360.22	$0.00	$304.50	$482.33	$487.20	$0.00		$0.00	$95.31	$0.00	$0.00	$96.95	$0.00	$0.00	$0.00	$0.00	$0.00
71140603	SUP	HCPCS C1713		71140603  -  PLATE BN 88MM TC100 3 HL CLVRLF SS ORTH SM FRAG SET	BOTH IP/OP	$744.45 	$550.89	$0.00	$595.56	$335.00	$335.00	$0.00	$0.00	$0.00	$155.16	$552.53	$552.53	$0.00	$0.00	$155.14	$0.00	$440.34	$440.34	$0.00	$372.23	$589.60	$595.56	$0.00		$0.00	$116.51	$0.00	$0.00	$118.52	$0.00	$0.00	$0.00	$0.00	$0.00
71140604	SUP	HCPCS C1713		71140604  -  PLATE BN 104MM TC100 4 HL CLVRLF SS ORTH SM FRAG SET	BOTH IP/OP	$798.00 	$590.52	$0.00	$638.40	$359.10	$359.10	$0.00	$0.00	$0.00	$166.32	$592.28	$592.28	$0.00	$0.00	$166.30	$0.00	$472.02	$472.02	$0.00	$399.00	$632.02	$638.40	$0.00		$0.00	$124.89	$0.00	$0.00	$127.04	$0.00	$0.00	$0.00	$0.00	$0.00
71140606	SUP	HCPCS C1713		71140606  -  PLATE BN 70MM TC100 6 HL CRV RECON SS PLVC 3.5MM SCR	BOTH IP/OP	"$1,039.50 "	$769.23	$0.00	$831.60	$467.78	$467.78	$0.00	$0.00	$0.00	$216.66	$771.52	$771.52	$0.00	$0.00	$216.63	$0.00	$614.86	$614.86	$0.00	$519.75	$823.28	$831.60	$0.00		$0.00	$162.68	$0.00	$0.00	$165.49	$0.00	$0.00	$0.00	$0.00	$0.00
71140608	SUP	HCPCS C1713		71140608  -  PLATE BN 94MM TC100 8 HL CRV RECON SS PLVC 3.5MM SCR	BOTH IP/OP	"$1,134.00 "	$839.16	$0.00	$907.20	$510.30	$510.30	$0.00	$0.00	$0.00	$236.35	$841.65	$841.65	$0.00	$0.00	$236.33	$0.00	$670.76	$670.76	$0.00	$567.00	$898.13	$907.20	$0.00		$0.00	$177.47	$0.00	$0.00	$180.53	$0.00	$0.00	$0.00	$0.00	$0.00
71140610	SUP	HCPCS C1713		71140610  -  PLATE BN 118MM TC100 10 HL CRV RECON SS PLVC 3.5MM SCR	BOTH IP/OP	"$1,186.50 "	$878.01	$0.00	$949.20	$533.93	$533.93	$0.00	$0.00	$0.00	$247.30	$880.62	$880.62	$0.00	$0.00	$247.27	$0.00	$701.81	$701.81	$0.00	$593.25	$939.71	$949.20	$0.00		$0.00	$185.69	$0.00	$0.00	$188.89	$0.00	$0.00	$0.00	$0.00	$0.00
71140612	SUP	HCPCS C1713		71140612  -  PLATE BN 142MM TC100 12 HL CRV RECON SS PLVC 3.5MM SCR	BOTH IP/OP	"$1,244.25 "	$920.75	$0.00	$995.40	$559.91	$559.91	$0.00	$0.00	$0.00	$259.33	$923.48	$923.48	$0.00	$0.00	$259.30	$0.00	$735.97	$735.97	$0.00	$622.13	$985.45	$995.40	$0.00		$0.00	$194.73	$0.00	$0.00	$198.08	$0.00	$0.00	$0.00	$0.00	$0.00
71140614	SUP	HCPCS C1713		71140614  -  PLATE BN 166MM TC100 14 HL CRV RECON SS PLVC 3.5MM SCR	BOTH IP/OP	"$1,401.75 "	"$1,037.30"	$0.00	"$1,121.40"	$630.79	$630.79	$0.00	$0.00	$0.00	$292.16	"$1,040.38"	"$1,040.38"	$0.00	$0.00	$292.12	$0.00	$829.14	$829.14	$0.00	$700.88	"$1,110.19"	"$1,121.40"	$0.00		$0.00	$219.37	$0.00	$0.00	$223.16	$0.00	$0.00	$0.00	$0.00	$0.00
71140616	SUP	HCPCS C1713		71140616  -  PLATE BN 190MM TC100 16 HL CRV RECON SS PLVC 3.5MM SCR	BOTH IP/OP	"$1,485.75 "	"$1,099.46"	$0.00	"$1,188.60"	$668.59	$668.59	$0.00	$0.00	$0.00	$309.67	"$1,102.72"	"$1,102.72"	$0.00	$0.00	$309.63	$0.00	$878.82	$878.82	$0.00	$742.88	"$1,176.71"	"$1,188.60"	$0.00		$0.00	$232.52	$0.00	$0.00	$236.53	$0.00	$0.00	$0.00	$0.00	$0.00
71140618	SUP	HCPCS C1713		71140618  -  PLATE BN 214MM TC100 18 HL CRV RECON SS PLVC 3.5MM SCR	BOTH IP/OP	"$1,601.25 "	"$1,184.93"	$0.00	"$1,281.00"	$720.56	$720.56	$0.00	$0.00	$0.00	$333.74	"$1,188.45"	"$1,188.45"	$0.00	$0.00	$333.70	$0.00	$947.14	$947.14	$0.00	$800.63	"$1,268.19"	"$1,281.00"	$0.00		$0.00	$250.60	$0.00	$0.00	$254.92	$0.00	$0.00	$0.00	$0.00	$0.00
71140625	SUP	HCPCS C1713		71140625  -  PLATE BN 120MM TC100 5 HL CLVRLF SS ORTH SM FRAG SET	BOTH IP/OP	"$1,013.25 "	$749.81	$0.00	$810.60	$455.96	$455.96	$0.00	$0.00	$0.00	$211.19	$752.03	$752.03	$0.00	$0.00	$211.16	$0.00	$599.34	$599.34	$0.00	$506.63	$802.49	$810.60	$0.00		$0.00	$158.57	$0.00	$0.00	$161.31	$0.00	$0.00	$0.00	$0.00	$0.00
71140626	SUP	HCPCS C1713		71140626  -  PLATE BN 136MM TC100 6 HL CLVRLF SS ORTH SM FRAG SET	BOTH IP/OP	"$1,113.00 "	$823.62	$0.00	$890.40	$500.85	$500.85	$0.00	$0.00	$0.00	$231.98	$826.07	$826.07	$0.00	$0.00	$231.95	$0.00	$658.34	$658.34	$0.00	$556.50	$881.50	$890.40	$0.00		$0.00	$174.18	$0.00	$0.00	$177.19	$0.00	$0.00	$0.00	$0.00	$0.00
71140627	SUP	HCPCS C1713		71140627  -  PLATE BN 152MM TC100 7 HL CLVRLF SS ORTH SM FRAG SET	BOTH IP/OP	"$1,186.50 "	$878.01	$0.00	$949.20	$533.93	$533.93	$0.00	$0.00	$0.00	$247.30	$880.62	$880.62	$0.00	$0.00	$247.27	$0.00	$701.81	$701.81	$0.00	$593.25	$939.71	$949.20	$0.00		$0.00	$185.69	$0.00	$0.00	$188.89	$0.00	$0.00	$0.00	$0.00	$0.00
71140628	SUP	HCPCS C1713		71140628  -  PLATE BN 168MM TC100 8 HL CLVRLF SS ORTH SM FRAG SET	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71140629	SUP	HCPCS C1713		71140629  -  PLATE BN 184MM TC100 9 HL CLVRLF SS ORTH SM FRAG SET	BOTH IP/OP	"$1,365.00 "	"$1,010.10"	$0.00	"$1,092.00"	$614.25	$614.25	$0.00	$0.00	$0.00	$284.50	"$1,013.10"	"$1,013.10"	$0.00	$0.00	$284.47	$0.00	$807.40	$807.40	$0.00	$682.50	"$1,081.08"	"$1,092.00"	$0.00		$0.00	$213.62	$0.00	$0.00	$217.31	$0.00	$0.00	$0.00	$0.00	$0.00
71140704	SUP	HCPCS C1713		71140704  -  PLATE BN 80MM TC100 4 HL T BTRS SS ORTH LG FRAG SET	BOTH IP/OP	$926.10 	$685.31	$0.00	$740.88	$416.75	$416.75	$0.00	$0.00	$0.00	$193.02	$687.35	$687.35	$0.00	$0.00	$193.00	$0.00	$547.79	$547.79	$0.00	$463.05	$733.47	$740.88	$0.00		$0.00	$144.93	$0.00	$0.00	$147.44	$0.00	$0.00	$0.00	$0.00	$0.00
71140705	SUP	HCPCS C1713		71140705  -  PLATE BN 96MM TC100 5 HL T BTRS SS ORTH LG FRAG SET	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
71140706	SUP	HCPCS C1713		71140706  -  PLATE BN 112MM TC100 6 HL T BTRS SS ORTH LG FRAG SET	BOTH IP/OP	"$1,249.50 "	$924.63	$0.00	$999.60	$562.28	$562.28	$0.00	$0.00	$0.00	$260.43	$927.38	$927.38	$0.00	$0.00	$260.40	$0.00	$739.08	$739.08	$0.00	$624.75	$989.60	$999.60	$0.00		$0.00	$195.55	$0.00	$0.00	$198.92	$0.00	$0.00	$0.00	$0.00	$0.00
71140804	SUP	HCPCS C1713		71140804  -  PLATE BN 86MM TC100 4 HL L BTRS RT ANG SS TIB LT LG FRAG SET	BOTH IP/OP	$828.45 	$613.05	$0.00	$662.76	$372.80	$372.80	$0.00	$0.00	$0.00	$172.67	$614.88	$614.88	$0.00	$0.00	$172.65	$0.00	$490.03	$490.03	$0.00	$414.23	$656.13	$662.76	$0.00		$0.00	$129.65	$0.00	$0.00	$131.89	$0.00	$0.00	$0.00	$0.00	$0.00
71140904	SUP	HCPCS C1713		71140904  -  PLATE BN 86MM TC100 4 HL L BTRS LT ANG SS TIB RT LG FRAG SET	BOTH IP/OP	$828.45 	$613.05	$0.00	$662.76	$372.80	$372.80	$0.00	$0.00	$0.00	$172.67	$614.88	$614.88	$0.00	$0.00	$172.65	$0.00	$490.03	$490.03	$0.00	$414.23	$656.13	$662.76	$0.00		$0.00	$129.65	$0.00	$0.00	$131.89	$0.00	$0.00	$0.00	$0.00	$0.00
71141003	SUP	HCPCS C1713		71141003  -  PLATE BN 86.5MM TC100 3 HL BTRS SS TIBHD RL LG FRAG SET	BOTH IP/OP	"$1,422.75 "	"$1,052.84"	$0.00	"$1,138.20"	$640.24	$640.24	$0.00	$0.00	$0.00	$296.54	"$1,055.97"	"$1,055.97"	$0.00	$0.00	$296.50	$0.00	$841.56	$841.56	$0.00	$711.38	"$1,126.82"	"$1,138.20"	$0.00		$0.00	$222.66	$0.00	$0.00	$226.50	$0.00	$0.00	$0.00	$0.00	$0.00
71141005	SUP	HCPCS C1713		71141005  -  PLATE BN 188MM TC100 5 HL BTRS SS TIBHD RL LG FRAG SET	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71141007	SUP	HCPCS C1713		71141007  -  PLATE BN 149MM TC100 7 HL BTRS SS TIBHD RL LG FRAG SET	BOTH IP/OP	"$1,785.00 "	"$1,320.90"	$0.00	"$1,428.00"	$803.25	$803.25	$0.00	$0.00	$0.00	$372.04	"$1,324.83"	"$1,324.83"	$0.00	$0.00	$371.99	$0.00	"$1,055.83"	"$1,055.83"	$0.00	$892.50	"$1,413.72"	"$1,428.00"	$0.00		$0.00	$279.35	$0.00	$0.00	$284.17	$0.00	$0.00	$0.00	$0.00	$0.00
71141009	SUP	HCPCS C1713		71141009  -  PLATE BN 181MM TC100 9 HL BTRS SS TIBHD RL LG FRAG SET	BOTH IP/OP	"$1,905.75 "	"$1,410.26"	$0.00	"$1,524.60"	$857.59	$857.59	$0.00	$0.00	$0.00	$397.21	"$1,414.45"	"$1,414.45"	$0.00	$0.00	$397.16	$0.00	"$1,127.25"	"$1,127.25"	$0.00	$952.88	"$1,509.35"	"$1,524.60"	$0.00		$0.00	$298.25	$0.00	$0.00	$303.40	$0.00	$0.00	$0.00	$0.00	$0.00
71141011	SUP	HCPCS C1713		71141011  -  PLATE BN 214MM TC100 11 HL BTRS SS TIBHD RL LG FRAG SET	BOTH IP/OP	"$2,499.00 "	"$1,849.26"	$0.00	"$1,999.20"	"$1,124.55"	"$1,124.55"	$0.00	$0.00	$0.00	$520.85	"$1,854.76"	"$1,854.76"	$0.00	$0.00	$520.79	$0.00	"$1,478.16"	"$1,478.16"	$0.00	"$1,249.50"	"$1,979.21"	"$1,999.20"	$0.00		$0.00	$391.09	$0.00	$0.00	$397.84	$0.00	$0.00	$0.00	$0.00	$0.00
71141013	SUP	HCPCS C1713		71141013  -  PLATE BN 246MM TC100 13 HL BTRS SS TIBHD RL LG FRAG SET	BOTH IP/OP	"$2,593.50 "	"$1,919.19"	$0.00	"$2,074.80"	"$1,167.08"	"$1,167.08"	$0.00	$0.00	$0.00	$540.55	"$1,924.90"	"$1,924.90"	$0.00	$0.00	$540.49	$0.00	"$1,278.60"	"$1,278.60"	$0.00	"$1,296.75"	"$2,054.05"	"$2,074.80"	$0.00		$0.00	$405.88	$0.00	$0.00	$412.89	$0.00	$0.00	$0.00	$0.00	$0.00
71141103	SUP	HCPCS C1713		71141103  -  PLATE BN 86.5MM TC100 3 HL BTRS SS TIBHD L/L LG FRAG SET	BOTH IP/OP	"$1,422.75 "	"$1,052.84"	$0.00	"$1,138.20"	$640.24	$640.24	$0.00	$0.00	$0.00	$296.54	"$1,055.97"	"$1,055.97"	$0.00	$0.00	$296.50	$0.00	$841.56	$841.56	$0.00	$711.38	"$1,126.82"	"$1,138.20"	$0.00		$0.00	$222.66	$0.00	$0.00	$226.50	$0.00	$0.00	$0.00	$0.00	$0.00
71141105	SUP	HCPCS C1713		71141105  -  PLATE BN 188MM TC100 5 HL BTRS SS TIBHD L/L LG FRAG SET	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71141107	SUP	HCPCS C1713		71141107  -  PLATE BN 149MM TC100 7 HL BTRS SS TIBHD L/L LG FRAG SET	BOTH IP/OP	"$1,785.00 "	"$1,320.90"	$0.00	"$1,428.00"	$803.25	$803.25	$0.00	$0.00	$0.00	$372.04	"$1,324.83"	"$1,324.83"	$0.00	$0.00	$371.99	$0.00	"$1,055.83"	"$1,055.83"	$0.00	$892.50	"$1,413.72"	"$1,428.00"	$0.00		$0.00	$279.35	$0.00	$0.00	$284.17	$0.00	$0.00	$0.00	$0.00	$0.00
71141109	SUP	HCPCS C1713		71141109  -  PLATE BN 181MM TC100 9 HL BTRS SS TIBHD L/L LG FRAG SET	BOTH IP/OP	"$1,905.75 "	"$1,410.26"	$0.00	"$1,524.60"	$857.59	$857.59	$0.00	$0.00	$0.00	$397.21	"$1,414.45"	"$1,414.45"	$0.00	$0.00	$397.16	$0.00	"$1,127.25"	"$1,127.25"	$0.00	$952.88	"$1,509.35"	"$1,524.60"	$0.00		$0.00	$298.25	$0.00	$0.00	$303.40	$0.00	$0.00	$0.00	$0.00	$0.00
71141111	SUP	HCPCS C1713		71141111  -  PLATE BN 214MM TC100 11 HL BTRS SS TIBHD L/L LG FRAG SET	BOTH IP/OP	"$2,499.00 "	"$1,849.26"	$0.00	"$1,999.20"	"$1,124.55"	"$1,124.55"	$0.00	$0.00	$0.00	$520.85	"$1,854.76"	"$1,854.76"	$0.00	$0.00	$520.79	$0.00	"$1,478.16"	"$1,478.16"	$0.00	"$1,249.50"	"$1,979.21"	"$1,999.20"	$0.00		$0.00	$391.09	$0.00	$0.00	$397.84	$0.00	$0.00	$0.00	$0.00	$0.00
71141113	SUP	HCPCS C1713		71141113  -  PLATE BN 246MM TC100 13 HL BTRS SS TIBHD L/L LG FRAG SET	BOTH IP/OP	"$2,593.50 "	"$1,919.19"	$0.00	"$2,074.80"	"$1,167.08"	"$1,167.08"	$0.00	$0.00	$0.00	$540.55	"$1,924.90"	"$1,924.90"	$0.00	$0.00	$540.49	$0.00	"$1,278.60"	"$1,278.60"	$0.00	"$1,296.75"	"$2,054.05"	"$2,074.80"	$0.00		$0.00	$405.88	$0.00	$0.00	$412.89	$0.00	$0.00	$0.00	$0.00	$0.00
71141206	SUP	HCPCS C1713		71141206  -  PLATE BN BRD 103MM TC100 6 HL CMPR SS ORTH 4.5MM SCR LG FRAG	BOTH IP/OP	$546.00 	$404.04	$0.00	$436.80	$245.70	$245.70	$0.00	$0.00	$0.00	$113.80	$405.24	$405.24	$0.00	$0.00	$113.79	$0.00	$322.96	$322.96	$0.00	$273.00	$432.43	$436.80	$0.00		$0.00	$85.45	$0.00	$0.00	$86.92	$0.00	$0.00	$0.00	$0.00	$0.00
71141207	SUP	HCPCS C1713		71141207  -  PLATE BN BRD 119MM TC100 7 HL CMPR SS ORTH 4.5MM SCR LG FRAG	BOTH IP/OP	$546.00 	$404.04	$0.00	$436.80	$245.70	$245.70	$0.00	$0.00	$0.00	$113.80	$405.24	$405.24	$0.00	$0.00	$113.79	$0.00	$322.96	$322.96	$0.00	$273.00	$432.43	$436.80	$0.00		$0.00	$85.45	$0.00	$0.00	$86.92	$0.00	$0.00	$0.00	$0.00	$0.00
71141208	SUP	HCPCS C1713		71141208  -  PLATE BN BRD 135MM TC100 8 HL CMPR SS ORTH 4.5MM SCR LG FRAG	BOTH IP/OP	$680.40 	$503.50	$0.00	$544.32	$306.18	$306.18	$0.00	$0.00	$0.00	$141.81	$504.99	$504.99	$0.00	$0.00	$141.80	$0.00	$402.46	$402.46	$0.00	$340.20	$538.88	$544.32	$0.00		$0.00	$106.48	$0.00	$0.00	$108.32	$0.00	$0.00	$0.00	$0.00	$0.00
71141209	SUP	HCPCS C1713		71141209  -  PLATE BN BRD 151MM TC100 9 HL CMPR SS ORTH 4.5MM SCR LG FRAG	BOTH IP/OP	$680.40 	$503.50	$0.00	$544.32	$306.18	$306.18	$0.00	$0.00	$0.00	$141.81	$504.99	$504.99	$0.00	$0.00	$141.80	$0.00	$402.46	$402.46	$0.00	$340.20	$538.88	$544.32	$0.00		$0.00	$106.48	$0.00	$0.00	$108.32	$0.00	$0.00	$0.00	$0.00	$0.00
71141210	SUP	HCPCS C1713		71141210  -  PLATE BN BRD 167MM TC100 10 HL CMPR SS 4.5MM SCR LG FRAG SET	BOTH IP/OP	$680.40 	$503.50	$0.00	$544.32	$306.18	$306.18	$0.00	$0.00	$0.00	$141.81	$504.99	$504.99	$0.00	$0.00	$141.80	$0.00	$402.46	$402.46	$0.00	$340.20	$538.88	$544.32	$0.00		$0.00	$106.48	$0.00	$0.00	$108.32	$0.00	$0.00	$0.00	$0.00	$0.00
71141212	SUP	HCPCS C1713		71141212  -  PLATE BN BRD 199MM TC100 12 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	$731.85 	$541.57	$0.00	$585.48	$329.33	$329.33	$0.00	$0.00	$0.00	$152.54	$543.18	$543.18	$0.00	$0.00	$152.52	$0.00	$432.89	$432.89	$0.00	$365.93	$579.63	$585.48	$0.00		$0.00	$114.53	$0.00	$0.00	$116.51	$0.00	$0.00	$0.00	$0.00	$0.00
71141214	SUP	HCPCS C1713		71141214  -  PLATE BN BRD 231MM TC100 14 HL CMPR SS 4.5MM SCR LG FRAG SET	BOTH IP/OP	$731.85 	$541.57	$0.00	$585.48	$329.33	$329.33	$0.00	$0.00	$0.00	$152.54	$543.18	$543.18	$0.00	$0.00	$152.52	$0.00	$432.89	$432.89	$0.00	$365.93	$579.63	$585.48	$0.00		$0.00	$114.53	$0.00	$0.00	$116.51	$0.00	$0.00	$0.00	$0.00	$0.00
71141216	SUP	HCPCS C1713		71141216  -  PLATE BN BRD 263MM TC100 16 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	$926.10 	$685.31	$0.00	$740.88	$416.75	$416.75	$0.00	$0.00	$0.00	$193.02	$687.35	$687.35	$0.00	$0.00	$193.00	$0.00	$547.79	$547.79	$0.00	$463.05	$733.47	$740.88	$0.00		$0.00	$144.93	$0.00	$0.00	$147.44	$0.00	$0.00	$0.00	$0.00	$0.00
71141218	SUP	HCPCS C1713		71141218  -  PLATE BN BRD 295MM TC100 18 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	"$1,022.70 "	$756.80	$0.00	$818.16	$460.22	$460.22	$0.00	$0.00	$0.00	$213.16	$759.05	$759.05	$0.00	$0.00	$213.13	$0.00	$604.93	$604.93	$0.00	$511.35	$809.98	$818.16	$0.00		$0.00	$160.05	$0.00	$0.00	$162.81	$0.00	$0.00	$0.00	$0.00	$0.00
71141220	SUP	HCPCS C1713		71141220  -  PLATE BN BRD 326MM TC100 20 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	"$1,459.50 "	"$1,080.03"	$0.00	"$1,167.60"	$656.78	$656.78	$0.00	$0.00	$0.00	$304.20	"$1,083.24"	"$1,083.24"	$0.00	$0.00	$304.16	$0.00	$863.29	$863.29	$0.00	$729.75	"$1,155.92"	"$1,167.60"	$0.00		$0.00	$228.41	$0.00	$0.00	$232.35	$0.00	$0.00	$0.00	$0.00	$0.00
71141222	SUP	HCPCS C1713		71141222  -  PLATE BN BRD 358MM TC100 22 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	"$1,543.50 "	"$1,142.19"	$0.00	"$1,234.80"	$694.58	$694.58	$0.00	$0.00	$0.00	$321.70	"$1,145.59"	"$1,145.59"	$0.00	$0.00	$321.67	$0.00	$912.98	$912.98	$0.00	$771.75	"$1,222.45"	"$1,234.80"	$0.00		$0.00	$241.56	$0.00	$0.00	$245.73	$0.00	$0.00	$0.00	$0.00	$0.00
71141224	SUP	HCPCS C1713		71141224  -  PLATE BN BRD 390MM TC100 24 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	"$1,711.50 "	"$1,266.51"	$0.00	"$1,369.20"	$770.18	$770.18	$0.00	$0.00	$0.00	$356.72	"$1,270.28"	"$1,270.28"	$0.00	$0.00	$356.68	$0.00	"$1,012.35"	"$1,012.35"	$0.00	$855.75	"$1,355.51"	"$1,369.20"	$0.00		$0.00	$267.85	$0.00	$0.00	$272.47	$0.00	$0.00	$0.00	$0.00	$0.00
71141226	SUP	HCPCS C1713		71141226  -  PLATE BN BRD 423MM TC100 26 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	"$1,811.25 "	"$1,340.33"	$0.00	"$1,449.00"	$815.06	$815.06	$0.00	$0.00	$0.00	$377.51	"$1,344.31"	"$1,344.31"	$0.00	$0.00	$377.46	$0.00	"$1,071.35"	"$1,071.35"	$0.00	$905.63	"$1,434.51"	"$1,449.00"	$0.00		$0.00	$283.46	$0.00	$0.00	$288.35	$0.00	$0.00	$0.00	$0.00	$0.00
71141302	SUP	HCPCS C1713		71141302  -  PLATE BN 39MM TC100 2 HL SMTB SS ORTH LG FRAG SET	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
71141303	SUP	HCPCS C1713		71141303  -  PLATE BN 55MM TC100 3 HL SMTB SS ORTH LG FRAG SET	BOTH IP/OP	$147.00 	$108.78	$0.00	$117.60	$66.15	$66.15	$0.00	$0.00	$0.00	$30.64	$109.10	$109.10	$0.00	$0.00	$30.63	$0.00	$86.95	$86.95	$0.00	$73.50	$116.42	$117.60	$0.00		$0.00	$23.01	$0.00	$0.00	$23.40	$0.00	$0.00	$0.00	$0.00	$0.00
71141304	SUP	HCPCS C1713		71141304  -  PLATE BN 71MM TC100 4 HL SMTB SS ORTH LG FRAG SET	BOTH IP/OP	$159.60 	$118.10	$0.00	$127.68	$71.82	$71.82	$0.00	$0.00	$0.00	$33.26	$118.46	$118.46	$0.00	$0.00	$33.26	$0.00	$94.40	$94.40	$0.00	$79.80	$126.40	$127.68	$0.00		$0.00	$24.98	$0.00	$0.00	$25.41	$0.00	$0.00	$0.00	$0.00	$0.00
71141305	SUP	HCPCS C1713		71141305  -  PLATE BN 87MM TC100 5 HL SMTB SS ORTH LG FRAG SET	BOTH IP/OP	$166.95 	$123.54	$0.00	$133.56	$75.13	$75.13	$0.00	$0.00	$0.00	$34.80	$123.91	$123.91	$0.00	$0.00	$34.79	$0.00	$98.75	$98.75	$0.00	$83.48	$132.22	$133.56	$0.00		$0.00	$26.13	$0.00	$0.00	$26.58	$0.00	$0.00	$0.00	$0.00	$0.00
71141306	SUP	HCPCS C1713		71141306  -  PLATE BN 103MM TC100 6 HL SMTB SS ORTH LG FRAG SET	BOTH IP/OP	$177.45 	$131.31	$0.00	$141.96	$79.85	$79.85	$0.00	$0.00	$0.00	$36.99	$131.70	$131.70	$0.00	$0.00	$36.98	$0.00	$104.96	$104.96	$0.00	$88.73	$140.54	$141.96	$0.00		$0.00	$27.77	$0.00	$0.00	$28.25	$0.00	$0.00	$0.00	$0.00	$0.00
71141307	SUP	HCPCS C1713		71141307  -  PLATE BN 119MM TC100 7 HL SMTB SS ORTH LG FRAG SET	BOTH IP/OP	$192.15 	$142.19	$0.00	$153.72	$86.47	$86.47	$0.00	$0.00	$0.00	$40.05	$142.61	$142.61	$0.00	$0.00	$40.04	$0.00	$113.66	$113.66	$0.00	$96.08	$152.18	$153.72	$0.00		$0.00	$30.07	$0.00	$0.00	$30.59	$0.00	$0.00	$0.00	$0.00	$0.00
71141308	SUP	HCPCS C1713		71141308  -  PLATE BN 135MM TC100 8 HL SMTB SS ORTH LG FRAG SET	BOTH IP/OP	$246.75 	$182.60	$0.00	$197.40	$111.04	$111.04	$0.00	$0.00	$0.00	$51.43	$183.14	$183.14	$0.00	$0.00	$51.42	$0.00	$145.95	$145.95	$0.00	$123.38	$195.43	$197.40	$0.00		$0.00	$38.62	$0.00	$0.00	$39.28	$0.00	$0.00	$0.00	$0.00	$0.00
71141309	SUP	HCPCS C1713		71141309  -  PLATE BN 151MM TC100 9 HL SMTB SS ORTH LG FRAG SET	BOTH IP/OP	$218.40 	$161.62	$0.00	$174.72	$98.28	$98.28	$0.00	$0.00	$0.00	$45.52	$162.10	$162.10	$0.00	$0.00	$45.51	$0.00	$129.18	$129.18	$0.00	$109.20	$172.97	$174.72	$0.00		$0.00	$34.18	$0.00	$0.00	$34.77	$0.00	$0.00	$0.00	$0.00	$0.00
71141310	SUP	HCPCS C1713		71141310  -  PLATE BN 167MM TC100 10 HL SMTB SS ORTH LG FRAG SET	BOTH IP/OP	$270.90 	$200.47	$0.00	$216.72	$121.91	$121.91	$0.00	$0.00	$0.00	$56.46	$201.06	$201.06	$0.00	$0.00	$56.46	$0.00	$160.24	$160.24	$0.00	$135.45	$214.55	$216.72	$0.00		$0.00	$42.40	$0.00	$0.00	$43.13	$0.00	$0.00	$0.00	$0.00	$0.00
71141311	SUP	HCPCS C1713		71141311  -  PLATE BN 183MM TC100 11 HL SMTB SS ORTH LG FRAG SET	BOTH IP/OP	$282.45 	$209.01	$0.00	$225.96	$127.10	$127.10	$0.00	$0.00	$0.00	$58.87	$209.63	$209.63	$0.00	$0.00	$58.86	$0.00	$167.07	$167.07	$0.00	$141.23	$223.70	$225.96	$0.00		$0.00	$44.20	$0.00	$0.00	$44.97	$0.00	$0.00	$0.00	$0.00	$0.00
71141312	SUP	HCPCS C1713		71141312  -  PLATE BN 199MM TC100 12 HL SMTB SS ORTH LG FRAG SET	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$129.94	$129.94	$0.00	$0.00	$0.00	$60.18	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$170.80	$170.80	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$45.19	$0.00	$0.00	$45.97	$0.00	$0.00	$0.00	$0.00	$0.00
71141402	SUP	HCPCS C1713		71141402  -  PLATE BN NAR 39MM TC100 2 HL CMPR SS ORTH 4.5MM SCR	BOTH IP/OP	$352.80 	$261.07	$0.00	$282.24	$158.76	$158.76	$0.00	$0.00	$0.00	$73.53	$261.85	$261.85	$0.00	$0.00	$73.52	$0.00	$208.68	$208.68	$0.00	$176.40	$279.42	$282.24	$0.00		$0.00	$55.21	$0.00	$0.00	$56.17	$0.00	$0.00	$0.00	$0.00	$0.00
71141403	SUP	HCPCS C1713		71141403  -  PLATE BN NAR 55MM TC100 3 HL CMPR SS 4.5MM SCR LG FRAG SET	BOTH IP/OP	$368.55 	$272.73	$0.00	$294.84	$165.85	$165.85	$0.00	$0.00	$0.00	$76.82	$273.54	$273.54	$0.00	$0.00	$76.81	$0.00	$218.00	$218.00	$0.00	$184.28	$291.89	$294.84	$0.00		$0.00	$57.68	$0.00	$0.00	$58.67	$0.00	$0.00	$0.00	$0.00	$0.00
71141404	SUP	HCPCS C1713		71141404  -  PLATE BN NAR 71MM TC100 4 HL CMPR SS ORTH 4.5MM SCR LG FRAG	BOTH IP/OP	$368.55 	$272.73	$0.00	$294.84	$165.85	$165.85	$0.00	$0.00	$0.00	$76.82	$273.54	$273.54	$0.00	$0.00	$76.81	$0.00	$218.00	$218.00	$0.00	$184.28	$291.89	$294.84	$0.00		$0.00	$57.68	$0.00	$0.00	$58.67	$0.00	$0.00	$0.00	$0.00	$0.00
71141405	SUP	HCPCS C1713		71141405  -  PLATE BN NAR 87MM TC100 5 HL CMPR SS ORTH 4.5MM SCR LG FRAG	BOTH IP/OP	$368.55 	$272.73	$0.00	$294.84	$165.85	$165.85	$0.00	$0.00	$0.00	$76.82	$273.54	$273.54	$0.00	$0.00	$76.81	$0.00	$218.00	$218.00	$0.00	$184.28	$291.89	$294.84	$0.00		$0.00	$57.68	$0.00	$0.00	$58.67	$0.00	$0.00	$0.00	$0.00	$0.00
71141406	SUP	HCPCS C1713		71141406  -  PLATE BN NAR 103MM TC100 6 HL CMPR SS ORTH 4.5MM SCR LG FRAG	BOTH IP/OP	$410.55 	$303.81	$0.00	$328.44	$184.75	$184.75	$0.00	$0.00	$0.00	$85.57	$304.71	$304.71	$0.00	$0.00	$85.56	$0.00	$242.84	$242.84	$0.00	$205.28	$325.16	$328.44	$0.00		$0.00	$64.25	$0.00	$0.00	$65.36	$0.00	$0.00	$0.00	$0.00	$0.00
71141407	SUP	HCPCS C1713		71141407  -  PLATE BN NAR 119MM TC100 7 HL CMPR SS ORTH 4.5MM SCR LG FRAG	BOTH IP/OP	$410.55 	$303.81	$0.00	$328.44	$184.75	$184.75	$0.00	$0.00	$0.00	$85.57	$304.71	$304.71	$0.00	$0.00	$85.56	$0.00	$242.84	$242.84	$0.00	$205.28	$325.16	$328.44	$0.00		$0.00	$64.25	$0.00	$0.00	$65.36	$0.00	$0.00	$0.00	$0.00	$0.00
71141408	SUP	HCPCS C1713		71141408  -  PLATE BN NAR 135MM TC100 8 HL CMPR SS ORTH 4.5MM SCR	BOTH IP/OP	$410.55 	$303.81	$0.00	$328.44	$184.75	$184.75	$0.00	$0.00	$0.00	$85.57	$304.71	$304.71	$0.00	$0.00	$85.56	$0.00	$242.84	$242.84	$0.00	$205.28	$325.16	$328.44	$0.00		$0.00	$64.25	$0.00	$0.00	$65.36	$0.00	$0.00	$0.00	$0.00	$0.00
71141409	SUP	HCPCS C1713		71141409  -  PLATE BN NAR 151MM TC100 9 HL CMPR SS ORTH 4.5MM SCR LG FRAG	BOTH IP/OP	$410.55 	$303.81	$0.00	$328.44	$184.75	$184.75	$0.00	$0.00	$0.00	$85.57	$304.71	$304.71	$0.00	$0.00	$85.56	$0.00	$242.84	$242.84	$0.00	$205.28	$325.16	$328.44	$0.00		$0.00	$64.25	$0.00	$0.00	$65.36	$0.00	$0.00	$0.00	$0.00	$0.00
71141410	SUP	HCPCS C1713		71141410  -  PLATE BN NAR 167MM TC100 10 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71141411	SUP	HCPCS C1713		71141411  -  PLATE BN NAR 183MM TC100 11 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71141412	SUP	HCPCS C1713		71141412  -  PLATE BN NAR 199MM TC100 12 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71141413	SUP	HCPCS C1713		71141413  -  PLATE BN NAR 215MM TC100 13 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$283.50	$283.50	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$98.60	$0.00	$0.00	$100.30	$0.00	$0.00	$0.00	$0.00	$0.00
71141414	SUP	HCPCS C1713		71141414  -  PLATE BN NAR 231MM TC100 14 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	$763.35 	$564.88	$0.00	$610.68	$343.51	$343.51	$0.00	$0.00	$0.00	$159.10	$566.56	$566.56	$0.00	$0.00	$159.08	$0.00	$451.52	$451.52	$0.00	$381.68	$604.57	$610.68	$0.00		$0.00	$119.46	$0.00	$0.00	$121.53	$0.00	$0.00	$0.00	$0.00	$0.00
71141415	SUP	HCPCS C1713		71141415  -  PLATE BN NAR 247MM TC100 15 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	$805.35 	$595.96	$0.00	$644.28	$362.41	$362.41	$0.00	$0.00	$0.00	$167.86	$597.73	$597.73	$0.00	$0.00	$167.83	$0.00	$476.36	$476.36	$0.00	$402.68	$637.84	$644.28	$0.00		$0.00	$126.04	$0.00	$0.00	$128.21	$0.00	$0.00	$0.00	$0.00	$0.00
71141416	SUP	HCPCS C1713		71141416  -  PLATE BN NAR 263MM TC100 16 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	$805.35 	$595.96	$0.00	$644.28	$362.41	$362.41	$0.00	$0.00	$0.00	$167.86	$597.73	$597.73	$0.00	$0.00	$167.83	$0.00	$476.36	$476.36	$0.00	$402.68	$637.84	$644.28	$0.00		$0.00	$126.04	$0.00	$0.00	$128.21	$0.00	$0.00	$0.00	$0.00	$0.00
71141418	SUP	HCPCS C1713		71141418  -  PLATE BN NAR 295MM TC100 18 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
71141420	SUP	HCPCS C1713		71141420  -  PLATE BN NAR 326MM TC100 20 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	"$1,038.45 "	$768.45	$0.00	$830.76	$467.30	$467.30	$0.00	$0.00	$0.00	$216.44	$770.74	$770.74	$0.00	$0.00	$216.41	$0.00	$614.24	$614.24	$0.00	$519.23	$822.45	$830.76	$0.00		$0.00	$162.52	$0.00	$0.00	$165.32	$0.00	$0.00	$0.00	$0.00	$0.00
71141422	SUP	HCPCS C1713		71141422  -  PLATE BN NAR 358MM TC100 22 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	"$1,401.75 "	"$1,037.30"	$0.00	"$1,121.40"	$630.79	$630.79	$0.00	$0.00	$0.00	$292.16	"$1,040.38"	"$1,040.38"	$0.00	$0.00	$292.12	$0.00	$829.14	$829.14	$0.00	$700.88	"$1,110.19"	"$1,121.40"	$0.00		$0.00	$219.37	$0.00	$0.00	$223.16	$0.00	$0.00	$0.00	$0.00	$0.00
71141424	SUP	HCPCS C1713		71141424  -  PLATE BN NAR 390MM TC100 24 HL CMPR SS ORTH 4.5MM SCR LG	BOTH IP/OP	"$1,517.25 "	"$1,122.77"	$0.00	"$1,213.80"	$682.76	$682.76	$0.00	$0.00	$0.00	$316.23	"$1,126.10"	"$1,126.10"	$0.00	$0.00	$316.19	$0.00	$897.45	$897.45	$0.00	$758.63	"$1,201.66"	"$1,213.80"	$0.00		$0.00	$237.45	$0.00	$0.00	$241.55	$0.00	$0.00	$0.00	$0.00	$0.00
71141505	SUP	HCPCS C1713		71141505  -  PLATE BN 100MM TC100 5 HL SPN SS ORTH 4.5MM SCR LG FRAG SET	BOTH IP/OP	$866.25 	$641.03	$0.00	$693.00	$389.81	$389.81	$0.00	$0.00	$0.00	$180.55	$642.93	$642.93	$0.00	$0.00	$180.53	$0.00	$512.39	$512.39	$0.00	$433.13	$686.07	$693.00	$0.00		$0.00	$135.57	$0.00	$0.00	$137.91	$0.00	$0.00	$0.00	$0.00	$0.00
71141506	SUP	HCPCS C1713		71141506  -  PLATE BN 120MM TC100 6 HL SPN SS ORTH 4.5MM SCR LG FRAG SET	BOTH IP/OP	$753.90 	$557.89	$0.00	$603.12	$339.26	$339.26	$0.00	$0.00	$0.00	$157.13	$559.54	$559.54	$0.00	$0.00	$157.11	$0.00	$445.93	$445.93	$0.00	$376.95	$597.09	$603.12	$0.00		$0.00	$117.99	$0.00	$0.00	$120.02	$0.00	$0.00	$0.00	$0.00	$0.00
71141603	SUP	HCPCS C1713		71141603  -  PLATE BN 68MM TC100 3 HL T SS ORTH 4.5MM SCR LG FRAG SET	BOTH IP/OP	$568.05 	$420.36	$0.00	$454.44	$255.62	$255.62	$0.00	$0.00	$0.00	$118.40	$421.61	$421.61	$0.00	$0.00	$118.38	$0.00	$336.00	$336.00	$0.00	$284.03	$449.90	$454.44	$0.00		$0.00	$88.90	$0.00	$0.00	$90.43	$0.00	$0.00	$0.00	$0.00	$0.00
71141604	SUP	HCPCS C1713		71141604  -  PLATE BN 84MM TC100 4 HL T SS ORTH 4.5MM SCR LG FRAG SET	BOTH IP/OP	$631.05 	$466.98	$0.00	$504.84	$283.97	$283.97	$0.00	$0.00	$0.00	$131.53	$468.37	$468.37	$0.00	$0.00	$131.51	$0.00	$373.27	$373.27	$0.00	$315.53	$499.79	$504.84	$0.00		$0.00	$98.76	$0.00	$0.00	$100.46	$0.00	$0.00	$0.00	$0.00	$0.00
71141605	SUP	HCPCS C1713		71141605  -  PLATE BN 100MM TC100 5 HL T SS ORTH 4.5MM SCR LG FRAG SET	BOTH IP/OP	$670.95 	$496.50	$0.00	$536.76	$301.93	$301.93	$0.00	$0.00	$0.00	$139.84	$497.98	$497.98	$0.00	$0.00	$139.83	$0.00	$396.87	$396.87	$0.00	$335.48	$531.39	$536.76	$0.00		$0.00	$105.00	$0.00	$0.00	$106.82	$0.00	$0.00	$0.00	$0.00	$0.00
71141606	SUP	HCPCS C1713		71141606  -  PLATE BN 116MM TC100 6 HL T SS ORTH 4.5MM SCR LG FRAG SET	BOTH IP/OP	$742.35 	$549.34	$0.00	$593.88	$334.06	$334.06	$0.00	$0.00	$0.00	$154.72	$550.97	$550.97	$0.00	$0.00	$154.71	$0.00	$439.10	$439.10	$0.00	$371.18	$587.94	$593.88	$0.00		$0.00	$116.18	$0.00	$0.00	$118.18	$0.00	$0.00	$0.00	$0.00	$0.00
71141608	SUP	HCPCS C1713		71141608  -  PLATE BN 148MM TC100 8 HL T SS ORTH 4.5MM SCR LG FRAG SET	BOTH IP/OP	"$1,025.85 "	$759.13	$0.00	$820.68	$461.63	$461.63	$0.00	$0.00	$0.00	$213.81	$761.39	$761.39	$0.00	$0.00	$213.79	$0.00	$606.79	$606.79	$0.00	$512.93	$812.47	$820.68	$0.00		$0.00	$160.55	$0.00	$0.00	$163.32	$0.00	$0.00	$0.00	$0.00	$0.00
71141704	SUP	HCPCS C1713		71141704  -  PLATE BN 123MM TC100 4 HL HK SS ORTH 4.5MM SCR LG FRAG SET	BOTH IP/OP	"$2,084.25 "	"$1,542.35"	$0.00	"$1,667.40"	$937.91	$937.91	$0.00	$0.00	$0.00	$434.41	"$1,546.93"	"$1,546.93"	$0.00	$0.00	$434.36	$0.00	"$1,232.83"	"$1,232.83"	$0.00	"$1,042.13"	"$1,650.73"	"$1,667.40"	$0.00		$0.00	$326.19	$0.00	$0.00	$331.81	$0.00	$0.00	$0.00	$0.00	$0.00
71141809	SUP	HCPCS C1713		71141809  -  PLATE BN 188MM TC100 9 HL CBR HD SS ORTH 4.5MM SCR LG FRAG	BOTH IP/OP	$945.00 	$699.30	$0.00	$756.00	$425.25	$425.25	$0.00	$0.00	$0.00	$196.96	$701.38	$701.38	$0.00	$0.00	$196.94	$0.00	$558.97	$558.97	$0.00	$472.50	$748.44	$756.00	$0.00		$0.00	$147.89	$0.00	$0.00	$150.44	$0.00	$0.00	$0.00	$0.00	$0.00
71141900	SUP	HCPCS C1713		71141900  -  PLATE BN 20MM TC100 2 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET	BOTH IP/OP	$345.45 	$255.63	$0.00	$276.36	$155.45	$155.45	$0.00	$0.00	$0.00	$72.00	$256.39	$256.39	$0.00	$0.00	$71.99	$0.00	$204.33	$204.33	$0.00	$172.73	$273.60	$276.36	$0.00		$0.00	$54.06	$0.00	$0.00	$55.00	$0.00	$0.00	$0.00	$0.00	$0.00
71141902	SUP	HCPCS C1713		71141902  -  PLATE BN 26MM TC100 2 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET	BOTH IP/OP	$410.55 	$303.81	$0.00	$328.44	$184.75	$184.75	$0.00	$0.00	$0.00	$85.57	$304.71	$304.71	$0.00	$0.00	$85.56	$0.00	$242.84	$242.84	$0.00	$205.28	$325.16	$328.44	$0.00		$0.00	$64.25	$0.00	$0.00	$65.36	$0.00	$0.00	$0.00	$0.00	$0.00
71141904	SUP	HCPCS C1713		71141904  -  PLATE BN 36MM TC100 4 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET	BOTH IP/OP	$316.05 	$233.88	$0.00	$252.84	$142.22	$142.22	$0.00	$0.00	$0.00	$65.87	$234.57	$234.57	$0.00	$0.00	$65.86	$0.00	$186.94	$186.94	$0.00	$158.03	$250.31	$252.84	$0.00		$0.00	$49.46	$0.00	$0.00	$50.32	$0.00	$0.00	$0.00	$0.00	$0.00
71141905	SUP	HCPCS C1713		71141905  -  PLATE BN 44MM TC100 5 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET	BOTH IP/OP	$375.90 	$278.17	$0.00	$300.72	$169.16	$169.16	$0.00	$0.00	$0.00	$78.35	$278.99	$278.99	$0.00	$0.00	$78.34	$0.00	$222.34	$222.34	$0.00	$187.95	$297.71	$300.72	$0.00		$0.00	$58.83	$0.00	$0.00	$59.84	$0.00	$0.00	$0.00	$0.00	$0.00
71141906	SUP	HCPCS C1713		71141906  -  PLATE BN 52MM 6 HL 2.7MM SCR	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71141907	SUP	HCPCS C1713		71141907  -  PLATE BN 60MM TC100 7 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET	BOTH IP/OP	$452.55 	$334.89	$0.00	$362.04	$203.65	$203.65	$0.00	$0.00	$0.00	$94.32	$335.88	$335.88	$0.00	$0.00	$94.31	$0.00	$267.68	$267.68	$0.00	$226.28	$358.42	$362.04	$0.00		$0.00	$70.82	$0.00	$0.00	$72.05	$0.00	$0.00	$0.00	$0.00	$0.00
71141908	SUP	HCPCS C1713		71141908  -  PLATE BN 68MM TC100 8 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET	BOTH IP/OP	$495.60 	$366.74	$0.00	$396.48	$223.02	$223.02	$0.00	$0.00	$0.00	$103.30	$367.83	$367.83	$0.00	$0.00	$103.28	$0.00	$293.15	$293.15	$0.00	$247.80	$392.52	$396.48	$0.00		$0.00	$77.56	$0.00	$0.00	$78.90	$0.00	$0.00	$0.00	$0.00	$0.00
71141909	SUP	HCPCS C1713		71141909  -  PLATE BN 76MM TC100 9 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET	BOTH IP/OP	$639.45 	$473.19	$0.00	$511.56	$287.75	$287.75	$0.00	$0.00	$0.00	$133.28	$474.60	$474.60	$0.00	$0.00	$133.26	$0.00	$378.23	$378.23	$0.00	$319.73	$506.44	$511.56	$0.00		$0.00	$100.07	$0.00	$0.00	$101.80	$0.00	$0.00	$0.00	$0.00	$0.00
71141910	SUP	HCPCS C1713		71141910  -  PLATE BN 84MM TC100 10 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET	BOTH IP/OP	$701.40 	$519.04	$0.00	$561.12	$315.63	$315.63	$0.00	$0.00	$0.00	$146.19	$520.58	$520.58	$0.00	$0.00	$146.17	$0.00	$414.88	$414.88	$0.00	$350.70	$555.51	$561.12	$0.00		$0.00	$109.77	$0.00	$0.00	$111.66	$0.00	$0.00	$0.00	$0.00	$0.00
71141912	SUP	HCPCS C1713		71141912  -  PLATE BN 100MM TC100 12 HL CMPR SS ORTH 2.7MM SCR SM FRAG	BOTH IP/OP	$777.00 	$574.98	$0.00	$621.60	$349.65	$349.65	$0.00	$0.00	$0.00	$161.95	$576.69	$576.69	$0.00	$0.00	$161.93	$0.00	$459.60	$459.60	$0.00	$388.50	$615.38	$621.60	$0.00		$0.00	$121.60	$0.00	$0.00	$123.70	$0.00	$0.00	$0.00	$0.00	$0.00
71142007	SUP	HCPCS C1713		71142007  -  PLATE BN 158MM TC100 7 HL BTRS SS CNDYL LT 4.5MM SCR LG FRAG	BOTH IP/OP	"$1,953.00 "	"$1,445.22"	$0.00	"$1,562.40"	$878.85	$878.85	$0.00	$0.00	$0.00	$407.05	"$1,449.52"	"$1,449.52"	$0.00	$0.00	$407.01	$0.00	"$1,155.20"	"$1,155.20"	$0.00	$976.50	"$1,546.78"	"$1,562.40"	$0.00		$0.00	$305.64	$0.00	$0.00	$310.92	$0.00	$0.00	$0.00	$0.00	$0.00
71142009	SUP	HCPCS C1713		71142009  -  PLATE BN 190MM TC100 9 HL BTRS SS CNDYL LT 4.5MM SCR LG FRAG	BOTH IP/OP	"$2,026.50 "	"$1,499.61"	$0.00	"$1,621.20"	$911.93	$911.93	$0.00	$0.00	$0.00	$422.37	"$1,504.07"	"$1,504.07"	$0.00	$0.00	$422.32	$0.00	"$1,198.67"	"$1,198.67"	$0.00	"$1,013.25"	"$1,604.99"	"$1,621.20"	$0.00		$0.00	$317.15	$0.00	$0.00	$322.62	$0.00	$0.00	$0.00	$0.00	$0.00
71142011	SUP	HCPCS C1713		71142011  -  PLATE BN 221MM TC100 11 HL BTRS SS CNDYL LT 4.5MM SCR LG	BOTH IP/OP	"$2,541.00 "	"$1,880.34"	$0.00	"$2,032.80"	"$1,143.45"	"$1,143.45"	$0.00	$0.00	$0.00	$529.61	"$1,885.93"	"$1,885.93"	$0.00	$0.00	$529.54	$0.00	"$1,252.71"	"$1,252.71"	$0.00	"$1,270.50"	"$2,012.47"	"$2,032.80"	$0.00		$0.00	$397.67	$0.00	$0.00	$404.53	$0.00	$0.00	$0.00	$0.00	$0.00
71142013	SUP	HCPCS C1713		71142013  -  PLATE BN 253MM TC100 13 HL BTRS SS CNDYL LT 4.5MM SCR LG	BOTH IP/OP	"$2,136.75 "	"$1,581.20"	$0.00	"$1,709.40"	$961.54	$961.54	$0.00	$0.00	$0.00	$445.35	"$1,585.90"	"$1,585.90"	$0.00	$0.00	$445.30	$0.00	"$1,263.89"	"$1,263.89"	$0.00	"$1,068.38"	"$1,692.31"	"$1,709.40"	$0.00		$0.00	$334.40	$0.00	$0.00	$340.17	$0.00	$0.00	$0.00	$0.00	$0.00
71142015	SUP	HCPCS C1713		71142015  -  PLATE BN 285MM TC100 15 HL BTRS SS CNDYL LT 4.5MM SCR LG	BOTH IP/OP	"$2,682.75 "	"$1,985.24"	$0.00	"$2,146.20"	"$1,207.24"	"$1,207.24"	$0.00	$0.00	$0.00	$559.15	"$1,991.14"	"$1,991.14"	$0.00	$0.00	$559.09	$0.00	"$1,322.60"	"$1,322.60"	$0.00	"$1,341.38"	"$2,124.74"	"$2,146.20"	$0.00		$0.00	$419.85	$0.00	$0.00	$427.09	$0.00	$0.00	$0.00	$0.00	$0.00
71142107	SUP	HCPCS C1713		71142107  -  PLATE BN 158MM TC100 7 HL BTRS SS CNDYL RT 4.5MM SCR LG FRAG	BOTH IP/OP	"$2,367.75 "	"$1,752.14"	$0.00	"$1,894.20"	"$1,065.49"	"$1,065.49"	$0.00	$0.00	$0.00	$493.50	"$1,757.34"	"$1,757.34"	$0.00	$0.00	$493.44	$0.00	"$1,400.52"	"$1,400.52"	$0.00	"$1,183.88"	"$1,875.26"	"$1,894.20"	$0.00		$0.00	$370.55	$0.00	$0.00	$376.95	$0.00	$0.00	$0.00	$0.00	$0.00
71142109	SUP	HCPCS C1713		71142109  -  PLATE BN 190MM TC100 9 HL BTRS SS CNDYL RT 4.5MM SCR LG FRAG	BOTH IP/OP	"$2,026.50 "	"$1,499.61"	$0.00	"$1,621.20"	$911.93	$911.93	$0.00	$0.00	$0.00	$422.37	"$1,504.07"	"$1,504.07"	$0.00	$0.00	$422.32	$0.00	"$1,198.67"	"$1,198.67"	$0.00	"$1,013.25"	"$1,604.99"	"$1,621.20"	$0.00		$0.00	$317.15	$0.00	$0.00	$322.62	$0.00	$0.00	$0.00	$0.00	$0.00
71142111	SUP	HCPCS C1713		71142111  -  PLATE BN 221MM TC100 11 HL BTRS SS CNDYL RT 4.5MM SCR LG	BOTH IP/OP	"$2,541.00 "	"$1,880.34"	$0.00	"$2,032.80"	"$1,143.45"	"$1,143.45"	$0.00	$0.00	$0.00	$529.61	"$1,885.93"	"$1,885.93"	$0.00	$0.00	$529.54	$0.00	"$1,252.71"	"$1,252.71"	$0.00	"$1,270.50"	"$2,012.47"	"$2,032.80"	$0.00		$0.00	$397.67	$0.00	$0.00	$404.53	$0.00	$0.00	$0.00	$0.00	$0.00
71142113	SUP	HCPCS C1713		71142113  -  PLATE BN 253MM TC100 13 HL BTRS SS CNDYL RT 4.5MM SCR LG	BOTH IP/OP	"$2,604.00 "	"$1,926.96"	$0.00	"$2,083.20"	"$1,171.80"	"$1,171.80"	$0.00	$0.00	$0.00	$542.74	"$1,932.69"	"$1,932.69"	$0.00	$0.00	$542.67	$0.00	"$1,283.77"	"$1,283.77"	$0.00	"$1,302.00"	"$2,062.37"	"$2,083.20"	$0.00		$0.00	$407.53	$0.00	$0.00	$414.56	$0.00	$0.00	$0.00	$0.00	$0.00
71142115	SUP	HCPCS C1713		71142115  -  PLATE BN 285MM TC100 15 HL BTRS SS CNDYL RT 4.5MM SCR LG	BOTH IP/OP	"$2,682.75 "	"$1,985.24"	$0.00	"$2,146.20"	"$1,207.24"	"$1,207.24"	$0.00	$0.00	$0.00	$559.15	"$1,991.14"	"$1,991.14"	$0.00	$0.00	$559.09	$0.00	"$1,322.60"	"$1,322.60"	$0.00	"$1,341.38"	"$2,124.74"	"$2,146.20"	$0.00		$0.00	$419.85	$0.00	$0.00	$427.09	$0.00	$0.00	$0.00	$0.00	$0.00
71143004	SUP	HCPCS C1713		71143004  -  WASHER ORTH 4.5MM 2.2MM STRL TC100 SS	BOTH IP/OP	$94.40 	$69.86	$0.00	$75.52	$42.48	$42.48	$0.00	$0.00	$0.00	$19.68	$70.06	$70.06	$0.00	$0.00	$19.67	$0.00	$55.84	$55.84	$0.00	$47.20	$74.76	$75.52	$0.00		$0.00	$14.77	$0.00	$0.00	$15.03	$0.00	$0.00	$0.00	$0.00	$0.00
71143007	SUP	HCPCS C1713		71143007  -  WASHER ORTH 7MM 3.7MM STRL TC100 SS	BOTH IP/OP	$94.40 	$69.86	$0.00	$75.52	$42.48	$42.48	$0.00	$0.00	$0.00	$19.68	$70.06	$70.06	$0.00	$0.00	$19.67	$0.00	$55.84	$55.84	$0.00	$47.20	$74.76	$75.52	$0.00		$0.00	$14.77	$0.00	$0.00	$15.03	$0.00	$0.00	$0.00	$0.00	$0.00
71143010	SUP	HCPCS C1713		71143010  -  WASHER ORTH THK2MM 10MM ILZ SPC CIRC	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$49.05	$49.05	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$0.00	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00		$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
71143013	SUP	HCPCS C1713		71143013  -  WASHER ORTH 13MM 6.6MM STRL TC100 SS	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$54.00	$54.00	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$0.00	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00		$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
71143045	SUP	HCPCS C1713		71143045  -  NUT ORTH STRL TC100 SS 4.5 MM CORT SCR	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71143104	SUP	HCPCS C1713		71143104  -  WASHER ORTH 4.5MM 2.2MM NS TC100 SS	BOTH IP/OP	$94.40 	$69.86	$0.00	$75.52	$42.48	$42.48	$0.00	$0.00	$0.00	$19.68	$70.06	$70.06	$0.00	$0.00	$19.67	$0.00	$55.84	$55.84	$0.00	$47.20	$74.76	$75.52	$0.00		$0.00	$14.77	$0.00	$0.00	$15.03	$0.00	$0.00	$0.00	$0.00	$0.00
71143107	SUP	HCPCS C1713		71143107  -  WASHER ORTH HEX 7MM NS TC100	BOTH IP/OP	$94.40 	$69.86	$0.00	$75.52	$42.48	$42.48	$0.00	$0.00	$0.00	$19.68	$70.06	$70.06	$0.00	$0.00	$19.67	$0.00	$55.84	$55.84	$0.00	$47.20	$74.76	$75.52	$0.00		$0.00	$14.77	$0.00	$0.00	$15.03	$0.00	$0.00	$0.00	$0.00	$0.00
71143110	SUP	HCPCS C1713		71143110  -  WASHER ORTH 10MM NS TC100	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$49.05	$49.05	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$0.00	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00		$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
71143113	SUP	HCPCS C1713		71143113  -  WASHER ORTH 13MM NS TC100 SS	BOTH IP/OP	$94.40 	$69.86	$0.00	$75.52	$42.48	$42.48	$0.00	$0.00	$0.00	$19.68	$70.06	$70.06	$0.00	$0.00	$19.67	$0.00	$55.84	$55.84	$0.00	$47.20	$74.76	$75.52	$0.00		$0.00	$14.77	$0.00	$0.00	$15.03	$0.00	$0.00	$0.00	$0.00	$0.00
71144010	SUP	HCPCS C1713		71144010  -  PLATE BN 60MM STRL TC100 TMPLT SS CALCANEUS 3.5MM CORT SCR 4	BOTH IP/OP	"$1,338.75 "	$990.68	$0.00	"$1,071.00"	$602.44	$602.44	$0.00	$0.00	$0.00	$279.03	$993.62	$993.62	$0.00	$0.00	$279.00	$0.00	$791.87	$791.87	$0.00	$669.38	"$1,060.29"	"$1,071.00"	$0.00		$0.00	$209.51	$0.00	$0.00	$213.13	$0.00	$0.00	$0.00	$0.00	$0.00
71144011	SUP	HCPCS C1713		71144011  -  PLATE BN 70MM STRL TC100 TMPLT SS CALCANEUS 3.5MM CORT SCR 4	BOTH IP/OP	"$1,354.50 "	"$1,002.33"	$0.00	"$1,083.60"	$609.53	$609.53	$0.00	$0.00	$0.00	$282.31	"$1,005.31"	"$1,005.31"	$0.00	$0.00	$282.28	$0.00	$801.19	$801.19	$0.00	$677.25	"$1,072.76"	"$1,083.60"	$0.00		$0.00	$211.98	$0.00	$0.00	$215.64	$0.00	$0.00	$0.00	$0.00	$0.00
71144012	SUP	HCPCS C1713		71144012  -  PLATE BN STRL TC100 9 HL BNDRG TMPLT SS CALCANEUS 3.5 MM SCR	BOTH IP/OP	"$1,559.25 "	"$1,153.85"	$0.00	"$1,247.40"	$701.66	$701.66	$0.00	$0.00	$0.00	$324.99	"$1,157.28"	"$1,157.28"	$0.00	$0.00	$324.95	$0.00	$922.30	$922.30	$0.00	$779.63	"$1,234.93"	"$1,247.40"	$0.00		$0.00	$244.02	$0.00	$0.00	$248.23	$0.00	$0.00	$0.00	$0.00	$0.00
71145020	SUP	HCPCS C1713		71145020  -  PLATE BN 100MM TC100 20 HL STRG SS ORTH 1.5MM SCR MN FRAG	BOTH IP/OP	$570.15 	$421.91	$0.00	$456.12	$256.57	$256.57	$0.00	$0.00	$0.00	$118.83	$423.17	$423.17	$0.00	$0.00	$118.82	$0.00	$337.24	$337.24	$0.00	$285.08	$451.56	$456.12	$0.00		$0.00	$89.23	$0.00	$0.00	$90.77	$0.00	$0.00	$0.00	$0.00	$0.00
71145022	SUP	HCPCS C1713		71145022  -  PLATE BN TC100 3 HLE/HD 9 HL SHFT T SS ORTH 1.5 MM SCR MN	BOTH IP/OP	$504.00 	$372.96	$0.00	$403.20	$226.80	$226.80	$0.00	$0.00	$0.00	$105.05	$374.07	$374.07	$0.00	$0.00	$105.03	$0.00	$298.12	$298.12	$0.00	$252.00	$399.17	$403.20	$0.00		$0.00	$78.88	$0.00	$0.00	$80.24	$0.00	$0.00	$0.00	$0.00	$0.00
71145024	SUP	HCPCS C1713		71145024  -  PLATE BN TC100 4 HLE/HD 9 HL SHFT T SS ORTH 1.5 MM SCR MN	BOTH IP/OP	$534.45 	$395.49	$0.00	$427.56	$240.50	$240.50	$0.00	$0.00	$0.00	$111.39	$396.67	$396.67	$0.00	$0.00	$111.38	$0.00	$316.13	$316.13	$0.00	$267.23	$423.28	$427.56	$0.00		$0.00	$83.64	$0.00	$0.00	$85.08	$0.00	$0.00	$0.00	$0.00	$0.00
71145026	SUP	HCPCS C1713		71145026  -  PLATE BN TC100 7 HL SS CNDYL LT 1.5 MM SCR MN FRAG SET	BOTH IP/OP	$708.75 	$524.48	$0.00	$567.00	$318.94	$318.94	$0.00	$0.00	$0.00	$147.72	$526.03	$526.03	$0.00	$0.00	$147.70	$0.00	$419.23	$419.23	$0.00	$354.38	$561.33	$567.00	$0.00		$0.00	$110.92	$0.00	$0.00	$112.83	$0.00	$0.00	$0.00	$0.00	$0.00
71145028	SUP	HCPCS C1713		71145028  -  PLATE BN TC100 7 HL SS CNDYL RT 1.5 MM SCR MN FRAG SET	BOTH IP/OP	$708.75 	$524.48	$0.00	$567.00	$318.94	$318.94	$0.00	$0.00	$0.00	$147.72	$526.03	$526.03	$0.00	$0.00	$147.70	$0.00	$419.23	$419.23	$0.00	$354.38	$561.33	$567.00	$0.00		$0.00	$110.92	$0.00	$0.00	$112.83	$0.00	$0.00	$0.00	$0.00	$0.00
71145030	SUP	HCPCS C1713		71145030  -  PLATE BN TC100 4 HL H SS ORTH 1.5 MM SCR MN FRAG SET	BOTH IP/OP	$406.35 	$300.70	$0.00	$325.08	$182.86	$182.86	$0.00	$0.00	$0.00	$84.69	$301.59	$301.59	$0.00	$0.00	$84.68	$0.00	$240.36	$240.36	$0.00	$203.18	$321.83	$325.08	$0.00		$0.00	$63.59	$0.00	$0.00	$64.69	$0.00	$0.00	$0.00	$0.00	$0.00
71146020	SUP	HCPCS C1713		71146020  -  PLATE BN 20MM TC100 3 HL STRG SS CNDYL 2MM SCR MN FRAG SET	BOTH IP/OP	$134.40 	$99.46	$0.00	$107.52	$60.48	$60.48	$0.00	$0.00	$0.00	$28.01	$99.75	$99.75	$0.00	$0.00	$28.01	$0.00	$79.50	$79.50	$0.00	$67.20	$106.44	$107.52	$0.00		$0.00	$21.03	$0.00	$0.00	$21.40	$0.00	$0.00	$0.00	$0.00	$0.00
71146022	SUP	HCPCS C1713		71146022  -  PLATE BN 22MM TC100 4 HL STRG SS CNDYL 2MM SCR MN FRAG SET	BOTH IP/OP	$148.05 	$109.56	$0.00	$118.44	$66.62	$66.62	$0.00	$0.00	$0.00	$30.86	$109.88	$109.88	$0.00	$0.00	$30.85	$0.00	$87.57	$87.57	$0.00	$74.03	$117.26	$118.44	$0.00		$0.00	$23.17	$0.00	$0.00	$23.57	$0.00	$0.00	$0.00	$0.00	$0.00
71146024	SUP	HCPCS C1713		71146024  -  PLATE BN 24MM TC100 5 HL STRG SS CNDYL 2MM SCR MN FRAG SET	BOTH IP/OP	$159.60 	$118.10	$0.00	$127.68	$71.82	$71.82	$0.00	$0.00	$0.00	$33.26	$118.46	$118.46	$0.00	$0.00	$33.26	$0.00	$94.40	$94.40	$0.00	$79.80	$126.40	$127.68	$0.00		$0.00	$24.98	$0.00	$0.00	$25.41	$0.00	$0.00	$0.00	$0.00	$0.00
71146026	SUP	HCPCS C1713		71146026  -  PLATE BN 35MM TC100 6 HL STRG SS ORTH 2MM SCR MN FRAG SET	BOTH IP/OP	$177.45 	$131.31	$0.00	$141.96	$79.85	$79.85	$0.00	$0.00	$0.00	$36.99	$131.70	$131.70	$0.00	$0.00	$36.98	$0.00	$104.96	$104.96	$0.00	$88.73	$140.54	$141.96	$0.00		$0.00	$27.77	$0.00	$0.00	$28.25	$0.00	$0.00	$0.00	$0.00	$0.00
71146028	SUP	HCPCS C1713		71146028  -  PLATE BN 28MM TC100 20 HL STRG SS CNDYL 2MM SCR MN FRAG SET	BOTH IP/OP	$568.05 	$420.36	$0.00	$454.44	$255.62	$255.62	$0.00	$0.00	$0.00	$118.40	$421.61	$421.61	$0.00	$0.00	$118.38	$0.00	$336.00	$336.00	$0.00	$284.03	$449.90	$454.44	$0.00		$0.00	$88.90	$0.00	$0.00	$90.43	$0.00	$0.00	$0.00	$0.00	$0.00
71146030	SUP	HCPCS C1713		71146030  -  PLATE BN 5X1.2MM TC100 3 HLE/HD 9 HL SHFT T SS CNDYL 2MM SCR	BOTH IP/OP	$504.00 	$372.96	$0.00	$403.20	$226.80	$226.80	$0.00	$0.00	$0.00	$105.05	$374.07	$374.07	$0.00	$0.00	$105.03	$0.00	$298.12	$298.12	$0.00	$252.00	$399.17	$403.20	$0.00		$0.00	$78.88	$0.00	$0.00	$80.24	$0.00	$0.00	$0.00	$0.00	$0.00
71146032	SUP	HCPCS C1713		71146032  -  PLATE BN 5X1.2MM TC100 4 HLE/HD 9 HL SHFT T SS CNDYL 2MM SCR	BOTH IP/OP	$534.45 	$395.49	$0.00	$427.56	$240.50	$240.50	$0.00	$0.00	$0.00	$111.39	$396.67	$396.67	$0.00	$0.00	$111.38	$0.00	$316.13	$316.13	$0.00	$267.23	$423.28	$427.56	$0.00		$0.00	$83.64	$0.00	$0.00	$85.08	$0.00	$0.00	$0.00	$0.00	$0.00
71146034	SUP	HCPCS C1713		71146034  -  PLATE BN 5X.9MM TC100 2 HLE/HD 2 HL SHFT T SS CNDYL 2MM SCR	BOTH IP/OP	$134.40 	$99.46	$0.00	$107.52	$60.48	$60.48	$0.00	$0.00	$0.00	$28.01	$99.75	$99.75	$0.00	$0.00	$28.01	$0.00	$79.50	$79.50	$0.00	$67.20	$106.44	$107.52	$0.00		$0.00	$21.03	$0.00	$0.00	$21.40	$0.00	$0.00	$0.00	$0.00	$0.00
71146036	SUP	HCPCS C1713		71146036  -  PLATE BN 5X.9MM TC100 2 HL SHFT L RT OBLQ SS CNDYL 2MM SCR	BOTH IP/OP	$134.40 	$99.46	$0.00	$107.52	$60.48	$60.48	$0.00	$0.00	$0.00	$28.01	$99.75	$99.75	$0.00	$0.00	$28.01	$0.00	$79.50	$79.50	$0.00	$67.20	$106.44	$107.52	$0.00		$0.00	$21.03	$0.00	$0.00	$21.40	$0.00	$0.00	$0.00	$0.00	$0.00
71146038	SUP	HCPCS C1713		71146038  -  PLATE BN 5X.9MM TC100 2 HL SHFT L LT OBLQ SS CNDYL 2MM SCR	BOTH IP/OP	$134.40 	$99.46	$0.00	$107.52	$60.48	$60.48	$0.00	$0.00	$0.00	$28.01	$99.75	$99.75	$0.00	$0.00	$28.01	$0.00	$79.50	$79.50	$0.00	$67.20	$106.44	$107.52	$0.00		$0.00	$21.03	$0.00	$0.00	$21.40	$0.00	$0.00	$0.00	$0.00	$0.00
71146040	SUP	HCPCS C1713		71146040  -  PLATE BN TC100 7 HL SS CNDYL LT 2 MM SCR MN FRAG SET	BOTH IP/OP	$678.30 	$501.94	$0.00	$542.64	$305.24	$305.24	$0.00	$0.00	$0.00	$141.37	$503.43	$503.43	$0.00	$0.00	$141.36	$0.00	$401.21	$401.21	$0.00	$339.15	$537.21	$542.64	$0.00		$0.00	$106.15	$0.00	$0.00	$107.99	$0.00	$0.00	$0.00	$0.00	$0.00
71146042	SUP	HCPCS C1713		71146042  -  PLATE BN 39X5X12MM TC100 7 HL SS CNDYL RT 2MM SCR MN FRAG	BOTH IP/OP	$678.30 	$501.94	$0.00	$542.64	$305.24	$305.24	$0.00	$0.00	$0.00	$141.37	$503.43	$503.43	$0.00	$0.00	$141.36	$0.00	$401.21	$401.21	$0.00	$339.15	$537.21	$542.64	$0.00		$0.00	$106.15	$0.00	$0.00	$107.99	$0.00	$0.00	$0.00	$0.00	$0.00
71146044	SUP	HCPCS C1713		71146044  -  PLATE BN TC100 L SS RT ORTH 2 MM SCR MN FRAG SET	BOTH IP/OP	$134.40 	$99.46	$0.00	$107.52	$60.48	$60.48	$0.00	$0.00	$0.00	$28.01	$99.75	$99.75	$0.00	$0.00	$28.01	$0.00	$79.50	$79.50	$0.00	$67.20	$106.44	$107.52	$0.00		$0.00	$21.03	$0.00	$0.00	$21.40	$0.00	$0.00	$0.00	$0.00	$0.00
71146046	SUP	HCPCS C1713		71146046  -  PLATE BN TC100 L SS LT ORTH 2 MM SCR MN FRAG SET	BOTH IP/OP	$134.40 	$99.46	$0.00	$107.52	$60.48	$60.48	$0.00	$0.00	$0.00	$28.01	$99.75	$99.75	$0.00	$0.00	$28.01	$0.00	$79.50	$79.50	$0.00	$67.20	$106.44	$107.52	$0.00		$0.00	$21.03	$0.00	$0.00	$21.40	$0.00	$0.00	$0.00	$0.00	$0.00
71146048	SUP	HCPCS C1713		71146048  -  PLATE BN TC100 4 HL H SS ORTH 2 MM SCR MN FRAG SET	BOTH IP/OP	$406.35 	$300.70	$0.00	$325.08	$182.86	$182.86	$0.00	$0.00	$0.00	$84.69	$301.59	$301.59	$0.00	$0.00	$84.68	$0.00	$240.36	$240.36	$0.00	$203.18	$321.83	$325.08	$0.00		$0.00	$63.59	$0.00	$0.00	$64.69	$0.00	$0.00	$0.00	$0.00	$0.00
71147001	SUP	HCPCS C1713		71147001  -  PLATE BN TC100 L SS RT ORTH 2.7 MM SCR MN FRAG SET	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
71147002	SUP	HCPCS C1713		71147002  -  PLATE BN 35X7X1.2MM TC100 L LT OBLQ SS CNDYL 2.7MM SCR MN	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
71147003	SUP	HCPCS C1713		71147003  -  PLATE BN TC100 L SS LT ORTH 2.7 MM SCR MN FRAG SET	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
71147004	SUP	HCPCS C1713		71147004  -  PLATE BN 35X7X1.2MM TC100 L RT OBLQ SS CNDYL 2.7MM SCR MN	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
71147006	SUP	HCPCS C1713		71147006  -  PLATE BN 32X7X1.2MM TC100 3 HL T SS CNDYL 2.7MM SCR MN FRAG	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
71147008	SUP	HCPCS C1713		71147008  -  PLATE BN 57X7X1.4MM TC100 7 HL SS CNDYL LT 2.7MM SCR MN FRAG	BOTH IP/OP	$720.30 	$533.02	$0.00	$576.24	$324.14	$324.14	$0.00	$0.00	$0.00	$150.13	$534.61	$534.61	$0.00	$0.00	$150.11	$0.00	$426.06	$426.06	$0.00	$360.15	$570.48	$576.24	$0.00		$0.00	$112.73	$0.00	$0.00	$114.67	$0.00	$0.00	$0.00	$0.00	$0.00
71147010	SUP	HCPCS C1713		71147010  -  PLATE BN 57X7X1.4MM TC100 7 HL SS CNDYL RT 2.7MM SCR MN FRAG	BOTH IP/OP	$720.30 	$533.02	$0.00	$576.24	$324.14	$324.14	$0.00	$0.00	$0.00	$150.13	$534.61	$534.61	$0.00	$0.00	$150.11	$0.00	$426.06	$426.06	$0.00	$360.15	$570.48	$576.24	$0.00		$0.00	$112.73	$0.00	$0.00	$114.67	$0.00	$0.00	$0.00	$0.00	$0.00
71147012	SUP	HCPCS C1713		71147012  -  PLATE BN TC100 7 HL MULTIFRAGMENT SS ORTH 2.7 MM SCR MN FRAG	BOTH IP/OP	$169.05 	$125.10	$0.00	$135.24	$76.07	$76.07	$0.00	$0.00	$0.00	$35.23	$125.47	$125.47	$0.00	$0.00	$35.23	$0.00	$99.99	$99.99	$0.00	$84.53	$133.89	$135.24	$0.00		$0.00	$26.46	$0.00	$0.00	$26.91	$0.00	$0.00	$0.00	$0.00	$0.00
71148003	SUP	HCPCS C1713		71148003  -  PLATE BN 23MM TC100 3 HL .25 TBLR SS ORTH 2.7MM SCR MN FRAG	BOTH IP/OP	$159.60 	$118.10	$0.00	$127.68	$71.82	$71.82	$0.00	$0.00	$0.00	$33.26	$118.46	$118.46	$0.00	$0.00	$33.26	$0.00	$94.40	$94.40	$0.00	$79.80	$126.40	$127.68	$0.00		$0.00	$24.98	$0.00	$0.00	$25.41	$0.00	$0.00	$0.00	$0.00	$0.00
71148004	SUP	HCPCS C1713		71148004  -  PLATE BN 31MM TC100 4 HL .25 TBLR SS CNDYL 2.7MM SCR MN FRAG	BOTH IP/OP	$175.35 	$129.76	$0.00	$140.28	$78.91	$78.91	$0.00	$0.00	$0.00	$36.55	$130.14	$130.14	$0.00	$0.00	$36.54	$0.00	$103.72	$103.72	$0.00	$87.68	$138.88	$140.28	$0.00		$0.00	$27.44	$0.00	$0.00	$27.92	$0.00	$0.00	$0.00	$0.00	$0.00
71148005	SUP	HCPCS C1713		71148005  -  PLATE BN 39MM TC100 5 HL .25 TBLR SS CNDYL 2.7MM SCR MN FRAG	BOTH IP/OP	$185.85 	$137.53	$0.00	$148.68	$83.63	$83.63	$0.00	$0.00	$0.00	$38.74	$137.94	$137.94	$0.00	$0.00	$38.73	$0.00	$109.93	$109.93	$0.00	$92.93	$147.19	$148.68	$0.00		$0.00	$29.09	$0.00	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$0.00
71148006	SUP	HCPCS C1713		71148006  -  PLATE BN 47MM TC100 6 HL .25 TBLR SS CNDYL 2.7MM SCR MN FRAG	BOTH IP/OP	$205.80 	$152.29	$0.00	$164.64	$92.61	$92.61	$0.00	$0.00	$0.00	$42.89	$152.74	$152.74	$0.00	$0.00	$42.89	$0.00	$121.73	$121.73	$0.00	$102.90	$162.99	$164.64	$0.00		$0.00	$32.21	$0.00	$0.00	$32.76	$0.00	$0.00	$0.00	$0.00	$0.00
71148007	SUP	HCPCS C1713		71148007  -  PLATE BN 55MM TC100 7 HL .25 TBLR SS ORTH 2.7MM SCR MN FRAG	BOTH IP/OP	$214.20 	$158.51	$0.00	$171.36	$96.39	$96.39	$0.00	$0.00	$0.00	$44.64	$158.98	$158.98	$0.00	$0.00	$44.64	$0.00	$126.70	$126.70	$0.00	$107.10	$169.65	$171.36	$0.00		$0.00	$33.52	$0.00	$0.00	$34.10	$0.00	$0.00	$0.00	$0.00	$0.00
71148008	SUP	HCPCS C1713		71148008  -  PLATE BN 63MM TC100 QT TBLR SS ORTH 2.7MM SCR MN FRAG SET	BOTH IP/OP	$227.85 	$168.61	$0.00	$182.28	$102.53	$102.53	$0.00	$0.00	$0.00	$47.49	$169.11	$169.11	$0.00	$0.00	$47.48	$0.00	$134.77	$134.77	$0.00	$113.93	$180.46	$182.28	$0.00		$0.00	$35.66	$0.00	$0.00	$36.27	$0.00	$0.00	$0.00	$0.00	$0.00
71149006	SUP	HCPCS C1713		71149006  -  SCREW BN 1.5MM 6MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149007	SUP	HCPCS C1713		71149007  -  SCREW BN 1.5MM 7MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149008	SUP	HCPCS C1713		71149008  -  SCREW BN 1.5MM 8MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149009	SUP	HCPCS C1713		71149009  -  SCREW BN 1.5MM 9MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149010	SUP	HCPCS C1713		71149010  -  SCREW BN 1.5MM 10MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149011	SUP	HCPCS C1713		71149011  -  SCREW BN 1.5MM 11MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149012	SUP	HCPCS C1713		71149012  -  SCREW BN 1.5MM 12MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149014	SUP	HCPCS C1713		71149014  -  SCREW BN 1.5MM 14MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149016	SUP	HCPCS C1713		71149016  -  SCREW BN 1.5MM 16MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149018	SUP	HCPCS C1713		71149018  -  SCREW BN 1.5MM 18MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149020	SUP	HCPCS C1713		71149020  -  SCREW BN 1.5MM 20MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149022	SUP	HCPCS C1713		71149022  -  SCREW BN 1.5MM 22MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149024	SUP	HCPCS C1713		71149024  -  SCREW BN 1.5MM 24MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149106	SUP	HCPCS C1713		71149106  -  SCREW BN 1.5MM 6MM TC100 ST HEX SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149107	SUP	HCPCS C1713		71149107  -  SCREW BN 1.5MM 7MM TC100 ST HEX SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149108	SUP	HCPCS C1713		71149108  -  SCREW BN 1.5MM 8MM TC100 ST HEX SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149109	SUP	HCPCS C1713		71149109  -  SCREW BN 1.5MM 9MM TC100 ST HEX SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149110	SUP	HCPCS C1713		71149110  -  SCREW BN 1.5MM 10MM TC100 ST HEX SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149111	SUP	HCPCS C1713		71149111  -  SCREW BN 1.5MM 11MM TC100 ST HEX SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149112	SUP	HCPCS C1713		71149112  -  SCREW BN 1.5MM 12MM TC100 ST HEX SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149114	SUP	HCPCS C1713		71149114  -  SCREW BN 1.5MM 14MM TC100 ST HEX SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149116	SUP	HCPCS C1713		71149116  -  SCREW BN 1.5MM 16MM TC100 ST HEX SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149118	SUP	HCPCS C1713		71149118  -  SCREW BN 1.5MM 3MM 18MM TC100 HEX HD ST SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149120	SUP	HCPCS C1713		71149120  -  SCREW BN 1.5MM 3MM 20MM TC100 HEX HD ST SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149122	SUP	HCPCS C1713		71149122  -  SCREW BN 1.5MM 3MM 22MM TC100 HEX HD ST SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149124	SUP	HCPCS C1713		71149124  -  SCREW BN 1.5MM 3MM 24MM TC100 HEX HD ST SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149206	SUP	HCPCS C1713		71149206  -  SCREW BN 2MM 6MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149208	SUP	HCPCS C1713		71149208  -  SCREW BN 2MM 8MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149210	SUP	HCPCS C1713		71149210  -  SCREW BN 2MM 10MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149212	SUP	HCPCS C1713		71149212  -  SCREW BN 2MM 12MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149214	SUP	HCPCS C1713		71149214  -  SCREW BN 2MM 14MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149216	SUP	HCPCS C1713		71149216  -  SCREW BN 2MM 16MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149218	SUP	HCPCS C1713		71149218  -  SCREW BN 2MM 18MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149220	SUP	HCPCS C1713		71149220  -  SCREW BN 2MM 20MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149222	SUP	HCPCS C1713		71149222  -  SCREW BN 2MM 22MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149224	SUP	HCPCS C1713		71149224  -  SCREW BN 2MM 24MM TC100 ST LTWT MDLR CRCTE HD SS CORT MN	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149226	SUP	HCPCS C1713		71149226  -  SCREW BN 2MM 26MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149228	SUP	HCPCS C1713		71149228  -  SCREW BN 2MM 28MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149230	SUP	HCPCS C1713		71149230  -  SCREW BN 2MM 30MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149232	SUP	HCPCS C1713		71149232  -  SCREW BN 2MM 32MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149234	SUP	HCPCS C1713		71149234  -  SCREW BN 2MM 34MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149236	SUP	HCPCS C1713		71149236  -  SCREW BN 2MM 36MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149238	SUP	HCPCS C1713		71149238  -  SCREW BN 2MM 38MM TC100 ST CRCTE HD SS CORT MN FRAG SET	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
71149306	SUP	HCPCS C1713		71149306  -  SCREW BN MN 2MM 4MM 6MM TC100 ST HEX HD SS CORT MN FRAG SYS	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149308	SUP	HCPCS C1713		71149308  -  SCREW BN 2MM 4MM 8MM TC100 ST HEX HD SS CORT MN FRAG SYS	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149310	SUP	HCPCS C1713		71149310  -  SCREW BN 2MM 4MM 10MM TC100 ST HEX HD SS CORT MN FRAG SYS	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149312	SUP	HCPCS C1713		71149312  -  SCREW BN 2MM 4MM 12MM TC100 ST HEX HD SS CORT MN FRAG SYS	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149314	SUP	HCPCS C1713		71149314  -  SCREW BN 2MM 4MM 14MM TC100 ST HEX HD SS CORT MN FRAG SYS	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149316	SUP	HCPCS C1713		71149316  -  SCREW BN 2MM 4MM 16MM TC100 ST HEX HD SS CORT MN FRAG SYS	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149318	SUP	HCPCS C1713		71149318  -  SCREW BN 2MM 4MM 18MM TC100 ST HEX HD SS CORT MN FRAG SYS	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149320	SUP	HCPCS C1713		71149320  -  SCREW BN 2MM 4MM 20MM TC100 ST HEX HD SS CORT MN FRAG SYS	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149322	SUP	HCPCS C1713		71149322  -  SCREW BN 2MM 4MM 22MM TC100 ST HEX HD SS CORT MN FRAG SYS	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149324	SUP	HCPCS C1713		71149324  -  SCREW BN 2MM 4MM 24MM TC100 ST HEX HD SS CORT MN FRAG SYS	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149326	SUP	HCPCS C1713		71149326  -  SCREW BN 2MM 26MM TC100 ST CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149328	SUP	HCPCS C1713		71149328  -  SCREW BN 2MM 28MM TC100 ST CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149330	SUP	HCPCS C1713		71149330  -  SCREW BN 2MM 30MM TC100 ST CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149332	SUP	HCPCS C1713		71149332  -  SCREW BN 2MM 32MM TC100 ST CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149334	SUP	HCPCS C1713		71149334  -  SCREW BN 2MM 34MM TC100 ST CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149336	SUP	HCPCS C1713		71149336  -  SCREW BN 2MM 36MM TC100 ST CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149338	SUP	HCPCS C1713		71149338  -  SCREW BN 2MM 38MM TC100 ST CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
71149406	SUP	HCPCS C1713		71149406  -  SCREW BN 2.7MM 5MM 6MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149408	SUP	HCPCS C1713		71149408  -  SCREW BN 2.7MM 5MM 8MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149410	SUP	HCPCS C1713		71149410  -  SCREW BN 2.7MM 5MM 10MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149412	SUP	HCPCS C1713		71149412  -  SCREW BN 2.7MM 5MM 12MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149414	SUP	HCPCS C1713		71149414  -  SCREW BN 2.7MM 5MM 14MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149416	SUP	HCPCS C1713		71149416  -  SCREW BN 2.7MM 5MM 16MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149418	SUP	HCPCS C1713		71149418  -  SCREW BN 2.7MM 18MM TC100 ST CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149420	SUP	HCPCS C1713		71149420  -  SCREW BN 2.7MM 5MM 20MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149422	SUP	HCPCS C1713		71149422  -  SCREW BN 2.7MM 5MM 22MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149424	SUP	HCPCS C1713		71149424  -  SCREW BN 2.7MM 5MM 24MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149426	SUP	HCPCS C1713		71149426  -  SCREW BN 2.7MM 5MM 26MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149428	SUP	HCPCS C1713		71149428  -  SCREW BN 2.7MM 5MM 28MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149430	SUP	HCPCS C1713		71149430  -  SCREW BN 2.7MM 5MM 30MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149432	SUP	HCPCS C1713		71149432  -  SCREW BN 2.7MM 5MM 32MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149434	SUP	HCPCS C1713		71149434  -  SCREW BN 2.7MM 5MM 34MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149436	SUP	HCPCS C1713		71149436  -  SCREW BN 2.7MM 5MM 36MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149438	SUP	HCPCS C1713		71149438  -  SCREW BN 2.7MM 5MM 38MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149440	SUP	HCPCS C1713		71149440  -  SCREW BN 2.7MM 5MM 40MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149445	SUP	HCPCS C1713		71149445  -  SCREW BN 2.7MM 5MM 45MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149450	SUP	HCPCS C1713		71149450  -  SCREW BN 2.7MM 5MM 50MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149455	SUP	HCPCS C1713		71149455  -  SCREW BN 2.7MM 5MM 55MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149460	SUP	HCPCS C1713		71149460  -  SCREW BN 2.7MM 5MM 60MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149465	SUP	HCPCS C1713		71149465  -  SCREW BN 2.7MM 5MM 65MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149470	SUP	HCPCS C1713		71149470  -  SCREW BN 2.7MM 5MM 70MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71149510	SUP	HCPCS C1713		71149510  -  SCREW BN 3.5MM 6MM 10MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149512	SUP	HCPCS C1713		71149512  -  SCREW BN 3.5MM 6MM 12MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149514	SUP	HCPCS C1713		71149514  -  SCREW BN 3.5MM 14MM ST DIST CORT VOLR RDS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149516	SUP	HCPCS C1713		71149516  -  SCREW BN HEX 3.5MM 16MM ST DIST CORT VOLR RDS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149518	SUP	HCPCS C1713		71149518  -  SCREW BN 3.5MM 6MM 18MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149520	SUP	HCPCS C1713		71149520  -  SCREW BN 3.5MM 6MM 20MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149522	SUP	HCPCS C1713		71149522  -  SCREW BN 3.5MM 6MM 22MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149524	SUP	HCPCS C1713		71149524  -  SCREW BN 3.5MM 6MM 24MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149526	SUP	HCPCS C1713		71149526  -  SCREW BN 3.5MM 6MM 26MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149528	SUP	HCPCS C1713		71149528  -  SCREW BN 3.5MM 6MM 28MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149530	SUP	HCPCS C1713		71149530  -  SCREW BN 3.5MM 6MM 30MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149532	SUP	HCPCS C1713		71149532  -  SCREW BN 3.5MM 6MM 32MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149534	SUP	HCPCS C1713		71149534  -  SCREW BN 3.5MM 6MM 34MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149536	SUP	HCPCS C1713		71149536  -  SCREW BN 3.5MM 6MM 36MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149538	SUP	HCPCS C1713		71149538  -  SCREW BN 3.5MM 6MM 38MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149540	SUP	HCPCS C1713		71149540  -  SCREW BN 3.5MM 6MM 40MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149545	SUP	HCPCS C1713		71149545  -  SCREW BN 3.5MM 6MM 45MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149550	SUP	HCPCS C1713		71149550  -  SCREW BN 3.5MM 6MM 50MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149555	SUP	HCPCS C1713		71149555  -  SCREW BN 3.5MM 6MM 55MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
71149560	SUP	HCPCS C1713		71149560  -  SCREW BN 3.5MM 6MM 60MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
71149565	SUP	HCPCS C1713		71149565  -  SCREW BN 3.5MM 6MM 65MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
71149570	SUP	HCPCS C1713		71149570  -  SCREW BN 3.5MM 6MM 70MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
71149575	SUP	HCPCS C1713		71149575  -  SCREW BN 3.5MM 6MM 75MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
71149580	SUP	HCPCS C1713		71149580  -  SCREW BN 3.5MM 6MM 80MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
71149585	SUP	HCPCS C1713		71149585  -  SCREW BN 3.5MM 6MM 85MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
71149590	SUP	HCPCS C1713		71149590  -  SCREW BN 3.5MM 6MM 90MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
71149595	SUP	HCPCS C1713		71149595  -  SCREW BN 3.5MM 6MM 95MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
71149600	SUP	HCPCS C1713		71149600  -  SCREW BN 3.5MM 100MM TC100 ST DP HEX HD SS CORT SM FRAG SET	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
71149605	SUP	HCPCS C1713		71149605  -  SCREW BN 3.5MM 105MM TC100 ST DP HEX HD SS CORT SM FRAG SET	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
71149610	SUP	HCPCS C1713		71149610  -  SCREW BN 3.5MM 110MM TC100 ST DP HEX HD SS CORT SM FRAG SET	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
71149615	SUP	HCPCS C1713		71149615  -  SCREW BN 3.5MM 115MM STRL TC100 ST DP HEX HD SS CORT SM FRAG	BOTH IP/OP	$93.35 	$69.08	$0.00	$74.68	$42.01	$42.01	$0.00	$0.00	$0.00	$19.46	$69.28	$69.28	$0.00	$0.00	$19.45	$0.00	$55.22	$55.22	$0.00	$46.68	$73.93	$74.68	$0.00		$0.00	$14.61	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
71149620	SUP	HCPCS C1713		71149620  -  SCREW BN 3.5MM 120MM STRL TC100 ST DP HEX HD SS CORT SM FRAG	BOTH IP/OP	$93.35 	$69.08	$0.00	$74.68	$42.01	$42.01	$0.00	$0.00	$0.00	$19.46	$69.28	$69.28	$0.00	$0.00	$19.45	$0.00	$55.22	$55.22	$0.00	$46.68	$73.93	$74.68	$0.00		$0.00	$14.61	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
71149625	SUP	HCPCS C1713		71149625  -  SCREW BN 3.5MM 125MM STRL TC100 ST DP HEX HD SS CORT SM FRAG	BOTH IP/OP	$93.35 	$69.08	$0.00	$74.68	$42.01	$42.01	$0.00	$0.00	$0.00	$19.46	$69.28	$69.28	$0.00	$0.00	$19.45	$0.00	$55.22	$55.22	$0.00	$46.68	$73.93	$74.68	$0.00		$0.00	$14.61	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
71149630	SUP	HCPCS C1713		71149630  -  SCREW BN 3.5MM 130MM STRL TC100 ST DP HEX HD SS CORT SM FRAG	BOTH IP/OP	$93.35 	$69.08	$0.00	$74.68	$42.01	$42.01	$0.00	$0.00	$0.00	$19.46	$69.28	$69.28	$0.00	$0.00	$19.45	$0.00	$55.22	$55.22	$0.00	$46.68	$73.93	$74.68	$0.00		$0.00	$14.61	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
71149714	SUP	HCPCS C1713		71149714  -  SCREW BN 4.5MM 14MM TC100 ST HEX SCKT SS CORT LG SCR SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149716	SUP	HCPCS C1713		71149716  -  SCREW BN 4.5MM 16MM TC100 ST HEX SCKT SS CORT LG FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149718	SUP	HCPCS C1713		71149718  -  SCREW BN 4.5MM 18MM TC100 ST HEX SCKT SS CORT LG SCR SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149720	SUP	HCPCS C1713		71149720  -  SCREW BN 4.5MM 20MM TC100 ST HEX SCKT SS CORT LG SCR SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149722	SUP	HCPCS C1713		71149722  -  SCREW BN 4.5MM 22MM TC100 ST HEX SCKT SS CORT LG FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149724	SUP	HCPCS C1713		71149724  -  SCREW BN 4.5MM 24MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149726	SUP	HCPCS C1713		71149726  -  SCREW BN 4.5MM 26MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149728	SUP	HCPCS C1713		71149728  -  SCREW BN 4.5MM 28MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149730	SUP	HCPCS C1713		71149730  -  SCREW BN 4.5MM 30MM TC100 ST HEX SCKT SS CORT LG FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149732	SUP	HCPCS C1713		71149732  -  SCREW BN 4.5MM 32MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149734	SUP	HCPCS C1713		71149734  -  SCREW BN 4.5MM 34MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149736	SUP	HCPCS C1713		71149736  -  SCREW BN 4.5MM 36MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149738	SUP	HCPCS C1713		71149738  -  SCREW BN 4.5MM 38MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149740	SUP	HCPCS C1713		71149740  -  SCREW BN 4.5MM 40MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149742	SUP	HCPCS C1713		71149742  -  SCREW BN HEX 4.5MM 42MM TC100 ST SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149744	SUP	HCPCS C1713		71149744  -  SCREW BN HEX 4.5MM 44MM TC100 ST SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149746	SUP	HCPCS C1713		71149746  -  SCREW BN 4.5MM 46MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149748	SUP	HCPCS C1713		71149748  -  SCREW BN 4.5MM 48MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149750	SUP	HCPCS C1713		71149750  -  SCREW BN 4.5MM 50MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149752	SUP	HCPCS C1713		71149752  -  SCREW BN 4.5MM 52MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149754	SUP	HCPCS C1713		71149754  -  SCREW BN 4.5MM 54MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149756	SUP	HCPCS C1713		71149756  -  SCREW BN 4.5MM 56MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149758	SUP	HCPCS C1713		71149758  -  SCREW BN 4.5MM 58MM TC100 ST HEX SCKT SS CORT LG FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149760	SUP	HCPCS C1713		71149760  -  SCREW BN 4.5MM 60MM TC100 ST HEX SCKT SS CORT LG SCR SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149762	SUP	HCPCS C1713		71149762  -  SCREW BN 4.5MM 62MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149764	SUP	HCPCS C1713		71149764  -  SCREW BN 4.5MM 64MM TC100 ST HEX SCKT SS CORT LG FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149766	SUP	HCPCS C1713		71149766  -  SCREW BN 4.5MM 66MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149768	SUP	HCPCS C1713		71149768  -  SCREW BN 4.5MM 68MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149770	SUP	HCPCS C1713		71149770  -  SCREW BN 4.5MM 70MM TC100 ST HEX SCKT SS CORT LG FRAG SET	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71149772	SUP	HCPCS C1713		71149772  -  SCREW BN 4.5MM 72MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149776	SUP	HCPCS C1713		71149776  -  SCREW BN 4.5MM 76MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149785	SUP	HCPCS C1713		71149785  -  SCREW BN 4.5MM 85MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149795	SUP	HCPCS C1713		71149795  -  SCREW BN 4.5MM 95MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149800	SUP	HCPCS C1713		71149800  -  SCREW BN 4.5MM 100MM TC100 ST HEX HD SS CORT LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149805	SUP	HCPCS C1713		71149805  -  SCREW BN 4.5MM 105MM TC100 ST HEX HD SS CORT LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149810	SUP	HCPCS C1713		71149810  -  SCREW BN 4.5MM 110MM TC100 ST HEX HD SS CORT LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149815	SUP	HCPCS C1713		71149815  -  SCREW BN 4.5MM 115MM TC100 ST HEX HD SS CORT LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149820	SUP	HCPCS C1713		71149820  -  SCREW BN 4.5MM 120MM TC100 ST HEX HD SS CORT LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149825	SUP	HCPCS C1713		71149825  -  SCREW BN 4.5MM 125MM TC100 ST HEX HD SS CORT LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149830	SUP	HCPCS C1713		71149830  -  SCREW BN 4.5MM 130MM TC100 ST HEX HD SS CORT LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149835	SUP	HCPCS C1713		71149835  -  SCREW BN 4.5MM 135MM TC100 ST HEX HD SS CORT LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149840	SUP	HCPCS C1713		71149840  -  SCREW BN 4.5MM 140MM TC100 ST HEX HD SS CORT LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71149845	SUP	HCPCS C1713		71149845  -  SCREW BN 4.5MM 145MM TC100 ST HEX HD SS CORT LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71160095	SUP	HCPCS C1713		71160095  -  SCREW BN 95MM LG TI ORTH	BOTH IP/OP	$689.85 	$510.49	$0.00	$551.88	$310.43	$310.43	$0.00	$0.00	$0.00	$143.78	$512.01	$512.01	$0.00	$0.00	$143.76	$0.00	$408.05	$408.05	$0.00	$344.93	$546.36	$551.88	$0.00		$0.00	$107.96	$0.00	$0.00	$109.82	$0.00	$0.00	$0.00	$0.00	$0.00
71161008	SUP	HCPCS C1769		71161008  -  WIRE FX .8MM 70MM STRL KRSH TROC PNT 1 END SS ORTH	BOTH IP/OP	$47.70 	$35.30	$0.00	$38.16	$25.90	$25.90	$0.00	$0.00	$0.00	$9.94	$35.40	$35.40	$0.00	$0.00	$9.94	$0.00	$28.21	$28.21	$0.00	$23.85	$37.78	$38.16	$0.00		$0.00	$7.47	$0.00	$0.00	$7.59	$0.00	$0.00	$0.00	$0.00	$0.00
71161010	SUP	HCPCS C1769		71161010  -  WIRE FX 1MM 150MM STRL KRSH TROC PNT 1 END SS ORTH	BOTH IP/OP	$47.70 	$35.30	$0.00	$38.16	$25.90	$25.90	$0.00	$0.00	$0.00	$9.94	$35.40	$35.40	$0.00	$0.00	$9.94	$0.00	$28.21	$28.21	$0.00	$23.85	$37.78	$38.16	$0.00		$0.00	$7.47	$0.00	$0.00	$7.59	$0.00	$0.00	$0.00	$0.00	$0.00
71161020	SUP	Custom 27203010		71161020  -  WIRE FX 2MM 150MM STRL KRSH TROC PNT SS ORTH DISP	BOTH IP/OP	$67.20 	$49.73	$0.00	$53.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.88	$49.88	$0.00	$0.00	$14.00	$0.00	$0.00	$0.00	$0.00	$33.60	$53.22	$53.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71161040	SUP	HCPCS C1713		71161040  -  SCREW BN P/T 6.5MM 40MM NS 20MM CNN TI	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161045	SUP	HCPCS C1713		71161045  -  SCREW BN P/T 6.5MM 45MM NS 20MM CNN TI	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161050	SUP	HCPCS C1713		71161050  -  SCREW BN P/T 6.5MM 50MM NS 20MM CNN TI	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161055	SUP	HCPCS C1713		71161055  -  SCREW BN P/T 6.5MM 55MM NS 20MM CNN TI	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161060	SUP	HCPCS C1713		71161060  -  SCREW BN P/T 6.5MM 60MM NS 20MM CNN TI	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161065	SUP	HCPCS C1713		71161065  -  SCREW BN P/T 6.5MM 65MM NS 20MM CNN TI	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161066	SUP	HCPCS C1769		71161066  -  WIRE FX .6MM STRL KRSH	BOTH IP/OP	$47.70 	$35.30	$0.00	$38.16	$25.90	$25.90	$0.00	$0.00	$0.00	$9.94	$35.40	$35.40	$0.00	$0.00	$9.94	$0.00	$28.21	$28.21	$0.00	$23.85	$37.78	$38.16	$0.00		$0.00	$7.47	$0.00	$0.00	$7.59	$0.00	$0.00	$0.00	$0.00	$0.00
71161070	SUP	HCPCS C1713		71161070  -  SCREW BN 6.5MM 70MM NS 20MM CNN P/T TI ORTH	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161075	SUP	HCPCS C1713		71161075  -  SCREW BN 6.5MM 75MM NS 20MM CNN P/T TI ORTH	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161080	SUP	HCPCS C1713		71161080  -  SCREW BN LG 6.5MM 80MM STRL 20MM CNN THRD TI ORTH	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161085	SUP	HCPCS C1713		71161085  -  SCREW BN 6.5MM 85MM NS 20MM CNN P/T TI ORTH	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161090	SUP	HCPCS C1713		71161090  -  SCREW BN 6.5MM 90MM NS 20MM CNN P/T TI ORTH	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161095	SUP	HCPCS C1713		71161095  -  SCREW BN 6.5MM 95MM NS 20MM CNN P/T TI ORTH	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161100	SUP	HCPCS C1713		71161100  -  SCREW BN 6.5MM 100MM NS 20MM CNN P/T TI ORTH	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161105	SUP	HCPCS C1713		71161105  -  SCREW BN 6.5MM 105MM NS 20MM CNN P/T TI ORTH	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161110	SUP	HCPCS C1713		71161110  -  SCREW BN 6.5MM 110MM NS 20MM CNN P/T TI ORTH	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
71161303	SUP	HCPCS C1713		71161303  -  PLATE BN 130D CLS 3 HL CMPR TI HIP	BOTH IP/OP	"$1,422.75 "	"$1,052.84"	$0.00	"$1,138.20"	$640.24	$640.24	$0.00	$0.00	$0.00	$296.54	"$1,055.97"	"$1,055.97"	$0.00	$0.00	$296.50	$0.00	$841.56	$841.56	$0.00	$711.38	"$1,126.82"	"$1,138.20"	$0.00		$0.00	$222.66	$0.00	$0.00	$226.50	$0.00	$0.00	$0.00	$0.00	$0.00
71161352	SUP	HCPCS C1713		71161352  -  PLATE BN 135D CLS 2 HL CMPR TI HIP	BOTH IP/OP	"$1,422.75 "	"$1,052.84"	$0.00	"$1,138.20"	$640.24	$640.24	$0.00	$0.00	$0.00	$296.54	"$1,055.97"	"$1,055.97"	$0.00	$0.00	$296.50	$0.00	$841.56	$841.56	$0.00	$711.38	"$1,126.82"	"$1,138.20"	$0.00		$0.00	$222.66	$0.00	$0.00	$226.50	$0.00	$0.00	$0.00	$0.00	$0.00
71161354	SUP	HCPCS C1713		71161354  -  PLATE BN 135D CLS 4 HL CMPR TI HIP	BOTH IP/OP	"$1,422.75 "	"$1,052.84"	$0.00	"$1,138.20"	$640.24	$640.24	$0.00	$0.00	$0.00	$296.54	"$1,055.97"	"$1,055.97"	$0.00	$0.00	$296.50	$0.00	$841.56	$841.56	$0.00	$711.38	"$1,126.82"	"$1,138.20"	$0.00		$0.00	$222.66	$0.00	$0.00	$226.50	$0.00	$0.00	$0.00	$0.00	$0.00
71161355	SUP	HCPCS C1713		71161355  -  PLATE BN 135D CLS 5 HL CMPR TI HIP	BOTH IP/OP	"$1,422.75 "	"$1,052.84"	$0.00	"$1,138.20"	$640.24	$640.24	$0.00	$0.00	$0.00	$296.54	"$1,055.97"	"$1,055.97"	$0.00	$0.00	$296.50	$0.00	$841.56	$841.56	$0.00	$711.38	"$1,126.82"	"$1,138.20"	$0.00		$0.00	$222.66	$0.00	$0.00	$226.50	$0.00	$0.00	$0.00	$0.00	$0.00
71161404	SUP	HCPCS C1713		71161404  -  PLATE BN 140D CLS 4 HL CMPR TI HIP	BOTH IP/OP	"$1,422.75 "	"$1,052.84"	$0.00	"$1,138.20"	$640.24	$640.24	$0.00	$0.00	$0.00	$296.54	"$1,055.97"	"$1,055.97"	$0.00	$0.00	$296.50	$0.00	$841.56	$841.56	$0.00	$711.38	"$1,126.82"	"$1,138.20"	$0.00		$0.00	$222.66	$0.00	$0.00	$226.50	$0.00	$0.00	$0.00	$0.00	$0.00
71161405	SUP	HCPCS C1713		71161405  -  PLATE BN 140D CLS 5 HL CMPR TI HIP	BOTH IP/OP	"$1,422.75 "	"$1,052.84"	$0.00	"$1,138.20"	$640.24	$640.24	$0.00	$0.00	$0.00	$296.54	"$1,055.97"	"$1,055.97"	$0.00	$0.00	$296.50	$0.00	$841.56	$841.56	$0.00	$711.38	"$1,126.82"	"$1,138.20"	$0.00		$0.00	$222.66	$0.00	$0.00	$226.50	$0.00	$0.00	$0.00	$0.00	$0.00
71161506	SUP	HCPCS C1713		71161506  -  SCREW BN 1.5MM 6MM TC100 HEX SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161507	SUP	HCPCS C1713		71161507  -  SCREW BN 1.5MM 7MM TC100 HEX SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161508	SUP	HCPCS C1713		71161508  -  SCREW BN 1.5MM 8MM TC100 HEX SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161509	SUP	HCPCS C1713		71161509  -  SCREW BN 1.5MM 9MM TC100 HEX SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161510	SUP	HCPCS C1713		71161510  -  SCREW BN 1.5MM 10MM TC100 HEX SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161511	SUP	HCPCS C1713		71161511  -  SCREW BN 1.5MM 11MM TC100 HEX SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161512	SUP	HCPCS C1713		71161512  -  SCREW BN 1.5MM 12MM TC100 HEX SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161514	SUP	HCPCS C1713		71161514  -  SCREW BN 1.5MM 14MM TC100 HEX SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161516	SUP	HCPCS C1713		71161516  -  SCREW BN 1.5MM 16MM TC100 HEX SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161518	SUP	HCPCS C1713		71161518  -  SCREW BN 1.5MM 18MM TC100 HEX SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161520	SUP	HCPCS C1713		71161520  -  SCREW BN 1.5MM 20MM TC100 HEX SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161606	SUP	HCPCS C1713		71161606  -  SCREW BN MN 1.5MM 6MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161607	SUP	HCPCS C1713		71161607  -  SCREW BN MN 1.5MM 7MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161608	SUP	HCPCS C1713		71161608  -  SCREW BN MN 1.5MM 8MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161609	SUP	HCPCS C1713		71161609  -  SCREW BN MN 1.5MM 9MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161610	SUP	HCPCS C1713		71161610  -  SCREW BN 1.5MM 10MM TC100 CRCTE SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161611	SUP	HCPCS C1713		71161611  -  SCREW BN MN 1.5MM 11MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161612	SUP	HCPCS C1713		71161612  -  SCREW BN 1.5MM 12MM TC100 CRCTE SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161614	SUP	HCPCS C1713		71161614  -  SCREW BN 1.5MM 14MM TC100 CRCTE SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161616	SUP	HCPCS C1713		71161616  -  SCREW BN 1.5MM 16MM TC100 CRCTE SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161618	SUP	HCPCS C1713		71161618  -  SCREW BN 1.5MM 18MM TC100 CRCTE SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71161620	SUP	HCPCS C1713		71161620  -  SCREW BN 1.5MM 20MM TC100 CRCTE SCKT SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162008	SUP	HCPCS C1713		71162008  -  SCREW BN 2MM 8MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162010	SUP	HCPCS C1713		71162010  -  SCREW BN 2MM 10MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162012	SUP	HCPCS C1713		71162012  -  SCREW BN 2MM 12MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162014	SUP	HCPCS C1713		71162014  -  SCREW BN 2MM 14MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162016	SUP	HCPCS C1713		71162016  -  SCREW BN 2MM 16MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162018	SUP	HCPCS C1713		71162018  -  SCREW BN 2MM 18MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162020	SUP	HCPCS C1713		71162020  -  SCREW BN 2MM 20MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162022	SUP	HCPCS C1713		71162022  -  SCREW BN 2MM 22MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162024	SUP	HCPCS C1713		71162024  -  SCREW BN 2MM 24MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162026	SUP	HCPCS C1713		71162026  -  SCREW BN 2MM 26MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162028	SUP	HCPCS C1713		71162028  -  SCREW BN 2MM 28MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162030	SUP	HCPCS C1713		71162030  -  SCREW BN 2MM 30MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162032	SUP	HCPCS C1713		71162032  -  SCREW BN 2MM 32MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162036	SUP	HCPCS C1713		71162036  -  SCREW BN 2MM 36MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162038	SUP	HCPCS C1713		71162038  -  SCREW BN 2MM 38MM TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162106	SUP	HCPCS C1713		71162106  -  SCREW BN 2MM 6MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162108	SUP	HCPCS C1713		71162108  -  SCREW BN 2MM 8MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162110	SUP	HCPCS C1713		71162110  -  SCREW BN 2MM 10MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162112	SUP	HCPCS C1713		71162112  -  SCREW BN 2MM 12MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162114	SUP	HCPCS C1713		71162114  -  SCREW BN 2MM 14MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162116	SUP	HCPCS C1713		71162116  -  SCREW BN 2MM 16MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162118	SUP	HCPCS C1713		71162118  -  SCREW BN 2MM 18MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162120	SUP	HCPCS C1713		71162120  -  SCREW BN 2MM 20MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162122	SUP	HCPCS C1713		71162122  -  SCREW BN 2MM 22MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162124	SUP	HCPCS C1713		71162124  -  SCREW BN 2MM 24MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162126	SUP	HCPCS C1713		71162126  -  SCREW BN 2MM 26MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162128	SUP	HCPCS C1713		71162128  -  SCREW BN 2MM 28MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162130	SUP	HCPCS C1713		71162130  -  SCREW BN 2MM 30MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162132	SUP	HCPCS C1713		71162132  -  SCREW BN 2MM 32MM TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162134	SUP	HCPCS C1713		71162134  -  SCREW BN 2MM 34MM STRL TC100 CRCTE HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71162206	SUP	HCPCS C1713		71162206  -  SCREW BN 2MM 6MM STRL TC100 HEX HD SS CORT	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71163006	SUP	HCPCS C1769		71163006  -  WIRE FX .6MM 175MM STRL KRSH CRLGE SS ORTH	BOTH IP/OP	$50.40 	$37.30	$0.00	$40.32	$27.37	$27.37	$0.00	$0.00	$0.00	$10.50	$37.41	$37.41	$0.00	$0.00	$10.50	$0.00	$29.81	$29.81	$0.00	$25.20	$39.92	$40.32	$0.00		$0.00	$7.89	$0.00	$0.00	$8.02	$0.00	$0.00	$0.00	$0.00	$0.00
71163008	SUP	HCPCS C1769		71163008  -  WIRE FX .8MM 200MM STRL KRSH CRLGE SS ORTH	BOTH IP/OP	$50.40 	$37.30	$0.00	$40.32	$27.37	$27.37	$0.00	$0.00	$0.00	$10.50	$37.41	$37.41	$0.00	$0.00	$10.50	$0.00	$29.81	$29.81	$0.00	$25.20	$39.92	$40.32	$0.00		$0.00	$7.89	$0.00	$0.00	$8.02	$0.00	$0.00	$0.00	$0.00	$0.00
71164026	SUP	HCPCS C1713		71164026  -  SCREW BN 4.5MM 26MM ST CMPR TI CORT HIP	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164028	SUP	HCPCS C1713		71164028  -  SCREW BN 4.5MM 28MM ST CMPR TI CORT	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164030	SUP	HCPCS C1713		71164030  -  SCREW BN 4.5MM 30MM ST TI ORTH	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164032	SUP	HCPCS C1713		71164032  -  SCREW BN 4.5MM 32MM ST CMPR TI CORT	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164034	SUP	HCPCS C1713		71164034  -  SCREW BN 4.5MM 34MM ST CMPR TI CORT HIP	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164036	SUP	HCPCS C1713		71164036  -  SCREW BN 4.5MM 36MM ST CMPR TI CORT HIP	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164038	SUP	HCPCS C1713		71164038  -  SCREW BN 4.5MM 38MM ST CMPR TI CORT	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164040	SUP	HCPCS C1713		71164040  -  SCREW BN 4.5MM 40MM ST CMPR TI CORT HIP	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164042	SUP	HCPCS C1713		71164042  -  SCREW BN 4.5MM 42MM ST CMPR TI CORT HIP	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164044	SUP	HCPCS C1713		71164044  -  SCREW BN 4.5MM 44MM ST CMPR TI CORT HIP	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164046	SUP	HCPCS C1713		71164046  -  SCREW BN 4.5MM 46MM ST CMPR TI CORT HIP	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164048	SUP	HCPCS C1713		71164048  -  SCREW BN 4.5MM 48MM ST CMPR TI CORT HIP	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164050	SUP	HCPCS C1713		71164050  -  SCREW BN 4.5MM 50MM ST CMPR TI CORT HIP	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71164052	SUP	HCPCS C1713		71164052  -  SCREW BN 4.5MM 52MM ST CMPR TI CORT HIP	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$27.17	$27.17	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
71170001	SUP	Custom 27203010		71170001  -  BIT DRL 1.1MM QC	BOTH IP/OP	$163.80 	$121.21	$0.00	$131.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.57	$121.57	$0.00	$0.00	$34.14	$0.00	$0.00	$0.00	$0.00	$81.90	$129.73	$131.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170003	SUP	Custom 27203010		71170003  -  BIT DRL 1.5MM 85MM STRL 60MM TC100 QC	BOTH IP/OP	$163.80 	$121.21	$0.00	$131.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.57	$121.57	$0.00	$0.00	$34.14	$0.00	$0.00	$0.00	$0.00	$81.90	$129.73	$131.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170005	SUP	Custom 27203010		71170005  -  BIT DRL 2MM STRL GLD HL	BOTH IP/OP	$163.80 	$121.21	$0.00	$131.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.57	$121.57	$0.00	$0.00	$34.14	$0.00	$0.00	$0.00	$0.00	$81.90	$129.73	$131.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170007	SUP	Custom 27203010		71170007  -  BIT DRL 2.7MM QC	BOTH IP/OP	$163.80 	$121.21	$0.00	$131.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.57	$121.57	$0.00	$0.00	$34.14	$0.00	$0.00	$0.00	$0.00	$81.90	$129.73	$131.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170071	SUP	Custom 27203010		71170071  -  BIT DRL 2.5MM 110MM AU STRL QC	BOTH IP/OP	$270.90 	$200.47	$0.00	$216.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.06	$201.06	$0.00	$0.00	$56.46	$0.00	$0.00	$0.00	$0.00	$135.45	$214.55	$216.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170073	SUP	Custom 27203010		71170073  -  BIT DRL 3.5MM 110MM STRL QC	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$0.00	$0.00	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170111	SUP	Custom 27203010		71170111  -  BIT DRL 3.2MM 145MM STRL QC	BOTH IP/OP	$163.80 	$121.21	$0.00	$131.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.57	$121.57	$0.00	$0.00	$34.14	$0.00	$0.00	$0.00	$0.00	$81.90	$129.73	$131.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170113	SUP	Custom 27203010		71170113  -  BIT DRL 4.5MM 145MM STRL QC	BOTH IP/OP	$204.75 	$151.52	$0.00	$163.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.97	$151.97	$0.00	$0.00	$42.67	$0.00	$0.00	$0.00	$0.00	$102.38	$162.16	$163.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170147	SUP	Custom 27203010		71170147  -  BIT DRL LNG 3.5MM 195MM STRL QC	BOTH IP/OP	$279.30 	$206.68	$0.00	$223.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.30	$207.30	$0.00	$0.00	$58.21	$0.00	$0.00	$0.00	$0.00	$139.65	$221.21	$223.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170149	SUP	Custom 27203010		71170149  -  BIT DRL LNG 4.5MM 195MM STRL QC	BOTH IP/OP	$279.30 	$206.68	$0.00	$223.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.30	$207.30	$0.00	$0.00	$58.21	$0.00	$0.00	$0.00	$0.00	$139.65	$221.21	$223.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170151	SUP	Custom 27203010		71170151  -  BIT DRL 4.5MM 196MM STRL QC 3 FLT	BOTH IP/OP	$433.65 	$320.90	$0.00	$346.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$321.86	$321.86	$0.00	$0.00	$90.37	$0.00	$0.00	$0.00	$0.00	$216.83	$343.45	$346.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170153	SUP	Custom 27203010		71170153  -  BIT DRL 2.5MM 230MM STRL QC 3 FLT	BOTH IP/OP	$576.45 	$426.57	$0.00	$461.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.84	$427.84	$0.00	$0.00	$120.13	$0.00	$0.00	$0.00	$0.00	$288.23	$456.55	$461.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170155	SUP	Custom 27203010		71170155  -  BIT DRL 3.2MM 230MM STRL QC 3 FLT	BOTH IP/OP	$576.45 	$426.57	$0.00	$461.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.84	$427.84	$0.00	$0.00	$120.13	$0.00	$0.00	$0.00	$0.00	$288.23	$456.55	$461.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71170315	SUP	HCPCS C1713		71170315  -  SCREW BN 6MM 190MM TC100 SCHNZ DMD PT SS ORTH	BOTH IP/OP	"$1,000.65 "	$740.48	$0.00	$800.52	$450.29	$450.29	$0.00	$0.00	$0.00	$208.56	$742.68	$742.68	$0.00	$0.00	$208.54	$0.00	$591.88	$591.88	$0.00	$500.33	$792.51	$800.52	$0.00		$0.00	$156.60	$0.00	$0.00	$159.30	$0.00	$0.00	$0.00	$0.00	$0.00
71173501	SUP	Custom 27203010		71173501  -  BIT DRILL 2MM 190MM QUICK CONNECT PERI-LOC DISPOSABLE	BOTH IP/OP	$180.60 	$133.64	$0.00	$144.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.04	$134.04	$0.00	$0.00	$37.64	$0.00	$0.00	$0.00	$0.00	$90.30	$143.04	$144.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71173505	SUP	Custom 27203010		71173505  -  BIT DRL 3.5MM 220MM STRL PRLC AO QCK CNCT CLBRT DISP	BOTH IP/OP	$280.35 	$207.46	$0.00	$224.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.08	$208.08	$0.00	$0.00	$58.42	$0.00	$0.00	$0.00	$0.00	$140.18	$222.04	$224.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71173581	SUP	Custom 27203010		71173581  -  BIT DRL 2.7MM 155MM CNN DISP	BOTH IP/OP	$743.40 	$550.12	$0.00	$594.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$551.75	$551.75	$0.00	$0.00	$154.92	$0.00	$0.00	$0.00	$0.00	$371.70	$588.77	$594.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71173807	SUP	HCPCS C1713		71173807  -  PIN FX 2MM 14MM VLP	BOTH IP/OP	$307.50 	$227.55	$0.00	$246.00	$138.38	$138.38	$0.00	$0.00	$0.00	$64.09	$228.23	$228.23	$0.00	$0.00	$64.08	$0.00	$181.89	$181.89	$0.00	$153.75	$243.54	$246.00	$0.00		$0.00	$48.12	$0.00	$0.00	$48.95	$0.00	$0.00	$0.00	$0.00	$0.00
71173808	SUP	HCPCS C1713		71173808  -  PIN FIX 2MM 25MM TRIAL	BOTH IP/OP	$332.50 	$246.05	$0.00	$266.00	$149.63	$149.63	$0.00	$0.00	$0.00	$69.30	$246.78	$246.78	$0.00	$0.00	$69.29	$0.00	$196.67	$196.67	$0.00	$166.25	$263.34	$266.00	$0.00		$0.00	$52.04	$0.00	$0.00	$52.93	$0.00	$0.00	$0.00	$0.00	$0.00
71174904	SUP	HCPCS C1713		71174904  -  PIN FX 1.5MM	BOTH IP/OP	$343.75 	$254.38	$0.00	$275.00	$154.69	$154.69	$0.00	$0.00	$0.00	$71.65	$255.13	$255.13	$0.00	$0.00	$71.64	$0.00	$203.33	$203.33	$0.00	$171.88	$272.25	$275.00	$0.00		$0.00	$53.80	$0.00	$0.00	$54.73	$0.00	$0.00	$0.00	$0.00	$0.00
71174909	SUP	HCPCS C1713		71174909  -  PIN FX 1.8MM	BOTH IP/OP	$343.75 	$254.38	$0.00	$275.00	$154.69	$154.69	$0.00	$0.00	$0.00	$71.65	$255.13	$255.13	$0.00	$0.00	$71.64	$0.00	$203.33	$203.33	$0.00	$171.88	$272.25	$275.00	$0.00		$0.00	$53.80	$0.00	$0.00	$54.73	$0.00	$0.00	$0.00	$0.00	$0.00
71174914	SUP	HCPCS C1713		71174914  -  PIN FX 2MM 30MM EVOS MN	BOTH IP/OP	$343.75 	$254.38	$0.00	$275.00	$154.69	$154.69	$0.00	$0.00	$0.00	$71.65	$255.13	$255.13	$0.00	$0.00	$71.64	$0.00	$203.33	$203.33	$0.00	$171.88	$272.25	$275.00	$0.00		$0.00	$53.80	$0.00	$0.00	$54.73	$0.00	$0.00	$0.00	$0.00	$0.00
71175022	SUP	Custom 27203010		71175022  -  DRILL SRG SM LNG 2.5MM STRL LF EVOS AO QCK CNCT REUSE	BOTH IP/OP	$270.88 	$200.45	$0.00	$216.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.04	$201.04	$0.00	$0.00	$56.45	$0.00	$0.00	$0.00	$0.00	$135.44	$214.54	$216.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71175023	SUP	Custom 27203010		71175023  -  DRILL SRG SM SHRT 2.5MM STRL LF EVOS AO QCK CNCT REUSE	BOTH IP/OP	$225.50 	$166.87	$0.00	$180.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.37	$167.37	$0.00	$0.00	$46.99	$0.00	$0.00	$0.00	$0.00	$112.75	$178.60	$180.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71175027	SUP	Custom 27203010		71175027  -  SCREW BN 3.5MM 14MM STRL EVOS ST CORT	BOTH IP/OP	$312.13 	$230.98	$0.00	$249.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.66	$231.66	$0.00	$0.00	$65.05	$0.00	$0.00	$0.00	$0.00	$156.06	$247.21	$249.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71175029	SUP	Custom 27203010		71175029  -  TAP BN 4.7MM STRL LF EVOS AO QCK CNCT DISP	BOTH IP/OP	$309.38 	$228.94	$0.00	$247.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.62	$229.62	$0.00	$0.00	$64.47	$0.00	$0.00	$0.00	$0.00	$154.69	$245.03	$247.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71175701	SUP	HCPCS C1713		71175701  -  PIN DRL 3.2MM 358MM DRL TIP	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$56.19	$56.19	$0.00	$0.00	$0.00	$26.03	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$73.86	$73.86	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$19.54	$0.00	$0.00	$19.88	$0.00	$0.00	$0.00	$0.00	$0.00
71175702	SUP	HCPCS C1713		71175702  -  PIN FX 4.5MM 80MM PRLC TRL TARGETER DRL TIP	BOTH IP/OP	$348.75 	$258.08	$0.00	$279.00	$156.94	$156.94	$0.00	$0.00	$0.00	$72.69	$258.84	$258.84	$0.00	$0.00	$72.68	$0.00	$206.29	$206.29	$0.00	$174.38	$276.21	$279.00	$0.00		$0.00	$54.58	$0.00	$0.00	$55.52	$0.00	$0.00	$0.00	$0.00	$0.00
71175703	SUP	HCPCS C1713		71175703  -  PIN FX 3.5MM 18MM TARGETER	BOTH IP/OP	$348.75 	$258.08	$0.00	$279.00	$156.94	$156.94	$0.00	$0.00	$0.00	$72.69	$258.84	$258.84	$0.00	$0.00	$72.68	$0.00	$206.29	$206.29	$0.00	$174.38	$276.21	$279.00	$0.00		$0.00	$54.58	$0.00	$0.00	$55.52	$0.00	$0.00	$0.00	$0.00	$0.00
71175705	SUP	HCPCS C1713		71175705  -  PIN FX SHRT 4.5MM 80MM PRLC TRL DRL TIP	BOTH IP/OP	$348.75 	$258.08	$0.00	$279.00	$156.94	$156.94	$0.00	$0.00	$0.00	$72.69	$258.84	$258.84	$0.00	$0.00	$72.68	$0.00	$206.29	$206.29	$0.00	$174.38	$276.21	$279.00	$0.00		$0.00	$54.58	$0.00	$0.00	$55.52	$0.00	$0.00	$0.00	$0.00	$0.00
71175706	SUP	HCPCS C1713		71175706  -  PIN FX SHRT 3.5MM 18MM PRLC TRL DRL TIP	BOTH IP/OP	$348.75 	$258.08	$0.00	$279.00	$156.94	$156.94	$0.00	$0.00	$0.00	$72.69	$258.84	$258.84	$0.00	$0.00	$72.68	$0.00	$206.29	$206.29	$0.00	$174.38	$276.21	$279.00	$0.00		$0.00	$54.58	$0.00	$0.00	$55.52	$0.00	$0.00	$0.00	$0.00	$0.00
71176011	SUP	Custom 27203010		71176011  -  BIT DRL 1.1MM 30MM QC	BOTH IP/OP	$244.65 	$181.04	$0.00	$195.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.58	$181.58	$0.00	$0.00	$50.99	$0.00	$0.00	$0.00	$0.00	$122.33	$193.76	$195.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176015	SUP	Custom 27203010		71176015  -  BIT DRL 1.5MM 85MM QC	BOTH IP/OP	$244.65 	$181.04	$0.00	$195.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.58	$181.58	$0.00	$0.00	$50.99	$0.00	$0.00	$0.00	$0.00	$122.33	$193.76	$195.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176016	SUP	Custom 27203010		71176016  -  BIT DRL 1.5MM 110MM STRL 85MM TC100 QC	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176020	SUP	Custom 27203010		71176020  -  BIT DRL 2MM 100MM QC	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$0.00	$0.00	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176021	SUP	Custom 27203010		71176021  -  BIT DRL 2MM 125MM QC	BOTH IP/OP	$257.25 	$190.37	$0.00	$205.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$190.93	$190.93	$0.00	$0.00	$53.61	$0.00	$0.00	$0.00	$0.00	$128.63	$203.74	$205.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176025	SUP	Custom 27203010		71176025  -  BIT DRL 2.5MM 110MM AU QC	BOTH IP/OP	$273.00 	$202.02	$0.00	$218.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.62	$202.62	$0.00	$0.00	$56.89	$0.00	$0.00	$0.00	$0.00	$136.50	$216.22	$218.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176026	SUP	Custom 27203010		71176026  -  BIT DRL 2.5MM 180MM AU QC	BOTH IP/OP	$354.90 	$262.63	$0.00	$283.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.41	$263.41	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.45	$281.08	$283.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176027	SUP	Custom 27203010		71176027  -  BIT DRL 2.7MM 100MM QC	BOTH IP/OP	$244.65 	$181.04	$0.00	$195.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.58	$181.58	$0.00	$0.00	$50.99	$0.00	$0.00	$0.00	$0.00	$122.33	$193.76	$195.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176028	SUP	Custom 27203010		71176028  -  BIT DRL 2.7MM 125MM STRL QC	BOTH IP/OP	$267.75 	$198.14	$0.00	$214.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.72	$198.72	$0.00	$0.00	$55.80	$0.00	$0.00	$0.00	$0.00	$133.88	$212.06	$214.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176032	SUP	Custom 27203010		71176032  -  BIT DRL 3.2MM 145MM STRL QC	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$0.00	$0.00	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176033	SUP	Custom 27203010		71176033  -  BIT DRL 3.2MM 195MM QC	BOTH IP/OP	$354.90 	$262.63	$0.00	$283.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.41	$263.41	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.45	$281.08	$283.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176035	SUP	Custom 27203010		71176035  -  BIT DRL 3.5MM 110MM QC	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$0.00	$0.00	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176037	SUP	Custom 27203010		71176037  -  BIT DRL 3.5MM 195MM QC	BOTH IP/OP	$354.90 	$262.63	$0.00	$283.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.41	$263.41	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.45	$281.08	$283.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176045	SUP	Custom 27203010		71176045  -  BIT DRL 4.5MM 145MM QC	BOTH IP/OP	$354.90 	$262.63	$0.00	$283.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.41	$263.41	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.45	$281.08	$283.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176047	SUP	Custom 27203010		71176047  -  BIT DRL 4.5MM 195MM QC	BOTH IP/OP	$354.90 	$262.63	$0.00	$283.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.41	$263.41	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.45	$281.08	$283.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176125	SUP	Custom 27203010		71176125  -  BIT DRL 2.5MM 230MM QC 3 FLT	BOTH IP/OP	$606.90 	$449.11	$0.00	$485.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$450.44	$450.44	$0.00	$0.00	$126.48	$0.00	$0.00	$0.00	$0.00	$303.45	$480.66	$485.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176132	SUP	Custom 27203010		71176132  -  BIT DRL LNG 3.2MM 230MM QC 3 FLT	BOTH IP/OP	$606.90 	$449.11	$0.00	$485.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$450.44	$450.44	$0.00	$0.00	$126.48	$0.00	$0.00	$0.00	$0.00	$303.45	$480.66	$485.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176145	SUP	Custom 27203010		71176145  -  BIT DRL 4.5MM 196MM STRL QC 3 FLT	BOTH IP/OP	$470.40 	$348.10	$0.00	$376.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$349.13	$349.13	$0.00	$0.00	$98.03	$0.00	$0.00	$0.00	$0.00	$235.20	$372.56	$376.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176511	SUP	Custom 27203010		71176511  -  BIT DRL 1.1MM 45MM STRL NQCK CPLNG	BOTH IP/OP	$233.10 	$172.49	$0.00	$186.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.01	$173.01	$0.00	$0.00	$48.58	$0.00	$0.00	$0.00	$0.00	$116.55	$184.62	$186.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176516	SUP	Custom 27203010		71176516  -  BIT DRL 1.5MM 95MM STRL NQCK CPLNG	BOTH IP/OP	$241.50 	$178.71	$0.00	$193.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.24	$179.24	$0.00	$0.00	$50.33	$0.00	$0.00	$0.00	$0.00	$120.75	$191.27	$193.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176521	SUP	Custom 27203010		71176521  -  BIT DRL 2MM 110MM NQCK CPLNG	BOTH IP/OP	$281.40 	$208.24	$0.00	$225.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.86	$208.86	$0.00	$0.00	$58.64	$0.00	$0.00	$0.00	$0.00	$140.70	$222.87	$225.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176525	SUP	Custom 27203010		71176525  -  BIT DRL 2.5MM 95MM AU NQCK CPLNG	BOTH IP/OP	$296.10 	$219.11	$0.00	$236.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.77	$219.77	$0.00	$0.00	$61.71	$0.00	$0.00	$0.00	$0.00	$148.05	$234.51	$236.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176528	SUP	Custom 27203010		71176528  -  BIT DRL 2.7MM 110MM NQCK CPLNG	BOTH IP/OP	$255.15 	$188.81	$0.00	$204.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.37	$189.37	$0.00	$0.00	$53.17	$0.00	$0.00	$0.00	$0.00	$127.58	$202.08	$204.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176532	SUP	Custom 27203010		71176532  -  BIT DRL 3.2MM 130MM NQCK CPLNG	BOTH IP/OP	$224.70 	$166.28	$0.00	$179.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.77	$166.77	$0.00	$0.00	$46.83	$0.00	$0.00	$0.00	$0.00	$112.35	$177.96	$179.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176533	SUP	Custom 27203010		71176533  -  BIT DRL 3.2MM 180MM NQCK CPLNG	BOTH IP/OP	$352.80 	$261.07	$0.00	$282.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$261.85	$261.85	$0.00	$0.00	$73.52	$0.00	$0.00	$0.00	$0.00	$176.40	$279.42	$282.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176535	SUP	Custom 27203010		71176535  -  BIT DRL 3.5MM 95MM NQCK CPLNG	BOTH IP/OP	$270.90 	$200.47	$0.00	$216.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.06	$201.06	$0.00	$0.00	$56.46	$0.00	$0.00	$0.00	$0.00	$135.45	$214.55	$216.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176537	SUP	Custom 27203010		71176537  -  BIT DRL 3.5MM 180MM NQCK CPLNG	BOTH IP/OP	$281.40 	$208.24	$0.00	$225.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.86	$208.86	$0.00	$0.00	$58.64	$0.00	$0.00	$0.00	$0.00	$140.70	$222.87	$225.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176545	SUP	Custom 27203010		71176545  -  BIT DRL 4.5MM 130MM STRL NQCK CPLNG	BOTH IP/OP	$270.90 	$200.47	$0.00	$216.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.06	$201.06	$0.00	$0.00	$56.46	$0.00	$0.00	$0.00	$0.00	$135.45	$214.55	$216.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71176547	SUP	Custom 27203010		71176547  -  BIT DRL 4.5MM 180MM NQCK CPLNG	BOTH IP/OP	$303.45 	$224.55	$0.00	$242.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.22	$225.22	$0.00	$0.00	$63.24	$0.00	$0.00	$0.00	$0.00	$151.73	$240.33	$242.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71177134	SUP	Custom 27203010		71177134  -  BIT DRL 5MM CNN	BOTH IP/OP	$918.75 	$679.88	$0.00	$735.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$681.90	$681.90	$0.00	$0.00	$191.47	$0.00	$0.00	$0.00	$0.00	$459.38	$727.65	$735.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71177135	SUP	Custom 27203010		71177135  -  BIT DRL 5.5MM CNN 8MM SCR	BOTH IP/OP	$918.75 	$679.88	$0.00	$735.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$681.90	$681.90	$0.00	$0.00	$191.47	$0.00	$0.00	$0.00	$0.00	$459.38	$727.65	$735.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71177197	SUP	Custom 27203010		71177197  -  BIT DRL SHRT 2MM VLP MN-MOD AO QC OVR	BOTH IP/OP	$242.00 	$179.08	$0.00	$193.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.61	$179.61	$0.00	$0.00	$50.43	$0.00	$0.00	$0.00	$0.00	$121.00	$191.66	$193.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71177201	SUP	HCPCS C1713		71177201  -  PIN GD 3.2MM 300MM THRD	BOTH IP/OP	$170.80 	$126.39	$0.00	$136.64	$76.86	$76.86	$0.00	$0.00	$0.00	$35.60	$126.77	$126.77	$0.00	$0.00	$35.59	$0.00	$101.03	$101.03	$0.00	$85.40	$135.27	$136.64	$0.00		$0.00	$26.73	$0.00	$0.00	$27.19	$0.00	$0.00	$0.00	$0.00	$0.00
71177202	SUP	Custom 27203010		71177202  -  BIT DRL 3.2MM 300MM QC	BOTH IP/OP	$361.20 	$267.29	$0.00	$288.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.08	$268.08	$0.00	$0.00	$75.27	$0.00	$0.00	$0.00	$0.00	$180.60	$286.07	$288.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71190808	SUP	HCPCS C1713		71190808  -  PIN HLF 6MM HAP ORTH	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$38.25	$38.25	$0.00	$0.00	$0.00	$17.72	$63.09	$63.09	$0.00	$0.00	$17.71	$0.00	$50.28	$50.28	$0.00	$42.50	$67.32	$68.00	$0.00		$0.00	$13.30	$0.00	$0.00	$13.53	$0.00	$0.00	$0.00	$0.00	$0.00
71191010	SUP	HCPCS C1713		71191010  -  TRIAL SRG 3.5MM SMPL LCK PLT HUM LT PROX	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
71191019	SUP	HCPCS C1713		71191019  -  TRIAL SRG SMPL LCK PLT RT OLCRN	BOTH IP/OP	$500.85 	$370.63	$0.00	$400.68	$225.38	$225.38	$0.00	$0.00	$0.00	$104.39	$371.73	$371.73	$0.00	$0.00	$104.38	$0.00	$296.25	$296.25	$0.00	$250.43	$396.67	$400.68	$0.00		$0.00	$78.38	$0.00	$0.00	$79.74	$0.00	$0.00	$0.00	$0.00	$0.00
71191025	SUP	HCPCS C1713		71191025  -  TRIAL SRG 10 HL SMPL LCK PLT INFR MDL CLVCL	BOTH IP/OP	$465.15 	$344.21	$0.00	$372.12	$209.32	$209.32	$0.00	$0.00	$0.00	$96.95	$345.23	$345.23	$0.00	$0.00	$96.94	$0.00	$275.14	$275.14	$0.00	$232.58	$368.40	$372.12	$0.00		$0.00	$72.80	$0.00	$0.00	$74.05	$0.00	$0.00	$0.00	$0.00	$0.00
71192010	SUP	HCPCS C1713		71192010  -  TRIAL SRG 2.7MM 55MM SMPL LCK SCR CORT	BOTH IP/OP	$18.23 	$13.49	$0.00	$14.58	$8.20	$8.20	$0.00	$0.00	$0.00	$3.80	$13.53	$13.53	$0.00	$0.00	$3.80	$0.00	$10.78	$10.78	$0.00	$9.11	$14.44	$14.58	$0.00		$0.00	$2.85	$0.00	$0.00	$2.90	$0.00	$0.00	$0.00	$0.00	$0.00
71192011	SUP	HCPCS C1713		71192011  -  TRIAL SRG 2.7MM 20MM SMPL SCR CORT	BOTH IP/OP	$17.65 	$13.06	$0.00	$14.12	$7.94	$7.94	$0.00	$0.00	$0.00	$3.68	$13.10	$13.10	$0.00	$0.00	$3.68	$0.00	$10.44	$10.44	$0.00	$8.83	$13.98	$14.12	$0.00		$0.00	$2.76	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$0.00
71192012	SUP	HCPCS C1713		71192012  -  TRIAL SRG 2.7MM 55MM SMPL SCR CORT	BOTH IP/OP	$19.53 	$14.45	$0.00	$15.62	$8.79	$8.79	$0.00	$0.00	$0.00	$4.07	$14.49	$14.49	$0.00	$0.00	$4.07	$0.00	$11.55	$11.55	$0.00	$9.76	$15.47	$15.62	$0.00		$0.00	$3.06	$0.00	$0.00	$3.11	$0.00	$0.00	$0.00	$0.00	$0.00
71192016	SUP	HCPCS C1713		71192016  -  TRIAL SRG 2.5MM 20MM SMPL SCR CORT	BOTH IP/OP	$17.65 	$13.06	$0.00	$14.12	$7.94	$7.94	$0.00	$0.00	$0.00	$3.68	$13.10	$13.10	$0.00	$0.00	$3.68	$0.00	$10.44	$10.44	$0.00	$8.83	$13.98	$14.12	$0.00		$0.00	$2.76	$0.00	$0.00	$2.81	$0.00	$0.00	$0.00	$0.00	$0.00
71192535	SUP	HCPCS C1713		71192535  -  TRIAL SRG 5MM 35MM HEX SCR ORTH SMPL	BOTH IP/OP	$26.78 	$19.82	$0.00	$21.42	$12.05	$12.05	$0.00	$0.00	$0.00	$5.58	$19.87	$19.87	$0.00	$0.00	$5.58	$0.00	$15.84	$15.84	$0.00	$13.39	$21.21	$21.42	$0.00		$0.00	$4.19	$0.00	$0.00	$4.26	$0.00	$0.00	$0.00	$0.00	$0.00
71192570	SUP	HCPCS C1713		71192570  -  TRIAL SRG 5MM 70MM HEX SCR ORTH SMPL	BOTH IP/OP	$39.33 	$29.10	$0.00	$31.46	$17.70	$17.70	$0.00	$0.00	$0.00	$8.20	$29.19	$29.19	$0.00	$0.00	$8.20	$0.00	$23.26	$23.26	$0.00	$19.66	$31.15	$31.46	$0.00		$0.00	$6.15	$0.00	$0.00	$6.26	$0.00	$0.00	$0.00	$0.00	$0.00
71193006	SUP	HCPCS C1713		71193006  -  SCREW SET ASIAN SMPL HIP IM NL	BOTH IP/OP	$65.30 	$48.32	$0.00	$52.24	$29.39	$29.39	$0.00	$0.00	$0.00	$13.61	$48.47	$48.47	$0.00	$0.00	$13.61	$0.00	$38.62	$38.62	$0.00	$32.65	$51.72	$52.24	$0.00		$0.00	$10.22	$0.00	$0.00	$10.40	$0.00	$0.00	$0.00	$0.00	$0.00
71193039	SUP	HCPCS C1713		71193039  -  NAIL IM 11.5MM 40CM TRGN RTRGD TI FEM	BOTH IP/OP	$178.88 	$132.37	$0.00	$143.10	$80.49	$80.49	$0.00	$0.00	$0.00	$37.28	$132.76	$132.76	$0.00	$0.00	$37.28	$0.00	$105.80	$105.80	$0.00	$89.44	$141.67	$143.10	$0.00		$0.00	$27.99	$0.00	$0.00	$28.48	$0.00	$0.00	$0.00	$0.00	$0.00
71193111	SUP	HCPCS C1713		71193111  -  TRIAL SRG MT-NL SMPL CAP NL	BOTH IP/OP	$29.35 	$21.72	$0.00	$23.48	$13.21	$13.21	$0.00	$0.00	$0.00	$6.12	$21.78	$21.78	$0.00	$0.00	$6.12	$0.00	$17.36	$17.36	$0.00	$14.68	$23.25	$23.48	$0.00		$0.00	$4.59	$0.00	$0.00	$4.67	$0.00	$0.00	$0.00	$0.00	$0.00
71193125	SUP	HCPCS C1713		71193125  -  NAIL IM 11.5MM 25CM TRGN TI FEM	BOTH IP/OP	$176.40 	$130.54	$0.00	$141.12	$79.38	$79.38	$0.00	$0.00	$0.00	$36.77	$130.92	$130.92	$0.00	$0.00	$36.76	$0.00	$104.34	$104.34	$0.00	$88.20	$139.71	$141.12	$0.00		$0.00	$27.61	$0.00	$0.00	$28.08	$0.00	$0.00	$0.00	$0.00	$0.00
71193632	SUP	HCPCS C1713		71193632  -  NAIL IM 10MM 32CM TRGN TI TIB DIST	BOTH IP/OP	$239.63 	$177.33	$0.00	$191.70	$107.83	$107.83	$0.00	$0.00	$0.00	$49.94	$177.85	$177.85	$0.00	$0.00	$49.94	$0.00	$141.74	$141.74	$0.00	$119.81	$189.79	$191.70	$0.00		$0.00	$37.50	$0.00	$0.00	$38.15	$0.00	$0.00	$0.00	$0.00	$0.00
71194828	SUP	HCPCS C1713		71194828  -  NAIL IM 10/8.5MM 28CM TRGN BNT TI HUM	BOTH IP/OP	$339.75 	$251.42	$0.00	$271.80	$152.89	$152.89	$0.00	$0.00	$0.00	$70.81	$252.16	$252.16	$0.00	$0.00	$70.80	$0.00	$200.96	$200.96	$0.00	$169.88	$269.08	$271.80	$0.00		$0.00	$53.17	$0.00	$0.00	$54.09	$0.00	$0.00	$0.00	$0.00	$0.00
71220006	SUP	HCPCS C1713		71220006  -  SCREW BN 2.7MM 6MM TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220008	SUP	HCPCS C1713		71220008  -  SCREW BN 2.7MM 8MM TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220010	SUP	HCPCS C1713		71220010  -  SCREW BN MN 2.7MM 10MM TC100 SS CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220012	SUP	HCPCS C1713		71220012  -  SCREW BN MN 2.7MM 12MM TC100 SS CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220014	SUP	HCPCS C1713		71220014  -  SCREW BN MN 2.7MM 14MM TC100 SS CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220016	SUP	HCPCS C1713		71220016  -  SCREW BN MN 2.7MM 16MM TC100 SS CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220018	SUP	HCPCS C1713		71220018  -  SCREW BN 2.7MM 18MM TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220020	SUP	HCPCS C1713		71220020  -  SCREW BN 2.7MM 20MM TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220022	SUP	HCPCS C1713		71220022  -  SCREW BN 2.7MM 22MM TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220024	SUP	HCPCS C1713		71220024  -  SCREW BN 2.7MM 24MM TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220026	SUP	HCPCS C1713		71220026  -  SCREW BN 2.7MM 26MM TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220028	SUP	HCPCS C1713		71220028  -  SCREW BN 2.7MM 28MM TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220030	SUP	HCPCS C1713		71220030  -  SCREW BN 2.7MM 30MM TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220032	SUP	HCPCS C1713		71220032  -  SCREW BN 2.7MM 32MM TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220034	SUP	HCPCS C1713		71220034  -  SCREW BN MN 2.7MM 34MM TC100 SS CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220036	SUP	HCPCS C1713		71220036  -  SCREW BN 2.7MM 36MM TC100 ST HEX HD SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220038	SUP	HCPCS C1713		71220038  -  SCREW BN 2.7MM 38MM TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220040	SUP	HCPCS C1713		71220040  -  SCREW BN 2.7MM 40MM TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220045	SUP	HCPCS C1713		71220045  -  SCREW BN MN 2.7MM 45MM TC100 SS CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71220050	SUP	HCPCS C1713		71220050  -  SCREW BN 2.7MM 50MM STRL TC100 SS CORT MN FRAG SET	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222010	SUP	HCPCS C1713		71222010  -  SCREW BN 3.5MM 6MM 10MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222012	SUP	HCPCS C1713		71222012  -  SCREW BN 3.5MM 6MM 12MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222014	SUP	HCPCS C1713		71222014  -  SCREW BN 3.5MM 6MM 14MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222016	SUP	HCPCS C1713		71222016  -  SCREW BN 3.5MM 6MM 16MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222018	SUP	HCPCS C1713		71222018  -  SCREW BN 3.5MM 6MM 18MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222020	SUP	HCPCS C1713		71222020  -  SCREW BN 3.5MM 6MM 20MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222022	SUP	HCPCS C1713		71222022  -  SCREW BN 3.5MM 6MM 22MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222024	SUP	HCPCS C1713		71222024  -  SCREW BN 3.5MM 6MM 24MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222026	SUP	HCPCS C1713		71222026  -  SCREW BN 3.5MM 6MM 26MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222028	SUP	HCPCS C1713		71222028  -  SCREW BN 3.5MM 6MM 28MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222030	SUP	HCPCS C1713		71222030  -  SCREW BN 3.5MM 6MM 30MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222032	SUP	HCPCS C1713		71222032  -  SCREW BN 3.5MM 6MM 32MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222034	SUP	HCPCS C1713		71222034  -  SCREW BN 3.5MM 6MM 34MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222036	SUP	HCPCS C1713		71222036  -  SCREW BN 3.5MM 6MM 36MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222038	SUP	HCPCS C1713		71222038  -  SCREW BN 3.5MM 6MM 38MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222040	SUP	HCPCS C1713		71222040  -  SCREW BN 3.5MM 6MM 40MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222045	SUP	HCPCS C1713		71222045  -  SCREW BN 3.5MM 6MM 45MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222050	SUP	HCPCS C1713		71222050  -  SCREW BN 3.5MM 6MM 50MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222055	SUP	HCPCS C1713		71222055  -  SCREW BN 3.5MM 6MM 55MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71222060	SUP	HCPCS C1713		71222060  -  SCREW BN 3.5MM 6MM 60MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$89.40 	$66.16	$0.00	$71.52	$40.23	$40.23	$0.00	$0.00	$0.00	$18.63	$66.35	$66.35	$0.00	$0.00	$18.63	$0.00	$52.88	$52.88	$0.00	$44.70	$70.80	$71.52	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222065	SUP	HCPCS C1713		71222065  -  SCREW BN 3.5MM 6MM 65MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$89.40 	$66.16	$0.00	$71.52	$40.23	$40.23	$0.00	$0.00	$0.00	$18.63	$66.35	$66.35	$0.00	$0.00	$18.63	$0.00	$52.88	$52.88	$0.00	$44.70	$70.80	$71.52	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222070	SUP	HCPCS C1713		71222070  -  SCREW BN 3.5MM 6MM 70MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$89.40 	$66.16	$0.00	$71.52	$40.23	$40.23	$0.00	$0.00	$0.00	$18.63	$66.35	$66.35	$0.00	$0.00	$18.63	$0.00	$52.88	$52.88	$0.00	$44.70	$70.80	$71.52	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222075	SUP	HCPCS C1713		71222075  -  SCREW BN 3.5MM 6MM 75MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$89.40 	$66.16	$0.00	$71.52	$40.23	$40.23	$0.00	$0.00	$0.00	$18.63	$66.35	$66.35	$0.00	$0.00	$18.63	$0.00	$52.88	$52.88	$0.00	$44.70	$70.80	$71.52	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222080	SUP	HCPCS C1713		71222080  -  SCREW BN 3.5MM 6MM 80MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$89.40 	$66.16	$0.00	$71.52	$40.23	$40.23	$0.00	$0.00	$0.00	$18.63	$66.35	$66.35	$0.00	$0.00	$18.63	$0.00	$52.88	$52.88	$0.00	$44.70	$70.80	$71.52	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222085	SUP	HCPCS C1713		71222085  -  SCREW BN 3.5MM 6MM 85MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$89.40 	$66.16	$0.00	$71.52	$40.23	$40.23	$0.00	$0.00	$0.00	$18.63	$66.35	$66.35	$0.00	$0.00	$18.63	$0.00	$52.88	$52.88	$0.00	$44.70	$70.80	$71.52	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222090	SUP	HCPCS C1713		71222090  -  SCREW BN 3.5MM 6MM 90MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$89.40 	$66.16	$0.00	$71.52	$40.23	$40.23	$0.00	$0.00	$0.00	$18.63	$66.35	$66.35	$0.00	$0.00	$18.63	$0.00	$52.88	$52.88	$0.00	$44.70	$70.80	$71.52	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222095	SUP	HCPCS C1713		71222095  -  SCREW BN 3.5MM 6MM 95MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$89.40 	$66.16	$0.00	$71.52	$40.23	$40.23	$0.00	$0.00	$0.00	$18.63	$66.35	$66.35	$0.00	$0.00	$18.63	$0.00	$52.88	$52.88	$0.00	$44.70	$70.80	$71.52	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222100	SUP	HCPCS C1713		71222100  -  SCREW BN 3.5MM 100MM TC100 SS CORT SM FRAG SET	BOTH IP/OP	$89.40 	$66.16	$0.00	$71.52	$40.23	$40.23	$0.00	$0.00	$0.00	$18.63	$66.35	$66.35	$0.00	$0.00	$18.63	$0.00	$52.88	$52.88	$0.00	$44.70	$70.80	$71.52	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222105	SUP	HCPCS C1713		71222105  -  SCREW BN 3.5MM 105MM TC100 SS CORT SM FRAG SET	BOTH IP/OP	$89.40 	$66.16	$0.00	$71.52	$40.23	$40.23	$0.00	$0.00	$0.00	$18.63	$66.35	$66.35	$0.00	$0.00	$18.63	$0.00	$52.88	$52.88	$0.00	$44.70	$70.80	$71.52	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222110	SUP	HCPCS C1713		71222110  -  SCREW BN SM 3.5MM 110MM TC100 SS CORT	BOTH IP/OP	$89.40 	$66.16	$0.00	$71.52	$40.23	$40.23	$0.00	$0.00	$0.00	$18.63	$66.35	$66.35	$0.00	$0.00	$18.63	$0.00	$52.88	$52.88	$0.00	$44.70	$70.80	$71.52	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222115	SUP	HCPCS C1713		71222115  -  SCREW BN 3.5MM 115MM TC100 SS CORT SM FRAG SET	BOTH IP/OP	$101.48 	$75.10	$0.00	$81.18	$45.66	$45.66	$0.00	$0.00	$0.00	$21.15	$75.31	$75.31	$0.00	$0.00	$21.15	$0.00	$60.02	$60.02	$0.00	$50.74	$80.37	$81.18	$0.00		$0.00	$15.88	$0.00	$0.00	$16.15	$0.00	$0.00	$0.00	$0.00	$0.00
71222120	SUP	HCPCS C1713		71222120  -  SCREW BN 3.5MM 120MM TC100 SS CORT SM FRAG SET	BOTH IP/OP	$101.48 	$75.10	$0.00	$81.18	$45.66	$45.66	$0.00	$0.00	$0.00	$21.15	$75.31	$75.31	$0.00	$0.00	$21.15	$0.00	$60.02	$60.02	$0.00	$50.74	$80.37	$81.18	$0.00		$0.00	$15.88	$0.00	$0.00	$16.15	$0.00	$0.00	$0.00	$0.00	$0.00
71222130	SUP	HCPCS C1713		71222130  -  SCREW BN 3.5MM 130MM TC100 SS CORT SM FRAG SET	BOTH IP/OP	$101.48 	$75.10	$0.00	$81.18	$45.66	$45.66	$0.00	$0.00	$0.00	$21.15	$75.31	$75.31	$0.00	$0.00	$21.15	$0.00	$60.02	$60.02	$0.00	$50.74	$80.37	$81.18	$0.00		$0.00	$15.88	$0.00	$0.00	$16.15	$0.00	$0.00	$0.00	$0.00	$0.00
71223010	SUP	HCPCS C1713		71223010  -  SCREW BN FT 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223012	SUP	HCPCS C1713		71223012  -  SCREW BN FT 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223014	SUP	HCPCS C1713		71223014  -  SCREW BN FT 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223016	SUP	HCPCS C1713		71223016  -  SCREW BN FT 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223018	SUP	HCPCS C1713		71223018  -  SCREW BN FT 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223020	SUP	HCPCS C1713		71223020  -  SCREW BN FT 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223022	SUP	HCPCS C1713		71223022  -  SCREW BN FT 4MM 6MM 22MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223024	SUP	HCPCS C1713		71223024  -  SCREW BN FT 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223026	SUP	HCPCS C1713		71223026  -  SCREW BN FT 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223028	SUP	HCPCS C1713		71223028  -  SCREW BN FT 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223030	SUP	HCPCS C1713		71223030  -  SCREW BN FT 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223032	SUP	HCPCS C1713		71223032  -  SCREW BN FT 4MM 6MM 32MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223035	SUP	HCPCS C1713		71223035  -  SCREW BN FT 4MM 6MM 35MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223036	SUP	HCPCS C1713		71223036  -  SCREW BN FT 4MM 6MM 36MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223040	SUP	HCPCS C1713		71223040  -  SCREW BN FT 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223045	SUP	HCPCS C1713		71223045  -  SCREW BN FT 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223050	SUP	HCPCS C1713		71223050  -  SCREW BN FT 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223055	SUP	HCPCS C1713		71223055  -  SCREW BN FT 4MM 6MM 55MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223060	SUP	HCPCS C1713		71223060  -  SCREW BN FT 4MM 6MM 60MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$61.70 	$45.66	$0.00	$49.36	$27.77	$27.77	$0.00	$0.00	$0.00	$12.86	$45.79	$45.79	$0.00	$0.00	$12.86	$0.00	$36.50	$36.50	$0.00	$30.85	$48.87	$49.36	$0.00		$0.00	$9.66	$0.00	$0.00	$9.82	$0.00	$0.00	$0.00	$0.00	$0.00
71223065	SUP	HCPCS C1713		71223065  -  SCREW BN FT 4MM 6MM 65MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71223070	SUP	HCPCS C1713		71223070  -  SCREW BN FT 4MM 6MM 70MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71223075	SUP	HCPCS C1713		71223075  -  SCREW BN FT 4MM 6MM 75MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71223080	SUP	HCPCS C1713		71223080  -  SCREW BN FT 4MM 6MM 80MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71223085	SUP	HCPCS C1713		71223085  -  SCREW BN FT 4MM 6MM 85MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$81.53 	$60.33	$0.00	$65.22	$36.69	$36.69	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$40.76	$64.57	$65.22	$0.00		$0.00	$12.76	$0.00	$0.00	$12.98	$0.00	$0.00	$0.00	$0.00	$0.00
71223090	SUP	HCPCS C1713		71223090  -  SCREW BN FT 4MM 6MM 90MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$81.53 	$60.33	$0.00	$65.22	$36.69	$36.69	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$40.76	$64.57	$65.22	$0.00		$0.00	$12.76	$0.00	$0.00	$12.98	$0.00	$0.00	$0.00	$0.00	$0.00
71223095	SUP	HCPCS C1713		71223095  -  SCREW BN FT 4MM 6MM 95MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$81.53 	$60.33	$0.00	$65.22	$36.69	$36.69	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$40.76	$64.57	$65.22	$0.00		$0.00	$12.76	$0.00	$0.00	$12.98	$0.00	$0.00	$0.00	$0.00	$0.00
71223100	SUP	HCPCS C1713		71223100  -  SCREW BN FT 4MM 100MM TC100 SS CANC SM FRAG SET	BOTH IP/OP	$81.53 	$60.33	$0.00	$65.22	$36.69	$36.69	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$40.76	$64.57	$65.22	$0.00		$0.00	$12.76	$0.00	$0.00	$12.98	$0.00	$0.00	$0.00	$0.00	$0.00
71223210	SUP	HCPCS C1713		71223210  -  SCREW BN P/T 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223212	SUP	HCPCS C1713		71223212  -  SCREW BN P/T 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223214	SUP	HCPCS C1713		71223214  -  SCREW BN P/T 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223216	SUP	HCPCS C1713		71223216  -  SCREW BN P/T 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223218	SUP	HCPCS C1713		71223218  -  SCREW BN P/T 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223220	SUP	HCPCS C1713		71223220  -  SCREW BN P/T 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223222	SUP	HCPCS C1713		71223222  -  SCREW BN P/T 4MM 6MM 22MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223224	SUP	HCPCS C1713		71223224  -  SCREW BN P/T 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223226	SUP	HCPCS C1713		71223226  -  SCREW BN P/T 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223228	SUP	HCPCS C1713		71223228  -  SCREW BN P/T 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223230	SUP	HCPCS C1713		71223230  -  SCREW BN P/T 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223235	SUP	HCPCS C1713		71223235  -  SCREW BN P/T 4MM 6MM 35MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223240	SUP	HCPCS C1713		71223240  -  SCREW BN P/T 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223245	SUP	HCPCS C1713		71223245  -  SCREW BN P/T 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223250	SUP	HCPCS C1713		71223250  -  SCREW BN P/T 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223255	SUP	HCPCS C1713		71223255  -  SCREW BN P/T 4MM 6MM 55MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223260	SUP	HCPCS C1713		71223260  -  SCREW BN P/T 4MM 6MM 60MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$59.53 	$44.05	$0.00	$47.62	$26.79	$26.79	$0.00	$0.00	$0.00	$12.41	$44.18	$44.18	$0.00	$0.00	$12.41	$0.00	$35.21	$35.21	$0.00	$29.76	$47.15	$47.62	$0.00		$0.00	$9.32	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$0.00
71223265	SUP	HCPCS C1713		71223265  -  SCREW BN P/T 4MM 6MM 65MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71223270	SUP	HCPCS C1713		71223270  -  SCREW BN P/T 4MM 6MM 70MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71223275	SUP	HCPCS C1713		71223275  -  SCREW BN P/T 4MM 6MM 75MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71223280	SUP	HCPCS C1713		71223280  -  SCREW BN P/T 4MM 6MM 80MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71223285	SUP	HCPCS C1713		71223285  -  SCREW BN P/T 4MM 6MM 85MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71223290	SUP	HCPCS C1713		71223290  -  SCREW BN P/T 4MM 6MM 90MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71223295	SUP	HCPCS C1713		71223295  -  SCREW BN P/T 4MM 6MM 95MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71223300	SUP	HCPCS C1713		71223300  -  SCREW BN 4MM 100MM TC100 P/T SS CANC	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225014	SUP	HCPCS C1713		71225014  -  SCREW BN 4.5MM 14MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225016	SUP	HCPCS C1713		71225016  -  SCREW BN 4.5MM 16MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225018	SUP	HCPCS C1713		71225018  -  SCREW BN 4.5MM 18MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225020	SUP	HCPCS C1713		71225020  -  SCREW BN 4.5MM 20MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225022	SUP	HCPCS C1713		71225022  -  SCREW BN 4.5MM 22MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225024	SUP	HCPCS C1713		71225024  -  SCREW BN 4.5MM 24MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225026	SUP	HCPCS C1713		71225026  -  SCREW BN 4.5MM 26MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225028	SUP	HCPCS C1713		71225028  -  SCREW BN 4.5MM 28MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225030	SUP	HCPCS C1713		71225030  -  SCREW BN 4.5MM 30MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225032	SUP	HCPCS C1713		71225032  -  SCREW BN 4.5MM 32MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225034	SUP	HCPCS C1713		71225034  -  SCREW BN 4.5MM 34MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225036	SUP	HCPCS C1713		71225036  -  SCREW BN 4.5MM 36MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225038	SUP	HCPCS C1713		71225038  -  SCREW BN 4.5MM 38MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225040	SUP	HCPCS C1713		71225040  -  SCREW BN 4.5MM 40MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225042	SUP	HCPCS C1713		71225042  -  SCREW BN 4.5MM 42MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225044	SUP	HCPCS C1713		71225044  -  SCREW BN 4.5MM 44MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225046	SUP	HCPCS C1713		71225046  -  SCREW BN 4.5MM 46MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225048	SUP	HCPCS C1713		71225048  -  SCREW BN 4.5MM 48MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225050	SUP	HCPCS C1713		71225050  -  SCREW BN 4.5MM 50MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225052	SUP	HCPCS C1713		71225052  -  SCREW BN 4.5MM 52MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225054	SUP	HCPCS C1713		71225054  -  SCREW BN 4.5MM 54MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225056	SUP	HCPCS C1713		71225056  -  SCREW BN 4.5MM 56MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225058	SUP	HCPCS C1713		71225058  -  SCREW BN 4.5MM 58MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225060	SUP	HCPCS C1713		71225060  -  SCREW BN 4.5MM 8MM 60MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225062	SUP	HCPCS C1713		71225062  -  SCREW BN 4.5MM 62MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225064	SUP	HCPCS C1713		71225064  -  SCREW BN 4.5MM 64MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225066	SUP	HCPCS C1713		71225066  -  SCREW BN 4.5MM 66MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225068	SUP	HCPCS C1713		71225068  -  SCREW BN 4.5MM 68MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225070	SUP	HCPCS C1713		71225070  -  SCREW BN 4.5MM 70MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225072	SUP	HCPCS C1713		71225072  -  SCREW BN 4.5MM 72MM TC100 CORT	BOTH IP/OP	$57.60 	$42.62	$0.00	$46.08	$25.92	$25.92	$0.00	$0.00	$0.00	$12.01	$42.75	$42.75	$0.00	$0.00	$12.00	$0.00	$34.07	$34.07	$0.00	$28.80	$45.62	$46.08	$0.00		$0.00	$9.01	$0.00	$0.00	$9.17	$0.00	$0.00	$0.00	$0.00	$0.00
71225076	SUP	HCPCS C1713		71225076  -  SCREW BN 4.5MM 8MM 76MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$99.33 	$73.50	$0.00	$79.46	$44.70	$44.70	$0.00	$0.00	$0.00	$20.70	$73.72	$73.72	$0.00	$0.00	$20.70	$0.00	$58.75	$58.75	$0.00	$49.66	$78.67	$79.46	$0.00		$0.00	$15.54	$0.00	$0.00	$15.81	$0.00	$0.00	$0.00	$0.00	$0.00
71225080	SUP	HCPCS C1713		71225080  -  SCREW BN 4.5MM 8MM 80MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$99.33 	$73.50	$0.00	$79.46	$44.70	$44.70	$0.00	$0.00	$0.00	$20.70	$73.72	$73.72	$0.00	$0.00	$20.70	$0.00	$58.75	$58.75	$0.00	$49.66	$78.67	$79.46	$0.00		$0.00	$15.54	$0.00	$0.00	$15.81	$0.00	$0.00	$0.00	$0.00	$0.00
71225085	SUP	HCPCS C1713		71225085  -  SCREW BN 4.5MM 8MM 85MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$99.33 	$73.50	$0.00	$79.46	$44.70	$44.70	$0.00	$0.00	$0.00	$20.70	$73.72	$73.72	$0.00	$0.00	$20.70	$0.00	$58.75	$58.75	$0.00	$49.66	$78.67	$79.46	$0.00		$0.00	$15.54	$0.00	$0.00	$15.81	$0.00	$0.00	$0.00	$0.00	$0.00
71225090	SUP	HCPCS C1713		71225090  -  SCREW BN 4.5MM 8MM 90MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$99.33 	$73.50	$0.00	$79.46	$44.70	$44.70	$0.00	$0.00	$0.00	$20.70	$73.72	$73.72	$0.00	$0.00	$20.70	$0.00	$58.75	$58.75	$0.00	$49.66	$78.67	$79.46	$0.00		$0.00	$15.54	$0.00	$0.00	$15.81	$0.00	$0.00	$0.00	$0.00	$0.00
71225095	SUP	HCPCS C1713		71225095  -  SCREW BN 4.5MM 8MM 95MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$99.33 	$73.50	$0.00	$79.46	$44.70	$44.70	$0.00	$0.00	$0.00	$20.70	$73.72	$73.72	$0.00	$0.00	$20.70	$0.00	$58.75	$58.75	$0.00	$49.66	$78.67	$79.46	$0.00		$0.00	$15.54	$0.00	$0.00	$15.81	$0.00	$0.00	$0.00	$0.00	$0.00
71225100	SUP	HCPCS C1713		71225100  -  SCREW BN 4.5MM 100MM TC100 SS CORT LG FRAG SET	BOTH IP/OP	$99.33 	$73.50	$0.00	$79.46	$44.70	$44.70	$0.00	$0.00	$0.00	$20.70	$73.72	$73.72	$0.00	$0.00	$20.70	$0.00	$58.75	$58.75	$0.00	$49.66	$78.67	$79.46	$0.00		$0.00	$15.54	$0.00	$0.00	$15.81	$0.00	$0.00	$0.00	$0.00	$0.00
71225105	SUP	HCPCS C1713		71225105  -  SCREW BN 4.5MM 105MM TC100 SS CORT LG FRAG SET	BOTH IP/OP	$99.33 	$73.50	$0.00	$79.46	$44.70	$44.70	$0.00	$0.00	$0.00	$20.70	$73.72	$73.72	$0.00	$0.00	$20.70	$0.00	$58.75	$58.75	$0.00	$49.66	$78.67	$79.46	$0.00		$0.00	$15.54	$0.00	$0.00	$15.81	$0.00	$0.00	$0.00	$0.00	$0.00
71225110	SUP	HCPCS C1713		71225110  -  SCREW BN LG 4.5MM 110MM TC100 SS CORT	BOTH IP/OP	$108.15 	$80.03	$0.00	$86.52	$48.67	$48.67	$0.00	$0.00	$0.00	$22.54	$80.27	$80.27	$0.00	$0.00	$22.54	$0.00	$63.97	$63.97	$0.00	$54.08	$85.65	$86.52	$0.00		$0.00	$16.93	$0.00	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$0.00
71225115	SUP	HCPCS C1713		71225115  -  SCREW BN 4.5MM 115MM TC100 SS CORT LG FRAG SET	BOTH IP/OP	$108.15 	$80.03	$0.00	$86.52	$48.67	$48.67	$0.00	$0.00	$0.00	$22.54	$80.27	$80.27	$0.00	$0.00	$22.54	$0.00	$63.97	$63.97	$0.00	$54.08	$85.65	$86.52	$0.00		$0.00	$16.93	$0.00	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$0.00
71225120	SUP	HCPCS C1713		71225120  -  SCREW BN 4.5MM 120MM TC100 SS CORT LG FRAG SET	BOTH IP/OP	$108.15 	$80.03	$0.00	$86.52	$48.67	$48.67	$0.00	$0.00	$0.00	$22.54	$80.27	$80.27	$0.00	$0.00	$22.54	$0.00	$63.97	$63.97	$0.00	$54.08	$85.65	$86.52	$0.00		$0.00	$16.93	$0.00	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$0.00
71225125	SUP	HCPCS C1713		71225125  -  SCREW BN 4.5MM 125MM TC100 SS CORT LG FRAG SET	BOTH IP/OP	$108.15 	$80.03	$0.00	$86.52	$48.67	$48.67	$0.00	$0.00	$0.00	$22.54	$80.27	$80.27	$0.00	$0.00	$22.54	$0.00	$63.97	$63.97	$0.00	$54.08	$85.65	$86.52	$0.00		$0.00	$16.93	$0.00	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$0.00
71225130	SUP	HCPCS C1713		71225130  -  SCREW BN 4.5MM 130MM TC100 SS CORT LG FRAG SET	BOTH IP/OP	$108.15 	$80.03	$0.00	$86.52	$48.67	$48.67	$0.00	$0.00	$0.00	$22.54	$80.27	$80.27	$0.00	$0.00	$22.54	$0.00	$63.97	$63.97	$0.00	$54.08	$85.65	$86.52	$0.00		$0.00	$16.93	$0.00	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$0.00
71225135	SUP	HCPCS C1713		71225135  -  SCREW BN 4.5MM 135MM TC100 SS CORT LG FRAG SET	BOTH IP/OP	$108.15 	$80.03	$0.00	$86.52	$48.67	$48.67	$0.00	$0.00	$0.00	$22.54	$80.27	$80.27	$0.00	$0.00	$22.54	$0.00	$63.97	$63.97	$0.00	$54.08	$85.65	$86.52	$0.00		$0.00	$16.93	$0.00	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$0.00
71225140	SUP	HCPCS C1713		71225140  -  SCREW BN 4.5MM 140MM TC100 SS CORT LG FRAG SET	BOTH IP/OP	$108.15 	$80.03	$0.00	$86.52	$48.67	$48.67	$0.00	$0.00	$0.00	$22.54	$80.27	$80.27	$0.00	$0.00	$22.54	$0.00	$63.97	$63.97	$0.00	$54.08	$85.65	$86.52	$0.00		$0.00	$16.93	$0.00	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$0.00
71225145	SUP	HCPCS C1713		71225145  -  SCREW BN 4.5MM 145MM TC100 SS CORT LG FRAG SET	BOTH IP/OP	$108.15 	$80.03	$0.00	$86.52	$48.67	$48.67	$0.00	$0.00	$0.00	$22.54	$80.27	$80.27	$0.00	$0.00	$22.54	$0.00	$63.97	$63.97	$0.00	$54.08	$85.65	$86.52	$0.00		$0.00	$16.93	$0.00	$0.00	$17.22	$0.00	$0.00	$0.00	$0.00	$0.00
71225225	SUP	HCPCS C1713		71225225  -  SCREW BN 4.5MM 25MM STRL 12MM TC100 SS MLR LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71225230	SUP	HCPCS C1713		71225230  -  SCREW BN 4.5MM 30MM STRL 15MM TC100 SS MLR LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71225235	SUP	HCPCS C1713		71225235  -  SCREW BN 4.5MM 35MM STRL 18MM TC100 SS MLR LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71225240	SUP	HCPCS C1713		71225240  -  SCREW BN 4.5MM 40MM STRL 20MM TC100 SS MLR LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71225245	SUP	HCPCS C1713		71225245  -  SCREW BN 4.5MM 45MM STRL 22MM TC100 SS MLR LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71225250	SUP	HCPCS C1713		71225250  -  SCREW BN 4.5MM 50MM STRL 24MM TC100 SS MLR LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71225255	SUP	HCPCS C1713		71225255  -  SCREW BN 4.5MM 55MM STRL 26MM TC100 SS MLR LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71225260	SUP	HCPCS C1713		71225260  -  SCREW BN 4.5MM 60MM STRL 28MM TC100 SS MLR LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71225265	SUP	HCPCS C1713		71225265  -  SCREW BN 4.5MM 65MM STRL 30MM TC100 SS MLR LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71225270	SUP	HCPCS C1713		71225270  -  SCREW BN 4.5MM 70MM STRL 32MM TC100 SS MLR LG FRAG SET	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
71225320	SUP	HCPCS C1713		71225320  -  PLATE BN 90D 10MM DSPL 40MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225321	SUP	HCPCS C1713		71225321  -  PLATE BN 90D 10MM DSPL 50MM TC100 4 HL OSTM SS ADLT PROX FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225322	SUP	HCPCS C1713		71225322  -  PLATE BN 90D 10MM DSPL 55MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225323	SUP	HCPCS C1713		71225323  -  PLATE BN 90D 10MM DSPL 60MM TC100 4 HL OSTM SS ADLT PROX FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225324	SUP	HCPCS C1713		71225324  -  PLATE BN 90D 10MM DSPL 65MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225325	SUP	HCPCS C1713		71225325  -  PLATE BN 90D 10MM DSPL 70MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225326	SUP	HCPCS C1713		71225326  -  PLATE BN 90D 10MM DSPL 80MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225327	SUP	HCPCS C1713		71225327  -  PLATE BN 90D 15MM DSPL 40MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225328	SUP	HCPCS C1713		71225328  -  PLATE BN 90D 15MM DSPL 50MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225329	SUP	HCPCS C1713		71225329  -  PLATE BN 90D 15MM DSPL 55MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225330	SUP	HCPCS C1713		71225330  -  PLATE BN 90D 15MM DSPL 60MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225331	SUP	HCPCS C1713		71225331  -  PLATE BN 90D 15MM DSPL 65MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225332	SUP	HCPCS C1713		71225332  -  PLATE BN 90D 15MM DSPL 70MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225333	SUP	HCPCS C1713		71225333  -  PLATE BN 90D 15MM DSPL 75MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225334	SUP	HCPCS C1713		71225334  -  PLATE BN 90D 15MM DSPL 80MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225335	SUP	HCPCS C1713		71225335  -  PLATE BN 90D 20MM DSPL 50MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225336	SUP	HCPCS C1713		71225336  -  PLATE BN 90D 20MM DSPL 60MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225337	SUP	HCPCS C1713		71225337  -  PLATE BN 90D 20MM DSPL 70MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225338	SUP	HCPCS C1713		71225338  -  PLATE BN 90D 20MM DSPL 75MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225339	SUP	HCPCS C1713		71225339  -  PLATE BN 100D 10MM DSPL 50MM TC100 4 HL OSTM SS ADLT FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225340	SUP	HCPCS C1713		71225340  -  PLATE BN 100D 10MM DSPL 60MM TC100 4 HL OSTM SS ADLT FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225341	SUP	HCPCS C1713		71225341  -  PLATE BN 110D 65MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225342	SUP	HCPCS C1713		71225342  -  PLATE BN 110D 75MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225343	SUP	HCPCS C1713		71225343  -  PLATE BN 110D 85MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225344	SUP	HCPCS C1713		71225344  -  PLATE BN 120D 65MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225345	SUP	HCPCS C1713		71225345  -  PLATE BN 120D 75MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225346	SUP	HCPCS C1713		71225346  -  PLATE BN 120D 85MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225347	SUP	HCPCS C1713		71225347  -  PLATE BN 130D 65MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225348	SUP	HCPCS C1713		71225348  -  PLATE BN 130D 70MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225349	SUP	HCPCS C1713		71225349  -  PLATE BN 130D 75MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225350	SUP	HCPCS C1713		71225350  -  PLATE BN 130D 80MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225351	SUP	HCPCS C1713		71225351  -  PLATE BN 130D 85MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225352	SUP	HCPCS C1713		71225352  -  PLATE BN 130D 90MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225353	SUP	HCPCS C1713		71225353  -  PLATE BN 130D 95MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225354	SUP	HCPCS C1713		71225354  -  PLATE BN 130D 100MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225355	SUP	HCPCS C1713		71225355  -  PLATE BN 130D 105MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225356	SUP	HCPCS C1713		71225356  -  PLATE BN 130D 110MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225400	SUP	HCPCS C1713		71225400  -  PLATE BN 95D 92MM 50MM TC100 5 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225401	SUP	HCPCS C1713		71225401  -  PLATE BN 95D 92MM 60MM TC100 5 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225402	SUP	HCPCS C1713		71225402  -  PLATE BN 95D 92MM 70MM TC100 5 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225403	SUP	HCPCS C1713		71225403  -  PLATE BN 95D 92MM 80MM TC100 5 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225404	SUP	HCPCS C1713		71225404  -  PLATE BN 95D 124MM 50MM TC100 7 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225405	SUP	HCPCS C1713		71225405  -  PLATE BN 95D 124MM 60MM TC100 7 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225406	SUP	HCPCS C1713		71225406  -  PLATE BN 95D 124MM 70MM TC100 7 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225407	SUP	HCPCS C1713		71225407  -  PLATE BN 95D 124MM 80MM TC100 7 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225408	SUP	HCPCS C1713		71225408  -  PLATE BN 95D 156MM 50MM TC100 9 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225409	SUP	HCPCS C1713		71225409  -  PLATE BN 95D 156MM 60MM TC100 9 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225410	SUP	HCPCS C1713		71225410  -  PLATE BN 95D 156MM 70MM TC100 9 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225411	SUP	HCPCS C1713		71225411  -  PLATE BN 95D 156MM 80MM TC100 9 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225412	SUP	HCPCS C1713		71225412  -  PLATE BN 95D 204MM 50MM TC100 12 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225413	SUP	HCPCS C1713		71225413  -  PLATE BN 95D 204MM 60MM TC100 12 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225414	SUP	HCPCS C1713		71225414  -  PLATE BN 95D 204MM 70MM TC100 12 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225415	SUP	HCPCS C1713		71225415  -  PLATE BN 95D 204MM 80MM TC100 12 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225416	SUP	HCPCS C1713		71225416  -  PLATE BN 95D 235MM 50MM TC100 14 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$2,955.75 "	"$2,187.26"	$0.00	"$2,364.60"	"$1,330.09"	"$1,330.09"	$0.00	$0.00	$0.00	$616.05	"$2,193.76"	"$2,193.76"	$0.00	$0.00	$615.98	$0.00	"$1,457.18"	"$1,457.18"	$0.00	"$1,477.88"	"$2,340.95"	"$2,364.60"	$0.00		$0.00	$462.57	$0.00	$0.00	$470.56	$0.00	$0.00	$0.00	$0.00	$0.00
71225417	SUP	HCPCS C1713		71225417  -  PLATE BN 95D 235MM 60MM TC100 14 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$2,955.75 "	"$2,187.26"	$0.00	"$2,364.60"	"$1,330.09"	"$1,330.09"	$0.00	$0.00	$0.00	$616.05	"$2,193.76"	"$2,193.76"	$0.00	$0.00	$615.98	$0.00	"$1,457.18"	"$1,457.18"	$0.00	"$1,477.88"	"$2,340.95"	"$2,364.60"	$0.00		$0.00	$462.57	$0.00	$0.00	$470.56	$0.00	$0.00	$0.00	$0.00	$0.00
71225418	SUP	HCPCS C1713		71225418  -  PLATE BN 95D 235MM 70MM TC100 14 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$2,955.75 "	"$2,187.26"	$0.00	"$2,364.60"	"$1,330.09"	"$1,330.09"	$0.00	$0.00	$0.00	$616.05	"$2,193.76"	"$2,193.76"	$0.00	$0.00	$615.98	$0.00	"$1,457.18"	"$1,457.18"	$0.00	"$1,477.88"	"$2,340.95"	"$2,364.60"	$0.00		$0.00	$462.57	$0.00	$0.00	$470.56	$0.00	$0.00	$0.00	$0.00	$0.00
71225419	SUP	HCPCS C1713		71225419  -  PLATE BN 95D 235MM 80MM TC100 14 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$2,955.75 "	"$2,187.26"	$0.00	"$2,364.60"	"$1,330.09"	"$1,330.09"	$0.00	$0.00	$0.00	$616.05	"$2,193.76"	"$2,193.76"	$0.00	$0.00	$615.98	$0.00	"$1,457.18"	"$1,457.18"	$0.00	"$1,477.88"	"$2,340.95"	"$2,364.60"	$0.00		$0.00	$462.57	$0.00	$0.00	$470.56	$0.00	$0.00	$0.00	$0.00	$0.00
71225420	SUP	HCPCS C1713		71225420  -  PLATE BN 95D 267MM 60MM TC100 16 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$2,955.75 "	"$2,187.26"	$0.00	"$2,364.60"	"$1,330.09"	"$1,330.09"	$0.00	$0.00	$0.00	$616.05	"$2,193.76"	"$2,193.76"	$0.00	$0.00	$615.98	$0.00	"$1,457.18"	"$1,457.18"	$0.00	"$1,477.88"	"$2,340.95"	"$2,364.60"	$0.00		$0.00	$462.57	$0.00	$0.00	$470.56	$0.00	$0.00	$0.00	$0.00	$0.00
71225421	SUP	HCPCS C1713		71225421  -  PLATE BN 95D 267MM 70MM TC100 16 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$2,955.75 "	"$2,187.26"	$0.00	"$2,364.60"	"$1,330.09"	"$1,330.09"	$0.00	$0.00	$0.00	$616.05	"$2,193.76"	"$2,193.76"	$0.00	$0.00	$615.98	$0.00	"$1,457.18"	"$1,457.18"	$0.00	"$1,477.88"	"$2,340.95"	"$2,364.60"	$0.00		$0.00	$462.57	$0.00	$0.00	$470.56	$0.00	$0.00	$0.00	$0.00	$0.00
71225422	SUP	HCPCS C1713		71225422  -  PLATE BN 95D 267MM 80MM TC100 16 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$2,955.75 "	"$2,187.26"	$0.00	"$2,364.60"	"$1,330.09"	"$1,330.09"	$0.00	$0.00	$0.00	$616.05	"$2,193.76"	"$2,193.76"	$0.00	$0.00	$615.98	$0.00	"$1,457.18"	"$1,457.18"	$0.00	"$1,477.88"	"$2,340.95"	"$2,364.60"	$0.00		$0.00	$462.57	$0.00	$0.00	$470.56	$0.00	$0.00	$0.00	$0.00	$0.00
71225423	SUP	HCPCS C1713		71225423  -  PLATE BN 95D 299MM 60MM TC100 18 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$2,955.75 "	"$2,187.26"	$0.00	"$2,364.60"	"$1,330.09"	"$1,330.09"	$0.00	$0.00	$0.00	$616.05	"$2,193.76"	"$2,193.76"	$0.00	$0.00	$615.98	$0.00	"$1,457.18"	"$1,457.18"	$0.00	"$1,477.88"	"$2,340.95"	"$2,364.60"	$0.00		$0.00	$462.57	$0.00	$0.00	$470.56	$0.00	$0.00	$0.00	$0.00	$0.00
71225424	SUP	HCPCS C1713		71225424  -  PLATE BN 95D 299MM 70MM TC100 18 HL OSTM SS ADLT CNDYL FEM	BOTH IP/OP	"$2,955.75 "	"$2,187.26"	$0.00	"$2,364.60"	"$1,330.09"	"$1,330.09"	$0.00	$0.00	$0.00	$616.05	"$2,193.76"	"$2,193.76"	$0.00	$0.00	$615.98	$0.00	"$1,457.18"	"$1,457.18"	$0.00	"$1,477.88"	"$2,340.95"	"$2,364.60"	$0.00		$0.00	$462.57	$0.00	$0.00	$470.56	$0.00	$0.00	$0.00	$0.00	$0.00
71225430	SUP	HCPCS C1713		71225430  -  PLATE BN 95D SM STAT 92MM 40MM TC100 5 HL OSTM SS CNDYL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71225431	SUP	HCPCS C1713		71225431  -  PLATE BN 95D SM STAT 92MM 50MM TC100 5 HL OSTM SS CNDYL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71225432	SUP	HCPCS C1713		71225432  -  PLATE BN 95D SM STAT 92MM 60MM TC100 5 HL OSTM SS CNDYL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71225433	SUP	HCPCS C1713		71225433  -  PLATE BN 95D SM STAT 92MM 70MM TC100 5 HL OSTM SS CNDYL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71225434	SUP	HCPCS C1713		71225434  -  PLATE BN 95D SM STAT 124MM 40MM TC100 7 HL OSTM SS CNDYL	BOTH IP/OP	"$1,580.25 "	"$1,169.39"	$0.00	"$1,264.20"	$711.11	$711.11	$0.00	$0.00	$0.00	$329.36	"$1,172.86"	"$1,172.86"	$0.00	$0.00	$329.32	$0.00	$934.72	$934.72	$0.00	$790.13	"$1,251.56"	"$1,264.20"	$0.00		$0.00	$247.31	$0.00	$0.00	$251.58	$0.00	$0.00	$0.00	$0.00	$0.00
71225435	SUP	HCPCS C1713		71225435  -  PLATE BN 95D SM STAT 124MM 50MM TC100 7 HL OSTM SS CNDYL	BOTH IP/OP	"$1,580.25 "	"$1,169.39"	$0.00	"$1,264.20"	$711.11	$711.11	$0.00	$0.00	$0.00	$329.36	"$1,172.86"	"$1,172.86"	$0.00	$0.00	$329.32	$0.00	$934.72	$934.72	$0.00	$790.13	"$1,251.56"	"$1,264.20"	$0.00		$0.00	$247.31	$0.00	$0.00	$251.58	$0.00	$0.00	$0.00	$0.00	$0.00
71225436	SUP	HCPCS C1713		71225436  -  PLATE BN 95D SM STAT 124MM 60MM TC100 7 HL OSTM SS CNDYL	BOTH IP/OP	"$1,580.25 "	"$1,169.39"	$0.00	"$1,264.20"	$711.11	$711.11	$0.00	$0.00	$0.00	$329.36	"$1,172.86"	"$1,172.86"	$0.00	$0.00	$329.32	$0.00	$934.72	$934.72	$0.00	$790.13	"$1,251.56"	"$1,264.20"	$0.00		$0.00	$247.31	$0.00	$0.00	$251.58	$0.00	$0.00	$0.00	$0.00	$0.00
71225437	SUP	HCPCS C1713		71225437  -  PLATE BN 95D SM STAT 124MM 70MM TC100 7 HL OSTM SS CNDYL	BOTH IP/OP	"$1,580.25 "	"$1,169.39"	$0.00	"$1,264.20"	$711.11	$711.11	$0.00	$0.00	$0.00	$329.36	"$1,172.86"	"$1,172.86"	$0.00	$0.00	$329.32	$0.00	$934.72	$934.72	$0.00	$790.13	"$1,251.56"	"$1,264.20"	$0.00		$0.00	$247.31	$0.00	$0.00	$251.58	$0.00	$0.00	$0.00	$0.00	$0.00
71225438	SUP	HCPCS C1713		71225438  -  PLATE BN 95D SM STAT 156MM 40MM TC100 9 HL OSTM SS CNDYL	BOTH IP/OP	"$1,711.50 "	"$1,266.51"	$0.00	"$1,369.20"	$770.18	$770.18	$0.00	$0.00	$0.00	$356.72	"$1,270.28"	"$1,270.28"	$0.00	$0.00	$356.68	$0.00	"$1,012.35"	"$1,012.35"	$0.00	$855.75	"$1,355.51"	"$1,369.20"	$0.00		$0.00	$267.85	$0.00	$0.00	$272.47	$0.00	$0.00	$0.00	$0.00	$0.00
71225439	SUP	HCPCS C1713		71225439  -  PLATE BN 95D SM STAT 156MM 50MM TC100 9 HL OSTM SS CNDYL	BOTH IP/OP	"$1,711.50 "	"$1,266.51"	$0.00	"$1,369.20"	$770.18	$770.18	$0.00	$0.00	$0.00	$356.72	"$1,270.28"	"$1,270.28"	$0.00	$0.00	$356.68	$0.00	"$1,012.35"	"$1,012.35"	$0.00	$855.75	"$1,355.51"	"$1,369.20"	$0.00		$0.00	$267.85	$0.00	$0.00	$272.47	$0.00	$0.00	$0.00	$0.00	$0.00
71225440	SUP	HCPCS C1713		71225440  -  PLATE BN 95D SM STAT 156MM 60MM TC100 9 HL OSTM SS CNDYL	BOTH IP/OP	"$1,711.50 "	"$1,266.51"	$0.00	"$1,369.20"	$770.18	$770.18	$0.00	$0.00	$0.00	$356.72	"$1,270.28"	"$1,270.28"	$0.00	$0.00	$356.68	$0.00	"$1,012.35"	"$1,012.35"	$0.00	$855.75	"$1,355.51"	"$1,369.20"	$0.00		$0.00	$267.85	$0.00	$0.00	$272.47	$0.00	$0.00	$0.00	$0.00	$0.00
71225441	SUP	HCPCS C1713		71225441  -  PLATE BN 95D SM STAT 156MM 70MM TC100 9 HL OSTM SS CNDYL	BOTH IP/OP	"$1,711.50 "	"$1,266.51"	$0.00	"$1,369.20"	$770.18	$770.18	$0.00	$0.00	$0.00	$356.72	"$1,270.28"	"$1,270.28"	$0.00	$0.00	$356.68	$0.00	"$1,012.35"	"$1,012.35"	$0.00	$855.75	"$1,355.51"	"$1,369.20"	$0.00		$0.00	$267.85	$0.00	$0.00	$272.47	$0.00	$0.00	$0.00	$0.00	$0.00
71225500	SUP	HCPCS C1713		71225500  -  PLATE BN 130D 50MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71225501	SUP	HCPCS C1713		71225501  -  PLATE BN 130D 60MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71225502	SUP	HCPCS C1713		71225502  -  PLATE BN 130D 70MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71225503	SUP	HCPCS C1713		71225503  -  PLATE BN 130D 75MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71225504	SUP	HCPCS C1713		71225504  -  PLATE BN 130D 80MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71225505	SUP	HCPCS C1713		71225505  -  PLATE BN 130D 85MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71225506	SUP	HCPCS C1713		71225506  -  PLATE BN 130D 90MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71225507	SUP	HCPCS C1713		71225507  -  PLATE BN 130D 95MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71225508	SUP	HCPCS C1713		71225508  -  PLATE BN 130D 100MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71225509	SUP	HCPCS C1713		71225509  -  PLATE BN 130D 105MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71225510	SUP	HCPCS C1713		71225510  -  PLATE BN 130D 110MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,412.25 "	"$1,045.07"	$0.00	"$1,129.80"	$635.51	$635.51	$0.00	$0.00	$0.00	$294.35	"$1,048.17"	"$1,048.17"	$0.00	$0.00	$294.31	$0.00	$835.35	$835.35	$0.00	$706.13	"$1,118.50"	"$1,129.80"	$0.00		$0.00	$221.02	$0.00	$0.00	$224.83	$0.00	$0.00	$0.00	$0.00	$0.00
71225511	SUP	HCPCS C1713		71225511  -  PLATE BN 130D 50MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,496.25 "	"$1,107.23"	$0.00	"$1,197.00"	$673.31	$673.31	$0.00	$0.00	$0.00	$311.86	"$1,110.52"	"$1,110.52"	$0.00	$0.00	$311.82	$0.00	$885.03	$885.03	$0.00	$748.13	"$1,185.03"	"$1,197.00"	$0.00		$0.00	$234.16	$0.00	$0.00	$238.20	$0.00	$0.00	$0.00	$0.00	$0.00
71225512	SUP	HCPCS C1713		71225512  -  PLATE BN 130D 60MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,496.25 "	"$1,107.23"	$0.00	"$1,197.00"	$673.31	$673.31	$0.00	$0.00	$0.00	$311.86	"$1,110.52"	"$1,110.52"	$0.00	$0.00	$311.82	$0.00	$885.03	$885.03	$0.00	$748.13	"$1,185.03"	"$1,197.00"	$0.00		$0.00	$234.16	$0.00	$0.00	$238.20	$0.00	$0.00	$0.00	$0.00	$0.00
71225513	SUP	HCPCS C1713		71225513  -  PLATE BN 130D 70MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,496.25 "	"$1,107.23"	$0.00	"$1,197.00"	$673.31	$673.31	$0.00	$0.00	$0.00	$311.86	"$1,110.52"	"$1,110.52"	$0.00	$0.00	$311.82	$0.00	$885.03	$885.03	$0.00	$748.13	"$1,185.03"	"$1,197.00"	$0.00		$0.00	$234.16	$0.00	$0.00	$238.20	$0.00	$0.00	$0.00	$0.00	$0.00
71225514	SUP	HCPCS C1713		71225514  -  PLATE BN 130D 80MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,496.25 "	"$1,107.23"	$0.00	"$1,197.00"	$673.31	$673.31	$0.00	$0.00	$0.00	$311.86	"$1,110.52"	"$1,110.52"	$0.00	$0.00	$311.82	$0.00	$885.03	$885.03	$0.00	$748.13	"$1,185.03"	"$1,197.00"	$0.00		$0.00	$234.16	$0.00	$0.00	$238.20	$0.00	$0.00	$0.00	$0.00	$0.00
71225515	SUP	HCPCS C1713		71225515  -  PLATE BN 130D 90MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,496.25 "	"$1,107.23"	$0.00	"$1,197.00"	$673.31	$673.31	$0.00	$0.00	$0.00	$311.86	"$1,110.52"	"$1,110.52"	$0.00	$0.00	$311.82	$0.00	$885.03	$885.03	$0.00	$748.13	"$1,185.03"	"$1,197.00"	$0.00		$0.00	$234.16	$0.00	$0.00	$238.20	$0.00	$0.00	$0.00	$0.00	$0.00
71225516	SUP	HCPCS C1713		71225516  -  PLATE BN 130D 70MM 152MM TC100 9 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225517	SUP	HCPCS C1713		71225517  -  PLATE BN 130D 80MM 152MM TC100 9 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225518	SUP	HCPCS C1713		71225518  -  PLATE BN 130D 90MM 152MM TC100 9 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
71225519	SUP	HCPCS C1713		71225519  -  PLATE BN 130D 70MM 200MM TC100 12 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,911.00 "	"$1,414.14"	$0.00	"$1,528.80"	$859.95	$859.95	$0.00	$0.00	$0.00	$398.30	"$1,418.34"	"$1,418.34"	$0.00	$0.00	$398.25	$0.00	"$1,130.36"	"$1,130.36"	$0.00	$955.50	"$1,513.51"	"$1,528.80"	$0.00		$0.00	$299.07	$0.00	$0.00	$304.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225520	SUP	HCPCS C1713		71225520  -  PLATE BN 130D 80MM 200MM TC100 12 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,911.00 "	"$1,414.14"	$0.00	"$1,528.80"	$859.95	$859.95	$0.00	$0.00	$0.00	$398.30	"$1,418.34"	"$1,418.34"	$0.00	$0.00	$398.25	$0.00	"$1,130.36"	"$1,130.36"	$0.00	$955.50	"$1,513.51"	"$1,528.80"	$0.00		$0.00	$299.07	$0.00	$0.00	$304.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225521	SUP	HCPCS C1713		71225521  -  PLATE BN 130D 90MM 200MM TC100 12 HL OSTM SS ADLT FEM PROX	BOTH IP/OP	"$1,911.00 "	"$1,414.14"	$0.00	"$1,528.80"	$859.95	$859.95	$0.00	$0.00	$0.00	$398.30	"$1,418.34"	"$1,418.34"	$0.00	$0.00	$398.25	$0.00	"$1,130.36"	"$1,130.36"	$0.00	$955.50	"$1,513.51"	"$1,528.80"	$0.00		$0.00	$299.07	$0.00	$0.00	$304.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225530	SUP	HCPCS C1713		71225530  -  PLATE BN 130D SM STAT 50MM 60MM TC100 4 HL OSTM SS FEM PROX	BOTH IP/OP	"$1,580.25 "	"$1,169.39"	$0.00	"$1,264.20"	$711.11	$711.11	$0.00	$0.00	$0.00	$329.36	"$1,172.86"	"$1,172.86"	$0.00	$0.00	$329.32	$0.00	$934.72	$934.72	$0.00	$790.13	"$1,251.56"	"$1,264.20"	$0.00		$0.00	$247.31	$0.00	$0.00	$251.58	$0.00	$0.00	$0.00	$0.00	$0.00
71225531	SUP	HCPCS C1713		71225531  -  PLATE BN 130D SM STAT 60MM 60MM TC100 4 HL OSTM SS FEM PROX	BOTH IP/OP	"$1,580.25 "	"$1,169.39"	$0.00	"$1,264.20"	$711.11	$711.11	$0.00	$0.00	$0.00	$329.36	"$1,172.86"	"$1,172.86"	$0.00	$0.00	$329.32	$0.00	$934.72	$934.72	$0.00	$790.13	"$1,251.56"	"$1,264.20"	$0.00		$0.00	$247.31	$0.00	$0.00	$251.58	$0.00	$0.00	$0.00	$0.00	$0.00
71225532	SUP	HCPCS C1713		71225532  -  PLATE BN 130D SM STAT 70MM 60MM TC100 4 HL OSTM SS FEM PROX	BOTH IP/OP	"$1,580.25 "	"$1,169.39"	$0.00	"$1,264.20"	$711.11	$711.11	$0.00	$0.00	$0.00	$329.36	"$1,172.86"	"$1,172.86"	$0.00	$0.00	$329.32	$0.00	$934.72	$934.72	$0.00	$790.13	"$1,251.56"	"$1,264.20"	$0.00		$0.00	$247.31	$0.00	$0.00	$251.58	$0.00	$0.00	$0.00	$0.00	$0.00
71225533	SUP	HCPCS C1713		71225533  -  PLATE BN 130D SM STAT 80MM 60MM TC100 4 HL OSTM SS FEM PROX	BOTH IP/OP	"$1,580.25 "	"$1,169.39"	$0.00	"$1,264.20"	$711.11	$711.11	$0.00	$0.00	$0.00	$329.36	"$1,172.86"	"$1,172.86"	$0.00	$0.00	$329.32	$0.00	$934.72	$934.72	$0.00	$790.13	"$1,251.56"	"$1,264.20"	$0.00		$0.00	$247.31	$0.00	$0.00	$251.58	$0.00	$0.00	$0.00	$0.00	$0.00
71225534	SUP	HCPCS C1713		71225534  -  PLATE BN 130D SM STAT 50MM 104MM TC100 6 HL OSTM SS FEM PROX	BOTH IP/OP	"$1,680.00 "	"$1,243.20"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$350.15	"$1,246.90"	"$1,246.90"	$0.00	$0.00	$350.11	$0.00	$993.72	$993.72	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$262.92	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
71225535	SUP	HCPCS C1713		71225535  -  PLATE BN 130D SM STAT 104MM 70MM TC100 6 HL ANG SS FEM PROX	BOTH IP/OP	"$1,680.00 "	"$1,243.20"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$350.15	"$1,246.90"	"$1,246.90"	$0.00	$0.00	$350.11	$0.00	$993.72	$993.72	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$262.92	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
71225536	SUP	HCPCS C1713		71225536  -  PLATE BN 130D SM STAT 104MM 60MM TC100 6 HL ANG SS FEM PROX	BOTH IP/OP	"$1,680.00 "	"$1,243.20"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$350.15	"$1,246.90"	"$1,246.90"	$0.00	$0.00	$350.11	$0.00	$993.72	$993.72	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$262.92	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
71225537	SUP	HCPCS C1713		71225537  -  PLATE BN 130D SM STAT 104MM 80MM TC100 6 HL ANG SS FEM PROX	BOTH IP/OP	"$1,680.00 "	"$1,243.20"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$350.15	"$1,246.90"	"$1,246.90"	$0.00	$0.00	$350.11	$0.00	$993.72	$993.72	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$262.92	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
71225539	SUP	HCPCS C1713		71225539  -  PLATE BN 130D SM STAT 152MM 60MM TC100 9 HL ANG SS FEM PROX	BOTH IP/OP	"$1,853.25 "	"$1,371.41"	$0.00	"$1,482.60"	$833.96	$833.96	$0.00	$0.00	$0.00	$386.26	"$1,375.48"	"$1,375.48"	$0.00	$0.00	$386.22	$0.00	"$1,096.20"	"$1,096.20"	$0.00	$926.63	"$1,467.77"	"$1,482.60"	$0.00		$0.00	$290.03	$0.00	$0.00	$295.04	$0.00	$0.00	$0.00	$0.00	$0.00
71225540	SUP	HCPCS C1713		71225540  -  PLATE BN 130D SM STAT 152MM 72MM TC100 9 HL ANG SS FEM PROX	BOTH IP/OP	"$1,853.25 "	"$1,371.41"	$0.00	"$1,482.60"	$833.96	$833.96	$0.00	$0.00	$0.00	$386.26	"$1,375.48"	"$1,375.48"	$0.00	$0.00	$386.22	$0.00	"$1,096.20"	"$1,096.20"	$0.00	$926.63	"$1,467.77"	"$1,482.60"	$0.00		$0.00	$290.03	$0.00	$0.00	$295.04	$0.00	$0.00	$0.00	$0.00	$0.00
71225541	SUP	HCPCS C1713		71225541  -  PLATE BN 130D SM STAT 152MM 80MM TC100 9 HL ANG SS FEM PROX	BOTH IP/OP	"$1,853.25 "	"$1,371.41"	$0.00	"$1,482.60"	$833.96	$833.96	$0.00	$0.00	$0.00	$386.26	"$1,375.48"	"$1,375.48"	$0.00	$0.00	$386.22	$0.00	"$1,096.20"	"$1,096.20"	$0.00	$926.63	"$1,467.77"	"$1,482.60"	$0.00		$0.00	$290.03	$0.00	$0.00	$295.04	$0.00	$0.00	$0.00	$0.00	$0.00
71225600	SUP	HCPCS C1713		71225600  -  PLATE BN 90D 7MM 25MM TC100 3 HL ANG SS PED PROX FEM 3.5MM	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
71225601	SUP	HCPCS C1713		71225601  -  PLATE BN 90D 12MM 25MM TC100 3 HL ANG SS PED PROX FEM 3.5MM	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
71225602	SUP	HCPCS C1713		71225602  -  PLATE BN 90D 7MM 32MM TC100 3 HL ANG SS PED PROX FEM 3.5MM	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
71225603	SUP	HCPCS C1713		71225603  -  PLATE BN 90D 12MM 32MM TC100 3 HL ANG SS PED PROX FEM 3.5MM	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
71225610	SUP	HCPCS C1713		71225610  -  PLATE BN 115D 5MM 30MM TC100 BFUR ANG SS PED FEM PROX 3.5MM	BOTH IP/OP	$680.40 	$503.50	$0.00	$544.32	$306.18	$306.18	$0.00	$0.00	$0.00	$141.81	$504.99	$504.99	$0.00	$0.00	$141.80	$0.00	$402.46	$402.46	$0.00	$340.20	$538.88	$544.32	$0.00		$0.00	$106.48	$0.00	$0.00	$108.32	$0.00	$0.00	$0.00	$0.00	$0.00
71225611	SUP	HCPCS C1713		71225611  -  PLATE BN 115D 5MM 35MM TC100 BFUR ANG SS PED FEM PROX 3.5MM	BOTH IP/OP	$680.40 	$503.50	$0.00	$544.32	$306.18	$306.18	$0.00	$0.00	$0.00	$141.81	$504.99	$504.99	$0.00	$0.00	$141.80	$0.00	$402.46	$402.46	$0.00	$340.20	$538.88	$544.32	$0.00		$0.00	$106.48	$0.00	$0.00	$108.32	$0.00	$0.00	$0.00	$0.00	$0.00
71225620	SUP	HCPCS C1713		71225620  -  PLATE BN 80D 8MM 35MM TC100 3 HL ANG SS PED PROX FEM 4.5MM	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
71225621	SUP	HCPCS C1713		71225621  -  PLATE BN 80D 8MM 45MM TC100 3 HL ANG SS PED PROX FEM 4.5MM	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
71225622	SUP	HCPCS C1713		71225622  -  PLATE BN 90D 8MM 35MM TC100 3 HL ANG SS PED PROX FEM 4.5MM	BOTH IP/OP	$951.30 	$703.96	$0.00	$761.04	$428.09	$428.09	$0.00	$0.00	$0.00	$198.27	$706.05	$706.05	$0.00	$0.00	$198.25	$0.00	$562.69	$562.69	$0.00	$475.65	$753.43	$761.04	$0.00		$0.00	$148.88	$0.00	$0.00	$151.45	$0.00	$0.00	$0.00	$0.00	$0.00
71225623	SUP	HCPCS C1713		71225623  -  PLATE BN 90D 8MM 45MM TC100 3 HL ANG SS PED PROX FEM 4.5MM	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
71225624	SUP	HCPCS C1713		71225624  -  PLATE BN 100D 8MM 35MM TC100 3 HL ANG SS PED PROX FEM 4.5MM	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
71225625	SUP	HCPCS C1713		71225625  -  PLATE BN 100D 8MM 45MM TC100 3 HL ANG SS PED PROX FEM 4.5MM	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
71225640	SUP	HCPCS C1713		71225640  -  PLATE BN 90D 10MM 40MM TC100 3 HL ANG SS PED PROX FEM 4.5MM	BOTH IP/OP	"$1,302.00 "	$963.48	$0.00	"$1,041.60"	$585.90	$585.90	$0.00	$0.00	$0.00	$271.37	$966.34	$966.34	$0.00	$0.00	$271.34	$0.00	$770.13	$770.13	$0.00	$651.00	"$1,031.18"	"$1,041.60"	$0.00		$0.00	$203.76	$0.00	$0.00	$207.28	$0.00	$0.00	$0.00	$0.00	$0.00
71225641	SUP	HCPCS C1713		71225641  -  PLATE BN 90D 15MM 40MM TC100 3 HL ANG SS PED PROX FEM 4.5MM	BOTH IP/OP	"$1,302.00 "	$963.48	$0.00	"$1,041.60"	$585.90	$585.90	$0.00	$0.00	$0.00	$271.37	$966.34	$966.34	$0.00	$0.00	$271.34	$0.00	$770.13	$770.13	$0.00	$651.00	"$1,031.18"	"$1,041.60"	$0.00		$0.00	$203.76	$0.00	$0.00	$207.28	$0.00	$0.00	$0.00	$0.00	$0.00
71225642	SUP	HCPCS C1713		71225642  -  PLATE BN 90D 10MM 50MM TC100 3 HL ANG SS PED FEM PROX 4.5MM	BOTH IP/OP	"$1,302.00 "	$963.48	$0.00	"$1,041.60"	$585.90	$585.90	$0.00	$0.00	$0.00	$271.37	$966.34	$966.34	$0.00	$0.00	$271.34	$0.00	$770.13	$770.13	$0.00	$651.00	"$1,031.18"	"$1,041.60"	$0.00		$0.00	$203.76	$0.00	$0.00	$207.28	$0.00	$0.00	$0.00	$0.00	$0.00
71225643	SUP	HCPCS C1713		71225643  -  PLATE BN 90D 15MM 50MM TC100 3 HL ANG SS PED FEM PROX 4.5MM	BOTH IP/OP	"$1,302.00 "	$963.48	$0.00	"$1,041.60"	$585.90	$585.90	$0.00	$0.00	$0.00	$271.37	$966.34	$966.34	$0.00	$0.00	$271.34	$0.00	$770.13	$770.13	$0.00	$651.00	"$1,031.18"	"$1,041.60"	$0.00		$0.00	$203.76	$0.00	$0.00	$207.28	$0.00	$0.00	$0.00	$0.00	$0.00
71225644	SUP	HCPCS C1713		71225644  -  PLATE BN 90D 15MM 60MM TC100 3 HL ANG SS PED FEM PROX 4.5MM	BOTH IP/OP	"$1,302.00 "	$963.48	$0.00	"$1,041.60"	$585.90	$585.90	$0.00	$0.00	$0.00	$271.37	$966.34	$966.34	$0.00	$0.00	$271.34	$0.00	$770.13	$770.13	$0.00	$651.00	"$1,031.18"	"$1,041.60"	$0.00		$0.00	$203.76	$0.00	$0.00	$207.28	$0.00	$0.00	$0.00	$0.00	$0.00
71225716	SUP	HCPCS C1713		71225716  -  SCREW BN 3.5MM 16MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225718	SUP	HCPCS C1713		71225718  -  SCREW BN 3.5MM 18MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225720	SUP	HCPCS C1713		71225720  -  SCREW BN 3.5MM 20MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225722	SUP	HCPCS C1713		71225722  -  SCREW BN 3.5MM 22MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225724	SUP	HCPCS C1713		71225724  -  SCREW BN 3.5MM 24MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225726	SUP	HCPCS C1713		71225726  -  SCREW BN 3.5MM 26MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225728	SUP	HCPCS C1713		71225728  -  SCREW BN 3.5MM 28MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225730	SUP	HCPCS C1713		71225730  -  SCREW BN 3.5MM 30MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225732	SUP	HCPCS C1713		71225732  -  SCREW BN 3.5MM 32MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225734	SUP	HCPCS C1713		71225734  -  SCREW BN 3.5MM 34MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225736	SUP	HCPCS C1713		71225736  -  SCREW BN 3.5MM 36MM STRL 12MM TC100 ST SS ORTH	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225738	SUP	HCPCS C1713		71225738  -  SCREW BN 3.5MM 38MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225740	SUP	HCPCS C1713		71225740  -  SCREW BN 3.5MM 40MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225745	SUP	HCPCS C1713		71225745  -  SCREW BN 3.5MM 45MM STRL 15MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225750	SUP	HCPCS C1713		71225750  -  SCREW BN 3.5MM 50MM STRL 15MM TC100 ST SHFT SS ORTH SM FRAG	BOTH IP/OP	$65.53 	$48.49	$0.00	$52.42	$29.49	$29.49	$0.00	$0.00	$0.00	$13.66	$48.63	$48.63	$0.00	$0.00	$13.66	$0.00	$38.76	$38.76	$0.00	$32.76	$51.90	$52.42	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
71225822	SUP	HCPCS C1713		71225822  -  SCREW BN 4.5MM 22MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71225824	SUP	HCPCS C1713		71225824  -  SCREW BN 4.5MM 24MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71225826	SUP	HCPCS C1713		71225826  -  SCREW BN 4.5MM 26MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71225828	SUP	HCPCS C1713		71225828  -  SCREW BN 4.5MM 28MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71225830	SUP	HCPCS C1713		71225830  -  SCREW BN 4.5MM 30MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71225832	SUP	HCPCS C1713		71225832  -  SCREW BN 4.5MM 32MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71225834	SUP	HCPCS C1713		71225834  -  SCREW BN 4.5MM 34MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71225836	SUP	HCPCS C1713		71225836  -  SCREW BN 4.5MM 36MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71225838	SUP	HCPCS C1713		71225838  -  SCREW BN 4.5MM 38MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71225840	SUP	HCPCS C1713		71225840  -  SCREW BN 4.5MM 40MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$67.53 	$49.97	$0.00	$54.02	$30.39	$30.39	$0.00	$0.00	$0.00	$14.07	$50.12	$50.12	$0.00	$0.00	$14.07	$0.00	$39.94	$39.94	$0.00	$33.76	$53.48	$54.02	$0.00		$0.00	$10.57	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
71225842	SUP	HCPCS C1713		71225842  -  SCREW BN 4.5MM 42MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225844	SUP	HCPCS C1713		71225844  -  SCREW BN 4.5MM 44MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225846	SUP	HCPCS C1713		71225846  -  SCREW BN 4.5MM 46MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225848	SUP	HCPCS C1713		71225848  -  SCREW BN 4.5MM 48MM STRL 12MM TC100 ST SS ORTH	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225850	SUP	HCPCS C1713		71225850  -  SCREW BN 4.5MM 50MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225852	SUP	HCPCS C1713		71225852  -  SCREW BN 4.5MM 52MM STRL 15MM TC100 ST SS ORTH	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225854	SUP	HCPCS C1713		71225854  -  SCREW BN 4.5MM 54MM STRL 15MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225856	SUP	HCPCS C1713		71225856  -  SCREW BN 4.5MM 56MM STRL 15MM TC100 ST SS ORTH	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225858	SUP	HCPCS C1713		71225858  -  SCREW BN 4.5MM 58MM STRL 15MM TC100 ST SS ORTH	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225860	SUP	HCPCS C1713		71225860  -  SCREW BN 4.5MM 60MM STRL 15MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225864	SUP	HCPCS C1713		71225864  -  SCREW BN 4.5MM 64MM STRL 18MM TC100 ST SS ORTH	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225868	SUP	HCPCS C1713		71225868  -  SCREW BN 4.5MM 68MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225872	SUP	HCPCS C1713		71225872  -  SCREW BN 4.5MM 72MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
71225876	SUP	HCPCS C1713		71225876  -  SCREW BN 4.5MM 76MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71225880	SUP	HCPCS C1713		71225880  -  SCREW BN 4.5MM 80MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71225885	SUP	HCPCS C1713		71225885  -  SCREW BN 4.5MM 85MM STRL 22MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71225890	SUP	HCPCS C1713		71225890  -  SCREW BN 4.5MM 90MM STRL 22MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71225895	SUP	HCPCS C1713		71225895  -  SCREW BN 4.5MM 95MM STRL 26MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71225900	SUP	HCPCS C1713		71225900  -  SCREW BN 4.5MM 100MM STRL 26MM TC100 ST SHFT SS ORTH LG FRAG	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
71226030	SUP	HCPCS C1713		71226030  -  SCREW BN P/T 6.5MM 8MM 30MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71226035	SUP	HCPCS C1713		71226035  -  SCREW BN P/T 6.5MM 8MM 35MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71226040	SUP	HCPCS C1713		71226040  -  SCREW BN P/T 6.5MM 8MM 40MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71226045	SUP	HCPCS C1713		71226045  -  SCREW BN P/T 6.5MM 8MM 45MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71226050	SUP	HCPCS C1713		71226050  -  SCREW BN P/T 6.5MM 8MM 50MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71226055	SUP	HCPCS C1713		71226055  -  SCREW BN P/T 6.5MM 8MM 55MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71226060	SUP	HCPCS C1713		71226060  -  SCREW BN P/T 6.5MM 8MM 60MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71226065	SUP	HCPCS C1713		71226065  -  SCREW BN P/T 6.5MM 8MM 65MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71226070	SUP	HCPCS C1713		71226070  -  SCREW BN P/T 6.5MM 8MM 70MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71226075	SUP	HCPCS C1713		71226075  -  SCREW BN P/T 6.5MM 8MM 75MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71226080	SUP	HCPCS C1713		71226080  -  SCREW BN P/T 6.5MM 8MM 80MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71226085	SUP	HCPCS C1713		71226085  -  SCREW BN P/T 6.5MM 8MM 85MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71226090	SUP	HCPCS C1713		71226090  -  SCREW BN P/T 6.5MM 8MM 90MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71226095	SUP	HCPCS C1713		71226095  -  SCREW BN P/T 6.5MM 8MM 95MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71226100	SUP	HCPCS C1713		71226100  -  SCREW BN 6.5MM 100MM 16MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71226105	SUP	HCPCS C1713		71226105  -  SCREW BN 6.5MM 105MM 16MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71226110	SUP	HCPCS C1713		71226110  -  SCREW BN 6.5MM 110MM 16MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71226115	SUP	HCPCS C1713		71226115  -  SCREW BN 6.5MM 115MM 16MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71226120	SUP	HCPCS C1713		71226120  -  SCREW BN 6.5MM 120MM 16MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71226125	SUP	HCPCS C1713		71226125  -  SCREW BN 6.5MM 125MM 16MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71226130	SUP	HCPCS C1713		71226130  -  SCREW BN 6.5MM 130MM 16MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71226135	SUP	HCPCS C1713		71226135  -  SCREW BN 6.5MM 135MM 16MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71226140	SUP	HCPCS C1713		71226140  -  SCREW BN 6.5MM 140MM 16MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71226145	SUP	HCPCS C1713		71226145  -  SCREW BN 6.5MM 145MM 16MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71226150	SUP	HCPCS C1713		71226150  -  SCREW BN 6.5MM 150MM 16MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71228045	SUP	HCPCS C1713		71228045  -  SCREW BN 6.5MM 45MM 32MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71228050	SUP	HCPCS C1713		71228050  -  SCREW BN 6.5MM 50MM 32MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71228055	SUP	HCPCS C1713		71228055  -  SCREW BN 6.5MM 55MM 32MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71228060	SUP	HCPCS C1713		71228060  -  SCREW BN 6.5MM 60MM 32MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71228065	SUP	HCPCS C1713		71228065  -  SCREW BN 6.5MM 65MM 32MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71228070	SUP	HCPCS C1713		71228070  -  SCREW BN 6.5MM 70MM 32MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71228075	SUP	HCPCS C1713		71228075  -  SCREW BN 6.5MM 75MM 32MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71228080	SUP	HCPCS C1713		71228080  -  SCREW BN 6.5MM 80MM 32MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71228085	SUP	HCPCS C1713		71228085  -  SCREW BN 6.5MM 85MM 32MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$143.85 	$106.45	$0.00	$115.08	$64.73	$64.73	$0.00	$0.00	$0.00	$29.98	$106.77	$106.77	$0.00	$0.00	$29.98	$0.00	$85.09	$85.09	$0.00	$71.93	$113.93	$115.08	$0.00		$0.00	$22.51	$0.00	$0.00	$22.90	$0.00	$0.00	$0.00	$0.00	$0.00
71228090	SUP	HCPCS C1713		71228090  -  SCREW BN 6.5MM 90MM 32MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71228095	SUP	HCPCS C1713		71228095  -  SCREW BN 6.5MM 95MM 32MM TC100 THRD SS CANC LG FRAG SET	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71228100	SUP	HCPCS C1713		71228100  -  SCREW BN 6.5MM 100MM 32MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71228105	SUP	HCPCS C1713		71228105  -  SCREW BN 6.5MM 105MM 32MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71228110	SUP	HCPCS C1713		71228110  -  SCREW BN 6.5MM 110MM 32MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71228115	SUP	HCPCS C1713		71228115  -  SCREW BN 6.5MM 115MM 32MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71228120	SUP	HCPCS C1713		71228120  -  SCREW BN 6.5MM 120MM 32MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71228125	SUP	HCPCS C1713		71228125  -  SCREW BN 6.5MM 125MM 32MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71228130	SUP	HCPCS C1713		71228130  -  SCREW BN 6.5MM 130MM 32MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71228135	SUP	HCPCS C1713		71228135  -  SCREW BN 6.5MM 135MM 32MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71228140	SUP	HCPCS C1713		71228140  -  SCREW BN 6.5MM 140MM 32MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71228145	SUP	HCPCS C1713		71228145  -  SCREW BN 6.5MM 145MM 32MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71228150	SUP	HCPCS C1713		71228150  -  SCREW BN 6.5MM 150MM 32MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71229025	SUP	HCPCS C1713		71229025  -  SCREW BN FT 6.5MM 8MM 25MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71229030	SUP	HCPCS C1713		71229030  -  SCREW BN FT 6.5MM 8MM 30MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71229035	SUP	HCPCS C1713		71229035  -  SCREW BN FT 6.5MM 8MM 35MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71229040	SUP	HCPCS C1713		71229040  -  SCREW BN FT 6.5MM 8MM 40MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71229045	SUP	HCPCS C1713		71229045  -  SCREW BN FT 6.5MM 8MM 45MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71229050	SUP	HCPCS C1713		71229050  -  SCREW BN FT 6.5MM 8MM 50MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71229055	SUP	HCPCS C1713		71229055  -  SCREW BN FT 6.5MM 8MM 55MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71229060	SUP	HCPCS C1713		71229060  -  SCREW BN FT 6.5MM 8MM 60MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71229065	SUP	HCPCS C1713		71229065  -  SCREW BN FT 6.5MM 8MM 65MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71229070	SUP	HCPCS C1713		71229070  -  SCREW BN FT 6.5MM 8MM 70MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71229075	SUP	HCPCS C1713		71229075  -  SCREW BN FT 6.5MM 75MM TC100 CANC	BOTH IP/OP	$123.90 	$91.69	$0.00	$99.12	$55.76	$55.76	$0.00	$0.00	$0.00	$25.82	$91.96	$91.96	$0.00	$0.00	$25.82	$0.00	$73.29	$73.29	$0.00	$61.95	$98.13	$99.12	$0.00		$0.00	$19.39	$0.00	$0.00	$19.72	$0.00	$0.00	$0.00	$0.00	$0.00
71229080	SUP	HCPCS C1713		71229080  -  SCREW BN FT 6.5MM 80MM TC100 CANC	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71229085	SUP	HCPCS C1713		71229085  -  SCREW BN FT 6.5MM 85MM TC100 CANC	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71229090	SUP	HCPCS C1713		71229090  -  SCREW BN FT 6.5MM 90MM TC100 CANC	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71229095	SUP	HCPCS C1713		71229095  -  SCREW BN FT 6.5MM 8MM 95MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71229100	SUP	HCPCS C1713		71229100  -  SCREW BN FT 6.5MM 100MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71229105	SUP	HCPCS C1713		71229105  -  SCREW BN FT 6.5MM 105MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71229110	SUP	HCPCS C1713		71229110  -  SCREW BN FT 6.5MM 110MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$135.45 	$100.23	$0.00	$108.36	$60.95	$60.95	$0.00	$0.00	$0.00	$28.23	$100.53	$100.53	$0.00	$0.00	$28.23	$0.00	$80.12	$80.12	$0.00	$67.73	$107.28	$108.36	$0.00		$0.00	$21.20	$0.00	$0.00	$21.56	$0.00	$0.00	$0.00	$0.00	$0.00
71229115	SUP	HCPCS C1713		71229115  -  SCREW BN FT 6.5MM 115MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71229120	SUP	HCPCS C1713		71229120  -  SCREW BN FT 6.5MM 120MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71229125	SUP	HCPCS C1713		71229125  -  SCREW BN FT 6.5MM 125MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71229130	SUP	HCPCS C1713		71229130  -  SCREW BN FT 6.5MM 130MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71229135	SUP	HCPCS C1713		71229135  -  SCREW BN FT 6.5MM 135MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71229140	SUP	HCPCS C1713		71229140  -  SCREW BN FT 6.5MM 140MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71229145	SUP	HCPCS C1713		71229145  -  SCREW BN FT 6.5MM 145MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71229150	SUP	HCPCS C1713		71229150  -  SCREW BN FT 6.5MM 150MM TC100 SS CANC LG FRAG SET	BOTH IP/OP	$174.30 	$128.98	$0.00	$139.44	$78.44	$78.44	$0.00	$0.00	$0.00	$36.33	$129.37	$129.37	$0.00	$0.00	$36.32	$0.00	$103.10	$103.10	$0.00	$87.15	$138.05	$139.44	$0.00		$0.00	$27.28	$0.00	$0.00	$27.75	$0.00	$0.00	$0.00	$0.00	$0.00
71453122	SUP	HCPCS C1776		71453122  -  INSERT TIB 5-6 11MM LEGION CR HI FLXN XLPE KN	BOTH IP/OP	"$10,175.00 "	"$7,529.50"	$0.00	"$8,140.00"	"$4,578.75"	"$4,578.75"	$0.00	$0.00	$0.00	"$2,120.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,120.47"	$0.00	"$5,016.28"	"$5,016.28"	$0.00	"$5,087.50"	"$8,058.60"	"$8,140.00"	$0.00		$0.00	"$1,592.39"	$0.00	$0.00	"$1,619.86"	$0.00	$0.00	$0.00	$0.00	$0.00
71525986	SUP	HCPCS C1713		71525986  -  SCREW BN 5MM 55MM ORTH	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$137.70	$137.70	$0.00	$0.00	$0.00	$63.78	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$181.00	$181.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$47.89	$0.00	$0.00	$48.72	$0.00	$0.00	$0.00	$0.00	$0.00
71525989	SUP	HCPCS C1713		71525989  -  SCREW BN 5MM 70MM ORTH	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$137.70	$137.70	$0.00	$0.00	$0.00	$63.78	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$181.00	$181.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$47.89	$0.00	$0.00	$48.72	$0.00	$0.00	$0.00	$0.00	$0.00
71525990	SUP	HCPCS C1713		71525990  -  SCREW BN 5MM 75MM ORTH	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$137.70	$137.70	$0.00	$0.00	$0.00	$63.78	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$181.00	$181.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$47.89	$0.00	$0.00	$48.72	$0.00	$0.00	$0.00	$0.00	$0.00
71525991	SUP	HCPCS C1713		71525991  -  SCREW BN 5MM 80MM ORTH	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$137.70	$137.70	$0.00	$0.00	$0.00	$63.78	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$181.00	$181.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$47.89	$0.00	$0.00	$48.72	$0.00	$0.00	$0.00	$0.00	$0.00
71525993	SUP	HCPCS C1713		71525993  -  SCREW BN 5MM 90MM ORTH	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$137.70	$137.70	$0.00	$0.00	$0.00	$63.78	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$181.00	$181.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$47.89	$0.00	$0.00	$48.72	$0.00	$0.00	$0.00	$0.00	$0.00
71525994	SUP	HCPCS C1713		71525994  -  SCREW BN 5MM 95MM ORTH	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$137.70	$137.70	$0.00	$0.00	$0.00	$63.78	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$181.00	$181.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$47.89	$0.00	$0.00	$48.72	$0.00	$0.00	$0.00	$0.00	$0.00
71525995	SUP	HCPCS C1713		71525995  -  SCREW BN 5MM 100MM ORTH	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$137.70	$137.70	$0.00	$0.00	$0.00	$63.78	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$181.00	$181.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$47.89	$0.00	$0.00	$48.72	$0.00	$0.00	$0.00	$0.00	$0.00
71525996	SUP	HCPCS C1713		71525996  -  SCREW BN 5MM 105MM ORTH	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$137.70	$137.70	$0.00	$0.00	$0.00	$63.78	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$181.00	$181.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$47.89	$0.00	$0.00	$48.72	$0.00	$0.00	$0.00	$0.00	$0.00
71525997	SUP	HCPCS C1713		71525997  -  SCREW BN 5MM 110MM ORTH	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$137.70	$137.70	$0.00	$0.00	$0.00	$63.78	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$181.00	$181.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$47.89	$0.00	$0.00	$48.72	$0.00	$0.00	$0.00	$0.00	$0.00
71631035	SUP	Custom 27203010		71631035  -  DRILL SURG 6.4MM STERILE	BOTH IP/OP	$587.25 	$434.57	$0.00	$469.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$435.86	$435.86	$0.00	$0.00	$122.38	$0.00	$0.00	$0.00	$0.00	$293.63	$465.10	$469.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71631110	SUP	Custom 27203010		71631110  -  BIT DRILL LONG 4MM PILOT TRIGEN GOLD STERILE DISPOSABLE	BOTH IP/OP	$504.00 	$372.96	$0.00	$403.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.07	$374.07	$0.00	$0.00	$105.03	$0.00	$0.00	$0.00	$0.00	$252.00	$399.17	$403.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71631112	SUP	Custom 27203010		71631112  -  BIT DRL SHRT 3.2MM STRL TRGN PILT	BOTH IP/OP	$148.50 	$109.89	$0.00	$118.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$110.22	$110.22	$0.00	$0.00	$30.95	$0.00	$0.00	$0.00	$0.00	$74.25	$117.61	$118.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71631117	SUP	Custom 27203010		71631117  -  BIT DRILL 4MM TRGN SHRT PILT STRL DISP	BOTH IP/OP	$340.88 	$252.25	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.00	$253.00	$0.00	$0.00	$71.04	$0.00	$0.00	$0.00	$0.00	$78.75	$124.74	$126.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71631626	SUP	HCPCS C1769		71631626  -  GUIDE ROD ORTH BALL 3MM 1000MM STRL TRGN BALL TIP SS DISP	BOTH IP/OP	$433.13 	$320.52	$0.00	$346.50	$235.19	$235.19	$0.00	$0.00	$0.00	$90.27	$321.47	$321.47	$0.00	$0.00	$90.26	$0.00	$256.19	$256.19	$0.00	$216.56	$343.04	$346.50	$0.00		$0.00	$67.78	$0.00	$0.00	$68.95	$0.00	$0.00	$0.00	$0.00	$0.00
71631690	SUP	Custom 27203010		71631690  -  GUIDEWIRE ORTHOPEDIC THREAD 3.2MM TRIGEN DISTAL FEMUR	BOTH IP/OP	$209.25 	$154.85	$0.00	$167.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$104.63	$165.73	$167.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71632001	SUP	HCPCS C1713		71632001  -  NUT ORTH 5MM STRL TRGN STBLK LCK STAB 5MM SCR	BOTH IP/OP	$585.00 	$432.90	$0.00	$468.00	$263.25	$263.25	$0.00	$0.00	$0.00	$121.93	$434.19	$434.19	$0.00	$0.00	$121.91	$0.00	$346.03	$346.03	$0.00	$292.50	$463.32	$468.00	$0.00		$0.00	$91.55	$0.00	$0.00	$93.13	$0.00	$0.00	$0.00	$0.00	$0.00
71632002	SUP	HCPCS C1713		71632002  -  NUT ORTH 4.5MM STBLK WSHR	BOTH IP/OP	$303.75 	$224.78	$0.00	$243.00	$136.69	$136.69	$0.00	$0.00	$0.00	$63.31	$225.44	$225.44	$0.00	$0.00	$63.30	$0.00	$179.67	$179.67	$0.00	$151.88	$240.57	$243.00	$0.00		$0.00	$47.54	$0.00	$0.00	$48.36	$0.00	$0.00	$0.00	$0.00	$0.00
71632125	SUP	HCPCS C1713		71632125  -  SCREW BN 4.5MM 25MM GRY TRGN ST SLFDRL FLUT TIP CPTR TI KN	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632130	SUP	HCPCS C1713		71632130  -  SCREW BN 4.5MM 30MM GRY TRGN ST SLFDRL CPTR FLUT TIP TI KN	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632135	SUP	HCPCS C1713		71632135  -  SCREW BN 4.5MM 35MM GRY TRGN ST SLFDRL CPTR FLUT TIP TI KN	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632140	SUP	HCPCS C1713		71632140  -  SCREW BN 4.5MM 40MM GRY TRGN ST SLFDRL FLUT TIP CPTR TI KN	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632150	SUP	HCPCS C1713		71632150  -  SCREW BN 4.5MM 50MM GRY TRGN ST SLFDRL FLUT TIP CPTR TI KN	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632200	SUP	HCPCS C1713		71632200  -  SCREW BN 5MM 100MM AU TRGN ST SLFDRL FLUT TIP CPTR TI KN	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632205	SUP	HCPCS C1713		71632205  -  SCREW BN 5MM 105MM AU TRGN ST SLFDRL FLUT TIP CPTR TI KN IM	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632210	SUP	HCPCS C1713		71632210  -  SCREW BN 5MM 110MM AU TRGN ST SLFDRL FLUT TIP CPTR TI KN IM	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632220	SUP	HCPCS C1713		71632220  -  SCREW BN 5MM 20MM AU TRGN ST SLFDRL CPTR FLUT TIP THRD TI KN	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632230	SUP	HCPCS C1713		71632230  -  SCREW BN 5MM 30MM AU TRGN FLUT TIP ST DRL CPTR TI KN	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632260	SUP	HCPCS C1713		71632260  -  SCREW BN 5MM 60MM AU TRGN CPTR SLF DRL ST TI KN	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632275	SUP	HCPCS C1713		71632275  -  SCREW BN 5MM 75MM AU TRGN ST SLF DRL FLUT TIP CPTR TI KN	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632280	SUP	HCPCS C1713		71632280  -  SCREW BN 5MM 80MM AU TRGN ST SLF DRL FLUT TIP CPTR TI KN	BOTH IP/OP	$407.25 	$301.37	$0.00	$325.80	$183.26	$183.26	$0.00	$0.00	$0.00	$84.88	$302.26	$302.26	$0.00	$0.00	$84.87	$0.00	$240.89	$240.89	$0.00	$203.63	$322.54	$325.80	$0.00		$0.00	$63.73	$0.00	$0.00	$64.83	$0.00	$0.00	$0.00	$0.00	$0.00
71632300	SUP	HCPCS C1713		71632300  -  SCREW BN 6.4MM 100MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM	BOTH IP/OP	$685.13 	$507.00	$0.00	$548.10	$308.31	$308.31	$0.00	$0.00	$0.00	$142.80	$508.50	$508.50	$0.00	$0.00	$142.78	$0.00	$405.25	$405.25	$0.00	$342.56	$542.62	$548.10	$0.00		$0.00	$107.22	$0.00	$0.00	$109.07	$0.00	$0.00	$0.00	$0.00	$0.00
71632305	SUP	HCPCS C1713		71632305  -  SCREW BN 6.4MM 105MM BLU TRGN ST SLFDRL CPTR RECON TI KN IM	BOTH IP/OP	$685.13 	$507.00	$0.00	$548.10	$308.31	$308.31	$0.00	$0.00	$0.00	$142.80	$508.50	$508.50	$0.00	$0.00	$142.78	$0.00	$405.25	$405.25	$0.00	$342.56	$542.62	$548.10	$0.00		$0.00	$107.22	$0.00	$0.00	$109.07	$0.00	$0.00	$0.00	$0.00	$0.00
71632316	SUP	HCPCS C1713		71632316  -  SCREW BN 6.4MM 115MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM	BOTH IP/OP	$685.13 	$507.00	$0.00	$548.10	$308.31	$308.31	$0.00	$0.00	$0.00	$142.80	$508.50	$508.50	$0.00	$0.00	$142.78	$0.00	$405.25	$405.25	$0.00	$342.56	$542.62	$548.10	$0.00		$0.00	$107.22	$0.00	$0.00	$109.07	$0.00	$0.00	$0.00	$0.00	$0.00
71632325	SUP	HCPCS C1713		71632325  -  SCREW BN 6.4MM 125MM BLU TRGN CPTR RECON TI KN IM NL	BOTH IP/OP	$685.13 	$507.00	$0.00	$548.10	$308.31	$308.31	$0.00	$0.00	$0.00	$142.80	$508.50	$508.50	$0.00	$0.00	$142.78	$0.00	$405.25	$405.25	$0.00	$342.56	$542.62	$548.10	$0.00		$0.00	$107.22	$0.00	$0.00	$109.07	$0.00	$0.00	$0.00	$0.00	$0.00
71632375	SUP	HCPCS C1713		71632375  -  SCREW BN 6.4MM 75MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM	BOTH IP/OP	$685.13 	$507.00	$0.00	$548.10	$308.31	$308.31	$0.00	$0.00	$0.00	$142.80	$508.50	$508.50	$0.00	$0.00	$142.78	$0.00	$405.25	$405.25	$0.00	$342.56	$542.62	$548.10	$0.00		$0.00	$107.22	$0.00	$0.00	$109.07	$0.00	$0.00	$0.00	$0.00	$0.00
71632380	SUP	HCPCS C1713		71632380  -  SCREW BN 6.4MM 80MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM	BOTH IP/OP	$685.13 	$507.00	$0.00	$548.10	$308.31	$308.31	$0.00	$0.00	$0.00	$142.80	$508.50	$508.50	$0.00	$0.00	$142.78	$0.00	$405.25	$405.25	$0.00	$342.56	$542.62	$548.10	$0.00		$0.00	$107.22	$0.00	$0.00	$109.07	$0.00	$0.00	$0.00	$0.00	$0.00
71632385	SUP	HCPCS C1713		71632385  -  SCREW BN 6.4MM 85MM BLU TRGN CPTR RECON TI KN IM NL	BOTH IP/OP	$685.13 	$507.00	$0.00	$548.10	$308.31	$308.31	$0.00	$0.00	$0.00	$142.80	$508.50	$508.50	$0.00	$0.00	$142.78	$0.00	$405.25	$405.25	$0.00	$342.56	$542.62	$548.10	$0.00		$0.00	$107.22	$0.00	$0.00	$109.07	$0.00	$0.00	$0.00	$0.00	$0.00
71632390	SUP	HCPCS C1713		71632390  -  SCREW BN 6.4MM 90MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM	BOTH IP/OP	$685.13 	$507.00	$0.00	$548.10	$308.31	$308.31	$0.00	$0.00	$0.00	$142.80	$508.50	$508.50	$0.00	$0.00	$142.78	$0.00	$405.25	$405.25	$0.00	$342.56	$542.62	$548.10	$0.00		$0.00	$107.22	$0.00	$0.00	$109.07	$0.00	$0.00	$0.00	$0.00	$0.00
71632395	SUP	HCPCS C1713		71632395  -  SCREW BN 6.4MM 95MM BLU TRGN ST SLFDRL CPTR RECON TI KN IM	BOTH IP/OP	$685.13 	$507.00	$0.00	$548.10	$308.31	$308.31	$0.00	$0.00	$0.00	$142.80	$508.50	$508.50	$0.00	$0.00	$142.78	$0.00	$405.25	$405.25	$0.00	$342.56	$542.62	$548.10	$0.00		$0.00	$107.22	$0.00	$0.00	$109.07	$0.00	$0.00	$0.00	$0.00	$0.00
71633005	SUP	HCPCS C1713		71633005  -  CAP END 5MM 5MM TRGN XTD TI FEM IM NL	BOTH IP/OP	$418.50 	$309.69	$0.00	$334.80	$188.33	$188.33	$0.00	$0.00	$0.00	$87.23	$310.61	$310.61	$0.00	$0.00	$87.22	$0.00	$247.54	$247.54	$0.00	$209.25	$331.45	$334.80	$0.00		$0.00	$65.50	$0.00	$0.00	$66.63	$0.00	$0.00	$0.00	$0.00	$0.00
71633010	SUP	HCPCS C1713		71633010  -  CAP END 10MM 10MM TRGN XTD TI FEM IM NL	BOTH IP/OP	$418.50 	$309.69	$0.00	$334.80	$188.33	$188.33	$0.00	$0.00	$0.00	$87.23	$310.61	$310.61	$0.00	$0.00	$87.22	$0.00	$247.54	$247.54	$0.00	$209.25	$331.45	$334.80	$0.00		$0.00	$65.50	$0.00	$0.00	$66.63	$0.00	$0.00	$0.00	$0.00	$0.00
71633015	SUP	HCPCS C1713		71633015  -  CAP END 15MM TRGN TI ORTH IM NL	BOTH IP/OP	$418.50 	$309.69	$0.00	$334.80	$188.33	$188.33	$0.00	$0.00	$0.00	$87.23	$310.61	$310.61	$0.00	$0.00	$87.22	$0.00	$247.54	$247.54	$0.00	$209.25	$331.45	$334.80	$0.00		$0.00	$65.50	$0.00	$0.00	$66.63	$0.00	$0.00	$0.00	$0.00	$0.00
71633020	SUP	HCPCS C1713		71633020  -  CAP END 20MM TRGN TI ORTH IM NL	BOTH IP/OP	$418.50 	$309.69	$0.00	$334.80	$188.33	$188.33	$0.00	$0.00	$0.00	$87.23	$310.61	$310.61	$0.00	$0.00	$87.22	$0.00	$247.54	$247.54	$0.00	$209.25	$331.45	$334.80	$0.00		$0.00	$65.50	$0.00	$0.00	$66.63	$0.00	$0.00	$0.00	$0.00	$0.00
71633315	SUP	HCPCS C1713		71633315  -  NAIL IM 11.5MM 15CM AU TRGN SET TI KN SP CNDL	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
71633320	SUP	HCPCS C1713		71633320  -  NAIL IM 11.5MM 20CM AU TRGN TI KN TIB	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
71633325	SUP	HCPCS C1713		71633325  -  NAIL IM 11.5MM 25CM AU TRGN SET TI KN SP CNDL	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
71633415	SUP	HCPCS C1713		71633415  -  NAIL IM 13MM 15CM AU TRGN SET TI KN SP CNDL	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
71633420	SUP	HCPCS C1713		71633420  -  NAIL IM 13MM 20CM AU TRGN SET TI KN SP CNDL	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
71633425	SUP	HCPCS C1713		71633425  -  NAIL IM 13MM 25CM AU TRGN SET TI KN SP CNDL	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
71633448	SUP	HCPCS C1713		71633448  -  NAIL IM 13MM 48CM AU TRGN RTRGD ANTGRD TI FEM TIB	BOTH IP/OP	"$6,490.00 "	"$4,802.60"	$0.00	"$5,192.00"	"$2,920.50"	"$2,920.50"	$0.00	$0.00	$0.00	"$1,352.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,352.52"	$0.00	"$3,199.57"	"$3,199.57"	$0.00	"$3,245.00"	"$5,140.08"	"$5,192.00"	$0.00		$0.00	"$1,015.69"	$0.00	$0.00	"$1,033.21"	$0.00	$0.00	$0.00	$0.00	$0.00
71634000	SUP	HCPCS C1713		71634000  -  CAP END 0MM TRGN SET TI DISP INTNL HEX IM NL	BOTH IP/OP	$420.75 	$311.36	$0.00	$336.60	$189.34	$189.34	$0.00	$0.00	$0.00	$87.69	$312.28	$312.28	$0.00	$0.00	$87.68	$0.00	$248.87	$248.87	$0.00	$210.38	$333.23	$336.60	$0.00		$0.00	$65.85	$0.00	$0.00	$66.98	$0.00	$0.00	$0.00	$0.00	$0.00
71634005	SUP	HCPCS C1713		71634005  -  CAP END 5MM TRGN SET TI DISP INTNL HEX IM NL	BOTH IP/OP	$420.75 	$311.36	$0.00	$336.60	$189.34	$189.34	$0.00	$0.00	$0.00	$87.69	$312.28	$312.28	$0.00	$0.00	$87.68	$0.00	$248.87	$248.87	$0.00	$210.38	$333.23	$336.60	$0.00		$0.00	$65.85	$0.00	$0.00	$66.98	$0.00	$0.00	$0.00	$0.00	$0.00
71634010	SUP	HCPCS C1713		71634010  -  CAP END 10MM 10MM TRGN TI ORTH IM NL	BOTH IP/OP	$420.75 	$311.36	$0.00	$336.60	$189.34	$189.34	$0.00	$0.00	$0.00	$87.69	$312.28	$312.28	$0.00	$0.00	$87.68	$0.00	$248.87	$248.87	$0.00	$210.38	$333.23	$336.60	$0.00		$0.00	$65.85	$0.00	$0.00	$66.98	$0.00	$0.00	$0.00	$0.00	$0.00
71634015	SUP	HCPCS C1713		71634015  -  CAP END 15MM 15MM TRGN ORTH IM NL	BOTH IP/OP	$420.75 	$311.36	$0.00	$336.60	$189.34	$189.34	$0.00	$0.00	$0.00	$87.69	$312.28	$312.28	$0.00	$0.00	$87.68	$0.00	$248.87	$248.87	$0.00	$210.38	$333.23	$336.60	$0.00		$0.00	$65.85	$0.00	$0.00	$66.98	$0.00	$0.00	$0.00	$0.00	$0.00
71634020	SUP	HCPCS C1713		71634020  -  CAP END 20MM TRGN TI INTNL HEX IM NL	BOTH IP/OP	$420.75 	$311.36	$0.00	$336.60	$189.34	$189.34	$0.00	$0.00	$0.00	$87.69	$312.28	$312.28	$0.00	$0.00	$87.68	$0.00	$248.87	$248.87	$0.00	$210.38	$333.23	$336.60	$0.00		$0.00	$65.85	$0.00	$0.00	$66.98	$0.00	$0.00	$0.00	$0.00	$0.00
71634230	SUP	HCPCS C1713		71634230  -  NAIL IM STD 10MM 30CM LIME TRGN ANTGRD FAN TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634232	SUP	HCPCS C1713		71634232  -  NAIL IM STD 10MM 32CM LIME TRGN ANTGRD FAN TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634234	SUP	HCPCS C1713		71634234  -  NAIL IM STD 10MM 34CM LIME TRGN ANTGRD FAN TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634236	SUP	HCPCS C1713		71634236  -  NAIL IM STD 10MM 36CM LIME TRGN ANTGRD FAN TI FEM LT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71634238	SUP	HCPCS C1713		71634238  -  NAIL IM STD 10MM 38CM LIME TRGN ANTGRD FAN TI FEM LT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71634240	SUP	HCPCS C1713		71634240  -  NAIL IM STD 10MM 40CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71634242	SUP	HCPCS C1713		71634242  -  NAIL IM STD 10MM 42CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71634244	SUP	HCPCS C1713		71634244  -  NAIL IM STD 10MM 44CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634246	SUP	HCPCS C1713		71634246  -  NAIL IM STD 10MM 46CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634248	SUP	HCPCS C1713		71634248  -  NAIL IM STD 10MM 48CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634250	SUP	HCPCS C1713		71634250  -  NAIL IM 10MM 50CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634330	SUP	HCPCS C1713		71634330  -  NAIL IM 11.5MM 30CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634332	SUP	HCPCS C1713		71634332  -  NAIL IM STD 11.5MM 32CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634334	SUP	HCPCS C1713		71634334  -  NAIL IM STD 11.5MM 34CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634336	SUP	HCPCS C1713		71634336  -  NAIL IM STD 11.5MM 36CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71634338	SUP	HCPCS C1713		71634338  -  NAIL IM STD 11.5MM 38CM FAN LIME TRGN ANTGRD RECON TI FEM LT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71634340	SUP	HCPCS C1713		71634340  -  NAIL IM STD 11.5MM 40CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71634342	SUP	HCPCS C1713		71634342  -  NAIL IM STD 11.5MM 42CM FAN LIME TRGN ANTGRD TI LT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71634344	SUP	HCPCS C1713		71634344  -  NAIL IM STD 11.5MM 44CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634346	SUP	HCPCS C1713		71634346  -  NAIL IM STD 11.5MM 46CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634348	SUP	HCPCS C1713		71634348  -  NAIL IM STD 11.5MM 48CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634350	SUP	HCPCS C1713		71634350  -  NAIL IM 11.5MM 50CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634430	SUP	HCPCS C1713		71634430  -  NAIL IM 13MM 30CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634432	SUP	HCPCS C1713		71634432  -  NAIL IM STD 13MM 32CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634434	SUP	HCPCS C1713		71634434  -  NAIL IM STD 13MM 34CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634436	SUP	HCPCS C1713		71634436  -  NAIL IM STD 13MM 36CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71634438	SUP	HCPCS C1713		71634438  -  NAIL IM STD 13MM 38CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71634440	SUP	HCPCS C1713		71634440  -  NAIL IM STD 13MM 40CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71634442	SUP	HCPCS C1713		71634442  -  NAIL IM STD 13MM 42CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71634444	SUP	HCPCS C1713		71634444  -  NAIL IM STD 13MM 44CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634446	SUP	HCPCS C1713		71634446  -  NAIL IM STD 13MM 46CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634448	SUP	HCPCS C1713		71634448  -  NAIL IM STD 13MM 48CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634450	SUP	HCPCS C1713		71634450  -  NAIL IM 13MM 50CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71634830	SUP	HCPCS C1713		71634830  -  NAIL IM 130D 8.5MM 30CM ROSE TN RT	BOTH IP/OP	"$3,971.25 "	"$2,938.73"	$0.00	"$3,177.00"	"$1,787.06"	"$1,787.06"	$0.00	$0.00	$0.00	$827.71	"$2,947.46"	"$2,947.46"	$0.00	$0.00	$827.61	$0.00	"$1,957.83"	"$1,957.83"	$0.00	"$1,985.63"	"$3,145.23"	"$3,177.00"	$0.00		$0.00	$621.50	$0.00	$0.00	$632.22	$0.00	$0.00	$0.00	$0.00	$0.00
71635230	SUP	HCPCS C1713		71635230  -  NAIL IM 10MM 30CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635232	SUP	HCPCS C1713		71635232  -  NAIL IM STD 10MM 32CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635234	SUP	HCPCS C1713		71635234  -  NAIL IM STD 10MM 34CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635236	SUP	HCPCS C1713		71635236  -  NAIL IM 130D STD 10MM 36CM ROSE TRGN ANTGRD RND XSECT CNN TI	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71635238	SUP	HCPCS C1713		71635238  -  NAIL IM STD 10MM 38CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71635240	SUP	HCPCS C1713		71635240  -  NAIL IM STD 10MM 40CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71635242	SUP	HCPCS C1713		71635242  -  NAIL IM STD 10MM 42CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71635244	SUP	HCPCS C1713		71635244  -  NAIL IM STD 10MM 44CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635246	SUP	HCPCS C1713		71635246  -  NAIL IM STD 10MM 46CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635248	SUP	HCPCS C1713		71635248  -  NAIL IM STD 10MM 48CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635250	SUP	HCPCS C1713		71635250  -  NAIL IM 10MM 50CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635330	SUP	HCPCS C1713		71635330  -  NAIL IM 11.5MM 30CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635332	SUP	HCPCS C1713		71635332  -  NAIL IM STD 11.5MM 32CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635334	SUP	HCPCS C1713		71635334  -  NAIL IM STD 11.5MM 34CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635336	SUP	HCPCS C1713		71635336  -  NAIL IM STD 11.5MM 36CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71635338	SUP	HCPCS C1713		71635338  -  NAIL IM STD 11.5MM 38CM FAN ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71635340	SUP	HCPCS C1713		71635340  -  NAIL IM STD 11.5MM 40CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71635342	SUP	HCPCS C1713		71635342  -  NAIL IM STD 11.5MM 42CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71635344	SUP	HCPCS C1713		71635344  -  NAIL IM STD 11.5MM 44CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635346	SUP	HCPCS C1713		71635346  -  NAIL IM STD 11.5MM 46CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635348	SUP	HCPCS C1713		71635348  -  NAIL IM STD 11.5MM 48CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635350	SUP	HCPCS C1713		71635350  -  NAIL IM 11.5MM 50CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635430	SUP	HCPCS C1713		71635430  -  NAIL IM 13MM 30CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635432	SUP	HCPCS C1713		71635432  -  NAIL IM STD 13MM 32CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635434	SUP	HCPCS C1713		71635434  -  NAIL IM STD 13MM 34CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635436	SUP	HCPCS C1713		71635436  -  NAIL IM STD 13MM 36CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71635438	SUP	HCPCS C1713		71635438  -  NAIL IM STD 13MM 38CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71635440	SUP	HCPCS C1713		71635440  -  NAIL IM STD 13MM 40CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71635442	SUP	HCPCS C1713		71635442  -  NAIL IM STD 13MM 42CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71635444	SUP	HCPCS C1713		71635444  -  NAIL IM STD 13MM 44CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635446	SUP	HCPCS C1713		71635446  -  NAIL IM STD 13MM 46CM ROSE TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635448	SUP	HCPCS C1713		71635448  -  NAIL IM STD 13MM 48CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71635450	SUP	HCPCS C1713		71635450  -  NAIL IM 13MM 50CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71636126	SUP	HCPCS C1713		71636126  -  NAIL IM 8.5IN 26IN GRY TRGN ANTGRD TI FEM	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71636128	SUP	HCPCS C1713		71636128  -  NAIL IM 8.5MM 28CM GRY TRGN ANTGRD TI FEM	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71636130	SUP	HCPCS C1713		71636130  -  NAIL IM 10MM 30CM GRY TRGN ANTGRD TI FEM	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71636132	SUP	HCPCS C1713		71636132  -  NAIL IM 8.5MM 32CM GRY TRGN ANTGRD TI KN FEM	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71636134	SUP	HCPCS C1713		71636134  -  NAIL IM 8.5MM 34CM GRY TRGN CNN ANTGRD TI FEM	BOTH IP/OP	"$4,044.38 "	"$2,992.84"	$0.00	"$3,235.50"	"$1,819.97"	"$1,819.97"	$0.00	$0.00	$0.00	$842.95	"$3,001.74"	"$3,001.74"	$0.00	$0.00	$842.85	$0.00	"$1,993.88"	"$1,993.88"	$0.00	"$2,022.19"	"$3,203.15"	"$3,235.50"	$0.00		$0.00	$632.94	$0.00	$0.00	$643.86	$0.00	$0.00	$0.00	$0.00	$0.00
71636136	SUP	HCPCS C1713		71636136  -  NAIL IM 8.5MM 36CM GRY TRGN ANTGRD TI FEM	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71636138	SUP	HCPCS C1713		71636138  -  NAIL IM 8.5MM 38CM GRY TRGN ANTGRD TI FEM	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71636140	SUP	HCPCS C1713		71636140  -  NAIL IM 8.5MM 40CM GRY TRGN ANTGRD TI FEM	BOTH IP/OP	"$3,870.00 "	"$2,863.80"	$0.00	"$3,096.00"	"$1,741.50"	"$1,741.50"	$0.00	$0.00	$0.00	$806.60	"$2,872.31"	"$2,872.31"	$0.00	$0.00	$806.51	$0.00	"$1,907.91"	"$1,907.91"	$0.00	"$1,935.00"	"$3,065.04"	"$3,096.00"	$0.00		$0.00	$605.66	$0.00	$0.00	$616.10	$0.00	$0.00	$0.00	$0.00	$0.00
71637124	SUP	HCPCS C1713		71637124  -  NAIL IM 135D 8.5MM 24CM LIME LT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71637130	SUP	HCPCS C1713		71637130  -  NAIL IM 135D 8.5MM 30CM LIME LT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71637132	SUP	HCPCS C1713		71637132  -  NAIL IM 135D 8.5MM 32CM LIME LT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71637134	SUP	HCPCS C1713		71637134  -  NAIL IM 135D 8.5MM 34CM LIME LT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71637136	SUP	HCPCS C1713		71637136  -  NAIL IM 135D 8.5MM 36CM LIME LT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71637138	SUP	HCPCS C1713		71637138  -  NAIL IM 135D 8.5MM 38CM LIME LT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71637140	SUP	HCPCS C1713		71637140  -  NAIL IM 135D 8.5MM 40CM LIME LT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71637230	SUP	HCPCS C1713		71637230  -  NAIL IM 135D 10MM 30CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637232	SUP	HCPCS C1713		71637232  -  NAIL IM 135D 10MM 32CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637234	SUP	HCPCS C1713		71637234  -  NAIL IM 135D 10MM 34MM LGHT LIME TRGN ANTGRD TI LT	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637236	SUP	HCPCS C1713		71637236  -  NAIL IM 135D 10MM 36MM LGHT LIME TRGN ANTGRD TI LT	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637238	SUP	HCPCS C1713		71637238  -  NAIL IM 135D 10MM 38MM LGHT LIME TRGN ANTGRD TI LT	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71637240	SUP	HCPCS C1713		71637240  -  NAIL IM 135D 10MM 40CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71637242	SUP	HCPCS C1713		71637242  -  NAIL IM 135D 10MM 42CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71637244	SUP	HCPCS C1713		71637244  -  NAIL IM 135D 10MM 44CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637246	SUP	HCPCS C1713		71637246  -  NAIL IM 135D 10MM 46CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637248	SUP	HCPCS C1713		71637248  -  NAIL IM 135D 10MM 48CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637250	SUP	HCPCS C1713		71637250  -  NAIL IM 135D 10MM 50CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637330	SUP	HCPCS C1713		71637330  -  NAIL IM 135D 11.5MM 30CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637332	SUP	HCPCS C1713		71637332  -  NAIL IM 135D 11.5MM 32CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637334	SUP	HCPCS C1713		71637334  -  NAIL IM 135D 11.5MM 34CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637336	SUP	HCPCS C1713		71637336  -  NAIL IM 135D 11.5MM 36CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71637338	SUP	HCPCS C1713		71637338  -  NAIL IM 135D 11.5MM 38CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71637340	SUP	HCPCS C1713		71637340  -  NAIL IM 135D 11.5MM 40CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71637342	SUP	HCPCS C1713		71637342  -  NAIL IM 135D 11.5MM 42CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71637344	SUP	HCPCS C1713		71637344  -  NAIL IM 135D 11.5MM 44CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637346	SUP	HCPCS C1713		71637346  -  NAIL IM 135D 11.5MM 46CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637348	SUP	HCPCS C1713		71637348  -  NAIL IM 135D 11.5MM 48CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637350	SUP	HCPCS C1713		71637350  -  NAIL IM 135D 11.5MM 50CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637430	SUP	HCPCS C1713		71637430  -  NAIL IM 135D 13MM 30CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637432	SUP	HCPCS C1713		71637432  -  NAIL IM 135D 13MM 32CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637434	SUP	HCPCS C1713		71637434  -  NAIL IM 135D 13MM 34CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637436	SUP	HCPCS C1713		71637436  -  NAIL IM 135D 13MM 36CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71637438	SUP	HCPCS C1713		71637438  -  NAIL IM 135D 13MM 38CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71637440	SUP	HCPCS C1713		71637440  -  NAIL IM 135D 13MM 40CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71637442	SUP	HCPCS C1713		71637442  -  NAIL IM 135D 13MM 42CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71637444	SUP	HCPCS C1713		71637444  -  NAIL IM 135D 13MM 44CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637446	SUP	HCPCS C1713		71637446  -  NAIL IM 135D 13MM 46CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637448	SUP	HCPCS C1713		71637448  -  NAIL IM 135D 13MM 48CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71637450	SUP	HCPCS C1713		71637450  -  NAIL IM 135D 13MM 50CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638124	SUP	HCPCS C1713		71638124  -  NAIL IM 135D 8.5MM 24CM ROSE RT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71638128	SUP	HCPCS C1713		71638128  -  NAIL IM 135D 8.5MM 28CM ROSE RT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71638130	SUP	HCPCS C1713		71638130  -  NAIL IM 135D 8.5MM 30CM ROSE RT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71638132	SUP	HCPCS C1713		71638132  -  NAIL IM 135D 8.5MM 32CM ROSE RT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71638134	SUP	HCPCS C1713		71638134  -  NAIL IM 135D 8.5MM 34CM ROSE RT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71638136	SUP	HCPCS C1713		71638136  -  NAIL IM 135D 8.5MM 36CM ROSE RT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71638138	SUP	HCPCS C1713		71638138  -  NAIL IM 135D 8.5MM 38CM ROSE RT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71638140	SUP	HCPCS C1713		71638140  -  NAIL IM 135D 8.5MM 40CM ROSE RT TROCH	BOTH IP/OP	"$2,840.63 "	"$2,102.07"	$0.00	"$2,272.50"	"$1,278.28"	"$1,278.28"	$0.00	$0.00	$0.00	$592.06	"$2,108.31"	"$2,108.31"	$0.00	$0.00	$591.99	$0.00	"$1,400.43"	"$1,400.43"	$0.00	"$1,420.31"	"$2,249.78"	"$2,272.50"	$0.00		$0.00	$444.56	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	$0.00
71638230	SUP	HCPCS C1713		71638230  -  NAIL IM 135D 10MM 30CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638232	SUP	HCPCS C1713		71638232  -  NAIL IM 135D 10MM 32CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638234	SUP	HCPCS C1713		71638234  -  NAIL IM 135D 10MM 34CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638236	SUP	HCPCS C1713		71638236  -  NAIL IM 135D 10MM 36CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71638238	SUP	HCPCS C1713		71638238  -  NAIL IM 135D 10MM 38CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71638240	SUP	HCPCS C1713		71638240  -  NAIL IM 135D 10MM 40CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71638242	SUP	HCPCS C1713		71638242  -  NAIL IM 135D 10MM 42CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71638244	SUP	HCPCS C1713		71638244  -  NAIL IM 135D 10MM 44CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638246	SUP	HCPCS C1713		71638246  -  NAIL IM 135D 10MM 46CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638248	SUP	HCPCS C1713		71638248  -  NAIL IM 135D 10MM 48CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638250	SUP	HCPCS C1713		71638250  -  NAIL IM 135D 10MM 50CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638330	SUP	HCPCS C1713		71638330  -  NAIL IM 135D 11.5MM 30CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638332	SUP	HCPCS C1713		71638332  -  NAIL IM 135D 11.5MM 32CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638334	SUP	HCPCS C1713		71638334  -  NAIL IM 135D 11.5MM 34CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638336	SUP	HCPCS C1713		71638336  -  NAIL IM 135D 11.5MM 36CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71638338	SUP	HCPCS C1713		71638338  -  NAIL IM 135D 11.5MM 38CM ROSE TN TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71638340	SUP	HCPCS C1713		71638340  -  NAIL IM 135D 11.5MM 40CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71638342	SUP	HCPCS C1713		71638342  -  NAIL IM 135D 11.5MM 42CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71638344	SUP	HCPCS C1713		71638344  -  NAIL IM 135D 11.5MM 44CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638346	SUP	HCPCS C1713		71638346  -  NAIL IM 135D 11.5MM 46CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638348	SUP	HCPCS C1713		71638348  -  NAIL IM 135D 11.5MM 48CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638350	SUP	HCPCS C1713		71638350  -  NAIL IM 135D 11.5MM 50CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638430	SUP	HCPCS C1713		71638430  -  NAIL IM 135D 13MM 30CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638432	SUP	HCPCS C1713		71638432  -  NAIL IM 135D 13MM 32CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638434	SUP	HCPCS C1713		71638434  -  NAIL IM 135D 13MM 34CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638436	SUP	HCPCS C1713		71638436  -  NAIL IM 135D 13MM 36CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71638438	SUP	HCPCS C1713		71638438  -  NAIL IM 135D 13MM 38CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71638440	SUP	HCPCS C1713		71638440  -  NAIL IM 135D 13MM 40CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71638442	SUP	HCPCS C1713		71638442  -  NAIL IM 135D 13MM 42CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,696.88 "	"$3,475.69"	$0.00	"$3,757.50"	"$2,113.59"	"$2,113.59"	$0.00	$0.00	$0.00	$978.95	"$3,486.02"	"$3,486.02"	$0.00	$0.00	$978.83	$0.00	"$2,315.56"	"$2,315.56"	$0.00	"$2,348.44"	"$3,719.93"	"$3,757.50"	$0.00		$0.00	$735.06	$0.00	$0.00	$747.74	$0.00	$0.00	$0.00	$0.00	$0.00
71638444	SUP	HCPCS C1713		71638444  -  NAIL IM 135D 13MM 44CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638446	SUP	HCPCS C1713		71638446  -  NAIL IM 135D 13MM 46CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638448	SUP	HCPCS C1713		71638448  -  NAIL IM 135D 13MM 48CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71638450	SUP	HCPCS C1713		71638450  -  NAIL IM 135D 13MM 50CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
71639215	SUP	HCPCS C1713		71639215  -  NAIL IM SHRT BND 10MM 15CM BLU TRGN ANTGRD TI FEM TROCH	BOTH IP/OP	"$2,857.50 "	"$2,114.55"	$0.00	"$2,286.00"	"$1,285.88"	"$1,285.88"	$0.00	$0.00	$0.00	$595.57	"$2,120.84"	"$2,120.84"	$0.00	$0.00	$595.50	$0.00	"$1,408.75"	"$1,408.75"	$0.00	"$1,428.75"	"$2,263.14"	"$2,286.00"	$0.00		$0.00	$447.20	$0.00	$0.00	$454.91	$0.00	$0.00	$0.00	$0.00	$0.00
71639315	SUP	HCPCS C1713		71639315  -  NAIL IM SHRT 11.5MM 15CM BLU TRGN ANTGRD BND TI FEM TROCH	BOTH IP/OP	"$4,033.13 "	"$2,984.52"	$0.00	"$3,226.50"	"$1,814.91"	"$1,814.91"	$0.00	$0.00	$0.00	$840.60	"$2,993.39"	"$2,993.39"	$0.00	$0.00	$840.50	$0.00	"$1,988.33"	"$1,988.33"	$0.00	"$2,016.56"	"$3,194.24"	"$3,226.50"	$0.00		$0.00	$631.18	$0.00	$0.00	$642.07	$0.00	$0.00	$0.00	$0.00	$0.00
71640530	SUP	HCPCS C1713		71640530  -  NAIL IM 9MM 30CM ROSE TRGN MT-TN ANTGRD FEM TROCH RT	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640532	SUP	HCPCS C1713		71640532  -  NAIL IM 9MM 32CM ROSE TRGN MT-TN ANTGRD FEM TROCH RT	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640534	SUP	HCPCS C1713		71640534  -  NAIL IM 9MM 34CM ROSE TRGN MT-TN ANTGRD FEM TROCH RT	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640536	SUP	HCPCS C1713		71640536  -  NAIL IM 9MM 36CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640538	SUP	HCPCS C1713		71640538  -  NAIL IM 9MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640540	SUP	HCPCS C1713		71640540  -  NAIL IM 9MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640542	SUP	HCPCS C1713		71640542  -  NAIL IM 9MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640544	SUP	HCPCS C1713		71640544  -  NAIL IM 9MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640546	SUP	HCPCS C1713		71640546  -  NAIL IM 9MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640548	SUP	HCPCS C1713		71640548  -  NAIL IM 9MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640550	SUP	HCPCS C1713		71640550  -  NAIL IM 9MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640630	SUP	HCPCS C1713		71640630  -  NAIL IM 10MM 30CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640632	SUP	HCPCS C1713		71640632  -  NAIL IM 10MM 32CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640634	SUP	HCPCS C1713		71640634  -  NAIL IM 10MM 34CM ROSE TRGN MT-TN RT	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640636	SUP	HCPCS C1713		71640636  -  NAIL IM 10MM 36CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640638	SUP	HCPCS C1713		71640638  -  NAIL IM 10MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640640	SUP	HCPCS C1713		71640640  -  NAIL IM 10MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640642	SUP	HCPCS C1713		71640642  -  NAIL IM 10MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640644	SUP	HCPCS C1713		71640644  -  NAIL IM 10MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640646	SUP	HCPCS C1713		71640646  -  NAIL IM 10MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640648	SUP	HCPCS C1713		71640648  -  NAIL IM 10MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640650	SUP	HCPCS C1713		71640650  -  NAIL IM 10MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640730	SUP	HCPCS C1713		71640730  -  NAIL IM 11.5MM 30CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640732	SUP	HCPCS C1713		71640732  -  NAIL IM 11.5MM 32CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640734	SUP	HCPCS C1713		71640734  -  NAIL IM 11.5MM 34CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640736	SUP	HCPCS C1713		71640736  -  NAIL IM 11.5MM 36CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640738	SUP	HCPCS C1713		71640738  -  NAIL IM 11.5MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640740	SUP	HCPCS C1713		71640740  -  NAIL IM 11.5MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640742	SUP	HCPCS C1713		71640742  -  NAIL IM 11.5MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640744	SUP	HCPCS C1713		71640744  -  NAIL IM 11.5MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640746	SUP	HCPCS C1713		71640746  -  NAIL IM 11.5MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640748	SUP	HCPCS C1713		71640748  -  NAIL IM 11.5MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640750	SUP	HCPCS C1713		71640750  -  NAIL IM 11.5MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640830	SUP	HCPCS C1713		71640830  -  NAIL IM 13MM 30CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640832	SUP	HCPCS C1713		71640832  -  NAIL IM 13MM 32CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640834	SUP	HCPCS C1713		71640834  -  NAIL IM 13MM 34CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640836	SUP	HCPCS C1713		71640836  -  NAIL IM 13MM 36CM MT-NL TN RT	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640838	SUP	HCPCS C1713		71640838  -  NAIL IM 13MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640840	SUP	HCPCS C1713		71640840  -  NAIL IM 13MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640842	SUP	HCPCS C1713		71640842  -  NAIL IM 13MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640844	SUP	HCPCS C1713		71640844  -  NAIL IM 13MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640846	SUP	HCPCS C1713		71640846  -  NAIL IM 13MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640848	SUP	HCPCS C1713		71640848  -  NAIL IM 13MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71640850	SUP	HCPCS C1713		71640850  -  NAIL IM 13MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71641123	SUP	Custom 27203010		71641123  -  BIT DRL SHRT 4MM STRL TRGN AO STP SET DPHSL DISP	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642120	SUP	HCPCS C1713		71642120  -  SCREW BN 4.5MM 20MM TRGN CPTR TI ORTH	BOTH IP/OP	$283.50 	$209.79	$0.00	$226.80	$127.58	$127.58	$0.00	$0.00	$0.00	$59.09	$210.41	$210.41	$0.00	$0.00	$59.08	$0.00	$167.69	$167.69	$0.00	$141.75	$224.53	$226.80	$0.00		$0.00	$44.37	$0.00	$0.00	$45.13	$0.00	$0.00	$0.00	$0.00	$0.00
71642125	SUP	HCPCS C1713		71642125  -  SCREW BN 4.5MM 25MM GRY TRGN INTNL CPTR HEX TI FEM IM NL	BOTH IP/OP	$438.75 	$324.68	$0.00	$351.00	$197.44	$197.44	$0.00	$0.00	$0.00	$91.45	$325.64	$325.64	$0.00	$0.00	$91.44	$0.00	$259.52	$259.52	$0.00	$219.38	$347.49	$351.00	$0.00		$0.00	$68.66	$0.00	$0.00	$69.85	$0.00	$0.00	$0.00	$0.00	$0.00
71642130	SUP	HCPCS C1713		71642130  -  SCREW BN 4.5MM 30MM GRY TRGN INTNL CPTR TI FEM IM NL	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642135	SUP	HCPCS C1713		71642135  -  SCREW BN HEX 4.5MM 35MM GRY TRGN INTNL CPTR TI FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642140	SUP	HCPCS C1713		71642140  -  SCREW BN HEX 4.5MM 40MM GRY TRGN INTNL CPTR TI KN TIB IM NL	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642145	SUP	HCPCS C1713		71642145  -  SCREW BN 4.5MM 45MM GRY TRGN INTNL CPTR TI ORTH IM NL	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642150	SUP	HCPCS C1713		71642150  -  SCREW BN HEX 4.5MM 50MM GRY TRGN INTNL CPTR TI FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642155	SUP	HCPCS C1713		71642155  -  SCREW BN FT 4.5MM 55MM GRY TRGN INTNL CPTR HEX HD TI FEM	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642160	SUP	HCPCS C1713		71642160  -  SCREW BN 4.5MM 60MM GRY TRGN INTNL CPTR HEX HD TI FEM IM NL	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642165	SUP	HCPCS C1713		71642165  -  SCREW BN 4.5MM 65MM GRY TRGN INTNL CPTR TI ORTH IM NL	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642200	SUP	HCPCS C1713		71642200  -  SCREW BN HEX 5MM 100MM AU TRGN INTNL CPTR TI FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642205	SUP	HCPCS C1713		71642205  -  SCREW BN FT 5MM 105MM AU TRGN NTERNAL CPTR HEX HD TI FEM	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642210	SUP	HCPCS C1713		71642210  -  SCREW BN FT 5MM 110MM AU TRGN INTNL CPTR HEX HD TI FEM	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642220	SUP	HCPCS C1713		71642220  -  SCREW BN 5MM 20MM TRGN INTNL CPTR HEX HD TI FEM IM NL	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642225	SUP	HCPCS C1713		71642225  -  SCREW BN 5MM 25MM AU INTNL CPTR HEX TI FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642230	SUP	HCPCS C1713		71642230  -  SCREW BN 5MM 30MM AU INTNL CPTR HEX TI FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642235	SUP	HCPCS C1713		71642235  -  SCREW BN HEX 5MM 35MM AU TRGN INTNL CPTR TI FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642240	SUP	HCPCS C1713		71642240  -  SCREW BONE HEXAGON 5MM 40MM INTERNAL CAPTURE TRIGEN GOLD	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642245	SUP	HCPCS C1713		71642245  -  SCREW BONE HEXAGON 5MM 45MM INTERNAL CAPTURE TRIGEN GOLD	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642250	SUP	HCPCS C1713		71642250  -  SCREW BONE HEXAGON 5MM 50MM INTERNAL CAPTURE TRIGEN GOLD	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642255	SUP	HCPCS C1713		71642255  -  SCREW BN HEX 5MM 55MM AU TRGN INTNL CPTR TI FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642260	SUP	HCPCS C1713		71642260  -  SCREW BONE HEXAGON 5MM 60MM INTERNAL CAPTURE TRIGEN GOLD	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642265	SUP	HCPCS C1713		71642265  -  SCREW BN HEX 5MM 65MM AU TRGN INTNL CPTR TI FEM IM NL	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642270	SUP	HCPCS C1713		71642270  -  SCREW BONE HEXAGON 5MM 70MM INTERNAL CAPTURE TRIGEN GOLD	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642275	SUP	HCPCS C1713		71642275  -  SCREW BN HEX 5MM 75MM AU TRGN INTNL CPTR TI FEM IM NL	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642280	SUP	HCPCS C1713		71642280  -  SCREW BN HEX 5MM 80MM AU TRGN INTNL CPTR TI FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642285	SUP	HCPCS C1713		71642285  -  SCREW BN HEX 5MM 85MM AU TRGN INTNL CPTR TI FEM IM NL	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642290	SUP	HCPCS C1713		71642290  -  SCREW BN HEX 5MM 90MM AU TRGN INTNL CPTR TI FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642295	SUP	HCPCS C1713		71642295  -  SCREW BN HEX 5MM 95MM AU TRGN INTNL CPTR TI FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71642300	SUP	HCPCS C1713		71642300  -  SCREW BONE HEXAGON 6.4MM 100MM INTERNAL CAPTURE	BOTH IP/OP	$727.88 	$538.63	$0.00	$582.30	$327.54	$327.54	$0.00	$0.00	$0.00	$151.71	$540.23	$540.23	$0.00	$0.00	$151.69	$0.00	$430.54	$430.54	$0.00	$363.94	$576.48	$582.30	$0.00		$0.00	$113.91	$0.00	$0.00	$115.88	$0.00	$0.00	$0.00	$0.00	$0.00
71642305	SUP	HCPCS C1713		71642305  -  SCREW BONE HEXAGON 6.4MM 105MM INTERNAL CAPTURE	BOTH IP/OP	$727.88 	$538.63	$0.00	$582.30	$327.54	$327.54	$0.00	$0.00	$0.00	$151.71	$540.23	$540.23	$0.00	$0.00	$151.69	$0.00	$430.54	$430.54	$0.00	$363.94	$576.48	$582.30	$0.00		$0.00	$113.91	$0.00	$0.00	$115.88	$0.00	$0.00	$0.00	$0.00	$0.00
71642320	SUP	HCPCS C1713		71642320  -  SCREW BN HEX 6.4MM 120MM BLU TRGN INTNL CPTR RECON TI FEM IM	BOTH IP/OP	$727.88 	$538.63	$0.00	$582.30	$327.54	$327.54	$0.00	$0.00	$0.00	$151.71	$540.23	$540.23	$0.00	$0.00	$151.69	$0.00	$430.54	$430.54	$0.00	$363.94	$576.48	$582.30	$0.00		$0.00	$113.91	$0.00	$0.00	$115.88	$0.00	$0.00	$0.00	$0.00	$0.00
71642325	SUP	HCPCS C1713		71642325  -  SCREW BN HEX 6.4MM 125MM BLU TRGN INTNL CPTR RECON TI FEM IM	BOTH IP/OP	$727.88 	$538.63	$0.00	$582.30	$327.54	$327.54	$0.00	$0.00	$0.00	$151.71	$540.23	$540.23	$0.00	$0.00	$151.69	$0.00	$430.54	$430.54	$0.00	$363.94	$576.48	$582.30	$0.00		$0.00	$113.91	$0.00	$0.00	$115.88	$0.00	$0.00	$0.00	$0.00	$0.00
71642365	SUP	HCPCS C1713		71642365  -  SCREW BN HEX 6.4MM 65MM BLU TRGN INTNL CPTR RECON TI FEM IM	BOTH IP/OP	$727.88 	$538.63	$0.00	$582.30	$327.54	$327.54	$0.00	$0.00	$0.00	$151.71	$540.23	$540.23	$0.00	$0.00	$151.69	$0.00	$430.54	$430.54	$0.00	$363.94	$576.48	$582.30	$0.00		$0.00	$113.91	$0.00	$0.00	$115.88	$0.00	$0.00	$0.00	$0.00	$0.00
71642370	SUP	HCPCS C1713		71642370  -  SCREW BONE HEXAGON 6.4MM 70MM INTERNAL CAPTURE	BOTH IP/OP	$727.88 	$538.63	$0.00	$582.30	$327.54	$327.54	$0.00	$0.00	$0.00	$151.71	$540.23	$540.23	$0.00	$0.00	$151.69	$0.00	$430.54	$430.54	$0.00	$363.94	$576.48	$582.30	$0.00		$0.00	$113.91	$0.00	$0.00	$115.88	$0.00	$0.00	$0.00	$0.00	$0.00
71642375	SUP	HCPCS C1713		71642375  -  SCREW BONE HEXAGON 6.4MM 75MM INTERNAL CAPTURE	BOTH IP/OP	$727.88 	$538.63	$0.00	$582.30	$327.54	$327.54	$0.00	$0.00	$0.00	$151.71	$540.23	$540.23	$0.00	$0.00	$151.69	$0.00	$430.54	$430.54	$0.00	$363.94	$576.48	$582.30	$0.00		$0.00	$113.91	$0.00	$0.00	$115.88	$0.00	$0.00	$0.00	$0.00	$0.00
71642380	SUP	HCPCS C1713		71642380  -  SCREW BONE HEXAGON 6.4MM 80MM INTERNAL CAPTURE	BOTH IP/OP	$727.88 	$538.63	$0.00	$582.30	$327.54	$327.54	$0.00	$0.00	$0.00	$151.71	$540.23	$540.23	$0.00	$0.00	$151.69	$0.00	$430.54	$430.54	$0.00	$363.94	$576.48	$582.30	$0.00		$0.00	$113.91	$0.00	$0.00	$115.88	$0.00	$0.00	$0.00	$0.00	$0.00
71642385	SUP	HCPCS C1713		71642385  -  SCREW BONE HEXAGON 6.4MM 85MM INTERNAL CAPTURE	BOTH IP/OP	$727.88 	$538.63	$0.00	$582.30	$327.54	$327.54	$0.00	$0.00	$0.00	$151.71	$540.23	$540.23	$0.00	$0.00	$151.69	$0.00	$430.54	$430.54	$0.00	$363.94	$576.48	$582.30	$0.00		$0.00	$113.91	$0.00	$0.00	$115.88	$0.00	$0.00	$0.00	$0.00	$0.00
71642390	SUP	HCPCS C1713		71642390  -  SCREW BN 6.4MM 90MM BLU INTNL CPTR RECON HEX TI TROCH TRGN	BOTH IP/OP	$727.88 	$538.63	$0.00	$582.30	$327.54	$327.54	$0.00	$0.00	$0.00	$151.71	$540.23	$540.23	$0.00	$0.00	$151.69	$0.00	$430.54	$430.54	$0.00	$363.94	$576.48	$582.30	$0.00		$0.00	$113.91	$0.00	$0.00	$115.88	$0.00	$0.00	$0.00	$0.00	$0.00
71642395	SUP	HCPCS C1713		71642395  -  SCREW BN 6.4MM 95MM BLU INTNL CPTR RECON HEX TI TROCH TRGN	BOTH IP/OP	$727.88 	$538.63	$0.00	$582.30	$327.54	$327.54	$0.00	$0.00	$0.00	$151.71	$540.23	$540.23	$0.00	$0.00	$151.69	$0.00	$430.54	$430.54	$0.00	$363.94	$576.48	$582.30	$0.00		$0.00	$113.91	$0.00	$0.00	$115.88	$0.00	$0.00	$0.00	$0.00	$0.00
71642520	SUP	HCPCS C1713		71642520  -  SCREW BN 5MM 20MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642527	SUP	HCPCS C1713		71642527  -  SCREW BN 5MM 27.5MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642530	SUP	HCPCS C1713		71642530  -  SCREW BN 5MM 30MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642532	SUP	HCPCS C1713		71642532  -  SCREW BN 5MM 32.5MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642535	SUP	HCPCS C1713		71642535  -  SCREW BN 5MM 35MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642537	SUP	HCPCS C1713		71642537  -  SCREW BN 5MM 37.5MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642540	SUP	HCPCS C1713		71642540  -  SCREW BN 5MM 40MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642542	SUP	HCPCS C1713		71642542  -  SCREW BN 5MM 42.5MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642545	SUP	HCPCS C1713		71642545  -  SCREW BN 5MM 45MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642550	SUP	HCPCS C1713		71642550  -  SCREW BN 5MM 50MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642552	SUP	HCPCS C1713		71642552  -  SCREW BN 5MM 52.5MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642555	SUP	HCPCS C1713		71642555  -  SCREW BN 5MM 55MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642557	SUP	HCPCS C1713		71642557  -  SCREW BN 5MM 57.5MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642565	SUP	HCPCS C1713		71642565  -  SCREW BN 5MM 65MM SURESHOT	BOTH IP/OP	$356.63 	$263.91	$0.00	$285.30	$160.48	$160.48	$0.00	$0.00	$0.00	$74.33	$264.69	$264.69	$0.00	$0.00	$74.32	$0.00	$210.94	$210.94	$0.00	$178.31	$282.45	$285.30	$0.00		$0.00	$55.81	$0.00	$0.00	$56.77	$0.00	$0.00	$0.00	$0.00	$0.00
71642575	SUP	HCPCS C1713		71642575  -  SCREW BN 5MM 75MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642630	SUP	HCPCS C1713		71642630  -  SCREW BN 2.5MM 30MM TN SURESHOT LG CMPR TROCH	BOTH IP/OP	$706.00 	$522.44	$0.00	$564.80	$317.70	$317.70	$0.00	$0.00	$0.00	$147.15	$523.99	$523.99	$0.00	$0.00	$147.13	$0.00	$417.60	$417.60	$0.00	$353.00	$559.15	$564.80	$0.00		$0.00	$110.49	$0.00	$0.00	$112.40	$0.00	$0.00	$0.00	$0.00	$0.00
71642735	SUP	HCPCS C1713		71642735  -  SCREW SET 0MM TN SURESHOT	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$283.50	$283.50	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$98.60	$0.00	$0.00	$100.30	$0.00	$0.00	$0.00	$0.00	$0.00
71642736	SUP	HCPCS C1713		71642736  -  SCREW SET 5MM TN SURESHOT	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$283.50	$283.50	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$98.60	$0.00	$0.00	$100.30	$0.00	$0.00	$0.00	$0.00	$0.00
71642737	SUP	HCPCS C1713		71642737  -  SCREW SET 10MM TN SURESHOT	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$283.50	$283.50	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$98.60	$0.00	$0.00	$100.30	$0.00	$0.00	$0.00	$0.00	$0.00
71642840	SUP	HCPCS C1713		71642840  -  SCREW BN 4.5MM 40MM SURESHOT LNG BN	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642845	SUP	HCPCS C1713		71642845  -  SCREW BN 4.5MM 45MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642850	SUP	HCPCS C1713		71642850  -  SCREW BN 4.5MM 50MM SURESHOT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
71642935	SUP	HCPCS C1713		71642935  -  SCREW BN 35MM MT-TN CMPR FEM	BOTH IP/OP	$559.13 	$413.76	$0.00	$447.30	$251.61	$251.61	$0.00	$0.00	$0.00	$116.54	$414.98	$414.98	$0.00	$0.00	$116.52	$0.00	$330.72	$330.72	$0.00	$279.56	$442.83	$447.30	$0.00		$0.00	$87.50	$0.00	$0.00	$89.01	$0.00	$0.00	$0.00	$0.00	$0.00
71642936	SUP	HCPCS C1713		71642936  -  SET SCR MT-TN INTGR CNN	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$192.38	$192.38	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
71642937	SUP	HCPCS C1713		71642937  -  SET SCR 5MM TRGN MT-TN	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$192.38	$192.38	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
71642938	SUP	HCPCS C1713		71642938  -  SCREW SET 10MM MT-TN MT-TN	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$192.38	$192.38	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
71644536	SUP	HCPCS C1713		71644536  -  NAIL IM 14.5MM 36CM LIME ANTGRD FEM	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71644538	SUP	HCPCS C1713		71644538  -  NAIL IM 14.5MM 38CM LIME ANTGRD FEM	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71644540	SUP	HCPCS C1713		71644540  -  NAIL IM 14.5MM 40CM LIME ANTGRD FEM	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71644542	SUP	HCPCS C1713		71644542  -  NAIL IM 14.5MM 42CM LIME ANTGRD FEM	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71644544	SUP	HCPCS C1713		71644544  -  NAIL IM 14.5MM 44CM LIME ANTGRD FEM	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71644636	SUP	HCPCS C1713		71644636  -  NAIL IM 16MM 36CM LIME ANTGRD FEM	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71644638	SUP	HCPCS C1713		71644638  -  NAIL IM 16MM 38CM LIME ANTGRD FEM	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71644640	SUP	HCPCS C1713		71644640  -  NAIL IM 16MM 40CM LIME ANTGRD FEM	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71644642	SUP	HCPCS C1713		71644642  -  NAIL IM 16MM 42CM LIME ANTGRD FEM	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71644644	SUP	HCPCS C1713		71644644  -  NAIL IM 16MM 44CM LIME TRGN ANTGRD TI FEM LT	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71645020	SUP	HCPCS C1713		71645020  -  SCREW BN 5MM 20MM TRGN LOPRFL FEM	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645022	SUP	HCPCS C1713		71645022  -  SCREW BONE 5MM 22.5MM TRGN FEM LP HEXDRIVER	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645025	SUP	HCPCS C1713		71645025  -  SCREW BN 5MM 25MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645027	SUP	HCPCS C1713		71645027  -  SCREW BN 5MM 27MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645030	SUP	HCPCS C1713		71645030  -  SCREW BN 5MM 30MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645032	SUP	HCPCS C1713		71645032  -  SCREW BN 5MM 32.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645035	SUP	HCPCS C1713		71645035  -  SCREW BN 5MM 35MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645037	SUP	HCPCS C1713		71645037  -  SCREW BN 5MM 37.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645040	SUP	HCPCS C1713		71645040  -  SCREW BN 5MM 40MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645042	SUP	HCPCS C1713		71645042  -  SCREW BN 5MM 42.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645045	SUP	HCPCS C1713		71645045  -  SCREW BN 5MM 45MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645047	SUP	HCPCS C1713		71645047  -  SCREW BN 5MM 47.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645050	SUP	HCPCS C1713		71645050  -  SCREW BN 5MM 50MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645052	SUP	HCPCS C1713		71645052  -  SCREW BN 5MM 52.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645055	SUP	HCPCS C1713		71645055  -  SCREW BN 5MM 55MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645057	SUP	HCPCS C1713		71645057  -  SCREW BN 5MM 57MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645060	SUP	HCPCS C1713		71645060  -  SCREW BN 5MM 60MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645062	SUP	HCPCS C1713		71645062  -  SCREW BONE 5MM 62.5MM LP TRIGEN FEMUR	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645065	SUP	HCPCS C1713		71645065  -  SCREW BN LOPRFL 5MM 65MM TRGN FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645067	SUP	HCPCS C1713		71645067  -  SCREW BN 5MM 67MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645070	SUP	HCPCS C1713		71645070  -  SCREW BN 5MM 70MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645072	SUP	HCPCS C1713		71645072  -  SCREW BN 5MM 72MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645075	SUP	HCPCS C1713		71645075  -  SCREW BN 5MM 75MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645077	SUP	HCPCS C1713		71645077  -  SCREW BONE 5MM 77.5MM LP TRIGEN FEMUR	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645080	SUP	HCPCS C1713		71645080  -  SCREW BN 5MM 80MM LOPRFL INTNL HEX FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645085	SUP	HCPCS C1713		71645085  -  SCREW BN LOPRFL 5MM 85MM TRGN FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645090	SUP	HCPCS C1713		71645090  -  SCREW BN LOPRFL 5MM 90MM TRGN FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645095	SUP	HCPCS C1713		71645095  -  SCREW BN 5MM 95MM TRGN LOPRFL HEXDRIVER FEM	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645100	SUP	HCPCS C1713		71645100  -  SCREW BONE 5MM 100MM TRGN FEM LP	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645105	SUP	HCPCS C1713		71645105  -  SCREW BN 5MM 105MM TRGN LOPRFL IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645110	SUP	HCPCS C1713		71645110  -  SCREW BN 5MM 110MM TRGN LOPRFL IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645124	SUP	HCPCS C1713		71645124  -  NAIL IM 130D 8.5MM 24CM LIME TRGN ANTGRD TI ADLT FEM LT	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71645126	SUP	HCPCS C1713		71645126  -  NAIL IM 130D 8.5MM 26CM LIME TRGN ANTGRD TI PED LT TROCH	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71645128	SUP	HCPCS C1713		71645128  -  NAIL IM 130D 8.5MM 28CM TRGN ANTGRD TI PED LT TROCH	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71645130	SUP	HCPCS C1713		71645130  -  NAIL IM 130D 8.5MM 30CM LIME TRGN ANTGRD TI PED LT TROCH	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71645132	SUP	HCPCS C1713		71645132  -  NAIL IM 130D 8.5MM 32CM LIME TRGN ANTGRD PED LT TROCH	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71645134	SUP	HCPCS C1713		71645134  -  NAIL IM 130D 8.5MM 34CM LIME TRGN ANTGRD TI ADLT FEM LT	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71645136	SUP	HCPCS C1713		71645136  -  NAIL IM 130D 8.5MM 36CM LIME TRGN ANTGRD SET TI PED LT TROCH	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71645138	SUP	HCPCS C1713		71645138  -  NAIL IM 130D 8.5MM 38CM LIME TRGN ANTGRD TI ADLT FEM LT	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71645140	SUP	HCPCS C1713		71645140  -  NAIL IM 130D 8.5MM 40CM LIME TRGN ANTGRD SET TI PED LT TROCH	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71645420	SUP	HCPCS C1713		71645420  -  SCREW BN 4.5MM 20MM TRGN LOPRFL IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645422	SUP	HCPCS C1713		71645422  -  SCREW BN 4.5MM 22.5MM TRGN LOPRFL IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645425	SUP	HCPCS C1713		71645425  -  SCREW BN LOPRFL 4.5MM 25MM TRGN FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645427	SUP	HCPCS C1713		71645427  -  SCREW BONE 4.5MM 27.5MM TRGN LP IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645430	SUP	HCPCS C1713		71645430  -  SCREW BN LOPRFL 4.5MM 30MM TRGN FEM IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645432	SUP	HCPCS C1713		71645432  -  SCREW BN 4.5MM 32.5MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645435	SUP	HCPCS C1713		71645435  -  SCREW BONE LP 4.5MM 35MM TRIGEN FEMUR INTRAMEDULLARY NAIL	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645437	SUP	HCPCS C1713		71645437  -  SCREW BN 4.5MM 37.5MM TRGN LOPRFL IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645440	SUP	HCPCS C1713		71645440  -  SCREW BN 4.5MM 40MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645442	SUP	HCPCS C1713		71645442  -  SCREW BN 4.5MM 42.5MM TRGN LOPRFL FEM	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645445	SUP	HCPCS C1713		71645445  -  SCREW BN 4.5MM 45MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645447	SUP	HCPCS C1713		71645447  -  SCREW BN 4.5MM 47.5MM TRGN LOPRFL IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645450	SUP	HCPCS C1713		71645450  -  SCREW BN 4.5MM 50MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645452	SUP	HCPCS C1713		71645452  -  SCREW BN 4.5MM 52.5MM TRGN LOPRFL IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645455	SUP	HCPCS C1713		71645455  -  SCREW BN 4.5MM 55MM TRGN LOPRFL IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645457	SUP	HCPCS C1713		71645457  -  SCREW BN 4.5MM 57.5MM TRGN LOPRFL IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645460	SUP	HCPCS C1713		71645460  -  SCREW BN 4.5MM 60MM TRGN LOPRFL IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645462	SUP	HCPCS C1713		71645462  -  SCREW BN 4.5MM 62.5MM TRGN LOPRFL IM NL SYS	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645465	SUP	HCPCS C1713		71645465  -  SCREW BN 4.5MM 6.5MM TRGN LOPRFL FEM	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
71645536	SUP	HCPCS C1713		71645536  -  NAIL IM 14.5MM 36CM ROSE ANTGRD FEM RT	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71645538	SUP	HCPCS C1713		71645538  -  NAIL IM 14.5MM 38CM ROSE ANTGRD FEM RT	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71645540	SUP	HCPCS C1713		71645540  -  NAIL IM 14.5MM 40CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71645542	SUP	HCPCS C1713		71645542  -  NAIL IM 14.5MM 42CM ROSE ANTGRD FEM RT	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71645544	SUP	HCPCS C1713		71645544  -  NAIL IM 14.5MM 44CM ROSE ANTGRD FEM RT	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71645636	SUP	HCPCS C1713		71645636  -  NAIL IM 16MM 36CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71645638	SUP	HCPCS C1713		71645638  -  NAIL IM 16MM 38CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71645640	SUP	HCPCS C1713		71645640  -  NAIL IM 16MM 40CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71645642	SUP	HCPCS C1713		71645642  -  NAIL IM 16MM 42CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71645644	SUP	HCPCS C1713		71645644  -  NAIL IM 16MM 44CM ROSE TRGN ANTGRD TI FEM RT	BOTH IP/OP	"$7,008.75 "	"$5,186.48"	$0.00	"$5,607.00"	"$3,153.94"	"$3,153.94"	$0.00	$0.00	$0.00	"$1,460.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,460.62"	$0.00	"$3,455.31"	"$3,455.31"	$0.00	"$3,504.38"	"$5,550.93"	"$5,607.00"	$0.00		$0.00	"$1,096.87"	$0.00	$0.00	"$1,115.79"	$0.00	$0.00	$0.00	$0.00	$0.00
71646124	SUP	HCPCS C1713		71646124  -  NAIL IM 130D 8.5MM 24CM ROSE TRGN ANTGRD TI ADLT FEM RT	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71646126	SUP	HCPCS C1713		71646126  -  NAIL IM 130D 8.5MM 26CM ROSE TRGN ANTGRD TI ADLT FEM RT	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71646128	SUP	HCPCS C1713		71646128  -  NAIL IM 130D 8.5MM 28CM ROSE TRGN ANTGRD TI ADLT FEM RT	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71646130	SUP	HCPCS C1713		71646130  -  NAIL IM 8.5MM 30CM TN RT	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71646132	SUP	HCPCS C1713		71646132  -  NAIL IM 130D 8.5MM 32CM ROSE TRGN ANTGRD TI ADLT FEM RT	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71646134	SUP	HCPCS C1713		71646134  -  NAIL IM 130D 8.5MM 34CM ROSE TRGN ANTGRD TI ADLT FEM RT	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71646136	SUP	HCPCS C1713		71646136  -  NAIL IM 130D 8.5MM 36CM ROSE TRGN ANTGRD TI ADLT FEM RT	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71646138	SUP	HCPCS C1713		71646138  -  NAIL INTRAMEDULLARY 130D 8.5MM 38CM ANTEGRADE TRIGEN ROSE	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71646140	SUP	HCPCS C1713		71646140  -  NAIL IM 130D 8.5MM 40CM ROSE TRGN ANTGRD TI PED RT TROCH	BOTH IP/OP	"$3,751.88 "	"$2,776.39"	$0.00	"$3,001.50"	"$1,688.34"	"$1,688.34"	$0.00	$0.00	$0.00	$781.98	"$2,784.64"	"$2,784.64"	$0.00	$0.00	$781.89	$0.00	"$1,849.67"	"$1,849.67"	$0.00	"$1,875.94"	"$2,971.49"	"$3,001.50"	$0.00		$0.00	$587.17	$0.00	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00
71647230	SUP	HCPCS C1713		71647230  -  NAIL IM 130D 10MM 30CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647232	SUP	HCPCS C1713		71647232  -  NAIL IM 130D 10MM 32CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647234	SUP	HCPCS C1713		71647234  -  NAIL IM 130D 10MM 34CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647236	SUP	HCPCS C1713		71647236  -  NAIL INTRAMEDULLARY 130D 10MM 36CM ANTEGRADE TRIGEN LIME	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647238	SUP	HCPCS C1713		71647238  -  NAIL IM 130D 10MM 38CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647240	SUP	HCPCS C1713		71647240  -  NAIL INTRAMEDULLARY 130D 10MM 40CM ANTEGRADE TRIGEN LIME	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647242	SUP	HCPCS C1713		71647242  -  NAIL IM 130D 10MM 42CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647244	SUP	HCPCS C1713		71647244  -  NAIL IM 130D 10MM 44CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647246	SUP	HCPCS C1713		71647246  -  NAIL INTRAMEDULLARY 130D 10MM 46CM ANTEGRADE TRIGEN LIME	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647248	SUP	HCPCS C1713		71647248  -  NAIL IM 130D 10MM 48CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647250	SUP	HCPCS C1713		71647250  -  NAIL IM 130D 10MM 50CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647330	SUP	HCPCS C1713		71647330  -  NAIL IM 130D 11.5MM 30CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647332	SUP	HCPCS C1713		71647332  -  NAIL IM 130D 11.5MM 32CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647334	SUP	HCPCS C1713		71647334  -  NAIL IM 130D 11.5MM 34CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647336	SUP	HCPCS C1713		71647336  -  NAIL IM 130D 11.5MM 36CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647338	SUP	HCPCS C1713		71647338  -  NAIL INTRAMEDULLARY 130D 11.5MM 38CM 5 HOLE STATIC DYNAMIC	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647340	SUP	HCPCS C1713		71647340  -  NAIL INTRAMEDULLARY 130D 11.5MM 40CM 5 HOLE STATIC DYNAMIC	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647342	SUP	HCPCS C1713		71647342  -  NAIL INTRAMEDULLARY 130D 11.5MM 42CM ANTEGRADE TRIGEN LIME	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647346	SUP	HCPCS C1713		71647346  -  NAIL IM 130D 11.5MM 46CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647348	SUP	HCPCS C1713		71647348  -  NAIL IM 130D 11.5MM 48CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647350	SUP	HCPCS C1713		71647350  -  NAIL IM 130D 11.5MM 50CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647430	SUP	HCPCS C1713		71647430  -  NAIL IM 130D 13MM 30CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647432	SUP	HCPCS C1713		71647432  -  NAIL IM 130D 13MM 32CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647434	SUP	HCPCS C1713		71647434  -  NAIL IM 130D 13MM 34CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647436	SUP	HCPCS C1713		71647436  -  NAIL IM 130D 13MM 36CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647438	SUP	HCPCS C1713		71647438  -  NAIL IM 130D 13MM 38CM LIME TRGN ANTGRD TI LT TROCH IM NL	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647440	SUP	HCPCS C1713		71647440  -  NAIL IM 130D 13MM 40CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647442	SUP	HCPCS C1713		71647442  -  NAIL IM 130D 13MM 42CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647444	SUP	HCPCS C1713		71647444  -  NAIL IM 130D 13MM 44CM LIME TRGN TN 5 HL STC DYNMC PROX DIST	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647446	SUP	HCPCS C1713		71647446  -  NAIL IM 130D 13MM 46CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647448	SUP	HCPCS C1713		71647448  -  NAIL IM 130D 13MM 48CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71647450	SUP	HCPCS C1713		71647450  -  NAIL IM 130D 13MM 50CM LIME TRGN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648230	SUP	HCPCS C1713		71648230  -  NAIL IM 130D 10MM 30CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648232	SUP	HCPCS C1713		71648232  -  NAIL IM 130D 10MM 32CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648234	SUP	HCPCS C1713		71648234  -  NAIL IM 130D 10MM 34CM ROSE TRGN TN 5 HL STC DYNMC RND XSECT	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648236	SUP	HCPCS C1713		71648236  -  NAIL INTRAMEDULLARY 130D 10MM 36CM ANTEGRADE TRIGEN ROSE	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648238	SUP	HCPCS C1713		71648238  -  NAIL INTRAMEDULLARY 130D 10MM 38CM SET ANTEGRADE TRIGEN ROSE	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648240	SUP	HCPCS C1713		71648240  -  NAIL INTRAMEDULLARY 130D 10MM 40CM ANTEGRADE TRIGEN ROSE	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648242	SUP	HCPCS C1713		71648242  -  NAIL INTRAMEDULLARY 130D 10MM 42CM ANTEGRADE TRIGEN ROSE	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648244	SUP	HCPCS C1713		71648244  -  NAIL IM 130D 10MM 44CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648246	SUP	HCPCS C1713		71648246  -  NAIL IM 130D 10MM 46CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648248	SUP	HCPCS C1713		71648248  -  NAIL IM 130D 10MM 48CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648250	SUP	HCPCS C1713		71648250  -  NAIL IM 130D 10MM 50CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648330	SUP	HCPCS C1713		71648330  -  NAIL IM 130D 11.5MM 30CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648332	SUP	HCPCS C1713		71648332  -  NAIL IM 130D 11.5MM 32CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648334	SUP	HCPCS C1713		71648334  -  NAIL INTRAMEDULLARY 130D 11.5MM 34CM ANTEGRADE TRIGEN ROSE	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648336	SUP	HCPCS C1713		71648336  -  NAIL IM 130D 11.5MM 36CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648338	SUP	HCPCS C1713		71648338  -  NAIL INTRAMEDULLARY 130D 11.5MM 38CM SET ANTEGRADE TRIGEN	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648340	SUP	HCPCS C1713		71648340  -  NAIL INTRAMEDULLARY 130D 11.5MM 40CM ANTEGRADE SET TRIGEN	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648342	SUP	HCPCS C1713		71648342  -  NAIL IM 130D 11.5MM 42CM ROSE STRL TRGN TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648344	SUP	HCPCS C1713		71648344  -  NAIL INTRAMEDULLARY TRIGEN TITANIUM  L44 CM OD11.5 MM TAN	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648348	SUP	HCPCS C1713		71648348  -  NAIL IM 130D 11.5MM 48CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648350	SUP	HCPCS C1713		71648350  -  NAIL IM 130D 11.5MM 50CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648430	SUP	HCPCS C1713		71648430  -  NAIL IM 130D 13MM 30CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648432	SUP	HCPCS C1713		71648432  -  NAIL IM 130D 13MM 32CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648434	SUP	HCPCS C1713		71648434  -  NAIL IM 130D 13MM 34CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648436	SUP	HCPCS C1713		71648436  -  NAIL IM 130D 13MM 36CM ROSE TRGN ANTGRD TN SET TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648438	SUP	HCPCS C1713		71648438  -  NAIL IM 130D 13MM 38CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648440	SUP	HCPCS C1713		71648440  -  NAIL IM 130D 13MM 40CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648442	SUP	HCPCS C1713		71648442  -  NAIL IM 130D 13MM 42CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648446	SUP	HCPCS C1713		71648446  -  NAIL IM 130D 13MM 46CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648448	SUP	HCPCS C1713		71648448  -  NAIL IM 130D 13MM 48CM ROSE TRGN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71648450	SUP	HCPCS C1713		71648450  -  NAIL IM 130D RT ANG 13MM 50CM ROSE TN SET TROCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
71649530	SUP	HCPCS C1713		71649530  -  NAIL IM 9MM 30CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649532	SUP	HCPCS C1713		71649532  -  NAIL IM 9MM 32CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649534	SUP	HCPCS C1713		71649534  -  NAIL IM 9MM 34CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649536	SUP	HCPCS C1713		71649536  -  NAIL IM 9MM 36CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649538	SUP	HCPCS C1713		71649538  -  NAIL IM 9MM 38CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649540	SUP	HCPCS C1713		71649540  -  NAIL IM 9MM 40CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649542	SUP	HCPCS C1713		71649542  -  NAIL IM 9MM 42MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649544	SUP	HCPCS C1713		71649544  -  NAIL IM 9MM 44MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649546	SUP	HCPCS C1713		71649546  -  NAIL IM 9MM 46MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649548	SUP	HCPCS C1713		71649548  -  NAIL IM 9MM 48MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649550	SUP	HCPCS C1713		71649550  -  NAIL IM 9MM 50MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649630	SUP	HCPCS C1713		71649630  -  NAIL IM 10MM 30MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649632	SUP	HCPCS C1713		71649632  -  NAIL IM 10MM 32MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649634	SUP	HCPCS C1713		71649634  -  NAIL IM 10MM 34CM LIME TRGN MT-TN LT	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649636	SUP	HCPCS C1713		71649636  -  NAIL IM 10MM 36MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649638	SUP	HCPCS C1713		71649638  -  NAIL IM 10MM 38MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649640	SUP	HCPCS C1713		71649640  -  NAIL IM 10MM 40MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649642	SUP	HCPCS C1713		71649642  -  NAIL IM 10MM 42MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649644	SUP	HCPCS C1713		71649644  -  NAIL IM 10MM 44MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649646	SUP	HCPCS C1713		71649646  -  NAIL IM 10MM 46MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649648	SUP	HCPCS C1713		71649648  -  NAIL IM 10MM 48MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649650	SUP	HCPCS C1713		71649650  -  NAIL IM 10MM 50MM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649730	SUP	HCPCS C1713		71649730  -  NAIL IM 11.5MM 30CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649732	SUP	HCPCS C1713		71649732  -  NAIL IM 11.5MM 32CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649734	SUP	HCPCS C1713		71649734  -  NAIL IM 11.5MM 34CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649736	SUP	HCPCS C1713		71649736  -  NAIL IM 11.5MM 36CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649738	SUP	HCPCS C1713		71649738  -  NAIL IM 11.5MM 38CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649740	SUP	HCPCS C1713		71649740  -  NAIL IM 11.5MM 40CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649742	SUP	HCPCS C1713		71649742  -  NAIL IM 11.5MM 42CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649744	SUP	HCPCS C1713		71649744  -  NAIL IM 11.5MM 44CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649746	SUP	HCPCS C1713		71649746  -  NAIL IM 11.5MM 46CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649748	SUP	HCPCS C1713		71649748  -  NAIL IM 11.5MM 48CM MT-TN LT	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649750	SUP	HCPCS C1713		71649750  -  NAIL IM 11.5MM 50CM MT-TN LT	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649830	SUP	HCPCS C1713		71649830  -  NAIL IM 13MM 30CM LIME TRGN MT-TN LT	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649832	SUP	HCPCS C1713		71649832  -  NAIL IM 13MM 32CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649834	SUP	HCPCS C1713		71649834  -  NAIL IM 13MM 34CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649836	SUP	HCPCS C1713		71649836  -  NAIL IM 13MM 36CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649838	SUP	HCPCS C1713		71649838  -  NAIL IM 13MM 38CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649840	SUP	HCPCS C1713		71649840  -  NAIL IM 13MM 40CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649842	SUP	HCPCS C1713		71649842  -  NAIL IM 13MM 42CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649844	SUP	HCPCS C1713		71649844  -  NAIL IM 13MM 44CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649846	SUP	HCPCS C1713		71649846  -  NAIL IM 13MM 46CM LIME TRGN MT-TN ANTGRD FEM LT TROCH	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649848	SUP	HCPCS C1713		71649848  -  NAIL IM 13MM 48CM MT-TN LT	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71649850	SUP	HCPCS C1713		71649850  -  NAIL IM 13MM 50CM MT-TN LT	BOTH IP/OP	"$3,526.88 "	"$2,609.89"	$0.00	"$2,821.50"	"$1,587.09"	"$1,587.09"	$0.00	$0.00	$0.00	$735.09	"$2,617.65"	"$2,617.65"	$0.00	$0.00	$735.00	$0.00	"$1,738.75"	"$1,738.75"	$0.00	"$1,763.44"	"$2,793.29"	"$2,821.50"	$0.00		$0.00	$551.96	$0.00	$0.00	$561.48	$0.00	$0.00	$0.00	$0.00	$0.00
71653018	SUP	HCPCS C1713		71653018  -  NAIL IM 10MM 18CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653020	SUP	HCPCS C1713		71653020  -  NAIL IM 10MM 20CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653022	SUP	HCPCS C1713		71653022  -  NAIL IM 10MM 22CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653024	SUP	HCPCS C1713		71653024  -  NAIL IM 10MM 24CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653026	SUP	HCPCS C1713		71653026  -  NAIL IM 10MM 26CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653028	SUP	HCPCS C1713		71653028  -  NAIL IM 10MM 28CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653030	SUP	HCPCS C1713		71653030  -  NAIL IM 10MM 30CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653032	SUP	HCPCS C1713		71653032  -  NAIL IM 10MM 32CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653034	SUP	HCPCS C1713		71653034  -  NAIL IM 10MM 34CM AU TRGN MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653036	SUP	HCPCS C1713		71653036  -  NAIL IM 10MM 36CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653038	SUP	HCPCS C1713		71653038  -  NAIL IM 10MM 38CM AU TRGN MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653040	SUP	HCPCS C1713		71653040  -  NAIL IM STD 10MM 40CM AU STRL TRGN MT-NL RTRGD HMR SLT TI	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653042	SUP	HCPCS C1713		71653042  -  NAIL IM STD 10MM 42CM AU STRL TRGN MT-NL RTRGD HMR SLT TI	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653044	SUP	HCPCS C1713		71653044  -  NAIL IM 10MM 44CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653046	SUP	HCPCS C1713		71653046  -  NAIL IM 10MM 46CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653048	SUP	HCPCS C1713		71653048  -  NAIL IM 10MM 48CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653050	SUP	HCPCS C1713		71653050  -  NAIL IM 10MM 50CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653120	SUP	HCPCS C1713		71653120  -  NAIL IM 11.5MM 20CM TRGN TI SP CNDL	BOTH IP/OP	"$3,510.00 "	"$2,597.40"	$0.00	"$2,808.00"	"$1,579.50"	"$1,579.50"	$0.00	$0.00	$0.00	$731.57	"$2,605.12"	"$2,605.12"	$0.00	$0.00	$731.48	$0.00	"$1,730.43"	"$1,730.43"	$0.00	"$1,755.00"	"$2,779.92"	"$2,808.00"	$0.00		$0.00	$549.32	$0.00	$0.00	$558.79	$0.00	$0.00	$0.00	$0.00	$0.00
71653125	SUP	HCPCS C1713		71653125  -  NAIL IM 11.5MM 25CM TRGN TI SP CNDL	BOTH IP/OP	"$3,510.00 "	"$2,597.40"	$0.00	"$2,808.00"	"$1,579.50"	"$1,579.50"	$0.00	$0.00	$0.00	$731.57	"$2,605.12"	"$2,605.12"	$0.00	$0.00	$731.48	$0.00	"$1,730.43"	"$1,730.43"	$0.00	"$1,755.00"	"$2,779.92"	"$2,808.00"	$0.00		$0.00	$549.32	$0.00	$0.00	$558.79	$0.00	$0.00	$0.00	$0.00	$0.00
71653218	SUP	HCPCS C1713		71653218  -  NAIL IM 11.5MM 18CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653220	SUP	HCPCS C1713		71653220  -  NAIL IM 11.5MM 20CM MT-NL RTRGD TI6AL4V FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653222	SUP	HCPCS C1713		71653222  -  NAIL IM 11.5MM 22CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653224	SUP	HCPCS C1713		71653224  -  NAIL IM 11.5MM 24CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653226	SUP	HCPCS C1713		71653226  -  NAIL IM 11.5MM 26CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653228	SUP	HCPCS C1713		71653228  -  NAIL IM 11.5MM 28CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653230	SUP	HCPCS C1713		71653230  -  NAIL IM 11.5MM 30CM TRGN MT-NL IMPL SET RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653232	SUP	HCPCS C1713		71653232  -  NAIL IM 11.5MM 32CM AU TRGN MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653234	SUP	HCPCS C1713		71653234  -  NAIL IM 11.5MM 34CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653236	SUP	HCPCS C1713		71653236  -  NAIL IM 11.5MM 36CM TRGN MT-NL IMPL SET RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653238	SUP	HCPCS C1713		71653238  -  NAIL IM 10MM 38CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653240	SUP	HCPCS C1713		"71653240  -  RETROGRADE FEMUR NAIL, 11.5MMX40CM"	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653242	SUP	HCPCS C1713		71653242  -  NAIL IM 11.5MM 42CM TRGN MT-NL RTRGD FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653244	SUP	HCPCS C1713		71653244  -  NAIL IM 11.5MM 44CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653246	SUP	HCPCS C1713		71653246  -  NAIL IM 11.5MM 46CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653248	SUP	HCPCS C1713		71653248  -  NAIL IM 11.5MM 48CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653250	SUP	HCPCS C1713		71653250  -  NAIL IM 11.5MM 50CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653320	SUP	HCPCS C1713		71653320  -  NAIL IM 13MM 20CM TRGN TI TIB	BOTH IP/OP	"$3,510.00 "	"$2,597.40"	$0.00	"$2,808.00"	"$1,579.50"	"$1,579.50"	$0.00	$0.00	$0.00	$731.57	"$2,605.12"	"$2,605.12"	$0.00	$0.00	$731.48	$0.00	"$1,730.43"	"$1,730.43"	$0.00	"$1,755.00"	"$2,779.92"	"$2,808.00"	$0.00		$0.00	$549.32	$0.00	$0.00	$558.79	$0.00	$0.00	$0.00	$0.00	$0.00
71653325	SUP	HCPCS C1713		71653325  -  NAIL IM 13MM 25CM TRGN TI TIB	BOTH IP/OP	"$3,510.00 "	"$2,597.40"	$0.00	"$2,808.00"	"$1,579.50"	"$1,579.50"	$0.00	$0.00	$0.00	$731.57	"$2,605.12"	"$2,605.12"	$0.00	$0.00	$731.48	$0.00	"$1,730.43"	"$1,730.43"	$0.00	"$1,755.00"	"$2,779.92"	"$2,808.00"	$0.00		$0.00	$549.32	$0.00	$0.00	$558.79	$0.00	$0.00	$0.00	$0.00	$0.00
71653418	SUP	HCPCS C1713		71653418  -  NAIL IM 13MM 18CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653420	SUP	HCPCS C1713		71653420  -  NAIL IM 13MM 20CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653422	SUP	HCPCS C1713		71653422  -  NAIL IM 13MM 22CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653424	SUP	HCPCS C1713		71653424  -  NAIL IM 13MM 24CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653426	SUP	HCPCS C1713		71653426  -  NAIL IM 13MM 26CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653428	SUP	HCPCS C1713		71653428  -  NAIL IM 13MM 28CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653430	SUP	HCPCS C1713		71653430  -  NAIL IM 13MM 30CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653432	SUP	HCPCS C1713		71653432  -  NAIL IM 13MM 32CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653434	SUP	HCPCS C1713		71653434  -  NAIL IM 13MM 34CM TRGN MT-NL IMPL SET RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653436	SUP	HCPCS C1713		71653436  -  NAIL IM 13MM 36CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653438	SUP	HCPCS C1713		71653438  -  NAIL IM 13MM 38CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653440	SUP	HCPCS C1713		71653440  -  NAIL IM STD 13MM 40CM AU STRL TRGN MT-NL RTRGD HMR SLT TI	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653442	SUP	HCPCS C1713		71653442  -  NAIL IM 13MM 42CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653444	SUP	HCPCS C1713		71653444  -  NAIL IM 13MM 44CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653446	SUP	HCPCS C1713		71653446  -  NAIL IM 13MM 46CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653448	SUP	HCPCS C1713		71653448  -  NAIL IM 13MM 48CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71653450	SUP	HCPCS C1713		71653450  -  NAIL IM 13MM 50CM MT-NL RTRGD TI FEM	BOTH IP/OP	"$3,622.50 "	"$2,680.65"	$0.00	"$2,898.00"	"$1,630.13"	"$1,630.13"	$0.00	$0.00	$0.00	$755.02	"$2,688.62"	"$2,688.62"	$0.00	$0.00	$754.93	$0.00	"$1,785.89"	"$1,785.89"	$0.00	"$1,811.25"	"$2,869.02"	"$2,898.00"	$0.00		$0.00	$566.92	$0.00	$0.00	$576.70	$0.00	$0.00	$0.00	$0.00	$0.00
71655016	SUP	HCPCS C1713		71655016  -  NAIL IM 8.5MM 16CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655018	SUP	HCPCS C1713		71655018  -  NAIL IM 8.5MM 18CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655020	SUP	HCPCS C1713		71655020  -  NAIL IM 8.5MM 20CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655022	SUP	HCPCS C1713		71655022  -  NAIL IM 8.5MM 22CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655024	SUP	HCPCS C1713		71655024  -  NAIL IM 8.5MM 24CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655026	SUP	HCPCS C1713		71655026  -  NAIL IM 8.5MM 26CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655028	SUP	HCPCS C1713		71655028  -  NAIL IM 8.5MM 28CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655029	SUP	HCPCS C1713		71655029  -  NAIL IM 8.5MM 29CM TRGN MT-NL TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655030	SUP	HCPCS C1713		71655030  -  NAIL 8.5MM 30CM TIB MT-NAIL IM TI	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655031	SUP	HCPCS C1713		71655031  -  NAIL IM 8.5MM 31CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655032	SUP	HCPCS C1713		71655032  -  NAIL IM 8.5MM 32CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655034	SUP	HCPCS C1713		71655034  -  NAIL IM 8.5MM 34CM TRGN MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655035	SUP	HCPCS C1713		71655035  -  NAIL IM 8.5MM 35CM MT-NL TI TIB METAPHYSIS	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655036	SUP	HCPCS C1713		71655036  -  NAIL IM 8.5MM 36CM TRGN MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655037	SUP	HCPCS C1713		71655037  -  NAIL IM 8.5MM 37CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655038	SUP	HCPCS C1713		71655038  -  NAIL IM 8.5MM 38CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655039	SUP	HCPCS C1713		71655039  -  NAIL IM 8.5MM 39CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655040	SUP	HCPCS C1713		71655040  -  NAIL IM 8.5MM 40CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655041	SUP	HCPCS C1713		71655041  -  NAIL IM 8.5MM 41CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655042	SUP	HCPCS C1713		71655042  -  NAIL IM 8.5MM 42CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655043	SUP	HCPCS C1713		71655043  -  NAIL IM 8.5MM 43CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655044	SUP	HCPCS C1713		71655044  -  NAIL IM 8.5MM 44CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655046	SUP	HCPCS C1713		71655046  -  NAIL IM 8.5MM 46CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655048	SUP	HCPCS C1713		71655048  -  NAIL IM 8.5MM 48CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655050	SUP	HCPCS C1713		71655050  -  NAIL IM 8.5MM 50CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655116	SUP	HCPCS C1713		71655116  -  NAIL IM 10MM 16CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655118	SUP	HCPCS C1713		71655118  -  NAIL IM 10MM 18CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655120	SUP	HCPCS C1713		71655120  -  NAIL IM 10MM 20CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655122	SUP	HCPCS C1713		71655122  -  NAIL IM 10MM 22CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655124	SUP	HCPCS C1713		71655124  -  NAIL IM 10MM 24CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655126	SUP	HCPCS C1713		71655126  -  NAIL IM 10MM 26CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655128	SUP	HCPCS C1713		71655128  -  NAIL IM 10MM 28CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655129	SUP	HCPCS C1713		71655129  -  NAIL IM 10MM 29CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655130	SUP	HCPCS C1713		71655130  -  NAIL IM 10MM 30CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655131	SUP	HCPCS C1713		71655131  -  NAIL IM 10MM 31CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655132	SUP	HCPCS C1713		71655132  -  NAIL INTRAMEDULLARY 10MM 32CM META-NAIL TITANIUM TIBIA	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655133	SUP	HCPCS C1713		71655133  -  NAIL IM 10MM 33CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655134	SUP	HCPCS C1713		71655134  -  NAIL INTRAMEDULLARY 10MM 34CM META-NAIL TITANIUM TIBIA	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655135	SUP	HCPCS C1713		71655135  -  NAIL INTRAMEDULLARY 10MM 35CM META-NAIL TITANIUM TIBIA	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655136	SUP	HCPCS C1713		71655136  -  NAIL INTRAMEDULLARY 10MM 36CM META-NAIL TITANIUM TIBIA	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655137	SUP	HCPCS C1713		71655137  -  NAIL INTRAMEDULLARY 10MM 37CM META-NAIL TITANIUM TIBIA	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655138	SUP	HCPCS C1713		71655138  -  NAIL INTRAMEDULLARY 10MM 38CM META-NAIL TITANIUM TIBIA	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655139	SUP	HCPCS C1713		71655139  -  NAIL INTRAMEDULLARY 10MM 39CM META-NAIL TITANIUM TIBIA	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655142	SUP	HCPCS C1713		71655142  -  NAIL IM 10MM 42CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655143	SUP	HCPCS C1713		71655143  -  NAIL IM 10MM 43CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655144	SUP	HCPCS C1713		71655144  -  NAIL IM 10MM 44CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655146	SUP	HCPCS C1713		71655146  -  NAIL IM 10MM 46CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655148	SUP	HCPCS C1713		71655148  -  NAIL IM 10MM 48CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655150	SUP	HCPCS C1713		71655150  -  NAIL IM 10MM 50CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655216	SUP	HCPCS C1713		71655216  -  NAIL IM 11.5MM 16CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655218	SUP	HCPCS C1713		71655218  -  NAIL IM 11.5MM 18CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655220	SUP	HCPCS C1713		71655220  -  NAIL IM 11.5MM 20CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655222	SUP	HCPCS C1713		71655222  -  NAIL IM 11.5MM 22CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655224	SUP	HCPCS C1713		71655224  -  NAIL IM 11.5MM 24CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655226	SUP	HCPCS C1713		71655226  -  NAIL IM 11.5MM 26CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655228	SUP	HCPCS C1713		71655228  -  NAIL IM 11.5MM 28CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655229	SUP	HCPCS C1713		71655229  -  NAIL IM 11.5MM 29CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655230	SUP	HCPCS C1713		71655230  -  NAIL IM 11.5MM 30CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655231	SUP	HCPCS C1713		71655231  -  NAIL IM 11.5MM 31CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655232	SUP	HCPCS C1713		71655232  -  NAIL IM 11.5MM 32CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655233	SUP	HCPCS C1713		71655233  -  NAIL IM 11.5MM 33CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655234	SUP	HCPCS C1713		71655234  -  NAIL IM 11.5MM 34CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655235	SUP	HCPCS C1713		71655235  -  NAIL IM 11.5MM 35CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655236	SUP	HCPCS C1713		71655236  -  NAIL 11.5MM 36CM TIB TRGN MT-NAIL IM HMR SLT TI	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655237	SUP	HCPCS C1713		71655237  -  NAIL IM 11.5MM 37CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655238	SUP	HCPCS C1713		71655238  -  NAIL IM 11.5MM 38CM AU STRL TRGN MT-NL HMR SLT TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655239	SUP	HCPCS C1713		71655239  -  NAIL IM 11.5MM 39CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655240	SUP	HCPCS C1713		71655240  -  NAIL INTRAMEDULLARY 11.5MM 40CM META-NAIL TITANIUM TIBIA	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655241	SUP	HCPCS C1713		71655241  -  NAIL IM 11.5MM 41CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655242	SUP	HCPCS C1713		71655242  -  NAIL IM 11.5MM 42CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655243	SUP	HCPCS C1713		71655243  -  NAIL IM 11.5MM 43CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655244	SUP	HCPCS C1713		71655244  -  NAIL IM 11.5MM 44CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655246	SUP	HCPCS C1713		71655246  -  NAIL IM 11.5MM 46CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655248	SUP	HCPCS C1713		71655248  -  NAIL IM 11.5MM 48CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655250	SUP	HCPCS C1713		71655250  -  NAIL IM 11.5MM 50CM MT-NL TI TIB	BOTH IP/OP	"$3,538.13 "	"$2,618.22"	$0.00	"$2,830.50"	"$1,592.16"	"$1,592.16"	$0.00	$0.00	$0.00	$737.43	"$2,626.00"	"$2,626.00"	$0.00	$0.00	$737.35	$0.00	"$1,744.30"	"$1,744.30"	$0.00	"$1,769.06"	"$2,802.20"	"$2,830.50"	$0.00		$0.00	$553.72	$0.00	$0.00	$563.27	$0.00	$0.00	$0.00	$0.00	$0.00
71655316	SUP	HCPCS C1713		71655316  -  NAIL IM 13MM 16CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655318	SUP	HCPCS C1713		71655318  -  NAIL IM 13MM 18CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655320	SUP	HCPCS C1713		71655320  -  NAIL IM 13MM 20CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655322	SUP	HCPCS C1713		71655322  -  NAIL IM 13MM 22CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655324	SUP	HCPCS C1713		71655324  -  NAIL IM 13MM 24CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655326	SUP	HCPCS C1713		71655326  -  NAIL IM 13MM 26CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655328	SUP	HCPCS C1713		71655328  -  NAIL IM 13MM 28CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655329	SUP	HCPCS C1713		71655329  -  NAIL IM 13MM 29CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655330	SUP	HCPCS C1713		71655330  -  NAIL IM 13MM 30CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655331	SUP	HCPCS C1713		71655331  -  NAIL IM 13MM 31CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655332	SUP	HCPCS C1713		71655332  -  NAIL IM 13MM 32CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655333	SUP	HCPCS C1713		71655333  -  NAIL IM 13MM 33CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655334	SUP	HCPCS C1713		71655334  -  NAIL IM RND 13MM 34CM AU MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655335	SUP	HCPCS C1713		71655335  -  NAIL IM 13MM 35CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655336	SUP	HCPCS C1713		71655336  -  NAIL IM 13MM 36CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655337	SUP	HCPCS C1713		71655337  -  NAIL IM 13MM 37CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655338	SUP	HCPCS C1713		71655338  -  NAIL IM 13MM 38CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655339	SUP	HCPCS C1713		71655339  -  NAIL IM 13MM 39CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655340	SUP	HCPCS C1713		71655340  -  NAIL IM RND 13MM 40CM AU MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655341	SUP	HCPCS C1713		71655341  -  NAIL IM 13MM 41CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655342	SUP	HCPCS C1713		71655342  -  NAIL IM 13MM 42CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655343	SUP	HCPCS C1713		71655343  -  NAIL IM 13MM 43CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655344	SUP	HCPCS C1713		71655344  -  NAIL IM 13MM 44CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655346	SUP	HCPCS C1713		71655346  -  NAIL IM 13MM 46CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655348	SUP	HCPCS C1713		71655348  -  NAIL IM 13MM 48CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71655350	SUP	HCPCS C1713		71655350  -  NAIL IM 13MM 50CM MT-NL TI TIB	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
71656000	SUP	HCPCS C1713		71656000  -  CAP END 0MM MT-NL NL SCR SET TI TIB	BOTH IP/OP	$354.38 	$262.24	$0.00	$283.50	$159.47	$159.47	$0.00	$0.00	$0.00	$73.86	$263.02	$263.02	$0.00	$0.00	$73.85	$0.00	$209.61	$209.61	$0.00	$177.19	$280.67	$283.50	$0.00		$0.00	$55.46	$0.00	$0.00	$56.42	$0.00	$0.00	$0.00	$0.00	$0.00
71661222	SUP	HCPCS C1713		71661222  -  SCREW BN 4.5MM 22MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661224	SUP	HCPCS C1713		71661224  -  SCREW BN 4.5MM 24MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661226	SUP	HCPCS C1713		71661226  -  SCREW BN 4.5MM 26MM IMHS CP CPTR LCK HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661228	SUP	HCPCS C1713		71661228  -  SCREW BN 4.5MM 28MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661230	SUP	HCPCS C1713		71661230  -  SCREW BN 4.5MM 30MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661232	SUP	HCPCS C1713		71661232  -  SCREW BN 4.5MM 32MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661234	SUP	HCPCS C1713		71661234  -  SCREW BN 4.5MM 34MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661236	SUP	HCPCS C1713		71661236  -  SCREW BN 4.5MM 36MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661238	SUP	HCPCS C1713		71661238  -  SCREW BN 4.5MM 38MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661240	SUP	HCPCS C1713		71661240  -  SCREW BN 4.5MM 40MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661242	SUP	HCPCS C1713		71661242  -  SCREW BN 4.5MM 42MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661244	SUP	HCPCS C1713		71661244  -  SCREW BN 4.5MM 44MM IMHS CP LCK CPTR HIP IM NL	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661246	SUP	HCPCS C1713		71661246  -  SCREW BN 4.5MM 46MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661248	SUP	HCPCS C1713		71661248  -  SCREW BN 4.5MM 48MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661250	SUP	HCPCS C1713		71661250  -  SCREW BN 4.5MM 50MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661252	SUP	HCPCS C1713		71661252  -  SCREW BN 4.5MM 52MM IMHS CP LCK CPTR HIP IM NL	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661254	SUP	HCPCS C1713		71661254  -  SCREW BN 4.5MM 54MM IMHS CP LCK CPTR HIP IM NL	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661256	SUP	HCPCS C1713		71661256  -  SCREW BN 4.5MM 56MM IMHS CP LCK CPTR HIP IM NL	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661258	SUP	HCPCS C1713		71661258  -  SCREW BN 4.5MM 58MM IMHS CP LCK CPTR HIP IM NL SYS	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661260	SUP	HCPCS C1713		71661260  -  SCREW BN 4.5MM 60MM IMHS CP LCK CPTR HIP IM NL	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661262	SUP	HCPCS C1713		71661262  -  SCREW BN 4.5MM 62MM IMHS CP LCK CPTR HIP IM NL	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71661264	SUP	HCPCS C1713		71661264  -  SCREW BN 4.5MM 64MM IMHS CP LCK CPTR HIP IM NL	BOTH IP/OP	$593.25 	$439.01	$0.00	$474.60	$266.96	$266.96	$0.00	$0.00	$0.00	$123.65	$440.31	$440.31	$0.00	$0.00	$123.63	$0.00	$350.91	$350.91	$0.00	$296.63	$469.85	$474.60	$0.00		$0.00	$92.84	$0.00	$0.00	$94.45	$0.00	$0.00	$0.00	$0.00	$0.00
71665026	SUP	HCPCS C1769		71665026  -  GUIDE ROD ORTHOPEDIC 3MM 600MM BALL TIP TRIGEN DISPOSABLE	BOTH IP/OP	$490.88 	$363.25	$0.00	$392.70	$266.55	$266.55	$0.00	$0.00	$0.00	$102.31	$364.33	$364.33	$0.00	$0.00	$102.30	$0.00	$290.35	$290.35	$0.00	$245.44	$388.78	$392.70	$0.00		$0.00	$76.82	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$0.00
71672030	SUP	HCPCS C1713		71672030  -  SCREW BONE 11MM 30MM COMPRESSION INTERTAN TROCHANTER	BOTH IP/OP	$659.25 	$487.85	$0.00	$527.40	$296.66	$296.66	$0.00	$0.00	$0.00	$137.40	$489.30	$489.30	$0.00	$0.00	$137.39	$0.00	$389.95	$389.95	$0.00	$329.63	$522.13	$527.40	$0.00		$0.00	$103.17	$0.00	$0.00	$104.95	$0.00	$0.00	$0.00	$0.00	$0.00
71672035	SUP	HCPCS C1713		71672035  -  SCREW BN 35MM CMPR ORTH	BOTH IP/OP	$676.00 	$500.24	$0.00	$540.80	$304.20	$304.20	$0.00	$0.00	$0.00	$140.90	$501.73	$501.73	$0.00	$0.00	$140.88	$0.00	$399.85	$399.85	$0.00	$338.00	$535.39	$540.80	$0.00		$0.00	$105.79	$0.00	$0.00	$107.62	$0.00	$0.00	$0.00	$0.00	$0.00
71672040	SUP	HCPCS C1713		71672040  -  SCREW BN 40MM CMPR ORTH	BOTH IP/OP	$460.13 	$340.50	$0.00	$368.10	$207.06	$207.06	$0.00	$0.00	$0.00	$95.90	$341.50	$341.50	$0.00	$0.00	$95.89	$0.00	$272.16	$272.16	$0.00	$230.06	$364.42	$368.10	$0.00		$0.00	$72.01	$0.00	$0.00	$73.25	$0.00	$0.00	$0.00	$0.00	$0.00
71673040	SUP	HCPCS C1713		71673040  -  NAIL IM 130D 10MM 40CM INTERTAN LT TROCH	BOTH IP/OP	"$3,155.63 "	"$2,335.17"	$0.00	"$2,524.50"	"$1,420.03"	"$1,420.03"	$0.00	$0.00	$0.00	$657.71	"$2,342.10"	"$2,342.10"	$0.00	$0.00	$657.63	$0.00	"$1,555.72"	"$1,555.72"	$0.00	"$1,577.81"	"$2,499.26"	"$2,524.50"	$0.00		$0.00	$493.86	$0.00	$0.00	$502.38	$0.00	$0.00	$0.00	$0.00	$0.00
71673125	SUP	HCPCS C1713		71673125  -  SCREW BN 11MM 125MM LG	BOTH IP/OP	$892.00 	$660.08	$0.00	$713.60	$401.40	$401.40	$0.00	$0.00	$0.00	$185.92	$662.04	$662.04	$0.00	$0.00	$185.89	$0.00	$527.62	$527.62	$0.00	$446.00	$706.46	$713.60	$0.00		$0.00	$139.60	$0.00	$0.00	$142.01	$0.00	$0.00	$0.00	$0.00	$0.00
71674029	SUP	HCPCS C1713		71674029  -  GUIDEPIN ORTH 343MM 3.2MM THRD	BOTH IP/OP	$335.65 	$248.38	$0.00	$268.52	$151.04	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.83	$265.83	$268.52	$0.00		$0.00	$52.53	$0.00	$0.00	$53.44	$0.00	$0.00	$0.00	$0.00	$0.00
71674034	SUP	HCPCS C1713		71674034  -  GUIDE SURG 7MM 7MM COMPRESSION SCREW TRIGEN INTERTAN	BOTH IP/OP	$381.38 	$282.22	$0.00	$305.10	$171.62	$171.62	$0.00	$0.00	$0.00	$0.00	$283.06	$283.06	$0.00	$0.00	$79.48	$0.00	$0.00	$0.00	$0.00	$190.69	$302.05	$305.10	$0.00		$0.00	$59.69	$0.00	$0.00	$60.71	$0.00	$0.00	$0.00	$0.00	$0.00
71674130	SUP	Custom 27203010		71674130  -  GUIDE PIN ORTHOPEDIC 3.2MM 343MM BRAD POINT TIP THREADED	BOTH IP/OP	$308.25 	$228.11	$0.00	$246.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.78	$228.78	$0.00	$0.00	$64.24	$0.00	$0.00	$0.00	$0.00	$154.13	$244.13	$246.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71674540	SUP	HCPCS C1713		71674540  -  INTERTAN LAG SCREW DRILL	BOTH IP/OP	"$1,032.75 "	$764.24	$0.00	$826.20	$464.74	$464.74	$0.00	$0.00	$0.00	$215.25	$766.51	$766.51	$0.00	$0.00	$215.23	$0.00	$610.87	$610.87	$0.00	$516.38	$817.94	$826.20	$0.00		$0.00	$161.63	$0.00	$0.00	$164.41	$0.00	$0.00	$0.00	$0.00	$0.00
71675030	SUP	HCPCS C1713		71675030  -  SCREW BN INTERTAN SET	BOTH IP/OP	$493.88 	$365.47	$0.00	$395.10	$222.24	$222.24	$0.00	$0.00	$0.00	$102.94	$366.55	$366.55	$0.00	$0.00	$102.92	$0.00	$292.13	$292.13	$0.00	$246.94	$391.15	$395.10	$0.00		$0.00	$77.29	$0.00	$0.00	$78.62	$0.00	$0.00	$0.00	$0.00	$0.00
71675040	SUP	HCPCS C1713		71675040  -  CAP END INTERTAN TROCH IM NL	BOTH IP/OP	$279.00 	$206.46	$0.00	$223.20	$125.55	$125.55	$0.00	$0.00	$0.00	$58.15	$207.07	$207.07	$0.00	$0.00	$58.14	$0.00	$165.03	$165.03	$0.00	$139.50	$220.97	$223.20	$0.00		$0.00	$43.66	$0.00	$0.00	$44.42	$0.00	$0.00	$0.00	$0.00	$0.00
71675201	SUP	HCPCS C1713		71675201  -  NAIL IM 125D SHRT 10MM 180MM INTERTAN TI TROCH	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675202	SUP	HCPCS C1713		71675202  -  NAIL IM 125D 11.5MM 18CM INTERTAN TI TROCH	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675203	SUP	HCPCS C1713		71675203  -  NAIL IM 125D SHRT 13MM 18CM INTERTAN TI TROCH	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675204	SUP	HCPCS C1713		71675204  -  NAIL IM 125D 10MM 20CM INTERTAN TI TROCH	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675205	SUP	HCPCS C1713		71675205  -  NAIL IM 125D 11.5MM 20CM INTERTAN TI TROCH	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675206	SUP	HCPCS C1713		71675206  -  NAIL IM 125D 13MM 20CM INTERTAN	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675207	SUP	HCPCS C1713		71675207  -  NAIL IM 130D SHRT 10MM 18CM INTERTAN ANTGRD TI INTST	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675208	SUP	HCPCS C1713		71675208  -  NAIL IM 130D SHRT 11.5MM 18CM INTERTAN ANTGRD TI INTST	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675209	SUP	HCPCS C1713		71675209  -  NAIL IM 130D SHRT 13MM 18CM INTERTAN TI TROCH	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675210	SUP	HCPCS C1713		71675210  -  NAIL IM 130D 10MM 20CM INTERTAN TI ORTH	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675211	SUP	HCPCS C1713		71675211  -  NAIL IM 130D 11.5MM 20CM INTERTAN TI TROCH	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675212	SUP	HCPCS C1713		71675212  -  NAIL IM 130D 13MM 20CM INTERTAN TI TROCH	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675213	SUP	HCPCS C1713		71675213  -  NAIL IM 125D 10MM 26CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675214	SUP	HCPCS C1713		71675214  -  NAIL IM 125D 10MM 26CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675215	SUP	HCPCS C1713		71675215  -  NAIL IM 125D 10MM 28CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675216	SUP	HCPCS C1713		71675216  -  NAIL IM 125D 10MM 28CM INTERTAN TI RT ORTH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675217	SUP	HCPCS C1713		71675217  -  NAIL IM 125D 10MM 30CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675218	SUP	HCPCS C1713		71675218  -  NAIL IM 125D 10MM 30CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675219	SUP	HCPCS C1713		71675219  -  NAIL IM 125D 10MM 32CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675220	SUP	HCPCS C1713		71675220  -  NAIL IM 125D 10MM 32CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675221	SUP	HCPCS C1713		71675221  -  NAIL IM 125D LG 10MM 34CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675222	SUP	HCPCS C1713		71675222  -  NAIL IM 125D 10MM 34CM ROSE INTERTAN TI RT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675223	SUP	HCPCS C1713		71675223  -  NAIL IM 125D 10MM 36CM LIME INTERTAN TI LT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675224	SUP	HCPCS C1713		71675224  -  NAIL IM 125D 10MM 36CM ROSE INTERTAN TI RT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675225	SUP	HCPCS C1713		71675225  -  NAIL IM 125D LG 10MM 38CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675226	SUP	HCPCS C1713		71675226  -  NAIL IM 125D LG 10MM 38CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675227	SUP	HCPCS C1713		71675227  -  NAIL IM 125D LG 10MM 40CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675228	SUP	HCPCS C1713		71675228  -  NAIL IM 125D LG 10MM 400MM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675229	SUP	HCPCS C1713		71675229  -  NAIL IM 125D 10MM 42CM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675230	SUP	HCPCS C1713		71675230  -  NAIL IM 125D 10MM 42CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675231	SUP	HCPCS C1713		71675231  -  NAIL IM 125D 10MM 44CM INTERTAN LT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675232	SUP	HCPCS C1713		71675232  -  NAIL IM 125D 10MM 44CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675233	SUP	HCPCS C1713		71675233  -  NAIL IM 125D 10MM 46CM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675234	SUP	HCPCS C1713		71675234  -  NAIL IM 125D 10MM 46CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675235	SUP	HCPCS C1713		71675235  -  NAIL IM 125D 11.5MM 26CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675236	SUP	HCPCS C1713		71675236  -  NAIL IM 125D 11.5MM 26CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675237	SUP	HCPCS C1713		71675237  -  NAIL IM 125D 11.5MM 28CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675238	SUP	HCPCS C1713		71675238  -  NAIL IM 125D 11.5MM 28CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675239	SUP	HCPCS C1713		71675239  -  NAIL IM 125D LG 11.5MM 30CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675240	SUP	HCPCS C1713		71675240  -  NAIL IM 125D 11.5MM 30CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675241	SUP	HCPCS C1713		71675241  -  NAIL IM 125D 11.5MM 32CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675242	SUP	HCPCS C1713		71675242  -  NAIL IM 125D 11.5MM 32CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675243	SUP	HCPCS C1713		71675243  -  NAIL IM 125D LG 11.5MM 34CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675244	SUP	HCPCS C1713		71675244  -  NAIL IM 125D 11.5MM 34CM ROSE INTERTAN TI RT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675245	SUP	HCPCS C1713		71675245  -  NAIL IM 125D LG 11.5MM 360MM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675246	SUP	HCPCS C1713		71675246  -  NAIL IM 125D LG 11.5MM 36CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675247	SUP	HCPCS C1713		71675247  -  NAIL IM 125D 11.5MM 38CM LIME INTERTAN TI LT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675248	SUP	HCPCS C1713		71675248  -  NAIL IM 125D LG 11.5MM 380MM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675249	SUP	HCPCS C1713		71675249  -  NAIL IM 125D LG 11.5MM 40CM LIME TRGN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675250	SUP	HCPCS C1713		71675250  -  NAIL IM 125D LG 11.5MM 400MM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675251	SUP	HCPCS C1713		71675251  -  NAIL IM 125D 11.5MM 42CM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675252	SUP	HCPCS C1713		71675252  -  NAIL IM 125D 11.5MM 42CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675253	SUP	HCPCS C1713		71675253  -  NAIL IM 125D 11.5MM 44CM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675254	SUP	HCPCS C1713		71675254  -  NAIL IM 125D 11.5MM 44CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675255	SUP	HCPCS C1713		71675255  -  NAIL IM 125D 11.5MM 46CM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675256	SUP	HCPCS C1713		71675256  -  NAIL IM 125D 11.5MM 46CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675257	SUP	HCPCS C1713		71675257  -  NAIL IM 130D 10MM 26CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675258	SUP	HCPCS C1713		71675258  -  NAIL IM 130D 10MM 26CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675259	SUP	HCPCS C1713		71675259  -  NAIL IM 130D 10MM 28CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675260	SUP	HCPCS C1713		71675260  -  NAIL IM 130D 10MM 28CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675261	SUP	HCPCS C1713		71675261  -  NAIL IM 130D 10MM 30CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675262	SUP	HCPCS C1713		71675262  -  NAIL IM 130D 10MM 30CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675263	SUP	HCPCS C1713		71675263  -  NAIL IM 130D 10MM 32CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675264	SUP	HCPCS C1713		71675264  -  NAIL IM 130D 10MM 32CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675265	SUP	HCPCS C1713		71675265  -  NAIL IM 130D LNG 10MM 34CM LIME ROSE INTERTAN TRGN NK ANG LT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675266	SUP	HCPCS C1713		71675266  -  NAIL IM 130D LNG 10MM 34CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675267	SUP	HCPCS C1713		71675267  -  NAIL IM 130D LNG 10MM 36CM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675268	SUP	HCPCS C1713		71675268  -  NAIL IM 130D LNG 10MM 36CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675269	SUP	HCPCS C1713		71675269  -  NAIL IM 130D 10MM 38CM LIME INTERTAN TI LT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675270	SUP	HCPCS C1713		71675270  -  NAIL IM 130D LNG 10MM 380MM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675271	SUP	HCPCS C1713		71675271  -  NAIL IM 130D LNG 10MM 40CM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675272	SUP	HCPCS C1713		71675272  -  NAIL IM 130D LNG 10MM 40CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675273	SUP	HCPCS C1713		71675273  -  NAIL IM 130D 10MM 42CM INTERTAN LT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675274	SUP	HCPCS C1713		71675274  -  NAIL IM 130D LNG 10MM 42CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675275	SUP	HCPCS C1713		71675275  -  NAIL IM 130D 10MM 44CM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675276	SUP	HCPCS C1713		71675276  -  NAIL IM 130D 10MM 44CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675277	SUP	HCPCS C1713		71675277  -  NAIL IM 130D 10MM 46CM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675278	SUP	HCPCS C1713		71675278  -  NAIL IM 130D 10MM 46CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675279	SUP	HCPCS C1713		71675279  -  NAIL IM 130D 11.5MM 26CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675280	SUP	HCPCS C1713		71675280  -  NAIL IM 130D 11.5MM 26CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675281	SUP	HCPCS C1713		71675281  -  NAIL IM 130D 11.5MM 28CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675282	SUP	HCPCS C1713		71675282  -  NAIL IM 130D 11.5MM 28CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675283	SUP	HCPCS C1713		71675283  -  NAIL IM 130D 11.5MM 30CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675284	SUP	HCPCS C1713		71675284  -  NAIL IM 130D 11.5MM 30CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675285	SUP	HCPCS C1713		71675285  -  NAIL IM 130D 11.5MM 32CM INTERTAN LT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675286	SUP	HCPCS C1713		71675286  -  NAIL IM 130D 11.5MM 32CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675287	SUP	HCPCS C1713		71675287  -  NAIL IM 130D 11.5MM 34CM INTERTAN ANTGRD TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675288	SUP	HCPCS C1713		71675288  -  NAIL IM 130D LNG 11.5MM 34CM ROSE INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675289	SUP	HCPCS C1713		71675289  -  NAIL IM 130D LNG 11.5MM 360MM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675290	SUP	HCPCS C1713		71675290  -  NAIL IM 130D LNG 11.5MM 36CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675291	SUP	HCPCS C1713		71675291  -  NAIL IM 130D LNG 11.5MM 380MM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675292	SUP	HCPCS C1713		71675292  -  NAIL IM 130D LNG 11.5MM 380MM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675293	SUP	HCPCS C1713		71675293  -  NAIL IM 130D LNG 11.5MM 40CM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675294	SUP	HCPCS C1713		71675294  -  NAIL IM 130D LNG 11.5MM 40CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675295	SUP	HCPCS C1713		71675295  -  NAIL IM 130D LNG 11.5MM 42CM LIME INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675361	SUP	HCPCS C1713		71675361  -  NAIL IM 135D 13MM 26CM INTERTAN TI LT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675362	SUP	HCPCS C1713		71675362  -  NAIL IM 135D 13MM 26CM INTERTAN TI RT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675363	SUP	HCPCS C1713		71675363  -  NAIL IM 135D 13MM 28CM INTERTAN TI LT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675364	SUP	HCPCS C1713		71675364  -  NAIL IM 135D 13MM 28CM INTERTAN TI RT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675365	SUP	HCPCS C1713		71675365  -  NAIL IM 135D 13MM 30CM INTERTAN TI LT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675366	SUP	HCPCS C1713		71675366  -  NAIL IM 135D 13MM 30CM INTERTAN TI RT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675367	SUP	HCPCS C1713		71675367  -  NAIL IM 135D 13MM 32CM INTERTAN TI LT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675368	SUP	HCPCS C1713		71675368  -  NAIL IM 135D 13MM 32CM INTERTAN TI RT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675369	SUP	HCPCS C1713		71675369  -  NAIL IM 135D 13MM 34CM INTERTAN TI LT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675370	SUP	HCPCS C1713		71675370  -  NAIL IM 135D 13MM 34CM INTERTAN TI RT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675371	SUP	HCPCS C1713		71675371  -  NAIL IM 135D 13MM 36CM INTERTAN TI LT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675372	SUP	HCPCS C1713		71675372  -  NAIL IM 135D 13MM 36CM INTERTAN TI RT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675373	SUP	HCPCS C1713		71675373  -  NAIL IM 135D 13MM 38CM INTERTAN TI LT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675374	SUP	HCPCS C1713		71675374  -  NAIL IM 135D 13MM 38CM INTERTAN TI RT TROCH	BOTH IP/OP	"$6,220.00 "	"$4,602.80"	$0.00	"$4,976.00"	"$2,799.00"	"$2,799.00"	$0.00	$0.00	$0.00	"$1,296.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,296.25"	$0.00	"$3,066.46"	"$3,066.46"	$0.00	"$3,110.00"	"$4,926.24"	"$4,976.00"	$0.00		$0.00	$973.43	$0.00	$0.00	$990.22	$0.00	$0.00	$0.00	$0.00	$0.00
71675375	SUP	HCPCS C1713		71675375  -  NAIL IM 135D 13MM 40CM INTERTAN TI LT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675376	SUP	HCPCS C1713		71675376  -  NAIL IM 135D 13MM 40CM INTERTAN TI RT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675377	SUP	HCPCS C1713		71675377  -  NAIL IM 135D 13MM 42CM INTERTAN TI LT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675378	SUP	HCPCS C1713		71675378  -  NAIL IM 135D 13MM 42CM INTERTAN TI RT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675379	SUP	HCPCS C1713		71675379  -  NAIL IM 135D 13MM 44CM INTERTAN TI LT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675380	SUP	HCPCS C1713		71675380  -  NAIL IM 135D 13MM 44CM INTERTAN TI RT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675381	SUP	HCPCS C1713		71675381  -  NAIL IM 135D 13MM 46CM INTERTAN TI LT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675382	SUP	HCPCS C1713		71675382  -  NAIL IM 135D 13MM 46CM INTERTAN TI RT TROCH	BOTH IP/OP	"$5,550.00 "	"$4,107.00"	$0.00	"$4,440.00"	"$2,497.50"	"$2,497.50"	$0.00	$0.00	$0.00	"$1,156.76"	"$4,119.21"	"$4,119.21"	$0.00	$0.00	"$1,156.62"	$0.00	"$2,736.15"	"$2,736.15"	$0.00	"$2,775.00"	"$4,395.60"	"$4,440.00"	$0.00		$0.00	$868.58	$0.00	$0.00	$883.56	$0.00	$0.00	$0.00	$0.00	$0.00
71675383	SUP	HCPCS C1713		71675383  -  NAIL IM 125D 10MM 18CM INTERTAN	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675384	SUP	HCPCS C1713		71675384  -  NAIL IM 130D 10MM 18CM INTERTAN	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675385	SUP	HCPCS C1713		71675385  -  NAIL IM 125D SHRT 10MM 20CM INTERTAN TROCH	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675386	SUP	HCPCS C1713		71675386  -  NAIL IM 130D SHRT 10MM 20CM INTERTAN TROCH	BOTH IP/OP	"$3,330.00 "	"$2,464.20"	$0.00	"$2,664.00"	"$1,498.50"	"$1,498.50"	$0.00	$0.00	$0.00	$694.06	"$2,471.53"	"$2,471.53"	$0.00	$0.00	$693.97	$0.00	"$1,641.69"	"$1,641.69"	$0.00	"$1,665.00"	"$2,637.36"	"$2,664.00"	$0.00		$0.00	$521.15	$0.00	$0.00	$530.14	$0.00	$0.00	$0.00	$0.00	$0.00
71675401	SUP	HCPCS C1713		71675401  -  NAIL IM 125D 13MM 26CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675402	SUP	HCPCS C1713		71675402  -  NAIL IM 125D 13MM 26CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675403	SUP	HCPCS C1713		71675403  -  NAIL IM 125D 13MM 28CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675404	SUP	HCPCS C1713		71675404  -  NAIL IM 125D 13MM 28CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675405	SUP	HCPCS C1713		71675405  -  NAIL IM 125D 13MM 30CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675406	SUP	HCPCS C1713		71675406  -  NAIL IM 125D 13MM 30CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675407	SUP	HCPCS C1713		71675407  -  NAIL IM 125D LNG 13MM 32CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675408	SUP	HCPCS C1713		71675408  -  NAIL IM 125D 13MM 32CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675409	SUP	HCPCS C1713		71675409  -  NAIL IM 125D 13MM 34CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675410	SUP	HCPCS C1713		71675410  -  NAIL IM 125D 13MM 34CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675411	SUP	HCPCS C1713		71675411  -  NAIL IM 125D 13MM 36CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675412	SUP	HCPCS C1713		71675412  -  NAIL IM 125D 13MM 36CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675413	SUP	HCPCS C1713		71675413  -  NAIL IM 125D 13MM 38CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675414	SUP	HCPCS C1713		71675414  -  NAIL IM 125D 13MM 38CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675415	SUP	HCPCS C1713		71675415  -  NAIL IM 125D 13MM 40CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675416	SUP	HCPCS C1713		71675416  -  NAIL IM 125D 13MM 40CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675417	SUP	HCPCS C1713		71675417  -  NAIL IM 125D 13MM 42CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675418	SUP	HCPCS C1713		71675418  -  NAIL IM 125D 13MM 42CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675419	SUP	HCPCS C1713		71675419  -  NAIL IM 125D 13MM 44CM INTERTAN LT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675420	SUP	HCPCS C1713		71675420  -  NAIL IM 125D 13MM 44CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675421	SUP	HCPCS C1713		71675421  -  NAIL IM 125D 13MM 46CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675422	SUP	HCPCS C1713		71675422  -  NAIL IM 125D 13MM 46CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675423	SUP	HCPCS C1713		71675423  -  NAIL IM 130D 13MM 26CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675424	SUP	HCPCS C1713		71675424  -  NAIL IM 130D 13MM 26CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675425	SUP	HCPCS C1713		71675425  -  NAIL IM 130D 13MM 28CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675426	SUP	HCPCS C1713		71675426  -  NAIL IM 130D 13MM 28CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675427	SUP	HCPCS C1713		71675427  -  NAIL IM 130D 13MM 30CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675428	SUP	HCPCS C1713		71675428  -  NAIL IM 130D 13MM 30CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675429	SUP	HCPCS C1713		71675429  -  NAIL IM 130D 13MM 32CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675430	SUP	HCPCS C1713		71675430  -  NAIL IM 130D 13MM 32CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675431	SUP	HCPCS C1713		71675431  -  NAIL IM 130D 13MM 34CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675432	SUP	HCPCS C1713		71675432  -  NAIL IM 130D 13MM 34CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675433	SUP	HCPCS C1713		71675433  -  NAIL IM 130D 13MM 36CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675434	SUP	HCPCS C1713		71675434  -  NAIL IM 130D 13MM 36CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675435	SUP	HCPCS C1713		71675435  -  NAIL IM 130D 13MM 38CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675436	SUP	HCPCS C1713		71675436  -  NAIL IM 130D 13MM 38CM INTERTAN ANTGRD TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675437	SUP	HCPCS C1713		71675437  -  NAIL IM 130D 13MM 40CM INTERTAN TI LT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675438	SUP	HCPCS C1713		71675438  -  NAIL IM 130D 13MM 40CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675439	SUP	HCPCS C1713		71675439  -  NAIL IM 130D 13MM 42CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675440	SUP	HCPCS C1713		71675440  -  NAIL IM 130D 13MM 42CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675441	SUP	HCPCS C1713		71675441  -  NAIL IM 130D 13MM 44CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675442	SUP	HCPCS C1713		71675442  -  NAIL IM 130D 13MM 44CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675443	SUP	HCPCS C1713		71675443  -  NAIL IM 130D 13MM 46CM INTERTAN TI LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675444	SUP	HCPCS C1713		71675444  -  NAIL IM 130D 13MM 46CM INTERTAN TI RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675501	SUP	HCPCS C1713		71675501  -  NAIL IM 125D 10MM 26CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675502	SUP	HCPCS C1713		71675502  -  NAIL IM 130D 10MM 26CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675503	SUP	HCPCS C1713		71675503  -  NAIL IM 125D 10MM 28CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675504	SUP	HCPCS C1713		71675504  -  NAIL IM 130D 10MM 28CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675505	SUP	HCPCS C1713		71675505  -  NAIL IM 125D 10MM 30CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675506	SUP	HCPCS C1713		71675506  -  NAIL IM 130D 10MM 30CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675507	SUP	HCPCS C1713		71675507  -  NAIL IM 125D 10MM 32CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675508	SUP	HCPCS C1713		71675508  -  NAIL IM 130D 10MM 30CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675509	SUP	HCPCS C1713		71675509  -  NAIL IM 125D 10MM 34CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675510	SUP	HCPCS C1713		71675510  -  NAIL IM 130D 10MM 34CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675511	SUP	HCPCS C1713		71675511  -  NAIL IM 125D 10MM 36CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675512	SUP	HCPCS C1713		71675512  -  NAIL IM 130D 10MM 36CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675513	SUP	HCPCS C1713		71675513  -  NAIL IM 125D 10MM 38CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675514	SUP	HCPCS C1713		71675514  -  NAIL IM 130D 10MM 38CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675515	SUP	HCPCS C1713		71675515  -  NAIL IM 125D 10MM 40CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675516	SUP	HCPCS C1713		71675516  -  NAIL IM 130D 10MM 40CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675517	SUP	HCPCS C1713		71675517  -  NAIL IM 125D 10MM 42CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675518	SUP	HCPCS C1713		71675518  -  NAIL IM 130D 10MM 42CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675519	SUP	HCPCS C1713		71675519  -  NAIL IM 125D 10MM 44CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675520	SUP	HCPCS C1713		71675520  -  NAIL IM 130D 10MM 44CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675521	SUP	HCPCS C1713		71675521  -  NAIL IM 125D 10MM 46CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675522	SUP	HCPCS C1713		71675522  -  NAIL IM 130D 10MM 46CM INTERTAN LT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675523	SUP	HCPCS C1713		71675523  -  NAIL IM 125D 10MM 26CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675524	SUP	HCPCS C1713		71675524  -  NAIL IM 130D 10MM 26CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675525	SUP	HCPCS C1713		71675525  -  NAIL IM 125D 10MM 28CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675526	SUP	HCPCS C1713		71675526  -  NAIL IM 130D 10MM 28CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675527	SUP	HCPCS C1713		71675527  -  NAIL IM 125D 10MM 30CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675528	SUP	HCPCS C1713		71675528  -  NAIL IM 130D 10MM 30CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675529	SUP	HCPCS C1713		71675529  -  NAIL IM 125D 10MM 36CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675530	SUP	HCPCS C1713		71675530  -  NAIL IM 130D 10MM 32CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675531	SUP	HCPCS C1713		71675531  -  NAIL IM 125D 10MM 34CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675532	SUP	HCPCS C1713		71675532  -  NAIL IM 130D 10MM 34CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675533	SUP	HCPCS C1713		71675533  -  NAIL IM 125D 10MM 36CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675534	SUP	HCPCS C1713		71675534  -  NAIL IM 130D 10MM 36CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675535	SUP	HCPCS C1713		71675535  -  NAIL IM 125D 10MM 38CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675536	SUP	HCPCS C1713		71675536  -  NAIL IM 130D 10MM 38CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675537	SUP	HCPCS C1713		71675537  -  NAIL IM 125D 10MM 40CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675538	SUP	HCPCS C1713		71675538  -  NAIL IM 130D 10MM 40CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675539	SUP	HCPCS C1713		71675539  -  NAIL IM 125D 10MM 42CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675540	SUP	HCPCS C1713		71675540  -  NAIL IM 130D 10MM 42CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675541	SUP	HCPCS C1713		71675541  -  NAIL IM 125D 10MM 44CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675542	SUP	HCPCS C1713		71675542  -  NAIL IM 130D 10MM 44CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675543	SUP	HCPCS C1713		71675543  -  NAIL IM 125D 10MM 46CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71675544	SUP	HCPCS C1713		71675544  -  NAIL IM 130D 10MM 46CM INTERTAN RT TROCH	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676501	SUP	HCPCS C1713		71676501  -  NAIL IM 125D 1.5MM 26CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676502	SUP	HCPCS C1713		71676502  -  NAIL IM 125D 1.5MM 26CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676503	SUP	HCPCS C1713		71676503  -  NAIL IM 125D 1.5MM 28CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676504	SUP	HCPCS C1713		71676504  -  NAIL IM 125D 1.5MM 10MM 28CM INTERTAN INTERTROCHANTER RT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676505	SUP	HCPCS C1713		71676505  -  NAIL IM 125D 1.5MM 30CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676506	SUP	HCPCS C1713		71676506  -  NAIL IM 125D 1.5MM 30CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676507	SUP	HCPCS C1713		71676507  -  NAIL IM 125D 1.5MM 32CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676508	SUP	HCPCS C1713		71676508  -  NAIL IM 125D 1.5MM 32CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676509	SUP	HCPCS C1713		71676509  -  NAIL IM 125D 1.5MM 34CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676510	SUP	HCPCS C1713		71676510  -  NAIL IM 125D 1.5MM 34CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676511	SUP	HCPCS C1713		71676511  -  NAIL IM 125D 1.5MM 36CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676512	SUP	HCPCS C1713		71676512  -  NAIL IM 125D 1.5MM 36CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676513	SUP	HCPCS C1713		71676513  -  NAIL IM 125D 1.5MM 38CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676514	SUP	HCPCS C1713		71676514  -  NAIL IM 125D 1.5MM 38CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676515	SUP	HCPCS C1713		71676515  -  NAIL IM 125D 1.5MM 40CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676516	SUP	HCPCS C1713		71676516  -  NAIL IM 125D 1.5MM 40CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676517	SUP	HCPCS C1713		71676517  -  NAIL IM 125D 1.5MM 42CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676518	SUP	HCPCS C1713		71676518  -  NAIL IM 125D 1.5MM 42CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676519	SUP	HCPCS C1713		71676519  -  NAIL IM 125D 1.5MM 44CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676520	SUP	HCPCS C1713		71676520  -  NAIL IM 125D 1.5MM 44CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676521	SUP	HCPCS C1713		71676521  -  NAIL IM 125D 1.5MM 46CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676522	SUP	HCPCS C1713		71676522  -  NAIL IM 125D 1.5MM 46CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676523	SUP	HCPCS C1713		71676523  -  NAIL IM 130D 1.5MM 26CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676524	SUP	HCPCS C1713		71676524  -  NAIL IM 130D 1.5MM 26CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676525	SUP	HCPCS C1713		71676525  -  NAIL IM 130D 1.5MM 28CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676526	SUP	HCPCS C1713		71676526  -  NAIL IM 130D 1.5MM 28CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676527	SUP	HCPCS C1713		71676527  -  NAIL IM 130D 1.5MM 30CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676528	SUP	HCPCS C1713		71676528  -  NAIL IM 130D 1.5MM 30CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676529	SUP	HCPCS C1713		71676529  -  NAIL IM 130D 1.5MM 32CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676530	SUP	HCPCS C1713		71676530  -  NAIL IM 130D 1.5MM 32CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676531	SUP	HCPCS C1713		71676531  -  NAIL IM 130D 1.5MM 34CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676532	SUP	HCPCS C1713		71676532  -  NAIL IM 130D 1.5MM 34CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676533	SUP	HCPCS C1713		71676533  -  NAIL IM 130D 1.5MM 36CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676534	SUP	HCPCS C1713		71676534  -  NAIL IM 130D 1.5MM 36CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676535	SUP	HCPCS C1713		71676535  -  NAIL IM 130D 1.5MM 38CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676536	SUP	HCPCS C1713		71676536  -  NAIL IM 130D 1.5MM 38CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676537	SUP	HCPCS C1713		71676537  -  NAIL IM 130D 1.5MM 40CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676538	SUP	HCPCS C1713		71676538  -  NAIL IM 130D 1.5MM 40CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676539	SUP	HCPCS C1713		71676539  -  NAIL IM 130D 1.5MM 42CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676540	SUP	HCPCS C1713		71676540  -  NAIL IM 130D 1.5MM 42CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676541	SUP	HCPCS C1713		71676541  -  NAIL IM 130D 1.5MM 44CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676542	SUP	HCPCS C1713		71676542  -  NAIL IM 130D 1.5MM 44CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676543	SUP	HCPCS C1713		71676543  -  NAIL IM 130D 1.5MM 46CM 10MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676544	SUP	HCPCS C1713		71676544  -  NAIL IM 130D 1.5MM 46CM 10MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676545	SUP	HCPCS C1713		71676545  -  NAIL IM 125D 1.5MM 26CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676546	SUP	HCPCS C1713		71676546  -  NAIL IM 125D 1.5MM 26CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676547	SUP	HCPCS C1713		71676547  -  NAIL IM 125D 1.5MM 28CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676548	SUP	HCPCS C1713		71676548  -  NAIL IM 125D 1.5MM 28CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676549	SUP	HCPCS C1713		71676549  -  NAIL IM 125D 1.5MM 30CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676550	SUP	HCPCS C1713		71676550  -  NAIL IM 125D 1.5MM 30CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676551	SUP	HCPCS C1713		71676551  -  NAIL IM 125D 1.5MM 32CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676552	SUP	HCPCS C1713		71676552  -  NAIL IM 125D 1.5MM 32CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676553	SUP	HCPCS C1713		71676553  -  NAIL INTRAMEDULLARY 125D 1.5MM 34CM 11.5MM INTERTAN LEFT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676554	SUP	HCPCS C1713		71676554  -  NAIL IM 125D 1.5MM 34CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676555	SUP	HCPCS C1713		71676555  -  NAIL IM 125D 1.5MM 36CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676556	SUP	HCPCS C1713		71676556  -  NAIL IM 125D 1.5MM 36CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676557	SUP	HCPCS C1713		71676557  -  NAIL IM 125D 1.5MM 38CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676558	SUP	HCPCS C1713		71676558  -  NAIL INTRAMEDULLARY 125D 1.5MM 38CM 11.5MM INTERTAN RIGHT	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676559	SUP	HCPCS C1713		71676559  -  NAIL IM 125D 1.5MM 40CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676560	SUP	HCPCS C1713		71676560  -  NAIL IM 125D 1.5MM 40CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676561	SUP	HCPCS C1713		71676561  -  NAIL IM 125D 1.5MM 42CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676562	SUP	HCPCS C1713		71676562  -  NAIL IM 125D 1.5MM 42CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676563	SUP	HCPCS C1713		71676563  -  NAIL IM 125D 1.5MM 44CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676564	SUP	HCPCS C1713		71676564  -  NAIL IM 125D 1.5MM 44CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676565	SUP	HCPCS C1713		71676565  -  NAIL IM 125D 1.5MM 46CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676566	SUP	HCPCS C1713		71676566  -  NAIL IM 125D 1.5MM 46CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676567	SUP	HCPCS C1713		71676567  -  NAIL IM 130D 1.5MM 26CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676568	SUP	HCPCS C1713		71676568  -  NAIL IM 130D 1.5MM 26CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676569	SUP	HCPCS C1713		71676569  -  NAIL IM 130D 1.5MM 28CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676570	SUP	HCPCS C1713		71676570  -  NAIL IM 130D 1.5MM 28CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676571	SUP	HCPCS C1713		71676571  -  NAIL IM 130D 1.5MM 30CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676572	SUP	HCPCS C1713		71676572  -  NAIL IM 130D 1.5MM 30CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676573	SUP	HCPCS C1713		71676573  -  NAIL IM 130D 1.5MM 32CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676574	SUP	HCPCS C1713		71676574  -  NAIL IM 130D 1.5MM 32CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676575	SUP	HCPCS C1713		71676575  -  NAIL IM 130D 1.5MM 34CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676576	SUP	HCPCS C1713		71676576  -  NAIL IM 130D 1.5MM 34CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676577	SUP	HCPCS C1713		71676577  -  NAIL IM 130D 1.5MM 36CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676578	SUP	HCPCS C1713		71676578  -  NAIL IM 130D 1.5MM 36CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676579	SUP	HCPCS C1713		71676579  -  NAIL IM 130D 1.5MM 38CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676580	SUP	HCPCS C1713		71676580  -  NAIL IM 130D 1.5MM 38CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676581	SUP	HCPCS C1713		71676581  -  NAIL IM 130D 1.5MM 40CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676582	SUP	HCPCS C1713		71676582  -  NAIL IM 130D 1.5MM 40CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676583	SUP	HCPCS C1713		71676583  -  NAIL IM 130D 1.5MM 42CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676584	SUP	HCPCS C1713		71676584  -  NAIL IM 130D 1.5MM 42CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676585	SUP	HCPCS C1713		71676585  -  NAIL IM 130D 1.5MM 44CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676586	SUP	HCPCS C1713		71676586  -  NAIL IM 130D 1.5MM 44CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676587	SUP	HCPCS C1713		71676587  -  NAIL IM 130D 1.5MM 46CM 11.5MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676588	SUP	HCPCS C1713		71676588  -  NAIL IM 130D 1.5MM 46CM 11.5MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676589	SUP	HCPCS C1713		71676589  -  NAIL IM 125D 1.5MM 26CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676590	SUP	HCPCS C1713		71676590  -  NAIL IM 125D 1.5MM 26CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676591	SUP	HCPCS C1713		71676591  -  NAIL IM 125D 1.5MM 28CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676592	SUP	HCPCS C1713		71676592  -  NAIL IM 125D 1.5MM 28CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676593	SUP	HCPCS C1713		71676593  -  NAIL IM 125D 1.5MM 30CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676594	SUP	HCPCS C1713		71676594  -  NAIL IM 125D 1.5MM 30CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676595	SUP	HCPCS C1713		71676595  -  NAIL IM 125D 1.5MM 32CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676596	SUP	HCPCS C1713		71676596  -  NAIL IM 125D 1.5MM 32CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676597	SUP	HCPCS C1713		71676597  -  NAIL IM 125D 1.5MM 34CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676598	SUP	HCPCS C1713		71676598  -  NAIL IM 125D 1.5MM 34CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676599	SUP	HCPCS C1713		71676599  -  NAIL IM 125D 1.5MM 36CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676600	SUP	HCPCS C1713		71676600  -  NAIL IM 125D 1.5MM 36CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676601	SUP	HCPCS C1713		71676601  -  NAIL IM 125D 1.5MM 38CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676602	SUP	HCPCS C1713		71676602  -  NAIL IM 125D 1.5MM 38CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676603	SUP	HCPCS C1713		71676603  -  NAIL IM 125D 1.5MM 40CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676604	SUP	HCPCS C1713		71676604  -  NAIL IM 125D 1.5MM 40CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676605	SUP	HCPCS C1713		71676605  -  NAIL IM 125D 1.5MM 42CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676606	SUP	HCPCS C1713		71676606  -  NAIL IM 125D 1.5MM 42CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676607	SUP	HCPCS C1713		71676607  -  NAIL IM 125D 1.5MM 44CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676608	SUP	HCPCS C1713		71676608  -  NAIL IM 125D 1.5MM 44CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676609	SUP	HCPCS C1713		71676609  -  NAIL IM 125D 1.5MM 46CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676610	SUP	HCPCS C1713		71676610  -  NAIL IM 125D 1.5MM 46CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676611	SUP	HCPCS C1713		71676611  -  NAIL IM 130D 1.5MM 26CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676612	SUP	HCPCS C1713		71676612  -  NAIL IM 130D 1.5MM 26CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676613	SUP	HCPCS C1713		71676613  -  NAIL IM 130D 1.5MM 28CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676614	SUP	HCPCS C1713		71676614  -  NAIL IM 130D 1.5MM 28CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676615	SUP	HCPCS C1713		71676615  -  NAIL IM 130D 1.5MM 30CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676616	SUP	HCPCS C1713		71676616  -  NAIL IM 130D 1.5MM 30CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676617	SUP	HCPCS C1713		71676617  -  NAIL IM 130D 1.5MM 32CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676618	SUP	HCPCS C1713		71676618  -  NAIL IM 130D 1.5MM 32CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676619	SUP	HCPCS C1713		71676619  -  NAIL IM 130D 1.5MM 34CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676620	SUP	HCPCS C1713		71676620  -  NAIL IM 130D 1.5MM 34CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676621	SUP	HCPCS C1713		71676621  -  NAIL IM 130D 1.5MM 36CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676622	SUP	HCPCS C1713		71676622  -  NAIL IM 130D 1.5MM 36CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676623	SUP	HCPCS C1713		71676623  -  NAIL IM 130D 1.5MM 38CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676624	SUP	HCPCS C1713		71676624  -  NAIL IM 130D 1.5MM 38CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676625	SUP	HCPCS C1713		71676625  -  NAIL IM 130D 1.5MM 40CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676626	SUP	HCPCS C1713		71676626  -  NAIL IM 130D 1.5MM 40CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676627	SUP	HCPCS C1713		71676627  -  NAIL IM 130D 1.5MM 42CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676628	SUP	HCPCS C1713		71676628  -  NAIL IM 130D 1.5MM 42CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676629	SUP	HCPCS C1713		71676629  -  NAIL IM 130D 1.5MM 44CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676630	SUP	HCPCS C1713		71676630  -  NAIL IM 130D 1.5MM 44CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676631	SUP	HCPCS C1713		71676631  -  NAIL IM 130D 1.5MM 46CM 13MM INTERTAN LT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71676632	SUP	HCPCS C1713		71676632  -  NAIL IM 130D 1.5MM 46CM 13MM INTERTAN RT INTERTROCHANTER	BOTH IP/OP	"$4,443.75 "	"$3,288.38"	$0.00	"$3,555.00"	"$1,999.69"	"$1,999.69"	$0.00	$0.00	$0.00	$926.19	"$3,298.15"	"$3,298.15"	$0.00	$0.00	$926.08	$0.00	"$2,190.77"	"$2,190.77"	$0.00	"$2,221.88"	"$3,519.45"	"$3,555.00"	$0.00		$0.00	$695.45	$0.00	$0.00	$707.45	$0.00	$0.00	$0.00	$0.00	$0.00
71677070	SUP	HCPCS C1713		71677070  -  SCREW BN 70/65MM INTERTAN LG CMPR TROCH CMBN PK	BOTH IP/OP	"$1,417.50 "	"$1,048.95"	$0.00	"$1,134.00"	$637.88	$637.88	$0.00	$0.00	$0.00	$295.44	"$1,052.07"	"$1,052.07"	$0.00	$0.00	$295.41	$0.00	$838.45	$838.45	$0.00	$708.75	"$1,122.66"	"$1,134.00"	$0.00		$0.00	$221.84	$0.00	$0.00	$225.67	$0.00	$0.00	$0.00	$0.00	$0.00
71677075	SUP	HCPCS C1713		71677075  -  SCREW BN 75/70MM INTERTAN LG CMPR TROCH CMBN PK	BOTH IP/OP	"$1,417.50 "	"$1,048.95"	$0.00	"$1,134.00"	$637.88	$637.88	$0.00	$0.00	$0.00	$295.44	"$1,052.07"	"$1,052.07"	$0.00	$0.00	$295.41	$0.00	$838.45	$838.45	$0.00	$708.75	"$1,122.66"	"$1,134.00"	$0.00		$0.00	$221.84	$0.00	$0.00	$225.67	$0.00	$0.00	$0.00	$0.00	$0.00
71677080	SUP	HCPCS C1713		71677080  -  KIT SCR 80MMX70MM INTERTAN LG CMPR TROCH TI CMBN PK	BOTH IP/OP	"$1,417.50 "	"$1,048.95"	$0.00	"$1,134.00"	$637.88	$637.88	$0.00	$0.00	$0.00	$295.44	"$1,052.07"	"$1,052.07"	$0.00	$0.00	$295.41	$0.00	$838.45	$838.45	$0.00	$708.75	"$1,122.66"	"$1,134.00"	$0.00		$0.00	$221.84	$0.00	$0.00	$225.67	$0.00	$0.00	$0.00	$0.00	$0.00
71677085	SUP	HCPCS C1713		71677085  -  SCREW BN 11MM 7MM 85MM 80MM INTERTAN KT CMPR LG INTGR INTLK	BOTH IP/OP	"$1,417.50 "	"$1,048.95"	$0.00	"$1,134.00"	$637.88	$637.88	$0.00	$0.00	$0.00	$295.44	"$1,052.07"	"$1,052.07"	$0.00	$0.00	$295.41	$0.00	$838.45	$838.45	$0.00	$708.75	"$1,122.66"	"$1,134.00"	$0.00		$0.00	$221.84	$0.00	$0.00	$225.67	$0.00	$0.00	$0.00	$0.00	$0.00
71677090	SUP	HCPCS C1713		71677090  -  KIT SCREW 4.5MM 90MM 85MM LAG COMPRESSION INTEGRATE	BOTH IP/OP	"$1,417.50 "	"$1,048.95"	$0.00	"$1,134.00"	$637.88	$637.88	$0.00	$0.00	$0.00	$295.44	"$1,052.07"	"$1,052.07"	$0.00	$0.00	$295.41	$0.00	$838.45	$838.45	$0.00	$708.75	"$1,122.66"	"$1,134.00"	$0.00		$0.00	$221.84	$0.00	$0.00	$225.67	$0.00	$0.00	$0.00	$0.00	$0.00
71677095	SUP	HCPCS C1713		71677095  -  KIT SCREW 4.5MM 95MM 90MM LAG COMPRESSION INTEGRATED INTLCK	BOTH IP/OP	"$1,417.50 "	"$1,048.95"	$0.00	"$1,134.00"	$637.88	$637.88	$0.00	$0.00	$0.00	$295.44	"$1,052.07"	"$1,052.07"	$0.00	$0.00	$295.41	$0.00	$838.45	$838.45	$0.00	$708.75	"$1,122.66"	"$1,134.00"	$0.00		$0.00	$221.84	$0.00	$0.00	$225.67	$0.00	$0.00	$0.00	$0.00	$0.00
71677120	SUP	HCPCS C1713		71677120  -  SCREW BN 11MM 7MM 120MM 115MM INTERTAN KT CMPR LG INTGR	BOTH IP/OP	"$1,417.50 "	"$1,048.95"	$0.00	"$1,134.00"	$637.88	$637.88	$0.00	$0.00	$0.00	$295.44	"$1,052.07"	"$1,052.07"	$0.00	$0.00	$295.41	$0.00	$838.45	$838.45	$0.00	$708.75	"$1,122.66"	"$1,134.00"	$0.00		$0.00	$221.84	$0.00	$0.00	$225.67	$0.00	$0.00	$0.00	$0.00	$0.00
71677125	SUP	HCPCS C1713		71677125  -  SCREW BN 125/120MM INTERTAN LG CMPR TROCH CMBN PK	BOTH IP/OP	"$1,417.50 "	"$1,048.95"	$0.00	"$1,134.00"	$637.88	$637.88	$0.00	$0.00	$0.00	$295.44	"$1,052.07"	"$1,052.07"	$0.00	$0.00	$295.41	$0.00	$838.45	$838.45	$0.00	$708.75	"$1,122.66"	"$1,134.00"	$0.00		$0.00	$221.84	$0.00	$0.00	$225.67	$0.00	$0.00	$0.00	$0.00	$0.00
71678005	SUP	HCPCS C1713		71678005  -  SCREW BN 11MM 105MM INTERTAN LG TI SUBTROCHANTER	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
71678010	SUP	HCPCS C1713		71678010  -  SCREW BN 11MM 100MM INTERTAN LG TI SUBTROCHANTER	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
71678011	SUP	HCPCS C1713		71678011  -  SCREW BN 11MM 110MM INTERTAN LG TI SUBTROCHANTER	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
71678012	SUP	HCPCS C1713		71678012  -  SCREW BN 11MM 120MM INTERTAN LG TI SUBTROCHANTER	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
71678015	SUP	HCPCS C1713		71678015  -  SCREW BN 11MM 115MM INTERTAN LG TI SUBTROCHANTER	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
71678025	SUP	HCPCS C1713		71678025  -  SCREW BN 11MM 125MM INTERTAN LG SBTCH	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
71678070	SUP	HCPCS C1713		71678070  -  SCREW BN 11MM 70MM INTERTAN LG SBTCH	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
71678075	SUP	HCPCS C1713		71678075  -  SCREW BN 11MM 75MM INTERTAN LG SBTCH	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
71678080	SUP	HCPCS C1713		71678080  -  SCREW BN 11MM 80MM INTERTAN LG TI SUBTROCHANTER	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
71678085	SUP	HCPCS C1713		71678085  -  SCREW BN 11MM 85MM INTERTAN LG TI SUBTROCHANTER	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
71678090	SUP	HCPCS C1713		71678090  -  SCREW BN 11MM 90MM INTERTAN LG TI SUBTROCHANTER	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
71678095	SUP	HCPCS C1713		71678095  -  SCREW BN 11MM 95MM INTERTAN LG TI SUBTROCHANTER	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
71679002	SUP	HCPCS C1713		71679002  -  PLATE BN 127D 80MM INTERTAN CHS 2 HL SS	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$936.00	$936.00	$0.00	$0.00	$0.00	$433.52	"$1,543.78"	"$1,543.78"	$0.00	$0.00	$433.47	$0.00	"$1,230.32"	"$1,230.32"	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00		$0.00	$325.52	$0.00	$0.00	$331.14	$0.00	$0.00	$0.00	$0.00	$0.00
71679003	SUP	HCPCS C1713		71679003  -  PLATE BN 127D 92MM INTERTAN CHS 3 HL SS	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$936.00	$936.00	$0.00	$0.00	$0.00	$433.52	"$1,543.78"	"$1,543.78"	$0.00	$0.00	$433.47	$0.00	"$1,230.32"	"$1,230.32"	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00		$0.00	$325.52	$0.00	$0.00	$331.14	$0.00	$0.00	$0.00	$0.00	$0.00
71679004	SUP	HCPCS C1713		71679004  -  PLATE BN 127D 104MM INTERTAN CHS 4 HL SS	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$936.00	$936.00	$0.00	$0.00	$0.00	$433.52	"$1,543.78"	"$1,543.78"	$0.00	$0.00	$433.47	$0.00	"$1,230.32"	"$1,230.32"	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00		$0.00	$325.52	$0.00	$0.00	$331.14	$0.00	$0.00	$0.00	$0.00	$0.00
71679005	SUP	HCPCS C1713		71679005  -  PLATE BN 127D 116MM INTERTAN CHS 5 HL SS HIP	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$936.00	$936.00	$0.00	$0.00	$0.00	$433.52	"$1,543.78"	"$1,543.78"	$0.00	$0.00	$433.47	$0.00	"$1,230.32"	"$1,230.32"	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00		$0.00	$325.52	$0.00	$0.00	$331.14	$0.00	$0.00	$0.00	$0.00	$0.00
71679006	SUP	HCPCS C1713		71679006  -  PLATE BN 127D 128MM INTERTAN CHS 6 HL SS HIP	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$936.00	$936.00	$0.00	$0.00	$0.00	$433.52	"$1,543.78"	"$1,543.78"	$0.00	$0.00	$433.47	$0.00	"$1,230.32"	"$1,230.32"	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00		$0.00	$325.52	$0.00	$0.00	$331.14	$0.00	$0.00	$0.00	$0.00	$0.00
71679102	SUP	HCPCS C1713		71679102  -  PLATE BN 135D 84MM INTERTAN CHS 2 HL SS	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$936.00	$936.00	$0.00	$0.00	$0.00	$433.52	"$1,543.78"	"$1,543.78"	$0.00	$0.00	$433.47	$0.00	"$1,230.32"	"$1,230.32"	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00		$0.00	$325.52	$0.00	$0.00	$331.14	$0.00	$0.00	$0.00	$0.00	$0.00
71679103	SUP	HCPCS C1713		71679103  -  PLATE BN 135D 96MM INTERTAN CHS 3 HL SS HIP	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$936.00	$936.00	$0.00	$0.00	$0.00	$433.52	"$1,543.78"	"$1,543.78"	$0.00	$0.00	$433.47	$0.00	"$1,230.32"	"$1,230.32"	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00		$0.00	$325.52	$0.00	$0.00	$331.14	$0.00	$0.00	$0.00	$0.00	$0.00
71679104	SUP	HCPCS C1713		71679104  -  PLATE BN 135D 4 HL CMPR ORTH	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$936.00	$936.00	$0.00	$0.00	$0.00	$433.52	"$1,543.78"	"$1,543.78"	$0.00	$0.00	$433.47	$0.00	"$1,230.32"	"$1,230.32"	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00		$0.00	$325.52	$0.00	$0.00	$331.14	$0.00	$0.00	$0.00	$0.00	$0.00
71679105	SUP	HCPCS C1713		71679105  -  PLATE BN 135D 120MM INTERTAN CHS 5 HL SS HIP	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$936.00	$936.00	$0.00	$0.00	$0.00	$433.52	"$1,543.78"	"$1,543.78"	$0.00	$0.00	$433.47	$0.00	"$1,230.32"	"$1,230.32"	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00		$0.00	$325.52	$0.00	$0.00	$331.14	$0.00	$0.00	$0.00	$0.00	$0.00
71679106	SUP	HCPCS C1713		71679106  -  SCREW BN 135D 132MM INTERTAN CHS 6 HL SS	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$936.00	$936.00	$0.00	$0.00	$0.00	$433.52	"$1,543.78"	"$1,543.78"	$0.00	$0.00	$433.47	$0.00	"$1,230.32"	"$1,230.32"	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00		$0.00	$325.52	$0.00	$0.00	$331.14	$0.00	$0.00	$0.00	$0.00	$0.00
71679230	SUP	HCPCS C1713		71679230  -  SCREW BN 30MM INTERTAN CHS CMPR SS	BOTH IP/OP	$904.00 	$668.96	$0.00	$723.20	$406.80	$406.80	$0.00	$0.00	$0.00	$188.42	$670.95	$670.95	$0.00	$0.00	$188.39	$0.00	$534.72	$534.72	$0.00	$452.00	$715.97	$723.20	$0.00		$0.00	$141.48	$0.00	$0.00	$143.92	$0.00	$0.00	$0.00	$0.00	$0.00
71679265	SUP	HCPCS C1713		71679265  -  SCREW BN 65/60 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,642.00 "	"$1,215.08"	$0.00	"$1,313.60"	$738.90	$738.90	$0.00	$0.00	$0.00	$342.23	"$1,218.69"	"$1,218.69"	$0.00	$0.00	$342.19	$0.00	$971.24	$971.24	$0.00	$821.00	"$1,300.46"	"$1,313.60"	$0.00		$0.00	$256.97	$0.00	$0.00	$261.41	$0.00	$0.00	$0.00	$0.00	$0.00
71679270	SUP	HCPCS C1713		71679270  -  SCREW BN 70/65 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,642.00 "	"$1,215.08"	$0.00	"$1,313.60"	$738.90	$738.90	$0.00	$0.00	$0.00	$342.23	"$1,218.69"	"$1,218.69"	$0.00	$0.00	$342.19	$0.00	$971.24	$971.24	$0.00	$821.00	"$1,300.46"	"$1,313.60"	$0.00		$0.00	$256.97	$0.00	$0.00	$261.41	$0.00	$0.00	$0.00	$0.00	$0.00
71679275	SUP	HCPCS C1713		71679275  -  SCREW BN 75/70 INTERTAN CHS CMPR LG SS HIP	BOTH IP/OP	"$1,642.00 "	"$1,215.08"	$0.00	"$1,313.60"	$738.90	$738.90	$0.00	$0.00	$0.00	$342.23	"$1,218.69"	"$1,218.69"	$0.00	$0.00	$342.19	$0.00	$971.24	$971.24	$0.00	$821.00	"$1,300.46"	"$1,313.60"	$0.00		$0.00	$256.97	$0.00	$0.00	$261.41	$0.00	$0.00	$0.00	$0.00	$0.00
71679280	SUP	HCPCS C1713		71679280  -  SCREW BN 80/75 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,642.00 "	"$1,215.08"	$0.00	"$1,313.60"	$738.90	$738.90	$0.00	$0.00	$0.00	$342.23	"$1,218.69"	"$1,218.69"	$0.00	$0.00	$342.19	$0.00	$971.24	$971.24	$0.00	$821.00	"$1,300.46"	"$1,313.60"	$0.00		$0.00	$256.97	$0.00	$0.00	$261.41	$0.00	$0.00	$0.00	$0.00	$0.00
71679285	SUP	HCPCS C1713		71679285  -  SCREW BN 85/80 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,642.00 "	"$1,215.08"	$0.00	"$1,313.60"	$738.90	$738.90	$0.00	$0.00	$0.00	$342.23	"$1,218.69"	"$1,218.69"	$0.00	$0.00	$342.19	$0.00	$971.24	$971.24	$0.00	$821.00	"$1,300.46"	"$1,313.60"	$0.00		$0.00	$256.97	$0.00	$0.00	$261.41	$0.00	$0.00	$0.00	$0.00	$0.00
71679290	SUP	HCPCS C1713		71679290  -  SCREW BN 90/85 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,642.00 "	"$1,215.08"	$0.00	"$1,313.60"	$738.90	$738.90	$0.00	$0.00	$0.00	$342.23	"$1,218.69"	"$1,218.69"	$0.00	$0.00	$342.19	$0.00	$971.24	$971.24	$0.00	$821.00	"$1,300.46"	"$1,313.60"	$0.00		$0.00	$256.97	$0.00	$0.00	$261.41	$0.00	$0.00	$0.00	$0.00	$0.00
71679295	SUP	HCPCS C1713		71679295  -  SCREW BN 95/90 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,642.00 "	"$1,215.08"	$0.00	"$1,313.60"	$738.90	$738.90	$0.00	$0.00	$0.00	$342.23	"$1,218.69"	"$1,218.69"	$0.00	$0.00	$342.19	$0.00	$971.24	$971.24	$0.00	$821.00	"$1,300.46"	"$1,313.60"	$0.00		$0.00	$256.97	$0.00	$0.00	$261.41	$0.00	$0.00	$0.00	$0.00	$0.00
71679300	SUP	HCPCS C1713		71679300  -  SCREW BN 100/95 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,642.00 "	"$1,215.08"	$0.00	"$1,313.60"	$738.90	$738.90	$0.00	$0.00	$0.00	$342.23	"$1,218.69"	"$1,218.69"	$0.00	$0.00	$342.19	$0.00	$971.24	$971.24	$0.00	$821.00	"$1,300.46"	"$1,313.60"	$0.00		$0.00	$256.97	$0.00	$0.00	$261.41	$0.00	$0.00	$0.00	$0.00	$0.00
71679305	SUP	HCPCS C1713		71679305  -  SCREW BN 105/100 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,642.00 "	"$1,215.08"	$0.00	"$1,313.60"	$738.90	$738.90	$0.00	$0.00	$0.00	$342.23	"$1,218.69"	"$1,218.69"	$0.00	$0.00	$342.19	$0.00	$971.24	$971.24	$0.00	$821.00	"$1,300.46"	"$1,313.60"	$0.00		$0.00	$256.97	$0.00	$0.00	$261.41	$0.00	$0.00	$0.00	$0.00	$0.00
71679310	SUP	HCPCS C1713		71679310  -  SCREW BN 110/105 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,642.00 "	"$1,215.08"	$0.00	"$1,313.60"	$738.90	$738.90	$0.00	$0.00	$0.00	$342.23	"$1,218.69"	"$1,218.69"	$0.00	$0.00	$342.19	$0.00	$971.24	$971.24	$0.00	$821.00	"$1,300.46"	"$1,313.60"	$0.00		$0.00	$256.97	$0.00	$0.00	$261.41	$0.00	$0.00	$0.00	$0.00	$0.00
71679315	SUP	HCPCS C1713		71679315  -  SCREW BN 115/110 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,642.00 "	"$1,215.08"	$0.00	"$1,313.60"	$738.90	$738.90	$0.00	$0.00	$0.00	$342.23	"$1,218.69"	"$1,218.69"	$0.00	$0.00	$342.19	$0.00	$971.24	$971.24	$0.00	$821.00	"$1,300.46"	"$1,313.60"	$0.00		$0.00	$256.97	$0.00	$0.00	$261.41	$0.00	$0.00	$0.00	$0.00	$0.00
71679320	SUP	HCPCS C1713		71679320  -  SCREW BN 120/115 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,530.00 "	"$1,132.20"	$0.00	"$1,224.00"	$688.50	$688.50	$0.00	$0.00	$0.00	$318.89	"$1,135.57"	"$1,135.57"	$0.00	$0.00	$318.85	$0.00	$905.00	$905.00	$0.00	$765.00	"$1,211.76"	"$1,224.00"	$0.00		$0.00	$239.45	$0.00	$0.00	$243.58	$0.00	$0.00	$0.00	$0.00	$0.00
71679325	SUP	HCPCS C1713		71679325  -  SCREW BN 125/120 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,530.00 "	"$1,132.20"	$0.00	"$1,224.00"	$688.50	$688.50	$0.00	$0.00	$0.00	$318.89	"$1,135.57"	"$1,135.57"	$0.00	$0.00	$318.85	$0.00	$905.00	$905.00	$0.00	$765.00	"$1,211.76"	"$1,224.00"	$0.00		$0.00	$239.45	$0.00	$0.00	$243.58	$0.00	$0.00	$0.00	$0.00	$0.00
71679330	SUP	HCPCS C1713		71679330  -  SCREW BN 130/125 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,530.00 "	"$1,132.20"	$0.00	"$1,224.00"	$688.50	$688.50	$0.00	$0.00	$0.00	$318.89	"$1,135.57"	"$1,135.57"	$0.00	$0.00	$318.85	$0.00	$905.00	$905.00	$0.00	$765.00	"$1,211.76"	"$1,224.00"	$0.00		$0.00	$239.45	$0.00	$0.00	$243.58	$0.00	$0.00	$0.00	$0.00	$0.00
71679335	SUP	HCPCS C1713		71679335  -  SCREW BN 135/130MM INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,530.00 "	"$1,132.20"	$0.00	"$1,224.00"	$688.50	$688.50	$0.00	$0.00	$0.00	$318.89	"$1,135.57"	"$1,135.57"	$0.00	$0.00	$318.85	$0.00	$905.00	$905.00	$0.00	$765.00	"$1,211.76"	"$1,224.00"	$0.00		$0.00	$239.45	$0.00	$0.00	$243.58	$0.00	$0.00	$0.00	$0.00	$0.00
71679340	SUP	HCPCS C1713		71679340  -  SCREW BN 140/135 INTERTAN CHS LG CMPR SS	BOTH IP/OP	"$1,530.00 "	"$1,132.20"	$0.00	"$1,224.00"	$688.50	$688.50	$0.00	$0.00	$0.00	$318.89	"$1,135.57"	"$1,135.57"	$0.00	$0.00	$318.85	$0.00	$905.00	$905.00	$0.00	$765.00	"$1,211.76"	"$1,224.00"	$0.00		$0.00	$239.45	$0.00	$0.00	$243.58	$0.00	$0.00	$0.00	$0.00	$0.00
71683935	SUP	HCPCS C1713		71683935  -  CAP END IMHS CP HIP IM NL	BOTH IP/OP	$700.88 	$518.65	$0.00	$560.70	$315.39	$315.39	$0.00	$0.00	$0.00	$146.08	$520.19	$520.19	$0.00	$0.00	$146.06	$0.00	$414.57	$414.57	$0.00	$350.44	$555.10	$560.70	$0.00		$0.00	$109.69	$0.00	$0.00	$111.58	$0.00	$0.00	$0.00	$0.00	$0.00
71683940	SUP	HCPCS C1713		71683940  -  SET SCR IMHS CP CNN INTRAMEDULLARLY HIP SCR	BOTH IP/OP	$476.88 	$352.89	$0.00	$381.50	$214.59	$214.59	$0.00	$0.00	$0.00	$99.39	$353.94	$353.94	$0.00	$0.00	$99.38	$0.00	$282.07	$282.07	$0.00	$238.44	$377.69	$381.50	$0.00		$0.00	$74.63	$0.00	$0.00	$75.92	$0.00	$0.00	$0.00	$0.00	$0.00
71683945	SUP	HCPCS C1713		71683945  -  SCREW BN 19MM IMHS CP CPTR CMPR HIP IM NL SYS	BOTH IP/OP	$600.25 	$444.19	$0.00	$480.20	$270.11	$270.11	$0.00	$0.00	$0.00	$125.11	$445.51	$445.51	$0.00	$0.00	$125.09	$0.00	$355.05	$355.05	$0.00	$300.13	$475.40	$480.20	$0.00		$0.00	$93.94	$0.00	$0.00	$95.56	$0.00	$0.00	$0.00	$0.00	$0.00
71684070	SUP	HCPCS C1713		71684070  -  SCREW BN 12.7MM 70MM IMHS CP LG SBTCH IM NL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684075	SUP	HCPCS C1713		71684075  -  SCREW BN 12.7MM 75MM IMHS CP LG SBTCH IM NL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684080	SUP	HCPCS C1713		71684080  -  SCREW BN 12.7MM 80MM IMHS CP LG SBTCH IM NL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684085	SUP	HCPCS C1713		71684085  -  SCREW BN 12.7MM 85MM IMHS CP LG SUBTROCHANTER IM NL SYS	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684090	SUP	HCPCS C1713		71684090  -  SCREW BN 12.7MM 90MM IMHS CP LG SUBTROCHANTER IM NL SYS	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684095	SUP	HCPCS C1713		71684095  -  SCREW BN 12.7MM 95MM IMHS CP LG SBTCH IM NL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684100	SUP	HCPCS C1713		71684100  -  SCREW BN 12.7MM 100MM IMHS CP LG SUBTROCHANTER IM NL SYS	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684105	SUP	HCPCS C1713		71684105  -  SCREW BN 12.7MM 105MM IMHS CP LG SUBTROCHANTER IM NL SYS	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684110	SUP	HCPCS C1713		71684110  -  SCREW BN 12.7MM 110MM IMHS CP LG SUBTROCHANTER IM NL SYS	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684115	SUP	HCPCS C1713		71684115  -  SCREW BN 12.7MM 115MM IMHS CP LG SUBTROCHANTER IM NL SYS	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684120	SUP	HCPCS C1713		71684120  -  SCREW BN 12.7MM 120MM IMHS CP LG SBTCH IM NL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684125	SUP	HCPCS C1713		71684125  -  SCREW BN 12.7MM 125MM IMHS CP LG SBTCH IM NL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684130	SUP	HCPCS C1713		71684130  -  SCREW BN 12.7MM 130MM IMHS CP LG SBTCH IM NL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684135	SUP	HCPCS C1713		71684135  -  SCREW BN 12.7MM 135MM IMHS CP LG SBTCH IM NL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71684140	SUP	HCPCS C1713		71684140  -  SCREW BN 12.7MM 140MM IMHS CP LG SBTCH IM NL	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
71687000	SUP	Custom 27203010		71687000  -  GUIDE PIN ORTHOPEDIC 3.2MM THREAD TIP IMHS CP INTRAMEDULLARY	BOTH IP/OP	$189.00 	$139.86	$0.00	$151.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$140.28	$140.28	$0.00	$0.00	$39.39	$0.00	$0.00	$0.00	$0.00	$94.50	$149.69	$151.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71751136	SUP	HCPCS C1713		71751136  -  TROCAR SRG 3.2MM 3.2MM TRGN PIN HUM DISP	BOTH IP/OP	$353.25 	$261.41	$0.00	$282.60	$158.96	$158.96	$0.00	$0.00	$0.00	$73.63	$262.18	$262.18	$0.00	$0.00	$73.62	$0.00	$208.95	$208.95	$0.00	$176.63	$279.77	$282.60	$0.00		$0.00	$55.28	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$0.00
71751148	SUP	Custom 27203010		71751148  -  BIT DRL SHRT 3.2MM STRL TRGN GRAD BRAD PNT DISP IM NL	BOTH IP/OP	$505.13 	$373.80	$0.00	$404.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.90	$374.90	$0.00	$0.00	$105.27	$0.00	$0.00	$0.00	$0.00	$252.56	$400.06	$404.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71751149	SUP	Custom 27203010		71751149  -  BIT DRL LNG 3.2MM STRL TRGN GRAD BRAD PNT DISP IM NL	BOTH IP/OP	$505.13 	$373.80	$0.00	$404.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.90	$374.90	$0.00	$0.00	$105.27	$0.00	$0.00	$0.00	$0.00	$252.56	$400.06	$404.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71754020	SUP	HCPCS C1713		71754020  -  SCREW BN 4MM 20MM TRGN ST TI HUM CORT IM NL SYS	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$0.00	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
71754022	SUP	HCPCS C1713		71754022  -  SCREW BN 4MM 22MM TRGN ST TI HUM CORT IM NL SYS	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$0.00	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
71754024	SUP	HCPCS C1713		71754024  -  SCREW BN 4MM 24MM TRGN ST TI HUM CORT IM NL SYS	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$0.00	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
71754026	SUP	HCPCS C1713		71754026  -  SCREW BN 4MM 26MM TRGN ST TI HUM CORT IM NL SYS	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$0.00	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
71754028	SUP	HCPCS C1713		71754028  -  SCREW BN 4MM 28MM TRGN ST TI HUM CORT IM NL SYS	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$0.00	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
71754030	SUP	HCPCS C1713		71754030  -  SCREW BN 4MM 30MM TRGN ST TI HUM CORT IM NL SYS	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$0.00	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
71754032	SUP	HCPCS C1713		71754032  -  SCREW BN 4MM 32MM TRGN ST TI HUM CORT IM NL SYS	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$0.00	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
71754034	SUP	HCPCS C1713		71754034  -  SCREW BN 4MM 34MM TRGN ST TI HUM CORT IM NL SYS	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$0.00	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
71754036	SUP	HCPCS C1713		71754036  -  SCREW BN 4MM 36MM TRGN ST TI HUM CORT IM NL SYS	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$0.00	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
71754038	SUP	HCPCS C1713		71754038  -  SCREW BN 4MM 38MM TRGN ST TI HUM CORT IM NL SYS	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$0.00	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
71754040	SUP	HCPCS C1713		71754040  -  SCREW BN 4MM 40MM TRGN ST TI HUM CORT IM NL SYS	BOTH IP/OP	$360.00 	$266.40	$0.00	$288.00	$162.00	$162.00	$0.00	$0.00	$0.00	$75.03	$267.19	$267.19	$0.00	$0.00	$75.02	$0.00	$212.94	$212.94	$0.00	$180.00	$285.12	$288.00	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
71754042	SUP	HCPCS C1713		71754042  -  SCREW BN 4MM 42MM TRGN ST TI HUM CORT IM NL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$153.90	$153.90	$0.00	$0.00	$0.00	$71.28	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$202.29	$202.29	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$53.52	$0.00	$0.00	$54.45	$0.00	$0.00	$0.00	$0.00	$0.00
71754044	SUP	HCPCS C1713		71754044  -  SCREW BN 4MM 44MM TRGN ST TI HUM CORT IM NL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$153.90	$153.90	$0.00	$0.00	$0.00	$71.28	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$202.29	$202.29	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$53.52	$0.00	$0.00	$54.45	$0.00	$0.00	$0.00	$0.00	$0.00
71754046	SUP	HCPCS C1713		71754046  -  SCREW BN 4MM 44MM TRGN ST TI HUM CORT IM NL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$153.90	$153.90	$0.00	$0.00	$0.00	$71.28	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$202.29	$202.29	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$53.52	$0.00	$0.00	$54.45	$0.00	$0.00	$0.00	$0.00	$0.00
71754048	SUP	HCPCS C1713		71754048  -  SCREW BN 4MM 48MM TRGN ST TI HUM CORT IM NL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$153.90	$153.90	$0.00	$0.00	$0.00	$71.28	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$202.29	$202.29	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$53.52	$0.00	$0.00	$54.45	$0.00	$0.00	$0.00	$0.00	$0.00
71754050	SUP	HCPCS C1713		71754050  -  SCREW BN 4MM 50MM TRGN ST TI HUM CORT IM NL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$153.90	$153.90	$0.00	$0.00	$0.00	$71.28	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$202.29	$202.29	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$53.52	$0.00	$0.00	$54.45	$0.00	$0.00	$0.00	$0.00	$0.00
71754052	SUP	HCPCS C1713		71754052  -  SCREW BN 4MM 52MM TRGN ST TI HUM CORT IM NL	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$139.73	$139.73	$0.00	$0.00	$0.00	$64.72	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$183.66	$183.66	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$48.59	$0.00	$0.00	$49.43	$0.00	$0.00	$0.00	$0.00	$0.00
71754054	SUP	HCPCS C1713		71754054  -  SCREW BN 4MM 54MM TRGN ST TI HUM CORT IM NL	BOTH IP/OP	$342.00 	$253.08	$0.00	$273.60	$153.90	$153.90	$0.00	$0.00	$0.00	$71.28	$253.83	$253.83	$0.00	$0.00	$71.27	$0.00	$202.29	$202.29	$0.00	$171.00	$270.86	$273.60	$0.00		$0.00	$53.52	$0.00	$0.00	$54.45	$0.00	$0.00	$0.00	$0.00	$0.00
71754056	SUP	HCPCS C1713		71754056  -  SCREW BN 4MM 56MM TRGN ST TI HUM CORT IM NL	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$139.73	$139.73	$0.00	$0.00	$0.00	$64.72	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$183.66	$183.66	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$48.59	$0.00	$0.00	$49.43	$0.00	$0.00	$0.00	$0.00	$0.00
71754058	SUP	HCPCS C1713		71754058  -  SCREW BN 4MM 58MM TRGN ST TI HUM CORT IM NL	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$139.73	$139.73	$0.00	$0.00	$0.00	$64.72	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$183.66	$183.66	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$48.59	$0.00	$0.00	$49.43	$0.00	$0.00	$0.00	$0.00	$0.00
71754060	SUP	HCPCS C1713		71754060  -  SCREW BN 4MM 60MM TRGN ST TI HUM CORT IM NL	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$139.73	$139.73	$0.00	$0.00	$0.00	$64.72	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$183.66	$183.66	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$48.59	$0.00	$0.00	$49.43	$0.00	$0.00	$0.00	$0.00	$0.00
71755024	SUP	HCPCS C1713		71755024  -  SCREW BN 5MM 24MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755026	SUP	HCPCS C1713		71755026  -  SCREW BN 5MM 26MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755028	SUP	HCPCS C1713		71755028  -  SCREW BN 5MM 28MM TRGN CNN ST TI HUM CANC IM NL	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755030	SUP	HCPCS C1713		71755030  -  SCREW BN 5MM 30MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755032	SUP	HCPCS C1713		71755032  -  SCREW BN 5MM 32MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755034	SUP	HCPCS C1713		71755034  -  SCREW BN 5MM 34MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755036	SUP	HCPCS C1713		71755036  -  SCREW BN 5MM 36MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755038	SUP	HCPCS C1713		71755038  -  SCREW BN 5MM 38MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755040	SUP	HCPCS C1713		71755040  -  SCREW BN 5MM 40MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755042	SUP	HCPCS C1713		71755042  -  SCREW BN 5MM 42MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755044	SUP	HCPCS C1713		71755044  -  SCREW BN 5MM 44MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755046	SUP	HCPCS C1713		71755046  -  SCREW BN 5MM 46MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755048	SUP	HCPCS C1713		71755048  -  SCREW BN 5MM 48MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755050	SUP	HCPCS C1713		71755050  -  SCREW BN 5MM 50MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755052	SUP	HCPCS C1713		71755052  -  SCREW BN 5MM 52MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755054	SUP	HCPCS C1713		71755054  -  SCREW BN 5MM 54MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755056	SUP	HCPCS C1713		71755056  -  SCREW BN 5MM 56MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755058	SUP	HCPCS C1713		71755058  -  SCREW BN 5MM 58MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755060	SUP	HCPCS C1713		71755060  -  SCREW BN 5MM 60MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755062	SUP	HCPCS C1713		71755062  -  SCREW BN 5MM 62MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71755064	SUP	HCPCS C1713		71755064  -  SCREW BN 5MM 64MM TRGN ST TI HUM CANC IM NL SYS	BOTH IP/OP	$437.63 	$323.85	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$91.21	$324.81	$324.81	$0.00	$0.00	$91.20	$0.00	$258.86	$258.86	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$68.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
71760000	SUP	HCPCS C1713		71760000  -  CAP END 0MM TRGN HUM IM NL	BOTH IP/OP	$221.63 	$164.01	$0.00	$177.30	$99.73	$99.73	$0.00	$0.00	$0.00	$46.19	$164.49	$164.49	$0.00	$0.00	$46.19	$0.00	$131.09	$131.09	$0.00	$110.81	$175.53	$177.30	$0.00		$0.00	$34.68	$0.00	$0.00	$35.28	$0.00	$0.00	$0.00	$0.00	$0.00
71760816	SUP	HCPCS C1713		71760816  -  NAIL IM 8/7MM 16CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71760818	SUP	HCPCS C1713		71760818  -  NAIL IM 8/7MM 18CM TRGN STRG TI HUM	BOTH IP/OP	"$3,048.75 "	"$2,256.08"	$0.00	"$2,439.00"	"$1,371.94"	"$1,371.94"	$0.00	$0.00	$0.00	$635.44	"$2,262.78"	"$2,262.78"	$0.00	$0.00	$635.36	$0.00	"$1,503.03"	"$1,503.03"	$0.00	"$1,524.38"	"$2,414.61"	"$2,439.00"	$0.00		$0.00	$477.13	$0.00	$0.00	$485.36	$0.00	$0.00	$0.00	$0.00	$0.00
71760820	SUP	HCPCS C1713		71760820  -  NAIL IM 8/7MM 20CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71760822	SUP	HCPCS C1713		71760822  -  NAIL IM 8/7MM 22CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71760826	SUP	HCPCS C1713		71760826  -  NAIL IM 8/7MM 26CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71760828	SUP	HCPCS C1713		71760828  -  NAIL IM 8/7MM 28CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71760830	SUP	HCPCS C1713		71760830  -  NAIL IM 8/7MM 30CM HUM	BOTH IP/OP	"$4,370.00 "	"$3,233.80"	$0.00	"$3,496.00"	"$1,966.50"	"$1,966.50"	$0.00	$0.00	$0.00	$910.82	"$3,243.41"	"$3,243.41"	$0.00	$0.00	$910.71	$0.00	"$2,154.41"	"$2,154.41"	$0.00	"$2,185.00"	"$3,461.04"	"$3,496.00"	$0.00		$0.00	$683.91	$0.00	$0.00	$695.70	$0.00	$0.00	$0.00	$0.00	$0.00
71760918	SUP	HCPCS C1713		71760918  -  NAIL IM 8/7MM 18CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71760920	SUP	HCPCS C1713		71760920  -  NAIL IM 9/7.5MM 20CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71760922	SUP	HCPCS C1713		71760922  -  NAIL IM 9/7.5MM 22CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71760924	SUP	HCPCS C1713		71760924  -  NAIL IM 9/7.5MM 24CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71760926	SUP	HCPCS C1713		71760926  -  NAIL IM 9/7.5MM 26CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71760928	SUP	HCPCS C1713		71760928  -  NAIL IM 9/7.5MM 28CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71760930	SUP	HCPCS C1713		71760930  -  NAIL IM 9/7MM 30CM HUM	BOTH IP/OP	"$4,370.00 "	"$3,233.80"	$0.00	"$3,496.00"	"$1,966.50"	"$1,966.50"	$0.00	$0.00	$0.00	$910.82	"$3,243.41"	"$3,243.41"	$0.00	$0.00	$910.71	$0.00	"$2,154.41"	"$2,154.41"	$0.00	"$2,185.00"	"$3,461.04"	"$3,496.00"	$0.00		$0.00	$683.91	$0.00	$0.00	$695.70	$0.00	$0.00	$0.00	$0.00	$0.00
71761018	SUP	HCPCS C1713		71761018  -  NAIL IM 10/8.5MM 18CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71761020	SUP	HCPCS C1713		71761020  -  NAIL IM 10/8.5MM 20CM TRGN STRG TI HUM	BOTH IP/OP	"$3,048.75 "	"$2,256.08"	$0.00	"$2,439.00"	"$1,371.94"	"$1,371.94"	$0.00	$0.00	$0.00	$635.44	"$2,262.78"	"$2,262.78"	$0.00	$0.00	$635.36	$0.00	"$1,503.03"	"$1,503.03"	$0.00	"$1,524.38"	"$2,414.61"	"$2,439.00"	$0.00		$0.00	$477.13	$0.00	$0.00	$485.36	$0.00	$0.00	$0.00	$0.00	$0.00
71761022	SUP	HCPCS C1713		71761022  -  NAIL IM 10/8.5MM 22CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71761024	SUP	HCPCS C1713		71761024  -  NAIL IM 10/8.5MM 24CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71761026	SUP	HCPCS C1713		71761026  -  NAIL IM 10/8.5MM 26CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71761028	SUP	HCPCS C1713		71761028  -  NAIL IM 10/8.5MM 28CM TRGN STRG TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71761030	SUP	HCPCS C1713		71761030  -  NAIL IM 10/8.5MM 30CM HUM	BOTH IP/OP	"$4,370.00 "	"$3,233.80"	$0.00	"$3,496.00"	"$1,966.50"	"$1,966.50"	$0.00	$0.00	$0.00	$910.82	"$3,243.41"	"$3,243.41"	$0.00	$0.00	$910.71	$0.00	"$2,154.41"	"$2,154.41"	$0.00	"$2,185.00"	"$3,461.04"	"$3,496.00"	$0.00		$0.00	$683.91	$0.00	$0.00	$695.70	$0.00	$0.00	$0.00	$0.00	$0.00
71761118	SUP	HCPCS C1713		71761118  -  NAIL IM 11/9.5MM 18CM HUM	BOTH IP/OP	"$4,370.00 "	"$3,233.80"	$0.00	"$3,496.00"	"$1,966.50"	"$1,966.50"	$0.00	$0.00	$0.00	$910.82	"$3,243.41"	"$3,243.41"	$0.00	$0.00	$910.71	$0.00	"$2,154.41"	"$2,154.41"	$0.00	"$2,185.00"	"$3,461.04"	"$3,496.00"	$0.00		$0.00	$683.91	$0.00	$0.00	$695.70	$0.00	$0.00	$0.00	$0.00	$0.00
71761120	SUP	HCPCS C1713		71761120  -  NAIL IM 11/9.5MM 20CM HUM	BOTH IP/OP	"$4,370.00 "	"$3,233.80"	$0.00	"$3,496.00"	"$1,966.50"	"$1,966.50"	$0.00	$0.00	$0.00	$910.82	"$3,243.41"	"$3,243.41"	$0.00	$0.00	$910.71	$0.00	"$2,154.41"	"$2,154.41"	$0.00	"$2,185.00"	"$3,461.04"	"$3,496.00"	$0.00		$0.00	$683.91	$0.00	$0.00	$695.70	$0.00	$0.00	$0.00	$0.00	$0.00
71761122	SUP	HCPCS C1713		71761122  -  NAIL IM 11/9.5MM 22CM HUM	BOTH IP/OP	"$4,370.00 "	"$3,233.80"	$0.00	"$3,496.00"	"$1,966.50"	"$1,966.50"	$0.00	$0.00	$0.00	$910.82	"$3,243.41"	"$3,243.41"	$0.00	$0.00	$910.71	$0.00	"$2,154.41"	"$2,154.41"	$0.00	"$2,185.00"	"$3,461.04"	"$3,496.00"	$0.00		$0.00	$683.91	$0.00	$0.00	$695.70	$0.00	$0.00	$0.00	$0.00	$0.00
71761124	SUP	HCPCS C1713		71761124  -  NAIL IM 11/9.5MM 24CM HUM	BOTH IP/OP	"$4,370.00 "	"$3,233.80"	$0.00	"$3,496.00"	"$1,966.50"	"$1,966.50"	$0.00	$0.00	$0.00	$910.82	"$3,243.41"	"$3,243.41"	$0.00	$0.00	$910.71	$0.00	"$2,154.41"	"$2,154.41"	$0.00	"$2,185.00"	"$3,461.04"	"$3,496.00"	$0.00		$0.00	$683.91	$0.00	$0.00	$695.70	$0.00	$0.00	$0.00	$0.00	$0.00
71761126	SUP	HCPCS C1713		71761126  -  NAIL IM 11/9.5MM 26CM HUM	BOTH IP/OP	"$3,048.75 "	"$2,256.08"	$0.00	"$2,439.00"	"$1,371.94"	"$1,371.94"	$0.00	$0.00	$0.00	$635.44	"$2,262.78"	"$2,262.78"	$0.00	$0.00	$635.36	$0.00	"$1,503.03"	"$1,503.03"	$0.00	"$1,524.38"	"$2,414.61"	"$2,439.00"	$0.00		$0.00	$477.13	$0.00	$0.00	$485.36	$0.00	$0.00	$0.00	$0.00	$0.00
71761128	SUP	HCPCS C1713		71761128  -  NAIL IM 11/9.5MM 28CM HUM	BOTH IP/OP	"$4,370.00 "	"$3,233.80"	$0.00	"$3,496.00"	"$1,966.50"	"$1,966.50"	$0.00	$0.00	$0.00	$910.82	"$3,243.41"	"$3,243.41"	$0.00	$0.00	$910.71	$0.00	"$2,154.41"	"$2,154.41"	$0.00	"$2,185.00"	"$3,461.04"	"$3,496.00"	$0.00		$0.00	$683.91	$0.00	$0.00	$695.70	$0.00	$0.00	$0.00	$0.00	$0.00
71761130	SUP	HCPCS C1713		71761130  -  NAIL IM 11/9.5MM 30CM HUM	BOTH IP/OP	"$4,370.00 "	"$3,233.80"	$0.00	"$3,496.00"	"$1,966.50"	"$1,966.50"	$0.00	$0.00	$0.00	$910.82	"$3,243.41"	"$3,243.41"	$0.00	$0.00	$910.71	$0.00	"$2,154.41"	"$2,154.41"	$0.00	"$2,185.00"	"$3,461.04"	"$3,496.00"	$0.00		$0.00	$683.91	$0.00	$0.00	$695.70	$0.00	$0.00	$0.00	$0.00	$0.00
71770816	SUP	HCPCS C1713		71770816  -  NAIL IM LNG 8/7MM 16CM TRGN IMPL SET BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770818	SUP	HCPCS C1713		71770818  -  NAIL IM 8/7MM 18CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770820	SUP	HCPCS C1713		71770820  -  NAIL IM 8/7MM 20CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770822	SUP	HCPCS C1713		71770822  -  NAIL IM 8/7MM 22CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770824	SUP	HCPCS C1713		71770824  -  NAIL IM 8/7MM 24CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770826	SUP	HCPCS C1713		71770826  -  NAIL IM LNG 8/7MM 26CM TRGN IMPL SET BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770828	SUP	HCPCS C1713		71770828  -  NAIL IM 8/7MM 28CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770830	SUP	HCPCS C1713		71770830  -  NAIL IM 8/7MM 30CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770918	SUP	HCPCS C1713		71770918  -  NAIL IM 9/7.5MM 18CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770920	SUP	HCPCS C1713		71770920  -  NAIL IM LNG 9/7.5MM 20CM TRGN IMPL SET BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770922	SUP	HCPCS C1713		71770922  -  NAIL IM LNG 9/7.5MM 22CM TRGN IMPL SET BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770924	SUP	HCPCS C1713		71770924  -  NAIL IM LNG 9/7.5MM 24CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770926	SUP	HCPCS C1713		71770926  -  NAIL IM 9 7.5MM 26CM TRGN SET TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770928	SUP	HCPCS C1713		71770928  -  NAIL IM 9/7.5MM 28CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71770930	SUP	HCPCS C1713		71770930  -  NAIL IM 9/7.5MM 30CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71771018	SUP	HCPCS C1713		71771018  -  NAIL IM 10/8.5MM 18CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71771020	SUP	HCPCS C1713		71771020  -  NAIL IM 10/8.5MM 20CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71771022	SUP	HCPCS C1713		71771022  -  NAIL IM LNG 10MM 8.5MM 22CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71771024	SUP	HCPCS C1713		71771024  -  NAIL IM 10MM 8.5MM 24CM FRSGHT BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71771026	SUP	HCPCS C1713		71771026  -  NAIL IM 10MM 8.5MM 26CM TRGN IMPL SET TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71771028	SUP	HCPCS C1713		71771028  -  NAIL IM 10 8.5MM 28CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71771030	SUP	HCPCS C1713		71771030  -  NAIL IM 10/8.5MM 30CM TRGN BNT TI HUM	BOTH IP/OP	"$3,656.25 "	"$2,705.63"	$0.00	"$2,925.00"	"$1,645.31"	"$1,645.31"	$0.00	$0.00	$0.00	$762.05	"$2,713.67"	"$2,713.67"	$0.00	$0.00	$761.96	$0.00	"$1,802.53"	"$1,802.53"	$0.00	"$1,828.13"	"$2,895.75"	"$2,925.00"	$0.00		$0.00	$572.20	$0.00	$0.00	$582.08	$0.00	$0.00	$0.00	$0.00	$0.00
71771118	SUP	HCPCS C1713		71771118  -  NAIL IM 11/9.5MM 18CM HUM	BOTH IP/OP	"$2,576.25 "	"$1,906.43"	$0.00	"$2,061.00"	"$1,159.31"	"$1,159.31"	$0.00	$0.00	$0.00	$536.95	"$1,912.09"	"$1,912.09"	$0.00	$0.00	$536.89	$0.00	"$1,270.09"	"$1,270.09"	$0.00	"$1,288.13"	"$2,040.39"	"$2,061.00"	$0.00		$0.00	$403.18	$0.00	$0.00	$410.14	$0.00	$0.00	$0.00	$0.00	$0.00
71771120	SUP	HCPCS C1713		71771120  -  NAIL IM 11/9.5MM 20CM HUM	BOTH IP/OP	"$2,576.25 "	"$1,906.43"	$0.00	"$2,061.00"	"$1,159.31"	"$1,159.31"	$0.00	$0.00	$0.00	$536.95	"$1,912.09"	"$1,912.09"	$0.00	$0.00	$536.89	$0.00	"$1,270.09"	"$1,270.09"	$0.00	"$1,288.13"	"$2,040.39"	"$2,061.00"	$0.00		$0.00	$403.18	$0.00	$0.00	$410.14	$0.00	$0.00	$0.00	$0.00	$0.00
71771122	SUP	HCPCS C1713		71771122  -  NAIL IM 11/9.5MM 22CM HUM	BOTH IP/OP	"$2,576.25 "	"$1,906.43"	$0.00	"$2,061.00"	"$1,159.31"	"$1,159.31"	$0.00	$0.00	$0.00	$536.95	"$1,912.09"	"$1,912.09"	$0.00	$0.00	$536.89	$0.00	"$1,270.09"	"$1,270.09"	$0.00	"$1,288.13"	"$2,040.39"	"$2,061.00"	$0.00		$0.00	$403.18	$0.00	$0.00	$410.14	$0.00	$0.00	$0.00	$0.00	$0.00
71771124	SUP	HCPCS C1713		71771124  -  NAIL IM 11/9.5MM 24CM HUM	BOTH IP/OP	"$2,576.25 "	"$1,906.43"	$0.00	"$2,061.00"	"$1,159.31"	"$1,159.31"	$0.00	$0.00	$0.00	$536.95	"$1,912.09"	"$1,912.09"	$0.00	$0.00	$536.89	$0.00	"$1,270.09"	"$1,270.09"	$0.00	"$1,288.13"	"$2,040.39"	"$2,061.00"	$0.00		$0.00	$403.18	$0.00	$0.00	$410.14	$0.00	$0.00	$0.00	$0.00	$0.00
71771126	SUP	HCPCS C1713		71771126  -  NAIL IM 11/9.5MM 26CM HUM	BOTH IP/OP	"$2,576.25 "	"$1,906.43"	$0.00	"$2,061.00"	"$1,159.31"	"$1,159.31"	$0.00	$0.00	$0.00	$536.95	"$1,912.09"	"$1,912.09"	$0.00	$0.00	$536.89	$0.00	"$1,270.09"	"$1,270.09"	$0.00	"$1,288.13"	"$2,040.39"	"$2,061.00"	$0.00		$0.00	$403.18	$0.00	$0.00	$410.14	$0.00	$0.00	$0.00	$0.00	$0.00
71771128	SUP	HCPCS C1713		71771128  -  NAIL IM 11/9.5MM 28CM HUM	BOTH IP/OP	"$2,576.25 "	"$1,906.43"	$0.00	"$2,061.00"	"$1,159.31"	"$1,159.31"	$0.00	$0.00	$0.00	$536.95	"$1,912.09"	"$1,912.09"	$0.00	$0.00	$536.89	$0.00	"$1,270.09"	"$1,270.09"	$0.00	"$1,288.13"	"$2,040.39"	"$2,061.00"	$0.00		$0.00	$403.18	$0.00	$0.00	$410.14	$0.00	$0.00	$0.00	$0.00	$0.00
71771130	SUP	HCPCS C1713		71771130  -  NAIL IM 11/9.5MM 30CM HUM	BOTH IP/OP	"$3,048.75 "	"$2,256.08"	$0.00	"$2,439.00"	"$1,371.94"	"$1,371.94"	$0.00	$0.00	$0.00	$635.44	"$2,262.78"	"$2,262.78"	$0.00	$0.00	$635.36	$0.00	"$1,503.03"	"$1,503.03"	$0.00	"$1,524.38"	"$2,414.61"	"$2,439.00"	$0.00		$0.00	$477.13	$0.00	$0.00	$485.36	$0.00	$0.00	$0.00	$0.00	$0.00
71800308	SUP	HCPCS C1713		71800308  -  PLATE BN 165MM PRLC 8 HL LCK SS TIB RT PROX LAT 4.5MM SCR	BOTH IP/OP	"$3,402.00 "	"$2,517.48"	$0.00	"$2,721.60"	"$1,530.90"	"$1,530.90"	$0.00	$0.00	$0.00	$709.06	"$2,524.96"	"$2,524.96"	$0.00	$0.00	$708.98	$0.00	"$1,677.19"	"$1,677.19"	$0.00	"$1,701.00"	"$2,694.38"	"$2,721.60"	$0.00		$0.00	$532.41	$0.00	$0.00	$541.60	$0.00	$0.00	$0.00	$0.00	$0.00
71800313	SUP	HCPCS C1713		71800313  -  PLATE BN 255MM PRLC 13 HL LCK SS TIB RT PROX LAT 4.5MM SCR	BOTH IP/OP	"$3,491.25 "	"$2,583.53"	$0.00	"$2,793.00"	"$1,571.06"	"$1,571.06"	$0.00	$0.00	$0.00	$727.66	"$2,591.21"	"$2,591.21"	$0.00	$0.00	$727.58	$0.00	"$1,721.19"	"$1,721.19"	$0.00	"$1,745.63"	"$2,765.07"	"$2,793.00"	$0.00		$0.00	$546.38	$0.00	$0.00	$555.81	$0.00	$0.00	$0.00	$0.00	$0.00
71800413	SUP	HCPCS C1713		71800413  -  PLATE BN 187MM PRLC 13 HL LCK SS TIB LT PROX LAT 3.5MM SCR	BOTH IP/OP	"$3,491.25 "	"$2,583.53"	$0.00	"$2,793.00"	"$1,571.06"	"$1,571.06"	$0.00	$0.00	$0.00	$727.66	"$2,591.21"	"$2,591.21"	$0.00	$0.00	$727.58	$0.00	"$1,721.19"	"$1,721.19"	$0.00	"$1,745.63"	"$2,765.07"	"$2,793.00"	$0.00		$0.00	$546.38	$0.00	$0.00	$555.81	$0.00	$0.00	$0.00	$0.00	$0.00
71800513	SUP	HCPCS C1713		71800513  -  PLATE BN 187MM PRLC 13 HL LCK SS TIB RT PROX LAT 3.5MM SCR	BOTH IP/OP	"$3,491.25 "	"$2,583.53"	$0.00	"$2,793.00"	"$1,571.06"	"$1,571.06"	$0.00	$0.00	$0.00	$727.66	"$2,591.21"	"$2,591.21"	$0.00	$0.00	$727.58	$0.00	"$1,721.19"	"$1,721.19"	$0.00	"$1,745.63"	"$2,765.07"	"$2,793.00"	$0.00		$0.00	$546.38	$0.00	$0.00	$555.81	$0.00	$0.00	$0.00	$0.00	$0.00
71801222	SUP	HCPCS C1713		71801222  -  SCREW BN 3.5MM 22MM STRL PRLC VLP ST LCK FT FIB CORT	BOTH IP/OP	$244.65 	$181.04	$0.00	$195.72	$110.09	$110.09	$0.00	$0.00	$0.00	$50.99	$181.58	$181.58	$0.00	$0.00	$50.99	$0.00	$144.71	$144.71	$0.00	$122.33	$193.76	$195.72	$0.00		$0.00	$38.29	$0.00	$0.00	$38.95	$0.00	$0.00	$0.00	$0.00	$0.00
71801320	SUP	HCPCS C1713		71801320  -  SCREW BN HEX LOPRFL 3.5MM 20MM STRL PRLC VLP ST FT CORT	BOTH IP/OP	$43.58 	$32.25	$0.00	$34.86	$19.61	$19.61	$0.00	$0.00	$0.00	$9.08	$32.34	$32.34	$0.00	$0.00	$9.08	$0.00	$25.77	$25.77	$0.00	$21.79	$34.52	$34.86	$0.00		$0.00	$6.82	$0.00	$0.00	$6.94	$0.00	$0.00	$0.00	$0.00	$0.00
71801328	SUP	HCPCS C1713		71801328  -  SCREW BN LOPRFL 3.5MM 28MM STRL VLP ST HEX DRV RCS CORT FT	BOTH IP/OP	$43.58 	$32.25	$0.00	$34.86	$19.61	$19.61	$0.00	$0.00	$0.00	$9.08	$32.34	$32.34	$0.00	$0.00	$9.08	$0.00	$25.77	$25.77	$0.00	$21.79	$34.52	$34.86	$0.00		$0.00	$6.82	$0.00	$0.00	$6.94	$0.00	$0.00	$0.00	$0.00	$0.00
71801332	SUP	HCPCS C1713		71801332  -  SCREW BN HEX LOPRFL 3.5MM 32MM STRL PRLC VLP ST FT CORT	BOTH IP/OP	$43.58 	$32.25	$0.00	$34.86	$19.61	$19.61	$0.00	$0.00	$0.00	$9.08	$32.34	$32.34	$0.00	$0.00	$9.08	$0.00	$25.77	$25.77	$0.00	$21.79	$34.52	$34.86	$0.00		$0.00	$6.82	$0.00	$0.00	$6.94	$0.00	$0.00	$0.00	$0.00	$0.00
71801336	SUP	HCPCS C1713		71801336  -  SCREW BN LOPRFL 3.5MM 36MM STRL VLP ST HEX DRV RCS CORT FT	BOTH IP/OP	$43.58 	$32.25	$0.00	$34.86	$19.61	$19.61	$0.00	$0.00	$0.00	$9.08	$32.34	$32.34	$0.00	$0.00	$9.08	$0.00	$25.77	$25.77	$0.00	$21.79	$34.52	$34.86	$0.00		$0.00	$6.82	$0.00	$0.00	$6.94	$0.00	$0.00	$0.00	$0.00	$0.00
71801340	SUP	HCPCS C1713		71801340  -  SCREW BN LOPRFL 3.5MM 40MM STRL VLP ST HEX DRV RCS CORT FT	BOTH IP/OP	$43.58 	$32.25	$0.00	$34.86	$19.61	$19.61	$0.00	$0.00	$0.00	$9.08	$32.34	$32.34	$0.00	$0.00	$9.08	$0.00	$25.77	$25.77	$0.00	$21.79	$34.52	$34.86	$0.00		$0.00	$6.82	$0.00	$0.00	$6.94	$0.00	$0.00	$0.00	$0.00	$0.00
71801365	SUP	HCPCS C1713		71801365  -  SCREW BN HEX LOPRFL 3.5MM 65MM STRL PRLC VLP ST FT CORT	BOTH IP/OP	$43.58 	$32.25	$0.00	$34.86	$19.61	$19.61	$0.00	$0.00	$0.00	$9.08	$32.34	$32.34	$0.00	$0.00	$9.08	$0.00	$25.77	$25.77	$0.00	$21.79	$34.52	$34.86	$0.00		$0.00	$6.82	$0.00	$0.00	$6.94	$0.00	$0.00	$0.00	$0.00	$0.00
71801375	SUP	HCPCS C1713		71801375  -  SCREW BN HEX LOPRFL 3.5MM 75MM STRL PRLC VLP ST FT CORT	BOTH IP/OP	$43.58 	$32.25	$0.00	$34.86	$19.61	$19.61	$0.00	$0.00	$0.00	$9.08	$32.34	$32.34	$0.00	$0.00	$9.08	$0.00	$25.77	$25.77	$0.00	$21.79	$34.52	$34.86	$0.00		$0.00	$6.82	$0.00	$0.00	$6.94	$0.00	$0.00	$0.00	$0.00	$0.00
71802506	SUP	HCPCS C1713		71802506  -  SCREW BN 2.5MM 6MM ST CORT	BOTH IP/OP	$75.58 	$55.93	$0.00	$60.46	$34.01	$34.01	$0.00	$0.00	$0.00	$15.75	$56.09	$56.09	$0.00	$0.00	$15.75	$0.00	$44.70	$44.70	$0.00	$37.79	$59.86	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
71802508	SUP	HCPCS C1713		71802508  -  SCREW BN 2.5MM 8MM ST CORT	BOTH IP/OP	$75.58 	$55.93	$0.00	$60.46	$34.01	$34.01	$0.00	$0.00	$0.00	$15.75	$56.09	$56.09	$0.00	$0.00	$15.75	$0.00	$44.70	$44.70	$0.00	$37.79	$59.86	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
71802532	SUP	HCPCS C1713		71802532  -  SCREW BN 2.5MM 32MM ST CORT	BOTH IP/OP	$75.58 	$55.93	$0.00	$60.46	$34.01	$34.01	$0.00	$0.00	$0.00	$15.75	$56.09	$56.09	$0.00	$0.00	$15.75	$0.00	$44.70	$44.70	$0.00	$37.79	$59.86	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
71802534	SUP	HCPCS C1713		71802534  -  SCREW BN 2.5MM 34MM ST CORT	BOTH IP/OP	$75.58 	$55.93	$0.00	$60.46	$34.01	$34.01	$0.00	$0.00	$0.00	$15.75	$56.09	$56.09	$0.00	$0.00	$15.75	$0.00	$44.70	$44.70	$0.00	$37.79	$59.86	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
71802536	SUP	HCPCS C1713		71802536  -  SCREW BN 2.5MM 36MM ST CORT	BOTH IP/OP	$75.58 	$55.93	$0.00	$60.46	$34.01	$34.01	$0.00	$0.00	$0.00	$15.75	$56.09	$56.09	$0.00	$0.00	$15.75	$0.00	$44.70	$44.70	$0.00	$37.79	$59.86	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
71802538	SUP	HCPCS C1713		71802538  -  SCREW BN 2.5MM 38MM ST CORT	BOTH IP/OP	$75.58 	$55.93	$0.00	$60.46	$34.01	$34.01	$0.00	$0.00	$0.00	$15.75	$56.09	$56.09	$0.00	$0.00	$15.75	$0.00	$44.70	$44.70	$0.00	$37.79	$59.86	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
71802540	SUP	HCPCS C1713		71802540  -  SCREW BN 2.5MM 40MM ST CORT	BOTH IP/OP	$75.58 	$55.93	$0.00	$60.46	$34.01	$34.01	$0.00	$0.00	$0.00	$15.75	$56.09	$56.09	$0.00	$0.00	$15.75	$0.00	$44.70	$44.70	$0.00	$37.79	$59.86	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
71802545	SUP	HCPCS C1713		71802545  -  SCREW BN 2.5MM 45MM ST CORT	BOTH IP/OP	$75.58 	$55.93	$0.00	$60.46	$34.01	$34.01	$0.00	$0.00	$0.00	$15.75	$56.09	$56.09	$0.00	$0.00	$15.75	$0.00	$44.70	$44.70	$0.00	$37.79	$59.86	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
71802550	SUP	HCPCS C1713		71802550  -  SCREW BN 2.5MM 50MM ST CORT	BOTH IP/OP	$75.58 	$55.93	$0.00	$60.46	$34.01	$34.01	$0.00	$0.00	$0.00	$15.75	$56.09	$56.09	$0.00	$0.00	$15.75	$0.00	$44.70	$44.70	$0.00	$37.79	$59.86	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
71802606	SUP	HCPCS C1713		71802606  -  PLATE BN 70MM PRLC 6 HL LCK RECON SS 3.5MM SCR	BOTH IP/OP	"$1,060.50 "	$784.77	$0.00	$848.40	$477.23	$477.23	$0.00	$0.00	$0.00	$221.03	$787.10	$787.10	$0.00	$0.00	$221.01	$0.00	$627.29	$627.29	$0.00	$530.25	$839.92	$848.40	$0.00		$0.00	$165.97	$0.00	$0.00	$168.83	$0.00	$0.00	$0.00	$0.00	$0.00
71803006	SUP	HCPCS C1713		71803006  -  SCREW BN 2.7MM 6MM STRL ST CORT FOREFOOT MIDFOOT	BOTH IP/OP	$75.58 	$55.93	$0.00	$60.46	$34.01	$34.01	$0.00	$0.00	$0.00	$15.75	$56.09	$56.09	$0.00	$0.00	$15.75	$0.00	$44.70	$44.70	$0.00	$37.79	$59.86	$60.46	$0.00		$0.00	$11.83	$0.00	$0.00	$12.03	$0.00	$0.00	$0.00	$0.00	$0.00
71809006	SUP	HCPCS C1713		71809006  -  PLATE BN TBLR RCHRD 6 HL LCK HIP 3.5MM SCR	BOTH IP/OP	$347.55 	$257.19	$0.00	$278.04	$156.40	$156.40	$0.00	$0.00	$0.00	$72.44	$257.95	$257.95	$0.00	$0.00	$72.43	$0.00	$205.58	$205.58	$0.00	$173.78	$275.26	$278.04	$0.00		$0.00	$54.39	$0.00	$0.00	$55.33	$0.00	$0.00	$0.00	$0.00	$0.00
71823032	SUP	HCPCS C1713		71823032  -  SCREW BN 2.7MM 32MM ST SS CORT PRLC VLP SM FRAG SYS	BOTH IP/OP	$44.90 	$33.23	$0.00	$35.92	$20.21	$20.21	$0.00	$0.00	$0.00	$9.36	$33.32	$33.32	$0.00	$0.00	$9.36	$0.00	$26.56	$26.56	$0.00	$22.45	$35.56	$35.92	$0.00		$0.00	$7.03	$0.00	$0.00	$7.15	$0.00	$0.00	$0.00	$0.00	$0.00
71840112	SUP	HCPCS C1713		71840112  -  TEMPLATE BNDRG TC100 12 HL CMPR LG FRAG PLT	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
71840202	SUP	HCPCS C1713		71840202  -  PLATE BN 26MM 2 HL CMPR 3.5MM SCR SM FRAG SET	BOTH IP/OP	$332.85 	$246.31	$0.00	$266.28	$149.78	$149.78	$0.00	$0.00	$0.00	$69.37	$247.04	$247.04	$0.00	$0.00	$69.37	$0.00	$196.88	$196.88	$0.00	$166.43	$263.62	$266.28	$0.00		$0.00	$52.09	$0.00	$0.00	$52.99	$0.00	$0.00	$0.00	$0.00	$0.00
71840203	SUP	HCPCS C1713		71840203  -  PLATE BN 39MM 3 HL CMPR ORTH 3.5MM SCR SM FRAG SET	BOTH IP/OP	$341.25 	$252.53	$0.00	$273.00	$153.56	$153.56	$0.00	$0.00	$0.00	$71.13	$253.28	$253.28	$0.00	$0.00	$71.12	$0.00	$201.85	$201.85	$0.00	$170.63	$270.27	$273.00	$0.00		$0.00	$53.41	$0.00	$0.00	$54.33	$0.00	$0.00	$0.00	$0.00	$0.00
71840204	SUP	HCPCS C1713		71840204  -  PLATE BN 52MM TC100 4 HL CMPR PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$354.90 	$262.63	$0.00	$283.92	$159.71	$159.71	$0.00	$0.00	$0.00	$73.97	$263.41	$263.41	$0.00	$0.00	$73.96	$0.00	$209.92	$209.92	$0.00	$177.45	$281.08	$283.92	$0.00		$0.00	$55.54	$0.00	$0.00	$56.50	$0.00	$0.00	$0.00	$0.00	$0.00
71840205	SUP	HCPCS C1713		71840205  -  PLATE BN 65MM TC100 5 HL CMPR PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$382.20 	$282.83	$0.00	$305.76	$171.99	$171.99	$0.00	$0.00	$0.00	$79.66	$283.67	$283.67	$0.00	$0.00	$79.65	$0.00	$226.07	$226.07	$0.00	$191.10	$302.70	$305.76	$0.00		$0.00	$59.81	$0.00	$0.00	$60.85	$0.00	$0.00	$0.00	$0.00	$0.00
71840206	SUP	HCPCS C1713		71840206  -  PLATE BN 78MM TC100 6 HL CMPR PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
71840207	SUP	HCPCS C1713		71840207  -  PLATE BN 91MM TC100 7 HL CMPR PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$414.75 	$306.92	$0.00	$331.80	$186.64	$186.64	$0.00	$0.00	$0.00	$86.44	$307.83	$307.83	$0.00	$0.00	$86.43	$0.00	$245.32	$245.32	$0.00	$207.38	$328.48	$331.80	$0.00		$0.00	$64.91	$0.00	$0.00	$66.03	$0.00	$0.00	$0.00	$0.00	$0.00
71840208	SUP	HCPCS C1713		71840208  -  PLATE BN 104MM TC100 8 HL CMPR PLVC 3.5MM SCR SM FRAG SET	BOTH IP/OP	$446.25 	$330.23	$0.00	$357.00	$200.81	$200.81	$0.00	$0.00	$0.00	$93.01	$331.21	$331.21	$0.00	$0.00	$93.00	$0.00	$263.96	$263.96	$0.00	$223.13	$353.43	$357.00	$0.00		$0.00	$69.84	$0.00	$0.00	$71.04	$0.00	$0.00	$0.00	$0.00	$0.00
71840209	SUP	HCPCS C1713		71840209  -  PLATE BN 117MM 9 HL CMPR ORTH 3.5MM SCR SM FRAG SET	BOTH IP/OP	$454.65 	$336.44	$0.00	$363.72	$204.59	$204.59	$0.00	$0.00	$0.00	$94.76	$337.44	$337.44	$0.00	$0.00	$94.75	$0.00	$268.93	$268.93	$0.00	$227.33	$360.08	$363.72	$0.00		$0.00	$71.15	$0.00	$0.00	$72.38	$0.00	$0.00	$0.00	$0.00	$0.00
71840210	SUP	HCPCS C1713		71840210  -  PLATE BN 130MM 10 HL CMPR ORTH 3.5MM SCR SM FRAG SET	BOTH IP/OP	$470.40 	$348.10	$0.00	$376.32	$211.68	$211.68	$0.00	$0.00	$0.00	$98.04	$349.13	$349.13	$0.00	$0.00	$98.03	$0.00	$278.24	$278.24	$0.00	$235.20	$372.56	$376.32	$0.00		$0.00	$73.62	$0.00	$0.00	$74.89	$0.00	$0.00	$0.00	$0.00	$0.00
71840211	SUP	HCPCS C1713		71840211  -  PLATE BN 143MM 11 HL CMPR 3.5MM SCR SM FRAG SET	BOTH IP/OP	$470.40 	$348.10	$0.00	$376.32	$211.68	$211.68	$0.00	$0.00	$0.00	$98.04	$349.13	$349.13	$0.00	$0.00	$98.03	$0.00	$278.24	$278.24	$0.00	$235.20	$372.56	$376.32	$0.00		$0.00	$73.62	$0.00	$0.00	$74.89	$0.00	$0.00	$0.00	$0.00	$0.00
71840212	SUP	HCPCS C1713		71840212  -  PLATE BN 156MM 12 HL CMPR 3.5MM SCR SM FRAG SET	BOTH IP/OP	$520.80 	$385.39	$0.00	$416.64	$234.36	$234.36	$0.00	$0.00	$0.00	$108.55	$386.54	$386.54	$0.00	$0.00	$108.53	$0.00	$308.05	$308.05	$0.00	$260.40	$412.47	$416.64	$0.00		$0.00	$81.51	$0.00	$0.00	$82.91	$0.00	$0.00	$0.00	$0.00	$0.00
71840214	SUP	HCPCS C1713		71840214  -  PLATE BN 182MM 14 HL CMPR 3.5MM SCR SM FRAG SET	BOTH IP/OP	"$1,181.25 "	$874.13	$0.00	$945.00	$531.56	$531.56	$0.00	$0.00	$0.00	$246.20	$876.72	$876.72	$0.00	$0.00	$246.17	$0.00	$698.71	$698.71	$0.00	$590.63	$935.55	$945.00	$0.00		$0.00	$184.87	$0.00	$0.00	$188.06	$0.00	$0.00	$0.00	$0.00	$0.00
71840215	SUP	HCPCS C1713		71840215  -  PLATE BN 195MM 15 HL CMPR 3.5MM SCR SM FRAG SET	BOTH IP/OP	"$1,233.75 "	$912.98	$0.00	$987.00	$555.19	$555.19	$0.00	$0.00	$0.00	$257.14	$915.69	$915.69	$0.00	$0.00	$257.11	$0.00	$729.76	$729.76	$0.00	$616.88	$977.13	$987.00	$0.00		$0.00	$193.08	$0.00	$0.00	$196.41	$0.00	$0.00	$0.00	$0.00	$0.00
71840216	SUP	HCPCS C1713		71840216  -  PLATE BN 208MM 16 HL CMPR 3.5MM SCR SM FRAG SET	BOTH IP/OP	"$1,359.75 "	"$1,006.22"	$0.00	"$1,087.80"	$611.89	$611.89	$0.00	$0.00	$0.00	$283.41	"$1,009.21"	"$1,009.21"	$0.00	$0.00	$283.37	$0.00	$804.29	$804.29	$0.00	$679.88	"$1,076.92"	"$1,087.80"	$0.00		$0.00	$212.80	$0.00	$0.00	$216.47	$0.00	$0.00	$0.00	$0.00	$0.00
71840218	SUP	HCPCS C1713		71840218  -  PLATE BN 234MM 18 HL CMPR 3.5MM SCR SM FRAG SET	BOTH IP/OP	"$1,517.25 "	"$1,122.77"	$0.00	"$1,213.80"	$682.76	$682.76	$0.00	$0.00	$0.00	$316.23	"$1,126.10"	"$1,126.10"	$0.00	$0.00	$316.19	$0.00	$897.45	$897.45	$0.00	$758.63	"$1,201.66"	"$1,213.80"	$0.00		$0.00	$237.45	$0.00	$0.00	$241.55	$0.00	$0.00	$0.00	$0.00	$0.00
71840220	SUP	HCPCS C1713		71840220  -  PLATE BN 260MM 20 HL CMPR 3.5MM SCR SM FRAG SET	BOTH IP/OP	"$1,711.50 "	"$1,266.51"	$0.00	"$1,369.20"	$770.18	$770.18	$0.00	$0.00	$0.00	$356.72	"$1,270.28"	"$1,270.28"	$0.00	$0.00	$356.68	$0.00	"$1,012.35"	"$1,012.35"	$0.00	$855.75	"$1,355.51"	"$1,369.20"	$0.00		$0.00	$267.85	$0.00	$0.00	$272.47	$0.00	$0.00	$0.00	$0.00	$0.00
71841012	SUP	HCPCS C1713		71841012  -  TEMPLATE BNDRG TC100 12 HL SM FRAG PLT	BOTH IP/OP	$88.68 	$65.62	$0.00	$70.94	$39.90	$39.90	$0.00	$0.00	$0.00	$18.48	$65.81	$65.81	$0.00	$0.00	$18.48	$0.00	$52.45	$52.45	$0.00	$44.34	$70.23	$70.94	$0.00		$0.00	$13.88	$0.00	$0.00	$14.12	$0.00	$0.00	$0.00	$0.00	$0.00
71841206	SUP	HCPCS C1713		71841206  -  PLATE BN BRD 108MM 6 HL CMPR 4.5MM SCR	BOTH IP/OP	$577.50 	$427.35	$0.00	$462.00	$259.88	$259.88	$0.00	$0.00	$0.00	$120.37	$428.62	$428.62	$0.00	$0.00	$120.35	$0.00	$341.59	$341.59	$0.00	$288.75	$457.38	$462.00	$0.00		$0.00	$90.38	$0.00	$0.00	$91.94	$0.00	$0.00	$0.00	$0.00	$0.00
71841207	SUP	HCPCS C1713		71841207  -  PLATE BN BRD 126MM 7 HL CMPR 4.5MM SCR	BOTH IP/OP	$577.50 	$427.35	$0.00	$462.00	$259.88	$259.88	$0.00	$0.00	$0.00	$120.37	$428.62	$428.62	$0.00	$0.00	$120.35	$0.00	$341.59	$341.59	$0.00	$288.75	$457.38	$462.00	$0.00		$0.00	$90.38	$0.00	$0.00	$91.94	$0.00	$0.00	$0.00	$0.00	$0.00
71841208	SUP	HCPCS C1713		71841208  -  PLATE BN BRD 144MM 8 HL CMPR 4.5MM SCR	BOTH IP/OP	$718.20 	$531.47	$0.00	$574.56	$323.19	$323.19	$0.00	$0.00	$0.00	$149.69	$533.05	$533.05	$0.00	$0.00	$149.67	$0.00	$424.82	$424.82	$0.00	$359.10	$568.81	$574.56	$0.00		$0.00	$112.40	$0.00	$0.00	$114.34	$0.00	$0.00	$0.00	$0.00	$0.00
71841209	SUP	HCPCS C1713		71841209  -  PLATE BN BRD 162MM 9 HL CMPR 4.5MM SCR	BOTH IP/OP	$718.20 	$531.47	$0.00	$574.56	$323.19	$323.19	$0.00	$0.00	$0.00	$149.69	$533.05	$533.05	$0.00	$0.00	$149.67	$0.00	$424.82	$424.82	$0.00	$359.10	$568.81	$574.56	$0.00		$0.00	$112.40	$0.00	$0.00	$114.34	$0.00	$0.00	$0.00	$0.00	$0.00
71841210	SUP	HCPCS C1713		71841210  -  PLATE BN BRD 180MM 10 HL CMPR 4.5MM SCR	BOTH IP/OP	$718.20 	$531.47	$0.00	$574.56	$323.19	$323.19	$0.00	$0.00	$0.00	$149.69	$533.05	$533.05	$0.00	$0.00	$149.67	$0.00	$424.82	$424.82	$0.00	$359.10	$568.81	$574.56	$0.00		$0.00	$112.40	$0.00	$0.00	$114.34	$0.00	$0.00	$0.00	$0.00	$0.00
71841211	SUP	HCPCS C1713		71841211  -  PLATE BN BRD 198MM 11 HL CMPR 4.5MM SCR	BOTH IP/OP	$904.05 	$669.00	$0.00	$723.24	$406.82	$406.82	$0.00	$0.00	$0.00	$188.43	$670.99	$670.99	$0.00	$0.00	$188.40	$0.00	$534.75	$534.75	$0.00	$452.03	$716.01	$723.24	$0.00		$0.00	$141.48	$0.00	$0.00	$143.92	$0.00	$0.00	$0.00	$0.00	$0.00
71841212	SUP	HCPCS C1713		71841212  -  PLATE BN BRD 216MM 12 HL CMPR ORTH 4.5MM SCR	BOTH IP/OP	$770.70 	$570.32	$0.00	$616.56	$346.82	$346.82	$0.00	$0.00	$0.00	$160.63	$572.01	$572.01	$0.00	$0.00	$160.61	$0.00	$455.87	$455.87	$0.00	$385.35	$610.39	$616.56	$0.00		$0.00	$120.61	$0.00	$0.00	$122.70	$0.00	$0.00	$0.00	$0.00	$0.00
71841214	SUP	HCPCS C1713		71841214  -  PLATE BN BRD 252MM 14 HL CMPR 4.5MM SCR	BOTH IP/OP	$770.70 	$570.32	$0.00	$616.56	$346.82	$346.82	$0.00	$0.00	$0.00	$160.63	$572.01	$572.01	$0.00	$0.00	$160.61	$0.00	$455.87	$455.87	$0.00	$385.35	$610.39	$616.56	$0.00		$0.00	$120.61	$0.00	$0.00	$122.70	$0.00	$0.00	$0.00	$0.00	$0.00
71841218	SUP	HCPCS C1713		71841218  -  PLATE BN BRD 324MM 18 HL CMPR 4.5MM SCR	BOTH IP/OP	"$1,139.25 "	$843.05	$0.00	$911.40	$512.66	$512.66	$0.00	$0.00	$0.00	$237.45	$845.55	$845.55	$0.00	$0.00	$237.42	$0.00	$673.87	$673.87	$0.00	$569.63	$902.29	$911.40	$0.00		$0.00	$178.29	$0.00	$0.00	$181.37	$0.00	$0.00	$0.00	$0.00	$0.00
71841222	SUP	HCPCS C1713		71841222  -  PLATE BN BRD 396MM 22 HL CMPR 4.5MM SCR	BOTH IP/OP	"$1,722.00 "	"$1,274.28"	$0.00	"$1,377.60"	$774.90	$774.90	$0.00	$0.00	$0.00	$358.91	"$1,278.07"	"$1,278.07"	$0.00	$0.00	$358.86	$0.00	"$1,018.56"	"$1,018.56"	$0.00	$861.00	"$1,363.82"	"$1,377.60"	$0.00		$0.00	$269.49	$0.00	$0.00	$274.14	$0.00	$0.00	$0.00	$0.00	$0.00
71841402	SUP	HCPCS C1713		71841402  -  PLATE BN NAR 36MM 2 HL CMPR 4.5MM SCR	BOTH IP/OP	$473.55 	$350.43	$0.00	$378.84	$213.10	$213.10	$0.00	$0.00	$0.00	$98.70	$351.47	$351.47	$0.00	$0.00	$98.69	$0.00	$280.10	$280.10	$0.00	$236.78	$375.05	$378.84	$0.00		$0.00	$74.11	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
71841403	SUP	HCPCS C1713		71841403  -  PLATE BN NAR 54MM 3 HL CMPR 4.5MM SCR	BOTH IP/OP	$387.45 	$286.71	$0.00	$309.96	$174.35	$174.35	$0.00	$0.00	$0.00	$80.75	$287.57	$287.57	$0.00	$0.00	$80.74	$0.00	$229.18	$229.18	$0.00	$193.73	$306.86	$309.96	$0.00		$0.00	$60.64	$0.00	$0.00	$61.68	$0.00	$0.00	$0.00	$0.00	$0.00
71841404	SUP	HCPCS C1713		71841404  -  PLATE BN NAR 72MM 4 HL CMPR 4.5MM SCR	BOTH IP/OP	$387.45 	$286.71	$0.00	$309.96	$174.35	$174.35	$0.00	$0.00	$0.00	$80.75	$287.57	$287.57	$0.00	$0.00	$80.74	$0.00	$229.18	$229.18	$0.00	$193.73	$306.86	$309.96	$0.00		$0.00	$60.64	$0.00	$0.00	$61.68	$0.00	$0.00	$0.00	$0.00	$0.00
71841405	SUP	HCPCS C1713		71841405  -  PLATE BN NAR 90MM 5 HL CMPR 4.5MM SCR	BOTH IP/OP	$387.45 	$286.71	$0.00	$309.96	$174.35	$174.35	$0.00	$0.00	$0.00	$80.75	$287.57	$287.57	$0.00	$0.00	$80.74	$0.00	$229.18	$229.18	$0.00	$193.73	$306.86	$309.96	$0.00		$0.00	$60.64	$0.00	$0.00	$61.68	$0.00	$0.00	$0.00	$0.00	$0.00
71841406	SUP	HCPCS C1713		71841406  -  PLATE BN NAR 108MM 6 HL CMPR 4.5MM SCR	BOTH IP/OP	$441.00 	$326.34	$0.00	$352.80	$198.45	$198.45	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$220.50	$349.27	$352.80	$0.00		$0.00	$69.02	$0.00	$0.00	$70.21	$0.00	$0.00	$0.00	$0.00	$0.00
71841407	SUP	HCPCS C1713		71841407  -  PLATE BN NAR 126MM 7 HL CMPR 4.5MM SCR	BOTH IP/OP	$441.00 	$326.34	$0.00	$352.80	$198.45	$198.45	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$220.50	$349.27	$352.80	$0.00		$0.00	$69.02	$0.00	$0.00	$70.21	$0.00	$0.00	$0.00	$0.00	$0.00
71841408	SUP	HCPCS C1713		71841408  -  PLATE BN NAR 144MM 8 HL CMPR 4.5MM SCR	BOTH IP/OP	$441.00 	$326.34	$0.00	$352.80	$198.45	$198.45	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$220.50	$349.27	$352.80	$0.00		$0.00	$69.02	$0.00	$0.00	$70.21	$0.00	$0.00	$0.00	$0.00	$0.00
71841409	SUP	HCPCS C1713		71841409  -  PLATE BN NAR 162MM 9 HL CMPR 4.5MM SCR	BOTH IP/OP	$441.00 	$326.34	$0.00	$352.80	$198.45	$198.45	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$220.50	$349.27	$352.80	$0.00		$0.00	$69.02	$0.00	$0.00	$70.21	$0.00	$0.00	$0.00	$0.00	$0.00
71841410	SUP	HCPCS C1713		71841410  -  PLATE BN NAR 180MM 10 HL CMPR 4.5MM SCR	BOTH IP/OP	$568.05 	$420.36	$0.00	$454.44	$255.62	$255.62	$0.00	$0.00	$0.00	$118.40	$421.61	$421.61	$0.00	$0.00	$118.38	$0.00	$336.00	$336.00	$0.00	$284.03	$449.90	$454.44	$0.00		$0.00	$88.90	$0.00	$0.00	$90.43	$0.00	$0.00	$0.00	$0.00	$0.00
71841411	SUP	HCPCS C1713		71841411  -  PLATE BN NAR 198MM 11 HL CMPR 4.5MM SCR	BOTH IP/OP	$568.05 	$420.36	$0.00	$454.44	$255.62	$255.62	$0.00	$0.00	$0.00	$118.40	$421.61	$421.61	$0.00	$0.00	$118.38	$0.00	$336.00	$336.00	$0.00	$284.03	$449.90	$454.44	$0.00		$0.00	$88.90	$0.00	$0.00	$90.43	$0.00	$0.00	$0.00	$0.00	$0.00
71841412	SUP	HCPCS C1713		71841412  -  PLATE BN NAR 216MM 12 HL CMPR 4.5MM SCR	BOTH IP/OP	$568.05 	$420.36	$0.00	$454.44	$255.62	$255.62	$0.00	$0.00	$0.00	$118.40	$421.61	$421.61	$0.00	$0.00	$118.38	$0.00	$336.00	$336.00	$0.00	$284.03	$449.90	$454.44	$0.00		$0.00	$88.90	$0.00	$0.00	$90.43	$0.00	$0.00	$0.00	$0.00	$0.00
71841413	SUP	HCPCS C1713		71841413  -  PLATE BN NAR 234MM 13 HL CMPR 4.5MM SCR	BOTH IP/OP	$820.05 	$606.84	$0.00	$656.04	$369.02	$369.02	$0.00	$0.00	$0.00	$170.92	$608.64	$608.64	$0.00	$0.00	$170.90	$0.00	$485.06	$485.06	$0.00	$410.03	$649.48	$656.04	$0.00		$0.00	$128.34	$0.00	$0.00	$130.55	$0.00	$0.00	$0.00	$0.00	$0.00
71841414	SUP	HCPCS C1713		71841414  -  PLATE BN NAR 252MM 14 HL CMPR 4.5MM SCR	BOTH IP/OP	$820.05 	$606.84	$0.00	$656.04	$369.02	$369.02	$0.00	$0.00	$0.00	$170.92	$608.64	$608.64	$0.00	$0.00	$170.90	$0.00	$485.06	$485.06	$0.00	$410.03	$649.48	$656.04	$0.00		$0.00	$128.34	$0.00	$0.00	$130.55	$0.00	$0.00	$0.00	$0.00	$0.00
71841416	SUP	HCPCS C1713		71841416  -  PLATE BN NAR 288MM 16 HL CMPR 4.5MM SCR	BOTH IP/OP	$866.25 	$641.03	$0.00	$693.00	$389.81	$389.81	$0.00	$0.00	$0.00	$180.55	$642.93	$642.93	$0.00	$0.00	$180.53	$0.00	$512.39	$512.39	$0.00	$433.13	$686.07	$693.00	$0.00		$0.00	$135.57	$0.00	$0.00	$137.91	$0.00	$0.00	$0.00	$0.00	$0.00
71841418	SUP	HCPCS C1713		71841418  -  PLATE BN NAR 324MM 18 HL CMPR 4.5MM SCR	BOTH IP/OP	"$1,270.50 "	$940.17	$0.00	"$1,016.40"	$571.73	$571.73	$0.00	$0.00	$0.00	$264.80	$942.97	$942.97	$0.00	$0.00	$264.77	$0.00	$751.50	$751.50	$0.00	$635.25	"$1,006.24"	"$1,016.40"	$0.00		$0.00	$198.83	$0.00	$0.00	$202.26	$0.00	$0.00	$0.00	$0.00	$0.00
71841420	SUP	HCPCS C1713		71841420  -  PLATE BN NAR 360MM 20 HL CMPR 4.5MM SCR	BOTH IP/OP	"$1,396.50 "	"$1,033.41"	$0.00	"$1,117.20"	$628.43	$628.43	$0.00	$0.00	$0.00	$291.07	"$1,036.48"	"$1,036.48"	$0.00	$0.00	$291.03	$0.00	$826.03	$826.03	$0.00	$698.25	"$1,106.03"	"$1,117.20"	$0.00		$0.00	$218.55	$0.00	$0.00	$222.32	$0.00	$0.00	$0.00	$0.00	$0.00
71925062	SUP	Custom 27203010		71925062  -  GUIDE PIN ORTHOPEDIC 2.4MM 450MM THREAD	BOTH IP/OP	"$1,605.00 "	"$1,187.70"	$0.00	"$1,191.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,191.23"	"$1,191.23"	$0.00	$0.00	$334.48	$0.00	$0.00	$0.00	$0.00	$511.25	$809.82	$818.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71931590	SUP	HCPCS C1713		71931590  -  NAIL IM 11.5MM 60CM FEM	BOTH IP/OP	"$6,918.75 "	"$5,119.88"	$0.00	"$5,535.00"	"$3,113.44"	"$3,113.44"	$0.00	$0.00	$0.00	"$1,442.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,441.87"	$0.00	"$3,410.94"	"$3,410.94"	$0.00	"$3,459.38"	"$5,479.65"	"$5,535.00"	$0.00		$0.00	"$1,082.78"	$0.00	$0.00	"$1,101.47"	$0.00	$0.00	$0.00	$0.00	$0.00
71931594	SUP	HCPCS C1713		71931594  -  NAIL IM 11.5MM 80CM KN RT FEM	BOTH IP/OP	"$6,918.75 "	"$5,119.88"	$0.00	"$5,535.00"	"$3,113.44"	"$3,113.44"	$0.00	$0.00	$0.00	"$1,442.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,441.87"	$0.00	"$3,410.94"	"$3,410.94"	$0.00	"$3,459.38"	"$5,479.65"	"$5,535.00"	$0.00		$0.00	"$1,082.78"	$0.00	$0.00	"$1,101.47"	$0.00	$0.00	$0.00	$0.00	$0.00
71931602	SUP	HCPCS C1713		71931602  -  NAIL IM 11.5MM FAN FSN KN	BOTH IP/OP	"$6,918.75 "	"$5,119.88"	$0.00	"$5,535.00"	"$3,113.44"	"$3,113.44"	$0.00	$0.00	$0.00	"$1,442.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,441.87"	$0.00	"$3,410.94"	"$3,410.94"	$0.00	"$3,459.38"	"$5,479.65"	"$5,535.00"	$0.00		$0.00	"$1,082.78"	$0.00	$0.00	"$1,101.47"	$0.00	$0.00	$0.00	$0.00	$0.00
71931604	SUP	HCPCS C1713		71931604  -  NAIL IM 11.5MM 85MM LCK FSN FEM	BOTH IP/OP	"$6,918.75 "	"$5,119.88"	$0.00	"$5,535.00"	"$3,113.44"	"$3,113.44"	$0.00	$0.00	$0.00	"$1,442.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,441.87"	$0.00	"$3,410.94"	"$3,410.94"	$0.00	"$3,459.38"	"$5,479.65"	"$5,535.00"	$0.00		$0.00	"$1,082.78"	$0.00	$0.00	"$1,101.47"	$0.00	$0.00	$0.00	$0.00	$0.00
71931663	SUP	HCPCS C1713		71931663  -  NAIL IM 13MM 75CM FSN LT KN	BOTH IP/OP	"$6,918.75 "	"$5,119.88"	$0.00	"$5,535.00"	"$3,113.44"	"$3,113.44"	$0.00	$0.00	$0.00	"$1,442.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,441.87"	$0.00	"$3,410.94"	"$3,410.94"	$0.00	"$3,459.38"	"$5,479.65"	"$5,535.00"	$0.00		$0.00	"$1,082.78"	$0.00	$0.00	"$1,101.47"	$0.00	$0.00	$0.00	$0.00	$0.00
71931664	SUP	HCPCS C1713		71931664  -  NAIL IM 13MM 80CM KN FEM	BOTH IP/OP	"$6,918.75 "	"$5,119.88"	$0.00	"$5,535.00"	"$3,113.44"	"$3,113.44"	$0.00	$0.00	$0.00	"$1,442.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,441.87"	$0.00	"$3,410.94"	"$3,410.94"	$0.00	"$3,459.38"	"$5,479.65"	"$5,535.00"	$0.00		$0.00	"$1,082.78"	$0.00	$0.00	"$1,101.47"	$0.00	$0.00	$0.00	$0.00	$0.00
71931665	SUP	HCPCS C1713		71931665  -  NAIL IM 85CMX13MM ANTGRD FSN LT	BOTH IP/OP	"$6,918.75 "	"$5,119.88"	$0.00	"$5,535.00"	"$3,113.44"	"$3,113.44"	$0.00	$0.00	$0.00	"$1,442.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,441.87"	$0.00	"$3,410.94"	"$3,410.94"	$0.00	"$3,459.38"	"$5,479.65"	"$5,535.00"	$0.00		$0.00	"$1,082.78"	$0.00	$0.00	"$1,101.47"	$0.00	$0.00	$0.00	$0.00	$0.00
71931672	SUP	HCPCS C1713		71931672  -  NAIL IM 13MM 75CM KN FEM	BOTH IP/OP	"$6,918.75 "	"$5,119.88"	$0.00	"$5,535.00"	"$3,113.44"	"$3,113.44"	$0.00	$0.00	$0.00	"$1,442.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,441.87"	$0.00	"$3,410.94"	"$3,410.94"	$0.00	"$3,459.38"	"$5,479.65"	"$5,535.00"	$0.00		$0.00	"$1,082.78"	$0.00	$0.00	"$1,101.47"	$0.00	$0.00	$0.00	$0.00	$0.00
71933134	SUP	HCPCS C1713		71933134  -  SCREW BN 3MM 4MM 30MM 3MM SM HDLS SCR CNN SCR SYS TI ACPT	BOTH IP/OP	"$6,283.13 "	"$4,649.52"	$0.00	"$5,026.50"	"$2,827.41"	"$2,827.41"	$0.00	$0.00	$0.00	"$1,309.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,309.40"	$0.00	"$3,097.58"	"$3,097.58"	$0.00	"$3,141.56"	"$4,976.24"	"$5,026.50"	$0.00		$0.00	$983.31	$0.00	$0.00	"$1,000.27"	$0.00	$0.00	$0.00	$0.00	$0.00
71933306	SUP	Custom 27203010		71933306  -  RING EXFIX 255MM 2/3 RING	BOTH IP/OP	"$9,400.00 "	"$6,956.00"	$0.00	"$7,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,958.96"	$0.00	$0.00	$0.00	$0.00	"$4,700.00"	"$7,444.80"	"$7,520.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71933335	SUP	Custom 27203010		71933335  -  RAIL XTRNFX STD SEG DIST MDLR SYS	BOTH IP/OP	"$1,534.25 "	"$1,135.35"	$0.00	"$1,227.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,138.72"	"$1,138.72"	$0.00	$0.00	$319.74	$0.00	$0.00	$0.00	$0.00	$767.13	"$1,215.13"	"$1,227.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71933336	SUP	Custom 27203010		71933336  -  ARCH XTRNFX RAIL ROT CNCT	BOTH IP/OP	"$2,443.75 "	"$1,808.38"	$0.00	"$1,955.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,813.75"	"$1,813.75"	$0.00	$0.00	$509.28	$0.00	$0.00	$0.00	$0.00	"$1,221.88"	"$1,935.45"	"$1,955.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71933338	SUP	Custom 27203010		71933338  -  ARCH XTRNFX RAIL ROT CNCT	BOTH IP/OP	"$1,525.75 "	"$1,129.06"	$0.00	"$1,220.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,132.41"	"$1,132.41"	$0.00	$0.00	$317.97	$0.00	$0.00	$0.00	$0.00	$762.88	"$1,208.39"	"$1,220.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71933339	SUP	Custom 27203010		71933339  -  ARCH XTRNFX RAIL ROT CNCT	BOTH IP/OP	"$1,323.88 "	$979.67	$0.00	"$1,059.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$982.58	$982.58	$0.00	$0.00	$275.90	$0.00	$0.00	$0.00	$0.00	$661.94	"$1,048.51"	"$1,059.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71933501	SUP	HCPCS C1713		71933501  -  SCREW BN 4.5MM 48MM ST CORT	BOTH IP/OP	$38.50 	$28.49	$0.00	$30.80	$17.33	$17.33	$0.00	$0.00	$0.00	$8.02	$28.57	$28.57	$0.00	$0.00	$8.02	$0.00	$22.77	$22.77	$0.00	$19.25	$30.49	$30.80	$0.00		$0.00	$6.03	$0.00	$0.00	$6.13	$0.00	$0.00	$0.00	$0.00	$0.00
71933626	SUP	Custom 27203010		71933626  -  CONNECTOR XTRNFX RAIL CLP	BOTH IP/OP	"$1,039.13 "	$768.96	$0.00	$831.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$771.24	$771.24	$0.00	$0.00	$216.55	$0.00	$0.00	$0.00	$0.00	$519.56	$822.99	$831.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71933940	SUP	Custom 27203010		71933940  -  RAIL XTRNFX SM MDLR RL ARC CNCT	BOTH IP/OP	"$1,564.00 "	"$1,157.36"	$0.00	"$1,251.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,160.80"	"$1,160.80"	$0.00	$0.00	$325.94	$0.00	$0.00	$0.00	$0.00	$782.00	"$1,238.69"	"$1,251.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71933941	SUP	Custom 27203010		71933941  -  RAIL XTRNFX SM	BOTH IP/OP	"$2,613.75 "	"$1,934.18"	$0.00	"$2,091.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,939.93"	"$1,939.93"	$0.00	$0.00	$544.71	$0.00	$0.00	$0.00	$0.00	"$1,306.88"	"$2,070.09"	"$2,091.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71933943	SUP	Custom 27203010		71933943  -  RAIL XTRNFX SM ARC ROT CNCT	BOTH IP/OP	"$1,323.88 "	$979.67	$0.00	"$1,059.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$982.58	$982.58	$0.00	$0.00	$275.90	$0.00	$0.00	$0.00	$0.00	$661.94	"$1,048.51"	"$1,059.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934046	SUP	Custom 27203010		71934046  -  ARCH XTRNFX SHRT MDLR RL SM RAIL	BOTH IP/OP	"$2,613.75 "	"$1,934.18"	$0.00	"$2,091.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,939.93"	"$1,939.93"	$0.00	$0.00	$544.71	$0.00	$0.00	$0.00	$0.00	"$1,306.88"	"$2,070.09"	"$2,091.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934155	SUP	Custom 27203010		71934155  -  RAIL XTRNFX SM ARC PREASSEMBLE	BOTH IP/OP	"$9,360.63 "	"$6,926.87"	$0.00	"$7,488.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,950.75"	$0.00	$0.00	$0.00	$0.00	"$4,680.31"	"$7,413.62"	"$7,488.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934479	SUP	HCPCS C1713		71934479  -  NAIL IM 125D 10MM 24CM TRGN FEM	BOTH IP/OP	"$3,780.00 "	"$2,797.20"	$0.00	"$3,024.00"	"$1,701.00"	"$1,701.00"	$0.00	$0.00	$0.00	$787.85	"$2,805.52"	"$2,805.52"	$0.00	$0.00	$787.75	$0.00	"$1,863.54"	"$1,863.54"	$0.00	"$1,890.00"	"$2,993.76"	"$3,024.00"	$0.00		$0.00	$591.57	$0.00	$0.00	$601.78	$0.00	$0.00	$0.00	$0.00	$0.00
71934482	SUP	HCPCS C1713		71934482  -  NAIL IM 130D 11.5MM 24CM TRGN FEM	BOTH IP/OP	"$3,780.00 "	"$2,797.20"	$0.00	"$3,024.00"	"$1,701.00"	"$1,701.00"	$0.00	$0.00	$0.00	$787.85	"$2,805.52"	"$2,805.52"	$0.00	$0.00	$787.75	$0.00	"$1,863.54"	"$1,863.54"	$0.00	"$1,890.00"	"$2,993.76"	"$3,024.00"	$0.00		$0.00	$591.57	$0.00	$0.00	$601.78	$0.00	$0.00	$0.00	$0.00	$0.00
71934624	SUP	Custom 27203010		71934624  -  RAIL XTRNFX ARC CNCT THRD	BOTH IP/OP	"$1,525.75 "	"$1,129.06"	$0.00	"$1,220.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,132.41"	"$1,132.41"	$0.00	$0.00	$317.97	$0.00	$0.00	$0.00	$0.00	$762.88	"$1,208.39"	"$1,220.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934625	SUP	Custom 27203010		71934625  -  RAIL XTRNFX ARC	BOTH IP/OP	"$2,496.88 "	"$1,847.69"	$0.00	"$1,997.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,853.18"	"$1,853.18"	$0.00	$0.00	$520.35	$0.00	$0.00	$0.00	$0.00	"$1,248.44"	"$1,977.53"	"$1,997.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934626	SUP	Custom 27203010		71934626  -  RAIL XTRNFX SM ARC CNCT THRD	BOTH IP/OP	"$1,525.75 "	"$1,129.06"	$0.00	"$1,220.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,132.41"	"$1,132.41"	$0.00	$0.00	$317.97	$0.00	$0.00	$0.00	$0.00	$762.88	"$1,208.39"	"$1,220.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934627	SUP	Custom 27203010		71934627  -  RAIL XTRNFX SM ARC	BOTH IP/OP	"$2,496.88 "	"$1,847.69"	$0.00	"$1,997.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,853.18"	"$1,853.18"	$0.00	$0.00	$520.35	$0.00	$0.00	$0.00	$0.00	"$1,248.44"	"$1,977.53"	"$1,997.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934628	SUP	Custom 27203010		71934628  -  RAIL XTRNFX SM ARCH	BOTH IP/OP	"$2,496.88 "	"$1,847.69"	$0.00	"$1,997.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,853.18"	"$1,853.18"	$0.00	$0.00	$520.35	$0.00	$0.00	$0.00	$0.00	"$1,248.44"	"$1,977.53"	"$1,997.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934629	SUP	Custom 27203010		71934629  -  RAIL XTRNFX 180MM ARC	BOTH IP/OP	"$2,496.88 "	"$1,847.69"	$0.00	"$1,997.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,853.18"	"$1,853.18"	$0.00	$0.00	$520.35	$0.00	$0.00	$0.00	$0.00	"$1,248.44"	"$1,977.53"	"$1,997.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934630	SUP	Custom 27203010		71934630  -  RAIL XTRNFX SM 180MM ARC	BOTH IP/OP	"$2,496.88 "	"$1,847.69"	$0.00	"$1,997.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,853.18"	"$1,853.18"	$0.00	$0.00	$520.35	$0.00	$0.00	$0.00	$0.00	"$1,248.44"	"$1,977.53"	"$1,997.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934647	SUP	Custom 27203010		71934647  -  RAIL XTRNFX 50MM LCK	BOTH IP/OP	"$1,071.00 "	$792.54	$0.00	$856.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$794.90	$794.90	$0.00	$0.00	$223.20	$0.00	$0.00	$0.00	$0.00	$535.50	$848.23	$856.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934648	SUP	Custom 27203010		71934648  -  RAIL XTRNFX 60MM LCK	BOTH IP/OP	"$1,060.38 "	$784.68	$0.00	$848.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$787.01	$787.01	$0.00	$0.00	$220.98	$0.00	$0.00	$0.00	$0.00	$530.19	$839.82	$848.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934649	SUP	Custom 27203010		71934649  -  RAIL XTRNFX 70MM LCK	BOTH IP/OP	"$1,071.00 "	$792.54	$0.00	$856.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$794.90	$794.90	$0.00	$0.00	$223.20	$0.00	$0.00	$0.00	$0.00	$535.50	$848.23	$856.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934650	SUP	Custom 27203010		71934650  -  RAIL XTRNFX 80MM LCK	BOTH IP/OP	"$1,060.38 "	$784.68	$0.00	$848.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$787.01	$787.01	$0.00	$0.00	$220.98	$0.00	$0.00	$0.00	$0.00	$530.19	$839.82	$848.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934651	SUP	Custom 27203010		71934651  -  RAIL XTRNFX 90MM LCK	BOTH IP/OP	"$1,060.38 "	$784.68	$0.00	$848.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$787.01	$787.01	$0.00	$0.00	$220.98	$0.00	$0.00	$0.00	$0.00	$530.19	$839.82	$848.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934652	SUP	Custom 27203010		71934652  -  RAIL XTRNFX 100MM LCK	BOTH IP/OP	"$1,060.38 "	$784.68	$0.00	$848.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$787.01	$787.01	$0.00	$0.00	$220.98	$0.00	$0.00	$0.00	$0.00	$530.19	$839.82	$848.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934776	SUP	HCPCS C1713		71934776  -  NAIL 10MM 34CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934777	SUP	HCPCS C1713		71934777  -  NAIL 10MM 36CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934778	SUP	HCPCS C1713		71934778  -  NAIL 10MM 38CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934779	SUP	HCPCS C1713		71934779  -  NAIL 10MM 40CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934780	SUP	HCPCS C1713		71934780  -  NAIL 10MM 42CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934781	SUP	HCPCS C1713		71934781  -  NAIL 10MM 44CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934782	SUP	HCPCS C1713		71934782  -  NAIL 10MM 34CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934783	SUP	HCPCS C1713		71934783  -  NAIL 10MM 36CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934784	SUP	HCPCS C1713		71934784  -  NAIL 10MM 38CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934785	SUP	HCPCS C1713		71934785  -  NAIL 10MM 40CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934787	SUP	HCPCS C1713		71934787  -  NAIL 10MM 44CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934788	SUP	HCPCS C1713		71934788  -  NAIL 11.5MM 36CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934789	SUP	HCPCS C1713		71934789  -  NAIL 11.5MM 38CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934790	SUP	HCPCS C1713		71934790  -  NAIL 11.5MM 40CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934791	SUP	HCPCS C1713		71934791  -  NAIL 11.5MM 42CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934792	SUP	HCPCS C1713		71934792  -  NAIL 11.5MM 44CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934793	SUP	HCPCS C1713		71934793  -  NAIL 11.5MM 46CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934794	SUP	HCPCS C1713		71934794  -  NAIL 11.5MM 36CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934795	SUP	HCPCS C1713		71934795  -  NAIL 11.5MM 38CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934796	SUP	HCPCS C1713		71934796  -  NAIL 11.5MM 40CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934797	SUP	HCPCS C1713		71934797  -  NAIL 11.5MM 42CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934798	SUP	HCPCS C1713		71934798  -  NAIL 11.5MM 44CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934799	SUP	HCPCS C1713		71934799  -  NAIL 11.5MM 46CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934800	SUP	HCPCS C1713		71934800  -  NAIL 13MM 36CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934801	SUP	HCPCS C1713		71934801  -  NAIL 13MM 38CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934802	SUP	HCPCS C1713		71934802  -  NAIL 13MM 40CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934803	SUP	HCPCS C1713		71934803  -  NAIL 13MM 42CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934804	SUP	HCPCS C1713		71934804  -  NAIL 13MM 44CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934805	SUP	HCPCS C1713		71934805  -  NAIL 13MM 46CM FEM LEFT IM 25D ANTGRD LIME	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934806	SUP	HCPCS C1713		71934806  -  NAIL 13MM 36CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934807	SUP	HCPCS C1713		71934807  -  NAIL 13MM 38CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934808	SUP	HCPCS C1713		71934808  -  NAIL 13MM 40CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934809	SUP	HCPCS C1713		71934809  -  NAIL 13MM 42CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934810	SUP	HCPCS C1713		71934810  -  NAIL 13MM 44CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934811	SUP	HCPCS C1713		71934811  -  NAIL 13MM 46CM FEM RIGHT IM 25D ANTGRD ROSE	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934845	SUP	Custom 27203010		71934845  -  RAIL XTRNFX 339MM	BOTH IP/OP	"$2,666.88 "	"$1,973.49"	$0.00	"$2,133.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,979.35"	"$1,979.35"	$0.00	$0.00	$555.78	$0.00	$0.00	$0.00	$0.00	"$1,333.44"	"$2,112.17"	"$2,133.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934846	SUP	Custom 27203010		71934846  -  RAIL XTRNFX SM 226MM	BOTH IP/OP	"$2,666.88 "	"$1,973.49"	$0.00	"$2,133.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,979.35"	"$1,979.35"	$0.00	$0.00	$555.78	$0.00	$0.00	$0.00	$0.00	"$1,333.44"	"$2,112.17"	"$2,133.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71934996	SUP	HCPCS C1713		71934996  -  NAIL 10MM 46CM LEFT FAN IM 25D LIME DH	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934997	SUP	HCPCS C1713		71934997  -  NAIL 10MM 46CM RIGHT FAN IM 25D ROSE DH	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934998	SUP	HCPCS C1713		71934998  -  NAIL 11.5MM 32CM LEFT FAN IM 25D LIME DH	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71934999	SUP	HCPCS C1713		71934999  -  NAIL 11.5MM 34CM LEFT FAN IM 25D LIME DH	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71935001	SUP	HCPCS C1713		71935001  -  NAIL 11.5MM 34CM RIGHT FAN IM 25D ROSE DH	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71935002	SUP	HCPCS C1713		71935002  -  NAIL 13MM 32CM LEFT FAN IM 25D LIME DH	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71935003	SUP	HCPCS C1713		71935003  -  NAIL 13MM 34CM LEFT FAN IM 25D LIME DH	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71935004	SUP	HCPCS C1713		71935004  -  NAIL 13MM 32CM RIGHT FAN IM 25D ROSE DH	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
71935005	SUP	HCPCS C1713		71935005  -  NAIL 13MM 34CM RIGHT FAN IM 25D ROSE DH	BOTH IP/OP	"$4,522.50 "	"$3,346.65"	$0.00	"$3,618.00"	"$2,035.13"	"$2,035.13"	$0.00	$0.00	$0.00	$942.60	"$3,356.60"	"$3,356.60"	$0.00	$0.00	$942.49	$0.00	"$2,229.59"	"$2,229.59"	$0.00	"$2,261.25"	"$3,581.82"	"$3,618.00"	$0.00		$0.00	$707.77	$0.00	$0.00	$719.98	$0.00	$0.00	$0.00	$0.00	$0.00
72200634	SUP	Custom 27203010		72200634  -  PAD PSTN 9IN 1.5IN 11IN SUPN POST HIP PERINEUM DISP	BOTH IP/OP	$208.70 	$154.44	$0.00	$166.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.90	$154.90	$0.00	$0.00	$43.49	$0.00	$0.00	$0.00	$0.00	$104.35	$165.29	$166.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72202468	SUP	HCPCS C1713		72202468  -  DEVICE FX 360D CRV FSTFX 2 ANCH PRETIE 2-0 5MM SUT MNSCL	BOTH IP/OP	"$1,163.90 "	$861.29	$0.00	$931.12	$523.76	$523.76	$0.00	$0.00	$0.00	$242.59	$863.85	$863.85	$0.00	$0.00	$242.56	$0.00	$688.45	$688.45	$0.00	$581.95	$921.81	$931.12	$0.00		$0.00	$182.15	$0.00	$0.00	$185.29	$0.00	$0.00	$0.00	$0.00	$0.00
72400024	SUP	HCPCS C1815		72400024  -  IMPL URO A800 CONTINENCE URN CNTRL SYS INHBZN 61-70 CMW URN	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
72400025	SUP	HCPCS C1815		72400025  -  IMPLANT UROLOGICAL 71-80CU CM PRESSURE BALLOON AMS 800	BOTH IP/OP	"$5,867.50 "	"$4,341.95"	$0.00	"$4,694.00"	"$2,640.38"	"$2,640.38"	$0.00	$0.00	$0.00	"$1,222.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,222.79"	$0.00	"$2,892.68"	"$2,892.68"	$0.00	"$2,933.75"	"$4,647.06"	"$4,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$934.11	$0.00	$0.00	$0.00	$0.00	$0.00
72402006	SUP	HCPCS C1713		72402006  -  SCREW BN T6 2MM 3MM 6MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402007	SUP	HCPCS C1713		72402007  -  SCREW BN T6 2MM 3MM 7MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402008	SUP	HCPCS C1713		72402008  -  SCREW BN T6 2MM 8MM STRL EVOS ST SLFRET DRV SS SM BN LNG BN	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402009	SUP	HCPCS C1713		72402009  -  SCREW BN T6 2MM 3MM 9MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402010	SUP	HCPCS C1713		72402010  -  SCREW BN T6 2MM 3MM 10MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402011	SUP	HCPCS C1713		72402011  -  SCREW BN T6 2MM 3MM 11MM EVOS ST CORT MN PLT SYS	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402012	SUP	HCPCS C1713		72402012  -  SCREW BN T6 2MM 3MM 12MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402013	SUP	HCPCS C1713		72402013  -  SCREW BN T6 2MM 3MM 13MM EVOS ST CORT MN PLT SYS	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402014	SUP	HCPCS C1713		72402014  -  SCREW BN T6 2MM 3MM 14MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402015	SUP	HCPCS C1713		72402015  -  SCREW BN T6 2MM 3MM 15MM STRL EVOS MN ST CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402016	SUP	HCPCS C1713		72402016  -  SCREW BN T6 2MM 3MM 16MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402017	SUP	HCPCS C1713		72402017  -  SCREW BN T6 2MM 3MM 17MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402018	SUP	HCPCS C1713		72402018  -  SCREW BN T6 2MM 3MM 18MM EVOS ST CORT MN PLT SYS	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402019	SUP	HCPCS C1713		72402019  -  SCREW BN T6 2MM 3MM 19MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402020	SUP	HCPCS C1713		72402020  -  SCREW BN T6 2MM 3MM 20MM EVOS ST CORT MN PLT SYS	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402021	SUP	HCPCS C1713		72402021  -  SCREW BN T6 2MM 3MM 21MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402022	SUP	HCPCS C1713		72402022  -  SCREW BN T6 2MM 3MM 22MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402023	SUP	HCPCS C1713		72402023  -  SCREW BN T6 2MM 3MM 23MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402024	SUP	HCPCS C1713		72402024  -  SCREW BN T6 2MM 3MM 24MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402026	SUP	HCPCS C1713		72402026  -  SCREW BN T6 2MM 3MM 26MM STRL EVOS MN ST DRVR LNG BN SM BN	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402028	SUP	HCPCS C1713		72402028  -  SCREW BN T6 2MM 3MM 28MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402030	SUP	HCPCS C1713		72402030  -  SCREW BN T6 2MM 3MM 30MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402032	SUP	HCPCS C1713		72402032  -  SCREW BN T6 2MM 3MM 32MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402034	SUP	HCPCS C1713		72402034  -  SCREW BN T6 2MM 3MM 34MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402036	SUP	HCPCS C1713		72402036  -  SCREW BN T6 2MM 3MM 36MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402038	SUP	HCPCS C1713		72402038  -  SCREW BN T6 2MM 3MM 38MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402040	SUP	HCPCS C1713		72402040  -  SCREW BN T6 2MM 3MM 40MM STRL SLFRET SCRDRVR ST FLT HD CORT	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72402406	SUP	HCPCS C1713		72402406  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 6MM STRL SLFRET SCRDRVR ST FLT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402407	SUP	HCPCS C1713		72402407  -  SCREW BN T7 2.4MM 7MM STRL EVOS MN SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402408	SUP	HCPCS C1713		72402408  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 8MM STRL SLFRET SCRDRVR ST FLT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402409	SUP	HCPCS C1713		72402409  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 9MM STRL SLFRET SCRDRVR ST FLT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402410	SUP	HCPCS C1713		72402410  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 10MM STRL SLFRET SCRDRVR ST	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402411	SUP	HCPCS C1713		72402411  -  SCREW BN T7 2.4MM 3.8MM 11MM STRL EVOS MN ST DRVR LNG BN SM	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402412	SUP	HCPCS C1713		72402412  -  SCREW BN T7 2.4MM 3.8MM 12MM STRL EVOS MN ST DRVR LNG BN SM	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402413	SUP	HCPCS C1713		72402413  -  SCREW BN T7 2.4MM 3.8MM 13MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402414	SUP	HCPCS C1713		72402414  -  SCREW BN T7 2.4MM 14MM EVOS ST SLFRET DRV SS SM BN LNG BN	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402415	SUP	HCPCS C1713		72402415  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 15MM STRL SLFRET SCRDRVR ST	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402416	SUP	HCPCS C1713		72402416  -  SCREW BN T7 2.4MM 16MM EVOS ST SLFRET DRV SS SM BN LNG BN	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402417	SUP	HCPCS C1713		72402417  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 17MM STRL SLFRET SCRDRVR ST	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402418	SUP	HCPCS C1713		72402418  -  SCREW BN T7 2.4MM 3.8MM 18MM STRL EVOS MN ST DRVR LNG BN SM	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402419	SUP	HCPCS C1713		72402419  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 19MM STRL SLFRET SCRDRVR ST	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402420	SUP	HCPCS C1713		72402420  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 20MM STRL SLFRET SCRDRVR ST	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402421	SUP	HCPCS C1713		72402421  -  SCREW BN T7 2.4MM 21MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402422	SUP	HCPCS C1713		72402422  -  SCREW BN T7 2.4MM 22MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402423	SUP	HCPCS C1713		72402423  -  SCREW BN T7 2.4MM 23MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402424	SUP	HCPCS C1713		72402424  -  SCREW BN T7 2.4MM 24MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402426	SUP	HCPCS C1713		72402426  -  SCREW BN T7 2.4MM 26MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402430	SUP	HCPCS C1713		72402430  -  SCREW BN T7 2.4MM 30MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402432	SUP	HCPCS C1713		72402432  -  SCREW BN T7 2.4MM 32MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402434	SUP	HCPCS C1713		72402434  -  SCREW BN T7 2.4MM 34MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402436	SUP	HCPCS C1713		72402436  -  SCREW BN T7 2.4MM 36MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402438	SUP	HCPCS C1713		72402438  -  SCREW BN T7 2.4MM 38MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402442	SUP	HCPCS C1713		72402442  -  SCREW BN T7 2.4MM 42MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402444	SUP	HCPCS C1713		72402444  -  SCREW BN T7 2.4MM 44MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402446	SUP	HCPCS C1713		72402446  -  SCREW BN T7 2.4MM 46MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402448	SUP	HCPCS C1713		72402448  -  SCREW BN T7 2.4MM 48MM STRL EVOS MN ST CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402455	SUP	HCPCS C1713		72402455  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 55MM STRL SLFRET SCRDRVR ST	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402460	SUP	HCPCS C1713		72402460  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 60MM STRL SLFRET SCRDRVR ST	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
72402465	SUP	HCPCS C1713		72402465  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 65MM STRL SLFRET SCRDRVR ST	BOTH IP/OP	$106.15 	$78.55	$0.00	$84.92	$47.77	$47.77	$0.00	$0.00	$0.00	$22.12	$78.78	$78.78	$0.00	$0.00	$22.12	$0.00	$62.79	$62.79	$0.00	$53.08	$84.07	$84.92	$0.00		$0.00	$16.61	$0.00	$0.00	$16.90	$0.00	$0.00	$0.00	$0.00	$0.00
72402470	SUP	HCPCS C1713		72402470  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 70MM STRL SLFRET SCRDRVR ST	BOTH IP/OP	$106.15 	$78.55	$0.00	$84.92	$47.77	$47.77	$0.00	$0.00	$0.00	$22.12	$78.78	$78.78	$0.00	$0.00	$22.12	$0.00	$62.79	$62.79	$0.00	$53.08	$84.07	$84.92	$0.00		$0.00	$16.61	$0.00	$0.00	$16.90	$0.00	$0.00	$0.00	$0.00	$0.00
72402475	SUP	HCPCS C1713		72402475  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 75MM STRL SLFRET SCRDRVR ST	BOTH IP/OP	$106.15 	$78.55	$0.00	$84.92	$47.77	$47.77	$0.00	$0.00	$0.00	$22.12	$78.78	$78.78	$0.00	$0.00	$22.12	$0.00	$62.79	$62.79	$0.00	$53.08	$84.07	$84.92	$0.00		$0.00	$16.61	$0.00	$0.00	$16.90	$0.00	$0.00	$0.00	$0.00	$0.00
72402480	SUP	HCPCS C1713		72402480  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 80MM STRL SLFRET SCRDRVR ST	BOTH IP/OP	$106.15 	$78.55	$0.00	$84.92	$47.77	$47.77	$0.00	$0.00	$0.00	$22.12	$78.78	$78.78	$0.00	$0.00	$22.12	$0.00	$62.79	$62.79	$0.00	$53.08	$84.07	$84.92	$0.00		$0.00	$16.61	$0.00	$0.00	$16.90	$0.00	$0.00	$0.00	$0.00	$0.00
72402706	SUP	HCPCS C1713		72402706  -  SCREW BN T8 2MM 2.7MM 4.5MM 6MM ST CORT EVOS	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402707	SUP	HCPCS C1713		72402707  -  SCREW BN T7 2.7MM 4.5MM 7MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402708	SUP	HCPCS C1713		72402708  -  SCREW BN T8 2.7MM 4.5MM 8MM EVOS ST CORT MN PLT SYS	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402709	SUP	HCPCS C1713		72402709  -  SCREW BN T8 2.7MM 9MM EVOS ST SLFRET DRV SS SM BN LNG BN	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402710	SUP	HCPCS C1713		72402710  -  SCREW BN T8 2.7MM 4.5MM 10MM EVOS ST CORT MN PLT SYS	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402711	SUP	HCPCS C1713		72402711  -  SCREW BN 2.7MM 4.5MM 11MM EVOS T8 DRVR 2 END DRL GD ST CORT	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402712	SUP	HCPCS C1713		72402712  -  SCREW BN T8 2.7MM 12MM STRL EVOS MN SS CORT	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402713	SUP	HCPCS C1713		72402713  -  SCREW BN 2.7MM 4.5MM 13MM EVOS T8 DRVR 2 END DRL GD ST CORT	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402714	SUP	HCPCS C1713		72402714  -  SCREW BN T7 2.7MM 4.5MM 14MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402715	SUP	HCPCS C1713		72402715  -  SCREW BN T7 2.7MM 4.5MM 15MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402716	SUP	HCPCS C1713		72402716  -  SCREW BN T8 2.7MM 4.5MM 16MM EVOS ST CORT MN PLT SYS	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402717	SUP	HCPCS C1713		72402717  -  SCREW BN T8 2.7MM 4.5MM 17MM NS EVOS ST CORT MN PLT SYS	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402718	SUP	HCPCS C1713		72402718  -  SCREW BN T8 2.7MM 4.5MM 18MM NS EVOS ST CORT MN PLT SYS	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402719	SUP	HCPCS C1713		72402719  -  SCREW BN T8 2MM 2.7MM 4.5MM 19MM ST CORT EVOS	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402720	SUP	HCPCS C1713		72402720  -  SCREW BN T7 2.7MM 4.5MM 20MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402721	SUP	HCPCS C1713		72402721  -  SCREW BN T7 2.7MM 4.5MM 21MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402722	SUP	HCPCS C1713		72402722  -  SCREW BN T7 2.7MM 4.5MM 22MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402723	SUP	HCPCS C1713		72402723  -  SCREW BN T7 2.7MM 4.5MM 23MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402724	SUP	HCPCS C1713		72402724  -  SCREW BN T7 2.7MM 4.5MM 24MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402726	SUP	HCPCS C1713		72402726  -  SCREW BN T7 2.7MM 4.5MM 26MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402728	SUP	HCPCS C1713		72402728  -  SCREW BN T8 2MM 2.7MM 4.5MM 28MM ST CORT EVOS	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402730	SUP	HCPCS C1713		72402730  -  SCREW BN T7 2.7MM 4.5MM 30MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402732	SUP	HCPCS C1713		72402732  -  SCREW BN T8 2MM 2.7MM 4.5MM 32MM ST CORT EVOS	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402734	SUP	HCPCS C1713		72402734  -  SCREW BN T7 2.7MM 4.5MM 34MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402736	SUP	HCPCS C1713		72402736  -  SCREW BN T8 2MM 2.7MM 4.5MM 36MM ST CORT EVOS	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402738	SUP	HCPCS C1713		72402738  -  SCREW BN T8 2.7MM 4.5MM 38MM STRL EVOS MN ST CORT	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402740	SUP	HCPCS C1713		72402740  -  SCREW BN T8 2.7MM 4.5MM 40MM STRL EVOS MN ST DRVR LNG BN SM	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402742	SUP	HCPCS C1713		72402742  -  SCREW BN T7 2.7MM 4.5MM 42MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402744	SUP	HCPCS C1713		72402744  -  SCREW BN T8 2MM 2.7MM 4.5MM 44MM ST CORT EVOS	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402746	SUP	HCPCS C1713		72402746  -  SCREW BN T7 2.7MM 4.5MM 46MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402748	SUP	HCPCS C1713		72402748  -  SCREW BN T7 2.7MM 4.5MM 48MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402750	SUP	HCPCS C1713		72402750  -  SCREW BN T7 2.7MM 4.5MM 50MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402755	SUP	HCPCS C1713		72402755  -  SCREW BN T7 2.7MM 4.5MM 55MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402760	SUP	HCPCS C1713		72402760  -  SCREW BN T7 2.7MM 4.5MM 60MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$81.68 	$60.44	$0.00	$65.34	$36.75	$36.75	$0.00	$0.00	$0.00	$17.02	$60.62	$60.62	$0.00	$0.00	$17.02	$0.00	$48.31	$48.31	$0.00	$40.84	$64.69	$65.34	$0.00		$0.00	$12.78	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402765	SUP	HCPCS C1713		72402765  -  SCREW BN T7 2.7MM 4.5MM 65MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$110.28 	$81.61	$0.00	$88.22	$49.62	$49.62	$0.00	$0.00	$0.00	$22.98	$81.85	$81.85	$0.00	$0.00	$22.98	$0.00	$65.23	$65.23	$0.00	$55.14	$87.34	$88.22	$0.00		$0.00	$17.26	$0.00	$0.00	$17.56	$0.00	$0.00	$0.00	$0.00	$0.00
72402770	SUP	HCPCS C1713		72402770  -  SCREW BN T7 2.7MM 4.5MM 70MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$110.28 	$81.61	$0.00	$88.22	$49.62	$49.62	$0.00	$0.00	$0.00	$22.98	$81.85	$81.85	$0.00	$0.00	$22.98	$0.00	$65.23	$65.23	$0.00	$55.14	$87.34	$88.22	$0.00		$0.00	$17.26	$0.00	$0.00	$17.56	$0.00	$0.00	$0.00	$0.00	$0.00
72402775	SUP	HCPCS C1713		72402775  -  SCREW BN T8 2.7MM 4.5MM 75MM STRL EVOS MN ST DRVR LNG BN SM	BOTH IP/OP	$110.28 	$81.61	$0.00	$88.22	$49.62	$49.62	$0.00	$0.00	$0.00	$22.98	$81.85	$81.85	$0.00	$0.00	$22.98	$0.00	$65.23	$65.23	$0.00	$55.14	$87.34	$88.22	$0.00		$0.00	$17.26	$0.00	$0.00	$17.56	$0.00	$0.00	$0.00	$0.00	$0.00
72402780	SUP	HCPCS C1713		72402780  -  SCREW BN T7 2.7MM 4.5MM 80MM STRL SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$110.28 	$81.61	$0.00	$88.22	$49.62	$49.62	$0.00	$0.00	$0.00	$22.98	$81.85	$81.85	$0.00	$0.00	$22.98	$0.00	$65.23	$65.23	$0.00	$55.14	$87.34	$88.22	$0.00		$0.00	$17.26	$0.00	$0.00	$17.56	$0.00	$0.00	$0.00	$0.00	$0.00
72403513	SUP	HCPCS C1713		72403513  -  SCREW BN 1.7MM 5MM ST AX STAB LWR PRFL	BOTH IP/OP	$58.73 	$43.46	$0.00	$46.98	$26.43	$26.43	$0.00	$0.00	$0.00	$12.24	$43.59	$43.59	$0.00	$0.00	$12.24	$0.00	$34.74	$34.74	$0.00	$29.36	$46.51	$46.98	$0.00		$0.00	$9.19	$0.00	$0.00	$9.35	$0.00	$0.00	$0.00	$0.00	$0.00
72403514	SUP	HCPCS C1713		72403514  -  SCREW BN 1.7MM 4MM SLF DRL AX STAB LWR PRFL	BOTH IP/OP	$58.73 	$43.46	$0.00	$46.98	$26.43	$26.43	$0.00	$0.00	$0.00	$12.24	$43.59	$43.59	$0.00	$0.00	$12.24	$0.00	$34.74	$34.74	$0.00	$29.36	$46.51	$46.98	$0.00		$0.00	$9.19	$0.00	$0.00	$9.35	$0.00	$0.00	$0.00	$0.00	$0.00
72403528	SUP	HCPCS C1713		72403528  -  SCREW BN 3.5MM 28MM STRL EVOS ST CORT	BOTH IP/OP	$58.73 	$43.46	$0.00	$46.98	$26.43	$26.43	$0.00	$0.00	$0.00	$12.24	$43.59	$43.59	$0.00	$0.00	$12.24	$0.00	$34.74	$34.74	$0.00	$29.36	$46.51	$46.98	$0.00		$0.00	$9.19	$0.00	$0.00	$9.35	$0.00	$0.00	$0.00	$0.00	$0.00
72403540	SUP	HCPCS C1713		72403540  -  SCREW BN 3.5MM 40MM STRL EVOS ST CORT	BOTH IP/OP	$58.73 	$43.46	$0.00	$46.98	$26.43	$26.43	$0.00	$0.00	$0.00	$12.24	$43.59	$43.59	$0.00	$0.00	$12.24	$0.00	$34.74	$34.74	$0.00	$29.36	$46.51	$46.98	$0.00		$0.00	$9.19	$0.00	$0.00	$9.35	$0.00	$0.00	$0.00	$0.00	$0.00
72403550	SUP	HCPCS C1713		72403550  -  SCREW BN 3.5MM 50MM STRL EVOS ST CORT	BOTH IP/OP	$58.73 	$43.46	$0.00	$46.98	$26.43	$26.43	$0.00	$0.00	$0.00	$12.24	$43.59	$43.59	$0.00	$0.00	$12.24	$0.00	$34.74	$34.74	$0.00	$29.36	$46.51	$46.98	$0.00		$0.00	$9.19	$0.00	$0.00	$9.35	$0.00	$0.00	$0.00	$0.00	$0.00
72403830	SUP	HCPCS C1771		72403830  -  SLING PUBOVAGINAL MONARC FMALE	BOTH IP/OP	"$3,177.50 "	"$2,351.35"	$0.00	"$2,542.00"	"$1,429.88"	"$1,429.88"	$0.00	$0.00	$0.00	$662.27	"$2,358.34"	"$2,358.34"	$0.00	$0.00	$662.19	$0.00	"$1,566.51"	"$1,566.51"	$0.00	"$1,588.75"	"$2,516.58"	"$2,542.00"	$0.00		$0.00	$497.28	$0.00	$0.00	$505.86	$0.00	$0.00	$0.00	$0.00	$0.00
72403867	SUP	HCPCS C1813		72403867  -  PROS PENL AMS 700 DP PENOSCROTAL	BOTH IP/OP	$725.00 	$536.50	$0.00	$580.00	$326.25	$326.25	$0.00	$0.00	$0.00	$0.00	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$0.00	$0.00	$0.00	$362.50	$574.20	$580.00	$0.00		$0.00	$0.00	$0.00	$0.00	$115.42	$0.00	$0.00	$0.00	$0.00	$0.00
72404127	SUP	HCPCS C1813		72404127  -  PROS PENL A800 PMP INHBZN	BOTH IP/OP	"$10,500.00 "	"$7,770.00"	$0.00	"$8,400.00"	"$4,725.00"	"$4,725.00"	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,188.20"	$0.00	$0.00	$0.00	$0.00	"$5,250.00"	"$8,316.00"	"$8,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	"$1,671.60"	$0.00	$0.00	$0.00	$0.00	$0.00
72404131	SUP	HCPCS C1815		72404131  -  IMPLANT UROLOGICAL 4.5CM CUFF AMS 800 INHIBIZONE SPHINCTER	BOTH IP/OP	"$9,010.63 "	"$6,667.87"	$0.00	"$7,208.50"	"$4,054.78"	"$4,054.78"	$0.00	$0.00	$0.00	"$1,878.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,877.81"	$0.00	"$4,442.24"	"$4,442.24"	$0.00	"$4,505.31"	"$7,136.42"	"$7,208.50"	$0.00		$0.00	$0.00	$0.00	$0.00	"$1,434.49"	$0.00	$0.00	$0.00	$0.00	$0.00
72404132	SUP	HCPCS C1815		72404132  -  IMPLANT UROLOGICAL 5CM CONTINENCE PUMP AMS 800 INHIBIZONE	BOTH IP/OP	"$12,487.50 "	"$9,240.75"	$0.00	"$9,990.00"	"$5,619.38"	"$5,619.38"	$0.00	$0.00	$0.00	"$2,602.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,602.40"	$0.00	"$6,156.34"	"$6,156.34"	$0.00	"$6,243.75"	"$9,890.10"	"$9,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	"$1,988.01"	$0.00	$0.00	$0.00	$0.00	$0.00
72404133	SUP	HCPCS C1815		72404133  -  IMPLANT UROLOGICAL 5.5CM CONTINENCE PUMP AMS 800 INHIBIZONE	BOTH IP/OP	"$12,487.50 "	"$9,240.75"	$0.00	"$9,990.00"	"$5,619.38"	"$5,619.38"	$0.00	$0.00	$0.00	"$2,602.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,602.40"	$0.00	"$6,156.34"	"$6,156.34"	$0.00	"$6,243.75"	"$9,890.10"	"$9,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	"$1,988.01"	$0.00	$0.00	$0.00	$0.00	$0.00
72404250	SUP	HCPCS C1813		72404250  -  PROSTHESIS PENILE 12/12MM PRECONNECT PUMP PRECON MS	BOTH IP/OP	"$19,557.50 "	"$14,472.55"	$0.00	"$15,646.00"	"$8,800.88"	"$8,800.88"	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,075.78"	$0.00	$0.00	$0.00	$0.00	"$9,778.75"	"$15,489.54"	"$15,646.00"	$0.00		$0.00	$0.00	$0.00	$0.00	"$3,113.55"	$0.00	$0.00	$0.00	$0.00	$0.00
72404256	SUP	HCPCS C1813		72404256  -  PROSTHESIS PENL AMS 700 LGX MS PMP 15CM 3 PC INFL	BOTH IP/OP	"$23,330.00 "	"$17,264.20"	$0.00	"$18,664.00"	"$10,498.50"	"$10,498.50"	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,861.97"	$0.00	$0.00	$0.00	$0.00	"$11,665.00"	"$18,477.36"	"$18,664.00"	$0.00		$0.00	$0.00	$0.00	$0.00	"$3,714.14"	$0.00	$0.00	$0.00	$0.00	$0.00
72404257	SUP	HCPCS C1813		72404257  -  PROSTHESIS PENILE 18CM INFLATABLE AMS 700 MS PUMP INHIBIZONE	BOTH IP/OP	"$21,352.50 "	"$15,800.85"	$0.00	"$17,082.00"	"$9,608.63"	"$9,608.63"	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,449.86"	$0.00	$0.00	$0.00	$0.00	"$10,676.25"	"$16,911.18"	"$17,082.00"	$0.00		$0.00	$0.00	$0.00	$0.00	"$3,399.32"	$0.00	$0.00	$0.00	$0.00	$0.00
72412006	SUP	HCPCS C1713		72412006  -  SCREW BN T6 2.7MM 4.5MM 6MM STRL LCK SLFRET SCRDRVR ST FLT	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412007	SUP	HCPCS C1713		72412007  -  SCREW BN T6 2MM 3.3MM 7MM STRL LCK SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412008	SUP	HCPCS C1713		72412008  -  SCREW BN T6 2MM 8MM STRL EVOS ST SLFRET DRV SS SM BN LNG BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412009	SUP	HCPCS C1713		72412009  -  SCREW BN T6 2MM 3.3MM 9MM STRL LCK SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412010	SUP	HCPCS C1713		72412010  -  SCREW BN T6 2MM 3.3MM 10MM STRL EVOS MN LCK DRVR LNG BN SM	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412011	SUP	HCPCS C1713		72412011  -  SCREW BN T6 2MM 3.3MM 11MM STRL LCK SLFRET SCRDRVR ST FLT HD	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412012	SUP	HCPCS C1713		72412012  -  SCREW BN T6 2MM 3.3MM 12MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412013	SUP	HCPCS C1713		72412013  -  SCREW BN T6 2MM 3.3MM 13MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412014	SUP	HCPCS C1713		72412014  -  SCREW BN T6 2MM 3.3MM 14MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412015	SUP	HCPCS C1713		72412015  -  SCREW BN T6 2MM 3.3MM 15MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412016	SUP	HCPCS C1713		72412016  -  SCREW BN T6 2MM 3.3MM 16MM STRL EVOS MN LCK DRVR LNG BN SM	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412017	SUP	HCPCS C1713		72412017  -  SCREW BN T6 2MM 3.3MM 17MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412018	SUP	HCPCS C1713		72412018  -  SCREW BN T6 2MM 3.3MM 18MM STRL EVOS MN LCK DRVR LNG BN SM	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412019	SUP	HCPCS C1713		72412019  -  SCREW BN T6 2MM 3.3MM 19MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412020	SUP	HCPCS C1713		72412020  -  SCREW BN T6 2MM 3.3MM 20MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412021	SUP	HCPCS C1713		72412021  -  SCREW BN T6 2MM 3.3MM 21MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412022	SUP	HCPCS C1713		72412022  -  SCREW BN T6 2MM 3.3MM 22MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412023	SUP	HCPCS C1713		72412023  -  SCREW BN T6 2MM 3.3MM 23MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412024	SUP	HCPCS C1713		72412024  -  SCREW BN T6 2MM 3.3MM 24MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412026	SUP	HCPCS C1713		72412026  -  SCREW BN T6 2MM 3.3MM 26MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412028	SUP	HCPCS C1713		72412028  -  SCREW BN T6 2MM 3.3MM 28MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412030	SUP	HCPCS C1713		72412030  -  SCREW BN T6 2MM 3.3MM 30MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412032	SUP	HCPCS C1713		72412032  -  SCREW BN T6 2MM 3.3MM 32MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412034	SUP	HCPCS C1713		72412034  -  SCREW BN T6 2MM 3.3MM 34MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412036	SUP	HCPCS C1713		72412036  -  SCREW BN T6 2MM 3.3MM 36MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412038	SUP	HCPCS C1713		72412038  -  SCREW BN T6 2MM 3.3MM 38MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412040	SUP	HCPCS C1713		72412040  -  SCREW BN T6 2MM 3.3MM 40MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$246.13 	$182.14	$0.00	$196.90	$110.76	$110.76	$0.00	$0.00	$0.00	$51.30	$182.67	$182.67	$0.00	$0.00	$51.29	$0.00	$145.58	$145.58	$0.00	$123.06	$194.93	$196.90	$0.00		$0.00	$38.52	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$0.00
72412406	SUP	HCPCS C1713		72412406  -  SCREW BN T7 2.4MM 3.8MM 6MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412407	SUP	HCPCS C1713		72412407  -  SCREW BN T7 2.4MM 3.8MM 7MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412408	SUP	HCPCS C1713		72412408  -  SCREW BN T7 2.4MM 3.8MM 8MM STRL EVOS LCK SM BN LNG BN MN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412409	SUP	HCPCS C1713		72412409  -  SCREW BN T7 2.4MM 3.8MM 9MM STRL EVOS MN LCK SS LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412410	SUP	HCPCS C1713		72412410  -  SCREW BN T7 2.4MM 3.8MM 10MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412411	SUP	HCPCS C1713		72412411  -  SCREW BN T7 2.4MM 3.8MM 11MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412412	SUP	HCPCS C1713		72412412  -  SCREW BN T7 2.4MM 3.8MM 12MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412413	SUP	HCPCS C1713		72412413  -  SCREW BN T7 2.4MM 3.8MM 13MM STRL EVOS MN LCK DRVR LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412414	SUP	HCPCS C1713		72412414  -  SCREW BN T7 2.4MM 3.8MM 14MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412415	SUP	HCPCS C1713		72412415  -  SCREW BN T7 2.4MM 3.8MM 15MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412416	SUP	HCPCS C1713		72412416  -  SCREW BN T7 2.4MM 3.8MM 16MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412417	SUP	HCPCS C1713		72412417  -  SCREW BN T7 2.4MM 3.8MM 17MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412418	SUP	HCPCS C1713		72412418  -  SCREW BN T7 2.4MM 3.8MM 18MM STRL EVOS MN LCK DRVR LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412419	SUP	HCPCS C1713		72412419  -  SCREW BN T7 2.4MM 3.8MM 19MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412420	SUP	HCPCS C1713		72412420  -  SCREW BN T7 2.4MM 3.8MM 20MM STRL EVOS LCK SM BN LNG BN MN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412421	SUP	HCPCS C1713		72412421  -  SCREW BN T7 2.4MM 3.8MM 21MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412422	SUP	HCPCS C1713		72412422  -  SCREW BN T7 2.4MM 3.8MM 22MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412423	SUP	HCPCS C1713		72412423  -  SCREW BN T7 2.4MM 3.8MM 23MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412424	SUP	HCPCS C1713		72412424  -  SCREW BN T7 2.4MM 3.8MM 24MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412426	SUP	HCPCS C1713		72412426  -  SCREW BN T7 2.4MM 3.8MM 26MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412428	SUP	HCPCS C1713		72412428  -  SCREW BN T7 2.4MM 3.8MM 28MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412430	SUP	HCPCS C1713		72412430  -  SCREW BN T7 2.4MM 3.8MM 30MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412432	SUP	HCPCS C1713		72412432  -  SCREW BN T7 2.4MM 3.8MM 32MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412434	SUP	HCPCS C1713		72412434  -  SCREW BN T7 2.4MM 3.8MM 34MM STRL EVOS MN LCK SS LNG BN SM	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412436	SUP	HCPCS C1713		72412436  -  SCREW BN T7 2.4MM 3.8MM 36MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412438	SUP	HCPCS C1713		72412438  -  SCREW BN T7 2.4MM 3.8MM 38MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412440	SUP	HCPCS C1713		72412440  -  SCREW BN T7 2.4MM 3.8MM 40MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412442	SUP	HCPCS C1713		72412442  -  SCREW BN T7 2.4MM 3.8MM 42MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412444	SUP	HCPCS C1713		72412444  -  SCREW BN T7 2.4MM 3.8MM 44MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412446	SUP	HCPCS C1713		72412446  -  SCREW BN T7 2.4MM 3.8MM 46MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412448	SUP	HCPCS C1713		72412448  -  SCREW BN T7 2.4MM 3.8MM 48MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412450	SUP	HCPCS C1713		72412450  -  SCREW BN T7 2.4MM 3.8MM 50MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412455	SUP	HCPCS C1713		72412455  -  SCREW BN T7 2.4MM 3.8MM 55MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412460	SUP	HCPCS C1713		72412460  -  SCREW BN T7 2.4MM 3.8MM 60MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$251.63 	$186.21	$0.00	$201.30	$113.23	$113.23	$0.00	$0.00	$0.00	$52.44	$186.76	$186.76	$0.00	$0.00	$52.44	$0.00	$148.84	$148.84	$0.00	$125.81	$199.29	$201.30	$0.00		$0.00	$39.38	$0.00	$0.00	$40.06	$0.00	$0.00	$0.00	$0.00	$0.00
72412465	SUP	HCPCS C1713		72412465  -  SCREW BN T7 2.4MM 3.8MM 65MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$279.13 	$206.56	$0.00	$223.30	$125.61	$125.61	$0.00	$0.00	$0.00	$58.18	$207.17	$207.17	$0.00	$0.00	$58.17	$0.00	$165.10	$165.10	$0.00	$139.56	$221.07	$223.30	$0.00		$0.00	$43.68	$0.00	$0.00	$44.44	$0.00	$0.00	$0.00	$0.00	$0.00
72412470	SUP	HCPCS C1713		72412470  -  SCREW BN T7 2.4MM 3.8MM 70MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$279.13 	$206.56	$0.00	$223.30	$125.61	$125.61	$0.00	$0.00	$0.00	$58.18	$207.17	$207.17	$0.00	$0.00	$58.17	$0.00	$165.10	$165.10	$0.00	$139.56	$221.07	$223.30	$0.00		$0.00	$43.68	$0.00	$0.00	$44.44	$0.00	$0.00	$0.00	$0.00	$0.00
72412475	SUP	HCPCS C1713		72412475  -  SCREW BN T7 2.4MM 3.8MM 75MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$279.13 	$206.56	$0.00	$223.30	$125.61	$125.61	$0.00	$0.00	$0.00	$58.18	$207.17	$207.17	$0.00	$0.00	$58.17	$0.00	$165.10	$165.10	$0.00	$139.56	$221.07	$223.30	$0.00		$0.00	$43.68	$0.00	$0.00	$44.44	$0.00	$0.00	$0.00	$0.00	$0.00
72412480	SUP	HCPCS C1713		72412480  -  SCREW BN T7 2.4MM 3.8MM 80MM STRL EVOS MN LCK LNG BN SM BN	BOTH IP/OP	$279.13 	$206.56	$0.00	$223.30	$125.61	$125.61	$0.00	$0.00	$0.00	$58.18	$207.17	$207.17	$0.00	$0.00	$58.17	$0.00	$165.10	$165.10	$0.00	$139.56	$221.07	$223.30	$0.00		$0.00	$43.68	$0.00	$0.00	$44.44	$0.00	$0.00	$0.00	$0.00	$0.00
72412706	SUP	HCPCS C1713		72412706  -  SCREW BN T8 2.7MM 4.5MM 6MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412707	SUP	HCPCS C1713		72412707  -  SCREW BN T8 2.7MM 4.5MM 7MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412708	SUP	HCPCS C1713		72412708  -  SCREW BN T8 2.7MM 4.3MM 8MM STRL EVOS LCK SM BN LNG BN MN	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412709	SUP	HCPCS C1713		72412709  -  SCREW BN T8 2.7MM 4.5MM 9MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412710	SUP	HCPCS C1713		72412710  -  SCREW BN T8 2.7MM 4.5MM 10MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412711	SUP	HCPCS C1713		72412711  -  SCREW BN T8 2.7MM 4.5MM 11MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412712	SUP	HCPCS C1713		72412712  -  SCREW BN T8 2.7MM 4.5MM 12MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412713	SUP	HCPCS C1713		72412713  -  SCREW BN T8 2.7MM 4.5MM 13MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412714	SUP	HCPCS C1713		72412714  -  SCREW BN T8 2MM 2.7MM 4.3MM 14MM ST LCK SM BN LNG BN EVOS	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412715	SUP	HCPCS C1713		72412715  -  SCREW BN T8 2.7MM 4.5MM 15MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412716	SUP	HCPCS C1713		72412716  -  SCREW BN T8 2MM 2.7MM 4.3MM 16MM ST LCK EVOS	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412717	SUP	HCPCS C1713		72412717  -  SCREW BN T8 2.7MM 4.5MM 17MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412718	SUP	HCPCS C1713		72412718  -  SCREW BN T8 2MM 2.7MM 4.3MM 18MM ST LCK SM BN LNG BN EVOS	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412719	SUP	HCPCS C1713		72412719  -  SCREW BN T8 2.7MM 4.5MM 19MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412720	SUP	HCPCS C1713		72412720  -  SCREW BN T8 2.7MM 4.5MM 20MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412721	SUP	HCPCS C1713		72412721  -  SCREW BN T8 2.7MM 4.5MM 21MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412722	SUP	HCPCS C1713		72412722  -  SCREW BN T8 2.7MM 4.5MM 22MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412723	SUP	HCPCS C1713		72412723  -  SCREW BN T8 2.7MM 4.5MM 23MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412724	SUP	HCPCS C1713		72412724  -  SCREW BN T8 2MM 2.7MM 4.3MM 24MM ST LCK EVOS	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412726	SUP	HCPCS C1713		72412726  -  SCREW BN T8 2.7MM 4.3MM 26MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412728	SUP	HCPCS C1713		72412728  -  SCREW BN T8 2.7MM 4.3MM 28MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412730	SUP	HCPCS C1713		72412730  -  SCREW BN T8 2.7MM 4.3MM 30MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412732	SUP	HCPCS C1713		72412732  -  SCREW BN T8 2.7MM 4.3MM 32MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412734	SUP	HCPCS C1713		72412734  -  SCREW BN T8 2.7MM 4.3MM 34MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412736	SUP	HCPCS C1713		72412736  -  SCREW BN T8 2.7MM 4.3MM 36MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412738	SUP	HCPCS C1713		72412738  -  SCREW BN T8 2.7MM 4.3MM 38MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412740	SUP	HCPCS C1713		72412740  -  SCREW BN T8 2.7MM 4.3MM 40MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412742	SUP	HCPCS C1713		72412742  -  SCREW BN T8 2.7MM 4.3MM 42MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412744	SUP	HCPCS C1713		72412744  -  SCREW BN T8 2.7MM 4.3MM 44MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412746	SUP	HCPCS C1713		72412746  -  SCREW BN T8 2.7MM 4.3MM 46MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412748	SUP	HCPCS C1713		72412748  -  SCREW BN T8 2.7MM 4.3MM 48MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412750	SUP	HCPCS C1713		72412750  -  SCREW BN T8 2.7MM 4.3MM 50MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412755	SUP	HCPCS C1713		72412755  -  SCREW BN T8 2.7MM 4.3MM 55MM LCK SLF RTN FLT HD SS LNG BN SM	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412760	SUP	HCPCS C1713		72412760  -  SCREW BN T8 2.7MM 4.5MM 60MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$254.38 	$188.24	$0.00	$203.50	$114.47	$114.47	$0.00	$0.00	$0.00	$53.02	$188.80	$188.80	$0.00	$0.00	$53.01	$0.00	$150.46	$150.46	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
72412765	SUP	HCPCS C1713		72412765  -  SCREW BN T8 2.7MM 4.5MM 65MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$287.38 	$212.66	$0.00	$229.90	$129.32	$129.32	$0.00	$0.00	$0.00	$59.90	$213.29	$213.29	$0.00	$0.00	$59.89	$0.00	$169.98	$169.98	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$44.97	$0.00	$0.00	$45.75	$0.00	$0.00	$0.00	$0.00	$0.00
72412770	SUP	HCPCS C1713		72412770  -  SCREW BN T8 2.7MM 4.5MM 70MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$287.38 	$212.66	$0.00	$229.90	$129.32	$129.32	$0.00	$0.00	$0.00	$59.90	$213.29	$213.29	$0.00	$0.00	$59.89	$0.00	$169.98	$169.98	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$44.97	$0.00	$0.00	$45.75	$0.00	$0.00	$0.00	$0.00	$0.00
72412775	SUP	HCPCS C1713		72412775  -  SCREW BN T8 2.7MM 4.5MM 75MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$287.38 	$212.66	$0.00	$229.90	$129.32	$129.32	$0.00	$0.00	$0.00	$59.90	$213.29	$213.29	$0.00	$0.00	$59.89	$0.00	$169.98	$169.98	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$44.97	$0.00	$0.00	$45.75	$0.00	$0.00	$0.00	$0.00	$0.00
72412780	SUP	HCPCS C1713		72412780  -  SCREW BN T8 2.7MM 4.5MM 80MM STRL EVOS MN ST SS CORT	BOTH IP/OP	$287.38 	$212.66	$0.00	$229.90	$129.32	$129.32	$0.00	$0.00	$0.00	$59.90	$213.29	$213.29	$0.00	$0.00	$59.89	$0.00	$169.98	$169.98	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$44.97	$0.00	$0.00	$45.75	$0.00	$0.00	$0.00	$0.00	$0.00
72413565	SUP	HCPCS C1713		72413565  -  SCREW BN 3.5MM 65MM STRL EVOS ST LCK	BOTH IP/OP	$305.25 	$225.89	$0.00	$244.20	$137.36	$137.36	$0.00	$0.00	$0.00	$63.62	$226.56	$226.56	$0.00	$0.00	$63.61	$0.00	$180.56	$180.56	$0.00	$152.63	$241.76	$244.20	$0.00		$0.00	$47.77	$0.00	$0.00	$48.60	$0.00	$0.00	$0.00	$0.00	$0.00
72413570	SUP	HCPCS C1713		72413570  -  SCREW BN 3.5MM 70MM STRL EVOS ST LCK	BOTH IP/OP	$305.25 	$225.89	$0.00	$244.20	$137.36	$137.36	$0.00	$0.00	$0.00	$63.62	$226.56	$226.56	$0.00	$0.00	$63.61	$0.00	$180.56	$180.56	$0.00	$152.63	$241.76	$244.20	$0.00		$0.00	$47.77	$0.00	$0.00	$48.60	$0.00	$0.00	$0.00	$0.00	$0.00
72423010	SUP	HCPCS C1713		72423010  -  SCREW BN T7 3MM 3.8MM 10MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423012	SUP	HCPCS C1713		72423012  -  SCREW BN T7 3MM 3.8MM 12MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423014	SUP	HCPCS C1713		72423014  -  SCREW BN T7 3MM 3.8MM 14MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423016	SUP	HCPCS C1713		72423016  -  SCREW BN T7 3MM 3.8MM 16MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423018	SUP	HCPCS C1713		72423018  -  SCREW BN T7 3MM 3.8MM 18MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423020	SUP	HCPCS C1713		72423020  -  SCREW BN T7 3MM 3.8MM 20MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423022	SUP	HCPCS C1713		72423022  -  SCREW BN T7 3MM 3.8MM 22MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423024	SUP	HCPCS C1713		72423024  -  SCREW BN T7 3MM 3.8MM 24MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423026	SUP	HCPCS C1713		72423026  -  SCREW BN T7 3MM 3.8MM 26MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423028	SUP	HCPCS C1713		72423028  -  SCREW BN T7 3MM 3.8MM 28MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423030	SUP	HCPCS C1713		72423030  -  SCREW BN T7 3MM 3.8MM 30MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423032	SUP	HCPCS C1713		72423032  -  SCREW BN T7 3MM 3.8MM 32MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423034	SUP	HCPCS C1713		72423034  -  SCREW BN T7 3MM 3.8MM 34MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423036	SUP	HCPCS C1713		72423036  -  SCREW BN T7 3MM 3.8MM 36MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423038	SUP	HCPCS C1713		72423038  -  SCREW BN T7 3MM 3.8MM 38MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423040	SUP	HCPCS C1713		72423040  -  SCREW BN T7 3MM 3.8MM 40MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423042	SUP	HCPCS C1713		72423042  -  SCREW BN T7 3MM 3.8MM 42MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423044	SUP	HCPCS C1713		72423044  -  SCREW BN T7 3MM 3.8MM 44MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423046	SUP	HCPCS C1713		72423046  -  SCREW BN T7 3MM 3.8MM 46MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423048	SUP	HCPCS C1713		72423048  -  SCREW BN T7 3MM 3.8MM 48MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423050	SUP	HCPCS C1713		72423050  -  SCREW BN T7 3MM 3.8MM 50MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423055	SUP	HCPCS C1713		72423055  -  SCREW BN T7 3MM 3.8MM 55MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423060	SUP	HCPCS C1713		72423060  -  SCREW BN T7 3MM 3.8MM 60MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
72423065	SUP	HCPCS C1713		72423065  -  SCREW BN T7 3MM 3.8MM 65MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72423070	SUP	HCPCS C1713		72423070  -  SCREW BN T7 3MM 3.8MM 70MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72423075	SUP	HCPCS C1713		72423075  -  SCREW BN T7 3MM 3.8MM 75MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72423080	SUP	HCPCS C1713		72423080  -  SCREW BN T7 3MM 3.8MM 80MM STRL EVOS MN SS LNG BN SM BN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424010	SUP	HCPCS C1713		72424010  -  SCREW BN T8 FT 4MM 4.5MM 10MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424012	SUP	HCPCS C1713		72424012  -  SCREW BN T8 FT 4MM 4.5MM 12MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424014	SUP	HCPCS C1713		72424014  -  SCREW BN T8 FT 4MM 4.5MM 14MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424016	SUP	HCPCS C1713		72424016  -  SCREW BN T8 FT 4MM 4.5MM 16MM SLFRET SCRDRVR EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424018	SUP	HCPCS C1713		72424018  -  SCREW BN T8 FT 4MM 4.5MM 18MM SLFRET SCRDRVR EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424020	SUP	HCPCS C1713		72424020  -  SCREW BN T8 FT 4MM 4.5MM 20MM SLFRET SCRDRVR EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424022	SUP	HCPCS C1713		72424022  -  SCREW BN T8 FT 4MM 4.5MM 22MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424024	SUP	HCPCS C1713		72424024  -  SCREW BN T8 FT 4MM 4.5MM 24MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424026	SUP	HCPCS C1713		72424026  -  SCREW BN T8 FT 4MM 4.5MM 10MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424028	SUP	HCPCS C1713		72424028  -  SCREW BN T8 FT 4MM 4.5MM 10MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424030	SUP	HCPCS C1713		72424030  -  SCREW BN T8 FT 4MM 4.5MM 30MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424032	SUP	HCPCS C1713		72424032  -  SCREW BN FT T8 4MM 4.5MM 32MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424034	SUP	HCPCS C1713		72424034  -  SCREW BN FT T8 4MM 4.5MM 34MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424036	SUP	HCPCS C1713		72424036  -  SCREW BN FT T8 4MM 4.5MM 36MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424038	SUP	HCPCS C1713		72424038  -  SCREW BN FT T8 4MM 4.5MM 38MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424040	SUP	HCPCS C1713		72424040  -  SCREW BN FT T8 4MM 4.5MM 40MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424042	SUP	HCPCS C1713		72424042  -  SCREW BN FT T8 4MM 4.5MM 42MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424044	SUP	HCPCS C1713		72424044  -  SCREW BN FT T8 4MM 4.5MM 44MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424046	SUP	HCPCS C1713		72424046  -  SCREW BN FT T8 4MM 4.5MM 46MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424048	SUP	HCPCS C1713		72424048  -  SCREW BN FT T8 4MM 4.5MM 48MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424050	SUP	HCPCS C1713		72424050  -  SCREW BN FT T8 4MM 4.5MM 50MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424055	SUP	HCPCS C1713		72424055  -  SCREW BN FT T8 4MM 4.5MM 55MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424060	SUP	HCPCS C1713		72424060  -  SCREW BN FT T8 4MM 4.5MM 60MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424065	SUP	HCPCS C1713		72424065  -  SCREW BN FT T8 4MM 4.5MM 65MM STRL EVOS MN VA SLFRET SCRDRVR	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424070	SUP	HCPCS C1713		72424070  -  SCREW BN FT T8 4MM 4.5MM 70MM STRL EVOS MN LNG BN SM BN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424075	SUP	HCPCS C1713		72424075  -  SCREW BN FT T8 4MM 4.5MM 75MM STRL EVOS MN LNG BN SM BN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72424080	SUP	HCPCS C1713		72424080  -  SCREW BN FT T8 4MM 4.5MM 80MM STRL EVOS MN LNG BN SM BN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434026	SUP	HCPCS C1713		72434026  -  SCREW BN T8 P/T 4MM 4.5MM 26MM SLFRET SCRDRVR EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434028	SUP	HCPCS C1713		72434028  -  SCREW BN T8 P/T 4MM 4.5MM 28MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434030	SUP	HCPCS C1713		72434030  -  SCREW BN T8 P/T 4MM 4.5MM 30MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434032	SUP	HCPCS C1713		72434032  -  SCREW BN T8 P/T 4MM 4.5MM 32MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434034	SUP	HCPCS C1713		72434034  -  SCREW BN T8 P/T 4MM 4.5MM 34MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434036	SUP	HCPCS C1713		72434036  -  SCREW BN T8 P/T 4MM 4.5MM 36MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434038	SUP	HCPCS C1713		72434038  -  SCREW BN T8 P/T 4MM 4.5MM 38MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434040	SUP	HCPCS C1713		72434040  -  SCREW BN T8 P/T 4MM 4.5MM 40MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434042	SUP	HCPCS C1713		72434042  -  SCREW BN T8 P/T 4MM 4.5MM 42MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434044	SUP	HCPCS C1713		72434044  -  SCREW BN T8 P/T 4MM 4.5MM 44MM SLFRET SCRDRVR EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434046	SUP	HCPCS C1713		72434046  -  SCREW BN T8 P/T 4MM 4.5MM 46MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434048	SUP	HCPCS C1713		72434048  -  SCREW BN T8 P/T 4MM 4.5MM 48MM SLFRET SCRDRVR EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434050	SUP	HCPCS C1713		72434050  -  SCREW BN T8 P/T 4MM 4.5MM 50MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434055	SUP	HCPCS C1713		72434055  -  SCREW BN T8 P/T 4MM 4.5MM 55MM SLFRET SCRDRVR EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434060	SUP	HCPCS C1713		72434060  -  SCREW BN T8 P/T 4MM 4.5MM 60MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$84.77	$84.77	$0.00	$0.00	$0.00	$39.26	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$111.42	$111.42	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$29.48	$0.00	$0.00	$29.99	$0.00	$0.00	$0.00	$0.00	$0.00
72434065	SUP	HCPCS C1713		72434065  -  SCREW BN T8 P/T 4MM 4.5MM 65MM SLFRET SCRDRVR EVOS MN	BOTH IP/OP	$213.13 	$157.72	$0.00	$170.50	$95.91	$95.91	$0.00	$0.00	$0.00	$44.42	$158.18	$158.18	$0.00	$0.00	$44.42	$0.00	$126.06	$126.06	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$33.35	$0.00	$0.00	$33.93	$0.00	$0.00	$0.00	$0.00	$0.00
72434070	SUP	HCPCS C1713		72434070  -  SCREW BN T8 P/T 4MM 4.5MM 70MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$213.13 	$157.72	$0.00	$170.50	$95.91	$95.91	$0.00	$0.00	$0.00	$44.42	$158.18	$158.18	$0.00	$0.00	$44.42	$0.00	$126.06	$126.06	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$33.35	$0.00	$0.00	$33.93	$0.00	$0.00	$0.00	$0.00	$0.00
72434075	SUP	HCPCS C1713		72434075  -  SCREW BN T8 P/T 4MM 4.5MM 75MM SLFRET SCRDRVR TAP EVOS MN	BOTH IP/OP	$213.13 	$157.72	$0.00	$170.50	$95.91	$95.91	$0.00	$0.00	$0.00	$44.42	$158.18	$158.18	$0.00	$0.00	$44.42	$0.00	$126.06	$126.06	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$33.35	$0.00	$0.00	$33.93	$0.00	$0.00	$0.00	$0.00	$0.00
72434080	SUP	HCPCS C1713		72434080  -  SCREW BN T8 P/T 4MM 4.5MM 80MM SLFRET SCRDRVR EVOS MN	BOTH IP/OP	$213.13 	$157.72	$0.00	$170.50	$95.91	$95.91	$0.00	$0.00	$0.00	$44.42	$158.18	$158.18	$0.00	$0.00	$44.42	$0.00	$126.06	$126.06	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$33.35	$0.00	$0.00	$33.93	$0.00	$0.00	$0.00	$0.00	$0.00
72441010	SUP	HCPCS C1713		72441010  -  PLATE BN 127MM STRL EVOS 10 HL CMPR 3.5MM SCR	BOTH IP/OP	$456.50 	$337.81	$0.00	$365.20	$205.43	$205.43	$0.00	$0.00	$0.00	$95.15	$338.81	$338.81	$0.00	$0.00	$95.13	$0.00	$270.02	$270.02	$0.00	$228.25	$361.55	$365.20	$0.00		$0.00	$71.44	$0.00	$0.00	$72.67	$0.00	$0.00	$0.00	$0.00	$0.00
72442050	SUP	HCPCS C1713		72442050  -  PLATE BN T 36MM EVOS MN 2 HLE/HD 6 HL SHFT LOPRFL VA SS SM	BOTH IP/OP	"$1,225.13 "	$906.60	$0.00	$980.10	$551.31	$551.31	$0.00	$0.00	$0.00	$255.35	$909.29	$909.29	$0.00	$0.00	$255.32	$0.00	$724.66	$724.66	$0.00	$612.56	$970.30	$980.10	$0.00		$0.00	$191.73	$0.00	$0.00	$195.04	$0.00	$0.00	$0.00	$0.00	$0.00
72442052	SUP	HCPCS C1713		72442052  -  PLATE BN T 46MM EVOS MN 2 HLE/HD 8 HL SHFT LOPRFL VA SS SM	BOTH IP/OP	"$1,225.13 "	$906.60	$0.00	$980.10	$551.31	$551.31	$0.00	$0.00	$0.00	$255.35	$909.29	$909.29	$0.00	$0.00	$255.32	$0.00	$724.66	$724.66	$0.00	$612.56	$970.30	$980.10	$0.00		$0.00	$191.73	$0.00	$0.00	$195.04	$0.00	$0.00	$0.00	$0.00	$0.00
72442054	SUP	HCPCS C1713		72442054  -  PLATE BN 5MM SPC T 31X5-15.3X1.2MM STRL 71MM EVOS MN 3	BOTH IP/OP	"$1,225.13 "	$906.60	$0.00	$980.10	$551.31	$551.31	$0.00	$0.00	$0.00	$255.35	$909.29	$909.29	$0.00	$0.00	$255.32	$0.00	$724.66	$724.66	$0.00	$612.56	$970.30	$980.10	$0.00		$0.00	$191.73	$0.00	$0.00	$195.04	$0.00	$0.00	$0.00	$0.00	$0.00
72442056	SUP	HCPCS C1713		72442056  -  PLATE BN T 51MM EVOS MN 2 HLE/HD 9 HL SHFT LOPRFL VA SS SM	BOTH IP/OP	"$1,225.13 "	$906.60	$0.00	$980.10	$551.31	$551.31	$0.00	$0.00	$0.00	$255.35	$909.29	$909.29	$0.00	$0.00	$255.32	$0.00	$724.66	$724.66	$0.00	$612.56	$970.30	$980.10	$0.00		$0.00	$191.73	$0.00	$0.00	$195.04	$0.00	$0.00	$0.00	$0.00	$0.00
72442058	SUP	HCPCS C1713		72442058  -  PLATE BN 21MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2MM	BOTH IP/OP	"$1,266.38 "	$937.12	$0.00	"$1,013.10"	$569.87	$569.87	$0.00	$0.00	$0.00	$263.94	$939.90	$939.90	$0.00	$0.00	$263.91	$0.00	$749.06	$749.06	$0.00	$633.19	"$1,002.97"	"$1,013.10"	$0.00		$0.00	$198.19	$0.00	$0.00	$201.61	$0.00	$0.00	$0.00	$0.00	$0.00
72442060	SUP	HCPCS C1713		72442060  -  PLATE BN 5MM SPC 31X5X1.2MM STRL EVOS LOPRFL 6 HL VA FLX SS	BOTH IP/OP	"$1,266.38 "	$937.12	$0.00	"$1,013.10"	$569.87	$569.87	$0.00	$0.00	$0.00	$263.94	$939.90	$939.90	$0.00	$0.00	$263.91	$0.00	$749.06	$749.06	$0.00	$633.19	"$1,002.97"	"$1,013.10"	$0.00		$0.00	$198.19	$0.00	$0.00	$201.61	$0.00	$0.00	$0.00	$0.00	$0.00
72442062	SUP	HCPCS C1713		72442062  -  PLATE BN 41MM EVOS MN 8 HL FLX LOPRFL VA SS SM BN LNG BN 2MM	BOTH IP/OP	"$1,266.38 "	$937.12	$0.00	"$1,013.10"	$569.87	$569.87	$0.00	$0.00	$0.00	$263.94	$939.90	$939.90	$0.00	$0.00	$263.91	$0.00	$749.06	$749.06	$0.00	$633.19	"$1,002.97"	"$1,013.10"	$0.00		$0.00	$198.19	$0.00	$0.00	$201.61	$0.00	$0.00	$0.00	$0.00	$0.00
72442064	SUP	HCPCS C1713		72442064  -  PLATE BN 51MM EVOS MN 10 HL FLX LOPRFL VA SS SM BN LNG BN 2	BOTH IP/OP	"$1,266.38 "	$937.12	$0.00	"$1,013.10"	$569.87	$569.87	$0.00	$0.00	$0.00	$263.94	$939.90	$939.90	$0.00	$0.00	$263.91	$0.00	$749.06	$749.06	$0.00	$633.19	"$1,002.97"	"$1,013.10"	$0.00		$0.00	$198.19	$0.00	$0.00	$201.61	$0.00	$0.00	$0.00	$0.00	$0.00
72442066	SUP	HCPCS C1713		72442066  -  PLATE BN 101MM EVOS MN 20 HL FLX LOPRFL VA SS SM BN LNG BN 2	BOTH IP/OP	"$1,266.38 "	$937.12	$0.00	"$1,013.10"	$569.87	$569.87	$0.00	$0.00	$0.00	$263.94	$939.90	$939.90	$0.00	$0.00	$263.91	$0.00	$749.06	$749.06	$0.00	$633.19	"$1,002.97"	"$1,013.10"	$0.00		$0.00	$198.19	$0.00	$0.00	$201.61	$0.00	$0.00	$0.00	$0.00	$0.00
72442068	SUP	HCPCS C1713		72442068  -  PLATE BN 21MM EVOS MN 4 HL STRTH LOPRFL VA SS SM BN LNG BN 2	BOTH IP/OP	"$1,266.38 "	$937.12	$0.00	"$1,013.10"	$569.87	$569.87	$0.00	$0.00	$0.00	$263.94	$939.90	$939.90	$0.00	$0.00	$263.91	$0.00	$749.06	$749.06	$0.00	$633.19	"$1,002.97"	"$1,013.10"	$0.00		$0.00	$198.19	$0.00	$0.00	$201.61	$0.00	$0.00	$0.00	$0.00	$0.00
72442070	SUP	HCPCS C1713		72442070  -  PLATE BN 31MM EVOS MN 6 HL STRTH LOPRFL VA SS SM BN LNG BN 2	BOTH IP/OP	"$1,266.38 "	$937.12	$0.00	"$1,013.10"	$569.87	$569.87	$0.00	$0.00	$0.00	$263.94	$939.90	$939.90	$0.00	$0.00	$263.91	$0.00	$749.06	$749.06	$0.00	$633.19	"$1,002.97"	"$1,013.10"	$0.00		$0.00	$198.19	$0.00	$0.00	$201.61	$0.00	$0.00	$0.00	$0.00	$0.00
72442072	SUP	HCPCS C1713		72442072  -  PLATE BN 41MM EVOS MN 8 HL STRTH LOPRFL VA SS SM BN LNG BN 2	BOTH IP/OP	"$1,266.38 "	$937.12	$0.00	"$1,013.10"	$569.87	$569.87	$0.00	$0.00	$0.00	$263.94	$939.90	$939.90	$0.00	$0.00	$263.91	$0.00	$749.06	$749.06	$0.00	$633.19	"$1,002.97"	"$1,013.10"	$0.00		$0.00	$198.19	$0.00	$0.00	$201.61	$0.00	$0.00	$0.00	$0.00	$0.00
72442074	SUP	HCPCS C1713		72442074  -  PLATE BN 51MM EVOS MN 10 HL STRTH LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$1,266.38 "	$937.12	$0.00	"$1,013.10"	$569.87	$569.87	$0.00	$0.00	$0.00	$263.94	$939.90	$939.90	$0.00	$0.00	$263.91	$0.00	$749.06	$749.06	$0.00	$633.19	"$1,002.97"	"$1,013.10"	$0.00		$0.00	$198.19	$0.00	$0.00	$201.61	$0.00	$0.00	$0.00	$0.00	$0.00
72442076	SUP	HCPCS C1713		72442076  -  PLATE BN 101MM EVOS MN 20 HL STRTH LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$1,266.38 "	$937.12	$0.00	"$1,013.10"	$569.87	$569.87	$0.00	$0.00	$0.00	$263.94	$939.90	$939.90	$0.00	$0.00	$263.91	$0.00	$749.06	$749.06	$0.00	$633.19	"$1,002.97"	"$1,013.10"	$0.00		$0.00	$198.19	$0.00	$0.00	$201.61	$0.00	$0.00	$0.00	$0.00	$0.00
72442078	SUP	HCPCS C1713		72442078  -  PLATE BN STRG 28MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG	BOTH IP/OP	"$1,512.50 "	"$1,119.25"	$0.00	"$1,210.00"	$680.63	$680.63	$0.00	$0.00	$0.00	$315.24	"$1,122.58"	"$1,122.58"	$0.00	$0.00	$315.21	$0.00	$894.64	$894.64	$0.00	$756.25	"$1,197.90"	"$1,210.00"	$0.00		$0.00	$236.71	$0.00	$0.00	$240.79	$0.00	$0.00	$0.00	$0.00	$0.00
72442080	SUP	HCPCS C1713		72442080  -  PLATE BN STRG 38MM EVOS MN 7 HL TINE LOPRFL VA SS SM BN LNG	BOTH IP/OP	"$1,512.50 "	"$1,119.25"	$0.00	"$1,210.00"	$680.63	$680.63	$0.00	$0.00	$0.00	$315.24	"$1,122.58"	"$1,122.58"	$0.00	$0.00	$315.21	$0.00	$894.64	$894.64	$0.00	$756.25	"$1,197.90"	"$1,210.00"	$0.00		$0.00	$236.71	$0.00	$0.00	$240.79	$0.00	$0.00	$0.00	$0.00	$0.00
72442120	SUP	HCPCS C1713		72442120  -  WASHER ORTH 5MM EVOS 2MM SCR MN PLT SYS	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72442124	SUP	HCPCS C1713		72442124  -  WASHER ORTH 6MM EVOS 2.4MM SCR MN PLT SYS	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72442127	SUP	HCPCS C1713		72442127  -  WASHER ORTH 7MM EVOS 2.7MM SCR MN PLT SYS	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$33.08	$33.08	$0.00	$0.00	$0.00	$15.32	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$43.48	$43.48	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$11.50	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$0.00
72442135	SUP	HCPCS C1713		72442135  -  WASHER ORTH STRL EVOS 3.5 MM SCR	BOTH IP/OP	$83.60 	$61.86	$0.00	$66.88	$37.62	$37.62	$0.00	$0.00	$0.00	$17.42	$62.05	$62.05	$0.00	$0.00	$17.42	$0.00	$49.45	$49.45	$0.00	$41.80	$66.21	$66.88	$0.00		$0.00	$13.08	$0.00	$0.00	$13.31	$0.00	$0.00	$0.00	$0.00	$0.00
72442220	SUP	HCPCS C1713		72442220  -  WASHER ORTH 10MM EVOS 2 2.4MM SCR MN PLT SYS	BOTH IP/OP	$147.13 	$108.88	$0.00	$117.70	$66.21	$66.21	$0.00	$0.00	$0.00	$30.66	$109.20	$109.20	$0.00	$0.00	$30.66	$0.00	$87.02	$87.02	$0.00	$73.56	$116.53	$117.70	$0.00		$0.00	$23.03	$0.00	$0.00	$23.42	$0.00	$0.00	$0.00	$0.00	$0.00
72442224	SUP	HCPCS C1713		72442224  -  WASHER ORTH 11MM EVOS 2 2.4MM SCR MN PLT SYS	BOTH IP/OP	$147.13 	$108.88	$0.00	$117.70	$66.21	$66.21	$0.00	$0.00	$0.00	$30.66	$109.20	$109.20	$0.00	$0.00	$30.66	$0.00	$87.02	$87.02	$0.00	$73.56	$116.53	$117.70	$0.00		$0.00	$23.03	$0.00	$0.00	$23.42	$0.00	$0.00	$0.00	$0.00	$0.00
72442227	SUP	HCPCS C1713		72442227  -  WASHER ORTH 13MM EVOS 2 2.7MM SCR MN PLT SYS	BOTH IP/OP	$147.13 	$108.88	$0.00	$117.70	$66.21	$66.21	$0.00	$0.00	$0.00	$30.66	$109.20	$109.20	$0.00	$0.00	$30.66	$0.00	$87.02	$87.02	$0.00	$73.56	$116.53	$117.70	$0.00		$0.00	$23.03	$0.00	$0.00	$23.42	$0.00	$0.00	$0.00	$0.00	$0.00
72442450	SUP	HCPCS C1713		72442450  -  PLATE BN T 43MM EVOS MN 2 HLE/HD 6 HL SHFT LOPRFL VA SS SM	BOTH IP/OP	"$1,553.75 "	"$1,149.78"	$0.00	"$1,243.00"	$699.19	$699.19	$0.00	$0.00	$0.00	$323.84	"$1,153.19"	"$1,153.19"	$0.00	$0.00	$323.80	$0.00	$919.04	$919.04	$0.00	$776.88	"$1,230.57"	"$1,243.00"	$0.00		$0.00	$243.16	$0.00	$0.00	$247.36	$0.00	$0.00	$0.00	$0.00	$0.00
72442452	SUP	HCPCS C1713		72442452  -  PLATE BN T 55MM EVOS MN 2 HLE/HD 8 HL SHFT LOPRFL VA SS SM	BOTH IP/OP	"$1,553.75 "	"$1,149.78"	$0.00	"$1,243.00"	$699.19	$699.19	$0.00	$0.00	$0.00	$323.84	"$1,153.19"	"$1,153.19"	$0.00	$0.00	$323.80	$0.00	$919.04	$919.04	$0.00	$776.88	"$1,230.57"	"$1,243.00"	$0.00		$0.00	$243.16	$0.00	$0.00	$247.36	$0.00	$0.00	$0.00	$0.00	$0.00
72442454	SUP	HCPCS C1713		72442454  -  PLATE BN T 37MM EVOS MN 3 HLE/HD 5 HL SHFT LOPRFL VA SS SM	BOTH IP/OP	"$1,553.75 "	"$1,149.78"	$0.00	"$1,243.00"	$699.19	$699.19	$0.00	$0.00	$0.00	$323.84	"$1,153.19"	"$1,153.19"	$0.00	$0.00	$323.80	$0.00	$919.04	$919.04	$0.00	$776.88	"$1,230.57"	"$1,243.00"	$0.00		$0.00	$243.16	$0.00	$0.00	$247.36	$0.00	$0.00	$0.00	$0.00	$0.00
72442456	SUP	HCPCS C1713		72442456  -  PLATE BN T 61MM EVOS MN 3 HLE/HD 9 HL SHFT LOPRFL VA SS SM	BOTH IP/OP	"$1,553.75 "	"$1,149.78"	$0.00	"$1,243.00"	$699.19	$699.19	$0.00	$0.00	$0.00	$323.84	"$1,153.19"	"$1,153.19"	$0.00	$0.00	$323.80	$0.00	$919.04	$919.04	$0.00	$776.88	"$1,230.57"	"$1,243.00"	$0.00		$0.00	$243.16	$0.00	$0.00	$247.36	$0.00	$0.00	$0.00	$0.00	$0.00
72442458	SUP	HCPCS C1713		72442458  -  PLATE BN 25MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2.4	BOTH IP/OP	"$1,595.00 "	"$1,180.30"	$0.00	"$1,276.00"	$717.75	$717.75	$0.00	$0.00	$0.00	$332.44	"$1,183.81"	"$1,183.81"	$0.00	$0.00	$332.40	$0.00	$943.44	$943.44	$0.00	$797.50	"$1,263.24"	"$1,276.00"	$0.00		$0.00	$249.62	$0.00	$0.00	$253.92	$0.00	$0.00	$0.00	$0.00	$0.00
72442460	SUP	HCPCS C1713		72442460  -  PLATE BN 37X6X1.4MM EVOS MN 6 HL FLX LOPRFL VA SS LG BN SM	BOTH IP/OP	"$1,595.00 "	"$1,180.30"	$0.00	"$1,276.00"	$717.75	$717.75	$0.00	$0.00	$0.00	$332.44	"$1,183.81"	"$1,183.81"	$0.00	$0.00	$332.40	$0.00	$943.44	$943.44	$0.00	$797.50	"$1,263.24"	"$1,276.00"	$0.00		$0.00	$249.62	$0.00	$0.00	$253.92	$0.00	$0.00	$0.00	$0.00	$0.00
72442462	SUP	HCPCS C1713		72442462  -  PLATE BN 49MM EVOS MN 8 HL FLX LOPRFL VA SS SM BN LNG BN 2.4	BOTH IP/OP	"$1,595.00 "	"$1,180.30"	$0.00	"$1,276.00"	$717.75	$717.75	$0.00	$0.00	$0.00	$332.44	"$1,183.81"	"$1,183.81"	$0.00	$0.00	$332.40	$0.00	$943.44	$943.44	$0.00	$797.50	"$1,263.24"	"$1,276.00"	$0.00		$0.00	$249.62	$0.00	$0.00	$253.92	$0.00	$0.00	$0.00	$0.00	$0.00
72442464	SUP	HCPCS C1713		72442464  -  PLATE BN 61MM EVOS MN 10 HL FLX LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$1,595.00 "	"$1,180.30"	$0.00	"$1,276.00"	$717.75	$717.75	$0.00	$0.00	$0.00	$332.44	"$1,183.81"	"$1,183.81"	$0.00	$0.00	$332.40	$0.00	$943.44	$943.44	$0.00	$797.50	"$1,263.24"	"$1,276.00"	$0.00		$0.00	$249.62	$0.00	$0.00	$253.92	$0.00	$0.00	$0.00	$0.00	$0.00
72442466	SUP	HCPCS C1713		72442466  -  PLATE BN 121MM EVOS MN 20 HL FLX LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$1,595.00 "	"$1,180.30"	$0.00	"$1,276.00"	$717.75	$717.75	$0.00	$0.00	$0.00	$332.44	"$1,183.81"	"$1,183.81"	$0.00	$0.00	$332.40	$0.00	$943.44	$943.44	$0.00	$797.50	"$1,263.24"	"$1,276.00"	$0.00		$0.00	$249.62	$0.00	$0.00	$253.92	$0.00	$0.00	$0.00	$0.00	$0.00
72442468	SUP	HCPCS C1713		72442468  -  PLATE BN 25MM STRL EVOS MN 4 HL LOPRFL VA LCK SS 2.4MM SCR	BOTH IP/OP	"$1,595.00 "	"$1,180.30"	$0.00	"$1,276.00"	$717.75	$717.75	$0.00	$0.00	$0.00	$332.44	"$1,183.81"	"$1,183.81"	$0.00	$0.00	$332.40	$0.00	$943.44	$943.44	$0.00	$797.50	"$1,263.24"	"$1,276.00"	$0.00		$0.00	$249.62	$0.00	$0.00	$253.92	$0.00	$0.00	$0.00	$0.00	$0.00
72442470	SUP	HCPCS C1713		72442470  -  PLATE BN 37MM EVOS MN 6 HL STRTH LOPRFL SS	BOTH IP/OP	"$1,595.00 "	"$1,180.30"	$0.00	"$1,276.00"	$717.75	$717.75	$0.00	$0.00	$0.00	$332.44	"$1,183.81"	"$1,183.81"	$0.00	$0.00	$332.40	$0.00	$943.44	$943.44	$0.00	$797.50	"$1,263.24"	"$1,276.00"	$0.00		$0.00	$249.62	$0.00	$0.00	$253.92	$0.00	$0.00	$0.00	$0.00	$0.00
72442472	SUP	HCPCS C1713		72442472  -  PLATE BN 49MM EVOS MN 20 HL STRENGHT LOPRFL VA SS SM BN LNG	BOTH IP/OP	"$1,595.00 "	"$1,180.30"	$0.00	"$1,276.00"	$717.75	$717.75	$0.00	$0.00	$0.00	$332.44	"$1,183.81"	"$1,183.81"	$0.00	$0.00	$332.40	$0.00	$943.44	$943.44	$0.00	$797.50	"$1,263.24"	"$1,276.00"	$0.00		$0.00	$249.62	$0.00	$0.00	$253.92	$0.00	$0.00	$0.00	$0.00	$0.00
72442474	SUP	HCPCS C1713		72442474  -  PLATE BN 61MM EVOS MN 10 HL STRENGHT LOPRFL VA SS SM BN LNG	BOTH IP/OP	"$1,595.00 "	"$1,180.30"	$0.00	"$1,276.00"	$717.75	$717.75	$0.00	$0.00	$0.00	$332.44	"$1,183.81"	"$1,183.81"	$0.00	$0.00	$332.40	$0.00	$943.44	$943.44	$0.00	$797.50	"$1,263.24"	"$1,276.00"	$0.00		$0.00	$249.62	$0.00	$0.00	$253.92	$0.00	$0.00	$0.00	$0.00	$0.00
72442476	SUP	HCPCS C1713		72442476  -  PLATE BN 121MM EVOS MN 20 HL STRENGHT LOPRFL VA SS SM BN LNG	BOTH IP/OP	"$1,595.00 "	"$1,180.30"	$0.00	"$1,276.00"	$717.75	$717.75	$0.00	$0.00	$0.00	$332.44	"$1,183.81"	"$1,183.81"	$0.00	$0.00	$332.40	$0.00	$943.44	$943.44	$0.00	$797.50	"$1,263.24"	"$1,276.00"	$0.00		$0.00	$249.62	$0.00	$0.00	$253.92	$0.00	$0.00	$0.00	$0.00	$0.00
72442478	SUP	HCPCS C1713		72442478  -  PLATE BN STRG 34MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG	BOTH IP/OP	"$1,677.50 "	"$1,241.35"	$0.00	"$1,342.00"	$754.88	$754.88	$0.00	$0.00	$0.00	$349.63	"$1,245.04"	"$1,245.04"	$0.00	$0.00	$349.59	$0.00	$992.24	$992.24	$0.00	$838.75	"$1,328.58"	"$1,342.00"	$0.00		$0.00	$262.53	$0.00	$0.00	$267.06	$0.00	$0.00	$0.00	$0.00	$0.00
72442482	SUP	HCPCS C1713		72442482  -  PLATE BN 47MM EVOS MN 5 HL LOPRFL VA SS SM BN LNG BN 2.4MM	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442484	SUP	HCPCS C1713		72442484  -  PLATE BN 59MM EVOS MN 7 HL LOPRFL VA SS SM BN LNG BN 2.4MM	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442486	SUP	HCPCS C1713		72442486  -  PLATE BN Y 45MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$1,966.25 "	"$1,455.03"	$0.00	"$1,573.00"	$884.81	$884.81	$0.00	$0.00	$0.00	$409.82	"$1,459.35"	"$1,459.35"	$0.00	$0.00	$409.77	$0.00	"$1,163.04"	"$1,163.04"	$0.00	$983.13	"$1,557.27"	"$1,573.00"	$0.00		$0.00	$307.72	$0.00	$0.00	$313.03	$0.00	$0.00	$0.00	$0.00	$0.00
72442488	SUP	HCPCS C1713		72442488  -  PLATE BN Y 57MM EVOS MN 7 HL TINE LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$1,966.25 "	"$1,455.03"	$0.00	"$1,573.00"	$884.81	$884.81	$0.00	$0.00	$0.00	$409.82	"$1,459.35"	"$1,459.35"	$0.00	$0.00	$409.77	$0.00	"$1,163.04"	"$1,163.04"	$0.00	$983.13	"$1,557.27"	"$1,573.00"	$0.00		$0.00	$307.72	$0.00	$0.00	$313.03	$0.00	$0.00	$0.00	$0.00	$0.00
72442490	SUP	HCPCS C1713		72442490  -  PLATE BN 3ANG 55MM EVOS MN 6 HL LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442492	SUP	HCPCS C1713		72442492  -  PLATE BN 3ANG 67MM EVOS MN 8 HL LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442494	SUP	HCPCS C1713		72442494  -  PLATE BN TRPZD 24X18X1.4MM EVOS LOPRFL VA 5 HL SS 2.4MM SCR	BOTH IP/OP	"$2,000.63 "	"$1,480.47"	$0.00	"$1,600.50"	$900.28	$900.28	$0.00	$0.00	$0.00	$416.98	"$1,484.86"	"$1,484.86"	$0.00	$0.00	$416.93	$0.00	"$1,183.37"	"$1,183.37"	$0.00	"$1,000.31"	"$1,584.50"	"$1,600.50"	$0.00		$0.00	$313.10	$0.00	$0.00	$318.50	$0.00	$0.00	$0.00	$0.00	$0.00
72442720	SUP	HCPCS C1713		72442720  -  PLATE BN T 42X7.5-21.5X1.4MM STRL EVOS MN 3 HLE/HD 5 HL SHFT	BOTH IP/OP	"$1,718.75 "	"$1,271.88"	$0.00	"$1,375.00"	$773.44	$773.44	$0.00	$0.00	$0.00	$358.23	"$1,275.66"	"$1,275.66"	$0.00	$0.00	$358.19	$0.00	"$1,016.64"	"$1,016.64"	$0.00	$859.38	"$1,361.25"	"$1,375.00"	$0.00		$0.00	$268.98	$0.00	$0.00	$273.63	$0.00	$0.00	$0.00	$0.00	$0.00
72442722	SUP	HCPCS C1713		72442722  -  PLATE BN T 71MM EVOS MN 3 HLE/HD 9 HL SHFT LOPRFL VA SS SM	BOTH IP/OP	"$1,718.75 "	"$1,271.88"	$0.00	"$1,375.00"	$773.44	$773.44	$0.00	$0.00	$0.00	$358.23	"$1,275.66"	"$1,275.66"	$0.00	$0.00	$358.19	$0.00	"$1,016.64"	"$1,016.64"	$0.00	$859.38	"$1,361.25"	"$1,375.00"	$0.00		$0.00	$268.98	$0.00	$0.00	$273.63	$0.00	$0.00	$0.00	$0.00	$0.00
72442724	SUP	HCPCS C1713		72442724  -  PLATE BN 28MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2.7	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442726	SUP	HCPCS C1713		72442726  -  PLATE BN 42MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2.7	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442728	SUP	HCPCS C1713		72442728  -  PLATE BN 56MM EVOS MN 8 HL FLX LOPRFL VA SS SM BN LNG BN 2.7	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442760	SUP	HCPCS C1713		72442760  -  PLATE BN 70MM EVOS MN 10 HL FLX LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442762	SUP	HCPCS C1713		72442762  -  PLATE BN 140MM EVOS MN 20 HL FLX LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442764	SUP	HCPCS C1713		72442764  -  PLATE BN 28MM EVOS MN 4 HL STRENGHT LOPRFL VA SS SM BN LNG	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442766	SUP	HCPCS C1713		72442766  -  PLATE BN 7MM SPC 42X7.5X2.2MM 140MM EVOS MN 6 HL SHFT VA LCK	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442768	SUP	HCPCS C1713		72442768  -  PLATE BN 7MM SPC 56X7.5X2.2MM 140MM EVOS MN 6 HL SHFT VA LCK	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442770	SUP	HCPCS C1713		72442770  -  PLATE BN 7MM SPC 70X7.5X2.2MM 140MM EVOS MN 6 HL SHFT VA LCK	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442772	SUP	HCPCS C1713		72442772  -  PLATE BN 140MM EVOS MN 20 HL STRENGHT LOPRFL VA SS SM BN LNG	BOTH IP/OP	"$1,753.13 "	"$1,297.32"	$0.00	"$1,402.50"	$788.91	$788.91	$0.00	$0.00	$0.00	$365.40	"$1,301.17"	"$1,301.17"	$0.00	$0.00	$365.35	$0.00	"$1,036.97"	"$1,036.97"	$0.00	$876.56	"$1,388.48"	"$1,402.50"	$0.00		$0.00	$274.36	$0.00	$0.00	$279.10	$0.00	$0.00	$0.00	$0.00	$0.00
72442774	SUP	HCPCS C1713		72442774  -  PLATE BN STRG 38MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG	BOTH IP/OP	"$1,842.50 "	"$1,363.45"	$0.00	"$1,474.00"	$829.13	$829.13	$0.00	$0.00	$0.00	$384.02	"$1,367.50"	"$1,367.50"	$0.00	$0.00	$383.98	$0.00	"$1,089.84"	"$1,089.84"	$0.00	$921.25	"$1,459.26"	"$1,474.00"	$0.00		$0.00	$288.35	$0.00	$0.00	$293.33	$0.00	$0.00	$0.00	$0.00	$0.00
72442776	SUP	HCPCS C1713		72442776  -  PLATE BN STRG 52MM EVOS MN 7 HL TINE LOPRFL VA SS SM BN LNG	BOTH IP/OP	"$1,842.50 "	"$1,363.45"	$0.00	"$1,474.00"	$829.13	$829.13	$0.00	$0.00	$0.00	$384.02	"$1,367.50"	"$1,367.50"	$0.00	$0.00	$383.98	$0.00	"$1,089.84"	"$1,089.84"	$0.00	$921.25	"$1,459.26"	"$1,474.00"	$0.00		$0.00	$288.35	$0.00	$0.00	$293.33	$0.00	$0.00	$0.00	$0.00	$0.00
72442778	SUP	HCPCS C1713		72442778  -  PLATE BN Y 55MM EVOS MN 5 HL LOPRFL VA SS SM BN LNG BN 2.7MM	BOTH IP/OP	"$1,931.88 "	"$1,429.59"	$0.00	"$1,545.50"	$869.34	$869.34	$0.00	$0.00	$0.00	$402.65	"$1,433.84"	"$1,433.84"	$0.00	$0.00	$402.60	$0.00	"$1,142.70"	"$1,142.70"	$0.00	$965.94	"$1,530.05"	"$1,545.50"	$0.00		$0.00	$302.34	$0.00	$0.00	$307.55	$0.00	$0.00	$0.00	$0.00	$0.00
72442780	SUP	HCPCS C1713		72442780  -  PLATE BN Y 69MM EVOS MN 7 HL LOPRFL VA SS SM BN LNG BN 2.7MM	BOTH IP/OP	"$1,931.88 "	"$1,429.59"	$0.00	"$1,545.50"	$869.34	$869.34	$0.00	$0.00	$0.00	$402.65	"$1,433.84"	"$1,433.84"	$0.00	$0.00	$402.60	$0.00	"$1,142.70"	"$1,142.70"	$0.00	$965.94	"$1,530.05"	"$1,545.50"	$0.00		$0.00	$302.34	$0.00	$0.00	$307.55	$0.00	$0.00	$0.00	$0.00	$0.00
72442782	SUP	HCPCS C1713		72442782  -  PLATE BN Y 52MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$2,206.88 "	"$1,633.09"	$0.00	"$1,765.50"	$993.09	$993.09	$0.00	$0.00	$0.00	$459.97	"$1,637.94"	"$1,637.94"	$0.00	$0.00	$459.91	$0.00	"$1,305.37"	"$1,305.37"	$0.00	"$1,103.44"	"$1,747.85"	"$1,765.50"	$0.00		$0.00	$345.38	$0.00	$0.00	$351.33	$0.00	$0.00	$0.00	$0.00	$0.00
72442784	SUP	HCPCS C1713		72442784  -  PLATE BN Y 66MM EVOS MN 7HOLE TINE LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$2,206.88 "	"$1,633.09"	$0.00	"$1,765.50"	$993.09	$993.09	$0.00	$0.00	$0.00	$459.97	"$1,637.94"	"$1,637.94"	$0.00	$0.00	$459.91	$0.00	"$1,305.37"	"$1,305.37"	$0.00	"$1,103.44"	"$1,747.85"	"$1,765.50"	$0.00		$0.00	$345.38	$0.00	$0.00	$351.33	$0.00	$0.00	$0.00	$0.00	$0.00
72442786	SUP	HCPCS C1713		72442786  -  PLATE BN 3ANG 54MM EVOS MN 6 HL LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$1,931.88 "	"$1,429.59"	$0.00	"$1,545.50"	$869.34	$869.34	$0.00	$0.00	$0.00	$402.65	"$1,433.84"	"$1,433.84"	$0.00	$0.00	$402.60	$0.00	"$1,142.70"	"$1,142.70"	$0.00	$965.94	"$1,530.05"	"$1,545.50"	$0.00		$0.00	$302.34	$0.00	$0.00	$307.55	$0.00	$0.00	$0.00	$0.00	$0.00
72442788	SUP	HCPCS C1713		72442788  -  PLATE BN 3ANG 68MM EVOS MN 8 HL LOPRFL VA SS SM BN LNG BN	BOTH IP/OP	"$1,931.88 "	"$1,429.59"	$0.00	"$1,545.50"	$869.34	$869.34	$0.00	$0.00	$0.00	$402.65	"$1,433.84"	"$1,433.84"	$0.00	$0.00	$402.60	$0.00	"$1,142.70"	"$1,142.70"	$0.00	$965.94	"$1,530.05"	"$1,545.50"	$0.00		$0.00	$302.34	$0.00	$0.00	$307.55	$0.00	$0.00	$0.00	$0.00	$0.00
72800107	SUP	HCPCS C1713		72800107  -  PLATE BN 98MM PRLC VLP 7 HL LCK TIB LT POSTEROMEDIAL PROX	BOTH IP/OP	"$2,157.75 "	"$1,596.74"	$0.00	"$1,726.20"	$970.99	$970.99	$0.00	$0.00	$0.00	$449.73	"$1,601.48"	"$1,601.48"	$0.00	$0.00	$449.68	$0.00	"$1,276.31"	"$1,276.31"	$0.00	"$1,078.88"	"$1,708.94"	"$1,726.20"	$0.00		$0.00	$337.69	$0.00	$0.00	$343.51	$0.00	$0.00	$0.00	$0.00	$0.00
72823110	SUP	HCPCS C1713		72823110  -  SCREW BN 2.7MM 10MM PRLC VLP LCK ST SS CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823112	SUP	HCPCS C1713		72823112  -  SCREW BN 2.7MM 12MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823114	SUP	HCPCS C1713		72823114  -  SCREW BN 2.7MM 14MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823116	SUP	HCPCS C1713		72823116  -  SCREW BN 2.7MM 16MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823118	SUP	HCPCS C1713		72823118  -  SCREW BN 2.7MM 18MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823120	SUP	HCPCS C1713		72823120  -  SCREW BN 2.7MM 20MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823122	SUP	HCPCS C1713		72823122  -  SCREW BN 2.7MM 22MM VLP LCK ST VA FT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823124	SUP	HCPCS C1713		72823124  -  SCREW BN 2.7MM 24MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823126	SUP	HCPCS C1713		72823126  -  SCREW BN 2.7MM 26MM PRLC VLP LCK ST CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823128	SUP	HCPCS C1713		72823128  -  SCREW BN 2.7MM 28MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823130	SUP	HCPCS C1713		72823130  -  SCREW BN 2.7MM 30MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823132	SUP	HCPCS C1713		72823132  -  SCREW BN 2.7MM 32MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823134	SUP	HCPCS C1713		72823134  -  SCREW BN 2.7MM 34MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823136	SUP	HCPCS C1713		72823136  -  SCREW BN 2.7MM 36MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823138	SUP	HCPCS C1713		72823138  -  SCREW BN 2.7MM 38MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823140	SUP	HCPCS C1713		72823140  -  SCREW BN 2.7MM 40MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823210	SUP	HCPCS C1713		72823210  -  SCREW BN FT 4MM 10MM PRLC VLP OSTEOPENIA CORT	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823212	SUP	HCPCS C1713		72823212  -  SCREW BN FT 4MM 12MM PRLC VLP SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823214	SUP	HCPCS C1713		72823214  -  SCREW BN FT 4MM 14MM PRLC VLP OSTEOPENIA CORT FT	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823216	SUP	HCPCS C1713		72823216  -  SCREW BN FT 4MM 16MM PRLC VLP OSTEOPENIA CORT	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823218	SUP	HCPCS C1713		72823218  -  SCREW BN FT 4MM 18MM PRLC VLP SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823220	SUP	HCPCS C1713		72823220  -  SCREW BN FT 4MM 20MM PRLC VLP OSTEOPENIA CORT	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823222	SUP	HCPCS C1713		72823222  -  SCREW BN 4MM 22MM PRLC VLP FT OSTEOPENIA	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823224	SUP	HCPCS C1713		72823224  -  SCREW BN FT 4MM 24MM PRLC VLP OSTEOPENIA CORT	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823226	SUP	HCPCS C1713		72823226  -  SCREW BN FT 4MM 26MM PRLC VLP OSTEOPENIA CORT	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823228	SUP	HCPCS C1713		72823228  -  SCREW BN FT 4MM 28MM PRLC VLP OSTEOPENIA CORT FT	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823230	SUP	HCPCS C1713		72823230  -  SCREW BN FT 4MM 4.9MM 30MM NS LOPRFL HEX FT PRLC VLP	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823232	SUP	HCPCS C1713		72823232  -  SCREW BONE FULTHD 4MM 32MM OSTEOPENIA VAR ANG PERI-LOC VLP	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823234	SUP	HCPCS C1713		72823234  -  SCREW BONE 4MM 34MM FULTHRD OSTEOPENIA PERI-LOC VLP	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823236	SUP	HCPCS C1713		72823236  -  SCREW BN FT 4MM 36MM PRLC VLP SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823238	SUP	HCPCS C1713		72823238  -  SCREW BN 4MM 38MM PRLC VLP FT OSTEOPENIA	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823240	SUP	HCPCS C1713		72823240  -  SCREW BN FT 4MM 40MM PRLC VLP SS FOREFOOT MIDFOOT CORT	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
72823410	SUP	HCPCS C1713		72823410  -  SCREW BN 4MM 10MM PRLC VLP LCK OSTEOPENIA CORT	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823412	SUP	HCPCS C1713		72823412  -  SCREW BN 4MM 12MM PRLC VLP LCK OSTEOPENIA CORT	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823414	SUP	HCPCS C1713		72823414  -  SCREW BN 4MM 14MM PRLC VLP LCK OSTEOPENIA CORT	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823416	SUP	HCPCS C1713		72823416  -  SCREW BN 4MM 16MM PRLC VLP LCK OSTEOPENIA CORT	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823418	SUP	HCPCS C1713		72823418  -  SCREW BN 4MM 18MM PRLC VLP LCK OSTEOPENIA CORT	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823420	SUP	HCPCS C1713		72823420  -  SCREW BN 4MM 20MM PRLC VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823422	SUP	HCPCS C1713		72823422  -  SCREW BN 4MM 22MM PRLC VLP LCK OSTEOPENIA CORT	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823424	SUP	HCPCS C1713		72823424  -  SCREW BN 4MM 24MM PRLC VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823426	SUP	HCPCS C1713		72823426  -  SCREW BONE 4MM 26MM LOCKING OSTEOPENIA PERI-LOC VLP CORTICAL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823428	SUP	HCPCS C1713		72823428  -  SCREW BN 4MM 4.9MM 28MM LCK LOPRFL HD FT PRLC VLP OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823430	SUP	HCPCS C1713		72823430  -  SCREW BONE 4MM 30MM LOCKING OSTEOPENIA PERI-LOC VLP CORTICAL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823432	SUP	HCPCS C1713		72823432  -  SCREW BONE 4MM 32MM LOCKING OSTEOPENIA PERI-LOC VLP CORTICAL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823434	SUP	HCPCS C1713		72823434  -  SCREW BN 4MM 34MM PRLC VLP LCK OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823436	SUP	HCPCS C1713		72823436  -  SCREW BN 4MM 36MM PRLC VLP LCK OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823438	SUP	HCPCS C1713		72823438  -  SCREW BN 4MM 38MM PRLC VLP LCK OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823440	SUP	HCPCS C1713		72823440  -  SCREW BN 4MM 40MM PRLC VLP LCK OSTEOPENIA CORT	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823510	SUP	HCPCS C1713		72823510  -  SCREW BN 15D 2.5MM 5MM 5.4MM 10MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823512	SUP	HCPCS C1713		72823512  -  SCREW BN 15D 2.5MM 5MM 5.4MM 12MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823514	SUP	HCPCS C1713		72823514  -  SCREW BN 15D 2.5MM 5MM 5.4MM 14MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823516	SUP	HCPCS C1713		72823516  -  SCREW BN 15D 2.5MM 5MM 5.4MM 16MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823518	SUP	HCPCS C1713		72823518  -  SCREW BN 15D 2.5MM 5MM 5.4MM 18MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823520	SUP	HCPCS C1713		72823520  -  SCREW BN 15D 2.5MM 5MM 5.4MM 20MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823522	SUP	HCPCS C1713		72823522  -  SCREW BN 15D 2.5MM 5MM 5.4MM 22MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823524	SUP	HCPCS C1713		72823524  -  SCREW BN 15D 2.5MM 5MM 5.4MM 24MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823526	SUP	HCPCS C1713		72823526  -  SCREW BN 15D 2.5MM 5MM 5.4MM 26MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823528	SUP	HCPCS C1713		72823528  -  SCREW BN 15D 2.5MM 5MM 5.4MM 28MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823530	SUP	HCPCS C1713		72823530  -  SCREW BN 15D 2.5MM 5MM 5.4MM 30MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823532	SUP	HCPCS C1713		72823532  -  SCREW BN 15D 2.5MM 5MM 5.4MM 32MM VLP LCK LOPRFL HD HEX RCS	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823534	SUP	HCPCS C1713		72823534  -  SCREW BN 15D 2.5MM 5MM 5.4MM 34MM VLP LCK LOPRFL HD HEX RCS	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823536	SUP	HCPCS C1713		72823536  -  SCREW BN 15D 2.5MM 5MM 5.4MM 36MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823538	SUP	HCPCS C1713		72823538  -  SCREW BN 15D 2.5MM 5MM 5.4MM 38MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823540	SUP	HCPCS C1713		72823540  -  SCREW BN 15D 2.5MM 5MM 5.4MM 40MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823542	SUP	HCPCS C1713		72823542  -  SCREW BN 15D 2.5MM 5MM 5.4MM 42MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823544	SUP	HCPCS C1713		72823544  -  SCREW BN 15D 2.5MM 5MM 5.4MM 44MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823546	SUP	HCPCS C1713		72823546  -  SCREW BN 15D 2.5MM 5MM 5.4MM 46MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823548	SUP	HCPCS C1713		72823548  -  SCREW BN 15D 2.5MM 5MM 5.4MM 48MM VLP LCK LOPRFL HD HEX RCS	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823550	SUP	HCPCS C1713		72823550  -  SCREW BN 15D 2.5MM 5MM 5.4MM 50MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823555	SUP	HCPCS C1713		72823555  -  SCREW BN 15D 2.5MM 5MM 5.4MM 55MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823560	SUP	HCPCS C1713		72823560  -  SCREW BN 15D 2.5MM 5MM 5.4MM 60MMX3.3MM VLP LCK LOPRFL HD	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
73804026	SUP	HCPCS C1713		73804026  -  SCREW BN T20 3.5MM 26MM PRLC ST STRDR CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73804028	SUP	HCPCS C1713		73804028  -  SCREW BN 3.5MM 28MM PRLC ST T20 STRDR RCS CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73804030	SUP	HCPCS C1713		73804030  -  SCREW BN 3.5MM 30MM PRLC ST T20 STRDR RCS CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73804032	SUP	HCPCS C1713		73804032  -  SCREW BN 3.5MM 32MM PRLC ST T20 STRDR RCS CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73804034	SUP	HCPCS C1713		73804034  -  SCREW BN T20 3.5MM 34MM PRLC ST STRDR CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73804038	SUP	HCPCS C1713		73804038  -  SCREW BN 3.5MM 38MM PRLC ST T20 STRDR RCS CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73804040	SUP	HCPCS C1713		73804040  -  SCREW BN 3.5MM 40MM PRLC ST T20 STRDR RCS CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73804044	SUP	HCPCS C1713		73804044  -  SCREW BN 3.5MM 44MM PRLC ST T20 STRDR RCS CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73804050	SUP	HCPCS C1713		73804050  -  SCREW BN 3.5MM 50MM PRLC ST T20 STRDR RCS CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73805026	SUP	HCPCS C1713		73805026  -  SCREW BN T20 3.5MM 26MM PRLC ST LCK	BOTH IP/OP	$254.10 	$188.03	$0.00	$203.28	$114.35	$114.35	$0.00	$0.00	$0.00	$52.96	$188.59	$188.59	$0.00	$0.00	$52.95	$0.00	$150.30	$150.30	$0.00	$127.05	$201.25	$203.28	$0.00		$0.00	$39.77	$0.00	$0.00	$40.45	$0.00	$0.00	$0.00	$0.00	$0.00
73805030	SUP	HCPCS C1713		73805030  -  SCREW BN 3.5MM 30MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN	BOTH IP/OP	$254.10 	$188.03	$0.00	$203.28	$114.35	$114.35	$0.00	$0.00	$0.00	$52.96	$188.59	$188.59	$0.00	$0.00	$52.95	$0.00	$150.30	$150.30	$0.00	$127.05	$201.25	$203.28	$0.00		$0.00	$39.77	$0.00	$0.00	$40.45	$0.00	$0.00	$0.00	$0.00	$0.00
73805065	SUP	HCPCS C1713		73805065  -  SCREW BN 3.5MM 65MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN	BOTH IP/OP	$292.95 	$216.78	$0.00	$234.36	$131.83	$131.83	$0.00	$0.00	$0.00	$61.06	$217.43	$217.43	$0.00	$0.00	$61.05	$0.00	$173.28	$173.28	$0.00	$146.48	$232.02	$234.36	$0.00		$0.00	$45.85	$0.00	$0.00	$46.64	$0.00	$0.00	$0.00	$0.00	$0.00
73805070	SUP	HCPCS C1713		73805070  -  SCREW BN 3.5MM 70MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN	BOTH IP/OP	$292.95 	$216.78	$0.00	$234.36	$131.83	$131.83	$0.00	$0.00	$0.00	$61.06	$217.43	$217.43	$0.00	$0.00	$61.05	$0.00	$173.28	$173.28	$0.00	$146.48	$232.02	$234.36	$0.00		$0.00	$45.85	$0.00	$0.00	$46.64	$0.00	$0.00	$0.00	$0.00	$0.00
73805075	SUP	HCPCS C1713		73805075  -  SCREW BN 3.5MM 75MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN	BOTH IP/OP	$292.95 	$216.78	$0.00	$234.36	$131.83	$131.83	$0.00	$0.00	$0.00	$61.06	$217.43	$217.43	$0.00	$0.00	$61.05	$0.00	$173.28	$173.28	$0.00	$146.48	$232.02	$234.36	$0.00		$0.00	$45.85	$0.00	$0.00	$46.64	$0.00	$0.00	$0.00	$0.00	$0.00
73805080	SUP	HCPCS C1713		73805080  -  SCREW BN 3.5MM 80MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN	BOTH IP/OP	$292.95 	$216.78	$0.00	$234.36	$131.83	$131.83	$0.00	$0.00	$0.00	$61.06	$217.43	$217.43	$0.00	$0.00	$61.05	$0.00	$173.28	$173.28	$0.00	$146.48	$232.02	$234.36	$0.00		$0.00	$45.85	$0.00	$0.00	$46.64	$0.00	$0.00	$0.00	$0.00	$0.00
73805230	SUP	HCPCS C1713		73805230  -  SCREW BN FT 4MM 30MM PRLC T20 STRDR RCS CANC	BOTH IP/OP	$64.43 	$47.68	$0.00	$51.54	$28.99	$28.99	$0.00	$0.00	$0.00	$13.43	$47.82	$47.82	$0.00	$0.00	$13.43	$0.00	$38.11	$38.11	$0.00	$32.21	$51.03	$51.54	$0.00		$0.00	$10.08	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
73806024	SUP	HCPCS C1713		73806024  -  SCREW BN 4.5MM 24MM PRLC ST T25 STRDR RCS FT/ANKL CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73806026	SUP	HCPCS C1713		73806026  -  SCREW BN 4.5MM 26MM PRLC ST T25 STRDR RCS FT/ANKL CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73806028	SUP	HCPCS C1713		73806028  -  SCREW BN 4.5MM 28MM PRLC ST T25 STRDR RCS FT/ANKL CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73806030	SUP	HCPCS C1713		73806030  -  SCREW BN 4.5MM 30MM PRLC ST T25 STRDR RCS FT/ANKL CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73806034	SUP	HCPCS C1713		73806034  -  SCREW BN 4.5MM 34MM PRLC ST T25 STRDR RCS FT/ANKL CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73806040	SUP	HCPCS C1713		73806040  -  SCREW BN 4.5MM 40MM PRLC ST T25 STRDR RCS FT/ANKL CORT	BOTH IP/OP	$48.83 	$36.13	$0.00	$39.06	$21.97	$21.97	$0.00	$0.00	$0.00	$10.18	$36.24	$36.24	$0.00	$0.00	$10.18	$0.00	$28.88	$28.88	$0.00	$24.41	$38.67	$39.06	$0.00		$0.00	$7.64	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$0.00
73807060	SUP	HCPCS C1713		73807060  -  SCREW BN 4.5MM 60MM PRLC ST LCK T25 STRDR RCS ANKL/FT	BOTH IP/OP	$298.20 	$220.67	$0.00	$238.56	$134.19	$134.19	$0.00	$0.00	$0.00	$62.15	$221.32	$221.32	$0.00	$0.00	$62.14	$0.00	$176.39	$176.39	$0.00	$149.10	$236.17	$238.56	$0.00		$0.00	$46.67	$0.00	$0.00	$47.47	$0.00	$0.00	$0.00	$0.00	$0.00
73807066	SUP	HCPCS C1713		73807066  -  SCREW BN 4.5MM 66MM PRLC ST LCK T25 STRDR RCS ANKL/FT	BOTH IP/OP	$298.20 	$220.67	$0.00	$238.56	$134.19	$134.19	$0.00	$0.00	$0.00	$62.15	$221.32	$221.32	$0.00	$0.00	$62.14	$0.00	$176.39	$176.39	$0.00	$149.10	$236.17	$238.56	$0.00		$0.00	$46.67	$0.00	$0.00	$47.47	$0.00	$0.00	$0.00	$0.00	$0.00
73807070	SUP	HCPCS C1713		73807070  -  SCREW BN 4.5MM 70MM PRLC ST LCK T25 STRDR RCS ANKL/FT	BOTH IP/OP	$298.20 	$220.67	$0.00	$238.56	$134.19	$134.19	$0.00	$0.00	$0.00	$62.15	$221.32	$221.32	$0.00	$0.00	$62.14	$0.00	$176.39	$176.39	$0.00	$149.10	$236.17	$238.56	$0.00		$0.00	$46.67	$0.00	$0.00	$47.47	$0.00	$0.00	$0.00	$0.00	$0.00
73807074	SUP	HCPCS C1713		73807074  -  SCREW BN 4.5MM 74MM PRLC ST LCK T25 STRDR RCS ANKL/FT	BOTH IP/OP	$298.20 	$220.67	$0.00	$238.56	$134.19	$134.19	$0.00	$0.00	$0.00	$62.15	$221.32	$221.32	$0.00	$0.00	$62.14	$0.00	$176.39	$176.39	$0.00	$149.10	$236.17	$238.56	$0.00		$0.00	$46.67	$0.00	$0.00	$47.47	$0.00	$0.00	$0.00	$0.00	$0.00
73807076	SUP	HCPCS C1713		73807076  -  SCREW BN 4.5MM 76MM PRLC ST LCK T25 STRDR RCS ANKL/FT	BOTH IP/OP	$298.20 	$220.67	$0.00	$238.56	$134.19	$134.19	$0.00	$0.00	$0.00	$62.15	$221.32	$221.32	$0.00	$0.00	$62.14	$0.00	$176.39	$176.39	$0.00	$149.10	$236.17	$238.56	$0.00		$0.00	$46.67	$0.00	$0.00	$47.47	$0.00	$0.00	$0.00	$0.00	$0.00
73807085	SUP	HCPCS C1713		73807085  -  SCREW BN 4.5MM 85MM PRLC ST LCK T25 STRDR RCS ANKL/FT	BOTH IP/OP	$298.20 	$220.67	$0.00	$238.56	$134.19	$134.19	$0.00	$0.00	$0.00	$62.15	$221.32	$221.32	$0.00	$0.00	$62.14	$0.00	$176.39	$176.39	$0.00	$149.10	$236.17	$238.56	$0.00		$0.00	$46.67	$0.00	$0.00	$47.47	$0.00	$0.00	$0.00	$0.00	$0.00
73807090	SUP	HCPCS C1713		73807090  -  SCREW BN 4.5MM 90MM PRLC ST LCK T25 STRDR RCS ANKL/FT	BOTH IP/OP	$309.75 	$229.22	$0.00	$247.80	$139.39	$139.39	$0.00	$0.00	$0.00	$64.56	$229.90	$229.90	$0.00	$0.00	$64.55	$0.00	$183.22	$183.22	$0.00	$154.88	$245.32	$247.80	$0.00		$0.00	$48.48	$0.00	$0.00	$49.31	$0.00	$0.00	$0.00	$0.00	$0.00
74132105	SUP	HCPCS C1713		74132105  -  SCREW BN 6.5MM 105MM 22MM CNN CNCL P/T SS	BOTH IP/OP	$481.50 	$356.31	$0.00	$385.20	$216.68	$216.68	$0.00	$0.00	$0.00	$100.36	$357.37	$357.37	$0.00	$0.00	$100.34	$0.00	$284.81	$284.81	$0.00	$240.75	$381.35	$385.20	$0.00		$0.00	$75.35	$0.00	$0.00	$76.65	$0.00	$0.00	$0.00	$0.00	$0.00
74133070	SUP	HCPCS C1713		74133070  -  SCREW BN FT 6.5MM 70MM CNN LCK SS	BOTH IP/OP	$554.63 	$410.43	$0.00	$443.70	$249.58	$249.58	$0.00	$0.00	$0.00	$115.60	$411.64	$411.64	$0.00	$0.00	$115.58	$0.00	$328.06	$328.06	$0.00	$277.31	$439.27	$443.70	$0.00		$0.00	$86.80	$0.00	$0.00	$88.30	$0.00	$0.00	$0.00	$0.00	$0.00
74133075	SUP	HCPCS C1713		74133075  -  SCREW BN FT 6.5MM 75MM CNN LCK SS	BOTH IP/OP	$684.00 	$506.16	$0.00	$547.20	$307.80	$307.80	$0.00	$0.00	$0.00	$142.56	$507.66	$507.66	$0.00	$0.00	$142.55	$0.00	$404.59	$404.59	$0.00	$342.00	$541.73	$547.20	$0.00		$0.00	$107.05	$0.00	$0.00	$108.89	$0.00	$0.00	$0.00	$0.00	$0.00
74133080	SUP	HCPCS C1713		74133080  -  SCREW BN FT 6.5MM 80MM CNN LCK SS	BOTH IP/OP	$684.00 	$506.16	$0.00	$547.20	$307.80	$307.80	$0.00	$0.00	$0.00	$142.56	$507.66	$507.66	$0.00	$0.00	$142.55	$0.00	$404.59	$404.59	$0.00	$342.00	$541.73	$547.20	$0.00		$0.00	$107.05	$0.00	$0.00	$108.89	$0.00	$0.00	$0.00	$0.00	$0.00
74133085	SUP	HCPCS C1713		74133085  -  SCREW BN FT 6.5MM 85MM CNN LCK SS	BOTH IP/OP	$684.00 	$506.16	$0.00	$547.20	$307.80	$307.80	$0.00	$0.00	$0.00	$142.56	$507.66	$507.66	$0.00	$0.00	$142.55	$0.00	$404.59	$404.59	$0.00	$342.00	$541.73	$547.20	$0.00		$0.00	$107.05	$0.00	$0.00	$108.89	$0.00	$0.00	$0.00	$0.00	$0.00
74133411	SUP	HCPCS C1713		74133411  -  PIN FX SHRT 4.5MM 80MM PRLC TRL	BOTH IP/OP	$480.00 	$355.20	$0.00	$384.00	$216.00	$216.00	$0.00	$0.00	$0.00	$100.04	$356.26	$356.26	$0.00	$0.00	$100.03	$0.00	$283.92	$283.92	$0.00	$240.00	$380.16	$384.00	$0.00		$0.00	$75.12	$0.00	$0.00	$76.42	$0.00	$0.00	$0.00	$0.00	$0.00
74133412	SUP	HCPCS C1713		74133412  -  PIN FX 3.5MM 18MM PRLC	BOTH IP/OP	$520.00 	$384.80	$0.00	$416.00	$234.00	$234.00	$0.00	$0.00	$0.00	$108.38	$385.94	$385.94	$0.00	$0.00	$108.37	$0.00	$307.58	$307.58	$0.00	$260.00	$411.84	$416.00	$0.00		$0.00	$81.38	$0.00	$0.00	$82.78	$0.00	$0.00	$0.00	$0.00	$0.00
74133413	SUP	HCPCS C1713		74133413  -  PIN FX SHRT 3.5MM 18MM PRLC PRV FX	BOTH IP/OP	$520.00 	$384.80	$0.00	$416.00	$234.00	$234.00	$0.00	$0.00	$0.00	$108.38	$385.94	$385.94	$0.00	$0.00	$108.37	$0.00	$307.58	$307.58	$0.00	$260.00	$411.84	$416.00	$0.00		$0.00	$81.38	$0.00	$0.00	$82.78	$0.00	$0.00	$0.00	$0.00	$0.00
74133420	SUP	Custom 27203010		74133420  -  BIT DRL 2.7MM 358MM TARGETER	BOTH IP/OP	"$1,102.00 "	$815.48	$0.00	$881.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$817.90	$817.90	$0.00	$0.00	$229.66	$0.00	$0.00	$0.00	$0.00	$551.00	$872.78	$881.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74133421	SUP	HCPCS C1713		74133421  -  PIN FX SHRT 4.5MM 80MM PRLC TARGETER DRL TIP PRV FX	BOTH IP/OP	$520.00 	$384.80	$0.00	$416.00	$234.00	$234.00	$0.00	$0.00	$0.00	$108.38	$385.94	$385.94	$0.00	$0.00	$108.37	$0.00	$307.58	$307.58	$0.00	$260.00	$411.84	$416.00	$0.00		$0.00	$81.38	$0.00	$0.00	$82.78	$0.00	$0.00	$0.00	$0.00	$0.00
74133424	SUP	HCPCS C1713		74133424  -  PLATE BN TLL PRLC CBL SDL	BOTH IP/OP	$363.38 	$268.90	$0.00	$290.70	$163.52	$163.52	$0.00	$0.00	$0.00	$75.74	$269.70	$269.70	$0.00	$0.00	$75.73	$0.00	$214.94	$214.94	$0.00	$181.69	$287.80	$290.70	$0.00		$0.00	$56.87	$0.00	$0.00	$57.85	$0.00	$0.00	$0.00	$0.00	$0.00
74133425	SUP	HCPCS C1713		74133425  -  SCREW BN PRLC HL FIL	BOTH IP/OP	$492.00 	$364.08	$0.00	$393.60	$221.40	$221.40	$0.00	$0.00	$0.00	$102.55	$365.16	$365.16	$0.00	$0.00	$102.53	$0.00	$291.02	$291.02	$0.00	$246.00	$389.66	$393.60	$0.00		$0.00	$77.00	$0.00	$0.00	$78.33	$0.00	$0.00	$0.00	$0.00	$0.00
74402001	SUP	HCPCS C1713		74402001  -  WASHER ORTH VLP 2 MM SCR	BOTH IP/OP	$146.00 	$108.04	$0.00	$116.80	$65.70	$65.70	$0.00	$0.00	$0.00	$30.43	$108.36	$108.36	$0.00	$0.00	$30.43	$0.00	$86.36	$86.36	$0.00	$73.00	$115.63	$116.80	$0.00		$0.00	$22.85	$0.00	$0.00	$23.24	$0.00	$0.00	$0.00	$0.00	$0.00
74402006	SUP	HCPCS C1713		74402006  -  SCREW BN T6 2MM 6MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402007	SUP	HCPCS C1713		74402007  -  SCREW BN T6 2MM 7MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402008	SUP	HCPCS C1713		74402008  -  SCREW BN T6 2MM 8MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402009	SUP	HCPCS C1713		74402009  -  SCREW BN T6 2MM 9MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402011	SUP	HCPCS C1713		74402011  -  SCREW BN T6 2MM 11MM VLP ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402012	SUP	HCPCS C1713		74402012  -  SCREW BN T6 2MM 12MM VLP ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402013	SUP	HCPCS C1713		74402013  -  SCREW BN T6 2MM 13MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402014	SUP	HCPCS C1713		74402014  -  SCREW BN T6 2MM 14MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402015	SUP	HCPCS C1713		74402015  -  SCREW BN T6 2MM 15MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402016	SUP	HCPCS C1713		74402016  -  SCREW BN T6 2MM 16MM VLP ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402017	SUP	HCPCS C1713		74402017  -  SCREW BN T6 2MM 17MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402018	SUP	HCPCS C1713		74402018  -  SCREW BN T6 2MM 18MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402019	SUP	HCPCS C1713		74402019  -  SCREW BN T6 2MM 19MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402020	SUP	HCPCS C1713		74402020  -  SCREW BN T6 2MM 20MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402021	SUP	HCPCS C1713		74402021  -  SCREW BN T6 2MM 21MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402022	SUP	HCPCS C1713		74402022  -  SCREW BN T6 2MM 22MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402023	SUP	HCPCS C1713		74402023  -  SCREW BN T6 2MM 23MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402024	SUP	HCPCS C1713		74402024  -  SCREW BN T6 2MM 24MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402026	SUP	HCPCS C1713		74402026  -  SCREW BN T6 2MM 26MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402028	SUP	HCPCS C1713		74402028  -  SCREW BN T6 2MM 28MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402030	SUP	HCPCS C1713		74402030  -  SCREW BN T6 2MM 30MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402032	SUP	HCPCS C1713		74402032  -  SCREW BN T6 2MM 32MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402034	SUP	HCPCS C1713		74402034  -  SCREW BN T6 2MM 34MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402036	SUP	HCPCS C1713		74402036  -  SCREW BN T6 2MM 36MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402038	SUP	HCPCS C1713		74402038  -  SCREW BN T6 2MM 38MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402040	SUP	HCPCS C1713		74402040  -  SCREW BN T6 2MM 40MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402401	SUP	HCPCS C1713		74402401  -  WASHER ORTH VLP 2.4 MM T7 SCR	BOTH IP/OP	$146.00 	$108.04	$0.00	$116.80	$65.70	$65.70	$0.00	$0.00	$0.00	$30.43	$108.36	$108.36	$0.00	$0.00	$30.43	$0.00	$86.36	$86.36	$0.00	$73.00	$115.63	$116.80	$0.00		$0.00	$22.85	$0.00	$0.00	$23.24	$0.00	$0.00	$0.00	$0.00	$0.00
74402406	SUP	HCPCS C1713		74402406  -  SCREW BN T7 2.4MM 6MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402407	SUP	HCPCS C1713		74402407  -  SCREW BN T7 2.4MM 7MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402408	SUP	HCPCS C1713		74402408  -  SCREW BN T7 2.4MM 8MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402409	SUP	HCPCS C1713		74402409  -  SCREW BN T7 2.4MM 9MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402410	SUP	HCPCS C1713		74402410  -  SCREW BN T7 2.4MM 10MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402411	SUP	HCPCS C1713		74402411  -  SCREW BN T7 2.4MM 11MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402412	SUP	HCPCS C1713		74402412  -  SCREW BN T7 2.4MM 12MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402413	SUP	HCPCS C1713		74402413  -  SCREW BN T7 2.4MM 13MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402414	SUP	HCPCS C1713		74402414  -  SCREW BN T7 2.4MM 14MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402415	SUP	HCPCS C1713		74402415  -  SCREW BN T7 2.4MM 15MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402416	SUP	HCPCS C1713		74402416  -  SCREW BN T7 2.4MM 16MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402417	SUP	HCPCS C1713		74402417  -  SCREW BN T7 2.4MM 17MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402418	SUP	HCPCS C1713		74402418  -  SCREW BN T7 2.4MM 18MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402419	SUP	HCPCS C1713		74402419  -  SCREW BN T7 2.4MM 19MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402420	SUP	HCPCS C1713		74402420  -  SCREW BN T7 2.4MM 20MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402421	SUP	HCPCS C1713		74402421  -  SCREW BN T7 2.4MM 21MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402422	SUP	HCPCS C1713		74402422  -  SCREW BN T7 2.4MM 22MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402423	SUP	HCPCS C1713		74402423  -  SCREW BN T7 2.4MM 23MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402424	SUP	HCPCS C1713		74402424  -  SCREW BN T7 2.4MM 24MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402426	SUP	HCPCS C1713		74402426  -  SCREW BN T7 2.4MM 26MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402428	SUP	HCPCS C1713		74402428  -  SCREW BN T7 2.4MM 28MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402430	SUP	HCPCS C1713		74402430  -  SCREW BN T7 2.4MM 30MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402434	SUP	HCPCS C1713		74402434  -  SCREW BN T7 2.4MM 34MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402438	SUP	HCPCS C1713		74402438  -  SCREW BN T7 2.4MM 38MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402440	SUP	HCPCS C1713		74402440  -  SCREW BN T7 2.4MM 40MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402442	SUP	HCPCS C1713		74402442  -  SCREW BN T7 2.4MM 42MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402444	SUP	HCPCS C1713		74402444  -  SCREW BN T7 2.4MM 44MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402446	SUP	HCPCS C1713		74402446  -  SCREW BN T7 2.4MM 46MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402448	SUP	HCPCS C1713		74402448  -  SCREW BN T7 2.4MM 48MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402450	SUP	HCPCS C1713		74402450  -  SCREW BN T7 2.4MM 50MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402455	SUP	HCPCS C1713		74402455  -  SCREW BN T7 2.4MM 55MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402460	SUP	HCPCS C1713		74402460  -  SCREW BN T7 2.4MM 60MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402465	SUP	HCPCS C1713		74402465  -  SCREW BN T7 2.4MM 65MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402470	SUP	HCPCS C1713		74402470  -  SCREW BN T7 2.4MM 70MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402475	SUP	HCPCS C1713		74402475  -  SCREW BN T7 2.4MM 75MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402480	SUP	HCPCS C1713		74402480  -  SCREW BN T7 2.4MM 80MM VLP ST TI FT CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74412007	SUP	HCPCS C1713		74412007  -  SCREW BN T6 2MM 7MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412008	SUP	HCPCS C1713		74412008  -  SCREW BN T6 2MM 8MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412011	SUP	HCPCS C1713		74412011  -  SCREW BN T6 2MM 11MM VLP LCK ST TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412012	SUP	HCPCS C1713		74412012  -  SCREW BN T6 2MM 12MM NS VLP LCK ST TI SM BN LNG BN	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412014	SUP	HCPCS C1713		74412014  -  SCREW BN T6 2MM 14MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412015	SUP	HCPCS C1713		74412015  -  SCREW BN T6 2MM 15MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412016	SUP	HCPCS C1713		74412016  -  SCREW BN T6 2MM 16MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412017	SUP	HCPCS C1713		74412017  -  SCREW BN T6 2MM 17MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412018	SUP	HCPCS C1713		74412018  -  SCREW BN T6 2MM 18MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412019	SUP	HCPCS C1713		74412019  -  SCREW BN T6 2MM 19MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412020	SUP	HCPCS C1713		74412020  -  SCREW BN T6 2MM 20MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412021	SUP	HCPCS C1713		74412021  -  SCREW BN T6 2MM 21MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412022	SUP	HCPCS C1713		74412022  -  SCREW BN T6 2MM 22MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412023	SUP	HCPCS C1713		74412023  -  SCREW BN T6 2MM 23MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412024	SUP	HCPCS C1713		74412024  -  SCREW BN T6 2MM 24MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412026	SUP	HCPCS C1713		74412026  -  SCREW BN T6 2MM 26MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412028	SUP	HCPCS C1713		74412028  -  SCREW BN T6 2MM 28MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412030	SUP	HCPCS C1713		74412030  -  SCREW BN T6 2MM 30MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412032	SUP	HCPCS C1713		74412032  -  SCREW BN T6 2MM 32MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412034	SUP	HCPCS C1713		74412034  -  SCREW BN T6 2MM 34MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412036	SUP	HCPCS C1713		74412036  -  SCREW BN T6 2MM 36MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412038	SUP	HCPCS C1713		74412038  -  SCREW BN T6 2MM 38MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412040	SUP	HCPCS C1713		74412040  -  SCREW BN T6 2MM 40MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412406	SUP	HCPCS C1713		74412406  -  SCREW BN T7 2.4MM 6MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412407	SUP	HCPCS C1713		74412407  -  SCREW BN T7 2.4MM 7MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412408	SUP	HCPCS C1713		74412408  -  SCREW BN T7 2.4MM 8MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412409	SUP	HCPCS C1713		74412409  -  SCREW BN T7 2.4MM 9MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412410	SUP	HCPCS C1713		74412410  -  SCREW BN T7 2.4MM 10MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412411	SUP	HCPCS C1713		74412411  -  SCREW BN T7 2.4MM 11MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412412	SUP	HCPCS C1713		74412412  -  SCREW BN T7 2.4MM 12MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412413	SUP	HCPCS C1713		74412413  -  SCREW BN 2.4MM 13MM VLP LCK ST T7 DRVR TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412414	SUP	HCPCS C1713		74412414  -  SCREW BN 2.4MM 14MM VLP LCK ST T7 DRVR TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412415	SUP	HCPCS C1713		74412415  -  SCREW BN T7 2.4MM 15MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412416	SUP	HCPCS C1713		74412416  -  SCREW BN T7 2.4MM 16MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412417	SUP	HCPCS C1713		74412417  -  SCREW BN T7 2.4MM 17MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412418	SUP	HCPCS C1713		74412418  -  SCREW BN 2.4MM 18MM VLP LCK ST T7 DRVR TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412419	SUP	HCPCS C1713		74412419  -  SCREW BN T7 2.4MM 19MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412420	SUP	HCPCS C1713		74412420  -  SCREW BN T7 2.4MM 20MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412421	SUP	HCPCS C1713		74412421  -  SCREW BN T7 2.4MM 21MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412422	SUP	HCPCS C1713		74412422  -  SCREW BN 2.4MM 22MM VLP LCK ST T7 DRVR TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412423	SUP	HCPCS C1713		74412423  -  SCREW BN T7 2.4MM 23MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412424	SUP	HCPCS C1713		74412424  -  SCREW BN T7 2.4MM 24MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412426	SUP	HCPCS C1713		74412426  -  SCREW BN T7 2.4MM 26MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412428	SUP	HCPCS C1713		74412428  -  SCREW BN T7 2.4MM 28MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412430	SUP	HCPCS C1713		74412430  -  SCREW BN T7 2.4MM 30MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412432	SUP	HCPCS C1713		74412432  -  SCREW BN T7 2.4MM 32MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412434	SUP	HCPCS C1713		74412434  -  SCREW BN T7 2.4MM 34MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412436	SUP	HCPCS C1713		74412436  -  SCREW BN T7 2.4MM 36MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412438	SUP	HCPCS C1713		74412438  -  SCREW BN T7 2.4MM 38MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412440	SUP	HCPCS C1713		74412440  -  SCREW BN T7 2.4MM 40MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412442	SUP	HCPCS C1713		74412442  -  SCREW BN T7 2.4MM 42MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412444	SUP	HCPCS C1713		74412444  -  SCREW BN T7 2.4MM 44MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412446	SUP	HCPCS C1713		74412446  -  SCREW BN T7 2.4MM 46MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412448	SUP	HCPCS C1713		74412448  -  SCREW BN T7 2.4MM 48MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412450	SUP	HCPCS C1713		74412450  -  SCREW BN T7 2.4MM 50MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412455	SUP	HCPCS C1713		74412455  -  SCREW BN T7 2.4MM 55MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412460	SUP	HCPCS C1713		74412460  -  SCREW BN T7 2.4MM 60MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412465	SUP	HCPCS C1713		74412465  -  SCREW BN T7 2.4MM 65MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412470	SUP	HCPCS C1713		74412470  -  SCREW BN T7 2.4MM 70MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412475	SUP	HCPCS C1713		74412475  -  SCREW BN T7 2.4MM 75MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412480	SUP	HCPCS C1713		74412480  -  SCREW BN T7 2.4MM 80MM VLP LCK ST TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74423010	SUP	HCPCS C1713		74423010  -  SCREW BN T7 3MM 10MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423012	SUP	HCPCS C1713		74423012  -  SCREW BN T7 3MM 12MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423014	SUP	HCPCS C1713		74423014  -  SCREW BN T7 3MM 14MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423016	SUP	HCPCS C1713		74423016  -  SCREW BN T7 3MM 16MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423018	SUP	HCPCS C1713		74423018  -  SCREW BN T7 3MM 18MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423020	SUP	HCPCS C1713		74423020  -  SCREW BN T7 3MM 20MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423022	SUP	HCPCS C1713		74423022  -  SCREW BN T7 3MM 22MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423024	SUP	HCPCS C1713		74423024  -  SCREW BN T7 3MM 24MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423026	SUP	HCPCS C1713		74423026  -  SCREW BN T7 3MM 26MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423028	SUP	HCPCS C1713		74423028  -  SCREW BN T7 3MM 28MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423030	SUP	HCPCS C1713		74423030  -  SCREW BN T7 3MM 30MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423032	SUP	HCPCS C1713		74423032  -  SCREW BN T7 3MM 32MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423034	SUP	HCPCS C1713		74423034  -  SCREW BN T7 3MM 34MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423036	SUP	HCPCS C1713		74423036  -  SCREW BN T7 3MM 36MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423038	SUP	HCPCS C1713		74423038  -  SCREW BN T7 3MM 38MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423040	SUP	HCPCS C1713		74423040  -  SCREW BN T7 3MM 40MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423042	SUP	HCPCS C1713		74423042  -  SCREW BN T7 3MM 42MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423044	SUP	HCPCS C1713		74423044  -  SCREW BN T7 3MM 44MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423046	SUP	HCPCS C1713		74423046  -  SCREW BN T7 3MM 46MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423048	SUP	HCPCS C1713		74423048  -  SCREW BN T7 3MM 48MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423050	SUP	HCPCS C1713		74423050  -  SCREW BN T7 3MM 50MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423055	SUP	HCPCS C1713		74423055  -  SCREW BN T7 3MM 55MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423060	SUP	HCPCS C1713		74423060  -  SCREW BN T7 3MM 60MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423065	SUP	HCPCS C1713		74423065  -  SCREW BN T7 3MM 65MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423070	SUP	HCPCS C1713		74423070  -  SCREW BN T7 3MM 70MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423075	SUP	HCPCS C1713		74423075  -  SCREW BN T7 3MM 75MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74423080	SUP	HCPCS C1713		74423080  -  SCREW BN T7 3MM 80MM VLP TI FT OSTEOPENIA	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$79.20	$79.20	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
74442010	SUP	HCPCS C1713		74442010  -  PLATE BN Y VLP MN-MOD 6 HL 2MM SCR	BOTH IP/OP	"$1,608.75 "	"$1,190.48"	$0.00	"$1,287.00"	$723.94	$723.94	$0.00	$0.00	$0.00	$335.30	"$1,194.01"	"$1,194.01"	$0.00	$0.00	$335.26	$0.00	$951.58	$951.58	$0.00	$804.38	"$1,274.13"	"$1,287.00"	$0.00		$0.00	$251.77	$0.00	$0.00	$256.11	$0.00	$0.00	$0.00	$0.00	$0.00
74442012	SUP	HCPCS C1713		74442012  -  PLATE BN Y VLP MN-MOD 8 HL 2MM SCR	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
74442014	SUP	HCPCS C1713		74442014  -  PLATE BN T VLP MN-MOD 2X6 HL 2MM SCR	BOTH IP/OP	"$1,124.75 "	$832.32	$0.00	$899.80	$506.14	$506.14	$0.00	$0.00	$0.00	$234.43	$834.79	$834.79	$0.00	$0.00	$234.40	$0.00	$665.29	$665.29	$0.00	$562.38	$890.80	$899.80	$0.00		$0.00	$176.02	$0.00	$0.00	$179.06	$0.00	$0.00	$0.00	$0.00	$0.00
74442016	SUP	HCPCS C1713		74442016  -  PLATE BN T 1.2MM VLP MN-MOD 2 HLE/HD 8 HL SHFT TI SM BN 2MM	BOTH IP/OP	"$1,443.75 "	"$1,068.38"	$0.00	"$1,155.00"	$649.69	$649.69	$0.00	$0.00	$0.00	$300.91	"$1,071.55"	"$1,071.55"	$0.00	$0.00	$300.88	$0.00	$853.98	$853.98	$0.00	$721.88	"$1,143.45"	"$1,155.00"	$0.00		$0.00	$225.95	$0.00	$0.00	$229.85	$0.00	$0.00	$0.00	$0.00	$0.00
74442018	SUP	HCPCS C1713		74442018  -  PLATE BN T VLP MN-MOD 3X6 HL 2MM SCR	BOTH IP/OP	"$1,608.75 "	"$1,190.48"	$0.00	"$1,287.00"	$723.94	$723.94	$0.00	$0.00	$0.00	$335.30	"$1,194.01"	"$1,194.01"	$0.00	$0.00	$335.26	$0.00	$951.58	$951.58	$0.00	$804.38	"$1,274.13"	"$1,287.00"	$0.00		$0.00	$251.77	$0.00	$0.00	$256.11	$0.00	$0.00	$0.00	$0.00	$0.00
74442020	SUP	HCPCS C1713		74442020  -  PLATE BN T VLP MN-MOD 3X8 HL 2MM SCR	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
74442022	SUP	HCPCS C1713		74442022  -  PLATE BN STRG VLP MN-MOD 6 HL 2MM SCR	BOTH IP/OP	$965.25 	$714.29	$0.00	$772.20	$434.36	$434.36	$0.00	$0.00	$0.00	$201.18	$716.41	$716.41	$0.00	$0.00	$201.16	$0.00	$570.95	$570.95	$0.00	$482.63	$764.48	$772.20	$0.00		$0.00	$151.06	$0.00	$0.00	$153.67	$0.00	$0.00	$0.00	$0.00	$0.00
74442024	SUP	HCPCS C1713		74442024  -  PLATE BN STRG VLP MN-MOD 8 HL 2MM SCR	BOTH IP/OP	"$1,285.63 "	$951.37	$0.00	"$1,028.50"	$578.53	$578.53	$0.00	$0.00	$0.00	$267.96	$954.19	$954.19	$0.00	$0.00	$267.92	$0.00	$760.45	$760.45	$0.00	$642.81	"$1,018.22"	"$1,028.50"	$0.00		$0.00	$201.20	$0.00	$0.00	$204.67	$0.00	$0.00	$0.00	$0.00	$0.00
74442028	SUP	HCPCS C1713		74442028  -  PLATE BN STOUT VLP MN-MOD 6 HL 2MM SCR	BOTH IP/OP	"$1,124.75 "	$832.32	$0.00	$899.80	$506.14	$506.14	$0.00	$0.00	$0.00	$234.43	$834.79	$834.79	$0.00	$0.00	$234.40	$0.00	$665.29	$665.29	$0.00	$562.38	$890.80	$899.80	$0.00		$0.00	$176.02	$0.00	$0.00	$179.06	$0.00	$0.00	$0.00	$0.00	$0.00
74442030	SUP	HCPCS C1713		74442030  -  PLATE BN STOUT VLP MN-MOD 8 HL 2MM SCR	BOTH IP/OP	"$1,443.75 "	"$1,068.38"	$0.00	"$1,155.00"	$649.69	$649.69	$0.00	$0.00	$0.00	$300.91	"$1,071.55"	"$1,071.55"	$0.00	$0.00	$300.88	$0.00	$853.98	$853.98	$0.00	$721.88	"$1,143.45"	"$1,155.00"	$0.00		$0.00	$225.95	$0.00	$0.00	$229.85	$0.00	$0.00	$0.00	$0.00	$0.00
74442410	SUP	HCPCS C1713		74442410  -  PLATE BN Y VLP MN-MOD 6 HL 2.4MM SCR	BOTH IP/OP	"$1,608.75 "	"$1,190.48"	$0.00	"$1,287.00"	$723.94	$723.94	$0.00	$0.00	$0.00	$335.30	"$1,194.01"	"$1,194.01"	$0.00	$0.00	$335.26	$0.00	$951.58	$951.58	$0.00	$804.38	"$1,274.13"	"$1,287.00"	$0.00		$0.00	$251.77	$0.00	$0.00	$256.11	$0.00	$0.00	$0.00	$0.00	$0.00
74442412	SUP	HCPCS C1713		74442412  -  PLATE BN Y VLP MN-MOD 8 HL 2.4MM SCR	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
74442414	SUP	HCPCS C1713		74442414  -  PLATE BN T VLP MN-MOD 2X6 HL SM BN 2.4MM	BOTH IP/OP	"$1,124.75 "	$832.32	$0.00	$899.80	$506.14	$506.14	$0.00	$0.00	$0.00	$234.43	$834.79	$834.79	$0.00	$0.00	$234.40	$0.00	$665.29	$665.29	$0.00	$562.38	$890.80	$899.80	$0.00		$0.00	$176.02	$0.00	$0.00	$179.06	$0.00	$0.00	$0.00	$0.00	$0.00
74442416	SUP	HCPCS C1713		74442416  -  PLATE BN T VLP MN-MOD 2X8 HL 2.4MM SCR	BOTH IP/OP	"$1,443.75 "	"$1,068.38"	$0.00	"$1,155.00"	$649.69	$649.69	$0.00	$0.00	$0.00	$300.91	"$1,071.55"	"$1,071.55"	$0.00	$0.00	$300.88	$0.00	$853.98	$853.98	$0.00	$721.88	"$1,143.45"	"$1,155.00"	$0.00		$0.00	$225.95	$0.00	$0.00	$229.85	$0.00	$0.00	$0.00	$0.00	$0.00
74442418	SUP	HCPCS C1713		74442418  -  PLATE BN T VLP MN-MOD 3X6 HL 2.4MM SCR	BOTH IP/OP	"$1,608.75 "	"$1,190.48"	$0.00	"$1,287.00"	$723.94	$723.94	$0.00	$0.00	$0.00	$335.30	"$1,194.01"	"$1,194.01"	$0.00	$0.00	$335.26	$0.00	$951.58	$951.58	$0.00	$804.38	"$1,274.13"	"$1,287.00"	$0.00		$0.00	$251.77	$0.00	$0.00	$256.11	$0.00	$0.00	$0.00	$0.00	$0.00
74442420	SUP	HCPCS C1713		74442420  -  PLATE BN T VLP MN-MOD 3X8 HL 2.4MM SCR	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
74442422	SUP	HCPCS C1713		74442422  -  PLATE BN STRG VLP MN-MOD 6 HL 2.4MM SCR	BOTH IP/OP	$965.25 	$714.29	$0.00	$772.20	$434.36	$434.36	$0.00	$0.00	$0.00	$201.18	$716.41	$716.41	$0.00	$0.00	$201.16	$0.00	$570.95	$570.95	$0.00	$482.63	$764.48	$772.20	$0.00		$0.00	$151.06	$0.00	$0.00	$153.67	$0.00	$0.00	$0.00	$0.00	$0.00
74442424	SUP	HCPCS C1713		74442424  -  PLATE BN STRG VLP MN-MOD 8 HL 2.4MM SCR	BOTH IP/OP	"$1,285.63 "	$951.37	$0.00	"$1,028.50"	$578.53	$578.53	$0.00	$0.00	$0.00	$267.96	$954.19	$954.19	$0.00	$0.00	$267.92	$0.00	$760.45	$760.45	$0.00	$642.81	"$1,018.22"	"$1,028.50"	$0.00		$0.00	$201.20	$0.00	$0.00	$204.67	$0.00	$0.00	$0.00	$0.00	$0.00
74442426	SUP	HCPCS C1713		74442426  -  PLATE BN STRG VLP MN-MOD 12 HL 2.4MM SCR	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
74442428	SUP	HCPCS C1713		74442428  -  PLATE BN VLP MN-MOD 12X3 HL MESH 2.4 MM SCR	BOTH IP/OP	"$2,413.13 "	"$1,785.72"	$0.00	"$1,930.50"	"$1,085.91"	"$1,085.91"	$0.00	$0.00	$0.00	$502.96	"$1,791.02"	"$1,791.02"	$0.00	$0.00	$502.90	$0.00	"$1,427.36"	"$1,427.36"	$0.00	"$1,206.56"	"$1,911.20"	"$1,930.50"	$0.00		$0.00	$377.65	$0.00	$0.00	$384.17	$0.00	$0.00	$0.00	$0.00	$0.00
74442430	SUP	HCPCS C1713		74442430  -  PLATE BN STOUT VLP MN-MOD 6 HL 2.4MM SCR	BOTH IP/OP	"$1,124.75 "	$832.32	$0.00	$899.80	$506.14	$506.14	$0.00	$0.00	$0.00	$234.43	$834.79	$834.79	$0.00	$0.00	$234.40	$0.00	$665.29	$665.29	$0.00	$562.38	$890.80	$899.80	$0.00		$0.00	$176.02	$0.00	$0.00	$179.06	$0.00	$0.00	$0.00	$0.00	$0.00
74442432	SUP	HCPCS C1713		74442432  -  PLATE BN STOUT VLP MN-MOD 8 HL 2.4MM SCR	BOTH IP/OP	"$1,443.75 "	"$1,068.38"	$0.00	"$1,155.00"	$649.69	$649.69	$0.00	$0.00	$0.00	$300.91	"$1,071.55"	"$1,071.55"	$0.00	$0.00	$300.88	$0.00	$853.98	$853.98	$0.00	$721.88	"$1,143.45"	"$1,155.00"	$0.00		$0.00	$225.95	$0.00	$0.00	$229.85	$0.00	$0.00	$0.00	$0.00	$0.00
74442434	SUP	HCPCS C1713		74442434  -  PLATE BN STOUT VLP MN-MOD 12 HL 2.4MM SCR	BOTH IP/OP	"$1,766.88 "	"$1,307.49"	$0.00	"$1,413.50"	$795.09	$795.09	$0.00	$0.00	$0.00	$368.26	"$1,311.37"	"$1,311.37"	$0.00	$0.00	$368.22	$0.00	"$1,045.11"	"$1,045.11"	$0.00	$883.44	"$1,399.37"	"$1,413.50"	$0.00		$0.00	$276.52	$0.00	$0.00	$281.29	$0.00	$0.00	$0.00	$0.00	$0.00
74444020	SUP	HCPCS C1713		74444020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74444025	SUP	HCPCS C1713		74444025  -  SCREW BN 4MM 25MM LGC CD HZN MA TI SPNE 4.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74444030	SUP	HCPCS C1713		74444030  -  SCREW BN 4MM 30MM LGC CD HZN MA TI SPNE 4.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74444035	SUP	HCPCS C1713		74444035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74444040	SUP	HCPCS C1713		74444040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74444520	SUP	HCPCS C1713		74444520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74444525	SUP	HCPCS C1713		74444525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74444530	SUP	HCPCS C1713		74444530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74444535	SUP	HCPCS C1713		74444535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74444540	SUP	HCPCS C1713		74444540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74445025	SUP	HCPCS C1713		74445025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74445030	SUP	HCPCS C1713		74445030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74445035	SUP	HCPCS C1713		74445035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74445040	SUP	HCPCS C1713		74445040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74445045	SUP	HCPCS C1713		74445045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74445050	SUP	HCPCS C1713		74445050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74445525	SUP	HCPCS C1713		74445525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74445530	SUP	HCPCS C1713		74445530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74445535	SUP	HCPCS C1713		74445535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74445540	SUP	HCPCS C1713		74445540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74445545	SUP	HCPCS C1713		74445545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74445550	SUP	HCPCS C1713		74445550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446025	SUP	HCPCS C1713		74446025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446030	SUP	HCPCS C1713		74446030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446035	SUP	HCPCS C1713		74446035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446040	SUP	HCPCS C1713		74446040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446045	SUP	HCPCS C1713		74446045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446050	SUP	HCPCS C1713		74446050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446525	SUP	HCPCS C1713		74446525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446530	SUP	HCPCS C1713		74446530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446535	SUP	HCPCS C1713		74446535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446540	SUP	HCPCS C1713		74446540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446545	SUP	HCPCS C1713		74446545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446550	SUP	HCPCS C1713		74446550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74446555	SUP	HCPCS C1713		74446555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74447525	SUP	HCPCS C1713		74447525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74447530	SUP	HCPCS C1713		74447530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74447535	SUP	HCPCS C1713		74447535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74447540	SUP	HCPCS C1713		74447540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74447545	SUP	HCPCS C1713		74447545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74447550	SUP	HCPCS C1713		74447550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74447555	SUP	HCPCS C1713		74447555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74462002	SUP	Custom 27203010		74462002  -  BIT DRL SHRT 1.5MM VLP MN-MOD QC	BOTH IP/OP	$242.00 	$179.08	$0.00	$193.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.61	$179.61	$0.00	$0.00	$50.43	$0.00	$0.00	$0.00	$0.00	$121.00	$191.66	$193.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74462004	SUP	Custom 27203010		74462004  -  BIT DRL LNG 1.5MM VLP MN-MOD QC	BOTH IP/OP	$281.88 	$208.59	$0.00	$225.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$209.21	$209.21	$0.00	$0.00	$58.74	$0.00	$0.00	$0.00	$0.00	$140.94	$223.25	$225.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74462006	SUP	Custom 27203010		74462006  -  BIT DRL 2MM VLP MN-MOD QC OVR	BOTH IP/OP	$242.00 	$179.08	$0.00	$193.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.61	$179.61	$0.00	$0.00	$50.43	$0.00	$0.00	$0.00	$0.00	$121.00	$191.66	$193.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74462410	SUP	Custom 27203010		74462410  -  BIT DRL 2.4MM VLP MN-MOD AO QC OVR	BOTH IP/OP	$242.00 	$179.08	$0.00	$193.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.61	$179.61	$0.00	$0.00	$50.43	$0.00	$0.00	$0.00	$0.00	$121.00	$191.66	$193.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74640132	SUP	HCPCS C1713		74640132  -  SCREW BN 9MM 32MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640134	SUP	HCPCS C1713		74640134  -  SCREW BN 9MM 34MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640136	SUP	HCPCS C1713		74640136  -  SCREW BN 9MM 36MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640138	SUP	HCPCS C1713		74640138  -  SCREW BN 9MM 38MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640234	SUP	HCPCS C1713		74640234  -  SCREW BN 10MM 34MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640236	SUP	HCPCS C1713		74640236  -  SCREW BN 10MM 36MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640238	SUP	HCPCS C1713		74640238  -  SCREW BN 10MM 38MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640240	SUP	HCPCS C1713		74640240  -  SCREW BN 10MM 40MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640336	SUP	HCPCS C1713		74640336  -  SCREW BN 11.5MM 36MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640338	SUP	HCPCS C1713		74640338  -  SCREW BN 11.5MM 38MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640340	SUP	HCPCS C1713		74640340  -  SCREW BN 11.5MM 40MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640342	SUP	HCPCS C1713		74640342  -  SCREW BN 11.5MM 42MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640440	SUP	HCPCS C1713		74640440  -  SCREW BN 13MM 40MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74640442	SUP	HCPCS C1713		74640442  -  SCREW BN 13MM 42MM TN SURESHOT RT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74644020	SUP	HCPCS C1713		74644020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74644025	SUP	HCPCS C1713		74644025  -  SCREW BN 4MM 25MM STRL LGC CD HZN MA SS SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74644030	SUP	HCPCS C1713		74644030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74644035	SUP	HCPCS C1713		74644035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74644040	SUP	HCPCS C1713		74644040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74644520	SUP	HCPCS C1713		74644520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74644525	SUP	HCPCS C1713		74644525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74644530	SUP	HCPCS C1713		74644530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74644535	SUP	HCPCS C1713		74644535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74644540	SUP	HCPCS C1713		74644540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74645025	SUP	HCPCS C1713		74645025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74645030	SUP	HCPCS C1713		74645030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74645035	SUP	HCPCS C1713		74645035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74645040	SUP	HCPCS C1713		74645040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74645045	SUP	HCPCS C1713		74645045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74645050	SUP	HCPCS C1713		74645050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74645525	SUP	HCPCS C1713		74645525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74645530	SUP	HCPCS C1713		74645530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74645535	SUP	HCPCS C1713		74645535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74645540	SUP	HCPCS C1713		74645540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74645545	SUP	HCPCS C1713		74645545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74645550	SUP	HCPCS C1713		74645550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646025	SUP	HCPCS C1713		74646025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646030	SUP	HCPCS C1713		74646030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646035	SUP	HCPCS C1713		74646035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646040	SUP	HCPCS C1713		74646040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646045	SUP	HCPCS C1713		74646045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646050	SUP	HCPCS C1713		74646050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646525	SUP	HCPCS C1713		74646525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646530	SUP	HCPCS C1713		74646530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646535	SUP	HCPCS C1713		74646535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646540	SUP	HCPCS C1713		74646540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646545	SUP	HCPCS C1713		74646545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646550	SUP	HCPCS C1713		74646550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74646555	SUP	HCPCS C1713		74646555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74647525	SUP	HCPCS C1713		74647525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74647530	SUP	HCPCS C1713		74647530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74647535	SUP	HCPCS C1713		74647535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74647540	SUP	HCPCS C1713		74647540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74647545	SUP	HCPCS C1713		74647545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74647550	SUP	HCPCS C1713		74647550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74647555	SUP	HCPCS C1713		74647555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
74649132	SUP	HCPCS C1713		74649132  -  SCREW BN 9MM 32MM SURESHOT TN LT EVAL	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649134	SUP	HCPCS C1713		74649134  -  SCREW BN 9MM 34MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649136	SUP	HCPCS C1713		74649136  -  SCREW BN 9MM 36MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649138	SUP	HCPCS C1713		74649138  -  SCREW BN 9MM 38MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649234	SUP	HCPCS C1713		74649234  -  SCREW BN 10MM 34MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649236	SUP	HCPCS C1713		74649236  -  SCREW BN 10MM 36MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649238	SUP	HCPCS C1713		74649238  -  SCREW BN 10MM 38MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649240	SUP	HCPCS C1713		74649240  -  SCREW BN 10MM 40MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649336	SUP	HCPCS C1713		74649336  -  SCREW BN 11.5MM 36MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649338	SUP	HCPCS C1713		74649338  -  SCREW BN 11.5MM 38MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649340	SUP	HCPCS C1713		74649340  -  SCREW BN 11.5MM 40MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649342	SUP	HCPCS C1713		74649342  -  SCREW BN 11.5MM 42MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649440	SUP	HCPCS C1713		74649440  -  SCREW BN 13MM 40MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74649442	SUP	HCPCS C1713		74649442  -  SCREW BN 13MM 42MM TN SURESHOT LT TROCH	BOTH IP/OP	"$5,270.00 "	"$3,899.80"	$0.00	"$4,216.00"	"$2,371.50"	"$2,371.50"	$0.00	$0.00	$0.00	"$1,098.40"	"$3,911.39"	"$3,911.39"	$0.00	$0.00	"$1,098.27"	$0.00	"$2,598.11"	"$2,598.11"	$0.00	"$2,635.00"	"$4,173.84"	"$4,216.00"	$0.00		$0.00	$824.76	$0.00	$0.00	$838.98	$0.00	$0.00	$0.00	$0.00	$0.00
74692424	SUP	HCPCS C1713		74692424  -  SCREW BN 2.4MM 24MM D-RAD SMRT PK LCK ST T7 DRVR TI DIST	BOTH IP/OP	$182.70 	$135.20	$0.00	$146.16	$82.22	$82.22	$0.00	$0.00	$0.00	$38.08	$135.60	$135.60	$0.00	$0.00	$38.07	$0.00	$108.07	$108.07	$0.00	$91.35	$144.70	$146.16	$0.00		$0.00	$28.59	$0.00	$0.00	$29.09	$0.00	$0.00	$0.00	$0.00	$0.00
74800060	SUP	HCPCS C1713		74800060  -  SCREW BN CONE 6.5MM 60MM CNN SS PROX FEM	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74800065	SUP	HCPCS C1713		74800065  -  SCREW BN CONE 6.5MM 65MM CNN SS PROX FEM	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74800070	SUP	HCPCS C1713		74800070  -  SCREW BN CONE 6.5MM 70MM CNN SS PROX FEM	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74800075	SUP	HCPCS C1713		74800075  -  SCREW BN CONE 6.5MM 75MM CNN SS PROX FEM	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74800080	SUP	HCPCS C1713		74800080  -  SCREW BN CONE 6.5MM 80MM CNN SS PROX FEM	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74800085	SUP	HCPCS C1713		74800085  -  SCREW BN CONE 6.5MM 85MM CNN SS PROX FEM	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74800095	SUP	HCPCS C1713		74800095  -  SCREW BN CONE 6.5MM 95MM CNN SS PROX FEM	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74800100	SUP	HCPCS C1713		74800100  -  SCREW BN CONE 6.5MM 100MM CNN SS PROX FEM	BOTH IP/OP	$559.13 	$413.76	$0.00	$447.30	$251.61	$251.61	$0.00	$0.00	$0.00	$116.54	$414.98	$414.98	$0.00	$0.00	$116.52	$0.00	$330.72	$330.72	$0.00	$279.56	$442.83	$447.30	$0.00		$0.00	$87.50	$0.00	$0.00	$89.01	$0.00	$0.00	$0.00	$0.00	$0.00
74800105	SUP	HCPCS C1713		74800105  -  SCREW BN CONE 6.5MM 105MM CNN SS PROX FEM	BOTH IP/OP	$559.13 	$413.76	$0.00	$447.30	$251.61	$251.61	$0.00	$0.00	$0.00	$116.54	$414.98	$414.98	$0.00	$0.00	$116.52	$0.00	$330.72	$330.72	$0.00	$279.56	$442.83	$447.30	$0.00		$0.00	$87.50	$0.00	$0.00	$89.01	$0.00	$0.00	$0.00	$0.00	$0.00
74800110	SUP	HCPCS C1713		74800110  -  SCREW BN CONE 6.5MM 110MM CNN SS PROX FEM	BOTH IP/OP	$559.13 	$413.76	$0.00	$447.30	$251.61	$251.61	$0.00	$0.00	$0.00	$116.54	$414.98	$414.98	$0.00	$0.00	$116.52	$0.00	$330.72	$330.72	$0.00	$279.56	$442.83	$447.30	$0.00		$0.00	$87.50	$0.00	$0.00	$89.01	$0.00	$0.00	$0.00	$0.00	$0.00
74800115	SUP	HCPCS C1713		74800115  -  SCREW BN CONE 6.5MM 115MM CNN SS PROX FEM	BOTH IP/OP	$559.13 	$413.76	$0.00	$447.30	$251.61	$251.61	$0.00	$0.00	$0.00	$116.54	$414.98	$414.98	$0.00	$0.00	$116.52	$0.00	$330.72	$330.72	$0.00	$279.56	$442.83	$447.30	$0.00		$0.00	$87.50	$0.00	$0.00	$89.01	$0.00	$0.00	$0.00	$0.00	$0.00
74800120	SUP	HCPCS C1713		74800120  -  SCREW BN CONE 6.5MM 120MM CNN SS PROX FEM	BOTH IP/OP	$559.13 	$413.76	$0.00	$447.30	$251.61	$251.61	$0.00	$0.00	$0.00	$116.54	$414.98	$414.98	$0.00	$0.00	$116.52	$0.00	$330.72	$330.72	$0.00	$279.56	$442.83	$447.30	$0.00		$0.00	$87.50	$0.00	$0.00	$89.01	$0.00	$0.00	$0.00	$0.00	$0.00
74800125	SUP	HCPCS C1713		74800125  -  SCREW BN CONE 6.5MM 125MM CNN SS PROX FEM	BOTH IP/OP	$559.13 	$413.76	$0.00	$447.30	$251.61	$251.61	$0.00	$0.00	$0.00	$116.54	$414.98	$414.98	$0.00	$0.00	$116.52	$0.00	$330.72	$330.72	$0.00	$279.56	$442.83	$447.30	$0.00		$0.00	$87.50	$0.00	$0.00	$89.01	$0.00	$0.00	$0.00	$0.00	$0.00
74800130	SUP	HCPCS C1713		74800130  -  SCREW BN CONE 6.5MM 130MM CNN SS PROX FEM	BOTH IP/OP	$559.13 	$413.76	$0.00	$447.30	$251.61	$251.61	$0.00	$0.00	$0.00	$116.54	$414.98	$414.98	$0.00	$0.00	$116.52	$0.00	$330.72	$330.72	$0.00	$279.56	$442.83	$447.30	$0.00		$0.00	$87.50	$0.00	$0.00	$89.01	$0.00	$0.00	$0.00	$0.00	$0.00
74800260	SUP	HCPCS C1713		74800260  -  SCREW BN 6.5MM 60MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800265	SUP	HCPCS C1713		74800265  -  SCREW BN 6.5MM 65MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800270	SUP	HCPCS C1713		74800270  -  SCREW BN 6.5MM 70MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800275	SUP	HCPCS C1713		74800275  -  SCREW BN 6.5MM 75MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800280	SUP	HCPCS C1713		74800280  -  SCREW BN 6.5MM 80MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800285	SUP	HCPCS C1713		74800285  -  SCREW BN 6.5MM 85MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800290	SUP	HCPCS C1713		74800290  -  SCREW BN 6.5MM 90MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800295	SUP	HCPCS C1713		74800295  -  SCREW BN 6.5MM 95MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800300	SUP	HCPCS C1713		74800300  -  SCREW BN 6.5MM 100MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800305	SUP	HCPCS C1713		74800305  -  SCREW BN 6.5MM 105MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800310	SUP	HCPCS C1713		74800310  -  SCREW BN 6.5MM 110MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800315	SUP	HCPCS C1713		74800315  -  SCREW BN 6.5MM 115MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800320	SUP	HCPCS C1713		74800320  -  SCREW BN 6.5MM 120MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800325	SUP	HCPCS C1713		74800325  -  SCREW BN 6.5MM 125MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800330	SUP	HCPCS C1713		74800330  -  SCREW BN 6.5MM 130MM CNN LCK SS PROX FEM	BOTH IP/OP	$645.75 	$477.86	$0.00	$516.60	$290.59	$290.59	$0.00	$0.00	$0.00	$134.59	$479.28	$479.28	$0.00	$0.00	$134.57	$0.00	$381.96	$381.96	$0.00	$322.88	$511.43	$516.60	$0.00		$0.00	$101.06	$0.00	$0.00	$102.80	$0.00	$0.00	$0.00	$0.00	$0.00
74800402	SUP	HCPCS C1713		74800402  -  PLATE BN 44MM 2 HL LCK SS LT PROX FEM 4.5MM SCR	BOTH IP/OP	"$3,380.63 "	"$2,501.67"	$0.00	"$2,704.50"	"$1,521.28"	"$1,521.28"	$0.00	$0.00	$0.00	$704.61	"$2,509.10"	"$2,509.10"	$0.00	$0.00	$704.52	$0.00	"$1,666.65"	"$1,666.65"	$0.00	"$1,690.31"	"$2,677.46"	"$2,704.50"	$0.00		$0.00	$529.07	$0.00	$0.00	$538.20	$0.00	$0.00	$0.00	$0.00	$0.00
74800404	SUP	HCPCS C1713		74800404  -  PLATE BN 144MM 4 HL LCK SS LT PROX FEM 4.5MM SCR	BOTH IP/OP	"$3,431.25 "	"$2,539.13"	$0.00	"$2,745.00"	"$1,544.06"	"$1,544.06"	$0.00	$0.00	$0.00	$715.16	"$2,546.67"	"$2,546.67"	$0.00	$0.00	$715.07	$0.00	"$1,691.61"	"$1,691.61"	$0.00	"$1,715.63"	"$2,717.55"	"$2,745.00"	$0.00		$0.00	$536.99	$0.00	$0.00	$546.26	$0.00	$0.00	$0.00	$0.00	$0.00
74800406	SUP	HCPCS C1713		74800406  -  PLATE BN 180MM 6 HL LCK SS LT PROX FEM 4.5MM SCR	BOTH IP/OP	"$3,498.75 "	"$2,589.08"	$0.00	"$2,799.00"	"$1,574.44"	"$1,574.44"	$0.00	$0.00	$0.00	$729.23	"$2,596.77"	"$2,596.77"	$0.00	$0.00	$729.14	$0.00	"$1,724.88"	"$1,724.88"	$0.00	"$1,749.38"	"$2,771.01"	"$2,799.00"	$0.00		$0.00	$547.55	$0.00	$0.00	$557.00	$0.00	$0.00	$0.00	$0.00	$0.00
74800409	SUP	HCPCS C1713		74800409  -  PLATE BN 234MM 9 HL LCK SS LT PROX FEM 4.5MM SCR	BOTH IP/OP	"$3,633.75 "	"$2,688.98"	$0.00	"$2,907.00"	"$1,635.19"	"$1,635.19"	$0.00	$0.00	$0.00	$757.36	"$2,696.97"	"$2,696.97"	$0.00	$0.00	$757.27	$0.00	"$1,791.44"	"$1,791.44"	$0.00	"$1,816.88"	"$2,877.93"	"$2,907.00"	$0.00		$0.00	$568.68	$0.00	$0.00	$578.49	$0.00	$0.00	$0.00	$0.00	$0.00
74800412	SUP	HCPCS C1713		74800412  -  PLATE BN 288MM 12 HL LCK SS LT PROX FEM 4.5MM SCR	BOTH IP/OP	"$4,246.88 "	"$3,142.69"	$0.00	"$3,397.50"	"$1,911.09"	"$1,911.09"	$0.00	$0.00	$0.00	$885.15	"$3,152.03"	"$3,152.03"	$0.00	$0.00	$885.05	$0.00	"$2,093.71"	"$2,093.71"	$0.00	"$2,123.44"	"$3,363.53"	"$3,397.50"	$0.00		$0.00	$664.64	$0.00	$0.00	$676.10	$0.00	$0.00	$0.00	$0.00	$0.00
74800415	SUP	HCPCS C1713		74800415  -  PLATE BN 15MM LCK SS LT PROX FEM	BOTH IP/OP	"$4,584.38 "	"$3,392.44"	$0.00	"$3,667.50"	"$2,062.97"	"$2,062.97"	$0.00	$0.00	$0.00	$955.50	"$3,402.52"	"$3,402.52"	$0.00	$0.00	$955.38	$0.00	"$2,260.10"	"$2,260.10"	$0.00	"$2,292.19"	"$3,630.83"	"$3,667.50"	$0.00		$0.00	$717.45	$0.00	$0.00	$729.83	$0.00	$0.00	$0.00	$0.00	$0.00
74800418	SUP	HCPCS C1713		74800418  -  PLATE BN 396MM 18 HL LCK SS LT PROX FEM 4.5MM SCR	BOTH IP/OP	"$4,921.88 "	"$3,642.19"	$0.00	"$3,937.50"	"$2,214.84"	"$2,214.84"	$0.00	$0.00	$0.00	"$1,025.84"	"$3,653.02"	"$3,653.02"	$0.00	$0.00	"$1,025.72"	$0.00	"$2,426.48"	"$2,426.48"	$0.00	"$2,460.94"	"$3,898.13"	"$3,937.50"	$0.00		$0.00	$770.27	$0.00	$0.00	$783.56	$0.00	$0.00	$0.00	$0.00	$0.00
74800502	SUP	HCPCS C1713		74800502  -  PLATE BN 99MM 2 HL LCK SS RT PROX FEM 4.5MM SCR	BOTH IP/OP	"$3,380.63 "	"$2,501.67"	$0.00	"$2,704.50"	"$1,521.28"	"$1,521.28"	$0.00	$0.00	$0.00	$704.61	"$2,509.10"	"$2,509.10"	$0.00	$0.00	$704.52	$0.00	"$1,666.65"	"$1,666.65"	$0.00	"$1,690.31"	"$2,677.46"	"$2,704.50"	$0.00		$0.00	$529.07	$0.00	$0.00	$538.20	$0.00	$0.00	$0.00	$0.00	$0.00
74800504	SUP	HCPCS C1713		74800504  -  PLATE BN 144MM 4 HL LCK SS RT PROX FEM 4.5MM SCR	BOTH IP/OP	"$3,431.25 "	"$2,539.13"	$0.00	"$2,745.00"	"$1,544.06"	"$1,544.06"	$0.00	$0.00	$0.00	$715.16	"$2,546.67"	"$2,546.67"	$0.00	$0.00	$715.07	$0.00	"$1,691.61"	"$1,691.61"	$0.00	"$1,715.63"	"$2,717.55"	"$2,745.00"	$0.00		$0.00	$536.99	$0.00	$0.00	$546.26	$0.00	$0.00	$0.00	$0.00	$0.00
74800506	SUP	HCPCS C1713		74800506  -  PLATE BN 180MM 6 HL LCK SS RT PROX FEM 4.5MM SCR	BOTH IP/OP	"$3,498.75 "	"$2,589.08"	$0.00	"$2,799.00"	"$1,574.44"	"$1,574.44"	$0.00	$0.00	$0.00	$729.23	"$2,596.77"	"$2,596.77"	$0.00	$0.00	$729.14	$0.00	"$1,724.88"	"$1,724.88"	$0.00	"$1,749.38"	"$2,771.01"	"$2,799.00"	$0.00		$0.00	$547.55	$0.00	$0.00	$557.00	$0.00	$0.00	$0.00	$0.00	$0.00
74800509	SUP	HCPCS C1713		74800509  -  PLATE BN 234MM 9 HL LCK SS RT PROX FEM 4.5MM SCR	BOTH IP/OP	"$3,633.75 "	"$2,688.98"	$0.00	"$2,907.00"	"$1,635.19"	"$1,635.19"	$0.00	$0.00	$0.00	$757.36	"$2,696.97"	"$2,696.97"	$0.00	$0.00	$757.27	$0.00	"$1,791.44"	"$1,791.44"	$0.00	"$1,816.88"	"$2,877.93"	"$2,907.00"	$0.00		$0.00	$568.68	$0.00	$0.00	$578.49	$0.00	$0.00	$0.00	$0.00	$0.00
74800512	SUP	HCPCS C1713		74800512  -  PLATE BN 288MM 12 HL LCK SS RT PROX FEM 4.5MM SCR	BOTH IP/OP	"$4,246.88 "	"$3,142.69"	$0.00	"$3,397.50"	"$1,911.09"	"$1,911.09"	$0.00	$0.00	$0.00	$885.15	"$3,152.03"	"$3,152.03"	$0.00	$0.00	$885.05	$0.00	"$2,093.71"	"$2,093.71"	$0.00	"$2,123.44"	"$3,363.53"	"$3,397.50"	$0.00		$0.00	$664.64	$0.00	$0.00	$676.10	$0.00	$0.00	$0.00	$0.00	$0.00
74800515	SUP	HCPCS C1713		74800515  -  PLATE BN 342MM 15 HL LCK SS RT PROX FEM 4.5MM SCR	BOTH IP/OP	"$4,550.63 "	"$3,367.47"	$0.00	"$3,640.50"	"$2,047.78"	"$2,047.78"	$0.00	$0.00	$0.00	$948.46	"$3,377.47"	"$3,377.47"	$0.00	$0.00	$948.35	$0.00	"$2,243.46"	"$2,243.46"	$0.00	"$2,275.31"	"$3,604.10"	"$3,640.50"	$0.00		$0.00	$712.17	$0.00	$0.00	$724.46	$0.00	$0.00	$0.00	$0.00	$0.00
74800518	SUP	HCPCS C1713		74800518  -  PLATE BN 396MM PRLC 18 HL LCK SS FEM RT PROX 4.5MM SCR	BOTH IP/OP	"$4,882.50 "	"$3,613.05"	$0.00	"$3,906.00"	"$2,197.13"	"$2,197.13"	$0.00	$0.00	$0.00	"$1,017.64"	"$3,623.79"	"$3,623.79"	$0.00	$0.00	"$1,017.51"	$0.00	"$2,407.07"	"$2,407.07"	$0.00	"$2,441.25"	"$3,866.94"	"$3,906.00"	$0.00		$0.00	$764.11	$0.00	$0.00	$777.29	$0.00	$0.00	$0.00	$0.00	$0.00
74800601	SUP	HCPCS C1713		74800601  -  PLATE BN SHRT PRLC CBL SDL SS	BOTH IP/OP	$408.38 	$302.20	$0.00	$326.70	$183.77	$183.77	$0.00	$0.00	$0.00	$85.12	$303.10	$303.10	$0.00	$0.00	$85.11	$0.00	$241.55	$241.55	$0.00	$204.19	$323.44	$326.70	$0.00		$0.00	$63.91	$0.00	$0.00	$65.01	$0.00	$0.00	$0.00	$0.00	$0.00
74800602	SUP	HCPCS C1713		74800602  -  PLATE BN TLL PRLC CBL SDL SS	BOTH IP/OP	$408.38 	$302.20	$0.00	$326.70	$183.77	$183.77	$0.00	$0.00	$0.00	$85.12	$303.10	$303.10	$0.00	$0.00	$85.11	$0.00	$241.55	$241.55	$0.00	$204.19	$323.44	$326.70	$0.00		$0.00	$63.91	$0.00	$0.00	$65.01	$0.00	$0.00	$0.00	$0.00	$0.00
74800603	SUP	HCPCS C1713		74800603  -  SCREW BN 4.5MM PRLC HL FIL SS FEM PROX	BOTH IP/OP	$319.50 	$236.43	$0.00	$255.60	$143.78	$143.78	$0.00	$0.00	$0.00	$66.59	$237.13	$237.13	$0.00	$0.00	$66.58	$0.00	$188.98	$188.98	$0.00	$159.75	$253.04	$255.60	$0.00		$0.00	$50.00	$0.00	$0.00	$50.86	$0.00	$0.00	$0.00	$0.00	$0.00
74800607	SUP	HCPCS C1713		74800607  -  PLATE BN PRLC LCK INS HEX SS HUM 4.5 MM SCR	BOTH IP/OP	$231.75 	$171.50	$0.00	$185.40	$104.29	$104.29	$0.00	$0.00	$0.00	$48.30	$172.00	$172.00	$0.00	$0.00	$48.30	$0.00	$137.08	$137.08	$0.00	$115.88	$183.55	$185.40	$0.00		$0.00	$36.27	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$0.00
74820060	SUP	HCPCS C1713		74820060  -  SCREW BN CONE 6.5MM 60MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820065	SUP	HCPCS C1713		74820065  -  SCREW BN CONE 6.5MM 65MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820070	SUP	HCPCS C1713		74820070  -  SCREW BN CONE 6.5MM 70MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820075	SUP	HCPCS C1713		74820075  -  SCREW BN CONE 6.5MM 75MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820080	SUP	HCPCS C1713		74820080  -  SCREW BN CONE 6.5MM 80MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820085	SUP	HCPCS C1713		74820085  -  SCREW BN CONE 6.5MM 85MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820090	SUP	HCPCS C1713		74820090  -  SCREW BN CONE 6.5MM 90MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820095	SUP	HCPCS C1713		74820095  -  SCREW BN CONE 6.5MM 95MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820100	SUP	HCPCS C1713		74820100  -  SCREW BN CONE 6.5MM 100MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820105	SUP	HCPCS C1713		74820105  -  SCREW BN CONE 6.5MM 105MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820110	SUP	HCPCS C1713		74820110  -  SCREW BN CONE 6.5MM 110MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820115	SUP	HCPCS C1713		74820115  -  SCREW BN CONE 6.5MM 115MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820120	SUP	HCPCS C1713		74820120  -  SCREW BN CONE 6.5MM 120MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820125	SUP	HCPCS C1713		74820125  -  SCREW BN CONE 6.5MM 125MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820130	SUP	HCPCS C1713		74820130  -  SCREW BN CONE 6.5MM 130MM PRLC CNN SS FEM PROX	BOTH IP/OP	$555.75 	$411.26	$0.00	$444.60	$250.09	$250.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$277.88	$440.15	$444.60	$0.00		$0.00	$86.97	$0.00	$0.00	$88.48	$0.00	$0.00	$0.00	$0.00	$0.00
74820260	SUP	HCPCS C1713		74820260  -  SCREW BN FT 6.5MM 60MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820265	SUP	HCPCS C1713		74820265  -  SCREW BN FT 6.5MM 65MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820270	SUP	HCPCS C1713		74820270  -  SCREW BN FT 6.5MM 70MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820275	SUP	HCPCS C1713		74820275  -  SCREW BN FT 6.5MM 75MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820280	SUP	HCPCS C1713		74820280  -  SCREW BN FT 6.5MM 80MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820285	SUP	HCPCS C1713		74820285  -  SCREW BN FT 6.5MM 85MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820290	SUP	HCPCS C1713		74820290  -  SCREW BN FT 6.5MM 90MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820295	SUP	HCPCS C1713		74820295  -  SCREW BN FT 6.5MM 95MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820300	SUP	HCPCS C1713		74820300  -  SCREW BN FT 6.5MM 100MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820305	SUP	HCPCS C1713		74820305  -  SCREW BN FT 6.5MM 105MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820310	SUP	HCPCS C1713		74820310  -  SCREW BN FT 6.5MM 110MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820315	SUP	HCPCS C1713		74820315  -  SCREW BN FT 6.5MM 115MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820320	SUP	HCPCS C1713		74820320  -  SCREW BN FT 6.5MM 120MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820325	SUP	HCPCS C1713		74820325  -  SCREW BN FT 6.5MM 125MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820330	SUP	HCPCS C1713		74820330  -  SCREW BN FT 6.5MM 130MM PRLC LCK CNN SS FEM PROX	BOTH IP/OP	$637.88 	$472.03	$0.00	$510.30	$287.04	$287.04	$0.00	$0.00	$0.00	$132.95	$473.43	$473.43	$0.00	$0.00	$132.93	$0.00	$377.30	$377.30	$0.00	$318.94	$505.20	$510.30	$0.00		$0.00	$99.83	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00
74820402	SUP	HCPCS C1713		74820402  -  PLATE BN 99MMX2MM LCK FEM PROX 4.5MM SCR	BOTH IP/OP	"$3,493.13 "	"$2,584.92"	$0.00	"$2,794.50"	"$1,571.91"	"$1,571.91"	$0.00	$0.00	$0.00	$728.05	"$2,592.60"	"$2,592.60"	$0.00	$0.00	$727.97	$0.00	"$1,722.11"	"$1,722.11"	$0.00	"$1,746.56"	"$2,766.56"	"$2,794.50"	$0.00		$0.00	$546.67	$0.00	$0.00	$556.11	$0.00	$0.00	$0.00	$0.00	$0.00
74820404	SUP	HCPCS C1713		74820404  -  PLATE BN 144MM 4 HL LCK LT PROX FEM 4.5MM SCR	BOTH IP/OP	"$3,549.38 "	"$2,626.54"	$0.00	"$2,839.50"	"$1,597.22"	"$1,597.22"	$0.00	$0.00	$0.00	$739.78	"$2,634.35"	"$2,634.35"	$0.00	$0.00	$739.69	$0.00	"$1,749.84"	"$1,749.84"	$0.00	"$1,774.69"	"$2,811.11"	"$2,839.50"	$0.00		$0.00	$555.48	$0.00	$0.00	$565.06	$0.00	$0.00	$0.00	$0.00	$0.00
74820406	SUP	HCPCS C1713		74820406  -  PLATE BN 180MMX6MM LCK FEM PROX 4.5MM SCR	BOTH IP/OP	"$3,611.25 "	"$2,672.33"	$0.00	"$2,889.00"	"$1,625.06"	"$1,625.06"	$0.00	$0.00	$0.00	$752.67	"$2,680.27"	"$2,680.27"	$0.00	$0.00	$752.58	$0.00	"$1,780.35"	"$1,780.35"	$0.00	"$1,805.63"	"$2,860.11"	"$2,889.00"	$0.00		$0.00	$565.16	$0.00	$0.00	$574.91	$0.00	$0.00	$0.00	$0.00	$0.00
74820409	SUP	HCPCS C1713		74820409  -  PLATE BN 234MM 9 HL LCK FEM PROX 4.5MM SCR	BOTH IP/OP	"$3,746.25 "	"$2,772.23"	$0.00	"$2,997.00"	"$1,685.81"	"$1,685.81"	$0.00	$0.00	$0.00	$780.81	"$2,780.47"	"$2,780.47"	$0.00	$0.00	$780.72	$0.00	"$1,846.90"	"$1,846.90"	$0.00	"$1,873.13"	"$2,967.03"	"$2,997.00"	$0.00		$0.00	$586.29	$0.00	$0.00	$596.40	$0.00	$0.00	$0.00	$0.00	$0.00
74820412	SUP	HCPCS C1713		74820412  -  PLATE BN 288MM 12 HL LCK LT PROX FEM 4.5MM SCR	BOTH IP/OP	"$4,218.75 "	"$3,121.88"	$0.00	"$3,375.00"	"$1,898.44"	"$1,898.44"	$0.00	$0.00	$0.00	$879.29	"$3,131.16"	"$3,131.16"	$0.00	$0.00	$879.19	$0.00	"$2,079.84"	"$2,079.84"	$0.00	"$2,109.38"	"$3,341.25"	"$3,375.00"	$0.00		$0.00	$660.23	$0.00	$0.00	$671.63	$0.00	$0.00	$0.00	$0.00	$0.00
74820502	SUP	HCPCS C1713		74820502  -  PLATE BN 4.5MM 99MM 2 HL LCK FEM RT	BOTH IP/OP	"$3,493.13 "	"$2,584.92"	$0.00	"$2,794.50"	"$1,571.91"	"$1,571.91"	$0.00	$0.00	$0.00	$728.05	"$2,592.60"	"$2,592.60"	$0.00	$0.00	$727.97	$0.00	"$1,722.11"	"$1,722.11"	$0.00	"$1,746.56"	"$2,766.56"	"$2,794.50"	$0.00		$0.00	$546.67	$0.00	$0.00	$556.11	$0.00	$0.00	$0.00	$0.00	$0.00
74820504	SUP	HCPCS C1713		74820504  -  PLATE BN 144MM 4 HL LCK FEM RT PROX 4.5MM SCR	BOTH IP/OP	"$3,549.38 "	"$2,626.54"	$0.00	"$2,839.50"	"$1,597.22"	"$1,597.22"	$0.00	$0.00	$0.00	$739.78	"$2,634.35"	"$2,634.35"	$0.00	$0.00	$739.69	$0.00	"$1,749.84"	"$1,749.84"	$0.00	"$1,774.69"	"$2,811.11"	"$2,839.50"	$0.00		$0.00	$555.48	$0.00	$0.00	$565.06	$0.00	$0.00	$0.00	$0.00	$0.00
74820506	SUP	HCPCS C1713		74820506  -  PLATE BN 180MM 6 HL LCK PROX FEM RT 4.5MM SCR	BOTH IP/OP	"$3,611.25 "	"$2,672.33"	$0.00	"$2,889.00"	"$1,625.06"	"$1,625.06"	$0.00	$0.00	$0.00	$752.67	"$2,680.27"	"$2,680.27"	$0.00	$0.00	$752.58	$0.00	"$1,780.35"	"$1,780.35"	$0.00	"$1,805.63"	"$2,860.11"	"$2,889.00"	$0.00		$0.00	$565.16	$0.00	$0.00	$574.91	$0.00	$0.00	$0.00	$0.00	$0.00
74820509	SUP	HCPCS C1713		74820509  -  PLATE BN 234MM 9 HL LCK RT PROX FEM 4.5MM SCR	BOTH IP/OP	"$3,746.25 "	"$2,772.23"	$0.00	"$2,997.00"	"$1,685.81"	"$1,685.81"	$0.00	$0.00	$0.00	$780.81	"$2,780.47"	"$2,780.47"	$0.00	$0.00	$780.72	$0.00	"$1,846.90"	"$1,846.90"	$0.00	"$1,873.13"	"$2,967.03"	"$2,997.00"	$0.00		$0.00	$586.29	$0.00	$0.00	$596.40	$0.00	$0.00	$0.00	$0.00	$0.00
74820512	SUP	HCPCS C1713		74820512  -  PLATE BN 288MM 12 HL LCK FEM RT PROX 4.5MM SCR	BOTH IP/OP	"$4,218.75 "	"$3,121.88"	$0.00	"$3,375.00"	"$1,898.44"	"$1,898.44"	$0.00	$0.00	$0.00	$879.29	"$3,131.16"	"$3,131.16"	$0.00	$0.00	$879.19	$0.00	"$2,079.84"	"$2,079.84"	$0.00	"$2,109.38"	"$3,341.25"	"$3,375.00"	$0.00		$0.00	$660.23	$0.00	$0.00	$671.63	$0.00	$0.00	$0.00	$0.00	$0.00
75001233	SUP	HCPCS C1713		75001233  -  PIN FX 34MM LCK DIST	BOTH IP/OP	$602.50 	$445.85	$0.00	$482.00	$271.13	$271.13	$0.00	$0.00	$0.00	$125.58	$447.18	$447.18	$0.00	$0.00	$125.56	$0.00	$356.38	$356.38	$0.00	$301.25	$477.18	$482.00	$0.00		$0.00	$94.29	$0.00	$0.00	$95.92	$0.00	$0.00	$0.00	$0.00	$0.00
75001234	SUP	HCPCS C1713		75001234  -  PIN FX 36MM LCK DIST	BOTH IP/OP	$602.50 	$445.85	$0.00	$482.00	$271.13	$271.13	$0.00	$0.00	$0.00	$125.58	$447.18	$447.18	$0.00	$0.00	$125.56	$0.00	$356.38	$356.38	$0.00	$301.25	$477.18	$482.00	$0.00		$0.00	$94.29	$0.00	$0.00	$95.92	$0.00	$0.00	$0.00	$0.00	$0.00
75001235	SUP	HCPCS C1713		75001235  -  PIN FX 38MM LCK DIST	BOTH IP/OP	$602.50 	$445.85	$0.00	$482.00	$271.13	$271.13	$0.00	$0.00	$0.00	$125.58	$447.18	$447.18	$0.00	$0.00	$125.56	$0.00	$356.38	$356.38	$0.00	$301.25	$477.18	$482.00	$0.00		$0.00	$94.29	$0.00	$0.00	$95.92	$0.00	$0.00	$0.00	$0.00	$0.00
75001236	SUP	HCPCS C1713		75001236  -  PIN FX 40MM LCK DIST	BOTH IP/OP	$602.50 	$445.85	$0.00	$482.00	$271.13	$271.13	$0.00	$0.00	$0.00	$125.58	$447.18	$447.18	$0.00	$0.00	$125.56	$0.00	$356.38	$356.38	$0.00	$301.25	$477.18	$482.00	$0.00		$0.00	$94.29	$0.00	$0.00	$95.92	$0.00	$0.00	$0.00	$0.00	$0.00
75001237	SUP	HCPCS C1713		75001237  -  PIN FX 42MM LCK DIST	BOTH IP/OP	$602.50 	$445.85	$0.00	$482.00	$271.13	$271.13	$0.00	$0.00	$0.00	$125.58	$447.18	$447.18	$0.00	$0.00	$125.56	$0.00	$356.38	$356.38	$0.00	$301.25	$477.18	$482.00	$0.00		$0.00	$94.29	$0.00	$0.00	$95.92	$0.00	$0.00	$0.00	$0.00	$0.00
75001238	SUP	HCPCS C1713		75001238  -  PIN FX 44MM LCK DIST	BOTH IP/OP	$602.50 	$445.85	$0.00	$482.00	$271.13	$271.13	$0.00	$0.00	$0.00	$125.58	$447.18	$447.18	$0.00	$0.00	$125.56	$0.00	$356.38	$356.38	$0.00	$301.25	$477.18	$482.00	$0.00		$0.00	$94.29	$0.00	$0.00	$95.92	$0.00	$0.00	$0.00	$0.00	$0.00
75001239	SUP	HCPCS C1713		75001239  -  PIN FX 46MM LCK DIST	BOTH IP/OP	$602.50 	$445.85	$0.00	$482.00	$271.13	$271.13	$0.00	$0.00	$0.00	$125.58	$447.18	$447.18	$0.00	$0.00	$125.56	$0.00	$356.38	$356.38	$0.00	$301.25	$477.18	$482.00	$0.00		$0.00	$94.29	$0.00	$0.00	$95.92	$0.00	$0.00	$0.00	$0.00	$0.00
75001240	SUP	HCPCS C1713		75001240  -  PIN FX 50MM LCK DIST	BOTH IP/OP	$602.50 	$445.85	$0.00	$482.00	$271.13	$271.13	$0.00	$0.00	$0.00	$125.58	$447.18	$447.18	$0.00	$0.00	$125.56	$0.00	$356.38	$356.38	$0.00	$301.25	$477.18	$482.00	$0.00		$0.00	$94.29	$0.00	$0.00	$95.92	$0.00	$0.00	$0.00	$0.00	$0.00
75001241	SUP	HCPCS C1713		75001241  -  PIN FX 60MM LCK DIST	BOTH IP/OP	$602.50 	$445.85	$0.00	$482.00	$271.13	$271.13	$0.00	$0.00	$0.00	$125.58	$447.18	$447.18	$0.00	$0.00	$125.56	$0.00	$356.38	$356.38	$0.00	$301.25	$477.18	$482.00	$0.00		$0.00	$94.29	$0.00	$0.00	$95.92	$0.00	$0.00	$0.00	$0.00	$0.00
75001242	SUP	HCPCS C1713		75001242  -  PIN FX 70MM LCK DIST	BOTH IP/OP	$602.50 	$445.85	$0.00	$482.00	$271.13	$271.13	$0.00	$0.00	$0.00	$125.58	$447.18	$447.18	$0.00	$0.00	$125.56	$0.00	$356.38	$356.38	$0.00	$301.25	$477.18	$482.00	$0.00		$0.00	$94.29	$0.00	$0.00	$95.92	$0.00	$0.00	$0.00	$0.00	$0.00
75405535	SUP	HCPCS C1713		75405535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75405540	SUP	HCPCS C1713		75405540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75405545	SUP	HCPCS C1713		75405545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75406535	SUP	HCPCS C1713		75406535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75406540	SUP	HCPCS C1713		75406540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75406545	SUP	HCPCS C1713		75406545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75407535	SUP	HCPCS C1713		75407535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75407540	SUP	HCPCS C1713		75407540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75407545	SUP	HCPCS C1713		75407545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75407550	SUP	HCPCS C1713		75407550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444020	SUP	HCPCS C1713		75444020  -  SCREW BN FLUT 4MM 20MM STRL LGC CD HZN G4 TCH MA ST LCK MECH	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444025	SUP	HCPCS C1713		75444025  -  SCREW BN 4MM 25MM STRL CD HZN LGC MA TI PDCL SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444030	SUP	HCPCS C1713		75444030  -  SCREW BN FLUT 4MM 30MM STRL LGC CD HZN G4 TCH MA ST LCK MECH	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444040	SUP	HCPCS C1713		75444040  -  SCREW BN FLUT 4MM 40MM STRL LGC CD HZN G4 TCH MA ST LCK MECH	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444045	SUP	HCPCS C1713		75444045  -  SCREW BN 4MM 45MM STRL CD HZN LGC MA TI SPNE PDCL 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444050	SUP	HCPCS C1713		75444050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444520	SUP	HCPCS C1713		75444520  -  SCREW BN FLUT 4.5MM 20MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444525	SUP	HCPCS C1713		75444525  -  SCREW BN FLUT 4.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444530	SUP	HCPCS C1713		75444530  -  SCREW BN FLUT 4.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444535	SUP	HCPCS C1713		75444535  -  SCREW BN FLUT 4.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444540	SUP	HCPCS C1713		75444540  -  SCREW BN FLUT 4.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444545	SUP	HCPCS C1713		75444545  -  SCREW BN FLUT 4.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75444550	SUP	HCPCS C1713		75444550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445020	SUP	HCPCS C1713		75445020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445025	SUP	HCPCS C1713		75445025  -  SCREW BN FLUT 5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445030	SUP	HCPCS C1713		75445030  -  SCREW BN FLUT 5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445035	SUP	HCPCS C1713		75445035  -  SCREW BN FLUT 5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445040	SUP	HCPCS C1713		75445040  -  SCREW BN FLUT 5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445045	SUP	HCPCS C1713		75445045  -  SCREW BN FLUT 5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445050	SUP	HCPCS C1713		75445050  -  SCREW BN FLUT 5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445520	SUP	HCPCS C1713		75445520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445525	SUP	HCPCS C1713		75445525  -  SCREW BN FLUT 5.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445530	SUP	HCPCS C1713		75445530  -  SCREW BN FLUT 5.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445535	SUP	HCPCS C1713		75445535  -  SCREW BN FLUT 5.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445540	SUP	HCPCS C1713		75445540  -  SCREW BN FLUT 5.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445545	SUP	HCPCS C1713		75445545  -  SCREW BN FLUT 5.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445550	SUP	HCPCS C1713		75445550  -  SCREW BN FLUT 5.5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445555	SUP	HCPCS C1713		75445555  -  SCREW BN FLUT 5.5MM 55MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75445560	SUP	HCPCS C1713		75445560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446025	SUP	HCPCS C1713		75446025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446030	SUP	HCPCS C1713		75446030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446035	SUP	HCPCS C1713		75446035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446040	SUP	HCPCS C1713		75446040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446045	SUP	HCPCS C1713		75446045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446050	SUP	HCPCS C1713		75446050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446055	SUP	HCPCS C1713		75446055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446060	SUP	HCPCS C1713		75446060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446070	SUP	HCPCS C1713		75446070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446520	SUP	HCPCS C1713		75446520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446525	SUP	HCPCS C1713		75446525  -  SCREW BN FLUT 6.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446530	SUP	HCPCS C1713		75446530  -  SCREW BN FLUT 6.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446535	SUP	HCPCS C1713		75446535  -  SCREW BN FLUT 6.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446540	SUP	HCPCS C1713		75446540  -  SCREW BN FLUT 6.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446545	SUP	HCPCS C1713		75446545  -  SCREW BN FLUT 6.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446550	SUP	HCPCS C1713		75446550  -  SCREW BN FLUT 6.5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446555	SUP	HCPCS C1713		75446555  -  SCREW BN FLUT 6.5MM 55MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446560	SUP	HCPCS C1713		75446560  -  SCREW BN FLUT 6.5MM 60MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75446565	SUP	HCPCS C1713		75446565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75447525	SUP	HCPCS C1713		75447525  -  SCREW BN FLUT 7.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75447530	SUP	HCPCS C1713		75447530  -  SCREW BN FLUT 7.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75447535	SUP	HCPCS C1713		75447535  -  SCREW BN FLUT 7.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75447540	SUP	HCPCS C1713		75447540  -  SCREW BN FLUT 7.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75447545	SUP	HCPCS C1713		75447545  -  SCREW BN FLUT 7.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75447550	SUP	HCPCS C1713		75447550  -  SCREW BN FLUT 7.5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75447555	SUP	HCPCS C1713		75447555  -  SCREW BN FLUT 7.5MM 55MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75447560	SUP	HCPCS C1713		75447560  -  SCREW BN FLUT 7.5MM 60MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75447565	SUP	HCPCS C1713		75447565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75447570	SUP	HCPCS C1713		75447570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75448525	SUP	HCPCS C1713		75448525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75448530	SUP	HCPCS C1713		75448530  -  SCREW BN FLUT 8.5MM 30MM STRL LGC CD HZN G4 TCH MA ST LCK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75448535	SUP	HCPCS C1713		75448535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75448540	SUP	HCPCS C1713		75448540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75448545	SUP	HCPCS C1713		75448545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75448550	SUP	HCPCS C1713		75448550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75448555	SUP	HCPCS C1713		75448555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75448560	SUP	HCPCS C1713		75448560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75448565	SUP	HCPCS C1713		75448565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75454020	SUP	HCPCS C1713		75454020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454025	SUP	HCPCS C1713		75454025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454030	SUP	HCPCS C1713		75454030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454035	SUP	HCPCS C1713		75454035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454040	SUP	HCPCS C1713		75454040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454045	SUP	HCPCS C1713		75454045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454050	SUP	HCPCS C1713		75454050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454520	SUP	HCPCS C1713		75454520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454525	SUP	HCPCS C1713		75454525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454530	SUP	HCPCS C1713		75454530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454535	SUP	HCPCS C1713		75454535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454540	SUP	HCPCS C1713		75454540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454545	SUP	HCPCS C1713		75454545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75454550	SUP	HCPCS C1713		75454550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455020	SUP	HCPCS C1713		75455020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455025	SUP	HCPCS C1713		75455025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455030	SUP	HCPCS C1713		75455030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455035	SUP	HCPCS C1713		75455035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455040	SUP	HCPCS C1713		75455040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455045	SUP	HCPCS C1713		75455045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455050	SUP	HCPCS C1713		75455050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455520	SUP	HCPCS C1713		75455520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455525	SUP	HCPCS C1713		75455525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455530	SUP	HCPCS C1713		75455530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455535	SUP	HCPCS C1713		75455535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455540	SUP	HCPCS C1713		75455540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455545	SUP	HCPCS C1713		75455545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455550	SUP	HCPCS C1713		75455550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455555	SUP	HCPCS C1713		75455555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75455560	SUP	HCPCS C1713		75455560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456020	SUP	HCPCS C1713		75456020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456025	SUP	HCPCS C1713		75456025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456030	SUP	HCPCS C1713		75456030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456035	SUP	HCPCS C1713		75456035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456040	SUP	HCPCS C1713		75456040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456045	SUP	HCPCS C1713		75456045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456050	SUP	HCPCS C1713		75456050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456055	SUP	HCPCS C1713		75456055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456060	SUP	HCPCS C1713		75456060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456065	SUP	HCPCS C1713		75456065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456070	SUP	HCPCS C1713		75456070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456520	SUP	HCPCS C1713		75456520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456525	SUP	HCPCS C1713		75456525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456530	SUP	HCPCS C1713		75456530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456535	SUP	HCPCS C1713		75456535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456540	SUP	HCPCS C1713		75456540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456545	SUP	HCPCS C1713		75456545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456550	SUP	HCPCS C1713		75456550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456555	SUP	HCPCS C1713		75456555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456560	SUP	HCPCS C1713		75456560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75456565	SUP	HCPCS C1713		75456565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75457525	SUP	HCPCS C1713		75457525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75457530	SUP	HCPCS C1713		75457530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75457535	SUP	HCPCS C1713		75457535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75457540	SUP	HCPCS C1713		75457540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75457545	SUP	HCPCS C1713		75457545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75457550	SUP	HCPCS C1713		75457550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75457555	SUP	HCPCS C1713		75457555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75457560	SUP	HCPCS C1713		75457560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75457565	SUP	HCPCS C1713		75457565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75457570	SUP	HCPCS C1713		75457570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75458525	SUP	HCPCS C1713		75458525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75458530	SUP	HCPCS C1713		75458530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75458535	SUP	HCPCS C1713		75458535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75458540	SUP	HCPCS C1713		75458540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75458545	SUP	HCPCS C1713		75458545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75458550	SUP	HCPCS C1713		75458550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75458555	SUP	HCPCS C1713		75458555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75458560	SUP	HCPCS C1713		75458560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75458565	SUP	HCPCS C1713		75458565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,643.00 "	"$1,955.82"	$0.00	"$2,114.40"	"$1,189.35"	"$1,189.35"	$0.00	$0.00	$0.00	$550.87	"$1,961.63"	"$1,961.63"	$0.00	$0.00	$550.80	$0.00	"$1,303.00"	"$1,303.00"	$0.00	"$1,321.50"	"$2,093.26"	"$2,114.40"	$0.00		$0.00	$413.63	$0.00	$0.00	$420.77	$0.00	$0.00	$0.00	$0.00	$0.00
75464015	SUP	HCPCS C1713		75464015  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464020	SUP	HCPCS C1713		75464020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464025	SUP	HCPCS C1713		75464025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464030	SUP	HCPCS C1713		75464030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464035	SUP	HCPCS C1713		75464035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464040	SUP	HCPCS C1713		75464040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464045	SUP	HCPCS C1713		75464045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464050	SUP	HCPCS C1713		75464050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464055	SUP	HCPCS C1713		75464055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464060	SUP	HCPCS C1713		75464060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464515	SUP	HCPCS C1713		75464515  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464520	SUP	HCPCS C1713		75464520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464525	SUP	HCPCS C1713		75464525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464530	SUP	HCPCS C1713		75464530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464535	SUP	HCPCS C1713		75464535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464540	SUP	HCPCS C1713		75464540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464545	SUP	HCPCS C1713		75464545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464550	SUP	HCPCS C1713		75464550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464555	SUP	HCPCS C1713		75464555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75464560	SUP	HCPCS C1713		75464560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465015	SUP	HCPCS C1713		75465015  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465020	SUP	HCPCS C1713		75465020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465025	SUP	HCPCS C1713		75465025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465030	SUP	HCPCS C1713		75465030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465035	SUP	HCPCS C1713		75465035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465040	SUP	HCPCS C1713		75465040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465045	SUP	HCPCS C1713		75465045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465050	SUP	HCPCS C1713		75465050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465055	SUP	HCPCS C1713		75465055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465060	SUP	HCPCS C1713		75465060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465515	SUP	HCPCS C1713		75465515  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465520	SUP	HCPCS C1713		75465520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465525	SUP	HCPCS C1713		75465525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75465530	SUP	HCPCS C1713		75465530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75470735	SUP	Custom 27803010		75470735  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$0.00	$0.00	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75470740	SUP	Custom 27803010		75470740  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$0.00	$0.00	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75470745	SUP	Custom 27803010		75470745  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$0.00	$0.00	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75470750	SUP	Custom 27803010		75470750  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$0.00	$0.00	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75470755	SUP	Custom 27803010		75470755  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$0.00	$0.00	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75470760	SUP	Custom 27803010		75470760  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$0.00	$0.00	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75470865	SUP	Custom 27803010		75470865  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$0.00	$0.00	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75470870	SUP	Custom 27803010		75470870  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$0.00	$0.00	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75470875	SUP	Custom 27803010		75470875  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$0.00	$0.00	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75494520	SUP	HCPCS C1713		75494520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75494525	SUP	HCPCS C1713		75494525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75494530	SUP	HCPCS C1713		75494530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75494535	SUP	HCPCS C1713		75494535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75494540	SUP	HCPCS C1713		75494540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75494545	SUP	HCPCS C1713		75494545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75494550	SUP	HCPCS C1713		75494550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495020	SUP	HCPCS C1713		75495020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495025	SUP	HCPCS C1713		75495025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495030	SUP	HCPCS C1713		75495030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495035	SUP	HCPCS C1713		75495035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495040	SUP	HCPCS C1713		75495040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495045	SUP	HCPCS C1713		75495045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495050	SUP	HCPCS C1713		75495050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495520	SUP	HCPCS C1713		75495520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495525	SUP	HCPCS C1713		75495525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495530	SUP	HCPCS C1713		75495530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495535	SUP	HCPCS C1713		75495535  -  SCREW BN 5.5MM 35MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495540	SUP	HCPCS C1713		75495540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495545	SUP	HCPCS C1713		75495545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495550	SUP	HCPCS C1713		75495550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495555	SUP	HCPCS C1713		75495555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75495560	SUP	HCPCS C1713		75495560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75496520	SUP	HCPCS C1713		75496520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75496525	SUP	HCPCS C1713		75496525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75496530	SUP	HCPCS C1713		75496530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75496535	SUP	HCPCS C1713		75496535  -  SCREW BN 6.5MM 35MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75496540	SUP	HCPCS C1713		75496540  -  SCREW BN 6.5MM 40MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75496545	SUP	HCPCS C1713		75496545  -  SCREW BN 6.5MM 45MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75496550	SUP	HCPCS C1713		75496550  -  SCREW BN 6.5MM 50MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75496555	SUP	HCPCS C1713		75496555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75496560	SUP	HCPCS C1713		75496560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75496565	SUP	HCPCS C1713		75496565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75497525	SUP	HCPCS C1713		75497525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75497530	SUP	HCPCS C1713		75497530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75497535	SUP	HCPCS C1713		75497535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75497540	SUP	HCPCS C1713		75497540  -  SCREW BN 7.5MM 40MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75497545	SUP	HCPCS C1713		75497545  -  SCREW BN 7.5MM 45MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75497550	SUP	HCPCS C1713		75497550  -  SCREW BN 7.5MM 50MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75497555	SUP	HCPCS C1713		75497555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75497560	SUP	HCPCS C1713		75497560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75497565	SUP	HCPCS C1713		75497565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75497570	SUP	HCPCS C1713		75497570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75498525	SUP	HCPCS C1713		75498525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75498530	SUP	HCPCS C1713		75498530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75498535	SUP	HCPCS C1713		75498535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75498540	SUP	HCPCS C1713		75498540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75498545	SUP	HCPCS C1713		75498545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75498550	SUP	HCPCS C1713		75498550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75498555	SUP	HCPCS C1713		75498555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75498560	SUP	HCPCS C1713		75498560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75498565	SUP	HCPCS C1713		75498565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644020	SUP	HCPCS C1713		75644020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644025	SUP	HCPCS C1713		75644025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644030	SUP	HCPCS C1713		75644030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644035	SUP	HCPCS C1713		75644035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644040	SUP	HCPCS C1713		75644040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644045	SUP	HCPCS C1713		75644045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644050	SUP	HCPCS C1713		75644050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644520	SUP	HCPCS C1713		75644520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644525	SUP	HCPCS C1713		75644525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644530	SUP	HCPCS C1713		75644530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644535	SUP	HCPCS C1713		75644535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644540	SUP	HCPCS C1713		75644540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644545	SUP	HCPCS C1713		75644545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75644550	SUP	HCPCS C1713		75644550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645020	SUP	HCPCS C1713		75645020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645025	SUP	HCPCS C1713		75645025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645030	SUP	HCPCS C1713		75645030  -  SCREW BN FLUT 5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645035	SUP	HCPCS C1713		75645035  -  SCREW BN FLUT 5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645040	SUP	HCPCS C1713		75645040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645045	SUP	HCPCS C1713		75645045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645050	SUP	HCPCS C1713		75645050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645520	SUP	HCPCS C1713		75645520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645525	SUP	HCPCS C1713		75645525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645530	SUP	HCPCS C1713		75645530  -  SCREW BN FLUT 5.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645535	SUP	HCPCS C1713		75645535  -  SCREW BN FLUT 5.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645540	SUP	HCPCS C1713		75645540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645545	SUP	HCPCS C1713		75645545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645550	SUP	HCPCS C1713		75645550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645555	SUP	HCPCS C1713		75645555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75645560	SUP	HCPCS C1713		75645560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646025	SUP	HCPCS C1713		75646025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646030	SUP	HCPCS C1713		75646030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646035	SUP	HCPCS C1713		75646035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646040	SUP	HCPCS C1713		75646040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646045	SUP	HCPCS C1713		75646045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646050	SUP	HCPCS C1713		75646050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646055	SUP	HCPCS C1713		75646055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646060	SUP	HCPCS C1713		75646060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646065	SUP	HCPCS C1713		75646065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646070	SUP	HCPCS C1713		75646070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646520	SUP	HCPCS C1713		75646520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646525	SUP	HCPCS C1713		75646525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646530	SUP	HCPCS C1713		75646530  -  SCREW BN FLUT 6.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646535	SUP	HCPCS C1713		75646535  -  SCREW BN FLUT 6.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646540	SUP	HCPCS C1713		75646540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646545	SUP	HCPCS C1713		75646545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646550	SUP	HCPCS C1713		75646550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646555	SUP	HCPCS C1713		75646555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646560	SUP	HCPCS C1713		75646560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75646565	SUP	HCPCS C1713		75646565  -  SCREW BN FLUT 6.5MM 65MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75647525	SUP	HCPCS C1713		75647525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75647530	SUP	HCPCS C1713		75647530  -  SCREW BN FLUT 7.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75647535	SUP	HCPCS C1713		75647535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75647540	SUP	HCPCS C1713		75647540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75647545	SUP	HCPCS C1713		75647545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75647550	SUP	HCPCS C1713		75647550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75647555	SUP	HCPCS C1713		75647555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75647560	SUP	HCPCS C1713		75647560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75647565	SUP	HCPCS C1713		75647565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75647570	SUP	HCPCS C1713		75647570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75648525	SUP	HCPCS C1713		75648525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75648530	SUP	HCPCS C1713		75648530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75648535	SUP	HCPCS C1713		75648535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75648540	SUP	HCPCS C1713		75648540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75648545	SUP	HCPCS C1713		75648545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75648550	SUP	HCPCS C1713		75648550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75648555	SUP	HCPCS C1713		75648555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75648560	SUP	HCPCS C1713		75648560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75648565	SUP	HCPCS C1713		75648565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75654020	SUP	HCPCS C1713		75654020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654025	SUP	HCPCS C1713		75654025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654030	SUP	HCPCS C1713		75654030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654035	SUP	HCPCS C1713		75654035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654040	SUP	HCPCS C1713		75654040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654045	SUP	HCPCS C1713		75654045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654050	SUP	HCPCS C1713		75654050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654520	SUP	HCPCS C1713		75654520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654525	SUP	HCPCS C1713		75654525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654530	SUP	HCPCS C1713		75654530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654535	SUP	HCPCS C1713		75654535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654540	SUP	HCPCS C1713		75654540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654545	SUP	HCPCS C1713		75654545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75654550	SUP	HCPCS C1713		75654550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655020	SUP	HCPCS C1713		75655020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655025	SUP	HCPCS C1713		75655025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655030	SUP	HCPCS C1713		75655030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655035	SUP	HCPCS C1713		75655035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655040	SUP	HCPCS C1713		75655040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655045	SUP	HCPCS C1713		75655045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655050	SUP	HCPCS C1713		75655050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655520	SUP	HCPCS C1713		75655520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655525	SUP	HCPCS C1713		75655525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655530	SUP	HCPCS C1713		75655530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655535	SUP	HCPCS C1713		75655535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655540	SUP	HCPCS C1713		75655540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655545	SUP	HCPCS C1713		75655545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655550	SUP	HCPCS C1713		75655550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655555	SUP	HCPCS C1713		75655555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75655560	SUP	HCPCS C1713		75655560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656020	SUP	HCPCS C1713		75656020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656025	SUP	HCPCS C1713		75656025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656030	SUP	HCPCS C1713		75656030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656035	SUP	HCPCS C1713		75656035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656040	SUP	HCPCS C1713		75656040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656045	SUP	HCPCS C1713		75656045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656050	SUP	HCPCS C1713		75656050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656055	SUP	HCPCS C1713		75656055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656060	SUP	HCPCS C1713		75656060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656065	SUP	HCPCS C1713		75656065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656070	SUP	HCPCS C1713		75656070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656520	SUP	HCPCS C1713		75656520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656525	SUP	HCPCS C1713		75656525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656530	SUP	HCPCS C1713		75656530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656535	SUP	HCPCS C1713		75656535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656540	SUP	HCPCS C1713		75656540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656545	SUP	HCPCS C1713		75656545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656550	SUP	HCPCS C1713		75656550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656555	SUP	HCPCS C1713		75656555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656560	SUP	HCPCS C1713		75656560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75656565	SUP	HCPCS C1713		75656565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75657525	SUP	HCPCS C1713		75657525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75657530	SUP	HCPCS C1713		75657530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75657535	SUP	HCPCS C1713		75657535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75657540	SUP	HCPCS C1713		75657540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75657545	SUP	HCPCS C1713		75657545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75657550	SUP	HCPCS C1713		75657550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75657555	SUP	HCPCS C1713		75657555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75657560	SUP	HCPCS C1713		75657560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75657565	SUP	HCPCS C1713		75657565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75657570	SUP	HCPCS C1713		75657570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75658525	SUP	HCPCS C1713		75658525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75658530	SUP	HCPCS C1713		75658530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75658535	SUP	HCPCS C1713		75658535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75658540	SUP	HCPCS C1713		75658540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75658545	SUP	HCPCS C1713		75658545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75658550	SUP	HCPCS C1713		75658550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75658555	SUP	HCPCS C1713		75658555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75658560	SUP	HCPCS C1713		75658560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75658565	SUP	HCPCS C1713		75658565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,452.50 "	"$1,814.85"	$0.00	"$1,962.00"	"$1,103.63"	"$1,103.63"	$0.00	$0.00	$0.00	$511.16	"$1,820.25"	"$1,820.25"	$0.00	$0.00	$511.10	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,226.25"	"$1,942.38"	"$1,962.00"	$0.00		$0.00	$383.82	$0.00	$0.00	$390.44	$0.00	$0.00	$0.00	$0.00	$0.00
75694520	SUP	HCPCS C1713		75694520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75694525	SUP	HCPCS C1713		75694525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75694530	SUP	HCPCS C1713		75694530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75694535	SUP	HCPCS C1713		75694535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75694540	SUP	HCPCS C1713		75694540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75694545	SUP	HCPCS C1713		75694545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75694550	SUP	HCPCS C1713		75694550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695020	SUP	HCPCS C1713		75695020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695025	SUP	HCPCS C1713		75695025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695030	SUP	HCPCS C1713		75695030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695035	SUP	HCPCS C1713		75695035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695040	SUP	HCPCS C1713		75695040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695045	SUP	HCPCS C1713		75695045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695050	SUP	HCPCS C1713		75695050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695520	SUP	HCPCS C1713		75695520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695525	SUP	HCPCS C1713		75695525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695530	SUP	HCPCS C1713		75695530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695535	SUP	HCPCS C1713		75695535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695540	SUP	HCPCS C1713		75695540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695545	SUP	HCPCS C1713		75695545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695550	SUP	HCPCS C1713		75695550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695555	SUP	HCPCS C1713		75695555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75695560	SUP	HCPCS C1713		75695560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75696520	SUP	HCPCS C1713		75696520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75696525	SUP	HCPCS C1713		75696525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75696530	SUP	HCPCS C1713		75696530  -  SCREW BN FLUT 6.5MM 30MM CD HZN LGC MA RDC SS SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75696535	SUP	HCPCS C1713		75696535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75696540	SUP	HCPCS C1713		75696540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75696545	SUP	HCPCS C1713		75696545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75696550	SUP	HCPCS C1713		75696550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75696555	SUP	HCPCS C1713		75696555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75696560	SUP	HCPCS C1713		75696560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75696565	SUP	HCPCS C1713		75696565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75697525	SUP	HCPCS C1713		75697525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75697530	SUP	HCPCS C1713		75697530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75697535	SUP	HCPCS C1713		75697535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75697540	SUP	HCPCS C1713		75697540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75697545	SUP	HCPCS C1713		75697545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75697550	SUP	HCPCS C1713		75697550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75697555	SUP	HCPCS C1713		75697555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75697560	SUP	HCPCS C1713		75697560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75697565	SUP	HCPCS C1713		75697565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75697570	SUP	HCPCS C1713		75697570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75698525	SUP	HCPCS C1713		75698525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75698530	SUP	HCPCS C1713		75698530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75698535	SUP	HCPCS C1713		75698535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75698540	SUP	HCPCS C1713		75698540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75698545	SUP	HCPCS C1713		75698545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75698550	SUP	HCPCS C1713		75698550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75698555	SUP	HCPCS C1713		75698555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75698560	SUP	HCPCS C1713		75698560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
75698565	SUP	HCPCS C1713		75698565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76440020	SUP	HCPCS C1713		76440020  -  SCREW BONE 20MM CD HZN LGC PDCL TI MULTIAX 5.5MM ROD STRL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
76444020	SUP	HCPCS C1713		76444020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444025	SUP	HCPCS C1713		76444025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444030	SUP	HCPCS C1713		76444030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444035	SUP	HCPCS C1713		76444035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444040	SUP	HCPCS C1713		76444040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444045	SUP	HCPCS C1713		76444045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444050	SUP	HCPCS C1713		76444050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444520	SUP	HCPCS C1713		76444520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444525	SUP	HCPCS C1713		76444525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444530	SUP	HCPCS C1713		76444530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444535	SUP	HCPCS C1713		76444535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444540	SUP	HCPCS C1713		76444540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444545	SUP	HCPCS C1713		76444545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76444550	SUP	HCPCS C1713		76444550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445020	SUP	HCPCS C1713		76445020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445025	SUP	HCPCS C1713		76445025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445030	SUP	HCPCS C1713		76445030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445035	SUP	HCPCS C1713		76445035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445040	SUP	HCPCS C1713		76445040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445045	SUP	HCPCS C1713		76445045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445050	SUP	HCPCS C1713		76445050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445520	SUP	HCPCS C1713		76445520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445525	SUP	HCPCS C1713		76445525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445530	SUP	HCPCS C1713		76445530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445535	SUP	HCPCS C1713		76445535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445540	SUP	HCPCS C1713		76445540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445545	SUP	HCPCS C1713		76445545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445550	SUP	HCPCS C1713		76445550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445555	SUP	HCPCS C1713		76445555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76445560	SUP	HCPCS C1713		76445560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446025	SUP	HCPCS C1713		76446025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446030	SUP	HCPCS C1713		76446030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446035	SUP	HCPCS C1713		76446035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446040	SUP	HCPCS C1713		76446040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446045	SUP	HCPCS C1713		76446045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446050	SUP	HCPCS C1713		76446050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446055	SUP	HCPCS C1713		76446055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446060	SUP	HCPCS C1713		76446060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446065	SUP	HCPCS C1713		76446065  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446070	SUP	HCPCS C1713		76446070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446075	SUP	HCPCS C1713		76446075  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446520	SUP	HCPCS C1713		76446520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446525	SUP	HCPCS C1713		76446525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446530	SUP	HCPCS C1713		76446530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446535	SUP	HCPCS C1713		76446535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446540	SUP	HCPCS C1713		76446540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446545	SUP	HCPCS C1713		76446545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446550	SUP	HCPCS C1713		76446550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446555	SUP	HCPCS C1713		76446555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446560	SUP	HCPCS C1713		76446560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446565	SUP	HCPCS C1713		76446565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446570	SUP	HCPCS C1713		76446570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76446575	SUP	HCPCS C1713		76446575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76447525	SUP	HCPCS C1713		76447525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76447530	SUP	HCPCS C1713		76447530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76447535	SUP	HCPCS C1713		76447535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76447540	SUP	HCPCS C1713		76447540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76447545	SUP	HCPCS C1713		76447545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76447550	SUP	HCPCS C1713		76447550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76447555	SUP	HCPCS C1713		76447555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76447560	SUP	HCPCS C1713		76447560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76447565	SUP	HCPCS C1713		76447565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76447570	SUP	HCPCS C1713		76447570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76447575	SUP	HCPCS C1713		76447575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76448525	SUP	HCPCS C1713		76448525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76448530	SUP	HCPCS C1713		76448530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76448535	SUP	HCPCS C1713		76448535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76448540	SUP	HCPCS C1713		76448540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76448545	SUP	HCPCS C1713		76448545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76448550	SUP	HCPCS C1713		76448550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76448555	SUP	HCPCS C1713		76448555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76448560	SUP	HCPCS C1713		76448560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76448565	SUP	HCPCS C1713		76448565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76448570	SUP	HCPCS C1713		76448570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76448575	SUP	HCPCS C1713		76448575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76494520	SUP	HCPCS C1713		76494520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76494525	SUP	HCPCS C1713		76494525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76494530	SUP	HCPCS C1713		76494530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76494535	SUP	HCPCS C1713		76494535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76494540	SUP	HCPCS C1713		76494540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76494545	SUP	HCPCS C1713		76494545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76494550	SUP	HCPCS C1713		76494550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495020	SUP	HCPCS C1713		76495020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495025	SUP	HCPCS C1713		76495025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495030	SUP	HCPCS C1713		76495030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495035	SUP	HCPCS C1713		76495035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495040	SUP	HCPCS C1713		76495040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495045	SUP	HCPCS C1713		76495045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495050	SUP	HCPCS C1713		76495050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495520	SUP	HCPCS C1713		76495520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495525	SUP	HCPCS C1713		76495525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495530	SUP	HCPCS C1713		76495530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495535	SUP	HCPCS C1713		76495535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495540	SUP	HCPCS C1713		76495540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495545	SUP	HCPCS C1713		76495545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495550	SUP	HCPCS C1713		76495550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495555	SUP	HCPCS C1713		76495555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76495560	SUP	HCPCS C1713		76495560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76496525	SUP	HCPCS C1713		76496525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76496530	SUP	HCPCS C1713		76496530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76496535	SUP	HCPCS C1713		76496535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76496540	SUP	HCPCS C1713		76496540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76496545	SUP	HCPCS C1713		76496545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76496550	SUP	HCPCS C1713		76496550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76496555	SUP	HCPCS C1713		76496555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76496560	SUP	HCPCS C1713		76496560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76496565	SUP	HCPCS C1713		76496565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76496570	SUP	HCPCS C1713		76496570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76496575	SUP	HCPCS C1713		76496575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76497525	SUP	HCPCS C1713		76497525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76497530	SUP	HCPCS C1713		76497530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76497535	SUP	HCPCS C1713		76497535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76497540	SUP	HCPCS C1713		76497540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76497545	SUP	HCPCS C1713		76497545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76497550	SUP	HCPCS C1713		76497550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76497555	SUP	HCPCS C1713		76497555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76497560	SUP	HCPCS C1713		76497560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76497565	SUP	HCPCS C1713		76497565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76497570	SUP	HCPCS C1713		76497570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76497575	SUP	HCPCS C1713		76497575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76498525	SUP	HCPCS C1713		76498525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76498530	SUP	HCPCS C1713		76498530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76498535	SUP	HCPCS C1713		76498535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76498540	SUP	HCPCS C1713		76498540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76498545	SUP	HCPCS C1713		76498545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76498550	SUP	HCPCS C1713		76498550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76498555	SUP	HCPCS C1713		76498555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76498560	SUP	HCPCS C1713		76498560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76498565	SUP	HCPCS C1713		76498565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76498570	SUP	HCPCS C1713		76498570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76498575	SUP	HCPCS C1713		76498575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644020	SUP	HCPCS C1713		76644020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644025	SUP	HCPCS C1713		76644025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644030	SUP	HCPCS C1713		76644030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644035	SUP	HCPCS C1713		76644035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644040	SUP	HCPCS C1713		76644040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644045	SUP	HCPCS C1713		76644045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644050	SUP	HCPCS C1713		76644050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644520	SUP	HCPCS C1713		76644520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644525	SUP	HCPCS C1713		76644525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644530	SUP	HCPCS C1713		76644530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644535	SUP	HCPCS C1713		76644535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644540	SUP	HCPCS C1713		76644540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644545	SUP	HCPCS C1713		76644545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76644550	SUP	HCPCS C1713		76644550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645020	SUP	HCPCS C1713		76645020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645025	SUP	HCPCS C1713		76645025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645030	SUP	HCPCS C1713		76645030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645035	SUP	HCPCS C1713		76645035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645040	SUP	HCPCS C1713		76645040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645045	SUP	HCPCS C1713		76645045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645050	SUP	HCPCS C1713		76645050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645520	SUP	HCPCS C1713		76645520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645525	SUP	HCPCS C1713		76645525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645530	SUP	HCPCS C1713		76645530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645535	SUP	HCPCS C1713		76645535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645540	SUP	HCPCS C1713		76645540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645545	SUP	HCPCS C1713		76645545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645550	SUP	HCPCS C1713		76645550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645555	SUP	HCPCS C1713		76645555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76645560	SUP	HCPCS C1713		76645560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646025	SUP	HCPCS C1713		76646025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646030	SUP	HCPCS C1713		76646030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646035	SUP	HCPCS C1713		76646035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646040	SUP	HCPCS C1713		76646040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646045	SUP	HCPCS C1713		76646045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646050	SUP	HCPCS C1713		76646050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646055	SUP	HCPCS C1713		76646055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646060	SUP	HCPCS C1713		76646060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646065	SUP	HCPCS C1713		76646065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646070	SUP	HCPCS C1713		76646070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646075	SUP	HCPCS C1713		76646075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646525	SUP	HCPCS C1713		76646525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646530	SUP	HCPCS C1713		76646530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646535	SUP	HCPCS C1713		76646535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646540	SUP	HCPCS C1713		76646540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646545	SUP	HCPCS C1713		76646545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646550	SUP	HCPCS C1713		76646550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646555	SUP	HCPCS C1713		76646555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646560	SUP	HCPCS C1713		76646560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646565	SUP	HCPCS C1713		76646565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646570	SUP	HCPCS C1713		76646570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76646575	SUP	HCPCS C1713		76646575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76647525	SUP	HCPCS C1713		76647525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76647530	SUP	HCPCS C1713		76647530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76647535	SUP	HCPCS C1713		76647535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76647540	SUP	HCPCS C1713		76647540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76647545	SUP	HCPCS C1713		76647545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76647550	SUP	HCPCS C1713		76647550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76647555	SUP	HCPCS C1713		76647555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76647560	SUP	HCPCS C1713		76647560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76647565	SUP	HCPCS C1713		76647565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76647570	SUP	HCPCS C1713		76647570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76647575	SUP	HCPCS C1713		76647575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76648525	SUP	HCPCS C1713		76648525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76648530	SUP	HCPCS C1713		76648530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76648535	SUP	HCPCS C1713		76648535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76648540	SUP	HCPCS C1713		76648540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76648545	SUP	HCPCS C1713		76648545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76648550	SUP	HCPCS C1713		76648550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76648555	SUP	HCPCS C1713		76648555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76648560	SUP	HCPCS C1713		76648560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76648565	SUP	HCPCS C1713		76648565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76648570	SUP	HCPCS C1713		76648570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76648575	SUP	HCPCS C1713		76648575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76694520	SUP	HCPCS C1713		76694520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76694525	SUP	HCPCS C1713		76694525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76694530	SUP	HCPCS C1713		76694530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76694535	SUP	HCPCS C1713		76694535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76694540	SUP	HCPCS C1713		76694540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76694545	SUP	HCPCS C1713		76694545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76694550	SUP	HCPCS C1713		76694550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695020	SUP	HCPCS C1713		76695020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695025	SUP	HCPCS C1713		76695025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695030	SUP	HCPCS C1713		76695030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695035	SUP	HCPCS C1713		76695035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695040	SUP	HCPCS C1713		76695040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695045	SUP	HCPCS C1713		76695045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695050	SUP	HCPCS C1713		76695050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695520	SUP	HCPCS C1713		76695520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695525	SUP	HCPCS C1713		76695525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695530	SUP	HCPCS C1713		76695530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695535	SUP	HCPCS C1713		76695535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695540	SUP	HCPCS C1713		76695540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695545	SUP	HCPCS C1713		76695545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695550	SUP	HCPCS C1713		76695550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695555	SUP	HCPCS C1713		76695555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76695560	SUP	HCPCS C1713		76695560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76696525	SUP	HCPCS C1713		76696525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76696530	SUP	HCPCS C1713		76696530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76696535	SUP	HCPCS C1713		76696535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76696540	SUP	HCPCS C1713		76696540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76696545	SUP	HCPCS C1713		76696545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76696550	SUP	HCPCS C1713		76696550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76696555	SUP	HCPCS C1713		76696555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76696560	SUP	HCPCS C1713		76696560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76696565	SUP	HCPCS C1713		76696565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76696570	SUP	HCPCS C1713		76696570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76696575	SUP	HCPCS C1713		76696575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76697525	SUP	HCPCS C1713		76697525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76697530	SUP	HCPCS C1713		76697530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76697535	SUP	HCPCS C1713		76697535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76697540	SUP	HCPCS C1713		76697540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76697545	SUP	HCPCS C1713		76697545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76697550	SUP	HCPCS C1713		76697550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76697555	SUP	HCPCS C1713		76697555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76697560	SUP	HCPCS C1713		76697560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76697565	SUP	HCPCS C1713		76697565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76697570	SUP	HCPCS C1713		76697570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76697575	SUP	HCPCS C1713		76697575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76698525	SUP	HCPCS C1713		76698525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76698530	SUP	HCPCS C1713		76698530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76698535	SUP	HCPCS C1713		76698535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76698540	SUP	HCPCS C1713		76698540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76698545	SUP	HCPCS C1713		76698545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76698550	SUP	HCPCS C1713		76698550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76698555	SUP	HCPCS C1713		76698555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76698560	SUP	HCPCS C1713		76698560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76698565	SUP	HCPCS C1713		76698565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76698570	SUP	HCPCS C1713		76698570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
76698575	SUP	HCPCS C1713		76698575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
77101050	SUP	HCPCS C1762		77101050  -  GRAFT SFT TIS ALGRF	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77101054	SUP	Custom 27803010		77101054  -  SPACER CMNT 4D 14X12X5MM CERV SPNL BONE PLUG	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	$0.00	$0.00	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77101060	SUP	HCPCS C1713		77101060  -  SPACER ALGRF 0D 14X12X6MM BIO AVS OPN PLG CRV	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
77101064	SUP	Custom 27803010		77101064  -  SPACER CMNT 4D 14X12X6MM CERV SPNL BONE PLUG	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	$0.00	$0.00	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77101070	SUP	HCPCS C1713		77101070  -  PLATE 0D 8MM HOLE BONE CERV	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
77101074	SUP	HCPCS C1713		77101074  -  PLATE 4D 7IN HOLE BONE CERV SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
77101080	SUP	HCPCS C1713		77101080  -  PLATE 0D 7MM HOLE BONE CERV	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
77101084	SUP	HCPCS C1713		77101084  -  SCREW BONE 8MM 14MM 12MM SPNL WDG	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
77101090	SUP	HCPCS C1713		77101090  -  PLATE 0D 9MM HOLE BONE CERV	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
77101094	SUP	HCPCS C1713		77101094  -  SPACER ALGRF 4D 14X12X9MM BIO AVS OPN PLG CRV	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
77101100	SUP	Custom 27803010		77101100  -  SPACER SPNL 14X12X10MM AVS 0D CAGE BIO	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	$0.00	$0.00	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77102050	SUP	HCPCS C1713		77102050  -  PLATE 0D 14X12IN N LORD CCANC 5 HOLE BONE	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
77102054	SUP	Custom 27803010		77102054  -  SPACER SPNL 5MM AVS 4D BONE PLUG BABSR	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	$0.00	$0.00	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77102060	SUP	HCPCS C1713		77102060  -  PLATE 0D 14X12IN N LORD CCANC 6 HOLE BONE	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
77102064	SUP	Custom 27803010		77102064  -  SPACER SPNL 6MM AVS 4D BONE PLUG BABSR	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	$0.00	$0.00	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77102070	SUP	HCPCS C1713		77102070  -  PLATE 0D 14X12IN N LORD CCANC 7 HOLE BONE	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
77102074	SUP	Custom 27803010		77102074  -  SPACER SPNL 7MM AVS 4D BONE PLUG BABSR	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	$0.00	$0.00	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77102084	SUP	Custom 27803010		77102084  -  SPACER SPNL 8MM AVS 4D BONE PLUG BABSR	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	$0.00	$0.00	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77102090	SUP	HCPCS C1713		77102090  -  PLATE 0D 14X12IN N LORD CCANC 9 HOLE BONE	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
77102094	SUP	Custom 27803010		77102094  -  SPACER ALGRF 4D LORDOSIS 12MM 14X9MM BIO AVS PRESERVON FRZDR	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	$0.00	$0.00	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77102100	SUP	Custom 27803010		77102100  -  SPACER ALGRF 4D 14X12X10MM BIO AVS OPN PLG CRV	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	$0.00	$0.00	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77102104	SUP	HCPCS C1713		77102104  -  SPACER ALGRF 4D LORDOSIS 12MM 14X10MM BIO AVS FRZDR C PLG 1	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	"$3,003.75"	"$3,003.75"	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	"$1,062.66"	$0.00	$0.00	$0.00	$0.00	$0.00
77562815	SUP	Custom 27203010		77562815  -  BIT DRILL FLEXIBLE 3.2MM	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$0.00	$0.00	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77805200	SUP	HCPCS C1887		CATHETER GUID XB3 CURVE 7FR .078IN 100CM PTFE VSBR BLUE YLW	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
77805500	SUP	HCPCS C1887		CATHETER GUID XB3.5 CURVE 7FR .078IN 100CM SH PTFE VSBR BLUE	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
77805600	SUP	HCPCS C1887		CATHETER GUID XB4 CURVE 7FR .078IN 100CM PTFE VSBR BLUE YLW	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
77827100	SUP	HCPCS C1887		CATHETER GUID MPA1 CURVE 7FR .078IN 100CM SH PTFE VSBR BLUE	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
80008455	SUP	HCPCS C1892		612603 - INTRODUCER SHTH 7FR 19CM 16CM TRAW ADPR DILAT SET INDN SPNLK	BOTH IP/OP	$69.35 	$51.32	$0.00	$55.48	$37.66	$37.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.68	$54.93	$55.48	$0.00		$0.00	$10.85	$0.00	$0.00	$11.04	$0.00	$0.00	$0.00	$0.00	$0.00
80100100	SUP	HCPCS C1769		80100100  -  GUIDEWIRE ORTH .045IN	BOTH IP/OP	$37.50 	$27.75	$0.00	$30.00	$20.36	$20.36	$0.00	$0.00	$0.00	$7.82	$27.83	$27.83	$0.00	$0.00	$7.82	$0.00	$22.18	$22.18	$0.00	$18.75	$29.70	$30.00	$0.00		$0.00	$5.87	$0.00	$0.00	$5.97	$0.00	$0.00	$0.00	$0.00	$0.00
80100101	SUP	HCPCS C1769		80100101  -  GUIDEWIRE SRG .035IN	BOTH IP/OP	$37.50 	$27.75	$0.00	$30.00	$20.36	$20.36	$0.00	$0.00	$0.00	$7.82	$27.83	$27.83	$0.00	$0.00	$7.82	$0.00	$22.18	$22.18	$0.00	$18.75	$29.70	$30.00	$0.00		$0.00	$5.87	$0.00	$0.00	$5.97	$0.00	$0.00	$0.00	$0.00	$0.00
80100102	SUP	Custom 27203010		80100102  -  WIRE FX .035IN 7IN KRSH STRG	BOTH IP/OP	$37.50 	$27.75	$0.00	$30.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.83	$27.83	$0.00	$0.00	$7.82	$0.00	$0.00	$0.00	$0.00	$18.75	$29.70	$30.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80100103	SUP	Custom 27203010		80100103  -  WIRE FX .035IN KRSH BIOTRACK	BOTH IP/OP	$37.50 	$27.75	$0.00	$30.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.83	$27.83	$0.00	$0.00	$7.82	$0.00	$0.00	$0.00	$0.00	$18.75	$29.70	$30.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80100125	SUP	Custom 27203010		80100125  -  HANDLE QRLSE SCRDRVR NONSTRL	BOTH IP/OP	$730.00 	$540.20	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.81	$541.81	$0.00	$0.00	$152.13	$0.00	$0.00	$0.00	$0.00	$365.00	$578.16	$584.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80200102	SUP	HCPCS C1713		80200102  -  PIN FIX 203MM 4.8MM RUSH A IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80200103	SUP	HCPCS C1713		80200103  -  PIN FIX 222MM 4.8MM RUSH B IM SS NONSTRL	BOTH IP/OP	"$1,183.00 "	$875.42	$0.00	$946.40	$642.37	$642.37	$0.00	$0.00	$0.00	$246.57	$878.02	$878.02	$844.31	$0.00	$246.54	$0.00	$117.12	$117.12	$0.00	$591.50	$156.82	$946.40	$0.00		$0.00	$185.14	$0.00	$0.00	$188.33	$0.00	$0.00	$0.00	$0.00	$0.00
80200104	SUP	HCPCS C1713		80200104  -  PIN FIX 241MM 4.8MM RUSH C IM SS NONSTRL	BOTH IP/OP	$163.00 	$120.62	$0.00	$156.82	$88.51	$88.51	$0.00	$0.00	$0.00	$33.97	$120.98	$120.98	$116.33	$0.00	$33.97	$0.00	$117.12	$117.12	$0.00	$81.50	$156.82	$130.40	$0.00		$0.00	$25.51	$0.00	$0.00	$25.95	$0.00	$0.00	$0.00	$0.00	$0.00
80200105	SUP	HCPCS C1713		80200105  -  PIN FIX 260MM 4.8MM RUSH D IM SS NONSTRL	BOTH IP/OP	$88.00 	$65.12	$0.00	$156.82	$47.78	$47.78	$0.00	$0.00	$0.00	$18.34	$65.31	$65.31	$62.81	$0.00	$18.34	$0.00	$117.12	$117.12	$0.00	$44.00	$156.82	$70.40	$0.00		$0.00	$13.77	$0.00	$0.00	$14.01	$0.00	$0.00	$0.00	$0.00	$0.00
80200106	SUP	HCPCS C1713		80200106  -  PIN FIX 279MM 4.8MM RUSH E IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80200107	SUP	HCPCS C1713		80200107  -  PIN FIX 298MM 4.8MM RUSH F IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80200108	SUP	HCPCS C1713		80200108  -  PIN FIX 318MM 4.8MM RUSH G IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80200109	SUP	HCPCS C1713		80200109  -  PIN FIX 337MM 4.8MM RUSH H IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80200110	SUP	HCPCS C1713		80200110  -  PIN FIX 35.6CM 4.8MM RUSH I IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80200111	SUP	HCPCS C1713		80200111  -  PIN FIX 18.4CM 4.8MM RUSH A1 IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80200112	SUP	HCPCS C1713		80200112  -  PIN FIX 37.5CM 4.8MM RUSH J IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80200113	SUP	HCPCS C1713		80200113  -  PIN FIX 39.4CM 4.8MM RUSH K IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80200114	SUP	HCPCS C1713		80200114  -  PIN FIX 41.3CM 4.8MM RUSH L IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80200115	SUP	HCPCS C1713		80200115  -  PIN FIX 43.2CM 4.8MM RUSH M IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80200116	SUP	HCPCS C1713		80200116  -  PIN FIX 45.1CM 4.8MM RUSH N IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80200117	SUP	HCPCS C1713		80200117  -  PIN FIX 47CM 4.8MM RUSH O IM SS NONSTRL	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$89.10	$89.10	$0.00	$0.00	$0.00	$41.27	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$117.12	$117.12	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
80202700	SUP	HCPCS C1713		80202700  -  SET TRAUMA FIX 4.8MM RACK RUSH NONSTRL	BOTH IP/OP	"$7,028.00 "	"$5,200.72"	$0.00	"$5,622.40"	"$3,162.60"	"$3,162.60"	$0.00	$0.00	$0.00	"$1,464.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,464.64"	$0.00	"$3,464.80"	"$3,464.80"	$0.00	"$3,514.00"	"$5,566.18"	"$5,622.40"	$0.00		$0.00	"$1,099.88"	$0.00	$0.00	"$1,118.86"	$0.00	$0.00	$0.00	$0.00	$0.00
80300102	SUP	HCPCS C1713		80300102  -  PIN FIX 102MM 3.2MM RUSH IM	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300103	SUP	HCPCS C1713		80300103  -  PIN FX 1/8IN 4.5IN RUSH MDLRY	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300104	SUP	HCPCS C1713		80300104  -  PIN FIX 127MM 3.2MM RUSH C IM SS NONSTRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300105	SUP	HCPCS C1713		80300105  -  PIN FIX 140MM 3.2MM RUSH D IM SS NONSTRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300106	SUP	HCPCS C1713		80300106  -  PIN FIX 152MM 3.2MM RUSH E IM SS NONSTRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300107	SUP	HCPCS C1713		80300107  -  PIN FIX 165MM 3.2MM RUSH F IM SS NONSTRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300108	SUP	HCPCS C1713		80300108  -  PIN FIX 178MM 3.2MM RUSH G IM SS NONSTRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300109	SUP	HCPCS C1713		80300109  -  PIN FIX 191MM 3.2MM RUSH H IM SS NONSTRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300110	SUP	HCPCS C1713		80300110  -  PIN FIX 203MM 3.2MM RUSH I IM SS NONSTRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300111	SUP	HCPCS C1713		80300111  -  PIN FIX 216MM 3.2MM RUSH J IM SS NONSTRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300112	SUP	HCPCS C1713		80300112  -  PIN FIX 229MM 3.2MM RUSH K IM SS NONSTRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300113	SUP	HCPCS C1713		80300113  -  PIN FIX 241MM 3.2MM RUSH L IM SS NONSTRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300114	SUP	HCPCS C1713		80300114  -  PIN FIX 254MM 3.2MM RUSH M IM SS NONSTRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80300120	SUP	HCPCS C1713		80300120  -  PIN FIX 267MM 3.2MM RUSH N IM SS NONSTRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$134.64	$75.74	$75.74	$0.00	$0.00	$0.00	$35.08	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$99.55	$99.55	$0.00	$84.15	$133.29	$134.64	$0.00		$0.00	$26.34	$0.00	$0.00	$26.79	$0.00	$0.00	$0.00	$0.00	$0.00
80302700	SUP	HCPCS C1713		80302700  -  SET TRAUMA FIX 3.2MM RACK RUSH NONSTRL	BOTH IP/OP	"$5,604.00 "	"$4,146.96"	$0.00	"$4,483.20"	"$2,521.80"	"$2,521.80"	$0.00	$0.00	$0.00	"$1,168.01"	"$4,159.29"	"$4,159.29"	$0.00	$0.00	"$1,167.87"	$0.00	"$2,762.77"	"$2,762.77"	$0.00	"$2,802.00"	"$4,438.37"	"$4,483.20"	$0.00		$0.00	$877.03	$0.00	$0.00	$892.16	$0.00	$0.00	$0.00	$0.00	$0.00
80322944	SUP	HCPCS C1713		186801020  -  PLATE BN 20MM NS SKYLINE 1 LVL SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
80400102	SUP	HCPCS C1713		80400102  -  PIN FIX 2.5CM 2.4MM RUSH A IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80400103	SUP	HCPCS C1713		80400103  -  PIN FIX 3.2CM 2.4MM RUSH B IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80400104	SUP	HCPCS C1713		80400104  -  PIN FIX 3.8CM 2.4MM RUSH C IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80400105	SUP	HCPCS C1713		80400105  -  PIN FIX 4.5CM 2.4MM RUSH D IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80400106	SUP	HCPCS C1713		80400106  -  PIN FIX 5.1CM 2.4MM RUSH E IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80400107	SUP	HCPCS C1713		80400107  -  PIN FIX 5.7CM 2.4MM RUSH F IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80400108	SUP	HCPCS C1713		80400108  -  PIN FIX 6.4CM 2.4MM RUSH G IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80400109	SUP	HCPCS C1713		80400109  -  PIN FIX 7CM 2.4MM RUSH H IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80400110	SUP	HCPCS C1713		80400110  -  PIN FIX 7.6CM 2.4MM RUSH I IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80400111	SUP	HCPCS C1713		80400111  -  PIN FIX 8.3CM 2.4MM RUSH J IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80400112	SUP	HCPCS C1713		80400112  -  PIN FIX 8.9CM 2.4MM RUSH K IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80400113	SUP	HCPCS C1713		80400113  -  PIN FIX 9.5CM 2.4MM RUSH L IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80400114	SUP	HCPCS C1713		80400114  -  PIN FIX 10.2CM 2.4MM RUSH M IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80402700	SUP	HCPCS C1713		80402700  -  SET TRAUMA FIX 2.4MM RACK RUSH NONSTRL	BOTH IP/OP	"$8,110.00 "	"$6,001.40"	$0.00	"$6,488.00"	"$3,649.50"	"$3,649.50"	$0.00	$0.00	$0.00	"$1,690.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,690.12"	$0.00	"$3,998.23"	"$3,998.23"	$0.00	"$4,055.00"	"$6,423.12"	"$6,488.00"	$0.00		$0.00	"$1,269.22"	$0.00	$0.00	"$1,291.11"	$0.00	$0.00	$0.00	$0.00	$0.00
80600103	SUP	HCPCS C1713		80600103  -  PIN FIX 11.4CM 2.4MM RUSH N LNG IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80600104	SUP	HCPCS C1713		80600104  -  PIN FIX 12.7CM 2.4MM RUSH O LNG IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80600105	SUP	HCPCS C1713		80600105  -  PIN FIX 14CM 2.4MM RUSH P LNG IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80600106	SUP	HCPCS C1713		80600106  -  PIN FIX 15.2CM 2.4MM RUSH Q LNG IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80600107	SUP	HCPCS C1713		80600107  -  PIN FIX 16.5CM 2.4MM RUSH R LNG IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80600108	SUP	HCPCS C1713		80600108  -  PIN FIX 17.8CM 2.4MM RUSH S LNG IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80600109	SUP	HCPCS C1713		80600109  -  PIN 19.1CM 2.4MM RUSH T LNG IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80600110	SUP	HCPCS C1713		80600110  -  PIN FIX 20.3CM 2.4MM RUSH U LNG IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80600111	SUP	HCPCS C1713		80600111  -  PIN FIX 21.6CM 2.4MM RUSH V LNG IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80600112	SUP	HCPCS C1713		80600112  -  PIN FIX 22.9CM 2.4MM RUSH W LNG IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80600113	SUP	HCPCS C1713		80600113  -  PIN FIX 24.1CM 2.4MM RUSH X LNG IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
80600114	SUP	HCPCS C1713		80600114  -  PIN FIX 25.4CM 2.4MM RUSH Y LNG IM SS NONSTRL	BOTH IP/OP	$150.70 	$111.52	$0.00	$120.56	$67.82	$67.82	$0.00	$0.00	$0.00	$31.41	$111.85	$111.85	$0.00	$0.00	$31.41	$0.00	$89.14	$89.14	$0.00	$75.35	$119.35	$120.56	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
83545201	SUP	HCPCS C1713		83545201  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545251	SUP	HCPCS C1713		83545251  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545301	SUP	HCPCS C1713		83545301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545306	SUP	HCPCS C1713		83545306  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83545309	SUP	HCPCS C1713		83545309  -  SCREW BN 4.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545351	SUP	HCPCS C1713		83545351  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545356	SUP	HCPCS C1713		83545356  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83545359	SUP	HCPCS C1713		83545359  -  SCREW BN 4.5MM 35MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545401	SUP	HCPCS C1713		83545401  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545406	SUP	HCPCS C1713		83545406  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83545409	SUP	HCPCS C1713		83545409  -  SCREW BN 4.5MM 40MM 3DX TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545451	SUP	HCPCS C1713		83545451  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545456	SUP	HCPCS C1713		83545456  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83545459	SUP	HCPCS C1713		83545459  -  SCREW BN 4.5MM 45MM TSRH OSTEOGRIP THNLN SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545501	SUP	HCPCS C1713		83545501  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545506	SUP	HCPCS C1713		83545506  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83545509	SUP	HCPCS C1713		83545509  -  SCREW BN 4.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545551	SUP	HCPCS C1713		83545551  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545556	SUP	HCPCS C1713		83545556  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83545559	SUP	HCPCS C1713		83545559  -  SCREW BN 4.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545601	SUP	HCPCS C1713		83545601  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83545606	SUP	HCPCS C1713		83545606  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83545609	SUP	HCPCS C1713		83545609  -  SCREW BN 4.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555201	SUP	HCPCS C1713		83555201  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555251	SUP	HCPCS C1713		83555251  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555301	SUP	HCPCS C1713		83555301  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555306	SUP	HCPCS C1713		83555306  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83555307	SUP	HCPCS C1713		83555307  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83555308	SUP	HCPCS C1713		83555308  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83555309	SUP	HCPCS C1713		83555309  -  SCREW BN 5.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555351	SUP	HCPCS C1713		83555351  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555356	SUP	HCPCS C1713		83555356  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83555357	SUP	HCPCS C1713		83555357  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83555358	SUP	HCPCS C1713		83555358  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83555359	SUP	HCPCS C1713		83555359  -  SCREW BN 5.5MM 35MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555401	SUP	HCPCS C1713		83555401  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555406	SUP	HCPCS C1713		83555406  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83555407	SUP	HCPCS C1713		83555407  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83555408	SUP	HCPCS C1713		83555408  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83555409	SUP	HCPCS C1713		83555409  -  SCREW BN 5.5MM 40MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555451	SUP	HCPCS C1713		83555451  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555456	SUP	HCPCS C1713		83555456  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83555457	SUP	HCPCS C1713		83555457  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83555458	SUP	HCPCS C1713		83555458  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83555459	SUP	HCPCS C1713		83555459  -  SCREW BN 5.5MM 45MM TSRH THNLN OSTEOGRIP SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555501	SUP	HCPCS C1713		83555501  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555506	SUP	HCPCS C1713		83555506  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83555507	SUP	HCPCS C1713		83555507  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83555508	SUP	HCPCS C1713		83555508  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83555509	SUP	HCPCS C1713		83555509  -  SCREW BN 5.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555551	SUP	HCPCS C1713		83555551  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555556	SUP	HCPCS C1713		83555556  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83555557	SUP	HCPCS C1713		83555557  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83555559	SUP	HCPCS C1713		83555559  -  SCREW BN 5.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555601	SUP	HCPCS C1713		83555601  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83555606	SUP	HCPCS C1713		83555606  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83555607	SUP	HCPCS C1713		83555607  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83555608	SUP	HCPCS C1713		83555608  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83555609	SUP	HCPCS C1713		83555609  -  SCREW BN 5.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565201	SUP	HCPCS C1713		83565201  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565251	SUP	HCPCS C1713		83565251  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565259	SUP	HCPCS C1713		83565259  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565301	SUP	HCPCS C1713		83565301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565306	SUP	HCPCS C1713		83565306  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83565307	SUP	HCPCS C1713		83565307  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83565308	SUP	HCPCS C1713		83565308  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83565309	SUP	HCPCS C1713		83565309  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565351	SUP	HCPCS C1713		83565351  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565356	SUP	HCPCS C1713		83565356  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83565357	SUP	HCPCS C1713		83565357  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83565358	SUP	HCPCS C1713		83565358  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83565359	SUP	HCPCS C1713		83565359  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565401	SUP	HCPCS C1713		83565401  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565406	SUP	HCPCS C1713		83565406  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83565407	SUP	HCPCS C1713		83565407  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83565408	SUP	HCPCS C1713		83565408  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83565409	SUP	HCPCS C1713		83565409  -  SCREW BN 6.5MM 40MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565451	SUP	HCPCS C1713		83565451  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565454	SUP	HCPCS C1713		83565454  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83565456	SUP	HCPCS C1713		83565456  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83565457	SUP	HCPCS C1713		83565457  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83565458	SUP	HCPCS C1713		83565458  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83565459	SUP	HCPCS C1713		83565459  -  SCREW BN 6.5MM 45MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565501	SUP	HCPCS C1713		83565501  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565504	SUP	HCPCS C1713		83565504  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83565506	SUP	HCPCS C1713		83565506  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83565507	SUP	HCPCS C1713		83565507  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83565508	SUP	HCPCS C1713		83565508  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83565509	SUP	HCPCS C1713		83565509  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565551	SUP	HCPCS C1713		83565551  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565554	SUP	HCPCS C1713		83565554  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83565556	SUP	HCPCS C1713		83565556  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83565557	SUP	HCPCS C1713		83565557  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83565558	SUP	HCPCS C1713		83565558  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83565559	SUP	HCPCS C1713		83565559  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565601	SUP	HCPCS C1713		83565601  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83565606	SUP	HCPCS C1713		83565606  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83565607	SUP	HCPCS C1713		83565607  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83565608	SUP	HCPCS C1713		83565608  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83565609	SUP	HCPCS C1713		83565609  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575201	SUP	HCPCS C1713		83575201  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575251	SUP	HCPCS C1713		83575251  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575301	SUP	HCPCS C1713		83575301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575306	SUP	HCPCS C1713		83575306  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83575307	SUP	HCPCS C1713		83575307  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83575308	SUP	HCPCS C1713		83575308  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83575309	SUP	HCPCS C1713		83575309  -  SCREW BN 7.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575351	SUP	HCPCS C1713		83575351  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575356	SUP	HCPCS C1713		83575356  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83575357	SUP	HCPCS C1713		83575357  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83575358	SUP	HCPCS C1713		83575358  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83575359	SUP	HCPCS C1713		83575359  -  SCREW BN 7.5MM 35MM TSRH OSTEOGRIP RECON TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575401	SUP	HCPCS C1713		83575401  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575406	SUP	HCPCS C1713		83575406  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83575407	SUP	HCPCS C1713		83575407  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83575408	SUP	HCPCS C1713		83575408  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83575409	SUP	HCPCS C1713		83575409  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575451	SUP	HCPCS C1713		83575451  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575456	SUP	HCPCS C1713		83575456  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83575457	SUP	HCPCS C1713		83575457  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83575458	SUP	HCPCS C1713		83575458  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83575459	SUP	HCPCS C1713		83575459  -  SCREW BN 7.5MM 45MM TSRH OSTEOGRIP THNLN TI SPNE PDCL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575501	SUP	HCPCS C1713		83575501  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575506	SUP	HCPCS C1713		83575506  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83575507	SUP	HCPCS C1713		83575507  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83575508	SUP	HCPCS C1713		83575508  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83575509	SUP	HCPCS C1713		83575509  -  SCREW BN 7.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575551	SUP	HCPCS C1713		83575551  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575556	SUP	HCPCS C1713		83575556  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83575557	SUP	HCPCS C1713		83575557  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83575558	SUP	HCPCS C1713		83575558  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83575559	SUP	HCPCS C1713		83575559  -  SCREW BN 7.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575601	SUP	HCPCS C1713		83575601  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83575606	SUP	HCPCS C1713		83575606  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83575607	SUP	HCPCS C1713		83575607  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83575608	SUP	HCPCS C1713		83575608  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
83575609	SUP	HCPCS C1713		83575609  -  SCREW BN 7.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585201	SUP	HCPCS C1713		83585201  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585251	SUP	HCPCS C1713		83585251  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585301	SUP	HCPCS C1713		83585301  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585306	SUP	HCPCS C1713		83585306  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83585307	SUP	HCPCS C1713		83585307  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83585309	SUP	HCPCS C1713		83585309  -  SCREW BN 8.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE PDCL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585351	SUP	HCPCS C1713		83585351  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585356	SUP	HCPCS C1713		83585356  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83585357	SUP	HCPCS C1713		83585357  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83585359	SUP	HCPCS C1713		83585359  -  SCREW BN 8.5MM 35MM TSRH OSTEOGRIP THNLN SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585401	SUP	HCPCS C1713		83585401  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585406	SUP	HCPCS C1713		83585406  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83585407	SUP	HCPCS C1713		83585407  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83585409	SUP	HCPCS C1713		83585409  -  SCREW BN 8.5MM 40MM TSRH OSTEOGRIP THNLN SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585451	SUP	HCPCS C1713		83585451  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585456	SUP	HCPCS C1713		83585456  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83585457	SUP	HCPCS C1713		83585457  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83585459	SUP	HCPCS C1713		83585459  -  SCREW BN 8.5MM 45MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585501	SUP	HCPCS C1713		83585501  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585506	SUP	HCPCS C1713		83585506  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83585507	SUP	HCPCS C1713		83585507  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83585509	SUP	HCPCS C1713		83585509  -  SCREW BN 8.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585551	SUP	HCPCS C1713		83585551  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585556	SUP	HCPCS C1713		83585556  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83585557	SUP	HCPCS C1713		83585557  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83585559	SUP	HCPCS C1713		83585559  -  SCREW BN 8.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585601	SUP	HCPCS C1713		83585601  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
83585606	SUP	HCPCS C1713		83585606  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$742.50	$742.50	$0.00	$0.00	$0.00	$343.90	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$975.98	$975.98	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$258.23	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
83585607	SUP	HCPCS C1713		83585607  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$810.00	$810.00	$0.00	$0.00	$0.00	$375.17	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	"$1,064.70"	"$1,064.70"	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$281.70	$0.00	$0.00	$286.56	$0.00	$0.00	$0.00	$0.00	$0.00
83585609	SUP	HCPCS C1713		83585609  -  SCREW BN 8.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$1,072.50 "	$793.65	$0.00	$858.00	$482.63	$482.63	$0.00	$0.00	$0.00	$223.54	$796.01	$796.01	$0.00	$0.00	$223.51	$0.00	$634.38	$634.38	$0.00	$536.25	$849.42	$858.00	$0.00		$0.00	$167.85	$0.00	$0.00	$170.74	$0.00	$0.00	$0.00	$0.00	$0.00
86944520	SUP	HCPCS C1713		86944520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86944525	SUP	HCPCS C1713		86944525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86944530	SUP	HCPCS C1713		86944530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86944535	SUP	HCPCS C1713		86944535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86944540	SUP	HCPCS C1713		86944540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86944545	SUP	HCPCS C1713		86944545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86944550	SUP	HCPCS C1713		86944550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945020	SUP	HCPCS C1713		86945020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945025	SUP	HCPCS C1713		86945025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945030	SUP	HCPCS C1713		86945030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945035	SUP	HCPCS C1713		86945035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945040	SUP	HCPCS C1713		86945040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945045	SUP	HCPCS C1713		86945045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945050	SUP	HCPCS C1713		86945050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945520	SUP	HCPCS C1713		86945520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945525	SUP	HCPCS C1713		86945525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945530	SUP	HCPCS C1713		86945530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945535	SUP	HCPCS C1713		86945535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945540	SUP	HCPCS C1713		86945540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945545	SUP	HCPCS C1713		86945545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945550	SUP	HCPCS C1713		86945550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945555	SUP	HCPCS C1713		86945555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945560	SUP	HCPCS C1713		86945560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86945565	SUP	HCPCS C1713		86945565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86946520	SUP	HCPCS C1713		86946520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86946530	SUP	HCPCS C1713		86946530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86946535	SUP	HCPCS C1713		86946535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86946540	SUP	HCPCS C1713		86946540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86946545	SUP	HCPCS C1713		86946545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86946550	SUP	HCPCS C1713		86946550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86946555	SUP	HCPCS C1713		86946555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86946560	SUP	HCPCS C1713		86946560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86946565	SUP	HCPCS C1713		86946565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86946570	SUP	HCPCS C1713		86946570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86946575	SUP	HCPCS C1713		86946575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86947520	SUP	HCPCS C1713		86947520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86947525	SUP	HCPCS C1713		86947525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86947530	SUP	HCPCS C1713		86947530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86947535	SUP	HCPCS C1713		86947535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86947540	SUP	HCPCS C1713		86947540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86947545	SUP	HCPCS C1713		86947545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86947550	SUP	HCPCS C1713		86947550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86947555	SUP	HCPCS C1713		86947555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86947560	SUP	HCPCS C1713		86947560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86947565	SUP	HCPCS C1713		86947565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86947570	SUP	HCPCS C1713		86947570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86947575	SUP	HCPCS C1713		86947575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86948520	SUP	HCPCS C1713		86948520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86948525	SUP	HCPCS C1713		86948525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86948530	SUP	HCPCS C1713		86948530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86948535	SUP	HCPCS C1713		86948535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86948540	SUP	HCPCS C1713		86948540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86948545	SUP	HCPCS C1713		86948545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86948550	SUP	HCPCS C1713		86948550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86948555	SUP	HCPCS C1713		86948555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86948560	SUP	HCPCS C1713		86948560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86948565	SUP	HCPCS C1713		86948565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86948570	SUP	HCPCS C1713		86948570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86948575	SUP	HCPCS C1713		86948575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992320	SUP	HCPCS C1713		86992320  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992325	SUP	HCPCS C1713		86992325  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992330	SUP	HCPCS C1713		86992330  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992335	SUP	HCPCS C1713		86992335  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992340	SUP	HCPCS C1713		86992340  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992345	SUP	HCPCS C1713		86992345  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992350	SUP	HCPCS C1713		86992350  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992420	SUP	HCPCS C1713		86992420  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992425	SUP	HCPCS C1713		86992425  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992430	SUP	HCPCS C1713		86992430  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992435	SUP	HCPCS C1713		86992435  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992440	SUP	HCPCS C1713		86992440  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992445	SUP	HCPCS C1713		86992445  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992450	SUP	HCPCS C1713		86992450  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992525	SUP	HCPCS C1713		86992525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992530	SUP	HCPCS C1713		86992530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992535	SUP	HCPCS C1713		86992535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992540	SUP	HCPCS C1713		86992540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992545	SUP	HCPCS C1713		86992545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992550	SUP	HCPCS C1713		86992550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992555	SUP	HCPCS C1713		86992555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992625	SUP	HCPCS C1713		86992625  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992630	SUP	HCPCS C1713		86992630  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992635	SUP	HCPCS C1713		86992635  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992640	SUP	HCPCS C1713		86992640  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992645	SUP	HCPCS C1713		86992645  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992650	SUP	HCPCS C1713		86992650  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992655	SUP	HCPCS C1713		86992655  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992725	SUP	HCPCS C1713		86992725  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992730	SUP	HCPCS C1713		86992730  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992735	SUP	HCPCS C1713		86992735  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992740	SUP	HCPCS C1713		86992740  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992745	SUP	HCPCS C1713		86992745  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
86992750	SUP	HCPCS C1713		86992750  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88900101	SUP	HCPCS C1713		88900101  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900102	SUP	HCPCS C1713		88900102  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900105	SUP	HCPCS C1713		88900105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900107	SUP	HCPCS C1713		88900107  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900108	SUP	HCPCS C1713		88900108  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900109	SUP	HCPCS C1713		88900109  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900110	SUP	HCPCS C1713		88900110  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900111	SUP	HCPCS C1713		88900111  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900113	SUP	HCPCS C1713		88900113  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900114	SUP	HCPCS C1713		88900114  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900201	SUP	HCPCS C1713		88900201  -  HOOK SPNL TSRH SILO LT OFST TI LMR THOR 5.5 MM ROD	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900202	SUP	HCPCS C1713		88900202  -  HOOK SPNL TSRH SILO LT OFST TI LMR THOR 5.5 MM ROD	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900205	SUP	HCPCS C1713		88900205  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900207	SUP	HCPCS C1713		88900207  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900208	SUP	HCPCS C1713		88900208  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900209	SUP	HCPCS C1713		88900209  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900210	SUP	HCPCS C1713		88900210  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900211	SUP	HCPCS C1713		88900211  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900213	SUP	HCPCS C1713		88900213  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88900214	SUP	HCPCS C1713		88900214  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
88901000	SUP	HCPCS C1713		88901000  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
88905512	SUP	Custom 27803010		88905512  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88905522	SUP	Custom 27803010		88905522  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88905532	SUP	Custom 27803010		88905532  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88924520	SUP	HCPCS C1713		88924520  -  SCREW BN 4.5MM 20MM TSRH SILO FA TI SPNE 5.5MM ROD	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88924525	SUP	HCPCS C1713		88924525  -  SCREW BN 4.5MM 25MM TSRH SILO FA TI SPNE 5.5MM ROD	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88924530	SUP	HCPCS C1713		88924530  -  SCREW BN 4.5MM 30MM TSRH SILO FA TI SPNE 5.5MM ROD	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88924535	SUP	HCPCS C1713		88924535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88924540	SUP	HCPCS C1713		88924540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88924545	SUP	HCPCS C1713		88924545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88924550	SUP	HCPCS C1713		88924550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925025	SUP	HCPCS C1713		88925025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925030	SUP	HCPCS C1713		88925030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925035	SUP	HCPCS C1713		88925035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925040	SUP	HCPCS C1713		88925040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925045	SUP	HCPCS C1713		88925045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925050	SUP	HCPCS C1713		88925050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925055	SUP	HCPCS C1713		88925055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925525	SUP	HCPCS C1713		88925525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925530	SUP	HCPCS C1713		88925530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925535	SUP	HCPCS C1713		88925535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925540	SUP	HCPCS C1713		88925540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925545	SUP	HCPCS C1713		88925545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925550	SUP	HCPCS C1713		88925550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88925555	SUP	HCPCS C1713		88925555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88926525	SUP	HCPCS C1713		88926525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88926530	SUP	HCPCS C1713		88926530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88926535	SUP	HCPCS C1713		88926535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88926540	SUP	HCPCS C1713		88926540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88926545	SUP	HCPCS C1713		88926545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88926550	SUP	HCPCS C1713		88926550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88926555	SUP	HCPCS C1713		88926555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88926560	SUP	HCPCS C1713		88926560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88927530	SUP	HCPCS C1713		88927530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88927535	SUP	HCPCS C1713		88927535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88927540	SUP	HCPCS C1713		88927540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88927545	SUP	HCPCS C1713		88927545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88927550	SUP	HCPCS C1713		88927550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88927555	SUP	HCPCS C1713		88927555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88927560	SUP	HCPCS C1713		88927560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,906.50 "	"$1,410.81"	$0.00	"$1,525.20"	$857.93	$857.93	$0.00	$0.00	$0.00	$397.36	"$1,415.00"	"$1,415.00"	$0.00	$0.00	$397.31	$0.00	"$1,127.69"	"$1,127.69"	$0.00	$953.25	"$1,509.95"	"$1,525.20"	$0.00		$0.00	$298.37	$0.00	$0.00	$303.51	$0.00	$0.00	$0.00	$0.00	$0.00
88934520	SUP	Custom 27803010		88934520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88934525	SUP	Custom 27803010		88934525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88934530	SUP	HCPCS C1713		88934530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88934535	SUP	Custom 27803010		88934535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88935525	SUP	HCPCS C1713		88935525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88935530	SUP	HCPCS C1713		88935530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88935535	SUP	HCPCS C1713		88935535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88935540	SUP	HCPCS C1713		88935540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88935545	SUP	HCPCS C1713		88935545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88935550	SUP	HCPCS C1713		88935550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88935555	SUP	HCPCS C1713		88935555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88936525	SUP	HCPCS C1713		88936525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88936530	SUP	HCPCS C1713		88936530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88936535	SUP	HCPCS C1713		88936535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88936540	SUP	HCPCS C1713		88936540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88936545	SUP	HCPCS C1713		88936545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88936550	SUP	HCPCS C1713		88936550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88936555	SUP	HCPCS C1713		88936555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88936560	SUP	HCPCS C1713		88936560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88937525	SUP	HCPCS C1713		88937525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88937530	SUP	HCPCS C1713		88937530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88937535	SUP	HCPCS C1713		88937535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88937540	SUP	HCPCS C1713		88937540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88937545	SUP	HCPCS C1713		88937545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88937550	SUP	HCPCS C1713		88937550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88937555	SUP	HCPCS C1713		88937555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88937560	SUP	HCPCS C1713		88937560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
88944520	SUP	HCPCS C1713		88944520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88944525	SUP	HCPCS C1713		88944525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88944530	SUP	HCPCS C1713		88944530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88944535	SUP	HCPCS C1713		88944535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88944540	SUP	HCPCS C1713		88944540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88944545	SUP	HCPCS C1713		88944545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88944550	SUP	HCPCS C1713		88944550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945025	SUP	HCPCS C1713		88945025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945030	SUP	HCPCS C1713		88945030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945035	SUP	HCPCS C1713		88945035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945040	SUP	HCPCS C1713		88945040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945045	SUP	HCPCS C1713		88945045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945050	SUP	HCPCS C1713		88945050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945055	SUP	HCPCS C1713		88945055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945525	SUP	HCPCS C1713		88945525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945530	SUP	HCPCS C1713		88945530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945535	SUP	HCPCS C1713		88945535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945540	SUP	HCPCS C1713		88945540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945545	SUP	HCPCS C1713		88945545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945550	SUP	HCPCS C1713		88945550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88945555	SUP	HCPCS C1713		88945555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88946525	SUP	HCPCS C1713		88946525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88946530	SUP	HCPCS C1713		88946530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88946535	SUP	HCPCS C1713		88946535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88946540	SUP	HCPCS C1713		88946540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88946545	SUP	HCPCS C1713		88946545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88946550	SUP	HCPCS C1713		88946550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88946555	SUP	HCPCS C1713		88946555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88946560	SUP	HCPCS C1713		88946560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88947525	SUP	HCPCS C1713		88947525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88947530	SUP	HCPCS C1713		88947530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88947535	SUP	HCPCS C1713		88947535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88947540	SUP	HCPCS C1713		88947540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88947545	SUP	HCPCS C1713		88947545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88947550	SUP	HCPCS C1713		88947550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88947555	SUP	HCPCS C1713		88947555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88947560	SUP	HCPCS C1713		88947560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88947565	SUP	HCPCS C1713		88947565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
88947570	SUP	HCPCS C1713		88947570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,658.00 "	"$1,966.92"	$0.00	"$2,126.40"	"$1,196.10"	"$1,196.10"	$0.00	$0.00	$0.00	$553.99	"$1,972.77"	"$1,972.77"	$0.00	$0.00	$553.93	$0.00	"$1,310.39"	"$1,310.39"	$0.00	"$1,329.00"	"$2,105.14"	"$2,126.40"	$0.00		$0.00	$415.98	$0.00	$0.00	$423.15	$0.00	$0.00	$0.00	$0.00	$0.00
98716200	SUP	HCPCS C1713		98716200  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$880.50 	$651.57	$0.00	$704.40	$396.23	$396.23	$0.00	$0.00	$0.00	$183.52	$653.51	$653.51	$0.00	$0.00	$183.50	$0.00	$520.82	$520.82	$0.00	$440.25	$697.36	$704.40	$0.00		$0.00	$137.80	$0.00	$0.00	$140.18	$0.00	$0.00	$0.00	$0.00	$0.00
98716250	SUP	HCPCS C1713		98716250  -  SCREW BN 6.5MM 25MM PRMD VA TI SPNE ANT	BOTH IP/OP	$880.50 	$651.57	$0.00	$704.40	$396.23	$396.23	$0.00	$0.00	$0.00	$183.52	$653.51	$653.51	$0.00	$0.00	$183.50	$0.00	$520.82	$520.82	$0.00	$440.25	$697.36	$704.40	$0.00		$0.00	$137.80	$0.00	$0.00	$140.18	$0.00	$0.00	$0.00	$0.00	$0.00
98716300	SUP	HCPCS C1713		98716300  -  SCREW BN 6.5MM 30MM PRMD VA TI SPNE ANT	BOTH IP/OP	$880.50 	$651.57	$0.00	$704.40	$396.23	$396.23	$0.00	$0.00	$0.00	$183.52	$653.51	$653.51	$0.00	$0.00	$183.50	$0.00	$520.82	$520.82	$0.00	$440.25	$697.36	$704.40	$0.00		$0.00	$137.80	$0.00	$0.00	$140.18	$0.00	$0.00	$0.00	$0.00	$0.00
98716350	SUP	HCPCS C1713		98716350  -  SCREW BN 6.5MM 35MM PRMD VA TI SPNE ANT	BOTH IP/OP	$880.50 	$651.57	$0.00	$704.40	$396.23	$396.23	$0.00	$0.00	$0.00	$183.52	$653.51	$653.51	$0.00	$0.00	$183.50	$0.00	$520.82	$520.82	$0.00	$440.25	$697.36	$704.40	$0.00		$0.00	$137.80	$0.00	$0.00	$140.18	$0.00	$0.00	$0.00	$0.00	$0.00
99415530	SUP	HCPCS C1713		99415530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99415535	SUP	HCPCS C1713		99415535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99415540	SUP	HCPCS C1713		99415540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99415545	SUP	HCPCS C1713		99415545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99415550	SUP	HCPCS C1713		99415550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99415555	SUP	HCPCS C1713		99415555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99416530	SUP	HCPCS C1713		99416530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99416535	SUP	HCPCS C1713		99416535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99416540	SUP	HCPCS C1713		99416540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99416545	SUP	HCPCS C1713		99416545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99416550	SUP	HCPCS C1713		99416550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99417535	SUP	HCPCS C1713		99417535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99417540	SUP	HCPCS C1713		99417540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99417545	SUP	HCPCS C1713		99417545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99417550	SUP	HCPCS C1713		99417550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
99435530	SUP	Custom 27803010		99435530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99435535	SUP	Custom 27803010		99435535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99435540	SUP	Custom 27803010		99435540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99435545	SUP	Custom 27803010		99435545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99435550	SUP	Custom 27803010		99435550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99435555	SUP	Custom 27803010		99435555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99436530	SUP	Custom 27803010		99436530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99436535	SUP	Custom 27803010		99436535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99436540	SUP	Custom 27803010		99436540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99436545	SUP	Custom 27803010		99436545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99436550	SUP	Custom 27803010		99436550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99436555	SUP	Custom 27803010		99436555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99436560	SUP	Custom 27803010		99436560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99437535	SUP	Custom 27803010		99437535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99437540	SUP	HCPCS C1713		99437540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$741.15	$741.15	$0.00	$0.00	$0.00	$343.28	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$974.20	$974.20	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$257.76	$0.00	$0.00	$262.20	$0.00	$0.00	$0.00	$0.00	$0.00
99437545	SUP	HCPCS C1713		99437545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$741.15	$741.15	$0.00	$0.00	$0.00	$343.28	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$974.20	$974.20	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$257.76	$0.00	$0.00	$262.20	$0.00	$0.00	$0.00	$0.00	$0.00
99437550	SUP	Custom 27803010		99437550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99437555	SUP	Custom 27803010		99437555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99437560	SUP	Custom 27803010		99437560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,647.00 "	"$1,218.78"	$0.00	"$1,317.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.40"	"$1,222.40"	$0.00	$0.00	$343.23	$0.00	$0.00	$0.00	$0.00	$823.50	"$1,304.42"	"$1,317.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99453105	SUP	HCPCS C1713		99453105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
99453110	SUP	HCPCS C1713		99453110  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$201.00 	$148.74	$0.00	$160.80	$90.45	$90.45	$0.00	$0.00	$0.00	$41.89	$149.18	$149.18	$0.00	$0.00	$41.89	$0.00	$118.89	$118.89	$0.00	$100.50	$159.19	$160.80	$0.00		$0.00	$31.46	$0.00	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00
99453115	SUP	HCPCS C1713		99453115  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
99453200	SUP	Custom 27803010		99453200  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,596.43 "	"$1,181.36"	$0.00	"$1,277.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,184.87"	"$1,184.87"	$0.00	$0.00	$332.69	$0.00	$0.00	$0.00	$0.00	$798.21	"$1,264.37"	"$1,277.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99453201	SUP	Custom 27803010		99453201  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,596.43 "	"$1,181.36"	$0.00	"$1,277.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,184.87"	"$1,184.87"	$0.00	$0.00	$332.69	$0.00	$0.00	$0.00	$0.00	$798.21	"$1,264.37"	"$1,277.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99453202	SUP	Custom 27803010		99453202  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,596.43 "	"$1,181.36"	$0.00	"$1,277.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,184.87"	"$1,184.87"	$0.00	$0.00	$332.69	$0.00	$0.00	$0.00	$0.00	$798.21	"$1,264.37"	"$1,277.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99453301	SUP	HCPCS C1713		99453301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,596.43 "	"$1,181.36"	$0.00	"$1,277.14"	$718.39	$718.39	$0.00	$0.00	$0.00	$332.73	"$1,184.87"	"$1,184.87"	$0.00	$0.00	$332.69	$0.00	$944.29	$944.29	$0.00	$798.21	"$1,264.37"	"$1,277.14"	$0.00		$0.00	$249.84	$0.00	$0.00	$254.15	$0.00	$0.00	$0.00	$0.00	$0.00
99453302	SUP	Custom 27803010		99453302  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,596.43 "	"$1,181.36"	$0.00	"$1,277.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,184.87"	"$1,184.87"	$0.00	$0.00	$332.69	$0.00	$0.00	$0.00	$0.00	$798.21	"$1,264.37"	"$1,277.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99453305	SUP	Custom 27803010		99453305  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,596.43 "	"$1,181.36"	$0.00	"$1,277.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,184.87"	"$1,184.87"	$0.00	$0.00	$332.69	$0.00	$0.00	$0.00	$0.00	$798.21	"$1,264.37"	"$1,277.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99453306	SUP	Custom 27803010		99453306  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,596.43 "	"$1,181.36"	$0.00	"$1,277.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,184.87"	"$1,184.87"	$0.00	$0.00	$332.69	$0.00	$0.00	$0.00	$0.00	$798.21	"$1,264.37"	"$1,277.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99453501	SUP	Custom 27803010		99453501  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,183.50 "	$875.79	$0.00	$946.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$878.39	$878.39	$0.00	$0.00	$246.64	$0.00	$0.00	$0.00	$0.00	$591.75	$937.33	$946.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99453502	SUP	Custom 27803010		99453502  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,183.50 "	$875.79	$0.00	$946.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$878.39	$878.39	$0.00	$0.00	$246.64	$0.00	$0.00	$0.00	$0.00	$591.75	$937.33	$946.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99460035	SUP	HCPCS C1713		99460035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99460040	SUP	HCPCS C1713		99460040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99460045	SUP	HCPCS C1713		99460045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99460050	SUP	HCPCS C1713		99460050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99460055	SUP	HCPCS C1713		99460055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99460060	SUP	HCPCS C1713		99460060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99460065	SUP	HCPCS C1713		99460065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99460070	SUP	HCPCS C1713		99460070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99460075	SUP	HCPCS C1713		99460075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99460080	SUP	HCPCS C1713		99460080  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99461035	SUP	HCPCS C1713		99461035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99461040	SUP	HCPCS C1713		99461040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99461045	SUP	HCPCS C1713		99461045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99461050	SUP	HCPCS C1713		99461050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99461055	SUP	HCPCS C1713		99461055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99461060	SUP	HCPCS C1713		99461060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99461065	SUP	HCPCS C1713		99461065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99461070	SUP	HCPCS C1713		99461070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99461075	SUP	HCPCS C1713		99461075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99461080	SUP	HCPCS C1713		99461080  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99462040	SUP	HCPCS C1713		99462040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99462060	SUP	HCPCS C1713		99462060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99462080	SUP	HCPCS C1713		99462080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99464035	SUP	HCPCS C1713		99464035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	"$1,130.63"	"$1,130.63"	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$393.21	$0.00	$0.00	$399.99	$0.00	$0.00	$0.00	$0.00	$0.00
99464040	SUP	HCPCS C1713		99464040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	"$1,130.63"	"$1,130.63"	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$393.21	$0.00	$0.00	$399.99	$0.00	$0.00	$0.00	$0.00	$0.00
99464050	SUP	HCPCS C1713		99464050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	"$1,130.63"	"$1,130.63"	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$393.21	$0.00	$0.00	$399.99	$0.00	$0.00	$0.00	$0.00	$0.00
99464060	SUP	HCPCS C1713		99464060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	"$1,130.63"	"$1,130.63"	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$393.21	$0.00	$0.00	$399.99	$0.00	$0.00	$0.00	$0.00	$0.00
99464070	SUP	HCPCS C1713		99464070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	"$1,130.63"	"$1,130.63"	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$393.21	$0.00	$0.00	$399.99	$0.00	$0.00	$0.00	$0.00	$0.00
99465106	SUP	HCPCS C1713		99465106  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
99465115	SUP	Custom 27803010		99465115  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$192.00 	$142.08	$0.00	$153.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.50	$142.50	$0.00	$0.00	$40.01	$0.00	$0.00	$0.00	$0.00	$96.00	$152.06	$153.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99465126	SUP	HCPCS C1713		99465126  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
99465135	SUP	HCPCS C1713		99465135  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$109.50 	$81.03	$0.00	$87.60	$49.28	$49.28	$0.00	$0.00	$0.00	$22.82	$81.27	$81.27	$0.00	$0.00	$22.82	$0.00	$64.77	$64.77	$0.00	$54.75	$86.72	$87.60	$0.00		$0.00	$17.14	$0.00	$0.00	$17.43	$0.00	$0.00	$0.00	$0.00	$0.00
99465140	SUP	HCPCS C1713		99465140  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$192.00 	$142.08	$0.00	$153.60	$86.40	$86.40	$0.00	$0.00	$0.00	$40.02	$142.50	$142.50	$0.00	$0.00	$40.01	$0.00	$113.57	$113.57	$0.00	$96.00	$152.06	$153.60	$0.00		$0.00	$30.05	$0.00	$0.00	$30.57	$0.00	$0.00	$0.00	$0.00	$0.00
99466035	SUP	HCPCS C1713		99466035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	"$1,130.63"	"$1,130.63"	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$393.21	$0.00	$0.00	$399.99	$0.00	$0.00	$0.00	$0.00	$0.00
99466040	SUP	HCPCS C1713		99466040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	"$1,130.63"	"$1,130.63"	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$393.21	$0.00	$0.00	$399.99	$0.00	$0.00	$0.00	$0.00	$0.00
99466050	SUP	HCPCS C1713		99466050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	"$1,130.63"	"$1,130.63"	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$393.21	$0.00	$0.00	$399.99	$0.00	$0.00	$0.00	$0.00	$0.00
99466060	SUP	HCPCS C1713		99466060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	"$1,130.63"	"$1,130.63"	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$393.21	$0.00	$0.00	$399.99	$0.00	$0.00	$0.00	$0.00	$0.00
99466070	SUP	HCPCS C1713		99466070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	"$1,130.63"	"$1,130.63"	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$393.21	$0.00	$0.00	$399.99	$0.00	$0.00	$0.00	$0.00	$0.00
99467085	SUP	HCPCS C1713		99467085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99467090	SUP	HCPCS C1713		99467090  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99467095	SUP	HCPCS C1713		99467095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99467100	SUP	HCPCS C1713		99467100  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,425.50 "	"$1,794.87"	$0.00	"$1,940.40"	"$1,091.48"	"$1,091.48"	$0.00	$0.00	$0.00	$505.53	"$1,800.21"	"$1,800.21"	$0.00	$0.00	$505.47	$0.00	"$1,434.68"	"$1,434.68"	$0.00	"$1,212.75"	"$1,921.00"	"$1,940.40"	$0.00		$0.00	$379.59	$0.00	$0.00	$386.14	$0.00	$0.00	$0.00	$0.00	$0.00
99467105	SUP	HCPCS C1713		99467105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,425.50 "	"$1,794.87"	$0.00	"$1,940.40"	"$1,091.48"	"$1,091.48"	$0.00	$0.00	$0.00	$505.53	"$1,800.21"	"$1,800.21"	$0.00	$0.00	$505.47	$0.00	"$1,434.68"	"$1,434.68"	$0.00	"$1,212.75"	"$1,921.00"	"$1,940.40"	$0.00		$0.00	$379.59	$0.00	$0.00	$386.14	$0.00	$0.00	$0.00	$0.00	$0.00
99467110	SUP	HCPCS C1713		99467110  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,425.50 "	"$1,794.87"	$0.00	"$1,940.40"	"$1,091.48"	"$1,091.48"	$0.00	$0.00	$0.00	$505.53	"$1,800.21"	"$1,800.21"	$0.00	$0.00	$505.47	$0.00	"$1,434.68"	"$1,434.68"	$0.00	"$1,212.75"	"$1,921.00"	"$1,940.40"	$0.00		$0.00	$379.59	$0.00	$0.00	$386.14	$0.00	$0.00	$0.00	$0.00	$0.00
99467115	SUP	HCPCS C1713		99467115  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,425.50 "	"$1,794.87"	$0.00	"$1,940.40"	"$1,091.48"	"$1,091.48"	$0.00	$0.00	$0.00	$505.53	"$1,800.21"	"$1,800.21"	$0.00	$0.00	$505.47	$0.00	"$1,434.68"	"$1,434.68"	$0.00	"$1,212.75"	"$1,921.00"	"$1,940.40"	$0.00		$0.00	$379.59	$0.00	$0.00	$386.14	$0.00	$0.00	$0.00	$0.00	$0.00
99467120	SUP	HCPCS C1713		99467120  -  PLATE BN STRG 120MM TI SPNE	BOTH IP/OP	"$2,425.50 "	"$1,794.87"	$0.00	"$1,940.40"	"$1,091.48"	"$1,091.48"	$0.00	$0.00	$0.00	$505.53	"$1,800.21"	"$1,800.21"	$0.00	$0.00	$505.47	$0.00	"$1,434.68"	"$1,434.68"	$0.00	"$1,212.75"	"$1,921.00"	"$1,940.40"	$0.00		$0.00	$379.59	$0.00	$0.00	$386.14	$0.00	$0.00	$0.00	$0.00	$0.00
99467125	SUP	HCPCS C1713		99467125  -  PLATE BN STRG 125MM TI SPNE	BOTH IP/OP	"$2,425.50 "	"$1,794.87"	$0.00	"$1,940.40"	"$1,091.48"	"$1,091.48"	$0.00	$0.00	$0.00	$505.53	"$1,800.21"	"$1,800.21"	$0.00	$0.00	$505.47	$0.00	"$1,434.68"	"$1,434.68"	$0.00	"$1,212.75"	"$1,921.00"	"$1,940.40"	$0.00		$0.00	$379.59	$0.00	$0.00	$386.14	$0.00	$0.00	$0.00	$0.00	$0.00
99467130	SUP	HCPCS C1713		99467130  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,425.50 "	"$1,794.87"	$0.00	"$1,940.40"	"$1,091.48"	"$1,091.48"	$0.00	$0.00	$0.00	$505.53	"$1,800.21"	"$1,800.21"	$0.00	$0.00	$505.47	$0.00	"$1,434.68"	"$1,434.68"	$0.00	"$1,212.75"	"$1,921.00"	"$1,940.40"	$0.00		$0.00	$379.59	$0.00	$0.00	$386.14	$0.00	$0.00	$0.00	$0.00	$0.00
99467135	SUP	HCPCS C1713		99467135  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,425.50 "	"$1,794.87"	$0.00	"$1,940.40"	"$1,091.48"	"$1,091.48"	$0.00	$0.00	$0.00	$505.53	"$1,800.21"	"$1,800.21"	$0.00	$0.00	$505.47	$0.00	"$1,434.68"	"$1,434.68"	$0.00	"$1,212.75"	"$1,921.00"	"$1,940.40"	$0.00		$0.00	$379.59	$0.00	$0.00	$386.14	$0.00	$0.00	$0.00	$0.00	$0.00
99467140	SUP	HCPCS C1713		99467140  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,425.50 "	"$1,794.87"	$0.00	"$1,940.40"	"$1,091.48"	"$1,091.48"	$0.00	$0.00	$0.00	$505.53	"$1,800.21"	"$1,800.21"	$0.00	$0.00	$505.47	$0.00	"$1,434.68"	"$1,434.68"	$0.00	"$1,212.75"	"$1,921.00"	"$1,940.40"	$0.00		$0.00	$379.59	$0.00	$0.00	$386.14	$0.00	$0.00	$0.00	$0.00	$0.00
99467145	SUP	HCPCS C1713		99467145  -  PLATE BN STRG 145MM TI SPNE	BOTH IP/OP	"$2,425.50 "	"$1,794.87"	$0.00	"$1,940.40"	"$1,091.48"	"$1,091.48"	$0.00	$0.00	$0.00	$505.53	"$1,800.21"	"$1,800.21"	$0.00	$0.00	$505.47	$0.00	"$1,434.68"	"$1,434.68"	$0.00	"$1,212.75"	"$1,921.00"	"$1,940.40"	$0.00		$0.00	$379.59	$0.00	$0.00	$386.14	$0.00	$0.00	$0.00	$0.00	$0.00
99467150	SUP	HCPCS C1713		99467150  -  PLATE BN STRG 150MM TI SPNE	BOTH IP/OP	"$2,425.50 "	"$1,794.87"	$0.00	"$1,940.40"	"$1,091.48"	"$1,091.48"	$0.00	$0.00	$0.00	$505.53	"$1,800.21"	"$1,800.21"	$0.00	$0.00	$505.47	$0.00	"$1,434.68"	"$1,434.68"	$0.00	"$1,212.75"	"$1,921.00"	"$1,940.40"	$0.00		$0.00	$379.59	$0.00	$0.00	$386.14	$0.00	$0.00	$0.00	$0.00	$0.00
99467170	SUP	HCPCS C1713		99467170  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,887.50 "	"$2,136.75"	$0.00	"$2,310.00"	"$1,299.38"	"$1,299.38"	$0.00	$0.00	$0.00	$601.83	"$2,143.10"	"$2,143.10"	$0.00	$0.00	$601.76	$0.00	"$1,423.54"	"$1,423.54"	$0.00	"$1,443.75"	"$2,286.90"	"$2,310.00"	$0.00		$0.00	$451.89	$0.00	$0.00	$459.69	$0.00	$0.00	$0.00	$0.00	$0.00
99467180	SUP	HCPCS C1713		99467180  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,887.50 "	"$2,136.75"	$0.00	"$2,310.00"	"$1,299.38"	"$1,299.38"	$0.00	$0.00	$0.00	$601.83	"$2,143.10"	"$2,143.10"	$0.00	$0.00	$601.76	$0.00	"$1,423.54"	"$1,423.54"	$0.00	"$1,443.75"	"$2,286.90"	"$2,310.00"	$0.00		$0.00	$451.89	$0.00	$0.00	$459.69	$0.00	$0.00	$0.00	$0.00	$0.00
99467190	SUP	HCPCS C1713		99467190  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,887.50 "	"$2,136.75"	$0.00	"$2,310.00"	"$1,299.38"	"$1,299.38"	$0.00	$0.00	$0.00	$601.83	"$2,143.10"	"$2,143.10"	$0.00	$0.00	$601.76	$0.00	"$1,423.54"	"$1,423.54"	$0.00	"$1,443.75"	"$2,286.90"	"$2,310.00"	$0.00		$0.00	$451.89	$0.00	$0.00	$459.69	$0.00	$0.00	$0.00	$0.00	$0.00
99467200	SUP	HCPCS C1713		99467200  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,887.50 "	"$2,136.75"	$0.00	"$2,310.00"	"$1,299.38"	"$1,299.38"	$0.00	$0.00	$0.00	$601.83	"$2,143.10"	"$2,143.10"	$0.00	$0.00	$601.76	$0.00	"$1,423.54"	"$1,423.54"	$0.00	"$1,443.75"	"$2,286.90"	"$2,310.00"	$0.00		$0.00	$451.89	$0.00	$0.00	$459.69	$0.00	$0.00	$0.00	$0.00	$0.00
99468085	SUP	HCPCS C1713		99468085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99468090	SUP	HCPCS C1713		99468090  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99468095	SUP	HCPCS C1713		99468095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
99468100	SUP	HCPCS C1713		99468100  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,253.00 "	"$1,667.22"	$0.00	"$1,802.40"	"$1,013.85"	"$1,013.85"	$0.00	$0.00	$0.00	$469.58	"$1,672.18"	"$1,672.18"	$0.00	$0.00	$469.53	$0.00	"$1,332.65"	"$1,332.65"	$0.00	"$1,126.50"	"$1,784.38"	"$1,802.40"	$0.00		$0.00	$352.59	$0.00	$0.00	$358.68	$0.00	$0.00	$0.00	$0.00	$0.00
100003331	SUP	Custom 27203010		100003331  -  KIT ELTRD NS LF ENSITE NAVX SRFC DISP	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$333.99	$333.99	$0.00	$0.00	$93.78	$0.00	$0.00	$0.00	$0.00	$225.00	$356.40	$360.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
136521000	SUP	HCPCS C1776		136521000  -  HEAD FEM +1MM 12/14 STD TPR 32MM STRL LF ART/EZE MTL HIP	BOTH IP/OP	"$2,985.00 "	"$2,208.90"	$0.00	"$2,388.00"	"$1,343.25"	"$1,343.25"	$0.00	$0.00	$0.00	$622.15	"$2,215.47"	"$2,215.47"	$0.00	$0.00	$622.07	$0.00	"$1,471.61"	"$1,471.61"	$0.00	"$1,492.50"	"$2,364.12"	"$2,388.00"	$0.00		$0.00	$467.15	$0.00	$0.00	$475.21	$0.00	$0.00	$0.00	$0.00	$0.00
136522000	SUP	HCPCS C1776		136522000  -  HEAD FEM +5MM 12/14 STD TPR 32MM STRL LF ART/EZE MTL HIP	BOTH IP/OP	"$2,985.00 "	"$2,208.90"	$0.00	"$2,388.00"	"$1,343.25"	"$1,343.25"	$0.00	$0.00	$0.00	$622.15	"$2,215.47"	"$2,215.47"	$0.00	$0.00	$622.07	$0.00	"$1,471.61"	"$1,471.61"	$0.00	"$1,492.50"	"$2,364.12"	"$2,388.00"	$0.00		$0.00	$467.15	$0.00	$0.00	$475.21	$0.00	$0.00	$0.00	$0.00	$0.00
136523000	SUP	HCPCS C1776		136523000  -  HEAD FEM +9MM 12/14 STD TPR 32MM STRL LF ART/EZE MTL HIP	BOTH IP/OP	"$3,045.00 "	"$2,253.30"	$0.00	"$2,436.00"	"$1,370.25"	"$1,370.25"	$0.00	$0.00	$0.00	$634.65	"$2,260.00"	"$2,260.00"	$0.00	$0.00	$634.58	$0.00	"$1,501.19"	"$1,501.19"	$0.00	"$1,522.50"	"$2,411.64"	"$2,436.00"	$0.00		$0.00	$476.54	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
154106000	SUP	HCPCS C1776		154106000  -  STEM FEMORAL 1 HIGH OFFST 105MM CEMENTED HIP	BOTH IP/OP	"$14,182.50 "	"$10,495.05"	$0.00	"$11,346.00"	"$6,382.13"	"$6,382.13"	$0.00	$0.00	$0.00	"$2,955.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,955.63"	$0.00	"$6,991.97"	"$6,991.97"	$0.00	"$7,091.25"	"$11,232.54"	"$11,346.00"	$0.00		$0.00	"$2,219.56"	$0.00	$0.00	"$2,257.85"	$0.00	$0.00	$0.00	$0.00	$0.00
154118000	SUP	HCPCS C1776		154118000  -  STEM FEMORAL 3 150MM CEMENTED EXTN PROSTALAC HIP RIGHT	BOTH IP/OP	"$14,820.00 "	"$10,966.80"	$0.00	"$11,856.00"	"$6,669.00"	"$6,669.00"	$0.00	$0.00	$0.00	"$3,088.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,088.49"	$0.00	"$7,306.26"	"$7,306.26"	$0.00	"$7,410.00"	"$11,737.44"	"$11,856.00"	$0.00		$0.00	"$2,319.33"	$0.00	$0.00	"$2,359.34"	$0.00	$0.00	$0.00	$0.00	$0.00
177300130	SUP	Custom 27803010		177300130  -  CAGE SPNL 12MM STD PRLL 14X30MM NS LF BENGAL STKBL RDLCNT	BOTH IP/OP	"$8,790.00 "	"$6,504.60"	$0.00	"$7,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,831.84"	$0.00	$0.00	$0.00	$0.00	"$4,395.00"	"$6,961.68"	"$7,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
177306122	SUP	Custom 27803010		177306122  -  CAGE SPNL 12MM STD LRDTC 14X22MM NS LF BENGAL STKBL RDLCNT	BOTH IP/OP	"$8,790.00 "	"$6,504.60"	$0.00	"$7,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,831.84"	$0.00	$0.00	$0.00	$0.00	"$4,395.00"	"$6,961.68"	"$7,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
177306124	SUP	Custom 27803010		177306124  -  CAGE SPNL STD LRDTC 24X14X12MM NS LF BENGAL STKBL RDLCNT	BOTH IP/OP	"$8,790.00 "	"$6,504.60"	$0.00	"$7,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,831.84"	$0.00	$0.00	$0.00	$0.00	"$4,395.00"	"$6,961.68"	"$7,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
177306126	SUP	Custom 27803010		177306126  -  CAGE SPNL 12MM STD LRDTC 14X26MM NS LF BENGAL STKBL RDLCNT	BOTH IP/OP	"$8,790.00 "	"$6,504.60"	$0.00	"$7,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,831.84"	$0.00	$0.00	$0.00	$0.00	"$4,395.00"	"$6,961.68"	"$7,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
177306128	SUP	Custom 27803010		177306128  -  CAGE SPNL 12MM STD LRDTC 14X28MM NS LF BENGAL STKBL RDLCNT	BOTH IP/OP	"$8,790.00 "	"$6,504.60"	$0.00	"$7,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,831.84"	$0.00	$0.00	$0.00	$0.00	"$4,395.00"	"$6,961.68"	"$7,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
177306130	SUP	Custom 27803010		177306130  -  CAGE SPNL 12MM STD LRDTC 14X30MM NS LF BENGAL STKBL RDLCNT	BOTH IP/OP	"$8,790.00 "	"$6,504.60"	$0.00	"$7,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,831.84"	$0.00	$0.00	$0.00	$0.00	"$4,395.00"	"$6,961.68"	"$7,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
179702000	SUP	HCPCS C1713		179702000  -  SCREW SET 1 INNER MNOAX EXPEDIUM TITANIUM SPN	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
179706070	SUP	HCPCS C1713		179706070  -  SCREW BONE 10MM 70MM T27 VIPER TITANIUM ILIUM	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
179706870	SUP	HCPCS C1713		179706870  -  SCREW BONE 8MM 70MM VIPER TITANIUM SPN ILIUM PEDICLE T27	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
179706880	SUP	HCPCS C1713		179706880  -  SCREW BONE 8MM 80MM VIPER TITANIUM SPN ILIUM PEDICLE T27	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
179706970	SUP	HCPCS C1713		179706970  -  SCREW BONE 9MM 70MM VIPER TITANIUM ILIUM T27	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712035	SUP	HCPCS C1713		179712035  -  SCREW BN 7.5MM 35MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712040	SUP	HCPCS C1713		179712040  -  SCREW BN 7.5MM 40MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712045	SUP	HCPCS C1713		179712045  -  SCREW BN 7.5MM 45MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712050	SUP	HCPCS C1713		179712050  -  SCREW BN 7.5MM 50MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712055	SUP	HCPCS C1713		179712055  -  SCREW BN 7.5MM 55MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712080	SUP	HCPCS C1713		179712080  -  SCREW BONE 7.5MM 80MM XPDM TI SPNL POLYAX 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712420	SUP	HCPCS C1713		179712420  -  SCREW BONE 4.35MM 20MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712425	SUP	HCPCS C1713		179712425  -  SCREW BONE 4.35MM 25MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712430	SUP	HCPCS C1713		179712430  -  SCREW BONE 4.35MM 30MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712435	SUP	HCPCS C1713		179712435  -  SCREW BONE 4.35MM 35MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712440	SUP	HCPCS C1713		179712440  -  SCREW BONE 4.35MM 40MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712445	SUP	HCPCS C1713		179712445  -  SCREW BN 4.5MM 45MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712530	SUP	HCPCS C1713		179712530  -  SCREW BONE 5MM 30MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712535	SUP	HCPCS C1713		179712535  -  SCREW BONE 5MM 35MM 1 INNIE POLYAX EXPEDIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712540	SUP	HCPCS C1713		179712540  -  SCREW BONE 5MM 40MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712545	SUP	HCPCS C1713		179712545  -  SCREW BONE 5MM 45MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712550	SUP	HCPCS C1713		179712550  -  SCREW BONE 5MM 50MM 1 INNIE POLYAX EXPEDIUM TITANIUM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712630	SUP	HCPCS C1713		179712630  -  SCREW BONE 6MM 30MM POLYAX 1 INNIE EXPEDIUM TITANIUM SPN 5.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712635	SUP	HCPCS C1713		179712635  -  SCREW BONE 6MM 35MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712640	SUP	HCPCS C1713		179712640  -  SCREW BONE 6MM 40MM XPDM TI ANT CERV SPN POLYAX 1 INNIE 5.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712645	SUP	HCPCS C1713		179712645  -  SCREW BONE 6MM 45MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712650	SUP	HCPCS C1713		179712650  -  SCREW BONE 6MM 50MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN 5.5	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712735	SUP	HCPCS C1713		179712735  -  SCREW BONE 7MM 35MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712740	SUP	HCPCS C1713		179712740  -  SCREW BONE 7MM 40MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712745	SUP	HCPCS C1713		179712745  -  SCREW BONE 7MM 45MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712750	SUP	HCPCS C1713		179712750  -  SCREW BONE 7MM 50MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179712755	SUP	HCPCS C1713		179712755  -  SCREW BONE 7MM 55MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179715540	SUP	HCPCS C1713		179715540  -  SCREW BONE 5.5MM 40MM POLYAX EXPEDIUM TITANIUM SPN 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179715545	SUP	HCPCS C1713		179715545  -  SCREW BONE 5.5MM 45MM POLYAX EXPEDIUM TITANIUM SPN 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179715635	SUP	HCPCS C1713		179715635  -  SCREW BONE 6.5MM 35MM POLYAX EXPEDIUM TITANIUM SPN 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179715645	SUP	HCPCS C1713		179715645  -  SCREW BONE 6.5MM 45MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
179722050	SUP	HCPCS C1713		179722050  -  SET SCR DISTAL TI UNT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
179722890	SUP	HCPCS C1713		179722890  -  SCREW DI POLYAXL 8 X 90MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
179762120	SUP	HCPCS C1713		179762120  -  ROD SPINAL 5.5MM 120MM PRECUT HEXAGONAL END EXPEDIUM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
179762300	SUP	HCPCS C1713		179762300  -  ROD SPINAL 300MM NONSTRL	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$627.75	$627.75	$0.00	$0.00	$0.00	$290.75	"$1,035.37"	"$1,035.37"	$0.00	$0.00	$290.72	$0.00	$825.14	$825.14	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00		$0.00	$218.32	$0.00	$0.00	$222.08	$0.00	$0.00	$0.00	$0.00	$0.00
179762480	SUP	HCPCS C1713		179762480  -  ROD SPINAL 5.5MM 480MM PRECUT HEXAGONAL END EXPEDIUM	BOTH IP/OP	"$1,395.00 "	"$1,032.30"	$0.00	"$1,116.00"	$627.75	$627.75	$0.00	$0.00	$0.00	$290.75	"$1,035.37"	"$1,035.37"	$0.00	$0.00	$290.72	$0.00	$825.14	$825.14	$0.00	$697.50	"$1,104.84"	"$1,116.00"	$0.00		$0.00	$218.32	$0.00	$0.00	$222.08	$0.00	$0.00	$0.00	$0.00	$0.00
179771055	SUP	HCPCS C1713		179771055  -  ROD SPNL 5.5MM 55MM NS XPDM PREBNT LN TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
179771065	SUP	HCPCS C1713		179771065  -  ROD SPINAL 5.5MM 65MM PRELORDOSED LINE EXPEDIUM TITANIUM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
179771075	SUP	HCPCS C1713		179771075  -  ROD SPINAL 5.5MM 75MM PRELORDOSED LINE EXPEDIUM TITANIUM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
179771085	SUP	HCPCS C1713		179771085  -  ROD SPINAL 5.5MM 85MM PRELORDOSED LINE EXPEDIUM TITANIUM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
179771090	SUP	HCPCS C1713		179771090  -  ROD SPINAL 5.5MM 90MM PRELORDOSED LINE EXPEDIUM TITANIUM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
179771095	SUP	HCPCS C1713		179771095  -  ROD SPINAL 5.5MM 95MM PRELORDOSED LINE EXPEDIUM TITANIUM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
179772045	SUP	Custom 27803010		179772045  -  ROD SPNL 45MM 5.5MM MS M SI TI PREBNT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
179772055	SUP	Custom 27803010		179772055  -  ROD SPNL 55MM 5.5MM MS M SI TI PREBNT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
179793020	SUP	HCPCS C1713		179793020  -  CONNECTOR ROD 5.5MM 20MM OPEN FIX TITANIUM LATERAL	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$968.63	$968.63	$0.00	$0.00	$0.00	$448.63	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	"$1,273.20"	"$1,273.20"	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$336.87	$0.00	$0.00	$342.68	$0.00	$0.00	$0.00	$0.00	$0.00
179797020	SUP	HCPCS C1713		179797020  -  CONNECTOR ROD 5.5MM 20MM OPEN EXPEDIUM TITANIUM ILIAC SPN	BOTH IP/OP	"$2,550.00 "	"$1,887.00"	$0.00	"$2,040.00"	"$1,147.50"	"$1,147.50"	$0.00	$0.00	$0.00	$531.48	"$1,892.61"	"$1,892.61"	$0.00	$0.00	$531.42	$0.00	"$1,257.15"	"$1,257.15"	$0.00	"$1,275.00"	"$2,019.60"	"$2,040.00"	$0.00		$0.00	$399.08	$0.00	$0.00	$405.96	$0.00	$0.00	$0.00	$0.00	$0.00
179797025	SUP	HCPCS C1713		179797025  -  CONNECTOR ROD 5.5MM 20MM OPEN EXTENDED TAB EXPEDIUM TITANIUM	BOTH IP/OP	"$2,550.00 "	"$1,887.00"	$0.00	"$2,040.00"	"$1,147.50"	"$1,147.50"	$0.00	$0.00	$0.00	$531.48	"$1,892.61"	"$1,892.61"	$0.00	$0.00	$531.42	$0.00	"$1,257.15"	"$1,257.15"	$0.00	"$1,275.00"	"$2,019.60"	"$2,040.00"	$0.00		$0.00	$399.08	$0.00	$0.00	$405.96	$0.00	$0.00	$0.00	$0.00	$0.00
179797040	SUP	HCPCS C1713		179797040  -  CONNECTOR ROD 5.5MM 40MM OPEN EXPEDIUM TITANIUM ILIAC SPN	BOTH IP/OP	"$2,550.00 "	"$1,887.00"	$0.00	"$2,040.00"	"$1,147.50"	"$1,147.50"	$0.00	$0.00	$0.00	$531.48	"$1,892.61"	"$1,892.61"	$0.00	$0.00	$531.42	$0.00	"$1,257.15"	"$1,257.15"	$0.00	"$1,275.00"	"$2,019.60"	"$2,040.00"	$0.00		$0.00	$399.08	$0.00	$0.00	$405.96	$0.00	$0.00	$0.00	$0.00	$0.00
179798020	SUP	HCPCS C1713		179798020  -  CONNECTOR ROD 5.5MM 20MM XPDM CLS TI SPNE ILC	BOTH IP/OP	"$2,550.00 "	"$1,887.00"	$0.00	"$2,040.00"	"$1,147.50"	"$1,147.50"	$0.00	$0.00	$0.00	$531.48	"$1,892.61"	"$1,892.61"	$0.00	$0.00	$531.42	$0.00	"$1,257.15"	"$1,257.15"	$0.00	"$1,275.00"	"$2,019.60"	"$2,040.00"	$0.00		$0.00	$399.08	$0.00	$0.00	$405.96	$0.00	$0.00	$0.00	$0.00	$0.00
183612032	SUP	HCPCS C1713		183612032  -  PLATE 32MM LVL 2 EGL PLUS BONE ANT CERV SPN	BOTH IP/OP	"$2,328.75 "	"$1,723.28"	$0.00	"$1,863.00"	"$1,047.94"	"$1,047.94"	$0.00	$0.00	$0.00	$485.37	"$1,728.40"	"$1,728.40"	$0.00	$0.00	$485.31	$0.00	"$1,377.46"	"$1,377.46"	$0.00	"$1,164.38"	"$1,844.37"	"$1,863.00"	$0.00		$0.00	$364.45	$0.00	$0.00	$370.74	$0.00	$0.00	$0.00	$0.00	$0.00
183651016	SUP	HCPCS C1713		183651016  -  SCREW BONE 4.4MM 16MM EGL PLUS SWIFT PLUS ANT CERV SPN OVSZ	BOTH IP/OP	$388.13 	$287.22	$0.00	$310.50	$174.66	$174.66	$0.00	$0.00	$0.00	$80.89	$288.07	$288.07	$0.00	$0.00	$80.89	$0.00	$229.58	$229.58	$0.00	$194.06	$307.40	$310.50	$0.00		$0.00	$60.74	$0.00	$0.00	$61.79	$0.00	$0.00	$0.00	$0.00	$0.00
183656016	SUP	HCPCS C1713		183656016  -  SCREW BONE 4.25MM 16MM EGL PLUS SWIFT PLUS ANT CERV SPN PRIM	BOTH IP/OP	$388.13 	$287.22	$0.00	$310.50	$174.66	$174.66	$0.00	$0.00	$0.00	$80.89	$288.07	$288.07	$0.00	$0.00	$80.89	$0.00	$229.58	$229.58	$0.00	$194.06	$307.40	$310.50	$0.00		$0.00	$60.74	$0.00	$0.00	$61.79	$0.00	$0.00	$0.00	$0.00	$0.00
185200320	SUP	HCPCS C1757		185200320  -  TUBE NASOPHARYNGEAL 32FR 170MM ADJUSTABLE FLANGE ROUND TIP	BOTH IP/OP	$11.68 	$8.64	$0.00	$9.34	$0.00	$0.00	$0.00	$0.00	$0.00	$2.43	$8.67	$8.67	$0.00	$0.00	$2.43	$0.00	$6.91	$6.91	$0.00	$5.84	$9.25	$9.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186715000	SUP	HCPCS C1713		186715000  -  SCREW SET TI SPNL 1 INNIE INR XPDM	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
186715080	SUP	HCPCS C1713		186715080  -  SCREW BONE 7.5MM 80MM POLYAX CANN VIPER 2 TITANIUM SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186715530	SUP	HCPCS C1713		186715530  -  SCREW BONE 5MM 30MM VPR TI SPNL POLYAX CANN MN INV SRG	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186715535	SUP	HCPCS C1713		186715535  -  SCREW BONE 5MM 35MM VPR TI SPNL POLYAX CANN MN INV SRG	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186715540	SUP	HCPCS C1713		186715540  -  SCREW BONE 5MM 40MM VPR TI SPNL POLYAX CANN MN INV SRG	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186715635	SUP	HCPCS C1713		186715635  -  SCREW BONE 6MM 35MM VPR TI SPNL POLYAX CANN MN INV SRG	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186715640	SUP	HCPCS C1713		186715640  -  SCREW BONE 6MM 40MM POLYAX CANN VIPER TITANIUM SPN MIS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186715645	SUP	HCPCS C1713		186715645  -  SCREW BONE 6MM 45MM VPR TI SPNL POLYAX CANN MN INV SRG	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186715730	SUP	HCPCS C1713		186715730  -  SCREW BONE 7MM 30MM POLYAX CANN VIPER 2 TITANIUM SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186715855	SUP	HCPCS C1713		186715855  -  SCREW BONE 8MM 55MM POLYAX VIPER TITANIUM SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186731530	SUP	HCPCS C1713		186731530  -  SCREW BONE 5MM 30MM POLYAX FIX TITANIUM SPN CORTICAL 5.5MM	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
186731535	SUP	HCPCS C1713		186731535  -  SCREW BONE 5MM 35MM POLYAX FIX TITANIUM SPN CORTICAL 5.5MM	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
186731540	SUP	HCPCS C1713		186731540  -  SCREW BONE 5MM 40MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
186731635	SUP	HCPCS C1713		186731635  -  SCREW BONE 6MM 35MM XPDM VPR TI SPN CORT FIX 5.5MM	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
186731640	SUP	HCPCS C1713		186731640  -  SCREW BONE 6MM 40MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
186731650	SUP	HCPCS C1713		186731650  -  SCREW BN 6MM 50MM VPR FX TI SPNE CORT 5.5MM ROD	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
186750030	SUP	HCPCS C1713		186750030  -  SCREW BONE 5MM 30MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186750035	SUP	HCPCS C1713		186750035  -  SCREW BONE 5MM 35MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186750040	SUP	HCPCS C1713		186750040  -  SCREW BONE 5MM 40MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186750045	SUP	HCPCS C1713		186750045  -  SCREW BONE 5MM 45MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186750050	SUP	HCPCS C1713		186750050  -  SCREW BONE 5MM 50MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186750230	SUP	HCPCS C1713		186750230  -  SCREW BONE  5X30MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186750235	SUP	HCPCS C1713		186750235  -  SCREW BONE  5X35MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186750250	SUP	HCPCS C1713		186750250  -  SCREW BONE  5X50MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186750255	SUP	HCPCS C1713		186750255  -  SCREW BONE  5X55MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186750430	SUP	HCPCS C1713		186750430  -  SCREW BONE  5X30MM VIPER PRIME CFXFEN XTAB	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
186750435	SUP	HCPCS C1713		186750435  -  SCREW BONE  5X35MM VIPER PRIME CFXFEN XTAB	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
186750450	SUP	HCPCS C1713		186750450  -  SCREW BONE  5X50MM VIPER PRIME CFXFEN XTAB	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
186750455	SUP	HCPCS C1713		186750455  -  SCREW BONE  5X55MM VIPER PRIME CFXFEN XTAB	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
186760035	SUP	HCPCS C1713		186760035  -  SCREW BONE 6MM 35MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186760040	SUP	HCPCS C1713		186760040  -  SCREW BONE 6MM 40MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186760045	SUP	HCPCS C1713		186760045  -  SCREW BONE 6MM 45MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186760050	SUP	HCPCS C1713		186760050  -  SCREW BONE 6MM 50MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186760230	SUP	HCPCS C1713		186760230  -  SCREW BONE  6X30MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186760255	SUP	HCPCS C1713		186760255  -  SCREW BONE  6X55MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186760430	SUP	HCPCS C1713		186760430  -  SCREW BONE  6X30MM VIPER PRIME CFXFEN XTAB	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
186760455	SUP	HCPCS C1713		186760455  -  SCREW BONE  6X55MM VIPER PRIME CFXFEN XTAB	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
186770035	SUP	HCPCS C1713		186770035  -  SCREW BONE 7MM 35MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186770040	SUP	HCPCS C1713		186770040  -  SCREW BONE 7MM 40MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186770045	SUP	HCPCS C1713		186770045  -  SCREW BONE 7MM 45MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186770050	SUP	HCPCS C1713		186770050  -  SCREW BONE 7MM 50MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186770230	SUP	HCPCS C1713		186770230  -  SCREW BONE  7X30MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186770235	SUP	HCPCS C1713		186770235  -  SCREW BONE  7X35MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186770430	SUP	HCPCS C1713		186770430  -  SCREW BONE  7X30MM VIPER PRIME CFXFEN XTAB	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
186770435	SUP	HCPCS C1713		186770435  -  SCREW BONE  7X35MM VIPER PRIME CFXFEN XTAB	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
186770460	SUP	HCPCS C1713		186770460  -  SCREW BONE  7X60MM VIPER PRIME CFXFEN XTAB	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
186775235	SUP	HCPCS C1713		186775235  -  SCREW BONE  7.5X35MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186775240	SUP	HCPCS C1713		186775240  -  SCREW BONE  7.5X40MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186775245	SUP	HCPCS C1713		186775245  -  SCREW BONE  7.5X45MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186775250	SUP	HCPCS C1713		186775250  -  SCREW BONE  7.5X50MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186775255	SUP	HCPCS C1713		186775255  -  SCREW BONE  7.5X55MM TI VIPER PRIME X-TAB	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
186787040	SUP	Custom 27803010		186787040  -  ROD SPNL 40MM VPR 2 TI KYPHOSED MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186787080	SUP	Custom 27803010		186787080  -  ROD SPNL 80MM VPR 2 TI KYPHOSED MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186787090	SUP	Custom 27803010		186787090  -  ROD SPNL 90MM VPR 2 TI KYPHOSED MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186787100	SUP	Custom 27803010		186787100  -  ROD SPNL 100MM VPR 2 TI KYPHOSED MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186787110	SUP	Custom 27803010		186787110  -  ROD SPNL 110MM VPR 2 TI KYPHOSED MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186787200	SUP	Custom 27803010		186787200  -  ROD SPNL 200MM VPR 2 TI KYPHOSED MN INV SRG	BOTH IP/OP	"$1,710.00 "	"$1,265.40"	$0.00	"$1,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,269.16"	"$1,269.16"	$0.00	$0.00	$356.36	$0.00	$0.00	$0.00	$0.00	$855.00	"$1,354.32"	"$1,368.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186788035	SUP	HCPCS C1713		186788035  -  ROD SPINAL 35MM LORDOTIC VIPER 2 TITANIUM MINIMALLY INVASIVE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
186788045	SUP	Custom 27803010		186788045  -  ROD SPNL 45MM VPR 2 TI LRDTC MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186788065	SUP	Custom 27803010		186788065  -  ROD SPNL 65MM VPR 2 PRELORDOTIC MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186788075	SUP	Custom 27803010		186788075  -  ROD SPNL 75MM 5.5MM VPR 2 TI LRDTC MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186788080	SUP	Custom 27803010		186788080  -  ROD SPNL 80MM VPR 2 TI LRDTC MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186788090	SUP	Custom 27803010		186788090  -  ROD SPNL 90MM 5.5MM VPR 2 TI LRDTC MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186788100	SUP	Custom 27803010		186788100  -  ROD SPNL 100MM VPR 2 TI LRDTC MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186788120	SUP	HCPCS C1713		186788120  -  ROD SPINAL 120MM LORDOTIC VIPER 2 TITANIUM MINIMALLY	BOTH IP/OP	"$1,537.50 "	"$1,137.75"	$0.00	"$1,230.00"	$691.88	$691.88	$0.00	$0.00	$0.00	$320.45	"$1,141.13"	"$1,141.13"	$0.00	$0.00	$320.42	$0.00	$909.43	$909.43	$0.00	$768.75	"$1,217.70"	"$1,230.00"	$0.00		$0.00	$240.62	$0.00	$0.00	$244.77	$0.00	$0.00	$0.00	$0.00	$0.00
186788150	SUP	Custom 27803010		186788150  -  ROD SPNL 150MM VPR 2 TI LRDTC MN INV SRG	BOTH IP/OP	"$1,537.50 "	"$1,137.75"	$0.00	"$1,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,141.13"	"$1,141.13"	$0.00	$0.00	$320.42	$0.00	$0.00	$0.00	$0.00	$768.75	"$1,217.70"	"$1,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186789040	SUP	Custom 27803010		186789040  -  ROD SPNL 40MM VPR 2 TI STR MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186789050	SUP	Custom 27803010		186789050  -  ROD SPNL 50MM VPR 2 TI STR MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186789070	SUP	Custom 27803010		186789070  -  ROD SPNL 70MM VPR 2 TI STR MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186789080	SUP	Custom 27803010		186789080  -  ROD SPNL 80MM VPR 2 TI STR MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186789100	SUP	Custom 27803010		186789100  -  ROD SPNL 100MM VPR 2 TI STR MN INV SRG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186789150	SUP	HCPCS C1713		186789150  -  ROD SPINAL 150MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE	BOTH IP/OP	"$1,537.50 "	"$1,137.75"	$0.00	"$1,230.00"	$691.88	$691.88	$0.00	$0.00	$0.00	$320.45	"$1,141.13"	"$1,141.13"	$0.00	$0.00	$320.42	$0.00	$909.43	$909.43	$0.00	$768.75	"$1,217.70"	"$1,230.00"	$0.00		$0.00	$240.62	$0.00	$0.00	$244.77	$0.00	$0.00	$0.00	$0.00	$0.00
186789200	SUP	Custom 27803010		186789200  -  ROD SPNL 200MM VPR 2 TI STR MN INV SRG	BOTH IP/OP	"$1,710.00 "	"$1,265.40"	$0.00	"$1,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,269.16"	"$1,269.16"	$0.00	$0.00	$356.36	$0.00	$0.00	$0.00	$0.00	$855.00	"$1,354.32"	"$1,368.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186789300	SUP	Custom 27803010		186789300  -  ROD SPNL 300MM VPR 2 TI STR MN INV SRG	BOTH IP/OP	"$1,882.50 "	"$1,393.05"	$0.00	"$1,506.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,397.19"	"$1,397.19"	$0.00	$0.00	$392.31	$0.00	$0.00	$0.00	$0.00	$941.25	"$1,490.94"	"$1,506.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186789400	SUP	HCPCS C1713		186789400  -  ROD SPINAL 400MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE	BOTH IP/OP	"$2,055.00 "	"$1,520.70"	$0.00	"$1,644.00"	$924.75	$924.75	$0.00	$0.00	$0.00	$428.31	"$1,525.22"	"$1,525.22"	$0.00	$0.00	$428.26	$0.00	"$1,215.53"	"$1,215.53"	$0.00	"$1,027.50"	"$1,627.56"	"$1,644.00"	$0.00		$0.00	$321.61	$0.00	$0.00	$327.16	$0.00	$0.00	$0.00	$0.00	$0.00
186789480	SUP	HCPCS C1713		186789480  -  ROD SPINAL STR 480MM VIPER 2 TITANIUM MINIMALLY INVASIVE	BOTH IP/OP	"$2,055.00 "	"$1,520.70"	$0.00	"$1,644.00"	$924.75	$924.75	$0.00	$0.00	$0.00	$428.31	"$1,525.22"	"$1,525.22"	$0.00	$0.00	$428.26	$0.00	"$1,215.53"	"$1,215.53"	$0.00	"$1,027.50"	"$1,627.56"	"$1,644.00"	$0.00		$0.00	$321.61	$0.00	$0.00	$327.16	$0.00	$0.00	$0.00	$0.00	$0.00
186801012	SUP	HCPCS C1713		186801012  -  PLATE BONE PRELORDOTIC 19.8X16X2.5MM 12MM LEVEL 1 MEDIAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
186801014	SUP	HCPCS C1713		186801014  -  PLATE BONE PRELORDOTIC 21.8X16X2.5MM 14MM LEVEL 1 MEDIAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
186801016	SUP	HCPCS C1713		186801016  -  PLATE BONE PRELORDOTIC 23.8X16X2.5MM 16MM LEVEL 1 MEDIAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
186801024	SUP	HCPCS C1713		186801024  -  PLATE BN 14MM PREBNT 24X16X2.5MM NS SKYLINE 1 LVL TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
186801026	SUP	HCPCS C1713		186801026  -  PLATE 26MM TI 1 LVL SKYLINE BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
186801028	SUP	HCPCS C1713		186801028  -  PLATE 28MM TI 1 LVL SKYLINE BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
186801030	SUP	HCPCS C1713		186801030  -  PLATE 30MM TI 1 LVL SKYLINE BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
186802028	SUP	HCPCS C1713		186802028  -  PLATE BONE PRELORDOTIC 35.8X16X2.5MM 28MM LEVEL 2 MEDIAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186802030	SUP	HCPCS C1713		186802030  -  PLATE 30MM TI 2 LVL SKYLINE BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186802032	SUP	HCPCS C1713		186802032  -  PLATE 32MM TI 2 LVL SKYLINE BONE SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186802036	SUP	HCPCS C1713		186802036  -  PLATE 36MM TI 2 LVL SKYLINE BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
186803039	SUP	HCPCS C1713		186803039  -  PLATE BN 39MM NS SKYLINE 3 LVL SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
186803042	SUP	HCPCS C1713		186803042  -  PLATE BONE PRELORDOTIC 49.8X16X2.5MM 42MM LEVEL 3 MEDIAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
186803045	SUP	HCPCS C1713		186803045  -  PLATE BONE PRELORDOTIC 52.8X16X2.5MM 45MM LEVEL 3 MEDIAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
186803051	SUP	HCPCS C1713		186803051  -  PLATE BONE PRELORDOTIC 58.8X16X2.5MM 51MM LEVEL 3 MEDIAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
186820012	SUP	Custom 27203010		186820012  -  14MM DRILL	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
186850012	SUP	HCPCS C1713		186850012  -  SCREW BONE 12MM VAR ANG SELF DRILL SKYLINE TITANIUM SPN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186850014	SUP	HCPCS C1713		186850014  -  SCREW BONE 0-20D 4MM 14MM VARIABLE SLFDRILL SKYLINE GOLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186850016	SUP	HCPCS C1713		186850016  -  SCREW BONE 16MM SKYLINE TI SPNL SLFDRILL VAR ANG	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186850017	SUP	HCPCS C1713		186850017  -  SCREW BN 0-20D 4MM 17MM LGHT GRN SKYLINE VAR SLFDRL TI ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186850018	SUP	HCPCS C1713		186850018  -  SCREW BONE 18MM VAR ANG SELF DRILL SKYLINE TITANIUM SPN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186852014	SUP	HCPCS C1713		186852014  -  SCREW BONE 14MM SKYLINE TI SPNL SLFTAP VAR ANG	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186852015	SUP	HCPCS C1713		186852015  -  SCREW BONE 15MM SLFTAP VAR ANG SKYLINE TITANIUM SPN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186852016	SUP	HCPCS C1713		186852016  -  SCREW BONE 16MM SKYLINE TI SPNL SLFTAP VAR ANG	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186852017	SUP	HCPCS C1713		186852017  -  SCREW BONE 17MM SLFTAP VAR ANG SKYLINE TITANIUM SPN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186852018	SUP	HCPCS C1713		186852018  -  SCREW BONE 18MM SKYLINE TI SPNL SLFTAP VAR ANG	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186854014	SUP	HCPCS C1713		186854014  -  SCREW BONE LARGE DIAMETER 14MM VAR ANG SELF TAP SKYLINE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186854016	SUP	HCPCS C1713		186854016  -  SCREW BN OVSZ 4.5MM 16MM NS SKYLINE VAR SLF DRL TI SPNE CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186854018	SUP	HCPCS C1713		186854018  -  SCREW BONE LARGE DIAMETER 18MM VAR ANG SELF TAP SKYLINE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186862014	SUP	HCPCS C1713		186862014  -  SCREW BONE 4MM 14MM SKYLINE TI ANT CERV SPN SLFTAP CNSTRN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186862016	SUP	HCPCS C1713		186862016  -  SCREW BONE 16MM SKYLINE TI SPNL SLFTAP CNSTRN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
186864014	SUP	HCPCS C1713		186864014  -  SCREW BONE 14MM SKYLINE TI SPNL SLFTAP CNSTRN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
187301105	SUP	Custom 27803010		187301105  -  CAGE SPNL 7D STD 5MM NS LF BENGAL CFRP CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
187301106	SUP	Custom 27803010		187301106  -  CAGE SPNL 7D STD 6MM NS LF BENGAL CFRP CRV INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
187301107	SUP	Custom 27803010		187301107  -  CAGE SPNL 7D STD 7MM NS LF BENGAL CFRP CRV INTRBD FS	BOTH IP/OP	"$2,458.13 "	"$1,819.02"	$0.00	"$1,966.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,824.42"	"$1,824.42"	$0.00	$0.00	$512.27	$0.00	$0.00	$0.00	$0.00	"$1,229.06"	"$1,946.84"	"$1,966.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
187301108	SUP	Custom 27803010		187301108  -  CAGE SPNL 7D STD 8MM NS LF BENGAL CFRP CRV INTRBD FS	BOTH IP/OP	"$2,458.13 "	"$1,819.02"	$0.00	"$1,966.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,824.42"	"$1,824.42"	$0.00	$0.00	$512.27	$0.00	$0.00	$0.00	$0.00	"$1,229.06"	"$1,946.84"	"$1,966.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
187301207	SUP	HCPCS C1713		187301207  -  CAGE SPNL 7D LG LRDTC 7MM NS LF BENGAL CFBR LMBR INTRBD FS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
187823107	SUP	HCPCS C1713		187823107  -  CAGE SPNL PRLL BLT 23X9X7MM NS LF CNCRD	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
187823108	SUP	Custom 27803010		187823108  -  CAGE SPNL PRLL BLT NOSE 23X9X8MM NS LF CNCRD RADOPQ CFRP	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
187823409	SUP	Custom 27803010		187823409  -  CAGE SPNL 5D LRDTC BLT NOSE 23X9X9MM NS LF CNCRD RADOPQ CFRP	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
187823410	SUP	Custom 27803010		187823410  -  CAGE SPNL 5D LRDTC BLT NOSE 23X9X10MM NS LF CNCRD RADOPQ	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
187827108	SUP	Custom 27803010		187827108  -  CAGE SPNL PRLL BLT NOSE 27X9X8MM NS LF CNCRD RADOPQ CFRP	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
187827212	SUP	Custom 27803010		187827212  -  CAGE SPNL PRLL BLT NOSE 27X11X12MM NS LF CNCRD RADOPQ CFRP	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
187827409	SUP	Custom 27803010		187827409  -  CAGE SPNL 5D LRDTC BLT NOSE 27X9X9MM NS LF CNCRD RADOPQ CFRP	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188311002	SUP	HCPCS C1713		188311002  -  ROD SPINAL 3.5-5.5MM 420MM 2 OPENING MOUNTAINEER TITANIUM	BOTH IP/OP	"$2,145.00 "	"$1,587.30"	$0.00	"$1,716.00"	$965.25	$965.25	$0.00	$0.00	$0.00	$447.07	"$1,592.02"	"$1,592.02"	$0.00	$0.00	$447.02	$0.00	"$1,268.77"	"$1,268.77"	$0.00	"$1,072.50"	"$1,698.84"	"$1,716.00"	$0.00		$0.00	$335.69	$0.00	$0.00	$341.48	$0.00	$0.00	$0.00	$0.00	$0.00
188311200	SUP	Custom 27803010		188311200  -  CONCTR SPNL 3.5MM 3.5MM MTNR OCT WDBND	BOTH IP/OP	"$1,740.00 "	"$1,287.60"	$0.00	"$1,392.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,291.43"	"$1,291.43"	$0.00	$0.00	$362.62	$0.00	$0.00	$0.00	$0.00	$870.00	"$1,378.08"	"$1,392.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188312001	SUP	Custom 27803010		188312001  -  CONCTR ROD MTNR OFFST ASMBLY OCT SPN LAT	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$0.00	$0.00	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188312003	SUP	Custom 27803010		188312003  -  CONCTR ROD MTNR J HOOK ASMBLY OCT SPN	BOTH IP/OP	"$1,170.00 "	$865.80	$0.00	$936.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$868.37	$868.37	$0.00	$0.00	$243.83	$0.00	$0.00	$0.00	$0.00	$585.00	$926.64	$936.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188316030	SUP	Custom 27803010		188316030  -  ROD SPNL 30MM 3.5MM MTNR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188316035	SUP	Custom 27803010		188316035  -  ROD SPNL 35MM 3.5MM MTNR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188316040	SUP	Custom 27803010		188316040  -  ROD SPNL 40MM 3.5MM MTNR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188316045	SUP	Custom 27803010		188316045  -  ROD SPNL 45MM 3.5MM MTNR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188316050	SUP	Custom 27803010		188316050  -  ROD SPNL 50MM 3.5MM MTNR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188316055	SUP	Custom 27803010		188316055  -  ROD SPNL 55MM 3.5MM MTNR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188316060	SUP	Custom 27803010		188316060  -  ROD SPNL 60MM 3.5MM MTNR TI RGD STRL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188316065	SUP	Custom 27803010		188316065  -  ROD SPNL 65MM 3.5MM MTNR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188316070	SUP	Custom 27803010		188316070  -  ROD SPNL 70MM 3.5MM MTNR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188316075	SUP	Custom 27803010		188316075  -  ROD SPNL 75MM 3.5MM MTNR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188316085	SUP	HCPCS C1713		188316085  -  ROD SPINAL 3.5MM 85MM MOUNTAINEER	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
188316100	SUP	Custom 27803010		188316100  -  ROD SPNL 100MM 3.5MM MTNR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188316120	SUP	Custom 27803010		188316120  -  ROD SPNL 120MM 3.5MM MTNR TI RGD STRL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188318310	SUP	HCPCS C1713		188318310  -  SCREW BONE 3.5MM 10MM MTNR TI OCT SPN FIXANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188318312	SUP	HCPCS C1713		188318312  -  SCREW BONE 3.5MM 12MM MTNR TI OCT SPN FIXANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188318314	SUP	HCPCS C1713		188318314  -  SCREW BONE 3.5MM 14MM MTNR TI SPNL FIXANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188318316	SUP	HCPCS C1713		188318316  -  SCREW BONE 3.5MM 16MM MTNR TI OCT SPN FIXANG MDLN FIX SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188318318	SUP	HCPCS C1713		188318318  -  SCREW BONE 3.5MM 18MM MTNR TI OCT SPN FIXANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188318320	SUP	HCPCS C1713		188318320  -  SCREW BONE 3.5MM 20MM MTNR TI OCT SPN FIXANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188318324	SUP	HCPCS C1713		188318324  -  SCREW BONE 3.5MM 24MM MTNR TI OCT SPN FIXANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188318412	SUP	HCPCS C1713		188318412  -  SCREW BONE 4MM 12MM MTNR TI OCT SPN FIXANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188318414	SUP	HCPCS C1713		188318414  -  SCREW BONE 4MM 14MM MTNR TI OCT SPN FIXANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188318418	SUP	HCPCS C1713		188318418  -  SCREW BONE 4MM 18MM MTNR TI OCT SPN FIXANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188318420	SUP	HCPCS C1713		188318420  -  SCREW BONE 4MM 20MM MTNR TI OCT SPN FIXANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188318426	SUP	HCPCS C1713		188318426  -  SCREW BONE 4MM 26MM MTNR TI OCT SPN FIXANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188319310	SUP	HCPCS C1713		188319310  -  SCREW BONE 3.5MM 10MM MTNR TI OCT SPN MDLN FIX SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188319312	SUP	HCPCS C1713		188319312  -  SCREW BONE 3.5MM 12MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188319314	SUP	HCPCS C1713		188319314  -  SCREW BONE 3.5MM 14MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188319316	SUP	HCPCS C1713		188319316  -  SCREW BONE 3.5MM 16MM MTNR MDL LAT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188319420	SUP	HCPCS C1713		188319420  -  SCREW BONE 4MM 20MM MTNR TI OCT SPN MDLN FIX SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188319424	SUP	HCPCS C1713		188319424  -  SCREW BONE 4MM 24MM MTNR TI OCT SPN MDLN FIX SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188319426	SUP	HCPCS C1713		188319426  -  SCREW BONE 4MM 26MM MTNR TI OCT SPN MDLN FIX SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188319525	SUP	HCPCS C1713		188319525  -  SCREW BONE 4.35MM 25MM MTNR TI ML OCT SPN FIXANG	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188319530	SUP	HCPCS C1713		188319530  -  SCREW BONE 4.35MM 30MM MTNR TI OCT SPN STRL MDLN FIX SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188319535	SUP	HCPCS C1713		188319535  -  SCREW BONE 4.35MM 35MM FIX ANGLE MOUNTAINEER TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188341021	SUP	HCPCS C1713		188341021  -  PLATE BN 21MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188341028	SUP	HCPCS C1713		188341028  -  PLATE BN 28MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188341035	SUP	HCPCS C1713		188341035  -  PLATE BN 35MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188341042	SUP	HCPCS C1713		188341042  -  PLATE BN 42MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
188341100	SUP	Custom 27803010		188341100  -  NUT OUTR MTNR OCT SPN TI HEAD TO HEAD CX CONECTION	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188341200	SUP	HCPCS C1713		188341200  -  SCREW BONE 3.5MM 200MM MTNR TI OCT SPN INR HEAD TO HEAD CX	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
188341300	SUP	Custom 27803010		188341300  -  CONCTR ROD CX HEAD TO HEAD HOOK	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188342200	SUP	HCPCS C1713		188342200  -  SCREW BONE 3.5MM 20MM MTNR TI OCT SPN INR HEAD TO HEAD CX	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
188362006	SUP	HCPCS C1713		188362006  -  SCREW BONE 4.5MM 6MM MTNR TI OCT SPN	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
188362007	SUP	HCPCS C1713		188362007  -  SCREW BONE 4.5MM 7MM MTNR TI OCT SPN	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
188362008	SUP	HCPCS C1713		188362008  -  SCREW BONE 4.5MM 8MM MTNR TI OCT SPN	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
188362010	SUP	HCPCS C1713		188362010  -  SCREW BONE 4.5MM 10MM MTNR TI OCT SPN	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
188362012	SUP	HCPCS C1713		188362012  -  SCREW BONE 4.5MM 12MM MTNR TI OCT SPN	BOTH IP/OP	$765.00 	$566.10	$0.00	$612.00	$344.25	$344.25	$0.00	$0.00	$0.00	$159.45	$567.78	$567.78	$0.00	$0.00	$159.43	$0.00	$452.50	$452.50	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$119.72	$0.00	$0.00	$121.79	$0.00	$0.00	$0.00	$0.00	$0.00
188362025	SUP	HCPCS C1713		188362025  -  SCREW BONE 4.5MM 25MM MTNR TI OCT SPN	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
188362031	SUP	HCPCS C1713		188362031  -  PLATE BN 31MM NS MTNR SPNE OC 3.5MM SCR	BOTH IP/OP	"$8,130.00 "	"$6,016.20"	$0.00	"$6,504.00"	"$3,658.50"	"$3,658.50"	$0.00	$0.00	$0.00	"$1,694.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,694.29"	$0.00	"$4,008.09"	"$4,008.09"	$0.00	"$4,065.00"	"$6,438.96"	"$6,504.00"	$0.00		$0.00	"$1,272.35"	$0.00	$0.00	"$1,294.30"	$0.00	$0.00	$0.00	$0.00	$0.00
188362106	SUP	HCPCS C1713		188362106  -  SCREW BONE 5.25MM 6MM MTNR TI OCT SPN	BOTH IP/OP	$817.50 	$604.95	$0.00	$654.00	$367.88	$367.88	$0.00	$0.00	$0.00	$170.39	$606.75	$606.75	$0.00	$0.00	$170.37	$0.00	$483.55	$483.55	$0.00	$408.75	$647.46	$654.00	$0.00		$0.00	$127.94	$0.00	$0.00	$130.15	$0.00	$0.00	$0.00	$0.00	$0.00
188363200	SUP	Custom 27803010		188363200  -  ROD SPNL 120MM 3.5MM MTNR TI PREBNT STRL	BOTH IP/OP	$877.50 	$649.35	$0.00	$702.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$651.28	$651.28	$0.00	$0.00	$182.87	$0.00	$0.00	$0.00	$0.00	$438.75	$694.98	$702.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188901040	SUP	Custom 27803010		188901040  -  CAGE SPNL 0D MED 20MM 40-56MM NS LF X-MESH XPD FTPRNT TI	BOTH IP/OP	"$13,737.50 "	"$10,165.75"	$0.00	"$10,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,862.90"	$0.00	$0.00	$0.00	$0.00	"$6,868.75"	"$10,880.10"	"$10,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
188920022	SUP	Custom 27803010		188920022  -  CAGE SPNL 0D SM 16MM 22-30MM NS LF X-MESH XPD FTPRNT TI POST	BOTH IP/OP	"$11,743.75 "	"$8,690.38"	$0.00	"$9,395.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,447.40"	$0.00	$0.00	$0.00	$0.00	"$5,871.88"	"$9,301.05"	"$9,395.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
189401207	SUP	Custom 27803010		189401207  -  CONCTR ROD F7 5.5MM SFX TI MDL SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
189401208	SUP	Custom 27803010		189401208  -  CONCTR ROD F8 5.5MM XPDM SFX CX MDL OFFST TI SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
189401209	SUP	Custom 27803010		189401209  -  CONCTR ROD F9 5.5MM SFX TI MDL SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
189401302	SUP	HCPCS C1713		189401302  -  CONNECTOR ROD A2 5.5MM EXPEDIUM SFX TITANIUM LATERAL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
189401404	SUP	Custom 27803010		189401404  -  CONCTR ROD A4 5.5MM SFX TI MDL SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
189401405	SUP	Custom 27803010		189401405  -  CONCTR ROD A5 MED 5.5MM SFX XLNK TI SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
189401406	SUP	Custom 27803010		189401406  -  CONCTR ROD MED A6 5.5MM SFX XLNK TI SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
189403303	SUP	Custom 27803010		189403303  -  CONCTR ROD A3 6.35MM SFX TI LAT SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
189706012	SUP	HCPCS C1713		189706012  -  SCREW BONE 4.6MM 12MM UNIPLATE 2 TI ANT CERV SPN SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
189707012	SUP	HCPCS C1713		189707012  -  SCREW BONE 4.6MM 12MM UNIPLATE 2 TI ANT CERV SPN SLFDRILL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
189707014	SUP	HCPCS C1713		189707014  -  SCREW BONE 4.6MM 14MM UNIPLATE 2 TI ANT CERV SPN SLFDRILL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
189707015	SUP	HCPCS C1713		189707015  -  SCREW BONE 4.6MM 15MM UNIPLATE 2 TI ANT CERV SPN SLFDRILL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
196789120	SUP	HCPCS C1713		196789120  -  ROD SPINAL STR 120MM VIPER 2 COCR MIS	BOTH IP/OP	"$1,612.50 "	"$1,193.25"	$0.00	"$1,290.00"	$725.63	$725.63	$0.00	$0.00	$0.00	$336.09	"$1,196.80"	"$1,196.80"	$0.00	$0.00	$336.05	$0.00	$953.79	$953.79	$0.00	$806.25	"$1,277.10"	"$1,290.00"	$0.00		$0.00	$252.36	$0.00	$0.00	$256.71	$0.00	$0.00	$0.00	$0.00	$0.00
206710000	SUP	HCPCS C1713		0206710000  -  KIT BN CMNT STRL BIOPREP PREP PLG INSRTR BRSH CURT SCT FEM	BOTH IP/OP	$256.29 	$189.65	$0.00	$205.03	$115.33	$115.33	$0.00	$0.00	$0.00	$53.42	$190.22	$190.22	$0.00	$0.00	$53.41	$0.00	$151.60	$151.60	$0.00	$128.15	$202.98	$205.03	$0.00		$0.00	$40.11	$0.00	$0.00	$40.80	$0.00	$0.00	$0.00	$0.00	$0.00
219501200	SUP	Custom 27203010		00219501200  -  CARRIER GRAFT 1.5 1 PLATEAU GROOVE 8X3IN RATCHET HANDLE	BOTH IP/OP	$81.20 	$60.09	$0.00	$64.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.27	$60.27	$0.00	$0.00	$16.92	$0.00	$0.00	$0.00	$0.00	$40.60	$64.31	$64.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
234020053	SUP	HCPCS C1713		234020053  -  PIN FIX 2.4MM 12IN TROCAR TIPPED EYE LOOP LATEX FREE FEMUR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
234800835	SUP	HCPCS C1713		00234800835  -  SCREW BONE 3.5MM 2.7MM 8MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234802435	SUP	HCPCS C1713		00234802435  -  SCREW BONE 3.5MM 2.7MM 24MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234802835	SUP	HCPCS C1713		00234802835  -  SCREW BONE 3.5MM 2.7MM 28MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234803035	SUP	HCPCS C1713		00234803035  -  SCREW BONE 3.5MM 2.7MM 30MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234803235	SUP	HCPCS C1713		00234803235  -  SCREW BONE 3.5MM 2.7MM 32MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234803435	SUP	HCPCS C1713		00234803435  -  SCREW BONE 3.5MM 2.7MM 34MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234803635	SUP	HCPCS C1713		00234803635  -  SCREW BONE 3.5MM 2.7MM 36MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234803835	SUP	HCPCS C1713		00234803835  -  SCREW BONE 3.5MM 2.7MM 38MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234804035	SUP	HCPCS C1713		00234804035  -  SCREW BONE 3.5MM 2.7MM 40MM SLFTAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234804235	SUP	HCPCS C1713		00234804235  -  SCREW BONE 3.5MM 2.7MM 42MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234804435	SUP	HCPCS C1713		00234804435  -  SCREW BONE 3.5MM 2.7MM 44MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234804635	SUP	HCPCS C1713		00234804635  -  SCREW BONE 3.5MM 2.7MM 46MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234804835	SUP	HCPCS C1713		00234804835  -  SCREW BONE 3.5MM 2.7MM 48MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234805035	SUP	HCPCS C1713		00234805035  -  SCREW BONE 3.5MM 2.7MM 50MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234805235	SUP	HCPCS C1713		00234805235  -  SCREW BONE 3.5MM 2.7MM 52MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234805435	SUP	HCPCS C1713		00234805435  -  SCREW BONE 3.5MM 2.7MM 54MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234805635	SUP	HCPCS C1713		00234805635  -  SCREW BONE 2.5MM 3.5MM 2.7MM 56MM SELF TAP LOCK STAINLESS	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234805835	SUP	HCPCS C1713		00234805835  -  SCREW BONE 3.5MM 2.7MM 58MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234806035	SUP	HCPCS C1713		00234806035  -  SCREW BONE 3.5MM 2.7MM 60MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234806535	SUP	HCPCS C1713		00234806535  -  SCREW BONE 3.5MM 2.7MM 65MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234807035	SUP	HCPCS C1713		00234807035  -  SCREW BONE 3.5MM 2.7MM 70MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234807535	SUP	HCPCS C1713		00234807535  -  SCREW BONE 3.5MM 2.7MM 75MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234808035	SUP	HCPCS C1713		00234808035  -  SCREW BONE 3.5MM 2.7MM 80MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234808535	SUP	HCPCS C1713		00234808535  -  SCREW BONE 3.5MM 2.7MM 85MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234809035	SUP	HCPCS C1713		00234809035  -  SCREW BONE 3.5MM 2.7MM 90MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234809535	SUP	HCPCS C1713		00234809535  -  SCREW BONE 3.5MM 2.7MM 95MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234810035	SUP	HCPCS C1713		00234810035  -  SCREW BONE 3.5MM 2.7MM 100MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234810535	SUP	HCPCS C1713		00234810535  -  SCREW BONE 3.5MM 2.7MM 105MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
234811035	SUP	HCPCS C1713		00234811035  -  SCREW BONE 3.5MM 2.7MM 110MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
235701710	SUP	HCPCS C1713		00235701710  -  PLATE BONE 158MM 10 HOLE LOCK STAINLESS STEEL FIBULA RIGHT	BOTH IP/OP	"$1,404.15 "	"$1,039.07"	$0.00	"$1,123.32"	$631.87	$631.87	$0.00	$0.00	$0.00	$292.66	"$1,042.16"	"$1,042.16"	$0.00	$0.00	$292.62	$0.00	$830.55	$830.55	$0.00	$702.08	"$1,112.09"	"$1,123.32"	$0.00		$0.00	$219.75	$0.00	$0.00	$223.54	$0.00	$0.00	$0.00	$0.00	$0.00
235701808	SUP	HCPCS C1713		00235701808  -  PLATE BONE 132MM 8 HOLE LOCK STAINLESS STEEL FIBULA LEFT	BOTH IP/OP	"$1,319.05 "	$976.10	$0.00	"$1,055.24"	$593.57	$593.57	$0.00	$0.00	$0.00	$274.92	$979.00	$979.00	$0.00	$0.00	$274.89	$0.00	$780.22	$780.22	$0.00	$659.53	"$1,044.69"	"$1,055.24"	$0.00		$0.00	$206.43	$0.00	$0.00	$209.99	$0.00	$0.00	$0.00	$0.00	$0.00
235701810	SUP	HCPCS C1713		00235701810  -  PLATE BONE 158MM 10 HOLE LOCK STAINLESS STEEL FIBULA LEFT	BOTH IP/OP	"$1,404.15 "	"$1,039.07"	$0.00	"$1,123.32"	$631.87	$631.87	$0.00	$0.00	$0.00	$292.66	"$1,042.16"	"$1,042.16"	$0.00	$0.00	$292.62	$0.00	$830.55	$830.55	$0.00	$702.08	"$1,112.09"	"$1,123.32"	$0.00		$0.00	$219.75	$0.00	$0.00	$223.54	$0.00	$0.00	$0.00	$0.00	$0.00
248001040	SUP	HCPCS C1713		00248001040  -  SCREW BONE 4MM 10MM 5MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248001041	SUP	HCPCS C1713		00248001041  -  SCREW BONE FULTHD 4MM 10MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248001240	SUP	HCPCS C1713		00248001240  -  SCREW BONE 4MM 12MM 5MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248001241	SUP	HCPCS C1713		00248001241  -  SCREW BONE FULTHD 4MM 12MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248001440	SUP	HCPCS C1713		00248001440  -  SCREW BONE 4MM 14MM 5MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248001441	SUP	HCPCS C1713		00248001441  -  SCREW BONE FULTHD 4MM 14MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248001640	SUP	HCPCS C1713		00248001640  -  SCREW BONE 4MM 16MM 6MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248001641	SUP	HCPCS C1713		00248001641  -  SCREW BONE FULTHD 4MM 16MM FORTE STAINLESS STEEL	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248001840	SUP	HCPCS C1713		00248001840  -  SCREW BONE 4MM 18MM 7MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248001841	SUP	HCPCS C1713		00248001841  -  SCREW BONE FULTHD 4MM 18MM FORTE STAINLESS STEEL	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248002040	SUP	HCPCS C1713		00248002040  -  SCREW BONE 4MM 20MM 8MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248002041	SUP	HCPCS C1713		00248002041  -  SCREW BONE FULTHD 4MM 20MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248002240	SUP	HCPCS C1713		00248002240  -  SCREW BONE 4MM 22MM 9MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248002241	SUP	HCPCS C1713		00248002241  -  SCREW BONE FULTHD 4MM 22MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248002440	SUP	HCPCS C1713		00248002440  -  SCREW BONE 4MM 24MM 10MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248002441	SUP	HCPCS C1713		00248002441  -  SCREW BONE FULTHD 4MM 24MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248002640	SUP	HCPCS C1713		00248002640  -  SCREW BONE 4MM 26MM 12MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248002641	SUP	HCPCS C1713		00248002641  -  SCREW BONE FULTHD 4MM 26MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248002840	SUP	HCPCS C1713		00248002840  -  SCREW BONE 4MM 28MM 14MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248002841	SUP	HCPCS C1713		00248002841  -  SCREW BONE FULTHD 4MM 28MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248003040	SUP	HCPCS C1713		00248003040  -  SCREW BONE 4MM 30MM 14MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248003041	SUP	HCPCS C1713		00248003041  -  SCREW BONE FULTHD 4MM 30MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248003240	SUP	HCPCS C1713		00248003240  -  SCREW BONE 4MM 32MM 14MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248003241	SUP	HCPCS C1713		00248003241  -  SCREW BONE FULTHD 4MM 32MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248003440	SUP	HCPCS C1713		00248003440  -  SCREW BONE 4MM 34MM 14MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248003441	SUP	HCPCS C1713		00248003441  -  SCREW BONE FULTHD 4MM 34MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248003640	SUP	HCPCS C1713		00248003640  -  SCREW BONE 4MM 36MM 14MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248003641	SUP	HCPCS C1713		00248003641  -  SCREW BONE FULTHD 4MM 36MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248003840	SUP	HCPCS C1713		00248003840  -  SCREW BONE 4MM 38MM 14MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248003841	SUP	HCPCS C1713		00248003841  -  SCREW BONE FULTHD 4MM 38MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248004040	SUP	HCPCS C1713		00248004040  -  SCREW BONE 4MM 40MM 14MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248004041	SUP	HCPCS C1713		00248004041  -  SCREW BONE FULTHD 4MM 40MM FORTE STAINLESS STEEL CANCELLOUS	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
248781032	SUP	Custom 27203010		248781032  -  STATION EYEWASH 17.5X15IN 4 SCREW HOLE SAFETY BOTTLE WALL	BOTH IP/OP	$141.66 	$104.83	$0.00	$113.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.14	$105.14	$0.00	$0.00	$29.52	$0.00	$0.00	$0.00	$0.00	$70.83	$112.19	$113.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
272350250	SUP	HCPCS C1769		272350250  -  GUIDEWIRE ORTHOPEDIC 1.57MM SHARP	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$101.81	$101.81	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
279351100	SUP	Custom 27203010		0279351100  -  ELTRD ESURG 90MM 3.5MM SERFAS ENRG 90D PRB SCT ARTHRO LATEX	BOTH IP/OP	$507.88 	$375.83	$0.00	$406.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$376.94	$376.94	$0.00	$0.00	$105.84	$0.00	$0.00	$0.00	$0.00	$253.94	$402.24	$406.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
279351300	SUP	Custom 27203010		0279351300  -  PROBE SCT 90MM SERFAS ENRG 3.5MM LATEX FREE	BOTH IP/OP	$522.75 	$386.84	$0.00	$418.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$387.99	$387.99	$0.00	$0.00	$108.94	$0.00	$0.00	$0.00	$0.00	$261.38	$414.02	$418.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
283903611	SUP	HCPCS C1894		283903611  -  NEEDLE SPNL 11GA 6IN INTRO CNFD DMD TIP	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$89.60	$89.60	$0.00	$0.00	$0.00	$34.39	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$97.60	$97.60	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
286565001	SUP	Custom 27803010		286565001  -  HOLDER IMPL SWIFT PIN TEMP FIX THRD	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$0.00	$0.00	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
286705200	SUP	Custom 27203010		286705200  -  GWIRE ORTH 1.37MM VPR THRD BLNT DISP	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
286705220	SUP	Custom 27203010		286705220  -  GWIRE ORTH 1.45MM VPR 2 BLNT	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$0.00	$0.00	$0.00	$287.50	$455.40	$460.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
286820012	SUP	Custom 27203010		286820012  -  BIT DRL 2.2MM 12MM NS SKYLINE REUSE ANT CRV PLT SYS	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
286820014	SUP	Custom 27203010		286820014  -  DRILL SURG 14MM	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
286820016	SUP	Custom 27203010		286820016  -  BIT DRILL FLAT 16MM CHUCK SKYLINE DISPOSABLE	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
286850100	SUP	HCPCS C1713		286850100  -  PIN FIX STR TEMPORARY SKYLINE SPN	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
286850200	SUP	HCPCS C1713		286850200  -  PIN FIX 200MM 50MM THREADED TEMPORARY SKYLINE SPN	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
288301114	SUP	Custom 27203010		288301114  -  GUIDE DRILL 14MM FIX	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$0.00	$0.00	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288302030	SUP	Custom 27203010		288302030  -  TAP SURG 3MM	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288302035	SUP	Custom 27203010		288302035  -  TAP SPINAL 3.5MM STAINLESS STEEL DISPOSABLE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288302040	SUP	Custom 27203010		288302040  -  TAP SURG 4MM MOUNTAINEER DISPOSABLE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
288310035	SUP	Custom 27100030		288310035  -  BIT DRILL 3.5MM QC	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$0.00	$0.00	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
292301001	SUP	Custom 27011340		292301001  -  HALTER TRC 19-26IN 3DHLCR HEAD	BOTH IP/OP	"$1,560.00 "	"$1,154.40"	$0.00	"$1,248.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,157.83"	"$1,157.83"	$0.00	$0.00	$325.10	$0.00	$0.00	$0.00	$0.00	$780.00	"$1,235.52"	"$1,248.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
306573000	SUP	HCPCS C1713		306573000  -  KIT BN CMNT ACM BWL CMNT CRTDG FEM NOZ MED PRS 180GM	BOTH IP/OP	"$1,440.03 "	"$1,065.62"	$0.00	"$1,152.02"	$648.01	$648.01	$0.00	$0.00	$0.00	$300.14	"$1,068.79"	"$1,068.79"	$0.00	$0.00	$300.10	$0.00	$990.35	$990.35	$0.00	$720.01	$185.55	"$1,152.02"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
306573000	SUP	HCPCS C1713		0306573000  -  KIT BN CMNT ACM BWL CMNT CRTDG FEM NOZ MED PRS 180GM	BOTH IP/OP	"$1,440.03 "	"$1,065.62"	$0.00	"$1,152.02"	$648.01	$648.01	$0.00	$0.00	$0.00	$300.14	"$1,068.79"	"$1,068.79"	$0.00	$0.00	$300.10	$0.00	$990.35	$990.35	$0.00	$720.01	"$1,140.50"	"$1,152.02"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
321500000	SUP	Custom 27203010		AIRWAY ESPH 5 ADLT ARNC LRYNG MASK CUF CURVE UNQ LF PVC 40ML	BOTH IP/OP	$15.63 	$11.57	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.81	$12.38	$12.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336612008	SUP	Custom 27803010		336612008  -  CAGE SPNL 12MM 8MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336612009	SUP	Custom 27803010		336612009  -  CAGE SPNL 12MM 9MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336612010	SUP	Custom 27803010		336612010  -  CAGE SPNL 12MM 10MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336612011	SUP	Custom 27803010		336612011  -  CAGE SPNL 12MM 11MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336612012	SUP	Custom 27803010		336612012  -  CAGE SPNL 12MM 12MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336612040	SUP	Custom 27803010		336612040  -  CAGE SPNL 12MM 40MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336612080	SUP	Custom 27803010		336612080  -  CAGE SPNL 12MM 80MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336614008	SUP	Custom 27803010		336614008  -  CAGE SPNL 14MM 8MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336614009	SUP	Custom 27803010		336614009  -  CAGE SPNL 14MM 9MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336614010	SUP	Custom 27803010		336614010  -  CAGE SPNL 14MM 10MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336614011	SUP	Custom 27803010		336614011  -  CAGE SPNL 14MM 11MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336614012	SUP	Custom 27803010		336614012  -  CAGE SPNL 14MM 12MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336614040	SUP	Custom 27803010		336614040  -  CAGE SPNL 14MM 40MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336614080	SUP	Custom 27803010		336614080  -  CAGE SPNL 14MM 80MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336616040	SUP	Custom 27803010		336616040  -  CAGE SPNL 16MM 40MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336616080	SUP	Custom 27803010		336616080  -  CAGE SPNL 16MM 80MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336620040	SUP	Custom 27803010		336620040  -  CAGE SPNL 20MM 40MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336620080	SUP	Custom 27803010		336620080  -  CAGE SPNL 20MM 80MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336620120	SUP	Custom 27803010		336620120  -  CAGE SPNL 20MM 120MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336625040	SUP	Custom 27803010		336625040  -  CAGE SPNL 25MM 40MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336625080	SUP	Custom 27803010		336625080  -  CAGE SPNL 25MM 80MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
336625120	SUP	Custom 27803010		336625120  -  CAGE SPNL 25MM 120MM VBOSS TI THORLMBR INTRBD FS	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	$0.00	$0.00	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
380544150	SUP	Custom 27203010		380544150  -  CUTTER ENDSCP ANG AGRS+ FRML 4.5MM	BOTH IP/OP	$238.00 	$176.12	$0.00	$190.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.64	$176.64	$0.00	$0.00	$49.60	$0.00	$0.00	$0.00	$0.00	$119.00	$188.50	$190.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
381003004	SUP	HCPCS C1773		381003004  -  KIT SNR 3.2FR 2-4MM 175CM 150CM ATRIEVE VASC SNR 3 LOOP SHRT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$678.75	$678.75	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
381003008	SUP	HCPCS C1773		381003008  -  KIT SNR 15D 3.2FR 4-8MM 175CM 150CM ATRIEVE VASC SNR 3 SHRT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$678.75	$678.75	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
382006010	SUP	HCPCS C1773		382006010  -  KIT SNR 6-10MM 6FR .062IN 120CM 100CM ATRIEVE VASC SNR 3	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$373.31	$373.31	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
382006015	SUP	HCPCS C1773		382006015  -  KIT SNR 9-15MM 6FR .062IN 120CM 100CM ATRIEVE VASC SNR 3	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$373.31	$373.31	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
382006020	SUP	HCPCS C1757		382006020  -  SNARE VASC STD 12-20MM 6FR 120CM 100CM ENSNR CATH	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
382007030	SUP	HCPCS C1773		382007030  -  KIT SNR MN 18-30MM 7FR 120CM 100CM ATRIEVE VASC SNR DLV CATH	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$373.31	$373.31	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
382007045	SUP	HCPCS C1773		382007045  -  KIT SNR 27-45MM 7FR 120MM 100MM ATRIEVE VASC SNR DLV CATH	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$373.31	$373.31	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
382412000	SUP	Custom 27203010		382412000  -  KNEE  IMMOBILIZER MEDIUM	BOTH IP/OP	$48.24 	$35.70	$0.00	$38.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.80	$35.80	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$24.12	$38.21	$38.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
392006015	SUP	Custom 27203010		SYSTEM SNARE 9 15MM TRIPLE LOOP STANDARD	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
408831100	SUP	Custom 27203010		0408831100  -  TOGA SRG XL FLYTE SURGICOOL PLWY ZP	BOTH IP/OP	$27.27 	$20.18	$0.00	$21.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.24	$20.24	$0.00	$0.00	$5.68	$0.00	$0.00	$0.00	$0.00	$13.64	$21.60	$21.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
436020300	SUP	HCPCS C1713		436020300  -  ENDCAP 436020300 EXTNDED 20 X 30MM 0 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436020305	SUP	HCPCS C1713		436020305  -  ENDCAP 436020305 EXTND 20 X 30MM 15 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436020350	SUP	HCPCS C1713		436020350  -  ENDCAP 436020350 EXTNDED 20 X 35MM 0 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436020355	SUP	HCPCS C1713		436020355  -  ENDCAP 436020355 EXTND 20 X 35MM 15 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436020400	SUP	HCPCS C1713		436020400  -  ENDCAP 436020400 EXTNDED 20 X 40MM 0 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436020405	SUP	HCPCS C1713		436020405  -  ENDCAP 436020405 EXTND 20 X 40MM 15 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436020450	SUP	HCPCS C1713		436020450  -  ENDCAP 436020450 EXTNDED 20 X 45MM 0 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436020455	SUP	HCPCS C1713		436020455  -  ENDCAP 436020455 EXTND 20 X 45MM 15 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436025300	SUP	HCPCS C1713		436025300  -  ENDCAP 436025300 EXTNDED 25 X 30MM 0 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436025305	SUP	HCPCS C1713		436025305  -  ENDCAP 436025305 EXTND 25 X 30MM 15 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436025350	SUP	HCPCS C1713		436025350  -  ENDCAP 436025350 EXTNDED 25 X 35MM 0 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436025355	SUP	HCPCS C1713		436025355  -  ENDCAP 436025355 EXTND 25 X 35MM 15 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436025400	SUP	HCPCS C1713		436025400  -  ENDCAP 436025400 EXTNDED 25 X 40MM 0 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436025405	SUP	HCPCS C1713		436025405  -  ENDCAP 436025405 EXTND 25 X 40MM 15 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436025450	SUP	HCPCS C1713		436025450  -  ENDCAP 436025450 EXTNDED 25 X 45MM 0 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436025455	SUP	HCPCS C1713		436025455  -  ENDCAP 436025455 EXTND 25 X 45MM 15 DEG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436120300	SUP	HCPCS C1713		436120300  -  ENDCAP 436120300 EXTENDED 20 X 30MM STER	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436120305	SUP	HCPCS C1713		436120305  -  ENDCAP 436120305 EXTND 20X30MM 15 DEG ST	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436120350	SUP	HCPCS C1713		436120350  -  ENDCAP 436120350 EXTENDED 20 X 35MM STER	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436120355	SUP	HCPCS C1713		436120355  -  ENDCAP 436120355 EXTND 20X35MM 15 DEG ST	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436120400	SUP	HCPCS C1713		436120400  -  ENDCAP 436120400 EXTENDED 20 X 40MM STER	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436120405	SUP	HCPCS C1713		436120405  -  ENDCAP 436120405 EXTND 20X40MM 15 DEG ST	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436120450	SUP	HCPCS C1713		436120450  -  ENDCAP 436120450 EXTENDED 20 X 45MM STER	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436120455	SUP	HCPCS C1713		436120455  -  ENDCAP 436120455 EXTND 20X45MM 15 DEG ST	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436125300	SUP	HCPCS C1713		436125300  -  ENDCAP 436125300 EXTENDED 25 X 30MM STER	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436125305	SUP	HCPCS C1713		436125305  -  ENDCAP 436125305 EXTND 25X30MM 15 DEG ST	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436125350	SUP	HCPCS C1713		436125350  -  ENDCAP 436125350 EXTENDED 25 X 35MM STER	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436125355	SUP	HCPCS C1713		436125355  -  ENDCAP 436125355 EXTND 25X35MM 15 DEG ST	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436125400	SUP	HCPCS C1713		436125400  -  ENDCAP 436125400 EXTENDED 25 X 40MM STER	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436125405	SUP	HCPCS C1713		436125405  -  ENDCAP 436125405 EXTND 25X40MM 15 DEG ST	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436125450	SUP	HCPCS C1713		436125450  -  ENDCAP 436125450 EXTENDED 25 X 45MM STER	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
436125455	SUP	HCPCS C1713		436125455  -  ENDCAP 436125455 EXTND 25X45MM 15 DEG ST	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
480316022	SUP	HCPCS C1713		480316022  -  SCREW BONE LONG STANDARD 6MM 22MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316025	SUP	HCPCS C1713		480316025  -  SCREW BONE LONG STANDARD 6MM 25MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316028	SUP	HCPCS C1713		480316028  -  SCREW BONE LONG STANDARD 6MM 28MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316031	SUP	HCPCS C1713		480316031  -  SCREW BONE LONG STANDARD 6MM 31MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316034	SUP	HCPCS C1713		480316034  -  SCREW BONE LONG STANDARD 6MM 34MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316037	SUP	HCPCS C1713		480316037  -  SCREW BONE LONG STANDARD 6MM 37MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316040	SUP	HCPCS C1713		480316040  -  SCREW BONE LONG STANDARD 6MM 40MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316043	SUP	HCPCS C1713		480316043  -  SCREW BONE LONG STANDARD 6MM 43MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316046	SUP	HCPCS C1713		480316046  -  SCREW BONE LONG STANDARD 6MM 46MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316049	SUP	HCPCS C1713		480316049  -  SCREW BONE LONG STANDARD 6MM 49MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316052	SUP	HCPCS C1713		480316052  -  SCREW BONE LONG STANDARD 6MM 52MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316055	SUP	HCPCS C1713		480316055  -  SCREW BONE LONG STANDARD 6MM 55MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316058	SUP	HCPCS C1713		480316058  -  SCREW BONE LONG STANDARD 6MM 58MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316061	SUP	HCPCS C1713		480316061  -  SCREW BONE LONG STANDARD 6MM 61MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316064	SUP	HCPCS C1713		480316064  -  SCREW BONE LONG STANDARD 6MM 64MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316067	SUP	HCPCS C1713		480316067  -  SCREW BONE LONG STANDARD 6MM 67MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316522	SUP	HCPCS C1713		480316522  -  SCREW BONE STANDARD 6.5MM 22MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316525	SUP	HCPCS C1713		480316525  -  SCREW BONE STANDARD 6.5MM 25MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316528	SUP	HCPCS C1713		480316528  -  SCREW BONE STANDARD 6.5MM 28MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316531	SUP	HCPCS C1713		480316531  -  SCREW BONE STANDARD 6.5MM 31MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316534	SUP	HCPCS C1713		480316534  -  SCREW BONE STANDARD 6.5MM 34MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316537	SUP	HCPCS C1713		480316537  -  SCREW BONE STANDARD 6.5MM 37MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316540	SUP	HCPCS C1713		480316540  -  SCREW BONE LONG STANDARD 6.5MM 40MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316543	SUP	HCPCS C1713		480316543  -  SCREW BONE LONG STANDARD 6.5MM 43MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316546	SUP	HCPCS C1713		480316546  -  SCREW BONE LONG STANDARD 6.5MM 46MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316549	SUP	HCPCS C1713		480316549  -  SCREW BONE LONG STANDARD 6.5MM 49MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316552	SUP	HCPCS C1713		480316552  -  SCREW BONE LONG STANDARD 6.5MM 52MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316555	SUP	HCPCS C1713		480316555  -  SCREW BONE LONG STANDARD 6.5MM 55MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316558	SUP	HCPCS C1713		480316558  -  SCREW BONE LONG STANDARD 6.5MM 58MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316561	SUP	HCPCS C1713		480316561  -  SCREW BONE LONG STANDARD 6.5MM 61MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316564	SUP	HCPCS C1713		480316564  -  SCREW BONE LONG STANDARD 6.5MM 64MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
480316567	SUP	HCPCS C1713		480316567  -  SCREW BONE LONG STANDARD 6.5MM 67MM SPN THORACIC	BOTH IP/OP	$914.88 	$677.01	$0.00	$731.90	$411.69	$411.69	$0.00	$0.00	$0.00	$190.68	$679.02	$679.02	$0.00	$0.00	$190.66	$0.00	$541.15	$541.15	$0.00	$457.44	$724.58	$731.90	$0.00		$0.00	$143.18	$0.00	$0.00	$145.65	$0.00	$0.00	$0.00	$0.00	$0.00
481322040	SUP	HCPCS C1713		481322040  -  ROD SPNL 4.5MM 40MM NS LF XIA PREBNT PCUT VIT SPNE	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
481322050	SUP	HCPCS C1713		481322050  -  ROD SPNL 50MM 4.5MM XIA PREBNT VIT PCUT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
481322070	SUP	HCPCS C1713		481322070  -  ROD SPNL PREBNT HEX 4.5MM 70MM PCUT VITALIUM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
482204020	SUP	HCPCS C1713		482204020  -  SCREW BONE 4MM 20MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
482204025	SUP	HCPCS C1713		482204025  -  SCREW BONE 4MM 25MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
482204030	SUP	HCPCS C1713		482204030  -  SCREW BONE 4MM 30MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
482204035	SUP	HCPCS C1713		482204035  -  SCREW BONE 4MM 35MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
482204040	SUP	HCPCS C1713		482204040  -  SCREW BONE 4MM 40MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
482205025	SUP	HCPCS C1713		482205025  -  SCREW BONE 5MM 25MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
482205030	SUP	HCPCS C1713		482205030  -  SCREW BONE 5MM 30MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
482205035	SUP	HCPCS C1713		482205035  -  SCREW BONE 5MM 35MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
482205040	SUP	HCPCS C1713		482205040  -  SCREW BONE 5MM 40MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
482205045	SUP	HCPCS C1713		482205045  -  SCREW BONE 5MM 45MM MNOAX XIA STAINLESS STEEL SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
482214020	SUP	HCPCS C1713		482214020  -  SCREW BONE 4MM 20MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	"$2,581.88"	"$2,581.88"	$0.00	$0.00	$0.00	"$1,195.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	"$2,828.59"	"$2,828.59"	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$897.92	$0.00	$0.00	$913.41	$0.00	$0.00	$0.00	$0.00	$0.00
482214025	SUP	HCPCS C1713		482214025  -  SCREW BONE 4MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	"$2,581.88"	"$2,581.88"	$0.00	$0.00	$0.00	"$1,195.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	"$2,828.59"	"$2,828.59"	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$897.92	$0.00	$0.00	$913.41	$0.00	$0.00	$0.00	$0.00	$0.00
482214030	SUP	HCPCS C1713		482214030  -  SCREW BONE 4MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	"$2,581.88"	"$2,581.88"	$0.00	$0.00	$0.00	"$1,195.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	"$2,828.59"	"$2,828.59"	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$897.92	$0.00	$0.00	$913.41	$0.00	$0.00	$0.00	$0.00	$0.00
482214035	SUP	HCPCS C1713		482214035  -  SCREW BONE 4MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
482214040	SUP	HCPCS C1713		482214040  -  SCREW BONE 4MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
482215025	SUP	HCPCS C1713		482215025  -  SCREW BONE 5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
482215030	SUP	HCPCS C1713		482215030  -  SCREW BONE 5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
482215035	SUP	HCPCS C1713		482215035  -  SCREW BONE 5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	"$2,379.38"	"$2,379.38"	$0.00	$0.00	$0.00	"$1,102.05"	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	"$2,606.74"	"$2,606.74"	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$827.49	$0.00	$0.00	$841.77	$0.00	$0.00	$0.00	$0.00	$0.00
482215040	SUP	HCPCS C1713		482215040  -  SCREW BONE 5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
482215045	SUP	HCPCS C1713		482215045  -  SCREW BONE 5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
482301500	SUP	HCPCS C1713		482301500  -  SCREW BONE 1.5MM 100MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
482301540	SUP	HCPCS C1713		482301540  -  SCREW BONE 1.5MM 40MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
482301545	SUP	HCPCS C1713		482301545  -  SCREW BONE 1.5MM 45MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
482301550	SUP	HCPCS C1713		482301550  -  SCREW BONE 1.5MM 50MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
482301555	SUP	HCPCS C1713		482301555  -  SCREW BONE 1.5MM 55MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
482301560	SUP	HCPCS C1713		482301560  -  SCREW BONE 1.5MM 60MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
482301565	SUP	HCPCS C1713		482301565  -  SCREW BONE 1.5MM 65MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
482301570	SUP	HCPCS C1713		482301570  -  SCREW BONE 1.5MM 70MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
482301580	SUP	HCPCS C1713		482301580  -  SCREW BONE 1.5MM 80MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
482301590	SUP	HCPCS C1713		482301590  -  SCREW BONE 1.5MM 90MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
482304020	SUP	HCPCS C1713		482304020  -  SCREW BONE 4MM 20MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482304025	SUP	HCPCS C1713		482304025  -  SCREW BONE 4MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482304030	SUP	HCPCS C1713		482304030  -  SCREW BONE 4MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482304035	SUP	HCPCS C1713		482304035  -  SCREW BONE 4MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482304040	SUP	HCPCS C1713		482304040  -  SCREW BONE 4MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482304045	SUP	HCPCS C1713		482304045  -  SCREW BONE 4MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482304520	SUP	HCPCS C1713		482304520  -  SCREW BONE 4.5MM 20MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482304525	SUP	HCPCS C1713		482304525  -  SCREW BONE 4.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482304530	SUP	HCPCS C1713		482304530  -  SCREW BONE 4.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482304535	SUP	HCPCS C1713		482304535  -  SCREW BONE 4.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482304540	SUP	HCPCS C1713		482304540  -  SCREW BONE 4.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482304545	SUP	HCPCS C1713		482304545  -  SCREW BONE 4.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305020	SUP	HCPCS C1713		482305020  -  SCREW BONE 5MM 20MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305025	SUP	HCPCS C1713		482305025  -  SCREW BONE 5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305030	SUP	HCPCS C1713		482305030  -  SCREW BONE 5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305035	SUP	HCPCS C1713		482305035  -  SCREW BONE 5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305040	SUP	HCPCS C1713		482305040  -  SCREW BONE 5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305045	SUP	HCPCS C1713		482305045  -  SCREW BONE 5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305050	SUP	HCPCS C1713		482305050  -  SCREW BONE 5MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305525	SUP	HCPCS C1713		482305525  -  SCREW BONE 5.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305530	SUP	HCPCS C1713		482305530  -  SCREW BONE 5.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305535	SUP	HCPCS C1713		482305535  -  SCREW BONE 5.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305540	SUP	HCPCS C1713		482305540  -  SCREW BONE 5.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305545	SUP	HCPCS C1713		482305545  -  SCREW BONE 5.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305550	SUP	HCPCS C1713		482305550  -  SCREW BONE 5.5MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482305555	SUP	HCPCS C1713		482305555  -  SCREW BONE 5.5MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306025	SUP	HCPCS C1713		482306025  -  SCREW BONE 6MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306030	SUP	HCPCS C1713		482306030  -  SCREW BONE 6MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306035	SUP	HCPCS C1713		482306035  -  SCREW BONE 6MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306040	SUP	HCPCS C1713		482306040  -  SCREW BONE 6MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306045	SUP	HCPCS C1713		482306045  -  SCREW BONE 6MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306050	SUP	HCPCS C1713		482306050  -  SCREW BONE 6MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306055	SUP	HCPCS C1713		482306055  -  SCREW BONE 6MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306060	SUP	HCPCS C1713		482306060  -  SCREW BONE 6MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306065	SUP	HCPCS C1713		482306065  -  SCREW BONE 6MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306070	SUP	HCPCS C1713		482306070  -  SCREW BONE 6MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306080	SUP	HCPCS C1713		482306080  -  SCREW BONE 6MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306090	SUP	HCPCS C1713		482306090  -  SCREW BONE 6MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306525	SUP	HCPCS C1713		482306525  -  SCREW BONE 6.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306530	SUP	HCPCS C1713		482306530  -  SCREW BONE 6.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306535	SUP	HCPCS C1713		482306535  -  SCREW BONE 6.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306540	SUP	HCPCS C1713		482306540  -  SCREW BONE 6.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306545	SUP	HCPCS C1713		482306545  -  SCREW BONE 6.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306550	SUP	HCPCS C1713		482306550  -  SCREW BONE 6.5MM 50MM MULTIAX XIA 3 TITANIUM SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306555	SUP	HCPCS C1713		482306555  -  SCREW BONE 6.5MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306560	SUP	HCPCS C1713		482306560  -  SCREW BONE 6.5MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306565	SUP	HCPCS C1713		482306565  -  SCREW BONE 6.5MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306570	SUP	HCPCS C1713		482306570  -  SCREW BONE 6.5MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306580	SUP	HCPCS C1713		482306580  -  SCREW BONE 6.5MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482306590	SUP	HCPCS C1713		482306590  -  SCREW BONE 6.5MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307025	SUP	HCPCS C1713		482307025  -  SCREW BONE 7MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307030	SUP	HCPCS C1713		482307030  -  SCREW BONE 7MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307035	SUP	HCPCS C1713		482307035  -  SCREW BONE 7MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307040	SUP	HCPCS C1713		482307040  -  SCREW BONE 7MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307045	SUP	HCPCS C1713		482307045  -  SCREW BONE 7MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307050	SUP	HCPCS C1713		482307050  -  SCREW BONE 7MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307055	SUP	HCPCS C1713		482307055  -  SCREW BONE 7MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307060	SUP	HCPCS C1713		482307060  -  SCREW BONE 7MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307065	SUP	HCPCS C1713		482307065  -  SCREW BONE 7MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307070	SUP	HCPCS C1713		482307070  -  SCREW BONE 7MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307080	SUP	HCPCS C1713		482307080  -  SCREW BONE 7MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307090	SUP	HCPCS C1713		482307090  -  SCREW BONE 7MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307525	SUP	HCPCS C1713		482307525  -  SCREW BONE 7.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307530	SUP	HCPCS C1713		482307530  -  SCREW BONE 7.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307535	SUP	HCPCS C1713		482307535  -  SCREW BONE 7.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307540	SUP	HCPCS C1713		482307540  -  SCREW BONE 7.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307545	SUP	HCPCS C1713		482307545  -  SCREW BONE 7.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307550	SUP	HCPCS C1713		482307550  -  SCREW BONE 7.5MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307555	SUP	HCPCS C1713		482307555  -  SCREW BONE 7.5MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307560	SUP	HCPCS C1713		482307560  -  SCREW BONE 7.5MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307565	SUP	HCPCS C1713		482307565  -  SCREW BONE 7.5MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307570	SUP	HCPCS C1713		482307570  -  SCREW BONE 7.5MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307580	SUP	HCPCS C1713		482307580  -  SCREW BONE 7.5MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482307590	SUP	HCPCS C1713		482307590  -  SCREW BONE 7.5MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308500	SUP	HCPCS C1713		482308500  -  SCREW BONE 8.5MM 100MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308525	SUP	HCPCS C1713		482308525  -  SCREW BONE 8.5MM 25MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308530	SUP	HCPCS C1713		482308530  -  SCREW BONE 8.5MM 30MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308535	SUP	HCPCS C1713		482308535  -  SCREW BONE 8.5MM 35MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308540	SUP	HCPCS C1713		482308540  -  SCREW BONE 8.5MM 40MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308545	SUP	HCPCS C1713		482308545  -  SCREW BONE 8.5MM 45MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308550	SUP	HCPCS C1713		482308550  -  SCREW BONE 8.5MM 50MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308555	SUP	HCPCS C1713		482308555  -  SCREW BONE 8.5MM 55MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308560	SUP	HCPCS C1713		482308560  -  SCREW BONE 8.5MM 60MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308565	SUP	HCPCS C1713		482308565  -  SCREW BONE 8.5MM 65MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308570	SUP	HCPCS C1713		482308570  -  SCREW BONE 8.5MM 70MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308580	SUP	HCPCS C1713		482308580  -  SCREW BONE 8.5MM 80MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482308590	SUP	HCPCS C1713		482308590  -  SCREW BONE 8.5MM 90MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482309500	SUP	HCPCS C1713		482309500  -  SCREW BONE 9.5MM 100MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482309540	SUP	HCPCS C1713		482309540  -  SCREW BONE 9.5MM 40MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482309545	SUP	HCPCS C1713		482309545  -  SCREW BONE 9.5MM 45MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482309550	SUP	HCPCS C1713		482309550  -  SCREW BONE 9.5MM 50MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482309555	SUP	HCPCS C1713		482309555  -  SCREW BONE 9.5MM 55MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482309560	SUP	HCPCS C1713		482309560  -  SCREW BONE 9.5MM 60MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482309565	SUP	HCPCS C1713		482309565  -  SCREW BONE 9.5MM 65MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482309570	SUP	HCPCS C1713		482309570  -  SCREW BONE 9.5MM 70MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482309580	SUP	HCPCS C1713		482309580  -  SCREW BONE 9.5MM 80MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482309590	SUP	HCPCS C1713		482309590  -  SCREW BONE 9.5MM 90MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
482311500	SUP	HCPCS C1713		482311500  -  SCREW BONE 1.5MM 100MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482311540	SUP	HCPCS C1713		482311540  -  SCREW BONE 1.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482311545	SUP	HCPCS C1713		482311545  -  SCREW BONE 1.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482311550	SUP	HCPCS C1713		482311550  -  SCREW BONE 1.5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482311555	SUP	HCPCS C1713		482311555  -  SCREW BONE 1.5MM 55MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482311560	SUP	HCPCS C1713		482311560  -  SCREW BONE 1.5MM 60MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482311565	SUP	HCPCS C1713		482311565  -  SCREW BONE 1.5MM 65MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482311570	SUP	HCPCS C1713		482311570  -  SCREW BONE 1.5MM 70MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482311580	SUP	HCPCS C1713		482311580  -  SCREW BONE 1.5MM 80MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482311590	SUP	HCPCS C1713		482311590  -  SCREW BONE 1.5MM 90MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482314020	SUP	HCPCS C1713		482314020  -  SCREW BONE 4MM 20MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482314025	SUP	HCPCS C1713		482314025  -  SCREW BONE 4MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482314030	SUP	HCPCS C1713		482314030  -  SCREW BONE 4MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482314035	SUP	HCPCS C1713		482314035  -  SCREW BONE 4MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482314040	SUP	HCPCS C1713		482314040  -  SCREW BONE 4MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482314045	SUP	HCPCS C1713		482314045  -  SCREW BONE 4MM 45MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482314520	SUP	HCPCS C1713		482314520  -  SCREW BONE 4.5MM 20MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482314525	SUP	HCPCS C1713		482314525  -  SCREW BONE 4.5MM 25MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482314530	SUP	HCPCS C1713		482314530  -  SCREW BONE 4.5MM 30MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482314535	SUP	HCPCS C1713		482314535  -  SCREW BONE 4.5MM 35MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482314540	SUP	HCPCS C1713		482314540  -  SCREW BONE 4.5MM 40MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482314545	SUP	HCPCS C1713		482314545  -  SCREW BONE 4.5MM 45MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315020	SUP	HCPCS C1713		482315020  -  SCREW BONE 5MM 20MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315025	SUP	HCPCS C1713		482315025  -  SCREW BONE 5MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315030	SUP	HCPCS C1713		482315030  -  SCREW BONE 5MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315035	SUP	HCPCS C1713		482315035  -  SCREW BONE 5MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315040	SUP	HCPCS C1713		482315040  -  SCREW BONE 5MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315045	SUP	HCPCS C1713		482315045  -  SCREW BONE 5MM 45MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315050	SUP	HCPCS C1713		482315050  -  SCREW BONE 5MM 50MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315525	SUP	HCPCS C1713		482315525  -  SCREW BONE 5.5MM 25MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315530	SUP	HCPCS C1713		482315530  -  SCREW BONE 5.5MM 30MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315535	SUP	HCPCS C1713		482315535  -  SCREW BONE 5.5MM 35MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315540	SUP	HCPCS C1713		482315540  -  SCREW BONE 5.5MM 40MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315545	SUP	HCPCS C1713		482315545  -  SCREW BONE 5.5MM 45MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315550	SUP	HCPCS C1713		482315550  -  SCREW BONE 5.5MM 50MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482315555	SUP	HCPCS C1713		482315555  -  SCREW BONE 5.5MM 55MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316025	SUP	HCPCS C1713		482316025  -  SCREW BONE 6MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316030	SUP	HCPCS C1713		482316030  -  SCREW BONE 6MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316035	SUP	HCPCS C1713		482316035  -  SCREW BONE 6MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316040	SUP	HCPCS C1713		482316040  -  SCREW BONE 6MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316045	SUP	HCPCS C1713		482316045  -  SCREW BN 6MM 50MM XIA 3 PA TI SPNE THORLMBR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316050	SUP	HCPCS C1713		482316050  -  SCREW BONE 6MM 50MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316055	SUP	HCPCS C1713		482316055  -  SCREW BONE 6MM 55MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316060	SUP	HCPCS C1713		482316060  -  SCREW BONE 6MM 60MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316065	SUP	HCPCS C1713		482316065  -  SCREW BN 6MM 70MM XIA 3 PA TI SPNE THORLMBR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316070	SUP	HCPCS C1713		482316070  -  SCREW BONE 6MM 70MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316080	SUP	HCPCS C1713		482316080  -  SCREW BONE 6MM 80MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316090	SUP	HCPCS C1713		482316090  -  SCREW BONE 6MM 90MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316525	SUP	HCPCS C1713		482316525  -  SCREW BONE 6.5MM 25MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316530	SUP	HCPCS C1713		482316530  -  SCREW BONE 6.5MM 30MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316535	SUP	HCPCS C1713		482316535  -  SCREW BONE 6.5MM 35MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316540	SUP	HCPCS C1713		482316540  -  SCREW BONE 6.5MM 40MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316545	SUP	HCPCS C1713		482316545  -  SCREW BONE 6.5MM 45MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316550	SUP	HCPCS C1713		482316550  -  SCREW BONE 6.5MM 50MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316555	SUP	HCPCS C1713		482316555  -  SCREW BONE 6.5MM 55MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316560	SUP	HCPCS C1713		482316560  -  SCREW BONE 6.5MM 60MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316565	SUP	HCPCS C1713		482316565  -  SCREW BONE 6.5MM 65MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316570	SUP	HCPCS C1713		482316570  -  SCREW BONE 6.5MM 70MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316580	SUP	HCPCS C1713		482316580  -  SCREW BONE 6.5MM 80MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482316590	SUP	HCPCS C1713		482316590  -  SCREW BONE 6.5MM 90MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317025	SUP	HCPCS C1713		482317025  -  SCREW BONE 7MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317030	SUP	HCPCS C1713		482317030  -  SCREW BONE 7MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317035	SUP	HCPCS C1713		482317035  -  SCREW BONE 7MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317040	SUP	HCPCS C1713		482317040  -  SCREW BONE 7MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317045	SUP	HCPCS C1713		482317045  -  SCREW BONE 7MM 45MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317050	SUP	HCPCS C1713		482317050  -  SCREW BONE 7MM 50MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317055	SUP	HCPCS C1713		482317055  -  SCREW BONE 7MM 55MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317060	SUP	HCPCS C1713		482317060  -  SCREW BONE 7MM 60MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317065	SUP	HCPCS C1713		482317065  -  SCREW BONE 7MM 65MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317070	SUP	HCPCS C1713		482317070  -  SCREW BONE 7MM 70MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317080	SUP	HCPCS C1713		482317080  -  SCREW BONE 7MM 80MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317090	SUP	HCPCS C1713		482317090  -  SCREW BONE 7MM 90MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317525	SUP	HCPCS C1713		482317525  -  SCREW BONE 7.5MM 25MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317530	SUP	HCPCS C1713		482317530  -  SCREW BONE 7.5MM 30MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317535	SUP	HCPCS C1713		482317535  -  SCREW BONE 7.5MM 35MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317540	SUP	HCPCS C1713		482317540  -  SCREW BONE 7.5MM 40MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317545	SUP	HCPCS C1713		482317545  -  SCREW BONE 7.5MM 45MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317550	SUP	HCPCS C1713		482317550  -  SCREW BONE 7.5MM 55MM CANN XIA TITANIUM SPN THORACOLUMBAR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317555	SUP	HCPCS C1713		482317555  -  SCREW BONE 7.5MM 55MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317560	SUP	HCPCS C1713		482317560  -  SCREW BONE 7.5MM 60MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317565	SUP	HCPCS C1713		482317565  -  SCREW BONE 7.5MM 65MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317570	SUP	HCPCS C1713		482317570  -  SCREW BONE 7.5MM 70MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317580	SUP	HCPCS C1713		482317580  -  SCREW BONE 7.5MM 80MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482317590	SUP	HCPCS C1713		482317590  -  SCREW BONE 7.5MM 90MM POLYAX XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318500	SUP	HCPCS C1713		482318500  -  SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318525	SUP	HCPCS C1713		482318525  -  SCREW BONE 8.5MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318530	SUP	HCPCS C1713		482318530  -  SCREW BONE 8.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318535	SUP	HCPCS C1713		482318535  -  SCREW BONE 8.5MM 35MM XIA 3 TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318540	SUP	HCPCS C1713		482318540  -  SCREW BONE 8.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318545	SUP	HCPCS C1713		482318545  -  SCREW BONE 8.5MM 45MM POLYAX REVISION SPN ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318550	SUP	HCPCS C1713		482318550  -  SCREW BONE 8.5MM 50MM POLYAX REVISION SPN ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318555	SUP	HCPCS C1713		482318555  -  SCREW BONE 8.5MM 55MM POLYAX REVISION SPN ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318560	SUP	HCPCS C1713		482318560  -  SCREW BONE 8.5MM 60MM REVISION POLYAX SPN PEDICLE	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318565	SUP	HCPCS C1713		482318565  -  SCREW BONE 8.5MM 65MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318570	SUP	HCPCS C1713		482318570  -  BOLT SPINAL 8.5MM 70MM POLYAX XIA ILIUM	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318580	SUP	HCPCS C1713		482318580  -  SCREW BONE 80MM XIA TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482318590	SUP	HCPCS C1713		482318590  -  SCREW BN 9.5MM 100MM REV PA ILSCRL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482319500	SUP	HCPCS C1713		482319500  -  SCREW BONE 9.5MM 100MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482319540	SUP	HCPCS C1713		482319540  -  SCREW BONE 9.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482319545	SUP	HCPCS C1713		482319545  -  SCREW BONE 9.5MM 45MM POLYAX REVISION SPN ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482319550	SUP	HCPCS C1713		482319550  -  SCREW BONE 9.5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482319555	SUP	HCPCS C1713		482319555  -  SCREW BONE 9.5MM 55MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482319560	SUP	HCPCS C1713		482319560  -  SCREW BONE 9.5MM 60MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482319565	SUP	HCPCS C1713		482319565  -  SCREW BONE 9.5MM 65MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482319570	SUP	HCPCS C1713		482319570  -  SCREW BONE 9.5MM 70MM POLYAX RED PROFILE REVISION XIA SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482319580	SUP	HCPCS C1713		482319580  -  SCREW BONE 9.5MM 80MM POLYAX RED PROFILE REVISION XIA SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482319590	SUP	HCPCS C1713		482319590  -  SCREW BONE 9.5MM 90MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482326500	SUP	HCPCS C1713		482326500  -  SCREW BONE 6.5MM 100MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482326530	SUP	HCPCS C1713		482326530  -  SCREW BONE 6.5MM 30MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482326535	SUP	HCPCS C1713		482326535  -  SCREW BONE 6.5MM 35MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482326540	SUP	HCPCS C1713		482326540  -  SCREW BONE 6.5MM 40MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482326545	SUP	HCPCS C1713		482326545  -  SCREW BONE 6.5MM 45MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482326550	SUP	HCPCS C1713		482326550  -  SCREW BONE 6.5MM 50MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482326555	SUP	HCPCS C1713		482326555  -  SCREW BONE 6.5MM 55MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482326560	SUP	HCPCS C1713		482326560  -  SCREW BONE 6.5MM 60MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482326565	SUP	HCPCS C1713		482326565  -  SCREW BONE 6.5MM 65MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482326570	SUP	HCPCS C1713		482326570  -  SCREW BONE 6.5MM 70MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482326580	SUP	HCPCS C1713		482326580  -  SCREW BONE 6.5MM 80MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482326590	SUP	HCPCS C1713		482326590  -  SCREW BONE 6.5MM 90MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482327500	SUP	HCPCS C1713		482327500  -  SCREW BONE 7.5MM 100MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482327530	SUP	HCPCS C1713		482327530  -  SCREW BONE 7.5MM 30MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482327535	SUP	HCPCS C1713		482327535  -  SCREW BONE 7.5MM 35MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482327540	SUP	HCPCS C1713		482327540  -  SCREW BONE 7.5MM 40MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482327545	SUP	HCPCS C1713		482327545  -  SCREW BONE 7.5MM 45MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482327550	SUP	HCPCS C1713		482327550  -  SCREW BONE 7.5MM 50MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482327555	SUP	HCPCS C1713		482327555  -  SCREW BONE 7.5MM 55MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482327560	SUP	HCPCS C1713		482327560  -  SCREW BONE 7.5MM 60MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482327565	SUP	HCPCS C1713		482327565  -  SCREW BONE 7.5MM 65MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482327570	SUP	HCPCS C1713		482327570  -  SCREW BONE 7.5MM 70MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482327580	SUP	HCPCS C1713		482327580  -  SCREW BONE 7.5MM 80MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482327590	SUP	HCPCS C1713		482327590  -  SCREW BONE 7.5MM 90MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482328500	SUP	HCPCS C1713		482328500  -  SCREW BONE 8.5MM 100MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482328530	SUP	HCPCS C1713		482328530  -  SCREW BONE 8.5MM 30MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482328535	SUP	HCPCS C1713		482328535  -  SCREW BONE 8.5MM 35MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482328540	SUP	HCPCS C1713		482328540  -  SCREW BONE 8.5MM 40MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482328545	SUP	HCPCS C1713		482328545  -  SCREW BONE 8.5MM 45MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482328550	SUP	HCPCS C1713		482328550  -  SCREW BONE 8.5MM 50MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482328555	SUP	HCPCS C1713		482328555  -  SCREW BONE 8.5MM 55MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482328560	SUP	HCPCS C1713		482328560  -  SCREW BONE 8.5MM 60MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482328565	SUP	HCPCS C1713		482328565  -  SCREW BONE 8.5MM 65MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482328570	SUP	HCPCS C1713		482328570  -  SCREW BONE 8.5MM 70MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482328580	SUP	HCPCS C1713		482328580  -  SCREW BONE 8.5MM 80MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482328590	SUP	HCPCS C1713		482328590  -  SCREW BONE 8.5MM 90MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482329500	SUP	HCPCS C1713		482329500  -  SCREW BONE 9.5MM 100MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482329530	SUP	HCPCS C1713		482329530  -  SCREW BONE 9.5MM 30MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482329535	SUP	HCPCS C1713		482329535  -  SCREW BONE 9.5MM 35MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482329540	SUP	HCPCS C1713		482329540  -  SCREW BONE 9.5MM 40MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482329545	SUP	HCPCS C1713		482329545  -  SCREW BONE 9.5MM 45MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482329550	SUP	HCPCS C1713		482329550  -  SCREW BONE 9.5MM 50MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482329555	SUP	HCPCS C1713		482329555  -  SCREW BONE 9.5MM 55MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482329560	SUP	HCPCS C1713		482329560  -  SCREW BONE 9.5MM 60MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482329565	SUP	HCPCS C1713		482329565  -  SCREW BONE 9.5MM 65MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482329570	SUP	HCPCS C1713		482329570  -  SCREW BONE 9.5MM 70MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482329580	SUP	HCPCS C1713		482329580  -  SCREW BONE 9.5MM 80MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482329590	SUP	HCPCS C1713		482329590  -  SCREW BONE 9.5MM 90MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482335020	SUP	HCPCS C1713		482335020  -  SCREW BONE 5MM 20MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482335025	SUP	HCPCS C1713		482335025  -  SCREW BONE 5MM 25MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482335030	SUP	HCPCS C1713		482335030  -  SCREW BONE 5MM 30MM UNIPLNR XIA SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482335035	SUP	HCPCS C1713		482335035  -  SCREW BONE 5MM 35MM UNIPLNR XIA SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482335040	SUP	HCPCS C1713		482335040  -  SCREW BONE 5MM 40MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482335045	SUP	HCPCS C1713		482335045  -  SCREW BONE 5MM 45MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482336025	SUP	HCPCS C1713		482336025  -  SCREW BONE 6MM 25MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482336030	SUP	HCPCS C1713		482336030  -  SCREW BONE 6MM 30MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482336035	SUP	HCPCS C1713		482336035  -  SCREW BONE 6MM 35MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482336040	SUP	HCPCS C1713		482336040  -  SCREW BONE 6MM 40MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482336045	SUP	HCPCS C1713		482336045  -  SCREW BONE 6MM 45MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482336050	SUP	HCPCS C1713		482336050  -  SCREW BONE 6MM 50MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482336055	SUP	HCPCS C1713		482336055  -  SCREW BONE 6MM 55MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482336060	SUP	HCPCS C1713		482336060  -  SCREW BONE 6MM 60MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482337030	SUP	HCPCS C1713		482337030  -  SCREW BONE 7MM 30MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482337035	SUP	HCPCS C1713		482337035  -  SCREW BONE 7MM 35MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482337040	SUP	HCPCS C1713		482337040  -  SCREW BONE 7MM 40MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482337045	SUP	HCPCS C1713		482337045  -  SCREW BONE 7MM 45MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482337050	SUP	HCPCS C1713		482337050  -  SCREW BONE 7MM 50MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482337055	SUP	HCPCS C1713		482337055  -  SCREW BONE 7MM 55MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482337060	SUP	HCPCS C1713		482337060  -  SCREW BONE 7MM 60MM UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482364520	SUP	HCPCS C1713		482364520  -  SCREW BONE 4.5MM 20MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482364525	SUP	HCPCS C1713		482364525  -  SCREW BONE 4.5MM 25MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482364530	SUP	HCPCS C1713		482364530  -  SCREW BONE 4.5MM 30MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482364535	SUP	HCPCS C1713		482364535  -  SCREW BONE 4.5MM 35MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482364540	SUP	HCPCS C1713		482364540  -  SCREW BONE 4.5MM 40MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482364545	SUP	HCPCS C1713		482364545  -  SCREW BONE 4.5MM 45MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365020	SUP	HCPCS C1713		482365020  -  SCREW BONE 5MM 20MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365025	SUP	HCPCS C1713		482365025  -  SCREW BONE 5MM 25MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365030	SUP	HCPCS C1713		482365030  -  SCREW BONE 5MM 30MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365035	SUP	HCPCS C1713		482365035  -  SCREW BONE 5MM 35MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365040	SUP	HCPCS C1713		482365040  -  SCREW BONE 5MM 40MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365045	SUP	HCPCS C1713		482365045  -  SCREW BONE 5MM 45MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365520	SUP	HCPCS C1713		482365520  -  SCREW BONE 5.5MM 20MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365525	SUP	HCPCS C1713		482365525  -  SCREW BONE 5.5MM 25MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365530	SUP	HCPCS C1713		482365530  -  SCREW BONE 5.5MM 30MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365535	SUP	HCPCS C1713		482365535  -  SCREW BONE 5.5MM 35MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365540	SUP	HCPCS C1713		482365540  -  SCREW BONE 5.5MM 40MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365545	SUP	HCPCS C1713		482365545  -  SCREW BONE 5.5MM 45MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365550	SUP	HCPCS C1713		482365550  -  SCREW BONE 5.5MM 50MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482365555	SUP	HCPCS C1713		482365555  -  SCREW BONE 5.5MM 55MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366025	SUP	HCPCS C1713		482366025  -  SCREW BONE 6MM 25MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366030	SUP	HCPCS C1713		482366030  -  SCREW BONE 6MM 30MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366035	SUP	HCPCS C1713		482366035  -  SCREW BONE 6MM 35MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366040	SUP	HCPCS C1713		482366040  -  SCREW BONE 6MM 40MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366045	SUP	HCPCS C1713		482366045  -  SCREW BONE 6MM 45MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366050	SUP	HCPCS C1713		482366050  -  SCREW BONE 6MM 50MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366055	SUP	HCPCS C1713		482366055  -  SCREW BONE 6MM 55MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366060	SUP	HCPCS C1713		482366060  -  SCREW BONE 6MM 60MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366525	SUP	HCPCS C1713		482366525  -  SCREW BONE 6.5MM 25MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366530	SUP	HCPCS C1713		482366530  -  SCREW BONE 6.5MM 30MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366535	SUP	HCPCS C1713		482366535  -  SCREW BONE 6.5MM 35MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366540	SUP	HCPCS C1713		482366540  -  SCREW BONE 6.5MM 40MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366545	SUP	HCPCS C1713		482366545  -  SCREW BONE 6.5MM 45MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366550	SUP	HCPCS C1713		482366550  -  SCREW BONE 6.5MM 50MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366555	SUP	HCPCS C1713		482366555  -  SCREW BONE 6.5MM 55MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482366560	SUP	HCPCS C1713		482366560  -  SCREW BONE 6.5MM 60MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367030	SUP	HCPCS C1713		482367030  -  SCREW BONE 7MM 30MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367035	SUP	HCPCS C1713		482367035  -  SCREW BONE 7MM 35MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367040	SUP	HCPCS C1713		482367040  -  SCREW BONE 7MM 40MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367045	SUP	HCPCS C1713		482367045  -  SCREW BONE 7MM 45MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367050	SUP	HCPCS C1713		482367050  -  SCREW BONE 7MM 50MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367055	SUP	HCPCS C1713		482367055  -  SCREW BONE 7MM 55MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367060	SUP	HCPCS C1713		482367060  -  SCREW BONE 7MM 60MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367530	SUP	HCPCS C1713		482367530  -  SCREW BONE 7.5MM 30MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367535	SUP	HCPCS C1713		482367535  -  SCREW BONE 7.5MM 35MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367540	SUP	HCPCS C1713		482367540  -  SCREW BONE 7.5MM 40MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367545	SUP	HCPCS C1713		482367545  -  SCREW BONE 7.5MM 45MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367550	SUP	HCPCS C1713		482367550  -  SCREW BONE 7.5MM 50MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367555	SUP	HCPCS C1713		482367555  -  SCREW BONE 7.5MM 55MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482367560	SUP	HCPCS C1713		482367560  -  SCREW BONE 7.5MM 60MM REDX UNIPLNR XIA 3 SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482376500	SUP	HCPCS C1713		482376500  -  SCREW BONE 6.5MM 100MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482376530	SUP	HCPCS C1713		482376530  -  SCREW BONE 6.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482376535	SUP	HCPCS C1713		482376535  -  SCREW BONE 6.5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482376540	SUP	HCPCS C1713		482376540  -  SCREW BONE 6.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482376545	SUP	HCPCS C1713		482376545  -  SCREW BONE 6.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482376550	SUP	HCPCS C1713		482376550  -  SCREW BONE 6.5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482376555	SUP	HCPCS C1713		482376555  -  SCREW BONE 6.5MM 55MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482376560	SUP	HCPCS C1713		482376560  -  SCREW BONE 6.5MM 60MM REVISION POLYAX CLOSE HEAD ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482376565	SUP	HCPCS C1713		482376565  -  SCREW BONE 6.5MM 65MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482376570	SUP	HCPCS C1713		482376570  -  SCREW BONE 6.5MM 70MM REVISION POLYAX CLOSE HEAD ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482376580	SUP	HCPCS C1713		482376580  -  SCREW BONE 6.5MM 80MM REVISION POLYAX CLOSE HEAD ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482376590	SUP	HCPCS C1713		482376590  -  SCREW BONE 6.5MM 90MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482377500	SUP	HCPCS C1713		482377500  -  SCREW BONE 7.5MM 100MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482377530	SUP	HCPCS C1713		482377530  -  SCREW BONE 7.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482377535	SUP	HCPCS C1713		482377535  -  SCREW BONE 7.5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482377540	SUP	HCPCS C1713		482377540  -  SCREW BONE 7.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482377545	SUP	HCPCS C1713		482377545  -  SCREW BONE 7.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482377550	SUP	HCPCS C1713		482377550  -  SCREW BONE 7.5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482377555	SUP	HCPCS C1713		482377555  -  SCREW BONE 7.5MM 55MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482377560	SUP	HCPCS C1713		482377560  -  SCREW BONE 7.5MM 60MM REVISION POLYAX CLOSE HEAD ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482377565	SUP	HCPCS C1713		482377565  -  SCREW BONE 7.5MM 65MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482377570	SUP	HCPCS C1713		482377570  -  SCREW BONE 7.5MM 70MM REVISION POLYAX CLOSE HEAD ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482377580	SUP	HCPCS C1713		482377580  -  SCREW BONE 7.5MM 80MM REVISION POLYAX CLOSE HEAD ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482377590	SUP	HCPCS C1713		482377590  -  SCREW BONE 7.5MM 90MM REVISION POLYAX CLOSE HEAD ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482378500	SUP	HCPCS C1713		482378500  -  SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482378530	SUP	HCPCS C1713		482378530  -  SCREW BONE 8.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482378535	SUP	HCPCS C1713		482378535  -  SCREW BONE 8.5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482378540	SUP	HCPCS C1713		482378540  -  SCREW BONE 8.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482378545	SUP	HCPCS C1713		482378545  -  SCREW BONE 8.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482378550	SUP	HCPCS C1713		482378550  -  SCREW BONE 8.5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482378555	SUP	HCPCS C1713		482378555  -  SCREW BONE 8.5MM 55MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482378560	SUP	HCPCS C1713		482378560  -  SCREW BONE 8.5MM 60MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482378565	SUP	HCPCS C1713		482378565  -  SCREW BONE 8.5MM 65MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482378570	SUP	HCPCS C1713		482378570  -  SCREW BONE 8.5MM 70MM REVISION POLYAX CLOSE HEAD ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482378580	SUP	HCPCS C1713		482378580  -  SCREW BONE 8.5MM 80MM REVISION POLYAX CLOSE HEAD ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482378590	SUP	HCPCS C1713		482378590  -  SCREW BONE 8.5MM 90MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482379500	SUP	HCPCS C1713		482379500  -  SCREW BONE 9.5MM 100MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482379530	SUP	HCPCS C1713		482379530  -  SCREW BONE 9.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482379535	SUP	HCPCS C1713		482379535  -  SCREW BONE 9.5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482379540	SUP	HCPCS C1713		482379540  -  SCREW BONE 9.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482379545	SUP	HCPCS C1713		482379545  -  SCREW BONE 9.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482379550	SUP	HCPCS C1713		482379550  -  SCREW BONE 9.5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482379555	SUP	HCPCS C1713		482379555  -  SCREW BONE 9.5MM 55MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482379560	SUP	HCPCS C1713		482379560  -  SCREW BONE 9.5MM 60MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482379565	SUP	HCPCS C1713		482379565  -  SCREW BONE 9.5MM 65MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482379570	SUP	HCPCS C1713		482379570  -  SCREW BONE 9.5MM 70MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482379580	SUP	HCPCS C1713		482379580  -  SCREW BONE 9.5MM 80MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482379590	SUP	HCPCS C1713		482379590  -  SCREW BONE 9.5MM 90MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482384020	SUP	HCPCS C1713		482384020  -  SCREW BONE 4MM 20MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482384025	SUP	HCPCS C1713		482384025  -  SCREW BONE 4MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482384030	SUP	HCPCS C1713		482384030  -  SCREW BONE 4MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482384035	SUP	HCPCS C1713		482384035  -  SCREW BONE 4MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482384040	SUP	HCPCS C1713		482384040  -  SCREW BONE 4MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482384045	SUP	HCPCS C1713		482384045  -  SCREW BONE 4MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482384520	SUP	HCPCS C1713		482384520  -  SCREW BONE 4.5MM 20MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482384525	SUP	HCPCS C1713		482384525  -  SCREW BONE 4.5MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482384530	SUP	HCPCS C1713		482384530  -  SCREW BONE 4.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482384535	SUP	HCPCS C1713		482384535  -  SCREW BONE 4.5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482384540	SUP	HCPCS C1713		482384540  -  SCREW BONE 4.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482384545	SUP	HCPCS C1713		482384545  -  SCREW BONE 4.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385020	SUP	Custom 27803010		482385020  -  CONNECTOR ROD 5MM 20MM ROD TO ROD RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
482385025	SUP	HCPCS C1713		482385025  -  SCREW BONE 5MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385030	SUP	HCPCS C1713		482385030  -  SCREW BONE 5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385035	SUP	HCPCS C1713		482385035  -  SCREW BONE 5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385040	SUP	HCPCS C1713		482385040  -  SCREW BONE 5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385045	SUP	HCPCS C1713		482385045  -  SCREW BONE 5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385050	SUP	HCPCS C1713		482385050  -  SCREW BONE 5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385525	SUP	HCPCS C1713		482385525  -  SCREW BONE 5.5MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385530	SUP	HCPCS C1713		482385530  -  SCREW BONE 5.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385535	SUP	HCPCS C1713		482385535  -  SCREW BONE 5.5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385540	SUP	HCPCS C1713		482385540  -  SCREW BONE 5.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385545	SUP	HCPCS C1713		482385545  -  SCREW BONE 5.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385550	SUP	HCPCS C1713		482385550  -  SCREW BONE 5.5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482385555	SUP	HCPCS C1713		482385555  -  SCREW BONE 5.5MM 55MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482386525	SUP	HCPCS C1713		482386525  -  SCREW BONE 6.5MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482386530	SUP	HCPCS C1713		482386530  -  SCREW BONE 6.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482386535	SUP	HCPCS C1713		482386535  -  SCREW BONE 6.5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482386540	SUP	HCPCS C1713		482386540  -  SCREW BONE 6.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482386545	SUP	HCPCS C1713		482386545  -  SCREW BONE 6.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482386550	SUP	HCPCS C1713		482386550  -  SCREW BONE 6.5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482386555	SUP	HCPCS C1713		482386555  -  SCREW BONE 6.5MM 55MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482386560	SUP	HCPCS C1713		482386560  -  SCREW BONE 6.5MM 60MM REVISION POLYAX BIASED ANGLE	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482386565	SUP	HCPCS C1713		482386565  -  SCREW BONE 6.5MM 65MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482386570	SUP	HCPCS C1713		482386570  -  SCREW BONE 6.5MM 70MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482386580	SUP	HCPCS C1713		482386580  -  SCREW BONE 6.5MM 80MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482386590	SUP	HCPCS C1713		482386590  -  SCREW BONE 6.5MM 90MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482387525	SUP	HCPCS C1713		482387525  -  SCREW BONE 7.5MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482387530	SUP	HCPCS C1713		482387530  -  SCREW BONE 7.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482387535	SUP	HCPCS C1713		482387535  -  SCREW BONE 7.5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482387540	SUP	HCPCS C1713		482387540  -  SCREW BONE 7.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482387545	SUP	HCPCS C1713		482387545  -  SCREW BONE 7.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482387550	SUP	HCPCS C1713		482387550  -  SCREW BONE 7.5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482387555	SUP	HCPCS C1713		482387555  -  SCREW BONE 7.5MM 55MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482387560	SUP	HCPCS C1713		482387560  -  SCREW BONE 7.5MM 60MM REVISION POLYAX BIASED ANGLE	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482387565	SUP	HCPCS C1713		482387565  -  SCREW BONE 7.5MM 65MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482387570	SUP	HCPCS C1713		482387570  -  SCREW BONE 7.5MM 70MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482387580	SUP	HCPCS C1713		482387580  -  SCREW BONE 7.5MM 80MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482387590	SUP	HCPCS C1713		482387590  -  SCREW BONE 7.5MM 90MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482388500	SUP	HCPCS C1713		482388500  -  SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482388560	SUP	HCPCS C1713		482388560  -  SCREW BONE 8.5MM 60MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482388570	SUP	HCPCS C1713		482388570  -  SCREW BONE 8.5MM 70MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482388580	SUP	HCPCS C1713		482388580  -  SCREW BONE 8.5MM 80MM REVISION POLYAX BIASED ANGLE	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482388590	SUP	HCPCS C1713		482388590  -  SCREW BONE 8.5MM 90MM REVISION POLYAX BIASED ANGLE	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482389500	SUP	HCPCS C1713		482389500  -  SCREW BONE 9.5MM 100MM REVISION POLYAX BIASED ANGLE	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482389560	SUP	HCPCS C1713		482389560  -  SCREW BONE 9.5MM 60MM REVISION POLYAX BIASED ANGLE	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482389570	SUP	HCPCS C1713		482389570  -  SCREW BONE 9.5MM 70MM REVISION POLYAX BIASED ANGLE	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482389580	SUP	HCPCS C1713		482389580  -  SCREW BONE 9.5MM 80MM REVISION POLYAX BIASED ANGLE	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482389590	SUP	HCPCS C1713		482389590  -  SCREW BONE 9.5MM 90MM REVISION POLYAX BIASED ANGLE	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
482396500	SUP	HCPCS C1713		482396500  -  SCREW BONE 6.5MM 100MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482396560	SUP	HCPCS C1713		482396560  -  SCREW BONE 6.5MM 60MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482396570	SUP	HCPCS C1713		482396570  -  SCREW BONE 6.5MM 70MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482396580	SUP	HCPCS C1713		482396580  -  SCREW BONE 6.5MM 80MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482396590	SUP	HCPCS C1713		482396590  -  SCREW BONE 6.5MM 90MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482397500	SUP	HCPCS C1713		482397500  -  SCREW BONE 7.5MM 100MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482397560	SUP	HCPCS C1713		482397560  -  SCREW BONE 7.5MM 60MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482397570	SUP	HCPCS C1713		482397570  -  SCREW BONE 15D 7.5MM 70MM REVISION MNOAX BIASED ANGLE	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482397580	SUP	HCPCS C1713		482397580  -  SCREW BONE 15D 7.5MM 80MM REVISION MNOAX BIASED ANGLE	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482397590	SUP	HCPCS C1713		482397590  -  SCREW BONE 7.5MM 90MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482398500	SUP	HCPCS C1713		482398500  -  SCREW BONE 8.5MM 100MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482398560	SUP	HCPCS C1713		482398560  -  SCREW BONE 8.5MM 60MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482398570	SUP	HCPCS C1713		482398570  -  SCREW BONE 8.5MM 70MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482398580	SUP	HCPCS C1713		482398580  -  SCREW BONE 8.5MM 80MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482398590	SUP	HCPCS C1713		482398590  -  SCREW BONE 8.5MM 90MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482399500	SUP	HCPCS C1713		482399500  -  SCREW BONE 9.5MM 100MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482399560	SUP	HCPCS C1713		482399560  -  SCREW BONE 9.5MM 60MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482399570	SUP	HCPCS C1713		482399570  -  SCREW BONE 9.5MM 70MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482399580	SUP	HCPCS C1713		482399580  -  SCREW BONE 9.5MM 80MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482399590	SUP	HCPCS C1713		482399590  -  SCREW BONE 9.5MM 90MM REVISION MNOAX ILIOSACRAL	BOTH IP/OP	"$3,654.83 "	"$2,704.57"	$0.00	"$2,923.86"	"$1,644.67"	"$1,644.67"	$0.00	$0.00	$0.00	$761.76	"$2,712.61"	"$2,712.61"	$0.00	$0.00	$761.67	$0.00	"$1,801.83"	"$1,801.83"	$0.00	"$1,827.41"	"$2,894.63"	"$2,923.86"	$0.00		$0.00	$571.98	$0.00	$0.00	$581.85	$0.00	$0.00	$0.00	$0.00	$0.00
482700601	SUP	HCPCS C1713		00482700601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 6MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482700701	SUP	HCPCS C1713		00482700701  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 7MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482700800	SUP	HCPCS C1713		00482700800  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 8MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482700801	SUP	HCPCS C1713		00482700801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 8MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482700901	SUP	HCPCS C1713		00482700901  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 9MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482701000	SUP	HCPCS C1713		00482701000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 10MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482701001	SUP	HCPCS C1713		00482701001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 10MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482701200	SUP	HCPCS C1713		00482701200  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 12MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482701201	SUP	HCPCS C1713		00482701201  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 12MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482701400	SUP	HCPCS C1713		00482701400  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 14MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482701401	SUP	HCPCS C1713		00482701401  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 14MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482701600	SUP	HCPCS C1713		00482701600  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 16MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482701601	SUP	HCPCS C1713		00482701601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 16MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482701800	SUP	HCPCS C1713		00482701800  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 18MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482701801	SUP	HCPCS C1713		00482701801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 18MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482702000	SUP	HCPCS C1713		00482702000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 20MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482702200	SUP	HCPCS C1713		00482702200  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 22MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482702201	SUP	HCPCS C1713		00482702201  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 22MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482702400	SUP	HCPCS C1713		00482702400  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 24MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482702401	SUP	HCPCS C1713		00482702401  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 24MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482702600	SUP	HCPCS C1713		00482702600  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 26MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482702601	SUP	HCPCS C1713		00482702601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 26MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482702800	SUP	HCPCS C1713		00482702800  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 28MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482702801	SUP	HCPCS C1713		00482702801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 28MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482703000	SUP	HCPCS C1713		00482703000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 30MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482703001	SUP	HCPCS C1713		00482703001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 30MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482703200	SUP	HCPCS C1713		00482703200  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 32MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482703201	SUP	HCPCS C1713		00482703201  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 32MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482703400	SUP	HCPCS C1713		00482703400  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 34MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482703401	SUP	HCPCS C1713		00482703401  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 34MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482703600	SUP	HCPCS C1713		00482703600  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 36MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482703601	SUP	HCPCS C1713		00482703601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 36MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482703800	SUP	HCPCS C1713		00482703800  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 38MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482703801	SUP	HCPCS C1713		00482703801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 38MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482704000	SUP	HCPCS C1713		00482704000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 40MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482704001	SUP	HCPCS C1713		00482704001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 40MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482704201	SUP	HCPCS C1713		00482704201  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 42MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482704401	SUP	HCPCS C1713		00482704401  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 44MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482704500	SUP	HCPCS C1713		00482704500  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 45MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482704501	SUP	HCPCS C1713		00482704501  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 45MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482704601	SUP	HCPCS C1713		00482704601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 46MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482704801	SUP	HCPCS C1713		00482704801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 48MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482705000	SUP	HCPCS C1713		00482705000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 50MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482705001	SUP	HCPCS C1713		00482705001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 50MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482705201	SUP	HCPCS C1713		00482705201  -  SCREW BONE SMALL HEXAGON 2.7MM 52MM SELF TAP CORTICAL	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482705401	SUP	HCPCS C1713		00482705401  -  SCREW BONE SMALL HEXAGON 2.7MM 54MM SELF TAP CORTICAL	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482705500	SUP	HCPCS C1713		00482705500  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 55MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482705501	SUP	HCPCS C1713		00482705501  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 55MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482705601	SUP	HCPCS C1713		00482705601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 56MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482705801	SUP	HCPCS C1713		00482705801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 58MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482706000	SUP	HCPCS C1713		00482706000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 60MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482706001	SUP	HCPCS C1713		00482706001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 60MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482706500	SUP	HCPCS C1713		00482706500  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 65MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482706501	SUP	HCPCS C1713		00482706501  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 65MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482707000	SUP	HCPCS C1713		00482707000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 70MM STAINLESS STEEL	BOTH IP/OP	$32.20 	$23.83	$0.00	$25.76	$14.49	$14.49	$0.00	$0.00	$0.00	$6.71	$23.90	$23.90	$0.00	$0.00	$6.71	$0.00	$19.05	$19.05	$0.00	$16.10	$25.50	$25.76	$0.00		$0.00	$5.04	$0.00	$0.00	$5.13	$0.00	$0.00	$0.00	$0.00	$0.00
482707001	SUP	HCPCS C1713		00482707001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 70MM SELF TAP STAINLESS	BOTH IP/OP	$36.80 	$27.23	$0.00	$29.44	$16.56	$16.56	$0.00	$0.00	$0.00	$7.67	$27.31	$27.31	$0.00	$0.00	$7.67	$0.00	$21.77	$21.77	$0.00	$18.40	$29.15	$29.44	$0.00		$0.00	$5.76	$0.00	$0.00	$5.86	$0.00	$0.00	$0.00	$0.00	$0.00
482802540	SUP	HCPCS C1713		482802540  -  SCREW BONE 5.5MM 40MM 15MM ES2 LT XIA 3 SHRT BLADE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
482802640	SUP	HCPCS C1713		482802640  -  SCREW BONE 6.5MM 40MM 15MM ES2 LT XIA 3 SHRT BLADE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
482802645	SUP	HCPCS C1713		482802645  -  SCREW BONE 6.5MM 45MM 15MM ES2 LT XIA 3 SHRT BLADE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
482802650	SUP	HCPCS C1713		482802650  -  SCREW BN SHRT BLDE LOPRFL 6.5MM 50MM 15MM ES2 LT XIA 3 6 PNT	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
482802745	SUP	HCPCS C1713		482802745  -  SCREW BN SHRT BLDE LOPRFL 7.5MM 45MM 15MM ES2 LT XIA 3 6 PNT	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
482804545	SUP	HCPCS C1713		482804545  -  SCREW BN LNG BLDE LOPRFL 5.5MM 45MM 15MM ES2 LT XIA 3 6 PNT	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
482804645	SUP	HCPCS C1713		482804645  -  SCREW BN LNG BLDE LOPRFL 6.5MM 45MM 15MM ES2 LT XIA 3 6 PNT	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
482804650	SUP	HCPCS C1713		482804650  -  SCREW BN LNG BLDE LOPRFL 6.5MM 50MM 15MM ES2 LT XIA 3 6 PNT	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
482804750	SUP	HCPCS C1713		482804750  -  SCREW BN LNG BLDE LOPRFL 7.5MM 50MM 15MM ES2 LT XIA 3 6 PNT	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
482806050	SUP	HCPCS C1713		482806050  -  ROD SPNL HEX 5.5MM 50MM ES2 RDS TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
482806055	SUP	HCPCS C1713		482806055  -  ROD SPNL HEX 5.5MM 55MM ES2 RDS TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
482807060	SUP	HCPCS C1713		"482807060  -  TITANIUM STRAIGHT ROD, 5.5X60MM"	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
482807090	SUP	HCPCS C1713		482807090  -  ROD SPNL 90MM 5.5MM ES2 STR HEX TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
482911180	SUP	HCPCS C1713		482911180  -  ENDCAP SPNL 18MM 0D	BOTH IP/OP	$746.78 	$552.62	$0.00	$597.42	$336.05	$336.05	$0.00	$0.00	$0.00	$155.65	$554.26	$554.26	$0.00	$0.00	$155.63	$0.00	$441.72	$441.72	$0.00	$373.39	$591.45	$597.42	$0.00		$0.00	$116.87	$0.00	$0.00	$118.89	$0.00	$0.00	$0.00	$0.00	$0.00
483510098	SUP	Custom 27803010		483510098  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X9MM AVS UNILIF HLW	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483510108	SUP	Custom 27803010		483510108  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X10MM AVS UNILIF HLW	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483510118	SUP	Custom 27803010		483510118  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X11MM AVS UNILIF HLW	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483510128	SUP	Custom 27803010		483510128  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X12MM AVS UNILIF HLW	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483510138	SUP	Custom 27803010		483510138  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X13MM AVS UNILIF HLW	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483510140	SUP	Custom 27803010		483510140  -  SPACER SPNL 0D WDG NOSE 20X11X14MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483510144	SUP	Custom 27803010		483510144  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X14MM AVS UNILIF HLW	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483510148	SUP	Custom 27803010		483510148  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X14MM AVS UNILIF HLW	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483510150	SUP	Custom 27803010		483510150  -  SPACER SPNL 0D WDG NOSE 20X11X15MM AVS UNILIF HLW PEEK-OPTM	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483510154	SUP	Custom 27803010		483510154  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X15MM AVS UNILIF HLW	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483510158	SUP	Custom 27803010		483510158  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X15MM AVS UNILIF HLW	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483510168	SUP	Custom 27803010		483510168  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X16MM AVS UNILIF HLW	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483515098	SUP	Custom 27803010		483515098  -  SPACER SPNL 8D WDG 25X11X9MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483515108	SUP	Custom 27803010		483515108  -  SPACER SPNL 8D WDG 25X11X10MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483515118	SUP	Custom 27803010		483515118  -  SPACER SPNL 8D WDG 25X11X11MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483515128	SUP	Custom 27803010		483515128  -  SPACER SPNL 8D WDG 25X11X12MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483515138	SUP	Custom 27803010		483515138  -  SPACER SPNL 8D WDG 25X11X13MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483515140	SUP	Custom 27803010		483515140  -  SPACER SPNL 0D RECT 25X11X14MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483515144	SUP	Custom 27803010		483515144  -  SPACER SPNL 4D WDG 25X11X14MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483515148	SUP	Custom 27803010		483515148  -  SPACER SPNL 8D WDG 25X11X14MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483515150	SUP	Custom 27803010		483515150  -  SPACER SPNL 0D RECT 25X11X15MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483515154	SUP	Custom 27803010		483515154  -  SPACER SPNL 4D WDG 25X11X15MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483515158	SUP	Custom 27803010		483515158  -  SPACER SPNL 8D WDG 25X11X15MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
483515168	SUP	Custom 27803010		483515168  -  SPACER SPNL 8D WDG 25X11X16MM AVS PL HLW PEEK PLIF	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486610000	SUP	HCPCS C1713		486610000  -  CAP LOCKING SPN	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
486610425	SUP	HCPCS C1713		486610425  -  SCREW BONE STANDARD 4.75MM 25MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610430	SUP	HCPCS C1713		486610430  -  SCREW BONE STANDARD 4.75MM 30MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610435	SUP	HCPCS C1713		486610435  -  SCREW BONE STANDARD 4.75MM 35MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610440	SUP	HCPCS C1713		486610440  -  SCREW BONE STANDARD 4.75MM 40MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610445	SUP	HCPCS C1713		486610445  -  SCREW BONE STANDARD 4.75MM 45MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610450	SUP	HCPCS C1713		486610450  -  SCREW BONE 4.75MM 50MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610455	SUP	HCPCS C1713		486610455  -  SCREW BONE 4.75MM 55MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610525	SUP	HCPCS C1713		486610525  -  SCREW BONE 5.75MM 25MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610530	SUP	HCPCS C1713		486610530  -  SCREW BONE STANDARD 5.75MM 30MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610535	SUP	HCPCS C1713		486610535  -  SCREW BONE STANDARD 5.75MM 35MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610540	SUP	HCPCS C1713		486610540  -  SCREW BONE STANDARD 5.75MM 40MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610545	SUP	HCPCS C1713		486610545  -  SCREW BONE STANDARD 5.75MM 45MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610550	SUP	HCPCS C1713		486610550  -  SCREW BONE 5.75MM 50MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610555	SUP	HCPCS C1713		486610555  -  SCREW BONE 5.75MM 55MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610560	SUP	HCPCS C1713		486610560  -  SCREW BONE 5.75MM 60MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610565	SUP	HCPCS C1713		486610565  -  SCREW BONE 5.75MM 65MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610600	SUP	HCPCS C1713		486610600  -  SCREW BONE 6.75MM 100MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610625	SUP	HCPCS C1713		486610625  -  SCREW BONE 6.75MM 25MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610630	SUP	HCPCS C1713		486610630  -  SCREW BONE STANDARD 6.75MM 30MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610635	SUP	HCPCS C1713		486610635  -  SCREW BONE STANDARD 6.75MM 35MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610640	SUP	HCPCS C1713		486610640  -  SCREW BONE STANDARD 6.75MM 40MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610645	SUP	HCPCS C1713		486610645  -  SCREW BONE STANDARD 6.75MM 45MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610650	SUP	HCPCS C1713		486610650  -  SCREW BONE STANDARD 6.75MM 50MM RAD SPN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610655	SUP	HCPCS C1713		486610655  -  SCREW BONE 6.75MM 55MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610660	SUP	HCPCS C1713		486610660  -  SCREW BONE 6.75MM 60MM SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610665	SUP	HCPCS C1713		486610665  -  SCREW BONE 6.75MM 65MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610670	SUP	HCPCS C1713		486610670  -  SCREW BONE 6.75MM 70MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610680	SUP	HCPCS C1713		486610680  -  SCREW BONE 6.75MM 80MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610690	SUP	HCPCS C1713		486610690  -  SCREW BONE 6.75MM 90MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610700	SUP	HCPCS C1713		486610700  -  SCREW BONE 7.75MM 100MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610725	SUP	HCPCS C1713		486610725  -  SCREW BONE 7.75MM 25MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610730	SUP	HCPCS C1713		486610730  -  SCREW BONE 7.75MM 30MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610735	SUP	HCPCS C1713		486610735  -  SCREW BONE 7.75MM 35MM RADSTD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610740	SUP	HCPCS C1713		486610740  -  SCREW BONE 7.75MM 40MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610745	SUP	HCPCS C1713		486610745  -  SCREW BONE 7.75MM 45MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610750	SUP	HCPCS C1713		486610750  -  SCREW BONE 7.75MM 50MM SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610755	SUP	HCPCS C1713		486610755  -  SCREW BONE 7.75MM 55MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610760	SUP	HCPCS C1713		486610760  -  SCREW BONE 7.75MM 60MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610765	SUP	HCPCS C1713		486610765  -  SCREW BONE 7.75MM 65MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610770	SUP	HCPCS C1713		486610770  -  SCREW BONE 7.75MM 70MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610780	SUP	HCPCS C1713		486610780  -  SCREW BONE 7.75MM 80MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610790	SUP	HCPCS C1713		486610790  -  SCREW BONE 7.75MM 90MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610800	SUP	HCPCS C1713		486610800  -  SCREW BONE 8.75MM 100MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610830	SUP	HCPCS C1713		486610830  -  SCREW BONE 8.75MM 30MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610835	SUP	HCPCS C1713		486610835  -  SCREW BONE 8.75MM 35MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610840	SUP	HCPCS C1713		486610840  -  SCREW BONE 8.75MM 40MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610845	SUP	HCPCS C1713		486610845  -  SCREW BONE 8.75MM 45MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610850	SUP	HCPCS C1713		486610850  -  SCREW BONE 8.75MM 50MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610855	SUP	HCPCS C1713		486610855  -  SCREW BONE 8.75MM 55MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610860	SUP	HCPCS C1713		486610860  -  SCREW BONE 8.75MM 60MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610865	SUP	HCPCS C1713		486610865  -  SCREW BONE 8.75MM 65MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610870	SUP	HCPCS C1713		486610870  -  SCREW BONE 8.75MM 70MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610880	SUP	HCPCS C1713		486610880  -  SCREW BONE 8.75MM 80MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610890	SUP	HCPCS C1713		486610890  -  SCREW BONE 8.75MM 90MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610900	SUP	HCPCS C1713		486610900  -  SCREW BONE 9.75MM 100MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610960	SUP	HCPCS C1713		486610960  -  SCREW BONE 9.75MM 60MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610970	SUP	HCPCS C1713		486610970  -  SCREW BONE 9.75MM 70MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610980	SUP	HCPCS C1713		486610980  -  SCREW BONE 9.75MM 80MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486610990	SUP	HCPCS C1713		486610990  -  SCREW BONE 9.75MM 90MM RADSTD SPNL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486611425	SUP	HCPCS C1713		486611425  -  SCREW BONE 4.75MM 25MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611430	SUP	HCPCS C1713		486611430  -  SCREW BONE 4.75MM 30MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611435	SUP	HCPCS C1713		486611435  -  SCREW BONE 4.75MM 35MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611440	SUP	HCPCS C1713		486611440  -  SCREW BONE 4.75MM 40MM MULTIANG TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611445	SUP	HCPCS C1713		486611445  -  SCREW BONE 4.75MM 45MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611450	SUP	HCPCS C1713		486611450  -  SCREW BONE 4.75MM 50MM MULTIANG TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611455	SUP	HCPCS C1713		486611455  -  SCREW BONE 4.75MM 55MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611525	SUP	HCPCS C1713		486611525  -  SCREW BONE 5.75MM 25MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611530	SUP	HCPCS C1713		486611530  -  SCREW BONE 5.75MM 30MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611535	SUP	HCPCS C1713		486611535  -  SCREW BONE 5.75MM 35MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611540	SUP	HCPCS C1713		486611540  -  SCREW BONE 5MM 40MM MULTIANG TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611545	SUP	HCPCS C1713		486611545  -  SCREW BONE 5.75MM 45MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611550	SUP	HCPCS C1713		486611550  -  SCREW BONE 5.75MM 50MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611555	SUP	HCPCS C1713		486611555  -  SCREW BONE 5MM 55MM MULTIANG TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611560	SUP	HCPCS C1713		486611560  -  SCREW BONE 5.75MM 60MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611565	SUP	HCPCS C1713		486611565  -  SCREW BONE 5.75MM 65MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611600	SUP	HCPCS C1713		486611600  -  SCREW BONE 6.75MM 100MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611625	SUP	HCPCS C1713		486611625  -  SCREW BONE 6.75MM 25MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611630	SUP	HCPCS C1713		486611630  -  SCREW BONE 6.75MM 30MM MULTIANG TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611635	SUP	HCPCS C1713		486611635  -  SCREW BONE 6.75MM 35MM MULTIANG TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611640	SUP	HCPCS C1713		486611640  -  SCREW BONE 6.75MM 40MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611645	SUP	HCPCS C1713		486611645  -  SCREW BONE 6.75MM 45MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611650	SUP	HCPCS C1713		486611650  -  SCREW BONE 6.75MM 50MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611655	SUP	HCPCS C1713		486611655  -  SCREW BONE 6.75MM 55MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611660	SUP	HCPCS C1713		486611660  -  SCREW BONE 6.75MM 60MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611665	SUP	HCPCS C1713		486611665  -  SCREW BONE 6.75MM 65MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611670	SUP	HCPCS C1713		486611670  -  SCREW BONE 6.75MM 70MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611680	SUP	HCPCS C1713		486611680  -  SCREW BONE 6.75MM 80MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611690	SUP	HCPCS C1713		486611690  -  SCREW BONE 6.75MM 90MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611700	SUP	HCPCS C1713		486611700  -  SCREW BONE 7.75MM 100MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611725	SUP	HCPCS C1713		486611725  -  SCREW BONE 7.75MM 25MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611730	SUP	HCPCS C1713		486611730  -  SCREW BONE 7.75MM 30MM MULTIANG TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611735	SUP	HCPCS C1713		486611735  -  SCREW BONE 7.75MM 35MM MULTIANG TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611740	SUP	HCPCS C1713		486611740  -  SCREW BONE 7.75MM 40MM MULTIANG TITANIUM SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611745	SUP	HCPCS C1713		486611745  -  SCREW BONE 7.75MM 45MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611750	SUP	HCPCS C1713		486611750  -  SCREW BONE 7.75MM 50MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611755	SUP	HCPCS C1713		486611755  -  SCREW BONE 7.75MM 55MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611760	SUP	HCPCS C1713		486611760  -  SCREW BONE 7.75MM 60MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611765	SUP	HCPCS C1713		486611765  -  SCREW BONE 7.75MM 65MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611770	SUP	HCPCS C1713		486611770  -  SCREW BONE 7.75MM 70MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611780	SUP	HCPCS C1713		486611780  -  SCREW BONE 7.75MM 80MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611790	SUP	HCPCS C1713		486611790  -  SCREW BONE 7.75MM 90MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611800	SUP	HCPCS C1713		486611800  -  SCREW BONE 8.75MM 100MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611830	SUP	HCPCS C1713		486611830  -  SCREW BONE 8.75MM 30MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611835	SUP	HCPCS C1713		486611835  -  SCREW BONE 8.75MM 35MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611840	SUP	HCPCS C1713		486611840  -  SCREW BONE 8.75MM 40MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611845	SUP	HCPCS C1713		486611845  -  SCREW BONE 8.75MM 45MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611850	SUP	HCPCS C1713		486611850  -  SCREW BONE 8.75MM 50MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611855	SUP	HCPCS C1713		486611855  -  SCREW BONE 8.75MM 55MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611860	SUP	HCPCS C1713		486611860  -  SCREW BONE 8.75MM 60MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611865	SUP	HCPCS C1713		486611865  -  SCREW BONE 8.75MM 65MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611870	SUP	HCPCS C1713		486611870  -  SCREW BONE 8.75MM 70MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611880	SUP	HCPCS C1713		486611880  -  SCREW BONE 8.75MM 80MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611890	SUP	HCPCS C1713		486611890  -  SCREW BONE 8.75MM 90MM MULTIANG RAD SPN	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
486611900	SUP	HCPCS C1713		486611900  -  SCREW BONE 9.75MM 100MM RAD SPNL MULTIANG	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486611960	SUP	HCPCS C1713		486611960  -  SCREW BONE 9.75MM 60MM RADL SPNL MULTIANG	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486611970	SUP	HCPCS C1713		486611970  -  SCREW BONE 9.75MM 70MM RAD SPNL CANN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486611980	SUP	HCPCS C1713		486611980  -  SCREW BONE 9.75MM 80MM RAD SPNL MULTIANG	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486611990	SUP	HCPCS C1713		486611990  -  SCREW BONE 9.75MM 90MM RAD SPNL MULTIANG	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
486612535	SUP	HCPCS C1713		486612535  -  SCREW BONE 5.75MM 35MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612540	SUP	HCPCS C1713		486612540  -  SCREW BONE 5.75MM 40MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612545	SUP	HCPCS C1713		486612545  -  SCREW BONE 5.75MM 45MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612550	SUP	HCPCS C1713		486612550  -  SCREW BONE 5.75MM 50MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612630	SUP	HCPCS C1713		486612630  -  SCREW BONE 6.75MM 30MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612635	SUP	Custom 27203010		486612635  -  SCREW BONE 6.75MM 35MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	$0.00	$0.00	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486612640	SUP	HCPCS C1713		486612640  -  SCREW BONE 6.75MM 40MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612645	SUP	HCPCS C1713		486612645  -  SCREW BONE 6.75MM 45MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612650	SUP	HCPCS C1713		486612650  -  SCREW BONE 6.75MM 50MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612655	SUP	HCPCS C1713		486612655  -  SCREW BONE 6.75MM 55MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612730	SUP	HCPCS C1713		486612730  -  SCREW BONE 7.75MM 30MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612735	SUP	HCPCS C1713		486612735  -  SCREW BONE 7.75MM 35MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612740	SUP	HCPCS C1713		486612740  -  SCREW BONE 7.75MM 40MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612745	SUP	HCPCS C1713		486612745  -  SCREW BONE 7.75MM 45MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612750	SUP	HCPCS C1713		486612750  -  SCREW BONE 7.75MM 50MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486612755	SUP	HCPCS C1713		486612755  -  SCREW BONE 7.75MM 55MM MULTIANG CANN RAD SPN	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
486613000	SUP	Custom 27803010		486613000  -  ROD SPINAL 5.5MM 100MM NONHEXAGONAL TITANIUM RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613003	SUP	Custom 27803010		486613003  -  ROD SPINAL 5.5MM 30MM W/O HEXAGONAL RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613004	SUP	Custom 27803010		486613004  -  ROD SPINAL 40MM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613005	SUP	Custom 27803010		486613005  -  ROD SPINAL 5.5MM 50MM NONHEXAGONAL RAD TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613006	SUP	Custom 27803010		486613006  -  ROD SPINAL 5.5MM 60MM W/O HEXAGONAL RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613007	SUP	Custom 27803010		486613007  -  ROD SPNL 5.5MM 70MM RDS NONHEXAGONAL	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613008	SUP	Custom 27803010		486613008  -  ROD SPINAL 5.5MM 80MM W/O HEXAGONAL RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613009	SUP	Custom 27803010		486613009  -  ROD SPINAL 5.5MM 90MM NONHEXAGONAL RAD TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613010	SUP	Custom 27803010		486613010  -  ROD SPINAL 5.5MM 110MM W/O HEXAGONAL RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613020	SUP	Custom 27803010		486613020  -  ROD SPINAL 5.5MM 120MM RAD W/O HEXAGONAL	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613050	SUP	Custom 27803010		486613050  -  ROD SPINAL 5.5MM 50MM HEXAGON RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613053	SUP	Custom 27803010		486613053  -  ROD SPINAL 5.5MM 35MM RAD NONHEXAGONAL	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613054	SUP	Custom 27803010		486613054  -  ROD SPINAL 5.5MM 45MM NONHEXAGONAL RAD TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613060	SUP	Custom 27803010		486613060  -  ROD SPINAL 5.5MM 60MM HEXAGON RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613070	SUP	Custom 27803010		486613070  -  ROD SPINAL 5.5MM 70MM HEXAGON RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613080	SUP	Custom 27803010		486613080  -  ROD SPINAL 5.5MM 80MM HEXAGON RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613090	SUP	Custom 27803010		486613090  -  ROD SPINAL 5.5MM 90MM HEXAGON RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613100	SUP	Custom 27803010		486613100  -  ROD SPINAL 5.5MM 100MM HEXAGON RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613110	SUP	Custom 27803010		486613110  -  ROD SPINAL 5.5MM 110MM HEXAGON RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613120	SUP	Custom 27803010		486613120  -  ROD SPINAL 5.5MM 120MM HEXAGONAL RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613140	SUP	Custom 27803010		486613140  -  ROD SPINAL 5.5MM 140MM HEXAGON RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613160	SUP	Custom 27803010		486613160  -  ROD SPINAL 5.5MM 160MM HEXAGON RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613180	SUP	Custom 27803010		486613180  -  ROD SPINAL 5.5MM 180MM HEXAGONAL RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613200	SUP	Custom 27803010		486613200  -  ROD SPINAL 5.5MM 200MM HEXAGON RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613220	SUP	Custom 27803010		486613220  -  ROD SPINAL 5.5MM 220MM RAD HEXAGONAL	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613240	SUP	Custom 27803010		486613240  -  ROD SPINAL 5.5MM 240MM HEXAGON RAD	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613260	SUP	Custom 27803010		486613260  -  ROD SPINAL 5.5MM 260MM HEXAGON RAD	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613280	SUP	Custom 27803010		486613280  -  ROD SPINAL 5.5MM 280MM HEXAGON RAD	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613300	SUP	Custom 27803010		486613300  -  ROD SPINAL 5.5MM 300MM HEXAGONAL RAD	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613320	SUP	Custom 27803010		486613320  -  ROD SPINAL 5.5MM 320MM HEXAGON RAD	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613340	SUP	Custom 27803010		486613340  -  ROD SPINAL 5.5MM 340MM HEXAGON RAD	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613360	SUP	Custom 27803010		486613360  -  ROD SPINAL 5.5MM 360MM HEXAGON RAD	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613380	SUP	Custom 27803010		486613380  -  ROD SPINAL 5.5MM 380MM HEXAGON RAD	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613400	SUP	Custom 27803010		486613400  -  ROD SPINAL 5.5MM 400MM RAD HEXAGONAL	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613600	SUP	Custom 27803010		486613600  -  ROD SPINAL 5.5MM 600MM HEXAGONAL RAD	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613601	SUP	Custom 27803010		486613601  -  ROD SPINAL 6.5MM 600MM RAD VITALLIUM PEDICLE	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486613602	SUP	Custom 27803010		486613602  -  ROD SPINAL 5.5MM HEXAGON VITALLIUM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614022	SUP	Custom 27803010		486614022  -  CONNECTOR ROD 22MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614024	SUP	Custom 27803010		486614024  -  CONNECTOR ROD 24MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614026	SUP	Custom 27803010		486614026  -  CONNECTOR ROD 26MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614028	SUP	Custom 27803010		486614028  -  CONNECTOR ROD 28MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614030	SUP	Custom 27803010		486614030  -  CONNECTOR ROD 30MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614032	SUP	Custom 27803010		486614032  -  CONNECTOR ROD 32MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614034	SUP	Custom 27803010		486614034  -  CONNECTOR ROD 34MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614036	SUP	Custom 27803010		486614036  -  CONNECTOR ROD 36MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614100	SUP	Custom 27803010		486614100  -  CONNECTOR ROD SHORT CROSS VARIABLE RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614110	SUP	Custom 27803010		486614110  -  CONNECTOR ROD MEDIUM CROSS RAD VARIABLE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614120	SUP	Custom 27803010		486614120  -  CONNECTOR ROD LONG CROSS VARIABLE RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614130	SUP	Custom 27803010		486614130  -  CONNECTOR ROD MEDIUM CROSS CVD RAD VARIABLE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614140	SUP	Custom 27803010		486614140  -  CONNECTOR ROD LONG VARIABLE CROSS CVD RAD MA	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614170	SUP	Custom 27803010		486614170  -  CONNECTOR ROD MEDIUM CROSS MULTIANGLED RAD VARIABLE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614180	SUP	Custom 27803010		486614180  -  CONNECTOR ROD LONG POLYAX CROSS VAR ANG RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614215	SUP	Custom 27803010		486614215  -  CONNECTOR ROD 15MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614216	SUP	Custom 27803010		486614216  -  CONNECTOR ROD 16MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614217	SUP	Custom 27803010		486614217  -  CONNECTOR ROD 18MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614218	SUP	Custom 27803010		486614218  -  CONNECTOR ROD 18MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614219	SUP	Custom 27803010		486614219  -  CONNECTOR ROD 19MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614220	SUP	Custom 27803010		486614220  -  CONNECTOR ROD 20MM CROSS RAD SPN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614300	SUP	Custom 27803010		486614300  -  CONNECTOR ROD 0D SMALL ROD TO ROD RAD SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614305	SUP	Custom 27803010		486614305  -  CONNECTOR ROD 105D OFFST RAD BEN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614310	SUP	Custom 27803010		486614310  -  CONNECTOR ROD NEUTRAL OFFST RAD	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614320	SUP	Custom 27803010		486614320  -  CONNECTOR ROD NEUTRAL LONG OFFST RAD SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614330	SUP	Custom 27803010		486614330  -  CONNECTOR ROD 30D SMALL ROD TO ROD RAD SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614375	SUP	Custom 27803010		486614375  -  CONNECTOR ROD 75D SMALL ROD TO ROD RAD SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614400	SUP	Custom 27803010		486614400  -  CONNECTOR ROD 10D LARGE ROD TO ROD RAD SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614430	SUP	Custom 27803010		486614430  -  CONNECTOR ROD 10D LARGE ROD TO ROD RAD SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614530	SUP	Custom 27803010		486614530  -  CONCTR ROD 5MM RAD ROD TO ROD SPNL	BOTH IP/OP	"$2,076.80 "	"$1,536.83"	$0.00	"$1,661.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,541.40"	"$1,541.40"	$0.00	$0.00	$432.81	$0.00	$0.00	$0.00	$0.00	"$1,038.40"	"$1,644.83"	"$1,661.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614550	SUP	Custom 27803010		486614550  -  CONNECTOR ROD 5MM ROD TO ROD RAD SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614555	SUP	Custom 27803010		486614555  -  CONNECTOR ROD ROD TO ROD POLYAX RAD SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614560	SUP	Custom 27803010		486614560  -  CONNECTOR ROD 5MM ROD TO ROD RAD SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486614565	SUP	Custom 27803010		486614565  -  CONNECTOR ROD OFFST RAD SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615000	SUP	Custom 27803010		486615000  -  ROD SPINAL 5.5MM 100MM RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615010	SUP	Custom 27803010		486615010  -  ROD SPINAL 5.5MM 110MM RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615020	SUP	Custom 27803010		486615020  -  ROD SPINAL 5.5MM 120MM RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615030	SUP	Custom 27803010		486615030  -  ROD SPINAL 5.5MM 30MM RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615035	SUP	Custom 27803010		486615035  -  ROD SPNL 35MM BN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615040	SUP	Custom 27803010		486615040  -  ROD SPINAL 5.5MM 40MM TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615045	SUP	Custom 27803010		486615045  -  ROD SPINAL 5.5MM 45MM TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615050	SUP	Custom 27803010		486615050  -  ROD SPINAL 50X5.5MM RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615060	SUP	Custom 27803010		486615060  -  ROD SPINAL 60X5.5MM RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615070	SUP	Custom 27803010		486615070  -  ROD SPINAL 70X5.5MM RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615080	SUP	Custom 27803010		486615080  -  ROD SPNL 5.5MM 80MM SPRL RDS	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615090	SUP	Custom 27803010		486615090  -  ROD SPINAL 5.5MM 90MM TITANIUM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615500	SUP	Custom 27803010		486615500  -  ROD SPINAL 5.5MM 100MM RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615510	SUP	Custom 27803010		486615510  -  ROD SPINAL 5.5MM 110MM MAX RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615520	SUP	Custom 27803010		486615520  -  ROD SPINAL 5.5MM 120MM RAD MAX	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615550	SUP	Custom 27803010		486615550  -  ROD SPINAL 5.5MM 50MM RAD MAX	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615560	SUP	Custom 27803010		486615560  -  ROD SPNL 60MM ISOBAR	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615570	SUP	Custom 27803010		486615570  -  ROD SPNL 5.5MM 70MM MAX	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615580	SUP	Custom 27803010		486615580  -  ROD SPINAL 5.5MM 80MM MAX RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486615590	SUP	Custom 27803010		486615590  -  ROD SPINAL 5.5MM 90MM MAX RAD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616000	SUP	Custom 27803010		486616000  -  HOOK SPNL RADSM LMNR STR BLADE	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616001	SUP	Custom 27803010		486616001  -  HOOK SPNL RADSM LMNR NAR BLADE	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616002	SUP	Custom 27803010		486616002  -  HOOK SPNL RADLG LMNR STR BLADE	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616003	SUP	Custom 27803010		486616003  -  HOOK SPNL RADLG LMNR NAR BLADE	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616004	SUP	Custom 27803010		486616004  -  HOOK SPNL RAD LMNR XTD BLADE	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616005	SUP	Custom 27803010		486616005  -  HOOK SPNL RADLG LMNR RIGHT OFFST	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616006	SUP	Custom 27803010		486616006  -  HOOK SPNL RADLG LMNR LEFT OFFST	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616007	SUP	Custom 27803010		486616007  -  HOOK SPNL RAD LMNR ANG BLADE	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616008	SUP	Custom 27803010		486616008  -  HOOK SPNL RAD LMNR THOR	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616009	SUP	Custom 27803010		486616009  -  HOOK SPNL RAD LMNR THOR	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616010	SUP	Custom 27803010		486616010  -  HOOK SPNL RAD LMNR THOR	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616011	SUP	Custom 27803010		486616011  -  HOOK SPNL RAD LMNR THOR	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616012	SUP	Custom 27803010		486616012  -  HOOK SPNL RAD LMNR THOR	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616013	SUP	Custom 27803010		486616013  -  HOOK SPNL RAD LMNR THOR	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616014	SUP	Custom 27803010		486616014  -  HOOK SPNL RADSM PDCL	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616015	SUP	Custom 27803010		486616015  -  HOOK SPNL RADLG PDCL	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616016	SUP	Custom 27803010		486616016  -  HOOK SPNL RAD RIGHT TRNSVRS PRC	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616017	SUP	Custom 27803010		486616017  -  HOOK SPNL RAD LEFT TRNSVRS PRC	BOTH IP/OP	"$2,392.80 "	"$1,770.67"	$0.00	"$1,914.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,775.94"	"$1,775.94"	$0.00	$0.00	$498.66	$0.00	$0.00	$0.00	$0.00	"$1,196.40"	"$1,895.10"	"$1,914.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616018	SUP	Custom 27803010		486616018  -  HOOK SPNL RAD LMNR NAR BLADE	BOTH IP/OP	"$2,686.30 "	"$1,987.86"	$0.00	"$2,149.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,993.77"	"$1,993.77"	$0.00	$0.00	$559.82	$0.00	$0.00	$0.00	$0.00	"$1,343.15"	"$2,127.55"	"$2,149.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616019	SUP	Custom 27803010		486616019  -  HOOK SPNL RAD LMNR STD BLADE	BOTH IP/OP	"$2,686.30 "	"$1,987.86"	$0.00	"$2,149.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,993.77"	"$1,993.77"	$0.00	$0.00	$559.82	$0.00	$0.00	$0.00	$0.00	"$1,343.15"	"$2,127.55"	"$2,149.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616020	SUP	Custom 27803010		486616020  -  HOOK SPNL RAD LMNR ANG BLADE	BOTH IP/OP	"$2,686.30 "	"$1,987.86"	$0.00	"$2,149.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,993.77"	"$1,993.77"	$0.00	$0.00	$559.82	$0.00	$0.00	$0.00	$0.00	"$1,343.15"	"$2,127.55"	"$2,149.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616021	SUP	Custom 27803010		486616021  -  HOOK SPNL RAD LMNR THOR	BOTH IP/OP	"$2,686.30 "	"$1,987.86"	$0.00	"$2,149.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,993.77"	"$1,993.77"	$0.00	$0.00	$559.82	$0.00	$0.00	$0.00	$0.00	"$1,343.15"	"$2,127.55"	"$2,149.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486616022	SUP	Custom 27803010		486616022  -  HOOK SPNL RAD PDCL	BOTH IP/OP	"$2,686.30 "	"$1,987.86"	$0.00	"$2,149.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,993.77"	"$1,993.77"	$0.00	$0.00	$559.82	$0.00	$0.00	$0.00	$0.00	"$1,343.15"	"$2,127.55"	"$2,149.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
486617005	SUP	HCPCS C1713		486617005  -  STAPLE BONE DUAL RSTRL RADXS	BOTH IP/OP	"$2,493.88 "	"$1,845.47"	$0.00	"$1,995.10"	"$1,122.24"	"$1,122.24"	$0.00	$0.00	$0.00	$519.79	"$1,850.95"	"$1,850.95"	$0.00	$0.00	$519.72	$0.00	"$1,475.13"	"$1,475.13"	$0.00	"$1,246.94"	"$1,975.15"	"$1,995.10"	$0.00		$0.00	$390.29	$0.00	$0.00	$397.02	$0.00	$0.00	$0.00	$0.00	$0.00
486617006	SUP	HCPCS C1713		486617006  -  STAPLE BONE DUAL CDL RADXS	BOTH IP/OP	"$2,493.88 "	"$1,845.47"	$0.00	"$1,995.10"	"$1,122.24"	"$1,122.24"	$0.00	$0.00	$0.00	$519.79	"$1,850.95"	"$1,850.95"	$0.00	$0.00	$519.72	$0.00	"$1,475.13"	"$1,475.13"	$0.00	"$1,246.94"	"$1,975.15"	"$1,995.10"	$0.00		$0.00	$390.29	$0.00	$0.00	$397.02	$0.00	$0.00	$0.00	$0.00	$0.00
486617010	SUP	HCPCS C1713		486617010  -  STAPLE BONE DUAL CDL RADSM	BOTH IP/OP	"$2,493.88 "	"$1,845.47"	$0.00	"$1,995.10"	"$1,122.24"	"$1,122.24"	$0.00	$0.00	$0.00	$519.79	"$1,850.95"	"$1,850.95"	$0.00	$0.00	$519.72	$0.00	"$1,475.13"	"$1,475.13"	$0.00	"$1,246.94"	"$1,975.15"	"$1,995.10"	$0.00		$0.00	$390.29	$0.00	$0.00	$397.02	$0.00	$0.00	$0.00	$0.00	$0.00
486617015	SUP	HCPCS C1713		486617015  -  STAPLE BONE DUAL RSTRL RADSM	BOTH IP/OP	"$2,493.88 "	"$1,845.47"	$0.00	"$1,995.10"	"$1,122.24"	"$1,122.24"	$0.00	$0.00	$0.00	$519.79	"$1,850.95"	"$1,850.95"	$0.00	$0.00	$519.72	$0.00	"$1,475.13"	"$1,475.13"	$0.00	"$1,246.94"	"$1,975.15"	"$1,995.10"	$0.00		$0.00	$390.29	$0.00	$0.00	$397.02	$0.00	$0.00	$0.00	$0.00	$0.00
486617020	SUP	HCPCS C1713		486617020  -  STAPLE BONE DUAL CDL RADMED	BOTH IP/OP	"$2,493.88 "	"$1,845.47"	$0.00	"$1,995.10"	"$1,122.24"	"$1,122.24"	$0.00	$0.00	$0.00	$519.79	"$1,850.95"	"$1,850.95"	$0.00	$0.00	$519.72	$0.00	"$1,475.13"	"$1,475.13"	$0.00	"$1,246.94"	"$1,975.15"	"$1,995.10"	$0.00		$0.00	$390.29	$0.00	$0.00	$397.02	$0.00	$0.00	$0.00	$0.00	$0.00
486617025	SUP	HCPCS C1713		486617025  -  STAPLE BONE DUAL RSTRL RADMED	BOTH IP/OP	"$2,493.88 "	"$1,845.47"	$0.00	"$1,995.10"	"$1,122.24"	"$1,122.24"	$0.00	$0.00	$0.00	$519.79	"$1,850.95"	"$1,850.95"	$0.00	$0.00	$519.72	$0.00	"$1,475.13"	"$1,475.13"	$0.00	"$1,246.94"	"$1,975.15"	"$1,995.10"	$0.00		$0.00	$390.29	$0.00	$0.00	$397.02	$0.00	$0.00	$0.00	$0.00	$0.00
486617030	SUP	HCPCS C1713		486617030  -  STAPLE BONE DUAL CDL RADLG	BOTH IP/OP	"$2,493.88 "	"$1,845.47"	$0.00	"$1,995.10"	"$1,122.24"	"$1,122.24"	$0.00	$0.00	$0.00	$519.79	"$1,850.95"	"$1,850.95"	$0.00	$0.00	$519.72	$0.00	"$1,475.13"	"$1,475.13"	$0.00	"$1,246.94"	"$1,975.15"	"$1,995.10"	$0.00		$0.00	$390.29	$0.00	$0.00	$397.02	$0.00	$0.00	$0.00	$0.00	$0.00
486617035	SUP	HCPCS C1713		486617035  -  STAPLE BONE DUAL RSTRL RADLG	BOTH IP/OP	"$2,493.88 "	"$1,845.47"	$0.00	"$1,995.10"	"$1,122.24"	"$1,122.24"	$0.00	$0.00	$0.00	$519.79	"$1,850.95"	"$1,850.95"	$0.00	$0.00	$519.72	$0.00	"$1,475.13"	"$1,475.13"	$0.00	"$1,246.94"	"$1,975.15"	"$1,995.10"	$0.00		$0.00	$390.29	$0.00	$0.00	$397.02	$0.00	$0.00	$0.00	$0.00	$0.00
486617040	SUP	HCPCS C1713		486617040  -  STAPLE BONE SGL TI RAD	BOTH IP/OP	"$1,031.95 "	$763.64	$0.00	$825.56	$464.38	$464.38	$0.00	$0.00	$0.00	$215.08	$765.91	$765.91	$0.00	$0.00	$215.06	$0.00	$610.40	$610.40	$0.00	$515.98	$817.30	$825.56	$0.00		$0.00	$161.50	$0.00	$0.00	$164.29	$0.00	$0.00	$0.00	$0.00	$0.00
486617045	SUP	HCPCS C1713		486617045  -  WASHER RAD ORTH	BOTH IP/OP	$780.43 	$577.52	$0.00	$624.34	$351.19	$351.19	$0.00	$0.00	$0.00	$162.66	$579.23	$579.23	$0.00	$0.00	$162.64	$0.00	$461.62	$461.62	$0.00	$390.21	$618.10	$624.34	$0.00		$0.00	$122.14	$0.00	$0.00	$124.24	$0.00	$0.00	$0.00	$0.00	$0.00
486617050	SUP	HCPCS C1713		486617050  -  WASHER 4.75MM RADTALL ORTH	BOTH IP/OP	$795.48 	$588.66	$0.00	$636.38	$357.96	$357.96	$0.00	$0.00	$0.00	$165.80	$590.40	$590.40	$0.00	$0.00	$165.78	$0.00	$470.52	$470.52	$0.00	$397.74	$630.02	$636.38	$0.00		$0.00	$124.49	$0.00	$0.00	$126.64	$0.00	$0.00	$0.00	$0.00	$0.00
486617051	SUP	HCPCS C1713		486617051  -  WASHER 5.75MM RADTALL ORTH	BOTH IP/OP	$795.48 	$588.66	$0.00	$636.38	$357.96	$357.96	$0.00	$0.00	$0.00	$165.80	$590.40	$590.40	$0.00	$0.00	$165.78	$0.00	$470.52	$470.52	$0.00	$397.74	$630.02	$636.38	$0.00		$0.00	$124.49	$0.00	$0.00	$126.64	$0.00	$0.00	$0.00	$0.00	$0.00
486617052	SUP	HCPCS C1713		486617052  -  WASHER 6.75MM RADTALL ORTH	BOTH IP/OP	$795.48 	$588.66	$0.00	$636.38	$357.96	$357.96	$0.00	$0.00	$0.00	$165.80	$590.40	$590.40	$0.00	$0.00	$165.78	$0.00	$470.52	$470.52	$0.00	$397.74	$630.02	$636.38	$0.00		$0.00	$124.49	$0.00	$0.00	$126.64	$0.00	$0.00	$0.00	$0.00	$0.00
486617053	SUP	HCPCS C1713		486617053  -  WASHER 7.75MM RADTALL ORTH	BOTH IP/OP	$795.48 	$588.66	$0.00	$636.38	$357.96	$357.96	$0.00	$0.00	$0.00	$165.80	$590.40	$590.40	$0.00	$0.00	$165.78	$0.00	$470.52	$470.52	$0.00	$397.74	$630.02	$636.38	$0.00		$0.00	$124.49	$0.00	$0.00	$126.64	$0.00	$0.00	$0.00	$0.00	$0.00
486617054	SUP	HCPCS C1713		486617054  -  WASHER 8.75MM RADTALL ORTH	BOTH IP/OP	$795.48 	$588.66	$0.00	$636.38	$357.96	$357.96	$0.00	$0.00	$0.00	$165.80	$590.40	$590.40	$0.00	$0.00	$165.78	$0.00	$470.52	$470.52	$0.00	$397.74	$630.02	$636.38	$0.00		$0.00	$124.49	$0.00	$0.00	$126.64	$0.00	$0.00	$0.00	$0.00	$0.00
488514535	SUP	HCPCS C1713		488514535  -  SCREW BN 4.5MM 35MM STRL XIA PA SPNE LMBR CORT	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
488515035	SUP	HCPCS C1713		488515035  -  SCREW BN 5MM 35MM XIA CT PA SPNE CORT	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
488515540	SUP	HCPCS C1713		488515540  -  SCREW BN 5.5MM 40MM STRL XIA PA SPNE LMBR CORT	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
540133500	SUP	Custom 27803010		540133500  -  SYSTEM BONE CEMENT CARTRIDGE SELF CLEAN MIXING PADDLES SNAP	BOTH IP/OP	$920.42 	$681.11	$0.00	$736.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$683.14	$683.14	$0.00	$0.00	$191.82	$0.00	$0.00	$0.00	$0.00	$460.21	$728.97	$736.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
582010140	SUP	Custom 27203010		582010140  -  BURR SURG ROUND 4MM ROUND SOFT TOUCH LATEX FREE ELITE	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
606004102	SUP	HCPCS Q4130		606004102  -  MATRIX TISS THK1MM RECT 20X10CM STRL SURGIMEND PRS	BOTH IP/OP	"$9,000.00 "	"$6,660.00"	$0.00	"$9,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,875.83"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,875.60"	$0.00	"$4,437.00"	"$4,437.00"	$0.00	"$5,875.00"	"$9,306.00"	"$9,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
606200006	SUP	HCPCS C1713		606200006  -  SCREW BONE 2.7MM 16MM SPN SNPOF	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$6,900.00"	"$3,881.25"	"$3,881.25"	$0.00	$0.00	$0.00	"$1,172.39"	"$4,174.88"	"$4,174.88"	$0.00	$0.00	"$1,172.25"	$0.00	"$2,773.13"	"$2,773.13"	$0.00	"$4,312.50"	"$6,831.00"	"$6,900.00"	$0.00		$0.00	"$1,349.81"	$0.00	$0.00	"$1,373.10"	$0.00	$0.00	$0.00	$0.00	$0.00
630505036	SUP	HCPCS C1776		630505036  -  LINER ACETAB STANDARD NEUTRAL 50/52/54MM 36MM 6.8MM PRIM	BOTH IP/OP	"$2,978.75 "	"$2,204.28"	$0.00	"$2,383.00"	"$1,340.44"	"$1,340.44"	$0.00	$0.00	$0.00	$620.85	"$2,210.83"	"$2,210.83"	$0.00	$0.00	$620.77	$0.00	"$1,468.52"	"$1,468.52"	$0.00	"$1,489.38"	"$2,359.17"	"$2,383.00"	$0.00		$0.00	$466.17	$0.00	$0.00	$474.22	$0.00	$0.00	$0.00	$0.00	$0.00
630505636	SUP	HCPCS C1776		630505636  -  LINER ACETAB STANDARD NEUTRAL 56MM 36MM 7.9MM PRIM MODULAR	BOTH IP/OP	"$4,007.50 "	"$2,965.55"	$0.00	"$3,206.00"	"$1,803.38"	"$1,803.38"	$0.00	$0.00	$0.00	$835.26	"$2,974.37"	"$2,974.37"	$0.00	$0.00	$835.16	$0.00	"$1,975.70"	"$1,975.70"	$0.00	"$2,003.75"	"$3,173.94"	"$3,206.00"	$0.00		$0.00	$627.17	$0.00	$0.00	$637.99	$0.00	$0.00	$0.00	$0.00	$0.00
641003030	SUP	HCPCS C1713		641003030  -  ROD SPNL 30MM 4.75MM CD HZN COCRMO CAP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003035	SUP	HCPCS C1713		641003035  -  ROD SPNL 35MM 4.75MM CD HZN COCRMO CAP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003040	SUP	HCPCS C1713		641003040  -  ROD SPNL 40MM 4.75MM CD HZN COCRMO CAP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003045	SUP	HCPCS C1713		641003045  -  ROD SPNL 45MM 4.75MM CD HZN COCRMO CAP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003050	SUP	HCPCS C1713		641003050  -  ROD SPNL 50MM 4.75MM CD HZN COCRMO CAP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003055	SUP	HCPCS C1713		641003055  -  ROD SPNL 55MM 4.75MM CD HZN COCRMO CAP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003060	SUP	HCPCS C1713		641003060  -  ROD SPNL 60MM 4.75MM CD HZN COCRMO CAP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003065	SUP	HCPCS C1713		641003065  -  ROD SPNL 65MM 4.75MM CD HZN COCRMO CAP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003070	SUP	HCPCS C1713		641003070  -  ROD SPNL 70MM 4.75MM CD HZN COCRMO CAP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003075	SUP	HCPCS C1713		641003075  -  ROD SPNL 75MM 4.75MM CD HZN CAP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003080	SUP	HCPCS C1713		641003080  -  ROD SPNL 80MM 4.75MM CD HZN COCRMO CAP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003085	SUP	HCPCS C1713		641003085  -  ROD SPNL 85MM 4.75MM CD HZN COCRMO CAP STRL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003090	SUP	HCPCS C1713		641003090  -  ROD SPNL 90MM 4.75MM CD HZN COCRMO CAP STRL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
641003095	SUP	HCPCS C1713		641003095  -  ROD SPNL 95MM 4.75MM CD HZN COCRMO CAP STRL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
651506000	SUP	HCPCS C1894		651506000  -  SYSTEM INTRO .018IN 80CM SKTR GW SS	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$109.96	$109.96	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
654000100	SUP	HCPCS C1713		654000100  -  ROD SPNL 5.5MM 100MM NS CD HZN SOLERA TI PERC	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	$0.00	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00		$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
673395000	SUP	Custom 27203010		ADAPTER QCK 800 SER ANALY	BOTH IP/OP	$39.38 	$29.14	$0.00	$31.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.69	$31.19	$31.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
703046000	SUP	Custom 27203010		"0703046000  -  CTRY,PENCIL,PUSH BUTTON,SMOKE EVAC,70MM"	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
755308040	SUP	HCPCS C1729		755308040  -  CATHETER DRN 8FR 40CM STRL LF SKTR LCK PGTL RADOPQ BAND PU	BOTH IP/OP	$227.50 	$168.35	$0.00	$182.00	$123.53	$123.53	$0.00	$0.00	$0.00	$47.42	$168.85	$168.85	$0.00	$0.00	$47.41	$0.00	$134.57	$134.57	$0.00	$113.75	$180.18	$182.00	$0.00		$0.00	$35.60	$0.00	$0.00	$36.22	$0.00	$0.00	$0.00	$0.00	$0.00
755608035	SUP	HCPCS C1729		755608035  -  CATHETER NPHSTM PGTL CRV LOPRFL 8FR 35CM SKTR LCK KINK RST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$128.96	$128.96	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
755610035	SUP	HCPCS C1729		755610035  -  CATHETER NPHSTM .038IN PGTL CRV 10FR 35CM SKTR LCK GW PU BIL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
756506020	SUP	HCPCS C1729		756506020  -  CATHETER DRN 6FR 20CM SKTR CHC LCK AP LOPRFL TROC STY	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$130.32	$130.32	$0.00	$0.00	$0.00	$50.02	$178.13	$178.13	$0.00	$0.00	$50.02	$0.00	$141.96	$141.96	$0.00	$120.00	$190.08	$192.00	$0.00		$0.00	$37.56	$0.00	$0.00	$38.21	$0.00	$0.00	$0.00	$0.00	$0.00
756510025	SUP	HCPCS C1729		756510025  -  CATHETER DRN PGTL CRV 10FR 25CM SKTR CHC LCK LCK TROC STY LG	BOTH IP/OP	$234.95 	$173.86	$0.00	$187.96	$127.58	$127.58	$0.00	$0.00	$0.00	$48.97	$174.38	$174.38	$0.00	$0.00	$48.96	$0.00	$138.97	$138.97	$0.00	$117.47	$186.08	$187.96	$0.00		$0.00	$36.77	$0.00	$0.00	$37.40	$0.00	$0.00	$0.00	$0.00	$0.00
756512025	SUP	HCPCS C1729		756512025  -  CATHETER DRN PGTL CRV 12FR 25CM SKTR CHC LCK LCK TROC STY LG	BOTH IP/OP	"$1,174.73 "	$869.30	$0.00	$939.78	$637.88	$637.88	$0.00	$0.00	$0.00	$244.84	$871.88	$871.88	$0.00	$0.00	$244.81	$0.00	$694.85	$694.85	$0.00	$587.36	$930.39	$939.78	$0.00		$0.00	$183.84	$0.00	$0.00	$187.02	$0.00	$0.00	$0.00	$0.00	$0.00
756514025	SUP	HCPCS C1729		756514025  -  CATHETER DRN PGTL CRV 14FR 25CM SKTR CHC LCK LCK TROC STY LG	BOTH IP/OP	"$1,135.00 "	$839.90	$0.00	$908.00	$616.31	$616.31	$0.00	$0.00	$0.00	$236.56	$842.40	$842.40	$0.00	$0.00	$236.53	$0.00	$671.35	$671.35	$0.00	$567.50	$898.92	$908.00	$0.00		$0.00	$177.63	$0.00	$0.00	$180.69	$0.00	$0.00	$0.00	$0.00	$0.00
771600010	SUP	Custom 27203010		00771600010  -  CARRIER GRAFT 16X4IN BOARD LATEX FREE MESHGRAFT	BOTH IP/OP	$126.88 	$93.89	$0.00	$101.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.17	$94.17	$0.00	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$63.44	$100.49	$101.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778114545	SUP	Custom 27803010		778114545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778114555	SUP	Custom 27803010		778114555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778114565	SUP	Custom 27803010		778114565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778115545	SUP	Custom 27803010		778115545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778115555	SUP	Custom 27803010		778115555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778115565	SUP	Custom 27803010		778115565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778116545	SUP	Custom 27803010		778116545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778116555	SUP	Custom 27803010		778116555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778116565	SUP	Custom 27803010		778116565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778124545	SUP	Custom 27803010		778124545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	$0.00	$0.00	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778124555	SUP	Custom 27803010		778124555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	$0.00	$0.00	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778124565	SUP	Custom 27803010		778124565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,052.75 "	"$1,519.04"	$0.00	"$1,642.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,523.55"	"$1,523.55"	$0.00	$0.00	$427.79	$0.00	$0.00	$0.00	$0.00	"$1,026.38"	"$1,625.78"	"$1,642.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778125555	SUP	Custom 27803010		778125555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	$0.00	$0.00	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778125565	SUP	Custom 27803010		778125565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	$0.00	$0.00	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778126565	SUP	Custom 27803010		778126565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	$0.00	$0.00	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778144545	SUP	Custom 27803010		778144545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778144565	SUP	Custom 27803010		778144565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,981.85 "	"$1,466.57"	$0.00	"$1,585.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.93"	"$1,470.93"	$0.00	$0.00	$413.02	$0.00	$0.00	$0.00	$0.00	$990.93	"$1,569.63"	"$1,585.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778145545	SUP	Custom 27803010		778145545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778145555	SUP	Custom 27803010		778145555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778145565	SUP	Custom 27803010		778145565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,981.85 "	"$1,466.57"	$0.00	"$1,585.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.93"	"$1,470.93"	$0.00	$0.00	$413.02	$0.00	$0.00	$0.00	$0.00	$990.93	"$1,569.63"	"$1,585.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778146545	SUP	Custom 27803010		778146545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	$0.00	$0.00	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778146555	SUP	Custom 27803010		778146555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	$0.00	$0.00	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778146565	SUP	Custom 27803010		778146565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778161045	SUP	HCPCS C1713		778161045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778161065	SUP	HCPCS C1713		778161065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778162045	SUP	HCPCS C1713		778162045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778162055	SUP	HCPCS C1713		778162055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778162065	SUP	HCPCS C1713		778162065  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778164045	SUP	HCPCS C1713		778164045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778164065	SUP	HCPCS C1713		778164065  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778167045	SUP	HCPCS C1713		778167045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778167055	SUP	HCPCS C1713		778167055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778167065	SUP	HCPCS C1713		778167065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778170001	SUP	HCPCS C1713		778170001  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
778214545	SUP	Custom 27803010		778214545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778214555	SUP	Custom 27803010		778214555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778214565	SUP	Custom 27803010		778214565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778215545	SUP	Custom 27803010		778215545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778215555	SUP	Custom 27803010		778215555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778215565	SUP	Custom 27803010		778215565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778216545	SUP	Custom 27803010		778216545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778216555	SUP	Custom 27803010		778216555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778216565	SUP	Custom 27803010		778216565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778224545	SUP	Custom 27803010		778224545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,969.50 "	"$1,457.43"	$0.00	"$1,575.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,461.76"	"$1,461.76"	$0.00	$0.00	$410.44	$0.00	$0.00	$0.00	$0.00	$984.75	"$1,559.84"	"$1,575.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778224555	SUP	Custom 27803010		778224555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,969.50 "	"$1,457.43"	$0.00	"$1,575.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,461.76"	"$1,461.76"	$0.00	$0.00	$410.44	$0.00	$0.00	$0.00	$0.00	$984.75	"$1,559.84"	"$1,575.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778224565	SUP	Custom 27803010		778224565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,251.70 "	"$1,666.26"	$0.00	"$1,801.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,671.21"	"$1,671.21"	$0.00	$0.00	$469.25	$0.00	$0.00	$0.00	$0.00	"$1,125.85"	"$1,783.35"	"$1,801.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778225555	SUP	Custom 27803010		778225555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,969.50 "	"$1,457.43"	$0.00	"$1,575.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,461.76"	"$1,461.76"	$0.00	$0.00	$410.44	$0.00	$0.00	$0.00	$0.00	$984.75	"$1,559.84"	"$1,575.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778225565	SUP	Custom 27803010		778225565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,969.50 "	"$1,457.43"	$0.00	"$1,575.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,461.76"	"$1,461.76"	$0.00	$0.00	$410.44	$0.00	$0.00	$0.00	$0.00	$984.75	"$1,559.84"	"$1,575.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778226565	SUP	Custom 27803010		778226565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,969.50 "	"$1,457.43"	$0.00	"$1,575.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,461.76"	"$1,461.76"	$0.00	$0.00	$410.44	$0.00	$0.00	$0.00	$0.00	$984.75	"$1,559.84"	"$1,575.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778244545	SUP	Custom 27803010		778244545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,981.85 "	"$1,466.57"	$0.00	"$1,585.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.93"	"$1,470.93"	$0.00	$0.00	$413.02	$0.00	$0.00	$0.00	$0.00	$990.93	"$1,569.63"	"$1,585.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778244555	SUP	Custom 27803010		778244555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778244565	SUP	Custom 27803010		778244565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778245545	SUP	Custom 27803010		778245545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,981.85 "	"$1,466.57"	$0.00	"$1,585.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.93"	"$1,470.93"	$0.00	$0.00	$413.02	$0.00	$0.00	$0.00	$0.00	$990.93	"$1,569.63"	"$1,585.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778245555	SUP	Custom 27803010		778245555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,981.85 "	"$1,466.57"	$0.00	"$1,585.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.93"	"$1,470.93"	$0.00	$0.00	$413.02	$0.00	$0.00	$0.00	$0.00	$990.93	"$1,569.63"	"$1,585.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778245565	SUP	Custom 27803010		778245565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,175.95 "	"$1,610.20"	$0.00	"$1,740.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,614.99"	"$1,614.99"	$0.00	$0.00	$453.47	$0.00	$0.00	$0.00	$0.00	"$1,087.98"	"$1,723.35"	"$1,740.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778246545	SUP	Custom 27803010		778246545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,052.75 "	"$1,519.04"	$0.00	"$1,642.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,523.55"	"$1,523.55"	$0.00	$0.00	$427.79	$0.00	$0.00	$0.00	$0.00	"$1,026.38"	"$1,625.78"	"$1,642.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778246555	SUP	Custom 27803010		778246555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,052.75 "	"$1,519.04"	$0.00	"$1,642.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,523.55"	"$1,523.55"	$0.00	$0.00	$427.79	$0.00	$0.00	$0.00	$0.00	"$1,026.38"	"$1,625.78"	"$1,642.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778246565	SUP	Custom 27803010		778246565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,981.85 "	"$1,466.57"	$0.00	"$1,585.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,470.93"	"$1,470.93"	$0.00	$0.00	$413.02	$0.00	$0.00	$0.00	$0.00	$990.93	"$1,569.63"	"$1,585.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
778261045	SUP	HCPCS C1713		778261045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778261055	SUP	HCPCS C1713		778261055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778261065	SUP	HCPCS C1713		778261065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778262045	SUP	HCPCS C1713		778262045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778262055	SUP	HCPCS C1713		778262055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778262065	SUP	HCPCS C1713		778262065  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778264045	SUP	HCPCS C1713		778264045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778264055	SUP	HCPCS C1713		778264055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778264065	SUP	HCPCS C1713		778264065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778267045	SUP	HCPCS C1713		778267045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778267055	SUP	HCPCS C1713		778267055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778267065	SUP	HCPCS C1713		778267065  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
778270001	SUP	HCPCS C1713		778270001  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
779115545	SUP	Custom 27803010		779115545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
779115555	SUP	Custom 27803010		779115555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
779115565	SUP	Custom 27803010		779115565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	$0.00	$0.00	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
779124555	SUP	Custom 27803010		779124555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,251.70 "	"$1,666.26"	$0.00	"$1,801.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,671.21"	"$1,671.21"	$0.00	$0.00	$469.25	$0.00	$0.00	$0.00	$0.00	"$1,125.85"	"$1,783.35"	"$1,801.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
779125555	SUP	Custom 27803010		779125555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,251.70 "	"$1,666.26"	$0.00	"$1,801.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,671.21"	"$1,671.21"	$0.00	$0.00	$469.25	$0.00	$0.00	$0.00	$0.00	"$1,125.85"	"$1,783.35"	"$1,801.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
779125565	SUP	Custom 27803010		779125565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,251.70 "	"$1,666.26"	$0.00	"$1,801.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,671.21"	"$1,671.21"	$0.00	$0.00	$469.25	$0.00	$0.00	$0.00	$0.00	"$1,125.85"	"$1,783.35"	"$1,801.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
779144555	SUP	Custom 27803010		779144555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,251.70 "	"$1,666.26"	$0.00	"$1,801.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,671.21"	"$1,671.21"	$0.00	$0.00	$469.25	$0.00	$0.00	$0.00	$0.00	"$1,125.85"	"$1,783.35"	"$1,801.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
779145555	SUP	Custom 27803010		779145555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,251.70 "	"$1,666.26"	$0.00	"$1,801.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,671.21"	"$1,671.21"	$0.00	$0.00	$469.25	$0.00	$0.00	$0.00	$0.00	"$1,125.85"	"$1,783.35"	"$1,801.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
779146555	SUP	Custom 27803010		779146555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,251.70 "	"$1,666.26"	$0.00	"$1,801.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,671.21"	"$1,671.21"	$0.00	$0.00	$469.25	$0.00	$0.00	$0.00	$0.00	"$1,125.85"	"$1,783.35"	"$1,801.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
779170005	SUP	HCPCS C1713		779170005  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
880000010	SUP	Custom 27203010		00880000010  -  BLADE DERMATOME 1.25-4.25IN STERILE	BOTH IP/OP	$140.38 	$103.88	$0.00	$99.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.23	$99.23	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$60.63	$96.03	$97.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
998604014	SUP	HCPCS C1776		998604014  -  SET TOT JOINT 11MM 8IN TREPHINE MRI NONSTRL	BOTH IP/OP	"$2,037.50 "	"$1,507.75"	$0.00	"$1,630.00"	$916.88	$916.88	$0.00	$0.00	$0.00	$424.67	"$1,512.23"	"$1,512.23"	$0.00	$0.00	$424.62	$0.00	"$1,205.18"	"$1,205.18"	$0.00	"$1,018.75"	"$1,613.70"	"$1,630.00"	$0.00		$0.00	$318.87	$0.00	$0.00	$324.37	$0.00	$0.00	$0.00	$0.00	$0.00
1474000500	SUP	HCPCS C1713		1474000500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475000500	SUP	HCPCS C1713		1475000500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001030	SUP	HCPCS C1713		1475001030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001035	SUP	HCPCS C1713		1475001035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001040	SUP	HCPCS C1713		1475001040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001045	SUP	HCPCS C1713		1475001045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001050	SUP	HCPCS C1713		1475001050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001055	SUP	HCPCS C1713		1475001055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001060	SUP	HCPCS C1713		1475001060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001065	SUP	HCPCS C1713		1475001065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001070	SUP	HCPCS C1713		1475001070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001075	SUP	HCPCS C1713		1475001075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001080	SUP	HCPCS C1713		1475001080  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001085	SUP	HCPCS C1713		1475001085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001090	SUP	HCPCS C1713		1475001090  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001100	SUP	HCPCS C1713		1475001100  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001110	SUP	HCPCS C1713		1475001110  -  ROD SPNL CRV PREBNT 4.75MM 110MM NS SOLERA CD HZN CCM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475001120	SUP	HCPCS C1713		1475001120  -  ROD SPNL CRV 4.75MM 120MM NS SOLERA CD HZN COCR MLBDN	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475005040	SUP	HCPCS C1713		1475005040  -  ROD SPNL CRV 4.75MM 40MM NS SXTNT COCR MLBDN	BOTH IP/OP	"$2,820.00 "	"$2,086.80"	$0.00	"$2,256.00"	"$1,269.00"	"$1,269.00"	$0.00	$0.00	$0.00	$587.76	"$2,093.00"	"$2,093.00"	$0.00	$0.00	$587.69	$0.00	"$1,390.26"	"$1,390.26"	$0.00	"$1,410.00"	"$2,233.44"	"$2,256.00"	$0.00		$0.00	$441.33	$0.00	$0.00	$448.94	$0.00	$0.00	$0.00	$0.00	$0.00
1475005050	SUP	HCPCS C1713		1475005050  -  ROD SPINAL CURVE 4.75MM 50MM SEXTANT COCR	BOTH IP/OP	"$2,820.00 "	"$2,086.80"	$0.00	"$2,256.00"	"$1,269.00"	"$1,269.00"	$0.00	$0.00	$0.00	$587.76	"$2,093.00"	"$2,093.00"	$0.00	$0.00	$587.69	$0.00	"$1,390.26"	"$1,390.26"	$0.00	"$1,410.00"	"$2,233.44"	"$2,256.00"	$0.00		$0.00	$441.33	$0.00	$0.00	$448.94	$0.00	$0.00	$0.00	$0.00	$0.00
1475200500	SUP	HCPCS C1713		1475200500  -  ROD SPINAL 500MM LINE STR COCR MOLYBDENUM 4.75MM	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$956.48	$956.48	$0.00	$0.00	$0.00	$443.01	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	"$1,257.23"	"$1,257.23"	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$332.64	$0.00	$0.00	$338.38	$0.00	$0.00	$0.00	$0.00	$0.00
1475501030	SUP	HCPCS C1713		1475501030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501035	SUP	HCPCS C1713		1475501035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501040	SUP	HCPCS C1713		1475501040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501045	SUP	HCPCS C1713		1475501045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501050	SUP	HCPCS C1713		1475501050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501055	SUP	HCPCS C1713		1475501055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501060	SUP	HCPCS C1713		1475501060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501065	SUP	HCPCS C1713		1475501065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501070	SUP	HCPCS C1713		1475501070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501075	SUP	HCPCS C1713		1475501075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501080	SUP	HCPCS C1713		1475501080  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501085	SUP	HCPCS C1713		1475501085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501090	SUP	HCPCS C1713		1475501090  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501095	SUP	HCPCS C1713		1475501095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501100	SUP	HCPCS C1713		1475501100  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501105	SUP	HCPCS C1713		1475501105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501110	SUP	HCPCS C1713		1475501110  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501115	SUP	HCPCS C1713		1475501115  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1475501120	SUP	HCPCS C1713		1475501120  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476000500	SUP	HCPCS C1713		1476000500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006040	SUP	HCPCS C1713		1476006040  -  ROD SPNL 40MM 4.75MM LNGT II STR CCM PLUS PERC	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006070	SUP	HCPCS C1713		1476006070  -  ROD SPINAL 70MM STR CCM PLUS 4.75MM PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006080	SUP	HCPCS C1713		1476006080  -  ROD SPINAL 80MM STR CCM PLUS 4.75MM PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006090	SUP	HCPCS C1713		1476006090  -  ROD SPINAL STR 4.75MM 90MM CCM PLUS PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006100	SUP	HCPCS C1713		1476006100  -  ROD SPINAL 100MM STR CCM PLUS 4.75MM PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006110	SUP	HCPCS C1713		1476006110  -  ROD SPINAL 110MM STR COCR 4.75MM PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006120	SUP	HCPCS C1713		1476006120  -  ROD SPINAL 120MM STR CCM PLUS 4.75MM PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006130	SUP	HCPCS C1713		1476006130  -  ROD SPINAL STR 4.75MM 130MM CCM PLUS PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006140	SUP	HCPCS C1713		1476006140  -  ROD SPINAL 140MM STR CCM PLUS 4.75MM PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006150	SUP	HCPCS C1713		1476006150  -  ROD SPINAL 150MM STR CCM PLUS 4.75MM PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006160	SUP	HCPCS C1713		1476006160  -  ROD SPINAL 160MM STR CCM PLUS 4.75MM PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006170	SUP	HCPCS C1713		1476006170  -  ROD SPINAL 170MM SOLERA STR COCR MOLYBDENUM 4.75MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006180	SUP	HCPCS C1713		1476006180  -  ROD SPINAL 180MM STR CCM PLUS 4.75MM PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006200	SUP	HCPCS C1713		1476006200  -  ROD SPINAL 200MM STR CCM PLUS 4.75MM PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476006220	SUP	HCPCS C1713		1476006220  -  ROD SPNL STRG 4.75MM 220MM CCM + PERC	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1476200500	SUP	HCPCS C1713		1476200500  -  ROD SPINAL 500MM LINE CD HORIZON CURVE COBALT 5.5MM STERILE	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$956.48	$956.48	$0.00	$0.00	$0.00	$443.01	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	"$1,257.23"	"$1,257.23"	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$332.64	$0.00	$0.00	$338.38	$0.00	$0.00	$0.00	$0.00	$0.00
1553200500	SUP	HCPCS C1713		1553200500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201030	SUP	HCPCS C1713		1553201030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201035	SUP	HCPCS C1713		1553201035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201040	SUP	HCPCS C1713		1553201040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201045	SUP	HCPCS C1713		1553201045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201050	SUP	HCPCS C1713		1553201050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201055	SUP	HCPCS C1713		1553201055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201060	SUP	HCPCS C1713		1553201060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201070	SUP	HCPCS C1713		1553201070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201080	SUP	HCPCS C1713		1553201080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201090	SUP	HCPCS C1713		1553201090  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201100	SUP	HCPCS C1713		1553201100  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201110	SUP	HCPCS C1713		1553201110  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1553201120	SUP	HCPCS C1713		1553201120  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1554200500	SUP	HCPCS C1713		1554200500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555000500	SUP	HCPCS C1713		1555000500  -  ROD SPNL STRG 5.5MM 500MM NS CD HZN COCRMO	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555006100	SUP	HCPCS C1713		1555006100  -  ROD SPINAL 100MM PRECUT CD HORIZON STR COCR 5.5MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555006110	SUP	HCPCS C1713		1555006110  -  ROD SPNL STRG 5.5MM 110MM CCM PERC	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555006120	SUP	HCPCS C1713		1555006120  -  ROD SPINAL 120MM STR CCM 5.5MM PERCUTANEOUS	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555006170	SUP	HCPCS C1713		1555006170  -  ROD SPINAL 170MM PRECUT CD HORIZON STR COCR 5.5MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501030	SUP	HCPCS C1713		1555501030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501035	SUP	HCPCS C1713		1555501035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501040	SUP	HCPCS C1713		1555501040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501045	SUP	HCPCS C1713		1555501045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501050	SUP	HCPCS C1713		1555501050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501055	SUP	HCPCS C1713		1555501055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501060	SUP	HCPCS C1713		1555501060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501070	SUP	HCPCS C1713		1555501070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501080	SUP	HCPCS C1713		1555501080  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501090	SUP	HCPCS C1713		1555501090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501100	SUP	HCPCS C1713		1555501100  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501110	SUP	HCPCS C1713		1555501110  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1555501120	SUP	HCPCS C1713		1555501120  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556000500	SUP	HCPCS C1713		1556000500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556000600	SUP	HCPCS C1713		1556000600  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001030	SUP	HCPCS C1713		1556001030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001035	SUP	HCPCS C1713		1556001035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001040	SUP	HCPCS C1713		1556001040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001045	SUP	HCPCS C1713		1556001045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001050	SUP	HCPCS C1713		1556001050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001055	SUP	HCPCS C1713		1556001055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001060	SUP	HCPCS C1713		1556001060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001065	SUP	HCPCS C1713		1556001065  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001070	SUP	HCPCS C1713		1556001070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001075	SUP	HCPCS C1713		1556001075  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001080	SUP	HCPCS C1713		1556001080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001085	SUP	HCPCS C1713		1556001085  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001090	SUP	HCPCS C1713		1556001090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001095	SUP	HCPCS C1713		1556001095  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001100	SUP	HCPCS C1713		1556001100  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001105	SUP	HCPCS C1713		1556001105  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001110	SUP	HCPCS C1713		1556001110  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1556001115	SUP	HCPCS C1713		1556001115  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1603200500	SUP	HCPCS C1713		1603200500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1604200500	SUP	HCPCS C1713		1604200500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1605000500	SUP	HCPCS C1713		1605000500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1606000500	SUP	HCPCS C1713		1606000500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1606000600	SUP	HCPCS C1713		1606000600  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1606000700	SUP	HCPCS C1713		1606000700  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1606200500	SUP	HCPCS C1713		1606200500  -  ROD SPINAL 500MM LINE STR RED CCM PLUS 6MM	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
1607002003	SUP	Custom 27203010		1607002003  -  BURR SURG BARREL EGG 6MM STERILE	BOTH IP/OP	$145.75 	$107.86	$0.00	$116.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.18	$108.18	$0.00	$0.00	$30.37	$0.00	$0.00	$0.00	$0.00	$72.88	$115.43	$116.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1608002005	SUP	Custom 27203010		1608002005  -  BURR SURG 6.1MM 54MM 9.5MM PEAR HEAD STAINLESS STEEL STERILE	BOTH IP/OP	$145.75 	$107.86	$0.00	$116.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.18	$108.18	$0.00	$0.00	$30.37	$0.00	$0.00	$0.00	$0.00	$72.88	$115.43	$116.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1705015006	SUP	Custom 27203010		1705015006  -  PATCH CV THK.6MM 15X5CM STRL GRTX	BOTH IP/OP	"$1,555.00 "	"$1,150.70"	$0.00	"$1,244.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,154.12"	"$1,154.12"	$0.00	$0.00	$324.06	$0.00	$0.00	$0.00	$0.00	$777.50	"$1,231.56"	"$1,244.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3571129240	SUP	HCPCS C1713		3571129240  -  SCREW BN 4.5MM 40MM ST HEX HD HIP	BOTH IP/OP	$50.88 	$37.65	$0.00	$40.70	$22.89	$22.89	$0.00	$0.00	$0.00	$10.60	$37.76	$37.76	$0.00	$0.00	$10.60	$0.00	$30.09	$30.09	$0.00	$25.44	$40.30	$40.70	$0.00		$0.00	$7.96	$0.00	$0.00	$8.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571140003	SUP	HCPCS C1713		3571140003  -  PLATE BN 45MM 3 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	$798.00 	$590.52	$0.00	$638.40	$359.10	$359.10	$0.00	$0.00	$0.00	$166.32	$592.28	$592.28	$0.00	$0.00	$166.30	$0.00	$472.02	$472.02	$0.00	$399.00	$632.02	$638.40	$0.00		$0.00	$124.89	$0.00	$0.00	$127.04	$0.00	$0.00	$0.00	$0.00	$0.00
3571140004	SUP	HCPCS C1713		3571140004  -  PLATE BN 61MM 4 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	$846.30 	$626.26	$0.00	$677.04	$380.84	$380.84	$0.00	$0.00	$0.00	$176.39	$628.12	$628.12	$0.00	$0.00	$176.37	$0.00	$500.59	$500.59	$0.00	$423.15	$670.27	$677.04	$0.00		$0.00	$132.45	$0.00	$0.00	$134.73	$0.00	$0.00	$0.00	$0.00	$0.00
3571140005	SUP	HCPCS C1713		3571140005  -  PLATE BN 77MM STRL 5 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	$910.35 	$673.66	$0.00	$728.28	$409.66	$409.66	$0.00	$0.00	$0.00	$189.74	$675.66	$675.66	$0.00	$0.00	$189.72	$0.00	$538.47	$538.47	$0.00	$455.18	$721.00	$728.28	$0.00		$0.00	$142.47	$0.00	$0.00	$144.93	$0.00	$0.00	$0.00	$0.00	$0.00
3571140006	SUP	HCPCS C1713		3571140006  -  PLATE BN 93MM STRL 6 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	$972.30 	$719.50	$0.00	$777.84	$437.54	$437.54	$0.00	$0.00	$0.00	$202.65	$721.64	$721.64	$0.00	$0.00	$202.63	$0.00	$575.12	$575.12	$0.00	$486.15	$770.06	$777.84	$0.00		$0.00	$152.16	$0.00	$0.00	$154.79	$0.00	$0.00	$0.00	$0.00	$0.00
3571140007	SUP	HCPCS C1713		3571140007  -  PLATE BN 109MM STRL 7 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	"$1,025.85 "	$759.13	$0.00	$820.68	$461.63	$461.63	$0.00	$0.00	$0.00	$213.81	$761.39	$761.39	$0.00	$0.00	$213.79	$0.00	$606.79	$606.79	$0.00	$512.93	$812.47	$820.68	$0.00		$0.00	$160.55	$0.00	$0.00	$163.32	$0.00	$0.00	$0.00	$0.00	$0.00
3571140008	SUP	HCPCS C1713		3571140008  -  PLATE BN 125MM STRL 8 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	"$1,302.00 "	$963.48	$0.00	"$1,041.60"	$585.90	$585.90	$0.00	$0.00	$0.00	$271.37	$966.34	$966.34	$0.00	$0.00	$271.34	$0.00	$770.13	$770.13	$0.00	$651.00	"$1,031.18"	"$1,041.60"	$0.00		$0.00	$203.76	$0.00	$0.00	$207.28	$0.00	$0.00	$0.00	$0.00	$0.00
3571140009	SUP	HCPCS C1713		3571140009  -  PLATE BN 141MM STRL 9 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	"$1,391.25 "	"$1,029.53"	$0.00	"$1,113.00"	$626.06	$626.06	$0.00	$0.00	$0.00	$289.97	"$1,032.59"	"$1,032.59"	$0.00	$0.00	$289.94	$0.00	$822.92	$822.92	$0.00	$695.63	"$1,101.87"	"$1,113.00"	$0.00		$0.00	$217.73	$0.00	$0.00	$221.49	$0.00	$0.00	$0.00	$0.00	$0.00
3571140010	SUP	HCPCS C1713		3571140010  -  PLATE BN 157MM STRL 10 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	"$1,464.75 "	"$1,083.92"	$0.00	"$1,171.80"	$659.14	$659.14	$0.00	$0.00	$0.00	$305.29	"$1,087.14"	"$1,087.14"	$0.00	$0.00	$305.25	$0.00	$866.40	$866.40	$0.00	$732.38	"$1,160.08"	"$1,171.80"	$0.00		$0.00	$229.23	$0.00	$0.00	$233.19	$0.00	$0.00	$0.00	$0.00	$0.00
3571140011	SUP	HCPCS C1713		3571140011  -  PLATE BN 173MM STRL 11 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	"$1,506.75 "	"$1,115.00"	$0.00	"$1,205.40"	$678.04	$678.04	$0.00	$0.00	$0.00	$314.04	"$1,118.31"	"$1,118.31"	$0.00	$0.00	$314.01	$0.00	$891.24	$891.24	$0.00	$753.38	"$1,193.35"	"$1,205.40"	$0.00		$0.00	$235.81	$0.00	$0.00	$239.87	$0.00	$0.00	$0.00	$0.00	$0.00
3571140012	SUP	HCPCS C1713		3571140012  -  PLATE BN 189MM STRL 12 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	"$1,302.00 "	$963.48	$0.00	"$1,041.60"	$585.90	$585.90	$0.00	$0.00	$0.00	$271.37	$966.34	$966.34	$0.00	$0.00	$271.34	$0.00	$770.13	$770.13	$0.00	$651.00	"$1,031.18"	"$1,041.60"	$0.00		$0.00	$203.76	$0.00	$0.00	$207.28	$0.00	$0.00	$0.00	$0.00	$0.00
3571140013	SUP	HCPCS C1713		3571140013  -  PLATE BN 205MM STRL 13 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	"$1,701.00 "	"$1,258.74"	$0.00	"$1,360.80"	$765.45	$765.45	$0.00	$0.00	$0.00	$354.53	"$1,262.48"	"$1,262.48"	$0.00	$0.00	$354.49	$0.00	"$1,006.14"	"$1,006.14"	$0.00	$850.50	"$1,347.19"	"$1,360.80"	$0.00		$0.00	$266.21	$0.00	$0.00	$270.80	$0.00	$0.00	$0.00	$0.00	$0.00
3571140014	SUP	HCPCS C1713		3571140014  -  PLATE BN 221MM 14 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	"$1,422.75 "	"$1,052.84"	$0.00	"$1,138.20"	$640.24	$640.24	$0.00	$0.00	$0.00	$296.54	"$1,055.97"	"$1,055.97"	$0.00	$0.00	$296.50	$0.00	$841.56	$841.56	$0.00	$711.38	"$1,126.82"	"$1,138.20"	$0.00		$0.00	$222.66	$0.00	$0.00	$226.50	$0.00	$0.00	$0.00	$0.00	$0.00
3571140015	SUP	HCPCS C1713		3571140015  -  PLATE BN 237MM STRL 15 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	"$1,806.00 "	"$1,336.44"	$0.00	"$1,444.80"	$812.70	$812.70	$0.00	$0.00	$0.00	$376.42	"$1,340.41"	"$1,340.41"	$0.00	$0.00	$376.37	$0.00	"$1,068.25"	"$1,068.25"	$0.00	$903.00	"$1,430.35"	"$1,444.80"	$0.00		$0.00	$282.64	$0.00	$0.00	$287.52	$0.00	$0.00	$0.00	$0.00	$0.00
3571140016	SUP	HCPCS C1713		3571140016  -  PLATE BN 253MM STRL 16 HL RECON PLVC 4.5MM SCR	BOTH IP/OP	"$1,869.00 "	"$1,383.06"	$0.00	"$1,495.20"	$841.05	$841.05	$0.00	$0.00	$0.00	$389.55	"$1,387.17"	"$1,387.17"	$0.00	$0.00	$389.50	$0.00	"$1,105.51"	"$1,105.51"	$0.00	$934.50	"$1,480.25"	"$1,495.20"	$0.00		$0.00	$292.50	$0.00	$0.00	$297.54	$0.00	$0.00	$0.00	$0.00	$0.00
3571140104	SUP	HCPCS C1713		3571140104  -  PLATE BN 46MM STRL 4 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	$875.70 	$648.02	$0.00	$700.56	$394.07	$394.07	$0.00	$0.00	$0.00	$182.52	$649.94	$649.94	$0.00	$0.00	$182.50	$0.00	$517.98	$517.98	$0.00	$437.85	$693.55	$700.56	$0.00		$0.00	$137.05	$0.00	$0.00	$139.41	$0.00	$0.00	$0.00	$0.00	$0.00
3571140105	SUP	HCPCS C1713		3571140105  -  PLATE BN 58MM 5 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	$812.70 	$601.40	$0.00	$650.16	$365.72	$365.72	$0.00	$0.00	$0.00	$169.39	$603.19	$603.19	$0.00	$0.00	$169.37	$0.00	$480.71	$480.71	$0.00	$406.35	$643.66	$650.16	$0.00		$0.00	$127.19	$0.00	$0.00	$129.38	$0.00	$0.00	$0.00	$0.00	$0.00
3571140106	SUP	HCPCS C1713		3571140106  -  PLATE BN 70MM 6 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$1,022.70 "	$756.80	$0.00	$818.16	$460.22	$460.22	$0.00	$0.00	$0.00	$213.16	$759.05	$759.05	$0.00	$0.00	$213.13	$0.00	$604.93	$604.93	$0.00	$511.35	$809.98	$818.16	$0.00		$0.00	$160.05	$0.00	$0.00	$162.81	$0.00	$0.00	$0.00	$0.00	$0.00
3571140107	SUP	HCPCS C1713		3571140107  -  PLATE BN 82MM 7 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	$974.40 	$721.06	$0.00	$779.52	$438.48	$438.48	$0.00	$0.00	$0.00	$203.09	$723.20	$723.20	$0.00	$0.00	$203.06	$0.00	$576.36	$576.36	$0.00	$487.20	$771.72	$779.52	$0.00		$0.00	$152.49	$0.00	$0.00	$155.12	$0.00	$0.00	$0.00	$0.00	$0.00
3571140108	SUP	HCPCS C1713		3571140108  -  PLATE BN 94MM 8 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$1,118.25 "	$827.51	$0.00	$894.60	$503.21	$503.21	$0.00	$0.00	$0.00	$233.07	$829.97	$829.97	$0.00	$0.00	$233.04	$0.00	$661.44	$661.44	$0.00	$559.13	$885.65	$894.60	$0.00		$0.00	$175.01	$0.00	$0.00	$178.03	$0.00	$0.00	$0.00	$0.00	$0.00
3571140109	SUP	HCPCS C1713		3571140109  -  PLATE BN 106MM 9 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$1,050.00 "	$777.00	$0.00	$840.00	$472.50	$472.50	$0.00	$0.00	$0.00	$218.85	$779.31	$779.31	$0.00	$0.00	$218.82	$0.00	$621.08	$621.08	$0.00	$525.00	$831.60	$840.00	$0.00		$0.00	$164.33	$0.00	$0.00	$167.16	$0.00	$0.00	$0.00	$0.00	$0.00
3571140110	SUP	HCPCS C1713		3571140110  -  PLATE BN 118MM 10 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
3571140111	SUP	HCPCS C1713		3571140111  -  PLATE BN 130MM STRL 11 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$1,118.25 "	$827.51	$0.00	$894.60	$503.21	$503.21	$0.00	$0.00	$0.00	$233.07	$829.97	$829.97	$0.00	$0.00	$233.04	$0.00	$661.44	$661.44	$0.00	$559.13	$885.65	$894.60	$0.00		$0.00	$175.01	$0.00	$0.00	$178.03	$0.00	$0.00	$0.00	$0.00	$0.00
3571140112	SUP	HCPCS C1713		3571140112  -  PLATE BN 142MM 12 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
3571140113	SUP	HCPCS C1713		3571140113  -  PLATE BN 154MM STRL 13 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$1,496.25 "	"$1,107.23"	$0.00	"$1,197.00"	$673.31	$673.31	$0.00	$0.00	$0.00	$311.86	"$1,110.52"	"$1,110.52"	$0.00	$0.00	$311.82	$0.00	$885.03	$885.03	$0.00	$748.13	"$1,185.03"	"$1,197.00"	$0.00		$0.00	$234.16	$0.00	$0.00	$238.20	$0.00	$0.00	$0.00	$0.00	$0.00
3571140114	SUP	HCPCS C1713		3571140114  -  PLATE BN 166MM 14 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$1,380.75 "	"$1,021.76"	$0.00	"$1,104.60"	$621.34	$621.34	$0.00	$0.00	$0.00	$287.78	"$1,024.79"	"$1,024.79"	$0.00	$0.00	$287.75	$0.00	$816.71	$816.71	$0.00	$690.38	"$1,093.55"	"$1,104.60"	$0.00		$0.00	$216.09	$0.00	$0.00	$219.82	$0.00	$0.00	$0.00	$0.00	$0.00
3571140115	SUP	HCPCS C1713		3571140115  -  PLATE BN 178MM STRL 15 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$1,648.50 "	"$1,219.89"	$0.00	"$1,318.80"	$741.83	$741.83	$0.00	$0.00	$0.00	$343.59	"$1,223.52"	"$1,223.52"	$0.00	$0.00	$343.55	$0.00	$975.09	$975.09	$0.00	$824.25	"$1,305.61"	"$1,318.80"	$0.00		$0.00	$257.99	$0.00	$0.00	$262.44	$0.00	$0.00	$0.00	$0.00	$0.00
3571140116	SUP	HCPCS C1713		3571140116  -  PLATE BN 190MM 16 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$1,407.00 "	"$1,041.18"	$0.00	"$1,125.60"	$633.15	$633.15	$0.00	$0.00	$0.00	$293.25	"$1,044.28"	"$1,044.28"	$0.00	$0.00	$293.22	$0.00	$832.24	$832.24	$0.00	$703.50	"$1,114.34"	"$1,125.60"	$0.00		$0.00	$220.20	$0.00	$0.00	$223.99	$0.00	$0.00	$0.00	$0.00	$0.00
3571140118	SUP	HCPCS C1713		3571140118  -  PLATE BN 214MM 18 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$1,480.50 "	"$1,095.57"	$0.00	"$1,184.40"	$666.23	$666.23	$0.00	$0.00	$0.00	$308.57	"$1,098.83"	"$1,098.83"	$0.00	$0.00	$308.54	$0.00	$875.72	$875.72	$0.00	$740.25	"$1,172.56"	"$1,184.40"	$0.00		$0.00	$231.70	$0.00	$0.00	$235.70	$0.00	$0.00	$0.00	$0.00	$0.00
3571140120	SUP	HCPCS C1713		3571140120  -  PLATE BN 238MM STRL 20 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$1,800.75 "	"$1,332.56"	$0.00	"$1,440.60"	$810.34	$810.34	$0.00	$0.00	$0.00	$375.32	"$1,336.52"	"$1,336.52"	$0.00	$0.00	$375.28	$0.00	"$1,065.14"	"$1,065.14"	$0.00	$900.38	"$1,426.19"	"$1,440.60"	$0.00		$0.00	$281.82	$0.00	$0.00	$286.68	$0.00	$0.00	$0.00	$0.00	$0.00
3571140122	SUP	HCPCS C1713		3571140122  -  PLATE BN 263MM STRL 22 HL RECON PLVC 3.5MM SCR	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,827.00"	"$1,027.69"	"$1,027.69"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,141.88"	"$1,808.73"	"$1,827.00"	$0.00		$0.00	$357.41	$0.00	$0.00	$363.57	$0.00	$0.00	$0.00	$0.00	$0.00
3571140202	SUP	HCPCS C1713		3571140202  -  PLATE BN 25MM STRL 2 HL 3.5MM SCR SM FRAG	BOTH IP/OP	$296.10 	$219.11	$0.00	$236.88	$133.25	$133.25	$0.00	$0.00	$0.00	$61.71	$219.77	$219.77	$0.00	$0.00	$61.71	$0.00	$175.14	$175.14	$0.00	$148.05	$234.51	$236.88	$0.00		$0.00	$46.34	$0.00	$0.00	$47.14	$0.00	$0.00	$0.00	$0.00	$0.00
3571140203	SUP	HCPCS C1713		3571140203  -  PLATE BN 37MM STRL 3 HL 3.5MM SCR SM FRAG	BOTH IP/OP	$309.75 	$229.22	$0.00	$247.80	$139.39	$139.39	$0.00	$0.00	$0.00	$64.56	$229.90	$229.90	$0.00	$0.00	$64.55	$0.00	$183.22	$183.22	$0.00	$154.88	$245.32	$247.80	$0.00		$0.00	$48.48	$0.00	$0.00	$49.31	$0.00	$0.00	$0.00	$0.00	$0.00
3571140204	SUP	HCPCS C1713		3571140204  -  PLATE BN 49MM STRL 4 HL 3.5MM SCR SM FRAG	BOTH IP/OP	$316.05 	$233.88	$0.00	$252.84	$142.22	$142.22	$0.00	$0.00	$0.00	$65.87	$234.57	$234.57	$0.00	$0.00	$65.86	$0.00	$186.94	$186.94	$0.00	$158.03	$250.31	$252.84	$0.00		$0.00	$49.46	$0.00	$0.00	$50.32	$0.00	$0.00	$0.00	$0.00	$0.00
3571140205	SUP	HCPCS C1713		3571140205  -  PLATE BN 61MM STRL 5 HL 3.5MM SCR SM FRAG	BOTH IP/OP	$345.45 	$255.63	$0.00	$276.36	$155.45	$155.45	$0.00	$0.00	$0.00	$72.00	$256.39	$256.39	$0.00	$0.00	$71.99	$0.00	$204.33	$204.33	$0.00	$172.73	$273.60	$276.36	$0.00		$0.00	$54.06	$0.00	$0.00	$55.00	$0.00	$0.00	$0.00	$0.00	$0.00
3571140206	SUP	HCPCS C1713		3571140206  -  PLATE BN 73MM STRL 6 HL 3.5MM SCR SM FRAG	BOTH IP/OP	$361.20 	$267.29	$0.00	$288.96	$162.54	$162.54	$0.00	$0.00	$0.00	$75.28	$268.08	$268.08	$0.00	$0.00	$75.27	$0.00	$213.65	$213.65	$0.00	$180.60	$286.07	$288.96	$0.00		$0.00	$56.53	$0.00	$0.00	$57.50	$0.00	$0.00	$0.00	$0.00	$0.00
3571140207	SUP	HCPCS C1713		3571140207  -  PLATE BN 85MM STRL 7 HL 3.5MM SCR SM FRAG	BOTH IP/OP	$378.00 	$279.72	$0.00	$302.40	$170.10	$170.10	$0.00	$0.00	$0.00	$78.78	$280.55	$280.55	$0.00	$0.00	$78.78	$0.00	$223.59	$223.59	$0.00	$189.00	$299.38	$302.40	$0.00		$0.00	$59.16	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$0.00
3571140208	SUP	HCPCS C1713		3571140208  -  PLATE BN 97MM STRL 8 HL 3.5MM SCR SM FRAG	BOTH IP/OP	$405.30 	$299.92	$0.00	$324.24	$182.39	$182.39	$0.00	$0.00	$0.00	$84.47	$300.81	$300.81	$0.00	$0.00	$84.46	$0.00	$239.73	$239.73	$0.00	$202.65	$321.00	$324.24	$0.00		$0.00	$63.43	$0.00	$0.00	$64.52	$0.00	$0.00	$0.00	$0.00	$0.00
3571140209	SUP	HCPCS C1713		3571140209  -  PLATE BN 109MM STRL 9 HL 3.5MM SCR SM FRAG	BOTH IP/OP	$414.75 	$306.92	$0.00	$331.80	$186.64	$186.64	$0.00	$0.00	$0.00	$86.44	$307.83	$307.83	$0.00	$0.00	$86.43	$0.00	$245.32	$245.32	$0.00	$207.38	$328.48	$331.80	$0.00		$0.00	$64.91	$0.00	$0.00	$66.03	$0.00	$0.00	$0.00	$0.00	$0.00
3571140210	SUP	HCPCS C1713		3571140210  -  PLATE BN 121MM STRL 10 HL 3.5MM SCR SM FRAG	BOTH IP/OP	$426.30 	$315.46	$0.00	$341.04	$191.84	$191.84	$0.00	$0.00	$0.00	$88.85	$316.40	$316.40	$0.00	$0.00	$88.84	$0.00	$252.16	$252.16	$0.00	$213.15	$337.63	$341.04	$0.00		$0.00	$66.72	$0.00	$0.00	$67.87	$0.00	$0.00	$0.00	$0.00	$0.00
3571140212	SUP	HCPCS C1713		3571140212  -  PLATE BN 145MM STRL 12 HL 3.5MM SCR SM FRAG	BOTH IP/OP	$473.55 	$350.43	$0.00	$378.84	$213.10	$213.10	$0.00	$0.00	$0.00	$98.70	$351.47	$351.47	$0.00	$0.00	$98.69	$0.00	$280.10	$280.10	$0.00	$236.78	$375.05	$378.84	$0.00		$0.00	$74.11	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
3571140214	SUP	HCPCS C1713		3571140214  -  PLATE BN 169MM STRL 14 HL 3.5MM SCR SM FRAG	BOTH IP/OP	$889.35 	$658.12	$0.00	$711.48	$400.21	$400.21	$0.00	$0.00	$0.00	$185.36	$660.08	$660.08	$0.00	$0.00	$185.34	$0.00	$526.05	$526.05	$0.00	$444.68	$704.37	$711.48	$0.00		$0.00	$139.18	$0.00	$0.00	$141.58	$0.00	$0.00	$0.00	$0.00	$0.00
3571140216	SUP	HCPCS C1713		3571140216  -  PLATE BN 194MM STRL 16 HL 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,025.85 "	$759.13	$0.00	$820.68	$461.63	$461.63	$0.00	$0.00	$0.00	$213.81	$761.39	$761.39	$0.00	$0.00	$213.79	$0.00	$606.79	$606.79	$0.00	$512.93	$812.47	$820.68	$0.00		$0.00	$160.55	$0.00	$0.00	$163.32	$0.00	$0.00	$0.00	$0.00	$0.00
3571140218	SUP	HCPCS C1713		3571140218  -  PLATE BN 217MM STRL 18 HL 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,380.75 "	"$1,021.76"	$0.00	"$1,104.60"	$621.34	$621.34	$0.00	$0.00	$0.00	$287.78	"$1,024.79"	"$1,024.79"	$0.00	$0.00	$287.75	$0.00	$816.71	$816.71	$0.00	$690.38	"$1,093.55"	"$1,104.60"	$0.00		$0.00	$216.09	$0.00	$0.00	$219.82	$0.00	$0.00	$0.00	$0.00	$0.00
3571140220	SUP	HCPCS C1713		3571140220  -  PLATE BN 242MM STRL 20 HL 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,270.50 "	$940.17	$0.00	"$1,016.40"	$571.73	$571.73	$0.00	$0.00	$0.00	$264.80	$942.97	$942.97	$0.00	$0.00	$264.77	$0.00	$751.50	$751.50	$0.00	$635.25	"$1,006.24"	"$1,016.40"	$0.00		$0.00	$198.83	$0.00	$0.00	$202.26	$0.00	$0.00	$0.00	$0.00	$0.00
3571140222	SUP	HCPCS C1713		3571140222  -  PLATE BN 265MM STRL 22 HL 3.5MM SCR SM FRAG	BOTH IP/OP	"$1,701.00 "	"$1,258.74"	$0.00	"$1,360.80"	$765.45	$765.45	$0.00	$0.00	$0.00	$354.53	"$1,262.48"	"$1,262.48"	$0.00	$0.00	$354.49	$0.00	"$1,006.14"	"$1,006.14"	$0.00	$850.50	"$1,347.19"	"$1,360.80"	$0.00		$0.00	$266.21	$0.00	$0.00	$270.80	$0.00	$0.00	$0.00	$0.00	$0.00
3571140302	SUP	HCPCS C1713		3571140302  -  PLATE BN 25MM STRL 1/3 TBLR 2 HL COLR	BOTH IP/OP	$169.05 	$125.10	$0.00	$135.24	$76.07	$76.07	$0.00	$0.00	$0.00	$35.23	$125.47	$125.47	$0.00	$0.00	$35.23	$0.00	$99.99	$99.99	$0.00	$84.53	$133.89	$135.24	$0.00		$0.00	$26.46	$0.00	$0.00	$26.91	$0.00	$0.00	$0.00	$0.00	$0.00
3571140303	SUP	HCPCS C1713		3571140303  -  PLATE BN 37MM STRL 1/3 TBLR 3 HL COLR	BOTH IP/OP	$143.85 	$106.45	$0.00	$115.08	$64.73	$64.73	$0.00	$0.00	$0.00	$29.98	$106.77	$106.77	$0.00	$0.00	$29.98	$0.00	$85.09	$85.09	$0.00	$71.93	$113.93	$115.08	$0.00		$0.00	$22.51	$0.00	$0.00	$22.90	$0.00	$0.00	$0.00	$0.00	$0.00
3571140304	SUP	HCPCS C1713		3571140304  -  PLATE BN 49MM STRL 1/3 TBLR 4 HL COLR	BOTH IP/OP	$169.05 	$125.10	$0.00	$135.24	$76.07	$76.07	$0.00	$0.00	$0.00	$35.23	$125.47	$125.47	$0.00	$0.00	$35.23	$0.00	$99.99	$99.99	$0.00	$84.53	$133.89	$135.24	$0.00		$0.00	$26.46	$0.00	$0.00	$26.91	$0.00	$0.00	$0.00	$0.00	$0.00
3571140305	SUP	HCPCS C1713		3571140305  -  PLATE BN 61MM STRL 1/3 TBLR 5 HL COLR	BOTH IP/OP	$211.05 	$156.18	$0.00	$168.84	$94.97	$94.97	$0.00	$0.00	$0.00	$43.99	$156.64	$156.64	$0.00	$0.00	$43.98	$0.00	$124.84	$124.84	$0.00	$105.53	$167.15	$168.84	$0.00		$0.00	$33.03	$0.00	$0.00	$33.60	$0.00	$0.00	$0.00	$0.00	$0.00
3571140306	SUP	HCPCS C1713		3571140306  -  PLATE BN 73MM STRL 1/3 TBLR 6 HL COLR DIST FIB	BOTH IP/OP	$175.35 	$129.76	$0.00	$140.28	$78.91	$78.91	$0.00	$0.00	$0.00	$36.55	$130.14	$130.14	$0.00	$0.00	$36.54	$0.00	$103.72	$103.72	$0.00	$87.68	$138.88	$140.28	$0.00		$0.00	$27.44	$0.00	$0.00	$27.92	$0.00	$0.00	$0.00	$0.00	$0.00
3571140307	SUP	HCPCS C1713		3571140307  -  PLATE BN 85MM STRL 1/3 TBLR 7 HL COLR DIST FIB	BOTH IP/OP	$175.35 	$129.76	$0.00	$140.28	$78.91	$78.91	$0.00	$0.00	$0.00	$36.55	$130.14	$130.14	$0.00	$0.00	$36.54	$0.00	$103.72	$103.72	$0.00	$87.68	$138.88	$140.28	$0.00		$0.00	$27.44	$0.00	$0.00	$27.92	$0.00	$0.00	$0.00	$0.00	$0.00
3571140308	SUP	HCPCS C1713		3571140308  -  PLATE BN 97MM STRL 1/3 TBLR 8 HL COLR DIST FIB	BOTH IP/OP	$177.45 	$131.31	$0.00	$141.96	$79.85	$79.85	$0.00	$0.00	$0.00	$36.99	$131.70	$131.70	$0.00	$0.00	$36.98	$0.00	$104.96	$104.96	$0.00	$88.73	$140.54	$141.96	$0.00		$0.00	$27.77	$0.00	$0.00	$28.25	$0.00	$0.00	$0.00	$0.00	$0.00
3571140309	SUP	HCPCS C1713		3571140309  -  PLATE BN 109MM STRL 1/3 TBLR 9 HL COLR DIST FIB	BOTH IP/OP	$177.45 	$131.31	$0.00	$141.96	$79.85	$79.85	$0.00	$0.00	$0.00	$36.99	$131.70	$131.70	$0.00	$0.00	$36.98	$0.00	$104.96	$104.96	$0.00	$88.73	$140.54	$141.96	$0.00		$0.00	$27.77	$0.00	$0.00	$28.25	$0.00	$0.00	$0.00	$0.00	$0.00
3571140310	SUP	HCPCS C1713		3571140310  -  PLATE BN 121MM STRL 1/3 TBLR 10 HL COLR DIST FIB	BOTH IP/OP	$177.45 	$131.31	$0.00	$141.96	$79.85	$79.85	$0.00	$0.00	$0.00	$36.99	$131.70	$131.70	$0.00	$0.00	$36.98	$0.00	$104.96	$104.96	$0.00	$88.73	$140.54	$141.96	$0.00		$0.00	$27.77	$0.00	$0.00	$28.25	$0.00	$0.00	$0.00	$0.00	$0.00
3571140312	SUP	HCPCS C1713		3571140312  -  PLATE BN 145MM STRL 1/3 TBLR 12 HL COLR DIST FIB	BOTH IP/OP	$181.65 	$134.42	$0.00	$145.32	$81.74	$81.74	$0.00	$0.00	$0.00	$37.86	$134.82	$134.82	$0.00	$0.00	$37.86	$0.00	$107.45	$107.45	$0.00	$90.83	$143.87	$145.32	$0.00		$0.00	$28.43	$0.00	$0.00	$28.92	$0.00	$0.00	$0.00	$0.00	$0.00
3571140403	SUP	HCPCS C1713		3571140403  -  PLATE BN T RT ANG 50MM STRL 3X3 HL	BOTH IP/OP	$313.95 	$232.32	$0.00	$251.16	$141.28	$141.28	$0.00	$0.00	$0.00	$65.44	$233.01	$233.01	$0.00	$0.00	$65.43	$0.00	$185.70	$185.70	$0.00	$156.98	$248.65	$251.16	$0.00		$0.00	$49.13	$0.00	$0.00	$49.98	$0.00	$0.00	$0.00	$0.00	$0.00
3571140404	SUP	HCPCS C1713		3571140404  -  PLATE BN T RT ANG 56MM STRL 4X4 HL	BOTH IP/OP	$320.25 	$236.99	$0.00	$256.20	$144.11	$144.11	$0.00	$0.00	$0.00	$66.75	$237.69	$237.69	$0.00	$0.00	$66.74	$0.00	$189.43	$189.43	$0.00	$160.13	$253.64	$256.20	$0.00		$0.00	$50.12	$0.00	$0.00	$50.98	$0.00	$0.00	$0.00	$0.00	$0.00
3571140405	SUP	HCPCS C1713		3571140405  -  PLATE BN T RT ANG 67MM STRL 3X5 HL	BOTH IP/OP	$360.15 	$266.51	$0.00	$288.12	$162.07	$162.07	$0.00	$0.00	$0.00	$75.06	$267.30	$267.30	$0.00	$0.00	$75.06	$0.00	$213.03	$213.03	$0.00	$180.08	$285.24	$288.12	$0.00		$0.00	$56.36	$0.00	$0.00	$57.34	$0.00	$0.00	$0.00	$0.00	$0.00
3571140406	SUP	HCPCS C1713		3571140406  -  PLATE BN T RT ANG 78MM STRL 4X6 HL	BOTH IP/OP	$414.75 	$306.92	$0.00	$331.80	$186.64	$186.64	$0.00	$0.00	$0.00	$86.44	$307.83	$307.83	$0.00	$0.00	$86.43	$0.00	$245.32	$245.32	$0.00	$207.38	$328.48	$331.80	$0.00		$0.00	$64.91	$0.00	$0.00	$66.03	$0.00	$0.00	$0.00	$0.00	$0.00
3571140503	SUP	HCPCS C1713		3571140503  -  PLATE BN T 53MM STRL 3X3 HL OBLQ	BOTH IP/OP	$563.85 	$417.25	$0.00	$451.08	$253.73	$253.73	$0.00	$0.00	$0.00	$117.52	$418.49	$418.49	$0.00	$0.00	$117.51	$0.00	$333.52	$333.52	$0.00	$281.93	$446.57	$451.08	$0.00		$0.00	$88.24	$0.00	$0.00	$89.76	$0.00	$0.00	$0.00	$0.00	$0.00
3571140504	SUP	HCPCS C1713		3571140504  -  PLATE BN T 63MM STRL 3X4 HL OBLQ	BOTH IP/OP	$588.00 	$435.12	$0.00	$470.40	$264.60	$264.60	$0.00	$0.00	$0.00	$122.55	$436.41	$436.41	$0.00	$0.00	$122.54	$0.00	$347.80	$347.80	$0.00	$294.00	$465.70	$470.40	$0.00		$0.00	$92.02	$0.00	$0.00	$93.61	$0.00	$0.00	$0.00	$0.00	$0.00
3571140505	SUP	HCPCS C1713		3571140505  -  PLATE BN T 73MM STRL 5X4 HL OBLQ	BOTH IP/OP	$609.00 	$450.66	$0.00	$487.20	$274.05	$274.05	$0.00	$0.00	$0.00	$126.93	$452.00	$452.00	$0.00	$0.00	$126.92	$0.00	$360.22	$360.22	$0.00	$304.50	$482.33	$487.20	$0.00		$0.00	$95.31	$0.00	$0.00	$96.95	$0.00	$0.00	$0.00	$0.00	$0.00
3571140603	SUP	HCPCS C1713		3571140603  -  PLATE BN CLVRLF 88MM STRL 3 HL	BOTH IP/OP	$744.45 	$550.89	$0.00	$595.56	$335.00	$335.00	$0.00	$0.00	$0.00	$155.16	$552.53	$552.53	$0.00	$0.00	$155.14	$0.00	$440.34	$440.34	$0.00	$372.23	$589.60	$595.56	$0.00		$0.00	$116.51	$0.00	$0.00	$118.52	$0.00	$0.00	$0.00	$0.00	$0.00
3571140604	SUP	HCPCS C1713		3571140604  -  PLATE BN CLVRLF 104MM STRL 4 HL	BOTH IP/OP	$798.00 	$590.52	$0.00	$638.40	$359.10	$359.10	$0.00	$0.00	$0.00	$166.32	$592.28	$592.28	$0.00	$0.00	$166.30	$0.00	$472.02	$472.02	$0.00	$399.00	$632.02	$638.40	$0.00		$0.00	$124.89	$0.00	$0.00	$127.04	$0.00	$0.00	$0.00	$0.00	$0.00
3571140606	SUP	HCPCS C1713		3571140606  -  PLATE BN CRV 70MM 6 HL RECON SS 3.5MM SCR	BOTH IP/OP	"$1,039.50 "	$769.23	$0.00	$831.60	$467.78	$467.78	$0.00	$0.00	$0.00	$216.66	$771.52	$771.52	$0.00	$0.00	$216.63	$0.00	$614.86	$614.86	$0.00	$519.75	$823.28	$831.60	$0.00		$0.00	$162.68	$0.00	$0.00	$165.49	$0.00	$0.00	$0.00	$0.00	$0.00
3571140608	SUP	HCPCS C1713		3571140608  -  PLATE BN CRV 94MM 8 HL RECON SS 3.5MM SCR	BOTH IP/OP	"$1,134.00 "	$839.16	$0.00	$907.20	$510.30	$510.30	$0.00	$0.00	$0.00	$236.35	$841.65	$841.65	$0.00	$0.00	$236.33	$0.00	$670.76	$670.76	$0.00	$567.00	$898.13	$907.20	$0.00		$0.00	$177.47	$0.00	$0.00	$180.53	$0.00	$0.00	$0.00	$0.00	$0.00
3571140610	SUP	HCPCS C1713		3571140610  -  PLATE BN CRV 118MM 10 HL RECON SS 3.5MM SCR	BOTH IP/OP	"$1,186.50 "	$878.01	$0.00	$949.20	$533.93	$533.93	$0.00	$0.00	$0.00	$247.30	$880.62	$880.62	$0.00	$0.00	$247.27	$0.00	$701.81	$701.81	$0.00	$593.25	$939.71	$949.20	$0.00		$0.00	$185.69	$0.00	$0.00	$188.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571140612	SUP	HCPCS C1713		3571140612  -  PLATE BN CRV 142MM 12 HL RECON SS 3.5MM SCR	BOTH IP/OP	"$1,244.25 "	$920.75	$0.00	$995.40	$559.91	$559.91	$0.00	$0.00	$0.00	$259.33	$923.48	$923.48	$0.00	$0.00	$259.30	$0.00	$735.97	$735.97	$0.00	$622.13	$985.45	$995.40	$0.00		$0.00	$194.73	$0.00	$0.00	$198.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571140614	SUP	HCPCS C1713		3571140614  -  PLATE BN CRV 166MM 14 HL RECON SS 3.5MM SCR	BOTH IP/OP	"$1,401.75 "	"$1,037.30"	$0.00	"$1,121.40"	$630.79	$630.79	$0.00	$0.00	$0.00	$292.16	"$1,040.38"	"$1,040.38"	$0.00	$0.00	$292.12	$0.00	$829.14	$829.14	$0.00	$700.88	"$1,110.19"	"$1,121.40"	$0.00		$0.00	$219.37	$0.00	$0.00	$223.16	$0.00	$0.00	$0.00	$0.00	$0.00
3571140616	SUP	HCPCS C1713		3571140616  -  PLATE BN CRV 190MM 16 HL RECON SS 3.5MM SCR	BOTH IP/OP	"$1,485.75 "	"$1,099.46"	$0.00	"$1,188.60"	$668.59	$668.59	$0.00	$0.00	$0.00	$309.67	"$1,102.72"	"$1,102.72"	$0.00	$0.00	$309.63	$0.00	$878.82	$878.82	$0.00	$742.88	"$1,176.71"	"$1,188.60"	$0.00		$0.00	$232.52	$0.00	$0.00	$236.53	$0.00	$0.00	$0.00	$0.00	$0.00
3571140618	SUP	HCPCS C1713		3571140618  -  PLATE BN CRV 214MM STRL 18 HL RECON SS 3.5MM SCR	BOTH IP/OP	"$1,601.25 "	"$1,184.93"	$0.00	"$1,281.00"	$720.56	$720.56	$0.00	$0.00	$0.00	$333.74	"$1,188.45"	"$1,188.45"	$0.00	$0.00	$333.70	$0.00	$947.14	$947.14	$0.00	$800.63	"$1,268.19"	"$1,281.00"	$0.00		$0.00	$250.60	$0.00	$0.00	$254.92	$0.00	$0.00	$0.00	$0.00	$0.00
3571140704	SUP	HCPCS C1713		3571140704  -  PLATE BN 80MM STRL 4 HL TBTRS	BOTH IP/OP	$926.10 	$685.31	$0.00	$740.88	$416.75	$416.75	$0.00	$0.00	$0.00	$193.02	$687.35	$687.35	$0.00	$0.00	$193.00	$0.00	$547.79	$547.79	$0.00	$463.05	$733.47	$740.88	$0.00		$0.00	$144.93	$0.00	$0.00	$147.44	$0.00	$0.00	$0.00	$0.00	$0.00
3571140705	SUP	HCPCS C1713		3571140705  -  PLATE BN 96MM STRL 5 HL TBTRS	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
3571140706	SUP	HCPCS C1713		3571140706  -  PLATE BN 112MM STRL 6 HL TBTRS	BOTH IP/OP	"$1,249.50 "	$924.63	$0.00	$999.60	$562.28	$562.28	$0.00	$0.00	$0.00	$260.43	$927.38	$927.38	$0.00	$0.00	$260.40	$0.00	$739.08	$739.08	$0.00	$624.75	$989.60	$999.60	$0.00		$0.00	$195.55	$0.00	$0.00	$198.92	$0.00	$0.00	$0.00	$0.00	$0.00
3571140804	SUP	HCPCS C1713		3571140804  -  PLATE BN 86MM STRL 4 HL L BTRS TIB LT	BOTH IP/OP	$828.45 	$613.05	$0.00	$662.76	$372.80	$372.80	$0.00	$0.00	$0.00	$172.67	$614.88	$614.88	$0.00	$0.00	$172.65	$0.00	$490.03	$490.03	$0.00	$414.23	$656.13	$662.76	$0.00		$0.00	$129.65	$0.00	$0.00	$131.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571140904	SUP	HCPCS C1713		3571140904  -  PLATE BN 86MM STRL 4 HL L BTRS TIB RT	BOTH IP/OP	$828.45 	$613.05	$0.00	$662.76	$372.80	$372.80	$0.00	$0.00	$0.00	$172.67	$614.88	$614.88	$0.00	$0.00	$172.65	$0.00	$490.03	$490.03	$0.00	$414.23	$656.13	$662.76	$0.00		$0.00	$129.65	$0.00	$0.00	$131.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571141003	SUP	HCPCS C1713		3571141003  -  PLATE BN STRL 3 HL BTRS TIBHD RL	BOTH IP/OP	"$1,422.75 "	"$1,052.84"	$0.00	"$1,138.20"	$640.24	$640.24	$0.00	$0.00	$0.00	$296.54	"$1,055.97"	"$1,055.97"	$0.00	$0.00	$296.50	$0.00	$841.56	$841.56	$0.00	$711.38	"$1,126.82"	"$1,138.20"	$0.00		$0.00	$222.66	$0.00	$0.00	$226.50	$0.00	$0.00	$0.00	$0.00	$0.00
3571141005	SUP	HCPCS C1713		3571141005  -  PLATE BN 118MM STRL 5 HL BTRS TIBHD RL	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
3571141007	SUP	HCPCS C1713		3571141007  -  PLATE BN 149MM STRL 7 HL BTRS TIBHD RL	BOTH IP/OP	"$1,785.00 "	"$1,320.90"	$0.00	"$1,428.00"	$803.25	$803.25	$0.00	$0.00	$0.00	$372.04	"$1,324.83"	"$1,324.83"	$0.00	$0.00	$371.99	$0.00	"$1,055.83"	"$1,055.83"	$0.00	$892.50	"$1,413.72"	"$1,428.00"	$0.00		$0.00	$279.35	$0.00	$0.00	$284.17	$0.00	$0.00	$0.00	$0.00	$0.00
3571141009	SUP	HCPCS C1713		3571141009  -  PLATE BN 181MM STRL 9 HL BTRS TIBHD RL	BOTH IP/OP	"$1,905.75 "	"$1,410.26"	$0.00	"$1,524.60"	$857.59	$857.59	$0.00	$0.00	$0.00	$397.21	"$1,414.45"	"$1,414.45"	$0.00	$0.00	$397.16	$0.00	"$1,127.25"	"$1,127.25"	$0.00	$952.88	"$1,509.35"	"$1,524.60"	$0.00		$0.00	$298.25	$0.00	$0.00	$303.40	$0.00	$0.00	$0.00	$0.00	$0.00
3571141011	SUP	HCPCS C1713		3571141011  -  PLATE BN 214MM STRL 11 HL BTRS TIBHD RL	BOTH IP/OP	"$2,499.00 "	"$1,849.26"	$0.00	"$1,999.20"	"$1,124.55"	"$1,124.55"	$0.00	$0.00	$0.00	$520.85	"$1,854.76"	"$1,854.76"	$0.00	$0.00	$520.79	$0.00	"$1,478.16"	"$1,478.16"	$0.00	"$1,249.50"	"$1,979.21"	"$1,999.20"	$0.00		$0.00	$391.09	$0.00	$0.00	$397.84	$0.00	$0.00	$0.00	$0.00	$0.00
3571141013	SUP	HCPCS C1713		3571141013  -  PLATE BN 246MM STRL 13 HL BTRS TIBHD RL	BOTH IP/OP	"$2,593.50 "	"$1,919.19"	$0.00	"$2,074.80"	"$1,167.08"	"$1,167.08"	$0.00	$0.00	$0.00	$540.55	"$1,924.90"	"$1,924.90"	$0.00	$0.00	$540.49	$0.00	"$1,278.60"	"$1,278.60"	$0.00	"$1,296.75"	"$2,054.05"	"$2,074.80"	$0.00		$0.00	$405.88	$0.00	$0.00	$412.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571141103	SUP	HCPCS C1713		3571141103  -  PLATE BN STRL 3 HL BTRS TIBHD L/L	BOTH IP/OP	"$1,422.75 "	"$1,052.84"	$0.00	"$1,138.20"	$640.24	$640.24	$0.00	$0.00	$0.00	$296.54	"$1,055.97"	"$1,055.97"	$0.00	$0.00	$296.50	$0.00	$841.56	$841.56	$0.00	$711.38	"$1,126.82"	"$1,138.20"	$0.00		$0.00	$222.66	$0.00	$0.00	$226.50	$0.00	$0.00	$0.00	$0.00	$0.00
3571141105	SUP	HCPCS C1713		3571141105  -  PLATE BN 118MM STRL 5 HL BTRS TIBHD L/L	BOTH IP/OP	"$1,669.50 "	"$1,235.43"	$0.00	"$1,335.60"	$751.28	$751.28	$0.00	$0.00	$0.00	$347.97	"$1,239.10"	"$1,239.10"	$0.00	$0.00	$347.92	$0.00	$987.51	$987.51	$0.00	$834.75	"$1,322.24"	"$1,335.60"	$0.00		$0.00	$261.28	$0.00	$0.00	$265.78	$0.00	$0.00	$0.00	$0.00	$0.00
3571141107	SUP	HCPCS C1713		3571141107  -  PLATE BN 149MM STRL 7 HL BTRS TIBHD L/L	BOTH IP/OP	"$1,785.00 "	"$1,320.90"	$0.00	"$1,428.00"	$803.25	$803.25	$0.00	$0.00	$0.00	$372.04	"$1,324.83"	"$1,324.83"	$0.00	$0.00	$371.99	$0.00	"$1,055.83"	"$1,055.83"	$0.00	$892.50	"$1,413.72"	"$1,428.00"	$0.00		$0.00	$279.35	$0.00	$0.00	$284.17	$0.00	$0.00	$0.00	$0.00	$0.00
3571141109	SUP	HCPCS C1713		3571141109  -  PLATE BN 181MM STRL 9 HL BTRS TIBHD L/L	BOTH IP/OP	"$1,905.75 "	"$1,410.26"	$0.00	"$1,524.60"	$857.59	$857.59	$0.00	$0.00	$0.00	$397.21	"$1,414.45"	"$1,414.45"	$0.00	$0.00	$397.16	$0.00	"$1,127.25"	"$1,127.25"	$0.00	$952.88	"$1,509.35"	"$1,524.60"	$0.00		$0.00	$298.25	$0.00	$0.00	$303.40	$0.00	$0.00	$0.00	$0.00	$0.00
3571141111	SUP	HCPCS C1713		3571141111  -  PLATE BN 214MM STRL 11 HL BTRS TIBHD L/L	BOTH IP/OP	"$2,499.00 "	"$1,849.26"	$0.00	"$1,999.20"	"$1,124.55"	"$1,124.55"	$0.00	$0.00	$0.00	$520.85	"$1,854.76"	"$1,854.76"	$0.00	$0.00	$520.79	$0.00	"$1,478.16"	"$1,478.16"	$0.00	"$1,249.50"	"$1,979.21"	"$1,999.20"	$0.00		$0.00	$391.09	$0.00	$0.00	$397.84	$0.00	$0.00	$0.00	$0.00	$0.00
3571141113	SUP	HCPCS C1713		3571141113  -  PLATE BN 246MM STRL 13 HL BTRS TIBHD L/L	BOTH IP/OP	"$2,593.50 "	"$1,919.19"	$0.00	"$2,074.80"	"$1,167.08"	"$1,167.08"	$0.00	$0.00	$0.00	$540.55	"$1,924.90"	"$1,924.90"	$0.00	$0.00	$540.49	$0.00	"$1,278.60"	"$1,278.60"	$0.00	"$1,296.75"	"$2,054.05"	"$2,074.80"	$0.00		$0.00	$405.88	$0.00	$0.00	$412.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571141206	SUP	HCPCS C1713		3571141206  -  PLATE BN BRD 103MM STRL 6 HL 4.5MM SCR	BOTH IP/OP	$546.00 	$404.04	$0.00	$436.80	$245.70	$245.70	$0.00	$0.00	$0.00	$113.80	$405.24	$405.24	$0.00	$0.00	$113.79	$0.00	$322.96	$322.96	$0.00	$273.00	$432.43	$436.80	$0.00		$0.00	$85.45	$0.00	$0.00	$86.92	$0.00	$0.00	$0.00	$0.00	$0.00
3571141207	SUP	HCPCS C1713		3571141207  -  PLATE BN BRD 119MM STRL 7 HL 4.5MM SCR	BOTH IP/OP	$546.00 	$404.04	$0.00	$436.80	$245.70	$245.70	$0.00	$0.00	$0.00	$113.80	$405.24	$405.24	$0.00	$0.00	$113.79	$0.00	$322.96	$322.96	$0.00	$273.00	$432.43	$436.80	$0.00		$0.00	$85.45	$0.00	$0.00	$86.92	$0.00	$0.00	$0.00	$0.00	$0.00
3571141208	SUP	HCPCS C1713		3571141208  -  PLATE BN BRD 135MM STRL 8 HL 4.5MM SCR	BOTH IP/OP	$680.40 	$503.50	$0.00	$544.32	$306.18	$306.18	$0.00	$0.00	$0.00	$141.81	$504.99	$504.99	$0.00	$0.00	$141.80	$0.00	$402.46	$402.46	$0.00	$340.20	$538.88	$544.32	$0.00		$0.00	$106.48	$0.00	$0.00	$108.32	$0.00	$0.00	$0.00	$0.00	$0.00
3571141209	SUP	HCPCS C1713		3571141209  -  PLATE BN BRD 151MM STRL 9 HL 4.5MM SCR	BOTH IP/OP	$680.40 	$503.50	$0.00	$544.32	$306.18	$306.18	$0.00	$0.00	$0.00	$141.81	$504.99	$504.99	$0.00	$0.00	$141.80	$0.00	$402.46	$402.46	$0.00	$340.20	$538.88	$544.32	$0.00		$0.00	$106.48	$0.00	$0.00	$108.32	$0.00	$0.00	$0.00	$0.00	$0.00
3571141210	SUP	HCPCS C1713		3571141210  -  PLATE BN BRD 167MM STRL 10 HL 4.5MM SCR	BOTH IP/OP	$680.40 	$503.50	$0.00	$544.32	$306.18	$306.18	$0.00	$0.00	$0.00	$141.81	$504.99	$504.99	$0.00	$0.00	$141.80	$0.00	$402.46	$402.46	$0.00	$340.20	$538.88	$544.32	$0.00		$0.00	$106.48	$0.00	$0.00	$108.32	$0.00	$0.00	$0.00	$0.00	$0.00
3571141212	SUP	HCPCS C1713		3571141212  -  PLATE BN BRD 199MM STRL 12 HL 4.5MM SCR	BOTH IP/OP	$731.85 	$541.57	$0.00	$585.48	$329.33	$329.33	$0.00	$0.00	$0.00	$152.54	$543.18	$543.18	$0.00	$0.00	$152.52	$0.00	$432.89	$432.89	$0.00	$365.93	$579.63	$585.48	$0.00		$0.00	$114.53	$0.00	$0.00	$116.51	$0.00	$0.00	$0.00	$0.00	$0.00
3571141214	SUP	HCPCS C1713		3571141214  -  PLATE BN BRD 231MM STRL 14 HL 4.5MM SCR	BOTH IP/OP	$731.85 	$541.57	$0.00	$585.48	$329.33	$329.33	$0.00	$0.00	$0.00	$152.54	$543.18	$543.18	$0.00	$0.00	$152.52	$0.00	$432.89	$432.89	$0.00	$365.93	$579.63	$585.48	$0.00		$0.00	$114.53	$0.00	$0.00	$116.51	$0.00	$0.00	$0.00	$0.00	$0.00
3571141216	SUP	HCPCS C1713		3571141216  -  PLATE BN BRD 263MM STRL 16 HL 4.5MM SCR	BOTH IP/OP	$926.10 	$685.31	$0.00	$740.88	$416.75	$416.75	$0.00	$0.00	$0.00	$193.02	$687.35	$687.35	$0.00	$0.00	$193.00	$0.00	$547.79	$547.79	$0.00	$463.05	$733.47	$740.88	$0.00		$0.00	$144.93	$0.00	$0.00	$147.44	$0.00	$0.00	$0.00	$0.00	$0.00
3571141218	SUP	HCPCS C1713		3571141218  -  PLATE BN BRD 295MM STRL 18 HL 4.5MM SCR	BOTH IP/OP	"$1,022.70 "	$756.80	$0.00	$818.16	$460.22	$460.22	$0.00	$0.00	$0.00	$213.16	$759.05	$759.05	$0.00	$0.00	$213.13	$0.00	$604.93	$604.93	$0.00	$511.35	$809.98	$818.16	$0.00		$0.00	$160.05	$0.00	$0.00	$162.81	$0.00	$0.00	$0.00	$0.00	$0.00
3571141220	SUP	HCPCS C1713		3571141220  -  PLATE BN BRD 326MM STRL 20 HL 4.5MM SCR	BOTH IP/OP	"$1,459.50 "	"$1,080.03"	$0.00	"$1,167.60"	$656.78	$656.78	$0.00	$0.00	$0.00	$304.20	"$1,083.24"	"$1,083.24"	$0.00	$0.00	$304.16	$0.00	$863.29	$863.29	$0.00	$729.75	"$1,155.92"	"$1,167.60"	$0.00		$0.00	$228.41	$0.00	$0.00	$232.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571141222	SUP	HCPCS C1713		3571141222  -  PLATE BN BRD 358MM STRL 22 HL 4.5MM SCR	BOTH IP/OP	"$1,543.50 "	"$1,142.19"	$0.00	"$1,234.80"	$694.58	$694.58	$0.00	$0.00	$0.00	$321.70	"$1,145.59"	"$1,145.59"	$0.00	$0.00	$321.67	$0.00	$912.98	$912.98	$0.00	$771.75	"$1,222.45"	"$1,234.80"	$0.00		$0.00	$241.56	$0.00	$0.00	$245.73	$0.00	$0.00	$0.00	$0.00	$0.00
3571141224	SUP	HCPCS C1713		3571141224  -  PLATE BN BRD 390MM STRL 24 HL 4.5MM SCR	BOTH IP/OP	"$1,711.50 "	"$1,266.51"	$0.00	"$1,369.20"	$770.18	$770.18	$0.00	$0.00	$0.00	$356.72	"$1,270.28"	"$1,270.28"	$0.00	$0.00	$356.68	$0.00	"$1,012.35"	"$1,012.35"	$0.00	$855.75	"$1,355.51"	"$1,369.20"	$0.00		$0.00	$267.85	$0.00	$0.00	$272.47	$0.00	$0.00	$0.00	$0.00	$0.00
3571141302	SUP	HCPCS C1713		3571141302  -  PLATE BN 39MM STRL 2 HL SMTB	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
3571141303	SUP	HCPCS C1713		3571141303  -  PLATE BN 55MM STRL 3 HL SMTB	BOTH IP/OP	$147.00 	$108.78	$0.00	$117.60	$66.15	$66.15	$0.00	$0.00	$0.00	$30.64	$109.10	$109.10	$0.00	$0.00	$30.63	$0.00	$86.95	$86.95	$0.00	$73.50	$116.42	$117.60	$0.00		$0.00	$23.01	$0.00	$0.00	$23.40	$0.00	$0.00	$0.00	$0.00	$0.00
3571141304	SUP	HCPCS C1713		3571141304  -  PLATE BN 71MM STRL 4 HL SMTB	BOTH IP/OP	$159.60 	$118.10	$0.00	$127.68	$71.82	$71.82	$0.00	$0.00	$0.00	$33.26	$118.46	$118.46	$0.00	$0.00	$33.26	$0.00	$94.40	$94.40	$0.00	$79.80	$126.40	$127.68	$0.00		$0.00	$24.98	$0.00	$0.00	$25.41	$0.00	$0.00	$0.00	$0.00	$0.00
3571141305	SUP	HCPCS C1713		3571141305  -  PLATE BN 87MM STRL 5 HL SMTB	BOTH IP/OP	$166.95 	$123.54	$0.00	$133.56	$75.13	$75.13	$0.00	$0.00	$0.00	$34.80	$123.91	$123.91	$0.00	$0.00	$34.79	$0.00	$98.75	$98.75	$0.00	$83.48	$132.22	$133.56	$0.00		$0.00	$26.13	$0.00	$0.00	$26.58	$0.00	$0.00	$0.00	$0.00	$0.00
3571141306	SUP	HCPCS C1713		3571141306  -  PLATE BN 103MM STRL 6 HL SMTB	BOTH IP/OP	$177.45 	$131.31	$0.00	$141.96	$79.85	$79.85	$0.00	$0.00	$0.00	$36.99	$131.70	$131.70	$0.00	$0.00	$36.98	$0.00	$104.96	$104.96	$0.00	$88.73	$140.54	$141.96	$0.00		$0.00	$27.77	$0.00	$0.00	$28.25	$0.00	$0.00	$0.00	$0.00	$0.00
3571141307	SUP	HCPCS C1713		3571141307  -  PLATE BN 119MM STRL 7 HL SMTB	BOTH IP/OP	$192.15 	$142.19	$0.00	$153.72	$86.47	$86.47	$0.00	$0.00	$0.00	$40.05	$142.61	$142.61	$0.00	$0.00	$40.04	$0.00	$113.66	$113.66	$0.00	$96.08	$152.18	$153.72	$0.00		$0.00	$30.07	$0.00	$0.00	$30.59	$0.00	$0.00	$0.00	$0.00	$0.00
3571141308	SUP	HCPCS C1713		3571141308  -  PLATE BN 135MM STRL 8 HL SMTB	BOTH IP/OP	$246.75 	$182.60	$0.00	$197.40	$111.04	$111.04	$0.00	$0.00	$0.00	$51.43	$183.14	$183.14	$0.00	$0.00	$51.42	$0.00	$145.95	$145.95	$0.00	$123.38	$195.43	$197.40	$0.00		$0.00	$38.62	$0.00	$0.00	$39.28	$0.00	$0.00	$0.00	$0.00	$0.00
3571141309	SUP	HCPCS C1713		3571141309  -  PLATE BN 151MM STRL 9 HL SMTB	BOTH IP/OP	$218.40 	$161.62	$0.00	$174.72	$98.28	$98.28	$0.00	$0.00	$0.00	$45.52	$162.10	$162.10	$0.00	$0.00	$45.51	$0.00	$129.18	$129.18	$0.00	$109.20	$172.97	$174.72	$0.00		$0.00	$34.18	$0.00	$0.00	$34.77	$0.00	$0.00	$0.00	$0.00	$0.00
3571141310	SUP	HCPCS C1713		3571141310  -  PLATE BN 167MM STRL 10 HL SMTB	BOTH IP/OP	$270.90 	$200.47	$0.00	$216.72	$121.91	$121.91	$0.00	$0.00	$0.00	$56.46	$201.06	$201.06	$0.00	$0.00	$56.46	$0.00	$160.24	$160.24	$0.00	$135.45	$214.55	$216.72	$0.00		$0.00	$42.40	$0.00	$0.00	$43.13	$0.00	$0.00	$0.00	$0.00	$0.00
3571141311	SUP	HCPCS C1713		3571141311  -  PLATE BN 183MM STRL 11 HL SMTB	BOTH IP/OP	$282.45 	$209.01	$0.00	$225.96	$127.10	$127.10	$0.00	$0.00	$0.00	$58.87	$209.63	$209.63	$0.00	$0.00	$58.86	$0.00	$167.07	$167.07	$0.00	$141.23	$223.70	$225.96	$0.00		$0.00	$44.20	$0.00	$0.00	$44.97	$0.00	$0.00	$0.00	$0.00	$0.00
3571141312	SUP	HCPCS C1713		3571141312  -  PLATE BN 199MM STRL 12 HL SMTB	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$129.94	$129.94	$0.00	$0.00	$0.00	$60.18	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$170.80	$170.80	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$45.19	$0.00	$0.00	$45.97	$0.00	$0.00	$0.00	$0.00	$0.00
3571141402	SUP	HCPCS C1713		3571141402  -  PLATE BN NAR 39MM 2 HL SS 4.5MM SCR	BOTH IP/OP	$336.00 	$248.64	$0.00	$268.80	$151.20	$151.20	$0.00	$0.00	$0.00	$70.03	$249.38	$249.38	$0.00	$0.00	$70.02	$0.00	$198.74	$198.74	$0.00	$168.00	$266.11	$268.80	$0.00		$0.00	$52.58	$0.00	$0.00	$53.49	$0.00	$0.00	$0.00	$0.00	$0.00
3571141403	SUP	HCPCS C1713		3571141403  -  PLATE BN NAR 55MM 3 HL SS 4.5MM SCR	BOTH IP/OP	$352.80 	$261.07	$0.00	$282.24	$158.76	$158.76	$0.00	$0.00	$0.00	$73.53	$261.85	$261.85	$0.00	$0.00	$73.52	$0.00	$208.68	$208.68	$0.00	$176.40	$279.42	$282.24	$0.00		$0.00	$55.21	$0.00	$0.00	$56.17	$0.00	$0.00	$0.00	$0.00	$0.00
3571141404	SUP	HCPCS C1713		3571141404  -  PLATE BN NAR 71MM STRL 4 HL 4.5MM SCR	BOTH IP/OP	$368.55 	$272.73	$0.00	$294.84	$165.85	$165.85	$0.00	$0.00	$0.00	$76.82	$273.54	$273.54	$0.00	$0.00	$76.81	$0.00	$218.00	$218.00	$0.00	$184.28	$291.89	$294.84	$0.00		$0.00	$57.68	$0.00	$0.00	$58.67	$0.00	$0.00	$0.00	$0.00	$0.00
3571141405	SUP	HCPCS C1713		3571141405  -  PLATE BN NAR 87MM STRL 5 HL 4.5MM SCR	BOTH IP/OP	$368.55 	$272.73	$0.00	$294.84	$165.85	$165.85	$0.00	$0.00	$0.00	$76.82	$273.54	$273.54	$0.00	$0.00	$76.81	$0.00	$218.00	$218.00	$0.00	$184.28	$291.89	$294.84	$0.00		$0.00	$57.68	$0.00	$0.00	$58.67	$0.00	$0.00	$0.00	$0.00	$0.00
3571141406	SUP	HCPCS C1713		3571141406  -  PLATE BN NAR 103MM STRL 6 HL 4.5MM SCR	BOTH IP/OP	$410.55 	$303.81	$0.00	$328.44	$184.75	$184.75	$0.00	$0.00	$0.00	$85.57	$304.71	$304.71	$0.00	$0.00	$85.56	$0.00	$242.84	$242.84	$0.00	$205.28	$325.16	$328.44	$0.00		$0.00	$64.25	$0.00	$0.00	$65.36	$0.00	$0.00	$0.00	$0.00	$0.00
3571141407	SUP	HCPCS C1713		3571141407  -  PLATE BN NAR 119MM STRL 7 HL 4.5MM SCR	BOTH IP/OP	$410.55 	$303.81	$0.00	$328.44	$184.75	$184.75	$0.00	$0.00	$0.00	$85.57	$304.71	$304.71	$0.00	$0.00	$85.56	$0.00	$242.84	$242.84	$0.00	$205.28	$325.16	$328.44	$0.00		$0.00	$64.25	$0.00	$0.00	$65.36	$0.00	$0.00	$0.00	$0.00	$0.00
3571141408	SUP	HCPCS C1713		3571141408  -  PLATE BN NAR 135MM STRL 8 HL 4.5MM SCR	BOTH IP/OP	$410.55 	$303.81	$0.00	$328.44	$184.75	$184.75	$0.00	$0.00	$0.00	$85.57	$304.71	$304.71	$0.00	$0.00	$85.56	$0.00	$242.84	$242.84	$0.00	$205.28	$325.16	$328.44	$0.00		$0.00	$64.25	$0.00	$0.00	$65.36	$0.00	$0.00	$0.00	$0.00	$0.00
3571141409	SUP	HCPCS C1713		3571141409  -  PLATE BN NAR 151MM STRL 9 HL 4.5MM SCR	BOTH IP/OP	$410.55 	$303.81	$0.00	$328.44	$184.75	$184.75	$0.00	$0.00	$0.00	$85.57	$304.71	$304.71	$0.00	$0.00	$85.56	$0.00	$242.84	$242.84	$0.00	$205.28	$325.16	$328.44	$0.00		$0.00	$64.25	$0.00	$0.00	$65.36	$0.00	$0.00	$0.00	$0.00	$0.00
3571141410	SUP	HCPCS C1713		3571141410  -  PLATE BN NAR 167MM STRL 10 HL 4.5MM SCR	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
3571141411	SUP	HCPCS C1713		3571141411  -  PLATE BN NAR 183MM STRL 11 HL 4.5MM SCR	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
3571141412	SUP	HCPCS C1713		3571141412  -  PLATE BN NAR 199MM STRL 12 HL 4.5MM SCR	BOTH IP/OP	$535.50 	$396.27	$0.00	$428.40	$240.98	$240.98	$0.00	$0.00	$0.00	$111.61	$397.45	$397.45	$0.00	$0.00	$111.60	$0.00	$316.75	$316.75	$0.00	$267.75	$424.12	$428.40	$0.00		$0.00	$83.81	$0.00	$0.00	$85.25	$0.00	$0.00	$0.00	$0.00	$0.00
3571141413	SUP	HCPCS C1713		3571141413  -  PLATE BN NAR 215MM STRL 13 HL 4.5MM SCR	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$283.50	$283.50	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$98.60	$0.00	$0.00	$100.30	$0.00	$0.00	$0.00	$0.00	$0.00
3571141414	SUP	HCPCS C1713		3571141414  -  PLATE BN NAR 231MM STRL 14 HL 4.5MM SCR	BOTH IP/OP	$763.35 	$564.88	$0.00	$610.68	$343.51	$343.51	$0.00	$0.00	$0.00	$159.10	$566.56	$566.56	$0.00	$0.00	$159.08	$0.00	$451.52	$451.52	$0.00	$381.68	$604.57	$610.68	$0.00		$0.00	$119.46	$0.00	$0.00	$121.53	$0.00	$0.00	$0.00	$0.00	$0.00
3571141415	SUP	HCPCS C1713		3571141415  -  PLATE BN NAR 247MM STRL 15 HL 4.5MM SCR	BOTH IP/OP	$805.35 	$595.96	$0.00	$644.28	$362.41	$362.41	$0.00	$0.00	$0.00	$167.86	$597.73	$597.73	$0.00	$0.00	$167.83	$0.00	$476.36	$476.36	$0.00	$402.68	$637.84	$644.28	$0.00		$0.00	$126.04	$0.00	$0.00	$128.21	$0.00	$0.00	$0.00	$0.00	$0.00
3571141416	SUP	HCPCS C1713		3571141416  -  PLATE BN NAR 263MM STRL 16 HL 4.5MM SCR	BOTH IP/OP	$805.35 	$595.96	$0.00	$644.28	$362.41	$362.41	$0.00	$0.00	$0.00	$167.86	$597.73	$597.73	$0.00	$0.00	$167.83	$0.00	$476.36	$476.36	$0.00	$402.68	$637.84	$644.28	$0.00		$0.00	$126.04	$0.00	$0.00	$128.21	$0.00	$0.00	$0.00	$0.00	$0.00
3571141418	SUP	HCPCS C1713		3571141418  -  PLATE BN NAR 295MM STRL 18 HL 4.5MM SCR	BOTH IP/OP	"$1,149.75 "	$850.82	$0.00	$919.80	$517.39	$517.39	$0.00	$0.00	$0.00	$239.64	$853.34	$853.34	$0.00	$0.00	$239.61	$0.00	$680.08	$680.08	$0.00	$574.88	$910.60	$919.80	$0.00		$0.00	$179.94	$0.00	$0.00	$183.04	$0.00	$0.00	$0.00	$0.00	$0.00
3571141420	SUP	HCPCS C1713		3571141420  -  PLATE BN NAR 326MM STRL 20 HL 4.5MM SCR	BOTH IP/OP	"$1,038.45 "	$768.45	$0.00	$830.76	$467.30	$467.30	$0.00	$0.00	$0.00	$216.44	$770.74	$770.74	$0.00	$0.00	$216.41	$0.00	$614.24	$614.24	$0.00	$519.23	$822.45	$830.76	$0.00		$0.00	$162.52	$0.00	$0.00	$165.32	$0.00	$0.00	$0.00	$0.00	$0.00
3571141422	SUP	HCPCS C1713		3571141422  -  PLATE BN NAR 358MM STRL 22 HL 4.5MM SCR	BOTH IP/OP	"$1,401.75 "	"$1,037.30"	$0.00	"$1,121.40"	$630.79	$630.79	$0.00	$0.00	$0.00	$292.16	"$1,040.38"	"$1,040.38"	$0.00	$0.00	$292.12	$0.00	$829.14	$829.14	$0.00	$700.88	"$1,110.19"	"$1,121.40"	$0.00		$0.00	$219.37	$0.00	$0.00	$223.16	$0.00	$0.00	$0.00	$0.00	$0.00
3571141424	SUP	HCPCS C1713		3571141424  -  PLATE BN NAR 390MM STRL 24 HL 4.5MM SCR	BOTH IP/OP	"$1,517.25 "	"$1,122.77"	$0.00	"$1,213.80"	$682.76	$682.76	$0.00	$0.00	$0.00	$316.23	"$1,126.10"	"$1,126.10"	$0.00	$0.00	$316.19	$0.00	$897.45	$897.45	$0.00	$758.63	"$1,201.66"	"$1,213.80"	$0.00		$0.00	$237.45	$0.00	$0.00	$241.55	$0.00	$0.00	$0.00	$0.00	$0.00
3571141603	SUP	HCPCS C1713		3571141603  -  PLATE BN T 68MM STRL 3 HL	BOTH IP/OP	$568.05 	$420.36	$0.00	$454.44	$255.62	$255.62	$0.00	$0.00	$0.00	$118.40	$421.61	$421.61	$0.00	$0.00	$118.38	$0.00	$336.00	$336.00	$0.00	$284.03	$449.90	$454.44	$0.00		$0.00	$88.90	$0.00	$0.00	$90.43	$0.00	$0.00	$0.00	$0.00	$0.00
3571141604	SUP	HCPCS C1713		3571141604  -  PLATE BN T 84MM STRL 4 HL	BOTH IP/OP	$631.05 	$466.98	$0.00	$504.84	$283.97	$283.97	$0.00	$0.00	$0.00	$131.53	$468.37	$468.37	$0.00	$0.00	$131.51	$0.00	$373.27	$373.27	$0.00	$315.53	$499.79	$504.84	$0.00		$0.00	$98.76	$0.00	$0.00	$100.46	$0.00	$0.00	$0.00	$0.00	$0.00
3571141605	SUP	HCPCS C1713		3571141605  -  PLATE BN T 100MM STRL 5 HL	BOTH IP/OP	$670.95 	$496.50	$0.00	$536.76	$301.93	$301.93	$0.00	$0.00	$0.00	$139.84	$497.98	$497.98	$0.00	$0.00	$139.83	$0.00	$396.87	$396.87	$0.00	$335.48	$531.39	$536.76	$0.00		$0.00	$105.00	$0.00	$0.00	$106.82	$0.00	$0.00	$0.00	$0.00	$0.00
3571141606	SUP	HCPCS C1713		3571141606  -  PLATE BN T 116MM STRL 6 HL	BOTH IP/OP	$742.35 	$549.34	$0.00	$593.88	$334.06	$334.06	$0.00	$0.00	$0.00	$154.72	$550.97	$550.97	$0.00	$0.00	$154.71	$0.00	$439.10	$439.10	$0.00	$371.18	$587.94	$593.88	$0.00		$0.00	$116.18	$0.00	$0.00	$118.18	$0.00	$0.00	$0.00	$0.00	$0.00
3571141608	SUP	HCPCS C1713		3571141608  -  PLATE BN T 148MM STRL 8 HL	BOTH IP/OP	"$1,025.85 "	$759.13	$0.00	$820.68	$461.63	$461.63	$0.00	$0.00	$0.00	$213.81	$761.39	$761.39	$0.00	$0.00	$213.79	$0.00	$606.79	$606.79	$0.00	$512.93	$812.47	$820.68	$0.00		$0.00	$160.55	$0.00	$0.00	$163.32	$0.00	$0.00	$0.00	$0.00	$0.00
3571142007	SUP	HCPCS C1713		3571142007  -  PLATE BN 158MM STRL 7 HL BTRS CNDYL	BOTH IP/OP	"$1,953.00 "	"$1,445.22"	$0.00	"$1,562.40"	$878.85	$878.85	$0.00	$0.00	$0.00	$407.05	"$1,449.52"	"$1,449.52"	$0.00	$0.00	$407.01	$0.00	"$1,155.20"	"$1,155.20"	$0.00	$976.50	"$1,546.78"	"$1,562.40"	$0.00		$0.00	$305.64	$0.00	$0.00	$310.92	$0.00	$0.00	$0.00	$0.00	$0.00
3571142009	SUP	HCPCS C1713		3571142009  -  PLATE BN 190MM STRL 9 HL BTRS CNDYL	BOTH IP/OP	"$2,026.50 "	"$1,499.61"	$0.00	"$1,621.20"	$911.93	$911.93	$0.00	$0.00	$0.00	$422.37	"$1,504.07"	"$1,504.07"	$0.00	$0.00	$422.32	$0.00	"$1,198.67"	"$1,198.67"	$0.00	"$1,013.25"	"$1,604.99"	"$1,621.20"	$0.00		$0.00	$317.15	$0.00	$0.00	$322.62	$0.00	$0.00	$0.00	$0.00	$0.00
3571142011	SUP	HCPCS C1713		3571142011  -  PLATE BN 221MM STRL 11 HL BTRS CNDYL	BOTH IP/OP	"$2,541.00 "	"$1,880.34"	$0.00	"$2,032.80"	"$1,143.45"	"$1,143.45"	$0.00	$0.00	$0.00	$529.61	"$1,885.93"	"$1,885.93"	$0.00	$0.00	$529.54	$0.00	"$1,252.71"	"$1,252.71"	$0.00	"$1,270.50"	"$2,012.47"	"$2,032.80"	$0.00		$0.00	$397.67	$0.00	$0.00	$404.53	$0.00	$0.00	$0.00	$0.00	$0.00
3571142013	SUP	HCPCS C1713		3571142013  -  PLATE BN 253MM STRL 13 HL BTRS CNDYL	BOTH IP/OP	"$2,136.75 "	"$1,581.20"	$0.00	"$1,709.40"	$961.54	$961.54	$0.00	$0.00	$0.00	$445.35	"$1,585.90"	"$1,585.90"	$0.00	$0.00	$445.30	$0.00	"$1,263.89"	"$1,263.89"	$0.00	"$1,068.38"	"$1,692.31"	"$1,709.40"	$0.00		$0.00	$334.40	$0.00	$0.00	$340.17	$0.00	$0.00	$0.00	$0.00	$0.00
3571142015	SUP	HCPCS C1713		3571142015  -  PLATE BN 285MM STRL 15 HL BTRS CNDYL	BOTH IP/OP	"$2,682.75 "	"$1,985.24"	$0.00	"$2,146.20"	"$1,207.24"	"$1,207.24"	$0.00	$0.00	$0.00	$559.15	"$1,991.14"	"$1,991.14"	$0.00	$0.00	$559.09	$0.00	"$1,322.60"	"$1,322.60"	$0.00	"$1,341.38"	"$2,124.74"	"$2,146.20"	$0.00		$0.00	$419.85	$0.00	$0.00	$427.09	$0.00	$0.00	$0.00	$0.00	$0.00
3571142107	SUP	HCPCS C1713		3571142107  -  PLATE BN 158MM STRL 7 HL BTRS CNDYL	BOTH IP/OP	"$2,367.75 "	"$1,752.14"	$0.00	"$1,894.20"	"$1,065.49"	"$1,065.49"	$0.00	$0.00	$0.00	$493.50	"$1,757.34"	"$1,757.34"	$0.00	$0.00	$493.44	$0.00	"$1,400.52"	"$1,400.52"	$0.00	"$1,183.88"	"$1,875.26"	"$1,894.20"	$0.00		$0.00	$370.55	$0.00	$0.00	$376.95	$0.00	$0.00	$0.00	$0.00	$0.00
3571142109	SUP	HCPCS C1713		3571142109  -  PLATE BN 190MM STRL 9 HL BTRS CNDYL	BOTH IP/OP	"$2,026.50 "	"$1,499.61"	$0.00	"$1,621.20"	$911.93	$911.93	$0.00	$0.00	$0.00	$422.37	"$1,504.07"	"$1,504.07"	$0.00	$0.00	$422.32	$0.00	"$1,198.67"	"$1,198.67"	$0.00	"$1,013.25"	"$1,604.99"	"$1,621.20"	$0.00		$0.00	$317.15	$0.00	$0.00	$322.62	$0.00	$0.00	$0.00	$0.00	$0.00
3571142111	SUP	HCPCS C1713		3571142111  -  PLATE BN 221MM STRL 11 HL BTRS CNDYL	BOTH IP/OP	"$2,541.00 "	"$1,880.34"	$0.00	"$2,032.80"	"$1,143.45"	"$1,143.45"	$0.00	$0.00	$0.00	$529.61	"$1,885.93"	"$1,885.93"	$0.00	$0.00	$529.54	$0.00	"$1,252.71"	"$1,252.71"	$0.00	"$1,270.50"	"$2,012.47"	"$2,032.80"	$0.00		$0.00	$397.67	$0.00	$0.00	$404.53	$0.00	$0.00	$0.00	$0.00	$0.00
3571142113	SUP	HCPCS C1713		3571142113  -  PLATE BN 253MM STRL 13 HL BTRS CNDYL	BOTH IP/OP	"$2,604.00 "	"$1,926.96"	$0.00	"$2,083.20"	"$1,171.80"	"$1,171.80"	$0.00	$0.00	$0.00	$542.74	"$1,932.69"	"$1,932.69"	$0.00	$0.00	$542.67	$0.00	"$1,283.77"	"$1,283.77"	$0.00	"$1,302.00"	"$2,062.37"	"$2,083.20"	$0.00		$0.00	$407.53	$0.00	$0.00	$414.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571142115	SUP	HCPCS C1713		3571142115  -  PLATE BN 285MM STRL 15 HL BTRS CNDYL	BOTH IP/OP	"$2,682.75 "	"$1,985.24"	$0.00	"$2,146.20"	"$1,207.24"	"$1,207.24"	$0.00	$0.00	$0.00	$559.15	"$1,991.14"	"$1,991.14"	$0.00	$0.00	$559.09	$0.00	"$1,322.60"	"$1,322.60"	$0.00	"$1,341.38"	"$2,124.74"	"$2,146.20"	$0.00		$0.00	$419.85	$0.00	$0.00	$427.09	$0.00	$0.00	$0.00	$0.00	$0.00
3571143113	SUP	HCPCS C1713		3571143113  -  WASHER BN 13MM SS	BOTH IP/OP	$85.20 	$63.05	$0.00	$68.16	$38.34	$38.34	$0.00	$0.00	$0.00	$17.76	$63.24	$63.24	$0.00	$0.00	$17.76	$0.00	$50.40	$50.40	$0.00	$42.60	$67.48	$68.16	$0.00		$0.00	$13.33	$0.00	$0.00	$13.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571145020	SUP	HCPCS C1713		3571145020  -  PLATE BN STRG STRL 20 HL SS CNDYL 1.5MM SCR	BOTH IP/OP	$570.15 	$421.91	$0.00	$456.12	$256.57	$256.57	$0.00	$0.00	$0.00	$118.83	$423.17	$423.17	$0.00	$0.00	$118.82	$0.00	$337.24	$337.24	$0.00	$285.08	$451.56	$456.12	$0.00		$0.00	$89.23	$0.00	$0.00	$90.77	$0.00	$0.00	$0.00	$0.00	$0.00
3571145022	SUP	HCPCS C1713		3571145022  -  PLATE BN T 3X9 HL SS CNDYL 1.5MM SCR	BOTH IP/OP	$504.00 	$372.96	$0.00	$403.20	$226.80	$226.80	$0.00	$0.00	$0.00	$105.05	$374.07	$374.07	$0.00	$0.00	$105.03	$0.00	$298.12	$298.12	$0.00	$252.00	$399.17	$403.20	$0.00		$0.00	$78.88	$0.00	$0.00	$80.24	$0.00	$0.00	$0.00	$0.00	$0.00
3571145024	SUP	HCPCS C1713		3571145024  -  PLATE BN T 4X9 HL SS CNDYL 1.5MM SCR	BOTH IP/OP	$534.45 	$395.49	$0.00	$427.56	$240.50	$240.50	$0.00	$0.00	$0.00	$111.39	$396.67	$396.67	$0.00	$0.00	$111.38	$0.00	$316.13	$316.13	$0.00	$267.23	$423.28	$427.56	$0.00		$0.00	$83.64	$0.00	$0.00	$85.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571145026	SUP	HCPCS C1713		3571145026  -  PLATE BN 6 HL SS CNDYL LT 1.5 MM SCR	BOTH IP/OP	$708.75 	$524.48	$0.00	$567.00	$318.94	$318.94	$0.00	$0.00	$0.00	$147.72	$526.03	$526.03	$0.00	$0.00	$147.70	$0.00	$419.23	$419.23	$0.00	$354.38	$561.33	$567.00	$0.00		$0.00	$110.92	$0.00	$0.00	$112.83	$0.00	$0.00	$0.00	$0.00	$0.00
3571145028	SUP	HCPCS C1713		3571145028  -  PLATE BN 6 HL SS CNDYL RT 1.5 MM SCR	BOTH IP/OP	$708.75 	$524.48	$0.00	$567.00	$318.94	$318.94	$0.00	$0.00	$0.00	$147.72	$526.03	$526.03	$0.00	$0.00	$147.70	$0.00	$419.23	$419.23	$0.00	$354.38	$561.33	$567.00	$0.00		$0.00	$110.92	$0.00	$0.00	$112.83	$0.00	$0.00	$0.00	$0.00	$0.00
3571145030	SUP	HCPCS C1713		3571145030  -  PLATE BN H STRL 4 HL CNDYL 1.5MM SCR	BOTH IP/OP	$406.35 	$300.70	$0.00	$325.08	$182.86	$182.86	$0.00	$0.00	$0.00	$84.69	$301.59	$301.59	$0.00	$0.00	$84.68	$0.00	$240.36	$240.36	$0.00	$203.18	$321.83	$325.08	$0.00		$0.00	$63.59	$0.00	$0.00	$64.69	$0.00	$0.00	$0.00	$0.00	$0.00
3571146020	SUP	HCPCS C1713		3571146020  -  PLATE BN STRG 3 HL SS CNDYL 2MM SCR	BOTH IP/OP	$134.40 	$99.46	$0.00	$107.52	$60.48	$60.48	$0.00	$0.00	$0.00	$28.01	$99.75	$99.75	$0.00	$0.00	$28.01	$0.00	$79.50	$79.50	$0.00	$67.20	$106.44	$107.52	$0.00		$0.00	$21.03	$0.00	$0.00	$21.40	$0.00	$0.00	$0.00	$0.00	$0.00
3571146022	SUP	HCPCS C1713		3571146022  -  PLATE BN STRG 4 HL SS CNDYL 2MM SCR	BOTH IP/OP	$148.05 	$109.56	$0.00	$118.44	$66.62	$66.62	$0.00	$0.00	$0.00	$30.86	$109.88	$109.88	$0.00	$0.00	$30.85	$0.00	$87.57	$87.57	$0.00	$74.03	$117.26	$118.44	$0.00		$0.00	$23.17	$0.00	$0.00	$23.57	$0.00	$0.00	$0.00	$0.00	$0.00
3571146024	SUP	HCPCS C1713		3571146024  -  PLATE BN STRG 5 HL SS CNDYL 2MM SCR	BOTH IP/OP	$159.60 	$118.10	$0.00	$127.68	$71.82	$71.82	$0.00	$0.00	$0.00	$33.26	$118.46	$118.46	$0.00	$0.00	$33.26	$0.00	$94.40	$94.40	$0.00	$79.80	$126.40	$127.68	$0.00		$0.00	$24.98	$0.00	$0.00	$25.41	$0.00	$0.00	$0.00	$0.00	$0.00
3571146026	SUP	HCPCS C1713		3571146026  -  PLATE BN STRG STRL 6 HL CNDYL 2MM SCR	BOTH IP/OP	$177.45 	$131.31	$0.00	$141.96	$79.85	$79.85	$0.00	$0.00	$0.00	$36.99	$131.70	$131.70	$0.00	$0.00	$36.98	$0.00	$104.96	$104.96	$0.00	$88.73	$140.54	$141.96	$0.00		$0.00	$27.77	$0.00	$0.00	$28.25	$0.00	$0.00	$0.00	$0.00	$0.00
3571146028	SUP	HCPCS C1713		3571146028  -  PLATE BN STRG 20 HL SS CNDYL 2MM SCR	BOTH IP/OP	$568.05 	$420.36	$0.00	$454.44	$255.62	$255.62	$0.00	$0.00	$0.00	$118.40	$421.61	$421.61	$0.00	$0.00	$118.38	$0.00	$336.00	$336.00	$0.00	$284.03	$449.90	$454.44	$0.00		$0.00	$88.90	$0.00	$0.00	$90.43	$0.00	$0.00	$0.00	$0.00	$0.00
3571146030	SUP	HCPCS C1713		3571146030  -  PLATE BN T 3X9 HL SS CNDYL 2MM SCR	BOTH IP/OP	$504.00 	$372.96	$0.00	$403.20	$226.80	$226.80	$0.00	$0.00	$0.00	$105.05	$374.07	$374.07	$0.00	$0.00	$105.03	$0.00	$298.12	$298.12	$0.00	$252.00	$399.17	$403.20	$0.00		$0.00	$78.88	$0.00	$0.00	$80.24	$0.00	$0.00	$0.00	$0.00	$0.00
3571146032	SUP	HCPCS C1713		3571146032  -  PLATE BN T 4X9 HL SS CNDYL 2MM SCR	BOTH IP/OP	$534.45 	$395.49	$0.00	$427.56	$240.50	$240.50	$0.00	$0.00	$0.00	$111.39	$396.67	$396.67	$0.00	$0.00	$111.38	$0.00	$316.13	$316.13	$0.00	$267.23	$423.28	$427.56	$0.00		$0.00	$83.64	$0.00	$0.00	$85.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571146034	SUP	HCPCS C1713		3571146034  -  PLATE BN T 2X2 HL SS CNDYL 2MM SCR	BOTH IP/OP	$134.40 	$99.46	$0.00	$107.52	$60.48	$60.48	$0.00	$0.00	$0.00	$28.01	$99.75	$99.75	$0.00	$0.00	$28.01	$0.00	$79.50	$79.50	$0.00	$67.20	$106.44	$107.52	$0.00		$0.00	$21.03	$0.00	$0.00	$21.40	$0.00	$0.00	$0.00	$0.00	$0.00
3571146036	SUP	HCPCS C1713		3571146036  -  PLATE BN L 3 HL OBLQ SS CNDYL RT 2MM SCR	BOTH IP/OP	$134.40 	$99.46	$0.00	$107.52	$60.48	$60.48	$0.00	$0.00	$0.00	$28.01	$99.75	$99.75	$0.00	$0.00	$28.01	$0.00	$79.50	$79.50	$0.00	$67.20	$106.44	$107.52	$0.00		$0.00	$21.03	$0.00	$0.00	$21.40	$0.00	$0.00	$0.00	$0.00	$0.00
3571146038	SUP	HCPCS C1713		3571146038  -  PLATE BN L 3 HL OBLQ SS CNDYL LT 2MM SCR	BOTH IP/OP	$134.40 	$99.46	$0.00	$107.52	$60.48	$60.48	$0.00	$0.00	$0.00	$28.01	$99.75	$99.75	$0.00	$0.00	$28.01	$0.00	$79.50	$79.50	$0.00	$67.20	$106.44	$107.52	$0.00		$0.00	$21.03	$0.00	$0.00	$21.40	$0.00	$0.00	$0.00	$0.00	$0.00
3571146040	SUP	HCPCS C1713		3571146040  -  PLATE BN 6 HL OBLQ SS CNDYL LT 2 MM SCR	BOTH IP/OP	$678.30 	$501.94	$0.00	$542.64	$305.24	$305.24	$0.00	$0.00	$0.00	$141.37	$503.43	$503.43	$0.00	$0.00	$141.36	$0.00	$401.21	$401.21	$0.00	$339.15	$537.21	$542.64	$0.00		$0.00	$106.15	$0.00	$0.00	$107.99	$0.00	$0.00	$0.00	$0.00	$0.00
3571146042	SUP	HCPCS C1713		3571146042  -  PLATE BN 6 HL OBLQ SS CNDYL RT 2 MM SCR	BOTH IP/OP	$678.30 	$501.94	$0.00	$542.64	$305.24	$305.24	$0.00	$0.00	$0.00	$141.37	$503.43	$503.43	$0.00	$0.00	$141.36	$0.00	$401.21	$401.21	$0.00	$339.15	$537.21	$542.64	$0.00		$0.00	$106.15	$0.00	$0.00	$107.99	$0.00	$0.00	$0.00	$0.00	$0.00
3571146048	SUP	HCPCS C1713		3571146048  -  PLATE BN H STRL 4 HL CNDYL 2MM SCR	BOTH IP/OP	$406.35 	$300.70	$0.00	$325.08	$182.86	$182.86	$0.00	$0.00	$0.00	$84.69	$301.59	$301.59	$0.00	$0.00	$84.68	$0.00	$240.36	$240.36	$0.00	$203.18	$321.83	$325.08	$0.00		$0.00	$63.59	$0.00	$0.00	$64.69	$0.00	$0.00	$0.00	$0.00	$0.00
3571147001	SUP	HCPCS C1713		3571147001  -  PLATE BN L STRL CNDYL RT 2.7MM SCR	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
3571147002	SUP	HCPCS C1713		3571147002  -  PLATE BN L 3 HL OBLQ SS CNDYL LT 2.7MM SCR	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
3571147003	SUP	HCPCS C1713		3571147003  -  PLATE BN L STRL CNDYL LT 2.7MM SCR	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
3571147004	SUP	HCPCS C1713		3571147004  -  PLATE BN L 3 HL OBLQ SS CNDYL RT 2.7MM SCR	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
3571147006	SUP	HCPCS C1713		3571147006  -  PLATE BN T 3 HL SS CNDYL 2.7MM SCR	BOTH IP/OP	$142.80 	$105.67	$0.00	$114.24	$64.26	$64.26	$0.00	$0.00	$0.00	$29.76	$105.99	$105.99	$0.00	$0.00	$29.76	$0.00	$84.47	$84.47	$0.00	$71.40	$113.10	$114.24	$0.00		$0.00	$22.35	$0.00	$0.00	$22.73	$0.00	$0.00	$0.00	$0.00	$0.00
3571147008	SUP	HCPCS C1713		3571147008  -  PLATE BN 6 HL SS CNDYL LT 2.7 MM SCR	BOTH IP/OP	$720.30 	$533.02	$0.00	$576.24	$324.14	$324.14	$0.00	$0.00	$0.00	$150.13	$534.61	$534.61	$0.00	$0.00	$150.11	$0.00	$426.06	$426.06	$0.00	$360.15	$570.48	$576.24	$0.00		$0.00	$112.73	$0.00	$0.00	$114.67	$0.00	$0.00	$0.00	$0.00	$0.00
3571147010	SUP	HCPCS C1713		3571147010  -  PLATE BN 6 HL SS CNDYL RT 2.7 MM SCR	BOTH IP/OP	$720.30 	$533.02	$0.00	$576.24	$324.14	$324.14	$0.00	$0.00	$0.00	$150.13	$534.61	$534.61	$0.00	$0.00	$150.11	$0.00	$426.06	$426.06	$0.00	$360.15	$570.48	$576.24	$0.00		$0.00	$112.73	$0.00	$0.00	$114.67	$0.00	$0.00	$0.00	$0.00	$0.00
3571147012	SUP	HCPCS C1713		3571147012  -  PLATE BN STRL 7 HL MLT FRAG CNDYL 2.7 MM SCR	BOTH IP/OP	$169.05 	$125.10	$0.00	$135.24	$76.07	$76.07	$0.00	$0.00	$0.00	$35.23	$125.47	$125.47	$0.00	$0.00	$35.23	$0.00	$99.99	$99.99	$0.00	$84.53	$133.89	$135.24	$0.00		$0.00	$26.46	$0.00	$0.00	$26.91	$0.00	$0.00	$0.00	$0.00	$0.00
3571148003	SUP	HCPCS C1713		3571148003  -  PLATE BN STRL 3 HL QT TBLR SS CNDYL	BOTH IP/OP	$159.60 	$118.10	$0.00	$127.68	$71.82	$71.82	$0.00	$0.00	$0.00	$33.26	$118.46	$118.46	$0.00	$0.00	$33.26	$0.00	$94.40	$94.40	$0.00	$79.80	$126.40	$127.68	$0.00		$0.00	$24.98	$0.00	$0.00	$25.41	$0.00	$0.00	$0.00	$0.00	$0.00
3571148004	SUP	HCPCS C1713		3571148004  -  PLATE BN 4 HL QT TBLR SS CNDYL	BOTH IP/OP	$175.35 	$129.76	$0.00	$140.28	$78.91	$78.91	$0.00	$0.00	$0.00	$36.55	$130.14	$130.14	$0.00	$0.00	$36.54	$0.00	$103.72	$103.72	$0.00	$87.68	$138.88	$140.28	$0.00		$0.00	$27.44	$0.00	$0.00	$27.92	$0.00	$0.00	$0.00	$0.00	$0.00
3571148005	SUP	HCPCS C1713		3571148005  -  PLATE BN 5 HL QT TBLR SS CNDYL	BOTH IP/OP	$185.85 	$137.53	$0.00	$148.68	$83.63	$83.63	$0.00	$0.00	$0.00	$38.74	$137.94	$137.94	$0.00	$0.00	$38.73	$0.00	$109.93	$109.93	$0.00	$92.93	$147.19	$148.68	$0.00		$0.00	$29.09	$0.00	$0.00	$29.59	$0.00	$0.00	$0.00	$0.00	$0.00
3571148006	SUP	HCPCS C1713		3571148006  -  PLATE BN 6 HL QT TBLR SS CNDYL	BOTH IP/OP	$205.80 	$152.29	$0.00	$164.64	$92.61	$92.61	$0.00	$0.00	$0.00	$42.89	$152.74	$152.74	$0.00	$0.00	$42.89	$0.00	$121.73	$121.73	$0.00	$102.90	$162.99	$164.64	$0.00		$0.00	$32.21	$0.00	$0.00	$32.76	$0.00	$0.00	$0.00	$0.00	$0.00
3571148007	SUP	HCPCS C1713		3571148007  -  PLATE BN STRL 7 HL QT TBLR CNDYL	BOTH IP/OP	$214.20 	$158.51	$0.00	$171.36	$96.39	$96.39	$0.00	$0.00	$0.00	$44.64	$158.98	$158.98	$0.00	$0.00	$44.64	$0.00	$126.70	$126.70	$0.00	$107.10	$169.65	$171.36	$0.00		$0.00	$33.52	$0.00	$0.00	$34.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571148008	SUP	HCPCS C1713		3571148008  -  PLATE BN STRL 8 HL QT TBLR CNDYL	BOTH IP/OP	$227.85 	$168.61	$0.00	$182.28	$102.53	$102.53	$0.00	$0.00	$0.00	$47.49	$169.11	$169.11	$0.00	$0.00	$47.48	$0.00	$134.77	$134.77	$0.00	$113.93	$180.46	$182.28	$0.00		$0.00	$35.66	$0.00	$0.00	$36.27	$0.00	$0.00	$0.00	$0.00	$0.00
3571149106	SUP	HCPCS C1713		3571149106  -  SCREW BN 1.5MM 6MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149107	SUP	HCPCS C1713		3571149107  -  SCREW BN 1.5MM 7MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149108	SUP	HCPCS C1713		3571149108  -  SCREW BN 1.5MM 8MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149109	SUP	HCPCS C1713		3571149109  -  SCREW BN 1.5MM 9MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149110	SUP	HCPCS C1713		3571149110  -  SCREW BN 1.5MM 10MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149111	SUP	HCPCS C1713		3571149111  -  SCREW BN 1.5MM 11MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149112	SUP	HCPCS C1713		3571149112  -  SCREW BN 1.5MM 12MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149114	SUP	HCPCS C1713		3571149114  -  SCREW BN 1.5MM 14MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149116	SUP	HCPCS C1713		3571149116  -  SCREW BN 1.5MM 16MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149118	SUP	HCPCS C1713		3571149118  -  SCREW BN 1.5MM 18MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149120	SUP	HCPCS C1713		3571149120  -  SCREW BN 1.5MM 20MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149122	SUP	HCPCS C1713		3571149122  -  SCREW BN 1.5MM 22MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149124	SUP	HCPCS C1713		3571149124  -  SCREW BN 1.5MM 24MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$77.55 	$57.39	$0.00	$62.04	$34.90	$34.90	$0.00	$0.00	$0.00	$16.16	$57.56	$57.56	$0.00	$0.00	$16.16	$0.00	$45.87	$45.87	$0.00	$38.78	$61.42	$62.04	$0.00		$0.00	$12.14	$0.00	$0.00	$12.35	$0.00	$0.00	$0.00	$0.00	$0.00
3571149306	SUP	HCPCS C1713		3571149306  -  SCREW BN 2MM 6MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149308	SUP	HCPCS C1713		3571149308  -  SCREW BN 2MM 8MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149310	SUP	HCPCS C1713		3571149310  -  SCREW BN 2MM 10MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149312	SUP	HCPCS C1713		3571149312  -  SCREW BN 2MM 12MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149314	SUP	HCPCS C1713		3571149314  -  SCREW BN 2MM 14MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149316	SUP	HCPCS C1713		3571149316  -  SCREW BN 2MM 16MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149318	SUP	HCPCS C1713		3571149318  -  SCREW BN 2MM 18MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149320	SUP	HCPCS C1713		3571149320  -  SCREW BN 2MM 20MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149322	SUP	HCPCS C1713		3571149322  -  SCREW BN 2MM 22MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149324	SUP	HCPCS C1713		3571149324  -  SCREW BN 2MM 24MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149326	SUP	HCPCS C1713		3571149326  -  SCREW BN 2MM 26MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149328	SUP	HCPCS C1713		3571149328  -  SCREW BN 2MM 28MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149330	SUP	HCPCS C1713		3571149330  -  SCREW BN 2MM 30MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$79.43 	$58.78	$0.00	$63.54	$35.74	$35.74	$0.00	$0.00	$0.00	$16.55	$58.95	$58.95	$0.00	$0.00	$16.55	$0.00	$46.98	$46.98	$0.00	$39.71	$62.91	$63.54	$0.00		$0.00	$12.43	$0.00	$0.00	$12.64	$0.00	$0.00	$0.00	$0.00	$0.00
3571149406	SUP	HCPCS C1713		3571149406  -  SCREW BN 2.7MM 6MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149408	SUP	HCPCS C1713		3571149408  -  SCREW BN 2.7MM 8MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149410	SUP	HCPCS C1713		3571149410  -  SCREW BN 2.7MM 10MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149412	SUP	HCPCS C1713		3571149412  -  SCREW BN 2.7MM 12MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149414	SUP	HCPCS C1713		3571149414  -  SCREW BN 2.7MM 14MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149416	SUP	HCPCS C1713		3571149416  -  SCREW BN 2.7MM 16MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149418	SUP	HCPCS C1713		3571149418  -  SCREW BN 2.7MM 18MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149420	SUP	HCPCS C1713		3571149420  -  SCREW BN 2.7MM 20MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149422	SUP	HCPCS C1713		3571149422  -  SCREW BN 2.7MM 22MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149424	SUP	HCPCS C1713		3571149424  -  SCREW BN 2.7MM 24MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149426	SUP	HCPCS C1713		3571149426  -  SCREW BN 2.7MM 26MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149428	SUP	HCPCS C1713		3571149428  -  SCREW BN 2.7MM 28MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149430	SUP	HCPCS C1713		3571149430  -  SCREW BN 2.7MM 30MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149432	SUP	HCPCS C1713		3571149432  -  SCREW BN 2.7MM 32MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149434	SUP	HCPCS C1713		3571149434  -  SCREW BN 2.7MM 34MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149436	SUP	HCPCS C1713		3571149436  -  SCREW BN 2.7MM 36MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149440	SUP	HCPCS C1713		3571149440  -  SCREW BN 2.7MM 40MM STRL TC100 HEX HD ST SS CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149445	SUP	HCPCS C1713		3571149445  -  SCREW BN 2.7MM 45MM STRL HEX HD ST CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149450	SUP	HCPCS C1713		3571149450  -  SCREW BN 2.7MM 50MM STRL HEX HD ST CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149455	SUP	HCPCS C1713		3571149455  -  SCREW BN 2.7MM 55MM STRL HEX HD ST CORT	BOTH IP/OP	$69.73 	$51.60	$0.00	$55.78	$31.38	$31.38	$0.00	$0.00	$0.00	$14.53	$51.75	$51.75	$0.00	$0.00	$14.53	$0.00	$41.24	$41.24	$0.00	$34.86	$55.23	$55.78	$0.00		$0.00	$10.91	$0.00	$0.00	$11.10	$0.00	$0.00	$0.00	$0.00	$0.00
3571149510	SUP	HCPCS C1713		3571149510  -  SCREW BN 3.5MM 10MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149512	SUP	HCPCS C1713		3571149512  -  SCREW BN 3.5MM 12MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149514	SUP	HCPCS C1713		3571149514  -  SCREW BN 3.5MM 14MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149516	SUP	HCPCS C1713		3571149516  -  SCREW BN 3.5MM 16MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149518	SUP	HCPCS C1713		3571149518  -  SCREW BN 3.5MM 18MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149520	SUP	HCPCS C1713		3571149520  -  SCREW BN 3.5MM 20MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149522	SUP	HCPCS C1713		3571149522  -  SCREW BN 3.5MM 22MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149524	SUP	HCPCS C1713		3571149524  -  SCREW BN 3.5MM 24MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149526	SUP	HCPCS C1713		3571149526  -  SCREW BN 3.5MM 26MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149528	SUP	HCPCS C1713		3571149528  -  SCREW BN 3.5MM 28MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149530	SUP	HCPCS C1713		3571149530  -  SCREW BN 3.5MM 30MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149532	SUP	HCPCS C1713		3571149532  -  SCREW BN 3.5MM 32MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149534	SUP	HCPCS C1713		3571149534  -  SCREW BN 3.5MM 34MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149536	SUP	HCPCS C1713		3571149536  -  SCREW BN 3.5MM 36MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149538	SUP	HCPCS C1713		3571149538  -  SCREW BN 3.5MM 38MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149540	SUP	HCPCS C1713		3571149540  -  SCREW BN 3.5MM 40MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149545	SUP	HCPCS C1713		3571149545  -  SCREW BN 3.5MM 45MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149550	SUP	HCPCS C1713		3571149550  -  SCREW BN 3.5MM 50MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149555	SUP	HCPCS C1713		3571149555  -  SCREW BN 3.5MM 55MM STRL HEX HD ST CORT	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571149560	SUP	HCPCS C1713		3571149560  -  SCREW BN 3.5MM 60MM STRL HEX HD ST CORT	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571149565	SUP	HCPCS C1713		3571149565  -  SCREW BN 3.5MM 65MM STRL HEX HD ST CORT	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571149570	SUP	HCPCS C1713		3571149570  -  SCREW BN 3.5MM 70MM STRL HEX HD ST CORT	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571149575	SUP	HCPCS C1713		3571149575  -  SCREW BN 3.5MM 75MM STRL HEX HD ST CORT	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571149580	SUP	HCPCS C1713		3571149580  -  SCREW BN 3.5MM 80MM STRL HEX HD ST CORT	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571149585	SUP	HCPCS C1713		3571149585  -  SCREW BN 3.5MM 85MM STRL HEX HD ST CORT	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571149590	SUP	HCPCS C1713		3571149590  -  SCREW BN 3.5MM 90MM STRL HEX HD ST CORT	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571149595	SUP	HCPCS C1713		3571149595  -  SCREW BN 3.5MM 95MM STRL HEX HD ST CORT	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571149600	SUP	HCPCS C1713		3571149600  -  SCREW BN 3.5MM 100MM STRL HEX HD ST CORT	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571149605	SUP	HCPCS C1713		3571149605  -  SCREW BN 3.5MM 105MM STRL HEX HD ST CORT	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571149610	SUP	HCPCS C1713		3571149610  -  SCREW BN 3.5MM 110MM STRL HEX HD ST CORT	BOTH IP/OP	$91.45 	$67.67	$0.00	$73.16	$41.15	$41.15	$0.00	$0.00	$0.00	$19.06	$67.87	$67.87	$0.00	$0.00	$19.06	$0.00	$54.09	$54.09	$0.00	$45.73	$72.43	$73.16	$0.00		$0.00	$14.31	$0.00	$0.00	$14.56	$0.00	$0.00	$0.00	$0.00	$0.00
3571149615	SUP	HCPCS C1713		3571149615  -  SCREW BN 3.5MM 115MM STRL HEX HD ST CORT	BOTH IP/OP	$93.35 	$69.08	$0.00	$74.68	$42.01	$42.01	$0.00	$0.00	$0.00	$19.46	$69.28	$69.28	$0.00	$0.00	$19.45	$0.00	$55.22	$55.22	$0.00	$46.68	$73.93	$74.68	$0.00		$0.00	$14.61	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
3571149620	SUP	HCPCS C1713		3571149620  -  SCREW BN 3.5MM 120MM STRL HEX HD ST CORT	BOTH IP/OP	$93.35 	$69.08	$0.00	$74.68	$42.01	$42.01	$0.00	$0.00	$0.00	$19.46	$69.28	$69.28	$0.00	$0.00	$19.45	$0.00	$55.22	$55.22	$0.00	$46.68	$73.93	$74.68	$0.00		$0.00	$14.61	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
3571149625	SUP	HCPCS C1713		3571149625  -  SCREW BN 3.5MM 125MM STRL HEX HD ST CORT	BOTH IP/OP	$93.35 	$69.08	$0.00	$74.68	$42.01	$42.01	$0.00	$0.00	$0.00	$19.46	$69.28	$69.28	$0.00	$0.00	$19.45	$0.00	$55.22	$55.22	$0.00	$46.68	$73.93	$74.68	$0.00		$0.00	$14.61	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
3571149630	SUP	HCPCS C1713		3571149630  -  SCREW BN 3.5MM 130MM STRL HEX HD ST CORT	BOTH IP/OP	$93.35 	$69.08	$0.00	$74.68	$42.01	$42.01	$0.00	$0.00	$0.00	$19.46	$69.28	$69.28	$0.00	$0.00	$19.45	$0.00	$55.22	$55.22	$0.00	$46.68	$73.93	$74.68	$0.00		$0.00	$14.61	$0.00	$0.00	$14.86	$0.00	$0.00	$0.00	$0.00	$0.00
3571149714	SUP	HCPCS C1713		3571149714  -  SCREW BN 4.5MM 14MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149716	SUP	HCPCS C1713		3571149716  -  SCREW BN 4.5MM 16MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149718	SUP	HCPCS C1713		3571149718  -  SCREW BN 4.5MM 18MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149720	SUP	HCPCS C1713		3571149720  -  SCREW BN 4.5MM 20MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149722	SUP	HCPCS C1713		3571149722  -  SCREW BN 4.5MM 22MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149724	SUP	HCPCS C1713		3571149724  -  SCREW BN 4.5MM 24MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149726	SUP	HCPCS C1713		3571149726  -  SCREW BN 4.5MM 26MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149728	SUP	HCPCS C1713		3571149728  -  SCREW BN 4.5MM 28MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149730	SUP	HCPCS C1713		3571149730  -  SCREW BN 4.5MM 30MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149732	SUP	HCPCS C1713		3571149732  -  SCREW BN 4.5MM 32MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149734	SUP	HCPCS C1713		3571149734  -  SCREW BN 4.5MM 34MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149736	SUP	HCPCS C1713		3571149736  -  SCREW BN 4.5MM 36MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149738	SUP	HCPCS C1713		3571149738  -  SCREW BN 4.5MM 38MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149740	SUP	HCPCS C1713		3571149740  -  SCREW BN 4.5MM 40MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149742	SUP	HCPCS C1713		3571149742  -  SCREW BN 4.5MM 42MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149744	SUP	HCPCS C1713		3571149744  -  SCREW BN 4.5MM 44MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149746	SUP	HCPCS C1713		3571149746  -  SCREW BN 4.5MM 46MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149748	SUP	HCPCS C1713		3571149748  -  SCREW BN 4.5MM 48MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149750	SUP	HCPCS C1713		3571149750  -  SCREW BN 4.5MM 50MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149752	SUP	HCPCS C1713		3571149752  -  SCREW BN 4.5MM 52MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149754	SUP	HCPCS C1713		3571149754  -  SCREW BN 4.5MM 54MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149756	SUP	HCPCS C1713		3571149756  -  SCREW BN 4.5MM 56MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149758	SUP	HCPCS C1713		3571149758  -  SCREW BN 4.5MM 58MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149760	SUP	HCPCS C1713		3571149760  -  SCREW BN 4.5MM 60MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149762	SUP	HCPCS C1713		3571149762  -  SCREW BN 4.5MM 62MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149764	SUP	HCPCS C1713		3571149764  -  SCREW BN 4.5MM 64MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149766	SUP	HCPCS C1713		3571149766  -  SCREW BN 4.5MM 66MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149768	SUP	HCPCS C1713		3571149768  -  SCREW BN 4.5MM 68MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149770	SUP	HCPCS C1713		3571149770  -  SCREW BN 4.5MM 70MM STRL HEX HD ST CORT	BOTH IP/OP	$75.70 	$56.02	$0.00	$60.56	$34.07	$34.07	$0.00	$0.00	$0.00	$15.78	$56.18	$56.18	$0.00	$0.00	$15.78	$0.00	$44.78	$44.78	$0.00	$37.85	$59.95	$60.56	$0.00		$0.00	$11.85	$0.00	$0.00	$12.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571149772	SUP	HCPCS C1713		3571149772  -  SCREW BN 4.5MM 72MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149776	SUP	HCPCS C1713		3571149776  -  SCREW BN 4.5MM 76MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149780	SUP	HCPCS C1713		3571149780  -  SCREW BN 4.5MM 80MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149785	SUP	HCPCS C1713		3571149785  -  SCREW BN 4.5MM 85MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149790	SUP	HCPCS C1713		3571149790  -  SCREW BN 4.5MM 90MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149795	SUP	HCPCS C1713		3571149795  -  SCREW BN 4.5MM 95MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149800	SUP	HCPCS C1713		3571149800  -  SCREW BN 4.5MM 100MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149805	SUP	HCPCS C1713		3571149805  -  SCREW BN 4.5MM 105MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149810	SUP	HCPCS C1713		3571149810  -  SCREW BN 4.5MM 110MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149815	SUP	HCPCS C1713		3571149815  -  SCREW BN 4.5MM 115MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149820	SUP	HCPCS C1713		3571149820  -  SCREW BN 4.5MM 120MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149825	SUP	HCPCS C1713		3571149825  -  SCREW BN 4.5MM 125MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149830	SUP	HCPCS C1713		3571149830  -  SCREW BN 4.5MM 130MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149835	SUP	HCPCS C1713		3571149835  -  SCREW BN 4.5MM 135MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149840	SUP	HCPCS C1713		3571149840  -  SCREW BN 4.5MM 140MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571149845	SUP	HCPCS C1713		3571149845  -  SCREW BN 4.5MM 145MM STRL HEX HD ST CORT	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$56.70	$56.70	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$19.72	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00
3571223010	SUP	HCPCS C1713		3571223010  -  SCREW BN FT 4MM 10MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223012	SUP	HCPCS C1713		3571223012  -  SCREW BN FT 4MM 12MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223014	SUP	HCPCS C1713		3571223014  -  SCREW BN FT 4MM 14MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223016	SUP	HCPCS C1713		3571223016  -  SCREW BN FT 4MM 16MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223018	SUP	HCPCS C1713		3571223018  -  SCREW BN FT 4MM 18MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223020	SUP	HCPCS C1713		3571223020  -  SCREW BN FT 4MM 20MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223022	SUP	HCPCS C1713		3571223022  -  SCREW BN FT 4MM 22MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223024	SUP	HCPCS C1713		3571223024  -  SCREW BN FT 4MM 24MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223026	SUP	HCPCS C1713		3571223026  -  SCREW BN FT 4MM 26MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223028	SUP	HCPCS C1713		3571223028  -  SCREW BN FT 4MM 28MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223030	SUP	HCPCS C1713		3571223030  -  SCREW BN FT 4MM 30MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223035	SUP	HCPCS C1713		3571223035  -  SCREW BN FT 4MM 35MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223040	SUP	HCPCS C1713		3571223040  -  SCREW BN FT 4MM 40MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223045	SUP	HCPCS C1713		3571223045  -  SCREW BN FT 4MM 45MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223050	SUP	HCPCS C1713		3571223050  -  SCREW BN FT 4MM 50MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223055	SUP	HCPCS C1713		3571223055  -  SCREW BN FT 4MM 55MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223060	SUP	HCPCS C1713		3571223060  -  SCREW BN FT 4MM 60MM STRL CANC	BOTH IP/OP	$57.03 	$42.20	$0.00	$45.62	$25.66	$25.66	$0.00	$0.00	$0.00	$11.89	$42.32	$42.32	$0.00	$0.00	$11.88	$0.00	$33.73	$33.73	$0.00	$28.51	$45.17	$45.62	$0.00		$0.00	$8.92	$0.00	$0.00	$9.08	$0.00	$0.00	$0.00	$0.00	$0.00
3571223210	SUP	HCPCS C1713		3571223210  -  SCREW BN P/T 4MM 10MM STRL CANC	BOTH IP/OP	$55.08 	$40.76	$0.00	$44.06	$24.78	$24.78	$0.00	$0.00	$0.00	$11.48	$40.88	$40.88	$0.00	$0.00	$11.48	$0.00	$32.58	$32.58	$0.00	$27.54	$43.62	$44.06	$0.00		$0.00	$8.62	$0.00	$0.00	$8.77	$0.00	$0.00	$0.00	$0.00	$0.00
3571223212	SUP	HCPCS C1713		3571223212  -  SCREW BN P/T 4MM 12MM STRL CANC	BOTH IP/OP	$55.08 	$40.76	$0.00	$44.06	$24.78	$24.78	$0.00	$0.00	$0.00	$11.48	$40.88	$40.88	$0.00	$0.00	$11.48	$0.00	$32.58	$32.58	$0.00	$27.54	$43.62	$44.06	$0.00		$0.00	$8.62	$0.00	$0.00	$8.77	$0.00	$0.00	$0.00	$0.00	$0.00
3571223214	SUP	HCPCS C1713		3571223214  -  SCREW BN P/T 4MM 14MM STRL CANC	BOTH IP/OP	$36.75 	$27.20	$0.00	$29.40	$16.54	$16.54	$0.00	$0.00	$0.00	$7.66	$27.28	$27.28	$0.00	$0.00	$7.66	$0.00	$21.74	$21.74	$0.00	$18.38	$29.11	$29.40	$0.00		$0.00	$5.75	$0.00	$0.00	$5.85	$0.00	$0.00	$0.00	$0.00	$0.00
3571223216	SUP	HCPCS C1713		3571223216  -  SCREW BN P/T 4MM 16MM STRL CANC	BOTH IP/OP	$36.75 	$27.20	$0.00	$29.40	$16.54	$16.54	$0.00	$0.00	$0.00	$7.66	$27.28	$27.28	$0.00	$0.00	$7.66	$0.00	$21.74	$21.74	$0.00	$18.38	$29.11	$29.40	$0.00		$0.00	$5.75	$0.00	$0.00	$5.85	$0.00	$0.00	$0.00	$0.00	$0.00
3571223218	SUP	HCPCS C1713		3571223218  -  SCREW BN P/T 4MM 18MM STRL CANC	BOTH IP/OP	$36.75 	$27.20	$0.00	$29.40	$16.54	$16.54	$0.00	$0.00	$0.00	$7.66	$27.28	$27.28	$0.00	$0.00	$7.66	$0.00	$21.74	$21.74	$0.00	$18.38	$29.11	$29.40	$0.00		$0.00	$5.75	$0.00	$0.00	$5.85	$0.00	$0.00	$0.00	$0.00	$0.00
3571223220	SUP	HCPCS C1713		3571223220  -  SCREW BN P/T 4MM 20MM STRL CANC	BOTH IP/OP	$36.75 	$27.20	$0.00	$29.40	$16.54	$16.54	$0.00	$0.00	$0.00	$7.66	$27.28	$27.28	$0.00	$0.00	$7.66	$0.00	$21.74	$21.74	$0.00	$18.38	$29.11	$29.40	$0.00		$0.00	$5.75	$0.00	$0.00	$5.85	$0.00	$0.00	$0.00	$0.00	$0.00
3571223222	SUP	HCPCS C1713		3571223222  -  SCREW BN P/T 4MM 22MM STRL CANC	BOTH IP/OP	$36.75 	$27.20	$0.00	$29.40	$16.54	$16.54	$0.00	$0.00	$0.00	$7.66	$27.28	$27.28	$0.00	$0.00	$7.66	$0.00	$21.74	$21.74	$0.00	$18.38	$29.11	$29.40	$0.00		$0.00	$5.75	$0.00	$0.00	$5.85	$0.00	$0.00	$0.00	$0.00	$0.00
3571223226	SUP	HCPCS C1713		3571223226  -  SCREW BN P/T 4MM 26MM STRL CANC	BOTH IP/OP	$36.75 	$27.20	$0.00	$29.40	$16.54	$16.54	$0.00	$0.00	$0.00	$7.66	$27.28	$27.28	$0.00	$0.00	$7.66	$0.00	$21.74	$21.74	$0.00	$18.38	$29.11	$29.40	$0.00		$0.00	$5.75	$0.00	$0.00	$5.85	$0.00	$0.00	$0.00	$0.00	$0.00
3571223228	SUP	HCPCS C1713		3571223228  -  SCREW BN P/T 4MM 28MM STRL CANC	BOTH IP/OP	$36.75 	$27.20	$0.00	$29.40	$16.54	$16.54	$0.00	$0.00	$0.00	$7.66	$27.28	$27.28	$0.00	$0.00	$7.66	$0.00	$21.74	$21.74	$0.00	$18.38	$29.11	$29.40	$0.00		$0.00	$5.75	$0.00	$0.00	$5.85	$0.00	$0.00	$0.00	$0.00	$0.00
3571223230	SUP	HCPCS C1713		3571223230  -  SCREW BN P/T 4MM 30MM STRL CANC	BOTH IP/OP	$36.75 	$27.20	$0.00	$29.40	$16.54	$16.54	$0.00	$0.00	$0.00	$7.66	$27.28	$27.28	$0.00	$0.00	$7.66	$0.00	$21.74	$21.74	$0.00	$18.38	$29.11	$29.40	$0.00		$0.00	$5.75	$0.00	$0.00	$5.85	$0.00	$0.00	$0.00	$0.00	$0.00
3571223235	SUP	HCPCS C1713		3571223235  -  SCREW BN P/T 4MM 35MM STRL CANC	BOTH IP/OP	$36.75 	$27.20	$0.00	$29.40	$16.54	$16.54	$0.00	$0.00	$0.00	$7.66	$27.28	$27.28	$0.00	$0.00	$7.66	$0.00	$21.74	$21.74	$0.00	$18.38	$29.11	$29.40	$0.00		$0.00	$5.75	$0.00	$0.00	$5.85	$0.00	$0.00	$0.00	$0.00	$0.00
3571223240	SUP	HCPCS C1713		3571223240  -  SCREW BN P/T 4MM 40MM STRL CANC	BOTH IP/OP	$36.75 	$27.20	$0.00	$29.40	$16.54	$16.54	$0.00	$0.00	$0.00	$7.66	$27.28	$27.28	$0.00	$0.00	$7.66	$0.00	$21.74	$21.74	$0.00	$18.38	$29.11	$29.40	$0.00		$0.00	$5.75	$0.00	$0.00	$5.85	$0.00	$0.00	$0.00	$0.00	$0.00
3571223245	SUP	HCPCS C1713		3571223245  -  SCREW BN P/T 4MM 45MM STRL CANC	BOTH IP/OP	$36.75 	$27.20	$0.00	$29.40	$16.54	$16.54	$0.00	$0.00	$0.00	$7.66	$27.28	$27.28	$0.00	$0.00	$7.66	$0.00	$21.74	$21.74	$0.00	$18.38	$29.11	$29.40	$0.00		$0.00	$5.75	$0.00	$0.00	$5.85	$0.00	$0.00	$0.00	$0.00	$0.00
3571223250	SUP	HCPCS C1713		3571223250  -  SCREW BN P/T 4MM 50MM STRL CANC	BOTH IP/OP	$36.75 	$27.20	$0.00	$29.40	$16.54	$16.54	$0.00	$0.00	$0.00	$7.66	$27.28	$27.28	$0.00	$0.00	$7.66	$0.00	$21.74	$21.74	$0.00	$18.38	$29.11	$29.40	$0.00		$0.00	$5.75	$0.00	$0.00	$5.85	$0.00	$0.00	$0.00	$0.00	$0.00
3571226030	SUP	HCPCS C1713		3571226030  -  SCREW BN 6.5MM 30MM STRL 16MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571226035	SUP	HCPCS C1713		3571226035  -  SCREW BN 6.5MM 35MM STRL 16MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571226040	SUP	HCPCS C1713		3571226040  -  SCREW BN 6.5MM 40MM STRL 16MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571226045	SUP	HCPCS C1713		3571226045  -  SCREW BN 6.5MM 45MM STRL 16MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571226050	SUP	HCPCS C1713		3571226050  -  SCREW BN 6.5MM 50MM STRL 16MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571226055	SUP	HCPCS C1713		3571226055  -  SCREW BN 6.5MM 55MM STRL 16MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571226060	SUP	HCPCS C1713		3571226060  -  SCREW BN 6.5MM 60MM STRL 16MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571226065	SUP	HCPCS C1713		3571226065  -  SCREW BN 6.5MM 65MM STRL 16MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571226070	SUP	HCPCS C1713		3571226070  -  SCREW BN 6.5MM 70MM STRL 16MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571226075	SUP	HCPCS C1713		3571226075  -  SCREW BN 6.5MM 75MM STRL 16MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571226080	SUP	HCPCS C1713		3571226080  -  SCREW BN 6.5MM 80MM STRL 16MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571226085	SUP	HCPCS C1713		3571226085  -  SCREW BN 6.5MM 85MM STRL 16MM THRD CANC	BOTH IP/OP	$124.95 	$92.46	$0.00	$99.96	$56.23	$56.23	$0.00	$0.00	$0.00	$26.04	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$73.91	$73.91	$0.00	$62.48	$98.96	$99.96	$0.00		$0.00	$19.55	$0.00	$0.00	$19.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571226090	SUP	HCPCS C1713		3571226090  -  SCREW BN 6.5MM 90MM STRL 16MM THRD CANC	BOTH IP/OP	$124.95 	$92.46	$0.00	$99.96	$56.23	$56.23	$0.00	$0.00	$0.00	$26.04	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$73.91	$73.91	$0.00	$62.48	$98.96	$99.96	$0.00		$0.00	$19.55	$0.00	$0.00	$19.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571226095	SUP	HCPCS C1713		3571226095  -  SCREW BN 6.5MM 95MM STRL 16MM THRD CANC	BOTH IP/OP	$124.95 	$92.46	$0.00	$99.96	$56.23	$56.23	$0.00	$0.00	$0.00	$26.04	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$73.91	$73.91	$0.00	$62.48	$98.96	$99.96	$0.00		$0.00	$19.55	$0.00	$0.00	$19.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571226100	SUP	HCPCS C1713		3571226100  -  SCREW BN 6.5MM 100MM STRL 16MM THRD CANC	BOTH IP/OP	$124.95 	$92.46	$0.00	$99.96	$56.23	$56.23	$0.00	$0.00	$0.00	$26.04	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$73.91	$73.91	$0.00	$62.48	$98.96	$99.96	$0.00		$0.00	$19.55	$0.00	$0.00	$19.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571226105	SUP	HCPCS C1713		3571226105  -  SCREW BN 6.5MM 105MM STRL 16MM THRD CANC	BOTH IP/OP	$124.95 	$92.46	$0.00	$99.96	$56.23	$56.23	$0.00	$0.00	$0.00	$26.04	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$73.91	$73.91	$0.00	$62.48	$98.96	$99.96	$0.00		$0.00	$19.55	$0.00	$0.00	$19.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571226110	SUP	HCPCS C1713		3571226110  -  SCREW BN 6.5MM 110MM STRL 16MM THRD CANC	BOTH IP/OP	$124.95 	$92.46	$0.00	$99.96	$56.23	$56.23	$0.00	$0.00	$0.00	$26.04	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$73.91	$73.91	$0.00	$62.48	$98.96	$99.96	$0.00		$0.00	$19.55	$0.00	$0.00	$19.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571228045	SUP	HCPCS C1713		3571228045  -  SCREW BN 6.5MM 45MM STRL 32MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571228050	SUP	HCPCS C1713		3571228050  -  SCREW BN 6.5MM 50MM STRL 32MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571228055	SUP	HCPCS C1713		3571228055  -  SCREW BN 6.5MM 55MM STRL 32MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571228060	SUP	HCPCS C1713		3571228060  -  SCREW BN 6.5MM 60MM STRL 32MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571228065	SUP	HCPCS C1713		3571228065  -  SCREW BN 6.5MM 65MM STRL 32MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571228070	SUP	HCPCS C1713		3571228070  -  SCREW BN 6.5MM 70MM STRL 32MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571228075	SUP	HCPCS C1713		3571228075  -  SCREW BN 6.5MM 75MM STRL 32MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571228080	SUP	HCPCS C1713		3571228080  -  SCREW BN 6.5MM 80MM STRL 32MM THRD CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571228085	SUP	HCPCS C1713		3571228085  -  SCREW BN 6.5MM 85MM STRL 32MM THRD CANC	BOTH IP/OP	$124.95 	$92.46	$0.00	$99.96	$56.23	$56.23	$0.00	$0.00	$0.00	$26.04	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$73.91	$73.91	$0.00	$62.48	$98.96	$99.96	$0.00		$0.00	$19.55	$0.00	$0.00	$19.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571228090	SUP	HCPCS C1713		3571228090  -  SCREW BN 6.5MM 90MM STRL 32MM THRD CANC	BOTH IP/OP	$124.95 	$92.46	$0.00	$99.96	$56.23	$56.23	$0.00	$0.00	$0.00	$26.04	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$73.91	$73.91	$0.00	$62.48	$98.96	$99.96	$0.00		$0.00	$19.55	$0.00	$0.00	$19.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571228095	SUP	HCPCS C1713		3571228095  -  SCREW BN 6.5MM 95MM STRL 32MM THRD CANC	BOTH IP/OP	$124.95 	$92.46	$0.00	$99.96	$56.23	$56.23	$0.00	$0.00	$0.00	$26.04	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$73.91	$73.91	$0.00	$62.48	$98.96	$99.96	$0.00		$0.00	$19.55	$0.00	$0.00	$19.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571228100	SUP	HCPCS C1713		3571228100  -  SCREW BN 6.5MM 100MM STRL 32MM THRD CANC	BOTH IP/OP	$124.95 	$92.46	$0.00	$99.96	$56.23	$56.23	$0.00	$0.00	$0.00	$26.04	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$73.91	$73.91	$0.00	$62.48	$98.96	$99.96	$0.00		$0.00	$19.55	$0.00	$0.00	$19.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571228105	SUP	HCPCS C1713		3571228105  -  SCREW BN 6.5MM 105MM STRL 32MM THRD CANC	BOTH IP/OP	$124.95 	$92.46	$0.00	$99.96	$56.23	$56.23	$0.00	$0.00	$0.00	$26.04	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$73.91	$73.91	$0.00	$62.48	$98.96	$99.96	$0.00		$0.00	$19.55	$0.00	$0.00	$19.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571228110	SUP	HCPCS C1713		3571228110  -  SCREW BN 6.5MM 110MM STRL 32MM THRD CANC	BOTH IP/OP	$124.95 	$92.46	$0.00	$99.96	$56.23	$56.23	$0.00	$0.00	$0.00	$26.04	$92.74	$92.74	$0.00	$0.00	$26.04	$0.00	$73.91	$73.91	$0.00	$62.48	$98.96	$99.96	$0.00		$0.00	$19.55	$0.00	$0.00	$19.89	$0.00	$0.00	$0.00	$0.00	$0.00
3571229025	SUP	HCPCS C1713		3571229025  -  SCREW BN FT 6.5MM 25MM STRL CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571229030	SUP	HCPCS C1713		3571229030  -  SCREW BN FT 6.5MM 30MM STRL CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571229035	SUP	HCPCS C1713		3571229035  -  SCREW BN FT 6.5MM 35MM STRL CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571229040	SUP	HCPCS C1713		3571229040  -  SCREW BN FT 6.5MM 40MM STRL CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571229045	SUP	HCPCS C1713		3571229045  -  SCREW BN FT 6.5MM 45MM STRL CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571229050	SUP	HCPCS C1713		3571229050  -  SCREW BN FT 6.5MM 50MM STRL CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571229055	SUP	HCPCS C1713		3571229055  -  SCREW BN FT 6.5MM 55MM STRL CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
3571229060	SUP	HCPCS C1713		3571229060  -  SCREW BN FT 6.5MM 60MM STRL CANC	BOTH IP/OP	$113.40 	$83.92	$0.00	$90.72	$51.03	$51.03	$0.00	$0.00	$0.00	$23.64	$84.17	$84.17	$0.00	$0.00	$23.63	$0.00	$67.08	$67.08	$0.00	$56.70	$89.81	$90.72	$0.00		$0.00	$17.75	$0.00	$0.00	$18.05	$0.00	$0.00	$0.00	$0.00	$0.00
4823714020	SUP	HCPCS C1713		4823714020  -  SCREW BONE 4MM 20MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823714025	SUP	HCPCS C1713		4823714025  -  SCREW BONE 4MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823714030	SUP	HCPCS C1713		4823714030  -  SCREW BONE 4MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823714035	SUP	HCPCS C1713		4823714035  -  SCREW BONE 4MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823714040	SUP	HCPCS C1713		4823714040  -  SCREW BONE 4MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823714045	SUP	HCPCS C1713		4823714045  -  SCREW BONE 4MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823714520	SUP	HCPCS C1713		4823714520  -  SCREW BONE 4.5MM 20MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823714525	SUP	HCPCS C1713		4823714525  -  SCREW BONE 4.5MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823714530	SUP	HCPCS C1713		4823714530  -  SCREW BONE 4.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823714535	SUP	HCPCS C1713		4823714535  -  SCREW BONE 4.5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823714540	SUP	HCPCS C1713		4823714540  -  SCREW BONE 4.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823714545	SUP	HCPCS C1713		4823714545  -  SCREW BONE 4.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715020	SUP	HCPCS C1713		4823715020  -  SCREW BONE 5MM 20MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715025	SUP	HCPCS C1713		4823715025  -  SCREW BONE 5MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715030	SUP	HCPCS C1713		4823715030  -  SCREW BONE 5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715035	SUP	HCPCS C1713		4823715035  -  SCREW BONE 5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715040	SUP	HCPCS C1713		4823715040  -  SCREW BONE 5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715045	SUP	HCPCS C1713		4823715045  -  SCREW BONE 5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715050	SUP	HCPCS C1713		4823715050  -  SCREW BONE 5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715525	SUP	HCPCS C1713		4823715525  -  SCREW BONE 5.5MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715530	SUP	HCPCS C1713		4823715530  -  SCREW BONE 5.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715535	SUP	HCPCS C1713		4823715535  -  SCREW BONE 5.5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715540	SUP	HCPCS C1713		4823715540  -  SCREW BONE 5.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715545	SUP	HCPCS C1713		4823715545  -  SCREW BONE 5.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715550	SUP	HCPCS C1713		4823715550  -  SCREW BONE 5.5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823715555	SUP	HCPCS C1713		4823715555  -  SCREW BONE 5.5MM 55MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823716525	SUP	HCPCS C1713		4823716525  -  SCREW BONE 6.5MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823716530	SUP	HCPCS C1713		4823716530  -  SCREW BONE 6.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823716535	SUP	HCPCS C1713		4823716535  -  SCREW BONE 6.5MM 35MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823716540	SUP	HCPCS C1713		4823716540  -  SCREW BONE 6.5MM 40MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823716545	SUP	HCPCS C1713		4823716545  -  SCREW BONE 6.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823716550	SUP	HCPCS C1713		4823716550  -  SCREW BONE 6.5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823716555	SUP	HCPCS C1713		4823716555  -  SCREW BONE 6.5MM 55MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823716560	SUP	HCPCS C1713		4823716560  -  SCREW BONE 6.5MM 60MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823716565	SUP	HCPCS C1713		4823716565  -  SCREW BONE 6.5MM 65MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823716570	SUP	HCPCS C1713		4823716570  -  SCREW BONE 6.5MM 70MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823716580	SUP	HCPCS C1713		4823716580  -  SCREW BONE 6.5MM 80MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823716590	SUP	HCPCS C1713		4823716590  -  SCREW BONE 6.5MM 90MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823717525	SUP	HCPCS C1713		4823717525  -  SCREW BONE 7.5MM 25MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823717530	SUP	HCPCS C1713		4823717530  -  SCREW BONE 7.5MM 30MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823717535	SUP	HCPCS C1713		4823717535  -  SCREW BONE 7.5MM 35MM REVISION POLYAX MEDIAL BIASED	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823717540	SUP	HCPCS C1713		4823717540  -  SCREW BONE 7.5MM 40MM REVISION POLYAX MEDIAL BIASED	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823717545	SUP	HCPCS C1713		4823717545  -  SCREW BONE 7.5MM 45MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823717550	SUP	HCPCS C1713		4823717550  -  SCREW BONE 7.5MM 50MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823717555	SUP	HCPCS C1713		4823717555  -  SCREW BONE 7.5MM 55MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823717560	SUP	HCPCS C1713		4823717560  -  SCREW BONE 7.5MM 60MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823717565	SUP	HCPCS C1713		4823717565  -  SCREW BONE 7.5MM 65MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823717570	SUP	HCPCS C1713		4823717570  -  SCREW BONE 7.5MM 70MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823717580	SUP	HCPCS C1713		4823717580  -  SCREW BONE 7.5MM 80MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823717590	SUP	HCPCS C1713		4823717590  -  SCREW BONE 7.5MM 90MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823718500	SUP	HCPCS C1713		4823718500  -  SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823718560	SUP	HCPCS C1713		4823718560  -  SCREW BONE 8.5MM 60MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823718570	SUP	HCPCS C1713		4823718570  -  SCREW BONE 8.5MM 70MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823718580	SUP	HCPCS C1713		4823718580  -  SCREW BONE 8.5MM 80MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823718590	SUP	HCPCS C1713		4823718590  -  SCREW BONE 8.5MM 90MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823719500	SUP	HCPCS C1713		4823719500  -  SCREW BONE 9.5MM 100MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823719560	SUP	HCPCS C1713		4823719560  -  SCREW BONE 9.5MM 60MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823719570	SUP	HCPCS C1713		4823719570  -  SCREW BONE 9.5MM 70MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823719580	SUP	HCPCS C1713		4823719580  -  SCREW BONE 9.5MM 80MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
4823719590	SUP	HCPCS C1713		4823719590  -  SCREW BONE 9.5MM 90MM REVISION POLYAX ILIOSACRAL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
5100060001	SUP	Custom 27203010		5100060001  -  BIT DRILL LARGE 14MM PERFORATOR HUDSON END SHARP CRANIAL	BOTH IP/OP	$474.38 	$351.04	$0.00	$379.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.08	$352.08	$0.00	$0.00	$98.86	$0.00	$0.00	$0.00	$0.00	$237.19	$375.71	$379.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5130020060	SUP	Custom 27203010		5130020060  -  BURR SURG LONG 6MM 7.9MM DRUM FLUTED	BOTH IP/OP	$244.38 	$180.84	$0.00	$195.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.38	$181.38	$0.00	$0.00	$50.93	$0.00	$0.00	$0.00	$0.00	$122.19	$193.55	$195.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5130130250	SUP	Custom 27203010		5130130250  -  BURR SURG LONG .8MM 25.4MM DISK DIAMOND STERILE	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5220030575	SUP	Custom 27203010		5220030575  -  BURR SURG MEDIUM 7.5MM PRECISION ACORN	BOTH IP/OP	$488.75 	$361.68	$0.00	$391.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$362.75	$362.75	$0.00	$0.00	$101.86	$0.00	$0.00	$0.00	$0.00	$244.38	$387.09	$391.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5450800303	SUP	Custom 27203010		5450800303  -  TIP ASPIRAT 25KHZ SUPERLONG SPETZLER MICRO CLAW BONE	BOTH IP/OP	"$10,675.00 "	"$7,899.50"	$0.00	"$8,540.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,224.67"	$0.00	$0.00	$0.00	$0.00	"$5,337.50"	"$8,454.60"	"$8,540.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5450800306	SUP	Custom 27203010		5450800306  -  TIP ASPIRAT 25KHZ UNIVERSAL ULTRASONIC LARGE DIAMETER SOFT	BOTH IP/OP	"$8,455.28 "	"$6,256.91"	$0.00	"$6,764.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,762.08"	$0.00	$0.00	$0.00	$0.00	"$4,227.64"	"$6,696.58"	"$6,764.22"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5450800307	SUP	Custom 27203010		5450800307  -  TIP ASPIRAT 25KHZ UNIVERSAL STR SONOPET DISPOSABLE	BOTH IP/OP	"$7,750.00 "	"$5,735.00"	$0.00	"$6,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,615.10"	$0.00	$0.00	$0.00	$0.00	"$3,875.00"	"$6,138.00"	"$6,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5450800308	SUP	Custom 27203010		5450800308  -  TIP ASP LG DIA STRG 4.6IN STRL LF SONOPET SFT TIS DISP	BOTH IP/OP	"$1,649.99 "	"$1,220.99"	$0.00	"$1,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$0.00	$0.00	$0.00	$825.00	"$1,306.79"	"$1,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820009060	SUP	Custom 27203010		5820009060  -  BURR SURG ROUND 6MM PRECISION	BOTH IP/OP	$505.88 	$374.35	$0.00	$404.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$375.46	$375.46	$0.00	$0.00	$105.42	$0.00	$0.00	$0.00	$0.00	$252.94	$400.66	$404.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820009075	SUP	Custom 27203010		5820009075  -  BURR SURG ROUND 7.5MM RIM GLIDE PRECISION	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820010010	SUP	Custom 27203010		5820010010  -  BURR SURG ROUND FLUTE 1MM TPS ELITE	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820010125	SUP	Custom 27203010		5820010125  -  BURR SURG 2.5MM ROUND SOFT TOUCH FLUTED ELITE STERILE	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820010130	SUP	Custom 27203010		5820010130  -  BURR SURG 3MM TPS ELT OSTN RND FLUT SFTCH 5 NTCH	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820010150	SUP	Custom 27203010		5820010150  -  BURR SURG ROUND FLUTE 5MM 5 NOTCH SOFT TOUCH SMOOTH CUT GOOD	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820010160	SUP	Custom 27203010		5820010160  -  BURR SURG ROUND FLUTE 6MM SOFT TOUCH ROUND FLUTED AGGRESSIVE	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820010170	SUP	Custom 27203010		5820010170  -  BURR SURG 7MM ROUND SOFT TOUCH ELITE STERILE	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820012010	SUP	Custom 27203010		5820012010  -  BURR SURG ROUND 1MM ROUND HEAD CUTTING TPS ELITE DIAMOND	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820012020	SUP	Custom 27203010		5820012020  -  BURR SRG RND 2MM TPS ELT DMD	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820012025	SUP	Custom 27203010		5820012025  -  BURR SURG ROUND 2.5MM TPS ELITE DIAMOND	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820012050	SUP	Custom 27203010		5820012050  -  BURR SURG DIAMOND 5MM 5 STEP NOTCH NUMBER SAFETY MARK CUT	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820012060	SUP	Custom 27203010		5820012060  -  BURR SURG ROUND 6MM LATEX FREE ELITE DIAMOND STERILE	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820013060	SUP	Custom 27203010		5820013060  -  BURR SRG RND CRS DMD 6MM STRL LF TPS ELT DISP	BOTH IP/OP	$777.50 	$575.35	$0.00	$622.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$577.06	$577.06	$0.00	$0.00	$162.03	$0.00	$0.00	$0.00	$0.00	$388.75	$615.78	$622.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820070011	SUP	Custom 27203010		5820070011  -  BURR SURG STR 1.1MM 6MM ROUTER STR	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820107020	SUP	Custom 27203010		5820107020  -  BURR SRG 2MM 3.1MM STRL LF MTCH HD SFTCH DISP NEURO	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820107120	SUP	Custom 27203010		5820107120  -  BURR SURG 2MM 3.1MM DIAMOND NEURO ELITE STERILE	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820107125	SUP	Custom 27203010		5820107125  -  BIT DRILL 2.5MM 3.4MM NEURO ELITE STERILE	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820107130	SUP	Custom 27203010		5820107130  -  BURR SURG 3MM 3.8MM DIAMOND NEURO ELITE STERILE	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6279409577	SUP	Custom 27203010		6279409577  -  DRESSING BURN ADH SIL NYL 15X10IN BBRN	BOTH IP/OP	$248.05 	$183.56	$0.00	$198.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.10	$184.10	$0.00	$0.00	$51.69	$0.00	$0.00	$0.00	$0.00	$124.03	$196.46	$198.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6770200005	SUP	Custom 27203010		6770200005  -  FORCEPS BP .5MM 8IN SPTZLR MLS 2 IRR DISP	BOTH IP/OP	"$1,209.99 "	$895.39	$0.00	$967.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$898.05	$898.05	$0.00	$0.00	$252.16	$0.00	$0.00	$0.00	$0.00	$605.00	$958.31	$967.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6770200010	SUP	Custom 27203010		6770200010  -  FORCEPS BP 1MM 8IN SPTZLR MLS 2 IRR DISP	BOTH IP/OP	"$1,135.50 "	$840.27	$0.00	$908.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$842.77	$842.77	$0.00	$0.00	$236.64	$0.00	$0.00	$0.00	$0.00	$567.75	$899.32	$908.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065149527	SUP	Custom 27203010		8065149527  -  CANNULA OPHTHALMIC SHORT 23GA SOFT TIP STERILE DISPOSABLE	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$333.99	$333.99	$0.00	$0.00	$93.78	$0.00	$0.00	$0.00	$0.00	$225.00	$356.40	$360.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065149530	SUP	Custom 27203010		8065149530  -  CANNULA OPTH SHRT 25GA .8MM STRL GRSHBR SFTP DISP	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.40	$33.40	$0.00	$0.00	$9.38	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065740632	SUP	Custom 27203010		8065740632  -  PACK PHACO 30D RND .9MM STRL LF ABS LGC MXV DISP	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065741080	SUP	Custom 27203010		8065741080  -  PACK PHACO US BSC	BOTH IP/OP	$113.55 	$84.03	$0.00	$90.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.28	$84.28	$0.00	$0.00	$23.66	$0.00	$0.00	$0.00	$0.00	$56.78	$89.93	$90.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065741089	SUP	Custom 27203010		8065741089  -  PACK PHACO 30D 1.1MM STRL INFNT RND US ABS TIP FLD MGMT SYS	BOTH IP/OP	$342.50 	$253.45	$0.00	$274.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.20	$254.20	$0.00	$0.00	$71.38	$0.00	$0.00	$0.00	$0.00	$171.25	$271.26	$274.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065750157	SUP	Custom 27203010		8065750157  -  PACK VITRECTOMY INFINITI ANTERIOR STERILE DISPOSABLE	BOTH IP/OP	$434.00 	$321.16	$0.00	$347.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$322.11	$322.11	$0.00	$0.00	$90.45	$0.00	$0.00	$0.00	$0.00	$217.00	$343.73	$347.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065750159	SUP	Custom 27203010		8065750159  -  KIT PHACOEMULSIFICATION .9MM SMALL PART MICROSMOOTH STERILE	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.97	$38.97	$0.00	$0.00	$10.94	$0.00	$0.00	$0.00	$0.00	$26.25	$41.58	$42.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065751176	SUP	Custom 27203010		8065751176  -  TIP 30 DEG OZIL 12 PHACO	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$0.00	$0.00	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065751177	SUP	Custom 27203010		8065751177  -  TIP PHACOEMULSIFICATION 45D .9MM 12MM MINIFLARE OZIL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$0.00	$0.00	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065751576	SUP	Custom 27203010		8065751576  -  PROBE LASER 23GA ILLUMINATED PIK RFID	BOTH IP/OP	"$3,570.90 "	"$2,642.47"	$0.00	"$2,856.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,650.32"	"$2,650.32"	$0.00	$0.00	$744.18	$0.00	$0.00	$0.00	$0.00	"$1,785.45"	"$2,828.15"	"$2,856.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065751577	SUP	Custom 27203010		8065751577  -  ILLUMINATOR OPHTHALMIC 25GA RADIO FREQUENCY IDENTIFICATION	BOTH IP/OP	"$3,731.10 "	"$2,761.01"	$0.00	"$2,984.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,769.22"	"$2,769.22"	$0.00	$0.00	$777.56	$0.00	$0.00	$0.00	$0.00	"$1,865.55"	"$2,955.03"	"$2,984.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065751592	SUP	Custom 27203010		8065751592  -  PROBE LASER 78D 23GA 2IN ILLUMINATION CURVE TIP LARGE	BOTH IP/OP	"$2,760.00 "	"$2,042.40"	$0.00	"$2,208.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,048.47"	"$2,048.47"	$0.00	$0.00	$575.18	$0.00	$0.00	$0.00	$0.00	"$1,380.00"	"$2,185.92"	"$2,208.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065751593	SUP	Custom 27203010		8065751593  -  PROBE LASER 78D 25GA 2IN ILLUMINATION CURVE TIP LARGE	BOTH IP/OP	$540.75 	$400.16	$0.00	"$2,595.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$0.00	$0.00	$0.00	"$1,622.25"	"$2,569.64"	"$2,595.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065751922	SUP	Custom 27203010		8065751922  -  SET OPHTHALMIC INTREPID IRRIGATION ASPIRATION BIMANUAL HANDP	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065752201	SUP	Custom 27203010		8065752201  -  PACK PHACO 45D .9MM STRL ABS TIP FLD MGMT SYS ULT SLV DISP	BOTH IP/OP	"$1,663.65 "	"$1,231.10"	$0.00	"$1,330.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,234.76"	"$1,234.76"	$0.00	$0.00	$346.70	$0.00	$0.00	$0.00	$0.00	$831.83	"$1,317.61"	"$1,330.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065754003	SUP	HCPCS L8610		8065754003  -  SHUNT GLCM STRL LF CYPASS	BOTH IP/OP	"$3,962.50 "	"$2,932.25"	$0.00	"$3,170.00"	"$1,783.13"	"$1,783.13"	$0.00	$0.00	$0.00	$825.88	"$2,940.97"	"$2,940.97"	$0.00	$0.00	$825.79	$0.00	"$1,953.51"	"$1,953.51"	$0.00	"$1,981.25"	"$3,138.30"	"$3,170.00"	$0.00		$0.00	$620.13	$0.00	$0.00	$630.83	$0.00	$0.00	$0.00	$0.00	$0.00
8065817001	SUP	Custom 27203010		8065817001  -  TIP IRR/ASPIRAT .3MM ULFL 1 PC STR	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,224.63"	"$1,224.63"	$0.00	$0.00	$343.86	$0.00	$0.00	$0.00	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065900163	SUP	Custom 27203010		8065900163  -  KIT ACCESSORY PROCEDURAL LIQUID PERFLUORON	BOTH IP/OP	"$3,049.88 "	"$2,256.91"	$0.00	"$2,439.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,263.62"	"$2,263.62"	$0.00	$0.00	$635.59	$0.00	$0.00	$0.00	$0.00	"$1,524.94"	"$2,415.50"	"$2,439.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065992747	SUP	Custom 27203010		8065992747  -  KNIFE OPHTHALMIC ANGLE 2 BEVEL 2.75MM SLIT SATIN FINISH FULL	BOTH IP/OP	$46.13 	$34.14	$0.00	$36.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.23	$34.23	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$23.06	$36.53	$36.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8065997001	SUP	HCPCS C1713		8065997001  -  SCREW BN 2.3MM STRL IKNF II STNCRSNT TIP STRG DISP	BOTH IP/OP	$41.58 	$30.77	$0.00	$33.26	$18.71	$18.71	$0.00	$0.00	$0.00	$8.67	$30.86	$30.86	$0.00	$0.00	$8.66	$0.00	$24.59	$24.59	$0.00	$20.79	$32.93	$33.26	$0.00		$0.00	$6.51	$0.00	$0.00	$6.62	$0.00	$0.00	$0.00	$0.00	$0.00
8450107030	SUP	Custom 27203010		8450107030  -  BURR SURG 3MM MATCH HEAD LATEX FREE	BOTH IP/OP	$466.35 	$345.10	$0.00	$373.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.12	$346.12	$0.00	$0.00	$97.19	$0.00	$0.00	$0.00	$0.00	$233.18	$369.35	$373.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8815668007	SUP	Custom 27203010		TRAY CATH 19.5CM 11.5FR MHRKR DUAL STRG NDLHLDR GZE SPNG SH	BOTH IP/OP	$314.88 	$233.01	$0.00	$251.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.44	$249.38	$251.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8831663001	SUP	Custom 27203010		TRAY CATH MHRKR INS 2LUM STRG EXTN	BOTH IP/OP	$314.88 	$233.01	$0.00	$251.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.44	$249.38	$251.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8884200026	SUP	Custom 27203010		PROBE THRMTR ORAL CORD ADLT FLC 2000 REUSE	BOTH IP/OP	$114.85 	$84.99	$0.00	$91.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.43	$90.96	$91.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8886808300	SUP	Custom 27803010		8886808300  -  RING ANSTM 2MM 25MM STRL VALTRAC RADOPQ BFRG MECH LCK CNCT	BOTH IP/OP	$829.45 	$613.79	$0.00	$663.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$615.62	$615.62	$0.00	$0.00	$172.86	$0.00	$0.00	$0.00	$0.00	$414.72	$656.92	$663.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8886808800	SUP	Custom 27803010		8886808800  -  RING ANSTM 2MM 28MM STRL VALTRAC RADOPQ BFRG MECH LCK CNCT	BOTH IP/OP	$777.13 	$575.08	$0.00	$621.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$388.56	$615.49	$621.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8887654088	SUP	HCPCS C1729		CATHETER URTH DOV 8FR 2W FOLEY BLN SIL-EL 3ML LTX PED	BOTH IP/OP	$10.33 	$7.64	$0.00	$8.26	$5.61	$5.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.16	$8.18	$8.26	$0.00		$0.00	$1.62	$0.00	$0.00	$1.64	$0.00	$0.00	$0.00	$0.00	$0.00
8887654104	SUP	HCPCS C1729		CATHETER URTH DOV 10FR FOLEY 2W SIL-EL 3ML LTX PED	BOTH IP/OP	$10.33 	$7.64	$0.00	$8.26	$5.61	$5.61	$0.00	$0.00	$0.00	$2.15	$7.66	$7.66	$0.00	$0.00	$2.15	$0.00	$6.11	$6.11	$0.00	$5.16	$8.18	$8.26	$0.00		$0.00	$1.62	$0.00	$0.00	$1.64	$0.00	$0.00	$0.00	$0.00	$0.00
8888119362	SUP	HCPCS C1750		8888119362  -  CATHETER HMDIAL 14.5FR 19CM MH MXD SPORTPACK 2 LUM KINK RST	BOTH IP/OP	$210.68 	$155.90	$0.00	$168.54	$94.81	$94.81	$0.00	$0.00	$0.00	$43.91	$156.37	$156.37	$0.00	$0.00	$43.91	$0.00	$124.62	$124.62	$0.00	$105.34	$166.86	$168.54	$0.00		$0.00	$32.97	$0.00	$0.00	$33.54	$0.00	$0.00	$0.00	$0.00	$0.00
8888160333	SUP	Custom 27203010		8888160333  -  CATHETER UMB 3.5FR 15IN .15ML CLR STRL LF ARG 1 LUM LL HUB	BOTH IP/OP	$86.01 	$63.65	$0.00	$63.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.83	$63.83	$0.00	$0.00	$17.92	$0.00	$0.00	$0.00	$0.00	$16.92	$27.99	$27.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8888160341	SUP	Custom 27203010		8888160341  -  CAP TUBE 13MM BLU EZTPR DBL FLNG SL THB TAB PE	BOTH IP/OP	$34.28 	$25.37	$0.00	$27.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.44	$25.44	$0.00	$0.00	$7.14	$0.00	$0.00	$0.00	$0.00	$16.92	$27.99	$27.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8888160358	SUP	HCPCS C1729		CATHETER UMB 3.5FR 15IN FLXB SMTH LUER LOCK LOCK HUB WNG ARG	BOTH IP/OP	$33.33 	$24.66	$0.00	$26.66	$18.10	$18.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.66	$26.40	$26.66	$0.00		$0.00	$5.22	$0.00	$0.00	$5.31	$0.00	$0.00	$0.00	$0.00	$0.00
8888160408	SUP	Custom 27203010		8888160408  -  TRAY CATH LF A NEOS 2 TIER DSGN FN TIP FCP INS DEPH FR MGLN	BOTH IP/OP	$126.90 	$93.91	$0.00	$104.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.19	$94.19	$0.00	$0.00	$26.45	$0.00	$0.00	$0.00	$0.00	$63.33	$104.77	$101.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8888265108	SUP	Custom 27203010		TUBE NG 36IN 10FR SNTNL LN A SLM SM SIL	BOTH IP/OP	$28.47 	$21.07	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.13	$21.13	$0.00	$0.00	$5.93	$0.00	$0.00	$0.00	$0.00	$14.36	$22.75	$22.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8888492120	SUP	HCPCS C1758		8888492120  -  CATH URTH DV RBNL 20FR 16IN PVC STRL LATEX FREE	BOTH IP/OP	$1.38 	$1.02	$0.00	$1.11	$0.75	$0.75	$0.00	$0.00	$0.00	$0.29	$1.03	$1.03	$0.00	$0.00	$0.29	$0.00	$0.82	$0.82	$0.00	$0.69	$1.09	$1.11	$0.00		$0.00	$0.22	$0.00	$0.00	$0.22	$0.00	$0.00	$0.00	$0.00	$0.00
8888560805	SUP	HCPCS C1729		8888560805  -  CATHETER DRAIN 8FR 9IN SHARP TROCAR TIP RADIOPQ DEPTH MARK	BOTH IP/OP	$34.18 	$25.29	$0.00	$28.98	$19.67	$19.67	$0.00	$0.00	$0.00	$7.12	$25.36	$25.36	$0.00	$0.00	$7.12	$0.00	$20.21	$20.21	$0.00	$18.11	$28.69	$28.98	$0.00		$0.00	$5.67	$0.00	$0.00	$5.77	$0.00	$0.00	$0.00	$0.00	$0.00
8888561019	SUP	HCPCS C1729		8888561019  -  CATHETER DRN 10FR 3.3MM 9IN TROC STRG SFT PVC THOR	BOTH IP/OP	$34.18 	$25.29	$0.00	$28.69	$18.84	$18.84	$0.00	$0.00	$0.00	$7.12	$25.36	$25.36	$0.00	$0.00	$7.12	$0.00	$20.21	$20.21	$0.00	$17.34	$28.69	$27.75	$0.00		$0.00	$5.67	$0.00	$0.00	$5.52	$0.00	$0.00	$0.00	$0.00	$0.00
8888561027	SUP	HCPCS C1729		8888561027  -  CATHETER DRAIN 12FR 9IN SHARP TROCAR TIP RADIOPQ DEPTH MARK	BOTH IP/OP	$34.18 	$25.29	$0.00	$28.69	$18.84	$18.84	$0.00	$0.00	$0.00	$7.12	$25.36	$25.36	$0.00	$0.00	$7.12	$0.00	$20.21	$20.21	$0.00	$17.34	$28.69	$27.75	$0.00		$0.00	$5.67	$0.00	$0.00	$5.52	$0.00	$0.00	$0.00	$0.00	$0.00
8888570515	SUP	HCPCS C1725		CATHETER DRAIN 16FR 5.3MM 20IN 4 SD EYE STRG THOR THRMSNS	BOTH IP/OP	$12.63 	$9.35	$0.00	$10.10	$6.86	$6.86	$0.00	$0.00	$0.00	$2.63	$9.37	$9.37	$0.00	$0.00	$2.63	$0.00	$7.47	$7.47	$0.00	$6.31	$10.00	$10.10	$0.00		$0.00	$1.98	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$0.00
8888570523	SUP	HCPCS C1725		CATHETER DRAIN 20FR 6.7MM 20IN EYLT RT ANG THRMSNS DEPTH	BOTH IP/OP	$12.63 	$9.35	$0.00	$10.10	$6.86	$6.86	$0.00	$0.00	$0.00	$2.63	$9.37	$9.37	$0.00	$0.00	$2.63	$0.00	$7.47	$7.47	$0.00	$6.31	$10.00	$10.10	$0.00		$0.00	$1.98	$0.00	$0.00	$2.01	$0.00	$0.00	$0.00	$0.00	$0.00
8888570572	SUP	HCPCS C1729		8888570572  -  CATH DRAIN 40FR 20IN ARG 6 EYLT STR THRMSNS DEPTH MARK	BOTH IP/OP	$12.83 	$9.49	$0.00	$98.50	$66.86	$66.86	$0.00	$0.00	$0.00	$2.67	$9.52	$9.52	$0.00	$0.00	$2.67	$0.00	$7.59	$7.59	$0.00	$61.56	$97.52	$98.50	$0.00		$0.00	$19.27	$0.00	$0.00	$19.60	$0.00	$0.00	$0.00	$0.00	$0.00
8888571042	SUP	HCPCS C1729		8888571042  -  CATHETER DRAIN RIGHT ANG 28FR 20IN 6 SIDE EYE RADIOPQ TUBE	BOTH IP/OP	$185.03 	$136.92	$0.00	$155.33	$101.98	$101.98	$0.00	$0.00	$0.00	$38.56	$137.33	$137.33	$0.00	$0.00	$38.56	$0.00	$109.44	$109.44	$0.00	$93.90	$155.33	$150.24	$0.00		$0.00	$30.69	$0.00	$0.00	$29.90	$0.00	$0.00	$0.00	$0.00	$0.00
8888577700	SUP	Custom 27803010		8888577700  -  SHUNT CARDIO 11IN 8FR ARG CRTD 4 TUBE KIT PLSH TPR END	BOTH IP/OP	$86.51 	$64.02	$0.00	$69.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.20	$64.20	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$43.25	$68.52	$69.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8888577775	SUP	HCPCS C1877		8888577775  -  SHUNT CARDIO 6IN 8-14FR ARG CRTD 4 TUBE KT PLSH TPR END	BOTH IP/OP	$137.21 	$101.54	$0.00	$101.84	$39.56	$39.56	$0.00	$0.00	$0.00	$0.00	$101.84	$101.84	$0.00	$0.00	$28.59	$0.00	$0.00	$0.00	$0.00	$43.95	$69.62	$70.33	$0.00		$0.00	$13.76	$0.00	$0.00	$13.99	$0.00	$0.00	$0.00	$0.00	$0.00
8888590018	SUP	HCPCS C1725		CATHETER DRAIN 20IN 18FR FERG VNTRC PVC 4 EYLT VNT STRL LF	BOTH IP/OP	$123.61 	$91.47	$0.00	$91.74	$40.55	$40.55	$0.00	$0.00	$0.00	$25.76	$91.74	$91.74	$0.00	$0.00	$25.76	$0.00	$73.11	$73.11	$0.00	$37.34	$59.15	$59.74	$0.00		$0.00	$11.69	$0.00	$0.00	$11.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410004020	SUP	HCPCS C1713		54410004020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410004025	SUP	HCPCS C1713		54410004025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410004030	SUP	HCPCS C1713		54410004030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410004035	SUP	HCPCS C1713		54410004035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410004040	SUP	HCPCS C1713		54410004040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410004045	SUP	HCPCS C1713		54410004045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410004520	SUP	HCPCS C1713		54410004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410004525	SUP	HCPCS C1713		54410004525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410004530	SUP	HCPCS C1713		54410004530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410004535	SUP	HCPCS C1713		54410004535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410004540	SUP	HCPCS C1713		54410004540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410004545	SUP	HCPCS C1713		54410004545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005020	SUP	HCPCS C1713		54410005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005025	SUP	HCPCS C1713		54410005025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005030	SUP	HCPCS C1713		54410005030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005035	SUP	HCPCS C1713		54410005035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005040	SUP	HCPCS C1713		54410005040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005045	SUP	HCPCS C1713		54410005045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005050	SUP	HCPCS C1713		54410005050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005520	SUP	HCPCS C1713		54410005520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005525	SUP	HCPCS C1713		54410005525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005530	SUP	HCPCS C1713		54410005530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005535	SUP	HCPCS C1713		54410005535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005540	SUP	HCPCS C1713		54410005540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005545	SUP	HCPCS C1713		54410005545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005550	SUP	HCPCS C1713		54410005550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410005555	SUP	HCPCS C1713		54410005555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006025	SUP	HCPCS C1713		54410006025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006030	SUP	HCPCS C1713		54410006030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006035	SUP	HCPCS C1713		54410006035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006040	SUP	HCPCS C1713		54410006040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006045	SUP	HCPCS C1713		54410006045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006050	SUP	HCPCS C1713		54410006050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006055	SUP	HCPCS C1713		54410006055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006520	SUP	HCPCS C1713		54410006520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006525	SUP	HCPCS C1713		54410006525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006530	SUP	HCPCS C1713		54410006530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006535	SUP	HCPCS C1713		54410006535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006540	SUP	HCPCS C1713		54410006540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006545	SUP	HCPCS C1713		54410006545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006550	SUP	HCPCS C1713		54410006550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006555	SUP	HCPCS C1713		54410006555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410006560	SUP	HCPCS C1713		54410006560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410007530	SUP	HCPCS C1713		54410007530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410007535	SUP	HCPCS C1713		54410007535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410007540	SUP	HCPCS C1713		54410007540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410007545	SUP	HCPCS C1713		54410007545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410007550	SUP	HCPCS C1713		54410007550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410007555	SUP	HCPCS C1713		54410007555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54410007560	SUP	HCPCS C1713		54410007560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
54740044520	SUP	HCPCS C1713		54740044520  -  SCREW BONE 4.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740044525	SUP	HCPCS C1713		54740044525  -  SCREW BONE 4.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740044530	SUP	HCPCS C1713		54740044530  -  SCREW BONE 4.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740044535	SUP	HCPCS C1713		54740044535  -  SCREW BONE 4.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740044540	SUP	HCPCS C1713		54740044540  -  SCREW BONE 4.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740044545	SUP	HCPCS C1713		54740044545  -  SCREW BONE 4.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740044550	SUP	HCPCS C1713		54740044550  -  SCREW BONE 4.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740044555	SUP	HCPCS C1713		54740044555  -  SCREW BONE 4.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740044560	SUP	HCPCS C1713		54740044560  -  SCREW BONE 4.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740045520	SUP	HCPCS C1713		54740045520  -  SCREW BONE 5.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740045525	SUP	HCPCS C1713		54740045525  -  SCREW BONE 5.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740045530	SUP	HCPCS C1713		54740045530  -  SCREW BONE 5.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740045535	SUP	HCPCS C1713		54740045535  -  SCREW BONE 5.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740045540	SUP	HCPCS C1713		54740045540  -  SCREW BONE 5.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740045545	SUP	HCPCS C1713		54740045545  -  SCREW BONE 5.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740045550	SUP	HCPCS C1713		54740045550  -  SCREW BONE 5.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740045555	SUP	HCPCS C1713		54740045555  -  SCREW BONE 5.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740045560	SUP	HCPCS C1713		54740045560  -  SCREW BONE 5.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740046520	SUP	HCPCS C1713		54740046520  -  SCREW BONE 6.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740046525	SUP	HCPCS C1713		54740046525  -  SCREW BONE 6.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740046530	SUP	HCPCS C1713		54740046530  -  SCREW BONE 6.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740046535	SUP	HCPCS C1713		54740046535  -  SCREW BONE 6.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740046540	SUP	HCPCS C1713		54740046540  -  SCREW BONE 6.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740046545	SUP	HCPCS C1713		54740046545  -  SCREW BONE 6.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740046550	SUP	HCPCS C1713		54740046550  -  SCREW BONE 6.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740046555	SUP	HCPCS C1713		54740046555  -  SCREW BONE 6.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740046560	SUP	HCPCS C1713		54740046560  -  SCREW BONE 6.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740047520	SUP	HCPCS C1713		54740047520  -  SCREW BONE 7.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740047525	SUP	HCPCS C1713		54740047525  -  SCREW BONE 7.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740047530	SUP	HCPCS C1713		54740047530  -  SCREW BONE 7.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740047535	SUP	HCPCS C1713		54740047535  -  SCREW BONE 7.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740047540	SUP	HCPCS C1713		54740047540  -  SCREW BONE 7.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740047545	SUP	HCPCS C1713		54740047545  -  SCREW BONE 7.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740047550	SUP	HCPCS C1713		54740047550  -  SCREW BONE 7.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740047555	SUP	HCPCS C1713		54740047555  -  SCREW BONE 7.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740047560	SUP	HCPCS C1713		54740047560  -  SCREW BONE 7.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54740105515	SUP	HCPCS C1713		54740105515  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105520	SUP	HCPCS C1713		54740105520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105525	SUP	HCPCS C1713		54740105525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105530	SUP	HCPCS C1713		54740105530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105535	SUP	HCPCS C1713		54740105535  -  SCREW BN 5.5MM 35MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105540	SUP	HCPCS C1713		54740105540  -  SCREW BN 5.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105545	SUP	HCPCS C1713		54740105545  -  SCREW BN 5.5MM 45MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105550	SUP	HCPCS C1713		54740105550  -  SCREW BN 5.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105555	SUP	HCPCS C1713		54740105555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105560	SUP	HCPCS C1713		54740105560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105565	SUP	HCPCS C1713		54740105565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105570	SUP	HCPCS C1713		54740105570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105575	SUP	HCPCS C1713		54740105575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740105580	SUP	HCPCS C1713		54740105580  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106015	SUP	HCPCS C1713		54740106015  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106020	SUP	HCPCS C1713		54740106020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106025	SUP	HCPCS C1713		54740106025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106030	SUP	HCPCS C1713		54740106030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106035	SUP	HCPCS C1713		54740106035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106040	SUP	HCPCS C1713		54740106040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106045	SUP	HCPCS C1713		54740106045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106050	SUP	HCPCS C1713		54740106050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106055	SUP	HCPCS C1713		54740106055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106060	SUP	HCPCS C1713		54740106060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106065	SUP	HCPCS C1713		54740106065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106070	SUP	HCPCS C1713		54740106070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106075	SUP	HCPCS C1713		54740106075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106080	SUP	HCPCS C1713		54740106080  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106515	SUP	HCPCS C1713		54740106515  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106520	SUP	HCPCS C1713		54740106520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106525	SUP	HCPCS C1713		54740106525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106530	SUP	HCPCS C1713		54740106530  -  SCREW BN 6.5MM 30MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106535	SUP	HCPCS C1713		54740106535  -  SCREW BN 6.5MM 35MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106540	SUP	HCPCS C1713		54740106540  -  SCREW BN 6.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106545	SUP	HCPCS C1713		54740106545  -  SCREW BN 6.5MM 45MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106550	SUP	HCPCS C1713		54740106550  -  SCREW BN 6.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106555	SUP	HCPCS C1713		54740106555  -  SCREW BN 6.5MM 55MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106560	SUP	HCPCS C1713		54740106560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106565	SUP	HCPCS C1713		54740106565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106570	SUP	HCPCS C1713		54740106570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106575	SUP	HCPCS C1713		54740106575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740106580	SUP	HCPCS C1713		54740106580  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107020	SUP	HCPCS C1713		54740107020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107025	SUP	HCPCS C1713		54740107025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107030	SUP	HCPCS C1713		54740107030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107035	SUP	HCPCS C1713		54740107035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107040	SUP	HCPCS C1713		54740107040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107045	SUP	HCPCS C1713		54740107045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107050	SUP	HCPCS C1713		54740107050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107055	SUP	HCPCS C1713		54740107055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107060	SUP	HCPCS C1713		54740107060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107065	SUP	HCPCS C1713		54740107065  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107070	SUP	HCPCS C1713		54740107070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107075	SUP	HCPCS C1713		54740107075  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107080	SUP	HCPCS C1713		54740107080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107500	SUP	HCPCS C1713		54740107500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107511	SUP	HCPCS C1713		54740107511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107520	SUP	HCPCS C1713		54740107520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107525	SUP	HCPCS C1713		54740107525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107530	SUP	HCPCS C1713		54740107530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107535	SUP	HCPCS C1713		54740107535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107540	SUP	HCPCS C1713		54740107540  -  SCREW BN 7.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107545	SUP	HCPCS C1713		54740107545  -  SCREW BN 7.5MM 45MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107550	SUP	HCPCS C1713		54740107550  -  SCREW BN 7.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107555	SUP	HCPCS C1713		54740107555  -  SCREW BN 7.5MM 55MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107560	SUP	HCPCS C1713		54740107560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107565	SUP	HCPCS C1713		54740107565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107570	SUP	HCPCS C1713		54740107570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107575	SUP	HCPCS C1713		54740107575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107580	SUP	HCPCS C1713		54740107580  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107585	SUP	HCPCS C1713		54740107585  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107590	SUP	HCPCS C1713		54740107590  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740107595	SUP	HCPCS C1713		54740107595  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108000	SUP	HCPCS C1713		54740108000  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108011	SUP	HCPCS C1713		54740108011  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108020	SUP	HCPCS C1713		54740108020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108025	SUP	HCPCS C1713		54740108025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108030	SUP	HCPCS C1713		54740108030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108035	SUP	HCPCS C1713		54740108035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108040	SUP	HCPCS C1713		54740108040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108045	SUP	HCPCS C1713		54740108045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108050	SUP	HCPCS C1713		54740108050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108055	SUP	HCPCS C1713		54740108055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108060	SUP	HCPCS C1713		54740108060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108065	SUP	HCPCS C1713		54740108065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108070	SUP	HCPCS C1713		54740108070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108075	SUP	HCPCS C1713		54740108075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108080	SUP	HCPCS C1713		54740108080  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108085	SUP	HCPCS C1713		54740108085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108090	SUP	HCPCS C1713		54740108090  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108095	SUP	HCPCS C1713		54740108095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108500	SUP	HCPCS C1713		54740108500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108511	SUP	HCPCS C1713		54740108511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108520	SUP	HCPCS C1713		54740108520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108525	SUP	HCPCS C1713		54740108525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108530	SUP	HCPCS C1713		54740108530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108535	SUP	HCPCS C1713		54740108535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108540	SUP	HCPCS C1713		54740108540  -  SCREW BN 8.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108545	SUP	HCPCS C1713		54740108545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108550	SUP	HCPCS C1713		54740108550  -  SCREW BN 8.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108555	SUP	HCPCS C1713		54740108555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108560	SUP	HCPCS C1713		54740108560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108565	SUP	HCPCS C1713		54740108565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108570	SUP	HCPCS C1713		54740108570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108575	SUP	HCPCS C1713		54740108575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108580	SUP	HCPCS C1713		54740108580  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108585	SUP	HCPCS C1713		54740108585  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108590	SUP	HCPCS C1713		54740108590  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740108595	SUP	HCPCS C1713		54740108595  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109500	SUP	HCPCS C1713		54740109500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109511	SUP	HCPCS C1713		54740109511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109520	SUP	HCPCS C1713		54740109520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109525	SUP	HCPCS C1713		54740109525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109530	SUP	HCPCS C1713		54740109530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109535	SUP	HCPCS C1713		54740109535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109540	SUP	HCPCS C1713		54740109540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109545	SUP	HCPCS C1713		54740109545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109550	SUP	HCPCS C1713		54740109550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109555	SUP	HCPCS C1713		54740109555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109560	SUP	HCPCS C1713		54740109560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109565	SUP	HCPCS C1713		54740109565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109570	SUP	HCPCS C1713		54740109570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109575	SUP	HCPCS C1713		54740109575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109580	SUP	HCPCS C1713		54740109580  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109585	SUP	HCPCS C1713		54740109585  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109590	SUP	HCPCS C1713		54740109590  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54740109595	SUP	HCPCS C1713		54740109595  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54750014525	SUP	HCPCS C1713		54750014525  -  SCREW BONE 4.5MM 25MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750014530	SUP	HCPCS C1713		54750014530  -  SCREW BONE 4.5MM 30MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750014535	SUP	HCPCS C1713		54750014535  -  SCREW BONE 4.5MM 35MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750014540	SUP	HCPCS C1713		54750014540  -  SCREW BONE 4.5MM 40MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750014545	SUP	HCPCS C1713		54750014545  -  SCREW BONE 4.5MM 45MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750014550	SUP	HCPCS C1713		54750014550  -  SCREW BONE 4.5MM 50MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750014555	SUP	HCPCS C1713		54750014555  -  SCREW BONE 4.5MM 55MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750015525	SUP	HCPCS C1713		54750015525  -  SCREW BONE 5.5MM 25MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750015530	SUP	HCPCS C1713		54750015530  -  SCREW BONE 5.5MM 30MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750015535	SUP	HCPCS C1713		54750015535  -  SCREW BONE 5.5MM 35MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750015540	SUP	HCPCS C1713		54750015540  -  SCREW BONE 5.5MM 40MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750015545	SUP	HCPCS C1713		54750015545  -  SCREW BONE 5.5MM 45MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750015550	SUP	HCPCS C1713		54750015550  -  SCREW BONE 5.5MM 50MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750015555	SUP	HCPCS C1713		54750015555  -  SCREW BONE 5.5MM 55MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750015560	SUP	HCPCS C1713		54750015560  -  SCREW BONE 5.5MM 60MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750015565	SUP	HCPCS C1713		54750015565  -  SCREW BONE 5.5MM 65MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750016530	SUP	HCPCS C1713		54750016530  -  SCREW BONE 6.5MM 30MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750016535	SUP	HCPCS C1713		54750016535  -  SCREW BONE 6.5MM 35MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750016540	SUP	HCPCS C1713		54750016540  -  SCREW BONE 6.5MM 40MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750016545	SUP	HCPCS C1713		54750016545  -  SCREW BONE 6.5MM 45MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750016550	SUP	HCPCS C1713		54750016550  -  SCREW BONE 6.5MM 50MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750016555	SUP	HCPCS C1713		54750016555  -  SCREW BONE 6.5MM 55MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750016560	SUP	HCPCS C1713		54750016560  -  SCREW BONE 6.5MM 60MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750016565	SUP	HCPCS C1713		54750016565  -  SCREW BONE 6.5MM 65MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750017530	SUP	HCPCS C1713		54750017530  -  SCREW BONE 7.5MM 30MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750017535	SUP	HCPCS C1713		54750017535  -  SCREW BONE 7.5MM 35MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750017540	SUP	HCPCS C1713		54750017540  -  SCREW BONE 7.5MM 40MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750017545	SUP	HCPCS C1713		54750017545  -  SCREW BONE 7.5MM 45MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750017550	SUP	HCPCS C1713		54750017550  -  SCREW BONE 7.5MM 50MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750017555	SUP	HCPCS C1713		54750017555  -  SCREW BONE 7.5MM 55MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750017560	SUP	HCPCS C1713		54750017560  -  SCREW BONE 7.5MM 60MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750017565	SUP	HCPCS C1713		54750017565  -  SCREW BONE 7.5MM 65MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750017570	SUP	HCPCS C1713		54750017570  -  SCREW BONE 7.5MM 70MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750018530	SUP	HCPCS C1713		54750018530  -  SCREW BONE 8.5MM 30MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750018535	SUP	HCPCS C1713		54750018535  -  SCREW BONE 8.5MM 35MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750018540	SUP	HCPCS C1713		54750018540  -  SCREW BONE 8.5MM 40MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750018545	SUP	HCPCS C1713		54750018545  -  SCREW BONE 8.5MM 45MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750018550	SUP	HCPCS C1713		54750018550  -  SCREW BONE 8.5MM 50MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750018555	SUP	HCPCS C1713		54750018555  -  SCREW BONE 8.5MM 55MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750018560	SUP	HCPCS C1713		54750018560  -  SCREW BONE 8.5MM 60MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750018565	SUP	HCPCS C1713		54750018565  -  SCREW BONE 8.5MM 65MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54750018570	SUP	HCPCS C1713		54750018570  -  SCREW BONE 8.5MM 70MM CD HZN SPN MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840004020	SUP	HCPCS C1713		54840004020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004025	SUP	HCPCS C1713		54840004025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004030	SUP	HCPCS C1713		54840004030  -  SCREW BN 4MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004035	SUP	HCPCS C1713		54840004035  -  SCREW BN 4MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004040	SUP	HCPCS C1713		54840004040  -  SCREW BN 4MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004045	SUP	HCPCS C1713		54840004045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004050	SUP	HCPCS C1713		54840004050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004055	SUP	HCPCS C1713		54840004055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004520	SUP	HCPCS C1713		54840004520  -  SCREW BN 4.5MM 20MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004525	SUP	HCPCS C1713		54840004525  -  SCREW BN 4.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004530	SUP	HCPCS C1713		54840004530  -  SCREW BN 4.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004535	SUP	HCPCS C1713		54840004535  -  SCREW BN 4.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004540	SUP	HCPCS C1713		54840004540  -  SCREW BN 4.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004545	SUP	HCPCS C1713		54840004545  -  SCREW BN 4.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004550	SUP	HCPCS C1713		54840004550  -  SCREW BN 4.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840004555	SUP	HCPCS C1713		54840004555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005020	SUP	HCPCS C1713		54840005020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005025	SUP	HCPCS C1713		54840005025  -  SCREW BN 5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005030	SUP	HCPCS C1713		54840005030  -  SCREW BN 5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005035	SUP	HCPCS C1713		54840005035  -  SCREW BN 5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005040	SUP	HCPCS C1713		54840005040  -  SCREW BN 5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005045	SUP	HCPCS C1713		54840005045  -  SCREW BN 5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005050	SUP	HCPCS C1713		54840005050  -  SCREW BN 5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005055	SUP	HCPCS C1713		54840005055  -  SCREW BN 5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005520	SUP	HCPCS C1713		54840005520  -  SCREW BN 5.5MM 20MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005525	SUP	HCPCS C1713		54840005525  -  SCREW BN 5.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005530	SUP	HCPCS C1713		54840005530  -  SCREW BN 5.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005535	SUP	HCPCS C1713		54840005535  -  SCREW BN 5.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005540	SUP	HCPCS C1713		54840005540  -  SCREW BN 5.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005545	SUP	HCPCS C1713		54840005545  -  SCREW BN 5.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005550	SUP	HCPCS C1713		54840005550  -  SCREW BN 5.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005555	SUP	HCPCS C1713		54840005555  -  SCREW BN 5.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840005560	SUP	HCPCS C1713		54840005560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006020	SUP	HCPCS C1713		54840006020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006025	SUP	HCPCS C1713		54840006025  -  SCREW BN 6MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006030	SUP	HCPCS C1713		54840006030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006035	SUP	HCPCS C1713		54840006035  -  SCREW BN 6MM 35MM NS CD HZN MA COCR SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006040	SUP	HCPCS C1713		54840006040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006045	SUP	HCPCS C1713		54840006045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006050	SUP	HCPCS C1713		54840006050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006055	SUP	HCPCS C1713		54840006055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006060	SUP	HCPCS C1713		54840006060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006520	SUP	HCPCS C1713		54840006520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006525	SUP	HCPCS C1713		54840006525  -  SCREW BN 6.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006530	SUP	HCPCS C1713		54840006530  -  SCREW BN 6.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006535	SUP	HCPCS C1713		54840006535  -  SCREW BN 6.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006540	SUP	HCPCS C1713		54840006540  -  SCREW BN 6.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006545	SUP	HCPCS C1713		54840006545  -  SCREW BN 6.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006550	SUP	HCPCS C1713		54840006550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006555	SUP	HCPCS C1713		54840006555  -  SCREW BN 6.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006560	SUP	HCPCS C1713		54840006560  -  SCREW BN 6.5MM 60MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006565	SUP	HCPCS C1713		54840006565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006570	SUP	HCPCS C1713		54840006570  -  SCREW BN 6.5MM 70MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840006580	SUP	HCPCS C1713		54840006580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007500	SUP	HCPCS C1713		54840007500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007520	SUP	HCPCS C1713		54840007520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007525	SUP	HCPCS C1713		54840007525  -  SCREW BN 7.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007530	SUP	HCPCS C1713		54840007530  -  SCREW BN 7.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007535	SUP	HCPCS C1713		54840007535  -  SCREW BN 7.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007540	SUP	HCPCS C1713		54840007540  -  SCREW BN 7.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007545	SUP	HCPCS C1713		54840007545  -  SCREW BN 7.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007550	SUP	HCPCS C1713		54840007550  -  SCREW BN 7.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007555	SUP	HCPCS C1713		54840007555  -  SCREW BN 7.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007560	SUP	HCPCS C1713		54840007560  -  SCREW BN 7.5MM 60MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007565	SUP	HCPCS C1713		54840007565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007570	SUP	HCPCS C1713		54840007570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007580	SUP	HCPCS C1713		54840007580  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840007590	SUP	HCPCS C1713		54840007590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008500	SUP	HCPCS C1713		54840008500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008525	SUP	HCPCS C1713		54840008525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008530	SUP	HCPCS C1713		54840008530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008535	SUP	HCPCS C1713		54840008535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008540	SUP	HCPCS C1713		54840008540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008545	SUP	HCPCS C1713		54840008545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008550	SUP	HCPCS C1713		54840008550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008555	SUP	HCPCS C1713		54840008555  -  SCREW BN 8.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008560	SUP	HCPCS C1713		54840008560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008565	SUP	HCPCS C1713		54840008565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008570	SUP	HCPCS C1713		54840008570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008580	SUP	HCPCS C1713		54840008580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840008590	SUP	HCPCS C1713		54840008590  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009500	SUP	HCPCS C1713		54840009500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009525	SUP	HCPCS C1713		54840009525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009530	SUP	HCPCS C1713		54840009530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009535	SUP	HCPCS C1713		54840009535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009540	SUP	HCPCS C1713		54840009540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009545	SUP	HCPCS C1713		54840009545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009550	SUP	HCPCS C1713		54840009550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009555	SUP	HCPCS C1713		54840009555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009560	SUP	HCPCS C1713		54840009560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009565	SUP	HCPCS C1713		54840009565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009570	SUP	HCPCS C1713		54840009570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009580	SUP	HCPCS C1713		54840009580  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840009590	SUP	HCPCS C1713		54840009590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54840014530	SUP	HCPCS C1713		54840014530  -  SCREW BONE 30MM MULTIAX CANN SOLERA CD HORIZON COCR 4.5MM	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840014535	SUP	HCPCS C1713		54840014535  -  SCREW BONE 35MM MULTIAX CANN SOLERA CD HORIZON COCR 4.5MM	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840014540	SUP	HCPCS C1713		54840014540  -  SCREW BONE 40MM MULTIAX CANN SOLERA CD HORIZON COCR 4.5MM	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840014545	SUP	HCPCS C1713		54840014545  -  SCREW BONE 4.5MM 45MM MULTIAX CANN SOLERA CD HORIZON COCR	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840015535	SUP	HCPCS C1713		54840015535  -  SCREW BONE 5.5MM 35MM MULTIAX CANN COCR SPN	BOTH IP/OP	"$6,492.50 "	"$4,804.45"	$0.00	"$5,194.00"	"$2,921.63"	"$2,921.63"	$0.00	$0.00	$0.00	"$1,353.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,353.04"	$0.00	"$3,200.80"	"$3,200.80"	$0.00	"$3,246.25"	"$5,142.06"	"$5,194.00"	$0.00		$0.00	"$1,016.08"	$0.00	$0.00	"$1,033.61"	$0.00	$0.00	$0.00	$0.00	$0.00
54840015540	SUP	HCPCS C1713		54840015540  -  SCREW BONE 5.5MM 40MM MULTIAX CANN SOLERA CD HORIZON COCR	BOTH IP/OP	"$6,492.50 "	"$4,804.45"	$0.00	"$5,194.00"	"$2,921.63"	"$2,921.63"	$0.00	$0.00	$0.00	"$1,353.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,353.04"	$0.00	"$3,200.80"	"$3,200.80"	$0.00	"$3,246.25"	"$5,142.06"	"$5,194.00"	$0.00		$0.00	"$1,016.08"	$0.00	$0.00	"$1,033.61"	$0.00	$0.00	$0.00	$0.00	$0.00
54840015545	SUP	HCPCS C1713		54840015545  -  SCREW BONE 5.5MM 45MM MULTIAX CANN SOLERA CD HORIZON	BOTH IP/OP	"$6,492.50 "	"$4,804.45"	$0.00	"$5,194.00"	"$2,921.63"	"$2,921.63"	$0.00	$0.00	$0.00	"$1,353.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,353.04"	$0.00	"$3,200.80"	"$3,200.80"	$0.00	"$3,246.25"	"$5,142.06"	"$5,194.00"	$0.00		$0.00	"$1,016.08"	$0.00	$0.00	"$1,033.61"	$0.00	$0.00	$0.00	$0.00	$0.00
54840015550	SUP	HCPCS C1713		54840015550  -  SCREW BONE 5.5MM 50MM MULTIAX CANN SOLERA CD HORIZON	BOTH IP/OP	"$6,492.50 "	"$4,804.45"	$0.00	"$5,194.00"	"$2,921.63"	"$2,921.63"	$0.00	$0.00	$0.00	"$1,353.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,353.04"	$0.00	"$3,200.80"	"$3,200.80"	$0.00	"$3,246.25"	"$5,142.06"	"$5,194.00"	$0.00		$0.00	"$1,016.08"	$0.00	$0.00	"$1,033.61"	$0.00	$0.00	$0.00	$0.00	$0.00
54840016535	SUP	HCPCS C1713		54840016535  -  SCREW BONE LP 6.5MM 35MM 2 LEAD MULTIAX CANN COLOR CODED	BOTH IP/OP	"$6,492.50 "	"$4,804.45"	$0.00	"$5,194.00"	"$2,921.63"	"$2,921.63"	$0.00	$0.00	$0.00	"$1,353.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,353.04"	$0.00	"$3,200.80"	"$3,200.80"	$0.00	"$3,246.25"	"$5,142.06"	"$5,194.00"	$0.00		$0.00	"$1,016.08"	$0.00	$0.00	"$1,033.61"	$0.00	$0.00	$0.00	$0.00	$0.00
54840016540	SUP	HCPCS C1713		54840016540  -  SCREW BN 6.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$6,492.50 "	"$4,804.45"	$0.00	"$5,194.00"	"$2,921.63"	"$2,921.63"	$0.00	$0.00	$0.00	"$1,353.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,353.04"	$0.00	"$3,200.80"	"$3,200.80"	$0.00	"$3,246.25"	"$5,142.06"	"$5,194.00"	$0.00		$0.00	"$1,016.08"	$0.00	$0.00	"$1,033.61"	$0.00	$0.00	$0.00	$0.00	$0.00
54840016545	SUP	HCPCS C1713		54840016545  -  SCREW BN 6.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$6,492.50 "	"$4,804.45"	$0.00	"$5,194.00"	"$2,921.63"	"$2,921.63"	$0.00	$0.00	$0.00	"$1,353.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,353.04"	$0.00	"$3,200.80"	"$3,200.80"	$0.00	"$3,246.25"	"$5,142.06"	"$5,194.00"	$0.00		$0.00	"$1,016.08"	$0.00	$0.00	"$1,033.61"	$0.00	$0.00	$0.00	$0.00	$0.00
54840016550	SUP	HCPCS C1713		54840016550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM	BOTH IP/OP	"$6,492.50 "	"$4,804.45"	$0.00	"$5,194.00"	"$2,921.63"	"$2,921.63"	$0.00	$0.00	$0.00	"$1,353.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,353.04"	$0.00	"$3,200.80"	"$3,200.80"	$0.00	"$3,246.25"	"$5,142.06"	"$5,194.00"	$0.00		$0.00	"$1,016.08"	$0.00	$0.00	"$1,033.61"	$0.00	$0.00	$0.00	$0.00	$0.00
54840016555	SUP	HCPCS C1713		54840016555  -  SCREW BONE 6.5MM 55MM SOLERA CD HZN OSTEOGRIP TI	BOTH IP/OP	"$6,492.50 "	"$4,804.45"	$0.00	"$5,194.00"	"$2,921.63"	"$2,921.63"	$0.00	$0.00	$0.00	"$1,353.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,353.04"	$0.00	"$3,200.80"	"$3,200.80"	$0.00	"$3,246.25"	"$5,142.06"	"$5,194.00"	$0.00		$0.00	"$1,016.08"	$0.00	$0.00	"$1,033.61"	$0.00	$0.00	$0.00	$0.00	$0.00
54840017540	SUP	HCPCS C1713		54840017540  -  SCREW BONE 7.5MM 40MM MULTIAX CANN COCR SPN	BOTH IP/OP	"$6,492.50 "	"$4,804.45"	$0.00	"$5,194.00"	"$2,921.63"	"$2,921.63"	$0.00	$0.00	$0.00	"$1,353.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,353.04"	$0.00	"$3,200.80"	"$3,200.80"	$0.00	"$3,246.25"	"$5,142.06"	"$5,194.00"	$0.00		$0.00	"$1,016.08"	$0.00	$0.00	"$1,033.61"	$0.00	$0.00	$0.00	$0.00	$0.00
54840017545	SUP	HCPCS C1713		54840017545  -  SCREW BONE 7.5MM 45MM MULTIAX CANN SOLERA CD HORIZON COCR	BOTH IP/OP	"$6,492.50 "	"$4,804.45"	$0.00	"$5,194.00"	"$2,921.63"	"$2,921.63"	$0.00	$0.00	$0.00	"$1,353.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,353.04"	$0.00	"$3,200.80"	"$3,200.80"	$0.00	"$3,246.25"	"$5,142.06"	"$5,194.00"	$0.00		$0.00	"$1,016.08"	$0.00	$0.00	"$1,033.61"	$0.00	$0.00	$0.00	$0.00	$0.00
54840044520	SUP	HCPCS C1713		54840044520  -  SCREW BONE 4.5MM 20MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840044525	SUP	HCPCS C1713		54840044525  -  SCREW BONE 4.5MM 25MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840044530	SUP	HCPCS C1713		54840044530  -  SCREW BONE 4.5MM 30MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840044535	SUP	HCPCS C1713		54840044535  -  SCREW BONE 4.5MM 35MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840044540	SUP	HCPCS C1713		54840044540  -  SCREW BONE 4.5MM 40MM MULTIAX ATS SPN 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840044545	SUP	HCPCS C1713		54840044545  -  SCREW BONE 4.5MM 45MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840044550	SUP	HCPCS C1713		54840044550  -  SCREW BONE 4.5MM 50MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840044555	SUP	HCPCS C1713		54840044555  -  SCREW BONE 4.5MM 55MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840044560	SUP	HCPCS C1713		54840044560  -  SCREW BONE 4.5MM 60MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840045520	SUP	HCPCS C1713		54840045520  -  SCREW BONE 5.5MM 20MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840045525	SUP	HCPCS C1713		54840045525  -  SCREW BONE 5.5MM 25MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840045530	SUP	HCPCS C1713		54840045530  -  SCREW BONE 5.5MM 30MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840045535	SUP	HCPCS C1713		54840045535  -  SCREW BONE 5.5MM 35MM MULTIAX ATS SPN 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840045540	SUP	HCPCS C1713		54840045540  -  SCREW BONE 5.5MM 40MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840045545	SUP	HCPCS C1713		54840045545  -  SCREW BONE 5.5MM 45MM MULTIAX ATS SPN 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840045550	SUP	HCPCS C1713		54840045550  -  SCREW BONE 5.5MM 50MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840045555	SUP	HCPCS C1713		54840045555  -  SCREW BONE 5.5MM 55MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840045560	SUP	HCPCS C1713		54840045560  -  SCREW BONE 5.5MM 60MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840046520	SUP	HCPCS C1713		54840046520  -  SCREW BONE 6.5MM 20MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840046525	SUP	HCPCS C1713		54840046525  -  SCREW BONE 6.5MM 25MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840046530	SUP	HCPCS C1713		54840046530  -  SCREW BONE 6.5MM 30MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840046535	SUP	HCPCS C1713		54840046535  -  SCREW BONE 6.5MM 35MM MULTIAX ATS SPN 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840046540	SUP	HCPCS C1713		54840046540  -  SCREW BONE 6.5MM 40MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840046545	SUP	HCPCS C1713		54840046545  -  SCREW BONE 6.5MM 45MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840046550	SUP	HCPCS C1713		54840046550  -  SCREW BONE 6.5MM 50MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840046555	SUP	HCPCS C1713		54840046555  -  SCREW BONE 6.5MM 55MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840046560	SUP	HCPCS C1713		54840046560  -  SCREW BONE 6.5MM 60MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840047520	SUP	HCPCS C1713		54840047520  -  SCREW BONE 7.5MM 20MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840047525	SUP	HCPCS C1713		54840047525  -  SCREW BONE 7.5MM 25MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840047530	SUP	HCPCS C1713		54840047530  -  SCREW BONE 7.5MM 30MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840047535	SUP	HCPCS C1713		54840047535  -  SCREW BONE 7.5MM 35MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840047540	SUP	HCPCS C1713		54840047540  -  SCREW BONE 7.5MM 40MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840047545	SUP	HCPCS C1713		54840047545  -  SCREW BONE 7.5MM 45MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840047550	SUP	HCPCS C1713		54840047550  -  SCREW BONE 7.5MM 50MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840047555	SUP	HCPCS C1713		54840047555  -  SCREW BONE 7.5MM 55MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54840047560	SUP	HCPCS C1713		54840047560  -  SCREW BONE 7.5MM 60MM ATS SPN MULTIAX 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850014530	SUP	HCPCS C1713		54850014530  -  SCREW BONE 4.5MM 30MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850014535	SUP	HCPCS C1713		54850014535  -  SCREW BN 4.5MM 35MM MAS CNN XTN TAB SPNE 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850014540	SUP	HCPCS C1713		54850014540  -  SCREW BN 4.5MM 40MM MAS CNN XTN TAB SPNE 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850014545	SUP	HCPCS C1713		54850014545  -  SCREW BN 4.5MM 45MM MAS CNN XTN TAB SPNE 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850014550	SUP	HCPCS C1713		54850014550  -  SCREW BONE 4.5MM 50MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850014555	SUP	HCPCS C1713		54850014555  -  SCREW BONE 4.5MM 55MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850014560	SUP	HCPCS C1713		54850014560  -  SCREW BONE 4.5MM 60MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850014565	SUP	HCPCS C1713		54850014565  -  SCREW BONE 4.5MM 65MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850014570	SUP	HCPCS C1713		54850014570  -  SCREW BONE 4.5MM 70MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850014575	SUP	HCPCS C1713		54850014575  -  SCREW BONE 4.5MM 75MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850015530	SUP	HCPCS C1713		54850015530  -  SCREW BONE 5.5MM 30MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850015535	SUP	HCPCS C1713		54850015535  -  SCREW BN 5.5MM 35MM MAS CNN XTN TAB SPNE 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850015540	SUP	HCPCS C1713		54850015540  -  SCREW BN 5.5MM 40MM NS SOLERA CD HZN MA CNN XTD TAB SPNE	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850015545	SUP	HCPCS C1713		54850015545  -  SCREW BN 5.5MM 45MM NS SOLERA CD HZN MA CNN XTD TAB SPNE	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850015550	SUP	HCPCS C1713		54850015550  -  SCREW BN 5.5MM 50MM NS SOLERA CD HZN MA CNN XTD TAB SPNE	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850015555	SUP	HCPCS C1713		54850015555  -  SCREW BONE 5.5MM 55MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850015560	SUP	HCPCS C1713		54850015560  -  SCREW BONE 5.5MM 60MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850015565	SUP	HCPCS C1713		54850015565  -  SCREW BONE 5.5MM 65MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850015570	SUP	HCPCS C1713		54850015570  -  SCREW BONE 5.5MM 70MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850015575	SUP	HCPCS C1713		54850015575  -  SCREW BONE 5.5MM 75MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850016530	SUP	HCPCS C1713		54850016530  -  SCREW BONE 6.5MM 30MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850016535	SUP	HCPCS C1713		54850016535  -  SCREW BN 6.5MM 35MM NS SOLERA CD HZN MA CNN XTD TAB SPNE	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850016540	SUP	HCPCS C1713		54850016540  -  SCREW BN 6.5MM 40MM NS SOLERA CD HZN MA CNN XTD TAB SPNE	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850016545	SUP	HCPCS C1713		54850016545  -  SCREW BN 6.5MM 45MM NS SOLERA CD HZN MA CNN XTD TAB SPNE	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850016550	SUP	HCPCS C1713		54850016550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN MA CNN XTD TAB SPNE	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850016555	SUP	HCPCS C1713		54850016555  -  SCREW BN 6.5MM 55MM NS SOLERA CD HZN MA CNN XTD TAB SPNE	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850016560	SUP	HCPCS C1713		54850016560  -  SCREW BONE 6.5MM 60MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850016565	SUP	HCPCS C1713		54850016565  -  SCREW BONE 6.5MM 65MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850017530	SUP	HCPCS C1713		54850017530  -  SCREW BONE 7.5MM 30MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850017535	SUP	HCPCS C1713		54850017535  -  SCREW BONE 7.5MM 35MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850017540	SUP	HCPCS C1713		54850017540  -  SCREW BN 7.5MM 40MM MAS CNN XTN TAB SPNE 4.75MM ROD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850017545	SUP	HCPCS C1713		54850017545  -  SCREW BN 7.5MM 45MM NS SOLERA CD HZN MA CNN XTD TAB SPNE	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850017550	SUP	HCPCS C1713		54850017550  -  SCREW BN 7.5MM 50MM NS SOLERA CD HZN MA CNN XTD TAB SPNE	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850017555	SUP	HCPCS C1713		54850017555  -  SCREW BN 7.5MM 55MM NS SOLERA CD HZN MA CNN XTD TAB SPNE	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850017560	SUP	HCPCS C1713		54850017560  -  SCREW BN 7.5MM 60MM NS SOLERA CD HZN MA CNN XTD TAB SPNE	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850017565	SUP	HCPCS C1713		54850017565  -  SCREW BONE 7.5MM 65MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850018530	SUP	HCPCS C1713		54850018530  -  SCREW BONE 8.5MM 30MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850018535	SUP	HCPCS C1713		54850018535  -  SCREW BONE 8.5MM 35MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850018540	SUP	HCPCS C1713		54850018540  -  SCREW BONE 8.5MM 40MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850018545	SUP	HCPCS C1713		54850018545  -  SCREW BONE 8.5MM 45MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850018550	SUP	HCPCS C1713		54850018550  -  SCREW BONE 8.5MM 50MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850018555	SUP	HCPCS C1713		54850018555  -  SCREW BONE 8.5MM 55MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850018560	SUP	HCPCS C1713		54850018560  -  SCREW BONE 8.5MM 60MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850018565	SUP	HCPCS C1713		54850018565  -  SCREW BONE 8.5MM 65MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850018570	SUP	HCPCS C1713		54850018570  -  SCREW BONE 8.5MM 70MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850018575	SUP	HCPCS C1713		54850018575  -  SCREW BONE 8.5MM 75MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54850018580	SUP	HCPCS C1713		54850018580  -  SCREW BONE 8.5MM 80MM CD HZN SPNL MULTIAX CANN XTD	BOTH IP/OP	"$3,895.50 "	"$2,882.67"	$0.00	"$3,116.40"	"$1,752.98"	"$1,752.98"	$0.00	$0.00	$0.00	$811.92	"$2,891.24"	"$2,891.24"	$0.00	$0.00	$811.82	$0.00	"$1,920.48"	"$1,920.48"	$0.00	"$1,947.75"	"$3,085.24"	"$3,116.40"	$0.00		$0.00	$609.65	$0.00	$0.00	$620.16	$0.00	$0.00	$0.00	$0.00	$0.00
54890004525	SUP	HCPCS C1713		54890004525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890004530	SUP	HCPCS C1713		54890004530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890004535	SUP	HCPCS C1713		54890004535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890004540	SUP	HCPCS C1713		54890004540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890005525	SUP	HCPCS C1713		54890005525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890005530	SUP	HCPCS C1713		54890005530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890005535	SUP	HCPCS C1713		54890005535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890005540	SUP	HCPCS C1713		54890005540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890005545	SUP	HCPCS C1713		54890005545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890005550	SUP	HCPCS C1713		54890005550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890006530	SUP	HCPCS C1713		54890006530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890006535	SUP	HCPCS C1713		54890006535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890006540	SUP	HCPCS C1713		54890006540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890006545	SUP	HCPCS C1713		54890006545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890006550	SUP	HCPCS C1713		54890006550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN MA RDC COCR SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890006555	SUP	HCPCS C1713		54890006555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890007535	SUP	HCPCS C1713		54890007535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890007540	SUP	HCPCS C1713		54890007540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890007545	SUP	HCPCS C1713		54890007545  -  SCREW BN 7.5MM 45MM NS SOLERA CD HZN MA RDC COCR SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890007550	SUP	HCPCS C1713		54890007550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
54890007555	SUP	HCPCS C1713		54890007555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55410004020	SUP	HCPCS C1713		55410004020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410004025	SUP	HCPCS C1713		55410004025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410004030	SUP	HCPCS C1713		55410004030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410004035	SUP	HCPCS C1713		55410004035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410004040	SUP	HCPCS C1713		55410004040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410004045	SUP	HCPCS C1713		55410004045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410004520	SUP	HCPCS C1713		55410004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410004525	SUP	HCPCS C1713		55410004525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410004530	SUP	HCPCS C1713		55410004530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410004535	SUP	HCPCS C1713		55410004535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410004540	SUP	HCPCS C1713		55410004540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410004545	SUP	HCPCS C1713		55410004545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005020	SUP	HCPCS C1713		55410005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005025	SUP	HCPCS C1713		55410005025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005030	SUP	HCPCS C1713		55410005030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005035	SUP	HCPCS C1713		55410005035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005040	SUP	HCPCS C1713		55410005040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005045	SUP	HCPCS C1713		55410005045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005520	SUP	HCPCS C1713		55410005520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005525	SUP	HCPCS C1713		55410005525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005530	SUP	HCPCS C1713		55410005530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005535	SUP	HCPCS C1713		55410005535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005540	SUP	HCPCS C1713		55410005540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005545	SUP	HCPCS C1713		55410005545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410005550	SUP	HCPCS C1713		55410005550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006025	SUP	HCPCS C1713		55410006025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006030	SUP	HCPCS C1713		55410006030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006035	SUP	HCPCS C1713		55410006035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006040	SUP	HCPCS C1713		55410006040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006045	SUP	HCPCS C1713		55410006045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006050	SUP	HCPCS C1713		55410006050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006055	SUP	HCPCS C1713		55410006055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006520	SUP	HCPCS C1713		55410006520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006525	SUP	HCPCS C1713		55410006525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006530	SUP	HCPCS C1713		55410006530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006535	SUP	HCPCS C1713		55410006535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006540	SUP	HCPCS C1713		55410006540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006545	SUP	HCPCS C1713		55410006545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006550	SUP	HCPCS C1713		55410006550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410006555	SUP	HCPCS C1713		55410006555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410007535	SUP	HCPCS C1713		55410007535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410007540	SUP	HCPCS C1713		55410007540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410007545	SUP	HCPCS C1713		55410007545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410007550	SUP	HCPCS C1713		55410007550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55410007555	SUP	HCPCS C1713		55410007555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,990.50 "	"$1,472.97"	$0.00	"$1,592.40"	$895.73	$895.73	$0.00	$0.00	$0.00	$414.87	"$1,477.35"	"$1,477.35"	$0.00	$0.00	$414.82	$0.00	"$1,177.38"	"$1,177.38"	$0.00	$995.25	"$1,576.48"	"$1,592.40"	$0.00		$0.00	$311.51	$0.00	$0.00	$316.89	$0.00	$0.00	$0.00	$0.00	$0.00
55740105535	SUP	HCPCS C1713		55740105535  -  SCREW BN 5.5MM 35MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740105540	SUP	HCPCS C1713		55740105540  -  SCREW BN 5.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740105545	SUP	HCPCS C1713		55740105545  -  SCREW BN 5.5MM 45MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740105550	SUP	HCPCS C1713		55740105550  -  SCREW BN 5.5MM 50MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740106540	SUP	HCPCS C1713		55740106540  -  SCREW BN 6.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740106545	SUP	HCPCS C1713		55740106545  -  SCREW BN 6.5MM 45MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740106550	SUP	HCPCS C1713		55740106550  -  SCREW BN 6.5MM 50MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740106555	SUP	HCPCS C1713		55740106555  -  SCREW BN 6.5MM 55MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740107540	SUP	HCPCS C1713		55740107540  -  SCREW BN 7.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740107545	SUP	HCPCS C1713		55740107545  -  SCREW BN 7.5MM 45MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740107550	SUP	HCPCS C1713		55740107550  -  SCREW BN 7.5MM 50MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740107555	SUP	HCPCS C1713		55740107555  -  SCREW BN 7.5MM 55MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740108535	SUP	HCPCS C1713		55740108535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740108540	SUP	HCPCS C1713		55740108540  -  SCREW BN 8.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740108545	SUP	HCPCS C1713		55740108545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55740108550	SUP	HCPCS C1713		55740108550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811004025	SUP	HCPCS C1713		55811004025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811004030	SUP	HCPCS C1713		55811004030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811004035	SUP	HCPCS C1713		55811004035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811004040	SUP	HCPCS C1713		55811004040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811004045	SUP	HCPCS C1713		55811004045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811004520	SUP	HCPCS C1713		55811004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811004525	SUP	HCPCS C1713		55811004525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811004530	SUP	HCPCS C1713		55811004530  -  SCREW BN 4.5MM 30MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811004535	SUP	HCPCS C1713		55811004535  -  SCREW BN 4.5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811004540	SUP	HCPCS C1713		55811004540  -  SCREW BN 4.5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811004545	SUP	HCPCS C1713		55811004545  -  SCREW BN 4.5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005020	SUP	HCPCS C1713		55811005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005025	SUP	HCPCS C1713		55811005025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005030	SUP	HCPCS C1713		55811005030  -  SCREW BN 5MM 30MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005035	SUP	HCPCS C1713		55811005035  -  SCREW BN 5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005040	SUP	HCPCS C1713		55811005040  -  SCREW BN 5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005045	SUP	HCPCS C1713		55811005045  -  SCREW BN 5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005050	SUP	HCPCS C1713		55811005050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005520	SUP	HCPCS C1713		55811005520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005525	SUP	HCPCS C1713		55811005525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005530	SUP	HCPCS C1713		55811005530  -  SCREW BN 5.5MM 30MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005535	SUP	HCPCS C1713		55811005535  -  SCREW BN 5.5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005540	SUP	HCPCS C1713		55811005540  -  SCREW BN 5.5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005545	SUP	HCPCS C1713		55811005545  -  SCREW BN 5.5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005550	SUP	HCPCS C1713		55811005550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811005555	SUP	HCPCS C1713		55811005555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006030	SUP	HCPCS C1713		55811006030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006035	SUP	HCPCS C1713		55811006035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006040	SUP	HCPCS C1713		55811006040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006045	SUP	HCPCS C1713		55811006045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006050	SUP	HCPCS C1713		55811006050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006525	SUP	HCPCS C1713		55811006525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006530	SUP	HCPCS C1713		55811006530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006535	SUP	HCPCS C1713		55811006535  -  SCREW BN 6.5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006540	SUP	HCPCS C1713		55811006540  -  SCREW BN 6.5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006545	SUP	HCPCS C1713		55811006545  -  SCREW BN 6.5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006550	SUP	HCPCS C1713		55811006550  -  SCREW BN 6.5MM 50MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006555	SUP	HCPCS C1713		55811006555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811006560	SUP	HCPCS C1713		55811006560  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811007535	SUP	HCPCS C1713		55811007535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811007540	SUP	HCPCS C1713		55811007540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811007545	SUP	HCPCS C1713		55811007545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811007550	SUP	HCPCS C1713		55811007550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811007555	SUP	HCPCS C1713		55811007555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811008540	SUP	HCPCS C1713		55811008540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811008545	SUP	HCPCS C1713		55811008545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55811008550	SUP	HCPCS C1713		55811008550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840001540	SUP	HCPCS C1713		55840001540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840001545	SUP	HCPCS C1713		55840001545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840001550	SUP	HCPCS C1713		55840001550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840001555	SUP	HCPCS C1713		55840001555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004020	SUP	HCPCS C1713		55840004020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004025	SUP	HCPCS C1713		55840004025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004030	SUP	HCPCS C1713		55840004030  -  SCREW BN 4MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004035	SUP	HCPCS C1713		55840004035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004040	SUP	HCPCS C1713		55840004040  -  SCREW BN 4MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004045	SUP	HCPCS C1713		55840004045  -  SCREW BN 4MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004050	SUP	HCPCS C1713		55840004050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004055	SUP	HCPCS C1713		55840004055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004520	SUP	HCPCS C1713		55840004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004525	SUP	HCPCS C1713		55840004525  -  SCREW BN 4.5MM 25MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004530	SUP	HCPCS C1713		55840004530  -  SCREW BN 4.5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004535	SUP	HCPCS C1713		55840004535  -  SCREW BN 4.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004540	SUP	HCPCS C1713		55840004540  -  SCREW BN 4.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004545	SUP	HCPCS C1713		55840004545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004550	SUP	HCPCS C1713		55840004550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840004555	SUP	HCPCS C1713		55840004555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005020	SUP	HCPCS C1713		55840005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005025	SUP	HCPCS C1713		55840005025  -  SCREW BN 5MM 25MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005030	SUP	HCPCS C1713		55840005030  -  SCREW BN 5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005035	SUP	HCPCS C1713		55840005035  -  SCREW BN 5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005040	SUP	HCPCS C1713		55840005040  -  SCREW BN 5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005045	SUP	HCPCS C1713		55840005045  -  SCREW BN 5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005050	SUP	HCPCS C1713		55840005050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005055	SUP	HCPCS C1713		55840005055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005520	SUP	HCPCS C1713		55840005520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005525	SUP	HCPCS C1713		55840005525  -  SCREW BN 5.5MM 25MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005530	SUP	HCPCS C1713		55840005530  -  SCREW BN 5.5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005535	SUP	HCPCS C1713		55840005535  -  SCREW BN 5.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005540	SUP	HCPCS C1713		55840005540  -  SCREW BN 5.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005545	SUP	HCPCS C1713		55840005545  -  SCREW BN 5.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005550	SUP	HCPCS C1713		55840005550  -  SCREW BN 5.5MM 50MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005555	SUP	HCPCS C1713		55840005555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840005560	SUP	HCPCS C1713		55840005560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006020	SUP	HCPCS C1713		55840006020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006025	SUP	HCPCS C1713		55840006025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006030	SUP	HCPCS C1713		55840006030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006035	SUP	HCPCS C1713		55840006035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006040	SUP	HCPCS C1713		55840006040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006045	SUP	HCPCS C1713		55840006045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006050	SUP	HCPCS C1713		55840006050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006055	SUP	HCPCS C1713		55840006055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006060	SUP	HCPCS C1713		55840006060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006500	SUP	HCPCS C1713		55840006500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006520	SUP	HCPCS C1713		55840006520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006525	SUP	HCPCS C1713		55840006525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006530	SUP	HCPCS C1713		55840006530  -  SCREW BN 6.5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006535	SUP	HCPCS C1713		55840006535  -  SCREW BN 6.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006540	SUP	HCPCS C1713		55840006540  -  SCREW BN 6.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006545	SUP	HCPCS C1713		55840006545  -  SCREW BN 6.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006550	SUP	HCPCS C1713		55840006550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006555	SUP	HCPCS C1713		55840006555  -  SCREW BN 6.5MM 55MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006560	SUP	HCPCS C1713		55840006560  -  SCREW BN 6.5MM 60MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006565	SUP	HCPCS C1713		55840006565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006570	SUP	HCPCS C1713		55840006570  -  SCREW BN 6.5MM 70MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006580	SUP	HCPCS C1713		55840006580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840006590	SUP	HCPCS C1713		55840006590  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840007500	SUP	HCPCS C1713		55840007500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840007525	SUP	HCPCS C1713		55840007525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840007530	SUP	HCPCS C1713		55840007530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840007535	SUP	HCPCS C1713		55840007535  -  SCREW BN 7.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840007540	SUP	HCPCS C1713		55840007540  -  SCREW BN 7.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
55840007545	SUP	HCPCS C1713		55840007545  -  SCREW BN 7.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840007550	SUP	HCPCS C1713		55840007550  -  SCREW BN 7.5MM 50MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840007555	SUP	HCPCS C1713		55840007555  -  SCREW BN 7.5MM 55MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840007560	SUP	HCPCS C1713		55840007560  -  SCREW BN 7.5MM 60MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840007565	SUP	HCPCS C1713		55840007565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840007570	SUP	HCPCS C1713		55840007570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840007580	SUP	HCPCS C1713		55840007580  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840007590	SUP	HCPCS C1713		55840007590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008500	SUP	HCPCS C1713		55840008500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008525	SUP	HCPCS C1713		55840008525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008530	SUP	HCPCS C1713		55840008530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008535	SUP	HCPCS C1713		55840008535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008540	SUP	HCPCS C1713		55840008540  -  SCREW BN 8.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008545	SUP	HCPCS C1713		55840008545  -  SCREW BN 8.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008550	SUP	HCPCS C1713		55840008550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008555	SUP	HCPCS C1713		55840008555  -  SCREW BN 8.5MM 55MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008560	SUP	HCPCS C1713		55840008560  -  SCREW BN 8.5MM 60MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008565	SUP	HCPCS C1713		55840008565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008570	SUP	HCPCS C1713		55840008570  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008580	SUP	HCPCS C1713		55840008580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840008590	SUP	HCPCS C1713		55840008590  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009500	SUP	HCPCS C1713		55840009500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009525	SUP	HCPCS C1713		55840009525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009530	SUP	HCPCS C1713		55840009530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009535	SUP	HCPCS C1713		55840009535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009540	SUP	HCPCS C1713		55840009540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009545	SUP	HCPCS C1713		55840009545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009550	SUP	HCPCS C1713		55840009550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009555	SUP	HCPCS C1713		55840009555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009560	SUP	HCPCS C1713		55840009560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009565	SUP	HCPCS C1713		55840009565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009570	SUP	HCPCS C1713		55840009570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009580	SUP	HCPCS C1713		55840009580  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840009590	SUP	HCPCS C1713		55840009590  -  SCREW BN 9.5MM 90MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55840015545	SUP	HCPCS C1713		55840015545  -  SCREW BONE 5.5MM 45MM MULTIAX CANN SOLERA COCR SPN 5.5/6MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
55840015550	SUP	HCPCS C1713		55840015550  -  SCREW BONE 5.5MM 50MM CANN MULTIAX COCR SPN 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
55840016550	SUP	HCPCS C1713		55840016550  -  SCREW BONE 6.5MM 50MM MULTIAX CANN SOLERA COCR SPN 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
55840016555	SUP	HCPCS C1713		55840016555  -  SCREW BONE 6.5MM 55MM MULTIAX CANN COCR SPN 5.5 ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
55890004015	SUP	HCPCS C1713		55890004015  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004020	SUP	HCPCS C1713		55890004020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004025	SUP	HCPCS C1713		55890004025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004030	SUP	HCPCS C1713		55890004030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004035	SUP	HCPCS C1713		55890004035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004040	SUP	HCPCS C1713		55890004040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004045	SUP	HCPCS C1713		55890004045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004050	SUP	HCPCS C1713		55890004050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004055	SUP	HCPCS C1713		55890004055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004060	SUP	HCPCS C1713		55890004060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004065	SUP	HCPCS C1713		55890004065  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004070	SUP	HCPCS C1713		55890004070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004075	SUP	HCPCS C1713		55890004075  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004080	SUP	HCPCS C1713		55890004080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004515	SUP	HCPCS C1713		55890004515  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004520	SUP	HCPCS C1713		55890004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004525	SUP	HCPCS C1713		55890004525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004530	SUP	HCPCS C1713		55890004530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004535	SUP	HCPCS C1713		55890004535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004540	SUP	HCPCS C1713		55890004540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004545	SUP	HCPCS C1713		55890004545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004550	SUP	HCPCS C1713		55890004550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004555	SUP	HCPCS C1713		55890004555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004560	SUP	HCPCS C1713		55890004560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004565	SUP	HCPCS C1713		55890004565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004570	SUP	HCPCS C1713		55890004570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004575	SUP	HCPCS C1713		55890004575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890004580	SUP	HCPCS C1713		55890004580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005015	SUP	HCPCS C1713		55890005015  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005020	SUP	HCPCS C1713		55890005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005025	SUP	HCPCS C1713		55890005025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005030	SUP	HCPCS C1713		55890005030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005035	SUP	HCPCS C1713		55890005035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005040	SUP	HCPCS C1713		55890005040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005045	SUP	HCPCS C1713		55890005045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005050	SUP	HCPCS C1713		55890005050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005055	SUP	HCPCS C1713		55890005055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005060	SUP	HCPCS C1713		55890005060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005065	SUP	HCPCS C1713		55890005065  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005070	SUP	HCPCS C1713		55890005070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005075	SUP	HCPCS C1713		55890005075  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005080	SUP	HCPCS C1713		55890005080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005085	SUP	HCPCS C1713		55890005085  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005090	SUP	HCPCS C1713		55890005090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005515	SUP	HCPCS C1713		55890005515  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005520	SUP	HCPCS C1713		55890005520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005525	SUP	HCPCS C1713		55890005525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005530	SUP	HCPCS C1713		55890005530  -  SCREW BN 5.5MM 30MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005535	SUP	HCPCS C1713		55890005535  -  SCREW BN 5.5MM 35MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005540	SUP	HCPCS C1713		55890005540  -  SCREW BN 5.5MM 40MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005545	SUP	HCPCS C1713		55890005545  -  SCREW BN 5.5MM 45MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005550	SUP	HCPCS C1713		55890005550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005555	SUP	HCPCS C1713		55890005555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005560	SUP	HCPCS C1713		55890005560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005565	SUP	HCPCS C1713		55890005565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005570	SUP	HCPCS C1713		55890005570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005575	SUP	HCPCS C1713		55890005575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890005580	SUP	HCPCS C1713		55890005580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006015	SUP	HCPCS C1713		55890006015  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006020	SUP	HCPCS C1713		55890006020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006025	SUP	HCPCS C1713		55890006025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006030	SUP	HCPCS C1713		55890006030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006035	SUP	HCPCS C1713		55890006035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006040	SUP	HCPCS C1713		55890006040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006045	SUP	HCPCS C1713		55890006045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006050	SUP	HCPCS C1713		55890006050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006055	SUP	HCPCS C1713		55890006055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006060	SUP	HCPCS C1713		55890006060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006065	SUP	HCPCS C1713		55890006065  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006070	SUP	HCPCS C1713		55890006070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006075	SUP	HCPCS C1713		55890006075  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006080	SUP	HCPCS C1713		55890006080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006515	SUP	HCPCS C1713		55890006515  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006520	SUP	HCPCS C1713		55890006520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006525	SUP	HCPCS C1713		55890006525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006530	SUP	HCPCS C1713		55890006530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006535	SUP	HCPCS C1713		55890006535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006540	SUP	HCPCS C1713		55890006540  -  SCREW BN 6.5MM 40MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006545	SUP	HCPCS C1713		55890006545  -  SCREW BN 6.5MM 45MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006550	SUP	HCPCS C1713		55890006550  -  SCREW BN 6.5MM 50MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006555	SUP	HCPCS C1713		55890006555  -  SCREW BN 6.5MM 55MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006560	SUP	HCPCS C1713		55890006560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006565	SUP	HCPCS C1713		55890006565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006570	SUP	HCPCS C1713		55890006570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006575	SUP	HCPCS C1713		55890006575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890006580	SUP	HCPCS C1713		55890006580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007015	SUP	HCPCS C1713		55890007015  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007020	SUP	HCPCS C1713		55890007020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007025	SUP	HCPCS C1713		55890007025  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007030	SUP	HCPCS C1713		55890007030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007035	SUP	HCPCS C1713		55890007035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007040	SUP	HCPCS C1713		55890007040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007045	SUP	HCPCS C1713		55890007045  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007050	SUP	HCPCS C1713		55890007050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007055	SUP	HCPCS C1713		55890007055  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007060	SUP	HCPCS C1713		55890007060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007065	SUP	HCPCS C1713		55890007065  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007070	SUP	HCPCS C1713		55890007070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007075	SUP	HCPCS C1713		55890007075  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007080	SUP	HCPCS C1713		55890007080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007500	SUP	HCPCS C1713		55890007500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007511	SUP	HCPCS C1713		55890007511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007515	SUP	HCPCS C1713		55890007515  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007520	SUP	HCPCS C1713		55890007520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007525	SUP	HCPCS C1713		55890007525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007530	SUP	HCPCS C1713		55890007530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007535	SUP	HCPCS C1713		55890007535  -  SCREW BN 7.5MM 35MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007540	SUP	HCPCS C1713		55890007540  -  SCREW BN 7.5MM 40MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007545	SUP	HCPCS C1713		55890007545  -  SCREW BN 7.5MM 45MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007550	SUP	HCPCS C1713		55890007550  -  SCREW BN 7.5MM 50MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007555	SUP	HCPCS C1713		55890007555  -  SCREW BN 7.5MM 55MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007560	SUP	HCPCS C1713		55890007560  -  SCREW BN 7.5MM 60MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007565	SUP	HCPCS C1713		55890007565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007570	SUP	HCPCS C1713		55890007570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007575	SUP	HCPCS C1713		55890007575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007580	SUP	HCPCS C1713		55890007580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007585	SUP	HCPCS C1713		55890007585  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007590	SUP	HCPCS C1713		55890007590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890007595	SUP	HCPCS C1713		55890007595  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008000	SUP	HCPCS C1713		55890008000  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008011	SUP	HCPCS C1713		55890008011  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008015	SUP	HCPCS C1713		55890008015  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008020	SUP	HCPCS C1713		55890008020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008025	SUP	HCPCS C1713		55890008025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008030	SUP	HCPCS C1713		55890008030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008035	SUP	HCPCS C1713		55890008035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008040	SUP	HCPCS C1713		55890008040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008045	SUP	HCPCS C1713		55890008045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008050	SUP	HCPCS C1713		55890008050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008055	SUP	HCPCS C1713		55890008055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008060	SUP	HCPCS C1713		55890008060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008065	SUP	HCPCS C1713		55890008065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008070	SUP	HCPCS C1713		55890008070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008075	SUP	HCPCS C1713		55890008075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008080	SUP	HCPCS C1713		55890008080  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008085	SUP	HCPCS C1713		55890008085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008090	SUP	HCPCS C1713		55890008090  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008095	SUP	HCPCS C1713		55890008095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008500	SUP	HCPCS C1713		55890008500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008511	SUP	HCPCS C1713		55890008511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008515	SUP	HCPCS C1713		55890008515  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008520	SUP	HCPCS C1713		55890008520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008525	SUP	HCPCS C1713		55890008525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008530	SUP	HCPCS C1713		55890008530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008535	SUP	HCPCS C1713		55890008535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008540	SUP	HCPCS C1713		55890008540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008545	SUP	HCPCS C1713		55890008545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008550	SUP	HCPCS C1713		55890008550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008555	SUP	HCPCS C1713		55890008555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008560	SUP	HCPCS C1713		55890008560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008565	SUP	HCPCS C1713		55890008565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008570	SUP	HCPCS C1713		55890008570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008575	SUP	HCPCS C1713		55890008575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008580	SUP	HCPCS C1713		55890008580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008585	SUP	HCPCS C1713		55890008585  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008590	SUP	HCPCS C1713		55890008590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890008595	SUP	HCPCS C1713		55890008595  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009000	SUP	HCPCS C1713		55890009000  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009011	SUP	HCPCS C1713		55890009011  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009015	SUP	HCPCS C1713		55890009015  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009020	SUP	HCPCS C1713		55890009020  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009025	SUP	HCPCS C1713		55890009025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009030	SUP	HCPCS C1713		55890009030  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009035	SUP	HCPCS C1713		55890009035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009040	SUP	HCPCS C1713		55890009040  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009045	SUP	HCPCS C1713		55890009045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009050	SUP	HCPCS C1713		55890009050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009055	SUP	HCPCS C1713		55890009055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009060	SUP	HCPCS C1713		55890009060  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009065	SUP	HCPCS C1713		55890009065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009070	SUP	HCPCS C1713		55890009070  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009075	SUP	HCPCS C1713		55890009075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009080	SUP	HCPCS C1713		55890009080  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009085	SUP	HCPCS C1713		55890009085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009090	SUP	HCPCS C1713		55890009090  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009095	SUP	HCPCS C1713		55890009095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009500	SUP	HCPCS C1713		55890009500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009511	SUP	HCPCS C1713		55890009511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009515	SUP	HCPCS C1713		55890009515  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009520	SUP	HCPCS C1713		55890009520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009525	SUP	HCPCS C1713		55890009525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009530	SUP	HCPCS C1713		55890009530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009535	SUP	HCPCS C1713		55890009535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009540	SUP	HCPCS C1713		55890009540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009545	SUP	HCPCS C1713		55890009545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009550	SUP	HCPCS C1713		55890009550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009555	SUP	HCPCS C1713		55890009555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009560	SUP	HCPCS C1713		55890009560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009565	SUP	HCPCS C1713		55890009565  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009570	SUP	HCPCS C1713		55890009570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009575	SUP	HCPCS C1713		55890009575  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009580	SUP	HCPCS C1713		55890009580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009585	SUP	HCPCS C1713		55890009585  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009590	SUP	HCPCS C1713		55890009590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55890009595	SUP	HCPCS C1713		55890009595  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
60181210100	SUP	Custom 27203010		ADAPTER TRNQT 36IN DUAL EXTN CPC CONNCTR STRL LF	BOTH IP/OP	$50.83 	$37.61	$0.00	$40.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.41	$40.26	$40.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60707010400	SUP	Custom 27203010		60707010400  -  CUFF TRNQT 24X4IN 2 PORT 1 BLDR W/O SLV ATS STRL LATEX FREE	BOTH IP/OP	$73.39 	$54.31	$0.00	$58.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.47	$54.47	$0.00	$0.00	$15.29	$0.00	$0.00	$0.00	$0.00	$36.69	$58.12	$58.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60707010500	SUP	Custom 27203010		60707010500  -  CUFF TRNQT 30X4IN 2 PORT 1 BLDR W/O SLV ATS STRL LATEX FREE	BOTH IP/OP	$78.02 	$57.73	$0.00	$62.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.91	$57.91	$0.00	$0.00	$16.26	$0.00	$0.00	$0.00	$0.00	$39.01	$61.79	$62.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60707010600	SUP	Custom 27203010		60707010600  -  CUFF TRNQT 34X4IN 2 PORT 1 BLDR W/O SLV ATS STRL LATEX FREE	BOTH IP/OP	$84.46 	$62.50	$0.00	$67.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.69	$62.69	$0.00	$0.00	$17.60	$0.00	$0.00	$0.00	$0.00	$42.23	$66.89	$67.57	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60707010700	SUP	Custom 27203010		60707010700  -  CUFF TRNQT CYL 42X4IN RUBY STRL LF ATS 3K 2 PORT BLDR POS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$0.00	$0.00	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9.89803E+11	SUP	Custom 27203010		989803104341  -  TUBING MONITR SMALL STATURE 10FT NIBP LATEX FREE REUSABLE	BOTH IP/OP	$252.17 	$186.61	$0.00	$187.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.16	$187.16	$0.00	$0.00	$52.55	$0.00	$0.00	$0.00	$0.00	$62.16	$98.45	$99.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0.8P8	SUP	Custom 27803010		0.8P8  -  PATCH VASCULAR 8X.8CM BIOLOGIC XENOSURE THK.45MM TAPER	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
00-0114-006-00	SUP	Custom 27203010		00-0114-006-00  -  HOLDER PIN 3/16IN 21X11CM LF BHLR-STNM THB SCR SS SKL TRX	BOTH IP/OP	$442.00 	$327.08	$0.00	$353.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.05	$328.05	$0.00	$0.00	$92.11	$0.00	$0.00	$0.00	$0.00	$221.00	$350.06	$353.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
000-2090	SUP	HCPCS C1781		000-2090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,277.13 "	$945.08	$0.00	"$1,021.70"	$574.71	$574.71	$0.00	$0.00	$0.00	$266.18	$947.88	$947.88	$0.00	$0.00	$266.15	$0.00	$755.42	$755.42	$0.00	$638.56	"$1,011.49"	"$1,021.70"	$0.00		$0.00	$199.87	$0.00	$0.00	$203.32	$0.00	$0.00	$0.00	$0.00	$0.00
00085-4602-02	SUP	HCPCS C2626		00085-4602-02  -  SCREW SYSTEM INSPIREASE DRUG DELIVERY EA	BOTH IP/OP	$111.93 	$82.83	$0.00	$89.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.07	$83.07	$0.00	$0.00	$23.33	$0.00	$0.00	$0.00	$0.00	$55.97	$88.65	$89.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0010DTR	SUP	Custom 27203010		BAG LNDR RD 38X38IN DRAWTAPE 40GL	BOTH IP/OP	$1.40 	$1.04	$0.00	$1.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.70	$1.11	$1.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
00208-00	SUP	Custom 27203010		ASSEMBLY ANTICOAGULATION/ASPIRATION TUBING FOR CELL SAVER PA	BOTH IP/OP	$63.38 	$46.90	$0.00	$50.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.04	$47.04	$0.00	$0.00	$13.21	$0.00	$0.00	$0.00	$0.00	$31.69	$50.20	$50.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
00-2348-010-35	SUP	HCPCS C1713		00-2348-010-35  -  SCREW BONE 3.5MM 10MM SS 2.7MM HEAD CORT PERIART SLFTAP	BOTH IP/OP	$74.75 	$55.32	$0.00	$59.80	$33.64	$33.64	$0.00	$0.00	$0.00	$15.58	$55.48	$55.48	$0.00	$0.00	$15.58	$0.00	$44.21	$44.21	$0.00	$37.38	$59.20	$59.80	$0.00		$0.00	$11.70	$0.00	$0.00	$11.90	$0.00	$0.00	$0.00	$0.00	$0.00
00-2348-012-35	SUP	HCPCS C1713		00-2348-012-35  -  SCREW BONE 3.5MM 2.7MM 12MM SS 2.7MM HEAD PERIART SLFTAP	BOTH IP/OP	$74.75 	$55.32	$0.00	$59.80	$33.64	$33.64	$0.00	$0.00	$0.00	$15.58	$55.48	$55.48	$0.00	$0.00	$15.58	$0.00	$44.21	$44.21	$0.00	$37.38	$59.20	$59.80	$0.00		$0.00	$11.70	$0.00	$0.00	$11.90	$0.00	$0.00	$0.00	$0.00	$0.00
00-2348-014-35	SUP	HCPCS C1713		00-2348-014-35  -  SCREW BONE 3.5MM 2.7MM 14MM SS 2.7MM HEAD CORT PERIART	BOTH IP/OP	$74.75 	$55.32	$0.00	$59.80	$33.64	$33.64	$0.00	$0.00	$0.00	$15.58	$55.48	$55.48	$0.00	$0.00	$15.58	$0.00	$44.21	$44.21	$0.00	$37.38	$59.20	$59.80	$0.00		$0.00	$11.70	$0.00	$0.00	$11.90	$0.00	$0.00	$0.00	$0.00	$0.00
00-2348-016-35	SUP	HCPCS C1713		00-2348-016-35  -  SCREW BONE 3.5MM 2.7MM 16MM SS 2.7MM HEAD CORT PERIART	BOTH IP/OP	$74.75 	$55.32	$0.00	$59.80	$33.64	$33.64	$0.00	$0.00	$0.00	$15.58	$55.48	$55.48	$0.00	$0.00	$15.58	$0.00	$44.21	$44.21	$0.00	$37.38	$59.20	$59.80	$0.00		$0.00	$11.70	$0.00	$0.00	$11.90	$0.00	$0.00	$0.00	$0.00	$0.00
00-2348-018-35	SUP	HCPCS C1713		00-2348-018-35  -  SCREW BONE 3.5MM 2.7MM 18MM SS 2.7MM HEAD CORT PERIART	BOTH IP/OP	$74.75 	$55.32	$0.00	$59.80	$33.64	$33.64	$0.00	$0.00	$0.00	$15.58	$55.48	$55.48	$0.00	$0.00	$15.58	$0.00	$44.21	$44.21	$0.00	$37.38	$59.20	$59.80	$0.00		$0.00	$11.70	$0.00	$0.00	$11.90	$0.00	$0.00	$0.00	$0.00	$0.00
00-2348-020-35	SUP	HCPCS C1713		00-2348-020-35  -  SCREW BONE 3.5MM 2.7MM 20MM SS 2.7MM HEAD CORT PERIART	BOTH IP/OP	$74.75 	$55.32	$0.00	$59.80	$33.64	$33.64	$0.00	$0.00	$0.00	$15.58	$55.48	$55.48	$0.00	$0.00	$15.58	$0.00	$44.21	$44.21	$0.00	$37.38	$59.20	$59.80	$0.00		$0.00	$11.70	$0.00	$0.00	$11.90	$0.00	$0.00	$0.00	$0.00	$0.00
00-2348-022-35	SUP	HCPCS C1713		00-2348-022-35  -  SCREW BONE 3.5MM 2.7MM 22MM SS 2.7MM HEAD CORT PERIART	BOTH IP/OP	$74.75 	$55.32	$0.00	$59.80	$33.64	$33.64	$0.00	$0.00	$0.00	$15.58	$55.48	$55.48	$0.00	$0.00	$15.58	$0.00	$44.21	$44.21	$0.00	$37.38	$59.20	$59.80	$0.00		$0.00	$11.70	$0.00	$0.00	$11.90	$0.00	$0.00	$0.00	$0.00	$0.00
00-2348-026-35	SUP	HCPCS C1713		00-2348-026-35  -  SCREW BONE 3.5MM 2.7MM 26MM SS 2.7MM HEAD CORT PERIART	BOTH IP/OP	$74.75 	$55.32	$0.00	$59.80	$33.64	$33.64	$0.00	$0.00	$0.00	$15.58	$55.48	$55.48	$0.00	$0.00	$15.58	$0.00	$44.21	$44.21	$0.00	$37.38	$59.20	$59.80	$0.00		$0.00	$11.70	$0.00	$0.00	$11.90	$0.00	$0.00	$0.00	$0.00	$0.00
00-2357-017-04	SUP	HCPCS C1713		00-2357-017-04  -  PLATE 80MM 4 HOLE LCK BONE RIGHT DISTAL LAT FIB	BOTH IP/OP	"$1,378.00 "	"$1,019.72"	$0.00	"$1,102.40"	$620.10	$620.10	$0.00	$0.00	$0.00	$287.21	"$1,022.75"	"$1,022.75"	$0.00	$0.00	$287.18	$0.00	$815.09	$815.09	$0.00	$689.00	"$1,091.38"	"$1,102.40"	$0.00		$0.00	$215.66	$0.00	$0.00	$219.38	$0.00	$0.00	$0.00	$0.00	$0.00
00-2357-017-06	SUP	HCPCS C1713		00-2357-017-06  -  PLATE 106MM 6 HOLE LCK BONE RIGHT DISTAL LAT FIB	BOTH IP/OP	"$1,478.75 "	"$1,094.28"	$0.00	"$1,183.00"	$665.44	$665.44	$0.00	$0.00	$0.00	$308.21	"$1,097.53"	"$1,097.53"	$0.00	$0.00	$308.17	$0.00	$874.68	$874.68	$0.00	$739.38	"$1,171.17"	"$1,183.00"	$0.00		$0.00	$231.42	$0.00	$0.00	$235.42	$0.00	$0.00	$0.00	$0.00	$0.00
00-2357-017-08	SUP	HCPCS C1713		00-2357-017-08  -  PLATE 132MM 8 HOLE LCK BONE RL DISTAL FIB	BOTH IP/OP	"$1,579.50 "	"$1,168.83"	$0.00	"$1,263.60"	$710.78	$710.78	$0.00	$0.00	$0.00	$329.21	"$1,172.30"	"$1,172.30"	$0.00	$0.00	$329.17	$0.00	$934.27	$934.27	$0.00	$789.75	"$1,250.96"	"$1,263.60"	$0.00		$0.00	$247.19	$0.00	$0.00	$251.46	$0.00	$0.00	$0.00	$0.00	$0.00
00-2357-018-04	SUP	HCPCS C1713		00-2357-018-04  -  PLATE 40 HOLE BONE RIGHT FIB	BOTH IP/OP	"$1,378.00 "	"$1,019.72"	$0.00	"$1,102.40"	$620.10	$620.10	$0.00	$0.00	$0.00	$287.21	"$1,022.75"	"$1,022.75"	$0.00	$0.00	$287.18	$0.00	$815.09	$815.09	$0.00	$689.00	"$1,091.38"	"$1,102.40"	$0.00		$0.00	$215.66	$0.00	$0.00	$219.38	$0.00	$0.00	$0.00	$0.00	$0.00
00-2357-018-06	SUP	HCPCS C1713		00-2357-018-06  -  PLATE 106MM 6 HOLE LCK BONE LEFT DISTAL LAT FIB	BOTH IP/OP	"$1,478.75 "	"$1,094.28"	$0.00	"$1,183.00"	$665.44	$665.44	$0.00	$0.00	$0.00	$308.21	"$1,097.53"	"$1,097.53"	$0.00	$0.00	$308.17	$0.00	$874.68	$874.68	$0.00	$739.38	"$1,171.17"	"$1,183.00"	$0.00		$0.00	$231.42	$0.00	$0.00	$235.42	$0.00	$0.00	$0.00	$0.00	$0.00
00-2359-012-38	SUP	HCPCS C1713		00-2359-012-38  -  SCREW BONE 3.5MM 2.7MM 12MM SS PERIART LCK HEAD NONSTRL	BOTH IP/OP	$201.50 	$149.11	$0.00	$161.20	$90.68	$90.68	$0.00	$0.00	$0.00	$42.00	$149.55	$149.55	$0.00	$0.00	$41.99	$0.00	$119.19	$119.19	$0.00	$100.75	$159.59	$161.20	$0.00		$0.00	$31.53	$0.00	$0.00	$32.08	$0.00	$0.00	$0.00	$0.00	$0.00
00-2359-014-38	SUP	HCPCS C1713		00-2359-014-38  -  SCREW BONE 3.5MM 2.7MM 14MM SS PERIART LCK NONSTRL	BOTH IP/OP	$201.50 	$149.11	$0.00	$161.20	$90.68	$90.68	$0.00	$0.00	$0.00	$42.00	$149.55	$149.55	$0.00	$0.00	$41.99	$0.00	$119.19	$119.19	$0.00	$100.75	$159.59	$161.20	$0.00		$0.00	$31.53	$0.00	$0.00	$32.08	$0.00	$0.00	$0.00	$0.00	$0.00
00-2359-016-26	SUP	HCPCS C1713		00-2359-016-26  -  SCREW BONE 2.7MM 16MM SS CONICAL NONSTRL	BOTH IP/OP	$113.75 	$84.18	$0.00	$91.00	$51.19	$51.19	$0.00	$0.00	$0.00	$23.71	$84.43	$84.43	$0.00	$0.00	$23.71	$0.00	$67.28	$67.28	$0.00	$56.88	$90.09	$91.00	$0.00		$0.00	$17.80	$0.00	$0.00	$18.11	$0.00	$0.00	$0.00	$0.00	$0.00
00-2359-016-38	SUP	HCPCS C1713		00-2359-016-38  -  SCREW BONE 3.5MM 2.7MM 16MM SS PERIART LCK NONSTRL	BOTH IP/OP	$201.50 	$149.11	$0.00	$161.20	$90.68	$90.68	$0.00	$0.00	$0.00	$42.00	$149.55	$149.55	$0.00	$0.00	$41.99	$0.00	$119.19	$119.19	$0.00	$100.75	$159.59	$161.20	$0.00		$0.00	$31.53	$0.00	$0.00	$32.08	$0.00	$0.00	$0.00	$0.00	$0.00
00-2359-018-35	SUP	HCPCS C1713		00-2359-018-35  -  SCREW BONE 3.5MM 18MM SS PERIART LCK NONSTRL	BOTH IP/OP	$217.75 	$161.14	$0.00	$174.20	$97.99	$97.99	$0.00	$0.00	$0.00	$45.38	$161.61	$161.61	$0.00	$0.00	$45.38	$0.00	$128.80	$128.80	$0.00	$108.88	$172.46	$174.20	$0.00		$0.00	$34.08	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$0.00
00-2359-018-38	SUP	HCPCS C1713		00-2359-018-38  -  SCREW BONE 3.5MM 2.7MM 18MM SS 2.7MM HEAD PERIART LCK	BOTH IP/OP	$201.50 	$149.11	$0.00	$161.20	$90.68	$90.68	$0.00	$0.00	$0.00	$42.00	$149.55	$149.55	$0.00	$0.00	$41.99	$0.00	$119.19	$119.19	$0.00	$100.75	$159.59	$161.20	$0.00		$0.00	$31.53	$0.00	$0.00	$32.08	$0.00	$0.00	$0.00	$0.00	$0.00
00-2359-040-35	SUP	HCPCS C1713		00-2359-040-35  -  SCREW BONE 3.5MM 40MM PRLC SS PERIART LCK NCLNLT NONSTRL PLT	BOTH IP/OP	$217.75 	$161.14	$0.00	$174.20	$97.99	$97.99	$0.00	$0.00	$0.00	$45.38	$161.61	$161.61	$0.00	$0.00	$45.38	$0.00	$128.80	$128.80	$0.00	$108.88	$172.46	$174.20	$0.00		$0.00	$34.08	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$0.00
00-2359-044-35	SUP	HCPCS C1713		00-2359-044-35  -  SCREW BONE 3.5MM 44MM SS PERIART LCK NCLNLT NONSTRL PLT SYS	BOTH IP/OP	$217.75 	$161.14	$0.00	$174.20	$97.99	$97.99	$0.00	$0.00	$0.00	$45.38	$161.61	$161.61	$0.00	$0.00	$45.38	$0.00	$128.80	$128.80	$0.00	$108.88	$172.46	$174.20	$0.00		$0.00	$34.08	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$0.00
00-2359-046-35	SUP	HCPCS C1713		00-2359-046-35  -  SCREW BONE 3.5MM 46MM SS PERIART NON CANN LCK NONSTRL PLT	BOTH IP/OP	$217.75 	$161.14	$0.00	$174.20	$97.99	$97.99	$0.00	$0.00	$0.00	$45.38	$161.61	$161.61	$0.00	$0.00	$45.38	$0.00	$128.80	$128.80	$0.00	$108.88	$172.46	$174.20	$0.00		$0.00	$34.08	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$0.00
00-2359-048-35	SUP	HCPCS C1713		00-2359-048-35  -  SCREW BONE 3.5MM 48MM SS PERIART NCLNLT LCK NONSTRL PLT SYS	BOTH IP/OP	$217.75 	$161.14	$0.00	$174.20	$97.99	$97.99	$0.00	$0.00	$0.00	$45.38	$161.61	$161.61	$0.00	$0.00	$45.38	$0.00	$128.80	$128.80	$0.00	$108.88	$172.46	$174.20	$0.00		$0.00	$34.08	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$0.00
00-2359-050-37	SUP	HCPCS C1713		00-2359-050-37  -  SCREW BONE 3.5MM 50MM PRLC SS PERIART CANN CONICAL LCK	BOTH IP/OP	$191.75 	$141.90	$0.00	$153.40	$86.29	$86.29	$0.00	$0.00	$0.00	$39.97	$142.32	$142.32	$0.00	$0.00	$39.96	$0.00	$113.42	$113.42	$0.00	$95.88	$151.87	$153.40	$0.00		$0.00	$30.01	$0.00	$0.00	$30.53	$0.00	$0.00	$0.00	$0.00	$0.00
00-2410-029-00	SUP	Custom 27203010		00-2410-029-00  -  BIT DRL 2.5MM 220MM QCK CNCT	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
00-2490-012-30	SUP	HCPCS C1713		00-2490-012-30  -  PIN EXFIX 305MM 3MM NTR NAIL THRD	BOTH IP/OP	$211.25 	$156.33	$0.00	$169.00	$95.06	$95.06	$0.00	$0.00	$0.00	$44.03	$156.79	$156.79	$0.00	$0.00	$44.02	$0.00	$124.95	$124.95	$0.00	$105.63	$167.31	$169.00	$0.00		$0.00	$33.06	$0.00	$0.00	$33.63	$0.00	$0.00	$0.00	$0.00	$0.00
00-2490-034-49	SUP	Custom 27203010		00-2490-034-49  -  DRILL SRG 4.9MM RTRGD CLBRT FEM	BOTH IP/OP	$955.50 	$707.07	$0.00	$764.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$709.17	$709.17	$0.00	$0.00	$199.13	$0.00	$0.00	$0.00	$0.00	$477.75	$756.76	$764.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
00-2490-046-30	SUP	HCPCS C1713		00-2490-046-30  -  PIN 3MM NTR NAIL THRD STD IM NAIL	BOTH IP/OP	$227.50 	$168.35	$0.00	$182.00	$102.38	$102.38	$0.00	$0.00	$0.00	$47.42	$168.85	$168.85	$0.00	$0.00	$47.41	$0.00	$134.57	$134.57	$0.00	$113.75	$180.18	$182.00	$0.00		$0.00	$35.60	$0.00	$0.00	$36.22	$0.00	$0.00	$0.00	$0.00	$0.00
00-2490-047-30	SUP	HCPCS C1713		00-2490-047-30  -  PIN FIX 355MM 3MM NTR NAIL NTHRD	BOTH IP/OP	$253.50 	$187.59	$0.00	$202.80	$114.08	$114.08	$0.00	$0.00	$0.00	$52.84	$188.15	$188.15	$0.00	$0.00	$52.83	$0.00	$149.95	$149.95	$0.00	$126.75	$200.77	$202.80	$0.00		$0.00	$39.67	$0.00	$0.00	$40.36	$0.00	$0.00	$0.00	$0.00	$0.00
00-4806-100-20	SUP	Custom 27203010		00-4806-100-20  -  BIT DRL 2MM 100MM QCK CNCT	BOTH IP/OP	$139.75 	$103.42	$0.00	$111.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.72	$103.72	$0.00	$0.00	$29.12	$0.00	$0.00	$0.00	$0.00	$69.88	$110.68	$111.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
00-4806-110-25	SUP	Custom 27203010		00-4806-110-25  -  BIT DRL 2.5MM 110MM QCK CNCT	BOTH IP/OP	$139.75 	$103.42	$0.00	$111.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.72	$103.72	$0.00	$0.00	$29.12	$0.00	$0.00	$0.00	$0.00	$69.88	$110.68	$111.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
00-4806-110-35	SUP	Custom 27203010		00-4806-110-35  -  BIT DRL 3.5MM	BOTH IP/OP	$139.75 	$103.42	$0.00	$111.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.72	$103.72	$0.00	$0.00	$29.12	$0.00	$0.00	$0.00	$0.00	$69.88	$110.68	$111.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
00-4827-020-01	SUP	HCPCS C1713		00-4827-020-01  -  SCREW BONE 2.7MM 20MM ZPS SS SM CORT SLFTAP SM HEX RECESS	BOTH IP/OP	$45.50 	$33.67	$0.00	$36.40	$20.48	$20.48	$0.00	$0.00	$0.00	$9.48	$33.77	$33.77	$0.00	$0.00	$9.48	$0.00	$26.91	$26.91	$0.00	$22.75	$36.04	$36.40	$0.00		$0.00	$7.12	$0.00	$0.00	$7.24	$0.00	$0.00	$0.00	$0.00	$0.00
00-4828-012-02	SUP	HCPCS C1713		00-4828-012-02  -  SCREW BONE 2.7MM 12MM SS UNV LCK NONSTRL	BOTH IP/OP	$217.75 	$161.14	$0.00	$174.20	$97.99	$97.99	$0.00	$0.00	$0.00	$45.38	$161.61	$161.61	$0.00	$0.00	$45.38	$0.00	$128.80	$128.80	$0.00	$108.88	$172.46	$174.20	$0.00		$0.00	$34.08	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$0.00
00-4828-014-02	SUP	HCPCS C1713		00-4828-014-02  -  SCREW BONE 2.7MM 14MM SS UNV LCK NONSTRL	BOTH IP/OP	$217.75 	$161.14	$0.00	$174.20	$97.99	$97.99	$0.00	$0.00	$0.00	$45.38	$161.61	$161.61	$0.00	$0.00	$45.38	$0.00	$128.80	$128.80	$0.00	$108.88	$172.46	$174.20	$0.00		$0.00	$34.08	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$0.00
00-4828-016-02	SUP	HCPCS C1713		00-4828-016-02  -  SCREW BONE 2.7MM 16MM ORTH	BOTH IP/OP	$217.75 	$161.14	$0.00	$174.20	$97.99	$97.99	$0.00	$0.00	$0.00	$45.38	$161.61	$161.61	$0.00	$0.00	$45.38	$0.00	$128.80	$128.80	$0.00	$108.88	$172.46	$174.20	$0.00		$0.00	$34.08	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$0.00
00-4828-018-02	SUP	HCPCS C1713		00-4828-018-02  -  SCREW BONE 2.7MM 18MM SS UNV LCK NONSTRL	BOTH IP/OP	$217.75 	$161.14	$0.00	$174.20	$97.99	$97.99	$0.00	$0.00	$0.00	$45.38	$161.61	$161.61	$0.00	$0.00	$45.38	$0.00	$128.80	$128.80	$0.00	$108.88	$172.46	$174.20	$0.00		$0.00	$34.08	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$0.00
00-4828-020-02	SUP	HCPCS C1713		00-4828-020-02  -  SCREW BONE 2.7MM 20MM SS UNV PERIART ELB LCK NONSTRL	BOTH IP/OP	$217.75 	$161.14	$0.00	$174.20	$97.99	$97.99	$0.00	$0.00	$0.00	$45.38	$161.61	$161.61	$0.00	$0.00	$45.38	$0.00	$128.80	$128.80	$0.00	$108.88	$172.46	$174.20	$0.00		$0.00	$34.08	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$0.00
00-4835-016-01	SUP	HCPCS C1713		00-4835-016-01  -  SCREW BONE 3.5MM 16MM ZPS SS SM CORT SLFTAP SM HEX RECESS	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$10.84	$38.59	$38.59	$0.00	$0.00	$10.84	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$8.14	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
00-4835-018-01	SUP	HCPCS C1713		00-4835-018-01  -  SCREW BONE 3.5MM 18MM ZPS SS LNG CORT SLFTAP SM HEX RECESS	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$10.84	$38.59	$38.59	$0.00	$0.00	$10.84	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$8.14	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
00-4835-026-01	SUP	HCPCS C1713		00-4835-026-01  -  SCREW BONE 3.5MM 26MM ZPS SS CORT SLFTAP SM HEX RECESS	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$10.84	$38.59	$38.59	$0.00	$0.00	$10.84	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$8.14	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
00-4835-040-01	SUP	HCPCS C1713		00-4835-040-01  -  SCREW BONE 3.5MM 40MM ZPS SS CORT SLFTAP SM HEX RECESS SM	BOTH IP/OP	$52.00 	$38.48	$0.00	$41.60	$23.40	$23.40	$0.00	$0.00	$0.00	$10.84	$38.59	$38.59	$0.00	$0.00	$10.84	$0.00	$30.76	$30.76	$0.00	$26.00	$41.18	$41.60	$0.00		$0.00	$8.14	$0.00	$0.00	$8.28	$0.00	$0.00	$0.00	$0.00	$0.00
00-4840-040-00	SUP	HCPCS C1713		00-4840-040-00  -  SCREW BONE 4MM 40MM 14MM ZPS SS PTHRD CANC SM HEX RECESS	BOTH IP/OP	$42.25 	$31.27	$0.00	$33.80	$19.01	$19.01	$0.00	$0.00	$0.00	$8.81	$31.36	$31.36	$0.00	$0.00	$8.80	$0.00	$24.99	$24.99	$0.00	$21.13	$33.46	$33.80	$0.00		$0.00	$6.61	$0.00	$0.00	$6.73	$0.00	$0.00	$0.00	$0.00	$0.00
00-4840-050-00	SUP	HCPCS C1713		00-4840-050-00  -  SCREW BONE 4MM 50MM ZPS SS FULTHD CANC SM HEX RECESS NONSTRL	BOTH IP/OP	$42.25 	$31.27	$0.00	$33.80	$19.01	$19.01	$0.00	$0.00	$0.00	$8.81	$31.36	$31.36	$0.00	$0.00	$8.80	$0.00	$24.99	$24.99	$0.00	$21.13	$33.46	$33.80	$0.00		$0.00	$6.61	$0.00	$0.00	$6.73	$0.00	$0.00	$0.00	$0.00	$0.00
00-4840-050-01	SUP	HCPCS C1713		00-4840-050-01  -  SCREW BONE 4MM 15MM ZPS SS CANC PTTHRD SM HEX RECESS FRAG	BOTH IP/OP	$42.25 	$31.27	$0.00	$33.80	$19.01	$19.01	$0.00	$0.00	$0.00	$8.81	$31.36	$31.36	$0.00	$0.00	$8.80	$0.00	$24.99	$24.99	$0.00	$21.13	$33.46	$33.80	$0.00		$0.00	$6.61	$0.00	$0.00	$6.73	$0.00	$0.00	$0.00	$0.00	$0.00
00-4901-016-15	SUP	Custom 27203010		00-4901-016-15  -  WIRE 1.6MM .063IN 15.2CM KWIRE ZPS SS 1 END TROCAR PNT	BOTH IP/OP	$16.58 	$12.27	$0.00	$13.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.30	$12.30	$0.00	$0.00	$3.45	$0.00	$0.00	$0.00	$0.00	$8.29	$13.13	$13.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
005280-901	SUP	Custom 27203010		005280-901  -  LGTR 8MM FRNG FLLPN TUBE BAND STRL DISP ENDSCP LATEX FREE	BOTH IP/OP	$36.09 	$26.71	$0.00	$28.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.79	$26.79	$0.00	$0.00	$7.52	$0.00	$0.00	$0.00	$0.00	$18.05	$28.58	$28.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
00-6202-066-20	SUP	HCPCS C1776		00-6202-066-20  -  SHELL ACETAB 66MM HIP MLHL PRIM MDLR REV TRB MTL STRL	BOTH IP/OP	"$7,315.00 "	"$5,413.10"	$0.00	"$5,852.00"	"$3,291.75"	"$3,291.75"	$0.00	$0.00	$0.00	"$1,524.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,524.45"	$0.00	"$3,606.30"	"$3,606.30"	$0.00	"$3,657.50"	"$5,793.48"	"$5,852.00"	$0.00		$0.00	"$1,144.80"	$0.00	$0.00	"$1,164.55"	$0.00	$0.00	$0.00	$0.00	$0.00
00-6250-65-20	SUP	HCPCS C1713		00-6250-65-20  -  SCREW BN 6.5MM 20MM TRLG ST	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
00-6250-65-35	SUP	HCPCS C1713		00-6250-65-35  -  SCREW BN 6.5MM 35MM TRLG ST	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
00-6334-050-28	SUP	HCPCS C1776		00-6334-050-28  -  LINER ACETAB TRLG 8.3MM 50/52/54MM 28MM LNGVT HIP	BOTH IP/OP	"$14,925.00 "	"$11,044.50"	$0.00	"$11,940.00"	"$6,716.25"	"$6,716.25"	$0.00	$0.00	$0.00	"$3,110.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,110.37"	$0.00	"$7,358.03"	"$7,358.03"	$0.00	"$7,462.50"	"$11,820.60"	"$11,940.00"	$0.00		$0.00	"$2,335.76"	$0.00	$0.00	"$2,376.06"	$0.00	$0.00	$0.00	$0.00	$0.00
00-7708-000-10	SUP	Custom 27203010		00-7708-000-10  -  CRR GFT 8IN SKIN PVC BRD CRR STRL LATEX FREE	BOTH IP/OP	$67.79 	$50.16	$0.00	$54.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.31	$50.31	$0.00	$0.00	$14.13	$0.00	$0.00	$0.00	$0.00	$33.89	$53.69	$54.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
008556P	SUP	HCPCS C1733		008556P  -  CATHETER EP 5FR 110CM BP TEMP PCNG BLN FLW AST	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
01-0001-S	SUP	Custom 27803010		01-0001-S  -  CBL SLV ORTH 850MM 2MM HIP COCR SET STRL	BOTH IP/OP	"$1,047.50 "	$775.15	$0.00	$838.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.45	$777.45	$0.00	$0.00	$218.30	$0.00	$0.00	$0.00	$0.00	$523.75	$829.62	$838.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
01-0002-S	SUP	Custom 27203010		01-0002-S  -  SLEEVE CABLE 850MM 1.6MM ORTH COCR STRL	BOTH IP/OP	"$1,047.50 "	$775.15	$0.00	$838.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.45	$777.45	$0.00	$0.00	$218.30	$0.00	$0.00	$0.00	$0.00	$523.75	$829.62	$838.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
01-0011-S	SUP	Custom 27803010		01-0011-S  -  CABLE ORTH COCR 2MM 850MM	BOTH IP/OP	$715.00 	$529.10	$0.00	$572.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$530.67	$530.67	$0.00	$0.00	$149.01	$0.00	$0.00	$0.00	$0.00	$357.50	$566.28	$572.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
01-0012-S	SUP	Custom 27803010		01-0012-S  -  CABLE ORTH COCR 1.6MM 850MM STRL	BOTH IP/OP	$715.00 	$529.10	$0.00	$572.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$530.67	$530.67	$0.00	$0.00	$149.01	$0.00	$0.00	$0.00	$0.00	$357.50	$566.28	$572.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
01-0013-S	SUP	Custom 27203010		01-0013-S  -  SLEEVE CABLE 2MM COCR STRL	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$0.00	$0.00	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
01-0014-S	SUP	Custom 27203010		01-0014-S  -  SLEEVE CABLE 1.6MM COCR STRL	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$0.00	$0.00	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
01-0020-S	SUP	Custom 27203010		01-0020-S  -  SLEEVE CABLE 850MM 2MM SS STRL	BOTH IP/OP	"$1,047.50 "	$775.15	$0.00	$838.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.45	$777.45	$0.00	$0.00	$218.30	$0.00	$0.00	$0.00	$0.00	$523.75	$829.62	$838.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
01-0022-S	SUP	Custom 27203010		01-0022-S  -  SLEEVE CMPR SS 2MM	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$0.00	$0.00	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
010-0604	SUP	Custom 27203010		010-0604  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$225.25 	$166.69	$0.00	$180.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.18	$167.18	$0.00	$0.00	$46.94	$0.00	$0.00	$0.00	$0.00	$112.63	$178.40	$180.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
010-0806	SUP	Custom 27203010		010-0806  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$272.00 	$201.28	$0.00	$217.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.88	$201.88	$0.00	$0.00	$56.68	$0.00	$0.00	$0.00	$0.00	$136.00	$215.42	$217.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
010-103L	SUP	HCPCS C1713		010-103L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
010-103R	SUP	HCPCS C1713		010-103R  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
010-2001-5	SUP	HCPCS C1781		010-2001-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,606.50 "	"$1,188.81"	$0.00	"$1,285.20"	$722.93	$722.93	$0.00	$0.00	$0.00	$334.83	"$1,192.34"	"$1,192.34"	$0.00	$0.00	$334.79	$0.00	$950.24	$950.24	$0.00	$803.25	"$1,272.35"	"$1,285.20"	$0.00		$0.00	$251.42	$0.00	$0.00	$255.75	$0.00	$0.00	$0.00	$0.00	$0.00
010-2010	SUP	HCPCS C1781		010-2010  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,115.63 "	$825.57	$0.00	$892.50	$502.03	$502.03	$0.00	$0.00	$0.00	$232.52	$828.02	$828.02	$0.00	$0.00	$232.50	$0.00	$659.89	$659.89	$0.00	$557.81	$883.58	$892.50	$0.00		$0.00	$174.60	$0.00	$0.00	$177.61	$0.00	$0.00	$0.00	$0.00	$0.00
010-234	SUP	HCPCS C1713		010-234  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
01-02950	SUP	Custom 27803010		01-02950  -  BAR ARCH 5IN ERICH SS FACE FX	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.12	$24.12	$0.00	$0.00	$6.77	$0.00	$0.00	$0.00	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
01-0298	SUP	HCPCS C1713		01-0298  -  BAR ARCH PREFORM OMNIMAX MMF SYSTEM	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
01-0299	SUP	Custom 27203010		01-0299  -  BAR ARCH 1MR ROLL WIRE INSTR ERICH	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0102L12	SUP	HCPCS C1729		0102L12  -  CATHETER URETHRAL 12FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE	BOTH IP/OP	$25.13 	$18.60	$0.00	$20.40	$13.85	$13.85	$0.00	$0.00	$0.00	$5.24	$18.65	$18.65	$0.00	$0.00	$5.24	$0.00	$14.86	$14.86	$0.00	$12.75	$20.20	$20.40	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
0102L14	SUP	HCPCS C1729		0102L14  -  CATH URTH BDX LBR 14FR FOLEY 2W CDE RADIOPQ DDRGL 5ML STRL	BOTH IP/OP	$25.75 	$19.06	$0.00	$20.92	$14.20	$14.20	$0.00	$0.00	$0.00	$5.24	$18.65	$18.65	$0.00	$0.00	$5.24	$0.00	$14.86	$14.86	$0.00	$13.07	$20.71	$20.92	$0.00		$0.00	$4.09	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$0.00
0102L16	SUP	HCPCS C1729		0102L16  -  CATH URTH BDX LBR 16FR FOLEY 2W CDE 1 EYE DDRGL 5ML STRL	BOTH IP/OP	$26.15 	$19.35	$0.00	$20.92	$14.20	$14.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.07	$20.71	$20.92	$0.00		$0.00	$4.09	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$0.00
0102L18	SUP	HCPCS C1729		0102L18  -  CATH URTH BDX LBR 18FR FOLEY 2W CDE RADIOPQ DDRGL 5ML STRL	BOTH IP/OP	$25.13 	$18.60	$0.00	$20.92	$14.20	$14.20	$0.00	$0.00	$0.00	$5.24	$18.65	$18.65	$0.00	$0.00	$5.24	$0.00	$14.86	$14.86	$0.00	$13.07	$20.70	$20.92	$0.00		$0.00	$4.09	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$0.00
0102L20	SUP	HCPCS C1729		0102L20  -  CATH URTH BDX LBR 20FR FOLEY 2W CDE 1 EYE DDRGL 5ML STRL	BOTH IP/OP	$25.75 	$19.06	$0.00	$20.92	$14.20	$14.20	$0.00	$0.00	$0.00	$5.24	$18.65	$18.65	$0.00	$0.00	$5.24	$0.00	$14.86	$14.86	$0.00	$13.07	$20.70	$20.92	$0.00		$0.00	$4.09	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$0.00
0102L22	SUP	Custom 27203010		0102L22  -  CATHETER URETHRAL 22FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE	BOTH IP/OP	$25.13 	$18.60	$0.00	$20.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.65	$18.65	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$12.56	$19.90	$20.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0102L24	SUP	Custom 27203010		0102L24  -  CATHETER URETHRAL 24FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE	BOTH IP/OP	$25.13 	$18.60	$0.00	$20.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.65	$18.65	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$12.56	$19.90	$20.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0102SI16	SUP	Custom 27203010		0102SI16  -  CATHETER URTH 16FR 5CC RD STRL LTX BDX IC 2W FL MED OLV CDE	BOTH IP/OP	$35.13 	$26.00	$0.00	$28.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.07	$26.07	$0.00	$0.00	$7.32	$0.00	$0.00	$0.00	$0.00	$17.56	$27.82	$28.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0102SI18	SUP	Custom 27203010		0102SI18  -  CATHETER URTH 18FR 5CC RD STRL LTX BDX IC 2W FL MED OLV CDE	BOTH IP/OP	$35.13 	$26.00	$0.00	$28.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.07	$26.07	$0.00	$0.00	$7.32	$0.00	$0.00	$0.00	$0.00	$17.56	$27.82	$28.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0102SI20	SUP	Custom 27203010		0102SI20  -  CATHETER URTH 20FR 5CC RD STRL LTX BDX IC 2W FL INFCT CNTRL	BOTH IP/OP	$35.13 	$26.00	$0.00	$28.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.07	$26.07	$0.00	$0.00	$7.32	$0.00	$0.00	$0.00	$0.00	$17.56	$27.82	$28.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0102SI22	SUP	Custom 27203010		0102SI22  -  CATHETER URTH 22FR 5CC RD STRL LTX BDX IC 2W FL MED OLV CDE	BOTH IP/OP	$35.13 	$26.00	$0.00	$28.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.07	$26.07	$0.00	$0.00	$7.32	$0.00	$0.00	$0.00	$0.00	$17.56	$27.82	$28.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0102SI24	SUP	Custom 27203010		0102SI24  -  CATHETER URTH 24FR 5CC RD STRL LTX BDX IC 2W FL INFCT CNTRL	BOTH IP/OP	$35.13 	$26.00	$0.00	$28.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.07	$26.07	$0.00	$0.00	$7.32	$0.00	$0.00	$0.00	$0.00	$17.56	$27.82	$28.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
01-0301	SUP	Custom 27203010		01-0301  -  BAND RUBBER SMALL 4MM ARCH BAR	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.40	$33.40	$0.00	$0.00	$9.38	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
01-03490	SUP	Custom 27203010		01-03490  -  WIRE FX .5MM 160MM LGT BLNT	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
01-03492	SUP	Custom 27203010		01-03492  -  WIRE FX .64MM 160MM LGT BLNT	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0104-07	SUP	Custom 27203010		MEDIA CULT TETRATHIONATE BROTH BASE 2KG	BOTH IP/OP	$547.50 	$405.15	$0.00	$438.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$273.75	$433.62	$438.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0112-18	SUP	Custom 27203010		0112-18  -  TUBE GSTRM Y 18FR ORNG LF MGNPRT BLN RND SKN DISK DEHP-FR	BOTH IP/OP	"$1,000.88 "	$740.65	$0.00	$75.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.48	$75.48	$0.00	$0.00	$21.19	$0.00	$0.00	$0.00	$0.00	$33.31	$52.76	$53.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0112-20	SUP	HCPCS B4087		0112-20  -  TUBE GSTRM UNV 20FR 7-10ML STRL ASMB VAL G SIL ENTRL	BOTH IP/OP	$45.31 	$33.53	$0.00	$36.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.63	$33.63	$0.00	$0.00	$9.44	$0.00	$0.00	$0.00	$0.00	$22.65	$35.89	$36.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0112-22	SUP	HCPCS B4087		0112-22  -  TUBE GSTRM 22FR 14IN BLU LF MGNPRT YPRT BLN CNCT SIL DISP	BOTH IP/OP	$45.31 	$33.53	$0.00	$36.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.63	$33.63	$0.00	$0.00	$9.44	$0.00	$0.00	$0.00	$0.00	$22.65	$35.89	$36.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0112-24	SUP	HCPCS B4087		0112-24  -  TUBE GSTRM 24FR 14IN PEACH LF MGNPRT SDPRT BLN REPL SIL	BOTH IP/OP	$45.31 	$33.53	$0.00	$36.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.63	$33.63	$0.00	$0.00	$9.44	$0.00	$0.00	$0.00	$0.00	$22.65	$35.89	$36.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0119L22	SUP	Custom 27203010		0119L22  -  CATHETER URETHRAL STANDARD 22FR 3 WAY 2 OPPOSING DRAIN EYE	BOTH IP/OP	$21.05 	$15.58	$0.00	$16.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.62	$15.62	$0.00	$0.00	$4.39	$0.00	$0.00	$0.00	$0.00	$10.53	$16.67	$16.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0119SI18	SUP	Custom 27203010		0119SI18  -  CATHETER URTH 18FR 5CC AMBR STRL LTX BDX IC 3W FL BLN INFCT	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.00	$0.00	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0120-14-1.7	SUP	Custom 27203010		0120-14-1.7  -  KIT GASTROSTOMY LP TAPER 14FR 1.7CM 12IN ENTERAL FEED TUBE	BOTH IP/OP	$259.94 	$192.36	$0.00	$209.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.93	$192.93	$0.00	$0.00	$54.17	$0.00	$0.00	$0.00	$0.00	$129.97	$209.07	$207.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0120-18-2.3	SUP	HCPCS C1713		0120-18-2.3  -  KIT GASTROSTOMY 18FR 2.3CM INTERNAL RETENTION BALLOON	BOTH IP/OP	$260.08 	$192.46	$0.00	$208.06	$117.03	$117.03	$0.00	$0.00	$0.00	$54.21	$193.03	$193.03	$0.00	$0.00	$54.20	$0.00	$153.83	$153.83	$0.00	$130.04	$205.98	$208.06	$0.00		$0.00	$40.70	$0.00	$0.00	$41.40	$0.00	$0.00	$0.00	$0.00	$0.00
0120-18-2.5	SUP	Custom 27203010		0120-18-2.5  -  KIT GASTROSTOMY LP TAPER 18FR 2.5CM ENTERAL FEED TUBE DEHP	BOTH IP/OP	$494.62 	$366.02	$0.00	$367.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$367.11	$367.11	$0.00	$0.00	$103.08	$0.00	$0.00	$0.00	$0.00	$129.97	$209.07	$207.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0120-18-4.5	SUP	HCPCS C1713		0120-18-4.5  -  KIT GASTROSTOMY LP TAPER 18FR 4.5CM ENTERAL FEED TUBE DEHP	BOTH IP/OP	$260.08 	$192.46	$0.00	$208.06	$117.03	$117.03	$0.00	$0.00	$0.00	$54.21	$193.03	$193.03	$0.00	$0.00	$54.20	$0.00	$153.83	$153.83	$0.00	$130.04	$205.98	$208.06	$0.00		$0.00	$40.70	$0.00	$0.00	$41.40	$0.00	$0.00	$0.00	$0.00	$0.00
012DTC	SUP	Custom 27203010		012DTC  -  BAG DRAWTAPE 38 X38 CLEAR	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-016	SUP	HCPCS C1713		015-016  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$452.63 	$334.95	$0.00	$362.10	$203.68	$203.68	$0.00	$0.00	$0.00	$94.34	$335.94	$335.94	$0.00	$0.00	$94.33	$0.00	$267.73	$267.73	$0.00	$226.31	$358.48	$362.10	$0.00		$0.00	$70.84	$0.00	$0.00	$72.06	$0.00	$0.00	$0.00	$0.00	$0.00
015-016-C	SUP	HCPCS C1713		015-016-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$488.75 	$361.68	$0.00	$391.00	$219.94	$219.94	$0.00	$0.00	$0.00	$101.87	$362.75	$362.75	$0.00	$0.00	$101.86	$0.00	$289.10	$289.10	$0.00	$244.38	$387.09	$391.00	$0.00		$0.00	$76.49	$0.00	$0.00	$77.81	$0.00	$0.00	$0.00	$0.00	$0.00
015-017	SUP	HCPCS C1713		015-017  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$435.63 	$322.37	$0.00	$348.50	$196.03	$196.03	$0.00	$0.00	$0.00	$90.80	$323.32	$323.32	$0.00	$0.00	$90.78	$0.00	$257.67	$257.67	$0.00	$217.81	$345.02	$348.50	$0.00		$0.00	$68.18	$0.00	$0.00	$69.35	$0.00	$0.00	$0.00	$0.00	$0.00
015-017-C	SUP	HCPCS C1713		015-017-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$463.25 	$342.81	$0.00	$370.60	$208.46	$208.46	$0.00	$0.00	$0.00	$96.55	$343.82	$343.82	$0.00	$0.00	$96.54	$0.00	$274.01	$274.01	$0.00	$231.63	$366.89	$370.60	$0.00		$0.00	$72.50	$0.00	$0.00	$73.75	$0.00	$0.00	$0.00	$0.00	$0.00
015-018	SUP	HCPCS C1713		015-018  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$461.13 	$341.24	$0.00	$368.90	$207.51	$207.51	$0.00	$0.00	$0.00	$96.11	$342.25	$342.25	$0.00	$0.00	$96.10	$0.00	$272.76	$272.76	$0.00	$230.56	$365.21	$368.90	$0.00		$0.00	$72.17	$0.00	$0.00	$73.41	$0.00	$0.00	$0.00	$0.00	$0.00
015-018-C	SUP	HCPCS C1713		015-018-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$463.25 	$342.81	$0.00	$370.60	$208.46	$208.46	$0.00	$0.00	$0.00	$96.55	$343.82	$343.82	$0.00	$0.00	$96.54	$0.00	$274.01	$274.01	$0.00	$231.63	$366.89	$370.60	$0.00		$0.00	$72.50	$0.00	$0.00	$73.75	$0.00	$0.00	$0.00	$0.00	$0.00
015-032	SUP	HCPCS C1713		015-032  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$654.50 	$484.33	$0.00	$523.60	$294.53	$294.53	$0.00	$0.00	$0.00	$136.41	$485.77	$485.77	$0.00	$0.00	$136.40	$0.00	$387.14	$387.14	$0.00	$327.25	$518.36	$523.60	$0.00		$0.00	$102.43	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$0.00
015-040	SUP	HCPCS C1713		015-040  -  PLATE BN STD STRG 4MM TIMESH 2 HL TI CRNL 1.5MM SCR	BOTH IP/OP	$93.50 	$69.19	$0.00	$74.80	$42.08	$42.08	$0.00	$0.00	$0.00	$19.49	$69.40	$69.40	$0.00	$0.00	$19.49	$0.00	$55.31	$55.31	$0.00	$46.75	$74.05	$74.80	$0.00		$0.00	$14.63	$0.00	$0.00	$14.89	$0.00	$0.00	$0.00	$0.00	$0.00
015-040-C	SUP	HCPCS C1713		015-040-C  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$95.63 	$70.77	$0.00	$76.50	$43.03	$43.03	$0.00	$0.00	$0.00	$19.93	$70.97	$70.97	$0.00	$0.00	$19.93	$0.00	$56.56	$56.56	$0.00	$47.81	$75.74	$76.50	$0.00		$0.00	$14.97	$0.00	$0.00	$15.22	$0.00	$0.00	$0.00	$0.00	$0.00
015-042	SUP	HCPCS C1713		015-042  -  PLATE BN STD STRG 8MM TIMESH 2 HL TI CRNL 1.5MM SCR	BOTH IP/OP	$95.63 	$70.77	$0.00	$76.50	$43.03	$43.03	$0.00	$0.00	$0.00	$19.93	$70.97	$70.97	$0.00	$0.00	$19.93	$0.00	$56.56	$56.56	$0.00	$47.81	$75.74	$76.50	$0.00		$0.00	$14.97	$0.00	$0.00	$15.22	$0.00	$0.00	$0.00	$0.00	$0.00
015-042-C	SUP	HCPCS C1713		015-042-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$95.63 	$70.77	$0.00	$76.50	$43.03	$43.03	$0.00	$0.00	$0.00	$19.93	$70.97	$70.97	$0.00	$0.00	$19.93	$0.00	$56.56	$56.56	$0.00	$47.81	$75.74	$76.50	$0.00		$0.00	$14.97	$0.00	$0.00	$15.22	$0.00	$0.00	$0.00	$0.00	$0.00
015-044	SUP	HCPCS C1713		015-044  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$93.50 	$69.19	$0.00	$74.80	$42.08	$42.08	$0.00	$0.00	$0.00	$19.49	$69.40	$69.40	$0.00	$0.00	$19.49	$0.00	$55.31	$55.31	$0.00	$46.75	$74.05	$74.80	$0.00		$0.00	$14.63	$0.00	$0.00	$14.89	$0.00	$0.00	$0.00	$0.00	$0.00
015-044-C	SUP	HCPCS C1713		015-044-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$102.00 	$75.48	$0.00	$81.60	$45.90	$45.90	$0.00	$0.00	$0.00	$21.26	$75.70	$75.70	$0.00	$0.00	$21.26	$0.00	$60.33	$60.33	$0.00	$51.00	$80.78	$81.60	$0.00		$0.00	$15.96	$0.00	$0.00	$16.24	$0.00	$0.00	$0.00	$0.00	$0.00
015-090	SUP	HCPCS C1713		015-090  -  PLATE BN STD CRV TIMESH 12 HL TI CRNL	BOTH IP/OP	$486.63 	$360.11	$0.00	$389.30	$218.98	$218.98	$0.00	$0.00	$0.00	$101.42	$361.17	$361.17	$0.00	$0.00	$101.41	$0.00	$287.84	$287.84	$0.00	$243.31	$385.41	$389.30	$0.00		$0.00	$76.16	$0.00	$0.00	$77.47	$0.00	$0.00	$0.00	$0.00	$0.00
015-090-C	SUP	HCPCS C1713		015-090-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$486.63 	$360.11	$0.00	$389.30	$218.98	$218.98	$0.00	$0.00	$0.00	$101.42	$361.17	$361.17	$0.00	$0.00	$101.41	$0.00	$287.84	$287.84	$0.00	$243.31	$385.41	$389.30	$0.00		$0.00	$76.16	$0.00	$0.00	$77.47	$0.00	$0.00	$0.00	$0.00	$0.00
015-1006	SUP	Custom 27203010		015-1006  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$265.63 	$196.57	$0.00	$212.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.15	$197.15	$0.00	$0.00	$55.36	$0.00	$0.00	$0.00	$0.00	$132.81	$210.38	$212.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-102L	SUP	HCPCS C1713		015-102L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
015-102R	SUP	HCPCS C1713		015-102R  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
015-104L	SUP	HCPCS C1713		015-104L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
015-104R	SUP	HCPCS C1713		015-104R  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
015-105L	SUP	HCPCS C1713		015-105L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$403.75 	$298.78	$0.00	$323.00	$181.69	$181.69	$0.00	$0.00	$0.00	$84.15	$299.66	$299.66	$0.00	$0.00	$84.14	$0.00	$238.82	$238.82	$0.00	$201.88	$319.77	$323.00	$0.00		$0.00	$63.19	$0.00	$0.00	$64.28	$0.00	$0.00	$0.00	$0.00	$0.00
015-105R	SUP	HCPCS C1713		015-105R  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$403.75 	$298.78	$0.00	$323.00	$181.69	$181.69	$0.00	$0.00	$0.00	$84.15	$299.66	$299.66	$0.00	$0.00	$84.14	$0.00	$238.82	$238.82	$0.00	$201.88	$319.77	$323.00	$0.00		$0.00	$63.19	$0.00	$0.00	$64.28	$0.00	$0.00	$0.00	$0.00	$0.00
015-106L	SUP	HCPCS C1713		015-106L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
015-106R	SUP	HCPCS C1713		015-106R  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
015-107R	SUP	HCPCS C1713		015-107R  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
015-1206	SUP	Custom 27203010		015-1206  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$267.75 	$198.14	$0.00	$214.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.72	$198.72	$0.00	$0.00	$55.80	$0.00	$0.00	$0.00	$0.00	$133.88	$212.06	$214.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-1208	SUP	Custom 27203010		015-1208  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$267.75 	$198.14	$0.00	$214.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.72	$198.72	$0.00	$0.00	$55.80	$0.00	$0.00	$0.00	$0.00	$133.88	$212.06	$214.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-130	SUP	HCPCS C1713		015-130  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$403.75 	$298.78	$0.00	$323.00	$181.69	$181.69	$0.00	$0.00	$0.00	$84.15	$299.66	$299.66	$0.00	$0.00	$84.14	$0.00	$238.82	$238.82	$0.00	$201.88	$319.77	$323.00	$0.00		$0.00	$63.19	$0.00	$0.00	$64.28	$0.00	$0.00	$0.00	$0.00	$0.00
015-1304	SUP	Custom 27203010		015-1304  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$252.88 	$187.13	$0.00	$202.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.68	$187.68	$0.00	$0.00	$52.70	$0.00	$0.00	$0.00	$0.00	$126.44	$200.28	$202.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-1306	SUP	Custom 27203010		015-1306  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$252.88 	$187.13	$0.00	$202.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.68	$187.68	$0.00	$0.00	$52.70	$0.00	$0.00	$0.00	$0.00	$126.44	$200.28	$202.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-1308	SUP	Custom 27203010		015-1308  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$267.75 	$198.14	$0.00	$214.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.72	$198.72	$0.00	$0.00	$55.80	$0.00	$0.00	$0.00	$0.00	$133.88	$212.06	$214.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-1312	SUP	Custom 27203010		015-1312  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$225.25 	$166.69	$0.00	$180.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.18	$167.18	$0.00	$0.00	$46.94	$0.00	$0.00	$0.00	$0.00	$112.63	$178.40	$180.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-132	SUP	HCPCS C1713		015-132  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$403.75 	$298.78	$0.00	$323.00	$181.69	$181.69	$0.00	$0.00	$0.00	$84.15	$299.66	$299.66	$0.00	$0.00	$84.14	$0.00	$238.82	$238.82	$0.00	$201.88	$319.77	$323.00	$0.00		$0.00	$63.19	$0.00	$0.00	$64.28	$0.00	$0.00	$0.00	$0.00	$0.00
015-160	SUP	HCPCS C1713		015-160  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$403.75 	$298.78	$0.00	$323.00	$181.69	$181.69	$0.00	$0.00	$0.00	$84.15	$299.66	$299.66	$0.00	$0.00	$84.14	$0.00	$238.82	$238.82	$0.00	$201.88	$319.77	$323.00	$0.00		$0.00	$63.19	$0.00	$0.00	$64.28	$0.00	$0.00	$0.00	$0.00	$0.00
015-161	SUP	HCPCS C1713		015-161  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$403.75 	$298.78	$0.00	$323.00	$181.69	$181.69	$0.00	$0.00	$0.00	$84.15	$299.66	$299.66	$0.00	$0.00	$84.14	$0.00	$238.82	$238.82	$0.00	$201.88	$319.77	$323.00	$0.00		$0.00	$63.19	$0.00	$0.00	$64.28	$0.00	$0.00	$0.00	$0.00	$0.00
015-2001-4	SUP	HCPCS C1781		015-2001-4  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,519.38 "	"$1,124.34"	$0.00	"$1,215.50"	$683.72	$683.72	$0.00	$0.00	$0.00	$316.68	"$1,127.68"	"$1,127.68"	$0.00	$0.00	$316.64	$0.00	$898.71	$898.71	$0.00	$759.69	"$1,203.35"	"$1,215.50"	$0.00		$0.00	$237.78	$0.00	$0.00	$241.88	$0.00	$0.00	$0.00	$0.00	$0.00
015-2001-4-C	SUP	HCPCS C1713		015-2001-4-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,468.38 "	"$1,086.60"	$0.00	"$1,174.70"	$660.77	$660.77	$0.00	$0.00	$0.00	$306.05	"$1,089.83"	"$1,089.83"	$0.00	$0.00	$306.01	$0.00	$868.54	$868.54	$0.00	$734.19	"$1,162.96"	"$1,174.70"	$0.00		$0.00	$229.80	$0.00	$0.00	$233.77	$0.00	$0.00	$0.00	$0.00	$0.00
015-2001-5	SUP	HCPCS C1713		015-2001-5  -  PLATE BN 11CMX7.5CMX5MM GRIDMESH TI CRNM HERNIATED CRV DISK	BOTH IP/OP	"$1,489.63 "	"$1,102.33"	$0.00	"$1,191.70"	$670.33	$670.33	$0.00	$0.00	$0.00	$310.48	"$1,105.60"	"$1,105.60"	$0.00	$0.00	$310.44	$0.00	$881.11	$881.11	$0.00	$744.81	"$1,179.79"	"$1,191.70"	$0.00		$0.00	$233.13	$0.00	$0.00	$237.15	$0.00	$0.00	$0.00	$0.00	$0.00
015-2001-5-C	SUP	HCPCS C1713		015-2001-5-C  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,538.50 "	"$1,138.49"	$0.00	"$1,230.80"	$692.33	$692.33	$0.00	$0.00	$0.00	$320.66	"$1,141.87"	"$1,141.87"	$0.00	$0.00	$320.62	$0.00	$910.02	$910.02	$0.00	$769.25	"$1,218.49"	"$1,230.80"	$0.00		$0.00	$240.78	$0.00	$0.00	$244.93	$0.00	$0.00	$0.00	$0.00	$0.00
015-2010	SUP	HCPCS C1713		015-2010  -  PLATE BN SQ RECT 8MM TIMESH MESH TI CRNM 1.5MM SCR	BOTH IP/OP	"$1,230.38 "	$910.48	$0.00	$984.30	$553.67	$553.67	$0.00	$0.00	$0.00	$256.44	$913.18	$913.18	$0.00	$0.00	$256.41	$0.00	$727.77	$727.77	$0.00	$615.19	$974.46	$984.30	$0.00		$0.00	$192.55	$0.00	$0.00	$195.88	$0.00	$0.00	$0.00	$0.00	$0.00
0152-0218S	SUP	Custom 27803010		0152-0218S  -  WIRE FX 1.8MM 310MM STRL KRSH CNDYL SCR	BOTH IP/OP	$192.10 	$142.15	$0.00	$166.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.58	$142.58	$0.00	$0.00	$40.03	$0.00	$0.00	$0.00	$0.00	$103.81	$164.44	$166.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-2050	SUP	Custom 27203010		015-2050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,241.00 "	$918.34	$0.00	$992.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$921.07	$921.07	$0.00	$0.00	$258.62	$0.00	$0.00	$0.00	$0.00	$620.50	$982.87	$992.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-230	SUP	HCPCS C1713		015-230  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$384.63 	$284.63	$0.00	$307.70	$173.08	$173.08	$0.00	$0.00	$0.00	$80.17	$285.47	$285.47	$0.00	$0.00	$80.16	$0.00	$227.51	$227.51	$0.00	$192.31	$304.63	$307.70	$0.00		$0.00	$60.19	$0.00	$0.00	$61.23	$0.00	$0.00	$0.00	$0.00	$0.00
015-233	SUP	HCPCS C1713		015-233  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$384.63 	$284.63	$0.00	$307.70	$173.08	$173.08	$0.00	$0.00	$0.00	$80.17	$285.47	$285.47	$0.00	$0.00	$80.16	$0.00	$227.51	$227.51	$0.00	$192.31	$304.63	$307.70	$0.00		$0.00	$60.19	$0.00	$0.00	$61.23	$0.00	$0.00	$0.00	$0.00	$0.00
015-234	SUP	HCPCS C1713		015-234  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$384.63 	$284.63	$0.00	$307.70	$173.08	$173.08	$0.00	$0.00	$0.00	$80.17	$285.47	$285.47	$0.00	$0.00	$80.16	$0.00	$227.51	$227.51	$0.00	$192.31	$304.63	$307.70	$0.00		$0.00	$60.19	$0.00	$0.00	$61.23	$0.00	$0.00	$0.00	$0.00	$0.00
015-236	SUP	HCPCS C1713		015-236  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$363.38 	$268.90	$0.00	$290.70	$163.52	$163.52	$0.00	$0.00	$0.00	$75.74	$269.70	$269.70	$0.00	$0.00	$75.73	$0.00	$214.94	$214.94	$0.00	$181.69	$287.80	$290.70	$0.00		$0.00	$56.87	$0.00	$0.00	$57.85	$0.00	$0.00	$0.00	$0.00	$0.00
015-237	SUP	HCPCS C1713		015-237  -  PLATE BN 2Y 5MM TIMESH 3X3 HL TI CRNL 1.5MM SCR	BOTH IP/OP	$376.13 	$278.34	$0.00	$300.90	$169.26	$169.26	$0.00	$0.00	$0.00	$78.39	$279.16	$279.16	$0.00	$0.00	$78.38	$0.00	$222.48	$222.48	$0.00	$188.06	$297.89	$300.90	$0.00		$0.00	$58.86	$0.00	$0.00	$59.88	$0.00	$0.00	$0.00	$0.00	$0.00
015-246	SUP	HCPCS C1713		015-246  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$233.75 	$172.98	$0.00	$187.00	$105.19	$105.19	$0.00	$0.00	$0.00	$48.72	$173.49	$173.49	$0.00	$0.00	$48.71	$0.00	$138.26	$138.26	$0.00	$116.88	$185.13	$187.00	$0.00		$0.00	$36.58	$0.00	$0.00	$37.21	$0.00	$0.00	$0.00	$0.00	$0.00
015-247	SUP	HCPCS C1713		015-247  -  PLATE BN STRG 5MM TIMESH 2X2 HL TI CRNMXF 1.5MM SCR	BOTH IP/OP	$233.75 	$172.98	$0.00	$187.00	$105.19	$105.19	$0.00	$0.00	$0.00	$48.72	$173.49	$173.49	$0.00	$0.00	$48.71	$0.00	$138.26	$138.26	$0.00	$116.88	$185.13	$187.00	$0.00		$0.00	$36.58	$0.00	$0.00	$37.21	$0.00	$0.00	$0.00	$0.00	$0.00
015-255	SUP	HCPCS C1713		015-255  -  PLATE BN X TIMESH TI CRNM 1.5MM SCR	BOTH IP/OP	$384.63 	$284.63	$0.00	$307.70	$173.08	$173.08	$0.00	$0.00	$0.00	$80.17	$285.47	$285.47	$0.00	$0.00	$80.16	$0.00	$227.51	$227.51	$0.00	$192.31	$304.63	$307.70	$0.00		$0.00	$60.19	$0.00	$0.00	$61.23	$0.00	$0.00	$0.00	$0.00	$0.00
015-257	SUP	HCPCS C1713		015-257  -  PLATE BN STD SM SQ TIMESH 4 HL TI CRNL 1.5MM SCR	BOTH IP/OP	$393.13 	$290.92	$0.00	$314.50	$176.91	$176.91	$0.00	$0.00	$0.00	$81.94	$291.78	$291.78	$0.00	$0.00	$81.93	$0.00	$232.53	$232.53	$0.00	$196.56	$311.36	$314.50	$0.00		$0.00	$61.52	$0.00	$0.00	$62.59	$0.00	$0.00	$0.00	$0.00	$0.00
015-257-C	SUP	HCPCS C1713		015-257-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$414.38 	$306.64	$0.00	$331.50	$186.47	$186.47	$0.00	$0.00	$0.00	$86.37	$307.55	$307.55	$0.00	$0.00	$86.36	$0.00	$245.10	$245.10	$0.00	$207.19	$328.19	$331.50	$0.00		$0.00	$64.85	$0.00	$0.00	$65.97	$0.00	$0.00	$0.00	$0.00	$0.00
015-258	SUP	HCPCS C1713		015-258  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$401.63 	$297.21	$0.00	$321.30	$180.73	$180.73	$0.00	$0.00	$0.00	$83.71	$298.09	$298.09	$0.00	$0.00	$83.70	$0.00	$237.56	$237.56	$0.00	$200.81	$318.09	$321.30	$0.00		$0.00	$62.85	$0.00	$0.00	$63.94	$0.00	$0.00	$0.00	$0.00	$0.00
015-260-11	SUP	HCPCS C1781		015-260-11  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$431.38 	$319.22	$0.00	$345.10	$194.12	$194.12	$0.00	$0.00	$0.00	$89.91	$320.17	$320.17	$0.00	$0.00	$89.90	$0.00	$255.16	$255.16	$0.00	$215.69	$341.65	$345.10	$0.00		$0.00	$67.51	$0.00	$0.00	$68.67	$0.00	$0.00	$0.00	$0.00	$0.00
015-260-14	SUP	HCPCS C1781		015-260-14  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$431.38 	$319.22	$0.00	$345.10	$194.12	$194.12	$0.00	$0.00	$0.00	$89.91	$320.17	$320.17	$0.00	$0.00	$89.90	$0.00	$255.16	$255.16	$0.00	$215.69	$341.65	$345.10	$0.00		$0.00	$67.51	$0.00	$0.00	$68.67	$0.00	$0.00	$0.00	$0.00	$0.00
015-260-18	SUP	HCPCS C1781		015-260-18  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$465.38 	$344.38	$0.00	$372.30	$209.42	$209.42	$0.00	$0.00	$0.00	$97.00	$345.40	$345.40	$0.00	$0.00	$96.98	$0.00	$275.27	$275.27	$0.00	$232.69	$368.58	$372.30	$0.00		$0.00	$72.83	$0.00	$0.00	$74.09	$0.00	$0.00	$0.00	$0.00	$0.00
015-260-25	SUP	Custom 27803010		015-260-25  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$558.88 	$413.57	$0.00	$447.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$414.80	$414.80	$0.00	$0.00	$116.47	$0.00	$0.00	$0.00	$0.00	$279.44	$442.63	$447.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-262-14	SUP	Custom 27803010		015-262-14  -  COVER BUR HL 14MM TIMESH FAN BLDE TI CRNL	BOTH IP/OP	$431.38 	$319.22	$0.00	$345.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.17	$320.17	$0.00	$0.00	$89.90	$0.00	$0.00	$0.00	$0.00	$215.69	$341.65	$345.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-262-16	SUP	Custom 27803010		015-262-16  -  LG BURR HOLE CVR.	BOTH IP/OP	$320.63 	$237.27	$0.00	$256.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$237.97	$237.97	$0.00	$0.00	$66.82	$0.00	$0.00	$0.00	$0.00	$160.31	$253.94	$256.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-262-18	SUP	Custom 27803010		015-262-18  -  COVER BUR HL 18MM TIMESH FAN BLDE TI CRNMXF 1.5MM SCR	BOTH IP/OP	$439.88 	$325.51	$0.00	$351.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$326.48	$326.48	$0.00	$0.00	$91.67	$0.00	$0.00	$0.00	$0.00	$219.94	$348.38	$351.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
015-273	SUP	HCPCS C1713		015-273  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$618.38 	$457.60	$0.00	$494.70	$278.27	$278.27	$0.00	$0.00	$0.00	$128.88	$458.96	$458.96	$0.00	$0.00	$128.87	$0.00	$365.77	$365.77	$0.00	$309.19	$489.76	$494.70	$0.00		$0.00	$96.78	$0.00	$0.00	$98.45	$0.00	$0.00	$0.00	$0.00	$0.00
015-275	SUP	HCPCS C1713		015-275  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$433.50 	$320.79	$0.00	$346.80	$195.08	$195.08	$0.00	$0.00	$0.00	$90.35	$321.74	$321.74	$0.00	$0.00	$90.34	$0.00	$256.42	$256.42	$0.00	$216.75	$343.33	$346.80	$0.00		$0.00	$67.84	$0.00	$0.00	$69.01	$0.00	$0.00	$0.00	$0.00	$0.00
015-276	SUP	HCPCS C1713		015-276  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$454.75 	$336.52	$0.00	$363.80	$204.64	$204.64	$0.00	$0.00	$0.00	$94.78	$337.52	$337.52	$0.00	$0.00	$94.77	$0.00	$268.98	$268.98	$0.00	$227.38	$360.16	$363.80	$0.00		$0.00	$71.17	$0.00	$0.00	$72.40	$0.00	$0.00	$0.00	$0.00	$0.00
016-100	SUP	Custom 27803010		016-100  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,436.50 "	"$1,063.01"	$0.00	"$1,149.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,066.17"	"$1,066.17"	$0.00	$0.00	$299.37	$0.00	$0.00	$0.00	$0.00	$718.25	"$1,137.71"	"$1,149.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
016-120	SUP	Custom 27803010		016-120  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,967.75 "	"$1,456.14"	$0.00	"$1,574.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,460.46"	"$1,460.46"	$0.00	$0.00	$410.08	$0.00	$0.00	$0.00	$0.00	$983.88	"$1,558.46"	"$1,574.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
016-128	SUP	Custom 27803010		016-128  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,646.88 "	"$1,218.69"	$0.00	"$1,317.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.31"	"$1,222.31"	$0.00	$0.00	$343.21	$0.00	$0.00	$0.00	$0.00	$823.44	"$1,304.33"	"$1,317.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
016-152	SUP	Custom 27803010		016-152  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,171.75 "	"$1,607.10"	$0.00	"$1,737.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,611.87"	"$1,611.87"	$0.00	$0.00	$452.59	$0.00	$0.00	$0.00	$0.00	"$1,085.88"	"$1,720.03"	"$1,737.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
016-200	SUP	Custom 27803010		016-200  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,069.38 "	"$3,011.34"	$0.00	"$3,255.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,020.29"	"$3,020.29"	$0.00	$0.00	$848.06	$0.00	$0.00	$0.00	$0.00	"$2,034.69"	"$3,222.95"	"$3,255.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0166L30	SUP	HCPCS C1729		CATHETER URINARY BARDEX LUBRICATH FOLEY 30FR 30ML 2 WAY 2 ST	BOTH IP/OP	$9.58 	$7.09	$0.00	$7.66	$5.20	$5.20	$0.00	$0.00	$0.00	$2.00	$7.11	$7.11	$0.00	$0.00	$2.00	$0.00	$5.66	$5.66	$0.00	$4.79	$7.59	$7.66	$0.00		$0.00	$1.50	$0.00	$0.00	$1.52	$0.00	$0.00	$0.00	$0.00	$0.00
0166SI20	SUP	Custom 27203010		0166SI20  -  CATHETER URTH 20FR 30CC STRL LTX BDX IC 2W FL BLN ATRM INS	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.00	$0.00	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0166SI28	SUP	Custom 27203010		0166SI28  -  CATHETER URTH 28FR 30CC STRL LTX BDX IC 2W FL BLN ATRM INS	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.00	$0.00	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0167L18	SUP	Custom 27203010		0167L18  -  CATHETER URETHRAL 18FR FOLEY 3 WAY ROUND TIP 2 STAGGERED EYE	BOTH IP/OP	$21.20 	$15.69	$0.00	$16.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.73	$15.73	$0.00	$0.00	$4.42	$0.00	$0.00	$0.00	$0.00	$10.60	$16.79	$16.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0167L20	SUP	Custom 27203010		0167L20  -  CATHETER URETHRAL STANDARD 20FR 3 WAY 2 STAGGER DRAIN EYE	BOTH IP/OP	$21.20 	$15.69	$0.00	$16.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.73	$15.73	$0.00	$0.00	$4.42	$0.00	$0.00	$0.00	$0.00	$10.60	$16.79	$16.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0167L22	SUP	Custom 27203010		0167L22  -  CATHETER URETHRAL STANDARD 22FR 3 WAY 2 STAGGER DRAIN EYE	BOTH IP/OP	$21.20 	$15.69	$0.00	$16.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.73	$15.73	$0.00	$0.00	$4.42	$0.00	$0.00	$0.00	$0.00	$10.60	$16.79	$16.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0196L16	SUP	Custom 27203010		0196L16  -  CATHETER URTH 16FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN	BOTH IP/OP	$29.40 	$21.76	$0.00	$24.82	$0.00	$0.00	$0.00	$0.00	$0.00	$6.13	$21.82	$21.82	$0.00	$0.00	$6.13	$0.00	$17.39	$17.39	$0.00	$15.51	$24.58	$24.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0196L18	SUP	Custom 27203010		0196L18  -  CATHETER URTH 18FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN	BOTH IP/OP	$29.40 	$21.76	$0.00	$23.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.82	$21.82	$0.00	$0.00	$6.13	$0.00	$0.00	$0.00	$0.00	$14.70	$23.28	$23.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0196L20	SUP	Custom 27203010		0196L20  -  CATHETER URTH 20FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN	BOTH IP/OP	$352.80 	$261.07	$0.00	$261.85	$0.00	$0.00	$0.00	$0.00	$0.00	$73.53	$261.85	$261.85	$0.00	$0.00	$73.52	$0.00	$208.68	$208.68	$0.00	$14.78	$23.40	$23.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0196L22	SUP	Custom 27203010		0196L22  -  CATHETER URTH 22FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN	BOTH IP/OP	$29.40 	$21.76	$0.00	$23.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.82	$21.82	$0.00	$0.00	$6.13	$0.00	$0.00	$0.00	$0.00	$14.70	$23.28	$23.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.00024.001	SUP	Custom 27203010		02.00024.001  -  BIT DRILL 145MM 4.3MM NCB SHRT STD FEM SS QC NONSTRL	BOTH IP/OP	$230.75 	$170.76	$0.00	$184.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$171.26	$171.26	$0.00	$0.00	$48.09	$0.00	$0.00	$0.00	$0.00	$115.38	$182.75	$184.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.300	SUP	HCPCS C1713		02.001.300  -  PLATE BONE CURVE 242X17.5X5.2MM 10 HOLE LP PRECONTOUR	BOTH IP/OP	"$3,079.88 "	"$2,279.11"	$0.00	"$2,392.14"	"$1,345.58"	"$1,345.58"	$0.00	$0.00	$0.00	$641.92	"$2,285.88"	"$2,285.88"	$0.00	$0.00	$641.85	$0.00	"$1,518.38"	"$1,518.38"	$0.00	"$1,495.09"	"$2,368.22"	"$2,392.14"	$0.00		$0.00	$454.33	$0.00	$0.00	$476.04	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.300S	SUP	HCPCS C1713		02.001.300S  -  PLATE 242MM SS 4.5MM SCR 10 HOLE CVD LCP BONE LEFT CNDYLR	BOTH IP/OP	"$3,171.25 "	"$2,346.73"	$0.00	"$2,887.94"	"$1,624.47"	"$1,624.47"	$0.00	$0.00	$0.00	$660.97	"$2,353.70"	"$2,353.70"	$0.00	$0.00	$660.89	$0.00	"$1,563.43"	"$1,563.43"	$0.00	"$1,804.96"	"$2,859.06"	"$2,887.94"	$0.00		$0.00	$564.95	$0.00	$0.00	$574.70	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.302	SUP	HCPCS C1713		02.001.302  -  PLATE BN CRV 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL	BOTH IP/OP	"$3,144.53 "	"$2,326.95"	$0.00	"$2,442.36"	"$1,373.83"	"$1,373.83"	$0.00	$0.00	$0.00	$655.40	"$2,333.87"	"$2,333.87"	$0.00	$0.00	$655.32	$0.00	"$1,550.25"	"$1,550.25"	$0.00	"$1,526.48"	"$2,417.94"	"$2,442.36"	$0.00		$0.00	$463.87	$0.00	$0.00	$486.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.304	SUP	HCPCS C1713		02.001.304  -  PLATE BN CRV 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL	BOTH IP/OP	"$3,210.60 "	"$2,375.84"	$0.00	"$2,493.68"	"$1,402.70"	"$1,402.70"	$0.00	$0.00	$0.00	$669.17	"$2,382.91"	"$2,382.91"	$0.00	$0.00	$669.09	$0.00	"$1,582.83"	"$1,582.83"	$0.00	"$1,558.55"	"$2,468.74"	"$2,493.68"	$0.00		$0.00	$473.62	$0.00	$0.00	$496.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.304S	SUP	HCPCS C1713		02.001.304S  -  PLATE 314MM SS 4.5MM SCR 14 HOLE CVD LCK LCP BONE LEFT	BOTH IP/OP	"$3,301.98 "	"$2,443.47"	$0.00	"$3,007.34"	"$1,691.63"	"$1,691.63"	$0.00	$0.00	$0.00	$688.21	"$2,450.73"	"$2,450.73"	$0.00	$0.00	$688.13	$0.00	"$1,627.87"	"$1,627.87"	$0.00	"$1,879.59"	"$2,977.27"	"$3,007.34"	$0.00		$0.00	$588.31	$0.00	$0.00	$598.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.306	SUP	HCPCS C1713		02.001.306  -  PLATE BN CRV 350X17.5X5.2MM NS LCP CMBN 16 HL LOPRFL	BOTH IP/OP	"$3,272.45 "	"$2,421.61"	$0.00	"$2,541.72"	"$1,429.72"	"$1,429.72"	$0.00	$0.00	$0.00	$682.06	"$2,428.81"	"$2,428.81"	$0.00	$0.00	$681.98	$0.00	"$1,613.32"	"$1,613.32"	$0.00	"$1,588.58"	"$2,516.30"	"$2,541.72"	$0.00		$0.00	$482.74	$0.00	$0.00	$505.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.308	SUP	HCPCS C1713		02.001.308  -  PLATE BN CRV 386X17.5X5.2MM NS LCP CMBN 18 HL LOPRFL	BOTH IP/OP	"$3,453.78 "	"$2,555.80"	$0.00	"$2,682.56"	"$1,508.94"	"$1,508.94"	$0.00	$0.00	$0.00	$719.85	"$2,563.39"	"$2,563.39"	$0.00	$0.00	$719.77	$0.00	"$1,702.71"	"$1,702.71"	$0.00	"$1,676.60"	"$2,655.73"	"$2,682.56"	$0.00		$0.00	$509.49	$0.00	$0.00	$533.83	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.308S	SUP	HCPCS C1713		02.001.308S  -  PLATE 386MM SS 4.5MM SCR 18 HOLE CVD LCK LCP BONE LEFT	BOTH IP/OP	"$3,545.15 "	"$2,623.41"	$0.00	"$3,126.76"	"$1,758.80"	"$1,758.80"	$0.00	$0.00	$0.00	$738.90	"$2,631.21"	"$2,631.21"	$0.00	$0.00	$738.81	$0.00	"$1,747.76"	"$1,747.76"	$0.00	"$1,954.23"	"$3,095.49"	"$3,126.76"	$0.00		$0.00	$611.67	$0.00	$0.00	$622.23	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.320	SUP	HCPCS C1713		02.001.320  -  PLATE BN CRV 242X17.5X5.2MM NS LCP CMBN 10 HL LOPRFL	BOTH IP/OP	"$3,079.88 "	"$2,279.11"	$0.00	"$2,392.14"	"$1,345.58"	"$1,345.58"	$0.00	$0.00	$0.00	$641.92	"$2,285.88"	"$2,285.88"	$0.00	$0.00	$641.85	$0.00	"$1,518.38"	"$1,518.38"	$0.00	"$1,495.09"	"$2,368.22"	"$2,392.14"	$0.00		$0.00	$454.33	$0.00	$0.00	$476.04	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.322	SUP	HCPCS C1713		02.001.322  -  PLATE BN CRV 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL	BOTH IP/OP	"$3,144.53 "	"$2,326.95"	$0.00	"$2,442.36"	"$1,373.83"	"$1,373.83"	$0.00	$0.00	$0.00	$655.40	"$2,333.87"	"$2,333.87"	$0.00	$0.00	$655.32	$0.00	"$1,550.25"	"$1,550.25"	$0.00	"$1,526.48"	"$2,417.94"	"$2,442.36"	$0.00		$0.00	$463.87	$0.00	$0.00	$486.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.324	SUP	HCPCS C1713		02.001.324  -  PLATE BN CRV 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL	BOTH IP/OP	"$3,210.60 "	"$2,375.84"	$0.00	"$2,493.68"	"$1,402.70"	"$1,402.70"	$0.00	$0.00	$0.00	$669.17	"$2,382.91"	"$2,382.91"	$0.00	$0.00	$669.09	$0.00	"$1,582.83"	"$1,582.83"	$0.00	"$1,558.55"	"$2,468.74"	"$2,493.68"	$0.00		$0.00	$473.62	$0.00	$0.00	$496.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.326	SUP	HCPCS C1713		02.001.326  -  PLATE BN CRV 350X17.5X5.2MM NS LCP CMBN 16 HL LOPRFL	BOTH IP/OP	"$3,272.45 "	"$2,421.61"	$0.00	"$2,541.72"	"$1,429.72"	"$1,429.72"	$0.00	$0.00	$0.00	$682.06	"$2,428.81"	"$2,428.81"	$0.00	$0.00	$681.98	$0.00	"$1,613.32"	"$1,613.32"	$0.00	"$1,588.58"	"$2,516.30"	"$2,541.72"	$0.00		$0.00	$482.74	$0.00	$0.00	$505.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.328	SUP	HCPCS C1713		02.001.328  -  PLATE BN CRV 386X17.5X5.2MM NS LCP CMBN 18 HL LOPRFL	BOTH IP/OP	"$3,453.78 "	"$2,555.80"	$0.00	"$2,682.56"	"$1,508.94"	"$1,508.94"	$0.00	$0.00	$0.00	$719.85	"$2,563.39"	"$2,563.39"	$0.00	$0.00	$719.77	$0.00	"$1,702.71"	"$1,702.71"	$0.00	"$1,676.60"	"$2,655.73"	"$2,682.56"	$0.00		$0.00	$509.49	$0.00	$0.00	$533.83	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.330S	SUP	HCPCS C1713		02.001.330S  -  PLATE BN CRV 422X17.5X5.2MM STRL LCP CMBN 20 HL LOPRFL	BOTH IP/OP	"$3,597.18 "	"$2,661.91"	$0.00	"$2,793.92"	"$1,571.58"	"$1,571.58"	$0.00	$0.00	$0.00	$749.74	"$2,669.82"	"$2,669.82"	$0.00	$0.00	$749.65	$0.00	"$1,773.41"	"$1,773.41"	$0.00	"$1,746.20"	"$2,765.98"	"$2,793.92"	$0.00		$0.00	$530.64	$0.00	$0.00	$555.99	$0.00	$0.00	$0.00	$0.00	$0.00
02.001.332S	SUP	HCPCS C1713		02.001.332S  -  PLATE BN CRV 458X17.5X5.2MM STRL LCP CMBN 22 HL LOPRFL	BOTH IP/OP	"$3,654.80 "	"$2,704.55"	$0.00	"$2,838.68"	"$1,596.76"	"$1,596.76"	$0.00	$0.00	$0.00	$761.75	"$2,712.59"	"$2,712.59"	$0.00	$0.00	$761.66	$0.00	"$1,801.82"	"$1,801.82"	$0.00	"$1,774.18"	"$2,810.29"	"$2,838.68"	$0.00		$0.00	$539.14	$0.00	$0.00	$564.90	$0.00	$0.00	$0.00	$0.00	$0.00
02.007.000S	SUP	Custom 27203010		02.007.000S  -  NAIL INTRAMEDULLARY END CAP STAINLESS STEEL OLECRANON	BOTH IP/OP	"$1,210.30 "	$895.62	$0.00	$940.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$898.28	$898.28	$0.00	$0.00	$252.23	$0.00	$0.00	$0.00	$0.00	$587.53	$930.64	$940.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.007.001	SUP	HCPCS C1713		02.007.001  -  NAIL INTRAMEDULLARY OSTMY IMPLANT STAINLESS STEEL OLECRANON	BOTH IP/OP	$684.75 	$506.72	$0.00	$547.80	$308.14	$308.14	$0.00	$0.00	$0.00	$142.72	$508.22	$508.22	$0.00	$0.00	$142.70	$0.00	$405.03	$405.03	$0.00	$342.38	$542.32	$547.80	$0.00		$0.00	$107.16	$0.00	$0.00	$109.01	$0.00	$0.00	$0.00	$0.00	$0.00
02.03150.044	SUP	HCPCS C1713		02.03150.044  -  SCREW BONE 44MM CORT	BOTH IP/OP	$344.50 	$254.93	$0.00	$275.60	$155.03	$155.03	$0.00	$0.00	$0.00	$71.80	$255.69	$255.69	$0.00	$0.00	$71.79	$0.00	$203.77	$203.77	$0.00	$172.25	$272.84	$275.60	$0.00		$0.00	$53.91	$0.00	$0.00	$54.84	$0.00	$0.00	$0.00	$0.00	$0.00
02.03150.048	SUP	HCPCS C1713		02.03150.048  -  SCREW BONE 48MM TI CORT	BOTH IP/OP	$344.50 	$254.93	$0.00	$275.60	$155.03	$155.03	$0.00	$0.00	$0.00	$71.80	$255.69	$255.69	$0.00	$0.00	$71.79	$0.00	$203.77	$203.77	$0.00	$172.25	$272.84	$275.60	$0.00		$0.00	$53.91	$0.00	$0.00	$54.84	$0.00	$0.00	$0.00	$0.00	$0.00
02.03150.055	SUP	HCPCS C1713		02.03150.055  -  SCREW BONE 55MM CORT	BOTH IP/OP	$344.50 	$254.93	$0.00	$275.60	$155.03	$155.03	$0.00	$0.00	$0.00	$71.80	$255.69	$255.69	$0.00	$0.00	$71.79	$0.00	$203.77	$203.77	$0.00	$172.25	$272.84	$275.60	$0.00		$0.00	$53.91	$0.00	$0.00	$54.84	$0.00	$0.00	$0.00	$0.00	$0.00
02.03150.300	SUP	HCPCS C1713		02.03150.300  -  SCREW BONE 3.5MM 8MM NCB M8 PROX HUM PROTASUL-64 LCK IM NAIL	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$143.33	$143.33	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.03152.055	SUP	HCPCS C1713		02.03152.055  -  SCREW BONE 5MM 55MM 32MM NCB PROTASUL 64 CANC FEM SLFTAP	BOTH IP/OP	$295.75 	$218.86	$0.00	$236.60	$133.09	$133.09	$0.00	$0.00	$0.00	$61.64	$219.51	$219.51	$0.00	$0.00	$61.63	$0.00	$174.94	$174.94	$0.00	$147.88	$234.23	$236.60	$0.00		$0.00	$46.28	$0.00	$0.00	$47.08	$0.00	$0.00	$0.00	$0.00	$0.00
02.03152.065	SUP	HCPCS C1713		02.03152.065  -  SCREW BONE 5MM 65MM 32MM NCB PROTASUL-64 CANC SLFTAP NONSTRL	BOTH IP/OP	$295.75 	$218.86	$0.00	$236.60	$133.09	$133.09	$0.00	$0.00	$0.00	$61.64	$219.51	$219.51	$0.00	$0.00	$61.63	$0.00	$174.94	$174.94	$0.00	$147.88	$234.23	$236.60	$0.00		$0.00	$46.28	$0.00	$0.00	$47.08	$0.00	$0.00	$0.00	$0.00	$0.00
02.03152.080	SUP	HCPCS C1713		02.03152.080  -  SCREW BONE 5MM 80MM 32MM NCB PROTASUL-64 CANC SLFTAP NONSTRL	BOTH IP/OP	$295.75 	$218.86	$0.00	$236.60	$133.09	$133.09	$0.00	$0.00	$0.00	$61.64	$219.51	$219.51	$0.00	$0.00	$61.63	$0.00	$174.94	$174.94	$0.00	$147.88	$234.23	$236.60	$0.00		$0.00	$46.28	$0.00	$0.00	$47.08	$0.00	$0.00	$0.00	$0.00	$0.00
02.03152.085	SUP	HCPCS C1713		02.03152.085  -  SCREW BONE 5MM 85MM 32MM NCB PROTASUL-64 CANC SLFTAP NONSTRL	BOTH IP/OP	$295.75 	$218.86	$0.00	$236.60	$133.09	$133.09	$0.00	$0.00	$0.00	$61.64	$219.51	$219.51	$0.00	$0.00	$61.63	$0.00	$174.94	$174.94	$0.00	$147.88	$234.23	$236.60	$0.00		$0.00	$46.28	$0.00	$0.00	$47.08	$0.00	$0.00	$0.00	$0.00	$0.00
02.03260.109	SUP	HCPCS C1713		02.03260.109  -  PLATE 246MM PROTASUL-64 9 HOLE NCB-DF BONE LEFT FEM NONSTRL	BOTH IP/OP	"$2,957.50 "	"$2,188.55"	$0.00	"$2,366.00"	"$1,330.88"	"$1,330.88"	$0.00	$0.00	$0.00	$616.42	"$2,195.06"	"$2,195.06"	$0.00	$0.00	$616.34	$0.00	"$1,458.05"	"$1,458.05"	$0.00	"$1,478.75"	"$2,342.34"	"$2,366.00"	$0.00		$0.00	$462.85	$0.00	$0.00	$470.83	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.004	SUP	HCPCS C1713		02.100.004  -  PLATE BN 57X10X3.4MM NS CMBN 4 HL LCK LOPRFL COAX SS PUBIC	BOTH IP/OP	"$1,478.80 "	"$1,094.31"	$0.00	"$1,148.58"	$646.08	$646.08	$0.00	$0.00	$0.00	$308.22	"$1,097.57"	"$1,097.57"	$0.00	$0.00	$308.18	$0.00	$874.71	$874.71	$0.00	$717.86	"$1,137.10"	"$1,148.58"	$0.00		$0.00	$218.15	$0.00	$0.00	$228.57	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.006	SUP	HCPCS C1713		02.100.006  -  PLATE BN 78X10X3.4MM NS CMBN 6 HL LCK LOPRFL COAX SS PUBIC	BOTH IP/OP	"$1,620.78 "	"$1,199.38"	$0.00	"$1,258.84"	$708.10	$708.10	$0.00	$0.00	$0.00	$337.81	"$1,202.94"	"$1,202.94"	$0.00	$0.00	$337.77	$0.00	$958.69	$958.69	$0.00	$786.78	"$1,246.25"	"$1,258.84"	$0.00		$0.00	$239.09	$0.00	$0.00	$250.51	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.014	SUP	HCPCS C1713		02.100.014  -  PLATE BONE 57MM 4 HOLE LP STAINLESS STEEL PUBIC SYMPHYSIS	BOTH IP/OP	"$1,623.58 "	"$1,201.45"	$0.00	"$1,261.02"	$709.32	$709.32	$0.00	$0.00	$0.00	$338.39	"$1,205.02"	"$1,205.02"	$0.00	$0.00	$338.35	$0.00	$960.34	$960.34	$0.00	$788.14	"$1,248.41"	"$1,261.02"	$0.00		$0.00	$239.50	$0.00	$0.00	$250.94	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.016	SUP	HCPCS C1713		02.100.016  -  PLATE BONE 78MM 6 HOLE LP STAINLESS STEEL PUBIC SYMPHYSIS	BOTH IP/OP	"$1,781.00 "	"$1,317.94"	$0.00	"$1,383.32"	$778.12	$778.12	$0.00	$0.00	$0.00	$371.20	"$1,321.86"	"$1,321.86"	$0.00	$0.00	$371.16	$0.00	"$1,053.46"	"$1,053.46"	$0.00	$864.58	"$1,369.49"	"$1,383.32"	$0.00		$0.00	$262.73	$0.00	$0.00	$275.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.020	SUP	HCPCS C1713		02.100.020  -  PLATE BONE LOCK LCP STAINLESS STEEL NAVICULAR NONSTRL	BOTH IP/OP	"$1,464.73 "	"$1,083.90"	$0.00	"$1,137.66"	$639.93	$639.93	$0.00	$0.00	$0.00	$305.29	"$1,087.12"	"$1,087.12"	$0.00	$0.00	$305.25	$0.00	$866.38	$866.38	$0.00	$711.04	"$1,126.29"	"$1,137.66"	$0.00		$0.00	$216.07	$0.00	$0.00	$226.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.021	SUP	HCPCS C1713		02.100.021  -  PLATE BONE LOCK STAINLESS STEEL LEFT CUBOID NONSTRL 2.4/2.7	BOTH IP/OP	"$1,425.38 "	"$1,054.78"	$0.00	"$1,107.08"	$622.73	$622.73	$0.00	$0.00	$0.00	$297.08	"$1,057.91"	"$1,057.91"	$0.00	$0.00	$297.05	$0.00	$843.11	$843.11	$0.00	$691.93	"$1,096.01"	"$1,107.08"	$0.00		$0.00	$210.27	$0.00	$0.00	$220.31	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.022	SUP	HCPCS C1713		02.100.022  -  PLATE BONE LOCK STAINLESS STEEL RIGHT CUBOID NONSTRL 2.4/2.7	BOTH IP/OP	"$1,425.38 "	"$1,054.78"	$0.00	"$1,107.08"	$622.73	$622.73	$0.00	$0.00	$0.00	$297.08	"$1,057.91"	"$1,057.91"	$0.00	$0.00	$297.05	$0.00	$843.11	$843.11	$0.00	$691.93	"$1,096.01"	"$1,107.08"	$0.00		$0.00	$210.27	$0.00	$0.00	$220.31	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.023	SUP	HCPCS C1713		02.100.023  -  PLATE BONE LOCK STAINLESS STEEL TALAR NONSTRL 2.4/2.7 MM	BOTH IP/OP	"$1,408.50 "	"$1,042.29"	$0.00	"$1,093.98"	$615.36	$615.36	$0.00	$0.00	$0.00	$293.57	"$1,045.39"	"$1,045.39"	$0.00	$0.00	$293.53	$0.00	$833.13	$833.13	$0.00	$683.74	"$1,083.04"	"$1,093.98"	$0.00		$0.00	$207.78	$0.00	$0.00	$217.70	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.032S	SUP	HCPCS C1713		02.100.032S  -  PLATE BN 100MM STRL LCP CMBN 6 HL SS ANKL ANT 4.5MM CORT	BOTH IP/OP	"$2,015.98 "	"$1,491.83"	$0.00	"$1,565.80"	$880.76	$880.76	$0.00	$0.00	$0.00	$420.18	"$1,496.26"	"$1,496.26"	$0.00	$0.00	$420.13	$0.00	"$1,192.45"	"$1,192.45"	$0.00	$978.63	"$1,550.14"	"$1,565.80"	$0.00		$0.00	$297.39	$0.00	$0.00	$311.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.033S	SUP	HCPCS C1713		02.100.033S  -  PLATE BONE 116MM 7 HOLE LCP STAINLESS STEEL ANTERIOR ANKLE	BOTH IP/OP	"$2,069.95 "	"$1,531.76"	$0.00	"$1,607.72"	$904.34	$904.34	$0.00	$0.00	$0.00	$431.43	"$1,536.32"	"$1,536.32"	$0.00	$0.00	$431.38	$0.00	"$1,224.38"	"$1,224.38"	$0.00	"$1,004.83"	"$1,591.64"	"$1,607.72"	$0.00		$0.00	$305.35	$0.00	$0.00	$319.94	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.103	SUP	HCPCS C1713		02.100.103  -  PLATE BN STRG 39X10.1X3.7MM NS CMBN 3 HL LCK LOPRFL RECON SS	BOTH IP/OP	$983.98 	$728.15	$0.00	$764.26	$429.90	$429.90	$0.00	$0.00	$0.00	$205.08	$730.31	$730.31	$0.00	$0.00	$205.06	$0.00	$582.02	$582.02	$0.00	$477.66	$756.62	$764.26	$0.00		$0.00	$145.15	$0.00	$0.00	$152.09	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.104	SUP	HCPCS C1713		02.100.104  -  PLATE BN STRG 52X10.1X3.7MM NS CMBN 4 HL LCK LOPRFL RECON SS	BOTH IP/OP	"$1,033.18 "	$764.55	$0.00	$802.48	$451.40	$451.40	$0.00	$0.00	$0.00	$215.34	$766.82	$766.82	$0.00	$0.00	$215.31	$0.00	$611.12	$611.12	$0.00	$501.55	$794.46	$802.48	$0.00		$0.00	$152.41	$0.00	$0.00	$159.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.105	SUP	HCPCS C1713		02.100.105  -  PLATE BN STRG 65X10.1X3.7MM NS CMBN 5 HL LCK LOPRFL RECON SS	BOTH IP/OP	"$1,079.58 "	$798.89	$0.00	$838.50	$471.66	$471.66	$0.00	$0.00	$0.00	$225.01	$801.26	$801.26	$0.00	$0.00	$224.98	$0.00	$638.57	$638.57	$0.00	$524.06	$830.12	$838.50	$0.00		$0.00	$159.25	$0.00	$0.00	$166.86	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.106	SUP	HCPCS C1713		02.100.106  -  PLATE BN STRG 78X10.1X3.7MM NS CMBN 6 HL LCK LOPRFL RECON SS	BOTH IP/OP	"$1,124.55 "	$832.17	$0.00	$873.44	$491.31	$491.31	$0.00	$0.00	$0.00	$234.38	$834.64	$834.64	$0.00	$0.00	$234.36	$0.00	$665.17	$665.17	$0.00	$545.90	$864.71	$873.44	$0.00		$0.00	$165.89	$0.00	$0.00	$173.81	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.107	SUP	HCPCS C1713		02.100.107  -  PLATE BN STRG 91X10.1X3.7MM NS CMBN 7 HL LCK LOPRFL RECON SS	BOTH IP/OP	"$1,168.13 "	$864.42	$0.00	$907.28	$510.35	$510.35	$0.00	$0.00	$0.00	$243.47	$866.98	$866.98	$0.00	$0.00	$243.44	$0.00	$690.95	$690.95	$0.00	$567.05	$898.21	$907.28	$0.00		$0.00	$172.32	$0.00	$0.00	$180.55	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.108	SUP	HCPCS C1713		02.100.108  -  PLATE BN STRG 104X10.1X3.7MM NS CMBN 8 HL LCK LOPRFL RECON	BOTH IP/OP	"$1,213.13 "	$897.72	$0.00	$942.22	$530.00	$530.00	$0.00	$0.00	$0.00	$252.85	$900.38	$900.38	$0.00	$0.00	$252.82	$0.00	$717.56	$717.56	$0.00	$588.89	$932.80	$942.22	$0.00		$0.00	$178.95	$0.00	$0.00	$187.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.109	SUP	HCPCS C1713		02.100.109  -  PLATE BN STRG 117X10.1X3.7MM NS CMBN 9 HL LCK LOPRFL RECON	BOTH IP/OP	"$1,258.10 "	$930.99	$0.00	$977.16	$549.65	$549.65	$0.00	$0.00	$0.00	$262.22	$933.76	$933.76	$0.00	$0.00	$262.19	$0.00	$744.17	$744.17	$0.00	$610.73	$967.39	$977.16	$0.00		$0.00	$185.59	$0.00	$0.00	$194.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.110	SUP	HCPCS C1713		02.100.110  -  PLATE BN STRG 130X10.1X3.7MM NS CMBN 10 HL LCK LOPRFL RECON	BOTH IP/OP	"$1,304.48 "	$965.32	$0.00	"$1,013.20"	$569.93	$569.93	$0.00	$0.00	$0.00	$271.89	$968.18	$968.18	$0.00	$0.00	$271.85	$0.00	$771.60	$771.60	$0.00	$633.25	"$1,003.07"	"$1,013.20"	$0.00		$0.00	$192.43	$0.00	$0.00	$201.63	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.111	SUP	HCPCS C1713		02.100.111  -  PLATE BN STRG 143X10.1X3.7MM NS CMBN 11 HL LCK LOPRFL RECON	BOTH IP/OP	"$1,349.48 "	$998.62	$0.00	"$1,048.12"	$589.57	$589.57	$0.00	$0.00	$0.00	$281.26	"$1,001.58"	"$1,001.58"	$0.00	$0.00	$281.23	$0.00	$798.21	$798.21	$0.00	$655.08	"$1,037.64"	"$1,048.12"	$0.00		$0.00	$199.07	$0.00	$0.00	$208.58	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.112	SUP	HCPCS C1713		02.100.112  -  PLATE BN STRG 156X10.1X3.7MM NS CMBN 12 HL LCK LOPRFL RECON	BOTH IP/OP	"$1,393.05 "	"$1,030.86"	$0.00	"$1,081.98"	$608.61	$608.61	$0.00	$0.00	$0.00	$290.35	"$1,033.92"	"$1,033.92"	$0.00	$0.00	$290.31	$0.00	$823.99	$823.99	$0.00	$676.24	"$1,071.16"	"$1,081.98"	$0.00		$0.00	$205.50	$0.00	$0.00	$215.31	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.113	SUP	HCPCS C1713		02.100.113  -  PLATE BN STRG 169X10.1X3.7MM NS CMBN 13 HL LCK LOPRFL RECON	BOTH IP/OP	"$1,439.43 "	"$1,065.18"	$0.00	"$1,118.00"	$628.88	$628.88	$0.00	$0.00	$0.00	$300.01	"$1,068.34"	"$1,068.34"	$0.00	$0.00	$299.98	$0.00	$851.42	$851.42	$0.00	$698.75	"$1,106.82"	"$1,118.00"	$0.00		$0.00	$212.34	$0.00	$0.00	$222.48	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.114	SUP	HCPCS C1713		02.100.114  -  PLATE BN STRG 182X10.1X3.7MM NS CMBN 14 HL LCK LOPRFL RECON	BOTH IP/OP	"$1,487.23 "	"$1,100.55"	$0.00	"$1,155.12"	$649.76	$649.76	$0.00	$0.00	$0.00	$309.97	"$1,103.82"	"$1,103.82"	$0.00	$0.00	$309.94	$0.00	$879.69	$879.69	$0.00	$721.95	"$1,143.57"	"$1,155.12"	$0.00		$0.00	$219.39	$0.00	$0.00	$229.87	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.115	SUP	HCPCS C1713		02.100.115  -  PLATE BN STRG 195X10.1X3.7MM NS CMBN 15 HL LCK LOPRFL RECON	BOTH IP/OP	"$1,532.20 "	"$1,133.83"	$0.00	"$1,190.06"	$669.41	$669.41	$0.00	$0.00	$0.00	$319.35	"$1,137.20"	"$1,137.20"	$0.00	$0.00	$319.31	$0.00	$906.30	$906.30	$0.00	$743.79	"$1,178.16"	"$1,190.06"	$0.00		$0.00	$226.03	$0.00	$0.00	$236.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.116	SUP	HCPCS C1713		02.100.116  -  PLATE BN STRG 208X10.1X3.7MM NS CMBN 16 HL LCK LOPRFL RECON	BOTH IP/OP	"$1,577.18 "	"$1,167.11"	$0.00	"$1,225.00"	$689.06	$689.06	$0.00	$0.00	$0.00	$328.72	"$1,170.58"	"$1,170.58"	$0.00	$0.00	$328.68	$0.00	$932.90	$932.90	$0.00	$765.63	"$1,212.75"	"$1,225.00"	$0.00		$0.00	$232.66	$0.00	$0.00	$243.78	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.118	SUP	HCPCS C1713		02.100.118  -  PLATE BN STRG 234X10.1X3.7MM NS CMBN 18 HL LCK LOPRFL RECON	BOTH IP/OP	"$1,622.18 "	"$1,200.41"	$0.00	"$1,259.94"	$708.72	$708.72	$0.00	$0.00	$0.00	$338.10	"$1,203.98"	"$1,203.98"	$0.00	$0.00	$338.06	$0.00	$959.52	$959.52	$0.00	$787.46	"$1,247.34"	"$1,259.94"	$0.00		$0.00	$239.30	$0.00	$0.00	$250.73	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.120	SUP	HCPCS C1713		02.100.120  -  PLATE BN STRG 260X10.1X3.7MM NS CMBN 20 HL LCK LOPRFL RECON	BOTH IP/OP	"$1,669.98 "	"$1,235.79"	$0.00	"$1,297.06"	$729.60	$729.60	$0.00	$0.00	$0.00	$348.06	"$1,239.46"	"$1,239.46"	$0.00	$0.00	$348.02	$0.00	$987.79	$987.79	$0.00	$810.66	"$1,284.09"	"$1,297.06"	$0.00		$0.00	$246.35	$0.00	$0.00	$258.11	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.203	SUP	HCPCS C1713		02.100.203  -  PLATE BONE WIDE ANGLE LP 39MM 3 HOLE RECONSTRUCTION	BOTH IP/OP	$607.25 	$449.37	$0.00	$471.66	$265.31	$265.31	$0.00	$0.00	$0.00	$126.57	$450.70	$450.70	$0.00	$0.00	$126.55	$0.00	$359.19	$359.19	$0.00	$294.79	$466.95	$471.66	$0.00		$0.00	$89.58	$0.00	$0.00	$93.86	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.204	SUP	HCPCS C1713		02.100.204  -  PLATE BONE WIDE ANGLE LP 52MM 4 HOLE RECONSTRUCTION	BOTH IP/OP	$635.38 	$470.18	$0.00	$493.50	$277.59	$277.59	$0.00	$0.00	$0.00	$132.43	$471.58	$471.58	$0.00	$0.00	$132.41	$0.00	$375.82	$375.82	$0.00	$308.44	$488.57	$493.50	$0.00		$0.00	$93.73	$0.00	$0.00	$98.21	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.205	SUP	HCPCS C1713		02.100.205  -  PLATE BONE WIDE ANGLE LP 65MM 5 HOLE RECONSTRUCTION	BOTH IP/OP	$662.08 	$489.94	$0.00	$514.24	$289.26	$289.26	$0.00	$0.00	$0.00	$137.99	$491.39	$491.39	$0.00	$0.00	$137.98	$0.00	$391.62	$391.62	$0.00	$321.40	$509.10	$514.24	$0.00		$0.00	$97.67	$0.00	$0.00	$102.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.206	SUP	HCPCS C1713		02.100.206  -  PLATE BONE WIDE ANGLE LP 78MM 6 HOLE RECONSTRUCTION	BOTH IP/OP	$693.00 	$512.82	$0.00	$538.26	$302.77	$302.77	$0.00	$0.00	$0.00	$144.44	$514.34	$514.34	$0.00	$0.00	$144.42	$0.00	$409.91	$409.91	$0.00	$336.41	$532.88	$538.26	$0.00		$0.00	$102.23	$0.00	$0.00	$107.11	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.207	SUP	HCPCS C1713		02.100.207  -  PLATE BONE WIDE ANGLE LP 91MM 7 HOLE RECONSTRUCTION	BOTH IP/OP	$721.13 	$533.64	$0.00	$560.10	$315.06	$315.06	$0.00	$0.00	$0.00	$150.30	$535.22	$535.22	$0.00	$0.00	$150.28	$0.00	$426.55	$426.55	$0.00	$350.06	$554.50	$560.10	$0.00		$0.00	$106.38	$0.00	$0.00	$111.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.208	SUP	HCPCS C1713		02.100.208  -  PLATE BONE WIDE ANGLE 104MM 8 HOLE LP STAINLESS STEEL PELVIS	BOTH IP/OP	$747.83 	$553.39	$0.00	$580.84	$326.72	$326.72	$0.00	$0.00	$0.00	$155.87	$555.04	$555.04	$0.00	$0.00	$155.85	$0.00	$442.34	$442.34	$0.00	$363.03	$575.03	$580.84	$0.00		$0.00	$110.32	$0.00	$0.00	$115.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.209	SUP	HCPCS C1713		02.100.209  -  PLATE BONE WIDE ANGLE LP 117MM 9 HOLE RECONSTRUCTION	BOTH IP/OP	$778.75 	$576.28	$0.00	$604.86	$340.23	$340.23	$0.00	$0.00	$0.00	$162.31	$577.99	$577.99	$0.00	$0.00	$162.29	$0.00	$460.63	$460.63	$0.00	$378.04	$598.82	$604.86	$0.00		$0.00	$114.88	$0.00	$0.00	$120.37	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.210	SUP	HCPCS C1713		02.100.210  -  PLATE BONE WIDE ANGLE LP 130MM 10 HOLE RECONSTRUCTION	BOTH IP/OP	$808.28 	$598.13	$0.00	$627.78	$353.13	$353.13	$0.00	$0.00	$0.00	$168.46	$599.90	$599.90	$0.00	$0.00	$168.44	$0.00	$478.09	$478.09	$0.00	$392.36	$621.51	$627.78	$0.00		$0.00	$119.23	$0.00	$0.00	$124.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.211	SUP	HCPCS C1713		02.100.211  -  PLATE BONE WIDE ANGLE LP 143MM 11 HOLE RECONSTRUCTION	BOTH IP/OP	$850.45 	$629.33	$0.00	$660.54	$371.55	$371.55	$0.00	$0.00	$0.00	$177.26	$631.20	$631.20	$0.00	$0.00	$177.23	$0.00	$503.04	$503.04	$0.00	$412.84	$653.94	$660.54	$0.00		$0.00	$125.45	$0.00	$0.00	$131.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.212	SUP	HCPCS C1713		02.100.212  -  PLATE BN WA 156X10.1X3.85MM NS CMBN 12 HL RECON LOPRFL SS	BOTH IP/OP	$898.25 	$664.71	$0.00	$697.66	$392.43	$392.43	$0.00	$0.00	$0.00	$187.22	$666.68	$666.68	$0.00	$0.00	$187.20	$0.00	$531.31	$531.31	$0.00	$436.04	$690.69	$697.66	$0.00		$0.00	$132.50	$0.00	$0.00	$138.83	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.213	SUP	HCPCS C1713		02.100.213  -  PLATE BONE WIDE ANGLE LP 169MM 13 HOLE RECONSTRUCTION	BOTH IP/OP	$944.63 	$699.03	$0.00	$733.68	$412.70	$412.70	$0.00	$0.00	$0.00	$196.88	$701.10	$701.10	$0.00	$0.00	$196.86	$0.00	$558.75	$558.75	$0.00	$458.55	$726.34	$733.68	$0.00		$0.00	$139.35	$0.00	$0.00	$146.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.214	SUP	HCPCS C1713		02.100.214  -  PLATE BONE WIDE ANGLE LP 182MM 14 HOLE RECONSTRUCTION	BOTH IP/OP	$985.40 	$729.20	$0.00	$765.36	$430.52	$430.52	$0.00	$0.00	$0.00	$205.38	$731.36	$731.36	$0.00	$0.00	$205.36	$0.00	$582.86	$582.86	$0.00	$478.35	$757.71	$765.36	$0.00		$0.00	$145.36	$0.00	$0.00	$152.31	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.215	SUP	HCPCS C1713		02.100.215  -  PLATE BONE WIDE ANGLE LP 195MM 15 HOLE RECONSTRUCTION	BOTH IP/OP	"$1,034.60 "	$765.60	$0.00	$803.56	$452.00	$452.00	$0.00	$0.00	$0.00	$215.64	$767.88	$767.88	$0.00	$0.00	$215.61	$0.00	$611.97	$611.97	$0.00	$502.23	$795.52	$803.56	$0.00		$0.00	$152.62	$0.00	$0.00	$159.91	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.216	SUP	HCPCS C1713		02.100.216  -  PLATE BONE WIDE ANGLE LP 208MM 16 HOLE RECONSTRUCTION	BOTH IP/OP	"$1,080.98 "	$799.93	$0.00	$839.60	$472.28	$472.28	$0.00	$0.00	$0.00	$225.30	$802.30	$802.30	$0.00	$0.00	$225.28	$0.00	$639.40	$639.40	$0.00	$524.75	$831.20	$839.60	$0.00		$0.00	$159.46	$0.00	$0.00	$167.08	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.218	SUP	HCPCS C1713		02.100.218  -  PLATE BONE WIDE ANGLE LP 234MM 18 HOLE RECONSTRUCTION	BOTH IP/OP	"$1,127.38 "	$834.26	$0.00	$875.62	$492.54	$492.54	$0.00	$0.00	$0.00	$234.97	$836.74	$836.74	$0.00	$0.00	$234.94	$0.00	$666.84	$666.84	$0.00	$547.26	$866.87	$875.62	$0.00		$0.00	$166.30	$0.00	$0.00	$174.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.220	SUP	HCPCS C1713		02.100.220  -  PLATE BONE WIDE ANGLE LP 260MM 20 HOLE RECONSTRUCTION	BOTH IP/OP	"$1,169.53 "	$865.45	$0.00	$908.38	$510.96	$510.96	$0.00	$0.00	$0.00	$243.76	$868.02	$868.02	$0.00	$0.00	$243.73	$0.00	$691.77	$691.77	$0.00	$567.74	$899.30	$908.38	$0.00		$0.00	$172.53	$0.00	$0.00	$180.77	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.301	SUP	HCPCS C1713		02.100.301  -  PLATE BONE 1 HOLE SPRING LCP STAINLESS STEEL PELVIC NONSTRL	BOTH IP/OP	$424.53 	$314.15	$0.00	$329.72	$185.47	$185.47	$0.00	$0.00	$0.00	$88.48	$315.08	$315.08	$0.00	$0.00	$88.47	$0.00	$251.11	$251.11	$0.00	$206.08	$326.42	$329.72	$0.00		$0.00	$62.62	$0.00	$0.00	$65.61	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.302	SUP	HCPCS C1713		02.100.302  -  PLATE BONE 2 HOLE SPRING LCP STAINLESS STEEL PELVIC NONSTRL	BOTH IP/OP	$461.08 	$341.20	$0.00	$358.12	$201.44	$201.44	$0.00	$0.00	$0.00	$96.10	$342.21	$342.21	$0.00	$0.00	$96.09	$0.00	$272.73	$272.73	$0.00	$223.83	$354.54	$358.12	$0.00		$0.00	$68.01	$0.00	$0.00	$71.27	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.303	SUP	HCPCS C1713		02.100.303  -  PLATE BONE 3 HOLE SPRING LCP STAINLESS STEEL PELVIC NONSTRL	BOTH IP/OP	$506.05 	$374.48	$0.00	$393.04	$221.09	$221.09	$0.00	$0.00	$0.00	$105.47	$375.59	$375.59	$0.00	$0.00	$105.46	$0.00	$299.33	$299.33	$0.00	$245.65	$389.11	$393.04	$0.00		$0.00	$74.65	$0.00	$0.00	$78.21	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.325S	SUP	HCPCS C1713		02.100.325S  -  PLATE BONE STANDARD QUADRILATERAL SURFACE STAINLESS STEEL	BOTH IP/OP	$736.58 	$545.07	$0.00	$572.10	$321.81	$321.81	$0.00	$0.00	$0.00	$153.52	$546.69	$546.69	$0.00	$0.00	$153.50	$0.00	$435.68	$435.68	$0.00	$357.56	$566.38	$572.10	$0.00		$0.00	$108.66	$0.00	$0.00	$113.85	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.326S	SUP	HCPCS C1713		02.100.326S  -  PLATE BONE LONG QUADRILATERAL SURFACE STAINLESS STEEL PELVIS	BOTH IP/OP	$811.08 	$600.20	$0.00	$629.96	$354.35	$354.35	$0.00	$0.00	$0.00	$169.05	$601.98	$601.98	$0.00	$0.00	$169.03	$0.00	$479.75	$479.75	$0.00	$393.73	$623.66	$629.96	$0.00		$0.00	$119.65	$0.00	$0.00	$125.36	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.327S	SUP	HCPCS C1713		02.100.327S  -  PLATE BONE SHORT LP QUADRILATERAL SURFACE STAINLESS STEEL	BOTH IP/OP	$669.10 	$495.13	$0.00	$519.70	$292.33	$292.33	$0.00	$0.00	$0.00	$139.46	$496.61	$496.61	$0.00	$0.00	$139.44	$0.00	$395.77	$395.77	$0.00	$324.81	$514.51	$519.70	$0.00		$0.00	$98.70	$0.00	$0.00	$103.42	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.360	SUP	HCPCS C1713		02.100.360  -  PLATE BONE J CVD 130X10.1X3.7MM 10 HOLE LOCKING COAXIAL	BOTH IP/OP	"$1,356.50 "	"$1,003.81"	$0.00	"$1,053.58"	$592.64	$592.64	$0.00	$0.00	$0.00	$282.73	"$1,006.79"	"$1,006.79"	$0.00	$0.00	$282.69	$0.00	$802.37	$802.37	$0.00	$658.49	"$1,043.05"	"$1,053.58"	$0.00		$0.00	$200.10	$0.00	$0.00	$209.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.361	SUP	HCPCS C1713		02.100.361  -  PLATE BN 88MM RDS J 130X10.1X3.7MM NS CMBN 10 HL LCK LOPRFL	BOTH IP/OP	"$1,356.50 "	"$1,003.81"	$0.00	"$1,053.58"	$592.64	$592.64	$0.00	$0.00	$0.00	$282.73	"$1,006.79"	"$1,006.79"	$0.00	$0.00	$282.69	$0.00	$802.37	$802.37	$0.00	$658.49	"$1,043.05"	"$1,053.58"	$0.00		$0.00	$200.10	$0.00	$0.00	$209.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.362	SUP	HCPCS C1713		02.100.362  -  PLATE BONE 156MM 12 HOLE J LOCKING LP RECONSTRUCTION LCP	BOTH IP/OP	"$1,432.40 "	"$1,059.98"	$0.00	"$1,112.54"	$625.80	$625.80	$0.00	$0.00	$0.00	$298.55	"$1,063.13"	"$1,063.13"	$0.00	$0.00	$298.51	$0.00	$847.26	$847.26	$0.00	$695.34	"$1,101.42"	"$1,112.54"	$0.00		$0.00	$211.30	$0.00	$0.00	$221.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.363	SUP	HCPCS C1713		02.100.363  -  PLATE BONE J CVD 156X10.1X3.7MM 12 HOLE LOCKING COAXIAL	BOTH IP/OP	"$1,432.40 "	"$1,059.98"	$0.00	"$1,112.54"	$625.80	$625.80	$0.00	$0.00	$0.00	$298.55	"$1,063.13"	"$1,063.13"	$0.00	$0.00	$298.51	$0.00	$847.26	$847.26	$0.00	$695.34	"$1,101.42"	"$1,112.54"	$0.00		$0.00	$211.30	$0.00	$0.00	$221.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.364	SUP	HCPCS C1713		02.100.364  -  PLATE BONE J CVD 182X10.1X3.7MM 14 HOLE LOCKING COAXIAL	BOTH IP/OP	"$1,509.73 "	"$1,117.20"	$0.00	"$1,172.60"	$659.59	$659.59	$0.00	$0.00	$0.00	$314.66	"$1,120.52"	"$1,120.52"	$0.00	$0.00	$314.63	$0.00	$893.00	$893.00	$0.00	$732.88	"$1,160.87"	"$1,172.60"	$0.00		$0.00	$222.71	$0.00	$0.00	$233.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.365	SUP	HCPCS C1713		02.100.365  -  PLATE BONE 182MM 14 HOLE J LOCKING LP RECONSTRUCTION LCP	BOTH IP/OP	"$1,509.73 "	"$1,117.20"	$0.00	"$1,172.60"	$659.59	$659.59	$0.00	$0.00	$0.00	$314.66	"$1,120.52"	"$1,120.52"	$0.00	$0.00	$314.63	$0.00	$893.00	$893.00	$0.00	$732.88	"$1,160.87"	"$1,172.60"	$0.00		$0.00	$222.71	$0.00	$0.00	$233.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.366	SUP	HCPCS C1713		02.100.366  -  PLATE BN 88MM RDS J 208X10.1X3.7MM NS CMBN 16 HL LCK LOPRFL	BOTH IP/OP	"$1,596.88 "	"$1,181.69"	$0.00	"$1,240.28"	$697.66	$697.66	$0.00	$0.00	$0.00	$332.83	"$1,185.20"	"$1,185.20"	$0.00	$0.00	$332.79	$0.00	$944.55	$944.55	$0.00	$775.18	"$1,227.88"	"$1,240.28"	$0.00		$0.00	$235.56	$0.00	$0.00	$246.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.100.367	SUP	HCPCS C1713		02.100.367  -  PLATE BN 88MM RDS J 208X10.1X3.7MM NS CMBN 16 HL LCK LOPRFL	BOTH IP/OP	"$1,596.88 "	"$1,181.69"	$0.00	"$1,240.28"	$697.66	$697.66	$0.00	$0.00	$0.00	$332.83	"$1,185.20"	"$1,185.20"	$0.00	$0.00	$332.79	$0.00	$944.55	$944.55	$0.00	$775.18	"$1,227.88"	"$1,240.28"	$0.00		$0.00	$235.56	$0.00	$0.00	$246.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.102.001	SUP	HCPCS C1713		02.102.001  -  PLATE BONE UNIVERSAL 131MM LOCKING STABILIZATION LCP	BOTH IP/OP	"$1,234.20 "	$913.31	$0.00	$958.60	$539.21	$539.21	$0.00	$0.00	$0.00	$257.24	$916.02	$916.02	$0.00	$0.00	$257.21	$0.00	$730.03	$730.03	$0.00	$599.13	$949.01	$958.60	$0.00		$0.00	$182.06	$0.00	$0.00	$190.76	$0.00	$0.00	$0.00	$0.00	$0.00
02.104.004	SUP	HCPCS C1713		02.104.004  -  PLATE BN 122MM NS LCP CMBN 4 HL PRECONTOUR LMT CNTCT TPR HD	BOTH IP/OP	"$2,292.68 "	"$1,696.58"	$0.00	"$1,780.72"	"$1,001.66"	"$1,001.66"	$0.00	$0.00	$0.00	$477.85	"$1,701.62"	"$1,701.62"	$0.00	$0.00	$477.79	$0.00	"$1,356.12"	"$1,356.12"	$0.00	"$1,112.95"	"$1,762.91"	"$1,780.72"	$0.00		$0.00	$338.21	$0.00	$0.00	$354.36	$0.00	$0.00	$0.00	$0.00	$0.00
02.104.006	SUP	HCPCS C1713		02.104.006  -  PLATE BONE 158MM 6 HOLE LCP STAINLESS STEEL RIGHT DISTAL	BOTH IP/OP	"$2,623.03 "	"$1,941.04"	$0.00	"$2,037.30"	"$1,145.98"	"$1,145.98"	$0.00	$0.00	$0.00	$546.70	"$1,946.81"	"$1,946.81"	$0.00	$0.00	$546.64	$0.00	"$1,293.15"	"$1,293.15"	$0.00	"$1,273.31"	"$2,016.93"	"$2,037.30"	$0.00		$0.00	$386.94	$0.00	$0.00	$405.42	$0.00	$0.00	$0.00	$0.00	$0.00
02.104.008	SUP	HCPCS C1713		02.104.008  -  PLATE BONE 194MM 8 HOLE LOCKING TAPER HEAD LIMIT CONTACT	BOTH IP/OP	"$2,783.28 "	"$2,059.63"	$0.00	"$2,161.76"	"$1,215.99"	"$1,215.99"	$0.00	$0.00	$0.00	$580.10	"$2,065.75"	"$2,065.75"	$0.00	$0.00	$580.03	$0.00	"$1,372.15"	"$1,372.15"	$0.00	"$1,351.10"	"$2,140.14"	"$2,161.76"	$0.00		$0.00	$410.58	$0.00	$0.00	$430.19	$0.00	$0.00	$0.00	$0.00	$0.00
02.104.010	SUP	HCPCS C1713		02.104.010  -  PLATE BONE 230MM 10 HOLE LCP STAINLESS STEEL EXTART RIGHT	BOTH IP/OP	"$2,946.33 "	"$2,180.28"	$0.00	"$2,288.42"	"$1,287.24"	"$1,287.24"	$0.00	$0.00	$0.00	$614.09	"$2,186.76"	"$2,186.76"	$0.00	$0.00	$614.01	$0.00	"$1,452.54"	"$1,452.54"	$0.00	"$1,430.26"	"$2,265.54"	"$2,288.42"	$0.00		$0.00	$434.63	$0.00	$0.00	$455.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.104.012	SUP	HCPCS C1713		02.104.012  -  PLATE BN 266MM NS LCP CMBN 12 HL PRECONTOUR LMT CNTCT TPR HD	BOTH IP/OP	"$3,366.63 "	"$2,491.31"	$0.00	"$2,614.86"	"$1,470.86"	"$1,470.86"	$0.00	$0.00	$0.00	$701.69	"$2,498.71"	"$2,498.71"	$0.00	$0.00	$701.60	$0.00	"$1,659.75"	"$1,659.75"	$0.00	"$1,634.29"	"$2,588.72"	"$2,614.86"	$0.00		$0.00	$496.63	$0.00	$0.00	$520.36	$0.00	$0.00	$0.00	$0.00	$0.00
02.104.014	SUP	HCPCS C1713		02.104.014  -  PLATE BN 302MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT TPR HD	BOTH IP/OP	"$3,705.40 "	"$2,742.00"	$0.00	"$2,877.98"	"$1,618.86"	"$1,618.86"	$0.00	$0.00	$0.00	$772.30	"$2,750.15"	"$2,750.15"	$0.00	$0.00	$772.21	$0.00	"$1,826.76"	"$1,826.76"	$0.00	"$1,798.74"	"$2,849.20"	"$2,877.98"	$0.00		$0.00	$546.61	$0.00	$0.00	$572.72	$0.00	$0.00	$0.00	$0.00	$0.00
02.104.024	SUP	HCPCS C1713		02.104.024  -  PLATE BN 122MM NS LCP CMBN 4 HL PRECONTOUR LMT CNTCT TPR HD	BOTH IP/OP	"$2,292.68 "	"$1,696.58"	$0.00	"$1,780.72"	"$1,001.66"	"$1,001.66"	$0.00	$0.00	$0.00	$477.85	"$1,701.62"	"$1,701.62"	$0.00	$0.00	$477.79	$0.00	"$1,356.12"	"$1,356.12"	$0.00	"$1,112.95"	"$1,762.91"	"$1,780.72"	$0.00		$0.00	$338.21	$0.00	$0.00	$354.36	$0.00	$0.00	$0.00	$0.00	$0.00
02.104.026	SUP	HCPCS C1713		02.104.026  -  PLATE BONE 158MM 6 HOLE LCP STAINLESS STEEL LEFT DISTAL	BOTH IP/OP	"$2,623.03 "	"$1,941.04"	$0.00	"$2,037.30"	"$1,145.98"	"$1,145.98"	$0.00	$0.00	$0.00	$546.70	"$1,946.81"	"$1,946.81"	$0.00	$0.00	$546.64	$0.00	"$1,293.15"	"$1,293.15"	$0.00	"$1,273.31"	"$2,016.93"	"$2,037.30"	$0.00		$0.00	$386.94	$0.00	$0.00	$405.42	$0.00	$0.00	$0.00	$0.00	$0.00
02.104.028	SUP	HCPCS C1713		02.104.028  -  PLATE BONE 194MM 8 HOLE LCP STAINLESS STEEL LEFT DISTAL	BOTH IP/OP	"$2,783.28 "	"$2,059.63"	$0.00	"$2,161.76"	"$1,215.99"	"$1,215.99"	$0.00	$0.00	$0.00	$580.10	"$2,065.75"	"$2,065.75"	$0.00	$0.00	$580.03	$0.00	"$1,372.15"	"$1,372.15"	$0.00	"$1,351.10"	"$2,140.14"	"$2,161.76"	$0.00		$0.00	$410.58	$0.00	$0.00	$430.19	$0.00	$0.00	$0.00	$0.00	$0.00
02.104.030	SUP	HCPCS C1713		02.104.030  -  PLATE BONE 230MM 10 HOLE LCP STAINLESS STEEL LEFT DISTAL	BOTH IP/OP	"$2,946.33 "	"$2,180.28"	$0.00	"$2,288.42"	"$1,287.24"	"$1,287.24"	$0.00	$0.00	$0.00	$614.09	"$2,186.76"	"$2,186.76"	$0.00	$0.00	$614.01	$0.00	"$1,452.54"	"$1,452.54"	$0.00	"$1,430.26"	"$2,265.54"	"$2,288.42"	$0.00		$0.00	$434.63	$0.00	$0.00	$455.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.104.032	SUP	HCPCS C1713		02.104.032  -  PLATE BN 266MM NS LCP CMBN 12 HL PRECONTOUR LMT CNTCT TPR HD	BOTH IP/OP	"$3,366.63 "	"$2,491.31"	$0.00	"$2,614.86"	"$1,470.86"	"$1,470.86"	$0.00	$0.00	$0.00	$701.69	"$2,498.71"	"$2,498.71"	$0.00	$0.00	$701.60	$0.00	"$1,659.75"	"$1,659.75"	$0.00	"$1,634.29"	"$2,588.72"	"$2,614.86"	$0.00		$0.00	$496.63	$0.00	$0.00	$520.36	$0.00	$0.00	$0.00	$0.00	$0.00
02.104.034	SUP	HCPCS C1713		02.104.034  -  PLATE BN 302MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT TPR HD	BOTH IP/OP	"$3,705.40 "	"$2,742.00"	$0.00	"$2,877.98"	"$1,618.86"	"$1,618.86"	$0.00	$0.00	$0.00	$772.30	"$2,750.15"	"$2,750.15"	$0.00	$0.00	$772.21	$0.00	"$1,826.76"	"$1,826.76"	$0.00	"$1,798.74"	"$2,849.20"	"$2,877.98"	$0.00		$0.00	$546.61	$0.00	$0.00	$572.72	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.002	SUP	HCPCS C1713		02.107.002  -  PLATE BN 73MM NS LCP CMBN 2 HL VA TPR TIP RND PRFL SS OLCRN	BOTH IP/OP	"$1,730.40 "	"$1,280.50"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$360.66	"$1,284.30"	"$1,284.30"	$0.00	$0.00	$360.62	$0.00	"$1,023.53"	"$1,023.53"	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$255.26	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.002S	SUP	HCPCS C1713		02.107.002S  -  PLATE BONE 73MM 2 HOLE VAR ANG LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,821.78 "	"$1,348.12"	$0.00	"$1,414.98"	$795.93	$795.93	$0.00	$0.00	$0.00	$379.70	"$1,352.12"	"$1,352.12"	$0.00	$0.00	$379.66	$0.00	"$1,077.58"	"$1,077.58"	$0.00	$884.36	"$1,400.83"	"$1,414.98"	$0.00		$0.00	$268.74	$0.00	$0.00	$281.58	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.102	SUP	HCPCS C1713		02.107.102  -  PLATE BONE 73MM 2 HOLE VAR ANG LCP STAINLESS STEEL ELBOW	BOTH IP/OP	"$1,730.40 "	"$1,280.50"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$360.66	"$1,284.30"	"$1,284.30"	$0.00	$0.00	$360.62	$0.00	"$1,023.53"	"$1,023.53"	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$255.26	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.102S	SUP	HCPCS C1713		02.107.102S  -  PLATE BN 73MM STRL LCP CMBN 2 HL VA TPR TIP RND PRFL SS	BOTH IP/OP	"$1,821.78 "	"$1,348.12"	$0.00	"$1,414.98"	$795.93	$795.93	$0.00	$0.00	$0.00	$379.70	"$1,352.12"	"$1,352.12"	$0.00	$0.00	$379.66	$0.00	"$1,077.58"	"$1,077.58"	$0.00	$884.36	"$1,400.83"	"$1,414.98"	$0.00		$0.00	$268.74	$0.00	$0.00	$281.58	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.202S	SUP	HCPCS C1713		02.107.202S  -  PLATE BONE 90MM 2 HOLE VAR ANG LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$2,036.85 "	"$1,507.27"	$0.00	"$1,582.02"	$889.89	$889.89	$0.00	$0.00	$0.00	$424.53	"$1,511.75"	"$1,511.75"	$0.00	$0.00	$424.48	$0.00	"$1,204.80"	"$1,204.80"	$0.00	$988.76	"$1,566.20"	"$1,582.02"	$0.00		$0.00	$300.47	$0.00	$0.00	$314.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.204	SUP	HCPCS C1713		02.107.204  -  PLATE BN 116MM NS LCP CMBN 4 HL VA TPR TIP RND PRFL SS OLCRN	BOTH IP/OP	"$1,945.48 "	"$1,439.66"	$0.00	"$1,511.06"	$849.97	$849.97	$0.00	$0.00	$0.00	$405.49	"$1,443.93"	"$1,443.93"	$0.00	$0.00	$405.44	$0.00	"$1,150.75"	"$1,150.75"	$0.00	$944.41	"$1,495.95"	"$1,511.06"	$0.00		$0.00	$286.99	$0.00	$0.00	$300.70	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.204S	SUP	HCPCS C1713		02.107.204S  -  PLATE BONE 116MM 4 HOLE VAR ANG LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$2,036.85 "	"$1,507.27"	$0.00	"$1,582.02"	$889.89	$889.89	$0.00	$0.00	$0.00	$424.53	"$1,511.75"	"$1,511.75"	$0.00	$0.00	$424.48	$0.00	"$1,204.80"	"$1,204.80"	$0.00	$988.76	"$1,566.20"	"$1,582.02"	$0.00		$0.00	$300.47	$0.00	$0.00	$314.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.206S	SUP	HCPCS C1713		02.107.206S  -  PLATE BONE 142MM 2 HOLE VAR ANG RECONSTRUCTION SEGMENT	BOTH IP/OP	"$2,036.85 "	"$1,507.27"	$0.00	"$1,582.02"	$889.89	$889.89	$0.00	$0.00	$0.00	$424.53	"$1,511.75"	"$1,511.75"	$0.00	$0.00	$424.48	$0.00	"$1,204.80"	"$1,204.80"	$0.00	$988.76	"$1,566.20"	"$1,582.02"	$0.00		$0.00	$300.47	$0.00	$0.00	$314.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.208S	SUP	HCPCS C1713		02.107.208S  -  PLATE BN 169MM STRL LCP CMBN 8 HL VA TPR TIP RND PRFL SS	BOTH IP/OP	"$2,036.85 "	"$1,507.27"	$0.00	"$1,582.02"	$889.89	$889.89	$0.00	$0.00	$0.00	$424.53	"$1,511.75"	"$1,511.75"	$0.00	$0.00	$424.48	$0.00	"$1,204.80"	"$1,204.80"	$0.00	$988.76	"$1,566.20"	"$1,582.02"	$0.00		$0.00	$300.47	$0.00	$0.00	$314.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.302S	SUP	HCPCS C1713		02.107.302S  -  PLATE BONE 90MM 2 HOLE VAR ANG LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$2,036.85 "	"$1,507.27"	$0.00	"$1,582.02"	$889.89	$889.89	$0.00	$0.00	$0.00	$424.53	"$1,511.75"	"$1,511.75"	$0.00	$0.00	$424.48	$0.00	"$1,204.80"	"$1,204.80"	$0.00	$988.76	"$1,566.20"	"$1,582.02"	$0.00		$0.00	$300.47	$0.00	$0.00	$314.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.304	SUP	HCPCS C1713		02.107.304  -  PLATE BN 116MM NS LCP CMBN 4 HL VA TPR TIP RND PRFL SS OLCRN	BOTH IP/OP	"$1,945.48 "	"$1,439.66"	$0.00	"$1,511.06"	$849.97	$849.97	$0.00	$0.00	$0.00	$405.49	"$1,443.93"	"$1,443.93"	$0.00	$0.00	$405.44	$0.00	"$1,150.75"	"$1,150.75"	$0.00	$944.41	"$1,495.95"	"$1,511.06"	$0.00		$0.00	$286.99	$0.00	$0.00	$300.70	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.304S	SUP	HCPCS C1713		02.107.304S  -  PLATE BONE 116MM 4 HOLE VAR ANG RECONSTRUCTION SEGMENT	BOTH IP/OP	"$2,036.85 "	"$1,507.27"	$0.00	"$1,582.02"	$889.89	$889.89	$0.00	$0.00	$0.00	$424.53	"$1,511.75"	"$1,511.75"	$0.00	$0.00	$424.48	$0.00	"$1,204.80"	"$1,204.80"	$0.00	$988.76	"$1,566.20"	"$1,582.02"	$0.00		$0.00	$300.47	$0.00	$0.00	$314.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.306S	SUP	HCPCS C1713		02.107.306S  -  PLATE BONE 142MM 6 HOLE VAR ANG STAINLESS STEEL LEFT	BOTH IP/OP	"$2,036.85 "	"$1,507.27"	$0.00	"$1,582.02"	$889.89	$889.89	$0.00	$0.00	$0.00	$424.53	"$1,511.75"	"$1,511.75"	$0.00	$0.00	$424.48	$0.00	"$1,204.80"	"$1,204.80"	$0.00	$988.76	"$1,566.20"	"$1,582.02"	$0.00		$0.00	$300.47	$0.00	$0.00	$314.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.308S	SUP	HCPCS C1713		02.107.308S  -  PLATE BN 169MM STRL LCP CMBN 8 HL VA TPR TIP RND PRFL SS	BOTH IP/OP	"$2,036.85 "	"$1,507.27"	$0.00	"$1,582.02"	$889.89	$889.89	$0.00	$0.00	$0.00	$424.53	"$1,511.75"	"$1,511.75"	$0.00	$0.00	$424.48	$0.00	"$1,204.80"	"$1,204.80"	$0.00	$988.76	"$1,566.20"	"$1,582.02"	$0.00		$0.00	$300.47	$0.00	$0.00	$314.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.408S	SUP	HCPCS C1713		02.107.408S  -  PLATE BONE 157MM 8 HOLE VAR ANG RECONSTRUCTION SEGMENT	BOTH IP/OP	"$2,329.23 "	"$1,723.63"	$0.00	"$1,809.12"	"$1,017.63"	"$1,017.63"	$0.00	$0.00	$0.00	$485.47	"$1,728.75"	"$1,728.75"	$0.00	$0.00	$485.41	$0.00	"$1,377.74"	"$1,377.74"	$0.00	"$1,130.70"	"$1,791.03"	"$1,809.12"	$0.00		$0.00	$343.60	$0.00	$0.00	$360.01	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.506S	SUP	HCPCS C1713		02.107.506S  -  PLATE BN 131MM STRL LCP CMBN 6 HL VA TPR TIP RND PRFL SS	BOTH IP/OP	"$2,261.40 "	"$1,673.44"	$0.00	"$1,809.12"	"$1,017.63"	"$1,017.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,130.70"	"$1,791.03"	"$1,809.12"	$0.00		$0.00	$343.60	$0.00	$0.00	$360.01	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.508	SUP	HCPCS C1713		02.107.508  -  PLATE BN 157MM NS LCP CMBN 8 HL VA TPR TIP RND PRFL SS ULNA	BOTH IP/OP	"$2,237.85 "	"$1,656.01"	$0.00	"$1,738.14"	$977.70	$977.70	$0.00	$0.00	$0.00	$466.42	"$1,660.93"	"$1,660.93"	$0.00	$0.00	$466.37	$0.00	"$1,323.69"	"$1,323.69"	$0.00	"$1,086.34"	"$1,720.76"	"$1,738.14"	$0.00		$0.00	$330.12	$0.00	$0.00	$345.89	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.508S	SUP	HCPCS C1713		02.107.508S  -  PLATE BONE 157MM 8 HOLE VAR ANG RECONSTRUCTION SEGMENT	BOTH IP/OP	"$2,329.23 "	"$1,723.63"	$0.00	"$1,809.12"	"$1,017.63"	"$1,017.63"	$0.00	$0.00	$0.00	$485.47	"$1,728.75"	"$1,728.75"	$0.00	$0.00	$485.41	$0.00	"$1,377.74"	"$1,377.74"	$0.00	"$1,130.70"	"$1,791.03"	"$1,809.12"	$0.00		$0.00	$343.60	$0.00	$0.00	$360.01	$0.00	$0.00	$0.00	$0.00	$0.00
02.107.512S	SUP	HCPCS C1713		02.107.512S  -  PLATE BONE 211MM 12 HOLE VAR ANG RECONSTRUCTION SEGMENT	BOTH IP/OP	"$2,329.23 "	"$1,723.63"	$0.00	"$1,809.12"	"$1,017.63"	"$1,017.63"	$0.00	$0.00	$0.00	$485.47	"$1,728.75"	"$1,728.75"	$0.00	$0.00	$485.41	$0.00	"$1,377.74"	"$1,377.74"	$0.00	"$1,130.70"	"$1,791.03"	"$1,809.12"	$0.00		$0.00	$343.60	$0.00	$0.00	$360.01	$0.00	$0.00	$0.00	$0.00	$0.00
02.108.200	SUP	Custom 27203010		02.108.200  -  GUIDEWIRE ORTHOPEDIC THREAD 3MM 230MM DRILL TIP NONSTRL	BOTH IP/OP	$36.13 	$26.74	$0.00	$28.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.81	$26.81	$0.00	$0.00	$7.53	$0.00	$0.00	$0.00	$0.00	$17.54	$27.78	$28.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.108.310	SUP	HCPCS C1713		02.108.310  -  PLATE BONE 100D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP	BOTH IP/OP	"$1,005.08 "	$743.76	$0.00	$780.64	$439.11	$439.11	$0.00	$0.00	$0.00	$209.48	$745.97	$745.97	$0.00	$0.00	$209.46	$0.00	$594.50	$594.50	$0.00	$487.90	$772.83	$780.64	$0.00		$0.00	$148.26	$0.00	$0.00	$155.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.108.311	SUP	HCPCS C1713		02.108.311  -  PLATE BONE 110D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP	BOTH IP/OP	"$1,005.08 "	$743.76	$0.00	$780.64	$439.11	$439.11	$0.00	$0.00	$0.00	$209.48	$745.97	$745.97	$0.00	$0.00	$209.46	$0.00	$594.50	$594.50	$0.00	$487.90	$772.83	$780.64	$0.00		$0.00	$148.26	$0.00	$0.00	$155.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.108.313	SUP	HCPCS C1713		02.108.313  -  PLATE BN 120D 75X19-12MM NS LCP 4 HL SHFT SS PED HIP 3.5MM	BOTH IP/OP	"$1,005.08 "	$743.76	$0.00	$780.64	$439.11	$439.11	$0.00	$0.00	$0.00	$209.48	$745.97	$745.97	$0.00	$0.00	$209.46	$0.00	$594.50	$594.50	$0.00	$487.90	$772.83	$780.64	$0.00		$0.00	$148.26	$0.00	$0.00	$155.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.108.315	SUP	HCPCS C1713		02.108.315  -  PLATE BONE 150D 60X18.5MM 3 HOLE LCP STAINLESS STEEL	BOTH IP/OP	"$1,005.08 "	$743.76	$0.00	$780.64	$439.11	$439.11	$0.00	$0.00	$0.00	$209.48	$745.97	$745.97	$0.00	$0.00	$209.46	$0.00	$594.50	$594.50	$0.00	$487.90	$772.83	$780.64	$0.00		$0.00	$148.26	$0.00	$0.00	$155.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.108.320	SUP	HCPCS C1713		02.108.320  -  PLATE BONE 100D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP	BOTH IP/OP	"$1,044.43 "	$772.88	$0.00	$811.20	$456.30	$456.30	$0.00	$0.00	$0.00	$217.68	$775.17	$775.17	$0.00	$0.00	$217.66	$0.00	$617.78	$617.78	$0.00	$507.00	$803.09	$811.20	$0.00		$0.00	$154.07	$0.00	$0.00	$161.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.108.321	SUP	HCPCS C1713		02.108.321  -  PLATE BONE 110D 5 HOLE LCP STAINLESS STEEL PEDIATRIC HIP	BOTH IP/OP	"$1,044.43 "	$772.88	$0.00	$811.20	$456.30	$456.30	$0.00	$0.00	$0.00	$217.68	$775.17	$775.17	$0.00	$0.00	$217.66	$0.00	$617.78	$617.78	$0.00	$507.00	$803.09	$811.20	$0.00		$0.00	$154.07	$0.00	$0.00	$161.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.108.323	SUP	HCPCS C1713		02.108.323  -  PLATE BN 120D 95X23-15MM NS LCP 4 HL SHFT SS PED HIP 5MM SCR	BOTH IP/OP	"$1,044.43 "	$772.88	$0.00	$811.20	$456.30	$456.30	$0.00	$0.00	$0.00	$217.68	$775.17	$775.17	$0.00	$0.00	$217.66	$0.00	$617.78	$617.78	$0.00	$507.00	$803.09	$811.20	$0.00		$0.00	$154.07	$0.00	$0.00	$161.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.108.325	SUP	HCPCS C1713		02.108.325  -  PLATE BONE 150D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP	BOTH IP/OP	"$1,044.43 "	$772.88	$0.00	$811.20	$456.30	$456.30	$0.00	$0.00	$0.00	$217.68	$775.17	$775.17	$0.00	$0.00	$217.66	$0.00	$617.78	$617.78	$0.00	$507.00	$803.09	$811.20	$0.00		$0.00	$154.07	$0.00	$0.00	$161.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.005	SUP	HCPCS C1713		02.110.005  -  PLATE BN NS LCP 5 HL SHFT SS RDS RT VOLR DIST	BOTH IP/OP	"$2,921.03 "	"$2,161.56"	$0.00	"$2,268.76"	"$1,276.18"	"$1,276.18"	$0.00	$0.00	$0.00	$608.81	"$2,167.98"	"$2,167.98"	$0.00	$0.00	$608.74	$0.00	"$1,440.07"	"$1,440.07"	$0.00	"$1,417.98"	"$2,246.07"	"$2,268.76"	$0.00		$0.00	$430.90	$0.00	$0.00	$451.48	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.007	SUP	HCPCS C1713		02.110.007  -  PLATE BN NS LCP 7 HL SHFT SS RDS RT VOLR DIST	BOTH IP/OP	"$2,992.73 "	"$2,214.62"	$0.00	"$2,324.44"	"$1,307.50"	"$1,307.50"	$0.00	$0.00	$0.00	$623.76	"$2,221.20"	"$2,221.20"	$0.00	$0.00	$623.68	$0.00	"$1,475.41"	"$1,475.41"	$0.00	"$1,452.78"	"$2,301.20"	"$2,324.44"	$0.00		$0.00	$441.47	$0.00	$0.00	$462.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.009	SUP	HCPCS C1713		02.110.009  -  PLATE BN NS LCP 9 HL SHFT SS RDS RT VOLR DIST	BOTH IP/OP	"$3,063.00 "	"$2,266.62"	$0.00	"$2,379.04"	"$1,338.21"	"$1,338.21"	$0.00	$0.00	$0.00	$638.41	"$2,273.36"	"$2,273.36"	$0.00	$0.00	$638.33	$0.00	"$1,510.06"	"$1,510.06"	$0.00	"$1,486.90"	"$2,355.25"	"$2,379.04"	$0.00		$0.00	$451.84	$0.00	$0.00	$473.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.011	SUP	HCPCS C1713		02.110.011  -  PLATE BN NS LCP 11 HL SHFT SS RDS RT VOLR DIST	BOTH IP/OP	"$3,251.38 "	"$2,406.02"	$0.00	"$2,525.34"	"$1,420.50"	"$1,420.50"	$0.00	$0.00	$0.00	$677.67	"$2,413.17"	"$2,413.17"	$0.00	$0.00	$677.59	$0.00	"$1,602.93"	"$1,602.93"	$0.00	"$1,578.34"	"$2,500.09"	"$2,525.34"	$0.00		$0.00	$479.63	$0.00	$0.00	$502.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.013S	SUP	HCPCS C1713		02.110.013S  -  PLATE BONE 13 HOLE LCP STAINLESS STEEL RIGHT DIAPHYSIS	BOTH IP/OP	"$3,432.70 "	"$2,540.20"	$0.00	"$2,666.18"	"$1,499.73"	"$1,499.73"	$0.00	$0.00	$0.00	$715.46	"$2,547.75"	"$2,547.75"	$0.00	$0.00	$715.37	$0.00	"$1,692.32"	"$1,692.32"	$0.00	"$1,666.36"	"$2,639.52"	"$2,666.18"	$0.00		$0.00	$506.38	$0.00	$0.00	$530.57	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.015S	SUP	HCPCS C1713		02.110.015S  -  PLATE BONE 15 HOLE LCP STAINLESS STEEL RIGHT DIAPHYSIS	BOTH IP/OP	"$3,611.23 "	"$2,672.31"	$0.00	"$2,804.84"	"$1,577.72"	"$1,577.72"	$0.00	$0.00	$0.00	$752.67	"$2,680.25"	"$2,680.25"	$0.00	$0.00	$752.58	$0.00	"$1,780.33"	"$1,780.33"	$0.00	"$1,753.03"	"$2,776.79"	"$2,804.84"	$0.00		$0.00	$532.71	$0.00	$0.00	$558.16	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.105	SUP	HCPCS C1713		02.110.105  -  PLATE BN NS LCP 5 HL SHFT SS RDS LT VOLR DIST	BOTH IP/OP	"$2,921.03 "	"$2,161.56"	$0.00	"$2,268.76"	"$1,276.18"	"$1,276.18"	$0.00	$0.00	$0.00	$608.81	"$2,167.98"	"$2,167.98"	$0.00	$0.00	$608.74	$0.00	"$1,440.07"	"$1,440.07"	$0.00	"$1,417.98"	"$2,246.07"	"$2,268.76"	$0.00		$0.00	$430.90	$0.00	$0.00	$451.48	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.107	SUP	HCPCS C1713		02.110.107  -  PLATE BN NS LCP 7 HL SHFT SS RDS LT VOLR DIST	BOTH IP/OP	"$2,992.73 "	"$2,214.62"	$0.00	"$2,324.44"	"$1,307.50"	"$1,307.50"	$0.00	$0.00	$0.00	$623.76	"$2,221.20"	"$2,221.20"	$0.00	$0.00	$623.68	$0.00	"$1,475.41"	"$1,475.41"	$0.00	"$1,452.78"	"$2,301.20"	"$2,324.44"	$0.00		$0.00	$441.47	$0.00	$0.00	$462.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.109	SUP	HCPCS C1713		02.110.109  -  PLATE BN NS LCP 9 HL SHFT SS RDS LT VOLR DIST	BOTH IP/OP	"$3,063.00 "	"$2,266.62"	$0.00	"$2,379.04"	"$1,338.21"	"$1,338.21"	$0.00	$0.00	$0.00	$638.41	"$2,273.36"	"$2,273.36"	$0.00	$0.00	$638.33	$0.00	"$1,510.06"	"$1,510.06"	$0.00	"$1,486.90"	"$2,355.25"	"$2,379.04"	$0.00		$0.00	$451.84	$0.00	$0.00	$473.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.111	SUP	HCPCS C1713		02.110.111  -  PLATE BN NS LCP 11 HL SHFT SS RDS LT VOLR DIST	BOTH IP/OP	"$3,133.30 "	"$2,318.64"	$0.00	"$2,433.62"	"$1,368.91"	"$1,368.91"	$0.00	$0.00	$0.00	$653.06	"$2,325.54"	"$2,325.54"	$0.00	$0.00	$652.98	$0.00	"$1,544.72"	"$1,544.72"	$0.00	"$1,521.01"	"$2,409.29"	"$2,433.62"	$0.00		$0.00	$462.21	$0.00	$0.00	$484.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.113S	SUP	HCPCS C1713		02.110.113S  -  PLATE BONE 13 HOLE LCP STAINLESS STEEL LEFT DISTAL VOLAR	BOTH IP/OP	"$3,497.38 "	"$2,588.06"	$0.00	"$2,716.40"	"$1,527.98"	"$1,527.98"	$0.00	$0.00	$0.00	$728.94	"$2,595.75"	"$2,595.75"	$0.00	$0.00	$728.85	$0.00	"$1,724.21"	"$1,724.21"	$0.00	"$1,697.75"	"$2,689.24"	"$2,716.40"	$0.00		$0.00	$515.92	$0.00	$0.00	$540.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.115S	SUP	HCPCS C1713		02.110.115S  -  PLATE BONE 15 HOLE LCP STAINLESS STEEL LEFT DISTAL VOLAR	BOTH IP/OP	"$3,611.23 "	"$2,672.31"	$0.00	"$2,804.84"	"$1,577.72"	"$1,577.72"	$0.00	$0.00	$0.00	$752.67	"$2,680.25"	"$2,680.25"	$0.00	$0.00	$752.58	$0.00	"$1,780.33"	"$1,780.33"	$0.00	"$1,753.03"	"$2,776.79"	"$2,804.84"	$0.00		$0.00	$532.71	$0.00	$0.00	$558.16	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.150	SUP	HCPCS C1713		02.110.150  -  PLATE BN STD BND 118MM NS LCP FSN SS WRST	BOTH IP/OP	"$3,145.95 "	"$2,328.00"	$0.00	"$2,443.44"	"$1,374.44"	"$1,374.44"	$0.00	$0.00	$0.00	$655.69	"$2,334.92"	"$2,334.92"	$0.00	$0.00	$655.62	$0.00	"$1,550.95"	"$1,550.95"	$0.00	"$1,527.15"	"$2,419.01"	"$2,443.44"	$0.00		$0.00	$464.08	$0.00	$0.00	$486.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.151	SUP	HCPCS C1713		02.110.151  -  PLATE BN SHRT BND 118MM NS LCP FSN SS WRST	BOTH IP/OP	"$3,145.95 "	"$2,328.00"	$0.00	"$2,443.44"	"$1,374.44"	"$1,374.44"	$0.00	$0.00	$0.00	$655.69	"$2,334.92"	"$2,334.92"	$0.00	$0.00	$655.62	$0.00	"$1,550.95"	"$1,550.95"	$0.00	"$1,527.15"	"$2,419.01"	"$2,443.44"	$0.00		$0.00	$464.08	$0.00	$0.00	$486.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.152	SUP	HCPCS C1713		02.110.152  -  PLATE BONE STR 112MM FUSION LCP STAINLESS STEEL WRIST	BOTH IP/OP	"$3,145.95 "	"$2,328.00"	$0.00	"$2,443.44"	"$1,374.44"	"$1,374.44"	$0.00	$0.00	$0.00	$655.69	"$2,334.92"	"$2,334.92"	$0.00	$0.00	$655.62	$0.00	"$1,550.95"	"$1,550.95"	$0.00	"$1,527.15"	"$2,419.01"	"$2,443.44"	$0.00		$0.00	$464.08	$0.00	$0.00	$486.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.201	SUP	HCPCS C1713		02.110.201  -  PLATE BN 48MM NS LCP CMBN 5 HLE/HD 3 HL SHFT VA SS RDS RT	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.202	SUP	HCPCS C1713		02.110.202  -  PLATE BN 66MM NS LCP CMBN 5 HLE/HD 5 HL SHFT VA SS RDS RT	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.203	SUP	HCPCS C1713		02.110.203  -  PLATE BN 48MM NS LCP CMBN 5 HLE/HD 3 HL SHFT VA SS RDS LT	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.204	SUP	HCPCS C1713		02.110.204  -  PLATE BN 66MM NS LCP CMBN 5 HLE/HD 5 HL SHFT VA SS RDS LT	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.205	SUP	HCPCS C1713		02.110.205  -  PLATE BN 45MM NS LCP CMBN 4 HLE/HD 3 HL SHFT VA SS RDS RT	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.206	SUP	HCPCS C1713		02.110.206  -  PLATE BN 65MM NS LCP CMBN 4 HLE/HD 5 HL SHFT VA SS RDS RT	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.207	SUP	HCPCS C1713		02.110.207  -  PLATE BN 45MM NS LCP CMBN 4 HLE/HD 3 HL SHFT VA SS RDS LT	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.208	SUP	HCPCS C1713		02.110.208  -  PLATE BN 65MM NS LCP CMBN 4 HLE/HD 5 HL SHFT VA SS RDS LT	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.300	SUP	Custom 27203010		02.110.300  -  WIRE FIX 1.8MM 150MM TROCAR POINT KWIRE STAINLESS STEEL	BOTH IP/OP	$15.18 	$11.23	$0.00	$11.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.27	$11.27	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$7.37	$11.67	$11.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.330	SUP	HCPCS C1713		02.110.330  -  PLATE BN CNTR 50.5MM NS LCP CMBN 9 HLE/HD 3 HL SHFT CLMN RND	BOTH IP/OP	"$1,570.15 "	"$1,161.91"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$327.26	"$1,165.37"	"$1,165.37"	$0.00	$0.00	$327.22	$0.00	$928.74	$928.74	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.331	SUP	HCPCS C1713		02.110.331  -  PLATE BN CNTR 50.5MM NS LCP CMBN 9 HLE/HD 3 HL SHFT CLMN RND	BOTH IP/OP	"$1,570.15 "	"$1,161.91"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$327.26	"$1,165.37"	"$1,165.37"	$0.00	$0.00	$327.22	$0.00	$928.74	$928.74	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.340	SUP	HCPCS C1713		02.110.340  -  PLATE BN CNTR 59.5MM NS LCP CMBN 9 HLE/HD 4 HL SHFT CLMN RND	BOTH IP/OP	"$1,619.35 "	"$1,198.32"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$337.51	"$1,201.88"	"$1,201.88"	$0.00	$0.00	$337.47	$0.00	$957.85	$957.85	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.341	SUP	HCPCS C1713		02.110.341  -  PLATE BN CNTR 59.5MM NS LCP CMBN 9 HLE/HD 4 HL SHFT CLMN RND	BOTH IP/OP	"$1,619.35 "	"$1,198.32"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$337.51	"$1,201.88"	"$1,201.88"	$0.00	$0.00	$337.47	$0.00	$957.85	$957.85	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.350	SUP	HCPCS C1713		02.110.350  -  PLATE BN CNTR 68.5MM NS LCP CMBN 9 HLE/HD 5 HL SHFT CLMN RND	BOTH IP/OP	"$1,667.15 "	"$1,233.69"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$347.48	"$1,237.36"	"$1,237.36"	$0.00	$0.00	$347.43	$0.00	$986.12	$986.12	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.351	SUP	HCPCS C1713		02.110.351  -  PLATE BN CNTR 68.5MM NS LCP CMBN 9 HLE/HD 5 HL SHFT CLMN RND	BOTH IP/OP	"$1,667.15 "	"$1,233.69"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$347.48	"$1,237.36"	"$1,237.36"	$0.00	$0.00	$347.43	$0.00	$986.12	$986.12	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.430	SUP	HCPCS C1713		02.110.430  -  PLATE BN CNTR 50.5MM NS LCP CMBN 8 HLE/HD 3 HL SHFT CLMN RND	BOTH IP/OP	"$1,570.15 "	"$1,161.91"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$327.26	"$1,165.37"	"$1,165.37"	$0.00	$0.00	$327.22	$0.00	$928.74	$928.74	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.431	SUP	HCPCS C1713		02.110.431  -  PLATE BN CNTR 50.5MM NS LCP CMBN 8 HLE/HD 3 HL SHFT CLMN RND	BOTH IP/OP	"$1,570.15 "	"$1,161.91"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$327.26	"$1,165.37"	"$1,165.37"	$0.00	$0.00	$327.22	$0.00	$928.74	$928.74	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.440	SUP	HCPCS C1713		02.110.440  -  PLATE BN CNTR 59.5MM NS LCP CMBN 8 HLE/HD 4 HL SHFT CLMN RND	BOTH IP/OP	"$1,619.35 "	"$1,198.32"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$337.51	"$1,201.88"	"$1,201.88"	$0.00	$0.00	$337.47	$0.00	$957.85	$957.85	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.441	SUP	HCPCS C1713		02.110.441  -  PLATE BN CNTR 59.5MM NS LCP CMBN 8 HLE/HD 4 HL SHFT CLMN RND	BOTH IP/OP	"$1,619.35 "	"$1,198.32"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$337.51	"$1,201.88"	"$1,201.88"	$0.00	$0.00	$337.47	$0.00	$957.85	$957.85	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.450	SUP	HCPCS C1713		02.110.450  -  PLATE BN CNTR 68.5MM NS LCP CMBN 8 HLE/HD 5 HL SHFT CLMN RND	BOTH IP/OP	"$1,667.15 "	"$1,233.69"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$347.48	"$1,237.36"	"$1,237.36"	$0.00	$0.00	$347.43	$0.00	$986.12	$986.12	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.451	SUP	HCPCS C1713		02.110.451  -  PLATE BN CNTR 68.5MM NS LCP CMBN 8 HLE/HD 5 HL SHFT CLMN RND	BOTH IP/OP	"$1,667.15 "	"$1,233.69"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$347.48	"$1,237.36"	"$1,237.36"	$0.00	$0.00	$347.43	$0.00	$986.12	$986.12	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.730	SUP	HCPCS C1713		02.110.730  -  PLATE BN CNTR 45MM NS LCP CMBN 6 HLE/HD 3 HL SHFT CLMN RND	BOTH IP/OP	"$1,570.15 "	"$1,161.91"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$327.26	"$1,165.37"	"$1,165.37"	$0.00	$0.00	$327.22	$0.00	$928.74	$928.74	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.731	SUP	HCPCS C1713		02.110.731  -  PLATE BN CNTR 45MM NS LCP CMBN 6 HLE/HD 3 HL SHFT CLMN RND	BOTH IP/OP	"$1,570.15 "	"$1,161.91"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$327.26	"$1,165.37"	"$1,165.37"	$0.00	$0.00	$327.22	$0.00	$928.74	$928.74	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.740	SUP	HCPCS C1713		02.110.740  -  PLATE BN CNTR 54MM NS LCP CMBN 6 HLE/HD 4 HL SHFT CLMN RND	BOTH IP/OP	"$1,619.35 "	"$1,198.32"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$337.51	"$1,201.88"	"$1,201.88"	$0.00	$0.00	$337.47	$0.00	$957.85	$957.85	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.741	SUP	HCPCS C1713		02.110.741  -  PLATE BN CNTR 54MM NS LCP CMBN 6 HLE/HD 4 HL SHFT CLMN RND	BOTH IP/OP	"$1,619.35 "	"$1,198.32"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$337.51	"$1,201.88"	"$1,201.88"	$0.00	$0.00	$337.47	$0.00	$957.85	$957.85	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.750	SUP	HCPCS C1713		02.110.750  -  PLATE BN CNTR 63MM NS LCP CMBN 6 HLE/HD 5 HL SHFT CLMN RND	BOTH IP/OP	"$1,667.15 "	"$1,233.69"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$347.48	"$1,237.36"	"$1,237.36"	$0.00	$0.00	$347.43	$0.00	$986.12	$986.12	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.751	SUP	HCPCS C1713		02.110.751  -  PLATE BN CNTR 63MM NS LCP CMBN 6 HLE/HD 5 HL SHFT CLMN RND	BOTH IP/OP	"$1,667.15 "	"$1,233.69"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$347.48	"$1,237.36"	"$1,237.36"	$0.00	$0.00	$347.43	$0.00	$986.12	$986.12	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.830	SUP	HCPCS C1713		02.110.830  -  PLATE BN CNTR 45MM NS LCP CMBN 7 HLE/HD 3 HL SHFT CLMN RND	BOTH IP/OP	"$1,570.15 "	"$1,161.91"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$327.26	"$1,165.37"	"$1,165.37"	$0.00	$0.00	$327.22	$0.00	$928.74	$928.74	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.831	SUP	HCPCS C1713		02.110.831  -  PLATE BN CNTR 45MM NS LCP CMBN 7 HLE/HD 3 HL SHFT CLMN RND	BOTH IP/OP	"$1,570.15 "	"$1,161.91"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$327.26	"$1,165.37"	"$1,165.37"	$0.00	$0.00	$327.22	$0.00	$928.74	$928.74	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.840	SUP	HCPCS C1713		02.110.840  -  PLATE BN CNTR 54MM NS LCP CMBN 7 HLE/HD 4 HL SHFT CLMN RND	BOTH IP/OP	"$1,619.35 "	"$1,198.32"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$337.51	"$1,201.88"	"$1,201.88"	$0.00	$0.00	$337.47	$0.00	$957.85	$957.85	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.841	SUP	HCPCS C1713		02.110.841  -  PLATE BN CNTR 54MM NS LCP CMBN 7 HLE/HD 4 HL SHFT CLMN RND	BOTH IP/OP	"$1,619.35 "	"$1,198.32"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$337.51	"$1,201.88"	"$1,201.88"	$0.00	$0.00	$337.47	$0.00	$957.85	$957.85	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.850	SUP	HCPCS C1713		02.110.850  -  PLATE BN CNTR 63MM NS LCP CMBN 7 HLE/HD 5 HL SHFT CLMN RND	BOTH IP/OP	"$1,667.15 "	"$1,233.69"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$347.48	"$1,237.36"	"$1,237.36"	$0.00	$0.00	$347.43	$0.00	$986.12	$986.12	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.110.851	SUP	HCPCS C1713		02.110.851  -  PLATE BN CNTR 63MM NS LCP CMBN 7 HLE/HD 5 HL SHFT CLMN RND	BOTH IP/OP	"$1,667.15 "	"$1,233.69"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$347.48	"$1,237.36"	"$1,237.36"	$0.00	$0.00	$347.43	$0.00	$986.12	$986.12	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.500.01S	SUP	HCPCS C1713		02.111.500.01S  -  PLATE BONE 1.25MM 150MM REDX SMALL STOP WIRE THREADED	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.500.10	SUP	HCPCS C1713		02.111.500.10  -  WIRE REDX SMALL 1.25MM 150MM THREAD STOP STAINLESS STEEL	BOTH IP/OP	$32.19 	$23.82	$0.00	$25.00	$14.06	$14.06	$0.00	$0.00	$0.00	$6.71	$23.89	$23.89	$0.00	$0.00	$6.71	$0.00	$19.04	$19.04	$0.00	$15.63	$24.75	$25.00	$0.00		$0.00	$4.75	$0.00	$0.00	$4.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.501.01S	SUP	HCPCS C1713		02.111.501.01S  -  PLATE BONE 1.25MM REDX WIRE LARGE STOP THREADED TIP LCP	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.501.10	SUP	HCPCS C1713		02.111.501.10  -  WIRE REDX 1.25MM 150MM THREAD TIP LARGE STOP STAINLESS STEEL	BOTH IP/OP	$31.25 	$23.13	$0.00	$25.00	$14.06	$14.06	$0.00	$0.00	$0.00	$6.51	$23.20	$23.20	$0.00	$0.00	$6.51	$0.00	$18.49	$18.49	$0.00	$15.63	$24.75	$25.00	$0.00		$0.00	$4.75	$0.00	$0.00	$4.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.520	SUP	HCPCS C1713		02.111.520  -  PLATE BONE 42MM 6X2 HOLE 2 COLUMN VAR ANG LCP STAINLESS	BOTH IP/OP	"$1,802.10 "	"$1,333.55"	$0.00	"$1,399.68"	$787.32	$787.32	$0.00	$0.00	$0.00	$375.60	"$1,337.52"	"$1,337.52"	$0.00	$0.00	$375.56	$0.00	"$1,065.94"	"$1,065.94"	$0.00	$874.80	"$1,385.68"	"$1,399.68"	$0.00		$0.00	$265.84	$0.00	$0.00	$278.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.521	SUP	HCPCS C1713		02.111.521  -  PLATE BN NAR 42MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,802.10 "	"$1,333.55"	$0.00	"$1,399.68"	$787.32	$787.32	$0.00	$0.00	$0.00	$375.60	"$1,337.52"	"$1,337.52"	$0.00	$0.00	$375.56	$0.00	"$1,065.94"	"$1,065.94"	$0.00	$874.80	"$1,385.68"	"$1,399.68"	$0.00		$0.00	$265.84	$0.00	$0.00	$278.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.530	SUP	HCPCS C1713		02.111.530  -  PLATE BN NAR 51MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.531	SUP	HCPCS C1713		02.111.531  -  PLATE BONE NARROW 51MM 6X3 HOLE 2 COLUMN VAR ANG LCP	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.540	SUP	HCPCS C1713		02.111.540  -  PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG SET LCP	BOTH IP/OP	"$1,944.08 "	"$1,438.62"	$0.00	"$1,509.96"	$849.35	$849.35	$0.00	$0.00	$0.00	$405.19	"$1,442.89"	"$1,442.89"	$0.00	$0.00	$405.15	$0.00	"$1,149.92"	"$1,149.92"	$0.00	$943.73	"$1,494.86"	"$1,509.96"	$0.00		$0.00	$286.78	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.541	SUP	HCPCS C1713		02.111.541  -  PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG LCP	BOTH IP/OP	"$1,944.08 "	"$1,438.62"	$0.00	"$1,509.96"	$849.35	$849.35	$0.00	$0.00	$0.00	$405.19	"$1,442.89"	"$1,442.89"	$0.00	$0.00	$405.15	$0.00	"$1,149.92"	"$1,149.92"	$0.00	$943.73	"$1,494.86"	"$1,509.96"	$0.00		$0.00	$286.78	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.550	SUP	HCPCS C1713		02.111.550  -  PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG LCP	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.551	SUP	HCPCS C1713		02.111.551  -  PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG SET LCP	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.620	SUP	HCPCS C1713		02.111.620  -  PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,802.10 "	"$1,333.55"	$0.00	"$1,399.68"	$787.32	$787.32	$0.00	$0.00	$0.00	$375.60	"$1,337.52"	"$1,337.52"	$0.00	$0.00	$375.56	$0.00	"$1,065.94"	"$1,065.94"	$0.00	$874.80	"$1,385.68"	"$1,399.68"	$0.00		$0.00	$265.84	$0.00	$0.00	$278.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.621	SUP	HCPCS C1713		02.111.621  -  PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,802.10 "	"$1,333.55"	$0.00	"$1,399.68"	$787.32	$787.32	$0.00	$0.00	$0.00	$375.60	"$1,337.52"	"$1,337.52"	$0.00	$0.00	$375.56	$0.00	"$1,065.94"	"$1,065.94"	$0.00	$874.80	"$1,385.68"	"$1,399.68"	$0.00		$0.00	$265.84	$0.00	$0.00	$278.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.630	SUP	HCPCS C1713		02.111.630  -  PLATE BN STD 54MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.630S	SUP	HCPCS C1713		02.111.630S  -  PLATE BONE 58MM 6X3 HOLE 2 COLUMN VAR ANG LCP STAINLESS	BOTH IP/OP	"$1,965.15 "	"$1,454.21"	$0.00	"$1,526.34"	$858.57	$858.57	$0.00	$0.00	$0.00	$409.59	"$1,458.53"	"$1,458.53"	$0.00	$0.00	$409.54	$0.00	"$1,162.39"	"$1,162.39"	$0.00	$953.96	"$1,511.08"	"$1,526.34"	$0.00		$0.00	$289.89	$0.00	$0.00	$303.74	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.631	SUP	HCPCS C1713		02.111.631  -  PLATE BN STD 54MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.631S	SUP	HCPCS C1713		02.111.631S  -  PLATE BONE 54MM 6X3 HOLE 2 COLUMN VAR ANG LCP STAINLESS	BOTH IP/OP	"$1,965.15 "	"$1,454.21"	$0.00	"$1,526.34"	$858.57	$858.57	$0.00	$0.00	$0.00	$409.59	"$1,458.53"	"$1,458.53"	$0.00	$0.00	$409.54	$0.00	"$1,162.39"	"$1,162.39"	$0.00	$953.96	"$1,511.08"	"$1,526.34"	$0.00		$0.00	$289.89	$0.00	$0.00	$303.74	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.640	SUP	HCPCS C1713		02.111.640  -  PLATE BN STD 66MM NS LCP CMBN 6 HLE/HD 4 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,944.08 "	"$1,438.62"	$0.00	"$1,509.96"	$849.35	$849.35	$0.00	$0.00	$0.00	$405.19	"$1,442.89"	"$1,442.89"	$0.00	$0.00	$405.15	$0.00	"$1,149.92"	"$1,149.92"	$0.00	$943.73	"$1,494.86"	"$1,509.96"	$0.00		$0.00	$286.78	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.641	SUP	HCPCS C1713		02.111.641  -  PLATE BN STD 66MM NS LCP CMBN 6 HLE/HD 4 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,944.08 "	"$1,438.62"	$0.00	"$1,509.96"	$849.35	$849.35	$0.00	$0.00	$0.00	$405.19	"$1,442.89"	"$1,442.89"	$0.00	$0.00	$405.15	$0.00	"$1,149.92"	"$1,149.92"	$0.00	$943.73	"$1,494.86"	"$1,509.96"	$0.00		$0.00	$286.78	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.650	SUP	HCPCS C1713		02.111.650  -  PLATE BN STD 75MM NS LCP CMBN 6 HLE/HD 5 HL SHFT 2 CLMN VA	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.651	SUP	HCPCS C1713		02.111.651  -  PLATE BN STD 75MM NS LCP CMBN 6 HLE/HD 5 HL SHFT 2 CLMN VA	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.720	SUP	HCPCS C1713		02.111.720  -  PLATE BN STD 47MM NS LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,802.10 "	"$1,333.55"	$0.00	"$1,399.68"	$787.32	$787.32	$0.00	$0.00	$0.00	$375.60	"$1,337.52"	"$1,337.52"	$0.00	$0.00	$375.56	$0.00	"$1,065.94"	"$1,065.94"	$0.00	$874.80	"$1,385.68"	"$1,399.68"	$0.00		$0.00	$265.84	$0.00	$0.00	$278.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.721	SUP	HCPCS C1713		02.111.721  -  PLATE BN STD 47MM NS LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,802.10 "	"$1,333.55"	$0.00	"$1,399.68"	$787.32	$787.32	$0.00	$0.00	$0.00	$375.60	"$1,337.52"	"$1,337.52"	$0.00	$0.00	$375.56	$0.00	"$1,065.94"	"$1,065.94"	$0.00	$874.80	"$1,385.68"	"$1,399.68"	$0.00		$0.00	$265.84	$0.00	$0.00	$278.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.730	SUP	HCPCS C1713		02.111.730  -  PLATE BN STD 55MM NS LCP CMBN 7 HLE/HD 3 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.731	SUP	HCPCS C1713		02.111.731  -  PLATE BN STD 55MM NS LCP CMBN 7 HLE/HD 3 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.740	SUP	HCPCS C1713		02.111.740  -  PLATE BN STD 68MM NS LCP CMBN 7 HLE/HD 4 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,944.08 "	"$1,438.62"	$0.00	"$1,509.96"	$849.35	$849.35	$0.00	$0.00	$0.00	$405.19	"$1,442.89"	"$1,442.89"	$0.00	$0.00	$405.15	$0.00	"$1,149.92"	"$1,149.92"	$0.00	$943.73	"$1,494.86"	"$1,509.96"	$0.00		$0.00	$286.78	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.741	SUP	HCPCS C1713		02.111.741  -  PLATE BN STD 68MM NS LCP CMBN 7 HLE/HD 4 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,944.08 "	"$1,438.62"	$0.00	"$1,509.96"	$849.35	$849.35	$0.00	$0.00	$0.00	$405.19	"$1,442.89"	"$1,442.89"	$0.00	$0.00	$405.15	$0.00	"$1,149.92"	"$1,149.92"	$0.00	$943.73	"$1,494.86"	"$1,509.96"	$0.00		$0.00	$286.78	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.750	SUP	HCPCS C1713		02.111.750  -  PLATE BN STD 77MM NS LCP CMBN 7 HLE/HD 5 HL SHFT 2 CLMN VA	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.111.751	SUP	HCPCS C1713		02.111.751  -  PLATE BN STD 77MM NS LCP CMBN 7 HLE/HD 5 HL SHFT 2 CLMN VA	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.006	SUP	HCPCS C1713		02.112.006  -  PLATE BN 69MM NS LCP CMBN 3 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,623.58 "	"$1,201.45"	$0.00	"$1,261.02"	$709.32	$709.32	$0.00	$0.00	$0.00	$338.39	"$1,205.02"	"$1,205.02"	$0.00	$0.00	$338.35	$0.00	$960.34	$960.34	$0.00	$788.14	"$1,248.41"	"$1,261.02"	$0.00		$0.00	$239.50	$0.00	$0.00	$250.94	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.007	SUP	HCPCS C1713		02.112.007  -  PLATE BN 69MM NS LCP CMBN 3 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,623.58 "	"$1,201.45"	$0.00	"$1,261.02"	$709.32	$709.32	$0.00	$0.00	$0.00	$338.39	"$1,205.02"	"$1,205.02"	$0.00	$0.00	$338.35	$0.00	$960.34	$960.34	$0.00	$788.14	"$1,248.41"	"$1,261.02"	$0.00		$0.00	$239.50	$0.00	$0.00	$250.94	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.008	SUP	HCPCS C1713		02.112.008  -  PLATE BN 108MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.009	SUP	HCPCS C1713		02.112.009  -  PLATE BN 108MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.010	SUP	HCPCS C1713		02.112.010  -  PLATE BN 81MM NS LCP CMBN 4 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,648.88 "	"$1,220.17"	$0.00	"$1,280.68"	$720.38	$720.38	$0.00	$0.00	$0.00	$343.67	"$1,223.80"	"$1,223.80"	$0.00	$0.00	$343.63	$0.00	$975.31	$975.31	$0.00	$800.43	"$1,267.87"	"$1,280.68"	$0.00		$0.00	$243.24	$0.00	$0.00	$254.86	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.011	SUP	HCPCS C1713		02.112.011  -  PLATE BN 81MM NS LCP CMBN 4 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,648.88 "	"$1,220.17"	$0.00	"$1,280.68"	$720.38	$720.38	$0.00	$0.00	$0.00	$343.67	"$1,223.80"	"$1,223.80"	$0.00	$0.00	$343.63	$0.00	$975.31	$975.31	$0.00	$800.43	"$1,267.87"	"$1,280.68"	$0.00		$0.00	$243.24	$0.00	$0.00	$254.86	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.012	SUP	HCPCS C1713		02.112.012  -  PLATE BN 94MM NS LCP CMBN 5 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,677.00 "	"$1,240.98"	$0.00	"$1,302.52"	$732.67	$732.67	$0.00	$0.00	$0.00	$349.53	"$1,244.67"	"$1,244.67"	$0.00	$0.00	$349.49	$0.00	$991.95	$991.95	$0.00	$814.08	"$1,289.49"	"$1,302.52"	$0.00		$0.00	$247.38	$0.00	$0.00	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.013	SUP	HCPCS C1713		02.112.013  -  PLATE BN 94MM NS LCP CMBN 5 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,677.00 "	"$1,240.98"	$0.00	"$1,302.52"	$732.67	$732.67	$0.00	$0.00	$0.00	$349.53	"$1,244.67"	"$1,244.67"	$0.00	$0.00	$349.49	$0.00	$991.95	$991.95	$0.00	$814.08	"$1,289.49"	"$1,302.52"	$0.00		$0.00	$247.38	$0.00	$0.00	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.018	SUP	HCPCS C1713		02.112.018  -  PLATE BN 123MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.019	SUP	HCPCS C1713		02.112.019  -  PLATE BN 123MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.020	SUP	HCPCS C1713		02.112.020  -  PLATE BN 135MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.021	SUP	HCPCS C1713		02.112.021  -  PLATE BN 135MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.026	SUP	HCPCS C1713		02.112.026  -  PLATE BN 94MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.027	SUP	HCPCS C1713		02.112.027  -  PLATE BN 94MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.028	SUP	HCPCS C1713		02.112.028  -  PLATE BN 110MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.029	SUP	HCPCS C1713		02.112.029  -  PLATE BN 110MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.030	SUP	HCPCS C1713		02.112.030  -  PLATE BN 120MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.031	SUP	HCPCS C1713		02.112.031  -  PLATE BN 120MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.040	SUP	HCPCS C1713		02.112.040  -  PLATE BONE 79MM 6 HOLE LCP STAINLESS STEEL ANTERIOR MEDIAL	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.041	SUP	HCPCS C1713		02.112.041  -  PLATE BONE 91MM 7 HOLE LCP STAINLESS STEEL MEDIAL ANTERIOR	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.042	SUP	HCPCS C1713		02.112.042  -  PLATE BONE 8 HOLE LCP STAINLESS STEEL MEDIAL ANTERIOR	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.045	SUP	HCPCS C1713		02.112.045  -  PLATE BONE 77MM 7 HOLE VAR ANG LCP STAINLESS STEEL LATERAL	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.046	SUP	HCPCS C1713		02.112.046  -  PLATE BONE 89MM 9 HOLE VAR ANG LCP STAINLESS STEEL LATERAL	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.047	SUP	HCPCS C1713		02.112.047  -  PLATE BONE 101MM 10 HOLE VAR ANG LCP STAINLESS STEEL LATERAL	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.048	SUP	HCPCS C1713		02.112.048  -  PLATE BONE 113MM 11 HOLE VAR ANG LCP STAINLESS STEEL LATERAL	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.049	SUP	HCPCS C1713		02.112.049  -  PLATE BONE 12 HOLE LCP STAINLESS STEEL LATERAL VOLAR	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.080	SUP	HCPCS C1713		02.112.080  -  PLATE BN 85MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.081	SUP	HCPCS C1713		02.112.081  -  PLATE BN 85MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.082	SUP	HCPCS C1713		02.112.082  -  PLATE BN 100MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.083	SUP	HCPCS C1713		02.112.083  -  PLATE BN 100MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.084	SUP	HCPCS C1713		02.112.084  -  PLATE BN 115MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.085	SUP	HCPCS C1713		02.112.085  -  PLATE BN 115MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.090	SUP	HCPCS C1713		02.112.090  -  PLATE BN 105MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.091	SUP	HCPCS C1713		02.112.091  -  PLATE BN 105MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.092	SUP	HCPCS C1713		02.112.092  -  PLATE BN 120MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.093	SUP	HCPCS C1713		02.112.093  -  PLATE BN 120MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.094	SUP	HCPCS C1713		02.112.094  -  PLATE BN 130MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.095	SUP	HCPCS C1713		02.112.095  -  PLATE BN 130MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.106	SUP	HCPCS C1713		02.112.106  -  PLATE BONE 77MM 3 HOLE LCP STAINLESS STEEL RIGHT DISTAL	BOTH IP/OP	"$1,186.40 "	$877.94	$0.00	$921.48	$518.33	$518.33	$0.00	$0.00	$0.00	$247.28	$880.55	$880.55	$0.00	$0.00	$247.25	$0.00	$701.76	$701.76	$0.00	$575.93	$912.27	$921.48	$0.00		$0.00	$175.01	$0.00	$0.00	$183.37	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.107	SUP	HCPCS C1713		02.112.107  -  PLATE BONE 77MM 3 HOLE LCP STAINLESS STEEL LEFT DISTAL	BOTH IP/OP	"$1,186.40 "	$877.94	$0.00	$921.48	$518.33	$518.33	$0.00	$0.00	$0.00	$247.28	$880.55	$880.55	$0.00	$0.00	$247.25	$0.00	$701.76	$701.76	$0.00	$575.93	$912.27	$921.48	$0.00		$0.00	$175.01	$0.00	$0.00	$183.37	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.108	SUP	HCPCS C1713		02.112.108  -  PLATE BONE 9CM 4 HOLE LCP STAINLESS STEEL RIGHT POSTLAT	BOTH IP/OP	"$1,206.08 "	$892.50	$0.00	$936.76	$526.93	$526.93	$0.00	$0.00	$0.00	$251.38	$895.15	$895.15	$0.00	$0.00	$251.35	$0.00	$713.39	$713.39	$0.00	$585.48	$927.39	$936.76	$0.00		$0.00	$177.92	$0.00	$0.00	$186.42	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.109	SUP	HCPCS C1713		02.112.109  -  PLATE BONE 9CM 4 HOLE LCP STAINLESS STEEL LEFT POSTLAT	BOTH IP/OP	"$1,206.08 "	$892.50	$0.00	$936.76	$526.93	$526.93	$0.00	$0.00	$0.00	$251.38	$895.15	$895.15	$0.00	$0.00	$251.35	$0.00	$713.39	$713.39	$0.00	$585.48	$927.39	$936.76	$0.00		$0.00	$177.92	$0.00	$0.00	$186.42	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.110	SUP	HCPCS C1713		02.112.110  -  PLATE BONE 103MM 5 HOLE LCP STAINLESS STEEL RIGHT DISTAL	BOTH IP/OP	"$1,221.55 "	$903.95	$0.00	$948.78	$533.69	$533.69	$0.00	$0.00	$0.00	$254.60	$906.63	$906.63	$0.00	$0.00	$254.57	$0.00	$722.55	$722.55	$0.00	$592.99	$939.30	$948.78	$0.00		$0.00	$180.20	$0.00	$0.00	$188.81	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.111	SUP	HCPCS C1713		02.112.111  -  PLATE BONE 103MM 5 HOLE LCP STAINLESS STEEL LEFT POSTLAT	BOTH IP/OP	"$1,221.55 "	$903.95	$0.00	$948.78	$533.69	$533.69	$0.00	$0.00	$0.00	$254.60	$906.63	$906.63	$0.00	$0.00	$254.57	$0.00	$722.55	$722.55	$0.00	$592.99	$939.30	$948.78	$0.00		$0.00	$180.20	$0.00	$0.00	$188.81	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.112	SUP	HCPCS C1713		02.112.112  -  PLATE BONE 112MM 6 HOLE LCP STAINLESS STEEL RIGHT POSTLAT	BOTH IP/OP	"$1,241.23 "	$918.51	$0.00	$964.06	$542.28	$542.28	$0.00	$0.00	$0.00	$258.70	$921.24	$921.24	$0.00	$0.00	$258.67	$0.00	$734.18	$734.18	$0.00	$602.54	$954.42	$964.06	$0.00		$0.00	$183.10	$0.00	$0.00	$191.85	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.113	SUP	HCPCS C1713		02.112.113  -  PLATE BONE 112MM 6 HOLE LCP STAINLESS STEEL LEFT POSTLAT	BOTH IP/OP	"$1,241.23 "	$918.51	$0.00	$964.06	$542.28	$542.28	$0.00	$0.00	$0.00	$258.70	$921.24	$921.24	$0.00	$0.00	$258.67	$0.00	$734.18	$734.18	$0.00	$602.54	$954.42	$964.06	$0.00		$0.00	$183.10	$0.00	$0.00	$191.85	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.114	SUP	HCPCS C1713		02.112.114  -  PLATE BONE 12.9CM 7 HOLE LCP STAINLESS STEEL RIGHT POSTLAT	BOTH IP/OP	"$1,258.10 "	$930.99	$0.00	$977.16	$549.65	$549.65	$0.00	$0.00	$0.00	$262.22	$933.76	$933.76	$0.00	$0.00	$262.19	$0.00	$744.17	$744.17	$0.00	$610.73	$967.39	$977.16	$0.00		$0.00	$185.59	$0.00	$0.00	$194.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.115	SUP	HCPCS C1713		02.112.115  -  PLATE BONE 12.9CM 7 HOLE LCP STAINLESS STEEL LEFT POSTLAT	BOTH IP/OP	"$1,258.10 "	$930.99	$0.00	$977.16	$549.65	$549.65	$0.00	$0.00	$0.00	$262.22	$933.76	$933.76	$0.00	$0.00	$262.19	$0.00	$744.17	$744.17	$0.00	$610.73	$967.39	$977.16	$0.00		$0.00	$185.59	$0.00	$0.00	$194.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.118	SUP	HCPCS C1713		02.112.118  -  PLATE BONE 151MM 9 HOLE LCP STAINLESS STEEL RIGHT POSTLAT	BOTH IP/OP	"$1,276.38 "	$944.52	$0.00	$991.36	$557.64	$557.64	$0.00	$0.00	$0.00	$266.03	$947.33	$947.33	$0.00	$0.00	$266.00	$0.00	$754.98	$754.98	$0.00	$619.60	$981.45	$991.36	$0.00		$0.00	$188.29	$0.00	$0.00	$197.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.119	SUP	HCPCS C1713		02.112.119  -  PLATE BONE 151MM 9 HOLE LCP STAINLESS STEEL LEFT POSTLAT	BOTH IP/OP	"$1,276.38 "	$944.52	$0.00	$991.36	$557.64	$557.64	$0.00	$0.00	$0.00	$266.03	$947.33	$947.33	$0.00	$0.00	$266.00	$0.00	$754.98	$754.98	$0.00	$619.60	$981.45	$991.36	$0.00		$0.00	$188.29	$0.00	$0.00	$197.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.122	SUP	HCPCS C1713		02.112.122  -  PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL RIGHT POSTLAT	BOTH IP/OP	"$1,296.05 "	$959.08	$0.00	"$1,006.64"	$566.24	$566.24	$0.00	$0.00	$0.00	$270.13	$961.93	$961.93	$0.00	$0.00	$270.10	$0.00	$766.61	$766.61	$0.00	$629.15	$996.57	"$1,006.64"	$0.00		$0.00	$191.19	$0.00	$0.00	$200.32	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.123	SUP	HCPCS C1713		02.112.123  -  PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL LEFT POSTLAT	BOTH IP/OP	"$1,296.05 "	$959.08	$0.00	"$1,006.64"	$566.24	$566.24	$0.00	$0.00	$0.00	$270.13	$961.93	$961.93	$0.00	$0.00	$270.10	$0.00	$766.61	$766.61	$0.00	$629.15	$996.57	"$1,006.64"	$0.00		$0.00	$191.19	$0.00	$0.00	$200.32	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.126	SUP	HCPCS C1713		02.112.126  -  PLATE BONE 126MM 13 HOLE LCP STAINLESS STEEL RIGHT POSTLAT	BOTH IP/OP	"$1,312.93 "	$971.57	$0.00	"$1,019.74"	$573.60	$573.60	$0.00	$0.00	$0.00	$273.65	$974.45	$974.45	$0.00	$0.00	$273.61	$0.00	$776.60	$776.60	$0.00	$637.34	"$1,009.55"	"$1,019.74"	$0.00		$0.00	$193.68	$0.00	$0.00	$202.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.127	SUP	HCPCS C1713		02.112.127  -  PLATE BONE 127MM 13 HOLE LCP STAINLESS STEEL LEFT POSTLAT	BOTH IP/OP	"$1,312.93 "	$971.57	$0.00	"$1,019.74"	$573.60	$573.60	$0.00	$0.00	$0.00	$273.65	$974.45	$974.45	$0.00	$0.00	$273.61	$0.00	$776.60	$776.60	$0.00	$637.34	"$1,009.55"	"$1,019.74"	$0.00		$0.00	$193.68	$0.00	$0.00	$202.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.130	SUP	HCPCS C1713		02.112.130  -  PLATE BONE 233MM 15 HOLE LCP STAINLESS STEEL RIGHT DISTAL	BOTH IP/OP	"$1,329.78 "	$984.04	$0.00	"$1,032.84"	$580.97	$580.97	$0.00	$0.00	$0.00	$277.16	$986.96	$986.96	$0.00	$0.00	$277.13	$0.00	$786.56	$786.56	$0.00	$645.53	"$1,022.51"	"$1,032.84"	$0.00		$0.00	$196.16	$0.00	$0.00	$205.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.131	SUP	HCPCS C1713		02.112.131  -  PLATE BONE 233MM 15 HOLE LCP STAINLESS STEEL LEFT POSTLAT	BOTH IP/OP	"$1,329.78 "	$984.04	$0.00	"$1,032.84"	$580.97	$580.97	$0.00	$0.00	$0.00	$277.16	$986.96	$986.96	$0.00	$0.00	$277.13	$0.00	$786.56	$786.56	$0.00	$645.53	"$1,022.51"	"$1,032.84"	$0.00		$0.00	$196.16	$0.00	$0.00	$205.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.136	SUP	HCPCS C1713		02.112.136  -  PLATE BN CNTR 73MM NS LCP CMBN 3 HL SS FIB RT DIST LAT	BOTH IP/OP	"$1,147.05 "	$848.82	$0.00	$890.90	$501.13	$501.13	$0.00	$0.00	$0.00	$239.07	$851.34	$851.34	$0.00	$0.00	$239.05	$0.00	$678.48	$678.48	$0.00	$556.81	$881.99	$890.90	$0.00		$0.00	$169.21	$0.00	$0.00	$177.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.137	SUP	HCPCS C1713		02.112.137  -  PLATE BN CNTR 73MM NS LCP CMBN 3 HL SS FIB LT DIST LAT	BOTH IP/OP	"$1,147.05 "	$848.82	$0.00	$890.90	$501.13	$501.13	$0.00	$0.00	$0.00	$239.07	$851.34	$851.34	$0.00	$0.00	$239.05	$0.00	$678.48	$678.48	$0.00	$556.81	$881.99	$890.90	$0.00		$0.00	$169.21	$0.00	$0.00	$177.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.138	SUP	HCPCS C1713		02.112.138  -  PLATE BN CNTR 86MM NS LCP CMBN 4 HL SS FIB RT DIST LAT	BOTH IP/OP	"$1,166.73 "	$863.38	$0.00	$906.20	$509.74	$509.74	$0.00	$0.00	$0.00	$243.17	$865.94	$865.94	$0.00	$0.00	$243.15	$0.00	$690.12	$690.12	$0.00	$566.38	$897.14	$906.20	$0.00		$0.00	$172.11	$0.00	$0.00	$180.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.138S	SUP	HCPCS C1713		02.112.138S  -  PLATE BONE 86MM 4 HOLE LOCKING COMPRESSION LCP STAINLESS	BOTH IP/OP	"$1,258.10 "	$930.99	$0.00	$977.16	$549.65	$549.65	$0.00	$0.00	$0.00	$262.22	$933.76	$933.76	$0.00	$0.00	$262.19	$0.00	$744.17	$744.17	$0.00	$610.73	$967.39	$977.16	$0.00		$0.00	$185.59	$0.00	$0.00	$194.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.139	SUP	HCPCS C1713		02.112.139  -  PLATE BN CNTR 86MM NS LCP CMBN 4 HL SS FIB LT DIST LAT	BOTH IP/OP	"$1,166.73 "	$863.38	$0.00	$906.20	$509.74	$509.74	$0.00	$0.00	$0.00	$243.17	$865.94	$865.94	$0.00	$0.00	$243.15	$0.00	$690.12	$690.12	$0.00	$566.38	$897.14	$906.20	$0.00		$0.00	$172.11	$0.00	$0.00	$180.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.140	SUP	HCPCS C1713		02.112.140  -  PLATE BN CNTR 99MM NS LCP CMBN 5 HL SS FIB RT DIST LAT	BOTH IP/OP	"$1,182.18 "	$874.81	$0.00	$918.20	$516.49	$516.49	$0.00	$0.00	$0.00	$246.39	$877.41	$877.41	$0.00	$0.00	$246.37	$0.00	$699.26	$699.26	$0.00	$573.88	$909.02	$918.20	$0.00		$0.00	$174.39	$0.00	$0.00	$182.72	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.141	SUP	HCPCS C1713		02.112.141  -  PLATE BN CNTR 99MM NS LCP CMBN 5 HL SS FIB LT DIST LAT	BOTH IP/OP	"$1,182.18 "	$874.81	$0.00	$918.20	$516.49	$516.49	$0.00	$0.00	$0.00	$246.39	$877.41	$877.41	$0.00	$0.00	$246.37	$0.00	$699.26	$699.26	$0.00	$573.88	$909.02	$918.20	$0.00		$0.00	$174.39	$0.00	$0.00	$182.72	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.142	SUP	HCPCS C1713		02.112.142  -  PLATE BN CNTR 112MM NS LCP CMBN 6 HL SS FIB RT DIST LAT	BOTH IP/OP	"$1,200.45 "	$888.33	$0.00	$932.40	$524.48	$524.48	$0.00	$0.00	$0.00	$250.20	$890.97	$890.97	$0.00	$0.00	$250.17	$0.00	$710.07	$710.07	$0.00	$582.75	$923.08	$932.40	$0.00		$0.00	$177.09	$0.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.143	SUP	HCPCS C1713		02.112.143  -  PLATE BN CNTR 112MM NS LCP CMBN 6 HL SS FIB LT DIST LAT	BOTH IP/OP	"$1,200.45 "	$888.33	$0.00	$932.40	$524.48	$524.48	$0.00	$0.00	$0.00	$250.20	$890.97	$890.97	$0.00	$0.00	$250.17	$0.00	$710.07	$710.07	$0.00	$582.75	$923.08	$932.40	$0.00		$0.00	$177.09	$0.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.144	SUP	HCPCS C1713		02.112.144  -  PLATE BONE 125MM 7 HOLE LCP STAINLESS STEEL RIGHT DISTAL	BOTH IP/OP	"$1,217.33 "	$900.82	$0.00	$945.50	$531.84	$531.84	$0.00	$0.00	$0.00	$253.72	$903.50	$903.50	$0.00	$0.00	$253.69	$0.00	$720.05	$720.05	$0.00	$590.94	$936.05	$945.50	$0.00		$0.00	$179.58	$0.00	$0.00	$188.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.145	SUP	HCPCS C1713		02.112.145  -  PLATE BN CNTR 125MM NS LCP CMBN 7 HL SS FIB LT DIST LAT	BOTH IP/OP	"$1,217.33 "	$900.82	$0.00	$945.50	$531.84	$531.84	$0.00	$0.00	$0.00	$253.72	$903.50	$903.50	$0.00	$0.00	$253.69	$0.00	$720.05	$720.05	$0.00	$590.94	$936.05	$945.50	$0.00		$0.00	$179.58	$0.00	$0.00	$188.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.148	SUP	HCPCS C1713		02.112.148  -  PLATE BONE 151MM 9 HOLE ANATOMICALLY CNTOUR LCP STAINLESS	BOTH IP/OP	"$1,276.38 "	$944.52	$0.00	$991.36	$557.64	$557.64	$0.00	$0.00	$0.00	$266.03	$947.33	$947.33	$0.00	$0.00	$266.00	$0.00	$754.98	$754.98	$0.00	$619.60	$981.45	$991.36	$0.00		$0.00	$188.29	$0.00	$0.00	$197.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.149	SUP	HCPCS C1713		02.112.149  -  PLATE BONE 151MM 9 HOLE LCP STAINLESS STEEL LEFT DISTAL	BOTH IP/OP	"$1,276.38 "	$944.52	$0.00	$991.36	$557.64	$557.64	$0.00	$0.00	$0.00	$266.03	$947.33	$947.33	$0.00	$0.00	$266.00	$0.00	$754.98	$754.98	$0.00	$619.60	$981.45	$991.36	$0.00		$0.00	$188.29	$0.00	$0.00	$197.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.152	SUP	HCPCS C1713		02.112.152  -  PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL RIGHT LATERAL	BOTH IP/OP	"$1,296.05 "	$959.08	$0.00	"$1,006.64"	$566.24	$566.24	$0.00	$0.00	$0.00	$270.13	$961.93	$961.93	$0.00	$0.00	$270.10	$0.00	$766.61	$766.61	$0.00	$629.15	$996.57	"$1,006.64"	$0.00		$0.00	$191.19	$0.00	$0.00	$200.32	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.153	SUP	HCPCS C1713		02.112.153  -  PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL LEFT LATERAL	BOTH IP/OP	"$1,296.05 "	$959.08	$0.00	"$1,006.64"	$566.24	$566.24	$0.00	$0.00	$0.00	$270.13	$961.93	$961.93	$0.00	$0.00	$270.10	$0.00	$766.61	$766.61	$0.00	$629.15	$996.57	"$1,006.64"	$0.00		$0.00	$191.19	$0.00	$0.00	$200.32	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.156	SUP	HCPCS C1713		02.112.156  -  PLATE BONE 203MM 13 HOLE LCP STAINLESS STEEL RIGHT LATERAL	BOTH IP/OP	"$1,350.88 "	$999.65	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$281.56	"$1,002.62"	"$1,002.62"	$0.00	$0.00	$281.52	$0.00	$799.04	$799.04	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.157	SUP	HCPCS C1713		02.112.157  -  PLATE BONE 203MM 13 HOLE LCP STAINLESS STEEL LEFT LATERAL	BOTH IP/OP	"$1,350.88 "	$999.65	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$281.56	"$1,002.62"	"$1,002.62"	$0.00	$0.00	$281.52	$0.00	$799.04	$799.04	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.160	SUP	HCPCS C1713		02.112.160  -  PLATE BONE 299MM 15 HOLE LCP STAINLESS STEEL RIGHT LATERAL	BOTH IP/OP	"$1,370.55 "	"$1,014.21"	$0.00	"$1,064.50"	$598.78	$598.78	$0.00	$0.00	$0.00	$285.66	"$1,017.22"	"$1,017.22"	$0.00	$0.00	$285.62	$0.00	$810.68	$810.68	$0.00	$665.31	"$1,053.86"	"$1,064.50"	$0.00		$0.00	$202.18	$0.00	$0.00	$211.84	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.161	SUP	HCPCS C1713		02.112.161  -  PLATE BONE 229MM 15 HOLE LCP STAINLESS STEEL LEFT LATERAL	BOTH IP/OP	"$1,370.55 "	"$1,014.21"	$0.00	"$1,064.50"	$598.78	$598.78	$0.00	$0.00	$0.00	$285.66	"$1,017.22"	"$1,017.22"	$0.00	$0.00	$285.62	$0.00	$810.68	$810.68	$0.00	$665.31	"$1,053.86"	"$1,064.50"	$0.00		$0.00	$202.18	$0.00	$0.00	$211.84	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.203	SUP	HCPCS C1713		02.112.203  -  PLATE BONE T 64MM 3 HOLE LCP STAINLESS STEEL DISTAL TIBIA	BOTH IP/OP	"$1,384.60 "	"$1,024.60"	$0.00	"$1,075.42"	$604.92	$604.92	$0.00	$0.00	$0.00	$288.59	"$1,027.65"	"$1,027.65"	$0.00	$0.00	$288.55	$0.00	$818.99	$818.99	$0.00	$672.14	"$1,064.67"	"$1,075.42"	$0.00		$0.00	$204.25	$0.00	$0.00	$214.01	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.205S	SUP	HCPCS C1713		02.112.205S  -  PLATE BONE T 90X4.5X1.5MM 5 HOLE 4 LOCKING ANGULAR STABILITY	BOTH IP/OP	"$1,530.80 "	"$1,132.79"	$0.00	"$1,188.98"	$668.80	$668.80	$0.00	$0.00	$0.00	$319.06	"$1,136.16"	"$1,136.16"	$0.00	$0.00	$319.02	$0.00	$905.47	$905.47	$0.00	$743.11	"$1,177.09"	"$1,188.98"	$0.00		$0.00	$225.82	$0.00	$0.00	$236.61	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.208	SUP	HCPCS C1713		02.112.208  -  PLATE BONE T 13.2CM 8 HOLE LCP STAINLESS STEEL POSTERIOR	BOTH IP/OP	"$2,396.70 "	"$1,773.56"	$0.00	"$1,861.52"	"$1,047.11"	"$1,047.11"	$0.00	$0.00	$0.00	$499.53	"$1,778.83"	"$1,778.83"	$0.00	$0.00	$499.47	$0.00	"$1,417.65"	"$1,417.65"	$0.00	"$1,163.45"	"$1,842.90"	"$1,861.52"	$0.00		$0.00	$353.55	$0.00	$0.00	$370.44	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.212	SUP	HCPCS C1713		02.112.212  -  PLATE BONE T 184MM 4 LOCKING 12 HOLE SHAFT PROFILE ANGULAR	BOTH IP/OP	"$2,558.35 "	"$1,893.18"	$0.00	"$1,987.08"	"$1,117.73"	"$1,117.73"	$0.00	$0.00	$0.00	$533.22	"$1,898.81"	"$1,898.81"	$0.00	$0.00	$533.16	$0.00	"$1,261.27"	"$1,261.27"	$0.00	"$1,241.93"	"$1,967.21"	"$1,987.08"	$0.00		$0.00	$377.40	$0.00	$0.00	$395.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.216	SUP	HCPCS C1713		02.112.216  -  PLATE BONE T 236MM 4 LOCKING 16 HOLE SHAFT PROFILE ANGULAR	BOTH IP/OP	"$2,652.55 "	"$1,962.89"	$0.00	"$2,060.22"	"$1,158.87"	"$1,158.87"	$0.00	$0.00	$0.00	$552.86	"$1,968.72"	"$1,968.72"	$0.00	$0.00	$552.79	$0.00	"$1,307.71"	"$1,307.71"	$0.00	"$1,287.64"	"$2,039.62"	"$2,060.22"	$0.00		$0.00	$391.29	$0.00	$0.00	$409.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.510	SUP	HCPCS C1713		02.112.510  -  PLATE BN LO BND 109MM NS LCP CMBN 4 HL LOPRFL RND EDG SS TIB	BOTH IP/OP	"$2,597.73 "	"$1,922.32"	$0.00	"$2,017.64"	"$1,134.92"	"$1,134.92"	$0.00	$0.00	$0.00	$541.43	"$1,928.03"	"$1,928.03"	$0.00	$0.00	$541.37	$0.00	"$1,280.68"	"$1,280.68"	$0.00	"$1,261.03"	"$1,997.46"	"$2,017.64"	$0.00		$0.00	$383.21	$0.00	$0.00	$401.51	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.511	SUP	HCPCS C1713		02.112.511  -  PLATE BN LO BND 109MM NS LCP CMBN 4 HL LOPRFL RND EDG SS TIB	BOTH IP/OP	"$2,597.73 "	"$1,922.32"	$0.00	"$2,017.64"	"$1,134.92"	"$1,134.92"	$0.00	$0.00	$0.00	$541.43	"$1,928.03"	"$1,928.03"	$0.00	$0.00	$541.37	$0.00	"$1,280.68"	"$1,280.68"	$0.00	"$1,261.03"	"$1,997.46"	"$2,017.64"	$0.00		$0.00	$383.21	$0.00	$0.00	$401.51	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.514	SUP	HCPCS C1713		02.112.514  -  PLATE BN LO BND 135MM NS LCP CMBN 6 HL LOPRFL RND EDG SS TIB	BOTH IP/OP	"$2,627.25 "	"$1,944.17"	$0.00	"$2,040.58"	"$1,147.83"	"$1,147.83"	$0.00	$0.00	$0.00	$547.58	"$1,949.94"	"$1,949.94"	$0.00	$0.00	$547.52	$0.00	"$1,295.23"	"$1,295.23"	$0.00	"$1,275.36"	"$2,020.18"	"$2,040.58"	$0.00		$0.00	$387.56	$0.00	$0.00	$406.08	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.514S	SUP	HCPCS C1713		02.112.514S  -  PLATE BN 135MM STRL LCP CMBN 6 HL LO BND LOPRFL RND EDG SS	BOTH IP/OP	"$2,718.60 "	"$2,011.76"	$0.00	"$2,111.54"	"$1,187.74"	"$1,187.74"	$0.00	$0.00	$0.00	$566.62	"$2,017.74"	"$2,017.74"	$0.00	$0.00	$566.56	$0.00	"$1,340.27"	"$1,340.27"	$0.00	"$1,319.71"	"$2,090.43"	"$2,111.54"	$0.00		$0.00	$401.04	$0.00	$0.00	$420.20	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.515	SUP	HCPCS C1713		02.112.515  -  PLATE BONE 135MM 6 HOLE LOW BEND LP HEAD ROUNDED EDGE LCP	BOTH IP/OP	"$2,627.25 "	"$1,944.17"	$0.00	"$2,040.58"	"$1,147.83"	"$1,147.83"	$0.00	$0.00	$0.00	$547.58	"$1,949.94"	"$1,949.94"	$0.00	$0.00	$547.52	$0.00	"$1,295.23"	"$1,295.23"	$0.00	"$1,275.36"	"$2,020.18"	"$2,040.58"	$0.00		$0.00	$387.56	$0.00	$0.00	$406.08	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.518	SUP	HCPCS C1713		02.112.518  -  PLATE BN 161MM NS LCP CMBN 8 HL LO BND LOPRFL RND EDG SS TIB	BOTH IP/OP	"$2,652.55 "	"$1,962.89"	$0.00	"$2,060.22"	"$1,158.87"	"$1,158.87"	$0.00	$0.00	$0.00	$552.86	"$1,968.72"	"$1,968.72"	$0.00	$0.00	$552.79	$0.00	"$1,307.71"	"$1,307.71"	$0.00	"$1,287.64"	"$2,039.62"	"$2,060.22"	$0.00		$0.00	$391.29	$0.00	$0.00	$409.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.519	SUP	HCPCS C1713		02.112.519  -  PLATE BONE 161MM 8 HOLE LOW BEND ROUNDED EDGE LP LCP	BOTH IP/OP	"$2,652.55 "	"$1,962.89"	$0.00	"$2,060.22"	"$1,158.87"	"$1,158.87"	$0.00	$0.00	$0.00	$552.86	"$1,968.72"	"$1,968.72"	$0.00	$0.00	$552.79	$0.00	"$1,307.71"	"$1,307.71"	$0.00	"$1,287.64"	"$2,039.62"	"$2,060.22"	$0.00		$0.00	$391.29	$0.00	$0.00	$409.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.522	SUP	HCPCS C1713		02.112.522  -  PLATE BONE 187MM 10 HOLE LOW BEND ROUNDED EDGE LP LCP	BOTH IP/OP	"$2,680.65 "	"$1,983.68"	$0.00	"$2,082.06"	"$1,171.16"	"$1,171.16"	$0.00	$0.00	$0.00	$558.71	"$1,989.58"	"$1,989.58"	$0.00	$0.00	$558.65	$0.00	"$1,321.56"	"$1,321.56"	$0.00	"$1,301.29"	"$2,061.24"	"$2,082.06"	$0.00		$0.00	$395.44	$0.00	$0.00	$414.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.523	SUP	HCPCS C1713		02.112.523  -  PLATE BONE 187MM 10 HOLE LOW BEND ROUNDED EDGE LP LCP	BOTH IP/OP	"$2,680.65 "	"$1,983.68"	$0.00	"$2,082.06"	"$1,171.16"	"$1,171.16"	$0.00	$0.00	$0.00	$558.71	"$1,989.58"	"$1,989.58"	$0.00	$0.00	$558.65	$0.00	"$1,321.56"	"$1,321.56"	$0.00	"$1,301.29"	"$2,061.24"	"$2,082.06"	$0.00		$0.00	$395.44	$0.00	$0.00	$414.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.526	SUP	HCPCS C1713		02.112.526  -  PLATE BONE 213MM 12 HOLE LOW BEND LCP STAINLESS STEEL TIBIA	BOTH IP/OP	"$2,710.18 "	"$2,005.53"	$0.00	"$2,105.00"	"$1,184.06"	"$1,184.06"	$0.00	$0.00	$0.00	$564.87	"$2,011.49"	"$2,011.49"	$0.00	$0.00	$564.80	$0.00	"$1,336.12"	"$1,336.12"	$0.00	"$1,315.63"	"$2,083.95"	"$2,105.00"	$0.00		$0.00	$399.79	$0.00	$0.00	$418.90	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.527	SUP	HCPCS C1713		02.112.527  -  PLATE BONE 213MM 12 HOLE LOW BEND LCP STAINLESS STEEL TIBIA	BOTH IP/OP	"$2,710.18 "	"$2,005.53"	$0.00	"$2,105.00"	"$1,184.06"	"$1,184.06"	$0.00	$0.00	$0.00	$564.87	"$2,011.49"	"$2,011.49"	$0.00	$0.00	$564.80	$0.00	"$1,336.12"	"$1,336.12"	$0.00	"$1,315.63"	"$2,083.95"	"$2,105.00"	$0.00		$0.00	$399.79	$0.00	$0.00	$418.90	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.530	SUP	HCPCS C1713		02.112.530  -  PLATE BONE 239MM 14 HOLE LOW BEND LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$2,745.33 "	"$2,031.54"	$0.00	"$2,132.28"	"$1,199.41"	"$1,199.41"	$0.00	$0.00	$0.00	$572.19	"$2,037.58"	"$2,037.58"	$0.00	$0.00	$572.13	$0.00	"$1,353.45"	"$1,353.45"	$0.00	"$1,332.68"	"$2,110.96"	"$2,132.28"	$0.00		$0.00	$404.98	$0.00	$0.00	$424.32	$0.00	$0.00	$0.00	$0.00	$0.00
02.112.531	SUP	HCPCS C1713		02.112.531  -  PLATE BONE 239MM 14 HOLE LOW BEND LCP STAINLESS STEEL TIBIA	BOTH IP/OP	"$2,745.33 "	"$2,031.54"	$0.00	"$2,132.28"	"$1,199.41"	"$1,199.41"	$0.00	$0.00	$0.00	$572.19	"$2,037.58"	"$2,037.58"	$0.00	$0.00	$572.13	$0.00	"$1,353.45"	"$1,353.45"	$0.00	"$1,332.68"	"$2,110.96"	"$2,132.28"	$0.00		$0.00	$404.98	$0.00	$0.00	$424.32	$0.00	$0.00	$0.00	$0.00	$0.00
02.113.001	SUP	Custom 27203010		02.113.001  -  GUIDEWIRE ORTHOPEDIC 1.6MM 200MM DRILL TIP LCP STAINLESS	BOTH IP/OP	$69.58 	$51.49	$0.00	$54.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.64	$51.64	$0.00	$0.00	$14.50	$0.00	$0.00	$0.00	$0.00	$33.78	$53.50	$54.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.113.103	SUP	HCPCS C1713		02.113.103  -  PLATE BONE 62MM 3 HOLE SHARP HOOK LP PRECONTOUR SCALLOPED	BOTH IP/OP	"$1,019.13 "	$754.16	$0.00	$791.56	$445.25	$445.25	$0.00	$0.00	$0.00	$212.41	$756.39	$756.39	$0.00	$0.00	$212.39	$0.00	$602.81	$602.81	$0.00	$494.73	$783.64	$791.56	$0.00		$0.00	$150.34	$0.00	$0.00	$157.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.002	SUP	HCPCS C1713		02.114.002  -  PLATE BONE 23MM 4 HOLE LCP STAINLESS STEEL NONSTRL 1.5MM	BOTH IP/OP	$410.45 	$303.73	$0.00	$318.80	$179.33	$179.33	$0.00	$0.00	$0.00	$85.55	$304.64	$304.64	$0.00	$0.00	$85.54	$0.00	$242.78	$242.78	$0.00	$199.25	$315.61	$318.80	$0.00		$0.00	$60.55	$0.00	$0.00	$63.44	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.003	SUP	HCPCS C1713		02.114.003  -  PLATE BONE 29MM 6 HOLE ADAPTION LCP STAINLESS STEEL HAND	BOTH IP/OP	$752.05 	$556.52	$0.00	$584.12	$328.57	$328.57	$0.00	$0.00	$0.00	$156.75	$558.17	$558.17	$0.00	$0.00	$156.73	$0.00	$444.84	$444.84	$0.00	$365.08	$578.28	$584.12	$0.00		$0.00	$110.94	$0.00	$0.00	$116.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.004	SUP	HCPCS C1713		02.114.004  -  PLATE BONE 36MM 6 HOLE LCP STAINLESS STEEL NONSTRL 1.5MM	BOTH IP/OP	$410.45 	$303.73	$0.00	$318.80	$179.33	$179.33	$0.00	$0.00	$0.00	$85.55	$304.64	$304.64	$0.00	$0.00	$85.54	$0.00	$242.78	$242.78	$0.00	$199.25	$315.61	$318.80	$0.00		$0.00	$60.55	$0.00	$0.00	$63.44	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.005	SUP	HCPCS C1713		02.114.005  -  PLATE BONE 59MM 12 HOLE ADAPTION LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	$752.05 	$556.52	$0.00	$584.12	$328.57	$328.57	$0.00	$0.00	$0.00	$156.75	$558.17	$558.17	$0.00	$0.00	$156.73	$0.00	$444.84	$444.84	$0.00	$365.08	$578.28	$584.12	$0.00		$0.00	$110.94	$0.00	$0.00	$116.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.006	SUP	HCPCS C1713		02.114.006  -  PLATE BONE 3X8 HOLE T LCP STAINLESS STEEL NONSTRL 1.5 MM	BOTH IP/OP	$790.00 	$584.60	$0.00	$613.60	$345.15	$345.15	$0.00	$0.00	$0.00	$164.66	$586.34	$586.34	$0.00	$0.00	$164.64	$0.00	$467.29	$467.29	$0.00	$383.50	$607.46	$613.60	$0.00		$0.00	$116.54	$0.00	$0.00	$122.11	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.007	SUP	HCPCS C1713		02.114.007  -  PLATE BONE 4X8 HOLE T LCP STAINLESS STEEL NONSTRL 1.5 MM	BOTH IP/OP	$790.00 	$584.60	$0.00	$613.60	$345.15	$345.15	$0.00	$0.00	$0.00	$164.66	$586.34	$586.34	$0.00	$0.00	$164.64	$0.00	$467.29	$467.29	$0.00	$383.50	$607.46	$613.60	$0.00		$0.00	$116.54	$0.00	$0.00	$122.11	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.009	SUP	HCPCS C1713		02.114.009  -  PLATE BONE H EXTENDED LCP STAINLESS STEEL LEFT NONSTRL 1.5	BOTH IP/OP	$760.48 	$562.76	$0.00	$590.66	$332.25	$332.25	$0.00	$0.00	$0.00	$158.50	$564.42	$564.42	$0.00	$0.00	$158.48	$0.00	$449.82	$449.82	$0.00	$369.16	$584.76	$590.66	$0.00		$0.00	$112.18	$0.00	$0.00	$117.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.010	SUP	HCPCS C1713		02.114.010  -  PLATE BONE H EXTENDED LCP STAINLESS STEEL RIGHT NONSTRL 1.5	BOTH IP/OP	$760.48 	$562.76	$0.00	$590.66	$332.25	$332.25	$0.00	$0.00	$0.00	$158.50	$564.42	$564.42	$0.00	$0.00	$158.48	$0.00	$449.82	$449.82	$0.00	$369.16	$584.76	$590.66	$0.00		$0.00	$112.18	$0.00	$0.00	$117.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.013	SUP	HCPCS C1713		02.114.013  -  PLATE BONE 3X8 HOLE Y LCP STAINLESS STEEL NONSTRL 1.5 MM	BOTH IP/OP	$760.48 	$562.76	$0.00	$590.66	$332.25	$332.25	$0.00	$0.00	$0.00	$158.50	$564.42	$564.42	$0.00	$0.00	$158.48	$0.00	$449.82	$449.82	$0.00	$369.16	$584.76	$590.66	$0.00		$0.00	$112.18	$0.00	$0.00	$117.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.014	SUP	HCPCS C1713		02.114.014  -  PLATE BONE 6 HOLE LCP STAINLESS STEEL CONDYLE NONSTRL 1.5 MM	BOTH IP/OP	$944.63 	$699.03	$0.00	$733.68	$412.70	$412.70	$0.00	$0.00	$0.00	$196.88	$701.10	$701.10	$0.00	$0.00	$196.86	$0.00	$558.75	$558.75	$0.00	$458.55	$726.34	$733.68	$0.00		$0.00	$139.35	$0.00	$0.00	$146.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.502	SUP	HCPCS C1713		02.114.502  -  PLATE BONE 2.3CM 4 HOLE SHORT THREADED DRILL GUIDE LP CUT TO	BOTH IP/OP	$490.58 	$363.03	$0.00	$381.04	$214.34	$214.34	$0.00	$0.00	$0.00	$102.25	$364.10	$364.10	$0.00	$0.00	$102.24	$0.00	$290.18	$290.18	$0.00	$238.15	$377.23	$381.04	$0.00		$0.00	$72.37	$0.00	$0.00	$75.83	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.503	SUP	HCPCS C1713		02.114.503  -  PLATE BONE 2.9CM 6 HOLE SHORT THREADED DRILL GUIDE ADAPTION	BOTH IP/OP	$836.38 	$618.92	$0.00	$649.62	$365.41	$365.41	$0.00	$0.00	$0.00	$174.32	$620.76	$620.76	$0.00	$0.00	$174.30	$0.00	$494.72	$494.72	$0.00	$406.01	$643.13	$649.62	$0.00		$0.00	$123.38	$0.00	$0.00	$129.27	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.504	SUP	HCPCS C1713		02.114.504  -  PLATE BONE 3.6CM 6 HOLE SHORT THREADED DRILL GUIDE LP CUT TO	BOTH IP/OP	$490.58 	$363.03	$0.00	$381.04	$214.34	$214.34	$0.00	$0.00	$0.00	$102.25	$364.10	$364.10	$0.00	$0.00	$102.24	$0.00	$290.18	$290.18	$0.00	$238.15	$377.23	$381.04	$0.00		$0.00	$72.37	$0.00	$0.00	$75.83	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.505	SUP	HCPCS C1713		02.114.505  -  PLATE BONE 5.9CM 12 HOLE SHORT THREADED DRILL GUIDE ADAPTION	BOTH IP/OP	$836.38 	$618.92	$0.00	$649.62	$365.41	$365.41	$0.00	$0.00	$0.00	$174.32	$620.76	$620.76	$0.00	$0.00	$174.30	$0.00	$494.72	$494.72	$0.00	$406.01	$643.13	$649.62	$0.00		$0.00	$123.38	$0.00	$0.00	$129.27	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.506	SUP	HCPCS C1713		02.114.506  -  PLATE BONE T 3X8 HOLE SHORT THREADED DRILL GUIDE LP CUT TO	BOTH IP/OP	$885.58 	$655.33	$0.00	$687.84	$386.91	$386.91	$0.00	$0.00	$0.00	$184.58	$657.27	$657.27	$0.00	$0.00	$184.55	$0.00	$523.82	$523.82	$0.00	$429.90	$680.96	$687.84	$0.00		$0.00	$130.64	$0.00	$0.00	$136.88	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.507	SUP	HCPCS C1713		02.114.507  -  PLATE BONE T 4 HOLE HEAD 8 HOLE SHAFT LP CUT TO LENGTH LCP	BOTH IP/OP	$885.58 	$655.33	$0.00	$687.84	$386.91	$386.91	$0.00	$0.00	$0.00	$184.58	$657.27	$657.27	$0.00	$0.00	$184.55	$0.00	$523.82	$523.82	$0.00	$429.90	$680.96	$687.84	$0.00		$0.00	$130.64	$0.00	$0.00	$136.88	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.509	SUP	HCPCS C1713		02.114.509  -  PLATE BONE H EXTENDED PRELOADED DRILL GUIDE LP CUT TO LENGTH	BOTH IP/OP	$846.23 	$626.21	$0.00	$657.26	$369.71	$369.71	$0.00	$0.00	$0.00	$176.37	$628.07	$628.07	$0.00	$0.00	$176.35	$0.00	$500.54	$500.54	$0.00	$410.79	$650.69	$657.26	$0.00		$0.00	$124.83	$0.00	$0.00	$130.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.510	SUP	HCPCS C1713		02.114.510  -  PLATE BONE H EXTENDED PRELOADED DRILL GUIDE LP CUT TO LENGTH	BOTH IP/OP	$846.23 	$626.21	$0.00	$657.26	$369.71	$369.71	$0.00	$0.00	$0.00	$176.37	$628.07	$628.07	$0.00	$0.00	$176.35	$0.00	$500.54	$500.54	$0.00	$410.79	$650.69	$657.26	$0.00		$0.00	$124.83	$0.00	$0.00	$130.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.513	SUP	HCPCS C1713		02.114.513  -  PLATE BONE Y 3X8 HOLE LP SHORT THREADED DRILL GUIDE CUT TO	BOTH IP/OP	$846.23 	$626.21	$0.00	$657.26	$369.71	$369.71	$0.00	$0.00	$0.00	$176.37	$628.07	$628.07	$0.00	$0.00	$176.35	$0.00	$500.54	$500.54	$0.00	$410.79	$650.69	$657.26	$0.00		$0.00	$124.83	$0.00	$0.00	$130.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.114.514	SUP	HCPCS C1713		02.114.514  -  PLATE BONE 6 HOLE LP SHORT THREADED DRILL GUIDE CUT TO	BOTH IP/OP	"$1,030.38 "	$762.48	$0.00	$800.28	$450.16	$450.16	$0.00	$0.00	$0.00	$214.76	$764.74	$764.74	$0.00	$0.00	$214.73	$0.00	$609.47	$609.47	$0.00	$500.18	$792.28	$800.28	$0.00		$0.00	$152.00	$0.00	$0.00	$159.26	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.130	SUP	HCPCS C1713		02.115.130  -  PLATE BONE 90D L 37MM 2X3 HOLE VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$1,026.15 "	$759.35	$0.00	$797.02	$448.32	$448.32	$0.00	$0.00	$0.00	$213.88	$761.61	$761.61	$0.00	$0.00	$213.85	$0.00	$606.97	$606.97	$0.00	$498.14	$789.05	$797.02	$0.00		$0.00	$151.37	$0.00	$0.00	$158.61	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.131	SUP	HCPCS C1713		02.115.131  -  PLATE BONE -90D L 37MM 2X3 HOLE VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$1,026.15 "	$759.35	$0.00	$797.02	$448.32	$448.32	$0.00	$0.00	$0.00	$213.88	$761.61	$761.61	$0.00	$0.00	$213.85	$0.00	$606.97	$606.97	$0.00	$498.14	$789.05	$797.02	$0.00		$0.00	$151.37	$0.00	$0.00	$158.61	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.150	SUP	HCPCS C1713		02.115.150  -  PLATE BONE 90+ D L 51MM 2 HOLE HEAD 5 HOLE SHAFT VAR ANG LCP	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.150S	SUP	HCPCS C1713		02.115.150S  -  PLATE BN +90D L 51MM STRL LCP CMBN 2 HLE/HD 5 HL SHFT VA SS	BOTH IP/OP	"$1,135.48 "	$840.26	$0.00	$908.38	$510.96	$510.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$567.74	$899.30	$908.38	$0.00		$0.00	$172.53	$0.00	$0.00	$180.77	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.151	SUP	HCPCS C1713		02.115.151  -  PLATE BONE -90D 51MM 2X5 HOLE L VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.230	SUP	HCPCS C1713		02.115.230  -  PLATE BONE +90D L 37MM 3X3 HOLE VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$1,026.15 "	$759.35	$0.00	$797.02	$448.32	$448.32	$0.00	$0.00	$0.00	$213.88	$761.61	$761.61	$0.00	$0.00	$213.85	$0.00	$606.97	$606.97	$0.00	$498.14	$789.05	$797.02	$0.00		$0.00	$151.37	$0.00	$0.00	$158.61	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.231	SUP	HCPCS C1713		02.115.231  -  PLATE BONE -90D 37MM 3X3 HOLE L VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$1,026.15 "	$759.35	$0.00	$797.02	$448.32	$448.32	$0.00	$0.00	$0.00	$213.88	$761.61	$761.61	$0.00	$0.00	$213.85	$0.00	$606.97	$606.97	$0.00	$498.14	$789.05	$797.02	$0.00		$0.00	$151.37	$0.00	$0.00	$158.61	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.250	SUP	HCPCS C1713		02.115.250  -  PLATE BONE +90D 51MM 3X5 HOLE L VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.251	SUP	HCPCS C1713		02.115.251  -  PLATE BONE -90D 51MM 3X5 HOLE L VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.330	SUP	HCPCS C1713		02.115.330  -  PLATE BONE 37MM 3X3 HOLE T VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$1,059.90 "	$784.33	$0.00	$823.22	$463.06	$463.06	$0.00	$0.00	$0.00	$220.91	$786.66	$786.66	$0.00	$0.00	$220.88	$0.00	$626.93	$626.93	$0.00	$514.51	$814.99	$823.22	$0.00		$0.00	$156.35	$0.00	$0.00	$163.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.350	SUP	HCPCS C1713		02.115.350  -  PLATE BONE 51MM 3X5 HOLE T VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$1,106.28 "	$818.65	$0.00	$859.24	$483.32	$483.32	$0.00	$0.00	$0.00	$230.58	$821.08	$821.08	$0.00	$0.00	$230.55	$0.00	$654.36	$654.36	$0.00	$537.03	$850.65	$859.24	$0.00		$0.00	$163.19	$0.00	$0.00	$170.99	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.430	SUP	HCPCS C1713		02.115.430  -  PLATE BONE 20D 41MM 3X3 HOLE L VAR ANG OBLIQUE LCP STAINLESS	BOTH IP/OP	"$1,026.15 "	$759.35	$0.00	$797.02	$448.32	$448.32	$0.00	$0.00	$0.00	$213.88	$761.61	$761.61	$0.00	$0.00	$213.85	$0.00	$606.97	$606.97	$0.00	$498.14	$789.05	$797.02	$0.00		$0.00	$151.37	$0.00	$0.00	$158.61	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.430S	SUP	HCPCS C1713		02.115.430S  -  PLATE BN +20D OBLQ L 41MM STRL LCP CMBN 3 HLE/HD 3 HL SHFT	BOTH IP/OP	"$1,084.98 "	$802.89	$0.00	$867.98	$488.24	$488.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$542.49	$859.30	$867.98	$0.00		$0.00	$164.85	$0.00	$0.00	$172.73	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.431	SUP	HCPCS C1713		02.115.431  -  PLATE BONE -20D L 41MM 3X3 HOLE VAR ANG OBLIQUE LCP	BOTH IP/OP	"$1,026.15 "	$759.35	$0.00	$797.02	$448.32	$448.32	$0.00	$0.00	$0.00	$213.88	$761.61	$761.61	$0.00	$0.00	$213.85	$0.00	$606.97	$606.97	$0.00	$498.14	$789.05	$797.02	$0.00		$0.00	$151.37	$0.00	$0.00	$158.61	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.431S	SUP	HCPCS C1713		02.115.431S  -  PLATE BN -20D OBLQ L 41MM STRL LCP CMBN 3 HLE/HD 3 HL SHFT	BOTH IP/OP	"$1,117.53 "	$826.97	$0.00	$867.98	$488.24	$488.24	$0.00	$0.00	$0.00	$232.92	$829.43	$829.43	$0.00	$0.00	$232.89	$0.00	$661.02	$661.02	$0.00	$542.49	$859.30	$867.98	$0.00		$0.00	$164.85	$0.00	$0.00	$172.73	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.450	SUP	HCPCS C1713		02.115.450  -  PLATE BONE +20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LCP	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.451	SUP	HCPCS C1713		02.115.451  -  PLATE BONE -20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LCP	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.530	SUP	HCPCS C1713		02.115.530  -  PLATE BONE 46MM 5 HOLE VAR ANG COLUMN LCP STAINLESS STEEL	BOTH IP/OP	"$1,006.48 "	$744.80	$0.00	$781.72	$439.72	$439.72	$0.00	$0.00	$0.00	$209.77	$747.01	$747.01	$0.00	$0.00	$209.75	$0.00	$595.33	$595.33	$0.00	$488.58	$773.90	$781.72	$0.00		$0.00	$148.47	$0.00	$0.00	$155.56	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.540	SUP	HCPCS C1713		02.115.540  -  PLATE BONE 57MM 6 HOLE VAR ANG COLUMN LCP STAINLESS STEEL	BOTH IP/OP	"$1,059.90 "	$784.33	$0.00	$823.22	$463.06	$463.06	$0.00	$0.00	$0.00	$220.91	$786.66	$786.66	$0.00	$0.00	$220.88	$0.00	$626.93	$626.93	$0.00	$514.51	$814.99	$823.22	$0.00		$0.00	$156.35	$0.00	$0.00	$163.82	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.630	SUP	HCPCS C1713		02.115.630  -  PLATE BONE 90D 41MM 3 HOLE VAR ANG INTERMEDIATE COLUMN LCP	BOTH IP/OP	"$1,106.28 "	$818.65	$0.00	$859.24	$483.32	$483.32	$0.00	$0.00	$0.00	$230.58	$821.08	$821.08	$0.00	$0.00	$230.55	$0.00	$654.36	$654.36	$0.00	$537.03	$850.65	$859.24	$0.00		$0.00	$163.19	$0.00	$0.00	$170.99	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.631	SUP	HCPCS C1713		02.115.631  -  PLATE BONE -90D 41MM 3 HOLE VAR ANG INTERMEDIATE COLUMN LCP	BOTH IP/OP	"$1,106.28 "	$818.65	$0.00	$859.24	$483.32	$483.32	$0.00	$0.00	$0.00	$230.58	$821.08	$821.08	$0.00	$0.00	$230.55	$0.00	$654.36	$654.36	$0.00	$537.03	$850.65	$859.24	$0.00		$0.00	$163.19	$0.00	$0.00	$170.99	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.640	SUP	HCPCS C1713		02.115.640  -  PLATE BONE +90D 49MM 4 HOLE VAR ANG INTERMEDIATE COLUMN LCP	BOTH IP/OP	"$1,147.05 "	$848.82	$0.00	$890.90	$501.13	$501.13	$0.00	$0.00	$0.00	$239.07	$851.34	$851.34	$0.00	$0.00	$239.05	$0.00	$678.48	$678.48	$0.00	$556.81	$881.99	$890.90	$0.00		$0.00	$169.21	$0.00	$0.00	$177.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.641	SUP	HCPCS C1713		02.115.641  -  PLATE BONE -90D 49MM 4 HOLE VAR ANG INTERMEDIATE COLUMN LCP	BOTH IP/OP	"$1,147.05 "	$848.82	$0.00	$890.90	$501.13	$501.13	$0.00	$0.00	$0.00	$239.07	$851.34	$851.34	$0.00	$0.00	$239.05	$0.00	$678.48	$678.48	$0.00	$556.81	$881.99	$890.90	$0.00		$0.00	$169.21	$0.00	$0.00	$177.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.115.751S	SUP	HCPCS C1713		02.115.751S  -  PLATE BN 57MM STRL LCP CMBN 6 HLE/HD 5 HL SHFT VA SS RDS LT	BOTH IP/OP	"$1,834.23 "	"$1,357.33"	$0.00	"$1,467.38"	$825.40	$825.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$917.11	"$1,452.71"	"$1,467.38"	$0.00		$0.00	$278.70	$0.00	$0.00	$292.01	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.003S	SUP	HCPCS C1713		02.117.003S  -  PLATE BN SHRT 75MM STRL LCP CMBN 3 HL VA TPR TIP LAT SPRT SS	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.004S	SUP	HCPCS C1713		02.117.004S  -  PLATE BONE MEDIUM 88MM 4 HOLE VAR ANG LATERAL SUPPORT	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.007S	SUP	HCPCS C1713		02.117.007S  -  PLATE BONE LONG 127MM 7 HOLE VAR ANG TAPER TIP LATERAL	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.009S	SUP	HCPCS C1713		02.117.009S  -  PLATE BONE XLONG 153MM 9 HOLE VAR ANG LATERAL SUPPORT	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.103S	SUP	HCPCS C1713		02.117.103S  -  PLATE BONE SHORT 75MM 3 HOLE VAR ANG LATERAL SUPPORT LCP	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.104	SUP	HCPCS C1713		02.117.104  -  PLATE BN MED 88MM NS LCP CMBN 4 HL VA TPR TIP LAT SPRT SS	BOTH IP/OP	"$2,204.13 "	"$1,631.06"	$0.00	"$1,711.94"	$962.97	$962.97	$0.00	$0.00	$0.00	$459.39	"$1,635.90"	"$1,635.90"	$0.00	$0.00	$459.34	$0.00	"$1,303.74"	"$1,303.74"	$0.00	"$1,069.96"	"$1,694.82"	"$1,711.94"	$0.00		$0.00	$325.14	$0.00	$0.00	$340.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.104S	SUP	HCPCS C1713		02.117.104S  -  PLATE BONE MEDIUM 88MM 4 HOLE VAR ANG LATERAL SUPPORT	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.107S	SUP	HCPCS C1713		02.117.107S  -  PLATE BONE LONG 127MM 7 HOLE VAR ANG LATERAL SUPPORT TAPERED	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.203S	SUP	HCPCS C1713		02.117.203S  -  PLATE SHRT 75MM SS 2.7/3.5MM SCR 3 HOLE VAR ANG	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.204S	SUP	HCPCS C1713		02.117.204S  -  PLATE BN MED 88MM STRL LCP CMBN 4 HL VA TPR TIP RND PRFL SS	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.207S	SUP	HCPCS C1713		02.117.207S  -  PLATE BN LNG 127MM STRL LCP CMBN 7 HL VA TPR TIP RND PRFL SS	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.303S	SUP	HCPCS C1713		02.117.303S  -  PLATE BONE SHORT 75MM 3 HOLE VAR ANG ROUND PROFILE TAPERED	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.304S	SUP	HCPCS C1713		02.117.304S  -  PLATE BONE MEDIUM 88MM 4 HOLE VAR ANG ROUND PROFILE TAPERED	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.307S	SUP	HCPCS C1713		02.117.307S  -  PLATE BN LNG 127MM STRL LCP CMBN 7 HL VA TPR TIP RND PRFL SS	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.309S	SUP	HCPCS C1713		02.117.309S  -  PLATE BONE XLONG 153MM 9 HOLE VAR ANG ROUND PROFILE TAPERED	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.401S	SUP	HCPCS C1713		02.117.401S  -  PLATE BONE SHORT 69MM 1 HOLE VAR ANG ROUND PROFILE TAPERED	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.402S	SUP	HCPCS C1713		02.117.402S  -  PLATE BN MED 82MM STRL LCP CMBN 2 HL VA TPR TIP RND PRFL SS	BOTH IP/OP	"$2,164.50 "	"$1,601.73"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.404S	SUP	HCPCS C1713		02.117.404S  -  PLATE BONE LONG 108MM 4 HOLE VAR ANG TAPER TIP ROUND PROFILE	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.406S	SUP	HCPCS C1713		02.117.406S  -  PLATE BONE XLONG 134MM 6 HOLE VAR ANG TAPER TIP ROUND	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.501S	SUP	HCPCS C1713		02.117.501S  -  PLATE BONE SHORT 69MM 1 HOLE VAR ANG ROUND PROFILE TAPERED	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.502	SUP	HCPCS C1713		02.117.502  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$2,138.05 "	"$1,582.16"	$0.00	"$1,660.62"	$934.10	$934.10	$0.00	$0.00	$0.00	$445.62	"$1,586.86"	"$1,586.86"	$0.00	$0.00	$445.57	$0.00	"$1,264.66"	"$1,264.66"	$0.00	"$1,037.89"	"$1,644.02"	"$1,660.62"	$0.00		$0.00	$315.40	$0.00	$0.00	$330.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.502S	SUP	HCPCS C1713		02.117.502S  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG ROUND PROFILE TAPERED	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.504	SUP	HCPCS C1713		02.117.504  -  PLATE BN LNG 108MM NS LCP CMBN 4 HL VA TPR TIP RND PRFL SS	BOTH IP/OP	"$2,138.05 "	"$1,582.16"	$0.00	"$1,660.62"	$934.10	$934.10	$0.00	$0.00	$0.00	$445.62	"$1,586.86"	"$1,586.86"	$0.00	$0.00	$445.57	$0.00	"$1,264.66"	"$1,264.66"	$0.00	"$1,037.89"	"$1,644.02"	"$1,660.62"	$0.00		$0.00	$315.40	$0.00	$0.00	$330.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.504S	SUP	HCPCS C1713		02.117.504S  -  PLATE BONE LONG 108MM 4 HOLE VAR ANG ROUND PROFILE TAPERED	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.506	SUP	HCPCS C1713		02.117.506  -  PLATE BN XLNG 134MM NS LCP CMBN 6 HL VA TPR TIP RND PRFL SS	BOTH IP/OP	"$2,138.05 "	"$1,582.16"	$0.00	"$1,660.62"	$934.10	$934.10	$0.00	$0.00	$0.00	$445.62	"$1,586.86"	"$1,586.86"	$0.00	$0.00	$445.57	$0.00	"$1,264.66"	"$1,264.66"	$0.00	"$1,037.89"	"$1,644.02"	"$1,660.62"	$0.00		$0.00	$315.40	$0.00	$0.00	$330.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.506S	SUP	HCPCS C1713		02.117.506S  -  PLATE BN XLNG 134MM STRL LCP CMBN 6 HL VA TPR TIP RND PRFL	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.601S	SUP	HCPCS C1713		02.117.601S  -  PLATE BONE LCP COMBI STAINLESS STEEL SHORT L72 MM HUMERUS RI	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.602	SUP	HCPCS C1713		02.117.602  -  PLATE BONE MEDIUM 85MM 2 HOLE EXTENDED VAR ANG LCP STAINLESS	BOTH IP/OP	"$2,204.13 "	"$1,631.06"	$0.00	"$1,711.94"	$962.97	$962.97	$0.00	$0.00	$0.00	$459.39	"$1,635.90"	"$1,635.90"	$0.00	$0.00	$459.34	$0.00	"$1,303.74"	"$1,303.74"	$0.00	"$1,069.96"	"$1,694.82"	"$1,711.94"	$0.00		$0.00	$325.14	$0.00	$0.00	$340.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.602S	SUP	HCPCS C1713		02.117.602S  -  PLATE BONE LCP COMBI STAINLESS STEEL MEDIUM L85 MM HUMERUS R	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.604	SUP	HCPCS C1713		02.117.604  -  PLATE BN LNG 111MM NS LCP CMBN 4 HL VA TPR TIP XTD SS HUM RT	BOTH IP/OP	"$2,204.13 "	"$1,631.06"	$0.00	"$1,711.94"	$962.97	$962.97	$0.00	$0.00	$0.00	$459.39	"$1,635.90"	"$1,635.90"	$0.00	$0.00	$459.34	$0.00	"$1,303.74"	"$1,303.74"	$0.00	"$1,069.96"	"$1,694.82"	"$1,711.94"	$0.00		$0.00	$325.14	$0.00	$0.00	$340.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.604S	SUP	HCPCS C1713		02.117.604S  -  PLATE BONE LONG 111MM 4 HOLE EXTENDED VAR ANG ROUND PROFILE	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.606S	SUP	HCPCS C1713		02.117.606S  -  PLATE BN XLNG 137MM STRL LCP CMBN 6 HL VA TPR TIP XTD SS HUM	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.701S	SUP	HCPCS C1713		02.117.701S  -  PLATE BONE SHORT 72MM 1 HOLE VAR ANG EXTENDED LCP STAINLESS	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.702S	SUP	HCPCS C1713		02.117.702S  -  PLATE BONE MEDIUM 85MM 2 HOLE EXTENDED VAR ANG ROUND PROFILE	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.704	SUP	HCPCS C1713		02.117.704  -  PLATE BN LNG 111MM NS LCP CMBN 4 HL VA TPR TIP XTD SS HUM LT	BOTH IP/OP	"$2,204.13 "	"$1,631.06"	$0.00	"$1,711.94"	$962.97	$962.97	$0.00	$0.00	$0.00	$459.39	"$1,635.90"	"$1,635.90"	$0.00	$0.00	$459.34	$0.00	"$1,303.74"	"$1,303.74"	$0.00	"$1,069.96"	"$1,694.82"	"$1,711.94"	$0.00		$0.00	$325.14	$0.00	$0.00	$340.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.704S	SUP	HCPCS C1713		02.117.704S  -  PLATE BN LNG 111MM STRL LCP CMBN 4 HL VA TPR TIP XTD SS HUM	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.706	SUP	HCPCS C1713		02.117.706  -  PLATE BN XLNG 137MM NS LCP CMBN 6 HL VA TPR TIP XTD SS HUM	BOTH IP/OP	"$2,204.13 "	"$1,631.06"	$0.00	"$1,711.94"	$962.97	$962.97	$0.00	$0.00	$0.00	$459.39	"$1,635.90"	"$1,635.90"	$0.00	$0.00	$459.34	$0.00	"$1,303.74"	"$1,303.74"	$0.00	"$1,069.96"	"$1,694.82"	"$1,711.94"	$0.00		$0.00	$325.14	$0.00	$0.00	$340.68	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.706S	SUP	HCPCS C1713		02.117.706S  -  PLATE BONE XLONG 137MM 6 HOLE VAR ANG TAPER TIP EXTEND LCP	BOTH IP/OP	"$2,295.50 "	"$1,698.67"	$0.00	"$1,782.90"	"$1,002.88"	"$1,002.88"	$0.00	$0.00	$0.00	$478.44	"$1,703.72"	"$1,703.72"	$0.00	$0.00	$478.38	$0.00	"$1,357.79"	"$1,357.79"	$0.00	"$1,114.31"	"$1,765.07"	"$1,782.90"	$0.00		$0.00	$338.62	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.802	SUP	HCPCS C1713		02.117.802  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$2,138.05 "	"$1,582.16"	$0.00	"$1,660.62"	$934.10	$934.10	$0.00	$0.00	$0.00	$445.62	"$1,586.86"	"$1,586.86"	$0.00	$0.00	$445.57	$0.00	"$1,264.66"	"$1,264.66"	$0.00	"$1,037.89"	"$1,644.02"	"$1,660.62"	$0.00		$0.00	$315.40	$0.00	$0.00	$330.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.802S	SUP	HCPCS C1713		02.117.802S  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG ROUND PROFILE TAPERED	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.805S	SUP	HCPCS C1713		02.117.805S  -  PLATE BONE LONG 121MM 5 HOLE VAR ANG ROUND PROFILE TAPERED	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.807S	SUP	HCPCS C1713		02.117.807S  -  PLATE BONE LCP COMBI STAINLESS STEEL XLONG L147 MM HUMERUS R	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.902	SUP	HCPCS C1713		02.117.902  -  PLATE BN MED 82MM NS LCP CMBN 2 HL VA TPR TIP RND PRFL SS	BOTH IP/OP	"$2,138.05 "	"$1,582.16"	$0.00	"$1,660.62"	$934.10	$934.10	$0.00	$0.00	$0.00	$445.62	"$1,586.86"	"$1,586.86"	$0.00	$0.00	$445.57	$0.00	"$1,264.66"	"$1,264.66"	$0.00	"$1,037.89"	"$1,644.02"	"$1,660.62"	$0.00		$0.00	$315.40	$0.00	$0.00	$330.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.902S	SUP	HCPCS C1713		02.117.902S  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG EXTENDED LCP STAINLESS	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.905	SUP	HCPCS C1713		02.117.905  -  PLATE BN LNG 121MM NS LCP CMBN 5 HL VA TPR TIP RND PRFL SS	BOTH IP/OP	"$2,138.05 "	"$1,582.16"	$0.00	"$1,660.62"	$934.10	$934.10	$0.00	$0.00	$0.00	$445.62	"$1,586.86"	"$1,586.86"	$0.00	$0.00	$445.57	$0.00	"$1,264.66"	"$1,264.66"	$0.00	"$1,037.89"	"$1,644.02"	"$1,660.62"	$0.00		$0.00	$315.40	$0.00	$0.00	$330.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.905S	SUP	HCPCS C1713		02.117.905S  -  PLATE BONE LONG 121MM 5 HOLE VAR ANG ROUND PROFILE TAPERED	BOTH IP/OP	"$2,229.43 "	"$1,649.78"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$464.67	"$1,654.68"	"$1,654.68"	$0.00	$0.00	$464.61	$0.00	"$1,318.70"	"$1,318.70"	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.117.909S	SUP	HCPCS C1713		02.117.909S  -  PLATE BN 173MM STRL LCP CMBN 9 HL VA TPR TIP RND PRFL SS HUM	BOTH IP/OP	"$2,164.50 "	"$1,601.73"	$0.00	"$1,731.60"	$974.03	$974.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,082.25"	"$1,714.28"	"$1,731.60"	$0.00		$0.00	$328.88	$0.00	$0.00	$344.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.003S	SUP	HCPCS C1713		02.118.003S  -  PLATE BN 112MM STRL LCP CMBN 4 HL VA LOPRFL SS TIB LT DIST	BOTH IP/OP	"$2,857.78 "	"$2,114.76"	$0.00	"$2,219.62"	"$1,248.54"	"$1,248.54"	$0.00	$0.00	$0.00	$595.63	"$2,121.04"	"$2,121.04"	$0.00	$0.00	$595.56	$0.00	"$1,408.88"	"$1,408.88"	$0.00	"$1,387.26"	"$2,197.43"	"$2,219.62"	$0.00		$0.00	$421.57	$0.00	$0.00	$441.70	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.005S	SUP	HCPCS C1713		02.118.005S  -  PLATE BN 142MM STRL LCP CMBN 6 HL VA LOPRFL SS TIB LT DIST	BOTH IP/OP	"$2,888.70 "	"$2,137.64"	$0.00	"$2,243.64"	"$1,262.05"	"$1,262.05"	$0.00	$0.00	$0.00	$602.08	"$2,143.99"	"$2,143.99"	$0.00	$0.00	$602.01	$0.00	"$1,424.13"	"$1,424.13"	$0.00	"$1,402.28"	"$2,221.20"	"$2,243.64"	$0.00		$0.00	$426.13	$0.00	$0.00	$446.48	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.006S	SUP	HCPCS C1713		02.118.006S  -  PLATE BN 172MM STRL LCP CMBN 8 HL VA LOPRFL SS TIB RT DIST	BOTH IP/OP	"$2,916.80 "	"$2,158.43"	$0.00	"$2,265.48"	"$1,274.33"	"$1,274.33"	$0.00	$0.00	$0.00	$607.93	"$2,164.85"	"$2,164.85"	$0.00	$0.00	$607.86	$0.00	"$1,437.98"	"$1,437.98"	$0.00	"$1,415.93"	"$2,242.83"	"$2,265.48"	$0.00		$0.00	$430.28	$0.00	$0.00	$450.83	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.007S	SUP	HCPCS C1713		02.118.007S  -  PLATE BN 172MM STRL LCP CMBN 8 HL VA LOPRFL SS TIB LT DIST	BOTH IP/OP	"$2,916.80 "	"$2,158.43"	$0.00	"$2,265.48"	"$1,274.33"	"$1,274.33"	$0.00	$0.00	$0.00	$607.93	"$2,164.85"	"$2,164.85"	$0.00	$0.00	$607.86	$0.00	"$1,437.98"	"$1,437.98"	$0.00	"$1,415.93"	"$2,242.83"	"$2,265.48"	$0.00		$0.00	$430.28	$0.00	$0.00	$450.83	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.011S	SUP	HCPCS C1713		02.118.011S  -  PLATE BN 232MM STRL LCP CMBN 12 HL VA LOPRFL SS TIB LT DIST	BOTH IP/OP	"$3,422.85 "	"$2,532.91"	$0.00	"$2,658.54"	"$1,495.43"	"$1,495.43"	$0.00	$0.00	$0.00	$713.41	"$2,540.44"	"$2,540.44"	$0.00	$0.00	$713.32	$0.00	"$1,687.47"	"$1,687.47"	$0.00	"$1,661.59"	"$2,631.96"	"$2,658.54"	$0.00		$0.00	$504.93	$0.00	$0.00	$529.05	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.510	SUP	HCPCS C1713		02.118.510  -  SCREW BN T8 2.7MM 10MM NS LCP ST STRDR LOPRFL SS ELB MTPHSL	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.512	SUP	HCPCS C1713		02.118.512  -  SCREW BONE T8 LP 2.7MM 12MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.514	SUP	HCPCS C1713		02.118.514  -  SCREW BONE T8 LP 2.7MM 14MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.516	SUP	HCPCS C1713		02.118.516  -  SCREW BONE T8 LP 2.7MM 16MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.518	SUP	HCPCS C1713		02.118.518  -  SCREW BONE T8 LP 2.7MM 18MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.520	SUP	HCPCS C1713		02.118.520  -  SCREW BONE T8 LP 2.7MM 20MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.522	SUP	HCPCS C1713		02.118.522  -  SCREW BONE T8 LP 2.7MM 22MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.524	SUP	HCPCS C1713		02.118.524  -  SCREW BONE T8 2.7MM 24MM SELF TAP STARDRIVE LP LCP STAINLESS	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.526	SUP	HCPCS C1713		02.118.526  -  SCREW BONE 2.7MM 26MM VAR ANG SELF TAP T8 STARDRIVE LP HEAD	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.528	SUP	HCPCS C1713		02.118.528  -  SCREW BONE T8 LP 2.7MM 28MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.530	SUP	HCPCS C1713		02.118.530  -  SCREW BONE T8 LP 2.7MM 30MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.532	SUP	HCPCS C1713		02.118.532  -  SCREW BONE T8 LP 2.7MM 32MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.534	SUP	HCPCS C1713		02.118.534  -  SCREW BONE T8 LP 2.7MM 34MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.536	SUP	HCPCS C1713		02.118.536  -  SCREW BN T8 2.7MM 36MM NS ST STRDR LOPRFL HD SS MTPHSL	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.538	SUP	HCPCS C1713		02.118.538  -  SCREW BONE T8 LP 2.7MM 38MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.540	SUP	HCPCS C1713		02.118.540  -  SCREW BN T8 2.7MM 40MM NS LCP ST STRDR LOPRFL SS ELB MTPHSL	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.542	SUP	HCPCS C1713		02.118.542  -  SCREW BONE T8 2.7MM 42MM SELF TAP STARDRIVE LP LCP STAINLESS	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.544	SUP	HCPCS C1713		02.118.544  -  SCREW BONE 2.7MM 44MM VAR ANG SELF TAP T8 STARDRIVE LP HEAD	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.546	SUP	HCPCS C1713		02.118.546  -  SCREW BONE T8 LP 2.7MM 46MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.548	SUP	HCPCS C1713		02.118.548  -  SCREW BONE T8 LP 2.7MM 48MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.550	SUP	HCPCS C1713		02.118.550  -  SCREW BONE T8 LP 2.7MM 50MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.552	SUP	HCPCS C1713		02.118.552  -  SCREW BONE 2.7MM 52MM VAR ANG SELF TAP T8 STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.554	SUP	HCPCS C1713		02.118.554  -  SCREW BONE T8 LP 2.7MM 54MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.556	SUP	HCPCS C1713		02.118.556  -  SCREW BONE T8 LP 2.7MM 56MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.558	SUP	HCPCS C1713		02.118.558  -  SCREW BONE T8 LP 2.7MM 58MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.560	SUP	HCPCS C1713		02.118.560  -  SCREW BONE T8 LP 2.7MM 60MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.562	SUP	HCPCS C1713		02.118.562  -  SCREW BONE T8 LP 2.7MM 62MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.564	SUP	HCPCS C1713		02.118.564  -  SCREW BONE T8 LP 2.7MM 64MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.566	SUP	HCPCS C1713		02.118.566  -  SCREW BONE T8 LP 2.7MM 66MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.568	SUP	HCPCS C1713		02.118.568  -  SCREW BONE T8 LP 2.7MM 68MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.570	SUP	HCPCS C1713		02.118.570  -  SCREW BONE T8 LP 2.7MM 70MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$37.46	$37.46	$0.00	$0.00	$0.00	$17.87	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$50.72	$50.72	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$12.65	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$0.00
02.118.575S	SUP	HCPCS C1713		02.118.575S  -  SCREW BN 2.7MM 75MM STRL LCP T8 STRDR RCS ST LOPRFL SS	BOTH IP/OP	$177.13 	$131.08	$0.00	$137.56	$77.38	$77.38	$0.00	$0.00	$0.00	$36.92	$131.46	$131.46	$0.00	$0.00	$36.91	$0.00	$104.77	$104.77	$0.00	$85.98	$136.18	$137.56	$0.00		$0.00	$26.13	$0.00	$0.00	$27.37	$0.00	$0.00	$0.00	$0.00	$0.00
02.120.601	SUP	HCPCS C1713		02.120.601  -  PLATE BONE 4 HOLE LOCKING LCP STAINLESS STEEL FEMUR PROXIMAL	BOTH IP/OP	$940.40 	$695.90	$0.00	$730.42	$410.86	$410.86	$0.00	$0.00	$0.00	$196.00	$697.96	$697.96	$0.00	$0.00	$195.98	$0.00	$556.25	$556.25	$0.00	$456.51	$723.12	$730.42	$0.00		$0.00	$138.73	$0.00	$0.00	$145.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.120.602	SUP	HCPCS C1713		02.120.602  -  PLATE BONE 8 HOLE ATTCH LOCKING LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$1,030.38 "	$762.48	$0.00	$800.28	$450.16	$450.16	$0.00	$0.00	$0.00	$214.76	$764.74	$764.74	$0.00	$0.00	$214.73	$0.00	$609.47	$609.47	$0.00	$500.18	$792.28	$800.28	$0.00		$0.00	$152.00	$0.00	$0.00	$159.26	$0.00	$0.00	$0.00	$0.00	$0.00
02.120.603	SUP	HCPCS C1713		02.120.603  -  PLATE BONE 4.5MM 4 HOLE ATTCH LOCKING LCP STAINLESS STEEL	BOTH IP/OP	$940.40 	$695.90	$0.00	$730.42	$410.86	$410.86	$0.00	$0.00	$0.00	$196.00	$697.96	$697.96	$0.00	$0.00	$195.98	$0.00	$556.25	$556.25	$0.00	$456.51	$723.12	$730.42	$0.00		$0.00	$138.73	$0.00	$0.00	$145.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.120.604	SUP	HCPCS C1713		02.120.604  -  PLATE BONE 4.5MM 8 HOLE ATTCH LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$1,030.38 "	$762.48	$0.00	$800.28	$450.16	$450.16	$0.00	$0.00	$0.00	$214.76	$764.74	$764.74	$0.00	$0.00	$214.73	$0.00	$609.47	$609.47	$0.00	$500.18	$792.28	$800.28	$0.00		$0.00	$152.00	$0.00	$0.00	$159.26	$0.00	$0.00	$0.00	$0.00	$0.00
02.120.606	SUP	HCPCS C1713		02.120.606  -  SCREW BONE 2 PART CONNECT STARDRIVE LCP STAINLESS STEEL	BOTH IP/OP	$303.63 	$224.69	$0.00	$235.82	$132.65	$132.65	$0.00	$0.00	$0.00	$63.28	$225.35	$225.35	$0.00	$0.00	$63.28	$0.00	$179.59	$179.59	$0.00	$147.39	$233.47	$235.82	$0.00		$0.00	$44.79	$0.00	$0.00	$46.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.120.701	SUP	HCPCS C1713		02.120.701  -  PLATE BONE 69MM 1 HOLE SET W/O CASE LCP STAINLESS STEEL	BOTH IP/OP	"$1,750.08 "	"$1,295.06"	$0.00	"$1,359.30"	$764.61	$764.61	$0.00	$0.00	$0.00	$364.76	"$1,298.91"	"$1,298.91"	$0.00	$0.00	$364.72	$0.00	"$1,035.17"	"$1,035.17"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$258.17	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.120.702	SUP	HCPCS C1713		02.120.702  -  PLATE BONE 79MM 2 HOLE SET W/O CASE LCP STAINLESS STEEL	BOTH IP/OP	"$1,769.78 "	"$1,309.64"	$0.00	"$1,374.58"	$773.20	$773.20	$0.00	$0.00	$0.00	$368.87	"$1,313.53"	"$1,313.53"	$0.00	$0.00	$368.82	$0.00	"$1,046.82"	"$1,046.82"	$0.00	$859.11	"$1,360.84"	"$1,374.58"	$0.00		$0.00	$261.07	$0.00	$0.00	$273.54	$0.00	$0.00	$0.00	$0.00	$0.00
02.120.704	SUP	HCPCS C1713		02.120.704  -  PLATE BONE 105MM 4 HOLE LCP STAINLESS STEEL TIBIA	BOTH IP/OP	"$1,788.05 "	"$1,323.16"	$0.00	"$1,388.76"	$781.18	$781.18	$0.00	$0.00	$0.00	$372.67	"$1,327.09"	"$1,327.09"	$0.00	$0.00	$372.63	$0.00	"$1,057.63"	"$1,057.63"	$0.00	$867.98	"$1,374.87"	"$1,388.76"	$0.00		$0.00	$263.77	$0.00	$0.00	$276.36	$0.00	$0.00	$0.00	$0.00	$0.00
02.120.706	SUP	HCPCS C1713		02.120.706  -  PLATE BONE 131MM 6 HOLE LCP STAINLESS STEEL TIBIA	BOTH IP/OP	"$1,804.90 "	"$1,335.63"	$0.00	"$1,401.88"	$788.56	$788.56	$0.00	$0.00	$0.00	$376.19	"$1,339.60"	"$1,339.60"	$0.00	$0.00	$376.14	$0.00	"$1,067.60"	"$1,067.60"	$0.00	$876.18	"$1,387.86"	"$1,401.88"	$0.00		$0.00	$266.25	$0.00	$0.00	$278.97	$0.00	$0.00	$0.00	$0.00	$0.00
02.120.708	SUP	HCPCS C1713		02.120.708  -  PLATE BONE 157MM 8 HOLE SET W/O CASE LCP STAINLESS STEEL	BOTH IP/OP	"$1,876.60 "	"$1,388.68"	$0.00	"$1,457.56"	$819.88	$819.88	$0.00	$0.00	$0.00	$391.13	"$1,392.81"	"$1,392.81"	$0.00	$0.00	$391.08	$0.00	"$1,110.01"	"$1,110.01"	$0.00	$910.98	"$1,442.98"	"$1,457.56"	$0.00		$0.00	$276.83	$0.00	$0.00	$290.05	$0.00	$0.00	$0.00	$0.00	$0.00
02.120.710	SUP	HCPCS C1713		02.120.710  -  PLATE BONE 183MM 10 HOLE SET W/O CASE LCP STAINLESS STEEL	BOTH IP/OP	"$1,896.28 "	"$1,403.25"	$0.00	"$1,472.84"	$828.47	$828.47	$0.00	$0.00	$0.00	$395.23	"$1,407.42"	"$1,407.42"	$0.00	$0.00	$395.18	$0.00	"$1,121.65"	"$1,121.65"	$0.00	$920.53	"$1,458.11"	"$1,472.84"	$0.00		$0.00	$279.73	$0.00	$0.00	$293.10	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.020	SUP	HCPCS C1713		02.123.020  -  PLATE BN CNTR 91MM NS LCP CMBN 2 HL LMT CNTCT TPR TIP SS HUM	BOTH IP/OP	"$2,857.78 "	"$2,114.76"	$0.00	"$2,219.62"	"$1,248.54"	"$1,248.54"	$0.00	$0.00	$0.00	$595.63	"$2,121.04"	"$2,121.04"	$0.00	$0.00	$595.56	$0.00	"$1,408.88"	"$1,408.88"	$0.00	"$1,387.26"	"$2,197.43"	"$2,219.62"	$0.00		$0.00	$421.57	$0.00	$0.00	$441.70	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.021	SUP	HCPCS C1713		02.123.021  -  PLATE BN CNTR 91MM NS LCP CMBN 2 HL LMT CNTCT TPR TIP SS HUM	BOTH IP/OP	"$2,857.78 "	"$2,114.76"	$0.00	"$2,219.62"	"$1,248.54"	"$1,248.54"	$0.00	$0.00	$0.00	$595.63	"$2,121.04"	"$2,121.04"	$0.00	$0.00	$595.56	$0.00	"$1,408.88"	"$1,408.88"	$0.00	"$1,387.26"	"$2,197.43"	"$2,219.62"	$0.00		$0.00	$421.57	$0.00	$0.00	$441.70	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.022	SUP	HCPCS C1713		02.123.022  -  PLATE BONE 91MM 4 HOLE LCP STAINLESS STEEL PERIARTICULAR	BOTH IP/OP	"$2,943.53 "	"$2,178.21"	$0.00	"$2,286.22"	"$1,286.00"	"$1,286.00"	$0.00	$0.00	$0.00	$613.50	"$2,184.68"	"$2,184.68"	$0.00	$0.00	$613.43	$0.00	"$1,451.16"	"$1,451.16"	$0.00	"$1,428.89"	"$2,263.36"	"$2,286.22"	$0.00		$0.00	$434.22	$0.00	$0.00	$454.96	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.023	SUP	HCPCS C1713		02.123.023  -  PLATE BN CNTR 127MM NS LCP CMBN 4 HL LMT CNTCT TPR TIP SS	BOTH IP/OP	"$2,943.53 "	"$2,178.21"	$0.00	"$2,286.22"	"$1,286.00"	"$1,286.00"	$0.00	$0.00	$0.00	$613.50	"$2,184.68"	"$2,184.68"	$0.00	$0.00	$613.43	$0.00	"$1,451.16"	"$1,451.16"	$0.00	"$1,428.89"	"$2,263.36"	"$2,286.22"	$0.00		$0.00	$434.22	$0.00	$0.00	$454.96	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.024	SUP	HCPCS C1713		02.123.024  -  PLATE BONE 163MM 6 HOLE LCP STAINLESS STEEL PERIARTICULAR	BOTH IP/OP	"$3,100.95 "	"$2,294.70"	$0.00	"$2,408.52"	"$1,354.79"	"$1,354.79"	$0.00	$0.00	$0.00	$646.32	"$2,301.53"	"$2,301.53"	$0.00	$0.00	$646.24	$0.00	"$1,528.77"	"$1,528.77"	$0.00	"$1,505.33"	"$2,384.43"	"$2,408.52"	$0.00		$0.00	$457.44	$0.00	$0.00	$479.30	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.025	SUP	HCPCS C1713		02.123.025  -  PLATE BONE 163MM 6 HOLE LCP STAINLESS STEEL LEFT PROXIMAL	BOTH IP/OP	"$3,100.95 "	"$2,294.70"	$0.00	"$2,408.52"	"$1,354.79"	"$1,354.79"	$0.00	$0.00	$0.00	$646.32	"$2,301.53"	"$2,301.53"	$0.00	$0.00	$646.24	$0.00	"$1,528.77"	"$1,528.77"	$0.00	"$1,505.33"	"$2,384.43"	"$2,408.52"	$0.00		$0.00	$457.44	$0.00	$0.00	$479.30	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.026	SUP	HCPCS C1713		02.123.026  -  PLATE BN CNTR 199MM NS LCP CMBN 8 HL LMT CNTCT TPR TIP SS	BOTH IP/OP	"$3,220.45 "	"$2,383.13"	$0.00	"$2,501.32"	"$1,406.99"	"$1,406.99"	$0.00	$0.00	$0.00	$671.22	"$2,390.22"	"$2,390.22"	$0.00	$0.00	$671.14	$0.00	"$1,587.68"	"$1,587.68"	$0.00	"$1,563.33"	"$2,476.31"	"$2,501.32"	$0.00		$0.00	$475.07	$0.00	$0.00	$497.76	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.027	SUP	HCPCS C1713		02.123.027  -  PLATE BN CNTR 199MM NS LCP CMBN 8 HL LMT CNTCT TPR TIP SS	BOTH IP/OP	"$3,220.45 "	"$2,383.13"	$0.00	"$2,501.32"	"$1,406.99"	"$1,406.99"	$0.00	$0.00	$0.00	$671.22	"$2,390.22"	"$2,390.22"	$0.00	$0.00	$671.14	$0.00	"$1,587.68"	"$1,587.68"	$0.00	"$1,563.33"	"$2,476.31"	"$2,501.32"	$0.00		$0.00	$475.07	$0.00	$0.00	$497.76	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.028	SUP	HCPCS C1713		02.123.028  -  PLATE BN CNTR 235MM NS LCP CMBN 10 HL LMT CNTCT TPR TIP SS	BOTH IP/OP	"$3,341.33 "	"$2,472.58"	$0.00	"$2,595.20"	"$1,459.80"	"$1,459.80"	$0.00	$0.00	$0.00	$696.42	"$2,479.93"	"$2,479.93"	$0.00	$0.00	$696.33	$0.00	"$1,647.27"	"$1,647.27"	$0.00	"$1,622.00"	"$2,569.25"	"$2,595.20"	$0.00		$0.00	$492.90	$0.00	$0.00	$516.44	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.029	SUP	HCPCS C1713		02.123.029  -  PLATE BONE 235MM 10 HOLE LCP STAINLESS STEEL LEFT PROXIMAL	BOTH IP/OP	"$3,341.33 "	"$2,472.58"	$0.00	"$2,595.20"	"$1,459.80"	"$1,459.80"	$0.00	$0.00	$0.00	$696.42	"$2,479.93"	"$2,479.93"	$0.00	$0.00	$696.33	$0.00	"$1,647.27"	"$1,647.27"	$0.00	"$1,622.00"	"$2,569.25"	"$2,595.20"	$0.00		$0.00	$492.90	$0.00	$0.00	$516.44	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.030	SUP	HCPCS C1713		02.123.030  -  PLATE BN CNTR 271MM NS LCP CMBN 12 HL LMT CNTCT TPR TIP SS	BOTH IP/OP	"$3,448.18 "	"$2,551.65"	$0.00	"$2,678.18"	"$1,506.48"	"$1,506.48"	$0.00	$0.00	$0.00	$718.69	"$2,559.24"	"$2,559.24"	$0.00	$0.00	$718.60	$0.00	"$1,699.95"	"$1,699.95"	$0.00	"$1,673.86"	"$2,651.40"	"$2,678.18"	$0.00		$0.00	$508.66	$0.00	$0.00	$532.96	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.031	SUP	HCPCS C1713		02.123.031  -  PLATE BONE 271MM 12 HOLE LCP STAINLESS STEEL PERIARTICULAR	BOTH IP/OP	"$3,448.18 "	"$2,551.65"	$0.00	"$2,678.18"	"$1,506.48"	"$1,506.48"	$0.00	$0.00	$0.00	$718.69	"$2,559.24"	"$2,559.24"	$0.00	$0.00	$718.60	$0.00	"$1,699.95"	"$1,699.95"	$0.00	"$1,673.86"	"$2,651.40"	"$2,678.18"	$0.00		$0.00	$508.66	$0.00	$0.00	$532.96	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.032S	SUP	HCPCS C1713		02.123.032S  -  PLATE BONE 307MM 14 HOLE LCP STAINLESS STEEL PERIARTICULAR	BOTH IP/OP	"$3,767.25 "	"$2,787.77"	$0.00	"$2,926.02"	"$1,645.89"	"$1,645.89"	$0.00	$0.00	$0.00	$785.19	"$2,796.05"	"$2,796.05"	$0.00	$0.00	$785.09	$0.00	"$1,857.25"	"$1,857.25"	$0.00	"$1,828.76"	"$2,896.76"	"$2,926.02"	$0.00		$0.00	$555.73	$0.00	$0.00	$582.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.033S	SUP	HCPCS C1713		02.123.033S  -  PLATE BONE 307MM 14 HOLE LCP STAINLESS STEEL PERIARTICULAR	BOTH IP/OP	"$3,767.25 "	"$2,787.77"	$0.00	"$2,926.02"	"$1,645.89"	"$1,645.89"	$0.00	$0.00	$0.00	$785.19	"$2,796.05"	"$2,796.05"	$0.00	$0.00	$785.09	$0.00	"$1,857.25"	"$1,857.25"	$0.00	"$1,828.76"	"$2,896.76"	"$2,926.02"	$0.00		$0.00	$555.73	$0.00	$0.00	$582.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.040	SUP	HCPCS C1713		02.123.040  -  PLATE BONE 109MM 3 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL	BOTH IP/OP	"$2,898.55 "	"$2,144.93"	$0.00	"$2,251.30"	"$1,266.36"	"$1,266.36"	$0.00	$0.00	$0.00	$604.13	"$2,151.30"	"$2,151.30"	$0.00	$0.00	$604.06	$0.00	"$1,428.99"	"$1,428.99"	$0.00	"$1,407.06"	"$2,228.79"	"$2,251.30"	$0.00		$0.00	$427.58	$0.00	$0.00	$448.01	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.041	SUP	HCPCS C1713		02.123.041  -  PLATE BN CNTR 109MM NS LCP CMBN 3 HL LMT CNTCT TPR TIP SS	BOTH IP/OP	"$2,898.55 "	"$2,144.93"	$0.00	"$2,251.30"	"$1,266.36"	"$1,266.36"	$0.00	$0.00	$0.00	$604.13	"$2,151.30"	"$2,151.30"	$0.00	$0.00	$604.06	$0.00	"$1,428.99"	"$1,428.99"	$0.00	"$1,407.06"	"$2,228.79"	"$2,251.30"	$0.00		$0.00	$427.58	$0.00	$0.00	$448.01	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.042	SUP	HCPCS C1713		02.123.042  -  PLATE BN CNTR 145MM NS LCP CMBN 5 HL LMT CNTCT TPR TIP SS	BOTH IP/OP	"$3,016.63 "	"$2,232.31"	$0.00	"$2,343.00"	"$1,317.94"	"$1,317.94"	$0.00	$0.00	$0.00	$628.74	"$2,238.94"	"$2,238.94"	$0.00	$0.00	$628.66	$0.00	"$1,487.20"	"$1,487.20"	$0.00	"$1,464.38"	"$2,319.57"	"$2,343.00"	$0.00		$0.00	$445.00	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
02.123.043	SUP	HCPCS C1713		02.123.043  -  PLATE BONE 14.5CM 5 HOLE SET LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$3,016.63 "	"$2,232.31"	$0.00	"$2,343.00"	"$1,317.94"	"$1,317.94"	$0.00	$0.00	$0.00	$628.74	"$2,238.94"	"$2,238.94"	$0.00	$0.00	$628.66	$0.00	"$1,487.20"	"$1,487.20"	$0.00	"$1,464.38"	"$2,319.57"	"$2,343.00"	$0.00		$0.00	$445.00	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.030S	SUP	HCPCS C1713		02.124.030S  -  PLATE BONE 356MM 15 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$3,318.85 "	"$2,455.95"	$0.00	"$2,577.74"	"$1,449.98"	"$1,449.98"	$0.00	$0.00	$0.00	$691.73	"$2,463.25"	"$2,463.25"	$0.00	$0.00	$691.65	$0.00	"$1,636.19"	"$1,636.19"	$0.00	"$1,611.09"	"$2,551.97"	"$2,577.74"	$0.00		$0.00	$489.58	$0.00	$0.00	$512.97	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.031S	SUP	HCPCS C1713		02.124.031S  -  PLATE BONE 356MM 15 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$3,318.85 "	"$2,455.95"	$0.00	"$2,577.74"	"$1,449.98"	"$1,449.98"	$0.00	$0.00	$0.00	$691.73	"$2,463.25"	"$2,463.25"	$0.00	$0.00	$691.65	$0.00	"$1,636.19"	"$1,636.19"	$0.00	"$1,611.09"	"$2,551.97"	"$2,577.74"	$0.00		$0.00	$489.58	$0.00	$0.00	$512.97	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.034S	SUP	HCPCS C1713		02.124.034S  -  PLATE BN 396MM STRL LCP CMBN 17 HL PSHP RND TIP LOPRFL SS	BOTH IP/OP	"$3,379.28 "	"$2,500.67"	$0.00	"$2,624.68"	"$1,476.38"	"$1,476.38"	$0.00	$0.00	$0.00	$704.33	"$2,508.10"	"$2,508.10"	$0.00	$0.00	$704.24	$0.00	"$1,665.98"	"$1,665.98"	$0.00	"$1,640.43"	"$2,598.43"	"$2,624.68"	$0.00		$0.00	$498.50	$0.00	$0.00	$522.31	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.035S	SUP	HCPCS C1713		02.124.035S  -  PLATE BONE 396MM 17 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$3,379.28 "	"$2,500.67"	$0.00	"$2,624.68"	"$1,476.38"	"$1,476.38"	$0.00	$0.00	$0.00	$704.33	"$2,508.10"	"$2,508.10"	$0.00	$0.00	$704.24	$0.00	"$1,665.98"	"$1,665.98"	$0.00	"$1,640.43"	"$2,598.43"	"$2,624.68"	$0.00		$0.00	$498.50	$0.00	$0.00	$522.31	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.038S	SUP	HCPCS C1713		02.124.038S  -  PLATE BONE 436MM 19 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$3,441.13 "	"$2,546.44"	$0.00	"$2,672.72"	"$1,503.41"	"$1,503.41"	$0.00	$0.00	$0.00	$717.22	"$2,554.00"	"$2,554.00"	$0.00	$0.00	$717.13	$0.00	"$1,696.47"	"$1,696.47"	$0.00	"$1,670.45"	"$2,645.99"	"$2,672.72"	$0.00		$0.00	$507.62	$0.00	$0.00	$531.87	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.039S	SUP	HCPCS C1713		02.124.039S  -  PLATE BONE 436MM 19 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR	BOTH IP/OP	"$3,441.13 "	"$2,546.44"	$0.00	"$2,672.72"	"$1,503.41"	"$1,503.41"	$0.00	$0.00	$0.00	$717.22	"$2,554.00"	"$2,554.00"	$0.00	$0.00	$717.13	$0.00	"$1,696.47"	"$1,696.47"	$0.00	"$1,670.45"	"$2,645.99"	"$2,672.72"	$0.00		$0.00	$507.62	$0.00	$0.00	$531.87	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.200	SUP	HCPCS C1713		02.124.200  -  PLATE BN CNTR LO BND 76MM NS LCP CMBN 4 HL LMT CNTCT SS TIB	BOTH IP/OP	"$2,663.78 "	"$1,971.20"	$0.00	"$2,068.96"	"$1,163.79"	"$1,163.79"	$0.00	$0.00	$0.00	$555.20	"$1,977.05"	"$1,977.05"	$0.00	$0.00	$555.13	$0.00	"$1,313.24"	"$1,313.24"	$0.00	"$1,293.10"	"$2,048.27"	"$2,068.96"	$0.00		$0.00	$392.95	$0.00	$0.00	$411.72	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.200S	SUP	HCPCS C1713		02.124.200S  -  PLATE BN 76MM STRL LCP CMBN 4 HL LO BND LMT CNTCT SS TIB RT	BOTH IP/OP	"$2,755.15 "	"$2,038.81"	$0.00	"$2,139.92"	"$1,203.71"	"$1,203.71"	$0.00	$0.00	$0.00	$574.24	"$2,044.87"	"$2,044.87"	$0.00	$0.00	$574.17	$0.00	"$1,358.29"	"$1,358.29"	$0.00	"$1,337.45"	"$2,118.52"	"$2,139.92"	$0.00		$0.00	$406.43	$0.00	$0.00	$425.84	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.201	SUP	HCPCS C1713		02.124.201  -  PLATE BN CNTR LO BND 76MM NS LCP CMBN 4 HL LMT CNTCT SS TIB	BOTH IP/OP	"$2,663.78 "	"$1,971.20"	$0.00	"$2,068.96"	"$1,163.79"	"$1,163.79"	$0.00	$0.00	$0.00	$555.20	"$1,977.05"	"$1,977.05"	$0.00	$0.00	$555.13	$0.00	"$1,313.24"	"$1,313.24"	$0.00	"$1,293.10"	"$2,048.27"	"$2,068.96"	$0.00		$0.00	$392.95	$0.00	$0.00	$411.72	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.201S	SUP	HCPCS C1713		02.124.201S  -  PLATE BN 76MM STRL LCP CMBN 4 HL LO BND LMT CNTCT SS TIB LT	BOTH IP/OP	"$2,755.15 "	"$2,038.81"	$0.00	"$2,139.92"	"$1,203.71"	"$1,203.71"	$0.00	$0.00	$0.00	$574.24	"$2,044.87"	"$2,044.87"	$0.00	$0.00	$574.17	$0.00	"$1,358.29"	"$1,358.29"	$0.00	"$1,337.45"	"$2,118.52"	"$2,139.92"	$0.00		$0.00	$406.43	$0.00	$0.00	$425.84	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.204	SUP	HCPCS C1713		02.124.204  -  PLATE BN CNTR LO BND 102MM NS LCP CMBN 6 HL LMT CNTCT SS TIB	BOTH IP/OP	"$2,696.13 "	"$1,995.14"	$0.00	"$2,094.08"	"$1,177.92"	"$1,177.92"	$0.00	$0.00	$0.00	$561.94	"$2,001.06"	"$2,001.06"	$0.00	$0.00	$561.87	$0.00	"$1,329.19"	"$1,329.19"	$0.00	"$1,308.80"	"$2,073.14"	"$2,094.08"	$0.00		$0.00	$397.72	$0.00	$0.00	$416.72	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.205	SUP	HCPCS C1713		02.124.205  -  PLATE BN CNTR LO BND 102MM NS LCP CMBN 6 HL LMT CNTCT SS TIB	BOTH IP/OP	"$2,696.13 "	"$1,995.14"	$0.00	"$2,094.08"	"$1,177.92"	"$1,177.92"	$0.00	$0.00	$0.00	$561.94	"$2,001.06"	"$2,001.06"	$0.00	$0.00	$561.87	$0.00	"$1,329.19"	"$1,329.19"	$0.00	"$1,308.80"	"$2,073.14"	"$2,094.08"	$0.00		$0.00	$397.72	$0.00	$0.00	$416.72	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.205S	SUP	HCPCS C1713		02.124.205S  -  PLATE BN 102MM STRL LCP CMBN 6 HL LO BND LMT CNTCT SS TIB LT	BOTH IP/OP	"$2,787.50 "	"$2,062.75"	$0.00	"$2,165.04"	"$1,217.84"	"$1,217.84"	$0.00	$0.00	$0.00	$580.98	"$2,068.88"	"$2,068.88"	$0.00	$0.00	$580.92	$0.00	"$1,374.24"	"$1,374.24"	$0.00	"$1,353.15"	"$2,143.39"	"$2,165.04"	$0.00		$0.00	$411.20	$0.00	$0.00	$430.84	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.208	SUP	HCPCS C1713		02.124.208  -  PLATE BN CNTR LO BND 128MM NS LCP CMBN 8 HL LMT CNTCT SS TIB	BOTH IP/OP	"$2,727.05 "	"$2,018.02"	$0.00	"$2,118.10"	"$1,191.43"	"$1,191.43"	$0.00	$0.00	$0.00	$568.39	"$2,024.02"	"$2,024.02"	$0.00	$0.00	$568.32	$0.00	"$1,344.44"	"$1,344.44"	$0.00	"$1,323.81"	"$2,096.92"	"$2,118.10"	$0.00		$0.00	$402.28	$0.00	$0.00	$421.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.209	SUP	HCPCS C1713		02.124.209  -  PLATE BN CNTR LO BND 128MM NS LCP CMBN 8 HL LMT CNTCT SS TIB	BOTH IP/OP	"$2,727.05 "	"$2,018.02"	$0.00	"$2,118.10"	"$1,191.43"	"$1,191.43"	$0.00	$0.00	$0.00	$568.39	"$2,024.02"	"$2,024.02"	$0.00	$0.00	$568.32	$0.00	"$1,344.44"	"$1,344.44"	$0.00	"$1,323.81"	"$2,096.92"	"$2,118.10"	$0.00		$0.00	$402.28	$0.00	$0.00	$421.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.212	SUP	HCPCS C1713		02.124.212  -  PLATE BN CNTR LO BND 154MM NS LCP CMBN 10 HL LMT CNTCT SS	BOTH IP/OP	"$2,756.58 "	"$2,039.87"	$0.00	"$2,141.02"	"$1,204.32"	"$1,204.32"	$0.00	$0.00	$0.00	$574.54	"$2,045.93"	"$2,045.93"	$0.00	$0.00	$574.47	$0.00	"$1,358.99"	"$1,358.99"	$0.00	"$1,338.14"	"$2,119.61"	"$2,141.02"	$0.00		$0.00	$406.64	$0.00	$0.00	$426.06	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.213	SUP	HCPCS C1713		02.124.213  -  PLATE BN CNTR LO BND 154MM NS LCP CMBN 10 HL LMT CNTCT SS	BOTH IP/OP	"$2,756.58 "	"$2,039.87"	$0.00	"$2,141.02"	"$1,204.32"	"$1,204.32"	$0.00	$0.00	$0.00	$574.54	"$2,045.93"	"$2,045.93"	$0.00	$0.00	$574.47	$0.00	"$1,358.99"	"$1,358.99"	$0.00	"$1,338.14"	"$2,119.61"	"$2,141.02"	$0.00		$0.00	$406.64	$0.00	$0.00	$426.06	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.216	SUP	HCPCS C1713		02.124.216  -  PLATE BN CNTR LO BND 180MM NS LCP CMBN 12 HL LMT CNTCT SS	BOTH IP/OP	"$2,887.30 "	"$2,136.60"	$0.00	"$2,242.56"	"$1,261.44"	"$1,261.44"	$0.00	$0.00	$0.00	$601.79	"$2,142.95"	"$2,142.95"	$0.00	$0.00	$601.71	$0.00	"$1,423.44"	"$1,423.44"	$0.00	"$1,401.60"	"$2,220.13"	"$2,242.56"	$0.00		$0.00	$425.92	$0.00	$0.00	$446.27	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.217	SUP	HCPCS C1713		02.124.217  -  PLATE BN CNTR LO BND 180MM NS LCP CMBN 12 HL LMT CNTCT SS	BOTH IP/OP	"$2,887.30 "	"$2,136.60"	$0.00	"$2,242.56"	"$1,261.44"	"$1,261.44"	$0.00	$0.00	$0.00	$601.79	"$2,142.95"	"$2,142.95"	$0.00	$0.00	$601.71	$0.00	"$1,423.44"	"$1,423.44"	$0.00	"$1,401.60"	"$2,220.13"	"$2,242.56"	$0.00		$0.00	$425.92	$0.00	$0.00	$446.27	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.220	SUP	HCPCS C1713		02.124.220  -  PLATE BN CNTR LO BND 206MM NS LCP CMBN 14 HL LMT CNTCT SS	BOTH IP/OP	"$2,918.23 "	"$2,159.49"	$0.00	"$2,266.58"	"$1,274.95"	"$1,274.95"	$0.00	$0.00	$0.00	$608.23	"$2,165.91"	"$2,165.91"	$0.00	$0.00	$608.16	$0.00	"$1,438.68"	"$1,438.68"	$0.00	"$1,416.61"	"$2,243.92"	"$2,266.58"	$0.00		$0.00	$430.48	$0.00	$0.00	$451.05	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.220S	SUP	HCPCS C1713		02.124.220S  -  PLATE BN 206MM STRL LCP CMBN 14 HL LO BND LMT CNTCT SS TIB	BOTH IP/OP	"$3,009.60 "	"$2,227.10"	$0.00	"$2,337.54"	"$1,314.87"	"$1,314.87"	$0.00	$0.00	$0.00	$627.28	"$2,233.73"	"$2,233.73"	$0.00	$0.00	$627.20	$0.00	"$1,483.73"	"$1,483.73"	$0.00	"$1,460.96"	"$2,314.17"	"$2,337.54"	$0.00		$0.00	$443.96	$0.00	$0.00	$465.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.221	SUP	HCPCS C1713		02.124.221  -  PLATE BN CNTR LO BND 206MM NS LCP CMBN 14 HL LMT CNTCT SS	BOTH IP/OP	"$2,918.23 "	"$2,159.49"	$0.00	"$2,266.58"	"$1,274.95"	"$1,274.95"	$0.00	$0.00	$0.00	$608.23	"$2,165.91"	"$2,165.91"	$0.00	$0.00	$608.16	$0.00	"$1,438.68"	"$1,438.68"	$0.00	"$1,416.61"	"$2,243.92"	"$2,266.58"	$0.00		$0.00	$430.48	$0.00	$0.00	$451.05	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.224	SUP	HCPCS C1713		02.124.224  -  PLATE BN CNTR LO BND 232MM NS LCP CMBN 16 HL LMT CNTCT SS	BOTH IP/OP	"$3,020.83 "	"$2,235.41"	$0.00	"$2,346.28"	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$0.00	$629.62	"$2,242.06"	"$2,242.06"	$0.00	$0.00	$629.54	$0.00	"$1,489.27"	"$1,489.27"	$0.00	"$1,466.43"	"$2,322.82"	"$2,346.28"	$0.00		$0.00	$445.62	$0.00	$0.00	$466.91	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.225	SUP	HCPCS C1713		02.124.225  -  PLATE BN CNTR LO BND 232MM NS LCP CMBN 16 HL LMT CNTCT SS	BOTH IP/OP	"$3,020.83 "	"$2,235.41"	$0.00	"$2,346.28"	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$0.00	$629.62	"$2,242.06"	"$2,242.06"	$0.00	$0.00	$629.54	$0.00	"$1,489.27"	"$1,489.27"	$0.00	"$1,466.43"	"$2,322.82"	"$2,346.28"	$0.00		$0.00	$445.62	$0.00	$0.00	$466.91	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.408S	SUP	HCPCS C1713		02.124.408S  -  PLATE CURVE 195MM SS 4.5MM SCR 8 HOLE 4 CLMN THRD	BOTH IP/OP	"$3,282.30 "	"$2,428.90"	$0.00	"$2,549.36"	"$1,434.02"	"$1,434.02"	$0.00	$0.00	$0.00	$684.11	"$2,436.12"	"$2,436.12"	$0.00	$0.00	$684.03	$0.00	"$1,618.17"	"$1,618.17"	$0.00	"$1,593.35"	"$2,523.87"	"$2,549.36"	$0.00		$0.00	$484.19	$0.00	$0.00	$507.32	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.410S	SUP	HCPCS C1713		02.124.410S  -  PLATE BONE CURVE 230MM 10 HOLE VAR ANG LCP COMBI STAINLESS	BOTH IP/OP	"$3,431.30 "	"$2,539.16"	$0.00	"$2,665.08"	"$1,499.11"	"$1,499.11"	$0.00	$0.00	$0.00	$715.17	"$2,546.71"	"$2,546.71"	$0.00	$0.00	$715.08	$0.00	"$1,691.63"	"$1,691.63"	$0.00	"$1,665.68"	"$2,638.43"	"$2,665.08"	$0.00		$0.00	$506.17	$0.00	$0.00	$530.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.411	SUP	HCPCS C1713		02.124.411  -  PLATE BONE CURVE 23CM 10 HOLE VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$3,339.93 "	"$2,471.55"	$0.00	"$2,594.12"	"$1,459.19"	"$1,459.19"	$0.00	$0.00	$0.00	$696.12	"$2,478.89"	"$2,478.89"	$0.00	$0.00	$696.04	$0.00	"$1,646.58"	"$1,646.58"	$0.00	"$1,621.33"	"$2,568.18"	"$2,594.12"	$0.00		$0.00	$492.69	$0.00	$0.00	$516.23	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.412	SUP	HCPCS C1713		02.124.412  -  PLATE BONE 267MM 12 HOLE VAR ANG CVD LCP STAINLESS STEEL	BOTH IP/OP	"$3,410.20 "	"$2,523.55"	$0.00	"$2,648.70"	"$1,489.89"	"$1,489.89"	$0.00	$0.00	$0.00	$710.77	"$2,531.05"	"$2,531.05"	$0.00	$0.00	$710.69	$0.00	"$1,681.23"	"$1,681.23"	$0.00	"$1,655.44"	"$2,622.22"	"$2,648.70"	$0.00		$0.00	$503.06	$0.00	$0.00	$527.09	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.412S	SUP	HCPCS C1713		02.124.412S  -  PLATE BN CRV 266MM STRL LCP CMBN 12 HL 4 CLMN THRD VA SS	BOTH IP/OP	"$3,300.58 "	"$2,442.43"	$0.00	"$2,640.46"	"$1,485.26"	"$1,485.26"	$0.00	$0.00	$0.00	$687.92	"$2,449.69"	"$2,449.69"	$0.00	$0.00	$687.84	$0.00	"$1,627.18"	"$1,627.18"	$0.00	"$1,650.29"	"$2,614.06"	"$2,640.46"	$0.00		$0.00	$516.54	$0.00	$0.00	$525.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.413	SUP	HCPCS C1713		02.124.413  -  PLATE BN CRV 266MM NS LCP CMBN 12 HL 4 CLMN THRD VA SS CNDRL	BOTH IP/OP	"$3,410.20 "	"$2,523.55"	$0.00	"$2,648.70"	"$1,489.89"	"$1,489.89"	$0.00	$0.00	$0.00	$710.77	"$2,531.05"	"$2,531.05"	$0.00	$0.00	$710.69	$0.00	"$1,681.23"	"$1,681.23"	$0.00	"$1,655.44"	"$2,622.22"	"$2,648.70"	$0.00		$0.00	$503.06	$0.00	$0.00	$527.09	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.413S	SUP	HCPCS C1713		02.124.413S  -  PLATE BN CRV 266MM STRL LCP CMBN 12 HL 4 CLMN THRD VA SS	BOTH IP/OP	"$3,501.58 "	"$2,591.17"	$0.00	"$2,719.68"	"$1,529.82"	"$1,529.82"	$0.00	$0.00	$0.00	$729.82	"$2,598.87"	"$2,598.87"	$0.00	$0.00	$729.73	$0.00	"$1,726.28"	"$1,726.28"	$0.00	"$1,699.80"	"$2,692.48"	"$2,719.68"	$0.00		$0.00	$516.54	$0.00	$0.00	$541.22	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.414S	SUP	HCPCS C1713		02.124.414S  -  PLATE BN CRV 301MM STRL LCP CMBN 14 HL 4 CLMN THRD VA SS	BOTH IP/OP	"$3,730.70 "	"$2,760.72"	$0.00	"$2,897.64"	"$1,629.92"	"$1,629.92"	$0.00	$0.00	$0.00	$777.57	"$2,768.93"	"$2,768.93"	$0.00	$0.00	$777.48	$0.00	"$1,839.24"	"$1,839.24"	$0.00	"$1,811.03"	"$2,868.66"	"$2,897.64"	$0.00		$0.00	$550.34	$0.00	$0.00	$576.63	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.415	SUP	HCPCS C1713		02.124.415  -  PLATE BN CRV 301MM NS LCP CMBN 14 HL 4 CLMN THRD VA SS CNDRL	BOTH IP/OP	"$3,639.35 "	"$2,693.12"	$0.00	"$2,826.68"	"$1,590.01"	"$1,590.01"	$0.00	$0.00	$0.00	$758.53	"$2,701.13"	"$2,701.13"	$0.00	$0.00	$758.44	$0.00	"$1,794.20"	"$1,794.20"	$0.00	"$1,766.68"	"$2,798.41"	"$2,826.68"	$0.00		$0.00	$536.86	$0.00	$0.00	$562.51	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.416	SUP	HCPCS C1713		02.124.416  -  PLATE BONE CURVE 336MM 16 HOLE LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$3,709.63 "	"$2,745.13"	$0.00	"$2,881.26"	"$1,620.71"	"$1,620.71"	$0.00	$0.00	$0.00	$773.18	"$2,753.28"	"$2,753.28"	$0.00	$0.00	$773.09	$0.00	"$1,828.85"	"$1,828.85"	$0.00	"$1,800.79"	"$2,852.45"	"$2,881.26"	$0.00		$0.00	$547.23	$0.00	$0.00	$573.37	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.416S	SUP	HCPCS C1713		02.124.416S  -  PLATE CURVE 336MM SS 4.5MM SCR 16 HOLE 4 CLMN THRD	BOTH IP/OP	"$3,801.00 "	"$2,812.74"	$0.00	"$2,952.22"	"$1,660.62"	"$1,660.62"	$0.00	$0.00	$0.00	$792.22	"$2,821.10"	"$2,821.10"	$0.00	$0.00	$792.13	$0.00	"$1,873.89"	"$1,873.89"	$0.00	"$1,845.14"	"$2,922.70"	"$2,952.22"	$0.00		$0.00	$560.71	$0.00	$0.00	$587.49	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.417S	SUP	HCPCS C1713		02.124.417S  -  PLATE BONE CURVE 336MM 16 HOLE VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$3,801.00 "	"$2,812.74"	$0.00	"$2,952.22"	"$1,660.62"	"$1,660.62"	$0.00	$0.00	$0.00	$792.22	"$2,821.10"	"$2,821.10"	$0.00	$0.00	$792.13	$0.00	"$1,873.89"	"$1,873.89"	$0.00	"$1,845.14"	"$2,922.70"	"$2,952.22"	$0.00		$0.00	$560.71	$0.00	$0.00	$587.49	$0.00	$0.00	$0.00	$0.00	$0.00
02.124.419	SUP	HCPCS C1713		02.124.419  -  PLATE BONE 375MM 18 HOLE VAR ANG CVD LCP STAINLESS STEEL	BOTH IP/OP	"$3,951.40 "	"$2,924.04"	$0.00	"$3,069.04"	"$1,726.34"	"$1,726.34"	$0.00	$0.00	$0.00	$823.57	"$2,932.73"	"$2,932.73"	$0.00	$0.00	$823.47	$0.00	"$1,948.04"	"$1,948.04"	$0.00	"$1,918.15"	"$3,038.35"	"$3,069.04"	$0.00		$0.00	$582.90	$0.00	$0.00	$610.74	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.004	SUP	HCPCS C1713		02.130.004  -  SCREW BN T4 1.3MM 4MM SLFRET ST TIP STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.005	SUP	HCPCS C1713		02.130.005  -  SCREW BN T4 1.3MM 5MM SLFRET ST TIP STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.006	SUP	HCPCS C1713		02.130.006  -  SCREW BN T4 1.3MM 6MM SLFRET ST TIP STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.007	SUP	HCPCS C1713		02.130.007  -  SCREW BN T4 1.3MM 7MM SLFRET ST TIP STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.008	SUP	HCPCS C1713		02.130.008  -  SCREW BN T4 1.3MM 8MM SLFRET ST TIP STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.009	SUP	HCPCS C1713		02.130.009  -  SCREW BN T4 1.3MM 9MM SLFRET ST TIP STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.010	SUP	HCPCS C1713		02.130.010  -  SCREW BN T4 1.3MM 10MM SLFRET ST TIP STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.011	SUP	HCPCS C1713		02.130.011  -  SCREW BN T4 1.3MM 11MM NS SLFRET ST TIP STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.012	SUP	HCPCS C1713		02.130.012  -  SCREW BN T4 1.3MM 12MM NS SLFRET ST TIP STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.013	SUP	HCPCS C1713		02.130.013  -  SCREW BN T4 1.3MM 13MM SLFRET ST TIP STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.014	SUP	HCPCS C1713		02.130.014  -  SCREW BN T4 1.3MM 14MM SLFRET ST TIP STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.015	SUP	HCPCS C1713		02.130.015  -  SCREW BN T4 1.3MM 15MM SLFRET ST STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.016	SUP	HCPCS C1713		02.130.016  -  SCREW BN T4 1.3MM 16MM ST TIP SLFRET STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.018	SUP	HCPCS C1713		02.130.018  -  SCREW BN T4 1.3MM 18MM ST TIP SLFRET LCK STRDR SS CORT	BOTH IP/OP	$81.53 	$60.33	$0.00	$63.32	$35.62	$35.62	$0.00	$0.00	$0.00	$16.99	$60.51	$60.51	$0.00	$0.00	$16.99	$0.00	$48.22	$48.22	$0.00	$39.58	$62.69	$63.32	$0.00		$0.00	$12.03	$0.00	$0.00	$12.60	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.104	SUP	HCPCS C1713		02.130.104  -  SCREW BN T4 1.3MM 4MM ST TIP SLFRET LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.105	SUP	HCPCS C1713		02.130.105  -  SCREW BN T4 1.3MM 5MM ST TIP SLFRET LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.106	SUP	HCPCS C1713		02.130.106  -  SCREW BN T4 1.3MM 6MM ST TIP SLFRET LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.107	SUP	HCPCS C1713		02.130.107  -  SCREW BN T4 1.3MM 7MM ST TIP SLFRET LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.108	SUP	HCPCS C1713		02.130.108  -  SCREW BN T4 1.3MM 8MM ST TIP SLFRET LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.109	SUP	HCPCS C1713		02.130.109  -  SCREW BN T4 1.3MM 9MM ST TIP SLFRET LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.110	SUP	HCPCS C1713		02.130.110  -  SCREW BN T4 1.3MM 10MM ST TIP SLFRET LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.111	SUP	HCPCS C1713		02.130.111  -  SCREW BN T4 1.3MM 11MM ST TIP SLFRET LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.112	SUP	HCPCS C1713		02.130.112  -  SCREW BN T4 1.3MM 12MM ST TIP SLFRET LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.113	SUP	HCPCS C1713		02.130.113  -  SCREW BN T4 1.3MM 13MM ST TIP SLFRET LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.114	SUP	HCPCS C1713		02.130.114  -  SCREW BN T4 1.3MM 14MM SLFRET ST TIP LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.115	SUP	HCPCS C1713		02.130.115  -  SCREW BN T4 1.3MM 15MM ST TIP SLFRET LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.116	SUP	HCPCS C1713		02.130.116  -  SCREW BN T4 1.3MM 16MM ST TIP SLFRET LCK STRDR SS HND	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.118	SUP	HCPCS C1713		02.130.118  -  SCREW BN T4 1.3MM 18MM ST SLF RTN LCK STRDR SS	BOTH IP/OP	$215.08 	$159.16	$0.00	$167.04	$93.96	$93.96	$0.00	$0.00	$0.00	$44.83	$159.63	$159.63	$0.00	$0.00	$44.82	$0.00	$127.22	$127.22	$0.00	$104.40	$165.37	$167.04	$0.00		$0.00	$31.73	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.150	SUP	HCPCS C1713		02.130.150  -  PLATE BN STRG .75MM LCK 6 HL LOPRFL PRECONTOUR SS HND 1.3MM	BOTH IP/OP	$723.93 	$535.71	$0.00	$562.28	$316.28	$316.28	$0.00	$0.00	$0.00	$150.88	$537.30	$537.30	$0.00	$0.00	$150.87	$0.00	$428.20	$428.20	$0.00	$351.43	$556.66	$562.28	$0.00		$0.00	$106.79	$0.00	$0.00	$111.89	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.151	SUP	HCPCS C1713		02.130.151  -  PLATE BN STRG .75MM LCK 12 HL LOPRFL PRECONTOUR SS HND 1.3MM	BOTH IP/OP	$794.23 	$587.73	$0.00	$616.86	$346.98	$346.98	$0.00	$0.00	$0.00	$165.54	$589.47	$589.47	$0.00	$0.00	$165.52	$0.00	$469.78	$469.78	$0.00	$385.54	$610.70	$616.86	$0.00		$0.00	$117.16	$0.00	$0.00	$122.76	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.152	SUP	HCPCS C1713		02.130.152  -  PLATE BN T .75MM LCK 3 HLE/HD 5 HL SHFT LOPRFL SS HND 1.3MM	BOTH IP/OP	$794.23 	$587.73	$0.00	$616.86	$346.98	$346.98	$0.00	$0.00	$0.00	$165.54	$589.47	$589.47	$0.00	$0.00	$165.52	$0.00	$469.78	$469.78	$0.00	$385.54	$610.70	$616.86	$0.00		$0.00	$117.16	$0.00	$0.00	$122.76	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.153	SUP	HCPCS C1713		02.130.153  -  PLATE BN Y .75MM LCK 3 HLE/HD 5 HL SHFT LOPRFL SS HND 1.3MM	BOTH IP/OP	$794.23 	$587.73	$0.00	$616.86	$346.98	$346.98	$0.00	$0.00	$0.00	$165.54	$589.47	$589.47	$0.00	$0.00	$165.52	$0.00	$469.78	$469.78	$0.00	$385.54	$610.70	$616.86	$0.00		$0.00	$117.16	$0.00	$0.00	$122.76	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.154	SUP	HCPCS C1713		02.130.154  -  PLATE BN .75MM LCK 2 HLE/HD 5 HL SHFT LOPRFL SS PHLNG BS 1.3	BOTH IP/OP	$905.28 	$669.91	$0.00	$703.12	$395.51	$395.51	$0.00	$0.00	$0.00	$188.68	$671.90	$671.90	$0.00	$0.00	$188.66	$0.00	$535.47	$535.47	$0.00	$439.45	$696.09	$703.12	$0.00		$0.00	$133.54	$0.00	$0.00	$139.92	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.156	SUP	HCPCS C1713		02.130.156  -  PLATE BN CRV .75MM LCK LOPRFL PRECONTOUR SS PHLNG HD RT 1.3	BOTH IP/OP	$905.28 	$669.91	$0.00	$703.12	$395.51	$395.51	$0.00	$0.00	$0.00	$188.68	$671.90	$671.90	$0.00	$0.00	$188.66	$0.00	$535.47	$535.47	$0.00	$439.45	$696.09	$703.12	$0.00		$0.00	$133.54	$0.00	$0.00	$139.92	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.157	SUP	HCPCS C1713		02.130.157  -  PLATE BN CRV .75MM LCK LOPRFL PRECONTOUR SS PHLNG HD LT 1.3	BOTH IP/OP	$905.28 	$669.91	$0.00	$703.12	$395.51	$395.51	$0.00	$0.00	$0.00	$188.68	$671.90	$671.90	$0.00	$0.00	$188.66	$0.00	$535.47	$535.47	$0.00	$439.45	$696.09	$703.12	$0.00		$0.00	$133.54	$0.00	$0.00	$139.92	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.158	SUP	HCPCS C1713		02.130.158  -  PLATE BN STRUT OBLQ .75MM 8 HL LCK LOPRFL PRECONTOUR SS HND	BOTH IP/OP	$794.23 	$587.73	$0.00	$616.86	$346.98	$346.98	$0.00	$0.00	$0.00	$165.54	$589.47	$589.47	$0.00	$0.00	$165.52	$0.00	$469.78	$469.78	$0.00	$385.54	$610.70	$616.86	$0.00		$0.00	$117.16	$0.00	$0.00	$122.76	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.159	SUP	HCPCS C1713		02.130.159  -  PLATE BN STRUT OBLQ .75MM 8 HL LCK LOPRFL PRECONTOUR SS HND	BOTH IP/OP	$794.23 	$587.73	$0.00	$616.86	$346.98	$346.98	$0.00	$0.00	$0.00	$165.54	$589.47	$589.47	$0.00	$0.00	$165.52	$0.00	$469.78	$469.78	$0.00	$385.54	$610.70	$616.86	$0.00		$0.00	$117.16	$0.00	$0.00	$122.76	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.161	SUP	HCPCS C1713		02.130.161  -  PLATE BN WEB .75MM 14 HL LCK LOPRFL PRECONTOUR SS HND 1.3MM	BOTH IP/OP	$836.38 	$618.92	$0.00	$649.62	$365.41	$365.41	$0.00	$0.00	$0.00	$174.32	$620.76	$620.76	$0.00	$0.00	$174.30	$0.00	$494.72	$494.72	$0.00	$406.01	$643.13	$649.62	$0.00		$0.00	$123.38	$0.00	$0.00	$129.27	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.204	SUP	HCPCS C1713		02.130.204  -  SCREW BN T4 1.5MM 4MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.205	SUP	HCPCS C1713		02.130.205  -  SCREW BN T4 1.5MM 5MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.206	SUP	HCPCS C1713		02.130.206  -  SCREW BN T4 1.5MM 6MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.207	SUP	HCPCS C1713		02.130.207  -  SCREW BN T4 1.5MM 7MM PUR ST VA LCK STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.208	SUP	HCPCS C1713		02.130.208  -  SCREW BN T4 1.5MM 8MM ST LCK VA STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.209	SUP	HCPCS C1713		02.130.209  -  SCREW BN T4 1.5MM 9MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.210	SUP	HCPCS C1713		02.130.210  -  SCREW BN T4 1.5MM 10MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.211	SUP	HCPCS C1713		02.130.211  -  SCREW BN T4 1.5MM 11MM ST LCK VA STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.212	SUP	HCPCS C1713		02.130.212  -  SCREW BN T4 1.5MM 12MM ST LCK VA STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.213	SUP	HCPCS C1713		02.130.213  -  SCREW BN T4 1.5MM 13MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.214	SUP	HCPCS C1713		02.130.214  -  SCREW BN T4 1.5MM 14MM PUR ST TIP LCK VA STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.215	SUP	HCPCS C1713		02.130.215  -  SCREW BN T4 1.5MM 15MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.216	SUP	HCPCS C1713		02.130.216  -  SCREW BN T4 1.5MM 16MM PUR ST TIP LCK VA STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.218	SUP	HCPCS C1713		02.130.218  -  SCREW BN T4 1.5MM 18MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.220	SUP	HCPCS C1713		02.130.220  -  SCREW BN T4 1.5MM 20MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.222	SUP	HCPCS C1713		02.130.222  -  SCREW BN T4 1.5MM 22MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.224	SUP	HCPCS C1713		02.130.224  -  SCREW BN T4 1.5MM 24MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$238.98 	$176.85	$0.00	$185.60	$104.40	$104.40	$0.00	$0.00	$0.00	$49.81	$177.37	$177.37	$0.00	$0.00	$49.80	$0.00	$141.35	$141.35	$0.00	$116.00	$183.74	$185.60	$0.00		$0.00	$35.25	$0.00	$0.00	$36.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.250	SUP	HCPCS C1713		02.130.250  -  PLATE BN STRG 1MM 6 HL VA LCK LOPRFL SS 1.5MM SCR	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.251	SUP	HCPCS C1713		02.130.251  -  PLATE BN STRG 1MM NS 12 HL VA LCK LOPRFL SS 1.5MM SCR	BOTH IP/OP	$884.18 	$654.29	$0.00	$686.74	$386.29	$386.29	$0.00	$0.00	$0.00	$184.28	$656.23	$656.23	$0.00	$0.00	$184.26	$0.00	$522.99	$522.99	$0.00	$429.21	$679.88	$686.74	$0.00		$0.00	$130.43	$0.00	$0.00	$136.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.252	SUP	HCPCS C1713		02.130.252  -  PLATE BN T 1MM 3 HLE/HD 7 HL SHFT VA LCK SS 1.5MM SCR	BOTH IP/OP	$884.18 	$654.29	$0.00	$686.74	$386.29	$386.29	$0.00	$0.00	$0.00	$184.28	$656.23	$656.23	$0.00	$0.00	$184.26	$0.00	$522.99	$522.99	$0.00	$429.21	$679.88	$686.74	$0.00		$0.00	$130.43	$0.00	$0.00	$136.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.253	SUP	HCPCS C1713		02.130.253  -  PLATE BN Y 1MM 3 HLE/HD 7 HL SHFT VA LCK SS 1.5MM SCR	BOTH IP/OP	$884.18 	$654.29	$0.00	$686.74	$386.29	$386.29	$0.00	$0.00	$0.00	$184.28	$656.23	$656.23	$0.00	$0.00	$184.26	$0.00	$522.99	$522.99	$0.00	$429.21	$679.88	$686.74	$0.00		$0.00	$130.43	$0.00	$0.00	$136.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.254	SUP	HCPCS C1713		02.130.254  -  PLATE BN 1MM 2 HLE/HD 6 HL SHFT VA LCK PHLNG BS 1.5MM SCR	BOTH IP/OP	$969.93 	$717.75	$0.00	$753.34	$423.75	$423.75	$0.00	$0.00	$0.00	$202.16	$719.88	$719.88	$0.00	$0.00	$202.13	$0.00	$573.71	$573.71	$0.00	$470.84	$745.81	$753.34	$0.00		$0.00	$143.08	$0.00	$0.00	$149.91	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.255	SUP	HCPCS C1713		02.130.255  -  PLATE BN STRG 1MM 2 HLE/HD 6 HL SHFT VA LCK SS CNDRL 1.5MM	BOTH IP/OP	$927.75 	$686.54	$0.00	$720.58	$405.33	$405.33	$0.00	$0.00	$0.00	$193.37	$688.58	$688.58	$0.00	$0.00	$193.34	$0.00	$548.76	$548.76	$0.00	$450.36	$713.38	$720.58	$0.00		$0.00	$136.86	$0.00	$0.00	$143.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.256	SUP	HCPCS C1713		02.130.256  -  PLATE BN CRV 1MM VA LCK LOPRFL PRECONTOUR SS PHLNG HD RT 1.5	BOTH IP/OP	$969.93 	$717.75	$0.00	$753.34	$423.75	$423.75	$0.00	$0.00	$0.00	$202.16	$719.88	$719.88	$0.00	$0.00	$202.13	$0.00	$573.71	$573.71	$0.00	$470.84	$745.81	$753.34	$0.00		$0.00	$143.08	$0.00	$0.00	$149.91	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.257	SUP	HCPCS C1713		02.130.257  -  PLATE BN CRV 1MM VA LCK LOPRFL PRECONTOUR SS PHLNG HD LT 1.5	BOTH IP/OP	$969.93 	$717.75	$0.00	$753.34	$423.75	$423.75	$0.00	$0.00	$0.00	$202.16	$719.88	$719.88	$0.00	$0.00	$202.13	$0.00	$573.71	$573.71	$0.00	$470.84	$745.81	$753.34	$0.00		$0.00	$143.08	$0.00	$0.00	$149.91	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.258	SUP	HCPCS C1713		02.130.258  -  PLATE BN STRUT OBLQ 1MM VA LCK 8 HL LOPRFL SS HND RT 1.5MM	BOTH IP/OP	$884.18 	$654.29	$0.00	$686.74	$386.29	$386.29	$0.00	$0.00	$0.00	$184.28	$656.23	$656.23	$0.00	$0.00	$184.26	$0.00	$522.99	$522.99	$0.00	$429.21	$679.88	$686.74	$0.00		$0.00	$130.43	$0.00	$0.00	$136.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.259	SUP	HCPCS C1713		02.130.259  -  PLATE BN STRUT OBLQ 1MM VA LCK 8 HL LOPRFL SS HND LT 1.5MM	BOTH IP/OP	$884.18 	$654.29	$0.00	$686.74	$386.29	$386.29	$0.00	$0.00	$0.00	$184.28	$656.23	$656.23	$0.00	$0.00	$184.26	$0.00	$522.99	$522.99	$0.00	$429.21	$679.88	$686.74	$0.00		$0.00	$130.43	$0.00	$0.00	$136.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.260	SUP	HCPCS C1713		02.130.260  -  PLATE BN STRUT 1MM VA LCK 12 HL LOPRFL SS HND 1.5MM SCR	BOTH IP/OP	$969.93 	$717.75	$0.00	$753.34	$423.75	$423.75	$0.00	$0.00	$0.00	$202.16	$719.88	$719.88	$0.00	$0.00	$202.13	$0.00	$573.71	$573.71	$0.00	$470.84	$745.81	$753.34	$0.00		$0.00	$143.08	$0.00	$0.00	$149.91	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.261	SUP	HCPCS C1713		02.130.261  -  PLATE BN WEB 1MM VA LCK 14 HL LOPRFL SS HND 1.5MM SCR	BOTH IP/OP	$884.18 	$654.29	$0.00	$686.74	$386.29	$386.29	$0.00	$0.00	$0.00	$184.28	$656.23	$656.23	$0.00	$0.00	$184.26	$0.00	$522.99	$522.99	$0.00	$429.21	$679.88	$686.74	$0.00		$0.00	$130.43	$0.00	$0.00	$136.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.263	SUP	HCPCS C1713		02.130.263  -  PLATE BN CNTR 1MM VA LCK LOPRFL SS 1ST MTCRPL DRSL 1.5MM SCR	BOTH IP/OP	$941.83 	$696.95	$0.00	$731.50	$411.47	$411.47	$0.00	$0.00	$0.00	$196.30	$699.02	$699.02	$0.00	$0.00	$196.28	$0.00	$557.09	$557.09	$0.00	$457.19	$724.19	$731.50	$0.00		$0.00	$138.93	$0.00	$0.00	$145.57	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.264	SUP	HCPCS C1713		02.130.264  -  PLATE BN Y 1MM VA LCK ELONGATE HL SS 1ST MTCRPL RL 1.5MM SCR	BOTH IP/OP	"$1,237.00 "	$915.38	$0.00	$960.78	$540.44	$540.44	$0.00	$0.00	$0.00	$257.82	$918.10	$918.10	$0.00	$0.00	$257.79	$0.00	$731.69	$731.69	$0.00	$600.49	$951.18	$960.78	$0.00		$0.00	$182.48	$0.00	$0.00	$191.20	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.265	SUP	HCPCS C1713		02.130.265  -  PLATE BN Y 1MM VA LCK ELONGATE HL SS 1ST MATECARPAL L/L 1.5	BOTH IP/OP	"$1,237.00 "	$915.38	$0.00	$960.78	$540.44	$540.44	$0.00	$0.00	$0.00	$257.82	$918.10	$918.10	$0.00	$0.00	$257.79	$0.00	$731.69	$731.69	$0.00	$600.49	$951.18	$960.78	$0.00		$0.00	$182.48	$0.00	$0.00	$191.20	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.266	SUP	HCPCS C1713		02.130.266  -  PLATE BN 1MM VA LCK 6 HL ROT CRRT SS MTCRPL PHALANGE 1.5MM	BOTH IP/OP	"$1,237.00 "	$915.38	$0.00	$960.78	$540.44	$540.44	$0.00	$0.00	$0.00	$257.82	$918.10	$918.10	$0.00	$0.00	$257.79	$0.00	$731.69	$731.69	$0.00	$600.49	$951.18	$960.78	$0.00		$0.00	$182.48	$0.00	$0.00	$191.20	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.268	SUP	HCPCS C1713		02.130.268  -  PLATE BN 1MM VA LCK KWR HL SS MTCRPL NK 1.5MM SCR	BOTH IP/OP	"$1,237.00 "	$915.38	$0.00	$960.78	$540.44	$540.44	$0.00	$0.00	$0.00	$257.82	$918.10	$918.10	$0.00	$0.00	$257.79	$0.00	$731.69	$731.69	$0.00	$600.49	$951.18	$960.78	$0.00		$0.00	$182.48	$0.00	$0.00	$191.20	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.306	SUP	HCPCS C1713		02.130.306  -  SCREW BN T6 2MM 6MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.307	SUP	HCPCS C1713		02.130.307  -  SCREW BN T6 2MM 7MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.308	SUP	HCPCS C1713		02.130.308  -  SCREW BN T6 2MM 8MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.309	SUP	HCPCS C1713		02.130.309  -  SCREW BN T6 2MM 9MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.310	SUP	HCPCS C1713		02.130.310  -  SCREW BN T6 2MM 10MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.311	SUP	HCPCS C1713		02.130.311  -  SCREW BN T6 2MM 11MM PUR VA LCK ST TIP STRDR SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.312	SUP	HCPCS C1713		02.130.312  -  SCREW BN T6 2MM 12MM PUR STRDR VA ST LCK SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.313	SUP	HCPCS C1713		02.130.313  -  SCREW BN T6 2MM 13MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.314	SUP	HCPCS C1713		02.130.314  -  SCREW BN T6 2MM 14MM PUR NS STRDR ST LCK VA SS	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.315	SUP	HCPCS C1713		02.130.315  -  SCREW BN T6 2MM 15MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.316	SUP	HCPCS C1713		02.130.316  -  SCREW BN T6 2MM 16MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.318	SUP	HCPCS C1713		02.130.318  -  SCREW BN T6 2MM 18MM PUR STRDR VA ST LCK SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.320	SUP	HCPCS C1713		02.130.320  -  SCREW BN T6 2MM 20MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.322	SUP	HCPCS C1713		02.130.322  -  SCREW BN T6 2MM 22MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.324	SUP	HCPCS C1713		02.130.324  -  SCREW BN T6 2MM 24MM PUR ST TIP VA LCK STRDR SS HND	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$108.09	$108.09	$0.00	$0.00	$0.00	$51.56	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$146.34	$146.34	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$36.50	$0.00	$0.00	$38.24	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.350	SUP	HCPCS C1713		02.130.350  -  PLATE BN STRG 1.3MM 6 HL LCK VA LOPRFL HND 2MM SCR	BOTH IP/OP	$948.85 	$702.15	$0.00	$736.96	$414.54	$414.54	$0.00	$0.00	$0.00	$197.76	$704.24	$704.24	$0.00	$0.00	$197.74	$0.00	$561.24	$561.24	$0.00	$460.60	$729.59	$736.96	$0.00		$0.00	$139.97	$0.00	$0.00	$146.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.351	SUP	HCPCS C1713		02.130.351  -  PLATE BN FT STRG 1.3MM 12 HL VA LCK COAX SS HND 2MM SCR	BOTH IP/OP	"$1,019.13 "	$754.16	$0.00	$791.56	$445.25	$445.25	$0.00	$0.00	$0.00	$212.41	$756.39	$756.39	$0.00	$0.00	$212.39	$0.00	$602.81	$602.81	$0.00	$494.73	$783.64	$791.56	$0.00		$0.00	$150.34	$0.00	$0.00	$157.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.352	SUP	HCPCS C1713		02.130.352  -  PLATE BN FT T 1.3MM 3 HLE/HD 7 HL SHFT VA LCK SS HND 2MM SCR	BOTH IP/OP	"$1,019.13 "	$754.16	$0.00	$791.56	$445.25	$445.25	$0.00	$0.00	$0.00	$212.41	$756.39	$756.39	$0.00	$0.00	$212.39	$0.00	$602.81	$602.81	$0.00	$494.73	$783.64	$791.56	$0.00		$0.00	$150.34	$0.00	$0.00	$157.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.353	SUP	HCPCS C1713		02.130.353  -  PLATE BN Y 1.3MM 3 HLE/HD 7 HL SHFT LCK VA SS HND 2MM SCR	BOTH IP/OP	"$1,019.13 "	$754.16	$0.00	$791.56	$445.25	$445.25	$0.00	$0.00	$0.00	$212.41	$756.39	$756.39	$0.00	$0.00	$212.39	$0.00	$602.81	$602.81	$0.00	$494.73	$783.64	$791.56	$0.00		$0.00	$150.34	$0.00	$0.00	$157.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.354	SUP	HCPCS C1713		02.130.354  -  PLATE BN CNTR 1.3MM 2 HLE/HD 6 HL SHFT LCK ELONGATE HL SS	BOTH IP/OP	"$1,117.53 "	$826.97	$0.00	$867.98	$488.24	$488.24	$0.00	$0.00	$0.00	$232.92	$829.43	$829.43	$0.00	$0.00	$232.89	$0.00	$661.02	$661.02	$0.00	$542.49	$859.30	$867.98	$0.00		$0.00	$164.85	$0.00	$0.00	$172.73	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.355	SUP	HCPCS C1713		02.130.355  -  PLATE BN 1.3MM 2 HLE/HD 6 HL SHFT LCK VA SS CNDRL 2MM SCR	BOTH IP/OP	"$1,089.40 "	$806.16	$0.00	$846.14	$475.95	$475.95	$0.00	$0.00	$0.00	$227.06	$808.55	$808.55	$0.00	$0.00	$227.03	$0.00	$644.38	$644.38	$0.00	$528.84	$837.68	$846.14	$0.00		$0.00	$160.71	$0.00	$0.00	$168.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.360	SUP	HCPCS C1713		02.130.360  -  PLATE BN STRUT 1.3MM 12 HL LCK VA LOPRFL SS HND 2MM SCR	BOTH IP/OP	"$1,117.53 "	$826.97	$0.00	$867.98	$488.24	$488.24	$0.00	$0.00	$0.00	$232.92	$829.43	$829.43	$0.00	$0.00	$232.89	$0.00	$661.02	$661.02	$0.00	$542.49	$859.30	$867.98	$0.00		$0.00	$164.85	$0.00	$0.00	$172.73	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.363	SUP	HCPCS C1713		02.130.363  -  PLATE BN 1.3MM LCK VA LOPRFL ANTM CNTR SS 1ST MTCRPL DRSL 2	BOTH IP/OP	"$1,398.68 "	"$1,035.02"	$0.00	"$1,086.34"	$611.07	$611.07	$0.00	$0.00	$0.00	$291.52	"$1,038.10"	"$1,038.10"	$0.00	$0.00	$291.48	$0.00	$827.32	$827.32	$0.00	$678.96	"$1,075.48"	"$1,086.34"	$0.00		$0.00	$206.33	$0.00	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00
02.130.366	SUP	HCPCS C1713		02.130.366  -  PLATE BN 1.3MM 6 HL LCK VA ROT CRRT SS HND 2MM SCR	BOTH IP/OP	"$1,398.68 "	"$1,035.02"	$0.00	"$1,086.34"	$611.07	$611.07	$0.00	$0.00	$0.00	$291.52	"$1,038.10"	"$1,038.10"	$0.00	$0.00	$291.48	$0.00	$827.32	$827.32	$0.00	$678.96	"$1,075.48"	"$1,086.34"	$0.00		$0.00	$206.33	$0.00	$0.00	$216.18	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.210	SUP	HCPCS C1713		02.161.210  -  PLATE BONE NARROW 10 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	$704.25 	$521.15	$0.00	$547.00	$307.69	$307.69	$0.00	$0.00	$0.00	$146.78	$522.69	$522.69	$0.00	$0.00	$146.77	$0.00	$416.56	$416.56	$0.00	$341.88	$541.53	$547.00	$0.00		$0.00	$103.89	$0.00	$0.00	$108.85	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.212	SUP	HCPCS C1713		02.161.212  -  PLATE BONE NARROW CVD 12 HOLE LCP STAINLESS STEEL HUMERUS	BOTH IP/OP	"$1,072.55 "	$793.69	$0.00	$833.04	$468.59	$468.59	$0.00	$0.00	$0.00	$223.55	$796.05	$796.05	$0.00	$0.00	$223.52	$0.00	$634.41	$634.41	$0.00	$520.65	$824.71	$833.04	$0.00		$0.00	$158.22	$0.00	$0.00	$165.77	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.214	SUP	HCPCS C1713		02.161.214  -  PLATE BONE NARROW 14 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	"$1,241.23 "	$918.51	$0.00	$964.06	$542.28	$542.28	$0.00	$0.00	$0.00	$258.70	$921.24	$921.24	$0.00	$0.00	$258.67	$0.00	$734.18	$734.18	$0.00	$602.54	$954.42	$964.06	$0.00		$0.00	$183.10	$0.00	$0.00	$191.85	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.216	SUP	HCPCS C1713		02.161.216  -  PLATE BONE NARROW 16 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	"$1,341.03 "	$992.36	$0.00	"$1,041.58"	$585.89	$585.89	$0.00	$0.00	$0.00	$279.50	$995.31	$995.31	$0.00	$0.00	$279.47	$0.00	$793.22	$793.22	$0.00	$650.99	"$1,031.17"	"$1,041.58"	$0.00		$0.00	$197.82	$0.00	$0.00	$207.27	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.218	SUP	HCPCS C1713		02.161.218  -  PLATE BONE NARROW 18 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	"$1,509.73 "	"$1,117.20"	$0.00	"$1,172.60"	$659.59	$659.59	$0.00	$0.00	$0.00	$314.66	"$1,120.52"	"$1,120.52"	$0.00	$0.00	$314.63	$0.00	$893.00	$893.00	$0.00	$732.88	"$1,160.87"	"$1,172.60"	$0.00		$0.00	$222.71	$0.00	$0.00	$233.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.220	SUP	HCPCS C1713		02.161.220  -  PLATE BONE NARROW 20 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	"$1,675.58 "	"$1,239.93"	$0.00	"$1,301.42"	$732.05	$732.05	$0.00	$0.00	$0.00	$349.23	"$1,243.61"	"$1,243.61"	$0.00	$0.00	$349.19	$0.00	$991.10	$991.10	$0.00	$813.39	"$1,288.41"	"$1,301.42"	$0.00		$0.00	$247.18	$0.00	$0.00	$258.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.222	SUP	HCPCS C1713		02.161.222  -  PLATE BONE NARROW 22 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	"$1,675.58 "	"$1,239.93"	$0.00	"$1,301.42"	$732.05	$732.05	$0.00	$0.00	$0.00	$349.23	"$1,243.61"	"$1,243.61"	$0.00	$0.00	$349.19	$0.00	$991.10	$991.10	$0.00	$813.39	"$1,288.41"	"$1,301.42"	$0.00		$0.00	$247.18	$0.00	$0.00	$258.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.240	SUP	HCPCS C1713		02.161.240  -  PLATE BONE NARROW 10 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	"$1,165.33 "	$862.34	$0.00	$905.10	$509.12	$509.12	$0.00	$0.00	$0.00	$242.88	$864.90	$864.90	$0.00	$0.00	$242.85	$0.00	$689.29	$689.29	$0.00	$565.69	$896.05	$905.10	$0.00		$0.00	$171.90	$0.00	$0.00	$180.11	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.242	SUP	HCPCS C1713		02.161.242  -  PLATE BONE NARROW 12 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	"$1,345.25 "	$995.49	$0.00	"$1,044.86"	$587.73	$587.73	$0.00	$0.00	$0.00	$280.38	$998.44	$998.44	$0.00	$0.00	$280.35	$0.00	$795.72	$795.72	$0.00	$653.04	"$1,034.42"	"$1,044.86"	$0.00		$0.00	$198.45	$0.00	$0.00	$207.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.244	SUP	HCPCS C1713		02.161.244  -  PLATE BONE NARROW 14 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	"$1,435.20 "	"$1,062.05"	$0.00	"$1,114.72"	$627.03	$627.03	$0.00	$0.00	$0.00	$299.13	"$1,065.21"	"$1,065.21"	$0.00	$0.00	$299.10	$0.00	$848.92	$848.92	$0.00	$696.70	"$1,103.57"	"$1,114.72"	$0.00		$0.00	$211.72	$0.00	$0.00	$221.83	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.246	SUP	HCPCS C1713		02.161.246  -  PLATE BONE NARROW 16 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	"$1,613.73 "	"$1,194.16"	$0.00	"$1,253.38"	$705.03	$705.03	$0.00	$0.00	$0.00	$336.34	"$1,197.71"	"$1,197.71"	$0.00	$0.00	$336.30	$0.00	$954.52	$954.52	$0.00	$783.36	"$1,240.85"	"$1,253.38"	$0.00		$0.00	$238.05	$0.00	$0.00	$249.42	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.248	SUP	HCPCS C1713		02.161.248  -  PLATE BONE NARROW 18 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	"$1,969.38 "	"$1,457.34"	$0.00	"$1,529.62"	$860.41	$860.41	$0.00	$0.00	$0.00	$410.47	"$1,461.67"	"$1,461.67"	$0.00	$0.00	$410.42	$0.00	"$1,164.89"	"$1,164.89"	$0.00	$956.01	"$1,514.33"	"$1,529.62"	$0.00		$0.00	$290.51	$0.00	$0.00	$304.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.250	SUP	HCPCS C1713		02.161.250  -  PLATE BONE NARROW 20 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	"$2,329.23 "	"$1,723.63"	$0.00	"$1,809.12"	"$1,017.63"	"$1,017.63"	$0.00	$0.00	$0.00	$485.47	"$1,728.75"	"$1,728.75"	$0.00	$0.00	$485.41	$0.00	"$1,377.74"	"$1,377.74"	$0.00	"$1,130.70"	"$1,791.03"	"$1,809.12"	$0.00		$0.00	$343.60	$0.00	$0.00	$360.01	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.252	SUP	HCPCS C1713		02.161.252  -  PLATE BONE NARROW 22 HOLE CVD LCP STAINLESS STEEL NONSTRL	BOTH IP/OP	"$2,597.73 "	"$1,922.32"	$0.00	"$2,017.64"	"$1,134.92"	"$1,134.92"	$0.00	$0.00	$0.00	$541.43	"$1,928.03"	"$1,928.03"	$0.00	$0.00	$541.37	$0.00	"$1,280.68"	"$1,280.68"	$0.00	"$1,261.03"	"$1,997.46"	"$2,017.64"	$0.00		$0.00	$383.21	$0.00	$0.00	$401.51	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.270	SUP	HCPCS C1713		02.161.270  -  PLATE BONE BROAD 10 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5	BOTH IP/OP	$889.80 	$658.45	$0.00	$691.10	$388.74	$388.74	$0.00	$0.00	$0.00	$185.46	$660.41	$660.41	$0.00	$0.00	$185.43	$0.00	$526.32	$526.32	$0.00	$431.94	$684.19	$691.10	$0.00		$0.00	$131.26	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.272	SUP	HCPCS C1713		02.161.272  -  PLATE BONE BROAD CVD 12 HOLE LCP STAINLESS STEEL TIBIA	BOTH IP/OP	"$1,156.88 "	$856.09	$0.00	$898.56	$505.44	$505.44	$0.00	$0.00	$0.00	$241.12	$858.63	$858.63	$0.00	$0.00	$241.09	$0.00	$684.29	$684.29	$0.00	$561.60	$889.57	$898.56	$0.00		$0.00	$170.66	$0.00	$0.00	$178.81	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.274	SUP	HCPCS C1713		02.161.274  -  PLATE BONE BROAD 14 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5	BOTH IP/OP	"$1,241.23 "	$918.51	$0.00	$964.06	$542.28	$542.28	$0.00	$0.00	$0.00	$258.70	$921.24	$921.24	$0.00	$0.00	$258.67	$0.00	$734.18	$734.18	$0.00	$602.54	$954.42	$964.06	$0.00		$0.00	$183.10	$0.00	$0.00	$191.85	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.276	SUP	HCPCS C1713		02.161.276  -  PLATE BN BRD CRV NS LCP CMBN 16 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$1,341.03 "	$992.36	$0.00	"$1,041.58"	$585.89	$585.89	$0.00	$0.00	$0.00	$279.50	$995.31	$995.31	$0.00	$0.00	$279.47	$0.00	$793.22	$793.22	$0.00	$650.99	"$1,031.17"	"$1,041.58"	$0.00		$0.00	$197.82	$0.00	$0.00	$207.27	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.278	SUP	HCPCS C1713		02.161.278  -  PLATE BONE BROAD 18 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5	BOTH IP/OP	"$1,509.73 "	"$1,117.20"	$0.00	"$1,172.60"	$659.59	$659.59	$0.00	$0.00	$0.00	$314.66	"$1,120.52"	"$1,120.52"	$0.00	$0.00	$314.63	$0.00	$893.00	$893.00	$0.00	$732.88	"$1,160.87"	"$1,172.60"	$0.00		$0.00	$222.71	$0.00	$0.00	$233.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.280	SUP	HCPCS C1713		02.161.280  -  PLATE BONE BROAD 20 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5	BOTH IP/OP	"$1,608.10 "	"$1,189.99"	$0.00	"$1,249.02"	$702.57	$702.57	$0.00	$0.00	$0.00	$335.17	"$1,193.53"	"$1,193.53"	$0.00	$0.00	$335.13	$0.00	$951.19	$951.19	$0.00	$780.64	"$1,236.53"	"$1,249.02"	$0.00		$0.00	$237.22	$0.00	$0.00	$248.55	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.282	SUP	HCPCS C1713		02.161.282  -  PLATE BONE BROAD 22 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5	BOTH IP/OP	"$1,692.45 "	"$1,252.41"	$0.00	"$1,314.52"	$739.42	$739.42	$0.00	$0.00	$0.00	$352.75	"$1,256.14"	"$1,256.14"	$0.00	$0.00	$352.71	$0.00	"$1,001.08"	"$1,001.08"	$0.00	$821.58	"$1,301.37"	"$1,314.52"	$0.00		$0.00	$249.66	$0.00	$0.00	$261.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.284	SUP	HCPCS C1713		02.161.284  -  PLATE BONE BROAD 24 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5	BOTH IP/OP	"$1,692.45 "	"$1,252.41"	$0.00	"$1,314.52"	$739.42	$739.42	$0.00	$0.00	$0.00	$352.75	"$1,256.14"	"$1,256.14"	$0.00	$0.00	$352.71	$0.00	"$1,001.08"	"$1,001.08"	$0.00	$821.58	"$1,301.37"	"$1,314.52"	$0.00		$0.00	$249.66	$0.00	$0.00	$261.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.286	SUP	HCPCS C1713		02.161.286  -  PLATE BONE BROAD 26 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5	BOTH IP/OP	"$1,795.08 "	"$1,328.36"	$0.00	"$1,394.22"	$784.25	$784.25	$0.00	$0.00	$0.00	$374.14	"$1,332.30"	"$1,332.30"	$0.00	$0.00	$374.09	$0.00	"$1,061.79"	"$1,061.79"	$0.00	$871.39	"$1,380.28"	"$1,394.22"	$0.00		$0.00	$264.80	$0.00	$0.00	$277.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.288	SUP	HCPCS C1713		02.161.288  -  PLATE BONE BROAD 28 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5	BOTH IP/OP	"$1,973.60 "	"$1,460.46"	$0.00	"$1,532.88"	$862.25	$862.25	$0.00	$0.00	$0.00	$411.35	"$1,464.81"	"$1,464.81"	$0.00	$0.00	$411.30	$0.00	"$1,167.38"	"$1,167.38"	$0.00	$958.05	"$1,517.55"	"$1,532.88"	$0.00		$0.00	$291.14	$0.00	$0.00	$305.04	$0.00	$0.00	$0.00	$0.00	$0.00
02.161.290	SUP	HCPCS C1713		02.161.290  -  PLATE BONE BROAD 30 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5	BOTH IP/OP	"$2,153.53 "	"$1,593.61"	$0.00	"$1,672.64"	$940.86	$940.86	$0.00	$0.00	$0.00	$448.85	"$1,598.35"	"$1,598.35"	$0.00	$0.00	$448.79	$0.00	"$1,273.81"	"$1,273.81"	$0.00	"$1,045.40"	"$1,655.91"	"$1,672.64"	$0.00		$0.00	$317.68	$0.00	$0.00	$332.86	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.003	SUP	HCPCS C1713		02.200.003  -  PLUG PLT 3.5MM NS LCP THRD STRDR RCS SS LOPRFL PLVC SYS	BOTH IP/OP	$203.83 	$150.83	$0.00	$158.32	$89.06	$89.06	$0.00	$0.00	$0.00	$42.48	$151.28	$151.28	$0.00	$0.00	$42.48	$0.00	$120.56	$120.56	$0.00	$98.95	$156.74	$158.32	$0.00		$0.00	$30.07	$0.00	$0.00	$31.51	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.010	SUP	HCPCS C1713		02.200.010  -  SCREW BONE T15 LP 3.5MM 6MM 10MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.012	SUP	HCPCS C1713		02.200.012  -  SCREW BONE FULTHD 3.5MM 6MM 12MM T15 STARDRIVE SELF TAP LP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.014	SUP	HCPCS C1713		02.200.014  -  SCREW BONE T15 LP 3.5MM 6MM 14MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.016	SUP	HCPCS C1713		02.200.016  -  SCREW BONE T15 LP 3.5MM 6MM 16MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.018	SUP	HCPCS C1713		02.200.018  -  SCREW BONE T15 LP 3.5MM 6MM 18MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.020	SUP	HCPCS C1713		02.200.020  -  SCREW BONE FULTHD 3.5MM 20MM T15 STARDRIVE RECESS SLFTAP LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.022	SUP	HCPCS C1713		02.200.022  -  SCREW BONE T15 LP 3.5MM 6MM 22MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.024	SUP	HCPCS C1713		02.200.024  -  SCREW BONE T15 LP 3.5MM 6MM 24MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.026	SUP	HCPCS C1713		02.200.026  -  SCREW BONE T15 LP 3.5MM 6MM 26MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.028	SUP	HCPCS C1713		02.200.028  -  SCREW BONE T15 LP 3.5MM 6MM 28MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.030	SUP	HCPCS C1713		02.200.030  -  SCREW BONE FULTHD 3.5MM 6MM 30MM T15 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.032	SUP	HCPCS C1713		02.200.032  -  SCREW BONE T15 LP 3.5MM 6MM 32MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.034	SUP	HCPCS C1713		02.200.034  -  SCREW BONE T15 LP 3.5MM 6MM 34MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.036	SUP	HCPCS C1713		02.200.036  -  SCREW BONE T15 LP 3.5MM 6MM 36MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.038	SUP	HCPCS C1713		02.200.038  -  SCREW BONE FULTHD LP 3.5MM 6MM 38MM SELF TAP T15 STARDRIVE	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.040	SUP	HCPCS C1713		02.200.040  -  SCREW BONE T15 LP 3.5MM 6MM 40MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.042	SUP	HCPCS C1713		02.200.042  -  SCREW BONE T15 LP 3.5MM 6MM 42MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.044	SUP	HCPCS C1713		02.200.044  -  SCREW BONE T15 LP 3.5MM 6MM 44MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.045	SUP	HCPCS C1713		02.200.045  -  SCREW BONE 3.5MM 45MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.046	SUP	HCPCS C1713		02.200.046  -  SCREW BONE T15 LP 3.5MM 6MM 46MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.048	SUP	HCPCS C1713		02.200.048  -  SCREW BONE 3.5MM 48MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.050	SUP	HCPCS C1713		02.200.050  -  SCREW BONE T15 LP 3.5MM 6MM 50MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.055	SUP	HCPCS C1713		02.200.055  -  SCREW BONE T15 LP 3.5MM 6MM 55MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.060	SUP	HCPCS C1713		02.200.060  -  SCREW BONE 3.5MM 60MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.065	SUP	HCPCS C1713		02.200.065  -  SCREW BONE 3.5MM 65MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.070	SUP	HCPCS C1713		02.200.070  -  SCREW BONE 3.5MM 70MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.075	SUP	HCPCS C1713		02.200.075  -  SCREW BONE 3.5MM 75MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.080	SUP	HCPCS C1713		02.200.080  -  SCREW BONE 3.5MM 80MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.085	SUP	HCPCS C1713		02.200.085  -  SCREW BONE T15 LP 3.5MM 6MM 85MM SELF TAP STARDRIVE LCP	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.090	SUP	HCPCS C1713		02.200.090  -  SCREW BONE 3.5MM 90MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.095	SUP	HCPCS C1713		02.200.095  -  SCREW BONE 3.5MM 95MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.100	SUP	HCPCS C1713		02.200.100  -  SCREW BONE 3.5MM 100MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$59.05 	$43.70	$0.00	$45.86	$25.80	$25.80	$0.00	$0.00	$0.00	$12.31	$43.83	$43.83	$0.00	$0.00	$12.31	$0.00	$34.93	$34.93	$0.00	$28.66	$45.41	$45.86	$0.00		$0.00	$8.71	$0.00	$0.00	$9.13	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.105	SUP	HCPCS C1713		02.200.105  -  SCREW BONE 3.5MM 105MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$59.05 	$43.70	$0.00	$45.86	$25.80	$25.80	$0.00	$0.00	$0.00	$12.31	$43.83	$43.83	$0.00	$0.00	$12.31	$0.00	$34.93	$34.93	$0.00	$28.66	$45.41	$45.86	$0.00		$0.00	$8.71	$0.00	$0.00	$9.13	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.110	SUP	HCPCS C1713		02.200.110  -  SCREW BONE 3.5MM 110MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$59.05 	$43.70	$0.00	$45.86	$25.80	$25.80	$0.00	$0.00	$0.00	$12.31	$43.83	$43.83	$0.00	$0.00	$12.31	$0.00	$34.93	$34.93	$0.00	$28.66	$45.41	$45.86	$0.00		$0.00	$8.71	$0.00	$0.00	$9.13	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.115	SUP	HCPCS C1713		02.200.115  -  SCREW BONE 3.5MM 115MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$59.05 	$43.70	$0.00	$45.86	$25.80	$25.80	$0.00	$0.00	$0.00	$12.31	$43.83	$43.83	$0.00	$0.00	$12.31	$0.00	$34.93	$34.93	$0.00	$28.66	$45.41	$45.86	$0.00		$0.00	$8.71	$0.00	$0.00	$9.13	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.120	SUP	HCPCS C1713		02.200.120  -  SCREW BONE 3.5MM 120MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$59.05 	$43.70	$0.00	$45.86	$25.80	$25.80	$0.00	$0.00	$0.00	$12.31	$43.83	$43.83	$0.00	$0.00	$12.31	$0.00	$34.93	$34.93	$0.00	$28.66	$45.41	$45.86	$0.00		$0.00	$8.71	$0.00	$0.00	$9.13	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.125	SUP	HCPCS C1713		02.200.125  -  SCREW BONE 3.5MM 125MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$59.05 	$43.70	$0.00	$45.86	$25.80	$25.80	$0.00	$0.00	$0.00	$12.31	$43.83	$43.83	$0.00	$0.00	$12.31	$0.00	$34.93	$34.93	$0.00	$28.66	$45.41	$45.86	$0.00		$0.00	$8.71	$0.00	$0.00	$9.13	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.130	SUP	HCPCS C1713		02.200.130  -  SCREW BONE 3.5MM 130MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$191.18 	$141.47	$0.00	$148.48	$83.52	$83.52	$0.00	$0.00	$0.00	$39.85	$141.89	$141.89	$0.00	$0.00	$39.84	$0.00	$113.08	$113.08	$0.00	$92.80	$147.00	$148.48	$0.00		$0.00	$28.20	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.135	SUP	HCPCS C1713		02.200.135  -  SCREW BONE 3.5MM 135MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$191.18 	$141.47	$0.00	$148.48	$83.52	$83.52	$0.00	$0.00	$0.00	$39.85	$141.89	$141.89	$0.00	$0.00	$39.84	$0.00	$113.08	$113.08	$0.00	$92.80	$147.00	$148.48	$0.00		$0.00	$28.20	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.140	SUP	HCPCS C1713		02.200.140  -  SCREW BONE 3.5MM 140MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$191.18 	$141.47	$0.00	$148.48	$83.52	$83.52	$0.00	$0.00	$0.00	$39.85	$141.89	$141.89	$0.00	$0.00	$39.84	$0.00	$113.08	$113.08	$0.00	$92.80	$147.00	$148.48	$0.00		$0.00	$28.20	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.145	SUP	HCPCS C1713		02.200.145  -  SCREW BONE 3.5MM 145MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$191.18 	$141.47	$0.00	$148.48	$83.52	$83.52	$0.00	$0.00	$0.00	$39.85	$141.89	$141.89	$0.00	$0.00	$39.84	$0.00	$113.08	$113.08	$0.00	$92.80	$147.00	$148.48	$0.00		$0.00	$28.20	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
02.200.150	SUP	HCPCS C1713		02.200.150  -  SCREW BONE 3.5MM 150MM SLFTAP LP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$191.18 	$141.47	$0.00	$148.48	$83.52	$83.52	$0.00	$0.00	$0.00	$39.85	$141.89	$141.89	$0.00	$0.00	$39.84	$0.00	$113.08	$113.08	$0.00	$92.80	$147.00	$148.48	$0.00		$0.00	$28.20	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.014	SUP	HCPCS C1713		02.204.014  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 14MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.016	SUP	HCPCS C1713		02.204.016  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 16MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.018	SUP	HCPCS C1713		02.204.018  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 18MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.020	SUP	HCPCS C1713		02.204.020  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 20MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.022	SUP	HCPCS C1713		02.204.022  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 22MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.024	SUP	HCPCS C1713		02.204.024  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 24MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.026	SUP	HCPCS C1713		02.204.026  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 26MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.028	SUP	HCPCS C1713		02.204.028  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 28MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.030	SUP	HCPCS C1713		02.204.030  -  SCREW BONE FULTHD 4MM 30MM T25 STARDRIVE RECESS SLFTAP TIP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.032	SUP	HCPCS C1713		02.204.032  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 32MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.034	SUP	HCPCS C1713		02.204.034  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 34MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.036	SUP	HCPCS C1713		02.204.036  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 36MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.038	SUP	HCPCS C1713		02.204.038  -  SCREW BONE FULTHD 4MM 38MM T25 STARDRIVE SELF TAP TIP LOCK	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.040	SUP	HCPCS C1713		02.204.040  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 40MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.042	SUP	HCPCS C1713		02.204.042  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 42MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.044	SUP	HCPCS C1713		02.204.044  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 44MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.046	SUP	HCPCS C1713		02.204.046  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 46MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.048	SUP	HCPCS C1713		02.204.048  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 48MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.050	SUP	HCPCS C1713		02.204.050  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 50MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.052	SUP	HCPCS C1713		02.204.052  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 52MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.054	SUP	HCPCS C1713		02.204.054  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 54MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.056	SUP	HCPCS C1713		02.204.056  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 56MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.058	SUP	HCPCS C1713		02.204.058  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 58MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.060	SUP	HCPCS C1713		02.204.060  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 60MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.062	SUP	HCPCS C1713		02.204.062  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 62MM FIX ANGLE SELF TAP	BOTH IP/OP	$269.90 	$199.73	$0.00	$209.62	$117.91	$117.91	$0.00	$0.00	$0.00	$56.25	$200.32	$200.32	$0.00	$0.00	$56.25	$0.00	$159.65	$159.65	$0.00	$131.01	$207.53	$209.62	$0.00		$0.00	$39.81	$0.00	$0.00	$41.71	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.420	SUP	HCPCS C1713		02.204.420  -  SCREW BONE 4MM 20MM LOCK STAINLESS STEEL PERIARTICULAR	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.424	SUP	HCPCS C1713		02.204.424  -  SCREW BONE 4MM 24MM LOCK STAINLESS STEEL PERIARTICULAR	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.428	SUP	HCPCS C1713		02.204.428  -  SCREW BONE 4MM 3.4MM 28MM LOCKING SLFTAP TIP THREADED	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.432	SUP	HCPCS C1713		02.204.432  -  SCREW BONE 4MM 32MM LOCKING SLFTAP TIP THREADED CONICAL HEAD	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.436	SUP	HCPCS C1713		02.204.436  -  SCREW BONE 4MM 36MM LOCKING SLFTAP TIP THREADED CONICAL HEAD	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.440	SUP	HCPCS C1713		02.204.440  -  SCREW BONE 4MM 40MM LOCKING SLFTAP TIP THREADED CONICAL HEAD	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.444	SUP	HCPCS C1713		02.204.444  -  SCREW BONE 4MM 44MM LOCKING SLFTAP TIP THREADED CONICAL HEAD	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.448	SUP	HCPCS C1713		02.204.448  -  SCREW BONE 4MM 48MM LOCKING HEX RECESS STAINLESS STEEL	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.452	SUP	HCPCS C1713		02.204.452  -  SCREW BONE 4MM 52MM LOCKING HEX RECESS STAINLESS STEEL	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.456	SUP	HCPCS C1713		02.204.456  -  SCREW BONE 4MM 56MM LOCKING HEX RECESS STAINLESS STEEL	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.204.460	SUP	HCPCS C1713		02.204.460  -  SCREW BONE 4MM 60MM LOCKING HEX RECESS STAINLESS STEEL	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.025	SUP	HCPCS C1713		02.205.025  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 25MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.030	SUP	HCPCS C1713		02.205.030  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 30MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.035	SUP	HCPCS C1713		02.205.035  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 35MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.040	SUP	HCPCS C1713		02.205.040  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 40MM CANN LOCKING SLFDRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.045	SUP	HCPCS C1713		02.205.045  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 45MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.050	SUP	HCPCS C1713		02.205.050  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 50MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.055	SUP	HCPCS C1713		02.205.055  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 55MM CANN LOCK DRILL SELF	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.060	SUP	HCPCS C1713		02.205.060  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 60MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.065	SUP	HCPCS C1713		02.205.065  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 65MM CANN LOCK DRILL SELF	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.070	SUP	HCPCS C1713		02.205.070  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 70MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.075	SUP	HCPCS C1713		02.205.075  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 75MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.080	SUP	HCPCS C1713		02.205.080  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 80MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.085	SUP	HCPCS C1713		02.205.085  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 85MM CANN LOCKING SLFDRILL	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.090	SUP	HCPCS C1713		02.205.090  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 90MM SELF DRILL SELF TAP	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.095	SUP	HCPCS C1713		02.205.095  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 95MM CANN LOCK DRILL SELF	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.100	SUP	HCPCS C1713		02.205.100  -  SCREW BONE FULTHD 5MM 100MM SELF TAP SELF DRILL CANN LOCK	BOTH IP/OP	$379.53 	$280.85	$0.00	$294.78	$165.81	$165.81	$0.00	$0.00	$0.00	$79.10	$281.68	$281.68	$0.00	$0.00	$79.09	$0.00	$224.49	$224.49	$0.00	$184.24	$291.84	$294.78	$0.00		$0.00	$55.99	$0.00	$0.00	$58.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.105	SUP	HCPCS C1713		02.205.105  -  SCREW BONE FULTHD 5MM 105MM SELF TAP SELF DRILL CANN LOCK	BOTH IP/OP	$379.53 	$280.85	$0.00	$294.78	$165.81	$165.81	$0.00	$0.00	$0.00	$79.10	$281.68	$281.68	$0.00	$0.00	$79.09	$0.00	$224.49	$224.49	$0.00	$184.24	$291.84	$294.78	$0.00		$0.00	$55.99	$0.00	$0.00	$58.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.110	SUP	HCPCS C1713		02.205.110  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 110MM SELF DRILL SELF TAP	BOTH IP/OP	$379.53 	$280.85	$0.00	$294.78	$165.81	$165.81	$0.00	$0.00	$0.00	$79.10	$281.68	$281.68	$0.00	$0.00	$79.09	$0.00	$224.49	$224.49	$0.00	$184.24	$291.84	$294.78	$0.00		$0.00	$55.99	$0.00	$0.00	$58.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.115	SUP	HCPCS C1713		02.205.115  -  SCREW BONE FULTHD 5MM 115MM SELF TAP TIP SELF DRILL CANN	BOTH IP/OP	$379.53 	$280.85	$0.00	$294.78	$165.81	$165.81	$0.00	$0.00	$0.00	$79.10	$281.68	$281.68	$0.00	$0.00	$79.09	$0.00	$224.49	$224.49	$0.00	$184.24	$291.84	$294.78	$0.00		$0.00	$55.99	$0.00	$0.00	$58.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.120	SUP	HCPCS C1713		02.205.120  -  SCREW BONE FULTHD 5MM 120MM SELF TAP SELF DRILL CANN LOCK	BOTH IP/OP	$379.53 	$280.85	$0.00	$294.78	$165.81	$165.81	$0.00	$0.00	$0.00	$79.10	$281.68	$281.68	$0.00	$0.00	$79.09	$0.00	$224.49	$224.49	$0.00	$184.24	$291.84	$294.78	$0.00		$0.00	$55.99	$0.00	$0.00	$58.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.125	SUP	HCPCS C1713		02.205.125  -  SCREW BONE FULTHD 5MM 125MM SELF TAP SELF DRILL CANN LOCK	BOTH IP/OP	$379.53 	$280.85	$0.00	$294.78	$165.81	$165.81	$0.00	$0.00	$0.00	$79.10	$281.68	$281.68	$0.00	$0.00	$79.09	$0.00	$224.49	$224.49	$0.00	$184.24	$291.84	$294.78	$0.00		$0.00	$55.99	$0.00	$0.00	$58.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.130	SUP	HCPCS C1713		02.205.130  -  SCREW BONE FULTHD 5MM 130MM SELF TAP SELF DRILL CANN LOCK	BOTH IP/OP	$379.53 	$280.85	$0.00	$294.78	$165.81	$165.81	$0.00	$0.00	$0.00	$79.10	$281.68	$281.68	$0.00	$0.00	$79.09	$0.00	$224.49	$224.49	$0.00	$184.24	$291.84	$294.78	$0.00		$0.00	$55.99	$0.00	$0.00	$58.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.135	SUP	HCPCS C1713		02.205.135  -  SCREW BONE FULTHD 5MM 135MM SELF TAP SELF DRILL CANN LOCK	BOTH IP/OP	$379.53 	$280.85	$0.00	$294.78	$165.81	$165.81	$0.00	$0.00	$0.00	$79.10	$281.68	$281.68	$0.00	$0.00	$79.09	$0.00	$224.49	$224.49	$0.00	$184.24	$291.84	$294.78	$0.00		$0.00	$55.99	$0.00	$0.00	$58.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.140	SUP	HCPCS C1713		02.205.140  -  SCREW BONE FULTHD 5MM 140MM SELF TAP SELF DRILL CANN LOCK	BOTH IP/OP	$379.53 	$280.85	$0.00	$294.78	$165.81	$165.81	$0.00	$0.00	$0.00	$79.10	$281.68	$281.68	$0.00	$0.00	$79.09	$0.00	$224.49	$224.49	$0.00	$184.24	$291.84	$294.78	$0.00		$0.00	$55.99	$0.00	$0.00	$58.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.145	SUP	HCPCS C1713		02.205.145  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 145MM SELF DRILL SELF TAP	BOTH IP/OP	$379.53 	$280.85	$0.00	$294.78	$165.81	$165.81	$0.00	$0.00	$0.00	$79.10	$281.68	$281.68	$0.00	$0.00	$79.09	$0.00	$224.49	$224.49	$0.00	$184.24	$291.84	$294.78	$0.00		$0.00	$55.99	$0.00	$0.00	$58.66	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.240	SUP	HCPCS C1713		02.205.240  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 40MM SELF DRILL	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.245	SUP	HCPCS C1713		02.205.245  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 45MM SELF DRILL	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.250	SUP	HCPCS C1713		02.205.250  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 50MM SELF DRILL	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.255	SUP	HCPCS C1713		02.205.255  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 55MM SELF DRILL	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.260	SUP	HCPCS C1713		02.205.260  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 60MM SELF DRILL	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.265	SUP	HCPCS C1713		02.205.265  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 65MM SELF DRILL	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.270	SUP	HCPCS C1713		02.205.270  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 70MM SELF DRILL	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.275	SUP	HCPCS C1713		02.205.275  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 75MM SELF DRILL	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.280	SUP	HCPCS C1713		02.205.280  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 80MM SELF DRILL	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.285	SUP	HCPCS C1713		02.205.285  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 85MM SELF DRILL	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.290	SUP	HCPCS C1713		02.205.290  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 90MM SELF DRILL	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
02.205.295	SUP	HCPCS C1713		02.205.295  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 95MM SELF DRILL	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
02.206.214	SUP	HCPCS C1713		02.206.214  -  SCREW BONE T15 3.5MM 14MM LP HEAD STARDRIVE SELF TAP TIP	BOTH IP/OP	$67.48 	$49.94	$0.00	$52.40	$29.48	$29.48	$0.00	$0.00	$0.00	$14.06	$50.08	$50.08	$0.00	$0.00	$14.06	$0.00	$39.91	$39.91	$0.00	$32.75	$51.88	$52.40	$0.00		$0.00	$9.95	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.206.216	SUP	HCPCS C1713		02.206.216  -  SCREW BONE T15 3.5MM 16MM SELF TAP LP STARDRIVE STAINLESS	BOTH IP/OP	$67.48 	$49.94	$0.00	$52.40	$29.48	$29.48	$0.00	$0.00	$0.00	$14.06	$50.08	$50.08	$0.00	$0.00	$14.06	$0.00	$39.91	$39.91	$0.00	$32.75	$51.88	$52.40	$0.00		$0.00	$9.95	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.206.218	SUP	HCPCS C1713		02.206.218  -  SCREW BONE T15 LP 3.5MM 18MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$67.48 	$49.94	$0.00	$52.40	$29.48	$29.48	$0.00	$0.00	$0.00	$14.06	$50.08	$50.08	$0.00	$0.00	$14.06	$0.00	$39.91	$39.91	$0.00	$32.75	$51.88	$52.40	$0.00		$0.00	$9.95	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.206.228	SUP	HCPCS C1713		02.206.228  -  SCREW BONE T15 3.5MM 28MM LP HEAD STARDRIVE SELF TAP TIP	BOTH IP/OP	$67.48 	$49.94	$0.00	$52.40	$29.48	$29.48	$0.00	$0.00	$0.00	$14.06	$50.08	$50.08	$0.00	$0.00	$14.06	$0.00	$39.91	$39.91	$0.00	$32.75	$51.88	$52.40	$0.00		$0.00	$9.95	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.206.230	SUP	Custom 27203010		02.206.230  -  SCREW BONE 3.5MM 30MM LCP SS MIDFT HINDFOOT TIB	BOTH IP/OP	$67.48 	$49.94	$0.00	$52.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.08	$50.08	$0.00	$0.00	$14.06	$0.00	$0.00	$0.00	$0.00	$32.75	$51.88	$52.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.206.232	SUP	HCPCS C1713		02.206.232  -  SCREW BONE 3.5MM 32MM SS T15 LP CLVCL FEM HUM TIB	BOTH IP/OP	$67.48 	$49.94	$0.00	$52.40	$29.48	$29.48	$0.00	$0.00	$0.00	$14.06	$50.08	$50.08	$0.00	$0.00	$14.06	$0.00	$39.91	$39.91	$0.00	$32.75	$51.88	$52.40	$0.00		$0.00	$9.95	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.206.238	SUP	HCPCS C1713		02.206.238  -  SCREW BONE T15 3.5MM 38MM LP HEAD STARDRIVE SELF TAP TIP	BOTH IP/OP	$67.48 	$49.94	$0.00	$52.40	$29.48	$29.48	$0.00	$0.00	$0.00	$14.06	$50.08	$50.08	$0.00	$0.00	$14.06	$0.00	$39.91	$39.91	$0.00	$32.75	$51.88	$52.40	$0.00		$0.00	$9.95	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.206.240	SUP	HCPCS C1713		02.206.240  -  SCREW BONE 3.5MM 40MM SELF TAP LP HEAD TI5 STARDRIVE LCP	BOTH IP/OP	$67.48 	$49.94	$0.00	$52.40	$29.48	$29.48	$0.00	$0.00	$0.00	$14.06	$50.08	$50.08	$0.00	$0.00	$14.06	$0.00	$39.91	$39.91	$0.00	$32.75	$51.88	$52.40	$0.00		$0.00	$9.95	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.001	SUP	HCPCS C1769		02.207.001  -  GUIDEWIRE ORTHOPEDIC FLUTE 2.8MM 450MM NONSTRL	BOTH IP/OP	$167.28 	$123.79	$0.00	$129.92	$88.18	$88.18	$0.00	$0.00	$0.00	$34.86	$124.15	$124.15	$0.00	$0.00	$34.86	$0.00	$98.94	$98.94	$0.00	$81.20	$128.62	$129.92	$0.00		$0.00	$24.68	$0.00	$0.00	$25.85	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.020	SUP	HCPCS C1713		02.207.020  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 20MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.025	SUP	HCPCS C1713		02.207.025  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 25MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.030	SUP	HCPCS C1713		02.207.030  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 30MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.035	SUP	HCPCS C1713		02.207.035  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 35MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.040	SUP	HCPCS C1713		02.207.040  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 40MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.045	SUP	HCPCS C1713		02.207.045  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 45MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.050	SUP	HCPCS C1713		02.207.050  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 50MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.055	SUP	HCPCS C1713		02.207.055  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 55MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.060	SUP	HCPCS C1713		02.207.060  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 60MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.065	SUP	HCPCS C1713		02.207.065  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 65MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.070	SUP	HCPCS C1713		02.207.070  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 70MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.075	SUP	HCPCS C1713		02.207.075  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 75MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.080	SUP	HCPCS C1713		02.207.080  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 80MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.085	SUP	HCPCS C1713		02.207.085  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 85MM SLFTAP TIP SLFDRILL	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.090	SUP	HCPCS C1713		02.207.090  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 90MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.095	SUP	HCPCS C1713		02.207.095  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 95MM SELF DRILL SELF TAP	BOTH IP/OP	$546.83 	$404.65	$0.00	$424.72	$238.91	$238.91	$0.00	$0.00	$0.00	$113.97	$405.85	$405.85	$0.00	$0.00	$113.96	$0.00	$323.45	$323.45	$0.00	$265.45	$420.47	$424.72	$0.00		$0.00	$80.66	$0.00	$0.00	$84.52	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.100	SUP	HCPCS C1713		02.207.100  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 100MM SELF DRILL SELF TAP	BOTH IP/OP	$559.48 	$414.02	$0.00	$434.54	$244.43	$244.43	$0.00	$0.00	$0.00	$116.61	$415.24	$415.24	$0.00	$0.00	$116.59	$0.00	$330.93	$330.93	$0.00	$271.59	$430.20	$434.54	$0.00		$0.00	$82.53	$0.00	$0.00	$86.47	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.105	SUP	HCPCS C1713		02.207.105  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 105MM SELF DRILL SELF TAP	BOTH IP/OP	$559.48 	$414.02	$0.00	$434.54	$244.43	$244.43	$0.00	$0.00	$0.00	$116.61	$415.24	$415.24	$0.00	$0.00	$116.59	$0.00	$330.93	$330.93	$0.00	$271.59	$430.20	$434.54	$0.00		$0.00	$82.53	$0.00	$0.00	$86.47	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.110	SUP	HCPCS C1713		02.207.110  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 110MM SELF DRILL SELF TAP	BOTH IP/OP	$559.48 	$414.02	$0.00	$434.54	$244.43	$244.43	$0.00	$0.00	$0.00	$116.61	$415.24	$415.24	$0.00	$0.00	$116.59	$0.00	$330.93	$330.93	$0.00	$271.59	$430.20	$434.54	$0.00		$0.00	$82.53	$0.00	$0.00	$86.47	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.115	SUP	HCPCS C1713		02.207.115  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 115MM SELF DRILL SELF TAP	BOTH IP/OP	$559.48 	$414.02	$0.00	$434.54	$244.43	$244.43	$0.00	$0.00	$0.00	$116.61	$415.24	$415.24	$0.00	$0.00	$116.59	$0.00	$330.93	$330.93	$0.00	$271.59	$430.20	$434.54	$0.00		$0.00	$82.53	$0.00	$0.00	$86.47	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.120	SUP	HCPCS C1713		02.207.120  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 120MM SELF DRILL SELF TAP	BOTH IP/OP	$559.48 	$414.02	$0.00	$434.54	$244.43	$244.43	$0.00	$0.00	$0.00	$116.61	$415.24	$415.24	$0.00	$0.00	$116.59	$0.00	$330.93	$330.93	$0.00	$271.59	$430.20	$434.54	$0.00		$0.00	$82.53	$0.00	$0.00	$86.47	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.125	SUP	HCPCS C1713		02.207.125  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 125MM SELF DRILL SELF TAP	BOTH IP/OP	$559.48 	$414.02	$0.00	$434.54	$244.43	$244.43	$0.00	$0.00	$0.00	$116.61	$415.24	$415.24	$0.00	$0.00	$116.59	$0.00	$330.93	$330.93	$0.00	$271.59	$430.20	$434.54	$0.00		$0.00	$82.53	$0.00	$0.00	$86.47	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.130	SUP	HCPCS C1713		02.207.130  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 130MM SELF DRILL SELF TAP	BOTH IP/OP	$559.48 	$414.02	$0.00	$434.54	$244.43	$244.43	$0.00	$0.00	$0.00	$116.61	$415.24	$415.24	$0.00	$0.00	$116.59	$0.00	$330.93	$330.93	$0.00	$271.59	$430.20	$434.54	$0.00		$0.00	$82.53	$0.00	$0.00	$86.47	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.135	SUP	HCPCS C1713		02.207.135  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 135MM SELF DRILL SELF TAP	BOTH IP/OP	$559.48 	$414.02	$0.00	$434.54	$244.43	$244.43	$0.00	$0.00	$0.00	$116.61	$415.24	$415.24	$0.00	$0.00	$116.59	$0.00	$330.93	$330.93	$0.00	$271.59	$430.20	$434.54	$0.00		$0.00	$82.53	$0.00	$0.00	$86.47	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.140	SUP	HCPCS C1713		02.207.140  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 140MM SELF DRILL SELF TAP	BOTH IP/OP	$559.48 	$414.02	$0.00	$434.54	$244.43	$244.43	$0.00	$0.00	$0.00	$116.61	$415.24	$415.24	$0.00	$0.00	$116.59	$0.00	$330.93	$330.93	$0.00	$271.59	$430.20	$434.54	$0.00		$0.00	$82.53	$0.00	$0.00	$86.47	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.145	SUP	HCPCS C1713		02.207.145  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 145MM SELF DRILL SELF TAP	BOTH IP/OP	$559.48 	$414.02	$0.00	$434.54	$244.43	$244.43	$0.00	$0.00	$0.00	$116.61	$415.24	$415.24	$0.00	$0.00	$116.59	$0.00	$330.93	$330.93	$0.00	$271.59	$430.20	$434.54	$0.00		$0.00	$82.53	$0.00	$0.00	$86.47	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.250	SUP	HCPCS C1713		02.207.250  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 50MM SELF DRILL	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.255	SUP	HCPCS C1713		02.207.255  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 55MM SELF DRILL	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.260	SUP	HCPCS C1713		02.207.260  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 60MM SELF DRILL	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.265	SUP	HCPCS C1713		02.207.265  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 65MM SELF DRILL	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.270	SUP	HCPCS C1713		02.207.270  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 70MM SELF DRILL	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.275	SUP	HCPCS C1713		02.207.275  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 75MM SELF DRILL	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.280	SUP	HCPCS C1713		02.207.280  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 80MM SELF DRILL	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.285	SUP	HCPCS C1713		02.207.285  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 85MM SELF DRILL	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.290	SUP	HCPCS C1713		02.207.290  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 90MM SELF DRILL	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.295	SUP	HCPCS C1713		02.207.295  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 95MM SELF DRILL	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.450	SUP	HCPCS C1713		02.207.450  -  SCREW BONE CONICAL PTHRD 7.3MM 5MM 50MM SELF TAP SELF DRILL	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.455	SUP	HCPCS C1713		02.207.455  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 55MM SELF DRILL SELF TAP	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.460	SUP	HCPCS C1713		02.207.460  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 60MM SELF DRILL SELF TAP	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.465	SUP	HCPCS C1713		02.207.465  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 65MM SELF DRILL SELF TAP	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.470	SUP	HCPCS C1713		02.207.470  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 70MM SELF DRILL SELF TAP	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.475	SUP	HCPCS C1713		02.207.475  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 75MM SELF DRILL SELF TAP	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.480	SUP	HCPCS C1713		02.207.480  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 80MM SELF DRILL SELF TAP	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.485	SUP	HCPCS C1713		02.207.485  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 85MM SELF DRILL SELF TAP	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.490	SUP	HCPCS C1713		02.207.490  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 90MM SELF DRILL SELF TAP	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.495	SUP	HCPCS C1713		02.207.495  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 95MM SELF DRILL SELF TAP	BOTH IP/OP	$487.78 	$360.96	$0.00	$378.86	$213.11	$213.11	$0.00	$0.00	$0.00	$101.66	$362.03	$362.03	$0.00	$0.00	$101.65	$0.00	$288.52	$288.52	$0.00	$236.79	$375.08	$378.86	$0.00		$0.00	$71.95	$0.00	$0.00	$75.39	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.500	SUP	HCPCS C1713		02.207.500  -  SCREW BONE PTHRD 7.3MM 100MM CANN SMOOTH CONICAL HEAD	BOTH IP/OP	$518.70 	$383.84	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.505	SUP	HCPCS C1713		02.207.505  -  SCREW BONE PTHRD 7.3MM 105MM CANN SMOOTH CONICAL HEAD	BOTH IP/OP	$518.70 	$383.84	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.510	SUP	HCPCS C1713		02.207.510  -  SCREW BONE PTHRD 7.3MM 110MM CANN SMOOTH CONICAL HEAD	BOTH IP/OP	$518.70 	$383.84	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.515	SUP	HCPCS C1713		02.207.515  -  SCREW BONE PTHRD 7.3MM 115MM CANN SMOOTH CONICAL HEAD	BOTH IP/OP	$518.70 	$383.84	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.520	SUP	HCPCS C1713		02.207.520  -  SCREW BONE PTHRD 7.3MM 120MM CANN SMOOTH CONICAL HEAD	BOTH IP/OP	$518.70 	$383.84	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.525	SUP	HCPCS C1713		02.207.525  -  SCREW BONE PTHRD 7.3MM 125MM CANN SMOOTH CONICAL HEAD	BOTH IP/OP	$518.70 	$383.84	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.530	SUP	HCPCS C1713		02.207.530  -  SCREW BONE PTHRD 7.3MM 130MM CANN SMOOTH CONICAL HEAD	BOTH IP/OP	$518.70 	$383.84	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.535	SUP	HCPCS C1713		02.207.535  -  SCREW BONE PTHRD 7.3MM 135MM CANN SMOOTH CONICAL HEAD	BOTH IP/OP	$518.70 	$383.84	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.540	SUP	HCPCS C1713		02.207.540  -  SCREW BONE PTHRD 7.3MM 140MM CANN SMOOTH CONICAL HEAD	BOTH IP/OP	$518.70 	$383.84	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.545	SUP	HCPCS C1713		02.207.545  -  SCREW BONE PTHRD 7.3MM 145MM CANN SMOOTH CONICAL HEAD	BOTH IP/OP	$518.70 	$383.84	$0.00	$402.88	$226.62	$226.62	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$251.80	$398.85	$402.88	$0.00		$0.00	$76.52	$0.00	$0.00	$80.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.600	SUP	HCPCS C1713		02.207.600  -  SCREW BONE 7.3MM 45MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.601	SUP	HCPCS C1713		02.207.601  -  SCREW BONE 7.3MM 50MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.602	SUP	HCPCS C1713		02.207.602  -  SCREW BONE 7.3MM 55MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.603	SUP	HCPCS C1713		02.207.603  -  SCREW BONE 7.3MM 60MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.604	SUP	HCPCS C1713		02.207.604  -  SCREW BONE 7.3MM 65MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.605	SUP	HCPCS C1713		02.207.605  -  SCREW BONE 7.3MM 70MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.606	SUP	HCPCS C1713		02.207.606  -  SCREW BONE 7.3MM 75MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.607	SUP	HCPCS C1713		02.207.607  -  SCREW BONE 7.3MM 80MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.608	SUP	HCPCS C1713		02.207.608  -  SCREW BONE 7.3MM 85MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.609	SUP	HCPCS C1713		02.207.609  -  SCREW BONE 7.3MM 90MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.610	SUP	HCPCS C1713		02.207.610  -  SCREW BONE 7.3MM 95MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.611	SUP	HCPCS C1713		02.207.611  -  SCREW BONE 7.3MM 100MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.612	SUP	HCPCS C1713		02.207.612  -  SCREW BONE 7.3MM 105MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.613	SUP	HCPCS C1713		02.207.613  -  SCREW BONE 7.3MM 110MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.614	SUP	HCPCS C1713		02.207.614  -  SCREW BONE 7.3MM 115MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.615	SUP	HCPCS C1713		02.207.615  -  SCREW BONE 7.3MM 120MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.616	SUP	HCPCS C1713		02.207.616  -  SCREW BONE 7.3MM 125MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.617	SUP	HCPCS C1713		02.207.617  -  SCREW BONE 7.3MM 103MM 10MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.618	SUP	HCPCS C1713		02.207.618  -  SCREW BONE 7.3MM 45MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.619	SUP	HCPCS C1713		02.207.619  -  SCREW BONE 7.3MM 50MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.620	SUP	HCPCS C1713		02.207.620  -  SCREW BONE 7.3MM 55MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.621	SUP	HCPCS C1713		02.207.621  -  SCREW BONE 7.3MM 60MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.622	SUP	HCPCS C1713		02.207.622  -  SCREW BONE 7.3MM 65MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.623	SUP	HCPCS C1713		02.207.623  -  SCREW BONE 7.3MM 70MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.624	SUP	HCPCS C1713		02.207.624  -  SCREW BONE 7.3MM 75MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.625	SUP	HCPCS C1713		02.207.625  -  SCREW BONE 7.3MM 80MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.626	SUP	HCPCS C1713		02.207.626  -  SCREW BONE 7.3MM 85MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.627	SUP	HCPCS C1713		02.207.627  -  SCREW BONE 7.3MM 90MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.628	SUP	HCPCS C1713		02.207.628  -  SCREW BONE 7.3MM 95MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.629	SUP	HCPCS C1713		02.207.629  -  SCREW BONE 7.3MM 100MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.630	SUP	HCPCS C1713		02.207.630  -  SCREW BONE 7.3MM 105MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.631	SUP	HCPCS C1713		02.207.631  -  SCREW BONE 7.3MM 110MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.632	SUP	HCPCS C1713		02.207.632  -  SCREW BONE 7.3MM 115MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.633	SUP	HCPCS C1713		02.207.633  -  SCREW BONE 7.3MM 120MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.634	SUP	HCPCS C1713		02.207.634  -  SCREW BONE 7.3MM 125MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.635	SUP	HCPCS C1713		02.207.635  -  SCREW BONE 7.3MM 130MM 20MM CANN THREADED SCFE STAINLESS	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.636	SUP	Custom 27803010		02.207.636  -  WASHER ORTHOPEDIC OVAL 1MM STAINLESS STEEL FEMUR NONSTRL	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.207.637	SUP	Custom 27803010		02.207.637  -  WASHER ORTHOPEDIC OVAL 2MM STAINLESS STEEL FEMUR NONSTRL	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.078	SUP	HCPCS C1713		02.210.078  -  PIN FIX 1.8MM 8MM T8 STARDRIVE RECESS VAR ANG LOCKING	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.080	SUP	HCPCS C1713		02.210.080  -  PIN FIX 1.8MM 10MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.082	SUP	HCPCS C1713		02.210.082  -  PIN FIX 1.8MM 12MM T8 STARDRIVE RECESS BUTTRESS VAR ANG	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.084	SUP	HCPCS C1713		02.210.084  -  PIN FIX 1.8MM 14MM T8 STARDRIVE RECESS BUTTRESS VAR ANG	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.086	SUP	Custom 27203010		02.210.086  -  PIN FIX 1.8MM 16MM T8 STARDRIVE RECESS BUTTRESS VAR ANG	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$0.00	$0.00	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.088	SUP	Custom 27203010		02.210.088  -  PIN FIX 1.8MM 18MM T8 STARDRIVE RECESS BUTTRESS VAR ANG	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$0.00	$0.00	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.090	SUP	HCPCS C1713		02.210.090  -  PIN FIX 1.8MM 20MM T8 STARDRIVE RECESS BUTTRESS VAR ANG	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.092	SUP	Custom 27203010		02.210.092  -  PIN FIX 1.8MM 22MM T8 STARDRIVE RECESS BUTTRESS VAR ANG	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$0.00	$0.00	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.094	SUP	HCPCS C1713		02.210.094  -  PIN FIX 1.8MM 24MM T8 STARDRIVE RECESS BUTTRESS VAR ANG	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.096	SUP	HCPCS C1713		02.210.096  -  PIN FIX 1.8MM 26MM T8 STARDRIVE RECESS BUTTRESS VAR ANG	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.098	SUP	HCPCS C1713		02.210.098  -  PIN FIX 1.8MM 28MM T8 STARDRIVE RECESS BUTTRESS VAR ANG	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.100	SUP	HCPCS C1713		02.210.100  -  PIN FIX 1.8MM 30MM T8 STARDRIVE RECESS VAR ANG LOCKING	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.107	SUP	HCPCS C1713		02.210.107  -  SCREW BONE 2.4MM 7MM STARDRIVE VAR ANG SLFTAP LOCKING LCP	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.108	SUP	HCPCS C1713		02.210.108  -  SCREW BONE T8 2.4MM 8MM VAR ANG SELF TAP THREAD STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.109	SUP	HCPCS C1713		02.210.109  -  SCREW BONE 2.4MM 9MM STARDRIVE VAR ANG SLFTAP LOCKING LCP	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.110	SUP	HCPCS C1713		02.210.110  -  SCREW BONE T8 2.4MM 10MM VAR ANG SELF TAP THREAD STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.111	SUP	HCPCS C1713		02.210.111  -  SCREW BONE 2.4MM 11MM STARDRIVE VAR ANG SLFTAP LOCKING LCP	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.112	SUP	HCPCS C1713		02.210.112  -  SCREW BONE T8 2.4MM 12MM VAR ANG SELF TAP THREAD STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.113	SUP	HCPCS C1713		02.210.113  -  SCREW BONE 2.4MM 13MM STARDRIVE VAR ANG SLFTAP LOCKING LCP	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.114	SUP	HCPCS C1713		02.210.114  -  SCREW BONE T8 2.4MM 14MM VAR ANG SELF TAP THREAD STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.116	SUP	HCPCS C1713		02.210.116  -  SCREW BONE T8 2.4MM 16MM VAR ANG SELF TAP THREAD STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.118	SUP	HCPCS C1713		02.210.118  -  SCREW BONE T8 2.4MM 18MM VAR ANG SELF TAP THREAD STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.120	SUP	HCPCS C1713		02.210.120  -  SCREW BONE 2.4MM 20MM T8 STARDRIVE RECESS LOCKING VAR ANG	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.122	SUP	HCPCS C1713		02.210.122  -  SCREW BONE 2.4MM 22MM VAR ANG SELF TAP THREAD T8 STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.124	SUP	HCPCS C1713		02.210.124  -  SCREW BONE T8 2.4MM 24MM VAR ANG SELF TAP THREAD STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.126	SUP	HCPCS C1713		02.210.126  -  SCREW BONE T8 2.4MM 26MM VAR ANG SELF TAP THREAD STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.128	SUP	HCPCS C1713		02.210.128  -  SCREW BONE T8 2.4MM 28MM VAR ANG SELF TAP THREAD STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.130	SUP	HCPCS C1713		02.210.130  -  SCREW BONE T8 2.4MM 30MM VAR ANG SELF TAP THREAD STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.132	SUP	HCPCS C1713		02.210.132  -  SCREW BONE 2.4MM 32MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.134	SUP	HCPCS C1713		02.210.134  -  SCREW BONE 2.4MM 34MM SLFTAP LOCKING VAR ANG T8 STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.136	SUP	HCPCS C1713		02.210.136  -  SCREW BONE 2.4MM 36MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.138	SUP	HCPCS C1713		02.210.138  -  SCREW BONE 2.4MM 38MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.140	SUP	HCPCS C1713		02.210.140  -  SCREW BONE 2.4MM 40MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.142	SUP	HCPCS C1713		02.210.142  -  SCREW BONE 2.4MM 42MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.144	SUP	HCPCS C1713		02.210.144  -  SCREW BONE 2.4MM 44MM SLFTAP LOCKING VAR ANG T8 STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.146	SUP	HCPCS C1713		02.210.146  -  SCREW BONE 2.4MM 46MM SLFTAP LOCKING VAR ANG T8 STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.148	SUP	HCPCS C1713		02.210.148  -  SCREW BONE 2.4MM 48MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.150	SUP	HCPCS C1713		02.210.150  -  SCREW BONE 2.4MM 50MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.152	SUP	HCPCS C1713		02.210.152  -  SCREW BONE 2.4MM 52MM SLFTAP LOCKING VAR ANG T8 STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.154	SUP	HCPCS C1713		02.210.154  -  SCREW BONE 2.4MM 54MM SLFTAP LOCKING VAR ANG T8 STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.156	SUP	HCPCS C1713		02.210.156  -  SCREW BONE 2.4MM 56MM SLFTAP LOCKING VAR ANG T8 STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.158	SUP	HCPCS C1713		02.210.158  -  SCREW BONE 2.4MM 58MM STARDRIVE SLFTAP LOCKING VAR ANG	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.160	SUP	HCPCS C1713		02.210.160  -  SCREW BONE 2.4MM 60MM STARDRIVE SLFTAP LOCKING VAR ANG	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.942	SUP	HCPCS C1713		02.210.942  -  SCREW BONE T8 2.4MM 42MM SLFTAP STARDRIVE RECESS STAINLESS	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.944	SUP	HCPCS C1713		02.210.944  -  SCREW BONE 2.4MM 44MM T8 STARDRIVE RECESS SLFTAP LCP	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.946	SUP	HCPCS C1713		02.210.946  -  SCREW BONE 2.4MM 46MM T8 STARDRIVE RECESS SLFTAP LCP	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.948	SUP	HCPCS C1713		02.210.948  -  SCREW BONE 2.4MM 48MM T8 STARDRIVE RECESS SLFTAP LCP	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.950	SUP	HCPCS C1713		02.210.950  -  SCREW BONE 2.4MM 50MM T8 STARDRIVE RECESS SLFTAP LCP	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.952	SUP	HCPCS C1713		02.210.952  -  SCREW BONE T8 2.4MM 52MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.954	SUP	HCPCS C1713		02.210.954  -  SCREW BONE 2.4MM 54MM T8 STARDRIVE RECESS SLFTAP LCP	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.956	SUP	HCPCS C1713		02.210.956  -  SCREW BONE T8 2.4MM 56MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.958	SUP	HCPCS C1713		02.210.958  -  SCREW BONE 2.4MM 58MM T8 STARDRIVE SLFTAP STAINLESS STEEL	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
02.210.960	SUP	HCPCS C1713		02.210.960  -  SCREW BONE 2.4MM 60MM T8 STARDRIVE SLFTAP STAINLESS STEEL	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.008	SUP	HCPCS C1713		02.211.008  -  SCREW BONE 2.7MM 8MM T8 STARDRIVE RECESS VAR ANG SLFTAP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.009	SUP	HCPCS C1713		02.211.009  -  SCREW BONE 2.7MM 9MM T8 STARDRIVE RECESS VAR ANG SLFTAP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.010	SUP	HCPCS C1713		02.211.010  -  SCREW BONE T8 2.7MM 10MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.011	SUP	HCPCS C1713		02.211.011  -  SCREW BONE 2.7MM 11MM T8 STARDRIVE RECESS VAR ANG SLFTAP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.012	SUP	HCPCS C1713		02.211.012  -  SCREW BONE T8 2.7MM 12MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.013	SUP	HCPCS C1713		02.211.013  -  SCREW BONE 2.7MM 13MM T8 STARDRIVE RECESS VAR ANG SLFTAP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.014	SUP	HCPCS C1713		02.211.014  -  SCREW BONE T8 2.7MM 14MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.016	SUP	HCPCS C1713		02.211.016  -  SCREW BONE T8 2.7MM 16MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.018	SUP	HCPCS C1713		02.211.018  -  SCREW BONE T8 2.7MM 18MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.020	SUP	HCPCS C1713		02.211.020  -  SCREW BONE T8 2.7MM 20MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.022	SUP	HCPCS C1713		02.211.022  -  SCREW BONE T8 2.7MM 22MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.024	SUP	HCPCS C1713		02.211.024  -  SCREW BONE T8 2.7MM 24MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.026	SUP	HCPCS C1713		02.211.026  -  SCREW BONE T8 2.7MM 26MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.028	SUP	HCPCS C1713		02.211.028  -  SCREW BONE T8 2.7MM 28MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.030	SUP	HCPCS C1713		02.211.030  -  SCREW BONE 2.7MM 30MM LOCK VAR ANG SELF TAP T8 STARDRIVE	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.032	SUP	HCPCS C1713		02.211.032  -  SCREW BONE T8 2.7MM 32MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.034	SUP	HCPCS C1713		02.211.034  -  SCREW BONE T8 2.7MM 34MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.036	SUP	HCPCS C1713		02.211.036  -  SCREW BONE 2.7MM 36MM LOCK VAR ANG SELF TAP T8 STARDRIVE	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.038	SUP	HCPCS C1713		02.211.038  -  SCREW BONE T8 2.7MM 38MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.040	SUP	HCPCS C1713		02.211.040  -  SCREW BONE T8 2.7MM 40MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.042	SUP	HCPCS C1713		02.211.042  -  SCREW BONE 2.7MM 42MM VAR ANG SELF TAP T8 STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.044	SUP	HCPCS C1713		02.211.044  -  SCREW BONE T8 2.7MM 44MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.046	SUP	HCPCS C1713		02.211.046  -  SCREW BONE T8 2.7MM 46MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.048	SUP	HCPCS C1713		02.211.048  -  SCREW BONE T8 2.7MM 48MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.050	SUP	HCPCS C1713		02.211.050  -  SCREW BONE T8 2.7MM 50MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.052	SUP	HCPCS C1713		02.211.052  -  SCREW BONE T8 2.7MM 52MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.054	SUP	HCPCS C1713		02.211.054  -  SCREW BONE T8 2.7MM 54MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.056	SUP	HCPCS C1713		02.211.056  -  SCREW BONE T8 2.7MM 56MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.058	SUP	HCPCS C1713		02.211.058  -  SCREW BONE T8 2.7MM 58MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.060	SUP	HCPCS C1713		02.211.060  -  SCREW BONE T8 2.7MM 60MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$267.08 	$197.64	$0.00	$207.44	$116.69	$116.69	$0.00	$0.00	$0.00	$55.67	$198.22	$198.22	$0.00	$0.00	$55.66	$0.00	$157.97	$157.97	$0.00	$129.65	$205.37	$207.44	$0.00		$0.00	$39.40	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.201	SUP	HCPCS C1713		02.211.201  -  PLATE BN XS X 24MM NS LCP VA LCK LOPRFL CMPR WRE HL SS	BOTH IP/OP	"$1,772.58 "	"$1,311.71"	$0.00	"$1,376.76"	$774.43	$774.43	$0.00	$0.00	$0.00	$369.45	"$1,315.61"	"$1,315.61"	$0.00	$0.00	$369.40	$0.00	"$1,048.48"	"$1,048.48"	$0.00	$860.48	"$1,362.99"	"$1,376.76"	$0.00		$0.00	$261.48	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.202	SUP	HCPCS C1713		02.211.202  -  PLATE BN SM X 27MM NS LCP VA LCK LOPRFL CMPR WRE HL SS	BOTH IP/OP	"$1,772.58 "	"$1,311.71"	$0.00	"$1,376.76"	$774.43	$774.43	$0.00	$0.00	$0.00	$369.45	"$1,315.61"	"$1,315.61"	$0.00	$0.00	$369.40	$0.00	"$1,048.48"	"$1,048.48"	$0.00	$860.48	"$1,362.99"	"$1,376.76"	$0.00		$0.00	$261.48	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.203	SUP	HCPCS C1713		02.211.203  -  PLATE BN MED X 32MM NS LCP VA LCK LOPRFL CMPR WRE HL SS	BOTH IP/OP	"$1,772.58 "	"$1,311.71"	$0.00	"$1,376.76"	$774.43	$774.43	$0.00	$0.00	$0.00	$369.45	"$1,315.61"	"$1,315.61"	$0.00	$0.00	$369.40	$0.00	"$1,048.48"	"$1,048.48"	$0.00	$860.48	"$1,362.99"	"$1,376.76"	$0.00		$0.00	$261.48	$0.00	$0.00	$273.98	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.204	SUP	HCPCS C1713		02.211.204  -  PLATE BN LG X 36MM NS LCP VA LCK LOPRFL CMPR WRE HL SS	BOTH IP/OP	"$1,821.78 "	"$1,348.12"	$0.00	"$1,414.98"	$795.93	$795.93	$0.00	$0.00	$0.00	$379.70	"$1,352.12"	"$1,352.12"	$0.00	$0.00	$379.66	$0.00	"$1,077.58"	"$1,077.58"	$0.00	$884.36	"$1,400.83"	"$1,414.98"	$0.00		$0.00	$268.74	$0.00	$0.00	$281.58	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.210	SUP	HCPCS C1713		02.211.210  -  PLATE BONE LP OPENING WEDGE LOCKING VAR ANG ANATOMIC LCP	BOTH IP/OP	"$1,778.20 "	"$1,315.87"	$0.00	"$1,381.12"	$776.88	$776.88	$0.00	$0.00	$0.00	$370.62	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$370.58	$0.00	"$1,051.81"	"$1,051.81"	$0.00	$863.20	"$1,367.31"	"$1,381.12"	$0.00		$0.00	$262.31	$0.00	$0.00	$274.84	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.211	SUP	HCPCS C1713		02.211.211  -  PLATE BONE 3MM SPACER OPENING WEDGE LOCKING VAR ANG LCP	BOTH IP/OP	"$1,730.40 "	"$1,280.50"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$360.66	"$1,284.30"	"$1,284.30"	$0.00	$0.00	$360.62	$0.00	"$1,023.53"	"$1,023.53"	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$255.26	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.212	SUP	HCPCS C1713		02.211.212  -  PLATE BONE 4MM SPACER OPENING WEDGE LOCKING VAR ANG LCP	BOTH IP/OP	"$1,730.40 "	"$1,280.50"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$360.66	"$1,284.30"	"$1,284.30"	$0.00	$0.00	$360.62	$0.00	"$1,023.53"	"$1,023.53"	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$255.26	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.213	SUP	HCPCS C1713		02.211.213  -  PLATE BONE 5MM SPACER OPENING WEDGE LOCKING VAR ANG LCP	BOTH IP/OP	"$1,730.40 "	"$1,280.50"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$360.66	"$1,284.30"	"$1,284.30"	$0.00	$0.00	$360.62	$0.00	"$1,023.53"	"$1,023.53"	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$255.26	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.214	SUP	HCPCS C1713		02.211.214  -  PLATE BONE 6MM SPACER OPENING WEDGE VAR ANG LOCKING LCP	BOTH IP/OP	"$1,778.20 "	"$1,315.87"	$0.00	"$1,381.12"	$776.88	$776.88	$0.00	$0.00	$0.00	$370.62	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$370.58	$0.00	"$1,051.81"	"$1,051.81"	$0.00	$863.20	"$1,367.31"	"$1,381.12"	$0.00		$0.00	$262.31	$0.00	$0.00	$274.84	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.215	SUP	HCPCS C1713		02.211.215  -  PLATE BONE 7MM SPACER OPENING WEDGE VAR ANG LOCKING LCP	BOTH IP/OP	"$1,778.20 "	"$1,315.87"	$0.00	"$1,381.12"	$776.88	$776.88	$0.00	$0.00	$0.00	$370.62	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$370.58	$0.00	"$1,051.81"	"$1,051.81"	$0.00	$863.20	"$1,367.31"	"$1,381.12"	$0.00		$0.00	$262.31	$0.00	$0.00	$274.84	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.220	SUP	HCPCS C1713		02.211.220  -  PLATE BN CNTR NS LCP VA LCK LOPRFL SS NAVICULAR 2.4/2.7MM	BOTH IP/OP	"$2,109.95 "	"$1,561.36"	$0.00	"$1,638.80"	$921.83	$921.83	$0.00	$0.00	$0.00	$439.77	"$1,566.00"	"$1,566.00"	$0.00	$0.00	$439.71	$0.00	"$1,248.04"	"$1,248.04"	$0.00	"$1,024.25"	"$1,622.41"	"$1,638.80"	$0.00		$0.00	$311.25	$0.00	$0.00	$326.12	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.221	SUP	HCPCS C1713		02.211.221  -  PLATE BN CNTR NS LCP VA LCK LOPRFL SS CUBOID LT 2.4/2.7MM	BOTH IP/OP	"$2,109.95 "	"$1,561.36"	$0.00	"$1,638.80"	$921.83	$921.83	$0.00	$0.00	$0.00	$439.77	"$1,566.00"	"$1,566.00"	$0.00	$0.00	$439.71	$0.00	"$1,248.04"	"$1,248.04"	$0.00	"$1,024.25"	"$1,622.41"	"$1,638.80"	$0.00		$0.00	$311.25	$0.00	$0.00	$326.12	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.222	SUP	HCPCS C1713		02.211.222  -  PLATE BN CNTR NS LCP VA LCK LOPRFL SS CUBOID RT 2.4/2.7MM	BOTH IP/OP	"$2,109.95 "	"$1,561.36"	$0.00	"$1,638.80"	$921.83	$921.83	$0.00	$0.00	$0.00	$439.77	"$1,566.00"	"$1,566.00"	$0.00	$0.00	$439.71	$0.00	"$1,248.04"	"$1,248.04"	$0.00	"$1,024.25"	"$1,622.41"	"$1,638.80"	$0.00		$0.00	$311.25	$0.00	$0.00	$326.12	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.224	SUP	HCPCS C1713		02.211.224  -  PLATE BONE 5X12 HOLE VAR ANG LOCK MESH LCP STAINLESS STEEL	BOTH IP/OP	"$2,971.63 "	"$2,199.01"	$0.00	"$2,308.06"	"$1,298.28"	"$1,298.28"	$0.00	$0.00	$0.00	$619.36	"$2,205.54"	"$2,205.54"	$0.00	$0.00	$619.29	$0.00	"$1,465.01"	"$1,465.01"	$0.00	"$1,442.54"	"$2,284.98"	"$2,308.06"	$0.00		$0.00	$438.36	$0.00	$0.00	$459.30	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.230	SUP	HCPCS C1713		02.211.230  -  PLATE BN 0D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.231	SUP	HCPCS C1713		02.211.231  -  PLATE BN 0D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.232	SUP	HCPCS C1713		02.211.232  -  PLATE BN 5D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.233	SUP	HCPCS C1713		02.211.233  -  PLATE BN 5D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.234	SUP	HCPCS C1713		02.211.234  -  PLATE BN 10D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.235	SUP	HCPCS C1713		02.211.235  -  PLATE BN 10D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.236	SUP	HCPCS C1713		02.211.236  -  PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.237	SUP	HCPCS C1713		02.211.237  -  PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.238	SUP	HCPCS C1713		02.211.238  -  PLATE BN 5D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.239	SUP	HCPCS C1713		02.211.239  -  PLATE BN 5D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.240	SUP	HCPCS C1713		02.211.240  -  PLATE BN 10D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.241	SUP	HCPCS C1713		02.211.241  -  PLATE BN 10D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.242	SUP	HCPCS C1713		02.211.242  -  PLATE BN 5D LG 57MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST	BOTH IP/OP	"$2,109.95 "	"$1,561.36"	$0.00	"$1,638.80"	$921.83	$921.83	$0.00	$0.00	$0.00	$439.77	"$1,566.00"	"$1,566.00"	$0.00	$0.00	$439.71	$0.00	"$1,248.04"	"$1,248.04"	$0.00	"$1,024.25"	"$1,622.41"	"$1,638.80"	$0.00		$0.00	$311.25	$0.00	$0.00	$326.12	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.243	SUP	HCPCS C1713		02.211.243  -  PLATE BN 5D LG 57MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST	BOTH IP/OP	"$2,109.95 "	"$1,561.36"	$0.00	"$1,638.80"	$921.83	$921.83	$0.00	$0.00	$0.00	$439.77	"$1,566.00"	"$1,566.00"	$0.00	$0.00	$439.71	$0.00	"$1,248.04"	"$1,248.04"	$0.00	"$1,024.25"	"$1,622.41"	"$1,638.80"	$0.00		$0.00	$311.25	$0.00	$0.00	$326.12	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.244	SUP	HCPCS C1713		02.211.244  -  PLATE BONE 0D 53MM VAR ANG FUSION REVISION DORSIFLEXION LCP	BOTH IP/OP	"$2,341.88 "	"$1,732.99"	$0.00	"$1,818.94"	"$1,023.15"	"$1,023.15"	$0.00	$0.00	$0.00	$488.11	"$1,738.14"	"$1,738.14"	$0.00	$0.00	$488.05	$0.00	"$1,385.22"	"$1,385.22"	$0.00	"$1,136.84"	"$1,800.75"	"$1,818.94"	$0.00		$0.00	$345.47	$0.00	$0.00	$361.97	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.245	SUP	HCPCS C1713		02.211.245  -  PLATE BONE 0D 53MM VAR ANG FUSION REVISION DORSIFLEXION LCP	BOTH IP/OP	"$2,341.88 "	"$1,732.99"	$0.00	"$1,818.94"	"$1,023.15"	"$1,023.15"	$0.00	$0.00	$0.00	$488.11	"$1,738.14"	"$1,738.14"	$0.00	$0.00	$488.05	$0.00	"$1,385.22"	"$1,385.22"	$0.00	"$1,136.84"	"$1,800.75"	"$1,818.94"	$0.00		$0.00	$345.47	$0.00	$0.00	$361.97	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.246	SUP	HCPCS C1713		02.211.246  -  PLATE BN STD 39MM NS LCP VA FSN LOPRFL PRECONTOUR SS 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.247	SUP	HCPCS C1713		02.211.247  -  PLATE BN LNG 48MM NS LCP VA FSN LOPRFL PRECONTOUR SS 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.250	SUP	HCPCS C1713		02.211.250  -  PLATE BN SHRT CLVRLF 38MM NS LCP VA FSN LOPRFL CMPR WRE HL	BOTH IP/OP	"$1,603.90 "	"$1,186.89"	$0.00	"$1,245.74"	$700.73	$700.73	$0.00	$0.00	$0.00	$334.29	"$1,190.41"	"$1,190.41"	$0.00	$0.00	$334.25	$0.00	$948.71	$948.71	$0.00	$778.59	"$1,233.29"	"$1,245.74"	$0.00		$0.00	$236.60	$0.00	$0.00	$247.90	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.251	SUP	HCPCS C1713		02.211.251  -  PLATE BN STD CLVRLF 45MM NS LCP VA FSN LOPRFL CMPR WRE HL SS	BOTH IP/OP	"$1,646.08 "	"$1,218.10"	$0.00	"$1,278.50"	$719.16	$719.16	$0.00	$0.00	$0.00	$343.08	"$1,221.72"	"$1,221.72"	$0.00	$0.00	$343.04	$0.00	$973.65	$973.65	$0.00	$799.06	"$1,265.72"	"$1,278.50"	$0.00		$0.00	$242.82	$0.00	$0.00	$254.42	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.252	SUP	HCPCS C1713		02.211.252  -  PLATE BN LNG CLVRLF 64MM NS LCP VA FSN LOPRFL CMPR WRE HL SS	BOTH IP/OP	"$1,686.83 "	"$1,248.25"	$0.00	"$1,310.16"	$736.97	$736.97	$0.00	$0.00	$0.00	$351.58	"$1,251.96"	"$1,251.96"	$0.00	$0.00	$351.53	$0.00	$997.76	$997.76	$0.00	$818.85	"$1,297.06"	"$1,310.16"	$0.00		$0.00	$248.84	$0.00	$0.00	$260.72	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.253	SUP	HCPCS C1713		02.211.253  -  PLATE BONE T SHORT 35MM 2 HOLE FUSION VAR ANG LCP STAINLESS	BOTH IP/OP	"$1,603.90 "	"$1,186.89"	$0.00	"$1,245.74"	$700.73	$700.73	$0.00	$0.00	$0.00	$334.29	"$1,190.41"	"$1,190.41"	$0.00	$0.00	$334.25	$0.00	$948.71	$948.71	$0.00	$778.59	"$1,233.29"	"$1,245.74"	$0.00		$0.00	$236.60	$0.00	$0.00	$247.90	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.254	SUP	HCPCS C1713		02.211.254  -  PLATE BONE STANDARD 42MM 2 HOLE T FUSION VAR ANG LCP	BOTH IP/OP	"$1,646.08 "	"$1,218.10"	$0.00	"$1,278.50"	$719.16	$719.16	$0.00	$0.00	$0.00	$343.08	"$1,221.72"	"$1,221.72"	$0.00	$0.00	$343.04	$0.00	$973.65	$973.65	$0.00	$799.06	"$1,265.72"	"$1,278.50"	$0.00		$0.00	$242.82	$0.00	$0.00	$254.42	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.255	SUP	HCPCS C1713		02.211.255  -  PLATE BONE T LONG 6.1CM 2 HOLE VAR ANG LCP STAINLESS STEEL	BOTH IP/OP	"$1,686.83 "	"$1,248.25"	$0.00	"$1,310.16"	$736.97	$736.97	$0.00	$0.00	$0.00	$351.58	"$1,251.96"	"$1,251.96"	$0.00	$0.00	$351.53	$0.00	$997.76	$997.76	$0.00	$818.85	"$1,297.06"	"$1,310.16"	$0.00		$0.00	$248.84	$0.00	$0.00	$260.72	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.256	SUP	HCPCS C1713		02.211.256  -  PLATE BN SHRT L 37MM NS LCP VA FSN LOPRFL CMPR WRE HL SS	BOTH IP/OP	"$1,648.88 "	"$1,220.17"	$0.00	"$1,280.68"	$720.38	$720.38	$0.00	$0.00	$0.00	$343.67	"$1,223.80"	"$1,223.80"	$0.00	$0.00	$343.63	$0.00	$975.31	$975.31	$0.00	$800.43	"$1,267.87"	"$1,280.68"	$0.00		$0.00	$243.24	$0.00	$0.00	$254.86	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.257	SUP	HCPCS C1713		02.211.257  -  PLATE BN SHRT L 37MM NS LCP VA FSN LOPRFL CMPR WRE HL SS	BOTH IP/OP	"$1,603.90 "	"$1,186.89"	$0.00	"$1,245.74"	$700.73	$700.73	$0.00	$0.00	$0.00	$334.29	"$1,190.41"	"$1,190.41"	$0.00	$0.00	$334.25	$0.00	$948.71	$948.71	$0.00	$778.59	"$1,233.29"	"$1,245.74"	$0.00		$0.00	$236.60	$0.00	$0.00	$247.90	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.258	SUP	HCPCS C1713		02.211.258  -  PLATE BN STD L 44MM NS LCP VA FSN LOPRFL CMPR WRE HL SS	BOTH IP/OP	"$1,692.45 "	"$1,252.41"	$0.00	"$1,314.52"	$739.42	$739.42	$0.00	$0.00	$0.00	$352.75	"$1,256.14"	"$1,256.14"	$0.00	$0.00	$352.71	$0.00	"$1,001.08"	"$1,001.08"	$0.00	$821.58	"$1,301.37"	"$1,314.52"	$0.00		$0.00	$249.66	$0.00	$0.00	$261.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.259	SUP	HCPCS C1713		02.211.259  -  PLATE BN STD L 44MM NS LCP VA FSN LOPRFL CMPR WRE HL SS	BOTH IP/OP	"$1,692.45 "	"$1,252.41"	$0.00	"$1,314.52"	$739.42	$739.42	$0.00	$0.00	$0.00	$352.75	"$1,256.14"	"$1,256.14"	$0.00	$0.00	$352.71	$0.00	"$1,001.08"	"$1,001.08"	$0.00	$821.58	"$1,301.37"	"$1,314.52"	$0.00		$0.00	$249.66	$0.00	$0.00	$261.59	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.260	SUP	HCPCS C1713		02.211.260  -  PLATE BN LNG L 62MM NS LCP VA FSN LOPRFL CMPR WRE HL SS	BOTH IP/OP	"$1,734.63 "	"$1,283.63"	$0.00	"$1,347.28"	$757.85	$757.85	$0.00	$0.00	$0.00	$361.54	"$1,287.44"	"$1,287.44"	$0.00	$0.00	$361.50	$0.00	"$1,026.03"	"$1,026.03"	$0.00	$842.05	"$1,333.81"	"$1,347.28"	$0.00		$0.00	$255.89	$0.00	$0.00	$268.11	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.261	SUP	HCPCS C1713		02.211.261  -  PLATE BN LNG L 62MM NS LCP VA FSN LOPRFL CMPR WRE HL SS	BOTH IP/OP	"$1,734.63 "	"$1,283.63"	$0.00	"$1,347.28"	$757.85	$757.85	$0.00	$0.00	$0.00	$361.54	"$1,287.44"	"$1,287.44"	$0.00	$0.00	$361.50	$0.00	"$1,026.03"	"$1,026.03"	$0.00	$842.05	"$1,333.81"	"$1,347.28"	$0.00		$0.00	$255.89	$0.00	$0.00	$268.11	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.262	SUP	HCPCS C1713		02.211.262  -  PLATE BONE 27MM 2 HOLE STR FUSION VAR ANG LOCKING LCP	BOTH IP/OP	"$1,435.20 "	"$1,062.05"	$0.00	"$1,114.72"	$627.03	$627.03	$0.00	$0.00	$0.00	$299.13	"$1,065.21"	"$1,065.21"	$0.00	$0.00	$299.10	$0.00	$848.92	$848.92	$0.00	$696.70	"$1,103.57"	"$1,114.72"	$0.00		$0.00	$211.72	$0.00	$0.00	$221.83	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.263	SUP	HCPCS C1713		02.211.263  -  PLATE BONE 43MM 4 HOLE STR FUSION VAR ANG LOCKING LCP	BOTH IP/OP	"$1,518.15 "	"$1,123.43"	$0.00	"$1,179.14"	$663.27	$663.27	$0.00	$0.00	$0.00	$316.42	"$1,126.77"	"$1,126.77"	$0.00	$0.00	$316.38	$0.00	$897.99	$897.99	$0.00	$736.96	"$1,167.35"	"$1,179.14"	$0.00		$0.00	$223.95	$0.00	$0.00	$234.65	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.265	SUP	HCPCS C1713		02.211.265  -  PLATE BONE XLONG 92MM 3 HOLE T FUSION VAR ANG LCP STAINLESS	BOTH IP/OP	"$2,109.95 "	"$1,561.36"	$0.00	"$1,638.80"	$921.83	$921.83	$0.00	$0.00	$0.00	$439.77	"$1,566.00"	"$1,566.00"	$0.00	$0.00	$439.71	$0.00	"$1,248.04"	"$1,248.04"	$0.00	"$1,024.25"	"$1,622.41"	"$1,638.80"	$0.00		$0.00	$311.25	$0.00	$0.00	$326.12	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.266	SUP	HCPCS C1713		02.211.266  -  PLATE BN 43MM NS LCP VA FSN LOPRFL PRECONTOUR SS	BOTH IP/OP	"$1,686.83 "	"$1,248.25"	$0.00	"$1,310.16"	$736.97	$736.97	$0.00	$0.00	$0.00	$351.58	"$1,251.96"	"$1,251.96"	$0.00	$0.00	$351.53	$0.00	$997.76	$997.76	$0.00	$818.85	"$1,297.06"	"$1,310.16"	$0.00		$0.00	$248.84	$0.00	$0.00	$260.72	$0.00	$0.00	$0.00	$0.00	$0.00
02.211.412S	SUP	HCPCS C1713		02.211.412S  -  PLATE BN LNG 56MM STRL LCP VA LCK LOPRFL PRECONTOUR SS CALC	BOTH IP/OP	"$2,042.48 "	"$1,511.44"	$0.00	"$1,586.38"	$892.34	$892.34	$0.00	$0.00	$0.00	$425.70	"$1,515.92"	"$1,515.92"	$0.00	$0.00	$425.65	$0.00	"$1,208.12"	"$1,208.12"	$0.00	$991.49	"$1,570.52"	"$1,586.38"	$0.00		$0.00	$301.30	$0.00	$0.00	$315.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.212.054	SUP	HCPCS C1713		02.212.054  -  SCREW BONE T15 3.5MM 54MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.212.056	SUP	HCPCS C1713		02.212.056  -  SCREW BONE T15 3.5MM 56MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.212.058	SUP	HCPCS C1713		02.212.058  -  SCREW BONE T15 3.5MM 58MM SELF TAP STARDRIVE LCP STAINLESS	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.006	SUP	HCPCS C1713		02.214.006  -  SCREW BONE 1.5MM 6MM T4 STARDRIVE RECESS LOCKING SLFTAP	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.007	SUP	HCPCS C1713		02.214.007  -  SCREW BONE T4 LP 1.5MM 7MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.008	SUP	HCPCS C1713		02.214.008  -  SCREW BONE T4 LP 1.5MM 8MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.009	SUP	HCPCS C1713		02.214.009  -  SCREW BONE T4 LP 1.5MM 9MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.010	SUP	HCPCS C1713		02.214.010  -  SCREW BONE T4 1.5MM 10MM SELF TAP SELF RETAINING LP	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.011	SUP	HCPCS C1713		02.214.011  -  SCREW BONE T4 LP 1.5MM 11MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.012	SUP	HCPCS C1713		02.214.012  -  SCREW BONE T4 LP 1.5MM 12MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.013	SUP	HCPCS C1713		02.214.013  -  SCREW BONE T4 LP 1.5MM 13MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.014	SUP	HCPCS C1713		02.214.014  -  SCREW BONE 1.5MM 14MM LOCK SELF TAP MODULAR T4 STARDRIVE LCP	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.015	SUP	HCPCS C1713		02.214.015  -  SCREW BONE T4 LP 1.5MM 15MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.016	SUP	HCPCS C1713		02.214.016  -  SCREW BONE T4 LP 1.5MM 16MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.018	SUP	HCPCS C1713		02.214.018  -  SCREW BONE T4 LP 1.5MM 18MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.020	SUP	HCPCS C1713		02.214.020  -  SCREW BONE T4 LP 1.5MM 20MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.022	SUP	HCPCS C1713		02.214.022  -  SCREW BONE T4 LP 1.5MM 22MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.024	SUP	HCPCS C1713		02.214.024  -  SCREW BONE T4 LP 1.5MM 24MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.104	SUP	HCPCS C1713		02.214.104  -  SCREW BN T4 1.5MM 4MM ST TIP VA LCK STRDR SS CORT	BOTH IP/OP	$87.15 	$64.49	$0.00	$67.70	$38.08	$38.08	$0.00	$0.00	$0.00	$18.16	$64.68	$64.68	$0.00	$0.00	$18.16	$0.00	$51.55	$51.55	$0.00	$42.31	$67.03	$67.70	$0.00		$0.00	$12.86	$0.00	$0.00	$13.47	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.105	SUP	HCPCS C1713		02.214.105  -  SCREW BN T4 1.5MM 5MM SLFRET ST STRDR SS HND CORT VA LCK SYS	BOTH IP/OP	$87.15 	$64.49	$0.00	$67.70	$38.08	$38.08	$0.00	$0.00	$0.00	$18.16	$64.68	$64.68	$0.00	$0.00	$18.16	$0.00	$51.55	$51.55	$0.00	$42.31	$67.03	$67.70	$0.00		$0.00	$12.86	$0.00	$0.00	$13.47	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.106	SUP	HCPCS C1713		02.214.106  -  SCREW BONE T4 LP 1.5MM 6MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.107	SUP	HCPCS C1713		02.214.107  -  SCREW BONE T4 LP 1.5MM 7MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.108	SUP	HCPCS C1713		02.214.108  -  SCREW BONE T4 LP 1.5MM 8MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.109	SUP	HCPCS C1713		02.214.109  -  SCREW BONE T4 LP 1.5MM 9MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.110	SUP	HCPCS C1713		02.214.110  -  SCREW BONE T4 LP 1.5MM 10MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.111	SUP	HCPCS C1713		02.214.111  -  SCREW BONE T4 LP 1.5MM 11MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.112	SUP	HCPCS C1713		02.214.112  -  SCREW BONE T4 LP 1.5MM 12MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.113	SUP	HCPCS C1713		02.214.113  -  SCREW BONE T4 LP 1.5MM 13MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.114	SUP	HCPCS C1713		02.214.114  -  SCREW BONE T4 LP 1.5MM 14MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.115	SUP	HCPCS C1713		02.214.115  -  SCREW BONE T4 LP 1.5MM 15MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.116	SUP	HCPCS C1713		02.214.116  -  SCREW BONE T4 LP 1.5MM 16MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.118	SUP	HCPCS C1713		02.214.118  -  SCREW BONE T4 LP 1.5MM 18MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.120	SUP	HCPCS C1713		02.214.120  -  SCREW BONE T4 LP 1.5MM 20MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.122	SUP	HCPCS C1713		02.214.122  -  SCREW BONE T4 LP 1.5MM 22MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.214.124	SUP	HCPCS C1713		02.214.124  -  SCREW BONE T4 LP 1.5MM 24MM SELF TAP SELF RETAINING THREAD	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.002S	SUP	Custom 27803010		02.221.002S  -  BUTTON CERCLAGE 2.5MM T15 STARDRIVE STAINLESS STEEL STERILE	BOTH IP/OP	$343.00 	$253.82	$0.00	$266.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.57	$254.57	$0.00	$0.00	$71.48	$0.00	$0.00	$0.00	$0.00	$166.50	$263.74	$266.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.003S	SUP	Custom 27803010		02.221.003S  -  BUTTON FIX 3.5MM 3.5MM T25 STARDRIVE/HEXAGONAL RECESS	BOTH IP/OP	$343.00 	$253.82	$0.00	$266.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.57	$254.57	$0.00	$0.00	$71.48	$0.00	$0.00	$0.00	$0.00	$166.50	$263.74	$266.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.004S	SUP	Custom 27803010		02.221.004S  -  BUTTON FIX 4MM CERCLAGE HEXAGONAL CANN STAINLESS STEEL	BOTH IP/OP	$343.00 	$253.82	$0.00	$266.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.57	$254.57	$0.00	$0.00	$71.48	$0.00	$0.00	$0.00	$0.00	$166.50	$263.74	$266.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.005S	SUP	Custom 27803010		02.221.005S  -  PIN POSITIONING 5MM CRIMP STAINLESS STEEL STERILE	BOTH IP/OP	$515.90 	$381.77	$0.00	$400.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.90	$382.90	$0.00	$0.00	$107.51	$0.00	$0.00	$0.00	$0.00	$250.44	$396.70	$400.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.006S	SUP	HCPCS C1713		02.221.006S  -  PIN POSITIONING 7.3MM CRIMP STAINLESS STEEL STERILE	BOTH IP/OP	$515.90 	$381.77	$0.00	$400.70	$225.39	$225.39	$0.00	$0.00	$0.00	$107.53	$382.90	$382.90	$0.00	$0.00	$107.51	$0.00	$305.15	$305.15	$0.00	$250.44	$396.70	$400.70	$0.00		$0.00	$76.10	$0.00	$0.00	$79.74	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.458	SUP	HCPCS C1713		02.221.458  -  SCREW BONE 5MM 8MM SLFTAP LOCKING LCP STAINLESS STEEL DISTAL	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.460	SUP	HCPCS C1713		02.221.460  -  SCREW BONE 5MM 10MM SLFTAP LOCKING LCP STAINLESS STEEL	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.462	SUP	HCPCS C1713		02.221.462  -  SCREW BONE 5MM 12MM SLFTAP LOCKING LCP STAINLESS STEEL	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.508	SUP	HCPCS C1713		02.221.508  -  SCREW BONE T25 BLUNT CONE 5MM 4.4MM 8MM SELF TAP THREAD HEAD	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.510	SUP	HCPCS C1713		02.221.510  -  SCREW BONE FULTHD 5MM 4.4MM 10MM T25 STARDRIVE RECESS	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.510S	SUP	HCPCS C1713		02.221.510S  -  SCREW BONE 5MM 10MM LCP SS PROX MDL PERIART FEM/TIB	BOTH IP/OP	$489.18 	$361.99	$0.00	$425.24	$239.20	$239.20	$0.00	$0.00	$0.00	$101.96	$363.07	$363.07	$0.00	$0.00	$101.94	$0.00	$289.35	$289.35	$0.00	$265.78	$420.99	$425.24	$0.00		$0.00	$83.19	$0.00	$0.00	$84.62	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.512	SUP	HCPCS C1713		02.221.512  -  SCREW BONE T25 BLUNT CONE 5MM 4.4MM 12MM SELF TAP THREAD	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.514	SUP	HCPCS C1713		02.221.514  -  SCREW BONE 5MM 14MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
02.221.518	SUP	HCPCS C1713		02.221.518  -  SCREW BONE 5MM 18MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
02.224.030S	SUP	HCPCS C1713		02.224.030S  -  SCREW BONE HELIX 30MM LCP DHHS STAINLESS STEEL HIP STERILE	BOTH IP/OP	$173.60 	$128.46	$0.00	$134.82	$75.84	$75.84	$0.00	$0.00	$0.00	$36.18	$128.85	$128.85	$0.00	$0.00	$36.18	$0.00	$102.68	$102.68	$0.00	$84.26	$133.48	$134.82	$0.00		$0.00	$25.61	$0.00	$0.00	$26.83	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.000	SUP	HCPCS C1713		02.226.000  -  GUIDEWIRE ORTHOPEDIC 1.6MM 220MM TROCAR POINT THREADED	BOTH IP/OP	$70.98 	$52.53	$0.00	$55.12	$31.01	$31.01	$0.00	$0.00	$0.00	$14.79	$52.68	$52.68	$0.00	$0.00	$14.79	$0.00	$41.98	$41.98	$0.00	$34.45	$54.57	$55.12	$0.00		$0.00	$10.47	$0.00	$0.00	$10.97	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.001	SUP	HCPCS C1713		02.226.001  -  GUIDEWIRE ORTHOPEDIC 1.6MM 220MM TROCAR POINT NONTHREADED	BOTH IP/OP	$70.28 	$52.01	$0.00	$54.60	$30.71	$30.71	$0.00	$0.00	$0.00	$14.65	$52.16	$52.16	$0.00	$0.00	$14.65	$0.00	$41.57	$41.57	$0.00	$34.13	$54.05	$54.60	$0.00		$0.00	$10.37	$0.00	$0.00	$10.87	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.010	SUP	HCPCS C1713		02.226.010  -  SCREW BONE T8 3MM 2MM 1.1MM 10MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.011	SUP	HCPCS C1713		02.226.011  -  SCREW BONE T8 3MM 2MM 1.1MM 11MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.012	SUP	HCPCS C1713		02.226.012  -  SCREW BONE T8 3MM 2MM 1.1MM 12MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.013	SUP	HCPCS C1713		02.226.013  -  SCREW BONE T8 3MM 2MM 1.1MM 13MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.014	SUP	HCPCS C1713		02.226.014  -  SCREW BONE T8 3MM 2MM 1.1MM 14MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.015	SUP	HCPCS C1713		02.226.015  -  SCREW BONE T8 3MM 2MM 1.1MM 15MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.016	SUP	HCPCS C1713		02.226.016  -  SCREW BONE T8 3MM 2MM 1.1MM 16MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.017	SUP	HCPCS C1713		02.226.017  -  SCREW BONE T8 3MM 2MM 1.1MM 17MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.018	SUP	HCPCS C1713		02.226.018  -  SCREW BONE 1.1MM SHORT THREAD 3MM 2MM 18MM 4MM T8 STARDRIVE	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.019	SUP	HCPCS C1713		02.226.019  -  SCREW BONE T8 3MM 2MM 1.1MM 19MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.020	SUP	HCPCS C1713		02.226.020  -  SCREW BONE T8 3MM 2MM 1.1MM 20MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.021	SUP	HCPCS C1713		02.226.021  -  SCREW BONE T8 3MM 2MM 1.1MM 21MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.022	SUP	HCPCS C1713		02.226.022  -  SCREW BONE T8 3MM 2MM 1.1MM 22MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.023	SUP	HCPCS C1713		02.226.023  -  SCREW BONE T8 3MM 2MM 1.1MM 23MM 4MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.024	SUP	HCPCS C1713		02.226.024  -  SCREW BONE T8 3MM 2MM 1.1MM 24MM 5MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.025	SUP	HCPCS C1713		02.226.025  -  SCREW BONE T8 3MM 2MM 1.1MM 25MM 5MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.026	SUP	HCPCS C1713		02.226.026  -  SCREW BONE T8 3MM 2MM 1.1MM 26MM 5MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.027	SUP	HCPCS C1713		02.226.027  -  SCREW BONE T8 3MM 2MM 1.1MM 27MM 6MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.028	SUP	HCPCS C1713		02.226.028  -  SCREW BONE T8 3MM 2MM 1.1MM 28MM 6MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.029	SUP	HCPCS C1713		02.226.029  -  SCREW BONE T8 3MM 2MM 1.1MM 29MM 6MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.030	SUP	HCPCS C1713		02.226.030  -  SCREW BONE T8 3MM 2MM 1.1MM 30MM 7MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.032	SUP	HCPCS C1713		02.226.032  -  SCREW BONE T8 3MM 2MM 1.1MM 32MM 7MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.034	SUP	HCPCS C1713		02.226.034  -  SCREW BONE T8 3MM 2MM 1.1MM 34MM 8MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.036	SUP	HCPCS C1713		02.226.036  -  SCREW BONE 1.1MM SHORT THREAD 3MM 2MM 36MM 9MM T8 STARDRIVE	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.038	SUP	HCPCS C1713		02.226.038  -  SCREW BONE T8 3MM 2MM 1.1MM 38MM 9MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.040	SUP	HCPCS C1713		02.226.040  -  SCREW BONE T8 3MM 2MM 1.1MM 40MM 10MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.116	SUP	HCPCS C1713		02.226.116  -  SCREW BONE LNGTHRD 3MM 2MM 16MM 5MM SELF TAP DRILL	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.117	SUP	HCPCS C1713		02.226.117  -  SCREW BONE LNGTHRD 3MM 2MM 17MM 6MM T8 STARDRIVE CANN SELF	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.118	SUP	HCPCS C1713		02.226.118  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 18MM 6MM T8 STARDRIVE CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.119	SUP	HCPCS C1713		02.226.119  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 19MM 7MM T8 STARDRIVE CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.120	SUP	HCPCS C1713		02.226.120  -  SCREW BONE LNGTHRD 3MM 2MM 20MM 7MM T8 STARDRIVE CANN SELF	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.121	SUP	HCPCS C1713		02.226.121  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 21MM 8MM T8 STARDRIVE CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.122	SUP	HCPCS C1713		02.226.122  -  SCREW BONE T8 3MM 2MM 1.1MM 22MM 8MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.123	SUP	HCPCS C1713		02.226.123  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 23MM 8MM T8 STARDRIVE CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.124	SUP	HCPCS C1713		02.226.124  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 24MM 8MM T8 STARDRIVE CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.125	SUP	HCPCS C1713		02.226.125  -  SCREW BONE T8 3MM 2MM 1.1MM 25MM 8MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.126	SUP	HCPCS C1713		02.226.126  -  SCREW BONE 1.1MM LNGTHRD 3MM 2MM 26MM 10MM T8 STARDRIVE	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.127	SUP	HCPCS C1713		02.226.127  -  SCREW BONE T8 3MM 2MM 1.1MM 27MM 10MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.128	SUP	HCPCS C1713		02.226.128  -  SCREW BONE T8 3MM 2MM 1.1MM 28MM 10MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.129	SUP	HCPCS C1713		02.226.129  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 29MM 10MM T8 STARDRIVE CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.130	SUP	HCPCS C1713		02.226.130  -  SCREW BONE T8 3MM 2MM 1.1MM 30MM 12MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.132	SUP	HCPCS C1713		02.226.132  -  SCREW BONE 1.1MM LNGTHRD 3MM 2MM 32MM 12MM COMPRESSION CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.134	SUP	HCPCS C1713		02.226.134  -  SCREW BONE T8 3MM 2MM 1.1MM 34MM 14MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.136	SUP	HCPCS C1713		02.226.136  -  SCREW BONE LNGTHRD 3MM 2MM 36MM 14MM COMPRESSION CANN T8	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.138	SUP	HCPCS C1713		02.226.138  -  SCREW BN T8 L/T FLUT 3MM 2MM 38MM NS 16MM CMPR CNN ST HDLS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.140	SUP	HCPCS C1713		02.226.140  -  SCREW BONE T8 3MM 2MM 1.1MM 40MM 16MM SELF DRILL SELF TAP	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.209	SUP	HCPCS C1713		02.226.209  -  SCREW BONE SHORT THREAD 2.4MM 9MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.210	SUP	HCPCS C1713		02.226.210  -  SCREW BONE T8 2.4MM 10MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.211	SUP	HCPCS C1713		02.226.211  -  SCREW BONE T8 2.4MM 11MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.212	SUP	HCPCS C1713		02.226.212  -  SCREW BONE T8 2.4MM 12MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.213	SUP	HCPCS C1713		02.226.213  -  SCREW BONE T8 2.4MM 13MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.214	SUP	HCPCS C1713		02.226.214  -  SCREW BONE T8 2.4MM 14MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.215	SUP	HCPCS C1713		02.226.215  -  SCREW BONE T8 2.4MM 15MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.216	SUP	HCPCS C1713		02.226.216  -  SCREW BONE T8 2.4MM 16MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.217	SUP	HCPCS C1713		02.226.217  -  SCREW BONE T8 2.4MM 17MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.218	SUP	HCPCS C1713		02.226.218  -  SCREW BONE T8 2.4MM 18MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.219	SUP	HCPCS C1713		02.226.219  -  SCREW BONE T8 2.4MM 19MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.220	SUP	HCPCS C1713		02.226.220  -  SCREW BONE T8 2.4MM 20MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.221	SUP	HCPCS C1713		02.226.221  -  SCREW BONE T8 2.4MM 21MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.222	SUP	HCPCS C1713		02.226.222  -  SCREW BONE T8 2.4MM 22MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.223	SUP	HCPCS C1713		02.226.223  -  SCREW BONE T8 2.4MM 23MM 4MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.224	SUP	HCPCS C1713		02.226.224  -  SCREW BONE T8 2.4MM 24MM 5MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.225	SUP	HCPCS C1713		02.226.225  -  SCREW BONE T8 2.4MM 25MM 5MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.226	SUP	HCPCS C1713		02.226.226  -  SCREW BONE T8 2.4MM 26MM 5MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.227	SUP	HCPCS C1713		02.226.227  -  SCREW BONE T8 2.4MM 27MM 6MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.228	SUP	HCPCS C1713		02.226.228  -  SCREW BONE T8 2.4MM 28MM 6MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.229	SUP	HCPCS C1713		02.226.229  -  SCREW BONE T8 2.4MM 29MM 6MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.230	SUP	HCPCS C1713		02.226.230  -  SCREW BONE T8 2.4MM 30MM 7MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.232	SUP	HCPCS C1713		02.226.232  -  SCREW BONE T8 2.4MM 32MM 7MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.234	SUP	HCPCS C1713		02.226.234  -  SCREW BONE T8 2.4MM 34MM 8MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.236	SUP	HCPCS C1713		02.226.236  -  SCREW BONE T8 2.4MM 36MM 9MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.238	SUP	HCPCS C1713		02.226.238  -  SCREW BONE T8 2.4MM 38MM 9MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.240	SUP	HCPCS C1713		02.226.240  -  SCREW BONE T8 2.4MM 40MM 10MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.317	SUP	HCPCS C1713		02.226.317  -  SCREW BONE T8 2.4MM 17MM 6MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.318	SUP	HCPCS C1713		02.226.318  -  SCREW BONE T8 2.4MM 18MM 6MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.319	SUP	HCPCS C1713		02.226.319  -  SCREW BONE T8 2.4MM 19MM 7MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.320	SUP	HCPCS C1713		02.226.320  -  SCREW BONE T8 2.4MM 20MM 7MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.321	SUP	HCPCS C1713		02.226.321  -  SCREW BONE T8 2.4MM 21MM 8MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.322	SUP	HCPCS C1713		02.226.322  -  SCREW BONE T8 2.4MM 22MM 8MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.323	SUP	HCPCS C1713		02.226.323  -  SCREW BONE T8 2.4MM 23MM 8MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.324	SUP	HCPCS C1713		02.226.324  -  SCREW BONE T8 2.4MM 24MM 8MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.325	SUP	HCPCS C1713		02.226.325  -  SCREW BONE T8 2.4MM 25MM 8MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.326	SUP	HCPCS C1713		02.226.326  -  SCREW BONE T8 2.4MM 26MM 10MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.327	SUP	HCPCS C1713		02.226.327  -  SCREW BONE T8 2.4MM 27MM 10MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.328	SUP	HCPCS C1713		02.226.328  -  SCREW BONE T8 2.4MM 28MM 10MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.329	SUP	HCPCS C1713		02.226.329  -  SCREW BONE T8 2.4MM 29MM 10MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.330	SUP	HCPCS C1713		02.226.330  -  SCREW BONE T8 2.4MM 30MM 12MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.332	SUP	HCPCS C1713		02.226.332  -  SCREW BONE T8 2.4MM 32MM 12MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.334	SUP	HCPCS C1713		02.226.334  -  SCREW BONE T8 2.4MM 34MM 14MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.336	SUP	HCPCS C1713		02.226.336  -  SCREW BONE T8 2.4MM 36MM 14MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.338	SUP	HCPCS C1713		02.226.338  -  SCREW BONE T8 2.4MM 38MM 16MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.340	SUP	HCPCS C1713		02.226.340  -  SCREW BONE T8 2.4MM 40MM 16MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.620	SUP	HCPCS C1713		02.226.620  -  SCREW BONE T15 4.5MM 20MM 7MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.622	SUP	HCPCS C1713		02.226.622  -  SCREW BONE T15 4.5MM 22MM 7MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.624	SUP	HCPCS C1713		02.226.624  -  SCREW BONE T15 4.5MM 24MM 7MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.626	SUP	HCPCS C1713		02.226.626  -  SCREW BONE T15 4.5MM 26MM 7MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.628	SUP	HCPCS C1713		02.226.628  -  SCREW BONE T15 4.5MM 28MM 7MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.630	SUP	HCPCS C1713		02.226.630  -  SCREW BONE SHORT THREAD 4.5MM 30MM 7MM COMPRESSION HEADLESS	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.632	SUP	HCPCS C1713		02.226.632  -  SCREW BONE T15 4.5MM 32MM 7MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.634	SUP	HCPCS C1713		02.226.634  -  SCREW BONE T15 4.5MM 34MM 7MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.636	SUP	HCPCS C1713		02.226.636  -  SCREW BONE T15 4.5MM 36MM 7MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.638	SUP	HCPCS C1713		02.226.638  -  SCREW BONE T15 4.5MM 38MM 7MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.640	SUP	HCPCS C1713		02.226.640  -  SCREW BONE T15 4.5MM 40MM 8MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.642	SUP	HCPCS C1713		02.226.642  -  SCREW BONE T15 4.5MM 42MM 8MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.644	SUP	HCPCS C1713		02.226.644  -  SCREW BONE T15 4.5MM 44MM 9MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.646	SUP	HCPCS C1713		02.226.646  -  SCREW BONE T15 4.5MM 46MM 9MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.648	SUP	HCPCS C1713		02.226.648  -  SCREW BONE T15 4.5MM 48MM 9MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.650	SUP	HCPCS C1713		02.226.650  -  SCREW BONE T15 4.5MM 50MM 10MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.652	SUP	HCPCS C1713		02.226.652  -  SCREW BONE T15 4.5MM 52MM 10MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.654	SUP	HCPCS C1713		02.226.654  -  SCREW BONE T15 4.5MM 54MM 11MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.656	SUP	HCPCS C1713		02.226.656  -  SCREW BONE T15 4.5MM 56MM 11MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.658	SUP	HCPCS C1713		02.226.658  -  SCREW BONE T15 4.5MM 58MM 11MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.660	SUP	HCPCS C1713		02.226.660  -  SCREW BONE T15 4.5MM 60MM 12MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.665	SUP	HCPCS C1713		02.226.665  -  SCREW BONE T15 4.5MM 65MM 13MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.670	SUP	HCPCS C1713		02.226.670  -  SCREW BONE T15 4.5MM 70MM 14MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.675	SUP	HCPCS C1713		02.226.675  -  SCREW BONE T15 4.5MM 75MM 15MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.680	SUP	HCPCS C1713		02.226.680  -  SCREW BONE T15 4.5MM 80MM 16MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.685	SUP	HCPCS C1713		02.226.685  -  SCREW BONE T15 4.5MM 85MM 17MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.690	SUP	HCPCS C1713		02.226.690  -  SCREW BONE T15 4.5MM 90MM 18MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.695	SUP	HCPCS C1713		02.226.695  -  SCREW BONE T15 4.5MM 95MM 19MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.700	SUP	HCPCS C1713		02.226.700  -  SCREW BONE T15 4.5MM 100MM 20MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.730	SUP	HCPCS C1713		02.226.730  -  SCREW BONE T15 4.5MM 30MM 12MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.732	SUP	HCPCS C1713		02.226.732  -  SCREW BONE T15 4.5MM 32MM 12MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.734	SUP	HCPCS C1713		02.226.734  -  SCREW BONE T15 4.5MM 34MM 12MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.736	SUP	HCPCS C1713		02.226.736  -  SCREW BONE T15 4.5MM 36MM 14MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.738	SUP	HCPCS C1713		02.226.738  -  SCREW BONE T15 4.5MM 38MM 14MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.740	SUP	HCPCS C1713		02.226.740  -  SCREW BONE T15 4.5MM 40MM 16MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.742	SUP	HCPCS C1713		02.226.742  -  SCREW BONE T15 4.5MM 42MM 16MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.744	SUP	HCPCS C1713		02.226.744  -  SCREW BONE T15 4.5MM 44MM 18MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.746	SUP	HCPCS C1713		02.226.746  -  SCREW BONE T15 4.5MM 46MM 18MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.748	SUP	HCPCS C1713		02.226.748  -  SCREW BONE T15 4.5MM 48MM 18MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.750	SUP	HCPCS C1713		02.226.750  -  SCREW BONE T15 4.5MM 50MM 20MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.752	SUP	HCPCS C1713		02.226.752  -  SCREW BONE T15 4.5MM 52MM 20MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.754	SUP	HCPCS C1713		02.226.754  -  SCREW BONE T15 4.5MM 54MM 22MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.756	SUP	HCPCS C1713		02.226.756  -  SCREW BONE LNGTHRD 4.5MM 56MM 22MM SLFDRILL SLFTAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.758	SUP	HCPCS C1713		02.226.758  -  SCREW BONE T15 4.5MM 58MM 22MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.760	SUP	HCPCS C1713		02.226.760  -  SCREW BONE T15 4.5MM 60MM 24MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.765	SUP	HCPCS C1713		02.226.765  -  SCREW BONE T15 4.5MM 65MM 26MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.770	SUP	HCPCS C1713		02.226.770  -  SCREW BONE T15 4.5MM 70MM 28MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.775	SUP	HCPCS C1713		02.226.775  -  SCREW BONE T15 4.5MM 75MM 30MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.780	SUP	HCPCS C1713		02.226.780  -  SCREW BONE T15 4.5MM 80MM 32MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.785	SUP	HCPCS C1713		02.226.785  -  SCREW BONE T15 4.5MM 85MM 34MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.790	SUP	HCPCS C1713		02.226.790  -  SCREW BONE T15 4.5MM 90MM 36MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.795	SUP	HCPCS C1713		02.226.795  -  SCREW BONE T15 4.5MM 95MM 38MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.226.800	SUP	HCPCS C1713		02.226.800  -  SCREW BONE T15 4.5MM 100MM 40MM SELF DRILL SELF TAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.001	SUP	HCPCS C1713		02.227.001  -  GUIDEWIRE ORTHOPEDIC 2.8MM 300MM NONTHREADED TROCAR POINT	BOTH IP/OP	$79.40 	$58.76	$0.00	$61.68	$34.70	$34.70	$0.00	$0.00	$0.00	$16.55	$58.93	$58.93	$0.00	$0.00	$16.55	$0.00	$46.97	$46.97	$0.00	$38.55	$61.06	$61.68	$0.00		$0.00	$11.71	$0.00	$0.00	$12.27	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.030	SUP	HCPCS C1713		02.227.030  -  SCREW BONE 6.5MM 30MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.035	SUP	HCPCS C1713		02.227.035  -  SCREW BONE 6.5MM 35MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.040	SUP	HCPCS C1713		02.227.040  -  SCREW BONE 6.5MM 40MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.045	SUP	HCPCS C1713		02.227.045  -  SCREW BONE 6.5MM 45MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.050	SUP	HCPCS C1713		02.227.050  -  SCREW BONE 6.5MM 50MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.055	SUP	HCPCS C1713		02.227.055  -  SCREW BONE 6.5MM 55MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.060	SUP	HCPCS C1713		02.227.060  -  SCREW BONE 6.5MM 60MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.065	SUP	HCPCS C1713		02.227.065  -  SCREW BONE 6.5MM 65MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.070	SUP	HCPCS C1713		02.227.070  -  SCREW BONE 6.5MM 70MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.075	SUP	HCPCS C1713		02.227.075  -  SCREW BONE 6.5MM 75MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.080	SUP	HCPCS C1713		02.227.080  -  SCREW BONE 6.5MM 80MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.085	SUP	HCPCS C1713		02.227.085  -  SCREW BONE 6.5MM 85MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.090	SUP	HCPCS C1713		02.227.090  -  SCREW BONE 6.5MM 90MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.095	SUP	HCPCS C1713		02.227.095  -  SCREW BONE 6.5MM 95MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.100	SUP	HCPCS C1713		02.227.100  -  SCREW BONE 6.5MM 100MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.105	SUP	HCPCS C1713		02.227.105  -  SCREW BONE 6.5MM 105MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.110	SUP	HCPCS C1713		02.227.110  -  SCREW BONE 6.5MM 110MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.115	SUP	HCPCS C1713		02.227.115  -  SCREW BONE 6.5MM 115MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.120	SUP	HCPCS C1713		02.227.120  -  SCREW BONE 6.5MM 120MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.125	SUP	HCPCS C1713		02.227.125  -  SCREW BONE 6.5MM 125MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.130	SUP	HCPCS C1713		02.227.130  -  SCREW BONE 6.5MM 130MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.135	SUP	HCPCS C1713		02.227.135  -  SCREW BONE 6.5MM 135MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.140	SUP	HCPCS C1713		02.227.140  -  SCREW BONE 6.5MM 140MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.145	SUP	HCPCS C1713		02.227.145  -  SCREW BONE 6.5MM 145MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.150	SUP	HCPCS C1713		02.227.150  -  SCREW BONE 6.5MM 150MM 16MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.245	SUP	HCPCS C1713		02.227.245  -  SCREW BONE 6.5MM 45MM 32MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.250	SUP	HCPCS C1713		02.227.250  -  SCREW BONE 6.5MM 50MM 32MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.255	SUP	HCPCS C1713		02.227.255  -  SCREW BONE 6.5MM 55MM 32MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.260	SUP	HCPCS C1713		02.227.260  -  SCREW BONE 6.5MM 60MM 32MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.265	SUP	HCPCS C1713		02.227.265  -  SCREW BONE 6.5MM 65MM 32MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.270	SUP	HCPCS C1713		02.227.270  -  SCREW BONE 6.5MM 70MM 32MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.275	SUP	HCPCS C1713		02.227.275  -  SCREW BONE 6.5MM 75MM 32MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.280	SUP	HCPCS C1713		02.227.280  -  SCREW BONE 6.5MM 80MM 32MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.285	SUP	HCPCS C1713		02.227.285  -  SCREW BONE 6.5MM 7.5MM 85MM 32MM 2 LEAD COMPRESSION SLFTAP	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.290	SUP	HCPCS C1713		02.227.290  -  SCREW BN 6.5MM 7.5MM 90MM NS 32MM CMPR ST SLF DRL HDLS SS	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.295	SUP	HCPCS C1713		02.227.295  -  SCREW BONE 6.5MM 95MM 32MM COMPRESSION HEADLESS STAINLESS	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.300	SUP	HCPCS C1713		02.227.300  -  SCREW BONE 6.5MM 100MM 32MM COMPRESSION HEADLESS STAINLESS	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.305	SUP	HCPCS C1713		02.227.305  -  SCREW BONE FLUTE 6.5MM 7.5MM 105MM 32MM 2 LEAD SELF TAP SELF	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.310	SUP	HCPCS C1713		02.227.310  -  SCREW BONE FLUTE 6.5MM 7.5MM 110MM 32MM 2 LEAD SELF TAP SELF	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.315	SUP	HCPCS C1713		02.227.315  -  SCREW BONE FLUTE 6.5MM 7.5MM 115MM 32MM 2 LEAD SELF TAP SELF	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.320	SUP	HCPCS C1713		02.227.320  -  SCREW BN 4MM FLUT 6.5MM 7.5MM 120MM NS 32MM 2 LD ST SLF DRL	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.325	SUP	HCPCS C1713		02.227.325  -  SCREW BN 4MM FLUT 6.5MM 7.5MM 125MM NS 32MM 2 LD ST SLF DRL	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.330	SUP	HCPCS C1713		02.227.330  -  SCREW BONE FLUTE 6.5MM 7.5MM 130MM 32MM 2 LEAD SELF TAP SELF	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.335	SUP	HCPCS C1713		02.227.335  -  SCREW BONE 6.5MM 135MM 32MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.340	SUP	HCPCS C1713		02.227.340  -  SCREW BONE 6.5MM 140MM 32MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.345	SUP	HCPCS C1713		02.227.345  -  SCREW BONE 6.5MM 145MM 32MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.227.350	SUP	HCPCS C1713		02.227.350  -  SCREW BONE 6.5MM 150MM 32MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
02.230.109	SUP	HCPCS C1713		02.230.109  -  SCREW BONE T4 1.5MM 9MM 4MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.230.110	SUP	HCPCS C1713		02.230.110  -  SCREW BONE T4 1.5MM 10MM 4MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.230.111	SUP	HCPCS C1713		02.230.111  -  SCREW BONE T4 1.5MM 11MM 4MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.230.112	SUP	HCPCS C1713		02.230.112  -  SCREW BONE T4 1.5MM 12MM 4MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.230.113	SUP	HCPCS C1713		02.230.113  -  SCREW BONE T4 1.5MM 13MM 4MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.230.114	SUP	HCPCS C1713		02.230.114  -  SCREW BONE 1.5MM 1MM 14MM 4MM COMPRESSION THREAD HEADLESS T4	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.230.115	SUP	HCPCS C1713		02.230.115  -  SCREW BONE T4 1.5MM 15MM 4MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.230.116	SUP	HCPCS C1713		02.230.116  -  SCREW BONE T4 1.5MM 16MM 5MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.230.117	SUP	HCPCS C1713		02.230.117  -  SCREW BONE T4 1.5MM 17MM 5MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.230.118	SUP	HCPCS C1713		02.230.118  -  SCREW BONE T4 1.5MM 18MM 5MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.230.119	SUP	HCPCS C1713		02.230.119  -  SCREW BONE T4 1.5MM 19MM 5MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.230.120	SUP	HCPCS C1713		02.230.120  -  SCREW BONE T4 1.5MM 20MM 6MM SELF DRILL SELF TAP COMPRESSION	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.012	SUP	HCPCS C1713		02.231.012  -  SCREW BONE T25 5MM 12MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$479.35 	$354.72	$0.00	$372.30	$209.42	$209.42	$0.00	$0.00	$0.00	$99.91	$355.77	$355.77	$0.00	$0.00	$99.90	$0.00	$283.54	$283.54	$0.00	$232.69	$368.58	$372.30	$0.00		$0.00	$70.71	$0.00	$0.00	$74.09	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.016	SUP	HCPCS C1713		02.231.016  -  SCREW BONE T25 5MM 16MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$479.35 	$354.72	$0.00	$372.30	$209.42	$209.42	$0.00	$0.00	$0.00	$99.91	$355.77	$355.77	$0.00	$0.00	$99.90	$0.00	$283.54	$283.54	$0.00	$232.69	$368.58	$372.30	$0.00		$0.00	$70.71	$0.00	$0.00	$74.09	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.018S	SUP	HCPCS C1713		02.231.018S  -  SCREW BN T25 5MM 18MM STRL ST LCK VA THRD RND HD SS CNDRL	BOTH IP/OP	$570.70 	$422.32	$0.00	$443.28	$249.35	$249.35	$0.00	$0.00	$0.00	$118.95	$423.57	$423.57	$0.00	$0.00	$118.93	$0.00	$337.57	$337.57	$0.00	$277.05	$438.85	$443.28	$0.00		$0.00	$84.19	$0.00	$0.00	$88.21	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.220	SUP	HCPCS C1713		02.231.220  -  SCREW BONE T25 5MM 20MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.222	SUP	HCPCS C1713		02.231.222  -  SCREW BONE T25 5MM 22MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.224	SUP	HCPCS C1713		02.231.224  -  SCREW BONE T25 5MM 24MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.226	SUP	HCPCS C1713		02.231.226  -  SCREW BONE T25 5MM 26MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.228	SUP	HCPCS C1713		02.231.228  -  SCREW BONE T25 5MM 28MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.230	SUP	HCPCS C1713		02.231.230  -  SCREW BONE T25 5MM 30MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.234	SUP	HCPCS C1713		02.231.234  -  SCREW BONE T25 5MM 34MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.236	SUP	HCPCS C1713		02.231.236  -  SCREW BONE T25 5MM 36MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.238	SUP	HCPCS C1713		02.231.238  -  SCREW BONE T25 5MM 38MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.240	SUP	HCPCS C1713		02.231.240  -  SCREW BONE T25 5MM 40MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.280	SUP	HCPCS C1713		02.231.280  -  SCREW BONE T25 5MM 80MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.285	SUP	HCPCS C1713		02.231.285  -  SCREW BONE T25 5MM 85MM VAR ANG SELF TAP STARDRIVE LCP	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.295S	SUP	HCPCS C1713		02.231.295S  -  SCREW BN 5MM 95MM STRL LCP T25 STRDR RCS LCK VA ST SS CNDYL	BOTH IP/OP	$435.78 	$322.48	$0.00	$338.46	$190.38	$190.38	$0.00	$0.00	$0.00	$90.83	$323.43	$323.43	$0.00	$0.00	$90.82	$0.00	$257.76	$257.76	$0.00	$211.54	$335.08	$338.46	$0.00		$0.00	$64.28	$0.00	$0.00	$67.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.300S	SUP	HCPCS C1713		02.231.300S  -  SCREW BN 5MM 100MM STRL LCP T25 STRDR RCS LCK VA ST SS CNDYL	BOTH IP/OP	$435.78 	$322.48	$0.00	$338.46	$190.38	$190.38	$0.00	$0.00	$0.00	$90.83	$323.43	$323.43	$0.00	$0.00	$90.82	$0.00	$257.76	$257.76	$0.00	$211.54	$335.08	$338.46	$0.00		$0.00	$64.28	$0.00	$0.00	$67.35	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.640	SUP	HCPCS C1713		02.231.640  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 40MM VAR ANG SELF DRILL	BOTH IP/OP	$463.88 	$343.27	$0.00	$360.30	$202.67	$202.67	$0.00	$0.00	$0.00	$96.68	$344.29	$344.29	$0.00	$0.00	$96.67	$0.00	$274.38	$274.38	$0.00	$225.19	$356.70	$360.30	$0.00		$0.00	$68.43	$0.00	$0.00	$71.70	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.675	SUP	HCPCS C1713		02.231.675  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 75MM VAR ANG SELF DRILL	BOTH IP/OP	$463.88 	$343.27	$0.00	$360.30	$202.67	$202.67	$0.00	$0.00	$0.00	$96.68	$344.29	$344.29	$0.00	$0.00	$96.67	$0.00	$274.38	$274.38	$0.00	$225.19	$356.70	$360.30	$0.00		$0.00	$68.43	$0.00	$0.00	$71.70	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.680	SUP	HCPCS C1713		02.231.680  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 80MM VAR ANG SELF DRILL	BOTH IP/OP	$463.88 	$343.27	$0.00	$360.30	$202.67	$202.67	$0.00	$0.00	$0.00	$96.68	$344.29	$344.29	$0.00	$0.00	$96.67	$0.00	$274.38	$274.38	$0.00	$225.19	$356.70	$360.30	$0.00		$0.00	$50.39	$0.00	$0.00	$71.70	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.685	SUP	HCPCS C1713		02.231.685  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 85MM VAR ANG SELF DRILL	BOTH IP/OP	$463.88 	$343.27	$0.00	$360.30	$202.67	$202.67	$0.00	$0.00	$0.00	$96.68	$344.29	$344.29	$0.00	$0.00	$96.67	$0.00	$274.38	$274.38	$0.00	$225.19	$356.70	$360.30	$0.00		$0.00	$68.43	$0.00	$0.00	$71.70	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.690	SUP	HCPCS C1713		02.231.690  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 90MM VAR ANG SELF DRILL	BOTH IP/OP	$463.88 	$343.27	$0.00	$360.30	$202.67	$202.67	$0.00	$0.00	$0.00	$96.68	$344.29	$344.29	$0.00	$0.00	$96.67	$0.00	$274.38	$274.38	$0.00	$225.19	$356.70	$360.30	$0.00		$0.00	$68.43	$0.00	$0.00	$71.70	$0.00	$0.00	$0.00	$0.00	$0.00
02.231.695S	SUP	HCPCS C1713		02.231.695S  -  SCREW BN 5MM 3.5MM 95MM STRL VA ST TIP LCK CNN SS CNDRL	BOTH IP/OP	$560.88 	$415.05	$0.00	$435.62	$245.04	$245.04	$0.00	$0.00	$0.00	$116.90	$416.28	$416.28	$0.00	$0.00	$116.89	$0.00	$331.76	$331.76	$0.00	$272.26	$431.27	$435.62	$0.00		$0.00	$82.74	$0.00	$0.00	$86.69	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.010	SUP	HCPCS C1713		02.240.010  -  SCREW BONE T15 FULTHD 3.7MM 10MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.012	SUP	HCPCS C1713		02.240.012  -  SCREW BONE T15 FULTHD 3.7MM 12MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.014	SUP	HCPCS C1713		02.240.014  -  SCREW BONE T15 FULTHD 3.7MM 14MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.016	SUP	HCPCS C1713		02.240.016  -  SCREW BONE T15 FULTHD 3.7MM 16MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.018	SUP	HCPCS C1713		02.240.018  -  SCREW BONE T15 FULTHD 3.7MM 18MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.020	SUP	HCPCS C1713		02.240.020  -  SCREW BONE T15 FULTHD 3.7MM 20MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.022	SUP	HCPCS C1713		02.240.022  -  SCREW BONE T15 FULTHD 3.7MM 22MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.024	SUP	HCPCS C1713		02.240.024  -  SCREW BONE T15 FULTHD 3.7MM 24MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.026	SUP	HCPCS C1713		02.240.026  -  SCREW BONE T15 FULTHD 3.7MM 26MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.028	SUP	HCPCS C1713		02.240.028  -  SCREW BONE T15 FULTHD 3.7MM 28MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.030	SUP	HCPCS C1713		02.240.030  -  SCREW BONE T15 FULTHD 3.7MM 30MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.032	SUP	HCPCS C1713		02.240.032  -  SCREW BONE T15 FULTHD 3.7MM 32MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.034	SUP	HCPCS C1713		02.240.034  -  SCREW BONE T15 FULTHD 3.7MM 34MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.036	SUP	HCPCS C1713		02.240.036  -  SCREW BONE T15 FULTHD 3.7MM 36MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.038	SUP	HCPCS C1713		02.240.038  -  SCREW BONE T15 FULTHD 3.7MM 38MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.040	SUP	HCPCS C1713		02.240.040  -  SCREW BONE T15 FULTHD 3.7MM 40MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.042	SUP	HCPCS C1713		02.240.042  -  SCREW BONE T15 FULTHD 3.7MM 42MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.044	SUP	HCPCS C1713		02.240.044  -  SCREW BONE T15 FULTHD 3.7MM 44MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.046	SUP	HCPCS C1713		02.240.046  -  SCREW BONE T15 FULTHD 3.7MM 46MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.048	SUP	HCPCS C1713		02.240.048  -  SCREW BONE T15 FULTHD 3.7MM 48MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.050	SUP	HCPCS C1713		02.240.050  -  SCREW BONE T15 FULTHD 3.7MM 50MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.052	SUP	HCPCS C1713		02.240.052  -  SCREW BONE T15 FULTHD 3.7MM 52MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.054	SUP	HCPCS C1713		02.240.054  -  SCREW BONE T15 FULTHD 3.7MM 54MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.056	SUP	HCPCS C1713		02.240.056  -  SCREW BONE T15 FULTHD 3.7MM 56MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.058	SUP	HCPCS C1713		02.240.058  -  SCREW BONE T15 FULTHD 3.7MM 58MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.060	SUP	HCPCS C1713		02.240.060  -  SCREW BONE T15 FULTHD 3.7MM 60MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.065	SUP	HCPCS C1713		02.240.065  -  SCREW BONE T15 FULTHD 3.7MM 65MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.070	SUP	HCPCS C1713		02.240.070  -  SCREW BONE T15 FULTHD 3.7MM 70MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.075	SUP	HCPCS C1713		02.240.075  -  SCREW BONE T15 FULTHD 3.7MM 75MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.080	SUP	HCPCS C1713		02.240.080  -  SCREW BONE T15 FULTHD 3.7MM 80MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.085	SUP	HCPCS C1713		02.240.085  -  SCREW BONE T15 FULTHD 3.7MM 85MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.090	SUP	HCPCS C1713		02.240.090  -  SCREW BONE T15 FULTHD 3.7MM 90MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.095	SUP	HCPCS C1713		02.240.095  -  SCREW BONE T15 FULTHD 3.7MM 95MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$358.45 	$265.25	$0.00	$278.40	$156.60	$156.60	$0.00	$0.00	$0.00	$74.71	$266.04	$266.04	$0.00	$0.00	$74.70	$0.00	$212.02	$212.02	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$52.88	$0.00	$0.00	$55.40	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.210	SUP	HCPCS C1713		02.240.210  -  SCREW BONE CONE 3.7MM 10MM 6MM SELF DRILL SELF TAP LOCK CANN	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.212	SUP	HCPCS C1713		02.240.212  -  SCREW BONE CONE 3.7MM 12MM 8MM SELF DRILL SELF TAP LOCK CANN	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.214	SUP	HCPCS C1713		02.240.214  -  SCREW BONE CONE 3.7MM 14MM 8MM SELF DRILL SELF TAP LOCK CANN	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.216	SUP	HCPCS C1713		02.240.216  -  SCREW BONE CONE 3.7MM 16MM 8MM SELF DRILL SELF TAP LOCK CANN	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.218	SUP	HCPCS C1713		02.240.218  -  SCREW BONE CONE 3.7MM 18MM 8MM SELF DRILL SELF TAP LOCK CANN	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.220	SUP	HCPCS C1713		02.240.220  -  SCREW BONE CONE 3.7MM 20MM 15MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.222	SUP	HCPCS C1713		02.240.222  -  SCREW BONE CONE 3.7MM 22MM 15MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.224	SUP	HCPCS C1713		02.240.224  -  SCREW BONE CONE 3.7MM 24MM 15MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.226	SUP	HCPCS C1713		02.240.226  -  SCREW BONE CONE 3.7MM 26MM 15MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.228	SUP	HCPCS C1713		02.240.228  -  SCREW BONE CONE 3.7MM 28MM 15MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.230	SUP	HCPCS C1713		02.240.230  -  SCREW BONE CONE 3.7MM 30MM 15MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.232	SUP	HCPCS C1713		02.240.232  -  SCREW BONE CONE 3.7MM 32MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.234	SUP	HCPCS C1713		02.240.234  -  SCREW BONE CONE 3.7MM 34MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.236	SUP	HCPCS C1713		02.240.236  -  SCREW BONE CONE 3.7MM 36MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.238	SUP	HCPCS C1713		02.240.238  -  SCREW BONE CONE 3.7MM 38MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.240	SUP	HCPCS C1713		02.240.240  -  SCREW BONE CONE 3.7MM 40MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.242	SUP	HCPCS C1713		02.240.242  -  SCREW BONE CONE 3.7MM 42MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.244	SUP	HCPCS C1713		02.240.244  -  SCREW BONE CONE 3.7MM 44MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.246	SUP	HCPCS C1713		02.240.246  -  SCREW BONE CONE 3.7MM 46MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.248	SUP	HCPCS C1713		02.240.248  -  SCREW BONE CONE 3.7MM 48MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.250	SUP	HCPCS C1713		02.240.250  -  SCREW BONE CONE 3.7MM 50MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.252	SUP	HCPCS C1713		02.240.252  -  SCREW BONE CONE 3.7MM 52MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.254	SUP	HCPCS C1713		02.240.254  -  SCREW BONE CONE 3.7MM 54MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.256	SUP	HCPCS C1713		02.240.256  -  SCREW BONE CONE 3.7MM 56MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.258	SUP	HCPCS C1713		02.240.258  -  SCREW BONE CONE 3.7MM 58MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.260	SUP	HCPCS C1713		02.240.260  -  SCREW BONE CONE 3.7MM 60MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.265	SUP	HCPCS C1713		02.240.265  -  SCREW BONE CONE 3.7MM 65MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.270	SUP	HCPCS C1713		02.240.270  -  SCREW BONE CONE 3.7MM 70MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.275	SUP	HCPCS C1713		02.240.275  -  SCREW BONE CONE 3.7MM 75MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.280	SUP	HCPCS C1713		02.240.280  -  SCREW BONE CONE 3.7MM 80MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.285	SUP	HCPCS C1713		02.240.285  -  SCREW BONE CONE 3.7MM 85MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.290	SUP	HCPCS C1713		02.240.290  -  SCREW BONE CONE 3.7MM 90MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.240.295	SUP	HCPCS C1713		02.240.295  -  SCREW BONE CONE 3.7MM 95MM 25MM SELF DRILL SELF TAP LOCK	BOTH IP/OP	$313.48 	$231.98	$0.00	$243.48	$136.96	$136.96	$0.00	$0.00	$0.00	$65.34	$232.66	$232.66	$0.00	$0.00	$65.33	$0.00	$185.42	$185.42	$0.00	$152.18	$241.05	$243.48	$0.00		$0.00	$46.24	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$0.00
02.306.006	SUP	HCPCS C1713		02.306.006  -  NAIL INTRAMEDULLARY SHORT CANN ORTHOPEDIC NONSTRL PELVIC	BOTH IP/OP	$967.13 	$715.68	$0.00	$751.16	$422.53	$422.53	$0.00	$0.00	$0.00	$201.57	$717.80	$717.80	$0.00	$0.00	$201.55	$0.00	$572.05	$572.05	$0.00	$469.48	$743.65	$751.16	$0.00		$0.00	$142.67	$0.00	$0.00	$149.48	$0.00	$0.00	$0.00	$0.00	$0.00
02.306.007	SUP	HCPCS C1713		02.306.007  -  NAIL INTRAMEDULLARY LONG CANN ORTHOPEDIC NONSTRL PELVIC	BOTH IP/OP	$967.13 	$715.68	$0.00	$751.16	$422.53	$422.53	$0.00	$0.00	$0.00	$201.57	$717.80	$717.80	$0.00	$0.00	$201.55	$0.00	$572.05	$572.05	$0.00	$469.48	$743.65	$751.16	$0.00		$0.00	$142.67	$0.00	$0.00	$149.48	$0.00	$0.00	$0.00	$0.00	$0.00
02.600.020	SUP	Custom 27203010		02.600.020  -  WIRE FX 1.6MM 400MM NS KRSH TROC PNT SS	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$0.00	$0.00	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02.600.022.02S	SUP	HCPCS C1713		02.600.022.02S  -  PIN 12MM DSTRCT STRL	BOTH IP/OP	$204.75 	$151.52	$0.00	$163.80	$92.14	$92.14	$0.00	$0.00	$0.00	$42.68	$151.97	$151.97	$0.00	$0.00	$42.67	$0.00	$121.11	$121.11	$0.00	$102.38	$162.16	$163.80	$0.00		$0.00	$32.04	$0.00	$0.00	$32.60	$0.00	$0.00	$0.00	$0.00	$0.00
0200-12LV	SUP	Custom 27203010		0200-12LV  -  TUBE JJNSTM 12FR 2-3ML STRL LF MC SLK MED PORT RADOPQ STRP	BOTH IP/OP	$337.35 	$249.64	$0.00	$269.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.38	$250.38	$0.00	$0.00	$70.30	$0.00	$0.00	$0.00	$0.00	$168.68	$267.18	$269.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0200-18	SUP	Custom 27203010		0200-18  -  TUBE JEJUNOSTOMY STANDARD J 18FR TRIMMABLE DISTAL TIP	BOTH IP/OP	$337.35 	$249.64	$0.00	$273.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.38	$250.38	$0.00	$0.00	$70.30	$0.00	$0.00	$0.00	$0.00	$171.21	$271.19	$273.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
022-001	SUP	Custom 27203010		022-001  -  WIRE PACING 2-0 TAPER LOOP 1/8IN 61CM 89MM 1 ARM SNAP OFF	BOTH IP/OP	$49.32 	$36.50	$0.00	$39.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.61	$36.61	$0.00	$0.00	$10.28	$0.00	$0.00	$0.00	$0.00	$24.66	$39.06	$39.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02-2005-S	SUP	HCPCS C1713		02-2005-S  -  PLATE SS 5 HOLE CMPR BONE 6MM STRL	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
02-2007-S	SUP	HCPCS C1713		02-2007-S  -  PLATE 203.2MM SS 7 HOLE 8 GRV CMPR BONE ORTH STRL	BOTH IP/OP	"$1,342.50 "	$993.45	$0.00	"$1,074.00"	$604.13	$604.13	$0.00	$0.00	$0.00	$279.81	$996.40	$996.40	$0.00	$0.00	$279.78	$0.00	$794.09	$794.09	$0.00	$671.25	"$1,063.26"	"$1,074.00"	$0.00		$0.00	$210.10	$0.00	$0.00	$213.73	$0.00	$0.00	$0.00	$0.00	$0.00
02-2009-S	SUP	HCPCS C1713		02-2009-S  -  PLATE 6 SS 9 HOLE CMPR BONE 10MM STRL	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
02-2011-S	SUP	HCPCS C1713		02-2011-S  -  PLATE 6 12IN SS 11 HOLE 12 GRV CMPR BONE 12MM STRL	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
02-205-085	SUP	HCPCS C1713		02-205-085  -  SCREW BONE 5MM 85MM LCP SS PROX FEM CANN LCK NONSTRL	BOTH IP/OP	$415.40 	$307.40	$0.00	$332.32	$186.93	$186.93	$0.00	$0.00	$0.00	$86.58	$308.31	$308.31	$0.00	$0.00	$86.57	$0.00	$245.71	$245.71	$0.00	$207.70	$329.00	$332.32	$0.00		$0.00	$65.01	$0.00	$0.00	$66.13	$0.00	$0.00	$0.00	$0.00	$0.00
02-205-280	SUP	HCPCS C1713		02-205-280  -  SCREW BONE 5MM 80MM LCP SS PERIART FEM/TIB CANN CONICAL	BOTH IP/OP	$354.75 	$262.52	$0.00	$283.80	$159.64	$159.64	$0.00	$0.00	$0.00	$73.94	$263.30	$263.30	$0.00	$0.00	$73.93	$0.00	$209.83	$209.83	$0.00	$177.38	$280.96	$283.80	$0.00		$0.00	$55.52	$0.00	$0.00	$56.48	$0.00	$0.00	$0.00	$0.00	$0.00
02-210-122	SUP	HCPCS C1713		02-210-122  -  SCREW BONE 2.4MM 22MM LCP SS DISTAL RADL LCK VAR ANG	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
023-001	SUP	Custom 27203010		KIT IMMUN TST ELISA ANCRDLPN IGG IGM 96 TST	BOTH IP/OP	$962.50 	$712.25	$0.00	$770.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0250-18	SUP	HCPCS B4088		0250-18  -  TUBE JJNSTM 18FR 45CM 7-10ML STRL LF MC SLK RADOPQ STRP RTNT	BOTH IP/OP	$564.68 	$417.86	$0.00	$451.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$419.10	$419.10	$0.00	$0.00	$117.68	$0.00	$0.00	$0.00	$0.00	$282.34	$447.23	$451.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0250-22	SUP	HCPCS B4088		0250-22  -  TUBE JJNSTM 22FR 45CM 7-10ML STRL LF MC SLK RADOPQ STRP RTNT	BOTH IP/OP	$564.68 	$417.86	$0.00	$451.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$419.10	$419.10	$0.00	$0.00	$117.68	$0.00	$0.00	$0.00	$0.00	$282.34	$447.23	$451.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
025-200	SUP	Custom 27203010		025-200  -  WIRE PACING 2-0 26MM .5 CIR CURVE TAPER 61CM 89MM M25 STYLE	BOTH IP/OP	$32.29 	$23.89	$0.00	$25.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.97	$23.97	$0.00	$0.00	$6.73	$0.00	$0.00	$0.00	$0.00	$16.15	$25.57	$25.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0270-0626	SUP	Custom 27203010		LARYNGOSCOPE VID 3 STAT GVL GLIDESCOPE DISP	BOTH IP/OP	$35.73 	$26.44	$0.00	$28.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.86	$28.30	$28.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0270-0628	SUP	Custom 27203010		LARYNGOSCOPE VID 4 LG GLIDESCOPE	BOTH IP/OP	$35.73 	$26.44	$0.00	$28.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.86	$28.30	$28.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0277082085S5	SUP	Custom 27203010		0277082085S5  -  BIT DRILL 7/64IN 128MM	BOTH IP/OP	$722.50 	$534.65	$0.00	$578.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$536.24	$536.24	$0.00	$0.00	$150.57	$0.00	$0.00	$0.00	$0.00	$361.25	$572.22	$578.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
028506-CE	SUP	HCPCS C1729		028506-CE  -  CATH URTH 6FR 25CM 2W FOLEY CLOSE END RND SIL 1.5ML	BOTH IP/OP	$49.75 	$36.82	$0.00	$39.80	$27.01	$27.01	$0.00	$0.00	$0.00	$10.37	$36.92	$36.92	$0.00	$0.00	$10.37	$0.00	$29.43	$29.43	$0.00	$24.88	$39.40	$39.80	$0.00		$0.00	$7.79	$0.00	$0.00	$7.92	$0.00	$0.00	$0.00	$0.00	$0.00
0298-097-100	SUP	Custom 27203010		0298-097-100  -  BLADE SAW THK.031IN 32MM CUT EDGE HEAVY DUTY STERNUM	BOTH IP/OP	$57.13 	$42.28	$0.00	$45.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.40	$42.40	$0.00	$0.00	$11.90	$0.00	$0.00	$0.00	$0.00	$28.56	$45.25	$45.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
02B002	SUP	HCPCS C1776		02B002  -  GRAFT SFT TIS STRUT AT	BOTH IP/OP	"$4,592.50 "	"$3,398.45"	$0.00	"$3,674.00"	"$2,066.63"	"$2,066.63"	$0.00	$0.00	$0.00	$957.19	"$3,408.55"	"$3,408.55"	$0.00	$0.00	$957.08	$0.00	"$2,264.10"	"$2,264.10"	$0.00	"$2,296.25"	"$3,637.26"	"$3,674.00"	$0.00		$0.00	$718.73	$0.00	$0.00	$731.13	$0.00	$0.00	$0.00	$0.00	$0.00
02B003	SUP	Custom 27804086		02B003  -  FILLER BN VOID BLCK .5-1MM 4.5X5X10MM .3ML STRL PO 200R RSRB	BOTH IP/OP	"$6,170.00 "	"$4,565.80"	$0.00	"$4,936.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,285.83"	$0.00	$0.00	$0.00	$0.00	"$3,085.00"	"$4,886.64"	"$4,936.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.000.409.98S	SUP	Custom 27203010		03.000.409.98S  -  CUTTER SRG THK.6MM 24.6X12.85X2.6MM STRL DMD PIEZOELECTRIC	BOTH IP/OP	$623.25 	$461.21	$0.00	$498.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$462.58	$462.58	$0.00	$0.00	$129.89	$0.00	$0.00	$0.00	$0.00	$311.63	$493.61	$498.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.000.410.98S	SUP	Custom 27203010		03.000.410.98S  -  CUTTER SRG THK.6MM RND 21.9X12.4X1.8MM STRL DMD	BOTH IP/OP	$623.25 	$461.21	$0.00	$498.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$462.58	$462.58	$0.00	$0.00	$129.89	$0.00	$0.00	$0.00	$0.00	$311.63	$493.61	$498.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.000.411.98S	SUP	Custom 27803010		03.000.411.98S  -  SINUS LIFT 22.9X10.1X5X0.4MM FOR PIEZOELECTRIC SYSTEM-STER	BOTH IP/OP	$623.25 	$461.21	$0.00	$498.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$462.58	$462.58	$0.00	$0.00	$129.89	$0.00	$0.00	$0.00	$0.00	$311.63	$493.61	$498.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.007.020	SUP	HCPCS C1769		03.007.020  -  GUIDEWIRE ORTHOPEDIC 2.8MM 180MM 10MM TROCAR NONSTRL	BOTH IP/OP	$117.35 	$86.84	$0.00	$91.16	$61.87	$61.87	$0.00	$0.00	$0.00	$24.46	$87.10	$87.10	$0.00	$0.00	$24.46	$0.00	$69.41	$69.41	$0.00	$56.98	$90.25	$91.16	$0.00		$0.00	$17.31	$0.00	$0.00	$18.14	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.015	SUP	Custom 27203010		03.010.015  -  SET TRAUMA FIX CANN COMPRESSION DEVICE TITANIUM TIBIA	BOTH IP/OP	$875.25 	$647.69	$0.00	$679.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.61	$649.61	$0.00	$0.00	$182.40	$0.00	$0.00	$0.00	$0.00	$424.88	$673.00	$679.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.025	SUP	HCPCS C1713		03.010.025  -  WIRE FIX 2MM 240MM TROCAR POINT KWIRE NONSTRL EXPERT CANN	BOTH IP/OP	$66.00 	$48.84	$0.00	$51.26	$28.83	$28.83	$0.00	$0.00	$0.00	$13.76	$48.99	$48.99	$0.00	$0.00	$13.75	$0.00	$39.04	$39.04	$0.00	$32.04	$50.75	$51.26	$0.00		$0.00	$9.73	$0.00	$0.00	$10.20	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.028	SUP	Custom 27203010		03.010.028  -  BIT DRL 15MM 280MM NS CNN LG QC	BOTH IP/OP	$971.53 	$718.93	$0.00	$754.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$721.07	$721.07	$0.00	$0.00	$202.47	$0.00	$0.00	$0.00	$0.00	$471.61	$747.04	$754.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.029	SUP	Custom 27203010		03.010.029  -  BIT DRILL LARGE 17MM 280MM QUICK COUPLING CANN NONSTRL	BOTH IP/OP	"$1,215.13 "	$899.20	$0.00	$943.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.87	$901.87	$0.00	$0.00	$253.23	$0.00	$0.00	$0.00	$0.00	$589.86	$934.35	$943.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.034	SUP	Custom 27203010		03.010.034  -  BIT DRL 13MM 465MM NS CNN LG QC FLXB	BOTH IP/OP	"$1,365.38 "	"$1,010.38"	$0.00	"$1,060.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,013.38"	"$1,013.38"	$0.00	$0.00	$284.54	$0.00	$0.00	$0.00	$0.00	$662.80	"$1,049.88"	"$1,060.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.036	SUP	Custom 27203010		03.010.036  -  BIT DRILL LARGE 12MM 190MM CANN LARGE QUICK COUPLING EXPERT	BOTH IP/OP	"$1,025.50 "	$758.87	$0.00	$796.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$761.13	$761.13	$0.00	$0.00	$213.71	$0.00	$0.00	$0.00	$0.00	$497.81	$788.54	$796.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.044	SUP	HCPCS C1713		03.010.044  -  SCREW INSERTION HANDLE CANN CONNCTNG EXPERT NONSTRL TIBIAL	BOTH IP/OP	$598.08 	$442.58	$0.00	$464.54	$261.30	$261.30	$0.00	$0.00	$0.00	$124.65	$443.89	$443.89	$0.00	$0.00	$124.64	$0.00	$353.76	$353.76	$0.00	$290.34	$459.90	$464.54	$0.00		$0.00	$88.23	$0.00	$0.00	$92.44	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.060	SUP	Custom 27203010		03.010.060  -  BIT DRL 100MM 3 FLUT 3.2MM 330MM NS CLBRT QC	BOTH IP/OP	$462.43 	$342.20	$0.00	$359.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.21	$343.21	$0.00	$0.00	$96.37	$0.00	$0.00	$0.00	$0.00	$224.48	$355.57	$359.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.061	SUP	Custom 27203010		03.010.061  -  BIT DRL 100MM 3 FLUT 4.2MM 330MM NS CLBRT QC	BOTH IP/OP	$462.43 	$342.20	$0.00	$359.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.21	$343.21	$0.00	$0.00	$96.37	$0.00	$0.00	$0.00	$0.00	$224.48	$355.57	$359.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.062	SUP	Custom 27203010		03.010.062  -  BIT DRL 100MM 3 FLUT 5MM 330MM NS CLBRT QC	BOTH IP/OP	$462.43 	$342.20	$0.00	$359.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.21	$343.21	$0.00	$0.00	$96.37	$0.00	$0.00	$0.00	$0.00	$224.48	$355.57	$359.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.078	SUP	Custom 27203010		03.010.078  -  BIT DRL 4.5-6.5MM 485MM NS LG QC STP	BOTH IP/OP	$980.28 	$725.41	$0.00	$761.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$727.56	$727.56	$0.00	$0.00	$204.29	$0.00	$0.00	$0.00	$0.00	$475.86	$753.77	$761.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.089	SUP	Custom 27203010		03.010.089  -  BIT DRL 135MM 4.5MM 165MM NS CNN JCHK STP	BOTH IP/OP	$692.90 	$512.75	$0.00	$538.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$514.27	$514.27	$0.00	$0.00	$144.40	$0.00	$0.00	$0.00	$0.00	$336.36	$532.80	$538.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.089S	SUP	Custom 27203010		03.010.089S  -  BIT DRILL 165MM 4.5MM CANN JCHK STOP 135MM STRL	BOTH IP/OP	$849.48 	$628.62	$0.00	$679.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$630.48	$630.48	$0.00	$0.00	$177.03	$0.00	$0.00	$0.00	$0.00	$424.74	$672.79	$679.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.100	SUP	Custom 27203010		03.010.100  -  BIT DRILL 3.2MM 145MM 3 FLUTED QUICK COUPLING NEEDLE POINT	BOTH IP/OP	$459.50 	$340.03	$0.00	$356.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.04	$341.04	$0.00	$0.00	$95.76	$0.00	$0.00	$0.00	$0.00	$223.06	$353.33	$356.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.101	SUP	Custom 27203010		03.010.101  -  BIT DRILL 4.2MM 145MM 3 FLUTED QUICK COUPLING NEEDLE POINT	BOTH IP/OP	$459.50 	$340.03	$0.00	$356.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.04	$341.04	$0.00	$0.00	$95.76	$0.00	$0.00	$0.00	$0.00	$223.06	$353.33	$356.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.102	SUP	Custom 27203010		03.010.102  -  BIT DRILL 5MM 145MM QUICK COUPLING 3 FLUTED NONSTRL	BOTH IP/OP	$459.50 	$340.03	$0.00	$356.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.04	$341.04	$0.00	$0.00	$95.76	$0.00	$0.00	$0.00	$0.00	$223.06	$353.33	$356.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.103	SUP	Custom 27203010		03.010.103  -  BIT DRL 3 FLUT 3.2MM 145MM NS QC	BOTH IP/OP	$329.68 	$243.96	$0.00	$256.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.68	$244.68	$0.00	$0.00	$68.70	$0.00	$0.00	$0.00	$0.00	$160.04	$253.50	$256.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.104	SUP	Custom 27203010		03.010.104  -  BIT DRL 3 FLUT 4.2MM 145MM NS QC NDL PNT	BOTH IP/OP	$329.68 	$243.96	$0.00	$256.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.68	$244.68	$0.00	$0.00	$68.70	$0.00	$0.00	$0.00	$0.00	$160.04	$253.50	$256.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.105	SUP	Custom 27203010		03.010.105  -  BIT DRILL SHORT 5MM 145MM 3 FLUTED QUICK COUPLING NEEDLE	BOTH IP/OP	$329.68 	$243.96	$0.00	$256.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.68	$244.68	$0.00	$0.00	$68.70	$0.00	$0.00	$0.00	$0.00	$160.04	$253.50	$256.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.115	SUP	HCPCS C1769		03.010.115  -  GUIDEWIRE ORTHOPEDIC 3.2MM 290MM THREAD NONSTRL TITANIUM	BOTH IP/OP	$183.80 	$136.01	$0.00	$142.76	$96.90	$96.90	$0.00	$0.00	$0.00	$38.31	$136.42	$136.42	$0.00	$0.00	$38.30	$0.00	$108.72	$108.72	$0.00	$89.23	$141.33	$142.76	$0.00		$0.00	$27.11	$0.00	$0.00	$28.41	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.165	SUP	Custom 27203010		03.010.165  -  BIT DRILL LARGE 15MM 310MM LARGE QUICK COUPLING CANN	BOTH IP/OP	"$1,336.20 "	$988.79	$0.00	"$1,037.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$991.73	$991.73	$0.00	$0.00	$278.46	$0.00	$0.00	$0.00	$0.00	$648.64	"$1,027.45"	"$1,037.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.167	SUP	Custom 27203010		03.010.167  -  BIT DRILL LARGE 17MM 310MM LARGE QUICK COUPLING CANN	BOTH IP/OP	"$1,429.58 "	"$1,057.89"	$0.00	"$1,110.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,061.03"	"$1,061.03"	$0.00	$0.00	$297.92	$0.00	$0.00	$0.00	$0.00	$693.96	"$1,099.24"	"$1,110.34"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.228	SUP	Custom 27203010		03.010.228  -  BIT DRILL LARGE 3.2MM 474MM 3 FLUTE CALIBRATED NONSTRL 5MM	BOTH IP/OP	$827.95 	$612.68	$0.00	$643.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$614.50	$614.50	$0.00	$0.00	$172.54	$0.00	$0.00	$0.00	$0.00	$401.93	$636.65	$643.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.437S	SUP	Custom 27203010		03.010.437S  -  SLEEVE PROTECTION 12MM STERILE SUPRAPATELLAR	BOTH IP/OP	$195.48 	$144.66	$0.00	$151.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.08	$145.08	$0.00	$0.00	$40.74	$0.00	$0.00	$0.00	$0.00	$94.89	$150.31	$151.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.010.439	SUP	Custom 27203010		03.010.439  -  BIT DRILL LARGE 12MM 270MM QUICK COUPLING CANN NAIL-EX	BOTH IP/OP	$935.05 	$691.94	$0.00	$726.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$693.99	$693.99	$0.00	$0.00	$194.86	$0.00	$0.00	$0.00	$0.00	$453.91	$719.00	$726.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.019.003	SUP	Custom 27203010		03.019.003  -  BIT DRILL 10MM HOLLOW NONSTRL OPEN MEDULLARY CANAL MULTILOC	BOTH IP/OP	$551.40 	$408.04	$0.00	$428.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$409.25	$409.25	$0.00	$0.00	$114.91	$0.00	$0.00	$0.00	$0.00	$267.68	$424.00	$428.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.019.016	SUP	Custom 27203010		03.019.016  -  BIT DRL 3 FLUT 3.8MM 270MM NS QC CLBRT	BOTH IP/OP	$408.45 	$302.25	$0.00	$317.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$303.15	$303.15	$0.00	$0.00	$85.12	$0.00	$0.00	$0.00	$0.00	$198.28	$314.07	$317.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.019.026	SUP	HCPCS C1713		03.019.026  -  GUIDE ROD ORTH 2.5MM 230MM NS MULTILOC STP TROC TIP SS HLW	BOTH IP/OP	$39.38 	$29.14	$0.00	$30.60	$17.21	$17.21	$0.00	$0.00	$0.00	$8.21	$29.22	$29.22	$0.00	$0.00	$8.21	$0.00	$23.29	$23.29	$0.00	$19.13	$30.29	$30.60	$0.00		$0.00	$5.81	$0.00	$0.00	$6.09	$0.00	$0.00	$0.00	$0.00	$0.00
03.019.026S	SUP	HCPCS C1713		03.019.026S  -  GUIDE ROD ORTH 2.5MM 230MM STRL STP TROC TIP SS HLW DRL	BOTH IP/OP	$134.20 	$99.31	$0.00	$104.24	$58.64	$58.64	$0.00	$0.00	$0.00	$27.97	$99.60	$99.60	$0.00	$0.00	$27.97	$0.00	$79.38	$79.38	$0.00	$65.15	$103.20	$104.24	$0.00		$0.00	$19.80	$0.00	$0.00	$20.74	$0.00	$0.00	$0.00	$0.00	$0.00
03.100.034	SUP	HCPCS C1713		03.100.034  -  TEMPLATE SIZING 20 HOLE PELVIS 3.5 MM LP RECONSTRUCTION	BOTH IP/OP	$185.55 	$137.31	$0.00	$144.12	$81.07	$81.07	$0.00	$0.00	$0.00	$38.67	$137.72	$137.72	$0.00	$0.00	$38.67	$0.00	$109.75	$109.75	$0.00	$90.08	$142.68	$144.12	$0.00		$0.00	$27.37	$0.00	$0.00	$28.68	$0.00	$0.00	$0.00	$0.00	$0.00
03.100.036	SUP	HCPCS C1713		03.100.036  -  TEMPLATE BENDING 88MM 16 HOLE PELVIS 3.5MM LP CVD	BOTH IP/OP	$210.85 	$156.03	$0.00	$163.78	$92.13	$92.13	$0.00	$0.00	$0.00	$43.95	$156.49	$156.49	$0.00	$0.00	$43.94	$0.00	$124.72	$124.72	$0.00	$102.36	$162.15	$163.78	$0.00		$0.00	$31.10	$0.00	$0.00	$32.59	$0.00	$0.00	$0.00	$0.00	$0.00
03.100.037	SUP	HCPCS C1713		03.100.037  -  TEMPLATE BENDING 108MM RAD 16 HOLE PELVIS NONSTRL 3.5MM LP	BOTH IP/OP	$210.85 	$156.03	$0.00	$163.78	$92.13	$92.13	$0.00	$0.00	$0.00	$43.95	$156.49	$156.49	$0.00	$0.00	$43.94	$0.00	$124.72	$124.72	$0.00	$102.36	$162.15	$163.78	$0.00		$0.00	$31.10	$0.00	$0.00	$32.59	$0.00	$0.00	$0.00	$0.00	$0.00
03.111.002	SUP	Custom 27203010		03.111.002  -  BIT DRILL 5MM 300MM 200MM 3 FLUTED CANN CALIBRATION NONSTRL	BOTH IP/OP	$735.18 	$544.03	$0.00	$571.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.65	$545.65	$0.00	$0.00	$153.21	$0.00	$0.00	$0.00	$0.00	$356.89	$565.31	$571.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.112.003	SUP	Custom 27203010		03.112.003  -  BIT DRILL SHORT 2.8MM CALIBRATED STOP NONSTRL	BOTH IP/OP	$233.35 	$172.68	$0.00	$181.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.19	$173.19	$0.00	$0.00	$48.63	$0.00	$0.00	$0.00	$0.00	$113.28	$179.43	$181.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.114.007	SUP	Custom 27203010		03.114.007  -  BIT DRL 2 FLUT 1.1MM 75MM NS 61MM MNQK CPLNG 1.5MM CORT SCR	BOTH IP/OP	$168.68 	$124.82	$0.00	$131.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.19	$125.19	$0.00	$0.00	$35.15	$0.00	$0.00	$0.00	$0.00	$81.89	$129.71	$131.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.120.023	SUP	Custom 27203010		03.120.023  -  DEVICE XTRNFX PUL RDC 4.3 MM PERC DRL GD	BOTH IP/OP	$979.78 	$725.04	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$727.19	$727.19	$0.00	$0.00	$204.19	$0.00	$0.00	$0.00	$0.00	$475.61	$753.37	$760.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.120.026	SUP	Custom 27203010		03.120.026  -  GUIDEWIRE ORTHOPEDIC 2.5MM 300MM DRILL TIP NONSTRL	BOTH IP/OP	$127.93 	$94.67	$0.00	$99.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.95	$94.95	$0.00	$0.00	$26.66	$0.00	$0.00	$0.00	$0.00	$62.10	$98.37	$99.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.122.002	SUP	Custom 27203010		03.122.002  -  BIT DRL 95MM 2.8MM 248MM NS QC CLBRT	BOTH IP/OP	$296.60 	$219.48	$0.00	$230.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.14	$220.14	$0.00	$0.00	$61.81	$0.00	$0.00	$0.00	$0.00	$143.98	$228.06	$230.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.122.056	SUP	Custom 27203010		03.122.056  -  DEVICE MEASURING AIMING NOSE PHILOS NONSTRL	BOTH IP/OP	"$2,745.33 "	"$2,031.54"	$0.00	"$2,132.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,037.58"	"$2,037.58"	$0.00	$0.00	$572.13	$0.00	$0.00	$0.00	$0.00	"$1,332.68"	"$2,110.96"	"$2,132.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.100	SUP	Custom 27203010		03.130.100  -  BIT DRL 1MM 75MM KRSH THRD HL WRE HND 1.3MM SCR	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.102	SUP	Custom 27203010		03.130.102  -  BIT DRL 1MM 61MM MNQK CPLNG THRD HL	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.110	SUP	Custom 27203010		03.130.110  -  BIT DRL 1.3MM 60MM KRSH THRD HL WRE GLD HND	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.112	SUP	Custom 27203010		03.130.112  -  BIT DRL 1.3MM 46MM MNQK CPLNG GLD HL	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.120	SUP	Custom 27203010		03.130.120  -  GUIDE DRL 1MM THRD 1.3MM LCK PLT	BOTH IP/OP	$499.03 	$369.28	$0.00	$387.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$370.38	$370.38	$0.00	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$242.24	$383.71	$387.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.125	SUP	Custom 27203010		03.130.125  -  SLEEVE DRL 1.3MM 1MM YLW 2 1.3MM CORT SCR	BOTH IP/OP	$618.50 	$457.69	$0.00	$480.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$459.05	$459.05	$0.00	$0.00	$128.90	$0.00	$0.00	$0.00	$0.00	$300.25	$475.60	$480.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.130	SUP	HCPCS C1713		03.130.130  -  HOLDER PLT 1.3-2 MM	BOTH IP/OP	$529.95 	$392.16	$0.00	$411.60	$231.53	$231.53	$0.00	$0.00	$0.00	$110.45	$393.33	$393.33	$0.00	$0.00	$110.44	$0.00	$313.47	$313.47	$0.00	$257.25	$407.48	$411.60	$0.00		$0.00	$78.18	$0.00	$0.00	$81.91	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.140	SUP	HCPCS C1713		03.130.140  -  PIN BNDRG 1.3MM LCK PLT	BOTH IP/OP	$499.03 	$369.28	$0.00	$387.58	$218.01	$218.01	$0.00	$0.00	$0.00	$104.01	$370.38	$370.38	$0.00	$0.00	$104.00	$0.00	$295.17	$295.17	$0.00	$242.24	$383.71	$387.58	$0.00		$0.00	$73.61	$0.00	$0.00	$77.13	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.200	SUP	Custom 27203010		03.130.200  -  BIT DRL 1.1MM 70MM KWR 1.5MM SCR THRD HL	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.202	SUP	Custom 27203010		03.130.202  -  BIT DRL 1.1MM 56MM MNQK CPLNG THRD HL	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.210	SUP	Custom 27203010		03.130.210  -  BIT DRL 1.5MM 62MM BLU KWR ATCH 2MM SCR GLD HL	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.212	SUP	Custom 27203010		03.130.212  -  BIT DRL 1.5MM 48MM MNQK CPLNG GLD HL	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.215	SUP	Custom 27203010		03.130.215  -  COUNTERSINK DRL 1.3 MM 1.5 MM 2 MM SCR	BOTH IP/OP	$414.68 	$306.86	$0.00	$322.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.77	$307.77	$0.00	$0.00	$86.42	$0.00	$0.00	$0.00	$0.00	$201.30	$318.86	$322.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.221	SUP	Custom 27203010		03.130.221  -  GUIDE DRL 1.1MM 2 VA FRHD 1.5MM LCK PLT	BOTH IP/OP	"$1,234.20 "	$913.31	$0.00	$958.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$916.02	$916.02	$0.00	$0.00	$257.21	$0.00	$0.00	$0.00	$0.00	$599.13	$949.01	$958.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.225	SUP	Custom 27203010		03.130.225  -  SLEEVE DRL 1.5MM 1.1MM RD 2 1.5MM CORT SCR	BOTH IP/OP	$618.50 	$457.69	$0.00	$480.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$459.05	$459.05	$0.00	$0.00	$128.90	$0.00	$0.00	$0.00	$0.00	$300.25	$475.60	$480.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.250	SUP	Custom 27203010		03.130.250  -  GAUGE D 1.3/1.5/2 MM SCR	BOTH IP/OP	"$2,242.08 "	"$1,659.14"	$0.00	"$1,741.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,664.07"	"$1,664.07"	$0.00	$0.00	$467.25	$0.00	$0.00	$0.00	$0.00	"$1,088.39"	"$1,724.01"	"$1,741.42"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.260	SUP	HCPCS C1713		03.130.260  -  PLIERS PLT BNDRG RT 1.3 MM LCK 1.5/2 MM VA PLT	BOTH IP/OP	$833.58 	$616.85	$0.00	$647.44	$364.19	$364.19	$0.00	$0.00	$0.00	$173.74	$618.68	$618.68	$0.00	$0.00	$173.72	$0.00	$493.06	$493.06	$0.00	$404.65	$640.97	$647.44	$0.00		$0.00	$122.97	$0.00	$0.00	$128.84	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.261	SUP	HCPCS C1713		03.130.261  -  PLIERS PLT BNDRG LT 1.3 MM LCK 1.5/2 MM VA PLT	BOTH IP/OP	$833.58 	$616.85	$0.00	$647.44	$364.19	$364.19	$0.00	$0.00	$0.00	$173.74	$618.68	$618.68	$0.00	$0.00	$173.72	$0.00	$493.06	$493.06	$0.00	$404.65	$640.97	$647.44	$0.00		$0.00	$122.97	$0.00	$0.00	$128.84	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.292	SUP	Custom 27203010		03.130.292  -  GUIDE DRL YLW INS 1MM BIT	BOTH IP/OP	$217.88 	$161.23	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.71	$161.71	$0.00	$0.00	$45.41	$0.00	$0.00	$0.00	$0.00	$105.76	$167.53	$169.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.293	SUP	Custom 27203010		03.130.293  -  GUIDE DRL RD INS 1.1MM BIT	BOTH IP/OP	$217.88 	$161.23	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.71	$161.71	$0.00	$0.00	$45.41	$0.00	$0.00	$0.00	$0.00	$105.76	$167.53	$169.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.294	SUP	Custom 27203010		03.130.294  -  GUIDE DRL YLW INS 1.3MM BIT	BOTH IP/OP	$217.88 	$161.23	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.71	$161.71	$0.00	$0.00	$45.41	$0.00	$0.00	$0.00	$0.00	$105.76	$167.53	$169.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.295	SUP	Custom 27203010		03.130.295  -  GUIDE DRL RD INS 1.5MM BIT	BOTH IP/OP	$217.88 	$161.23	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.71	$161.71	$0.00	$0.00	$45.41	$0.00	$0.00	$0.00	$0.00	$105.76	$167.53	$169.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.296	SUP	Custom 27203010		03.130.296  -  GUIDE DRL BLU INS 1.5MM BIT	BOTH IP/OP	$217.88 	$161.23	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.71	$161.71	$0.00	$0.00	$45.41	$0.00	$0.00	$0.00	$0.00	$105.76	$167.53	$169.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.297	SUP	Custom 27203010		03.130.297  -  GUIDE DRL BLU INS 2MM BIT	BOTH IP/OP	$217.88 	$161.23	$0.00	$169.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.71	$161.71	$0.00	$0.00	$45.41	$0.00	$0.00	$0.00	$0.00	$105.76	$167.53	$169.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.300	SUP	Custom 27203010		03.130.300  -  BIT DRL 1.5MM 88MM BLU KRSH WRE ATCH 2MM SCR	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.302	SUP	Custom 27203010		03.130.302  -  BIT DRL 1.5MM 74MM 57MM CLR CD PILT HL MNQK CPLNG	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.310	SUP	Custom 27203010		03.130.310  -  BIT DRL 2MM 71MM 41MM CLR CD GLD HL JCHK	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.312	SUP	Custom 27203010		03.130.312  -  BIT DRL 2MM 57MM MNQK CPLNG GLD HL	BOTH IP/OP	$161.65 	$119.62	$0.00	$125.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.98	$119.98	$0.00	$0.00	$33.69	$0.00	$0.00	$0.00	$0.00	$78.48	$124.30	$125.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.321	SUP	Custom 27203010		03.130.321  -  GUIDE DRL 1.5MM 2 VA LCK FR HND 2MM PLT	BOTH IP/OP	"$1,234.20 "	$913.31	$0.00	$958.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$916.02	$916.02	$0.00	$0.00	$257.21	$0.00	$0.00	$0.00	$0.00	$599.13	$949.01	$958.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.130.325	SUP	Custom 27203010		03.130.325  -  SLEEVE DRL 1.5MM BLU 2 2MM CORT SCR	BOTH IP/OP	$618.50 	$457.69	$0.00	$480.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$459.05	$459.05	$0.00	$0.00	$128.90	$0.00	$0.00	$0.00	$0.00	$300.25	$475.60	$480.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.161.024	SUP	Custom 27203010		03.161.024  -  BIT DRL 3.2MM NS OCPTL CRV FSN SYS	BOTH IP/OP	"$1,060.00 "	$784.40	$0.00	$848.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$786.73	$786.73	$0.00	$0.00	$220.90	$0.00	$0.00	$0.00	$0.00	$530.00	$839.52	$848.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.161.026	SUP	HCPCS C1713		03.161.026  -  TAP SURG NONSTRL 4.5 MM OCCPTL SCREW	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
03.161.027	SUP	Custom 27203010		03.161.027  -  SCREWDRIVER SURG UNIVERSAL JOINT 4 MM OCCPTL SCREW	BOTH IP/OP	"$3,267.50 "	"$2,417.95"	$0.00	"$2,614.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,425.14"	"$2,425.14"	$0.00	$0.00	$680.95	$0.00	$0.00	$0.00	$0.00	"$1,633.75"	"$2,587.86"	"$2,614.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.211.410	SUP	Custom 27203010		03.211.410  -  WIRE FX 1.6MM 150MM NS 10MM LCP CMPR THRD	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$0.00	$0.00	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.211.415	SUP	Custom 27203010		03.211.415  -  WIRE FX 1.6MM 150MM NS 15MM LCP CMPR THRD	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$0.00	$0.00	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.211.420	SUP	Custom 27203010		03.211.420  -  WIRE FX 1.6MM 150MM NS 20MM LCP CMPR THRD	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$0.00	$0.00	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.211.425	SUP	Custom 27203010		03.211.425  -  WIRE FX 1.6MM 150MM NS 25MM LCP CMPR THRD	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$0.00	$0.00	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.211.430	SUP	Custom 27203010		03.211.430  -  WIRE FX 1.6MM 150MM NS 30MM LCP CMPR THRD	BOTH IP/OP	$85.75 	$63.46	$0.00	$66.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.64	$63.64	$0.00	$0.00	$17.87	$0.00	$0.00	$0.00	$0.00	$41.63	$65.93	$66.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.211.435	SUP	Custom 27203010		03.211.435  -  WIRE FX 1.6MM 150MM NS 35MM LCP CMPR THRD	BOTH IP/OP	$88.55 	$65.53	$0.00	$68.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.72	$65.72	$0.00	$0.00	$18.45	$0.00	$0.00	$0.00	$0.00	$42.99	$68.10	$68.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.211.440	SUP	Custom 27203010		03.211.440  -  WIRE FX 1.6MM 150MM NS 40MM LCP CMPR THRD	BOTH IP/OP	$88.55 	$65.53	$0.00	$68.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.72	$65.72	$0.00	$0.00	$18.45	$0.00	$0.00	$0.00	$0.00	$42.99	$68.10	$68.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.226.039	SUP	Custom 27203010		03.226.039  -  BIT DRILL 3.2MM CANN NONSTRL 4.5MM SCREW	BOTH IP/OP	$753.45 	$557.55	$0.00	$585.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$559.21	$559.21	$0.00	$0.00	$157.02	$0.00	$0.00	$0.00	$0.00	$365.75	$579.35	$585.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.226.042	SUP	Custom 27203010		03.226.042  -  BIT DRILL 4MM DEVICE CANN	BOTH IP/OP	$811.08 	$600.20	$0.00	$629.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$601.98	$601.98	$0.00	$0.00	$169.03	$0.00	$0.00	$0.00	$0.00	$393.73	$623.66	$629.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.227.042	SUP	Custom 27203010		03.227.042  -  BIT DRILL 6MM CANN NONSTRL 6.5MM HEADLESS COMPRESSION SCREW	BOTH IP/OP	$773.13 	$572.12	$0.00	$600.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$573.81	$573.81	$0.00	$0.00	$161.12	$0.00	$0.00	$0.00	$0.00	$375.31	$594.50	$600.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.301.010S	SUP	Custom 27203010		03.301.010S  -  SET EXFIX LARGE FRAME ANKLE STERILE	BOTH IP/OP	"$5,761.33 "	"$4,263.38"	$0.00	"$4,474.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.66"	$0.00	$0.00	$0.00	$0.00	"$2,796.76"	"$4,430.08"	"$4,474.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.301.011S	SUP	Custom 27203010		03.301.011S  -  KIT TRAUMA LARGE EXFIX STERILE	BOTH IP/OP	"$6,037.58 "	"$4,467.81"	$0.00	"$4,689.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,258.23"	$0.00	$0.00	$0.00	$0.00	"$2,930.86"	"$4,642.49"	"$4,689.38"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.301.012S	SUP	Custom 27203010		03.301.012S  -  KIT FRAME LARGE EXFIX PELVIC STERILE	BOTH IP/OP	"$8,095.05 "	"$5,990.34"	$0.00	"$6,287.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,687.01"	$0.00	$0.00	$0.00	$0.00	"$3,929.63"	"$6,224.53"	"$6,287.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.304.220S	SUP	HCPCS C1713		03.304.220S  -  FIXATOR XTRNFX 2.5MM 4MM 200MM STRL LF SCHNZ LOPRFL ROD CFBR	BOTH IP/OP	"$1,659.78 "	"$1,228.24"	$0.00	"$1,289.14"	$725.14	$725.14	$0.00	$0.00	$0.00	$345.94	"$1,231.89"	"$1,231.89"	$0.00	$0.00	$345.90	$0.00	$981.76	$981.76	$0.00	$805.71	"$1,276.25"	"$1,289.14"	$0.00		$0.00	$244.84	$0.00	$0.00	$256.54	$0.00	$0.00	$0.00	$0.00	$0.00
03.304.222S	SUP	HCPCS C1713		03.304.222S  -  FIXATOR XTRNFX 2.5-4MM 220MM STRL LOPRFL ROD CFBR WRST	BOTH IP/OP	"$1,659.78 "	"$1,228.24"	$0.00	"$1,289.14"	$725.14	$725.14	$0.00	$0.00	$0.00	$345.94	"$1,231.89"	"$1,231.89"	$0.00	$0.00	$345.90	$0.00	$981.76	$981.76	$0.00	$805.71	"$1,276.25"	"$1,289.14"	$0.00		$0.00	$244.84	$0.00	$0.00	$256.54	$0.00	$0.00	$0.00	$0.00	$0.00
03.304.320S	SUP	Custom 27203010		03.304.320S  -  FIXATOR XTRNFX 3MM 4MM 200MM STRL LF SCHNZ ROD LOPRFL SLF	BOTH IP/OP	"$2,106.48 "	"$1,558.80"	$0.00	"$1,636.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,563.43"	"$1,563.43"	$0.00	$0.00	$438.99	$0.00	$0.00	$0.00	$0.00	"$1,022.56"	"$1,619.74"	"$1,636.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.304.322S	SUP	Custom 27203010		03.304.322S  -  ROD EXFIX 220MM MRI SAFE LOW-PROFILE WRIST FIXATOR	BOTH IP/OP	"$2,106.48 "	"$1,558.80"	$0.00	"$1,636.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,563.43"	"$1,563.43"	$0.00	$0.00	$438.99	$0.00	$0.00	$0.00	$0.00	"$1,022.56"	"$1,619.74"	"$1,636.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.305.004	SUP	Custom 27203010		03.305.004  -  BIT DRL 24MM 1.8/4MM NS MATRIXRIB JLTCH CPLNG STP STRYK	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$0.00	$0.00	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.305.006	SUP	Custom 27203010		03.305.006  -  CLAMP XTRNFX NS ADJ MNDB XTRNFXTR II	BOTH IP/OP	"$1,392.50 "	"$1,030.45"	$0.00	"$1,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.51"	"$1,033.51"	$0.00	$0.00	$290.20	$0.00	$0.00	$0.00	$0.00	$696.25	"$1,102.86"	"$1,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.305.009	SUP	Custom 27203010		03.305.009  -  TEMPLATE SIZING 4MM ROD	BOTH IP/OP	$917.50 	$678.95	$0.00	$734.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$680.97	$680.97	$0.00	$0.00	$191.21	$0.00	$0.00	$0.00	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.305.500	SUP	Custom 27203010		03.305.500  -  ROD EXFIX 500MM NONSTRL MANDIB FIXATOR	BOTH IP/OP	"$4,300.00 "	"$3,182.00"	$0.00	"$3,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,191.46"	"$3,191.46"	$0.00	$0.00	$896.12	$0.00	$0.00	$0.00	$0.00	"$2,150.00"	"$3,405.60"	"$3,440.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.306.010	SUP	Custom 27203010		03.306.010  -  SET ORTHOPEDIC C CLMP II PELVIC	BOTH IP/OP	"$13,379.38 "	"$9,900.74"	$0.00	"$10,391.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,788.26"	$0.00	$0.00	$0.00	$0.00	"$6,494.85"	"$10,287.84"	"$10,391.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.307.001	SUP	Custom 27203010		03.307.001  -  CLAMP EXFIX WIRE FIX EXTERNAL MIDFAC DISTRCT	BOTH IP/OP	$632.50 	$468.05	$0.00	$506.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$469.44	$469.44	$0.00	$0.00	$131.81	$0.00	$0.00	$0.00	$0.00	$316.25	$500.94	$506.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.307.010	SUP	Custom 27203010		03.307.010  -  ROD EXFIX 100MM CARFBR NONSTRL MIDFAC DISTRCT	BOTH IP/OP	$515.00 	$381.10	$0.00	$412.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.23	$382.23	$0.00	$0.00	$107.33	$0.00	$0.00	$0.00	$0.00	$257.50	$407.88	$412.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.307.105	SUP	Custom 27203010		03.307.105  -  BAR EXFIX 50MM CONNCTNG EXTERNAL MIDFAC DISTRCT	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.46	$289.46	$0.00	$0.00	$81.28	$0.00	$0.00	$0.00	$0.00	$195.00	$308.88	$312.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.307.112	SUP	Custom 27203010		03.307.112  -  BAR EXFIX 120MM CONNCTNG EXTERNAL MIDFAC DISTRCT	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.46	$289.46	$0.00	$0.00	$81.28	$0.00	$0.00	$0.00	$0.00	$195.00	$308.88	$312.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.011	SUP	Custom 27203010		03.311.011  -  CLAMP EXFIX SCREW MR SAFE PIVOT SCHANZ NONSTRL	BOTH IP/OP	$680.63 	$503.67	$0.00	$528.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$505.16	$505.16	$0.00	$0.00	$141.84	$0.00	$0.00	$0.00	$0.00	$330.40	$523.35	$528.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.012	SUP	Custom 27803010		03.311.012  -  HINGE XTRNFX NS LCK MRI SAFE	BOTH IP/OP	$340.88 	$252.25	$0.00	$264.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.00	$253.00	$0.00	$0.00	$71.04	$0.00	$0.00	$0.00	$0.00	$165.48	$262.11	$264.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.022	SUP	HCPCS C1713		03.311.022  -  PLATE EXFIX 90D 2 HOLE OFFST CONNCTNG NONSTRL	BOTH IP/OP	$157.08 	$116.24	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$32.74	$116.58	$116.58	$0.00	$0.00	$32.73	$0.00	$92.91	$92.91	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.17	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.023	SUP	HCPCS C1713		03.311.023  -  PLATE EXFIX 90D 3 HOLE OFFST CONNCTNG NONSTRL	BOTH IP/OP	$168.20 	$124.47	$0.00	$130.64	$73.49	$73.49	$0.00	$0.00	$0.00	$35.06	$124.84	$124.84	$0.00	$0.00	$35.05	$0.00	$99.49	$99.49	$0.00	$81.65	$129.33	$130.64	$0.00		$0.00	$24.81	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.024	SUP	HCPCS C1713		03.311.024  -  PLATE EXFIX 90D 4 HOLE OFFST CONNCTNG NONSTRL	BOTH IP/OP	$180.45 	$133.53	$0.00	$140.16	$78.84	$78.84	$0.00	$0.00	$0.00	$37.61	$133.93	$133.93	$0.00	$0.00	$37.61	$0.00	$106.74	$106.74	$0.00	$87.60	$138.76	$140.16	$0.00		$0.00	$26.62	$0.00	$0.00	$27.89	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.025	SUP	HCPCS C1713		03.311.025  -  PLATE EXFIX 90D 5 HOLE OFFST CONNCTNG NONSTRL	BOTH IP/OP	$192.70 	$142.60	$0.00	$149.68	$84.20	$84.20	$0.00	$0.00	$0.00	$40.16	$143.02	$143.02	$0.00	$0.00	$40.16	$0.00	$113.98	$113.98	$0.00	$93.55	$148.18	$149.68	$0.00		$0.00	$28.43	$0.00	$0.00	$29.79	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.031	SUP	Custom 27203010		03.311.031  -  EXTRACTOR SRG 1.5MM 400MM NS SMTH MR SF DSTRCT OSTEOGENESIS	BOTH IP/OP	$119.20 	$88.21	$0.00	$92.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.47	$88.47	$0.00	$0.00	$24.84	$0.00	$0.00	$0.00	$0.00	$57.86	$91.66	$92.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.032	SUP	Custom 27203010		03.311.032  -  WIRE FIX 1.8MM 400MM SMOOTH MRI SAFE NONSTRL	BOTH IP/OP	$119.20 	$88.21	$0.00	$92.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.47	$88.47	$0.00	$0.00	$24.84	$0.00	$0.00	$0.00	$0.00	$57.86	$91.66	$92.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.033	SUP	Custom 27203010		03.311.033  -  WIRE FX 2MM 400MM NS SMTH MRI SAFE	BOTH IP/OP	$119.20 	$88.21	$0.00	$92.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.47	$88.47	$0.00	$0.00	$24.84	$0.00	$0.00	$0.00	$0.00	$57.86	$91.66	$92.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.036	SUP	Custom 27203010		03.311.036  -  WIRE XTRNFX 1.5MM SMTH HLF PNT TIP MRI SAFE	BOTH IP/OP	$119.20 	$88.21	$0.00	$92.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.47	$88.47	$0.00	$0.00	$24.84	$0.00	$0.00	$0.00	$0.00	$57.86	$91.66	$92.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.037	SUP	Custom 27203010		03.311.037  -  WIRE XTRNFX 1.8MM SMTH HLF PNT TIP MRI SAFE	BOTH IP/OP	$119.20 	$88.21	$0.00	$92.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.47	$88.47	$0.00	$0.00	$24.84	$0.00	$0.00	$0.00	$0.00	$57.86	$91.66	$92.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.038	SUP	Custom 27203010		03.311.038  -  WIRE XTRNFX 2MM SMTH HLF PNT TIP MRI SAFE	BOTH IP/OP	$119.20 	$88.21	$0.00	$92.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.47	$88.47	$0.00	$0.00	$24.84	$0.00	$0.00	$0.00	$0.00	$57.86	$91.66	$92.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.041	SUP	Custom 27203010		03.311.041  -  WIRE XTRNFX 1.5MM 400MM RDC MRI SAFE	BOTH IP/OP	$370.95 	$274.50	$0.00	$288.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.32	$275.32	$0.00	$0.00	$77.31	$0.00	$0.00	$0.00	$0.00	$180.08	$285.24	$288.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.042	SUP	Custom 27203010		03.311.042  -  WIRE XTRNFX 1.8MM 400MM RDC MRI SAFE	BOTH IP/OP	$370.95 	$274.50	$0.00	$288.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.32	$275.32	$0.00	$0.00	$77.31	$0.00	$0.00	$0.00	$0.00	$180.08	$285.24	$288.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.043	SUP	Custom 27203010		03.311.043  -  WIRE FX 2MM 400MM NS SMTH MRI SAFE	BOTH IP/OP	$370.95 	$274.50	$0.00	$288.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.32	$275.32	$0.00	$0.00	$77.31	$0.00	$0.00	$0.00	$0.00	$180.08	$285.24	$288.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.046	SUP	Custom 27203010		03.311.046  -  WIRE XTRNFX 1.5MM RDC HLF PNT TIP MRI SAFE	BOTH IP/OP	$370.95 	$274.50	$0.00	$288.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.32	$275.32	$0.00	$0.00	$77.31	$0.00	$0.00	$0.00	$0.00	$180.08	$285.24	$288.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.047	SUP	Custom 27203010		03.311.047  -  WIRE XTRNFX 1.8MM RDC HLF PNT TIP MRI SAFE	BOTH IP/OP	$370.95 	$274.50	$0.00	$288.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.32	$275.32	$0.00	$0.00	$77.31	$0.00	$0.00	$0.00	$0.00	$180.08	$285.24	$288.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.048	SUP	Custom 27203010		03.311.048  -  WIRE XTRNFX 2MM RDC HLF PNT TIP MRI SAFE	BOTH IP/OP	$370.95 	$274.50	$0.00	$288.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.32	$275.32	$0.00	$0.00	$77.31	$0.00	$0.00	$0.00	$0.00	$180.08	$285.24	$288.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.060	SUP	Custom 27203010		03.311.060  -  NUT XTRNFX SQ MRI SAFE	BOTH IP/OP	$127.00 	$93.98	$0.00	$98.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.26	$94.26	$0.00	$0.00	$26.47	$0.00	$0.00	$0.00	$0.00	$61.65	$97.65	$98.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.061.10	SUP	Custom 27203010		03.311.061.10  -  NUT XTRNFX NS LF DISP	BOTH IP/OP	$6.09 	$4.51	$0.00	$4.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.52	$4.52	$0.00	$0.00	$1.27	$0.00	$0.00	$0.00	$0.00	$3.05	$4.82	$4.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.062	SUP	Custom 27803010		03.311.062  -  NUT ORTHOPEDIC MRI SAFE NONSTRL	BOTH IP/OP	$246.18 	$182.17	$0.00	$191.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.71	$182.71	$0.00	$0.00	$51.30	$0.00	$0.00	$0.00	$0.00	$119.50	$189.29	$191.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.070	SUP	Custom 27203010		03.311.070  -  POST EXFIX SHORT WIRE MRI SAFE NONSTRL	BOTH IP/OP	$305.23 	$225.87	$0.00	$237.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$226.54	$226.54	$0.00	$0.00	$63.61	$0.00	$0.00	$0.00	$0.00	$148.16	$234.69	$237.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.071	SUP	Custom 27203010		03.311.071  -  POST XTRNFX TLL NS WRE MRI SAFE	BOTH IP/OP	$346.43 	$256.36	$0.00	$269.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.12	$257.12	$0.00	$0.00	$72.19	$0.00	$0.00	$0.00	$0.00	$168.18	$266.39	$269.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.090	SUP	Custom 27803010		03.311.090  -  WASHER XTRNFX SPHRCL CPLNG MRI SAFE	BOTH IP/OP	$54.03 	$39.98	$0.00	$41.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.10	$40.10	$0.00	$0.00	$11.26	$0.00	$0.00	$0.00	$0.00	$26.23	$41.54	$41.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.091	SUP	Custom 27203010		03.311.091  -  SUPPORT XTRNFX OBLQ NS	BOTH IP/OP	$859.98 	$636.39	$0.00	$667.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$638.27	$638.27	$0.00	$0.00	$179.22	$0.00	$0.00	$0.00	$0.00	$417.46	$661.26	$667.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.106	SUP	HCPCS C1713		03.311.106  -  ROD EXFIX 60MM THREAD SLOT MR SAFE NONSTRL DISTRACTION	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.108	SUP	HCPCS C1713		03.311.108  -  ROD EXFIX 80MM THREAD SLOT MR SAFE NONSTRL DISTRACTION	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.110	SUP	Custom 27203010		03.311.110  -  ROD EXFIX 100MM THREAD SLOT MR SAFE NONSTRL DISTRACTION	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$0.00	$0.00	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.112	SUP	HCPCS C1713		03.311.112  -  ROD EXFIX 120MM THREAD MR SAFE NONSTRL DISTRACTION	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$21.82	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$61.93	$61.93	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.115	SUP	HCPCS C1713		03.311.115  -  ROD EXFIX 150MM THREAD MR SAFE NONSTRL DISTRACTION	BOTH IP/OP	$104.70 	$77.48	$0.00	$81.32	$45.74	$45.74	$0.00	$0.00	$0.00	$0.00	$77.71	$77.71	$0.00	$0.00	$21.82	$0.00	$0.00	$0.00	$0.00	$50.83	$80.51	$81.32	$0.00		$0.00	$15.45	$0.00	$0.00	$16.18	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.120	SUP	Custom 27203010		03.311.120  -  ROD EXFIX 200MM THREAD MR SAFE NONSTRL DISTRACTION	BOTH IP/OP	$113.63 	$84.09	$0.00	$88.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.33	$84.33	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$55.16	$87.38	$88.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.125	SUP	Custom 27203010		03.311.125  -  ROD EXFIX 250MM THREAD MR SAFE NONSTRL DISTRACTION	BOTH IP/OP	$113.63 	$84.09	$0.00	$88.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.33	$84.33	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$55.16	$87.38	$88.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.130	SUP	Custom 27203010		03.311.130  -  ROD EXFIX 300MM THREAD MR SAFE NONSTRL DISTRACTION	BOTH IP/OP	$131.45 	$97.27	$0.00	$102.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.56	$97.56	$0.00	$0.00	$27.39	$0.00	$0.00	$0.00	$0.00	$63.81	$101.08	$102.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.135	SUP	Custom 27203010		03.311.135  -  ROD EXFIX 350MM THREAD MR SAFE NONSTRL DISTRACTION	BOTH IP/OP	$131.45 	$97.27	$0.00	$102.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.56	$97.56	$0.00	$0.00	$27.39	$0.00	$0.00	$0.00	$0.00	$63.81	$101.08	$102.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.140	SUP	Custom 27203010		03.311.140  -  ROD EXFIX 400MM THREAD MR SAFE NONSTRL DISTRACTION	BOTH IP/OP	$172.65 	$127.76	$0.00	$134.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$128.14	$128.14	$0.00	$0.00	$35.98	$0.00	$0.00	$0.00	$0.00	$83.81	$132.76	$134.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.171	SUP	Custom 27203010		03.311.171  -  POST XTRNFX NS 1 HL WRE FEM	BOTH IP/OP	$333.08 	$246.48	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.21	$247.21	$0.00	$0.00	$69.41	$0.00	$0.00	$0.00	$0.00	$161.69	$256.12	$258.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.172	SUP	Custom 27203010		03.311.172  -  POST XTRNFX NS 2 HL WRE FEM	BOTH IP/OP	$346.43 	$256.36	$0.00	$269.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.12	$257.12	$0.00	$0.00	$72.19	$0.00	$0.00	$0.00	$0.00	$168.18	$266.39	$269.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.173	SUP	Custom 27203010		03.311.173  -  POST XTRNFX NS 3 HL WRE FEM	BOTH IP/OP	$358.70 	$265.44	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$266.23	$266.23	$0.00	$0.00	$74.75	$0.00	$0.00	$0.00	$0.00	$174.13	$275.81	$278.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.174	SUP	Custom 27203010		03.311.174  -  POST XTRNFX NS 4 HL WRE FEM	BOTH IP/OP	$373.18 	$276.15	$0.00	$289.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.97	$276.97	$0.00	$0.00	$77.77	$0.00	$0.00	$0.00	$0.00	$181.15	$286.94	$289.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.175	SUP	Custom 27203010		03.311.175  -  POST XTRNFX NS 5 HL WRE FEM	BOTH IP/OP	$385.43 	$285.22	$0.00	$299.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.06	$286.06	$0.00	$0.00	$80.32	$0.00	$0.00	$0.00	$0.00	$187.10	$296.37	$299.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.200	SUP	HCPCS C1713		03.311.200  -  PLATE XTRNFX FLT NS 1 HL CNCT MRI SAFE FEM CFBR RING	BOTH IP/OP	$118.08 	$87.38	$0.00	$91.72	$51.59	$51.59	$0.00	$0.00	$0.00	$24.61	$87.64	$87.64	$0.00	$0.00	$24.61	$0.00	$69.84	$69.84	$0.00	$57.33	$90.80	$91.72	$0.00		$0.00	$17.42	$0.00	$0.00	$18.25	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.201	SUP	HCPCS C1713		03.311.201  -  PLATE XTRNFX NS 1 HL CNCT MRI SAFE FEM CFBR RING	BOTH IP/OP	$118.08 	$87.38	$0.00	$91.72	$51.59	$51.59	$0.00	$0.00	$0.00	$24.61	$87.64	$87.64	$0.00	$0.00	$24.61	$0.00	$69.84	$69.84	$0.00	$57.33	$90.80	$91.72	$0.00		$0.00	$17.42	$0.00	$0.00	$18.25	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.202	SUP	HCPCS C1713		03.311.202  -  PLATE XTRNFX NS 2 HL CNCT MRI SAFE FEM CFBR RING	BOTH IP/OP	$127.00 	$93.98	$0.00	$98.64	$55.49	$55.49	$0.00	$0.00	$0.00	$26.47	$94.26	$94.26	$0.00	$0.00	$26.47	$0.00	$75.12	$75.12	$0.00	$61.65	$97.65	$98.64	$0.00		$0.00	$18.73	$0.00	$0.00	$19.63	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.203	SUP	HCPCS C1713		03.311.203  -  PLATE XTRNFX NS 3 HL CNCT MRI SAFE FEM CFBR RING	BOTH IP/OP	$131.45 	$97.27	$0.00	$102.10	$57.43	$57.43	$0.00	$0.00	$0.00	$27.40	$97.56	$97.56	$0.00	$0.00	$27.39	$0.00	$77.75	$77.75	$0.00	$63.81	$101.08	$102.10	$0.00		$0.00	$19.39	$0.00	$0.00	$20.32	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.204	SUP	HCPCS C1713		03.311.204  -  PLATE XTRNFX NS 4 HL CNCT MRI SAFE FEM CFBR RING	BOTH IP/OP	$149.28 	$110.47	$0.00	$115.94	$65.22	$65.22	$0.00	$0.00	$0.00	$31.11	$110.79	$110.79	$0.00	$0.00	$31.11	$0.00	$88.30	$88.30	$0.00	$72.46	$114.78	$115.94	$0.00		$0.00	$22.02	$0.00	$0.00	$23.07	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.205	SUP	HCPCS C1713		03.311.205  -  PLATE XTRNFX NS 5 HL CNCT MRI SAFE FEM CFBR RING	BOTH IP/OP	$172.65 	$127.76	$0.00	$134.10	$75.43	$75.43	$0.00	$0.00	$0.00	$35.98	$128.14	$128.14	$0.00	$0.00	$35.98	$0.00	$102.12	$102.12	$0.00	$83.81	$132.76	$134.10	$0.00		$0.00	$25.47	$0.00	$0.00	$26.69	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.212	SUP	HCPCS C1713		03.311.212  -  PLATE XTRNFX NS 2 HL CNCT	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$54.99	$54.99	$0.00	$0.00	$0.00	$26.24	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$74.46	$74.46	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$18.57	$0.00	$0.00	$19.45	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.213	SUP	HCPCS C1713		03.311.213  -  PLATE XTRNFX NS 3 HL CNCT	BOTH IP/OP	$139.25 	$103.05	$0.00	$108.16	$60.84	$60.84	$0.00	$0.00	$0.00	$29.02	$103.35	$103.35	$0.00	$0.00	$29.02	$0.00	$82.37	$82.37	$0.00	$67.60	$107.08	$108.16	$0.00		$0.00	$20.54	$0.00	$0.00	$21.52	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.214	SUP	HCPCS C1713		03.311.214  -  PLATE XTRNFX NS 4 HL CNCT	BOTH IP/OP	$150.38 	$111.28	$0.00	$116.80	$65.70	$65.70	$0.00	$0.00	$0.00	$31.34	$111.61	$111.61	$0.00	$0.00	$31.34	$0.00	$88.95	$88.95	$0.00	$73.00	$115.63	$116.80	$0.00		$0.00	$22.18	$0.00	$0.00	$23.24	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.215	SUP	HCPCS C1713		03.311.215  -  PLATE XTRNFX NS 5 HL CNCT	BOTH IP/OP	$162.63 	$120.35	$0.00	$126.32	$71.06	$71.06	$0.00	$0.00	$0.00	$33.90	$120.70	$120.70	$0.00	$0.00	$33.89	$0.00	$96.19	$96.19	$0.00	$78.95	$125.06	$126.32	$0.00		$0.00	$23.99	$0.00	$0.00	$25.14	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.220	SUP	Custom 27203010		03.311.220  -  SPACER XTRNFX 20MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS	BOTH IP/OP	$72.98 	$54.01	$0.00	$56.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.16	$54.16	$0.00	$0.00	$15.21	$0.00	$0.00	$0.00	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.230	SUP	Custom 27803010		03.311.230  -  SPACER XTRNFX 30MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS	BOTH IP/OP	$79.10 	$58.53	$0.00	$61.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.71	$58.71	$0.00	$0.00	$16.48	$0.00	$0.00	$0.00	$0.00	$38.39	$60.81	$61.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.240	SUP	Custom 27203010		03.311.240  -  SPACER XTRNFX 40MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS	BOTH IP/OP	$87.45 	$64.71	$0.00	$67.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.91	$64.91	$0.00	$0.00	$18.22	$0.00	$0.00	$0.00	$0.00	$42.45	$67.24	$67.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.250	SUP	Custom 27203010		03.311.250  -  SPACER XTRNFX 50MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS	BOTH IP/OP	$118.08 	$87.38	$0.00	$91.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.64	$87.64	$0.00	$0.00	$24.61	$0.00	$0.00	$0.00	$0.00	$57.33	$90.80	$91.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.308	SUP	Custom 27203010		03.311.308  -  RING EXFIX HALF 80MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	$578.13 	$427.82	$0.00	$449.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$429.08	$429.08	$0.00	$0.00	$120.48	$0.00	$0.00	$0.00	$0.00	$280.65	$444.55	$449.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.310	SUP	Custom 27203010		03.311.310  -  RING EXFIX HALF 100MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	$623.80 	$461.61	$0.00	$484.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$462.98	$462.98	$0.00	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$302.83	$479.67	$484.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.311	SUP	Custom 27203010		03.311.311  -  RING EXFIX HALF 110MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	$639.40 	$473.16	$0.00	$496.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$474.56	$474.56	$0.00	$0.00	$133.25	$0.00	$0.00	$0.00	$0.00	$310.39	$491.66	$496.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.312	SUP	Custom 27203010		03.311.312  -  RING EXFIX HALF 120MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	$666.15 	$492.95	$0.00	$517.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$494.42	$494.42	$0.00	$0.00	$138.83	$0.00	$0.00	$0.00	$0.00	$323.36	$512.21	$517.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.313	SUP	Custom 27203010		03.311.313  -  RING EXFIX HALF 130MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	$682.85 	$505.31	$0.00	$530.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.81	$506.81	$0.00	$0.00	$142.31	$0.00	$0.00	$0.00	$0.00	$331.48	$525.06	$530.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.314	SUP	Custom 27203010		03.311.314  -  RING EXFIX HALF 140MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	$709.58 	$525.09	$0.00	$551.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.65	$526.65	$0.00	$0.00	$147.88	$0.00	$0.00	$0.00	$0.00	$344.46	$545.63	$551.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.315	SUP	Custom 27203010		03.311.315  -  RING EXFIX HALF 150MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	$755.25 	$558.89	$0.00	$586.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$560.55	$560.55	$0.00	$0.00	$157.39	$0.00	$0.00	$0.00	$0.00	$366.63	$580.73	$586.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.316	SUP	Custom 27203010		03.311.316  -  RING EXFIX HALF 160MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	$823.20 	$609.17	$0.00	$639.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.98	$610.98	$0.00	$0.00	$171.55	$0.00	$0.00	$0.00	$0.00	$399.61	$632.99	$639.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.318	SUP	Custom 27203010		03.311.318  -  RING EXFIX HALF 180MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	$884.48 	$654.52	$0.00	$686.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$656.46	$656.46	$0.00	$0.00	$184.32	$0.00	$0.00	$0.00	$0.00	$429.35	$680.09	$686.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.320	SUP	Custom 27203010		03.311.320  -  RING EXFIX HALF 200MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	$958.00 	$708.92	$0.00	$744.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$711.03	$711.03	$0.00	$0.00	$199.65	$0.00	$0.00	$0.00	$0.00	$465.05	$736.64	$744.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.322	SUP	Custom 27203010		03.311.322  -  RING EXFIX HALF 220MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	"$1,019.25 "	$754.25	$0.00	$791.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$756.49	$756.49	$0.00	$0.00	$212.41	$0.00	$0.00	$0.00	$0.00	$494.79	$783.75	$791.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.324	SUP	Custom 27203010		03.311.324  -  RING EXFIX HALF 240MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	"$1,063.83 "	$787.23	$0.00	$826.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$789.57	$789.57	$0.00	$0.00	$221.70	$0.00	$0.00	$0.00	$0.00	$516.41	$818.00	$826.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.344	SUP	Custom 27203010		03.311.344  -  RING EXFIX FULL 140MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	"$1,414.70 "	"$1,046.88"	$0.00	"$1,098.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,049.99"	"$1,049.99"	$0.00	$0.00	$294.82	$0.00	$0.00	$0.00	$0.00	$686.75	"$1,087.81"	"$1,098.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.346	SUP	Custom 27203010		03.311.346  -  RING EXFIX FULL 160MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	"$1,645.30 "	"$1,217.52"	$0.00	"$1,277.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,221.14"	"$1,221.14"	$0.00	$0.00	$342.88	$0.00	$0.00	$0.00	$0.00	$798.69	"$1,265.12"	"$1,277.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.348	SUP	Custom 27203010		03.311.348  -  RING EXFIX FULL 180MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	"$1,768.95 "	"$1,309.02"	$0.00	"$1,373.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,312.91"	"$1,312.91"	$0.00	$0.00	$368.65	$0.00	$0.00	$0.00	$0.00	$858.71	"$1,360.20"	"$1,373.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.350	SUP	Custom 27203010		03.311.350  -  RING EXFIX FULL 200MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	"$1,920.45 "	"$1,421.13"	$0.00	"$1,491.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,425.36"	"$1,425.36"	$0.00	$0.00	$400.22	$0.00	$0.00	$0.00	$0.00	$932.25	"$1,476.68"	"$1,491.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.373	SUP	Custom 27203010		03.311.373  -  RING EXFIX 5/8 130MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	$930.15 	$688.31	$0.00	$722.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$690.36	$690.36	$0.00	$0.00	$193.84	$0.00	$0.00	$0.00	$0.00	$451.53	$715.22	$722.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.375	SUP	Custom 27203010		03.311.375  -  RING EXFIX 5/8 150MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	"$1,019.25 "	$754.25	$0.00	$791.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$756.49	$756.49	$0.00	$0.00	$212.41	$0.00	$0.00	$0.00	$0.00	$494.79	$783.75	$791.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.376	SUP	Custom 27203010		03.311.376  -  RING EXFIX 5/8 160MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	"$1,106.15 "	$818.55	$0.00	$859.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$820.98	$820.98	$0.00	$0.00	$230.52	$0.00	$0.00	$0.00	$0.00	$536.96	$850.55	$859.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.378	SUP	Custom 27203010		03.311.378  -  RING EXFIX 5/8 180MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	"$1,284.38 "	$950.44	$0.00	$997.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$953.26	$953.26	$0.00	$0.00	$267.66	$0.00	$0.00	$0.00	$0.00	$623.49	$987.61	$997.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.380	SUP	Custom 27203010		03.311.380  -  RING EXFIX 5/8 200MM TITANIUM NONSTRL DISTRACTION	BOTH IP/OP	"$1,327.83 "	$982.59	$0.00	"$1,031.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$985.51	$985.51	$0.00	$0.00	$276.72	$0.00	$0.00	$0.00	$0.00	$644.58	"$1,021.01"	"$1,031.32"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.391	SUP	HCPCS C1713		03.311.391  -  PLATE XTRNFX 90D ARCH 180MM NS TI FEM DSTRCT OSTEOGENESIS	BOTH IP/OP	"$1,592.95 "	"$1,178.78"	$0.00	"$1,237.24"	$695.95	$695.95	$0.00	$0.00	$0.00	$332.01	"$1,182.29"	"$1,182.29"	$0.00	$0.00	$331.97	$0.00	$942.23	$942.23	$0.00	$773.28	"$1,224.87"	"$1,237.24"	$0.00		$0.00	$234.98	$0.00	$0.00	$246.21	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.392	SUP	HCPCS C1713		03.311.392  -  PLATE XTRNFX 120D ARCH 180MM NS TI FEM DSTRCT OSTEOGENESIS	BOTH IP/OP	"$1,636.38 "	"$1,210.92"	$0.00	"$1,270.98"	$714.93	$714.93	$0.00	$0.00	$0.00	$341.06	"$1,214.52"	"$1,214.52"	$0.00	$0.00	$341.02	$0.00	$967.92	$967.92	$0.00	$794.36	"$1,258.27"	"$1,270.98"	$0.00		$0.00	$241.39	$0.00	$0.00	$252.93	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.396	SUP	HCPCS C1713		03.311.396  -  PLATE XTRNFX 90D ARCH 240MM NS TI FEM DSTRCT OSTEOGENESIS	BOTH IP/OP	"$1,727.73 "	"$1,278.52"	$0.00	"$1,341.92"	$754.83	$754.83	$0.00	$0.00	$0.00	$360.10	"$1,282.32"	"$1,282.32"	$0.00	$0.00	$360.06	$0.00	"$1,021.95"	"$1,021.95"	$0.00	$838.70	"$1,328.50"	"$1,341.92"	$0.00		$0.00	$254.87	$0.00	$0.00	$267.04	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.397	SUP	HCPCS C1713		03.311.397  -  PLATE XTRNFX 120D ARCH 240MM NS TI FEM DSTRCT OSTEOGENESIS	BOTH IP/OP	"$1,768.95 "	"$1,309.02"	$0.00	"$1,373.94"	$772.84	$772.84	$0.00	$0.00	$0.00	$368.69	"$1,312.91"	"$1,312.91"	$0.00	$0.00	$368.65	$0.00	"$1,046.33"	"$1,046.33"	$0.00	$858.71	"$1,360.20"	"$1,373.94"	$0.00		$0.00	$260.95	$0.00	$0.00	$273.41	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.406	SUP	Custom 27803010		03.311.406  -  DISTRACTOR SURG 60MM 25MM LINEAR NONSTRL	BOTH IP/OP	"$1,019.25 "	$754.25	$0.00	$791.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$756.49	$756.49	$0.00	$0.00	$212.41	$0.00	$0.00	$0.00	$0.00	$494.79	$783.75	$791.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.412	SUP	Custom 27803010		03.311.412  -  DISTRACTOR SURG 85MM TRAVEL 120MM LINEAR MRI SAFE NONSTRL	BOTH IP/OP	"$1,106.15 "	$818.55	$0.00	$859.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$820.98	$820.98	$0.00	$0.00	$230.52	$0.00	$0.00	$0.00	$0.00	$536.96	$850.55	$859.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.418	SUP	Custom 27803010		03.311.418  -  DISTRACTOR SURG 180MM LINEAR MRI SAFE NONSTRL	BOTH IP/OP	"$1,239.83 "	$917.47	$0.00	$962.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$920.20	$920.20	$0.00	$0.00	$258.38	$0.00	$0.00	$0.00	$0.00	$601.85	$953.33	$962.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.425	SUP	Custom 27803010		03.311.425  -  DISTRACTOR SURG 215MM TRAVEL 250MM LINEAR MRI SAFE NONSTRL	BOTH IP/OP	"$1,504.95 "	"$1,113.66"	$0.00	"$1,168.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,116.97"	"$1,116.97"	$0.00	$0.00	$313.63	$0.00	$0.00	$0.00	$0.00	$730.55	"$1,157.19"	"$1,168.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.450	SUP	Custom 27803010		03.311.450  -  DISTRACTOR SURG ANGLE NONSTRL	BOTH IP/OP	$990.30 	$732.82	$0.00	$769.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$735.00	$735.00	$0.00	$0.00	$206.38	$0.00	$0.00	$0.00	$0.00	$480.73	$761.47	$769.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.451	SUP	Custom 27803010		03.311.451  -  DISTRACTOR SURG ANGLE PIVOT NONSTRL	BOTH IP/OP	$432.20 	$319.83	$0.00	$335.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.78	$320.78	$0.00	$0.00	$90.07	$0.00	$0.00	$0.00	$0.00	$209.81	$332.35	$335.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.810	SUP	Custom 27203010		03.311.810  -  RING EXFIX .5 100MM MRI SAFE CARFBR NONSTRL	BOTH IP/OP	$709.58 	$525.09	$0.00	$551.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.65	$526.65	$0.00	$0.00	$147.88	$0.00	$0.00	$0.00	$0.00	$344.46	$545.63	$551.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.812	SUP	Custom 27203010		03.311.812  -  RING EXFIX .5 120MM MRI SAFE CARFBR NONSTRL	BOTH IP/OP	$755.25 	$558.89	$0.00	$586.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$560.55	$560.55	$0.00	$0.00	$157.39	$0.00	$0.00	$0.00	$0.00	$366.63	$580.73	$586.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.814	SUP	Custom 27203010		03.311.814  -  RING EXFIX .5 140MM MRI SAFE CARFBR NONSTRL	BOTH IP/OP	$798.70 	$591.04	$0.00	$620.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$592.80	$592.80	$0.00	$0.00	$166.45	$0.00	$0.00	$0.00	$0.00	$387.71	$614.14	$620.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.816	SUP	Custom 27203010		03.311.816  -  RING EXFIX .5 160MM MRI SAFE CARFBR NONSTRL	BOTH IP/OP	$884.48 	$654.52	$0.00	$686.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$656.46	$656.46	$0.00	$0.00	$184.32	$0.00	$0.00	$0.00	$0.00	$429.35	$680.09	$686.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.818	SUP	Custom 27203010		03.311.818  -  RING EXFIX .5 180MM MRI SAFE CARFBR NONSTRL	BOTH IP/OP	$930.15 	$688.31	$0.00	$722.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$690.36	$690.36	$0.00	$0.00	$193.84	$0.00	$0.00	$0.00	$0.00	$451.53	$715.22	$722.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.820	SUP	Custom 27203010		03.311.820  -  RING EXFIX .5 200MM MRI SAFE CARFBR NONSTRL	BOTH IP/OP	$974.70 	$721.28	$0.00	$757.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.42	$723.42	$0.00	$0.00	$203.13	$0.00	$0.00	$0.00	$0.00	$473.16	$749.49	$757.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.844	SUP	Custom 27203010		03.311.844  -  RING EXFIX 140MM FULL RING MRI SAFE CARFBR	BOTH IP/OP	"$1,592.95 "	"$1,178.78"	$0.00	"$1,237.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,182.29"	"$1,182.29"	$0.00	$0.00	$331.97	$0.00	$0.00	$0.00	$0.00	$773.28	"$1,224.87"	"$1,237.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.846	SUP	Custom 27203010		03.311.846  -  RING EXFIX FULL 160MM FULL RING MRI SAFE CARFBR NONSTRL	BOTH IP/OP	"$1,768.95 "	"$1,309.02"	$0.00	"$1,373.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,312.91"	"$1,312.91"	$0.00	$0.00	$368.65	$0.00	$0.00	$0.00	$0.00	$858.71	"$1,360.20"	"$1,373.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.848	SUP	Custom 27203010		03.311.848  -  RING EXFIX 180MM FULL RING MRI SAFE CARFBR	BOTH IP/OP	"$1,947.18 "	"$1,440.91"	$0.00	"$1,512.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,445.19"	"$1,445.19"	$0.00	$0.00	$405.79	$0.00	$0.00	$0.00	$0.00	$945.23	"$1,497.24"	"$1,512.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.850	SUP	Custom 27203010		03.311.850  -  RING EXFIX 200MM FULL RING MRI SAFE CARFBR	BOTH IP/OP	"$2,122.08 "	"$1,570.34"	$0.00	"$1,648.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$442.24	$0.00	$0.00	$0.00	$0.00	"$1,030.13"	"$1,631.72"	"$1,648.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.874	SUP	Custom 27203010		03.311.874  -  RING EXFIX 5/8 140MM MRI SAFE CARFBR NONSTRL	BOTH IP/OP	$930.15 	$688.31	$0.00	$722.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$690.36	$690.36	$0.00	$0.00	$193.84	$0.00	$0.00	$0.00	$0.00	$451.53	$715.22	$722.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.876	SUP	Custom 27203010		03.311.876  -  RING EXFIX 5/8 160MM MRI SAFE CARFBR NONSTRL	BOTH IP/OP	$974.70 	$721.28	$0.00	$757.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.42	$723.42	$0.00	$0.00	$203.13	$0.00	$0.00	$0.00	$0.00	$473.16	$749.49	$757.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.878	SUP	Custom 27203010		03.311.878  -  RING EXFIX 5/8 180MM MRI SAFE CARFBR NONSTRL	BOTH IP/OP	"$1,019.25 "	$754.25	$0.00	$791.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$756.49	$756.49	$0.00	$0.00	$212.41	$0.00	$0.00	$0.00	$0.00	$494.79	$783.75	$791.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.880	SUP	Custom 27203010		03.311.880  -  RING EXFIX 5/8 200MM MRI SAFE CARFBR NONSTRL	BOTH IP/OP	"$1,063.83 "	$787.23	$0.00	$826.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$789.57	$789.57	$0.00	$0.00	$221.70	$0.00	$0.00	$0.00	$0.00	$516.41	$818.00	$826.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.891	SUP	HCPCS C1713		03.311.891  -  PLATE XTRNFX 90D ARCH 180MM NS MRI SAFE CFBR FEM	BOTH IP/OP	"$1,462.60 "	"$1,082.32"	$0.00	"$1,136.00"	$639.00	$639.00	$0.00	$0.00	$0.00	$304.84	"$1,085.54"	"$1,085.54"	$0.00	$0.00	$304.81	$0.00	$865.13	$865.13	$0.00	$710.00	"$1,124.64"	"$1,136.00"	$0.00		$0.00	$215.76	$0.00	$0.00	$226.06	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.892	SUP	HCPCS C1713		03.311.892  -  PLATE XTRNFX 120D ARCH 180MM NS MRI SAFE CFBR FEM	BOTH IP/OP	"$1,511.63 "	"$1,118.61"	$0.00	"$1,174.08"	$660.42	$660.42	$0.00	$0.00	$0.00	$315.06	"$1,121.93"	"$1,121.93"	$0.00	$0.00	$315.02	$0.00	$894.13	$894.13	$0.00	$733.80	"$1,162.34"	"$1,174.08"	$0.00		$0.00	$222.99	$0.00	$0.00	$233.64	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.896	SUP	HCPCS C1713		03.311.896  -  PLATE XTRNFX 90D ARCH 240MM NS MRI SAFE CFBR FEM	BOTH IP/OP	"$1,556.18 "	"$1,151.57"	$0.00	"$1,208.68"	$679.88	$679.88	$0.00	$0.00	$0.00	$324.35	"$1,154.99"	"$1,154.99"	$0.00	$0.00	$324.31	$0.00	$920.48	$920.48	$0.00	$755.43	"$1,196.59"	"$1,208.68"	$0.00		$0.00	$229.56	$0.00	$0.00	$240.53	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.897	SUP	HCPCS C1713		03.311.897  -  PLATE XTRNFX 120D ARCH 240MM NS MRI SAFE CFBR FEM	BOTH IP/OP	"$1,646.40 "	"$1,218.34"	$0.00	"$1,278.76"	$719.30	$719.30	$0.00	$0.00	$0.00	$343.15	"$1,221.96"	"$1,221.96"	$0.00	$0.00	$343.11	$0.00	$973.85	$973.85	$0.00	$799.23	"$1,265.97"	"$1,278.76"	$0.00		$0.00	$242.87	$0.00	$0.00	$254.47	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.910	SUP	Custom 27203010		03.311.910  -  RING EXFIX SHORT 100MM MRI SAFE CARFBR FT	BOTH IP/OP	"$1,144.03 "	$846.58	$0.00	$888.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$849.10	$849.10	$0.00	$0.00	$238.41	$0.00	$0.00	$0.00	$0.00	$555.35	$879.67	$888.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.914	SUP	Custom 27203010		03.311.914  -  RING EXFIX SHORT 140MM MRI SAFE CARFBR FT	BOTH IP/OP	"$1,189.70 "	$880.38	$0.00	$924.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.00	$883.00	$0.00	$0.00	$247.93	$0.00	$0.00	$0.00	$0.00	$577.53	$914.80	$924.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.916	SUP	Custom 27203010		03.311.916  -  RING EXFIX SHORT 160MM FT RING MRI SAFE CARFBR	BOTH IP/OP	"$1,236.48 "	$915.00	$0.00	$960.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$917.71	$917.71	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$600.24	$950.78	$960.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.918	SUP	Custom 27203010		03.311.918  -  RING EXFIX SHORT 180MM MRI SAFE CARFBR FT	BOTH IP/OP	"$1,282.15 "	$948.79	$0.00	$995.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$951.61	$951.61	$0.00	$0.00	$267.20	$0.00	$0.00	$0.00	$0.00	$622.40	$985.88	$995.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.940	SUP	Custom 27203010		03.311.940  -  RING EXFIX LONG 100MM MRI SAFE CARFBR FT	BOTH IP/OP	"$1,144.03 "	$846.58	$0.00	$888.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$849.10	$849.10	$0.00	$0.00	$238.41	$0.00	$0.00	$0.00	$0.00	$555.35	$879.67	$888.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.944	SUP	Custom 27203010		03.311.944  -  RING EXFIX LONG 140MM MRI SAFE CARFBR FT	BOTH IP/OP	"$1,189.70 "	$880.38	$0.00	$924.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.00	$883.00	$0.00	$0.00	$247.93	$0.00	$0.00	$0.00	$0.00	$577.53	$914.80	$924.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.946	SUP	Custom 27203010		03.311.946  -  RING EXFIX 160MM MRI SAFE CARFBR FT	BOTH IP/OP	"$1,236.48 "	$915.00	$0.00	$960.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$917.71	$917.71	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$600.24	$950.78	$960.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.948	SUP	Custom 27203010		03.311.948  -  RING EXFIX LONG 180MM MRI SAFE CARFBR FT	BOTH IP/OP	"$1,282.15 "	$948.79	$0.00	$995.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$951.61	$951.61	$0.00	$0.00	$267.20	$0.00	$0.00	$0.00	$0.00	$622.40	$985.88	$995.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.960	SUP	Custom 27203010		03.311.960  -  RING EXFIX SHORT 100MM MRI SAFE TITANIUM FT NONSTRL	BOTH IP/OP	"$1,504.95 "	"$1,113.66"	$0.00	"$1,168.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,116.97"	"$1,116.97"	$0.00	$0.00	$313.63	$0.00	$0.00	$0.00	$0.00	$730.55	"$1,157.19"	"$1,168.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.964	SUP	Custom 27203010		03.311.964  -  RING EXFIX SHORT 140MM MRI SAFE TITANIUM FT NONSTRL	BOTH IP/OP	"$1,566.20 "	"$1,158.99"	$0.00	"$1,216.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,162.43"	"$1,162.43"	$0.00	$0.00	$326.40	$0.00	$0.00	$0.00	$0.00	$760.30	"$1,204.32"	"$1,216.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.966	SUP	Custom 27203010		03.311.966  -  RING EXFIX SHORT 160MM MRI SAFE TITANIUM FT NONSTRL	BOTH IP/OP	"$1,628.60 "	"$1,205.16"	$0.00	"$1,264.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,208.75"	"$1,208.75"	$0.00	$0.00	$339.40	$0.00	$0.00	$0.00	$0.00	$790.58	"$1,252.27"	"$1,264.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.968	SUP	Custom 27203010		03.311.968  -  RING EXFIX SHORT 180MM MRI SAFE TITANIUM FT NONSTRL	BOTH IP/OP	"$1,689.85 "	"$1,250.49"	$0.00	"$1,312.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,254.21"	"$1,254.21"	$0.00	$0.00	$352.16	$0.00	$0.00	$0.00	$0.00	$820.31	"$1,299.38"	"$1,312.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.970	SUP	Custom 27203010		03.311.970  -  RING EXFIX SHORT 200MM MRI SAFE TITANIUM FT NONSTRL	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,359.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$849.51	"$1,345.63"	"$1,359.22"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.980	SUP	Custom 27203010		03.311.980  -  RING EXFIX LONG 100MM MRI SAFE TITANIUM FT NONSTRL	BOTH IP/OP	"$1,504.95 "	"$1,113.66"	$0.00	"$1,168.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,116.97"	"$1,116.97"	$0.00	$0.00	$313.63	$0.00	$0.00	$0.00	$0.00	$730.55	"$1,157.19"	"$1,168.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.984	SUP	Custom 27203010		03.311.984  -  RING EXFIX LONG 140MM MRI SAFE TITANIUM FT NONSTRL	BOTH IP/OP	"$1,566.20 "	"$1,158.99"	$0.00	"$1,216.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,162.43"	"$1,162.43"	$0.00	$0.00	$326.40	$0.00	$0.00	$0.00	$0.00	$760.30	"$1,204.32"	"$1,216.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.986	SUP	Custom 27203010		03.311.986  -  RING EXFIX LONG 160MM MRI SAFE TITANIUM FT NONSTRL	BOTH IP/OP	"$1,628.60 "	"$1,205.16"	$0.00	"$1,264.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,208.75"	"$1,208.75"	$0.00	$0.00	$339.40	$0.00	$0.00	$0.00	$0.00	$790.58	"$1,252.27"	"$1,264.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.988	SUP	Custom 27203010		03.311.988  -  RING EXFIX LONG 180+ MM MRI SAFE TITANIUM FT NONSTRL	BOTH IP/OP	"$1,689.85 "	"$1,250.49"	$0.00	"$1,312.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,254.21"	"$1,254.21"	$0.00	$0.00	$352.16	$0.00	$0.00	$0.00	$0.00	$820.31	"$1,299.38"	"$1,312.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.311.990	SUP	Custom 27203010		03.311.990  -  RING EXFIX LONG 200+ MM MRI SAFE TITANIUM FT NONSTRL	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,359.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$849.51	"$1,345.63"	"$1,359.22"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.390.052S	SUP	HCPCS C1713		03.390.052S  -  FIXATOR XTRNFX 200MM STRL SCHNZ PREASSEMBLE FRM SLF DRL CFBR	BOTH IP/OP	"$4,161.70 "	"$3,079.66"	$0.00	"$3,232.38"	"$1,818.21"	"$1,818.21"	$0.00	$0.00	$0.00	$867.40	"$3,088.81"	"$3,088.81"	$0.00	$0.00	$867.30	$0.00	"$2,051.72"	"$2,051.72"	$0.00	"$2,020.24"	"$3,200.06"	"$3,232.38"	$0.00		$0.00	$613.92	$0.00	$0.00	$643.24	$0.00	$0.00	$0.00	$0.00	$0.00
03.390.053S	SUP	Custom 27203010		03.390.053S  -  SET EXFIX 220MM SCREW ROD MRI SAFE DISTAL RAD NONSTRL	BOTH IP/OP	"$4,161.70 "	"$3,079.66"	$0.00	"$3,232.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,088.81"	"$3,088.81"	$0.00	$0.00	$867.30	$0.00	$0.00	$0.00	$0.00	"$2,020.24"	"$3,200.06"	"$3,232.38"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.390.054S	SUP	HCPCS C1713		03.390.054S  -  FIXATOR XTRNFX 240MM STRL SCHNZ PREASSEMBLE FRM SLF DRL CFBR	BOTH IP/OP	"$4,161.70 "	"$3,079.66"	$0.00	"$3,232.38"	"$1,818.21"	"$1,818.21"	$0.00	$0.00	$0.00	$867.40	"$3,088.81"	"$3,088.81"	$0.00	$0.00	$867.30	$0.00	"$2,051.72"	"$2,051.72"	$0.00	"$2,020.24"	"$3,200.06"	"$3,232.38"	$0.00		$0.00	$613.92	$0.00	$0.00	$643.24	$0.00	$0.00	$0.00	$0.00	$0.00
03.390.055S	SUP	HCPCS C1713		03.390.055S  -  FIXATOR EXFIX 200MM SLFDRILL SCHANZ SCREW ROD MRI SAFE	BOTH IP/OP	"$4,446.88 "	"$3,290.69"	$0.00	"$3,453.88"	"$1,942.81"	"$1,942.81"	$0.00	$0.00	$0.00	$926.84	"$3,300.47"	"$3,300.47"	$0.00	$0.00	$926.73	$0.00	"$2,192.31"	"$2,192.31"	$0.00	"$2,158.68"	"$3,419.34"	"$3,453.88"	$0.00		$0.00	$655.99	$0.00	$0.00	$687.32	$0.00	$0.00	$0.00	$0.00	$0.00
03.390.056S	SUP	HCPCS C1713		03.390.056S  -  FIXATOR EXFIX 220MM SLFDRILL SCHANZ SCREW ROD MRI SAFE	BOTH IP/OP	"$4,446.88 "	"$3,290.69"	$0.00	"$3,453.88"	"$1,942.81"	"$1,942.81"	$0.00	$0.00	$0.00	$926.84	"$3,300.47"	"$3,300.47"	$0.00	$0.00	$926.73	$0.00	"$2,192.31"	"$2,192.31"	$0.00	"$2,158.68"	"$3,419.34"	"$3,453.88"	$0.00		$0.00	$655.99	$0.00	$0.00	$687.32	$0.00	$0.00	$0.00	$0.00	$0.00
03.390.057S	SUP	Custom 27203010		03.390.057S  -  SET EXFIX SLFDRILL SCHANZ SCREW CARFBR ROD MR SAFE TITANIUM	BOTH IP/OP	"$4,446.88 "	"$3,290.69"	$0.00	"$3,453.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,300.47"	"$3,300.47"	$0.00	$0.00	$926.73	$0.00	$0.00	$0.00	$0.00	"$2,158.68"	"$3,419.34"	"$3,453.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.004	SUP	Custom 27203010		03.500.004  -  BIT DRILL 44.5MM 1.25MM TI JLTCH STOP 4MM OTHDNTC BONE ANCH	BOTH IP/OP	$355.50 	$263.07	$0.00	$284.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.85	$263.85	$0.00	$0.00	$74.09	$0.00	$0.00	$0.00	$0.00	$177.75	$281.56	$284.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.006	SUP	Custom 27203010		03.500.006  -  BIT DRILL 44.5MM 1.25MM TI JLTCH STOP 6MM OTHDNTC BONE ANCH	BOTH IP/OP	$355.50 	$263.07	$0.00	$284.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.85	$263.85	$0.00	$0.00	$74.09	$0.00	$0.00	$0.00	$0.00	$177.75	$281.56	$284.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.008	SUP	Custom 27203010		03.500.008  -  1.25MM DRILL BIT J-LATCH/8MM STOP/44.5MM	BOTH IP/OP	$355.50 	$263.07	$0.00	$284.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.85	$263.85	$0.00	$0.00	$74.09	$0.00	$0.00	$0.00	$0.00	$177.75	$281.56	$284.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.010	SUP	Custom 27203010		03.500.010  -  1.25MM DRILL BIT J-LATCH/10MM STOP/44.5MM	BOTH IP/OP	$355.50 	$263.07	$0.00	$284.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.85	$263.85	$0.00	$0.00	$74.09	$0.00	$0.00	$0.00	$0.00	$177.75	$281.56	$284.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.018	SUP	Custom 27203010		03.500.018  -  TEMPLATE BENDING STR NONSTRL CURVILINEAR DISTRCT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.030	SUP	Custom 27203010		03.500.030  -  TEMPLATE BENDING 30MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.031	SUP	Custom 27203010		03.500.031  -  TEMPLATE BENDING 30MM RAD LEFT NONSTRL CURVILINEAR DISTRCT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.040	SUP	Custom 27203010		03.500.040  -  TEMPLATE BENDING 40MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.041	SUP	Custom 27203010		03.500.041  -  TEMPLATE BENDING 40MM RAD LEFT NONSTRL CURVILINEAR DISTRCT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.050	SUP	Custom 27203010		03.500.050  -  TEMPLATE BENDING 50MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.051	SUP	Custom 27203010		03.500.051  -  TEMPLATE BENDING 50MM RAD LEFT NONSTRL CURVILINEAR DISTRCT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.070	SUP	Custom 27203010		03.500.070  -  TEMPLATE BENDING 70MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.071	SUP	Custom 27203010		03.500.071  -  TEMPLATE BENDING 70MM RAD LEFT NONSTRL CURVILINEAR DISTRCT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.100	SUP	Custom 27203010		03.500.100  -  TEMPLATE BENDING 100MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.500.101	SUP	Custom 27203010		03.500.101  -  TEMPLATE BENDING 100MM RAD LEFT NONSTRL CURVILINEAR DISTRCT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.008	SUP	Custom 27203010		03.501.008  -  BIT DRILL 8MM STOP 1.5MM 82MM J LATCH COUPLING 2 FLUTED	BOTH IP/OP	$502.50 	$371.85	$0.00	$402.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.96	$372.96	$0.00	$0.00	$104.72	$0.00	$0.00	$0.00	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.010	SUP	Custom 27203010		03.501.010  -  BIT DRILL 10MM STOP 82MM J LATCH TITANIUM NONSTRL	BOTH IP/OP	$502.50 	$371.85	$0.00	$402.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.96	$372.96	$0.00	$0.00	$104.72	$0.00	$0.00	$0.00	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.012	SUP	Custom 27203010		03.501.012  -  BIT DRILL 12MM STOP 1.5MM 82MM J LATCH COUPLING 2 FLUTED	BOTH IP/OP	$502.50 	$371.85	$0.00	$402.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.96	$372.96	$0.00	$0.00	$104.72	$0.00	$0.00	$0.00	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.014	SUP	Custom 27203010		03.501.014  -  BIT DRILL 1.5MM 82MM 14MM J LATCH COUPLING SELF STOP	BOTH IP/OP	$572.50 	$423.65	$0.00	$458.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.91	$424.91	$0.00	$0.00	$119.31	$0.00	$0.00	$0.00	$0.00	$286.25	$453.42	$458.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.016	SUP	Custom 27203010		03.501.016  -  BIT DRILL 16MM STOP 1.5MM 82MM J LATCH STERNUM NONSTRL	BOTH IP/OP	$572.50 	$423.65	$0.00	$458.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.91	$424.91	$0.00	$0.00	$119.31	$0.00	$0.00	$0.00	$0.00	$286.25	$453.42	$458.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.018	SUP	Custom 27203010		03.501.018  -  BIT DRILL 18MM STOP 1.5MM 82MM J LATCH STERNUM NONSTRL	BOTH IP/OP	$502.50 	$371.85	$0.00	$402.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.96	$372.96	$0.00	$0.00	$104.72	$0.00	$0.00	$0.00	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.020	SUP	Custom 27203010		03.501.020  -  BIT DRILL 20MM STOP 1.5MM 88MM J LATCH	BOTH IP/OP	$502.50 	$371.85	$0.00	$402.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.96	$372.96	$0.00	$0.00	$104.72	$0.00	$0.00	$0.00	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.022	SUP	Custom 27203010		03.501.022  -  BIT DRILL 1.5MM 88MM 22MM J LATCH COUPLING SELF STOP	BOTH IP/OP	$502.50 	$371.85	$0.00	$402.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.96	$372.96	$0.00	$0.00	$104.72	$0.00	$0.00	$0.00	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.024	SUP	Custom 27203010		03.501.024  -  BIT DRILL 88MM 1.5MM STRNL TI STOP JLTCH 24MM NONSTRL	BOTH IP/OP	$378.00 	$279.72	$0.00	$302.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.55	$280.55	$0.00	$0.00	$78.78	$0.00	$0.00	$0.00	$0.00	$189.00	$299.38	$302.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.036	SUP	Custom 27203010		03.501.036  -  BIT DRILL 135MM 2.2MM JLTCH STOP 6MM STRYK	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.038	SUP	Custom 27203010		03.501.038  -  BIT DRL 8MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.040	SUP	Custom 27203010		03.501.040  -  BIT DRILL 135MM 2.2MM JLTCH STOP 10MM	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.042	SUP	Custom 27203010		03.501.042  -  BIT DRL 12MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.044	SUP	Custom 27203010		03.501.044  -  BIT DRILL 135MM 2.2MM JLTCH STOP 14MM STRYK	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.046	SUP	Custom 27203010		03.501.046  -  BIT DRL 16MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.048	SUP	Custom 27203010		03.501.048  -  BIT DRL 18MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.072	SUP	HCPCS C1713		03.501.072  -  TEMPLATE BENDING CNTOUR NONSTRL MATRIXRIB LOCK PLATE	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.210	SUP	Custom 27203010		03.501.210  -  1.8MM DRILL BIT STRYKER J-LATCH/10MM STOP/82MM	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.212	SUP	Custom 27203010		03.501.212  -  BIT DRILL 82MM 1.8MM 12MM STOP JLTCH NONSTRL	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.214	SUP	Custom 27203010		03.501.214  -  BIT DRILL 82MM 1.8MM 14MM STOP STRNL JLTCH STRYK	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.216	SUP	Custom 27203010		03.501.216  -  BIT DRILL 82MM 1.8MM 16MM STOP STRNL JLTCH STRYK	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.218	SUP	Custom 27203010		03.501.218  -  BIT DRILL 82MM 1.8MM JLTCH STOP 18MM	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.220	SUP	Custom 27203010		03.501.220  -  BIT DRILL 88MM 1.8MM JLTCH FIX STOP 20MM STRYK	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.222	SUP	Custom 27203010		03.501.222  -  BIT DRILL 88MM 1.8MM JLTCH FIX STOP 22MM STRYK	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.224	SUP	Custom 27203010		03.501.224  -  1.8MM DRILL BIT STRYKER J-LATCH/24MM STOP/88MM	BOTH IP/OP	$398.25 	$294.71	$0.00	$318.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.58	$295.58	$0.00	$0.00	$83.00	$0.00	$0.00	$0.00	$0.00	$199.13	$315.41	$318.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.410	SUP	Custom 27203010		03.501.410  -  BIT DRILL 82MM 1.5MM 10MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.412	SUP	Custom 27203010		03.501.412  -  BIT DRILL 82MM 1.5MM 12MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.414	SUP	Custom 27203010		03.501.414  -  1.5MM DRILL BIT HEX COUPLING WITH 14MM STOP/82MM	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.416	SUP	Custom 27203010		03.501.416  -  BIT DRILL 82MM 1.5MM STRNL TI STOP HEX COULPLING FIX 16MM	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.418	SUP	Custom 27203010		03.501.418  -  BIT DRILL 82MM 1.5MM 18MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.420	SUP	Custom 27203010		03.501.420  -  BIT DRILL 88MM 1.5MM 20MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.422	SUP	Custom 27203010		03.501.422  -  1.5MM DRILL BIT HEX COUPLING WITH 22MM STOP/88MM	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.424	SUP	Custom 27203010		03.501.424  -  1.5MM DRILL BIT HEX COUPLING WITH 24MM STOP/88MM	BOTH IP/OP	$398.25 	$294.71	$0.00	$318.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.58	$295.58	$0.00	$0.00	$83.00	$0.00	$0.00	$0.00	$0.00	$199.13	$315.41	$318.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.510	SUP	Custom 27203010		03.501.510  -  BIT DRILL 82MM 1.8MM STRNL TI STOP HEX COULPLING FIX 10MM	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.512	SUP	Custom 27203010		03.501.512  -  BIT DRILL 82MM 1.8MM 12MM STOP HEX CPLNG NONSTRL	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.514	SUP	Custom 27203010		03.501.514  -  BIT DRILL 82MM 1.8MM STRNL TI STOP HEX COULPLING FIX 14MM	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.516	SUP	Custom 27203010		03.501.516  -  1.8MM DRILL BIT HEX COUPLING WITH 16MM STOP/82MM	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.518	SUP	Custom 27203010		03.501.518  -  1.8MM DRILL BIT HEX COUPLING WITH 18MM STOP/82MM	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.520	SUP	Custom 27203010		03.501.520  -  1.8MM DRILL BIT HEX COUPLING WITH 20MM STOP/88MM	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.522	SUP	Custom 27203010		03.501.522  -  BIT DRILL 88MM 1.8MM STRNL TI STOP HEX COULPLING FIX 22MM	BOTH IP/OP	$416.25 	$308.03	$0.00	$333.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.94	$308.94	$0.00	$0.00	$86.75	$0.00	$0.00	$0.00	$0.00	$208.13	$329.67	$333.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.524	SUP	Custom 27203010		03.501.524  -  1.8MM DRILL BIT HEX COUPLING WITH 24MM STOP/88MM	BOTH IP/OP	$398.25 	$294.71	$0.00	$318.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.58	$295.58	$0.00	$0.00	$83.00	$0.00	$0.00	$0.00	$0.00	$199.13	$315.41	$318.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.612	SUP	Custom 27203010		03.501.612  -  BIT DRL 2.2MM 135MM NS 12MM MATRIXRIB AO QC STP STRNM	BOTH IP/OP	$486.63 	$360.11	$0.00	$389.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.17	$361.17	$0.00	$0.00	$101.41	$0.00	$0.00	$0.00	$0.00	$243.31	$385.41	$389.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.614	SUP	Custom 27203010		03.501.614  -  BIT DRL 2.2MM 135MM NS 14MM MATRIXRIB AO QC STP STRNM	BOTH IP/OP	$398.25 	$294.71	$0.00	$318.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.13	$315.41	$318.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.501.764	SUP	Custom 27203010		03.501.764  -  BIT DRL 2 FLUT 2.2MM 14MM NS MATRIXRIB STP 90D SCRDRVR	BOTH IP/OP	$398.25 	$294.71	$0.00	$318.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.13	$315.41	$318.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.103	SUP	Custom 27203010		03.503.103  -  MATRIXMIDFACE 1.25MM DRILL BIT J-LATCH/3MM STOP/44.5MM	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.104	SUP	HCPCS C1713		03.503.104  -  PLATE 44.5X4MM MIDFAC STOP BONE NONSTRL	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$191.36	$191.36	$0.00	$0.00	$0.00	$88.63	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$251.54	$251.54	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$66.55	$0.00	$0.00	$67.70	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.106	SUP	Custom 27203010		03.503.106  -  BIT DRILL 44.5MM 1.25MM STOP JLTCH 6MM NONSTRL	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.108	SUP	Custom 27203010		03.503.108  -  BIT DRILL 44.5MM 1.25MM JLTCH STOP 8MM NONSTRL	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.110	SUP	Custom 27203010		03.503.110  -  BIT DRILL 44.5MM 1.25MM MTRXMDFACE 10MM STOP JLTCH	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.112	SUP	Custom 27203010		03.503.112  -  BIT DRILL 12MM 44.5MM 1.25MM MTRXMDFACE CRNMXF JLTCH CPLNG	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.118	SUP	Custom 27203010		03.503.118  -  BIT DRILL 18MM 44.5MM 1.25MM MTRXMDFACE CRNMXF JLTCH CPLNG	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.120	SUP	Custom 27203010		03.503.120  -  BIT DRL 1.25MM 80MM NS MATRIXMIDFACE JLTCH CPLNG WO STP	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.121	SUP	Custom 27203010		03.503.121  -  BIT DRILL 125MM 1.25MM MTRXMDFACE W/O STOP NONSTRL	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.122	SUP	Custom 27203010		03.503.122  -  BIT DRILL 125MM 1.25MM MTRXMDFACE JLTCH STOP 8MM PLT SYS	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.123	SUP	Custom 27203010		03.503.123  -  BIT DRILL 125MM 1.25MM MTRXMDFACE STOP JLTCH 18MM NONSTRL	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.133	SUP	Custom 27203010		03.503.133  -  MATRIXMIDFACE 1.25MM DRILL BIT MQC/3MM STOP/44.5MM	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.136	SUP	Custom 27203010		03.503.136  -  MATRIXMIDFACE 1.25MM DRILL BIT MQC/6MM STOP/44.5MM	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.140	SUP	Custom 27203010		03.503.140  -  BIT DRILL 44.5MM 1.25MM MTRXMDFACE MINI STOP QC 10MM NONSTRL	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.142	SUP	Custom 27203010		03.503.142  -  BIT DRILL 44.5MM 1.25MM MTRXMDFACE MINI STOP QC 12MM NONSTRL	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.148	SUP	Custom 27203010		03.503.148  -  BIT DRILL 44.5MM 1.25MM MTRXMDFACE MINI STOP QC 18MM NONSTRL	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.150	SUP	Custom 27203010		03.503.150  -  BIT DRILL 80MM 1.25MM MTRXMDFACE 2 FLUT MNQK CPLNG NONSTRL	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.151	SUP	Custom 27203010		03.503.151  -  BIT DRILL 125MM 1.25MM MTRXMDFACE 2 FLUT MNQK CPLNG NONSTRL	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.152	SUP	Custom 27203010		03.503.152  -  BIT DRILL 125MM 1.25MM MTRXMDFACE MINI STOP QC 8MM NONSTRL	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.153	SUP	Custom 27203010		03.503.153  -  BIT DRILL 125MM 1.25MM MTRXMDFACE MINI STOP QC 18MM NONSTRL	BOTH IP/OP	$425.25 	$314.69	$0.00	$340.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.62	$315.62	$0.00	$0.00	$88.62	$0.00	$0.00	$0.00	$0.00	$212.63	$336.80	$340.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.160	SUP	Custom 27203010		03.503.160  -  TMPLT BNDRG MTRXMAND NAR TNSNBND PLT NONSTRL	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.161	SUP	Custom 27203010		03.503.161  -  TMPLT BNDRG MTRX MANDIB 1 MM BRD TNSNBND PLT NONSTRL	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.162	SUP	Custom 27203010		03.503.162  -  TMPLT BNDRG MTRXMAND 1 MM THK ADP PLT NONSTRL	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.163	SUP	Custom 27203010		03.503.163  -  TMPLT BNDRG MTRXMAND 1.25 MM THK STR PLT NONSTRL	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.164	SUP	Custom 27203010		03.503.164  -  TMPLT BNDRG MTRXMAND 1.25 MM 2X2 HOLE THK CRSNT PLT NONSTRL	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.165	SUP	Custom 27203010		03.503.165  -  TMPLT BNDRG MTRXMAND 1.25 MM THK CRSNT PLT 3X3 HOLE NONSTRL	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.166	SUP	Custom 27203010		03.503.166  -  TMPLT BNDRG MTRXMAND 1.25MM NONSTRL	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.167	SUP	Custom 27203010		03.503.167  -  TMPLT BNDRG MTRXMAND 1.25 MM THK ADP PLT NONSTRL	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.168	SUP	Custom 27203010		03.503.168  -  TMPLT BNDRG MTRXMAND	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.169	SUP	Custom 27203010		03.503.169  -  TMPLT BNDRG MTRXMAND 1.5 MM PLT NONSTRL	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.170	SUP	Custom 27203010		03.503.170  -  TMPLT BNDRG MTRXMAND THK1.5MM 3X3 HOLE ANG PLT	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.171	SUP	Custom 27203010		03.503.171  -  TMPLT BNDRG MTRXMAND THK1.5MM CRSNT PLT 6 HOLE	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.172	SUP	Custom 27203010		03.503.172  -  TMPLT BNDRG MTRXMAND THK1.5MM 2X2 HOLE 3X3 HOLE BRD NONSTRL	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.173	SUP	Custom 27203010		03.503.173  -  TMPLT BNDRG 2MM MTRXMAND BRD CRSNT PLT	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.174	SUP	Custom 27203010		03.503.174  -  TMPLT BNDRG MTRXMAND 1.25MM NONSTRL	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.175	SUP	Custom 27203010		03.503.175  -  TMPLT BNDRG MTRXMAND 2MM 3X3 HOLE BRD ANG PLT	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$0.00	$0.00	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.176	SUP	HCPCS C1713		03.503.176  -  TEMPLATE BNDRG NS MATRIXMANDIBLE 2 MM ANG RECON PLT	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.177	SUP	Custom 27203010		03.503.177  -  TMPLT BNDRG MTRXMAND 2 MM 2 ANG RECON SM PLT NONSTRL	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.178	SUP	Custom 27203010		03.503.178  -  TMPLT BNDRG MTRXMAND 2 MM 2 ANG RECON MED PLT NONSTRL	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.179	SUP	Custom 27203010		03.503.179  -  TMPLT BNDRG MTRXMAND 2 MM 2 ANG RECON LG PLT NONSTRL	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.180	SUP	Custom 27203010		03.503.180  -  TMPLT BNDRG MATRIXMANDIBULAR RECON PLT	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.181	SUP	Custom 27203010		03.503.181  -  TMPLT BNDRG 2.5-2.8MM RECON	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.182	SUP	Custom 27203010		03.503.182  -  TMPLT BNDRG MTRXMAND PLT	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.183	SUP	Custom 27203010		03.503.183  -  TMPLT BNDRG MTRXMAND 2 ANG 2.5 MM RECON PLT NONSTRL	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.184	SUP	Custom 27203010		03.503.184  -  TMPLT BNDRG MTRXMAND 2.5 MM 2 ANG RECON LG PLT NONSTRL	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.201	SUP	Custom 27203010		03.503.201  -  BLADE SHRT HEX CPLNG SLFRET 52MM MTRXMDFACE SCRDRVR NONSTRL	BOTH IP/OP	"$1,586.25 "	"$1,173.83"	$0.00	"$1,269.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,177.31"	"$1,177.31"	$0.00	$0.00	$330.57	$0.00	$0.00	$0.00	$0.00	$793.13	"$1,256.31"	"$1,269.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.202	SUP	Custom 27203010		03.503.202  -  BLADE MED HEX CPLNG SLFRET 76MM MTRXMDFACE SCRDRVR CRNMXF	BOTH IP/OP	"$1,586.25 "	"$1,173.83"	$0.00	"$1,269.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,177.31"	"$1,177.31"	$0.00	$0.00	$330.57	$0.00	$0.00	$0.00	$0.00	$793.13	"$1,256.31"	"$1,269.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.203	SUP	Custom 27203010		03.503.203  -  BLADE LNG HEX CPLNG SLFRET 96MM MTRXMDFACE SCRDRVR CRNMXF	BOTH IP/OP	"$1,586.25 "	"$1,173.83"	$0.00	"$1,269.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,177.31"	"$1,177.31"	$0.00	$0.00	$330.57	$0.00	$0.00	$0.00	$0.00	$793.13	"$1,256.31"	"$1,269.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.244	SUP	Custom 27203010		03.503.244  -  BIT DRILL 44.5MM 1.1MM MTRXMDFACE CRNMXF JLTCH CPLNG STOP 4	BOTH IP/OP	$378.00 	$279.72	$0.00	$302.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.55	$280.55	$0.00	$0.00	$78.78	$0.00	$0.00	$0.00	$0.00	$189.00	$299.38	$302.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.246	SUP	Custom 27203010		03.503.246  -  BIT DRL 6MM 1.1MM 44.5MM NS MTRX JLTCH CPLNG STP STRYK	BOTH IP/OP	$378.00 	$279.72	$0.00	$302.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.55	$280.55	$0.00	$0.00	$78.78	$0.00	$0.00	$0.00	$0.00	$189.00	$299.38	$302.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.248	SUP	Custom 27203010		03.503.248  -  BIT DRL 8MM 1.1MM 44.5MM NS MTRX JLTCH CPLNG STP STRYK	BOTH IP/OP	$378.00 	$279.72	$0.00	$302.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.55	$280.55	$0.00	$0.00	$78.78	$0.00	$0.00	$0.00	$0.00	$189.00	$299.38	$302.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.264	SUP	Custom 27203010		03.503.264  -  MATRIX 1.1MM DRILL BIT/HXC 4MM STOP/52MM	BOTH IP/OP	$378.00 	$279.72	$0.00	$302.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.55	$280.55	$0.00	$0.00	$78.78	$0.00	$0.00	$0.00	$0.00	$189.00	$299.38	$302.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.360	SUP	Custom 27203010		03.503.360  -  BENDING TEMPLATE F/ORBITAL FLR PL/ANATOMIC/SM/MATRIXMIDFACE	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$0.00	$0.00	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.361	SUP	Custom 27203010		03.503.361  -  BENDING TEMPLATE F/ORBITAL FLR PL/ANATOMIC/MED/MATRIXMIDFACE	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$0.00	$0.00	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.362	SUP	Custom 27203010		03.503.362  -  BENDING TEMPLATE F/ORBITAL FLR PL/ANATOMIC/LRG/MATRIXMIDFACE	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$0.00	$0.00	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.363	SUP	Custom 27203010		03.503.363  -  BENDING TEMPLATE F/UNIVERSAL ORBITAL FLR PL/MATRIXMIDFACE	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$0.00	$0.00	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.364	SUP	Custom 27203010		03.503.364  -  BENDING TEMPLATE F/UNIVERSAL MEDIAL WALL PL/MATRIXMIDFACE	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$0.00	$0.00	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.365	SUP	Custom 27203010		03.503.365  -  TMPLT BNDRG ORBTL MESH PLT MTRXMDFACE PLT SYS NONSTRL	BOTH IP/OP	$515.25 	$381.29	$0.00	$412.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.42	$382.42	$0.00	$0.00	$107.38	$0.00	$0.00	$0.00	$0.00	$257.63	$408.08	$412.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.366	SUP	Custom 27203010		03.503.366  -  BENDING TEMPLATE F/ADAPTION PLATES/MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.367	SUP	Custom 27203010		03.503.367  -  BENDING TEMPLATE F/ORBITAL RIM PLATES/MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.368	SUP	Custom 27203010		03.503.368  -  BENDING TEMPLATE F/OBLIQUE L PLATES/2X3/MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.369	SUP	Custom 27203010		03.503.369  -  BENDING TEMPLATE F/OBLIQUE L PLATES/3X4/MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.370	SUP	Custom 27203010		03.503.370  -  TMPLT THK.5MM BNDRG 4X6 OBLQ L PLT MTRXMDFACE NONSTRL	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.371	SUP	Custom 27203010		03.503.371  -  BENDING TEMPLATE F/Y-PLATES 1X3/MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.372	SUP	Custom 27203010		03.503.372  -  BENDING TEMPLATE F/X-PLATES MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.373	SUP	Custom 27203010		03.503.373  -  BENDING TEMPLATE F/H-PLATES MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.374	SUP	Custom 27203010		03.503.374  -  BENDING TEMPLATE F/T-PLATES MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.375	SUP	Custom 27203010		03.503.375  -  BENDING TEMPLATE F/BOX PLATES 5MMX10MM/MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.376	SUP	Custom 27203010		03.503.376  -  TMPLT 10X10MM BNDRG	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.377	SUP	Custom 27203010		03.503.377  -  BENDING TEMPLATE F/STRUT PLATES/MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.378	SUP	Custom 27203010		03.503.378  -  BENDING TEMPLATE F/SILVER DOUBLE Y-PLATE/MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.379	SUP	Custom 27203010		03.503.379  -  BENDING TEMPLATE F/BLUE DOUBLE Y-PLATE/MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.380	SUP	Custom 27203010		03.503.380  -  BENDING TEMPLATE F/PINK DOUBLE Y-PLATE/MATRIXMIDFACE	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$0.00	$0.00	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.404	SUP	Custom 27203010		03.503.404  -  BIT DRL 4MM 1.5MM 50MM NS MATRIXMANDIBLE JLTCH CPLNG STP	BOTH IP/OP	$380.25 	$281.39	$0.00	$304.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.22	$282.22	$0.00	$0.00	$79.24	$0.00	$0.00	$0.00	$0.00	$190.13	$301.16	$304.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.406	SUP	Custom 27203010		03.503.406  -  MATRIXMANDIBLE 1.5MM DRILL BIT J-LATCH W/6MM STOP/50MM	BOTH IP/OP	$380.25 	$281.39	$0.00	$304.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.22	$282.22	$0.00	$0.00	$79.24	$0.00	$0.00	$0.00	$0.00	$190.13	$301.16	$304.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.408	SUP	Custom 27203010		03.503.408  -  BIT DRL 8MM 1.5MM 50MM NS MATRIXMANDIBLE JLTCH CPLNG STP	BOTH IP/OP	$380.25 	$281.39	$0.00	$304.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.22	$282.22	$0.00	$0.00	$79.24	$0.00	$0.00	$0.00	$0.00	$190.13	$301.16	$304.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.412	SUP	Custom 27203010		03.503.412  -  BIT DRILL 50MM MTRXMAND STOP JLTCH 12MM STRL	BOTH IP/OP	$380.25 	$281.39	$0.00	$304.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.22	$282.22	$0.00	$0.00	$79.24	$0.00	$0.00	$0.00	$0.00	$190.13	$301.16	$304.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.451	SUP	Custom 27203010		03.503.451  -  BIT DRL 1.5MM 90MM NS MATRIXMANDIBLE JLTCH CPLNG STRYK	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.452	SUP	Custom 27203010		03.503.452  -  BIT DRILL 1.5MM MTRXMAND	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.461	SUP	Custom 27203010		03.503.461  -  BIT DRILL 90MM 1.8MM JLTCH NSTRL	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.462	SUP	Custom 27203010		03.503.462  -  BIT DRILL 145MM 1.8MM JLTCH	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.471	SUP	Custom 27203010		03.503.471  -  BIT DRL 2.4MM 90MM NS MATRIXMANDIBLE JLTCH CPLNG STRYK	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.472	SUP	Custom 27203010		03.503.472  -  BIT DRILL 90MM 2.4MM CLBRT	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.476	SUP	Custom 27203010		03.503.476  -  BIT DRL 1.5MM 125MM NS MATRIXMANDIBLE JLTCH CPLNG CLBRT	BOTH IP/OP	$468.00 	$346.32	$0.00	$374.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$347.35	$347.35	$0.00	$0.00	$97.53	$0.00	$0.00	$0.00	$0.00	$234.00	$370.66	$374.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.477	SUP	Custom 27203010		03.503.477  -  BIT DRL 1.8MM 125MM NS MATRIXMANDIBLE JLTCH CPLNG CLBRT	BOTH IP/OP	$468.00 	$346.32	$0.00	$374.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$347.35	$347.35	$0.00	$0.00	$97.53	$0.00	$0.00	$0.00	$0.00	$234.00	$370.66	$374.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.478	SUP	Custom 27203010		03.503.478  -  BIT DRL 2.4MM 125MM NS MATRIXMANDIBLE JLTCH CPLNG CLBRT	BOTH IP/OP	$468.00 	$346.32	$0.00	$374.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$347.35	$347.35	$0.00	$0.00	$97.53	$0.00	$0.00	$0.00	$0.00	$234.00	$370.66	$374.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.479	SUP	Custom 27203010		03.503.479  -  BIT DRILL 125MM 1.5MM MTRXMAND MINI CPLNG QC CLBRT NONSTRL	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.480	SUP	Custom 27203010		03.503.480  -  BIT DRILL 125MM 1.8MM MTRXMAND CLBRT	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.481	SUP	Custom 27203010		03.503.481  -  BIT DRILL 125MM 2.4MM MTRXMAND MINI CLBRT QC NONSTRL	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.504	SUP	Custom 27203010		03.503.504  -  MATRIXMANDIBLE 1.5MM DRILL BIT MQC W/4MM STOP/50MM	BOTH IP/OP	$380.25 	$281.39	$0.00	$304.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.22	$282.22	$0.00	$0.00	$79.24	$0.00	$0.00	$0.00	$0.00	$190.13	$301.16	$304.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.506	SUP	Custom 27203010		03.503.506  -  MATRIXMANDIBLE 1.5MM DRILL BIT MQC W/6MM STOP/50MM	BOTH IP/OP	$380.25 	$281.39	$0.00	$304.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.22	$282.22	$0.00	$0.00	$79.24	$0.00	$0.00	$0.00	$0.00	$190.13	$301.16	$304.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.508	SUP	Custom 27203010		03.503.508  -  MATRIXMANDIBLE 1.5MM DRILL BIT MQC W/8MM STOP/50MM	BOTH IP/OP	$380.25 	$281.39	$0.00	$304.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.22	$282.22	$0.00	$0.00	$79.24	$0.00	$0.00	$0.00	$0.00	$190.13	$301.16	$304.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.512	SUP	Custom 27203010		03.503.512  -  MATRIXMANDIBLE 1.5MM DRILL BIT MQC W/12MM STOP/50MM	BOTH IP/OP	$380.25 	$281.39	$0.00	$304.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.22	$282.22	$0.00	$0.00	$79.24	$0.00	$0.00	$0.00	$0.00	$190.13	$301.16	$304.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.551	SUP	Custom 27203010		03.503.551  -  BIT DRILL MTRXMAND MINI QC	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.552	SUP	Custom 27203010		03.503.552  -  MATRIXMANDIBLE 1.5MM DRILL BIT MQC/145MM F/03.503.042	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.561	SUP	Custom 27203010		03.503.561  -  MATRIXMANDIBLE 1.8MM DRILL BIT MQC/90MM FOR 03.503.044	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.562	SUP	Custom 27203010		03.503.562  -  MATRIXMANDIBLE 1.8MM DRILL BIT MQC/145MM F/03.503.042	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.571	SUP	Custom 27203010		03.503.571  -  MATRIXMANDIBLE 2.4MM DRILL BIT MQC/90MM FOR 03.503.046	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.503.572	SUP	Custom 27203010		03.503.572  -  MATRIXMANDIBLE 2.4MM DRILL BIT MQC/145MM F/03.503.042	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$0.00	$0.00	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.507.002S	SUP	Custom 27203010		03.507.002S  -  TOOL REDX HEXGAON 2.4MM 78MM THREADED SLFDRILL COUPLING	BOTH IP/OP	$384.75 	$284.72	$0.00	$307.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$285.56	$285.56	$0.00	$0.00	$80.18	$0.00	$0.00	$0.00	$0.00	$192.38	$304.72	$307.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.507.003	SUP	Custom 27203010		03.507.003  -  BIT DRILL 78MM 3.5MM SLFTAP REDX TL 3.5MM SCR NONSTRL	BOTH IP/OP	$614.25 	$454.55	$0.00	$491.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$455.90	$455.90	$0.00	$0.00	$128.01	$0.00	$0.00	$0.00	$0.00	$307.13	$486.49	$491.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03.614.015	SUP	HCPCS C1713		03.614.015  -  TAP SURG 4.5MM 205MM 50MM CALIBRATED CANCELLOUS	BOTH IP/OP	$545.00 	$403.30	$0.00	$436.00	$245.25	$245.25	$0.00	$0.00	$0.00	$113.59	$404.50	$404.50	$0.00	$0.00	$113.58	$0.00	$322.37	$322.37	$0.00	$272.50	$431.64	$436.00	$0.00		$0.00	$85.29	$0.00	$0.00	$86.76	$0.00	$0.00	$0.00	$0.00	$0.00
03.620.104	SUP	HCPCS C1713		03.620.104  -  TAP 6MM HEX CPLNG SURG 4MM DUAL CORE SCR NONSTRL	BOTH IP/OP	$628.25 	$464.91	$0.00	$502.60	$282.71	$282.71	$0.00	$0.00	$0.00	$130.94	$466.29	$466.29	$0.00	$0.00	$130.93	$0.00	$371.61	$371.61	$0.00	$314.13	$497.57	$502.60	$0.00		$0.00	$98.32	$0.00	$0.00	$100.02	$0.00	$0.00	$0.00	$0.00	$0.00
03.620.105	SUP	HCPCS C1713		03.620.105  -  TAP 5MM 6MM HEX CPLNG SPNL DUAL CORE SCR NONSTRL	BOTH IP/OP	$628.25 	$464.91	$0.00	$502.60	$282.71	$282.71	$0.00	$0.00	$0.00	$130.94	$466.29	$466.29	$0.00	$0.00	$130.93	$0.00	$371.61	$371.61	$0.00	$314.13	$497.57	$502.60	$0.00		$0.00	$98.32	$0.00	$0.00	$100.02	$0.00	$0.00	$0.00	$0.00	$0.00
03.620.106	SUP	HCPCS C1713		03.620.106  -  TAP 6MM HEX CPLNG SURG NONSTRL	BOTH IP/OP	$628.25 	$464.91	$0.00	$502.60	$282.71	$282.71	$0.00	$0.00	$0.00	$130.94	$466.29	$466.29	$0.00	$0.00	$130.93	$0.00	$371.61	$371.61	$0.00	$314.13	$497.57	$502.60	$0.00		$0.00	$98.32	$0.00	$0.00	$100.02	$0.00	$0.00	$0.00	$0.00	$0.00
0301-14	SUP	Custom 27203010		0301-14  -  TUBE JJNSTM 14FR 9FR STRL LF MIC LL RADOPQ STRP TRM DIST TIP	BOTH IP/OP	$479.38 	$354.74	$0.00	$563.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$355.80	$355.80	$0.00	$0.00	$99.90	$0.00	$0.00	$0.00	$0.00	$239.69	$563.02	$383.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0110	SUP	HCPCS C1713		03-10-0110  -  PLATE BONE 10MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0112	SUP	HCPCS C1713		03-10-0112  -  PLATE BONE 12MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0114	SUP	HCPCS C1713		03-10-0114  -  PLATE BONE 14MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0116	SUP	HCPCS C1713		03-10-0116  -  PLATE BONE 16MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0118	SUP	HCPCS C1713		03-10-0118  -  PLATE BONE 18MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0120	SUP	HCPCS C1713		03-10-0120  -  PLATE BONE 20MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0122	SUP	HCPCS C1713		03-10-0122  -  PLATE BONE 22MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0124	SUP	HCPCS C1713		03-10-0124  -  PLATE BONE 24MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0126	SUP	HCPCS C1713		03-10-0126  -  PLATE BONE 26MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0229	SUP	HCPCS C1713		03-10-0229  -  PLATE 29MM TI 2 LVL BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0232	SUP	HCPCS C1713		03-10-0232  -  PLATE 32MM TI 2 LVL BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0235	SUP	HCPCS C1713		03-10-0235  -  PLATE 35MM TI 2 LVL BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0238	SUP	HCPCS C1713		03-10-0238  -  PLATE 38MM TI 2 LVL BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0241	SUP	HCPCS C1713		03-10-0241  -  PLATE 41MM TI 2 LVL BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0244	SUP	HCPCS C1713		03-10-0244  -  PLATE 44MM TI 2 LVL BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0343	SUP	HCPCS C1713		03-10-0343  -  PLATE BONE 43MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0346	SUP	HCPCS C1713		03-10-0346  -  PLATE BONE 46MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0349	SUP	HCPCS C1713		03-10-0349  -  PLATE BONE 49MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0352	SUP	HCPCS C1713		03-10-0352  -  PLATE BONE 52MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0355	SUP	HCPCS C1713		03-10-0355  -  PLATE BONE 55MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0358	SUP	HCPCS C1713		03-10-0358  -  PLATE BONE 58MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0362	SUP	HCPCS C1713		03-10-0362  -  PLATE BONE 62MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0366	SUP	HCPCS C1713		03-10-0366  -  PLATE BONE 66MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0460	SUP	HCPCS C1713		03-10-0460  -  PLATE BONE 60MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0464	SUP	HCPCS C1713		03-10-0464  -  PLATE BONE 64MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0468	SUP	HCPCS C1713		03-10-0468  -  PLATE BONE 68MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0472	SUP	HCPCS C1713		03-10-0472  -  PLATE BONE 72MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0476	SUP	HCPCS C1713		03-10-0476  -  PLATE BONE 76MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0480	SUP	HCPCS C1713		03-10-0480  -  PLATE BONE 80MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
03-10-0484	SUP	HCPCS C1713		03-10-0484  -  PLATE BONE 84MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
03-503-246	SUP	Custom 27203010		03-503-246  -  BIT DRILL 44.5MM 1.1MM MTRX 6MM STOP JLTCH CPLNG NONSTRL	BOTH IP/OP	$285.75 	$211.46	$0.00	$228.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.08	$212.08	$0.00	$0.00	$59.55	$0.00	$0.00	$0.00	$0.00	$142.88	$226.31	$228.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
038-001	SUP	Custom 27203010		KIT IMMUN TST ELISA B2-GLYPRTN 1 IGG 96 TST 038-001	BOTH IP/OP	$962.50 	$712.25	$0.00	$770.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0382-1425	SUP	HCPCS C1713		0382-1425  -  SCREW BONE 4.5MM 25MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
0382-1430	SUP	HCPCS C1713		0382-1430  -  SCREW BONE 4.5MM 30MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
0382-1445	SUP	HCPCS C1713		0382-1445  -  SCREW BN 4.5MM 45MM X2 PA TI SPNE THORLMBR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
0382-1525	SUP	HCPCS C1713		0382-1525  -  SCREW BONE 5.5MM 25MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
0382-1535	SUP	HCPCS C1713		0382-1535  -  SCREW BONE 5.5MM 35MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
0382-1650	SUP	HCPCS C1713		0382-1650  -  SCREW BONE 6.5MM 50MM POLYAX XIA II TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.000	SUP	HCPCS C1713		04.001.000  -  CAP END 0MM HUM XTD STARDRIVE RECESS CANN IM NAIL TI NONSTRL	BOTH IP/OP	$330.25 	$244.39	$0.00	$264.20	$148.61	$148.61	$0.00	$0.00	$0.00	$68.83	$245.11	$245.11	$0.00	$0.00	$68.82	$0.00	$195.34	$195.34	$0.00	$165.13	$261.56	$264.20	$0.00		$0.00	$51.68	$0.00	$0.00	$52.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.000S	SUP	Custom 27803010		04.001.000S  -  CAP END 0MM EXTENDED SPIRAL BLADE SELF HOLDING T25 STARDRIVE	BOTH IP/OP	$389.48 	$288.22	$0.00	$302.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.07	$289.07	$0.00	$0.00	$81.17	$0.00	$0.00	$0.00	$0.00	$189.08	$299.49	$302.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.001S	SUP	Custom 27803010		04.001.001S  -  CAP END 5MM EXTENDED SPIRAL BLADE SELF HOLDING T25 STARDRIVE	BOTH IP/OP	$389.48 	$288.22	$0.00	$302.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.07	$289.07	$0.00	$0.00	$81.17	$0.00	$0.00	$0.00	$0.00	$189.08	$299.49	$302.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.002S	SUP	Custom 27803010		04.001.002S  -  CAP END 10MM EXTENDED STARDRIVE RECESS NAIL-EX TITANIUM	BOTH IP/OP	$389.48 	$288.22	$0.00	$302.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.07	$289.07	$0.00	$0.00	$81.17	$0.00	$0.00	$0.00	$0.00	$189.08	$299.49	$302.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.003S	SUP	Custom 27803010		04.001.003S  -  CAP END 15MM 15MM EXTENDED SPIRAL BLADE SELF HOLDING T25	BOTH IP/OP	$389.48 	$288.22	$0.00	$302.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.07	$289.07	$0.00	$0.00	$81.17	$0.00	$0.00	$0.00	$0.00	$189.08	$299.49	$302.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.210S	SUP	HCPCS C1713		04.001.210S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 15CM CANN	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.218S	SUP	HCPCS C1713		04.001.218S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 19CM CANN	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.220S	SUP	HCPCS C1713		04.001.220S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 20CM CANN	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.222S	SUP	HCPCS C1713		04.001.222S  -  NAIL INTRAMEDULLARY UNIVERSAL 7MM 210MM SOLID CANN EXPERT	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.224S	SUP	HCPCS C1713		04.001.224S  -  NAIL INTRAMEDULLARY UNIVERSAL 7MM 220MM CANN ROUND BARREL	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.226S	SUP	HCPCS C1713		04.001.226S  -  NAIL INTRAMEDULLARY 7MM 230MM CANN NAIL-EX BLUE TITANIUM	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.228S	SUP	HCPCS C1713		04.001.228S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 24CM CANN	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.230S	SUP	HCPCS C1713		04.001.230S  -  NAIL INTRAMEDULLARY UNIVERSAL 7MM 250MM SOLID CANN EXPERT	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.232S	SUP	HCPCS C1713		04.001.232S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 26CM CANN	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.234S	SUP	HCPCS C1713		04.001.234S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 27CM CANN	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.236S	SUP	HCPCS C1713		04.001.236S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 28CM CANN	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.238S	SUP	HCPCS C1713		04.001.238S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 29CM CANN	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.240S	SUP	HCPCS C1713		04.001.240S  -  NAIL INTRAMEDULLARY 7MM 300MM SOLID CANN EXPERT BLUE	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.242S	SUP	HCPCS C1713		04.001.242S  -  NAIL INTRAMEDULLARY 7MM 310MM CANN NAIL-EX BLUE TITANIUM	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.244S	SUP	HCPCS C1713		04.001.244S  -  NAIL INTRAMEDULLARY 7MM 320MM SOLID CANN EXPERT BLUE	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.410S	SUP	HCPCS C1713		04.001.410S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 150MM CANN ROUND BARREL	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.418S	SUP	HCPCS C1713		04.001.418S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 19CM CANN	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.420S	SUP	HCPCS C1713		04.001.420S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 20CM CANN	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.422S	SUP	HCPCS C1713		04.001.422S  -  NAIL INTRAMEDULLARY 9MM 210MM SOLID CANN EXPERT BLUE	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.424S	SUP	HCPCS C1713		04.001.424S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 220MM CANN	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.426S	SUP	HCPCS C1713		04.001.426S  -  NAIL INTRAMEDULLARY 9MM 230MM CANN IMPLANT NAIL-EX TITANIUM	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.428S	SUP	HCPCS C1713		04.001.428S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 24CM CANN	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.430S	SUP	HCPCS C1713		04.001.430S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 250MM SOLID CANN EXPERT	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.432S	SUP	HCPCS C1713		04.001.432S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 260MM SOLID CANN EXPERT	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.434S	SUP	HCPCS C1713		04.001.434S  -  NAIL INTRAMEDULLARY 9MM 270MM SOLID CANN EXPERT BLUE	BOTH IP/OP	"$3,589.95 "	"$2,656.56"	$0.00	"$2,788.32"	"$1,568.43"	"$1,568.43"	$0.00	$0.00	$0.00	$748.24	"$2,664.46"	"$2,664.46"	$0.00	$0.00	$748.15	$0.00	"$1,769.85"	"$1,769.85"	$0.00	"$1,742.70"	"$2,760.44"	"$2,788.32"	$0.00		$0.00	$529.58	$0.00	$0.00	$554.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.436S	SUP	HCPCS C1713		04.001.436S  -  NAIL INTRAMEDULLARY 9MM 280MM SOLID CANN EXPERT BLUE	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.438S	SUP	HCPCS C1713		04.001.438S  -  NAIL INTRAMEDULLARY 9MM 290MM CANN NAIL-EX BLUE TITANIUM	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.440S	SUP	HCPCS C1713		04.001.440S  -  NAIL INTRAMEDULLARY 9MM 300MM SOLID CANN EXPERT BLUE	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.442S	SUP	HCPCS C1713		04.001.442S  -  NAIL INTRAMEDULLARY 9MM 310MM CANN NAIL-EX BLUE TITANIUM	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.444S	SUP	HCPCS C1713		04.001.444S  -  NAIL INTRAMEDULLARY 9MM 320MM SOLID CANN EXPERT BLUE	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.610S	SUP	HCPCS C1713		04.001.610S  -  NAIL INTRAMEDULLARY 11MM 150MM CANN EXPERT BLUE TITANIUM	BOTH IP/OP	"$3,697.90 "	"$2,736.45"	$0.00	"$2,872.16"	"$1,615.59"	"$1,615.59"	$0.00	$0.00	$0.00	$770.73	"$2,744.58"	"$2,744.58"	$0.00	$0.00	$770.64	$0.00	"$1,823.06"	"$1,823.06"	$0.00	"$1,795.10"	"$2,843.44"	"$2,872.16"	$0.00		$0.00	$545.50	$0.00	$0.00	$571.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.618S	SUP	HCPCS C1713		04.001.618S  -  NAIL INTRAMEDULLARY 11MM 19CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.620S	SUP	HCPCS C1713		04.001.620S  -  NAIL INTRAMEDULLARY 11MM 20CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.622S	SUP	HCPCS C1713		04.001.622S  -  NAIL INTRAMEDULLARY 11MM 21CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.624S	SUP	HCPCS C1713		04.001.624S  -  NAIL INTRAMEDULLARY 11MM 22CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.626S	SUP	HCPCS C1713		04.001.626S  -  NAIL INTRAMEDULLARY 11MM 23CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.628S	SUP	HCPCS C1713		04.001.628S  -  NAIL INTRAMEDULLARY 11MM 24CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.630S	SUP	HCPCS C1713		04.001.630S  -  NAIL INTRAMEDULLARY 11MM 25CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.632S	SUP	HCPCS C1713		04.001.632S  -  NAIL INTRAMEDULLARY 11MM 26CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.634S	SUP	HCPCS C1713		04.001.634S  -  NAIL INTRAMEDULLARY 11MM 270MM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.636S	SUP	HCPCS C1713		04.001.636S  -  NAIL INTRAMEDULLARY 11MM 28CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.638S	SUP	HCPCS C1713		04.001.638S  -  NAIL INTRAMEDULLARY 11MM 29CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.640S	SUP	HCPCS C1713		04.001.640S  -  NAIL INTRAMEDULLARY 11MM 30CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.642S	SUP	HCPCS C1713		04.001.642S  -  NAIL INTRAMEDULLARY 11MM 31CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.001.644S	SUP	HCPCS C1713		04.001.644S  -  NAIL INTRAMEDULLARY 11MM 32CM CANN NAIL-EX TITANIUM HUMERUS	BOTH IP/OP	"$3,823.35 "	"$2,829.28"	$0.00	"$2,969.60"	"$1,670.40"	"$1,670.40"	$0.00	$0.00	$0.00	$796.88	"$2,837.69"	"$2,837.69"	$0.00	$0.00	$796.79	$0.00	"$1,884.91"	"$1,884.91"	$0.00	"$1,856.00"	"$2,939.90"	"$2,969.60"	$0.00		$0.00	$564.01	$0.00	$0.00	$590.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.000S	SUP	Custom 27803010		04.003.000S  -  CAP END 0MM T40 STARDRIVE RECESS CANN FLUSH SELF RETAINING	BOTH IP/OP	$414.28 	$306.57	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.47	$307.47	$0.00	$0.00	$86.33	$0.00	$0.00	$0.00	$0.00	$201.11	$318.57	$321.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.001S	SUP	Custom 27803010		04.003.001S  -  CAP END 5MM T40 STARDRIVE RECESS CANN SELF RETAINING LATERAL	BOTH IP/OP	$414.28 	$306.57	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.47	$307.47	$0.00	$0.00	$86.33	$0.00	$0.00	$0.00	$0.00	$201.11	$318.57	$321.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.002S	SUP	Custom 27803010		04.003.002S  -  CAP END 10MM T40 STARDRIVE RECESS CANN SELF RETAINING	BOTH IP/OP	$414.28 	$306.57	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.47	$307.47	$0.00	$0.00	$86.33	$0.00	$0.00	$0.00	$0.00	$201.11	$318.57	$321.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.003S	SUP	Custom 27803010		04.003.003S  -  CAP END 15MM 12MM T40 STARDRIVE RECESS CANN SELF RETAINING	BOTH IP/OP	$414.28 	$306.57	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.47	$307.47	$0.00	$0.00	$86.33	$0.00	$0.00	$0.00	$0.00	$201.11	$318.57	$321.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.004S	SUP	Custom 27803010		04.003.004S  -  CAP END 20MM T40 STARDRIVE RECESS CANN SELF RETAINING	BOTH IP/OP	$414.28 	$306.57	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.47	$307.47	$0.00	$0.00	$86.33	$0.00	$0.00	$0.00	$0.00	$201.11	$318.57	$321.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.006S	SUP	Custom 27803010		04.003.006S  -  CAP END 5MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING	BOTH IP/OP	$414.28 	$306.57	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.47	$307.47	$0.00	$0.00	$86.33	$0.00	$0.00	$0.00	$0.00	$201.11	$318.57	$321.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.007S	SUP	Custom 27803010		04.003.007S  -  CAP END 10MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING	BOTH IP/OP	$414.28 	$306.57	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.47	$307.47	$0.00	$0.00	$86.33	$0.00	$0.00	$0.00	$0.00	$201.11	$318.57	$321.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.008S	SUP	Custom 27803010		04.003.008S  -  CAP END 15MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING	BOTH IP/OP	$414.28 	$306.57	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.47	$307.47	$0.00	$0.00	$86.33	$0.00	$0.00	$0.00	$0.00	$201.11	$318.57	$321.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.009S	SUP	Custom 27803010		04.003.009S  -  CAP END 20MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING	BOTH IP/OP	$414.28 	$306.57	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.47	$307.47	$0.00	$0.00	$86.33	$0.00	$0.00	$0.00	$0.00	$201.11	$318.57	$321.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.022	SUP	HCPCS C1713		04.003.022  -  SCREW BONE 6.5MM 60MM TI FEM SLFTAP TIP RECON T25 STARDRIVE	BOTH IP/OP	$400.38 	$296.28	$0.00	$320.30	$180.17	$180.17	$0.00	$0.00	$0.00	$83.45	$297.16	$297.16	$0.00	$0.00	$83.44	$0.00	$236.82	$236.82	$0.00	$200.19	$317.10	$320.30	$0.00		$0.00	$62.66	$0.00	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.022S	SUP	HCPCS C1713		04.003.022S  -  SCREW BN T25 6.5MM 60MM AU STRL ST BLNT TIP STRDR TI FEM LAT	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.023	SUP	HCPCS C1713		04.003.023  -  SCREW BONE 6.5MM 65MM TI FEM SLFTAP TIP RECON T25 STARDRIVE	BOTH IP/OP	$400.38 	$296.28	$0.00	$320.30	$180.17	$180.17	$0.00	$0.00	$0.00	$83.45	$297.16	$297.16	$0.00	$0.00	$83.44	$0.00	$236.82	$236.82	$0.00	$200.19	$317.10	$320.30	$0.00		$0.00	$62.66	$0.00	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.023S	SUP	HCPCS C1713		04.003.023S  -  SCREW BN T25 6.5MM 65MM AU STRL ST BLNT TIP STRDR TI FEM LAT	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.024	SUP	HCPCS C1713		04.003.024  -  SCREW BONE 6.5MM 70MM TI FEM T25 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$400.38 	$296.28	$0.00	$320.30	$180.17	$180.17	$0.00	$0.00	$0.00	$83.45	$297.16	$297.16	$0.00	$0.00	$83.44	$0.00	$236.82	$236.82	$0.00	$200.19	$317.10	$320.30	$0.00		$0.00	$62.66	$0.00	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.024S	SUP	HCPCS C1713		04.003.024S  -  SCREW BN T25 6.5MM 70MM AU STRL ST BLNT TIP STRDR TI FEM LAT	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.025	SUP	HCPCS C1713		04.003.025  -  SCREW BONE 6.5MM 75MM TI FEM SLFTAP TIP RECON T25 STARDRIVE	BOTH IP/OP	$400.38 	$296.28	$0.00	$320.30	$180.17	$180.17	$0.00	$0.00	$0.00	$83.45	$297.16	$297.16	$0.00	$0.00	$83.44	$0.00	$236.82	$236.82	$0.00	$200.19	$317.10	$320.30	$0.00		$0.00	$62.66	$0.00	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.025S	SUP	HCPCS C1713		04.003.025S  -  SCREW BN T25 6.5MM 75MM AU STRL ST BLNT TIP STRDR TI FEM LAT	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.026	SUP	HCPCS C1713		04.003.026  -  SCREW BONE 6.5MM 80MM TI FEM SLFTAP RECON STARDRIVE RECESS	BOTH IP/OP	$400.38 	$296.28	$0.00	$320.30	$180.17	$180.17	$0.00	$0.00	$0.00	$83.45	$297.16	$297.16	$0.00	$0.00	$83.44	$0.00	$236.82	$236.82	$0.00	$200.19	$317.10	$320.30	$0.00		$0.00	$62.66	$0.00	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.026S	SUP	HCPCS C1713		04.003.026S  -  SCREW BN T25 6.5MM 80MM AU STRL ST BLNT TIP STRDR TI FEM LAT	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.027	SUP	HCPCS C1713		04.003.027  -  SCREW BONE 6.5MM 85MM TI FEM SLFTAP TIP RECON T25 STARDRIVE	BOTH IP/OP	$400.38 	$296.28	$0.00	$320.30	$180.17	$180.17	$0.00	$0.00	$0.00	$83.45	$297.16	$297.16	$0.00	$0.00	$83.44	$0.00	$236.82	$236.82	$0.00	$200.19	$317.10	$320.30	$0.00		$0.00	$62.66	$0.00	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.027S	SUP	HCPCS C1713		04.003.027S  -  SCREW BN T25 6.5MM 85MM AU STRL ST BLNT TIP STRDR TI FEM LAT	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.028	SUP	HCPCS C1713		04.003.028  -  SCREW BONE 6.5MM 90MM TI FEM SLFTAP TIP RECON T25 STARDRIVE	BOTH IP/OP	$424.75 	$314.32	$0.00	$339.80	$191.14	$191.14	$0.00	$0.00	$0.00	$88.53	$315.25	$315.25	$0.00	$0.00	$88.52	$0.00	$251.24	$251.24	$0.00	$212.38	$336.40	$339.80	$0.00		$0.00	$66.47	$0.00	$0.00	$67.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.028S	SUP	HCPCS C1713		04.003.028S  -  SCREW BN T25 6.5MM 90MM AU STRL ST BLNT TIP STRDR TI FEM LAT	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.029	SUP	HCPCS C1713		04.003.029  -  SCREW BONE 6.5MM 95MM TI FEM SLFTAP TIP RECON T25 STARDRIVE	BOTH IP/OP	$424.75 	$314.32	$0.00	$339.80	$191.14	$191.14	$0.00	$0.00	$0.00	$88.53	$315.25	$315.25	$0.00	$0.00	$88.52	$0.00	$251.24	$251.24	$0.00	$212.38	$336.40	$339.80	$0.00		$0.00	$66.47	$0.00	$0.00	$67.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.029S	SUP	HCPCS C1713		04.003.029S  -  SCREW BN T25 6.5MM 95MM AU STRL ST BLNT TIP STRDR TI FEM LAT	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.030	SUP	HCPCS C1713		04.003.030  -  SCREW BONE NONSTRL 6.5MM 100MM TI FEM T25 STARDRIVE RECESS	BOTH IP/OP	$400.38 	$296.28	$0.00	$320.30	$180.17	$180.17	$0.00	$0.00	$0.00	$83.45	$297.16	$297.16	$0.00	$0.00	$83.44	$0.00	$236.82	$236.82	$0.00	$200.19	$317.10	$320.30	$0.00		$0.00	$62.66	$0.00	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.030S	SUP	HCPCS C1713		04.003.030S  -  SCREW BN T25 6.5MM 100MM AU STRL ST BLNT TIP STRDR TI FEM	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.031	SUP	HCPCS C1713		04.003.031  -  SCREW BONE 6.5MM 105MM TI FEM T25 STARDRIVE RECESS RECON	BOTH IP/OP	$424.75 	$314.32	$0.00	$339.80	$191.14	$191.14	$0.00	$0.00	$0.00	$88.53	$315.25	$315.25	$0.00	$0.00	$88.52	$0.00	$251.24	$251.24	$0.00	$212.38	$336.40	$339.80	$0.00		$0.00	$66.47	$0.00	$0.00	$67.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.031S	SUP	HCPCS C1713		04.003.031S  -  SCREW BN T25 6.5MM 105MM AU STRL ST BLNT TIP STRDR TI FEM	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.032	SUP	HCPCS C1713		04.003.032  -  SCREW BONE 6.5MM 110MM TI FEM T25 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$400.38 	$296.28	$0.00	$320.30	$180.17	$180.17	$0.00	$0.00	$0.00	$83.45	$297.16	$297.16	$0.00	$0.00	$83.44	$0.00	$236.82	$236.82	$0.00	$200.19	$317.10	$320.30	$0.00		$0.00	$62.66	$0.00	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.032S	SUP	HCPCS C1713		04.003.032S  -  SCREW BN T25 6.5MM 110MM AU STRL ST BLNT TIP STRDR TI FEM	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.033	SUP	HCPCS C1713		04.003.033  -  SCREW BONE 6.5MM 115MM TI FEM T25 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$400.38 	$296.28	$0.00	$320.30	$180.17	$180.17	$0.00	$0.00	$0.00	$83.45	$297.16	$297.16	$0.00	$0.00	$83.44	$0.00	$236.82	$236.82	$0.00	$200.19	$317.10	$320.30	$0.00		$0.00	$62.66	$0.00	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.033S	SUP	HCPCS C1713		04.003.033S  -  SCREW BN T25 6.5MM 115MM AU STRL ST BLNT TIP STRDR TI FEM	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.034	SUP	HCPCS C1713		04.003.034  -  SCREW BONE 6.5MM 120MM TI FEM T25 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$400.38 	$296.28	$0.00	$320.30	$180.17	$180.17	$0.00	$0.00	$0.00	$83.45	$297.16	$297.16	$0.00	$0.00	$83.44	$0.00	$236.82	$236.82	$0.00	$200.19	$317.10	$320.30	$0.00		$0.00	$62.66	$0.00	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.034S	SUP	HCPCS C1713		04.003.034S  -  SCREW BN T25 6.5MM 120MM AU STRL ST BLNT TIP STRDR TI FEM	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.035	SUP	HCPCS C1713		04.003.035  -  SCREW BONE 6.5MM 125MM TI FEM T25 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$400.38 	$296.28	$0.00	$320.30	$180.17	$180.17	$0.00	$0.00	$0.00	$83.45	$297.16	$297.16	$0.00	$0.00	$83.44	$0.00	$236.82	$236.82	$0.00	$200.19	$317.10	$320.30	$0.00		$0.00	$62.66	$0.00	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.035S	SUP	HCPCS C1713		04.003.035S  -  SCREW BN T25 6.5MM 125MM AU STRL ST BLNT TIP STRDR TI FEM	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.036	SUP	HCPCS C1713		04.003.036  -  SCREW BONE 6.5MM 130MM TI FEM T25 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$400.38 	$296.28	$0.00	$320.30	$180.17	$180.17	$0.00	$0.00	$0.00	$83.45	$297.16	$297.16	$0.00	$0.00	$83.44	$0.00	$236.82	$236.82	$0.00	$200.19	$317.10	$320.30	$0.00		$0.00	$62.66	$0.00	$0.00	$63.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.036S	SUP	HCPCS C1713		04.003.036S  -  SCREW BN T25 6.5MM 130MM AU STRL ST BLNT TIP STRDR TI FEM	BOTH IP/OP	$450.75 	$333.56	$0.00	$350.10	$196.93	$196.93	$0.00	$0.00	$0.00	$93.95	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$266.62	$266.62	$0.00	$218.81	$346.60	$350.10	$0.00		$0.00	$66.49	$0.00	$0.00	$69.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.240S	SUP	HCPCS C1713		04.003.240S  -  NAIL INTRAMEDULLARY 9MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.241S	SUP	HCPCS C1713		04.003.241S  -  NAIL INTRAMEDULLARY 9MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.244S	SUP	HCPCS C1713		04.003.244S  -  NAIL INTRAMEDULLARY 9MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.245S	SUP	HCPCS C1713		04.003.245S  -  NAIL INTRAMEDULLARY 9MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.248S	SUP	HCPCS C1713		04.003.248S  -  NAIL INTRAMEDULLARY 9MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.249S	SUP	HCPCS C1713		04.003.249S  -  NAIL INTRAMEDULLARY 9MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.252S	SUP	HCPCS C1713		04.003.252S  -  NAIL INTRAMEDULLARY 9MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.253S	SUP	HCPCS C1713		04.003.253S  -  NAIL INTRAMEDULLARY 9MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.256S	SUP	HCPCS C1713		04.003.256S  -  NAIL INTRAMEDULLARY 9MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.257S	SUP	HCPCS C1713		04.003.257S  -  NAIL INTRAMEDULLARY 9MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.260S	SUP	HCPCS C1713		04.003.260S  -  NAIL INTRAMEDULLARY 9MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.261S	SUP	HCPCS C1713		04.003.261S  -  NAIL INTRAMEDULLARY 9MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.264S	SUP	HCPCS C1713		04.003.264S  -  NAIL INTRAMEDULLARY 9MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.265S	SUP	HCPCS C1713		04.003.265S  -  NAIL INTRAMEDULLARY 9MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.268S	SUP	HCPCS C1713		04.003.268S  -  NAIL INTRAMEDULLARY 9MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.269S	SUP	HCPCS C1713		04.003.269S  -  NAIL INTRAMEDULLARY 9MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.272S	SUP	HCPCS C1713		04.003.272S  -  NAIL INTRAMEDULLARY 9MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.273S	SUP	HCPCS C1713		04.003.273S  -  NAIL INTRAMEDULLARY 9MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.276S	SUP	HCPCS C1713		04.003.276S  -  NAIL INTRAMEDULLARY 9MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.277S	SUP	HCPCS C1713		04.003.277S  -  NAIL INTRAMEDULLARY 9MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.340S	SUP	HCPCS C1713		04.003.340S  -  NAIL INTRAMEDULLARY 10MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.341S	SUP	HCPCS C1713		04.003.341S  -  NAIL INTRAMEDULLARY 10MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.344S	SUP	HCPCS C1713		04.003.344S  -  NAIL INTRAMEDULLARY 10MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.345S	SUP	HCPCS C1713		04.003.345S  -  NAIL INTRAMEDULLARY 10MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.348S	SUP	HCPCS C1713		04.003.348S  -  NAIL INTRAMEDULLARY 10MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.349S	SUP	HCPCS C1713		04.003.349S  -  NAIL INTRAMEDULLARY 10MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.352S	SUP	HCPCS C1713		04.003.352S  -  NAIL INTRAMEDULLARY 10MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.353S	SUP	HCPCS C1713		04.003.353S  -  NAIL INTRAMEDULLARY 10MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.356S	SUP	HCPCS C1713		04.003.356S  -  NAIL INTRAMEDULLARY 10MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.357S	SUP	HCPCS C1713		04.003.357S  -  NAIL INTRAMEDULLARY 10MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.360S	SUP	HCPCS C1713		04.003.360S  -  NAIL INTRAMEDULLARY 10MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.361S	SUP	HCPCS C1713		04.003.361S  -  NAIL INTRAMEDULLARY 10MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$594.10	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.364S	SUP	HCPCS C1713		04.003.364S  -  NAIL INTRAMEDULLARY 10MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.365S	SUP	HCPCS C1713		04.003.365S  -  NAIL INTRAMEDULLARY 10MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.368S	SUP	HCPCS C1713		04.003.368S  -  NAIL INTRAMEDULLARY 10MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.369S	SUP	HCPCS C1713		04.003.369S  -  NAIL INTRAMEDULLARY 10MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.372S	SUP	HCPCS C1713		04.003.372S  -  NAIL INTRAMEDULLARY 10MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.373S	SUP	HCPCS C1713		04.003.373S  -  NAIL INTRAMEDULLARY 10MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.376S	SUP	HCPCS C1713		04.003.376S  -  NAIL INTRAMEDULLARY 10MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.377S	SUP	HCPCS C1713		04.003.377S  -  NAIL INTRAMEDULLARY 10MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.440S	SUP	HCPCS C1713		04.003.440S  -  NAIL INTRAMEDULLARY 11MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.441S	SUP	HCPCS C1713		04.003.441S  -  NAIL INTRAMEDULLARY 11MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.444S	SUP	HCPCS C1713		04.003.444S  -  NAIL INTRAMEDULLARY 11MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.445S	SUP	HCPCS C1713		04.003.445S  -  NAIL INTRAMEDULLARY 11MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.448S	SUP	HCPCS C1713		04.003.448S  -  NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.449S	SUP	HCPCS C1713		04.003.449S  -  NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.452S	SUP	HCPCS C1713		04.003.452S  -  NAIL INTRAMEDULLARY 11MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.453S	SUP	HCPCS C1713		04.003.453S  -  NAIL INTRAMEDULLARY 11MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.456S	SUP	HCPCS C1713		04.003.456S  -  NAIL INTRAMEDULLARY 11MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.457S	SUP	HCPCS C1713		04.003.457S  -  NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.460S	SUP	HCPCS C1713		04.003.460S  -  NAIL INTRAMEDULLARY 11MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.461S	SUP	HCPCS C1713		04.003.461S  -  NAIL INTRAMEDULLARY 11MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.464S	SUP	HCPCS C1713		04.003.464S  -  NAIL INTRAMEDULLARY 11MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.465S	SUP	HCPCS C1713		04.003.465S  -  NAIL INTRAMEDULLARY 11MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.468S	SUP	HCPCS C1713		04.003.468S  -  NAIL INTRAMEDULLARY 11MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.469S	SUP	HCPCS C1713		04.003.469S  -  NAIL INTRAMEDULLARY 11MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.472S	SUP	HCPCS C1713		04.003.472S  -  NAIL INTRAMEDULLARY 11MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.473S	SUP	HCPCS C1713		04.003.473S  -  NAIL INTRAMEDULLARY 11MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.476S	SUP	HCPCS C1713		04.003.476S  -  NAIL INTRAMEDULLARY 11MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.477S	SUP	HCPCS C1713		04.003.477S  -  NAIL INTRAMEDULLARY 11MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.540S	SUP	HCPCS C1713		04.003.540S  -  NAIL INTRAMEDULLARY 12MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.541S	SUP	HCPCS C1713		04.003.541S  -  NAIL INTRAMEDULLARY 12MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.544S	SUP	HCPCS C1713		04.003.544S  -  NAIL INTRAMEDULLARY 12MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.545S	SUP	HCPCS C1713		04.003.545S  -  NAIL INTRAMEDULLARY 12MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.548S	SUP	HCPCS C1713		04.003.548S  -  NAIL INTRAMEDULLARY 12MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.549S	SUP	HCPCS C1713		04.003.549S  -  NAIL INTRAMEDULLARY 12MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.552S	SUP	HCPCS C1713		04.003.552S  -  NAIL INTRAMEDULLARY 12MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.553S	SUP	HCPCS C1713		04.003.553S  -  NAIL INTRAMEDULLARY 12MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.556S	SUP	HCPCS C1713		04.003.556S  -  NAIL INTRAMEDULLARY 12MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.557S	SUP	HCPCS C1713		04.003.557S  -  NAIL INTRAMEDULLARY 12MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.560S	SUP	HCPCS C1713		04.003.560S  -  NAIL INTRAMEDULLARY 12MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.561S	SUP	HCPCS C1713		04.003.561S  -  NAIL INTRAMEDULLARY 12MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.564S	SUP	HCPCS C1713		04.003.564S  -  NAIL INTRAMEDULLARY 12MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.565S	SUP	HCPCS C1713		04.003.565S  -  NAIL INTRAMEDULLARY 12MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.568S	SUP	HCPCS C1713		04.003.568S  -  NAIL INTRAMEDULLARY 12MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.569S	SUP	HCPCS C1713		04.003.569S  -  NAIL INTRAMEDULLARY 12MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.572S	SUP	HCPCS C1713		04.003.572S  -  NAIL INTRAMEDULLARY 12MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.573S	SUP	HCPCS C1713		04.003.573S  -  NAIL INTRAMEDULLARY 12MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.576S	SUP	HCPCS C1713		04.003.576S  -  NAIL INTRAMEDULLARY 12MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.577S	SUP	HCPCS C1713		04.003.577S  -  NAIL INTRAMEDULLARY 12MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.640S	SUP	HCPCS C1713		04.003.640S  -  NAIL INTRAMEDULLARY 13MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.641S	SUP	HCPCS C1713		04.003.641S  -  NAIL INTRAMEDULLARY 13MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.644S	SUP	HCPCS C1713		04.003.644S  -  NAIL INTRAMEDULLARY 13MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.645S	SUP	HCPCS C1713		04.003.645S  -  NAIL INTRAMEDULLARY 13MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.648S	SUP	HCPCS C1713		04.003.648S  -  NAIL INTRAMEDULLARY 13MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.649S	SUP	HCPCS C1713		04.003.649S  -  NAIL INTRAMEDULLARY 13MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.652S	SUP	HCPCS C1713		04.003.652S  -  NAIL INTRAMEDULLARY 13MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.653S	SUP	HCPCS C1713		04.003.653S  -  NAIL INTRAMEDULLARY 13MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.656S	SUP	HCPCS C1713		04.003.656S  -  NAIL INTRAMEDULLARY 13MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.657S	SUP	HCPCS C1713		04.003.657S  -  NAIL INTRAMEDULLARY 13MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.660S	SUP	HCPCS C1713		04.003.660S  -  NAIL INTRAMEDULLARY 13MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.661S	SUP	HCPCS C1713		04.003.661S  -  NAIL INTRAMEDULLARY 13MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.664S	SUP	HCPCS C1713		04.003.664S  -  NAIL INTRAMEDULLARY 13MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.665S	SUP	HCPCS C1713		04.003.665S  -  NAIL INTRAMEDULLARY 13MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.668S	SUP	HCPCS C1713		04.003.668S  -  NAIL INTRAMEDULLARY 13MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.669S	SUP	HCPCS C1713		04.003.669S  -  NAIL INTRAMEDULLARY 13MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.672S	SUP	HCPCS C1713		04.003.672S  -  NAIL INTRAMEDULLARY 13MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.673S	SUP	HCPCS C1713		04.003.673S  -  NAIL INTRAMEDULLARY 13MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.676S	SUP	HCPCS C1713		04.003.676S  -  NAIL INTRAMEDULLARY 13MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,136.28 "	"$2,320.85"	$0.00	"$2,435.96"	"$1,370.23"	"$1,370.23"	$0.00	$0.00	$0.00	$653.68	"$2,327.74"	"$2,327.74"	$0.00	$0.00	$653.60	$0.00	"$1,546.18"	"$1,546.18"	$0.00	"$1,522.48"	"$2,411.60"	"$2,435.96"	$0.00		$0.00	$462.65	$0.00	$0.00	$484.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.677S	SUP	HCPCS C1713		04.003.677S  -  NAIL INTRAMEDULLARY 13MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,242.78 "	"$2,399.66"	$0.00	"$2,518.66"	"$1,416.75"	"$1,416.75"	$0.00	$0.00	$0.00	$675.88	"$2,406.79"	"$2,406.79"	$0.00	$0.00	$675.79	$0.00	"$1,598.69"	"$1,598.69"	$0.00	"$1,574.16"	"$2,493.48"	"$2,518.66"	$0.00		$0.00	$478.36	$0.00	$0.00	$501.21	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.740S	SUP	HCPCS C1713		04.003.740S  -  NAIL INTRAMEDULLARY 14MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.741S	SUP	HCPCS C1713		04.003.741S  -  NAIL INTRAMEDULLARY 14MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.744S	SUP	HCPCS C1713		04.003.744S  -  NAIL INTRAMEDULLARY 14MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.745S	SUP	HCPCS C1713		04.003.745S  -  NAIL INTRAMEDULLARY 14MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.748S	SUP	HCPCS C1713		04.003.748S  -  NAIL INTRAMEDULLARY 14MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.749S	SUP	HCPCS C1713		04.003.749S  -  NAIL INTRAMEDULLARY 14MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.752S	SUP	HCPCS C1713		04.003.752S  -  NAIL INTRAMEDULLARY 14MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.753S	SUP	HCPCS C1713		04.003.753S  -  NAIL INTRAMEDULLARY 14MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.756S	SUP	HCPCS C1713		04.003.756S  -  NAIL INTRAMEDULLARY 14MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.757S	SUP	HCPCS C1713		04.003.757S  -  NAIL INTRAMEDULLARY 14MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.760S	SUP	HCPCS C1713		04.003.760S  -  NAIL INTRAMEDULLARY 14MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.761S	SUP	HCPCS C1713		04.003.761S  -  NAIL INTRAMEDULLARY 14MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.764S	SUP	HCPCS C1713		04.003.764S  -  NAIL INTRAMEDULLARY 14MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.765S	SUP	HCPCS C1713		04.003.765S  -  NAIL INTRAMEDULLARY 14MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.768S	SUP	HCPCS C1713		04.003.768S  -  NAIL INTRAMEDULLARY 14MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.769S	SUP	HCPCS C1713		04.003.769S  -  NAIL INTRAMEDULLARY 14MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.772S	SUP	HCPCS C1713		04.003.772S  -  NAIL INTRAMEDULLARY 14MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.773S	SUP	HCPCS C1713		04.003.773S  -  NAIL INTRAMEDULLARY 14MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.776S	SUP	HCPCS C1713		04.003.776S  -  NAIL INTRAMEDULLARY 14MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.777S	SUP	HCPCS C1713		04.003.777S  -  NAIL INTRAMEDULLARY 14MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.840S	SUP	HCPCS C1713		04.003.840S  -  NAIL INTRAMEDULLARY 15MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.841S	SUP	HCPCS C1713		04.003.841S  -  NAIL INTRAMEDULLARY 15MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.844S	SUP	HCPCS C1713		04.003.844S  -  NAIL INTRAMEDULLARY 15MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.845S	SUP	HCPCS C1713		04.003.845S  -  NAIL INTRAMEDULLARY 15MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.848S	SUP	HCPCS C1713		04.003.848S  -  NAIL INTRAMEDULLARY 15MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.849S	SUP	HCPCS C1713		04.003.849S  -  NAIL INTRAMEDULLARY 15MM 340MM RECONSTRUCTION ANATOMIC CANN	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.852S	SUP	HCPCS C1713		04.003.852S  -  NAIL INTRAMEDULLARY 15MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.853S	SUP	HCPCS C1713		04.003.853S  -  NAIL INTRAMEDULLARY 15MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.856S	SUP	HCPCS C1713		04.003.856S  -  NAIL INTRAMEDULLARY 15MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.857S	SUP	HCPCS C1713		04.003.857S  -  NAIL INTRAMEDULLARY 15MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.860S	SUP	HCPCS C1713		04.003.860S  -  NAIL INTRAMEDULLARY 15MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.861S	SUP	HCPCS C1713		04.003.861S  -  NAIL INTRAMEDULLARY 15MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.864S	SUP	HCPCS C1713		04.003.864S  -  NAIL INTRAMEDULLARY 15MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.865S	SUP	HCPCS C1713		04.003.865S  -  NAIL INTRAMEDULLARY 15MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.868S	SUP	HCPCS C1713		04.003.868S  -  NAIL INTRAMEDULLARY 15MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.869S	SUP	HCPCS C1713		04.003.869S  -  NAIL INTRAMEDULLARY 15MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.872S	SUP	HCPCS C1713		04.003.872S  -  NAIL INTRAMEDULLARY 15MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.873S	SUP	HCPCS C1713		04.003.873S  -  NAIL INTRAMEDULLARY 15MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.876S	SUP	HCPCS C1713		04.003.876S  -  NAIL INTRAMEDULLARY 15MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.877S	SUP	HCPCS C1713		04.003.877S  -  NAIL INTRAMEDULLARY 15MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.940S	SUP	HCPCS C1713		04.003.940S  -  NAIL INTRAMEDULLARY 16MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.941S	SUP	HCPCS C1713		04.003.941S  -  NAIL INTRAMEDULLARY 16MM 300MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.944S	SUP	HCPCS C1713		04.003.944S  -  NAIL INTRAMEDULLARY 16MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.945S	SUP	HCPCS C1713		04.003.945S  -  NAIL INTRAMEDULLARY 16MM 320MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.948S	SUP	HCPCS C1713		04.003.948S  -  NAIL INTRAMEDULLARY 16MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.949S	SUP	HCPCS C1713		04.003.949S  -  NAIL INTRAMEDULLARY 16MM 340MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.952S	SUP	HCPCS C1713		04.003.952S  -  NAIL INTRAMEDULLARY 16MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.953S	SUP	HCPCS C1713		04.003.953S  -  NAIL INTRAMEDULLARY 16MM 360MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.956S	SUP	HCPCS C1713		04.003.956S  -  NAIL INTRAMEDULLARY 16MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.957S	SUP	HCPCS C1713		04.003.957S  -  NAIL INTRAMEDULLARY 16MM 380MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.960S	SUP	HCPCS C1713		04.003.960S  -  NAIL INTRAMEDULLARY 16MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.961S	SUP	HCPCS C1713		04.003.961S  -  NAIL INTRAMEDULLARY 16MM 400MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.964S	SUP	HCPCS C1713		04.003.964S  -  NAIL INTRAMEDULLARY 16MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.965S	SUP	HCPCS C1713		04.003.965S  -  NAIL INTRAMEDULLARY 16MM 420MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.968S	SUP	HCPCS C1713		04.003.968S  -  NAIL INTRAMEDULLARY 16MM 440MM CANN LATERAL ENTRY	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.969S	SUP	HCPCS C1713		04.003.969S  -  NAIL INTRAMEDULLARY 16MM 440MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.972S	SUP	HCPCS C1713		04.003.972S  -  NAIL INTRAMEDULLARY 16MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.973S	SUP	HCPCS C1713		04.003.973S  -  NAIL INTRAMEDULLARY 16MM 460MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.976S	SUP	HCPCS C1713		04.003.976S  -  NAIL INTRAMEDULLARY 16MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.003.977S	SUP	HCPCS C1713		04.003.977S  -  NAIL INTRAMEDULLARY 16MM 480MM ANATOMIC CANN HELICAL FLUTED	BOTH IP/OP	"$3,340.50 "	"$2,471.97"	$0.00	"$2,594.58"	"$1,459.45"	"$1,459.45"	$0.00	$0.00	$0.00	$696.24	"$2,479.32"	"$2,479.32"	$0.00	$0.00	$696.16	$0.00	"$1,646.87"	"$1,646.87"	$0.00	"$1,621.61"	"$2,568.64"	"$2,594.58"	$0.00		$0.00	$492.78	$0.00	$0.00	$516.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.000S	SUP	Custom 27803010		04.004.000S  -  CAP END 5MM T40 STARDRIVE RECESS EXTENDED NAIL-EX GOLD	BOTH IP/OP	$414.28 	$306.57	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.47	$307.47	$0.00	$0.00	$86.33	$0.00	$0.00	$0.00	$0.00	$201.11	$318.57	$321.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.001S	SUP	Custom 27803010		04.004.001S  -  CAP END 5MM STARDRIVE T40 RECESS EXTENDED EXPERT GOLD	BOTH IP/OP	$504.73 	$373.50	$0.00	$392.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.61	$374.61	$0.00	$0.00	$105.18	$0.00	$0.00	$0.00	$0.00	$245.01	$388.10	$392.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.002S	SUP	Custom 27803010		04.004.002S  -  CAP END 10MM EXTN T40 STARDRIVE RECESS EXPERT GOLD TITANIUM	BOTH IP/OP	$504.73 	$373.50	$0.00	$392.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.61	$374.61	$0.00	$0.00	$105.18	$0.00	$0.00	$0.00	$0.00	$245.01	$388.10	$392.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.003S	SUP	Custom 27803010		04.004.003S  -  CAP END 15MM EXTN T40 STARDRIVE RECESS EXPERT GOLD TITANIUM	BOTH IP/OP	$504.73 	$373.50	$0.00	$392.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.61	$374.61	$0.00	$0.00	$105.18	$0.00	$0.00	$0.00	$0.00	$245.01	$388.10	$392.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.008S	SUP	Custom 27803010		04.004.008S  -  CAP END 0MM T40 STARDRIVE RECESS EXTENDED NAIL-EX GRAY	BOTH IP/OP	$414.28 	$306.57	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.47	$307.47	$0.00	$0.00	$86.33	$0.00	$0.00	$0.00	$0.00	$201.11	$318.57	$321.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.009S	SUP	Custom 27803010		04.004.009S  -  CAP END 5MM EXTENDED T40 STARDRIVE RECESS LOCKING HOLE	BOTH IP/OP	$504.73 	$373.50	$0.00	$392.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.61	$374.61	$0.00	$0.00	$105.18	$0.00	$0.00	$0.00	$0.00	$245.01	$388.10	$392.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.010S	SUP	Custom 27803010		04.004.010S  -  CAP END 10MM EXTENDED T40 STARDRIVE RECESS LOCKING HOLE	BOTH IP/OP	$504.73 	$373.50	$0.00	$392.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.61	$374.61	$0.00	$0.00	$105.18	$0.00	$0.00	$0.00	$0.00	$245.01	$388.10	$392.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.011S	SUP	Custom 27803010		04.004.011S  -  CAP END 15MM EXTN T40 STARDRIVE RECESS EXPERT GRAY TITANIUM	BOTH IP/OP	$504.73 	$373.50	$0.00	$392.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.61	$374.61	$0.00	$0.00	$105.18	$0.00	$0.00	$0.00	$0.00	$245.01	$388.10	$392.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.231S	SUP	HCPCS C1713		04.004.231S  -  NAIL INTRAMEDULLARY 8MM 25.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.234S	SUP	HCPCS C1713		04.004.234S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 270MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.237S	SUP	HCPCS C1713		04.004.237S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 285MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.240S	SUP	HCPCS C1713		04.004.240S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 300MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.243S	SUP	HCPCS C1713		04.004.243S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 315MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.246S	SUP	HCPCS C1713		04.004.246S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 330MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.249S	SUP	HCPCS C1713		04.004.249S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 345MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.252S	SUP	HCPCS C1713		04.004.252S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 360MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.255S	SUP	HCPCS C1713		04.004.255S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 375MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.258S	SUP	HCPCS C1713		04.004.258S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 390MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.261S	SUP	HCPCS C1713		04.004.261S  -  NAIL INTRAMEDULLARY 8MM 40.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$2,917.48 "	"$2,158.94"	$0.00	"$2,266.00"	"$1,274.63"	"$1,274.63"	$0.00	$0.00	$0.00	$608.07	"$2,165.35"	"$2,165.35"	$0.00	$0.00	$608.00	$0.00	"$1,438.32"	"$1,438.32"	$0.00	"$1,416.25"	"$2,243.34"	"$2,266.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$450.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.264S	SUP	HCPCS C1713		04.004.264S  -  NAIL INTRAMEDULLARY 8MM 42CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$2,917.48 "	"$2,158.94"	$0.00	"$2,266.00"	"$1,274.63"	"$1,274.63"	$0.00	$0.00	$0.00	$608.07	"$2,165.35"	"$2,165.35"	$0.00	$0.00	$608.00	$0.00	"$1,438.32"	"$1,438.32"	$0.00	"$1,416.25"	"$2,243.34"	"$2,266.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$450.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.267S	SUP	HCPCS C1713		04.004.267S  -  NAIL INTRAMEDULLARY 8MM 43.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.331S	SUP	HCPCS C1713		04.004.331S  -  NAIL INTRAMEDULLARY 9MM 25.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$2,927.68 "	"$2,166.48"	$0.00	"$2,273.94"	"$1,279.09"	"$1,279.09"	$0.00	$0.00	$0.00	$610.20	"$2,172.92"	"$2,172.92"	$0.00	$0.00	$610.13	$0.00	"$1,443.34"	"$1,443.34"	$0.00	"$1,421.21"	"$2,251.20"	"$2,273.94"	$0.00		$0.00	$431.88	$0.00	$0.00	$452.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.334S	SUP	HCPCS C1713		04.004.334S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 270MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.337S	SUP	HCPCS C1713		04.004.337S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 285MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.340S	SUP	HCPCS C1713		04.004.340S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 300MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.343S	SUP	HCPCS C1713		04.004.343S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 315MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.346S	SUP	HCPCS C1713		04.004.346S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 330MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.349S	SUP	HCPCS C1713		04.004.349S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 345MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.352S	SUP	HCPCS C1713		04.004.352S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 360MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.355S	SUP	HCPCS C1713		04.004.355S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 375MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.358S	SUP	HCPCS C1713		04.004.358S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 390MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.361S	SUP	HCPCS C1713		04.004.361S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 405MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.364S	SUP	HCPCS C1713		04.004.364S  -  NAIL INTRAMEDULLARY 9MM 42CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.367S	SUP	HCPCS C1713		04.004.367S  -  NAIL INTRAMEDULLARY 9MM 43.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.431S	SUP	HCPCS C1713		04.004.431S  -  NAIL INTRAMEDULLARY 10MM 25.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$2,917.48 "	"$2,158.94"	$0.00	"$2,266.00"	"$1,274.63"	"$1,274.63"	$0.00	$0.00	$0.00	$608.07	"$2,165.35"	"$2,165.35"	$0.00	$0.00	$608.00	$0.00	"$1,438.32"	"$1,438.32"	$0.00	"$1,416.25"	"$2,243.34"	"$2,266.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$450.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.434S	SUP	HCPCS C1713		04.004.434S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 270MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.437S	SUP	HCPCS C1713		04.004.437S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 285MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.440S	SUP	HCPCS C1713		04.004.440S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND BARREL 10MM 300MM CANN	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.443S	SUP	HCPCS C1713		04.004.443S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 315MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.446S	SUP	HCPCS C1713		04.004.446S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 33CM CANN EXPERT LIGHT	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.449S	SUP	HCPCS C1713		04.004.449S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 34.5CM CANN EXPERT LIGHT	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.452S	SUP	HCPCS C1713		04.004.452S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.455S	SUP	HCPCS C1713		04.004.455S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 375MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.458S	SUP	HCPCS C1713		04.004.458S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 390MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.461S	SUP	HCPCS C1713		04.004.461S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 405MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.464S	SUP	HCPCS C1713		04.004.464S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN ROUND BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.467S	SUP	HCPCS C1713		04.004.467S  -  NAIL INTRAMEDULLARY 10MM 43.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$2,927.68 "	"$2,166.48"	$0.00	"$2,273.94"	"$1,279.09"	"$1,279.09"	$0.00	$0.00	$0.00	$610.20	"$2,172.92"	"$2,172.92"	$0.00	$0.00	$610.13	$0.00	"$1,443.34"	"$1,443.34"	$0.00	"$1,421.21"	"$2,251.20"	"$2,273.94"	$0.00		$0.00	$431.88	$0.00	$0.00	$452.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.531S	SUP	HCPCS C1713		04.004.531S  -  NAIL INTRAMEDULLARY 11MM 25.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.534S	SUP	HCPCS C1713		04.004.534S  -  NAIL INTRAMEDULLARY 11MM 27CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.537S	SUP	HCPCS C1713		04.004.537S  -  NAIL INTRAMEDULLARY 11MM 28.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.540S	SUP	HCPCS C1713		04.004.540S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.543S	SUP	HCPCS C1713		04.004.543S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 315MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.546S	SUP	HCPCS C1713		04.004.546S  -  NAIL INTRAMEDULLARY 11MM 330MM CANN NAIL-EX LIGHT GREEN	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.549S	SUP	HCPCS C1713		04.004.549S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 345MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.552S	SUP	HCPCS C1713		04.004.552S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.555S	SUP	HCPCS C1713		04.004.555S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 375MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.558S	SUP	HCPCS C1713		04.004.558S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTE BARREL 11MM 390MM CANN	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.561S	SUP	HCPCS C1713		04.004.561S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 405MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.564S	SUP	HCPCS C1713		04.004.564S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.567S	SUP	HCPCS C1713		04.004.567S  -  NAIL INTRAMEDULLARY 11MM 43.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.631S	SUP	HCPCS C1713		04.004.631S  -  NAIL INTRAMEDULLARY 12MM 25.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.634S	SUP	HCPCS C1713		04.004.634S  -  NAIL INTRAMEDULLARY 12MM 27CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.637S	SUP	HCPCS C1713		04.004.637S  -  NAIL INTRAMEDULLARY 12MM 28.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.640S	SUP	HCPCS C1713		04.004.640S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.643S	SUP	HCPCS C1713		04.004.643S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTE 12MM 315MM CANN EXPERT	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.646S	SUP	HCPCS C1713		04.004.646S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTE BARREL 12MM 330MM CANN	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.649S	SUP	HCPCS C1713		04.004.649S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 345MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.652S	SUP	HCPCS C1713		04.004.652S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.655S	SUP	HCPCS C1713		04.004.655S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 375MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.658S	SUP	HCPCS C1713		04.004.658S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 390MM CANN EXPERT LIGHT	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.661S	SUP	HCPCS C1713		04.004.661S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 405MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.664S	SUP	HCPCS C1713		04.004.664S  -  NAIL INTRAMEDULLARY 12MM 42CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.667S	SUP	HCPCS C1713		04.004.667S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 435MM CANN FLUTED BARREL	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.731S	SUP	HCPCS C1713		04.004.731S  -  NAIL INTRAMEDULLARY 13MM 25.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.734S	SUP	HCPCS C1713		04.004.734S  -  NAIL INTRAMEDULLARY 13MM 27CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.737S	SUP	HCPCS C1713		04.004.737S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 285MM CANN FLUTED BARREL	BOTH IP/OP	"$2,927.68 "	"$2,166.48"	$0.00	"$2,273.94"	"$1,279.09"	"$1,279.09"	$0.00	$0.00	$0.00	$610.20	"$2,172.92"	"$2,172.92"	$0.00	$0.00	$610.13	$0.00	"$1,443.34"	"$1,443.34"	$0.00	"$1,421.21"	"$2,251.20"	"$2,273.94"	$0.00		$0.00	$431.88	$0.00	$0.00	$452.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.740S	SUP	HCPCS C1713		04.004.740S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN FLUTED BARREL	BOTH IP/OP	"$2,927.68 "	"$2,166.48"	$0.00	"$2,273.94"	"$1,279.09"	"$1,279.09"	$0.00	$0.00	$0.00	$610.20	"$2,172.92"	"$2,172.92"	$0.00	$0.00	$610.13	$0.00	"$1,443.34"	"$1,443.34"	$0.00	"$1,421.21"	"$2,251.20"	"$2,273.94"	$0.00		$0.00	$431.88	$0.00	$0.00	$452.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.743S	SUP	HCPCS C1713		04.004.743S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 315MM CANN FLUTED BARREL	BOTH IP/OP	"$2,927.68 "	"$2,166.48"	$0.00	"$2,273.94"	"$1,279.09"	"$1,279.09"	$0.00	$0.00	$0.00	$610.20	"$2,172.92"	"$2,172.92"	$0.00	$0.00	$610.13	$0.00	"$1,443.34"	"$1,443.34"	$0.00	"$1,421.21"	"$2,251.20"	"$2,273.94"	$0.00		$0.00	$431.88	$0.00	$0.00	$452.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.746S	SUP	HCPCS C1713		04.004.746S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 330MM CANN FLUTED BARREL	BOTH IP/OP	"$2,927.68 "	"$2,166.48"	$0.00	"$2,273.94"	"$1,279.09"	"$1,279.09"	$0.00	$0.00	$0.00	$610.20	"$2,172.92"	"$2,172.92"	$0.00	$0.00	$610.13	$0.00	"$1,443.34"	"$1,443.34"	$0.00	"$1,421.21"	"$2,251.20"	"$2,273.94"	$0.00		$0.00	$431.88	$0.00	$0.00	$452.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.749S	SUP	HCPCS C1713		04.004.749S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 345MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.752S	SUP	HCPCS C1713		04.004.752S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.755S	SUP	HCPCS C1713		04.004.755S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 375MM CANN FLUTED BARREL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.758S	SUP	HCPCS C1713		04.004.758S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 390MM CANN FLUTED BARREL	BOTH IP/OP	"$2,927.68 "	"$2,166.48"	$0.00	"$2,273.94"	"$1,279.09"	"$1,279.09"	$0.00	$0.00	$0.00	$610.20	"$2,172.92"	"$2,172.92"	$0.00	$0.00	$610.13	$0.00	"$1,443.34"	"$1,443.34"	$0.00	"$1,421.21"	"$2,251.20"	"$2,273.94"	$0.00		$0.00	$431.88	$0.00	$0.00	$452.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.761S	SUP	HCPCS C1713		04.004.761S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 405MM CANN FLUTED BARREL	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.764S	SUP	HCPCS C1713		04.004.764S  -  NAIL INTRAMEDULLARY 13MM 42CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.004.767S	SUP	HCPCS C1713		04.004.767S  -  NAIL INTRAMEDULLARY 13MM 43.5CM CANN NAIL-EX TITANIUM TIBIA	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.408	SUP	HCPCS C1713		04.005.408  -  SCREW BONE NONSTRL 4MM 18MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.408S	SUP	HCPCS C1713		04.005.408S  -  SCREW BN T25 FT 4MM 3.3MM 18MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.410	SUP	HCPCS C1713		04.005.410  -  SCREW BONE NONSTRL 4MM 20MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.410S	SUP	HCPCS C1713		04.005.410S  -  SCREW BN T25 FT 4MM 3.3MM 20MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.412	SUP	HCPCS C1713		04.005.412  -  SCREW BONE NONSTRL 4MM 22MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.412S	SUP	HCPCS C1713		04.005.412S  -  SCREW BN T25 FT 4MM 3.3MM 22MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.414	SUP	HCPCS C1713		04.005.414  -  SCREW BONE NONSTRL 4MM 24MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.414S	SUP	HCPCS C1713		04.005.414S  -  SCREW BN T25 FT 4MM 3.3MM 24MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.416	SUP	HCPCS C1713		04.005.416  -  SCREW BONE NONSTRL 4MM 26MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.416S	SUP	HCPCS C1713		04.005.416S  -  SCREW BN T25 FT 4MM 3.3MM 26MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.418	SUP	HCPCS C1713		04.005.418  -  SCREW BONE 4MM 28MM NLEX TI HUM TIB LCK STARDRIVE RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.418S	SUP	HCPCS C1713		04.005.418S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 28MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.420	SUP	HCPCS C1713		04.005.420  -  SCREW BONE 4MM 30MM NLEX TI HUM TIB LCK STARDRIVE RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.420S	SUP	HCPCS C1713		04.005.420S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 30MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.422	SUP	HCPCS C1713		04.005.422  -  SCREW BONE 4MM 32MM NLEX TI HUM TIB LCK STARDRIVE RECESS	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.422S	SUP	HCPCS C1713		04.005.422S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 32MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.424	SUP	HCPCS C1713		04.005.424  -  SCREW BONE NONSTRL 4MM 34MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.424S	SUP	HCPCS C1713		04.005.424S  -  SCREW BN T25 FT 4MM 3.3MM 34MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.426	SUP	HCPCS C1713		04.005.426  -  SCREW BONE NONSTRL 4MM 36MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.426S	SUP	HCPCS C1713		04.005.426S  -  SCREW BN T25 FT 4MM 3.3MM 36MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.428	SUP	HCPCS C1713		04.005.428  -  SCREW BONE NONSTRL 4MM 38MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.428S	SUP	HCPCS C1713		04.005.428S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 38MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.430	SUP	HCPCS C1713		04.005.430  -  SCREW BONE NONSTRL 4MM 40MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.430S	SUP	HCPCS C1713		04.005.430S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 40MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.432	SUP	HCPCS C1713		04.005.432  -  SCREW BONE NONSTRL 4MM 42MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.432S	SUP	HCPCS C1713		04.005.432S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 42MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.434	SUP	HCPCS C1713		04.005.434  -  SCREW BONE 4MM 44MM NLEX TI FULTHD HUM TIB SLFTAP LCK	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.434S	SUP	HCPCS C1713		04.005.434S  -  SCREW BN T25 FT 4MM 3.3MM 44MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.436	SUP	HCPCS C1713		04.005.436  -  SCREW BONE NONSTRL 4MM 46MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.436S	SUP	HCPCS C1713		04.005.436S  -  SCREW BN T25 FT 4MM 3.3MM 46MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.438	SUP	HCPCS C1713		04.005.438  -  SCREW BONE NONSTRL 4MM 48MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.438S	SUP	HCPCS C1713		04.005.438S  -  SCREW BN T25 FT 4MM 3.3MM 48MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.440	SUP	HCPCS C1713		04.005.440  -  SCREW BONE NONSTRL 4MM 50MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.440S	SUP	HCPCS C1713		04.005.440S  -  SCREW BN T25 FT 4MM 3.3MM 50MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.442	SUP	HCPCS C1713		04.005.442  -  SCREW BONE NONSTRL 4MM 52MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.442S	SUP	HCPCS C1713		04.005.442S  -  SCREW BN T25 FT 4MM 3.3MM 52MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.444	SUP	HCPCS C1713		04.005.444  -  SCREW BONE NONSTRL 4MM 54MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.444S	SUP	HCPCS C1713		04.005.444S  -  SCREW BN T25 FT 4MM 3.3MM 54MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.446	SUP	HCPCS C1713		04.005.446  -  SCREW BONE NONSTRL 4MM 56MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.446S	SUP	HCPCS C1713		04.005.446S  -  SCREW BN T25 FT 4MM 3.3MM 56MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.448	SUP	HCPCS C1713		04.005.448  -  SCREW BONE NONSTRL 4MM 58MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.448S	SUP	HCPCS C1713		04.005.448S  -  SCREW BN T25 FT 4MM 3.3MM 58MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.450	SUP	HCPCS C1713		04.005.450  -  SCREW BONE NONSTRL 4MM 60MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.450S	SUP	HCPCS C1713		04.005.450S  -  SCREW BN T25 FT 4MM 3.3MM 60MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.452	SUP	HCPCS C1713		04.005.452  -  SCREW BONE NONSTRL 4MM 62MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.452S	SUP	HCPCS C1713		04.005.452S  -  SCREW BN T25 FT 4MM 3.3MM 62MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.454	SUP	HCPCS C1713		04.005.454  -  SCREW BONE NONSTRL 4MM 64MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.454S	SUP	HCPCS C1713		04.005.454S  -  SCREW BN T25 FT 4MM 3.3MM 64MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.456	SUP	HCPCS C1713		04.005.456  -  SCREW BONE NONSTRL 4MM 66MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.456S	SUP	HCPCS C1713		04.005.456S  -  SCREW BN T25 FT 4MM 3.3MM 66MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.458	SUP	HCPCS C1713		04.005.458  -  SCREW BONE NONSTRL 4MM 68MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.458S	SUP	HCPCS C1713		04.005.458S  -  SCREW BN T25 FT 4MM 3.3MM 68MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.460	SUP	HCPCS C1713		04.005.460  -  SCREW BONE NONSTRL 4MM 70MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.460S	SUP	HCPCS C1713		04.005.460S  -  SCREW BN T25 FT 4MM 3.3MM 70MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.462	SUP	HCPCS C1713		04.005.462  -  SCREW BONE NONSTRL 4MM 72MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.462S	SUP	HCPCS C1713		04.005.462S  -  SCREW BN T25 FT 4MM 3.3MM 72MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.464	SUP	HCPCS C1713		04.005.464  -  SCREW BONE NONSTRL 4MM 74MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.464S	SUP	HCPCS C1713		04.005.464S  -  SCREW BN T25 FT 4MM 3.3MM 74MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.466	SUP	HCPCS C1713		04.005.466  -  SCREW BONE NONSTRL 4MM 76MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.466S	SUP	HCPCS C1713		04.005.466S  -  SCREW BN T25 FT 4MM 3.3MM 76MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.468	SUP	HCPCS C1713		04.005.468  -  SCREW BONE NONSTRL 4MM 78MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.468S	SUP	HCPCS C1713		04.005.468S  -  SCREW BN T25 FT 4MM 3.3MM 78MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.470	SUP	HCPCS C1713		04.005.470  -  SCREW BONE NONSTRL 4MM 80MM NLEX TI FULTHD HUM TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.470S	SUP	HCPCS C1713		04.005.470S  -  SCREW BN T25 FT 4MM 3.3MM 80MM BLU STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.516	SUP	HCPCS C1713		04.005.516  -  SCREW BONE 5MM 26MM NLEX TI FEM/TIB LCK STARDRIVE RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.516S	SUP	HCPCS C1713		04.005.516S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 26MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.518	SUP	HCPCS C1713		04.005.518  -  SCREW BONE 5MM 4.3MM 28MM NLEX TI FULTHD FEM/TIB T25	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.518S	SUP	HCPCS C1713		04.005.518S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 28MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.520	SUP	HCPCS C1713		04.005.520  -  SCREW BONE 5MM 30MM NLEX TI FULTHD FEM/TIB SLFTAP LCK	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.520S	SUP	HCPCS C1713		04.005.520S  -  SCREW BONE FULTHD 5MM 4.3MM 30MM T25 STARDRIVE RECESS	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.522	SUP	HCPCS C1713		04.005.522  -  SCREW BONE NONSTRL 5MM 32MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.522S	SUP	HCPCS C1713		04.005.522S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 32MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.524	SUP	HCPCS C1713		04.005.524  -  SCREW BONE NONSTRL 5MM 34MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.524S	SUP	HCPCS C1713		04.005.524S  -  SCREW BONE FULTHD 5MM 4.3MM 34MM T25 STARDRIVE RECESS	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.526	SUP	HCPCS C1713		04.005.526  -  SCREW BONE NONSTRL 5MM 36MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.526S	SUP	HCPCS C1713		04.005.526S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 36MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.528	SUP	HCPCS C1713		04.005.528  -  SCREW BONE NONSTRL 5MM 38MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.528S	SUP	HCPCS C1713		04.005.528S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 38MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.530	SUP	HCPCS C1713		04.005.530  -  SCREW BONE NONSTRL 5MM 40MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.530S	SUP	HCPCS C1713		04.005.530S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 40MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.532	SUP	HCPCS C1713		04.005.532  -  SCREW BONE NONSTRL 5MM 42MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.532S	SUP	HCPCS C1713		04.005.532S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 42MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.534	SUP	HCPCS C1713		04.005.534  -  SCREW BONE NONSTRL 5MM 44MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.534S	SUP	HCPCS C1713		04.005.534S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 44MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.536	SUP	HCPCS C1713		04.005.536  -  SCREW BONE NONSTRL 5MM 46MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.536S	SUP	HCPCS C1713		04.005.536S  -  SCREW BN T25 FT 5MM 4.3MM 46MM LGHT GRN STRL LCK ST BLNT TIP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.538	SUP	HCPCS C1713		04.005.538  -  SCREW BONE NONSTRL 5MM 48MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.538S	SUP	HCPCS C1713		04.005.538S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 48MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.540	SUP	HCPCS C1713		04.005.540  -  SCREW BONE NONSTRL 5MM 50MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.540S	SUP	HCPCS C1713		04.005.540S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 50MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.542	SUP	HCPCS C1713		04.005.542  -  SCREW BONE NONSTRL 5MM 52MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.542S	SUP	HCPCS C1713		04.005.542S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 52MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.544	SUP	HCPCS C1713		04.005.544  -  SCREW BONE NONSTRL 5MM 54MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.544S	SUP	HCPCS C1713		04.005.544S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 54MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.546	SUP	HCPCS C1713		04.005.546  -  SCREW BONE NONSTRL 5MM 56MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.546S	SUP	HCPCS C1713		04.005.546S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 56MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.548	SUP	HCPCS C1713		04.005.548  -  SCREW BONE NONSTRL 5MM 58MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.548S	SUP	HCPCS C1713		04.005.548S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 58MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.550	SUP	HCPCS C1713		04.005.550  -  SCREW BONE NONSTRL 5MM 60MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.550S	SUP	HCPCS C1713		04.005.550S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 60MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.552	SUP	HCPCS C1713		04.005.552  -  SCREW BONE 5MM 62MM NLEX TI FEM/TIB LCK STARDRIVE RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.552S	SUP	HCPCS C1713		04.005.552S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 62MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.554	SUP	HCPCS C1713		04.005.554  -  SCREW BONE 5MM 64MM NLEX TI FEM/TIB LCK STARDRIVE RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.554S	SUP	HCPCS C1713		04.005.554S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 64MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.556	SUP	HCPCS C1713		04.005.556  -  SCREW BONE 5MM 66MM NLEX TI FEM/TIB LCK STARDRIVE RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.556S	SUP	HCPCS C1713		04.005.556S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 66MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.558	SUP	HCPCS C1713		04.005.558  -  SCREW BONE 5MM 68MM NLEX TI FEM/TIB LCK STARDRIVE RECESS	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$138.44	$138.44	$0.00	$0.00	$0.00	$64.12	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$181.97	$181.97	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$48.15	$0.00	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.558S	SUP	HCPCS C1713		04.005.558S  -  SCREW BONE FULTHD 5MM 8MM 68MM T25 STARDRIVE RECESS LOCKING	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.560	SUP	HCPCS C1713		04.005.560  -  SCREW BONE 5MM 70MM NLEX TI FEM/TIB LCK STARDRIVE RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.560S	SUP	HCPCS C1713		04.005.560S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 70MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.562	SUP	HCPCS C1713		04.005.562  -  SCREW BONE 5MM 72MM NLEX TI FEM/TIB LCK STARDRIVE RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.562S	SUP	HCPCS C1713		04.005.562S  -  SCREW BN T25 FT 5MM 4.3MM 72MM LGHT GRN STRL LCK ST BLNT TIP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.564	SUP	HCPCS C1713		04.005.564  -  SCREW BONE 5MM 74MM NLEX TI FEM/TIB LCK STARDRIVE RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.564S	SUP	HCPCS C1713		04.005.564S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 74MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.566	SUP	HCPCS C1713		04.005.566  -  SCREW BONE 5MM 76MM NLEX TI FEM/TIB LCK STARDRIVE RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.566S	SUP	HCPCS C1713		04.005.566S  -  SCREW BONE FULTHD 5MM 8MM 76MM T25 STARDRIVE RECESS LOCKING	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.568	SUP	HCPCS C1713		04.005.568  -  SCREW BONE 5MM 78MM NLEX TI FEM/TIB LCK STARDRIVE RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.568S	SUP	HCPCS C1713		04.005.568S  -  SCREW BONE FULTHD 5MM 8MM 78MM LOCK CANN SELF TAP BLUNT TIP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.570	SUP	HCPCS C1713		04.005.570  -  SCREW BONE 5MM 80MM NLEX TI FEM/TIB LCK STARDRIVE RECESS	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.570S	SUP	HCPCS C1713		04.005.570S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 80MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.575	SUP	HCPCS C1713		04.005.575  -  SCREW BONE NONSTRL 5MM 85MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.575S	SUP	HCPCS C1713		04.005.575S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 85MM 2 LEAD SELF TAP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.580	SUP	HCPCS C1713		04.005.580  -  SCREW BONE NONSTRL 5MM 90MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.580S	SUP	HCPCS C1713		04.005.580S  -  SCREW BONE FULTHD 5MM 8MM 90MM T25 STARDRIVE RECESS LOCKING	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.585	SUP	HCPCS C1713		04.005.585  -  SCREW BONE NONSTRL 5MM 95MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.585S	SUP	HCPCS C1713		04.005.585S  -  SCREW BN T25 FT 5MM 4.3MM 95MM LGHT GRN STRL LCK ST BLNT TIP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.590	SUP	HCPCS C1713		04.005.590  -  SCREW BONE NONSTRL 5MM 100MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.590S	SUP	HCPCS C1713		04.005.590S  -  SCREW BONE FULTHD 5MM 8MM 100MM T25 STARDRIVE RECESS LOCKING	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.616	SUP	HCPCS C1713		04.005.616  -  SCREW BONE NONSTRL 6MM 26MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.616S	SUP	HCPCS C1713		04.005.616S  -  SCREW BN FT 6MM 8MM 26MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.618	SUP	HCPCS C1713		04.005.618  -  SCREW BONE NONSTRL 6MM 28MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.618S	SUP	HCPCS C1713		04.005.618S  -  SCREW BN FT 6MM 8MM 28MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.620	SUP	HCPCS C1713		04.005.620  -  SCREW BONE NONSTRL 6MM 30MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.620S	SUP	HCPCS C1713		04.005.620S  -  SCREW BN FT 6MM 8MM 30MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.622	SUP	HCPCS C1713		04.005.622  -  SCREW BONE NONSTRL 6MM 32MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.622S	SUP	HCPCS C1713		04.005.622S  -  SCREW BN T25 FT BLNT 6MM 8MM 32MM AQ STRL XPRT 2 LD ST LCK	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.624	SUP	HCPCS C1713		04.005.624  -  SCREW BONE NONSTRL 6MM 34MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.624S	SUP	HCPCS C1713		04.005.624S  -  SCREW BN FT 6MM 8MM 34MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.626	SUP	HCPCS C1713		04.005.626  -  SCREW BONE NONSTRL 6MM 36MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.626S	SUP	HCPCS C1713		04.005.626S  -  SCREW BN T25 FT BLNT 6MM 8MM 36MM AQ STRL XPRT 2 LD ST LCK	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.628	SUP	HCPCS C1713		04.005.628  -  SCREW BONE NONSTRL 6MM 38MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.628S	SUP	HCPCS C1713		04.005.628S  -  SCREW BN T25 FT 6MM 4.8MM 38MM AQ STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.630	SUP	HCPCS C1713		04.005.630  -  SCREW BONE NONSTRL 6MM 40MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.630S	SUP	HCPCS C1713		04.005.630S  -  SCREW BN FT 6MM 8MM 40MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.632	SUP	HCPCS C1713		04.005.632  -  SCREW BONE NONSTRL 6MM 42MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.632S	SUP	HCPCS C1713		04.005.632S  -  SCREW BN FT 6MM 8MM 42MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.634	SUP	HCPCS C1713		04.005.634  -  SCREW BONE NONSTRL 6MM 44MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.634S	SUP	HCPCS C1713		04.005.634S  -  SCREW BN T25 FT 6MM 4.8MM 44MM AQ STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.636	SUP	HCPCS C1713		04.005.636  -  SCREW BONE NONSTRL 6MM 46MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.636S	SUP	HCPCS C1713		04.005.636S  -  SCREW BN FT 6MM 8MM 46MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.638	SUP	HCPCS C1713		04.005.638  -  SCREW BONE NONSTRL 6MM 48MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.638S	SUP	HCPCS C1713		04.005.638S  -  SCREW BN FT 6MM 8MM 48MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.640	SUP	HCPCS C1713		04.005.640  -  SCREW BONE NONSTRL 6MM 50MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.640S	SUP	HCPCS C1713		04.005.640S  -  SCREW BN FT 6MM 8MM 50MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.642	SUP	HCPCS C1713		04.005.642  -  SCREW BONE NONSTRL 6MM 52MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.642S	SUP	HCPCS C1713		04.005.642S  -  SCREW BN T25 FT BLNT 6MM 8MM 52MM AQ STRL XPRT 2 LD ST LCK	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.644	SUP	HCPCS C1713		04.005.644  -  SCREW BONE NONSTRL 6MM 54MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.644S	SUP	HCPCS C1713		04.005.644S  -  SCREW BN T25 FT 6MM 8MM 54MM AQ STRL ST LCK BLNT TIP STRDR	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.646	SUP	HCPCS C1713		04.005.646  -  SCREW BONE NONSTRL 6MM 56MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.646S	SUP	HCPCS C1713		04.005.646S  -  SCREW BN T25 FT 6MM 8MM 56MM AQ STRL ST LCK 2 LD STRDR TI	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.648	SUP	HCPCS C1713		04.005.648  -  SCREW BONE NONSTRL 6MM 58MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.648S	SUP	HCPCS C1713		04.005.648S  -  SCREW BN T25 FT 6MM 4.8MM 58MM AQ STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.650	SUP	HCPCS C1713		04.005.650  -  SCREW BONE NONSTRL 6MM 60MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.650S	SUP	HCPCS C1713		04.005.650S  -  SCREW BN T25 FT 6MM 4.8MM 60MM AQ STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.654	SUP	HCPCS C1713		04.005.654  -  SCREW BONE NONSTRL 6MM 64MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.654S	SUP	HCPCS C1713		04.005.654S  -  SCREW BN T25 FT 6MM 4.8MM 64MM AQ STRL LCK CNN ST BLNT TIP	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.658	SUP	HCPCS C1713		04.005.658  -  SCREW BONE 6MM 68MM NLEX TI FEM LCK STARDRIVE RECESS NONSTRL	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.658S	SUP	HCPCS C1713		04.005.658S  -  SCREW BN T25 FT 6MM 4.8MM 68MM AQ STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.662	SUP	HCPCS C1713		04.005.662  -  SCREW BONE NONSTRL 6MM 72MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.662S	SUP	HCPCS C1713		04.005.662S  -  SCREW BN T25 FT 6MM 4.8MM 72MM AQ STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.666	SUP	HCPCS C1713		04.005.666  -  SCREW BONE NONSTRL 6MM 76MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.666S	SUP	HCPCS C1713		04.005.666S  -  SCREW BN T25 FT BLNT 6MM 8MM 76MM AQ STRL XPRT 2 LD ST LCK	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.670	SUP	HCPCS C1713		04.005.670  -  SCREW BONE 6MM 80MM NLEX TI FEM LCK STARDRIVE RECESS NONSTRL	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.670S	SUP	HCPCS C1713		04.005.670S  -  SCREW BN FT 6MM 8MM 80MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.675	SUP	HCPCS C1713		04.005.675  -  SCREW BONE NONSTRL 6MM 85MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.675S	SUP	HCPCS C1713		04.005.675S  -  SCREW BN T25 FT 6MM 4.8MM 85MM AQ STRL LCK ST BLNT TIP 2 LD	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.680	SUP	HCPCS C1713		04.005.680  -  SCREW BONE NONSTRL 6MM 90MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.680S	SUP	HCPCS C1713		04.005.680S  -  SCREW BN FT 6MM 8MM 90MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.685	SUP	HCPCS C1713		04.005.685  -  SCREW BONE NONSTRL 6MM 95MM NLEX TI FULTHD FEM/TIB SLFTAP	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.685S	SUP	HCPCS C1713		04.005.685S  -  SCREW BN FT 6MM 8MM 95MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.690	SUP	HCPCS C1713		04.005.690  -  SCREW BONE 6MM 100MM NLEX TI FULTHD FEM/TIB SLFTAP CANN LCK	BOTH IP/OP	$413.95 	$306.32	$0.00	$331.16	$186.28	$186.28	$0.00	$0.00	$0.00	$86.28	$307.23	$307.23	$0.00	$0.00	$86.27	$0.00	$244.85	$244.85	$0.00	$206.98	$327.85	$331.16	$0.00		$0.00	$64.78	$0.00	$0.00	$65.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.690S	SUP	HCPCS C1713		04.005.690S  -  SCREW BN FT 6MM 8MM 100MM AQ STRL NLEX T25 STRDR RCS LCK CNN	BOTH IP/OP	$436.18 	$322.77	$0.00	$338.76	$190.55	$190.55	$0.00	$0.00	$0.00	$90.91	$323.73	$323.73	$0.00	$0.00	$90.90	$0.00	$258.00	$258.00	$0.00	$211.73	$335.37	$338.76	$0.00		$0.00	$64.34	$0.00	$0.00	$67.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.691	SUP	HCPCS C1713		04.005.691  -  SCREW BONE FULTHD 6MM 105MM SLFTAP CANN LOCKING STARDRIVE	BOTH IP/OP	$341.35 	$252.60	$0.00	$265.12	$149.13	$149.13	$0.00	$0.00	$0.00	$71.15	$253.35	$253.35	$0.00	$0.00	$71.14	$0.00	$201.91	$201.91	$0.00	$165.70	$262.47	$265.12	$0.00		$0.00	$50.35	$0.00	$0.00	$52.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.692	SUP	HCPCS C1713		04.005.692  -  SCREW BONE FULTHD 6MM 110MM SLFTAP CANN LOCKING STARDRIVE	BOTH IP/OP	$341.35 	$252.60	$0.00	$265.12	$149.13	$149.13	$0.00	$0.00	$0.00	$71.15	$253.35	$253.35	$0.00	$0.00	$71.14	$0.00	$201.91	$201.91	$0.00	$165.70	$262.47	$265.12	$0.00		$0.00	$50.35	$0.00	$0.00	$52.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.693	SUP	HCPCS C1713		04.005.693  -  SCREW BONE FULTHD 6MM 115MM SLFTAP CANN LOCKING STARDRIVE	BOTH IP/OP	$341.35 	$252.60	$0.00	$265.12	$149.13	$149.13	$0.00	$0.00	$0.00	$71.15	$253.35	$253.35	$0.00	$0.00	$71.14	$0.00	$201.91	$201.91	$0.00	$165.70	$262.47	$265.12	$0.00		$0.00	$50.35	$0.00	$0.00	$52.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.694	SUP	HCPCS C1713		04.005.694  -  SCREW BONE FULTHD 6MM 120MM SLFTAP CANN LOCKING STARDRIVE	BOTH IP/OP	$341.35 	$252.60	$0.00	$265.12	$149.13	$149.13	$0.00	$0.00	$0.00	$71.15	$253.35	$253.35	$0.00	$0.00	$71.14	$0.00	$201.91	$201.91	$0.00	$165.70	$262.47	$265.12	$0.00		$0.00	$50.35	$0.00	$0.00	$52.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.005.695	SUP	HCPCS C1713		04.005.695  -  SCREW BONE FULTHD 6MM 125MM SLFTAP CANN LOCKING STARDRIVE	BOTH IP/OP	$341.35 	$252.60	$0.00	$265.12	$149.13	$149.13	$0.00	$0.00	$0.00	$71.15	$253.35	$253.35	$0.00	$0.00	$71.14	$0.00	$201.91	$201.91	$0.00	$165.70	$262.47	$265.12	$0.00		$0.00	$50.35	$0.00	$0.00	$52.76	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.000S	SUP	Custom 27803010		04.008.000S  -  CAP END T25 STARDRIVE RECESS NAIL-EX GOLD TITANIUM HINDFOOT	BOTH IP/OP	$428.88 	$317.37	$0.00	$333.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$318.31	$318.31	$0.00	$0.00	$89.38	$0.00	$0.00	$0.00	$0.00	$208.19	$329.77	$333.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.001S	SUP	Custom 27803010		04.008.001S  -  CAP END 0MM EXTENDED STARDRIVE RECESS NAIL-EX AQUA TITANIUM	BOTH IP/OP	$428.88 	$317.37	$0.00	$333.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$318.31	$318.31	$0.00	$0.00	$89.38	$0.00	$0.00	$0.00	$0.00	$208.19	$329.77	$333.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.010S	SUP	HCPCS C1713		04.008.010S  -  NAIL INTRAMEDULLARY 10MM 150CM CANN EXPERT GREEN TITANIUM	BOTH IP/OP	"$3,006.45 "	"$2,224.77"	$0.00	"$2,335.12"	"$1,313.51"	"$1,313.51"	$0.00	$0.00	$0.00	$626.62	"$2,231.39"	"$2,231.39"	$0.00	$0.00	$626.54	$0.00	"$1,482.18"	"$1,482.18"	$0.00	"$1,459.45"	"$2,311.77"	"$2,335.12"	$0.00		$0.00	$443.50	$0.00	$0.00	$464.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.016S	SUP	HCPCS C1713		04.008.016S  -  NAIL INTRAMEDULLARY 12D 10MM 180MM CANN BALL TIPPED REAMING	BOTH IP/OP	"$3,006.45 "	"$2,224.77"	$0.00	"$2,335.12"	"$1,313.51"	"$1,313.51"	$0.00	$0.00	$0.00	$626.62	"$2,231.39"	"$2,231.39"	$0.00	$0.00	$626.54	$0.00	"$1,482.18"	"$1,482.18"	$0.00	"$1,459.45"	"$2,311.77"	"$2,335.12"	$0.00		$0.00	$443.50	$0.00	$0.00	$464.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.028S	SUP	HCPCS C1713		04.008.028S  -  NAIL INTRAMEDULLARY 12D 10MM 240MM CANN BALL TIPPED REAMING	BOTH IP/OP	"$3,006.45 "	"$2,224.77"	$0.00	"$2,335.12"	"$1,313.51"	"$1,313.51"	$0.00	$0.00	$0.00	$626.62	"$2,231.39"	"$2,231.39"	$0.00	$0.00	$626.54	$0.00	"$1,482.18"	"$1,482.18"	$0.00	"$1,459.45"	"$2,311.77"	"$2,335.12"	$0.00		$0.00	$443.50	$0.00	$0.00	$464.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.060S	SUP	HCPCS C1713		04.008.060S  -  NAIL INTRAMEDULLARY 10MM 15CM CANN NAIL-EX GREEN TITANIUM	BOTH IP/OP	"$3,006.45 "	"$2,224.77"	$0.00	"$2,335.12"	"$1,313.51"	"$1,313.51"	$0.00	$0.00	$0.00	$626.62	"$2,231.39"	"$2,231.39"	$0.00	$0.00	$626.54	$0.00	"$1,482.18"	"$1,482.18"	$0.00	"$1,459.45"	"$2,311.77"	"$2,335.12"	$0.00		$0.00	$443.50	$0.00	$0.00	$464.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.066S	SUP	HCPCS C1713		04.008.066S  -  NAIL INTRAMEDULLARY 10MM 180MM CANN NAIL-EX GREEN TITANIUM	BOTH IP/OP	"$3,006.45 "	"$2,224.77"	$0.00	"$2,335.12"	"$1,313.51"	"$1,313.51"	$0.00	$0.00	$0.00	$626.62	"$2,231.39"	"$2,231.39"	$0.00	$0.00	$626.54	$0.00	"$1,482.18"	"$1,482.18"	$0.00	"$1,459.45"	"$2,311.77"	"$2,335.12"	$0.00		$0.00	$443.50	$0.00	$0.00	$464.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.078S	SUP	HCPCS C1713		04.008.078S  -  NAIL INTRAMEDULLARY 10MM 24CM CANN NAIL-EX TITANIUM LEFT	BOTH IP/OP	"$3,006.45 "	"$2,224.77"	$0.00	"$2,335.12"	"$1,313.51"	"$1,313.51"	$0.00	$0.00	$0.00	$626.62	"$2,231.39"	"$2,231.39"	$0.00	$0.00	$626.54	$0.00	"$1,482.18"	"$1,482.18"	$0.00	"$1,459.45"	"$2,311.77"	"$2,335.12"	$0.00		$0.00	$443.50	$0.00	$0.00	$464.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.210S	SUP	HCPCS C1713		04.008.210S  -  NAIL INTRAMEDULLARY 12MM 15CM CANN NAIL-EX TITANIUM RIGHT	BOTH IP/OP	"$3,096.90 "	"$2,291.71"	$0.00	"$2,405.36"	"$1,353.02"	"$1,353.02"	$0.00	$0.00	$0.00	$645.47	"$2,298.52"	"$2,298.52"	$0.00	$0.00	$645.39	$0.00	"$1,526.77"	"$1,526.77"	$0.00	"$1,503.35"	"$2,381.31"	"$2,405.36"	$0.00		$0.00	$456.84	$0.00	$0.00	$478.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.216S	SUP	HCPCS C1713		04.008.216S  -  NAIL INTRAMEDULLARY 12MM 180MM CANN NAIL-EX TITANIUM RIGHT	BOTH IP/OP	"$3,006.45 "	"$2,224.77"	$0.00	"$2,335.12"	"$1,313.51"	"$1,313.51"	$0.00	$0.00	$0.00	$626.62	"$2,231.39"	"$2,231.39"	$0.00	$0.00	$626.54	$0.00	"$1,482.18"	"$1,482.18"	$0.00	"$1,459.45"	"$2,311.77"	"$2,335.12"	$0.00		$0.00	$443.50	$0.00	$0.00	$464.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.228S	SUP	HCPCS C1713		04.008.228S  -  NAIL INTRAMEDULLARY 12MM 24CM CANN NAIL-EX TITANIUM RIGHT	BOTH IP/OP	"$3,006.45 "	"$2,224.77"	$0.00	"$2,335.12"	"$1,313.51"	"$1,313.51"	$0.00	$0.00	$0.00	$626.62	"$2,231.39"	"$2,231.39"	$0.00	$0.00	$626.54	$0.00	"$1,482.18"	"$1,482.18"	$0.00	"$1,459.45"	"$2,311.77"	"$2,335.12"	$0.00		$0.00	$443.50	$0.00	$0.00	$464.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.260S	SUP	HCPCS C1713		04.008.260S  -  NAIL INTRAMEDULLARY 12MM 15CM CANN NAIL-EX TITANIUM LEFT	BOTH IP/OP	"$3,096.90 "	"$2,291.71"	$0.00	"$2,405.36"	"$1,353.02"	"$1,353.02"	$0.00	$0.00	$0.00	$645.47	"$2,298.52"	"$2,298.52"	$0.00	$0.00	$645.39	$0.00	"$1,526.77"	"$1,526.77"	$0.00	"$1,503.35"	"$2,381.31"	"$2,405.36"	$0.00		$0.00	$456.84	$0.00	$0.00	$478.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.266S	SUP	HCPCS C1713		04.008.266S  -  NAIL INTRAMEDULLARY 12MM 18CM CANN NAIL-EX TITANIUM LEFT	BOTH IP/OP	"$3,006.45 "	"$2,224.77"	$0.00	"$2,335.12"	"$1,313.51"	"$1,313.51"	$0.00	$0.00	$0.00	$626.62	"$2,231.39"	"$2,231.39"	$0.00	$0.00	$626.54	$0.00	"$1,482.18"	"$1,482.18"	$0.00	"$1,459.45"	"$2,311.77"	"$2,335.12"	$0.00		$0.00	$443.50	$0.00	$0.00	$464.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.278S	SUP	HCPCS C1713		04.008.278S  -  NAIL INTRAMEDULLARY 12MM 24CM CANN NAIL-EX TITANIUM LEFT	BOTH IP/OP	"$3,006.45 "	"$2,224.77"	$0.00	"$2,335.12"	"$1,313.51"	"$1,313.51"	$0.00	$0.00	$0.00	$626.62	"$2,231.39"	"$2,231.39"	$0.00	$0.00	$626.54	$0.00	"$1,482.18"	"$1,482.18"	$0.00	"$1,459.45"	"$2,311.77"	"$2,335.12"	$0.00		$0.00	$443.50	$0.00	$0.00	$464.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.310S	SUP	HCPCS C1713		04.008.310S  -  NAIL INTRAMEDULLARY 13MM 15CM CANN NAIL-EX TITANIUM RIGHT	BOTH IP/OP	"$3,096.90 "	"$2,291.71"	$0.00	"$2,405.36"	"$1,353.02"	"$1,353.02"	$0.00	$0.00	$0.00	$645.47	"$2,298.52"	"$2,298.52"	$0.00	$0.00	$645.39	$0.00	"$1,526.77"	"$1,526.77"	$0.00	"$1,503.35"	"$2,381.31"	"$2,405.36"	$0.00		$0.00	$456.84	$0.00	$0.00	$478.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.316S	SUP	HCPCS C1713		04.008.316S  -  NAIL INTRAMEDULLARY 13MM 18CM CANN NAIL-EX TITANIUM RIGHT	BOTH IP/OP	"$3,096.90 "	"$2,291.71"	$0.00	"$2,405.36"	"$1,353.02"	"$1,353.02"	$0.00	$0.00	$0.00	$645.47	"$2,298.52"	"$2,298.52"	$0.00	$0.00	$645.39	$0.00	"$1,526.77"	"$1,526.77"	$0.00	"$1,503.35"	"$2,381.31"	"$2,405.36"	$0.00		$0.00	$456.84	$0.00	$0.00	$478.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.328S	SUP	HCPCS C1713		04.008.328S  -  NAIL INTRAMEDULLARY 13MM 240MM FLUTED EXPERT LIGHT GREEN	BOTH IP/OP	"$3,006.45 "	"$2,224.77"	$0.00	"$2,335.12"	"$1,313.51"	"$1,313.51"	$0.00	$0.00	$0.00	$626.62	"$2,231.39"	"$2,231.39"	$0.00	$0.00	$626.54	$0.00	"$1,482.18"	"$1,482.18"	$0.00	"$1,459.45"	"$2,311.77"	"$2,335.12"	$0.00		$0.00	$443.50	$0.00	$0.00	$464.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.360S	SUP	HCPCS C1713		04.008.360S  -  NAIL INTRAMEDULLARY 13MM 15CM CANN NAIL-EX TITANIUM LEFT	BOTH IP/OP	"$3,096.90 "	"$2,291.71"	$0.00	"$2,405.36"	"$1,353.02"	"$1,353.02"	$0.00	$0.00	$0.00	$645.47	"$2,298.52"	"$2,298.52"	$0.00	$0.00	$645.39	$0.00	"$1,526.77"	"$1,526.77"	$0.00	"$1,503.35"	"$2,381.31"	"$2,405.36"	$0.00		$0.00	$456.84	$0.00	$0.00	$478.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.366S	SUP	HCPCS C1713		04.008.366S  -  NAIL INTRAMEDULLARY 13MM 18CM CANN NAIL-EX TITANIUM LEFT	BOTH IP/OP	"$3,096.90 "	"$2,291.71"	$0.00	"$2,405.36"	"$1,353.02"	"$1,353.02"	$0.00	$0.00	$0.00	$645.47	"$2,298.52"	"$2,298.52"	$0.00	$0.00	$645.39	$0.00	"$1,526.77"	"$1,526.77"	$0.00	"$1,503.35"	"$2,381.31"	"$2,405.36"	$0.00		$0.00	$456.84	$0.00	$0.00	$478.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.008.378S	SUP	HCPCS C1713		04.008.378S  -  NAIL INTRAMEDULLARY 13MM 24CM CANN NAIL-EX TITANIUM LEFT	BOTH IP/OP	"$3,006.45 "	"$2,224.77"	$0.00	"$2,335.12"	"$1,313.51"	"$1,313.51"	$0.00	$0.00	$0.00	$626.62	"$2,231.39"	"$2,231.39"	$0.00	$0.00	$626.54	$0.00	"$1,482.18"	"$1,482.18"	$0.00	"$1,459.45"	"$2,311.77"	"$2,335.12"	$0.00		$0.00	$443.50	$0.00	$0.00	$464.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.000	SUP	HCPCS C1713		04.013.000  -  CAP END 0MM FEM XTD STARDRIVE RECESS CANN IM NAIL TI NONSTRL	BOTH IP/OP	$357.38 	$264.46	$0.00	$285.90	$160.82	$160.82	$0.00	$0.00	$0.00	$74.49	$265.24	$265.24	$0.00	$0.00	$74.48	$0.00	$211.39	$211.39	$0.00	$178.69	$283.04	$285.90	$0.00		$0.00	$55.93	$0.00	$0.00	$56.89	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.000S	SUP	Custom 27803010		04.013.000S  -  CAP END 0MM T40 STARDRIVE NAIL-EX GOLD TITANIUM FEMUR	BOTH IP/OP	$414.28 	$306.57	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.47	$307.47	$0.00	$0.00	$86.33	$0.00	$0.00	$0.00	$0.00	$201.11	$318.57	$321.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.041S	SUP	Custom 27803010		04.013.041S  -  BLADE INTRAMEDULLARY NAIL 45MM CANN SPIRAL RTRGRD NAIL-EX	BOTH IP/OP	"$1,161.15 "	$859.25	$0.00	$901.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.81	$861.81	$0.00	$0.00	$241.98	$0.00	$0.00	$0.00	$0.00	$563.66	$892.85	$901.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.042S	SUP	Custom 27803010		04.013.042S  -  BLADE INTRAMEDULLARY NAIL 50MM CANN SPIRAL RTRGRD NAIL-EX	BOTH IP/OP	"$1,161.15 "	$859.25	$0.00	$901.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.81	$861.81	$0.00	$0.00	$241.98	$0.00	$0.00	$0.00	$0.00	$563.66	$892.85	$901.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.043S	SUP	Custom 27803010		04.013.043S  -  BLADE INTRAMEDULLARY NAIL 55MM CANN SPIRAL RTRGRD NAIL-EX	BOTH IP/OP	"$1,161.15 "	$859.25	$0.00	$901.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.81	$861.81	$0.00	$0.00	$241.98	$0.00	$0.00	$0.00	$0.00	$563.66	$892.85	$901.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.044S	SUP	Custom 27803010		04.013.044S  -  BLADE INTRAMEDULLARY NAIL 60MM CANN SPIRAL RTRGRD NAIL-EX	BOTH IP/OP	"$1,161.15 "	$859.25	$0.00	$901.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.81	$861.81	$0.00	$0.00	$241.98	$0.00	$0.00	$0.00	$0.00	$563.66	$892.85	$901.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.045S	SUP	Custom 27803010		04.013.045S  -  BLADE INTRAMEDULLARY FIX SPIRAL 65MM RTRGRD EXPERT GOLD	BOTH IP/OP	"$1,161.15 "	$859.25	$0.00	$901.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.81	$861.81	$0.00	$0.00	$241.98	$0.00	$0.00	$0.00	$0.00	$563.66	$892.85	$901.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.046	SUP	HCPCS C1713		04.013.046  -  BLADE IM NAIL 70MM NLEX FEM TI CANN SPRL RTRGRD NONSTRL	BOTH IP/OP	"$1,214.65 "	$898.84	$0.00	$971.72	$546.59	$546.59	$0.00	$0.00	$0.00	$253.16	$901.51	$901.51	$0.00	$0.00	$253.13	$0.00	$718.47	$718.47	$0.00	$607.33	$962.00	$971.72	$0.00		$0.00	$190.09	$0.00	$0.00	$193.37	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.046S	SUP	Custom 27803010		04.013.046S  -  BLADE INTRAMEDULLARY NAIL 70MM SPIRAL RTRGRD NAIL-EX GOLD	BOTH IP/OP	"$1,161.15 "	$859.25	$0.00	$901.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.81	$861.81	$0.00	$0.00	$241.98	$0.00	$0.00	$0.00	$0.00	$563.66	$892.85	$901.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.047S	SUP	Custom 27803010		04.013.047S  -  BLADE INTRAMEDULLARY FIX 12.5MM 75MM SPIRAL CANN NAIL-EX	BOTH IP/OP	"$1,161.15 "	$859.25	$0.00	$901.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.81	$861.81	$0.00	$0.00	$241.98	$0.00	$0.00	$0.00	$0.00	$563.66	$892.85	$901.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.048S	SUP	Custom 27803010		04.013.048S  -  BLADE INTRAMEDULLARY FIX 80MM SPIRAL NAIL-EX TITANIUM FEMUR	BOTH IP/OP	"$1,161.15 "	$859.25	$0.00	$901.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.81	$861.81	$0.00	$0.00	$241.98	$0.00	$0.00	$0.00	$0.00	$563.66	$892.85	$901.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.049S	SUP	Custom 27803010		04.013.049S  -  BLADE INTRAMEDULLARY NAIL SPIRAL 12.5MM 85MM RTRGRD CANN	BOTH IP/OP	"$1,161.15 "	$859.25	$0.00	$901.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.81	$861.81	$0.00	$0.00	$241.98	$0.00	$0.00	$0.00	$0.00	$563.66	$892.85	$901.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.050S	SUP	Custom 27803010		04.013.050S  -  BLADE INTRAMEDULLARY FIX SPIRAL 90MM CANN RTRGRD EXPERT GOLD	BOTH IP/OP	"$1,161.15 "	$859.25	$0.00	$901.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.81	$861.81	$0.00	$0.00	$241.98	$0.00	$0.00	$0.00	$0.00	$563.66	$892.85	$901.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.051S	SUP	Custom 27803010		04.013.051S  -  BLADE INTRAMEDULLARY NAIL 95MM CANN SPIRAL RTRGRD NAIL-EX	BOTH IP/OP	"$1,161.15 "	$859.25	$0.00	$901.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.81	$861.81	$0.00	$0.00	$241.98	$0.00	$0.00	$0.00	$0.00	$563.66	$892.85	$901.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.052S	SUP	Custom 27803010		04.013.052S  -  BLADE INTRAMEDULLARY NAIL 100MM CANN SPIRAL RTRGRD NAIL-EX	BOTH IP/OP	"$1,161.15 "	$859.25	$0.00	$901.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.81	$861.81	$0.00	$0.00	$241.98	$0.00	$0.00	$0.00	$0.00	$563.66	$892.85	$901.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.312S	SUP	HCPCS C1713		04.013.312S  -  NAIL INTRAMEDULLARY 9MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.316S	SUP	HCPCS C1713		04.013.316S  -  NAIL INTRAMEDULLARY 9MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.320S	SUP	HCPCS C1713		04.013.320S  -  NAIL INTRAMEDULLARY 9MM 20CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.324S	SUP	HCPCS C1713		04.013.324S  -  NAIL INTRAMEDULLARY 9MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.328S	SUP	HCPCS C1713		04.013.328S  -  NAIL INTRAMEDULLARY 9MM 24CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.332S	SUP	HCPCS C1713		04.013.332S  -  NAIL INTRAMEDULLARY 9MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.336S	SUP	HCPCS C1713		04.013.336S  -  NAIL INTRAMEDULLARY 9MM 28CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,341.98 "	"$2,473.07"	$0.00	"$2,595.70"	"$1,460.08"	"$1,460.08"	$0.00	$0.00	$0.00	$696.55	"$2,480.41"	"$2,480.41"	$0.00	$0.00	$696.47	$0.00	"$1,647.59"	"$1,647.59"	$0.00	"$1,622.31"	"$2,569.75"	"$2,595.70"	$0.00		$0.00	$492.99	$0.00	$0.00	$516.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.340S	SUP	HCPCS C1713		04.013.340S  -  NAIL INTRAMEDULLARY 9MM 30CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.344S	SUP	HCPCS C1713		04.013.344S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 320MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.348S	SUP	HCPCS C1713		04.013.348S  -  NAIL INTRAMEDULLARY 9MM 34CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.352S	SUP	HCPCS C1713		04.013.352S  -  NAIL INTRAMEDULLARY 9MM 36CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.356S	SUP	HCPCS C1713		04.013.356S  -  NAIL INTRAMEDULLARY 9MM 38CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.360S	SUP	HCPCS C1713		04.013.360S  -  NAIL INTRAMEDULLARY 9MM 40CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.364S	SUP	HCPCS C1713		04.013.364S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 420MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.368S	SUP	HCPCS C1713		04.013.368S  -  NAIL INTRAMEDULLARY 9MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.372S	SUP	HCPCS C1713		04.013.372S  -  NAIL INTRAMEDULLARY 9MM 46CM CANN ANTEGRADE/RTRGRD NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.376S	SUP	HCPCS C1713		04.013.376S  -  NAIL INTRAMEDULLARY 9MM 48CM CANN ANTEGRADE/RTRGRD NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.412S	SUP	HCPCS C1713		04.013.412S  -  NAIL INTRAMEDULLARY 10MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.416S	SUP	HCPCS C1713		04.013.416S  -  NAIL INTRAMEDULLARY 10MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.420S	SUP	HCPCS C1713		04.013.420S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 200MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.424S	SUP	HCPCS C1713		04.013.424S  -  NAIL INTRAMEDULLARY 10MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.428S	SUP	HCPCS C1713		04.013.428S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 240MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.432S	SUP	HCPCS C1713		04.013.432S  -  NAIL INTRAMEDULLARY 10MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.436S	SUP	HCPCS C1713		04.013.436S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 280MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.440S	SUP	HCPCS C1713		04.013.440S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.444S	SUP	HCPCS C1713		04.013.444S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.448S	SUP	HCPCS C1713		04.013.448S  -  NAIL INTRAMEDULLARY 10MM 34CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.452S	SUP	HCPCS C1713		04.013.452S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.456S	SUP	HCPCS C1713		04.013.456S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.460S	SUP	HCPCS C1713		04.013.460S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.464S	SUP	HCPCS C1713		04.013.464S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND 10MM 420MM CANN RTRGRD	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.468S	SUP	HCPCS C1713		04.013.468S  -  NAIL INTRAMEDULLARY 10MM 440MM CANN NAIL-EX GREEN TITANIUM	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.472S	SUP	HCPCS C1713		04.013.472S  -  NAIL INTRAMEDULLARY 10MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.476S	SUP	HCPCS C1713		04.013.476S  -  NAIL INTRAMEDULLARY 10MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,341.98 "	"$2,473.07"	$0.00	"$2,595.70"	"$1,460.08"	"$1,460.08"	$0.00	$0.00	$0.00	$696.55	"$2,480.41"	"$2,480.41"	$0.00	$0.00	$696.47	$0.00	"$1,647.59"	"$1,647.59"	$0.00	"$1,622.31"	"$2,569.75"	"$2,595.70"	$0.00		$0.00	$492.99	$0.00	$0.00	$516.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.512S	SUP	HCPCS C1713		04.013.512S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 160MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.516S	SUP	HCPCS C1713		04.013.516S  -  NAIL INTRAMEDULLARY 11MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.520S	SUP	HCPCS C1713		04.013.520S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 200MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.524S	SUP	HCPCS C1713		04.013.524S  -  NAIL INTRAMEDULLARY 11MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.528S	SUP	HCPCS C1713		04.013.528S  -  NAIL INTRAMEDULLARY 11MM 24CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.532S	SUP	HCPCS C1713		04.013.532S  -  NAIL INTRAMEDULLARY 11MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.536S	SUP	HCPCS C1713		04.013.536S  -  NAIL INTRAMEDULLARY 11MM 28CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.540S	SUP	HCPCS C1713		04.013.540S  -  NAIL INTRAMEDULLARY 11MM 30CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.544S	SUP	HCPCS C1713		04.013.544S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTED BARREL 11MM 320MM CANN	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.548S	SUP	HCPCS C1713		04.013.548S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.552S	SUP	HCPCS C1713		04.013.552S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.556S	SUP	HCPCS C1713		04.013.556S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.560S	SUP	HCPCS C1713		04.013.560S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 400MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.564S	SUP	HCPCS C1713		04.013.564S  -  NAIL INTRAMEDULLARY 11MM 42CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.568S	SUP	HCPCS C1713		04.013.568S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.572S	SUP	HCPCS C1713		04.013.572S  -  NAIL INTRAMEDULLARY 11MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.576S	SUP	HCPCS C1713		04.013.576S  -  NAIL INTRAMEDULLARY 11MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,341.98 "	"$2,473.07"	$0.00	"$2,595.70"	"$1,460.08"	"$1,460.08"	$0.00	$0.00	$0.00	$696.55	"$2,480.41"	"$2,480.41"	$0.00	$0.00	$696.47	$0.00	"$1,647.59"	"$1,647.59"	$0.00	"$1,622.31"	"$2,569.75"	"$2,595.70"	$0.00		$0.00	$492.99	$0.00	$0.00	$516.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.612S	SUP	HCPCS C1713		04.013.612S  -  NAIL INTRAMEDULLARY 12MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.616S	SUP	HCPCS C1713		04.013.616S  -  NAIL INTRAMEDULLARY 12MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.620S	SUP	HCPCS C1713		04.013.620S  -  NAIL INTRAMEDULLARY 12MM 20CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.624S	SUP	HCPCS C1713		04.013.624S  -  NAIL INTRAMEDULLARY 12MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.628S	SUP	HCPCS C1713		04.013.628S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 240MM CANN FLUTED BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.632S	SUP	HCPCS C1713		04.013.632S  -  NAIL INTRAMEDULLARY 12MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.636S	SUP	HCPCS C1713		04.013.636S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 280MM CANN FLUTED BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.640S	SUP	HCPCS C1713		04.013.640S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTED 12MM 300MM CANN RTRGRD	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.644S	SUP	HCPCS C1713		04.013.644S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 320MM CANN FLUTED BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.648S	SUP	HCPCS C1713		04.013.648S  -  NAIL INTRAMEDULLARY 12MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.652S	SUP	HCPCS C1713		04.013.652S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 36CM CANN RTRGRD	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.656S	SUP	HCPCS C1713		04.013.656S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.660S	SUP	HCPCS C1713		04.013.660S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 400MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.664S	SUP	HCPCS C1713		04.013.664S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN ROUND BARREL	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.668S	SUP	HCPCS C1713		04.013.668S  -  NAIL INTRAMEDULLARY 12MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.672S	SUP	HCPCS C1713		04.013.672S  -  NAIL INTRAMEDULLARY 12MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,331.75 "	"$2,465.50"	$0.00	"$2,587.78"	"$1,455.63"	"$1,455.63"	$0.00	$0.00	$0.00	$694.42	"$2,472.82"	"$2,472.82"	$0.00	$0.00	$694.34	$0.00	"$1,642.55"	"$1,642.55"	$0.00	"$1,617.36"	"$2,561.91"	"$2,587.78"	$0.00		$0.00	$491.49	$0.00	$0.00	$514.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.676S	SUP	HCPCS C1713		04.013.676S  -  NAIL INTRAMEDULLARY 12MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.712S	SUP	HCPCS C1713		04.013.712S  -  NAIL INTRAMEDULLARY 13MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,331.75 "	"$2,465.50"	$0.00	"$2,587.78"	"$1,455.63"	"$1,455.63"	$0.00	$0.00	$0.00	$694.42	"$2,472.82"	"$2,472.82"	$0.00	$0.00	$694.34	$0.00	"$1,642.55"	"$1,642.55"	$0.00	"$1,617.36"	"$2,561.91"	"$2,587.78"	$0.00		$0.00	$491.49	$0.00	$0.00	$514.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.716S	SUP	HCPCS C1713		04.013.716S  -  NAIL INTRAMEDULLARY 13MM 18CM CANN RTRGRD NAIL-EX TITANIUM	BOTH IP/OP	"$3,331.75 "	"$2,465.50"	$0.00	"$2,587.78"	"$1,455.63"	"$1,455.63"	$0.00	$0.00	$0.00	$694.42	"$2,472.82"	"$2,472.82"	$0.00	$0.00	$694.34	$0.00	"$1,642.55"	"$1,642.55"	$0.00	"$1,617.36"	"$2,561.91"	"$2,587.78"	$0.00		$0.00	$491.49	$0.00	$0.00	$514.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.720S	SUP	HCPCS C1713		04.013.720S  -  NAIL INTRAMEDULLARY 13MM 200CM CANN RTRGRD ANTEGRADE EXPERT	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.724S	SUP	HCPCS C1713		04.013.724S  -  NAIL INTRAMEDULLARY 13MM 22CM CANN RTRGRD NAIL-EX TITANIUM	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.728S	SUP	HCPCS C1713		04.013.728S  -  NAIL INTRAMEDULLARY 13MM 24CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.732S	SUP	HCPCS C1713		04.013.732S  -  NAIL INTRAMEDULLARY 13MM 26CM CANN RTRGRD NAIL-EX TITANIUM	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.736S	SUP	HCPCS C1713		04.013.736S  -  NAIL INTRAMEDULLARY 13MM 28CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.740S	SUP	HCPCS C1713		04.013.740S  -  NAIL INTRAMEDULLARY 13MM 30CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.744S	SUP	HCPCS C1713		04.013.744S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM CANN RTRGRD NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.748S	SUP	HCPCS C1713		04.013.748S  -  NAIL INTRAMEDULLARY 13MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.752S	SUP	HCPCS C1713		04.013.752S  -  NAIL INTRAMEDULLARY 13MM 360CM CANN RTRGRD ANTEGRADE EXPERT	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.756S	SUP	HCPCS C1713		04.013.756S  -  NAIL INTRAMEDULLARY 13MM 380MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.760S	SUP	HCPCS C1713		04.013.760S  -  NAIL INTRAMEDULLARY 13MM 400CM CANN RTRGRD ANTEGRADE EXPERT	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.764S	SUP	HCPCS C1713		04.013.764S  -  NAIL INTRAMEDULLARY 13MM 420MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.768S	SUP	HCPCS C1713		04.013.768S  -  NAIL INTRAMEDULLARY 13MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.772S	SUP	HCPCS C1713		04.013.772S  -  NAIL INTRAMEDULLARY 13MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,331.75 "	"$2,465.50"	$0.00	"$2,587.78"	"$1,455.63"	"$1,455.63"	$0.00	$0.00	$0.00	$694.42	"$2,472.82"	"$2,472.82"	$0.00	$0.00	$694.34	$0.00	"$1,642.55"	"$1,642.55"	$0.00	"$1,617.36"	"$2,561.91"	"$2,587.78"	$0.00		$0.00	$491.49	$0.00	$0.00	$514.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.776S	SUP	HCPCS C1713		04.013.776S  -  NAIL INTRAMEDULLARY 13MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.812S	SUP	HCPCS C1713		04.013.812S  -  NAIL INTRAMEDULLARY 14MM 16CM CANN RTRGRD ANTEGRADE TITANIUM	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.816S	SUP	HCPCS C1713		04.013.816S  -  NAIL INTRAMEDULLARY 14MM 18CM CANN RTRGRD NAIL-EX TITANIUM	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.820S	SUP	HCPCS C1713		04.013.820S  -  NAIL INTRAMEDULLARY 14MM 20CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.824S	SUP	HCPCS C1713		04.013.824S  -  NAIL INTRAMEDULLARY 14MM 22CM CANN RTRGRD NAIL-EX TITANIUM	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.828S	SUP	HCPCS C1713		04.013.828S  -  NAIL INTRAMEDULLARY 14MM 240MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.832S	SUP	HCPCS C1713		04.013.832S  -  NAIL INTRAMEDULLARY 14MM 26CM CANN RTRGRD NAIL-EX TITANIUM	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.836S	SUP	HCPCS C1713		04.013.836S  -  NAIL INTRAMEDULLARY 14MM 280MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.840S	SUP	HCPCS C1713		04.013.840S  -  NAIL INTRAMEDULLARY 14MM 300MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.844S	SUP	HCPCS C1713		04.013.844S  -  NAIL INTRAMEDULLARY 14MM 320MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.848S	SUP	HCPCS C1713		04.013.848S  -  NAIL INTRAMEDULLARY 14MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.852S	SUP	HCPCS C1713		04.013.852S  -  NAIL INTRAMEDULLARY 14MM 360MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.856S	SUP	HCPCS C1713		04.013.856S  -  NAIL INTRAMEDULLARY 14MM 38CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.860S	SUP	HCPCS C1713		04.013.860S  -  NAIL INTRAMEDULLARY 14MM 40CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.864S	SUP	HCPCS C1713		04.013.864S  -  NAIL INTRAMEDULLARY 14MM 42CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.868S	SUP	HCPCS C1713		04.013.868S  -  NAIL INTRAMEDULLARY 14MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.872S	SUP	HCPCS C1713		04.013.872S  -  NAIL INTRAMEDULLARY 14MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.876S	SUP	HCPCS C1713		04.013.876S  -  NAIL INTRAMEDULLARY 14MM 480MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.912S	SUP	HCPCS C1713		04.013.912S  -  NAIL INTRAMEDULLARY 15MM 160MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.916S	SUP	HCPCS C1713		04.013.916S  -  NAIL INTRAMEDULLARY 15MM 18CM CANN RTRGRD NAIL-EX TITANIUM	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.920S	SUP	HCPCS C1713		04.013.920S  -  NAIL INTRAMEDULLARY 15MM 200MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,341.98 "	"$2,473.07"	$0.00	"$2,595.70"	"$1,460.08"	"$1,460.08"	$0.00	$0.00	$0.00	$696.55	"$2,480.41"	"$2,480.41"	$0.00	$0.00	$696.47	$0.00	"$1,647.59"	"$1,647.59"	$0.00	"$1,622.31"	"$2,569.75"	"$2,595.70"	$0.00		$0.00	$492.99	$0.00	$0.00	$516.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.924S	SUP	HCPCS C1713		04.013.924S  -  NAIL INTRAMEDULLARY 15MM 22CM CANN RTRGRD NAIL-EX TITANIUM	BOTH IP/OP	"$3,341.98 "	"$2,473.07"	$0.00	"$2,595.70"	"$1,460.08"	"$1,460.08"	$0.00	$0.00	$0.00	$696.55	"$2,480.41"	"$2,480.41"	$0.00	$0.00	$696.47	$0.00	"$1,647.59"	"$1,647.59"	$0.00	"$1,622.31"	"$2,569.75"	"$2,595.70"	$0.00		$0.00	$492.99	$0.00	$0.00	$516.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.928S	SUP	HCPCS C1713		04.013.928S  -  NAIL INTRAMEDULLARY 15MM 24CM CANN RTRGRD NAIL-EX TITANIUM	BOTH IP/OP	"$3,341.98 "	"$2,473.07"	$0.00	"$2,595.70"	"$1,460.08"	"$1,460.08"	$0.00	$0.00	$0.00	$696.55	"$2,480.41"	"$2,480.41"	$0.00	$0.00	$696.47	$0.00	"$1,647.59"	"$1,647.59"	$0.00	"$1,622.31"	"$2,569.75"	"$2,595.70"	$0.00		$0.00	$492.99	$0.00	$0.00	$516.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.932S	SUP	HCPCS C1713		04.013.932S  -  NAIL INTRAMEDULLARY 15MM 26CM CANN RTRGRD NAIL-EX TITANIUM	BOTH IP/OP	"$3,341.98 "	"$2,473.07"	$0.00	"$2,595.70"	"$1,460.08"	"$1,460.08"	$0.00	$0.00	$0.00	$696.55	"$2,480.41"	"$2,480.41"	$0.00	$0.00	$696.47	$0.00	"$1,647.59"	"$1,647.59"	$0.00	"$1,622.31"	"$2,569.75"	"$2,595.70"	$0.00		$0.00	$492.99	$0.00	$0.00	$516.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.936S	SUP	HCPCS C1713		04.013.936S  -  NAIL INTRAMEDULLARY 15MM 280MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,341.98 "	"$2,473.07"	$0.00	"$2,595.70"	"$1,460.08"	"$1,460.08"	$0.00	$0.00	$0.00	$696.55	"$2,480.41"	"$2,480.41"	$0.00	$0.00	$696.47	$0.00	"$1,647.59"	"$1,647.59"	$0.00	"$1,622.31"	"$2,569.75"	"$2,595.70"	$0.00		$0.00	$492.99	$0.00	$0.00	$516.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.940S	SUP	HCPCS C1713		04.013.940S  -  NAIL INTRAMEDULLARY 15MM 300MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.944S	SUP	HCPCS C1713		04.013.944S  -  NAIL INTRAMEDULLARY 15MM 320MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.948S	SUP	HCPCS C1713		04.013.948S  -  NAIL INTRAMEDULLARY 15MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.952S	SUP	HCPCS C1713		04.013.952S  -  NAIL INTRAMEDULLARY 15MM 360MM CANN RTRGRD ANTEGRADE FLUTED	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.956S	SUP	HCPCS C1713		04.013.956S  -  NAIL INTRAMEDULLARY 15MM 380MM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.960S	SUP	HCPCS C1713		04.013.960S  -  NAIL INTRAMEDULLARY 15MM 40CM CANN RTRGRD/ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.964S	SUP	HCPCS C1713		04.013.964S  -  NAIL INTRAMEDULLARY 15MM 42CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.968S	SUP	HCPCS C1713		04.013.968S  -  NAIL INTRAMEDULLARY 15MM 44CM CANN RTRGRD/ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,232.55 "	"$2,392.09"	$0.00	"$2,510.72"	"$1,412.28"	"$1,412.28"	$0.00	$0.00	$0.00	$673.74	"$2,399.20"	"$2,399.20"	$0.00	$0.00	$673.66	$0.00	"$1,593.65"	"$1,593.65"	$0.00	"$1,569.20"	"$2,485.61"	"$2,510.72"	$0.00		$0.00	$476.86	$0.00	$0.00	$499.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.972S	SUP	HCPCS C1713		04.013.972S  -  NAIL INTRAMEDULLARY 15MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,341.98 "	"$2,473.07"	$0.00	"$2,595.70"	"$1,460.08"	"$1,460.08"	$0.00	$0.00	$0.00	$696.55	"$2,480.41"	"$2,480.41"	$0.00	$0.00	$696.47	$0.00	"$1,647.59"	"$1,647.59"	$0.00	"$1,622.31"	"$2,569.75"	"$2,595.70"	$0.00		$0.00	$492.99	$0.00	$0.00	$516.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.013.976S	SUP	HCPCS C1713		04.013.976S  -  NAIL INTRAMEDULLARY 15MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX	BOTH IP/OP	"$3,444.08 "	"$2,548.62"	$0.00	"$2,675.02"	"$1,504.70"	"$1,504.70"	$0.00	$0.00	$0.00	$717.83	"$2,556.19"	"$2,556.19"	$0.00	$0.00	$717.75	$0.00	"$1,697.93"	"$1,697.93"	$0.00	"$1,671.89"	"$2,648.27"	"$2,675.02"	$0.00		$0.00	$508.06	$0.00	$0.00	$532.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.518S	SUP	HCPCS C1713		04.015.518S  -  SCREW BONE FULTHD 5MM 28MM 2 CORE LOCK GOLD TITANIUM KNEE	BOTH IP/OP	$477.00 	$352.98	$0.00	$370.50	$208.41	$208.41	$0.00	$0.00	$0.00	$99.42	$354.03	$354.03	$0.00	$0.00	$99.41	$0.00	$282.15	$282.15	$0.00	$231.56	$366.80	$370.50	$0.00		$0.00	$70.37	$0.00	$0.00	$73.73	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.520	SUP	HCPCS C1713		04.015.520  -  SCREW BONE T25 BLUNT 5MM 8MM 30MM 2 CORE SELF TAP LOCK	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.522S	SUP	HCPCS C1713		04.015.522S  -  SCREW BONE FULTHD 5MM 32MM 2 CORE LOCK T25 STARDRIVE RECESS	BOTH IP/OP	$482.85 	$357.31	$0.00	$375.02	$210.95	$210.95	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$234.39	$371.27	$375.02	$0.00		$0.00	$71.23	$0.00	$0.00	$74.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.525	SUP	HCPCS C1713		04.015.525  -  SCREW BONE T25 BLUNT 5MM 8MM 35MM 2 CORE SELF TAP LOCK	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.527S	SUP	HCPCS C1713		04.015.527S  -  SCREW BONE FULTHD 5MM 37MM 2 CORE LOCK T25 STARDRIVE RECESS	BOTH IP/OP	$482.85 	$357.31	$0.00	$375.02	$210.95	$210.95	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$234.39	$371.27	$375.02	$0.00		$0.00	$71.23	$0.00	$0.00	$74.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.530	SUP	HCPCS C1713		04.015.530  -  SCREW BONE T25 BLUNT 5MM 8MM 40MM 2 CORE SELF TAP LOCK	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.532S	SUP	HCPCS C1713		04.015.532S  -  SCREW BONE FULTHD 5MM 42MM 2 CORE LOCK T25 STARDRIVE RECESS	BOTH IP/OP	$482.85 	$357.31	$0.00	$375.02	$210.95	$210.95	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$234.39	$371.27	$375.02	$0.00		$0.00	$71.23	$0.00	$0.00	$74.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.535	SUP	HCPCS C1713		04.015.535  -  SCREW BONE T25 BLUNT 5MM 8MM 45MM 2 CORE SELF TAP LOCK	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.537S	SUP	HCPCS C1713		04.015.537S  -  SCREW BONE FULTHD 5MM 47MM 2 CORE LOCK T25 STARDRIVE RECESS	BOTH IP/OP	$482.85 	$357.31	$0.00	$375.02	$210.95	$210.95	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$234.39	$371.27	$375.02	$0.00		$0.00	$71.23	$0.00	$0.00	$74.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.540	SUP	HCPCS C1713		04.015.540  -  SCREW BONE T25 BLUNT 5MM 8MM 50MM 2 CORE SELF TAP LOCK	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.542S	SUP	HCPCS C1713		04.015.542S  -  SCREW BONE FULTHD 5MM 52MM 2 CORE LOCK T25 STARDRIVE RECESS	BOTH IP/OP	$482.85 	$357.31	$0.00	$375.02	$210.95	$210.95	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$234.39	$371.27	$375.02	$0.00		$0.00	$71.23	$0.00	$0.00	$74.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.545	SUP	HCPCS C1713		04.015.545  -  SCREW BONE T25 FULTHD 5MM 55MM 2 CORE LOCK STARDRIVE RECESS	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.547S	SUP	HCPCS C1713		04.015.547S  -  SCREW BONE FULTHD 5MM 57MM 2 CORE LOCK T25 STARDRIVE RECESS	BOTH IP/OP	$482.85 	$357.31	$0.00	$375.02	$210.95	$210.95	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$234.39	$371.27	$375.02	$0.00		$0.00	$71.23	$0.00	$0.00	$74.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.550	SUP	HCPCS C1713		04.015.550  -  SCREW BONE T25 BLUNT 5MM 8MM 60MM 2 CORE SELF TAP LOCK	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.552S	SUP	HCPCS C1713		04.015.552S  -  SCREW BONE FULTHD 5MM 62MM 2 CORE LOCK SELF TAP T25	BOTH IP/OP	$482.85 	$357.31	$0.00	$375.02	$210.95	$210.95	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$234.39	$371.27	$375.02	$0.00		$0.00	$71.23	$0.00	$0.00	$74.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.555	SUP	HCPCS C1713		04.015.555  -  SCREW BONE T25 BLUNT 5MM 8MM 65MM 2 CORE SELF TAP LOCK	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.555S	SUP	HCPCS C1713		04.015.555S  -  SCREW BONE 5MM 65MM NLEX TI FULTHD TIB SLFTAP LCK 2 CORE	BOTH IP/OP	$482.85 	$357.31	$0.00	$405.36	$228.02	$228.02	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$253.35	$401.31	$405.36	$0.00		$0.00	$79.30	$0.00	$0.00	$80.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.557S	SUP	HCPCS C1713		04.015.557S  -  SCREW BONE FULTHD 5MM 67MM 2 CORE LOCK T25 STARDRIVE RECESS	BOTH IP/OP	$482.85 	$357.31	$0.00	$375.02	$210.95	$210.95	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$234.39	$371.27	$375.02	$0.00		$0.00	$71.23	$0.00	$0.00	$74.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.560	SUP	HCPCS C1713		04.015.560  -  SCREW BONE T25 BLUNT 5MM 8MM 70MM 2 CORE SELF TAP LOCK	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.562S	SUP	HCPCS C1713		04.015.562S  -  SCREW BONE FULTHD 5MM 72MM 2 CORE LOCK T25 STARDRIVE RECESS	BOTH IP/OP	$482.85 	$357.31	$0.00	$375.02	$210.95	$210.95	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$234.39	$371.27	$375.02	$0.00		$0.00	$71.23	$0.00	$0.00	$74.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.565	SUP	HCPCS C1713		04.015.565  -  SCREW BONE T25 BLUNT 5MM 8MM 75MM 2 CORE SELF TAP LOCK	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.567S	SUP	HCPCS C1713		04.015.567S  -  SCREW BONE FULTHD 5MM 77MM 2 CORE LOCK T25 STARDRIVE RECESS	BOTH IP/OP	$482.85 	$357.31	$0.00	$375.02	$210.95	$210.95	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$234.39	$371.27	$375.02	$0.00		$0.00	$71.23	$0.00	$0.00	$74.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.570	SUP	HCPCS C1713		04.015.570  -  SCREW BONE T25 BLUNT 5MM 8MM 80MM 2 CORE SELF TAP LOCK	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.572S	SUP	HCPCS C1713		04.015.572S  -  SCREW BONE FULTHD 5MM 82MM 2 CORE LOCK T25 STARDRIVE RECESS	BOTH IP/OP	$482.85 	$357.31	$0.00	$375.02	$210.95	$210.95	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$234.39	$371.27	$375.02	$0.00		$0.00	$71.23	$0.00	$0.00	$74.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.575	SUP	HCPCS C1713		04.015.575  -  SCREW BONE T25 BLUNT 5MM 8MM 85MM 2 CORE SELF TAP LOCK	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.577S	SUP	HCPCS C1713		04.015.577S  -  SCREW BONE FULTHD 5MM 87MM 2 CORE LOCK T25 STARDRIVE RECESS	BOTH IP/OP	$482.85 	$357.31	$0.00	$375.02	$210.95	$210.95	$0.00	$0.00	$0.00	$100.64	$358.37	$358.37	$0.00	$0.00	$100.63	$0.00	$285.61	$285.61	$0.00	$234.39	$371.27	$375.02	$0.00		$0.00	$71.23	$0.00	$0.00	$74.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.015.580	SUP	HCPCS C1713		04.015.580  -  SCREW BONE T25 BLUNT 5MM 8MM 90MM 2 CORE SELF TAP LOCK	BOTH IP/OP	$388.03 	$287.14	$0.00	$301.38	$169.53	$169.53	$0.00	$0.00	$0.00	$80.87	$287.99	$287.99	$0.00	$0.00	$80.86	$0.00	$229.52	$229.52	$0.00	$188.36	$298.37	$301.38	$0.00		$0.00	$57.24	$0.00	$0.00	$59.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.016.034S	SUP	HCPCS C1713		04.016.034S  -  NAIL INTRAMEDULLARY SHORT STR 8MM 9.5MM 160MM CANN MULTILOC	BOTH IP/OP	"$3,667.28 "	"$2,713.79"	$0.00	"$2,848.36"	"$1,602.20"	"$1,602.20"	$0.00	$0.00	$0.00	$764.35	"$2,721.85"	"$2,721.85"	$0.00	$0.00	$764.26	$0.00	"$1,807.97"	"$1,807.97"	$0.00	"$1,780.23"	"$2,819.88"	"$2,848.36"	$0.00		$0.00	$540.98	$0.00	$0.00	$566.82	$0.00	$0.00	$0.00	$0.00	$0.00
04.016.255S	SUP	HCPCS C1713		04.016.255S  -  NAIL INTRAMEDULLARY LONG STR 7MM 255MM CANN ROUND BARREL	BOTH IP/OP	"$3,821.90 "	"$2,828.21"	$0.00	"$2,968.46"	"$1,669.76"	"$1,669.76"	$0.00	$0.00	$0.00	$796.58	"$2,836.61"	"$2,836.61"	$0.00	$0.00	$796.48	$0.00	"$1,884.20"	"$1,884.20"	$0.00	"$1,855.29"	"$2,938.78"	"$2,968.46"	$0.00		$0.00	$563.79	$0.00	$0.00	$590.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.017.240S	SUP	HCPCS C1713		04.017.240S  -  NAIL INTRAMEDULLARY LONG STR 7MM 240MM CANN ROUND BARREL	BOTH IP/OP	"$3,821.90 "	"$2,828.21"	$0.00	"$2,968.46"	"$1,669.76"	"$1,669.76"	$0.00	$0.00	$0.00	$796.58	"$2,836.61"	"$2,836.61"	$0.00	$0.00	$796.48	$0.00	"$1,884.20"	"$1,884.20"	$0.00	"$1,855.29"	"$2,938.78"	"$2,968.46"	$0.00		$0.00	$563.79	$0.00	$0.00	$590.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.018.225S	SUP	HCPCS C1713		04.018.225S  -  NAIL IM LNG STRG 8.5MM 9.5MM 225MM BLU STRL MULTILOC CNN TI	BOTH IP/OP	"$3,821.90 "	"$2,828.21"	$0.00	"$2,968.46"	"$1,669.76"	"$1,669.76"	$0.00	$0.00	$0.00	$796.58	"$2,836.61"	"$2,836.61"	$0.00	$0.00	$796.48	$0.00	"$1,884.20"	"$1,884.20"	$0.00	"$1,855.29"	"$2,938.78"	"$2,968.46"	$0.00		$0.00	$563.79	$0.00	$0.00	$590.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.018.255S	SUP	HCPCS C1713		04.018.255S  -  NAIL IM LNG STRG 8.5MM 9.5MM 255MM BLU STRL MULTILOC CNN TI	BOTH IP/OP	"$3,821.90 "	"$2,828.21"	$0.00	"$2,968.46"	"$1,669.76"	"$1,669.76"	$0.00	$0.00	$0.00	$796.58	"$2,836.61"	"$2,836.61"	$0.00	$0.00	$796.48	$0.00	"$1,884.20"	"$1,884.20"	$0.00	"$1,855.29"	"$2,938.78"	"$2,968.46"	$0.00		$0.00	$563.79	$0.00	$0.00	$590.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.018.270S	SUP	HCPCS C1713		04.018.270S  -  NAIL INTRAMEDULLARY LONG STR 8.5MM 270MM CANN ROUND BARREL	BOTH IP/OP	"$3,821.90 "	"$2,828.21"	$0.00	"$2,968.46"	"$1,669.76"	"$1,669.76"	$0.00	$0.00	$0.00	$796.58	"$2,836.61"	"$2,836.61"	$0.00	$0.00	$796.48	$0.00	"$1,884.20"	"$1,884.20"	$0.00	"$1,855.29"	"$2,938.78"	"$2,968.46"	$0.00		$0.00	$563.79	$0.00	$0.00	$590.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.030S	SUP	HCPCS C1713		04.019.030S  -  SCREW BONE FULTHD 4.5MM 30MM BLUNT TIP SELF CUTTING	BOTH IP/OP	$579.13 	$428.56	$0.00	$449.80	$253.01	$253.01	$0.00	$0.00	$0.00	$120.70	$429.83	$429.83	$0.00	$0.00	$120.69	$0.00	$342.55	$342.55	$0.00	$281.13	$445.30	$449.80	$0.00		$0.00	$85.43	$0.00	$0.00	$89.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.034S	SUP	HCPCS C1713		04.019.034S  -  SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 34MM SELF CUT	BOTH IP/OP	$579.13 	$428.56	$0.00	$449.80	$253.01	$253.01	$0.00	$0.00	$0.00	$120.70	$429.83	$429.83	$0.00	$0.00	$120.69	$0.00	$342.55	$342.55	$0.00	$281.13	$445.30	$449.80	$0.00		$0.00	$85.43	$0.00	$0.00	$89.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.036S	SUP	HCPCS C1713		04.019.036S  -  SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 36MM SELF CUT	BOTH IP/OP	$579.13 	$428.56	$0.00	$449.80	$253.01	$253.01	$0.00	$0.00	$0.00	$120.70	$429.83	$429.83	$0.00	$0.00	$120.69	$0.00	$342.55	$342.55	$0.00	$281.13	$445.30	$449.80	$0.00		$0.00	$85.43	$0.00	$0.00	$89.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.038S	SUP	HCPCS C1713		04.019.038S  -  SCREW BONE FULTHD 4.5MM 38MM BLUNT TIP SELF CUTTING	BOTH IP/OP	$579.13 	$428.56	$0.00	$449.80	$253.01	$253.01	$0.00	$0.00	$0.00	$120.70	$429.83	$429.83	$0.00	$0.00	$120.69	$0.00	$342.55	$342.55	$0.00	$281.13	$445.30	$449.80	$0.00		$0.00	$85.43	$0.00	$0.00	$89.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.040S	SUP	HCPCS C1713		04.019.040S  -  SCREW BONE FULTHD 4.5MM 3.9MM 40MM BLUNT TIP SELF CUTTING	BOTH IP/OP	$579.13 	$428.56	$0.00	$449.80	$253.01	$253.01	$0.00	$0.00	$0.00	$120.70	$429.83	$429.83	$0.00	$0.00	$120.69	$0.00	$342.55	$342.55	$0.00	$281.13	$445.30	$449.80	$0.00		$0.00	$85.43	$0.00	$0.00	$89.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.042S	SUP	HCPCS C1713		04.019.042S  -  SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 42MM SELF CUT	BOTH IP/OP	$579.13 	$428.56	$0.00	$449.80	$253.01	$253.01	$0.00	$0.00	$0.00	$120.70	$429.83	$429.83	$0.00	$0.00	$120.69	$0.00	$342.55	$342.55	$0.00	$281.13	$445.30	$449.80	$0.00		$0.00	$85.43	$0.00	$0.00	$89.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.044S	SUP	HCPCS C1713		04.019.044S  -  SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 44MM SELF CUT	BOTH IP/OP	$579.13 	$428.56	$0.00	$449.80	$253.01	$253.01	$0.00	$0.00	$0.00	$120.70	$429.83	$429.83	$0.00	$0.00	$120.69	$0.00	$342.55	$342.55	$0.00	$281.13	$445.30	$449.80	$0.00		$0.00	$85.43	$0.00	$0.00	$89.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.046S	SUP	HCPCS C1713		04.019.046S  -  SCREW BONE FULTHD 4.5MM 46MM BLUNT TIP SELF CUTTING	BOTH IP/OP	$579.13 	$428.56	$0.00	$449.80	$253.01	$253.01	$0.00	$0.00	$0.00	$120.70	$429.83	$429.83	$0.00	$0.00	$120.69	$0.00	$342.55	$342.55	$0.00	$281.13	$445.30	$449.80	$0.00		$0.00	$85.43	$0.00	$0.00	$89.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.050S	SUP	HCPCS C1713		04.019.050S  -  SCREW BN FT 4.5MM 3.9MM 50MM AU STRL MULTILOC BLNT TIP SLF	BOTH IP/OP	$579.13 	$428.56	$0.00	$449.80	$253.01	$253.01	$0.00	$0.00	$0.00	$120.70	$429.83	$429.83	$0.00	$0.00	$120.69	$0.00	$342.55	$342.55	$0.00	$281.13	$445.30	$449.80	$0.00		$0.00	$85.43	$0.00	$0.00	$89.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.225S	SUP	HCPCS C1713		04.019.225S  -  NAIL IM LNG STRG 8.5MM 9.5MM 225MM BLU STRL MULTILOC CNN TI	BOTH IP/OP	"$3,821.90 "	"$2,828.21"	$0.00	"$2,968.46"	"$1,669.76"	"$1,669.76"	$0.00	$0.00	$0.00	$796.58	"$2,836.61"	"$2,836.61"	$0.00	$0.00	$796.48	$0.00	"$1,884.20"	"$1,884.20"	$0.00	"$1,855.29"	"$2,938.78"	"$2,968.46"	$0.00		$0.00	$563.79	$0.00	$0.00	$590.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.240S	SUP	HCPCS C1713		04.019.240S  -  NAIL INTRAMEDULLARY LONG STR 8.5MM 240MM CANN ROUND BARREL	BOTH IP/OP	"$3,821.90 "	"$2,828.21"	$0.00	"$2,968.46"	"$1,669.76"	"$1,669.76"	$0.00	$0.00	$0.00	$796.58	"$2,836.61"	"$2,836.61"	$0.00	$0.00	$796.48	$0.00	"$1,884.20"	"$1,884.20"	$0.00	"$1,855.29"	"$2,938.78"	"$2,968.46"	$0.00		$0.00	$563.79	$0.00	$0.00	$590.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.255S	SUP	HCPCS C1713		04.019.255S  -  NAIL INTRAMEDULLARY MULTILOC TITANIUM ALUMINUM NIOBIUM LONG	BOTH IP/OP	"$3,821.90 "	"$2,828.21"	$0.00	"$2,968.46"	"$1,669.76"	"$1,669.76"	$0.00	$0.00	$0.00	$796.58	"$2,836.61"	"$2,836.61"	$0.00	$0.00	$796.48	$0.00	"$1,884.20"	"$1,884.20"	$0.00	"$1,855.29"	"$2,938.78"	"$2,968.46"	$0.00		$0.00	$563.79	$0.00	$0.00	$590.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.270S	SUP	HCPCS C1713		04.019.270S  -  NAIL INTRAMEDULLARY LONG STR 8.5MM 270MM CANN ROUND BARREL	BOTH IP/OP	"$3,821.90 "	"$2,828.21"	$0.00	"$2,968.46"	"$1,669.76"	"$1,669.76"	$0.00	$0.00	$0.00	$796.58	"$2,836.61"	"$2,836.61"	$0.00	$0.00	$796.48	$0.00	"$1,884.20"	"$1,884.20"	$0.00	"$1,855.29"	"$2,938.78"	"$2,968.46"	$0.00		$0.00	$563.79	$0.00	$0.00	$590.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.019.285S	SUP	HCPCS C1713		04.019.285S  -  NAIL INTRAMEDULLARY LONG STR 8.5MM 285MM CANN ROUND BARREL	BOTH IP/OP	"$3,821.90 "	"$2,828.21"	$0.00	"$2,968.46"	"$1,669.76"	"$1,669.76"	$0.00	$0.00	$0.00	$796.58	"$2,836.61"	"$2,836.61"	$0.00	$0.00	$796.48	$0.00	"$1,884.20"	"$1,884.20"	$0.00	"$1,855.29"	"$2,938.78"	"$2,968.46"	$0.00		$0.00	$563.79	$0.00	$0.00	$590.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.416S	SUP	HCPCS C1713		04.025.416S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 26MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.418S	SUP	HCPCS C1713		04.025.418S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 28MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.420S	SUP	HCPCS C1713		04.025.420S  -  SCREW BONE FULTHD 4MM 30MM T25 STARDRIVE RECESS LOCKING	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.422S	SUP	HCPCS C1713		04.025.422S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 32MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.424S	SUP	HCPCS C1713		04.025.424S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 34MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.426S	SUP	HCPCS C1713		04.025.426S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 36MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.428S	SUP	HCPCS C1713		04.025.428S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 38MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.430S	SUP	HCPCS C1713		04.025.430S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 40MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.432S	SUP	HCPCS C1713		04.025.432S  -  SCREW BONE 4MM 42MM T25 STARDRIVE RECESS ANGULAR STABLE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.434S	SUP	HCPCS C1713		04.025.434S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 44MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.436S	SUP	HCPCS C1713		04.025.436S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 46MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.438S	SUP	HCPCS C1713		04.025.438S  -  SCREW BONE FULTHD 4MM 48MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.440S	SUP	HCPCS C1713		04.025.440S  -  SCREW BONE FULTHD 4MM 50MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.442S	SUP	HCPCS C1713		04.025.442S  -  SCREW BONE FULTHD 4MM 52MM T25 STARDRIVE RECESS LOCKING	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.444S	SUP	HCPCS C1713		04.025.444S  -  SCREW BONE FULTHD 4MM 54MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.446S	SUP	HCPCS C1713		04.025.446S  -  SCREW BONE FULTHD 4MM 56MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.448S	SUP	HCPCS C1713		04.025.448S  -  SCREW BONE FULTHD 4MM 58MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.450S	SUP	HCPCS C1713		04.025.450S  -  SCREW BONE FULTHD 4MM 60MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.452S	SUP	HCPCS C1713		04.025.452S  -  SCREW BONE FULTHD 4MM 62MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.454S	SUP	HCPCS C1713		04.025.454S  -  SCREW BONE FULTHD 4MM 64MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.456S	SUP	HCPCS C1713		04.025.456S  -  SCREW BONE FULTHD 4MM 66MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.458S	SUP	HCPCS C1713		04.025.458S  -  SCREW BONE FULTHD 4MM 68MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.460S	SUP	HCPCS C1713		04.025.460S  -  SCREW BONE FULTHD 4MM 70MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.462S	SUP	HCPCS C1713		04.025.462S  -  SCREW BONE FULTHD 4MM 72MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.464S	SUP	HCPCS C1713		04.025.464S  -  SCREW BONE FULTHD 4MM 74MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.466S	SUP	HCPCS C1713		04.025.466S  -  SCREW BONE FULTHD 4MM 76MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.468S	SUP	HCPCS C1713		04.025.468S  -  SCREW BONE FULTHD 4MM 78MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.470S	SUP	HCPCS C1713		04.025.470S  -  SCREW BONE FULTHD 4MM 80MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.520S	SUP	HCPCS C1713		04.025.520S  -  SCREW BONE FULTHD 5MM 8MM 30MM T25 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.522S	SUP	HCPCS C1713		04.025.522S  -  SCREW BONE FULTHD 5MM 32MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.524S	SUP	HCPCS C1713		04.025.524S  -  SCREW BONE FULTHD 5MM 34MM T25 STARDRIVE RECESS LOCKING ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.526S	SUP	HCPCS C1713		04.025.526S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 36MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.528S	SUP	HCPCS C1713		04.025.528S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 38MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.530S	SUP	HCPCS C1713		04.025.530S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 40MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.532S	SUP	HCPCS C1713		04.025.532S  -  SCREW BONE FULTHD 5MM 8MM 42MM T25 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.534S	SUP	HCPCS C1713		04.025.534S  -  SCREW BONE FULTHD 5MM 30MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.536S	SUP	HCPCS C1713		04.025.536S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 46MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.538S	SUP	HCPCS C1713		04.025.538S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 48MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.540S	SUP	HCPCS C1713		04.025.540S  -  SCREW BONE FULTHD 5MM 50MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.542S	SUP	HCPCS C1713		04.025.542S  -  SCREW BONE FULTHD 5MM 52MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.544S	SUP	HCPCS C1713		04.025.544S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 54MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.546S	SUP	HCPCS C1713		04.025.546S  -  SCREW BONE FULTHD 5MM 56MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.548S	SUP	HCPCS C1713		04.025.548S  -  SCREW BONE FULTHD 5MM 58MM T25 STARDRIVE RECESS LOCKING ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.550S	SUP	HCPCS C1713		04.025.550S  -  SCREW BONE FULTHD 5MM 8MM 60MM T25 STARDRIVE RECESS SLFTAP	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.552S	SUP	HCPCS C1713		04.025.552S  -  SCREW BONE FULTHD 5MM 8MM 62MM SLFTAP BLUNT TIP T25	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.554S	SUP	HCPCS C1713		04.025.554S  -  SCREW BONE FULTHD 5MM 64MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.556S	SUP	HCPCS C1713		04.025.556S  -  SCREW BONE FULTHD 5MM 66MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.558S	SUP	HCPCS C1713		04.025.558S  -  SCREW BONE FULTHD 5MM 68MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.560S	SUP	HCPCS C1713		04.025.560S  -  SCREW BONE FULTHD 5MM 70MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.562S	SUP	HCPCS C1713		04.025.562S  -  SCREW BONE FULTHD 5MM 72MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.564S	SUP	HCPCS C1713		04.025.564S  -  SCREW BONE FULTHD 5MM 8MM 74MM SLFTAP BLUNT TIP T25	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.566S	SUP	HCPCS C1713		04.025.566S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 76MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.568S	SUP	HCPCS C1713		04.025.568S  -  SCREW BONE FULTHD 5MM 78MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.570S	SUP	HCPCS C1713		04.025.570S  -  SCREW BONE FULTHD 5MM 80MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.575S	SUP	HCPCS C1713		04.025.575S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 85MM SELF TAP STARDRIVE	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.580S	SUP	HCPCS C1713		04.025.580S  -  SCREW BONE FULTHD 5MM 90MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.585S	SUP	HCPCS C1713		04.025.585S  -  SCREW BONE FULTHD 5MM 95MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.590S	SUP	HCPCS C1713		04.025.590S  -  SCREW BONE FULTHD 5MM 100MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$418.65 	$309.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$87.26	$310.72	$310.72	$0.00	$0.00	$87.25	$0.00	$247.63	$247.63	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.622S	SUP	HCPCS C1713		04.025.622S  -  SCREW BONE FULTHD 6MM 32MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.624S	SUP	HCPCS C1713		04.025.624S  -  SCREW BONE FULTHD 6MM 34MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.626S	SUP	HCPCS C1713		04.025.626S  -  SCREW BONE FULTHD 6MM 36MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.628S	SUP	HCPCS C1713		04.025.628S  -  SCREW BONE FULTHD 6MM 38MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.630S	SUP	HCPCS C1713		04.025.630S  -  SCREW BONE FULTHD 6MM 40MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.632S	SUP	HCPCS C1713		04.025.632S  -  SCREW BONE FULTHD 6MM 42MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.634S	SUP	HCPCS C1713		04.025.634S  -  SCREW BONE FULTHD 6MM 44MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.636S	SUP	HCPCS C1713		04.025.636S  -  SCREW BONE FULTHD 6MM 46MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.638S	SUP	HCPCS C1713		04.025.638S  -  SCREW BONE FULTHD 6MM 48MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.640S	SUP	HCPCS C1713		04.025.640S  -  SCREW BONE FULTHD 6MM 50MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.642S	SUP	HCPCS C1713		04.025.642S  -  SCREW BONE FULTHD 6MM 52MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.644S	SUP	HCPCS C1713		04.025.644S  -  SCREW BONE FULTHD 6MM 54MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.646S	SUP	HCPCS C1713		04.025.646S  -  SCREW BONE FULTHD 6MM 56MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.648S	SUP	HCPCS C1713		04.025.648S  -  SCREW BONE FULTHD 6MM 58MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.650S	SUP	HCPCS C1713		04.025.650S  -  SCREW BONE FULTHD 6MM 60MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.652S	SUP	HCPCS C1713		04.025.652S  -  SCREW BONE FULTHD 6MM 62MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.654S	SUP	HCPCS C1713		04.025.654S  -  SCREW BONE FULTHD 6MM 64MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.656S	SUP	HCPCS C1713		04.025.656S  -  SCREW BONE FULTHD 6MM 66MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.658S	SUP	HCPCS C1713		04.025.658S  -  SCREW BONE FULTHD 6MM 68MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.660S	SUP	HCPCS C1713		04.025.660S  -  SCREW BONE FULTHD 6MM 70MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.662S	SUP	HCPCS C1713		04.025.662S  -  SCREW BONE FULTHD 6MM 72MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.664S	SUP	HCPCS C1713		04.025.664S  -  SCREW BONE FULTHD 6MM 74MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.666S	SUP	HCPCS C1713		04.025.666S  -  SCREW BONE FULTHD 6MM 78MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.668S	SUP	HCPCS C1713		04.025.668S  -  SCREW BONE FULTHD 6MM 78MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.670S	SUP	HCPCS C1713		04.025.670S  -  SCREW BONE FULTHD 6MM 80MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.675S	SUP	HCPCS C1713		04.025.675S  -  SCREW BONE FULTHD 6MM 85MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.680S	SUP	HCPCS C1713		04.025.680S  -  SCREW BONE FULTHD 6MM 90MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.685S	SUP	HCPCS C1713		04.025.685S  -  SCREW BONE FULTHD 6MM 95MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.690S	SUP	HCPCS C1713		04.025.690S  -  SCREW BONE FULTHD 6MM 100MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.695S	SUP	HCPCS C1713		04.025.695S  -  SCREW BONE FULTHD 6MM 105MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.700S	SUP	HCPCS C1713		04.025.700S  -  SCREW BONE FULTHD 6MM 110MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.705S	SUP	HCPCS C1713		04.025.705S  -  SCREW BONE FULTHD 6MM 115MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.710S	SUP	HCPCS C1713		04.025.710S  -  SCREW BONE FULTHD 6MM 120MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.025.715S	SUP	HCPCS C1713		04.025.715S  -  SCREW BONE FULTHD 6MM 125MM LOCKING STARDRIVE RECESS ASLS	BOTH IP/OP	$406.48 	$300.80	$0.00	$325.18	$182.91	$182.91	$0.00	$0.00	$0.00	$84.72	$301.69	$301.69	$0.00	$0.00	$84.71	$0.00	$240.43	$240.43	$0.00	$203.24	$321.93	$325.18	$0.00		$0.00	$61.76	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.030S	SUP	HCPCS C1713		04.030.030S  -  NAIL 10MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.031S	SUP	HCPCS C1713		04.030.031S  -  NAIL 10MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.032S	SUP	HCPCS C1713		04.030.032S  -  NAIL 10MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.033S	SUP	HCPCS C1713		04.030.033S  -  NAIL 10MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.034S	SUP	HCPCS C1713		04.030.034S  -  NAIL 10MM 34CM RIGHT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.035S	SUP	HCPCS C1713		04.030.035S  -  NAIL 10MM 34CM LEFT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.036S	SUP	HCPCS C1713		04.030.036S  -  NAIL 10MM 36CM RIGHT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.037S	SUP	HCPCS C1713		04.030.037S  -  NAIL 10MM 36CM LEFT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.038S	SUP	HCPCS C1713		04.030.038S  -  NAIL 10MM 38CM RIGHT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.039S	SUP	HCPCS C1713		04.030.039S  -  NAIL 10MM 38CM LEFT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.040S	SUP	HCPCS C1713		04.030.040S  -  NAIL 10MM 40CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.041S	SUP	HCPCS C1713		04.030.041S  -  NAIL 10MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.042S	SUP	HCPCS C1713		04.030.042S  -  NAIL 10MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.043S	SUP	HCPCS C1713		04.030.043S  -  NAIL 10MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL GRN	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.044S	SUP	HCPCS C1713		04.030.044S  -  NAIL 10MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.045S	SUP	HCPCS C1713		04.030.045S  -  NAIL 10MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.046S	SUP	HCPCS C1713		04.030.046S  -  NAIL 10MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.047S	SUP	HCPCS C1713		04.030.047S  -  NAIL 10MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.048S	SUP	HCPCS C1713		04.030.048S  -  NAIL 10MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.049S	SUP	HCPCS C1713		04.030.049S  -  NAIL 10MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.130S	SUP	HCPCS C1713		04.030.130S  -  NAIL 11MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.131S	SUP	HCPCS C1713		04.030.131S  -  NAIL 11MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.132S	SUP	HCPCS C1713		04.030.132S  -  NAIL 11MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.133S	SUP	HCPCS C1713		04.030.133S  -  NAIL 11MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.134S	SUP	HCPCS C1713		04.030.134S  -  NAIL IM 11MM 340MM LGHT GRN STRL NLEX CNN LAT ENTRY TI AL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.135S	SUP	HCPCS C1713		04.030.135S  -  NAIL 11MM 34CM LEFT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.136S	SUP	HCPCS C1713		04.030.136S  -  NAIL 11MM 36CM RIGHT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.137S	SUP	HCPCS C1713		04.030.137S  -  NAIL 11MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.138S	SUP	HCPCS C1713		04.030.138S  -  NAIL 11MM 38CM RIGHT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.139S	SUP	HCPCS C1713		04.030.139S  -  NAIL 11MM 38CM LEFT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.140S	SUP	HCPCS C1713		04.030.140S  -  NAIL 11MM 40CM RIGHT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.141S	SUP	HCPCS C1713		04.030.141S  -  NAIL 11MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.142S	SUP	HCPCS C1713		04.030.142S  -  NAIL 11MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.143S	SUP	HCPCS C1713		04.030.143S  -  NAIL 11MM 42CM LEFT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.144S	SUP	HCPCS C1713		04.030.144S  -  NAIL 11MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.145S	SUP	HCPCS C1713		04.030.145S  -  NAIL 11MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.146S	SUP	HCPCS C1713		04.030.146S  -  NAIL 11MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.147S	SUP	HCPCS C1713		04.030.147S  -  NAIL 11MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.148S	SUP	HCPCS C1713		04.030.148S  -  NAIL 11MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.149S	SUP	HCPCS C1713		04.030.149S  -  NAIL 11MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.230S	SUP	HCPCS C1713		04.030.230S  -  NAIL 12MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.231S	SUP	HCPCS C1713		04.030.231S  -  NAIL 12MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.232S	SUP	HCPCS C1713		04.030.232S  -  NAIL 12MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.233S	SUP	HCPCS C1713		04.030.233S  -  NAIL 12MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.234S	SUP	HCPCS C1713		04.030.234S  -  NAIL 12MM 34CM RIGHT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.235S	SUP	HCPCS C1713		04.030.235S  -  NAIL 12MM 34CM LEFT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.236S	SUP	HCPCS C1713		04.030.236S  -  NAIL 12MM 36CM RIGHT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.237S	SUP	HCPCS C1713		04.030.237S  -  NAIL 12MM 36CM LEFT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.238S	SUP	HCPCS C1713		04.030.238S  -  NAIL 12MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.239S	SUP	HCPCS C1713		04.030.239S  -  NAIL 12MM 38CM LEFT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.240S	SUP	HCPCS C1713		04.030.240S  -  NAIL 12MM 40CM RIGHT FEM NLEX IM CANN TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.241S	SUP	HCPCS C1713		04.030.241S  -  NAIL 12MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.242S	SUP	HCPCS C1713		04.030.242S  -  NAIL 12MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.243S	SUP	HCPCS C1713		04.030.243S  -  NAIL 12MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.244S	SUP	HCPCS C1713		04.030.244S  -  NAIL 12MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.245S	SUP	HCPCS C1713		04.030.245S  -  NAIL 12MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.246S	SUP	HCPCS C1713		04.030.246S  -  NAIL 12MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.247S	SUP	HCPCS C1713		04.030.247S  -  NAIL 12MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.248S	SUP	HCPCS C1713		04.030.248S  -  NAIL 12MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.249S	SUP	HCPCS C1713		04.030.249S  -  NAIL 12MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.330S	SUP	HCPCS C1713		04.030.330S  -  NAIL 13MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.331S	SUP	HCPCS C1713		04.030.331S  -  NAIL 13MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.332S	SUP	HCPCS C1713		04.030.332S  -  NAIL 13MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.333S	SUP	HCPCS C1713		04.030.333S  -  NAIL 13MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.334S	SUP	HCPCS C1713		04.030.334S  -  NAIL 13MM 34CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.335S	SUP	HCPCS C1713		04.030.335S  -  NAIL 13MM 34CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.336S	SUP	HCPCS C1713		04.030.336S  -  NAIL 13MM 36CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.337S	SUP	HCPCS C1713		04.030.337S  -  NAIL 13MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.338S	SUP	HCPCS C1713		04.030.338S  -  NAIL 13MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.339S	SUP	HCPCS C1713		04.030.339S  -  NAIL 13MM 38CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.340S	SUP	HCPCS C1713		04.030.340S  -  NAIL 13MM 40CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.341S	SUP	HCPCS C1713		04.030.341S  -  NAIL 13MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.342S	SUP	HCPCS C1713		04.030.342S  -  NAIL 13MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.343S	SUP	HCPCS C1713		04.030.343S  -  NAIL 13MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.344S	SUP	HCPCS C1713		04.030.344S  -  NAIL 13MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.345S	SUP	HCPCS C1713		04.030.345S  -  NAIL 13MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.346S	SUP	HCPCS C1713		04.030.346S  -  NAIL 13MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.347S	SUP	HCPCS C1713		04.030.347S  -  NAIL 13MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.348S	SUP	HCPCS C1713		04.030.348S  -  NAIL 13MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.349S	SUP	HCPCS C1713		04.030.349S  -  NAIL 13MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.430S	SUP	HCPCS C1713		04.030.430S  -  NAIL 14MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.431S	SUP	HCPCS C1713		04.030.431S  -  NAIL 14MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.432S	SUP	HCPCS C1713		04.030.432S  -  NAIL 14MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.433S	SUP	HCPCS C1713		04.030.433S  -  NAIL 14MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.434S	SUP	HCPCS C1713		04.030.434S  -  NAIL 14MM 34CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.435S	SUP	HCPCS C1713		04.030.435S  -  NAIL 14MM 34CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.436S	SUP	HCPCS C1713		04.030.436S  -  NAIL 14MM 36CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.437S	SUP	HCPCS C1713		04.030.437S  -  NAIL 14MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.438S	SUP	HCPCS C1713		04.030.438S  -  NAIL 14MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.439S	SUP	HCPCS C1713		04.030.439S  -  NAIL 14MM 38CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.440S	SUP	HCPCS C1713		04.030.440S  -  NAIL 14MM 40CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.441S	SUP	HCPCS C1713		04.030.441S  -  NAIL 14MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.442S	SUP	HCPCS C1713		04.030.442S  -  NAIL 14MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.443S	SUP	HCPCS C1713		04.030.443S  -  NAIL 14MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.444S	SUP	HCPCS C1713		04.030.444S  -  NAIL 14MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.445S	SUP	HCPCS C1713		04.030.445S  -  NAIL 14MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.446S	SUP	HCPCS C1713		04.030.446S  -  NAIL 14MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.447S	SUP	HCPCS C1713		04.030.447S  -  NAIL 14MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.448S	SUP	HCPCS C1713		04.030.448S  -  NAIL 14MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.449S	SUP	HCPCS C1713		04.030.449S  -  NAIL 14MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.530S	SUP	HCPCS C1713		04.030.530S  -  NAIL 15MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.531S	SUP	HCPCS C1713		04.030.531S  -  NAIL 15MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.532S	SUP	HCPCS C1713		04.030.532S  -  NAIL 15MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.533S	SUP	HCPCS C1713		04.030.533S  -  NAIL 15MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.534S	SUP	HCPCS C1713		04.030.534S  -  NAIL 15MM 34CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.535S	SUP	HCPCS C1713		04.030.535S  -  NAIL 15MM 34CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.536S	SUP	HCPCS C1713		04.030.536S  -  NAIL 15MM 36CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.537S	SUP	HCPCS C1713		04.030.537S  -  NAIL 15MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.538S	SUP	HCPCS C1713		04.030.538S  -  NAIL 15MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.539S	SUP	HCPCS C1713		04.030.539S  -  NAIL 15MM 38CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.540S	SUP	HCPCS C1713		04.030.540S  -  NAIL 15MM 40CM FEM NLEX IM CANN PROX BND TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.541S	SUP	HCPCS C1713		04.030.541S  -  NAIL 15MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.542S	SUP	HCPCS C1713		04.030.542S  -  NAIL 15MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.543S	SUP	HCPCS C1713		04.030.543S  -  NAIL 15MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.544S	SUP	HCPCS C1713		04.030.544S  -  NAIL 15MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.545S	SUP	HCPCS C1713		04.030.545S  -  NAIL 15MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.546S	SUP	HCPCS C1713		04.030.546S  -  NAIL 15MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.547S	SUP	HCPCS C1713		04.030.547S  -  NAIL 15MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.548S	SUP	HCPCS C1713		04.030.548S  -  NAIL 15MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.549S	SUP	HCPCS C1713		04.030.549S  -  NAIL 15MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.630S	SUP	HCPCS C1713		04.030.630S  -  NAIL 16MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.631S	SUP	HCPCS C1713		04.030.631S  -  NAIL 16MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.632S	SUP	HCPCS C1713		04.030.632S  -  NAIL 16MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.633S	SUP	HCPCS C1713		04.030.633S  -  NAIL 16MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.634S	SUP	HCPCS C1713		04.030.634S  -  NAIL 16MM 34CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.635S	SUP	HCPCS C1713		04.030.635S  -  NAIL 16MM 34CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.636S	SUP	HCPCS C1713		04.030.636S  -  NAIL 16MM 36CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.637S	SUP	HCPCS C1713		04.030.637S  -  NAIL 16MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.638S	SUP	HCPCS C1713		04.030.638S  -  NAIL 16MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.639S	SUP	HCPCS C1713		04.030.639S  -  NAIL 16MM 38CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.640S	SUP	HCPCS C1713		04.030.640S  -  NAIL 16MM 40CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.641S	SUP	HCPCS C1713		04.030.641S  -  NAIL 16MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.642S	SUP	HCPCS C1713		04.030.642S  -  NAIL 16MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.643S	SUP	HCPCS C1713		04.030.643S  -  NAIL 16MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.644S	SUP	HCPCS C1713		04.030.644S  -  NAIL 16MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.645S	SUP	HCPCS C1713		04.030.645S  -  NAIL 16MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.646S	SUP	HCPCS C1713		04.030.646S  -  NAIL 16MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.647S	SUP	HCPCS C1713		04.030.647S  -  NAIL 16MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.648S	SUP	HCPCS C1713		04.030.648S  -  NAIL 16MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.649S	SUP	HCPCS C1713		04.030.649S  -  NAIL 16MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.930S	SUP	HCPCS C1713		04.030.930S  -  NAIL 9MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.931S	SUP	HCPCS C1713		04.030.931S  -  NAIL 9MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.932S	SUP	HCPCS C1713		04.030.932S  -  NAIL 9MM 320MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.933S	SUP	HCPCS C1713		04.030.933S  -  NAIL 9MM 320MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.934S	SUP	HCPCS C1713		04.030.934S  -  NAIL 9MM 340MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.935S	SUP	HCPCS C1713		04.030.935S  -  NAIL 9MM 340MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.936S	SUP	HCPCS C1713		04.030.936S  -  NAIL 9MM 360MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.937S	SUP	HCPCS C1713		04.030.937S  -  NAIL 9MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.938S	SUP	HCPCS C1713		04.030.938S  -  NAIL 9MM 380MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.939S	SUP	HCPCS C1713		04.030.939S  -  NAIL 9MM 380MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.940S	SUP	HCPCS C1713		04.030.940S  -  NAIL 9MM 400MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.941S	SUP	HCPCS C1713		04.030.941S  -  NAIL 9MM 400MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.942S	SUP	HCPCS C1713		04.030.942S  -  NAIL 9MM 420MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.943S	SUP	HCPCS C1713		04.030.943S  -  NAIL 9MM 420MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.944S	SUP	HCPCS C1713		04.030.944S  -  NAIL 9MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.945S	SUP	HCPCS C1713		04.030.945S  -  NAIL 9MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.946S	SUP	HCPCS C1713		04.030.946S  -  NAIL 9MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.947S	SUP	HCPCS C1713		04.030.947S  -  NAIL 9MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.948S	SUP	HCPCS C1713		04.030.948S  -  NAIL 9MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.030.949S	SUP	HCPCS C1713		04.030.949S  -  NAIL 9MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL	BOTH IP/OP	"$3,685.58 "	"$2,727.33"	$0.00	"$2,948.46"	"$1,658.51"	"$1,658.51"	$0.00	$0.00	$0.00	$768.17	"$2,735.43"	"$2,735.43"	$0.00	$0.00	$768.07	$0.00	"$1,816.99"	"$1,816.99"	$0.00	"$1,842.79"	"$2,918.98"	"$2,948.46"	$0.00		$0.00	$576.79	$0.00	$0.00	$586.74	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.000S	SUP	HCPCS C1713		04.031.000S  -  CAP END 0MM T40 STARDRIVE RECESS CANN LATERAL ENTRY NAIL-EX	BOTH IP/OP	$389.38 	$288.14	$0.00	$302.42	$170.11	$170.11	$0.00	$0.00	$0.00	$81.16	$288.99	$288.99	$0.00	$0.00	$81.15	$0.00	$230.32	$230.32	$0.00	$189.01	$299.40	$302.42	$0.00		$0.00	$57.44	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.001S	SUP	HCPCS C1713		04.031.001S  -  CAP END 5MM T40 LATERAL ENTRY EXTN STARDRIVE RECESS NAIL-EX	BOTH IP/OP	$389.38 	$288.14	$0.00	$302.42	$170.11	$170.11	$0.00	$0.00	$0.00	$81.16	$288.99	$288.99	$0.00	$0.00	$81.15	$0.00	$230.32	$230.32	$0.00	$189.01	$299.40	$302.42	$0.00		$0.00	$57.44	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.002S	SUP	HCPCS C1713		04.031.002S  -  CAP END 10MM T40 EXTENDED STARDRIVE RECESS NAIL-EX TITANIUM	BOTH IP/OP	$389.38 	$288.14	$0.00	$302.42	$170.11	$170.11	$0.00	$0.00	$0.00	$81.16	$288.99	$288.99	$0.00	$0.00	$81.15	$0.00	$230.32	$230.32	$0.00	$189.01	$299.40	$302.42	$0.00		$0.00	$57.44	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.003S	SUP	HCPCS C1713		04.031.003S  -  CAP END 15MM T40 LATERAL ENTRY EXTN STARDRIVE RECESS NAIL-EX	BOTH IP/OP	$389.38 	$288.14	$0.00	$302.42	$170.11	$170.11	$0.00	$0.00	$0.00	$81.16	$288.99	$288.99	$0.00	$0.00	$81.15	$0.00	$230.32	$230.32	$0.00	$189.01	$299.40	$302.42	$0.00		$0.00	$57.44	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.021	SUP	HCPCS C1713		04.031.021  -  SCREW BONE PTHRD 5MM 55MM T25 STARDRIVE RECESS SLFTAP BLUNT	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.022	SUP	HCPCS C1713		04.031.022  -  SCREW BONE PTHRD 5MM 60MM T25 STARDRIVE RECESS SLFTAP BLUNT	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.023	SUP	HCPCS C1713		04.031.023  -  SCREW BONE STANDARD PTHRD BLUNT 5MM 8.2MM 65MM SELF TAP SELF	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.024	SUP	HCPCS C1713		04.031.024  -  SCREW BONE STANDARD PTHRD BLUNT 5MM 8.2MM 70MM SELF TAP SELF	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.025	SUP	HCPCS C1713		04.031.025  -  SCREW BONE PTHRD 5MM 75MM RECONSTRUCTION STARDRIVE RECESS	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.026	SUP	HCPCS C1713		04.031.026  -  SCREW BONE PTHRD 5MM 80MM RECONSTRUCTION STARDRIVE RECESS	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.027	SUP	HCPCS C1713		04.031.027  -  SCREW BONE PTHRD 5MM 85MM RECONSTRUCTION STARDRIVE RECESS	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.028	SUP	HCPCS C1713		04.031.028  -  SCREW BONE PTHRD 5MM 90MM RECONSTRUCTION STARDRIVE RECESS	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.029	SUP	HCPCS C1713		04.031.029  -  SCREW BONE PTHRD 5MM 3.2MM 95MM T25 STARDRIVE RECESS	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.030	SUP	HCPCS C1713		04.031.030  -  SCREW BONE PTHRD 5MM 100MM RECONSTRUCTION STARDRIVE RECESS	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.031	SUP	HCPCS C1713		04.031.031  -  SCREW BONE PTHRD 5MM 105MM RECONSTRUCTION STARDRIVE RECESS	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.032	SUP	HCPCS C1713		04.031.032  -  SCREW BONE PTHRD 5MM 110MM RECONSTRUCTION STARDRIVE RECESS	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.033	SUP	HCPCS C1713		04.031.033  -  SCREW BONE PTHRD 5MM 115MM RECONSTRUCTION STARDRIVE RECESS	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.034	SUP	HCPCS C1713		04.031.034  -  SCREW BONE PTHRD 5MM 120MM RECONSTRUCTION STARDRIVE RECESS	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.035	SUP	HCPCS C1713		04.031.035  -  SCREW BONE PTHRD 5MM 125MM RECONSTRUCTION STARDRIVE RECESS	BOTH IP/OP	$321.90 	$238.21	$0.00	$250.02	$140.64	$140.64	$0.00	$0.00	$0.00	$67.09	$238.91	$238.91	$0.00	$0.00	$67.08	$0.00	$190.40	$190.40	$0.00	$156.26	$247.52	$250.02	$0.00		$0.00	$47.49	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.924S	SUP	HCPCS C1713		04.031.924S  -  NAIL INTRAMEDULLARY 8.2MM 240MM LATERAL ENTRY EXPERT	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.925S	SUP	HCPCS C1713		04.031.925S  -  NAIL INTRAMEDULLARY 8.2MM 240MM LATERAL ENTRY EXPERT	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.926S	SUP	HCPCS C1713		04.031.926S  -  NAIL INTRAMEDULLARY 8.2MM 260MM LATERAL ENTRY EXPERT	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.927S	SUP	HCPCS C1713		04.031.927S  -  NAIL INTRAMEDULLARY 8.2MM 260MM LATERAL ENTRY EXPERT	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.928S	SUP	HCPCS C1713		04.031.928S  -  NAIL INTRAMEDULLARY 8.2MM 280MM LATERAL ENTRY EXPERT	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.929S	SUP	HCPCS C1713		04.031.929S  -  NAIL INTRAMEDULLARY 8.2MM 280MM LATERAL ENTRY EXPERT	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.930S	SUP	HCPCS C1713		04.031.930S  -  NAIL INTRAMEDULLARY 8.2MM 300MM LATERAL ENTRY EXPERT	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.931S	SUP	HCPCS C1713		04.031.931S  -  NAIL INTRAMEDULLARY 8.2MM 300MM LATERAL ENTRY EXPERT	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.932S	SUP	HCPCS C1713		04.031.932S  -  NAIL INTRAMEDULLARY 8.2MM 320MM LATERAL ENTRY TITANIUM	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.933S	SUP	HCPCS C1713		04.031.933S  -  NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.934S	SUP	HCPCS C1713		04.031.934S  -  NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.935S	SUP	HCPCS C1713		04.031.935S  -  NAIL INTRAMEDULLARY 8.2MM 340MM LATERAL ENTRY NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.936S	SUP	HCPCS C1713		04.031.936S  -  NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.937S	SUP	HCPCS C1713		04.031.937S  -  NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.938S	SUP	HCPCS C1713		04.031.938S  -  NAIL INTRAMEDULLARY 380MM CANN LATERAL ENTRY NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.939S	SUP	HCPCS C1713		04.031.939S  -  NAIL INTRAMEDULLARY 380MM CANN LATERAL ENTRY NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.940S	SUP	HCPCS C1713		04.031.940S  -  NAIL INTRAMEDULLARY 8.2MM 400MM LATERAL ENTRY EXPERT	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.941S	SUP	HCPCS C1713		04.031.941S  -  NAIL INTRAMEDULLARY 8.2MM 400MM LATERAL ENTRY EXPERT	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.944S	SUP	HCPCS C1713		04.031.944S  -  NAIL INTRAMEDULLARY 9MM 240MM LATERAL ENTRY CANN EXPERT DARK	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.945S	SUP	HCPCS C1713		04.031.945S  -  NAIL INTRAMEDULLARY 9MM 240MM LATERAL ENTRY CANN EXPERT DARK	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.946S	SUP	HCPCS C1713		04.031.946S  -  NAIL INTRAMEDULLARY 9MM 260MM LATERAL ENTRY CANN EXPERT DARK	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.947S	SUP	HCPCS C1713		04.031.947S  -  NAIL INTRAMEDULLARY 9MM 260MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.948S	SUP	HCPCS C1713		04.031.948S  -  NAIL INTRAMEDULLARY 9MM 280MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.949S	SUP	HCPCS C1713		04.031.949S  -  NAIL INTRAMEDULLARY 9MM 280MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.950S	SUP	HCPCS C1713		04.031.950S  -  NAIL INTRAMEDULLARY 9MM 300MM LATERAL ENTRY CANN HELICAL	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.951S	SUP	HCPCS C1713		04.031.951S  -  NAIL INTRAMEDULLARY 9MM 300MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.952S	SUP	HCPCS C1713		04.031.952S  -  NAIL INTRAMEDULLARY 9MM 320MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.953S	SUP	HCPCS C1713		04.031.953S  -  NAIL INTRAMEDULLARY 9MM 320MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.954S	SUP	HCPCS C1713		04.031.954S  -  NAIL INTRAMEDULLARY 9MM 340MM LATERAL ENTRY TITANIUM	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.955S	SUP	HCPCS C1713		04.031.955S  -  NAIL INTRAMEDULLARY 9MM 340MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.956S	SUP	HCPCS C1713		04.031.956S  -  NAIL INTRAMEDULLARY 9MM 360MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.957S	SUP	HCPCS C1713		04.031.957S  -  NAIL INTRAMEDULLARY 9MM 360MM LATERAL ENTRY NAIL-EX TITANIUM	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.958S	SUP	HCPCS C1713		04.031.958S  -  NAIL INTRAMEDULLARY 9MM 380MM LATERAL ENTRY NAIL-EX TITANIUM	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.959S	SUP	HCPCS C1713		04.031.959S  -  NAIL INTRAMEDULLARY 9MM 380MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.960S	SUP	HCPCS C1713		04.031.960S  -  NAIL INTRAMEDULLARY 9MM 400MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.961S	SUP	HCPCS C1713		04.031.961S  -  NAIL INTRAMEDULLARY 9MM 400MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,807.18 "	"$2,077.31"	$0.00	"$2,180.32"	"$1,226.43"	"$1,226.43"	$0.00	$0.00	$0.00	$585.09	"$2,083.49"	"$2,083.49"	$0.00	$0.00	$585.02	$0.00	"$1,383.94"	"$1,383.94"	$0.00	"$1,362.70"	"$2,158.52"	"$2,180.32"	$0.00		$0.00	$414.10	$0.00	$0.00	$433.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.964S	SUP	HCPCS C1713		04.031.964S  -  NAIL INTRAMEDULLARY 10MM 240MM LATERAL ENTRY CANN EXPERT	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.965S	SUP	HCPCS C1713		04.031.965S  -  NAIL INTRAMEDULLARY 10MM 240MM LATERAL ENTRY CANN EXPERT	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.966S	SUP	HCPCS C1713		04.031.966S  -  NAIL INTRAMEDULLARY 10MM 260MM LATERAL ENTRY CANN EXPERT	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.967S	SUP	HCPCS C1713		04.031.967S  -  NAIL INTRAMEDULLARY 10MM 260MM LATERAL ENTRY CANN EXPERT	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.968S	SUP	HCPCS C1713		04.031.968S  -  NAIL INTRAMEDULLARY 10MM 280MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.969S	SUP	HCPCS C1713		04.031.969S  -  NAIL INTRAMEDULLARY 10MM 280MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.970S	SUP	HCPCS C1713		04.031.970S  -  NAIL INTRAMEDULLARY 10MM 300MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.971S	SUP	HCPCS C1713		04.031.971S  -  NAIL INTRAMEDULLARY 10MM 300MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.972S	SUP	HCPCS C1713		04.031.972S  -  NAIL INTRAMEDULLARY 10MM 320MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.973S	SUP	HCPCS C1713		04.031.973S  -  NAIL INTRAMEDULLARY 10MM 320MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.974S	SUP	HCPCS C1713		04.031.974S  -  NAIL INTRAMEDULLARY 10MM 340MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.975S	SUP	HCPCS C1713		04.031.975S  -  NAIL INTRAMEDULLARY 10MM 340MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.976S	SUP	HCPCS C1713		04.031.976S  -  NAIL INTRAMEDULLARY 10MM 360MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.977S	SUP	HCPCS C1713		04.031.977S  -  NAIL INTRAMEDULLARY 10MM 360MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.978S	SUP	HCPCS C1713		04.031.978S  -  NAIL INTRAMEDULLARY 10MM 380MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.979S	SUP	HCPCS C1713		04.031.979S  -  NAIL INTRAMEDULLARY 10MM 380MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.980S	SUP	HCPCS C1713		04.031.980S  -  NAIL INTRAMEDULLARY 10MM 400MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.031.981S	SUP	HCPCS C1713		04.031.981S  -  NAIL INTRAMEDULLARY 10MM 400MM LATERAL ENTRY IMPLANT NAIL-EX	BOTH IP/OP	"$2,892.93 "	"$2,140.77"	$0.00	"$2,246.92"	"$1,263.89"	"$1,263.89"	$0.00	$0.00	$0.00	$602.96	"$2,147.13"	"$2,147.13"	$0.00	$0.00	$602.89	$0.00	"$1,426.21"	"$1,426.21"	$0.00	"$1,404.33"	"$2,224.45"	"$2,246.92"	$0.00		$0.00	$426.75	$0.00	$0.00	$447.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.001S	SUP	HCPCS C1713		04.032.001S  -  SCREW SET 130D TITANIUM INTRAMEDULLARY STERILE TROC NAIL	BOTH IP/OP	$322.38 	$238.56	$0.00	$250.40	$140.85	$140.85	$0.00	$0.00	$0.00	$67.19	$239.27	$239.27	$0.00	$0.00	$67.18	$0.00	$190.68	$190.68	$0.00	$156.50	$247.90	$250.40	$0.00		$0.00	$47.56	$0.00	$0.00	$49.83	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.070S	SUP	HCPCS C1713		04.032.070S  -  SCREW BONE THREAD 11MM 70X130MM FIX SELFTAPPING INVERSE	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.075S	SUP	HCPCS C1713		04.032.075S  -  SCREW BONE 11MM 75MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.080S	SUP	HCPCS C1713		04.032.080S  -  SCREW BONE 11MM 80MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.085S	SUP	HCPCS C1713		04.032.085S  -  SCREW BONE 11MM 85MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.090S	SUP	HCPCS C1713		04.032.090S  -  SCREW BONE 11MM 90MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.095S	SUP	HCPCS C1713		04.032.095S  -  SCREW BONE 11MM 95MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.100S	SUP	HCPCS C1713		04.032.100S  -  SCREW BONE 11MM 100MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.105S	SUP	HCPCS C1713		04.032.105S  -  SCREW BONE 11MM 105MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.110S	SUP	HCPCS C1713		04.032.110S  -  SCREW BONE 11MM 110MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.115S	SUP	HCPCS C1713		04.032.115S  -  SCREW BONE 11MM 115MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.120S	SUP	HCPCS C1713		04.032.120S  -  SCREW BONE 11MM 120MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.125S	SUP	HCPCS C1713		04.032.125S  -  SCREW BONE 11MM 125MM TITANIUM FEMUR TROCHANTER PROXIMAL	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.032.130S	SUP	HCPCS C1713		04.032.130S  -  SCREW BN 11MM 130MM AU STRL CNN SELP TAP INVERSE ANG THRD TI	BOTH IP/OP	"$1,102.80 "	$816.07	$0.00	$856.54	$481.80	$481.80	$0.00	$0.00	$0.00	$229.85	$818.50	$818.50	$0.00	$0.00	$229.82	$0.00	$652.31	$652.31	$0.00	$535.34	$847.98	$856.54	$0.00		$0.00	$162.68	$0.00	$0.00	$170.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.231S	SUP	HCPCS C1713		04.034.231S  -  NAIL INTRAMEDULLARY 8MM 255MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,927.68 "	"$2,166.48"	$0.00	"$2,273.94"	"$1,279.09"	"$1,279.09"	$0.00	$0.00	$0.00	$610.20	"$2,172.92"	"$2,172.92"	$0.00	$0.00	$610.13	$0.00	"$1,443.34"	"$1,443.34"	$0.00	"$1,421.21"	"$2,251.20"	"$2,273.94"	$0.00		$0.00	$431.88	$0.00	$0.00	$452.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.234S	SUP	HCPCS C1713		04.034.234S  -  NAIL INTRAMEDULLARY 8MM 27CM CANN PROXIMAL BEND NAIL-EX DARK	BOTH IP/OP	"$2,927.68 "	"$2,166.48"	$0.00	"$2,273.94"	"$1,279.09"	"$1,279.09"	$0.00	$0.00	$0.00	$610.20	"$2,172.92"	"$2,172.92"	$0.00	$0.00	$610.13	$0.00	"$1,443.34"	"$1,443.34"	$0.00	"$1,421.21"	"$2,251.20"	"$2,273.94"	$0.00		$0.00	$431.88	$0.00	$0.00	$452.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.237S	SUP	HCPCS C1713		04.034.237S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 285MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.240S	SUP	HCPCS C1713		04.034.240S  -  NAIL INTRAMEDULLARY 8MM 30CM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.243S	SUP	HCPCS C1713		04.034.243S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 315MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.246S	SUP	HCPCS C1713		04.034.246S  -  NAIL INTRAMEDULLARY 8MM 33CM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.249S	SUP	HCPCS C1713		04.034.249S  -  NAIL INTRAMEDULLARY 8MM 34.5CM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.252S	SUP	HCPCS C1713		04.034.252S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND BARREL 8MM 36CM CANN	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.255S	SUP	HCPCS C1713		04.034.255S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 375MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.258S	SUP	HCPCS C1713		04.034.258S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 390MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.261S	SUP	HCPCS C1713		04.034.261S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 405MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,917.48 "	"$2,158.94"	$0.00	"$2,266.00"	"$1,274.63"	"$1,274.63"	$0.00	$0.00	$0.00	$608.07	"$2,165.35"	"$2,165.35"	$0.00	$0.00	$608.00	$0.00	"$1,438.32"	"$1,438.32"	$0.00	"$1,416.25"	"$2,243.34"	"$2,266.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$450.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.264S	SUP	HCPCS C1713		04.034.264S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 420MM CANN PROXIMAL BEND	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.267S	SUP	HCPCS C1713		04.034.267S  -  NAIL INTRAMEDULLARY 8MM 43.5CM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.331S	SUP	HCPCS C1713		04.034.331S  -  NAIL INTRAMEDULLARY 9MM 25.5CM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.334S	SUP	HCPCS C1713		04.034.334S  -  NAIL INTRAMEDULLARY 9MM 27CM CANN PROXIMAL BEND NAIL-EX DARK	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.337S	SUP	HCPCS C1713		04.034.337S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 285MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.340S	SUP	HCPCS C1713		04.034.340S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 300MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.343S	SUP	HCPCS C1713		04.034.343S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 315MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.346S	SUP	HCPCS C1713		04.034.346S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 330MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.349S	SUP	HCPCS C1713		04.034.349S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 345MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.352S	SUP	HCPCS C1713		04.034.352S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND 9MM 36CM CANN PROXIMAL	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.355S	SUP	HCPCS C1713		04.034.355S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 375MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.358S	SUP	HCPCS C1713		04.034.358S  -  NAIL INTRAMEDULLARY 9MM 39CM PROXIMAL BEND CANN EXPERT	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.361S	SUP	HCPCS C1713		04.034.361S  -  NAIL INTRAMEDULLARY 9MM 40.5CM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.364S	SUP	HCPCS C1713		04.034.364S  -  NAIL INTRAMEDULLARY 9MM 420MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.367S	SUP	HCPCS C1713		04.034.367S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 435MM CANN PROXIMAL BEND	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.431S	SUP	HCPCS C1713		04.034.431S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 255MM CANN PROXIMAL BEND	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.434S	SUP	HCPCS C1713		04.034.434S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 270MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,927.68 "	"$2,166.48"	$0.00	"$2,273.94"	"$1,279.09"	"$1,279.09"	$0.00	$0.00	$0.00	$610.20	"$2,172.92"	"$2,172.92"	$0.00	$0.00	$610.13	$0.00	"$1,443.34"	"$1,443.34"	$0.00	"$1,421.21"	"$2,251.20"	"$2,273.94"	$0.00		$0.00	$431.88	$0.00	$0.00	$452.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.437S	SUP	HCPCS C1713		04.034.437S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 285MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.440S	SUP	HCPCS C1713		04.034.440S  -  NAIL INTRAMEDULLARY 10MM 30CM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.443S	SUP	HCPCS C1713		04.034.443S  -  NAIL INTRAMEDULLARY 10MM 315MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.446S	SUP	HCPCS C1713		04.034.446S  -  NAIL INTRAMEDULLARY 10MM 33CM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.449S	SUP	HCPCS C1713		04.034.449S  -  NAIL INTRAMEDULLARY 10MM 34.5CM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.452S	SUP	HCPCS C1713		04.034.452S  -  NAIL INTRAMEDULLARY 10MM 360MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.455S	SUP	HCPCS C1713		04.034.455S  -  NAIL INTRAMEDULLARY 10MM 375MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.458S	SUP	HCPCS C1713		04.034.458S  -  NAIL INTRAMEDULLARY 10MM 390MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.461S	SUP	HCPCS C1713		04.034.461S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 405MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.464S	SUP	HCPCS C1713		04.034.464S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,927.68 "	"$2,166.48"	$0.00	"$2,273.94"	"$1,279.09"	"$1,279.09"	$0.00	$0.00	$0.00	$610.20	"$2,172.92"	"$2,172.92"	$0.00	$0.00	$610.13	$0.00	"$1,443.34"	"$1,443.34"	$0.00	"$1,421.21"	"$2,251.20"	"$2,273.94"	$0.00		$0.00	$431.88	$0.00	$0.00	$452.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.467S	SUP	HCPCS C1713		04.034.467S  -  NAIL INTRAMEDULLARY 10MM 435MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.531S	SUP	HCPCS C1713		04.034.531S  -  NAIL INTRAMEDULLARY 11MM 255MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.534S	SUP	HCPCS C1713		04.034.534S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 270MM CANN PROXIMAL BEND	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.537S	SUP	HCPCS C1713		04.034.537S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 285MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.540S	SUP	HCPCS C1713		04.034.540S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTE BARREL 11MM 300MM CANN	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.543S	SUP	HCPCS C1713		04.034.543S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 315MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.546S	SUP	HCPCS C1713		04.034.546S  -  NAIL INTRAMEDULLARY 11MM 330MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.549S	SUP	HCPCS C1713		04.034.549S  -  NAIL INTRAMEDULLARY 11MM 345MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.552S	SUP	HCPCS C1713		04.034.552S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.555S	SUP	HCPCS C1713		04.034.555S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 375MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.558S	SUP	HCPCS C1713		04.034.558S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 390MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.561S	SUP	HCPCS C1713		04.034.561S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 405MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.564S	SUP	HCPCS C1713		04.034.564S  -  NAIL INTRAMEDULLARY 11MM 420MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.567S	SUP	HCPCS C1713		04.034.567S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 235MM CANN PROXIMAL BEND	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.631S	SUP	HCPCS C1713		04.034.631S  -  NAIL INTRAMEDULLARY 12MM 255MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.634S	SUP	HCPCS C1713		04.034.634S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 270MM CANN PROXIMAL BEND	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.637S	SUP	HCPCS C1713		04.034.637S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 285MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.640S	SUP	HCPCS C1713		04.034.640S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.643S	SUP	HCPCS C1713		04.034.643S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 315MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.646S	SUP	HCPCS C1713		04.034.646S  -  NAIL INTRAMEDULLARY 12MM 33CM CANN PROXIMAL BEND EXPERT	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.649S	SUP	HCPCS C1713		04.034.649S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 345MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.652S	SUP	HCPCS C1713		04.034.652S  -  NAIL INTRAMEDULLARY 12MM 360MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.655S	SUP	HCPCS C1713		04.034.655S  -  NAIL INTRAMEDULLARY 12MM 375MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.658S	SUP	HCPCS C1713		04.034.658S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 390MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.661S	SUP	HCPCS C1713		04.034.661S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 405MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.664S	SUP	HCPCS C1713		04.034.664S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN PROXIMAL BEND	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.667S	SUP	HCPCS C1713		04.034.667S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 435MM CANN PROXIMAL BEND	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.731S	SUP	HCPCS C1713		04.034.731S  -  NAIL INTRAMEDULLARY 13MM 255MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.734S	SUP	HCPCS C1713		04.034.734S  -  NAIL INTRAMEDULLARY 13MM 270MM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.737S	SUP	HCPCS C1713		04.034.737S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 285MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,917.48 "	"$2,158.94"	$0.00	"$2,266.00"	"$1,274.63"	"$1,274.63"	$0.00	$0.00	$0.00	$608.07	"$2,165.35"	"$2,165.35"	$0.00	$0.00	$608.00	$0.00	"$1,438.32"	"$1,438.32"	$0.00	"$1,416.25"	"$2,243.34"	"$2,266.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$450.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.740S	SUP	HCPCS C1713		04.034.740S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.743S	SUP	HCPCS C1713		04.034.743S  -  NAIL INTRAMEDULLARY 13MM 31.5CM CANN PROXIMAL BEND TITANIUM	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.746S	SUP	HCPCS C1713		04.034.746S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 330MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.749S	SUP	HCPCS C1713		04.034.749S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 345MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.752S	SUP	HCPCS C1713		04.034.752S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.755S	SUP	HCPCS C1713		04.034.755S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND BARREL 13MM 37.5CM CANN	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.758S	SUP	HCPCS C1713		04.034.758S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 390MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.761S	SUP	HCPCS C1713		04.034.761S  -  NAIL INTRAMEDULLARY 13MM 40.5CM CANN PROXIMAL BEND NAIL-EX	BOTH IP/OP	"$2,831.40 "	"$2,095.24"	$0.00	"$2,199.16"	"$1,237.03"	"$1,237.03"	$0.00	$0.00	$0.00	$590.13	"$2,101.47"	"$2,101.47"	$0.00	$0.00	$590.06	$0.00	"$1,395.88"	"$1,395.88"	$0.00	"$1,374.48"	"$2,177.17"	"$2,199.16"	$0.00		$0.00	$417.68	$0.00	$0.00	$437.63	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.764S	SUP	HCPCS C1713		04.034.764S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 420MM CANN PROXIMAL BEND	BOTH IP/OP	"$2,927.68 "	"$2,166.48"	$0.00	"$2,273.94"	"$1,279.09"	"$1,279.09"	$0.00	$0.00	$0.00	$610.20	"$2,172.92"	"$2,172.92"	$0.00	$0.00	$610.13	$0.00	"$1,443.34"	"$1,443.34"	$0.00	"$1,421.21"	"$2,251.20"	"$2,273.94"	$0.00		$0.00	$431.88	$0.00	$0.00	$452.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.034.767S	SUP	HCPCS C1713		04.034.767S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 435MM CANN PROXIMAL BEND	BOTH IP/OP	"$3,016.68 "	"$2,232.34"	$0.00	"$2,343.04"	"$1,317.96"	"$1,317.96"	$0.00	$0.00	$0.00	$628.75	"$2,238.98"	"$2,238.98"	$0.00	$0.00	$628.68	$0.00	"$1,487.22"	"$1,487.22"	$0.00	"$1,464.40"	"$2,319.61"	"$2,343.04"	$0.00		$0.00	$445.01	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.037.142S	SUP	HCPCS C1713		04.037.142S  -  NAIL IM 130D SHRT 11MM 170MM GRN STRL TFN-ADV CNN	BOTH IP/OP	"$3,133.30 "	"$2,318.64"	$0.00	"$2,433.62"	"$1,368.91"	"$1,368.91"	$0.00	$0.00	$0.00	$653.06	"$2,325.54"	"$2,325.54"	$0.00	$0.00	$652.98	$0.00	"$1,544.72"	"$1,544.72"	$0.00	"$1,521.01"	"$2,409.29"	"$2,433.62"	$0.00		$0.00	$462.21	$0.00	$0.00	$484.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.037.165S	SUP	HCPCS C1713		04.037.165S  -  NAIL IM 130D LNG 11MM 440MM GRN STRL TFN-ADV CNN PREASSEMBLE	BOTH IP/OP	"$4,391.38 "	"$3,249.62"	$0.00	"$3,410.78"	"$1,918.56"	"$1,918.56"	$0.00	$0.00	$0.00	$915.27	"$3,259.28"	"$3,259.28"	$0.00	$0.00	$915.16	$0.00	"$2,164.95"	"$2,164.95"	$0.00	"$2,131.74"	"$3,376.68"	"$3,410.78"	$0.00		$0.00	$647.80	$0.00	$0.00	$678.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.037.167S	SUP	HCPCS C1713		04.037.167S  -  NAIL IM 130D LNG 11MM 460MM GRN STRL TFN-ADV LAT RLF CUT CNN	BOTH IP/OP	"$4,391.38 "	"$3,249.62"	$0.00	"$3,410.78"	"$1,918.56"	"$1,918.56"	$0.00	$0.00	$0.00	$915.27	"$3,259.28"	"$3,259.28"	$0.00	$0.00	$915.16	$0.00	"$2,164.95"	"$2,164.95"	$0.00	"$2,131.74"	"$3,376.68"	"$3,410.78"	$0.00		$0.00	$647.80	$0.00	$0.00	$678.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.037.242S	SUP	HCPCS C1713		04.037.242S  -  NAIL IM 130D SHRT 12MM 170MM GRN STRL TFN-ADV CNN	BOTH IP/OP	"$3,133.30 "	"$2,318.64"	$0.00	"$2,433.62"	"$1,368.91"	"$1,368.91"	$0.00	$0.00	$0.00	$653.06	"$2,325.54"	"$2,325.54"	$0.00	$0.00	$652.98	$0.00	"$1,544.72"	"$1,544.72"	$0.00	"$1,521.01"	"$2,409.29"	"$2,433.62"	$0.00		$0.00	$462.21	$0.00	$0.00	$484.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.037.257S	SUP	HCPCS C1713		04.037.257S  -  NAIL IM 130D LNG 12MM 360MM GRN STRL TFN-ADV LAT RLF CUT CNN	BOTH IP/OP	"$4,391.38 "	"$3,249.62"	$0.00	"$3,410.78"	"$1,918.56"	"$1,918.56"	$0.00	$0.00	$0.00	$915.27	"$3,259.28"	"$3,259.28"	$0.00	$0.00	$915.16	$0.00	"$2,164.95"	"$2,164.95"	$0.00	"$2,131.74"	"$3,376.68"	"$3,410.78"	$0.00		$0.00	$647.80	$0.00	$0.00	$678.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.037.259S	SUP	HCPCS C1713		04.037.259S  -  NAIL IM 130D LNG 12MM 380MM GRN STRL TFN-ADV LAT RLF CUT CNN	BOTH IP/OP	"$4,391.38 "	"$3,249.62"	$0.00	"$3,410.78"	"$1,918.56"	"$1,918.56"	$0.00	$0.00	$0.00	$915.27	"$3,259.28"	"$3,259.28"	$0.00	$0.00	$915.16	$0.00	"$2,164.95"	"$2,164.95"	$0.00	"$2,131.74"	"$3,376.68"	"$3,410.78"	$0.00		$0.00	$647.80	$0.00	$0.00	$678.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.037.261S	SUP	HCPCS C1713		04.037.261S  -  NAIL IM 130D LNG 12MM 400MM GRN STRL TFN-ADV LAT RLF CUT CNN	BOTH IP/OP	"$4,391.38 "	"$3,249.62"	$0.00	"$3,410.78"	"$1,918.56"	"$1,918.56"	$0.00	$0.00	$0.00	$915.27	"$3,259.28"	"$3,259.28"	$0.00	$0.00	$915.16	$0.00	"$2,164.95"	"$2,164.95"	$0.00	"$2,131.74"	"$3,376.68"	"$3,410.78"	$0.00		$0.00	$647.80	$0.00	$0.00	$678.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.037.262S	SUP	HCPCS C1713		04.037.262S  -  NAIL IM 130D LNG 12MM 420MM GRN STRL TFN-ADV LAT RLF CUT CNN	BOTH IP/OP	"$4,391.38 "	"$3,249.62"	$0.00	"$3,410.78"	"$1,918.56"	"$1,918.56"	$0.00	$0.00	$0.00	$915.27	"$3,259.28"	"$3,259.28"	$0.00	$0.00	$915.16	$0.00	"$2,164.95"	"$2,164.95"	$0.00	"$2,131.74"	"$3,376.68"	"$3,410.78"	$0.00		$0.00	$647.80	$0.00	$0.00	$678.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.038.105S	SUP	HCPCS C1713		04.038.105S  -  SCREW BN 10.35MM 105MM AU STRL LF TFN-ADV CNN TI	BOTH IP/OP	"$1,426.78 "	"$1,055.82"	$0.00	"$1,108.18"	$623.35	$623.35	$0.00	$0.00	$0.00	$297.38	"$1,058.95"	"$1,058.95"	$0.00	$0.00	$297.34	$0.00	$843.94	$843.94	$0.00	$692.61	"$1,097.10"	"$1,108.18"	$0.00		$0.00	$210.47	$0.00	$0.00	$220.53	$0.00	$0.00	$0.00	$0.00	$0.00
04.038.285S	SUP	Custom 27203010		04.038.285S  -  BLADE IM NL HLCL 10.35MM 85MM AU STRL TFN-ADV CNN TI-6AL-7NB	BOTH IP/OP	"$1,497.08 "	"$1,107.84"	$0.00	"$1,162.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,111.13"	"$1,111.13"	$0.00	$0.00	$311.99	$0.00	$0.00	$0.00	$0.00	$726.73	"$1,151.13"	"$1,162.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.038.290S	SUP	Custom 27203010		04.038.290S  -  BLADE IM NL HLCL 90MM STRL TFN-ADV CNN TI FEM PROX	BOTH IP/OP	"$1,497.08 "	"$1,107.84"	$0.00	"$1,162.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,111.13"	"$1,111.13"	$0.00	$0.00	$311.99	$0.00	$0.00	$0.00	$0.00	$726.73	"$1,151.13"	"$1,162.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.038.295S	SUP	Custom 27203010		04.038.295S  -  BLADE IM NL HLCL 10.35MM 95MM AU STRL TFN-ADV CNN TI-6AL-7NB	BOTH IP/OP	"$1,497.08 "	"$1,107.84"	$0.00	"$1,162.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,111.13"	"$1,111.13"	$0.00	$0.00	$311.99	$0.00	$0.00	$0.00	$0.00	$726.73	"$1,151.13"	"$1,162.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.038.305S	SUP	Custom 27203010		04.038.305S  -  BLADE IM NL HLCL 10.35MM 105MM AU STRL TFN-ADV CNN TI-6AL-7	BOTH IP/OP	"$1,497.08 "	"$1,107.84"	$0.00	"$1,162.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,111.13"	"$1,111.13"	$0.00	$0.00	$311.99	$0.00	$0.00	$0.00	$0.00	$726.73	"$1,151.13"	"$1,162.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.100.020	SUP	HCPCS C1713		04.100.020  -  PLATE BONE LOCK TITANIUM FT NONSTRL 2.4-2.7 MM SCREWS	BOTH IP/OP	"$1,464.73 "	"$1,083.90"	$0.00	"$1,137.66"	$639.93	$639.93	$0.00	$0.00	$0.00	$305.29	"$1,087.12"	"$1,087.12"	$0.00	$0.00	$305.25	$0.00	$866.38	$866.38	$0.00	$711.04	"$1,126.29"	"$1,137.66"	$0.00		$0.00	$216.07	$0.00	$0.00	$226.39	$0.00	$0.00	$0.00	$0.00	$0.00
04.100.021	SUP	HCPCS C1713		04.100.021  -  PLATE BONE LOCK TITANIUM LEFT CUBOID FT NONSTRL 2.4-2.7 MM	BOTH IP/OP	"$1,425.38 "	"$1,054.78"	$0.00	"$1,107.08"	$622.73	$622.73	$0.00	$0.00	$0.00	$297.08	"$1,057.91"	"$1,057.91"	$0.00	$0.00	$297.05	$0.00	$843.11	$843.11	$0.00	$691.93	"$1,096.01"	"$1,107.08"	$0.00		$0.00	$210.27	$0.00	$0.00	$220.31	$0.00	$0.00	$0.00	$0.00	$0.00
04.100.022	SUP	HCPCS C1713		04.100.022  -  PLATE BONE LOCK TITANIUM RIGHT CUBOID FT NONSTRL 2.4-2.7 MM	BOTH IP/OP	"$1,425.38 "	"$1,054.78"	$0.00	"$1,107.08"	$622.73	$622.73	$0.00	$0.00	$0.00	$297.08	"$1,057.91"	"$1,057.91"	$0.00	$0.00	$297.05	$0.00	$843.11	$843.11	$0.00	$691.93	"$1,096.01"	"$1,107.08"	$0.00		$0.00	$210.27	$0.00	$0.00	$220.31	$0.00	$0.00	$0.00	$0.00	$0.00
04.100.023	SUP	HCPCS C1713		04.100.023  -  PLATE BONE LOCK TITANIUM TALUS FT NONSTRL 2.4-2.7 MM SCREW	BOTH IP/OP	"$1,408.50 "	"$1,042.29"	$0.00	"$1,093.98"	$615.36	$615.36	$0.00	$0.00	$0.00	$293.57	"$1,045.39"	"$1,045.39"	$0.00	$0.00	$293.53	$0.00	$833.13	$833.13	$0.00	$683.74	"$1,083.04"	"$1,093.98"	$0.00		$0.00	$207.78	$0.00	$0.00	$217.70	$0.00	$0.00	$0.00	$0.00	$0.00
04.100.032S	SUP	HCPCS C1713		04.100.032S  -  PLATE 100MM TI 6 HOLE LCP BONE ANT ANKL FT STRL	BOTH IP/OP	"$2,315.60 "	"$1,713.54"	$0.00	"$1,852.48"	"$1,042.02"	"$1,042.02"	$0.00	$0.00	$0.00	$482.63	"$1,718.64"	"$1,718.64"	$0.00	$0.00	$482.57	$0.00	"$1,369.68"	"$1,369.68"	$0.00	"$1,157.80"	"$1,833.96"	"$1,852.48"	$0.00		$0.00	$362.39	$0.00	$0.00	$368.64	$0.00	$0.00	$0.00	$0.00	$0.00
04.100.033S	SUP	HCPCS C1713		04.100.033S  -  PLATE 116MM TI 7 HOLE LCP BONE ANT ANKL FT STRL	BOTH IP/OP	"$2,380.43 "	"$1,761.52"	$0.00	"$1,904.34"	"$1,071.19"	"$1,071.19"	$0.00	$0.00	$0.00	$496.14	"$1,766.75"	"$1,766.75"	$0.00	$0.00	$496.08	$0.00	"$1,408.02"	"$1,408.02"	$0.00	"$1,190.21"	"$1,885.30"	"$1,904.34"	$0.00		$0.00	$372.54	$0.00	$0.00	$378.96	$0.00	$0.00	$0.00	$0.00	$0.00
04.104.004S	SUP	HCPCS C1713		04.104.004S  -  PLATE BONE 122MM 4 HOLE LCP TITANIUM EXTART RIGHT HUMERUS	BOTH IP/OP	"$2,384.05 "	"$1,764.20"	$0.00	"$1,851.70"	"$1,041.58"	"$1,041.58"	$0.00	$0.00	$0.00	$496.90	"$1,769.44"	"$1,769.44"	$0.00	$0.00	$496.84	$0.00	"$1,410.17"	"$1,410.17"	$0.00	"$1,157.31"	"$1,833.19"	"$1,851.70"	$0.00		$0.00	$351.69	$0.00	$0.00	$368.49	$0.00	$0.00	$0.00	$0.00	$0.00
04.104.006S	SUP	HCPCS C1713		04.104.006S  -  PLATE BONE 158MM 6 HOLE LCP TITANIUM EXTART RIGHT HUMERUS	BOTH IP/OP	"$2,714.40 "	"$2,008.66"	$0.00	"$2,108.26"	"$1,185.90"	"$1,185.90"	$0.00	$0.00	$0.00	$565.75	"$2,014.63"	"$2,014.63"	$0.00	$0.00	$565.68	$0.00	"$1,338.20"	"$1,338.20"	$0.00	"$1,317.66"	"$2,087.18"	"$2,108.26"	$0.00		$0.00	$400.42	$0.00	$0.00	$419.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.104.008S	SUP	HCPCS C1713		04.104.008S  -  PLATE BN 194MM STRL LCP CMBN 8 HL PRECONTOUR LMT CNTCT TI	BOTH IP/OP	"$2,874.65 "	"$2,127.24"	$0.00	"$2,232.74"	"$1,255.92"	"$1,255.92"	$0.00	$0.00	$0.00	$599.15	"$2,133.57"	"$2,133.57"	$0.00	$0.00	$599.08	$0.00	"$1,417.20"	"$1,417.20"	$0.00	"$1,395.46"	"$2,210.42"	"$2,232.74"	$0.00		$0.00	$424.06	$0.00	$0.00	$444.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.104.010S	SUP	HCPCS C1713		04.104.010S  -  PLATE BONE 230MM 10 HOLE LCP TITANIUM EXTART RIGHT HUMERUS	BOTH IP/OP	"$3,037.70 "	"$2,247.90"	$0.00	"$2,359.38"	"$1,327.15"	"$1,327.15"	$0.00	$0.00	$0.00	$633.13	"$2,254.58"	"$2,254.58"	$0.00	$0.00	$633.06	$0.00	"$1,497.59"	"$1,497.59"	$0.00	"$1,474.61"	"$2,335.79"	"$2,359.38"	$0.00		$0.00	$448.11	$0.00	$0.00	$469.52	$0.00	$0.00	$0.00	$0.00	$0.00
04.104.012S	SUP	HCPCS C1713		04.104.012S  -  PLATE BONE 266MM 12 HOLE LCP TITANIUM EXTART RIGHT HUMERUS	BOTH IP/OP	"$3,458.00 "	"$2,558.92"	$0.00	"$2,685.82"	"$1,510.77"	"$1,510.77"	$0.00	$0.00	$0.00	$720.73	"$2,566.53"	"$2,566.53"	$0.00	$0.00	$720.65	$0.00	"$1,704.79"	"$1,704.79"	$0.00	"$1,678.64"	"$2,658.97"	"$2,685.82"	$0.00		$0.00	$510.11	$0.00	$0.00	$534.48	$0.00	$0.00	$0.00	$0.00	$0.00
04.104.014S	SUP	HCPCS C1713		04.104.014S  -  PLATE BONE 302MM 14 HOLE LCP TITANIUM EXTART RIGHT HUMERUS	BOTH IP/OP	"$3,796.78 "	"$2,809.62"	$0.00	"$2,948.96"	"$1,658.79"	"$1,658.79"	$0.00	$0.00	$0.00	$791.34	"$2,817.97"	"$2,817.97"	$0.00	$0.00	$791.25	$0.00	"$1,871.81"	"$1,871.81"	$0.00	"$1,843.10"	"$2,919.47"	"$2,948.96"	$0.00		$0.00	$560.09	$0.00	$0.00	$586.84	$0.00	$0.00	$0.00	$0.00	$0.00
04.104.024S	SUP	HCPCS C1713		04.104.024S  -  PLATE BONE 122MM 4 HOLE LCP TITANIUM LEFT DISTAL EXTART	BOTH IP/OP	"$2,384.05 "	"$1,764.20"	$0.00	"$1,851.70"	"$1,041.58"	"$1,041.58"	$0.00	$0.00	$0.00	$496.90	"$1,769.44"	"$1,769.44"	$0.00	$0.00	$496.84	$0.00	"$1,410.17"	"$1,410.17"	$0.00	"$1,157.31"	"$1,833.19"	"$1,851.70"	$0.00		$0.00	$351.69	$0.00	$0.00	$368.49	$0.00	$0.00	$0.00	$0.00	$0.00
04.104.026S	SUP	HCPCS C1713		04.104.026S  -  PLATE BONE 158MM 6 HOLE LCP TITANIUM LEFT DISTAL EXTART	BOTH IP/OP	"$2,714.40 "	"$2,008.66"	$0.00	"$2,108.26"	"$1,185.90"	"$1,185.90"	$0.00	$0.00	$0.00	$565.75	"$2,014.63"	"$2,014.63"	$0.00	$0.00	$565.68	$0.00	"$1,338.20"	"$1,338.20"	$0.00	"$1,317.66"	"$2,087.18"	"$2,108.26"	$0.00		$0.00	$400.42	$0.00	$0.00	$419.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.104.028S	SUP	HCPCS C1713		04.104.028S  -  PLATE BONE 194MM 8 HOLE LCP TITANIUM LEFT DISTAL EXTART	BOTH IP/OP	"$2,874.65 "	"$2,127.24"	$0.00	"$2,232.74"	"$1,255.92"	"$1,255.92"	$0.00	$0.00	$0.00	$599.15	"$2,133.57"	"$2,133.57"	$0.00	$0.00	$599.08	$0.00	"$1,417.20"	"$1,417.20"	$0.00	"$1,395.46"	"$2,210.42"	"$2,232.74"	$0.00		$0.00	$424.06	$0.00	$0.00	$444.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.104.030S	SUP	HCPCS C1713		04.104.030S  -  PLATE BONE 230MM 10 HOLE LCP TITANIUM LEFT DISTAL EXTART	BOTH IP/OP	"$3,037.70 "	"$2,247.90"	$0.00	"$2,359.38"	"$1,327.15"	"$1,327.15"	$0.00	$0.00	$0.00	$633.13	"$2,254.58"	"$2,254.58"	$0.00	$0.00	$633.06	$0.00	"$1,497.59"	"$1,497.59"	$0.00	"$1,474.61"	"$2,335.79"	"$2,359.38"	$0.00		$0.00	$448.11	$0.00	$0.00	$469.52	$0.00	$0.00	$0.00	$0.00	$0.00
04.104.032S	SUP	HCPCS C1713		04.104.032S  -  PLATE BONE 266MM 12 HOLE LCP TITANIUM LEFT DISTAL EXTART	BOTH IP/OP	"$3,458.00 "	"$2,558.92"	$0.00	"$2,685.82"	"$1,510.77"	"$1,510.77"	$0.00	$0.00	$0.00	$720.73	"$2,566.53"	"$2,566.53"	$0.00	$0.00	$720.65	$0.00	"$1,704.79"	"$1,704.79"	$0.00	"$1,678.64"	"$2,658.97"	"$2,685.82"	$0.00		$0.00	$510.11	$0.00	$0.00	$534.48	$0.00	$0.00	$0.00	$0.00	$0.00
04.104.034S	SUP	HCPCS C1713		04.104.034S  -  PLATE BONE 302MM 14 HOLE LCP TITANIUM LEFT DISTAL EXTART	BOTH IP/OP	"$3,796.78 "	"$2,809.62"	$0.00	"$2,948.96"	"$1,658.79"	"$1,658.79"	$0.00	$0.00	$0.00	$791.34	"$2,817.97"	"$2,817.97"	$0.00	$0.00	$791.25	$0.00	"$1,871.81"	"$1,871.81"	$0.00	"$1,843.10"	"$2,919.47"	"$2,948.96"	$0.00		$0.00	$560.09	$0.00	$0.00	$586.84	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.005	SUP	HCPCS C1713		04.110.005  -  PLATE BONE 5 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL	BOTH IP/OP	"$2,921.03 "	"$2,161.56"	$0.00	"$2,268.76"	"$1,276.18"	"$1,276.18"	$0.00	$0.00	$0.00	$608.81	"$2,167.98"	"$2,167.98"	$0.00	$0.00	$608.74	$0.00	"$1,440.07"	"$1,440.07"	$0.00	"$1,417.98"	"$2,246.07"	"$2,268.76"	$0.00		$0.00	$430.90	$0.00	$0.00	$451.48	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.007	SUP	HCPCS C1713		04.110.007  -  PLATE BONE 7 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL	BOTH IP/OP	"$2,992.73 "	"$2,214.62"	$0.00	"$2,324.44"	"$1,307.50"	"$1,307.50"	$0.00	$0.00	$0.00	$623.76	"$2,221.20"	"$2,221.20"	$0.00	$0.00	$623.68	$0.00	"$1,475.41"	"$1,475.41"	$0.00	"$1,452.78"	"$2,301.20"	"$2,324.44"	$0.00		$0.00	$441.47	$0.00	$0.00	$462.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.009	SUP	HCPCS C1713		04.110.009  -  PLATE BONE 9 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL	BOTH IP/OP	"$3,063.00 "	"$2,266.62"	$0.00	"$2,379.04"	"$1,338.21"	"$1,338.21"	$0.00	$0.00	$0.00	$638.41	"$2,273.36"	"$2,273.36"	$0.00	$0.00	$638.33	$0.00	"$1,510.06"	"$1,510.06"	$0.00	"$1,486.90"	"$2,355.25"	"$2,379.04"	$0.00		$0.00	$451.84	$0.00	$0.00	$473.43	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.011	SUP	HCPCS C1713		04.110.011  -  PLATE BONE 11 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL	BOTH IP/OP	"$3,251.38 "	"$2,406.02"	$0.00	"$2,525.34"	"$1,420.50"	"$1,420.50"	$0.00	$0.00	$0.00	$677.67	"$2,413.17"	"$2,413.17"	$0.00	$0.00	$677.59	$0.00	"$1,602.93"	"$1,602.93"	$0.00	"$1,578.34"	"$2,500.09"	"$2,525.34"	$0.00		$0.00	$479.63	$0.00	$0.00	$502.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.013S	SUP	HCPCS C1713		04.110.013S  -  PLATE BONE 13 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL	BOTH IP/OP	"$3,497.38 "	"$2,588.06"	$0.00	"$2,716.40"	"$1,527.98"	"$1,527.98"	$0.00	$0.00	$0.00	$728.94	"$2,595.75"	"$2,595.75"	$0.00	$0.00	$728.85	$0.00	"$1,724.21"	"$1,724.21"	$0.00	"$1,697.75"	"$2,689.24"	"$2,716.40"	$0.00		$0.00	$515.92	$0.00	$0.00	$540.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.015S	SUP	HCPCS C1713		04.110.015S  -  PLATE BONE 15 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL	BOTH IP/OP	"$3,611.23 "	"$2,672.31"	$0.00	"$2,804.84"	"$1,577.72"	"$1,577.72"	$0.00	$0.00	$0.00	$752.67	"$2,680.25"	"$2,680.25"	$0.00	$0.00	$752.58	$0.00	"$1,780.33"	"$1,780.33"	$0.00	"$1,753.03"	"$2,776.79"	"$2,804.84"	$0.00		$0.00	$532.71	$0.00	$0.00	$558.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.105	SUP	HCPCS C1713		04.110.105  -  PLATE BONE 5 HOLE LCP TITANIUM LEFT DISTAL RADIAL NONSTRL	BOTH IP/OP	"$2,921.03 "	"$2,161.56"	$0.00	"$2,268.76"	"$1,276.18"	"$1,276.18"	$0.00	$0.00	$0.00	$608.81	"$2,167.98"	"$2,167.98"	$0.00	$0.00	$608.74	$0.00	"$1,440.07"	"$1,440.07"	$0.00	"$1,417.98"	"$2,246.07"	"$2,268.76"	$0.00		$0.00	$430.90	$0.00	$0.00	$451.48	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.107	SUP	HCPCS C1713		04.110.107  -  PLATE BONE 7 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL	BOTH IP/OP	"$2,992.73 "	"$2,214.62"	$0.00	"$2,324.44"	"$1,307.50"	"$1,307.50"	$0.00	$0.00	$0.00	$623.76	"$2,221.20"	"$2,221.20"	$0.00	$0.00	$623.68	$0.00	"$1,475.41"	"$1,475.41"	$0.00	"$1,452.78"	"$2,301.20"	"$2,324.44"	$0.00		$0.00	$441.47	$0.00	$0.00	$462.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.109	SUP	HCPCS C1713		04.110.109  -  PLATE BONE 9 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL	BOTH IP/OP	"$3,063.00 "	"$2,266.62"	$0.00	"$2,379.04"	"$1,338.21"	"$1,338.21"	$0.00	$0.00	$0.00	$638.41	"$2,273.36"	"$2,273.36"	$0.00	$0.00	$638.33	$0.00	"$1,510.06"	"$1,510.06"	$0.00	"$1,486.90"	"$2,355.25"	"$2,379.04"	$0.00		$0.00	$451.84	$0.00	$0.00	$473.43	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.111	SUP	HCPCS C1713		04.110.111  -  PLATE BONE 11 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL	BOTH IP/OP	"$3,251.38 "	"$2,406.02"	$0.00	"$2,525.34"	"$1,420.50"	"$1,420.50"	$0.00	$0.00	$0.00	$677.67	"$2,413.17"	"$2,413.17"	$0.00	$0.00	$677.59	$0.00	"$1,602.93"	"$1,602.93"	$0.00	"$1,578.34"	"$2,500.09"	"$2,525.34"	$0.00		$0.00	$479.63	$0.00	$0.00	$502.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.113S	SUP	HCPCS C1713		04.110.113S  -  PLATE BONE 13 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL	BOTH IP/OP	"$3,497.38 "	"$2,588.06"	$0.00	"$2,716.40"	"$1,527.98"	"$1,527.98"	$0.00	$0.00	$0.00	$728.94	"$2,595.75"	"$2,595.75"	$0.00	$0.00	$728.85	$0.00	"$1,724.21"	"$1,724.21"	$0.00	"$1,697.75"	"$2,689.24"	"$2,716.40"	$0.00		$0.00	$515.92	$0.00	$0.00	$540.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.115S	SUP	HCPCS C1713		04.110.115S  -  PLATE BONE 15 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL	BOTH IP/OP	"$3,611.23 "	"$2,672.31"	$0.00	"$2,804.84"	"$1,577.72"	"$1,577.72"	$0.00	$0.00	$0.00	$752.67	"$2,680.25"	"$2,680.25"	$0.00	$0.00	$752.58	$0.00	"$1,780.33"	"$1,780.33"	$0.00	"$1,753.03"	"$2,776.79"	"$2,804.84"	$0.00		$0.00	$532.71	$0.00	$0.00	$558.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.150	SUP	HCPCS C1713		04.110.150  -  PLATE BONE STANDARD BEND 118MM FUSION LCP TITANIUM WRIST	BOTH IP/OP	"$3,145.95 "	"$2,328.00"	$0.00	"$2,443.44"	"$1,374.44"	"$1,374.44"	$0.00	$0.00	$0.00	$655.69	"$2,334.92"	"$2,334.92"	$0.00	$0.00	$655.62	$0.00	"$1,550.95"	"$1,550.95"	$0.00	"$1,527.15"	"$2,419.01"	"$2,443.44"	$0.00		$0.00	$464.08	$0.00	$0.00	$486.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.151	SUP	HCPCS C1713		04.110.151  -  PLATE BN SHRT BND 118MM NS LCP FSN TI WRST	BOTH IP/OP	"$3,145.95 "	"$2,328.00"	$0.00	"$2,443.44"	"$1,374.44"	"$1,374.44"	$0.00	$0.00	$0.00	$655.69	"$2,334.92"	"$2,334.92"	$0.00	$0.00	$655.62	$0.00	"$1,550.95"	"$1,550.95"	$0.00	"$1,527.15"	"$2,419.01"	"$2,443.44"	$0.00		$0.00	$464.08	$0.00	$0.00	$486.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.152	SUP	HCPCS C1713		04.110.152  -  PLATE BONE 112MM STR FUSION LCP TITANIUM WRIST NONSTRL	BOTH IP/OP	"$3,145.95 "	"$2,328.00"	$0.00	"$2,443.44"	"$1,374.44"	"$1,374.44"	$0.00	$0.00	$0.00	$655.69	"$2,334.92"	"$2,334.92"	$0.00	$0.00	$655.62	$0.00	"$1,550.95"	"$1,550.95"	$0.00	"$1,527.15"	"$2,419.01"	"$2,443.44"	$0.00		$0.00	$464.08	$0.00	$0.00	$486.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.201	SUP	HCPCS C1713		04.110.201  -  PLATE BONE 5X3 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.202	SUP	HCPCS C1713		04.110.202  -  PLATE BONE 5X5 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.203	SUP	HCPCS C1713		04.110.203  -  PLATE BONE 4X3 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.204	SUP	HCPCS C1713		04.110.204  -  PLATE BONE 5X5 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.205	SUP	HCPCS C1713		04.110.205  -  PLATE BONE 4X3 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.206	SUP	HCPCS C1713		04.110.206  -  PLATE BONE 4X5 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.207	SUP	HCPCS C1713		04.110.207  -  PLATE BONE 4X3 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.208	SUP	HCPCS C1713		04.110.208  -  PLATE BONE 4X5 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.300	SUP	Custom 27203010		04.110.300  -  WIRE FIX 1.8MM 150MM TROCAR POINT DEPTH MARKING KWIRE	BOTH IP/OP	$20.10 	$14.87	$0.00	$15.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.92	$14.92	$0.00	$0.00	$4.19	$0.00	$0.00	$0.00	$0.00	$9.76	$15.46	$15.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.330	SUP	HCPCS C1713		04.110.330  -  PLATE BONE 50.5MM 9X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL	BOTH IP/OP	"$1,524.43 "	"$1,128.08"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$317.73	"$1,131.43"	"$1,131.43"	$0.00	$0.00	$317.69	$0.00	$901.70	$901.70	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.331	SUP	HCPCS C1713		04.110.331  -  PLATE BONE 50.5MM 9X3 HOLE COLUMN LCP TITANIUM LEFT DISTAL	BOTH IP/OP	"$1,524.43 "	"$1,128.08"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$317.73	"$1,131.43"	"$1,131.43"	$0.00	$0.00	$317.69	$0.00	$901.70	$901.70	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.340	SUP	HCPCS C1713		04.110.340  -  PLATE BONE 59.5MM 9X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL	BOTH IP/OP	"$1,572.20 "	"$1,163.43"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$327.69	"$1,166.89"	"$1,166.89"	$0.00	$0.00	$327.65	$0.00	$929.96	$929.96	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.341	SUP	HCPCS C1713		04.110.341  -  PLATE BONE 59.5MM 9X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL	BOTH IP/OP	"$1,572.20 "	"$1,163.43"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$327.69	"$1,166.89"	"$1,166.89"	$0.00	$0.00	$327.65	$0.00	$929.96	$929.96	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.350	SUP	HCPCS C1713		04.110.350  -  PLATE BONE 68.5MM 9X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL	BOTH IP/OP	"$1,618.60 "	"$1,197.76"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$337.36	"$1,201.32"	"$1,201.32"	$0.00	$0.00	$337.32	$0.00	$957.40	$957.40	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.351	SUP	HCPCS C1713		04.110.351  -  PLATE BONE 68.5MM 9X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL	BOTH IP/OP	"$1,618.60 "	"$1,197.76"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$337.36	"$1,201.32"	"$1,201.32"	$0.00	$0.00	$337.32	$0.00	$957.40	$957.40	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.430	SUP	HCPCS C1713		04.110.430  -  PLATE BONE 50.5MM 8X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL	BOTH IP/OP	"$1,524.43 "	"$1,128.08"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$317.73	"$1,131.43"	"$1,131.43"	$0.00	$0.00	$317.69	$0.00	$901.70	$901.70	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.431	SUP	HCPCS C1713		04.110.431  -  PLATE BN 50.5MM NS LCP CMBN 8 HLE/HD 3 HL SHFT CLMN RND EDG	BOTH IP/OP	"$1,524.43 "	"$1,128.08"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$317.73	"$1,131.43"	"$1,131.43"	$0.00	$0.00	$317.69	$0.00	$901.70	$901.70	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.440	SUP	HCPCS C1713		04.110.440  -  PLATE BONE 59.5MM 8X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL	BOTH IP/OP	"$1,572.20 "	"$1,163.43"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$327.69	"$1,166.89"	"$1,166.89"	$0.00	$0.00	$327.65	$0.00	$929.96	$929.96	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.441	SUP	HCPCS C1713		04.110.441  -  PLATE BONE 59.5MM 8X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL	BOTH IP/OP	"$1,572.20 "	"$1,163.43"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$327.69	"$1,166.89"	"$1,166.89"	$0.00	$0.00	$327.65	$0.00	$929.96	$929.96	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.450	SUP	HCPCS C1713		04.110.450  -  PLATE BONE 68.5MM 8X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL	BOTH IP/OP	"$1,618.60 "	"$1,197.76"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$337.36	"$1,201.32"	"$1,201.32"	$0.00	$0.00	$337.32	$0.00	$957.40	$957.40	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.451	SUP	HCPCS C1713		04.110.451  -  PLATE BONE 68.5MM 8X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL	BOTH IP/OP	"$1,618.60 "	"$1,197.76"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$337.36	"$1,201.32"	"$1,201.32"	$0.00	$0.00	$337.32	$0.00	$957.40	$957.40	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.730	SUP	HCPCS C1713		04.110.730  -  PLATE BONE 45MM 6X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL	BOTH IP/OP	"$1,524.43 "	"$1,128.08"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$317.73	"$1,131.43"	"$1,131.43"	$0.00	$0.00	$317.69	$0.00	$901.70	$901.70	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.731	SUP	HCPCS C1713		04.110.731  -  PLATE BONE 45MM 6X3 HOLE COLUMN LCP TITANIUM LEFT DISTAL	BOTH IP/OP	"$1,524.43 "	"$1,128.08"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$317.73	"$1,131.43"	"$1,131.43"	$0.00	$0.00	$317.69	$0.00	$901.70	$901.70	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.740	SUP	HCPCS C1713		04.110.740  -  PLATE BONE 54MM 6X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL	BOTH IP/OP	"$1,572.20 "	"$1,163.43"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$327.69	"$1,166.89"	"$1,166.89"	$0.00	$0.00	$327.65	$0.00	$929.96	$929.96	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.741	SUP	HCPCS C1713		04.110.741  -  PLATE BONE 54MM 6X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL	BOTH IP/OP	"$1,572.20 "	"$1,163.43"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$327.69	"$1,166.89"	"$1,166.89"	$0.00	$0.00	$327.65	$0.00	$929.96	$929.96	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.750	SUP	HCPCS C1713		04.110.750  -  PLATE BONE 63MM 6X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL	BOTH IP/OP	"$1,618.60 "	"$1,197.76"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$337.36	"$1,201.32"	"$1,201.32"	$0.00	$0.00	$337.32	$0.00	$957.40	$957.40	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.751	SUP	HCPCS C1713		04.110.751  -  PLATE BONE 63MM 6X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL	BOTH IP/OP	"$1,618.60 "	"$1,197.76"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$337.36	"$1,201.32"	"$1,201.32"	$0.00	$0.00	$337.32	$0.00	$957.40	$957.40	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.830	SUP	HCPCS C1713		04.110.830  -  PLATE BONE 45MM 7X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL	BOTH IP/OP	"$1,524.43 "	"$1,128.08"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$317.73	"$1,131.43"	"$1,131.43"	$0.00	$0.00	$317.69	$0.00	$901.70	$901.70	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.831	SUP	HCPCS C1713		04.110.831  -  PLATE BONE 45MM 7X3 HOLE COLUMN LCP TITANIUM LEFT VOLAR	BOTH IP/OP	"$1,524.43 "	"$1,128.08"	$0.00	"$1,219.54"	$685.99	$685.99	$0.00	$0.00	$0.00	$317.73	"$1,131.43"	"$1,131.43"	$0.00	$0.00	$317.69	$0.00	$901.70	$901.70	$0.00	$762.21	"$1,207.35"	"$1,219.54"	$0.00		$0.00	$231.62	$0.00	$0.00	$242.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.840	SUP	HCPCS C1713		04.110.840  -  PLATE BONE 54MM 7X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL	BOTH IP/OP	"$1,572.20 "	"$1,163.43"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$327.69	"$1,166.89"	"$1,166.89"	$0.00	$0.00	$327.65	$0.00	$929.96	$929.96	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.841	SUP	HCPCS C1713		04.110.841  -  PLATE BONE 54MM 7X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL	BOTH IP/OP	"$1,572.20 "	"$1,163.43"	$0.00	"$1,257.76"	$707.49	$707.49	$0.00	$0.00	$0.00	$327.69	"$1,166.89"	"$1,166.89"	$0.00	$0.00	$327.65	$0.00	$929.96	$929.96	$0.00	$786.10	"$1,245.18"	"$1,257.76"	$0.00		$0.00	$238.88	$0.00	$0.00	$250.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.850	SUP	HCPCS C1713		04.110.850  -  PLATE BONE 63MM 7X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL	BOTH IP/OP	"$1,618.60 "	"$1,197.76"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$337.36	"$1,201.32"	"$1,201.32"	$0.00	$0.00	$337.32	$0.00	$957.40	$957.40	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.110.851	SUP	HCPCS C1713		04.110.851  -  PLATE BONE 63MM 7X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL	BOTH IP/OP	"$1,618.60 "	"$1,197.76"	$0.00	"$1,294.88"	$728.37	$728.37	$0.00	$0.00	$0.00	$337.36	"$1,201.32"	"$1,201.32"	$0.00	$0.00	$337.32	$0.00	$957.40	$957.40	$0.00	$809.30	"$1,281.93"	"$1,294.88"	$0.00		$0.00	$245.93	$0.00	$0.00	$257.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.520	SUP	HCPCS C1713		04.111.520  -  PLATE BONE NARROW 42MM 6X2 HOLE 2 COLUMN VAR ANG LCP	BOTH IP/OP	"$1,802.10 "	"$1,333.55"	$0.00	"$1,399.68"	$787.32	$787.32	$0.00	$0.00	$0.00	$375.60	"$1,337.52"	"$1,337.52"	$0.00	$0.00	$375.56	$0.00	"$1,065.94"	"$1,065.94"	$0.00	$874.80	"$1,385.68"	"$1,399.68"	$0.00		$0.00	$265.84	$0.00	$0.00	$278.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.521	SUP	HCPCS C1713		04.111.521  -  PLATE BONE NARROW 42MM 6X2 HOLE 2 COLUMN VAR ANG LCP	BOTH IP/OP	"$1,802.10 "	"$1,333.55"	$0.00	"$1,399.68"	$787.32	$787.32	$0.00	$0.00	$0.00	$375.60	"$1,337.52"	"$1,337.52"	$0.00	$0.00	$375.56	$0.00	"$1,065.94"	"$1,065.94"	$0.00	$874.80	"$1,385.68"	"$1,399.68"	$0.00		$0.00	$265.84	$0.00	$0.00	$278.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.530	SUP	HCPCS C1713		04.111.530  -  PLATE BONE NARROW 51MM 6X3 HOLE 2 COLUMN VAR ANG LCP	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.531	SUP	HCPCS C1713		04.111.531  -  PLATE BONE NARROW 51MM 6X3 HOLE 2 COLUMN VAR ANG LCP	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.540	SUP	HCPCS C1713		04.111.540  -  PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG LCP	BOTH IP/OP	"$1,944.08 "	"$1,438.62"	$0.00	"$1,509.96"	$849.35	$849.35	$0.00	$0.00	$0.00	$405.19	"$1,442.89"	"$1,442.89"	$0.00	$0.00	$405.15	$0.00	"$1,149.92"	"$1,149.92"	$0.00	$943.73	"$1,494.86"	"$1,509.96"	$0.00		$0.00	$286.78	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.541	SUP	HCPCS C1713		04.111.541  -  PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG LCP	BOTH IP/OP	"$1,944.08 "	"$1,438.62"	$0.00	"$1,509.96"	$849.35	$849.35	$0.00	$0.00	$0.00	$405.19	"$1,442.89"	"$1,442.89"	$0.00	$0.00	$405.15	$0.00	"$1,149.92"	"$1,149.92"	$0.00	$943.73	"$1,494.86"	"$1,509.96"	$0.00		$0.00	$286.78	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.550	SUP	HCPCS C1713		04.111.550  -  PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG LCP	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.551	SUP	HCPCS C1713		04.111.551  -  PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG LCP	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.620	SUP	HCPCS C1713		04.111.620  -  PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,802.10 "	"$1,333.55"	$0.00	"$1,399.68"	$787.32	$787.32	$0.00	$0.00	$0.00	$375.60	"$1,337.52"	"$1,337.52"	$0.00	$0.00	$375.56	$0.00	"$1,065.94"	"$1,065.94"	$0.00	$874.80	"$1,385.68"	"$1,399.68"	$0.00		$0.00	$265.84	$0.00	$0.00	$278.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.621	SUP	HCPCS C1713		04.111.621  -  PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,802.10 "	"$1,333.55"	$0.00	"$1,399.68"	$787.32	$787.32	$0.00	$0.00	$0.00	$375.60	"$1,337.52"	"$1,337.52"	$0.00	$0.00	$375.56	$0.00	"$1,065.94"	"$1,065.94"	$0.00	$874.80	"$1,385.68"	"$1,399.68"	$0.00		$0.00	$265.84	$0.00	$0.00	$278.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.630	SUP	HCPCS C1713		04.111.630  -  PLATE BN STD 54MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.631	SUP	HCPCS C1713		04.111.631  -  PLATE BONE 54MM 6X3 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.640	SUP	HCPCS C1713		04.111.640  -  PLATE BONE 70MM 6X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM LEFT	BOTH IP/OP	"$1,944.08 "	"$1,438.62"	$0.00	"$1,509.96"	$849.35	$849.35	$0.00	$0.00	$0.00	$405.19	"$1,442.89"	"$1,442.89"	$0.00	$0.00	$405.15	$0.00	"$1,149.92"	"$1,149.92"	$0.00	$943.73	"$1,494.86"	"$1,509.96"	$0.00		$0.00	$286.78	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.641	SUP	HCPCS C1713		04.111.641  -  PLATE BONE 70MM 6X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM RIGHT	BOTH IP/OP	"$1,944.08 "	"$1,438.62"	$0.00	"$1,509.96"	$849.35	$849.35	$0.00	$0.00	$0.00	$405.19	"$1,442.89"	"$1,442.89"	$0.00	$0.00	$405.15	$0.00	"$1,149.92"	"$1,149.92"	$0.00	$943.73	"$1,494.86"	"$1,509.96"	$0.00		$0.00	$286.78	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.650	SUP	HCPCS C1713		04.111.650  -  PLATE BONE 75MM 6X5 HOLE 2 COLUMN VAR ANG LCP TITANIUM RIGHT	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.651	SUP	HCPCS C1713		04.111.651  -  PLATE BONE 75MM 6X5 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.720	SUP	HCPCS C1713		04.111.720  -  PLATE BN STD 47MM NS LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA	BOTH IP/OP	"$1,802.10 "	"$1,333.55"	$0.00	"$1,399.68"	$787.32	$787.32	$0.00	$0.00	$0.00	$375.60	"$1,337.52"	"$1,337.52"	$0.00	$0.00	$375.56	$0.00	"$1,065.94"	"$1,065.94"	$0.00	$874.80	"$1,385.68"	"$1,399.68"	$0.00		$0.00	$265.84	$0.00	$0.00	$278.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.721	SUP	HCPCS C1713		04.111.721  -  PLATE BONE 49MM 7X2 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT	BOTH IP/OP	"$1,802.10 "	"$1,333.55"	$0.00	"$1,399.68"	$787.32	$787.32	$0.00	$0.00	$0.00	$375.60	"$1,337.52"	"$1,337.52"	$0.00	$0.00	$375.56	$0.00	"$1,065.94"	"$1,065.94"	$0.00	$874.80	"$1,385.68"	"$1,399.68"	$0.00		$0.00	$265.84	$0.00	$0.00	$278.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.730	SUP	HCPCS C1713		04.111.730  -  PLATE BONE 55MM 7X3 HOLE 2 COLUMN VAR ANG LCP TITANIUM RIGHT	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.731	SUP	HCPCS C1713		04.111.731  -  PLATE BONE 55MM 7X3 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT	BOTH IP/OP	"$1,873.80 "	"$1,386.61"	$0.00	"$1,455.36"	$818.64	$818.64	$0.00	$0.00	$0.00	$390.55	"$1,390.73"	"$1,390.73"	$0.00	$0.00	$390.50	$0.00	"$1,108.35"	"$1,108.35"	$0.00	$909.60	"$1,440.81"	"$1,455.36"	$0.00		$0.00	$276.41	$0.00	$0.00	$289.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.740	SUP	HCPCS C1713		04.111.740  -  PLATE BONE 70MM 7X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM RIGHT	BOTH IP/OP	"$1,944.08 "	"$1,438.62"	$0.00	"$1,509.96"	$849.35	$849.35	$0.00	$0.00	$0.00	$405.19	"$1,442.89"	"$1,442.89"	$0.00	$0.00	$405.15	$0.00	"$1,149.92"	"$1,149.92"	$0.00	$943.73	"$1,494.86"	"$1,509.96"	$0.00		$0.00	$286.78	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.741	SUP	HCPCS C1713		04.111.741  -  PLATE BONE 70MM 7X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM LEFT	BOTH IP/OP	"$1,944.08 "	"$1,438.62"	$0.00	"$1,509.96"	$849.35	$849.35	$0.00	$0.00	$0.00	$405.19	"$1,442.89"	"$1,442.89"	$0.00	$0.00	$405.15	$0.00	"$1,149.92"	"$1,149.92"	$0.00	$943.73	"$1,494.86"	"$1,509.96"	$0.00		$0.00	$286.78	$0.00	$0.00	$300.48	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.750	SUP	HCPCS C1713		04.111.750  -  PLATE BONE 77MM 7X5 HOLE 2 COLUMN VAR ANG LCP TITANIUM RIGHT	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.111.751	SUP	HCPCS C1713		04.111.751  -  PLATE BONE 77MM 7X5 HOLE 2 COLUMN VARIABLE LCP TITANIUM LEFT	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.006	SUP	HCPCS C1713		04.112.006  -  PLATE BONE 69MM 3 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,623.58 "	"$1,201.45"	$0.00	"$1,261.02"	$709.32	$709.32	$0.00	$0.00	$0.00	$338.39	"$1,205.02"	"$1,205.02"	$0.00	$0.00	$338.35	$0.00	$960.34	$960.34	$0.00	$788.14	"$1,248.41"	"$1,261.02"	$0.00		$0.00	$239.50	$0.00	$0.00	$250.94	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.007	SUP	HCPCS C1713		04.112.007  -  PLATE BONE 69MM 3 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,623.58 "	"$1,201.45"	$0.00	"$1,261.02"	$709.32	$709.32	$0.00	$0.00	$0.00	$338.39	"$1,205.02"	"$1,205.02"	$0.00	$0.00	$338.35	$0.00	$960.34	$960.34	$0.00	$788.14	"$1,248.41"	"$1,261.02"	$0.00		$0.00	$239.50	$0.00	$0.00	$250.94	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.008	SUP	HCPCS C1713		04.112.008  -  PLATE BONE 108MM 6 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.009	SUP	HCPCS C1713		04.112.009  -  PLATE BONE 108MM 6 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.010	SUP	HCPCS C1713		04.112.010  -  PLATE BONE 81MM 4 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,648.88 "	"$1,220.17"	$0.00	"$1,280.68"	$720.38	$720.38	$0.00	$0.00	$0.00	$343.67	"$1,223.80"	"$1,223.80"	$0.00	$0.00	$343.63	$0.00	$975.31	$975.31	$0.00	$800.43	"$1,267.87"	"$1,280.68"	$0.00		$0.00	$243.24	$0.00	$0.00	$254.86	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.011	SUP	HCPCS C1713		04.112.011  -  PLATE BONE 81MM 4 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,648.88 "	"$1,220.17"	$0.00	"$1,280.68"	$720.38	$720.38	$0.00	$0.00	$0.00	$343.67	"$1,223.80"	"$1,223.80"	$0.00	$0.00	$343.63	$0.00	$975.31	$975.31	$0.00	$800.43	"$1,267.87"	"$1,280.68"	$0.00		$0.00	$243.24	$0.00	$0.00	$254.86	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.012	SUP	HCPCS C1713		04.112.012  -  PLATE BONE 94MM 5 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,677.00 "	"$1,240.98"	$0.00	"$1,302.52"	$732.67	$732.67	$0.00	$0.00	$0.00	$349.53	"$1,244.67"	"$1,244.67"	$0.00	$0.00	$349.49	$0.00	$991.95	$991.95	$0.00	$814.08	"$1,289.49"	"$1,302.52"	$0.00		$0.00	$247.38	$0.00	$0.00	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.013	SUP	HCPCS C1713		04.112.013  -  PLATE BONE 94MM 5 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,677.00 "	"$1,240.98"	$0.00	"$1,302.52"	$732.67	$732.67	$0.00	$0.00	$0.00	$349.53	"$1,244.67"	"$1,244.67"	$0.00	$0.00	$349.49	$0.00	$991.95	$991.95	$0.00	$814.08	"$1,289.49"	"$1,302.52"	$0.00		$0.00	$247.38	$0.00	$0.00	$259.20	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.018	SUP	HCPCS C1713		04.112.018  -  PLATE BONE 123MM 7 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.019	SUP	HCPCS C1713		04.112.019  -  PLATE BONE 123MM 7 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.020	SUP	HCPCS C1713		04.112.020  -  PLATE BONE 135MM 8 HOLE LATERAL EXTN LCP TITANIUM RIGHT	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.021	SUP	HCPCS C1713		04.112.021  -  PLATE BONE 135MM 8 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.026	SUP	HCPCS C1713		04.112.026  -  PLATE BN 94MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.027	SUP	HCPCS C1713		04.112.027  -  PLATE BONE 94MM 6 HOLE LCP TITANIUM LEFT SUPERIOR ANTERIOR	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.028	SUP	HCPCS C1713		04.112.028  -  PLATE BONE 110MM 7 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.029	SUP	HCPCS C1713		04.112.029  -  PLATE BONE 110MM 7 HOLE LCP TITANIUM LEFT SUPERIOR ANTERIOR	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.030	SUP	HCPCS C1713		04.112.030  -  PLATE BONE 120MM 8 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.031	SUP	HCPCS C1713		04.112.031  -  PLATE BONE 120MM 8 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.040S	SUP	HCPCS C1713		04.112.040S  -  PLATE BONE 79MM 6 HOLE LCP TITANIUM MEDIAL ANTERIOR CLAVICLE	BOTH IP/OP	"$1,876.60 "	"$1,388.68"	$0.00	"$1,457.56"	$819.88	$819.88	$0.00	$0.00	$0.00	$391.13	"$1,392.81"	"$1,392.81"	$0.00	$0.00	$391.08	$0.00	"$1,110.01"	"$1,110.01"	$0.00	$910.98	"$1,442.98"	"$1,457.56"	$0.00		$0.00	$276.83	$0.00	$0.00	$290.05	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.041	SUP	HCPCS C1713		04.112.041  -  PLATE BONE 91MM 7 HOLE LCP TITANIUM MEDIAL ANTERIOR CLAVICLE	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.042	SUP	HCPCS C1713		04.112.042  -  PLATE BONE 102MM 8 HOLE LCP TITANIUM MEDIAL ANTERIOR	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.045	SUP	HCPCS C1713		04.112.045  -  PLATE BONE 77MM 7 HOLE VAR ANG LCP TITANIUM LATERAL ANTERIOR	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.046	SUP	HCPCS C1713		04.112.046  -  PLATE BONE 89MM 9 HOLE VAR ANG LCP TITANIUM LATERAL ANTERIOR	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.047	SUP	HCPCS C1713		04.112.047  -  PLATE BONE 101MM 10 HOLE VAR ANG LCP TITANIUM LATERAL	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.048S	SUP	HCPCS C1713		04.112.048S  -  PLATE BONE 113MM 11 HOLE VAR ANG LCP TITANIUM LATERAL	BOTH IP/OP	"$1,876.60 "	"$1,388.68"	$0.00	"$1,457.56"	$819.88	$819.88	$0.00	$0.00	$0.00	$391.13	"$1,392.81"	"$1,392.81"	$0.00	$0.00	$391.08	$0.00	"$1,110.01"	"$1,110.01"	$0.00	$910.98	"$1,442.98"	"$1,457.56"	$0.00		$0.00	$276.83	$0.00	$0.00	$290.05	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.049S	SUP	HCPCS C1713		04.112.049S  -  PLATE BONE 124MM 12 HOLE VAR ANG LCP TITANIUM LATERAL	BOTH IP/OP	"$1,876.60 "	"$1,388.68"	$0.00	"$1,457.56"	$819.88	$819.88	$0.00	$0.00	$0.00	$391.13	"$1,392.81"	"$1,392.81"	$0.00	$0.00	$391.08	$0.00	"$1,110.01"	"$1,110.01"	$0.00	$910.98	"$1,442.98"	"$1,457.56"	$0.00		$0.00	$276.83	$0.00	$0.00	$290.05	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.080	SUP	HCPCS C1713		04.112.080  -  PLATE BONE 85MM 6 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.081	SUP	HCPCS C1713		04.112.081  -  PLATE BONE 85MM 6 HOLE LCP TITANIUM LEFT SUPERIOR ANTERIOR	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.082	SUP	HCPCS C1713		04.112.082  -  PLATE BONE 100MM 7 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.083	SUP	HCPCS C1713		04.112.083  -  PLATE BONE 100MM 7 HOLE LCP TITANIUM LEFT SUPERIOR CLAVICLE	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.084	SUP	HCPCS C1713		04.112.084  -  PLATE BONE 115MM 8 HOLE LCP TITANIUM RIGHT SUPERIOR CLAVICLE	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.085	SUP	HCPCS C1713		04.112.085  -  PLATE BONE 115MM 8 HOLE LCP TITANIUM LEFT SUPERIOR CLAVICLE	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.090	SUP	HCPCS C1713		04.112.090  -  PLATE BONE 105MM 6 HOLE LATERAL EXTN LCP TITANIUM RIGHT	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.091	SUP	HCPCS C1713		04.112.091  -  PLATE BN 105MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT	BOTH IP/OP	"$1,695.28 "	"$1,254.51"	$0.00	"$1,316.72"	$740.66	$740.66	$0.00	$0.00	$0.00	$353.34	"$1,258.23"	"$1,258.23"	$0.00	$0.00	$353.30	$0.00	"$1,002.76"	"$1,002.76"	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$250.08	$0.00	$0.00	$262.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.092	SUP	HCPCS C1713		04.112.092  -  PLATE BONE 120MM 7 HOLE LATERAL EXTN LCP TITANIUM RIGHT	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.093	SUP	HCPCS C1713		04.112.093  -  PLATE BONE 120MM 7 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,740.25 "	"$1,287.79"	$0.00	"$1,351.64"	$760.30	$760.30	$0.00	$0.00	$0.00	$362.71	"$1,291.61"	"$1,291.61"	$0.00	$0.00	$362.67	$0.00	"$1,029.36"	"$1,029.36"	$0.00	$844.78	"$1,338.12"	"$1,351.64"	$0.00		$0.00	$256.71	$0.00	$0.00	$268.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.094	SUP	HCPCS C1713		04.112.094  -  PLATE BONE 130MM 8 HOLE LATERAL EXTN LCP TITANIUM RIGHT	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.095	SUP	HCPCS C1713		04.112.095  -  PLATE BONE 130MM 8 HOLE LATERAL EXTN LCP TITANIUM LEFT	BOTH IP/OP	"$1,785.23 "	"$1,321.07"	$0.00	"$1,386.58"	$779.95	$779.95	$0.00	$0.00	$0.00	$372.09	"$1,324.99"	"$1,324.99"	$0.00	$0.00	$372.04	$0.00	"$1,055.96"	"$1,055.96"	$0.00	$866.61	"$1,372.72"	"$1,386.58"	$0.00		$0.00	$263.35	$0.00	$0.00	$275.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.106	SUP	HCPCS C1713		04.112.106  -  PLATE BONE 73MM 3 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT	BOTH IP/OP	"$1,186.40 "	$877.94	$0.00	$921.48	$518.33	$518.33	$0.00	$0.00	$0.00	$247.28	$880.55	$880.55	$0.00	$0.00	$247.25	$0.00	$701.76	$701.76	$0.00	$575.93	$912.27	$921.48	$0.00		$0.00	$175.01	$0.00	$0.00	$183.37	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.107	SUP	HCPCS C1713		04.112.107  -  PLATE BONE 73MM 3 HOLE LCP TITANIUM LEFT DISTAL POSTLAT	BOTH IP/OP	"$1,186.40 "	$877.94	$0.00	$921.48	$518.33	$518.33	$0.00	$0.00	$0.00	$247.28	$880.55	$880.55	$0.00	$0.00	$247.25	$0.00	$701.76	$701.76	$0.00	$575.93	$912.27	$921.48	$0.00		$0.00	$175.01	$0.00	$0.00	$183.37	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.108	SUP	HCPCS C1713		04.112.108  -  PLATE BONE 86MM 4 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT	BOTH IP/OP	"$1,206.08 "	$892.50	$0.00	$936.76	$526.93	$526.93	$0.00	$0.00	$0.00	$251.38	$895.15	$895.15	$0.00	$0.00	$251.35	$0.00	$713.39	$713.39	$0.00	$585.48	$927.39	$936.76	$0.00		$0.00	$177.92	$0.00	$0.00	$186.42	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.109	SUP	HCPCS C1713		04.112.109  -  PLATE BONE 86MM 4 HOLE LCP TITANIUM LEFT DISTAL POSTLAT	BOTH IP/OP	"$1,206.08 "	$892.50	$0.00	$936.76	$526.93	$526.93	$0.00	$0.00	$0.00	$251.38	$895.15	$895.15	$0.00	$0.00	$251.35	$0.00	$713.39	$713.39	$0.00	$585.48	$927.39	$936.76	$0.00		$0.00	$177.92	$0.00	$0.00	$186.42	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.110	SUP	HCPCS C1713		04.112.110  -  PLATE BONE 99MM 5 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT	BOTH IP/OP	"$1,221.55 "	$903.95	$0.00	$948.78	$533.69	$533.69	$0.00	$0.00	$0.00	$254.60	$906.63	$906.63	$0.00	$0.00	$254.57	$0.00	$722.55	$722.55	$0.00	$592.99	$939.30	$948.78	$0.00		$0.00	$180.20	$0.00	$0.00	$188.81	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.111	SUP	HCPCS C1713		04.112.111  -  PLATE BONE 99MM 5 HOLE LCP TITANIUM LEFT DISTAL POSTLAT	BOTH IP/OP	"$1,221.55 "	$903.95	$0.00	$948.78	$533.69	$533.69	$0.00	$0.00	$0.00	$254.60	$906.63	$906.63	$0.00	$0.00	$254.57	$0.00	$722.55	$722.55	$0.00	$592.99	$939.30	$948.78	$0.00		$0.00	$180.20	$0.00	$0.00	$188.81	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.112	SUP	HCPCS C1713		04.112.112  -  PLATE BONE 112MM 6 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT	BOTH IP/OP	"$1,241.23 "	$918.51	$0.00	$964.06	$542.28	$542.28	$0.00	$0.00	$0.00	$258.70	$921.24	$921.24	$0.00	$0.00	$258.67	$0.00	$734.18	$734.18	$0.00	$602.54	$954.42	$964.06	$0.00		$0.00	$183.10	$0.00	$0.00	$191.85	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.113	SUP	HCPCS C1713		04.112.113  -  PLATE BONE 112MM 6 HOLE LCP TITANIUM LEFT DISTAL POSTLAT	BOTH IP/OP	"$1,241.23 "	$918.51	$0.00	$964.06	$542.28	$542.28	$0.00	$0.00	$0.00	$258.70	$921.24	$921.24	$0.00	$0.00	$258.67	$0.00	$734.18	$734.18	$0.00	$602.54	$954.42	$964.06	$0.00		$0.00	$183.10	$0.00	$0.00	$191.85	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.114	SUP	HCPCS C1713		04.112.114  -  PLATE BONE 125MM 7 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT	BOTH IP/OP	"$1,258.10 "	$930.99	$0.00	$977.16	$549.65	$549.65	$0.00	$0.00	$0.00	$262.22	$933.76	$933.76	$0.00	$0.00	$262.19	$0.00	$744.17	$744.17	$0.00	$610.73	$967.39	$977.16	$0.00		$0.00	$185.59	$0.00	$0.00	$194.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.115	SUP	HCPCS C1713		04.112.115  -  PLATE BONE 125MM 7 HOLE LCP TITANIUM LEFT DISTAL POSTLAT	BOTH IP/OP	"$1,258.10 "	$930.99	$0.00	$977.16	$549.65	$549.65	$0.00	$0.00	$0.00	$262.22	$933.76	$933.76	$0.00	$0.00	$262.19	$0.00	$744.17	$744.17	$0.00	$610.73	$967.39	$977.16	$0.00		$0.00	$185.59	$0.00	$0.00	$194.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.118	SUP	HCPCS C1713		04.112.118  -  PLATE BONE 151MM 9 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT	BOTH IP/OP	"$1,276.38 "	$944.52	$0.00	$991.36	$557.64	$557.64	$0.00	$0.00	$0.00	$266.03	$947.33	$947.33	$0.00	$0.00	$266.00	$0.00	$754.98	$754.98	$0.00	$619.60	$981.45	$991.36	$0.00		$0.00	$188.29	$0.00	$0.00	$197.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.119	SUP	HCPCS C1713		04.112.119  -  PLATE BONE 151MM 9 HOLE LCP TITANIUM LEFT DISTAL POSTLAT	BOTH IP/OP	"$1,276.38 "	$944.52	$0.00	$991.36	$557.64	$557.64	$0.00	$0.00	$0.00	$266.03	$947.33	$947.33	$0.00	$0.00	$266.00	$0.00	$754.98	$754.98	$0.00	$619.60	$981.45	$991.36	$0.00		$0.00	$188.29	$0.00	$0.00	$197.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.122	SUP	HCPCS C1713		04.112.122  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT	BOTH IP/OP	"$1,296.05 "	$959.08	$0.00	"$1,006.64"	$566.24	$566.24	$0.00	$0.00	$0.00	$270.13	$961.93	$961.93	$0.00	$0.00	$270.10	$0.00	$766.61	$766.61	$0.00	$629.15	$996.57	"$1,006.64"	$0.00		$0.00	$191.19	$0.00	$0.00	$200.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.123	SUP	HCPCS C1713		04.112.123  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM LEFT DISTAL POSTLAT	BOTH IP/OP	"$1,296.05 "	$959.08	$0.00	"$1,006.64"	$566.24	$566.24	$0.00	$0.00	$0.00	$270.13	$961.93	$961.93	$0.00	$0.00	$270.10	$0.00	$766.61	$766.61	$0.00	$629.15	$996.57	"$1,006.64"	$0.00		$0.00	$191.19	$0.00	$0.00	$200.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.126	SUP	HCPCS C1713		04.112.126  -  PLATE BONE 207MM 13 HOLE LCP TITANIUM RIGHT POSTLAT DISTAL	BOTH IP/OP	"$1,312.93 "	$971.57	$0.00	"$1,019.74"	$573.60	$573.60	$0.00	$0.00	$0.00	$273.65	$974.45	$974.45	$0.00	$0.00	$273.61	$0.00	$776.60	$776.60	$0.00	$637.34	"$1,009.55"	"$1,019.74"	$0.00		$0.00	$193.68	$0.00	$0.00	$202.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.127	SUP	HCPCS C1713		04.112.127  -  PLATE BONE 207MM 13 HOLE LCP TITANIUM LEFT POSTLAT DISTAL	BOTH IP/OP	"$1,312.93 "	$971.57	$0.00	"$1,019.74"	$573.60	$573.60	$0.00	$0.00	$0.00	$273.65	$974.45	$974.45	$0.00	$0.00	$273.61	$0.00	$776.60	$776.60	$0.00	$637.34	"$1,009.55"	"$1,019.74"	$0.00		$0.00	$193.68	$0.00	$0.00	$202.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.130	SUP	HCPCS C1713		04.112.130  -  PLATE BONE 233MM 15 HOLE LCP RIGHT POSTLAT DISTAL FIBULAR	BOTH IP/OP	"$1,329.78 "	$984.04	$0.00	"$1,032.84"	$580.97	$580.97	$0.00	$0.00	$0.00	$277.16	$986.96	$986.96	$0.00	$0.00	$277.13	$0.00	$786.56	$786.56	$0.00	$645.53	"$1,022.51"	"$1,032.84"	$0.00		$0.00	$196.16	$0.00	$0.00	$205.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.131	SUP	HCPCS C1713		04.112.131  -  PLATE BONE 233MM 15 HOLE LCP LEFT POSTLAT DISTAL FIBULAR	BOTH IP/OP	"$1,329.78 "	$984.04	$0.00	"$1,032.84"	$580.97	$580.97	$0.00	$0.00	$0.00	$277.16	$986.96	$986.96	$0.00	$0.00	$277.13	$0.00	$786.56	$786.56	$0.00	$645.53	"$1,022.51"	"$1,032.84"	$0.00		$0.00	$196.16	$0.00	$0.00	$205.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.136	SUP	HCPCS C1713		04.112.136  -  PLATE BONE 73MM 3 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR	BOTH IP/OP	"$1,147.05 "	$848.82	$0.00	$890.90	$501.13	$501.13	$0.00	$0.00	$0.00	$239.07	$851.34	$851.34	$0.00	$0.00	$239.05	$0.00	$678.48	$678.48	$0.00	$556.81	$881.99	$890.90	$0.00		$0.00	$169.21	$0.00	$0.00	$177.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.137	SUP	HCPCS C1713		04.112.137  -  PLATE BONE 73MM 3 HOLE LCP TITANIUM LEFT DISTAL FIBULA	BOTH IP/OP	"$1,147.05 "	$848.82	$0.00	$890.90	$501.13	$501.13	$0.00	$0.00	$0.00	$239.07	$851.34	$851.34	$0.00	$0.00	$239.05	$0.00	$678.48	$678.48	$0.00	$556.81	$881.99	$890.90	$0.00		$0.00	$169.21	$0.00	$0.00	$177.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.138	SUP	HCPCS C1713		04.112.138  -  PLATE BONE 86MM LCP TITANIUM RIGHT LEFT DISTAL LATERAL	BOTH IP/OP	"$1,166.73 "	$863.38	$0.00	$906.20	$509.74	$509.74	$0.00	$0.00	$0.00	$243.17	$865.94	$865.94	$0.00	$0.00	$243.15	$0.00	$690.12	$690.12	$0.00	$566.38	$897.14	$906.20	$0.00		$0.00	$172.11	$0.00	$0.00	$180.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.139	SUP	HCPCS C1713		04.112.139  -  PLATE BONE 86MM 4 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR	BOTH IP/OP	"$1,166.73 "	$863.38	$0.00	$906.20	$509.74	$509.74	$0.00	$0.00	$0.00	$243.17	$865.94	$865.94	$0.00	$0.00	$243.15	$0.00	$690.12	$690.12	$0.00	$566.38	$897.14	$906.20	$0.00		$0.00	$172.11	$0.00	$0.00	$180.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.140	SUP	HCPCS C1713		04.112.140  -  PLATE BONE 99MM 5 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR	BOTH IP/OP	"$1,182.18 "	$874.81	$0.00	$918.20	$516.49	$516.49	$0.00	$0.00	$0.00	$246.39	$877.41	$877.41	$0.00	$0.00	$246.37	$0.00	$699.26	$699.26	$0.00	$573.88	$909.02	$918.20	$0.00		$0.00	$174.39	$0.00	$0.00	$182.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.141	SUP	HCPCS C1713		04.112.141  -  PLATE BONE 99MM 5 HOLE LCP TITANIUM LEFT DISTAL FIBULAR	BOTH IP/OP	"$1,182.18 "	$874.81	$0.00	$918.20	$516.49	$516.49	$0.00	$0.00	$0.00	$246.39	$877.41	$877.41	$0.00	$0.00	$246.37	$0.00	$699.26	$699.26	$0.00	$573.88	$909.02	$918.20	$0.00		$0.00	$174.39	$0.00	$0.00	$182.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.142	SUP	HCPCS C1713		04.112.142  -  PLATE BONE 112MM 6 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR	BOTH IP/OP	"$1,200.45 "	$888.33	$0.00	$932.40	$524.48	$524.48	$0.00	$0.00	$0.00	$250.20	$890.97	$890.97	$0.00	$0.00	$250.17	$0.00	$710.07	$710.07	$0.00	$582.75	$923.08	$932.40	$0.00		$0.00	$177.09	$0.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.143	SUP	HCPCS C1713		04.112.143  -  PLATE BONE 112MM 6 HOLE LCP TITANIUM LEFT LATERAL DISTAL	BOTH IP/OP	"$1,200.45 "	$888.33	$0.00	$932.40	$524.48	$524.48	$0.00	$0.00	$0.00	$250.20	$890.97	$890.97	$0.00	$0.00	$250.17	$0.00	$710.07	$710.07	$0.00	$582.75	$923.08	$932.40	$0.00		$0.00	$177.09	$0.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.144	SUP	HCPCS C1713		04.112.144  -  PLATE BONE 125MM 7 HOLE LCP TITANIUM RIGHT LATERAL DISTAL	BOTH IP/OP	"$1,217.33 "	$900.82	$0.00	$945.50	$531.84	$531.84	$0.00	$0.00	$0.00	$253.72	$903.50	$903.50	$0.00	$0.00	$253.69	$0.00	$720.05	$720.05	$0.00	$590.94	$936.05	$945.50	$0.00		$0.00	$179.58	$0.00	$0.00	$188.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.145	SUP	HCPCS C1713		04.112.145  -  PLATE BONE 125MM 7 HOLE LCP TITANIUM LEFT LATERAL DISTAL	BOTH IP/OP	"$1,217.33 "	$900.82	$0.00	$945.50	$531.84	$531.84	$0.00	$0.00	$0.00	$253.72	$903.50	$903.50	$0.00	$0.00	$253.69	$0.00	$720.05	$720.05	$0.00	$590.94	$936.05	$945.50	$0.00		$0.00	$179.58	$0.00	$0.00	$188.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.148	SUP	HCPCS C1713		04.112.148  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM RIGHT LATERAL DISTAL	BOTH IP/OP	"$1,276.38 "	$944.52	$0.00	$991.36	$557.64	$557.64	$0.00	$0.00	$0.00	$266.03	$947.33	$947.33	$0.00	$0.00	$266.00	$0.00	$754.98	$754.98	$0.00	$619.60	$981.45	$991.36	$0.00		$0.00	$188.29	$0.00	$0.00	$197.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.149	SUP	HCPCS C1713		04.112.149  -  PLATE BONE 151MM 9 HOLE LCP TITANIUM LEFT LATERAL DISTAL	BOTH IP/OP	"$1,276.38 "	$944.52	$0.00	$991.36	$557.64	$557.64	$0.00	$0.00	$0.00	$266.03	$947.33	$947.33	$0.00	$0.00	$266.00	$0.00	$754.98	$754.98	$0.00	$619.60	$981.45	$991.36	$0.00		$0.00	$188.29	$0.00	$0.00	$197.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.152	SUP	HCPCS C1713		04.112.152  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM RIGHT LATERAL DISTAL	BOTH IP/OP	"$1,296.05 "	$959.08	$0.00	"$1,006.64"	$566.24	$566.24	$0.00	$0.00	$0.00	$270.13	$961.93	$961.93	$0.00	$0.00	$270.10	$0.00	$766.61	$766.61	$0.00	$629.15	$996.57	"$1,006.64"	$0.00		$0.00	$191.19	$0.00	$0.00	$200.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.153	SUP	HCPCS C1713		04.112.153  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM LEFT LATERAL DISTAL	BOTH IP/OP	"$1,296.05 "	$959.08	$0.00	"$1,006.64"	$566.24	$566.24	$0.00	$0.00	$0.00	$270.13	$961.93	$961.93	$0.00	$0.00	$270.10	$0.00	$766.61	$766.61	$0.00	$629.15	$996.57	"$1,006.64"	$0.00		$0.00	$191.19	$0.00	$0.00	$200.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.156	SUP	HCPCS C1713		04.112.156  -  PLATE BONE 203MM 13 HOLE LCP RIGHT LATERAL DISTAL FIBULAR	BOTH IP/OP	"$1,350.88 "	$999.65	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$281.56	"$1,002.62"	"$1,002.62"	$0.00	$0.00	$281.52	$0.00	$799.04	$799.04	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.157	SUP	HCPCS C1713		04.112.157  -  PLATE BONE 203MM 13 HOLE LCP LEFT LATERAL DISTAL FIBULAR	BOTH IP/OP	"$1,350.88 "	$999.65	$0.00	"$1,049.22"	$590.19	$590.19	$0.00	$0.00	$0.00	$281.56	"$1,002.62"	"$1,002.62"	$0.00	$0.00	$281.52	$0.00	$799.04	$799.04	$0.00	$655.76	"$1,038.73"	"$1,049.22"	$0.00		$0.00	$199.28	$0.00	$0.00	$208.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.160	SUP	HCPCS C1713		04.112.160  -  PLATE BONE 229MM LCP LATERAL DISTAL FIBULAR NONSTRL 2.7/3.5	BOTH IP/OP	"$1,370.55 "	"$1,014.21"	$0.00	"$1,064.50"	$598.78	$598.78	$0.00	$0.00	$0.00	$285.66	"$1,017.22"	"$1,017.22"	$0.00	$0.00	$285.62	$0.00	$810.68	$810.68	$0.00	$665.31	"$1,053.86"	"$1,064.50"	$0.00		$0.00	$202.18	$0.00	$0.00	$211.84	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.161	SUP	HCPCS C1713		04.112.161  -  PLATE BONE 229MM 15 HOLE LCP LATERAL DISTAL FIBULAR NONSTRL	BOTH IP/OP	"$1,370.55 "	"$1,014.21"	$0.00	"$1,064.50"	$598.78	$598.78	$0.00	$0.00	$0.00	$285.66	"$1,017.22"	"$1,017.22"	$0.00	$0.00	$285.62	$0.00	$810.68	$810.68	$0.00	$665.31	"$1,053.86"	"$1,064.50"	$0.00		$0.00	$202.18	$0.00	$0.00	$211.84	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.510	SUP	HCPCS C1713		04.112.510  -  PLATE BONE 109MM 4 HOLE LOW BEND LCP TITANIUM RIGHT MEDIAL	BOTH IP/OP	"$2,684.88 "	"$1,986.81"	$0.00	"$2,085.34"	"$1,173.00"	"$1,173.00"	$0.00	$0.00	$0.00	$559.60	"$1,992.71"	"$1,992.71"	$0.00	$0.00	$559.53	$0.00	"$1,323.64"	"$1,323.64"	$0.00	"$1,303.34"	"$2,064.49"	"$2,085.34"	$0.00		$0.00	$396.06	$0.00	$0.00	$414.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.511	SUP	HCPCS C1713		04.112.511  -  PLATE BONE 109MM 4 HOLE LOW BEND LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$2,684.88 "	"$1,986.81"	$0.00	"$2,085.34"	"$1,173.00"	"$1,173.00"	$0.00	$0.00	$0.00	$559.60	"$1,992.71"	"$1,992.71"	$0.00	$0.00	$559.53	$0.00	"$1,323.64"	"$1,323.64"	$0.00	"$1,303.34"	"$2,064.49"	"$2,085.34"	$0.00		$0.00	$396.06	$0.00	$0.00	$414.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.514	SUP	HCPCS C1713		04.112.514  -  PLATE BONE 135MM 6 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,627.25 "	"$1,944.17"	$0.00	"$2,040.58"	"$1,147.83"	"$1,147.83"	$0.00	$0.00	$0.00	$547.58	"$1,949.94"	"$1,949.94"	$0.00	$0.00	$547.52	$0.00	"$1,295.23"	"$1,295.23"	$0.00	"$1,275.36"	"$2,020.18"	"$2,040.58"	$0.00		$0.00	$387.56	$0.00	$0.00	$406.08	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.515	SUP	HCPCS C1713		04.112.515  -  PLATE BONE 135MM 6 HOLE LOW BEND LCP TITANIUM LEFT MEDIAL	BOTH IP/OP	"$2,627.25 "	"$1,944.17"	$0.00	"$2,040.58"	"$1,147.83"	"$1,147.83"	$0.00	$0.00	$0.00	$547.58	"$1,949.94"	"$1,949.94"	$0.00	$0.00	$547.52	$0.00	"$1,295.23"	"$1,295.23"	$0.00	"$1,275.36"	"$2,020.18"	"$2,040.58"	$0.00		$0.00	$387.56	$0.00	$0.00	$406.08	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.518	SUP	HCPCS C1713		04.112.518  -  PLATE BONE 161MM 8 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,652.55 "	"$1,962.89"	$0.00	"$2,060.22"	"$1,158.87"	"$1,158.87"	$0.00	$0.00	$0.00	$552.86	"$1,968.72"	"$1,968.72"	$0.00	$0.00	$552.79	$0.00	"$1,307.71"	"$1,307.71"	$0.00	"$1,287.64"	"$2,039.62"	"$2,060.22"	$0.00		$0.00	$391.29	$0.00	$0.00	$409.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.519	SUP	HCPCS C1713		04.112.519  -  PLATE BONE 161MM 8 HOLE LOW BEND LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$2,652.55 "	"$1,962.89"	$0.00	"$2,060.22"	"$1,158.87"	"$1,158.87"	$0.00	$0.00	$0.00	$552.86	"$1,968.72"	"$1,968.72"	$0.00	$0.00	$552.79	$0.00	"$1,307.71"	"$1,307.71"	$0.00	"$1,287.64"	"$2,039.62"	"$2,060.22"	$0.00		$0.00	$391.29	$0.00	$0.00	$409.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.522	SUP	HCPCS C1713		04.112.522  -  PLATE BONE 187MM 10 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,680.65 "	"$1,983.68"	$0.00	"$2,082.06"	"$1,171.16"	"$1,171.16"	$0.00	$0.00	$0.00	$558.71	"$1,989.58"	"$1,989.58"	$0.00	$0.00	$558.65	$0.00	"$1,321.56"	"$1,321.56"	$0.00	"$1,301.29"	"$2,061.24"	"$2,082.06"	$0.00		$0.00	$395.44	$0.00	$0.00	$414.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.523	SUP	HCPCS C1713		04.112.523  -  PLATE BONE 187MM 10 HOLE LOW BEND LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$2,680.65 "	"$1,983.68"	$0.00	"$2,082.06"	"$1,171.16"	"$1,171.16"	$0.00	$0.00	$0.00	$558.71	"$1,989.58"	"$1,989.58"	$0.00	$0.00	$558.65	$0.00	"$1,321.56"	"$1,321.56"	$0.00	"$1,301.29"	"$2,061.24"	"$2,082.06"	$0.00		$0.00	$395.44	$0.00	$0.00	$414.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.526	SUP	HCPCS C1713		04.112.526  -  PLATE BONE 213MM 12 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,710.18 "	"$2,005.53"	$0.00	"$2,105.00"	"$1,184.06"	"$1,184.06"	$0.00	$0.00	$0.00	$564.87	"$2,011.49"	"$2,011.49"	$0.00	$0.00	$564.80	$0.00	"$1,336.12"	"$1,336.12"	$0.00	"$1,315.63"	"$2,083.95"	"$2,105.00"	$0.00		$0.00	$399.79	$0.00	$0.00	$418.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.527	SUP	HCPCS C1713		04.112.527  -  PLATE BONE 213MM 12 HOLE LOW BEND LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$2,710.18 "	"$2,005.53"	$0.00	"$2,105.00"	"$1,184.06"	"$1,184.06"	$0.00	$0.00	$0.00	$564.87	"$2,011.49"	"$2,011.49"	$0.00	$0.00	$564.80	$0.00	"$1,336.12"	"$1,336.12"	$0.00	"$1,315.63"	"$2,083.95"	"$2,105.00"	$0.00		$0.00	$399.79	$0.00	$0.00	$418.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.530	SUP	HCPCS C1713		04.112.530  -  PLATE BONE 239MM 14 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,838.10 "	"$2,100.19"	$0.00	"$2,204.34"	"$1,239.94"	"$1,239.94"	$0.00	$0.00	$0.00	$591.53	"$2,106.44"	"$2,106.44"	$0.00	$0.00	$591.46	$0.00	"$1,399.18"	"$1,399.18"	$0.00	"$1,377.71"	"$2,182.30"	"$2,204.34"	$0.00		$0.00	$418.66	$0.00	$0.00	$438.66	$0.00	$0.00	$0.00	$0.00	$0.00
04.112.531	SUP	HCPCS C1713		04.112.531  -  PLATE BONE 239MM 14 HOLE LOW BEND LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$2,838.10 "	"$2,100.19"	$0.00	"$2,204.34"	"$1,239.94"	"$1,239.94"	$0.00	$0.00	$0.00	$591.53	"$2,106.44"	"$2,106.44"	$0.00	$0.00	$591.46	$0.00	"$1,399.18"	"$1,399.18"	$0.00	"$1,377.71"	"$2,182.30"	"$2,204.34"	$0.00		$0.00	$418.66	$0.00	$0.00	$438.66	$0.00	$0.00	$0.00	$0.00	$0.00
04.113.103	SUP	HCPCS C1713		04.113.103  -  PLATE BONE 62MM 3 HOLE HOOK LCP TITANIUM NONSTRL 3.5MM	BOTH IP/OP	"$1,019.13 "	$754.16	$0.00	$791.56	$445.25	$445.25	$0.00	$0.00	$0.00	$212.41	$756.39	$756.39	$0.00	$0.00	$212.39	$0.00	$602.81	$602.81	$0.00	$494.73	$783.64	$791.56	$0.00		$0.00	$150.34	$0.00	$0.00	$157.52	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.002	SUP	HCPCS C1713		04.114.002  -  PLATE BONE 23MM 4 HOLE PURE STR LCP TITANIUM HAND WRIST	BOTH IP/OP	$410.45 	$303.73	$0.00	$318.80	$179.33	$179.33	$0.00	$0.00	$0.00	$85.55	$304.64	$304.64	$0.00	$0.00	$85.54	$0.00	$242.78	$242.78	$0.00	$199.25	$315.61	$318.80	$0.00		$0.00	$60.55	$0.00	$0.00	$63.44	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.003	SUP	HCPCS C1713		04.114.003  -  PLATE BONE 29MM 6 HOLE PURE STR LOCKING LCP TITANIUM HAND	BOTH IP/OP	$752.05 	$556.52	$0.00	$584.12	$328.57	$328.57	$0.00	$0.00	$0.00	$156.75	$558.17	$558.17	$0.00	$0.00	$156.73	$0.00	$444.84	$444.84	$0.00	$365.08	$578.28	$584.12	$0.00		$0.00	$110.94	$0.00	$0.00	$116.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.004	SUP	HCPCS C1713		04.114.004  -  PLATE BONE 36MM 6 HOLE PURE STR LCP TITANIUM HAND WRIST	BOTH IP/OP	$410.45 	$303.73	$0.00	$318.80	$179.33	$179.33	$0.00	$0.00	$0.00	$85.55	$304.64	$304.64	$0.00	$0.00	$85.54	$0.00	$242.78	$242.78	$0.00	$199.25	$315.61	$318.80	$0.00		$0.00	$60.55	$0.00	$0.00	$63.44	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.005	SUP	HCPCS C1713		04.114.005  -  PLATE BONE 59MM 12 HOLE PURE STR LOCKING ADAPTION LCP	BOTH IP/OP	$752.05 	$556.52	$0.00	$584.12	$328.57	$328.57	$0.00	$0.00	$0.00	$156.75	$558.17	$558.17	$0.00	$0.00	$156.73	$0.00	$444.84	$444.84	$0.00	$365.08	$578.28	$584.12	$0.00		$0.00	$110.94	$0.00	$0.00	$116.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.006	SUP	HCPCS C1713		04.114.006  -  PLATE BONE T 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW	BOTH IP/OP	$790.00 	$584.60	$0.00	$613.60	$345.15	$345.15	$0.00	$0.00	$0.00	$164.66	$586.34	$586.34	$0.00	$0.00	$164.64	$0.00	$467.29	$467.29	$0.00	$383.50	$607.46	$613.60	$0.00		$0.00	$116.54	$0.00	$0.00	$122.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.007	SUP	HCPCS C1713		04.114.007  -  PLATE BONE T 4X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW	BOTH IP/OP	$790.00 	$584.60	$0.00	$613.60	$345.15	$345.15	$0.00	$0.00	$0.00	$164.66	$586.34	$586.34	$0.00	$0.00	$164.64	$0.00	$467.29	$467.29	$0.00	$383.50	$607.46	$613.60	$0.00		$0.00	$116.54	$0.00	$0.00	$122.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.009	SUP	HCPCS C1713		04.114.009  -  PLATE BONE H LEFT EXTEND LCP TITANIUM SPN NONSTRL 1.5MM	BOTH IP/OP	$760.48 	$562.76	$0.00	$590.66	$332.25	$332.25	$0.00	$0.00	$0.00	$158.50	$564.42	$564.42	$0.00	$0.00	$158.48	$0.00	$449.82	$449.82	$0.00	$369.16	$584.76	$590.66	$0.00		$0.00	$112.18	$0.00	$0.00	$117.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.010	SUP	HCPCS C1713		04.114.010  -  PLATE BONE H RIGHT EXTEND LCP TITANIUM SPN NONSTRL 1.5MM	BOTH IP/OP	$760.48 	$562.76	$0.00	$590.66	$332.25	$332.25	$0.00	$0.00	$0.00	$158.50	$564.42	$564.42	$0.00	$0.00	$158.48	$0.00	$449.82	$449.82	$0.00	$369.16	$584.76	$590.66	$0.00		$0.00	$112.18	$0.00	$0.00	$117.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.013	SUP	HCPCS C1713		04.114.013  -  PLATE BONE Y 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW	BOTH IP/OP	$760.48 	$562.76	$0.00	$590.66	$332.25	$332.25	$0.00	$0.00	$0.00	$158.50	$564.42	$564.42	$0.00	$0.00	$158.48	$0.00	$449.82	$449.82	$0.00	$369.16	$584.76	$590.66	$0.00		$0.00	$112.18	$0.00	$0.00	$117.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.014	SUP	HCPCS C1713		04.114.014  -  PLATE BONE Y 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW	BOTH IP/OP	$884.18 	$654.29	$0.00	$686.74	$386.29	$386.29	$0.00	$0.00	$0.00	$184.28	$656.23	$656.23	$0.00	$0.00	$184.26	$0.00	$522.99	$522.99	$0.00	$429.21	$679.88	$686.74	$0.00		$0.00	$130.43	$0.00	$0.00	$136.66	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.502	SUP	HCPCS C1713		04.114.502  -  PLATE BONE SHORT THREAD 23MM 4 HOLE ASSEMBLE DRILL GUIDE LCP	BOTH IP/OP	$490.58 	$363.03	$0.00	$381.04	$214.34	$214.34	$0.00	$0.00	$0.00	$102.25	$364.10	$364.10	$0.00	$0.00	$102.24	$0.00	$290.18	$290.18	$0.00	$238.15	$377.23	$381.04	$0.00		$0.00	$72.37	$0.00	$0.00	$75.83	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.503	SUP	HCPCS C1713		04.114.503  -  PLATE BONE SHORT THREAD 29MM 6 HOLE ADAPTION LCP TITANIUM	BOTH IP/OP	$836.38 	$618.92	$0.00	$649.62	$365.41	$365.41	$0.00	$0.00	$0.00	$174.32	$620.76	$620.76	$0.00	$0.00	$174.30	$0.00	$494.72	$494.72	$0.00	$406.01	$643.13	$649.62	$0.00		$0.00	$123.38	$0.00	$0.00	$129.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.504	SUP	HCPCS C1713		04.114.504  -  PLATE BONE 36MM 6 HOLE PURE STR PREASSEMBLED DRILL SLEEVE	BOTH IP/OP	$490.58 	$363.03	$0.00	$381.04	$214.34	$214.34	$0.00	$0.00	$0.00	$102.25	$364.10	$364.10	$0.00	$0.00	$102.24	$0.00	$290.18	$290.18	$0.00	$238.15	$377.23	$381.04	$0.00		$0.00	$72.37	$0.00	$0.00	$75.83	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.505	SUP	HCPCS C1713		04.114.505  -  PLATE BONE 59MM 12 HOLE PURE STR PREASSEMBLED DRILL SLEEVE	BOTH IP/OP	$836.38 	$618.92	$0.00	$649.62	$365.41	$365.41	$0.00	$0.00	$0.00	$174.32	$620.76	$620.76	$0.00	$0.00	$174.30	$0.00	$494.72	$494.72	$0.00	$406.01	$643.13	$649.62	$0.00		$0.00	$123.38	$0.00	$0.00	$129.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.506	SUP	HCPCS C1713		04.114.506  -  PLATE BONE 3X8 HOLE T PREASSEMBLED DRILL SLEEVE LOCKING LCP	BOTH IP/OP	$885.58 	$655.33	$0.00	$687.84	$386.91	$386.91	$0.00	$0.00	$0.00	$184.58	$657.27	$657.27	$0.00	$0.00	$184.55	$0.00	$523.82	$523.82	$0.00	$429.90	$680.96	$687.84	$0.00		$0.00	$130.64	$0.00	$0.00	$136.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.507	SUP	HCPCS C1713		04.114.507  -  PLATE BONE 4X8 HOLE T PREASSEMBLED DRILL SLEEVE LOCKING LCP	BOTH IP/OP	$885.58 	$655.33	$0.00	$687.84	$386.91	$386.91	$0.00	$0.00	$0.00	$184.58	$657.27	$657.27	$0.00	$0.00	$184.55	$0.00	$523.82	$523.82	$0.00	$429.90	$680.96	$687.84	$0.00		$0.00	$130.64	$0.00	$0.00	$136.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.509	SUP	HCPCS C1713		04.114.509  -  PLATE BONE 8 HOLE STRUT PREASSEMBLED DRILL SLEEVE LOCKING	BOTH IP/OP	$846.23 	$626.21	$0.00	$657.26	$369.71	$369.71	$0.00	$0.00	$0.00	$176.37	$628.07	$628.07	$0.00	$0.00	$176.35	$0.00	$500.54	$500.54	$0.00	$410.79	$650.69	$657.26	$0.00		$0.00	$124.83	$0.00	$0.00	$130.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.510	SUP	HCPCS C1713		04.114.510  -  PLATE BONE H RIGHT EXTEND LCP TITANIUM SPN NONSTRL 1.5MM	BOTH IP/OP	$846.23 	$626.21	$0.00	$657.26	$369.71	$369.71	$0.00	$0.00	$0.00	$176.37	$628.07	$628.07	$0.00	$0.00	$176.35	$0.00	$500.54	$500.54	$0.00	$410.79	$650.69	$657.26	$0.00		$0.00	$124.83	$0.00	$0.00	$130.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.513	SUP	HCPCS C1713		04.114.513  -  PLATE BONE Y 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW	BOTH IP/OP	$846.23 	$626.21	$0.00	$657.26	$369.71	$369.71	$0.00	$0.00	$0.00	$176.37	$628.07	$628.07	$0.00	$0.00	$176.35	$0.00	$500.54	$500.54	$0.00	$410.79	$650.69	$657.26	$0.00		$0.00	$124.83	$0.00	$0.00	$130.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.114.514	SUP	HCPCS C1713		04.114.514  -  PLATE BONE 6 HOLE LCP TITANIUM CONDYLE NONSTRL 1.5 MM SCREWS	BOTH IP/OP	$968.53 	$716.71	$0.00	$752.26	$423.15	$423.15	$0.00	$0.00	$0.00	$201.86	$718.84	$718.84	$0.00	$0.00	$201.84	$0.00	$572.88	$572.88	$0.00	$470.16	$744.74	$752.26	$0.00		$0.00	$142.87	$0.00	$0.00	$149.70	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.130	SUP	HCPCS C1713		04.115.130  -  PLATE BONE +90D 37MM 2X3 HOLE L VAR ANG LOCKING LCP TITANIUM	BOTH IP/OP	"$1,026.15 "	$759.35	$0.00	$797.02	$448.32	$448.32	$0.00	$0.00	$0.00	$213.88	$761.61	$761.61	$0.00	$0.00	$213.85	$0.00	$606.97	$606.97	$0.00	$498.14	$789.05	$797.02	$0.00		$0.00	$151.37	$0.00	$0.00	$158.61	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.131	SUP	HCPCS C1713		04.115.131  -  PLATE BONE -90D 37MM 2X3 HOLE L VAR ANG LOCKING LCP TITANIUM	BOTH IP/OP	"$1,026.15 "	$759.35	$0.00	$797.02	$448.32	$448.32	$0.00	$0.00	$0.00	$213.88	$761.61	$761.61	$0.00	$0.00	$213.85	$0.00	$606.97	$606.97	$0.00	$498.14	$789.05	$797.02	$0.00		$0.00	$151.37	$0.00	$0.00	$158.61	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.150	SUP	HCPCS C1713		04.115.150  -  PLATE BONE +90D 51MM 2X5 HOLE L VAR ANG LOCKING LCP TITANIUM	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.151	SUP	HCPCS C1713		04.115.151  -  PLATE BONE -90D 51MM 2X5 HOLE L VAR ANG LOCKING LCP TITANIUM	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.230	SUP	HCPCS C1713		04.115.230  -  PLATE BONE +90D 37MM 3X3 HOLE L VAR ANG LOCKING LCP TITANIUM	BOTH IP/OP	"$1,026.15 "	$759.35	$0.00	$797.02	$448.32	$448.32	$0.00	$0.00	$0.00	$213.88	$761.61	$761.61	$0.00	$0.00	$213.85	$0.00	$606.97	$606.97	$0.00	$498.14	$789.05	$797.02	$0.00		$0.00	$151.37	$0.00	$0.00	$158.61	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.231	SUP	HCPCS C1713		04.115.231  -  PLATE BONE -90D 37MM 3X3 HOLE L VAR ANG LOCKING LCP TITANIUM	BOTH IP/OP	"$1,026.15 "	$759.35	$0.00	$797.02	$448.32	$448.32	$0.00	$0.00	$0.00	$213.88	$761.61	$761.61	$0.00	$0.00	$213.85	$0.00	$606.97	$606.97	$0.00	$498.14	$789.05	$797.02	$0.00		$0.00	$151.37	$0.00	$0.00	$158.61	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.250	SUP	HCPCS C1713		04.115.250  -  PLATE BONE +90D 51MM 3X5 HOLE L VAR ANG LOCKING LCP TITANIUM	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.251	SUP	HCPCS C1713		04.115.251  -  PLATE BONE -90D 51MM 3X5 HOLE L VAR ANG LOCKING LCP TITANIUM	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.330	SUP	HCPCS C1713		04.115.330  -  PLATE BONE 37MM 3X3 HOLE T VAR ANG LOCKING LCP TITANIUM	BOTH IP/OP	"$1,059.90 "	$784.33	$0.00	$823.22	$463.06	$463.06	$0.00	$0.00	$0.00	$220.91	$786.66	$786.66	$0.00	$0.00	$220.88	$0.00	$626.93	$626.93	$0.00	$514.51	$814.99	$823.22	$0.00		$0.00	$156.35	$0.00	$0.00	$163.82	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.350	SUP	HCPCS C1713		04.115.350  -  PLATE BONE 51MM 3X5 HOLE T VAR ANG LOCKING LCP TITANIUM	BOTH IP/OP	"$1,106.28 "	$818.65	$0.00	$859.24	$483.32	$483.32	$0.00	$0.00	$0.00	$230.58	$821.08	$821.08	$0.00	$0.00	$230.55	$0.00	$654.36	$654.36	$0.00	$537.03	$850.65	$859.24	$0.00		$0.00	$163.19	$0.00	$0.00	$170.99	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.430	SUP	HCPCS C1713		04.115.430  -  PLATE BONE +20D 41MM 3X3 HOLE L VAR ANG OPLIQUE LOCKING LCP	BOTH IP/OP	"$1,026.15 "	$759.35	$0.00	$797.02	$448.32	$448.32	$0.00	$0.00	$0.00	$213.88	$761.61	$761.61	$0.00	$0.00	$213.85	$0.00	$606.97	$606.97	$0.00	$498.14	$789.05	$797.02	$0.00		$0.00	$151.37	$0.00	$0.00	$158.61	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.431	SUP	HCPCS C1713		04.115.431  -  PLATE BONE -20D 41MM 3X3 HOLE L VAR ANG OBLIQUE LOCKING LCP	BOTH IP/OP	"$1,026.15 "	$759.35	$0.00	$797.02	$448.32	$448.32	$0.00	$0.00	$0.00	$213.88	$761.61	$761.61	$0.00	$0.00	$213.85	$0.00	$606.97	$606.97	$0.00	$498.14	$789.05	$797.02	$0.00		$0.00	$151.37	$0.00	$0.00	$158.61	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.450	SUP	HCPCS C1713		04.115.450  -  PLATE BONE +20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LOCKING LCP	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.451	SUP	HCPCS C1713		04.115.451  -  PLATE BONE -20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LOCKING LCP	BOTH IP/OP	"$1,078.18 "	$797.85	$0.00	$837.42	$471.05	$471.05	$0.00	$0.00	$0.00	$224.72	$800.22	$800.22	$0.00	$0.00	$224.69	$0.00	$637.74	$637.74	$0.00	$523.39	$829.05	$837.42	$0.00		$0.00	$159.05	$0.00	$0.00	$166.65	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.530	SUP	HCPCS C1713		04.115.530  -  PLATE BONE 46MM 3X5 HOLE VAR ANG COLUMN LOCKING LCP TITANIUM	BOTH IP/OP	"$1,059.90 "	$784.33	$0.00	$823.22	$463.06	$463.06	$0.00	$0.00	$0.00	$220.91	$786.66	$786.66	$0.00	$0.00	$220.88	$0.00	$626.93	$626.93	$0.00	$514.51	$814.99	$823.22	$0.00		$0.00	$156.35	$0.00	$0.00	$163.82	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.540	SUP	HCPCS C1713		04.115.540  -  PLATE BONE 57MM 6 HOLE L VAR ANG COLUMN LCP TITANIUM DISTAL	BOTH IP/OP	"$1,106.28 "	$818.65	$0.00	$859.24	$483.32	$483.32	$0.00	$0.00	$0.00	$230.58	$821.08	$821.08	$0.00	$0.00	$230.55	$0.00	$654.36	$654.36	$0.00	$537.03	$850.65	$859.24	$0.00		$0.00	$163.19	$0.00	$0.00	$170.99	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.630	SUP	HCPCS C1713		04.115.630  -  PLATE BONE +90D 41MM 2X3 HOLE VARIABLE INTERMEDIATE COLUMN	BOTH IP/OP	"$1,106.28 "	$818.65	$0.00	$859.24	$483.32	$483.32	$0.00	$0.00	$0.00	$230.58	$821.08	$821.08	$0.00	$0.00	$230.55	$0.00	$654.36	$654.36	$0.00	$537.03	$850.65	$859.24	$0.00		$0.00	$163.19	$0.00	$0.00	$170.99	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.631	SUP	HCPCS C1713		04.115.631  -  PLATE BONE -90D 41MM 2X3 HOLE VARIABLE INTERMEDIATE COLUMN	BOTH IP/OP	"$1,106.28 "	$818.65	$0.00	$859.24	$483.32	$483.32	$0.00	$0.00	$0.00	$230.58	$821.08	$821.08	$0.00	$0.00	$230.55	$0.00	$654.36	$654.36	$0.00	$537.03	$850.65	$859.24	$0.00		$0.00	$163.19	$0.00	$0.00	$170.99	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.640	SUP	HCPCS C1713		04.115.640  -  PLATE BONE +90D 49MM 2X4 HOLE VARIABLE INTERMEDIATE COLUMN	BOTH IP/OP	"$1,147.05 "	$848.82	$0.00	$890.90	$501.13	$501.13	$0.00	$0.00	$0.00	$239.07	$851.34	$851.34	$0.00	$0.00	$239.05	$0.00	$678.48	$678.48	$0.00	$556.81	$881.99	$890.90	$0.00		$0.00	$169.21	$0.00	$0.00	$177.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.115.641	SUP	HCPCS C1713		04.115.641  -  PLATE BONE -90D 49MM 2X4 HOLE VARIABLE INTERMEDIATE COLUMN	BOTH IP/OP	"$1,147.05 "	$848.82	$0.00	$890.90	$501.13	$501.13	$0.00	$0.00	$0.00	$239.07	$851.34	$851.34	$0.00	$0.00	$239.05	$0.00	$678.48	$678.48	$0.00	$556.81	$881.99	$890.90	$0.00		$0.00	$169.21	$0.00	$0.00	$177.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.120.601	SUP	HCPCS C1713		04.120.601  -  PLATE BONE 4.5MM 4 HOLE LOCKING ATTCH LCP TITANIUM FEMUR	BOTH IP/OP	$940.40 	$695.90	$0.00	$730.42	$410.86	$410.86	$0.00	$0.00	$0.00	$196.00	$697.96	$697.96	$0.00	$0.00	$195.98	$0.00	$556.25	$556.25	$0.00	$456.51	$723.12	$730.42	$0.00		$0.00	$138.73	$0.00	$0.00	$145.35	$0.00	$0.00	$0.00	$0.00	$0.00
04.120.602	SUP	HCPCS C1713		04.120.602  -  PLATE BONE 4.5MM 8 HOLE LOCKING ATTCH LCP TITANIUM FEMUR	BOTH IP/OP	"$1,030.38 "	$762.48	$0.00	$800.28	$450.16	$450.16	$0.00	$0.00	$0.00	$214.76	$764.74	$764.74	$0.00	$0.00	$214.73	$0.00	$609.47	$609.47	$0.00	$500.18	$792.28	$800.28	$0.00		$0.00	$152.00	$0.00	$0.00	$159.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.120.606	SUP	HCPCS C1713		04.120.606  -  SCREW BONE 6MM CONNCTNG STARDRIVE RECESS TITANIUM NONSTRL	BOTH IP/OP	$303.63 	$224.69	$0.00	$235.82	$132.65	$132.65	$0.00	$0.00	$0.00	$63.28	$225.35	$225.35	$0.00	$0.00	$63.28	$0.00	$179.59	$179.59	$0.00	$147.39	$233.47	$235.82	$0.00		$0.00	$44.79	$0.00	$0.00	$46.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.120.701	SUP	HCPCS C1713		04.120.701  -  PLATE BONE 69MM 1 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL	BOTH IP/OP	"$1,750.08 "	"$1,295.06"	$0.00	"$1,359.30"	$764.61	$764.61	$0.00	$0.00	$0.00	$364.76	"$1,298.91"	"$1,298.91"	$0.00	$0.00	$364.72	$0.00	"$1,035.17"	"$1,035.17"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$258.17	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.120.702	SUP	HCPCS C1713		04.120.702  -  PLATE BONE 79MM 2 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL	BOTH IP/OP	"$1,769.78 "	"$1,309.64"	$0.00	"$1,374.58"	$773.20	$773.20	$0.00	$0.00	$0.00	$368.87	"$1,313.53"	"$1,313.53"	$0.00	$0.00	$368.82	$0.00	"$1,046.82"	"$1,046.82"	$0.00	$859.11	"$1,360.84"	"$1,374.58"	$0.00		$0.00	$261.07	$0.00	$0.00	$273.54	$0.00	$0.00	$0.00	$0.00	$0.00
04.120.704	SUP	HCPCS C1713		04.120.704  -  PLATE BONE 105MM 4 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL	BOTH IP/OP	"$1,788.05 "	"$1,323.16"	$0.00	"$1,388.76"	$781.18	$781.18	$0.00	$0.00	$0.00	$372.67	"$1,327.09"	"$1,327.09"	$0.00	$0.00	$372.63	$0.00	"$1,057.63"	"$1,057.63"	$0.00	$867.98	"$1,374.87"	"$1,388.76"	$0.00		$0.00	$263.77	$0.00	$0.00	$276.36	$0.00	$0.00	$0.00	$0.00	$0.00
04.120.706	SUP	HCPCS C1713		04.120.706  -  PLATE BONE 131MM 6 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL	BOTH IP/OP	"$1,804.90 "	"$1,335.63"	$0.00	"$1,401.88"	$788.56	$788.56	$0.00	$0.00	$0.00	$376.19	"$1,339.60"	"$1,339.60"	$0.00	$0.00	$376.14	$0.00	"$1,067.60"	"$1,067.60"	$0.00	$876.18	"$1,387.86"	"$1,401.88"	$0.00		$0.00	$266.25	$0.00	$0.00	$278.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.120.708	SUP	HCPCS C1713		04.120.708  -  PLATE BONE 157MM 8 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL	BOTH IP/OP	"$1,824.60 "	"$1,350.20"	$0.00	"$1,417.16"	$797.15	$797.15	$0.00	$0.00	$0.00	$380.29	"$1,354.22"	"$1,354.22"	$0.00	$0.00	$380.25	$0.00	"$1,079.25"	"$1,079.25"	$0.00	$885.73	"$1,402.99"	"$1,417.16"	$0.00		$0.00	$269.16	$0.00	$0.00	$282.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.120.710	SUP	HCPCS C1713		04.120.710  -  PLATE BONE 183MM 10 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL	BOTH IP/OP	"$1,844.28 "	"$1,364.77"	$0.00	"$1,432.44"	$805.75	$805.75	$0.00	$0.00	$0.00	$384.39	"$1,368.82"	"$1,368.82"	$0.00	$0.00	$384.35	$0.00	"$1,090.89"	"$1,090.89"	$0.00	$895.28	"$1,418.12"	"$1,432.44"	$0.00		$0.00	$272.06	$0.00	$0.00	$285.06	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.030S	SUP	HCPCS C1713		04.124.030S  -  PLATE BONE 356MM 15 HOLE LCP TITANIUM FEMUR RIGHT DISTAL	BOTH IP/OP	"$3,318.85 "	"$2,455.95"	$0.00	"$2,577.74"	"$1,449.98"	"$1,449.98"	$0.00	$0.00	$0.00	$691.73	"$2,463.25"	"$2,463.25"	$0.00	$0.00	$691.65	$0.00	"$1,636.19"	"$1,636.19"	$0.00	"$1,611.09"	"$2,551.97"	"$2,577.74"	$0.00		$0.00	$489.58	$0.00	$0.00	$512.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.031S	SUP	HCPCS C1713		04.124.031S  -  PLATE BONE 356MM 15 HOLE LCP TITANIUM FEMUR LEFT DISTAL	BOTH IP/OP	"$3,318.85 "	"$2,455.95"	$0.00	"$2,577.74"	"$1,449.98"	"$1,449.98"	$0.00	$0.00	$0.00	$691.73	"$2,463.25"	"$2,463.25"	$0.00	$0.00	$691.65	$0.00	"$1,636.19"	"$1,636.19"	$0.00	"$1,611.09"	"$2,551.97"	"$2,577.74"	$0.00		$0.00	$489.58	$0.00	$0.00	$512.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.034S	SUP	HCPCS C1713		04.124.034S  -  PLATE BONE 396MM 17 HOLE LCP TITANIUM FEMUR RIGHT DISTAL	BOTH IP/OP	"$3,379.28 "	"$2,500.67"	$0.00	"$2,624.68"	"$1,476.38"	"$1,476.38"	$0.00	$0.00	$0.00	$704.33	"$2,508.10"	"$2,508.10"	$0.00	$0.00	$704.24	$0.00	"$1,665.98"	"$1,665.98"	$0.00	"$1,640.43"	"$2,598.43"	"$2,624.68"	$0.00		$0.00	$498.50	$0.00	$0.00	$522.31	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.035S	SUP	HCPCS C1713		04.124.035S  -  PLATE BONE 396MM 17 HOLE LCP TITANIUM FEMUR LEFT DISTAL	BOTH IP/OP	"$3,379.28 "	"$2,500.67"	$0.00	"$2,624.68"	"$1,476.38"	"$1,476.38"	$0.00	$0.00	$0.00	$704.33	"$2,508.10"	"$2,508.10"	$0.00	$0.00	$704.24	$0.00	"$1,665.98"	"$1,665.98"	$0.00	"$1,640.43"	"$2,598.43"	"$2,624.68"	$0.00		$0.00	$498.50	$0.00	$0.00	$522.31	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.038S	SUP	HCPCS C1713		04.124.038S  -  PLATE BONE 436MM 19 HOLE LCP TITANIUM FEMUR RIGHT DISTAL	BOTH IP/OP	"$3,441.13 "	"$2,546.44"	$0.00	"$2,672.72"	"$1,503.41"	"$1,503.41"	$0.00	$0.00	$0.00	$717.22	"$2,554.00"	"$2,554.00"	$0.00	$0.00	$717.13	$0.00	"$1,696.47"	"$1,696.47"	$0.00	"$1,670.45"	"$2,645.99"	"$2,672.72"	$0.00		$0.00	$507.62	$0.00	$0.00	$531.87	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.039S	SUP	HCPCS C1713		04.124.039S  -  PLATE BONE 436MM 19 HOLE LCP TITANIUM FEMUR LEFT DISTAL	BOTH IP/OP	"$3,441.13 "	"$2,546.44"	$0.00	"$2,672.72"	"$1,503.41"	"$1,503.41"	$0.00	$0.00	$0.00	$717.22	"$2,554.00"	"$2,554.00"	$0.00	$0.00	$717.13	$0.00	"$1,696.47"	"$1,696.47"	$0.00	"$1,670.45"	"$2,645.99"	"$2,672.72"	$0.00		$0.00	$507.62	$0.00	$0.00	$531.87	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.200	SUP	HCPCS C1713		04.124.200  -  PLATE BONE 76MM 4 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,663.78 "	"$1,971.20"	$0.00	"$2,068.96"	"$1,163.79"	"$1,163.79"	$0.00	$0.00	$0.00	$555.20	"$1,977.05"	"$1,977.05"	$0.00	$0.00	$555.13	$0.00	"$1,313.24"	"$1,313.24"	$0.00	"$1,293.10"	"$2,048.27"	"$2,068.96"	$0.00		$0.00	$392.95	$0.00	$0.00	$411.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.201	SUP	HCPCS C1713		04.124.201  -  PLATE BONE 76MM 6 HOLE LOW BEND LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$2,663.78 "	"$1,971.20"	$0.00	"$2,068.96"	"$1,163.79"	"$1,163.79"	$0.00	$0.00	$0.00	$555.20	"$1,977.05"	"$1,977.05"	$0.00	$0.00	$555.13	$0.00	"$1,313.24"	"$1,313.24"	$0.00	"$1,293.10"	"$2,048.27"	"$2,068.96"	$0.00		$0.00	$392.95	$0.00	$0.00	$411.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.204	SUP	HCPCS C1713		04.124.204  -  PLATE BONE 102MM 6 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,696.13 "	"$1,995.14"	$0.00	"$2,094.08"	"$1,177.92"	"$1,177.92"	$0.00	$0.00	$0.00	$561.94	"$2,001.06"	"$2,001.06"	$0.00	$0.00	$561.87	$0.00	"$1,329.19"	"$1,329.19"	$0.00	"$1,308.80"	"$2,073.14"	"$2,094.08"	$0.00		$0.00	$397.72	$0.00	$0.00	$416.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.205	SUP	HCPCS C1713		04.124.205  -  PLATE BONE 102MM 6 HOLE LOW BEND LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$2,696.13 "	"$1,995.14"	$0.00	"$2,094.08"	"$1,177.92"	"$1,177.92"	$0.00	$0.00	$0.00	$561.94	"$2,001.06"	"$2,001.06"	$0.00	$0.00	$561.87	$0.00	"$1,329.19"	"$1,329.19"	$0.00	"$1,308.80"	"$2,073.14"	"$2,094.08"	$0.00		$0.00	$397.72	$0.00	$0.00	$416.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.208	SUP	HCPCS C1713		04.124.208  -  PLATE BONE 128MM 8 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,727.05 "	"$2,018.02"	$0.00	"$2,118.10"	"$1,191.43"	"$1,191.43"	$0.00	$0.00	$0.00	$568.39	"$2,024.02"	"$2,024.02"	$0.00	$0.00	$568.32	$0.00	"$1,344.44"	"$1,344.44"	$0.00	"$1,323.81"	"$2,096.92"	"$2,118.10"	$0.00		$0.00	$402.28	$0.00	$0.00	$421.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.209	SUP	HCPCS C1713		04.124.209  -  PLATE BONE 128MM 8 HOLE LOW BEND LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$2,727.05 "	"$2,018.02"	$0.00	"$2,118.10"	"$1,191.43"	"$1,191.43"	$0.00	$0.00	$0.00	$568.39	"$2,024.02"	"$2,024.02"	$0.00	$0.00	$568.32	$0.00	"$1,344.44"	"$1,344.44"	$0.00	"$1,323.81"	"$2,096.92"	"$2,118.10"	$0.00		$0.00	$402.28	$0.00	$0.00	$421.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.212	SUP	HCPCS C1713		04.124.212  -  PLATE BONE 154MM 10 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,756.58 "	"$2,039.87"	$0.00	"$2,141.02"	"$1,204.32"	"$1,204.32"	$0.00	$0.00	$0.00	$574.54	"$2,045.93"	"$2,045.93"	$0.00	$0.00	$574.47	$0.00	"$1,358.99"	"$1,358.99"	$0.00	"$1,338.14"	"$2,119.61"	"$2,141.02"	$0.00		$0.00	$406.64	$0.00	$0.00	$426.06	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.213	SUP	HCPCS C1713		04.124.213  -  PLATE BONE 154MM 10 HOLE LOW BEND LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$2,756.58 "	"$2,039.87"	$0.00	"$2,141.02"	"$1,204.32"	"$1,204.32"	$0.00	$0.00	$0.00	$574.54	"$2,045.93"	"$2,045.93"	$0.00	$0.00	$574.47	$0.00	"$1,358.99"	"$1,358.99"	$0.00	"$1,338.14"	"$2,119.61"	"$2,141.02"	$0.00		$0.00	$406.64	$0.00	$0.00	$426.06	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.216	SUP	HCPCS C1713		04.124.216  -  PLATE BONE 180MM 12 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,887.30 "	"$2,136.60"	$0.00	"$2,242.56"	"$1,261.44"	"$1,261.44"	$0.00	$0.00	$0.00	$601.79	"$2,142.95"	"$2,142.95"	$0.00	$0.00	$601.71	$0.00	"$1,423.44"	"$1,423.44"	$0.00	"$1,401.60"	"$2,220.13"	"$2,242.56"	$0.00		$0.00	$425.92	$0.00	$0.00	$446.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.217	SUP	HCPCS C1713		04.124.217  -  PLATE BONE 180MM 12 HOLE LOW BEND LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$2,887.30 "	"$2,136.60"	$0.00	"$2,242.56"	"$1,261.44"	"$1,261.44"	$0.00	$0.00	$0.00	$601.79	"$2,142.95"	"$2,142.95"	$0.00	$0.00	$601.71	$0.00	"$1,423.44"	"$1,423.44"	$0.00	"$1,401.60"	"$2,220.13"	"$2,242.56"	$0.00		$0.00	$425.92	$0.00	$0.00	$446.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.220	SUP	HCPCS C1713		04.124.220  -  PLATE BONE 206MM 14 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$2,918.23 "	"$2,159.49"	$0.00	"$2,266.58"	"$1,274.95"	"$1,274.95"	$0.00	$0.00	$0.00	$608.23	"$2,165.91"	"$2,165.91"	$0.00	$0.00	$608.16	$0.00	"$1,438.68"	"$1,438.68"	$0.00	"$1,416.61"	"$2,243.92"	"$2,266.58"	$0.00		$0.00	$430.48	$0.00	$0.00	$451.05	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.221	SUP	HCPCS C1713		04.124.221  -  PLATE BONE 206MM 14 HOLE LOW BEND LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$2,918.23 "	"$2,159.49"	$0.00	"$2,266.58"	"$1,274.95"	"$1,274.95"	$0.00	$0.00	$0.00	$608.23	"$2,165.91"	"$2,165.91"	$0.00	$0.00	$608.16	$0.00	"$1,438.68"	"$1,438.68"	$0.00	"$1,416.61"	"$2,243.92"	"$2,266.58"	$0.00		$0.00	$430.48	$0.00	$0.00	$451.05	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.224	SUP	HCPCS C1713		04.124.224  -  PLATE BONE 232MM 16 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT	BOTH IP/OP	"$3,020.83 "	"$2,235.41"	$0.00	"$2,346.28"	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$0.00	$629.62	"$2,242.06"	"$2,242.06"	$0.00	$0.00	$629.54	$0.00	"$1,489.27"	"$1,489.27"	$0.00	"$1,466.43"	"$2,322.82"	"$2,346.28"	$0.00		$0.00	$445.62	$0.00	$0.00	$466.91	$0.00	$0.00	$0.00	$0.00	$0.00
04.124.225	SUP	HCPCS C1713		04.124.225  -  PLATE BONE 232MM 16 HOLE LOW BEND LCP TITANIUM TIBIA LEFT	BOTH IP/OP	"$3,020.83 "	"$2,235.41"	$0.00	"$2,346.28"	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$0.00	$629.62	"$2,242.06"	"$2,242.06"	$0.00	$0.00	$629.54	$0.00	"$1,489.27"	"$1,489.27"	$0.00	"$1,466.43"	"$2,322.82"	"$2,346.28"	$0.00		$0.00	$445.62	$0.00	$0.00	$466.91	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.001	SUP	HCPCS C1713		04.161.001  -  PLATE 50MM TI BONE OCCPTL NONSTRL	BOTH IP/OP	"$8,232.00 "	"$6,091.68"	$0.00	"$6,585.60"	"$3,704.40"	"$3,704.40"	$0.00	$0.00	$0.00	"$1,715.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,715.55"	$0.00	"$4,058.38"	"$4,058.38"	$0.00	"$4,116.00"	"$6,519.74"	"$6,585.60"	$0.00		$0.00	"$1,288.31"	$0.00	$0.00	"$1,310.53"	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.032	SUP	HCPCS C1713		04.161.032  -  ROD SPNL 240MM 3.5MM OCCPTL TI PREBNT	BOTH IP/OP	$892.50 	$660.45	$0.00	$714.00	$401.63	$401.63	$0.00	$0.00	$0.00	$186.02	$662.41	$662.41	$0.00	$0.00	$186.00	$0.00	$527.91	$527.91	$0.00	$446.25	$706.86	$714.00	$0.00		$0.00	$139.68	$0.00	$0.00	$142.09	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.210S	SUP	HCPCS C1713		04.161.210S  -  PLATE BONE NARROW 10 HOLE CVD LCP TITANIUM STERILE 3.5MM	BOTH IP/OP	$795.63 	$588.77	$0.00	$617.96	$347.60	$347.60	$0.00	$0.00	$0.00	$165.83	$590.51	$590.51	$0.00	$0.00	$165.81	$0.00	$470.61	$470.61	$0.00	$386.23	$611.78	$617.96	$0.00		$0.00	$117.37	$0.00	$0.00	$122.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.212S	SUP	HCPCS C1713		04.161.212S  -  PLATE BONE NARROW 12 HOLE CVD LCP TITANIUM PEDIATRIC STERILE	BOTH IP/OP	"$1,163.93 "	$861.31	$0.00	$904.02	$508.51	$508.51	$0.00	$0.00	$0.00	$242.59	$863.87	$863.87	$0.00	$0.00	$242.56	$0.00	$688.46	$688.46	$0.00	$565.01	$894.98	$904.02	$0.00		$0.00	$171.70	$0.00	$0.00	$179.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.214S	SUP	HCPCS C1713		04.161.214S  -  PLATE BONE CURVE NARROW 14 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,332.60 "	$986.12	$0.00	"$1,035.02"	$582.20	$582.20	$0.00	$0.00	$0.00	$277.75	$989.06	$989.06	$0.00	$0.00	$277.71	$0.00	$788.23	$788.23	$0.00	$646.89	"$1,024.67"	"$1,035.02"	$0.00		$0.00	$196.58	$0.00	$0.00	$205.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.216S	SUP	HCPCS C1713		04.161.216S  -  PLATE BONE CURVE NARROW 16 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,432.40 "	"$1,059.98"	$0.00	"$1,112.54"	$625.80	$625.80	$0.00	$0.00	$0.00	$298.55	"$1,063.13"	"$1,063.13"	$0.00	$0.00	$298.51	$0.00	$847.26	$847.26	$0.00	$695.34	"$1,101.42"	"$1,112.54"	$0.00		$0.00	$211.30	$0.00	$0.00	$221.40	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.218S	SUP	HCPCS C1713		04.161.218S  -  PLATE BONE CURVE NARROW 18 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,601.08 "	"$1,184.80"	$0.00	"$1,243.56"	$699.50	$699.50	$0.00	$0.00	$0.00	$333.70	"$1,188.32"	"$1,188.32"	$0.00	$0.00	$333.66	$0.00	$947.04	$947.04	$0.00	$777.23	"$1,231.12"	"$1,243.56"	$0.00		$0.00	$236.19	$0.00	$0.00	$247.47	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.220S	SUP	HCPCS C1713		04.161.220S  -  PLATE BONE CURVE NARROW 20 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,766.95 "	"$1,307.54"	$0.00	"$1,372.40"	$771.98	$771.98	$0.00	$0.00	$0.00	$368.28	"$1,311.43"	"$1,311.43"	$0.00	$0.00	$368.23	$0.00	"$1,045.15"	"$1,045.15"	$0.00	$857.75	"$1,358.68"	"$1,372.40"	$0.00		$0.00	$260.65	$0.00	$0.00	$273.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.222S	SUP	HCPCS C1713		04.161.222S  -  PLATE BONE CURVE NARROW 22 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,766.95 "	"$1,307.54"	$0.00	"$1,372.40"	$771.98	$771.98	$0.00	$0.00	$0.00	$368.28	"$1,311.43"	"$1,311.43"	$0.00	$0.00	$368.23	$0.00	"$1,045.15"	"$1,045.15"	$0.00	$857.75	"$1,358.68"	"$1,372.40"	$0.00		$0.00	$260.65	$0.00	$0.00	$273.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.240S	SUP	HCPCS C1713		04.161.240S  -  PLATE BONE CURVE NARROW 10 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,256.70 "	$929.96	$0.00	$976.06	$549.03	$549.03	$0.00	$0.00	$0.00	$261.93	$932.72	$932.72	$0.00	$0.00	$261.90	$0.00	$743.34	$743.34	$0.00	$610.04	$966.30	$976.06	$0.00		$0.00	$185.38	$0.00	$0.00	$194.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.242S	SUP	HCPCS C1713		04.161.242S  -  PLATE BONE CURVE NARROW 12 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,436.63 "	"$1,063.11"	$0.00	"$1,115.82"	$627.65	$627.65	$0.00	$0.00	$0.00	$299.43	"$1,066.26"	"$1,066.26"	$0.00	$0.00	$299.39	$0.00	$849.76	$849.76	$0.00	$697.39	"$1,104.67"	"$1,115.82"	$0.00		$0.00	$211.92	$0.00	$0.00	$222.05	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.244S	SUP	HCPCS C1713		04.161.244S  -  PLATE BONE CURVE NARROW 14 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,526.58 "	"$1,129.67"	$0.00	"$1,185.70"	$666.96	$666.96	$0.00	$0.00	$0.00	$318.18	"$1,133.02"	"$1,133.02"	$0.00	$0.00	$318.14	$0.00	$902.97	$902.97	$0.00	$741.06	"$1,173.85"	"$1,185.70"	$0.00		$0.00	$225.20	$0.00	$0.00	$235.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.246S	SUP	HCPCS C1713		04.161.246S  -  PLATE BONE CURVE NARROW 16 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,705.10 "	"$1,261.77"	$0.00	"$1,324.36"	$744.95	$744.95	$0.00	$0.00	$0.00	$355.39	"$1,265.53"	"$1,265.53"	$0.00	$0.00	$355.34	$0.00	"$1,008.57"	"$1,008.57"	$0.00	$827.73	"$1,311.12"	"$1,324.36"	$0.00		$0.00	$251.53	$0.00	$0.00	$263.55	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.248S	SUP	HCPCS C1713		04.161.248S  -  PLATE BONE CURVE NARROW 18 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$2,060.75 "	"$1,524.96"	$0.00	"$1,600.58"	$900.33	$900.33	$0.00	$0.00	$0.00	$429.51	"$1,529.49"	"$1,529.49"	$0.00	$0.00	$429.46	$0.00	"$1,218.93"	"$1,218.93"	$0.00	"$1,000.36"	"$1,584.58"	"$1,600.58"	$0.00		$0.00	$303.99	$0.00	$0.00	$318.52	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.250S	SUP	HCPCS C1713		04.161.250S  -  PLATE BONE CURVE NARROW 20 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$2,420.60 "	"$1,791.24"	$0.00	"$1,880.08"	"$1,057.55"	"$1,057.55"	$0.00	$0.00	$0.00	$504.51	"$1,796.57"	"$1,796.57"	$0.00	$0.00	$504.45	$0.00	"$1,431.78"	"$1,431.78"	$0.00	"$1,175.05"	"$1,861.28"	"$1,880.08"	$0.00		$0.00	$357.08	$0.00	$0.00	$374.14	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.252S	SUP	HCPCS C1713		04.161.252S  -  PLATE BONE CURVE NARROW 22 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$2,689.10 "	"$1,989.93"	$0.00	"$2,088.62"	"$1,174.85"	"$1,174.85"	$0.00	$0.00	$0.00	$560.48	"$1,995.85"	"$1,995.85"	$0.00	$0.00	$560.41	$0.00	"$1,325.73"	"$1,325.73"	$0.00	"$1,305.39"	"$2,067.74"	"$2,088.62"	$0.00		$0.00	$396.68	$0.00	$0.00	$415.64	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.270S	SUP	HCPCS C1713		04.161.270S  -  PLATE BONE CURVE BROAD 10 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	$981.18 	$726.07	$0.00	$762.08	$428.67	$428.67	$0.00	$0.00	$0.00	$204.50	$728.23	$728.23	$0.00	$0.00	$204.48	$0.00	$580.37	$580.37	$0.00	$476.30	$754.46	$762.08	$0.00		$0.00	$144.74	$0.00	$0.00	$151.65	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.272S	SUP	HCPCS C1713		04.161.272S  -  PLATE BONE CURVE BROAD 12 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,248.25 "	$923.71	$0.00	$969.52	$545.36	$545.36	$0.00	$0.00	$0.00	$260.17	$926.45	$926.45	$0.00	$0.00	$260.14	$0.00	$738.34	$738.34	$0.00	$605.95	$959.82	$969.52	$0.00		$0.00	$184.14	$0.00	$0.00	$192.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.274S	SUP	HCPCS C1713		04.161.274S  -  PLATE BONE CURVE BROAD 14 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,332.60 "	$986.12	$0.00	"$1,035.02"	$582.20	$582.20	$0.00	$0.00	$0.00	$277.75	$989.06	$989.06	$0.00	$0.00	$277.71	$0.00	$788.23	$788.23	$0.00	$646.89	"$1,024.67"	"$1,035.02"	$0.00		$0.00	$196.58	$0.00	$0.00	$205.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.276S	SUP	HCPCS C1713		04.161.276S  -  PLATE BONE CURVE BROAD 16 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,432.40 "	"$1,059.98"	$0.00	"$1,112.54"	$625.80	$625.80	$0.00	$0.00	$0.00	$298.55	"$1,063.13"	"$1,063.13"	$0.00	$0.00	$298.51	$0.00	$847.26	$847.26	$0.00	$695.34	"$1,101.42"	"$1,112.54"	$0.00		$0.00	$211.30	$0.00	$0.00	$221.40	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.278S	SUP	HCPCS C1713		04.161.278S  -  PLATE BONE CURVE BROAD 18 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,601.08 "	"$1,184.80"	$0.00	"$1,243.56"	$699.50	$699.50	$0.00	$0.00	$0.00	$333.70	"$1,188.32"	"$1,188.32"	$0.00	$0.00	$333.66	$0.00	$947.04	$947.04	$0.00	$777.23	"$1,231.12"	"$1,243.56"	$0.00		$0.00	$236.19	$0.00	$0.00	$247.47	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.280S	SUP	HCPCS C1713		04.161.280S  -  PLATE BONE CURVE BROAD 20 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,699.48 "	"$1,257.62"	$0.00	"$1,319.98"	$742.49	$742.49	$0.00	$0.00	$0.00	$354.21	"$1,261.35"	"$1,261.35"	$0.00	$0.00	$354.17	$0.00	"$1,005.24"	"$1,005.24"	$0.00	$824.99	"$1,306.78"	"$1,319.98"	$0.00		$0.00	$250.70	$0.00	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.282S	SUP	HCPCS C1713		04.161.282S  -  PLATE BONE CURVE BROAD 22 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,783.83 "	"$1,320.03"	$0.00	"$1,385.50"	$779.34	$779.34	$0.00	$0.00	$0.00	$371.79	"$1,323.95"	"$1,323.95"	$0.00	$0.00	$371.75	$0.00	"$1,055.13"	"$1,055.13"	$0.00	$865.94	"$1,371.65"	"$1,385.50"	$0.00		$0.00	$263.14	$0.00	$0.00	$275.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.284S	SUP	HCPCS C1713		04.161.284S  -  PLATE BONE CURVE BROAD 24 HOLE LCP TITANIUM PEDIATRIC SPN	BOTH IP/OP	"$1,783.83 "	"$1,320.03"	$0.00	"$1,385.50"	$779.34	$779.34	$0.00	$0.00	$0.00	$371.79	"$1,323.95"	"$1,323.95"	$0.00	$0.00	$371.75	$0.00	"$1,055.13"	"$1,055.13"	$0.00	$865.94	"$1,371.65"	"$1,385.50"	$0.00		$0.00	$263.14	$0.00	$0.00	$275.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.286S	SUP	HCPCS C1713		04.161.286S  -  PLATE BONE 26 HOLE CVD LCP TITANIUM PEDIATRIC STERILE 3.5 MM	BOTH IP/OP	"$1,886.45 "	"$1,395.97"	$0.00	"$1,465.20"	$824.18	$824.18	$0.00	$0.00	$0.00	$393.18	"$1,400.12"	"$1,400.12"	$0.00	$0.00	$393.14	$0.00	"$1,115.84"	"$1,115.84"	$0.00	$915.75	"$1,450.55"	"$1,465.20"	$0.00		$0.00	$278.28	$0.00	$0.00	$291.57	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.288S	SUP	HCPCS C1713		04.161.288S  -  PLATE BONE 28 HOLE CVD LCP TITANIUM PEDIATRIC STERILE 3.5 MM	BOTH IP/OP	"$2,064.95 "	"$1,528.06"	$0.00	"$1,603.86"	$902.17	$902.17	$0.00	$0.00	$0.00	$430.39	"$1,532.61"	"$1,532.61"	$0.00	$0.00	$430.34	$0.00	"$1,221.42"	"$1,221.42"	$0.00	"$1,002.41"	"$1,587.83"	"$1,603.86"	$0.00		$0.00	$304.62	$0.00	$0.00	$319.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.161.290S	SUP	HCPCS C1713		04.161.290S  -  PLATE BONE 30 HOLE CVD LCP TITANIUM PEDIATRIC STERILE 3.5 MM	BOTH IP/OP	"$2,244.90 "	"$1,661.23"	$0.00	"$1,743.60"	$980.78	$980.78	$0.00	$0.00	$0.00	$467.89	"$1,666.16"	"$1,666.16"	$0.00	$0.00	$467.84	$0.00	"$1,327.86"	"$1,327.86"	$0.00	"$1,089.75"	"$1,726.16"	"$1,743.60"	$0.00		$0.00	$331.16	$0.00	$0.00	$346.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.010	SUP	HCPCS C1713		04.200.010  -  SCREW BONE FULTHD 3.5MM 10MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.012	SUP	HCPCS C1713		04.200.012  -  SCREW BONE FULTHD 3.5MM 12MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.014	SUP	HCPCS C1713		04.200.014  -  SCREW BONE FULTHD 3.5MM 14MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.016	SUP	HCPCS C1713		04.200.016  -  SCREW BONE FULTHD 3.5MM 16MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.018	SUP	HCPCS C1713		04.200.018  -  SCREW BONE FULTHD 3.5MM 18MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.020	SUP	HCPCS C1713		04.200.020  -  SCREW BONE FULTHD 3.5MM 20MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.022	SUP	HCPCS C1713		04.200.022  -  SCREW BONE FULTHD 3.5MM 22MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.024	SUP	HCPCS C1713		04.200.024  -  SCREW BONE FULTHD 3.5MM 25MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.026	SUP	HCPCS C1713		04.200.026  -  SCREW BONE FULTHD 3.5MM 26MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.028	SUP	HCPCS C1713		04.200.028  -  SCREW BONE FULTHD 3.5MM 28MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.030	SUP	HCPCS C1713		04.200.030  -  SCREW BONE FULTHD 3.5MM 30MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.032	SUP	HCPCS C1713		04.200.032  -  SCREW BONE FULTHD 3.5MM 32MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.034	SUP	HCPCS C1713		04.200.034  -  SCREW BONE FULTHD 3.5MM 34MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.036	SUP	HCPCS C1713		04.200.036  -  SCREW BONE FULTHD 3.5MM 36MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.038	SUP	HCPCS C1713		04.200.038  -  SCREW BONE FULTHD 3.5MM 38MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.040	SUP	HCPCS C1713		04.200.040  -  SCREW BONE FULTHD 3.5MM 40MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.042	SUP	HCPCS C1713		04.200.042  -  SCREW BONE FULTHD 3.5MM 42MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.044	SUP	HCPCS C1713		04.200.044  -  SCREW BONE FULTHD 3.5MM 44MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.045	SUP	HCPCS C1713		04.200.045  -  SCREW BONE FULTHD 3.5MM 45MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.046	SUP	HCPCS C1713		04.200.046  -  SCREW BONE FULTHD 3.5MM 46MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.048	SUP	HCPCS C1713		04.200.048  -  SCREW BONE FULTHD 3.5MM 48MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.050	SUP	HCPCS C1713		04.200.050  -  SCREW BONE FULTHD 3.5MM 50MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.055	SUP	HCPCS C1713		04.200.055  -  SCREW BONE FULTHD 3.5MM 55MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.200.060	SUP	HCPCS C1713		04.200.060  -  SCREW BONE FULTHD 3.5MM 60MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$47.43 	$35.10	$0.00	$36.84	$20.72	$20.72	$0.00	$0.00	$0.00	$9.88	$35.20	$35.20	$0.00	$0.00	$9.88	$0.00	$28.05	$28.05	$0.00	$23.03	$36.47	$36.84	$0.00		$0.00	$7.00	$0.00	$0.00	$7.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.014	SUP	HCPCS C1713		04.204.014  -  SCREW BONE 4MM 14MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.016	SUP	HCPCS C1713		04.204.016  -  SCREW BONE 4MM 16MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.018	SUP	HCPCS C1713		04.204.018  -  SCREW BONE 4MM 18MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.020	SUP	HCPCS C1713		04.204.020  -  SCREW BONE 4MM 20MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.022	SUP	HCPCS C1713		04.204.022  -  SCREW BONE 4MM 22MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.024	SUP	HCPCS C1713		04.204.024  -  SCREW BONE 4MM 24MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.026	SUP	HCPCS C1713		04.204.026  -  SCREW BONE 4MM 26MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.028	SUP	HCPCS C1713		04.204.028  -  SCREW BONE 4MM 28MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.030	SUP	HCPCS C1713		04.204.030  -  SCREW BONE 4MM 30MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.032	SUP	HCPCS C1713		04.204.032  -  SCREW BONE 4MM 32MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.034	SUP	HCPCS C1713		04.204.034  -  SCREW BONE 4MM 34MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.036	SUP	HCPCS C1713		04.204.036  -  SCREW BONE 4MM 36MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.038	SUP	HCPCS C1713		04.204.038  -  SCREW BONE 4MM 38MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.040	SUP	HCPCS C1713		04.204.040  -  SCREW BONE 4MM 40MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.042	SUP	HCPCS C1713		04.204.042  -  SCREW BONE 4MM 42MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.044	SUP	HCPCS C1713		04.204.044  -  SCREW BONE 4MM 44MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.046	SUP	HCPCS C1713		04.204.046  -  SCREW BONE 4MM 46MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.048	SUP	HCPCS C1713		04.204.048  -  SCREW BONE 4MM 48MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.050	SUP	HCPCS C1713		04.204.050  -  SCREW BONE 4MM 50MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.052	SUP	HCPCS C1713		04.204.052  -  SCREW BONE 4MM 52MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.054	SUP	HCPCS C1713		04.204.054  -  SCREW BONE 4MM 54MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.056	SUP	HCPCS C1713		04.204.056  -  SCREW BONE 4MM 56MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.058	SUP	HCPCS C1713		04.204.058  -  SCREW BONE 4MM 58MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.060	SUP	HCPCS C1713		04.204.060  -  SCREW BONE 4MM 60MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.204.062	SUP	HCPCS C1713		04.204.062  -  SCREW BONE 4MM 62MM SLFTAP LOCKING STARDRIVE RECESS LCP	BOTH IP/OP	$254.40 	$188.26	$0.00	$203.52	$114.48	$114.48	$0.00	$0.00	$0.00	$53.02	$188.82	$188.82	$0.00	$0.00	$53.02	$0.00	$150.48	$150.48	$0.00	$127.20	$201.48	$203.52	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.025	SUP	HCPCS C1713		04.205.025  -  SCREW BONE 5MM 25MM LOCK CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.030	SUP	HCPCS C1713		04.205.030  -  SCREW BONE 5MM 30MM LOCK CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.035	SUP	HCPCS C1713		04.205.035  -  SCREW BONE 5MM 35MM LOCK CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.040	SUP	HCPCS C1713		04.205.040  -  SCREW BONE 5MM 40MM LOCK CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.045	SUP	HCPCS C1713		04.205.045  -  SCREW BONE 5MM 45MM LOCK CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.050	SUP	HCPCS C1713		04.205.050  -  SCREW BONE 5MM 50MM LOCK CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.055	SUP	HCPCS C1713		04.205.055  -  SCREW BONE 5MM 55MM LOCK CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.060	SUP	HCPCS C1713		04.205.060  -  SCREW BONE 5MM 60MM LOCK CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.065	SUP	HCPCS C1713		04.205.065  -  SCREW BONE 5MM 65MM CANN SELF DRILL LOCK THREAD CONICAL HEAD	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.070	SUP	HCPCS C1713		04.205.070  -  SCREW BONE 5MM 70MM LOCK CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.075	SUP	HCPCS C1713		04.205.075  -  SCREW BONE 5MM 75MM CANN SELF DRILL LOCK THREAD CONICAL HEAD	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.080	SUP	HCPCS C1713		04.205.080  -  SCREW BONE 5MM 80MM CANN SELF DRILL LOCK THREAD CONICAL HEAD	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.085	SUP	HCPCS C1713		04.205.085  -  SCREW BONE 5MM 85MM LOCK CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.090	SUP	HCPCS C1713		04.205.090  -  SCREW BONE 5MM 90MM LOCK CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.095	SUP	HCPCS C1713		04.205.095  -  SCREW BONE 5MM 95MM LOCK CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$368.30 	$272.54	$0.00	$286.06	$160.91	$160.91	$0.00	$0.00	$0.00	$76.76	$273.35	$273.35	$0.00	$0.00	$76.75	$0.00	$217.85	$217.85	$0.00	$178.79	$283.20	$286.06	$0.00		$0.00	$54.33	$0.00	$0.00	$56.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.240	SUP	HCPCS C1713		04.205.240  -  SCREW BONE CONE 5MM 40MM CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.245	SUP	HCPCS C1713		04.205.245  -  SCREW BONE CONE 5MM 45MM CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.250	SUP	HCPCS C1713		04.205.250  -  SCREW BONE CONE 5MM 50MM CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.255	SUP	HCPCS C1713		04.205.255  -  SCREW BONE CONE 5MM 55MM CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.260	SUP	HCPCS C1713		04.205.260  -  SCREW BONE CONE 5MM 60MM CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.265	SUP	HCPCS C1713		04.205.265  -  SCREW BONE CONE 5MM 65MM CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.270	SUP	HCPCS C1713		04.205.270  -  SCREW BONE CONE 5MM 70MM CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.275	SUP	HCPCS C1713		04.205.275  -  SCREW BONE CONE 5MM 75MM CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.280	SUP	HCPCS C1713		04.205.280  -  SCREW BONE CONE 5MM 80MM CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.285	SUP	HCPCS C1713		04.205.285  -  SCREW BONE CONE 5MM 85MM CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.290	SUP	HCPCS C1713		04.205.290  -  SCREW BONE CONE 5MM 90MM CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.205.295	SUP	HCPCS C1713		04.205.295  -  SCREW BONE CONE 5MM 95MM CANN LCP TITANIUM PERIARTICULAR	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.078	SUP	HCPCS C1713		04.210.078  -  PIN FIX 1.8MM 8MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$254.43 	$188.28	$0.00	$197.62	$111.16	$111.16	$0.00	$0.00	$0.00	$53.03	$188.83	$188.83	$0.00	$0.00	$53.02	$0.00	$150.49	$150.49	$0.00	$123.51	$195.65	$197.62	$0.00		$0.00	$37.53	$0.00	$0.00	$39.33	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.080	SUP	HCPCS C1713		04.210.080  -  PIN FIX 1.8MM 10MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.082	SUP	HCPCS C1713		04.210.082  -  PIN FIX 1.8MM 12MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.084	SUP	HCPCS C1713		04.210.084  -  PIN FIX 1.8MM 14MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.086	SUP	HCPCS C1713		04.210.086  -  PIN FIX 1.8MM 16MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.088	SUP	HCPCS C1713		04.210.088  -  PIN FIX 1.8MM 18MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.090	SUP	HCPCS C1713		04.210.090  -  PIN FIX 1.8MM 20MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.092	SUP	HCPCS C1713		04.210.092  -  PIN FIX 1.8MM 22MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.094	SUP	HCPCS C1713		04.210.094  -  PIN FIX 1.8MM 24MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.096	SUP	HCPCS C1713		04.210.096  -  PIN FIX 1.8MM 26MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.098	SUP	HCPCS C1713		04.210.098  -  PIN FIX 1.8MM 28MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.100	SUP	HCPCS C1713		04.210.100  -  PIN FIX 1.8MM 30MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.107	SUP	HCPCS C1713		04.210.107  -  SCREW BONE 2.4MM 7MM STARDRIVE LOCKING VAR ANG SLFTAP LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.108	SUP	HCPCS C1713		04.210.108  -  SCREW BONE 2.4MM 8MM T8 STARDRIVE RECESS LOCKING VAR ANG LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.109	SUP	HCPCS C1713		04.210.109  -  SCREW BONE 2.4MM 9MM STARDRIVE LOCKING VAR ANG SLFTAP LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.110	SUP	HCPCS C1713		04.210.110  -  SCREW BONE 2.4MM 10MM LOCKING VAR ANG STARDRIVE RECESS LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.111	SUP	HCPCS C1713		04.210.111  -  SCREW BONE 2.4MM 11MM STARDRIVE LOCKING VAR ANG SLFTAP LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.112	SUP	HCPCS C1713		04.210.112  -  SCREW BONE 2.4MM 12MM LOCKING VAR ANG STARDRIVE RECESS LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.113	SUP	HCPCS C1713		04.210.113  -  SCREW BONE 2.4MM 13MM STARDRIVE LOCKING VAR ANG SLFTAP LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.114	SUP	HCPCS C1713		04.210.114  -  SCREW BONE T8 2.4MM 14MM VAR ANG LOCK STARDRIVE LCP TITANIUM	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.116	SUP	HCPCS C1713		04.210.116  -  SCREW BONE T8 2.4MM 16MM VAR ANG LOCK STARDRIVE LCP TITANIUM	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.118	SUP	HCPCS C1713		04.210.118  -  SCREW BONE T8 2.4MM 18MM VAR ANG LOCK STARDRIVE LCP TITANIUM	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.120	SUP	HCPCS C1713		04.210.120  -  SCREW BONE T8 2.4MM 20MM VAR ANG LOCK STARDRIVE LCP TITANIUM	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.122	SUP	HCPCS C1713		04.210.122  -  SCREW BONE T8 2.4MM 22MM VAR ANG LOCK STARDRIVE LCP TITANIUM	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.124	SUP	HCPCS C1713		04.210.124  -  SCREW BONE T8 2.4MM 24MM VAR ANG LOCK STARDRIVE LCP TITANIUM	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.126	SUP	HCPCS C1713		04.210.126  -  SCREW BONE 2.4MM 26MM LOCKING VAR ANG STARDRIVE RECESS LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.128	SUP	HCPCS C1713		04.210.128  -  SCREW BONE 2.4MM 28MM LOCKING STARDRIVE RECESS VAR ANG LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.130	SUP	HCPCS C1713		04.210.130  -  SCREW BONE 2.4MM 30MM LOCKING STARDRIVE RECESS VAR ANG LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.132	SUP	HCPCS C1713		04.210.132  -  SCREW BONE 2.4MM 32MM LOCKING VAR ANG STARDRIVE RECESS LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.134	SUP	HCPCS C1713		04.210.134  -  SCREW BONE 2.4MM 34MM STARDRIVE LOCKING VAR ANG SLFTAP LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.136	SUP	HCPCS C1713		04.210.136  -  SCREW BONE 2.4MM 36MM STARDRIVE LOCKING VAR ANG SLFTAP LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.138	SUP	HCPCS C1713		04.210.138  -  SCREW BONE 2.4MM 38MM STARDRIVE LOCKING VAR ANG SLFTAP LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.140	SUP	HCPCS C1713		04.210.140  -  SCREW BONE 2.4MM 40MM STARDRIVE LOCKING VAR ANG SLFTAP LCP	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.142	SUP	HCPCS C1713		04.210.142  -  SCREW BONE 2.4MM 42MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.144	SUP	HCPCS C1713		04.210.144  -  SCREW BONE 2.4MM 44MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.146	SUP	HCPCS C1713		04.210.146  -  SCREW BONE 2.4MM 46MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.148	SUP	HCPCS C1713		04.210.148  -  SCREW BONE 2.4MM 48MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.150	SUP	HCPCS C1713		04.210.150  -  SCREW BONE 2.4MM 50MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.152	SUP	HCPCS C1713		04.210.152  -  SCREW BONE 2.4MM 52MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.154	SUP	HCPCS C1713		04.210.154  -  SCREW BONE 2.4MM 54MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.156	SUP	HCPCS C1713		04.210.156  -  SCREW BONE 2.4MM 56MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.158	SUP	HCPCS C1713		04.210.158  -  SCREW BONE 2.4MM 58MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.160	SUP	HCPCS C1713		04.210.160  -  SCREW BONE 2.4MM 60MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$250.23 	$185.17	$0.00	$194.34	$109.32	$109.32	$0.00	$0.00	$0.00	$52.15	$185.72	$185.72	$0.00	$0.00	$52.15	$0.00	$148.01	$148.01	$0.00	$121.46	$192.40	$194.34	$0.00		$0.00	$36.91	$0.00	$0.00	$38.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.942	SUP	HCPCS C1713		04.210.942  -  SCREW BONE 2.4MM 42MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP	BOTH IP/OP	$93.48 	$69.18	$0.00	$72.60	$40.84	$40.84	$0.00	$0.00	$0.00	$19.48	$69.38	$69.38	$0.00	$0.00	$19.48	$0.00	$55.29	$55.29	$0.00	$45.38	$71.87	$72.60	$0.00		$0.00	$13.79	$0.00	$0.00	$14.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.944	SUP	HCPCS C1713		04.210.944  -  SCREW BONE 2.4MM 44MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP	BOTH IP/OP	$93.48 	$69.18	$0.00	$72.60	$40.84	$40.84	$0.00	$0.00	$0.00	$19.48	$69.38	$69.38	$0.00	$0.00	$19.48	$0.00	$55.29	$55.29	$0.00	$45.38	$71.87	$72.60	$0.00		$0.00	$13.79	$0.00	$0.00	$14.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.946	SUP	HCPCS C1713		04.210.946  -  SCREW BONE 2.4MM 46MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP	BOTH IP/OP	$93.48 	$69.18	$0.00	$72.60	$40.84	$40.84	$0.00	$0.00	$0.00	$19.48	$69.38	$69.38	$0.00	$0.00	$19.48	$0.00	$55.29	$55.29	$0.00	$45.38	$71.87	$72.60	$0.00		$0.00	$13.79	$0.00	$0.00	$14.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.948	SUP	HCPCS C1713		04.210.948  -  SCREW BONE 2.4MM 48MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP	BOTH IP/OP	$93.48 	$69.18	$0.00	$72.60	$40.84	$40.84	$0.00	$0.00	$0.00	$19.48	$69.38	$69.38	$0.00	$0.00	$19.48	$0.00	$55.29	$55.29	$0.00	$45.38	$71.87	$72.60	$0.00		$0.00	$13.79	$0.00	$0.00	$14.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.950	SUP	HCPCS C1713		04.210.950  -  SCREW BONE 2.4MM 50MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP	BOTH IP/OP	$93.48 	$69.18	$0.00	$72.60	$40.84	$40.84	$0.00	$0.00	$0.00	$19.48	$69.38	$69.38	$0.00	$0.00	$19.48	$0.00	$55.29	$55.29	$0.00	$45.38	$71.87	$72.60	$0.00		$0.00	$13.79	$0.00	$0.00	$14.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.952	SUP	HCPCS C1713		04.210.952  -  SCREW BONE 2.4MM 52MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP	BOTH IP/OP	$93.48 	$69.18	$0.00	$72.60	$40.84	$40.84	$0.00	$0.00	$0.00	$19.48	$69.38	$69.38	$0.00	$0.00	$19.48	$0.00	$55.29	$55.29	$0.00	$45.38	$71.87	$72.60	$0.00		$0.00	$13.79	$0.00	$0.00	$14.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.954	SUP	HCPCS C1713		04.210.954  -  SCREW BONE 2.4MM 54MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP	BOTH IP/OP	$93.48 	$69.18	$0.00	$72.60	$40.84	$40.84	$0.00	$0.00	$0.00	$19.48	$69.38	$69.38	$0.00	$0.00	$19.48	$0.00	$55.29	$55.29	$0.00	$45.38	$71.87	$72.60	$0.00		$0.00	$13.79	$0.00	$0.00	$14.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.956	SUP	HCPCS C1713		04.210.956  -  SCREW BONE 2.4MM 56MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP	BOTH IP/OP	$93.48 	$69.18	$0.00	$72.60	$40.84	$40.84	$0.00	$0.00	$0.00	$19.48	$69.38	$69.38	$0.00	$0.00	$19.48	$0.00	$55.29	$55.29	$0.00	$45.38	$71.87	$72.60	$0.00		$0.00	$13.79	$0.00	$0.00	$14.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.958	SUP	HCPCS C1713		04.210.958  -  SCREW BONE 2.4MM 58MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP	BOTH IP/OP	$93.48 	$69.18	$0.00	$72.60	$40.84	$40.84	$0.00	$0.00	$0.00	$19.48	$69.38	$69.38	$0.00	$0.00	$19.48	$0.00	$55.29	$55.29	$0.00	$45.38	$71.87	$72.60	$0.00		$0.00	$13.79	$0.00	$0.00	$14.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.210.960	SUP	HCPCS C1713		04.210.960  -  SCREW BONE 2.4MM 60MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP	BOTH IP/OP	$93.48 	$69.18	$0.00	$72.60	$40.84	$40.84	$0.00	$0.00	$0.00	$19.48	$69.38	$69.38	$0.00	$0.00	$19.48	$0.00	$55.29	$55.29	$0.00	$45.38	$71.87	$72.60	$0.00		$0.00	$13.79	$0.00	$0.00	$14.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.008	SUP	HCPCS C1713		04.211.008  -  SCREW BONE 2.7MM 8MM T8 STARDRIVE RECESS VAR ANG SLFTAP	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.009	SUP	HCPCS C1713		04.211.009  -  SCREW BONE 2.7MM 9MM T8 STARDRIVE RECESS VAR ANG SLFTAP	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.010	SUP	HCPCS C1713		04.211.010  -  SCREW BONE 2.7MM 10MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.011	SUP	HCPCS C1713		04.211.011  -  SCREW BONE 2.7MM 11MM T8 STARDRIVE RECESS VAR ANG SLFTAP	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.012	SUP	HCPCS C1713		04.211.012  -  SCREW BONE 2.7MM 12MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.013	SUP	HCPCS C1713		04.211.013  -  SCREW BONE 2.7MM 13MM T8 STARDRIVE RECESS VAR ANG SLFTAP	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.014	SUP	HCPCS C1713		04.211.014  -  SCREW BONE 2.7MM 14MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.016	SUP	HCPCS C1713		04.211.016  -  SCREW BONE 2.7MM 16MM LOCKING VAR ANG SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.018	SUP	HCPCS C1713		04.211.018  -  SCREW BONE T8 2.7MM 18MM VAR ANG SELF TAP LOCK STARDRIVE LCP	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.020	SUP	HCPCS C1713		04.211.020  -  SCREW BONE T8 2.7MM 20MM VAR ANG SELF TAP LOCK STARDRIVE LCP	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.022	SUP	HCPCS C1713		04.211.022  -  SCREW BONE T8 2.7MM 22MM VAR ANG SELF TAP LOCK STARDRIVE LCP	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.024	SUP	HCPCS C1713		04.211.024  -  SCREW BONE T8 2.7MM 24MM VAR ANG SELF TAP LOCK STARDRIVE LCP	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.026	SUP	HCPCS C1713		04.211.026  -  SCREW BONE T8 2.7MM 26MM VAR ANG SELF TAP LOCK STARDRIVE LCP	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.028	SUP	HCPCS C1713		04.211.028  -  SCREW BONE T8 2.7MM 28MM VAR ANG SELF TAP LOCK STARDRIVE LCP	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.030	SUP	HCPCS C1713		04.211.030  -  SCREW BONE 2.7MM 30MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.032	SUP	HCPCS C1713		04.211.032  -  SCREW BONE 2.7MM 32MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.034	SUP	HCPCS C1713		04.211.034  -  SCREW BONE 2.7MM 34MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.036	SUP	HCPCS C1713		04.211.036  -  SCREW BONE 2.7MM 36MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.038	SUP	HCPCS C1713		04.211.038  -  SCREW BONE 2.7MM 38MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.040	SUP	HCPCS C1713		04.211.040  -  SCREW BONE 2.7MM 40MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.042	SUP	HCPCS C1713		04.211.042  -  SCREW BONE 2.7MM 42MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.044	SUP	HCPCS C1713		04.211.044  -  SCREW BONE 2.7MM 44MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.046	SUP	HCPCS C1713		04.211.046  -  SCREW BONE 2.7MM 46MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.048	SUP	HCPCS C1713		04.211.048  -  SCREW BONE 2.7MM 48MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.050	SUP	HCPCS C1713		04.211.050  -  SCREW BONE 2.7MM 50MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.052	SUP	HCPCS C1713		04.211.052  -  SCREW BONE 2.7MM 52MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.054	SUP	HCPCS C1713		04.211.054  -  SCREW BONE 2.7MM 54MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.056	SUP	HCPCS C1713		04.211.056  -  SCREW BONE 2.7MM 56MM VAR ANG LOCKING SLFTAP T8 STARDRIVE	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.058	SUP	HCPCS C1713		04.211.058  -  SCREW BONE 2.4MM 58MM LOCKING T8 STARDRIVE RECESS VAR ANG	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.060	SUP	HCPCS C1713		04.211.060  -  SCREW BONE 2.4MM 60MM LOCKING T8 STARDRIVE RECESS VAR ANG	BOTH IP/OP	$253.03 	$187.24	$0.00	$196.52	$110.54	$110.54	$0.00	$0.00	$0.00	$52.74	$187.80	$187.80	$0.00	$0.00	$52.73	$0.00	$149.66	$149.66	$0.00	$122.83	$194.55	$196.52	$0.00		$0.00	$37.33	$0.00	$0.00	$39.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.201	SUP	HCPCS C1713		04.211.201  -  PLATE BONE XS 24MM VAR ANG LOCKING X LCP TITANIUM FRFT MIDFT	BOTH IP/OP	"$1,821.78 "	"$1,348.12"	$0.00	"$1,414.98"	$795.93	$795.93	$0.00	$0.00	$0.00	$379.70	"$1,352.12"	"$1,352.12"	$0.00	$0.00	$379.66	$0.00	"$1,077.58"	"$1,077.58"	$0.00	$884.36	"$1,400.83"	"$1,414.98"	$0.00		$0.00	$268.74	$0.00	$0.00	$281.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.202	SUP	HCPCS C1713		04.211.202  -  PLATE BONE SMALL 27MM VAR ANG LOCKING X LCP TITANIUM FRFT	BOTH IP/OP	"$1,821.78 "	"$1,348.12"	$0.00	"$1,414.98"	$795.93	$795.93	$0.00	$0.00	$0.00	$379.70	"$1,352.12"	"$1,352.12"	$0.00	$0.00	$379.66	$0.00	"$1,077.58"	"$1,077.58"	$0.00	$884.36	"$1,400.83"	"$1,414.98"	$0.00		$0.00	$268.74	$0.00	$0.00	$281.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.203	SUP	HCPCS C1713		04.211.203  -  PLATE BONE MEDIUM 32MM VAR ANG LOCKING X LCP TITANIUM FRFT	BOTH IP/OP	"$1,821.78 "	"$1,348.12"	$0.00	"$1,414.98"	$795.93	$795.93	$0.00	$0.00	$0.00	$379.70	"$1,352.12"	"$1,352.12"	$0.00	$0.00	$379.66	$0.00	"$1,077.58"	"$1,077.58"	$0.00	$884.36	"$1,400.83"	"$1,414.98"	$0.00		$0.00	$268.74	$0.00	$0.00	$281.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.204	SUP	HCPCS C1713		04.211.204  -  PLATE BN LG X 36MM NS LCP VA LCK LOPRFL CMPR WRE HL TI	BOTH IP/OP	"$1,821.78 "	"$1,348.12"	$0.00	"$1,414.98"	$795.93	$795.93	$0.00	$0.00	$0.00	$379.70	"$1,352.12"	"$1,352.12"	$0.00	$0.00	$379.66	$0.00	"$1,077.58"	"$1,077.58"	$0.00	$884.36	"$1,400.83"	"$1,414.98"	$0.00		$0.00	$268.74	$0.00	$0.00	$281.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.210	SUP	HCPCS C1713		04.211.210  -  PLATE BONE 0MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT	BOTH IP/OP	"$1,778.20 "	"$1,315.87"	$0.00	"$1,381.12"	$776.88	$776.88	$0.00	$0.00	$0.00	$370.62	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$370.58	$0.00	"$1,051.81"	"$1,051.81"	$0.00	$863.20	"$1,367.31"	"$1,381.12"	$0.00		$0.00	$262.31	$0.00	$0.00	$274.84	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.211	SUP	HCPCS C1713		04.211.211  -  PLATE BONE 3MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT	BOTH IP/OP	"$1,778.20 "	"$1,315.87"	$0.00	"$1,381.12"	$776.88	$776.88	$0.00	$0.00	$0.00	$370.62	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$370.58	$0.00	"$1,051.81"	"$1,051.81"	$0.00	$863.20	"$1,367.31"	"$1,381.12"	$0.00		$0.00	$262.31	$0.00	$0.00	$274.84	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.212	SUP	HCPCS C1713		04.211.212  -  PLATE BONE 4MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT	BOTH IP/OP	"$1,778.20 "	"$1,315.87"	$0.00	"$1,381.12"	$776.88	$776.88	$0.00	$0.00	$0.00	$370.62	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$370.58	$0.00	"$1,051.81"	"$1,051.81"	$0.00	$863.20	"$1,367.31"	"$1,381.12"	$0.00		$0.00	$262.31	$0.00	$0.00	$274.84	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.213	SUP	HCPCS C1713		04.211.213  -  PLATE BONE 5MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT	BOTH IP/OP	"$1,730.40 "	"$1,280.50"	$0.00	"$1,344.00"	$756.00	$756.00	$0.00	$0.00	$0.00	$360.66	"$1,284.30"	"$1,284.30"	$0.00	$0.00	$360.62	$0.00	"$1,023.53"	"$1,023.53"	$0.00	$840.00	"$1,330.56"	"$1,344.00"	$0.00		$0.00	$255.26	$0.00	$0.00	$267.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.214	SUP	HCPCS C1713		04.211.214  -  PLATE BONE 6MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT	BOTH IP/OP	"$1,778.20 "	"$1,315.87"	$0.00	"$1,381.12"	$776.88	$776.88	$0.00	$0.00	$0.00	$370.62	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$370.58	$0.00	"$1,051.81"	"$1,051.81"	$0.00	$863.20	"$1,367.31"	"$1,381.12"	$0.00		$0.00	$262.31	$0.00	$0.00	$274.84	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.215	SUP	HCPCS C1713		04.211.215  -  PLATE BONE 7MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT	BOTH IP/OP	"$1,778.20 "	"$1,315.87"	$0.00	"$1,381.12"	$776.88	$776.88	$0.00	$0.00	$0.00	$370.62	"$1,319.78"	"$1,319.78"	$0.00	$0.00	$370.58	$0.00	"$1,051.81"	"$1,051.81"	$0.00	$863.20	"$1,367.31"	"$1,381.12"	$0.00		$0.00	$262.31	$0.00	$0.00	$274.84	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.220	SUP	HCPCS C1713		04.211.220  -  PLATE BONE VAR ANG LOCKING LCP TITANIUM NAVICULAR TARSAL	BOTH IP/OP	"$2,168.98 "	"$1,605.05"	$0.00	"$1,684.64"	$947.61	$947.61	$0.00	$0.00	$0.00	$452.07	"$1,609.81"	"$1,609.81"	$0.00	$0.00	$452.01	$0.00	"$1,282.95"	"$1,282.95"	$0.00	"$1,052.90"	"$1,667.79"	"$1,684.64"	$0.00		$0.00	$319.96	$0.00	$0.00	$335.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.221	SUP	HCPCS C1713		04.211.221  -  PLATE BONE VAR ANG LOCKING LCP TITANIUM LEFT CUBOID TARSAL	BOTH IP/OP	"$2,168.98 "	"$1,605.05"	$0.00	"$1,684.64"	$947.61	$947.61	$0.00	$0.00	$0.00	$452.07	"$1,609.81"	"$1,609.81"	$0.00	$0.00	$452.01	$0.00	"$1,282.95"	"$1,282.95"	$0.00	"$1,052.90"	"$1,667.79"	"$1,684.64"	$0.00		$0.00	$319.96	$0.00	$0.00	$335.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.222	SUP	HCPCS C1713		04.211.222  -  PLATE BONE VAR ANG LOCKING LCP TITANIUM RIGHT CUBOID TARSAL	BOTH IP/OP	"$2,168.98 "	"$1,605.05"	$0.00	"$1,684.64"	$947.61	$947.61	$0.00	$0.00	$0.00	$452.07	"$1,609.81"	"$1,609.81"	$0.00	$0.00	$452.01	$0.00	"$1,282.95"	"$1,282.95"	$0.00	"$1,052.90"	"$1,667.79"	"$1,684.64"	$0.00		$0.00	$319.96	$0.00	$0.00	$335.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.224	SUP	HCPCS C1713		04.211.224  -  PLATE BONE 5X12 HOLE MESH VAR ANG LOCKING LCP TITANIUM	BOTH IP/OP	"$3,054.58 "	"$2,260.39"	$0.00	"$2,372.48"	"$1,334.52"	"$1,334.52"	$0.00	$0.00	$0.00	$636.65	"$2,267.11"	"$2,267.11"	$0.00	$0.00	$636.57	$0.00	"$1,505.91"	"$1,505.91"	$0.00	"$1,482.80"	"$2,348.76"	"$2,372.48"	$0.00		$0.00	$450.60	$0.00	$0.00	$472.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.230	SUP	HCPCS C1713		04.211.230  -  PLATE BN 0D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.231	SUP	HCPCS C1713		04.211.231  -  PLATE BONE 0D SMALL 42MM FUSION VAR ANG LCP TITANIUM LEFT	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.232	SUP	HCPCS C1713		04.211.232  -  PLATE BONE 5D SMALL 42MM FUSION VAR ANG LCP TITANIUM RIGHT	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.233	SUP	HCPCS C1713		04.211.233  -  PLATE BONE 5D SMALL 42MM FUSION VAR ANG LCP TITANIUM LEFT	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.234	SUP	HCPCS C1713		04.211.234  -  PLATE BONE 10D SMALL 42MM FUSION VAR ANG LCP TITANIUM RIGHT	BOTH IP/OP	"$1,907.53 "	"$1,411.57"	$0.00	"$1,481.58"	$833.39	$833.39	$0.00	$0.00	$0.00	$397.58	"$1,415.77"	"$1,415.77"	$0.00	$0.00	$397.53	$0.00	"$1,128.30"	"$1,128.30"	$0.00	$925.99	"$1,466.77"	"$1,481.58"	$0.00		$0.00	$281.39	$0.00	$0.00	$294.83	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.235	SUP	HCPCS C1713		04.211.235  -  PLATE BONE 10D SMALL 42MM FUSION VAR ANG LCP TITANIUM LEFT	BOTH IP/OP	"$1,907.53 "	"$1,411.57"	$0.00	"$1,481.58"	$833.39	$833.39	$0.00	$0.00	$0.00	$397.58	"$1,415.77"	"$1,415.77"	$0.00	$0.00	$397.53	$0.00	"$1,128.30"	"$1,128.30"	$0.00	$925.99	"$1,466.77"	"$1,481.58"	$0.00		$0.00	$281.39	$0.00	$0.00	$294.83	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.236	SUP	HCPCS C1713		04.211.236  -  PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.237	SUP	HCPCS C1713		04.211.237  -  PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST	BOTH IP/OP	"$1,907.53 "	"$1,411.57"	$0.00	"$1,481.58"	$833.39	$833.39	$0.00	$0.00	$0.00	$397.58	"$1,415.77"	"$1,415.77"	$0.00	$0.00	$397.53	$0.00	"$1,128.30"	"$1,128.30"	$0.00	$925.99	"$1,466.77"	"$1,481.58"	$0.00		$0.00	$281.39	$0.00	$0.00	$294.83	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.238	SUP	HCPCS C1713		04.211.238  -  PLATE BONE 5D MEDIUM 52MM FUSION VAR ANG LCP TITANIUM RIGHT	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.239	SUP	HCPCS C1713		04.211.239  -  PLATE BN 5D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST	BOTH IP/OP	"$1,907.53 "	"$1,411.57"	$0.00	"$1,481.58"	$833.39	$833.39	$0.00	$0.00	$0.00	$397.58	"$1,415.77"	"$1,415.77"	$0.00	$0.00	$397.53	$0.00	"$1,128.30"	"$1,128.30"	$0.00	$925.99	"$1,466.77"	"$1,481.58"	$0.00		$0.00	$281.39	$0.00	$0.00	$294.83	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.240	SUP	HCPCS C1713		04.211.240  -  PLATE BONE 10D MEDIUM 52MM FUSION VAR ANG LCP TITANIUM RIGHT	BOTH IP/OP	"$1,907.53 "	"$1,411.57"	$0.00	"$1,481.58"	$833.39	$833.39	$0.00	$0.00	$0.00	$397.58	"$1,415.77"	"$1,415.77"	$0.00	$0.00	$397.53	$0.00	"$1,128.30"	"$1,128.30"	$0.00	$925.99	"$1,466.77"	"$1,481.58"	$0.00		$0.00	$281.39	$0.00	$0.00	$294.83	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.241	SUP	HCPCS C1713		04.211.241  -  PLATE BONE 10D MEDIUM 52MM FUSION VAR ANG LCP TITANIUM LEFT	BOTH IP/OP	"$1,907.53 "	"$1,411.57"	$0.00	"$1,481.58"	$833.39	$833.39	$0.00	$0.00	$0.00	$397.58	"$1,415.77"	"$1,415.77"	$0.00	$0.00	$397.53	$0.00	"$1,128.30"	"$1,128.30"	$0.00	$925.99	"$1,466.77"	"$1,481.58"	$0.00		$0.00	$281.39	$0.00	$0.00	$294.83	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.242	SUP	HCPCS C1713		04.211.242  -  PLATE BONE 5D LARGE 57MM FUSION VAR ANG LCP TITANIUM RIGHT	BOTH IP/OP	"$2,168.98 "	"$1,605.05"	$0.00	"$1,684.64"	$947.61	$947.61	$0.00	$0.00	$0.00	$452.07	"$1,609.81"	"$1,609.81"	$0.00	$0.00	$452.01	$0.00	"$1,282.95"	"$1,282.95"	$0.00	"$1,052.90"	"$1,667.79"	"$1,684.64"	$0.00		$0.00	$319.96	$0.00	$0.00	$335.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.243	SUP	HCPCS C1713		04.211.243  -  PLATE BONE 5D LARGE 57MM FUSION VAR ANG LCP TITANIUM LEFT	BOTH IP/OP	"$2,168.98 "	"$1,605.05"	$0.00	"$1,684.64"	$947.61	$947.61	$0.00	$0.00	$0.00	$452.07	"$1,609.81"	"$1,609.81"	$0.00	$0.00	$452.01	$0.00	"$1,282.95"	"$1,282.95"	$0.00	"$1,052.90"	"$1,667.79"	"$1,684.64"	$0.00		$0.00	$319.96	$0.00	$0.00	$335.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.244	SUP	HCPCS C1713		04.211.244  -  PLATE BONE 0D 53MM REVISION FUSION VAR ANG LCP TITANIUM	BOTH IP/OP	"$2,341.88 "	"$1,732.99"	$0.00	"$1,818.94"	"$1,023.15"	"$1,023.15"	$0.00	$0.00	$0.00	$488.11	"$1,738.14"	"$1,738.14"	$0.00	$0.00	$488.05	$0.00	"$1,385.22"	"$1,385.22"	$0.00	"$1,136.84"	"$1,800.75"	"$1,818.94"	$0.00		$0.00	$345.47	$0.00	$0.00	$361.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.245	SUP	HCPCS C1713		04.211.245  -  PLATE BONE 0D 53MM REVISION FUSION VAR ANG LCP TITANIUM LEFT	BOTH IP/OP	"$2,341.88 "	"$1,732.99"	$0.00	"$1,818.94"	"$1,023.15"	"$1,023.15"	$0.00	$0.00	$0.00	$488.11	"$1,738.14"	"$1,738.14"	$0.00	$0.00	$488.05	$0.00	"$1,385.22"	"$1,385.22"	$0.00	"$1,136.84"	"$1,800.75"	"$1,818.94"	$0.00		$0.00	$345.47	$0.00	$0.00	$361.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.246	SUP	HCPCS C1713		04.211.246  -  PLATE BONE LONG 39MM FUSION VAR ANG LCP TITANIUM FIRST	BOTH IP/OP	"$1,855.53 "	"$1,373.09"	$0.00	"$1,441.18"	$810.66	$810.66	$0.00	$0.00	$0.00	$386.74	"$1,377.17"	"$1,377.17"	$0.00	$0.00	$386.69	$0.00	"$1,097.54"	"$1,097.54"	$0.00	$900.74	"$1,426.77"	"$1,441.18"	$0.00		$0.00	$273.72	$0.00	$0.00	$286.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.247	SUP	HCPCS C1713		04.211.247  -  PLATE BONE LONG 48MM FUSION VAR ANG LCP TITANIUM FIRST	BOTH IP/OP	"$1,907.53 "	"$1,411.57"	$0.00	"$1,481.58"	$833.39	$833.39	$0.00	$0.00	$0.00	$397.58	"$1,415.77"	"$1,415.77"	$0.00	$0.00	$397.53	$0.00	"$1,128.30"	"$1,128.30"	$0.00	$925.99	"$1,466.77"	"$1,481.58"	$0.00		$0.00	$281.39	$0.00	$0.00	$294.83	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.250	SUP	HCPCS C1713		04.211.250  -  PLATE BONE SHORT 38MM CLOVERLEAF FUSION VAR ANG LCP TITANIUM	BOTH IP/OP	"$1,692.45 "	"$1,252.41"	$0.00	"$1,314.52"	$739.42	$739.42	$0.00	$0.00	$0.00	$352.75	"$1,256.14"	"$1,256.14"	$0.00	$0.00	$352.71	$0.00	"$1,001.08"	"$1,001.08"	$0.00	$821.58	"$1,301.37"	"$1,314.52"	$0.00		$0.00	$249.66	$0.00	$0.00	$261.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.251	SUP	HCPCS C1713		04.211.251  -  PLATE BONE STANDARD 45MM CLOVERLEAF FUSION VAR ANG LCP	BOTH IP/OP	"$1,692.45 "	"$1,252.41"	$0.00	"$1,314.52"	$739.42	$739.42	$0.00	$0.00	$0.00	$352.75	"$1,256.14"	"$1,256.14"	$0.00	$0.00	$352.71	$0.00	"$1,001.08"	"$1,001.08"	$0.00	$821.58	"$1,301.37"	"$1,314.52"	$0.00		$0.00	$249.66	$0.00	$0.00	$261.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.252	SUP	HCPCS C1713		04.211.252  -  PLATE BONE LONG 64MM CLOVERLEAF FUSION VAR ANG LCP TITANIUM	BOTH IP/OP	"$1,734.63 "	"$1,283.63"	$0.00	"$1,347.28"	$757.85	$757.85	$0.00	$0.00	$0.00	$361.54	"$1,287.44"	"$1,287.44"	$0.00	$0.00	$361.50	$0.00	"$1,026.03"	"$1,026.03"	$0.00	$842.05	"$1,333.81"	"$1,347.28"	$0.00		$0.00	$255.89	$0.00	$0.00	$268.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.253	SUP	HCPCS C1713		04.211.253  -  PLATE BONE SHORT 35MM T FUSION VAR ANG LCP TITANIUM FRFT	BOTH IP/OP	"$1,603.90 "	"$1,186.89"	$0.00	"$1,245.74"	$700.73	$700.73	$0.00	$0.00	$0.00	$334.29	"$1,190.41"	"$1,190.41"	$0.00	$0.00	$334.25	$0.00	$948.71	$948.71	$0.00	$778.59	"$1,233.29"	"$1,245.74"	$0.00		$0.00	$236.60	$0.00	$0.00	$247.90	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.254	SUP	HCPCS C1713		04.211.254  -  PLATE BONE STANDARD 42MM T FUSION VAR ANG LCP TITANIUM FRFT	BOTH IP/OP	"$1,692.45 "	"$1,252.41"	$0.00	"$1,314.52"	$739.42	$739.42	$0.00	$0.00	$0.00	$352.75	"$1,256.14"	"$1,256.14"	$0.00	$0.00	$352.71	$0.00	"$1,001.08"	"$1,001.08"	$0.00	$821.58	"$1,301.37"	"$1,314.52"	$0.00		$0.00	$249.66	$0.00	$0.00	$261.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.255	SUP	HCPCS C1713		04.211.255  -  PLATE BONE LONG 61MM T FUSION VAR ANG LCP TITANIUM FRFT	BOTH IP/OP	"$1,734.63 "	"$1,283.63"	$0.00	"$1,347.28"	$757.85	$757.85	$0.00	$0.00	$0.00	$361.54	"$1,287.44"	"$1,287.44"	$0.00	$0.00	$361.50	$0.00	"$1,026.03"	"$1,026.03"	$0.00	$842.05	"$1,333.81"	"$1,347.28"	$0.00		$0.00	$255.89	$0.00	$0.00	$268.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.256	SUP	HCPCS C1713		04.211.256  -  PLATE BONE SHORT 37MM L FUSION VAR ANG LCP TITANIUM RIGHT	BOTH IP/OP	"$1,648.88 "	"$1,220.17"	$0.00	"$1,280.68"	$720.38	$720.38	$0.00	$0.00	$0.00	$343.67	"$1,223.80"	"$1,223.80"	$0.00	$0.00	$343.63	$0.00	$975.31	$975.31	$0.00	$800.43	"$1,267.87"	"$1,280.68"	$0.00		$0.00	$243.24	$0.00	$0.00	$254.86	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.257	SUP	HCPCS C1713		04.211.257  -  PLATE BONE SHORT 37MM L FUSION VAR ANG LCP TITANIUM LEFT	BOTH IP/OP	"$1,648.88 "	"$1,220.17"	$0.00	"$1,280.68"	$720.38	$720.38	$0.00	$0.00	$0.00	$343.67	"$1,223.80"	"$1,223.80"	$0.00	$0.00	$343.63	$0.00	$975.31	$975.31	$0.00	$800.43	"$1,267.87"	"$1,280.68"	$0.00		$0.00	$243.24	$0.00	$0.00	$254.86	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.258	SUP	HCPCS C1713		04.211.258  -  PLATE BONE STANDARD 37MM L FUSION VAR ANG LCP TITANIUM RIGHT	BOTH IP/OP	"$1,692.45 "	"$1,252.41"	$0.00	"$1,314.52"	$739.42	$739.42	$0.00	$0.00	$0.00	$352.75	"$1,256.14"	"$1,256.14"	$0.00	$0.00	$352.71	$0.00	"$1,001.08"	"$1,001.08"	$0.00	$821.58	"$1,301.37"	"$1,314.52"	$0.00		$0.00	$249.66	$0.00	$0.00	$261.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.259	SUP	HCPCS C1713		04.211.259  -  PLATE BONE STANDARD 44MM L FUSION VAR ANG LCP TITANIUM LEFT	BOTH IP/OP	"$1,692.45 "	"$1,252.41"	$0.00	"$1,314.52"	$739.42	$739.42	$0.00	$0.00	$0.00	$352.75	"$1,256.14"	"$1,256.14"	$0.00	$0.00	$352.71	$0.00	"$1,001.08"	"$1,001.08"	$0.00	$821.58	"$1,301.37"	"$1,314.52"	$0.00		$0.00	$249.66	$0.00	$0.00	$261.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.260	SUP	HCPCS C1713		04.211.260  -  PLATE BONE LONG 62MM L FUSION VAR ANG LCP TITANIUM RIGHT	BOTH IP/OP	"$1,734.63 "	"$1,283.63"	$0.00	"$1,347.28"	$757.85	$757.85	$0.00	$0.00	$0.00	$361.54	"$1,287.44"	"$1,287.44"	$0.00	$0.00	$361.50	$0.00	"$1,026.03"	"$1,026.03"	$0.00	$842.05	"$1,333.81"	"$1,347.28"	$0.00		$0.00	$255.89	$0.00	$0.00	$268.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.261	SUP	HCPCS C1713		04.211.261  -  PLATE BN LNG L 62MM NS LCP VA FSN LOPRFL CMPR WRE HL TI	BOTH IP/OP	"$1,734.63 "	"$1,283.63"	$0.00	"$1,347.28"	$757.85	$757.85	$0.00	$0.00	$0.00	$361.54	"$1,287.44"	"$1,287.44"	$0.00	$0.00	$361.50	$0.00	"$1,026.03"	"$1,026.03"	$0.00	$842.05	"$1,333.81"	"$1,347.28"	$0.00		$0.00	$255.89	$0.00	$0.00	$268.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.262	SUP	HCPCS C1713		04.211.262  -  PLATE BONE 27MM 2 HOLE STR FUSION LOCKING VAR ANG LCP	BOTH IP/OP	"$1,475.98 "	"$1,092.23"	$0.00	"$1,146.40"	$644.85	$644.85	$0.00	$0.00	$0.00	$307.63	"$1,095.47"	"$1,095.47"	$0.00	$0.00	$307.59	$0.00	$873.04	$873.04	$0.00	$716.50	"$1,134.94"	"$1,146.40"	$0.00		$0.00	$217.73	$0.00	$0.00	$228.13	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.263	SUP	HCPCS C1713		04.211.263  -  PLATE BONE 40MM 4 HOLE STR FUSION LOCKING VAR ANG LCP	BOTH IP/OP	"$1,560.33 "	"$1,154.64"	$0.00	"$1,211.90"	$681.69	$681.69	$0.00	$0.00	$0.00	$325.21	"$1,158.07"	"$1,158.07"	$0.00	$0.00	$325.17	$0.00	$922.93	$922.93	$0.00	$757.44	"$1,199.78"	"$1,211.90"	$0.00		$0.00	$230.17	$0.00	$0.00	$241.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.265	SUP	HCPCS C1713		04.211.265  -  PLATE BONE XLONG 92MM 3 HOLE T FUSION VAR ANG LCP TITANIUM	BOTH IP/OP	"$2,168.98 "	"$1,605.05"	$0.00	"$1,684.64"	$947.61	$947.61	$0.00	$0.00	$0.00	$452.07	"$1,609.81"	"$1,609.81"	$0.00	$0.00	$452.01	$0.00	"$1,282.95"	"$1,282.95"	$0.00	"$1,052.90"	"$1,667.79"	"$1,684.64"	$0.00		$0.00	$319.96	$0.00	$0.00	$335.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.211.266	SUP	HCPCS C1713		04.211.266  -  PLATE BONE 43MM TMT FUSION VAR ANG LCP TITANIUM FRFT MIDFT	BOTH IP/OP	"$1,686.83 "	"$1,248.25"	$0.00	"$1,310.16"	$736.97	$736.97	$0.00	$0.00	$0.00	$351.58	"$1,251.96"	"$1,251.96"	$0.00	$0.00	$351.53	$0.00	$997.76	$997.76	$0.00	$818.85	"$1,297.06"	"$1,310.16"	$0.00		$0.00	$248.84	$0.00	$0.00	$260.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.212.054	SUP	HCPCS C1713		04.212.054  -  SCREW BONE 3.5MM 54MM SELF TAP LOCK LCP TITANIUM FIBULA	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.212.056	SUP	HCPCS C1713		04.212.056  -  SCREW BONE 3.5MM 56MM SELF TAP LOCK LCP TITANIUM FIBULA	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.212.058	SUP	HCPCS C1713		04.212.058  -  SCREW BONE 3.5MM 58MM SELF TAP LOCK LCP TITANIUM FIBULA	BOTH IP/OP	$234.75 	$173.72	$0.00	$182.34	$102.57	$102.57	$0.00	$0.00	$0.00	$48.93	$174.23	$174.23	$0.00	$0.00	$48.92	$0.00	$138.85	$138.85	$0.00	$113.96	$180.52	$182.34	$0.00		$0.00	$34.63	$0.00	$0.00	$36.29	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.006	SUP	HCPCS C1713		04.214.006  -  SCREW BONE 1.5MM 6MM LOCKING SLFTAP T4 STARDRIVE RECESS	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.007	SUP	HCPCS C1713		04.214.007  -  SCREW BONE 1.5MM 7MM LOCKING SLFTAP T4 STARDRIVE RECESS	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.008	SUP	HCPCS C1713		04.214.008  -  SCREW BONE 1.5MM 8MM LOCKING SLFTAP T4 STARDRIVE RECESS	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.009	SUP	HCPCS C1713		04.214.009  -  SCREW BONE 1.5MM 9MM LOCKING SLFTAP T4 STARDRIVE RECESS	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.010	SUP	HCPCS C1713		04.214.010  -  SCREW BONE 1.5MM 10MM LOCKING SLFTAP T4 STARDRIVE RECESS	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.011	SUP	HCPCS C1713		04.214.011  -  SCREW BONE 1.5MM 11MM LOCKING SLFTAP T4 STARDRIVE RECESS	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.012	SUP	HCPCS C1713		04.214.012  -  SCREW BONE 1.5MM 12MM LOCKING SLFTAP T4 STARDRIVE RECESS	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.013	SUP	HCPCS C1713		04.214.013  -  SCREW BONE 1.5MM 13MM SLFTAP STARDRIVE TITANIUM ALLOY	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.014	SUP	HCPCS C1713		04.214.014  -  SCREW BONE 1.5MM 14MM SLFTAP STARDRIVE TITANIUM ALLOY	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.015	SUP	HCPCS C1713		04.214.015  -  SCREW BONE 1.5MM 15MM SLFTAP STARDRIVE TITANIUM ALLOY	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.016	SUP	HCPCS C1713		04.214.016  -  SCREW BONE 1.5MM 16MM SLFTAP STARDRIVE TITANIUM ALLOY	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.018	SUP	HCPCS C1713		04.214.018  -  SCREW BONE 1.5MM 18MM SLFTAP STARDRIVE TITANIUM ALLOY	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.020	SUP	HCPCS C1713		04.214.020  -  SCREW BONE 1.5MM 20MM SLFTAP STARDRIVE TITANIUM ALLOY	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.022	SUP	HCPCS C1713		04.214.022  -  SCREW BONE 1.5MM 22MM LOCKING SLFTAP COMPACT STARDRIVE LCP	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.024	SUP	HCPCS C1713		04.214.024  -  SCREW BONE 1.5MM 24MM LOCKING SLFTAP COMPACT STARDRIVE LCP	BOTH IP/OP	$208.05 	$153.96	$0.00	$161.58	$90.89	$90.89	$0.00	$0.00	$0.00	$43.36	$154.41	$154.41	$0.00	$0.00	$43.36	$0.00	$123.06	$123.06	$0.00	$100.99	$159.97	$161.58	$0.00		$0.00	$30.69	$0.00	$0.00	$32.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.106	SUP	HCPCS C1713		04.214.106  -  SCREW BONE 1.5MM 6MM SLFTAP COMPACT STARDRIVE LCP TITANIUM	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.107	SUP	HCPCS C1713		04.214.107  -  SCREW BONE 1.5MM 7MM SLFTAP COMPACT STARDRIVE LCP TITANIUM	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.108	SUP	HCPCS C1713		04.214.108  -  SCREW BONE 1.5MM 8MM SLFTAP COMPACT STARDRIVE LCP TITANIUM	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.109	SUP	HCPCS C1713		04.214.109  -  SCREW BONE 1.5MM 9MM SLFTAP COMPACT STARDRIVE LCP TITANIUM	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.110	SUP	HCPCS C1713		04.214.110  -  SCREW BONE 1.5MM 8MM SLFTAP COMPACT STARDRIVE LCP TITANIUM	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.111	SUP	HCPCS C1713		04.214.111  -  SCREW BONE 1.5MM 11MM SLFTAP COMPACT STARDRIVE LCP TITANIUM	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.112	SUP	HCPCS C1713		04.214.112  -  SCREW BONE 1.5MM 12MM SLFTAP COMPACT STARDRIVE LCP TITANIUM	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.113	SUP	HCPCS C1713		04.214.113  -  SCREW BONE 1.5MM 13MM SLFTAP COMPACT STARDRIVE LCP TITANIUM	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.114	SUP	HCPCS C1713		04.214.114  -  SCREW BONE 1.5MM 14MM SLFTAP LCP STARDRIVE TITANIUM ALLOY	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.115	SUP	HCPCS C1713		04.214.115  -  SCREW BONE 1.5MM 15MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.116	SUP	HCPCS C1713		04.214.116  -  SCREW BONE 1.5MM 16MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.118	SUP	HCPCS C1713		04.214.118  -  SCREW BONE 1.5MM 18MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.120	SUP	HCPCS C1713		04.214.120  -  SCREW BONE 1.5MM 20MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.122	SUP	HCPCS C1713		04.214.122  -  SCREW BONE 1.5MM 22MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.214.124	SUP	HCPCS C1713		04.214.124  -  SCREW BONE 1.5MM 24MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP	BOTH IP/OP	$84.35 	$62.42	$0.00	$65.50	$36.84	$36.84	$0.00	$0.00	$0.00	$17.58	$62.60	$62.60	$0.00	$0.00	$17.58	$0.00	$49.89	$49.89	$0.00	$40.94	$64.85	$65.50	$0.00		$0.00	$12.44	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$0.00
04.221.002S	SUP	HCPCS C1713		04.221.002S  -  BUTTON FIX 2.5MM CERCLAGE HEXAGONAL STARDRIVE RECESS	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.221.003S	SUP	HCPCS C1713		04.221.003S  -  BUTTON FIX HEXAGON 3.5MM CERCLAGE T25 STARDRIVE TITANIUM	BOTH IP/OP	$341.58 	$252.77	$0.00	$265.30	$149.23	$149.23	$0.00	$0.00	$0.00	$71.19	$253.52	$253.52	$0.00	$0.00	$71.18	$0.00	$202.04	$202.04	$0.00	$165.81	$262.65	$265.30	$0.00		$0.00	$50.39	$0.00	$0.00	$52.79	$0.00	$0.00	$0.00	$0.00	$0.00
04.221.004S	SUP	HCPCS C1713		04.221.004S  -  NAIL INTRAMEDULLARY 4MM CANN HEXAGONAL TITANIUM ORTHOPEDIC	BOTH IP/OP	$343.00 	$253.82	$0.00	$266.40	$149.85	$149.85	$0.00	$0.00	$0.00	$71.49	$254.57	$254.57	$0.00	$0.00	$71.48	$0.00	$202.88	$202.88	$0.00	$166.50	$263.74	$266.40	$0.00		$0.00	$50.60	$0.00	$0.00	$53.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.221.005S	SUP	Custom 27803010		04.221.005S  -  CABLE ORTHOPEDIC 5MM POSITIONING PIN CRIMP STAINLESS STEEL	BOTH IP/OP	$515.90 	$381.77	$0.00	$400.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.90	$382.90	$0.00	$0.00	$107.51	$0.00	$0.00	$0.00	$0.00	$250.44	$396.70	$400.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.221.508	SUP	HCPCS C1713		04.221.508  -  SCREW BONE 5MM 8MM SLFTAP LOCKING STARDRIVE PERIPROSTHETIC	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
04.221.510	SUP	HCPCS C1713		04.221.510  -  SCREW BONE 5MM 10MM SLFTAP LOCKING STARDRIVE RECESS	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
04.221.512	SUP	HCPCS C1713		04.221.512  -  SCREW BONE 5MM 12MM SLFTAP LOCKING STARDRIVE RECESS TITANIUM	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
04.221.514	SUP	HCPCS C1713		04.221.514  -  SCREW BONE 5MM 14MM SLFTAP LOCKING STARDRIVE RECESS TITANIUM	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
04.221.518	SUP	HCPCS C1713		04.221.518  -  SCREW BONE 5MM 18MM SLFTAP LOCKING STARDRIVE RECESS TITANIUM	BOTH IP/OP	$397.80 	$294.37	$0.00	$308.98	$173.80	$173.80	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$193.11	$305.89	$308.98	$0.00		$0.00	$58.68	$0.00	$0.00	$61.49	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.010	SUP	HCPCS C1713		04.226.010  -  SCREW BONE SHORT THREAD 3MM 10MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.011	SUP	HCPCS C1713		04.226.011  -  SCREW BONE SHORT THREAD 3MM 11MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.012	SUP	HCPCS C1713		04.226.012  -  SCREW BONE SHORT THREAD 3MM 12MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.013	SUP	HCPCS C1713		04.226.013  -  SCREW BONE SHORT THREAD 3MM 13MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.014	SUP	HCPCS C1713		04.226.014  -  SCREW BONE SHORT THREAD 3MM 14MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.015	SUP	HCPCS C1713		04.226.015  -  SCREW BONE SHORT THREAD 3MM 15MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.016	SUP	HCPCS C1713		04.226.016  -  SCREW BONE SHORT THREAD 3MM 16MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.017	SUP	HCPCS C1713		04.226.017  -  SCREW BONE SHORT THREAD 3MM 17MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.018	SUP	HCPCS C1713		04.226.018  -  SCREW BONE SHORT THREAD 3MM 18MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.019	SUP	HCPCS C1713		04.226.019  -  SCREW BONE SHORT THREAD 3MM 19MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.020	SUP	HCPCS C1713		04.226.020  -  SCREW BONE SHORT THREAD 3MM 20MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.021	SUP	HCPCS C1713		04.226.021  -  SCREW BONE SHORT THREAD 3MM 21MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.022	SUP	HCPCS C1713		04.226.022  -  SCREW BONE SHORT THREAD 3MM 22MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.023	SUP	HCPCS C1713		04.226.023  -  SCREW BONE SHORT THREAD 3MM 23MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.024	SUP	HCPCS C1713		04.226.024  -  SCREW BONE SHORT THREAD 3MM 24MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.025	SUP	HCPCS C1713		04.226.025  -  SCREW BONE SHORT THREAD 3MM 25MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.026	SUP	HCPCS C1713		04.226.026  -  SCREW BONE SHORT THREAD 3MM 26MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.027	SUP	HCPCS C1713		04.226.027  -  SCREW BONE SHORT THREAD 3MM 27MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.028	SUP	HCPCS C1713		04.226.028  -  SCREW BONE SHORT THREAD 3MM 28MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.029	SUP	HCPCS C1713		04.226.029  -  SCREW BONE SHORT THREAD 3MM 29MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.030	SUP	HCPCS C1713		04.226.030  -  SCREW BONE SHORT THREAD 3MM 30MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.032	SUP	HCPCS C1713		04.226.032  -  SCREW BONE SHORT THREAD 3MM 32MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.034	SUP	HCPCS C1713		04.226.034  -  SCREW BONE SHORT THREAD 3MM 34MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.036	SUP	HCPCS C1713		04.226.036  -  SCREW BONE SHORT THREAD 3MM 36MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.038	SUP	HCPCS C1713		04.226.038  -  SCREW BONE SHORT THREAD 3MM 38MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.040	SUP	HCPCS C1713		04.226.040  -  SCREW BONE SHORT THREAD 3MM 40MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.116	SUP	HCPCS C1713		04.226.116  -  SCREW BONE LNGTHRD 3MM 16MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.117	SUP	HCPCS C1713		04.226.117  -  SCREW BONE 3MM 17MM 6MM COMPRESSION TITANIUM SMALL BONE	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.118	SUP	HCPCS C1713		04.226.118  -  SCREW BONE LNGTHRD 3MM 18MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.119	SUP	HCPCS C1713		04.226.119  -  SCREW BONE LNGTHRD 3MM 19MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.120	SUP	HCPCS C1713		04.226.120  -  SCREW BONE 3MM 20MM 7MM COMPRESSION TITANIUM SMALL BONE	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.121	SUP	HCPCS C1713		04.226.121  -  SCREW BONE LNGTHRD 3MM 21MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.122	SUP	HCPCS C1713		04.226.122  -  SCREW BONE LNGTHRD 3MM 22MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.123	SUP	HCPCS C1713		04.226.123  -  SCREW BONE LNGTHRD 3MM 23MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.124	SUP	HCPCS C1713		04.226.124  -  SCREW BONE LNGTHRD 3MM 24MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.125	SUP	HCPCS C1713		04.226.125  -  SCREW BONE LNGTHRD 3MM 25MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.126	SUP	HCPCS C1713		04.226.126  -  SCREW BONE LNGTHRD 3MM 26MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.127	SUP	HCPCS C1713		04.226.127  -  SCREW BONE LNGTHRD 3MM 27MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.128	SUP	HCPCS C1713		04.226.128  -  SCREW BONE LNGTHRD 3MM 28MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.129	SUP	HCPCS C1713		04.226.129  -  SCREW BONE LNGTHRD 3MM 29MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.130	SUP	HCPCS C1713		04.226.130  -  SCREW BONE LNGTHRD 3MM 30MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.132	SUP	HCPCS C1713		04.226.132  -  SCREW BONE LNGTHRD 3MM 32MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.134	SUP	HCPCS C1713		04.226.134  -  SCREW BONE LNGTHRD 3MM 34MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.136	SUP	HCPCS C1713		04.226.136  -  SCREW BONE LNGTHRD 3MM 36MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.138	SUP	HCPCS C1713		04.226.138  -  SCREW BONE LNGTHRD 3MM 38MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.140	SUP	HCPCS C1713		04.226.140  -  SCREW BONE LNGTHRD 3MM 40MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.209	SUP	HCPCS C1713		04.226.209  -  SCREW BONE SHORT THREAD 2.4MM 9MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.210	SUP	HCPCS C1713		04.226.210  -  SCREW BONE SHORT THREAD 2.4MM 10MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.211	SUP	HCPCS C1713		04.226.211  -  SCREW BONE SHORT THREAD 2.4MM 11MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.212	SUP	HCPCS C1713		04.226.212  -  SCREW BONE SHORT THREAD 2.4MM 12MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.213	SUP	HCPCS C1713		04.226.213  -  SCREW BONE SHORT THREAD 2.4MM 13MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.214	SUP	HCPCS C1713		04.226.214  -  SCREW BONE SHORT THREAD 2.4MM 14MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.215	SUP	HCPCS C1713		04.226.215  -  SCREW BONE SHORT THREAD 2.4MM 15MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.216	SUP	HCPCS C1713		04.226.216  -  SCREW BONE SHORT THREAD 2.4MM 16MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.217	SUP	HCPCS C1713		04.226.217  -  SCREW BONE SHORT THREAD 2.4MM 17MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.218	SUP	HCPCS C1713		04.226.218  -  SCREW BONE 2.4MM 18MM 4MM COMPRESSION TITANIUM SMALL BONE	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.219	SUP	HCPCS C1713		04.226.219  -  SCREW BONE SHORT THREAD 2.4MM 19MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.220	SUP	HCPCS C1713		04.226.220  -  SCREW BONE 2.4MM 20MM 4MM COMPRESSION TITANIUM SMALL BONE	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.221	SUP	HCPCS C1713		04.226.221  -  SCREW BONE SHORT THREAD 2.4MM 21MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.222	SUP	HCPCS C1713		04.226.222  -  SCREW BONE SHORT THREAD 2.4MM 22MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.223	SUP	HCPCS C1713		04.226.223  -  SCREW BONE SHORT THREAD 2.4MM 23MM 4MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.224	SUP	HCPCS C1713		04.226.224  -  SCREW BONE SHORT THREAD 2.4MM 24MM 5MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.225	SUP	HCPCS C1713		04.226.225  -  SCREW BONE SHORT THREAD 2.4MM 25MM 5MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.226	SUP	HCPCS C1713		04.226.226  -  SCREW BONE SHORT THREAD 2.4MM 26MM 5MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.227	SUP	HCPCS C1713		04.226.227  -  SCREW BONE SHORT THREAD 2.4MM 27MM 6MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.228	SUP	HCPCS C1713		04.226.228  -  SCREW BONE SHORT THREAD 2.4MM 28MM 6MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.229	SUP	HCPCS C1713		04.226.229  -  SCREW BONE SHORT THREAD 2.4MM 29MM 6MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.230	SUP	HCPCS C1713		04.226.230  -  SCREW BONE 2.4MM 30MM 7MM COMPRESSION TITANIUM SMALL BONE	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.232	SUP	HCPCS C1713		04.226.232  -  SCREW BONE SHORT THREAD 2.4MM 32MM 7MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.234	SUP	HCPCS C1713		04.226.234  -  SCREW BONE SHORT THREAD 2.4MM 34MM 8MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.236	SUP	HCPCS C1713		04.226.236  -  SCREW BONE SHORT THREAD 2.4MM 36MM 9MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.238	SUP	HCPCS C1713		04.226.238  -  SCREW BONE SHORT THREAD 2.4MM 38MM 9MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.240	SUP	HCPCS C1713		04.226.240  -  SCREW BONE 2.4MM 40MM 10MM COMPRESSION SHORT THREAD HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.317	SUP	HCPCS C1713		04.226.317  -  SCREW BONE LNGTHRD 2.4MM 17MM 6MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.318	SUP	HCPCS C1713		04.226.318  -  SCREW BONE LNGTHRD 2.4MM 18MM 6MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.319	SUP	HCPCS C1713		04.226.319  -  SCREW BONE LNGTHRD 2.4MM 19MM 7MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.320	SUP	HCPCS C1713		04.226.320  -  SCREW BONE LNGTHRD 2.4MM 20MM 7MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.321	SUP	HCPCS C1713		04.226.321  -  SCREW BONE LNGTHRD 2.4MM 21MM 8MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.322	SUP	HCPCS C1713		04.226.322  -  SCREW BONE LNGTHRD 2.4MM 22MM 8MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.323	SUP	HCPCS C1713		04.226.323  -  SCREW BONE LNGTHRD 2.4MM 23MM 8MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.324	SUP	HCPCS C1713		04.226.324  -  SCREW BONE LNGTHRD 2.4MM 24MM 8MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.325	SUP	HCPCS C1713		04.226.325  -  SCREW BONE LNGTHRD 2.4MM 25MM 8MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.326	SUP	HCPCS C1713		04.226.326  -  SCREW BONE LNGTHRD 2.4MM 26MM 10MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.327	SUP	HCPCS C1713		04.226.327  -  SCREW BONE LNGTHRD 2.4MM 27MM 10MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.328	SUP	HCPCS C1713		04.226.328  -  SCREW BONE LNGTHRD 2.4MM 28MM 10MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.329	SUP	HCPCS C1713		04.226.329  -  SCREW BONE LNGTHRD 2.4MM 29MM 10MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.330	SUP	HCPCS C1713		04.226.330  -  SCREW BONE LNGTHRD 2.4MM 30MM 12MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.332	SUP	HCPCS C1713		04.226.332  -  SCREW BONE LNGTHRD 2.4MM 32MM 12MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.334	SUP	HCPCS C1713		04.226.334  -  SCREW BONE LNGTHRD 2.4MM 34MM 14MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.336	SUP	HCPCS C1713		04.226.336  -  SCREW BONE LNGTHRD 2.4MM 36MM 14MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.338	SUP	HCPCS C1713		04.226.338  -  SCREW BONE LNGTHRD 2.4MM 38MM 16MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.340	SUP	HCPCS C1713		04.226.340  -  SCREW BONE LNGTHRD 2.4MM 40MM 16MM COMPRESSION HEADLESS	BOTH IP/OP	$641.00 	$474.34	$0.00	$497.86	$280.05	$280.05	$0.00	$0.00	$0.00	$133.60	$475.75	$475.75	$0.00	$0.00	$133.58	$0.00	$379.15	$379.15	$0.00	$311.16	$492.89	$497.86	$0.00		$0.00	$94.56	$0.00	$0.00	$99.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.620	SUP	HCPCS C1713		04.226.620  -  SCREW BONE SHORT THREAD 4.5MM 20MM 7MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.622	SUP	HCPCS C1713		04.226.622  -  SCREW BONE SHORT THREAD 4.5MM 22MM 7MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.624	SUP	HCPCS C1713		04.226.624  -  SCREW BONE SHORT THREAD 4.5MM 24MM 7MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.626	SUP	HCPCS C1713		04.226.626  -  SCREW BONE SHORT THREAD 4.5MM 26MM 7MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.628	SUP	HCPCS C1713		04.226.628  -  SCREW BONE SHORT THREAD 4.5MM 28MM 7MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.630	SUP	HCPCS C1713		04.226.630  -  SCREW BONE SHORT THREAD 4.5MM 30MM 7MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.632	SUP	HCPCS C1713		04.226.632  -  SCREW BONE SHORT THREAD 4.5MM 32MM 7MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.634	SUP	HCPCS C1713		04.226.634  -  SCREW BONE SHORT THREAD 4.5MM 34MM 7MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.636	SUP	HCPCS C1713		04.226.636  -  SCREW BONE SHORT THREAD 4.5MM 36MM 7MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.638	SUP	HCPCS C1713		04.226.638  -  SCREW BONE SHORT THREAD 4.5MM 38MM 7MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.640	SUP	HCPCS C1713		04.226.640  -  SCREW BONE SHORT THREAD 4.5MM 40MM 8MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.642	SUP	HCPCS C1713		04.226.642  -  SCREW BONE SHORT THREAD 4.5MM 42MM 8MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.644	SUP	HCPCS C1713		04.226.644  -  SCREW BONE SHORT THREAD 4.5MM 44MM 9MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.646	SUP	HCPCS C1713		04.226.646  -  SCREW BONE SHORT THREAD 4.5MM 46MM 9MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.648	SUP	HCPCS C1713		04.226.648  -  SCREW BONE SHORT THREAD 4.5MM 48MM 9MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.650	SUP	HCPCS C1713		04.226.650  -  SCREW BONE SHORT THREAD 4.5MM 50MM 10MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.652	SUP	HCPCS C1713		04.226.652  -  SCREW BONE SHORT THREAD 4.5MM 52MM 10MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.654	SUP	HCPCS C1713		04.226.654  -  SCREW BONE SHORT THREAD 6.5MM 54MM 16MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.656	SUP	HCPCS C1713		04.226.656  -  SCREW BONE SHORT THREAD 4.5MM 56MM 11MM COMPRESSION HEADLESS	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.658	SUP	HCPCS C1713		04.226.658  -  SCREW BONE SHORT THREAD 4.5MM 58MM 11MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.660	SUP	HCPCS C1713		04.226.660  -  SCREW BONE SHORT THREAD 4.5MM 60MM 12MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.665	SUP	HCPCS C1713		04.226.665  -  SCREW BONE SHORT THREAD 4.5MM 65MM 13MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.670	SUP	HCPCS C1713		04.226.670  -  SCREW BONE SHORT THREAD 4.5MM 70MM 14MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.675	SUP	HCPCS C1713		04.226.675  -  SCREW BONE SHORT THREAD 4.5MM 75MM 15MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.680	SUP	HCPCS C1713		04.226.680  -  SCREW BONE SHORT THREAD 4.5MM 80MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.685	SUP	HCPCS C1713		04.226.685  -  SCREW BONE SHORT THREAD 4.5MM 85MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.690	SUP	HCPCS C1713		04.226.690  -  SCREW BONE SHORT THREAD 4.5MM 90MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.695	SUP	HCPCS C1713		04.226.695  -  SCREW BONE SHORT THREAD 4.5MM 95MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.700	SUP	HCPCS C1713		04.226.700  -  SCREW BONE SHORT THREAD 4.5MM 100MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.730	SUP	HCPCS C1713		04.226.730  -  SCREW BONE LNGTHRD 4.5MM 32MM 12MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.732	SUP	HCPCS C1713		04.226.732  -  SCREW BONE LNGTHRD 4.5MM 32MM 12MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.734	SUP	HCPCS C1713		04.226.734  -  SCREW BONE LNGTHRD 4.5MM 34MM 12MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.736	SUP	HCPCS C1713		04.226.736  -  SCREW BONE LNGTHRD 4.5MM 36MM 14MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.738	SUP	HCPCS C1713		04.226.738  -  SCREW BONE LNGTHRD 4.5MM 38MM 14MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.740	SUP	HCPCS C1713		04.226.740  -  SCREW BONE LNGTHRD 4.5MM 40MM 16MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.742	SUP	HCPCS C1713		04.226.742  -  SCREW BONE LNGTHRD 4.5MM 42MM 16MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.744	SUP	HCPCS C1713		04.226.744  -  SCREW BONE LNGTHRD 4.5MM 44MM 18MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.746	SUP	HCPCS C1713		04.226.746  -  SCREW BONE LNGTHRD 4.5MM 46MM 18MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.748	SUP	HCPCS C1713		04.226.748  -  SCREW BONE LNGTHRD 4.5MM 48MM 18MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.750	SUP	HCPCS C1713		04.226.750  -  SCREW BONE LNGTHRD 4.5MM 50MM 20MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.752	SUP	HCPCS C1713		04.226.752  -  SCREW BONE LNGTHRD 4.5MM 52MM 20MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.754	SUP	HCPCS C1713		04.226.754  -  SCREW BONE LNGTHRD 4.5MM 54MM 22MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.756	SUP	HCPCS C1713		04.226.756  -  SCREW BONE LNGTHRD 4.5MM 56MM 22MM COMPRESSION HEADLESS	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.758	SUP	HCPCS C1713		04.226.758  -  SCREW BONE LNGTHRD 4.5MM 58MM 22MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.760	SUP	HCPCS C1713		04.226.760  -  SCREW BONE LNGTHRD 4.5MM 60MM 24MM COMPRESSION HEADLESS	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.765	SUP	HCPCS C1713		04.226.765  -  SCREW BONE LNGTHRD 4.5MM 65MM 26MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.770	SUP	HCPCS C1713		04.226.770  -  SCREW BONE LNGTHRD 4.5MM 70MM 28MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.775	SUP	HCPCS C1713		04.226.775  -  SCREW BONE LNGTHRD 4.5MM 75MM 30MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.780	SUP	HCPCS C1713		04.226.780  -  SCREW BONE LNGTHRD 4.5MM 80MM 32MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.785	SUP	HCPCS C1713		04.226.785  -  SCREW BONE LNGTHRD 4.5MM 85MM 34MM COMPRESSION HEADLESS	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.790	SUP	HCPCS C1713		04.226.790  -  SCREW BONE LNGTHRD 4.5MM 90MM 36MM COMPRESSION HEADLESS	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.795	SUP	HCPCS C1713		04.226.795  -  SCREW BONE LNGTHRD 4.5MM 95MM 38MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.226.800	SUP	HCPCS C1713		04.226.800  -  SCREW BONE LNGTHRD 4.5MM 100MM 40MM HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.030	SUP	HCPCS C1713		04.227.030  -  SCREW BONE 6.5MM 30MM 16MM HEADLESS COMPRESSION THREADED	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.035	SUP	HCPCS C1713		04.227.035  -  SCREW BONE 6.5MM 35MM 16MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.040	SUP	HCPCS C1713		04.227.040  -  SCREW BONE 6.5MM 40MM 16MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.045	SUP	HCPCS C1713		04.227.045  -  SCREW BONE 6.5MM 45MM 16MM HEADLESS COMPRESSION THREADED	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.050	SUP	HCPCS C1713		04.227.050  -  SCREW BONE 6.5MM 50MM 16MM HEADLESS COMPRESSION THREADED	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.055	SUP	HCPCS C1713		04.227.055  -  SCREW BONE 6.5MM 55MM 16MM HEADLESS COMPRESSION THREADED	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.060	SUP	HCPCS C1713		04.227.060  -  SCREW BONE 6.5MM 60MM 16MM HEADLESS COMPRESSION THREADED SET	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.065	SUP	HCPCS C1713		04.227.065  -  SCREW BONE 6.5MM 65MM 16MM HEADLESS COMPRESSION THREADED SET	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.070	SUP	HCPCS C1713		04.227.070  -  SCREW BONE 6.5MM 70MM 16MM COMPRESSION THREAD TITANIUM FEMUR	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.075	SUP	HCPCS C1713		04.227.075  -  SCREW BONE 6.5MM 75MM 16MM HEADLESS COMPRESSION THREADED SET	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.080	SUP	HCPCS C1713		04.227.080  -  SCREW BONE 6.5MM 80MM 16MM HEADLESS COMPRESSION THREADED SET	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.085	SUP	HCPCS C1713		04.227.085  -  SCREW BONE 6.5MM 85MM 16MM COMPRESSION HEADLESS THREADED	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.090	SUP	HCPCS C1713		04.227.090  -  SCREW BONE 6.5MM 90MM 16MM HEADLESS COMPRESSION THREADED	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.095	SUP	HCPCS C1713		04.227.095  -  SCREW BONE 6.5MM 95MM 16MM HEADLESS COMPRESSION THREADED	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.100	SUP	HCPCS C1713		04.227.100  -  SCREW BONE 6.5MM 100MM 16MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.105	SUP	HCPCS C1713		04.227.105  -  SCREW BONE 6.5MM 105MM 16MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.110	SUP	HCPCS C1713		04.227.110  -  SCREW BONE 6.5MM 105MM 16MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.115	SUP	HCPCS C1713		04.227.115  -  SCREW BONE 6.5MM 115MM 16MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.120	SUP	HCPCS C1713		04.227.120  -  SCREW BONE 6.5MM 120MM 16MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.125	SUP	HCPCS C1713		04.227.125  -  SCREW BONE 6.5MM 125MM 16MM HEADLESS COMPRESSION THREADED	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.130	SUP	HCPCS C1713		04.227.130  -  SCREW BONE 6.5MM 130MM 16MM HEADLESS COMPRESSION THREADED	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.135	SUP	HCPCS C1713		04.227.135  -  SCREW BONE 6.5MM 135MM 16MM HEADLESS COMPRESSION THREADED	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.140	SUP	HCPCS C1713		04.227.140  -  SCREW BONE 6.5MM 140MM 16MM HEADLESS COMPRESSION THREADED	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.145	SUP	HCPCS C1713		04.227.145  -  SCREW BONE 6.5MM 145MM 16MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.150	SUP	HCPCS C1713		04.227.150  -  SCREW BONE 6.5MM 150MM 16MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.245	SUP	HCPCS C1713		04.227.245  -  SCREW BONE 6.5MM 45MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.250	SUP	HCPCS C1713		04.227.250  -  SCREW BONE 6.5MM 50MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.255	SUP	HCPCS C1713		04.227.255  -  SCREW BONE 6.5MM 55MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.260	SUP	HCPCS C1713		04.227.260  -  SCREW BONE 6.5MM 60MM 32MM COMPRESSION HEADLESS TITANIUM	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.265	SUP	HCPCS C1713		04.227.265  -  SCREW BONE 6.5MM 65MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.270	SUP	HCPCS C1713		04.227.270  -  SCREW BONE 6.5MM 70MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.275	SUP	HCPCS C1713		04.227.275  -  SCREW BONE 6.5MM 75MM 32MM COMPRESSION THREAD TITANIUM FEMUR	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.280	SUP	HCPCS C1713		04.227.280  -  SCREW BONE 6.5MM 80MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.285	SUP	HCPCS C1713		04.227.285  -  SCREW BONE 6.5MM 85MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.290	SUP	HCPCS C1713		04.227.290  -  SCREW BONE 6.5MM 90MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.295	SUP	HCPCS C1713		04.227.295  -  SCREW BONE 6.5MM 95MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.300	SUP	HCPCS C1713		04.227.300  -  SCREW BONE 6.5MM 100MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.305	SUP	HCPCS C1713		04.227.305  -  SCREW BONE 6.5MM 105MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.310	SUP	HCPCS C1713		04.227.310  -  SCREW BONE 6.5MM 110MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.315	SUP	HCPCS C1713		04.227.315  -  SCREW BONE 6.5MM 115MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.320	SUP	HCPCS C1713		04.227.320  -  SCREW BONE 6.5MM 120MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.325	SUP	HCPCS C1713		04.227.325  -  SCREW BONE 6.5MM 125MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.330	SUP	HCPCS C1713		04.227.330  -  SCREW BONE 6.5MM 130MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.335	SUP	HCPCS C1713		04.227.335  -  SCREW BONE 6.5MM 135MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.340	SUP	HCPCS C1713		04.227.340  -  SCREW BONE 6.5MM 140MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.345	SUP	HCPCS C1713		04.227.345  -  SCREW BONE 6.5MM 145MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.227.350	SUP	HCPCS C1713		04.227.350  -  SCREW BONE 6.5MM 150MM 32MM THREADED HEADLESS COMPRESSION	BOTH IP/OP	$649.43 	$480.58	$0.00	$504.42	$283.74	$283.74	$0.00	$0.00	$0.00	$135.36	$482.00	$482.00	$0.00	$0.00	$135.34	$0.00	$384.13	$384.13	$0.00	$315.26	$499.38	$504.42	$0.00		$0.00	$95.80	$0.00	$0.00	$100.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.230.109	SUP	HCPCS C1713		04.230.109  -  SCREW BONE 1.5MM 9MM 4MM HEADLESS COMPRESSION THREAD	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.230.110	SUP	HCPCS C1713		04.230.110  -  SCREW BONE 1.5MM 10MM 4MM HEADLESS COMPRESSION THREAD	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.230.111	SUP	HCPCS C1713		04.230.111  -  SCREW BONE 1.5MM 11MM 4MM HEADLESS COMPRESSION THREAD	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.230.112	SUP	HCPCS C1713		04.230.112  -  SCREW BONE 1.5MM 12MM 4MM HEADLESS COMPRESSION THREAD	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.230.113	SUP	HCPCS C1713		04.230.113  -  SCREW BONE 1.5MM 13MM 4MM HEADLESS COMPRESSION THREAD	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.230.114	SUP	HCPCS C1713		04.230.114  -  SCREW BONE 1.5MM 14MM 4MM HEADLESS COMPRESSION THREAD	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.230.115	SUP	HCPCS C1713		04.230.115  -  SCREW BONE 1.5MM 15MM 4MM HEADLESS COMPRESSION THREAD	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.230.116	SUP	HCPCS C1713		04.230.116  -  SCREW BONE 1.5MM 16MM 5MM HEADLESS COMPRESSION THREAD	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.230.117	SUP	HCPCS C1713		04.230.117  -  SCREW BONE 1.5MM 17MM 5MM HEADLESS COMPRESSION THREAD	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.230.118	SUP	HCPCS C1713		04.230.118  -  SCREW BONE 1.5MM 18MM 5MM HEADLESS COMPRESSION THREAD	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.230.119	SUP	HCPCS C1713		04.230.119  -  SCREW BONE 1.5MM 19MM 5MM HEADLESS COMPRESSION THREAD	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.230.120	SUP	HCPCS C1713		04.230.120  -  SCREW BONE 1.5MM 20MM 6MM HEADLESS COMPRESSION THREAD	BOTH IP/OP	$486.38 	$359.92	$0.00	$377.76	$212.49	$212.49	$0.00	$0.00	$0.00	$101.37	$360.99	$360.99	$0.00	$0.00	$101.36	$0.00	$287.69	$287.69	$0.00	$236.10	$373.98	$377.76	$0.00		$0.00	$71.75	$0.00	$0.00	$75.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.003	SUP	HCPCS C1713		04.305.003  -  SCREW BONE 2.5/4MM 50MM BLUNT TIP SCHANZ TITANIUM MANDIB	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.004	SUP	HCPCS C1713		04.305.004  -  SCREW BONE 2.5/4MM 60MM BLUNT TIP SCHANZ TITANIUM MANDIB	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.005	SUP	HCPCS C1713		04.305.005  -  SCREW BONE 2.5/4MM 70MM BLUNT TIP SCHANZ TITANIUM MANDIB	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.010	SUP	HCPCS C1713		04.305.010  -  SCREW BONE 2.5/4MM 50MM SLFDRILL SCHANZ TITANIUM MANDIB	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$474.75	$474.75	$0.00	$0.00	$0.00	$219.89	$783.02	$783.02	$0.00	$0.00	$219.86	$0.00	$624.03	$624.03	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$165.11	$0.00	$0.00	$167.96	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.011	SUP	HCPCS C1713		04.305.011  -  SCREW BONE 2.5/4MM 60MM SLFDRILL SCHANZ TITANIUM MANDIB	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$474.75	$474.75	$0.00	$0.00	$0.00	$219.89	$783.02	$783.02	$0.00	$0.00	$219.86	$0.00	$624.03	$624.03	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$165.11	$0.00	$0.00	$167.96	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.012	SUP	HCPCS C1713		04.305.012  -  SCREW BONE 2.5/4MM 70MM SLFDRILL SCHANZ TITANIUM MANDIB	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$474.75	$474.75	$0.00	$0.00	$0.00	$219.89	$783.02	$783.02	$0.00	$0.00	$219.86	$0.00	$624.03	$624.03	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$165.11	$0.00	$0.00	$167.96	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.100	SUP	Custom 27203010		04.305.100  -  ROD EXFIX 4MM FULL PREBENT RAMUS TITANIUM MANDIB NONSTRL	BOTH IP/OP	"$2,167.50 "	"$1,603.95"	$0.00	"$1,734.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,608.72"	"$1,608.72"	$0.00	$0.00	$451.71	$0.00	$0.00	$0.00	$0.00	"$1,083.75"	"$1,716.66"	"$1,734.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.101	SUP	Custom 27203010		04.305.101  -  ROD EXFIX 4MM FULL PREBENT TITANIUM MANDIB NONSTRL MANDIB	BOTH IP/OP	"$1,852.50 "	"$1,370.85"	$0.00	"$1,482.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,374.93"	"$1,374.93"	$0.00	$0.00	$386.06	$0.00	$0.00	$0.00	$0.00	$926.25	"$1,467.18"	"$1,482.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.102	SUP	Custom 27203010		04.305.102  -  ROD EXFIX 4MM .75 PREBENT TITANIUM MANDIB NONSTRL MANDIB	BOTH IP/OP	"$1,702.50 "	"$1,259.85"	$0.00	"$1,362.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,263.60"	"$1,263.60"	$0.00	$0.00	$354.80	$0.00	$0.00	$0.00	$0.00	$851.25	"$1,348.38"	"$1,362.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.103	SUP	HCPCS C1713		04.305.103  -  ROD FIX 4MM .5 PREBENT TITANIUM MANDIB NONSTRL EXFIX SYSTEM	BOTH IP/OP	"$1,552.50 "	"$1,148.85"	$0.00	"$1,242.00"	$698.63	$698.63	$0.00	$0.00	$0.00	$323.58	"$1,152.27"	"$1,152.27"	$0.00	$0.00	$323.54	$0.00	$918.30	$918.30	$0.00	$776.25	"$1,229.58"	"$1,242.00"	$0.00		$0.00	$242.97	$0.00	$0.00	$247.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.128	SUP	HCPCS C1713		04.305.128  -  SCREW BONE 2.5MM 4MM 8MM SELF DRILL SCHANZ TITANIUM MANDIB	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$229.27	$816.42	$816.42	$0.00	$0.00	$229.24	$0.00	$650.65	$650.65	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.130	SUP	HCPCS C1713		04.305.130  -  SCREW XTRNFX 2.5MM 4MM 10MM SCHNZ SLF DRL TI MNDB RAMUS	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$229.27	$816.42	$816.42	$0.00	$0.00	$229.24	$0.00	$650.65	$650.65	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.134	SUP	HCPCS C1713		04.305.134  -  SCREW XTRNFX 2.5MM 4MM 14MM SCHNZ SLF DRL TI MNDB XTRNFXTR	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$229.27	$816.42	$816.42	$0.00	$0.00	$229.24	$0.00	$650.65	$650.65	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.138	SUP	HCPCS C1713		04.305.138  -  SCREW XTRNFX 2.5MM 4MM 18MM SCHNZ SLF DRL TI MNDB XTRNFXTR	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$229.27	$816.42	$816.42	$0.00	$0.00	$229.24	$0.00	$650.65	$650.65	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.140	SUP	HCPCS C1713		04.305.140  -  SCREW BONE 2.5/4MM 20MM SLFDRILL SCHANZ TITANIUM RAMUS	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$229.27	$816.42	$816.42	$0.00	$0.00	$229.24	$0.00	$650.65	$650.65	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.305.142	SUP	HCPCS C1713		04.305.142  -  SCREW BONE 2.5/4MM 22MM SLFDRILL SCHANZ TITANIUM MANDIB	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$229.27	$816.42	$816.42	$0.00	$0.00	$229.24	$0.00	$650.65	$650.65	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.307.001	SUP	Custom 27803010		04.307.001  -  FOOTPLATE BONE 40MM TITANIUM MAXL NONSTRL	BOTH IP/OP	"$1,277.50 "	$945.35	$0.00	"$1,022.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$948.16	$948.16	$0.00	$0.00	$266.23	$0.00	$0.00	$0.00	$0.00	$638.75	"$1,011.78"	"$1,022.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.307.008	SUP	HCPCS C1713		04.307.008  -  ROD FIX 80MM TITANIUM MAXL NONSTRL	BOTH IP/OP	$767.50 	$567.95	$0.00	$614.00	$345.38	$345.38	$0.00	$0.00	$0.00	$159.97	$569.64	$569.64	$0.00	$0.00	$159.95	$0.00	$453.98	$453.98	$0.00	$383.75	$607.86	$614.00	$0.00		$0.00	$120.11	$0.00	$0.00	$122.19	$0.00	$0.00	$0.00	$0.00	$0.00
04.307.108	SUP	HCPCS C1713		04.307.108  -  ROD FIX 80MM TALL OFFST TITANIUM MAXL NONSTRL	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
04.307.111	SUP	HCPCS C1713		04.307.111  -  ROD FIX 110MM TALL OFFST TITANIUM MAXL NONSTRL	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.000	SUP	HCPCS C1713		04.315.000  -  SCREW MACHINE 2.7MM TITANIUM CMF DISTRCT	BOTH IP/OP	$647.50 	$479.15	$0.00	$518.00	$291.38	$291.38	$0.00	$0.00	$0.00	$134.96	$480.57	$480.57	$0.00	$0.00	$134.94	$0.00	$383.00	$383.00	$0.00	$323.75	$512.82	$518.00	$0.00		$0.00	$101.33	$0.00	$0.00	$103.08	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.001	SUP	Custom 27803010		04.315.001  -  CAP END REMOVABLE CMF DISTRCT	BOTH IP/OP	"$1,070.00 "	$791.80	$0.00	$856.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$794.15	$794.15	$0.00	$0.00	$222.99	$0.00	$0.00	$0.00	$0.00	$535.00	$847.44	$856.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.003	SUP	Custom 27803010		04.315.003  -  AB DISTRACTOR BODY END ACT 15MM FOR CMF DISTRACTOR	BOTH IP/OP	"$11,330.00 "	"$8,384.20"	$0.00	"$9,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,361.17"	$0.00	$0.00	$0.00	$0.00	"$5,665.00"	"$8,973.36"	"$9,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.004	SUP	Custom 27803010		04.315.004  -  AB DISTRACTOR BODY END ACT. 20MM FOR CMF DISTRACTOR	BOTH IP/OP	"$11,330.00 "	"$8,384.20"	$0.00	"$9,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,361.17"	$0.00	$0.00	$0.00	$0.00	"$5,665.00"	"$8,973.36"	"$9,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.005	SUP	Custom 27803010		04.315.005  -  AB DISTRACTOR BODY END ACT. 25MM FOR CMF DISTRACTOR	BOTH IP/OP	"$11,330.00 "	"$8,384.20"	$0.00	"$9,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,361.17"	$0.00	$0.00	$0.00	$0.00	"$5,665.00"	"$8,973.36"	"$9,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.006	SUP	Custom 27803010		04.315.006  -  AB DISTRACTOR BODY END ACT. 30MM FOR CMF DISTRACTOR	BOTH IP/OP	"$11,330.00 "	"$8,384.20"	$0.00	"$9,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,361.17"	$0.00	$0.00	$0.00	$0.00	"$5,665.00"	"$8,973.36"	"$9,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.023	SUP	Custom 27803010		04.315.023  -  BC DISTRACTOR BODY END ACT. 15MM FOR CMF DISTRACTOR	BOTH IP/OP	"$11,330.00 "	"$8,384.20"	$0.00	"$9,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,361.17"	$0.00	$0.00	$0.00	$0.00	"$5,665.00"	"$8,973.36"	"$9,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.024	SUP	Custom 27803010		04.315.024  -  BC DISTRACTOR BODY END ACT. 20MM FOR CMF DISTRACTOR	BOTH IP/OP	"$11,330.00 "	"$8,384.20"	$0.00	"$9,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,361.17"	$0.00	$0.00	$0.00	$0.00	"$5,665.00"	"$8,973.36"	"$9,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.025	SUP	Custom 27803010		04.315.025  -  DISTRCT 25MM BODY SURG	BOTH IP/OP	"$11,330.00 "	"$8,384.20"	$0.00	"$9,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,361.17"	$0.00	$0.00	$0.00	$0.00	"$5,665.00"	"$8,973.36"	"$9,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.026	SUP	Custom 27803010		04.315.026  -  BC DISTRACTOR BODY END ACT. 30MM FOR CMF DISTRACTOR	BOTH IP/OP	"$11,330.00 "	"$8,384.20"	$0.00	"$9,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,361.17"	$0.00	$0.00	$0.00	$0.00	"$5,665.00"	"$8,973.36"	"$9,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.027	SUP	Custom 27803010		04.315.027  -  BC DISTRACTOR BODY END ACT 35MM FOR CMF DISTRACTOR	BOTH IP/OP	"$11,330.00 "	"$8,384.20"	$0.00	"$9,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,361.17"	$0.00	$0.00	$0.00	$0.00	"$5,665.00"	"$8,973.36"	"$9,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.028	SUP	Custom 27803010		04.315.028  -  BC DISTRACTOR BODY END ACT 40MM FOR CMF DISTRACTOR	BOTH IP/OP	"$11,330.00 "	"$8,384.20"	$0.00	"$9,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,361.17"	$0.00	$0.00	$0.00	$0.00	"$5,665.00"	"$8,973.36"	"$9,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.053	SUP	Custom 27803010		04.315.053  -  AB DISTRACTOR BODY END ACT. W/U-JOINT 15MM FOR CMF DSTR	BOTH IP/OP	"$11,952.50 "	"$8,844.85"	$0.00	"$9,562.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,490.90"	$0.00	$0.00	$0.00	$0.00	"$5,976.25"	"$9,466.38"	"$9,562.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.054	SUP	Custom 27803010		04.315.054  -  DISTRCT 20MM CRNMXF U JNT BD END ACT SURG TI NONSTRL	BOTH IP/OP	"$11,952.50 "	"$8,844.85"	$0.00	"$9,562.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,490.90"	$0.00	$0.00	$0.00	$0.00	"$5,976.25"	"$9,466.38"	"$9,562.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.055	SUP	Custom 27803010		04.315.055  -  AB DISTRACTOR BODY END ACT. W/U-JOINT 25MM FOR CMF DSTR	BOTH IP/OP	"$11,952.50 "	"$8,844.85"	$0.00	"$9,562.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,490.90"	$0.00	$0.00	$0.00	$0.00	"$5,976.25"	"$9,466.38"	"$9,562.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.056	SUP	Custom 27803010		04.315.056  -  AB DISTRACTOR BODY END ACT. W/U-JOINT 30MM FOR CMF DSTR	BOTH IP/OP	"$11,952.50 "	"$8,844.85"	$0.00	"$9,562.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,490.90"	$0.00	$0.00	$0.00	$0.00	"$5,976.25"	"$9,466.38"	"$9,562.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.063	SUP	Custom 27803010		04.315.063  -  DISTRCT 15MM CRNMXF BD END ACT U JNT SURG TI BC NONSTRL	BOTH IP/OP	"$11,952.50 "	"$8,844.85"	$0.00	"$9,562.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,490.90"	$0.00	$0.00	$0.00	$0.00	"$5,976.25"	"$9,466.38"	"$9,562.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.064	SUP	Custom 27803010		04.315.064  -  DISTRCT 20MM BD END ACT U JNT SURG TI BC CMF NONSTRL	BOTH IP/OP	"$11,952.50 "	"$8,844.85"	$0.00	"$9,562.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,490.90"	$0.00	$0.00	$0.00	$0.00	"$5,976.25"	"$9,466.38"	"$9,562.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.065	SUP	Custom 27803010		04.315.065  -  DISTRCT U JNT BODY 25MM SURG	BOTH IP/OP	"$11,952.50 "	"$8,844.85"	$0.00	"$9,562.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,490.90"	$0.00	$0.00	$0.00	$0.00	"$5,976.25"	"$9,466.38"	"$9,562.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.066	SUP	Custom 27803010		04.315.066  -  DISTRCT 30MM SURG NONSTRL	BOTH IP/OP	"$11,952.50 "	"$8,844.85"	$0.00	"$9,562.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,490.90"	$0.00	$0.00	$0.00	$0.00	"$5,976.25"	"$9,466.38"	"$9,562.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.067	SUP	Custom 27803010		04.315.067  -  BC DISTRACTOR BODY END ACT W/U-JOINT 35MM FOR CMF DSTR	BOTH IP/OP	"$11,952.50 "	"$8,844.85"	$0.00	"$9,562.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,490.90"	$0.00	$0.00	$0.00	$0.00	"$5,976.25"	"$9,466.38"	"$9,562.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.068	SUP	Custom 27803010		04.315.068  -  BC DISTRACTOR BODY END ACT W/U-JOINT 40MM FOR CMF DSTR	BOTH IP/OP	"$11,952.50 "	"$8,844.85"	$0.00	"$9,562.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,490.90"	$0.00	$0.00	$0.00	$0.00	"$5,976.25"	"$9,466.38"	"$9,562.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.104	SUP	Custom 27203010		04.315.104  -  ARM DISTRCT 20MM EXTN RIGID	BOTH IP/OP	"$2,282.50 "	"$1,689.05"	$0.00	"$1,826.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,694.07"	"$1,694.07"	$0.00	$0.00	$475.67	$0.00	$0.00	$0.00	$0.00	"$1,141.25"	"$1,807.74"	"$1,826.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.108	SUP	Custom 27203010		04.315.108  -  SET EXTN 40MM REMOVABLE RIGID ARM NONSTRL	BOTH IP/OP	"$2,282.50 "	"$1,689.05"	$0.00	"$1,826.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,694.07"	"$1,694.07"	$0.00	$0.00	$475.67	$0.00	$0.00	$0.00	$0.00	"$1,141.25"	"$1,807.74"	"$1,826.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.112	SUP	Custom 27803010		04.315.112  -  ARM EXTN 60MM RIGID REMOVAL TITANIUM COCR SILICONE NONSTRL	BOTH IP/OP	"$2,282.50 "	"$1,689.05"	$0.00	"$1,826.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,694.07"	"$1,694.07"	$0.00	$0.00	$475.67	$0.00	$0.00	$0.00	$0.00	"$1,141.25"	"$1,807.74"	"$1,826.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.125	SUP	Custom 27203010		04.315.125  -  SET EXTN 30MM FLEXIBLE REMOVABLE ARM	BOTH IP/OP	"$2,700.00 "	"$1,998.00"	$0.00	"$2,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,003.94"	"$2,003.94"	$0.00	$0.00	$562.68	$0.00	$0.00	$0.00	$0.00	"$1,350.00"	"$2,138.40"	"$2,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.127	SUP	Custom 27203010		04.315.127  -  SET EXTN 40MM FLEXIBLE REMOVABLE ARM	BOTH IP/OP	"$2,700.00 "	"$1,998.00"	$0.00	"$2,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,003.94"	"$2,003.94"	$0.00	$0.00	$562.68	$0.00	$0.00	$0.00	$0.00	"$1,350.00"	"$2,138.40"	"$2,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.132	SUP	Custom 27203010		04.315.132  -  ARM DISTRCT 60MM EXTN FLEXIBLE REMOVABLE TITANIUM NONSTRL	BOTH IP/OP	"$2,700.00 "	"$1,998.00"	$0.00	"$2,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,003.94"	"$2,003.94"	$0.00	$0.00	$562.68	$0.00	$0.00	$0.00	$0.00	"$1,350.00"	"$2,138.40"	"$2,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.201	SUP	Custom 27803010		04.315.201  -  COMPONENT DISTRCT 1MM A TYPE MESH FEET TITANIUM MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.202	SUP	Custom 27803010		04.315.202  -  COMPONENT DISTRCT 1MM MESH FT B TYPE INTERNAL MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.203	SUP	Custom 27803010		04.315.203  -  COMPONENT DISTRCT 1MM MESH FT C TYPE INTERNAL MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.211	SUP	Custom 27803010		04.315.211  -  FOOTPLATE BONE TYPE B CLOVERLEAF GREEN TITANIUM MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.212	SUP	Custom 27803010		04.315.212  -  FOOTPLATE BONE CLOVERLEAF B TYPE INTERNAL MANDIB 1 MM SCREW	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.213	SUP	Custom 27803010		04.315.213  -  FOOTPLATE BONE MESH C TYPE INTERNAL MANDIB 1 MM SCREW	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.301	SUP	Custom 27803010		04.315.301  -  FOOTPLATE BONE TYPE A MESH PINK TITANIUM MANDIB NONSTRL 1.5	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.302	SUP	HCPCS C1713		04.315.302  -  FOOTPLATE BONE B TYPE MESH TITANIUM MANDIB NONSTRL CMF	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$958.50	$958.50	$0.00	$0.00	$0.00	$443.95	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	"$1,259.90"	"$1,259.90"	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$333.35	$0.00	$0.00	$339.10	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.303	SUP	HCPCS C1713		04.315.303  -  FOOTPLATE BONE C TYPE MESH TITANIUM MANDIB NONSTRL CMF	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$958.50	$958.50	$0.00	$0.00	$0.00	$443.95	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	"$1,259.90"	"$1,259.90"	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$333.35	$0.00	$0.00	$339.10	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.311	SUP	Custom 27803010		04.315.311  -  FOOTPLATE BONE TYPE A CLOVERLEAF PINK TITANIUM MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.312	SUP	Custom 27803010		04.315.312  -  FOOTPLATE BONE TYPE B CLOVERLEAF PINK TITANIUM MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.313	SUP	Custom 27803010		04.315.313  -  FOOTPLATE BONE TYPE C CLOVERLEAF PINK TITANIUM MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.321	SUP	Custom 27803010		04.315.321  -  FOOTPLATE BONE 5.5MM TYPE B ELEVATED MESH OFFST PINK	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.322	SUP	Custom 27803010		04.315.322  -  FOOTPLATE BONE 7.5MM TYPE B ELEVATED MESH OFFST PINK	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.323	SUP	Custom 27803010		04.315.323  -  FOOTPLATE BONE TYPE C ELEVATED MESH OFFST PINK TITANIUM	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.401	SUP	Custom 27803010		04.315.401  -  FOOTPLATE BONE TYPE A MESH BLUE TITANIUM MANDIB NONSTRL 2MM	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.402	SUP	Custom 27803010		04.315.402  -  FOOTPLATE BONE TYPE B MESH BLUE TITANIUM MANDIB NONSTRL 2MM	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.403	SUP	Custom 27803010		04.315.403  -  FOOTPLATE BONE TYPE C MESH BLUE TITANIUM MANDIB NONSTRL 2MM	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.411	SUP	Custom 27803010		04.315.411  -  FOOTPLATE BONE TYPE A CLOVERLEAF BLUE TITANIUM MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.412	SUP	Custom 27803010		04.315.412  -  FOOTPLATE BONE TYPE B CLOVERLEAF BLUE TITANIUM MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.413	SUP	Custom 27803010		04.315.413  -  FOOTPLATE BONE TYPE C CLOVERLEAF BLUE TITANIUM MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.421	SUP	Custom 27803010		04.315.421  -  FOOTPLATE BONE 5.5MM TYPE B MESH OFFST BLUE TITANIUM MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.422	SUP	Custom 27803010		04.315.422  -  FOOTPLATE BONE 7.5MM TYPE C MESH OFFST BLUE TITANIUM MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.423	SUP	Custom 27803010		04.315.423  -  FOOTPLATE BONE TYPE C MESH OFFST BLUE TITANIUM MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.501	SUP	Custom 27803010		04.315.501  -  FOOTPLATE BONE TYPE A MESH YELLOW TITANIUM MANDIB NONSTRL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.502	SUP	Custom 27803010		04.315.502  -  COMPONENT DISTRCT 1.3MM MESH FEET INTERNAL B TYPE MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.503	SUP	Custom 27803010		04.315.503  -  COMPONENT DISTRCT 1.3MM MESH FEET C TYPE INTERNAL MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.511	SUP	Custom 27803010		04.315.511  -  FOOTPLATE BONE TYPE A CLOVERLEAF YELLOW TITANIUM MANDIB	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.512	SUP	HCPCS C1713		04.315.512  -  PLATE BONE B MANDIB NONSTRL 1.3 MM SCREWS	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$958.50	$958.50	$0.00	$0.00	$0.00	$443.95	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	"$1,259.90"	"$1,259.90"	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$333.35	$0.00	$0.00	$339.10	$0.00	$0.00	$0.00	$0.00	$0.00
04.315.513	SUP	HCPCS C1713		04.315.513  -  PLATE BONE C MANDIB NONSTRL 1.3 MM SCREWS	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$958.50	$958.50	$0.00	$0.00	$0.00	$443.95	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	"$1,259.90"	"$1,259.90"	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$333.35	$0.00	$0.00	$339.10	$0.00	$0.00	$0.00	$0.00	$0.00
04.402.007S	SUP	HCPCS C1713		04.402.007S  -  STEM RADIAL STR 7MM 26MM TITANIUM STERILE	BOTH IP/OP	"$3,286.33 "	"$2,431.88"	$0.00	"$2,629.06"	"$1,478.85"	"$1,478.85"	$0.00	$0.00	$0.00	$684.95	"$2,439.11"	"$2,439.11"	$0.00	$0.00	$684.87	$0.00	"$1,620.16"	"$1,620.16"	$0.00	"$1,643.16"	"$2,602.77"	"$2,629.06"	$0.00		$0.00	$499.33	$0.00	$0.00	$523.18	$0.00	$0.00	$0.00	$0.00	$0.00
04.449.000	SUP	HCPCS C1713		04.449.000  -  HEAD SCR CNDYLR TI NONSTRL	BOTH IP/OP	"$6,745.50 "	"$4,991.67"	$0.00	"$5,396.40"	"$3,035.48"	"$3,035.48"	$0.00	$0.00	$0.00	"$1,405.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,405.76"	$0.00	"$3,325.53"	"$3,325.53"	$0.00	"$3,372.75"	"$5,342.44"	"$5,396.40"	$0.00		$0.00	"$1,055.67"	$0.00	$0.00	"$1,073.88"	$0.00	$0.00	$0.00	$0.00	$0.00
04.449.010	SUP	HCPCS C1713		04.449.010  -  PLATE BONE 0MM CRNMXF TI LCK CNDYLR HEAD RECON NONSTRL	BOTH IP/OP	$771.75 	$571.10	$0.00	$617.40	$347.29	$347.29	$0.00	$0.00	$0.00	$160.85	$572.79	$572.79	$0.00	$0.00	$160.83	$0.00	$456.49	$456.49	$0.00	$385.88	$611.23	$617.40	$0.00		$0.00	$120.78	$0.00	$0.00	$122.86	$0.00	$0.00	$0.00	$0.00	$0.00
04.449.020	SUP	HCPCS C1713		04.449.020  -  PLATE 2MM CRNMXF LCK CNDYLR HEAD RECON BONE TI NONSTRL	BOTH IP/OP	$771.75 	$571.10	$0.00	$617.40	$347.29	$347.29	$0.00	$0.00	$0.00	$160.85	$572.79	$572.79	$0.00	$0.00	$160.83	$0.00	$456.49	$456.49	$0.00	$385.88	$611.23	$617.40	$0.00		$0.00	$120.78	$0.00	$0.00	$122.86	$0.00	$0.00	$0.00	$0.00	$0.00
04.449.030	SUP	HCPCS C1713		04.449.030  -  PLATE 4MM CRNMXF LCK CNDYLR HEAD RECON BONE TI NONSTRL	BOTH IP/OP	$771.75 	$571.10	$0.00	$617.40	$347.29	$347.29	$0.00	$0.00	$0.00	$160.85	$572.79	$572.79	$0.00	$0.00	$160.83	$0.00	$456.49	$456.49	$0.00	$385.88	$611.23	$617.40	$0.00		$0.00	$120.78	$0.00	$0.00	$122.86	$0.00	$0.00	$0.00	$0.00	$0.00
04.449.040	SUP	HCPCS C1713		04.449.040  -  PLATE 6MM CRNMXF LCK CNDYLR HEAD RECON BONE TI NONSTRL	BOTH IP/OP	$771.75 	$571.10	$0.00	$617.40	$347.29	$347.29	$0.00	$0.00	$0.00	$160.85	$572.79	$572.79	$0.00	$0.00	$160.83	$0.00	$456.49	$456.49	$0.00	$385.88	$611.23	$617.40	$0.00		$0.00	$120.78	$0.00	$0.00	$122.86	$0.00	$0.00	$0.00	$0.00	$0.00
04.497.000	SUP	HCPCS C1713		04.497.000  -  SCREW TI CNDYLR HEAD BONE NONSTRL	BOTH IP/OP	$328.50 	$243.09	$0.00	$262.80	$147.83	$147.83	$0.00	$0.00	$0.00	$68.47	$243.81	$243.81	$0.00	$0.00	$68.46	$0.00	$194.31	$194.31	$0.00	$164.25	$260.17	$262.80	$0.00		$0.00	$51.41	$0.00	$0.00	$52.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.497.001	SUP	HCPCS C1713		04.497.001  -  SCREW TI CNDYLR SLT HEAD BONE MTRXMAND	BOTH IP/OP	$384.75 	$284.72	$0.00	$307.80	$173.14	$173.14	$0.00	$0.00	$0.00	$80.19	$285.56	$285.56	$0.00	$0.00	$80.18	$0.00	$227.58	$227.58	$0.00	$192.38	$304.72	$307.80	$0.00		$0.00	$60.21	$0.00	$0.00	$61.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.000	SUP	HCPCS C1713		04.500.000  -  ROD FIX 110MM TITANIUM MAXL NONSTRL	BOTH IP/OP	$767.50 	$567.95	$0.00	$614.00	$345.38	$345.38	$0.00	$0.00	$0.00	$159.97	$569.64	$569.64	$0.00	$0.00	$159.95	$0.00	$453.98	$453.98	$0.00	$383.75	$607.86	$614.00	$0.00		$0.00	$120.11	$0.00	$0.00	$122.19	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.001	SUP	HCPCS C1713		04.500.001  -  SCREW SURG DISTRCT EXTERNAL TITANIUM MAXILLOMANDIBULAR	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$130.50	$130.50	$0.00	$0.00	$0.00	$60.44	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$171.54	$171.54	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$45.39	$0.00	$0.00	$46.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.002	SUP	HCPCS C1713		04.500.002  -  SCREW BONE 27MM SLFDRILL WIRE FIX TITANIUM MANDIB NONSTRL	BOTH IP/OP	$347.50 	$257.15	$0.00	$278.00	$156.38	$156.38	$0.00	$0.00	$0.00	$72.43	$257.91	$257.91	$0.00	$0.00	$72.42	$0.00	$205.55	$205.55	$0.00	$173.75	$275.22	$278.00	$0.00		$0.00	$54.38	$0.00	$0.00	$55.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.006	SUP	HCPCS C1713		04.500.006  -  ANCHOR SCR 6MM OTHDNTC BONE TI ANCHORAGE SLFDRILL	BOTH IP/OP	$274.50 	$203.13	$0.00	$219.60	$123.53	$123.53	$0.00	$0.00	$0.00	$57.21	$203.73	$203.73	$0.00	$0.00	$57.21	$0.00	$162.37	$162.37	$0.00	$137.25	$217.40	$219.60	$0.00		$0.00	$42.96	$0.00	$0.00	$43.70	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.008	SUP	HCPCS C1713		04.500.008  -  ANCHOR SCR 8MM OTHDNTC BONE TI SLFDRILL NONSTRL	BOTH IP/OP	$274.50 	$203.13	$0.00	$219.60	$123.53	$123.53	$0.00	$0.00	$0.00	$57.21	$203.73	$203.73	$0.00	$0.00	$57.21	$0.00	$162.37	$162.37	$0.00	$137.25	$217.40	$219.60	$0.00		$0.00	$42.96	$0.00	$0.00	$43.70	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.010	SUP	HCPCS C1713		04.500.010  -  SCREW ANCH 10MM TI ANCH SLFTAP OBA	BOTH IP/OP	$274.50 	$203.13	$0.00	$219.60	$123.53	$123.53	$0.00	$0.00	$0.00	$57.21	$203.73	$203.73	$0.00	$0.00	$57.21	$0.00	$162.37	$162.37	$0.00	$137.25	$217.40	$219.60	$0.00		$0.00	$42.96	$0.00	$0.00	$43.70	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.012	SUP	HCPCS C1713		04.500.012  -  TI OBA PLATE ANCHOR BRACKET DESIGN 4 HOLES	BOTH IP/OP	$483.75 	$357.98	$0.00	$387.00	$217.69	$217.69	$0.00	$0.00	$0.00	$100.83	$359.04	$359.04	$0.00	$0.00	$100.81	$0.00	$286.14	$286.14	$0.00	$241.88	$383.13	$387.00	$0.00		$0.00	$75.71	$0.00	$0.00	$77.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.013	SUP	HCPCS C1713		04.500.013  -  PLATE ANCH TI 4 HOLE DOMED DSGN	BOTH IP/OP	$483.75 	$357.98	$0.00	$387.00	$217.69	$217.69	$0.00	$0.00	$0.00	$100.83	$359.04	$359.04	$0.00	$0.00	$100.81	$0.00	$286.14	$286.14	$0.00	$241.88	$383.13	$387.00	$0.00		$0.00	$75.71	$0.00	$0.00	$77.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.014	SUP	HCPCS C1713		04.500.014  -  PLATE OTHDNTC 4 HOLE ANCH MESH PAD DSGN BONE TI NONSTRL	BOTH IP/OP	$483.75 	$357.98	$0.00	$387.00	$217.69	$217.69	$0.00	$0.00	$0.00	$100.83	$359.04	$359.04	$0.00	$0.00	$100.81	$0.00	$286.14	$286.14	$0.00	$241.88	$383.13	$387.00	$0.00		$0.00	$75.71	$0.00	$0.00	$77.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.015	SUP	HCPCS C1713		04.500.015  -  TI OBA PLATE ANCHOR BRACKET DESIGN 5 HOLES	BOTH IP/OP	$483.75 	$357.98	$0.00	$387.00	$217.69	$217.69	$0.00	$0.00	$0.00	$100.83	$359.04	$359.04	$0.00	$0.00	$100.81	$0.00	$286.14	$286.14	$0.00	$241.88	$383.13	$387.00	$0.00		$0.00	$75.71	$0.00	$0.00	$77.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.016	SUP	HCPCS C1713		04.500.016  -  PLATE ANCH TI 5 HOLE DOMED DSGN	BOTH IP/OP	$483.75 	$357.98	$0.00	$387.00	$217.69	$217.69	$0.00	$0.00	$0.00	$100.83	$359.04	$359.04	$0.00	$0.00	$100.81	$0.00	$286.14	$286.14	$0.00	$241.88	$383.13	$387.00	$0.00		$0.00	$75.71	$0.00	$0.00	$77.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.017	SUP	HCPCS C1713		04.500.017  -  PLATE OTHDNTC 5 HOLE ANCH MESH PAD DSGN BONE TI NONSTRL	BOTH IP/OP	$483.75 	$357.98	$0.00	$387.00	$217.69	$217.69	$0.00	$0.00	$0.00	$100.83	$359.04	$359.04	$0.00	$0.00	$100.81	$0.00	$286.14	$286.14	$0.00	$241.88	$383.13	$387.00	$0.00		$0.00	$75.71	$0.00	$0.00	$77.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.018	SUP	Custom 27803010		04.500.018  -  BODY DISTRCT 100MM RAD STR CURVILINEAR TITANIUM MANDIB	BOTH IP/OP	"$16,962.50 "	"$12,552.25"	$0.00	"$13,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,534.99"	$0.00	$0.00	$0.00	$0.00	"$8,481.25"	"$13,434.30"	"$13,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.024.01	SUP	HCPCS C1713		04.500.024.01  -  TI OBA PLATE ANCHOR SCREW SELF-DRILLING 4MM	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.026.01	SUP	HCPCS C1713		04.500.026.01  -  TI OBA PLATE ANCHOR SCREW SELF-DRILLING 6MM	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.028.01	SUP	HCPCS C1713		04.500.028.01  -  TI OBA PLATE ANCHOR SCREW SELF-DRILLING 8MM	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.034.01	SUP	HCPCS C1713		04.500.034.01  -  SCREW TI 4MM MAXFACL OTHDNTC ER BONE NONSTRL	BOTH IP/OP	$214.88 	$159.01	$0.00	$171.90	$96.69	$96.69	$0.00	$0.00	$0.00	$44.79	$159.48	$159.48	$0.00	$0.00	$44.78	$0.00	$127.10	$127.10	$0.00	$107.44	$170.18	$171.90	$0.00		$0.00	$33.63	$0.00	$0.00	$34.21	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.036.01	SUP	HCPCS C1713		04.500.036.01  -  TI OBA EMERGENCY SCREW 6MM	BOTH IP/OP	$214.88 	$159.01	$0.00	$171.90	$96.69	$96.69	$0.00	$0.00	$0.00	$44.79	$159.48	$159.48	$0.00	$0.00	$44.78	$0.00	$127.10	$127.10	$0.00	$107.44	$170.18	$171.90	$0.00		$0.00	$33.63	$0.00	$0.00	$34.21	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.038.01	SUP	HCPCS C1713		04.500.038.01  -  SCREW TI 8MM MAXFACL ER BONE	BOTH IP/OP	$214.88 	$159.01	$0.00	$171.90	$96.69	$96.69	$0.00	$0.00	$0.00	$44.79	$159.48	$159.48	$0.00	$0.00	$44.78	$0.00	$127.10	$127.10	$0.00	$107.44	$170.18	$171.90	$0.00		$0.00	$33.63	$0.00	$0.00	$34.21	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.100	SUP	Custom 27803010		04.500.100  -  BODY DSTRCT 100MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK	BOTH IP/OP	"$16,962.50 "	"$12,552.25"	$0.00	"$13,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,534.99"	$0.00	$0.00	$0.00	$0.00	"$8,481.25"	"$13,434.30"	"$13,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.101	SUP	Custom 27803010		04.500.101  -  BODY DSTRCT 100MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK	BOTH IP/OP	"$16,962.50 "	"$12,552.25"	$0.00	"$13,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,534.99"	$0.00	$0.00	$0.00	$0.00	"$8,481.25"	"$13,434.30"	"$13,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.130	SUP	Custom 27803010		04.500.130  -  BODY DSTRCT 30MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK	BOTH IP/OP	"$16,962.50 "	"$12,552.25"	$0.00	"$13,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,534.99"	$0.00	$0.00	$0.00	$0.00	"$8,481.25"	"$13,434.30"	"$13,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.131	SUP	Custom 27803010		04.500.131  -  BODY DSTRCT 30MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK	BOTH IP/OP	"$16,962.50 "	"$12,552.25"	$0.00	"$13,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,534.99"	$0.00	$0.00	$0.00	$0.00	"$8,481.25"	"$13,434.30"	"$13,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.140	SUP	Custom 27803010		04.500.140  -  BODY DSTRCT 40MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK	BOTH IP/OP	"$16,962.50 "	"$12,552.25"	$0.00	"$13,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,534.99"	$0.00	$0.00	$0.00	$0.00	"$8,481.25"	"$13,434.30"	"$13,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.141	SUP	Custom 27803010		04.500.141  -  BODY DSTRCT 40MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK	BOTH IP/OP	"$16,962.50 "	"$12,552.25"	$0.00	"$13,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,534.99"	$0.00	$0.00	$0.00	$0.00	"$8,481.25"	"$13,434.30"	"$13,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.150	SUP	Custom 27803010		04.500.150  -  BODY DSTRCT 50MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK	BOTH IP/OP	"$16,962.50 "	"$12,552.25"	$0.00	"$13,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,534.99"	$0.00	$0.00	$0.00	$0.00	"$8,481.25"	"$13,434.30"	"$13,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.151	SUP	Custom 27803010		04.500.151  -  BODY DSTRCT 50MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK	BOTH IP/OP	"$16,962.50 "	"$12,552.25"	$0.00	"$13,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,534.99"	$0.00	$0.00	$0.00	$0.00	"$8,481.25"	"$13,434.30"	"$13,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.170	SUP	Custom 27803010		04.500.170  -  BODY DSTRCT 70MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK	BOTH IP/OP	"$16,962.50 "	"$12,552.25"	$0.00	"$13,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,534.99"	$0.00	$0.00	$0.00	$0.00	"$8,481.25"	"$13,434.30"	"$13,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.500.171	SUP	Custom 27803010		04.500.171  -  BODY DSTRCT 70MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK	BOTH IP/OP	"$16,962.50 "	"$12,552.25"	$0.00	"$13,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,534.99"	$0.00	$0.00	$0.00	$0.00	"$8,481.25"	"$13,434.30"	"$13,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.001	SUP	HCPCS C1713		04.501.001  -  PLATE BN 1.5MM NS MATRIXRIB 15 HL PRECONTOUR LCK LOPRFL TI 3	BOTH IP/OP	"$4,307.50 "	"$3,187.55"	$0.00	"$3,446.00"	"$1,938.38"	"$1,938.38"	$0.00	$0.00	$0.00	$897.79	"$3,197.03"	"$3,197.03"	$0.00	$0.00	$897.68	$0.00	"$2,123.60"	"$2,123.60"	$0.00	"$2,153.75"	"$3,411.54"	"$3,446.00"	$0.00		$0.00	$674.12	$0.00	$0.00	$685.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.002	SUP	HCPCS C1713		04.501.002  -  PLATE BN 1.5MM NS MATRIXRIB 15 HL PRECONTOUR LCK LOPRFL TI 3	BOTH IP/OP	"$4,307.50 "	"$3,187.55"	$0.00	"$3,446.00"	"$1,938.38"	"$1,938.38"	$0.00	$0.00	$0.00	$897.79	"$3,197.03"	"$3,197.03"	$0.00	$0.00	$897.68	$0.00	"$2,123.60"	"$2,123.60"	$0.00	"$2,153.75"	"$3,411.54"	"$3,446.00"	$0.00		$0.00	$674.12	$0.00	$0.00	$685.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.003	SUP	HCPCS C1713		04.501.003  -  PLATE BN 1.5MM NS MATRIXRIB 16 HL PRECONTOUR LCK LOPRFL TI 4	BOTH IP/OP	"$4,154.38 "	"$3,074.24"	$0.00	"$3,323.50"	"$1,869.47"	"$1,869.47"	$0.00	$0.00	$0.00	$865.88	"$3,083.38"	"$3,083.38"	$0.00	$0.00	$865.77	$0.00	"$2,048.11"	"$2,048.11"	$0.00	"$2,077.19"	"$3,290.27"	"$3,323.50"	$0.00		$0.00	$650.16	$0.00	$0.00	$661.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.004	SUP	HCPCS C1713		04.501.004  -  PLATE BN 1.5MM NS MATRIXRIB 16 HL PRECONTOUR LCK LOPRFL TI 4	BOTH IP/OP	"$4,154.38 "	"$3,074.24"	$0.00	"$3,323.50"	"$1,869.47"	"$1,869.47"	$0.00	$0.00	$0.00	$865.88	"$3,083.38"	"$3,083.38"	$0.00	$0.00	$865.77	$0.00	"$2,048.11"	"$2,048.11"	$0.00	"$2,077.19"	"$3,290.27"	"$3,323.50"	$0.00		$0.00	$650.16	$0.00	$0.00	$661.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.005	SUP	HCPCS C1713		04.501.005  -  PLATE BN 1.5MM NS MATRIXRIB 17 HL PRECONTOUR LCK LOPRFL TI 6	BOTH IP/OP	"$4,154.38 "	"$3,074.24"	$0.00	"$3,323.50"	"$1,869.47"	"$1,869.47"	$0.00	$0.00	$0.00	$865.88	"$3,083.38"	"$3,083.38"	$0.00	$0.00	$865.77	$0.00	"$2,048.11"	"$2,048.11"	$0.00	"$2,077.19"	"$3,290.27"	"$3,323.50"	$0.00		$0.00	$650.16	$0.00	$0.00	$661.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.006	SUP	HCPCS C1713		04.501.006  -  PLATE BN 1.5MM NS MATRIXRIB 17 HL PRECONTOUR LCK LOPRFL TI 6	BOTH IP/OP	"$4,154.38 "	"$3,074.24"	$0.00	"$3,323.50"	"$1,869.47"	"$1,869.47"	$0.00	$0.00	$0.00	$865.88	"$3,083.38"	"$3,083.38"	$0.00	$0.00	$865.77	$0.00	"$2,048.11"	"$2,048.11"	$0.00	"$2,077.19"	"$3,290.27"	"$3,323.50"	$0.00		$0.00	$650.16	$0.00	$0.00	$661.38	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.007	SUP	HCPCS C1713		04.501.007  -  PLATE BN 1.5MM NS MATRIXRIB 18 HL PRECONTOUR LCK LOPRFL TI	BOTH IP/OP	"$4,307.50 "	"$3,187.55"	$0.00	"$3,446.00"	"$1,938.38"	"$1,938.38"	$0.00	$0.00	$0.00	$897.79	"$3,197.03"	"$3,197.03"	$0.00	$0.00	$897.68	$0.00	"$2,123.60"	"$2,123.60"	$0.00	"$2,153.75"	"$3,411.54"	"$3,446.00"	$0.00		$0.00	$674.12	$0.00	$0.00	$685.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.008	SUP	HCPCS C1713		04.501.008  -  PLATE BN 1.5MM NS MATRIXRIB 18 HL PRECONTOUR LCK LOPRFL TI	BOTH IP/OP	"$4,307.50 "	"$3,187.55"	$0.00	"$3,446.00"	"$1,938.38"	"$1,938.38"	$0.00	$0.00	$0.00	$897.79	"$3,197.03"	"$3,197.03"	$0.00	$0.00	$897.68	$0.00	"$2,123.60"	"$2,123.60"	$0.00	"$2,153.75"	"$3,411.54"	"$3,446.00"	$0.00		$0.00	$674.12	$0.00	$0.00	$685.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.009	SUP	HCPCS C1713		04.501.009  -  PLATE BONE UNIVERSAL 8 HOLE MATRIXRIB TITANIUM RIB NONSTRL	BOTH IP/OP	"$2,935.00 "	"$2,171.90"	$0.00	"$2,348.00"	"$1,320.75"	"$1,320.75"	$0.00	$0.00	$0.00	$611.73	"$2,178.36"	"$2,178.36"	$0.00	$0.00	$611.65	$0.00	"$1,446.96"	"$1,446.96"	$0.00	"$1,467.50"	"$2,324.52"	"$2,348.00"	$0.00		$0.00	$459.33	$0.00	$0.00	$467.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.010	SUP	HCPCS C1713		04.501.010  -  IMPLANT FIX SMALL 3MM SPLINT MATRIXRIB TITANIUM	BOTH IP/OP	"$1,557.50 "	"$1,152.55"	$0.00	"$1,246.00"	$700.88	$700.88	$0.00	$0.00	$0.00	$324.62	"$1,155.98"	"$1,155.98"	$0.00	$0.00	$324.58	$0.00	$921.26	$921.26	$0.00	$778.75	"$1,233.54"	"$1,246.00"	$0.00		$0.00	$243.75	$0.00	$0.00	$247.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.011	SUP	HCPCS C1713		04.501.011  -  IMPLANT FIX MEDIUM 4MM SPLINT MATRIXRIB TITANIUM	BOTH IP/OP	"$1,557.50 "	"$1,152.55"	$0.00	"$1,246.00"	$700.88	$700.88	$0.00	$0.00	$0.00	$324.62	"$1,155.98"	"$1,155.98"	$0.00	$0.00	$324.58	$0.00	$921.26	$921.26	$0.00	$778.75	"$1,233.54"	"$1,246.00"	$0.00		$0.00	$243.75	$0.00	$0.00	$247.95	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.012	SUP	Custom 27803010		04.501.012  -  IMPLANT FIX LARGE 5MM SPLINT MATRIXRIB TITANIUM	BOTH IP/OP	"$1,557.50 "	"$1,152.55"	$0.00	"$1,246.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,155.98"	"$1,155.98"	$0.00	$0.00	$324.58	$0.00	$0.00	$0.00	$0.00	$778.75	"$1,233.54"	"$1,246.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.016.01	SUP	HCPCS C1713		04.501.016.01  -  SCREW BONE 2.9MM 6MM SELF TAP LOCK MATRIXRIB TITANIUM RIB	BOTH IP/OP	$542.50 	$401.45	$0.00	$434.00	$244.13	$244.13	$0.00	$0.00	$0.00	$113.07	$402.64	$402.64	$0.00	$0.00	$113.06	$0.00	$320.89	$320.89	$0.00	$271.25	$429.66	$434.00	$0.00		$0.00	$84.90	$0.00	$0.00	$86.37	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.018.01	SUP	HCPCS C1713		04.501.018.01  -  SCREW BONE 2.9MM 8MM SELF TAP LOCK MATRIXRIB TITANIUM RIB	BOTH IP/OP	$542.50 	$401.45	$0.00	$434.00	$244.13	$244.13	$0.00	$0.00	$0.00	$113.07	$402.64	$402.64	$0.00	$0.00	$113.06	$0.00	$320.89	$320.89	$0.00	$271.25	$429.66	$434.00	$0.00		$0.00	$84.90	$0.00	$0.00	$86.37	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.020.01	SUP	HCPCS C1713		04.501.020.01  -  SCREW BONE 2.9MM 10MM SELF TAP LOCK MATRIXRIB TITANIUM RIB	BOTH IP/OP	$542.50 	$401.45	$0.00	$434.00	$244.13	$244.13	$0.00	$0.00	$0.00	$113.07	$402.64	$402.64	$0.00	$0.00	$113.06	$0.00	$320.89	$320.89	$0.00	$271.25	$429.66	$434.00	$0.00		$0.00	$84.90	$0.00	$0.00	$86.37	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.022.01	SUP	HCPCS C1713		04.501.022.01  -  SCREW BONE 2.9MM 12MM SELF TAP LOCK MATRIXRIB TITANIUM RIB	BOTH IP/OP	$524.88 	$388.41	$0.00	$419.90	$236.19	$236.19	$0.00	$0.00	$0.00	$109.40	$389.56	$389.56	$0.00	$0.00	$109.38	$0.00	$310.46	$310.46	$0.00	$262.44	$415.70	$419.90	$0.00		$0.00	$82.14	$0.00	$0.00	$83.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.024.01	SUP	HCPCS C1713		04.501.024.01  -  IMPLANT FIX 14MM SYSTEM SET MATRIXRIB	BOTH IP/OP	$542.50 	$401.45	$0.00	$434.00	$244.13	$244.13	$0.00	$0.00	$0.00	$113.07	$402.64	$402.64	$0.00	$0.00	$113.06	$0.00	$320.89	$320.89	$0.00	$271.25	$429.66	$434.00	$0.00		$0.00	$84.90	$0.00	$0.00	$86.37	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.026.01	SUP	HCPCS C1713		04.501.026.01  -  SCREW BONE 2.9MM 16MM ANGULAR STABLE SLFTAP LOCKING	BOTH IP/OP	$542.50 	$401.45	$0.00	$434.00	$244.13	$244.13	$0.00	$0.00	$0.00	$113.07	$402.64	$402.64	$0.00	$0.00	$113.06	$0.00	$320.89	$320.89	$0.00	$271.25	$429.66	$434.00	$0.00		$0.00	$84.90	$0.00	$0.00	$86.37	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.028.01	SUP	HCPCS C1713		04.501.028.01  -  SCREW BONE 2.9MM 18MM ANGULAR STABLE SLFTAP LOCKING	BOTH IP/OP	$542.50 	$401.45	$0.00	$434.00	$244.13	$244.13	$0.00	$0.00	$0.00	$113.07	$402.64	$402.64	$0.00	$0.00	$113.06	$0.00	$320.89	$320.89	$0.00	$271.25	$429.66	$434.00	$0.00		$0.00	$84.90	$0.00	$0.00	$86.37	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.036.05	SUP	HCPCS C1713		04.501.036.05  -  SCREW BONE 2.9MM 6MM MATRIXRIB TI RB SLFTAP NLCKG NONSTRL	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.094	SUP	HCPCS C1713		04.501.094  -  PLATE BN I 2.8MM NS MATRIXRIB 9 HL TI RB	BOTH IP/OP	"$3,170.00 "	"$2,345.80"	$0.00	"$2,536.00"	"$1,426.50"	"$1,426.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,585.00"	"$2,510.64"	"$2,536.00"	$0.00		$0.00	$496.11	$0.00	$0.00	$504.66	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.110.01	SUP	HCPCS C1713		04.501.110.01  -  SCREW BONE 3MM 10MM LOCK SELF DRILL TITANIUM STERNAL NONSTRL	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.112.01	SUP	HCPCS C1713		04.501.112.01  -  SCREW BONE 3MM 12MM SELF DRILL UNILOCK TITANIUM STERNUM	BOTH IP/OP	$490.88 	$363.25	$0.00	$392.70	$220.89	$220.89	$0.00	$0.00	$0.00	$102.31	$364.33	$364.33	$0.00	$0.00	$102.30	$0.00	$290.35	$290.35	$0.00	$245.44	$388.78	$392.70	$0.00		$0.00	$76.82	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.114.01	SUP	HCPCS C1713		04.501.114.01  -  SCREW BONE 3MM 14MM SELF DRILL UNILOCK TITANIUM STERNUM	BOTH IP/OP	$577.50 	$427.35	$0.00	$462.00	$259.88	$259.88	$0.00	$0.00	$0.00	$120.37	$428.62	$428.62	$0.00	$0.00	$120.35	$0.00	$341.59	$341.59	$0.00	$288.75	$457.38	$462.00	$0.00		$0.00	$90.38	$0.00	$0.00	$91.94	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.116.01	SUP	HCPCS C1713		04.501.116.01  -  SCREW BONE 3MM 16MM SELF DRILL UNILOCK TITANIUM STERNUM	BOTH IP/OP	$577.50 	$427.35	$0.00	$462.00	$259.88	$259.88	$0.00	$0.00	$0.00	$120.37	$428.62	$428.62	$0.00	$0.00	$120.35	$0.00	$341.59	$341.59	$0.00	$288.75	$457.38	$462.00	$0.00		$0.00	$90.38	$0.00	$0.00	$91.94	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.118.01	SUP	HCPCS C1713		04.501.118.01  -  SCREW BONE 3MM 18MM SELF DRILL UNILOCK TITANIUM STERNUM	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
04.501.120.01	SUP	HCPCS C1713		04.501.120.01  -  SCREW BONE 3MM 20MM SLFDRILL TITANIUM STERNUM NONSTRL	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.021	SUP	Custom 27803010		04.503.021  -  COVER BUR HOLE BLUE 12MM MATRIXNEURO TI NONSTRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$0.00	$0.00	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.022	SUP	Custom 27803010		04.503.022  -  COVER BUR HOLE 15MM MATRIXNEURO TI NONSTRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$0.00	$0.00	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.023	SUP	Custom 27803010		04.503.023  -  COVER BUR HOLE 17MM MATRIXNEURO MIDFAC CRANFCL TI NONSTRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$0.00	$0.00	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.024	SUP	Custom 27803010		04.503.024  -  COVER BUR HOLE 24MM MATRIXNEURO CRANIAL TI NONSTRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$0.00	$0.00	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.026	SUP	Custom 27803010		04.503.026  -  COVER BUR HOLE 12MM MATRIXNEURO CRNMXF TI SHNT NONSTRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$0.00	$0.00	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.027	SUP	Custom 27803010		04.503.027  -  COVER BUR HOLE 15MM MATRIXNEURO CRNMXF TI SHNT NONSTRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$0.00	$0.00	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.028	SUP	Custom 27803010		04.503.028  -  COVER BUR HOLE 17MM MATRIXNEURO TI SHNT NONSTRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$0.00	$0.00	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.029	SUP	Custom 27803010		04.503.029  -  COVER BUR HOLE 24MM MATRIXNEURO CRNMXF TI NONSTRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$0.00	$0.00	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.056	SUP	HCPCS C1713		04.503.056  -  PLATE BONE MATRIXNEURO CRANIAL TI MESH STRUT MALBLE NONSTRL	BOTH IP/OP	"$1,665.00 "	"$1,232.10"	$0.00	"$1,332.00"	$749.25	$749.25	$0.00	$0.00	$0.00	$347.03	"$1,235.76"	"$1,235.76"	$0.00	$0.00	$346.99	$0.00	$984.85	$984.85	$0.00	$832.50	"$1,318.68"	"$1,332.00"	$0.00		$0.00	$260.57	$0.00	$0.00	$265.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.057	SUP	HCPCS C1713		04.503.057  -  PLATE BONE MATRIXNEURO TMPR TI MESH MALBLE NONSTRL	BOTH IP/OP	"$2,202.75 "	"$1,630.04"	$0.00	"$1,762.20"	$991.24	$991.24	$0.00	$0.00	$0.00	$459.11	"$1,634.88"	"$1,634.88"	$0.00	$0.00	$459.05	$0.00	"$1,302.93"	"$1,302.93"	$0.00	"$1,101.38"	"$1,744.58"	"$1,762.20"	$0.00		$0.00	$344.73	$0.00	$0.00	$350.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.061	SUP	HCPCS C1713		04.503.061  -  PLATE BONE 9MM MATRIXNEURO CRNMXF TI 2 HOLE STR NONSTRL	BOTH IP/OP	$176.63 	$130.71	$0.00	$141.30	$79.48	$79.48	$0.00	$0.00	$0.00	$36.81	$131.09	$131.09	$0.00	$0.00	$36.81	$0.00	$104.47	$104.47	$0.00	$88.31	$139.89	$141.30	$0.00		$0.00	$27.64	$0.00	$0.00	$28.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.062	SUP	HCPCS C1713		04.503.062  -  PLATE BN STRG 12MMX.4MM NS MATRIXNEURO 2 HL TI CRNL	BOTH IP/OP	$183.38 	$135.70	$0.00	$146.70	$82.52	$82.52	$0.00	$0.00	$0.00	$38.22	$136.10	$136.10	$0.00	$0.00	$38.22	$0.00	$108.47	$108.47	$0.00	$91.69	$145.24	$146.70	$0.00		$0.00	$28.70	$0.00	$0.00	$29.19	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.063	SUP	HCPCS C1713		04.503.063  -  PLATE BN STRG 24MMX.4MM NS MATRIXNEURO 4 HL TI CRNL	BOTH IP/OP	$209.25 	$154.85	$0.00	$167.40	$94.16	$94.16	$0.00	$0.00	$0.00	$43.61	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$123.77	$123.77	$0.00	$104.63	$165.73	$167.40	$0.00		$0.00	$32.75	$0.00	$0.00	$33.31	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.064	SUP	HCPCS C1713		04.503.064  -  PLATE BN X .4MM NS MATRIXNEURO 4 HL TI CRNL	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$303.75	$303.75	$0.00	$0.00	$0.00	$140.69	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$399.26	$399.26	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$105.64	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.065	SUP	HCPCS C1713		04.503.065  -  PLATE BN BX 14X14X.4MM NS MATRIXNEURO 4 HL TI CRNL	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$303.75	$303.75	$0.00	$0.00	$0.00	$140.69	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$399.26	$399.26	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$105.64	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.066	SUP	HCPCS C1713		04.503.066  -  PLATE BONE 16X16MM MATRIXNEURO CRNMXF TI BOX NONSTRL	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$303.75	$303.75	$0.00	$0.00	$0.00	$140.69	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$399.26	$399.26	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$105.64	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.067	SUP	HCPCS C1713		04.503.067  -  PLATE BN Y .4MM NS MATRIXNEURO 5 HL TI CRNL	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$303.75	$303.75	$0.00	$0.00	$0.00	$140.69	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$399.26	$399.26	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$105.64	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.068	SUP	HCPCS C1713		04.503.068  -  PLATE BN 2Y 18MMX.4MM NS MATRIXNEURO 6 HL TI CRNL	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$303.75	$303.75	$0.00	$0.00	$0.00	$140.69	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$399.26	$399.26	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$105.64	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.069	SUP	HCPCS C1713		04.503.069  -  PLATE BN 2Y 21MMX.4MM NS MATRIXNEURO 6 HL TI CRNL	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$303.75	$303.75	$0.00	$0.00	$0.00	$140.69	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$399.26	$399.26	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$105.64	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.070	SUP	HCPCS C1713		04.503.070  -  PLATE BN .4MM NS MATRIXNEURO 5 HL ADP TI CRNL	BOTH IP/OP	$605.25 	$447.89	$0.00	$484.20	$272.36	$272.36	$0.00	$0.00	$0.00	$126.15	$449.22	$449.22	$0.00	$0.00	$126.13	$0.00	$358.01	$358.01	$0.00	$302.63	$479.36	$484.20	$0.00		$0.00	$94.72	$0.00	$0.00	$96.36	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.071	SUP	HCPCS C1713		04.503.071  -  PLATE BONE MATRIXNEURO CRNMXF TI 7 HOLE ADP NONSTRL	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.072	SUP	HCPCS C1713		04.503.072  -  PLATE BONE MATRIXNEURO CRNMXF TI 20 HOLE ADP NONSTRL	BOTH IP/OP	"$1,498.50 "	"$1,108.89"	$0.00	"$1,198.80"	$674.33	$674.33	$0.00	$0.00	$0.00	$312.32	"$1,112.19"	"$1,112.19"	$0.00	$0.00	$312.29	$0.00	$886.36	$886.36	$0.00	$749.25	"$1,186.81"	"$1,198.80"	$0.00		$0.00	$234.52	$0.00	$0.00	$238.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.073	SUP	HCPCS C1713		04.503.073  -  PLATE BN BX 16X10X.4MM NS MATRIXNEURO 4 HL TI CRNL	BOTH IP/OP	$643.50 	$476.19	$0.00	$514.80	$289.58	$289.58	$0.00	$0.00	$0.00	$134.12	$477.61	$477.61	$0.00	$0.00	$134.11	$0.00	$380.63	$380.63	$0.00	$321.75	$509.65	$514.80	$0.00		$0.00	$100.71	$0.00	$0.00	$102.45	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.074	SUP	HCPCS C1713		04.503.074  -  PLATE BONE 9MM MATRIXNEURO CRNMXF TI 2X3 HOLE STRUT NONSTRL	BOTH IP/OP	"$1,170.00 "	$865.80	$0.00	$936.00	$526.50	$526.50	$0.00	$0.00	$0.00	$243.86	$868.37	$868.37	$0.00	$0.00	$243.83	$0.00	$692.06	$692.06	$0.00	$585.00	$926.64	$936.00	$0.00		$0.00	$183.11	$0.00	$0.00	$186.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.075	SUP	HCPCS C1713		04.503.075  -  PLATE BONE 34X14MM MATRIXNEURO CRNMXF TI 2X4 HOLE STRUT	BOTH IP/OP	"$1,665.00 "	"$1,232.10"	$0.00	"$1,332.00"	$749.25	$749.25	$0.00	$0.00	$0.00	$347.03	"$1,235.76"	"$1,235.76"	$0.00	$0.00	$346.99	$0.00	$984.85	$984.85	$0.00	$832.50	"$1,318.68"	"$1,332.00"	$0.00		$0.00	$260.57	$0.00	$0.00	$265.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.076	SUP	HCPCS C1713		04.503.076  -  PLATE BONE MATRIXNEURO CRNMXF TI 2X3 HOLE STRUT CVD NONSTRL	BOTH IP/OP	"$1,091.25 "	$807.53	$0.00	$873.00	$491.06	$491.06	$0.00	$0.00	$0.00	$227.44	$809.93	$809.93	$0.00	$0.00	$227.42	$0.00	$645.47	$645.47	$0.00	$545.63	$864.27	$873.00	$0.00		$0.00	$170.78	$0.00	$0.00	$173.73	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.077	SUP	HCPCS C1713		04.503.077  -  TI MATRIXNEURO CURVED STRUT PLATE/2 X 4 HOLE	BOTH IP/OP	"$1,554.75 "	"$1,150.52"	$0.00	"$1,243.80"	$699.64	$699.64	$0.00	$0.00	$0.00	$324.05	"$1,153.94"	"$1,153.94"	$0.00	$0.00	$324.01	$0.00	$919.63	$919.63	$0.00	$777.38	"$1,231.36"	"$1,243.80"	$0.00		$0.00	$243.32	$0.00	$0.00	$247.52	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.081	SUP	HCPCS C1713		04.503.081  -  PLATE BONE 45X38X.4MM MATRIXNEURO TI CONTUR MESH MALBLE	BOTH IP/OP	"$3,831.75 "	"$2,835.50"	$0.00	"$3,065.40"	"$1,724.29"	"$1,724.29"	$0.00	$0.00	$0.00	$798.63	"$2,843.92"	"$2,843.92"	$0.00	$0.00	$798.54	$0.00	"$1,889.05"	"$1,889.05"	$0.00	"$1,915.88"	"$3,034.75"	"$3,065.40"	$0.00		$0.00	$599.67	$0.00	$0.00	$610.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.082	SUP	HCPCS C1713		04.503.082  -  PLATE BONE 45X38X.4MM MATRIXNEURO TI CONTUR MESH RGD NONSTRL	BOTH IP/OP	"$3,831.75 "	"$2,835.50"	$0.00	"$3,065.40"	"$1,724.29"	"$1,724.29"	$0.00	$0.00	$0.00	$798.63	"$2,843.92"	"$2,843.92"	$0.00	$0.00	$798.54	$0.00	"$1,889.05"	"$1,889.05"	$0.00	"$1,915.88"	"$3,034.75"	"$3,065.40"	$0.00		$0.00	$599.67	$0.00	$0.00	$610.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.083	SUP	HCPCS C1713		04.503.083  -  MESH CRNL CNTR 100X100X.4MM SLVR NS MATRIXNEURO RGD TI	BOTH IP/OP	"$5,964.75 "	"$4,413.92"	$0.00	"$4,771.80"	"$2,684.14"	"$2,684.14"	$0.00	$0.00	$0.00	"$1,243.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,243.05"	$0.00	"$2,940.62"	"$2,940.62"	$0.00	"$2,982.38"	"$4,724.08"	"$4,771.80"	$0.00		$0.00	$933.48	$0.00	$0.00	$949.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.084	SUP	HCPCS C1713		04.503.084  -  MESH CRNL CNTR 100X100X.4MM BLU NS MATRIXNEURO RGD TI	BOTH IP/OP	"$5,964.75 "	"$4,413.92"	$0.00	"$4,771.80"	"$2,684.14"	"$2,684.14"	$0.00	$0.00	$0.00	"$1,243.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,243.05"	$0.00	"$2,940.62"	"$2,940.62"	$0.00	"$2,982.38"	"$4,724.08"	"$4,771.80"	$0.00		$0.00	$933.48	$0.00	$0.00	$949.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.085	SUP	HCPCS C1713		04.503.085  -  PLATE BONE MATRIXNEURO CRNMXF TI CONTUR MESH RGD NONSTRL	BOTH IP/OP	"$22,842.00 "	"$16,903.08"	$0.00	"$18,273.60"	"$10,278.90"	"$10,278.90"	$0.00	$0.00	$0.00	"$4,760.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,760.27"	$0.00	"$11,261.11"	"$11,261.11"	$0.00	"$11,421.00"	"$18,090.86"	"$18,273.60"	$0.00		$0.00	"$3,574.77"	$0.00	$0.00	"$3,636.45"	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.086	SUP	HCPCS C1713		04.503.086  -  PLATE BONE MATRIXNEURO SM CRNMXF TI CONTUR MESH MALBLE ARC	BOTH IP/OP	"$2,202.75 "	"$1,630.04"	$0.00	"$1,762.20"	$991.24	$991.24	$0.00	$0.00	$0.00	$459.11	"$1,634.88"	"$1,634.88"	$0.00	$0.00	$459.05	$0.00	"$1,302.93"	"$1,302.93"	$0.00	"$1,101.38"	"$1,744.58"	"$1,762.20"	$0.00		$0.00	$344.73	$0.00	$0.00	$350.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.087	SUP	HCPCS C1713		04.503.087  -  PLATE BONE MATRIXNEURO LG CRNMXF TI CONTUR MESH MALBLE ARC	BOTH IP/OP	"$3,433.50 "	"$2,540.79"	$0.00	"$2,746.80"	"$1,545.08"	"$1,545.08"	$0.00	$0.00	$0.00	$715.63	"$2,548.34"	"$2,548.34"	$0.00	$0.00	$715.54	$0.00	"$1,692.72"	"$1,692.72"	$0.00	"$1,716.75"	"$2,719.33"	"$2,746.80"	$0.00		$0.00	$537.34	$0.00	$0.00	$546.61	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.088	SUP	HCPCS C1713		04.503.088  -  PLATE BONE MATRIXNEURO SM CRNMXF TI CONTUR MESH RGD ARC	BOTH IP/OP	"$2,202.75 "	"$1,630.04"	$0.00	"$1,762.20"	$991.24	$991.24	$0.00	$0.00	$0.00	$459.11	"$1,634.88"	"$1,634.88"	$0.00	$0.00	$459.05	$0.00	"$1,302.93"	"$1,302.93"	$0.00	"$1,101.38"	"$1,744.58"	"$1,762.20"	$0.00		$0.00	$344.73	$0.00	$0.00	$350.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.089	SUP	HCPCS C1713		04.503.089  -  PLATE LG MIDFAC RGD ARC BONE MATRIXNEURO TI NONSTRL BLUE	BOTH IP/OP	"$3,433.50 "	"$2,540.79"	$0.00	"$2,746.80"	"$1,545.08"	"$1,545.08"	$0.00	$0.00	$0.00	$715.63	"$2,548.34"	"$2,548.34"	$0.00	$0.00	$715.54	$0.00	"$1,692.72"	"$1,692.72"	$0.00	"$1,716.75"	"$2,719.33"	"$2,746.80"	$0.00		$0.00	$537.34	$0.00	$0.00	$546.61	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.090	SUP	HCPCS C1713		04.503.090  -  PLATE BONE 30MM MATRIXNEURO CRNMXF TI CONTUR MESH MALBLE	BOTH IP/OP	"$2,202.75 "	"$1,630.04"	$0.00	"$1,762.20"	$991.24	$991.24	$0.00	$0.00	$0.00	$459.11	"$1,634.88"	"$1,634.88"	$0.00	$0.00	$459.05	$0.00	"$1,302.93"	"$1,302.93"	$0.00	"$1,101.38"	"$1,744.58"	"$1,762.20"	$0.00		$0.00	$344.73	$0.00	$0.00	$350.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.091	SUP	HCPCS C1713		04.503.091  -  PLATE BONE 70MM MATRIXNEURO CRNMXF TI CONTUR MESH MALBLE	BOTH IP/OP	"$4,560.75 "	"$3,374.96"	$0.00	"$3,648.60"	"$2,052.34"	"$2,052.34"	$0.00	$0.00	$0.00	$950.57	"$3,384.99"	"$3,384.99"	$0.00	$0.00	$950.46	$0.00	"$2,248.45"	"$2,248.45"	$0.00	"$2,280.38"	"$3,612.11"	"$3,648.60"	$0.00		$0.00	$713.76	$0.00	$0.00	$726.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.092	SUP	HCPCS C1713		04.503.092  -  PLATE BONE 100MM MATRIXNEURO CRNMXF TI MESH CONTUR MALBLE	BOTH IP/OP	"$5,688.00 "	"$4,209.12"	$0.00	"$4,550.40"	"$2,559.60"	"$2,559.60"	$0.00	$0.00	$0.00	"$1,185.52"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,185.38"	$0.00	"$2,804.18"	"$2,804.18"	$0.00	"$2,844.00"	"$4,504.90"	"$4,550.40"	$0.00		$0.00	$890.17	$0.00	$0.00	$905.53	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.093	SUP	HCPCS C1713		04.503.093  -  PLATE BONE 30MM MATRIXNEURO CRNMXF TI CONTUR MESH RGD	BOTH IP/OP	"$2,202.75 "	"$1,630.04"	$0.00	"$1,762.20"	$991.24	$991.24	$0.00	$0.00	$0.00	$459.11	"$1,634.88"	"$1,634.88"	$0.00	$0.00	$459.05	$0.00	"$1,302.93"	"$1,302.93"	$0.00	"$1,101.38"	"$1,744.58"	"$1,762.20"	$0.00		$0.00	$344.73	$0.00	$0.00	$350.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.094	SUP	HCPCS C1713		04.503.094  -  PLATE BONE 70MM MATRIXNEURO CRNMXF TI CONTUR MESH RGD	BOTH IP/OP	"$4,560.75 "	"$3,374.96"	$0.00	"$3,648.60"	"$2,052.34"	"$2,052.34"	$0.00	$0.00	$0.00	$950.57	"$3,384.99"	"$3,384.99"	$0.00	$0.00	$950.46	$0.00	"$2,248.45"	"$2,248.45"	$0.00	"$2,280.38"	"$3,612.11"	"$3,648.60"	$0.00		$0.00	$713.76	$0.00	$0.00	$726.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.095	SUP	HCPCS C1713		04.503.095  -  PLATE BONE 100MM MATRIXNEURO .4MM CRNMXF TI CONTUR MESH RGD	BOTH IP/OP	"$5,688.00 "	"$4,209.12"	$0.00	"$4,550.40"	"$2,559.60"	"$2,559.60"	$0.00	$0.00	$0.00	"$1,185.52"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,185.38"	$0.00	"$2,804.18"	"$2,804.18"	$0.00	"$2,844.00"	"$4,504.90"	"$4,550.40"	$0.00		$0.00	$890.17	$0.00	$0.00	$905.53	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.096	SUP	HCPCS C1713		04.503.096  -  PLATE SM .4MM MSTD CONTUR MESH MALBLE BONE MATRIXNEURO TI	BOTH IP/OP	"$2,135.25 "	"$1,580.09"	$0.00	"$1,708.20"	$960.86	$960.86	$0.00	$0.00	$0.00	$445.04	"$1,584.78"	"$1,584.78"	$0.00	$0.00	$444.99	$0.00	"$1,263.00"	"$1,263.00"	$0.00	"$1,067.63"	"$1,691.12"	"$1,708.20"	$0.00		$0.00	$334.17	$0.00	$0.00	$339.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.097	SUP	HCPCS C1713		04.503.097  -  PLATE MED .4MM MSTD CONTUR MESH MALBLE BONE MATRIXNEURO TI	BOTH IP/OP	"$2,416.50 "	"$1,788.21"	$0.00	"$1,933.20"	"$1,087.43"	"$1,087.43"	$0.00	$0.00	$0.00	$503.66	"$1,793.53"	"$1,793.53"	$0.00	$0.00	$503.60	$0.00	"$1,429.36"	"$1,429.36"	$0.00	"$1,208.25"	"$1,913.87"	"$1,933.20"	$0.00		$0.00	$378.18	$0.00	$0.00	$384.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.098	SUP	HCPCS C1713		04.503.098  -  PLATE LG .4MM MSTD CONTUR MESH MALBLE BONE MATRIXNEURO TI	BOTH IP/OP	"$2,664.00 "	"$1,971.36"	$0.00	"$2,131.20"	"$1,198.80"	"$1,198.80"	$0.00	$0.00	$0.00	$555.24	"$1,977.22"	"$1,977.22"	$0.00	$0.00	$555.18	$0.00	"$1,313.35"	"$1,313.35"	$0.00	"$1,332.00"	"$2,109.89"	"$2,131.20"	$0.00		$0.00	$416.92	$0.00	$0.00	$424.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.103.01	SUP	HCPCS C1713		04.503.103.01  -  SCREW BONE 3MM MATRIXNEURO CRNMXF TI SLFDRILL NONSTRL	BOTH IP/OP	$217.13 	$160.68	$0.00	$173.70	$97.71	$97.71	$0.00	$0.00	$0.00	$45.25	$161.15	$161.15	$0.00	$0.00	$45.25	$0.00	$128.43	$128.43	$0.00	$108.56	$171.97	$173.70	$0.00		$0.00	$33.98	$0.00	$0.00	$34.57	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.104.01	SUP	HCPCS C1713		04.503.104.01  -  SCREW BN 4MM NS MATRIXNEURO SLF DRL TI CRNMXF	BOTH IP/OP	$217.13 	$160.68	$0.00	$173.70	$97.71	$97.71	$0.00	$0.00	$0.00	$45.25	$161.15	$161.15	$0.00	$0.00	$45.25	$0.00	$128.43	$128.43	$0.00	$108.56	$171.97	$173.70	$0.00		$0.00	$33.98	$0.00	$0.00	$34.57	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.105.01	SUP	HCPCS C1713		04.503.105.01  -  SCREW BN 5MM NS MATRIXNEURO SLF DRL TI CRNMXF	BOTH IP/OP	$217.13 	$160.68	$0.00	$173.70	$97.71	$97.71	$0.00	$0.00	$0.00	$45.25	$161.15	$161.15	$0.00	$0.00	$45.25	$0.00	$128.43	$128.43	$0.00	$108.56	$171.97	$173.70	$0.00		$0.00	$33.98	$0.00	$0.00	$34.57	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.113.01	SUP	HCPCS C1713		04.503.113.01  -  SCREW BONE 3MM MATRIXNEURO CRNMXF TI ER NONSTRL	BOTH IP/OP	$217.13 	$160.68	$0.00	$173.70	$97.71	$97.71	$0.00	$0.00	$0.00	$45.25	$161.15	$161.15	$0.00	$0.00	$45.25	$0.00	$128.43	$128.43	$0.00	$108.56	$171.97	$173.70	$0.00		$0.00	$33.98	$0.00	$0.00	$34.57	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.114.01	SUP	HCPCS C1713		04.503.114.01  -  SCREW BN 4MM NS MATRIXNEURO ER TI CRNMXF	BOTH IP/OP	$217.13 	$160.68	$0.00	$173.70	$97.71	$97.71	$0.00	$0.00	$0.00	$45.25	$161.15	$161.15	$0.00	$0.00	$45.25	$0.00	$128.43	$128.43	$0.00	$108.56	$171.97	$173.70	$0.00		$0.00	$33.98	$0.00	$0.00	$34.57	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.115.01	SUP	HCPCS C1713		04.503.115.01  -  SCREW BONE 5MM MATRIXNEURO CRNMXF TI ER NONSTRL	BOTH IP/OP	$217.13 	$160.68	$0.00	$173.70	$97.71	$97.71	$0.00	$0.00	$0.00	$45.25	$161.15	$161.15	$0.00	$0.00	$45.25	$0.00	$128.43	$128.43	$0.00	$108.56	$171.97	$173.70	$0.00		$0.00	$33.98	$0.00	$0.00	$34.57	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.120	SUP	HCPCS C1713		04.503.120  -  PLATE BONE 45X38MM MATRIXNEURO .6MM CRNMXF TI CONTUR MESH	BOTH IP/OP	"$3,831.75 "	"$2,835.50"	$0.00	"$3,065.40"	"$1,724.29"	"$1,724.29"	$0.00	$0.00	$0.00	$798.63	"$2,843.92"	"$2,843.92"	$0.00	$0.00	$798.54	$0.00	"$1,889.05"	"$1,889.05"	$0.00	"$1,915.88"	"$3,034.75"	"$3,065.40"	$0.00		$0.00	$599.67	$0.00	$0.00	$610.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.121	SUP	HCPCS C1713		04.503.121  -  PLATE 100X100X.6MM TI CONTUR MESH RGD MATRIXNEURO BONE	BOTH IP/OP	"$5,964.75 "	"$4,413.92"	$0.00	"$4,771.80"	"$2,684.14"	"$2,684.14"	$0.00	$0.00	$0.00	"$1,243.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,243.05"	$0.00	"$2,940.62"	"$2,940.62"	$0.00	"$2,982.38"	"$4,724.08"	"$4,771.80"	$0.00		$0.00	$933.48	$0.00	$0.00	$949.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.122	SUP	Custom 27803010		04.503.122  -  TI MATRIXNEURO CONTOUR MESH 200MM X 200MM/0.6MM RIGID	BOTH IP/OP	"$22,842.00 "	"$16,903.08"	$0.00	"$18,273.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,760.27"	$0.00	$0.00	$0.00	$0.00	"$11,421.00"	"$18,090.86"	"$18,273.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.123	SUP	Custom 27803010		04.503.123  -  TI MATRIXNEURO CONTOUR MESH SMALL ARC/0.6MM RIGID	BOTH IP/OP	"$2,202.75 "	"$1,630.04"	$0.00	"$1,762.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,634.88"	"$1,634.88"	$0.00	$0.00	$459.05	$0.00	$0.00	$0.00	$0.00	"$1,101.38"	"$1,744.58"	"$1,762.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.124	SUP	Custom 27803010		04.503.124  -  TI MATRIXNEURO CONTOUR MESH LARGE ARC/0.6MM RIGID	BOTH IP/OP	"$3,433.50 "	"$2,540.79"	$0.00	"$2,746.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,548.34"	"$2,548.34"	$0.00	$0.00	$715.54	$0.00	$0.00	$0.00	$0.00	"$1,716.75"	"$2,719.33"	"$2,746.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.125	SUP	HCPCS C1713		04.503.125  -  PLATE BONE PNK .6MM 30MM MATRIXNEURO TI CONTUR MESH RGD	BOTH IP/OP	"$2,202.75 "	"$1,630.04"	$0.00	"$1,762.20"	$991.24	$991.24	$0.00	$0.00	$0.00	$459.11	"$1,634.88"	"$1,634.88"	$0.00	$0.00	$459.05	$0.00	"$1,302.93"	"$1,302.93"	$0.00	"$1,101.38"	"$1,744.58"	"$1,762.20"	$0.00		$0.00	$344.73	$0.00	$0.00	$350.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.126	SUP	HCPCS C1713		04.503.126  -  PLATE BONE PNK .6MM 70MM MATRIXNEURO TI CONTUR MESH RGD	BOTH IP/OP	"$4,560.75 "	"$3,374.96"	$0.00	"$3,648.60"	"$2,052.34"	"$2,052.34"	$0.00	$0.00	$0.00	$950.57	"$3,384.99"	"$3,384.99"	$0.00	$0.00	$950.46	$0.00	"$2,248.45"	"$2,248.45"	$0.00	"$2,280.38"	"$3,612.11"	"$3,648.60"	$0.00		$0.00	$713.76	$0.00	$0.00	$726.07	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.127	SUP	Custom 27803010		04.503.127  -  TI MATRIXNEURO CONTOUR MESH 100MM DIA/0.6MM RIGID	BOTH IP/OP	"$5,688.00 "	"$4,209.12"	$0.00	"$4,550.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,185.38"	$0.00	$0.00	$0.00	$0.00	"$2,844.00"	"$4,504.90"	"$4,550.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.131S	SUP	Custom 27803010		04.503.131S  -  KIT SCR MATRIXNEURO 4MM STD RTU LP RPD INS CRANIAL BONE FLP	BOTH IP/OP	"$1,842.75 "	"$1,363.64"	$0.00	"$1,474.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,367.69"	"$1,367.69"	$0.00	$0.00	$384.03	$0.00	$0.00	$0.00	$0.00	$921.38	"$1,459.46"	"$1,474.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.134S	SUP	Custom 27803010		04.503.134S  -  MATRIXNEURO STERILE KIT 17MM BURR HOLE COVER/4MM	BOTH IP/OP	"$2,781.00 "	"$2,057.94"	$0.00	"$2,224.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,064.06"	"$2,064.06"	$0.00	$0.00	$579.56	$0.00	$0.00	$0.00	$0.00	"$1,390.50"	"$2,202.55"	"$2,224.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.203.01	SUP	HCPCS C1713		04.503.203.01  -  SCREW TI 3MM SLFTAP BONE MTRXMDFACE NONSTRL BRNZ	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.204.01	SUP	HCPCS C1713		04.503.204.01  -  SCREW TI 4MM SLFTAP ER BONE MTRXMDFACE BRNZ	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.205.01	SUP	HCPCS C1713		04.503.205.01  -  SCREW TI 5MM SLFTAP BONE MTRXMDFACE NONSTRL BRNZ	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.206.01	SUP	HCPCS C1713		04.503.206.01  -  SCREW TI 6MM SLFTAP BONE MTRXMDFACE NONSTRL BRNZ	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.208.01	SUP	HCPCS C1713		04.503.208.01  -  SCREW TI BRNZ 8MM MIDFAC SLFTAP BONE MTRXMDFACE NONSTRL	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.210.01	SUP	HCPCS C1713		04.503.210.01  -  SCREW TI 10MM CRNMXF SLFTAP BONE MTRXMDFACE NONSTRL BRNZ	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.212.01	SUP	HCPCS C1713		04.503.212.01  -  SCREW TI 12MM CRNMXF SLFTAP BONE MTRXMDFACE NONSTRL BRNZ	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.214.01	SUP	HCPCS C1713		04.503.214.01  -  SCREW TI 14MM CRNMXF SLFTAP BONE MTRXMDFACE NONSTRL BRNZ	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.216.01	SUP	HCPCS C1713		04.503.216.01  -  SCREW TI 16MM MIDFAC SLFTAP BONE NONSTRL	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.218.01	SUP	HCPCS C1713		04.503.218.01  -  TI MATRIXMIDFACE SCREW SELF-TAPPING 18MM	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.223.01	SUP	HCPCS C1713		04.503.223.01  -  SCREW BONE SLVR 3MM MTRXMDFACE CRNMXF TI SLFDRILL NONSTRL	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.224	SUP	HCPCS C1713		04.503.224  -  SCREW TI 4MM CRNMXF ORBTL FLR SLFDRILL BONE MTRX MIDFAC	BOTH IP/OP	$164.25 	$121.55	$0.00	$131.40	$73.91	$73.91	$0.00	$0.00	$0.00	$34.23	$121.91	$121.91	$0.00	$0.00	$34.23	$0.00	$97.15	$97.15	$0.00	$82.13	$130.09	$131.40	$0.00		$0.00	$25.71	$0.00	$0.00	$26.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.224.01	SUP	HCPCS C1713		04.503.224.01  -  SCREW TI 4MM 1.5MM MIDFAC SLFDRILL BONE MTRXMDFACE NONSTRL	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.225	SUP	HCPCS C1713		04.503.225  -  SCREW TI 5MM MIDFAC BONE MTRXMDFACE NONSTRL	BOTH IP/OP	$164.25 	$121.55	$0.00	$131.40	$73.91	$73.91	$0.00	$0.00	$0.00	$34.23	$121.91	$121.91	$0.00	$0.00	$34.23	$0.00	$97.15	$97.15	$0.00	$82.13	$130.09	$131.40	$0.00		$0.00	$25.71	$0.00	$0.00	$26.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.225.01	SUP	HCPCS C1713		04.503.225.01  -  SCREW TI 5MM 1.5MM ORBTL FLR SLFDRILL BONE MTRXMDFACE	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.226	SUP	HCPCS C1713		04.503.226  -  SCREW TI 6MM CRNMXF ORBTL FLR SLFDRILL BONE MTRXMDFACE	BOTH IP/OP	$164.25 	$121.55	$0.00	$131.40	$73.91	$73.91	$0.00	$0.00	$0.00	$34.23	$121.91	$121.91	$0.00	$0.00	$34.23	$0.00	$97.15	$97.15	$0.00	$82.13	$130.09	$131.40	$0.00		$0.00	$25.71	$0.00	$0.00	$26.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.226.01	SUP	HCPCS C1713		04.503.226.01  -  SCREW TI 6MM 1.5MM ORBTL FLR SLFDRILL BONE MTRXMDFACE	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.228.01	SUP	HCPCS C1713		04.503.228.01  -  SCREW TI 8MM 1.5MM ORBTL FLR SLFDRILL BONE MTRXMDFACE	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.233.01	SUP	HCPCS C1713		04.503.233.01  -  SCREW TI 3MM ER BONE MTRXMDFACE LBLU	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.234.01	SUP	HCPCS C1713		04.503.234.01  -  SCREW_ TI MATRIXMIDFACE EMERGENCY  4MM	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.235.01	SUP	HCPCS C1713		04.503.235.01  -  SCREW TI 5MM 1.5MM ORBTL FLR ER BONE MTRXMDFACE NONSTRL LBLU	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.236.01	SUP	HCPCS C1713		04.503.236.01  -  SCREW TI 6MM 1.5MM ORBTL FLR ER BONE MTRXMDFACE NONSTRL	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.238.01	SUP	HCPCS C1713		04.503.238.01  -  SCREW TI 8MM ER BONE MTRXMDFACE NONSTRL	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.240.01	SUP	HCPCS C1713		04.503.240.01  -  SCREW TI 10MM ER BONE MTRXMDFACE	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.242.01	SUP	HCPCS C1713		04.503.242.01  -  SCREW TI 12MM ER BONE MTRXMDFACE	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.244.01	SUP	HCPCS C1713		04.503.244.01  -  SCREW TI 14MM ER BONE MTRXMDFACE	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.246.01	SUP	HCPCS C1713		04.503.246.01  -  SCREW TI 16MM ER BONE MTRXMDFACE	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.248.01	SUP	HCPCS C1713		04.503.248.01  -  SCREW TI 18MM ER BONE MTRXMDFACE	BOTH IP/OP	$218.25 	$161.51	$0.00	$174.60	$98.21	$98.21	$0.00	$0.00	$0.00	$45.49	$161.99	$161.99	$0.00	$0.00	$45.48	$0.00	$129.09	$129.09	$0.00	$109.13	$172.85	$174.60	$0.00		$0.00	$34.16	$0.00	$0.00	$34.75	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.301	SUP	HCPCS C1713		04.503.301  -  PLATE BN SM .3MM NS MATRIXMIDFACE TI ORBT FLR	BOTH IP/OP	"$3,201.75 "	"$2,369.30"	$0.00	"$2,561.40"	"$1,440.79"	"$1,440.79"	$0.00	$0.00	$0.00	$667.32	"$2,376.34"	"$2,376.34"	$0.00	$0.00	$667.24	$0.00	"$1,578.46"	"$1,578.46"	$0.00	"$1,600.88"	"$2,535.79"	"$2,561.40"	$0.00		$0.00	$501.07	$0.00	$0.00	$509.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.302	SUP	HCPCS C1713		04.503.302  -  PLATE BN MED .3MM NS MATRIXMIDFACE TI ORBT FLR	BOTH IP/OP	"$3,201.75 "	"$2,369.30"	$0.00	"$2,561.40"	"$1,440.79"	"$1,440.79"	$0.00	$0.00	$0.00	$667.32	"$2,376.34"	"$2,376.34"	$0.00	$0.00	$667.24	$0.00	"$1,578.46"	"$1,578.46"	$0.00	"$1,600.88"	"$2,535.79"	"$2,561.40"	$0.00		$0.00	$501.07	$0.00	$0.00	$509.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.303	SUP	HCPCS C1713		04.503.303  -  PLATE BN LG .3MM NS MATRIXMIDFACE TI ORBT FLR	BOTH IP/OP	"$3,201.75 "	"$2,369.30"	$0.00	"$2,561.40"	"$1,440.79"	"$1,440.79"	$0.00	$0.00	$0.00	$667.32	"$2,376.34"	"$2,376.34"	$0.00	$0.00	$667.24	$0.00	"$1,578.46"	"$1,578.46"	$0.00	"$1,600.88"	"$2,535.79"	"$2,561.40"	$0.00		$0.00	$501.07	$0.00	$0.00	$509.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.304	SUP	HCPCS C1713		04.503.304  -  PLATE BN UNV .4MM NS MATRIXMIDFACE TI ORBT FLR	BOTH IP/OP	"$3,201.75 "	"$2,369.30"	$0.00	"$2,561.40"	"$1,440.79"	"$1,440.79"	$0.00	$0.00	$0.00	$667.32	"$2,376.34"	"$2,376.34"	$0.00	$0.00	$667.24	$0.00	"$1,578.46"	"$1,578.46"	$0.00	"$1,600.88"	"$2,535.79"	"$2,561.40"	$0.00		$0.00	$501.07	$0.00	$0.00	$509.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.305	SUP	HCPCS C1713		04.503.305  -  PLATE BN UNV .5MM NS MATRIXMIDFACE TI ORBT FLR MDL WL	BOTH IP/OP	"$3,201.75 "	"$2,369.30"	$0.00	"$2,561.40"	"$1,440.79"	"$1,440.79"	$0.00	$0.00	$0.00	$667.32	"$2,376.34"	"$2,376.34"	$0.00	$0.00	$667.24	$0.00	"$1,578.46"	"$1,578.46"	$0.00	"$1,600.88"	"$2,535.79"	"$2,561.40"	$0.00		$0.00	$501.07	$0.00	$0.00	$509.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.306	SUP	HCPCS C1713		04.503.306  -  PLATE BN .2MM NS MATRIXMIDFACE MESH TI ORBT FLR	BOTH IP/OP	"$3,323.25 "	"$2,459.21"	$0.00	"$2,658.60"	"$1,495.46"	"$1,495.46"	$0.00	$0.00	$0.00	$692.65	"$2,466.52"	"$2,466.52"	$0.00	$0.00	$692.57	$0.00	"$1,638.36"	"$1,638.36"	$0.00	"$1,661.63"	"$2,632.01"	"$2,658.60"	$0.00		$0.00	$520.09	$0.00	$0.00	$529.06	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.307	SUP	HCPCS C1713		04.503.307  -  PLATE BN .3MM NS MATRIXMIDFACE MESH TI ORBT FLR	BOTH IP/OP	"$3,323.25 "	"$2,459.21"	$0.00	"$2,658.60"	"$1,495.46"	"$1,495.46"	$0.00	$0.00	$0.00	$692.65	"$2,466.52"	"$2,466.52"	$0.00	$0.00	$692.57	$0.00	"$1,638.36"	"$1,638.36"	$0.00	"$1,661.63"	"$2,632.01"	"$2,658.60"	$0.00		$0.00	$520.09	$0.00	$0.00	$529.06	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.308	SUP	HCPCS C1713		04.503.308  -  PLATE BN .4MM NS MATRIXMIDFACE MESH TI ORBT FLR	BOTH IP/OP	"$3,323.25 "	"$2,459.21"	$0.00	"$2,658.60"	"$1,495.46"	"$1,495.46"	$0.00	$0.00	$0.00	$692.65	"$2,466.52"	"$2,466.52"	$0.00	$0.00	$692.57	$0.00	"$1,638.36"	"$1,638.36"	$0.00	"$1,661.63"	"$2,632.01"	"$2,658.60"	$0.00		$0.00	$520.09	$0.00	$0.00	$529.06	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.313	SUP	HCPCS C1713		04.503.313  -  PLATE BN STD MIC .4MM NS MATRIXMIDFACE 12 HL TI ORBT RIM	BOTH IP/OP	$927.00 	$685.98	$0.00	$741.60	$417.15	$417.15	$0.00	$0.00	$0.00	$193.21	$688.02	$688.02	$0.00	$0.00	$193.19	$0.00	$548.32	$548.32	$0.00	$463.50	$734.18	$741.60	$0.00		$0.00	$145.08	$0.00	$0.00	$147.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.314	SUP	HCPCS C1713		04.503.314  -  PLATE BONE .4MM MTRXMDFACE CRNMXF TI 6 HOLE ADP NONSTRL	BOTH IP/OP	$679.50 	$502.83	$0.00	$543.60	$305.78	$305.78	$0.00	$0.00	$0.00	$141.62	$504.32	$504.32	$0.00	$0.00	$141.61	$0.00	$401.92	$401.92	$0.00	$339.75	$538.16	$543.60	$0.00		$0.00	$106.34	$0.00	$0.00	$108.18	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.315	SUP	HCPCS C1713		04.503.315  -  PLATE BN STD MIC .4MM SLVR NS MATRIXMIDFACE 8 HL ADP TI MDFC	BOTH IP/OP	$841.50 	$622.71	$0.00	$673.20	$378.68	$378.68	$0.00	$0.00	$0.00	$175.39	$624.56	$624.56	$0.00	$0.00	$175.37	$0.00	$497.75	$497.75	$0.00	$420.75	$666.47	$673.20	$0.00		$0.00	$131.69	$0.00	$0.00	$133.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.316	SUP	HCPCS C1713		04.503.316  -  PLATE BN STD MIC .4MM NS MATRIXMIDFACE 20 HL ADP TI MDFC	BOTH IP/OP	"$1,680.75 "	"$1,243.76"	$0.00	"$1,344.60"	$756.34	$756.34	$0.00	$0.00	$0.00	$350.31	"$1,247.45"	"$1,247.45"	$0.00	$0.00	$350.27	$0.00	$994.16	$994.16	$0.00	$840.38	"$1,331.15"	"$1,344.60"	$0.00		$0.00	$263.04	$0.00	$0.00	$267.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.317	SUP	HCPCS C1713		04.503.317  -  PLATE BN STD MIC Y .4MM NS MATRIXMIDFACE 1X3 HL TI MDFC	BOTH IP/OP	$747.00 	$552.78	$0.00	$597.60	$336.15	$336.15	$0.00	$0.00	$0.00	$155.69	$554.42	$554.42	$0.00	$0.00	$155.67	$0.00	$441.85	$441.85	$0.00	$373.50	$591.62	$597.60	$0.00		$0.00	$116.91	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.318	SUP	HCPCS C1713		04.503.318  -  PLATE BN STD MIC 2Y .4MM NS MATRIXMIDFACE 6 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.322	SUP	HCPCS C1713		04.503.322  -  PLATE BN STD MN H .5MM NS MATRIXMIDFACE 11 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.323	SUP	HCPCS C1713		04.503.323  -  PLATE BN STD MN OB L L .5MM NS MATRIXMIDFACE 2X3 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.324	SUP	HCPCS C1713		04.503.324  -  PLATE BN STD MN OB R L .5MM NS MATRIXMIDFACE 2X3 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.325	SUP	HCPCS C1713		04.503.325  -  PLATE BN STD MN OB L L .5MM NS MATRIXMIDFACE 3X4 HL TI MDFC	BOTH IP/OP	$776.25 	$574.43	$0.00	$621.00	$349.31	$349.31	$0.00	$0.00	$0.00	$161.79	$576.13	$576.13	$0.00	$0.00	$161.77	$0.00	$459.15	$459.15	$0.00	$388.13	$614.79	$621.00	$0.00		$0.00	$121.48	$0.00	$0.00	$123.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.326	SUP	HCPCS C1713		04.503.326  -  PLATE BN STD MN OB R L .5MM NS MATRIXMIDFACE 3X4 HL TI MDFC	BOTH IP/OP	$776.25 	$574.43	$0.00	$621.00	$349.31	$349.31	$0.00	$0.00	$0.00	$161.79	$576.13	$576.13	$0.00	$0.00	$161.77	$0.00	$459.15	$459.15	$0.00	$388.13	$614.79	$621.00	$0.00		$0.00	$121.48	$0.00	$0.00	$123.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.327	SUP	HCPCS C1713		04.503.327  -  PLATE BN STD MN T .5MM NS MATRIXMIDFACE 3X4 HL TI MDFC	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$303.75	$303.75	$0.00	$0.00	$0.00	$140.69	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$399.26	$399.26	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$105.64	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.330	SUP	HCPCS C1713		04.503.330  -  PLATE BN STD MIC BX 10X5X.4MM NS MATRIXMIDFACE 4 HL TI MDFC	BOTH IP/OP	$747.00 	$552.78	$0.00	$597.60	$336.15	$336.15	$0.00	$0.00	$0.00	$155.69	$554.42	$554.42	$0.00	$0.00	$155.67	$0.00	$441.85	$441.85	$0.00	$373.50	$591.62	$597.60	$0.00		$0.00	$116.91	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.331	SUP	HCPCS C1713		04.503.331  -  PLATE BN STD MN BX 10X10X.4MM NS MATRIXMIDFACE 4 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.332	SUP	HCPCS C1713		04.503.332  -  PLATE BN STD MIC X .4MM NS MATRIXMIDFACE 4 HL TI MDFC	BOTH IP/OP	$747.00 	$552.78	$0.00	$597.60	$336.15	$336.15	$0.00	$0.00	$0.00	$155.69	$554.42	$554.42	$0.00	$0.00	$155.67	$0.00	$441.85	$441.85	$0.00	$373.50	$591.62	$597.60	$0.00		$0.00	$116.91	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.333	SUP	HCPCS C1713		04.503.333  -  PLATE BN STD MIC .4MM NS MATRIXMIDFACE 18 HL STRUT TI MDFC	BOTH IP/OP	"$1,599.75 "	"$1,183.82"	$0.00	"$1,279.80"	$719.89	$719.89	$0.00	$0.00	$0.00	$333.43	"$1,187.33"	"$1,187.33"	$0.00	$0.00	$333.39	$0.00	$946.25	$946.25	$0.00	$799.88	"$1,267.00"	"$1,279.80"	$0.00		$0.00	$250.36	$0.00	$0.00	$254.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.334	SUP	HCPCS C1713		04.503.334  -  PLATE BN STD MN OB L L .5MM NS MATRIXMIDFACE 4X6 HL TI MDFC	BOTH IP/OP	$803.25 	$594.41	$0.00	$642.60	$361.46	$361.46	$0.00	$0.00	$0.00	$167.42	$596.17	$596.17	$0.00	$0.00	$167.40	$0.00	$475.12	$475.12	$0.00	$401.63	$636.17	$642.60	$0.00		$0.00	$125.71	$0.00	$0.00	$127.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.335	SUP	HCPCS C1713		04.503.335  -  PLATE BN STD MN OB R L .5MM NS MATRIXMIDFACE 4X6 HL TI MDFC	BOTH IP/OP	$803.25 	$594.41	$0.00	$642.60	$361.46	$361.46	$0.00	$0.00	$0.00	$167.42	$596.17	$596.17	$0.00	$0.00	$167.40	$0.00	$475.12	$475.12	$0.00	$401.63	$636.17	$642.60	$0.00		$0.00	$125.71	$0.00	$0.00	$127.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.343	SUP	HCPCS C1713		04.503.343  -  PLATE BN STD MN .5MM NS MATRIXMIDFACE 12 HL TI ORBT RIM	BOTH IP/OP	$927.00 	$685.98	$0.00	$741.60	$417.15	$417.15	$0.00	$0.00	$0.00	$193.21	$688.02	$688.02	$0.00	$0.00	$193.19	$0.00	$548.32	$548.32	$0.00	$463.50	$734.18	$741.60	$0.00		$0.00	$145.08	$0.00	$0.00	$147.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.344	SUP	HCPCS C1713		04.503.344  -  PLATE .5MM ORBTL RIM 6 HOLE ADP BONE MTRXMDFACE TI NONSTRL	BOTH IP/OP	$679.50 	$502.83	$0.00	$543.60	$305.78	$305.78	$0.00	$0.00	$0.00	$141.62	$504.32	$504.32	$0.00	$0.00	$141.61	$0.00	$401.92	$401.92	$0.00	$339.75	$538.16	$543.60	$0.00		$0.00	$106.34	$0.00	$0.00	$108.18	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.345	SUP	HCPCS C1713		04.503.345  -  PLATE BN STD MN .5MM NS MATRIXMIDFACE 8 HL ADP TI MDFC	BOTH IP/OP	$841.50 	$622.71	$0.00	$673.20	$378.68	$378.68	$0.00	$0.00	$0.00	$175.39	$624.56	$624.56	$0.00	$0.00	$175.37	$0.00	$497.75	$497.75	$0.00	$420.75	$666.47	$673.20	$0.00		$0.00	$131.69	$0.00	$0.00	$133.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.346	SUP	HCPCS C1713		04.503.346  -  PLATE BONE BLUE .5MM MTRXMDFACE CRNMXF TI 20 HOLE ADP	BOTH IP/OP	"$1,680.75 "	"$1,243.76"	$0.00	"$1,247.45"	$672.30	$672.30	$0.00	$0.00	$0.00	$350.31	"$1,247.45"	"$1,247.45"	$0.00	$0.00	$350.27	$0.00	$994.16	$994.16	$0.00	$747.00	"$1,183.25"	"$1,195.20"	$0.00		$0.00	$233.81	$0.00	$0.00	$237.84	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.347	SUP	HCPCS C1713		04.503.347  -  PLATE BN STD MN Y .5MM NS MATRIXMIDFACE 1X3 HL TI MDFC	BOTH IP/OP	$747.00 	$552.78	$0.00	$597.60	$336.15	$336.15	$0.00	$0.00	$0.00	$155.69	$554.42	$554.42	$0.00	$0.00	$155.67	$0.00	$441.85	$441.85	$0.00	$373.50	$591.62	$597.60	$0.00		$0.00	$116.91	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.348	SUP	HCPCS C1713		04.503.348  -  PLATE BN STD MN 2Y .5MM NS MATRIXMIDFACE 6 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.352	SUP	HCPCS C1713		04.503.352  -  PLATE BN STD MED H .7MM NS MATRIXMIDFACE 11 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.353	SUP	HCPCS C1713		04.503.353  -  PLATE BN STD MED OB L L .7MM NS MATRIXMIDFACE 2X3 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.354	SUP	HCPCS C1713		04.503.354  -  PLATE BN STD MED OB R L .7MM NS MATRIXMIDFACE 2X3 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.355	SUP	HCPCS C1713		04.503.355  -  PLATE BN STD MN OB L L .7MM NS MATRIXMIDFACE 3X4 HL TI MDFC	BOTH IP/OP	$776.25 	$574.43	$0.00	$621.00	$349.31	$349.31	$0.00	$0.00	$0.00	$161.79	$576.13	$576.13	$0.00	$0.00	$161.77	$0.00	$459.15	$459.15	$0.00	$388.13	$614.79	$621.00	$0.00		$0.00	$121.48	$0.00	$0.00	$123.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.356	SUP	HCPCS C1713		04.503.356  -  PLATE BN STD MN OB R L .7MM NS MATRIXMIDFACE 3X4 HL TI MDFC	BOTH IP/OP	$776.25 	$574.43	$0.00	$621.00	$349.31	$349.31	$0.00	$0.00	$0.00	$161.79	$576.13	$576.13	$0.00	$0.00	$161.77	$0.00	$459.15	$459.15	$0.00	$388.13	$614.79	$621.00	$0.00		$0.00	$121.48	$0.00	$0.00	$123.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.357	SUP	HCPCS C1713		04.503.357  -  PLATE BN STD MED T .7MM NS MATRIXMIDFACE 3X4 HL TI MDFC	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$303.75	$303.75	$0.00	$0.00	$0.00	$140.69	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$399.26	$399.26	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$105.64	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.360	SUP	HCPCS C1713		04.503.360  -  PLATE BN STD MN BX 10X5X.5MM NS MATRIXMIDFACE 4 HL TI MDFC	BOTH IP/OP	$747.00 	$552.78	$0.00	$597.60	$336.15	$336.15	$0.00	$0.00	$0.00	$155.69	$554.42	$554.42	$0.00	$0.00	$155.67	$0.00	$441.85	$441.85	$0.00	$373.50	$591.62	$597.60	$0.00		$0.00	$116.91	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.361	SUP	HCPCS C1713		04.503.361  -  PLATE BN STD MN BX 10X10X.5MM NS MATRIXMIDFACE 4 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.362	SUP	HCPCS C1713		04.503.362  -  PLATE BN STD MN X .5MM NS MATRIXMIDFACE 4 HL TI MDFC	BOTH IP/OP	$747.00 	$552.78	$0.00	$597.60	$336.15	$336.15	$0.00	$0.00	$0.00	$155.69	$554.42	$554.42	$0.00	$0.00	$155.67	$0.00	$441.85	$441.85	$0.00	$373.50	$591.62	$597.60	$0.00		$0.00	$116.91	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.363	SUP	HCPCS C1713		04.503.363  -  PLATE BN STD MN .5MM NS MATRIXMIDFACE 18 HL STRUT TI MDFC	BOTH IP/OP	"$1,599.75 "	"$1,183.82"	$0.00	"$1,279.80"	$719.89	$719.89	$0.00	$0.00	$0.00	$333.43	"$1,187.33"	"$1,187.33"	$0.00	$0.00	$333.39	$0.00	$946.25	$946.25	$0.00	$799.88	"$1,267.00"	"$1,279.80"	$0.00		$0.00	$250.36	$0.00	$0.00	$254.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.364	SUP	HCPCS C1713		04.503.364  -  PLATE BN STD MED OB L L .7MM NS MATRIXMIDFACE 4X6 HL TI MDFC	BOTH IP/OP	$803.25 	$594.41	$0.00	$642.60	$361.46	$361.46	$0.00	$0.00	$0.00	$167.42	$596.17	$596.17	$0.00	$0.00	$167.40	$0.00	$475.12	$475.12	$0.00	$401.63	$636.17	$642.60	$0.00		$0.00	$125.71	$0.00	$0.00	$127.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.365	SUP	HCPCS C1713		04.503.365  -  PLATE BN STD MED OB R L .7MM NS MATRIXMIDFACE 4X6 HL TI MDFC	BOTH IP/OP	$803.25 	$594.41	$0.00	$642.60	$361.46	$361.46	$0.00	$0.00	$0.00	$167.42	$596.17	$596.17	$0.00	$0.00	$167.40	$0.00	$475.12	$475.12	$0.00	$401.63	$636.17	$642.60	$0.00		$0.00	$125.71	$0.00	$0.00	$127.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.373	SUP	HCPCS C1713		04.503.373  -  PLATE BN STD MED .7MM NS MATRIXMIDFACE 12 HL TI ORBT RIM	BOTH IP/OP	$927.00 	$685.98	$0.00	$741.60	$417.15	$417.15	$0.00	$0.00	$0.00	$193.21	$688.02	$688.02	$0.00	$0.00	$193.19	$0.00	$548.32	$548.32	$0.00	$463.50	$734.18	$741.60	$0.00		$0.00	$145.08	$0.00	$0.00	$147.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.374	SUP	HCPCS C1713		04.503.374  -  PLATE .7MM CRANFCL 6 HOLE ADP BONE MTRXMDFACE TI NONSTRL	BOTH IP/OP	$679.50 	$502.83	$0.00	$543.60	$305.78	$305.78	$0.00	$0.00	$0.00	$141.62	$504.32	$504.32	$0.00	$0.00	$141.61	$0.00	$401.92	$401.92	$0.00	$339.75	$538.16	$543.60	$0.00		$0.00	$106.34	$0.00	$0.00	$108.18	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.375	SUP	HCPCS C1713		04.503.375  -  PLATE BN STD MED .7MM NS MATRIXMIDFACE 8 HL ADP TI MDFC	BOTH IP/OP	$841.50 	$622.71	$0.00	$673.20	$378.68	$378.68	$0.00	$0.00	$0.00	$175.39	$624.56	$624.56	$0.00	$0.00	$175.37	$0.00	$497.75	$497.75	$0.00	$420.75	$666.47	$673.20	$0.00		$0.00	$131.69	$0.00	$0.00	$133.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.376	SUP	HCPCS C1713		04.503.376  -  PLATE BN STD MED .7MM NS MATRIXMIDFACE 20 HL ADP TI MDFC	BOTH IP/OP	"$1,680.75 "	"$1,243.76"	$0.00	"$1,344.60"	$756.34	$756.34	$0.00	$0.00	$0.00	$350.31	"$1,247.45"	"$1,247.45"	$0.00	$0.00	$350.27	$0.00	$994.16	$994.16	$0.00	$840.38	"$1,331.15"	"$1,344.60"	$0.00		$0.00	$263.04	$0.00	$0.00	$267.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.377	SUP	HCPCS C1713		04.503.377  -  PLATE BN STD MED Y .7MM NS MATRIXMIDFACE 1X3 HL TI MDFC	BOTH IP/OP	$747.00 	$552.78	$0.00	$597.60	$336.15	$336.15	$0.00	$0.00	$0.00	$155.69	$554.42	$554.42	$0.00	$0.00	$155.67	$0.00	$441.85	$441.85	$0.00	$373.50	$591.62	$597.60	$0.00		$0.00	$116.91	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.378	SUP	HCPCS C1713		04.503.378  -  PLATE BN STD MED 2Y .7MM NS MATRIXMIDFACE 6 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.382	SUP	HCPCS C1713		04.503.382  -  PLATE BN STD LG H .8MM NS MATRIXMIDFACE 11 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.383	SUP	HCPCS C1713		04.503.383  -  PLATE BN STD LG OB L L .8MM NS MATRIXMIDFACE 2X3 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.384	SUP	HCPCS C1713		04.503.384  -  PLATE BN STD LG OB R L .8MM NS MATRIXMIDFACE 2X3 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.385	SUP	HCPCS C1713		04.503.385  -  PLATE BN STD LG OB L L .8MM NS MATRIXMIDFACE 3X4 HL TI MDFC	BOTH IP/OP	$776.25 	$574.43	$0.00	$621.00	$349.31	$349.31	$0.00	$0.00	$0.00	$161.79	$576.13	$576.13	$0.00	$0.00	$161.77	$0.00	$459.15	$459.15	$0.00	$388.13	$614.79	$621.00	$0.00		$0.00	$121.48	$0.00	$0.00	$123.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.386	SUP	HCPCS C1713		04.503.386  -  PLATE BN STD LG OB R L .8MM NS MATRIXMIDFACE 3X4 HL TI MDFC	BOTH IP/OP	$776.25 	$574.43	$0.00	$621.00	$349.31	$349.31	$0.00	$0.00	$0.00	$161.79	$576.13	$576.13	$0.00	$0.00	$161.77	$0.00	$459.15	$459.15	$0.00	$388.13	$614.79	$621.00	$0.00		$0.00	$121.48	$0.00	$0.00	$123.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.387	SUP	HCPCS C1713		04.503.387  -  PLATE BN STD LG T .8MM NS MATRIXMIDFACE 3X4 HL TI MDFC	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$303.75	$303.75	$0.00	$0.00	$0.00	$140.69	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$399.26	$399.26	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$105.64	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.390	SUP	HCPCS C1713		04.503.390  -  PLATE BN STD MED BX 10X5X.7MM NS MATRIXMIDFACE 4 HL TI MDFC	BOTH IP/OP	$747.00 	$552.78	$0.00	$597.60	$336.15	$336.15	$0.00	$0.00	$0.00	$155.69	$554.42	$554.42	$0.00	$0.00	$155.67	$0.00	$441.85	$441.85	$0.00	$373.50	$591.62	$597.60	$0.00		$0.00	$116.91	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.391	SUP	HCPCS C1713		04.503.391  -  PLATE BN STD MED BX 10X10X.7MM NS MATRIXMIDFACE 4 HL TI MDFC	BOTH IP/OP	$758.25 	$561.11	$0.00	$606.60	$341.21	$341.21	$0.00	$0.00	$0.00	$158.04	$562.77	$562.77	$0.00	$0.00	$158.02	$0.00	$448.50	$448.50	$0.00	$379.13	$600.53	$606.60	$0.00		$0.00	$118.67	$0.00	$0.00	$120.71	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.392	SUP	HCPCS C1713		04.503.392  -  PLATE BN STD MED X .7MM NS MATRIXMIDFACE 4 HL TI MDFC	BOTH IP/OP	$747.00 	$552.78	$0.00	$597.60	$336.15	$336.15	$0.00	$0.00	$0.00	$155.69	$554.42	$554.42	$0.00	$0.00	$155.67	$0.00	$441.85	$441.85	$0.00	$373.50	$591.62	$597.60	$0.00		$0.00	$116.91	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.393	SUP	HCPCS C1713		04.503.393  -  PLATE BN STD MED .7MM NS MATRIXMIDFACE 18 HL STRUT TI MDFC	BOTH IP/OP	"$1,599.75 "	"$1,183.82"	$0.00	"$1,279.80"	$719.89	$719.89	$0.00	$0.00	$0.00	$333.43	"$1,187.33"	"$1,187.33"	$0.00	$0.00	$333.39	$0.00	$946.25	$946.25	$0.00	$799.88	"$1,267.00"	"$1,279.80"	$0.00		$0.00	$250.36	$0.00	$0.00	$254.68	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.394	SUP	HCPCS C1713		04.503.394  -  PLATE BN L OB L .8MM NS MATRIXMIDFACE 4X6 HL TI MDFC	BOTH IP/OP	$803.25 	$594.41	$0.00	$642.60	$361.46	$361.46	$0.00	$0.00	$0.00	$167.42	$596.17	$596.17	$0.00	$0.00	$167.40	$0.00	$475.12	$475.12	$0.00	$401.63	$636.17	$642.60	$0.00		$0.00	$125.71	$0.00	$0.00	$127.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.395	SUP	HCPCS C1713		04.503.395  -  PLATE BN STD LG OB R L .8MM NS MATRIXMIDFACE 4X6 HL TI MDFC	BOTH IP/OP	$803.25 	$594.41	$0.00	$642.60	$361.46	$361.46	$0.00	$0.00	$0.00	$167.42	$596.17	$596.17	$0.00	$0.00	$167.40	$0.00	$475.12	$475.12	$0.00	$401.63	$636.17	$642.60	$0.00		$0.00	$125.71	$0.00	$0.00	$127.88	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.396	SUP	HCPCS C1713		04.503.396  -  PLATE BN LG .8MM NS MATRIXMIDFACE 20 HL ADP TI MDFC	BOTH IP/OP	"$1,680.75 "	"$1,243.76"	$0.00	"$1,344.60"	$756.34	$756.34	$0.00	$0.00	$0.00	$350.31	"$1,247.45"	"$1,247.45"	$0.00	$0.00	$350.27	$0.00	$994.16	$994.16	$0.00	$840.38	"$1,331.15"	"$1,344.60"	$0.00		$0.00	$263.04	$0.00	$0.00	$267.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.397	SUP	HCPCS C1713		04.503.397  -  PLATE BONE .8MM MTRXMDFACE ORBTL RIM TI 12 HOLE NONSTRL	BOTH IP/OP	$927.00 	$685.98	$0.00	$741.60	$417.15	$417.15	$0.00	$0.00	$0.00	$193.21	$688.02	$688.02	$0.00	$0.00	$193.19	$0.00	$548.32	$548.32	$0.00	$463.50	$734.18	$741.60	$0.00		$0.00	$145.08	$0.00	$0.00	$147.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.398	SUP	HCPCS C1713		04.503.398  -  PLATE .8MM ORBTL RIM 6 HOLE ADP BONE MTRXMDFACE TI NONSTRL	BOTH IP/OP	$679.50 	$502.83	$0.00	$543.60	$305.78	$305.78	$0.00	$0.00	$0.00	$141.62	$504.32	$504.32	$0.00	$0.00	$141.61	$0.00	$401.92	$401.92	$0.00	$339.75	$538.16	$543.60	$0.00		$0.00	$106.34	$0.00	$0.00	$108.18	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.399	SUP	HCPCS C1713		04.503.399  -  PLATE .8MM ORBTL RIM 8 HOLE ADP BONE MTRXMDFACE TI NONSTRL	BOTH IP/OP	$841.50 	$622.71	$0.00	$673.20	$378.68	$378.68	$0.00	$0.00	$0.00	$175.39	$624.56	$624.56	$0.00	$0.00	$175.37	$0.00	$497.75	$497.75	$0.00	$420.75	$666.47	$673.20	$0.00		$0.00	$131.69	$0.00	$0.00	$133.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.405.01	SUP	HCPCS C1713		04.503.405.01  -  SCREW BONE 5MM 2MM MTRXMAND CRNMXF TI SLFTAP NONSTRL	BOTH IP/OP	$168.75 	$124.88	$0.00	$135.00	$75.94	$75.94	$0.00	$0.00	$0.00	$35.17	$125.25	$125.25	$0.00	$0.00	$35.17	$0.00	$99.82	$99.82	$0.00	$84.38	$133.65	$135.00	$0.00		$0.00	$26.41	$0.00	$0.00	$26.87	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.406	SUP	HCPCS C1713		04.503.406  -  SCREW TI 6MM 2MM MIDFAC SLFTAP BONE MTRXMDFACE NONSTRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$60.75	$60.75	$0.00	$0.00	$0.00	$28.14	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$79.85	$79.85	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$21.13	$0.00	$0.00	$21.49	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.406.01	SUP	HCPCS C1713		04.503.406.01  -  SCREW TI 6MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$168.75 	$124.88	$0.00	$135.00	$75.94	$75.94	$0.00	$0.00	$0.00	$35.17	$125.25	$125.25	$0.00	$0.00	$35.17	$0.00	$99.82	$99.82	$0.00	$84.38	$133.65	$135.00	$0.00		$0.00	$26.41	$0.00	$0.00	$26.87	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.408	SUP	HCPCS C1713		04.503.408  -  SCREW TI 8MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$60.75	$60.75	$0.00	$0.00	$0.00	$28.14	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$79.85	$79.85	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$21.13	$0.00	$0.00	$21.49	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.408.01	SUP	HCPCS C1713		04.503.408.01  -  SCREW TI 8MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$168.75 	$124.88	$0.00	$135.00	$75.94	$75.94	$0.00	$0.00	$0.00	$35.17	$125.25	$125.25	$0.00	$0.00	$35.17	$0.00	$99.82	$99.82	$0.00	$84.38	$133.65	$135.00	$0.00		$0.00	$26.41	$0.00	$0.00	$26.87	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.408.01E	SUP	HCPCS C1713		04.503.408.01E  -  SCREW TI 8MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$60.75	$60.75	$0.00	$0.00	$0.00	$28.14	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$79.85	$79.85	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$21.13	$0.00	$0.00	$21.49	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.410.01	SUP	HCPCS C1713		04.503.410.01  -  SCREW TI 10MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$168.75 	$124.88	$0.00	$135.00	$75.94	$75.94	$0.00	$0.00	$0.00	$35.17	$125.25	$125.25	$0.00	$0.00	$35.17	$0.00	$99.82	$99.82	$0.00	$84.38	$133.65	$135.00	$0.00		$0.00	$26.41	$0.00	$0.00	$26.87	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.412	SUP	HCPCS C1713		04.503.412  -  SCREW TI 12MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$60.75	$60.75	$0.00	$0.00	$0.00	$28.14	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$79.85	$79.85	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$21.13	$0.00	$0.00	$21.49	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.412.01	SUP	HCPCS C1713		04.503.412.01  -  SCREW TI 12MM 2MM SLFTAP ER BONE MTRXMAND NONSTRL	BOTH IP/OP	$168.75 	$124.88	$0.00	$135.00	$75.94	$75.94	$0.00	$0.00	$0.00	$35.17	$125.25	$125.25	$0.00	$0.00	$35.17	$0.00	$99.82	$99.82	$0.00	$84.38	$133.65	$135.00	$0.00		$0.00	$26.41	$0.00	$0.00	$26.87	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.414.01	SUP	HCPCS C1713		04.503.414.01  -  SCREW TI 14MM 2MM MANDIB SLFTAP BONE MTRX	BOTH IP/OP	$168.75 	$124.88	$0.00	$135.00	$75.94	$75.94	$0.00	$0.00	$0.00	$35.17	$125.25	$125.25	$0.00	$0.00	$35.17	$0.00	$99.82	$99.82	$0.00	$84.38	$133.65	$135.00	$0.00		$0.00	$26.41	$0.00	$0.00	$26.87	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.416.01	SUP	HCPCS C1713		04.503.416.01  -  SCREW TI 16MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$168.75 	$124.88	$0.00	$135.00	$75.94	$75.94	$0.00	$0.00	$0.00	$35.17	$125.25	$125.25	$0.00	$0.00	$35.17	$0.00	$99.82	$99.82	$0.00	$84.38	$133.65	$135.00	$0.00		$0.00	$26.41	$0.00	$0.00	$26.87	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.418.01	SUP	HCPCS C1713		04.503.418.01  -  SCREW TI 18MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$168.75 	$124.88	$0.00	$135.00	$75.94	$75.94	$0.00	$0.00	$0.00	$35.17	$125.25	$125.25	$0.00	$0.00	$35.17	$0.00	$99.82	$99.82	$0.00	$84.38	$133.65	$135.00	$0.00		$0.00	$26.41	$0.00	$0.00	$26.87	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.435.01	SUP	HCPCS C1713		04.503.435.01  -  SCREW TI 5MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$109.35	$109.35	$0.00	$0.00	$0.00	$50.65	$180.35	$180.35	$0.00	$0.00	$50.64	$0.00	$143.73	$143.73	$0.00	$121.50	$192.46	$194.40	$0.00		$0.00	$38.03	$0.00	$0.00	$38.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.436.01	SUP	HCPCS C1713		04.503.436.01  -  SCREW TI 6MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$109.35	$109.35	$0.00	$0.00	$0.00	$50.65	$180.35	$180.35	$0.00	$0.00	$50.64	$0.00	$143.73	$143.73	$0.00	$121.50	$192.46	$194.40	$0.00		$0.00	$38.03	$0.00	$0.00	$38.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.438.01	SUP	HCPCS C1713		04.503.438.01  -  SCREW TI 8MM 2.4MM SLFTAP ER BONE MTRXMAND NONSTRL	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$109.35	$109.35	$0.00	$0.00	$0.00	$50.65	$180.35	$180.35	$0.00	$0.00	$50.64	$0.00	$143.73	$143.73	$0.00	$121.50	$192.46	$194.40	$0.00		$0.00	$38.03	$0.00	$0.00	$38.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.440.01	SUP	HCPCS C1713		04.503.440.01  -  SCREW TI 10MM 2.4MM MANDIB SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$109.35	$109.35	$0.00	$0.00	$0.00	$50.65	$180.35	$180.35	$0.00	$0.00	$50.64	$0.00	$143.73	$143.73	$0.00	$121.50	$192.46	$194.40	$0.00		$0.00	$38.03	$0.00	$0.00	$38.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.442.01	SUP	HCPCS C1713		04.503.442.01  -  SCREW TI 12MM 2.4MM SLFTAP ER BONE MTRXMAND NONSTRL	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$109.35	$109.35	$0.00	$0.00	$0.00	$50.65	$180.35	$180.35	$0.00	$0.00	$50.64	$0.00	$143.73	$143.73	$0.00	$121.50	$192.46	$194.40	$0.00		$0.00	$38.03	$0.00	$0.00	$38.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.444	SUP	HCPCS C1713		04.503.444  -  SCREW TI 14MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$193.50 	$143.19	$0.00	$154.80	$87.08	$87.08	$0.00	$0.00	$0.00	$40.33	$143.62	$143.62	$0.00	$0.00	$40.33	$0.00	$114.46	$114.46	$0.00	$96.75	$153.25	$154.80	$0.00		$0.00	$30.28	$0.00	$0.00	$30.81	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.444.01	SUP	HCPCS C1713		04.503.444.01  -  SCREW BONE 14MM 2.4MM MTRXMAND CRNMXF TI SLFTAP NONSTRL	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$109.35	$109.35	$0.00	$0.00	$0.00	$50.65	$180.35	$180.35	$0.00	$0.00	$50.64	$0.00	$143.73	$143.73	$0.00	$121.50	$192.46	$194.40	$0.00		$0.00	$38.03	$0.00	$0.00	$38.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.446	SUP	HCPCS C1713		04.503.446  -  SCREW TI 16MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$193.50 	$143.19	$0.00	$154.80	$87.08	$87.08	$0.00	$0.00	$0.00	$40.33	$143.62	$143.62	$0.00	$0.00	$40.33	$0.00	$114.46	$114.46	$0.00	$96.75	$153.25	$154.80	$0.00		$0.00	$30.28	$0.00	$0.00	$30.81	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.446.01	SUP	HCPCS C1713		04.503.446.01  -  SCREW TI 16MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$109.35	$109.35	$0.00	$0.00	$0.00	$50.65	$180.35	$180.35	$0.00	$0.00	$50.64	$0.00	$143.73	$143.73	$0.00	$121.50	$192.46	$194.40	$0.00		$0.00	$38.03	$0.00	$0.00	$38.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.448.01	SUP	HCPCS C1713		04.503.448.01  -  SCREW TI 18MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$243.00 	$179.82	$0.00	$194.40	$109.35	$109.35	$0.00	$0.00	$0.00	$50.65	$180.35	$180.35	$0.00	$0.00	$50.64	$0.00	$143.73	$143.73	$0.00	$121.50	$192.46	$194.40	$0.00		$0.00	$38.03	$0.00	$0.00	$38.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.465.01	SUP	HCPCS C1713		04.503.465.01  -  SCREW TI 5MM 2.7MM SLFTAP BONE MTRXMAND NONSTRL ER	BOTH IP/OP	$265.50 	$196.47	$0.00	$212.40	$119.48	$119.48	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$132.75	$210.28	$212.40	$0.00		$0.00	$41.55	$0.00	$0.00	$42.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.466.01	SUP	HCPCS C1713		04.503.466.01  -  SCREW TI 6MM 2.7MM ER SLFTAP BONE MTRXMAND	BOTH IP/OP	$265.50 	$196.47	$0.00	$212.40	$119.48	$119.48	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$132.75	$210.28	$212.40	$0.00		$0.00	$41.55	$0.00	$0.00	$42.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.468	SUP	HCPCS C1713		04.503.468  -  SCREW TI 8MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.468.01	SUP	HCPCS C1713		04.503.468.01  -  SCREW TI 8MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL	BOTH IP/OP	$265.50 	$196.47	$0.00	$212.40	$119.48	$119.48	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$132.75	$210.28	$212.40	$0.00		$0.00	$41.55	$0.00	$0.00	$42.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.470	SUP	HCPCS C1713		04.503.470  -  SCREW TI 10MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.470.01	SUP	HCPCS C1713		04.503.470.01  -  SCREW TI 10MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL	BOTH IP/OP	$265.50 	$196.47	$0.00	$212.40	$119.48	$119.48	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$132.75	$210.28	$212.40	$0.00		$0.00	$41.55	$0.00	$0.00	$42.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.472.01	SUP	HCPCS C1713		04.503.472.01  -  SCREW TI 12MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL	BOTH IP/OP	$265.50 	$196.47	$0.00	$212.40	$119.48	$119.48	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$132.75	$210.28	$212.40	$0.00		$0.00	$41.55	$0.00	$0.00	$42.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.474.01	SUP	HCPCS C1713		04.503.474.01  -  SCREW TI 14MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL	BOTH IP/OP	$265.50 	$196.47	$0.00	$212.40	$119.48	$119.48	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$132.75	$210.28	$212.40	$0.00		$0.00	$41.55	$0.00	$0.00	$42.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.476.01	SUP	HCPCS C1713		04.503.476.01  -  SCREW TI 16MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL	BOTH IP/OP	$265.50 	$196.47	$0.00	$212.40	$119.48	$119.48	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$132.75	$210.28	$212.40	$0.00		$0.00	$41.55	$0.00	$0.00	$42.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.478.01	SUP	HCPCS C1713		04.503.478.01  -  SCREW TI 18MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL	BOTH IP/OP	$265.50 	$196.47	$0.00	$212.40	$119.48	$119.48	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$132.75	$210.28	$212.40	$0.00		$0.00	$41.55	$0.00	$0.00	$42.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.506.01	SUP	HCPCS C1713		04.503.506.01  -  SCREW TI 6MM 2MM MANDIB SLFDRILL MTRX BONE MTRXMAND NONSTRL	BOTH IP/OP	$187.88 	$139.03	$0.00	$150.30	$84.54	$84.54	$0.00	$0.00	$0.00	$39.16	$139.44	$139.44	$0.00	$0.00	$39.15	$0.00	$111.13	$111.13	$0.00	$93.94	$148.80	$150.30	$0.00		$0.00	$29.40	$0.00	$0.00	$29.91	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.508.01	SUP	HCPCS C1713		04.503.508.01  -  SCREW TI 8MM 2MM MANDIB SLFDRILL MTRX BONE MTRXMAND NONSTRL	BOTH IP/OP	$187.88 	$139.03	$0.00	$150.30	$84.54	$84.54	$0.00	$0.00	$0.00	$39.16	$139.44	$139.44	$0.00	$0.00	$39.15	$0.00	$111.13	$111.13	$0.00	$93.94	$148.80	$150.30	$0.00		$0.00	$29.40	$0.00	$0.00	$29.91	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.546.01	SUP	HCPCS C1713		04.503.546.01  -  SCREW BONE 6MM 2MM MTRXMAND CRNMXF TI LCK SLFDRILL NONSTRL	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$145.80	$145.80	$0.00	$0.00	$0.00	$67.53	$240.47	$240.47	$0.00	$0.00	$67.52	$0.00	$191.65	$191.65	$0.00	$162.00	$256.61	$259.20	$0.00		$0.00	$50.71	$0.00	$0.00	$51.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.548.01	SUP	HCPCS C1713		04.503.548.01  -  SCREW BONE 8MM 2MM MTRXMAND CRNMXF TI LCK SLFDRILL NONSTRL	BOTH IP/OP	$324.00 	$239.76	$0.00	$259.20	$145.80	$145.80	$0.00	$0.00	$0.00	$67.53	$240.47	$240.47	$0.00	$0.00	$67.52	$0.00	$191.65	$191.65	$0.00	$162.00	$256.61	$259.20	$0.00		$0.00	$50.71	$0.00	$0.00	$51.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.605	SUP	HCPCS C1713		04.503.605  -  SCREW TI 5MM 2MM LCK SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$252.00 	$186.48	$0.00	$201.60	$113.40	$113.40	$0.00	$0.00	$0.00	$52.52	$187.03	$187.03	$0.00	$0.00	$52.52	$0.00	$149.06	$149.06	$0.00	$126.00	$199.58	$201.60	$0.00		$0.00	$39.44	$0.00	$0.00	$40.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.605.01	SUP	HCPCS C1713		04.503.605.01  -  SCREW TI 5MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$317.25 	$234.77	$0.00	$253.80	$142.76	$142.76	$0.00	$0.00	$0.00	$66.12	$235.46	$235.46	$0.00	$0.00	$66.11	$0.00	$187.65	$187.65	$0.00	$158.63	$251.26	$253.80	$0.00		$0.00	$49.65	$0.00	$0.00	$50.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.606.01	SUP	HCPCS C1713		04.503.606.01  -  SCREW TI 6MM 2MM MANDIB SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$317.25 	$234.77	$0.00	$253.80	$142.76	$142.76	$0.00	$0.00	$0.00	$66.12	$235.46	$235.46	$0.00	$0.00	$66.11	$0.00	$187.65	$187.65	$0.00	$158.63	$251.26	$253.80	$0.00		$0.00	$49.65	$0.00	$0.00	$50.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.608	SUP	HCPCS C1713		04.503.608  -  SCREW TI 8MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$252.00 	$186.48	$0.00	$201.60	$113.40	$113.40	$0.00	$0.00	$0.00	$52.52	$187.03	$187.03	$0.00	$0.00	$52.52	$0.00	$149.06	$149.06	$0.00	$126.00	$199.58	$201.60	$0.00		$0.00	$39.44	$0.00	$0.00	$40.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.608.01	SUP	HCPCS C1713		04.503.608.01  -  SCREW TI 8MM 2.4MM SLFTAP ER BONE MTRXMAND STRL	BOTH IP/OP	$317.25 	$234.77	$0.00	$253.80	$142.76	$142.76	$0.00	$0.00	$0.00	$66.12	$235.46	$235.46	$0.00	$0.00	$66.11	$0.00	$187.65	$187.65	$0.00	$158.63	$251.26	$253.80	$0.00		$0.00	$49.65	$0.00	$0.00	$50.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.608.01E	SUP	HCPCS C1713		04.503.608.01E  -  SCREW TI 8MM 2.4MM SLFTAP ER BONE MTRXMAND STRL	BOTH IP/OP	$252.00 	$186.48	$0.00	$201.60	$113.40	$113.40	$0.00	$0.00	$0.00	$52.52	$187.03	$187.03	$0.00	$0.00	$52.52	$0.00	$149.06	$149.06	$0.00	$126.00	$199.58	$201.60	$0.00		$0.00	$39.44	$0.00	$0.00	$40.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.610	SUP	HCPCS C1713		04.503.610  -  SCREW TI 10MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$252.00 	$186.48	$0.00	$201.60	$113.40	$113.40	$0.00	$0.00	$0.00	$52.52	$187.03	$187.03	$0.00	$0.00	$52.52	$0.00	$149.06	$149.06	$0.00	$126.00	$199.58	$201.60	$0.00		$0.00	$39.44	$0.00	$0.00	$40.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.610.01	SUP	HCPCS C1713		04.503.610.01  -  SCREW TI 10MM 2MM MANDIB SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$317.25 	$234.77	$0.00	$253.80	$142.76	$142.76	$0.00	$0.00	$0.00	$66.12	$235.46	$235.46	$0.00	$0.00	$66.11	$0.00	$187.65	$187.65	$0.00	$158.63	$251.26	$253.80	$0.00		$0.00	$49.65	$0.00	$0.00	$50.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.612	SUP	HCPCS C1713		04.503.612  -  SCREW TI 12MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$252.00 	$186.48	$0.00	$201.60	$113.40	$113.40	$0.00	$0.00	$0.00	$52.52	$187.03	$187.03	$0.00	$0.00	$52.52	$0.00	$149.06	$149.06	$0.00	$126.00	$199.58	$201.60	$0.00		$0.00	$39.44	$0.00	$0.00	$40.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.612.01	SUP	HCPCS C1713		04.503.612.01  -  SCREW BONE 2MM 12MM TI MAXFACL SLFTAP LCK NONSTRL	BOTH IP/OP	$317.25 	$234.77	$0.00	$253.80	$142.76	$142.76	$0.00	$0.00	$0.00	$66.12	$235.46	$235.46	$0.00	$0.00	$66.11	$0.00	$187.65	$187.65	$0.00	$158.63	$251.26	$253.80	$0.00		$0.00	$49.65	$0.00	$0.00	$50.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.614	SUP	HCPCS C1713		04.503.614  -  SCREW TI 14MM 2MM LCK SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$252.00 	$186.48	$0.00	$201.60	$113.40	$113.40	$0.00	$0.00	$0.00	$52.52	$187.03	$187.03	$0.00	$0.00	$52.52	$0.00	$149.06	$149.06	$0.00	$126.00	$199.58	$201.60	$0.00		$0.00	$39.44	$0.00	$0.00	$40.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.614.01	SUP	HCPCS C1713		04.503.614.01  -  SCREW BONE 2MM 14MM TI MAXFACL SLFTAP LCK NONSTRL	BOTH IP/OP	$317.25 	$234.77	$0.00	$253.80	$142.76	$142.76	$0.00	$0.00	$0.00	$66.12	$235.46	$235.46	$0.00	$0.00	$66.11	$0.00	$187.65	$187.65	$0.00	$158.63	$251.26	$253.80	$0.00		$0.00	$49.65	$0.00	$0.00	$50.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.616	SUP	HCPCS C1713		04.503.616  -  SCREW TI 16MM 2MM LCK SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$252.00 	$186.48	$0.00	$201.60	$113.40	$113.40	$0.00	$0.00	$0.00	$52.52	$187.03	$187.03	$0.00	$0.00	$52.52	$0.00	$149.06	$149.06	$0.00	$126.00	$199.58	$201.60	$0.00		$0.00	$39.44	$0.00	$0.00	$40.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.616.01	SUP	HCPCS C1713		04.503.616.01  -  SCREW TI 16MM 2MM MANDIB SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$317.25 	$234.77	$0.00	$253.80	$142.76	$142.76	$0.00	$0.00	$0.00	$66.12	$235.46	$235.46	$0.00	$0.00	$66.11	$0.00	$187.65	$187.65	$0.00	$158.63	$251.26	$253.80	$0.00		$0.00	$49.65	$0.00	$0.00	$50.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.618.01	SUP	HCPCS C1713		04.503.618.01  -  SCREW TI 18MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$317.25 	$234.77	$0.00	$253.80	$142.76	$142.76	$0.00	$0.00	$0.00	$66.12	$235.46	$235.46	$0.00	$0.00	$66.11	$0.00	$187.65	$187.65	$0.00	$158.63	$251.26	$253.80	$0.00		$0.00	$49.65	$0.00	$0.00	$50.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.638.01	SUP	HCPCS C1713		04.503.638.01  -  SCREW TI 8MM 2.4MM MIDFAC SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$389.25 	$288.05	$0.00	$311.40	$175.16	$175.16	$0.00	$0.00	$0.00	$81.13	$288.90	$288.90	$0.00	$0.00	$81.12	$0.00	$230.24	$230.24	$0.00	$194.63	$308.29	$311.40	$0.00		$0.00	$60.92	$0.00	$0.00	$61.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.640	SUP	HCPCS C1713		04.503.640  -  SCREW TI 10MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$139.73	$139.73	$0.00	$0.00	$0.00	$64.72	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$183.66	$183.66	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$48.59	$0.00	$0.00	$49.43	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.640.01	SUP	HCPCS C1713		04.503.640.01  -  SCREW TI 10MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$389.25 	$288.05	$0.00	$311.40	$175.16	$175.16	$0.00	$0.00	$0.00	$81.13	$288.90	$288.90	$0.00	$0.00	$81.12	$0.00	$230.24	$230.24	$0.00	$194.63	$308.29	$311.40	$0.00		$0.00	$60.92	$0.00	$0.00	$61.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.642.01	SUP	HCPCS C1713		04.503.642.01  -  SCREW TI 12MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$389.25 	$288.05	$0.00	$311.40	$175.16	$175.16	$0.00	$0.00	$0.00	$81.13	$288.90	$288.90	$0.00	$0.00	$81.12	$0.00	$230.24	$230.24	$0.00	$194.63	$308.29	$311.40	$0.00		$0.00	$60.92	$0.00	$0.00	$61.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.644	SUP	HCPCS C1713		04.503.644  -  SCREW TI 14MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$139.73	$139.73	$0.00	$0.00	$0.00	$64.72	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$183.66	$183.66	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$48.59	$0.00	$0.00	$49.43	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.644.01	SUP	HCPCS C1713		04.503.644.01  -  SCREW TI 14MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$389.25 	$288.05	$0.00	$311.40	$175.16	$175.16	$0.00	$0.00	$0.00	$81.13	$288.90	$288.90	$0.00	$0.00	$81.12	$0.00	$230.24	$230.24	$0.00	$194.63	$308.29	$311.40	$0.00		$0.00	$60.92	$0.00	$0.00	$61.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.646	SUP	HCPCS C1713		04.503.646  -  SCREW TI 16MM 2.4MM LCK SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$139.73	$139.73	$0.00	$0.00	$0.00	$64.72	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$183.66	$183.66	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$48.59	$0.00	$0.00	$49.43	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.646.01	SUP	HCPCS C1713		04.503.646.01  -  SCREW TI 16MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$389.25 	$288.05	$0.00	$311.40	$175.16	$175.16	$0.00	$0.00	$0.00	$81.13	$288.90	$288.90	$0.00	$0.00	$81.12	$0.00	$230.24	$230.24	$0.00	$194.63	$308.29	$311.40	$0.00		$0.00	$60.92	$0.00	$0.00	$61.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.648.01	SUP	HCPCS C1713		04.503.648.01  -  SCREW TI 18MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL	BOTH IP/OP	$389.25 	$288.05	$0.00	$311.40	$175.16	$175.16	$0.00	$0.00	$0.00	$81.13	$288.90	$288.90	$0.00	$0.00	$81.12	$0.00	$230.24	$230.24	$0.00	$194.63	$308.29	$311.40	$0.00		$0.00	$60.92	$0.00	$0.00	$61.97	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.668.01	SUP	HCPCS C1713		04.503.668.01  -  SCREW BONE 2.8MM 8MM TI LCK	BOTH IP/OP	$447.75 	$331.34	$0.00	$358.20	$201.49	$201.49	$0.00	$0.00	$0.00	$93.32	$332.32	$332.32	$0.00	$0.00	$93.31	$0.00	$264.84	$264.84	$0.00	$223.88	$354.62	$358.20	$0.00		$0.00	$70.07	$0.00	$0.00	$71.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.670	SUP	HCPCS C1713		04.503.670  -  SCREW TI 10MM 2.9MM LCK SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.670.01	SUP	HCPCS C1713		04.503.670.01  -  SCREW BONE 2.8MM 10MM TI LCK	BOTH IP/OP	$447.75 	$331.34	$0.00	$358.20	$201.49	$201.49	$0.00	$0.00	$0.00	$93.32	$332.32	$332.32	$0.00	$0.00	$93.31	$0.00	$264.84	$264.84	$0.00	$223.88	$354.62	$358.20	$0.00		$0.00	$70.07	$0.00	$0.00	$71.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.672	SUP	HCPCS C1713		04.503.672  -  SCREW TI 12MM 2.9MM LCK SLFTAP BONE MTRXMAND NONSTRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.672.01	SUP	HCPCS C1713		04.503.672.01  -  SCREW BONE 2.9MM 12MM TI LCK	BOTH IP/OP	$447.75 	$331.34	$0.00	$358.20	$201.49	$201.49	$0.00	$0.00	$0.00	$93.32	$332.32	$332.32	$0.00	$0.00	$93.31	$0.00	$264.84	$264.84	$0.00	$223.88	$354.62	$358.20	$0.00		$0.00	$70.07	$0.00	$0.00	$71.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.674.01	SUP	HCPCS C1713		04.503.674.01  -  SCREW BONE 2.9MM 14MM TI LCK	BOTH IP/OP	$447.75 	$331.34	$0.00	$358.20	$201.49	$201.49	$0.00	$0.00	$0.00	$93.32	$332.32	$332.32	$0.00	$0.00	$93.31	$0.00	$264.84	$264.84	$0.00	$223.88	$354.62	$358.20	$0.00		$0.00	$70.07	$0.00	$0.00	$71.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.676.01	SUP	HCPCS C1713		04.503.676.01  -  SCREW BONE 2.8MM 16MM TI LCK	BOTH IP/OP	$447.75 	$331.34	$0.00	$358.20	$201.49	$201.49	$0.00	$0.00	$0.00	$93.32	$332.32	$332.32	$0.00	$0.00	$93.31	$0.00	$264.84	$264.84	$0.00	$223.88	$354.62	$358.20	$0.00		$0.00	$70.07	$0.00	$0.00	$71.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.678.01	SUP	HCPCS C1713		04.503.678.01  -  SCREW TI 18MM 2.9MM SLFTAP LCK BONE MTRXMAND	BOTH IP/OP	$447.75 	$331.34	$0.00	$358.20	$201.49	$201.49	$0.00	$0.00	$0.00	$93.32	$332.32	$332.32	$0.00	$0.00	$93.31	$0.00	$264.84	$264.84	$0.00	$223.88	$354.62	$358.20	$0.00		$0.00	$70.07	$0.00	$0.00	$71.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.701	SUP	HCPCS C1713		04.503.701  -  PLATE BN MN NAR 1MM NS MATRIXMANDIBLE 2X2 HL TNSNBND MLBL TI	BOTH IP/OP	$922.50 	$682.65	$0.00	$738.00	$415.13	$415.13	$0.00	$0.00	$0.00	$192.27	$684.68	$684.68	$0.00	$0.00	$192.25	$0.00	$545.66	$545.66	$0.00	$461.25	$730.62	$738.00	$0.00		$0.00	$144.37	$0.00	$0.00	$146.86	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.702	SUP	HCPCS C1713		04.503.702  -  PLATE MINI NAR 1MM MANDIB 2X2 HOLE TNSNBND BONE MTRXMAND TI	BOTH IP/OP	$922.50 	$682.65	$0.00	$738.00	$415.13	$415.13	$0.00	$0.00	$0.00	$192.27	$684.68	$684.68	$0.00	$0.00	$192.25	$0.00	$545.66	$545.66	$0.00	$461.25	$730.62	$738.00	$0.00		$0.00	$144.37	$0.00	$0.00	$146.86	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.703	SUP	HCPCS C1713		04.503.703  -  PLATE BN MN NAR 1MM NS MATRIXMANDIBLE 3X3 HL TNSNBND MLBL TI	BOTH IP/OP	"$1,005.75 "	$744.26	$0.00	$804.60	$452.59	$452.59	$0.00	$0.00	$0.00	$209.62	$746.47	$746.47	$0.00	$0.00	$209.60	$0.00	$594.90	$594.90	$0.00	$502.88	$796.55	$804.60	$0.00		$0.00	$157.40	$0.00	$0.00	$160.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.704	SUP	HCPCS C1713		04.503.704  -  PLATE MINI NAR NONSTRL 1MM 2X2 HOLE TNSNBND MALBLE BONE	BOTH IP/OP	"$1,005.75 "	$744.26	$0.00	$804.60	$452.59	$452.59	$0.00	$0.00	$0.00	$209.62	$746.47	$746.47	$0.00	$0.00	$209.60	$0.00	$594.90	$594.90	$0.00	$502.88	$796.55	$804.60	$0.00		$0.00	$157.40	$0.00	$0.00	$160.12	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.705	SUP	HCPCS C1713		04.503.705  -  PLATE BN 1MM NS MATRIXMANDIBLE 12 HL ADP TI MNDB	BOTH IP/OP	"$1,651.50 "	"$1,222.11"	$0.00	"$1,321.20"	$743.18	$743.18	$0.00	$0.00	$0.00	$344.21	"$1,225.74"	"$1,225.74"	$0.00	$0.00	$344.17	$0.00	$976.86	$976.86	$0.00	$825.75	"$1,307.99"	"$1,321.20"	$0.00		$0.00	$258.46	$0.00	$0.00	$262.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.706	SUP	HCPCS C1713		04.503.706  -  PLATE BN 1MM NS MATRIXMANDIBLE 20 HL ADP TI MNDB	BOTH IP/OP	"$1,809.00 "	"$1,338.66"	$0.00	"$1,447.20"	$814.05	$814.05	$0.00	$0.00	$0.00	$377.04	"$1,342.64"	"$1,342.64"	$0.00	$0.00	$377.00	$0.00	"$1,070.02"	"$1,070.02"	$0.00	$904.50	"$1,432.73"	"$1,447.20"	$0.00		$0.00	$283.11	$0.00	$0.00	$287.99	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.707	SUP	HCPCS C1713		04.503.707  -  PLATE BN BX 1MM NS MATRIXMANDIBLE 4 HL MLBL TI MNDB	BOTH IP/OP	$722.25 	$534.47	$0.00	$577.80	$325.01	$325.01	$0.00	$0.00	$0.00	$150.53	$536.05	$536.05	$0.00	$0.00	$150.52	$0.00	$427.21	$427.21	$0.00	$361.13	$572.02	$577.80	$0.00		$0.00	$113.03	$0.00	$0.00	$114.98	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.708	SUP	HCPCS C1713		04.503.708  -  PLATE BN 1MM NS MATRIXMANDIBLE 8 HL MLBL STRUT TI MNDB	BOTH IP/OP	"$1,419.75 "	"$1,050.62"	$0.00	"$1,135.80"	$638.89	$638.89	$0.00	$0.00	$0.00	$295.91	"$1,053.74"	"$1,053.74"	$0.00	$0.00	$295.88	$0.00	$839.78	$839.78	$0.00	$709.88	"$1,124.44"	"$1,135.80"	$0.00		$0.00	$222.19	$0.00	$0.00	$226.02	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.709	SUP	HCPCS C1713		04.503.709  -  PLATE BN MN CRV 1MM NS MATRIXMANDIBLE 8 HL MLBL STRUT TI	BOTH IP/OP	"$1,419.75 "	"$1,050.62"	$0.00	"$1,135.80"	$638.89	$638.89	$0.00	$0.00	$0.00	$295.91	"$1,053.74"	"$1,053.74"	$0.00	$0.00	$295.88	$0.00	$839.78	$839.78	$0.00	$709.88	"$1,124.44"	"$1,135.80"	$0.00		$0.00	$222.19	$0.00	$0.00	$226.02	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.710	SUP	HCPCS C1713		04.503.710  -  PLATE BN STRG 1.25MM NS MATRIXMANDIBLE DCP 2X2 HL TI MNDB	BOTH IP/OP	$893.25 	$661.01	$0.00	$714.60	$401.96	$401.96	$0.00	$0.00	$0.00	$186.18	$662.97	$662.97	$0.00	$0.00	$186.15	$0.00	$528.36	$528.36	$0.00	$446.63	$707.45	$714.60	$0.00		$0.00	$139.79	$0.00	$0.00	$142.21	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.711	SUP	HCPCS C1713		04.503.711  -  PLATE BN CRSNT 1.25MM NS MATRIXMANDIBLE 2X2 HL TI MNDB	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$0.00	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00		$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.712	SUP	HCPCS C1713		04.503.712  -  PLATE BN STRG 1.25MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB	BOTH IP/OP	"$1,050.75 "	$777.56	$0.00	$840.60	$472.84	$472.84	$0.00	$0.00	$0.00	$219.00	$779.87	$779.87	$0.00	$0.00	$218.98	$0.00	$621.52	$621.52	$0.00	$525.38	$832.19	$840.60	$0.00		$0.00	$164.44	$0.00	$0.00	$167.28	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.713	SUP	HCPCS C1713		04.503.713  -  PLATE BN CRSNT 1.25MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB	BOTH IP/OP	"$1,264.50 "	$935.73	$0.00	"$1,011.60"	$569.03	$569.03	$0.00	$0.00	$0.00	$263.55	$938.51	$938.51	$0.00	$0.00	$263.52	$0.00	$747.95	$747.95	$0.00	$632.25	"$1,001.48"	"$1,011.60"	$0.00		$0.00	$197.89	$0.00	$0.00	$201.31	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.714	SUP	HCPCS C1713		04.503.714  -  PLATE BN ANG 1.25MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB	BOTH IP/OP	"$1,323.00 "	$979.02	$0.00	"$1,058.40"	$595.35	$595.35	$0.00	$0.00	$0.00	$275.75	$981.93	$981.93	$0.00	$0.00	$275.71	$0.00	$782.55	$782.55	$0.00	$661.50	"$1,047.82"	"$1,058.40"	$0.00		$0.00	$207.05	$0.00	$0.00	$210.62	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.715	SUP	HCPCS C1713		04.503.715  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 6 HL TI MNDB	BOTH IP/OP	"$1,784.25 "	"$1,320.35"	$0.00	"$1,427.40"	$802.91	$802.91	$0.00	$0.00	$0.00	$371.88	"$1,324.27"	"$1,324.27"	$0.00	$0.00	$371.84	$0.00	"$1,055.38"	"$1,055.38"	$0.00	$892.13	"$1,413.13"	"$1,427.40"	$0.00		$0.00	$279.24	$0.00	$0.00	$284.05	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.716	SUP	HCPCS C1713		04.503.716  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 3X3 HL TI MNDB	BOTH IP/OP	"$1,784.25 "	"$1,320.35"	$0.00	"$1,427.40"	$802.91	$802.91	$0.00	$0.00	$0.00	$371.88	"$1,324.27"	"$1,324.27"	$0.00	$0.00	$371.84	$0.00	"$1,055.38"	"$1,055.38"	$0.00	$892.13	"$1,413.13"	"$1,427.40"	$0.00		$0.00	$279.24	$0.00	$0.00	$284.05	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.717	SUP	HCPCS C1713		04.503.717  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 12 HL TI MNDB	BOTH IP/OP	"$2,043.00 "	"$1,511.82"	$0.00	"$1,634.40"	$919.35	$919.35	$0.00	$0.00	$0.00	$425.81	"$1,516.31"	"$1,516.31"	$0.00	$0.00	$425.76	$0.00	"$1,208.43"	"$1,208.43"	$0.00	"$1,021.50"	"$1,618.06"	"$1,634.40"	$0.00		$0.00	$319.73	$0.00	$0.00	$325.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.718	SUP	HCPCS C1713		04.503.718  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 20 HL TI MNDB	BOTH IP/OP	"$2,819.25 "	"$2,086.25"	$0.00	"$2,255.40"	"$1,268.66"	"$1,268.66"	$0.00	$0.00	$0.00	$587.60	"$2,092.45"	"$2,092.45"	$0.00	$0.00	$587.53	$0.00	"$1,389.89"	"$1,389.89"	$0.00	"$1,409.63"	"$2,232.85"	"$2,255.40"	$0.00		$0.00	$441.21	$0.00	$0.00	$448.82	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.721	SUP	HCPCS C1713		04.503.721  -  PLATE BN ANG 1.5MM NS MATRIXMANDIBLE 3X3 HL TI MNDB	BOTH IP/OP	"$2,457.00 "	"$1,818.18"	$0.00	"$1,965.60"	"$1,105.65"	"$1,105.65"	$0.00	$0.00	$0.00	$512.10	"$1,823.59"	"$1,823.59"	$0.00	$0.00	$512.04	$0.00	"$1,453.32"	"$1,453.32"	$0.00	"$1,228.50"	"$1,945.94"	"$1,965.60"	$0.00		$0.00	$384.52	$0.00	$0.00	$391.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.722	SUP	HCPCS C1713		04.503.722  -  PLATE BN CRSNT 1.5MM NS MATRIXMANDIBLE 3X3 HL TI MNDB	BOTH IP/OP	"$2,457.00 "	"$1,818.18"	$0.00	"$1,965.60"	"$1,105.65"	"$1,105.65"	$0.00	$0.00	$0.00	$512.10	"$1,823.59"	"$1,823.59"	$0.00	$0.00	$512.04	$0.00	"$1,453.32"	"$1,453.32"	$0.00	"$1,228.50"	"$1,945.94"	"$1,965.60"	$0.00		$0.00	$384.52	$0.00	$0.00	$391.15	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.723	SUP	HCPCS C1713		04.503.723  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE DCP 2X2 HL TI MNDB	BOTH IP/OP	"$1,590.75 "	"$1,177.16"	$0.00	"$1,272.60"	$715.84	$715.84	$0.00	$0.00	$0.00	$331.55	"$1,180.65"	"$1,180.65"	$0.00	$0.00	$331.51	$0.00	$940.93	$940.93	$0.00	$795.38	"$1,259.87"	"$1,272.60"	$0.00		$0.00	$248.95	$0.00	$0.00	$253.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.724	SUP	HCPCS C1713		04.503.724  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB	BOTH IP/OP	"$1,683.00 "	"$1,245.42"	$0.00	"$1,346.40"	$757.35	$757.35	$0.00	$0.00	$0.00	$350.78	"$1,249.12"	"$1,249.12"	$0.00	$0.00	$350.74	$0.00	$995.49	$995.49	$0.00	$841.50	"$1,332.94"	"$1,346.40"	$0.00		$0.00	$263.39	$0.00	$0.00	$267.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.726	SUP	HCPCS C1713		04.503.726  -  PLATE BN BRD CRSNT 2MM NS MATRIXMANDIBLE 2X2 HL TI MNDB	BOTH IP/OP	"$1,732.50 "	"$1,282.05"	$0.00	"$1,386.00"	$779.63	$779.63	$0.00	$0.00	$0.00	$361.10	"$1,285.86"	"$1,285.86"	$0.00	$0.00	$361.05	$0.00	"$1,024.77"	"$1,024.77"	$0.00	$866.25	"$1,372.14"	"$1,386.00"	$0.00		$0.00	$271.14	$0.00	$0.00	$275.81	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.727	SUP	HCPCS C1713		04.503.727  -  PLATE BN BRD CRSNT 2MM NS MATRIXMANDIBLE 3X3 HL TI MNDB	BOTH IP/OP	"$1,863.00 "	"$1,378.62"	$0.00	"$1,490.40"	$838.35	$838.35	$0.00	$0.00	$0.00	$388.30	"$1,382.72"	"$1,382.72"	$0.00	$0.00	$388.25	$0.00	"$1,101.96"	"$1,101.96"	$0.00	$931.50	"$1,475.50"	"$1,490.40"	$0.00		$0.00	$291.56	$0.00	$0.00	$296.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.728	SUP	HCPCS C1713		04.503.728  -  PLATE BN STRG 2MM NS MATRIXMANDIBLE 6 HL TI MNDB	BOTH IP/OP	"$1,732.50 "	"$1,282.05"	$0.00	"$1,386.00"	$779.63	$779.63	$0.00	$0.00	$0.00	$361.10	"$1,285.86"	"$1,285.86"	$0.00	$0.00	$361.05	$0.00	"$1,024.77"	"$1,024.77"	$0.00	$866.25	"$1,372.14"	"$1,386.00"	$0.00		$0.00	$271.14	$0.00	$0.00	$275.81	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.729	SUP	HCPCS C1713		04.503.729  -  PLATE BN STRG 2MM NS MATRIXMANDIBLE 12 HL TI MNDB	BOTH IP/OP	"$2,342.25 "	"$1,733.27"	$0.00	"$1,873.80"	"$1,054.01"	"$1,054.01"	$0.00	$0.00	$0.00	$488.18	"$1,738.42"	"$1,738.42"	$0.00	$0.00	$488.12	$0.00	"$1,385.44"	"$1,385.44"	$0.00	"$1,171.13"	"$1,855.06"	"$1,873.80"	$0.00		$0.00	$366.56	$0.00	$0.00	$372.89	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.730	SUP	HCPCS C1713		04.503.730  -  PLATE BN STRG 2MM NS MATRIXMANDIBLE 20 HL TI MNDB	BOTH IP/OP	"$2,954.25 "	"$2,186.15"	$0.00	"$2,363.40"	"$1,329.41"	"$1,329.41"	$0.00	$0.00	$0.00	$615.74	"$2,192.64"	"$2,192.64"	$0.00	$0.00	$615.67	$0.00	"$1,456.45"	"$1,456.45"	$0.00	"$1,477.13"	"$2,339.77"	"$2,363.40"	$0.00		$0.00	$462.34	$0.00	$0.00	$470.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.731	SUP	HCPCS C1713		04.503.731  -  PLATE BN BRD ANG 2MM NS MATRIXMANDIBLE 3X3 HL TI MNDB	BOTH IP/OP	"$2,556.00 "	"$1,891.44"	$0.00	"$2,044.80"	"$1,150.20"	"$1,150.20"	$0.00	$0.00	$0.00	$532.73	"$1,897.06"	"$1,897.06"	$0.00	$0.00	$532.67	$0.00	"$1,260.11"	"$1,260.11"	$0.00	"$1,278.00"	"$2,024.35"	"$2,044.80"	$0.00		$0.00	$400.01	$0.00	$0.00	$406.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.732	SUP	HCPCS C1713		04.503.732  -  PLATE BN LT ANG 2MM NS MATRIXMANDIBLE 7X23 HL RECON TI MNDB	BOTH IP/OP	"$4,887.00 "	"$3,616.38"	$0.00	"$3,909.60"	"$2,199.15"	"$2,199.15"	$0.00	$0.00	$0.00	"$1,018.57"	"$3,627.13"	"$3,627.13"	$0.00	$0.00	"$1,018.45"	$0.00	"$2,409.29"	"$2,409.29"	$0.00	"$2,443.50"	"$3,870.50"	"$3,909.60"	$0.00		$0.00	$764.82	$0.00	$0.00	$778.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.733	SUP	HCPCS C1713		04.503.733  -  PLATE BN RT ANG 2MM NS MATRIXMANDIBLE 7X23 HL RECON TI MNDB	BOTH IP/OP	"$4,887.00 "	"$3,616.38"	$0.00	"$3,909.60"	"$2,199.15"	"$2,199.15"	$0.00	$0.00	$0.00	"$1,018.57"	"$3,627.13"	"$3,627.13"	$0.00	$0.00	"$1,018.45"	$0.00	"$2,409.29"	"$2,409.29"	$0.00	"$2,443.50"	"$3,870.50"	"$3,909.60"	$0.00		$0.00	$764.82	$0.00	$0.00	$778.01	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.734	SUP	HCPCS C1713		04.503.734  -  PLATE BN 2 ANG SM 2MM NS MATRIXMANDIBLE 4X20X4 HL RECON TI	BOTH IP/OP	"$5,656.50 "	"$4,185.81"	$0.00	"$4,525.20"	"$2,545.43"	"$2,545.43"	$0.00	$0.00	$0.00	"$1,178.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,178.81"	$0.00	"$2,788.65"	"$2,788.65"	$0.00	"$2,828.25"	"$4,479.95"	"$4,525.20"	$0.00		$0.00	$885.24	$0.00	$0.00	$900.51	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.735	SUP	HCPCS C1713		04.503.735  -  PLATE BN 2 ANG MED 2MM NS MATRIXMANDIBLE 5X22X5 HL RECON TI	BOTH IP/OP	"$5,973.75 "	"$4,420.58"	$0.00	"$4,779.00"	"$2,688.19"	"$2,688.19"	$0.00	$0.00	$0.00	"$1,245.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,244.93"	$0.00	"$2,945.06"	"$2,945.06"	$0.00	"$2,986.88"	"$4,731.21"	"$4,779.00"	$0.00		$0.00	$934.89	$0.00	$0.00	$951.02	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.736	SUP	HCPCS C1713		04.503.736  -  PLATE BN 2 ANG LG 2MM NS MATRIXMANDIBLE 6X24X6 HL RECON TI	BOTH IP/OP	"$6,293.25 "	"$4,657.01"	$0.00	"$5,034.60"	"$2,831.96"	"$2,831.96"	$0.00	$0.00	$0.00	"$1,311.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,311.51"	$0.00	"$3,102.57"	"$3,102.57"	$0.00	"$3,146.63"	"$4,984.25"	"$5,034.60"	$0.00		$0.00	$984.89	$0.00	$0.00	"$1,001.89"	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.737	SUP	HCPCS C1713		04.503.737  -  PLATE BN STRG 2.5MM NS MATRIXMANDIBLE 12 HL RECON TI MNDB	BOTH IP/OP	"$2,520.00 "	"$1,864.80"	$0.00	"$2,016.00"	"$1,134.00"	"$1,134.00"	$0.00	$0.00	$0.00	$525.23	"$1,870.34"	"$1,870.34"	$0.00	$0.00	$525.17	$0.00	"$1,242.36"	"$1,242.36"	$0.00	"$1,260.00"	"$1,995.84"	"$2,016.00"	$0.00		$0.00	$394.38	$0.00	$0.00	$401.18	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.738	SUP	HCPCS C1713		04.503.738  -  PLATE BN STRG 2.5MM NS MATRIXMANDIBLE 20 HL RECON TI MNDB	BOTH IP/OP	"$3,492.00 "	"$2,584.08"	$0.00	"$2,793.60"	"$1,571.40"	"$1,571.40"	$0.00	$0.00	$0.00	$727.82	"$2,591.76"	"$2,591.76"	$0.00	$0.00	$727.73	$0.00	"$1,721.56"	"$1,721.56"	$0.00	"$1,746.00"	"$2,765.66"	"$2,793.60"	$0.00		$0.00	$546.50	$0.00	$0.00	$555.93	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.739	SUP	HCPCS C1713		04.503.739  -  PLATE BN LT ANG 2.5MM NS MATRIXMANDIBLE 7X23 HL RECON TI	BOTH IP/OP	"$5,260.50 "	"$3,892.77"	$0.00	"$4,208.40"	"$2,367.23"	"$2,367.23"	$0.00	$0.00	$0.00	"$1,096.42"	"$3,904.34"	"$3,904.34"	$0.00	$0.00	"$1,096.29"	$0.00	"$2,593.43"	"$2,593.43"	$0.00	"$2,630.25"	"$4,166.32"	"$4,208.40"	$0.00		$0.00	$823.27	$0.00	$0.00	$837.47	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.740	SUP	HCPCS C1713		04.503.740  -  PLATE BN RT ANG 2.5MM NS MATRIXMANDIBLE 7X23 HL RECON TI	BOTH IP/OP	"$5,260.50 "	"$3,892.77"	$0.00	"$4,208.40"	"$2,367.23"	"$2,367.23"	$0.00	$0.00	$0.00	"$1,096.42"	"$3,904.34"	"$3,904.34"	$0.00	$0.00	"$1,096.29"	$0.00	"$2,593.43"	"$2,593.43"	$0.00	"$2,630.25"	"$4,166.32"	"$4,208.40"	$0.00		$0.00	$823.27	$0.00	$0.00	$837.47	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.741	SUP	HCPCS C1713		04.503.741  -  PLATE BN 2 ANG SM 2.5MM NS MATRIXMANDIBLE 4X20X4 HL RECON TI	BOTH IP/OP	"$6,090.75 "	"$4,507.16"	$0.00	"$4,872.60"	"$2,740.84"	"$2,740.84"	$0.00	$0.00	$0.00	"$1,269.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,269.31"	$0.00	"$3,002.74"	"$3,002.74"	$0.00	"$3,045.38"	"$4,823.87"	"$4,872.60"	$0.00		$0.00	$953.20	$0.00	$0.00	$969.65	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.742	SUP	HCPCS C1713		04.503.742  -  PLATE BN 2 ANG MED 2.5MM NS MATRIXMANDIBLE 5X22X5 HL RECON	BOTH IP/OP	"$6,428.25 "	"$4,756.91"	$0.00	"$5,142.60"	"$2,892.71"	"$2,892.71"	$0.00	$0.00	$0.00	"$1,339.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,339.65"	$0.00	"$3,169.13"	"$3,169.13"	$0.00	"$3,214.13"	"$5,091.17"	"$5,142.60"	$0.00		$0.00	"$1,006.02"	$0.00	$0.00	"$1,023.38"	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.743	SUP	HCPCS C1713		04.503.743  -  PLATE BN 2 ANG LG 2.5MM NS MATRIXMANDIBLE 6X24X6 HL RECON TI	BOTH IP/OP	"$6,783.75 "	"$5,019.98"	$0.00	"$5,427.00"	"$3,052.69"	"$3,052.69"	$0.00	$0.00	$0.00	"$1,413.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.73"	$0.00	"$3,344.39"	"$3,344.39"	$0.00	"$3,391.88"	"$5,372.73"	"$5,427.00"	$0.00		$0.00	"$1,061.66"	$0.00	$0.00	"$1,079.97"	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.750	SUP	HCPCS C1713		04.503.750  -  PLATE BN BRD MN 1MM NS MATRIXMANDIBLE 2X2 HL MLBL TNSNBND TI	BOTH IP/OP	"$1,152.00 "	$852.48	$0.00	$921.60	$518.40	$518.40	$0.00	$0.00	$0.00	$240.11	$855.01	$855.01	$0.00	$0.00	$240.08	$0.00	$681.41	$681.41	$0.00	$576.00	$912.38	$921.60	$0.00		$0.00	$180.29	$0.00	$0.00	$183.40	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.751	SUP	HCPCS C1713		04.503.751  -  PLATE BN BRD MN 1MM NS MATRIXMANDIBLE 2X3 HL MLBL TNSNBND TI	BOTH IP/OP	"$1,197.00 "	$885.78	$0.00	$957.60	$538.65	$538.65	$0.00	$0.00	$0.00	$249.48	$888.41	$888.41	$0.00	$0.00	$249.45	$0.00	$708.03	$708.03	$0.00	$598.50	$948.02	$957.60	$0.00		$0.00	$187.33	$0.00	$0.00	$190.56	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.752	SUP	HCPCS C1713		04.503.752  -  PLATE BN BRD MN 1MM NS MATRIXMANDIBLE 3X3 HL MLBL TNSNBND TI	BOTH IP/OP	"$1,244.25 "	$920.75	$0.00	$995.40	$559.91	$559.91	$0.00	$0.00	$0.00	$259.33	$923.48	$923.48	$0.00	$0.00	$259.30	$0.00	$735.97	$735.97	$0.00	$622.13	$985.45	$995.40	$0.00		$0.00	$194.73	$0.00	$0.00	$198.08	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.756	SUP	HCPCS C1713		04.503.756  -  PLATE BN 1.25MM NS MATRIXMANDIBLE 12 HL ADP TI MNDB	BOTH IP/OP	"$1,773.00 "	"$1,312.02"	$0.00	"$1,418.40"	$797.85	$797.85	$0.00	$0.00	$0.00	$369.54	"$1,315.92"	"$1,315.92"	$0.00	$0.00	$369.49	$0.00	"$1,048.73"	"$1,048.73"	$0.00	$886.50	"$1,404.22"	"$1,418.40"	$0.00		$0.00	$277.47	$0.00	$0.00	$282.26	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.761	SUP	HCPCS C1713		04.503.761  -  PLATE BONE STR 1.25MM 2X2 HOLE MTRXMAND DCP SILVER TITANIUM	BOTH IP/OP	"$1,188.00 "	$879.12	$0.00	$950.40	$534.60	$534.60	$0.00	$0.00	$0.00	$247.61	$881.73	$881.73	$0.00	$0.00	$247.58	$0.00	$702.70	$702.70	$0.00	$594.00	$940.90	$950.40	$0.00		$0.00	$185.92	$0.00	$0.00	$189.13	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.770	SUP	HCPCS C1713		04.503.770  -  PLATE BN STRG 2.8MM NS MATRIXMANDIBLE 12 HL RECON TI MNDB	BOTH IP/OP	"$2,965.50 "	"$2,194.47"	$0.00	"$2,372.40"	"$1,334.48"	"$1,334.48"	$0.00	$0.00	$0.00	$618.08	"$2,200.99"	"$2,200.99"	$0.00	$0.00	$618.01	$0.00	"$1,461.99"	"$1,461.99"	$0.00	"$1,482.75"	"$2,348.68"	"$2,372.40"	$0.00		$0.00	$464.10	$0.00	$0.00	$472.11	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.771	SUP	HCPCS C1713		04.503.771  -  PLATE BN STRG 2.8MM NS MATRIXMANDIBLE 20 HL RECON TI MNDB	BOTH IP/OP	"$4,338.00 "	"$3,210.12"	$0.00	"$3,470.40"	"$1,952.10"	"$1,952.10"	$0.00	$0.00	$0.00	$904.15	"$3,219.66"	"$3,219.66"	$0.00	$0.00	$904.04	$0.00	"$2,138.63"	"$2,138.63"	$0.00	"$2,169.00"	"$3,435.70"	"$3,470.40"	$0.00		$0.00	$678.90	$0.00	$0.00	$690.61	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.772	SUP	HCPCS C1713		04.503.772  -  PLATE BN LT ANG 2.8MM NS MATRIXMANDIBLE 7X23 HL RECON TI	BOTH IP/OP	"$6,444.00 "	"$4,768.56"	$0.00	"$5,155.20"	"$2,899.80"	"$2,899.80"	$0.00	$0.00	$0.00	"$1,343.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,342.93"	$0.00	"$3,176.89"	"$3,176.89"	$0.00	"$3,222.00"	"$5,103.65"	"$5,155.20"	$0.00		$0.00	"$1,008.49"	$0.00	$0.00	"$1,025.88"	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.773	SUP	HCPCS C1713		04.503.773  -  PLATE BN RT ANG 2.8MM NS MATRIXMANDIBLE 7X23 HL RECON TI	BOTH IP/OP	"$6,444.00 "	"$4,768.56"	$0.00	"$5,155.20"	"$2,899.80"	"$2,899.80"	$0.00	$0.00	$0.00	"$1,343.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,342.93"	$0.00	"$3,176.89"	"$3,176.89"	$0.00	"$3,222.00"	"$5,103.65"	"$5,155.20"	$0.00		$0.00	"$1,008.49"	$0.00	$0.00	"$1,025.88"	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.780	SUP	HCPCS C1713		04.503.780  -  PLATE 1MM RIGHT MANDIB 2 HOLE LCK TNSNBND PREBNT BONE	BOTH IP/OP	$987.75 	$730.94	$0.00	$790.20	$444.49	$444.49	$0.00	$0.00	$0.00	$205.87	$733.11	$733.11	$0.00	$0.00	$205.85	$0.00	$584.25	$584.25	$0.00	$493.88	$782.30	$790.20	$0.00		$0.00	$154.58	$0.00	$0.00	$157.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.781	SUP	HCPCS C1713		04.503.781  -  PLATE 1MM LEFT MANDIB 2 HOLE LCK TNSNBND PREBNT BONE	BOTH IP/OP	$987.75 	$730.94	$0.00	$790.20	$444.49	$444.49	$0.00	$0.00	$0.00	$205.87	$733.11	$733.11	$0.00	$0.00	$205.85	$0.00	$584.25	$584.25	$0.00	$493.88	$782.30	$790.20	$0.00		$0.00	$154.58	$0.00	$0.00	$157.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.783	SUP	HCPCS C1713		04.503.783  -  PLATE BONE 1MM 4 HOLE ADAPTION MTRXMAND SILVER TITANIUM	BOTH IP/OP	$927.00 	$685.98	$0.00	$741.60	$417.15	$417.15	$0.00	$0.00	$0.00	$193.21	$688.02	$688.02	$0.00	$0.00	$193.19	$0.00	$548.32	$548.32	$0.00	$463.50	$734.18	$741.60	$0.00		$0.00	$145.08	$0.00	$0.00	$147.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.801	SUP	HCPCS C1713		04.503.801  -  PLATE BN 3D SM .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM	BOTH IP/OP	"$4,167.00 "	"$3,083.58"	$0.00	"$3,333.60"	"$1,875.15"	"$1,875.15"	$0.00	$0.00	$0.00	$868.51	"$3,092.75"	"$3,092.75"	$0.00	$0.00	$868.40	$0.00	"$2,054.33"	"$2,054.33"	$0.00	"$2,083.50"	"$3,300.26"	"$3,333.60"	$0.00		$0.00	$652.14	$0.00	$0.00	$663.39	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.802	SUP	HCPCS C1713		04.503.802  -  PLATE BN 3D LG .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM	BOTH IP/OP	"$4,311.00 "	"$3,190.14"	$0.00	"$3,448.80"	"$1,939.95"	"$1,939.95"	$0.00	$0.00	$0.00	$898.52	"$3,199.62"	"$3,199.62"	$0.00	$0.00	$898.41	$0.00	"$2,125.32"	"$2,125.32"	$0.00	"$2,155.50"	"$3,414.31"	"$3,448.80"	$0.00		$0.00	$674.67	$0.00	$0.00	$686.31	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.811	SUP	HCPCS C1713		04.503.811  -  PLATE BN 3D SM .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM	BOTH IP/OP	"$4,167.00 "	"$3,083.58"	$0.00	"$3,333.60"	"$1,875.15"	"$1,875.15"	$0.00	$0.00	$0.00	$868.51	"$3,092.75"	"$3,092.75"	$0.00	$0.00	$868.40	$0.00	"$2,054.33"	"$2,054.33"	$0.00	"$2,083.50"	"$3,300.26"	"$3,333.60"	$0.00		$0.00	$652.14	$0.00	$0.00	$663.39	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.812	SUP	HCPCS C1713		04.503.812  -  PLATE BN 3D LG .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM	BOTH IP/OP	"$4,311.00 "	"$3,190.14"	$0.00	"$3,448.80"	"$1,939.95"	"$1,939.95"	$0.00	$0.00	$0.00	$898.52	"$3,199.62"	"$3,199.62"	$0.00	$0.00	$898.41	$0.00	"$2,125.32"	"$2,125.32"	$0.00	"$2,155.50"	"$3,414.31"	"$3,448.80"	$0.00		$0.00	$674.67	$0.00	$0.00	$686.31	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.820	SUP	HCPCS C1713		04.503.820  -  PLATE BN SHRT NS MATRIXWAVE 10 HL TI MXLMNDB	BOTH IP/OP	$776.25 	$574.43	$0.00	$621.00	$349.31	$349.31	$0.00	$0.00	$0.00	$161.79	$576.13	$576.13	$0.00	$0.00	$161.77	$0.00	$459.15	$459.15	$0.00	$388.13	$614.79	$621.00	$0.00		$0.00	$121.48	$0.00	$0.00	$123.58	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.824.01	SUP	HCPCS C1713		04.503.824.01  -  MATRIXWAVE MMF TI 1.85MM SCREW SELF-DRILLING/6MM LENGTH	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.825.01	SUP	HCPCS C1713		04.503.825.01  -  SCREW BONE 8MM SELF DRILL MATRIXWAVE TITANIUM 1.85MM	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.830	SUP	HCPCS C1713		04.503.830  -  PLATE RIGHT SUBCONDYLAR 7 HOLE MALBLE LMBD BONE MTRXMAND	BOTH IP/OP	"$2,099.25 "	"$1,553.45"	$0.00	"$1,679.40"	$944.66	$944.66	$0.00	$0.00	$0.00	$437.54	"$1,558.06"	"$1,558.06"	$0.00	$0.00	$437.48	$0.00	"$1,241.71"	"$1,241.71"	$0.00	"$1,049.63"	"$1,662.61"	"$1,679.40"	$0.00		$0.00	$328.53	$0.00	$0.00	$334.20	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.831	SUP	HCPCS C1713		04.503.831  -  PLATE LEFT SUBCONDYLAR 7 HOLE MALBLE LMBD BONE MTRXMAND	BOTH IP/OP	"$2,099.25 "	"$1,553.45"	$0.00	"$1,679.40"	$944.66	$944.66	$0.00	$0.00	$0.00	$437.54	"$1,558.06"	"$1,558.06"	$0.00	$0.00	$437.48	$0.00	"$1,241.71"	"$1,241.71"	$0.00	"$1,049.63"	"$1,662.61"	"$1,679.40"	$0.00		$0.00	$328.53	$0.00	$0.00	$334.20	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.834	SUP	HCPCS C1713		04.503.834  -  PLATE THK1MM SM SUBCONDYLAR 4 HOLE TRPZD MALBLE BONE	BOTH IP/OP	"$2,099.25 "	"$1,553.45"	$0.00	"$1,679.40"	$944.66	$944.66	$0.00	$0.00	$0.00	$437.54	"$1,558.06"	"$1,558.06"	$0.00	$0.00	$437.48	$0.00	"$1,241.71"	"$1,241.71"	$0.00	"$1,049.63"	"$1,662.61"	"$1,679.40"	$0.00		$0.00	$328.53	$0.00	$0.00	$334.20	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.900	SUP	HCPCS C1713		04.503.900  -  PLATE BN SM 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB RT	BOTH IP/OP	"$7,143.75 "	"$5,286.38"	$0.00	"$5,715.00"	"$3,214.69"	"$3,214.69"	$0.00	$0.00	$0.00	"$1,488.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,488.76"	$0.00	"$3,521.87"	"$3,521.87"	$0.00	"$3,571.88"	"$5,657.85"	"$5,715.00"	$0.00		$0.00	"$1,118.00"	$0.00	$0.00	"$1,137.29"	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.901	SUP	HCPCS C1713		04.503.901  -  PLATE BN SM 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB LT	BOTH IP/OP	"$7,143.75 "	"$5,286.38"	$0.00	"$5,715.00"	"$3,214.69"	"$3,214.69"	$0.00	$0.00	$0.00	"$1,488.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,488.76"	$0.00	"$3,521.87"	"$3,521.87"	$0.00	"$3,571.88"	"$5,657.85"	"$5,715.00"	$0.00		$0.00	"$1,118.00"	$0.00	$0.00	"$1,137.29"	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.902	SUP	HCPCS C1713		04.503.902  -  PLATE BN MED 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB RT	BOTH IP/OP	"$7,411.50 "	"$5,484.51"	$0.00	"$5,929.20"	"$3,335.18"	"$3,335.18"	$0.00	$0.00	$0.00	"$1,544.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,544.56"	$0.00	"$3,653.87"	"$3,653.87"	$0.00	"$3,705.75"	"$5,869.91"	"$5,929.20"	$0.00		$0.00	"$1,159.90"	$0.00	$0.00	"$1,179.91"	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.903	SUP	HCPCS C1713		04.503.903  -  PLATE BN MED 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB LT	BOTH IP/OP	"$7,411.50 "	"$5,484.51"	$0.00	"$5,929.20"	"$3,335.18"	"$3,335.18"	$0.00	$0.00	$0.00	"$1,544.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,544.56"	$0.00	"$3,653.87"	"$3,653.87"	$0.00	"$3,705.75"	"$5,869.91"	"$5,929.20"	$0.00		$0.00	"$1,159.90"	$0.00	$0.00	"$1,179.91"	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.904	SUP	HCPCS C1713		04.503.904  -  PLATE BN LG 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB RT	BOTH IP/OP	"$7,679.25 "	"$5,682.65"	$0.00	"$6,143.40"	"$3,455.66"	"$3,455.66"	$0.00	$0.00	$0.00	"$1,600.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,600.36"	$0.00	"$3,785.87"	"$3,785.87"	$0.00	"$3,839.63"	"$6,081.97"	"$6,143.40"	$0.00		$0.00	"$1,201.80"	$0.00	$0.00	"$1,222.54"	$0.00	$0.00	$0.00	$0.00	$0.00
04.503.905	SUP	HCPCS C1713		04.503.905  -  PLATE BN LG 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB LT	BOTH IP/OP	"$7,679.25 "	"$5,682.65"	$0.00	"$6,143.40"	"$3,455.66"	"$3,455.66"	$0.00	$0.00	$0.00	"$1,600.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,600.36"	$0.00	"$3,785.87"	"$3,785.87"	$0.00	"$3,839.63"	"$6,081.97"	"$6,143.40"	$0.00		$0.00	"$1,201.80"	$0.00	$0.00	"$1,222.54"	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.204.01	SUP	HCPCS C1713		04.511.204.01  -  SCREW TI 4MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.205.01	SUP	HCPCS C1713		04.511.205.01  -  SCREW BONE 1.85MM 15MM MTRX TI LEFT SLFDRILL NONSTRL	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.206.01	SUP	HCPCS C1713		04.511.206.01  -  SCREW TI 6MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.208.01	SUP	HCPCS C1713		04.511.208.01  -  SCREW TI 8MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.210.01	SUP	HCPCS C1713		04.511.210.01  -  SCREW TI 10MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.212.01	SUP	HCPCS C1713		04.511.212.01  -  SCREW TI 12MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.214.01	SUP	HCPCS C1713		04.511.214.01  -  SCREW TI 14MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.216.01	SUP	HCPCS C1713		04.511.216.01  -  SCREW TI 16MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.218.01	SUP	HCPCS C1713		04.511.218.01  -  SCREW TI 18MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX	BOTH IP/OP	$211.50 	$156.51	$0.00	$169.20	$95.18	$95.18	$0.00	$0.00	$0.00	$44.08	$156.98	$156.98	$0.00	$0.00	$44.08	$0.00	$125.10	$125.10	$0.00	$105.75	$167.51	$169.20	$0.00		$0.00	$33.10	$0.00	$0.00	$33.67	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.224.01	SUP	HCPCS C1713		04.511.224.01  -  SCREW TI 4MM 1.85MM MANDIB SLFDRILL ORTHGNAT BONE MTRX	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.225.01	SUP	HCPCS C1713		04.511.225.01  -  SCREW TI 5MM 1.85MM SLFDRILL BONE MATRIXORTHOGNATHIC NONSTRL	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.226.01	SUP	HCPCS C1713		04.511.226.01  -  SCREW BONE 1.85MM 6MM MTRX TI CRNMXF SLFDRILL ORTHGNAT	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.228.01	SUP	HCPCS C1713		04.511.228.01  -  SCREW TI 8MM 1.85MM MANDIB SLFDRILL ORTHGNAT BONE MTRX	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.234.01	SUP	HCPCS C1713		04.511.234.01  -  SCREW TI 4MM 2.1MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.235.01	SUP	HCPCS C1713		04.511.235.01  -  SCREW BONE 2.1MM 5MM MTRX TI LEFT STR NONSTRL	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.236.01	SUP	HCPCS C1713		04.511.236.01  -  SCREW TI 6MM 2.1MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.238.01	SUP	HCPCS C1713		04.511.238.01  -  SCREW TI 8MM 2.1MM MANDIB SLFDRILL ORTHGNAT BONE MTRX	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.240.01	SUP	HCPCS C1713		04.511.240.01  -  SCREW TI 10MM 2.1MM COARSE PTCH SLFTAP ORTHGNAT BONE MTRX	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.242.01	SUP	HCPCS C1713		04.511.242.01  -  SCREW TI 12MM 2.1MM SLFTAP COARSE PTCH BONE MTRX NONSTRL PNK	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.244.01	SUP	HCPCS C1713		04.511.244.01  -  SCREW TI 14MM 2.1MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.246.01	SUP	HCPCS C1713		04.511.246.01  -  SCREW BONE PNK 16MM 2.1MM MTRX CRNMXF TI SLFTAP COARSE PTCH	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.248.01	SUP	HCPCS C1713		04.511.248.01  -  SCREW TI 18MM 2.1MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.301	SUP	HCPCS C1713		04.511.301  -  PLATE BN 90D L 2MMX.5MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS	BOTH IP/OP	$657.00 	$486.18	$0.00	$525.60	$295.65	$295.65	$0.00	$0.00	$0.00	$136.94	$487.63	$487.63	$0.00	$0.00	$136.92	$0.00	$388.62	$388.62	$0.00	$328.50	$520.34	$525.60	$0.00		$0.00	$102.82	$0.00	$0.00	$104.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.302	SUP	HCPCS C1713		04.511.302  -  PLATE BN 90D L 6MMX.5MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS	BOTH IP/OP	$657.00 	$486.18	$0.00	$525.60	$295.65	$295.65	$0.00	$0.00	$0.00	$136.94	$487.63	$487.63	$0.00	$0.00	$136.92	$0.00	$388.62	$388.62	$0.00	$328.50	$520.34	$525.60	$0.00		$0.00	$102.82	$0.00	$0.00	$104.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.303	SUP	HCPCS C1713		04.511.303  -  PLATE BN 90D L 11MMX.5MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS	BOTH IP/OP	$657.00 	$486.18	$0.00	$525.60	$295.65	$295.65	$0.00	$0.00	$0.00	$136.94	$487.63	$487.63	$0.00	$0.00	$136.92	$0.00	$388.62	$388.62	$0.00	$328.50	$520.34	$525.60	$0.00		$0.00	$102.82	$0.00	$0.00	$104.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.304	SUP	HCPCS C1713		04.511.304  -  PLATE BN 90D L 2MMX.7MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS	BOTH IP/OP	$657.00 	$486.18	$0.00	$525.60	$295.65	$295.65	$0.00	$0.00	$0.00	$136.94	$487.63	$487.63	$0.00	$0.00	$136.92	$0.00	$388.62	$388.62	$0.00	$328.50	$520.34	$525.60	$0.00		$0.00	$102.82	$0.00	$0.00	$104.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.305	SUP	HCPCS C1713		04.511.305  -  PLATE BN 90D L 6MMX.7MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS	BOTH IP/OP	$657.00 	$486.18	$0.00	$525.60	$295.65	$295.65	$0.00	$0.00	$0.00	$136.94	$487.63	$487.63	$0.00	$0.00	$136.92	$0.00	$388.62	$388.62	$0.00	$328.50	$520.34	$525.60	$0.00		$0.00	$102.82	$0.00	$0.00	$104.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.306	SUP	HCPCS C1713		04.511.306  -  PLATE BN 90D L 11MMX.7MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS	BOTH IP/OP	$657.00 	$486.18	$0.00	$525.60	$295.65	$295.65	$0.00	$0.00	$0.00	$136.94	$487.63	$487.63	$0.00	$0.00	$136.92	$0.00	$388.62	$388.62	$0.00	$328.50	$520.34	$525.60	$0.00		$0.00	$102.82	$0.00	$0.00	$104.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.307	SUP	HCPCS C1713		04.511.307  -  PLATE 90D .8MM 2X2 HOLE L RVRS SHRT BAR BONE	BOTH IP/OP	$657.00 	$486.18	$0.00	$525.60	$295.65	$295.65	$0.00	$0.00	$0.00	$136.94	$487.63	$487.63	$0.00	$0.00	$136.92	$0.00	$388.62	$388.62	$0.00	$328.50	$520.34	$525.60	$0.00		$0.00	$102.82	$0.00	$0.00	$104.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.308	SUP	HCPCS C1713		04.511.308  -  PLATE 90D MED .8MM MAXL 2X2 HOLE L RVRS ORTHGNAT BONE MTRX	BOTH IP/OP	$657.00 	$486.18	$0.00	$525.60	$295.65	$295.65	$0.00	$0.00	$0.00	$136.94	$487.63	$487.63	$0.00	$0.00	$136.92	$0.00	$388.62	$388.62	$0.00	$328.50	$520.34	$525.60	$0.00		$0.00	$102.82	$0.00	$0.00	$104.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.309	SUP	HCPCS C1713		04.511.309  -  PLATE BN 90D L 11MMX.8MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS	BOTH IP/OP	$657.00 	$486.18	$0.00	$525.60	$295.65	$295.65	$0.00	$0.00	$0.00	$136.94	$487.63	$487.63	$0.00	$0.00	$136.92	$0.00	$388.62	$388.62	$0.00	$328.50	$520.34	$525.60	$0.00		$0.00	$102.82	$0.00	$0.00	$104.59	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.321	SUP	HCPCS C1713		04.511.321  -  PLATE BN L OBLQ 4MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$308.81	$308.81	$0.00	$0.00	$0.00	$143.03	$509.33	$509.33	$0.00	$0.00	$143.01	$0.00	$405.92	$405.92	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$107.40	$0.00	$0.00	$109.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.322	SUP	HCPCS C1713		04.511.322  -  PLATE BN L OBLQ 8MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$308.81	$308.81	$0.00	$0.00	$0.00	$143.03	$509.33	$509.33	$0.00	$0.00	$143.01	$0.00	$405.92	$405.92	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$107.40	$0.00	$0.00	$109.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.323	SUP	HCPCS C1713		04.511.323  -  PLATE BN L OBLQ 13MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$308.81	$308.81	$0.00	$0.00	$0.00	$143.03	$509.33	$509.33	$0.00	$0.00	$143.01	$0.00	$405.92	$405.92	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$107.40	$0.00	$0.00	$109.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.324	SUP	HCPCS C1713		04.511.324  -  PLATE BN L OBLQ 4MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$308.81	$308.81	$0.00	$0.00	$0.00	$143.03	$509.33	$509.33	$0.00	$0.00	$143.01	$0.00	$405.92	$405.92	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$107.40	$0.00	$0.00	$109.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.325	SUP	HCPCS C1713		04.511.325  -  PLATE BN L OBLQ 8MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$308.81	$308.81	$0.00	$0.00	$0.00	$143.03	$509.33	$509.33	$0.00	$0.00	$143.01	$0.00	$405.92	$405.92	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$107.40	$0.00	$0.00	$109.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.326	SUP	HCPCS C1713		04.511.326  -  PLATE BN L OBLQ 13MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$308.81	$308.81	$0.00	$0.00	$0.00	$143.03	$509.33	$509.33	$0.00	$0.00	$143.01	$0.00	$405.92	$405.92	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$107.40	$0.00	$0.00	$109.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.327	SUP	HCPCS C1713		04.511.327  -  PLATE BN L OBLQ 4MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$308.81	$308.81	$0.00	$0.00	$0.00	$143.03	$509.33	$509.33	$0.00	$0.00	$143.01	$0.00	$405.92	$405.92	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$107.40	$0.00	$0.00	$109.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.328	SUP	HCPCS C1713		04.511.328  -  PLATE BN L OBLQ 8MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$308.81	$308.81	$0.00	$0.00	$0.00	$143.03	$509.33	$509.33	$0.00	$0.00	$143.01	$0.00	$405.92	$405.92	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$107.40	$0.00	$0.00	$109.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.329	SUP	HCPCS C1713		04.511.329  -  PLATE BN L OBLQ 13MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$308.81	$308.81	$0.00	$0.00	$0.00	$143.03	$509.33	$509.33	$0.00	$0.00	$143.01	$0.00	$405.92	$405.92	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$107.40	$0.00	$0.00	$109.25	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.341	SUP	HCPCS C1713		04.511.341  -  PLATE BN L 4MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS	BOTH IP/OP	$717.75 	$531.14	$0.00	$574.20	$322.99	$322.99	$0.00	$0.00	$0.00	$149.60	$532.71	$532.71	$0.00	$0.00	$149.58	$0.00	$424.55	$424.55	$0.00	$358.88	$568.46	$574.20	$0.00		$0.00	$112.33	$0.00	$0.00	$114.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.342	SUP	HCPCS C1713		04.511.342  -  PLATE BN L 8MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS	BOTH IP/OP	$717.75 	$531.14	$0.00	$574.20	$322.99	$322.99	$0.00	$0.00	$0.00	$149.60	$532.71	$532.71	$0.00	$0.00	$149.58	$0.00	$424.55	$424.55	$0.00	$358.88	$568.46	$574.20	$0.00		$0.00	$112.33	$0.00	$0.00	$114.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.343	SUP	HCPCS C1713		04.511.343  -  PLATE BN L 12MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS	BOTH IP/OP	$717.75 	$531.14	$0.00	$574.20	$322.99	$322.99	$0.00	$0.00	$0.00	$149.60	$532.71	$532.71	$0.00	$0.00	$149.58	$0.00	$424.55	$424.55	$0.00	$358.88	$568.46	$574.20	$0.00		$0.00	$112.33	$0.00	$0.00	$114.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.344	SUP	HCPCS C1713		04.511.344  -  PLATE BN L 4MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS	BOTH IP/OP	$717.75 	$531.14	$0.00	$574.20	$322.99	$322.99	$0.00	$0.00	$0.00	$149.60	$532.71	$532.71	$0.00	$0.00	$149.58	$0.00	$424.55	$424.55	$0.00	$358.88	$568.46	$574.20	$0.00		$0.00	$112.33	$0.00	$0.00	$114.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.345	SUP	HCPCS C1713		04.511.345  -  PLATE BN L 8MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS	BOTH IP/OP	$717.75 	$531.14	$0.00	$574.20	$322.99	$322.99	$0.00	$0.00	$0.00	$149.60	$532.71	$532.71	$0.00	$0.00	$149.58	$0.00	$424.55	$424.55	$0.00	$358.88	$568.46	$574.20	$0.00		$0.00	$112.33	$0.00	$0.00	$114.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.346	SUP	HCPCS C1713		04.511.346  -  PLATE BN L 12MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS	BOTH IP/OP	$717.75 	$531.14	$0.00	$574.20	$322.99	$322.99	$0.00	$0.00	$0.00	$149.60	$532.71	$532.71	$0.00	$0.00	$149.58	$0.00	$424.55	$424.55	$0.00	$358.88	$568.46	$574.20	$0.00		$0.00	$112.33	$0.00	$0.00	$114.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.347	SUP	HCPCS C1713		04.511.347  -  PLATE BN L 4MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS	BOTH IP/OP	$717.75 	$531.14	$0.00	$574.20	$322.99	$322.99	$0.00	$0.00	$0.00	$149.60	$532.71	$532.71	$0.00	$0.00	$149.58	$0.00	$424.55	$424.55	$0.00	$358.88	$568.46	$574.20	$0.00		$0.00	$112.33	$0.00	$0.00	$114.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.348	SUP	HCPCS C1713		04.511.348  -  PLATE BN L 8MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS	BOTH IP/OP	$717.75 	$531.14	$0.00	$574.20	$322.99	$322.99	$0.00	$0.00	$0.00	$149.60	$532.71	$532.71	$0.00	$0.00	$149.58	$0.00	$424.55	$424.55	$0.00	$358.88	$568.46	$574.20	$0.00		$0.00	$112.33	$0.00	$0.00	$114.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.349	SUP	HCPCS C1713		04.511.349  -  PLATE BN L 12MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS	BOTH IP/OP	$717.75 	$531.14	$0.00	$574.20	$322.99	$322.99	$0.00	$0.00	$0.00	$149.60	$532.71	$532.71	$0.00	$0.00	$149.58	$0.00	$424.55	$424.55	$0.00	$358.88	$568.46	$574.20	$0.00		$0.00	$112.33	$0.00	$0.00	$114.27	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.381	SUP	HCPCS C1713		04.511.381  -  PLATE BN 2MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC	BOTH IP/OP	"$1,100.25 "	$814.19	$0.00	$880.20	$495.11	$495.11	$0.00	$0.00	$0.00	$229.32	$816.61	$816.61	$0.00	$0.00	$229.29	$0.00	$650.80	$650.80	$0.00	$550.13	$871.40	$880.20	$0.00		$0.00	$172.19	$0.00	$0.00	$175.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.382	SUP	HCPCS C1713		04.511.382  -  PLATE BN 2MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC	BOTH IP/OP	"$1,100.25 "	$814.19	$0.00	$880.20	$495.11	$495.11	$0.00	$0.00	$0.00	$229.32	$816.61	$816.61	$0.00	$0.00	$229.29	$0.00	$650.80	$650.80	$0.00	$550.13	$871.40	$880.20	$0.00		$0.00	$172.19	$0.00	$0.00	$175.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.383	SUP	HCPCS C1713		04.511.383  -  PLATE BN 4MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC	BOTH IP/OP	"$1,100.25 "	$814.19	$0.00	$880.20	$495.11	$495.11	$0.00	$0.00	$0.00	$229.32	$816.61	$816.61	$0.00	$0.00	$229.29	$0.00	$650.80	$650.80	$0.00	$550.13	$871.40	$880.20	$0.00		$0.00	$172.19	$0.00	$0.00	$175.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.384	SUP	HCPCS C1713		04.511.384  -  PLATE BN 4MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC	BOTH IP/OP	"$1,100.25 "	$814.19	$0.00	$880.20	$495.11	$495.11	$0.00	$0.00	$0.00	$229.32	$816.61	$816.61	$0.00	$0.00	$229.29	$0.00	$650.80	$650.80	$0.00	$550.13	$871.40	$880.20	$0.00		$0.00	$172.19	$0.00	$0.00	$175.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.385	SUP	HCPCS C1713		04.511.385  -  PLATE BN 6MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC	BOTH IP/OP	"$1,100.25 "	$814.19	$0.00	$880.20	$495.11	$495.11	$0.00	$0.00	$0.00	$229.32	$816.61	$816.61	$0.00	$0.00	$229.29	$0.00	$650.80	$650.80	$0.00	$550.13	$871.40	$880.20	$0.00		$0.00	$172.19	$0.00	$0.00	$175.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.386	SUP	HCPCS C1713		04.511.386  -  PLATE BN 6MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC	BOTH IP/OP	"$1,100.25 "	$814.19	$0.00	$880.20	$495.11	$495.11	$0.00	$0.00	$0.00	$229.32	$816.61	$816.61	$0.00	$0.00	$229.29	$0.00	$650.80	$650.80	$0.00	$550.13	$871.40	$880.20	$0.00		$0.00	$172.19	$0.00	$0.00	$175.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.387	SUP	HCPCS C1713		04.511.387  -  PLATE BN 8MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC	BOTH IP/OP	"$1,100.25 "	$814.19	$0.00	$880.20	$495.11	$495.11	$0.00	$0.00	$0.00	$229.32	$816.61	$816.61	$0.00	$0.00	$229.29	$0.00	$650.80	$650.80	$0.00	$550.13	$871.40	$880.20	$0.00		$0.00	$172.19	$0.00	$0.00	$175.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.388	SUP	HCPCS C1713		04.511.388  -  PLATE BN 8MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC	BOTH IP/OP	"$1,100.25 "	$814.19	$0.00	$880.20	$495.11	$495.11	$0.00	$0.00	$0.00	$229.32	$816.61	$816.61	$0.00	$0.00	$229.29	$0.00	$650.80	$650.80	$0.00	$550.13	$871.40	$880.20	$0.00		$0.00	$172.19	$0.00	$0.00	$175.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.389	SUP	HCPCS C1713		04.511.389  -  PLATE BN 10MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC	BOTH IP/OP	"$1,100.25 "	$814.19	$0.00	$880.20	$495.11	$495.11	$0.00	$0.00	$0.00	$229.32	$816.61	$816.61	$0.00	$0.00	$229.29	$0.00	$650.80	$650.80	$0.00	$550.13	$871.40	$880.20	$0.00		$0.00	$172.19	$0.00	$0.00	$175.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.390	SUP	HCPCS C1713		04.511.390  -  PLATE BN 10MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC	BOTH IP/OP	"$1,100.25 "	$814.19	$0.00	$880.20	$495.11	$495.11	$0.00	$0.00	$0.00	$229.32	$816.61	$816.61	$0.00	$0.00	$229.29	$0.00	$650.80	$650.80	$0.00	$550.13	$871.40	$880.20	$0.00		$0.00	$172.19	$0.00	$0.00	$175.16	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.401	SUP	HCPCS C1713		04.511.401  -  PLATE BN CRV 6MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL	BOTH IP/OP	$956.25 	$707.63	$0.00	$765.00	$430.31	$430.31	$0.00	$0.00	$0.00	$199.31	$709.73	$709.73	$0.00	$0.00	$199.28	$0.00	$565.62	$565.62	$0.00	$478.13	$757.35	$765.00	$0.00		$0.00	$149.65	$0.00	$0.00	$152.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.402	SUP	HCPCS C1713		04.511.402  -  PLATE BN CRV 8MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL	BOTH IP/OP	$956.25 	$707.63	$0.00	$765.00	$430.31	$430.31	$0.00	$0.00	$0.00	$199.31	$709.73	$709.73	$0.00	$0.00	$199.28	$0.00	$565.62	$565.62	$0.00	$478.13	$757.35	$765.00	$0.00		$0.00	$149.65	$0.00	$0.00	$152.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.403	SUP	HCPCS C1713		04.511.403  -  PLATE BN CRV 10MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL	BOTH IP/OP	$956.25 	$707.63	$0.00	$765.00	$430.31	$430.31	$0.00	$0.00	$0.00	$199.31	$709.73	$709.73	$0.00	$0.00	$199.28	$0.00	$565.62	$565.62	$0.00	$478.13	$757.35	$765.00	$0.00		$0.00	$149.65	$0.00	$0.00	$152.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.404	SUP	HCPCS C1713		04.511.404  -  PLATE BN CRV 12MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL	BOTH IP/OP	$956.25 	$707.63	$0.00	$765.00	$430.31	$430.31	$0.00	$0.00	$0.00	$199.31	$709.73	$709.73	$0.00	$0.00	$199.28	$0.00	$565.62	$565.62	$0.00	$478.13	$757.35	$765.00	$0.00		$0.00	$149.65	$0.00	$0.00	$152.24	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.421	SUP	HCPCS C1713		04.511.421  -  PLATE BN STRG 6MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL SGTL	BOTH IP/OP	$940.50 	$695.97	$0.00	$752.40	$423.23	$423.23	$0.00	$0.00	$0.00	$196.02	$698.04	$698.04	$0.00	$0.00	$196.00	$0.00	$556.31	$556.31	$0.00	$470.25	$744.88	$752.40	$0.00		$0.00	$147.19	$0.00	$0.00	$149.73	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.422	SUP	HCPCS C1713		04.511.422  -  PLATE BN STRG 8MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL SGTL	BOTH IP/OP	$940.50 	$695.97	$0.00	$752.40	$423.23	$423.23	$0.00	$0.00	$0.00	$196.02	$698.04	$698.04	$0.00	$0.00	$196.00	$0.00	$556.31	$556.31	$0.00	$470.25	$744.88	$752.40	$0.00		$0.00	$147.19	$0.00	$0.00	$149.73	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.423	SUP	HCPCS C1713		04.511.423  -  PLATE BN STRG 10MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL	BOTH IP/OP	$940.50 	$695.97	$0.00	$752.40	$423.23	$423.23	$0.00	$0.00	$0.00	$196.02	$698.04	$698.04	$0.00	$0.00	$196.00	$0.00	$556.31	$556.31	$0.00	$470.25	$744.88	$752.40	$0.00		$0.00	$147.19	$0.00	$0.00	$149.73	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.424	SUP	HCPCS C1713		04.511.424  -  PLATE BN STRG 12MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL	BOTH IP/OP	$940.50 	$695.97	$0.00	$752.40	$423.23	$423.23	$0.00	$0.00	$0.00	$196.02	$698.04	$698.04	$0.00	$0.00	$196.00	$0.00	$556.31	$556.31	$0.00	$470.25	$744.88	$752.40	$0.00		$0.00	$147.19	$0.00	$0.00	$149.73	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.444	SUP	HCPCS C1713		04.511.444  -  PLATE BN 33MMX.7MM NS MATRIXORTHOGNATHIC 4 HL SGTL SPLT ADJ	BOTH IP/OP	"$1,282.50 "	$949.05	$0.00	"$1,026.00"	$577.13	$577.13	$0.00	$0.00	$0.00	$267.31	$951.87	$951.87	$0.00	$0.00	$267.27	$0.00	$758.60	$758.60	$0.00	$641.25	"$1,015.74"	"$1,026.00"	$0.00		$0.00	$200.71	$0.00	$0.00	$204.17	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.445	SUP	Custom 27203010		04.511.445  -  INSRTR SURG LINR CNSTRN TI MTRX 40MMX.7MM NONSTRL	BOTH IP/OP	"$1,282.50 "	$949.05	$0.00	"$1,026.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$951.87	$951.87	$0.00	$0.00	$267.27	$0.00	$0.00	$0.00	$0.00	$641.25	"$1,015.74"	"$1,026.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.461	SUP	HCPCS C1713		04.511.461  -  PLATE BN 4MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL	BOTH IP/OP	$897.75 	$664.34	$0.00	$718.20	$403.99	$403.99	$0.00	$0.00	$0.00	$187.11	$666.31	$666.31	$0.00	$0.00	$187.09	$0.00	$531.02	$531.02	$0.00	$448.88	$711.02	$718.20	$0.00		$0.00	$140.50	$0.00	$0.00	$142.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.462	SUP	HCPCS C1713		04.511.462  -  PLATE BN 6MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL	BOTH IP/OP	$897.75 	$664.34	$0.00	$718.20	$403.99	$403.99	$0.00	$0.00	$0.00	$187.11	$666.31	$666.31	$0.00	$0.00	$187.09	$0.00	$531.02	$531.02	$0.00	$448.88	$711.02	$718.20	$0.00		$0.00	$140.50	$0.00	$0.00	$142.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.463	SUP	HCPCS C1713		04.511.463  -  PLATE BN 8MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL	BOTH IP/OP	$897.75 	$664.34	$0.00	$718.20	$403.99	$403.99	$0.00	$0.00	$0.00	$187.11	$666.31	$666.31	$0.00	$0.00	$187.09	$0.00	$531.02	$531.02	$0.00	$448.88	$711.02	$718.20	$0.00		$0.00	$140.50	$0.00	$0.00	$142.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.511.464	SUP	HCPCS C1713		04.511.464  -  PLATE BN 10MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL	BOTH IP/OP	$897.75 	$664.34	$0.00	$718.20	$403.99	$403.99	$0.00	$0.00	$0.00	$187.11	$666.31	$666.31	$0.00	$0.00	$187.09	$0.00	$531.02	$531.02	$0.00	$448.88	$711.02	$718.20	$0.00		$0.00	$140.50	$0.00	$0.00	$142.92	$0.00	$0.00	$0.00	$0.00	$0.00
04.600.022.02S	SUP	HCPCS C1713		04.600.022.02S  -  PIN 12MM DSTRCT TI STRL	BOTH IP/OP	$896.00 	$663.04	$0.00	$716.80	$403.20	$403.20	$0.00	$0.00	$0.00	$186.75	$665.01	$665.01	$0.00	$0.00	$186.73	$0.00	$529.98	$529.98	$0.00	$448.00	$709.63	$716.80	$0.00		$0.00	$140.22	$0.00	$0.00	$142.64	$0.00	$0.00	$0.00	$0.00	$0.00
04.600.023.02S	SUP	HCPCS C1713		04.600.023.02S  -  PIN 14MM DSTRCT TI STRL	BOTH IP/OP	$448.00 	$331.52	$0.00	$358.40	$201.60	$201.60	$0.00	$0.00	$0.00	$93.37	$332.51	$332.51	$0.00	$0.00	$93.36	$0.00	$264.99	$264.99	$0.00	$224.00	$354.82	$358.40	$0.00		$0.00	$70.11	$0.00	$0.00	$71.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.600.029.02S	SUP	HCPCS C1713		04.600.029.02S  -  PIN 16MM DSTRCT TI STRL	BOTH IP/OP	$448.00 	$331.52	$0.00	$358.40	$201.60	$201.60	$0.00	$0.00	$0.00	$93.37	$332.51	$332.51	$0.00	$0.00	$93.36	$0.00	$264.99	$264.99	$0.00	$224.00	$354.82	$358.40	$0.00		$0.00	$70.11	$0.00	$0.00	$71.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.601.108	SUP	HCPCS C1713		04.601.108  -  SCREW BN T15 4.5MM 3.2MM 8MM NS SLF RTN STRDR BLNT TIP TI	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
04.601.110	SUP	HCPCS C1713		04.601.110  -  SCREW BONE 4.5MM 10MM TI OCCPTL NONSTRL	BOTH IP/OP	$392.00 	$290.08	$0.00	$313.60	$176.40	$176.40	$0.00	$0.00	$0.00	$81.70	$290.94	$290.94	$0.00	$0.00	$81.69	$0.00	$231.87	$231.87	$0.00	$196.00	$310.46	$313.60	$0.00		$0.00	$61.35	$0.00	$0.00	$62.41	$0.00	$0.00	$0.00	$0.00	$0.00
04.601.112	SUP	HCPCS C1713		04.601.112  -  SCREW BONE 4.5MM 12MM TITANIUM OCCIPITOCERVICAL SPN NONSTRL	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
04.601.208	SUP	HCPCS C1713		04.601.208  -  SCREW BN T15 5MM 3.2MM 8MM NS SLFRET STRDR BLNT TIP 7%	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
04.601.210	SUP	HCPCS C1713		04.601.210  -  SCREW BN T15 5MM 3.2MM 10MM NS SLFRET STRDR BLNT TIP 7%	BOTH IP/OP	$399.00 	$295.26	$0.00	$319.20	$179.55	$179.55	$0.00	$0.00	$0.00	$83.16	$296.14	$296.14	$0.00	$0.00	$83.15	$0.00	$236.01	$236.01	$0.00	$199.50	$316.01	$319.20	$0.00		$0.00	$62.44	$0.00	$0.00	$63.52	$0.00	$0.00	$0.00	$0.00	$0.00
04.613.014	SUP	HCPCS C1713		04.613.014  -  PLATE 23MM TI 1 LVL VCTR BONE 14MM ANT CERV SPN NONSTRL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
04.613.016	SUP	HCPCS C1713		04.613.016  -  PLATE 25MM TI 1 LVL VCTR BONE 16MM ANT CERV SPN NONSTRL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
04.613.130	SUP	HCPCS C1713		04.613.130  -  PLATE BN BNT GRV PREBNT 39X16.5X2.5MM NS 30MM VCTR 2 LVL 1	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
04.613.132	SUP	HCPCS C1713		04.613.132  -  PLATE BN BNT GRV PREBNT 41X16.5X2.5MM NS 32MM VCTR 2 LVL 1	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
04.613.516	SUP	HCPCS C1713		04.613.516  -  SCREW BONE 4MM 16MM VCT-T TI ANT CERV SPN SLFRET SLFDRILL	BOTH IP/OP	$498.10 	$368.59	$0.00	$398.48	$224.15	$224.15	$0.00	$0.00	$0.00	$103.82	$369.69	$369.69	$0.00	$0.00	$103.80	$0.00	$294.63	$294.63	$0.00	$249.05	$394.50	$398.48	$0.00		$0.00	$77.95	$0.00	$0.00	$79.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.613.616	SUP	HCPCS C1713		04.613.616  -  SCREW BONE 4MM 16MM VCT-T TI ANT CERV SPN SLFTAP SLFRET VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
04.613.618	SUP	HCPCS C1713		04.613.618  -  SCREW BONE 4MM 18MM VCT-T TI ANT CERV SPN SLFTAP SLFRET VAR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
04.613.666	SUP	HCPCS C1713		04.613.666  -  SCREW BONE 4.5MM 16MM VCT-T TI ANT CERV SPN SLFTAP SLFRET	BOTH IP/OP	$477.70 	$353.50	$0.00	$382.16	$214.97	$214.97	$0.00	$0.00	$0.00	$99.56	$354.55	$354.55	$0.00	$0.00	$99.55	$0.00	$282.56	$282.56	$0.00	$238.85	$378.34	$382.16	$0.00		$0.00	$74.76	$0.00	$0.00	$76.05	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.010	SUP	HCPCS C1713		04.614.010  -  SCREW BONE 3.5MM 10MM SYNAPSE TI CANC SPNL POLYAX NONSTRL	BOTH IP/OP	"$2,576.00 "	"$1,906.24"	$0.00	"$2,060.80"	"$1,159.20"	"$1,159.20"	$0.00	$0.00	$0.00	$536.90	"$1,911.91"	"$1,911.91"	$0.00	$0.00	$536.84	$0.00	"$1,269.97"	"$1,269.97"	$0.00	"$1,288.00"	"$2,040.19"	"$2,060.80"	$0.00		$0.00	$403.14	$0.00	$0.00	$410.10	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.012	SUP	HCPCS C1713		04.614.012  -  SCREW BONE 3.5MM 12MM SYNAPSE TI CANC SPNL POLYAX NONSTRL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.014	SUP	HCPCS C1713		04.614.014  -  SCREW BONE 3.5MM 14MM SYNAPSE TI CANC SPNL POLYAX NONSTRL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.016	SUP	HCPCS C1713		04.614.016  -  SCREW BONE 3.5MM 16MM SYNAPSE TI CANC SPNL POLYAX NONSTRL	BOTH IP/OP	"$2,576.00 "	"$1,906.24"	$0.00	"$2,060.80"	"$1,159.20"	"$1,159.20"	$0.00	$0.00	$0.00	$536.90	"$1,911.91"	"$1,911.91"	$0.00	$0.00	$536.84	$0.00	"$1,269.97"	"$1,269.97"	$0.00	"$1,288.00"	"$2,040.19"	"$2,060.80"	$0.00		$0.00	$403.14	$0.00	$0.00	$410.10	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.020	SUP	HCPCS C1713		04.614.020  -  SCREW BONE 3.5MM 20MM SYNAPSE TI CANC SPNL POLYAX NONSTRL	BOTH IP/OP	"$2,576.00 "	"$1,906.24"	$0.00	"$2,060.80"	"$1,159.20"	"$1,159.20"	$0.00	$0.00	$0.00	$536.90	"$1,911.91"	"$1,911.91"	$0.00	$0.00	$536.84	$0.00	"$1,269.97"	"$1,269.97"	$0.00	"$1,288.00"	"$2,040.19"	"$2,060.80"	$0.00		$0.00	$403.14	$0.00	$0.00	$410.10	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.110	SUP	HCPCS C1713		04.614.110  -  SCREW BONE 4MM 10MM SYNAPSE TI CANC SPNL POLYAX	BOTH IP/OP	"$2,576.00 "	"$1,906.24"	$0.00	"$2,060.80"	"$1,159.20"	"$1,159.20"	$0.00	$0.00	$0.00	$536.90	"$1,911.91"	"$1,911.91"	$0.00	$0.00	$536.84	$0.00	"$1,269.97"	"$1,269.97"	$0.00	"$1,288.00"	"$2,040.19"	"$2,060.80"	$0.00		$0.00	$403.14	$0.00	$0.00	$410.10	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.112	SUP	HCPCS C1713		04.614.112  -  SCREW BONE 0-50D 4MM 2.4MM 12MM T15 STARDRIVE POLYAX SLFTAP	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.114	SUP	HCPCS C1713		04.614.114  -  SCREW BONE 4MM 2.4MM 14MM SYNAPSE TI 50- D T15 SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.118	SUP	HCPCS C1713		04.614.118  -  SCREW BN 50- D T15 4MM 2.4MM 18MM GRN GRY NS SYNAPSE PA ST	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.124	SUP	HCPCS C1713		04.614.124  -  SCREW BONE 4MM 24MM SYNAPSE TI CANC SPNL POLYAX	BOTH IP/OP	"$2,576.00 "	"$1,906.24"	$0.00	"$2,060.80"	"$1,159.20"	"$1,159.20"	$0.00	$0.00	$0.00	$536.90	"$1,911.91"	"$1,911.91"	$0.00	$0.00	$536.84	$0.00	"$1,269.97"	"$1,269.97"	$0.00	"$1,288.00"	"$2,040.19"	"$2,060.80"	$0.00		$0.00	$403.14	$0.00	$0.00	$410.10	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.126	SUP	HCPCS C1713		04.614.126  -  SCREW BONE 4MM 26MM SYNAPSE TI CANC SPNL POLYAX NONSTRL	BOTH IP/OP	"$2,576.00 "	"$1,906.24"	$0.00	"$2,060.80"	"$1,159.20"	"$1,159.20"	$0.00	$0.00	$0.00	$536.90	"$1,911.91"	"$1,911.91"	$0.00	$0.00	$536.84	$0.00	"$1,269.97"	"$1,269.97"	$0.00	"$1,288.00"	"$2,040.19"	"$2,060.80"	$0.00		$0.00	$403.14	$0.00	$0.00	$410.10	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.226	SUP	HCPCS C1713		04.614.226  -  SCREW BONE 40D LARGE DIAMETER T15 SQUARE 4.5MM 3.2MM 26MM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.508	SUP	HCPCS C1713		04.614.508  -  SCREW BONE 5MM 8MM TI SPNL LCK NONSTRL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.510	SUP	HCPCS C1713		04.614.510  -  ROD SPNL 120-175MM 3.5-6MM TI HRD NONSTRL	BOTH IP/OP	"$1,748.25 "	"$1,293.71"	$0.00	"$1,398.60"	$786.71	$786.71	$0.00	$0.00	$0.00	$364.38	"$1,297.55"	"$1,297.55"	$0.00	$0.00	$364.34	$0.00	"$1,034.09"	"$1,034.09"	$0.00	$874.13	"$1,384.61"	"$1,398.60"	$0.00		$0.00	$273.60	$0.00	$0.00	$278.32	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.513	SUP	Custom 27803010		04.614.513  -  TRNCON ROD 60MM SPNL TI NONSTRL	BOTH IP/OP	"$2,709.00 "	"$2,004.66"	$0.00	"$2,167.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,010.62"	"$2,010.62"	$0.00	$0.00	$564.56	$0.00	$0.00	$0.00	$0.00	"$1,354.50"	"$2,145.53"	"$2,167.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.516	SUP	Custom 27803010		04.614.516  -  TRNCON ROD MED TI TOP LD NONSTRL	BOTH IP/OP	"$3,150.00 "	"$2,331.00"	$0.00	"$2,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,337.93"	"$2,337.93"	$0.00	$0.00	$656.46	$0.00	$0.00	$0.00	$0.00	"$1,575.00"	"$2,494.80"	"$2,520.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.521	SUP	HCPCS C1713		04.614.521  -  SCREW BONE 7.5MM SYNAPSE TI SPNL LCK TRNCON NONSTRL	BOTH IP/OP	$218.75 	$161.88	$0.00	$175.00	$98.44	$98.44	$0.00	$0.00	$0.00	$45.59	$162.36	$162.36	$0.00	$0.00	$45.59	$0.00	$129.39	$129.39	$0.00	$109.38	$173.25	$175.00	$0.00		$0.00	$34.23	$0.00	$0.00	$34.83	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.522	SUP	HCPCS C1713		04.614.522  -  SCREW BONE SYNAPSE TI SPNL LCK TRNCON NONSTRL	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
04.614.745	SUP	HCPCS C1713		04.614.745  -  ROD SPNL 45MM 3.5MM CURVE TI NONSTRL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
04.617.129S	SUP	Custom 27803010		04.617.129S  -  SPACER SPNL STD LRDTC 9MM STRL ZERO-PPEEK-OPTM TI	BOTH IP/OP	"$10,500.00 "	"$7,770.00"	$0.00	"$8,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,188.20"	$0.00	$0.00	$0.00	$0.00	"$5,250.00"	"$8,316.00"	"$8,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.617.814	SUP	HCPCS C1713		04.617.814  -  SCREW BONE 3MM 14MM TI CERV SPN LCK NONSTRL	BOTH IP/OP	$722.50 	$534.65	$0.00	$578.00	$325.13	$325.13	$0.00	$0.00	$0.00	$150.59	$536.24	$536.24	$0.00	$0.00	$150.57	$0.00	$427.36	$427.36	$0.00	$361.25	$572.22	$578.00	$0.00		$0.00	$113.07	$0.00	$0.00	$115.02	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.000	SUP	Custom 27803010		04.620.000  -  CAP LCK PANGEA SPNL TI NONSTRL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.170	SUP	HCPCS C1713		04.620.170  -  ROD SPNL 70MM 6MM PANGEA USS PDCL TI CVD SFT PRECONTOURED	BOTH IP/OP	$483.00 	$357.42	$0.00	$386.40	$217.35	$217.35	$0.00	$0.00	$0.00	$100.67	$358.48	$358.48	$0.00	$0.00	$100.66	$0.00	$285.69	$285.69	$0.00	$241.50	$382.54	$386.40	$0.00		$0.00	$75.59	$0.00	$0.00	$76.89	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.203	SUP	Custom 27803010		04.620.203  -  TRNCON ROD 33-36.5MM PANGEA PDCL TI LP 6MM ROD NONSTRL	BOTH IP/OP	"$2,432.50 "	"$1,800.05"	$0.00	"$1,946.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,805.40"	"$1,805.40"	$0.00	$0.00	$506.93	$0.00	$0.00	$0.00	$0.00	"$1,216.25"	"$1,926.54"	"$1,946.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.204	SUP	Custom 27803010		04.620.204  -  TRNCON ROD 38.5-48MM 6MM PANGEA USS SPNL PDCL TI LP NONSTRL	BOTH IP/OP	"$2,432.50 "	"$1,800.05"	$0.00	"$1,946.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,805.40"	"$1,805.40"	$0.00	$0.00	$506.93	$0.00	$0.00	$0.00	$0.00	"$1,216.25"	"$1,926.54"	"$1,946.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.205	SUP	Custom 27803010		04.620.205  -  TRNCON ROD 49-69MM 6MM PANGEA USS SPNL PDCL TI LP NONSTRL	BOTH IP/OP	"$2,432.50 "	"$1,800.05"	$0.00	"$1,946.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,805.40"	"$1,805.40"	$0.00	$0.00	$506.93	$0.00	$0.00	$0.00	$0.00	"$1,216.25"	"$1,926.54"	"$1,946.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.425	SUP	HCPCS C1713		04.620.425  -  SCREW BONE 4MM 25MM PANGEA TI PDCL POLYAX STARDRIVE RECESS 2	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.430	SUP	HCPCS C1713		04.620.430  -  SCREW BONE 4MM 30MM PANGEA TI PDCL POLYAX STARDRIVE RECESS 2	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.530	SUP	HCPCS C1713		04.620.530  -  SCREW BONE 5MM 30MM PANGEA TI PDCL POLYAX DUAL CORE THRD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.535	SUP	HCPCS C1713		04.620.535  -  SCREW BONE 5MM 35MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.540	SUP	HCPCS C1713		04.620.540  -  SCREW BONE 5MM 40MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.630	SUP	HCPCS C1713		04.620.630  -  SCREW BONE 6MM 30MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.635	SUP	HCPCS C1713		04.620.635  -  SCREW BONE 6MM 35MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.640	SUP	HCPCS C1713		04.620.640  -  SCREW BONE 6MM 40MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.645	SUP	HCPCS C1713		04.620.645  -  SCREW BONE 6MM 45MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.650	SUP	HCPCS C1713		04.620.650  -  SCREW BONE 6MM 50MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.740	SUP	HCPCS C1713		04.620.740  -  SCREW BONE 7MM 40MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.745	SUP	HCPCS C1713		04.620.745  -  SCREW BONE 7MM 45MM PANGEA TI PDCL POLYAX 2 CORE NONSTRL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.620.750	SUP	HCPCS C1713		04.620.750  -  SCREW BONE 7MM 50MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
04.808.003	SUP	HCPCS C1713		04.808.003  -  CAGE SPNL 29X21MM SYNEX 2 TI ALIF NONSTRL	BOTH IP/OP	"$10,017.00 "	"$7,412.58"	$0.00	"$8,013.60"	"$4,507.65"	"$4,507.65"	$0.00	$0.00	$0.00	"$2,087.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,087.54"	$0.00	"$4,938.38"	"$4,938.38"	$0.00	"$5,008.50"	"$7,933.46"	"$8,013.60"	$0.00		$0.00	"$1,567.66"	$0.00	$0.00	"$1,594.71"	$0.00	$0.00	$0.00	$0.00	$0.00
04.808.004	SUP	HCPCS C1713		04.808.004  -  CAGE SPNL 25-33MM SYNEX 2 TI LMBR INTRBD FS CENTRL BODY	BOTH IP/OP	"$11,408.25 "	"$8,442.11"	$0.00	"$9,126.60"	"$5,133.71"	"$5,133.71"	$0.00	$0.00	$0.00	"$2,377.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,377.48"	$0.00	"$5,624.27"	"$5,624.27"	$0.00	"$5,704.13"	"$9,035.33"	"$9,126.60"	$0.00		$0.00	"$1,785.39"	$0.00	$0.00	"$1,816.19"	$0.00	$0.00	$0.00	$0.00	$0.00
04.808.018	SUP	HCPCS C1713		04.808.018  -  EPLT SPNL GOLD 20X19MM SYNEX 2 SM 0	BOTH IP/OP	"$2,040.50 "	"$1,509.97"	$0.00	"$1,632.40"	$918.23	$918.23	$0.00	$0.00	$0.00	$425.29	"$1,514.46"	"$1,514.46"	$0.00	$0.00	$425.24	$0.00	"$1,206.96"	"$1,206.96"	$0.00	"$1,020.25"	"$1,616.08"	"$1,632.40"	$0.00		$0.00	$319.34	$0.00	$0.00	$324.85	$0.00	$0.00	$0.00	$0.00	$0.00
04.808.027	SUP	HCPCS C1713		04.808.027  -  EPLT SPNL 25MM 22MM 0D TI NONSTRL	BOTH IP/OP	"$2,040.50 "	"$1,509.97"	$0.00	"$1,632.40"	$918.23	$918.23	$0.00	$0.00	$0.00	$425.29	"$1,514.46"	"$1,514.46"	$0.00	$0.00	$425.24	$0.00	"$1,206.96"	"$1,206.96"	$0.00	"$1,020.25"	"$1,616.08"	"$1,632.40"	$0.00		$0.00	$319.34	$0.00	$0.00	$324.85	$0.00	$0.00	$0.00	$0.00	$0.00
04-503-228	SUP	HCPCS C1713		04-503-228  -  SCREW TI 8MM SLFDRILL BONE MTRXMDFACE PLT SYS	BOTH IP/OP	$164.25 	$121.55	$0.00	$131.40	$73.91	$73.91	$0.00	$0.00	$0.00	$34.23	$121.91	$121.91	$0.00	$0.00	$34.23	$0.00	$97.15	$97.15	$0.00	$82.13	$130.09	$131.40	$0.00		$0.00	$25.71	$0.00	$0.00	$26.15	$0.00	$0.00	$0.00	$0.00	$0.00
04-503-346	SUP	HCPCS C1713		04-503-346  -  PLATE .5MM 20 HOLE ADP BONE MATRIXMIDFACE TI NSTRL BLUE	BOTH IP/OP	"$1,206.00 "	$892.44	$0.00	$964.80	$542.70	$542.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.00	$955.15	$964.80	$0.00		$0.00	$188.74	$0.00	$0.00	$192.00	$0.00	$0.00	$0.00	$0.00	$0.00
04-503-396	SUP	HCPCS C1713		04-503-396  -  PLATE STD MINI .8MM 20 HOLE ADP BONE MATRIXMIDFACE TI NSTRL	BOTH IP/OP	"$1,206.00 "	$892.44	$0.00	$964.80	$542.70	$542.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.00	$955.15	$964.80	$0.00		$0.00	$188.74	$0.00	$0.00	$192.00	$0.00	$0.00	$0.00	$0.00	$0.00
046-237	SUP	Custom 27803010		046-237  -  WIRE SUTURE 6 CCS-1 14IN 2 MONOFILAMENT MYO/WIRE II	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	$0.00	$0.00	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
050-508-000	SUP	Custom 27203010		CONNECTOR PRFSN STRG EQL .5IN X.5IN STRL	BOTH IP/OP	$19.90 	$14.73	$0.00	$15.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.77	$14.77	$0.00	$0.00	$4.15	$0.00	$0.00	$0.00	$0.00	$9.95	$15.76	$15.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
050-526-000	SUP	Custom 27011340		050-526-000  -  CONNECTOR PERFUSION 3/8INX3/8INX3/8IN 3/8INX3/8INX3/8IN Y	BOTH IP/OP	$0.53 	$0.39	$0.00	$0.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.39	$0.39	$0.00	$0.00	$0.11	$0.00	$0.00	$0.00	$0.00	$0.26	$0.42	$0.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
050-604-000	SUP	Custom 27203010		CONNECTOR PRFSN STRG LUER LOCK LOCK .25IN X.25IN	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0523-48	SUP	Custom 27203010		ADHESIVE LQ VL AMPULE MSTSL STRL 2/3ML SKN	BOTH IP/OP	$3.25 	$2.41	$0.00	$2.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.41	$2.41	$0.00	$0.00	$0.68	$0.00	$0.00	$0.00	$0.00	$1.63	$2.57	$2.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
05-538-51	SUP	Custom 27203010		TUBE CNTRF 119MM 17MM 15ML POLYPRO GRAD SKRT BTM SCR CAP	BOTH IP/OP	$1.18 	$0.87	$0.00	$0.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.59	$0.93	$0.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-200	SUP	HCPCS C1776		0580-0-200  -  STEM FEM 200MM OFFST EXTR 3 LNG	BOTH IP/OP	"$6,271.00 "	"$4,640.54"	$0.00	"$5,016.80"	"$2,821.95"	"$2,821.95"	$0.00	$0.00	$0.00	"$1,307.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,306.88"	$0.00	"$3,091.60"	"$3,091.60"	$0.00	"$3,135.50"	"$4,966.63"	"$5,016.80"	$0.00		$0.00	$981.41	$0.00	$0.00	$998.34	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-220	SUP	HCPCS C1776		0580-0-220  -  STEM FEM 220MM OFFST EXTR 3 LNG	BOTH IP/OP	"$6,271.00 "	"$4,640.54"	$0.00	"$5,016.80"	"$2,821.95"	"$2,821.95"	$0.00	$0.00	$0.00	"$1,307.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,306.88"	$0.00	"$3,091.60"	"$3,091.60"	$0.00	"$3,135.50"	"$4,966.63"	"$5,016.80"	$0.00		$0.00	$981.41	$0.00	$0.00	$998.34	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-240	SUP	HCPCS C1776		0580-0-240  -  STEM FEM 240MM OFFST EXTR 3 LNG	BOTH IP/OP	"$6,271.00 "	"$4,640.54"	$0.00	"$5,016.80"	"$2,821.95"	"$2,821.95"	$0.00	$0.00	$0.00	"$1,307.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,306.88"	$0.00	"$3,091.60"	"$3,091.60"	$0.00	"$3,135.50"	"$4,966.63"	"$5,016.80"	$0.00		$0.00	$981.41	$0.00	$0.00	$998.34	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-260	SUP	HCPCS C1776		0580-0-260  -  STEM FEM 260MM OFFST EXTR 3 LNG	BOTH IP/OP	"$6,271.00 "	"$4,640.54"	$0.00	"$5,016.80"	"$2,821.95"	"$2,821.95"	$0.00	$0.00	$0.00	"$1,307.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,306.88"	$0.00	"$3,091.60"	"$3,091.60"	$0.00	"$3,135.50"	"$4,966.63"	"$5,016.80"	$0.00		$0.00	$981.41	$0.00	$0.00	$998.34	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-330	SUP	HCPCS C1776		0580-0-330  -  STEM FEM 120MM EXTR 2 ANT POST	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-351	SUP	HCPCS C1776		0580-0-351  -  STEM FEM OFFST EXTR 1 35.5MM	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-352	SUP	HCPCS C1776		0580-0-352  -  STEM FEM OFFST SYS EXTR ORTHNX 37.5MM LG TOT HIP	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-371	SUP	HCPCS C1776		0580-0-371  -  STEM FEM OFFST EXTR ORTHNX 1 37.5MM HIP	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-372	SUP	HCPCS C1776		0580-0-372  -  STEM FEM OFFST EXTR 2 37.5MM	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-373	SUP	HCPCS C1776		0580-0-373  -  STEM FEM OFFST EXTR 3 37.5MM	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-374	SUP	HCPCS C1776		0580-0-374  -  STEM FEM OFFST EXTR 4 37.5MM	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-441	SUP	HCPCS C1776		0580-0-441  -  STEM FEM 44MM OFFST EXTR 1	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-442	SUP	HCPCS C1776		0580-0-442  -  STEM FEM OFFST EXTR 2 44MM	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-443	SUP	HCPCS C1776		0580-0-443  -  STEM FEM OFFST EXTR 3 44MM	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-444	SUP	HCPCS C1776		0580-0-444  -  STEM FEM OFFST EXTR 4 44MM	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-445	SUP	HCPCS C1776		0580-0-445  -  STEM FEM OFFST EXTR 5 44MM	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-446	SUP	HCPCS C1776		0580-0-446  -  STEM FEM OFFST EXTR 6 44MM	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-503	SUP	HCPCS C1776		0580-0-503  -  STEM FEM OFFST EXTR 3 50MM	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-504	SUP	HCPCS C1776		0580-0-504  -  STEM FEM 50MM OFFST EXTR 4	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-505	SUP	HCPCS C1776		0580-0-505  -  STEM FEM OFFST EXTR 5 50MM	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-0-506	SUP	HCPCS C1776		0580-0-506  -  STEM FEM OFFST EXTR 6 50MM	BOTH IP/OP	"$4,264.00 "	"$3,155.36"	$0.00	"$3,411.20"	"$1,918.80"	"$1,918.80"	$0.00	$0.00	$0.00	$888.72	"$3,164.74"	"$3,164.74"	$0.00	$0.00	$888.62	$0.00	"$2,102.15"	"$2,102.15"	$0.00	"$2,132.00"	"$3,377.09"	"$3,411.20"	$0.00		$0.00	$667.32	$0.00	$0.00	$678.83	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-044	SUP	HCPCS C1776		0580-1-044  -  STEM FEMORAL 0 44MM OFFST LONG CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-200	SUP	HCPCS C1776		0580-1-200  -  STEM FEMORAL 3 44MM OFFST LONG 200MM CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-220	SUP	HCPCS C1776		0580-1-220  -  STEM FEMORAL 3 44MM OFFST LONG 220MM CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-240	SUP	HCPCS C1776		0580-1-240  -  STEM FEMORAL 3 44MM OFFST LONG 240MM CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-260	SUP	HCPCS C1776		0580-1-260  -  STEM FEMORAL 3 44MM OFFST LONG 260MM CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-300	SUP	HCPCS C1776		0580-1-300  -  STEM FEMORAL 30MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-330	SUP	HCPCS C1776		0580-1-330  -  STEM FEMORAL 33MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-351	SUP	HCPCS C1776		0580-1-351  -  STEM FEMORAL 35.5MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-352	SUP	HCPCS C1776		0580-1-352  -  STEM FEMORAL 0 35.5MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-371	SUP	HCPCS C1776		0580-1-371  -  STEM FEMORAL 1 37.5MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-372	SUP	HCPCS C1776		0580-1-372  -  STEM FEMORAL 2 37.5MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-373	SUP	HCPCS C1776		0580-1-373  -  STEM FEMORAL 3 37.5MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-374	SUP	HCPCS C1776		0580-1-374  -  STEM FEMORAL 4 37.5MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-440	SUP	HCPCS C1776		0580-1-440  -  STEM FEMORAL 0 44MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-441	SUP	HCPCS C1776		0580-1-441  -  STEM FEMORAL 1 44MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-442	SUP	HCPCS C1776		0580-1-442  -  STEM FEMORAL 2 44MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-443	SUP	HCPCS C1776		0580-1-443  -  STEM FEMORAL 3 44MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-444	SUP	HCPCS C1776		0580-1-444  -  STEM FEMORAL 4 44MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-445	SUP	HCPCS C1776		0580-1-445  -  STEM FEMORAL 5 45MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-446	SUP	HCPCS C1776		0580-1-446  -  STEM FEMORAL 6 45MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-501	SUP	HCPCS C1776		0580-1-501  -  STEM FEMORAL 1 50MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-502	SUP	HCPCS C1776		0580-1-502  -  STEM FEMORAL 2 50MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-503	SUP	HCPCS C1776		0580-1-503  -  STEM FEMORAL 3 50MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-504	SUP	HCPCS C1776		0580-1-504  -  STEM FEMORAL 4 50MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-1-505	SUP	HCPCS C1776		0580-1-505  -  STEM FEMORAL 5 50MM OFFST CEMENTED EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-2-442	SUP	HCPCS C1776		0580-2-442  -  STEM FEM 205MM TPR EXTR V40 2 LNG 44MM	BOTH IP/OP	"$6,271.00 "	"$4,640.54"	$0.00	"$5,016.80"	"$2,821.95"	"$2,821.95"	$0.00	$0.00	$0.00	"$1,307.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,306.88"	$0.00	"$3,091.60"	"$3,091.60"	$0.00	"$3,135.50"	"$4,966.63"	"$5,016.80"	$0.00		$0.00	$981.41	$0.00	$0.00	$998.34	$0.00	$0.00	$0.00	$0.00	$0.00
0580-3-371	SUP	HCPCS C1776		0580-3-371  -  STEM FEM 1 37.5MM OFST 125MM STRL EXTR V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-3-422	SUP	HCPCS C1776		0580-3-422  -  STEM FEMORAL 2 44MM TAPER 44MM 205MM EXETER V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-3-441	SUP	HCPCS C1776		0580-3-441  -  STEM FEM 1 44MM OFST 125MM STRL EXTR V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-3-501	SUP	HCPCS C1776		0580-3-501  -  STEM FEM 1 50MM OFST 125MM STRL EXTR V40 HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
0580-9-300	SUP	Custom 27803010		0580-9-300  -  STEM SURG 30MM EXTR ANTEROPOSTERIOR ORTHNX AP1 TCHQ OFFST	BOTH IP/OP	$721.00 	$533.54	$0.00	$576.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$535.13	$535.13	$0.00	$0.00	$150.26	$0.00	$0.00	$0.00	$0.00	$360.50	$571.03	$576.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0586-0-022	SUP	Custom 27803010		0586-0-022  -  HEAD FEMORAL +0MM 22MM CEMENTED EXETER ORTHINOX HIP	BOTH IP/OP	"$1,155.00 "	$854.70	$0.00	$924.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.24	$857.24	$0.00	$0.00	$240.70	$0.00	$0.00	$0.00	$0.00	$577.50	$914.76	$924.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0586-0-026	SUP	Custom 27803010		0586-0-026  -  HEAD FEMORAL +0MM 26MM CEMENTED EXETER ORTHINOX HIP	BOTH IP/OP	"$1,155.00 "	$854.70	$0.00	$924.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.24	$857.24	$0.00	$0.00	$240.70	$0.00	$0.00	$0.00	$0.00	$577.50	$914.76	$924.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0586-0-028	SUP	Custom 27803010		0586-0-028  -  HEAD FEMORAL +0MM 28MM CEMENTED EXETER ORTHINOX HIP	BOTH IP/OP	"$1,155.00 "	$854.70	$0.00	$924.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.24	$857.24	$0.00	$0.00	$240.70	$0.00	$0.00	$0.00	$0.00	$577.50	$914.76	$924.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0586-0-032	SUP	Custom 27803010		0586-0-032  -  HEAD FEMORAL +0MM 32MM CEMENTED EXETER ORTHINOX HIP	BOTH IP/OP	"$1,155.00 "	$854.70	$0.00	$924.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.24	$857.24	$0.00	$0.00	$240.70	$0.00	$0.00	$0.00	$0.00	$577.50	$914.76	$924.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0586-0-326	SUP	Custom 27803010		0586-0-326  -  HEAD FEMORAL -3MM 26MM CEMENTED EXETER ORTHINOX HIP	BOTH IP/OP	"$1,155.00 "	$854.70	$0.00	$924.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.24	$857.24	$0.00	$0.00	$240.70	$0.00	$0.00	$0.00	$0.00	$577.50	$914.76	$924.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0586-0-328	SUP	Custom 27803010		0586-0-328  -  HEAD FEMORAL -3MM 28MM NECK EXETER ORTHINOX HIP	BOTH IP/OP	"$1,155.00 "	$854.70	$0.00	$924.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.24	$857.24	$0.00	$0.00	$240.70	$0.00	$0.00	$0.00	$0.00	$577.50	$914.76	$924.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0586-0-332	SUP	Custom 27803010		0586-0-332  -  HEAD FEMORAL -3MM 32MM NECK EXETER ORTHINOX HIP	BOTH IP/OP	"$1,155.00 "	$854.70	$0.00	$924.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.24	$857.24	$0.00	$0.00	$240.70	$0.00	$0.00	$0.00	$0.00	$577.50	$914.76	$924.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0586-5-026	SUP	Custom 27803010		0586-5-026  -  HEAD FEMORAL +5MM 26MM NECK EXETER ORTHINOX HIP	BOTH IP/OP	"$1,155.00 "	$854.70	$0.00	$924.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.24	$857.24	$0.00	$0.00	$240.70	$0.00	$0.00	$0.00	$0.00	$577.50	$914.76	$924.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0586-5-028	SUP	Custom 27803010		0586-5-028  -  HEAD FEMORAL +5MM 28MM NECK EXETER ORTHINOX HIP	BOTH IP/OP	"$1,155.00 "	$854.70	$0.00	$924.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.24	$857.24	$0.00	$0.00	$240.70	$0.00	$0.00	$0.00	$0.00	$577.50	$914.76	$924.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0586-5-032	SUP	Custom 27803010		0586-5-032  -  HEAD FEMORAL 5MM 35MM NECK EXETER ORTHINOX HIP	BOTH IP/OP	"$1,155.00 "	$854.70	$0.00	$924.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.24	$857.24	$0.00	$0.00	$240.70	$0.00	$0.00	$0.00	$0.00	$577.50	$914.76	$924.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
05CR000029	SUP	Custom 27203010		REAGENT ANALY RNS SOL ALC BLND 3.6L	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
05CR000037	SUP	Custom 27203010		REAGENT CYTO CYSTOLITH FLUID PRSV GYN 4L	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0650HYB0605A	SUP	HCPCS C1768		0650HYB0605A  -  GRAFT CARDIO 50CM 6MM 6MM 5CM HBRD REINF GORE NTNL	BOTH IP/OP	"$6,125.00 "	"$4,532.50"	$0.00	"$4,900.00"	"$2,756.25"	"$2,756.25"	$0.00	$0.00	$0.00	"$1,276.60"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,276.45"	$0.00	"$3,019.63"	"$3,019.63"	$0.00	"$3,062.50"	"$4,851.00"	"$4,900.00"	$0.00		$0.00	$958.56	$0.00	$0.00	$975.10	$0.00	$0.00	$0.00	$0.00	$0.00
0650HYB0610A	SUP	HCPCS C1768		0650HYB0610A  -  GRAFT VASCULAR 50CM HYBRID REINFORCED COATED NITINOL PTFE 10	BOTH IP/OP	"$7,125.00 "	"$5,272.50"	$0.00	"$5,700.00"	"$3,206.25"	"$3,206.25"	$0.00	$0.00	$0.00	"$1,485.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,484.85"	$0.00	"$3,512.63"	"$3,512.63"	$0.00	"$3,562.50"	"$5,643.00"	"$5,700.00"	$0.00		$0.00	"$1,115.06"	$0.00	$0.00	"$1,134.30"	$0.00	$0.00	$0.00	$0.00	$0.00
0650HYB0705A	SUP	HCPCS C1768		0650HYB0705A  -  GRAFT VASC 50CM 7MM 6MM GORE NTNL HBRD REINF CNFIG 5CM	BOTH IP/OP	"$6,125.00 "	"$4,532.50"	$0.00	"$4,900.00"	"$2,756.25"	"$2,756.25"	$0.00	$0.00	$0.00	"$1,276.60"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,276.45"	$0.00	"$3,019.63"	"$3,019.63"	$0.00	"$3,062.50"	"$4,851.00"	"$4,900.00"	$0.00		$0.00	$958.56	$0.00	$0.00	$975.10	$0.00	$0.00	$0.00	$0.00	$0.00
0650HYB0805A	SUP	HCPCS C1768		0650HYB0805A  -  GRAFT VASC 50CM 8MM 6MM GORE NTNL HBRD REINF CNFIG 5CM	BOTH IP/OP	"$6,125.00 "	"$4,532.50"	$0.00	"$4,900.00"	"$2,756.25"	"$2,756.25"	$0.00	$0.00	$0.00	"$1,276.60"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,276.45"	$0.00	"$3,019.63"	"$3,019.63"	$0.00	"$3,062.50"	"$4,851.00"	"$4,900.00"	$0.00		$0.00	$958.56	$0.00	$0.00	$975.10	$0.00	$0.00	$0.00	$0.00	$0.00
0684-00-0568-01	SUP	Custom 27803010		0684-00-0568-01  -  CATHETER IAB 7.5FR 6IN 40ML SNS + 2 STLK DEV FO INS KT INTRO	BOTH IP/OP	"$2,725.00 "	"$2,016.50"	$0.00	"$2,180.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,022.50"	"$2,022.50"	$0.00	$0.00	$567.89	$0.00	$0.00	$0.00	$0.00	"$1,362.50"	"$2,158.20"	"$2,180.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0684-00-0576-01	SUP	Custom 27803010		0684-00-0576-01  -  CATHETER IAB .025IN 8FR 17.4MM .027IN 6IN 50CC 258MM SNS +	BOTH IP/OP	"$2,613.63 "	"$1,934.09"	$0.00	"$2,090.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,939.83"	"$1,939.83"	$0.00	$0.00	$544.68	$0.00	$0.00	$0.00	$0.00	"$1,306.81"	"$2,069.99"	"$2,090.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
07.704.105S	SUP	HCPCS C1713		07.704.105S  -  FILLER BONE VOID DRILLABLE FAST SET PUTTY NORIAN 5ML STERILE	BOTH IP/OP	"$3,678.00 "	"$2,721.72"	$0.00	"$2,856.70"	"$1,606.89"	"$1,606.89"	$0.00	$0.00	$0.00	$766.59	"$2,729.81"	"$2,729.81"	$0.00	$0.00	$766.50	$0.00	"$1,813.25"	"$1,813.25"	$0.00	"$1,785.44"	"$2,828.14"	"$2,856.70"	$0.00		$0.00	$542.57	$0.00	$0.00	$568.48	$0.00	$0.00	$0.00	$0.00	$0.00
07.704.110S	SUP	HCPCS C1713		07.704.110S  -  FILLER BONE VOID DRILLABLE FAST SET PUTTY NORIAN 10ML	BOTH IP/OP	"$7,228.70 "	"$5,349.24"	$0.00	"$5,614.54"	"$3,158.18"	"$3,158.18"	$0.00	$0.00	$0.00	"$1,506.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,506.46"	$0.00	"$3,563.75"	"$3,563.75"	$0.00	"$3,509.09"	"$5,558.40"	"$5,614.54"	$0.00		$0.00	"$1,066.35"	$0.00	$0.00	"$1,117.29"	$0.00	$0.00	$0.00	$0.00	$0.00
07.704-003S	SUP	HCPCS C1713		07.704-003S  -  CEMENT BONE NRN SRS 3ML VOID FILR ROT MX STRL	BOTH IP/OP	"$2,018.60 "	"$1,493.76"	$0.00	"$1,614.88"	$908.37	$908.37	$0.00	$0.00	$0.00	$420.73	"$1,498.20"	"$1,498.20"	$0.00	$0.00	$420.68	$0.00	"$1,194.00"	"$1,194.00"	$0.00	"$1,009.30"	"$1,598.73"	"$1,614.88"	$0.00		$0.00	$315.91	$0.00	$0.00	$321.36	$0.00	$0.00	$0.00	$0.00	$0.00
07.704-005S	SUP	HCPCS C1713		07.704-005S  -  FILLER BONE VOID DRILLABLE INJECT REINFORCED BIORESORBABLE	BOTH IP/OP	"$3,678.00 "	"$2,721.72"	$0.00	"$2,856.70"	"$1,606.89"	"$1,606.89"	$0.00	$0.00	$0.00	$766.59	"$2,729.81"	"$2,729.81"	$0.00	$0.00	$766.50	$0.00	"$1,813.25"	"$1,813.25"	$0.00	"$1,785.44"	"$2,828.14"	"$2,856.70"	$0.00		$0.00	$518.81	$0.00	$0.00	$568.48	$0.00	$0.00	$0.00	$0.00	$0.00
07.704-010S	SUP	HCPCS C1713		07.704-010S  -  FILLER BONE VOID DRILLABLE INJECT REINFORCED BIORESORBABLE	BOTH IP/OP	"$7,228.70 "	"$5,349.24"	$0.00	"$5,614.54"	"$3,158.18"	"$3,158.18"	$0.00	$0.00	$0.00	"$1,506.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,506.46"	$0.00	"$3,563.75"	"$3,563.75"	$0.00	"$3,509.09"	"$5,558.40"	"$5,614.54"	$0.00		$0.00	"$1,066.35"	$0.00	$0.00	"$1,117.29"	$0.00	$0.00	$0.00	$0.00	$0.00
07-036P	SUP	HCPCS C1713		07-036P  -  7 MM WASHER	BOTH IP/OP	$28.50 	$21.09	$0.00	$22.80	$12.83	$12.83	$0.00	$0.00	$0.00	$5.94	$21.15	$21.15	$0.00	$0.00	$5.94	$0.00	$16.86	$16.86	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$4.46	$0.00	$0.00	$4.54	$0.00	$0.00	$0.00	$0.00	$0.00
07-150-10	SUP	Custom 27203010		07-150-10  -  PROBE DOPPLER 20MHZ 280MM BAYONETED STERILE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,038.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	$0.00	$0.00	$0.00	"$1,273.75"	"$2,017.62"	"$2,038.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
07-150-12	SUP	Custom 27203010		07-150-12  -  PROBE DOPPLER MINI NEURO DISPOSABLE	BOTH IP/OP	"$4,015.00 "	"$2,971.10"	$0.00	"$3,118.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,979.93"	"$2,979.93"	$0.00	$0.00	$836.73	$0.00	$0.00	$0.00	$0.00	"$1,948.75"	"$3,086.82"	"$3,118.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
073701-CD	SUP	Custom 27203010		073701-CD  -  SET DILAT S-CURVE HYDPHI PLMR SDPRT LFRIC SLIP SRFC 37CM	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$0.00	$0.00	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
07-40230	SUP	Custom 27803010		07-40230  -  DRILL DRL 2.4MM CNN D STP	BOTH IP/OP	$463.25 	$342.81	$0.00	$391.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.82	$343.82	$0.00	$0.00	$96.54	$0.00	$0.00	$0.00	$0.00	$244.75	$387.68	$391.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
07-40232	SUP	Custom 27803010		07-40232  -  TAP CANN DEPTH STOP SURG	BOTH IP/OP	$417.00 	$308.58	$0.00	$309.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$309.50	$309.50	$0.00	$0.00	$86.90	$0.00	$0.00	$0.00	$0.00	$187.69	$297.30	$300.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
07-40280	SUP	HCPCS C1713		07-40280  -  WIRE FIX 1MM 160MM KWIRE SS ORTH LEIBINGER	BOTH IP/OP	$44.25 	$32.75	$0.00	$32.84	$1.86	$1.86	$0.00	$0.00	$0.00	$9.22	$32.84	$32.84	$0.00	$0.00	$9.22	$0.00	$26.17	$26.17	$0.00	$2.06	$3.27	$3.30	$0.00		$0.00	$0.65	$0.00	$0.00	$0.66	$0.00	$0.00	$0.00	$0.00	$0.00
07-40281	SUP	HCPCS C1713		07-40281  -  WIRE FX 1.1MM 160MM NS KRSH LGTH MRK SS	BOTH IP/OP	$37.40 	$27.68	$0.00	$30.80	$17.33	$17.33	$0.00	$0.00	$0.00	$7.80	$27.76	$27.76	$0.00	$0.00	$7.79	$0.00	$22.12	$22.12	$0.00	$19.25	$30.49	$30.80	$0.00		$0.00	$6.03	$0.00	$0.00	$6.13	$0.00	$0.00	$0.00	$0.00	$0.00
07782G	SUP	Custom 27203010		CORK GRAD LAB 4	BOTH IP/OP	$0.25 	$0.19	$0.00	$0.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.13	$0.20	$0.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
08.510.543S	SUP	HCPCS C1713		08.510.543S  -  PLATE BONE 24MMX1.5MM SYNPOR POLYETHYLENE POROUS ORBTL FLOOR	BOTH IP/OP	"$1,447.50 "	"$1,071.15"	$0.00	"$1,158.00"	$651.38	$651.38	$0.00	$0.00	$0.00	$301.70	"$1,074.33"	"$1,074.33"	$0.00	$0.00	$301.66	$0.00	$856.20	$856.20	$0.00	$723.75	"$1,146.42"	"$1,158.00"	$0.00		$0.00	$226.53	$0.00	$0.00	$230.44	$0.00	$0.00	$0.00	$0.00	$0.00
08.520.221S	SUP	HCPCS C1713		08.520.221S  -  PLATE BN FAN .8MM STRL SYNPOR SMTH EXPOSE FX HL RADGR VSB TI	BOTH IP/OP	"$4,292.50 "	"$3,176.45"	$0.00	"$3,434.00"	"$1,931.63"	"$1,931.63"	$0.00	$0.00	$0.00	$894.66	"$3,185.89"	"$3,185.89"	$0.00	$0.00	$894.56	$0.00	"$2,116.20"	"$2,116.20"	$0.00	"$2,146.25"	"$3,399.66"	"$3,434.00"	$0.00		$0.00	$671.78	$0.00	$0.00	$683.37	$0.00	$0.00	$0.00	$0.00	$0.00
08.803.209	SUP	HCPCS C1713		08.803.209  -  SPACER SPNL BLT NOSE 32X10X9MM NS OPAL REVOLVE RADOPQ SLF	BOTH IP/OP	"$13,782.50 "	"$10,199.05"	$0.00	"$11,026.00"	"$6,202.13"	"$6,202.13"	$0.00	$0.00	$0.00	"$2,872.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,872.27"	$0.00	"$6,794.77"	"$6,794.77"	$0.00	"$6,891.25"	"$10,915.74"	"$11,026.00"	$0.00		$0.00	"$2,156.96"	$0.00	$0.00	"$2,194.17"	$0.00	$0.00	$0.00	$0.00	$0.00
08A020	SUP	Custom 27804086		08A020  -  GRAFT BONE CANC 30ML 4-10MM FRZDR	BOTH IP/OP	"$1,165.00 "	$862.10	$0.00	$952.56	$0.00	$0.00	$0.00	$0.00	$0.00	$242.82	$864.66	$864.66	$0.00	$0.00	$242.79	$0.00	$689.10	$689.10	$0.00	$595.35	$943.03	$952.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
08A022	SUP	Custom 27803010		08A022  -  GRAFT BN 15ML CHP CANC	BOTH IP/OP	$740.00 	$547.60	$0.00	$592.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.23	$549.23	$0.00	$0.00	$154.22	$0.00	$0.00	$0.00	$0.00	$370.00	$586.08	$592.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
08A024	SUP	Custom 27804086		08A024  -  GRAFT BN 4-10MM 5ML CHP CANC TBA 013470059 09	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$0.00	$0.00	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
09.402.022S	SUP	HCPCS C1713		09.402.022S  -  HEAD RADIAL STANDARD 22MM 12MM COCR ELBOW STERILE	BOTH IP/OP	"$3,286.33 "	"$2,431.88"	$0.00	"$2,629.06"	"$1,478.85"	"$1,478.85"	$0.00	$0.00	$0.00	$684.95	"$2,439.11"	"$2,439.11"	$0.00	$0.00	$684.87	$0.00	"$1,620.16"	"$1,620.16"	$0.00	"$1,643.16"	"$2,602.77"	"$2,629.06"	$0.00		$0.00	$499.33	$0.00	$0.00	$523.18	$0.00	$0.00	$0.00	$0.00	$0.00
0900-05	SUP	Custom 27203010		NUNC NULL STRIPS	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0920-2-920	SUP	Custom 27803010		0920-2-920  -  CENTRALIZER STEM EXETER PMMA	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0939-0-106	SUP	HCPCS C1713		0939-0-106  -  PLUG BONE CEMENT 6MM EXETER PMMA INTRAMEDULLARY	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
0939-0-108	SUP	HCPCS C1713		0939-0-108  -  PLUG BONE CEMENT 8MM EXETER PMMA INTRAMEDULLARY	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
0939-0-110	SUP	HCPCS C1713		0939-0-110  -  PLUG BONE CEMENT 10MM EXETER PMMA INTRAMEDULLARY	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
0939-0-112	SUP	HCPCS C1713		0939-0-112  -  PLUG BONE CEMENT 12MM EXETER PMMA INTRAMEDULLARY	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
0939-0-114	SUP	HCPCS C1713		0939-0-114  -  PLUG BONE CEMENT 14MM EXETER PMMA INTRAMEDULLARY	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
0939-0-116	SUP	HCPCS C1713		0939-0-116  -  PLUG BONE CEMENT 16MM EXETER PMMA INTRAMEDULLARY	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
0939-0-118	SUP	HCPCS C1713		0939-0-118  -  PLUG BONE CEMENT 18MM EXETER PMMA INTRAMEDULLARY	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
0939-0-120	SUP	HCPCS C1713		0939-0-120  -  PLUG BONE CEMENT 20MM EXETER PMMA INTRAMEDULLARY	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
0942-2-110	SUP	HCPCS C1713		0942-2-110  -  PLUG BONE CEMENT 10MM EXETER X-CHANGE	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
0942-2-112	SUP	HCPCS C1713		0942-2-112  -  PLUG BONE CEMENT 12MM EXETER X-CHANGE	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
0942-2-114	SUP	HCPCS C1713		0942-2-114  -  SPACER CEMENT 14MM 14MM BONE PLUGS ACCESSORIES EXETER	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
0942-2-116	SUP	HCPCS C1713		0942-2-116  -  PLUG BONE CEMENT 16MM EXETER X-CHANGE	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
0942-2-118	SUP	HCPCS C1713		0942-2-118  -  SPACER CEMENT 18MM BONE PLUGS ACCESSORIES EXETER X-CHANGE	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
0942-2-120	SUP	HCPCS C1713		0942-2-120  -  PLUG BONE CEMENT 20MM 20MM EXETER X-CHANGE HIP	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-000	SUP	HCPCS C1713		0942-8-000  -  SCREW BONE 3.5MM 10MM SELF TAP SELF DRILL X-CHANGE HIP	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-001	SUP	HCPCS C1713		0942-8-001  -  SCREW BONE 3.5MM 15MM SELF TAP SELF DRILL X-CHANGE HIP	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-002	SUP	HCPCS C1713		0942-8-002  -  SCREW BONE 3.5MM 20MM SELF TAP SELF DRILL X-CHANGE HIP	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-003	SUP	HCPCS C1713		0942-8-003  -  SCREW BONE 3.5MM 25MM SELF TAP SELF DRILL X-CHANGE HIP	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-004	SUP	HCPCS C1713		0942-8-004  -  SCREW BONE 3.5MM 30MM SELF TAP SELF DRILL X-CHANGE HIP	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-005	SUP	HCPCS C1713		0942-8-005  -  SCREW BONE 3.5MM 35MM SELF TAP SELF DRILL X-CHANGE HIP	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-010	SUP	HCPCS C1781		0942-8-010  -  MESH ACETAB CURVE X-CHANGE RSTOR HIP	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-020	SUP	HCPCS C1781		0942-8-020  -  MESH ACETAB LARGE X-CHANGE RSTOR HIP MEDIAL WALL	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-025	SUP	HCPCS C1781		0942-8-025  -  MESH ACETAB SMALL X-CHANGE RSTOR HIP MEDIAL WALL	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-030	SUP	HCPCS C1781		0942-8-030  -  MESH ACETAB FLAT X-CHANGE RSTOR HIP	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-040	SUP	HCPCS C1781		0942-8-040  -  MESH ACETAB SMALL X-CHANGE RSTOR HIP RIM	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-050	SUP	HCPCS C1781		0942-8-050  -  MESH ACETAB MEDIUM X-CHANGE RSTOR HIP RIM	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-060	SUP	HCPCS C1781		0942-8-060  -  MESH ACETAB LARGE X-CHANGE RSTOR HIP RIM	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
0942-8-070	SUP	HCPCS C1781		0942-8-070  -  MESH ACETAB ANATOMIC X-CHANGE RSTOR HIP FEMURAL	BOTH IP/OP	"$1,285.00 "	$950.90	$0.00	"$1,028.00"	$578.25	$578.25	$0.00	$0.00	$0.00	$267.83	$953.73	$953.73	$0.00	$0.00	$267.79	$0.00	$760.08	$760.08	$0.00	$642.50	"$1,017.72"	"$1,028.00"	$0.00		$0.00	$201.10	$0.00	$0.00	$204.57	$0.00	$0.00	$0.00	$0.00	$0.00
0994-001	SUP	HCPCS C1887		0994-001  -  CATHETER GD 6FR 140CM VNTR OTW RADOPQ STRBL ML LR COIL TRQ	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$882.38	$882.38	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
1000-00-0614	SUP	HCPCS C1713		1000-00-0614  -  CAGE SPNL 7D LRDTC 14X12X6MM COHERE LOPRFL MATTE FNSH PEEK	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
1000-00-0616	SUP	HCPCS C1713		1000-00-0616  -  CAGE SPNL 7D LRDTC 16X14X6MM COHERE LOPRFL MATTE FNSH PEEK	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
1000-00-0714	SUP	HCPCS C1713		1000-00-0714  -  CAGE SPNL 7D LRDTC 14X12X7MM COHERE LOPRFL MATTE FNSH PEEK	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
1000-00-0716	SUP	HCPCS C1713		1000-00-0716  -  CAGE SPNL 7D LRDTC 16X14X7MM COHERE LOPRFL MATTE FNSH PEEK	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
1000-00-0814	SUP	HCPCS C1713		1000-00-0814  -  CAGE SPNL 7D LRDTC 14X12X8MM COHERE LOPRFL MATTE FNSH PEEK	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
1000-00-0816	SUP	HCPCS C1713		1000-00-0816  -  CAGE SPNL 7D LRDTC 16X14X8MM COHERE LOPRFL MATTE FNSH PEEK	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
1000-00-0914	SUP	HCPCS C1713		1000-00-0914  -  CAGE SPNL 7D LRDTC 14X12X9MM COHERE LOPRFL MATTE FNSH PEEK	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
1000-00-0916	SUP	HCPCS C1713		1000-00-0916  -  CAGE SPNL 7D LRDTC 16X14X9MM COHERE LOPRFL MATTE FNSH PEEK	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
1000-00-1014	SUP	HCPCS C1713		1000-00-1014  -  CAGE SPNL 7D LRDTC 14X12X10MM COHERE LOPRFL MATTE FNSH PEEK	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
1000-00-1016	SUP	HCPCS C1713		1000-00-1016  -  CAGE SPNL 7D LRDTC 16X14X10MM COHERE LOPRFL MATTE FNSH PEEK	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
100-06	SUP	HCPCS C1713		100-06  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$248.63 	$183.99	$0.00	$198.90	$111.88	$111.88	$0.00	$0.00	$0.00	$51.82	$184.53	$184.53	$0.00	$0.00	$51.81	$0.00	$147.06	$147.06	$0.00	$124.31	$196.91	$198.90	$0.00		$0.00	$38.91	$0.00	$0.00	$39.58	$0.00	$0.00	$0.00	$0.00	$0.00
1001-2200	SUP	Custom 27803010		1001-2200  -  HEAD FEMORAL +00MM MORSE TAPER 32MM OMNIFIT COCR HIP	BOTH IP/OP	"$1,297.50 "	$960.15	$0.00	"$1,038.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.00	$963.00	$0.00	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$648.75	"$1,027.62"	"$1,038.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1001-2205	SUP	Custom 27803010		1001-2205  -  HEAD FEMORAL +05MM MORSE TAPER 22MM OMNIFIT COCR HIP	BOTH IP/OP	"$1,297.50 "	$960.15	$0.00	"$1,038.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.00	$963.00	$0.00	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$648.75	"$1,027.62"	"$1,038.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1001-2600	SUP	Custom 27803010		1001-2600  -  HEAD FEMORAL +00MM MORSE TAPER 26MM OMNIFIT COCR HIP	BOTH IP/OP	"$1,297.50 "	$960.15	$0.00	"$1,038.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.00	$963.00	$0.00	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$648.75	"$1,027.62"	"$1,038.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1001-2605	SUP	Custom 27803010		1001-2605  -  HEAD FEMORAL +05MM MORSE TAPER 26MM OMNIFIT COCR HIP	BOTH IP/OP	"$1,297.50 "	$960.15	$0.00	"$1,038.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.00	$963.00	$0.00	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$648.75	"$1,027.62"	"$1,038.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1001-2610	SUP	Custom 27803010		1001-2610  -  HEAD FEMORAL +10MM MORSE TAPER 26MM OMNIFIT COCR HIP	BOTH IP/OP	"$1,297.50 "	$960.15	$0.00	"$1,038.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.00	$963.00	$0.00	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$648.75	"$1,027.62"	"$1,038.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1001-2800	SUP	Custom 27803010		1001-2800  -  HEAD FEMORAL +00MM MORSE TAPER 28MM OMNIFIT COCR HIP	BOTH IP/OP	"$1,297.50 "	$960.15	$0.00	"$1,038.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.00	$963.00	$0.00	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$648.75	"$1,027.62"	"$1,038.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1001-2805	SUP	Custom 27803010		1001-2805  -  HEAD FEMORAL +5MM 28MM MORSE TAPERED LFIT COCR HIP	BOTH IP/OP	"$1,297.50 "	$960.15	$0.00	"$1,038.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.00	$963.00	$0.00	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$648.75	"$1,027.62"	"$1,038.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1001-2810	SUP	Custom 27803010		1001-2810  -  HEAD FEM +10 28MM HIP MRS TPR COCR LFIT	BOTH IP/OP	$814.00 	$602.36	$0.00	$651.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$604.15	$604.15	$0.00	$0.00	$169.64	$0.00	$0.00	$0.00	$0.00	$407.00	$644.69	$651.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1001-3200	SUP	Custom 27803010		1001-3200  -  HEAD FEMORAL +00MM MORSE TAPER 32MM OMNIFIT COCR HIP	BOTH IP/OP	"$1,297.50 "	$960.15	$0.00	"$1,038.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.00	$963.00	$0.00	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$648.75	"$1,027.62"	"$1,038.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1001-3205	SUP	Custom 27803010		1001-3205  -  HEAD FEMORAL +05MM MORSE TAPER 32MM OMNIFIT COCR HIP	BOTH IP/OP	"$1,297.50 "	$960.15	$0.00	"$1,038.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.00	$963.00	$0.00	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$648.75	"$1,027.62"	"$1,038.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1001-3210	SUP	Custom 27803010		1001-3210  -  HEAD FEMORAL +10MM MORSE TAPER 32MM OMNIFIT COCR HIP	BOTH IP/OP	"$1,297.50 "	$960.15	$0.00	"$1,038.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.00	$963.00	$0.00	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$648.75	"$1,027.62"	"$1,038.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1001-3299	SUP	Custom 27803010		1001-3299  -  HEAD FEMORAL +99MM MORSE TAPER 32MM OMNIFIT COCR HIP	BOTH IP/OP	"$1,297.50 "	$960.15	$0.00	"$1,038.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.00	$963.00	$0.00	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$648.75	"$1,027.62"	"$1,038.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1001-532	SUP	Custom 27203010		1001-532  -  CLAMP SURG 75-80GM CLAMPING PRESSURE MIDI STR BULLDOG	BOTH IP/OP	$209.50 	$155.03	$0.00	$167.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.49	$155.49	$0.00	$0.00	$43.66	$0.00	$0.00	$0.00	$0.00	$104.75	$165.92	$167.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1003381-13	SUP	HCPCS C1874		1003381-13  -  STENT CORON .014IN LP 4.5MM 13MM RAPEX SMOOTH SURFACE MARKER	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1003381-18	SUP	HCPCS C1874		1003381-18  -  SYSTEM COR STNT 4.5MM 18MM MTLNK UL RX LOPRFL RADOPQ SMTH	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1003381-28	SUP	HCPCS C1874		1003381-28  -  STENT CORON .014IN LP 4.5MM 28MM RAPEX SMOOTH SURFACE MARKER	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
100-36-01	SUP	Custom 27203010		100-36-01  -  CHEST TUBE INSERTION DEVICE MINIMALLY INVASIVE	BOTH IP/OP	"$5,025.00 "	"$3,718.50"	$0.00	"$4,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,729.56"	"$3,729.56"	$0.00	$0.00	"$1,047.21"	$0.00	$0.00	$0.00	$0.00	"$2,512.50"	"$3,979.80"	"$4,020.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1005359H	SUP	HCPCS C1760		1005359H  -  GUIDEWIRE VASCULAR STR .014IN 300CM 3CM HI-TORQUE WHISPER MS	BOTH IP/OP	$177.50 	$131.35	$0.00	$142.00	$79.88	$79.88	$0.00	$0.00	$0.00	$37.00	$131.74	$131.74	$0.00	$0.00	$36.99	$0.00	$104.99	$104.99	$0.00	$88.75	$140.58	$142.00	$0.00		$0.00	$27.78	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$0.00
1005359H NEW ITEM # 80322174	SUP	HCPCS C1760		1005359H NEW ITEM # 80322174  -  GUIDEWIRE VASCULAR STR .014IN 300CM 3CM HI-TORQUE WHISPER MS	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
1007-00	SUP	Custom 27203010		1007-00  -  VALVULOTOME ANGIOSCOPIC 98CM EXPANDABLE OTW 1.5MM	BOTH IP/OP	"$4,197.50 "	"$3,106.15"	$0.00	"$3,358.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,115.38"	"$3,115.38"	$0.00	$0.00	$874.76	$0.00	$0.00	$0.00	$0.00	"$2,098.75"	"$3,324.42"	"$3,358.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007822-08	SUP	HCPCS C1874		1007822-08  -  STENT CORON 2.25MM 8MM 2 RADIOPQ MARKER BALLOON EXPANDABLE	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007823-08	SUP	HCPCS C1874		1007823-08  -  STENT CORON 2.5MM 8MM .014IN RAPEX FLXB LP MTLNK MVSN COCR	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,300.00"	$731.25	$731.25	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
1007823-15	SUP	HCPCS C1874		1007823-15  -  STENT CORON LP 2.5MM 15MM 2 RADIOPQ MARKER BALLOON	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007823-28	SUP	HCPCS C1874		1007823-28  -  STENT CORON LP 2.5MM 28MM 2 RADIOPQ MARKER BALLOON	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007848-08	SUP	HCPCS C1874		1007848-08  -  SYSTEM CORON STENT 3MM 8MM RAPEX MULTI-LINK VISION BARE	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007848-12	SUP	HCPCS C1874		1007848-12  -  SYSTEM CORON STENT 3MM 12MM RAPEX MULTI-LINK VISION BARE	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007848-23	SUP	HCPCS C1874		1007848-23  -  STENT CORON LP 3MM 23MM 2 RADIOPQ MARKER BALLOON EXPANDABLE	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007848-28	SUP	HCPCS C1874		1007848-28  -  SYSTEM CORON STENT 3MM 28MM RAPEX MULTI-LINK VISION BARE	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007849-12	SUP	HCPCS C1874		1007849-12  -  SYSTEM COR STNT 3.5MM 12MM MTLNK VSN RX LOPRFL RADOPQ BLN	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007849-18	SUP	HCPCS C1874		1007849-18  -  STENT CORON LP 3.5MM 18MM 2 RADIOPQ MARKER BALLOON	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007849-23	SUP	HCPCS C1874		1007849-23  -  STENT CORON LP 3.5MM 23MM 2 RADIOPQ MARKER BALLOON	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007849-28	SUP	HCPCS C1874		1007849-28  -  SYSTEM COR STNT 3.5MM 28MM MTLNK VSN RX LOPRFL RADOPQ BLN	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007850-08	SUP	HCPCS C1874		1007850-08  -  STENT CORON 4MM 8MM .014IN RAPEX FLXB LP MTLNK VSN COCR	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,300.00"	$731.25	$731.25	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
1007850-12	SUP	HCPCS C1874		1007850-12  -  STENT CORON LP 4MM 12MM 2 RADIOPQ MARKER BALLOON EXPANDABLE	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1007850-15	SUP	HCPCS C1874		1007850-15  -  STENT CORON LP 4MM 15MM 2 RADIOPQ MARKER BALLOON EXPANDABLE	BOTH IP/OP	$875.00 	$647.50	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1008193-20	SUP	HCPCS C1725		1008193-20  -  CATHETER BLNDIL 5MM 135CM 20MM VTRC14 + RX LOPRFL FLXB KINK	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$244.35	$244.35	$0.00	$0.00	$0.00	$93.79	$333.99	$333.99	$0.00	$0.00	$93.78	$0.00	$266.18	$266.18	$0.00	$225.00	$356.40	$360.00	$0.00		$0.00	$70.43	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$0.00
1009539-08	SUP	HCPCS C1874		1009539-08  -  STENT COR 2.5MM 8MM 143CM XIENCE V DLV SYS RX RADOPQ TPR BLN	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009539-12	SUP	HCPCS C1874		1009539-12  -  SYSTEM COR STNT 2.5MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009539-15	SUP	HCPCS C1874		1009539-15  -  SYSTEM COR STNT 2.5MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009539-18	SUP	HCPCS C1874		1009539-18  -  SYSTEM COR STNT 2.5MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009539-23	SUP	HCPCS C1874		1009539-23  -  SYSTEM COR STNT 2.5MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009539-28	SUP	HCPCS C1874		1009539-28  -  SYSTEM COR STNT 2.5MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009540-12	SUP	HCPCS C1874		1009540-12  -  SYSTEM COR STNT 2.75MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009540-15	SUP	HCPCS C1874		1009540-15  -  SYSTEM COR STNT 2.75MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009540-18	SUP	HCPCS C1874		1009540-18  -  SYSTEM COR STNT 2.75MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009540-23	SUP	HCPCS C1874		1009540-23  -  SYSTEM COR STNT 2.75MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009540-28	SUP	HCPCS C1874		1009540-28  -  SYSTEM COR STNT 2.75MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009541-12	SUP	HCPCS C1874		1009541-12  -  SYSTEM COR STNT 3MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009541-15	SUP	HCPCS C1874		1009541-15  -  SYSTEM COR STNT 3MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009541-18	SUP	HCPCS C1874		1009541-18  -  SYSTEM COR STNT 3MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009541-23	SUP	HCPCS C1874		1009541-23  -  SYSTEM COR STNT 3MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009541-28	SUP	HCPCS C1874		1009541-28  -  SYSTEM COR STNT 3MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009542-08	SUP	HCPCS C1874		1009542-08  -  SYSTEM COR STNT 3.5MM 8MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009542-12	SUP	HCPCS C1874		1009542-12  -  SYSTEM COR STNT 3.5MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009542-15	SUP	HCPCS C1874		1009542-15  -  SYSTEM COR STNT 3.5MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009542-18	SUP	HCPCS C1874		1009542-18  -  SYSTEM COR STNT 3.5MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009542-23	SUP	HCPCS C1874		1009542-23  -  SYSTEM COR STNT 3.5MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009542-28	SUP	HCPCS C1874		1009542-28  -  SYSTEM COR STNT 3.5MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009543-08	SUP	HCPCS C1874		1009543-08  -  SYSTEM COR STNT 4MM 8MM 143CM XIENCE V RX DLV SYS RADOPQ TPR	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009543-12	SUP	HCPCS C1874		1009543-12  -  SYSTEM COR STNT 4MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009543-15	SUP	HCPCS C1874		1009543-15  -  SYSTEM COR STNT 4MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009543-18	SUP	HCPCS C1874		1009543-18  -  SYSTEM COR STNT 4MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009543-23	SUP	HCPCS C1874		1009543-23  -  SYSTEM COR STNT 4MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009543-28	SUP	HCPCS C1874		1009543-28  -  SYSTEM COR STNT 4MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009544-08	SUP	HCPCS C1874		1009544-08  -  SYSTEM COR STNT 2.25MM 8MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009544-15	SUP	HCPCS C1874		1009544-15  -  SYSTEM COR STNT 2.25MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009544-18	SUP	HCPCS C1874		1009544-18  -  SYSTEM COR STNT 2.25MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1009544-28	SUP	HCPCS C1874		1009544-28  -  SYSTEM COR STNT 2.25MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
1010-10-PAD	SUP	HCPCS A4565		1010-10-PAD  -  SLING ORTH XL	BOTH IP/OP	$7.07 	$5.23	$0.00	$5.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.25	$5.25	$0.00	$0.00	$1.47	$0.00	$0.00	$0.00	$0.00	$3.54	$5.60	$5.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1010-10-PAD-30	SUP	HCPCS A4565		1010-10-PAD-30  -  SLING ORTH MED	BOTH IP/OP	$7.07 	$5.23	$0.00	$5.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.25	$5.25	$0.00	$0.00	$1.47	$0.00	$0.00	$0.00	$0.00	$3.54	$5.60	$5.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1010-10-PAD-40	SUP	HCPCS A4565		1010-10-PAD-40  -  SLING ORTH LG	BOTH IP/OP	$7.07 	$5.23	$0.00	$5.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.25	$5.25	$0.00	$0.00	$1.47	$0.00	$0.00	$0.00	$0.00	$3.54	$5.60	$5.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1010480H	SUP	HCPCS C1769		GUIDEWIRE VASC .014IN 190CM 3CM STRG HTORQ PILT 50 HDRCT	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$101.81	$101.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
10-1073	SUP	Custom 27203010		10-1073  -  SET BONE BIOP 16CM BONOPTY CORT CANNU STY EJTR PIN DEPTH GA	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1011337-40	SUP	HCPCS C1876		1011337-40  -  STENT VASCULAR STR LP 5MM 8FR 40MM 132CM SELF EXPANDABLE	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
1011338-40	SUP	HCPCS C1876		1011338-40  -  STENT VASCULAR STR LP 6MM 8FR 40MM 132CM SELF EXPANDABLE	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
1011339-40	SUP	HCPCS C1876		1011339-40  -  STENT VASCULAR STR LP 7MM 8FR 40MM 132CM SELF EXPANDABLE	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
1011340-40	SUP	HCPCS C1876		1011340-40  -  STENT VASCULAR STR LP 8MM 8FR 40MM 132CM SELF EXPANDABLE	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
1011341-40	SUP	HCPCS C1876		1011341-40  -  STENT VASCULAR STR LP 9MM 8FR 40MM 132CM SELF EXPANDABLE	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
1011342-40	SUP	HCPCS C1876		1011342-40  -  STENT VASCULAR STR LP 10MM 8FR 40MM 132CM SELF EXPANDABLE	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
1011343-30	SUP	HCPCS C1876		1011343-30  -  STENT VASCULAR LP TAPER 6-8MM 8FR 30MM 132CM SELF EXPANDABLE	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
1011343-40	SUP	HCPCS C1876		1011343-40  -  STENT VASCULAR LP TAPER 6-8MM 8FR 40MM 132CM SELF EXPANDABLE	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
1011344-40	SUP	HCPCS C1876		1011344-40  -  STENT VASCULAR LP TAPER 7-10MM 8FR 40MM 132CM SELF	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
1011650-55	SUP	HCPCS C1760		1011650-55  -  SYSTEM EMBOLIC PROTECTION LP 4.5MM 6-8FR 300CM GWIRE	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
1012402-15A	SUP	HCPCS C1725		1012402-15A  -  CATHETER BLNDIL 1.5MM 145CM 15MM MN TREK II OTW 2 LUM ULT	BOTH IP/OP	$175.00 	$129.50	$0.00	$170.00	$115.39	$115.39	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
1012534-100	SUP	HCPCS C1876		1012534-100  -  STENT BILIARY 6MM 100MM 135CM SELF EXPANDABLE RADIOPQ MARKER	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
1012535-100	SUP	HCPCS C1876		1012535-100  -  STENT BILIARY 7MM 100MM 135CM SELF EXPANDABLE RADIOPQ MARKER	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
1016-17	SUP	HCPCS Q4116		1016-17  -  GRAFT SKIN MEDIUM FROZEN CADAVER NONMESHED 232 SQ CM/ Ľ SQ F	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$504.00	$504.00	$0.00	$0.00	$0.00	$233.44	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$662.48	$662.48	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$175.28	$0.00	$0.00	$178.30	$0.00	$0.00	$0.00	$0.00	$0.00
1017-17	SUP	HCPCS Q4116		1017-17  -  GRAFT SKN 154SQ CM NONMESHED CRPRS	BOTH IP/OP	$645.00 	$477.30	$0.00	$516.00	$290.25	$290.25	$0.00	$0.00	$0.00	$134.43	$478.72	$478.72	$0.00	$0.00	$134.42	$0.00	$381.52	$381.52	$0.00	$322.50	$510.84	$516.00	$0.00		$0.00	$100.94	$0.00	$0.00	$102.68	$0.00	$0.00	$0.00	$0.00	$0.00
101-L05-C	SUP	HCPCS C1713		101-L05-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
101-L25	SUP	HCPCS C1713		101-L25  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$403.75 	$298.78	$0.00	$323.00	$181.69	$181.69	$0.00	$0.00	$0.00	$84.15	$299.66	$299.66	$0.00	$0.00	$84.14	$0.00	$238.82	$238.82	$0.00	$201.88	$319.77	$323.00	$0.00		$0.00	$63.19	$0.00	$0.00	$64.28	$0.00	$0.00	$0.00	$0.00	$0.00
101-R25	SUP	HCPCS C1713		101-R25  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
1022-0004	SUP	Custom 27803010		1022-0004  -  STEM FEM COLLAR SMTH OMFLX 4	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1022-0005	SUP	Custom 27803010		1022-0005  -  STEM FEM COLLAR SMTH OMFLX 5	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1022-0006	SUP	Custom 27803010		1022-0006  -  STEM FEM COLLAR SMTH OMFLX 6	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1022-0007	SUP	Custom 27803010		1022-0007  -  STEM FEM COLLAR SMTH OMFLX 7	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1022-0008	SUP	Custom 27803010		1022-0008  -  STEM FEM COLLAR SMTH OMFLX 8	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1022-0009	SUP	Custom 27803010		1022-0009  -  STEM FEM COLLAR SMTH OMFLX 9	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1022-0010	SUP	Custom 27803010		1022-0010  -  STEM FEM COLLAR SMTH OMFLX 10	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1022-0011	SUP	Custom 27803010		1022-0011  -  STEM FEM COLLAR SMTH OMFLX 11	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1022-0012	SUP	Custom 27803010		1022-0012  -  STEM FEM COLLAR SMTH OMFLX 12	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1022-0013	SUP	Custom 27803010		1022-0013  -  STEM FEM COLLAR SMTH OMFLX 13	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1022-0014	SUP	Custom 27803010		1022-0014  -  STEM FEM COLLAR SMTH OMFLX 14	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103.25.180	SUP	Custom 27203010		103.25.180  -  BIT DRL 2 FLUT 2.5MM 180MM 154MM QC	BOTH IP/OP	$208.00 	$153.92	$0.00	$166.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.38	$154.38	$0.00	$0.00	$43.35	$0.00	$0.00	$0.00	$0.00	$104.00	$164.74	$166.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103-0304	SUP	Custom 27203010		103-0304  -  DEVICE CADENCE PRCS 1ML SYR INJECTOR INFLAT	BOTH IP/OP	$237.50 	$175.75	$0.00	$199.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$124.75	$197.60	$199.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
103-0601-200	SUP	HCPCS C1769		103-0601-200  -  GWIRE VASC .01IN 200CM 10CM SILVERSPEED HYDPHI	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$312.23	$312.23	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$287.50	$455.40	$460.00	$0.00		$0.00	$89.99	$0.00	$0.00	$91.54	$0.00	$0.00	$0.00	$0.00	$0.00
103-0602-300	SUP	HCPCS C1769		103-0602-300  -  GWIRE VASC .014IN 300CM 20CM FLXB EXCH XCLRT HYDPHI	BOTH IP/OP	$867.50 	$641.95	$0.00	$694.00	$471.05	$471.05	$0.00	$0.00	$0.00	$180.81	$643.86	$643.86	$0.00	$0.00	$180.79	$0.00	$513.13	$513.13	$0.00	$433.75	$687.06	$694.00	$0.00		$0.00	$135.76	$0.00	$0.00	$138.11	$0.00	$0.00	$0.00	$0.00	$0.00
103-0603-200	SUP	HCPCS C1769		103-0603-200  -  GWIRE VASC .016IN 200CM FLXB SILVERSPEED HYDPHI	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$291.86	$291.86	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$0.00	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00		$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
103-0605-200	SUP	HCPCS C1769		103-0605-200  -  GWIRE VASC 175CM 20CM .014IN SFT COIL TIP HYDPHI XPDN	BOTH IP/OP	$657.50 	$486.55	$0.00	$526.00	$357.02	$357.02	$0.00	$0.00	$0.00	$137.04	$488.00	$488.00	$0.00	$0.00	$137.02	$0.00	$388.91	$388.91	$0.00	$328.75	$520.74	$526.00	$0.00		$0.00	$102.90	$0.00	$0.00	$104.67	$0.00	$0.00	$0.00	$0.00	$0.00
103-0608	SUP	HCPCS C1769		103-0608  -  GWIRE VASC .008IN 200CM 10CM SFT COIL TIP TPR X SPRT MRG	BOTH IP/OP	"$1,090.00 "	$806.60	$0.00	$872.00	$591.87	$591.87	$0.00	$0.00	$0.00	$227.18	$809.00	$809.00	$0.00	$0.00	$227.16	$0.00	$644.74	$644.74	$0.00	$545.00	$863.28	$872.00	$0.00		$0.00	$170.59	$0.00	$0.00	$173.53	$0.00	$0.00	$0.00	$0.00	$0.00
103-L05	SUP	HCPCS C1713		103-L05  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$403.75 	$298.78	$0.00	$323.00	$181.69	$181.69	$0.00	$0.00	$0.00	$84.15	$299.66	$299.66	$0.00	$0.00	$84.14	$0.00	$238.82	$238.82	$0.00	$201.88	$319.77	$323.00	$0.00		$0.00	$63.19	$0.00	$0.00	$64.28	$0.00	$0.00	$0.00	$0.00	$0.00
103-R05	SUP	HCPCS C1713		103-R05  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$408.00 	$301.92	$0.00	$326.40	$183.60	$183.60	$0.00	$0.00	$0.00	$85.04	$302.82	$302.82	$0.00	$0.00	$85.03	$0.00	$241.33	$241.33	$0.00	$204.00	$323.14	$326.40	$0.00		$0.00	$63.85	$0.00	$0.00	$64.95	$0.00	$0.00	$0.00	$0.00	$0.00
10-403FC	SUP	Custom 27203010		10-403FC -  DEVICE SPECIMEN RETRIEVAL TISSUE REMOVAL MYOSURE	BOTH IP/OP	"$3,890.00 "	"$2,878.60"	$0.00	"$3,112.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,887.16"	"$2,887.16"	$0.00	$0.00	$810.68	$0.00	$0.00	$0.00	$0.00	"$1,945.00"	"$3,080.88"	"$3,112.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104-4112	SUP	HCPCS C2628		104-4112  -  CATH BLNOCC 2.8-2.2FR 4MM 150CM 15MM REINF SHFT HYDPHI	BOTH IP/OP	"$2,675.00 "	"$1,979.50"	$0.00	"$2,140.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$557.54	"$1,985.39"	"$1,985.39"	$0.00	$0.00	$557.47	$0.00	"$1,582.26"	"$1,582.26"	$0.00	"$1,337.50"	"$2,118.60"	"$2,140.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104-4127	SUP	HCPCS C2628		104-4127  -  CATH BLNOCC 2.8-2.2FR 20MM 150CM 4MM REINF SHFT HYDPHI	BOTH IP/OP	"$2,562.50 "	"$1,896.25"	$0.00	"$2,050.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$534.09	"$1,901.89"	"$1,901.89"	$0.00	$0.00	$534.03	$0.00	"$1,515.72"	"$1,515.72"	$0.00	"$1,281.25"	"$2,029.50"	"$2,050.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104-4132	SUP	HCPCS C2628		104-4132  -  CATH BLNOCC 2.3FR 4MM 150CM 30MM REINF SHFT HYDPHI	BOTH IP/OP	"$2,562.50 "	"$1,896.25"	$0.00	"$2,050.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$534.09	"$1,901.89"	"$1,901.89"	$0.00	$0.00	$534.03	$0.00	"$1,515.72"	"$1,515.72"	$0.00	"$1,281.25"	"$2,029.50"	"$2,050.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104-4310	SUP	HCPCS C1726		104-4310  -  HYPERGLIDE 3.0 X 10MM	BOTH IP/OP	"$2,675.00 "	"$1,979.50"	$0.00	"$2,140.00"	"$1,452.53"	"$1,452.53"	$0.00	$0.00	$0.00	$557.54	"$1,985.39"	"$1,985.39"	$0.00	$0.00	$557.47	$0.00	"$1,582.26"	"$1,582.26"	$0.00	"$1,337.50"	"$2,118.60"	"$2,140.00"	$0.00		$0.00	$418.64	$0.00	$0.00	$425.86	$0.00	$0.00	$0.00	$0.00	$0.00
104-4315	SUP	HCPCS C2628		104-4315  -  CATHETER BALLOON  HYPERGLIDE .010 IN L150 CM L15 MM	BOTH IP/OP	"$2,675.00 "	"$1,979.50"	$0.00	"$2,140.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$557.54	"$1,985.39"	"$1,985.39"	$0.00	$0.00	$557.47	$0.00	"$1,582.26"	"$1,582.26"	$0.00	"$1,337.50"	"$2,118.60"	"$2,140.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104-4470	SUP	HCPCS C1751		104-4470  -  CATHETER BLNOCC .01IN 2MM 2.5-2.8FR 4MM 150CM 7MM HYPERFORM	BOTH IP/OP	"$3,312.50 "	"$2,451.25"	$0.00	"$2,650.00"	"$1,798.69"	"$1,798.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,656.25"	"$2,623.50"	"$2,650.00"	$0.00		$0.00	$518.41	$0.00	$0.00	$527.35	$0.00	$0.00	$0.00	$0.00	$0.00
104-44770	SUP	HCPCS C2628		"104-44770  -  BALLOON, HYPERFORM 4MM X 7MM"	BOTH IP/OP	"$3,312.50 "	"$2,451.25"	$0.00	"$2,650.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$690.41	"$2,458.54"	"$2,458.54"	$0.00	$0.00	$690.33	$0.00	"$1,959.34"	"$1,959.34"	$0.00	"$1,656.25"	"$2,623.50"	"$2,650.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104-4515	SUP	HCPCS C1757		104-4515  -  CATHETER BLNOCC .01IN 4MM 2.8-2.2FR 5MM 150CM 15MM	BOTH IP/OP	"$2,675.00 "	"$1,979.50"	$0.00	"$2,140.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$557.54	"$1,985.39"	"$1,985.39"	$0.00	$0.00	$557.47	$0.00	"$1,582.26"	"$1,582.26"	$0.00	"$1,337.50"	"$2,118.60"	"$2,140.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104-4520	SUP	HCPCS C1757		104-4520  -  CATHETER BLNOCC 4MM 2.8-2.2FR 5MM 150CM 20MM HYPERGLIDE 1	BOTH IP/OP	"$2,562.50 "	"$1,896.25"	$0.00	"$2,050.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$534.09	"$1,901.89"	"$1,901.89"	$0.00	$0.00	$534.03	$0.00	"$1,515.72"	"$1,515.72"	$0.00	"$1,281.25"	"$2,029.50"	"$2,050.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104-4770	SUP	HCPCS C2628		104-4770  -  CATH BLNOCC .01IN 7MM 150CM 7MM GWIRE SL ASYM VASCULATURE	BOTH IP/OP	"$3,312.50 "	"$2,451.25"	$0.00	"$2,650.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$690.41	"$2,458.54"	"$2,458.54"	$0.00	$0.00	$690.33	$0.00	"$1,959.34"	"$1,959.34"	$0.00	"$1,656.25"	"$2,623.50"	"$2,650.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104834-001	SUP	Custom 27203010		104834-001  -  CATHETER THROMBECTOMY Y SPIKE 6FR LATEX FREE ANGIOJET POWER	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
104834-002	SUP	HCPCS C1757		104834-002  -  KIT THRMB 1.5MM 3-4FR 145CM LF 15MM ANGJT ULT ULT SYS OTW	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.72	$63.09	$63.09	$0.00	$0.00	$17.71	$0.00	$50.28	$50.28	$0.00	$42.50	$67.32	$68.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1050-02	SUP	Custom 27203010		1050-02  -  VLVLTM ANGIOSCOPIC ANTGRD 12.5CM LEMILLS	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	$0.00	$0.00	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1050-0523	SUP	HCPCS C1776		1050-0523  -  STEM FEM HDNK OMFT	BOTH IP/OP	"$5,486.00 "	"$4,059.64"	$0.00	"$4,388.80"	"$2,468.70"	"$2,468.70"	$0.00	$0.00	$0.00	"$1,143.42"	"$4,071.71"	"$4,071.71"	$0.00	$0.00	"$1,143.28"	$0.00	"$2,704.60"	"$2,704.60"	$0.00	"$2,743.00"	"$4,344.91"	"$4,388.80"	$0.00		$0.00	$858.56	$0.00	$0.00	$873.37	$0.00	$0.00	$0.00	$0.00	$0.00
1050-0531	SUP	HCPCS C1776		1050-0531  -  STEM FEM HDNK OMFT	BOTH IP/OP	"$5,486.00 "	"$4,059.64"	$0.00	"$4,388.80"	"$2,468.70"	"$2,468.70"	$0.00	$0.00	$0.00	"$1,143.42"	"$4,071.71"	"$4,071.71"	$0.00	$0.00	"$1,143.28"	$0.00	"$2,704.60"	"$2,704.60"	$0.00	"$2,743.00"	"$4,344.91"	"$4,388.80"	$0.00		$0.00	$858.56	$0.00	$0.00	$873.37	$0.00	$0.00	$0.00	$0.00	$0.00
1050-0727	SUP	HCPCS C1776		1050-0727  -  STEM FEM HDNK OMFT	BOTH IP/OP	"$5,486.00 "	"$4,059.64"	$0.00	"$4,388.80"	"$2,468.70"	"$2,468.70"	$0.00	$0.00	$0.00	"$1,143.42"	"$4,071.71"	"$4,071.71"	$0.00	$0.00	"$1,143.28"	$0.00	"$2,704.60"	"$2,704.60"	$0.00	"$2,743.00"	"$4,344.91"	"$4,388.80"	$0.00		$0.00	$858.56	$0.00	$0.00	$873.37	$0.00	$0.00	$0.00	$0.00	$0.00
1050-0737	SUP	HCPCS C1776		1050-0737  -  STEM FEM 37MM OMFT 7 HIP	BOTH IP/OP	"$5,486.00 "	"$4,059.64"	$0.00	"$4,388.80"	"$2,468.70"	"$2,468.70"	$0.00	$0.00	$0.00	"$1,143.42"	"$4,071.71"	"$4,071.71"	$0.00	$0.00	"$1,143.28"	$0.00	"$2,704.60"	"$2,704.60"	$0.00	"$2,743.00"	"$4,344.91"	"$4,388.80"	$0.00		$0.00	$858.56	$0.00	$0.00	$873.37	$0.00	$0.00	$0.00	$0.00	$0.00
1050-0747	SUP	HCPCS C1776		1050-0747  -  STEM FEM HDNK OMFT	BOTH IP/OP	"$5,486.00 "	"$4,059.64"	$0.00	"$4,388.80"	"$2,468.70"	"$2,468.70"	$0.00	$0.00	$0.00	"$1,143.42"	"$4,071.71"	"$4,071.71"	$0.00	$0.00	"$1,143.28"	$0.00	"$2,704.60"	"$2,704.60"	$0.00	"$2,743.00"	"$4,344.91"	"$4,388.80"	$0.00		$0.00	$858.56	$0.00	$0.00	$873.37	$0.00	$0.00	$0.00	$0.00	$0.00
1050-0932	SUP	HCPCS C1776		1050-0932  -  STEM FEM 32MM OMFT 9 HIP	BOTH IP/OP	"$5,486.00 "	"$4,059.64"	$0.00	"$4,388.80"	"$2,468.70"	"$2,468.70"	$0.00	$0.00	$0.00	"$1,143.42"	"$4,071.71"	"$4,071.71"	$0.00	$0.00	"$1,143.28"	$0.00	"$2,704.60"	"$2,704.60"	$0.00	"$2,743.00"	"$4,344.91"	"$4,388.80"	$0.00		$0.00	$858.56	$0.00	$0.00	$873.37	$0.00	$0.00	$0.00	$0.00	$0.00
1050-0943	SUP	HCPCS C1776		1050-0943  -  STEM FEM 43MM OMFT 9 HIP	BOTH IP/OP	"$5,486.00 "	"$4,059.64"	$0.00	"$4,388.80"	"$2,468.70"	"$2,468.70"	$0.00	$0.00	$0.00	"$1,143.42"	"$4,071.71"	"$4,071.71"	$0.00	$0.00	"$1,143.28"	$0.00	"$2,704.60"	"$2,704.60"	$0.00	"$2,743.00"	"$4,344.91"	"$4,388.80"	$0.00		$0.00	$858.56	$0.00	$0.00	$873.37	$0.00	$0.00	$0.00	$0.00	$0.00
1050-0955	SUP	HCPCS C1776		1050-0955  -  STEM FEM HDNK OMFT	BOTH IP/OP	"$5,486.00 "	"$4,059.64"	$0.00	"$4,388.80"	"$2,468.70"	"$2,468.70"	$0.00	$0.00	$0.00	"$1,143.42"	"$4,071.71"	"$4,071.71"	$0.00	$0.00	"$1,143.28"	$0.00	"$2,704.60"	"$2,704.60"	$0.00	"$2,743.00"	"$4,344.91"	"$4,388.80"	$0.00		$0.00	$858.56	$0.00	$0.00	$873.37	$0.00	$0.00	$0.00	$0.00	$0.00
1050-1136	SUP	HCPCS C1776		1050-1136  -  STEM FEM HDNK OMFT	BOTH IP/OP	"$5,486.00 "	"$4,059.64"	$0.00	"$4,388.80"	"$2,468.70"	"$2,468.70"	$0.00	$0.00	$0.00	"$1,143.42"	"$4,071.71"	"$4,071.71"	$0.00	$0.00	"$1,143.28"	$0.00	"$2,704.60"	"$2,704.60"	$0.00	"$2,743.00"	"$4,344.91"	"$4,388.80"	$0.00		$0.00	$858.56	$0.00	$0.00	$873.37	$0.00	$0.00	$0.00	$0.00	$0.00
1050-1149	SUP	HCPCS C1776		1050-1149  -  STEM FEM 49MM OMFT 11 HIP	BOTH IP/OP	"$5,486.00 "	"$4,059.64"	$0.00	"$4,388.80"	"$2,468.70"	"$2,468.70"	$0.00	$0.00	$0.00	"$1,143.42"	"$4,071.71"	"$4,071.71"	$0.00	$0.00	"$1,143.28"	$0.00	"$2,704.60"	"$2,704.60"	$0.00	"$2,743.00"	"$4,344.91"	"$4,388.80"	$0.00		$0.00	$858.56	$0.00	$0.00	$873.37	$0.00	$0.00	$0.00	$0.00	$0.00
1050-1163	SUP	HCPCS C1776		1050-1163  -  STEM FEM HDNK OMFT	BOTH IP/OP	"$5,486.00 "	"$4,059.64"	$0.00	"$4,388.80"	"$2,468.70"	"$2,468.70"	$0.00	$0.00	$0.00	"$1,143.42"	"$4,071.71"	"$4,071.71"	$0.00	$0.00	"$1,143.28"	$0.00	"$2,704.60"	"$2,704.60"	$0.00	"$2,743.00"	"$4,344.91"	"$4,388.80"	$0.00		$0.00	$858.56	$0.00	$0.00	$873.37	$0.00	$0.00	$0.00	$0.00	$0.00
105039-001	SUP	HCPCS C1757		105039-001  -  KIT CATH 50CM 6FR AVX ANGJT ULT .035IN CMPT SYS SHFT VSL OTW	BOTH IP/OP	"$1,850.00 "	"$1,369.00"	$0.00	"$1,480.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$385.59	"$1,373.07"	"$1,373.07"	$0.00	$0.00	$385.54	$0.00	"$1,094.28"	"$1,094.28"	$0.00	$925.00	"$1,465.20"	"$1,480.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
105040-001	SUP	HCPCS C1757		105040-001  -  SET THRMB 6FR 3MM 120CM LF ANGJT ULT XPEEDIOR 1 LUM OTW CATH	BOTH IP/OP	"$3,287.50 "	"$2,432.75"	$0.00	"$2,630.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$685.20	"$2,439.98"	"$2,439.98"	$0.00	$0.00	$685.12	$0.00	"$1,944.56"	"$1,944.56"	$0.00	"$1,643.75"	"$2,603.70"	"$2,630.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
105042-001	SUP	HCPCS C1757		105042-001  -  SET THROMBECTOMY XVC	BOTH IP/OP	"$4,362.50 "	"$3,228.25"	$0.00	"$3,490.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$909.25	"$3,237.85"	"$3,237.85"	$0.00	$0.00	$909.15	$0.00	"$2,580.42"	"$2,580.42"	$0.00	"$2,181.25"	"$3,455.10"	"$3,490.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
105-5055	SUP	HCPCS C1757		105-5055  -  CATHETER INFUS .010IN MICRO 2.7-1.5FR .013IN 170CM 25CM COIL	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
105-5056	SUP	HCPCS C1757		105-5056  -  CATHETER INFS .010IN MIC 2.7-1.5FR .013IN 170CM 25CM MRTHN	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
105-5091-150	SUP	HCPCS C1751		105-5091-150  -  CATH INFUS 250 PSI 5FR .014IN 155CM 150CM STR GWIRE NTNL	BOTH IP/OP	"$1,587.50 "	"$1,174.75"	$0.00	"$1,334.00"	$905.45	$905.45	$0.00	$0.00	$0.00	$330.87	"$1,178.24"	"$1,178.24"	$0.00	$0.00	$330.84	$0.00	$939.01	$939.01	$0.00	$833.75	"$1,320.66"	"$1,334.00"	$0.00		$0.00	$260.96	$0.00	$0.00	$265.47	$0.00	$0.00	$0.00	$0.00	$0.00
105-5092-150	SUP	HCPCS C1751		105-5092-150  -  CATH INFUS 45D MIC 2.4-1.9FR .014IN 150CM STR GWIRE BRAID	BOTH IP/OP	"$1,587.50 "	"$1,174.75"	$0.00	"$1,334.00"	$905.45	$905.45	$0.00	$0.00	$0.00	$330.87	"$1,178.24"	"$1,178.24"	$0.00	$0.00	$330.84	$0.00	$939.01	$939.01	$0.00	$833.75	"$1,320.66"	"$1,334.00"	$0.00		$0.00	$260.96	$0.00	$0.00	$265.47	$0.00	$0.00	$0.00	$0.00	$0.00
105-5094-153	SUP	HCPCS C1757		105-5094-153  -  MICROCATHETER GD 2.8-2.2FR 155CM NAUTICA 14XL OTW REINF ACPT	BOTH IP/OP	"$1,310.00 "	$969.40	$0.00	"$1,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$273.04	$972.28	$972.28	$0.00	$0.00	$273.00	$0.00	$774.87	$774.87	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1057-0018	SUP	HCPCS C1713		1057-0018  -  SPACER CMNT 18MM KNEE CMNT	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$33.75	$33.75	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$0.00	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
1057-0019	SUP	HCPCS C1713		1057-0019  -  SPACER CMNT 19MM KNEE CMNT	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$33.75	$33.75	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$0.00	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
1057-0020	SUP	HCPCS C1713		1057-0020  -  SPACER CMNT 20MM KNEE CMNT	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$33.75	$33.75	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$0.00	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
1057-0021	SUP	HCPCS C1713		1057-0021  -  SPACER CMNT 21MM KNEE CMNT	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$33.75	$33.75	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$0.00	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
1057-0022	SUP	HCPCS C1713		1057-0022  -  SPACER CMNT 22MM KNEE CMNT	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$33.75	$33.75	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$0.00	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
105-7100-060	SUP	Custom 27803010		105-7100-060  -  SYSTEM EMBL 1.5ML 1ML ONX18 SYR DMTH SLFXD	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,174.88"	"$4,174.88"	$0.00	$0.00	"$1,172.25"	$0.00	$0.00	$0.00	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
105-7100-080	SUP	HCPCS C1760		105-7100-080  -  PRTCL EMBL NADH LQ ONX34 8% EVOH	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,726.00"	"$2,658.38"	"$2,658.38"	$0.00	$0.00	$0.00	$0.00	"$4,174.88"	"$4,174.88"	$0.00	$0.00	"$1,172.25"	$0.00	$0.00	$0.00	$0.00	"$2,953.75"	"$4,678.74"	"$4,726.00"	$0.00		$0.00	$924.52	$0.00	$0.00	$940.47	$0.00	$0.00	$0.00	$0.00	$0.00
1058-0005	SUP	Custom 27803010		1058-0005  -  SPACER FEMORAL 5MM OMNIFIT BARIUM HIP PROXIMAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1058-0006	SUP	Custom 27803010		1058-0006  -  SPACER FEMORAL 6MM OMNIFIT BARIUM HIP PROXIMAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1058-0007	SUP	Custom 27803010		1058-0007  -  SPACER FEMORAL 7MM OMNIFIT BARIUM HIP PROXIMAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1058-0008	SUP	Custom 27803010		1058-0008  -  SPACER FEMORAL 8MM OMNIFIT BARIUM HIP PROXIMAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1058-0009	SUP	Custom 27803010		1058-0009  -  SPACER FEMORAL 9MM OMNIFIT BARIUM HIP PROXIMAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1058-0010	SUP	Custom 27803010		1058-0010  -  SPACER FEMORAL 10MM OMNIFIT BARIUM HIP PROXIMAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1058-0011	SUP	Custom 27803010		1058-0011  -  SPACER FEMORAL 11MM OMNIFIT BARIUM HIP PROXIMAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-2310	SUP	Custom 27803010		1059-2310  -  SPACER FEMORAL SMALL 10MM RING STYLE CEMENTED ACCOLADE C HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-2311	SUP	Custom 27803010		1059-2311  -  SPACER FEMORAL SMALL 11MM RING STYLE CEMENTED ACCOLADE C HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-2312	SUP	Custom 27803010		1059-2312  -  SPACER FEMORAL SMALL 12MM RING STYLE CEMENTED ACCOLADE C HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-2313	SUP	Custom 27803010		1059-2313  -  SPACER FEMORAL SMALL 13MM RING STYLE CEMENTED ACCOLADE C HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-2314	SUP	Custom 27803010		1059-2314  -  SPACER FEMORAL SMALL 14MM RING STYLE CEMENTED ACCOLADE C HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-2315	SUP	Custom 27803010		1059-2315  -  SPACER FEMORAL SMALL 15MM RING STYLE CEMENTED ACCOLADE C HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-4512	SUP	Custom 27803010		1059-4512  -  SPACER FEMORAL MEDIUM 12MM RING STYLE CEMENTED ACCOLADE C	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-4513	SUP	Custom 27803010		1059-4513  -  SPACER FEMORAL MEDIUM 13MM RING STYLE CEMENTED ACCOLADE C	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-4514	SUP	Custom 27803010		1059-4514  -  SPACER FEMORAL MEDIUM 14MM RING STYLE CEMENTED ACCOLADE C	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-4515	SUP	Custom 27803010		1059-4515  -  SPACER FEMORAL MEDIUM 15MM RING STYLE CEMENTED ACCOLADE C	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-4516	SUP	Custom 27803010		1059-4516  -  SPACER FEMORAL MEDIUM 16MM RING STYLE CEMENTED ACCOLADE C	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-4517	SUP	Custom 27803010		1059-4517  -  SPACER FEMORAL MEDIUM 17MM RING STYLE CEMENTED ACCOLADE C	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-6713	SUP	Custom 27803010		1059-6713  -  SPACER FEMORAL LARGE 13MM RING STYLE CEMENTED ACCOLADE C HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-6714	SUP	Custom 27803010		1059-6714  -  SPACER FEMORAL LARGE 14MM RING STYLE CEMENTED ACCOLADE C HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-6715	SUP	Custom 27803010		1059-6715  -  SPACER FEMORAL LARGE 15MM RING STYLE CEMENTED ACCOLADE C HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-6716	SUP	Custom 27803010		1059-6716  -  SPACER FEMORAL LARGE 16MM RING STYLE CEMENTED ACCOLADE C HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-6717	SUP	Custom 27803010		1059-6717  -  SPACER FEMORAL LARGE 17MM RING STYLE CEMENTED ACCOLADE C HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1059-6718	SUP	Custom 27803010		1059-6718  -  SPACER FEMORAL LARGE 18MM RING STYLE CEMENTED ACCOLADE C HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1064-0425	SUP	HCPCS C1776		1064-0425  -  STEM FEM CMNT OMFT EON HIP	BOTH IP/OP	"$5,062.00 "	"$3,745.88"	$0.00	"$4,049.60"	"$2,277.90"	"$2,277.90"	$0.00	$0.00	$0.00	"$1,055.05"	"$3,757.02"	"$3,757.02"	$0.00	$0.00	"$1,054.92"	$0.00	"$2,495.57"	"$2,495.57"	$0.00	"$2,531.00"	"$4,009.10"	"$4,049.60"	$0.00		$0.00	$792.20	$0.00	$0.00	$805.87	$0.00	$0.00	$0.00	$0.00	$0.00
1064-0525	SUP	HCPCS C1776		1064-0525  -  OMNIFIT CEMENTED STEM (MT)	BOTH IP/OP	"$5,062.00 "	"$3,745.88"	$0.00	"$4,049.60"	"$2,277.90"	"$2,277.90"	$0.00	$0.00	$0.00	"$1,055.05"	"$3,757.02"	"$3,757.02"	$0.00	$0.00	"$1,054.92"	$0.00	"$2,495.57"	"$2,495.57"	$0.00	"$2,531.00"	"$4,009.10"	"$4,049.60"	$0.00		$0.00	$792.20	$0.00	$0.00	$805.87	$0.00	$0.00	$0.00	$0.00	$0.00
1064-0625	SUP	HCPCS C1776		1064-0625  -  STEM FEM CMNT OMFT EON HIP	BOTH IP/OP	"$3,657.00 "	"$2,706.18"	$0.00	"$2,925.60"	"$1,645.65"	"$1,645.65"	$0.00	$0.00	$0.00	$762.21	"$2,714.23"	"$2,714.23"	$0.00	$0.00	$762.12	$0.00	"$1,802.90"	"$1,802.90"	$0.00	"$1,828.50"	"$2,896.34"	"$2,925.60"	$0.00		$0.00	$572.32	$0.00	$0.00	$582.19	$0.00	$0.00	$0.00	$0.00	$0.00
1064-0730	SUP	HCPCS C1776		1064-0730  -  STEM FEM CMNT OMFT EON HIP	BOTH IP/OP	"$5,062.00 "	"$3,745.88"	$0.00	"$4,049.60"	"$2,277.90"	"$2,277.90"	$0.00	$0.00	$0.00	"$1,055.05"	"$3,757.02"	"$3,757.02"	$0.00	$0.00	"$1,054.92"	$0.00	"$2,495.57"	"$2,495.57"	$0.00	"$2,531.00"	"$4,009.10"	"$4,049.60"	$0.00		$0.00	$792.20	$0.00	$0.00	$805.87	$0.00	$0.00	$0.00	$0.00	$0.00
1064-0830	SUP	HCPCS C1776		1064-0830  -  STEM FEM CMNT OMFT EON HIP	BOTH IP/OP	"$5,062.00 "	"$3,745.88"	$0.00	"$4,049.60"	"$2,277.90"	"$2,277.90"	$0.00	$0.00	$0.00	"$1,055.05"	"$3,757.02"	"$3,757.02"	$0.00	$0.00	"$1,054.92"	$0.00	"$2,495.57"	"$2,495.57"	$0.00	"$2,531.00"	"$4,009.10"	"$4,049.60"	$0.00		$0.00	$792.20	$0.00	$0.00	$805.87	$0.00	$0.00	$0.00	$0.00	$0.00
106552-001	SUP	HCPCS C1757		106552-001  -  CATH THRMB 90CM 6FR ANGJT DVX ULT .035IN OTW LP TIP RADIOPQ	BOTH IP/OP	"$3,787.50 "	"$2,802.75"	$0.00	"$3,030.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$789.41	"$2,811.08"	"$2,811.08"	$0.00	$0.00	$789.32	$0.00	"$2,240.31"	"$2,240.31"	$0.00	"$1,893.75"	"$2,999.70"	"$3,030.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106553-001	SUP	HCPCS C1757		106553-001  -  SET THROMBECTOMY LONG TAPER 4FR 2MM 135CM OTW RAPEX CATHETER	BOTH IP/OP	"$4,487.50 "	"$3,320.75"	$0.00	"$3,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$935.31	"$3,330.62"	"$3,330.62"	$0.00	$0.00	$935.20	$0.00	"$2,654.36"	"$2,654.36"	$0.00	"$2,243.75"	"$3,554.10"	"$3,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
106608-001	SUP	HCPCS C1757		106608-001  -  SET CATH 135CM 5FR 3MM SPIROFLEX VG ANGJT .014IN THRMB GWIRE	BOTH IP/OP	"$5,375.00 "	"$3,977.50"	$0.00	"$4,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.28"	"$3,989.33"	"$3,989.33"	$0.00	$0.00	"$1,120.15"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,687.50"	"$4,257.00"	"$4,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0002	SUP	HCPCS C1713		1067-0002  -  SPACER FEMORAL UNIVERSAL HOLE PLUG CEMENTED OMNIFIT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0008	SUP	HCPCS C1713		1067-0008  -  SPACER FEMORAL UNIVERSAL 8MM CEMENTED ACCOLADE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0009	SUP	HCPCS C1713		1067-0009  -  SPACER FEMORAL UNIVERSAL 9MM CEMENTED ACCOLADE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0010	SUP	Custom 27803010		1067-0010  -  SPACER CMNT UNV 10MM HIP DIST	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0011	SUP	HCPCS C1713		1067-0011  -  SPACER FEMORAL UNIVERSAL 11MM CEMENTED ACCOLADE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0012	SUP	Custom 27803010		1067-0012  -  SPACER FEMORAL UNIVERSAL 12MM CEMENTED ACCOLADE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0013	SUP	HCPCS C1713		1067-0013  -  SPACER FEMORAL UNIVERSAL 13MM CEMENTED ACCOLADE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0014	SUP	HCPCS C1713		1067-0014  -  SPACER CMNT UNV 14MM ACLD HIP DIST	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0015	SUP	HCPCS C1713		1067-0015  -  SPACER FEMORAL UNIVERSAL 15MM CEMENTED ACCOLADE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0016	SUP	HCPCS C1713		1067-0016  -  SPACER CMNT UNV 16MM ACLD HIP DIST	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0017	SUP	HCPCS C1713		1067-0017  -  SPACER CMNT UNV 17MM ACLD HIP DIST	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0018	SUP	HCPCS C1713		1067-0018  -  SPACER FEMORAL UNIVERSAL 18MM CEMENTED ACCOLADE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0019	SUP	HCPCS C1713		1067-0019  -  SPACER CMNT UNV 19MM ACLD HIP DIST	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0020	SUP	HCPCS C1713		1067-0020  -  SPACER FEMORAL UNIVERSAL 20MM PRIM C-STEM HIP DISTAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0021	SUP	HCPCS C1713		1067-0021  -  SPACER CMNT UNV 21MM ACLD HIP DIST	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0022	SUP	HCPCS C1713		1067-0022  -  SPACER CMNT UNV 22MM ACLD HIP DIST	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0023	SUP	HCPCS C1713		1067-0023  -  SPACER CMNT UNV 23MM ACLD HIP DIST	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0024	SUP	HCPCS C1713		1067-0024  -  SPACER CMNT UNV 24MM ACLD HIP DIST	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1067-0025	SUP	HCPCS C1713		1067-0025  -  SPACER FEM UNV 25MM ACLD POLYMETHYLMETHACRYLATE DIST HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
1074225-08	SUP	HCPCS C1874		1074225-08  -  STENT CORON .014IN TAPER 2.25MM 8MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074225-12	SUP	HCPCS C1874		1074225-12  -  STENT CORON .014IN TAPER 2.25MM 12MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074225-15	SUP	HCPCS C1874		1074225-15  -  STENT CORON .014IN TAPER 2.25MM 15MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074225-18	SUP	HCPCS C1874		1074225-18  -  STENT CORON .014IN TAPER 2.25MM 18MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074225-23	SUP	HCPCS C1874		1074225-23  -  STENT CORON .014IN TAPER 2.25MM 23MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074225-28	SUP	HCPCS C1874		1074225-28  -  STENT CORON .014IN TAPER 2.25MM 28MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074250-08	SUP	HCPCS C1874		1074250-08  -  STENT CORON .014IN TAPER 2.5MM 8MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074250-12	SUP	HCPCS C1874		1074250-12  -  STENT CORON .014IN TAPER 2.5MM 12MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074250-15	SUP	HCPCS C1874		1074250-15  -  STENT CORON .014IN TAPER 2.5MM 15MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074250-18	SUP	HCPCS C1874		1074250-18  -  STENT CORON .014IN TAPER 2.5MM 18MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074250-23	SUP	HCPCS C1874		1074250-23  -  STENT CORON .014IN TAPER 2.5MM 23MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074250-28	SUP	HCPCS C1874		1074250-28  -  STENT CORON .014IN TAPER 2.5MM 28MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074250-33	SUP	HCPCS C1874		1074250-33  -  STENT CORON .014IN TAPER 2.5MM 33MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074250-38	SUP	HCPCS C1874		1074250-38  -  STENT CORON .014IN TAPER 2.5MM 38MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074275-08	SUP	HCPCS C1874		1074275-08  -  STENT CORON .014IN TAPER 2.75MM 8MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074275-12	SUP	HCPCS C1874		1074275-12  -  STENT CORON .014IN TAPER 2.75MM 12MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074275-15	SUP	HCPCS C1874		1074275-15  -  STENT CORON .014IN TAPER 2.75MM 15MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074275-18	SUP	HCPCS C1874		1074275-18  -  STENT CORON .014IN TAPER 2.75MM 18MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074275-23	SUP	HCPCS C1874		1074275-23  -  STENT CORON .014IN TAPER 2.75MM 23MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074275-28	SUP	HCPCS C1874		1074275-28  -  STENT CORON .014IN TAPER 2.75MM 28MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074275-33	SUP	HCPCS C1874		1074275-33  -  STENT CORON .014IN TAPER 2.75MM 33MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074275-38	SUP	HCPCS C1874		1074275-38  -  STENT CORON .014IN TAPER 2.75MM 38MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074300-08	SUP	HCPCS C1874		1074300-08  -  STENT CORON .014IN TAPER 3MM 8MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074300-12	SUP	HCPCS C1874		1074300-12  -  STENT CORON .014IN TAPER 3MM 12MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074300-15	SUP	HCPCS C1874		1074300-15  -  STENT CORON .014IN TAPER 3MM 15MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074300-18	SUP	HCPCS C1874		1074300-18  -  STENT CORON .014IN TAPER 3MM 18MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074300-23	SUP	HCPCS C1874		1074300-23  -  STENT CORON .014IN TAPER 3MM 23MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074300-28	SUP	HCPCS C1874		1074300-28  -  STENT CORON .014IN TAPER 3MM 28MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074300-33	SUP	HCPCS C1874		1074300-33  -  STENT CORON .014IN TAPER 3MM 33MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074300-38	SUP	HCPCS C1874		1074300-38  -  STENT CORON .014IN TAPER 3MM 38MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074325-08	SUP	HCPCS C1874		1074325-08  -  STENT CORON .014IN TAPER 3.25MM .028IN 5FR 8MM 145CM 2	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074325-12	SUP	HCPCS C1874		1074325-12  -  STENT CORON .014IN TAPER 3.25MM .028IN 5FR 12MM 145CM 2	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074325-18	SUP	HCPCS C1874		1074325-18  -  STENT CORON .014IN TAPER 3.25MM 18MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074325-23	SUP	HCPCS C1874		1074325-23  -  STENT CORON .014IN TAPER 3.25MM 23MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074325-28	SUP	HCPCS C1874		1074325-28  -  STENT CORON .014IN TAPER 3.25MM 28MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074325-33	SUP	HCPCS C1874		1074325-33  -  STENT CORON .014IN TAPER 3.25MM 33MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074325-38	SUP	HCPCS C1874		1074325-38  -  STENT CORON .014IN TAPER 3.25MM 38MM 145CM 2 RADIOPQ MARKER	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074350-08	SUP	HCPCS C1874		1074350-08  -  STENT CORON .014IN TAPER 3.5MM 8MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074350-12	SUP	HCPCS C1874		1074350-12  -  STENT CORON .014IN TAPER 3.5MM 12MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074350-15	SUP	HCPCS C1874		1074350-15  -  STENT CORON .014IN TAPER 3.5MM 15MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074350-18	SUP	HCPCS C1874		1074350-18  -  STENT CORON .014IN TAPER 3.5MM 18MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074350-23	SUP	HCPCS C1874		1074350-23  -  STENT CORON .014IN TAPER 3.5MM 23MM 145CM 2 RADIOPQ 1 ACCES	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074350-28	SUP	HCPCS C1874		1074350-28  -  STENT CORON .014IN TAPER 3.5MM 28MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074350-33	SUP	HCPCS C1874		1074350-33  -  STENT CORON .014IN TAPER 3.5MM 33MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074350-38	SUP	HCPCS C1874		1074350-38  -  STENT CORON .014IN TAPER 3.5MM 38MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074400-08	SUP	HCPCS C1874		1074400-08  -  STENT CORON .014IN TAPER 4MM 8MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074400-12	SUP	HCPCS C1874		1074400-12  -  STENT CORON .014IN TAPER 4MM 12MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074400-15	SUP	HCPCS C1874		1074400-15  -  STENT CORON .014IN TAPER 4MM 15MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074400-18	SUP	HCPCS C1874		1074400-18  -  STENT CORON .014IN TAPER 4MM 18MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074400-23	SUP	HCPCS C1874		1074400-23  -  STENT CORON .014IN TAPER 4MM 23MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074400-28	SUP	HCPCS C1874		1074400-28  -  STENT CORON .014IN TAPER 4MM 28MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074400-33	SUP	HCPCS C1874		1074400-33  -  STENT CORON .014IN TAPER 4MM 33MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1074400-38	SUP	HCPCS C1874		1074400-38  -  STENT CORON .014IN TAPER 4MM 38MM 145CM 2 RADIOPQ MARKER 1	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
1082-MED	SUP	HCPCS L3702		1082-MED  -  SPRT ORTH MED 10IN LS CRST ELAST VLCR CLSR WHT	BOTH IP/OP	$44.75 	$33.12	$0.00	$208.54	$20.14	$20.14	$0.00	$0.00	$198.92	$208.54	$33.21	$33.21	$0.00	$0.00	$9.33	$0.00	$26.47	$26.47	$0.00	$22.38	$35.44	$35.80	$26.85		$26.85	$198.56	$0.00	$0.00	$202.65	$0.00	$0.00	$0.00	$0.00	$0.00
109681-001	SUP	HCPCS C1757		109681-001  -  SET THROMBECTOMY 6FR 3MM 120CM 15MM OTW CONTRAST INJEC PORT	BOTH IP/OP	"$4,225.00 "	"$3,126.50"	$0.00	"$3,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$880.60	"$3,135.80"	"$3,135.80"	$0.00	$0.00	$880.49	$0.00	"$2,499.09"	"$2,499.09"	$0.00	"$2,112.50"	"$3,346.20"	"$3,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10A001	SUP	Custom 27804086		10A001  -  GRAFT BONE 1-4MM CANCELLOUS CORTICAL 30ML	BOTH IP/OP	"$1,042.50 "	$771.45	$0.00	$834.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$773.74	$773.74	$0.00	$0.00	$217.26	$0.00	$0.00	$0.00	$0.00	$521.25	$825.66	$834.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10A002	SUP	Custom 27804086		10A002  -  GRAFT BONE 1-4MM CANCELLOUS CORTICAL 15ML	BOTH IP/OP	$595.00 	$440.30	$0.00	$476.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$441.61	$441.61	$0.00	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$297.50	$471.24	$476.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10AC50	SUP	Custom 27203010		10AC50  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$314.50 	$232.73	$0.00	$251.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.42	$233.42	$0.00	$0.00	$65.54	$0.00	$0.00	$0.00	$0.00	$157.25	$249.08	$251.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10AC60	SUP	Custom 27203010		10AC60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$314.50 	$232.73	$0.00	$251.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.42	$233.42	$0.00	$0.00	$65.54	$0.00	$0.00	$0.00	$0.00	$157.25	$249.08	$251.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA10	SUP	Custom 27203010		10BA10  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA10D	SUP	Custom 27203010		10BA10D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA10D-MN	SUP	Custom 27203010		10BA10D-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA10-MN	SUP	Custom 27203010		10BA10-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA20	SUP	Custom 27203010		10BA20  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA20D	SUP	Custom 27203010		10BA20D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA20D-MN	SUP	Custom 27203010		10BA20D-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA20-MN	SUP	Custom 27203010		10BA20-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA30	SUP	Custom 27203010		10BA30  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA30D	SUP	Custom 27203010		10BA30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA30DC	SUP	Custom 27203010		10BA30DC  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$329.38 	$243.74	$0.00	$263.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.46	$244.46	$0.00	$0.00	$68.64	$0.00	$0.00	$0.00	$0.00	$164.69	$260.87	$263.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA30D-MN	SUP	Custom 27203010		10BA30D-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA30-MN	SUP	Custom 27203010		10BA30-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA40	SUP	Custom 27203010		10BA40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA40D	SUP	Custom 27203010		10BA40D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA40DC	SUP	Custom 27203010		10BA40DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$335.75 	$248.46	$0.00	$268.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.19	$249.19	$0.00	$0.00	$69.97	$0.00	$0.00	$0.00	$0.00	$167.88	$265.91	$268.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA40D-MN	SUP	Custom 27203010		10BA40D-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA40DX	SUP	Custom 27203010		10BA40DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$346.38 	$256.32	$0.00	$277.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.08	$257.08	$0.00	$0.00	$72.18	$0.00	$0.00	$0.00	$0.00	$173.19	$274.33	$277.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA40-MN	SUP	Custom 27203010		10BA40-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$314.50 	$232.73	$0.00	$251.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.42	$233.42	$0.00	$0.00	$65.54	$0.00	$0.00	$0.00	$0.00	$157.25	$249.08	$251.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA50	SUP	Custom 27203010		10BA50  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$320.88 	$237.45	$0.00	$256.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.15	$238.15	$0.00	$0.00	$66.87	$0.00	$0.00	$0.00	$0.00	$160.44	$254.14	$256.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA50D	SUP	Custom 27203010		10BA50D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$329.38 	$243.74	$0.00	$263.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.46	$244.46	$0.00	$0.00	$68.64	$0.00	$0.00	$0.00	$0.00	$164.69	$260.87	$263.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA50DC	SUP	Custom 27203010		10BA50DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$329.38 	$243.74	$0.00	$263.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.46	$244.46	$0.00	$0.00	$68.64	$0.00	$0.00	$0.00	$0.00	$164.69	$260.87	$263.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA50D-MN	SUP	Custom 27203010		10BA50D-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA50DX	SUP	Custom 27203010		10BA50DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$335.75 	$248.46	$0.00	$268.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.19	$249.19	$0.00	$0.00	$69.97	$0.00	$0.00	$0.00	$0.00	$167.88	$265.91	$268.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA50-MN	SUP	Custom 27203010		10BA50-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$308.13 	$228.02	$0.00	$246.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.69	$228.69	$0.00	$0.00	$64.21	$0.00	$0.00	$0.00	$0.00	$154.06	$244.04	$246.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA60	SUP	Custom 27203010		10BA60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA60D	SUP	Custom 27203010		10BA60D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA60D-MN	SUP	Custom 27203010		10BA60D-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA60DX	SUP	Custom 27203010		10BA60DX  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10BA60-MN	SUP	Custom 27203010		10BA60-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$308.13 	$228.02	$0.00	$246.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.69	$228.69	$0.00	$0.00	$64.21	$0.00	$0.00	$0.00	$0.00	$154.06	$244.04	$246.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10CY40	SUP	Custom 27203010		10CY40  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10CY40BR	SUP	Custom 27203010		10CY40BR  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$354.88 	$262.61	$0.00	$283.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.39	$263.39	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.44	$281.06	$283.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10CY50	SUP	Custom 27203010		10CY50  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10CY50BR	SUP	Custom 27203010		10CY50BR  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$354.88 	$262.61	$0.00	$283.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.39	$263.39	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.44	$281.06	$283.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10CY50L	SUP	Custom 27203010		10CY50L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$0.00	$0.00	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10CY60	SUP	Custom 27203010		10CY60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10CY60BR	SUP	Custom 27203010		10CY60BR  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$354.88 	$262.61	$0.00	$283.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.39	$263.39	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.44	$281.06	$283.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10CY65DX	SUP	Custom 27203010		10CY65DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$340.00 	$251.60	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.35	$252.35	$0.00	$0.00	$70.86	$0.00	$0.00	$0.00	$0.00	$170.00	$269.28	$272.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10DCT	SUP	Custom 27203010		10DCT  -  TUBE TRCH 10 13.8MM 8.9MM 79MM STRL LF SHLY CUF DISP INR CNN	BOTH IP/OP	$93.68 	$69.32	$0.00	$76.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.53	$69.53	$0.00	$0.00	$19.52	$0.00	$0.00	$0.00	$0.00	$47.54	$75.30	$76.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10DFEN	SUP	Custom 27203010		10DFEN  -  TUBE TRACHEOSTOMY 10 13MM 8.9MM 79MM CUFF DISPOSABLE INNER	BOTH IP/OP	$91.35 	$67.60	$0.00	$73.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.80	$67.80	$0.00	$0.00	$19.04	$0.00	$0.00	$0.00	$0.00	$45.68	$72.35	$73.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10LGT	SUP	Custom 27203010		10LGT  -  TUBE TRACHEOSTOMY 10 13.7MM 8.9MM 50MM SMOOTH INNER CANNU	BOTH IP/OP	$114.73 	$84.90	$0.00	$93.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.15	$85.15	$0.00	$0.00	$23.91	$0.00	$0.00	$0.00	$0.00	$58.22	$92.23	$93.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10LGT	SUP	Custom 27203010		TUBE 8.9MM UNCUF LRNTMY INR CANNU SHLY TRCH 10 DISP	BOTH IP/OP	$114.73 	$84.90	$0.00	$95.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.15	$85.15	$0.00	$0.00	$23.91	$0.00	$0.00	$0.00	$0.00	$58.22	$95.02	$93.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10MH17	SUP	Custom 27203010		10MH17  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$284.75 	$210.72	$0.00	$227.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.34	$211.34	$0.00	$0.00	$59.34	$0.00	$0.00	$0.00	$0.00	$142.38	$225.52	$227.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10MH17D	SUP	Custom 27203010		10MH17D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10MH22	SUP	Custom 27203010		10MH22  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$278.38 	$206.00	$0.00	$222.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.61	$206.61	$0.00	$0.00	$58.01	$0.00	$0.00	$0.00	$0.00	$139.19	$220.48	$222.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10MH22D	SUP	Custom 27203010		10MH22D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10MH30	SUP	Custom 27203010		10MH30  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$286.88 	$212.29	$0.00	$229.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.92	$212.92	$0.00	$0.00	$59.78	$0.00	$0.00	$0.00	$0.00	$143.44	$227.21	$229.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10MH30DC	SUP	Custom 27203010		10MH30DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$310.25 	$229.59	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.27	$230.27	$0.00	$0.00	$64.66	$0.00	$0.00	$0.00	$0.00	$155.13	$245.72	$248.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10MH30D-MN	SUP	Custom 27203010		10MH30D-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10MH30L	SUP	Custom 27203010		10MH30L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$354.88 	$262.61	$0.00	$283.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.39	$263.39	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.44	$281.06	$283.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10MH30-MN	SUP	Custom 27203010		10MH30-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$308.13 	$228.02	$0.00	$246.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.69	$228.69	$0.00	$0.00	$64.21	$0.00	$0.00	$0.00	$0.00	$154.06	$244.04	$246.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10OV40	SUP	Custom 27203010		10OV40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10OV40L	SUP	Custom 27203010		10OV40L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$342.13 	$253.18	$0.00	$273.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.93	$253.93	$0.00	$0.00	$71.30	$0.00	$0.00	$0.00	$0.00	$171.06	$270.97	$273.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10SCT	SUP	Custom 27203010		10SCT  -  TUBE TRACHEOSTOMY 10 13.3MM 10MM 105MM CANNU CUFF LOW	BOTH IP/OP	$71.38 	$52.82	$0.00	$57.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.97	$52.97	$0.00	$0.00	$14.87	$0.00	$0.00	$0.00	$0.00	$36.22	$57.38	$57.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10TA23	SUP	Custom 27203010		10TA23  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$295.38 	$218.58	$0.00	$236.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.23	$219.23	$0.00	$0.00	$61.56	$0.00	$0.00	$0.00	$0.00	$147.69	$233.94	$236.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10X52	SUP	Custom 27203010		10X52  -  SUTURE NONABSORBABLE 2-0 V-5 30IN 2 ARM BRAID 10 STRAND	BOTH IP/OP	$137.82 	$101.99	$0.00	$111.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.29	$102.29	$0.00	$0.00	$28.72	$0.00	$0.00	$0.00	$0.00	$69.94	$110.78	$111.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
10X72	SUP	Custom 27203010		10X72  -  SUTURE NONABSORBABLE 2-0 V-7 30IN 2 ARM BRAID 10 STRAND	BOTH IP/OP	$137.91 	$102.05	$0.00	$111.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.36	$102.36	$0.00	$0.00	$28.74	$0.00	$0.00	$0.00	$0.00	$69.99	$110.86	$111.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110-08	SUP	HCPCS C1713		110-08  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$248.63 	$183.99	$0.00	$198.90	$111.88	$111.88	$0.00	$0.00	$0.00	$51.82	$184.53	$184.53	$0.00	$0.00	$51.81	$0.00	$147.06	$147.06	$0.00	$124.31	$196.91	$198.90	$0.00		$0.00	$38.91	$0.00	$0.00	$39.58	$0.00	$0.00	$0.00	$0.00	$0.00
11-0401-CA	SUP	Custom 27203010		11-0401-CA  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,600.00 "	"$2,664.00"	$0.00	"$2,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,671.92"	"$2,671.92"	$0.00	$0.00	$750.24	$0.00	$0.00	$0.00	$0.00	"$1,800.00"	"$2,851.20"	"$2,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11-0401-CAL	SUP	Custom 27203010		11-0401-CAL  -  KIT CRANIOTOMY SEPS SLIDOCAINE EPINEPHRINE STERILE	BOTH IP/OP	"$4,221.00 "	"$3,123.54"	$0.00	"$3,376.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,132.83"	"$3,132.83"	$0.00	$0.00	$879.66	$0.00	$0.00	$0.00	$0.00	"$2,110.50"	"$3,343.03"	"$3,376.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
11-0401-CE	SUP	Custom 27203010		11-0401-CE  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,712.50 "	"$2,747.25"	$0.00	"$2,970.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,755.42"	"$2,755.42"	$0.00	$0.00	$773.69	$0.00	$0.00	$0.00	$0.00	"$1,856.25"	"$2,940.30"	"$2,970.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1104B	SUP	Custom 27803010		1104B  -  KIT PRESSURE MONITR TRANSDUCER TIPPED CATHETER DRILL BIT	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	$0.00	$0.00	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110-4HMC	SUP	Custom 27203010		110-4HMC  -  KIT PRSS MNTR MIC 4FR 12FR STRL CMN TRNDCR TIP CATH DRN STY	BOTH IP/OP	"$5,034.00 "	"$3,725.16"	$0.00	"$4,027.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,736.23"	"$3,736.23"	$0.00	$0.00	"$1,049.09"	$0.00	$0.00	$0.00	$0.00	"$2,517.00"	"$3,986.93"	"$4,027.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
110-4L	SUP	Custom 27803010		110-4L  -  KIT PRESSURE MONITR 4FR TRANSDUCER TIPPED CATHETER BOLT	BOTH IP/OP	"$2,007.50 "	"$1,485.55"	$0.00	"$1,606.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,489.97"	"$1,489.97"	$0.00	$0.00	$418.36	$0.00	$0.00	$0.00	$0.00	"$1,003.75"	"$1,589.94"	"$1,606.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1111-1-501	SUP	HCPCS C1713		1111-1-501  -  TRAY STRL ML NUT GRS-K LCK NAIL SYS	BOTH IP/OP	$368.50 	$272.69	$0.00	$294.80	$165.83	$165.83	$0.00	$0.00	$0.00	$76.80	$273.50	$273.50	$0.00	$0.00	$76.80	$0.00	$217.97	$217.97	$0.00	$184.25	$291.85	$294.80	$0.00		$0.00	$57.67	$0.00	$0.00	$58.67	$0.00	$0.00	$0.00	$0.00	$0.00
111303-001	SUP	Custom 27203010		111303-001  -  SET THROMBECTOMY .014IN 3FR 1.5MM 145CM OTW DISTAL SHAFT	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1120-1810	SUP	Custom 27203010		TIP PIP 1-20UL TIPONE BVL RK STRL NTR	BOTH IP/OP	$132.50 	$98.05	$0.00	$106.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.25	$104.94	$106.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1156T/75	SUP	HCPCS C1900		1156T/75  -  LEAD PCNG S LOPRFL 5-5.6FR 7FR 75CM 8MM QUICKFLEX IS-1 BP	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1156T/86	SUP	HCPCS C1900		1156T/86  -  QUICKFLEX+++PMM#:89271	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1158T/75	SUP	HCPCS C1900		1158T/75  -  QUICKFLEX+++PMM#:89272	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1158T/86	SUP	HCPCS C1900		1158T/86  -  LEAD PCNG 16MM S 7FR 86CM QUICKFLEX IS 1 BP CNCT STRBL TIP	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1174108D	SUP	HCPCS C1751		1174108D  -  CATHETER CV 4FR P PICC SHRLK 3CG LUM MAXIMAL BRR TPS STY PP	BOTH IP/OP	$516.28 	$382.05	$0.00	$417.20	$283.17	$283.17	$0.00	$0.00	$0.00	$107.60	$383.18	$383.18	$0.00	$0.00	$107.59	$0.00	$305.38	$305.38	$0.00	$260.75	$413.03	$417.20	$0.00		$0.00	$81.61	$0.00	$0.00	$83.02	$0.00	$0.00	$0.00	$0.00	$0.00
11-996-16	SUP	Custom 27203010		SCISSORS 6.25IN SMTH SRR NTCH SURG TC	BOTH IP/OP	$367.50 	$271.95	$0.00	$294.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.75	$291.06	$294.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1200-01-1022	SUP	HCPCS C1713		"1200-01-1022  -  DYNANAIL, 10 MM X 22 CM"	BOTH IP/OP	"$11,000.00 "	"$8,140.00"	$0.00	"$8,800.00"	"$4,950.00"	"$4,950.00"	$0.00	$0.00	$0.00	"$2,292.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,292.40"	$0.00	"$5,423.00"	"$5,423.00"	$0.00	"$5,500.00"	"$8,712.00"	"$8,800.00"	$0.00		$0.00	"$1,721.50"	$0.00	$0.00	"$1,751.20"	$0.00	$0.00	$0.00	$0.00	$0.00
1200-01-1222	SUP	HCPCS C1713		"1200-01-1222  -  DYNANAIL, 12 MM X 22 CM"	BOTH IP/OP	"$11,000.00 "	"$8,140.00"	$0.00	"$8,800.00"	"$4,950.00"	"$4,950.00"	$0.00	$0.00	$0.00	"$2,292.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,292.40"	$0.00	"$5,423.00"	"$5,423.00"	$0.00	"$5,500.00"	"$8,712.00"	"$8,800.00"	$0.00		$0.00	"$1,721.50"	$0.00	$0.00	"$1,751.20"	$0.00	$0.00	$0.00	$0.00	$0.00
1200-02-5020	SUP	HCPCS C1713		1200-02-5020  -  SCREW BONE 5MM 20MM CORT	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
1200-02-5025	SUP	HCPCS C1713		"1200-02-5025  -  HEADED CORTICAL SCREW, 5.0 MM X 25 MM"	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
1200-02-5030	SUP	HCPCS C1713		1200-02-5030  -  SCREW BONE 5MM 30MM HEADED SECURE FIX DYNANAIL HINDFOOT	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
1200-02-5035	SUP	HCPCS C1713		"1200-02-5035  -  HEADED CORTICAL SCREW, 5.0 MM X 35 MM"	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
1200-02-5040	SUP	HCPCS C1713		"1200-02-5040  -  HEADED CORTICAL SCREW, 5.0 MM X 40 MM"	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
1200-02-5045	SUP	HCPCS C1713		"1200-02-5045  -  HEADED CORTICAL SCREW, 5.0 MM X 45 MM"	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
1200-02-5050	SUP	HCPCS C1713		"1200-02-5050  -  HEADED CORTICAL SCREW, 5.0 MM X 50 MM"	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
1200-02-5055	SUP	HCPCS C1713		"1200-02-5055  -  HEADED CORTICAL SCREW, 5.0 MM X 55 MM"	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
1200-02-5060	SUP	HCPCS C1713		"1200-02-5060  -  HEADED CORTICAL SCREW, 5.0 MM X 60 MM"	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
1200-03-5065	SUP	HCPCS C1713		1200-03-5065  -  SCREW BONE 5MM 65MM CORT	BOTH IP/OP	$428.13 	$316.82	$0.00	$342.50	$192.66	$192.66	$0.00	$0.00	$0.00	$89.23	$317.75	$317.75	$0.00	$0.00	$89.22	$0.00	$253.24	$253.24	$0.00	$214.06	$339.08	$342.50	$0.00		$0.00	$67.00	$0.00	$0.00	$68.16	$0.00	$0.00	$0.00	$0.00	$0.00
1200-03-5070	SUP	HCPCS C1713		"1200-03-5070  -  HEADLESS PA SCREW, 5.0 MM X 70 MM"	BOTH IP/OP	$428.13 	$316.82	$0.00	$342.50	$192.66	$192.66	$0.00	$0.00	$0.00	$89.23	$317.75	$317.75	$0.00	$0.00	$89.22	$0.00	$253.24	$253.24	$0.00	$214.06	$339.08	$342.50	$0.00		$0.00	$67.00	$0.00	$0.00	$68.16	$0.00	$0.00	$0.00	$0.00	$0.00
1200-03-5075	SUP	HCPCS C1713		"1200-03-5075  -  HEADLESS PA SCREW, 5.0 MM X 75 MM"	BOTH IP/OP	$428.13 	$316.82	$0.00	$342.50	$192.66	$192.66	$0.00	$0.00	$0.00	$89.23	$317.75	$317.75	$0.00	$0.00	$89.22	$0.00	$253.24	$253.24	$0.00	$214.06	$339.08	$342.50	$0.00		$0.00	$67.00	$0.00	$0.00	$68.16	$0.00	$0.00	$0.00	$0.00	$0.00
1200-03-5080	SUP	HCPCS C1713		"1200-03-5080  -  HEADLESS PA SCREW, 5.0 MM X 80 MM"	BOTH IP/OP	$428.13 	$316.82	$0.00	$342.50	$192.66	$192.66	$0.00	$0.00	$0.00	$89.23	$317.75	$317.75	$0.00	$0.00	$89.22	$0.00	$253.24	$253.24	$0.00	$214.06	$339.08	$342.50	$0.00		$0.00	$67.00	$0.00	$0.00	$68.16	$0.00	$0.00	$0.00	$0.00	$0.00
1200-03-5085	SUP	HCPCS C1713		"1200-03-5085  -  HEADLESS PA SCREW, 5.0 MM X 85 MM"	BOTH IP/OP	$428.13 	$316.82	$0.00	$342.50	$192.66	$192.66	$0.00	$0.00	$0.00	$89.23	$317.75	$317.75	$0.00	$0.00	$89.22	$0.00	$253.24	$253.24	$0.00	$214.06	$339.08	$342.50	$0.00		$0.00	$67.00	$0.00	$0.00	$68.16	$0.00	$0.00	$0.00	$0.00	$0.00
1200-03-5090	SUP	HCPCS C1713		"1200-03-5090  -  HEADLESS PA SCREW, 5.0 MM X 90 MM"	BOTH IP/OP	$428.13 	$316.82	$0.00	$342.50	$192.66	$192.66	$0.00	$0.00	$0.00	$89.23	$317.75	$317.75	$0.00	$0.00	$89.22	$0.00	$253.24	$253.24	$0.00	$214.06	$339.08	$342.50	$0.00		$0.00	$67.00	$0.00	$0.00	$68.16	$0.00	$0.00	$0.00	$0.00	$0.00
1200-03-5095	SUP	HCPCS C1713		"1200-03-5095  -  HEADLESS PA SCREW, 5.0 MM X 95 MM"	BOTH IP/OP	$428.13 	$316.82	$0.00	$342.50	$192.66	$192.66	$0.00	$0.00	$0.00	$89.23	$317.75	$317.75	$0.00	$0.00	$89.22	$0.00	$253.24	$253.24	$0.00	$214.06	$339.08	$342.50	$0.00		$0.00	$67.00	$0.00	$0.00	$68.16	$0.00	$0.00	$0.00	$0.00	$0.00
1200-03-5100	SUP	HCPCS C1713		"1200-03-5100  -  HEADLESS PA SCREW, 5.0 MM X 100 MM"	BOTH IP/OP	$428.13 	$316.82	$0.00	$342.50	$192.66	$192.66	$0.00	$0.00	$0.00	$89.23	$317.75	$317.75	$0.00	$0.00	$89.22	$0.00	$253.24	$253.24	$0.00	$214.06	$339.08	$342.50	$0.00		$0.00	$67.00	$0.00	$0.00	$68.16	$0.00	$0.00	$0.00	$0.00	$0.00
1200-03-5105	SUP	HCPCS C1713		"1200-03-5105  -  HEADLESS PA SCREW, 5.0 MM X 105 MM"	BOTH IP/OP	$428.13 	$316.82	$0.00	$342.50	$192.66	$192.66	$0.00	$0.00	$0.00	$89.23	$317.75	$317.75	$0.00	$0.00	$89.22	$0.00	$253.24	$253.24	$0.00	$214.06	$339.08	$342.50	$0.00		$0.00	$67.00	$0.00	$0.00	$68.16	$0.00	$0.00	$0.00	$0.00	$0.00
1200-03-5110	SUP	HCPCS C1713		"1200-03-5110  -  HEADLESS PA SCREW, 5.0 MM X 110 MM"	BOTH IP/OP	$428.13 	$316.82	$0.00	$342.50	$192.66	$192.66	$0.00	$0.00	$0.00	$89.23	$317.75	$317.75	$0.00	$0.00	$89.22	$0.00	$253.24	$253.24	$0.00	$214.06	$339.08	$342.50	$0.00		$0.00	$67.00	$0.00	$0.00	$68.16	$0.00	$0.00	$0.00	$0.00	$0.00
120602F	SUP	HCPCS C1884		120602F  -  CATHETER EMBL RND 2FR 4MM 60CM STRL LTX FGRTY BLN REINF SMTH	BOTH IP/OP	$220.00 	$162.80	$0.00	$174.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.24	$0.00	$0.00		$0.00	$34.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
120803F	SUP	HCPCS C1757		120803F  -  CATHETER EMBL RND 3FR 5MM 80CM .1ML STRL LTX FGRTY BLN REINF	BOTH IP/OP	$125.00 	$92.50	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
120804F	SUP	Custom 27203010		120804F  -  CATHETER EMBL RND 4FR 9MM 80CM .5ML STRL LTX FGRTY BLN REINF	BOTH IP/OP	$125.00 	$92.50	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
120805F	SUP	HCPCS C1757		120805F  -  CATHETER EMBL RND 5FR 11MM 80CM STRL LTX FGRTY BLN REINF	BOTH IP/OP	$125.00 	$92.50	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
120806F	SUP	HCPCS C1757		120806F  -  CATHETER EMBL RND 6FR 13MM 80CM STRL LTX FGRTY BLN REINF	BOTH IP/OP	$125.00 	$92.50	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
120807F	SUP	HCPCS C1757		120807F  -  CATHETER EMBL RND 7FR 14MM 80CM 2ML STRL LTX FGRTY BLN REINF	BOTH IP/OP	$129.95 	$96.16	$0.00	$102.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.92	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1210-3	SUP	HCPCS C1713		"1210-3  -  ""MRI PRESSURE PIN SET FOR TRACTION TONGS, 3"""""""	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$613.13	$613.13	$0.00	$0.00	$0.00	$283.98	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$805.92	$805.92	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$213.23	$0.00	$0.00	$216.91	$0.00	$0.00	$0.00	$0.00	$0.00
1210-5-250	SUP	HCPCS C1769		1210-5-250  -  GWIRE ORTH KWIRE GAMA	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$268.79	$268.79	$0.00	$0.00	$0.00	$103.17	$367.39	$367.39	$0.00	$0.00	$103.16	$0.00	$292.79	$292.79	$0.00	$247.50	$392.04	$396.00	$0.00		$0.00	$77.47	$0.00	$0.00	$78.80	$0.00	$0.00	$0.00	$0.00	$0.00
1210-6450	SUP	HCPCS C1713		1210-6450  -  WIRE FIX 3.2MM 450MM KWIRE SS ORTH GAMA	BOTH IP/OP	$127.88 	$94.63	$0.00	$102.30	$57.54	$57.54	$0.00	$0.00	$0.00	$26.65	$94.91	$94.91	$0.00	$0.00	$26.65	$0.00	$75.64	$75.64	$0.00	$63.94	$101.28	$102.30	$0.00		$0.00	$20.01	$0.00	$0.00	$20.36	$0.00	$0.00	$0.00	$0.00	$0.00
1210-6450S	SUP	Custom 27203010		1210-6450S  -  WIRE FX 3.2MM 450MM STRL KRSH	BOTH IP/OP	$192.50 	$142.45	$0.00	$154.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.87	$142.87	$0.00	$0.00	$40.12	$0.00	$0.00	$0.00	$0.00	$96.25	$152.46	$154.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12-1113	SUP	HCPCS C1713		12-1113  -  SCREW BN STD .5IN 9MM 120MM 21MM AMBI CLS IMHS LG	BOTH IP/OP	"$1,134.00 "	$839.16	$0.00	$907.20	$510.30	$510.30	$0.00	$0.00	$0.00	$236.35	$841.65	$841.65	$0.00	$0.00	$236.33	$0.00	$670.76	$670.76	$0.00	$567.00	$898.13	$907.20	$0.00		$0.00	$177.47	$0.00	$0.00	$180.53	$0.00	$0.00	$0.00	$0.00	$0.00
12-1114	SUP	HCPCS C1713		12-1114  -  SCREW BN STD .5IN 9MM 125MM 21MM AMBI CLS IMHS LG	BOTH IP/OP	"$1,134.00 "	$839.16	$0.00	$907.20	$510.30	$510.30	$0.00	$0.00	$0.00	$236.35	$841.65	$841.65	$0.00	$0.00	$236.33	$0.00	$670.76	$670.76	$0.00	$567.00	$898.13	$907.20	$0.00		$0.00	$177.47	$0.00	$0.00	$180.53	$0.00	$0.00	$0.00	$0.00	$0.00
1211-3055	SUP	Custom 27203010		1211-3055  -  DRILL SRG 5.5MM GMA NL DIST	BOTH IP/OP	$203.50 	$150.59	$0.00	$162.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.04	$151.04	$0.00	$0.00	$42.41	$0.00	$0.00	$0.00	$0.00	$101.75	$161.17	$162.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12-1180	SUP	HCPCS C1713		12-1180  -  SCREW BN 9/16IN 9MM 55MM 21MM AMBI CLS SPLG	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$544.50	$544.50	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$605.00	$958.32	$968.00	$0.00		$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
12-1182	SUP	HCPCS C1713		12-1182  -  SCREW BN 9/16IN 9MM 65MM 21MM AMBI CLS SPLG	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$544.50	$544.50	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$605.00	$958.32	$968.00	$0.00		$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
12-1183	SUP	HCPCS C1713		12-1183  -  SCREW BN 9/16IN 9MM 70MM 21MM AMBI CLS SPLG	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$544.50	$544.50	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$605.00	$958.32	$968.00	$0.00		$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
12-1184	SUP	HCPCS C1713		12-1184  -  SCREW BN 9/16IN 9MM 75MM 21MM AMBI CLS SPLG	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$544.50	$544.50	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$605.00	$958.32	$968.00	$0.00		$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
12-1185	SUP	HCPCS C1713		12-1185  -  SCREW BN 9/16IN 9MM 80MM 21MM AMBI CLS SPLG	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$544.50	$544.50	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$605.00	$958.32	$968.00	$0.00		$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
12-1186	SUP	HCPCS C1713		12-1186  -  SCREW BN 9/16IN 9MM 85MM 21MM AMBI CLS SPLG	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$544.50	$544.50	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$605.00	$958.32	$968.00	$0.00		$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
12-1187	SUP	HCPCS C1713		12-1187  -  SCREW BN 9/16IN 9MM 90MM 21MM AMBI CLS SPLG	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$544.50	$544.50	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$605.00	$958.32	$968.00	$0.00		$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
12-1188	SUP	HCPCS C1713		12-1188  -  SCREW BN 9/16IN 9MM 95MM 21MM AMBI CLS SPLG	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$544.50	$544.50	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$605.00	$958.32	$968.00	$0.00		$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
12-1189	SUP	HCPCS C1713		12-1189  -  SCREW BN 9/16IN 9MM 100MM 21MM AMBI CLS SPLG	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$544.50	$544.50	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$605.00	$958.32	$968.00	$0.00		$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
12-1190	SUP	HCPCS C1713		12-1190  -  SCREW BN 9/16IN 9MM 105MM 21MM AMBI CLS SPLG	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$968.00	$544.50	$544.50	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$605.00	$958.32	$968.00	$0.00		$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
1212-5160S	SUP	Custom 27203010		1212-5160S  -  DRILL SURG 160MM AO HIP GAMA 5.5MM STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$0.00	$0.00	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1212-5300S	SUP	Custom 27203010		1212-5300S  -  DRILL SURG 300MM AO CLBRT GAMA 5.5MM STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$0.00	$0.00	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1213-9091S	SUP	HCPCS C1713		1213-9091S  -  GDPN ORTH 400MM 4MM GAMMA3 HIP CANN CANN CTR STRL	BOTH IP/OP	$192.50 	$142.45	$0.00	$154.00	$86.63	$86.63	$0.00	$0.00	$0.00	$40.12	$142.87	$142.87	$0.00	$0.00	$40.12	$0.00	$113.86	$113.86	$0.00	$96.25	$152.46	$154.00	$0.00		$0.00	$30.13	$0.00	$0.00	$30.65	$0.00	$0.00	$0.00	$0.00	$0.00
1214-5055	SUP	Custom 27203010		1214-5055  -  BIT DRILL 300MM 5.2MM GAMA SS STRL	BOTH IP/OP	$213.13 	$157.72	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.18	$158.18	$0.00	$0.00	$44.42	$0.00	$0.00	$0.00	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1214-5160S	SUP	Custom 27203010		1214-5160S  -  BIT DRILL 165MM 5.5MM GAMA SS STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$0.00	$0.00	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1214-5-180	SUP	Custom 27203010		1214-5-180  -  BIT DRILL 220MM 5.5MM GAMA SS STRL	BOTH IP/OP	$203.50 	$150.59	$0.00	$162.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.04	$151.04	$0.00	$0.00	$42.41	$0.00	$0.00	$0.00	$0.00	$101.75	$161.17	$162.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1214-5300S	SUP	Custom 27203010		1214-5300S  -  BIT DRILL 300MM 5.5MM GAMA SS STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$0.00	$0.00	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-461	SUP	Custom 27803010		1235-2-461  -  CUP ACETAB 46MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-462	SUP	Custom 27803010		1235-2-462  -  CUP ACETAB 46MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-481	SUP	Custom 27803010		1235-2-481  -  CUP ACETAB 48MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-482	SUP	Custom 27803010		1235-2-482  -  CUP ACTB 48MM RSTR ADM MBL BR HIP PERI SLF LCK X3 HA HIP LT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-501	SUP	Custom 27803010		1235-2-501  -  CUP ACETAB 50MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-502	SUP	Custom 27803010		1235-2-502  -  CUP ACTB 50MM RSTR ADM MBL BR HIP PERI SLF LCK X3 HA HIP LT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-521	SUP	Custom 27803010		1235-2-521  -  CUP ACETAB 52MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-522	SUP	Custom 27803010		1235-2-522  -  SHELL ACETAB 52MM ANATOMIC DUAL MOBILITY MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-541	SUP	Custom 27803010		1235-2-541  -  CUP ACETAB 54MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-542	SUP	Custom 27803010		1235-2-542  -  CUP ACETAB 54MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-561	SUP	Custom 27803010		1235-2-561  -  CUP ACETAB 56MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-562	SUP	Custom 27803010		1235-2-562  -  CUP ACETAB 56MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-581	SUP	Custom 27803010		1235-2-581  -  CUP ACETAB 58MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-582	SUP	Custom 27803010		1235-2-582  -  CUP ACETAB 58MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-601	SUP	Custom 27803010		1235-2-601  -  CUP ACETAB 60MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-602	SUP	Custom 27803010		1235-2-602  -  CUP ACETAB 60MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-621	SUP	Custom 27803010		1235-2-621  -  CUP ACETAB 62MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-622	SUP	Custom 27803010		1235-2-622  -  CUP ACETAB 62MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-641	SUP	Custom 27803010		1235-2-641  -  CUP ACETAB 64MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-642	SUP	Custom 27803010		1235-2-642  -  CUP ACETAB 64MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-848	SUP	Custom 27803010		1235-2-848  -  INSERT ACETAB 0D 48MM 28MM 6.9MM ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	$0.00	$0.00	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-850	SUP	Custom 27803010		1235-2-850  -  INSERT ACTB 0D 50MM 28MM 7.9MM ADM MBL BR HIP RSTR DRTN	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	$0.00	$0.00	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-852	SUP	Custom 27803010		1235-2-852  -  INSERT ACETAB 0D 52MM 28MM 8.9MM ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	$0.00	$0.00	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-854	SUP	Custom 27803010		1235-2-854  -  INSERT ACETAB 0D 54MM 28MM 9.9MM ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	$0.00	$0.00	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-856	SUP	Custom 27803010		1235-2-856  -  INSERT ACETAB 0D 56MM 28MM 10.9MM ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	$0.00	$0.00	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-858	SUP	Custom 27803010		1235-2-858  -  INSERT ACETAB 0D 58MM 28MM 11.9MM ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	$0.00	$0.00	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-860	SUP	Custom 27803010		1235-2-860  -  INSERT ACETAB 0D 60MM 28MM 12.9MM ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	$0.00	$0.00	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-862	SUP	Custom 27803010		1235-2-862  -  INSERT ACETAB 0D 62MM 28MM 13.9MM ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	$0.00	$0.00	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1235-2-864	SUP	Custom 27803010		1235-2-864  -  INSERT ACETAB 0D 64MM 28MM 14.9MM ADM MOBILE BEARING HIP	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	$0.00	$0.00	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1236-2-242	SUP	HCPCS C1776		1236-2-242  -  INSERT ACTB MBL BR HIP ANTM DL MBL MDLR X3 HIP 22.2 MM FEM	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$906.75	$906.75	$0.00	$0.00	$0.00	$419.98	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	"$1,191.87"	"$1,191.87"	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$315.35	$0.00	$0.00	$320.79	$0.00	$0.00	$0.00	$0.00	$0.00
1236-2-244	SUP	HCPCS C1776		1236-2-244  -  INSERT ACTB 38MM ADM MDM MBL BR HIP RSTR X3 HIP 22.2MM FEM	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$906.75	$906.75	$0.00	$0.00	$0.00	$419.98	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	"$1,191.87"	"$1,191.87"	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$315.35	$0.00	$0.00	$320.79	$0.00	$0.00	$0.00	$0.00	$0.00
1236-2-846	SUP	HCPCS C1776		1236-2-846  -  INSERT ACTB 0D 46MM 28MM 5.9MM ADM MBL BR HIP RSTR X3	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$906.75	$906.75	$0.00	$0.00	$0.00	$419.98	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	"$1,191.87"	"$1,191.87"	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$315.35	$0.00	$0.00	$320.79	$0.00	$0.00	$0.00	$0.00	$0.00
1236-2-848	SUP	Custom 27803010		"1236-2-848  -  INSERT, X3 FOR ADM/ MDM, RESTORATION"	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	$0.00	$0.00	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1236-2-850	SUP	HCPCS C1776		1236-2-850  -  INSERT ACTB 0D 50MM 28MM 7.9MM ADM MBL BR HIP RSTR X3	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$906.75	$906.75	$0.00	$0.00	$0.00	$419.98	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	"$1,191.87"	"$1,191.87"	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$315.35	$0.00	$0.00	$320.79	$0.00	$0.00	$0.00	$0.00	$0.00
1236-2-856	SUP	HCPCS C1776		1236-2-856  -  INSERT ACTB 0D 56MM 28MM 10.9MM ADM MBL BR HIP RSTR X3	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$906.75	$906.75	$0.00	$0.00	$0.00	$419.98	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	"$1,191.87"	"$1,191.87"	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$315.35	$0.00	$0.00	$320.79	$0.00	$0.00	$0.00	$0.00	$0.00
1236-2-858	SUP	HCPCS C1776		1236-2-858  -  INSERT ACTB 58MM 14.9MM ADM MDM MBL BR HIP RSTR X3 HIP 28MM	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$906.75	$906.75	$0.00	$0.00	$0.00	$419.98	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	"$1,191.87"	"$1,191.87"	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$315.35	$0.00	$0.00	$320.79	$0.00	$0.00	$0.00	$0.00	$0.00
1236-2-860	SUP	HCPCS C1776		1236-2-860  -  INSERT ACTB 0D 60MM 28MM 12.9MM DRTN ADM X3	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$906.75	$906.75	$0.00	$0.00	$0.00	$419.98	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	"$1,191.87"	"$1,191.87"	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$315.35	$0.00	$0.00	$320.79	$0.00	$0.00	$0.00	$0.00	$0.00
1236-2-862	SUP	HCPCS C1776		1236-2-862  -  INSERT ACTB 62MM 13.9MM ADM MDM MBL BR HIP RSTR X3 HIP 28MM	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$906.75	$906.75	$0.00	$0.00	$0.00	$419.98	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	"$1,191.87"	"$1,191.87"	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$315.35	$0.00	$0.00	$320.79	$0.00	$0.00	$0.00	$0.00	$0.00
1236-2-864	SUP	HCPCS C1776		1236-2-864  -  INSERT ACTB 0D 64MM 28MM 14.9MM ADM MBL BR HIP RSTR X3	BOTH IP/OP	"$2,015.00 "	"$1,491.10"	$0.00	"$1,612.00"	$906.75	$906.75	$0.00	$0.00	$0.00	$419.98	"$1,495.53"	"$1,495.53"	$0.00	$0.00	$419.93	$0.00	"$1,191.87"	"$1,191.87"	$0.00	"$1,007.50"	"$1,595.88"	"$1,612.00"	$0.00		$0.00	$315.35	$0.00	$0.00	$320.79	$0.00	$0.00	$0.00	$0.00	$0.00
125-150P	SUP	Custom 27203010		125-150P  -  GUIDEPIN1.25 MM	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.67	$55.67	$0.00	$0.00	$15.63	$0.00	$0.00	$0.00	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1258T/75	SUP	HCPCS C1900		1258T/75  -  LEAD PACING MICRO S CURVE 4.3FR 75CM BIPOL STEERABLE TIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$3,420.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$2,137.50"	"$3,385.80"	"$3,420.00"	$0.00		$0.00	$669.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1258T/86	SUP	HCPCS C1900		1258T/86  -  LEAD PCNG MIC S 4.3FR 86CM QUICKFLEX BP STRBL TIP OPTIM INSL	BOTH IP/OP	"$4,275.00 "	"$3,163.50"	$0.00	"$3,420.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$891.02	"$3,172.91"	"$3,172.91"	$0.00	$0.00	$890.91	$0.00	"$2,107.58"	"$2,107.58"	$0.00	"$2,137.50"	"$3,385.80"	"$3,420.00"	$0.00		$0.00	$669.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1258T/92	SUP	HCPCS C1900		1258T/92  -  LEAD PACING MICRO S CURVE 4.3FR 92CM BIPOL STEERABLE TIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$3,420.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$2,137.50"	"$3,385.80"	"$3,420.00"	$0.00		$0.00	$669.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1259BOP16	SUP	Custom 27203010		1259BOP16  -  IMMOBILIZER ORTH THK3/8IN 16IN KNEE EZ WRP FOAM	BOTH IP/OP	$56.13 	$41.54	$0.00	$68.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.66	$41.66	$0.00	$0.00	$11.70	$0.00	$0.00	$0.00	$0.00	$42.95	$68.03	$68.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1259BOP18	SUP	Custom 27203010		1259BOP18  -  IMMOBILIZER ORTH THK3/8IN 18IN KNEE EZ WRP FOAM	BOTH IP/OP	$63.58 	$47.05	$0.00	$71.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.19	$47.19	$0.00	$0.00	$13.25	$0.00	$0.00	$0.00	$0.00	$44.82	$70.99	$71.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12673-03	SUP	HCPCS C1760		12673-03  -  DEVICE CLOSURE 6FR SUTURE MEDIATE KNOT PUSHER LATEX FREE	BOTH IP/OP	$65.00 	$48.10	$0.00	$520.00	$292.50	$292.50	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$325.00	$514.80	$520.00	$0.00		$0.00	$101.73	$0.00	$0.00	$103.48	$0.00	$0.00	$0.00	$0.00	$0.00
12744-16	SUP	HCPCS C1875		12744-16  -  STENT COR 3MM 16MM JSTNT GFTMSTR OTW BLN EXPANDABLE SS PTFE	BOTH IP/OP	"$5,987.50 "	"$4,430.75"	$0.00	"$4,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,247.80"	$0.00	$0.00	$0.00	$0.00	"$2,993.75"	"$4,742.10"	"$4,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12745-16	SUP	HCPCS C1875		12745-16  -  STENT COR 3.5MM 16MM JSTNT GFTMSTR OTW BLN EXPANDABLE SS	BOTH IP/OP	"$5,987.50 "	"$4,430.75"	$0.00	"$4,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,247.80"	$0.00	$0.00	$0.00	$0.00	"$2,993.75"	"$4,742.10"	"$4,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12746-19	SUP	HCPCS C1874		12746-19  -  STENT COR 4MM 19MM JSTNT GFTMSTR OTW BLN EXPANDABLE SS PTFE	BOTH IP/OP	"$5,987.50 "	"$4,430.75"	$0.00	"$4,790.00"	"$2,694.38"	"$2,694.38"	$0.00	$0.00	$0.00	"$1,247.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,247.80"	$0.00	"$2,951.84"	"$2,951.84"	$0.00	"$2,993.75"	"$4,742.10"	"$4,790.00"	$0.00		$0.00	$937.04	$0.00	$0.00	$953.21	$0.00	$0.00	$0.00	$0.00	$0.00
1275108D	SUP	HCPCS C1751		1275108D  -  CATHETER CV 5FR LF P PICC SHRLK 3CG 2 LUM MAXIMAL BRR TRY	BOTH IP/OP	$533.13 	$394.52	$0.00	$430.80	$292.41	$292.41	$0.00	$0.00	$0.00	$111.12	$395.69	$395.69	$0.00	$0.00	$111.10	$0.00	$315.34	$315.34	$0.00	$269.25	$426.49	$430.80	$0.00		$0.00	$84.28	$0.00	$0.00	$85.73	$0.00	$0.00	$0.00	$0.00	$0.00
12A0806F	SUP	HCPCS C1757		12A0806F  -  CATH EMBL 80CM 6FR FGRTY ART BLN INFLAT PORT TUBE PK STRL	BOTH IP/OP	$134.50 	$99.53	$0.00	$106.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.52	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12BA30	SUP	Custom 27203010		12BA30  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$329.38 	$243.74	$0.00	$263.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.46	$244.46	$0.00	$0.00	$68.64	$0.00	$0.00	$0.00	$0.00	$164.69	$260.87	$263.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12BA30D	SUP	Custom 27203010		12BA30D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.66	$258.66	$0.00	$0.00	$72.63	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12BA40	SUP	Custom 27203010		12BA40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$329.38 	$243.74	$0.00	$263.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.46	$244.46	$0.00	$0.00	$68.64	$0.00	$0.00	$0.00	$0.00	$164.69	$260.87	$263.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12BA40D	SUP	Custom 27203010		12BA40D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.66	$258.66	$0.00	$0.00	$72.63	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12BA40DX	SUP	Custom 27203010		12BA40DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$395.25 	$292.49	$0.00	$316.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$293.35	$293.35	$0.00	$0.00	$82.37	$0.00	$0.00	$0.00	$0.00	$197.63	$313.04	$316.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12BA50	SUP	Custom 27203010		12BA50  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$329.38 	$243.74	$0.00	$263.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.46	$244.46	$0.00	$0.00	$68.64	$0.00	$0.00	$0.00	$0.00	$164.69	$260.87	$263.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12BA50D	SUP	Custom 27203010		12BA50D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.66	$258.66	$0.00	$0.00	$72.63	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12BA60	SUP	Custom 27203010		12BA60  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$329.38 	$243.74	$0.00	$263.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.46	$244.46	$0.00	$0.00	$68.64	$0.00	$0.00	$0.00	$0.00	$164.69	$260.87	$263.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12BA60D	SUP	Custom 27203010		12BA60D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$329.38 	$243.74	$0.00	$263.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.46	$244.46	$0.00	$0.00	$68.64	$0.00	$0.00	$0.00	$0.00	$164.69	$260.87	$263.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12BA60DX	SUP	Custom 27203010		12BA60DX  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$401.63 	$297.21	$0.00	$321.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$298.09	$298.09	$0.00	$0.00	$83.70	$0.00	$0.00	$0.00	$0.00	$200.81	$318.09	$321.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12MH22	SUP	Custom 27203010		12MH22  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$295.38 	$218.58	$0.00	$236.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.23	$219.23	$0.00	$0.00	$61.56	$0.00	$0.00	$0.00	$0.00	$147.69	$233.94	$236.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12MH30	SUP	Custom 27203010		12MH30  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$299.63 	$221.73	$0.00	$239.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.38	$222.38	$0.00	$0.00	$62.44	$0.00	$0.00	$0.00	$0.00	$149.81	$237.31	$239.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12MH30D	SUP	Custom 27203010		12MH30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$340.00 	$251.60	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.35	$252.35	$0.00	$0.00	$70.86	$0.00	$0.00	$0.00	$0.00	$170.00	$269.28	$272.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
12TLW805F35	SUP	HCPCS C1757		12TLW805F35  -  CATHETER EMBOLECTOMY 5.5FR 11MM 80CM OTW RADIOPACITY LATEX	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13016540P3	SUP	HCPCS C1713		13016540P3  -  SCREW BN 6.5MM 40MM NS RELINE PA SPNL 2S	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13016545P3	SUP	HCPCS C1713		13016545P3  -  SCREW BN 6.5MM 45MM NS RELINE PA SPNL 2S	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13016550P3	SUP	HCPCS C1713		13016550P3  -  SCREW BN 6.5MM 50MM NS RELINE PA SPNL 2S	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
13-066P	SUP	HCPCS C1713		13-066P  -  WASHERS 13MM	BOTH IP/OP	$28.50 	$21.09	$0.00	$22.80	$12.83	$12.83	$0.00	$0.00	$0.00	$5.94	$21.15	$21.15	$0.00	$0.00	$5.94	$0.00	$16.86	$16.86	$0.00	$14.25	$22.57	$22.80	$0.00		$0.00	$4.46	$0.00	$0.00	$4.54	$0.00	$0.00	$0.00	$0.00	$0.00
1314-3042	SUP	Custom 27203010		1314-3042  -  BIT DRL 4.2MM 300MM TRFLT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
131712-01	SUP	HCPCS Q4130		131712-01  -  DRESSING BIO 12X3IN EZ DERM MSH	BOTH IP/OP	$459.00 	$339.66	$0.00	$340.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.67	$340.67	$0.00	$0.00	$95.66	$0.00	$0.00	$0.00	$0.00	$107.87	$170.87	$172.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1320-0125S	SUP	Custom 27203010		1320-0125S  -  CLIP SURG CLOSE TUBE STRL GAMMA3	BOTH IP/OP	$226.88 	$167.89	$0.00	$181.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.39	$168.39	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$113.44	$179.69	$181.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1320-0190	SUP	Custom 27203010		1320-0190  -  BIT DRILL 3 LAG STP STRL	BOTH IP/OP	"$2,695.00 "	"$1,994.30"	$0.00	"$2,156.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,000.23"	"$2,000.23"	$0.00	$0.00	$561.64	$0.00	$0.00	$0.00	$0.00	"$1,347.50"	"$2,134.44"	"$2,156.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1320-3030S	SUP	Custom 27203010		1320-3030S  -  BIT DRILL 300MM 3MM GAMA SS STRL	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1320-3042S	SUP	Custom 27203010		1320-3042S  -  BIT DRL 4.2MM 300MM STRL QC DISP	BOTH IP/OP	$281.88 	$208.59	$0.00	$225.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$209.21	$209.21	$0.00	$0.00	$58.74	$0.00	$0.00	$0.00	$0.00	$140.94	$223.25	$225.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
132-40-53	SUP	HCPCS C1776		132-40-53  -  LINER ACETAB LIPPED NOVATION CROWN CUP CONNEXION GXL GRAY 40	BOTH IP/OP	"$4,118.13 "	"$3,047.42"	$0.00	"$3,294.50"	"$1,853.16"	"$1,853.16"	$0.00	$0.00	$0.00	$858.32	"$3,056.47"	"$3,056.47"	$0.00	$0.00	$858.22	$0.00	"$2,030.24"	"$2,030.24"	$0.00	"$2,059.06"	"$3,261.56"	"$3,294.50"	$0.00		$0.00	$644.49	$0.00	$0.00	$655.61	$0.00	$0.00	$0.00	$0.00	$0.00
134046J	SUP	Custom 27203010		134046J  -  APPLIER IN CLP SM 9IN LF PRM SGCLP SUP INTLK 20 ATO CLIP LGT	BOTH IP/OP	$20.79 	$15.38	$0.00	$16.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.43	$15.43	$0.00	$0.00	$4.33	$0.00	$0.00	$0.00	$0.00	$10.40	$16.47	$16.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1365-24-000	SUP	HCPCS C1776		1365-24-000  -  HEAD FEM +13MM 12/14 STD 32MM STRL LF ART/EZE SKRT COCR HIP	BOTH IP/OP	"$2,897.50 "	"$2,144.15"	$0.00	"$2,318.00"	"$1,303.88"	"$1,303.88"	$0.00	$0.00	$0.00	$603.91	"$2,150.52"	"$2,150.52"	$0.00	$0.00	$603.84	$0.00	"$1,428.47"	"$1,428.47"	$0.00	"$1,448.75"	"$2,294.82"	"$2,318.00"	$0.00		$0.00	$453.46	$0.00	$0.00	$461.28	$0.00	$0.00	$0.00	$0.00	$0.00
13-678-31F	SUP	Custom 27203010		PIPETTE SERO BOROSIL GLS 1ML GRAD NONPLUGGED REG TIP NSTRL	BOTH IP/OP	$0.35 	$0.26	$0.00	$0.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.18	$0.28	$0.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
13-678-31J	SUP	Custom 27203010		PIPETTE SERO BOROSIL GLS 10ML GRAD NONPLUGGED REG TIP NSTRL	BOTH IP/OP	$0.55 	$0.41	$0.00	$0.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.28	$0.44	$0.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
138-36-53	SUP	HCPCS C1776		138-36-53  -  LINER ACETAB FACE NOVATION CONNEXION GXL 10D 53MM 36MM HIP	BOTH IP/OP	"$4,118.13 "	"$3,047.42"	$0.00	"$3,294.50"	"$1,853.16"	"$1,853.16"	$0.00	$0.00	$0.00	$858.32	"$3,056.47"	"$3,056.47"	$0.00	$0.00	$858.22	$0.00	"$2,030.24"	"$2,030.24"	$0.00	"$2,059.06"	"$3,261.56"	"$3,294.50"	$0.00		$0.00	$644.49	$0.00	$0.00	$655.61	$0.00	$0.00	$0.00	$0.00	$0.00
1385108QD	SUP	HCPCS C1751		1385108QD  -  CATHETER CV 5FR LF P PICC SHRLK 3CG 3 LUM MAXIMAL BRR TRY	BOTH IP/OP	$618.00 	$457.32	$0.00	$499.40	$338.97	$338.97	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$312.13	$494.41	$499.40	$0.00		$0.00	$97.70	$0.00	$0.00	$99.38	$0.00	$0.00	$0.00	$0.00	$0.00
14 377 259	SUP	Custom 27203010		SLIDE DECISLIDE URISYS ACRL INTGR CVRSLP UA 10 TST	BOTH IP/OP	$247.90 	$183.45	$0.00	$198.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.95	$196.34	$198.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14-375-560	SUP	Custom 27203010		PIPETTE KOVA DECANTING BLB SED SYS UA	BOTH IP/OP	$133.18 	$98.55	$0.00	$106.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.59	$105.48	$106.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14-521014	SUP	Custom 27203010		14-521014  -  BIT DRL 4MM 14MM MAXAN SPNE ANT CRV PLT SYS	BOTH IP/OP	$752.00 	$556.48	$0.00	$601.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$558.13	$558.13	$0.00	$0.00	$156.72	$0.00	$0.00	$0.00	$0.00	$376.00	$595.58	$601.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14-521614	SUP	HCPCS C1713		14-521614  -  SCREW BN 4MM 14MM MAXAN VA SLF DRL SPNE	BOTH IP/OP	"$1,064.00 "	$787.36	$0.00	$851.20	$478.80	$478.80	$0.00	$0.00	$0.00	$221.76	$789.70	$789.70	$0.00	$0.00	$221.74	$0.00	$629.36	$629.36	$0.00	$532.00	$842.69	$851.20	$0.00		$0.00	$166.52	$0.00	$0.00	$169.39	$0.00	$0.00	$0.00	$0.00	$0.00
14-521616	SUP	HCPCS C1713		14-521616  -  SCREW BONE 4MM 16MM MAXAN SPN VAR ANG	BOTH IP/OP	"$1,064.00 "	$787.36	$0.00	$851.20	$478.80	$478.80	$0.00	$0.00	$0.00	$221.76	$789.70	$789.70	$0.00	$0.00	$221.74	$0.00	$629.36	$629.36	$0.00	$532.00	$842.69	$851.20	$0.00		$0.00	$166.52	$0.00	$0.00	$169.39	$0.00	$0.00	$0.00	$0.00	$0.00
14-524004	SUP	HCPCS C1713		14-524004  -  ROD SPINAL 40MM PRECUT LINEUM UNIVERSAL BLUE TITANIUM 3.5MM	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
14-524008	SUP	HCPCS C1713		14-524008  -  ROD SPNL UNV 3.5MM 80MM BLU NS LINEUM PCUT TI OCT	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$229.27	$816.42	$816.42	$0.00	$0.00	$229.24	$0.00	$650.65	$650.65	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
14-524018	SUP	HCPCS C1713		14-524018  -  ROD SPINAL UNIVERSAL 3.5MM 180MM PRECUT LINEUM BLUE TITANIUM	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$229.27	$816.42	$816.42	$0.00	$0.00	$229.24	$0.00	$650.65	$650.65	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
14-524024	SUP	HCPCS C1713		14-524024  -  ROD SPNL UNV 3.5MM 240MM BLU NS LINEUM PCUT TI OCT	BOTH IP/OP	"$1,050.00 "	$777.00	$0.00	$840.00	$472.50	$472.50	$0.00	$0.00	$0.00	$218.85	$779.31	$779.31	$0.00	$0.00	$218.82	$0.00	$621.08	$621.08	$0.00	$525.00	$831.60	$840.00	$0.00		$0.00	$164.33	$0.00	$0.00	$167.16	$0.00	$0.00	$0.00	$0.00	$0.00
14-524038	SUP	HCPCS C1713		14-524038  -  SCREW SET PLUG LINEUM HELICAL FLANGE TITANIUM SPN CERV UPPER	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$193.50	$193.50	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$215.00	$340.56	$344.00	$0.00		$0.00	$67.30	$0.00	$0.00	$68.46	$0.00	$0.00	$0.00	$0.00	$0.00
14-524212	SUP	HCPCS C1713		14-524212  -  SCREW BN 3.5MM 12MM AU NS LINEUM TRNSL HLCL FLNG ST TOP LD	BOTH IP/OP	"$4,694.00 "	"$3,473.56"	$0.00	"$3,755.20"	"$2,112.30"	"$2,112.30"	$0.00	$0.00	$0.00	$978.35	"$3,483.89"	"$3,483.89"	$0.00	$0.00	$978.23	$0.00	"$2,314.14"	"$2,314.14"	$0.00	"$2,347.00"	"$3,717.65"	"$3,755.20"	$0.00		$0.00	$734.61	$0.00	$0.00	$747.28	$0.00	$0.00	$0.00	$0.00	$0.00
14-524214	SUP	HCPCS C1713		14-524214  -  SCREW BONE 14MM SELF TAP TOP LOAD FRICTION FIT SMOOTH SHANK	BOTH IP/OP	"$4,694.00 "	"$3,473.56"	$0.00	"$3,755.20"	"$2,112.30"	"$2,112.30"	$0.00	$0.00	$0.00	$978.35	"$3,483.89"	"$3,483.89"	$0.00	$0.00	$978.23	$0.00	"$2,314.14"	"$2,314.14"	$0.00	"$2,347.00"	"$3,717.65"	"$3,755.20"	$0.00		$0.00	$734.61	$0.00	$0.00	$747.28	$0.00	$0.00	$0.00	$0.00	$0.00
14-524218	SUP	HCPCS C1713		14-524218  -  SCREW BONE STANDARD 3.5MM 18MM SLFTAP TOP LOADING FRICTION	BOTH IP/OP	"$4,694.00 "	"$3,473.56"	$0.00	"$3,755.20"	"$2,112.30"	"$2,112.30"	$0.00	$0.00	$0.00	$978.35	"$3,483.89"	"$3,483.89"	$0.00	$0.00	$978.23	$0.00	"$2,314.14"	"$2,314.14"	$0.00	"$2,347.00"	"$3,717.65"	"$3,755.20"	$0.00		$0.00	$734.61	$0.00	$0.00	$747.28	$0.00	$0.00	$0.00	$0.00	$0.00
14-524378	SUP	HCPCS C1713		14-524378  -  SCREW BONE LINEUM TITANIUM L28 MM OD3.5 MM OCCIPITOCERVICOTH	BOTH IP/OP	"$4,694.00 "	"$3,473.56"	$0.00	"$3,755.20"	"$2,112.30"	"$2,112.30"	$0.00	$0.00	$0.00	$978.35	"$3,483.89"	"$3,483.89"	$0.00	$0.00	$978.23	$0.00	"$2,314.14"	"$2,314.14"	$0.00	"$2,347.00"	"$3,717.65"	"$3,755.20"	$0.00		$0.00	$734.61	$0.00	$0.00	$747.28	$0.00	$0.00	$0.00	$0.00	$0.00
14-524380	SUP	HCPCS C1713		14-524380  -  SCREW BONE 3.5MM 30MM SMOOTH SHANK TRANSLATION TECHNOLOGY	BOTH IP/OP	"$4,694.00 "	"$3,473.56"	$0.00	"$3,755.20"	"$2,112.30"	"$2,112.30"	$0.00	$0.00	$0.00	$978.35	"$3,483.89"	"$3,483.89"	$0.00	$0.00	$978.23	$0.00	"$2,314.14"	"$2,314.14"	$0.00	"$2,347.00"	"$3,717.65"	"$3,755.20"	$0.00		$0.00	$734.61	$0.00	$0.00	$747.28	$0.00	$0.00	$0.00	$0.00	$0.00
14-524512	SUP	HCPCS C1713		14-524512  -  SCREW BONE 12MM TRANSLATION TECHNOLOGY GREEN HEAD LINEUM	BOTH IP/OP	"$5,867.50 "	"$4,341.95"	$0.00	"$4,694.00"	"$2,640.38"	"$2,640.38"	$0.00	$0.00	$0.00	"$1,222.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,222.79"	$0.00	"$2,892.68"	"$2,892.68"	$0.00	"$2,933.75"	"$4,647.06"	"$4,694.00"	$0.00		$0.00	$918.26	$0.00	$0.00	$934.11	$0.00	$0.00	$0.00	$0.00	$0.00
14-524514	SUP	HCPCS C1713		14-524514  -  SCREW BN 4MM 14MM LINEUM TRNSL TCH GRN HD TI OCT SPNE	BOTH IP/OP	"$5,867.50 "	"$4,341.95"	$0.00	"$4,694.00"	"$2,640.38"	"$2,640.38"	$0.00	$0.00	$0.00	"$1,222.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,222.79"	$0.00	"$2,892.68"	"$2,892.68"	$0.00	"$2,933.75"	"$4,647.06"	"$4,694.00"	$0.00		$0.00	$918.26	$0.00	$0.00	$934.11	$0.00	$0.00	$0.00	$0.00	$0.00
14-524530	SUP	HCPCS C1713		14-524530  -  SCREW BONE 30MM TRANSLATION TECHNOLOGY GREEN HEAD LINEUM	BOTH IP/OP	"$4,694.00 "	"$3,473.56"	$0.00	"$3,755.20"	"$2,112.30"	"$2,112.30"	$0.00	$0.00	$0.00	$978.35	"$3,483.89"	"$3,483.89"	$0.00	$0.00	$978.23	$0.00	"$2,314.14"	"$2,314.14"	$0.00	"$2,347.00"	"$3,717.65"	"$3,755.20"	$0.00		$0.00	$734.61	$0.00	$0.00	$747.28	$0.00	$0.00	$0.00	$0.00	$0.00
14-524728	SUP	HCPCS C1713		14-524728  -  SCREW BONE 4.35MM 28MM TRANSLATION TECHNOLOGY BLUE HEAD	BOTH IP/OP	"$4,694.00 "	"$3,473.56"	$0.00	"$3,755.20"	"$2,112.30"	"$2,112.30"	$0.00	$0.00	$0.00	$978.35	"$3,483.89"	"$3,483.89"	$0.00	$0.00	$978.23	$0.00	"$2,314.14"	"$2,314.14"	$0.00	"$2,347.00"	"$3,717.65"	"$3,755.20"	$0.00		$0.00	$734.61	$0.00	$0.00	$747.28	$0.00	$0.00	$0.00	$0.00	$0.00
14-525000	SUP	HCPCS C1713		14-525000  -  DRILL SURG SLEEVE LINEUM STANDARD GOLD TITANIUM 3.5MM	BOTH IP/OP	$892.50 	$660.45	$0.00	$714.00	$401.63	$401.63	$0.00	$0.00	$0.00	$186.02	$662.41	$662.41	$0.00	$0.00	$186.00	$0.00	$527.91	$527.91	$0.00	$446.25	$706.86	$714.00	$0.00		$0.00	$139.68	$0.00	$0.00	$142.09	$0.00	$0.00	$0.00	$0.00	$0.00
14-525055	SUP	HCPCS C1713		14-525055  -  TAP SURGICAL LINEUM STANDARD OD3 MM OCCIPITOCERVICOTHORACIC	BOTH IP/OP	"$1,050.00 "	$777.00	$0.00	$840.00	$472.50	$472.50	$0.00	$0.00	$0.00	$218.85	$779.31	$779.31	$0.00	$0.00	$218.82	$0.00	$621.08	$621.08	$0.00	$525.00	$831.60	$840.00	$0.00		$0.00	$164.33	$0.00	$0.00	$167.16	$0.00	$0.00	$0.00	$0.00	$0.00
145-351	SUP	HCPCS C1768		145-351  -  STENT URET 4.8FR 24CM W/O GWIRE PRCFLX HDR+	BOTH IP/OP	$315.53 	$233.49	$0.00	$252.42	$141.99	$141.99	$0.00	$0.00	$0.00	$65.76	$234.18	$234.18	$0.00	$0.00	$65.76	$0.00	$186.63	$186.63	$0.00	$157.76	$249.90	$252.42	$0.00		$0.00	$49.38	$0.00	$0.00	$50.23	$0.00	$0.00	$0.00	$0.00	$0.00
145-5091-150	SUP	HCPCS C1751		145-5091-150  -  CATH INFUS 45D .014IN 2.1FR 1.7FR 150CM 3MM GWIRE TIP MCTH	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,418.00"	$962.47	$962.47	$0.00	$0.00	$0.00	$351.72	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$998.16	$998.16	$0.00	$886.25	"$1,403.82"	"$1,418.00"	$0.00		$0.00	$277.40	$0.00	$0.00	$282.18	$0.00	$0.00	$0.00	$0.00	$0.00
145-5092-150	SUP	HCPCS C1751		145-5092-150  -  CATH INFUS .014IN 45D 250 PSI 2.4-1.9FR .017IN 150CM 3MM	BOTH IP/OP	"$1,772.50 "	"$1,311.65"	$0.00	"$1,418.00"	$962.47	$962.47	$0.00	$0.00	$0.00	$369.43	"$1,315.55"	"$1,315.55"	$0.00	$0.00	$369.39	$0.00	"$1,048.43"	"$1,048.43"	$0.00	$886.25	"$1,403.82"	"$1,418.00"	$0.00		$0.00	$277.40	$0.00	$0.00	$282.18	$0.00	$0.00	$0.00	$0.00	$0.00
14574-01	SUP	HCPCS C2617		14574-01  -  STENT BIL 5MM 30MM 120CM .018IN SLF XPD FLXB TRNSHEP XPERT	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$898.83	"$3,200.74"	"$3,200.74"	$0.00	$0.00	$898.73	$0.00	"$2,126.06"	"$2,126.06"	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
14575-01	SUP	HCPCS C2617		14575-01  -  STENT BIL 5MM 40MM 120CM .018IN SLF XPD FLXB TRNSHEP XPERT	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$898.83	"$3,200.74"	"$3,200.74"	$0.00	$0.00	$898.73	$0.00	"$2,126.06"	"$2,126.06"	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
14577-01	SUP	HCPCS C2617		14577-01  -  STENT BIL 6MM 30MM 120CM .018IN SLF XPD FLXB TRNSHEP XPERT	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$898.83	"$3,200.74"	"$3,200.74"	$0.00	$0.00	$898.73	$0.00	"$2,126.06"	"$2,126.06"	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
14578-01	SUP	HCPCS C2617		14578-01  -  STENT BIL 6MM 40MM 120CM .018IN SLF XPD FLXB TRNSHEP XPERT	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$898.83	"$3,200.74"	"$3,200.74"	$0.00	$0.00	$898.73	$0.00	"$2,126.06"	"$2,126.06"	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
145FS38	SUP	HCPCS C1769		145FS38  -  GWIRE ENDSCP .038IN 145CM STR TIP HDRGLD HYDPHI STRL DISP	BOTH IP/OP	$157.50 	$116.55	$0.00	$126.00	$85.52	$85.52	$0.00	$0.00	$0.00	$32.83	$116.90	$116.90	$0.00	$0.00	$32.82	$0.00	$93.16	$93.16	$0.00	$78.75	$124.74	$126.00	$0.00		$0.00	$24.65	$0.00	$0.00	$25.07	$0.00	$0.00	$0.00	$0.00	$0.00
14679-01	SUP	HCPCS C1760		14679-01  -  DEVICE CLOSURE 6FR CLIP LATEX FREE STARCLOSE SE NITINOL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
14937-01	SUP	HCPCS C1769		14937-01  -  GUIDEWIRE VASC .014IN 300CM STRL 11CM ASAHI MRCLBRS 3 RADOPQ	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$32.58	$32.58	$0.00	$0.00	$0.00	$12.51	$44.53	$44.53	$0.00	$0.00	$12.50	$0.00	$35.49	$35.49	$0.00	$30.00	$47.52	$48.00	$0.00		$0.00	$9.39	$0.00	$0.00	$9.55	$0.00	$0.00	$0.00	$0.00	$0.00
149R	SUP	Custom 27203010		149R  -  BRUSH CYTOLOGY RING HANDLE 3MM LATEX FREE PULMONARY STERILE	BOTH IP/OP	$24.33 	$18.00	$0.00	$19.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.05	$18.05	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$12.16	$19.27	$19.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14AC50	SUP	Custom 27203010		14AC50  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14AC60	SUP	Custom 27203010		14AC60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14AC90	SUP	Custom 27203010		14AC90  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA20	SUP	Custom 27203010		14BA20  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.66	$258.66	$0.00	$0.00	$72.63	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA25	SUP	Custom 27203010		14BA25  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.66	$258.66	$0.00	$0.00	$72.63	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA25D	SUP	Custom 27203010		14BA25D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$371.88 	$275.19	$0.00	$297.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.01	$276.01	$0.00	$0.00	$77.50	$0.00	$0.00	$0.00	$0.00	$185.94	$294.53	$297.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA30	SUP	Custom 27203010		14BA30  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$354.88 	$262.61	$0.00	$283.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.39	$263.39	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.44	$281.06	$283.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA30D	SUP	Custom 27203010		14BA30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$371.88 	$275.19	$0.00	$297.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.01	$276.01	$0.00	$0.00	$77.50	$0.00	$0.00	$0.00	$0.00	$185.94	$294.53	$297.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA30DC	SUP	Custom 27203010		14BA30DC  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$376.13 	$278.34	$0.00	$300.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.16	$279.16	$0.00	$0.00	$78.38	$0.00	$0.00	$0.00	$0.00	$188.06	$297.89	$300.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA40D	SUP	Custom 27203010		14BA40D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$378.25 	$279.91	$0.00	$302.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.74	$280.74	$0.00	$0.00	$78.83	$0.00	$0.00	$0.00	$0.00	$189.13	$299.57	$302.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA40DC	SUP	Custom 27203010		14BA40DC  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$376.13 	$278.34	$0.00	$300.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.16	$279.16	$0.00	$0.00	$78.38	$0.00	$0.00	$0.00	$0.00	$188.06	$297.89	$300.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA40DX	SUP	Custom 27203010		14BA40DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA50	SUP	Custom 27203010		14BA50  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$363.38 	$268.90	$0.00	$290.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.70	$269.70	$0.00	$0.00	$75.73	$0.00	$0.00	$0.00	$0.00	$181.69	$287.80	$290.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA50D	SUP	Custom 27203010		14BA50D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$378.25 	$279.91	$0.00	$302.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.74	$280.74	$0.00	$0.00	$78.83	$0.00	$0.00	$0.00	$0.00	$189.13	$299.57	$302.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA50DC	SUP	Custom 27203010		14BA50DC  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$378.25 	$279.91	$0.00	$302.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.74	$280.74	$0.00	$0.00	$78.83	$0.00	$0.00	$0.00	$0.00	$189.13	$299.57	$302.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA50DX	SUP	Custom 27203010		14BA50DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA60	SUP	Custom 27203010		14BA60  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$354.88 	$262.61	$0.00	$283.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.39	$263.39	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.44	$281.06	$283.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA60D	SUP	Custom 27203010		14BA60D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$371.88 	$275.19	$0.00	$297.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.01	$276.01	$0.00	$0.00	$77.50	$0.00	$0.00	$0.00	$0.00	$185.94	$294.53	$297.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA60DC	SUP	Custom 27203010		14BA60DC  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$376.13 	$278.34	$0.00	$300.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.16	$279.16	$0.00	$0.00	$78.38	$0.00	$0.00	$0.00	$0.00	$188.06	$297.89	$300.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA60DX	SUP	Custom 27203010		14BA60DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA70DX	SUP	Custom 27203010		14BA70DX  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA75	SUP	Custom 27203010		14BA75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$354.88 	$262.61	$0.00	$283.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.39	$263.39	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.44	$281.06	$283.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA75D	SUP	Custom 27203010		14BA75D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$371.88 	$275.19	$0.00	$297.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.01	$276.01	$0.00	$0.00	$77.50	$0.00	$0.00	$0.00	$0.00	$185.94	$294.53	$297.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA80DX	SUP	Custom 27203010		14BA80DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14BA90	SUP	Custom 27203010		14BA90  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$354.88 	$262.61	$0.00	$283.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.39	$263.39	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.44	$281.06	$283.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14CY50	SUP	Custom 27203010		14CY50  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14CY50B	SUP	Custom 27203010		14CY50B  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14CY50DCSH	SUP	Custom 27203010		14CY50DCSH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$412.25 	$305.07	$0.00	$329.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.97	$305.97	$0.00	$0.00	$85.91	$0.00	$0.00	$0.00	$0.00	$206.13	$326.50	$329.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14CY60DCSH	SUP	Custom 27203010		14CY60DCSH  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$412.25 	$305.07	$0.00	$329.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.97	$305.97	$0.00	$0.00	$85.91	$0.00	$0.00	$0.00	$0.00	$206.13	$326.50	$329.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14CY65DX	SUP	Custom 27203010		14CY65DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$378.25 	$279.91	$0.00	$302.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.74	$280.74	$0.00	$0.00	$78.83	$0.00	$0.00	$0.00	$0.00	$189.13	$299.57	$302.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14CY70DCSH	SUP	Custom 27203010		14CY70DCSH  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$412.25 	$305.07	$0.00	$329.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.97	$305.97	$0.00	$0.00	$85.91	$0.00	$0.00	$0.00	$0.00	$206.13	$326.50	$329.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14CY75	SUP	Custom 27203010		14CY75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14CY76L	SUP	Custom 27203010		14CY76L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$388.88 	$287.77	$0.00	$311.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$288.62	$288.62	$0.00	$0.00	$81.04	$0.00	$0.00	$0.00	$0.00	$194.44	$307.99	$311.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14CY90	SUP	Custom 27203010		14CY90  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14HM126	SUP	Custom 27203010		14HM126  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14HM95	SUP	Custom 27203010		14HM95  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14MH30DC	SUP	Custom 27203010		14MH30DC  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$376.13 	$278.34	$0.00	$300.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.16	$279.16	$0.00	$0.00	$78.38	$0.00	$0.00	$0.00	$0.00	$188.06	$297.89	$300.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14OV55	SUP	Custom 27203010		14OV55  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14TA30	SUP	Custom 27203010		14TA30  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
14TA31	SUP	Custom 27203010		14TA31  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1501652SP	SUP	HCPCS C9250		1501652SP  -  KIT TISS CLSR FRZN SLNT ARTISS 4ML	BOTH IP/OP	$741.80 	$548.93	$0.00	$593.44	$333.81	$333.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.09	$370.90	$587.51	$593.44	$239.03		$239.03	$116.09	$0.00	$0.00	$118.09	$164.85	$0.00	$0.00	$0.00	$0.00
1501653SP	SUP	Custom 27203010		1501653SP  -  KIT TISS CLSR 10ML ARTISS DUO PREFL SYR HMN FBRN SLNT SPRY	BOTH IP/OP	"$1,494.23 "	"$1,105.73"	$0.00	"$1,494.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,109.01"	"$1,109.01"	$0.00	$0.00	$311.40	$0.00	$0.00	$0.00	$0.00	$934.31	"$1,479.95"	"$1,494.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
151F7	SUP	Custom 27203010		151F7  -  CATHETER ART LN STD 7FR 110CM SG 4 LUM S TIP TD FEM VN	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$0.00	$0.00	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15-28126	SUP	Custom 27203010		15-28126  -  SPLINT NSL MED FOAM RBR LTWT AL LNNG WTR RS ADH XTRN SKNPRP	BOTH IP/OP	$20.50 	$15.17	$0.00	$16.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.22	$15.22	$0.00	$0.00	$4.27	$0.00	$0.00	$0.00	$0.00	$10.25	$16.24	$16.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1541-01-000	SUP	HCPCS C1776		1541-01-000  -  STEM FEM 1 STD OFST 105MM LF PROSTALAC CMNT XTN HIP	BOTH IP/OP	"$13,132.50 "	"$9,718.05"	$0.00	"$10,506.00"	"$5,909.63"	"$5,909.63"	$0.00	$0.00	$0.00	"$2,737.14"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,736.81"	$0.00	"$6,474.32"	"$6,474.32"	$0.00	"$6,566.25"	"$10,400.94"	"$10,506.00"	$0.00		$0.00	"$2,055.24"	$0.00	$0.00	"$2,090.69"	$0.00	$0.00	$0.00	$0.00	$0.00
1541-28-000	SUP	HCPCS C1776		1541-28-000  -  STEM FEM 3 RT HIP	BOTH IP/OP	"$10,425.00 "	"$7,714.50"	$0.00	"$8,340.00"	"$4,691.25"	"$4,691.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,212.50"	"$8,256.60"	"$8,340.00"	$0.00		$0.00	"$1,631.51"	$0.00	$0.00	"$1,659.66"	$0.00	$0.00	$0.00	$0.00	$0.00
1541-42-320	SUP	HCPCS C1776		1541-42-320  -  CUP ACETAB 42MM 32MM CEMENTED PROSTALAC ALL POLY HIP	BOTH IP/OP	"$2,615.00 "	"$1,935.10"	$0.00	"$2,092.00"	"$1,176.75"	"$1,176.75"	$0.00	$0.00	$0.00	$545.03	"$1,940.85"	"$1,940.85"	$0.00	$0.00	$544.97	$0.00	"$1,289.20"	"$1,289.20"	$0.00	"$1,307.50"	"$2,071.08"	"$2,092.00"	$0.00		$0.00	$409.25	$0.00	$0.00	$416.31	$0.00	$0.00	$0.00	$0.00	$0.00
15-711	SUP	HCPCS C1894		INTRODUCER SHTH 5FR 2.5CM 10CM MINI GUIDEWIRE DILAT PNCL	BOTH IP/OP	$24.38 	$18.04	$0.00	$19.50	$13.24	$13.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.19	$19.31	$19.50	$0.00		$0.00	$3.81	$0.00	$0.00	$3.88	$0.00	$0.00	$0.00	$0.00	$0.00
1584S	SUP	Custom 27203010		1584S  -  WRAP COMPRESSION 5YDX4IN ELAST SELF ADHERENT FULL STRETCH	BOTH IP/OP	$69.35 	$51.32	$0.00	$56.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.47	$51.47	$0.00	$0.00	$14.45	$0.00	$0.00	$0.00	$0.00	$35.20	$55.75	$56.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15AC50	SUP	Custom 27203010		15AC50  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15AC60	SUP	Custom 27203010		15AC60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15BA40D	SUP	Custom 27203010		15BA40D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15BA40DX	SUP	Custom 27203010		15BA40DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$386.75 	$286.20	$0.00	$309.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.05	$287.05	$0.00	$0.00	$80.60	$0.00	$0.00	$0.00	$0.00	$193.38	$306.31	$309.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15BA50	SUP	Custom 27203010		15BA50  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$354.88 	$262.61	$0.00	$283.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.39	$263.39	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.44	$281.06	$283.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15BA50D	SUP	Custom 27203010		15BA50D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15BA60	SUP	Custom 27203010		15BA60  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$354.88 	$262.61	$0.00	$283.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.39	$263.39	$0.00	$0.00	$73.96	$0.00	$0.00	$0.00	$0.00	$177.44	$281.06	$283.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15BA60D	SUP	Custom 27203010		15BA60D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15CY50	SUP	Custom 27203010		15CY50  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15CY50L	SUP	Custom 27203010		15CY50L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15CY60	SUP	Custom 27203010		15CY60  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15CY65DX	SUP	Custom 27203010		15CY65DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$376.13 	$278.34	$0.00	$300.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.16	$279.16	$0.00	$0.00	$78.38	$0.00	$0.00	$0.00	$0.00	$188.06	$297.89	$300.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15MH17	SUP	Custom 27203010		15MH17  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15MH17D	SUP	Custom 27203010		15MH17D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$327.25 	$242.17	$0.00	$261.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.88	$242.88	$0.00	$0.00	$68.20	$0.00	$0.00	$0.00	$0.00	$163.63	$259.18	$261.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15MH22	SUP	Custom 27203010		15MH22  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15MH30D	SUP	Custom 27203010		15MH30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$363.38 	$268.90	$0.00	$290.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.70	$269.70	$0.00	$0.00	$75.73	$0.00	$0.00	$0.00	$0.00	$181.69	$287.80	$290.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15TA23	SUP	Custom 27203010		15TA23  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$342.13 	$253.18	$0.00	$273.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.93	$253.93	$0.00	$0.00	$71.30	$0.00	$0.00	$0.00	$0.00	$171.06	$270.97	$273.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
15TA23L	SUP	Custom 27203010		15TA23L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$342.13 	$253.18	$0.00	$273.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.93	$253.93	$0.00	$0.00	$71.30	$0.00	$0.00	$0.00	$0.00	$171.06	$270.97	$273.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1601-04132	SUP	HCPCS C1776		1601-04132  -  STEM FEM 132D 4 31.5MM OFST 5.1MM 110MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-05132	SUP	HCPCS C1776		1601-05132  -  STEM FEM 132D 5 32.5MM OFST 6MM 115MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-06127	SUP	HCPCS C1776		1601-06127  -  STEM FEM 127D 6 37.2MM OFST 6.9MM 120MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-06132	SUP	HCPCS C1776		1601-06132  -  STEM FEM 132D 6 33.6MM OFST 6.9MM 120MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-07127	SUP	HCPCS C1776		1601-07127  -  STEM FEM 127D 7 41.5MM OFST 7.4MM 130MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-07132	SUP	HCPCS C1776		1601-07132  -  STEM FEM 132D 7 37.5MM OFST 7.4MM 130MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-08127	SUP	HCPCS C1776		1601-08127  -  STEM FEM 127D 8 42.4MM OFST 8.1MM 136MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-08132	SUP	HCPCS C1776		1601-08132  -  STEM FEM 132D 8 38.4MM OFST 8.1MM 136MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-09127	SUP	HCPCS C1776		1601-09127  -  STEM FEM 127D 9 46.9MM OFST 8.9MM 142MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-09132	SUP	HCPCS C1776		1601-09132  -  STEM FEM 132D 9 42.6MM OFST 8.9MM 142MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-10127	SUP	HCPCS C1776		1601-10127  -  STEM FEM 127D 10 48.1MM OFST 9.7MM 148MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-10132	SUP	HCPCS C1776		1601-10132  -  STEM FEM 132D 10 43.8MM OFST 9.7MM 148MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-11127	SUP	HCPCS C1776		1601-11127  -  STEM FEM 127D 11 52.6MM OFST 9.7MM 155MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-11132	SUP	HCPCS C1776		1601-11132  -  STEM FEM 132D 11 47.9MM OFST 9.7MM 155MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-12127	SUP	HCPCS C1776		1601-12127  -  STEM FEM 127D 12 53.7MM OFST 10.7MM 160MM STRL SCRFT ADV	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
1601-12132	SUP	HCPCS C1776		1601-12132  -  STEM FEM 132D 12 49MM OFST 10.7MM 160MM STRL SCRFT ADV PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
16-3663	SUP	HCPCS C1776		16-3663  -  HEAD FEMORAL +3MM 28MM MODULAR TYPE 1 COCR HIP	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
1663H	SUP	Custom 27203010		1663H  -  SUTURE NABSB 3-0 PS1 18IN BLK ETH MTPS MFL	BOTH IP/OP	$29.35 	$21.72	$0.00	$23.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.79	$21.79	$0.00	$0.00	$6.12	$0.00	$0.00	$0.00	$0.00	$14.68	$23.25	$23.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1698G	SUP	Custom 27203010		1698G  -  SUTURE NABSB 6-0 P-3 18IN BLK ETH MTPS MFL	BOTH IP/OP	$9.77 	$7.23	$0.00	$7.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.25	$7.25	$0.00	$0.00	$2.04	$0.00	$0.00	$0.00	$0.00	$4.96	$7.86	$7.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1699T/40	SUP	HCPCS C1898		1699T/40  -  OPTISENSE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
1699T/58	SUP	HCPCS C1898		1699T/58  -  OPTISENSE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
1699TC/40	SUP	HCPCS C1898		1699TC/40  -  LEAD PCNG 6.2FR 40CM LF TNDRL FSR STRD ELUT ATR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
1699TC/46	SUP	HCPCS C1898		1699TC/46  -  OPTISENSE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
1699TC/52	SUP	HCPCS C1898		1699TC/52  -  LEAD PCNG 1.1MM SPC 6.2FR 52CM LF OPTISENSE 1 PASS VDD BP	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
16MH18	SUP	Custom 27203010		16MH18  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$269.88 	$199.71	$0.00	$215.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.30	$200.30	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$134.94	$213.74	$215.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16MH18L	SUP	Custom 27203010		16MH18L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$269.88 	$199.71	$0.00	$215.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.30	$200.30	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$134.94	$213.74	$215.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16MH22	SUP	Custom 27203010		16MH22  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$269.88 	$199.71	$0.00	$215.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.30	$200.30	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$134.94	$213.74	$215.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16TA11	SUP	Custom 27203010		16TA11  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$269.88 	$199.71	$0.00	$215.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.30	$200.30	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$134.94	$213.74	$215.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16TA13	SUP	Custom 27203010		16TA13  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$269.88 	$199.71	$0.00	$215.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.30	$200.30	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$134.94	$213.74	$215.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16TA15	SUP	Custom 27203010		16TA15  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$269.88 	$199.71	$0.00	$215.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.30	$200.30	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$134.94	$213.74	$215.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16TA17	SUP	Custom 27203010		16TA17  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$269.88 	$199.71	$0.00	$215.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.30	$200.30	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$134.94	$213.74	$215.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16TA23	SUP	Custom 27203010		16TA23  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$269.88 	$199.71	$0.00	$215.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.30	$200.30	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$134.94	$213.74	$215.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
16TA24	SUP	Custom 27203010		16TA24  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$269.88 	$199.71	$0.00	$215.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.30	$200.30	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$134.94	$213.74	$215.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17-0000E	SUP	Custom 27803010		17-0000E  -  SLEEVE ADAPTER V40 TITANIUM ALUM CERAMIC NONSTRL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-01	SUP	HCPCS C1713		17-001-01  -  CLIP ANEURYSM 1 8.5MM OPENING STANDARD 7MM STR SUGITA	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$547.88	$547.88	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$190.54	$0.00	$0.00	$193.83	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-02	SUP	HCPCS C1713		17-001-02  -  CLIP ANEURYSM 10.5MM STANDARD 10MM STR SUGITA TITANIUM 2	BOTH IP/OP	"$1,222.50 "	$904.65	$0.00	$974.00	$547.88	$547.88	$0.00	$0.00	$0.00	$254.80	$907.34	$907.34	$0.00	$0.00	$254.77	$0.00	$723.11	$723.11	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$190.54	$0.00	$0.00	$193.83	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-03	SUP	HCPCS C1713		17-001-03  -  CLIP ANEURYSM 11MM STANDARD 7MM BAYONET SUGITA TITANIUM 2	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-04	SUP	HCPCS C1713		17-001-04  -  CLIP ANEURYSM 9.5MM STANDARD 8MM BENT SUGITA TITANIUM 2	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-05	SUP	HCPCS C1713		17-001-05  -  CLIP ANRSM 8MM SGTA 11MM STD TI 2 SDWRD BNT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-06	SUP	HCPCS C1713		17-001-06  -  CLIP ANEURYSM 6 10MM OPENING STANDARD 9MM SIDEWARD CVD	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-07	SUP	HCPCS C1713		17-001-07  -  CLIP ANEURYSM 12MM STANDARD 8.5MM SLIGHTLY CVD BAYONET	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-08	SUP	HCPCS C1713		17-001-08  -  CLIP ANRSM 9MM SGTA 9.5MM STD TI 2 CVD NONSTRL	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-09	SUP	HCPCS C1713		17-001-09  -  CLIP ANEURYSM 10MM STANDARD 9MM SLIGHTLY CVD SUGITA TITANIUM	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-10	SUP	HCPCS C1713		17-001-10  -  CLIP ANEURYSM 11.5MM STANDARD 12MM STR SUGITA TITANIUM 2	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$547.88	$547.88	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$608.75	$742.50	$974.00	$0.00		$0.00	$146.72	$0.00	$0.00	$193.83	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-11	SUP	HCPCS C1713		17-001-11  -  CLIP ANRSM 12MM SGTA 13.5MM STD TI 2 SDWRD BNT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-13	SUP	HCPCS C1713		17-001-13  -  CLIP ANEURYSM 13MM STANDARD 10MM BAYONET SUGITA TITANIUM 2	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-15	SUP	HCPCS C1713		17-001-15  -  CLIP ANRSM 15MM SGTA 13.5MM STD TI 2 STR NONSTRL	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-18	SUP	HCPCS C1713		17-001-18  -  CLIP ANRSM 18MM SGTA 15.5MM STD TI 2 STR	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-20	SUP	HCPCS C1713		17-001-20  -  CLIP ANEURYSM 8MM STANDARD 5MM L SUGITA TITANIUM 2 NONSTRL	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-23	SUP	HCPCS C1713		17-001-23  -  CLIP ANRSM 6MM SGTA 9MM STD TI 2 J	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-26	SUP	HCPCS C1713		17-001-26  -  CLIP ANEURYSM 26 11MM OPENING STANDARD STR FENST SUGITA	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$903.63	$365.63	$365.63	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-27	SUP	HCPCS C1713		17-001-27  -  CLIP ANRSM 9MM 3.5MM SGTA 13MM STD TI 2 STR FENST	BOTH IP/OP	"$1,222.50 "	$904.65	$0.00	$907.34	$365.63	$365.63	$0.00	$0.00	$0.00	$254.80	$907.34	$907.34	$0.00	$0.00	$254.77	$0.00	$723.11	$723.11	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-29	SUP	HCPCS C1713		17-001-29  -  CLIP ANEURYSM 29 12MM OPENING STANDARD 5MM 6MM STR FENST	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-30	SUP	HCPCS C1713		17-001-30  -  CLIP ANEURYSM 14MM STANDARD 5MM 9MM STR FENST SUGITA	BOTH IP/OP	"$1,182.50 "	$875.05	$0.00	$946.00	$532.13	$532.13	$0.00	$0.00	$0.00	$246.46	$877.65	$877.65	$0.00	$0.00	$246.43	$0.00	$699.45	$699.45	$0.00	$591.25	$936.54	$946.00	$0.00		$0.00	$185.06	$0.00	$0.00	$188.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-31	SUP	HCPCS C1713		17-001-31  -  CLIP ANEURYSM 15.5MM STANDARD 5MM 12MM STR FENST SUGITA	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-35	SUP	HCPCS C1713		17-001-35  -  CLIP ANRSM 5MM 5MM SGTA 9.5MM STD TI 2 BNT FENST	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-36	SUP	HCPCS C1713		17-001-36  -  CLIP ANRSM 7.5MM 5MM SGTA 10MM STD TI 2 BNT FENST	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-37	SUP	HCPCS C1713		17-001-37  -  CLIP ANRSM 10MM 5MM SGTA 11MM STD TI 2 BNT FENST	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-38	SUP	HCPCS C1713		17-001-38  -  CLIP ANRSM 5MM 3.5MM SGTA 7.5MM STD TI 2 L FENST	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-41	SUP	HCPCS C1713		17-001-41  -  CLIP ANRSM 5MM 5MM SGTA 8.5MM STD TI 2 L FENST	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-48	SUP	HCPCS C1713		17-001-48  -  CLIP ANRSM 7.5MM SGTA 45D 11.5MM STD TI 2 ANG	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-50	SUP	HCPCS C1713		17-001-50  -  CLIP ANEURYSM 13MM STANDARD 14MM CVD SUGITA TITANIUM 2	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-51	SUP	HCPCS C1713		17-001-51  -  CLIP ANEURYSM 9MM STANDARD 7MM STR TEMPORARY SUGITA TITANIUM	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$547.88	$547.88	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$190.54	$0.00	$0.00	$193.83	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-52	SUP	HCPCS C1713		17-001-52  -  CLIP ANEURYSM 10.5MM STANDARD 10MM STR TEMPORARY SUGITA	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$903.63	$365.63	$365.63	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-53	SUP	HCPCS C1713		17-001-53  -  CLIP ANEURYSM 11.5MM STANDARD 7MM BAYONET TEMPORARY SUGITA	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-54	SUP	HCPCS C1713		17-001-54  -  CLIP ANRSM 8MM SGTA 9.5MM STD TI 2 BNT TEMP	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-55	SUP	HCPCS C1713		17-001-55  -  CLIP ANRSM 11MM SGTA 11MM STD TI 2 SLT CVD TEMP	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-56	SUP	HCPCS C1713		17-001-56  -  CLIP ANEURYSM 56 7MM MINI STR 6MM TEMPORARY WIDE OPENING	BOTH IP/OP	"$1,222.50 "	$904.65	$0.00	$974.00	$547.88	$547.88	$0.00	$0.00	$0.00	$254.80	$907.34	$907.34	$0.00	$0.00	$254.77	$0.00	$723.11	$723.11	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$190.54	$0.00	$0.00	$193.83	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-57	SUP	HCPCS C1713		17-001-57  -  CLIP ANEURYSM 7MM MINI 5MM BENT TEMPORARY SUGITA TITANIUM 2	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$903.63	$365.63	$365.63	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-58	SUP	HCPCS C1713		17-001-58  -  CLIP ANEURYSM 7MM MINI 6MM STR TEMPORARY SLIM TIP SUGITA	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$547.88	$547.88	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$190.54	$0.00	$0.00	$193.83	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-64	SUP	HCPCS C1713		17-001-64  -  CLIP ANRSM 8MM SGTA 10.5MM STD TI 2 SLT BNT	BOTH IP/OP	"$1,182.50 "	$875.05	$0.00	$946.00	$532.13	$532.13	$0.00	$0.00	$0.00	$246.46	$877.65	$877.65	$0.00	$0.00	$246.43	$0.00	$699.45	$699.45	$0.00	$591.25	$936.54	$946.00	$0.00		$0.00	$185.06	$0.00	$0.00	$188.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-65	SUP	HCPCS C1713		17-001-65  -  CLIP ANEURYSM 11MM STANDARD 11MM SLIGHTLY CVD SUGITA	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-66	SUP	HCPCS C1713		17-001-66  -  CLIP ANRSM 11MM SGTA 11MM STD TI 2 CVD NONSTRL	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$903.63	$421.88	$421.88	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-68	SUP	HCPCS C1713		17-001-68  -  CLIP ANEURYSM 10MM STANDARD 9MM SLIGHTLY CVD SUGITA TITANIUM	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$903.63	$421.88	$421.88	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-69	SUP	HCPCS C1713		17-001-69  -  CLIP ANRSM 9MM SGTA 69 9.5MM OPN STD TI 2 CVD	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$547.88	$547.88	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$190.54	$0.00	$0.00	$193.83	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-72	SUP	HCPCS C1713		17-001-72  -  TII 18.0 STRAIGHT 25MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-76	SUP	HCPCS C1713		17-001-76  -  CLIP ANRSM 10MM 5MM 8.5MM STD LEFT TI 2 L FENST	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-79	SUP	HCPCS C1713		17-001-79  -  CLIP ANRSM 10MM 5MM 8.5MM STD RIGHT TI 2 L FENST	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-80	SUP	HCPCS C1713		17-001-80  -  CLIP ANEURYSM 5.5MM MINI 4MM STR SUGITA TITANIUM 2 NONSTRL	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$547.88	$547.88	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$190.54	$0.00	$0.00	$193.83	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-81	SUP	HCPCS C1713		17-001-81  -  CLIP ANEURYSM 7MM MINI 6MM STR SUGITA TITANIUM 2 NONSTRL	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$547.88	$547.88	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$190.54	$0.00	$0.00	$193.83	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-83	SUP	HCPCS C1713		17-001-83  -  CLIP ANRSM 5MM SGTA 6.5MM MINI TI 2 CVD NONSTRL	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-84	SUP	HCPCS C1713		17-001-84  -  CLIP ANEURYSM 7MM MINI 5MM BENT SUGITA TITANIUM 2 NONSTRL	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-85	SUP	HCPCS C1713		17-001-85  -  CLIP ANRSM 4MM SGTA 5.5MM MINI TI 2 CVD NONSTRL	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-86	SUP	HCPCS C1713		17-001-86  -  CLIP ANRSM 7MM SGTA 7.5MM MINI TI 2 SDWRD CVD	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-88	SUP	HCPCS C1713		17-001-88  -  CLIP ANEURYSM 7.5MM MINI 7MM CVD SUGITA TITANIUM 2 NONSTRL	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-89	SUP	HCPCS C1713		17-001-89  -  CLIP ANRSM 5MM SGTA 89 8.5MM OPN MINI TI 2 BYNT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-90	SUP	HCPCS C1713		17-001-90  -  T2 20.5 STRAIGHT 30MM	BOTH IP/OP	"$1,740.05 "	"$1,287.64"	$0.00	"$1,392.04"	$783.02	$783.02	$0.00	$0.00	$0.00	$362.67	"$1,291.47"	"$1,291.47"	$0.00	$0.00	$362.63	$0.00	"$1,029.24"	"$1,029.24"	$0.00	$870.03	"$1,378.12"	"$1,392.04"	$0.00		$0.00	$272.32	$0.00	$0.00	$277.02	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-91	SUP	HCPCS C1713		17-001-91  -  T2 23.5 STRAIGHT 35MM	BOTH IP/OP	"$1,740.05 "	"$1,287.64"	$0.00	"$1,392.04"	$783.02	$783.02	$0.00	$0.00	$0.00	$362.67	"$1,291.47"	"$1,291.47"	$0.00	$0.00	$362.63	$0.00	"$1,029.24"	"$1,029.24"	$0.00	$870.03	"$1,378.12"	"$1,392.04"	$0.00		$0.00	$272.32	$0.00	$0.00	$277.02	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-92	SUP	HCPCS C1713		17-001-92  -  CLIP ANRSM 92 26MM OPN LNG STRG 40MM TI 2	BOTH IP/OP	"$1,740.05 "	"$1,287.64"	$0.00	"$1,392.04"	$783.02	$783.02	$0.00	$0.00	$0.00	$362.67	"$1,291.47"	"$1,291.47"	$0.00	$0.00	$362.63	$0.00	"$1,029.24"	"$1,029.24"	$0.00	$870.03	"$1,378.12"	"$1,392.04"	$0.00		$0.00	$272.32	$0.00	$0.00	$277.02	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-95	SUP	HCPCS C1713		17-001-95  -  CLIP ANEURYSM 5.5MM MINI 4MM STR SLIM TIP SUGITA TITANIUM 2	BOTH IP/OP	"$1,182.50 "	$875.05	$0.00	$946.00	$532.13	$532.13	$0.00	$0.00	$0.00	$246.46	$877.65	$877.65	$0.00	$0.00	$246.43	$0.00	$699.45	$699.45	$0.00	$591.25	$936.54	$946.00	$0.00		$0.00	$185.06	$0.00	$0.00	$188.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-96	SUP	HCPCS C1713		17-001-96  -  CLIP ANEURYSM 7MM MINI 6MM STR SLIM TIP SUGITA TITANIUM 2	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$547.88	$547.88	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$190.54	$0.00	$0.00	$193.83	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-97	SUP	HCPCS C1713		17-001-97  -  CLIP ANRSM 6.7MM SGTA 7MM MINI TI 2 CVD SLIM TIP	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-001-99	SUP	HCPCS C1713		17-001-99  -  CLIP ANRSM 5.2MM SGTA 6.5MM MINI TI 2 CVD SLIM TIP	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-002-03	SUP	HCPCS C1713		17-002-03  -  CLIP ANRSM 10 T2 STD TLL 4MM SGTA CRANK SHFT TI	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-002-05	SUP	HCPCS C1713		17-002-05  -  CLIP ANRSM 12MM 5MM HEAD STRNG 7.5MM STD TI 2	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-002-15	SUP	HCPCS C1713		17-002-15  -  CLIP ANEURYSM 8MM MINI 8MM STR SUGITA TITANIUM 2	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$547.88	$547.88	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$608.75	$742.50	$974.00	$0.00		$0.00	$146.72	$0.00	$0.00	$193.83	$0.00	$0.00	$0.00	$0.00	$0.00
17-002-16	SUP	HCPCS C1713		17-002-16  -  CLIP ANRSM 6.5MM SGTA 7MM MINI TI 2 CVD	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
17-002-17	SUP	HCPCS C1713		17-002-17  -  CLIP ANRSM 5.5MM SGTA 6.5MM MINI TI 2 SLT CVD	BOTH IP/OP	"$1,222.50 "	$904.65	$0.00	$907.34	$365.63	$365.63	$0.00	$0.00	$0.00	$254.80	$907.34	$907.34	$0.00	$0.00	$254.77	$0.00	$723.11	$723.11	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-002-19	SUP	Custom 27011340		17-002-19  -  CLIP ANRSM 6MM SGTA 8.5MM MINI TI 2 SDWRD BNT	BOTH IP/OP	"$1,182.50 "	$875.05	$0.00	$946.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$877.65	$877.65	$0.00	$0.00	$246.43	$0.00	$0.00	$0.00	$0.00	$591.25	$936.54	$946.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17-002-20	SUP	HCPCS C1713		17-002-20  -  CLIP ANRSM 7MM SGTA 10MM MINI TI 2 BYNT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-002-21	SUP	HCPCS C1713		17-002-21  -  CLIP ANRSM 5.5MM SGTA 6.5MM MINI TI 2 CVD SLIM TIP	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-25008	SUP	HCPCS C1874		170-03-25008  -  SYSTEM COR STNT 2.5MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-25012	SUP	HCPCS C1874		170-03-25012  -  SYSTEM COR STNT 2.5MM 12MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-25015	SUP	HCPCS C1874		170-03-25015  -  SYSTEM COR STNT 2.5MM 15MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-25018	SUP	HCPCS C1874		170-03-25018  -  SYSTEM COR STNT 2.5MM 18MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-25024	SUP	HCPCS C1874		170-03-25024  -  SYSTEM COR STNT 2.5MM 24MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-25030	SUP	HCPCS C1874		170-03-25030  -  SYSTEM COR STNT 2.5MM 30MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-27508	SUP	HCPCS C1874		170-03-27508  -  SYSTEM COR STNT 2.75MM 8MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-27512	SUP	HCPCS C1874		170-03-27512  -  SYSTEM COR STNT 2.75MM 12MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-27515	SUP	HCPCS C1874		170-03-27515  -  SYSTEM COR STNT 2.75MM 15MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-27518	SUP	HCPCS C1874		170-03-27518  -  SYSTEM COR STNT 2.75MM 18MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-27524	SUP	HCPCS C1874		170-03-27524  -  SYSTEM COR STNT 2.75MM 24MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-27530	SUP	HCPCS C1874		170-03-27530  -  SYSTEM COR STNT 2.75MM 30MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-30008	SUP	HCPCS C1874		170-03-30008  -  SYSTEM COR STNT 3MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-30012	SUP	HCPCS C1874		170-03-30012  -  SYSTEM COR STNT 3MM 12MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-30015	SUP	HCPCS C1874		170-03-30015  -  SYSTEM COR STNT 3MM 15MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-30018	SUP	HCPCS C1874		170-03-30018  -  SYSTEM COR STNT 3MM 18MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-30024	SUP	HCPCS C1874		170-03-30024  -  SYSTEM COR STNT 3MM 24MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-30030	SUP	HCPCS C1874		170-03-30030  -  SYSTEM COR STNT 3MM 30MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-35008	SUP	HCPCS C1874		170-03-35008  -  SYSTEM COR STNT 3.5MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-35012	SUP	HCPCS C1874		170-03-35012  -  SYSTEM COR STNT 3.5MM 12MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-35015	SUP	HCPCS C1876		170-03-35015  -  SYSTEM COR STNT 3.5MM 15MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-35018	SUP	HCPCS C1876		170-03-35018  -  SYSTEM COR STNT 3.5MM 18MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-35024	SUP	HCPCS C1874		170-03-35024  -  SYSTEM COR STNT 3.5MM 24MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-35030	SUP	HCPCS C1874		170-03-35030  -  SYSTEM COR STNT 3.5MM 30MM CBR PZF RX DLV SYS POLYZENE-F	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-40008	SUP	HCPCS C1874		170-03-40008  -  SYSTEM COR STNT 4MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-40012	SUP	HCPCS C1874		170-03-40012  -  SYSTEM COR STNT 4MM 12MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-40015	SUP	HCPCS C1874		170-03-40015  -  SYSTEM COR STNT 4MM 15MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-40018	SUP	HCPCS C1874		170-03-40018  -  SYSTEM COR STNT 4MM 18MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-40024	SUP	HCPCS C1874		170-03-40024  -  SYSTEM COR STNT 4MM 24MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
170-03-40030	SUP	HCPCS C1874		170-03-40030  -  SYSTEM COR STNT 4MM 30MM CBR PZF RX DLV SYS POLYZENE-F COCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
17-006-03	SUP	HCPCS C1713		17-006-03  -  CLIP ANRSM 11 T2 STD L 5MM SGTA WDW TI	BOTH IP/OP	"$1,302.30 "	$963.70	$0.00	"$1,041.84"	$586.04	$586.04	$0.00	$0.00	$0.00	$271.43	$966.57	$966.57	$0.00	$0.00	$271.40	$0.00	$770.31	$770.31	$0.00	$651.15	"$1,031.42"	"$1,041.84"	$0.00		$0.00	$203.81	$0.00	$0.00	$207.33	$0.00	$0.00	$0.00	$0.00	$0.00
17-006-36	SUP	HCPCS C1713		17-006-36  -  CLIP ANRSM 142 006-36 STD BNT 5MM 3MM FENESTRATE TI	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
17-006-39	SUP	HCPCS C1713		17-006-39  -  CLIP ANRSM STRG 3.5MM 4MM SGTA T2 FENESTRATE TI	BOTH IP/OP	"$1,217.50 "	$900.95	$0.00	$974.00	$547.88	$547.88	$0.00	$0.00	$0.00	$253.76	$903.63	$903.63	$0.00	$0.00	$253.73	$0.00	$720.15	$720.15	$0.00	$608.75	$964.26	$974.00	$0.00		$0.00	$190.54	$0.00	$0.00	$193.83	$0.00	$0.00	$0.00	$0.00	$0.00
17-006-40	SUP	HCPCS C1713		17-006-40  -  CLIP ANRSM STRG 5MM 4MM SGTA T2 FENESTRATE TI	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
1714G	SUP	Custom 27203010		1714G  -  SUTURE NONABSORBABLE 8-0 TG100-8 12IN 2 ARM MONOFILAMENT	BOTH IP/OP	$33.48 	$24.78	$0.00	$27.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.85	$24.85	$0.00	$0.00	$6.98	$0.00	$0.00	$0.00	$0.00	$16.99	$26.91	$27.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1716G	SUP	Custom 27203010		1716G  -  SUTURE NONABSORBABLE 8-0 TG175-8 12IN 2 ARM MONOFILAMENT	BOTH IP/OP	$33.61 	$24.87	$0.00	$27.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.95	$24.95	$0.00	$0.00	$7.00	$0.00	$0.00	$0.00	$0.00	$17.06	$27.02	$27.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200D600	SUP	Custom 27203010		17200D600  -  PUNCH SURG 6MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200D650	SUP	Custom 27203010		17200D650  -  PUNCH SURG 6.5MM CORNEUM 2 PC VAC UL SHRP BLADE	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200D700	SUP	Custom 27203010		17200D700  -  PUNCH SURG 7MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200D725	SUP	Custom 27203010		17200D725  -  PUNCH SURG 7.25MM CORNEUM 2 PC VAC UL SHRP BLADE	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200D750	SUP	Custom 27203010		17200D750  -  PUNCH SURG 7.5MM CORNEUM 2 PC VAC UL SHRP BLADE	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200D775	SUP	Custom 27203010		17200D775  -  PUNCH SURG 7.75MM CORNEUM 2 PC VAC UL SHRP BLADE	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200D800	SUP	Custom 27203010		17200D800  -  PUNCH SURG 8MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200D825	SUP	Custom 27203010		17200D825  -  PUNCH SURG 8.25MM CORNEUM 2 PC VAC UL SHRP BLADE	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200D850	SUP	Custom 27203010		17200D850  -  PUNCH SURG 8.5MM CORNEUM 2 PC VAC UL SHRP BLADE	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200D875	SUP	Custom 27203010		17200D875  -  PUNCH SURG 8.75MM CORNEUM 2 PC VAC UL SHRP BLADE	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200D900	SUP	Custom 27203010		17200D900  -  PUNCH SURG 9MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17200D950	SUP	Custom 27203010		17200D950  -  PUNCH SURG 9.5MM CORNEUM 2 PC VAC UL SHRP BLADE	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1722G	SUP	Custom 27203010		1722G  -  SUTURE MERS 6-0 S-14 18IN WVN TPE BRAID DBL ARM WHT NABSB	BOTH IP/OP	$33.57 	$24.84	$0.00	$26.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.91	$24.91	$0.00	$0.00	$7.00	$0.00	$0.00	$0.00	$0.00	$16.78	$26.59	$26.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17-2800E	SUP	Custom 27803010		17-2800E  -  HEAD FEMORAL C TAPER ALUM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17-2805E	SUP	Custom 27803010		17-2805E  -  HEAD FEMORAL +5MM 28MM C TAPER ALUM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17-28-3E	SUP	Custom 27803010		17-28-3E  -  HEAD FEMORAL +3MM 28MM C TAPER ALUM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
173050G	SUP	Custom 27203010		173050G  -  POUCH SPECIMEN RETRIEVAL 10MM 34.5CM MINIMIZE SPILLAGE	BOTH IP/OP	$147.95 	$109.48	$0.00	$120.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.81	$109.81	$0.00	$0.00	$30.83	$0.00	$0.00	$0.00	$0.00	$75.08	$118.93	$120.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17-3200E	SUP	Custom 27803010		17-3200E  -  HEAD FEM +0MM OFST CTPR 32MM STRL AL CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17-3205E	SUP	Custom 27803010		17-3205E  -  HEAD FEMORAL +5MM 32MM C TAPER ALUM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17-32-3E	SUP	Custom 27803010		17-32-3E  -  HEAD FEM -2.5MM CTPR 32MM STRL AL CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1735G	SUP	Custom 27203010		1735G  -  SUTURE ABSORBABLE 6-0 TG140-8 18IN 2 ARM MONOFILAMENT	BOTH IP/OP	$55.72 	$41.23	$0.00	$45.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.36	$41.36	$0.00	$0.00	$11.61	$0.00	$0.00	$0.00	$0.00	$28.28	$44.80	$45.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17-3600E	SUP	Custom 27803010		17-3600E  -  HEAD FEM +0MM OFST CTPR 36MM STRL AL CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17-3605E	SUP	Custom 27803010		17-3605E  -  HEAD FEMORAL +5MM 36MM C TAPER ALUM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
17-36-5E	SUP	HCPCS C1713		17-36-5E  -  HEAD FEMORAL -5MM C-TAPER 36MM OFFST ALUM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
174105-2	SUP	Custom 27203010		174105-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
175031EN	SUP	Custom 27203010		175031EN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$24.00 	$17.76	$0.00	$19.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.81	$17.81	$0.00	$0.00	$5.00	$0.00	$0.00	$0.00	$0.00	$12.00	$19.01	$19.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1754G	SUP	Custom 27203010		1754G  -  SUTURE NONABSORBABLE 9-0 TG140-8 6IN 2 ARM MONOFILAMENT	BOTH IP/OP	$42.02 	$31.09	$0.00	$33.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.19	$31.19	$0.00	$0.00	$8.76	$0.00	$0.00	$0.00	$0.00	$21.01	$33.28	$33.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1758SI16	SUP	Custom 27203010		1758SI16  -  CATHETER URTH 16FR 5CC STRL LF BARD LBRSL IC 2W FL BLN	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.00	$0.00	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1762G	SUP	Custom 27203010		1762G  -  SUTURE NONABSORBABLE 4-0 S-24 18IN MONOFILAMENT PLIABILIZE	BOTH IP/OP	$37.27 	$27.58	$0.00	$30.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.66	$27.66	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$18.91	$29.96	$30.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1764G	SUP	Custom 27203010		1764G  -  SUTURE NABSB 5-0 S-24 18IN WHT MERS SABRELOC 2 ARM BRD	BOTH IP/OP	$36.90 	$27.31	$0.00	$29.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.39	$27.39	$0.00	$0.00	$7.69	$0.00	$0.00	$0.00	$0.00	$18.73	$29.66	$29.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1773.00.126	SUP	HCPCS C1713		1773.00.126  -  CAGE SPNL 12MM STD PRLL 14X26MM NS LF BENGAL STKBL RDLCNT	BOTH IP/OP	"$8,790.00 "	"$6,504.60"	$0.00	"$7,032.00"	"$3,955.50"	"$3,955.50"	$0.00	$0.00	$0.00	"$1,832.06"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,831.84"	$0.00	"$4,333.47"	"$4,333.47"	$0.00	"$4,395.00"	"$6,961.68"	"$7,032.00"	$0.00		$0.00	"$1,375.64"	$0.00	$0.00	"$1,399.37"	$0.00	$0.00	$0.00	$0.00	$0.00
1779G	SUP	Custom 27203010		1779G  -  SUTURE NONABSORBABLE 4-0 S-2 18IN MONOFILAMENT PLIABILIZE	BOTH IP/OP	$33.94 	$25.12	$0.00	$27.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.19	$25.19	$0.00	$0.00	$7.07	$0.00	$0.00	$0.00	$0.00	$16.97	$26.88	$27.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
179071P	SUP	Custom 27203010		179071P  -  TROCAR LAPSCOP 100MM 5-12MM VPRT+ RPF BLADED CNVTRLS RDLCNT	BOTH IP/OP	$128.52 	$95.10	$0.00	$102.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.26	$101.79	$102.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
179075P	SUP	Custom 27203010		179075P  -  TROCAR LAPSCOP 5-12MM BLNTPRT PLUS VRSPRT SLV CNVTRLS STAB	BOTH IP/OP	$35.84 	$26.52	$0.00	$28.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.92	$28.39	$28.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
179078P	SUP	Custom 27203010		179078P  -  TROCAR LAPSCOP PYRAMID 10-15MM 100MM 5MM SAFETY SHIELD SELF	BOTH IP/OP	$120.15 	$88.91	$0.00	$96.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.18	$89.18	$0.00	$0.00	$25.04	$0.00	$0.00	$0.00	$0.00	$60.08	$95.16	$96.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
179094F	SUP	Custom 27203010		179094F  -  TROCAR LAPSCP 5MM LVN VPRT+ V2 VERSASEAL + FX CNN CNVTRLS	BOTH IP/OP	$73.95 	$54.72	$0.00	$59.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.98	$58.57	$59.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
179096PF	SUP	Custom 27203010		179096PF  -  TROCAR LAPSCOP 12MM VPRT+ V2 BLADED FIX CANNU STRL DISP	BOTH IP/OP	$86.28 	$63.85	$0.00	$98.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.03	$64.03	$0.00	$0.00	$17.98	$0.00	$0.00	$0.00	$0.00	$61.51	$97.42	$98.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
179097P	SUP	Custom 27203010		179097P  -  TROCAR LAPSCOP LONG 5-12MM 150MM SHARP LINEAR BLADE SPRING	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.09	$63.09	$0.00	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1797.12.765	SUP	HCPCS C1713		1797.12.765  -  SCREW BONE 7MM 65MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
1797.71.150	SUP	HCPCS C1713		1797.71.150  -  ROD SPNL PREBNT 5.5MM 150MM NS XPDM LN TI	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
1797.71.555	SUP	HCPCS C1713		1797.71.555  -  CONNECTOR ROD 5.5MM TOP NOTCH OUTER TO OUTER SIDE SPN	BOTH IP/OP	"$2,752.50 "	"$2,036.85"	$0.00	"$2,202.00"	"$1,238.63"	"$1,238.63"	$0.00	$0.00	$0.00	$573.69	"$2,042.91"	"$2,042.91"	$0.00	$0.00	$573.62	$0.00	"$1,356.98"	"$1,356.98"	$0.00	"$1,376.25"	"$2,179.98"	"$2,202.00"	$0.00		$0.00	$430.77	$0.00	$0.00	$438.20	$0.00	$0.00	$0.00	$0.00	$0.00
1797G	SUP	Custom 27203010		1797G  -  SUTURE ABSORBABLE 7-0 TG140-8 18IN 2 ARM MONOFILAMENT	BOTH IP/OP	$67.02 	$49.59	$0.00	$54.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.74	$49.74	$0.00	$0.00	$13.97	$0.00	$0.00	$0.00	$0.00	$34.01	$53.88	$54.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
180204HC-S-V	SUP	HCPCS C1884		COIL MICROPLEX 18SOFT 2MM X 4CM	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$5.63	$5.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
180208HC-S-V	SUP	HCPCS C1884		COIL MICROPLEX 18SOFT 2MM X 8CM	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$5.63	$5.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
180308HC-S-V	SUP	HCPCS C1884		COIL MICROPLEX 18SOFT 3MM X 8CM	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$5.63	$5.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
180320-1	SUP	HCPCS C1776		180320-1  -  COMPONENT PTLR RND 26MM RSRFC KN MCK SYS	BOTH IP/OP	"$2,192.50 "	"$1,622.45"	$0.00	"$1,754.00"	$986.63	$986.63	$0.00	$0.00	$0.00	$456.97	"$1,627.27"	"$1,627.27"	$0.00	$0.00	$456.92	$0.00	"$1,296.86"	"$1,296.86"	$0.00	"$1,096.25"	"$1,736.46"	"$1,754.00"	$0.00		$0.00	$343.13	$0.00	$0.00	$349.05	$0.00	$0.00	$0.00	$0.00	$0.00
180320-2	SUP	HCPCS C1776		180320-2  -  COMPONENT PTLR RND 29MM RSRFC KN MCK SYS	BOTH IP/OP	"$2,192.50 "	"$1,622.45"	$0.00	"$1,754.00"	$986.63	$986.63	$0.00	$0.00	$0.00	$456.97	"$1,627.27"	"$1,627.27"	$0.00	$0.00	$456.92	$0.00	"$1,296.86"	"$1,296.86"	$0.00	"$1,096.25"	"$1,736.46"	"$1,754.00"	$0.00		$0.00	$343.13	$0.00	$0.00	$349.05	$0.00	$0.00	$0.00	$0.00	$0.00
180320-3	SUP	HCPCS C1776		180320-3  -  COMPONENT PTLR RND 32MM RSRFC KN MCK SYS	BOTH IP/OP	"$2,192.50 "	"$1,622.45"	$0.00	"$1,754.00"	$986.63	$986.63	$0.00	$0.00	$0.00	$456.97	"$1,627.27"	"$1,627.27"	$0.00	$0.00	$456.92	$0.00	"$1,296.86"	"$1,296.86"	$0.00	"$1,096.25"	"$1,736.46"	"$1,754.00"	$0.00		$0.00	$343.13	$0.00	$0.00	$349.05	$0.00	$0.00	$0.00	$0.00	$0.00
180320-4	SUP	HCPCS C1776		180320-4  -  DOME PTLR RND 35MM RSRFC KN MCK SYS	BOTH IP/OP	"$2,192.50 "	"$1,622.45"	$0.00	"$1,754.00"	$986.63	$986.63	$0.00	$0.00	$0.00	$456.97	"$1,627.27"	"$1,627.27"	$0.00	$0.00	$456.92	$0.00	"$1,296.86"	"$1,296.86"	$0.00	"$1,096.25"	"$1,736.46"	"$1,754.00"	$0.00		$0.00	$343.13	$0.00	$0.00	$349.05	$0.00	$0.00	$0.00	$0.00	$0.00
180320-6	SUP	HCPCS C1776		180320-6  -  DOME PTLR RND 41MM RSRFC KN MCK SYS	BOTH IP/OP	"$2,192.50 "	"$1,622.45"	$0.00	"$1,754.00"	$986.63	$986.63	$0.00	$0.00	$0.00	$456.97	"$1,627.27"	"$1,627.27"	$0.00	$0.00	$456.92	$0.00	"$1,296.86"	"$1,296.86"	$0.00	"$1,096.25"	"$1,736.46"	"$1,754.00"	$0.00		$0.00	$343.13	$0.00	$0.00	$349.05	$0.00	$0.00	$0.00	$0.00	$0.00
180406HC-S-V	SUP	HCPCS C1884		COIL MICROPLEX 18SOFT 4MM X 6CM	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$5.63	$5.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
180512HC-S-V	SUP	HCPCS C1884		COIL MICROPLEX 18SOFT 5MM X 12CM	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$5.63	$5.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
180520HC-R-V	SUP	HCPCS C1884		COIL MICROPLEX 18REG 5MM X 20CM	BOTH IP/OP	"$1,536.65 "	"$1,137.12"	$0.00	"$1,229.32"	$691.49	$691.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.33	"$1,217.03"	"$1,229.32"	$0.00		$0.00	$240.49	$0.00	$0.00	$244.63	$0.00	$0.00	$0.00	$0.00	$0.00
1806-0004	SUP	HCPCS C1713		1806-0004  -  SCREW BONE T2 LCK INS	BOTH IP/OP	$460.63 	$340.87	$0.00	$368.50	$207.28	$207.28	$0.00	$0.00	$0.00	$96.01	$341.88	$341.88	$0.00	$0.00	$95.99	$0.00	$272.46	$272.46	$0.00	$230.31	$364.82	$368.50	$0.00		$0.00	$72.09	$0.00	$0.00	$73.33	$0.00	$0.00	$0.00	$0.00	$0.00
1806-0007	SUP	HCPCS C1713		1806-0007  -  SCREW BONE T2 CNDYLR INS	BOTH IP/OP	$426.25 	$315.43	$0.00	$341.00	$191.81	$191.81	$0.00	$0.00	$0.00	$88.84	$316.36	$316.36	$0.00	$0.00	$88.83	$0.00	$252.13	$252.13	$0.00	$213.13	$337.59	$341.00	$0.00		$0.00	$66.71	$0.00	$0.00	$67.86	$0.00	$0.00	$0.00	$0.00	$0.00
1806-0009	SUP	HCPCS C1713		1806-0009  -  SCREW BONE T2 FEM/TIB INS CMPR	BOTH IP/OP	$526.63 	$389.71	$0.00	$421.30	$236.98	$236.98	$0.00	$0.00	$0.00	$109.76	$390.86	$390.86	$0.00	$0.00	$109.75	$0.00	$311.50	$311.50	$0.00	$263.31	$417.09	$421.30	$0.00		$0.00	$82.42	$0.00	$0.00	$83.84	$0.00	$0.00	$0.00	$0.00	$0.00
1806-0050S	SUP	HCPCS C1713		1806-0050S  -  WIRE FX 3MM 285MM STRL KRSH T2 SS	BOTH IP/OP	$195.50 	$144.67	$0.00	$160.60	$90.34	$90.34	$0.00	$0.00	$0.00	$40.75	$145.10	$145.10	$0.00	$0.00	$40.74	$0.00	$115.64	$115.64	$0.00	$100.38	$158.99	$160.60	$0.00		$0.00	$31.42	$0.00	$0.00	$31.96	$0.00	$0.00	$0.00	$0.00	$0.00
1806-0073S	SUP	Custom 27203010		1806-0073S  -  TUBE ORTH TFLN T2 HUM NL SYS	BOTH IP/OP	$387.75 	$286.94	$0.00	$310.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.79	$287.79	$0.00	$0.00	$80.81	$0.00	$0.00	$0.00	$0.00	$193.88	$307.10	$310.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-0080S	SUP	HCPCS C1769		1806-0080S  -  GWIRE ORTH 800MM 3MM T2 TI BALL TIP FEM NAIL SYS STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$160.52	$160.52	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
1806-0083S	SUP	HCPCS C1769		1806-0083S  -  GWIRE ORTH 800MM 2.5MM T2 TI BALL TIP FEM NAIL SYS STRL	BOTH IP/OP	$290.70 	$215.12	$0.00	$235.40	$159.78	$159.78	$0.00	$0.00	$0.00	$60.59	$215.76	$215.76	$0.00	$0.00	$60.58	$0.00	$171.95	$171.95	$0.00	$147.13	$233.05	$235.40	$0.00		$0.00	$46.05	$0.00	$0.00	$46.84	$0.00	$0.00	$0.00	$0.00	$0.00
1806-0085S	SUP	HCPCS C1769		1806-0085S  -  GWIRE ORTH 1000MM 3MM T2 TI BALL TIP FEM NAIL SYS STRL	BOTH IP/OP	$312.80 	$231.47	$0.00	$269.50	$182.92	$182.92	$0.00	$0.00	$0.00	$65.20	$232.16	$232.16	$0.00	$0.00	$65.19	$0.00	$185.02	$185.02	$0.00	$168.44	$266.81	$269.50	$0.00		$0.00	$52.72	$0.00	$0.00	$53.63	$0.00	$0.00	$0.00	$0.00	$0.00
1806-0090S	SUP	HCPCS C1769		1806-0090S  -  GWIRE ORTH 800MM 3MM T2 TI SMTH TIP FEM NAIL SYS STRL	BOTH IP/OP	$294.10 	$217.63	$0.00	$242.00	$164.26	$164.26	$0.00	$0.00	$0.00	$61.30	$218.28	$218.28	$0.00	$0.00	$61.29	$0.00	$173.96	$173.96	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
1806-0093S	SUP	HCPCS C1769		1806-0093S  -  GWIRE ORTH 800MM 2.2MM T2 TI SMTH TIP FEM NAIL SYS STRL	BOTH IP/OP	$283.05 	$209.46	$0.00	$235.40	$159.78	$159.78	$0.00	$0.00	$0.00	$58.99	$210.08	$210.08	$0.00	$0.00	$58.99	$0.00	$167.42	$167.42	$0.00	$147.13	$233.05	$235.40	$0.00		$0.00	$46.05	$0.00	$0.00	$46.84	$0.00	$0.00	$0.00	$0.00	$0.00
1806-0225	SUP	Custom 27203010		1806-0225  -  BIT DRILL 3.5MM T2 LNG DRVR AO	BOTH IP/OP	$716.38 	$530.12	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$531.69	$531.69	$0.00	$0.00	$149.29	$0.00	$0.00	$0.00	$0.00	$358.19	$567.37	$573.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-1005	SUP	Custom 27203010		1806-1005  -  SET ORTH FEM TRGT DEV	BOTH IP/OP	"$6,639.88 "	"$4,913.51"	$0.00	"$5,311.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,383.75"	$0.00	$0.00	$0.00	$0.00	"$3,319.94"	"$5,258.78"	"$5,311.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-1250S	SUP	HCPCS C1769		1806-1250S  -  GWIRE ORTH 1250MM 3MM T2 BALL TIP STRL	BOTH IP/OP	$294.95 	$218.26	$0.00	$242.00	$164.26	$164.26	$0.00	$0.00	$0.00	$61.47	$218.91	$218.91	$0.00	$0.00	$61.47	$0.00	$174.46	$174.46	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
180615HC-S-V	SUP	HCPCS C1884		COIL MICROPLEX 18SOFT 6MM X 15CM	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$5.63	$5.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
1806-2020	SUP	Custom 27203010		1806-2020  -  DRILL SURG CRWN T2 NONSTRL	BOTH IP/OP	$598.13 	$442.62	$0.00	$478.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$443.93	$443.93	$0.00	$0.00	$124.65	$0.00	$0.00	$0.00	$0.00	$299.06	$473.72	$478.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
180620HC-R-V	SUP	HCPCS C1884		COIL MICROPLEX 18REG 6MM X 20CM	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$5.63	$5.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3025	SUP	Custom 27203010		1806-3025  -  BIT DRILL T2 CANN STP	BOTH IP/OP	"$2,151.88 "	"$1,592.39"	$0.00	"$1,721.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.12"	"$1,597.12"	$0.00	$0.00	$448.45	$0.00	$0.00	$0.00	$0.00	"$1,075.94"	"$1,704.29"	"$1,721.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3030	SUP	HCPCS C1713		1806-3030  -  WIRE FX 3.2MM 400MM NS KRSH T2 RECON SS NL SYS	BOTH IP/OP	$282.20 	$208.83	$0.00	$231.00	$129.94	$129.94	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$45.19	$0.00	$0.00	$45.97	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3030S	SUP	HCPCS C1713		1806-3030S  -  WIRE 400MM 3.2MM KWIRE T2 SS RECON NL SYS STRL	BOTH IP/OP	$373.15 	$276.13	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$77.77	$276.95	$276.95	$0.00	$0.00	$77.76	$0.00	$220.72	$220.72	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3031S	SUP	HCPCS C1713		1806-3031S  -  WIRE FX 3.2MM 400MM STRL KRSH T2 RECON COCR NL SYS	BOTH IP/OP	$237.15 	$175.49	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$49.43	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$140.27	$140.27	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3500S	SUP	Custom 27203010		1806-3500S  -  BIT DRILL 130MM 3.5MM T2 AO STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$0.00	$0.00	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3505	SUP	Custom 27203010		1806-3505  -  BIT DRILL 130MM 3.5MM T2 TRFLT	BOTH IP/OP	$226.88 	$167.89	$0.00	$181.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.39	$168.39	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$113.44	$179.69	$181.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3510S	SUP	Custom 27203010		1806-3510S  -  BIT DRILL 230MM 3.5MM T2 AO STRL	BOTH IP/OP	$207.63 	$153.65	$0.00	$166.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.10	$154.10	$0.00	$0.00	$43.27	$0.00	$0.00	$0.00	$0.00	$103.81	$164.44	$166.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3515	SUP	Custom 27203010		1806-3515  -  BIT DRILL 230MM 3.5MM T2 TRFLT	BOTH IP/OP	$259.50 	$192.03	$0.00	$192.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.60	$192.60	$0.00	$0.00	$54.08	$0.00	$0.00	$0.00	$0.00	$89.38	$141.57	$143.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3520S	SUP	Custom 27203010		1806-3520S  -  BIT DRILL 130MM 3.5MM T2 AO STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$0.00	$0.00	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3525S	SUP	Custom 27203010		1806-3525S  -  BIT DRILL 130MM 3.5MM T2 TRFLT STRL	BOTH IP/OP	$294.25 	$217.75	$0.00	$235.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.39	$218.39	$0.00	$0.00	$61.32	$0.00	$0.00	$0.00	$0.00	$147.13	$233.05	$235.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3540S	SUP	Custom 27203010		1806-3540S  -  BIT DRILL 230MM 3.5MM T2 AO STRL	BOTH IP/OP	$294.10 	$217.63	$0.00	$235.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.28	$218.28	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$147.13	$233.05	$235.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3545S	SUP	Custom 27203010		1806-3545S  -  BIT DRILL 230MM 3.5MM T2 TRFLT STRL	BOTH IP/OP	$259.50 	$192.03	$0.00	$192.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.60	$192.60	$0.00	$0.00	$54.08	$0.00	$0.00	$0.00	$0.00	$113.44	$179.69	$181.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3550S	SUP	Custom 27203010		1806-3550S  -  BIT DRL 3.5MM 130MM STRL AO CPLNG	BOTH IP/OP	$294.10 	$217.63	$0.00	$235.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.28	$218.28	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$147.13	$233.05	$235.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-3555S	SUP	Custom 27203010		1806-3555S  -  BIT DRILL 130MM 3.5MM T2 AO STRL	BOTH IP/OP	$259.50 	$192.03	$0.00	$192.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.60	$192.60	$0.00	$0.00	$54.08	$0.00	$0.00	$0.00	$0.00	$113.44	$179.69	$181.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4000S	SUP	Custom 27203010		1806-4000S  -  BIT DRL 4MM 180MM STRL AO CPLNG	BOTH IP/OP	$294.10 	$217.63	$0.00	$235.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.28	$218.28	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$147.13	$233.05	$235.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4005S	SUP	Custom 27203010		1806-4005S  -  BIT DRILL 180MM 4MM T2 TRFLT HUM NL SYS STRL	BOTH IP/OP	$294.10 	$217.63	$0.00	$235.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.28	$218.28	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$147.13	$233.05	$235.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4200S	SUP	Custom 27203010		1806-4200S  -  BIT DRILL 260MM 4.2MM T2 AO STRL	BOTH IP/OP	$200.75 	$148.56	$0.00	$160.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.00	$149.00	$0.00	$0.00	$41.84	$0.00	$0.00	$0.00	$0.00	$100.38	$158.99	$160.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4205	SUP	Custom 27203010		1806-4205  -  BIT DRILL 260MM 4.2MM T2 TRFLT	BOTH IP/OP	$191.13 	$141.44	$0.00	$152.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.85	$141.85	$0.00	$0.00	$39.83	$0.00	$0.00	$0.00	$0.00	$95.56	$151.37	$152.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4210	SUP	Custom 27203010		1806-4210  -  BIT DRILL 340MM 4.2MM T2 AO	BOTH IP/OP	$210.38 	$155.68	$0.00	$168.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.14	$156.14	$0.00	$0.00	$43.84	$0.00	$0.00	$0.00	$0.00	$105.19	$166.62	$168.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4220	SUP	Custom 27203010		1806-4220  -  BIT DRILL 180MM 4.2MM T2 AO	BOTH IP/OP	$210.38 	$155.68	$0.00	$168.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.14	$156.14	$0.00	$0.00	$43.84	$0.00	$0.00	$0.00	$0.00	$105.19	$166.62	$168.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4230S	SUP	Custom 27203010		1806-4230S  -  BIT DRILL 130MM 4.2MM T2 AO STRL	BOTH IP/OP	$200.75 	$148.56	$0.00	$160.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.00	$149.00	$0.00	$0.00	$41.84	$0.00	$0.00	$0.00	$0.00	$100.38	$158.99	$160.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4235	SUP	Custom 27203010		1806-4235  -  BIT DRILL 130MM 4.2MM T2 TRFLT	BOTH IP/OP	$191.13 	$141.44	$0.00	$152.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.85	$141.85	$0.00	$0.00	$39.83	$0.00	$0.00	$0.00	$0.00	$95.56	$151.37	$152.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4240	SUP	Custom 27203010		1806-4240  -  BIT DRILL 30MM 4.2MM T2 AO	BOTH IP/OP	$210.38 	$155.68	$0.00	$168.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.14	$156.14	$0.00	$0.00	$43.84	$0.00	$0.00	$0.00	$0.00	$105.19	$166.62	$168.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4245	SUP	Custom 27203010		1806-4245  -  BIT DRILL 230MM 4.2MM T2 TRFLT	BOTH IP/OP	$191.13 	$141.44	$0.00	$152.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.85	$141.85	$0.00	$0.00	$39.83	$0.00	$0.00	$0.00	$0.00	$95.56	$151.37	$152.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4250S	SUP	Custom 27203010		1806-4250S  -  BIT DRL 4.2MM 260MM STRL AO	BOTH IP/OP	$283.90 	$210.09	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.71	$210.71	$0.00	$0.00	$59.16	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4255S	SUP	Custom 27203010		1806-4255S  -  BIT DRILL 260MM 4.2MM T2 TRFLT STRL	BOTH IP/OP	$294.95 	$218.26	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.91	$218.91	$0.00	$0.00	$61.47	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4260S	SUP	Custom 27203010		1806-4260S  -  BIT DRL 4.2MM 340MM STRL AO CPLNG	BOTH IP/OP	$283.90 	$210.09	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.71	$210.71	$0.00	$0.00	$59.16	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4265S	SUP	Custom 27203010		1806-4265S  -  BIT DRILL 340MM 4.2MM T2 TRFLT STRL	BOTH IP/OP	$187.00 	$138.38	$0.00	$152.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.79	$138.79	$0.00	$0.00	$38.97	$0.00	$0.00	$0.00	$0.00	$95.56	$151.37	$152.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4270S	SUP	Custom 27203010		1806-4270S  -  DRILL SRG 4.2MM 180MM STRL AO CPLNG	BOTH IP/OP	$304.30 	$225.18	$0.00	$258.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.85	$225.85	$0.00	$0.00	$63.42	$0.00	$0.00	$0.00	$0.00	$161.56	$255.92	$258.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4275S	SUP	Custom 27203010		1806-4275S  -  BIT DRILL 180MM 4.2MM T2 TRFLT STRL	BOTH IP/OP	$204.85 	$151.59	$0.00	$168.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.04	$152.04	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$105.19	$166.62	$168.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4280S	SUP	Custom 27203010		1806-4280S  -  BIT DRL 4.2MM 130MM STRL AO CPLNG	BOTH IP/OP	$283.90 	$210.09	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.71	$210.71	$0.00	$0.00	$59.16	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4285S	SUP	Custom 27203010		1806-4285S  -  BIT DRILL 130MM 4.2MM T2 TRFLT STRL	BOTH IP/OP	$288.15 	$213.23	$0.00	$237.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.86	$213.86	$0.00	$0.00	$60.05	$0.00	$0.00	$0.00	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4290S	SUP	Custom 27203010		1806-4290S  -  BIT DRILL 230MM 4.2MM T2 AO STRL	BOTH IP/OP	$305.15 	$225.81	$0.00	$260.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$226.48	$226.48	$0.00	$0.00	$63.59	$0.00	$0.00	$0.00	$0.00	$162.94	$258.10	$260.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-4295S	SUP	Custom 27203010		1806-4295S  -  BIT DRILL GRN 230MM 4.2MM T2 AO CPLNG TRFLT STRL	BOTH IP/OP	$288.15 	$213.23	$0.00	$237.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.86	$213.86	$0.00	$0.00	$60.05	$0.00	$0.00	$0.00	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-5000S	SUP	Custom 27203010		1806-5000S  -  BIT DRL 5MM 230MM STRL AO CPLNG	BOTH IP/OP	$283.90 	$210.09	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.71	$210.71	$0.00	$0.00	$59.16	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-5005S	SUP	Custom 27203010		1806-5005S  -  BIT DRILL 230MM 5MM T2 TRFLT STRL DISP	BOTH IP/OP	$294.95 	$218.26	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.91	$218.91	$0.00	$0.00	$61.47	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-5010S	SUP	Custom 27203010		1806-5010S  -  BIT DRILL 180MM 5MM T2 STD AO FIT STRL	BOTH IP/OP	$294.95 	$218.26	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.91	$218.91	$0.00	$0.00	$61.47	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-5015S	SUP	Custom 27203010		1806-5015S  -  BIT DRILL 180MM 5MM T2 TRFLT OPTN STRL	BOTH IP/OP	$288.15 	$213.23	$0.00	$237.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.86	$213.86	$0.00	$0.00	$60.05	$0.00	$0.00	$0.00	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-5020S	SUP	Custom 27203010		1806-5020S  -  BIT DRILL 340MM 5MM T2 AO STRL	BOTH IP/OP	$305.15 	$225.81	$0.00	$260.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$226.48	$226.48	$0.00	$0.00	$63.59	$0.00	$0.00	$0.00	$0.00	$162.94	$258.10	$260.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-5025S	SUP	Custom 27203010		1806-5025S  -  BIT DRILL 340MM 5MM T2 TRFLT STRL	BOTH IP/OP	$288.15 	$213.23	$0.00	$237.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.86	$213.86	$0.00	$0.00	$60.05	$0.00	$0.00	$0.00	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1806-5032S	SUP	HCPCS C1713		1806-5032S  -  SCREW BONE 5MM 32.5MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1806-5045S	SUP	HCPCS C1713		1806-5045S  -  SCREW BONE 45MM ORTH LCK	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1806-8018S	SUP	Custom 27203010		1806-8018S  -  BIT DRILL 250MM 4.2MM S2 AO OBLQ STRL	BOTH IP/OP	$288.15 	$213.23	$0.00	$237.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.86	$213.86	$0.00	$0.00	$60.05	$0.00	$0.00	$0.00	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
180701-2	SUP	HCPCS C1776		180701-2  -  INSERT TIB 1 9MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180702-1	SUP	HCPCS C1776		180702-1  -  INSERT TIB 2 8MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180702-2	SUP	HCPCS C1776		180702-2  -  INSERT TIB 2 9MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180702-3	SUP	HCPCS C1776		180702-3  -  INSERT TIB 2 10MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180702-5	SUP	HCPCS C1776		180702-5  -  INSERT TIB 2 12MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180703-1	SUP	HCPCS C1776		180703-1  -  INSERT TIB 3 8MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180703-2	SUP	HCPCS C1776		180703-2  -  INSERT TIB 3 9MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180703-3	SUP	HCPCS C1776		180703-3  -  INSERT TIB 3 10MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180704-1	SUP	HCPCS C1776		180704-1  -  INSERT TIB 4 8MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180704-2	SUP	HCPCS C1776		180704-2  -  INSERT TIB 4 9MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180704-3	SUP	HCPCS C1776		180704-3  -  INSERT TIB 4 10MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180704-5	SUP	HCPCS C1776		180704-5  -  INSERT TIB 4 12MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180705-1	SUP	HCPCS C1776		180705-1  -  INSERT TIB 5 8MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180705-3	SUP	HCPCS C1776		180705-3  -  INSERT TIB 5 10MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180705-4	SUP	HCPCS C1776		180705-4  -  INSERT TIB 5 10MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180705-6	SUP	HCPCS C1776		180705-6  -  INSERT TIB 5 13MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180705-7	SUP	HCPCS C1776		180705-7  -  INSERT TIB 5 14MM ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180705-8	SUP	HCPCS C1776		180705-8  -  INSERT TIB 5 15MM ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180705-9	SUP	HCPCS C1776		180705-9  -  INSERT TIB 5 16MM ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180706-1	SUP	HCPCS C1776		180706-1  -  INSERT TIB 6 8MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180706-2	SUP	HCPCS C1776		180706-2  -  INSERT TIB 6 9MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180706-3	SUP	HCPCS C1776		180706-3  -  INSERT TIB 6 10MM ONLAY	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180706-4	SUP	HCPCS C1776		180706-4  -  INSERT TIB 6 11MM ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180706-6	SUP	HCPCS C1776		180706-6  -  INSERT TIB 6 13MM ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180706-7	SUP	HCPCS C1776		180706-7  -  INSERT TIB 6 14MM ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180706-8	SUP	HCPCS C1776		180706-8  -  INSERT TIB 6 15MM ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180706-9	SUP	HCPCS C1776		180706-9  -  INSERT TIB 6 16MM ONLAY MULTICOMPARTMENTAL KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180707-1	SUP	HCPCS C1776		180707-1  -  INSERT TIB 7 8MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180707-2	SUP	HCPCS C1776		180707-2  -  INSERT TIB 7 9MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180707-3	SUP	HCPCS C1776		180707-3  -  INSERT TIB 7 10MM ONLAY KN MCK SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180707-4	SUP	HCPCS C1776		180707-4  -  INSERT TIB 7 11MM ONLAY KN MULTICOMPARTMENTAL SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180707-6	SUP	HCPCS C1776		180707-6  -  INSERT TIB 7 13MM ONLAY KN MULTICOMPARTMENTAL SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180707-7	SUP	HCPCS C1776		180707-7  -  INSERT TIB 7 14MM ONLAY KN MULTICOMPARTMENTAL SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180707-8	SUP	HCPCS C1776		180707-8  -  INSERT TIB 7 15MM ONLAY KN MULTICOMPARTMENTAL SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180707-9	SUP	HCPCS C1776		180707-9  -  INSERT TIB 7 16MM ONLAY KN MULTICOMPARTMENTAL SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180708-4	SUP	HCPCS C1776		180708-4  -  INSERT TIB 8 11MM ONLAY KN MULTICOMPARTMENTAL SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180708-6	SUP	HCPCS C1776		180708-6  -  INSERT TIB 8 13MM ONLAY KN MULTICOMPARTMENTAL SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180708-7	SUP	HCPCS C1776		180708-7  -  INSERT TIB 8 14MM ONLAY KN MULTICOMPARTMENTAL SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180708-8	SUP	HCPCS C1776		180708-8  -  INSERT TIB 8 15MM ONLAY KN MULTICOMPARTMENTAL SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180708-9	SUP	HCPCS C1776		180708-9  -  INSERT TIB 8 16MM ONLAY KN MULTICOMPARTMENTAL SYS	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
180731-1	SUP	HCPCS C1776		180731-1  -  INSERT TIB 1 8MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180731-1-E	SUP	HCPCS C1776		180731-1-E  -  INSERT TIB 1 8MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180731-2	SUP	HCPCS C1776		180731-2  -  INSERT TIB 1 9MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180731-2-E	SUP	HCPCS C1776		180731-2-E  -  INSERT TIB 1 9MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180731-3	SUP	HCPCS C1776		180731-3  -  INSERT TIB 1 10MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180731-3-E	SUP	HCPCS C1776		180731-3-E  -  INSERT TIB 1 10MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180731-5	SUP	HCPCS C1776		180731-5  -  INSERT TIB 1 12MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180731-5-E	SUP	HCPCS C1776		180731-5-E  -  INSERT TIB 1 12MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180732-1	SUP	HCPCS C1776		180732-1  -  INSERT TIB 2 8MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180732-1-E	SUP	HCPCS C1776		180732-1-E  -  INSERT TIB 2 8MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180732-2	SUP	HCPCS C1776		180732-2  -  INSERT TIB 2 9MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180732-2-E	SUP	HCPCS C1776		180732-2-E  -  INSERT TIB 2 9MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180732-3	SUP	HCPCS C1776		180732-3  -  INSERT TIB 2 10MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180732-3-E	SUP	HCPCS C1776		180732-3-E  -  INSERT TIB 2 10MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180732-5	SUP	HCPCS C1776		180732-5  -  INSERT TIB	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180732-5-E	SUP	HCPCS C1776		180732-5-E  -  INSERT TIB 2 12MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180733-1	SUP	HCPCS C1776		180733-1  -  INSERT TIB 3 8MM MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180733-1-E	SUP	HCPCS C1776		180733-1-E  -  INSERT TIB 3 8MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180733-2	SUP	HCPCS C1776		180733-2  -  INSERT TIB 3 9MM MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180733-2-E	SUP	HCPCS C1776		180733-2-E  -  INSERT TIB 3 9MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180733-3	SUP	HCPCS C1776		180733-3  -  INSERT TIB 10MM STRL MAKO BRNG ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180733-3-E	SUP	HCPCS C1776		180733-3-E  -  INSERT TIB 3 10MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180733-5	SUP	HCPCS C1776		180733-5  -  INSERT TIB 3 12MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180733-5-E	SUP	HCPCS C1776		180733-5-E  -  INSERT TIB 3 12MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180734-1	SUP	HCPCS C1776		180734-1  -  INSERT TIB 4 8MM MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180734-1-E	SUP	HCPCS C1776		180734-1-E  -  INSERT TIB 4 8MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180734-2	SUP	HCPCS C1776		180734-2  -  INSERT TIB 4 9MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180734-2-E	SUP	HCPCS C1776		180734-2-E  -  INSERT TIB 4 9MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180734-3	SUP	HCPCS C1776		180734-3  -  INSERT TIB 10MM STRL MAKO BRNG ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180734-3-E	SUP	HCPCS C1776		180734-3-E  -  INSERT TIB 4 10MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180734-5	SUP	HCPCS C1776		180734-5  -  INSERT TIB	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180735-1	SUP	HCPCS C1776		180735-1  -  INSERT TIB 5 8MM MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180735-1-E	SUP	HCPCS C1776		180735-1-E  -  INSERT TIB 5 8MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180735-2	SUP	HCPCS C1776		180735-2  -  INSERT TIB 5 9MM MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180735-2-E	SUP	HCPCS C1776		180735-2-E  -  INSERT TIB 5 9MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180735-3	SUP	HCPCS C1776		180735-3  -  INSERT TIB	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180735-5	SUP	HCPCS C1776		180735-5  -  INSERT TIB 5 12MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180735-5-E	SUP	HCPCS C1776		180735-5-E  -  INSERT TIB 5 12MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180736-1	SUP	HCPCS C1776		180736-1  -  INSERT TIB 6 8MM MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180736-1-E	SUP	HCPCS C1776		180736-1-E  -  INSERT TIB 6 8MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180736-2	SUP	HCPCS C1776		180736-2  -  INSERT TIB 6 9MM MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180736-2-E	SUP	HCPCS C1776		180736-2-E  -  INSERT TIB 6 9MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180736-3	SUP	HCPCS C1776		180736-3  -  INSERT TIB 6 10MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180736-3-E	SUP	HCPCS C1776		180736-3-E  -  INSERT TIB 6 10MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180736-5	SUP	HCPCS C1776		180736-5  -  INSERT TIB	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180736-5-E	SUP	HCPCS C1776		180736-5-E  -  INSERT TIB 6 12MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180737-1	SUP	HCPCS C1776		180737-1  -  INSERT TIB 8MM STRL MAKO BRNG ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180737-1-E	SUP	HCPCS C1776		180737-1-E  -  INSERT TIB 7 8MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180737-2	SUP	HCPCS C1776		180737-2  -  INSERT TIB 7 9MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180737-2-E	SUP	HCPCS C1776		180737-2-E  -  INSERT TIB 7 9MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180737-3	SUP	HCPCS C1776		180737-3  -  INSERT TIB 7 10MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180737-3-E	SUP	HCPCS C1776		180737-3-E  -  INSERT TIB 7 10MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180737-5	SUP	HCPCS C1776		180737-5  -  INSERT TIB	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180737-5-E	SUP	HCPCS C1776		180737-5-E  -  INSERT TIB 7 12MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180738-1	SUP	HCPCS C1776		180738-1  -  INSERT TIB 8 8MM MAKO X3 UNCMP ONLAY KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180738-1-E	SUP	HCPCS C1776		180738-1-E  -  INSERT TIB 8 8MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180738-2	SUP	HCPCS C1776		180738-2  -  INSERT TIB	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180738-2-E	SUP	HCPCS C1776		180738-2-E  -  INSERT TIB 8 9MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180738-3	SUP	HCPCS C1776		180738-3  -  INSERT TIB	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180738-3-E	SUP	HCPCS C1776		180738-3-E  -  INSERT TIB 8 10MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180738-5	SUP	HCPCS C1776		180738-5  -  INSERT TIB	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
180738-5-E	SUP	HCPCS C1776		180738-5-E  -  INSERT TIB 8 12MM STRL MAKO UNCMP ONLAY X3 KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
18-131	SUP	HCPCS C1887		18-131  -  CATH GUID 130CM 20CM MCTH STR HYDPHI RNGD STC-18	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$665.18	$665.18	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
1818-0001S	SUP	HCPCS C1713		1818-0001S  -  SCREW BONE 8MM 14.5MM T2 TI ANKL CMPR CANN PRELD ARTHDES	BOTH IP/OP	$300.90 	$222.67	$0.00	$223.33	$124.37	$124.37	$0.00	$0.00	$0.00	$62.72	$223.33	$223.33	$0.00	$0.00	$62.71	$0.00	$177.98	$177.98	$0.00	$138.19	$218.89	$221.10	$0.00		$0.00	$43.25	$0.00	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00
1818-1015S	SUP	HCPCS C1713		1818-1015S  -  NAIL 10MM 15CM LEFT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1818-1020S	SUP	HCPCS C1713		1818-1020S  -  NAIL 10MM 20CM LEFT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1818-1030S	SUP	HCPCS C1713		1818-1030S  -  NAIL 10MM 30CM LEFT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1818-1115S	SUP	HCPCS C1713		1818-1115S  -  NAIL 11MM 15CM LEFT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1818-1120S	SUP	HCPCS C1713		1818-1120S  -  NAIL 11MM 20CM LEFT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1818-1130S	SUP	HCPCS C1713		1818-1130S  -  NAIL 11MM 30CM LEFT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1818-1215S	SUP	HCPCS C1713		1818-1215S  -  NAIL 12MM 15CM LEFT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1818-1220S	SUP	HCPCS C1713		1818-1220S  -  NAIL 12MM 20CM LEFT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1818-1230S	SUP	HCPCS C1713		1818-1230S  -  T2 ANKLE ARTHRODESIS NAIL LEFT 12MM X 300MM	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1819-1015S	SUP	HCPCS C1713		1819-1015S  -  NAIL 10MM 15CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1819-1020S	SUP	HCPCS C1713		1819-1020S  -  NAIL 10MM 20CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1819-1030S	SUP	HCPCS C1713		1819-1030S  -  NAIL 10MM 30CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1819-1115S	SUP	HCPCS C1713		1819-1115S  -  NAIL 11MM 15CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1819-1120S	SUP	HCPCS C1713		1819-1120S  -  NAIL 11MM 20CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1819-1130S	SUP	HCPCS C1713		1819-1130S  -  NAIL 11MM 30CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1819-1215S	SUP	HCPCS C1713		1819-1215S  -  NAIL 12MM 15CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1819-1220S	SUP	HCPCS C1713		1819-1220S  -  NAIL 12MM 20CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1819-1230S	SUP	HCPCS C1713		1819-1230S  -  NAIL 12MM 30CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL	BOTH IP/OP	"$3,744.25 "	"$2,770.75"	$0.00	"$2,788.50"	"$1,568.53"	"$1,568.53"	$0.00	$0.00	$0.00	$780.40	"$2,778.98"	"$2,778.98"	$0.00	$0.00	$780.30	$0.00	"$1,845.92"	"$1,845.92"	$0.00	"$1,742.81"	"$2,760.62"	"$2,788.50"	$0.00		$0.00	$545.50	$0.00	$0.00	$554.91	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0001S	SUP	HCPCS C1713		1822-0001S  -  SCREW BONE 8MM T2 TI TIB CMPR STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0003S	SUP	HCPCS C1713		1822-0003S  -  CAP END STD STRL T2 8MM	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0004S	SUP	HCPCS C1713		1822-0004S  -  CAP END FULTHRD T2	BOTH IP/OP	$239.25 	$177.05	$0.00	$191.40	$107.66	$107.66	$0.00	$0.00	$0.00	$49.87	$177.57	$177.57	$0.00	$0.00	$49.86	$0.00	$141.52	$141.52	$0.00	$119.63	$189.49	$191.40	$0.00		$0.00	$37.44	$0.00	$0.00	$38.09	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0005S	SUP	HCPCS C1713		1822-0005S  -  CAP END +5MM STRL T2 11.5MM	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0010S	SUP	HCPCS C1713		1822-0010S  -  CAP END 10MM 10+ MM HUM IM NAIL STRL T2 11.5MM	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0015S	SUP	HCPCS C1713		1822-0015S  -  CAP END 15MM FEM IM NAIL TI STRL T2	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0824S	SUP	HCPCS C1713		1822-0824S  -  NAIL 8MM 24CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0825S	SUP	HCPCS C1713		1822-0825S  -  NAIL 8MM 25.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0827S	SUP	HCPCS C1713		1822-0827S  -  NAIL 8MM 27CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0828S	SUP	HCPCS C1713		1822-0828S  -  NAIL 8MM 28.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0830S	SUP	HCPCS C1713		1822-0830S  -  NAIL 8MM 30CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0831S	SUP	HCPCS C1713		1822-0831S  -  NAIL 8MM 31.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0833S	SUP	HCPCS C1713		1822-0833S  -  NAIL 8MM 330MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0834S	SUP	HCPCS C1713		1822-0834S  -  NAIL 8MM 345MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0836S	SUP	HCPCS C1713		1822-0836S  -  NAIL 8MM 36CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0837S	SUP	HCPCS C1713		1822-0837S  -  NAIL 8MM 37.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0839S	SUP	HCPCS C1713		1822-0839S  -  NAIL 8MM 39CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0840S	SUP	HCPCS C1713		1822-0840S  -  NAIL 8MM 40.5CM TIB T2 IM STD TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0842S	SUP	HCPCS C1713		1822-0842S  -  NAIL 8MM 42CM TIB T2 IM STD TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0924S	SUP	HCPCS C1713		1822-0924S  -  NAIL 9MM 24CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0925S	SUP	HCPCS C1713		1822-0925S  -  NAIL 9MM 25.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0927S	SUP	HCPCS C1713		1822-0927S  -  NAIL 9MM 27CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0928S	SUP	HCPCS C1713		1822-0928S  -  NAIL 0D9MM 28.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0930S	SUP	HCPCS C1713		1822-0930S  -  NAIL 9MM 30CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0931S	SUP	HCPCS C1713		1822-0931S  -  NAIL 9MM 31.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0933S	SUP	HCPCS C1713		1822-0933S  -  NAIL 9MM 33CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0934S	SUP	HCPCS C1713		1822-0934S  -  NAIL 9MM 345MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0936S	SUP	HCPCS C1713		1822-0936S  -  NAIL 9MM 360MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0937S	SUP	HCPCS C1713		1822-0937S  -  NAIL 9MM 37.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0939S	SUP	HCPCS C1713		1822-0939S  -  NAIL 9MM 39CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0940S	SUP	HCPCS C1713		1822-0940S  -  NAIL 9MM 40.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0942S	SUP	HCPCS C1713		1822-0942S  -  NAIL 9MM 42CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-0945S	SUP	HCPCS C1713		1822-0945S  -  NAIL 9MM 450MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1024S	SUP	HCPCS C1713		1822-1024S  -  NAIL 10MM 24CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1025S	SUP	HCPCS C1713		1822-1025S  -  NAIL 10MM 25.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1027S	SUP	HCPCS C1713		1822-1027S  -  NAIL 10MM 27CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1028S	SUP	HCPCS C1713		1822-1028S  -  NAIL 10MM 28.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1030S	SUP	HCPCS C1713		1822-1030S  -  NAIL 10MM 300MM TIB T2 IM STD TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1031S	SUP	HCPCS C1713		1822-1031S  -  NAIL 10MM 31.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1033S	SUP	HCPCS C1713		1822-1033S  -  NAIL 10MM 33CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1034S	SUP	HCPCS C1713		1822-1034S  -  NAIL 10MM 34.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1036S	SUP	HCPCS C1713		1822-1036S  -  NAIL 10MM 36CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1037S	SUP	HCPCS C1713		1822-1037S  -  NAIL 10MM 37.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1039S	SUP	HCPCS C1713		1822-1039S  -  NAIL 11MM 390MM TIB T2 IM STD STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1040S	SUP	HCPCS C1713		1822-1040S  -  NAIL 10MM 40.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1042S	SUP	HCPCS C1713		1822-1042S  -  NAIL 10MM 420MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1043S	SUP	HCPCS C1713		1822-1043S  -  NAIL 10MM 435MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1045S	SUP	HCPCS C1713		1822-1045S  -  NAIL 10MM 450MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1046S	SUP	HCPCS C1713		1822-1046S  -  NAIL 10MM 465MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1048S	SUP	HCPCS C1713		1822-1048S  -  NAIL 10MM 480MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1124S	SUP	HCPCS C1713		1822-1124S  -  NAIL 11MM 240MM TIB T2 IM STD IMPL TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1125S	SUP	HCPCS C1713		1822-1125S  -  NAIL 11MM 25.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1127S	SUP	HCPCS C1713		1822-1127S  -  NAIL 11MM 27CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1128S	SUP	HCPCS C1713		1822-1128S  -  NAIL 11MM 28CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1130S	SUP	HCPCS C1713		1822-1130S  -  NAIL 11MM 300MM TIB T2 IM STD	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1131S	SUP	HCPCS C1713		1822-1131S  -  NAIL 11MM 315MM TIB T2 IM STD TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1133S	SUP	HCPCS C1713		1822-1133S  -  NAIL 11MM 330MM TIB T2 IM STD	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1134S	SUP	HCPCS C1713		1822-1134S  -  NAIL 11MM 345MM TIB T2 IM STD TI ALLOY STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1136S	SUP	HCPCS C1713		1822-1136S  -  NAIL 11MM 36CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1137S	SUP	HCPCS C1713		1822-1137S  -  NAIL 11MM 375MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1139S	SUP	HCPCS C1713		1822-1139S  -  NAIL 11MM 390MM TIB T2 IM STD TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1140S	SUP	HCPCS C1713		1822-1140S  -  NAIL 11MM 40.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1142S	SUP	HCPCS C1713		1822-1142S  -  NAIL 11MM 42CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1143S	SUP	HCPCS C1713		1822-1143S  -  NAIL 11MM 435MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1145S	SUP	HCPCS C1713		1822-1145S  -  NAIL 11MM 450MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1146S	SUP	HCPCS C1713		1822-1146S  -  NAIL 11MM 465MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1148S	SUP	HCPCS C1713		1822-1148S  -  NAIL 11MM 480MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1224S	SUP	HCPCS C1713		1822-1224S  -  NAIL 12MM 24CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1225S	SUP	HCPCS C1713		1822-1225S  -  NAIL 12MM 25.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1227S	SUP	HCPCS C1713		1822-1227S  -  NAIL 12MM 27CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1228S	SUP	HCPCS C1713		1822-1228S  -  NAIL 12MM 28.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1230S	SUP	HCPCS C1713		1822-1230S  -  NAIL 12MM 300MM TIB T2 IM STD TI	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1231S	SUP	HCPCS C1713		1822-1231S  -  NAIL 12MM 31.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1233S	SUP	HCPCS C1713		1822-1233S  -  NAIL 12MM 33CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1234S	SUP	HCPCS C1713		1822-1234S  -  NAIL 12MM 345MM TIB T2 IM STD TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1236S	SUP	HCPCS C1713		1822-1236S  -  NAIL 12MM 360MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1237S	SUP	HCPCS C1713		1822-1237S  -  NAIL 12MM 370MM TIB T2 IM STD TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1239S	SUP	HCPCS C1713		1822-1239S  -  NAIL 12MM 390MM TIB T2 IM STD TI	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1240S	SUP	HCPCS C1713		1822-1240S  -  NAIL 12MM 405MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1242S	SUP	HCPCS C1713		1822-1242S  -  NAIL 12MM 420MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1245S	SUP	HCPCS C1713		1822-1245S  -  NAIL 12MM 450MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1324S	SUP	HCPCS C1713		1822-1324S  -  NAIL 13MM 240MM TIB T2 IM STD	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1325S	SUP	HCPCS C1713		1822-1325S  -  NAIL 13MM 255MM TIB T2 IM STD	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1327S	SUP	HCPCS C1713		1822-1327S  -  NAIL 13MM 270MM TIB T2 IM STD	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1328S	SUP	HCPCS C1713		1822-1328S  -  NAIL 13MM 285MM TIB T2 IM STD	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1330S	SUP	HCPCS C1713		1822-1330S  -  NAIL 13MM 30CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1331S	SUP	HCPCS C1713		1822-1331S  -  NAIL 13MM 31.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1333S	SUP	HCPCS C1713		1822-1333S  -  NAIL 13MM 33CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1334S	SUP	HCPCS C1713		1822-1334S  -  NAIL 13MM 34.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1336S	SUP	HCPCS C1713		1822-1336S  -  NAIL 13MM 36CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1337S	SUP	HCPCS C1713		1822-1337S  -  NAIL 13MM 37.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1339S	SUP	HCPCS C1713		1822-1339S  -  NAIL 13MM 39CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1340S	SUP	HCPCS C1713		1822-1340S  -  NAIL 13MM 40.5CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1342S	SUP	HCPCS C1713		1822-1342S  -  NAIL 13MM 42CM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1424S	SUP	HCPCS C1713		1822-1424S  -  NAIL 14MM 240MM TIB T2 IM STD	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1425S	SUP	HCPCS C1713		1822-1425S  -  NAIL 14MM 255MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1427S	SUP	Custom 27803010		1822-1427S  -  CMPNT PATLR 15MM CONC SGL T2 MDL LAT STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	$0.00	$0.00	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1428S	SUP	HCPCS C1713		1822-1428S  -  NAIL 14MM 285MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1430S	SUP	HCPCS C1713		1822-1430S  -  NAIL 14MM 300MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1431S	SUP	HCPCS C1713		1822-1431S  -  NAIL 14MM 315MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1433S	SUP	HCPCS C1713		1822-1433S  -  NAIL 14MM 330MM TIB T2 IM STD TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1434S	SUP	HCPCS C1713		1822-1434S  -  NAIL 14MM 34.5CM TIB T2 IM STD STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1436S	SUP	HCPCS C1713		1822-1436S  -  NAIL 14MM 360MM TIB T2 IM STD TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1437S	SUP	HCPCS C1713		1822-1437S  -  NAIL 14MM 375MM TIB T2 IM STD LCK TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1439S	SUP	HCPCS C1713		1822-1439S  -  NAIL 14MM 390MM TIB T2 IM STD TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1440S	SUP	HCPCS C1713		1822-1440S  -  NAIL 14MM 405MM TIB T2 IM STD TI STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1442S	SUP	HCPCS C1713		1822-1442S  -  NAIL 14MM 420MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1524S	SUP	HCPCS C1713		1822-1524S  -  NAIL 15MM 240MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1525S	SUP	HCPCS C1713		1822-1525S  -  NAIL 15MM 255MM TIB T2 IM STD IMPL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1527S	SUP	HCPCS C1713		1822-1527S  -  NAIL 15MM 270MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1528S	SUP	HCPCS C1713		1822-1528S  -  NAIL 15MM 285MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1530S	SUP	HCPCS C1713		1822-1530S  -  NAIL 15MM 300MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1531S	SUP	HCPCS C1713		1822-1531S  -  NAIL 15MM 315MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1533S	SUP	HCPCS C1713		1822-1533S  -  NAIL 15MM 330MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1534S	SUP	HCPCS C1713		1822-1534S  -  NAIL 15MM 345MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1536S	SUP	HCPCS C1713		1822-1536S  -  NAIL 15MM 360MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1537S	SUP	HCPCS C1713		1822-1537S  -  NAIL 15MM 375MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1539S	SUP	HCPCS C1713		1822-1539S  -  NAIL 15MM 390MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1540S	SUP	HCPCS C1713		1822-1540S  -  NAIL 15MM 330MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1822-1542S	SUP	HCPCS C1713		1822-1542S  -  NAIL 15MM 420MM TIB T2 IM STD IMPL STRL	BOTH IP/OP	"$2,322.38 "	"$1,718.56"	$0.00	"$1,857.90"	"$1,045.07"	"$1,045.07"	$0.00	$0.00	$0.00	$484.04	"$1,723.67"	"$1,723.67"	$0.00	$0.00	$483.98	$0.00	"$1,373.68"	"$1,373.68"	$0.00	"$1,161.19"	"$1,839.32"	"$1,857.90"	$0.00		$0.00	$363.45	$0.00	$0.00	$369.72	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0000S	SUP	HCPCS C1713		1825-0000S  -  SCREW BONE 8MM T2 TI STD FEM CMPR STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0001S	SUP	HCPCS C1713		1825-0001S  -  SCREW BONE 8MM T2 TI +0MM FEM CMPR STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0005S	SUP	HCPCS C1713		1825-0005S  -  SCREW BONE 8MM T2 TI +5MM FEM CMPR STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0010S	SUP	HCPCS C1713		1825-0010S  -  SCREW BONE 8MM T2 TI +10MM FEM CMPR STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0015S	SUP	HCPCS C1713		1825-0015S  -  SCREW BONE 8MM T2 TI +15MM FEM CMPR STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0814S	SUP	HCPCS C1713		1825-0814S  -  NAIL 8MM 14CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0816S	SUP	HCPCS C1713		1825-0816S  -  NAIL 8MM 16CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0818S	SUP	HCPCS C1713		1825-0818S  -  NAIL 8MM 18CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0820S	SUP	HCPCS C1713		1825-0820S  -  NAIL 8MM 20CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0822S	SUP	HCPCS C1713		1825-0822S  -  NAIL 8MM 22CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0824S	SUP	HCPCS C1713		1825-0824S  -  NAIL 8MM 24CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0826S	SUP	HCPCS C1713		1825-0826S  -  NAIL 8MM 26CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0828S	SUP	HCPCS C1713		1825-0828S  -  NAIL 8MM 28CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0830S	SUP	HCPCS C1713		1825-0830S  -  NAIL 8MM 30CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0832S	SUP	HCPCS C1713		1825-0832S  -  NAIL 8MM 32CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0834S	SUP	HCPCS C1713		1825-0834S  -  NAIL 8MM 34CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0836S	SUP	HCPCS C1713		1825-0836S  -  NAIL 8MM 36CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0838S	SUP	HCPCS C1713		1825-0838S  -  NAIL 8MM 38CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0840S	SUP	HCPCS C1713		1825-0840S  -  NAIL 8MM 40CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0842S	SUP	HCPCS C1713		1825-0842S  -  NAIL 8MM 42CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0844S	SUP	HCPCS C1713		1825-0844S  -  NAIL 8MM 44CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0846S	SUP	HCPCS C1713		1825-0846S  -  NAIL 8MM 46CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0848S	SUP	HCPCS C1713		1825-0848S  -  NAIL 8MM 48CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0914S	SUP	HCPCS C1713		1825-0914S  -  NAIL 9MM 140MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0916S	SUP	HCPCS C1713		1825-0916S  -  NAIL 9MM 160MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0918S	SUP	HCPCS C1713		1825-0918S  -  NAIL 9MM 18CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0920S	SUP	HCPCS C1713		1825-0920S  -  NAIL 9MM 20CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0922S	SUP	HCPCS C1713		1825-0922S  -  NAIL 9MM 22CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0924S	SUP	HCPCS C1713		1825-0924S  -  NAIL 9MM 24CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0926S	SUP	HCPCS C1713		1825-0926S  -  NAIL 9MM 26CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0928S	SUP	HCPCS C1713		1825-0928S  -  NAIL 9MM 28CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0930S	SUP	HCPCS C1713		1825-0930S  -  NAIL 9MM 30CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0932S	SUP	HCPCS C1713		1825-0932S  -  NAIL 9MM 32CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0934S	SUP	HCPCS C1713		1825-0934S  -  NAIL 9MM 34CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0936S	SUP	HCPCS C1713		1825-0936S  -  NAIL 9MM 360MM FEM T2 IM TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0938S	SUP	HCPCS C1713		1825-0938S  -  NAIL 9MM 380MM FEM T2 IM TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0940S	SUP	HCPCS C1713		1825-0940S  -  NAIL 9MM 40CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0942S	SUP	HCPCS C1713		1825-0942S  -  NAIL 9MM 42CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0944S	SUP	HCPCS C1713		1825-0944S  -  NAIL 9MM 44CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0946S	SUP	HCPCS C1713		1825-0946S  -  NAIL 9MM 46CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-0948S	SUP	HCPCS C1713		1825-0948S  -  NAIL 9MM 48CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1014S	SUP	HCPCS C1713		1825-1014S  -  NAIL 10MM 140MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1016S	SUP	HCPCS C1713		1825-1016S  -  NAIL 10MM 160MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1018S	SUP	HCPCS C1713		1825-1018S  -  NAIL 10MM 18CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1020S	SUP	HCPCS C1713		1825-1020S  -  NAIL 10MM 20CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1022S	SUP	HCPCS C1713		1825-1022S  -  NAIL 10MM 22CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1024S	SUP	HCPCS C1713		1825-1024S  -  NAIL 10MM 24CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1026S	SUP	HCPCS C1713		1825-1026S  -  NAIL 10MM 26CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1028S	SUP	HCPCS C1713		1825-1028S  -  NAIL 10MM 60MM FEM T2 IM TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1030S	SUP	HCPCS C1713		1825-1030S  -  NAIL 10MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1032S	SUP	HCPCS C1713		1825-1032S  -  NAIL 10MM 320MM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1034S	SUP	HCPCS C1713		1825-1034S  -  NAIL 10MM 340MM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1036S	SUP	HCPCS C1713		1825-1036S  -  NAIL 10MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1038S	SUP	HCPCS C1713		1825-1038S  -  NAIL 10MM 38CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1040S	SUP	HCPCS C1713		1825-1040S  -  NAIL 10MM 400MM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1042S	SUP	HCPCS C1713		1825-1042S  -  NAIL 10MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1044S	SUP	HCPCS C1713		1825-1044S  -  NAIL 10MM 44CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1046S	SUP	HCPCS C1713		1825-1046S  -  NAIL 10MM 46CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1048S	SUP	HCPCS C1713		1825-1048S  -  NAIL 10MM 48CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1114S	SUP	HCPCS C1713		1825-1114S  -  NAIL 11MM 140MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1116S	SUP	HCPCS C1713		1825-1116S  -  NAIL 11MM 160MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1118S	SUP	HCPCS C1713		1825-1118S  -  NAIL 11MM 18CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1120S	SUP	HCPCS C1713		1825-1120S  -  NAIL 11MM 20CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1122S	SUP	HCPCS C1713		1825-1122S  -  NAIL 11MM 22CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1124S	SUP	HCPCS C1713		1825-1124S  -  NAIL 11MM 24CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1126S	SUP	HCPCS C1713		1825-1126S  -  NAIL 11MM 26CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1128S	SUP	HCPCS C1713		1825-1128S  -  NAIL 11MM 280MM FEM T2 IM TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1130S	SUP	HCPCS C1713		1825-1130S  -  NAIL 11MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1132S	SUP	HCPCS C1713		1825-1132S  -  NAIL 11MM 320MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1134S	SUP	HCPCS C1713		1825-1134S  -  NAIL 11MM 340MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1136S	SUP	HCPCS C1713		1825-1136S  -  NAIL 11MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1138S	SUP	HCPCS C1713		1825-1138S  -  NAIL 11MM 38CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1140S	SUP	HCPCS C1713		1825-1140S  -  NAIL 11MM 40CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1142S	SUP	HCPCS C1713		1825-1142S  -  NAIL 11MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1144S	SUP	HCPCS C1713		1825-1144S  -  NAIL 11MM 44CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1146S	SUP	HCPCS C1713		1825-1146S  -  NAIL 11MM 46CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1148S	SUP	HCPCS C1713		1825-1148S  -  NAIL 11MM 48CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1214S	SUP	HCPCS C1713		1825-1214S  -  NAIL 12MM 14CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1216S	SUP	HCPCS C1713		1825-1216S  -  NAIL 12MM 160MM FEM T2 IM ANTGRD RTRGRD STR LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1218S	SUP	HCPCS C1713		1825-1218S  -  NAIL 12MM 18CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1220S	SUP	HCPCS C1713		1825-1220S  -  NAIL 12MM 20CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1222S	SUP	HCPCS C1713		1825-1222S  -  NAIL 12MM 22CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1224S	SUP	HCPCS C1713		1825-1224S  -  NAIL 12MM 24CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1226S	SUP	HCPCS C1713		1825-1226S  -  NAIL 12MM 26CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1228S	SUP	HCPCS C1713		1825-1228S  -  NAIL 12MM 28CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1230S	SUP	HCPCS C1713		1825-1230S  -  NAIL 12MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1232S	SUP	HCPCS C1713		1825-1232S  -  NAIL 12MM 320MM FEM T2 IM TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1234S	SUP	HCPCS C1713		1825-1234S  -  NAIL 12MM 340MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1236S	SUP	HCPCS C1713		1825-1236S  -  NAIL 12MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1238S	SUP	HCPCS C1713		1825-1238S  -  NAIL 12MM 38CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1240S	SUP	HCPCS C1713		1825-1240S  -  NAIL 12MM 400MM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1242S	SUP	HCPCS C1713		1825-1242S  -  NAIL 12MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1244S	SUP	HCPCS C1713		1825-1244S  -  NAIL 12MM 440MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1246S	SUP	HCPCS C1713		1825-1246S  -  NAIL 12MM 46CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1248S	SUP	HCPCS C1713		1825-1248S  -  NAIL 12MM 48CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1314S	SUP	HCPCS C1713		1825-1314S  -  NAIL 13MM 140MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1316S	SUP	HCPCS C1713		1825-1316S  -  NAIL 13MM 160MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1318S	SUP	HCPCS C1713		1825-1318S  -  NAIL 13MM 18CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1320S	SUP	HCPCS C1713		1825-1320S  -  NAIL 13MM 20CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1322S	SUP	HCPCS C1713		1825-1322S  -  NAIL 13MM 22CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1324S	SUP	HCPCS C1713		1825-1324S  -  NAIL 13MM 24CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1326S	SUP	HCPCS C1713		1825-1326S  -  NAIL 13MM 26CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1328S	SUP	HCPCS C1713		1825-1328S  -  NAIL 13MM 28CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1330S	SUP	HCPCS C1713		1825-1330S  -  NAIL 13MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1332S	SUP	HCPCS C1713		1825-1332S  -  NAIL 13MM 32CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1334S	SUP	HCPCS C1713		1825-1334S  -  NAIL 13MM 34CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1336S	SUP	HCPCS C1713		1825-1336S  -  NAIL 13MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1338S	SUP	HCPCS C1713		1825-1338S  -  NAIL 13MM 380MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1340S	SUP	HCPCS C1713		1825-1340S  -  NAIL 13MM 40CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1342S	SUP	HCPCS C1713		1825-1342S  -  NAIL 13MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1344S	SUP	HCPCS C1713		1825-1344S  -  NAIL 13MM 440MM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1346S	SUP	HCPCS C1713		1825-1346S  -  NAIL 13MM 46CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1348S	SUP	HCPCS C1713		1825-1348S  -  NAIL 13MM 48CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1414S	SUP	HCPCS C1713		1825-1414S  -  NAIL 14MM 160MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1416S	SUP	HCPCS C1713		1825-1416S  -  NAIL 14MM 160MM FEM T2 IM	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1418S	SUP	HCPCS C1713		1825-1418S  -  NAIL 14MM 18CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1420S	SUP	HCPCS C1713		1825-1420S  -  NAIL 14MM 20CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1422S	SUP	HCPCS C1713		1825-1422S  -  NAIL 14MM 22CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1424S	SUP	HCPCS C1713		1825-1424S  -  NAIL 14MM 24CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1426S	SUP	HCPCS C1713		1825-1426S  -  NAIL 14MM 26CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1428S	SUP	HCPCS C1713		1825-1428S  -  NAIL 14MM 28CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1430S	SUP	HCPCS C1713		1825-1430S  -  NAIL 14MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1432S	SUP	HCPCS C1713		1825-1432S  -  NAIL 14MM 32CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1434S	SUP	HCPCS C1713		1825-1434S  -  NAIL 14MM 34CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1436S	SUP	HCPCS C1713		1825-1436S  -  NAIL 14MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1438S	SUP	HCPCS C1713		1825-1438S  -  NAIL 14MM 38CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1440S	SUP	HCPCS C1713		1825-1440S  -  NAIL 14MM 40CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1442S	SUP	HCPCS C1713		1825-1442S  -  NAIL 14MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1444S	SUP	HCPCS C1713		1825-1444S  -  NAIL 14MM 44CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1446S	SUP	HCPCS C1713		1825-1446S  -  NAIL 14MM 46CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1448S	SUP	HCPCS C1713		1825-1448S  -  NAIL 14MM 48CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1514S	SUP	HCPCS C1713		1825-1514S  -  NAIL 15MM 140MM FEM T2 IM LCK STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1516S	SUP	HCPCS C1713		1825-1516S  -  NAIL 15MM 160MM FEM T2 IM LCK STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1518S	SUP	HCPCS C1713		1825-1518S  -  NAIL 15MM 18CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1520S	SUP	HCPCS C1713		1825-1520S  -  NAIL 15MM 20CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1522S	SUP	HCPCS C1713		1825-1522S  -  NAIL 15MM 22CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1524S	SUP	HCPCS C1713		1825-1524S  -  NAIL 15MM 24CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1526S	SUP	HCPCS C1713		1825-1526S  -  NAIL 15MM 26CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1528S	SUP	HCPCS C1713		1825-1528S  -  NAIL 15MM 28CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1530S	SUP	HCPCS C1713		1825-1530S  -  NAIL 15MM 30CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1532S	SUP	HCPCS C1713		1825-1532S  -  NAIL 15MM 32CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1534S	SUP	HCPCS C1713		1825-1534S  -  NAIL 15MM 34CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1536S	SUP	HCPCS C1713		1825-1536S  -  NAIL 15MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1538S	SUP	HCPCS C1713		1825-1538S  -  NAIL 15MM 38CM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1540S	SUP	HCPCS C1713		1825-1540S  -  NAIL 15MM 400MM FEM T2 IM LCK TI STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1542S	SUP	HCPCS C1713		1825-1542S  -  NAIL 15MM 420MM FEM T2 IM LCK TI ALLOY STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1544S	SUP	HCPCS C1713		1825-1544S  -  NAIL 15MM 44CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1546S	SUP	HCPCS C1713		1825-1546S  -  NAIL 15MM 46CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1825-1548S	SUP	HCPCS C1713		1825-1548S  -  NAIL 15MM 48CM FEM T2 IM STRL	BOTH IP/OP	"$2,442.00 "	"$1,807.08"	$0.00	"$1,953.60"	"$1,098.90"	"$1,098.90"	$0.00	$0.00	$0.00	$508.97	"$1,812.45"	"$1,812.45"	$0.00	$0.00	$508.91	$0.00	"$1,444.44"	"$1,444.44"	$0.00	"$1,221.00"	"$1,934.06"	"$1,953.60"	$0.00		$0.00	$382.17	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0003S	SUP	HCPCS C1713		1826-0003S  -  CAP END 4MM ANKL INS ARTHDES NAIL STRL T2 8MM	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0917S	SUP	HCPCS C1713		1826-0917S  -  NAIL 9MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0920S	SUP	HCPCS C1713		1826-0920S  -  NAIL 9MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0924S	SUP	HCPCS C1713		1826-0924S  -  NAIL 9MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0926S	SUP	HCPCS C1713		1826-0926S  -  NAIL 9MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0928S	SUP	HCPCS C1713		1826-0928S  -  NAIL 9MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0930S	SUP	HCPCS C1713		1826-0930S  -  NAIL 9MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0932S	SUP	HCPCS C1713		1826-0932S  -  NAIL 9MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0934S	SUP	HCPCS C1713		1826-0934S  -  NAIL 9MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0936S	SUP	HCPCS C1713		1826-0936S  -  NAIL 9MM 36CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0938S	SUP	HCPCS C1713		1826-0938S  -  NAIL 9MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0940S	SUP	HCPCS C1713		1826-0940S  -  NAIL 9MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0942S	SUP	HCPCS C1713		1826-0942S  -  NAIL 9MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-0944S	SUP	HCPCS C1713		1826-0944S  -  NAIL 9MM 440MM SPCNDYL T2 IM	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1017S	SUP	HCPCS C1713		1826-1017S  -  NAIL 10MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1020S	SUP	HCPCS C1713		1826-1020S  -  NAIL 10MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1024S	SUP	HCPCS C1713		1826-1024S  -  NAIL 10MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1026S	SUP	HCPCS C1713		1826-1026S  -  NAIL 10MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1028S	SUP	HCPCS C1713		1826-1028S  -  NAIL 10MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1030S	SUP	HCPCS C1713		1826-1030S  -  NAIL 10MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1032S	SUP	HCPCS C1713		1826-1032S  -  NAIL 10MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1034S	SUP	HCPCS C1713		1826-1034S  -  NAIL 10MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1036S	SUP	HCPCS C1713		1826-1036S  -  NAIL 10MM 36CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1038S	SUP	HCPCS C1713		1826-1038S  -  NAIL 10MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1040S	SUP	HCPCS C1713		1826-1040S  -  NAIL 10MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1042S	SUP	HCPCS C1713		1826-1042S  -  NAIL 10MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1044S	SUP	HCPCS C1713		1826-1044S  -  NAIL 10MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1117S	SUP	HCPCS C1713		1826-1117S  -  NAIL 11MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1120S	SUP	HCPCS C1713		1826-1120S  -  NAIL 11MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1124S	SUP	HCPCS C1713		1826-1124S  -  NAIL 11MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1126S	SUP	HCPCS C1713		1826-1126S  -  NAIL 11MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1128S	SUP	HCPCS C1713		1826-1128S  -  NAIL 11MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1130S	SUP	HCPCS C1713		1826-1130S  -  NAIL 11MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1132S	SUP	HCPCS C1713		1826-1132S  -  NAIL 11MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1134S	SUP	HCPCS C1713		1826-1134S  -  NAIL 11MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1136S	SUP	HCPCS C1713		1826-1136S  -  NAIL 11MM 36CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1138S	SUP	HCPCS C1713		1826-1138S  -  NAIL 11MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1140S	SUP	HCPCS C1713		1826-1140S  -  NAIL 11MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1142S	SUP	HCPCS C1713		1826-1142S  -  NAIL 11MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1144S	SUP	HCPCS C1713		1826-1144S  -  NAIL 11MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1217S	SUP	HCPCS C1713		1826-1217S  -  NAIL 12MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1220S	SUP	HCPCS C1713		1826-1220S  -  NAIL 12MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1224S	SUP	HCPCS C1713		1826-1224S  -  NAIL 12MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1226S	SUP	HCPCS C1713		1826-1226S  -  NAIL 12MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1228S	SUP	HCPCS C1713		1826-1228S  -  NAIL 12MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1230S	SUP	HCPCS C1713		1826-1230S  -  NAIL 12MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1232S	SUP	HCPCS C1713		1826-1232S  -  NAIL 12MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1234S	SUP	HCPCS C1713		1826-1234S  -  NAIL 12MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1236S	SUP	HCPCS C1713		1826-1236S  -  NAIL 12MM 360MM SPCNDYL T2 IM	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1238S	SUP	HCPCS C1713		1826-1238S  -  NAIL 12MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1240S	SUP	HCPCS C1713		1826-1240S  -  NAIL 12MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1242S	SUP	HCPCS C1713		1826-1242S  -  NAIL 12MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1244S	SUP	HCPCS C1713		1826-1244S  -  NAIL 12MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1317S	SUP	HCPCS C1713		1826-1317S  -  NAIL 13MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1320S	SUP	HCPCS C1713		1826-1320S  -  NAIL 13MM 200MM SPCNDYL T2 IM SHRT TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1324S	SUP	HCPCS C1713		1826-1324S  -  NAIL 13MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1326S	SUP	HCPCS C1713		1826-1326S  -  NAIL 13MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1328S	SUP	HCPCS C1713		1826-1328S  -  NAIL 13MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1330S	SUP	HCPCS C1713		1826-1330S  -  NAIL 13MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1332S	SUP	HCPCS C1713		1826-1332S  -  NAIL 13MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1334S	SUP	HCPCS C1713		1826-1334S  -  NAIL 13MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1336S	SUP	HCPCS C1713		1826-1336S  -  NAIL 13MM 360MM SPCNDYL T2 IM LNG TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1338S	SUP	HCPCS C1713		1826-1338S  -  NAIL 13MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1340S	SUP	HCPCS C1713		1826-1340S  -  NAIL 13MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1342S	SUP	HCPCS C1713		1826-1342S  -  NAIL 13MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1344S	SUP	HCPCS C1713		1826-1344S  -  NAIL 13MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1417S	SUP	HCPCS C1713		1826-1417S  -  NAIL 14MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1420S	SUP	HCPCS C1713		1826-1420S  -  NAIL 14MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1424S	SUP	HCPCS C1713		1826-1424S  -  NAIL 14MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1426S	SUP	HCPCS C1713		1826-1426S  -  NAIL 14MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1428S	SUP	HCPCS C1713		1826-1428S  -  NAIL 14MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1430S	SUP	HCPCS C1713		1826-1430S  -  NAIL 14MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1432S	SUP	HCPCS C1713		1826-1432S  -  NAIL 14MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1434S	SUP	HCPCS C1713		1826-1434S  -  NAIL 14MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1436S	SUP	HCPCS C1713		1826-1436S  -  NAIL 14MM 36CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1438S	SUP	HCPCS C1713		1826-1438S  -  NAIL 14MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1440S	SUP	HCPCS C1713		1826-1440S  -  NAIL 14MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1442S	SUP	HCPCS C1713		1826-1442S  -  NAIL 14MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
1826-1444S	SUP	HCPCS C1713		1826-1444S  -  NAIL 14MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL	BOTH IP/OP	"$3,022.25 "	"$2,236.47"	$0.00	"$2,417.80"	"$1,360.01"	"$1,360.01"	$0.00	$0.00	$0.00	$629.91	"$2,243.11"	"$2,243.11"	$0.00	$0.00	$629.84	$0.00	"$1,489.97"	"$1,489.97"	$0.00	"$1,511.13"	"$2,393.62"	"$2,417.80"	$0.00		$0.00	$472.98	$0.00	$0.00	$481.14	$0.00	$0.00	$0.00	$0.00	$0.00
18-2800	SUP	Custom 27803010		18-2800  -  HEAD FEMORAL +0MM OFFST C TAPER 28MM HIGH PERFORMANCE BIOLOX	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18-2805	SUP	Custom 27803010		18-2805  -  HEAD FEMORAL +5MM OFFST C TAPER 28MM HIGH PERFORMANCE BIOLOX	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0824S	SUP	HCPCS C1713		1828-0824S  -  NAIL 8MM 24CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0826S	SUP	HCPCS C1713		1828-0826S  -  NAIL 8MM 26CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0828S	SUP	HCPCS C1713		1828-0828S  -  NAIL 8MM 28CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0830S	SUP	HCPCS C1713		1828-0830S  -  NAIL 8MM 30CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0832S	SUP	HCPCS C1713		1828-0832S  -  NAIL 8MM 32CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0834S	SUP	HCPCS C1713		1828-0834S  -  NAIL 8MM 34CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0836S	SUP	HCPCS C1713		1828-0836S  -  NAIL 8MM 36CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0838S	SUP	HCPCS C1713		1828-0838S  -  NAIL 8MM 38CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0840S	SUP	HCPCS C1713		1828-0840S  -  NAIL 8MM 40CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0842S	SUP	HCPCS C1713		1828-0842S  -  NAIL 8MM 42CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0844S	SUP	HCPCS C1713		1828-0844S  -  NAIL 8MM 44CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0846S	SUP	HCPCS C1713		1828-0846S  -  NAIL 8MM 46CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0848S	SUP	HCPCS C1713		1828-0848S  -  NAIL 8MM 48CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0924S	SUP	HCPCS C1713		1828-0924S  -  NAIL 9MM 24CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0926S	SUP	HCPCS C1713		1828-0926S  -  NAIL 9MM 26CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0928S	SUP	HCPCS C1713		1828-0928S  -  NAIL 9MM 28CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0930S	SUP	HCPCS C1713		1828-0930S  -  NAIL 9MM 30CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0932S	SUP	HCPCS C1713		1828-0932S  -  NAIL 9MM 32CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0934S	SUP	HCPCS C1713		1828-0934S  -  NAIL 9MM 34CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0936S	SUP	HCPCS C1713		1828-0936S  -  NAIL 9MM 36CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0938S	SUP	HCPCS C1713		1828-0938S  -  NAIL 9MM 38CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0940S	SUP	HCPCS C1713		1828-0940S  -  NAIL 9MM 40CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0942S	SUP	HCPCS C1713		1828-0942S  -  NAIL 9MM 42CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0944S	SUP	HCPCS C1713		1828-0944S  -  NAIL 9MM 44CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0946S	SUP	HCPCS C1713		1828-0946S  -  NAIL 9MM 46CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-0948S	SUP	HCPCS C1713		1828-0948S  -  NAIL 9MM 48CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1024S	SUP	HCPCS C1713		1828-1024S  -  NAIL 10MM 24CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1026S	SUP	HCPCS C1713		1828-1026S  -  NAIL 10MM 26CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1028S	SUP	HCPCS C1713		1828-1028S  -  NAIL 10MM 28CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1030S	SUP	HCPCS C1713		1828-1030S  -  NAIL 10MM 30CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1032S	SUP	HCPCS C1713		1828-1032S  -  NAIL 10MM 32CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1034S	SUP	HCPCS C1713		1828-1034S  -  NAIL 10MM 38CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1036S	SUP	HCPCS C1713		1828-1036S  -  NAIL 10MM 36CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1038S	SUP	HCPCS C1713		1828-1038S  -  NAIL 10MM 38CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1040S	SUP	HCPCS C1713		1828-1040S  -  NAIL 10MM 40CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1042S	SUP	HCPCS C1713		1828-1042S  -  NAIL 10MM 42CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1044S	SUP	HCPCS C1713		1828-1044S  -  NAIL 10MM 44CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1046S	SUP	HCPCS C1713		1828-1046S  -  NAIL 10MM 46CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1048S	SUP	HCPCS C1713		1828-1048S  -  NAIL 10MM 48CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1124S	SUP	HCPCS C1713		1828-1124S  -  NAIL 11MM 24CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1126S	SUP	HCPCS C1713		1828-1126S  -  NAIL 11MM 26CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1128S	SUP	HCPCS C1713		1828-1128S  -  NAIL 11MM 28CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1130S	SUP	HCPCS C1713		1828-1130S  -  NAIL 11MM 30CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1132S	SUP	HCPCS C1713		1828-1132S  -  T2 FEMORAL NAIL R1500 11MMX320MM	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1134S	SUP	HCPCS C1713		1828-1134S  -  NAIL 11MM 34CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1136S	SUP	HCPCS C1713		1828-1136S  -  NAIL 11MM 36CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1138S	SUP	HCPCS C1713		1828-1138S  -  NAIL 11MM 38CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1140S	SUP	HCPCS C1713		1828-1140S  -  NAIL 11MM 40CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1142S	SUP	HCPCS C1713		1828-1142S  -  NAIL 11MM 42CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1144S	SUP	HCPCS C1713		1828-1144S  -  NAIL 11MM 44CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1146S	SUP	HCPCS C1713		1828-1146S  -  NAIL 11MM 46CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1148S	SUP	HCPCS C1713		1828-1148S  -  NAIL 11MM 48CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1224S	SUP	HCPCS C1713		1828-1224S  -  NAIL 12MM 24CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1226S	SUP	HCPCS C1713		1828-1226S  -  NAIL 12MM 26CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1228S	SUP	HCPCS C1713		1828-1228S  -  NAIL 12MM 28CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1230S	SUP	HCPCS C1713		1828-1230S  -  NAIL 12MM 20CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1232S	SUP	HCPCS C1713		1828-1232S  -  NAIL 12MM 32CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1234S	SUP	HCPCS C1713		1828-1234S  -  NAIL 12MM 34CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1236S	SUP	HCPCS C1713		1828-1236S  -  NAIL 12MM 36CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1238S	SUP	HCPCS C1713		1828-1238S  -  NAIL 12MM 38CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1240S	SUP	HCPCS C1713		1828-1240S  -  NAIL 12MM 40CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1242S	SUP	HCPCS C1713		1828-1242S  -  NAIL 12MM 42CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1244S	SUP	HCPCS C1713		1828-1244S  -  NAIL 12MM 44CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1246S	SUP	HCPCS C1713		1828-1246S  -  NAIL 12MM 46CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1248S	SUP	HCPCS C1713		1828-1248S  -  NAIL 12MM 48CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1324S	SUP	HCPCS C1713		1828-1324S  -  NAIL 13MM 24CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1326S	SUP	HCPCS C1713		1828-1326S  -  NAIL 13MM 26CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1328S	SUP	HCPCS C1713		1828-1328S  -  NAIL 13MM 28CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1330S	SUP	HCPCS C1713		1828-1330S  -  NAIL 13MM 30CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1332S	SUP	HCPCS C1713		1828-1332S  -  NAIL 13MM 32CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1334S	SUP	HCPCS C1713		1828-1334S  -  NAIL 13MM 34CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1336S	SUP	HCPCS C1713		1828-1336S  -  NAIL 13MM 36CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1338S	SUP	HCPCS C1713		1828-1338S  -  NAIL 13MM 38CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1340S	SUP	HCPCS C1713		1828-1340S  -  NAIL 13MM 40CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1342S	SUP	HCPCS C1713		1828-1342S  -  NAIL 13MM 42CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1344S	SUP	HCPCS C1713		1828-1344S  -  NAIL 13MM 44CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1346S	SUP	HCPCS C1713		1828-1346S  -  NAIL 13MM 46CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1348S	SUP	HCPCS C1713		1828-1348S  -  NAIL 13MM 48CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1424S	SUP	HCPCS C1713		1828-1424S  -  NAIL 14MM 24CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1426S	SUP	HCPCS C1713		1828-1426S  -  NAIL 14MM 26CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1428S	SUP	HCPCS C1713		1828-1428S  -  NAIL 14MM 28CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1430S	SUP	HCPCS C1713		1828-1430S  -  NAIL 14MM 30CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1432S	SUP	HCPCS C1713		1828-1432S  -  NAIL 14MM 32CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1434S	SUP	HCPCS C1713		1828-1434S  -  NAIL 14MM 34CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1436S	SUP	HCPCS C1713		1828-1436S  -  NAIL 14MM 36CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1438S	SUP	HCPCS C1713		1828-1438S  -  NAIL 14MM 38CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1440S	SUP	HCPCS C1713		1828-1440S  -  NAIL 14MM 40CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1442S	SUP	HCPCS C1713		1828-1442S  -  NAIL 14MM 42CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1444S	SUP	HCPCS C1713		1828-1444S  -  NAIL 14MM 44CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1446S	SUP	HCPCS C1713		1828-1446S  -  NAIL 14MM 46CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1448S	SUP	HCPCS C1713		1828-1448S  -  NAIL 14MM 48CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1524S	SUP	HCPCS C1713		1828-1524S  -  NAIL 15MM 24CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1526S	SUP	HCPCS C1713		1828-1526S  -  NAIL 15MM 26CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1528S	SUP	HCPCS C1713		1828-1528S  -  NAIL 15MM 28CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1530S	SUP	HCPCS C1713		1828-1530S  -  NAIL 15MM 30CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1532S	SUP	HCPCS C1713		1828-1532S  -  NAIL 15MM 32CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1534S	SUP	HCPCS C1713		1828-1534S  -  NAIL 15MM 34CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1536S	SUP	HCPCS C1713		1828-1536S  -  NAIL 15MM 36CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1538S	SUP	HCPCS C1713		1828-1538S  -  NAIL 15MM 38CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1540S	SUP	HCPCS C1713		1828-1540S  -  NAIL 15MM 40CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1542S	SUP	HCPCS C1713		1828-1542S  -  NAIL 15MM 42CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1544S	SUP	HCPCS C1713		1828-1544S  -  NAIL 15MM 44CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1546S	SUP	HCPCS C1713		1828-1546S  -  NAIL 15MM 46CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
1828-1548S	SUP	HCPCS C1713		1828-1548S  -  NAIL 15MM 48CM FEM T2 IM LCK TI STRL R1.5	BOTH IP/OP	"$2,601.50 "	"$1,925.11"	$0.00	"$2,081.20"	"$1,170.68"	"$1,170.68"	$0.00	$0.00	$0.00	$542.22	"$1,930.83"	"$1,930.83"	$0.00	$0.00	$542.15	$0.00	"$1,282.54"	"$1,282.54"	$0.00	"$1,300.75"	"$2,060.39"	"$2,081.20"	$0.00		$0.00	$407.13	$0.00	$0.00	$414.16	$0.00	$0.00	$0.00	$0.00	$0.00
18-2825	SUP	Custom 27803010		18-2825  -  HEAD FEMORAL +2.5MM OFFST C TAPER 28MM HIGH PERFORMANCE	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18-28-3	SUP	Custom 27803010		18-28-3  -  HEAD FEM -2.5MM OFST CTPR 28MM HPRFR BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1104S	SUP	HCPCS C1713		1829-1104S  -  NAIL 11.5MM 54CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1108S	SUP	HCPCS C1713		1829-1108S  -  NAIL 11.5MM 58CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1112S	SUP	HCPCS C1713		1829-1112S  -  NAIL 11.5MM 62CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1116S	SUP	HCPCS C1713		1829-1116S  -  NAIL 11.5MM 66CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1120S	SUP	HCPCS C1713		1829-1120S  -  NAIL 11.5MM 70CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1124S	SUP	HCPCS C1713		1829-1124S  -  NAIL 11.5MM 74CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1128S	SUP	HCPCS C1713		1829-1128S  -  NAIL 11.5MM 78CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1154S	SUP	HCPCS C1713		1829-1154S  -  NAIL 11.5MM 54CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1158S	SUP	HCPCS C1713		1829-1158S  -  NAIL 11.5MM 58CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1162S	SUP	HCPCS C1713		1829-1162S  -  NAIL 11.5MM 62CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1166S	SUP	HCPCS C1713		1829-1166S  -  NAIL 11.5MM 66CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1170S	SUP	HCPCS C1713		1829-1170S  -  NAIL 11.5MM 70CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1174S	SUP	HCPCS C1713		1829-1174S  -  NAIL 11.5MM 75CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1178S	SUP	HCPCS C1713		1829-1178S  -  NAIL 11.5MM 78CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1304S	SUP	HCPCS C1713		1829-1304S  -  NAIL 13MM 54CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1308S	SUP	HCPCS C1713		1829-1308S  -  NAIL 13MM 58CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1312S	SUP	HCPCS C1713		1829-1312S  -  NAIL 13MM 62CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1316S	SUP	HCPCS C1713		1829-1316S  -  NAIL 13MM 66CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1320S	SUP	HCPCS C1713		1829-1320S  -  NAIL 13MM 70CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1324S	SUP	HCPCS C1713		1829-1324S  -  NAIL 13MM 74CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1328S	SUP	HCPCS C1713		1829-1328S  -  NAIL 13MM 78CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1354S	SUP	HCPCS C1713		1829-1354S  -  NAIL 13MM 54CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1358S	SUP	HCPCS C1713		1829-1358S  -  NAIL 13MM 58CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1362S	SUP	HCPCS C1713		1829-1362S  -  NAIL 13MM 62CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1366S	SUP	HCPCS C1713		1829-1366S  -  NAIL 13MM 66CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1370S	SUP	HCPCS C1713		1829-1370S  -  NAIL 13MM 70CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1374S	SUP	HCPCS C1713		1829-1374S  -  NAIL 13MM 74CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-1378S	SUP	HCPCS C1713		1829-1378S  -  NAIL 13MM 78CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2004S	SUP	HCPCS C1713		1829-2004S  -  NAIL 10MM 54CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2008S	SUP	HCPCS C1713		1829-2008S  -  NAIL 10MM 58CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2012S	SUP	HCPCS C1713		1829-2012S  -  NAIL 10MM 62CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2016S	SUP	HCPCS C1713		1829-2016S  -  NAIL 10MM 66CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2020S	SUP	HCPCS C1713		1829-2020S  -  NAIL 10MM 70CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2024S	SUP	HCPCS C1713		1829-2024S  -  NAIL 10MM 74CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2028S	SUP	HCPCS C1713		1829-2028S  -  NAIL 10MM 78CM LEFT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2054S	SUP	HCPCS C1713		1829-2054S  -  NAIL 10MM 54CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2058S	SUP	HCPCS C1713		1829-2058S  -  NAIL 10MM 58CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2062S	SUP	HCPCS C1713		1829-2062S  -  NAIL 10MM 62CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2066S	SUP	HCPCS C1713		1829-2066S  -  NAIL 10MM 66CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2070S	SUP	HCPCS C1713		1829-2070S  -  NAIL 10MM 70CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2074S	SUP	HCPCS C1713		1829-2074S  -  NAIL 10MM 74CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1829-2078S	SUP	HCPCS C1713		1829-2078S  -  NAIL 10MM 78CM RIGHT T2 IM ARTHDES TI STRL	BOTH IP/OP	"$10,267.15 "	"$7,597.69"	$0.00	"$6,926.70"	"$3,896.27"	"$3,896.27"	$0.00	$0.00	$0.00	"$2,139.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,139.67"	$0.00	"$5,061.70"	"$5,061.70"	$0.00	"$4,329.19"	"$6,857.44"	"$6,926.70"	$0.00		$0.00	"$1,355.04"	$0.00	$0.00	"$1,378.41"	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0001S	SUP	HCPCS C1713		1830-0001S  -  SCREW BONE T2 TI CMPR ADV STRL IM NAIL	BOTH IP/OP	$282.20 	$208.83	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0003S	SUP	HCPCS C1713		1830-0003S  -  CAP END 6MM HUM IM NAIL TI STRL T2 9MM	BOTH IP/OP	$282.20 	$208.83	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0005S	SUP	HCPCS C1713		1830-0005S  -  CAP END +5MM HUM IM NAIL TI STRL T2 9MM	BOTH IP/OP	$282.20 	$208.83	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0008S	SUP	HCPCS C1713		1830-0008S  -  WASHER HUM RND T2 ORTH TI IM NAIL STRL	BOTH IP/OP	$282.20 	$208.83	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0009S	SUP	HCPCS C1713		1830-0009S  -  WASHER HUM SQ T2 ORTH TI IM NAIL STRL	BOTH IP/OP	$282.20 	$208.83	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0010S	SUP	HCPCS C1713		1830-0010S  -  CAP END +10MM HUM IM NAIL TI STRL T2	BOTH IP/OP	$282.20 	$208.83	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0015S	SUP	HCPCS C1713		1830-0015S  -  CAP END +15MM HUM IM NAIL TI STRL T2	BOTH IP/OP	$282.20 	$208.83	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0020S	SUP	HCPCS C1713		1830-0020S  -  CAP END +20MM HUM IM NAIL TI STRL T2	BOTH IP/OP	$282.20 	$208.83	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0025S	SUP	HCPCS C1713		1830-0025S  -  CAP END +25MM HUM IM NAIL TI STRL T2	BOTH IP/OP	$282.20 	$208.83	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$58.82	$209.45	$209.45	$0.00	$0.00	$58.81	$0.00	$166.92	$166.92	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0714S	SUP	HCPCS C1713		1830-0714S  -  NAIL 7MM 14CM HUM T2 IM LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0716S	SUP	HCPCS C1713		1830-0716S  -  NAIL 7MM 16CM HUM T2 IM LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0718S	SUP	HCPCS C1713		1830-0718S  -  NAIL 7MM 18CM HUM T2 IM LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0719S	SUP	HCPCS C1713		1830-0719S  -  NAIL 7MM 19CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0720S	SUP	HCPCS C1713		1830-0720S  -  NAIL 7MM 20CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0721S	SUP	HCPCS C1713		1830-0721S  -  NAIL 7MM 21CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0722S	SUP	HCPCS C1713		1830-0722S  -  NAIL 7MM 22CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0723S	SUP	HCPCS C1713		1830-0723S  -  NAIL 7MM 23CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0724S	SUP	HCPCS C1713		1830-0724S  -  NAIL 7MM 24CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0725S	SUP	HCPCS C1713		1830-0725S  -  NAIL 7MM 25CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0726S	SUP	HCPCS C1713		1830-0726S  -  NAIL 7MM 26CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0727S	SUP	HCPCS C1713		1830-0727S  -  NAIL 7MM 27CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0728S	SUP	HCPCS C1713		1830-0728S  -  NAIL 7MM 28CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0729S	SUP	HCPCS C1713		1830-0729S  -  NAIL 7MM 29CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0730S	SUP	HCPCS C1713		1830-0730S  -  NAIL 7MM 30CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0731S	SUP	HCPCS C1713		1830-0731S  -  NAIL 7MM 31CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0732S	SUP	HCPCS C1713		1830-0732S  -  NAIL 7MM 32CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0814S	SUP	HCPCS C1713		1830-0814S  -  NAIL 8MM 14CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0816S	SUP	HCPCS C1713		1830-0816S  -  NAIL 8MM 16CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0818S	SUP	HCPCS C1713		1830-0818S  -  NAIL 8MM 18CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0819S	SUP	HCPCS C1713		1830-0819S  -  NAIL 8MM 19CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0820S	SUP	HCPCS C1713		1830-0820S  -  NAIL 8MM 20CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0821S	SUP	HCPCS C1713		1830-0821S  -  NAIL 8MM 21CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0822S	SUP	HCPCS C1713		1830-0822S  -  NAIL 8MM 22CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0823S	SUP	HCPCS C1713		1830-0823S  -  NAIL 8MM 23CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0824S	SUP	HCPCS C1713		1830-0824S  -  NAIL 8MM 24CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0825S	SUP	HCPCS C1713		1830-0825S  -  NAIL 8MM 25CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0826S	SUP	HCPCS C1713		1830-0826S  -  NAIL 8MM 26CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0827S	SUP	HCPCS C1713		1830-0827S  -  NAIL 8MM 27CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0828S	SUP	HCPCS C1713		1830-0828S  -  NAIL 8MM 28CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0829S	SUP	HCPCS C1713		1830-0829S  -  NAIL 8MM 29CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0830S	SUP	HCPCS C1713		1830-0830S  -  NAIL 8MM 30CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0831S	SUP	HCPCS C1713		1830-0831S  -  NAIL 8MM 31CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0832S	SUP	HCPCS C1713		1830-0832S  -  NAIL 8MM 32CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0914S	SUP	HCPCS C1713		1830-0914S  -  NAIL 9MM 14CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0916S	SUP	HCPCS C1713		1830-0916S  -  NAIL 9MM 16CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0918S	SUP	HCPCS C1713		1830-0918S  -  NAIL 9MM 18CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0919S	SUP	HCPCS C1713		1830-0919S  -  NAIL 9MM 19CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0920S	SUP	HCPCS C1713		1830-0920S  -  NAIL 9MM 20CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0921S	SUP	HCPCS C1713		1830-0921S  -  NAIL 9MM 21CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0922S	SUP	HCPCS C1713		1830-0922S  -  NAIL 9MM 22CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0923S	SUP	HCPCS C1713		1830-0923S  -  NAIL 9MM 23CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0924S	SUP	HCPCS C1713		1830-0924S  -  NAIL 9MM 24CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0925S	SUP	HCPCS C1713		1830-0925S  -  NAIL 9MM 25CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0926S	SUP	HCPCS C1713		1830-0926S  -  NAIL 9MM 26CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0927S	SUP	HCPCS C1713		1830-0927S  -  NAIL 9MM 27CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0928S	SUP	HCPCS C1713		1830-0928S  -  NAIL 9MM 28CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0929S	SUP	HCPCS C1713		1830-0929S  -  NAIL 9MM 29CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0930S	SUP	HCPCS C1713		1830-0930S  -  NAIL 9MM 30CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0931S	SUP	HCPCS C1713		1830-0931S  -  NAIL 9MM 31CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
1830-0932S	SUP	HCPCS C1713		1830-0932S  -  NAIL 9MM 32CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL	BOTH IP/OP	"$2,353.65 "	"$1,741.70"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$490.56	"$1,746.88"	"$1,746.88"	$0.00	$0.00	$490.50	$0.00	"$1,392.18"	"$1,392.18"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
18-3200	SUP	Custom 27803010		18-3200  -  HEAD FEMORAL +0MM OFFST C TAPER 32MM HIGH PERFORMANCE BIOLOX	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1832-0002S	SUP	HCPCS C1713		1832-0002S  -  CAP END +2MM PROX HUM IM NAIL TI STRL T2	BOTH IP/OP	$284.75 	$210.72	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$59.35	$211.34	$211.34	$0.00	$0.00	$59.34	$0.00	$168.43	$168.43	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1832-0003S	SUP	HCPCS C1713		1832-0003S  -  CAP END +3MM PROX HUM IM NAIL TI STRL T2	BOTH IP/OP	$284.75 	$210.72	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$59.35	$211.34	$211.34	$0.00	$0.00	$59.34	$0.00	$168.43	$168.43	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1832-0004S	SUP	HCPCS C1713		1832-0004S  -  CAP END +4MM PROX HUM IM NAIL TI STRL T2	BOTH IP/OP	$284.75 	$210.72	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$59.35	$211.34	$211.34	$0.00	$0.00	$59.34	$0.00	$168.43	$168.43	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
18-3205	SUP	Custom 27803010		18-3205  -  HEAD FEMORAL +5MM OFFST C TAPER 32MM HIGH PERFORMANCE BIOLOX	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18-3225	SUP	Custom 27803010		18-3225  -  HEAD FEMORAL +2.5MM OFFST C TAPER 32MM HIGH PERFORMANCE	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1832-2822S	SUP	HCPCS C1713		1832-2822S  -  NAIL 8MM 22CM LEFT PROX HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,918.05 "	"$2,159.36"	$0.00	"$2,343.00"	"$1,317.94"	"$1,317.94"	$0.00	$0.00	$0.00	$608.19	"$2,165.78"	"$2,165.78"	$0.00	$0.00	$608.12	$0.00	"$1,438.60"	"$1,438.60"	$0.00	"$1,464.38"	"$2,319.57"	"$2,343.00"	$0.00		$0.00	$458.35	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
1832-2824S	SUP	HCPCS C1713		1832-2824S  -  NAIL 8MM 240MM LEFT PROX HUM T2 IM LG	BOTH IP/OP	"$2,918.05 "	"$2,159.36"	$0.00	"$2,343.00"	"$1,317.94"	"$1,317.94"	$0.00	$0.00	$0.00	$608.19	"$2,165.78"	"$2,165.78"	$0.00	$0.00	$608.12	$0.00	"$1,438.60"	"$1,438.60"	$0.00	"$1,464.38"	"$2,319.57"	"$2,343.00"	$0.00		$0.00	$458.35	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
1832-2826S	SUP	HCPCS C1713		1832-2826S  -  NAIL 8MM 26CM LEFT PROX HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,918.05 "	"$2,159.36"	$0.00	"$2,343.00"	"$1,317.94"	"$1,317.94"	$0.00	$0.00	$0.00	$608.19	"$2,165.78"	"$2,165.78"	$0.00	$0.00	$608.12	$0.00	"$1,438.60"	"$1,438.60"	$0.00	"$1,464.38"	"$2,319.57"	"$2,343.00"	$0.00		$0.00	$458.35	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
1832-2828S	SUP	HCPCS C1713		1832-2828S  -  NAIL 8MM 28CM LEFT PROX HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,918.05 "	"$2,159.36"	$0.00	"$2,343.00"	"$1,317.94"	"$1,317.94"	$0.00	$0.00	$0.00	$608.19	"$2,165.78"	"$2,165.78"	$0.00	$0.00	$608.12	$0.00	"$1,438.60"	"$1,438.60"	$0.00	"$1,464.38"	"$2,319.57"	"$2,343.00"	$0.00		$0.00	$458.35	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
1832-2830S	SUP	HCPCS C1713		1832-2830S  -  NAIL 8MM 30CM LEFT PROX HUM T2 IM RTRGRD ANTGRD LCK TI STRL	BOTH IP/OP	"$2,918.05 "	"$2,159.36"	$0.00	"$2,343.00"	"$1,317.94"	"$1,317.94"	$0.00	$0.00	$0.00	$608.19	"$2,165.78"	"$2,165.78"	$0.00	$0.00	$608.12	$0.00	"$1,438.60"	"$1,438.60"	$0.00	"$1,464.38"	"$2,319.57"	"$2,343.00"	$0.00		$0.00	$458.35	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
18-32-3	SUP	Custom 27803010		18-32-3  -  HEAD FEMORAL -2.5MM OFFST C TAPER 32MM HIGH PERFORMANCE	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1832-3822S	SUP	HCPCS C1713		1832-3822S  -  NAIL 8MM 22CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI	BOTH IP/OP	"$2,918.05 "	"$2,159.36"	$0.00	"$2,343.00"	"$1,317.94"	"$1,317.94"	$0.00	$0.00	$0.00	$608.19	"$2,165.78"	"$2,165.78"	$0.00	$0.00	$608.12	$0.00	"$1,438.60"	"$1,438.60"	$0.00	"$1,464.38"	"$2,319.57"	"$2,343.00"	$0.00		$0.00	$458.35	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
1832-3824S	SUP	HCPCS C1713		1832-3824S  -  NAIL 8MM 24CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI	BOTH IP/OP	"$2,918.05 "	"$2,159.36"	$0.00	"$2,343.00"	"$1,317.94"	"$1,317.94"	$0.00	$0.00	$0.00	$608.19	"$2,165.78"	"$2,165.78"	$0.00	$0.00	$608.12	$0.00	"$1,438.60"	"$1,438.60"	$0.00	"$1,464.38"	"$2,319.57"	"$2,343.00"	$0.00		$0.00	$458.35	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
1832-3826S	SUP	HCPCS C1713		1832-3826S  -  NAIL 8MM 26CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI	BOTH IP/OP	"$2,918.05 "	"$2,159.36"	$0.00	"$2,343.00"	"$1,317.94"	"$1,317.94"	$0.00	$0.00	$0.00	$608.19	"$2,165.78"	"$2,165.78"	$0.00	$0.00	$608.12	$0.00	"$1,438.60"	"$1,438.60"	$0.00	"$1,464.38"	"$2,319.57"	"$2,343.00"	$0.00		$0.00	$458.35	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
1832-3828S	SUP	HCPCS C1713		1832-3828S  -  NAIL 8MM 28CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI	BOTH IP/OP	"$2,918.05 "	"$2,159.36"	$0.00	"$2,343.00"	"$1,317.94"	"$1,317.94"	$0.00	$0.00	$0.00	$608.19	"$2,165.78"	"$2,165.78"	$0.00	$0.00	$608.12	$0.00	"$1,438.60"	"$1,438.60"	$0.00	"$1,464.38"	"$2,319.57"	"$2,343.00"	$0.00		$0.00	$458.35	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
1832-3830S	SUP	HCPCS C1713		1832-3830S  -  NAIL 8MM 30CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI	BOTH IP/OP	"$2,918.05 "	"$2,159.36"	$0.00	"$2,343.00"	"$1,317.94"	"$1,317.94"	$0.00	$0.00	$0.00	$608.19	"$2,165.78"	"$2,165.78"	$0.00	$0.00	$608.12	$0.00	"$1,438.60"	"$1,438.60"	$0.00	"$1,464.38"	"$2,319.57"	"$2,343.00"	$0.00		$0.00	$458.35	$0.00	$0.00	$466.26	$0.00	$0.00	$0.00	$0.00	$0.00
18-3600	SUP	Custom 27803010		18-3600  -  HEAD FEMORAL 0MM OFFST C TAPER 36MM HIGH PERFORMANCE BIOLOX	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18-3605	SUP	Custom 27803010		18-3605  -  HEAD FEMORAL +5MM OFFST C TAPER 36MM HIGH PERFORMANCE BIOLOX	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18-3625	SUP	Custom 27803010		18-3625  -  HEAD FEMORAL +2.5MM OFFST C TAPER 36MM HIGH PERFORMANCE	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18-36-3	SUP	Custom 27803010		18-36-3  -  HEAD FEMORAL -2.5MM OFFST C TAPER 36MM HIGH PERFORMANCE	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18-36-5	SUP	Custom 27803010		18-36-5  -  HEAD FEMORAL -5MM OFFST C TAPER 36MM HIGH PERFORMANCE	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
18-3675	SUP	Custom 27803010		18-3675  -  HEAD FEMORAL +7.5MM 36MM C TAPER BIOLOX DELTA HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1846-0928S	SUP	HCPCS C1713		1846-0928S  -  NAIL 9MM 28CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-0930S	SUP	HCPCS C1713		1846-0930S  -  NAIL 9MM 30CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-0932S	SUP	HCPCS C1713		1846-0932S  -  NAIL 9MM 32CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-0934S	SUP	HCPCS C1713		1846-0934S  -  NAIL 9MM 34CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-0936S	SUP	HCPCS C1713		1846-0936S  -  NAIL 9MM 36CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-0938S	SUP	HCPCS C1713		1846-0938S  -  NAIL 9MM 38CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-0940S	SUP	HCPCS C1713		1846-0940S  -  NAIL 9MM 40CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-0942S	SUP	HCPCS C1713		1846-0942S  -  NAIL 9MM 42CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-0944S	SUP	HCPCS C1713		1846-0944S  -  NAIL 9MM 44CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-0946S	SUP	HCPCS C1713		1846-0946S  -  NAIL 9MM 460MM LEFT T2 IM RECON STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-0948S	SUP	HCPCS C1713		1846-0948S  -  NAIL 9MM 480MM LEFT T2 IM RECON STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1128S	SUP	HCPCS C1713		1846-1128S  -  NAIL 11MM 28CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1130S	SUP	HCPCS C1713		1846-1130S  -  NAIL 11MM 30CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1132S	SUP	HCPCS C1713		1846-1132S  -  NAIL 11MM 32CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1134S	SUP	HCPCS C1713		1846-1134S  -  NAIL 11MM 34CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1136S	SUP	HCPCS C1713		1846-1136S  -  NAIL 11MM 36CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1138S	SUP	HCPCS C1713		1846-1138S  -  NAIL 11MM 38CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1140S	SUP	HCPCS C1713		1846-1140S  -  NAIL 11MM 40CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1142S	SUP	HCPCS C1713		1846-1142S  -  NAIL 11MM 42CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1144S	SUP	HCPCS C1713		1846-1144S  -  NAIL 11MM 44CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1146S	SUP	HCPCS C1713		1846-1146S  -  NAIL 11MM 460MM LEFT T2 IM RECON STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1148S	SUP	HCPCS C1713		1846-1148S  -  NAIL 11MM 480MM LEFT T2 IM RECON STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1334S	SUP	HCPCS C1713		1846-1334S  -  NAIL 13MM 34CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1336S	SUP	HCPCS C1713		1846-1336S  -  NAIL 13MM 36CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1338S	SUP	HCPCS C1713		1846-1338S  -  NAIL 13MM 38CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1340S	SUP	HCPCS C1713		1846-1340S  -  NAIL 13MM 40CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1342S	SUP	HCPCS C1713		1846-1342S  -  NAIL 13MM 42CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1344S	SUP	HCPCS C1713		1846-1344S  -  NAIL 13MM 44CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1346S	SUP	HCPCS C1713		1846-1346S  -  NAIL 13MM 46CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1348S	SUP	HCPCS C1713		1846-1348S  -  NAIL 13MM 48CM LEFT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1534S	SUP	HCPCS C1713		1846-1534S  -  NAIL 15MM 340MM LEFT T2 IM RECON	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1536S	SUP	HCPCS C1713		1846-1536S  -  NAIL 360MM LEFT IM LCK ANTEGADE	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1538S	SUP	HCPCS C1713		1846-1538S  -  NAIL 15MM 380MM LEFT ORTH T2 IM ANTGRD RECON TI 5MM STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1540S	SUP	HCPCS C1713		1846-1540S  -  NAIL 400MM LEFT IM LCK ANTEGADE	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1542S	SUP	HCPCS C1713		1846-1542S  -  NAIL 420MM LEFT IM LCK ANTEGADE	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1544S	SUP	HCPCS C1713		1846-1544S  -  NAIL 440MM LEFT IM LCK ANTEGADE	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1546S	SUP	HCPCS C1713		1846-1546S  -  NAIL 460MM LEFT IM LCK RECON TI	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1846-1548S	SUP	HCPCS C1713		1846-1548S  -  NAIL 15MM 480MM LEFT T2 IM RECON	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0001S	SUP	HCPCS C1713		1847-0001S  -  SCREW SET T2 8MM STRL LCK RECON ANGL STAB TI PROX IM NL	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$129.94	$129.94	$0.00	$0.00	$0.00	$60.18	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$170.80	$170.80	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$45.19	$0.00	$0.00	$45.97	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0002S	SUP	HCPCS C1713		1847-0002S  -  SCREW SET TI 8MM PROX RECON MODE T2 STRL IM NAIL	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$129.94	$129.94	$0.00	$0.00	$0.00	$60.18	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$170.80	$170.80	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$45.19	$0.00	$0.00	$45.97	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0003S	SUP	HCPCS C1713		1847-0003S  -  SCREW SET TI 8MM PROX ANTGRD T2 STRL IM NAIL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0005S	SUP	HCPCS C1713		1847-0005S  -  CAP END +5MM RECON IM NAIL TI STRL T2	BOTH IP/OP	$284.75 	$210.72	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$59.35	$211.34	$211.34	$0.00	$0.00	$59.34	$0.00	$168.43	$168.43	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0010S	SUP	HCPCS C1713		1847-0010S  -  CAP END +10MM RECON IM NAIL TI STRL T2	BOTH IP/OP	$284.75 	$210.72	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$59.35	$211.34	$211.34	$0.00	$0.00	$59.34	$0.00	$168.43	$168.43	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0015S	SUP	HCPCS C1713		1847-0015S  -  CAP END +15MM RECON IM NAIL TI STRL T2	BOTH IP/OP	$284.75 	$210.72	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$59.35	$211.34	$211.34	$0.00	$0.00	$59.34	$0.00	$168.43	$168.43	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0928S	SUP	HCPCS C1713		1847-0928S  -  NAIL 9MM 28CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0930S	SUP	HCPCS C1713		1847-0930S  -  NAIL 9MM 30CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0932S	SUP	HCPCS C1713		1847-0932S  -  NAIL 9MM 32CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0934S	SUP	HCPCS C1713		1847-0934S  -  NAIL 9MM 34CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0936S	SUP	HCPCS C1713		1847-0936S  -  NAIL 9MM 36CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0938S	SUP	HCPCS C1713		1847-0938S  -  NAIL 9MM 38CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0940S	SUP	HCPCS C1713		1847-0940S  -  NAIL 9MM 40CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0942S	SUP	HCPCS C1713		1847-0942S  -  NAIL 9MM 42CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0944S	SUP	HCPCS C1713		1847-0944S  -  NAIL 9MM 44CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0946S	SUP	HCPCS C1713		1847-0946S  -  NAIL 9MM 460MM RIGHT T2 IM RECON STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-0948S	SUP	HCPCS C1713		1847-0948S  -  NAIL 9MM 480MM RIGHT T2 IM RECON STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1128S	SUP	HCPCS C1713		1847-1128S  -  NAIL 11MM 28CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1130S	SUP	HCPCS C1713		1847-1130S  -  NAIL 11MM 30CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1132S	SUP	HCPCS C1713		1847-1132S  -  NAIL 11MM 32CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1134S	SUP	HCPCS C1713		1847-1134S  -  NAIL 11MM 34CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1136S	SUP	HCPCS C1713		1847-1136S  -  NAIL 11MM 36CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1138S	SUP	HCPCS C1713		1847-1138S  -  NAIL 11MM 38CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1140S	SUP	HCPCS C1713		1847-1140S  -  NAIL 11MM 40CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1142S	SUP	HCPCS C1713		1847-1142S  -  NAIL 11MM 42CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1144S	SUP	HCPCS C1713		1847-1144S  -  NAIL 11MM 44CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1146S	SUP	HCPCS C1713		1847-1146S  -  NAIL 11MM 460MM RIGHT T2 IM RECON STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1148S	SUP	HCPCS C1713		1847-1148S  -  NAIL 11MM 480MM RIGHT T2 IM RECON STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1334S	SUP	HCPCS C1713		1847-1334S  -  NAIL 13MM 34CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1336S	SUP	HCPCS C1713		1847-1336S  -  NAIL 13MM 36CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1338S	SUP	HCPCS C1713		1847-1338S  -  NAIL 13MM 38CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1340S	SUP	HCPCS C1713		1847-1340S  -  NAIL 13MM 40CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1342S	SUP	HCPCS C1713		1847-1342S  -  NAIL 13MM 42CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1344S	SUP	HCPCS C1713		1847-1344S  -  NAIL 13MM 44CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1346S	SUP	HCPCS C1713		1847-1346S  -  NAIL 13MM 46CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1348S	SUP	HCPCS C1713		1847-1348S  -  NAIL 13MM 48CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1534S	SUP	HCPCS C1713		1847-1534S  -  NAIL 15MM 340MM RIGHT T2 IM RECON ANTEGADE TI	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1536S	SUP	HCPCS C1713		1847-1536S  -  NAIL 15MM 36CM RIGHT ORTH T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1538S	SUP	HCPCS C1713		1847-1538S  -  NAIL 15MM 38CM RIGHT T2 IM RECON TI STRL	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1540S	SUP	HCPCS C1713		1847-1540S  -  NAIL 15MM 400MM RIGHT T2 IM ANTGRD RECON TI	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1542S	SUP	HCPCS C1713		1847-1542S  -  NAIL 15MM 420MM RIGHT T2 IM LCK ANTEGADE RECON TI 5MM	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1544S	SUP	HCPCS C1713		1847-1544S  -  NAIL 15MM 440MM RIGHT T2 IM ANTGRD RECON TI	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1546S	SUP	HCPCS C1713		1847-1546S  -  NAIL 15MM 460MM RIGHT T2 IM RECON IMPL TI	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1847-1548S	SUP	HCPCS C1713		1847-1548S  -  NAIL 480MM IM LCK	BOTH IP/OP	"$3,196.88 "	"$2,365.69"	$0.00	"$2,557.50"	"$1,438.59"	"$1,438.59"	$0.00	$0.00	$0.00	$666.31	"$2,372.72"	"$2,372.72"	$0.00	$0.00	$666.23	$0.00	"$1,576.06"	"$1,576.06"	$0.00	"$1,598.44"	"$2,531.93"	"$2,557.50"	$0.00		$0.00	$500.31	$0.00	$0.00	$508.94	$0.00	$0.00	$0.00	$0.00	$0.00
1850-0002S	SUP	HCPCS C1713		1850-0002S  -  END CAP PLUS 0 MM	BOTH IP/OP	$278.80 	$206.31	$0.00	$247.50	$139.22	$139.22	$0.00	$0.00	$0.00	$58.11	$206.93	$206.93	$0.00	$0.00	$58.10	$0.00	$164.91	$164.91	$0.00	$154.69	$245.03	$247.50	$0.00		$0.00	$48.42	$0.00	$0.00	$49.25	$0.00	$0.00	$0.00	$0.00	$0.00
1850-0003S	SUP	HCPCS C1713		1850-0003S  -  T2 CANNULATED COMP. SCREW	BOTH IP/OP	$304.30 	$225.18	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$63.42	$225.85	$225.85	$0.00	$0.00	$63.42	$0.00	$179.99	$179.99	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
1850-0005S	SUP	HCPCS C1713		1850-0005S  -  END CAP PLUS 5 MM	BOTH IP/OP	$278.80 	$206.31	$0.00	$247.50	$139.22	$139.22	$0.00	$0.00	$0.00	$58.11	$206.93	$206.93	$0.00	$0.00	$58.10	$0.00	$164.91	$164.91	$0.00	$154.69	$245.03	$247.50	$0.00		$0.00	$48.42	$0.00	$0.00	$49.25	$0.00	$0.00	$0.00	$0.00	$0.00
1850-0010S	SUP	HCPCS C1713		1850-0010S  -  END CAP PLUS 10  MM	BOTH IP/OP	$278.80 	$206.31	$0.00	$247.50	$139.22	$139.22	$0.00	$0.00	$0.00	$58.11	$206.93	$206.93	$0.00	$0.00	$58.10	$0.00	$164.91	$164.91	$0.00	$154.69	$245.03	$247.50	$0.00		$0.00	$48.42	$0.00	$0.00	$49.25	$0.00	$0.00	$0.00	$0.00	$0.00
1850-0015S	SUP	HCPCS C1713		1850-0015S  -  END CAP PLUS 15 MM	BOTH IP/OP	$278.80 	$206.31	$0.00	$247.50	$139.22	$139.22	$0.00	$0.00	$0.00	$58.11	$206.93	$206.93	$0.00	$0.00	$58.10	$0.00	$164.91	$164.91	$0.00	$154.69	$245.03	$247.50	$0.00		$0.00	$48.42	$0.00	$0.00	$49.25	$0.00	$0.00	$0.00	$0.00	$0.00
186002-44	SUP	HCPCS C1776		186002-44  -  SHELL ACTB 44MM CH POR HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186002-46	SUP	HCPCS C1776		186002-46  -  SHELL ACTB HMSPHR 46MM 3.1MM PST RESTORIS CH CUP TI HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186002-48	SUP	HCPCS C1776		186002-48  -  SHELL ACTB HMSPHR 48MM 3.2MM PST RESTORIS CH CUP TI HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186002-50	SUP	HCPCS C1776		186002-50  -  SHELL ACTB HMSPHR 50MM 3.1MM STRL PST RESTORIS CH TI HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186002-52	SUP	HCPCS C1776		186002-52  -  SHELL ACTB HMSPHR 52MM 3.1MM STRL PST RESTORIS CH TI HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186002-54	SUP	HCPCS C1776		186002-54  -  SHELL ACTB HMSPHR 54MM 3.5MM STRL PST RESTORIS TI HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186002-56	SUP	HCPCS C1776		186002-56  -  SHELL ACTB HMSPHR 56MM 3.7MM STRL PST RESTORIS TI HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186002-58	SUP	HCPCS C1776		186002-58  -  SHELL ACTB 58MM CH POR HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186002-60	SUP	HCPCS C1776		186002-60  -  SHELL ACTB HMSPHR 60MM 4.8MM PST RESTORIS CH CUP TI HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186002-62	SUP	HCPCS C1776		186002-62  -  SHELL ACTB HMSPHR 62MM 4MM STRL PST RESTORIS CH CUP TI HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186002-64	SUP	HCPCS C1776		186002-64  -  SHELL ACTB HMSPHR 64MM 5MM PST RESTORIS CH CUP TI HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186002-66	SUP	HCPCS C1776		186002-66  -  SHELL ACTB HMSPHR 66MM 4.6MM PST RESTORIS CH CUP TI HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186002-68	SUP	HCPCS C1776		186002-68  -  SHELL ACTB HMSPHR 68MM 5.6MM PST RESTORIS CH CUP TI HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
186003-02	SUP	HCPCS C1776		186003-02  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186003-03	SUP	HCPCS C1776		186003-03  -  STEM FEM 3 12/14 TPR STRL RESTORIS STD NK HIP	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186003-04	SUP	HCPCS C1776		186003-04  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186003-05	SUP	HCPCS C1776		186003-05  -  STEM FEM 5 12/14 TPR STRL RESTORIS STD NK HIP	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186003-06	SUP	HCPCS C1776		186003-06  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186003-07	SUP	HCPCS C1776		186003-07  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186003-08	SUP	HCPCS C1776		186003-08  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186003-09	SUP	HCPCS C1776		186003-09  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186003-10	SUP	HCPCS C1776		186003-10  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186003-11	SUP	HCPCS C1776		186003-11  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186003-12	SUP	HCPCS C1776		186003-12  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186004-02	SUP	HCPCS C1776		186004-02  -  STEM FEM 2 12/14 TPR STRL RESTORIS HI OFST NK HIP	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186004-03	SUP	HCPCS C1776		186004-03  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186004-04	SUP	HCPCS C1776		186004-04  -  STEM FEM 4 12/14 TPR STRL RESTORIS HI OFST NK HIP	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186004-05	SUP	HCPCS C1776		186004-05  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186004-06	SUP	HCPCS C1776		186004-06  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186004-07	SUP	HCPCS C1776		186004-07  -  STEM FEM 7 12/14 TPR STRL RESTORIS XTD OFST NK HIP	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186004-08	SUP	HCPCS C1776		186004-08  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186004-09	SUP	HCPCS C1776		186004-09  -  STEM FEM 9 12/14 TPR STRL RESTORIS HI OFST NK HIP	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186004-10	SUP	HCPCS C1776		186004-10  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186004-11	SUP	HCPCS C1776		186004-11  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186004-12	SUP	HCPCS C1776		186004-12  -  STEM FEM	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
186005-15	SUP	HCPCS C1713		186005-15  -  SCREW ACTB 6.5MM 15MM ACTB	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$31.50	$31.50	$0.00	$0.00	$0.00	$14.59	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$41.41	$41.41	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
186005-20	SUP	HCPCS C1713		186005-20  -  SCREW ACTB 6.5MM 20MM ACTB	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$31.50	$31.50	$0.00	$0.00	$0.00	$14.59	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$41.41	$41.41	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
186005-25	SUP	HCPCS C1713		186005-25  -  SCREW ACTB 6.5MM 25MM ACTB	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$31.50	$31.50	$0.00	$0.00	$0.00	$14.59	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$41.41	$41.41	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
186005-30	SUP	HCPCS C1713		186005-30  -  SCREW ACTB 6.5MM 30MM ACTB	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$31.50	$31.50	$0.00	$0.00	$0.00	$14.59	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$41.41	$41.41	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
186005-35	SUP	HCPCS C1713		186005-35  -  SCREW ACTB 6.5MM 35MM ACTB	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$31.50	$31.50	$0.00	$0.00	$0.00	$14.59	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$41.41	$41.41	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
186005-40	SUP	HCPCS C1713		186005-40  -  SCREW ACTB 6.5MM 40MM STRL RESTORIS	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$31.50	$31.50	$0.00	$0.00	$0.00	$14.59	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$41.41	$41.41	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
186128-44	SUP	HCPCS C1776		186128-44  -  LINER ACTB 44MM 28MM 7.1MM RESTORIS WR RST OXDT STAB XLVE	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186128-46	SUP	HCPCS C1776		186128-46  -  LINER ACTB 46MM 28MM 7.1MM RESTORIS WR RST OXDT STAB XLVE	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186128-48	SUP	HCPCS C1776		186128-48  -  LINER ACTB 48MM 28MM 7.6MM RESTORIS WR RST OXDT STAB XLVE	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186128-50	SUP	HCPCS C1776		186128-50  -  LINER ACTB 50MM 28MM 8.6MM RESTORIS WR RST OXDT STAB XLVE	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186132-48	SUP	HCPCS C1776		186132-48  -  LINER ACTB NTRL 48MM 32MM E-POLY HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186132-50	SUP	HCPCS C1776		186132-50  -  LINER ACTB HMSPHR 50MM 32MM 6.9MM STRL 4.5MM RESTORIS XLVE	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186132-52	SUP	HCPCS C1776		186132-52  -  LINER ACTB NTRL 52MM 32MM E-POLY HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186132-54	SUP	HCPCS C1776		186132-54  -  LINER ACTB 54MM 32MM 7.8MM RESTORIS WR RST OXDT STAB XLVE	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186136-52	SUP	HCPCS C1776		186136-52  -  LINER ACTB HMSPHR 52MM 36MM 6.6MM STRL 3.7MM RESTORIS XLVE	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186136-54	SUP	HCPCS C1776		186136-54  -  LINER ACTB HMSPHR 36MM 54MM 6.7MM STRL RESTORIS XLVE HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186136-56	SUP	HCPCS C1776		186136-56  -  LINER ACTB HMSPHR 36MM 56MM 7.1MM STRL RESTORIS XLVE HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186136-58	SUP	HCPCS C1776		186136-58  -  LINER ACTB NTRL DOME TPR 58-60MM 36MM 7.7MM LD BRNG XLVE HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186136-62	SUP	HCPCS C1776		186136-62  -  LINER ACTB 62-64MM 36MM 9.3MM RESTORIS WR RST OXDT STAB XLVE	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186136-66	SUP	HCPCS C1776		186136-66  -  LINER ACTB 66-68MM 36MM 10.9MM RESTORIS WR RST OXDT STAB	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186140-56	SUP	HCPCS C1776		186140-56  -  LINER ACTB 7.5MM	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186140-58	SUP	HCPCS C1776		186140-58  -  LINER ACTB 8.4MM	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186140-62	SUP	HCPCS C1776		186140-62  -  LINER ACTB 10.3MM	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186140-66	SUP	HCPCS C1776		186140-66  -  LINER ACTB 11.9MM	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186228-44	SUP	HCPCS C1776		186228-44  -  LINER ACTB 44MM 28MM HW E-POLY HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186228-46	SUP	HCPCS C1776		186228-46  -  LINER ACTB 46MM 28MM HW E-POLY HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186228-48	SUP	HCPCS C1776		186228-48  -  LINER ACTB	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186228-50	SUP	HCPCS C1776		186228-50  -  LINER ACTB	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186232-48	SUP	HCPCS C1776		186232-48  -  LINER ACTB 48MM 32MM HW E-POLY HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186232-50	SUP	HCPCS C1776		186232-50  -  LINER ACTB 50MM PST RESTORIS HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186232-52	SUP	HCPCS C1776		186232-52  -  LINER ACTB 52MM 32MM HW E-POLY HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186232-54	SUP	HCPCS C1776		186232-54  -  LINER ACTB	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186236-52	SUP	HCPCS C1776		186236-52  -  LINER ACTB 52MM 36MM HW E-POLY HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186236-54	SUP	HCPCS C1776		186236-54  -  LINER ACTB 54MM 36MM HW E-POLY HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186236-56	SUP	HCPCS C1776		186236-56  -  LINER ACTB 56MM 36MM HW E-POLY HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186236-58	SUP	HCPCS C1776		186236-58  -  LINER ACTB 58-60MM 36MM HW E-POLY HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186236-62	SUP	HCPCS C1776		186236-62  -  LINER ACTB 62/63/64MM 36MM STRL RESTORIS HW XLVE HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186236-66	SUP	HCPCS C1776		186236-66  -  LINER ACTB	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$648.00	$648.00	$0.00	$0.00	$0.00	$300.13	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$851.76	$851.76	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$225.36	$0.00	$0.00	$229.25	$0.00	$0.00	$0.00	$0.00	$0.00
186628-00	SUP	HCPCS C1776		186628-00  -  HEAD FEM	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186628-01	SUP	HCPCS C1776		186628-01  -  HEAD FEM	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186628-02	SUP	HCPCS C1776		186628-02  -  HEAD FEM	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186632-00	SUP	HCPCS C1776		186632-00  -  HEAD FEM SM 32MM RESTORIS CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186632-01	SUP	HCPCS C1776		186632-01  -  SHELL ACTB HMSPHR 50MM 3.1MM STRL PST RESTORIS CH TI HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186632-02	SUP	HCPCS C1776		186632-02  -  HEAD FEM	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186632-03	SUP	HCPCS C1776		186632-03  -  HEAD FEM	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186636-00	SUP	HCPCS C1776		186636-00  -  HEAD FEM	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186636-01	SUP	HCPCS C1776		186636-01  -  HEAD FEM +0MM 12/14 TPR MED 36MM STRL RESTORIS CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186636-02	SUP	HCPCS C1776		186636-02  -  HEAD FEM LG 36MM RESTORIS CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186636-03	SUP	HCPCS C1776		186636-03  -  HEAD FEM XL 36MM RESTORIS CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186640-00	SUP	HCPCS C1776		186640-00  -  HEAD FEM SM 40MM RESTORIS CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186640-01	SUP	HCPCS C1776		186640-01  -  HEAD FEM MED 40MM RESTORIS CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186640-02	SUP	HCPCS C1776		186640-02  -  HEAD FEM LG 40MM RESTORIS CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
186640-03	SUP	HCPCS C1776		186640-03  -  HEAD FEM XL 40MM RESTORIS CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$776.25	$776.25	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
1867.31.430	SUP	HCPCS C1713		1867.31.430  -  SCREW BN 4.35MM 30MM NS VPR FX PA TI SPNE CORT 5.5MM ROD	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
1867.31.435	SUP	HCPCS C1713		1867.31.435  -  SCREW BN 4.35MM 35MM NS VPR FX PA TI SPNE CORT 5.5MM ROD	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
1867.31.525	SUP	HCPCS C1713		1867.31.525  -  SCREW BN 5MM 25MM NS VPR XPDM FX PA TI SPNE CORT 5.5MM ROD	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
1867.31.645	SUP	HCPCS C1713		1867.31.645  -  SCREW BONE 6MM 45MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
1867.31.675	SUP	HCPCS C1713		1867.31.675  -  SCREW BONE 7MM 50MM XPDM TI SPN CORT FIX 5.5MM ROD	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
1867.31.845	SUP	HCPCS C1713		1867.31.845  -  SCREW BONE 8MM 45MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
1867.31.850	SUP	HCPCS C1713		1867.31.850  -  SCREW BONE 8MM 50MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
1867-15-780	SUP	HCPCS C1713		1867-15-780  -  SCREW BN 7MM 80MM VPR 2 PA CNN TI SPNE MIS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
1882TC/46	SUP	HCPCS C1898		1882TC/46  -  TENDRIL ST OPTIM	BOTH IP/OP	$680.00 	$503.20	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
1882TC/52	SUP	HCPCS C1898		1882TC/52  -  TENDRIL ST OPTIM	BOTH IP/OP	$680.00 	$503.20	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
18-83525	SUP	Custom 27203010		18-83525  -  BLADE SHVR 18CM 3.5MM SKMR 15D LRYNG 2 CVD ANG TIP LP IRR	BOTH IP/OP	"$2,137.50 "	"$1,581.75"	$0.00	"$1,710.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,586.45"	"$1,586.45"	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	"$1,068.75"	"$1,692.90"	"$1,710.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1888TC/46	SUP	HCPCS C1898		1888TC/46  -  LEAD PCNG 46CM VNTRC LUBRICITY FLXB DRBLTY BIOSTABILITY	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
1888TC/52	SUP	HCPCS C1898		1888TC/52  -  LEAD PCNG 52CM VNTRC LUBRICITY FLXB DRBLTY BIOSTABILITY	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
1888TC/58	SUP	HCPCS C1898		1888TC/58  -  LEAD PCNG STRG THN 6FR 58CM TNDRL ST IS-1 BP CNCT XTD-RETRAC	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
1888TC/65	SUP	HCPCS C1898		1888TC/65  -  LEAD PCNG THN STRG 6FR 65CM TNDRL ST IS-1 BP CNCT XTD-RETRAC	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4020S	SUP	HCPCS C1713		1891-4020S  -  SCREW BONE 4MM 20MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4022S	SUP	HCPCS C1713		1891-4022S  -  SCREW BONE 4MM 22MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4024S	SUP	HCPCS C1713		1891-4024S  -  SCREW BONE 4MM 24MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4025S	SUP	HCPCS C1713		1891-4025S  -  SCREW BONE 4MM 25MM T2 TI ORTH SHFT PTHRD STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4026S	SUP	HCPCS C1713		1891-4026S  -  SCREW BONE 4MM 26MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4028S	SUP	HCPCS C1713		1891-4028S  -  SCREW BONE 4MM 28MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4030S	SUP	HCPCS C1713		1891-4030S  -  SCREW BONE 4MM 30MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4032S	SUP	HCPCS C1713		1891-4032S  -  SCREW BONE 4MM 32MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4034S	SUP	HCPCS C1713		1891-4034S  -  SCREW BONE 4MM 34MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4035S	SUP	HCPCS C1713		1891-4035S  -  SCREW BONE 4MM 35MM T2 TI ORTH SHFT PTHRD STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4036S	SUP	HCPCS C1713		1891-4036S  -  SCREW BONE 4MM 36MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4038S	SUP	HCPCS C1713		1891-4038S  -  SCREW BONE 4MM 38MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4040S	SUP	HCPCS C1713		1891-4040S  -  SCREW BONE 4MM 40MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4045S	SUP	HCPCS C1713		1891-4045S  -  SCREW BONE 4MM 45MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4050S	SUP	HCPCS C1713		1891-4050S  -  SCREW BONE 4MM 50MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4055S	SUP	HCPCS C1713		1891-4055S  -  SCREW BONE 4MM 55MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-4060S	SUP	HCPCS C1713		1891-4060S  -  SCREW BONE 4MM 60MM T2 TI PTHRD HUM SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5025S	SUP	HCPCS C1713		1891-5025S  -  SCREW BONE 5MM 25MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5030S	SUP	HCPCS C1713		1891-5030S  -  SCREW BONE 5MM 30MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5035S	SUP	HCPCS C1713		1891-5035S  -  SCREW BONE 5MM 35MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5040S	SUP	HCPCS C1713		1891-5040S  -  SCREW BONE 5MM 40MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5045S	SUP	HCPCS C1713		1891-5045S  -  SCREW BONE 5MM 45MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5050S	SUP	HCPCS C1713		1891-5050S  -  SCREW BONE 5MM 50MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5055S	SUP	HCPCS C1713		1891-5055S  -  SCREW BONE 5MM 55MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5060S	SUP	HCPCS C1713		1891-5060S  -  SCREW BONE 5MM 60MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5065S	SUP	HCPCS C1713		1891-5065S  -  SCREW BONE 5MM 65MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5070S	SUP	HCPCS C1713		1891-5070S  -  SCREW BONE 5MM 70MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5075S	SUP	HCPCS C1713		1891-5075S  -  SCREW BONE 5MM 75MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5080S	SUP	HCPCS C1713		1891-5080S  -  SCREW BONE 5MM 80MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5085S	SUP	HCPCS C1713		1891-5085S  -  SCREW BONE 5MM 85MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5090S	SUP	HCPCS C1713		1891-5090S  -  SCREW BONE 5MM 90MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5095S	SUP	HCPCS C1713		1891-5095S  -  SCREW BONE 5MM 95MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5100S	SUP	HCPCS C1713		1891-5100S  -  SCREW BONE 5MM 100MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5105S	SUP	HCPCS C1713		1891-5105S  -  SCREW BONE 5MM 105MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5110S	SUP	HCPCS C1713		1891-5110S  -  SCREW BONE 5MM 110MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5115S	SUP	HCPCS C1713		1891-5115S  -  SCREW BONE 5MM 115MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1891-5120S	SUP	HCPCS C1713		1891-5120S  -  SCREW BONE 5MM 120MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5001S	SUP	HCPCS C1713		1895-5001S  -  NUT ORTH 5MM T2 CNDYLR TI CNDYLR SCR STRL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5040S	SUP	HCPCS C1713		1895-5040S  -  SCREW BONE 5MM 40MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5045S	SUP	HCPCS C1713		1895-5045S  -  SCREW BONE 5MM 45MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5050S	SUP	HCPCS C1713		1895-5050S  -  SCREW BONE 5MM 50MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5055S	SUP	HCPCS C1713		1895-5055S  -  SCREW BONE 5MM 55MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5060S	SUP	HCPCS C1713		1895-5060S  -  SCREW BONE 5MM 60MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5065S	SUP	HCPCS C1713		1895-5065S  -  SCREW BONE 5MM 65MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5070S	SUP	HCPCS C1713		1895-5070S  -  SCREW BONE 5MM 70MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5075S	SUP	HCPCS C1713		1895-5075S  -  SCREW BONE 5MM 75MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5080S	SUP	HCPCS C1713		1895-5080S  -  SCREW BONE 5MM 80MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5085S	SUP	HCPCS C1713		1895-5085S  -  SCREW BONE 5MM 85MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5090S	SUP	HCPCS C1713		1895-5090S  -  SCREW BONE 5MM 90MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5095S	SUP	HCPCS C1713		1895-5095S  -  SCREW BONE 5MM 95MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5100S	SUP	HCPCS C1713		1895-5100S  -  SCREW BONE 5MM 100MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5105S	SUP	HCPCS C1713		1895-5105S  -  SCREW BONE 5MM 105MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5110S	SUP	HCPCS C1713		1895-5110S  -  SCREW BONE 5MM 110MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5115S	SUP	HCPCS C1713		1895-5115S  -  SCREW BONE 5MM 115MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1895-5120S	SUP	HCPCS C1713		1895-5120S  -  SCREW BONE 5MM 120MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4020S	SUP	HCPCS C1713		1896-4020S  -  SCREW BONE 4MM 20MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4022S	SUP	HCPCS C1713		1896-4022S  -  SCREW BONE 4MM 22MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4024S	SUP	HCPCS C1713		1896-4024S  -  SCREW BONE 4MM 24MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4025S	SUP	HCPCS C1713		1896-4025S  -  SCREW BN FT 4MM 25MM STRL LCK TI T2 NL SYS UNV SYS	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4026S	SUP	HCPCS C1713		1896-4026S  -  SCREW BONE 4MM 26MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4028S	SUP	HCPCS C1713		1896-4028S  -  SCREW BONE 4MM 28MM T2 TI DISTAL LCK FULTHRD STRL IM NL SYS	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4030S	SUP	HCPCS C1713		1896-4030S  -  SCREW BONE 4MM 30MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4032S	SUP	HCPCS C1713		1896-4032S  -  SCREW BONE 4MM 32MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4034S	SUP	HCPCS C1713		1896-4034S  -  SCREW BONE 4MM 34MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4035S	SUP	HCPCS C1713		1896-4035S  -  SCREW BONE 4MM 35MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4036S	SUP	HCPCS C1713		1896-4036S  -  SCREW BONE 4MM 36MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4038S	SUP	HCPCS C1713		1896-4038S  -  SCREW BONE 4MM 38MM T2 TI FULTHD LCK	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4040S	SUP	HCPCS C1713		1896-4040S  -  SCREW BONE 4MM 40MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4045S	SUP	HCPCS C1713		1896-4045S  -  SCREW BONE 4MM 45MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4050S	SUP	HCPCS C1713		1896-4050S  -  SCREW BONE 4MM 50MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4055S	SUP	HCPCS C1713		1896-4055S  -  SCREW BONE 4MM 55MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-4060S	SUP	HCPCS C1713		1896-4060S  -  SCREW BONE 4MM 60MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5025S	SUP	HCPCS C1713		1896-5025S  -  SCREW BONE 5MM 25MM T2 TI6AL4V PROX LCK FULTHRD STRL IM NL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5027S	SUP	HCPCS C1713		1896-5027S  -  SCREW BN FT 5MM 27.5MM STRL LCK TI T2 NL SYS UNV SYS	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5030S	SUP	HCPCS C1713		1896-5030S  -  SCREW BONE 5MM 30MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5032S	SUP	HCPCS C1713		1896-5032S  -  SCREW BN FT 5MM 32.5MM STRL LCK TI T2 NL SYS UNV SYS	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5035S	SUP	HCPCS C1713		1896-5035S  -  SCREW BONE 5MM 35MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5037S	SUP	HCPCS C1713		1896-5037S  -  SCREW BN FT 5MM 37.5MM STRL LCK TI T2 NL SYS UNV SYS	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5040S	SUP	HCPCS C1713		1896-5040S  -  SCREW BONE 5MM 40MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5042S	SUP	HCPCS C1713		1896-5042S  -  SCREW BN FT 5MM 42.5MM STRL LCK TI T2 NL SYS UNV SYS	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5045S	SUP	HCPCS C1713		1896-5045S  -  SCREW BONE 5MM 45MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5047S	SUP	HCPCS C1713		1896-5047S  -  SCREW BN FT 5MM 47.5MM STRL LCK TI T2 NL SYS UNV SYS	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5050S	SUP	HCPCS C1713		1896-5050S  -  SCREW BONE 5MM 50MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5052S	SUP	HCPCS C1713		1896-5052S  -  SCREW BN FT 5MM 52.5MM STRL LCK TI T2 NL SYS UNV SYS	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5055S	SUP	HCPCS C1713		1896-5055S  -  SCREW BONE 5MM 55MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5057S	SUP	HCPCS C1713		1896-5057S  -  SCREW BN FT 5MM 57.5MM STRL LCK TI T2 NL SYS UNV SYS	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5060S	SUP	HCPCS C1713		1896-5060S  -  SCREW BONE 5MM 60MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5065S	SUP	HCPCS C1713		1896-5065S  -  SCREW BN FT 5MM 65MM STRL LCK TI T2 NL SYS UNV SYS	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5070S	SUP	HCPCS C1713		1896-5070S  -  SCREW BONE 5MM 70MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5075S	SUP	HCPCS C1713		1896-5075S  -  SCREW BONE 5MM 75MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5080S	SUP	HCPCS C1713		1896-5080S  -  SCREW BONE 5MM 80MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5085S	SUP	HCPCS C1713		1896-5085S  -  SCREW BONE 5MM 85MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5090S	SUP	HCPCS C1713		1896-5090S  -  SCREW BONE 5MM 90MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5095S	SUP	HCPCS C1713		1896-5095S  -  SCREW BONE 5MM 95MM T2 TI FULTHD LCK STRL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5100S	SUP	HCPCS C1713		1896-5100S  -  SCREW BONE 5MM 100MM T2 FULTHD FEM HIP LCK STRL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5105S	SUP	HCPCS C1713		1896-5105S  -  SCREW BONE 5MM 105MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5110S	SUP	HCPCS C1713		1896-5110S  -  SCREW BONE 5MM 110MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5115S	SUP	HCPCS C1713		1896-5115S  -  SCREW BONE 5MM 115MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1896-5120S	SUP	HCPCS C1713		1896-5120S  -  SCREW BN FT 5MM 120MM STRL LCK TI T2 NL SYS UNV SYS	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$131.18	$131.18	$0.00	$0.00	$0.00	$60.76	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$172.42	$172.42	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$45.62	$0.00	$0.00	$46.41	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6065S	SUP	HCPCS C1713		1897-6065S  -  SCREW BONE 6.5MM 65MM T2 TI FEM LAG RECON STRL IM NAIL	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6070S	SUP	HCPCS C1713		1897-6070S  -  SCREW BONE 6.5MM 70MM T2 TI FEM LAG RECON STRL IM NAIL	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6075S	SUP	HCPCS C1713		1897-6075S  -  SCREW BN 6.5MM 75MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6080S	SUP	HCPCS C1713		1897-6080S  -  SCREW BN 6.5MM 80MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6085S	SUP	HCPCS C1713		1897-6085S  -  SCREW BN 6.5MM 85MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6090S	SUP	HCPCS C1713		1897-6090S  -  SCREW BN 6.5MM 90MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6095S	SUP	HCPCS C1713		1897-6095S  -  SCREW BN 6.5MM 95MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6100S	SUP	HCPCS C1713		1897-6100S  -  SCREW BN 6.5MM 100MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6105S	SUP	HCPCS C1713		1897-6105S  -  SCREW BN 6.5MM 105MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6110S	SUP	HCPCS C1713		1897-6110S  -  SCREW BONE 6.5MM 110MM T2 TI FEM LAG RECON STRL IM NAIL	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6115S	SUP	HCPCS C1713		1897-6115S  -  SCREW BONE 6.5MM 115MM T2 TI FEM LAG RECON STRL IM NAIL	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6120S	SUP	HCPCS C1713		1897-6120S  -  SCREW BONE 6.5MM 120MM T2 TI FEM LAG RECON STRL IM NAIL	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6125S	SUP	HCPCS C1713		1897-6125S  -  SCREW BONE 6.5MM 125MM T2 TI FEM LAG RECON STRL IM NAIL	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
1897-6130S	SUP	HCPCS C1713		1897-6130S  -  SCREW BONE 6.5MM 130MM T2 TI FEM LAG RECON STRL IM NAIL	BOTH IP/OP	$380.80 	$281.79	$0.00	$319.00	$179.44	$179.44	$0.00	$0.00	$0.00	$79.37	$282.63	$282.63	$0.00	$0.00	$79.36	$0.00	$225.24	$225.24	$0.00	$199.38	$315.81	$319.00	$0.00		$0.00	$62.40	$0.00	$0.00	$63.48	$0.00	$0.00	$0.00	$0.00	$0.00
19-0000T	SUP	Custom 27203010		19-0000T  -  SLEEVE ADPR +0MM OFST UNV CTPR TI	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19-0005T	SUP	Custom 27203010		19-0005T  -  SLEEVE ADPR 5MM OFST UNV CTPR STRL LF HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19-0025T	SUP	Custom 27203010		19-0025T  -  SLEEVE ADAPTER +2.5MM OFFST UNIVERSAL C TAPER TITANIUM	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
190-151	SUP	HCPCS C2617		190-151  -  STENT URET 8FR 22CM W/O GWIRE DUAL DRMTR PLRS HDR+	BOTH IP/OP	$306.25 	$226.63	$0.00	$245.00	$137.81	$137.81	$0.00	$0.00	$0.00	$63.83	$227.30	$227.30	$0.00	$0.00	$63.82	$0.00	$181.15	$181.15	$0.00	$153.13	$242.55	$245.00	$0.00		$0.00	$47.93	$0.00	$0.00	$48.76	$0.00	$0.00	$0.00	$0.00	$0.00
19-0325T	SUP	Custom 27203010		19-0325T  -  UNIVERSAL C-TAPER -2.5mm ADAPTER SLEEVE (Ti)	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
190-5091-150	SUP	HCPCS C1751		190-5091-150  -  CATH INFUS 90D .014IN ANG 2.1-1.7FR .017IN 150CM 5MM MCTH	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,418.00"	$962.47	$962.47	$0.00	$0.00	$0.00	$351.72	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$998.16	$998.16	$0.00	$886.25	"$1,403.82"	"$1,418.00"	$0.00		$0.00	$277.40	$0.00	$0.00	$282.18	$0.00	$0.00	$0.00	$0.00	$0.00
190-5092-150	SUP	HCPCS C1751		190-5092-150  -  CATH INFUS 90D 2.4-1.9FR .017IN 150CM 5MM MCTH ANG PSHP NTNL	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,418.00"	$962.47	$962.47	$0.00	$0.00	$0.00	$351.72	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$998.16	$998.16	$0.00	$886.25	"$1,403.82"	"$1,418.00"	$0.00		$0.00	$277.40	$0.00	$0.00	$282.18	$0.00	$0.00	$0.00	$0.00	$0.00
19-1005	SUP	HCPCS C1713		19-1005  -  PLATE BN STRG 15MM THINFLAP 2 HL TI CRNMXF	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$88.88	$88.88	$0.00	$0.00	$0.00	$41.16	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$116.82	$116.82	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$30.91	$0.00	$0.00	$31.44	$0.00	$0.00	$0.00	$0.00	$0.00
19-1010	SUP	HCPCS C1713		19-1010  -  PLATE BONE WIDE 2 HOLE THINFLAP TITANIUM CRANIOMAXILLOFACIAL	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
19-1015	SUP	HCPCS C1713		19-1015  -  PLATE BN SQ 13MM THINFLAP 4 HL TI CRNMXF	BOTH IP/OP	$780.00 	$577.20	$0.00	$624.00	$351.00	$351.00	$0.00	$0.00	$0.00	$162.57	$578.92	$578.92	$0.00	$0.00	$162.55	$0.00	$461.37	$461.37	$0.00	$390.00	$617.76	$624.00	$0.00		$0.00	$122.07	$0.00	$0.00	$124.18	$0.00	$0.00	$0.00	$0.00	$0.00
19-1019	SUP	HCPCS C1713		19-1019  -  COVER BURR HOLE 13.5MM BENT SPN	BOTH IP/OP	$847.50 	$627.15	$0.00	$678.00	$381.38	$381.38	$0.00	$0.00	$0.00	$176.64	$629.01	$629.01	$0.00	$0.00	$176.62	$0.00	$501.30	$501.30	$0.00	$423.75	$671.22	$678.00	$0.00		$0.00	$132.63	$0.00	$0.00	$134.92	$0.00	$0.00	$0.00	$0.00	$0.00
19-1020	SUP	HCPCS C1713		19-1020  -  PLATE BONE 18.5MM BURR HOLE THINFLAP TITANIUM	BOTH IP/OP	$847.50 	$627.15	$0.00	$678.00	$381.38	$381.38	$0.00	$0.00	$0.00	$176.64	$629.01	$629.01	$0.00	$0.00	$176.62	$0.00	$501.30	$501.30	$0.00	$423.75	$671.22	$678.00	$0.00		$0.00	$132.63	$0.00	$0.00	$134.92	$0.00	$0.00	$0.00	$0.00	$0.00
19-1021	SUP	HCPCS C1713		19-1021  -  COVER BURR HOLE BENT LP 24MM THINFLAP CRANIOMAXILLOFACIAL	BOTH IP/OP	$847.50 	$627.15	$0.00	$678.00	$381.38	$381.38	$0.00	$0.00	$0.00	$176.64	$629.01	$629.01	$0.00	$0.00	$176.62	$0.00	$501.30	$501.30	$0.00	$423.75	$671.22	$678.00	$0.00		$0.00	$132.63	$0.00	$0.00	$134.92	$0.00	$0.00	$0.00	$0.00	$0.00
19-1030	SUP	HCPCS C1713		19-1030  -  PLATE BONE 85X53X.5MM GRID PANEL THINFLAP TITANIUM	BOTH IP/OP	"$4,047.50 "	"$2,995.15"	$0.00	"$3,238.00"	"$1,821.38"	"$1,821.38"	$0.00	$0.00	$0.00	$843.60	"$3,004.05"	"$3,004.05"	$0.00	$0.00	$843.50	$0.00	"$1,995.42"	"$1,995.42"	$0.00	"$2,023.75"	"$3,205.62"	"$3,238.00"	$0.00		$0.00	$633.43	$0.00	$0.00	$644.36	$0.00	$0.00	$0.00	$0.00	$0.00
19-1040	SUP	HCPCS C1713		19-1040  -  PLATE BONE LONG 6 HOLE STR THINFLAP TITANIUM	BOTH IP/OP	$820.00 	$606.80	$0.00	$656.00	$369.00	$369.00	$0.00	$0.00	$0.00	$170.91	$608.60	$608.60	$0.00	$0.00	$170.89	$0.00	$485.03	$485.03	$0.00	$410.00	$649.44	$656.00	$0.00		$0.00	$128.33	$0.00	$0.00	$130.54	$0.00	$0.00	$0.00	$0.00	$0.00
19-1045	SUP	HCPCS C1713		19-1045  -  PLATE BONE LONG 4 HOLE STR THINFLAP TITANIUM	BOTH IP/OP	$405.00 	$299.70	$0.00	$324.00	$182.25	$182.25	$0.00	$0.00	$0.00	$84.41	$300.59	$300.59	$0.00	$0.00	$84.40	$0.00	$239.56	$239.56	$0.00	$202.50	$320.76	$324.00	$0.00		$0.00	$63.38	$0.00	$0.00	$64.48	$0.00	$0.00	$0.00	$0.00	$0.00
19-1050	SUP	HCPCS C1713		19-1050  -  PLATE BONE STANDARD 6 HOLE CVD THINFLAP TITANIUM CRANFCL	BOTH IP/OP	$820.00 	$606.80	$0.00	$656.00	$369.00	$369.00	$0.00	$0.00	$0.00	$170.91	$608.60	$608.60	$0.00	$0.00	$170.89	$0.00	$485.03	$485.03	$0.00	$410.00	$649.44	$656.00	$0.00		$0.00	$128.33	$0.00	$0.00	$130.54	$0.00	$0.00	$0.00	$0.00	$0.00
19-1060	SUP	HCPCS C1713		19-1060  -  PLATE BN 2Y 16MM THINFLAP 6 HL TI CRNMXF	BOTH IP/OP	$820.00 	$606.80	$0.00	$656.00	$369.00	$369.00	$0.00	$0.00	$0.00	$170.91	$608.60	$608.60	$0.00	$0.00	$170.89	$0.00	$485.03	$485.03	$0.00	$410.00	$649.44	$656.00	$0.00		$0.00	$128.33	$0.00	$0.00	$130.54	$0.00	$0.00	$0.00	$0.00	$0.00
19-1065	SUP	HCPCS C1713		19-1065  -  PLATE BONE STANDARD 6 HOLE Y THINFLAP TITANIUM	BOTH IP/OP	$880.00 	$651.20	$0.00	$704.00	$396.00	$396.00	$0.00	$0.00	$0.00	$183.41	$653.14	$653.14	$0.00	$0.00	$183.39	$0.00	$520.52	$520.52	$0.00	$440.00	$696.96	$704.00	$0.00		$0.00	$137.72	$0.00	$0.00	$140.10	$0.00	$0.00	$0.00	$0.00	$0.00
19-1200AU	SUP	Custom 27203010		19-1200AU  -  FORCEP BIPOL 8-.7MM HARDY BAYONETTE DISP	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$0.00	$0.00	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1924-508	SUP	Custom 27203010		1924-508  -  CIRCUIT BRTHG CSTM RESP HMD LN UNHT 1.5FT INF 10MM	BOTH IP/OP	$6.22 	$4.60	$0.00	$4.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.62	$4.62	$0.00	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$3.11	$4.93	$4.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1944/46	SUP	HCPCS C1898		1944/46  -  LEAD PCNG 10MM SPC S J 7FR 46CM ISFLX ATCPT IS-1 BP CNCT PSV	BOTH IP/OP	$680.00 	$503.20	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
1944/52	SUP	HCPCS C1898		1944/52  -  LEAD PCNG J 7FR 52CM ISFLX IS-1 BP CNCT TINE FX OPTIM STRD	BOTH IP/OP	$680.00 	$503.20	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
1948/46	SUP	HCPCS C1898		1948/46  -  LEAD PCNG STRG 46CM STRL LF ISFLX ATCPT TINE FX IS-1 BP CNCT	BOTH IP/OP	$680.00 	$503.20	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
1948/52	SUP	HCPCS C1898		1948/52  -  LEAD PCNG 7FR 52CM ISFLX BP PSV FX TINE IS 1 OPTIM STRD	BOTH IP/OP	$680.00 	$503.20	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
1948/58	SUP	HCPCS C1898		1948/58  -  LEAD PCNG STRG 7FR 58CM ISFLX ABRSN RST IS-1 BP CNCT TINE FX	BOTH IP/OP	$680.00 	$503.20	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
195-7112-6	SUP	Custom 27203010		REAGENT DPS EXCH BUFF RMD HS ANALY	BOTH IP/OP	"$2,335.00 "	"$1,727.90"	$0.00	"$1,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,167.50"	"$1,849.32"	"$1,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
195-7115	SUP	Custom 27203010		REAGENT WSH SOL CHM	BOTH IP/OP	$840.00 	$621.60	$0.00	$672.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$420.00	$665.28	$672.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
195-7119HS	SUP	Custom 27203010		REAGENT CHK MX ANALY	BOTH IP/OP	$36.88 	$27.29	$0.00	$29.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.44	$29.21	$29.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
195-7137	SUP	Custom 27203010		REAGENT DILU ANALY	BOTH IP/OP	$133.00 	$98.42	$0.00	$106.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.50	$105.34	$106.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
195-7150	SUP	Custom 27203010		CARTRIDGE ANALY PURF	BOTH IP/OP	$777.50 	$575.35	$0.00	$622.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$388.75	$615.78	$622.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1967.89.300	SUP	HCPCS C1713		1967.89.300  -  ROD SPINAL STR 300MM HEXAGON VIPER 2 COCR	BOTH IP/OP	"$1,957.50 "	"$1,448.55"	$0.00	"$1,566.00"	$880.88	$880.88	$0.00	$0.00	$0.00	$407.99	"$1,452.86"	"$1,452.86"	$0.00	$0.00	$407.94	$0.00	"$1,157.86"	"$1,157.86"	$0.00	$978.75	"$1,550.34"	"$1,566.00"	$0.00		$0.00	$306.35	$0.00	$0.00	$311.63	$0.00	$0.00	$0.00	$0.00	$0.00
1967.89.480	SUP	HCPCS C1713		1967.89.480  -  ROD SPINAL STR 480MM VIPER 2 COCR	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$958.50	$958.50	$0.00	$0.00	$0.00	$443.95	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	"$1,259.90"	"$1,259.90"	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$333.35	$0.00	$0.00	$339.10	$0.00	$0.00	$0.00	$0.00	$0.00
197230FLA	SUP	HCPCS C1894		197230FLA  -  SHEATH IRRIGATION ENDO-SCRUB 2 45D 4MM LEFT STERILE	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$373.31	$373.31	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
199.933S	SUP	Custom 27203010		199.933S  -  KIT SCRL BAR THRD 6MM 200MM STRL	BOTH IP/OP	"$2,308.15 "	"$1,708.03"	$0.00	"$1,792.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,713.11"	"$1,713.11"	$0.00	$0.00	$481.02	$0.00	$0.00	$0.00	$0.00	"$1,120.46"	"$1,774.82"	"$1,792.74"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
199.936S	SUP	HCPCS C1713		199.936S  -  BAR SACRAL 6MM 260MM THREAD SPN STERILE	BOTH IP/OP	"$2,308.15 "	"$1,708.03"	$0.00	"$1,792.74"	"$1,008.42"	"$1,008.42"	$0.00	$0.00	$0.00	$481.08	"$1,713.11"	"$1,713.11"	$0.00	$0.00	$481.02	$0.00	"$1,365.27"	"$1,365.27"	$0.00	"$1,120.46"	"$1,774.82"	"$1,792.74"	$0.00		$0.00	$340.49	$0.00	$0.00	$356.76	$0.00	$0.00	$0.00	$0.00	$0.00
19A001	SUP	Custom 27804086		19A001  -  GRAFT BONE 4-10MM FREEZE DRIED CANCELLOUS CORTICAL 30ML	BOTH IP/OP	"$1,022.50 "	$756.65	$0.00	$818.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.90	$758.90	$0.00	$0.00	$213.09	$0.00	$0.00	$0.00	$0.00	$511.25	$809.82	$818.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19A002	SUP	Custom 27804086		19A002  -  GRAFT BONE 4-10MM FREEZE DRIED CANCELLOUS CORTICAL 15ML	BOTH IP/OP	$582.50 	$431.05	$0.00	$466.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$432.33	$432.33	$0.00	$0.00	$121.39	$0.00	$0.00	$0.00	$0.00	$291.25	$461.34	$466.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
19AGFN-756	SUP	Custom 27803010		19AGFN-756  -  VALVE AORTIC 85D 19MM 17.8MM 1 DIGIT GRADIENT MECHANICAL	BOTH IP/OP	"$11,750.00 "	"$8,695.00"	$0.00	"$9,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,448.70"	$0.00	$0.00	$0.00	$0.00	"$5,875.00"	"$9,306.00"	"$9,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1DLMC03	SUP	HCPCS C1781		1DLMC03  -  MESH SURG THK1MM 15X10CM BIOMATERIAL DUALMESH GORE-TEX SOFT	BOTH IP/OP	$982.50 	$727.05	$0.00	$786.00	$442.13	$442.13	$0.00	$0.00	$0.00	$204.78	$729.21	$729.21	$0.00	$0.00	$204.75	$0.00	$581.15	$581.15	$0.00	$491.25	$778.14	$786.00	$0.00		$0.00	$153.76	$0.00	$0.00	$156.41	$0.00	$0.00	$0.00	$0.00	$0.00
1MTD202	SUP	Custom 27203010		1MTD202  -  DEVICE THYRPL 20CMX.4CMX.6MM VOCAL CORD SFT INERT NALRG	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2000-49	SUP	HCPCS C1877		2000-49  -  SHUNT CARDIO 9FR P-I CRTD OUTLYING T PORT 31CM STRL	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
200-120	SUP	Custom 27203010		200-120  -  KIT DIL .035IN 18GA 180CM GW INS NDL SCPL PCTV SHTH FLSH	BOTH IP/OP	$421.68 	$312.04	$0.00	$337.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.97	$312.97	$0.00	$0.00	$87.88	$0.00	$0.00	$0.00	$0.00	$210.84	$333.97	$337.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2240	SUP	Custom 27803010		2001-2240  -  INSERT ACETAB 10D 40MM 22MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2242	SUP	Custom 27803010		2001-2242  -  INSERT ACETAB 10D 42MM 22MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2244	SUP	Custom 27803010		2001-2244  -  INSERT ACETAB 10D 44MM 22MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2246	SUP	Custom 27803010		2001-2246  -  INSERT ACETAB 10D 46MM 22MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2248	SUP	Custom 27803010		2001-2248  -  INSERT ACETAB 10D 48MM 22MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2250	SUP	Custom 27803010		2001-2250  -  INSERT ACETAB 10D 50MM 22MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2252	SUP	Custom 27803010		2001-2252  -  INSERT ACETAB 10D 52MM 22MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2254	SUP	Custom 27803010		2001-2254  -  INSERT ACETAB 10D 54MM 22MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2256	SUP	Custom 27803010		2001-2256  -  INSERT ACETAB 10D 56MM 22MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2258	SUP	Custom 27803010		2001-2258  -  INSERT ACETAB 10D 58MM 22MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2261	SUP	Custom 27803010		2001-2261  -  INSERT ACETAB 10D 61MM 22MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2644	SUP	Custom 27803010		2001-2644  -  INSERT ACETAB 10D 44MM 26MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2646	SUP	Custom 27803010		2001-2646  -  INSERT ACETAB 10D 46MM 26MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2648	SUP	Custom 27803010		2001-2648  -  INSERT ACETAB 10D 48MM 26MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2650	SUP	Custom 27803010		2001-2650  -  INSERT ACETAB 10D 50MM 26MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2652	SUP	Custom 27803010		2001-2652  -  INSERT ACETAB 10D 52MM 26MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2654	SUP	Custom 27803010		2001-2654  -  INSERT ACETAB 10D 54MM 26MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2656	SUP	Custom 27803010		2001-2656  -  INSERT ACETAB 10D 56MM 26MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2658	SUP	Custom 27803010		2001-2658  -  INSERT ACETAB 10D 58MM 26MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2661	SUP	Custom 27803010		2001-2661  -  INSERT ACETAB 10D 61MM 26MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2844	SUP	Custom 27803010		2001-2844  -  INSERT ACETAB 10D 44MM 28MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2846	SUP	Custom 27803010		2001-2846  -  INSERT ACETAB 10D 46MM 28MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2848	SUP	Custom 27803010		2001-2848  -  INSERT ACETAB 10D 48MM 28MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2850	SUP	Custom 27803010		2001-2850  -  INSERT ACETAB 10D 50MM 28MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2852	SUP	Custom 27803010		2001-2852  -  INSERT ACETAB 10D 52MM 28MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2854	SUP	Custom 27803010		2001-2854  -  INSERT ACETAB 10D 54MM 28MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2856	SUP	Custom 27803010		2001-2856  -  INSERT ACETAB 10D 56MM 28MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2858	SUP	Custom 27803010		2001-2858  -  INSERT ACETAB 10D 58MM 28MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-2861	SUP	Custom 27803010		2001-2861  -  INSERT ACETAB 10D 61MM 28MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-3250	SUP	Custom 27803010		2001-3250  -  INSERT ACETAB 10D 50MM 32MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-3252	SUP	Custom 27803010		2001-3252  -  INSERT ACETAB 10D 52MM 32MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-3254	SUP	Custom 27803010		2001-3254  -  INSERT ACETAB 10D 54MM 32MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-3256	SUP	Custom 27803010		2001-3256  -  INSERT ACETAB 10D 56MM 32MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-3258	SUP	Custom 27803010		2001-3258  -  INSERT ACETAB 10D 58MM 32MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2001-3261	SUP	Custom 27803010		2001-3261  -  INSERT ACETAB 10D 61MM 32MM OMNIFIT HIP SERIES I	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2002-000	SUP	HCPCS C1729		2002-000  -  DRAIN INCISION SMALL STATURE 1 CHAMBER SUCTION CONTROL	BOTH IP/OP	$53.29 	$39.43	$0.00	$42.63	$28.94	$28.94	$0.00	$0.00	$0.00	$11.11	$39.55	$39.55	$0.00	$0.00	$11.11	$0.00	$31.52	$31.52	$0.00	$26.64	$42.21	$42.63	$0.00		$0.00	$8.34	$0.00	$0.00	$8.48	$0.00	$0.00	$0.00	$0.00	$0.00
20022 B-M	SUP	Custom 27803010		20022 B-M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$7,326.88 "	"$5,421.89"	$0.00	"$5,861.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,526.92"	$0.00	$0.00	$0.00	$0.00	"$3,663.44"	"$5,802.89"	"$5,861.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20026 A-H	SUP	Custom 27803010		20026 A-H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,543.75 "	"$1,142.38"	$0.00	"$1,235.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.77"	"$1,145.77"	$0.00	$0.00	$321.72	$0.00	$0.00	$0.00	$0.00	$771.88	"$1,222.65"	"$1,235.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20026 A-M	SUP	Custom 27803010		20026 A-M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,700.50 "	"$1,258.37"	$0.00	"$1,360.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,262.11"	"$1,262.11"	$0.00	$0.00	$354.38	$0.00	$0.00	$0.00	$0.00	$850.25	"$1,346.80"	"$1,360.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2003-01	SUP	Custom 27203010		2003-01  -  STABILIT FIRST FRACTURE KIT WITH POWERCURVE	BOTH IP/OP	"$7,000.00 "	"$5,180.00"	$0.00	"$5,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,458.80"	$0.00	$0.00	$0.00	$0.00	"$3,500.00"	"$5,544.00"	"$5,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20038 B	SUP	Custom 27803010		20038 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20038 C	SUP	Custom 27803010		20038 C  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20038 D	SUP	Custom 27803010		20038 D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,282.50 "	$949.05	$0.00	"$1,026.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$951.87	$951.87	$0.00	$0.00	$267.27	$0.00	$0.00	$0.00	$0.00	$641.25	"$1,015.74"	"$1,026.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20040 L	SUP	Custom 27203010		20040 L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,374.88 "	"$2,497.41"	$0.00	"$2,699.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,504.83"	"$2,504.83"	$0.00	$0.00	$703.32	$0.00	$0.00	$0.00	$0.00	"$1,687.44"	"$2,672.90"	"$2,699.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20040 M	SUP	Custom 27203010		20040 M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,374.88 "	"$2,497.41"	$0.00	"$2,699.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,504.83"	"$2,504.83"	$0.00	$0.00	$703.32	$0.00	$0.00	$0.00	$0.00	"$1,687.44"	"$2,672.90"	"$2,699.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20049 A-H	SUP	Custom 27803010		20049 A-H  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,615.00 "	"$1,195.10"	$0.00	"$1,292.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,198.65"	"$1,198.65"	$0.00	$0.00	$336.57	$0.00	$0.00	$0.00	$0.00	$807.50	"$1,279.08"	"$1,292.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20049 C-H	SUP	Custom 27803010		20049 C-H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,615.00 "	"$1,195.10"	$0.00	"$1,292.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,198.65"	"$1,198.65"	$0.00	$0.00	$336.57	$0.00	$0.00	$0.00	$0.00	$807.50	"$1,279.08"	"$1,292.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2240	SUP	Custom 27803010		2006-2240  -  INSERT ACETAB 40MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2242	SUP	Custom 27803010		2006-2242  -  INSERT ACETAB 42MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2244	SUP	Custom 27803010		2006-2244  -  INSERT ACETAB 20D 44MM 22MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2246	SUP	Custom 27803010		2006-2246  -  INSERT ACETAB 46MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2248	SUP	Custom 27803010		2006-2248  -  INSERT ACETAB 20D 48MM 22MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2250	SUP	Custom 27803010		2006-2250  -  INSERT ACETAB 50MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2252	SUP	Custom 27803010		2006-2252  -  INSERT ACETAB 20D 52MM 22MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2254	SUP	Custom 27803010		2006-2254  -  INSERT ACETAB 54MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2256	SUP	Custom 27803010		2006-2256  -  INSERT ACETAB 20D 56MM 22MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2258	SUP	Custom 27803010		2006-2258  -  INSERT ACETAB 58MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2261	SUP	Custom 27803010		2006-2261  -  INSERT ACETAB 20D 61MM 22MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2644	SUP	Custom 27803010		2006-2644  -  INSERT ACETAB 20D 44MM 26MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2646	SUP	Custom 27803010		2006-2646  -  INSERT ACETAB 46MM 26MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2648	SUP	Custom 27803010		2006-2648  -  INSERT ACETAB 20D 48MM 26MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2650	SUP	Custom 27803010		2006-2650  -  INSERT ACETAB 50MM 26MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2652	SUP	Custom 27803010		2006-2652  -  INSERT ACETAB 20D 52MM 26MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2654	SUP	Custom 27803010		2006-2654  -  INSERT ACETAB 54MM 26MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2656	SUP	Custom 27803010		2006-2656  -  INSERT ACETAB 20D 56MM 26MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2658	SUP	Custom 27803010		2006-2658  -  INSERT ACETAB 58MM 26MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2661	SUP	Custom 27803010		2006-2661  -  INSERT ACETAB 20D 61MM 26MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2846	SUP	Custom 27803010		2006-2846  -  INSERT ACETAB 46MM 28MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2848	SUP	Custom 27803010		2006-2848  -  INSERT ACETAB 20D 48MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2850	SUP	Custom 27803010		2006-2850  -  INSERT ACETAB 50MM 28MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2852	SUP	Custom 27803010		2006-2852  -  INSERT ACETAB 20D 52MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2854	SUP	Custom 27803010		2006-2854  -  INSERT ACETAB 54MM 28MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2856	SUP	Custom 27803010		2006-2856  -  INSERT ACETAB 20D 54MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2858	SUP	Custom 27803010		2006-2858  -  INSERT ACETAB 58MM 28MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-2861	SUP	Custom 27803010		2006-2861  -  INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-3250	SUP	Custom 27803010		2006-3250  -  INSERT ACETAB 50MM 32MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-3252	SUP	Custom 27803010		2006-3252  -  INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-3254	SUP	Custom 27803010		2006-3254  -  INSERT ACETAB 54MM 32MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-3256	SUP	Custom 27803010		2006-3256  -  INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-3258	SUP	Custom 27803010		2006-3258  -  INSERT ACETAB 58MM 32MM 20D HIP OMFT	BOTH IP/OP	"$1,925.63 "	"$1,424.97"	$0.00	"$1,540.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$401.30	$0.00	$0.00	$0.00	$0.00	$962.81	"$1,525.10"	"$1,540.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2006-3261	SUP	Custom 27803010		2006-3261  -  INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$2,002.50 "	"$1,481.85"	$0.00	"$1,602.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,486.26"	"$1,486.26"	$0.00	$0.00	$417.32	$0.00	$0.00	$0.00	$0.00	"$1,001.25"	"$1,585.98"	"$1,602.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2007-4-211	SUP	Custom 27203010		2007-4-211  -  VITALLIUM ALLERGY DISC	BOTH IP/OP	$60.13 	$44.50	$0.00	$48.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.62	$44.62	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$30.06	$47.62	$48.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2007-4-212	SUP	Custom 27203010		2007-4-212  -  TITANIUM ALLERGY DISC	BOTH IP/OP	$60.13 	$44.50	$0.00	$48.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.62	$44.62	$0.00	$0.00	$12.53	$0.00	$0.00	$0.00	$0.00	$30.06	$47.62	$48.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2008774-001	SUP	Custom 27203010		PROBE ORAL TEMP CLR CD TRB TMP THRMTR LF REUSE	BOTH IP/OP	$298.08 	$220.58	$0.00	$238.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.04	$236.08	$238.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.356.97	SUP	HCPCS C1713		201.356.97  -  SCREW BONE T6 LP 2MM 6MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.357.97	SUP	HCPCS C1713		201.357.97  -  SCREW BONE T6 LP 2MM 7MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.358.97	SUP	HCPCS C1713		201.358.97  -  SCREW BONE T6 LP 2MM 8MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.359.97	SUP	HCPCS C1713		201.359.97  -  SCREW BONE T6 LP 2MM 9MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.360.97	SUP	HCPCS C1713		201.360.97  -  SCREW BONE T6 LP 2MM 10MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.361.97	SUP	HCPCS C1713		201.361.97  -  SCREW BONE T6 LP 2MM 11MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.362.97	SUP	HCPCS C1713		201.362.97  -  SCREW BONE T6 LP 2MM 12MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.363.97	SUP	HCPCS C1713		201.363.97  -  SCREW BONE T6 LP 2MM 13MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.364.97	SUP	HCPCS C1713		201.364.97  -  SCREW BONE T6 LP 2MM 14MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.365.97	SUP	HCPCS C1713		201.365.97  -  SCREW BN T6 2MM 15MM ST SLF RTN STRDR SS CORT	BOTH IP/OP	$68.50 	$50.69	$0.00	$53.20	$29.93	$29.93	$0.00	$0.00	$0.00	$14.28	$50.84	$50.84	$0.00	$0.00	$14.28	$0.00	$40.52	$40.52	$0.00	$33.25	$52.67	$53.20	$0.00		$0.00	$10.11	$0.00	$0.00	$10.59	$0.00	$0.00	$0.00	$0.00	$0.00
201.366.97	SUP	HCPCS C1713		201.366.97  -  SCREW BONE T6 LP 2MM 16MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.368.97	SUP	HCPCS C1713		201.368.97  -  SCREW BONE T6 LP 2MM 18MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.370.97	SUP	HCPCS C1713		201.370.97  -  SCREW BONE T6 LP 2MM 20MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.372.97	SUP	HCPCS C1713		201.372.97  -  SCREW BONE T6 LP 2MM 22MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.374.97	SUP	HCPCS C1713		201.374.97  -  SCREW BONE T6 LP 2MM 24MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.375.97	SUP	HCPCS C1713		201.375.97  -  SCREW BONE T6 LP 2MM 26MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.376.97	SUP	HCPCS C1713		201.376.97  -  SCREW BONE T6 LP 2MM 28MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.377.97	SUP	HCPCS C1713		201.377.97  -  SCREW BONE T6 LP 2MM 30MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.378.97	SUP	HCPCS C1713		201.378.97  -  SCREW BONE T6 LP 2MM 32MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.379.97	SUP	HCPCS C1713		201.379.97  -  SCREW BONE T6 LP 2MM 34MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.380.97	SUP	HCPCS C1713		201.380.97  -  SCREW BONE T6 LP 2MM 36MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.381.97	SUP	HCPCS C1713		201.381.97  -  SCREW BONE T6 LP 2MM 38MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.382.97	SUP	HCPCS C1713		201.382.97  -  SCREW BONE T6 LP 2MM 40MM SELF TAP MODULAR STARDRIVE LCP	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
201.804.98	SUP	HCPCS C1713		201.804.98  -  SCREW BONE 2MM 3.5MM 4MM SLFTAP CRCIFRM RECESS STAINLESS	BOTH IP/OP	$119.38 	$88.34	$0.00	$95.50	$53.72	$53.72	$0.00	$0.00	$0.00	$24.88	$88.60	$88.60	$0.00	$0.00	$24.88	$0.00	$70.61	$70.61	$0.00	$59.69	$94.55	$95.50	$0.00		$0.00	$18.68	$0.00	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.806.98	SUP	HCPCS C1713		201.806.98  -  SCREW BONE 2MM 3.5MM 6MM SLFTAP CRCIFRM RECESS STAINLESS	BOTH IP/OP	$119.38 	$88.34	$0.00	$95.50	$53.72	$53.72	$0.00	$0.00	$0.00	$24.88	$88.60	$88.60	$0.00	$0.00	$24.88	$0.00	$70.61	$70.61	$0.00	$59.69	$94.55	$95.50	$0.00		$0.00	$18.68	$0.00	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.808.98	SUP	HCPCS C1713		201.808.98  -  SCREW BONE 2MM 3.5MM 8MM SLFTAP CRCIFRM RECESS STAINLESS	BOTH IP/OP	$119.38 	$88.34	$0.00	$95.50	$53.72	$53.72	$0.00	$0.00	$0.00	$24.88	$88.60	$88.60	$0.00	$0.00	$24.88	$0.00	$70.61	$70.61	$0.00	$59.69	$94.55	$95.50	$0.00		$0.00	$18.68	$0.00	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.810.98	SUP	HCPCS C1713		201.810.98  -  SCREW BONE 2MM 3.5MM 10MM SLFTAP CRCIFRM RECESS STAINLESS	BOTH IP/OP	$119.38 	$88.34	$0.00	$95.50	$53.72	$53.72	$0.00	$0.00	$0.00	$24.88	$88.60	$88.60	$0.00	$0.00	$24.88	$0.00	$70.61	$70.61	$0.00	$59.69	$94.55	$95.50	$0.00		$0.00	$18.68	$0.00	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.812.98	SUP	HCPCS C1713		201.812.98  -  SCREW BONE 2MM 3.5MM 12MM SLFTAP CRCIFRM RECESS STAINLESS	BOTH IP/OP	$119.38 	$88.34	$0.00	$95.50	$53.72	$53.72	$0.00	$0.00	$0.00	$24.88	$88.60	$88.60	$0.00	$0.00	$24.88	$0.00	$70.61	$70.61	$0.00	$59.69	$94.55	$95.50	$0.00		$0.00	$18.68	$0.00	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.814.98	SUP	HCPCS C1713		201.814.98  -  SCREW BONE 2MM 3.5MM 14MM SLFTAP CRCIFRM RECESS STAINLESS	BOTH IP/OP	$119.38 	$88.34	$0.00	$95.50	$53.72	$53.72	$0.00	$0.00	$0.00	$24.88	$88.60	$88.60	$0.00	$0.00	$24.88	$0.00	$70.61	$70.61	$0.00	$59.69	$94.55	$95.50	$0.00		$0.00	$18.68	$0.00	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$0.00
201.932E	SUP	HCPCS C1713		201.932E  -  SCREW BONE 12MM 2MM MAXFACL SS SLF DRILING IMF NONSTRL	BOTH IP/OP	$288.00 	$213.12	$0.00	$230.40	$129.60	$129.60	$0.00	$0.00	$0.00	$60.03	$213.75	$213.75	$0.00	$0.00	$60.02	$0.00	$170.35	$170.35	$0.00	$144.00	$228.10	$230.40	$0.00		$0.00	$45.07	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$0.00
2010-01	SUP	Custom 27203010		2010-01  -  LARYNGECTOMY PULMONARY KIT 9/36	BOTH IP/OP	$970.00 	$717.80	$0.00	$776.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$719.93	$719.93	$0.00	$0.00	$202.15	$0.00	$0.00	$0.00	$0.00	$485.00	$768.24	$776.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20100-190	SUP	HCPCS C1884		20100-190  -  SYSTEM EMBL PRTC .014IN 110UM 3.2FR 6FR 3.5-5.5MM 190CM F EZ	BOTH IP/OP	"$4,187.50 "	"$3,098.75"	$0.00	"$3,350.00"	"$1,884.38"	"$1,884.38"	$0.00	$0.00	$0.00	$872.78	"$3,107.96"	"$3,107.96"	$0.00	$0.00	$872.68	$0.00	"$2,064.44"	"$2,064.44"	$0.00	"$2,093.75"	"$3,316.50"	"$3,350.00"	$0.00		$0.00	$655.34	$0.00	$0.00	$666.65	$0.00	$0.00	$0.00	$0.00	$0.00
20-1226	SUP	Custom 27203010		20-1226  -  TUBE NASOGASTRIC 6FR 22IN 2 LUMEN Y PORT RADIOPQ STRIPE	BOTH IP/OP	$23.55 	$17.43	$0.00	$17.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.48	$17.48	$0.00	$0.00	$4.91	$0.00	$0.00	$0.00	$0.00	$10.31	$16.32	$16.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2012-320	SUP	HCPCS C1729		2012-320  -  DRAIN INCISION C220ML .25IN 1 COLLECT SUCTION CONTROL	BOTH IP/OP	$77.27 	$57.18	$0.00	$61.81	$41.96	$41.96	$0.00	$0.00	$0.00	$16.10	$57.35	$57.35	$0.00	$0.00	$16.10	$0.00	$45.70	$45.70	$0.00	$38.63	$61.20	$61.81	$0.00		$0.00	$12.09	$0.00	$0.00	$12.30	$0.00	$0.00	$0.00	$0.00	$0.00
20132-214	SUP	Custom 27203010		20132-214  -  PROBE ELECTROSURGICAL 2.3MM 220CM FLEXIBLE STR FIRE FIAPC	BOTH IP/OP	$547.38 	$405.06	$0.00	$437.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$406.26	$406.26	$0.00	$0.00	$114.07	$0.00	$0.00	$0.00	$0.00	$273.69	$433.52	$437.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20-1384KI	SUP	Custom 27203010		20-1384KI  -  KIT ESURG .75MM BYNT STRG 7.75IN STRL 3IN OLSN BP FCP SMTH	BOTH IP/OP	$118.41 	$87.62	$0.00	$94.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.88	$87.88	$0.00	$0.00	$24.68	$0.00	$0.00	$0.00	$0.00	$59.20	$93.78	$94.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
20-2050	SUP	Custom 27203010		20-2050  -  SEALANT DURA 5ML DURASEAL PG TRILYSINE AMINE	BOTH IP/OP	"$8,626.25 "	"$6,383.43"	$0.00	"$6,901.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,797.71"	$0.00	$0.00	$0.00	$0.00	"$4,313.13"	"$6,831.99"	"$6,901.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2020-6520-1	SUP	HCPCS C1713		2020-6520-1  -  SCREW BONE 6.5MM 20MM CANCELLOUS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2020-6525-1	SUP	HCPCS C1713		2020-6525-1  -  SCREW ACETAB 6.5MM 25MM PRIM HIP CANCELLOUS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2020-6530-1	SUP	HCPCS C1713		2020-6530-1  -  SCREW BONE 6.5MM 30MM CANCELLOUS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2020-6535-1	SUP	HCPCS C1713		2020-6535-1  -  SCREW ACETAB 6.5MM 35MM PRIM HIP CANCELLOUS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2020-6540-1	SUP	HCPCS C1713		2020-6540-1  -  SCREW ACETAB 6.5MM 40MM PRIM HIP CANCELLOUS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2020-6545-1	SUP	HCPCS C1713		2020-6545-1  -  SCREW ACETAB 6.5MM 45MM PRIM HIP CANCELLOUS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2020-6550-1	SUP	HCPCS C1713		2020-6550-1  -  SCREW ACETAB 6.5MM 50MM PRIM HIP CANCELLOUS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2020-6555-1	SUP	HCPCS C1713		2020-6555-1  -  SCREW ACETAB 6.5MM 55MM PRIM HIP CANCELLOUS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2020-6560-1	SUP	HCPCS C1713		2020-6560-1  -  SCREW ACETAB 6.5MM 60MM PRIM HIP CANCELLOUS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2028-4520-1	SUP	HCPCS C1713		2028-4520-1  -  SCREW BONE 4.5MM 20MM SECFIT X CANC	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
2028-4525-1	SUP	HCPCS C1713		2028-4525-1  -  SCREW BONE 4.5MM 25MM SECFIT X CANC	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
2028-4530-1	SUP	HCPCS C1713		2028-4530-1  -  SCREW BONE 4.5MM 30MM SECFIT X CANC	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
2028-4535	SUP	HCPCS C1713		2028-4535  -  S-FIT X-TRA BN SCRW 4.5 MM	BOTH IP/OP	$127.00 	$93.98	$0.00	$101.60	$57.15	$57.15	$0.00	$0.00	$0.00	$26.47	$94.26	$94.26	$0.00	$0.00	$26.47	$0.00	$75.12	$75.12	$0.00	$63.50	$100.58	$101.60	$0.00		$0.00	$19.88	$0.00	$0.00	$20.22	$0.00	$0.00	$0.00	$0.00	$0.00
2028-4535-1	SUP	HCPCS C1713		2028-4535-1  -  SCREW BONE 4.5MM 35MM SECFIT X CANC	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
2028-4540-1	SUP	HCPCS C1713		2028-4540-1  -  SCREW BONE 4.5MM 40MM SECFIT X CANC	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
2028-4545-1	SUP	HCPCS C1713		2028-4545-1  -  SCREW BONE 4.5MM 45MM SECFIT X CANC	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
2028-4550-1	SUP	HCPCS C1713		2028-4550-1  -  SCREW BONE 4.5MM 50MM SECFIT X CANC	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
2028-4555-1	SUP	HCPCS C1713		2028-4555-1  -  SCREW BONE 4.5MM 55MM SECFIT X CANC	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
2028-4560-1	SUP	HCPCS C1713		2028-4560-1  -  SCREW BONE 4.5MM 60MM SECFIT X CANC	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
2029-5515-1	SUP	HCPCS C1713		2029-5515-1  -  SCREW BONE 5.5MM 15MM CANCELLOUS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2029-5520-1	SUP	HCPCS C1713		2029-5520-1  -  SCREW ACETAB 5.5MM 20MM SECFIT TRIDENT TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2029-5525-1	SUP	HCPCS C1713		2029-5525-1  -  SCREW ACETAB 5.5MM 25MM SECFIT TRIDENT TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2029-5530-1	SUP	HCPCS C1713		2029-5530-1  -  SCREW ACETAB 5.5MM 30MM SECFIT TRIDENT TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2029-5535-1	SUP	HCPCS C1713		2029-5535-1  -  SCREW ACETAB 5.5MM 35MM SECFIT TRIDENT TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2029-5540-1	SUP	HCPCS C1713		2029-5540-1  -  SCREW ACETAB 5.5MM 40MM SECFIT TRIDENT TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2029-5545-1	SUP	HCPCS C1713		2029-5545-1  -  SCREW ACETAB 5.5MM 45MM SECFIT TRIDENT TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2029-5550-1	SUP	HCPCS C1713		2029-5550-1  -  SCREW ACETAB 5.5MM 50MM SECFIT TRIDENT TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2029-5555-1	SUP	HCPCS C1713		2029-5555-1  -  SCREW ACETAB 5.5MM 55MM SECFIT TRIDENT TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2029-5560-1	SUP	HCPCS C1713		2029-5560-1  -  SCREW ACETAB 5.5MM 60MM SECFIT TRIDENT TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2030-1125S	SUP	HCPCS C1713		2030-1125S  -  NAIL 300MM HIP GAMMA3 IM R2 LNG STRL STSCR	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2030-1130S	SUP	HCPCS C1713		2030-1130S  -  NAIL 11MM 30CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2030-1135S	SUP	HCPCS C1713		2030-1135S  -  NAIL 11MM 300MM RIGHT GAMA IM 135D R2 LNG LCK STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2030-1330S	SUP	HCPCS C1713		2030-1330S  -  NAIL 300MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
203-060-200	SUP	HCPCS C1769		203-060-200  -  GUILDWIRE X PEION -142	BOTH IP/OP	$657.50 	$486.55	$0.00	$526.00	$357.02	$357.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.75	$520.74	$526.00	$0.00		$0.00	$102.90	$0.00	$0.00	$104.67	$0.00	$0.00	$0.00	$0.00	$0.00
2030-6516-1	SUP	HCPCS C1713		2030-6516-1  -  SCREW BN 6.5MM 16MM NS TX TI ACTB CANC	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2030-6520-1	SUP	HCPCS C1713		2030-6520-1  -  SCREW BN 6.5MM 20MM NS TX TI ACTB CANC	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2030-6525-1	SUP	HCPCS C1713		2030-6525-1  -  SCREW ACETAB 6.5MM 25MM SECFIT TRIDENT TITANIUM CANCELLOUS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2030-6530-1	SUP	HCPCS C1713		2030-6530-1  -  SCREW BONE 6.5MM 30MM TRIDENT SECFIT TORX TITANIUM ACETAB	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2030-6535-1	SUP	HCPCS C1713		2030-6535-1  -  SCREW BN 6.5MM 35MM NS TX TI ACTB CANC	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2030-6540-1	SUP	HCPCS C1713		2030-6540-1  -  SCREW BN 6.5MM 40MM NS TX TI ACTB CANC	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2030-6545-1	SUP	HCPCS C1713		2030-6545-1  -  SCREW BN 6.5MM 45MM NS TX TI ACTB CANC	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2030-6550-1	SUP	HCPCS C1713		2030-6550-1  -  SCREW BONE HEMISPHERE 6.5MM 50MM TRIDENT TITANIUM ACETAB	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2030-6555-1	SUP	HCPCS C1713		2030-6555-1  -  SCREW BONE HEMISPHERE 6.5MM 55MM TRIDENT TITANIUM ACETAB	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2030-6560-1	SUP	HCPCS C1713		2030-6560-1  -  SCREW BONE HEMISPHERE 6.5MM 60MM TRIDENT TITANIUM ACETAB	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
2032-1125S	SUP	HCPCS C1713		2032-1125S  -  NAIL 320MM HIP RIGHT GAMMA3 IM R2 LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2032-1130S	SUP	HCPCS C1713		2032-1130S  -  NAIL 11MM 32CM RIGHT FEM GAMA IM 130D LNG KIT STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2032-1135S	SUP	HCPCS C1713		2032-1135S  -  NAIL 11MM 320MM HIP RIGHT GAMMA3 IM 135D LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2032-1330S	SUP	HCPCS C1713		2032-1330S  -  NAIL 13MM 32CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2034-1125S	SUP	HCPCS C1713		2034-1125S  -  NAIL 11MM 340MM HIP RIGHT GAMMA3 IM 125D LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2034-1130S	SUP	HCPCS C1713		2034-1130S  -  NAIL 11MM 34CM RIGHT FEM GAMA IM 130D LNG KIT TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2034-1135S	SUP	HCPCS C1713		2034-1135S  -  NAIL 11MM 340MM RIGHT GAMA IM 135D LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2034-1330S	SUP	HCPCS C1713		2034-1330S  -  NAIL 13MM 34CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2036-1125S	SUP	HCPCS C1713		2036-1125S  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 125D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2036-1130S	SUP	HCPCS C1713		2036-1130S  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2036-1135S	SUP	HCPCS C1713		2036-1135S  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 135D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2036-1330S	SUP	HCPCS C1713		2036-1330S  -  NAIL 13MM 36CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2038-1125S	SUP	HCPCS C1713		2038-1125S  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2038-1130S	SUP	HCPCS C1713		2038-1130S  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2038-1135S	SUP	HCPCS C1713		2038-1135S  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 135D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2038-1330S	SUP	HCPCS C1713		2038-1330S  -  NAIL 13MM 38CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2040-1125S	SUP	HCPCS C1713		2040-1125S  -  NAIL 400MM HIP LEFT GAMMA3 IM R2 LNG STRL STSCR	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2040-1130S	SUP	HCPCS C1713		2040-1130S  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2040-1135S	SUP	HCPCS C1713		2040-1135S  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 135D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2040-1330S	SUP	HCPCS C1713		2040-1330S  -  NAIL 400MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2240	SUP	Custom 27803010		2041-2240  -  INSERT ACETAB 40MM 22MM 10D HIP S2 OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2242	SUP	Custom 27803010		2041-2242  -  INSERT ACETAB 42MM 22MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2246	SUP	Custom 27803010		2041-2246  -  INSERT ACETAB 46MM 22MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2250	SUP	Custom 27803010		2041-2250  -  INSERT ACETAB 50MM 22MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2254	SUP	Custom 27803010		2041-2254  -  INSERT ACETAB 54MM 22MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2258	SUP	Custom 27803010		2041-2258  -  INSERT ACETAB 58MM 22MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2262	SUP	Custom 27803010		2041-2262  -  INSERT ACETAB 62MM 22MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2266	SUP	Custom 27803010		2041-2266  -  INSERT ACETAB 66MM 22MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2270	SUP	Custom 27803010		2041-2270  -  INSERT ACETAB 70MM 22MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2274	SUP	Custom 27803010		2041-2274  -  INSERT ACETAB 74MM 22MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2642	SUP	Custom 27803010		2041-2642  -  INSERT ACETAB 42MM 26MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2646	SUP	Custom 27803010		2041-2646  -  INSERT ACETAB 46MM 26MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2650	SUP	Custom 27803010		2041-2650  -  INSERT ACETAB 50-52MM 26MM 10D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2654	SUP	Custom 27803010		2041-2654  -  INSERT ACETAB 54-56MM 26MM 10D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2658	SUP	Custom 27803010		2041-2658  -  INSERT ACETAB 58MM 26MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2662	SUP	Custom 27803010		2041-2662  -  INSERT ACETAB 62MM 26MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2666	SUP	Custom 27803010		2041-2666  -  INSERT ACETAB 66MM 26MM -10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2670	SUP	Custom 27803010		2041-2670  -  INSERT ACETAB 70MM 26MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2674	SUP	Custom 27803010		2041-2674  -  INSERT ACETAB 74MM 26MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2846	SUP	Custom 27803010		2041-2846  -  INSERT ACETAB 46MM 28MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2850	SUP	Custom 27803010		2041-2850  -  INSERT ACETAB 50MM 28MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2854	SUP	Custom 27803010		2041-2854  -  INSERT ACETAB 55-56MM 28MM 10D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2858	SUP	Custom 27803010		2041-2858  -  INSERT ACETAB 58MM 28MM 10D HIP S2 OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2862	SUP	Custom 27803010		2041-2862  -  INSERT ACETAB 62MM 28MM 10D HIP S2 OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2866	SUP	Custom 27803010		2041-2866  -  INSERT ACETAB 66MM 28MM -10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2870	SUP	Custom 27803010		2041-2870  -  INSERT ACETAB 70MM 28MM -10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-2874	SUP	Custom 27803010		2041-2874  -  INSERT ACETAB 74MM 28MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-3250	SUP	Custom 27803010		2041-3250  -  INSERT ACETAB 10D 50-52MM 32MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-3254	SUP	Custom 27803010		2041-3254  -  INSERT ACETAB 10D 54MM 32MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-3258	SUP	Custom 27803010		2041-3258  -  INSERT ACETAB 58MM 32MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-3262	SUP	Custom 27803010		2041-3262  -  INSERT ACETAB 62MM 32MM 10D HIP S2 OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-3266	SUP	Custom 27803010		2041-3266  -  INSERT ACETAB 66MM 32MM -10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-3270	SUP	Custom 27803010		2041-3270  -  INSERT ACETAB 70MM 32MM -10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-3274	SUP	Custom 27803010		2041-3274  -  INSERT ACETAB 74MM 32MM 10D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2244	SUP	Custom 27803010		2041C-2244  -  INSERT ACETAB 10D 44MM 22MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2248	SUP	Custom 27803010		2041C-2248  -  INSERT ACETAB 10D 48MM 22MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2252	SUP	Custom 27803010		2041C-2252  -  INSERT ACETAB 10D 52MM 22MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2256	SUP	Custom 27803010		2041C-2256  -  INSERT ACETAB 10D 56MM 22MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2642	SUP	Custom 27803010		2041C-2642  -  INSERT ACETAB 26MM 10D HIP S2 XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2646	SUP	Custom 27803010		2041C-2646  -  INSERT ACETAB 10D 46MM 26MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2648	SUP	Custom 27803010		2041C-2648  -  INSERT ACETAB 10D 48MM 26MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2650	SUP	Custom 27803010		2041C-2650  -  INSERT ACETAB 10D 50MM 26MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2652	SUP	Custom 27803010		2041C-2652  -  INSERT ACETAB 10D 52MM 26MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2654	SUP	Custom 27803010		2041C-2654  -  INSERT ACETAB 10D 54MM 26MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2656	SUP	Custom 27803010		2041C-2656  -  INSERT ACETAB 10D 56MM 26MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2658	SUP	Custom 27803010		2041C-2658  -  INSERT ACETAB 10D 58MM 26MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2662	SUP	Custom 27803010		2041C-2662  -  INSERT ACETAB 10D 62MM 26MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2846	SUP	Custom 27803010		2041C-2846  -  INSERT ACETAB 10D 46MM 28MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2848	SUP	Custom 27803010		2041C-2848  -  INSERT ACETAB 10D 48MM 28MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2850	SUP	Custom 27803010		2041C-2850  -  INSERT ACETAB 10D 50MM 28MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2852	SUP	Custom 27803010		2041C-2852  -  INSERT ACETAB 10D 52MM 28MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2854	SUP	Custom 27803010		2041C-2854  -  INSERT ACETAB 10D 54-56MM 28MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2856	SUP	Custom 27803010		2041C-2856  -  INSERT ACETAB 10D 56MM 28MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2858	SUP	Custom 27803010		2041C-2858  -  INSERT ACETAB 10D 58MM 28MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-2862	SUP	Custom 27803010		2041C-2862  -  INSERT ACETAB 10D 62-72MM 28MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-3250	SUP	Custom 27803010		2041C-3250  -  INSERT ACETAB 10D 50-52MM 32MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-3254	SUP	Custom 27803010		2041C-3254  -  INSERT ACETAB 10D 54MM 32MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-3256	SUP	Custom 27803010		2041C-3256  -  INSERT ACETAB 10D 56MM 32MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-3258	SUP	Custom 27803010		2041C-3258  -  INSERT ACETAB 10D 58-60MM 32MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-3262	SUP	Custom 27803010		2041C-3262  -  INSERT ACETAB 10D 62MM 32MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-3266	SUP	Custom 27803010		2041C-3266  -  INSERT ACETAB 10D 66MM 32MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-3270	SUP	Custom 27803010		2041C-3270  -  INSERT ACETAB 10D 70MM 32MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041C-3274	SUP	Custom 27803010		2041C-3274  -  INSERT ACETAB 10D 74MM 32MM XFIRE HIP SERIES II	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-H-228	SUP	Custom 27803010		2041-H-228  -  LINER ACETAB 46-48MM 28MM HIP S2 CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041J-2246	SUP	Custom 27803010		2041J-2246  -  INSERT ACETAB 10D S2 OMFT	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-N-228	SUP	Custom 27803010		2041-N-228  -  LINER ACETAB 46-48MM 28MM HIP S2 CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2041-N-532	SUP	Custom 27803010		2041-N-532  -  LINER ACETAB 58-60MM 32MM HIP S2 CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-1125S	SUP	HCPCS C1713		2042-1125S  -  NAIL 11MM 42CM HIP RIGHT FEM GAMMA3 IM 125D LNG TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2042-1130S	SUP	HCPCS C1713		2042-1130S  -  NAIL 11MM 420MM RIGHT FEM GAMA IM 130D R2 LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2042-1135S	SUP	HCPCS C1713		2042-1135S  -  NAIL 11MM 420MM HIP RIGHT GAMMA3 IM 135D LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2042-1330S	SUP	HCPCS C1713		2042-1330S  -  NAIL 13MM 42CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2240	SUP	Custom 27803010		2042-2240  -  INSERT ACETAB 20D 40MM 22MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2242	SUP	Custom 27803010		2042-2242  -  INSERT ACETAB 42MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2246	SUP	Custom 27803010		2042-2246  -  INSERT ACETAB 46MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2250	SUP	Custom 27803010		2042-2250  -  INSERT ACETAB 20D 50MM 22MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2254	SUP	Custom 27803010		2042-2254  -  INSERT ACETAB 54MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2258	SUP	Custom 27803010		2042-2258  -  INSERT ACETAB 58MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2262	SUP	Custom 27803010		2042-2262  -  INSERT ACETAB 62MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2266	SUP	Custom 27803010		2042-2266  -  INSERT ACETAB 66MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2270	SUP	Custom 27803010		2042-2270  -  INSERT ACETAB 70MM 22MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2274	SUP	Custom 27803010		2042-2274  -  INSERT ACETAB 20D 74MM 22MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2642	SUP	Custom 27803010		2042-2642  -  INSERT ACETAB 20D 42MM 26MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2646	SUP	Custom 27803010		2042-2646  -  INSERT ACETAB 46MM 26MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2650	SUP	Custom 27803010		2042-2650  -  INSERT ACETAB 20D 50MM 26MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2654	SUP	Custom 27803010		2042-2654  -  INSERT ACETAB 20D 54MM 26MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2658	SUP	Custom 27803010		2042-2658  -  INSERT ACETAB 58MM 26MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2662	SUP	Custom 27803010		2042-2662  -  INSERT ACETAB 62MM 26MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2666	SUP	Custom 27803010		2042-2666  -  INSERT ACETAB 66MM 26MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2670	SUP	Custom 27803010		2042-2670  -  INSERT ACETAB 70MM 26MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2674	SUP	Custom 27803010		2042-2674  -  INSERT ACETAB 74MM 26MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2846	SUP	Custom 27803010		2042-2846  -  INSERT ACETAB 20D 46MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2850	SUP	Custom 27803010		2042-2850  -  INSERT ACETAB 20D 50MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2854	SUP	Custom 27803010		2042-2854  -  INSERT ACETAB 20D 54MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2858	SUP	Custom 27803010		2042-2858  -  INSERT ACETAB 20D 58MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2862	SUP	Custom 27803010		2042-2862  -  INSERT ACETAB 20D 62-72MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2866	SUP	Custom 27803010		2042-2866  -  INSERT ACETAB 20D 66MM 28MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2870	SUP	Custom 27803010		2042-2870  -  INSERT ACETAB 70MM 28MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-2874	SUP	Custom 27803010		2042-2874  -  INSERT ACETAB 74MM 28MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-3250	SUP	Custom 27803010		2042-3250  -  INSERT ACETAB 20D 50MM 32MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-3254	SUP	Custom 27803010		2042-3254  -  INSERT ACETAB 20D 54MM 32MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-3258	SUP	Custom 27803010		2042-3258  -  INSERT ACETAB 20D 58-60MM 32MM OMNIFIT HIP	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-3262	SUP	Custom 27803010		2042-3262  -  INSERT ACETAB 20D 62MM 32MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-3266	SUP	Custom 27803010		2042-3266  -  INSERT ACETAB 20D 66MM 32MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-3270	SUP	Custom 27803010		2042-3270  -  INSERT ACETAB 20D 70MM 32MM OMNIFIT HIP SERIES II	BOTH IP/OP	"$1,767.50 "	"$1,307.95"	$0.00	"$1,414.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.84"	"$1,311.84"	$0.00	$0.00	$368.35	$0.00	$0.00	$0.00	$0.00	$883.75	"$1,399.86"	"$1,414.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042-3274	SUP	Custom 27803010		2042-3274  -  INSERT ACETAB 74MM 32MM 20D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042C-2244	SUP	Custom 27803010		2042C-2244  -  INSERT ACETAB 22MM 20D HIP XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042C-2248	SUP	Custom 27803010		2042C-2248  -  INSERT ACETAB 22MM 20D HIP XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042C-2252	SUP	Custom 27803010		2042C-2252  -  INSERT ACETAB 22MM 20D HIP XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042C-2256	SUP	Custom 27803010		2042C-2256  -  INSERT ACETAB 22MM 20D HIP XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042C-2648	SUP	Custom 27803010		2042C-2648  -  INSERT ACETAB 26MM 20D HIP XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042C-2652	SUP	Custom 27803010		2042C-2652  -  INSERT ACETAB 26MM 20D HIP XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042C-2656	SUP	Custom 27803010		2042C-2656  -  INSERT ACETAB 26MM 20D HIP XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042C-2848	SUP	Custom 27803010		2042C-2848  -  INSERT ACETAB 28MM 20D HIP XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042C-2852	SUP	Custom 27803010		2042C-2852  -  INSERT ACETAB 28MM 20D HIP XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042C-2856	SUP	Custom 27803010		2042C-2856  -  INSERT ACETAB 56MM 28MM 20D HIP XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2042C-3256	SUP	Custom 27803010		2042C-3256  -  INSERT ACETAB 56MM 32MM 20D HIP XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2240	SUP	Custom 27803010		2043-2240  -  INSERT ACETAB 40MM 22MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2242	SUP	Custom 27803010		2043-2242  -  INSERT ACETAB 42MM 22MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2246	SUP	Custom 27803010		2043-2246  -  INSERT ACETAB 46-48MM 22MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2250	SUP	Custom 27803010		2043-2250  -  INSERT ACETAB 50-52MM 22MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2254	SUP	Custom 27803010		2043-2254  -  INSERT ACETAB 54-56MM 22MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2258	SUP	Custom 27803010		2043-2258  -  INSERT ACETAB 58-60MM 22MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2262	SUP	Custom 27803010		2043-2262  -  INSERT ACETAB 62-72MM 22MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2266	SUP	Custom 27803010		2043-2266  -  INSERT ACETAB 66MM 22MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2270	SUP	Custom 27803010		2043-2270  -  INSERT ACETAB 70MM 22MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2274	SUP	Custom 27803010		2043-2274  -  INSERT ACETAB 74MM 22MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2642	SUP	Custom 27803010		2043-2642  -  INSERT ACETAB 42MM 26MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2646	SUP	Custom 27803010		2043-2646  -  INSERT ACETAB 46-48MM 26MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2650	SUP	Custom 27803010		2043-2650  -  INSERT ACETAB 50-52MM 26MM 0D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2654	SUP	Custom 27803010		2043-2654  -  INSERT ACETAB 54-56MM 26MM 0D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2658	SUP	Custom 27803010		2043-2658  -  INSERT ACETAB 58MM ID 26MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2662	SUP	Custom 27803010		2043-2662  -  INSERT ACETAB 62-72MM 26MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2666	SUP	Custom 27803010		2043-2666  -  INSERT ACETAB 66MM 26MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2670	SUP	Custom 27803010		2043-2670  -  INSERT ACETAB 70MM 26MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2674	SUP	Custom 27803010		2043-2674  -  INSERT ACETAB 74MM 26MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2846	SUP	Custom 27803010		2043-2846  -  INSERT ACETAB 46-48MM 28MM 0D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2850	SUP	Custom 27803010		2043-2850  -  INSERT ACETAB 50-52MM 28MM 0D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2854	SUP	Custom 27803010		2043-2854  -  INSERT ACETAB 54-56MM 28MM 0D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2858	SUP	Custom 27803010		2043-2858  -  INSERT ACETAB 58-60MM 28MM 0D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2862	SUP	Custom 27803010		2043-2862  -  INSERT ACETAB 62-72MM 28MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2866	SUP	Custom 27803010		2043-2866  -  INSERT ACETAB 66MM 28MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2870	SUP	Custom 27803010		2043-2870  -  INSERT ACETAB 70MM 28MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-2874	SUP	Custom 27803010		2043-2874  -  INSERT ACETAB 74MM 28MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-3246	SUP	Custom 27803010		2043-3246  -  INSERT ACETAB 46-48MM 32MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-3250	SUP	Custom 27803010		2043-3250  -  INSERT ACETAB 50-52MM 32MM 0D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-3254	SUP	Custom 27803010		2043-3254  -  INSERT ACETAB 54-56MM 32MM 0D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-3258	SUP	Custom 27803010		2043-3258  -  INSERT ACETAB 58-60MM 32MM 0D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-3262	SUP	Custom 27803010		2043-3262  -  INSERT ACETAB 62-70MM 32MM 0D HIP S2 UHMWPE OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-3266	SUP	Custom 27803010		2043-3266  -  INSERT ACETAB 66MM 32MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-3270	SUP	Custom 27803010		2043-3270  -  INSERT ACETAB 70MM 32MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043-3274	SUP	Custom 27803010		2043-3274  -  INSERT ACETAB 74MM 32MM 0D HIP OMFT	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-2642	SUP	Custom 27803010		2043C-2642  -  INSERT ACETAB 42MM 26MM 0D HIP S2 XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-2646	SUP	Custom 27803010		2043C-2646  -  INSERT ACETAB 46MM 26MM 0D HIP S2 XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-2650	SUP	Custom 27803010		2043C-2650  -  INSERT ACETAB 26MM 0D HIP S2 XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-2654	SUP	Custom 27803010		2043C-2654  -  INSERT ACETAB 26MM 0D HIP S2 XFIRE	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$0.00	$0.00	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-2846	SUP	Custom 27803010		2043C-2846  -  INSERT ACETAB 0D 46MM 28MM XFIRE HIP	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-2850	SUP	Custom 27803010		2043C-2850  -  INSERT ACETAB 0D 50-52MM 28MM SERIES II XFIRE HIP	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-2854	SUP	Custom 27803010		2043C-2854  -  INSERT ACETAB 0D 54-56MM 28MM 11.4MM SERIES II OMNIFIT XFIRE	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-2858	SUP	Custom 27803010		2043C-2858  -  INSERT ACETAB 0D 58-60MM 28MM SERIES II XFIRE HIP	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-2862	SUP	Custom 27803010		2043C-2862  -  INSERT ACETAB 0D 62-72MM 28MM SERIES II XFIRE HIP	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-2866	SUP	Custom 27803010		2043C-2866  -  INSERT ACETAB 0D 66MM 28MM XFIRE HIP	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-3250	SUP	Custom 27803010		2043C-3250  -  INSERT ACETAB 0D 50MM 32MM XFIRE HIP	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-3254	SUP	Custom 27803010		2043C-3254  -  INSERT ACETAB 0D 32MM LINER XFIRE HIP	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-3258	SUP	Custom 27803010		2043C-3258  -  INSERT ACETAB 0D 58-60MM 32MM SERIES II XFIRE HIP	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-3262	SUP	Custom 27803010		2043C-3262  -  INSERT ACETAB 10D 62MM 32MM XFIRE HIP	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-3266	SUP	Custom 27803010		2043C-3266  -  INSERT ACETAB 0D 66MM 32MM XFIRE HIP	BOTH IP/OP	"$2,397.50 "	"$1,774.15"	$0.00	"$1,918.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.42"	"$1,779.42"	$0.00	$0.00	$499.64	$0.00	$0.00	$0.00	$0.00	"$1,198.75"	"$1,898.82"	"$1,918.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-3270	SUP	Custom 27803010		2043C-3270  -  INSERT ACETAB 0D 70MM 32MM XFIRE HIP	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2043C-3274	SUP	Custom 27803010		2043C-3274  -  INSERT ACETAB 0D 74MM 32MM XFIRE HIP	BOTH IP/OP	"$2,720.00 "	"$2,012.80"	$0.00	"$2,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.78"	"$2,018.78"	$0.00	$0.00	$566.85	$0.00	$0.00	$0.00	$0.00	"$1,360.00"	"$2,154.24"	"$2,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2044-1125S	SUP	HCPCS C1713		2044-1125S  -  NAIL 440MM HIP RIGHT GAMMA3 IM R2 LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2044-1130S	SUP	HCPCS C1713		2044-1130S  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 130D LNG TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2044-1135S	SUP	HCPCS C1713		2044-1135S  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2044-1330S	SUP	HCPCS C1713		2044-1330S  -  NAIL 440MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2040	SUP	Custom 27803010		2050-2040  -  SHELL ACETAB 40MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2040CS	SUP	Custom 27803010		2050-2040CS  -  SHELL ACETAB 40MM HIP SECFIT PSL	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2042	SUP	Custom 27803010		2050-2042  -  SHELL ACETAB 42MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2042CS	SUP	Custom 27803010		2050-2042CS  -  SHELL ACETAB 42MM HIP SECFIT PSL	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2044	SUP	Custom 27803010		2050-2044  -  SHELL ACETAB 44MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2044CS	SUP	Custom 27803010		2050-2044CS  -  SHELL ACETAB 44MM HIP SECFIT PSL	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2046	SUP	Custom 27803010		2050-2046  -  SHELL ACETAB 46MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,377.00 "	"$1,758.98"	$0.00	"$1,901.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,764.21"	"$1,764.21"	$0.00	$0.00	$495.37	$0.00	$0.00	$0.00	$0.00	"$1,188.50"	"$1,882.58"	"$1,901.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2048	SUP	Custom 27803010		2050-2048  -  SHELL ACETAB 48MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,377.00 "	"$1,758.98"	$0.00	"$1,901.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,764.21"	"$1,764.21"	$0.00	$0.00	$495.37	$0.00	$0.00	$0.00	$0.00	"$1,188.50"	"$1,882.58"	"$1,901.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2050	SUP	Custom 27803010		2050-2050  -  SHELL ACETAB 50MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,377.00 "	"$1,758.98"	$0.00	"$1,901.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,764.21"	"$1,764.21"	$0.00	$0.00	$495.37	$0.00	$0.00	$0.00	$0.00	"$1,188.50"	"$1,882.58"	"$1,901.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2052	SUP	Custom 27803010		2050-2052  -  SHELL ACETAB 52MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,377.00 "	"$1,758.98"	$0.00	"$1,901.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,764.21"	"$1,764.21"	$0.00	$0.00	$495.37	$0.00	$0.00	$0.00	$0.00	"$1,188.50"	"$1,882.58"	"$1,901.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2054	SUP	Custom 27803010		2050-2054  -  SHELL ACETAB 54MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,377.00 "	"$1,758.98"	$0.00	"$1,901.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,764.21"	"$1,764.21"	$0.00	$0.00	$495.37	$0.00	$0.00	$0.00	$0.00	"$1,188.50"	"$1,882.58"	"$1,901.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2056	SUP	Custom 27803010		2050-2056  -  SHELL ACETAB 56MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,377.00 "	"$1,758.98"	$0.00	"$1,901.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,764.21"	"$1,764.21"	$0.00	$0.00	$495.37	$0.00	$0.00	$0.00	$0.00	"$1,188.50"	"$1,882.58"	"$1,901.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2058	SUP	Custom 27803010		2050-2058  -  SHELL ACETAB 58MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,377.00 "	"$1,758.98"	$0.00	"$1,901.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,764.21"	"$1,764.21"	$0.00	$0.00	$495.37	$0.00	$0.00	$0.00	$0.00	"$1,188.50"	"$1,882.58"	"$1,901.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2060	SUP	Custom 27803010		2050-2060  -  SHELL ACETAB 60MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,377.00 "	"$1,758.98"	$0.00	"$1,901.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,764.21"	"$1,764.21"	$0.00	$0.00	$495.37	$0.00	$0.00	$0.00	$0.00	"$1,188.50"	"$1,882.58"	"$1,901.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2062	SUP	Custom 27803010		2050-2062  -  SHELL ACETAB 62MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,377.00 "	"$1,758.98"	$0.00	"$1,901.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,764.21"	"$1,764.21"	$0.00	$0.00	$495.37	$0.00	$0.00	$0.00	$0.00	"$1,188.50"	"$1,882.58"	"$1,901.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2064	SUP	Custom 27803010		2050-2064  -  SHELL ACETAB HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,377.00 "	"$1,758.98"	$0.00	"$1,901.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,764.21"	"$1,764.21"	$0.00	$0.00	$495.37	$0.00	$0.00	$0.00	$0.00	"$1,188.50"	"$1,882.58"	"$1,901.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2066	SUP	Custom 27803010		2050-2066  -  SHELL ACETAB 66MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2068	SUP	Custom 27803010		2050-2068  -  SHELL ACETAB 68MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2070	SUP	Custom 27803010		2050-2070  -  SHELL ACETAB 70MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-2072	SUP	Custom 27803010		2050-2072  -  SHELL ACETAB 72MM HIP CLSHOLE SECFIT PSL	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3040	SUP	Custom 27803010		2050-3040  -  SHELL ACETAB 40MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3042	SUP	Custom 27803010		2050-3042  -  SHELL ACETAB 42MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3044	SUP	Custom 27803010		2050-3044  -  SHELL ACETAB 44MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3046	SUP	Custom 27803010		2050-3046  -  SHELL ACETAB 46MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3048	SUP	Custom 27803010		2050-3048  -  SHELL ACETAB 48MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3050	SUP	Custom 27803010		2050-3050  -  SHELL ACETAB 50MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3052	SUP	Custom 27803010		2050-3052  -  SHELL ACETAB 52MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3054	SUP	Custom 27803010		2050-3054  -  SHELL ACETAB 54MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3056	SUP	Custom 27803010		2050-3056  -  SHELL ACETAB 56MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3058	SUP	Custom 27803010		2050-3058  -  SHELL ACETAB 58MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3060	SUP	Custom 27803010		2050-3060  -  SHELL ACETAB 60MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3062	SUP	Custom 27803010		2050-3062  -  SHELL ACETAB 62MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3064	SUP	Custom 27803010		2050-3064  -  SHELL ACETAB 64MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3066	SUP	Custom 27803010		2050-3066  -  SHELL ACETAB 66MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3068	SUP	Custom 27803010		2050-3068  -  SHELL ACETAB 68MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3070	SUP	Custom 27803010		2050-3070  -  SHELL ACETAB 70MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-3072	SUP	Custom 27803010		2050-3072  -  SHELL ACETAB 72MM HIP SCRLES SECFIT PSL	BOTH IP/OP	"$2,505.00 "	"$1,853.70"	$0.00	"$2,004.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.21"	"$1,859.21"	$0.00	$0.00	$522.04	$0.00	$0.00	$0.00	$0.00	"$1,252.50"	"$1,983.96"	"$2,004.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2050-5060P	SUP	Custom 27803010		2050-5060P  -  SHELL ACETAB ARC DEPOSITED OPTN SECFIT	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2040	SUP	Custom 27803010		2051-2040  -  SHELL ACETAB 40MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,135.00 "	"$1,579.90"	$0.00	"$1,708.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,584.60"	"$1,584.60"	$0.00	$0.00	$444.93	$0.00	$0.00	$0.00	$0.00	"$1,067.50"	"$1,690.92"	"$1,708.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2040P	SUP	Custom 27803010		2051-2040P  -  CUP ACETAB 40MM CLSHOLE SECFIT PSL HA HIP	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2042	SUP	Custom 27803010		2051-2042  -  SHELL ACETAB 42MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,135.00 "	"$1,579.90"	$0.00	"$1,708.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,584.60"	"$1,584.60"	$0.00	$0.00	$444.93	$0.00	$0.00	$0.00	$0.00	"$1,067.50"	"$1,690.92"	"$1,708.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2042P	SUP	Custom 27803010		2051-2042P  -  SHELL ACETAB 42MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2044	SUP	Custom 27803010		2051-2044  -  SHELL ACETAB 44MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,135.00 "	"$1,579.90"	$0.00	"$1,708.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,584.60"	"$1,584.60"	$0.00	$0.00	$444.93	$0.00	$0.00	$0.00	$0.00	"$1,067.50"	"$1,690.92"	"$1,708.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2044P	SUP	Custom 27803010		2051-2044P  -  SHELL ACETAB 44MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2046	SUP	Custom 27803010		2051-2046  -  SHELL ACETAB 46MM HIP CLSHOLE HYDRXAPT SECFIT	BOTH IP/OP	"$2,102.00 "	"$1,555.48"	$0.00	"$1,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,560.10"	"$1,560.10"	$0.00	$0.00	$438.06	$0.00	$0.00	$0.00	$0.00	"$1,051.00"	"$1,664.78"	"$1,681.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2046P	SUP	Custom 27803010		2051-2046P  -  CUP ACETAB 46MM CLSHOLE SECFIT PSL HA HIP	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2048	SUP	Custom 27803010		2051-2048  -  SHELL ACETAB 48MM CLSTR SH HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,102.00 "	"$1,555.48"	$0.00	"$1,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,560.10"	"$1,560.10"	$0.00	$0.00	$438.06	$0.00	$0.00	$0.00	$0.00	"$1,051.00"	"$1,664.78"	"$1,681.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2048P	SUP	Custom 27803010		2051-2048P  -  SHELL ACETAB 48MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2050	SUP	Custom 27803010		2051-2050  -  SHELL ACETAB 50MM CLSTR SH HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,102.00 "	"$1,555.48"	$0.00	"$1,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,560.10"	"$1,560.10"	$0.00	$0.00	$438.06	$0.00	$0.00	$0.00	$0.00	"$1,051.00"	"$1,664.78"	"$1,681.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2050P	SUP	Custom 27803010		2051-2050P  -  SHELL ACETAB 50MM HIP CLSHOLE HYDRXAPT PSL SECFIT	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2052	SUP	Custom 27803010		2051-2052  -  SHELL ACETAB 52MM CLSTR SH HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,102.00 "	"$1,555.48"	$0.00	"$1,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,560.10"	"$1,560.10"	$0.00	$0.00	$438.06	$0.00	$0.00	$0.00	$0.00	"$1,051.00"	"$1,664.78"	"$1,681.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2052P	SUP	Custom 27803010		2051-2052P  -  SHELL ACETAB 52MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2054	SUP	Custom 27803010		2051-2054  -  SHELL ACETAB 54MM CLSTR SH HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,102.00 "	"$1,555.48"	$0.00	"$1,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,560.10"	"$1,560.10"	$0.00	$0.00	$438.06	$0.00	$0.00	$0.00	$0.00	"$1,051.00"	"$1,664.78"	"$1,681.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2054P	SUP	Custom 27803010		2051-2054P  -  CUP ACETAB 54MM SECFIT PSL CLSTR HIP HYDRXAPT	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2056	SUP	Custom 27803010		2051-2056  -  SHELL ACETAB 56MM CLSTR CUP SH HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,102.00 "	"$1,555.48"	$0.00	"$1,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,560.10"	"$1,560.10"	$0.00	$0.00	$438.06	$0.00	$0.00	$0.00	$0.00	"$1,051.00"	"$1,664.78"	"$1,681.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2056P	SUP	Custom 27803010		2051-2056P  -  CUP ACETAB 56MM SECFIT PSL CLSTR HIP HYDRXAPT	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2058	SUP	Custom 27803010		2051-2058  -  CUP ACETAB 58MM SECFIT CLSTR SCR HOLE HIP HYDRXAPT	BOTH IP/OP	"$2,102.00 "	"$1,555.48"	$0.00	"$1,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,560.10"	"$1,560.10"	$0.00	$0.00	$438.06	$0.00	$0.00	$0.00	$0.00	"$1,051.00"	"$1,664.78"	"$1,681.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2058P	SUP	Custom 27803010		2051-2058P  -  CUP ACETAB 58MM SECFIT PSL CLSTR HIP HYDRXAPT	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2060	SUP	Custom 27803010		2051-2060  -  SHELL ACETAB 60MM CLSTR CUP SH HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,102.00 "	"$1,555.48"	$0.00	"$1,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,560.10"	"$1,560.10"	$0.00	$0.00	$438.06	$0.00	$0.00	$0.00	$0.00	"$1,051.00"	"$1,664.78"	"$1,681.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2060P	SUP	Custom 27803010		2051-2060P  -  CUP ACETAB 60MM SECFIT PSL CLSTR HIP HYDRXAPT	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2062	SUP	Custom 27803010		2051-2062  -  SHELL ACETAB CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,102.00 "	"$1,555.48"	$0.00	"$1,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,560.10"	"$1,560.10"	$0.00	$0.00	$438.06	$0.00	$0.00	$0.00	$0.00	"$1,051.00"	"$1,664.78"	"$1,681.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2062P	SUP	Custom 27803010		2051-2062P  -  CUP ACETAB 62MM SECFIT PSL CLSTR HIP HYDRXAPT	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2064	SUP	Custom 27803010		2051-2064  -  SHELL ACETAB 64MM HIP CLSHOLE PUREFIX HYDRXAPT SECFIT	BOTH IP/OP	"$2,102.00 "	"$1,555.48"	$0.00	"$1,681.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,560.10"	"$1,560.10"	$0.00	$0.00	$438.06	$0.00	$0.00	$0.00	$0.00	"$1,051.00"	"$1,664.78"	"$1,681.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2064P	SUP	Custom 27803010		2051-2064P  -  CUP ACETAB 64MM SECFIT PSL CLSTR HIP HYDRXAPT	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2066	SUP	Custom 27803010		2051-2066  -  SHELL ACETAB 66MM HIP CLSHOLE HYDRXAPT SECFIT	BOTH IP/OP	"$2,135.00 "	"$1,579.90"	$0.00	"$1,708.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,584.60"	"$1,584.60"	$0.00	$0.00	$444.93	$0.00	$0.00	$0.00	$0.00	"$1,067.50"	"$1,690.92"	"$1,708.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2066P	SUP	Custom 27803010		2051-2066P  -  SHELL ACETAB 66MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2068	SUP	Custom 27803010		2051-2068  -  SHELL ACETAB 68MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,135.00 "	"$1,579.90"	$0.00	"$1,708.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,584.60"	"$1,584.60"	$0.00	$0.00	$444.93	$0.00	$0.00	$0.00	$0.00	"$1,067.50"	"$1,690.92"	"$1,708.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2068P	SUP	Custom 27803010		2051-2068P  -  SHELL ACETAB 68MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2070	SUP	Custom 27803010		2051-2070  -  SHELL ACETAB 70MM HIP CLSHOLE HYDRXAPT SECFIT	BOTH IP/OP	"$2,135.00 "	"$1,579.90"	$0.00	"$1,708.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,584.60"	"$1,584.60"	$0.00	$0.00	$444.93	$0.00	$0.00	$0.00	$0.00	"$1,067.50"	"$1,690.92"	"$1,708.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2070P	SUP	Custom 27803010		2051-2070P  -  SHELL ACETAB 70MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2072	SUP	Custom 27803010		2051-2072  -  SHELL ACETAB 72MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,135.00 "	"$1,579.90"	$0.00	"$1,708.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,584.60"	"$1,584.60"	$0.00	$0.00	$444.93	$0.00	$0.00	$0.00	$0.00	"$1,067.50"	"$1,690.92"	"$1,708.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-2072P	SUP	Custom 27803010		2051-2072P  -  SHELL ACETAB 72MM HIP CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,228.00 "	"$1,648.72"	$0.00	"$1,782.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.62"	"$1,653.62"	$0.00	$0.00	$464.32	$0.00	$0.00	$0.00	$0.00	"$1,114.00"	"$1,764.58"	"$1,782.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3040	SUP	Custom 27803010		2051-3040  -  SHELL ACETAB 40MM HIP SCRLES HYDRXAPT SECFIT	BOTH IP/OP	"$2,260.00 "	"$1,672.40"	$0.00	"$1,808.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,677.37"	"$1,677.37"	$0.00	$0.00	$470.98	$0.00	$0.00	$0.00	$0.00	"$1,130.00"	"$1,789.92"	"$1,808.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3042	SUP	Custom 27803010		2051-3042  -  SHELL ACETAB 42MM HIP SCRLES HYDRXAPT SECFIT	BOTH IP/OP	"$2,260.00 "	"$1,672.40"	$0.00	"$1,808.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,677.37"	"$1,677.37"	$0.00	$0.00	$470.98	$0.00	$0.00	$0.00	$0.00	"$1,130.00"	"$1,789.92"	"$1,808.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3044	SUP	Custom 27803010		2051-3044  -  CUP ACETAB 44MM SECFIT PSL SCRLES HIP HYDRXAPT	BOTH IP/OP	"$2,260.00 "	"$1,672.40"	$0.00	"$1,808.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,677.37"	"$1,677.37"	$0.00	$0.00	$470.98	$0.00	$0.00	$0.00	$0.00	"$1,130.00"	"$1,789.92"	"$1,808.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3046	SUP	Custom 27803010		2051-3046  -  CUP ACETAB 46MM SECFIT PSL SCRLES HIP HYDRXAPT	BOTH IP/OP	"$2,227.00 "	"$1,647.98"	$0.00	"$1,781.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,652.88"	"$1,652.88"	$0.00	$0.00	$464.11	$0.00	$0.00	$0.00	$0.00	"$1,113.50"	"$1,763.78"	"$1,781.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3048	SUP	Custom 27803010		2051-3048  -  CUP ACETAB 48MM SECFIT PSL SCRLES HIP HYDRXAPT	BOTH IP/OP	"$2,227.00 "	"$1,647.98"	$0.00	"$1,781.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,652.88"	"$1,652.88"	$0.00	$0.00	$464.11	$0.00	$0.00	$0.00	$0.00	"$1,113.50"	"$1,763.78"	"$1,781.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3050	SUP	Custom 27803010		2051-3050  -  CUP ACETAB 50MM SECFIT PSL SCRLES HIP HYDRXAPT	BOTH IP/OP	"$2,227.00 "	"$1,647.98"	$0.00	"$1,781.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,652.88"	"$1,652.88"	$0.00	$0.00	$464.11	$0.00	$0.00	$0.00	$0.00	"$1,113.50"	"$1,763.78"	"$1,781.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3052	SUP	Custom 27803010		2051-3052  -  CUP ACETAB 52MM SECFIT PSL SCRLES HIP HYDRXAPT	BOTH IP/OP	"$2,227.00 "	"$1,647.98"	$0.00	"$1,781.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,652.88"	"$1,652.88"	$0.00	$0.00	$464.11	$0.00	$0.00	$0.00	$0.00	"$1,113.50"	"$1,763.78"	"$1,781.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3054	SUP	Custom 27803010		2051-3054  -  SHELL ACETAB 54MM HIP NO HOLE SLD PUREFIX HYDRXAPT SECFIT	BOTH IP/OP	"$2,227.00 "	"$1,647.98"	$0.00	"$1,781.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,652.88"	"$1,652.88"	$0.00	$0.00	$464.11	$0.00	$0.00	$0.00	$0.00	"$1,113.50"	"$1,763.78"	"$1,781.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3056	SUP	Custom 27803010		2051-3056  -  CUP ACETAB 56MM SECFIT NO HOLE SLD HIP HYDRXAPT	BOTH IP/OP	"$2,227.00 "	"$1,647.98"	$0.00	"$1,781.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,652.88"	"$1,652.88"	$0.00	$0.00	$464.11	$0.00	$0.00	$0.00	$0.00	"$1,113.50"	"$1,763.78"	"$1,781.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3058	SUP	Custom 27803010		2051-3058  -  CUP ACETAB 58MM SECFIT NO HOLE SLD HIP HYDRXAPT	BOTH IP/OP	"$2,227.00 "	"$1,647.98"	$0.00	"$1,781.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,652.88"	"$1,652.88"	$0.00	$0.00	$464.11	$0.00	$0.00	$0.00	$0.00	"$1,113.50"	"$1,763.78"	"$1,781.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3060	SUP	Custom 27803010		2051-3060  -  CUP ACETAB 60MM SECFIT NO HOLE SLD HIP HYDRXAPT	BOTH IP/OP	"$2,227.00 "	"$1,647.98"	$0.00	"$1,781.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,652.88"	"$1,652.88"	$0.00	$0.00	$464.11	$0.00	$0.00	$0.00	$0.00	"$1,113.50"	"$1,763.78"	"$1,781.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3062	SUP	Custom 27803010		2051-3062  -  SHELL ACETAB 62MM HIP SCRLES HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,227.00 "	"$1,647.98"	$0.00	"$1,781.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,652.88"	"$1,652.88"	$0.00	$0.00	$464.11	$0.00	$0.00	$0.00	$0.00	"$1,113.50"	"$1,763.78"	"$1,781.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3064	SUP	Custom 27803010		2051-3064  -  CUP ACETAB 64MM SECFIT PSL SCRLES HIP HYDRXAPT	BOTH IP/OP	"$2,227.00 "	"$1,647.98"	$0.00	"$1,781.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,652.88"	"$1,652.88"	$0.00	$0.00	$464.11	$0.00	$0.00	$0.00	$0.00	"$1,113.50"	"$1,763.78"	"$1,781.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3066	SUP	Custom 27803010		2051-3066  -  SHELL ACETAB 66MM HIP SCRLES HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,260.00 "	"$1,672.40"	$0.00	"$1,808.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,677.37"	"$1,677.37"	$0.00	$0.00	$470.98	$0.00	$0.00	$0.00	$0.00	"$1,130.00"	"$1,789.92"	"$1,808.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3068	SUP	Custom 27803010		2051-3068  -  SHELL ACETAB 68MM HIP SCRLES HYDRXAPT SECFIT PSL	BOTH IP/OP	"$2,260.00 "	"$1,672.40"	$0.00	"$1,808.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,677.37"	"$1,677.37"	$0.00	$0.00	$470.98	$0.00	$0.00	$0.00	$0.00	"$1,130.00"	"$1,789.92"	"$1,808.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3070	SUP	Custom 27803010		2051-3070  -  SHELL ACETAB 70MM HIP SCRLES HYDRXAPT SECFIT	BOTH IP/OP	"$2,260.00 "	"$1,672.40"	$0.00	"$1,808.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,677.37"	"$1,677.37"	$0.00	$0.00	$470.98	$0.00	$0.00	$0.00	$0.00	"$1,130.00"	"$1,789.92"	"$1,808.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2051-3072	SUP	Custom 27803010		2051-3072  -  SHELL ACETAB 72MM HIP SCRLES HYDRXAPT SECFIT	BOTH IP/OP	"$2,260.00 "	"$1,672.40"	$0.00	"$1,808.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,677.37"	"$1,677.37"	$0.00	$0.00	$470.98	$0.00	$0.00	$0.00	$0.00	"$1,130.00"	"$1,789.92"	"$1,808.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2048	SUP	Custom 27803010		2053-2048  -  SHELL ACETAB 48MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2050	SUP	Custom 27803010		2053-2050  -  SHELL ACETAB 50MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2052	SUP	Custom 27803010		2053-2052  -  SHELL ACETAB 52MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2054	SUP	Custom 27803010		2053-2054  -  SHELL ACETAB 54MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2056	SUP	Custom 27803010		2053-2056  -  SHELL ACETAB 56MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2058	SUP	Custom 27803010		2053-2058  -  SHELL ACETAB 58MM CLSHOLE HYDRXAPT SECFIT PSL	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2060	SUP	Custom 27803010		2053-2060  -  SHELL ACETAB 60MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2062	SUP	Custom 27803010		2053-2062  -  SHELL ACETAB 62MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2064	SUP	Custom 27803010		2053-2064  -  SHELL ACETAB 64MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2066	SUP	Custom 27803010		2053-2066  -  SHELL ACETAB 66MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2068	SUP	Custom 27803010		2053-2068  -  SHELL ACETAB 68MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2070	SUP	Custom 27803010		2053-2070  -  SHELL ACETAB 70MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2072	SUP	Custom 27803010		2053-2072  -  SHELL ACETAB 72MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2074	SUP	Custom 27803010		2053-2074  -  SHELL ACETAB 74MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2076	SUP	Custom 27803010		2053-2076  -  SHELL ACETAB 76MM HIP CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2078	SUP	Custom 27803010		2053-2078  -  SHELL ACETAB CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-2080	SUP	Custom 27803010		2053-2080  -  SHELL ACETAB CLSHOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,190.88 "	"$3,101.25"	$0.00	"$3,352.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.47"	"$3,110.47"	$0.00	$0.00	$873.38	$0.00	$0.00	$0.00	$0.00	"$2,095.44"	"$3,319.18"	"$3,352.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3048	SUP	Custom 27803010		2053-3048  -  SHELL ACETAB 48MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3050	SUP	Custom 27803010		2053-3050  -  SHELL ACETAB 50MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3052	SUP	Custom 27803010		2053-3052  -  SHELL ACETAB 52MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3054	SUP	Custom 27803010		2053-3054  -  SHELL ACETAB 54MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3056	SUP	Custom 27803010		2053-3056  -  SHELL ACETAB 56MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3058	SUP	Custom 27803010		2053-3058  -  SHELL ACETAB 58MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3060	SUP	Custom 27803010		2053-3060  -  SHELL ACETAB 60MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3062	SUP	Custom 27803010		2053-3062  -  SHELL ACETAB 62MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3064	SUP	Custom 27803010		2053-3064  -  SHELL ACETAB 64MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3066	SUP	Custom 27803010		2053-3066  -  SHELL ACETAB 66MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3068	SUP	Custom 27803010		2053-3068  -  SHELL ACETAB 68MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3070	SUP	Custom 27803010		2053-3070  -  SHELL ACETAB 70MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3072	SUP	Custom 27803010		2053-3072  -  SHELL ACETAB 72MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3074	SUP	Custom 27803010		2053-3074  -  SHELL ACETAB 74MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3076	SUP	Custom 27803010		2053-3076  -  SHELL ACETAB 76MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3078	SUP	Custom 27803010		2053-3078  -  SHELL ACETAB 78MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2053-3080	SUP	Custom 27803010		2053-3080  -  SHELL ACETAB 80MM HIP NO DOME HOLE HYDRXAPT SECFIT X	BOTH IP/OP	"$4,423.25 "	"$3,273.21"	$0.00	"$3,538.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,282.94"	"$3,282.94"	$0.00	$0.00	$921.81	$0.00	$0.00	$0.00	$0.00	"$2,211.63"	"$3,503.21"	"$3,538.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2060-0000	SUP	Custom 27803010		2060-0000  -  PLUG DOME HOLE ACETAB DOME	BOTH IP/OP	$127.00 	$93.98	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.26	$94.26	$0.00	$0.00	$26.47	$0.00	$0.00	$0.00	$0.00	$63.50	$100.58	$101.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2060-0000-1	SUP	Custom 27803010		2060-0000-1  -  PLUG DOME HL ACTB	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2078-1330S	SUP	HCPCS C1713		2078-1330S  -  NAIL 280MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX	BOTH IP/OP	"$2,090.00 "	"$1,546.60"	$0.00	"$1,672.00"	$940.50	$940.50	$0.00	$0.00	$0.00	$435.61	"$1,551.20"	"$1,551.20"	$0.00	$0.00	$435.56	$0.00	"$1,236.24"	"$1,236.24"	$0.00	"$1,045.00"	"$1,655.28"	"$1,672.00"	$0.00		$0.00	$327.09	$0.00	$0.00	$332.73	$0.00	$0.00	$0.00	$0.00	$0.00
2078-1530S	SUP	HCPCS C1713		2078-1530S  -  NAIL 280MM HIP LEFT GAMMA3 IM R2 LNG STRL STSCR	BOTH IP/OP	"$2,090.00 "	"$1,546.60"	$0.00	"$1,672.00"	$940.50	$940.50	$0.00	$0.00	$0.00	$435.61	"$1,551.20"	"$1,551.20"	$0.00	$0.00	$435.56	$0.00	"$1,236.24"	"$1,236.24"	$0.00	"$1,045.00"	"$1,655.28"	"$1,672.00"	$0.00		$0.00	$327.09	$0.00	$0.00	$332.73	$0.00	$0.00	$0.00	$0.00	$0.00
207-G	SUP	Custom 27203010		REMOVER STAIN ERANDO-SOL 1 GAL	BOTH IP/OP	$194.18 	$143.69	$0.00	$155.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.09	$153.79	$155.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2080-0015	SUP	HCPCS C1713		2080-0015  -  SCREW BN 6.5MM 15MM TX ACTB CANC TRITANIUM MLHL SHL	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$128.25	$128.25	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$0.00	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
2080-0020	SUP	HCPCS C1713		2080-0020  -  SCREW BN 6.5MM 20MM TX ACTB CANC TRITANIUM MLHL SHL	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$128.25	$128.25	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$0.00	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
2080-0025	SUP	HCPCS C1713		2080-0025  -  SCREW BN 6.5MM 25MM TX ACTB CANC TRITANIUM MLHL SHL	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$128.25	$128.25	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$0.00	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
2080-0030	SUP	HCPCS C1713		2080-0030  -  SCREW BN 6.5MM 30MM TX ACTB CANC TRITANIUM MLHL SHL	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$128.25	$128.25	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$0.00	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
2080-0035	SUP	HCPCS C1713		2080-0035  -  SCREW BN 6.5MM 35MM TX ACTB CANC TRITANIUM MLHL SHL	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$128.25	$128.25	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$0.00	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
2080-0040	SUP	HCPCS C1713		2080-0040  -  SCREW BN 6.5MM 40MM TX ACTB CANC TRITANIUM MLHL SHL	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$128.25	$128.25	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$0.00	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
2080-0045	SUP	HCPCS C1713		2080-0045  -  SCREW BN 6.5MM 45MM TX ACTB CANC TRITANIUM MLHL SHL	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$128.25	$128.25	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$0.00	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
2080-0050	SUP	HCPCS C1713		2080-0050  -  SCREW ACETAB 6.5MM 50MM GAP HIP CANCELLOUS	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$128.25	$128.25	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$0.00	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
2080-0055	SUP	HCPCS C1713		2080-0055  -  SCREW ACETAB 6.5MM 55MM PLATE TORX GAP II CANCELLOUS	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$128.25	$128.25	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$0.00	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
2080-0060	SUP	HCPCS C1713		2080-0060  -  SCREW ACETAB 6.5MM 60MM GAP II HIP STERILE	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$128.25	$128.25	$0.00	$0.00	$0.00	$59.40	$211.53	$211.53	$0.00	$0.00	$59.39	$0.00	$168.58	$168.58	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$44.60	$0.00	$0.00	$45.37	$0.00	$0.00	$0.00	$0.00	$0.00
2080-1125S	SUP	HCPCS C1713		2080-1125S  -  NAIL 300MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2080-1130S	SUP	HCPCS C1713		2080-1130S  -  NAIL 11MM 30CM LEFT FEM GAMA IM 130D LNG TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2080-1135S	SUP	HCPCS C1713		2080-1135S  -  NAIL 11MM 300MM HIP LEFT GAMMA3 IM 135D LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2080-1330S	SUP	HCPCS C1713		2080-1330S  -  NAIL 300MM HIP GAMMA3 IM R2 LNG ORTHNX	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0048L	SUP	Custom 27803010		2082-0048L  -  SHELL ACETAB 48MM 45MM RSTOR GAP II TITANIUM HIP LEFT	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0048R	SUP	Custom 27803010		2082-0048R  -  SHELL ACETAB 48MM RSTOR GAP II TITANIUM RIGHT HIP	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0052L	SUP	Custom 27803010		2082-0052L  -  SHELL ACETAB 52MM RSTOR GAP II TITANIUM LEFT HIP	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0052R	SUP	Custom 27803010		2082-0052R  -  SHELL ACETAB 52MM RSTOR GAP II TITANIUM RIGHT HIP	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0056L	SUP	Custom 27803010		2082-0056L  -  SHELL ACETAB 56MM 53MM RSTOR GAP II TITANIUM HIP LEFT	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0056R	SUP	Custom 27803010		2082-0056R  -  SHELL ACETAB 56MM RSTOR GAP II TITANIUM RIGHT HIP	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0060L	SUP	Custom 27803010		2082-0060L  -  SHELL ACETAB 60MM 56MM RSTOR GAP II TITANIUM HIP LEFT	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0060R	SUP	Custom 27803010		2082-0060R  -  SHELL ACETAB 60MM RSTOR GAP II TITANIUM RIGHT HIP	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0064L	SUP	Custom 27803010		2082-0064L  -  SHELL ACETAB 64MM 61MM RSTOR GAP II TITANIUM HIP LEFT	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0064R	SUP	Custom 27803010		2082-0064R  -  SHELL ACETAB 64MM RSTOR GAP II TITANIUM RIGHT HIP	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0068L	SUP	Custom 27803010		2082-0068L  -  SHELL ACETAB 68MM 64MM RSTOR GAP II TITANIUM HIP LEFT	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0068R	SUP	Custom 27803010		2082-0068R  -  SHELL ACETAB 68MM RSTOR GAP II TITANIUM RIGHT HIP	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0072L	SUP	Custom 27803010		2082-0072L  -  SHELL ACETAB 72MM 69MM RSTOR GAP II TITANIUM HIP LEFT	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-0072R	SUP	Custom 27803010		2082-0072R  -  SHELL ACETAB 72MM RSTOR GAP II TITANIUM RIGHT HIP	BOTH IP/OP	"$6,930.00 "	"$5,128.20"	$0.00	"$5,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,444.21"	$0.00	$0.00	$0.00	$0.00	"$3,465.00"	"$5,488.56"	"$5,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2082-1125S	SUP	HCPCS C1713		2082-1125S  -  NAIL 11MM 320MM LEFT GAMA IM LNG 125D LCK SCR STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2082-1130S	SUP	HCPCS C1713		2082-1130S  -  NAIL 11MM 32CM LEFT FEM GAMA IM 130D LNG TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2082-1135S	SUP	HCPCS C1713		2082-1135S  -  NAIL 11MM 32CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2082-1330S	SUP	HCPCS C1713		2082-1330S  -  NAIL 13MM 320MM LEFT GAMA IM LNG 130D LCK SCR STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2083-0048	SUP	Custom 27803010		2083-0048  -  SHELL ACETAB 48MM RING GAP OMNIFIT OSTEOLOCK RSTOR SECFIT	BOTH IP/OP	"$5,675.00 "	"$4,199.50"	$0.00	"$4,540.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,182.67"	$0.00	$0.00	$0.00	$0.00	"$2,837.50"	"$4,494.60"	"$4,540.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2083-0052	SUP	Custom 27803010		2083-0052  -  RING ACETAB 52MM RSTOR GAP TITANIUM HIP	BOTH IP/OP	"$5,675.00 "	"$4,199.50"	$0.00	"$4,540.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,182.67"	$0.00	$0.00	$0.00	$0.00	"$2,837.50"	"$4,494.60"	"$4,540.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2083-0056	SUP	Custom 27803010		2083-0056  -  RING ACETAB 56MM RSTOR GAP II TITANIUM HIP	BOTH IP/OP	"$5,675.00 "	"$4,199.50"	$0.00	"$4,540.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,182.67"	$0.00	$0.00	$0.00	$0.00	"$2,837.50"	"$4,494.60"	"$4,540.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2083-0060	SUP	Custom 27803010		2083-0060  -  RING ACETAB 60MM RSTOR GAP II TITANIUM HIP	BOTH IP/OP	"$5,675.00 "	"$4,199.50"	$0.00	"$4,540.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,182.67"	$0.00	$0.00	$0.00	$0.00	"$2,837.50"	"$4,494.60"	"$4,540.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2083-0064	SUP	Custom 27803010		2083-0064  -  RING ACETAB 64MM RSTOR GAP II TITANIUM HIP	BOTH IP/OP	"$5,675.00 "	"$4,199.50"	$0.00	"$4,540.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,182.67"	$0.00	$0.00	$0.00	$0.00	"$2,837.50"	"$4,494.60"	"$4,540.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2083-0068	SUP	Custom 27803010		2083-0068  -  SHELL ACETAB 68MM RING GAP OMNIFIT OSTEOLOCK RSTOR SECFIT	BOTH IP/OP	"$5,675.00 "	"$4,199.50"	$0.00	"$4,540.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,182.67"	$0.00	$0.00	$0.00	$0.00	"$2,837.50"	"$4,494.60"	"$4,540.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2083-0072	SUP	Custom 27803010		2083-0072  -  RING ACETAB 72MM RSTOR GAP II TITANIUM HIP	BOTH IP/OP	"$5,675.00 "	"$4,199.50"	$0.00	"$4,540.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,182.67"	$0.00	$0.00	$0.00	$0.00	"$2,837.50"	"$4,494.60"	"$4,540.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2084-1125S	SUP	HCPCS C1713		2084-1125S  -  NAIL 11MM 34CM LEFT HIP GAMA IM 125D LNG LCK ORTHNX STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2084-1130S	SUP	HCPCS C1713		2084-1130S  -  NAIL 11MM 34CM LEFT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2084-1135S	SUP	HCPCS C1713		2084-1135S  -  NAIL 11MM 34CM LEFT ORTH GAMA IM 135D LNG STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2084-1330S	SUP	HCPCS C1713		2084-1330S  -  NAIL 13MM 340MM HIP LEFT GAMMA3 IM 130D LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2086-1125S	SUP	HCPCS C1713		2086-1125S  -  NAIL 11MM 36CM HIP LEFT FEM GAMMA3 IM 125D LNG TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2086-1130S	SUP	HCPCS C1713		2086-1130S  -  NAIL 11MM 36CM LEFT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2086-1135S	SUP	HCPCS C1713		2086-1135S  -  NAIL 11MM 36CM LEFT ORTH GAMA IM 135D LNG STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2086-1330S	SUP	HCPCS C1713		2086-1330S  -  NAIL 13MM 360MM LEFT GAMA IM LNG 130D LCK SCR STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2088-1125S	SUP	HCPCS C1713		2088-1125S  -  NAIL 11MM 380MM HIP LEFT GAMMA3 IM 125D LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2088-1130S	SUP	HCPCS C1713		2088-1130S  -  NAIL 11MM 38CM LEFT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2088-1135S	SUP	HCPCS C1713		2088-1135S  -  NAIL 11MM 38CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2088-1330S	SUP	HCPCS C1713		2088-1330S  -  NAIL 13MM 380MM HIP LEFT GAMMA3 IM 130D LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2088TC/100	SUP	HCPCS C1898		2088TC/100  -  LEAD PCNG HLX 6FR 100CM TNDRL STS IS 1 BP CNCT RING ELTRD	BOTH IP/OP	$680.00 	$503.20	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
2088TC/46	SUP	HCPCS C1898		2088TC/46  -  LEAD PCNG HLX 6FR 46CM TNDRL STS IS-1 CNCT BP ACTFX XTD STRD	BOTH IP/OP	$680.00 	$503.20	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
2088TC/52	SUP	HCPCS C1898		2088TC/52  -  LEAD PCNG 6FR 52CM TNDRL STS IS-1 BP CNCT ACT RTRCT XTD HLX	BOTH IP/OP	$680.00 	$503.20	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
2088TC/58	SUP	HCPCS C1898		2088TC/58  -  LEAD PCNG HLX 6FR 58CM TNDRL STS IS 1 CNCT ACTFX BP SFT STRD	BOTH IP/OP	$680.00 	$503.20	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
2088TC/65	SUP	HCPCS C1898		2088TC/65  -  TENDRIL STS 2088TC/65	BOTH IP/OP	$680.00 	$503.20	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$141.73	$504.70	$504.70	$0.00	$0.00	$141.71	$0.00	$402.22	$402.22	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
209.740S	SUP	HCPCS C1713		209.740S  -  SCREW BN FT 7.3MM 140MM STRL CNN SS	BOTH IP/OP	$579.15 	$428.57	$0.00	$449.82	$253.02	$253.02	$0.00	$0.00	$0.00	$120.71	$429.85	$429.85	$0.00	$0.00	$120.69	$0.00	$342.57	$342.57	$0.00	$281.14	$445.33	$449.82	$0.00		$0.00	$85.43	$0.00	$0.00	$89.51	$0.00	$0.00	$0.00	$0.00	$0.00
2090-1125S	SUP	HCPCS C1713		2090-1125S  -  NAIL 400MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2090-1130S	SUP	HCPCS C1713		2090-1130S  -  NAIL 11MM 40CM LEFT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2090-1135S	SUP	HCPCS C1713		2090-1135S  -  NAIL 11MM 40CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2090-1330S	SUP	HCPCS C1713		2090-1330S  -  NAIL 13MM 400MM HIP LEFT GAMMA3 IM 130D LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2092-1125S	SUP	HCPCS C1713		2092-1125S  -  NAIL 11MM 420MM HIP LEFT GAMMA3 IM LNG 125D	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2092-1130S	SUP	HCPCS C1713		2092-1130S  -  NAIL 11MM 42CM LEFT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2092-1135S	SUP	HCPCS C1713		2092-1135S  -  NAIL 11MM 42CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2092-1330S	SUP	HCPCS C1713		2092-1330S  -  NAIL 13MM 42CM LEFT HIP GAMA IM 130D LNG LCK ORTHNX STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2092-1530S	SUP	HCPCS C1713		2092-1530S  -  NAIL 15MM 420MM HIP LEFT GAMMA3 IM 130D LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2092-3-963	SUP	HCPCS C1713		2092-3-963  -  PIN HALF 240MM 5MM APEX SLFDRILL 50MM	BOTH IP/OP	$119.85 	$88.69	$0.00	$97.90	$55.07	$55.07	$0.00	$0.00	$0.00	$24.98	$88.95	$88.95	$0.00	$0.00	$24.98	$0.00	$70.89	$70.89	$0.00	$61.19	$96.92	$97.90	$0.00		$0.00	$19.15	$0.00	$0.00	$19.48	$0.00	$0.00	$0.00	$0.00	$0.00
2094-1125S	SUP	HCPCS C1713		2094-1125S  -  NAIL 11MM 44CM LEFT HIP GAMA IM 125D LNG LCK ORTHNX STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2094-1130S	SUP	HCPCS C1713		2094-1130S  -  NAIL 11MM 44CM LEFT FEM GAMA IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2094-1135S	SUP	HCPCS C1713		2094-1135S  -  NAIL 11MM 44CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2094-1330S	SUP	HCPCS C1713		2094-1330S  -  NAIL 13MM 440MM HIP LEFT GAMMA3 IM 130D LNG	BOTH IP/OP	"$2,908.13 "	"$2,152.02"	$0.00	"$2,326.50"	"$1,308.66"	"$1,308.66"	$0.00	$0.00	$0.00	$606.13	"$2,158.41"	"$2,158.41"	$0.00	$0.00	$606.05	$0.00	"$1,433.71"	"$1,433.71"	$0.00	"$1,454.06"	"$2,303.24"	"$2,326.50"	$0.00		$0.00	$455.12	$0.00	$0.00	$462.97	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2250	SUP	Custom 27803010		2099-2250  -  INSERT ACETAB 50MM 22MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2252	SUP	Custom 27803010		2099-2252  -  INSERT ACETAB 52MM 22MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2254	SUP	Custom 27803010		2099-2254  -  INSERT ACETAB 54MM 22MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2256	SUP	Custom 27803010		2099-2256  -  INSERT ACETAB 56MM 22MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2258	SUP	Custom 27803010		2099-2258  -  INSERT ACETAB 58MM 22MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2261	SUP	Custom 27803010		2099-2261  -  INSERT ACETAB 61MM 22MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2266	SUP	Custom 27803010		2099-2266  -  INSERT ACETAB 66MM 22MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2270	SUP	Custom 27803010		2099-2270  -  INSERT ACETAB 70MM 22MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2274	SUP	Custom 27803010		2099-2274  -  INSERT ACETAB 74MM 22MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2656	SUP	Custom 27803010		2099-2656  -  INSERT ACETAB 56MM 26MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2658	SUP	Custom 27803010		2099-2658  -  INSERT ACETAB 58MM 26MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2661	SUP	Custom 27803010		2099-2661  -  INSERT ACETAB 61MM 26MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2666	SUP	Custom 27803010		2099-2666  -  INSERT ACETAB 66MM 26MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2670	SUP	Custom 27803010		2099-2670  -  INSERT ACETAB 70MM 26MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2674	SUP	Custom 27803010		2099-2674  -  INSERT ACETAB 74MM 26MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2858	SUP	Custom 27803010		2099-2858  -  INSERT ACETAB 58MM 28MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2861	SUP	Custom 27803010		2099-2861  -  INSERT ACETAB 61MM 28MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2866	SUP	Custom 27803010		2099-2866  -  INSERT ACETAB 66MM 28MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2870	SUP	Custom 27803010		2099-2870  -  INSERT ACETAB 70MM 28MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2099-2874	SUP	Custom 27803010		2099-2874  -  INSERT ACETAB 74MM 28MM CONSTRAIN HIP	BOTH IP/OP	"$6,550.00 "	"$4,847.00"	$0.00	"$5,240.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,365.02"	$0.00	$0.00	$0.00	$0.00	"$3,275.00"	"$5,187.60"	"$5,240.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21000 A	SUP	Custom 27803010		21000 A  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$888.25 	$657.31	$0.00	$710.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$659.26	$659.26	$0.00	$0.00	$185.11	$0.00	$0.00	$0.00	$0.00	$444.13	$703.49	$710.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21000 B	SUP	Custom 27803010		21000 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$997.50 	$738.15	$0.00	$798.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$740.34	$740.34	$0.00	$0.00	$207.88	$0.00	$0.00	$0.00	$0.00	$498.75	$790.02	$798.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21020 A-M	SUP	Custom 27803010		21020 A-M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,037.88 "	$768.03	$0.00	$830.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$770.31	$770.31	$0.00	$0.00	$216.29	$0.00	$0.00	$0.00	$0.00	$518.94	$822.00	$830.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21020 B-M	SUP	Custom 27803010		21020 B-M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,037.88 "	$768.03	$0.00	$830.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$770.31	$770.31	$0.00	$0.00	$216.29	$0.00	$0.00	$0.00	$0.00	$518.94	$822.00	$830.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-1500	SUP	HCPCS C9359		2102-1500  -  SUBSTITUTE BNGFT 100X25X4MM VOID FILR FOAM STRIP BIOACTIVE	BOTH IP/OP	"$3,857.50 "	"$2,854.55"	$0.00	"$3,086.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$804.00	"$2,863.04"	"$2,863.04"	$0.00	$0.00	$803.90	$0.00	"$1,901.75"	"$1,901.75"	$0.00	"$1,928.75"	"$3,055.14"	"$3,086.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-1505	SUP	HCPCS C9359		2102-1505  -  SUBSTITUTE BNGFT 240X25X4MM VOID FILR FOAM STRIP BIOACTIVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-1510	SUP	HCPCS C9359		2102-1510  -  SUBSTITUTE BNGFT 50X25X8MM VOID FILR FOAM STRIP COMPRESSION	BOTH IP/OP	"$3,997.00 "	"$2,957.78"	$0.00	"$3,197.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$833.07	"$2,966.57"	"$2,966.57"	$0.00	$0.00	$832.97	$0.00	"$1,970.52"	"$1,970.52"	$0.00	"$1,998.50"	"$3,165.62"	"$3,197.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-1520	SUP	HCPCS C9359		2102-1520  -  SUBSTITUTE BNGFT 25MMX100MMX8MM 100X25X8MM VOID FILR FOAM	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-1601	SUP	HCPCS C9359		2102-1601  -  SUBSTITUTE BNGFT FOAM PACK BIOACTIVE VITOSS BTCP COLLAGEN	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-1602	SUP	HCPCS C9359		2102-1602  -  SUBSTITUTE BNGFT VOID FILR FOAM PACK BIOACTIVE VITOSS BTCP	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-1605	SUP	HCPCS C9359		2102-1605  -  SUBSTITUTE BNGFT VOID FILR FOAM PACK BIOACTIVE VITOSS BTCP	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-1610	SUP	HCPCS C9359		2102-1610  -  SUBSTITUTE BNGFT VOID FILR FOAM PACK BIOACTIVE VITOSS BTCP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-1901	SUP	HCPCS C1713		2102-1901  -  SUBSTITUTE BNGFT BIOMODAL FOAM PACK VITOSS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-1902	SUP	HCPCS C1713		2102-1902  -  SUBSTITUTE BNGFT BIOMODAL FOAM PACK VITOSS	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-1905	SUP	HCPCS C1713		2102-1905  -  SUBSTITUTE BNGFT BIMODAL FOAM PACK VITOSS	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-1910	SUP	HCPCS C1713		2102-1910  -  SUBSTITUTE BNGFT BIOMODAL FOAM PACK VITOSS	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
2102-2110	SUP	HCPCS C1713		2102-2110  -  SUBSTITUTE BNGFT VOID FILR PACK BIOACTIVE COMPRESSION	BOTH IP/OP	"$4,589.50 "	"$3,396.23"	$0.00	"$5,040.00"	"$2,835.00"	"$2,835.00"	$0.00	$0.00	$0.00	$956.57	"$3,406.33"	"$3,406.33"	$0.00	$0.00	$956.45	$0.00	"$2,262.62"	"$2,262.62"	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$985.95	$0.00	$0.00	"$1,002.96"	$0.00	$0.00	$0.00	$0.00	$0.00
2108-110	SUP	Custom 27203010		BLADE SW W THK SGTL	BOTH IP/OP	$174.00 	$128.76	$0.00	$139.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.00	$137.81	$139.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2108-110-000	SUP	Custom 27203010		2108-110-000  -  BLADE SAW THK1.3MM 73MM WIDE 25MM 2 CUT SAGITTAL STAINLESS	BOTH IP/OP	$77.25 	$57.17	$0.00	$61.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.33	$57.33	$0.00	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$38.63	$61.18	$61.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2108-120	SUP	Custom 27203010		BLADE SW SHRT SGTL THN	BOTH IP/OP	$191.40 	$141.64	$0.00	$153.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.70	$151.59	$153.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2108-120-000	SUP	Custom 27203010		2108-120-000  -  BLADE SAW SHORT NARROW THIN 60.5X18.5X.64MM SAGITTAL	BOTH IP/OP	$77.25 	$57.17	$0.00	$61.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.33	$57.33	$0.00	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$38.63	$61.18	$61.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2108-120-006	SUP	Custom 27203010		2108-120-006  -  BLADE SAW THK.64MM 63X18.5MM SAGITTAL HEAVY DUTY STAINLESS	BOTH IP/OP	$77.25 	$57.17	$0.00	$61.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.33	$57.33	$0.00	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$38.63	$61.18	$61.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2108-131-000	SUP	Custom 27203010		2108-131-000  -  BLADE SAW THK.6MM 46X17MM SAGITTAL CUT EDGE SAFEDGE	BOTH IP/OP	$77.25 	$57.17	$0.00	$61.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.33	$57.33	$0.00	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$38.63	$61.18	$61.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2108-148	SUP	Custom 27203010		BLADE SW 34.5X9X.64MM SHRT NAR THN SGTL STRL	BOTH IP/OP	$191.40 	$141.64	$0.00	$153.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.70	$151.59	$153.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2108-148-000	SUP	Custom 27203010		2108-148-000  -  BLADE SAW THK.64MM SHORT NARROW THIN 34.5X9MM SAGITTAL	BOTH IP/OP	$77.25 	$57.17	$0.00	$61.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.33	$57.33	$0.00	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$38.63	$61.18	$61.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2108-151	SUP	Custom 27203010		BLADE SW 85X25.4X1.19MM W THK STANILESS STL SGTL WO OFST	BOTH IP/OP	$191.40 	$141.64	$0.00	$153.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.70	$151.59	$153.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2108-151-000	SUP	Custom 27203010		2108-151-000  -  BLADE SAW THK1.19MM WIDE THICK 85X25MM SAGITTAL STAINLESS	BOTH IP/OP	$77.25 	$57.17	$0.00	$61.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.33	$57.33	$0.00	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$38.63	$61.18	$61.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2108-175-000	SUP	Custom 27203010		2108-175-000  -  BLADE SAW THK1.5MM SHORT NARROW THIN 79.5X25MM SAGITTAL	BOTH IP/OP	$77.25 	$57.17	$0.00	$61.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.33	$57.33	$0.00	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$38.63	$61.18	$61.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2108-182-000	SUP	Custom 27203010		2108-182-000  -  BLADE SAW LONG THICK 18MM SAGITTAL NO OFFST STAINLESS STEEL	BOTH IP/OP	$72.89 	$53.94	$0.00	$58.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.10	$54.10	$0.00	$0.00	$15.19	$0.00	$0.00	$0.00	$0.00	$36.44	$57.73	$58.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2108-193-000	SUP	Custom 27203010		2108-193-000  -  BLADE SAW THK.96MM MEDIUM WIDE 81.5X25MM SAGITTAL STAINLESS	BOTH IP/OP	$77.25 	$57.17	$0.00	$61.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.33	$57.33	$0.00	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$38.63	$61.18	$61.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21-2000-24	SUP	HCPCS C1752		21-2000-24  -  CATHETER DLYS STRG BLNT 14.7FR 4.9MM 2.6MM 48CM DELTEC	BOTH IP/OP	$657.50 	$486.55	$0.00	$526.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$488.00	$488.00	$0.00	$0.00	$137.02	$0.00	$0.00	$0.00	$0.00	$328.75	$520.74	$526.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2120F	SUP	HCPCS C1880		2120F  -  FILTER CARDIO 7FR 48CM SIM VC SNF/SL FEM DLV KIT NTNL	BOTH IP/OP	"$1,937.50 "	"$1,433.75"	$0.00	"$1,550.00"	$871.88	$871.88	$0.00	$0.00	$0.00	$403.82	"$1,438.01"	"$1,438.01"	$0.00	$0.00	$403.78	$0.00	"$1,146.03"	"$1,146.03"	$0.00	$968.75	"$1,534.50"	"$1,550.00"	$0.00		$0.00	$303.22	$0.00	$0.00	$308.45	$0.00	$0.00	$0.00	$0.00	$0.00
21-2369	SUP	HCPCS C1751		21-2369  -  TRAY CATH 9FR 72.5CM 72.5L VENTRA 2 LUM SIL PERC	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$174.38	$174.38	$0.00	$0.00	$0.00	$80.76	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$229.21	$229.21	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$60.64	$0.00	$0.00	$61.69	$0.00	$0.00	$0.00	$0.00	$0.00
21-343	SUP	Custom 27203010		TIP PIP 1ML MLA 3 TRY AUTOCLAV	BOTH IP/OP	$146.65 	$108.52	$0.00	$117.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.33	$116.15	$117.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21-4055	SUP	HCPCS C1788		21-4055  -  TRAY INFS PORT 7.8FR 11.4MM 1MM 76CM 30.5MMX14.7MM PRTACTH	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$247.50	$247.50	$0.00	$0.00	$0.00	$114.63	$408.21	$408.21	$0.00	$0.00	$114.62	$0.00	$325.33	$325.33	$0.00	$275.00	$435.60	$440.00	$0.00		$0.00	$86.08	$0.00	$0.00	$87.56	$0.00	$0.00	$0.00	$0.00	$0.00
21-4065-24	SUP	HCPCS C1788		21-4065-24  -  TRAY INFS PORT 8.5FR STRL PRTACTH II 1 LUM CATHETHER PRTL	BOTH IP/OP	$769.35 	$569.32	$0.00	$640.00	$360.00	$360.00	$0.00	$0.00	$0.00	$160.35	$571.01	$571.01	$0.00	$0.00	$160.33	$0.00	$455.07	$455.07	$0.00	$400.00	$633.60	$640.00	$0.00		$0.00	$125.20	$0.00	$0.00	$127.36	$0.00	$0.00	$0.00	$0.00	$0.00
21-4082	SUP	HCPCS C1788		21-4082  -  PORT-A-CATHETER II	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$5.63	$5.63	$0.00	$0.00	$0.00	$2.61	$9.28	$9.28	$0.00	$0.00	$2.61	$0.00	$7.39	$7.39	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
21-4165-24	SUP	HCPCS C1788		21-4165-24  -  PROPORT PLASTIC	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$5.63	$5.63	$0.00	$0.00	$0.00	$2.61	$9.28	$9.28	$0.00	$0.00	$2.61	$0.00	$7.39	$7.39	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
21-4483-24	SUP	Custom 27203010		21-4483-24  -  TRAY INFUS PORT LP 6FR 1.9MM 1MM 76CM 1 LUMEN INTROD NEEDLE	BOTH IP/OP	"$1,693.28 "	"$1,253.03"	$0.00	"$1,290.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,256.75"	"$1,256.75"	$0.00	$0.00	$352.88	$0.00	$0.00	$0.00	$0.00	$806.33	"$1,277.22"	"$1,290.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21-4572	SUP	HCPCS C1788		DEVICE  PAST-PORT	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$5.63	$5.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
21-4572-24	SUP	HCPCS C1788		21-4572-24  -  KIT INFS PORT 5.8FR PSPRT T2 1 LUM PLFLW CATH INTRO UNAS	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
21-4590	SUP	HCPCS C1788		PASPORT ELITE KIT	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$5.63	$5.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
21-8067	SUP	HCPCS C1751		21-8067  -  KIT INFS PORT LOPRFL 10FR 3.2MM 1.4MM 760MM PCTH2 PLFL 2 LUM	BOTH IP/OP	"$1,070.00 "	$791.80	$0.00	$856.00	$481.50	$481.50	$0.00	$0.00	$0.00	$223.01	$794.15	$794.15	$0.00	$0.00	$222.99	$0.00	$632.91	$632.91	$0.00	$535.00	$847.44	$856.00	$0.00		$0.00	$167.46	$0.00	$0.00	$170.34	$0.00	$0.00	$0.00	$0.00	$0.00
219.952S	SUP	Custom 27803010		219.952S  -  WASHER ORTHOPEDIC SMALL OVAL STAINLESS STEEL STERILE 6.5/7.3	BOTH IP/OP	$373.93 	$276.71	$0.00	$290.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$277.53	$277.53	$0.00	$0.00	$77.93	$0.00	$0.00	$0.00	$0.00	$181.51	$287.52	$290.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
219.953S	SUP	Custom 27803010		219.953S  -  WASHER ORTHOPEDIC LARGE ROUND STAINLESS STEEL STERILE	BOTH IP/OP	$373.93 	$276.71	$0.00	$290.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$277.53	$277.53	$0.00	$0.00	$77.93	$0.00	$0.00	$0.00	$0.00	$181.51	$287.52	$290.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21AC60	SUP	Custom 27203010		21AC60  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$337.88 	$250.03	$0.00	$270.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.77	$250.77	$0.00	$0.00	$70.41	$0.00	$0.00	$0.00	$0.00	$168.94	$267.60	$270.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21AC75	SUP	Custom 27203010		21AC75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$337.88 	$250.03	$0.00	$270.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.77	$250.77	$0.00	$0.00	$70.41	$0.00	$0.00	$0.00	$0.00	$168.94	$267.60	$270.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21AC90	SUP	Custom 27203010		21AC90  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$337.88 	$250.03	$0.00	$270.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.77	$250.77	$0.00	$0.00	$70.41	$0.00	$0.00	$0.00	$0.00	$168.94	$267.60	$270.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21AGFN-756	SUP	Custom 27803010		21AGFN-756  -  VALVE AORTIC 85D 21MM 19.6MM 1 DIGIT GRADIENT MECHANICAL	BOTH IP/OP	"$11,750.00 "	"$8,695.00"	$0.00	"$9,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,448.70"	$0.00	$0.00	$0.00	$0.00	"$5,875.00"	"$9,306.00"	"$9,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21AJ-501	SUP	Custom 27803010		21AJ-501  -  VALVE AOR 85D 2.06SQ CM 1.51SQ CM 21MM 16.7MM MSTR SER MECH	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	$0.00	$0.00	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21BA50	SUP	Custom 27203010		21BA50  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$484.50 	$358.53	$0.00	$387.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.60	$359.60	$0.00	$0.00	$100.97	$0.00	$0.00	$0.00	$0.00	$242.25	$383.72	$387.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21BA50DX	SUP	Custom 27203010		21BA50DX  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$401.63 	$297.21	$0.00	$321.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$298.09	$298.09	$0.00	$0.00	$83.70	$0.00	$0.00	$0.00	$0.00	$200.81	$318.09	$321.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21BA60	SUP	Custom 27203010		21BA60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$401.63 	$297.21	$0.00	$321.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$298.09	$298.09	$0.00	$0.00	$83.70	$0.00	$0.00	$0.00	$0.00	$200.81	$318.09	$321.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21BA70DX	SUP	Custom 27203010		21BA70DX  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$401.63 	$297.21	$0.00	$321.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$298.09	$298.09	$0.00	$0.00	$83.70	$0.00	$0.00	$0.00	$0.00	$200.81	$318.09	$321.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21BA75	SUP	Custom 27203010		21BA75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$391.00 	$289.34	$0.00	$312.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.20	$290.20	$0.00	$0.00	$81.48	$0.00	$0.00	$0.00	$0.00	$195.50	$309.67	$312.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21BA90	SUP	Custom 27203010		21BA90  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$384.63 	$284.63	$0.00	$307.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$285.47	$285.47	$0.00	$0.00	$80.16	$0.00	$0.00	$0.00	$0.00	$192.31	$304.63	$307.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21CY64BC	SUP	Custom 27203010		21CY64BC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$374.00 	$276.76	$0.00	$299.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$277.58	$277.58	$0.00	$0.00	$77.94	$0.00	$0.00	$0.00	$0.00	$187.00	$296.21	$299.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21CY65DX	SUP	Custom 27203010		21CY65DX  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$386.75 	$286.20	$0.00	$309.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.05	$287.05	$0.00	$0.00	$80.60	$0.00	$0.00	$0.00	$0.00	$193.38	$306.31	$309.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21CY90	SUP	Custom 27203010		21CY90  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$335.75 	$248.46	$0.00	$268.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.19	$249.19	$0.00	$0.00	$69.97	$0.00	$0.00	$0.00	$0.00	$167.88	$265.91	$268.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21MH30	SUP	Custom 27203010		21MH30  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$337.88 	$250.03	$0.00	$270.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.77	$250.77	$0.00	$0.00	$70.41	$0.00	$0.00	$0.00	$0.00	$168.94	$267.60	$270.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21MJ-501	SUP	Custom 27803010		21MJ-501  -  VALVE MTRL 85D STD RING 21MM 16.7MM MSTR MECH LFLT ORFC	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	$0.00	$0.00	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21TA30	SUP	Custom 27203010		21TA30  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$371.88 	$275.19	$0.00	$297.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.01	$276.01	$0.00	$0.00	$77.50	$0.00	$0.00	$0.00	$0.00	$185.94	$294.53	$297.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2200-09-0040	SUP	Custom 27203010		2200-09-0040  -  DRILL SURG DYNANAIL 4MM DISP TIBIOTALOCALCANEAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2200-09-0050	SUP	Custom 27203010		2200-09-0050  -  DRILL SURG STP DYNANAIL 5MM DISP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2200-18-4031	SUP	Custom 27203010		2200-18-4031  -  GUIDEWIRE ORTH 400MM 3.1MM DYNANAIL TROCAR TIP	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2200-18-5031	SUP	Custom 27203010		2200-18-5031  -  GUIDEWIRE ORTH 500MM 3.1MM DYNANAIL BEAD TIP	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2200-19-0031	SUP	Custom 27203010		2200-19-0031  -  PIN FIX 3.1MM DYNANAIL STNM DISP	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22002 H	SUP	Custom 27803010		22002 H  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$748.13 	$553.62	$0.00	$598.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$555.26	$555.26	$0.00	$0.00	$155.91	$0.00	$0.00	$0.00	$0.00	$374.06	$592.52	$598.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22002 L	SUP	Custom 27803010		22002 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$748.13 	$553.62	$0.00	$598.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$555.26	$555.26	$0.00	$0.00	$155.91	$0.00	$0.00	$0.00	$0.00	$374.06	$592.52	$598.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22002 M	SUP	Custom 27803010		22002 M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$748.13 	$553.62	$0.00	$598.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$555.26	$555.26	$0.00	$0.00	$155.91	$0.00	$0.00	$0.00	$0.00	$374.06	$592.52	$598.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22-004-186	SUP	Custom 27203010		KIT SYR LUER LOCK SLIP NDL PRDVC SPRT FLTRPRO 23.5IU/ML 5/8	BOTH IP/OP	$313.60 	$232.06	$0.00	$250.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.80	$248.37	$250.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22017 A-L	SUP	Custom 27803010		22017 A-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,750.25 "	"$2,035.19"	$0.00	"$2,200.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.24"	"$2,041.24"	$0.00	$0.00	$573.15	$0.00	$0.00	$0.00	$0.00	"$1,375.13"	"$2,178.20"	"$2,200.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22017 A-M	SUP	Custom 27803010		22017 A-M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,750.25 "	"$2,035.19"	$0.00	"$2,200.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.24"	"$2,041.24"	$0.00	$0.00	$573.15	$0.00	$0.00	$0.00	$0.00	"$1,375.13"	"$2,178.20"	"$2,200.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22017 B-L	SUP	Custom 27803010		22017 B-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22017 B-M	SUP	Custom 27803010		22017 B-M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22017A-LL	SUP	HCPCS C1713		22017A-LL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
22017B-LL	SUP	Custom 27803010		22017B-LL  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22-046-221	SUP	Custom 27203010		RENOL OSMOLALITY CONTROL	BOTH IP/OP	$385.63 	$285.37	$0.00	$308.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.81	$305.42	$308.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22-046346	SUP	Custom 27203010		REAGENT METHNL ISOPRPNL FLX 95 1GL DEHYDRANT BTL HISTOLGY	BOTH IP/OP	$95.25 	$70.49	$0.00	$76.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.63	$75.44	$76.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22-046-781	SUP	Custom 27203010		CONTROL PROTINOL 280 OSMOLALITY 3X3ML	BOTH IP/OP	$412.65 	$305.36	$0.00	$330.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.33	$326.82	$330.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22050 B	SUP	Custom 27803010		22050 B  -  KIT VNCLSTM STD DOME 6MM STRL CSF SNP	BOTH IP/OP	$629.38 	$465.74	$0.00	$503.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$467.12	$467.12	$0.00	$0.00	$131.16	$0.00	$0.00	$0.00	$0.00	$314.69	$498.47	$503.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22082 F	SUP	Custom 27803010		22082 F  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22082 G	SUP	Custom 27803010		22082 G  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22082 H	SUP	Custom 27803010		22082 H  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22082 I	SUP	Custom 27803010		22082 I  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22082 K	SUP	Custom 27803010		22082 K  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$513.00 	$379.62	$0.00	$410.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.75	$380.75	$0.00	$0.00	$106.91	$0.00	$0.00	$0.00	$0.00	$256.50	$406.30	$410.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22097 A-L	SUP	Custom 27803010		22097 A-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22097 A-M	SUP	Custom 27803010		22097 A-M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22097 B-L	SUP	Custom 27803010		22097 B-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22097 B-M	SUP	Custom 27803010		22097 B-M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22098 B-L	SUP	Custom 27803010		22098 B-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22098 B-M	SUP	Custom 27803010		22098 B-M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22098 C-L	SUP	Custom 27803010		22098 C-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,415.25 "	"$2,527.29"	$0.00	"$2,732.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,534.80"	"$2,534.80"	$0.00	$0.00	$711.74	$0.00	$0.00	$0.00	$0.00	"$1,707.63"	"$2,704.88"	"$2,732.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22098 C-M	SUP	Custom 27803010		22098 C-M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,028.13 "	"$2,240.82"	$0.00	"$2,422.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,247.47"	"$2,247.47"	$0.00	$0.00	$631.06	$0.00	$0.00	$0.00	$0.00	"$1,514.06"	"$2,398.28"	"$2,422.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22101 A	SUP	Custom 27803010		22101 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22101 B	SUP	Custom 27803010		22101 B  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22101 C	SUP	Custom 27803010		22101 C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22101 D	SUP	Custom 27803010		22101 D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22-1266	SUP	Custom 27203010		22-1266  -  PROBE ESURG STR BIPOL TPR BLNT PNT WTFLD STRL 20-23GA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22-143-975	SUP	Custom 27203010		REAGENT XYLN CTRSLV 1GL CLR AGNT HISTOLGY	BOTH IP/OP	$481.98 	$356.67	$0.00	$385.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.99	$381.73	$385.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2220J	SUP	HCPCS C1880		2220J  -  FILTER CV 7FR 83CM SIM SBCLV DLV KT NTNL JUG VN VC	BOTH IP/OP	"$2,544.16 "	"$1,882.68"	$0.00	"$2,035.33"	"$1,144.87"	"$1,144.87"	$0.00	$0.00	$0.00	$530.27	"$1,888.28"	"$1,888.28"	$0.00	$0.00	$530.20	$0.00	"$1,254.27"	"$1,254.27"	$0.00	"$1,272.08"	"$2,014.97"	"$2,035.33"	$0.00		$0.00	$398.16	$0.00	$0.00	$405.03	$0.00	$0.00	$0.00	$0.00	$0.00
22-267-013	SUP	Custom 27203010		SLIDE 3X2IN MSCP X THK FRST END PRECLN PLN THK1.2MM	BOTH IP/OP	$245.15 	$181.41	$0.00	$196.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.58	$194.16	$196.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
224.510.	SUP	Custom 27803010		224.510.  -  ROD SPNL 100MM 5.5MM REVERE SS STR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
22438-19	SUP	HCPCS C1884		22438-19  -  SYSTEM EMBOLIC PROTECTION .014IN LARGE 4-7MM 5-6FR 190CM	BOTH IP/OP	"$3,425.00 "	"$2,534.50"	$0.00	"$2,740.00"	"$1,541.25"	"$1,541.25"	$0.00	$0.00	$0.00	$713.86	"$2,542.04"	"$2,542.04"	$0.00	$0.00	$713.77	$0.00	"$1,688.53"	"$1,688.53"	$0.00	"$1,712.50"	"$2,712.60"	"$2,740.00"	$0.00		$0.00	$536.01	$0.00	$0.00	$545.26	$0.00	$0.00	$0.00	$0.00	$0.00
22-553	SUP	HCPCS C2617		22-553  -  STENT URET 8FR 28CM REG DRMTR LG DRAIN HOLE LCK PGTL 22-553	BOTH IP/OP	$270.75 	$200.36	$0.00	$216.60	$121.84	$121.84	$0.00	$0.00	$0.00	$56.43	$200.95	$200.95	$0.00	$0.00	$56.42	$0.00	$160.15	$160.15	$0.00	$135.38	$214.43	$216.60	$0.00		$0.00	$42.37	$0.00	$0.00	$43.10	$0.00	$0.00	$0.00	$0.00	$0.00
226.662S	SUP	HCPCS C1713		226.662S  -  PLATE BRD 300MM SS 4.5MM SCR 16 HOLE CVD LCP BONE ORTH STRL	BOTH IP/OP	"$1,903.30 "	"$1,408.44"	$0.00	"$1,720.82"	$967.96	$967.96	$0.00	$0.00	$0.00	$396.70	"$1,412.63"	"$1,412.63"	$0.00	$0.00	$396.65	$0.00	"$1,125.80"	"$1,125.80"	$0.00	"$1,075.51"	"$1,703.62"	"$1,720.82"	$0.00		$0.00	$336.64	$0.00	$0.00	$342.44	$0.00	$0.00	$0.00	$0.00	$0.00
226.702S	SUP	HCPCS C1713		226.702S  -  PLATE BONE BROAD 372MM 20 HOLE CVD LCP STAINLESS STEEL	BOTH IP/OP	"$2,443.10 "	"$1,807.89"	$0.00	"$1,897.54"	"$1,067.37"	"$1,067.37"	$0.00	$0.00	$0.00	$509.20	"$1,813.27"	"$1,813.27"	$0.00	$0.00	$509.14	$0.00	"$1,445.09"	"$1,445.09"	$0.00	"$1,185.96"	"$1,878.57"	"$1,897.54"	$0.00		$0.00	$360.40	$0.00	$0.00	$377.61	$0.00	$0.00	$0.00	$0.00	$0.00
226.722S	SUP	HCPCS C1713		226.722S  -  PLATE BONE BROAD 408MM 22 HOLE CVD LCP STAINLESS STEEL	BOTH IP/OP	"$2,759.38 "	"$2,041.94"	$0.00	"$2,143.20"	"$1,205.55"	"$1,205.55"	$0.00	$0.00	$0.00	$575.12	"$2,048.01"	"$2,048.01"	$0.00	$0.00	$575.05	$0.00	"$1,360.37"	"$1,360.37"	$0.00	"$1,339.50"	"$2,121.77"	"$2,143.20"	$0.00		$0.00	$407.05	$0.00	$0.00	$426.50	$0.00	$0.00	$0.00	$0.00	$0.00
226.742S	SUP	HCPCS C1713		226.742S  -  PLATE BONE BROAD 443MM 24 HOLE CVD LCP STAINLESS STEEL	BOTH IP/OP	"$2,995.53 "	"$2,216.69"	$0.00	"$2,326.62"	"$1,308.72"	"$1,308.72"	$0.00	$0.00	$0.00	$624.34	"$2,223.28"	"$2,223.28"	$0.00	$0.00	$624.27	$0.00	"$1,476.79"	"$1,476.79"	$0.00	"$1,454.14"	"$2,303.36"	"$2,326.62"	$0.00		$0.00	$441.89	$0.00	$0.00	$463.00	$0.00	$0.00	$0.00	$0.00	$0.00
226.762S	SUP	HCPCS C1713		226.762S  -  PLATE BONE BROAD 479MM 26 HOLE CVD LCP STAINLESS STEEL	BOTH IP/OP	"$3,234.50 "	"$2,393.53"	$0.00	"$2,512.24"	"$1,413.14"	"$1,413.14"	$0.00	$0.00	$0.00	$674.15	"$2,400.65"	"$2,400.65"	$0.00	$0.00	$674.07	$0.00	"$1,594.61"	"$1,594.61"	$0.00	"$1,570.15"	"$2,487.12"	"$2,512.24"	$0.00		$0.00	$477.14	$0.00	$0.00	$499.94	$0.00	$0.00	$0.00	$0.00	$0.00
2284-0-426	SUP	Custom 27803010		2284-0-426  -  HEAD FEMORAL 15MM OFFST 26MM PCA HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2284-0-428	SUP	Custom 27803010		2284-0-428  -  HEAD FEM +15MM OFST 28MM STRL PCA HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2284-0-432	SUP	Custom 27803010		2284-0-432  -  HEAD FEMORAL +15MM OFFST 32MM PCA HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296003109S2	SUP	Custom 27203010		2296003109S2  -  BLADE SW LF CMND II MODIFICATION HVDTY SGTL MNT RT	BOTH IP/OP	$206.00 	$152.44	$0.00	$164.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.89	$152.89	$0.00	$0.00	$42.93	$0.00	$0.00	$0.00	$0.00	$103.00	$163.15	$164.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-003-115	SUP	Custom 27203010		2296-003-115  -  BLADE SW 29.5X7X.38MM PRCS LNG MIC NAR THN SS OSC/SAG STRL	BOTH IP/OP	$90.10 	$66.67	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.87	$66.87	$0.00	$0.00	$18.78	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-003-414	SUP	Custom 27203010		2296-003-414  -  BLADE SW MIC THN 25X5.5X.38MM STRL PRCS OSC/SAG SS	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.09	$63.09	$0.00	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-033-102	SUP	Custom 27203010		2296-033-102  -  BLADE SW MED W AGRS	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.09	$63.09	$0.00	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-033-103	SUP	Custom 27203010		2296-033-103  -  BLADE SW 25X7X.51MM CORE SS OSC/SAG AGRS STRL	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.09	$63.09	$0.00	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-033-104	SUP	Custom 27203010		2296-033-104  -  BLADE SW 16.5MM CORE TPS 34.5MM THK.51MM MIC OSC/SAG	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.09	$63.09	$0.00	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-033-105	SUP	Custom 27203010		2296-033-105  -  BLADE SAW THK.4MM MEDIUM 18.5X9MM OSCILLATING SAGITTAL	BOTH IP/OP	$90.10 	$66.67	$0.00	$72.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.87	$66.87	$0.00	$0.00	$18.78	$0.00	$0.00	$0.00	$0.00	$45.05	$71.36	$72.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-033-111	SUP	Custom 27203010		2296-033-111  -  BLADE SAW MEDIUM LONG 25X9MM SAGITTAL LATEX FREE STAINLESS	BOTH IP/OP	$90.10 	$66.67	$0.00	$72.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.87	$66.87	$0.00	$0.00	$18.78	$0.00	$0.00	$0.00	$0.00	$45.05	$71.36	$72.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-033-114	SUP	Custom 27203010		2296-033-114  -  BLADE SAW MEDIUM 18.5X7X.51MM SAGITTAL OSCILLATE AGGRESSIVE	BOTH IP/OP	$90.10 	$66.67	$0.00	$72.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.87	$66.87	$0.00	$0.00	$18.78	$0.00	$0.00	$0.00	$0.00	$45.05	$71.36	$72.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-033-125	SUP	Custom 27203010		2296-033-125  -  BLADE SW 31X9X.51MM LNG MED SS OSC/SAG AGRS	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.09	$63.09	$0.00	$0.00	$17.71	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-033-212	SUP	Custom 27203010		2296-033-212  -  BLADE SAW MEDIUM NARROW 18.5X5.5X.51MM AGGRESSIVE CORE TPS	BOTH IP/OP	$90.10 	$66.67	$0.00	$72.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.87	$66.87	$0.00	$0.00	$18.78	$0.00	$0.00	$0.00	$0.00	$45.05	$71.36	$72.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-033-411	SUP	Custom 27203010		2296-033-411  -  BLADE SW 9MM CORE TPS 11.5MM THK.51MM MIC OSC/SAG	BOTH IP/OP	$90.10 	$66.67	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.87	$66.87	$0.00	$0.00	$18.78	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-100-191	SUP	Custom 27203010		2296-100-191  -  BURR SURG 39MM 3MM RND DMD STRL	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$0.00	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-100-193	SUP	Custom 27203010		2296-100-193  -  BURR SURG 3MM 3.5MM RND DMD STRL	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$0.00	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-100-195	SUP	Custom 27203010		2296-100-195  -  BURR SURG 39MM 4MM RND DMD STRL	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$0.00	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-100-210	SUP	Custom 27203010		2296-100-210  -  BURR SURG 44.5MM 1MM CRB XCUT FSSR STRL	BOTH IP/OP	$18.02 	$13.33	$0.00	$14.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.37	$13.37	$0.00	$0.00	$3.76	$0.00	$0.00	$0.00	$0.00	$9.01	$14.27	$14.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-100-212	SUP	Custom 27203010		2296-100-212  -  BURR SURG 1.2MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE	BOTH IP/OP	$15.90 	$11.77	$0.00	$12.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.80	$11.80	$0.00	$0.00	$3.31	$0.00	$0.00	$0.00	$0.00	$7.95	$12.59	$12.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-100-216	SUP	Custom 27203010		2296-100-216  -  BURR SURG 1.6MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE	BOTH IP/OP	$15.90 	$11.77	$0.00	$12.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.80	$11.80	$0.00	$0.00	$3.31	$0.00	$0.00	$0.00	$0.00	$7.95	$12.59	$12.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-100-221	SUP	Custom 27203010		2296-100-221  -  BURR SURG 2.1MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE	BOTH IP/OP	$15.90 	$11.77	$0.00	$12.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.80	$11.80	$0.00	$0.00	$3.31	$0.00	$0.00	$0.00	$0.00	$7.95	$12.59	$12.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-100-240	SUP	Custom 27203010		2296-100-240  -  BURR SURG 39MM 4MM CRB RND 6 FLUT STRL	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$0.00	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-100-245	SUP	Custom 27203010		2296-100-245  -  BURR SURG 39MM 4.5MM CRB RND STRL	BOTH IP/OP	$138.00 	$102.12	$0.00	$110.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.42	$102.42	$0.00	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$69.00	$109.30	$110.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-100-418	SUP	Custom 27203010		2296-100-418  -  BURR SURG 1.8MM ROUND HEAD CARBIDE STERILE	BOTH IP/OP	$15.90 	$11.77	$0.00	$12.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.80	$11.80	$0.00	$0.00	$3.31	$0.00	$0.00	$0.00	$0.00	$7.95	$12.59	$12.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-100-423	SUP	Custom 27203010		2296-100-423  -  BURR SURG 2.3MM 45MM 8 FLUTED ROUND HEAD CARBIDE STERILE	BOTH IP/OP	$15.90 	$11.77	$0.00	$12.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.80	$11.80	$0.00	$0.00	$3.31	$0.00	$0.00	$0.00	$0.00	$7.95	$12.59	$12.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-101-230	SUP	Custom 27203010		2296-101-230  -  BURR SURG 3MM 55MM 6 FLUTED ROUND HEAD CARBIDE STERILE	BOTH IP/OP	$84.80 	$62.75	$0.00	$67.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.94	$62.94	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$42.40	$67.16	$67.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-101-418	SUP	Custom 27203010		2296-101-418  -  BURR SURG 1.8MM ROUND CARBIDE STERILE	BOTH IP/OP	$16.38 	$12.12	$0.00	$13.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.15	$12.15	$0.00	$0.00	$3.41	$0.00	$0.00	$0.00	$0.00	$8.19	$12.97	$13.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2296-101-421	SUP	Custom 27203010		2296-101-421  -  BURR SURG 2.1MM 58.5MM ROUND HEAD CROSS CUT FISSURE CARBIDE	BOTH IP/OP	$16.38 	$12.12	$0.00	$13.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.15	$12.15	$0.00	$0.00	$3.41	$0.00	$0.00	$0.00	$0.00	$8.19	$12.97	$13.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23011 L	SUP	Custom 27803010		23011 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,562.50 "	"$2,636.25"	$0.00	"$2,850.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,644.09"	"$2,644.09"	$0.00	$0.00	$742.43	$0.00	$0.00	$0.00	$0.00	"$1,781.25"	"$2,821.50"	"$2,850.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23011 M	SUP	Custom 27803010		23011 M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,738.25 "	"$2,766.31"	$0.00	"$2,990.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,774.53"	"$2,774.53"	$0.00	$0.00	$779.05	$0.00	$0.00	$0.00	$0.00	"$1,869.13"	"$2,960.69"	"$2,990.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23038 A	SUP	Custom 27803010		23038 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23038 B	SUP	Custom 27803010		23038 B  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23038 C	SUP	Custom 27803010		23038 C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23038 D	SUP	Custom 27803010		23038 D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23038 E	SUP	Custom 27803010		23038 E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23-038-386	SUP	Custom 27203010		MAS CSF TRK LIQCNTL 2X3.3.5ML	BOTH IP/OP	$196.88 	$145.69	$0.00	$157.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.44	$155.93	$157.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23059 L	SUP	Custom 27803010		23059 L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23059 M	SUP	Custom 27803010		23059 M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23064 B	SUP	Custom 27803010		23064 B  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23066 B	SUP	Custom 27803010		23066 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,401.25 "	"$1,036.93"	$0.00	"$1,121.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,040.01"	"$1,040.01"	$0.00	$0.00	$292.02	$0.00	$0.00	$0.00	$0.00	$700.63	"$1,109.79"	"$1,121.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23066 C	SUP	Custom 27803010		23066 C  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,258.75 "	$931.48	$0.00	"$1,007.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$934.24	$934.24	$0.00	$0.00	$262.32	$0.00	$0.00	$0.00	$0.00	$629.38	$996.93	"$1,007.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
231120M5	SUP	HCPCS C1713		231120M5  -  SCREW INTERFERENCE 20MM PROVEN BONE INGROWTH UNIFORMLY	BOTH IP/OP	$653.63 	$483.69	$0.00	$522.90	$294.13	$294.13	$0.00	$0.00	$0.00	$136.23	$485.12	$485.12	$0.00	$0.00	$136.22	$0.00	$386.62	$386.62	$0.00	$326.81	$517.67	$522.90	$0.00		$0.00	$102.29	$0.00	$0.00	$104.06	$0.00	$0.00	$0.00	$0.00	$0.00
23-112-1	SUP	Custom 27011340		23-112-1  -  SEALER BIPOL 5.1IN .226IN 2 ELTRD HMST DISP	BOTH IP/OP	"$1,450.78 "	"$1,073.58"	$0.00	"$1,160.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,076.77"	"$1,076.77"	$0.00	$0.00	$302.34	$0.00	$0.00	$0.00	$0.00	$725.39	"$1,149.02"	"$1,160.62"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23-139109	SUP	Custom 27203010		CONTROL MLANLT MAS URCHMTK LVL 1 15ML UA	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23-139110	SUP	Custom 27203010		CONTROL MLANLT MAS URCHMTK LVL 2 15ML UA	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2320A	SUP	HCPCS C1884		2320A  -  SYSTEM EMBL PRTC 103CM VC FEM AC APRCH INTROD GWIRE 7FR NTNL	BOTH IP/OP	"$2,544.16 "	"$1,882.68"	$0.00	"$2,035.33"	"$1,144.87"	"$1,144.87"	$0.00	$0.00	$0.00	$530.27	"$1,888.28"	"$1,888.28"	$0.00	$0.00	$530.20	$0.00	"$1,254.27"	"$1,254.27"	$0.00	"$1,272.08"	"$2,014.97"	"$2,035.33"	$0.00		$0.00	$398.16	$0.00	$0.00	$405.03	$0.00	$0.00	$0.00	$0.00	$0.00
23-247056	SUP	Custom 27203010		STAIN WRTS PRC HMTK 1GL REG HMTL	BOTH IP/OP	$360.70 	$266.92	$0.00	$288.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.35	$285.67	$288.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23-309178	SUP	Custom 27203010		REAGENT .85% NA CHLOR 20L PH 7.2 BUFF BLOOD BANK	BOTH IP/OP	$71.13 	$52.64	$0.00	$56.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.56	$56.33	$56.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23-453-18	SUP	Custom 27203010		ELEVATOR SURG 9 KNURL HNDL PROST	BOTH IP/OP	$131.25 	$97.13	$0.00	$105.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.63	$103.95	$105.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2347-15-02	SUP	HCPCS C1713		2347-15-02  -  PLATE 51MM SS 2 HOLE BONE PERIART RIGHT FIB DISTAL	BOTH IP/OP	$846.40 	$626.34	$0.00	$677.12	$380.88	$380.88	$0.00	$0.00	$0.00	$176.41	$628.20	$628.20	$0.00	$0.00	$176.39	$0.00	$500.65	$500.65	$0.00	$423.20	$670.35	$677.12	$0.00		$0.00	$132.46	$0.00	$0.00	$134.75	$0.00	$0.00	$0.00	$0.00	$0.00
2347-15-04	SUP	HCPCS C1713		2347-15-04  -  PLATE 74MM SS 4 HOLE BONE PERIART RIGHT FIB DISTAL	BOTH IP/OP	$852.15 	$630.59	$0.00	$681.72	$383.47	$383.47	$0.00	$0.00	$0.00	$177.61	$632.47	$632.47	$0.00	$0.00	$177.59	$0.00	$504.05	$504.05	$0.00	$426.08	$674.90	$681.72	$0.00		$0.00	$133.36	$0.00	$0.00	$135.66	$0.00	$0.00	$0.00	$0.00	$0.00
2347-15-06	SUP	HCPCS C1713		2347-15-06  -  PLATE 95MM SS 6 HOLE BONE PERIART RIGHT FIB DISTAL	BOTH IP/OP	$863.65 	$639.10	$0.00	$690.92	$388.64	$388.64	$0.00	$0.00	$0.00	$180.01	$641.00	$641.00	$0.00	$0.00	$179.98	$0.00	$510.85	$510.85	$0.00	$431.83	$684.01	$690.92	$0.00		$0.00	$135.16	$0.00	$0.00	$137.49	$0.00	$0.00	$0.00	$0.00	$0.00
2347-15-08	SUP	HCPCS C1713		2347-15-08  -  PLATE 116MM SS 8 HOLE BONE PERIART RIGHT FIB DISTAL	BOTH IP/OP	$876.20 	$648.39	$0.00	$700.96	$394.29	$394.29	$0.00	$0.00	$0.00	$182.62	$650.32	$650.32	$0.00	$0.00	$182.60	$0.00	$518.27	$518.27	$0.00	$438.10	$693.95	$700.96	$0.00		$0.00	$137.13	$0.00	$0.00	$139.49	$0.00	$0.00	$0.00	$0.00	$0.00
2347-15-10	SUP	HCPCS C1713		2347-15-10  -  PLATE 136MM SS 10 HOLE BONE FIB RIGHT DISTAL LAT	BOTH IP/OP	$891.00 	$659.34	$0.00	$712.80	$400.95	$400.95	$0.00	$0.00	$0.00	$185.71	$661.30	$661.30	$0.00	$0.00	$185.68	$0.00	$527.03	$527.03	$0.00	$445.50	$705.67	$712.80	$0.00		$0.00	$139.44	$0.00	$0.00	$141.85	$0.00	$0.00	$0.00	$0.00	$0.00
2347-15-12	SUP	HCPCS C1713		2347-15-12  -  PLATE 157MM SS 12 HOLE BONE FIB RIGHT DISTAL LAT	BOTH IP/OP	"$1,054.55 "	$780.37	$0.00	$843.64	$474.55	$474.55	$0.00	$0.00	$0.00	$219.79	$782.69	$782.69	$0.00	$0.00	$219.77	$0.00	$623.77	$623.77	$0.00	$527.28	$835.20	$843.64	$0.00		$0.00	$165.04	$0.00	$0.00	$167.88	$0.00	$0.00	$0.00	$0.00	$0.00
2347-15-14	SUP	HCPCS C1713		2347-15-14  -  PLATE 178MM SS 14 HOLE BONE FIB RIGHT DISTAL LAT	BOTH IP/OP	"$1,125.85 "	$833.13	$0.00	$900.68	$506.63	$506.63	$0.00	$0.00	$0.00	$234.66	$835.61	$835.61	$0.00	$0.00	$234.63	$0.00	$665.94	$665.94	$0.00	$562.93	$891.67	$900.68	$0.00		$0.00	$176.20	$0.00	$0.00	$179.24	$0.00	$0.00	$0.00	$0.00	$0.00
2347-15-16	SUP	HCPCS C1713		2347-15-16  -  PLATE 199MM SS 16 HOLE BONE FIB RIGHT DISTAL LAT	BOTH IP/OP	"$1,220.15 "	$902.91	$0.00	$976.12	$549.07	$549.07	$0.00	$0.00	$0.00	$254.31	$905.60	$905.60	$0.00	$0.00	$254.28	$0.00	$721.72	$721.72	$0.00	$610.08	$966.36	$976.12	$0.00		$0.00	$190.95	$0.00	$0.00	$194.25	$0.00	$0.00	$0.00	$0.00	$0.00
2347-15-18	SUP	HCPCS C1713		2347-15-18  -  PLATE 220MM SS 18 HOLE BONE FIB RIGHT DISTAL LAT	BOTH IP/OP	"$1,315.60 "	$973.54	$0.00	"$1,052.48"	$592.02	$592.02	$0.00	$0.00	$0.00	$274.20	$976.44	$976.44	$0.00	$0.00	$274.17	$0.00	$778.18	$778.18	$0.00	$657.80	"$1,041.96"	"$1,052.48"	$0.00		$0.00	$205.89	$0.00	$0.00	$209.44	$0.00	$0.00	$0.00	$0.00	$0.00
2347-15-20	SUP	HCPCS C1713		2347-15-20  -  PLATE 241MM SS 20 HOLE BONE FIB RIGHT DISTAL LAT	BOTH IP/OP	"$1,434.05 "	"$1,061.20"	$0.00	"$1,147.24"	$645.32	$645.32	$0.00	$0.00	$0.00	$298.89	"$1,064.35"	"$1,064.35"	$0.00	$0.00	$298.86	$0.00	$848.24	$848.24	$0.00	$717.03	"$1,135.77"	"$1,147.24"	$0.00		$0.00	$224.43	$0.00	$0.00	$228.30	$0.00	$0.00	$0.00	$0.00	$0.00
2347-16-02	SUP	HCPCS C1713		2347-16-02  -  PLATE 51MM SS 2 HOLE BONE FIB LEFT DISTAL LAT	BOTH IP/OP	$846.40 	$626.34	$0.00	$677.12	$380.88	$380.88	$0.00	$0.00	$0.00	$176.41	$628.20	$628.20	$0.00	$0.00	$176.39	$0.00	$500.65	$500.65	$0.00	$423.20	$670.35	$677.12	$0.00		$0.00	$132.46	$0.00	$0.00	$134.75	$0.00	$0.00	$0.00	$0.00	$0.00
2347-16-04	SUP	HCPCS C1713		2347-16-04  -  PLATE 74MM SS 2.7MM 3.5MM CORT PERIART 2.7MM CANC	BOTH IP/OP	$852.15 	$630.59	$0.00	$681.72	$383.47	$383.47	$0.00	$0.00	$0.00	$177.61	$632.47	$632.47	$0.00	$0.00	$177.59	$0.00	$504.05	$504.05	$0.00	$426.08	$674.90	$681.72	$0.00		$0.00	$133.36	$0.00	$0.00	$135.66	$0.00	$0.00	$0.00	$0.00	$0.00
2347-16-06	SUP	HCPCS C1713		2347-16-06  -  PLATE 95MM 6 HOLE BONE FIB L/L	BOTH IP/OP	$863.90 	$639.29	$0.00	$691.12	$388.76	$388.76	$0.00	$0.00	$0.00	$180.06	$641.19	$641.19	$0.00	$0.00	$180.04	$0.00	$511.00	$511.00	$0.00	$431.95	$684.21	$691.12	$0.00		$0.00	$135.20	$0.00	$0.00	$137.53	$0.00	$0.00	$0.00	$0.00	$0.00
2347-16-08	SUP	HCPCS C1713		2347-16-08  -  PLATE 116MM 8 HOLE BONE FIB L/L	BOTH IP/OP	$876.20 	$648.39	$0.00	$700.96	$394.29	$394.29	$0.00	$0.00	$0.00	$182.62	$650.32	$650.32	$0.00	$0.00	$182.60	$0.00	$518.27	$518.27	$0.00	$438.10	$693.95	$700.96	$0.00		$0.00	$137.13	$0.00	$0.00	$139.49	$0.00	$0.00	$0.00	$0.00	$0.00
2347-16-10	SUP	HCPCS C1713		2347-16-10  -  PLATE 135MM 10 HOLE BONE FIB L/L	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
2347-16-12	SUP	HCPCS C1713		2347-16-12  -  PLATE 157MM 12 HOLE BONE FIB L/L	BOTH IP/OP	"$1,054.55 "	$780.37	$0.00	$843.64	$474.55	$474.55	$0.00	$0.00	$0.00	$219.79	$782.69	$782.69	$0.00	$0.00	$219.77	$0.00	$623.77	$623.77	$0.00	$527.28	$835.20	$843.64	$0.00		$0.00	$165.04	$0.00	$0.00	$167.88	$0.00	$0.00	$0.00	$0.00	$0.00
2347-16-14	SUP	HCPCS C1713		2347-16-14  -  PLATE 178MM 14 HOLE BONE FIB L/L	BOTH IP/OP	"$1,125.85 "	$833.13	$0.00	$900.68	$506.63	$506.63	$0.00	$0.00	$0.00	$234.66	$835.61	$835.61	$0.00	$0.00	$234.63	$0.00	$665.94	$665.94	$0.00	$562.93	$891.67	$900.68	$0.00		$0.00	$176.20	$0.00	$0.00	$179.24	$0.00	$0.00	$0.00	$0.00	$0.00
2347-16-16	SUP	HCPCS C1713		2347-16-16  -  PLATE 199MM 16 HOLE BONE FIB L/L	BOTH IP/OP	"$1,220.15 "	$902.91	$0.00	$976.12	$549.07	$549.07	$0.00	$0.00	$0.00	$254.31	$905.60	$905.60	$0.00	$0.00	$254.28	$0.00	$721.72	$721.72	$0.00	$610.08	$966.36	$976.12	$0.00		$0.00	$190.95	$0.00	$0.00	$194.25	$0.00	$0.00	$0.00	$0.00	$0.00
2347-16-18	SUP	HCPCS C1713		2347-16-18  -  PLATE 220MM 18 HOLE BONE FIB L/L	BOTH IP/OP	"$1,315.60 "	$973.54	$0.00	"$1,052.48"	$592.02	$592.02	$0.00	$0.00	$0.00	$274.20	$976.44	$976.44	$0.00	$0.00	$274.17	$0.00	$778.18	$778.18	$0.00	$657.80	"$1,041.96"	"$1,052.48"	$0.00		$0.00	$205.89	$0.00	$0.00	$209.44	$0.00	$0.00	$0.00	$0.00	$0.00
2347-16-20	SUP	HCPCS C1713		2347-16-20  -  PLATE 241MM 20 HOLE BONE FIB L/L	BOTH IP/OP	"$1,434.05 "	"$1,061.20"	$0.00	"$1,147.24"	$645.32	$645.32	$0.00	$0.00	$0.00	$298.89	"$1,064.35"	"$1,064.35"	$0.00	$0.00	$298.86	$0.00	$848.24	$848.24	$0.00	$717.03	"$1,135.77"	"$1,147.24"	$0.00		$0.00	$224.43	$0.00	$0.00	$228.30	$0.00	$0.00	$0.00	$0.00	$0.00
2347-17-02	SUP	HCPCS C1713		2347-17-02  -  PLATE 51MM 2 HOLE BONE FIB RIGHT	BOTH IP/OP	$846.40 	$626.34	$0.00	$677.12	$380.88	$380.88	$0.00	$0.00	$0.00	$176.41	$628.20	$628.20	$0.00	$0.00	$176.39	$0.00	$500.65	$500.65	$0.00	$423.20	$670.35	$677.12	$0.00		$0.00	$132.46	$0.00	$0.00	$134.75	$0.00	$0.00	$0.00	$0.00	$0.00
2347-17-04	SUP	HCPCS C1713		2347-17-04  -  PLATE 73MM SS 4 HOLE BONE FIB RIGHT DISTAL LAT	BOTH IP/OP	$852.15 	$630.59	$0.00	$681.72	$383.47	$383.47	$0.00	$0.00	$0.00	$177.61	$632.47	$632.47	$0.00	$0.00	$177.59	$0.00	$504.05	$504.05	$0.00	$426.08	$674.90	$681.72	$0.00		$0.00	$133.36	$0.00	$0.00	$135.66	$0.00	$0.00	$0.00	$0.00	$0.00
2347-17-06	SUP	HCPCS C1713		2347-17-06  -  PLATE 94MM SS 6 HOLE BONE FIB RIGHT DISTAL LAT	BOTH IP/OP	$863.65 	$639.10	$0.00	$690.92	$388.64	$388.64	$0.00	$0.00	$0.00	$180.01	$641.00	$641.00	$0.00	$0.00	$179.98	$0.00	$510.85	$510.85	$0.00	$431.83	$684.01	$690.92	$0.00		$0.00	$135.16	$0.00	$0.00	$137.49	$0.00	$0.00	$0.00	$0.00	$0.00
2347-17-08	SUP	HCPCS C1713		2347-17-08  -  PLATE 115MM SS 8 HOLE BONE FIB RIGHT DISTAL LAT	BOTH IP/OP	$876.20 	$648.39	$0.00	$700.96	$394.29	$394.29	$0.00	$0.00	$0.00	$182.62	$650.32	$650.32	$0.00	$0.00	$182.60	$0.00	$518.27	$518.27	$0.00	$438.10	$693.95	$700.96	$0.00		$0.00	$137.13	$0.00	$0.00	$139.49	$0.00	$0.00	$0.00	$0.00	$0.00
2347-17-10	SUP	HCPCS C1713		2347-17-10  -  PLATE 135MM SS 10 HOLE BONE FIB RIGHT DISTAL LAT	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
2347-17-12	SUP	HCPCS C1713		2347-17-12  -  PLATE 156MM SS 12 HOLE BONE PERIART RIGHT FIB	BOTH IP/OP	"$1,054.55 "	$780.37	$0.00	$843.64	$474.55	$474.55	$0.00	$0.00	$0.00	$219.79	$782.69	$782.69	$0.00	$0.00	$219.77	$0.00	$623.77	$623.77	$0.00	$527.28	$835.20	$843.64	$0.00		$0.00	$165.04	$0.00	$0.00	$167.88	$0.00	$0.00	$0.00	$0.00	$0.00
2347-17-14	SUP	HCPCS C1713		2347-17-14  -  PLATE 177MM SS 14 HOLE BONE PERIART RIGHT FIB	BOTH IP/OP	"$1,125.85 "	$833.13	$0.00	$900.68	$506.63	$506.63	$0.00	$0.00	$0.00	$234.66	$835.61	$835.61	$0.00	$0.00	$234.63	$0.00	$665.94	$665.94	$0.00	$562.93	$891.67	$900.68	$0.00		$0.00	$176.20	$0.00	$0.00	$179.24	$0.00	$0.00	$0.00	$0.00	$0.00
2347-17-16	SUP	HCPCS C1713		2347-17-16  -  PLATE 198MM SS 16 HOLE BONE PERIART RIGHT FIB	BOTH IP/OP	"$1,220.15 "	$902.91	$0.00	$976.12	$549.07	$549.07	$0.00	$0.00	$0.00	$254.31	$905.60	$905.60	$0.00	$0.00	$254.28	$0.00	$721.72	$721.72	$0.00	$610.08	$966.36	$976.12	$0.00		$0.00	$190.95	$0.00	$0.00	$194.25	$0.00	$0.00	$0.00	$0.00	$0.00
2347-17-18	SUP	HCPCS C1713		2347-17-18  -  PLATE 219MM SS 18 HOLE BONE PERIART RIGHT FIB	BOTH IP/OP	"$1,315.60 "	$973.54	$0.00	"$1,052.48"	$592.02	$592.02	$0.00	$0.00	$0.00	$274.20	$976.44	$976.44	$0.00	$0.00	$274.17	$0.00	$778.18	$778.18	$0.00	$657.80	"$1,041.96"	"$1,052.48"	$0.00		$0.00	$205.89	$0.00	$0.00	$209.44	$0.00	$0.00	$0.00	$0.00	$0.00
2347-17-20	SUP	HCPCS C1713		2347-17-20  -  PLATE 239MM SS 20 HOLE BONE PERIART RIGHT FIB	BOTH IP/OP	"$1,284.05 "	$950.20	$0.00	"$1,027.24"	$577.82	$577.82	$0.00	$0.00	$0.00	$267.63	$953.02	$953.02	$0.00	$0.00	$267.60	$0.00	$759.52	$759.52	$0.00	$642.03	"$1,016.97"	"$1,027.24"	$0.00		$0.00	$200.95	$0.00	$0.00	$204.42	$0.00	$0.00	$0.00	$0.00	$0.00
2347-18-02	SUP	HCPCS C1713		2347-18-02  -  PLATE 51MM SS 2 HOLE BONE PERIART LEFT FIB	BOTH IP/OP	$846.40 	$626.34	$0.00	$677.12	$380.88	$380.88	$0.00	$0.00	$0.00	$176.41	$628.20	$628.20	$0.00	$0.00	$176.39	$0.00	$500.65	$500.65	$0.00	$423.20	$670.35	$677.12	$0.00		$0.00	$132.46	$0.00	$0.00	$134.75	$0.00	$0.00	$0.00	$0.00	$0.00
2347-18-04	SUP	HCPCS C1713		2347-18-04  -  PLATE BN 73MM STRL 4 HL SS FIB LT DIST LAT PERIART	BOTH IP/OP	$852.15 	$630.59	$0.00	$681.72	$383.47	$383.47	$0.00	$0.00	$0.00	$177.61	$632.47	$632.47	$0.00	$0.00	$177.59	$0.00	$504.05	$504.05	$0.00	$426.08	$674.90	$681.72	$0.00		$0.00	$133.36	$0.00	$0.00	$135.66	$0.00	$0.00	$0.00	$0.00	$0.00
2347-18-06	SUP	HCPCS C1713		2347-18-06  -  PLATE 94MM 6 HOLE BONE LEFT DISTAL LAT FIB	BOTH IP/OP	$863.65 	$639.10	$0.00	$690.92	$388.64	$388.64	$0.00	$0.00	$0.00	$180.01	$641.00	$641.00	$0.00	$0.00	$179.98	$0.00	$510.85	$510.85	$0.00	$431.83	$684.01	$690.92	$0.00		$0.00	$135.16	$0.00	$0.00	$137.49	$0.00	$0.00	$0.00	$0.00	$0.00
2347-18-08	SUP	HCPCS C1713		2347-18-08  -  PLATE 115MM SS 8 HOLE BONE FIB LEFT DISTAL LAT	BOTH IP/OP	$876.20 	$648.39	$0.00	$700.96	$394.29	$394.29	$0.00	$0.00	$0.00	$182.62	$650.32	$650.32	$0.00	$0.00	$182.60	$0.00	$518.27	$518.27	$0.00	$438.10	$693.95	$700.96	$0.00		$0.00	$137.13	$0.00	$0.00	$139.49	$0.00	$0.00	$0.00	$0.00	$0.00
2347-18-10	SUP	HCPCS C1713		2347-18-10  -  PLATE 135MM SS 10 HOLE BONE FIB LEFT DISTAL LAT	BOTH IP/OP	$966.00 	$714.84	$0.00	$772.80	$434.70	$434.70	$0.00	$0.00	$0.00	$201.34	$716.97	$716.97	$0.00	$0.00	$201.31	$0.00	$571.39	$571.39	$0.00	$483.00	$765.07	$772.80	$0.00		$0.00	$151.18	$0.00	$0.00	$153.79	$0.00	$0.00	$0.00	$0.00	$0.00
2347-18-12	SUP	HCPCS C1713		2347-18-12  -  PLATE 156MM SS 12 HOLE BONE FIB LEFT DISTAL LAT	BOTH IP/OP	"$1,054.55 "	$780.37	$0.00	$843.64	$474.55	$474.55	$0.00	$0.00	$0.00	$219.79	$782.69	$782.69	$0.00	$0.00	$219.77	$0.00	$623.77	$623.77	$0.00	$527.28	$835.20	$843.64	$0.00		$0.00	$165.04	$0.00	$0.00	$167.88	$0.00	$0.00	$0.00	$0.00	$0.00
2347-18-14	SUP	HCPCS C1713		2347-18-14  -  PLATE 177MM SS 14 HOLE BONE FIB LEFT DISTAL LAT	BOTH IP/OP	"$1,125.85 "	$833.13	$0.00	$900.68	$506.63	$506.63	$0.00	$0.00	$0.00	$234.66	$835.61	$835.61	$0.00	$0.00	$234.63	$0.00	$665.94	$665.94	$0.00	$562.93	$891.67	$900.68	$0.00		$0.00	$176.20	$0.00	$0.00	$179.24	$0.00	$0.00	$0.00	$0.00	$0.00
2347-18-16	SUP	HCPCS C1713		2347-18-16  -  PLATE 198MM SS 16 HOLE BONE FIB LEFT DISTAL LAT	BOTH IP/OP	"$1,220.15 "	$902.91	$0.00	$976.12	$549.07	$549.07	$0.00	$0.00	$0.00	$254.31	$905.60	$905.60	$0.00	$0.00	$254.28	$0.00	$721.72	$721.72	$0.00	$610.08	$966.36	$976.12	$0.00		$0.00	$190.95	$0.00	$0.00	$194.25	$0.00	$0.00	$0.00	$0.00	$0.00
2347-18-18	SUP	HCPCS C1713		2347-18-18  -  PLATE 219MM SS 18 HOLE BONE FIB LEFT DISTAL LAT	BOTH IP/OP	"$1,300.60 "	$962.44	$0.00	"$1,040.48"	$585.27	$585.27	$0.00	$0.00	$0.00	$271.08	$965.31	$965.31	$0.00	$0.00	$271.05	$0.00	$769.30	$769.30	$0.00	$650.30	"$1,030.08"	"$1,040.48"	$0.00		$0.00	$203.54	$0.00	$0.00	$207.06	$0.00	$0.00	$0.00	$0.00	$0.00
2347-18-20	SUP	HCPCS C1713		2347-18-20  -  PLATE 239MM SS 20 HOLE BONE FIB LEFT DISTAL LAT	BOTH IP/OP	"$1,434.05 "	"$1,061.20"	$0.00	"$1,147.24"	$645.32	$645.32	$0.00	$0.00	$0.00	$298.89	"$1,064.35"	"$1,064.35"	$0.00	$0.00	$298.86	$0.00	$848.24	$848.24	$0.00	$717.03	"$1,135.77"	"$1,147.24"	$0.00		$0.00	$224.43	$0.00	$0.00	$228.30	$0.00	$0.00	$0.00	$0.00	$0.00
2348-12-35	SUP	HCPCS C1713		2348-12-35  -  SCREW BN 3.5MM 2.7MM 12MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-14-35	SUP	HCPCS C1713		2348-14-35  -  SCREW BN 3.5MM 2.7MM 14MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-16-35	SUP	HCPCS C1713		2348-16-35  -  SCREW BN 3.5MM 2.7MM 16MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-18-35	SUP	HCPCS C1713		2348-18-35  -  SCREW BONE 3.5MM 2.7MM 18MM SELF TAP STAINLESS STEEL	BOTH IP/OP	$74.75 	$55.32	$0.00	$59.80	$33.64	$33.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.38	$59.20	$59.80	$0.00		$0.00	$11.70	$0.00	$0.00	$11.90	$0.00	$0.00	$0.00	$0.00	$0.00
2348-20-35	SUP	HCPCS C1713		2348-20-35  -  SCREW BN 2.7MM 3.5MM 20MM ST CORT	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-22-35	SUP	HCPCS C1713		2348-22-35  -  SCREW BN 3.5MM 2.7MM 22MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-24-35	SUP	HCPCS C1713		2348-24-35  -  SCREW BN 3.5MM 2.7MM 24MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-26-35	SUP	HCPCS C1713		2348-26-35  -  SCREW BN 3.5MM 2.7MM 26MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-28-35	SUP	HCPCS C1713		2348-28-35  -  SCREW BN 3.5MM 2.7MM 28MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-30-35	SUP	HCPCS C1713		2348-30-35  -  SCREW BN 3.5MM 2.7MM 30MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-32-35	SUP	HCPCS C1713		2348-32-35  -  SCREW BN 3.5MM 2.7MM 32MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-34-35	SUP	HCPCS C1713		2348-34-35  -  SCREW BN 3.5MM 2.7MM 34MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-36-35	SUP	HCPCS C1713		2348-36-35  -  SCREW BN 3.5MM 2.7MM 36MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-38-35	SUP	HCPCS C1713		2348-38-35  -  SCREW BN 3.5MM 2.7MM 38MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-40-35	SUP	HCPCS C1713		2348-40-35  -  SCREW BN 3.5MM 2.7MM 40MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-42-35	SUP	HCPCS C1713		2348-42-35  -  SCREW BN 3.5MM 2.7MM 42MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-44-35	SUP	HCPCS C1713		2348-44-35  -  SCREW BN 3.5MM 2.7MM 44MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$62.10 	$45.95	$0.00	$49.68	$27.95	$27.95	$0.00	$0.00	$0.00	$12.94	$46.09	$46.09	$0.00	$0.00	$12.94	$0.00	$36.73	$36.73	$0.00	$31.05	$49.18	$49.68	$0.00		$0.00	$9.72	$0.00	$0.00	$9.89	$0.00	$0.00	$0.00	$0.00	$0.00
2348-46-35	SUP	HCPCS C1713		2348-46-35  -  SCREW BN 3.5MM 2.7MM 46MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-48-35	SUP	HCPCS C1713		2348-48-35  -  SCREW BN 3.5MM 2.7MM 48MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-50-35	SUP	HCPCS C1713		2348-50-35  -  SCREW BN 3.5MM 2.7MM 50MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-52-35	SUP	HCPCS C1713		2348-52-35  -  SCREW BN 3.5MM 2.7MM 52MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-54-35	SUP	HCPCS C1713		2348-54-35  -  SCREW BN 3.5MM 2.7MM 54MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-56-35	SUP	HCPCS C1713		2348-56-35  -  SCREW BN 3.5MM 2.7MM 56MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-58-35	SUP	HCPCS C1713		2348-58-35  -  SCREW BN 3.5MM 58MM PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-60-35	SUP	HCPCS C1713		2348-60-35  -  SCREW BN 3.5MM 2.7MM 60MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-65-35	SUP	HCPCS C1713		2348-65-35  -  SCREW BN 3.5MM 2.7MM 65MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-70-35	SUP	HCPCS C1713		2348-70-35  -  SCREW BN 3.5MM 2.7MM 70MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-75-35	SUP	HCPCS C1713		2348-75-35  -  SCREW BN 3.5MM 2.7MM 75MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-80-35	SUP	HCPCS C1713		2348-80-35  -  SCREW BN 3.5MM 2.7MM 80MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-85-35	SUP	HCPCS C1713		2348-85-35  -  SCREW BN 3.5MM 2.7MM 85MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-90-35	SUP	HCPCS C1713		2348-90-35  -  SCREW BN 3.5MM 2.7MM 90MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
2348-95-35	SUP	HCPCS C1713		2348-95-35  -  SCREW BN 3.5MM 2.7MM 95MM NS ST SS ELB CORT PERIART	BOTH IP/OP	$60.85 	$45.03	$0.00	$48.68	$27.38	$27.38	$0.00	$0.00	$0.00	$12.68	$45.16	$45.16	$0.00	$0.00	$12.68	$0.00	$35.99	$35.99	$0.00	$30.43	$48.19	$48.68	$0.00		$0.00	$9.52	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$0.00
235-F	SUP	Custom 27803010		235-F  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,623.50 "	"$1,201.39"	$0.00	"$1,298.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,204.96"	"$1,204.96"	$0.00	$0.00	$338.34	$0.00	$0.00	$0.00	$0.00	$811.75	"$1,285.81"	"$1,298.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
236.504S	SUP	HCPCS C1713		236.504S  -  PLATE BN CNTR 112MM STRL LCP CMBN 4 HL ELONGATE HL PROX TAB	BOTH IP/OP	"$1,807.73 "	"$1,337.72"	$0.00	"$1,404.06"	$789.78	$789.78	$0.00	$0.00	$0.00	$376.78	"$1,341.69"	"$1,341.69"	$0.00	$0.00	$376.73	$0.00	"$1,069.27"	"$1,069.27"	$0.00	$877.54	"$1,390.02"	"$1,404.06"	$0.00		$0.00	$266.67	$0.00	$0.00	$279.41	$0.00	$0.00	$0.00	$0.00	$0.00
236-01	SUP	HCPCS C1713		236-01  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$490.88 	$363.25	$0.00	$392.70	$220.89	$220.89	$0.00	$0.00	$0.00	$102.31	$364.33	$364.33	$0.00	$0.00	$102.30	$0.00	$290.35	$290.35	$0.00	$245.44	$388.78	$392.70	$0.00		$0.00	$76.82	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$0.00
236-02	SUP	HCPCS C1713		236-02  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$575.88 	$426.15	$0.00	$460.70	$259.14	$259.14	$0.00	$0.00	$0.00	$120.03	$427.41	$427.41	$0.00	$0.00	$120.01	$0.00	$340.63	$340.63	$0.00	$287.94	$456.10	$460.70	$0.00		$0.00	$90.12	$0.00	$0.00	$91.68	$0.00	$0.00	$0.00	$0.00	$0.00
236-04	SUP	HCPCS C1713		236-04  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$735.25 	$544.09	$0.00	$588.20	$330.86	$330.86	$0.00	$0.00	$0.00	$153.24	$545.70	$545.70	$0.00	$0.00	$153.23	$0.00	$434.90	$434.90	$0.00	$367.63	$582.32	$588.20	$0.00		$0.00	$115.07	$0.00	$0.00	$117.05	$0.00	$0.00	$0.00	$0.00	$0.00
23-640-000	SUP	Custom 27203010		MAS CARDIOIMMUNE XL LVL 1 3ML 6/PK	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23-640-001	SUP	Custom 27203010		MAS CARDIOIMMUNE XL LVL 2 3ML 6/PK	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23-640-002	SUP	Custom 27203010		MAS CARDIOIMMUNE XL LVL 3 3ML 6/PK	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23-640-003	SUP	Custom 27203010		MAS CARDIOIMMUNE XL LVL L 3ML 6/PK	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23-666471	SUP	Custom 27203010		REAGENT B-OHB R1 R2 50ML ANALY	BOTH IP/OP	$854.13 	$632.06	$0.00	$683.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.06	$676.47	$683.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23-666472	SUP	Custom 27203010		CONTROL CHM 5ML SET B-OHB	BOTH IP/OP	$723.00 	$535.02	$0.00	$578.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.50	$572.62	$578.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
237.043S	SUP	HCPCS C1713		237.043S  -  PLATE BONE 90D 30MM 4 HOLE LIMITED CONTACT ANGLED BLADE CANN	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
237.044S	SUP	HCPCS C1713		237.044S  -  PLATE BONE 90D 40MM 4 HOLE LIMITED CONTACT ANGLED BLADE CANN	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
237.053S	SUP	HCPCS C1713		237.053S  -  PLATE BN 90D 30X11.7MM STRL 5 HL LMT CNTCT CNN SS 4.5MM SCR	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
237.054S	SUP	HCPCS C1713		237.054S  -  PLATE BONE 90D 40MM 5 HOLE LIMITED CONTACT ANGLED BLADE CANN	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
237.063S	SUP	HCPCS C1713		237.063S  -  PLATE BONE 90D 30MM 6 HOLE LIMITED CONTACT ANGLED BLADE CANN	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
237.064S	SUP	HCPCS C1713		237.064S  -  PLATE BONE 90D 40MM 6 HOLE LIMITED CONTACT ANGLED BLADE CANN	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
237.083S	SUP	HCPCS C1713		237.083S  -  PLATE BONE 90D 30MM 8 HOLE LIMITED CONTACT ANGLED BLADE CANN	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
237.084S	SUP	HCPCS C1713		237.084S  -  PLATE BONE 90D 40MM 8 HOLE LIMITED CONTACT ANGLED BLADE CANN	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
237.085S	SUP	HCPCS C1713		237.085S  -  PLATE BONE 90D 50MM 8 HOLE LIMITED CONTACT ANGLED BLADE CANN	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
237.086S	SUP	HCPCS C1713		237.086S  -  PLATE BN 90D 60X11.7MM STRL 8 HL LMT CNTCT CNN SS 4.5MM SCR	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
237.103S	SUP	HCPCS C1713		237.103S  -  PLATE BONE 90D 30MM 10 HOLE LIMITED CONTACT ANGLED BLADE	BOTH IP/OP	"$2,134.58 "	"$1,579.59"	$0.00	"$1,707.66"	$960.56	$960.56	$0.00	$0.00	$0.00	$444.90	"$1,584.28"	"$1,584.28"	$0.00	$0.00	$444.85	$0.00	"$1,262.60"	"$1,262.60"	$0.00	"$1,067.29"	"$1,690.59"	"$1,707.66"	$0.00		$0.00	$334.06	$0.00	$0.00	$339.82	$0.00	$0.00	$0.00	$0.00	$0.00
237.104S	SUP	HCPCS C1713		237.104S  -  PLATE BONE 90D 40MM 10 HOLE LIMITED CONTACT ANGLED BLADE	BOTH IP/OP	"$2,134.58 "	"$1,579.59"	$0.00	"$1,707.66"	$960.56	$960.56	$0.00	$0.00	$0.00	$444.90	"$1,584.28"	"$1,584.28"	$0.00	$0.00	$444.85	$0.00	"$1,262.60"	"$1,262.60"	$0.00	"$1,067.29"	"$1,690.59"	"$1,707.66"	$0.00		$0.00	$334.06	$0.00	$0.00	$339.82	$0.00	$0.00	$0.00	$0.00	$0.00
237.105S	SUP	HCPCS C1713		237.105S  -  PLATE BONE 90D 50MM 10 HOLE LIMITED CONTACT ANGLED BLADE	BOTH IP/OP	"$2,134.58 "	"$1,579.59"	$0.00	"$1,707.66"	$960.56	$960.56	$0.00	$0.00	$0.00	$444.90	"$1,584.28"	"$1,584.28"	$0.00	$0.00	$444.85	$0.00	"$1,262.60"	"$1,262.60"	$0.00	"$1,067.29"	"$1,690.59"	"$1,707.66"	$0.00		$0.00	$334.06	$0.00	$0.00	$339.82	$0.00	$0.00	$0.00	$0.00	$0.00
237.106S	SUP	HCPCS C1713		237.106S  -  PLATE BONE 90D 60MM 10 HOLE LIMITED CONTACT ANGLED BLADE	BOTH IP/OP	"$2,134.58 "	"$1,579.59"	$0.00	"$1,707.66"	$960.56	$960.56	$0.00	$0.00	$0.00	$444.90	"$1,584.28"	"$1,584.28"	$0.00	$0.00	$444.85	$0.00	"$1,262.60"	"$1,262.60"	$0.00	"$1,067.29"	"$1,690.59"	"$1,707.66"	$0.00		$0.00	$334.06	$0.00	$0.00	$339.82	$0.00	$0.00	$0.00	$0.00	$0.00
237.123S	SUP	HCPCS C1713		237.123S  -  PLATE BONE 90D 30MM 12 HOLE LIMITED CONTACT ANGLED BLADE	BOTH IP/OP	"$2,134.58 "	"$1,579.59"	$0.00	"$1,707.66"	$960.56	$960.56	$0.00	$0.00	$0.00	$444.90	"$1,584.28"	"$1,584.28"	$0.00	$0.00	$444.85	$0.00	"$1,262.60"	"$1,262.60"	$0.00	"$1,067.29"	"$1,690.59"	"$1,707.66"	$0.00		$0.00	$334.06	$0.00	$0.00	$339.82	$0.00	$0.00	$0.00	$0.00	$0.00
237.124S	SUP	HCPCS C1713		237.124S  -  PLATE BONE 90D 40MM 220MM 12 HOLE SHAFT LCP STAINLESS STEEL	BOTH IP/OP	"$2,134.58 "	"$1,579.59"	$0.00	"$1,707.66"	$960.56	$960.56	$0.00	$0.00	$0.00	$444.90	"$1,584.28"	"$1,584.28"	$0.00	$0.00	$444.85	$0.00	"$1,262.60"	"$1,262.60"	$0.00	"$1,067.29"	"$1,690.59"	"$1,707.66"	$0.00		$0.00	$334.06	$0.00	$0.00	$339.82	$0.00	$0.00	$0.00	$0.00	$0.00
237.125S	SUP	HCPCS C1713		237.125S  -  PLATE BONE 90D 50MM 12 HOLE LIMITED CONTACT ANGLED BLADE	BOTH IP/OP	"$2,134.58 "	"$1,579.59"	$0.00	"$1,707.66"	$960.56	$960.56	$0.00	$0.00	$0.00	$444.90	"$1,584.28"	"$1,584.28"	$0.00	$0.00	$444.85	$0.00	"$1,262.60"	"$1,262.60"	$0.00	"$1,067.29"	"$1,690.59"	"$1,707.66"	$0.00		$0.00	$334.06	$0.00	$0.00	$339.82	$0.00	$0.00	$0.00	$0.00	$0.00
237.126S	SUP	HCPCS C1713		237.126S  -  PLATE BONE 90D 60MM 12 HOLE LIMITED CONTACT ANGLED BLADE	BOTH IP/OP	"$2,134.58 "	"$1,579.59"	$0.00	"$1,707.66"	$960.56	$960.56	$0.00	$0.00	$0.00	$444.90	"$1,584.28"	"$1,584.28"	$0.00	$0.00	$444.85	$0.00	"$1,262.60"	"$1,262.60"	$0.00	"$1,067.29"	"$1,690.59"	"$1,707.66"	$0.00		$0.00	$334.06	$0.00	$0.00	$339.82	$0.00	$0.00	$0.00	$0.00	$0.00
237.143S	SUP	HCPCS C1713		237.143S  -  PLATE BONE 90D 30MM 14 HOLE LIMITED CONTACT ANGLED BLADE	BOTH IP/OP	"$2,709.63 "	"$2,005.13"	$0.00	"$2,167.70"	"$1,219.33"	"$1,219.33"	$0.00	$0.00	$0.00	$564.75	"$2,011.08"	"$2,011.08"	$0.00	$0.00	$564.69	$0.00	"$1,335.85"	"$1,335.85"	$0.00	"$1,354.81"	"$2,146.03"	"$2,167.70"	$0.00		$0.00	$424.06	$0.00	$0.00	$431.37	$0.00	$0.00	$0.00	$0.00	$0.00
237.144S	SUP	HCPCS C1713		237.144S  -  PLATE BONE 90D 40MM 14 HOLE LIMITED CONTACT ANGLED BLADE	BOTH IP/OP	"$2,709.63 "	"$2,005.13"	$0.00	"$2,167.70"	"$1,219.33"	"$1,219.33"	$0.00	$0.00	$0.00	$564.75	"$2,011.08"	"$2,011.08"	$0.00	$0.00	$564.69	$0.00	"$1,335.85"	"$1,335.85"	$0.00	"$1,354.81"	"$2,146.03"	"$2,167.70"	$0.00		$0.00	$424.06	$0.00	$0.00	$431.37	$0.00	$0.00	$0.00	$0.00	$0.00
237.145S	SUP	HCPCS C1713		237.145S  -  PLATE BONE 90D 50MM 14 HOLE LIMITED CONTACT ANGLED BLADE	BOTH IP/OP	"$2,709.63 "	"$2,005.13"	$0.00	"$2,167.70"	"$1,219.33"	"$1,219.33"	$0.00	$0.00	$0.00	$564.75	"$2,011.08"	"$2,011.08"	$0.00	$0.00	$564.69	$0.00	"$1,335.85"	"$1,335.85"	$0.00	"$1,354.81"	"$2,146.03"	"$2,167.70"	$0.00		$0.00	$424.06	$0.00	$0.00	$431.37	$0.00	$0.00	$0.00	$0.00	$0.00
237.146S	SUP	HCPCS C1713		237.146S  -  PLATE BONE 90D 60MM 14 HOLE LIMITED CONTACT ANGLED BLADE	BOTH IP/OP	"$2,709.63 "	"$2,005.13"	$0.00	"$2,167.70"	"$1,219.33"	"$1,219.33"	$0.00	$0.00	$0.00	$564.75	"$2,011.08"	"$2,011.08"	$0.00	$0.00	$564.69	$0.00	"$1,335.85"	"$1,335.85"	$0.00	"$1,354.81"	"$2,146.03"	"$2,167.70"	$0.00		$0.00	$424.06	$0.00	$0.00	$431.37	$0.00	$0.00	$0.00	$0.00	$0.00
237020T5	SUP	HCPCS C1713		237020T5  -  SCREW INTFR PLA 20MM 7.3MM ACL BABSR SLF REINF MATRYX STRL	BOTH IP/OP	$725.00 	$536.50	$0.00	$580.00	$326.25	$326.25	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$362.50	$574.20	$580.00	$0.00		$0.00	$113.46	$0.00	$0.00	$115.42	$0.00	$0.00	$0.00	$0.00	$0.00
238020T5	SUP	HCPCS C1713		238020T5  -  SCREW BABSR 20MM 8MM MATRYX	BOTH IP/OP	$725.00 	$536.50	$0.00	$580.00	$326.25	$326.25	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$362.50	$574.20	$580.00	$0.00		$0.00	$113.46	$0.00	$0.00	$115.42	$0.00	$0.00	$0.00	$0.00	$0.00
23-875-595	SUP	Custom 27203010		KIT BIOSTAR ACV HCG CNTRL POS NEG MCBLTST	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
239.955S	SUP	HCPCS C1713		239.955S  -  PLATE 93MM SS 3.5MM SCR 4 HOLE SM FRAG LCP BONE OD LEFT MDL	BOTH IP/OP	"$2,746.73 "	"$2,032.58"	$0.00	"$2,515.18"	"$1,414.79"	"$1,414.79"	$0.00	$0.00	$0.00	$572.49	"$2,038.62"	"$2,038.62"	$0.00	$0.00	$572.42	$0.00	"$1,354.14"	"$1,354.14"	$0.00	"$1,571.99"	"$2,490.03"	"$2,515.18"	$0.00		$0.00	$492.03	$0.00	$0.00	$500.52	$0.00	$0.00	$0.00	$0.00	$0.00
239.986S	SUP	HCPCS C1713		239.986S  -  PLATE BN CNTR 142MM STRL LCP CMBN 6 HL LMT CNTCT SS TIB RT	BOTH IP/OP	"$2,788.90 "	"$2,063.79"	$0.00	"$2,166.14"	"$1,218.45"	"$1,218.45"	$0.00	$0.00	$0.00	$581.28	"$2,069.92"	"$2,069.92"	$0.00	$0.00	$581.21	$0.00	"$1,374.93"	"$1,374.93"	$0.00	"$1,353.84"	"$2,144.48"	"$2,166.14"	$0.00		$0.00	$411.41	$0.00	$0.00	$431.06	$0.00	$0.00	$0.00	$0.00	$0.00
23AGFN-756	SUP	Custom 27803010		23AGFN-756  -  VALVE AOR 85D 23MM 21.4MM REGENT FLEXCUFF 1 DGT GRDNT LFLT	BOTH IP/OP	"$11,750.00 "	"$8,695.00"	$0.00	"$9,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,448.70"	$0.00	$0.00	$0.00	$0.00	"$5,875.00"	"$9,306.00"	"$9,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
23AJ-501	SUP	Custom 27803010		23AJ-501  -  VALVE AOR 85D STD 23MM 18.6MM MSTR-SER CUF LFLT OPN CNTRL	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	$0.00	$0.00	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
240.048S	SUP	HCPCS C1713		240.048S  -  PLATE BN CNTR 298MM STRL LCP CMBN 4 HL LMT CNTCT TPR END SS	BOTH IP/OP	"$3,023.65 "	"$2,237.50"	$0.00	"$2,348.46"	"$1,321.01"	"$1,321.01"	$0.00	$0.00	$0.00	$630.20	"$2,244.15"	"$2,244.15"	$0.00	$0.00	$630.13	$0.00	"$1,490.66"	"$1,490.66"	$0.00	"$1,467.79"	"$2,324.98"	"$2,348.46"	$0.00		$0.00	$446.04	$0.00	$0.00	$467.34	$0.00	$0.00	$0.00	$0.00	$0.00
240.049S	SUP	HCPCS C1713		240.049S  -  PLATE BONE 298MM 16 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$3,023.65 "	"$2,237.50"	$0.00	"$2,348.46"	"$1,321.01"	"$1,321.01"	$0.00	$0.00	$0.00	$630.20	"$2,244.15"	"$2,244.15"	$0.00	$0.00	$630.13	$0.00	"$1,490.66"	"$1,490.66"	$0.00	"$1,467.79"	"$2,324.98"	"$2,348.46"	$0.00		$0.00	$446.04	$0.00	$0.00	$467.34	$0.00	$0.00	$0.00	$0.00	$0.00
240.052S	SUP	HCPCS C1713		240.052S  -  PLATE BONE 334MM 18 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$3,081.28 "	"$2,280.15"	$0.00	"$2,393.22"	"$1,346.19"	"$1,346.19"	$0.00	$0.00	$0.00	$642.21	"$2,286.92"	"$2,286.92"	$0.00	$0.00	$642.14	$0.00	"$1,519.07"	"$1,519.07"	$0.00	"$1,495.76"	"$2,369.29"	"$2,393.22"	$0.00		$0.00	$454.54	$0.00	$0.00	$476.25	$0.00	$0.00	$0.00	$0.00	$0.00
240.053S	SUP	HCPCS C1713		240.053S  -  PLATE BONE 334MM 18 HOLE LCP STAINLESS STEEL TIBIA LEFT	BOTH IP/OP	"$3,081.28 "	"$2,280.15"	$0.00	"$2,393.22"	"$1,346.19"	"$1,346.19"	$0.00	$0.00	$0.00	$642.21	"$2,286.92"	"$2,286.92"	$0.00	$0.00	$642.14	$0.00	"$1,519.07"	"$1,519.07"	$0.00	"$1,495.76"	"$2,369.29"	"$2,393.22"	$0.00		$0.00	$454.54	$0.00	$0.00	$476.25	$0.00	$0.00	$0.00	$0.00	$0.00
240.054S	SUP	HCPCS C1713		240.054S  -  PLATE BONE 370MM 20 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$3,140.33 "	"$2,323.84"	$0.00	"$2,439.08"	"$1,371.98"	"$1,371.98"	$0.00	$0.00	$0.00	$654.52	"$2,330.75"	"$2,330.75"	$0.00	$0.00	$654.44	$0.00	"$1,548.18"	"$1,548.18"	$0.00	"$1,524.43"	"$2,414.69"	"$2,439.08"	$0.00		$0.00	$463.25	$0.00	$0.00	$485.38	$0.00	$0.00	$0.00	$0.00	$0.00
240.055S	SUP	HCPCS C1713		240.055S  -  PLATE BONE 370MM 20 HOLE LOCKING LCP STAINLESS STEEL	BOTH IP/OP	"$3,140.33 "	"$2,323.84"	$0.00	"$2,439.08"	"$1,371.98"	"$1,371.98"	$0.00	$0.00	$0.00	$654.52	"$2,330.75"	"$2,330.75"	$0.00	$0.00	$654.44	$0.00	"$1,548.18"	"$1,548.18"	$0.00	"$1,524.43"	"$2,414.69"	"$2,439.08"	$0.00		$0.00	$463.25	$0.00	$0.00	$485.38	$0.00	$0.00	$0.00	$0.00	$0.00
24003 L	SUP	Custom 27803010		24003 L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24003 LL	SUP	Custom 27803010		24003 LL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24003 M	SUP	Custom 27803010		24003 M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,147.00 "	"$1,588.78"	$0.00	"$1,717.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,593.50"	"$1,593.50"	$0.00	$0.00	$447.43	$0.00	$0.00	$0.00	$0.00	"$1,073.50"	"$1,700.42"	"$1,717.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24004 B	SUP	Custom 27803010		24004 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2400-58	SUP	Custom 27203010		2400-58  -  CATHETER CHOLANGIOGRAM 50CM REDDICK CYSTIC DUCT STERILE	BOTH IP/OP	"$1,499.38 "	"$1,109.54"	$0.00	"$1,199.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,112.84"	"$1,112.84"	$0.00	$0.00	$312.47	$0.00	$0.00	$0.00	$0.00	$749.69	"$1,187.51"	"$1,199.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24013-1	SUP	Custom 27803010		24013-1  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,723.88 "	"$3,495.67"	$0.00	"$3,779.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,506.06"	"$3,506.06"	$0.00	$0.00	$984.46	$0.00	$0.00	$0.00	$0.00	"$2,361.94"	"$3,741.31"	"$3,779.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24013-2	SUP	Custom 27803010		24013-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,723.88 "	"$3,495.67"	$0.00	"$3,779.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,506.06"	"$3,506.06"	$0.00	$0.00	$984.46	$0.00	$0.00	$0.00	$0.00	"$2,361.94"	"$3,741.31"	"$3,779.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24013-5	SUP	Custom 27803010		24013-5  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,723.88 "	"$3,495.67"	$0.00	"$3,779.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,506.06"	"$3,506.06"	$0.00	$0.00	$984.46	$0.00	$0.00	$0.00	$0.00	"$2,361.94"	"$3,741.31"	"$3,779.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24-025-01-09	SUP	HCPCS C1713		24-025-01-09  -  STERNAL LCK PLATE 6 HOLE XIPHOID PLATE 2.0MM THICK	BOTH IP/OP	$718.25 	$531.51	$0.00	$574.60	$323.21	$323.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.13	$568.85	$574.60	$0.00		$0.00	$112.41	$0.00	$0.00	$114.35	$0.00	$0.00	$0.00	$0.00	$0.00
24-025-03-09	SUP	HCPCS C1713		24-025-03-09  -  STERNAL LOCK PLATE 10 HOLE BODY PLATE 2.0MM THICK	BOTH IP/OP	$967.20 	$715.73	$0.00	$773.76	$435.24	$435.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.60	$766.02	$773.76	$0.00		$0.00	$151.37	$0.00	$0.00	$153.98	$0.00	$0.00	$0.00	$0.00	$0.00
24-025-04-09	SUP	HCPCS C1713		24-025-04-09  -  STERNAL LOCK PLATE 14 HOLE MANUBRIUM PLATE 2.0MM THICK	BOTH IP/OP	"$1,212.53 "	$897.27	$0.00	$970.02	$545.64	$545.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$606.26	$960.32	$970.02	$0.00		$0.00	$189.76	$0.00	$0.00	$193.03	$0.00	$0.00	$0.00	$0.00	$0.00
24027-1	SUP	Custom 27803010		24027-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24027-2	SUP	Custom 27803010		24027-2  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24027-4	SUP	Custom 27803010		24027-4  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,657.38 "	"$3,446.46"	$0.00	"$3,725.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,456.70"	"$3,456.70"	$0.00	$0.00	$970.60	$0.00	$0.00	$0.00	$0.00	"$2,328.69"	"$3,688.64"	"$3,725.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24027-5	SUP	Custom 27803010		24027-5  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24028-1	SUP	Custom 27803010		24028-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24028-2	SUP	Custom 27803010		24028-2  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24028-5	SUP	Custom 27803010		24028-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24039-1	SUP	Custom 27803010		24039-1  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,094.50 "	"$3,029.93"	$0.00	"$3,275.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,038.94"	"$3,038.94"	$0.00	$0.00	$853.29	$0.00	$0.00	$0.00	$0.00	"$2,047.25"	"$3,242.84"	"$3,275.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24039-2	SUP	Custom 27803010		24039-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,094.50 "	"$3,029.93"	$0.00	"$3,275.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,038.94"	"$3,038.94"	$0.00	$0.00	$853.29	$0.00	$0.00	$0.00	$0.00	"$2,047.25"	"$3,242.84"	"$3,275.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24039-5	SUP	Custom 27203010		24039-5  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,094.50 "	"$3,029.93"	$0.00	"$3,275.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,038.94"	"$3,038.94"	$0.00	$0.00	$853.29	$0.00	$0.00	$0.00	$0.00	"$2,047.25"	"$3,242.84"	"$3,275.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24079-1	SUP	Custom 27803010		24079-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,723.88 "	"$3,495.67"	$0.00	"$3,779.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,506.06"	"$3,506.06"	$0.00	$0.00	$984.46	$0.00	$0.00	$0.00	$0.00	"$2,361.94"	"$3,741.31"	"$3,779.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24079-2	SUP	Custom 27803010		24079-2  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$5,526.63 "	"$4,089.71"	$0.00	"$4,421.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,101.86"	"$4,101.86"	$0.00	$0.00	"$1,151.75"	$0.00	$0.00	$0.00	$0.00	"$2,763.31"	"$4,377.09"	"$4,421.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24079-5	SUP	Custom 27803010		24079-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,723.88 "	"$3,495.67"	$0.00	"$3,779.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,506.06"	"$3,506.06"	$0.00	$0.00	$984.46	$0.00	$0.00	$0.00	$0.00	"$2,361.94"	"$3,741.31"	"$3,779.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24088 C	SUP	Custom 27803010		24088 C  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24088 D	SUP	Custom 27803010		24088 D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$501.13 	$370.84	$0.00	$400.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.93	$371.93	$0.00	$0.00	$104.43	$0.00	$0.00	$0.00	$0.00	$250.56	$396.89	$400.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
241.072S	SUP	HCPCS C1713		241.072S  -  PLATE BN 12MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT	BOTH IP/OP	"$1,473.18 "	"$1,090.15"	$0.00	"$1,144.20"	$643.61	$643.61	$0.00	$0.00	$0.00	$307.05	"$1,093.39"	"$1,093.39"	$0.00	$0.00	$307.01	$0.00	$871.38	$871.38	$0.00	$715.13	"$1,132.76"	"$1,144.20"	$0.00		$0.00	$217.32	$0.00	$0.00	$227.70	$0.00	$0.00	$0.00	$0.00	$0.00
241.073S	SUP	HCPCS C1713		241.073S  -  PLATE BONE 12MM 4 HOLE HOOK LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$1,473.18 "	"$1,090.15"	$0.00	"$1,144.20"	$643.61	$643.61	$0.00	$0.00	$0.00	$307.05	"$1,093.39"	"$1,093.39"	$0.00	$0.00	$307.01	$0.00	$871.38	$871.38	$0.00	$715.13	"$1,132.76"	"$1,144.20"	$0.00		$0.00	$217.32	$0.00	$0.00	$227.70	$0.00	$0.00	$0.00	$0.00	$0.00
241.074S	SUP	HCPCS C1713		241.074S  -  PLATE BN 15MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT	BOTH IP/OP	"$1,473.18 "	"$1,090.15"	$0.00	"$1,144.20"	$643.61	$643.61	$0.00	$0.00	$0.00	$307.05	"$1,093.39"	"$1,093.39"	$0.00	$0.00	$307.01	$0.00	$871.38	$871.38	$0.00	$715.13	"$1,132.76"	"$1,144.20"	$0.00		$0.00	$217.32	$0.00	$0.00	$227.70	$0.00	$0.00	$0.00	$0.00	$0.00
241.075S	SUP	HCPCS C1713		241.075S  -  PLATE BN 15MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT	BOTH IP/OP	"$1,473.18 "	"$1,090.15"	$0.00	"$1,144.20"	$643.61	$643.61	$0.00	$0.00	$0.00	$307.05	"$1,093.39"	"$1,093.39"	$0.00	$0.00	$307.01	$0.00	$871.38	$871.38	$0.00	$715.13	"$1,132.76"	"$1,144.20"	$0.00		$0.00	$217.32	$0.00	$0.00	$227.70	$0.00	$0.00	$0.00	$0.00	$0.00
241.076S	SUP	HCPCS C1713		241.076S  -  PLATE BN 18MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT	BOTH IP/OP	"$1,473.18 "	"$1,090.15"	$0.00	"$1,144.20"	$643.61	$643.61	$0.00	$0.00	$0.00	$307.05	"$1,093.39"	"$1,093.39"	$0.00	$0.00	$307.01	$0.00	$871.38	$871.38	$0.00	$715.13	"$1,132.76"	"$1,144.20"	$0.00		$0.00	$217.32	$0.00	$0.00	$227.70	$0.00	$0.00	$0.00	$0.00	$0.00
241.077S	SUP	HCPCS C1713		241.077S  -  PLATE BONE 18MM 4 HOLE HOOK PRECONTOUR LCP STAINLESS STEEL	BOTH IP/OP	"$1,473.18 "	"$1,090.15"	$0.00	"$1,144.20"	$643.61	$643.61	$0.00	$0.00	$0.00	$307.05	"$1,093.39"	"$1,093.39"	$0.00	$0.00	$307.01	$0.00	$871.38	$871.38	$0.00	$715.13	"$1,132.76"	"$1,144.20"	$0.00		$0.00	$217.32	$0.00	$0.00	$227.70	$0.00	$0.00	$0.00	$0.00	$0.00
241.082S	SUP	HCPCS C1713		241.082S  -  PLATE BONE 12MM 5 HOLE HOOK LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,540.65 "	"$1,140.08"	$0.00	"$1,196.62"	$673.10	$673.10	$0.00	$0.00	$0.00	$321.11	"$1,143.47"	"$1,143.47"	$0.00	$0.00	$321.07	$0.00	$911.29	$911.29	$0.00	$747.89	"$1,184.66"	"$1,196.62"	$0.00		$0.00	$227.27	$0.00	$0.00	$238.13	$0.00	$0.00	$0.00	$0.00	$0.00
241.083S	SUP	HCPCS C1713		241.083S  -  PLATE BONE 12MM 5 HOLE HOOK LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$1,540.65 "	"$1,140.08"	$0.00	"$1,196.62"	$673.10	$673.10	$0.00	$0.00	$0.00	$321.11	"$1,143.47"	"$1,143.47"	$0.00	$0.00	$321.07	$0.00	$911.29	$911.29	$0.00	$747.89	"$1,184.66"	"$1,196.62"	$0.00		$0.00	$227.27	$0.00	$0.00	$238.13	$0.00	$0.00	$0.00	$0.00	$0.00
241.084S	SUP	HCPCS C1713		241.084S  -  PLATE BN 15MM 85MM STRL LCP CMBN 5 HL HK PRECONTOUR RND SHFT	BOTH IP/OP	"$1,540.65 "	"$1,140.08"	$0.00	"$1,196.62"	$673.10	$673.10	$0.00	$0.00	$0.00	$321.11	"$1,143.47"	"$1,143.47"	$0.00	$0.00	$321.07	$0.00	$911.29	$911.29	$0.00	$747.89	"$1,184.66"	"$1,196.62"	$0.00		$0.00	$227.27	$0.00	$0.00	$238.13	$0.00	$0.00	$0.00	$0.00	$0.00
241.085S	SUP	HCPCS C1713		241.085S  -  PLATE BONE 15MM 5 HOLE HOOK LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$1,540.65 "	"$1,140.08"	$0.00	"$1,196.62"	$673.10	$673.10	$0.00	$0.00	$0.00	$321.11	"$1,143.47"	"$1,143.47"	$0.00	$0.00	$321.07	$0.00	$911.29	$911.29	$0.00	$747.89	"$1,184.66"	"$1,196.62"	$0.00		$0.00	$227.27	$0.00	$0.00	$238.13	$0.00	$0.00	$0.00	$0.00	$0.00
241.086S	SUP	HCPCS C1713		241.086S  -  PLATE BN 18MM 85MM STRL LCP CMBN 5 HL HK PRECONTOUR RND SHFT	BOTH IP/OP	"$1,540.65 "	"$1,140.08"	$0.00	"$1,196.62"	$673.10	$673.10	$0.00	$0.00	$0.00	$321.11	"$1,143.47"	"$1,143.47"	$0.00	$0.00	$321.07	$0.00	$911.29	$911.29	$0.00	$747.89	"$1,184.66"	"$1,196.62"	$0.00		$0.00	$227.27	$0.00	$0.00	$238.13	$0.00	$0.00	$0.00	$0.00	$0.00
241.087S	SUP	HCPCS C1713		241.087S  -  PLATE BN 18MM 85MM STRL LCP CMBN 5 HL HK PRECONTOUR RND SHFT	BOTH IP/OP	"$1,540.65 "	"$1,140.08"	$0.00	"$1,196.62"	$673.10	$673.10	$0.00	$0.00	$0.00	$321.11	"$1,143.47"	"$1,143.47"	$0.00	$0.00	$321.07	$0.00	$911.29	$911.29	$0.00	$747.89	"$1,184.66"	"$1,196.62"	$0.00		$0.00	$227.27	$0.00	$0.00	$238.13	$0.00	$0.00	$0.00	$0.00	$0.00
241.094S	SUP	HCPCS C1713		241.094S  -  PLATE BN 15MM 99MM STRL LCP CMBN 6 HL HK PRECONTOUR RND SHFT	BOTH IP/OP	"$1,584.23 "	"$1,172.33"	$0.00	"$1,230.46"	$692.13	$692.13	$0.00	$0.00	$0.00	$330.19	"$1,175.81"	"$1,175.81"	$0.00	$0.00	$330.15	$0.00	$937.07	$937.07	$0.00	$769.04	"$1,218.16"	"$1,230.46"	$0.00		$0.00	$233.70	$0.00	$0.00	$244.86	$0.00	$0.00	$0.00	$0.00	$0.00
241.095S	SUP	HCPCS C1713		241.095S  -  PLATE BN 15MM 99MM STRL LCP CMBN 6 HL HK PRECONTOUR RND SHFT	BOTH IP/OP	"$1,584.23 "	"$1,172.33"	$0.00	"$1,230.46"	$692.13	$692.13	$0.00	$0.00	$0.00	$330.19	"$1,175.81"	"$1,175.81"	$0.00	$0.00	$330.15	$0.00	$937.07	$937.07	$0.00	$769.04	"$1,218.16"	"$1,230.46"	$0.00		$0.00	$233.70	$0.00	$0.00	$244.86	$0.00	$0.00	$0.00	$0.00	$0.00
241.096S	SUP	HCPCS C1713		241.096S  -  PLATE BN 18MM 99MM STRL LCP CMBN 6 HL HK PRECONTOUR RND SHFT	BOTH IP/OP	"$1,584.23 "	"$1,172.33"	$0.00	"$1,230.46"	$692.13	$692.13	$0.00	$0.00	$0.00	$330.19	"$1,175.81"	"$1,175.81"	$0.00	$0.00	$330.15	$0.00	$937.07	$937.07	$0.00	$769.04	"$1,218.16"	"$1,230.46"	$0.00		$0.00	$233.70	$0.00	$0.00	$244.86	$0.00	$0.00	$0.00	$0.00	$0.00
241.097S	SUP	HCPCS C1713		241.097S  -  PLATE BONE 18MM 6 HOLE HOOK LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$1,584.23 "	"$1,172.33"	$0.00	"$1,230.46"	$692.13	$692.13	$0.00	$0.00	$0.00	$330.19	"$1,175.81"	"$1,175.81"	$0.00	$0.00	$330.15	$0.00	$937.07	$937.07	$0.00	$769.04	"$1,218.16"	"$1,230.46"	$0.00		$0.00	$233.70	$0.00	$0.00	$244.86	$0.00	$0.00	$0.00	$0.00	$0.00
241.104S	SUP	HCPCS C1713		241.104S  -  PLATE BONE 15MM 7 HOLE HOOK LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,651.70 "	"$1,222.26"	$0.00	"$1,282.86"	$721.61	$721.61	$0.00	$0.00	$0.00	$344.26	"$1,225.89"	"$1,225.89"	$0.00	$0.00	$344.21	$0.00	$976.98	$976.98	$0.00	$801.79	"$1,270.04"	"$1,282.86"	$0.00		$0.00	$243.65	$0.00	$0.00	$255.29	$0.00	$0.00	$0.00	$0.00	$0.00
241.105S	SUP	HCPCS C1713		241.105S  -  PLATE BONE 15MM 7 HOLE HOOK LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$1,651.70 "	"$1,222.26"	$0.00	"$1,282.86"	$721.61	$721.61	$0.00	$0.00	$0.00	$344.26	"$1,225.89"	"$1,225.89"	$0.00	$0.00	$344.21	$0.00	$976.98	$976.98	$0.00	$801.79	"$1,270.04"	"$1,282.86"	$0.00		$0.00	$243.65	$0.00	$0.00	$255.29	$0.00	$0.00	$0.00	$0.00	$0.00
241.106S	SUP	HCPCS C1713		241.106S  -  PLATE BONE 18MM 7 HOLE HOOK LCP STAINLESS STEEL RIGHT	BOTH IP/OP	"$1,651.70 "	"$1,222.26"	$0.00	"$1,282.86"	$721.61	$721.61	$0.00	$0.00	$0.00	$344.26	"$1,225.89"	"$1,225.89"	$0.00	$0.00	$344.21	$0.00	$976.98	$976.98	$0.00	$801.79	"$1,270.04"	"$1,282.86"	$0.00		$0.00	$243.65	$0.00	$0.00	$255.29	$0.00	$0.00	$0.00	$0.00	$0.00
241.107S	SUP	HCPCS C1713		241.107S  -  PLATE BONE 18MM 7 HOLE HOOK LCP STAINLESS STEEL LEFT	BOTH IP/OP	"$1,651.70 "	"$1,222.26"	$0.00	"$1,282.86"	$721.61	$721.61	$0.00	$0.00	$0.00	$344.26	"$1,225.89"	"$1,225.89"	$0.00	$0.00	$344.21	$0.00	$976.98	$976.98	$0.00	$801.79	"$1,270.04"	"$1,282.86"	$0.00		$0.00	$243.65	$0.00	$0.00	$255.29	$0.00	$0.00	$0.00	$0.00	$0.00
241.266S	SUP	HCPCS C1713		241.266S  -  PLATE BN 116X11X2.5MM STRL LCP CMBN 7 HL PRECONTOUR LMT	BOTH IP/OP	"$2,204.13 "	"$1,631.06"	$0.00	"$1,711.94"	$962.97	$962.97	$0.00	$0.00	$0.00	$459.39	"$1,635.90"	"$1,635.90"	$0.00	$0.00	$459.34	$0.00	"$1,303.74"	"$1,303.74"	$0.00	"$1,069.96"	"$1,694.82"	"$1,711.94"	$0.00		$0.00	$325.14	$0.00	$0.00	$340.68	$0.00	$0.00	$0.00	$0.00	$0.00
241.919S	SUP	HCPCS C1713		241.919S  -  PLATE BONE LONG 160X12X3.7MM 6 HOLE PRECONTOUR LCP STAINLESS	BOTH IP/OP	"$3,185.30 "	"$2,357.12"	$0.00	"$2,474.02"	"$1,391.64"	"$1,391.64"	$0.00	$0.00	$0.00	$663.90	"$2,364.13"	"$2,364.13"	$0.00	$0.00	$663.82	$0.00	"$1,570.35"	"$1,570.35"	$0.00	"$1,546.26"	"$2,449.28"	"$2,474.02"	$0.00		$0.00	$469.88	$0.00	$0.00	$492.33	$0.00	$0.00	$0.00	$0.00	$0.00
241.921S	SUP	HCPCS C1713		241.921S  -  PLATE LNG 196MM SS 3.5MM SCR SM FRAG SET 8 HOLE LCP BONE	BOTH IP/OP	"$3,304.78 "	"$2,445.54"	$0.00	"$3,030.88"	"$1,704.87"	"$1,704.87"	$0.00	$0.00	$0.00	$688.80	"$2,452.80"	"$2,452.80"	$0.00	$0.00	$688.72	$0.00	"$1,629.25"	"$1,629.25"	$0.00	"$1,894.30"	"$3,000.57"	"$3,030.88"	$0.00		$0.00	$592.92	$0.00	$0.00	$603.15	$0.00	$0.00	$0.00	$0.00	$0.00
241-01	SUP	HCPCS C1781		241-01  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$465.38 	$344.38	$0.00	$372.30	$209.42	$209.42	$0.00	$0.00	$0.00	$97.00	$345.40	$345.40	$0.00	$0.00	$96.98	$0.00	$275.27	$275.27	$0.00	$232.69	$368.58	$372.30	$0.00		$0.00	$72.83	$0.00	$0.00	$74.09	$0.00	$0.00	$0.00	$0.00	$0.00
241-02	SUP	HCPCS C1781		241-02  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$571.63 	$423.01	$0.00	$457.30	$257.23	$257.23	$0.00	$0.00	$0.00	$119.14	$424.26	$424.26	$0.00	$0.00	$119.13	$0.00	$338.12	$338.12	$0.00	$285.81	$452.73	$457.30	$0.00		$0.00	$89.46	$0.00	$0.00	$91.00	$0.00	$0.00	$0.00	$0.00	$0.00
241-02-C	SUP	HCPCS C1781		241-02-C  -  PLATE BN 121MM FLEXMESH 2 HL STRP SKL	BOTH IP/OP	$575.88 	$426.15	$0.00	$460.70	$259.14	$259.14	$0.00	$0.00	$0.00	$120.03	$427.41	$427.41	$0.00	$0.00	$120.01	$0.00	$340.63	$340.63	$0.00	$287.94	$456.10	$460.70	$0.00		$0.00	$90.12	$0.00	$0.00	$91.68	$0.00	$0.00	$0.00	$0.00	$0.00
241-03	SUP	HCPCS C1781		241-03  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$652.38 	$482.76	$0.00	$521.90	$293.57	$293.57	$0.00	$0.00	$0.00	$135.97	$484.19	$484.19	$0.00	$0.00	$135.95	$0.00	$385.88	$385.88	$0.00	$326.19	$516.68	$521.90	$0.00		$0.00	$102.10	$0.00	$0.00	$103.86	$0.00	$0.00	$0.00	$0.00	$0.00
241-04	SUP	HCPCS C1713		241-04  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$735.25 	$544.09	$0.00	$588.20	$330.86	$330.86	$0.00	$0.00	$0.00	$153.24	$545.70	$545.70	$0.00	$0.00	$153.23	$0.00	$434.90	$434.90	$0.00	$367.63	$582.32	$588.20	$0.00		$0.00	$115.07	$0.00	$0.00	$117.05	$0.00	$0.00	$0.00	$0.00	$0.00
24106 A	SUP	Custom 27803010		24106 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24106 B	SUP	Custom 27803010		24106 B  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24106 C	SUP	Custom 27803010		24106 C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24106 D	SUP	Custom 27803010		24106 D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24106 E	SUP	Custom 27803010		24106 E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
24106 H	SUP	HCPCS C1725		24106 H  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,220.75 "	$903.36	$0.00	$976.60	$662.87	$662.87	$0.00	$0.00	$0.00	$254.43	$906.04	$906.04	$0.00	$0.00	$254.40	$0.00	$722.07	$722.07	$0.00	$610.38	$966.83	$976.60	$0.00		$0.00	$191.05	$0.00	$0.00	$194.34	$0.00	$0.00	$0.00	$0.00	$0.00
24133-1	SUP	Custom 27803010		24133-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$5,241.63 "	"$3,878.81"	$0.00	"$4,193.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,890.33"	"$3,890.33"	$0.00	$0.00	"$1,092.35"	$0.00	$0.00	$0.00	$0.00	"$2,620.81"	"$4,151.37"	"$4,193.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
242.531S	SUP	HCPCS C1713		242.531S  -  PLATE BONE 46MM 7 HOLE LCP STAINLESS STEEL DISTAL ULNA	BOTH IP/OP	"$1,561.73 "	"$1,155.68"	$0.00	"$1,212.98"	$682.30	$682.30	$0.00	$0.00	$0.00	$325.50	"$1,159.11"	"$1,159.11"	$0.00	$0.00	$325.46	$0.00	$923.76	$923.76	$0.00	$758.11	"$1,200.85"	"$1,212.98"	$0.00		$0.00	$230.38	$0.00	$0.00	$241.38	$0.00	$0.00	$0.00	$0.00	$0.00
24-2050	SUP	Custom 27203010		24-2050  -  DRILL SURG 1.8MM 50MM 26MM STOP BLADE LORENZ MANDIB	BOTH IP/OP	$432.50 	$320.05	$0.00	$346.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$321.00	$321.00	$0.00	$0.00	$90.13	$0.00	$0.00	$0.00	$0.00	$216.25	$342.54	$346.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
246.354S	SUP	HCPCS C1713		246.354S  -  PLATE BONE 27MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS	BOTH IP/OP	"$1,516.23 "	"$1,122.01"	$0.00	"$1,212.98"	$682.30	$682.30	$0.00	$0.00	$0.00	$316.02	"$1,125.34"	"$1,125.34"	$0.00	$0.00	$315.98	$0.00	$896.85	$896.85	$0.00	$758.11	"$1,200.85"	"$1,212.98"	$0.00		$0.00	$230.38	$0.00	$0.00	$241.38	$0.00	$0.00	$0.00	$0.00	$0.00
246.355S	SUP	HCPCS C1713		246.355S  -  PLATE BONE 32MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS	BOTH IP/OP	"$1,516.23 "	"$1,122.01"	$0.00	"$1,212.98"	$682.30	$682.30	$0.00	$0.00	$0.00	$316.02	"$1,125.34"	"$1,125.34"	$0.00	$0.00	$315.98	$0.00	$896.85	$896.85	$0.00	$758.11	"$1,200.85"	"$1,212.98"	$0.00		$0.00	$230.38	$0.00	$0.00	$241.38	$0.00	$0.00	$0.00	$0.00	$0.00
247.354S	SUP	HCPCS C1713		247.354S  -  PLATE BONE 34MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS	BOTH IP/OP	"$1,561.73 "	"$1,155.68"	$0.00	"$1,212.98"	$682.30	$682.30	$0.00	$0.00	$0.00	$325.50	"$1,159.11"	"$1,159.11"	$0.00	$0.00	$325.46	$0.00	$923.76	$923.76	$0.00	$758.11	"$1,200.85"	"$1,212.98"	$0.00		$0.00	$230.38	$0.00	$0.00	$241.38	$0.00	$0.00	$0.00	$0.00	$0.00
247.355S	SUP	HCPCS C1713		247.355S  -  PLATE BONE 40MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS	BOTH IP/OP	"$1,561.73 "	"$1,155.68"	$0.00	"$1,212.98"	$682.30	$682.30	$0.00	$0.00	$0.00	$325.50	"$1,159.11"	"$1,159.11"	$0.00	$0.00	$325.46	$0.00	$923.76	$923.76	$0.00	$758.11	"$1,200.85"	"$1,212.98"	$0.00		$0.00	$230.38	$0.00	$0.00	$241.38	$0.00	$0.00	$0.00	$0.00	$0.00
2480-10-41	SUP	HCPCS C1713		2480-10-41  -  SCREW BN FT 4MM 10MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-12-41	SUP	HCPCS C1713		2480-12-41  -  SCREW BN FT 4MM 12MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-14-41	SUP	HCPCS C1713		2480-14-41  -  SCREW BN FT 4MM 14MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-16-41	SUP	HCPCS C1713		2480-16-41  -  SCREW BN FT 4MM 16MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-18-41	SUP	HCPCS C1713		2480-18-41  -  SCREW BN FT 4MM 18MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-20-41	SUP	HCPCS C1713		2480-20-41  -  SCREW BN FT 4MM 20MM NS FORTE SS PERIART CANC	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-22-41	SUP	HCPCS C1713		2480-22-41  -  SCREW BN FT 4MM 22MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-24-41	SUP	HCPCS C1713		2480-24-41  -  SCREW BN FT 4MM 24MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-26-41	SUP	HCPCS C1713		2480-26-41  -  SCREW BN FT 4MM 26MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-28-41	SUP	HCPCS C1713		2480-28-41  -  SCREW BN FT 4MM 28MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-30-41	SUP	HCPCS C1713		2480-30-41  -  SCREW BN FT 4MM 30MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-32-41	SUP	HCPCS C1713		2480-32-41  -  SCREW BN FT 4MM 32MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-34-41	SUP	HCPCS C1713		2480-34-41  -  SCREW BN FT 4MM 34MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-36-41	SUP	HCPCS C1713		2480-36-41  -  SCREW BN FT 4MM 36MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-38-41	SUP	HCPCS C1713		2480-38-41  -  SCREW BN FT 4MM 38MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
2480-40-41	SUP	HCPCS C1713		2480-40-41  -  SCREW BN FT 4MM 40MM NS FORTE SS CANC PERIART	BOTH IP/OP	$111.55 	$82.55	$0.00	$89.24	$50.20	$50.20	$0.00	$0.00	$0.00	$23.25	$82.79	$82.79	$0.00	$0.00	$23.25	$0.00	$65.98	$65.98	$0.00	$55.78	$88.35	$89.24	$0.00		$0.00	$17.46	$0.00	$0.00	$17.76	$0.00	$0.00	$0.00	$0.00	$0.00
24B002	SUP	HCPCS C9359		24B002  -  GRAFT BONE PROX FEM HD FRZN ALLOWASH TCH GAMA IRR	BOTH IP/OP	"$3,260.00 "	"$2,412.40"	$0.00	"$2,608.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$679.47	"$2,419.57"	"$2,419.57"	$0.00	$0.00	$679.38	$0.00	"$1,607.18"	"$1,607.18"	$0.00	"$1,630.00"	"$2,581.92"	"$2,608.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
250.25S	SUP	HCPCS C1713		250.25S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 255MM STAINLESS STEEL	BOTH IP/OP	"$2,131.25 "	"$1,577.13"	$0.00	"$1,705.00"	$959.06	$959.06	$0.00	$0.00	$0.00	$444.21	"$1,581.81"	"$1,581.81"	$0.00	$0.00	$444.15	$0.00	"$1,260.63"	"$1,260.63"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
250.27S	SUP	HCPCS C1713		250.27S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 270MM STAINLESS STEEL	BOTH IP/OP	"$2,131.25 "	"$1,577.13"	$0.00	"$1,705.00"	$959.06	$959.06	$0.00	$0.00	$0.00	$444.21	"$1,581.81"	"$1,581.81"	$0.00	$0.00	$444.15	$0.00	"$1,260.63"	"$1,260.63"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
250.28S	SUP	HCPCS C1713		250.28S  -  NAIL 10MM 285MM TIB IM UNV SS STRL	BOTH IP/OP	"$2,533.98 "	"$1,875.15"	$0.00	"$2,027.18"	"$1,140.29"	"$1,140.29"	$0.00	$0.00	$0.00	$528.14	"$1,880.72"	"$1,880.72"	$0.00	$0.00	$528.08	$0.00	"$1,249.25"	"$1,249.25"	$0.00	"$1,266.99"	"$2,006.91"	"$2,027.18"	$0.00		$0.00	$396.57	$0.00	$0.00	$403.41	$0.00	$0.00	$0.00	$0.00	$0.00
250.30S	SUP	HCPCS C1713		250.30S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM TITANIUM TIBIA	BOTH IP/OP	"$2,131.25 "	"$1,577.13"	$0.00	"$1,705.00"	$959.06	$959.06	$0.00	$0.00	$0.00	$444.21	"$1,581.81"	"$1,581.81"	$0.00	$0.00	$444.15	$0.00	"$1,260.63"	"$1,260.63"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
250.31S	SUP	HCPCS C1713		250.31S  -  NAIL 10MM 315MM TIB IM UNV SS STRL	BOTH IP/OP	"$2,533.98 "	"$1,875.15"	$0.00	"$2,027.18"	"$1,140.29"	"$1,140.29"	$0.00	$0.00	$0.00	$528.14	"$1,880.72"	"$1,880.72"	$0.00	$0.00	$528.08	$0.00	"$1,249.25"	"$1,249.25"	$0.00	"$1,266.99"	"$2,006.91"	"$2,027.18"	$0.00		$0.00	$396.57	$0.00	$0.00	$403.41	$0.00	$0.00	$0.00	$0.00	$0.00
250.33S	SUP	HCPCS C1713		250.33S  -  NAIL 10MM 330MM TIB IM UNV SS STRL	BOTH IP/OP	"$2,533.98 "	"$1,875.15"	$0.00	"$2,027.18"	"$1,140.29"	"$1,140.29"	$0.00	$0.00	$0.00	$528.14	"$1,880.72"	"$1,880.72"	$0.00	$0.00	$528.08	$0.00	"$1,249.25"	"$1,249.25"	$0.00	"$1,266.99"	"$2,006.91"	"$2,027.18"	$0.00		$0.00	$396.57	$0.00	$0.00	$403.41	$0.00	$0.00	$0.00	$0.00	$0.00
250.34S	SUP	HCPCS C1713		250.34S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 345MM STAINLESS STEEL	BOTH IP/OP	"$2,131.25 "	"$1,577.13"	$0.00	"$1,705.00"	$959.06	$959.06	$0.00	$0.00	$0.00	$444.21	"$1,581.81"	"$1,581.81"	$0.00	$0.00	$444.15	$0.00	"$1,260.63"	"$1,260.63"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
250.36S	SUP	HCPCS C1713		250.36S  -  NAIL 10MM 360MM TIB IM UNV SS STRL	BOTH IP/OP	"$2,533.98 "	"$1,875.15"	$0.00	"$2,027.18"	"$1,140.29"	"$1,140.29"	$0.00	$0.00	$0.00	$528.14	"$1,880.72"	"$1,880.72"	$0.00	$0.00	$528.08	$0.00	"$1,249.25"	"$1,249.25"	$0.00	"$1,266.99"	"$2,006.91"	"$2,027.18"	$0.00		$0.00	$396.57	$0.00	$0.00	$403.41	$0.00	$0.00	$0.00	$0.00	$0.00
250.38S	SUP	HCPCS C1713		250.38S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM STAINLESS STEEL	BOTH IP/OP	"$2,131.25 "	"$1,577.13"	$0.00	"$1,705.00"	$959.06	$959.06	$0.00	$0.00	$0.00	$444.21	"$1,581.81"	"$1,581.81"	$0.00	$0.00	$444.15	$0.00	"$1,260.63"	"$1,260.63"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
250.40S	SUP	HCPCS C1713		250.40S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM STAINLESS STEEL	BOTH IP/OP	"$2,131.25 "	"$1,577.13"	$0.00	"$1,705.00"	$959.06	$959.06	$0.00	$0.00	$0.00	$444.21	"$1,581.81"	"$1,581.81"	$0.00	$0.00	$444.15	$0.00	"$1,260.63"	"$1,260.63"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
250.42S	SUP	HCPCS C1713		250.42S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM STAINLESS STEEL	BOTH IP/OP	"$2,131.25 "	"$1,577.13"	$0.00	"$1,705.00"	$959.06	$959.06	$0.00	$0.00	$0.00	$444.21	"$1,581.81"	"$1,581.81"	$0.00	$0.00	$444.15	$0.00	"$1,260.63"	"$1,260.63"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+10.00	SUP	HCPCS V2632		25000C+10.00  -  LENS IOL +10 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+10.50	SUP	HCPCS V2632		25000C+10.50  -  LENS IOL +10.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+11.00	SUP	HCPCS V2632		25000C+11.00  -  LENS IOL +11 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+11.50	SUP	HCPCS V2632		25000C+11.50  -  LENS IOL +11.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+12.00	SUP	HCPCS V2632		25000C+12.00  -  LENS IOL +12 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+12.50	SUP	HCPCS V2632		25000C+12.50  -  LENS IOL +12.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+13.00	SUP	HCPCS V2632		25000C+13.00  -  LENS IOL +13 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+13.50	SUP	HCPCS V2632		25000C+13.50  -  LENS IOL +13.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+14.00	SUP	HCPCS V2632		25000C+14.00  -  LENS IOL +14 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+14.50	SUP	HCPCS V2632		25000C+14.50  -  LENS IOL +14.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+15.00	SUP	HCPCS V2632		25000C+15.00  -  LENS IOL +15 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+15.50	SUP	HCPCS V2632		25000C+15.50  -  LENS IOL +15.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+16.00	SUP	HCPCS V2632		25000C+16.00  -  LENS IOL +16 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+16.50	SUP	HCPCS V2632		25000C+16.50  -  LENS IOL +16.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+17.00	SUP	HCPCS V2632		25000C+17.00  -  LENS IOL +17 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+17.50	SUP	HCPCS V2632		25000C+17.50  -  LENS IOL +17.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+18.00	SUP	HCPCS V2632		25000C+18.00  -  LENS IOL +18 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+18.50	SUP	HCPCS V2632		25000C+18.50  -  LENS IOL +18.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+19.00	SUP	HCPCS V2632		25000C+19.00  -  LENS IOL +19 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+19.50	SUP	HCPCS V2632		25000C+19.50  -  LENS IOL +19.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+20.00	SUP	HCPCS V2632		25000C+20.00  -  LENS IOL +20 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+20.50	SUP	HCPCS V2632		25000C+20.50  -  LENS IOL +20.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+21.00	SUP	HCPCS V2632		25000C+21.00  -  LENS IOL +21 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+21.50	SUP	HCPCS V2632		25000C+21.50  -  LENS IOL +21.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+22.00	SUP	HCPCS V2632		25000C+22.00  -  LENS IOL +22 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+22.50	SUP	HCPCS V2632		25000C+22.50  -  LENS IOL +22.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+23.00	SUP	HCPCS V2632		25000C+23.00  -  LENS IOL +23 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+23.50	SUP	HCPCS V2632		25000C+23.50  -  LENS IOL +23.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+24.00	SUP	HCPCS V2632		25000C+24.00  -  LENS IOL +24 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+24.50	SUP	HCPCS V2632		25000C+24.50  -  LENS IOL +24.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+25.00	SUP	HCPCS V2632		25000C+25.00  -  LENS IOL +25 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+25.50	SUP	HCPCS V2632		25000C+25.50  -  LENS IOL +25.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+26.00	SUP	HCPCS V2632		25000C+26.00  -  LENS IOL +26 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+26.50	SUP	HCPCS V2632		25000C+26.50  -  LENS IOL +26.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+27.00	SUP	HCPCS V2632		25000C+27.00  -  LENS IOL +27 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+27.50	SUP	HCPCS V2632		25000C+27.50  -  LENS IOL +27.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+28.00	SUP	HCPCS V2632		25000C+28.00  -  LENS IOL +28 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+28.50	SUP	HCPCS V2632		25000C+28.50  -  LENS IOL +28.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+29.00	SUP	HCPCS V2632		25000C+29.00  -  LENS IOL +29 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+29.50	SUP	HCPCS V2632		25000C+29.50  -  LENS IOL +29.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+30.00	SUP	HCPCS V2632		25000C+30.00  -  LENS IOL +30 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+6.00	SUP	HCPCS V2632		25000C+6.00  -  LENS IOL +6 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+6.50	SUP	HCPCS V2632		25000C+6.50  -  LENS IOL +6.5 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+7.00	SUP	HCPCS V2632		25000C+7.00  -  LENS IOL +7 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+7.50	SUP	HCPCS V2632		25000C+7.50  -  LENS IOL +7.5 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+8.00	SUP	HCPCS V2632		25000C+8.00  -  LENS IOL +8 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+8.50	SUP	HCPCS V2632		25000C+8.50  -  LENS IOL +8.5 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+9.00	SUP	HCPCS V2632		25000C+9.00  -  LENS IOL +9 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25000C+9.50	SUP	HCPCS V2632		25000C+9.50  -  LENS IOL +9.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25-003-10-09	SUP	HCPCS C1713		25-003-10-09  -  MESH CRNL 85X50X.3MM SM GRID PNL TI 1.5MM SCR	BOTH IP/OP	"$1,823.00 "	"$1,349.02"	$0.00	"$1,458.40"	$820.35	$820.35	$0.00	$0.00	$0.00	$379.96	"$1,353.03"	"$1,353.03"	$0.00	$0.00	$379.91	$0.00	"$1,078.30"	"$1,078.30"	$0.00	$911.50	"$1,443.82"	"$1,458.40"	$0.00		$0.00	$285.30	$0.00	$0.00	$290.22	$0.00	$0.00	$0.00	$0.00	$0.00
25-003-14-09	SUP	HCPCS C1713		25-003-14-09  -  NEURO PLATE  ULTRA LOW PROFILE BOX STYLE  2X2-HOLE  W/TAB	BOTH IP/OP	$701.53 	$519.13	$0.00	$561.22	$315.69	$315.69	$0.00	$0.00	$0.00	$146.22	$520.67	$520.67	$0.00	$0.00	$146.20	$0.00	$414.95	$414.95	$0.00	$350.76	$555.61	$561.22	$0.00		$0.00	$109.79	$0.00	$0.00	$111.68	$0.00	$0.00	$0.00	$0.00	$0.00
25-003-21-09	SUP	Custom 27803010		25-003-21-09  -  COVER BURR HOLE MEDIUM 15MM .3MM HOLE ULTRA LP SMOOTH	BOTH IP/OP	$789.55 	$584.27	$0.00	$631.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$586.00	$586.00	$0.00	$0.00	$164.54	$0.00	$0.00	$0.00	$0.00	$394.78	$625.32	$631.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25-003-25-09	SUP	Custom 27803010		25-003-25-09  -  COVER BURR HOLE LARGE 25MM .3MM HOLE ULTRA LP SMOOTH ROUNDED	BOTH IP/OP	$789.55 	$584.27	$0.00	$631.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$586.00	$586.00	$0.00	$0.00	$164.54	$0.00	$0.00	$0.00	$0.00	$394.78	$625.32	$631.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25-004-70-09	SUP	HCPCS C1781		25-004-70-09  -  PLATE BONE ROUND MICRO MESH 73MM .6MM PANEL CNTOUR TITANIUM	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
25-007-80-09	SUP	HCPCS C1713		25-007-80-09  -  MESH CRNL 3D 80X80X.3MM TI 1.5MM SCR	BOTH IP/OP	"$4,042.10 "	"$2,991.15"	$0.00	"$3,233.68"	"$1,818.95"	"$1,818.95"	$0.00	$0.00	$0.00	$842.47	"$3,000.05"	"$3,000.05"	$0.00	$0.00	$842.37	$0.00	"$1,992.76"	"$1,992.76"	$0.00	"$2,021.05"	"$3,201.34"	"$3,233.68"	$0.00		$0.00	$632.59	$0.00	$0.00	$643.50	$0.00	$0.00	$0.00	$0.00	$0.00
25-008-12-09	SUP	HCPCS C1781		25-008-12-09  -  PLATE BONE 3D MICRO MESH 120X120X.6MM TITANIUM FRONTAL MAXL	BOTH IP/OP	"$5,736.28 "	"$4,244.85"	$0.00	"$4,589.02"	"$2,581.32"	"$2,581.32"	$0.00	$0.00	$0.00	"$1,195.58"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.44"	$0.00	"$2,827.98"	"$2,827.98"	$0.00	"$2,868.14"	"$4,543.13"	"$4,589.02"	$0.00		$0.00	$897.73	$0.00	$0.00	$913.21	$0.00	$0.00	$0.00	$0.00	$0.00
25-008-80-09	SUP	HCPCS C1713		25-008-80-09  -  PLATE BONE 3D MESH 80X80X.6MM TITANIUM MANDIB 1.5MM SCREW	BOTH IP/OP	"$3,664.13 "	"$2,711.46"	$0.00	"$2,931.30"	"$1,648.86"	"$1,648.86"	$0.00	$0.00	$0.00	$763.70	"$2,719.51"	"$2,719.51"	$0.00	$0.00	$763.60	$0.00	"$1,806.41"	"$1,806.41"	$0.00	"$1,832.06"	"$2,901.99"	"$2,931.30"	$0.00		$0.00	$573.44	$0.00	$0.00	$583.33	$0.00	$0.00	$0.00	$0.00	$0.00
25014-1	SUP	Custom 27803010		25014-1  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,723.88 "	"$3,495.67"	$0.00	"$3,779.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,506.06"	"$3,506.06"	$0.00	$0.00	$984.46	$0.00	$0.00	$0.00	$0.00	"$2,361.94"	"$3,741.31"	"$3,779.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25014-2	SUP	Custom 27803010		25014-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,723.88 "	"$3,495.67"	$0.00	"$3,779.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,506.06"	"$3,506.06"	$0.00	$0.00	$984.46	$0.00	$0.00	$0.00	$0.00	"$2,361.94"	"$3,741.31"	"$3,779.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25014-5	SUP	Custom 27803010		25014-5  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,723.88 "	"$3,495.67"	$0.00	"$3,779.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,506.06"	"$3,506.06"	$0.00	$0.00	$984.46	$0.00	$0.00	$0.00	$0.00	"$2,361.94"	"$3,741.31"	"$3,779.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25-015-04-09	SUP	HCPCS C1713		25-015-04-09  -  PLATE BONE MICRO SQUARE .6MM 2X2 HOLE TITANIUM FRONTAL MAXL	BOTH IP/OP	$377.18 	$279.11	$0.00	$301.74	$169.73	$169.73	$0.00	$0.00	$0.00	$78.61	$279.94	$279.94	$0.00	$0.00	$78.60	$0.00	$223.10	$223.10	$0.00	$188.59	$298.73	$301.74	$0.00		$0.00	$59.03	$0.00	$0.00	$60.05	$0.00	$0.00	$0.00	$0.00	$0.00
25-015-06-09	SUP	HCPCS C1713		25-015-06-09  -  PLATE BONE MICRO SQUARE .6MM 3X2 HOLE TITANIUM MAXFACL 1.5MM	BOTH IP/OP	$452.60 	$334.92	$0.00	$362.08	$203.67	$203.67	$0.00	$0.00	$0.00	$94.33	$335.92	$335.92	$0.00	$0.00	$94.32	$0.00	$267.71	$267.71	$0.00	$226.30	$358.46	$362.08	$0.00		$0.00	$70.83	$0.00	$0.00	$72.05	$0.00	$0.00	$0.00	$0.00	$0.00
250-202	SUP	HCPCS C1892		SHEATH ACCES 35CM 12FR URETERAL FLEXOR	BOTH IP/OP	$296.10 	$219.11	$0.00	$236.88	$160.78	$160.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.05	$234.51	$236.88	$0.00		$0.00	$46.34	$0.00	$0.00	$47.14	$0.00	$0.00	$0.00	$0.00	$0.00
250-208	SUP	HCPCS C1892		SHEATH ACCES 36CM 13/15FR NVGTR URET DUAL TPR TIP HYDPHI	BOTH IP/OP	$286.00 	$211.64	$0.00	$228.80	$155.30	$155.30	$0.00	$0.00	$0.00	$59.61	$212.27	$212.27	$0.00	$0.00	$59.60	$0.00	$169.17	$169.17	$0.00	$143.00	$226.51	$228.80	$0.00		$0.00	$44.76	$0.00	$0.00	$45.53	$0.00	$0.00	$0.00	$0.00	$0.00
25-022-28-09	SUP	HCPCS C1713		25-022-28-09  -  PLATE BONE 2MMX1MM 2 STRIP MESH BLUE TITANIUM MAXFACL 2MM	BOTH IP/OP	$608.65 	$450.40	$0.00	$486.92	$273.89	$273.89	$0.00	$0.00	$0.00	$126.86	$451.74	$451.74	$0.00	$0.00	$126.84	$0.00	$360.02	$360.02	$0.00	$304.33	$482.05	$486.92	$0.00		$0.00	$95.25	$0.00	$0.00	$96.90	$0.00	$0.00	$0.00	$0.00	$0.00
25-040-25-09	SUP	HCPCS C1713		25-040-25-09  -  MESH CRNL 85X54X.2MM SCRN PNL TI 1MM SCR	BOTH IP/OP	"$1,191.80 "	$881.93	$0.00	$953.44	$536.31	$536.31	$0.00	$0.00	$0.00	$248.40	$884.55	$884.55	$0.00	$0.00	$248.37	$0.00	$704.95	$704.95	$0.00	$595.90	$943.91	$953.44	$0.00		$0.00	$186.52	$0.00	$0.00	$189.73	$0.00	$0.00	$0.00	$0.00	$0.00
25-043-01-09	SUP	HCPCS C1713		25-043-01-09  -  MESH CRNL .3MM TI ORBT FLR 1.5MM SCR	BOTH IP/OP	"$1,010.08 "	$747.46	$0.00	$808.06	$454.53	$454.53	$0.00	$0.00	$0.00	$210.52	$749.68	$749.68	$0.00	$0.00	$210.50	$0.00	$597.46	$597.46	$0.00	$505.04	$799.98	$808.06	$0.00		$0.00	$158.08	$0.00	$0.00	$160.80	$0.00	$0.00	$0.00	$0.00	$0.00
25-043-02-09	SUP	HCPCS C1713		25-043-02-09  -  MESH CRNL .5MM AU TI ORBT FLR 1.5MM SCR	BOTH IP/OP	"$1,010.08 "	$747.46	$0.00	$808.06	$454.53	$454.53	$0.00	$0.00	$0.00	$210.52	$749.68	$749.68	$0.00	$0.00	$210.50	$0.00	$597.46	$597.46	$0.00	$505.04	$799.98	$808.06	$0.00		$0.00	$158.08	$0.00	$0.00	$160.80	$0.00	$0.00	$0.00	$0.00	$0.00
25-044-02-09	SUP	HCPCS C1713		25-044-02-09  -  PLATE BN 3D PSHP .4MM TI LT ORBT FLR	BOTH IP/OP	"$2,758.28 "	"$2,041.13"	$0.00	"$2,206.62"	"$1,241.22"	"$1,241.22"	$0.00	$0.00	$0.00	$574.89	"$2,047.19"	"$2,047.19"	$0.00	$0.00	$574.82	$0.00	"$1,359.83"	"$1,359.83"	$0.00	"$1,379.14"	"$2,184.56"	"$2,206.62"	$0.00		$0.00	$431.67	$0.00	$0.00	$439.12	$0.00	$0.00	$0.00	$0.00	$0.00
25-045-40-09	SUP	HCPCS C1713		25-045-40-09  -  PLATE BN NS LF LVL 1 CRNMXF ORBT FLR	BOTH IP/OP	"$3,512.30 "	"$2,599.10"	$0.00	"$2,809.84"	"$1,580.54"	"$1,580.54"	$0.00	$0.00	$0.00	$732.05	"$2,606.83"	"$2,606.83"	$0.00	$0.00	$731.96	$0.00	"$1,731.56"	"$1,731.56"	$0.00	"$1,756.15"	"$2,781.74"	"$2,809.84"	$0.00		$0.00	$549.67	$0.00	$0.00	$559.16	$0.00	$0.00	$0.00	$0.00	$0.00
25-092-38-91	SUP	HCPCS C1713		25-092-38-91  -  DRILL FREE MAXDRIVE MMF SCREW  2.0MM X 12MM  8MM THD LNGTH	BOTH IP/OP	$264.55 	$195.77	$0.00	$211.64	$119.05	$119.05	$0.00	$0.00	$0.00	$55.14	$196.35	$196.35	$0.00	$0.00	$55.13	$0.00	$156.48	$156.48	$0.00	$132.28	$209.52	$211.64	$0.00		$0.00	$41.40	$0.00	$0.00	$42.12	$0.00	$0.00	$0.00	$0.00	$0.00
25-092-42-91	SUP	HCPCS C1713		25-092-42-91  -  DRILL FREE MAXDRIVE MMF SCREW  2.0MM X 16MM  12MM THD LNGTH	BOTH IP/OP	$264.55 	$195.77	$0.00	$211.64	$119.05	$119.05	$0.00	$0.00	$0.00	$55.14	$196.35	$196.35	$0.00	$0.00	$55.13	$0.00	$156.48	$156.48	$0.00	$132.28	$209.52	$211.64	$0.00		$0.00	$41.40	$0.00	$0.00	$42.12	$0.00	$0.00	$0.00	$0.00	$0.00
251.25S	SUP	HCPCS C1713		251.25S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER TUBULAR 11MM	BOTH IP/OP	"$2,131.25 "	"$1,577.13"	$0.00	"$1,705.00"	$959.06	$959.06	$0.00	$0.00	$0.00	$444.21	"$1,581.81"	"$1,581.81"	$0.00	$0.00	$444.15	$0.00	"$1,260.63"	"$1,260.63"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
251.28S	SUP	HCPCS C1713		251.28S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER 11MM 285MMX1.2MM 1	BOTH IP/OP	"$2,131.25 "	"$1,577.13"	$0.00	"$1,705.00"	$959.06	$959.06	$0.00	$0.00	$0.00	$444.21	"$1,581.81"	"$1,581.81"	$0.00	$0.00	$444.15	$0.00	"$1,260.63"	"$1,260.63"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
251.30S	SUP	HCPCS C1713		251.30S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TUBULAR BARREL 11MM	BOTH IP/OP	"$2,131.25 "	"$1,577.13"	$0.00	"$1,705.00"	$959.06	$959.06	$0.00	$0.00	$0.00	$444.21	"$1,581.81"	"$1,581.81"	$0.00	$0.00	$444.15	$0.00	"$1,260.63"	"$1,260.63"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
251.31S	SUP	HCPCS C1713		251.31S  -  NAIL 11MM 315MM TIB IM UNV SS STRL	BOTH IP/OP	"$2,533.98 "	"$1,875.15"	$0.00	"$2,027.18"	"$1,140.29"	"$1,140.29"	$0.00	$0.00	$0.00	$528.14	"$1,880.72"	"$1,880.72"	$0.00	$0.00	$528.08	$0.00	"$1,249.25"	"$1,249.25"	$0.00	"$1,266.99"	"$2,006.91"	"$2,027.18"	$0.00		$0.00	$396.57	$0.00	$0.00	$403.41	$0.00	$0.00	$0.00	$0.00	$0.00
251.33S	SUP	HCPCS C1713		251.33S  -  NAIL 11MM 330MM TIB IM UNV SS STRL	BOTH IP/OP	"$2,533.98 "	"$1,875.15"	$0.00	"$2,027.18"	"$1,140.29"	"$1,140.29"	$0.00	$0.00	$0.00	$528.14	"$1,880.72"	"$1,880.72"	$0.00	$0.00	$528.08	$0.00	"$1,249.25"	"$1,249.25"	$0.00	"$1,266.99"	"$2,006.91"	"$2,027.18"	$0.00		$0.00	$396.57	$0.00	$0.00	$403.41	$0.00	$0.00	$0.00	$0.00	$0.00
251.34S	SUP	HCPCS C1713		251.34S  -  NAIL 11MM 345MM TIB IM UNV SS STRL	BOTH IP/OP	"$2,533.98 "	"$1,875.15"	$0.00	"$2,027.18"	"$1,140.29"	"$1,140.29"	$0.00	$0.00	$0.00	$528.14	"$1,880.72"	"$1,880.72"	$0.00	$0.00	$528.08	$0.00	"$1,249.25"	"$1,249.25"	$0.00	"$1,266.99"	"$2,006.91"	"$2,027.18"	$0.00		$0.00	$396.57	$0.00	$0.00	$403.41	$0.00	$0.00	$0.00	$0.00	$0.00
251.36S	SUP	HCPCS C1713		251.36S  -  NAIL 11MM 360MM TIB IM UNV SS STRL	BOTH IP/OP	"$2,533.98 "	"$1,875.15"	$0.00	"$2,027.18"	"$1,140.29"	"$1,140.29"	$0.00	$0.00	$0.00	$528.14	"$1,880.72"	"$1,880.72"	$0.00	$0.00	$528.08	$0.00	"$1,249.25"	"$1,249.25"	$0.00	"$1,266.99"	"$2,006.91"	"$2,027.18"	$0.00		$0.00	$396.57	$0.00	$0.00	$403.41	$0.00	$0.00	$0.00	$0.00	$0.00
251.38S	SUP	HCPCS C1713		251.38S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TUBULAR BARREL 11MM	BOTH IP/OP	"$2,131.25 "	"$1,577.13"	$0.00	"$1,705.00"	$959.06	$959.06	$0.00	$0.00	$0.00	$444.21	"$1,581.81"	"$1,581.81"	$0.00	$0.00	$444.15	$0.00	"$1,260.63"	"$1,260.63"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
251.40S	SUP	HCPCS C1713		251.40S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER 11MM 400MMX1.2MM 1	BOTH IP/OP	"$2,135.38 "	"$1,580.18"	$0.00	"$1,708.30"	$960.92	$960.92	$0.00	$0.00	$0.00	$445.07	"$1,584.88"	"$1,584.88"	$0.00	$0.00	$445.01	$0.00	"$1,263.07"	"$1,263.07"	$0.00	"$1,067.69"	"$1,691.22"	"$1,708.30"	$0.00		$0.00	$334.19	$0.00	$0.00	$339.95	$0.00	$0.00	$0.00	$0.00	$0.00
251.42S	SUP	HCPCS C1713		251.42S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER 11MM 420MMX1.2MM 1	BOTH IP/OP	"$2,135.38 "	"$1,580.18"	$0.00	"$1,708.30"	$960.92	$960.92	$0.00	$0.00	$0.00	$445.07	"$1,584.88"	"$1,584.88"	$0.00	$0.00	$445.01	$0.00	"$1,263.07"	"$1,263.07"	$0.00	"$1,067.69"	"$1,691.22"	"$1,708.30"	$0.00		$0.00	$334.19	$0.00	$0.00	$339.95	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+10.00	SUP	HCPCS V2632		25100C+10.00  -  LENS IOL +10 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+10.50	SUP	HCPCS V2632		25100C+10.50  -  LENS IOL +10.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+11.00	SUP	HCPCS V2632		25100C+11.00  -  LENS IOL +11 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+11.50	SUP	HCPCS V2632		25100C+11.50  -  LENS IOL +11.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+12.00	SUP	HCPCS V2632		25100C+12.00  -  LENS IOL +12 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+12.50	SUP	HCPCS V2632		25100C+12.50  -  LENS IOL +12.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+13.00	SUP	HCPCS V2632		25100C+13.00  -  LENS IOL +13 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+13.50	SUP	HCPCS V2632		25100C+13.50  -  LENS IOL +13.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+14.00	SUP	HCPCS V2632		25100C+14.00  -  LENS IOL +14 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+14.50	SUP	HCPCS V2632		25100C+14.50  -  LENS IOL +14.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+15.00	SUP	HCPCS V2632		25100C+15.00  -  LENS IOL +15 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+15.50	SUP	HCPCS V2632		25100C+15.50  -  LENS IOL +15.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+16.00	SUP	HCPCS V2632		25100C+16.00  -  LENS IOL +16 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+16.50	SUP	HCPCS V2632		25100C+16.50  -  LENS IOL +16.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+17.00	SUP	HCPCS V2632		25100C+17.00  -  LENS IOL +17 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+17.50	SUP	HCPCS V2632		25100C+17.50  -  LENS IOL +17.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+18.00	SUP	HCPCS V2632		25100C+18.00  -  LENS IOL +18 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+18.50	SUP	HCPCS V2632		25100C+18.50  -  LENS IOL +18.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+19.00	SUP	HCPCS V2632		25100C+19.00  -  LENS IOL +19 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+19.50	SUP	HCPCS V2632		25100C+19.50  -  LENS IOL +19.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+20.00	SUP	HCPCS V2632		25100C+20.00  -  LENS IOL +20 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+20.50	SUP	HCPCS V2632		25100C+20.50  -  LENS IOL +20.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+21.00	SUP	HCPCS V2632		25100C+21.00  -  LENS IOL +21 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+21.50	SUP	HCPCS V2632		25100C+21.50  -  LENS IOL +21.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+22.00	SUP	HCPCS V2632		25100C+22.00  -  LENS IOL +22 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+22.50	SUP	HCPCS V2632		25100C+22.50  -  LENS IOL +22.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+23.00	SUP	HCPCS V2632		25100C+23.00  -  LENS IOL +23 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+23.50	SUP	HCPCS V2632		25100C+23.50  -  LENS IOL +23.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+24.00	SUP	HCPCS V2632		25100C+24.00  -  LENS IOL +24 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+24.50	SUP	HCPCS V2632		25100C+24.50  -  LENS IOL +24.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+25.00	SUP	HCPCS V2632		25100C+25.00  -  LENS IOL +25 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+25.50	SUP	HCPCS V2632		25100C+25.50  -  LENS IOL +25.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+26.00	SUP	HCPCS V2632		25100C+26.00  -  LENS IOL +26 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+26.50	SUP	HCPCS V2632		25100C+26.50  -  LENS IOL +26.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+27.00	SUP	HCPCS V2632		25100C+27.00  -  LENS IOL +27 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+27.50	SUP	HCPCS V2632		25100C+27.50  -  LENS IOL +27.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+28.00	SUP	HCPCS V2632		25100C+28.00  -  LENS IOL +28 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+28.50	SUP	HCPCS V2632		25100C+28.50  -  LENS IOL +28.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+29.00	SUP	HCPCS V2632		25100C+29.00  -  LENS IOL +29 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+29.50	SUP	HCPCS V2632		25100C+29.50  -  LENS IOL +29.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+30.00	SUP	HCPCS V2632		25100C+30.00  -  LENS IOL +30 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+6.00	SUP	HCPCS V2632		25100C+6.00  -  LENS IOL +6 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+6.50	SUP	HCPCS V2632		25100C+6.50  -  LENS IOL +6.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+7.00	SUP	HCPCS V2632		25100C+7.00  -  LENS IOL +7 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+7.50	SUP	HCPCS V2632		25100C+7.50  -  LENS IOL +7.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+8.50	SUP	HCPCS V2632		25100C+8.50  -  LENS IOL +8.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+9.00	SUP	HCPCS V2632		25100C+9.00  -  LENS IOL +9 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C+9.50	SUP	HCPCS V2632		25100C+9.50  -  LENS IOL +9.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25100C-8.00	SUP	HCPCS V2632		25100C-8.00  -  LENS IOL +8 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
25121-1	SUP	Custom 27203010		25121-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25121-2	SUP	Custom 27803010		25121-2  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25121-5	SUP	Custom 27203010		25121-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25-197-07-71	SUP	HCPCS C1713		25-197-07-71  -  PLATE BN STRL LVL 1 HBRD CRNMXF	BOTH IP/OP	$828.00 	$612.72	$0.00	$662.40	$372.60	$372.60	$0.00	$0.00	$0.00	$172.58	$614.54	$614.54	$0.00	$0.00	$172.56	$0.00	$489.76	$489.76	$0.00	$414.00	$655.78	$662.40	$0.00		$0.00	$129.58	$0.00	$0.00	$131.82	$0.00	$0.00	$0.00	$0.00	$0.00
25-198-06-71	SUP	HCPCS C1713		25-198-06-71  -  SCREW BN STRL LVL 1 MAXDRIVE CRNMXF	BOTH IP/OP	$358.00 	$264.92	$0.00	$286.40	$161.10	$161.10	$0.00	$0.00	$0.00	$74.62	$265.71	$265.71	$0.00	$0.00	$74.61	$0.00	$211.76	$211.76	$0.00	$179.00	$283.54	$286.40	$0.00		$0.00	$56.03	$0.00	$0.00	$56.99	$0.00	$0.00	$0.00	$0.00	$0.00
25-198-06-75	SUP	HCPCS C1713		25-198-06-75  -  SCREW BN STRL LVL 1 MAXDRIVE CRNMXF	BOTH IP/OP	"$1,790.00 "	"$1,324.60"	$0.00	"$1,432.00"	$805.50	$805.50	$0.00	$0.00	$0.00	$373.08	"$1,328.54"	"$1,328.54"	$0.00	$0.00	$373.04	$0.00	"$1,058.79"	"$1,058.79"	$0.00	$895.00	"$1,417.68"	"$1,432.00"	$0.00		$0.00	$280.14	$0.00	$0.00	$284.97	$0.00	$0.00	$0.00	$0.00	$0.00
25221B	SUP	Custom 27203010		SARSTEDT TUBES	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25222B	SUP	Custom 27203010		CAP TUBE 2ML	BOTH IP/OP	$157.50 	$116.55	$0.00	$126.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$78.75	$124.74	$126.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
252-952	SUP	Custom 27203010		MASK INFANT BMV AMBU	BOTH IP/OP	$176.50 	$130.61	$0.00	$141.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.25	$139.79	$141.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
253.27S	SUP	HCPCS C1713		253.27S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 270MM STAINLESS STEEL	BOTH IP/OP	"$2,135.38 "	"$1,580.18"	$0.00	"$1,708.30"	$960.92	$960.92	$0.00	$0.00	$0.00	$445.07	"$1,584.88"	"$1,584.88"	$0.00	$0.00	$445.01	$0.00	"$1,263.07"	"$1,263.07"	$0.00	"$1,067.69"	"$1,691.22"	"$1,708.30"	$0.00		$0.00	$334.19	$0.00	$0.00	$339.95	$0.00	$0.00	$0.00	$0.00	$0.00
25-302-70-91	SUP	HCPCS C1713		25-302-70-91  -  PLATE BONE MICRO STR MEDIUM .6MM 2 HOLE TITANIUM FRONTAL	BOTH IP/OP	$113.18 	$83.75	$0.00	$90.54	$50.93	$50.93	$0.00	$0.00	$0.00	$23.59	$84.00	$84.00	$0.00	$0.00	$23.59	$0.00	$66.94	$66.94	$0.00	$56.59	$89.64	$90.54	$0.00		$0.00	$17.71	$0.00	$0.00	$18.02	$0.00	$0.00	$0.00	$0.00	$0.00
25-304-00-91	SUP	HCPCS C1713		25-304-00-91  -  PLATE BONE MICRO REGULAR STR .6MM 4 HOLE TITANIUM MAXFACL	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$76.95	$76.95	$0.00	$0.00	$0.00	$35.64	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$101.15	$101.15	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$26.76	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$0.00
25-304-55-91	SUP	HCPCS C1713		25-304-55-91  -  PLATE BONE MICRO MEDIUM STR .6MM 4 HOLE TITANIUM MAXFACL 1.5	BOTH IP/OP	$176.13 	$130.34	$0.00	$140.90	$79.26	$79.26	$0.00	$0.00	$0.00	$36.71	$130.72	$130.72	$0.00	$0.00	$36.70	$0.00	$104.18	$104.18	$0.00	$88.06	$139.49	$140.90	$0.00		$0.00	$27.56	$0.00	$0.00	$28.04	$0.00	$0.00	$0.00	$0.00	$0.00
25-306-00-91	SUP	HCPCS C1713		25-306-00-91  -  PLATE BN MIC STRG .6MM THREADLOCK TS 6 HL TI MXLFCL 1.5MM	BOTH IP/OP	$230.50 	$170.57	$0.00	$184.40	$103.73	$103.73	$0.00	$0.00	$0.00	$48.04	$171.08	$171.08	$0.00	$0.00	$48.04	$0.00	$136.34	$136.34	$0.00	$115.25	$182.56	$184.40	$0.00		$0.00	$36.07	$0.00	$0.00	$36.70	$0.00	$0.00	$0.00	$0.00	$0.00
25-306-55-91	SUP	HCPCS C1713		25-306-55-91  -  PLATE BONE MICRO STR MEDIUM .6MM 6 HOLE TITANIUM MIDFAC 1.5	BOTH IP/OP	$230.50 	$170.57	$0.00	$184.40	$103.73	$103.73	$0.00	$0.00	$0.00	$48.04	$171.08	$171.08	$0.00	$0.00	$48.04	$0.00	$136.34	$136.34	$0.00	$115.25	$182.56	$184.40	$0.00		$0.00	$36.07	$0.00	$0.00	$36.70	$0.00	$0.00	$0.00	$0.00	$0.00
25-308-00-91	SUP	HCPCS C1713		25-308-00-91  -  PLATE BONE MICRO STR REGULAR .6MM 8 HOLE TITANIUM RIGHT	BOTH IP/OP	$253.80 	$187.81	$0.00	$203.04	$114.21	$114.21	$0.00	$0.00	$0.00	$52.90	$188.37	$188.37	$0.00	$0.00	$52.89	$0.00	$150.12	$150.12	$0.00	$126.90	$201.01	$203.04	$0.00		$0.00	$39.72	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
25-308-16-09	SUP	HCPCS C1713		25-308-16-09  -  MIDFACE PLATE  MEDIUM  6 HOLE  DOUBLE Y  0.8MM THICK	BOTH IP/OP	$660.40 	$488.70	$0.00	$528.32	$297.18	$297.18	$0.00	$0.00	$0.00	$137.64	$490.15	$490.15	$0.00	$0.00	$137.63	$0.00	$390.63	$390.63	$0.00	$330.20	$523.04	$528.32	$0.00		$0.00	$103.35	$0.00	$0.00	$105.14	$0.00	$0.00	$0.00	$0.00	$0.00
25-310-09-09	SUP	HCPCS C1713		25-310-09-09  -  PLATE LARGE L-SHAPE W/ TAB 10 HOLE 5X4 1MM	BOTH IP/OP	$608.65 	$450.40	$0.00	$486.92	$273.89	$273.89	$0.00	$0.00	$0.00	$126.86	$451.74	$451.74	$0.00	$0.00	$126.84	$0.00	$360.02	$360.02	$0.00	$304.33	$482.05	$486.92	$0.00		$0.00	$95.25	$0.00	$0.00	$96.90	$0.00	$0.00	$0.00	$0.00	$0.00
25-310-70-91	SUP	HCPCS C1713		25-310-70-91  -  PLATE BONE L MICRO .6MM TITANIUM MIDFAC 1.5MM SCREW	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$174.83	$174.83	$0.00	$0.00	$0.00	$80.97	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$229.80	$229.80	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$60.80	$0.00	$0.00	$61.85	$0.00	$0.00	$0.00	$0.00	$0.00
25-311-70-91	SUP	HCPCS C1713		25-311-70-91  -  PLATE BONE L MICRO MEDIUM .6MM TITANIUM RIGHT MIDFAC STERILE	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$174.83	$174.83	$0.00	$0.00	$0.00	$80.97	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$229.80	$229.80	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$60.80	$0.00	$0.00	$61.85	$0.00	$0.00	$0.00	$0.00	$0.00
25-311-85-91	SUP	HCPCS C1713		25-311-85-91  -  PLATE BONE L MICRO LONG .6MM TITANIUM RIGHT MIDFAC STERILE	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$174.83	$174.83	$0.00	$0.00	$0.00	$80.97	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$229.80	$229.80	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$60.80	$0.00	$0.00	$61.85	$0.00	$0.00	$0.00	$0.00	$0.00
25-314-85-91	SUP	HCPCS C1713		25-314-85-91  -  PLATE BN 100D LNG MIC L .6MM THREADLOCK TS 3X2 HL TI MXLFCL	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$174.83	$174.83	$0.00	$0.00	$0.00	$80.97	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$229.80	$229.80	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$60.80	$0.00	$0.00	$61.85	$0.00	$0.00	$0.00	$0.00	$0.00
25-315-06-91	SUP	HCPCS C1713		25-315-06-91  -  PLATE BONE T MICRO REGULAR .6MM TITANIUM MIDFAC STERILE 1.5	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$174.83	$174.83	$0.00	$0.00	$0.00	$80.97	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$229.80	$229.80	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$60.80	$0.00	$0.00	$61.85	$0.00	$0.00	$0.00	$0.00	$0.00
25-315-85-91	SUP	HCPCS C1713		25-315-85-91  -  PLATE BONE 100D L MICRO .6MM TITANIUM RIGHT MIDFAC STERILE	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$174.83	$174.83	$0.00	$0.00	$0.00	$80.97	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$229.80	$229.80	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$60.80	$0.00	$0.00	$61.85	$0.00	$0.00	$0.00	$0.00	$0.00
25-316-00-91	SUP	HCPCS C1713		25-316-00-91  -  PLATE BONE MICRO .6MM 16 HOLE TITANIUM MIDFAC STERILE 1.5MM	BOTH IP/OP	$414.88 	$307.01	$0.00	$331.90	$186.69	$186.69	$0.00	$0.00	$0.00	$86.47	$307.92	$307.92	$0.00	$0.00	$86.46	$0.00	$245.40	$245.40	$0.00	$207.44	$328.58	$331.90	$0.00		$0.00	$64.93	$0.00	$0.00	$66.05	$0.00	$0.00	$0.00	$0.00	$0.00
25-320-70-91	SUP	HCPCS C1713		25-320-70-91  -  PLATE BONE Y MICRO LONG .6MM TITANIUM MIDFAC STERILE 1.5MM	BOTH IP/OP	$389.73 	$288.40	$0.00	$311.78	$175.38	$175.38	$0.00	$0.00	$0.00	$81.23	$289.25	$289.25	$0.00	$0.00	$81.22	$0.00	$230.52	$230.52	$0.00	$194.86	$308.67	$311.78	$0.00		$0.00	$60.99	$0.00	$0.00	$62.04	$0.00	$0.00	$0.00	$0.00	$0.00
25-322-55-91	SUP	HCPCS C1713		25-322-55-91  -  PLATE BN MIC SHRT 2Y .6MM THREADLOCK TS 6 HL TI MXLFCL 1.5MM	BOTH IP/OP	$453.23 	$335.39	$0.00	$362.58	$203.95	$203.95	$0.00	$0.00	$0.00	$94.46	$336.38	$336.38	$0.00	$0.00	$94.45	$0.00	$268.08	$268.08	$0.00	$226.61	$358.96	$362.58	$0.00		$0.00	$70.93	$0.00	$0.00	$72.15	$0.00	$0.00	$0.00	$0.00	$0.00
25-322-70-91	SUP	HCPCS C1713		25-322-70-91  -  PLATE BONE 2Y MICRO MEDIUM .6MM TITANIUM RIGHT FRONTAL MAXL	BOTH IP/OP	$440.03 	$325.62	$0.00	$352.02	$198.01	$198.01	$0.00	$0.00	$0.00	$91.71	$326.59	$326.59	$0.00	$0.00	$91.70	$0.00	$260.27	$260.27	$0.00	$220.01	$348.50	$352.02	$0.00		$0.00	$68.86	$0.00	$0.00	$70.05	$0.00	$0.00	$0.00	$0.00	$0.00
25-325-10-91	SUP	HCPCS C1713		25-325-10-91  -  PLATE BN MIC CRV .6MM THREADLOCK TS 10 HL TI MXLFCL 1.5MM	BOTH IP/OP	$427.33 	$316.22	$0.00	$341.86	$192.30	$192.30	$0.00	$0.00	$0.00	$89.07	$317.16	$317.16	$0.00	$0.00	$89.05	$0.00	$252.76	$252.76	$0.00	$213.66	$338.45	$341.86	$0.00		$0.00	$66.88	$0.00	$0.00	$68.03	$0.00	$0.00	$0.00	$0.00	$0.00
25-326-55-91	SUP	HCPCS C1713		25-326-55-91  -  PLATE BONE X MICRO REGULAR .6MM TITANIUM MIDFAC STERILE 1.5	BOTH IP/OP	$427.33 	$316.22	$0.00	$341.86	$192.30	$192.30	$0.00	$0.00	$0.00	$89.07	$317.16	$317.16	$0.00	$0.00	$89.05	$0.00	$252.76	$252.76	$0.00	$213.66	$338.45	$341.86	$0.00		$0.00	$66.88	$0.00	$0.00	$68.03	$0.00	$0.00	$0.00	$0.00	$0.00
25-329-05-09	SUP	HCPCS C1713		25-329-05-09  -  PLATE BONE Y MICRO .6MM 6 HOLE TITANIUM MIDFAC 1.5MM SCREW	BOTH IP/OP	$414.38 	$306.64	$0.00	$331.50	$186.47	$186.47	$0.00	$0.00	$0.00	$86.37	$307.55	$307.55	$0.00	$0.00	$86.36	$0.00	$245.10	$245.10	$0.00	$207.19	$328.19	$331.50	$0.00		$0.00	$64.85	$0.00	$0.00	$65.97	$0.00	$0.00	$0.00	$0.00	$0.00
25-330-05-09	SUP	HCPCS C1713		25-330-05-09  -  PLATE BONE 100D L MICRO LEFT ANGLE .6MM 7 HOLE TITANIUM	BOTH IP/OP	$414.38 	$306.64	$0.00	$331.50	$186.47	$186.47	$0.00	$0.00	$0.00	$86.37	$307.55	$307.55	$0.00	$0.00	$86.36	$0.00	$245.10	$245.10	$0.00	$207.19	$328.19	$331.50	$0.00		$0.00	$64.85	$0.00	$0.00	$65.97	$0.00	$0.00	$0.00	$0.00	$0.00
25-330-07-09	SUP	HCPCS C1713		25-330-07-09  -  PLATE BONE T MICRO .6MM 6 HOLE TITANIUM MIDFAC 1.5MM SCREW	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$174.83	$174.83	$0.00	$0.00	$0.00	$80.97	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$229.80	$229.80	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$60.80	$0.00	$0.00	$61.85	$0.00	$0.00	$0.00	$0.00	$0.00
25-330-24-09	SUP	HCPCS C1713		25-330-24-09  -  PLATE BN MIC STRG .6MM THREADLOCK TS 24 HL TI MXLFCL 1.5MM	BOTH IP/OP	$582.75 	$431.24	$0.00	$466.20	$262.24	$262.24	$0.00	$0.00	$0.00	$121.46	$432.52	$432.52	$0.00	$0.00	$121.45	$0.00	$344.70	$344.70	$0.00	$291.38	$461.54	$466.20	$0.00		$0.00	$91.20	$0.00	$0.00	$92.77	$0.00	$0.00	$0.00	$0.00	$0.00
25-331-05-09	SUP	HCPCS C1713		25-331-05-09  -  PLATE BONE 100D L MICRO RIGHT ANG .6MM 7 HOLE TITANIUM	BOTH IP/OP	$414.38 	$306.64	$0.00	$331.50	$186.47	$186.47	$0.00	$0.00	$0.00	$86.37	$307.55	$307.55	$0.00	$0.00	$86.36	$0.00	$245.10	$245.10	$0.00	$207.19	$328.19	$331.50	$0.00		$0.00	$64.85	$0.00	$0.00	$65.97	$0.00	$0.00	$0.00	$0.00	$0.00
25-331-85-91	SUP	HCPCS C1713		25-331-85-91  -  PLATE BONE L MICRO .6MM TITANIUM MIDFAC 1.5MM SCREW	BOTH IP/OP	$414.38 	$306.64	$0.00	$331.50	$186.47	$186.47	$0.00	$0.00	$0.00	$86.37	$307.55	$307.55	$0.00	$0.00	$86.36	$0.00	$245.10	$245.10	$0.00	$207.19	$328.19	$331.50	$0.00		$0.00	$64.85	$0.00	$0.00	$65.97	$0.00	$0.00	$0.00	$0.00	$0.00
25-332-08-09	SUP	HCPCS C1713		25-332-08-09  -  PLATE BONE MICRO .6MM 8 HOLE INSERT TITANIUM ORBTL FLOOR	BOTH IP/OP	$401.43 	$297.06	$0.00	$321.14	$180.64	$180.64	$0.00	$0.00	$0.00	$83.67	$297.94	$297.94	$0.00	$0.00	$83.66	$0.00	$237.44	$237.44	$0.00	$200.71	$317.93	$321.14	$0.00		$0.00	$62.82	$0.00	$0.00	$63.91	$0.00	$0.00	$0.00	$0.00	$0.00
25-377-04	SUP	HCPCS C1713		25-377-04  -  PLATE MED LEFT MAXFACL L BONE .6MM	BOTH IP/OP	$325.50 	$240.87	$0.00	$260.40	$146.48	$146.48	$0.00	$0.00	$0.00	$67.84	$241.59	$241.59	$0.00	$0.00	$67.83	$0.00	$192.53	$192.53	$0.00	$162.75	$257.80	$260.40	$0.00		$0.00	$50.94	$0.00	$0.00	$51.82	$0.00	$0.00	$0.00	$0.00	$0.00
254.27S	SUP	HCPCS C1713		254.27S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 270MM STAINLESS STEEL	BOTH IP/OP	"$2,220.63 "	"$1,643.27"	$0.00	"$1,776.50"	$999.28	$999.28	$0.00	$0.00	$0.00	$462.83	"$1,648.15"	"$1,648.15"	$0.00	$0.00	$462.78	$0.00	"$1,313.50"	"$1,313.50"	$0.00	"$1,110.31"	"$1,758.74"	"$1,776.50"	$0.00		$0.00	$347.53	$0.00	$0.00	$353.52	$0.00	$0.00	$0.00	$0.00	$0.00
254.28S	SUP	HCPCS C1713		254.28S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 285MM STAINLESS STEEL	BOTH IP/OP	"$2,220.63 "	"$1,643.27"	$0.00	"$1,776.50"	$999.28	$999.28	$0.00	$0.00	$0.00	$462.83	"$1,648.15"	"$1,648.15"	$0.00	$0.00	$462.78	$0.00	"$1,313.50"	"$1,313.50"	$0.00	"$1,110.31"	"$1,758.74"	"$1,776.50"	$0.00		$0.00	$347.53	$0.00	$0.00	$353.52	$0.00	$0.00	$0.00	$0.00	$0.00
25-438-35-07	SUP	HCPCS C1713		25-438-35-07  -  SCREW BYRD MIDFACE LARGE	BOTH IP/OP	$640.00 	$473.60	$0.00	$512.00	$288.00	$288.00	$0.00	$0.00	$0.00	$133.39	$475.01	$475.01	$0.00	$0.00	$133.38	$0.00	$378.56	$378.56	$0.00	$320.00	$506.88	$512.00	$0.00		$0.00	$100.16	$0.00	$0.00	$101.89	$0.00	$0.00	$0.00	$0.00	$0.00
25-449-07-91	SUP	Custom 27203010		25-449-07-91  -  DRILL TWIST 1.5MM 50MM 7MM STOP	BOTH IP/OP	$290.05 	$214.64	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.28	$215.28	$0.00	$0.00	$60.45	$0.00	$0.00	$0.00	$0.00	$145.03	$229.72	$232.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25-449-16-91	SUP	Custom 27100030		25-449-16-91  -  DRILL TWIST 1.5MM 50MM 20MM NOTCH STOP STAINLESS STEEL	BOTH IP/OP	$290.05 	$214.64	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.28	$215.28	$0.00	$0.00	$60.45	$0.00	$0.00	$0.00	$0.00	$145.03	$229.72	$232.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25-452-00-91	SUP	Custom 27100030		25-452-00-91  -  DRILL TWIST 1.1MM 50MM NOTCH STAINLESS STEEL	BOTH IP/OP	$290.05 	$214.64	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.28	$215.28	$0.00	$0.00	$60.45	$0.00	$0.00	$0.00	$0.00	$145.03	$229.72	$232.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25-452-05-91	SUP	Custom 27100030		25-452-05-91  -  DRILL TWST 5MM 1.1MM 50MM J NTCH STP DISP	BOTH IP/OP	$290.05 	$214.64	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.28	$215.28	$0.00	$0.00	$60.45	$0.00	$0.00	$0.00	$0.00	$145.03	$229.72	$232.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25-452-07-91	SUP	Custom 27100030		25-452-07-91  -  BIT DRILL 1.1MM 50MM 7MM J NOTCH STOP TWIST STAINLESS STEEL	BOTH IP/OP	$290.05 	$214.64	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.28	$215.28	$0.00	$0.00	$60.45	$0.00	$0.00	$0.00	$0.00	$145.03	$229.72	$232.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25452-525	SUP	Custom 27203010		25452-525  -  LEAD CONNCTNG WIRE SNP	BOTH IP/OP	$10.94 	$8.10	$0.00	$8.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.12	$8.12	$0.00	$0.00	$2.28	$0.00	$0.00	$0.00	$0.00	$5.47	$8.66	$8.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25-458-19-07	SUP	Custom 27100030		25-458-19-07  -  DRILL TWIST J 1.9MM 50MM NOTCH DISPOSABLE 2.3MM FRAC SYSTEM	BOTH IP/OP	$290.05 	$214.64	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.28	$215.28	$0.00	$0.00	$60.45	$0.00	$0.00	$0.00	$0.00	$145.03	$229.72	$232.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25-460-19-07	SUP	Custom 27100030		25-460-19-07  -  DRILL TWIST 1.9MM 70MM STAINLESS STEEL	BOTH IP/OP	$290.05 	$214.64	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.28	$215.28	$0.00	$0.00	$60.45	$0.00	$0.00	$0.00	$0.00	$145.03	$229.72	$232.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25-469-11-07	SUP	Custom 27100030		25-469-11-07  -  BIT DRILL TWIST 1.5MM 115MM J NOTCH 2MM SCREW	BOTH IP/OP	$290.05 	$214.64	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.28	$215.28	$0.00	$0.00	$60.45	$0.00	$0.00	$0.00	$0.00	$145.03	$229.72	$232.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
255-000-001	SUP	Custom 27203010		255-000-001  -  GRSPR LAPSCOP ALGTR 250MM 2.3MM AL MINI STRL LATEX FREE	BOTH IP/OP	$534.86 	$395.80	$0.00	$427.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$396.97	$396.97	$0.00	$0.00	$111.46	$0.00	$0.00	$0.00	$0.00	$267.43	$423.61	$427.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2552-06-L	SUP	HCPCS L3935		2552-06-L  -  TRIGGER FINGER SPLINTS LARGE	BOTH IP/OP	$0.42 	$0.31	$0.00	$159.57	$0.19	$0.19	$0.00	$0.00	$152.21	$159.57	$0.31	$0.31	$0.00	$0.00	$0.09	$0.00	$0.25	$0.25	$0.00	$0.21	$0.33	$0.33	$0.25		$0.25	$151.93	$0.00	$0.00	$155.06	$0.00	$0.00	$0.00	$0.00	$0.00
2552-06-M	SUP	HCPCS L3935		2552-06-M  -  TRIGGER FINGER SPLINTS ME	BOTH IP/OP	$0.42 	$0.31	$0.00	$159.57	$0.19	$0.19	$0.00	$0.00	$152.21	$159.57	$0.31	$0.31	$0.00	$0.00	$0.09	$0.00	$0.25	$0.25	$0.00	$0.21	$0.33	$0.33	$0.25		$0.25	$151.93	$0.00	$0.00	$155.06	$0.00	$0.00	$0.00	$0.00	$0.00
2552-06-S	SUP	HCPCS L3935		2552-06-S  -  TRIGGER FINGER SPLINTS SMALL	BOTH IP/OP	$0.42 	$0.31	$0.00	$159.57	$0.19	$0.19	$0.00	$0.00	$152.21	$159.57	$0.31	$0.31	$0.00	$0.00	$0.09	$0.00	$0.25	$0.25	$0.00	$0.21	$0.33	$0.33	$0.25		$0.25	$151.93	$0.00	$0.00	$155.06	$0.00	$0.00	$0.00	$0.00	$0.00
25-550-04-91	SUP	HCPCS C1713		25-550-04-91  -  PLATE BONE MINI REGULAR 1MM 4 HOLE TITANIUM MANDIB 2MM SCREW	BOTH IP/OP	$178.73 	$132.26	$0.00	$142.98	$80.43	$80.43	$0.00	$0.00	$0.00	$37.25	$132.65	$132.65	$0.00	$0.00	$37.25	$0.00	$105.72	$105.72	$0.00	$89.36	$141.55	$142.98	$0.00		$0.00	$27.97	$0.00	$0.00	$28.45	$0.00	$0.00	$0.00	$0.00	$0.00
25-550-08-91	SUP	HCPCS C1713		25-550-08-91  -  PLATE BONE MINI REGULAR 1MM 8 HOLE TITANIUM MANDIB 2MM SCREW	BOTH IP/OP	$220.13 	$162.90	$0.00	$176.10	$99.06	$99.06	$0.00	$0.00	$0.00	$45.88	$163.38	$163.38	$0.00	$0.00	$45.87	$0.00	$130.20	$130.20	$0.00	$110.06	$174.34	$176.10	$0.00		$0.00	$34.45	$0.00	$0.00	$35.04	$0.00	$0.00	$0.00	$0.00	$0.00
25-551-04-91	SUP	HCPCS C1713		25-551-04-91  -  PLATE BONE MINI MEDIUM STANDARD 1MM 4 HOLE TITANIUM MAXFACL	BOTH IP/OP	$173.53 	$128.41	$0.00	$138.82	$78.09	$78.09	$0.00	$0.00	$0.00	$36.17	$128.79	$128.79	$0.00	$0.00	$36.16	$0.00	$102.64	$102.64	$0.00	$86.76	$137.44	$138.82	$0.00		$0.00	$27.16	$0.00	$0.00	$27.63	$0.00	$0.00	$0.00	$0.00	$0.00
25-552-04-91	SUP	HCPCS C1713		25-552-04-91  -  PLATE BONE MINI LONG STANDARD 1MM 4 HOLE TITANIUM MANDIB 2MM	BOTH IP/OP	$176.13 	$130.34	$0.00	$140.90	$79.26	$79.26	$0.00	$0.00	$0.00	$36.71	$130.72	$130.72	$0.00	$0.00	$36.70	$0.00	$104.18	$104.18	$0.00	$88.06	$139.49	$140.90	$0.00		$0.00	$27.56	$0.00	$0.00	$28.04	$0.00	$0.00	$0.00	$0.00	$0.00
25-552-06-91	SUP	HCPCS C1713		25-552-06-91  -  PLATE BONE MINI LONG STANDARD 1MM 6 HOLE TITANIUM MAXFACL 2	BOTH IP/OP	$204.58 	$151.39	$0.00	$163.66	$92.06	$92.06	$0.00	$0.00	$0.00	$42.64	$151.84	$151.84	$0.00	$0.00	$42.63	$0.00	$121.01	$121.01	$0.00	$102.29	$162.03	$163.66	$0.00		$0.00	$32.02	$0.00	$0.00	$32.57	$0.00	$0.00	$0.00	$0.00	$0.00
25-592-04-1	SUP	HCPCS C1713		25-592-04-1  -  LOCKING PLATE  4 HOLE	BOTH IP/OP	$158.10 	$116.99	$0.00	$126.48	$71.15	$71.15	$0.00	$0.00	$0.00	$32.95	$117.34	$117.34	$0.00	$0.00	$32.95	$0.00	$93.52	$93.52	$0.00	$79.05	$125.22	$126.48	$0.00		$0.00	$24.74	$0.00	$0.00	$25.17	$0.00	$0.00	$0.00	$0.00	$0.00
25-672-15-1	SUP	HCPCS C1713		25-672-15-1  -  SCREW TI 15MM 2MM MAXFACL XDR BONE	BOTH IP/OP	$99.98 	$73.99	$0.00	$79.98	$44.99	$44.99	$0.00	$0.00	$0.00	$20.84	$74.20	$74.20	$0.00	$0.00	$20.83	$0.00	$59.14	$59.14	$0.00	$49.99	$79.18	$79.98	$0.00		$0.00	$15.65	$0.00	$0.00	$15.92	$0.00	$0.00	$0.00	$0.00	$0.00
25-673-49-1	SUP	HCPCS C1713		25-673-49-1  -  SCREW TI 9MM 2.3MM MAXFACL XDR ER BONE	BOTH IP/OP	$592.88 	$438.73	$0.00	$474.30	$266.79	$266.79	$0.00	$0.00	$0.00	$123.57	$440.03	$440.03	$0.00	$0.00	$123.56	$0.00	$350.69	$350.69	$0.00	$296.44	$469.56	$474.30	$0.00		$0.00	$92.78	$0.00	$0.00	$94.39	$0.00	$0.00	$0.00	$0.00	$0.00
25-677-12	SUP	HCPCS C1713		25-677-12  -  SCREW TI 12MM 2.7MM MAXFACL XDR ER BONE	BOTH IP/OP	$238.00 	$176.12	$0.00	$190.40	$107.10	$107.10	$0.00	$0.00	$0.00	$49.61	$176.64	$176.64	$0.00	$0.00	$49.60	$0.00	$140.78	$140.78	$0.00	$119.00	$188.50	$190.40	$0.00		$0.00	$37.25	$0.00	$0.00	$37.89	$0.00	$0.00	$0.00	$0.00	$0.00
25-677-12-91	SUP	HCPCS C1713		25-677-12-91  -  SCREW BONE 2.7MM 12MM EMERGENCY CROSS DRIVE TITANIUM MANDIB	BOTH IP/OP	$270.15 	$199.91	$0.00	$216.12	$121.57	$121.57	$0.00	$0.00	$0.00	$56.31	$200.51	$200.51	$0.00	$0.00	$56.30	$0.00	$159.79	$159.79	$0.00	$135.08	$213.96	$216.12	$0.00		$0.00	$42.28	$0.00	$0.00	$43.01	$0.00	$0.00	$0.00	$0.00	$0.00
25-677-14	SUP	HCPCS C1713		25-677-14  -  SCREW TI 14MM 2.7MM MAXFACL XDR ER BONE	BOTH IP/OP	$238.00 	$176.12	$0.00	$190.40	$107.10	$107.10	$0.00	$0.00	$0.00	$49.61	$176.64	$176.64	$0.00	$0.00	$49.60	$0.00	$140.78	$140.78	$0.00	$119.00	$188.50	$190.40	$0.00		$0.00	$37.25	$0.00	$0.00	$37.89	$0.00	$0.00	$0.00	$0.00	$0.00
25-677-14-91	SUP	HCPCS C1713		25-677-14-91  -  SCREW BONE 2.7MM 14MM NONLOCKING CROSS DRIVE THREADLOCK TS	BOTH IP/OP	$270.15 	$199.91	$0.00	$216.12	$121.57	$121.57	$0.00	$0.00	$0.00	$56.31	$200.51	$200.51	$0.00	$0.00	$56.30	$0.00	$159.79	$159.79	$0.00	$135.08	$213.96	$216.12	$0.00		$0.00	$42.28	$0.00	$0.00	$43.01	$0.00	$0.00	$0.00	$0.00	$0.00
25-677-16-91	SUP	HCPCS C1713		25-677-16-91  -  SCREW BONE 2.7MM 16MM NONLOCKING CROSS DRIVE THREADLOCK TS	BOTH IP/OP	$270.15 	$199.91	$0.00	$216.12	$121.57	$121.57	$0.00	$0.00	$0.00	$56.31	$200.51	$200.51	$0.00	$0.00	$56.30	$0.00	$159.79	$159.79	$0.00	$135.08	$213.96	$216.12	$0.00		$0.00	$42.28	$0.00	$0.00	$43.01	$0.00	$0.00	$0.00	$0.00	$0.00
25-677-52-91	SUP	HCPCS C1713		25-677-52-91  -  SCREW BONE 3.2MM 12MM EMERGENCY CROSS DRIVE TITANIUM MANDIB	BOTH IP/OP	$321.15 	$237.65	$0.00	$256.92	$144.52	$144.52	$0.00	$0.00	$0.00	$66.94	$238.36	$238.36	$0.00	$0.00	$66.93	$0.00	$189.96	$189.96	$0.00	$160.58	$254.35	$256.92	$0.00		$0.00	$50.26	$0.00	$0.00	$51.13	$0.00	$0.00	$0.00	$0.00	$0.00
25-677-56-1	SUP	HCPCS C1713		25-677-56-1  -  SCREW TI 16MM 3.2MM MAXFACL XDR ER BONE	BOTH IP/OP	$230.50 	$170.57	$0.00	$184.40	$103.73	$103.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$115.25	$182.56	$184.40	$0.00		$0.00	$36.07	$0.00	$0.00	$36.70	$0.00	$0.00	$0.00	$0.00	$0.00
25-750-04-09	SUP	HCPCS C1713		25-750-04-09  -  PLATE BONE 3D 1MM 4 HOLE THREADLOCK TITANIUM MANDIB	BOTH IP/OP	$668.38 	$494.60	$0.00	$534.70	$300.77	$300.77	$0.00	$0.00	$0.00	$139.31	$496.07	$496.07	$0.00	$0.00	$139.29	$0.00	$395.34	$395.34	$0.00	$334.19	$529.36	$534.70	$0.00		$0.00	$104.60	$0.00	$0.00	$106.41	$0.00	$0.00	$0.00	$0.00	$0.00
25-750-14-09	SUP	HCPCS C1713		25-750-14-09  -  PLATE BONE 3D REGULAR 1MM 14 HOLE THREADLOCK TITANIUM MANDIB	BOTH IP/OP	"$1,308.90 "	$968.59	$0.00	"$1,047.12"	$589.01	$589.01	$0.00	$0.00	$0.00	$272.81	$971.47	$971.47	$0.00	$0.00	$272.77	$0.00	$774.21	$774.21	$0.00	$654.45	"$1,036.65"	"$1,047.12"	$0.00		$0.00	$204.84	$0.00	$0.00	$208.38	$0.00	$0.00	$0.00	$0.00	$0.00
25-752-04-09	SUP	HCPCS C1713		25-752-04-09  -  PLATE BN LNG MN 1MM THREADLOCK TS 4 HL LCK TI MNDB	BOTH IP/OP	$710.13 	$525.50	$0.00	$568.10	$319.56	$319.56	$0.00	$0.00	$0.00	$148.01	$527.05	$527.05	$0.00	$0.00	$147.99	$0.00	$420.04	$420.04	$0.00	$355.06	$562.42	$568.10	$0.00		$0.00	$111.13	$0.00	$0.00	$113.05	$0.00	$0.00	$0.00	$0.00	$0.00
25-752-06-09	SUP	HCPCS C1713		25-752-06-09  -  PLATE BONE MINI LONG 1MM 6 HOLE THREADLOCK GREEN TITANIUM	BOTH IP/OP	$779.75 	$577.02	$0.00	$623.80	$350.89	$350.89	$0.00	$0.00	$0.00	$162.52	$578.73	$578.73	$0.00	$0.00	$162.50	$0.00	$461.22	$461.22	$0.00	$389.88	$617.56	$623.80	$0.00		$0.00	$122.03	$0.00	$0.00	$124.14	$0.00	$0.00	$0.00	$0.00	$0.00
25-774-07-91	SUP	HCPCS C1713		25-774-07-91  -  SCREW BONE 2.7MM 7MM LOCKING CROSS DRIVE TITANIUM MANDIB	BOTH IP/OP	$328.63 	$243.19	$0.00	$262.90	$147.88	$147.88	$0.00	$0.00	$0.00	$68.49	$243.91	$243.91	$0.00	$0.00	$68.49	$0.00	$194.38	$194.38	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$51.43	$0.00	$0.00	$52.32	$0.00	$0.00	$0.00	$0.00	$0.00
25-774-09-91	SUP	HCPCS C1713		25-774-09-91  -  SCREW BONE 2.7MM 9MM LOCKING CROSS DRIVE TITANIUM MANDIB	BOTH IP/OP	$328.63 	$243.19	$0.00	$262.90	$147.88	$147.88	$0.00	$0.00	$0.00	$68.49	$243.91	$243.91	$0.00	$0.00	$68.49	$0.00	$194.38	$194.38	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$51.43	$0.00	$0.00	$52.32	$0.00	$0.00	$0.00	$0.00	$0.00
25-774-11-91	SUP	HCPCS C1713		25-774-11-91  -  SCREW BONE 2.7MM 11MM LOCKING CROSS DRIVE TITANIUM MANDIB	BOTH IP/OP	$328.63 	$243.19	$0.00	$262.90	$147.88	$147.88	$0.00	$0.00	$0.00	$68.49	$243.91	$243.91	$0.00	$0.00	$68.49	$0.00	$194.38	$194.38	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$51.43	$0.00	$0.00	$52.32	$0.00	$0.00	$0.00	$0.00	$0.00
25-774-13-91	SUP	HCPCS C1713		25-774-13-91  -  SCREW BONE 2.7MM 13MM LOCKING CROSS DRIVE TITANIUM MANDIB	BOTH IP/OP	$328.63 	$243.19	$0.00	$262.90	$147.88	$147.88	$0.00	$0.00	$0.00	$68.49	$243.91	$243.91	$0.00	$0.00	$68.49	$0.00	$194.38	$194.38	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$51.43	$0.00	$0.00	$52.32	$0.00	$0.00	$0.00	$0.00	$0.00
25-774-15-91	SUP	HCPCS C1713		25-774-15-91  -  SCREW BONE 2.7MM 15MM LOCKING CROSS DRIVE TITANIUM MANDIB	BOTH IP/OP	$328.63 	$243.19	$0.00	$262.90	$147.88	$147.88	$0.00	$0.00	$0.00	$68.49	$243.91	$243.91	$0.00	$0.00	$68.49	$0.00	$194.38	$194.38	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$51.43	$0.00	$0.00	$52.32	$0.00	$0.00	$0.00	$0.00	$0.00
25-780-04-91	SUP	HCPCS C1713		25-780-04-91  -  NEURO SCREW  ULTRA LOW PROFILE 1.5 X 4.0MM	BOTH IP/OP	$201.15 	$148.85	$0.00	$160.92	$90.52	$90.52	$0.00	$0.00	$0.00	$41.92	$149.29	$149.29	$0.00	$0.00	$41.92	$0.00	$118.98	$118.98	$0.00	$100.58	$159.31	$160.92	$0.00		$0.00	$31.48	$0.00	$0.00	$32.02	$0.00	$0.00	$0.00	$0.00	$0.00
25-872-05-91	SUP	HCPCS C1713		25-872-05-91  -  SCREW BN 2MM 5MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI	BOTH IP/OP	$124.33 	$92.00	$0.00	$99.46	$55.95	$55.95	$0.00	$0.00	$0.00	$25.91	$92.27	$92.27	$0.00	$0.00	$25.91	$0.00	$73.54	$73.54	$0.00	$62.16	$98.47	$99.46	$0.00		$0.00	$19.46	$0.00	$0.00	$19.79	$0.00	$0.00	$0.00	$0.00	$0.00
25-872-07-91	SUP	HCPCS C1713		25-872-07-91  -  SCREW BN 2MM 7MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI	BOTH IP/OP	$124.33 	$92.00	$0.00	$99.46	$55.95	$55.95	$0.00	$0.00	$0.00	$25.91	$92.27	$92.27	$0.00	$0.00	$25.91	$0.00	$73.54	$73.54	$0.00	$62.16	$98.47	$99.46	$0.00		$0.00	$19.46	$0.00	$0.00	$19.79	$0.00	$0.00	$0.00	$0.00	$0.00
25-872-09-91	SUP	HCPCS C1713		25-872-09-91  -  SCREW BN 2MM 9MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI	BOTH IP/OP	$124.33 	$92.00	$0.00	$99.46	$55.95	$55.95	$0.00	$0.00	$0.00	$25.91	$92.27	$92.27	$0.00	$0.00	$25.91	$0.00	$73.54	$73.54	$0.00	$62.16	$98.47	$99.46	$0.00		$0.00	$19.46	$0.00	$0.00	$19.79	$0.00	$0.00	$0.00	$0.00	$0.00
25-872-11-91	SUP	HCPCS C1713		25-872-11-91  -  SCREW BN 2MM 11MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI	BOTH IP/OP	$124.33 	$92.00	$0.00	$99.46	$55.95	$55.95	$0.00	$0.00	$0.00	$25.91	$92.27	$92.27	$0.00	$0.00	$25.91	$0.00	$73.54	$73.54	$0.00	$62.16	$98.47	$99.46	$0.00		$0.00	$19.46	$0.00	$0.00	$19.79	$0.00	$0.00	$0.00	$0.00	$0.00
25-872-13-91	SUP	HCPCS C1713		25-872-13-91  -  SCREW BN 2MM 13MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI	BOTH IP/OP	$124.33 	$92.00	$0.00	$99.46	$55.95	$55.95	$0.00	$0.00	$0.00	$25.91	$92.27	$92.27	$0.00	$0.00	$25.91	$0.00	$73.54	$73.54	$0.00	$62.16	$98.47	$99.46	$0.00		$0.00	$19.46	$0.00	$0.00	$19.79	$0.00	$0.00	$0.00	$0.00	$0.00
25-873-05-91	SUP	HCPCS C1713		25-873-05-91  -  SCREW BONE 2.3MM 5MM MAXDRIVE TITANIUM ORAL MAXFACL	BOTH IP/OP	$160.58 	$118.83	$0.00	$128.46	$72.26	$72.26	$0.00	$0.00	$0.00	$33.47	$119.18	$119.18	$0.00	$0.00	$33.46	$0.00	$94.98	$94.98	$0.00	$80.29	$127.18	$128.46	$0.00		$0.00	$25.13	$0.00	$0.00	$25.56	$0.00	$0.00	$0.00	$0.00	$0.00
25-873-07-91	SUP	HCPCS C1713		25-873-07-91  -  SCREW BONE 2.3MM 7MM MAXDRIVE TITANIUM ORAL MAXFACL	BOTH IP/OP	$160.58 	$118.83	$0.00	$128.46	$72.26	$72.26	$0.00	$0.00	$0.00	$33.47	$119.18	$119.18	$0.00	$0.00	$33.46	$0.00	$94.98	$94.98	$0.00	$80.29	$127.18	$128.46	$0.00		$0.00	$25.13	$0.00	$0.00	$25.56	$0.00	$0.00	$0.00	$0.00	$0.00
25-873-09-91	SUP	HCPCS C1713		25-873-09-91  -  SCREW BONE 2.3MM 9MM MAXDRIVE TITANIUM ORAL MAXFACL	BOTH IP/OP	$160.58 	$118.83	$0.00	$128.46	$72.26	$72.26	$0.00	$0.00	$0.00	$33.47	$119.18	$119.18	$0.00	$0.00	$33.46	$0.00	$94.98	$94.98	$0.00	$80.29	$127.18	$128.46	$0.00		$0.00	$25.13	$0.00	$0.00	$25.56	$0.00	$0.00	$0.00	$0.00	$0.00
25-873-13-91	SUP	HCPCS C1713		25-873-13-91  -  SCREW BONE 2.3MM 13MM MAXDRIVE TITANIUM ORAL MAXFACL	BOTH IP/OP	$160.58 	$118.83	$0.00	$128.46	$72.26	$72.26	$0.00	$0.00	$0.00	$33.47	$119.18	$119.18	$0.00	$0.00	$33.46	$0.00	$94.98	$94.98	$0.00	$80.29	$127.18	$128.46	$0.00		$0.00	$25.13	$0.00	$0.00	$25.56	$0.00	$0.00	$0.00	$0.00	$0.00
25-873-45-91	SUP	HCPCS C1713		25-873-45-91  -  SCREW BN 2.3MM 5MM NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET ER	BOTH IP/OP	$160.58 	$118.83	$0.00	$128.46	$72.26	$72.26	$0.00	$0.00	$0.00	$33.47	$119.18	$119.18	$0.00	$0.00	$33.46	$0.00	$94.98	$94.98	$0.00	$80.29	$127.18	$128.46	$0.00		$0.00	$25.13	$0.00	$0.00	$25.56	$0.00	$0.00	$0.00	$0.00	$0.00
25-873-47-91	SUP	HCPCS C1713		25-873-47-91  -  SCREW BN 2.3MM 7MM NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET ER	BOTH IP/OP	$160.58 	$118.83	$0.00	$128.46	$72.26	$72.26	$0.00	$0.00	$0.00	$33.47	$119.18	$119.18	$0.00	$0.00	$33.46	$0.00	$94.98	$94.98	$0.00	$80.29	$127.18	$128.46	$0.00		$0.00	$25.13	$0.00	$0.00	$25.56	$0.00	$0.00	$0.00	$0.00	$0.00
25-874-13-91	SUP	HCPCS C1713		25-874-13-91  -  SCREW BN 2.5MM 13MM NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET	BOTH IP/OP	$163.18 	$120.75	$0.00	$130.54	$73.43	$73.43	$0.00	$0.00	$0.00	$34.01	$121.11	$121.11	$0.00	$0.00	$34.01	$0.00	$96.52	$96.52	$0.00	$81.59	$129.24	$130.54	$0.00		$0.00	$25.54	$0.00	$0.00	$25.98	$0.00	$0.00	$0.00	$0.00	$0.00
25-875-09-91	SUP	HCPCS C1713		25-875-09-91  -  SCREW BONE MICRO 1.5MM 9MM MAXDRIVE TITANIUM ORAL MAXFACL	BOTH IP/OP	$124.33 	$92.00	$0.00	$99.46	$55.95	$55.95	$0.00	$0.00	$0.00	$25.91	$92.27	$92.27	$0.00	$0.00	$25.91	$0.00	$73.54	$73.54	$0.00	$62.16	$98.47	$99.46	$0.00		$0.00	$19.46	$0.00	$0.00	$19.79	$0.00	$0.00	$0.00	$0.00	$0.00
25-876-05-91	SUP	HCPCS C1713		25-876-05-91  -  SCREW BN MIC 1.8MM 5MM NS LVL 1 MAXDRIVE DRLFR ER TI-6AL-4V	BOTH IP/OP	$142.43 	$105.40	$0.00	$113.94	$64.09	$64.09	$0.00	$0.00	$0.00	$29.68	$105.71	$105.71	$0.00	$0.00	$29.68	$0.00	$84.24	$84.24	$0.00	$71.21	$112.80	$113.94	$0.00		$0.00	$22.29	$0.00	$0.00	$22.67	$0.00	$0.00	$0.00	$0.00	$0.00
25-876-07-91	SUP	HCPCS C1713		25-876-07-91  -  SCREW BONE MICRO 1.8MM 5MM EMERGENCY DRILL FREE MAXDRIVE	BOTH IP/OP	$142.43 	$105.40	$0.00	$113.94	$64.09	$64.09	$0.00	$0.00	$0.00	$29.68	$105.71	$105.71	$0.00	$0.00	$29.68	$0.00	$84.24	$84.24	$0.00	$71.21	$112.80	$113.94	$0.00		$0.00	$22.29	$0.00	$0.00	$22.67	$0.00	$0.00	$0.00	$0.00	$0.00
25-878-04-91	SUP	HCPCS C1713		25-878-04-91  -  SCREW BN MIC 1.5MM 4MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V	BOTH IP/OP	$142.43 	$105.40	$0.00	$113.94	$64.09	$64.09	$0.00	$0.00	$0.00	$29.68	$105.71	$105.71	$0.00	$0.00	$29.68	$0.00	$84.24	$84.24	$0.00	$71.21	$112.80	$113.94	$0.00		$0.00	$22.29	$0.00	$0.00	$22.67	$0.00	$0.00	$0.00	$0.00	$0.00
25-878-05-91	SUP	HCPCS C1713		25-878-05-91  -  SCREW BN MIC 1.5MM 5MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V	BOTH IP/OP	$142.43 	$105.40	$0.00	$113.94	$64.09	$64.09	$0.00	$0.00	$0.00	$29.68	$105.71	$105.71	$0.00	$0.00	$29.68	$0.00	$84.24	$84.24	$0.00	$71.21	$112.80	$113.94	$0.00		$0.00	$22.29	$0.00	$0.00	$22.67	$0.00	$0.00	$0.00	$0.00	$0.00
25-878-07-91	SUP	HCPCS C1713		25-878-07-91  -  SCREW BONE MICRO 1.5MM 7MM DRILL FREE MAXDRIVE TITANIUM ORAL	BOTH IP/OP	$142.43 	$105.40	$0.00	$113.94	$64.09	$64.09	$0.00	$0.00	$0.00	$29.68	$105.71	$105.71	$0.00	$0.00	$29.68	$0.00	$84.24	$84.24	$0.00	$71.21	$112.80	$113.94	$0.00		$0.00	$22.29	$0.00	$0.00	$22.67	$0.00	$0.00	$0.00	$0.00	$0.00
25-879-05-91	SUP	HCPCS C1713		25-879-05-91  -  SCREW BN MN 2MM 5MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V CRNMXF	BOTH IP/OP	$134.68 	$99.66	$0.00	$107.74	$60.60	$60.60	$0.00	$0.00	$0.00	$28.07	$99.96	$99.96	$0.00	$0.00	$28.07	$0.00	$79.66	$79.66	$0.00	$67.34	$106.67	$107.74	$0.00		$0.00	$21.08	$0.00	$0.00	$21.44	$0.00	$0.00	$0.00	$0.00	$0.00
25-879-07-91	SUP	HCPCS C1713		25-879-07-91  -  SCREW BN MN 2MM 7MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V CRNMXF	BOTH IP/OP	$134.68 	$99.66	$0.00	$107.74	$60.60	$60.60	$0.00	$0.00	$0.00	$28.07	$99.96	$99.96	$0.00	$0.00	$28.07	$0.00	$79.66	$79.66	$0.00	$67.34	$106.67	$107.74	$0.00		$0.00	$21.08	$0.00	$0.00	$21.44	$0.00	$0.00	$0.00	$0.00	$0.00
25-882-07-91	SUP	HCPCS C1713		25-882-07-91  -  SCREW BN 2MM 7MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET	BOTH IP/OP	$270.15 	$199.91	$0.00	$216.12	$121.57	$121.57	$0.00	$0.00	$0.00	$56.31	$200.51	$200.51	$0.00	$0.00	$56.30	$0.00	$159.79	$159.79	$0.00	$135.08	$213.96	$216.12	$0.00		$0.00	$42.28	$0.00	$0.00	$43.01	$0.00	$0.00	$0.00	$0.00	$0.00
25-882-09-91	SUP	HCPCS C1713		25-882-09-91  -  SCREW BN 2MM 9MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET	BOTH IP/OP	$270.15 	$199.91	$0.00	$216.12	$121.57	$121.57	$0.00	$0.00	$0.00	$56.31	$200.51	$200.51	$0.00	$0.00	$56.30	$0.00	$159.79	$159.79	$0.00	$135.08	$213.96	$216.12	$0.00		$0.00	$42.28	$0.00	$0.00	$43.01	$0.00	$0.00	$0.00	$0.00	$0.00
25-882-11-91	SUP	HCPCS C1713		25-882-11-91  -  SCREW BN 2MM 11MM NS LVL 1 MAXDRIVE LCK TI CRNMXF	BOTH IP/OP	$270.15 	$199.91	$0.00	$216.12	$121.57	$121.57	$0.00	$0.00	$0.00	$56.31	$200.51	$200.51	$0.00	$0.00	$56.30	$0.00	$159.79	$159.79	$0.00	$135.08	$213.96	$216.12	$0.00		$0.00	$42.28	$0.00	$0.00	$43.01	$0.00	$0.00	$0.00	$0.00	$0.00
25-882-13-91	SUP	HCPCS C1713		25-882-13-91  -  SCREW BONE 2MM 13MM LOCKING MAXDRIVE TITANIUM ORAL MAXFACL	BOTH IP/OP	$270.15 	$199.91	$0.00	$216.12	$121.57	$121.57	$0.00	$0.00	$0.00	$56.31	$200.51	$200.51	$0.00	$0.00	$56.30	$0.00	$159.79	$159.79	$0.00	$135.08	$213.96	$216.12	$0.00		$0.00	$42.28	$0.00	$0.00	$43.01	$0.00	$0.00	$0.00	$0.00	$0.00
25-882-15-91	SUP	HCPCS C1713		25-882-15-91  -  SCREW BN 2MM 15MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET	BOTH IP/OP	$270.15 	$199.91	$0.00	$216.12	$121.57	$121.57	$0.00	$0.00	$0.00	$56.31	$200.51	$200.51	$0.00	$0.00	$56.30	$0.00	$159.79	$159.79	$0.00	$135.08	$213.96	$216.12	$0.00		$0.00	$42.28	$0.00	$0.00	$43.01	$0.00	$0.00	$0.00	$0.00	$0.00
25-883-11-91	SUP	HCPCS C1713		25-883-11-91  -  SCREW BN 2.3MM 11MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE	BOTH IP/OP	$300.75 	$222.56	$0.00	$240.60	$135.34	$135.34	$0.00	$0.00	$0.00	$62.68	$223.22	$223.22	$0.00	$0.00	$62.68	$0.00	$177.89	$177.89	$0.00	$150.38	$238.19	$240.60	$0.00		$0.00	$47.07	$0.00	$0.00	$47.88	$0.00	$0.00	$0.00	$0.00	$0.00
25AGFN-756	SUP	Custom 27803010		25AGFN-756  -  VALVE AORTIC 85D 25MM 23MM 1 DIGIT GRADIENT MECHANICAL	BOTH IP/OP	"$11,750.00 "	"$8,695.00"	$0.00	"$9,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,448.70"	$0.00	$0.00	$0.00	$0.00	"$5,875.00"	"$9,306.00"	"$9,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25AJ-501	SUP	Custom 27803010		25AJ-501  -  VALVE AOR 25MM MSTR MECH STD CUF ROT	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	$0.00	$0.00	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
25MJ-501	SUP	Custom 27803010		25MJ-501  -  VALVE AORTIC 25MM MSTR HRT MECH	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	$0.00	$0.00	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
260-120	SUP	Custom 27203010		260-120  -  DILAT SURG AMPTZ PTFE COAX STY SF WIRE INTROD 8-10FR	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.22	$74.22	$0.00	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
260-250-	SUP	Custom 27203010		DILATOR SURG AMPTZ SET RNL STRL DISP	BOTH IP/OP	$566.60 	$419.28	$0.00	$453.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.30	$448.75	$453.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26026-2	SUP	Custom 27803010		26026-2  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,997.13 "	"$2,957.88"	$0.00	"$3,197.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,966.67"	"$2,966.67"	$0.00	$0.00	$833.00	$0.00	$0.00	$0.00	$0.00	"$1,998.56"	"$3,165.73"	"$3,197.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26026-5	SUP	Custom 27803010		26026-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,134.88 "	"$3,059.81"	$0.00	"$3,307.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,068.90"	"$3,068.90"	$0.00	$0.00	$861.71	$0.00	$0.00	$0.00	$0.00	"$2,067.44"	"$3,274.82"	"$3,307.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2627-2-905	SUP	Custom 27803010		2627-2-905  -  INSERT TIB STD 5MM KNEE CRUC RET HI	BOTH IP/OP	"$3,536.00 "	"$2,616.64"	$0.00	"$2,828.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,624.42"	"$2,624.42"	$0.00	$0.00	$736.90	$0.00	$0.00	$0.00	$0.00	"$1,768.00"	"$2,800.51"	"$2,828.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2627-2-915	SUP	Custom 27803010		2627-2-915  -  INSERT TIB STD 15MM KNEE CRUC RET HI	BOTH IP/OP	"$3,536.00 "	"$2,616.64"	$0.00	"$2,828.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,624.42"	"$2,624.42"	$0.00	$0.00	$736.90	$0.00	$0.00	$0.00	$0.00	"$1,768.00"	"$2,800.51"	"$2,828.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2627-6-901	SUP	HCPCS C1713		2627-6-901  -  PIN FIX VAK LCK ASMBLY ORTH SM	BOTH IP/OP	$342.88 	$253.73	$0.00	$274.30	$154.29	$154.29	$0.00	$0.00	$0.00	$71.46	$254.48	$254.48	$0.00	$0.00	$71.46	$0.00	$202.81	$202.81	$0.00	$171.44	$271.56	$274.30	$0.00		$0.00	$53.66	$0.00	$0.00	$54.59	$0.00	$0.00	$0.00	$0.00	$0.00
2642-1-109	SUP	Custom 27803010		2642-1-109  -  INSERT TIBIAL SMALL 9MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-1-111	SUP	Custom 27803010		2642-1-111  -  INSERT TIBIAL MEDIUM 11MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-1-113	SUP	Custom 27803010		2642-1-113  -  INSERT TIBIAL SMALL 13MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-1-116	SUP	Custom 27803010		2642-1-116  -  INSERT TIBIAL SMALL 16MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-1-119	SUP	Custom 27803010		2642-1-119  -  INSERT TIBIAL SMALL 19MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-1-122	SUP	Custom 27803010		2642-1-122  -  INSERT TIBIAL SMALL 22MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-1-125	SUP	Custom 27803010		2642-1-125  -  INSERT TIBIAL PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-1-128	SUP	Custom 27803010		2642-1-128  -  INSERT TIBIAL SMALL 28MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-1-131	SUP	Custom 27803010		2642-1-131  -  INSERT TIBIAL SMALL 31MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-3-111	SUP	Custom 27803010		2642-3-111  -  INSERT TIBIAL MEDIUM 11MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-3-113	SUP	Custom 27803010		2642-3-113  -  INSERT TIBIAL MEDIUM 13MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-3-116	SUP	Custom 27803010		2642-3-116  -  INSERT TIBIAL MEDIUM 16MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-3-119	SUP	Custom 27803010		2642-3-119  -  INSERT TIBIAL MEDIUM 19MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-3-122	SUP	Custom 27803010		2642-3-122  -  INSERT TIBIAL MEDIUM 22MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-3-125	SUP	Custom 27803010		2642-3-125  -  INSERT TIBIAL MEDIUM 25MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-3-128	SUP	Custom 27803010		2642-3-128  -  INSERT TIBIAL MEDIUM 28MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-3-131	SUP	Custom 27803010		2642-3-131  -  INSERT TIBIAL MEDIUM 31MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-5-109	SUP	Custom 27803010		2642-5-109  -  INSERT TIBIAL LARGE 19MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-5-111	SUP	Custom 27803010		2642-5-111  -  INSERT TIBIAL LARGE 11MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-5-113	SUP	Custom 27803010		2642-5-113  -  INSERT TIBIAL LARGE 13MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-5-116	SUP	Custom 27803010		2642-5-116  -  INSERT TIBIAL LARGE 16MM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-5-119	SUP	Custom 27803010		2642-5-119  -  INSERT TIBIAL LARGE 19MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-5-122	SUP	Custom 27803010		2642-5-122  -  INSERT TIBIAL LARGE 22MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-5-125	SUP	Custom 27803010		2642-5-125  -  INSERT TIBIAL LARGE 25MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-5-128	SUP	Custom 27803010		2642-5-128  -  INSERT TIBIAL LARGE 28MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-5-131	SUP	Custom 27803010		2642-5-131  -  INSERT TIBIAL LARGE 31MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-6-109	SUP	Custom 27803010		2642-6-109  -  INSERT TIBIAL XL 9MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-6-111	SUP	Custom 27803010		2642-6-111  -  INSERT TIBIAL PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-6-113	SUP	Custom 27803010		2642-6-113  -  INSERT TIBIAL PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-6-116	SUP	Custom 27803010		2642-6-116  -  INSERT TIBIAL XL 16MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-6-119	SUP	Custom 27803010		2642-6-119  -  INSERT TIBIAL XL 19MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-6-122	SUP	Custom 27803010		2642-6-122  -  INSERT TIBIAL XL 22MM PRIM PCA KNEE	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-6-125	SUP	Custom 27803010		2642-6-125  -  INSERT TIBIAL XL 25MM PRIM PCA KNEE	BOTH IP/OP	"$2,065.00 "	"$1,528.10"	$0.00	"$1,652.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,532.64"	"$1,532.64"	$0.00	$0.00	$430.35	$0.00	$0.00	$0.00	$0.00	"$1,032.50"	"$1,635.48"	"$1,652.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-6-128	SUP	Custom 27803010		2642-6-128  -  INSERT TIBIAL XL 28MM PRIM PCA KNEE	BOTH IP/OP	"$2,065.00 "	"$1,528.10"	$0.00	"$1,652.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,532.64"	"$1,532.64"	$0.00	$0.00	$430.35	$0.00	$0.00	$0.00	$0.00	"$1,032.50"	"$1,635.48"	"$1,652.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2642-6-131	SUP	Custom 27803010		2642-6-131  -  INSERT TIBIAL XL 31MM PRIM PCA KNEE	BOTH IP/OP	"$2,065.00 "	"$1,528.10"	$0.00	"$1,652.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,532.64"	"$1,532.64"	$0.00	$0.00	$430.35	$0.00	$0.00	$0.00	$0.00	"$1,032.50"	"$1,635.48"	"$1,652.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26AC60	SUP	Custom 27203010		26AC60  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26AC75	SUP	Custom 27203010		26AC75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26AC90	SUP	Custom 27203010		26AC90  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26BA50DX	SUP	Custom 27203010		26BA50DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$412.25 	$305.07	$0.00	$329.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.97	$305.97	$0.00	$0.00	$85.91	$0.00	$0.00	$0.00	$0.00	$206.13	$326.50	$329.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26BA60	SUP	Custom 27203010		26BA60  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$384.63 	$284.63	$0.00	$307.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$285.47	$285.47	$0.00	$0.00	$80.16	$0.00	$0.00	$0.00	$0.00	$192.31	$304.63	$307.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26BA70DX	SUP	Custom 27203010		26BA70DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$412.25 	$305.07	$0.00	$329.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.97	$305.97	$0.00	$0.00	$85.91	$0.00	$0.00	$0.00	$0.00	$206.13	$326.50	$329.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26BA75	SUP	Custom 27203010		26BA75  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$376.13 	$278.34	$0.00	$300.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.16	$279.16	$0.00	$0.00	$78.38	$0.00	$0.00	$0.00	$0.00	$188.06	$297.89	$300.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26BA90	SUP	Custom 27203010		26BA90  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$376.13 	$278.34	$0.00	$300.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.16	$279.16	$0.00	$0.00	$78.38	$0.00	$0.00	$0.00	$0.00	$188.06	$297.89	$300.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26CY75	SUP	Custom 27203010		26CY75  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.66	$258.66	$0.00	$0.00	$72.63	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26CY90	SUP	Custom 27203010		26CY90  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.66	$258.66	$0.00	$0.00	$72.63	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26L2	SUP	Custom 27203010		KIT MNLTX MONO LTX AGGL SERTST 50 TST	BOTH IP/OP	$355.10 	$262.77	$0.00	$284.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.55	$281.24	$284.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26MH30	SUP	Custom 27203010		26MH30  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$346.38 	$256.32	$0.00	$277.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.08	$257.08	$0.00	$0.00	$72.18	$0.00	$0.00	$0.00	$0.00	$173.19	$274.33	$277.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
26TA30	SUP	Custom 27203010		26TA30  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$380.38 	$281.48	$0.00	$304.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.31	$282.31	$0.00	$0.00	$79.27	$0.00	$0.00	$0.00	$0.00	$190.19	$301.26	$304.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27-0120	SUP	HCPCS C1713		27-0120  -  SCREW BN 2.7MM 12MM CNN XTRMT	BOTH IP/OP	$445.00 	$329.30	$0.00	$356.00	$200.25	$200.25	$0.00	$0.00	$0.00	$92.75	$330.28	$330.28	$0.00	$0.00	$92.74	$0.00	$263.22	$263.22	$0.00	$222.50	$352.44	$356.00	$0.00		$0.00	$69.64	$0.00	$0.00	$70.84	$0.00	$0.00	$0.00	$0.00	$0.00
27-0140	SUP	HCPCS C1713		27-0140  -  SCREW BN 2.7MM 14MM CNN XTRMT	BOTH IP/OP	$445.00 	$329.30	$0.00	$356.00	$200.25	$200.25	$0.00	$0.00	$0.00	$92.75	$330.28	$330.28	$0.00	$0.00	$92.74	$0.00	$263.22	$263.22	$0.00	$222.50	$352.44	$356.00	$0.00		$0.00	$69.64	$0.00	$0.00	$70.84	$0.00	$0.00	$0.00	$0.00	$0.00
27-0160	SUP	HCPCS C1713		27-0160  -  SCREW BN 2.7MM 16MM CNN XTRMT	BOTH IP/OP	$445.00 	$329.30	$0.00	$356.00	$200.25	$200.25	$0.00	$0.00	$0.00	$92.75	$330.28	$330.28	$0.00	$0.00	$92.74	$0.00	$263.22	$263.22	$0.00	$222.50	$352.44	$356.00	$0.00		$0.00	$69.64	$0.00	$0.00	$70.84	$0.00	$0.00	$0.00	$0.00	$0.00
27-0180	SUP	HCPCS C1713		27-0180  -  SCREW BN 2.7MM 18MM CNN XTRMT	BOTH IP/OP	$445.00 	$329.30	$0.00	$356.00	$200.25	$200.25	$0.00	$0.00	$0.00	$92.75	$330.28	$330.28	$0.00	$0.00	$92.74	$0.00	$263.22	$263.22	$0.00	$222.50	$352.44	$356.00	$0.00		$0.00	$69.64	$0.00	$0.00	$70.84	$0.00	$0.00	$0.00	$0.00	$0.00
27020 M	SUP	Custom 27803010		27020 M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,080.38 "	"$2,279.48"	$0.00	"$2,464.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,286.25"	"$2,286.25"	$0.00	$0.00	$641.95	$0.00	$0.00	$0.00	$0.00	"$1,540.19"	"$2,439.66"	"$2,464.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27-0200	SUP	HCPCS C1713		27-0200  -  SCREW BN 2.7MM 20MM CNN XTRMT	BOTH IP/OP	$445.00 	$329.30	$0.00	$356.00	$200.25	$200.25	$0.00	$0.00	$0.00	$92.75	$330.28	$330.28	$0.00	$0.00	$92.74	$0.00	$263.22	$263.22	$0.00	$222.50	$352.44	$356.00	$0.00		$0.00	$69.64	$0.00	$0.00	$70.84	$0.00	$0.00	$0.00	$0.00	$0.00
270-2149	SUP	Custom 27203010		VIAL VAR 2 SMPL PRC CAP ANALY	BOTH IP/OP	$78.75 	$58.28	$0.00	$63.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.38	$62.37	$63.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
270-2154	SUP	Custom 27203010		REAGENT B THAL VAR 2 RCDR PK 500 TST ANALY	BOTH IP/OP	"$4,392.50 "	"$3,250.45"	$0.00	"$3,514.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,196.25"	"$3,478.86"	"$3,514.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27-0220	SUP	HCPCS C1713		27-0220  -  SCREW BN 2.7MM 22MM CNN XTRMT	BOTH IP/OP	$445.00 	$329.30	$0.00	$356.00	$200.25	$200.25	$0.00	$0.00	$0.00	$92.75	$330.28	$330.28	$0.00	$0.00	$92.74	$0.00	$263.22	$263.22	$0.00	$222.50	$352.44	$356.00	$0.00		$0.00	$69.64	$0.00	$0.00	$70.84	$0.00	$0.00	$0.00	$0.00	$0.00
27-0240	SUP	HCPCS C1713		27-0240  -  SCREW BN 2.7MM 24MM CNN XTRMT	BOTH IP/OP	$445.00 	$329.30	$0.00	$356.00	$200.25	$200.25	$0.00	$0.00	$0.00	$92.75	$330.28	$330.28	$0.00	$0.00	$92.74	$0.00	$263.22	$263.22	$0.00	$222.50	$352.44	$356.00	$0.00		$0.00	$69.64	$0.00	$0.00	$70.84	$0.00	$0.00	$0.00	$0.00	$0.00
2703-3-626	SUP	Custom 27203010		2703-3-626  -  WIRE FX .015IN 72IN VIT	BOTH IP/OP	$284.38 	$210.44	$0.00	$227.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.06	$211.06	$0.00	$0.00	$59.26	$0.00	$0.00	$0.00	$0.00	$142.19	$225.23	$227.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2704-1-024	SUP	Custom 27203010		2704-1-024  -  WIRE FX .04IN 24MM VIT	BOTH IP/OP	$11.38 	$8.42	$0.00	$9.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.44	$8.44	$0.00	$0.00	$2.37	$0.00	$0.00	$0.00	$0.00	$5.69	$9.01	$9.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2704-3-018	SUP	Custom 27203010		2704-3-018  -  WIRE FX .046IN 18IN DLMLS VIT 6 PER TUBE	BOTH IP/OP	$58.50 	$43.29	$0.00	$46.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.42	$43.42	$0.00	$0.00	$12.19	$0.00	$0.00	$0.00	$0.00	$29.25	$46.33	$46.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27050K/6	SUP	Custom 27203010		27050K/6  -  ELTRD ESURG 27FR 1 PR PNT	BOTH IP/OP	$285.80 	$211.49	$0.00	$228.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.90	$226.35	$228.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27050KG/6	SUP	Custom 27203010		27050KG/6  -  ELTRD ESURG YLW 24-26FR URO RLLR CUT STRL DISP	BOTH IP/OP	$392.93 	$290.77	$0.00	$314.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.46	$311.20	$314.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 A	SUP	Custom 27803010		27065 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$665.00 	$492.10	$0.00	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.56	$493.56	$0.00	$0.00	$138.59	$0.00	$0.00	$0.00	$0.00	$332.50	$526.68	$532.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 B	SUP	Custom 27803010		27065 B  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$665.00 	$492.10	$0.00	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.56	$493.56	$0.00	$0.00	$138.59	$0.00	$0.00	$0.00	$0.00	$332.50	$526.68	$532.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 C	SUP	Custom 27803010		27065 C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$665.00 	$492.10	$0.00	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.56	$493.56	$0.00	$0.00	$138.59	$0.00	$0.00	$0.00	$0.00	$332.50	$526.68	$532.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 D	SUP	Custom 27803010		27065 D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$665.00 	$492.10	$0.00	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.56	$493.56	$0.00	$0.00	$138.59	$0.00	$0.00	$0.00	$0.00	$332.50	$526.68	$532.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 E	SUP	Custom 27803010		27065 E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$665.00 	$492.10	$0.00	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.56	$493.56	$0.00	$0.00	$138.59	$0.00	$0.00	$0.00	$0.00	$332.50	$526.68	$532.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 F	SUP	Custom 27803010		27065 F  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$665.00 	$492.10	$0.00	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.56	$493.56	$0.00	$0.00	$138.59	$0.00	$0.00	$0.00	$0.00	$332.50	$526.68	$532.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 G	SUP	Custom 27803010		27065 G  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$665.00 	$492.10	$0.00	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.56	$493.56	$0.00	$0.00	$138.59	$0.00	$0.00	$0.00	$0.00	$332.50	$526.68	$532.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 H	SUP	Custom 27803010		27065 H  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$665.00 	$492.10	$0.00	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.56	$493.56	$0.00	$0.00	$138.59	$0.00	$0.00	$0.00	$0.00	$332.50	$526.68	$532.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 J	SUP	Custom 27803010		27065 J  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$826.50 	$611.61	$0.00	$661.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$613.43	$613.43	$0.00	$0.00	$172.24	$0.00	$0.00	$0.00	$0.00	$413.25	$654.59	$661.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 K	SUP	Custom 27803010		27065 K  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$665.00 	$492.10	$0.00	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.56	$493.56	$0.00	$0.00	$138.59	$0.00	$0.00	$0.00	$0.00	$332.50	$526.68	$532.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 L	SUP	Custom 27803010		27065 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$665.00 	$492.10	$0.00	$532.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.56	$493.56	$0.00	$0.00	$138.59	$0.00	$0.00	$0.00	$0.00	$332.50	$526.68	$532.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 M	SUP	Custom 27803010		27065 M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$826.50 	$611.61	$0.00	$661.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$613.43	$613.43	$0.00	$0.00	$172.24	$0.00	$0.00	$0.00	$0.00	$413.25	$654.59	$661.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 N	SUP	Custom 27803010		27065 N  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$603.25 	$446.41	$0.00	$482.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$447.73	$447.73	$0.00	$0.00	$125.72	$0.00	$0.00	$0.00	$0.00	$301.63	$477.77	$482.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 R	SUP	Custom 27803010		27065 R  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$826.50 	$611.61	$0.00	$661.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$613.43	$613.43	$0.00	$0.00	$172.24	$0.00	$0.00	$0.00	$0.00	$413.25	$654.59	$661.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27065 T	SUP	Custom 27803010		27065 T  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$826.50 	$611.61	$0.00	$661.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$613.43	$613.43	$0.00	$0.00	$172.24	$0.00	$0.00	$0.00	$0.00	$413.25	$654.59	$661.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27097-1	SUP	Custom 27803010		27097-1  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,009.13 "	"$2,226.76"	$0.00	"$2,407.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,233.37"	"$2,233.37"	$0.00	$0.00	$627.10	$0.00	$0.00	$0.00	$0.00	"$1,504.56"	"$2,383.23"	"$2,407.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27167 L	SUP	Custom 27803010		27167 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27167 M	SUP	Custom 27803010		27167 M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27183-1	SUP	Custom 27803010		27183-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$5,080.13 "	"$3,759.30"	$0.00	"$4,064.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.47"	"$3,770.47"	$0.00	$0.00	"$1,058.70"	$0.00	$0.00	$0.00	$0.00	"$2,540.06"	"$4,023.46"	"$4,064.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27183-2	SUP	Custom 27803010		27183-2  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$5,080.13 "	"$3,759.30"	$0.00	"$4,064.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.47"	"$3,770.47"	$0.00	$0.00	"$1,058.70"	$0.00	$0.00	$0.00	$0.00	"$2,540.06"	"$4,023.46"	"$4,064.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27183-4	SUP	Custom 27803010		27183-4  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$5,080.13 "	"$3,759.30"	$0.00	"$4,064.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.47"	"$3,770.47"	$0.00	$0.00	"$1,058.70"	$0.00	$0.00	$0.00	$0.00	"$2,540.06"	"$4,023.46"	"$4,064.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27183-5	SUP	Custom 27803010		27183-5  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$5,080.13 "	"$3,759.30"	$0.00	"$4,064.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.47"	"$3,770.47"	$0.00	$0.00	"$1,058.70"	$0.00	$0.00	$0.00	$0.00	"$2,540.06"	"$4,023.46"	"$4,064.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202-01	SUP	HCPCS C1765		27202-01  -  BRR ADH PLLC ACD BIORESBL SHT SURGIWRAP 130X100X.02MM	BOTH IP/OP	$560.00 	$414.40	$0.00	$448.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$415.63	$415.63	$0.00	$0.00	$116.70	$0.00	$0.00	$0.00	$0.00	$280.00	$443.52	$448.00	$0.00		$0.00	$87.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27202-05	SUP	HCPCS C1765		27202-05  -  BARRIER ADHESION 130X100X.02MM BIORESORBABLE SHEET SURGIWRAP	BOTH IP/OP	$560.00 	$414.40	$0.00	$448.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.00	$443.52	$448.00	$0.00		$0.00	$87.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27203-5	SUP	Custom 27203010		27203-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$5,472.00 "	"$4,049.28"	$0.00	"$4,377.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,061.32"	"$4,061.32"	$0.00	$0.00	"$1,140.36"	$0.00	$0.00	$0.00	$0.00	"$2,736.00"	"$4,333.82"	"$4,377.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27204-05	SUP	HCPCS C1765		27204-05  -  BARRIER ADHESION 130X100X.02MM BIORESORBABLE SHEET SURGIWRAP	BOTH IP/OP	$642.50 	$475.45	$0.00	$514.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$476.86	$476.86	$0.00	$0.00	$133.90	$0.00	$0.00	$0.00	$0.00	$321.25	$508.86	$514.00	$0.00		$0.00	$100.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219-1	SUP	Custom 27803010		27219-1  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219-2	SUP	Custom 27803010		27219-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27219-5	SUP	Custom 27803010		27219-5  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,684.63"	"$2,684.63"	$0.00	$0.00	$753.81	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27224-1	SUP	Custom 27203010		27224-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27224-2	SUP	Custom 27203010		27224-2  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27224-4	SUP	Custom 27203010		27224-4  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27224-5	SUP	Custom 27203010		27224-5  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27241 L	SUP	Custom 27803010		27241 L  -  SHUNT NS 10MM 50MM PRTNL CATH NEO	BOTH IP/OP	"$1,211.25 "	$896.33	$0.00	$969.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$898.99	$898.99	$0.00	$0.00	$252.42	$0.00	$0.00	$0.00	$0.00	$605.63	$959.31	$969.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27242 L	SUP	Custom 27803010		27242 L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,562.63 "	"$1,896.35"	$0.00	"$2,050.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,901.98"	"$1,901.98"	$0.00	$0.00	$534.05	$0.00	$0.00	$0.00	$0.00	"$1,281.31"	"$2,029.60"	"$2,050.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27242 LL	SUP	Custom 27803010		27242 LL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,562.63 "	"$1,896.35"	$0.00	"$2,050.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,901.98"	"$1,901.98"	$0.00	$0.00	$534.05	$0.00	$0.00	$0.00	$0.00	"$1,281.31"	"$2,029.60"	"$2,050.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
274.00S	SUP	HCPCS C1713		274.00S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 340MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.01S	SUP	HCPCS C1713		274.01S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 36CM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.02S	SUP	HCPCS C1713		274.02S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.03S	SUP	HCPCS C1713		274.03S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.04S	SUP	HCPCS C1713		274.04S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.05S	SUP	HCPCS C1713		274.05S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 440MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.06S	SUP	HCPCS C1713		274.06S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 460MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.07S	SUP	HCPCS C1713		274.07S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 480MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.08S	SUP	HCPCS C1713		274.08S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.09S	SUP	HCPCS C1713		274.09S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.10S	SUP	HCPCS C1713		274.10S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.11S	SUP	HCPCS C1713		274.11S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.12S	SUP	HCPCS C1713		274.12S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.13S	SUP	HCPCS C1713		274.13S  -  NAIL INTRAMEDULLARY 400MM 11MM 40CM STAINLEES STEEL FEMUR	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.14S	SUP	HCPCS C1713		274.14S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.15S	SUP	HCPCS C1713		274.15S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.16S	SUP	HCPCS C1713		274.16S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 460MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.17S	SUP	HCPCS C1713		274.17S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 480MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.18S	SUP	HCPCS C1713		274.18S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.19S	SUP	HCPCS C1713		274.19S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 320MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.20S	SUP	HCPCS C1713		274.20S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 12MM 34CMX.12CM	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.21S	SUP	HCPCS C1713		274.21S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.22S	SUP	HCPCS C1713		274.22S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.23S	SUP	HCPCS C1713		274.23S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 4000CM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.24S	SUP	HCPCS C1713		274.24S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM STAINLESS STEEL	BOTH IP/OP	"$2,101.73 "	"$1,555.28"	$0.00	"$1,681.38"	$945.78	$945.78	$0.00	$0.00	$0.00	$438.05	"$1,559.90"	"$1,559.90"	$0.00	$0.00	$438.00	$0.00	"$1,243.17"	"$1,243.17"	$0.00	"$1,050.86"	"$1,664.57"	"$1,681.38"	$0.00		$0.00	$331.39	$0.00	$0.00	$334.59	$0.00	$0.00	$0.00	$0.00	$0.00
274.25S	SUP	HCPCS C1713		274.25S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 12MM 44CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.26S	SUP	HCPCS C1713		274.26S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 12MM 46CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.27S	SUP	HCPCS C1713		274.27S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 480MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.28S	SUP	HCPCS C1713		274.28S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.29S	SUP	HCPCS C1713		274.29S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 320MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.30S	SUP	HCPCS C1713		274.30S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 34CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.31S	SUP	HCPCS C1713		274.31S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.32S	SUP	HCPCS C1713		274.32S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 38CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.33S	SUP	HCPCS C1713		274.33S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 40CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.34S	SUP	HCPCS C1713		274.34S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 42CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.35S	SUP	HCPCS C1713		274.35S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 44CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.36S	SUP	HCPCS C1713		274.36S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 46CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.37S	SUP	HCPCS C1713		274.37S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 480CM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.38S	SUP	HCPCS C1713		274.38S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.39S	SUP	HCPCS C1713		274.39S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM FEMUR STERILE	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.40S	SUP	HCPCS C1713		274.40S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 34CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.41S	SUP	HCPCS C1713		274.41S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 36CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.42S	SUP	HCPCS C1713		274.42S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 38CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.43S	SUP	HCPCS C1713		274.43S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 40CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.44S	SUP	HCPCS C1713		274.44S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 42CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.45S	SUP	HCPCS C1713		274.45S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 44CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.46S	SUP	HCPCS C1713		274.46S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 46CMX.12CM	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.47S	SUP	HCPCS C1713		274.47S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 480MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.48S	SUP	HCPCS C1713		274.48S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 300MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.49S	SUP	HCPCS C1713		274.49S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 320MM STAINLESS STEEL	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$441.34	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	"$1,252.50"	"$1,252.50"	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
274.50S	SUP	HCPCS C1713		274.50S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 34CMX.12CM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.51S	SUP	HCPCS C1713		274.51S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 36CMX.12CM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.52S	SUP	HCPCS C1713		274.52S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 380MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.53S	SUP	HCPCS C1713		274.53S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 40CMX.12CM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.54S	SUP	HCPCS C1713		274.54S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 42CMX.12CM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.55S	SUP	HCPCS C1713		274.55S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 44CMX.12CM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.56S	SUP	HCPCS C1713		274.56S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 46CMX.12CM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.57S	SUP	HCPCS C1713		274.57S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 480MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.58S	SUP	HCPCS C1713		274.58S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 300MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.59S	SUP	HCPCS C1713		274.59S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 320MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.60S	SUP	HCPCS C1713		274.60S  -  NAIL INTRAMEDULLARY UNIVERSAL CONE THREAD TUBE BARREL 16MM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.61S	SUP	HCPCS C1713		274.61S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 36CMX.12CM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.62S	SUP	HCPCS C1713		274.62S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 38CMX.12CM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.63S	SUP	HCPCS C1713		274.63S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 40CMX.12CM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.64S	SUP	HCPCS C1713		274.64S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 42CMX.12CM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.65S	SUP	HCPCS C1713		274.65S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 44CMX.12CM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.66S	SUP	HCPCS C1713		274.66S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 46CMX.12CM	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.67S	SUP	HCPCS C1713		274.67S  -  NAIL INTRAMEDULLARY UNIVERSAL 16MM 480MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.68S	SUP	HCPCS C1713		274.68S  -  NAIL INTRAMEDULLARY UNIVERSAL 16MM 300MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.69S	SUP	HCPCS C1713		274.69S  -  NAIL INTRAMEDULLARY UNIVERSAL 16MM 320MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.70S	SUP	HCPCS C1713		274.70S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 34CM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.71S	SUP	HCPCS C1713		274.71S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 360MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.72S	SUP	HCPCS C1713		274.72S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 380MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.73S	SUP	HCPCS C1713		274.73S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 400MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.74S	SUP	HCPCS C1713		274.74S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 420MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.75S	SUP	HCPCS C1713		274.75S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 440MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.76S	SUP	HCPCS C1713		274.76S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 460MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.77S	SUP	HCPCS C1713		274.77S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 480MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.78S	SUP	HCPCS C1713		274.78S  -  NAIL INTRAMEDULLARY 300MM 17MM 30CM STAINLEES STEEL FEMUR	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.79S	SUP	HCPCS C1713		274.79S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 320MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.80S	SUP	HCPCS C1713		274.80S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 340MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.81S	SUP	HCPCS C1713		274.81S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 360MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.82S	SUP	HCPCS C1713		274.82S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 380MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.83S	SUP	HCPCS C1713		274.83S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 400MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.84S	SUP	HCPCS C1713		274.84S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 420MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.85S	SUP	HCPCS C1713		274.85S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 18MM 440MM STAINLESS	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.86S	SUP	HCPCS C1713		274.86S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 460MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.87S	SUP	HCPCS C1713		274.87S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 480MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.88S	SUP	HCPCS C1713		274.88S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 300MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.89S	SUP	HCPCS C1713		274.89S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 320MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.92S	SUP	HCPCS C1713		274.92S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 380MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.93S	SUP	HCPCS C1713		274.93S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 400MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.94S	SUP	HCPCS C1713		274.94S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 420MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.95S	SUP	HCPCS C1713		274.95S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 440MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.96S	SUP	HCPCS C1713		274.96S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 460MM STAINLESS STEEL	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
274.97S	SUP	HCPCS C1713		274.97S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 480MM DCP LC-DCP	BOTH IP/OP	"$2,277.00 "	"$1,684.98"	$0.00	"$1,821.60"	"$1,024.65"	"$1,024.65"	$0.00	$0.00	$0.00	$474.58	"$1,689.99"	"$1,689.99"	$0.00	$0.00	$474.53	$0.00	"$1,346.85"	"$1,346.85"	$0.00	"$1,138.50"	"$1,803.38"	"$1,821.60"	$0.00		$0.00	$356.35	$0.00	$0.00	$362.50	$0.00	$0.00	$0.00	$0.00	$0.00
27448 B	SUP	Custom 27803010		27448 B  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$418.00 	$309.32	$0.00	$334.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.24	$310.24	$0.00	$0.00	$87.11	$0.00	$0.00	$0.00	$0.00	$209.00	$331.06	$334.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27451-5	SUP	Custom 27803010		27451-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,662.13 "	"$3,449.98"	$0.00	"$3,729.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,460.23"	"$3,460.23"	$0.00	$0.00	$971.59	$0.00	$0.00	$0.00	$0.00	"$2,331.06"	"$3,692.41"	"$3,729.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27490 L	SUP	Custom 27803010		27490 L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,614.88 "	"$1,935.01"	$0.00	"$2,091.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,940.76"	"$1,940.76"	$0.00	$0.00	$544.94	$0.00	$0.00	$0.00	$0.00	"$1,307.44"	"$2,070.98"	"$2,091.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27496 L	SUP	Custom 27803010		27496 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27496 M	SUP	Custom 27803010		27496 M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27499-1	SUP	Custom 27803010		27499-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27499-5	SUP	Custom 27803010		27499-5  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,754.75 "	"$3,518.52"	$0.00	"$3,803.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,528.98"	"$3,528.98"	$0.00	$0.00	$990.89	$0.00	$0.00	$0.00	$0.00	"$2,377.38"	"$3,765.76"	"$3,803.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27505-1	SUP	Custom 27803010		27505-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,944.88 "	"$2,919.21"	$0.00	"$3,155.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,927.89"	"$2,927.89"	$0.00	$0.00	$822.11	$0.00	$0.00	$0.00	$0.00	"$1,972.44"	"$3,124.34"	"$3,155.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27553 H	SUP	Custom 27803010		27553 H  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,415.25 "	"$2,527.29"	$0.00	"$2,732.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,534.80"	"$2,534.80"	$0.00	$0.00	$711.74	$0.00	$0.00	$0.00	$0.00	"$1,707.63"	"$2,704.88"	"$2,732.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27553 L	SUP	Custom 27803010		27553 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,415.25 "	"$2,527.29"	$0.00	"$2,732.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,534.80"	"$2,534.80"	$0.00	$0.00	$711.74	$0.00	$0.00	$0.00	$0.00	"$1,707.63"	"$2,704.88"	"$2,732.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27553 M	SUP	Custom 27803010		27553 M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,415.25 "	"$2,527.29"	$0.00	"$2,732.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,534.80"	"$2,534.80"	$0.00	$0.00	$711.74	$0.00	$0.00	$0.00	$0.00	"$1,707.63"	"$2,704.88"	"$2,732.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27554-1	SUP	Custom 27803010		27554-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$5,170.38 "	"$3,826.08"	$0.00	"$4,136.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,837.45"	"$3,837.45"	$0.00	$0.00	"$1,077.51"	$0.00	$0.00	$0.00	$0.00	"$2,585.19"	"$4,094.94"	"$4,136.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27554-2	SUP	Custom 27803010		27554-2  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$5,170.38 "	"$3,826.08"	$0.00	"$4,136.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,837.45"	"$3,837.45"	$0.00	$0.00	"$1,077.51"	$0.00	$0.00	$0.00	$0.00	"$2,585.19"	"$4,094.94"	"$4,136.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27554-5	SUP	Custom 27803010		27554-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$5,170.38 "	"$3,826.08"	$0.00	"$4,136.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,837.45"	"$3,837.45"	$0.00	$0.00	"$1,077.51"	$0.00	$0.00	$0.00	$0.00	"$2,585.19"	"$4,094.94"	"$4,136.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
275-637-000	SUP	Custom 27203010		275-637-000  -  BLADE SHVR 3.5MM FULL RAD ARTHRO STRL	BOTH IP/OP	$136.70 	$101.16	$0.00	$109.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.46	$101.46	$0.00	$0.00	$28.49	$0.00	$0.00	$0.00	$0.00	$68.35	$108.27	$109.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
275-641-000	SUP	Custom 27203010		275-641-000  -  BURR SURG 2MM TMJ RND ARTHRO STRL	BOTH IP/OP	$144.78 	$107.14	$0.00	$115.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.45	$107.45	$0.00	$0.00	$30.17	$0.00	$0.00	$0.00	$0.00	$72.39	$114.67	$115.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27573A	SUP	Custom 27803010		27573A  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$653.13 	$483.32	$0.00	$522.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$484.75	$484.75	$0.00	$0.00	$136.11	$0.00	$0.00	$0.00	$0.00	$326.56	$517.28	$522.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27589A	SUP	Custom 27803010		27589A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$938.13 	$694.22	$0.00	$750.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$696.28	$696.28	$0.00	$0.00	$195.51	$0.00	$0.00	$0.00	$0.00	$469.06	$743.00	$750.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27589B	SUP	Custom 27803010		27589B  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27589C	SUP	Custom 27803010		27589C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27589D	SUP	Custom 27803010		27589D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$938.13 	$694.22	$0.00	$750.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$696.28	$696.28	$0.00	$0.00	$195.51	$0.00	$0.00	$0.00	$0.00	$469.06	$743.00	$750.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27589E	SUP	Custom 27803010		27589E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$938.13 	$694.22	$0.00	$750.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$696.28	$696.28	$0.00	$0.00	$195.51	$0.00	$0.00	$0.00	$0.00	$469.06	$743.00	$750.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27589F	SUP	Custom 27803010		27589F  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$938.13 	$694.22	$0.00	$750.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$696.28	$696.28	$0.00	$0.00	$195.51	$0.00	$0.00	$0.00	$0.00	$469.06	$743.00	$750.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27589H	SUP	Custom 27803010		27589H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$938.13 	$694.22	$0.00	$750.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$696.28	$696.28	$0.00	$0.00	$195.51	$0.00	$0.00	$0.00	$0.00	$469.06	$743.00	$750.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27607 A	SUP	Custom 27803010		27607 A  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27607 B	SUP	Custom 27803010		27607 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27607 C	SUP	Custom 27803010		27607 C  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27607 D	SUP	Custom 27803010		27607 D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27643L	SUP	Custom 27803010		27643L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27643M	SUP	Custom 27803010		27643M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27644DL	SUP	Custom 27803010		27644DL  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,237.13 "	"$2,395.48"	$0.00	"$2,589.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,402.59"	"$2,402.59"	$0.00	$0.00	$674.62	$0.00	$0.00	$0.00	$0.00	"$1,618.56"	"$2,563.81"	"$2,589.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27644DM	SUP	Custom 27803010		27644DM  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,237.13 "	"$2,395.48"	$0.00	"$2,589.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,402.59"	"$2,402.59"	$0.00	$0.00	$674.62	$0.00	$0.00	$0.00	$0.00	"$1,618.56"	"$2,563.81"	"$2,589.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27644HM	SUP	Custom 27803010		27644HM  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,237.13 "	"$2,395.48"	$0.00	"$2,589.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,402.59"	"$2,402.59"	$0.00	$0.00	$674.62	$0.00	$0.00	$0.00	$0.00	"$1,618.56"	"$2,563.81"	"$2,589.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27645L	SUP	Custom 27803010		27645L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27645M	SUP	Custom 27803010		27645M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27683H	SUP	Custom 27803010		27683H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27683L	SUP	Custom 27803010		27683L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27683M	SUP	Custom 27803010		27683M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,051.88 "	"$2,258.39"	$0.00	"$2,441.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.10"	"$2,265.10"	$0.00	$0.00	$636.01	$0.00	$0.00	$0.00	$0.00	"$1,525.94"	"$2,417.09"	"$2,441.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27862M	SUP	Custom 27803010		27862M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27-9020	SUP	HCPCS C1713		27-9020  -  CNTRSNK DRILL 2.7MM XTRMT 2.7MM SCR	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
279-251-101	SUP	Custom 27203010		279-251-101  -  ELTRD ESURG 2.5MM SERFAS ENRG PRB AARDVARK	BOTH IP/OP	$413.09 	$305.69	$0.00	$330.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.59	$306.59	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$206.54	$327.17	$330.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
279-351-100	SUP	Custom 27203010		279-351-100  -  ELTRD ESURG 90MM 3.5MM SERFAS ENRG 90D PRB SCT ARTHRO LATEX	BOTH IP/OP	$433.02 	$320.43	$0.00	$346.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$321.39	$321.39	$0.00	$0.00	$90.24	$0.00	$0.00	$0.00	$0.00	$216.51	$342.95	$346.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
279-351-300	SUP	Custom 27203010		279-351-300  -  PROBE SCT 90MM LF 3.5MM SERFAS ENRG	BOTH IP/OP	$433.02 	$320.43	$0.00	$346.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$321.39	$321.39	$0.00	$0.00	$90.24	$0.00	$0.00	$0.00	$0.00	$216.51	$342.95	$346.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2793G	SUP	Custom 27203010		2793G  -  SUTURE NABSB 9-0 BV100-4 5IN BLU PRLN MFL	BOTH IP/OP	$57.38 	$42.46	$0.00	$46.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.59	$42.59	$0.00	$0.00	$11.96	$0.00	$0.00	$0.00	$0.00	$29.12	$46.13	$46.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
279-401-100	SUP	Custom 27203010		279-401-100  -  PROBE SUCTION 90D 4MM ARTHRO SERFAS ENERGY MAXL STERILE	BOTH IP/OP	$393.03 	$290.84	$0.00	$314.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$291.70	$291.70	$0.00	$0.00	$81.91	$0.00	$0.00	$0.00	$0.00	$196.51	$311.28	$314.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
279-401-200	SUP	Custom 27203010		279-401-200  -  SURGICAL ARTHROSCOPIC SERFAS 90-S 4.0MM CRUISE ENERG PROBE	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2794G	SUP	Custom 27203010		2794G  -  SUTURE NONABSORBABLE 10-0 BV100-3 5CM MONOFILAMENT PROLENE	BOTH IP/OP	$63.69 	$47.13	$0.00	$50.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.27	$47.27	$0.00	$0.00	$13.27	$0.00	$0.00	$0.00	$0.00	$31.84	$50.44	$50.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27AGFN-756	SUP	Custom 27803010		27AGFN-756  -  VALVE AORTIC 85D 27MM 24.9MM 1 DIGIT GRADIENT MECHANICAL	BOTH IP/OP	"$11,750.00 "	"$8,695.00"	$0.00	"$9,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,448.70"	$0.00	$0.00	$0.00	$0.00	"$5,875.00"	"$9,306.00"	"$9,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27AJ-501	SUP	Custom 27803010		27AJ-501  -  VALVE AOR 85D 3.67SQ CM 3.08SQ CM 27MM 22.5MM MSTR SER MECH	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	$0.00	$0.00	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27B006	SUP	Custom 27804086		27B006  -  GRAFT BONE FEMORAL SHAFT	BOTH IP/OP	"$2,847.50 "	"$2,107.15"	$0.00	"$2,278.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,113.41"	"$2,113.41"	$0.00	$0.00	$593.42	$0.00	$0.00	$0.00	$0.00	"$1,423.75"	"$2,255.22"	"$2,278.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27MJ-501	SUP	Custom 27803010		27MJ-501  -  VALVE MTRL 85D 3.67SQ CM STD RING 27MM 22.5MM MSTR SER LFLT	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	$0.00	$0.00	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
280.651S	SUP	HCPCS C1713		280.651S  -  SCREW BONE 14MM 50MM LAG DHS/DCS STAINLESS STEEL HIP CONDYLE	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
280.655S	SUP	HCPCS C1713		280.655S  -  SCREW BONE 14MM 55MM LAG CANN DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
280.665S	SUP	HCPCS C1713		280.665S  -  SCREW BONE 14MM 65MM LAG CANN DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
280.675S	SUP	HCPCS C1713		280.675S  -  SCREW BONE 14MM 75MM LAG CANN DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
280.685S	SUP	HCPCS C1713		280.685S  -  SCREW BONE 14MM 85MM LAG CANN DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
280.695S	SUP	HCPCS C1713		280.695S  -  SCREW BONE 14MM 95MM LAG CANN DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
280.701S	SUP	HCPCS C1713		280.701S  -  SCREW BONE 14MM 100MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
280.705S	SUP	HCPCS C1713		280.705S  -  SCREW BONE 14MM 105MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
280.715S	SUP	HCPCS C1713		280.715S  -  SCREW BONE 14MM 115MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
280.725S	SUP	HCPCS C1713		280.725S  -  SCREW BONE 14MM 8.2MM 125MM 22MM 1 STEP LAG CANN DHS/DCS	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
280.735S	SUP	HCPCS C1713		280.735S  -  SCREW BONE 14MM 135MM 22MM LAG CANN DHS/DCS STAINLESS STEEL	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
280.745S	SUP	HCPCS C1713		280.745S  -  SCREW BONE 14MM 145MM LAG DHS/DCS STAINLESS STEEL HIP	BOTH IP/OP	$813.90 	$602.29	$0.00	$632.16	$355.59	$355.59	$0.00	$0.00	$0.00	$169.64	$604.08	$604.08	$0.00	$0.00	$169.62	$0.00	$481.42	$481.42	$0.00	$395.10	$625.84	$632.16	$0.00		$0.00	$120.06	$0.00	$0.00	$125.80	$0.00	$0.00	$0.00	$0.00	$0.00
2808G	SUP	Custom 27203010		2808G  -  SUTURE NABSB 8-0 BV130-5 5IN BLK ETH MTPS MFL	BOTH IP/OP	$40.53 	$29.99	$0.00	$32.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.08	$30.08	$0.00	$0.00	$8.45	$0.00	$0.00	$0.00	$0.00	$20.57	$32.58	$32.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
281.502S	SUP	HCPCS C1713		281.502S  -  PLATE 130D SHRT BRL 46MM SS 2 HOLE DHS/DCP BONE 25MM CNDYLR	BOTH IP/OP	"$1,162.60 "	$860.32	$0.00	$930.08	$523.17	$523.17	$0.00	$0.00	$0.00	$242.31	$862.88	$862.88	$0.00	$0.00	$242.29	$0.00	$687.68	$687.68	$0.00	$581.30	$920.78	$930.08	$0.00		$0.00	$181.95	$0.00	$0.00	$185.09	$0.00	$0.00	$0.00	$0.00	$0.00
2813G	SUP	Custom 27203010		2813G  -  SUTURE NABSB 9-0 BV130-4 5IN BLK ETH MFL	BOTH IP/OP	$40.86 	$30.24	$0.00	$33.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.33	$30.33	$0.00	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$20.74	$32.84	$33.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28164FGM	SUP	Custom 27203010		28164FGM  -  FORCEPS BIPOLAR 45 D L20 CM L1 MM OD3 MM INSERT ANGLED DISTA	BOTH IP/OP	"$2,490.00 "	"$1,842.60"	$0.00	"$1,992.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,848.08"	"$1,848.08"	$0.00	$0.00	$518.92	$0.00	$0.00	$0.00	$0.00	"$1,245.00"	"$1,972.08"	"$1,992.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.234S	SUP	Custom 27803010		282.234S  -  BLADE INTRAMEDULLARY NAIL HELIX 75MM LCP DHHS STERILE	BOTH IP/OP	$732.38 	$541.96	$0.00	$568.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$543.57	$543.57	$0.00	$0.00	$152.63	$0.00	$0.00	$0.00	$0.00	$355.51	$563.14	$568.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.235S	SUP	Custom 27803010		282.235S  -  BLADE INTRAMEDULLARY NAIL 80MM LCP DHHS STAINLESS STEEL HIP	BOTH IP/OP	$732.38 	$541.96	$0.00	$568.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$543.57	$543.57	$0.00	$0.00	$152.63	$0.00	$0.00	$0.00	$0.00	$355.51	$563.14	$568.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.236S	SUP	Custom 27803010		282.236S  -  BLADE SURG 85MM HELICAL STERILE	BOTH IP/OP	$732.38 	$541.96	$0.00	$568.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$543.57	$543.57	$0.00	$0.00	$152.63	$0.00	$0.00	$0.00	$0.00	$355.51	$563.14	$568.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.237S	SUP	Custom 27803010		282.237S  -  BLADE FIX 90MM HELICAL LCP DHHS STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$732.38 	$541.96	$0.00	$568.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$543.57	$543.57	$0.00	$0.00	$152.63	$0.00	$0.00	$0.00	$0.00	$355.51	$563.14	$568.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.238S	SUP	Custom 27803010		282.238S  -  BLADE FIX 95MM HELICAL LCP DHHS STAINLESS STEEL STERILE	BOTH IP/OP	$732.38 	$541.96	$0.00	$568.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$543.57	$543.57	$0.00	$0.00	$152.63	$0.00	$0.00	$0.00	$0.00	$355.51	$563.14	$568.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.239S	SUP	Custom 27803010		282.239S  -  BLADE FIX 100MM HELICAL LCP DHHS STAINLESS STEEL ORTHOPEDIC	BOTH IP/OP	$740.80 	$548.19	$0.00	$575.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.82	$549.82	$0.00	$0.00	$154.38	$0.00	$0.00	$0.00	$0.00	$359.61	$569.63	$575.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.240S	SUP	Custom 27803010		282.240S  -  BLADE FIX 105MM LCP DHHS STAINLESS STEEL HIP STERILE	BOTH IP/OP	$740.80 	$548.19	$0.00	$575.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.82	$549.82	$0.00	$0.00	$154.38	$0.00	$0.00	$0.00	$0.00	$359.61	$569.63	$575.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.241S	SUP	Custom 27803010		282.241S  -  BLADE INTRAMEDULLARY NAIL HELIX 110MM LCP DHHS STERILE	BOTH IP/OP	$740.80 	$548.19	$0.00	$575.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.82	$549.82	$0.00	$0.00	$154.38	$0.00	$0.00	$0.00	$0.00	$359.61	$569.63	$575.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.242S	SUP	Custom 27803010		282.242S  -  BLADE INTRAMEDULLARY NAIL HELIX 115MM LCP DHHS STERILE	BOTH IP/OP	$740.80 	$548.19	$0.00	$575.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.82	$549.82	$0.00	$0.00	$154.38	$0.00	$0.00	$0.00	$0.00	$359.61	$569.63	$575.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.243S	SUP	Custom 27803010		282.243S  -  BLADE FIX 120MM LCP DHHS STAINLESS STEEL HIP STERILE	BOTH IP/OP	$740.80 	$548.19	$0.00	$575.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.82	$549.82	$0.00	$0.00	$154.38	$0.00	$0.00	$0.00	$0.00	$359.61	$569.63	$575.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.244S	SUP	Custom 27803010		282.244S  -  BLADE FIX 125MM LCP DHHS STAINLESS STEEL HIP STERILE	BOTH IP/OP	$740.80 	$548.19	$0.00	$575.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.82	$549.82	$0.00	$0.00	$154.38	$0.00	$0.00	$0.00	$0.00	$359.61	$569.63	$575.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.245S	SUP	Custom 27803010		282.245S  -  BLADE FIX 130MM LCP DHHS STAINLESS STEEL HIP STERILE	BOTH IP/OP	$749.23 	$554.43	$0.00	$581.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.07	$556.07	$0.00	$0.00	$156.14	$0.00	$0.00	$0.00	$0.00	$363.70	$576.10	$581.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.246S	SUP	Custom 27803010		282.246S  -  BLADE FIX 135MM LCP DHHS STAINLESS STEEL HIP STERILE	BOTH IP/OP	$749.23 	$554.43	$0.00	$581.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.07	$556.07	$0.00	$0.00	$156.14	$0.00	$0.00	$0.00	$0.00	$363.70	$576.10	$581.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.247S	SUP	Custom 27803010		282.247S  -  BLADE FIX 140MM LCP DHHS STAINLESS STEEL HIP STERILE	BOTH IP/OP	$749.23 	$554.43	$0.00	$581.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.07	$556.07	$0.00	$0.00	$156.14	$0.00	$0.00	$0.00	$0.00	$363.70	$576.10	$581.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.248S	SUP	Custom 27803010		282.248S  -  BLADE FIX 145MM LCP DHHS STAINLESS STEEL HIP STERILE	BOTH IP/OP	$749.23 	$554.43	$0.00	$581.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.07	$556.07	$0.00	$0.00	$156.14	$0.00	$0.00	$0.00	$0.00	$363.70	$576.10	$581.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.249S	SUP	Custom 27803010		282.249S  -  BLADE FIX 150MM LCP DHHS STAINLESS STEEL HIP STERILE	BOTH IP/OP	$749.23 	$554.43	$0.00	$581.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.07	$556.07	$0.00	$0.00	$156.14	$0.00	$0.00	$0.00	$0.00	$363.70	$576.10	$581.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
282.605S	SUP	HCPCS C1713		282.605S  -  SIDEPLATE BONE 130D STANDARD BARREL 162MM 38MM 8 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.606S	SUP	HCPCS C1713		282.606S  -  SIDEPLATE BONE 130D STANDARD BARREL 198MM 38MM 10 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.607S	SUP	HCPCS C1713		282.607S  -  SIDEPLATE BONE 130D STANDARD BARREL 234MM 38MM 12 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.608S	SUP	HCPCS C1713		282.608S  -  SIDEPLATE BONE 130D STANDARD BARREL 270MM 38MM 14 HOLE LCP	BOTH IP/OP	"$1,862.55 "	"$1,378.29"	$0.00	"$1,446.64"	$813.74	$813.74	$0.00	$0.00	$0.00	$388.20	"$1,382.38"	"$1,382.38"	$0.00	$0.00	$388.16	$0.00	"$1,101.70"	"$1,101.70"	$0.00	$904.15	"$1,432.17"	"$1,446.64"	$0.00		$0.00	$274.76	$0.00	$0.00	$287.88	$0.00	$0.00	$0.00	$0.00	$0.00
282.615S	SUP	HCPCS C1713		282.615S  -  SIDEPLATE BONE 135D STANDARD BARREL 162MM 38MM 8 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.616S	SUP	HCPCS C1713		282.616S  -  SIDEPLATE BONE 135D STANDARD BARREL 198MM 38MM 10 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.617S	SUP	HCPCS C1713		282.617S  -  SIDEPLATE BONE 135D STANDARD BARREL 234MM 38MM 12 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.618S	SUP	HCPCS C1713		282.618S  -  SIDEPLATE BONE 135D STANDARD BARREL 270MM 38MM 14 HOLE LCP	BOTH IP/OP	"$1,862.55 "	"$1,378.29"	$0.00	"$1,446.64"	$813.74	$813.74	$0.00	$0.00	$0.00	$388.20	"$1,382.38"	"$1,382.38"	$0.00	$0.00	$388.16	$0.00	"$1,101.70"	"$1,101.70"	$0.00	$904.15	"$1,432.17"	"$1,446.64"	$0.00		$0.00	$274.76	$0.00	$0.00	$287.88	$0.00	$0.00	$0.00	$0.00	$0.00
282.619S	SUP	HCPCS C1713		282.619S  -  SIDEPLATE BONE 135D STANDARD BARREL 306MM 38MM 16 HOLE LCP	BOTH IP/OP	"$1,862.55 "	"$1,378.29"	$0.00	"$1,446.64"	$813.74	$813.74	$0.00	$0.00	$0.00	$388.20	"$1,382.38"	"$1,382.38"	$0.00	$0.00	$388.16	$0.00	"$1,101.70"	"$1,101.70"	$0.00	$904.15	"$1,432.17"	"$1,446.64"	$0.00		$0.00	$274.76	$0.00	$0.00	$287.88	$0.00	$0.00	$0.00	$0.00	$0.00
282.620S	SUP	HCPCS C1713		282.620S  -  SIDEPLATE BONE 135D STANDARD BARREL 342MM 38MM 18 HOLE LCP	BOTH IP/OP	"$1,915.95 "	"$1,417.80"	$0.00	"$1,488.12"	$837.07	$837.07	$0.00	$0.00	$0.00	$399.33	"$1,422.02"	"$1,422.02"	$0.00	$0.00	$399.28	$0.00	"$1,133.28"	"$1,133.28"	$0.00	$930.08	"$1,473.24"	"$1,488.12"	$0.00		$0.00	$282.64	$0.00	$0.00	$296.14	$0.00	$0.00	$0.00	$0.00	$0.00
282.621S	SUP	HCPCS C1713		282.621S  -  SIDEPLATE BONE 135D STANDARD BARREL 378MM 38MM 20 HOLE LCP	BOTH IP/OP	"$1,915.95 "	"$1,417.80"	$0.00	"$1,488.12"	$837.07	$837.07	$0.00	$0.00	$0.00	$399.33	"$1,422.02"	"$1,422.02"	$0.00	$0.00	$399.28	$0.00	"$1,133.28"	"$1,133.28"	$0.00	$930.08	"$1,473.24"	"$1,488.12"	$0.00		$0.00	$282.64	$0.00	$0.00	$296.14	$0.00	$0.00	$0.00	$0.00	$0.00
282.635S	SUP	HCPCS C1713		282.635S  -  SIDEPLATE BONE 140D STANDARD BARREL 162MM 38MM 8 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.636S	SUP	HCPCS C1713		282.636S  -  SIDEPLATE BONE 140D STANDARD BARREL 198MM 38MM 10 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.637S	SUP	HCPCS C1713		282.637S  -  SIDEPLATE BONE 140D STANDARD BARREL 234MM 38MM 12 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.638S	SUP	HCPCS C1713		282.638S  -  SIDEPLATE BONE 140D STANDARD BARREL 270MM 38MM 14 HOLE LCP	BOTH IP/OP	"$1,862.55 "	"$1,378.29"	$0.00	"$1,446.64"	$813.74	$813.74	$0.00	$0.00	$0.00	$388.20	"$1,382.38"	"$1,382.38"	$0.00	$0.00	$388.16	$0.00	"$1,101.70"	"$1,101.70"	$0.00	$904.15	"$1,432.17"	"$1,446.64"	$0.00		$0.00	$274.76	$0.00	$0.00	$287.88	$0.00	$0.00	$0.00	$0.00	$0.00
282.639S	SUP	HCPCS C1713		282.639S  -  SIDEPLATE BONE 140D STANDARD BARREL 306MM 38MM 16 HOLE LCP	BOTH IP/OP	"$1,862.55 "	"$1,378.29"	$0.00	"$1,446.64"	$813.74	$813.74	$0.00	$0.00	$0.00	$388.20	"$1,382.38"	"$1,382.38"	$0.00	$0.00	$388.16	$0.00	"$1,101.70"	"$1,101.70"	$0.00	$904.15	"$1,432.17"	"$1,446.64"	$0.00		$0.00	$274.76	$0.00	$0.00	$287.88	$0.00	$0.00	$0.00	$0.00	$0.00
282.645S	SUP	HCPCS C1713		282.645S  -  SIDEPLATE BONE 145D STANDARD BARREL 162MM 38MM 8 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.646S	SUP	HCPCS C1713		282.646S  -  SIDEPLATE BONE 145D STANDARD BARREL 198MM 38MM 10 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.647S	SUP	HCPCS C1713		282.647S  -  SIDEPLATE BONE 145D STANDARD BARREL 234MM 38MM 12 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.648S	SUP	HCPCS C1713		282.648S  -  SIDEPLATE BONE 145D STANDARD BARREL 270MM 38MM 14 HOLE LCP	BOTH IP/OP	"$1,862.55 "	"$1,378.29"	$0.00	"$1,446.64"	$813.74	$813.74	$0.00	$0.00	$0.00	$388.20	"$1,382.38"	"$1,382.38"	$0.00	$0.00	$388.16	$0.00	"$1,101.70"	"$1,101.70"	$0.00	$904.15	"$1,432.17"	"$1,446.64"	$0.00		$0.00	$274.76	$0.00	$0.00	$287.88	$0.00	$0.00	$0.00	$0.00	$0.00
282.649S	SUP	HCPCS C1713		282.649S  -  SIDEPLATE BONE 145D STANDARD BARREL 306MM 38MM 16 HOLE LCP	BOTH IP/OP	"$1,862.55 "	"$1,378.29"	$0.00	"$1,446.64"	$813.74	$813.74	$0.00	$0.00	$0.00	$388.20	"$1,382.38"	"$1,382.38"	$0.00	$0.00	$388.16	$0.00	"$1,101.70"	"$1,101.70"	$0.00	$904.15	"$1,432.17"	"$1,446.64"	$0.00		$0.00	$274.76	$0.00	$0.00	$287.88	$0.00	$0.00	$0.00	$0.00	$0.00
282.655S	SUP	HCPCS C1713		282.655S  -  SIDEPLATE BONE 150D STANDARD BARREL 162MM 38MM 8 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.656S	SUP	HCPCS C1713		282.656S  -  SIDEPLATE BONE 150D STANDARD BARREL 198MM 38MM 10 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.657S	SUP	HCPCS C1713		282.657S  -  SIDEPLATE BONE 150D STANDARD BARREL 234MM 38MM 12 HOLE LCP	BOTH IP/OP	"$1,453.48 "	"$1,075.58"	$0.00	"$1,128.92"	$635.02	$635.02	$0.00	$0.00	$0.00	$302.94	"$1,078.77"	"$1,078.77"	$0.00	$0.00	$302.90	$0.00	$859.73	$859.73	$0.00	$705.58	"$1,117.63"	"$1,128.92"	$0.00		$0.00	$214.41	$0.00	$0.00	$224.66	$0.00	$0.00	$0.00	$0.00	$0.00
282.658S	SUP	HCPCS C1713		282.658S  -  SIDEPLATE BONE 150D STANDARD BARREL 270MM 38MM 14 HOLE LCP	BOTH IP/OP	"$1,862.55 "	"$1,378.29"	$0.00	"$1,446.64"	$813.74	$813.74	$0.00	$0.00	$0.00	$388.20	"$1,382.38"	"$1,382.38"	$0.00	$0.00	$388.16	$0.00	"$1,101.70"	"$1,101.70"	$0.00	$904.15	"$1,432.17"	"$1,446.64"	$0.00		$0.00	$274.76	$0.00	$0.00	$287.88	$0.00	$0.00	$0.00	$0.00	$0.00
282.659S	SUP	HCPCS C1713		282.659S  -  SIDEPLATE BONE 150D STANDARD BARREL 306MM 38MM 16 HOLE LCP	BOTH IP/OP	"$1,862.55 "	"$1,378.29"	$0.00	"$1,446.64"	$813.74	$813.74	$0.00	$0.00	$0.00	$388.20	"$1,382.38"	"$1,382.38"	$0.00	$0.00	$388.16	$0.00	"$1,101.70"	"$1,101.70"	$0.00	$904.15	"$1,432.17"	"$1,446.64"	$0.00		$0.00	$274.76	$0.00	$0.00	$287.88	$0.00	$0.00	$0.00	$0.00	$0.00
282.660S	SUP	HCPCS C1713		282.660S  -  SIDEPLATE BONE 150D STANDARD BARREL 342MM 38MM 18 HOLE LCP	BOTH IP/OP	"$1,915.95 "	"$1,417.80"	$0.00	"$1,488.12"	$837.07	$837.07	$0.00	$0.00	$0.00	$399.33	"$1,422.02"	"$1,422.02"	$0.00	$0.00	$399.28	$0.00	"$1,133.28"	"$1,133.28"	$0.00	$930.08	"$1,473.24"	"$1,488.12"	$0.00		$0.00	$282.64	$0.00	$0.00	$296.14	$0.00	$0.00	$0.00	$0.00	$0.00
282.661S	SUP	HCPCS C1713		282.661S  -  SIDEPLATE BONE 150D STANDARD BARREL 378MM 38MM 20 HOLE LCP	BOTH IP/OP	"$1,915.95 "	"$1,417.80"	$0.00	"$1,488.12"	$837.07	$837.07	$0.00	$0.00	$0.00	$399.33	"$1,422.02"	"$1,422.02"	$0.00	$0.00	$399.28	$0.00	"$1,133.28"	"$1,133.28"	$0.00	$930.08	"$1,473.24"	"$1,488.12"	$0.00		$0.00	$282.64	$0.00	$0.00	$296.14	$0.00	$0.00	$0.00	$0.00	$0.00
282.671S	SUP	HCPCS C1713		282.671S  -  SIDEPLATE BONE 130D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.673S	SUP	HCPCS C1713		282.673S  -  SIDEPLATE BONE 130D SHORT BARREL 5 HOLE LCP DHHS STAINLESS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.674S	SUP	HCPCS C1713		282.674S  -  SIDEPLATE BONE 130D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.677S	SUP	HCPCS C1713		282.677S  -  SIDEPLATE BONE 135D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.679S	SUP	HCPCS C1713		282.679S  -  SIDEPLATE BONE 135D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.680S	SUP	HCPCS C1713		282.680S  -  SIDEPLATE BONE 135D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.681S	SUP	HCPCS C1713		282.681S  -  SIDEPLATE BONE 140D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.682S	SUP	HCPCS C1713		282.682S  -  SIDEPLATE BONE 140D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.684S	SUP	HCPCS C1713		282.684S  -  SIDEPLATE BONE 140D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.685S	SUP	HCPCS C1713		282.685S  -  SIDEPLATE BONE 140D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.686S	SUP	HCPCS C1713		282.686S  -  SIDEPLATE BONE 145D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.687S	SUP	HCPCS C1713		282.687S  -  SIDEPLATE BONE 145D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.689S	SUP	HCPCS C1713		282.689S  -  SIDEPLATE BONE 145D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.690S	SUP	HCPCS C1713		282.690S  -  SIDEPLATE BONE 145D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.692S	SUP	HCPCS C1713		282.692S  -  SIDEPLATE BONE 150D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.694S	SUP	HCPCS C1713		282.694S  -  SIDEPLATE BONE 150D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
282.695S	SUP	HCPCS C1713		282.695S  -  SIDEPLATE BONE 150D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS	BOTH IP/OP	"$1,179.38 "	$872.74	$0.00	$916.02	$515.26	$515.26	$0.00	$0.00	$0.00	$245.81	$875.33	$875.33	$0.00	$0.00	$245.78	$0.00	$697.60	$697.60	$0.00	$572.51	$906.86	$916.02	$0.00		$0.00	$173.98	$0.00	$0.00	$182.29	$0.00	$0.00	$0.00	$0.00	$0.00
28-300	SUP	Custom 27203010		28-300  -  GUIDEPIN THREAD-TIPPED 2.8MM X 300MM	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.67	$55.67	$0.00	$0.00	$15.63	$0.00	$0.00	$0.00	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2836-47	SUP	Custom 27203010		REAGENT MCBL ANSR SHIG BYD2 GRP C 1-7 LYPH 3ML	BOTH IP/OP	$262.83 	$194.49	$0.00	$210.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.41	$208.16	$210.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2837-47	SUP	Custom 27203010		REAGENT MCBL ANSR SHIG BYD2 GRP D LYPH DFC 3ML	BOTH IP/OP	$279.20 	$206.61	$0.00	$223.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.60	$221.13	$223.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2850G	SUP	Custom 27203010		2850G  -  SUTURE NONABSORBABLE 10-0 BV75-4 5IN MONOFILAMENT ETHILON	BOTH IP/OP	$69.48 	$51.42	$0.00	$56.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.57	$51.57	$0.00	$0.00	$14.48	$0.00	$0.00	$0.00	$0.00	$35.26	$55.85	$56.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2867-05-230	SUP	HCPCS C1769		2867-05-230  -  GUIDEWIRE ORTH 1.37MM VPR 2 SHRP	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$312.23	$312.23	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$287.50	$455.40	$460.00	$0.00		$0.00	$89.99	$0.00	$0.00	$91.54	$0.00	$0.00	$0.00	$0.00	$0.00
2887B	SUP	Custom 27203010		PROBE ORAL LNG CORD THRMTR BLUE TRB TMP	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2894G	SUP	Custom 27203010		2894G  -  SUTURE NONABSORBABLE 9-0 V100-3 5IN MONOFILAMENT ETHILON	BOTH IP/OP	$55.97 	$41.42	$0.00	$45.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.54	$41.54	$0.00	$0.00	$11.66	$0.00	$0.00	$0.00	$0.00	$28.40	$44.99	$45.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
28-M322090222290U	SUP	HCPCS C2625		28-M322090222290U  -  GRAFT EVAS 22MMX100MM RESR MAIN	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$5,210.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,210.00"	$0.00	"$12,325.00"	"$12,325.00"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M322150222290U	SUP	HCPCS C2625		28-M322150222290U  -  GRAFT EVAS 22MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M322190222290U	SUP	HCPCS C2625		28-M322190222290U  -  GRAFT EVAS 22MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M322250222390U	SUP	HCPCS C2625		28-M322250222390U  -  GRAFT EVAS 22MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M324090242290U	SUP	HCPCS C2625		28-M324090242290U  -  GRAFT EVAS 24MMX100MM RESR MAIN	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$5,210.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,210.00"	$0.00	"$12,325.00"	"$12,325.00"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M324150242290U	SUP	HCPCS C2625		28-M324150242290U  -  GRAFT EVAS 24MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M324190242290U	SUP	HCPCS C2625		28-M324190242290U  -  GRAFT EVAS 24MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M324250222390U	SUP	HCPCS C2625		28-M324250222390U  -  GRAFT EVAS 24MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M326095262290U	SUP	HCPCS C2625		28-M326095262290U  -  GRAFT EVAS 26MMX100MM RESR MAIN	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$5,210.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,210.00"	$0.00	"$12,325.00"	"$12,325.00"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M326155262290U	SUP	HCPCS C2625		28-M326155262290U  -  GRAFT EVAS 26MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M326195262290U	SUP	HCPCS C2625		28-M326195262290U  -  GRAFT EVAS 26MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M326250262390U	SUP	HCPCS C2625		28-M326250262390U  -  GRAFT EVAS 26MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M328095282290U	SUP	HCPCS C2625		28-M328095282290U  -  GRAFT EVAS 28MMX100MM RESR MAIN	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$5,210.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,210.00"	$0.00	"$12,325.00"	"$12,325.00"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M328155242290U	SUP	HCPCS C2625		28-M328155242290U  -  GRAFT EVAS 28/24X150 TAPERED	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M328155282290U	SUP	HCPCS C2625		28-M328155282290U  -  GRAFT EVAS 28MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M328195242290U	SUP	HCPCS C2625		28-M328195242290U  -  GRAFT EVAS 28/24X200 TAPERED	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M328195282290U	SUP	HCPCS C2625		28-M328195282290U  -  GRAFT EVAS 28MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M328250242390U	SUP	HCPCS C2625		28-M328250242390U  -  GRAFT EVAS 28/24X250 TAPERED	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M328250282390U	SUP	HCPCS C2625		28-M328250282390U  -  GRAFT EVAS 28MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M330095302290U	SUP	HCPCS C2625		28-M330095302290U  -  GRAFT EVAS 30MMX100MM RESR MAIN	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$5,210.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,210.00"	$0.00	"$12,325.00"	"$12,325.00"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M330155262290U	SUP	HCPCS C2625		28-M330155262290U  -  GRAFT EVAS 30/26X150 TAPERED	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M330155302290U	SUP	HCPCS C2625		28-M330155302290U  -  GRAFT EVAS 30MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M330200262390U	SUP	HCPCS C2625		28-M330200262390U  -  GRAFT EVAS 30/26X200 TAPERED	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M330200302390U	SUP	HCPCS C2625		28-M330200302390U  -  GRAFT EVAS 30MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M330250262390U	SUP	HCPCS C2625		28-M330250262390U  -  GRAFT EVAS 30/26X250 TAPERED	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M330250302390U	SUP	HCPCS C2625		28-M330250302390U  -  GRAFT EVAS 30MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M332095322290U	SUP	HCPCS C2625		28-M332095322290U  -  GRAFT EVAS 32MMX100MM RESR MAIN	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$5,210.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,210.00"	$0.00	"$12,325.00"	"$12,325.00"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M332155282290U	SUP	HCPCS C2625		28-M332155282290U  -  GRAFT EVAS 32/28X150 TAPERED	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M332155322290U	SUP	HCPCS C2625		28-M332155322290U  -  GRAFT EVAS 32MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M332200282390U	SUP	HCPCS C2625		28-M332200282390U  -  GRAFT EVAS 32/28X200 TAPERED	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M332200322390U	SUP	HCPCS C2625		28-M332200322390U  -  GRAFT EVAS 32MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M332250282490U	SUP	HCPCS C2625		28-M332250282490U  -  GRAFT EVAS 32/28X250 TAPERED	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M332250322490U	SUP	HCPCS C2625		28-M332250322490U  -  GRAFT EVAS 32MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M334100342390U	SUP	HCPCS C2625		28-M334100342390U  -  GRAFT EVAS 34MMX100MM RESR MAIN	BOTH IP/OP	"$42,375.00 "	"$31,357.50"	$0.00	"$20,890.88"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$8,832.01"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,830.95"	$0.00	"$20,890.88"	"$20,890.88"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M334145302390U	SUP	HCPCS C2625		28-M334145302390U  -  GRAFT EVAS 34/30X150 TAPERED	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M334145342390U	SUP	HCPCS C2625		28-M334145342390U  -  GRAFT EVAS 34MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M334200302490U	SUP	HCPCS C2625		28-M334200302490U  -  GRAFT EVAS 34/30X200 TAPERED	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M334200342490U	SUP	HCPCS C2625		28-M334200342490U  -  GRAFT EVAS 34MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M334250302490U	SUP	HCPCS C2625		28-M334250302490U  -  GRAFT EVAS 34/30X250 TAPERED	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M334250342490U	SUP	HCPCS C2625		28-M334250342490U  -  GRAFT EVAS 34MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M336100362390U	SUP	HCPCS C2625		28-M336100362390U  -  GRAFT EVAS 36MMX100MM RESR MAIN	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$5,210.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,210.00"	$0.00	"$12,325.00"	"$12,325.00"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M336145322490U	SUP	HCPCS C2625		28-M336145322490U  -  GRAFT EVAS 36/32X150 TAPERED	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M336145362490U	SUP	HCPCS C2625		28-M336145362490U  -  GRAFT EVAS 36MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M336190322490U	SUP	HCPCS C2625		28-M336190322490U  -  GRAFT EVAS 36/32X200 TAPERED	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M336190362490U	SUP	HCPCS C2625		28-M336190362490U  -  GRAFT EVAS 36MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M336250322490U	SUP	HCPCS C2625		28-M336250322490U  -  GRAFT EVAS 36/32X250 TAPERED	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M336250362490U	SUP	HCPCS C2625		28-M336250362490U  -  GRAFT EVAS 36MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M338100382490U	SUP	HCPCS C2625		28-M338100382490U  -  GRAFT EVAS 38MMX100MM RESR MAIN	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$5,210.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,210.00"	$0.00	"$12,325.00"	"$12,325.00"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M338145342490U	SUP	HCPCS C2625		28-M338145342490U  -  GRAFT EVAS 38/34X150 TAPERED	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M338145382490U	SUP	HCPCS C2625		28-M338145382490U  -  GRAFT EVAS 38MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M338190342590U	SUP	HCPCS C2625		28-M338190342590U  -  GRAFT EVAS 38/34X200 TAPERED	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M338190382590U	SUP	HCPCS C2625		28-M338190382590U  -  GRAFT EVAS 38MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M338250342590U	SUP	HCPCS C2625		28-M338250342590U  -  GRAFT EVAS 38/34X250 TAPERED	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M338250382590U	SUP	HCPCS C2625		28-M338250382590U  -  GRAFT EVAS 38MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M340105402490U	SUP	HCPCS C2625		28-M340105402490U  -  GRAFT EVAS 40MMX100MM RESR MAIN	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$5,210.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,210.00"	$0.00	"$12,325.00"	"$12,325.00"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M340145362590U	SUP	HCPCS C2625		28-M340145362590U  -  GRAFT EVAS 40/36X150 TAPERED	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M340145402590U	SUP	HCPCS C2625		28-M340145402590U  -  GRAFT EVAS 40MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M340195362590U	SUP	HCPCS C2625		28-M340195362590U  -  GRAFT EVAS 40/36X200 TAPERED	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M340195402590U	SUP	HCPCS C2625		28-M340195402590U  -  GRAFT EVAS 40MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M340250362590U	SUP	HCPCS C2625		28-M340250362590U  -  GRAFT EVAS 40/36X250 TAPERED	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M340250402590U	SUP	HCPCS C2625		28-M340250402590U  -  GRAFT EVAS 40MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M342105422590U	SUP	HCPCS C2625		28-M342105422590U  -  GRAFT EVAS 42MMX100MM RESR MAIN	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$5,210.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,210.00"	$0.00	"$12,325.00"	"$12,325.00"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M342150382590U	SUP	HCPCS C2625		28-M342150382590U  -  GRAFT EVAS 42/38X150 TAPERED	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M342150422590U	SUP	HCPCS C2625		28-M342150422590U  -  GRAFT EVAS 42MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M342195382590U	SUP	HCPCS C2625		28-M342195382590U  -  GRAFT EVAS 42/38X200 TAPERED	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M342195422590U	SUP	HCPCS C2625		28-M342195422590U  -  GRAFT EVAS 42MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M342250382590U	SUP	HCPCS C2625		28-M342250382590U  -  GRAFT EVAS 42/38X250 TAPERED	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M342250422590U	SUP	HCPCS C2625		28-M342250422590U  -  GRAFT EVAS 42MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M344105442590U	SUP	HCPCS C2625		28-M344105442590U  -  GRAFT EVAS 44MMX100MM RESR MAIN	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$5,210.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,210.00"	$0.00	"$12,325.00"	"$12,325.00"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M344155402590U	SUP	HCPCS C2625		28-M344155402590U  -  GRAFT EVAS 44/40X150 TAPERED	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M344155442590U	SUP	HCPCS C2625		28-M344155442590U  -  GRAFT EVAS 44MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M344200402590U	SUP	HCPCS C2625		28-M344200402590U  -  GRAFT EVAS 44/40X200 TAPERED	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M344200442590U	SUP	HCPCS C2625		28-M344200442590U  -  GRAFT EVAS 44MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M344250402690U	SUP	HCPCS C2625		28-M344250402690U  -  GRAFT EVAS 44/40X250 TAPERED	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M344250442690U	SUP	HCPCS C2625		28-M344250442690U  -  GRAFT EVAS 44MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M346105462690U	SUP	HCPCS C2625		28-M346105462690U  -  GRAFT EVAS 46MMX100MM RESR MAIN	BOTH IP/OP	"$25,000.00 "	"$18,500.00"	$0.00	"$20,000.00"	"$11,250.00"	"$11,250.00"	$0.00	$0.00	$0.00	"$5,210.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,210.00"	$0.00	"$12,325.00"	"$12,325.00"	$0.00	"$12,500.00"	"$19,800.00"	"$20,000.00"	$0.00		$0.00	"$3,912.50"	$0.00	$0.00	"$3,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M346155422690U	SUP	HCPCS C2625		28-M346155422690U  -  GRAFT EVAS 46/42X150 TAPERED	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M346155462690U	SUP	HCPCS C2625		28-M346155462690U  -  GRAFT EVAS 46MMX150MM RESR MAIN	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	"$13,500.00"	"$13,500.00"	$0.00	$0.00	$0.00	"$6,252.75"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	"$14,790.00"	"$14,790.00"	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	"$4,695.00"	$0.00	$0.00	"$4,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M346200422690U	SUP	HCPCS C2625		28-M346200422690U  -  GRAFT EVAS 46/42X200 TAPERED	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M346200462690U	SUP	HCPCS C2625		28-M346200462690U  -  GRAFT EVAS 46MMX200MM RESR MAIN	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	"$15,750.00"	"$15,750.00"	$0.00	$0.00	$0.00	"$7,294.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	"$17,255.00"	"$17,255.00"	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	"$5,477.50"	$0.00	$0.00	"$5,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M346250422690U	SUP	HCPCS C2625		28-M346250422690U  -  GRAFT EVAS 46/42X250 TAPERED	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
28-M346250462690U	SUP	HCPCS C2625		28-M346250462690U  -  GRAFT EVAS 46MMX250MM RESR MAIN	BOTH IP/OP	"$40,000.00 "	"$29,600.00"	$0.00	"$32,000.00"	"$18,000.00"	"$18,000.00"	$0.00	$0.00	$0.00	"$8,337.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,336.00"	$0.00	"$19,720.00"	"$19,720.00"	$0.00	"$20,000.00"	"$31,680.00"	"$32,000.00"	$0.00		$0.00	"$6,260.00"	$0.00	$0.00	"$6,368.00"	$0.00	$0.00	$0.00	$0.00	$0.00
290.20.280	SUP	Custom 27203010		290.20.280  -  WIRE FX STD 2MM 280MM NS KRSH SS	BOTH IP/OP	$48.75 	$36.08	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$0.00	$0.00	$0.00	$24.38	$38.61	$39.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.230.98	SUP	Custom 27203010		291.230.98  -  WIRE CERCLAGE .5MM 175MM PRECUT STAINLESS STEEL MANDIB	BOTH IP/OP	$31.50 	$23.31	$0.00	$25.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.38	$23.38	$0.00	$0.00	$6.56	$0.00	$0.00	$0.00	$0.00	$15.75	$24.95	$25.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.240.98	SUP	Custom 27203010		291.240.98  -  WIRE FIX 175MM .6MM MANDIB SS CRLGE PCUT NONSTRL	BOTH IP/OP	$27.00 	$19.98	$0.00	$21.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.04	$20.04	$0.00	$0.00	$5.63	$0.00	$0.00	$0.00	$0.00	$13.50	$21.38	$21.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.911.01S	SUP	Custom 27803010		291.911.01S  -  CABLE ORTH SS 1MM 750MM STRNL W/O NDL CRIMPING FRL PRLL END	BOTH IP/OP	$223.75 	$165.58	$0.00	$179.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.07	$166.07	$0.00	$0.00	$46.63	$0.00	$0.00	$0.00	$0.00	$111.88	$177.21	$179.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.916.01S	SUP	Custom 27803010		291.916.01S  -  CABLE ORTH SS 1MM 750MM STRNL NDL CRIMPING FRL PRLL END FIT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
291.916.03S	SUP	Custom 27803010		291.916.03S  -  CABLE ORTH SS 1MM 750MM STRNL NDL CRIMPING FRL PRLL END FIT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29-15044	SUP	HCPCS C1713		29-15044  -  DISK IMPL 4MM SLFTAP PRELD NONSTRL 1.5MM SCR	BOTH IP/OP	"$18,936.55 "	"$14,013.05"	$0.00	"$15,149.24"	"$8,521.45"	"$8,521.45"	$0.00	$0.00	$0.00	"$3,946.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,946.38"	$0.00	"$9,335.72"	"$9,335.72"	$0.00	"$9,468.28"	"$14,997.75"	"$15,149.24"	$0.00		$0.00	"$2,963.57"	$0.00	$0.00	"$3,014.70"	$0.00	$0.00	$0.00	$0.00	$0.00
293.48L	SUP	Custom 27203010		293.48L  -  PIN FIX 4.5MM 275MM 3 FLAT ROUND TROCAR POINT SMOOTH SHAFT	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
293.48X	SUP	Custom 27203010		293.48X  -  PIN FIX 4.5MM 300MM 3 FLAT ROUND TROCAR POINT SMOOTH SHAFT	BOTH IP/OP	$125.88 	$93.15	$0.00	$97.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.42	$93.42	$0.00	$0.00	$26.23	$0.00	$0.00	$0.00	$0.00	$61.10	$96.78	$97.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
294.30SHA	SUP	HCPCS C1713		294.30SHA  -  SCREW XTRNFX 4MM 3MM 80MM STRL 20MM SCHNZ SPD PNT SS HA SEF	BOTH IP/OP	$210.53 	$155.79	$0.00	$163.52	$91.98	$91.98	$0.00	$0.00	$0.00	$43.88	$156.25	$156.25	$0.00	$0.00	$43.87	$0.00	$124.53	$124.53	$0.00	$102.20	$161.88	$163.52	$0.00		$0.00	$31.06	$0.00	$0.00	$32.54	$0.00	$0.00	$0.00	$0.00	$0.00
294.43SHA	SUP	HCPCS C1713		294.43SHA  -  SCREW XTRNFX 4MM 60MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG	BOTH IP/OP	$210.53 	$155.79	$0.00	$163.52	$91.98	$91.98	$0.00	$0.00	$0.00	$43.88	$156.25	$156.25	$0.00	$0.00	$43.87	$0.00	$124.53	$124.53	$0.00	$102.20	$161.88	$163.52	$0.00		$0.00	$31.06	$0.00	$0.00	$32.54	$0.00	$0.00	$0.00	$0.00	$0.00
294.44SHA	SUP	HCPCS C1713		294.44SHA  -  SCREW XTRNFX 4MM 80MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG	BOTH IP/OP	$210.53 	$155.79	$0.00	$163.52	$91.98	$91.98	$0.00	$0.00	$0.00	$43.88	$156.25	$156.25	$0.00	$0.00	$43.87	$0.00	$124.53	$124.53	$0.00	$102.20	$161.88	$163.52	$0.00		$0.00	$31.06	$0.00	$0.00	$32.54	$0.00	$0.00	$0.00	$0.00	$0.00
294.45SHA	SUP	HCPCS C1713		294.45SHA  -  SCREW XTRNFX 4MM 100MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG	BOTH IP/OP	$210.53 	$155.79	$0.00	$163.52	$91.98	$91.98	$0.00	$0.00	$0.00	$43.88	$156.25	$156.25	$0.00	$0.00	$43.87	$0.00	$124.53	$124.53	$0.00	$102.20	$161.88	$163.52	$0.00		$0.00	$31.06	$0.00	$0.00	$32.54	$0.00	$0.00	$0.00	$0.00	$0.00
294.46SHA	SUP	HCPCS C1713		294.46SHA  -  SCREW XTRNFX 4MM 120MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG	BOTH IP/OP	$210.53 	$155.79	$0.00	$163.52	$91.98	$91.98	$0.00	$0.00	$0.00	$43.88	$156.25	$156.25	$0.00	$0.00	$43.87	$0.00	$124.53	$124.53	$0.00	$102.20	$161.88	$163.52	$0.00		$0.00	$31.06	$0.00	$0.00	$32.54	$0.00	$0.00	$0.00	$0.00	$0.00
294.52SHA	SUP	HCPCS C1713		294.52SHA  -  SCREW XTRNFX XLNG 5MM 100MM STRL 50MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$210.53 	$155.79	$0.00	$163.52	$91.98	$91.98	$0.00	$0.00	$0.00	$43.88	$156.25	$156.25	$0.00	$0.00	$43.87	$0.00	$124.53	$124.53	$0.00	$102.20	$161.88	$163.52	$0.00		$0.00	$31.06	$0.00	$0.00	$32.54	$0.00	$0.00	$0.00	$0.00	$0.00
294.53SHA	SUP	HCPCS C1713		294.53SHA  -  SCREW XTRNFX XLNG 5MM 125MM STRL 50MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$210.53 	$155.79	$0.00	$163.52	$91.98	$91.98	$0.00	$0.00	$0.00	$43.88	$156.25	$156.25	$0.00	$0.00	$43.87	$0.00	$124.53	$124.53	$0.00	$102.20	$161.88	$163.52	$0.00		$0.00	$31.06	$0.00	$0.00	$32.54	$0.00	$0.00	$0.00	$0.00	$0.00
294.54SHA	SUP	HCPCS C1713		294.54SHA  -  SCREW XTRNFX XLNG 5MM 150MM STRL 50MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$210.53 	$155.79	$0.00	$163.52	$91.98	$91.98	$0.00	$0.00	$0.00	$43.88	$156.25	$156.25	$0.00	$0.00	$43.87	$0.00	$124.53	$124.53	$0.00	$102.20	$161.88	$163.52	$0.00		$0.00	$31.06	$0.00	$0.00	$32.54	$0.00	$0.00	$0.00	$0.00	$0.00
294.55SHA	SUP	HCPCS C1713		294.55SHA  -  PIN HALF 5MM 170MM TROCAR BLUNT SCHANZ STAINLESS STEEL	BOTH IP/OP	$226.13 	$167.34	$0.00	$175.64	$98.80	$98.80	$0.00	$0.00	$0.00	$47.13	$167.83	$167.83	$0.00	$0.00	$47.12	$0.00	$133.75	$133.75	$0.00	$109.78	$173.88	$175.64	$0.00		$0.00	$33.36	$0.00	$0.00	$34.95	$0.00	$0.00	$0.00	$0.00	$0.00
294.56SHA	SUP	HCPCS C1713		294.56SHA  -  SCREW XTRNFX XLNG 5MM 200MM STRL 50MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$226.13 	$167.34	$0.00	$175.64	$98.80	$98.80	$0.00	$0.00	$0.00	$47.13	$167.83	$167.83	$0.00	$0.00	$47.12	$0.00	$133.75	$133.75	$0.00	$109.78	$173.88	$175.64	$0.00		$0.00	$33.36	$0.00	$0.00	$34.95	$0.00	$0.00	$0.00	$0.00	$0.00
294.57SHA	SUP	HCPCS C1713		294.57SHA  -  SCREW XTRNFX XLNG 5MM 250MM STRL 50MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$226.13 	$167.34	$0.00	$175.64	$98.80	$98.80	$0.00	$0.00	$0.00	$47.13	$167.83	$167.83	$0.00	$0.00	$47.12	$0.00	$133.75	$133.75	$0.00	$109.78	$173.88	$175.64	$0.00		$0.00	$33.36	$0.00	$0.00	$34.95	$0.00	$0.00	$0.00	$0.00	$0.00
294.67SHA	SUP	HCPCS C1713		294.67SHA  -  SCREW XTRNFX 6MM 160MM STRL 50MM SCHNZ SPD PNT SS HA LG	BOTH IP/OP	$210.53 	$155.79	$0.00	$163.52	$91.98	$91.98	$0.00	$0.00	$0.00	$43.88	$156.25	$156.25	$0.00	$0.00	$43.87	$0.00	$124.53	$124.53	$0.00	$102.20	$161.88	$163.52	$0.00		$0.00	$31.06	$0.00	$0.00	$32.54	$0.00	$0.00	$0.00	$0.00	$0.00
294.68SHA	SUP	HCPCS C1713		294.68SHA  -  SCREW XTRNFX 6MM 190MM STRL 50MM SCHNZ SPD PNT SS HA LG	BOTH IP/OP	$210.53 	$155.79	$0.00	$163.52	$91.98	$91.98	$0.00	$0.00	$0.00	$43.88	$156.25	$156.25	$0.00	$0.00	$43.87	$0.00	$124.53	$124.53	$0.00	$102.20	$161.88	$163.52	$0.00		$0.00	$31.06	$0.00	$0.00	$32.54	$0.00	$0.00	$0.00	$0.00	$0.00
294.73SHA	SUP	HCPCS C1713		294.73SHA  -  SCREW XTRNFX ST 4.5MM 125MM STRL 18MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$210.53 	$155.79	$0.00	$163.52	$91.98	$91.98	$0.00	$0.00	$0.00	$43.88	$156.25	$156.25	$0.00	$0.00	$43.87	$0.00	$124.53	$124.53	$0.00	$102.20	$161.88	$163.52	$0.00		$0.00	$31.06	$0.00	$0.00	$32.54	$0.00	$0.00	$0.00	$0.00	$0.00
294.74SHA	SUP	HCPCS C1713		294.74SHA  -  SCREW XTRNFX ST 4.5MM 150MM STRL 18MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$210.53 	$155.79	$0.00	$163.52	$91.98	$91.98	$0.00	$0.00	$0.00	$43.88	$156.25	$156.25	$0.00	$0.00	$43.87	$0.00	$124.53	$124.53	$0.00	$102.20	$161.88	$163.52	$0.00		$0.00	$31.06	$0.00	$0.00	$32.54	$0.00	$0.00	$0.00	$0.00	$0.00
294.75SHA	SUP	HCPCS C1713		294.75SHA  -  SCREW XTRNFX ST 4.5MM 175MM STRL 18MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$218.33 	$161.56	$0.00	$169.58	$95.39	$95.39	$0.00	$0.00	$0.00	$45.50	$162.04	$162.04	$0.00	$0.00	$45.50	$0.00	$129.14	$129.14	$0.00	$105.99	$167.89	$169.58	$0.00		$0.00	$32.21	$0.00	$0.00	$33.75	$0.00	$0.00	$0.00	$0.00	$0.00
294.76SHA	SUP	HCPCS C1713		294.76SHA  -  SCREW XTRNFX ST 4.5MM 200MM STRL 18MM SCHNZ BLNT TROC PNT SS	BOTH IP/OP	$218.33 	$161.56	$0.00	$169.58	$95.39	$95.39	$0.00	$0.00	$0.00	$45.50	$162.04	$162.04	$0.00	$0.00	$45.50	$0.00	$129.14	$129.14	$0.00	$105.99	$167.89	$169.58	$0.00		$0.00	$32.21	$0.00	$0.00	$33.75	$0.00	$0.00	$0.00	$0.00	$0.00
294.771SHA	SUP	HCPCS C1713		294.771SHA  -  SCREW BONE 4/3MM 80MM SLFDRILL SCHANZ STAINLESS STEEL DISTAL	BOTH IP/OP	$308.58 	$228.35	$0.00	$239.66	$134.81	$134.81	$0.00	$0.00	$0.00	$64.31	$229.02	$229.02	$0.00	$0.00	$64.31	$0.00	$182.52	$182.52	$0.00	$149.79	$237.27	$239.66	$0.00		$0.00	$45.52	$0.00	$0.00	$47.69	$0.00	$0.00	$0.00	$0.00	$0.00
294.775SHA	SUP	HCPCS C1713		294.775SHA  -  SCREW XTRNFX 4MM 80MM STRL 20MM SCHNZ SLF DRL SS HA HIP	BOTH IP/OP	$308.58 	$228.35	$0.00	$239.66	$134.81	$134.81	$0.00	$0.00	$0.00	$64.31	$229.02	$229.02	$0.00	$0.00	$64.31	$0.00	$182.52	$182.52	$0.00	$149.79	$237.27	$239.66	$0.00		$0.00	$45.52	$0.00	$0.00	$47.69	$0.00	$0.00	$0.00	$0.00	$0.00
294.776SHA	SUP	HCPCS C1713		294.776SHA  -  SCREW XTRNFX 4MM 100MM STRL 30MM SCHNZ SLF DRL SS HA HIP	BOTH IP/OP	$308.58 	$228.35	$0.00	$239.66	$134.81	$134.81	$0.00	$0.00	$0.00	$64.31	$229.02	$229.02	$0.00	$0.00	$64.31	$0.00	$182.52	$182.52	$0.00	$149.79	$237.27	$239.66	$0.00		$0.00	$45.52	$0.00	$0.00	$47.69	$0.00	$0.00	$0.00	$0.00	$0.00
294.777SHA	SUP	HCPCS C1713		294.777SHA  -  SCREW XTRNFX 4MM 125MM STRL 40MM SCHNZ SLF DRL SS HA HIP	BOTH IP/OP	$308.58 	$228.35	$0.00	$239.66	$134.81	$134.81	$0.00	$0.00	$0.00	$64.31	$229.02	$229.02	$0.00	$0.00	$64.31	$0.00	$182.52	$182.52	$0.00	$149.79	$237.27	$239.66	$0.00		$0.00	$45.52	$0.00	$0.00	$47.69	$0.00	$0.00	$0.00	$0.00	$0.00
294.778SHA	SUP	HCPCS C1713		294.778SHA  -  SCREW XTRNFX 4MM 150MM STRL 40MM SCHNZ SLF DRL SS HA HIP	BOTH IP/OP	$308.58 	$228.35	$0.00	$239.66	$134.81	$134.81	$0.00	$0.00	$0.00	$64.31	$229.02	$229.02	$0.00	$0.00	$64.31	$0.00	$182.52	$182.52	$0.00	$149.79	$237.27	$239.66	$0.00		$0.00	$45.52	$0.00	$0.00	$47.69	$0.00	$0.00	$0.00	$0.00	$0.00
294.779SHA	SUP	HCPCS C1713		294.779SHA  -  SCREW BONE 4MM 175MM SLFDRILL SCHANZ STAINLESS STEEL HA	BOTH IP/OP	$308.58 	$228.35	$0.00	$239.66	$134.81	$134.81	$0.00	$0.00	$0.00	$64.31	$229.02	$229.02	$0.00	$0.00	$64.31	$0.00	$182.52	$182.52	$0.00	$149.79	$237.27	$239.66	$0.00		$0.00	$45.52	$0.00	$0.00	$47.69	$0.00	$0.00	$0.00	$0.00	$0.00
294.782SHA	SUP	HCPCS C1713		294.782SHA  -  SCREW XTRNFX 5MM 100MM STRL 30MM SCHNZ SLF DRL SS HA HIP	BOTH IP/OP	$340.88 	$252.25	$0.00	$264.76	$148.93	$148.93	$0.00	$0.00	$0.00	$71.05	$253.00	$253.00	$0.00	$0.00	$71.04	$0.00	$201.63	$201.63	$0.00	$165.48	$262.11	$264.76	$0.00		$0.00	$50.28	$0.00	$0.00	$52.69	$0.00	$0.00	$0.00	$0.00	$0.00
294.783SHA	SUP	HCPCS C1713		294.783SHA  -  SCREW XTRNFX 5MM 125MM STRL 40MM SCHNZ SLF DRL SS HA HIP	BOTH IP/OP	$340.88 	$252.25	$0.00	$264.76	$148.93	$148.93	$0.00	$0.00	$0.00	$71.05	$253.00	$253.00	$0.00	$0.00	$71.04	$0.00	$201.63	$201.63	$0.00	$165.48	$262.11	$264.76	$0.00		$0.00	$50.28	$0.00	$0.00	$52.69	$0.00	$0.00	$0.00	$0.00	$0.00
294.784SHA	SUP	HCPCS C1713		294.784SHA  -  SCREW BONE 5MM 150MM 60MM SLFDRILL SCHANZ STAINLESS STEEL HA	BOTH IP/OP	$340.88 	$252.25	$0.00	$264.76	$148.93	$148.93	$0.00	$0.00	$0.00	$71.05	$253.00	$253.00	$0.00	$0.00	$71.04	$0.00	$201.63	$201.63	$0.00	$165.48	$262.11	$264.76	$0.00		$0.00	$50.28	$0.00	$0.00	$52.69	$0.00	$0.00	$0.00	$0.00	$0.00
294.785SHA	SUP	HCPCS C1713		294.785SHA  -  SCREW BONE 5MM 175MM 60MM SLFDRILL SCHANZ STAINLESS STEEL HA	BOTH IP/OP	$340.88 	$252.25	$0.00	$264.76	$148.93	$148.93	$0.00	$0.00	$0.00	$71.05	$253.00	$253.00	$0.00	$0.00	$71.04	$0.00	$201.63	$201.63	$0.00	$165.48	$262.11	$264.76	$0.00		$0.00	$50.28	$0.00	$0.00	$52.69	$0.00	$0.00	$0.00	$0.00	$0.00
294.786SHA	SUP	HCPCS C1713		294.786SHA  -  SCREW BONE 5MM 200MM 80MM SLFDRILL SCHANZ STAINLESS STEEL HA	BOTH IP/OP	$340.88 	$252.25	$0.00	$264.76	$148.93	$148.93	$0.00	$0.00	$0.00	$71.05	$253.00	$253.00	$0.00	$0.00	$71.04	$0.00	$201.63	$201.63	$0.00	$165.48	$262.11	$264.76	$0.00		$0.00	$50.28	$0.00	$0.00	$52.69	$0.00	$0.00	$0.00	$0.00	$0.00
294.788SHA	SUP	HCPCS C1713		294.788SHA  -  SCREW XTRNFX 5MM 250MM STRL 80MM SCHNZ SLF DRL SS HA HIP	BOTH IP/OP	$340.88 	$252.25	$0.00	$264.76	$148.93	$148.93	$0.00	$0.00	$0.00	$71.05	$253.00	$253.00	$0.00	$0.00	$71.04	$0.00	$201.63	$201.63	$0.00	$165.48	$262.11	$264.76	$0.00		$0.00	$50.28	$0.00	$0.00	$52.69	$0.00	$0.00	$0.00	$0.00	$0.00
294.796SHA	SUP	HCPCS C1713		294.796SHA  -  SCREW XTRNFX 6MM 200MM STRL 80MM SCHNZ SLF DRL SS HA HIP	BOTH IP/OP	$360.93 	$267.09	$0.00	$280.32	$157.68	$157.68	$0.00	$0.00	$0.00	$75.23	$267.88	$267.88	$0.00	$0.00	$75.22	$0.00	$213.49	$213.49	$0.00	$175.20	$277.52	$280.32	$0.00		$0.00	$53.24	$0.00	$0.00	$55.78	$0.00	$0.00	$0.00	$0.00	$0.00
2940511S	SUP	HCPCS C1713		2940511S  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940512S	SUP	HCPCS C1713		2940512S  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940513S	SUP	HCPCS C1713		2940513S  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940514S	SUP	HCPCS C1713		2940514S  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940515S	SUP	HCPCS C1713		2940515S  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940516S	SUP	HCPCS C1713		2940516S  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940517S	SUP	HCPCS C1713		2940517S  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940521M	SUP	HCPCS C1713		2940521M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940522M	SUP	HCPCS C1713		2940522M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940523M	SUP	HCPCS C1713		2940523M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940524M	SUP	HCPCS C1713		2940524M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940525M	SUP	HCPCS C1713		2940525M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940526M	SUP	HCPCS C1713		2940526M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940527M	SUP	HCPCS C1713		2940527M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940528M	SUP	HCPCS C1713		2940528M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940531L	SUP	HCPCS C1713		2940531L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940532L	SUP	HCPCS C1713		2940532L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940533L	SUP	HCPCS C1713		2940533L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940534L	SUP	HCPCS C1713		2940534L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940535L	SUP	HCPCS C1713		2940535L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940536L	SUP	HCPCS C1713		2940536L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940537L	SUP	HCPCS C1713		2940537L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
2940538L	SUP	HCPCS C1713		2940538L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
298.801.01S	SUP	Custom 27803010		298.801.01S  -  CABLE ORTHOPEDIC 1.7MM 750MM CRIMP CERCLAGE LCP STAINLESS	BOTH IP/OP	$919.33 	$680.30	$0.00	$714.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$682.32	$682.32	$0.00	$0.00	$191.59	$0.00	$0.00	$0.00	$0.00	$446.28	$706.90	$714.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
298.803S	SUP	Custom 27203010		298.803S  -  PIN POSITIONING 4.5MM CERCLAGE THREADED LCP STAINLESS STEEL	BOTH IP/OP	$343.00 	$253.82	$0.00	$266.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.57	$254.57	$0.00	$0.00	$71.48	$0.00	$0.00	$0.00	$0.00	$166.50	$263.74	$266.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29AJ-501	SUP	Custom 27803010		29AJ-501  -  VALVE AOR 85D 29MM 24.2MM MSTR SER MECH STD CUF LFLT OPN	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	$0.00	$0.00	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
29MJ-501	SUP	Custom 27803010		29MJ-501  -  VALVE MTRL 85D 4.41SQ CM STD RING 29MM 24.2MM MSTR SER LFLT	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	$0.00	$0.00	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B0061	SUP	Custom 25803010		SOLUTION IV 5% DEX 150ML VFLX LF	BOTH IP/OP	$2.23 	$1.65	$0.00	$1.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.11	$1.77	$1.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B0062Q	SUP	Custom 25803010		SOLUTION IV 5% DEX 250ML VFLX LF	BOTH IP/OP	$2.13 	$1.58	$0.00	$1.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.06	$1.69	$1.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B0063Q	SUP	Custom 25803010		SOLUTION IV 5% DEX 500ML VFLX LF	BOTH IP/OP	$2.15 	$1.59	$0.00	$1.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.08	$1.70	$1.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B0064X	SUP	Custom 25803010		SOLUTION IV 5% DEX 1L VFLX LF	BOTH IP/OP	$2.65 	$1.96	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.33	$2.10	$2.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B0089	SUP	Custom 25803010		SOLUTION IV 5% DEX 100ML MPK VFLX LF	BOTH IP/OP	$2.60 	$1.92	$0.00	$2.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.30	$2.06	$2.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B0163Q	SUP	Custom 25803010		SOLUTION IV 10% DEX 500ML VFLX LF	BOTH IP/OP	$2.73 	$2.02	$0.00	$2.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.36	$2.16	$2.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B0164X	SUP	Custom 25803010		SOLUTION IV 10% DEX 1L VFLX LF	BOTH IP/OP	$3.75 	$2.78	$0.00	$3.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$2.97	$3.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B1063Q	SUP	Custom 25803010		SOLUTION IV 5% DEX 0.9% NA CHLOR 500ML VFLX LF	BOTH IP/OP	$1.63 	$1.21	$0.00	$1.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.21	$1.21	$0.00	$0.00	$0.34	$0.00	$0.00	$0.00	$0.00	$0.81	$1.29	$1.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B1064X	SUP	Custom 25803010		SOLUTION IV 5% DEX 0.9% NA CHLOR 1L VFLX LF	BOTH IP/OP	$2.68 	$1.98	$0.00	$2.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.99	$1.99	$0.00	$0.00	$0.56	$0.00	$0.00	$0.00	$0.00	$1.34	$2.12	$2.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B1073Q	SUP	Custom 25803010		SOLUTION IV 5% DEX 0.45% NA CHLOR 500ML VFLX LF	BOTH IP/OP	$2.23 	$1.65	$0.00	$1.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.11	$1.77	$1.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B1074X	SUP	Custom 25803010		SOLUTION IV 5% DEX 0.45% NA CHLOR 1L VFLX LF	BOTH IP/OP	$2.70 	$2.00	$0.00	$2.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.35	$2.14	$2.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B1309	SUP	Custom 25803010		SOLUTION IV 0.9% NA CHLOR 100ML MPK VFLX LF	BOTH IP/OP	$41.25 	$30.53	$0.00	$33.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.63	$32.67	$33.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B1313Q	SUP	Custom 25803010		SOLUTION IV 0.45% NA CHLOR 500ML VFLX LF	BOTH IP/OP	$2.23 	$1.65	$0.00	$1.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.11	$1.77	$1.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B1314X	SUP	Custom 25803010		SOLUTION IV 0.45% NA CHLOR 1L VFLX LF	BOTH IP/OP	$2.83 	$2.09	$0.00	$2.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.41	$2.24	$2.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B1321	SUP	Custom 25803010		SOLUTION IV 0.9% NA CHLOR 150ML VFLX LF	BOTH IP/OP	$2.23 	$1.65	$0.00	$1.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.11	$1.77	$1.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B1654X	SUP	Custom 25803010		SOLUTION IV 20 MEQ K CHLOR 5% DEX 0.45% NA CHLOR VFLX 1L LF	BOTH IP/OP	$3.45 	$2.55	$0.00	$2.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.73	$2.73	$2.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B2074X	SUP	Custom 25803010		SOLUTION IV 5% DEX LR 1L VFLX LF	BOTH IP/OP	$2.68 	$1.98	$0.00	$2.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.34	$2.12	$2.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B2324X	SUP	Custom 25803010		SOLUTION IV LR 1L VFLX LF	BOTH IP/OP	$2.83 	$2.09	$0.00	$2.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.41	$2.24	$2.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B2544X	SUP	Custom 25803010		SOLUTION IV PLSMLT A VFLX MLT ELCLY VFLX 1L LF	BOTH IP/OP	$5.10 	$3.77	$0.00	$4.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.55	$4.04	$4.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2B7231	SUP	Custom 25803010		2B7231  -  SOLUTION IRRIGATION BAG USP CONTAINER 0.9% SODIUM CHLORIDE 1	BOTH IP/OP	$188.28 	$139.33	$0.00	$150.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.74	$139.74	$0.00	$0.00	$39.24	$0.00	$0.00	$0.00	$0.00	$94.14	$149.12	$150.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2C2164	SUP	Custom 27203010		2C2164  -  TUBINGIRRIGATION-LAPAROS	BOTH IP/OP	$36.89 	$27.30	$0.00	$29.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.38	$27.38	$0.00	$0.00	$7.69	$0.00	$0.00	$0.00	$0.00	$18.44	$29.22	$29.51	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2N03A	SUP	Custom 27803010		2N03A  -  SUTURE NABSB CV-2 THX-22 36IN WHT MFL GRTX	BOTH IP/OP	$68.75 	$50.88	$0.00	$53.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.03	$51.03	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$33.23	$52.64	$53.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2N05A	SUP	Custom 27803010		2N05A  -  SUTURE NABSB CV-2 THX-26 36IN WHT MFL GRTX	BOTH IP/OP	$68.75 	$50.88	$0.00	$53.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.03	$51.03	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$33.23	$52.64	$53.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2N1116	SUP	HCPCS C1753		CATHETER INTRAVASCULAR QUIK CATH 22G X 1IN LUER PLUG	BOTH IP/OP	$1.83 	$1.35	$0.00	$1.46	$0.99	$0.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.91	$1.45	$1.46	$0.00		$0.00	$0.29	$0.00	$0.00	$0.29	$0.00	$0.00	$0.00	$0.00	$0.00
2P9	SUP	Custom 27803010		2P9  -  PATCH VASCULAR 9X2CM XENOSURE THK.45MM BOVINE PERICARDIUM	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$0.00	$0.00	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3.0 NEO	SUP	Custom 27203010		3.0 NEO  -  TUBE 30MM 4.5MM 3MM UNCUF OBT TRCH PLVN CHLOR NEO	BOTH IP/OP	$94.29 	$69.77	$0.00	$75.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.98	$69.98	$0.00	$0.00	$19.65	$0.00	$0.00	$0.00	$0.00	$47.14	$74.68	$75.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30-0001	SUP	Custom 27203010		30-0001  -  GUIDE TRGT SCPHD ASMBLY NONSTRL	BOTH IP/OP	$61.25 	$45.33	$0.00	"$3,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.46	$45.46	$0.00	$0.00	$12.76	$0.00	$0.00	$0.00	$0.00	"$2,185.00"	"$3,461.04"	"$3,496.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30-0017-S	SUP	Custom 27203010		30-0017-S  -  GUIDE TRGT 1 .035IN SCPHD DISK STRL DISP	BOTH IP/OP	$652.50 	$482.85	$0.00	$522.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$484.29	$484.29	$0.00	$0.00	$135.98	$0.00	$0.00	$0.00	$0.00	$326.25	$516.78	$522.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30-0018-S	SUP	Custom 27203010		30-0018-S  -  GUIDE MINI TRGT SURG SCPHD	BOTH IP/OP	$652.50 	$482.85	$0.00	$522.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$484.29	$484.29	$0.00	$0.00	$135.98	$0.00	$0.00	$0.00	$0.00	$326.25	$516.78	$522.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30-0019-S	SUP	Custom 27203010		30-0019-S  -  GUIDE TRGT 3 .054IN SCPHD DISK STRL	BOTH IP/OP	$652.50 	$482.85	$0.00	$522.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$484.29	$484.29	$0.00	$0.00	$135.98	$0.00	$0.00	$0.00	$0.00	$326.25	$516.78	$522.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30-0021-S	SUP	HCPCS C1713		30-0021-S  -  SCREW BN 5.5MM 25MM ACTRK2 MTP MIDFOOT	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
30-0023-S	SUP	HCPCS C1713		30-0023-S  -  SCREW BN 5.5MM 30MM ACTRK2 MTP MIDFOOT	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
30-0025-S	SUP	HCPCS C1713		30-0025-S  -  SCREW BN 5.5MM 35MM ACUTRACK II	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
30-0027-S	SUP	HCPCS C1713		30-0027-S  -  SCREW BN 5.5MM 40MM ACUTRACK II	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
30-0029-S	SUP	HCPCS C1713		30-0029-S  -  SCREW BN 5.5MM 45MM ACTRK2 MTP MIDFOOT	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
30-0031-S	SUP	HCPCS C1713		30-0031-S  -  SCREW BN 50MM ACTRK2	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
30-0033-S	SUP	HCPCS C1713		30-0033-S  -  SCREW BONE 6MM 30MM ACTRK FSN DEV HMRTOE SYS	BOTH IP/OP	$895.00 	$662.30	$0.00	$716.00	$402.75	$402.75	$0.00	$0.00	$0.00	$186.54	$664.27	$664.27	$0.00	$0.00	$186.52	$0.00	$529.39	$529.39	$0.00	$447.50	$708.84	$716.00	$0.00		$0.00	$140.07	$0.00	$0.00	$142.48	$0.00	$0.00	$0.00	$0.00	$0.00
300-070	SUP	Custom 27203010		"300-070  -  BONE GRAFT HARVESTER, COREX 7MM"	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30-0084-S	SUP	HCPCS C1713		30-0084-S  -  SCREW BN 5.5MM 55MM ACTRK	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
30-0085-S	SUP	HCPCS C1713		30-0085-S  -  SCREW BN 5.5MM 60MM ACTRK	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
300-090	SUP	Custom 27203010		300-090  -  HARVESTER BN 9MM STRL LF COREX CANC BN DISP	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30-0093	SUP	HCPCS C1713		30-0093  -  PLATE SCR ACLC 2 BONE DISTAL VOLR RADL	BOTH IP/OP	$590.00 	$436.60	$0.00	$472.00	$265.50	$265.50	$0.00	$0.00	$0.00	$122.97	$437.90	$437.90	$0.00	$0.00	$122.96	$0.00	$348.99	$348.99	$0.00	$295.00	$467.28	$472.00	$0.00		$0.00	$92.34	$0.00	$0.00	$93.93	$0.00	$0.00	$0.00	$0.00	$0.00
30-0098	SUP	HCPCS C1713		30-0098  -  PIN FX 70MM NS TNSNBND	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$61.88	$61.88	$0.00	$0.00	$0.00	$28.66	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$81.33	$81.33	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$21.52	$0.00	$0.00	$21.89	$0.00	$0.00	$0.00	$0.00	$0.00
30-0099	SUP	HCPCS C1713		30-0099  -  PIN FX 90MM NS TNSNBND	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$61.88	$61.88	$0.00	$0.00	$0.00	$28.66	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$81.33	$81.33	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$21.52	$0.00	$0.00	$21.89	$0.00	$0.00	$0.00	$0.00	$0.00
30-0232	SUP	HCPCS C1713		30-0232  -  SCREW BONE 3.5MM 8MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0233	SUP	HCPCS C1713		30-0233  -  SCREW BONE 3.5MM 10MM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0234	SUP	HCPCS C1713		30-0234  -  SCREW BONE 3.5MM 12MM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0235	SUP	HCPCS C1713		30-0235  -  SCREW BONE 3.5MM 14MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0236	SUP	HCPCS C1713		30-0236  -  SCREW BONE 3.5MM 16MM DISTAL HUM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0237	SUP	HCPCS C1713		30-0237  -  SCREW BONE 3.5MM 18MM DISTAL HUM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0238	SUP	HCPCS C1713		30-0238  -  SCREW BONE 3.5MM 20MM LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0239	SUP	HCPCS C1713		30-0239  -  SCREW BONE 3.5MM 22MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0240	SUP	HCPCS C1713		30-0240  -  SCREW BONE 3.5MM 24MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0241	SUP	HCPCS C1713		30-0241  -  SCREW BONE 3.5MM 26MM DISTAL HUM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0242	SUP	HCPCS C1713		30-0242  -  SCREW BONE 3.5MM 28MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0243	SUP	HCPCS C1713		30-0243  -  SCREW BONE 3.5MM 30MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0244	SUP	HCPCS C1713		30-0244  -  SCREW BONE 3.5MM 32MM DISTAL HUM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0245	SUP	HCPCS C1713		30-0245  -  SCREW BONE 3.5MM 34MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0246	SUP	HCPCS C1713		30-0246  -  SCREW BONE 3.5MM 36MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0247	SUP	HCPCS C1713		30-0247  -  SCREW BONE 3.5MM 38MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0248	SUP	HCPCS C1713		30-0248  -  SCREW BONE 3.5MM 40MM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0249	SUP	HCPCS C1713		30-0249  -  SCREW BONE 3.5MM 45MM DISTAL HUM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0250	SUP	HCPCS C1713		30-0250  -  SCREW BONE 3.5MM 50MM DISTAL HUM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0251	SUP	HCPCS C1713		30-0251  -  SCREW BONE 3.5MM 55MM DISTAL HUM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0252	SUP	HCPCS C1713		30-0252  -  SCREW BONE 3.5MM 60MM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0255	SUP	HCPCS C1713		30-0255  -  SCREW BONE 3.5MM 8MM CORT ELB NLCKG HEXALOBE HEAD	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0256	SUP	HCPCS C1713		30-0256  -  SCREW BN 3.5MM 10MM NS HEXALOBE TI SM FRAG BS SET	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0257	SUP	HCPCS C1713		30-0257  -  SCREW BN 3.5MM 12MM NS HEXALOBE TI SM FRAG BS SET	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0258	SUP	HCPCS C1713		30-0258  -  SCREW BN 3.5MM 14MM NS HEXALOBE TI SM FRAG BS SET	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0259	SUP	HCPCS C1713		30-0259  -  SCREW BONE 3.5MM 16MM ELB NLCKG TRAUMA	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0260	SUP	HCPCS C1713		30-0260  -  SCREW BONE 3.5MM 18MM NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0261	SUP	HCPCS C1713		30-0261  -  SCREW BONE 3.5MM 20MM ELB NLCKG HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0262	SUP	HCPCS C1713		30-0262  -  SCREW BONE 3.5MM 22MM NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0263	SUP	HCPCS C1713		30-0263  -  SCREW BONE 3.5MM 24MM ELB NLCKG HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0264	SUP	HCPCS C1713		30-0264  -  SCREW BONE 3.5MM 26MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0265	SUP	HCPCS C1713		30-0265  -  SCREW BONE 3.5MM 28MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0266	SUP	HCPCS C1713		30-0266  -  SCREW BN 3.5MM 30MM NS HEXALOBE TI SM FRAG BS SET	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0267	SUP	HCPCS C1713		30-0267  -  SCREW BONE 3.5MM 32MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0268	SUP	HCPCS C1713		30-0268  -  SCREW BONE 3.5MM 34MM ELB NLCKG HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0269	SUP	HCPCS C1713		30-0269  -  SCREW BONE 3.5MM 36MM CORT ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0270	SUP	HCPCS C1713		30-0270  -  SCREW BONE 3.5MM 38MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0271	SUP	HCPCS C1713		30-0271  -  SCREW BONE 3.5MM 40MM ELB NLCKG HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0272	SUP	HCPCS C1713		30-0272  -  SCREW BONE 3.5MM 45MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0273	SUP	HCPCS C1713		30-0273  -  SCREW BONE 3.5MM 50MM DISTAL HUM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0274	SUP	HCPCS C1713		30-0274  -  SCREW BONE 3.5MM 55MM CORT ELB NLCKG HEXALOBE HEAD	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0275	SUP	HCPCS C1713		30-0275  -  SCREW BONE 3.5MM 60MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0276	SUP	HCPCS C1713		30-0276  -  SCREW BONE 3.5MM 65MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0278	SUP	HCPCS C1713		30-0278  -  SCREW BONE 3MM 8MM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0279	SUP	HCPCS C1713		30-0279  -  SCREW BONE 2.7MM 10MM ELB LCK	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0280	SUP	HCPCS C1713		30-0280  -  SCREW BONE 3MM 12MM ELB LCK	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0281	SUP	HCPCS C1713		30-0281  -  SCREW BONE 3MM 14MM CORT LCK	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0282	SUP	HCPCS C1713		30-0282  -  SCREW BONE 3MM 16MM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0283	SUP	HCPCS C1713		30-0283  -  SCREW BONE 3MM 18MM LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0284	SUP	HCPCS C1713		30-0284  -  SCREW BONE 3MM 20MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0285	SUP	HCPCS C1713		30-0285  -  SCREW BONE 3MM 22MM CORT ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0286	SUP	HCPCS C1713		30-0286  -  SCREW BONE 3MM 24MM CORT ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0287	SUP	HCPCS C1713		30-0287  -  SCREW BONE 3MM 26MM CORT ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0288	SUP	HCPCS C1713		30-0288  -  SCREW BONE 3MM 28MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0289	SUP	HCPCS C1713		30-0289  -  SCREW BONE 3MM 30MM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0290	SUP	HCPCS C1713		30-0290  -  SCREW BONE 3MM 32MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0291	SUP	HCPCS C1713		30-0291  -  SCREW BONE 3.5MM 34MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0292	SUP	HCPCS C1713		30-0292  -  SCREW BONE 3MM 36MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0293	SUP	HCPCS C1713		30-0293  -  SCREW BONE 3MM 38MM CORT ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0294	SUP	HCPCS C1713		30-0294  -  SCREW BONE 3MM 40MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0295	SUP	HCPCS C1713		30-0295  -  SCREW BONE 3MM 45MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0296	SUP	HCPCS C1713		30-0296  -  SCREW BONE 3MM 50MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0297	SUP	HCPCS C1713		30-0297  -  SCREW BN 3MM 55MM LCK HEXALOBE ELB	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0298	SUP	HCPCS C1713		30-0298  -  SCREW BONE 3MM 60MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0301	SUP	HCPCS C1713		30-0301  -  SCREW BONE 3MM 8MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0302	SUP	HCPCS C1713		30-0302  -  SCREW BONE 3MM 10MM ELB NLCKG HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0303	SUP	HCPCS C1713		30-0303  -  SCREW BONE 3MM 12MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0304	SUP	HCPCS C1713		30-0304  -  SCREW BONE 3MM 14MM DISTAL HUM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0305	SUP	HCPCS C1713		30-0305  -  SCREW BONE 3MM 16MM CORT ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0306	SUP	HCPCS C1713		30-0306  -  SCREW BN 3MM 18MM NONLOCK HEXALOBE HD	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0307	SUP	HCPCS C1713		30-0307  -  SCREW BONE 3MM 20MM CORT ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0308	SUP	HCPCS C1713		30-0308  -  SCREW BN 3MM 22MM NS HEXALOBE TI SM FRAG BS SET	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3003-0822S	SUP	HCPCS C1713		3003-0822S  -  SCREW SET TI 17.5MM 8MM TROC HIP GAMMA3 STRL LNG NAIL	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$129.94	$129.94	$0.00	$0.00	$0.00	$60.18	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$170.80	$170.80	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$45.19	$0.00	$0.00	$45.97	$0.00	$0.00	$0.00	$0.00	$0.00
30-0309	SUP	HCPCS C1713		30-0309  -  SCREW BONE 3MM 24MM CORT ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0310	SUP	HCPCS C1713		30-0310  -  SCREW BONE 3MM 26MM ELB NLCKG HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0311	SUP	HCPCS C1713		30-0311  -  SCREW BONE 3.5MM 28MM ELB NLCKG	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0312	SUP	HCPCS C1713		30-0312  -  SCREW BONE 3.5MM 30MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0313	SUP	HCPCS C1713		30-0313  -  SCREW BONE 3MM 32MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0314	SUP	HCPCS C1713		30-0314  -  SCREW BONE 3MM 34MM DISTAL HUM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0315	SUP	HCPCS C1713		30-0315  -  SCREW BONE 3MM 36MM CORT ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0316	SUP	HCPCS C1713		30-0316  -  SCREW BONE 3MM 38MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0317	SUP	HCPCS C1713		30-0317  -  SCREW BONE 3MM 40MM DISTAL HUM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0318	SUP	HCPCS C1713		30-0318  -  SCREW BONE 3MM 45MM CORT ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0319	SUP	HCPCS C1713		30-0319  -  SCREW BN 3MM 50MM NS HEXALOBE TI SM FRAG BS SET	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0320	SUP	HCPCS C1713		30-0320  -  SCREW BONE 3MM 55MM DISTAL HUM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0321	SUP	HCPCS C1713		30-0321  -  SCREW BONE 3MM 60MM DISTAL VOLR RADL NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0322	SUP	HCPCS C1713		30-0322  -  SCREW BONE 3MM 65MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0324	SUP	HCPCS C1713		30-0324  -  SCREW BONE 2.7MM 8MM DISTAL HUM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0325	SUP	HCPCS C1713		30-0325  -  SCREW BONE 2.7MM 10MM ELB LCK	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0326	SUP	HCPCS C1713		30-0326  -  SCREW BONE 2.7MM 12MM TRAUMA LCK	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0327	SUP	HCPCS C1713		30-0327  -  SCREW BONE 2.7MM 14MM DISTAL HUM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0328	SUP	HCPCS C1713		30-0328  -  SCREW BN 2.7MM 16MM NS LCK HEXALOBE TI SM FRAG BS SET	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0329	SUP	HCPCS C1713		30-0329  -  SCREW BONE 2.7MM 18MM DISTAL HUM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0330	SUP	HCPCS C1713		30-0330  -  SCREW BONE 2.7MM 20MM DISTAL HUM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0331	SUP	HCPCS C1713		30-0331  -  SCREW BN 2.7MM 22MM NS LCK HEXALOBE TI SM FRAG BS SET	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0332	SUP	HCPCS C1713		30-0332  -  SCREW BONE 2.7MM 24MM ELB LCK HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0333	SUP	HCPCS C1713		30-0333  -  SCREW BONE 2.7MM 26MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0334	SUP	HCPCS C1713		30-0334  -  SCREW BONE 2.7MM 28MM DISTAL HUM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0335	SUP	HCPCS C1713		30-0335  -  SCREW BONE 2.7MM 30MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0336	SUP	HCPCS C1713		30-0336  -  SCREW BONE 2.7MM 32MM ELB LCK HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0343	SUP	HCPCS C1713		30-0343  -  SCREW BONE 2.7MM 8MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0344	SUP	HCPCS C1713		30-0344  -  SCREW BONE 2.7MM 10MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0345	SUP	HCPCS C1713		30-0345  -  SCREW BONE 2.7MM 12MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0346	SUP	HCPCS C1713		30-0346  -  SCREW BONE 2.7MM 14MM NLCKG TRAUMA	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0347	SUP	HCPCS C1713		30-0347  -  SCREW BONE 2.7MM 16MM TI NLCKG	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0348	SUP	HCPCS C1713		30-0348  -  SCREW BONE 2.7MM 18MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0349	SUP	HCPCS C1713		30-0349  -  SCREW BONE 2.7MM 20MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0350	SUP	HCPCS C1713		30-0350  -  SCREW BN 2.7MM 22MM NS HEXALOBE TI SM FRAG BS SET	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0351	SUP	HCPCS C1713		30-0351  -  SCREW BN 2.7MM 24MM NS HEXALOBE TI SM FRAG BS SET	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0352	SUP	HCPCS C1713		30-0352  -  SCREW BONE 2.7MM 26MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0353	SUP	HCPCS C1713		30-0353  -  SCREW BONE 2.7MM 28MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0354	SUP	HCPCS C1713		30-0354  -  SCREW BN 2.7MM 30MM NS HEXALOBE TI SM FRAG BS SET	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0355	SUP	HCPCS C1713		30-0355  -  SCREW BONE 2.7MM 32MM ELB NLCKG HEXALOBE	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0370	SUP	Custom 27203010		30-0370  -  SLEEVE CMPR NS FRAG-LOC BN SCR	BOTH IP/OP	$650.00 	$481.00	$0.00	$520.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.43	$482.43	$0.00	$0.00	$135.46	$0.00	$0.00	$0.00	$0.00	$325.00	$514.80	$520.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30-0371	SUP	HCPCS C1713		30-0371  -  SCREW BN STRL FRAG-LOC CMPR	BOTH IP/OP	$395.00 	$292.30	$0.00	$316.00	$177.75	$177.75	$0.00	$0.00	$0.00	$82.33	$293.17	$293.17	$0.00	$0.00	$82.32	$0.00	$233.64	$233.64	$0.00	$197.50	$312.84	$316.00	$0.00		$0.00	$61.82	$0.00	$0.00	$62.88	$0.00	$0.00	$0.00	$0.00	$0.00
3004-15010	SUP	HCPCS C1713		3004-15010  -  SCREW BONE 10MM HEXALOBE MULTI TITANIUM 1.5MM HAND	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3004-15011	SUP	HCPCS C1713		3004-15011  -  SCREW BONE 1.5MM 11MM HEXALOBE MULTI TITANIUM HAND	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3004-23009	SUP	HCPCS C1713		3004-23009  -  SCREW BONE 9MM MULTI HEXALOBE 2.3MM ELBOW NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3004-23010	SUP	HCPCS C1713		3004-23010  -  SCREW BONE 10MM MULTI HEXALOBE TITANIUM 2.3MM HAND NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3004-23011	SUP	HCPCS C1713		3004-23011  -  SCREW BONE 11MM HEXALOBE DRIVER 2.3MM ELBOW	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3004-23012	SUP	HCPCS C1713		3004-23012  -  SCREW BONE 12MM MULTI HEXALOBE 2.3MM WRIST	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3004-23013	SUP	HCPCS C1713		3004-23013  -  SCREW BN 2.3MM 13MM MLLK VA HEXALOBE TI HND FX SYS	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3004-23014	SUP	HCPCS C1713		3004-23014  -  SCREW BONE 14MM HEXALOBE DRIVER 2.3MM ELBOW	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3004-23016	SUP	HCPCS C1713		3004-23016  -  SCREW BONE 2.3MM 16MM ELB HEXALOBE DRVR	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
30-0426	SUP	HCPCS C1713		30-0426  -  SCREW BONE 5.7MM 26MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0428	SUP	HCPCS C1713		30-0428  -  SCREW BONE 5.7MM 28MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0430	SUP	HCPCS C1713		30-0430  -  SCREW BONE 5.7MM 30MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0432	SUP	HCPCS C1713		30-0432  -  SCREW BONE 5.7MM 32MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0434	SUP	HCPCS C1713		30-0434  -  SCREW BONE 5.7MM 34MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0436	SUP	HCPCS C1713		30-0436  -  SCREW BONE 5.7MM 36MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0438	SUP	HCPCS C1713		30-0438  -  SCREW BONE 5.7MM 38MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0440	SUP	HCPCS C1713		30-0440  -  SCREW BONE 5.7MM 40MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0442	SUP	HCPCS C1713		30-0442  -  SCREW BONE 5.7MM 42MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0444	SUP	HCPCS C1713		30-0444  -  SCREW BONE 5.7MM 44MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0446	SUP	HCPCS C1713		30-0446  -  SCREW BONE 5.7MM 46MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0448	SUP	HCPCS C1713		30-0448  -  SCREW BONE 5.7MM 48MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0450	SUP	HCPCS C1713		30-0450  -  SCREW BONE 5.7MM 50MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0452	SUP	HCPCS C1713		30-0452  -  SCREW BONE 5.7MM 52MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
30-0454	SUP	HCPCS C1713		30-0454  -  SCREW BONE 5.7MM 54MM PLRS TI PROX CANC HUM LCK	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
3005-1100S	SUP	HCPCS C1713		3005-1100S  -  CAP END STD 15.3MM HIP FEM IM NAIL TI STRL GAMMA3 11MM	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$129.94	$129.94	$0.00	$0.00	$0.00	$60.18	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$170.80	$170.80	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$45.19	$0.00	$0.00	$45.97	$0.00	$0.00	$0.00	$0.00	$0.00
3005-1105S	SUP	HCPCS C1713		3005-1105S  -  CAP END +5MM HIP FEM IM NAIL TI STRL GAMMA3	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$129.94	$129.94	$0.00	$0.00	$0.00	$60.18	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$170.80	$170.80	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$45.19	$0.00	$0.00	$45.97	$0.00	$0.00	$0.00	$0.00	$0.00
3005-1110S	SUP	HCPCS C1713		3005-1110S  -  CAP END +10MM HIP FEM IM NAIL TI STRL GAMMA3	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$129.94	$129.94	$0.00	$0.00	$0.00	$60.18	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$170.80	$170.80	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$45.19	$0.00	$0.00	$45.97	$0.00	$0.00	$0.00	$0.00	$0.00
3006-00	SUP	Custom 27203010		3006-00  -  PIN SKL BLU STRL DORO ADLT	BOTH IP/OP	$49.67 	$36.76	$0.00	$39.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.86	$36.86	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$24.83	$39.34	$39.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3006-20	SUP	Custom 27203010		3006-20  -  PIN SKL TI ADLT CRNL DISP	BOTH IP/OP	$67.59 	$50.02	$0.00	$54.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.17	$50.17	$0.00	$0.00	$14.09	$0.00	$0.00	$0.00	$0.00	$33.80	$53.53	$54.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30-0650	SUP	HCPCS C1713		30-0650  -  SCREW BONE 50MM CANN COMPRESSION SELF CUTTING HELICAL RELIEF	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
3006570-06	SUP	Custom 27203010		CABLE QUIK-COMBO THERAPY	BOTH IP/OP	$648.13 	$479.62	$0.00	$518.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.06	$513.32	$518.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3008 A	SUP	HCPCS C1713		3008 A  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
3008 B	SUP	HCPCS C1713		3008 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
301130B	SUP	Custom 27203010		REAGENT MCBL KT AP CMB 2 250 TST	BOTH IP/OP	"$19,000.00 "	"$14,060.00"	$0.00	"$15,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,500.00"	"$15,048.00"	"$15,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3012-15008	SUP	HCPCS C1713		3012-15008  -  SCREW BONE HEXALOBE PTHRD 1.5MM 8MM LAG HAND NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3012-15009	SUP	HCPCS C1713		3012-15009  -  SCREW BONE 9MM LAG HEXALOBE PTHRD 1.5MM HAND NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3012-15010	SUP	HCPCS C1713		3012-15010  -  SCREW BONE 10MM LAG HEXALOBE PTHRD 1.5MM HAND NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3012-15011	SUP	HCPCS C1713		3012-15011  -  SCREW BONE 11MM HEXALOBE DRIVER LAG 1.5MM ELBOW	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3012-15013	SUP	HCPCS C1713		3012-15013  -  SCREW BONE 13MM HEXALOBE DRIVER LAG 1.5MM ELBOW	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3012-15014	SUP	HCPCS C1713		3012-15014  -  SCREW BONE 14MM HEXALOBE DRIVER LAG 1.5MM ELBOW	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3012-23008	SUP	HCPCS C1713		3012-23008  -  SCREW BONE 8MM LAG HEXALOBE PTHRD 2.3MM HAND NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3012-23009	SUP	HCPCS C1713		3012-23009  -  SCREW BONE 9MM LAG HEXALOBE 2.3MM HAND	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3012-23010	SUP	HCPCS C1713		3012-23010  -  SCREW BONE 10MM HEXALOBE LAG TITANIUM 2.3MM HAND METACARPAL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3012-23012	SUP	HCPCS C1713		3012-23012  -  SCREW BONE 12MM LAG HEXALOBE PTHRD 2.3MM HAND NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3012-23013	SUP	HCPCS C1713		3012-23013  -  SCREW BONE 2.3MM 13MM ACUMED TI HEXALOBE MTCRPL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3012-23016	SUP	HCPCS C1713		3012-23016  -  SCREW BN HEXALOBE 2.3MM 16MM YLW NS ACUMED LG LOPRFL TI	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3012-23018	SUP	HCPCS C1713		3012-23018  -  SCREW BONE 18MM LAG HEXALOBE PTHRD 2.3MM HAND NONSTRL	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
3013SP	SUP	Custom 27203010		3013SP  -  HEMOSTAT ABS SRGCL OXD REGENERATED CLU PWDR	BOTH IP/OP	$394.57 	$291.98	$0.00	$315.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$292.85	$292.85	$0.00	$0.00	$82.23	$0.00	$0.00	$0.00	$0.00	$197.28	$312.50	$315.65	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3016-16	SUP	Custom 27203010		CHEMICAL MTHY ALC ANHY 4L ACS LAB	BOTH IP/OP	$431.58 	$319.37	$0.00	$345.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.79	$341.81	$345.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30170007-S	SUP	HCPCS C1713		30170007-S  -  SCREW BONE 3.6/4.3MM 16MM BIOTRAK .045IN STD KNEE RESORB	BOTH IP/OP	"$1,617.50 "	"$1,196.95"	$0.00	"$1,294.00"	$727.88	$727.88	$0.00	$0.00	$0.00	$337.13	"$1,200.51"	"$1,200.51"	$0.00	$0.00	$337.09	$0.00	$956.75	$956.75	$0.00	$808.75	"$1,281.06"	"$1,294.00"	$0.00		$0.00	$253.14	$0.00	$0.00	$257.51	$0.00	$0.00	$0.00	$0.00	$0.00
30170008-S	SUP	HCPCS C1713		30170008-S  -  SCREW BN 18MM BIOTRAK	BOTH IP/OP	"$1,617.50 "	"$1,196.95"	$0.00	"$1,294.00"	$727.88	$727.88	$0.00	$0.00	$0.00	$337.13	"$1,200.51"	"$1,200.51"	$0.00	$0.00	$337.09	$0.00	$956.75	$956.75	$0.00	$808.75	"$1,281.06"	"$1,294.00"	$0.00		$0.00	$253.14	$0.00	$0.00	$257.51	$0.00	$0.00	$0.00	$0.00	$0.00
30170009-S	SUP	HCPCS C1713		30170009-S  -  SCREW BONE 20MM BIOTRAK CALC	BOTH IP/OP	"$1,617.50 "	"$1,196.95"	$0.00	"$1,294.00"	$727.88	$727.88	$0.00	$0.00	$0.00	$337.13	"$1,200.51"	"$1,200.51"	$0.00	$0.00	$337.09	$0.00	$956.75	$956.75	$0.00	$808.75	"$1,281.06"	"$1,294.00"	$0.00		$0.00	$253.14	$0.00	$0.00	$257.51	$0.00	$0.00	$0.00	$0.00	$0.00
30170010-S	SUP	HCPCS C1713		30170010-S  -  SCREW BN 22MM BIOTRAK	BOTH IP/OP	"$1,617.50 "	"$1,196.95"	$0.00	"$1,294.00"	$727.88	$727.88	$0.00	$0.00	$0.00	$337.13	"$1,200.51"	"$1,200.51"	$0.00	$0.00	$337.09	$0.00	$956.75	$956.75	$0.00	$808.75	"$1,281.06"	"$1,294.00"	$0.00		$0.00	$253.14	$0.00	$0.00	$257.51	$0.00	$0.00	$0.00	$0.00	$0.00
30170011-S	SUP	HCPCS C1713		30170011-S  -  SCREW BN 24MM BIOTRAK	BOTH IP/OP	"$1,617.50 "	"$1,196.95"	$0.00	"$1,294.00"	$727.88	$727.88	$0.00	$0.00	$0.00	$337.13	"$1,200.51"	"$1,200.51"	$0.00	$0.00	$337.09	$0.00	$956.75	$956.75	$0.00	$808.75	"$1,281.06"	"$1,294.00"	$0.00		$0.00	$253.14	$0.00	$0.00	$257.51	$0.00	$0.00	$0.00	$0.00	$0.00
30170057-S	SUP	HCPCS C1713		30170057-S  -  SCREW BN MN 16MM BIOTRAK	BOTH IP/OP	"$1,617.50 "	"$1,196.95"	$0.00	"$1,294.00"	$727.88	$727.88	$0.00	$0.00	$0.00	$337.13	"$1,200.51"	"$1,200.51"	$0.00	$0.00	$337.09	$0.00	$956.75	$956.75	$0.00	$808.75	"$1,281.06"	"$1,294.00"	$0.00		$0.00	$253.14	$0.00	$0.00	$257.51	$0.00	$0.00	$0.00	$0.00	$0.00
30170058-S	SUP	HCPCS C1713		30170058-S  -  SCREW BN MN 18MM BIOTRAK	BOTH IP/OP	"$1,617.50 "	"$1,196.95"	$0.00	"$1,294.00"	$727.88	$727.88	$0.00	$0.00	$0.00	$337.13	"$1,200.51"	"$1,200.51"	$0.00	$0.00	$337.09	$0.00	$956.75	$956.75	$0.00	$808.75	"$1,281.06"	"$1,294.00"	$0.00		$0.00	$253.14	$0.00	$0.00	$257.51	$0.00	$0.00	$0.00	$0.00	$0.00
30170059-S	SUP	HCPCS C1713		30170059-S  -  SCREW BN MN FT TPR 3.2-3.6MM 20MM STRL BIOTRAK RSRB RDLCNT	BOTH IP/OP	"$1,617.50 "	"$1,196.95"	$0.00	"$1,294.00"	$727.88	$727.88	$0.00	$0.00	$0.00	$337.13	"$1,200.51"	"$1,200.51"	$0.00	$0.00	$337.09	$0.00	$956.75	$956.75	$0.00	$808.75	"$1,281.06"	"$1,294.00"	$0.00		$0.00	$253.14	$0.00	$0.00	$257.51	$0.00	$0.00	$0.00	$0.00	$0.00
30170060-S	SUP	HCPCS C1713		30170060-S  -  SCREW BN MN FT TPR 3.2-3.7MM 22MM STRL BIOTRAK RSRB RDLCNT	BOTH IP/OP	"$1,617.50 "	"$1,196.95"	$0.00	"$1,294.00"	$727.88	$727.88	$0.00	$0.00	$0.00	$337.13	"$1,200.51"	"$1,200.51"	$0.00	$0.00	$337.09	$0.00	$956.75	$956.75	$0.00	$808.75	"$1,281.06"	"$1,294.00"	$0.00		$0.00	$253.14	$0.00	$0.00	$257.51	$0.00	$0.00	$0.00	$0.00	$0.00
30170061-S	SUP	HCPCS C1713		30170061-S  -  SCREW BONE 3.2/3.5MM 24MM BIOTRAK .035IN MINI WRST ANKL HAND	BOTH IP/OP	"$1,617.50 "	"$1,196.95"	$0.00	"$1,294.00"	$727.88	$727.88	$0.00	$0.00	$0.00	$337.13	"$1,200.51"	"$1,200.51"	$0.00	$0.00	$337.09	$0.00	$956.75	$956.75	$0.00	$808.75	"$1,281.06"	"$1,294.00"	$0.00		$0.00	$253.14	$0.00	$0.00	$257.51	$0.00	$0.00	$0.00	$0.00	$0.00
30170320-S	SUP	Custom 27203010		30170320-S  -  PIN FX 20MM BIOTRAK	BOTH IP/OP	$605.00 	$447.70	$0.00	$484.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.03	$449.03	$0.00	$0.00	$126.08	$0.00	$0.00	$0.00	$0.00	$302.50	$479.16	$484.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30170330-S	SUP	Custom 27203010		30170330-S  -  PIN FX 30MM BIOTRAK	BOTH IP/OP	$605.00 	$447.70	$0.00	$484.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.03	$449.03	$0.00	$0.00	$126.08	$0.00	$0.00	$0.00	$0.00	$302.50	$479.16	$484.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30170340-S	SUP	Custom 27203010		30170340-S  -  PIN FX 40MM BIOTRAK	BOTH IP/OP	$605.00 	$447.70	$0.00	$484.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.03	$449.03	$0.00	$0.00	$126.08	$0.00	$0.00	$0.00	$0.00	$302.50	$479.16	$484.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3044-0026	SUP	Custom 27803010		3044-0026  -  COMPONENT PATLR 26MM RECESSED UHMWPE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3044-0028	SUP	Custom 27803010		3044-0028  -  COMPONENT PATLR 28MM RECESSED UHMWPE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3044-0030	SUP	Custom 27803010		3044-0030  -  COMPONENT PATLR 30MM RECESSED UHMWPE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3044-0032	SUP	Custom 27803010		3044-0032  -  COMPONENT PATLR 32MM RECESSED UHMWPE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3045-0026	SUP	Custom 27803010		3045-0026  -  CMPNT PATLR MTLBLK RCSS	BOTH IP/OP	"$1,211.00 "	$896.14	$0.00	$968.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$898.80	$898.80	$0.00	$0.00	$252.37	$0.00	$0.00	$0.00	$0.00	$605.50	$959.11	$968.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3045-0028	SUP	Custom 27803010		3045-0028  -  CMPNT PATLR MTLBLK RCSS	BOTH IP/OP	"$1,211.00 "	$896.14	$0.00	$968.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$898.80	$898.80	$0.00	$0.00	$252.37	$0.00	$0.00	$0.00	$0.00	$605.50	$959.11	$968.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3045-0030	SUP	Custom 27803010		3045-0030  -  CMPNT PATLR MTLBLK RCSS	BOTH IP/OP	"$1,211.00 "	$896.14	$0.00	$968.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$898.80	$898.80	$0.00	$0.00	$252.37	$0.00	$0.00	$0.00	$0.00	$605.50	$959.11	$968.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3045-0032	SUP	Custom 27803010		3045-0032  -  CMPNT PATLR MTLBLK RCSS	BOTH IP/OP	"$1,211.00 "	$896.14	$0.00	$968.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$898.80	$898.80	$0.00	$0.00	$252.37	$0.00	$0.00	$0.00	$0.00	$605.50	$959.11	$968.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30-5052122	SUP	Custom 27203010		MILTEX HANK DILATOR SZ. 21-22	BOTH IP/OP	$174.38 	$129.04	$0.00	$139.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.19	$138.11	$139.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30-5052324	SUP	Custom 27203010		MILTEX HANK DILATOR SZ. 23-24	BOTH IP/OP	$174.38 	$129.04	$0.00	$139.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.19	$138.11	$139.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
30-505-2526	SUP	Custom 27203010		MILTEX HANK DILATOR SZ. 25-26	BOTH IP/OP	$181.85 	$134.57	$0.00	$145.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.93	$144.03	$145.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3051-0308	SUP	Custom 27803010		3051-0308  -  INSERT TIB LG KNEE SER 1 BRNG	BOTH IP/OP	$985.00 	$728.90	$0.00	$788.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$731.07	$731.07	$0.00	$0.00	$205.27	$0.00	$0.00	$0.00	$0.00	$492.50	$780.12	$788.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0308	SUP	Custom 27803010		3052-0308  -  INSERT TIBIAL 3 8MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0310	SUP	Custom 27803010		3052-0310  -  INSERT TIBIAL 3 10MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0312	SUP	Custom 27803010		3052-0312  -  INSERT TIBIAL 3 12MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0315	SUP	Custom 27803010		3052-0315  -  INSERT TIBIAL 3 15MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0318	SUP	Custom 27803010		3052-0318  -  INSERT TIBIAL 3 18MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0321	SUP	Custom 27803010		3052-0321  -  INSERT TIBIAL 3 21MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0324	SUP	Custom 27803010		3052-0324  -  INSERT TIBIAL 3 24MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0508	SUP	Custom 27803010		3052-0508  -  INSERT TIBIAL 5 8MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0510	SUP	Custom 27803010		3052-0510  -  INSERT TIBIAL 5 10MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0512	SUP	Custom 27803010		3052-0512  -  INSERT TIBIAL 5 12MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0515	SUP	Custom 27803010		3052-0515  -  INSERT TIBIAL 5 15MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0518	SUP	Custom 27803010		3052-0518  -  INSERT TIBIAL 5 18MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0521	SUP	Custom 27803010		3052-0521  -  INSERT TIBIAL 5 21MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0524	SUP	Custom 27803010		3052-0524  -  INSERT TIBIAL 5 24MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0708	SUP	Custom 27803010		3052-0708  -  INSERT TIBIAL 7 8MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0710	SUP	Custom 27803010		3052-0710  -  INSERT TIBIAL 7 10MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0712	SUP	Custom 27803010		3052-0712  -  INSERT TIBIAL 7 12MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0715	SUP	Custom 27803010		3052-0715  -  INSERT TIBIAL 7 15MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0718	SUP	Custom 27803010		3052-0718  -  INSERT TIBIAL 7 18MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0721	SUP	Custom 27803010		3052-0721  -  INSERT TIBIAL 7 21MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0724	SUP	Custom 27803010		3052-0724  -  INSERT TIBIAL 7 24MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0908	SUP	Custom 27803010		3052-0908  -  INSERT TIBIAL 9 8MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0910	SUP	Custom 27803010		3052-0910  -  INSERT TIBIAL 9 10MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0912	SUP	Custom 27803010		3052-0912  -  INSERT TIBIAL 9 12MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0915	SUP	Custom 27803010		3052-0915  -  INSERT TIBIAL 9 15MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0918	SUP	Custom 27803010		3052-0918  -  INSERT TIBIAL 9 18MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0921	SUP	Custom 27803010		3052-0921  -  INSERT TIBIAL 9 21MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-0924	SUP	Custom 27803010		3052-0924  -  INSERT TIBIAL 9 24MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-1108	SUP	Custom 27803010		3052-1108  -  INSERT TIBIAL 11 8MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-1110	SUP	Custom 27803010		3052-1110  -  INSERT TIBIAL 11 10MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-1112	SUP	Custom 27803010		3052-1112  -  INSERT TIBIAL 11 12MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-1115	SUP	Custom 27803010		3052-1115  -  INSERT TIBIAL 11 15MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-1118	SUP	Custom 27803010		3052-1118  -  INSERT TIBIAL 11 18MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-1121	SUP	Custom 27803010		3052-1121  -  INSERT TIBIAL 11 21MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3052-1124	SUP	Custom 27803010		3052-1124  -  INSERT TIBIAL 11 24MM BEARING KNEE SERIES II	BOTH IP/OP	"$2,060.00 "	"$1,524.40"	$0.00	"$1,648.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,528.93"	"$1,528.93"	$0.00	$0.00	$429.30	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	"$1,631.52"	"$1,648.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
305C2101	SUP	Custom 27803010		305C2101  -  VALVE AORTIC 21MM MSC BPRTH CNCH HLDR MODL 305 STRL	BOTH IP/OP	"$19,000.00 "	"$14,060.00"	$0.00	"$15,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,959.60"	$0.00	$0.00	$0.00	$0.00	"$9,500.00"	"$15,048.00"	"$15,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
305C219	SUP	Custom 27803010		305C219  -  VALVE AORTIC 19MM MSC BPRTH CNCH HLDR MODL 305 STRL	BOTH IP/OP	"$2,022.50 "	"$1,496.65"	$0.00	"$1,618.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,501.10"	"$1,501.10"	$0.00	$0.00	$421.49	$0.00	$0.00	$0.00	$0.00	"$1,011.25"	"$1,601.82"	"$1,618.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
305C221	SUP	Custom 27803010		305C221  -  VALVE AORTIC 21MM MSC BPRTH CNCH HLDR MODL 305 STRL	BOTH IP/OP	"$19,500.00 "	"$14,430.00"	$0.00	"$15,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,063.80"	$0.00	$0.00	$0.00	$0.00	"$9,750.00"	"$15,444.00"	"$15,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
305C223	SUP	Custom 27803010		305C223  -  VALVE AORTIC 23MM MSC CNCH BPRTH CNCH HLDR MODL 305	BOTH IP/OP	"$19,500.00 "	"$14,430.00"	$0.00	"$15,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,063.80"	$0.00	$0.00	$0.00	$0.00	"$9,750.00"	"$15,444.00"	"$15,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
305C227	SUP	Custom 27803010		305C227  -  VALVE AORTIC 27MM MSC BPRTH CNCH HLDR MODL 305	BOTH IP/OP	"$19,500.00 "	"$14,430.00"	$0.00	"$15,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,063.80"	$0.00	$0.00	$0.00	$0.00	"$9,750.00"	"$15,444.00"	"$15,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
305C229	SUP	Custom 27803010		305C229  -  VALVE AORTIC 29MM MSC BPRTH CNCH HLDR MODL 305 STRL	BOTH IP/OP	"$19,500.00 "	"$14,430.00"	$0.00	"$15,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,063.80"	$0.00	$0.00	$0.00	$0.00	"$9,750.00"	"$15,444.00"	"$15,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0070S	SUP	HCPCS C1713		3060-0070S  -  SCREW BONE 10.5MM 70MM GAMMA3 TI TROC HIP LAG STRL LNG NAIL	BOTH IP/OP	$694.38 	$513.84	$0.00	$555.50	$312.47	$312.47	$0.00	$0.00	$0.00	$144.73	$515.37	$515.37	$0.00	$0.00	$144.71	$0.00	$410.72	$410.72	$0.00	$347.19	$549.95	$555.50	$0.00		$0.00	$108.67	$0.00	$0.00	$110.54	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0075S	SUP	HCPCS C1713		3060-0075S  -  SCREW BN 10.5MM 75MM STRL GAMMA3 LG TI HIP TROCH NL 180	BOTH IP/OP	$804.38 	$595.24	$0.00	$643.50	$361.97	$361.97	$0.00	$0.00	$0.00	$167.65	$597.01	$597.01	$0.00	$0.00	$167.63	$0.00	$475.79	$475.79	$0.00	$402.19	$637.07	$643.50	$0.00		$0.00	$125.88	$0.00	$0.00	$128.06	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0080S	SUP	HCPCS C1713		3060-0080S  -  SCREW BONE 10.5MM 80MM GAMMA3 TI TROC HIP LAG STRL LNG NAIL	BOTH IP/OP	$804.38 	$595.24	$0.00	$643.50	$361.97	$361.97	$0.00	$0.00	$0.00	$167.65	$597.01	$597.01	$0.00	$0.00	$167.63	$0.00	$475.79	$475.79	$0.00	$402.19	$637.07	$643.50	$0.00		$0.00	$125.88	$0.00	$0.00	$128.06	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0085S	SUP	HCPCS C1713		3060-0085S  -  SCREW BN 10.5MM 85MM STRL GAMMA3 LG TI HIP TROCH NL 180	BOTH IP/OP	$804.38 	$595.24	$0.00	$643.50	$361.97	$361.97	$0.00	$0.00	$0.00	$167.65	$597.01	$597.01	$0.00	$0.00	$167.63	$0.00	$475.79	$475.79	$0.00	$402.19	$637.07	$643.50	$0.00		$0.00	$125.88	$0.00	$0.00	$128.06	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0090S	SUP	HCPCS C1713		3060-0090S  -  SCREW BN 10.5MM 90MM STRL GAMMA3 LG TI HIP TROCH NL 180	BOTH IP/OP	$804.38 	$595.24	$0.00	$643.50	$361.97	$361.97	$0.00	$0.00	$0.00	$167.65	$597.01	$597.01	$0.00	$0.00	$167.63	$0.00	$475.79	$475.79	$0.00	$402.19	$637.07	$643.50	$0.00		$0.00	$125.88	$0.00	$0.00	$128.06	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0095S	SUP	HCPCS C1713		3060-0095S  -  SCREW BN 10.5MM 95MM STRL GAMMA3 LG TI HIP TROCH NL 180	BOTH IP/OP	$804.38 	$595.24	$0.00	$643.50	$361.97	$361.97	$0.00	$0.00	$0.00	$167.65	$597.01	$597.01	$0.00	$0.00	$167.63	$0.00	$475.79	$475.79	$0.00	$402.19	$637.07	$643.50	$0.00		$0.00	$125.88	$0.00	$0.00	$128.06	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0100S	SUP	HCPCS C1713		3060-0100S  -  SCREW BN 10.5MM 100MM STRL GAMMA3 LG TI HIP TROCH NL 180	BOTH IP/OP	$804.38 	$595.24	$0.00	$643.50	$361.97	$361.97	$0.00	$0.00	$0.00	$167.65	$597.01	$597.01	$0.00	$0.00	$167.63	$0.00	$475.79	$475.79	$0.00	$402.19	$637.07	$643.50	$0.00		$0.00	$125.88	$0.00	$0.00	$128.06	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0105S	SUP	HCPCS C1713		3060-0105S  -  SCREW BN 10.5MM 105MM STRL GAMMA3 LG TI HIP TROCH NL 180	BOTH IP/OP	$804.38 	$595.24	$0.00	$643.50	$361.97	$361.97	$0.00	$0.00	$0.00	$167.65	$597.01	$597.01	$0.00	$0.00	$167.63	$0.00	$475.79	$475.79	$0.00	$402.19	$637.07	$643.50	$0.00		$0.00	$125.88	$0.00	$0.00	$128.06	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0110S	SUP	HCPCS C1713		3060-0110S  -  SCREW BN 10.5MM 110MM STRL GAMMA3 LG TI HIP TROCH NL 180	BOTH IP/OP	$804.38 	$595.24	$0.00	$643.50	$361.97	$361.97	$0.00	$0.00	$0.00	$167.65	$597.01	$597.01	$0.00	$0.00	$167.63	$0.00	$475.79	$475.79	$0.00	$402.19	$637.07	$643.50	$0.00		$0.00	$125.88	$0.00	$0.00	$128.06	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0115S	SUP	HCPCS C1713		3060-0115S  -  SCREW BN 10.5MM 115MM STRL GAMMA3 LG TI HIP TROCH NL 180	BOTH IP/OP	$804.38 	$595.24	$0.00	$643.50	$361.97	$361.97	$0.00	$0.00	$0.00	$167.65	$597.01	$597.01	$0.00	$0.00	$167.63	$0.00	$475.79	$475.79	$0.00	$402.19	$637.07	$643.50	$0.00		$0.00	$125.88	$0.00	$0.00	$128.06	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0120S	SUP	HCPCS C1713		3060-0120S  -  SCREW BN 10.5MM 120MM STRL GAMMA3 LG TI HIP TROCH NL 180	BOTH IP/OP	$804.38 	$595.24	$0.00	$643.50	$361.97	$361.97	$0.00	$0.00	$0.00	$167.65	$597.01	$597.01	$0.00	$0.00	$167.63	$0.00	$475.79	$475.79	$0.00	$402.19	$637.07	$643.50	$0.00		$0.00	$125.88	$0.00	$0.00	$128.06	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0125S	SUP	HCPCS C1713		3060-0125S  -  SCREW BN 10.5MM 125MM STRL GAMMA3 LG TI HIP TROCH NL 180	BOTH IP/OP	$756.25 	$559.63	$0.00	$605.00	$340.31	$340.31	$0.00	$0.00	$0.00	$157.62	$561.29	$561.29	$0.00	$0.00	$157.60	$0.00	$447.32	$447.32	$0.00	$378.13	$598.95	$605.00	$0.00		$0.00	$118.35	$0.00	$0.00	$120.40	$0.00	$0.00	$0.00	$0.00	$0.00
3060-0130S	SUP	HCPCS C1713		3060-0130S  -  SCREW BN 10.5MM 130MM STRL GAMMA3 LG TI HIP TROCH NL 180	BOTH IP/OP	$756.25 	$559.63	$0.00	$605.00	$340.31	$340.31	$0.00	$0.00	$0.00	$157.62	$561.29	$561.29	$0.00	$0.00	$157.60	$0.00	$447.32	$447.32	$0.00	$378.13	$598.95	$605.00	$0.00		$0.00	$118.35	$0.00	$0.00	$120.40	$0.00	$0.00	$0.00	$0.00	$0.00
3060L	SUP	Custom 27203010		RESTRAINT VST 65IN MED QRLSE TIE BACK CLSR STRAP	BOTH IP/OP	$42.03 	$31.10	$0.00	$33.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.01	$33.29	$33.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3060M	SUP	Custom 27203010		RESTRAINT VST 65IN MED CTTN QRLSE TIE BACK CLSR STRAP	BOTH IP/OP	$42.03 	$31.10	$0.00	$33.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.01	$33.29	$33.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3060S	SUP	Custom 27203010		RESTRAINT VST 65IN SM QRLSE TIE BACK CLSR STRAP	BOTH IP/OP	$42.03 	$31.10	$0.00	$33.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.01	$33.29	$33.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3060XL	SUP	Custom 27203010		RESTRAINT VST 75IN XL QRLSE TIE BACK CLSR STRAP	BOTH IP/OP	$42.03 	$31.10	$0.00	$33.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.01	$33.29	$33.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3060XXXL	SUP	Custom 27203010		RESTRAINT VST 3XL ZP QRLSE STRAP MESH	BOTH IP/OP	$61.23 	$45.31	$0.00	$48.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.61	$48.49	$48.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
309.004S	SUP	Custom 27203010		309.004S  -  BIT DRL 4MM STRL CRB 3.5MM SCR	BOTH IP/OP	$524.33 	$388.00	$0.00	$407.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.15	$389.15	$0.00	$0.00	$109.27	$0.00	$0.00	$0.00	$0.00	$254.53	$403.17	$407.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
309.006S	SUP	Custom 27203010		309.006S  -  BIT DRL 6MM STRL CRB	BOTH IP/OP	$597.43 	$442.10	$0.00	$464.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$443.41	$443.41	$0.00	$0.00	$124.50	$0.00	$0.00	$0.00	$0.00	$290.01	$459.38	$464.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3092-040	SUP	HCPCS C1713		CEMENT BONE ENDRN SST 40GM HVISC STRL	BOTH IP/OP	$365.00 	$270.10	$0.00	$292.00	$164.25	$164.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.50	$289.08	$292.00	$0.00		$0.00	$57.12	$0.00	$0.00	$58.11	$0.00	$0.00	$0.00	$0.00	$0.00
310.11.98	SUP	Custom 27203010		310.11.98  -  BIT DRILL 60MM 1.1MM QC NONSTRL	BOTH IP/OP	$209.25 	$154.85	$0.00	$167.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$104.63	$165.73	$167.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.15.98	SUP	Custom 27203010		310.15.98  -  BIT DRILL 85MM 1.5MM QC W/O STOP NONSTRL	BOTH IP/OP	$209.25 	$154.85	$0.00	$167.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$104.63	$165.73	$167.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.16.98	SUP	Custom 27203010		310.16.98  -  BIT DRILL 110MM 1.5MM QC W/O STOP NONSTRL	BOTH IP/OP	$209.25 	$154.85	$0.00	$167.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$104.63	$165.73	$167.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.16J	SUP	Custom 27203010		310.16J  -  BIT DRILL 1.5MM 95MM JACOBS CHUCK NONSTRL	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.21.98	SUP	Custom 27203010		310.21.98  -  BIT DRILL 125MM 2MM QC W/O STOP NONSTRL	BOTH IP/OP	$234.00 	$173.16	$0.00	$187.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.67	$173.67	$0.00	$0.00	$48.77	$0.00	$0.00	$0.00	$0.00	$117.00	$185.33	$187.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.21J	SUP	Custom 27203010		310.21J  -  BIT DRILL LONG 2MM 110MM JACOBS CHUCK DCP STAINLESS STEEL	BOTH IP/OP	$135.63 	$100.37	$0.00	$105.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.66	$100.66	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$65.84	$104.29	$105.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.-288	SUP	Custom 27203010		BIT DRILL 165MM 2.8MM QC NSTRL	BOTH IP/OP	$238.60 	$176.56	$0.00	$190.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.30	$188.97	$190.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.28J	SUP	Custom 27203010		310.28J  -  BIT DRILL 2.7MM 110MM JACOBS CHUCK STERILE	BOTH IP/OP	$143.38 	$106.10	$0.00	$111.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.41	$106.41	$0.00	$0.00	$29.88	$0.00	$0.00	$0.00	$0.00	$69.60	$110.25	$111.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.31.	SUP	Custom 27203010		310.31.  -  DRILL BIT  3.2MM X 145MM QUICK COUPLING	BOTH IP/OP	$91.79 	$67.92	$0.00	$73.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.13	$68.13	$0.00	$0.00	$19.13	$0.00	$0.00	$0.00	$0.00	$45.90	$72.70	$73.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310.60J	SUP	Custom 27203010		310.60J  -  BIT DRILL 6MM 195MM JACOBS CHUCK NONSTRL	BOTH IP/OP	$282.55 	$209.09	$0.00	$219.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$209.71	$209.71	$0.00	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$137.16	$217.27	$219.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3100-25	SUP	Custom 27203010		KIT SYR ART LN 25 UN 1ML BAL HEP	BOTH IP/OP	$1.35 	$1.00	$0.00	$1.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.68	$1.07	$1.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31004U	SUP	Custom 27203010		KIT IMMUN TST ELISA SPHL IGG 96 TST	BOTH IP/OP	$343.20 	$253.97	$0.00	$274.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$171.60	$271.81	$274.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310-25M	SUP	Custom 27803010		310-25M  -  VALVE MTRL 25MM MSC CNCH PIG	BOTH IP/OP	"$19,500.00 "	"$14,430.00"	$0.00	"$15,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,063.80"	$0.00	$0.00	$0.00	$0.00	"$9,750.00"	"$15,444.00"	"$15,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310-31M	SUP	Custom 27803010		310-31M  -  VALVE MTRL 31MM MSC CNCH PIG	BOTH IP/OP	"$19,500.00 "	"$14,430.00"	$0.00	"$15,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,063.80"	$0.00	$0.00	$0.00	$0.00	"$9,750.00"	"$15,444.00"	"$15,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310-33M	SUP	Custom 27803010		310-33M  -  VALVE MTRL 33MM MSC CNCH PIG	BOTH IP/OP	"$19,500.00 "	"$14,430.00"	$0.00	"$15,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,063.80"	$0.00	$0.00	$0.00	$0.00	"$9,750.00"	"$15,444.00"	"$15,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
310C29	SUP	Custom 27803010		310C29  -  VALVE MTRL 29MM MSC HRT PIG CNCH HLDR 310	BOTH IP/OP	"$19,500.00 "	"$14,430.00"	$0.00	"$15,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,063.80"	$0.00	$0.00	$0.00	$0.00	"$9,750.00"	"$15,444.00"	"$15,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
311.031.01S	SUP	HCPCS C1713		311.031.01S  -  TAP 4MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.032.01S	SUP	HCPCS C1713		311.032.01S  -  TAP 6MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.033.01S	SUP	HCPCS C1713		311.033.01S  -  TAP 3MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.034.01S	SUP	HCPCS C1713		311.034.01S  -  TAP 2MM RESORB CORTEX SCR 4MM SLFDRILL MNQK CPLNG STOP SURG	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.035.01S	SUP	HCPCS C1713		311.035.01S  -  TAP 5MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.035.97S	SUP	HCPCS C1713		311.035.97S  -  TAP SURG 1.5MM 5MM RESORB STOP STERILE CORTICAL SCREW	BOTH IP/OP	$700.20 	$518.15	$0.00	$543.84	$305.91	$305.91	$0.00	$0.00	$0.00	$145.94	$519.69	$519.69	$0.00	$0.00	$145.92	$0.00	$414.17	$414.17	$0.00	$339.90	$538.40	$543.84	$0.00		$0.00	$103.29	$0.00	$0.00	$108.22	$0.00	$0.00	$0.00	$0.00	$0.00
311.036.01S	SUP	HCPCS C1713		311.036.01S  -  TAP 2MM RESORB CORTEX SCR 6MM SLFDRILL MNQK CPLNG STOP SURG	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.037.01S	SUP	HCPCS C1713		311.037.01S  -  TAP 8MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.038.01S	SUP	HCPCS C1713		311.038.01S  -  TAP 2MM RESORB CORTEX SCR 8MM SLFDRILL MNQK CPLNG STOP SURG	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.044.01S	SUP	HCPCS C1713		311.044.01S  -  TAP 4MM SLFDRILL MNQK CPLNG STOP SURG 2.5MM RESORB ER SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.046.01S	SUP	HCPCS C1713		311.046.01S  -  TAP 6MM SLFDRILL MNQK CPLNG STOP SURG 2.5MM RESORB ER SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.048.01S	SUP	HCPCS C1713		311.048.01S  -  TAP 8MM SLFDRILL MNQK CPLNG STOP SURG 2.5MM RESORB ER SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.054.01S	SUP	HCPCS C1713		311.054.01S  -  TAP 2MM RESORB CORTEX SCR 1.5MM PLT 4MM SLFDRILL MNQK CPLNG	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.056.01S	SUP	HCPCS C1713		311.056.01S  -  TAP 2MM RESORB CORTEX SCR 1.5MM PLT 6MM SLFDRILL MNQK CPLNG	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.056.97S	SUP	HCPCS C1713		311.056.97S  -  TAP SURG 6MM STERILE 2MM RESORB CORTICAL SCREW	BOTH IP/OP	$700.20 	$518.15	$0.00	$543.84	$305.91	$305.91	$0.00	$0.00	$0.00	$145.94	$519.69	$519.69	$0.00	$0.00	$145.92	$0.00	$414.17	$414.17	$0.00	$339.90	$538.40	$543.84	$0.00		$0.00	$103.29	$0.00	$0.00	$108.22	$0.00	$0.00	$0.00	$0.00	$0.00
311.058.01S	SUP	HCPCS C1713		311.058.01S  -  TAP 2MM RESORB CORTEX SCR 1.5MM PLT 8MM SLFDRILL MNQK CPLNG	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.060.01S	SUP	HCPCS C1713		311.060.01S  -  TAP 4MM STOP SLFDRILL HEX CPLNG SURG 1.5MM RESORB CORTEX SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.061.01S	SUP	HCPCS C1713		311.061.01S  -  TAP 6MM STOP SLFDRILL HEX CPLNG SURG 1.5MM RESORB CORTEX SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.062.01S	SUP	HCPCS C1713		311.062.01S  -  TAP 3MM SLFDRILL HEX CPLNG STOP SURG 1.5MM RESORB CORTEX SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.063.01S	SUP	HCPCS C1713		311.063.01S  -  TAP 4MM STOP SLFDRILL HEX CPLNG SURG 2MM RESORB CORTEX SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.064.01S	SUP	HCPCS C1713		311.064.01S  -  TAP 6MM STOP SLFDRILL HEX CPLNG SURG 2MM RESORB CORTEX SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.065.01S	SUP	HCPCS C1713		311.065.01S  -  TAP 2MM RESORB CORTEX SCR 8MM SLFDRILL HEX CPLNG STOP SURG	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.067.01S	SUP	HCPCS C1713		311.067.01S  -  TAP 4MM SLFDRILL HEX CPLNG STOP SURG 2MM RESORB CORTEX SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.068.01S	SUP	HCPCS C1713		311.068.01S  -  TAP 6MM SLFDRILL HEX CPLNG STOP SURG 2MM RESORB CORTEX SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.069.01S	SUP	HCPCS C1713		311.069.01S  -  TAP 2MM RESORB CORTEX SCR 1.5MM PLT 8MM SLFDRILL HEX CPLNG	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.071.01S	SUP	HCPCS C1713		311.071.01S  -  TAP 4MM SLFDRILL HEX CPLNG STOP SURG 2.5MM RESORB ER SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.072.01S	SUP	HCPCS C1713		311.072.01S  -  TAP 6MM SLFDRILL HEX CPLNG STOP SURG 2.5MM RESORB ER SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.073.01S	SUP	HCPCS C1713		311.073.01S  -  TAP 8MM SLFDRILL HEX CPLNG STOP SURG 2.5MM RESORB ER SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.093.01S	SUP	HCPCS C1713		311.093.01S  -  TAP 5MM SLFDRILL HEX CPLNG STOP SURG 1.5MM RESORB CORTEX SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.094.01S	SUP	HCPCS C1713		311.094.01S  -  TAP 8MM SLFDRILL HEX CPLNG STOP SURG 1.5MM RESORB CORTEX SCR	BOTH IP/OP	$751.50 	$556.11	$0.00	$601.20	$338.18	$338.18	$0.00	$0.00	$0.00	$156.63	$557.76	$557.76	$0.00	$0.00	$156.61	$0.00	$444.51	$444.51	$0.00	$375.75	$595.19	$601.20	$0.00		$0.00	$117.61	$0.00	$0.00	$119.64	$0.00	$0.00	$0.00	$0.00	$0.00
311.100.01S	SUP	HCPCS C1713		311.100.01S  -  TAP SLFDRILL ADJ LGTH SURG 1.5 MM SCR STRL	BOTH IP/OP	"$1,021.50 "	$755.91	$0.00	$817.20	$459.68	$459.68	$0.00	$0.00	$0.00	$212.91	$758.16	$758.16	$0.00	$0.00	$212.88	$0.00	$604.22	$604.22	$0.00	$510.75	$809.03	$817.20	$0.00		$0.00	$159.86	$0.00	$0.00	$162.62	$0.00	$0.00	$0.00	$0.00	$0.00
311.101.01S	SUP	HCPCS C1713		311.101.01S  -  TAP SLFDRILL ADJ LGTH SURG 2 MM SCR STRL	BOTH IP/OP	"$1,021.50 "	$755.91	$0.00	$817.20	$459.68	$459.68	$0.00	$0.00	$0.00	$212.91	$758.16	$758.16	$0.00	$0.00	$212.88	$0.00	$604.22	$604.22	$0.00	$510.75	$809.03	$817.20	$0.00		$0.00	$159.86	$0.00	$0.00	$162.62	$0.00	$0.00	$0.00	$0.00	$0.00
311.102.01S	SUP	HCPCS C1713		311.102.01S  -  TAP SLFDRILL ADJ LGTH SURG 2.5 MM SCR STRL	BOTH IP/OP	"$1,021.50 "	$755.91	$0.00	$817.20	$459.68	$459.68	$0.00	$0.00	$0.00	$212.91	$758.16	$758.16	$0.00	$0.00	$212.88	$0.00	$604.22	$604.22	$0.00	$510.75	$809.03	$817.20	$0.00		$0.00	$159.86	$0.00	$0.00	$162.62	$0.00	$0.00	$0.00	$0.00	$0.00
311.110.01S	SUP	HCPCS C1713		311.110.01S  -  TAP SLFDRILL HEX CPLNG ADJ SURG 1.5 MM RESORB CORTEX SCR	BOTH IP/OP	"$1,021.50 "	$755.91	$0.00	$817.20	$459.68	$459.68	$0.00	$0.00	$0.00	$212.91	$758.16	$758.16	$0.00	$0.00	$212.88	$0.00	$604.22	$604.22	$0.00	$510.75	$809.03	$817.20	$0.00		$0.00	$159.86	$0.00	$0.00	$162.62	$0.00	$0.00	$0.00	$0.00	$0.00
311.111.01S	SUP	HCPCS C1713		311.111.01S  -  TAP SLFDRILL HEX CPLNG ADJ SURG 2 MM RESORB CORTEX SCR STRL	BOTH IP/OP	"$1,021.50 "	$755.91	$0.00	$817.20	$459.68	$459.68	$0.00	$0.00	$0.00	$212.91	$758.16	$758.16	$0.00	$0.00	$212.88	$0.00	$604.22	$604.22	$0.00	$510.75	$809.03	$817.20	$0.00		$0.00	$159.86	$0.00	$0.00	$162.62	$0.00	$0.00	$0.00	$0.00	$0.00
311.112.01S	SUP	HCPCS C1713		311.112.01S  -  TAP SLFDRILL ADJ LGTH HEX CPLNG SURG 2.5 MM SCR STRL	BOTH IP/OP	"$1,021.50 "	$755.91	$0.00	$817.20	$459.68	$459.68	$0.00	$0.00	$0.00	$212.91	$758.16	$758.16	$0.00	$0.00	$212.88	$0.00	$604.22	$604.22	$0.00	$510.75	$809.03	$817.20	$0.00		$0.00	$159.86	$0.00	$0.00	$162.62	$0.00	$0.00	$0.00	$0.00	$0.00
311.21.98	SUP	HCPCS C1713		311.21.98  -  TAP LNG MNQK CPLNG SURG 2MM CORTEX SCR	BOTH IP/OP	$283.50 	$209.79	$0.00	$226.80	$127.58	$127.58	$0.00	$0.00	$0.00	$59.09	$210.41	$210.41	$0.00	$0.00	$59.08	$0.00	$167.69	$167.69	$0.00	$141.75	$224.53	$226.80	$0.00		$0.00	$44.37	$0.00	$0.00	$45.13	$0.00	$0.00	$0.00	$0.00	$0.00
3120-0170S	SUP	HCPCS C1713		3120-0170S  -  NAIL 10MM 170MM TROC HIP GAMMA3 IM 120D TI STRL	BOTH IP/OP	"$2,710.65 "	"$2,005.88"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$564.97	"$2,011.84"	"$2,011.84"	$0.00	$0.00	$564.90	$0.00	"$1,336.35"	"$1,336.35"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3120-1180S	SUP	HCPCS C1713		3120-1180S  -  NAIL 11MM 180MM TROC HIP GAMMA3 IM 120D TI STRL	BOTH IP/OP	"$2,124.38 "	"$1,572.04"	$0.00	"$1,699.50"	$955.97	$955.97	$0.00	$0.00	$0.00	$442.77	"$1,576.71"	"$1,576.71"	$0.00	$0.00	$442.72	$0.00	"$1,256.57"	"$1,256.57"	$0.00	"$1,062.19"	"$1,682.51"	"$1,699.50"	$0.00		$0.00	$332.46	$0.00	$0.00	$338.20	$0.00	$0.00	$0.00	$0.00	$0.00
3125-0170S	SUP	HCPCS C1713		3125-0170S  -  NAIL 10MM 170MM TROC HIP GAMMA3 IM 125D TI STRL	BOTH IP/OP	"$2,710.65 "	"$2,005.88"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$564.97	"$2,011.84"	"$2,011.84"	$0.00	$0.00	$564.90	$0.00	"$1,336.35"	"$1,336.35"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3125-1180S	SUP	HCPCS C1713		3125-1180S  -  NAIL 11MM 180MM TROC HIP GAMMA3 IM 125D TI STRL	BOTH IP/OP	"$2,124.38 "	"$1,572.04"	$0.00	"$1,699.50"	$955.97	$955.97	$0.00	$0.00	$0.00	$442.77	"$1,576.71"	"$1,576.71"	$0.00	$0.00	$442.72	$0.00	"$1,256.57"	"$1,256.57"	$0.00	"$1,062.19"	"$1,682.51"	"$1,699.50"	$0.00		$0.00	$332.46	$0.00	$0.00	$338.20	$0.00	$0.00	$0.00	$0.00	$0.00
31287751A	SUP	Custom 27203010		CABLE EKG 5 LEAD 12 PNDN PT MONITR D-1585	BOTH IP/OP	$327.50 	$242.35	$0.00	$262.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.75	$259.38	$262.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3130-0170S	SUP	HCPCS C1713		3130-0170S  -  NAIL 10MM 170MM HIP TROC GAMMA3 IM 130D KIT TI STRL	BOTH IP/OP	"$2,710.65 "	"$2,005.88"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$564.97	"$2,011.84"	"$2,011.84"	$0.00	$0.00	$564.90	$0.00	"$1,336.35"	"$1,336.35"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3130-1180S	SUP	HCPCS C1713		3130-1180S  -  NAIL 11MM 180MM TROC HIP GAMMA3 IM 130D TI STRL	BOTH IP/OP	"$2,124.38 "	"$1,572.04"	$0.00	"$1,699.50"	$955.97	$955.97	$0.00	$0.00	$0.00	$442.77	"$1,576.71"	"$1,576.71"	$0.00	$0.00	$442.72	$0.00	"$1,256.57"	"$1,256.57"	$0.00	"$1,062.19"	"$1,682.51"	"$1,699.50"	$0.00		$0.00	$332.46	$0.00	$0.00	$338.20	$0.00	$0.00	$0.00	$0.00	$0.00
313-7034EA	SUP	Custom 27203010		313-7034EA  -  MASK CPAP 02 RESQ BITRAC ED WITH 7.5 CM VALVE & FLOW GENERAT	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.22	$74.22	$0.00	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
314.746S	SUP	Custom 27203010		314.746S  -  ASSEMBLY TUBE 520MM REAMER IRRIGATOR ASPIRAT STERILE	BOTH IP/OP	$824.18 	$609.89	$0.00	$640.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.70	$611.70	$0.00	$0.00	$171.76	$0.00	$0.00	$0.00	$0.00	$400.09	$633.74	$640.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31-462	SUP	HCPCS C1887		31-462  -  CATHETER 5FR 65CM COBRA 1	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
31-466	SUP	HCPCS C1887		31-466  -  CATHETER 5FR 65CM COBRA 2	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
315.40S	SUP	Custom 27203010		315.40S  -  BIT DRILL 195MM 4MM QC 3 FLT STRL	BOTH IP/OP	$380.73 	$281.74	$0.00	$295.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.57	$282.57	$0.00	$0.00	$79.34	$0.00	$0.00	$0.00	$0.00	$184.83	$292.76	$295.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31560-950	SUP	Custom 27203010		BULB SCP 3.5V FBROP LGHT HEAD ANOSCP SGSCP KLNSPC DISP	BOTH IP/OP	"$1,092.50 "	$808.45	$0.00	$874.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$546.25	$865.26	$874.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
315-92	SUP	Custom 27203010		BIT DRILL 230MM 2.5MM 200MM CLBRT QC 3 FLT NSTRL	BOTH IP/OP	$456.10 	$337.51	$0.00	$364.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.05	$361.23	$364.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.114.96	SUP	Custom 27203010		316.114.96  -  BIT DRILL 14MM STOP .76MM 44.5MM J LATCH NONSTRL	BOTH IP/OP	$246.00 	$182.04	$0.00	$191.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.58	$182.58	$0.00	$0.00	$51.27	$0.00	$0.00	$0.00	$0.00	$119.41	$189.15	$191.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.235.96	SUP	Custom 27203010		316.235.96  -  BIT DRILL 35MM STOP 1MM 60MM J LATCH NONSTRL	BOTH IP/OP	$246.00 	$182.04	$0.00	$191.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.58	$182.58	$0.00	$0.00	$51.27	$0.00	$0.00	$0.00	$0.00	$119.41	$189.15	$191.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
316.335.96	SUP	Custom 27203010		316.335.96  -  BIT DRILL 40MM STOP 1.3MM 65MM J LATCH NONSTRL	BOTH IP/OP	$246.00 	$182.04	$0.00	$191.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.58	$182.58	$0.00	$0.00	$51.27	$0.00	$0.00	$0.00	$0.00	$119.41	$189.15	$191.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.235.96	SUP	Custom 27203010		317.235.96  -  BIT DRILL 40MM STOP 1.1MM 65MM J LATCH TITANIUM NONSTRL	BOTH IP/OP	$246.00 	$182.04	$0.00	$191.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.58	$182.58	$0.00	$0.00	$51.27	$0.00	$0.00	$0.00	$0.00	$119.41	$189.15	$191.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
317.435.96	SUP	Custom 27203010		317.435.96  -  BIT DRILL 60MM STOP 1.5MM 85MM J LATCH NONSTRL	BOTH IP/OP	$246.00 	$182.04	$0.00	$191.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.58	$182.58	$0.00	$0.00	$51.27	$0.00	$0.00	$0.00	$0.00	$119.41	$189.15	$191.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
319416AM	SUP	Custom 27203010		319416AM  -  TRAY CATHETERIZATION 16FR 2 CONCTR TEMPERATURE SENSE	BOTH IP/OP	$66.48 	$49.20	$0.00	$54.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.34	$49.34	$0.00	$0.00	$13.85	$0.00	$0.00	$0.00	$0.00	$34.28	$54.30	$54.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31AJ-501	SUP	Custom 27803010		31AJ-501  -  VALVE AORTIC 85D 5.18SQ CM 31MM 26.1MM MECHANICAL HEART	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	$0.00	$0.00	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
31MJ-501	SUP	Custom 27803010		31MJ-501  -  VALVE MTRL 85D 5.18SQ CM STD 31MM 26.1MM MSTR-SER CUF LFLT	BOTH IP/OP	"$17,425.00 "	"$12,894.50"	$0.00	"$13,940.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,631.37"	$0.00	$0.00	$0.00	$0.00	"$8,712.50"	"$13,800.60"	"$13,940.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3220-0240S	SUP	HCPCS C1713		3220-0240S  -  NAIL 11MM 240MM RIGHT FEM HIP GAMMA3 IM 120D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3220-0260S	SUP	HCPCS C1713		3220-0260S  -  NAIL 11MM 260MM RIGHT FEM HIP GAMMA3 IM 120D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3220-0280S	SUP	HCPCS C1713		3220-0280S  -  NAIL 11MM 28CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3220-0300S	SUP	HCPCS C1713		3220-0300S  -  NAIL 11MM 30CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3220-0320S	SUP	HCPCS C1713		3220-0320S  -  NAIL 11MM 32CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3220-0340S	SUP	HCPCS C1713		3220-0340S  -  NAIL 11MM 34CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3220-0360S	SUP	HCPCS C1713		3220-0360S  -  NAIL 11MM 36CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3220-0380S	SUP	HCPCS C1713		3220-0380S  -  NAIL 11MM 38CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3220-0400S	SUP	HCPCS C1713		3220-0400S  -  NAIL 11MM 40CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3220-0420S	SUP	HCPCS C1713		3220-0420S  -  NAIL 11MM 42CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3220-0440S	SUP	HCPCS C1713		3220-0440S  -  NAIL 11MM 44CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3220-0460S	SUP	HCPCS C1713		3220-0460S  -  NAIL 11MM 46CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3220-3340S	SUP	HCPCS C1713		3220-3340S  -  NAIL 13MM 34CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-3360S	SUP	HCPCS C1713		3220-3360S  -  NAIL 13MM 36CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-3380S	SUP	HCPCS C1713		3220-3380S  -  NAIL 13MM 38CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-3400S	SUP	HCPCS C1713		3220-3400S  -  NAIL 13MM 40CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-3420S	SUP	HCPCS C1713		3220-3420S  -  NAIL 13MM 42CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-3440S	SUP	HCPCS C1713		3220-3440S  -  NAIL 13MM 44CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-3460S	SUP	HCPCS C1713		3220-3460S  -  NAIL 13MM 46CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-5340S	SUP	HCPCS C1713		3220-5340S  -  NAIL 15MM 34CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-5360S	SUP	HCPCS C1713		3220-5360S  -  NAIL 15MM 36CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-5380S	SUP	HCPCS C1713		3220-5380S  -  NAIL 15MM 38CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-5400S	SUP	HCPCS C1713		3220-5400S  -  NAIL 15MM 40CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-5420S	SUP	HCPCS C1713		3220-5420S  -  NAIL 15MM 42CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-5440S	SUP	HCPCS C1713		3220-5440S  -  NAIL 15MM 44CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3220-5460S	SUP	HCPCS C1713		3220-5460S  -  NAIL 15MM 46CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
32-250	SUP	HCPCS C1713		32-250  -  HOLDER NDL CRV 9IN STRATTE INS SHNK TC	BOTH IP/OP	$373.33 	$276.26	$0.00	$298.66	$168.00	$168.00	$0.00	$0.00	$0.00	$77.81	$277.08	$277.08	$0.00	$0.00	$77.80	$0.00	$220.82	$220.82	$0.00	$186.66	$295.68	$298.66	$0.00		$0.00	$58.43	$0.00	$0.00	$59.43	$0.00	$0.00	$0.00	$0.00	$0.00
3225-0240S	SUP	HCPCS C1713		3225-0240S  -  NAIL 11MM 240MM HIP RIGHT GAMMA3 IM 125D LNG	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3225-0260S	SUP	HCPCS C1713		3225-0260S  -  NAIL 11MM 260MM RIGHT FEM HIP GAMMA3 IM 125D LNG STRL	BOTH IP/OP	"$2,688.13 "	"$1,989.22"	$0.00	"$2,150.50"	"$1,209.66"	"$1,209.66"	$0.00	$0.00	$0.00	$560.27	"$1,995.13"	"$1,995.13"	$0.00	$0.00	$560.21	$0.00	"$1,325.25"	"$1,325.25"	$0.00	"$1,344.06"	"$2,129.00"	"$2,150.50"	$0.00		$0.00	$420.69	$0.00	$0.00	$427.95	$0.00	$0.00	$0.00	$0.00	$0.00
3225-0280S	SUP	HCPCS C1713		3225-0280S  -  NAIL 11MM 28CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3225-0300S	SUP	HCPCS C1713		3225-0300S  -  NAIL 11MM 30CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3225-0320S	SUP	HCPCS C1713		3225-0320S  -  NAIL 11MM 32CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3225-0340S	SUP	HCPCS C1713		3225-0340S  -  NAIL 11MM 34CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3225-0360S	SUP	HCPCS C1713		3225-0360S  -  NAIL 11MM 36CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3225-0380S	SUP	HCPCS C1713		3225-0380S  -  NAIL 11MM 38CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3225-0400S	SUP	HCPCS C1713		3225-0400S  -  NAIL 11MM 40CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3225-0420S	SUP	HCPCS C1713		3225-0420S  -  NAIL 11MM 42CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3225-0440S	SUP	HCPCS C1713		3225-0440S  -  NAIL 11MM 44CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3225-0460S	SUP	HCPCS C1713		3225-0460S  -  NAIL 11MM 46CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3225-3300S	SUP	HCPCS C1713		3225-3300S  -  NAIL 13MM 300MM RIGHT FEM HIP GAMMA3 IM 125D LNG STRL	BOTH IP/OP	"$2,688.13 "	"$1,989.22"	$0.00	"$2,150.50"	"$1,209.66"	"$1,209.66"	$0.00	$0.00	$0.00	$560.27	"$1,995.13"	"$1,995.13"	$0.00	$0.00	$560.21	$0.00	"$1,325.25"	"$1,325.25"	$0.00	"$1,344.06"	"$2,129.00"	"$2,150.50"	$0.00		$0.00	$420.69	$0.00	$0.00	$427.95	$0.00	$0.00	$0.00	$0.00	$0.00
3225-3320S	SUP	HCPCS C1713		3225-3320S  -  NAIL 13MM 32CM HIP RIGHT FEM GAMMA3 IM 125D LNG TI STRL	BOTH IP/OP	"$2,688.13 "	"$1,989.22"	$0.00	"$2,150.50"	"$1,209.66"	"$1,209.66"	$0.00	$0.00	$0.00	$560.27	"$1,995.13"	"$1,995.13"	$0.00	$0.00	$560.21	$0.00	"$1,325.25"	"$1,325.25"	$0.00	"$1,344.06"	"$2,129.00"	"$2,150.50"	$0.00		$0.00	$420.69	$0.00	$0.00	$427.95	$0.00	$0.00	$0.00	$0.00	$0.00
3225-3340S	SUP	HCPCS C1713		3225-3340S  -  NAIL 13MM 34CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-3360S	SUP	HCPCS C1713		3225-3360S  -  NAIL 13MM 36CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-3380S	SUP	HCPCS C1713		3225-3380S  -  NAIL 13MM 38CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-3400S	SUP	HCPCS C1713		3225-3400S  -  NAIL 13MM 40CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-3420S	SUP	HCPCS C1713		3225-3420S  -  NAIL 13MM 42CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-3440S	SUP	HCPCS C1713		3225-3440S  -  NAIL 13MM 44CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-3460S	SUP	HCPCS C1713		3225-3460S  -  NAIL 13MM 46CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-5300S	SUP	HCPCS C1713		3225-5300S  -  NAIL 15MM 300MM RIGHT FEM HIP GAMMA3 IM 125D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3225-5320S	SUP	HCPCS C1713		3225-5320S  -  NAIL 15MM 320MM RIGHT FEM HIP GAMMA3 IM 125D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3225-5340S	SUP	HCPCS C1713		3225-5340S  -  NAIL 15MM 34CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-5360S	SUP	HCPCS C1713		3225-5360S  -  NAIL 15MM 36CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-5380S	SUP	HCPCS C1713		3225-5380S  -  NAIL 15MM 38CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-5400S	SUP	HCPCS C1713		3225-5400S  -  NAIL 15MM 40CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-5420S	SUP	HCPCS C1713		3225-5420S  -  NAIL 15MM 42CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-5440S	SUP	HCPCS C1713		3225-5440S  -  NAIL 15MM 44CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3225-5460S	SUP	HCPCS C1713		3225-5460S  -  NAIL 15MM 46CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-0240S	SUP	HCPCS C1713		3230-0240S  -  NAIL 11MM 240MM RIGHT FEM HIP GAMMA3 IM LNG 130D STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3230-0260S	SUP	HCPCS C1713		3230-0260S  -  NAIL 11MM 260MM RIGHT FEM HIP GAMMA3 IM 130D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3230-0280S	SUP	HCPCS C1713		3230-0280S  -  NAIL 11MM 28CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3230-0300S	SUP	HCPCS C1713		3230-0300S  -  NAIL 11MM 30CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3230-0320S	SUP	HCPCS C1713		3230-0320S  -  NAIL 11MM 32CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3230-0340S	SUP	HCPCS C1713		3230-0340S  -  NAIL 11MM 34CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3230-0360S	SUP	HCPCS C1713		3230-0360S  -  NAIL 11MM 36CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3230-0380S	SUP	HCPCS C1713		3230-0380S  -  NAIL 11MM 38CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3230-0400S	SUP	HCPCS C1713		3230-0400S  -  NAIL 11MM 40CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3230-0420S	SUP	HCPCS C1713		3230-0420S  -  NAIL 11MM 42CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3230-0440S	SUP	HCPCS C1713		3230-0440S  -  NAIL 11MM 44CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3230-0460S	SUP	HCPCS C1713		3230-0460S  -  NAIL 11MM 46CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3230-3300S	SUP	HCPCS C1713		3230-3300S  -  NAIL 13MM 300MM RIGHT FEM HIP GAMMA3 IM 130D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3230-3320S	SUP	HCPCS C1713		3230-3320S  -  NAIL 13MM 32CM HIP RIGHT GAMMA3 IM LNG 130D	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3230-3340S	SUP	HCPCS C1713		3230-3340S  -  NAIL 13MM 34CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-3360S	SUP	HCPCS C1713		3230-3360S  -  NAIL 13MM 36CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-3380S	SUP	HCPCS C1713		3230-3380S  -  NAIL 13MM 38CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-3400S	SUP	HCPCS C1713		3230-3400S  -  NAIL 13MM 40CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-3420S	SUP	HCPCS C1713		3230-3420S  -  NAIL 13MM 42CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-3440S	SUP	HCPCS C1713		3230-3440S  -  NAIL 13MM 44CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-3460S	SUP	HCPCS C1713		3230-3460S  -  NAIL 13MM 46CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
323040R	SUP	Custom 27803010		323040R  -  KEEL LARYNGEAL 12MM UMBRELLA SHAPE RADIOPQ MONTGOMERY	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$0.00	$0.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
323050R	SUP	Custom 27803010		323050R  -  KEEL LARYNGEAL 14MM UMBRELLA SHAPE RADIOPQ MONTGOMERY	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$0.00	$0.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3230-5340S	SUP	HCPCS C1713		3230-5340S  -  NAIL 15MM 34CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-5360S	SUP	HCPCS C1713		3230-5360S  -  NAIL 15MM 36CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-5380S	SUP	HCPCS C1713		3230-5380S  -  NAIL 15MM 38CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-5400S	SUP	HCPCS C1713		3230-5400S  -  NAIL 15MM 40CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-5420S	SUP	HCPCS C1713		3230-5420S  -  NAIL 15MM 42CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-5440S	SUP	HCPCS C1713		3230-5440S  -  NAIL 15MM 44CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3230-5460S	SUP	HCPCS C1713		3230-5460S  -  NAIL 15MM 46CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
325014S	SUP	HCPCS C1713		325014S  -  SCREW BN P/T LOPRFL RVRS CUT FLUT FLT HEX 4MM 5MM 14MM STRL	BOTH IP/OP	$266.75 	$197.40	$0.00	$213.40	$120.04	$120.04	$0.00	$0.00	$0.00	$55.60	$197.98	$197.98	$0.00	$0.00	$55.59	$0.00	$157.78	$157.78	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$41.75	$0.00	$0.00	$42.47	$0.00	$0.00	$0.00	$0.00	$0.00
325016S	SUP	HCPCS C1713		325016S  -  SCREW BONE 4MM 16MM 8MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN	BOTH IP/OP	$266.75 	$197.40	$0.00	$213.40	$120.04	$120.04	$0.00	$0.00	$0.00	$55.60	$197.98	$197.98	$0.00	$0.00	$55.59	$0.00	$157.78	$157.78	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$41.75	$0.00	$0.00	$42.47	$0.00	$0.00	$0.00	$0.00	$0.00
325018S	SUP	HCPCS C1713		325018S  -  SCREW BN 4MM 18MM STRL ASNS III P/T IMPL SS	BOTH IP/OP	$266.75 	$197.40	$0.00	$213.40	$120.04	$120.04	$0.00	$0.00	$0.00	$55.60	$197.98	$197.98	$0.00	$0.00	$55.59	$0.00	$157.78	$157.78	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$41.75	$0.00	$0.00	$42.47	$0.00	$0.00	$0.00	$0.00	$0.00
325020S	SUP	HCPCS C1713		325020S  -  SCREW BONE 4MM 20MM ASNS 3 SS ORTH CANN STRL	BOTH IP/OP	$266.75 	$197.40	$0.00	$213.40	$120.04	$120.04	$0.00	$0.00	$0.00	$55.60	$197.98	$197.98	$0.00	$0.00	$55.59	$0.00	$157.78	$157.78	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$41.75	$0.00	$0.00	$42.47	$0.00	$0.00	$0.00	$0.00	$0.00
325022S	SUP	HCPCS C1713		325022S  -  SCREW BONE 4MM 22MM 8MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN	BOTH IP/OP	$266.75 	$197.40	$0.00	$213.40	$120.04	$120.04	$0.00	$0.00	$0.00	$55.60	$197.98	$197.98	$0.00	$0.00	$55.59	$0.00	$157.78	$157.78	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$41.75	$0.00	$0.00	$42.47	$0.00	$0.00	$0.00	$0.00	$0.00
325024S	SUP	HCPCS C1713		325024S  -  SCREW BONE 4MM 24MM 8MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN	BOTH IP/OP	$266.75 	$197.40	$0.00	$213.40	$120.04	$120.04	$0.00	$0.00	$0.00	$55.60	$197.98	$197.98	$0.00	$0.00	$55.59	$0.00	$157.78	$157.78	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$41.75	$0.00	$0.00	$42.47	$0.00	$0.00	$0.00	$0.00	$0.00
325026S	SUP	HCPCS C1713		325026S  -  SCREW BN P/T 4MM 26MM STRL 9MM ASNS III ST SLF DRL CNN SS	BOTH IP/OP	$266.75 	$197.40	$0.00	$213.40	$120.04	$120.04	$0.00	$0.00	$0.00	$55.60	$197.98	$197.98	$0.00	$0.00	$55.59	$0.00	$157.78	$157.78	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$41.75	$0.00	$0.00	$42.47	$0.00	$0.00	$0.00	$0.00	$0.00
325028S	SUP	HCPCS C1713		325028S  -  SCREW BN 4MM 28MM STRL 9.5MM ASNS III SLF DRL ST CNN SS HIP	BOTH IP/OP	$266.75 	$197.40	$0.00	$213.40	$120.04	$120.04	$0.00	$0.00	$0.00	$55.60	$197.98	$197.98	$0.00	$0.00	$55.59	$0.00	$157.78	$157.78	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$41.75	$0.00	$0.00	$42.47	$0.00	$0.00	$0.00	$0.00	$0.00
325030S	SUP	HCPCS C1713		325030S  -  SCREW BN P/T 4MM 30MM STRL ASNS III ST SLF DRL CNN SS HIP	BOTH IP/OP	$266.75 	$197.40	$0.00	$213.40	$120.04	$120.04	$0.00	$0.00	$0.00	$55.60	$197.98	$197.98	$0.00	$0.00	$55.59	$0.00	$157.78	$157.78	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$41.75	$0.00	$0.00	$42.47	$0.00	$0.00	$0.00	$0.00	$0.00
325210S	SUP	HCPCS C1713		325210S  -  SCREW BONE 4MM 10MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325212S	SUP	HCPCS C1713		325212S  -  SCREW BONE 4MM 12MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325214S	SUP	HCPCS C1713		325214S  -  SCREW BONE 4MM 14MM ASNS 3 SS FULTHRD CANN IMPL STRL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325216S	SUP	HCPCS C1713		325216S  -  SCREW BONE 4MM 16MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325218S	SUP	HCPCS C1713		325218S  -  SCREW BONE 4MM 18MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325220S	SUP	HCPCS C1713		325220S  -  SCREW BONE 4MM 20MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325222S	SUP	HCPCS C1713		325222S  -  SCREW BONE 4MM 22MM ASNS 3 SS FULTHRD CANN IMPL STRL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325224S	SUP	HCPCS C1713		325224S  -  SCREW BONE 4MM 24MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325226S	SUP	HCPCS C1713		325226S  -  SCREW BONE 4MM 26MM ASNS 3 SS FULTHD FEM HIP SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325228S	SUP	HCPCS C1713		325228S  -  SCREW BONE 4MM 28MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325230S	SUP	HCPCS C1713		325230S  -  SCREW BONE 4MM 30MM ASNS 3 SS FULTHD FEM HIP SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325232S	SUP	HCPCS C1713		325232S  -  SCREW BONE 4MM 32MM ASNS 3 SS CANN	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325234S	SUP	HCPCS C1713		325234S  -  SCREW BONE 4MM 34MM ASNS 3 SS FULTHD FEM HIP SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325236S	SUP	HCPCS C1713		325236S  -  SCREW BONE 4MM 36MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325238S	SUP	HCPCS C1713		325238S  -  SCREW BONE 4MM 38MM ASNS 3 SS FULTHD FEM HIP SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325240S	SUP	HCPCS C1713		325240S  -  SCREW BONE 4MM 40MM ASNS 3 SS FULTHD HIP CANN SLFTAP	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325242S	SUP	HCPCS C1713		325242S  -  SCREW BONE 4MM 42MM ASNS 3 SS CANN	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325244S	SUP	HCPCS C1713		325244S  -  SCREW BONE 4MM 44MM ASNS 3 SS FULTHD HIP CANN SLFTAP	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325246S	SUP	HCPCS C1713		325246S  -  SCREW BONE 4MM 46MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325248S	SUP	HCPCS C1713		325248S  -  SCREW BONE 4MM 48MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325250S	SUP	HCPCS C1713		325250S  -  SCREW BONE 4MM 50MM ASNS 3 SS PTHRD HIP CANN STRL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
325260S	SUP	HCPCS C1713		325260S  -  SCREW BONE 6.5MM 60MM ASNS 3 SS HIP CANN STRL	BOTH IP/OP	$242.25 	$179.27	$0.00	$179.80	$92.81	$92.81	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
325265S	SUP	HCPCS C1713		325265S  -  SCREW BONE 6.5MM 65MM ASNS 3 SS HIP CANN STRL	BOTH IP/OP	$206.25 	$152.63	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$42.99	$153.08	$153.08	$0.00	$0.00	$42.98	$0.00	$122.00	$122.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
325270S	SUP	HCPCS C1713		325270S  -  SCREW BONE 6.5MM 70MM ASNS 3 SS HIP CANN STRL	BOTH IP/OP	$206.25 	$152.63	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$42.99	$153.08	$153.08	$0.00	$0.00	$42.98	$0.00	$122.00	$122.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
325422S	SUP	HCPCS C1713		325422S  -  SCREW BONE 5MM 22MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325424S	SUP	HCPCS C1713		325424S  -  SCREW BONE 5MM 24MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325426S	SUP	HCPCS C1713		325426S  -  SCREW BONE 5MM 26MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325428S	SUP	HCPCS C1713		325428S  -  SCREW BONE 5MM 28MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325430S	SUP	HCPCS C1713		325430S  -  SCREW BONE 5MM 30MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325432S	SUP	HCPCS C1713		325432S  -  SCREW BONE 5MM 32MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325434S	SUP	HCPCS C1713		325434S  -  SCREW BONE 5MM 34MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325436S	SUP	HCPCS C1713		325436S  -  SCREW BONE 5MM 36MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325438S	SUP	HCPCS C1713		325438S  -  SCREW BONE 5MM 38MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325440S	SUP	HCPCS C1713		325440S  -  SCREW BONE 5MM 40MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325442S	SUP	HCPCS C1713		325442S  -  SCREW BONE 5MM 42MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325444S	SUP	HCPCS C1713		325444S  -  SCREW BONE 5MM 44MM ASNS 3 SS CANN	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325446S	SUP	HCPCS C1713		325446S  -  SCREW BONE 5MM 46MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325448S	SUP	HCPCS C1713		325448S  -  SCREW BONE 5MM 48MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325450S	SUP	HCPCS C1713		325450S  -  SCREW BONE 5MM 50MM 17MM ASNS 3 SS CANN PTHRD SLFDRILL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325455S	SUP	HCPCS C1713		325455S  -  SCREW BONE 5MM 55MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325460S	SUP	HCPCS C1713		325460S  -  SCREW BONE 5MM 60MM ASNS 3 SS PTHRD HIP CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325465S	SUP	HCPCS C1713		325465S  -  SCREW BONE 5MM 65MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325470S	SUP	HCPCS C1713		325470S  -  SCREW BONE 5MM 70MM ASNS 3 SS ORTH CANN PTHRD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325475S	SUP	HCPCS C1713		325475S  -  SCREW BONE 5MM 75MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325480S	SUP	HCPCS C1713		325480S  -  SCREW BONE 5MM 80MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325620S	SUP	HCPCS C1713		325620S  -  SCREW BONE 5MM 20MM ASNS 3 SS CANN	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325622S	SUP	HCPCS C1713		325622S  -  SCREW BONE 5MM 22MM ASNS 3 SS FULTHRD CANN SLFDRILL SLFTAP	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325624S	SUP	HCPCS C1713		325624S  -  SCREW BONE 5MM 24MM ASNS 3 SS FULTHD CANN SLFDRILL TAP	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325626S	SUP	HCPCS C1713		325626S  -  SCREW BONE 5MM 26MM ASNS 3 SS FULTHD ORTH CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325628S	SUP	HCPCS C1713		325628S  -  SCREW BONE 5MM 28MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325630S	SUP	HCPCS C1713		325630S  -  SCREW BONE 5MM 30MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325632S	SUP	HCPCS C1713		325632S  -  SCREW BONE 5MM 32MM ASNS 3 SS FULTHD ORTH CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325634S	SUP	HCPCS C1713		325634S  -  SCREW BONE 5MM 34MM ASNS 3 SS FULTHD ORTH CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325636S	SUP	HCPCS C1713		325636S  -  SCREW BONE 5MM 36MM SS FULTHRD IMPL STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325638S	SUP	HCPCS C1713		325638S  -  SCREW BONE 5MM 38MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325640S	SUP	HCPCS C1713		325640S  -  SCREW BONE 5MM 40MM ASNS 3 SS FULTHD ORTH CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325642S	SUP	HCPCS C1713		325642S  -  SCREW BONE 5MM 42MM ASNS 3 SS FULTHD ORTH CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325644S	SUP	HCPCS C1713		325644S  -  SCREW BONE 5MM 44MM ASNS 3 SS FULTHD ORTH CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325646S	SUP	HCPCS C1713		325646S  -  SCREW BONE 5MM 46MM ASNS 3 SS FULTHD ORTH CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325650S	SUP	HCPCS C1713		325650S  -  SCREW BONE 5MM 50MM ASNS 3 SS FULTHD ORTH CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325655S	SUP	HCPCS C1713		325655S  -  SCREW BONE 5MM 55MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325660S	SUP	HCPCS C1713		325660S  -  SCREW BONE 5MM 60MM ASNS 3 SS FULTHD ORTH CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325665S	SUP	HCPCS C1713		325665S  -  SCREW BONE 5MM 65MM ASNS 3 SS FULTHD ORTH CANN STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
325670S	SUP	HCPCS C1713		325670S  -  SCREW BONE 5MM 70MM ASNS 3 SS ORTH CANN FULTHD STRL	BOTH IP/OP	$299.75 	$221.82	$0.00	$239.80	$134.89	$134.89	$0.00	$0.00	$0.00	$62.48	$222.47	$222.47	$0.00	$0.00	$62.47	$0.00	$177.30	$177.30	$0.00	$149.88	$237.40	$239.80	$0.00		$0.00	$46.91	$0.00	$0.00	$47.72	$0.00	$0.00	$0.00	$0.00	$0.00
326040S	SUP	HCPCS C1713		326040S  -  SCREW BONE 6.5MM 40MM 20MM ASNS 3 SS ORTH SLFTAP SLFDRILL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326045S	SUP	HCPCS C1713		326045S  -  SCREW BONE 6.5MM 45MM ASNS 3 SS ORTH CANN THRD STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326050S	SUP	HCPCS C1713		326050S  -  SCREW BONE 6.5MM 50MM ASNS 3 SS ORTH CANN THRD STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326055S	SUP	HCPCS C1713		326055S  -  SCREW BONE 6.5MM 55MM ASNS 3 SS ORTH CANN THRD STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326060S	SUP	HCPCS C1713		326060S  -  SCREW BONE 6.5MM 60MM 20MM ASNS 3 SS HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326065S	SUP	HCPCS C1713		326065S  -  SCREW BONE 6.5MM 65MM ASNS 3 SS ORTH CANN THRD STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326070S	SUP	HCPCS C1713		326070S  -  SCREW BONE 6.5MM 70MM 20MM ASNS SS HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326075S	SUP	HCPCS C1713		326075S  -  SCREW BONE 6.5MM 75MM 20MM ASNS SS HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326080S	SUP	HCPCS C1713		326080S  -  SCREW BONE 6.5MM 80MM 20MM ASNS 3 SS HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326085S	SUP	HCPCS C1713		326085S  -  SCREW BONE 6.5MM 85MM 20MM ASNS 3 SS ORTH CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326090S	SUP	HCPCS C1713		326090S  -  SCREW BONE 6.5MM 90MM 20MM ASNS 3 SS ORTH CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326095S	SUP	HCPCS C1713		326095S  -  SCREW BONE 6.5MM 95MM 20MM ASNS 3 SS ORTH CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326100S	SUP	HCPCS C1713		326100S  -  SCREW BONE 6.5MM 100MM 20MM ASNS 3 SS HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326105S	SUP	HCPCS C1713		326105S  -  SCREW BONE 6.5MM 105MM 20MM ASNS 3 SS ORTH CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326110S	SUP	HCPCS C1713		326110S  -  SCREW BONE 6.5MM 110MM 20MM ASNS SS FEM HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326115S	SUP	HCPCS C1713		326115S  -  SCREW BONE 6.5MM 115MM 20MM ASNS 3 SS HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326120S	SUP	HCPCS C1713		326120S  -  SCREW BONE 6.5MM 120MM 20MM ASNS 3 SS ORTH SLFTAP SLFDRILL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326255S	SUP	HCPCS C1713		326255S  -  SCREW BONE 6.5MM 55MM 40MM ASNS 3 SS ORTH CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326260S	SUP	HCPCS C1713		326260S  -  SCREW BONE 6.5MM 60MM 40MM ASNS 3 SS ORTH CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326265S	SUP	HCPCS C1713		326265S  -  SCREW BONE 6.5MM 65MM 40MM ASNS SS HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326270S	SUP	HCPCS C1713		326270S  -  SCREW BONE 6.5MM 70MM 40MM ASNS SS PTHRD ORTH CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326275S	SUP	HCPCS C1713		326275S  -  SCREW BONE 6.5MM 75MM 40MM ASNS 3 SS ORTH SLFTAP SLFDRILL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326280S	SUP	HCPCS C1713		326280S  -  SCREW BONE 6.5MM 80MM 40MM ASNS 3 SS PTHRD HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326285S	SUP	HCPCS C1713		326285S  -  SCREW BONE 6.5MM 85MM 40MM ASNS 3 SS HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326290S	SUP	HCPCS C1713		326290S  -  SCREW BONE 6.5MM 90MM 40MM ASNS 3 SS HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326295S	SUP	HCPCS C1713		326295S  -  SCREW BONE 6.5MM 95MM 20MM ASNS 3 SS HIP CANN THRD IMPL STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326300S	SUP	HCPCS C1713		326300S  -  SCREW BONE 6.5MM 100MM 40MM ASNS 3 SS HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326305S	SUP	HCPCS C1713		326305S  -  SCREW BONE 6.5MM 105MM 40MM ASNS SS FEM HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326310S	SUP	HCPCS C1713		326310S  -  SCREW BONE 6.5MM 110MM 40MM ASNS SS CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326315S	SUP	HCPCS C1713		326315S  -  SCREW BONE 6.5MM 115MM 40MM ASNS SS CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326320S	SUP	HCPCS C1713		326320S  -  SCREW BONE 6.5MM 120MM 40MM ASNS SS CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326325S	SUP	HCPCS C1713		326325S  -  ASNIS III SS CANN SCR6.5X125MM	BOTH IP/OP	$436.90 	$323.31	$0.00	$352.00	$198.00	$198.00	$0.00	$0.00	$0.00	$91.06	$324.27	$324.27	$0.00	$0.00	$91.05	$0.00	$258.43	$258.43	$0.00	$220.00	$348.48	$352.00	$0.00		$0.00	$68.86	$0.00	$0.00	$70.05	$0.00	$0.00	$0.00	$0.00	$0.00
326330S	SUP	HCPCS C1713		326330S  -  ASNIS III SS CANN SCR6.5X130MM	BOTH IP/OP	$436.90 	$323.31	$0.00	$352.00	$198.00	$198.00	$0.00	$0.00	$0.00	$91.06	$324.27	$324.27	$0.00	$0.00	$91.05	$0.00	$258.43	$258.43	$0.00	$220.00	$348.48	$352.00	$0.00		$0.00	$68.86	$0.00	$0.00	$70.05	$0.00	$0.00	$0.00	$0.00	$0.00
326430S	SUP	HCPCS C1713		326430S  -  SCREW BONE 6.5MM 30MM ASNS 3 SS FULTHRD CANN SLFDRILL SLFTAP	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326435S	SUP	HCPCS C1713		326435S  -  SCREW BONE 6.5MM 35MM ASNS 3 TI FULTHRD CANN SLFDRILL SLFTAP	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326440S	SUP	HCPCS C1713		326440S  -  SCREW BONE 6.5MM 40MM ASNS 3 SS FULTHRD CANN SLFDRILL SLFTAP	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326445S	SUP	HCPCS C1713		326445S  -  SCREW BONE 6.5MM 45MM ASNS 3 SS CANN FULTHD SLFDRILL SLFTAP	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326450S	SUP	HCPCS C1713		326450S  -  SCREW BONE 6.5MM 50MM ASNS 3 SS ORTH CANN FULTHD STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326455S	SUP	HCPCS C1713		326455S  -  SCREW BONE 6.5MM 55MM ASNS 3 SS CANN	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326460S	SUP	HCPCS C1713		326460S  -  SCREW BONE 6.5MM 60MM ASNS 3 SS CANN	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326465S	SUP	HCPCS C1713		326465S  -  SCREW BONE 6.5MM 65MM ASNS 3 SS CANN FULTHD SLFDRILL SLFTAP	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326470S	SUP	HCPCS C1713		326470S  -  SCREW BONE 6.5MM 70MM ASNS 3 SS FULTHD CANN SLFDRILL SLFTAP	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326475S	SUP	HCPCS C1713		326475S  -  SCREW BONE 6.5MM 75MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326480S	SUP	HCPCS C1713		326480S  -  SCREW BONE 6.5MM 80MM ASNS 3 SS FULTHD ORTH CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326485S	SUP	HCPCS C1713		326485S  -  SCREW BONE 6.5MM 85MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326490S	SUP	HCPCS C1713		326490S  -  SCREW BONE 6.5MM 90MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326495S	SUP	HCPCS C1713		326495S  -  SCREW BONE 6.5MM 95MM ASNS 3 SS FULTHD ORTH CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326500S	SUP	HCPCS C1713		326500S  -  SCREW BONE 6.5MM 100MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326505S	SUP	HCPCS C1713		326505S  -  SCREW BONE 6.5MM 105MM ASNS 3 SS FULTHD SLFTAP SLFDRILL CANN	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326510S	SUP	HCPCS C1713		326510S  -  SCREW BONE 6.5MM 110MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326515S	SUP	HCPCS C1713		326515S  -  SCREW BONE 6.5MM 115MM ASNS 3 SS FULTHD SLFTAP SLFDRILL CANN	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326520S	SUP	HCPCS C1713		326520S  -  SCREW BONE 6.5MM 120MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
326525S	SUP	HCPCS C1713		326525S  -  SCREW BONE 6.5MM 125MM ASNS 3 SS FULTHRD CANN STRL	BOTH IP/OP	$385.50 	$285.27	$0.00	$297.00	$167.06	$167.06	$0.00	$0.00	$0.00	$80.35	$286.12	$286.12	$0.00	$0.00	$80.34	$0.00	$228.02	$228.02	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$58.10	$0.00	$0.00	$59.10	$0.00	$0.00	$0.00	$0.00	$0.00
326530S	SUP	HCPCS C1713		326530S  -  SCREW BONE 6.5MM 130MM ASNS 3 SS FULTHRD STRL	BOTH IP/OP	$385.50 	$285.27	$0.00	$297.00	$167.06	$167.06	$0.00	$0.00	$0.00	$80.35	$286.12	$286.12	$0.00	$0.00	$80.34	$0.00	$228.02	$228.02	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$58.10	$0.00	$0.00	$59.10	$0.00	$0.00	$0.00	$0.00	$0.00
326640S	SUP	HCPCS C1713		326640S  -  SCREW BONE 8MM 40MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326645S	SUP	HCPCS C1713		326645S  -  SCREW BONE 8MM 45MM 25MM ASNS SS CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326650S	SUP	HCPCS C1713		326650S  -  SCREW BONE 8MM 50MM 25MM ASNS SS CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326655S	SUP	HCPCS C1713		326655S  -  SCREW BONE 8MM 55MM 25MM ASNS 3 SS ORTH CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326660S	SUP	HCPCS C1713		326660S  -  SCREW BONE 8MM 60MM 25MM ASNS SS CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326665S	SUP	HCPCS C1713		326665S  -  SCREW BONE 8MM 65MM 25MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326670S	SUP	HCPCS C1713		326670S  -  SCREW BONE 8MM 70MM 25MM ASNS 3 SS CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326675S	SUP	HCPCS C1713		326675S  -  SCREW BONE 8MM 75MM 25MM ASNS SS CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326680S	SUP	HCPCS C1713		326680S  -  SCREW BONE 8MM 80MM 25MM ASNS 3 SS CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326685S	SUP	HCPCS C1713		326685S  -  SCREW BONE 8MM 85MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326690S	SUP	HCPCS C1713		326690S  -  SCREW BONE 8MM 90MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326695S	SUP	HCPCS C1713		326695S  -  SCREW BONE 8MM 95MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326700S	SUP	HCPCS C1713		326700S  -  SCREW BONE 8MM 100MM 25MM ASNS SS THRD CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326705S	SUP	HCPCS C1713		326705S  -  SCREW BONE 8MM 105MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326710S	SUP	HCPCS C1713		326710S  -  SCREW BONE 8MM 110MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326715S	SUP	HCPCS C1713		326715S  -  SCREW BONE 8MM 115MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326720S	SUP	HCPCS C1713		326720S  -  SCREW BONE 8MM 120MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326725S	SUP	HCPCS C1713		326725S  -  SCREW BONE 8MM 125MM 25MM ASNS 3 SS HIP STRL	BOTH IP/OP	$436.90 	$323.31	$0.00	$583.00	$327.94	$327.94	$0.00	$0.00	$0.00	$91.06	$324.27	$324.27	$0.00	$0.00	$91.05	$0.00	$258.43	$258.43	$0.00	$364.38	$577.17	$583.00	$0.00		$0.00	$114.05	$0.00	$0.00	$116.02	$0.00	$0.00	$0.00	$0.00	$0.00
326730S	SUP	HCPCS C1713		326730S  -  SCREW BONE 8MM 135MM 25MM ASNS 3 SS THRD STRL	BOTH IP/OP	$436.90 	$323.31	$0.00	$583.00	$327.94	$327.94	$0.00	$0.00	$0.00	$91.06	$324.27	$324.27	$0.00	$0.00	$91.05	$0.00	$258.43	$258.43	$0.00	$364.38	$577.17	$583.00	$0.00		$0.00	$114.05	$0.00	$0.00	$116.02	$0.00	$0.00	$0.00	$0.00	$0.00
326840S	SUP	HCPCS C1713		326840S  -  SCREW BONE 8MM 40MM ASNS 3 SS FULTHD SLFTAP SLFDRILL CANN	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326845S	SUP	HCPCS C1713		326845S  -  SCREW BONE 8MM 45MM ASNS 3 SS FULTHD CANN SLFDRILL SLFTAP	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326850S	SUP	HCPCS C1713		326850S  -  SCREW BONE 8MM 50MM ASNS 3 SS CANN	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326855S	SUP	HCPCS C1713		326855S  -  SCREW BONE 8MM 55MM ASNS 3 SS FULTHD CANN SLFDRILL SLFTAP	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326860S	SUP	HCPCS C1713		326860S  -  SCREW BONE 8MM 60MM ASNS 3 SS FULTHD SLFTAP SLFDRILL CANN	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326865S	SUP	HCPCS C1713		326865S  -  SCREW BONE 8MM 65MM ASNS 3 SS CANN	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326870S	SUP	HCPCS C1713		326870S  -  SCREW BONE 8MM 70MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326875S	SUP	HCPCS C1713		326875S  -  SCREW BONE 8MM 75MM ASNS 3 SS FULTHD SLFTAP SLFDRILL CANN	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326880S	SUP	HCPCS C1713		326880S  -  SCREW BONE 8MM 80MM ASNS 3 SS FULTHD CANN SLFDRILL SLFTAP	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326885S	SUP	HCPCS C1713		326885S  -  SCREW BONE 8MM 85MM ASNS 3 TI ORTH CANN PTHRD STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326890S	SUP	HCPCS C1713		326890S  -  SCREW BONE 8MM 90MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326895S	SUP	HCPCS C1713		326895S  -  SCREW BONE 8MM 95MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326900S	SUP	HCPCS C1713		326900S  -  SCREW BONE 8MM 100MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326905S	SUP	HCPCS C1713		326905S  -  SCREW BONE 8MM 105MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326910S	SUP	HCPCS C1713		326910S  -  SCREW BONE 8MM 110MM ASNS 3 SS FULTHD HIP CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326915S	SUP	HCPCS C1713		326915S  -  SCREW BONE 8MM 115MM ASNS 3 SS FEM HIP CANN STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326920S	SUP	HCPCS C1713		326920S  -  SCREW BONE 8MM 120MM ASNS 3 TI ORTH CANN PTHRD STRL	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$173.25	$173.25	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
326925S	SUP	HCPCS C1713		326925S  -  SCREW BONE 8MM 125MM ASNS 3 SS FULTHRD STRL	BOTH IP/OP	$385.50 	$285.27	$0.00	$302.50	$170.16	$170.16	$0.00	$0.00	$0.00	$80.35	$286.12	$286.12	$0.00	$0.00	$80.34	$0.00	$228.02	$228.02	$0.00	$189.06	$299.48	$302.50	$0.00		$0.00	$59.18	$0.00	$0.00	$60.20	$0.00	$0.00	$0.00	$0.00	$0.00
326930S	SUP	HCPCS C1713		326930S  -  SCREW BONE 8MM 130MM ASNS 3 SS FULTHRD CANN STRL	BOTH IP/OP	$385.50 	$285.27	$0.00	$302.50	$170.16	$170.16	$0.00	$0.00	$0.00	$80.35	$286.12	$286.12	$0.00	$0.00	$80.34	$0.00	$228.02	$228.02	$0.00	$189.06	$299.48	$302.50	$0.00		$0.00	$59.18	$0.00	$0.00	$60.20	$0.00	$0.00	$0.00	$0.00	$0.00
327-1010	SUP	HCPCS C1713		327-1010  -  SCREW BN 2.7MM 10MM ST CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
327-1012	SUP	HCPCS C1713		327-1012  -  SCREW BN 2.7MM 12MM ST CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
327-1014	SUP	HCPCS C1713		327-1014  -  SCREW BN 2.7MM 14MM ST CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
327-1016	SUP	HCPCS C1713		327-1016  -  SCREW BN 2.7MM 16MM ST CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
327-1018	SUP	HCPCS C1713		327-1018  -  SCREW BN 2.7MM 18MM ST CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
327-1020	SUP	HCPCS C1713		327-1020  -  SCREW BN 2.7MM 20MM ST CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
327-1022	SUP	HCPCS C1713		327-1022  -  SCREW BN 2.7MM 22MM ST CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
327-1024	SUP	HCPCS C1713		327-1024  -  SCREW BN 2.7MM 24MM ST CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
327-1026	SUP	HCPCS C1713		327-1026  -  SCREW BN 2.7MM 26MM ST CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
327-1028	SUP	HCPCS C1713		327-1028  -  SCREW BN 2.7MM 28MM ST CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
327-1030	SUP	HCPCS C1713		327-1030  -  SCREW BN 2.7MM 30MM ST CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
327-1032	SUP	HCPCS C1713		327-1032  -  SCREW BN 2.7MM 32MM ST CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
3300TFX19MM	SUP	Custom 27803010		3300TFX19MM  -  VALVE AOR LOPRFL 19MM CRP-ED PRIMNT MG EASE BPRTH THERMAFIX	BOTH IP/OP	"$22,275.00 "	"$16,483.50"	$0.00	"$17,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,642.11"	$0.00	$0.00	$0.00	$0.00	"$11,137.50"	"$17,641.80"	"$17,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3300TFX21MM	SUP	Custom 27803010		3300TFX21MM  -  VALVE AOR 21MM CRP-ED PRIMNT MG EASE THERMAFIX BPRTH SUP	BOTH IP/OP	"$22,275.00 "	"$16,483.50"	$0.00	"$17,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,642.11"	$0.00	$0.00	$0.00	$0.00	"$11,137.50"	"$17,641.80"	"$17,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3300TFX23MM	SUP	Custom 27803010		3300TFX23MM  -  VALVE AOR 23MM CRP-ED PRIMNT MG EASE THERMAFIX BPRTH STNT BS	BOTH IP/OP	"$22,275.00 "	"$16,483.50"	$0.00	"$17,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,642.11"	$0.00	$0.00	$0.00	$0.00	"$11,137.50"	"$17,641.80"	"$17,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3300TFX25MM	SUP	Custom 27803010		3300TFX25MM  -  VALVE AORTIC LP 25MM BIOPROSTHESIS THERMAFIX PROCESS STENT	BOTH IP/OP	"$22,275.00 "	"$16,483.50"	$0.00	"$17,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,642.11"	$0.00	$0.00	$0.00	$0.00	"$11,137.50"	"$17,641.80"	"$17,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3300TFX27MM	SUP	Custom 27803010		3300TFX27MM  -  VALVE AORTIC LP 27MM BIOPROSTHESIS THERMAFIX PROCESS STENT	BOTH IP/OP	"$22,275.00 "	"$16,483.50"	$0.00	"$17,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,642.11"	$0.00	$0.00	$0.00	$0.00	"$11,137.50"	"$17,641.80"	"$17,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3300TFX29MM	SUP	Custom 27803010		3300TFX29MM  -  VALVE AOR LOPRFL 29MM CRP-ED PRIMNT MG EASE BPRTH THERMAFIX	BOTH IP/OP	"$22,275.00 "	"$16,483.50"	$0.00	"$17,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,642.11"	$0.00	$0.00	$0.00	$0.00	"$11,137.50"	"$17,641.80"	"$17,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3304-G	SUP	Custom 27203010		3304-G  -  RING RTRCTR LNSTR NORYL RSN PLST CATH CLIP DISP STRL LATEX	BOTH IP/OP	$110.00 	$81.40	$0.00	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.64	$81.64	$0.00	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3307-G	SUP	Custom 27203010		3307-G  -  RING RTRCTR SM G2 NORYL RSN W/O STAY KIT RCTL BLUE DISP STRL	BOTH IP/OP	$121.28 	$89.75	$0.00	$97.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.64	$96.05	$97.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
331 443	SUP	HCPCS C1900		331 443  -  PHILOS DR	BOTH IP/OP	"$7,250.00 "	"$5,365.00"	$0.00	"$5,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,625.00"	"$5,742.00"	"$5,800.00"	$0.00		$0.00	"$1,134.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
331 446	SUP	HCPCS C1900		331 446  -  PHILOS SR	BOTH IP/OP	"$7,000.00 "	"$5,180.00"	$0.00	"$5,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,500.00"	"$5,544.00"	"$5,600.00"	$0.00		$0.00	"$1,095.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3320-0240S	SUP	HCPCS C1713		3320-0240S  -  NAIL 11MM 240MM LEFT FEM HIP GAMMA3 IM 120D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3320-0260S	SUP	HCPCS C1713		3320-0260S  -  NAIL 11MM 260MM LEFT FEM HIP GAMMA3 IM 120D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3320-0280S	SUP	HCPCS C1713		3320-0280S  -  NAIL 11MM 28CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3320-0300S	SUP	HCPCS C1713		3320-0300S  -  NAIL 11MM 30CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3320-0320S	SUP	HCPCS C1713		3320-0320S  -  NAIL 11MM 32CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3320-0340S	SUP	HCPCS C1713		3320-0340S  -  NAIL 11MM 34CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3320-0360S	SUP	HCPCS C1713		3320-0360S  -  NAIL 11MM 36CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3320-0380S	SUP	HCPCS C1713		3320-0380S  -  NAIL 11MM 38CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3320-0400S	SUP	HCPCS C1713		3320-0400S  -  NAIL 11MM 40CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3320-0420S	SUP	HCPCS C1713		3320-0420S  -  NAIL 11MM 42CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3320-0440S	SUP	HCPCS C1713		3320-0440S  -  NAIL 11MM 44CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3320-0460S	SUP	HCPCS C1713		3320-0460S  -  NAIL 11MM 46CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3320-3340S	SUP	HCPCS C1713		3320-3340S  -  NAIL 13MM 34CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-3360S	SUP	HCPCS C1713		3320-3360S  -  NAIL 13MM 36CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-3380S	SUP	HCPCS C1713		3320-3380S  -  NAIL 13MM 38CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-3400S	SUP	HCPCS C1713		3320-3400S  -  NAIL 13MM 40CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-3420S	SUP	HCPCS C1713		3320-3420S  -  NAIL 13MM 42CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-3440S	SUP	HCPCS C1713		3320-3440S  -  NAIL 13MM 46CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-3460S	SUP	HCPCS C1713		3320-3460S  -  NAIL 13MM 44CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-5340S	SUP	HCPCS C1713		3320-5340S  -  NAIL 15MM 34CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-5360S	SUP	HCPCS C1713		3320-5360S  -  NAIL 15MM 36CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-5380S	SUP	HCPCS C1713		3320-5380S  -  NAIL 15MM 38CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-5400S	SUP	HCPCS C1713		3320-5400S  -  NAIL 15MM 40CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-5420S	SUP	HCPCS C1713		3320-5420S  -  NAIL 15MM 42CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-5440S	SUP	HCPCS C1713		3320-5440S  -  NAIL 15MM 44CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3320-5460S	SUP	HCPCS C1713		3320-5460S  -  NAIL 15MM 46CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-0240S	SUP	HCPCS C1713		3325-0240S  -  NAIL 11MM 240MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3325-0260S	SUP	HCPCS C1713		3325-0260S  -  NAIL 11MM 260MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL	BOTH IP/OP	"$2,688.13 "	"$1,989.22"	$0.00	"$2,150.50"	"$1,209.66"	"$1,209.66"	$0.00	$0.00	$0.00	$560.27	"$1,995.13"	"$1,995.13"	$0.00	$0.00	$560.21	$0.00	"$1,325.25"	"$1,325.25"	$0.00	"$1,344.06"	"$2,129.00"	"$2,150.50"	$0.00		$0.00	$420.69	$0.00	$0.00	$427.95	$0.00	$0.00	$0.00	$0.00	$0.00
3325-0280S	SUP	HCPCS C1713		3325-0280S  -  NAIL 11MM 28CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3325-0300S	SUP	HCPCS C1713		3325-0300S  -  NAIL 11MM 30CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3325-0320S	SUP	HCPCS C1713		3325-0320S  -  NAIL 11MM 32CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3325-0340S	SUP	HCPCS C1713		3325-0340S  -  NAIL 11MM 34CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3325-0360S	SUP	HCPCS C1713		3325-0360S  -  NAIL 11MM 36CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3325-0380S	SUP	HCPCS C1713		3325-0380S  -  NAIL 11MM 38CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3325-0400S	SUP	HCPCS C1713		3325-0400S  -  NAIL 11MM 40CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3325-0420S	SUP	HCPCS C1713		3325-0420S  -  NAIL 11MM 42CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3325-0440S	SUP	HCPCS C1713		3325-0440S  -  NAIL 11MM 44CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3325-0460S	SUP	HCPCS C1713		3325-0460S  -  NAIL 11MM 46CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3325-3280S	SUP	HCPCS C1713		3325-3280S  -  NAIL 13MM 280MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3325-3300S	SUP	HCPCS C1713		3325-3300S  -  NAIL 13MM 30CM HIP LEFT GAMMA3 IM 125D LNG TI STRL	BOTH IP/OP	"$2,688.13 "	"$1,989.22"	$0.00	"$2,150.50"	"$1,209.66"	"$1,209.66"	$0.00	$0.00	$0.00	$560.27	"$1,995.13"	"$1,995.13"	$0.00	$0.00	$560.21	$0.00	"$1,325.25"	"$1,325.25"	$0.00	"$1,344.06"	"$2,129.00"	"$2,150.50"	$0.00		$0.00	$420.69	$0.00	$0.00	$427.95	$0.00	$0.00	$0.00	$0.00	$0.00
3325-3320S	SUP	HCPCS C1713		3325-3320S  -  NAIL 13MM 32CM LEFT FEM HIP GAMMA3 IM 125D LNG STRL	BOTH IP/OP	"$2,688.13 "	"$1,989.22"	$0.00	"$2,150.50"	"$1,209.66"	"$1,209.66"	$0.00	$0.00	$0.00	$560.27	"$1,995.13"	"$1,995.13"	$0.00	$0.00	$560.21	$0.00	"$1,325.25"	"$1,325.25"	$0.00	"$1,344.06"	"$2,129.00"	"$2,150.50"	$0.00		$0.00	$420.69	$0.00	$0.00	$427.95	$0.00	$0.00	$0.00	$0.00	$0.00
3325-3340S	SUP	HCPCS C1713		3325-3340S  -  NAIL 13MM 34CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-3360S	SUP	HCPCS C1713		3325-3360S  -  NAIL 13MM 36CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-3380S	SUP	HCPCS C1713		3325-3380S  -  NAIL 13MM 38CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-3400S	SUP	HCPCS C1713		3325-3400S  -  NAIL 13MM 40CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-3420S	SUP	HCPCS C1713		3325-3420S  -  NAIL 13MM 42CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-3440S	SUP	HCPCS C1713		3325-3440S  -  NAIL 13MM 44CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-3460S	SUP	HCPCS C1713		3325-3460S  -  NAIL 13MM 46CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-5280S	SUP	HCPCS C1713		3325-5280S  -  NAIL 15MM 280MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3325-5300S	SUP	HCPCS C1713		3325-5300S  -  NAIL 15MM 300MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3325-5320S	SUP	HCPCS C1713		3325-5320S  -  NAIL 15MM 320MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3325-5340S	SUP	HCPCS C1713		3325-5340S  -  NAIL 15MM 34CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-5360S	SUP	HCPCS C1713		3325-5360S  -  NAIL 15MM 36CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-5380S	SUP	HCPCS C1713		3325-5380S  -  NAIL 15MM 38CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-5400S	SUP	HCPCS C1713		3325-5400S  -  NAIL 15MM 40CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-5420S	SUP	HCPCS C1713		3325-5420S  -  NAIL 15MM 42CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-5440S	SUP	HCPCS C1713		3325-5440S  -  NAIL 15MM 44CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3325-5460S	SUP	HCPCS C1713		3325-5460S  -  NAIL 15MM 46CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-0240S	SUP	HCPCS C1713		3330-0240S  -  NAIL 11MM 240MM LEFT FEM HIP GAMMA3 IM 130D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3330-0260S	SUP	HCPCS C1713		3330-0260S  -  NAIL 11MM 260MM LEFT FEM HIP GAMMA3 IM 130D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3330-0280S	SUP	HCPCS C1713		3330-0280S  -  NAIL 11MM 28CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3330-0300S	SUP	HCPCS C1713		3330-0300S  -  NAIL 11MM 30CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3330-0320S	SUP	HCPCS C1713		3330-0320S  -  NAIL 11MM 32CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3330-0340S	SUP	HCPCS C1713		3330-0340S  -  NAIL 11MM 34CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3330-0360S	SUP	HCPCS C1713		3330-0360S  -  NAIL 11MM 36CM LEFT FEM HIP GAMMA3 IM 130D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3330-0380S	SUP	HCPCS C1713		3330-0380S  -  NAIL 11MM 38CM LEFT FEM HIP GAMMA3 IM 130D LNG KIT TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3330-0400S	SUP	HCPCS C1713		3330-0400S  -  NAIL 11MM 40CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3330-0420S	SUP	HCPCS C1713		3330-0420S  -  NAIL 11MM 42CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3330-0440S	SUP	HCPCS C1713		3330-0440S  -  NAIL 11MM 44CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,093.75 "	"$2,289.38"	$0.00	"$2,475.00"	"$1,392.19"	"$1,392.19"	$0.00	$0.00	$0.00	$644.81	"$2,296.18"	"$2,296.18"	$0.00	$0.00	$644.74	$0.00	"$1,525.22"	"$1,525.22"	$0.00	"$1,546.88"	"$2,450.25"	"$2,475.00"	$0.00		$0.00	$484.17	$0.00	$0.00	$492.53	$0.00	$0.00	$0.00	$0.00	$0.00
3330-0460S	SUP	HCPCS C1713		3330-0460S  -  NAIL 11MM 46CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$2,798.13 "	"$2,070.62"	$0.00	"$2,238.50"	"$1,259.16"	"$1,259.16"	$0.00	$0.00	$0.00	$583.20	"$2,076.77"	"$2,076.77"	$0.00	$0.00	$583.13	$0.00	"$1,379.48"	"$1,379.48"	$0.00	"$1,399.06"	"$2,216.12"	"$2,238.50"	$0.00		$0.00	$437.91	$0.00	$0.00	$445.46	$0.00	$0.00	$0.00	$0.00	$0.00
3330-3300S	SUP	HCPCS C1713		3330-3300S  -  NAIL 13MM 300MM LEFT FEM HIP GAMMA3 IM 130D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3330-3320S	SUP	HCPCS C1713		3330-3320S  -  NAIL 13MM 280MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL	BOTH IP/OP	"$2,447.50 "	"$1,811.15"	$0.00	"$1,958.00"	"$1,101.38"	"$1,101.38"	$0.00	$0.00	$0.00	$510.12	"$1,816.53"	"$1,816.53"	$0.00	$0.00	$510.06	$0.00	"$1,447.70"	"$1,447.70"	$0.00	"$1,223.75"	"$1,938.42"	"$1,958.00"	$0.00		$0.00	$383.03	$0.00	$0.00	$389.64	$0.00	$0.00	$0.00	$0.00	$0.00
3330-3340S	SUP	HCPCS C1713		3330-3340S  -  NAIL 13MM 34CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-3360S	SUP	HCPCS C1713		3330-3360S  -  NAIL 13MM 36CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-3380S	SUP	HCPCS C1713		3330-3380S  -  NAIL 13MM 38CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-3400S	SUP	HCPCS C1713		3330-3400S  -  NAIL 13MM 40CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-3420S	SUP	HCPCS C1713		3330-3420S  -  NAIL 13MM 42CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-3440S	SUP	HCPCS C1713		3330-3440S  -  NAIL 13MM 44CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-3460S	SUP	HCPCS C1713		3330-3460S  -  NAIL 13MM 46CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-5340S	SUP	HCPCS C1713		3330-5340S  -  NAIL 15MM 34CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-5360S	SUP	HCPCS C1713		3330-5360S  -  NAIL 15MM 36CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-5380S	SUP	HCPCS C1713		3330-5380S  -  NAIL 15MM 38CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-5400S	SUP	HCPCS C1713		3330-5400S  -  NAIL 15MM 40CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-5420S	SUP	HCPCS C1713		3330-5420S  -  NAIL 15MM 42CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-5440S	SUP	HCPCS C1713		3330-5440S  -  NAIL 15MM 44CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
3330-5460S	SUP	HCPCS C1713		3330-5460S  -  NAIL 15MM 46CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,293.13 "	"$2,436.92"	$0.00	"$2,634.50"	"$1,481.91"	"$1,481.91"	$0.00	$0.00	$0.00	$686.37	"$2,444.16"	"$2,444.16"	$0.00	$0.00	$686.29	$0.00	"$1,623.51"	"$1,623.51"	$0.00	"$1,646.56"	"$2,608.16"	"$2,634.50"	$0.00		$0.00	$515.37	$0.00	$0.00	$524.27	$0.00	$0.00	$0.00	$0.00	$0.00
333-070-003	SUP	Custom 27203010		333-070-003  -  OBT ENDSCP 70MM DRAIN CANNU	BOTH IP/OP	$203.06 	$150.26	$0.00	$162.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.71	$150.71	$0.00	$0.00	$42.32	$0.00	$0.00	$0.00	$0.00	$101.53	$160.82	$162.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
334 051	SUP	HCPCS C1900		334 051  -  PHILOS SR SYSTEM	BOTH IP/OP	"$8,000.00 "	"$5,920.00"	$0.00	"$6,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,000.00"	"$6,336.00"	"$6,400.00"	$0.00		$0.00	"$1,252.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
335-1012	SUP	HCPCS C1713		335-1012  -  SCREW BN 3.5MM 12MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1014	SUP	HCPCS C1713		335-1014  -  SCREW BN 3.5MM 14MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1016	SUP	HCPCS C1713		335-1016  -  SCREW BN 3.5MM 16MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1018	SUP	HCPCS C1713		335-1018  -  SCREW BN 3.5MM 18MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1020	SUP	HCPCS C1713		335-1020  -  SCREW BN 3.5MM 20MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1022	SUP	HCPCS C1713		335-1022  -  SCREW BN 3.5MM 22MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1024	SUP	HCPCS C1713		335-1024  -  SCREW BN 3.5MM 24MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1026	SUP	HCPCS C1713		335-1026  -  SCREW BN 3.5MM 26MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1028	SUP	HCPCS C1713		335-1028  -  SCREW BN 3.5MM 28MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1030	SUP	HCPCS C1713		335-1030  -  SCREW BN 3.5MM 30MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1032	SUP	HCPCS C1713		335-1032  -  SCREW BN 3.5MM 32MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1034	SUP	HCPCS C1713		335-1034  -  SCREW BN 3.5MM 34MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1036	SUP	HCPCS C1713		335-1036  -  SCREW BN 3.5MM 36MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1038	SUP	HCPCS C1713		335-1038  -  SCREW BN 3.5MM 38MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1040	SUP	HCPCS C1713		335-1040  -  SCREW BN 3.5MM 40MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1042	SUP	HCPCS C1713		335-1042  -  SCREW BN 3.5MM 42MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1044	SUP	HCPCS C1713		335-1044  -  SCREW BN 3.5MM 44MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1046	SUP	HCPCS C1713		335-1046  -  SCREW BN 3.5MM 46MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1048	SUP	HCPCS C1713		335-1048  -  SCREW BN 3.5MM 48MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1050	SUP	HCPCS C1713		335-1050  -  SCREW BN 3.5MM 50MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1055	SUP	HCPCS C1713		335-1055  -  SCREW BN 3.5MM 55MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
335-1060	SUP	HCPCS C1713		335-1060  -  SCREW BN 3.5MM 60MM NS ST SS CORT	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
3362-0-304	SUP	HCPCS C1713		3362-0-304  -  SDPLT BONE OMEGA+ 130D SHRT BRL HIP SS 4 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-0-305	SUP	HCPCS C1713		3362-0-305  -  SDPLT BONE OMEGA+ 130D SHRT BRL HIP SS 5 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-0-354	SUP	HCPCS C1713		3362-0-354  -  SDPLT BONE OMEGA+ 135D SHRT BRL HIP SS 4 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-0-355	SUP	HCPCS C1713		3362-0-355  -  SDPLT BONE OMEGA+ 135D SHRT BRL HIP SS 5 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-0-404	SUP	HCPCS C1713		3362-0-404  -  SDPLT BONE OMEGA+ 140D SHRT BRL HIP SS 4 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-0-405	SUP	HCPCS C1713		3362-0-405  -  SDPLT BONE OMEGA+ 140D SHRT BRL HIP SS 5 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-0-454	SUP	HCPCS C1713		3362-0-454  -  SDPLT BONE OMEGA+ 145D SHRT BRL HIP SS 4 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-0-455	SUP	HCPCS C1713		3362-0-455  -  SDPLT BONE OMEGA+ 145D SHRT BRL HIP SS 5 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-0-504	SUP	HCPCS C1713		3362-0-504  -  SDPLT BONE OMEGA+ 150D SHRT BRL HIP SS 4 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-0-505	SUP	HCPCS C1713		3362-0-505  -  SDPLT BONE OMEGA+ 150D SHRT BRL HIP SS 5 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-002	SUP	HCPCS C1713		3362-1-002  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 2 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-003	SUP	HCPCS C1713		3362-1-003  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 3 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-004	SUP	HCPCS C1713		3362-1-004  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 4 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-005	SUP	HCPCS C1713		3362-1-005  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 5 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-006	SUP	HCPCS C1713		3362-1-006  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 6 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-008	SUP	HCPCS C1713		3362-1-008  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 8 HOLE CMPR	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-010	SUP	HCPCS C1713		3362-1-010  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 10 HOLE CMPR	BOTH IP/OP	"$1,054.63 "	$780.43	$0.00	$843.70	$474.58	$474.58	$0.00	$0.00	$0.00	$219.81	$782.74	$782.74	$0.00	$0.00	$219.78	$0.00	$623.81	$623.81	$0.00	$527.31	$835.27	$843.70	$0.00		$0.00	$165.05	$0.00	$0.00	$167.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-012	SUP	HCPCS C1713		3362-1-012  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 12 HOLE CMPR	BOTH IP/OP	"$1,054.63 "	$780.43	$0.00	$843.70	$474.58	$474.58	$0.00	$0.00	$0.00	$219.81	$782.74	$782.74	$0.00	$0.00	$219.78	$0.00	$623.81	$623.81	$0.00	$527.31	$835.27	$843.70	$0.00		$0.00	$165.05	$0.00	$0.00	$167.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-102	SUP	HCPCS C1713		3362-1-102  -  SDPLT BONE OMEGA+ 135D HIP 2 HOLE	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-103	SUP	HCPCS C1713		3362-1-103  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 3 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-104	SUP	HCPCS C1713		3362-1-104  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 4 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-105	SUP	HCPCS C1713		3362-1-105  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 5 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-106	SUP	HCPCS C1713		3362-1-106  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 6 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-108	SUP	HCPCS C1713		3362-1-108  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 8 HOLE CMPR	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-110	SUP	HCPCS C1713		3362-1-110  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 10 HOLE CMPR	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-112	SUP	HCPCS C1713		3362-1-112  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 12 HOLE CMPR	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-202	SUP	HCPCS C1713		3362-1-202  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 2 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-203	SUP	HCPCS C1713		3362-1-203  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 3 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-204	SUP	HCPCS C1713		3362-1-204  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 4 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-205	SUP	HCPCS C1713		3362-1-205  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 5 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-206	SUP	HCPCS C1713		3362-1-206  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 6 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-208	SUP	HCPCS C1713		3362-1-208  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 8 HOLE CMPR	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-210	SUP	HCPCS C1713		3362-1-210  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 10 HOLE CMPR	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-212	SUP	HCPCS C1713		3362-1-212  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 12 HOLE CMPR	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-302	SUP	HCPCS C1713		3362-1-302  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 2 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-303	SUP	HCPCS C1713		3362-1-303  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 3 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-304	SUP	HCPCS C1713		3362-1-304  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 4 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-305	SUP	HCPCS C1713		3362-1-305  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 5 HOLE CMPR	BOTH IP/OP	$856.63 	$633.91	$0.00	$685.30	$385.48	$385.48	$0.00	$0.00	$0.00	$178.54	$635.79	$635.79	$0.00	$0.00	$178.52	$0.00	$506.69	$506.69	$0.00	$428.31	$678.45	$685.30	$0.00		$0.00	$134.06	$0.00	$0.00	$136.37	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-306	SUP	HCPCS C1713		3362-1-306  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 6 HOLE CMPR	BOTH IP/OP	$856.63 	$633.91	$0.00	$685.30	$385.48	$385.48	$0.00	$0.00	$0.00	$178.54	$635.79	$635.79	$0.00	$0.00	$178.52	$0.00	$506.69	$506.69	$0.00	$428.31	$678.45	$685.30	$0.00		$0.00	$134.06	$0.00	$0.00	$136.37	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-308	SUP	HCPCS C1713		3362-1-308  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 8 HOLE CMPR	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-310	SUP	HCPCS C1713		3362-1-310  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 10 HOLE CMPR	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-312	SUP	HCPCS C1713		3362-1-312  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 12 HOLE CMPR	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-402	SUP	HCPCS C1713		3362-1-402  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 2 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-403	SUP	HCPCS C1713		3362-1-403  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 3 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-404	SUP	HCPCS C1713		3362-1-404  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 4 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-405	SUP	HCPCS C1713		3362-1-405  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 5 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-406	SUP	HCPCS C1713		3362-1-406  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 6 HOLE CMPR	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-408	SUP	HCPCS C1713		3362-1-408  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 8 HOLE CMPR	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-410	SUP	HCPCS C1713		3362-1-410  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 10 HOLE CMPR	BOTH IP/OP	"$1,054.63 "	$780.43	$0.00	$843.70	$474.58	$474.58	$0.00	$0.00	$0.00	$219.81	$782.74	$782.74	$0.00	$0.00	$219.78	$0.00	$623.81	$623.81	$0.00	$527.31	$835.27	$843.70	$0.00		$0.00	$165.05	$0.00	$0.00	$167.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-1-412	SUP	HCPCS C1713		3362-1-412  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 12 HOLE CMPR	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-002	SUP	HCPCS C1713		3362-3-002  -  PLATE 130D STD BRL SS 2 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-003	SUP	HCPCS C1713		3362-3-003  -  PLATE 130D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-004	SUP	HCPCS C1713		3362-3-004  -  PLATE 130D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-005	SUP	HCPCS C1713		3362-3-005  -  PLATE 130D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-006	SUP	HCPCS C1713		3362-3-006  -  PLATE 130D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$856.63 	$633.91	$0.00	$685.30	$385.48	$385.48	$0.00	$0.00	$0.00	$178.54	$635.79	$635.79	$0.00	$0.00	$178.52	$0.00	$506.69	$506.69	$0.00	$428.31	$678.45	$685.30	$0.00		$0.00	$134.06	$0.00	$0.00	$136.37	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-008	SUP	HCPCS C1713		3362-3-008  -  PLATE 130D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-010	SUP	HCPCS C1713		3362-3-010  -  PLATE 130D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-012	SUP	HCPCS C1713		3362-3-012  -  PLATE 130D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-102	SUP	HCPCS C1713		3362-3-102  -  PLATE 135D STD BRL SS 2 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-103	SUP	HCPCS C1713		3362-3-103  -  PLATE 135D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-104	SUP	HCPCS C1713		3362-3-104  -  PLATE 135D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-105	SUP	HCPCS C1713		3362-3-105  -  PLATE 135D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-106	SUP	HCPCS C1713		3362-3-106  -  PLATE 135D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-108	SUP	HCPCS C1713		3362-3-108  -  PLATE 135D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-110	SUP	HCPCS C1713		3362-3-110  -  PLATE 135D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-112	SUP	HCPCS C1713		3362-3-112  -  PLATE 135D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-202	SUP	HCPCS C1713		3362-3-202  -  PLATE 140D STD BRL SS 2 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-203	SUP	HCPCS C1713		3362-3-203  -  PLATE 140D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-204	SUP	HCPCS C1713		3362-3-204  -  PLATE 140D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-205	SUP	HCPCS C1713		3362-3-205  -  PLATE 140D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-206	SUP	HCPCS C1713		3362-3-206  -  PLATE 140D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-208	SUP	HCPCS C1713		3362-3-208  -  PLATE 140D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-210	SUP	HCPCS C1713		3362-3-210  -  PLATE 140D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,054.63 "	$780.43	$0.00	$843.70	$474.58	$474.58	$0.00	$0.00	$0.00	$219.81	$782.74	$782.74	$0.00	$0.00	$219.78	$0.00	$623.81	$623.81	$0.00	$527.31	$835.27	$843.70	$0.00		$0.00	$165.05	$0.00	$0.00	$167.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-212	SUP	HCPCS C1713		3362-3-212  -  PLATE 140D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-302	SUP	HCPCS C1713		3362-3-302  -  PLATE 145D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-303	SUP	HCPCS C1713		3362-3-303  -  PLATE 145D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-304	SUP	HCPCS C1713		3362-3-304  -  PLATE 145D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-305	SUP	HCPCS C1713		3362-3-305  -  PLATE 145D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-306	SUP	HCPCS C1713		3362-3-306  -  PLATE 145D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-308	SUP	HCPCS C1713		3362-3-308  -  PLATE 145D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-310	SUP	HCPCS C1713		3362-3-310  -  PLATE 145D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-312	SUP	HCPCS C1713		3362-3-312  -  PLATE 145D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-402	SUP	HCPCS C1713		3362-3-402  -  PLATE 150D STD BRL SS 2 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-403	SUP	HCPCS C1713		3362-3-403  -  PLATE 150D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-404	SUP	HCPCS C1713		3362-3-404  -  PLATE 150D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-405	SUP	HCPCS C1713		3362-3-405  -  PLATE 150D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-406	SUP	HCPCS C1713		3362-3-406  -  PLATE 150D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-408	SUP	HCPCS C1713		3362-3-408  -  PLATE 150D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-410	SUP	HCPCS C1713		3362-3-410  -  PLATE 150D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-3-412	SUP	HCPCS C1713		3362-3-412  -  PLATE 150D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	"$1,058.75 "	$783.48	$0.00	$847.00	$476.44	$476.44	$0.00	$0.00	$0.00	$220.67	$785.80	$785.80	$0.00	$0.00	$220.64	$0.00	$626.25	$626.25	$0.00	$529.38	$838.53	$847.00	$0.00		$0.00	$165.69	$0.00	$0.00	$168.55	$0.00	$0.00	$0.00	$0.00	$0.00
3362-4-304	SUP	HCPCS C1713		3362-4-304  -  PLATE 130D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-4-305	SUP	HCPCS C1713		3362-4-305  -  PLATE 130D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-4-354	SUP	HCPCS C1713		3362-4-354  -  PLATE 135D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-4-355	SUP	HCPCS C1713		3362-4-355  -  PLATE 135D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-4-404	SUP	HCPCS C1713		3362-4-404  -  PLATE 140D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-4-405	SUP	HCPCS C1713		3362-4-405  -  PLATE 140D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-4-454	SUP	HCPCS C1713		3362-4-454  -  PLATE 145D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-4-455	SUP	HCPCS C1713		3362-4-455  -  PLATE 145D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-4-504	SUP	HCPCS C1713		3362-4-504  -  PLATE 150D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-4-505	SUP	HCPCS C1713		3362-4-505  -  PLATE 150D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP	BOTH IP/OP	$859.38 	$635.94	$0.00	$687.50	$386.72	$386.72	$0.00	$0.00	$0.00	$179.12	$637.83	$637.83	$0.00	$0.00	$179.09	$0.00	$508.32	$508.32	$0.00	$429.69	$680.63	$687.50	$0.00		$0.00	$134.49	$0.00	$0.00	$136.81	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-050	SUP	HCPCS C1713		3362-5-050  -  SCREW BONE 13MM 50MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-055	SUP	HCPCS C1713		3362-5-055  -  SCREW BONE 13MM 55MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-060	SUP	HCPCS C1713		3362-5-060  -  SCREW BONE 13MM 60MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-065	SUP	HCPCS C1713		3362-5-065  -  SCREW BONE 13MM 65MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-070	SUP	HCPCS C1713		3362-5-070  -  SCREW BONE 13MM 70MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-075	SUP	HCPCS C1713		3362-5-075  -  SCREW BONE 75MM OMEGA+ HIP LAG	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-080	SUP	HCPCS C1713		3362-5-080  -  SCREW BONE 13MM 80MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-085	SUP	HCPCS C1713		3362-5-085  -  SCREW BONE 13MM 85MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-090	SUP	HCPCS C1713		3362-5-090  -  SCREW BONE 13MM 90MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-095	SUP	HCPCS C1713		3362-5-095  -  SCREW BONE 13MM 95MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-100	SUP	HCPCS C1713		3362-5-100  -  SCREW BONE 13MM 100MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-105	SUP	HCPCS C1713		3362-5-105  -  SCREW BONE 13MM 105MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-110	SUP	HCPCS C1713		3362-5-110  -  SCREW BONE 13MM 110MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-115	SUP	HCPCS C1713		3362-5-115  -  SCREW BONE 13MM 115MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-120	SUP	HCPCS C1713		3362-5-120  -  SCREW BONE 13MM 120MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-125	SUP	HCPCS C1713		3362-5-125  -  SCREW BONE 13MM 125MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-5-130	SUP	HCPCS C1713		3362-5-130  -  SCREW BONE 13MM 130MM OMEGA+ SS STD FEM HIP LAG STRL	BOTH IP/OP	$466.40 	$345.14	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3362-6-055	SUP	HCPCS C1713		3362-6-055  -  SCREW BONE 55MM OMEGA+ SS HIP SUPLAG	BOTH IP/OP	$313.50 	$231.99	$0.00	$250.80	$141.08	$141.08	$0.00	$0.00	$0.00	$65.34	$232.68	$232.68	$0.00	$0.00	$65.33	$0.00	$185.44	$185.44	$0.00	$156.75	$248.29	$250.80	$0.00		$0.00	$49.06	$0.00	$0.00	$49.91	$0.00	$0.00	$0.00	$0.00	$0.00
3362-6-060	SUP	HCPCS C1713		3362-6-060  -  SCREW BONE 60MM OMEGA+ SS HIP SUPLAG	BOTH IP/OP	$229.63 	$169.93	$0.00	$183.70	$103.33	$103.33	$0.00	$0.00	$0.00	$47.86	$170.43	$170.43	$0.00	$0.00	$47.85	$0.00	$135.82	$135.82	$0.00	$114.81	$181.87	$183.70	$0.00		$0.00	$35.94	$0.00	$0.00	$36.56	$0.00	$0.00	$0.00	$0.00	$0.00
3362-6-070	SUP	HCPCS C1713		3362-6-070  -  SCREW BONE 70MM OMEGA+ SS HIP SUPLAG	BOTH IP/OP	$313.50 	$231.99	$0.00	$250.80	$141.08	$141.08	$0.00	$0.00	$0.00	$65.34	$232.68	$232.68	$0.00	$0.00	$65.33	$0.00	$185.44	$185.44	$0.00	$156.75	$248.29	$250.80	$0.00		$0.00	$49.06	$0.00	$0.00	$49.91	$0.00	$0.00	$0.00	$0.00	$0.00
3362-6-080	SUP	HCPCS C1713		3362-6-080  -  SCREW BONE 80MM OMEGA+ SS HIP SUPLAG	BOTH IP/OP	$280.50 	$207.57	$0.00	$224.40	$126.23	$126.23	$0.00	$0.00	$0.00	$58.46	$208.19	$208.19	$0.00	$0.00	$58.46	$0.00	$165.92	$165.92	$0.00	$140.25	$222.16	$224.40	$0.00		$0.00	$43.90	$0.00	$0.00	$44.66	$0.00	$0.00	$0.00	$0.00	$0.00
3362-6-090	SUP	HCPCS C1713		3362-6-090  -  SCREW BONE 90MM OMEGA+ SS HIP SUPLAG	BOTH IP/OP	$209.00 	$154.66	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$43.56	$155.12	$155.12	$0.00	$0.00	$43.56	$0.00	$123.62	$123.62	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
3362-6-100	SUP	HCPCS C1713		3362-6-100  -  SCREW BONE 100MM OMEGA+ SS HIP SUPLAG	BOTH IP/OP	$345.13 	$255.40	$0.00	$276.10	$155.31	$155.31	$0.00	$0.00	$0.00	$71.93	$256.15	$256.15	$0.00	$0.00	$71.92	$0.00	$204.14	$204.14	$0.00	$172.56	$273.34	$276.10	$0.00		$0.00	$54.01	$0.00	$0.00	$54.94	$0.00	$0.00	$0.00	$0.00	$0.00
3362-6-105	SUP	HCPCS C1713		3362-6-105  -  SCREW BONE 105MM OMEGA+ SS HIP SUPLAG	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
3362-6-110	SUP	HCPCS C1713		3362-6-110  -  SCREW BONE 110MM OMEGA+ SS HIP SUPLAG	BOTH IP/OP	$378.13 	$279.82	$0.00	$302.50	$170.16	$170.16	$0.00	$0.00	$0.00	$78.81	$280.64	$280.64	$0.00	$0.00	$78.80	$0.00	$223.66	$223.66	$0.00	$189.06	$299.48	$302.50	$0.00		$0.00	$59.18	$0.00	$0.00	$60.20	$0.00	$0.00	$0.00	$0.00	$0.00
3362-6-115	SUP	HCPCS C1713		3362-6-115  -  SCREW BONE 115MM OMEGA+ SS HIP SUPLAG	BOTH IP/OP	$345.13 	$255.40	$0.00	$276.10	$155.31	$155.31	$0.00	$0.00	$0.00	$71.93	$256.15	$256.15	$0.00	$0.00	$71.92	$0.00	$204.14	$204.14	$0.00	$172.56	$273.34	$276.10	$0.00		$0.00	$54.01	$0.00	$0.00	$54.94	$0.00	$0.00	$0.00	$0.00	$0.00
3362-6-120	SUP	HCPCS C1713		3362-6-120  -  SCREW BONE 120MM OMEGA+ SS HIP SUPLAG	BOTH IP/OP	$313.50 	$231.99	$0.00	$250.80	$141.08	$141.08	$0.00	$0.00	$0.00	$65.34	$232.68	$232.68	$0.00	$0.00	$65.33	$0.00	$185.44	$185.44	$0.00	$156.75	$248.29	$250.80	$0.00		$0.00	$49.06	$0.00	$0.00	$49.91	$0.00	$0.00	$0.00	$0.00	$0.00
3362-6-130	SUP	HCPCS C1713		3362-6-130  -  SCREW BONE 130MM OMEGA+ SS HIP SUPLAG	BOTH IP/OP	$313.50 	$231.99	$0.00	$250.80	$141.08	$141.08	$0.00	$0.00	$0.00	$65.34	$232.68	$232.68	$0.00	$0.00	$65.33	$0.00	$185.44	$185.44	$0.00	$156.75	$248.29	$250.80	$0.00		$0.00	$49.06	$0.00	$0.00	$49.91	$0.00	$0.00	$0.00	$0.00	$0.00
3363-0-354	SUP	HCPCS C1713		3363-0-354  -  PLATE 135D 25MM SS 4 HOLE CMPR OMEGA+ BONE HIP NONSTRL	BOTH IP/OP	$563.75 	$417.18	$0.00	$451.00	$253.69	$253.69	$0.00	$0.00	$0.00	$117.50	$418.42	$418.42	$0.00	$0.00	$117.49	$0.00	$333.46	$333.46	$0.00	$281.88	$446.49	$451.00	$0.00		$0.00	$88.23	$0.00	$0.00	$89.75	$0.00	$0.00	$0.00	$0.00	$0.00
3363-1-203	SUP	HCPCS C1713		3363-1-203  -  PLATE 140D SS 3 HOLE CMPR OMEGA+ BONE HIP NONSTRL	BOTH IP/OP	$501.88 	$371.39	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$104.60	$372.49	$372.49	$0.00	$0.00	$104.59	$0.00	$296.86	$296.86	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3363-1-303	SUP	HCPCS C1713		3363-1-303  -  PLATE 145D SS 3 HOLE CMPR OMEGA+ BONE HIP NONSTRL	BOTH IP/OP	$529.38 	$391.74	$0.00	$423.50	$238.22	$238.22	$0.00	$0.00	$0.00	$110.33	$392.90	$392.90	$0.00	$0.00	$110.32	$0.00	$313.13	$313.13	$0.00	$264.69	$419.27	$423.50	$0.00		$0.00	$82.85	$0.00	$0.00	$84.28	$0.00	$0.00	$0.00	$0.00	$0.00
3363-1-403	SUP	HCPCS C1713		3363-1-403  -  PLATE 150D SS 3 HOLE CMPR OMEGA+ BONE HIP NONSTRL	BOTH IP/OP	$501.88 	$371.39	$0.00	$401.50	$225.84	$225.84	$0.00	$0.00	$0.00	$104.60	$372.49	$372.49	$0.00	$0.00	$104.59	$0.00	$296.86	$296.86	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$78.54	$0.00	$0.00	$79.90	$0.00	$0.00	$0.00	$0.00	$0.00
3363-5-085	SUP	HCPCS C1713		3363-5-085  -  SCREW BONE 85MM OMEGA+ HIP LAG NONSTRL	BOTH IP/OP	$488.13 	$361.22	$0.00	$390.50	$219.66	$219.66	$0.00	$0.00	$0.00	$101.74	$362.29	$362.29	$0.00	$0.00	$101.73	$0.00	$288.73	$288.73	$0.00	$244.06	$386.60	$390.50	$0.00		$0.00	$76.39	$0.00	$0.00	$77.71	$0.00	$0.00	$0.00	$0.00	$0.00
3363-7-000	SUP	HCPCS C1713		3363-7-000  -  SCREW BONE OMEGA+ SS HIP CMPR NONSTRL	BOTH IP/OP	$52.25 	$38.67	$0.00	$41.80	$23.51	$23.51	$0.00	$0.00	$0.00	$10.89	$38.78	$38.78	$0.00	$0.00	$10.89	$0.00	$30.91	$30.91	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$8.18	$0.00	$0.00	$8.32	$0.00	$0.00	$0.00	$0.00	$0.00
33661200MR	SUP	HCPCS C1713		33661200MR  -  CAP LOCKING LARGE ROUND 12MM SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
33661200SR	SUP	HCPCS C1713		33661200SR  -  CAP LOCKING SMALL ROUND 12MM SPN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
33661205MR	SUP	HCPCS C1713		33661205MR  -  ENDCAP SPINAL 5D LARGE ROUND 12MM MODULAR VBOSS	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
33661205SR	SUP	Custom 27803010		33661205SR  -  ENDCAP SPINAL 5D SMALL ROUND 12MM MODULAR VBOSS	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33661400MR	SUP	Custom 27803010		33661400MR  -  ENDCAP SPINAL 0D LARGE ROUND 14MM MODULAR VBOSS	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33661400SR	SUP	Custom 27803010		33661400SR  -  ENDCAP SPINAL 0D SMALL ROUND 14MM MODULAR VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33661405MR	SUP	Custom 27803010		33661405MR  -  ENDCAP SPINAL 5D LARGE ROUND 14MM MODULAR VBOSS	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33661405SR	SUP	Custom 27803010		33661405SR  -  ENDCAP SPINAL 5D SMALL ROUND 14MM MODULAR VBOSS	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33661600MR	SUP	Custom 27803010		33661600MR  -  ENDCAP SPINAL LARGE 16MM ROUND VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33661600SR	SUP	Custom 27803010		33661600SR  -  ENDCAP SPINAL SMALL 16MM ROUND VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33661605MR	SUP	Custom 27803010		33661605MR  -  ENDCAP SPINAL 5D LARGE 16MM ROUND VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33661605SR	SUP	Custom 27803010		33661605SR  -  ENDCAP SPINAL 5D SMALL 16MM ROUND VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662000MO	SUP	Custom 27803010		33662000MO  -  ENDCAP SPINAL LARGE 20MM OVAL VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662000MR	SUP	Custom 27803010		33662000MR  -  ENDCAP SPINAL LARGE 20MM ROUND VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662000SO	SUP	Custom 27803010		33662000SO  -  ENDCAP SPINAL SMALL 20MM OVAL VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662000SR	SUP	Custom 27803010		33662000SR  -  ENDCAP SPINAL SMALL 20MM ROUND VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662005MO	SUP	Custom 27803010		33662005MO  -  ENDCAP SPINAL 5D LARGE 20MM OVAL VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662005MR	SUP	Custom 27803010		33662005MR  -  ENDCAP SPINAL 5D LARGE 20MM ROUND VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662005SO	SUP	Custom 27803010		33662005SO  -  ENDCAP SPINAL 5D SMALL 20MM OVAL VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662005SR	SUP	Custom 27803010		33662005SR  -  ENDCAP SPINAL 5D SMALL 20MM ROUND VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662010MO	SUP	Custom 27803010		33662010MO  -  ENDCAP SPINAL 10D LARGE 20MM OVAL VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662010SO	SUP	Custom 27803010		33662010SO  -  ENDCAP SPINAL 10D SMALL 20MM OVAL VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662500MO	SUP	Custom 27803010		33662500MO  -  ENDCAP SPINAL LARGE 25MM OVAL VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662500MR	SUP	Custom 27803010		33662500MR  -  ENDCAP SPINAL LARGE 25MM ROUND VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662500SO	SUP	Custom 27803010		33662500SO  -  ENDCAP SPINAL SMALL 25MM OVAL VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662500SR	SUP	Custom 27803010		33662500SR  -  ENDCAP SPINAL SMALL 25MM ROUND VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662505MO	SUP	Custom 27803010		33662505MO  -  ENDCAP SPINAL 5D LARGE 25MM OVAL VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662505MR	SUP	Custom 27803010		33662505MR  -  ENDCAP SPINAL 5D LARGE 25MM ROUND VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662505SO	SUP	Custom 27803010		33662505SO  -  ENDCAP SPINAL 5D SMALL 25MM OVAL VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662505SR	SUP	Custom 27803010		33662505SR  -  ENDCAP SPINAL 5D SMALL 25MM ROUND VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662510MO	SUP	Custom 27803010		33662510MO  -  ENDCAP SPINAL 10D LARGE 25MM OVAL VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33662510SO	SUP	Custom 27803010		33662510SO  -  ENDCAP SPINAL 10D SMALL 25MM OVAL VBOSS TITANIUM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3370-0-230	SUP	HCPCS C1713		3370-0-230  -  NAIL 12MM 21CM HIP GAMA IM 130D STD GAMA SYS STYKER ORTH	BOTH IP/OP	"$1,498.75 "	"$1,109.08"	$0.00	"$1,199.00"	$674.44	$674.44	$0.00	$0.00	$0.00	$312.38	"$1,112.37"	"$1,112.37"	$0.00	$0.00	$312.34	$0.00	$886.51	$886.51	$0.00	$749.38	"$1,187.01"	"$1,199.00"	$0.00		$0.00	$234.55	$0.00	$0.00	$238.60	$0.00	$0.00	$0.00	$0.00	$0.00
3370-0-235	SUP	HCPCS C1713		3370-0-235  -  NAIL 12MM 21MM HIP GAMA IM 135D STD GAMA SYS	BOTH IP/OP	"$1,155.00 "	$854.70	$0.00	$924.00	$519.75	$519.75	$0.00	$0.00	$0.00	$240.73	$857.24	$857.24	$0.00	$0.00	$240.70	$0.00	$683.18	$683.18	$0.00	$577.50	$914.76	$924.00	$0.00		$0.00	$180.76	$0.00	$0.00	$183.88	$0.00	$0.00	$0.00	$0.00	$0.00
3370-0-430	SUP	HCPCS C1713		3370-0-430  -  NAIL 14MM 21CM HIP GAMA IM 130D STD GAMA SYS STRYK ORTH	BOTH IP/OP	"$1,051.88 "	$778.39	$0.00	$841.50	$473.34	$473.34	$0.00	$0.00	$0.00	$219.24	$780.70	$780.70	$0.00	$0.00	$219.21	$0.00	$622.18	$622.18	$0.00	$525.94	$833.09	$841.50	$0.00		$0.00	$164.62	$0.00	$0.00	$167.46	$0.00	$0.00	$0.00	$0.00	$0.00
3370-0-435	SUP	HCPCS C1713		3370-0-435  -  NAIL 14MM 21CM HIP GAMA IM 135D STD SS GAMA SYS	BOTH IP/OP	"$1,361.25 "	"$1,007.33"	$0.00	"$1,089.00"	$612.56	$612.56	$0.00	$0.00	$0.00	$283.72	"$1,010.32"	"$1,010.32"	$0.00	$0.00	$283.68	$0.00	$805.18	$805.18	$0.00	$680.63	"$1,078.11"	"$1,089.00"	$0.00		$0.00	$213.04	$0.00	$0.00	$216.71	$0.00	$0.00	$0.00	$0.00	$0.00
3370-1-000	SUP	HCPCS C1713		3370-1-000  -  SCREW SET 8MM 27MM GMA HIP IM NL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
3370-1-050	SUP	HCPCS C1713		3370-1-050  -  SCREW BONE GAMA CAP NAIL	BOTH IP/OP	$195.25 	$144.49	$0.00	$156.20	$87.86	$87.86	$0.00	$0.00	$0.00	$40.69	$144.91	$144.91	$0.00	$0.00	$40.69	$0.00	$115.49	$115.49	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
3370-1-060	SUP	HCPCS C1713		3370-1-060  -  SCREW BONE 12MM 60MM GAMA SS FEM LAG IM NAIL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
3370-2-080	SUP	HCPCS C1713		3370-2-080  -  SCREW BONE 12MM 80MM GAMA LAG IM NAIL	BOTH IP/OP	$653.13 	$483.32	$0.00	$522.50	$293.91	$293.91	$0.00	$0.00	$0.00	$136.13	$484.75	$484.75	$0.00	$0.00	$136.11	$0.00	$386.32	$386.32	$0.00	$326.56	$517.28	$522.50	$0.00		$0.00	$102.21	$0.00	$0.00	$103.98	$0.00	$0.00	$0.00	$0.00	$0.00
3370-2-085	SUP	HCPCS C1713		3370-2-085  -  NAIL 12MM 85MM GAMA IM NAIL LAG	BOTH IP/OP	$653.13 	$483.32	$0.00	$522.50	$293.91	$293.91	$0.00	$0.00	$0.00	$136.13	$484.75	$484.75	$0.00	$0.00	$136.11	$0.00	$386.32	$386.32	$0.00	$326.56	$517.28	$522.50	$0.00		$0.00	$102.21	$0.00	$0.00	$103.98	$0.00	$0.00	$0.00	$0.00	$0.00
3370-2-090	SUP	HCPCS C1713		3370-2-090  -  NAIL 12MM 90MM GAMA IM NAIL LAG	BOTH IP/OP	$653.13 	$483.32	$0.00	$522.50	$293.91	$293.91	$0.00	$0.00	$0.00	$136.13	$484.75	$484.75	$0.00	$0.00	$136.11	$0.00	$386.32	$386.32	$0.00	$326.56	$517.28	$522.50	$0.00		$0.00	$102.21	$0.00	$0.00	$103.98	$0.00	$0.00	$0.00	$0.00	$0.00
3370-2-095	SUP	HCPCS C1713		3370-2-095  -  NAIL 12MM 95MM HIP GAMA IM NAIL LAG TI	BOTH IP/OP	$653.13 	$483.32	$0.00	$522.50	$293.91	$293.91	$0.00	$0.00	$0.00	$136.13	$484.75	$484.75	$0.00	$0.00	$136.11	$0.00	$386.32	$386.32	$0.00	$326.56	$517.28	$522.50	$0.00		$0.00	$102.21	$0.00	$0.00	$103.98	$0.00	$0.00	$0.00	$0.00	$0.00
3370-2-100	SUP	HCPCS C1713		3370-2-100  -  SCREW BONE 12MM 100MM GAMA FEM LAG IM NAIL	BOTH IP/OP	$653.13 	$483.32	$0.00	$522.50	$293.91	$293.91	$0.00	$0.00	$0.00	$136.13	$484.75	$484.75	$0.00	$0.00	$136.11	$0.00	$386.32	$386.32	$0.00	$326.56	$517.28	$522.50	$0.00		$0.00	$102.21	$0.00	$0.00	$103.98	$0.00	$0.00	$0.00	$0.00	$0.00
3370-2-105	SUP	HCPCS C1713		3370-2-105  -  SCREW BONE 105MM 12MM GAMA FEM LAG SCR IM NAIL	BOTH IP/OP	$653.13 	$483.32	$0.00	$522.50	$293.91	$293.91	$0.00	$0.00	$0.00	$136.13	$484.75	$484.75	$0.00	$0.00	$136.11	$0.00	$386.32	$386.32	$0.00	$326.56	$517.28	$522.50	$0.00		$0.00	$102.21	$0.00	$0.00	$103.98	$0.00	$0.00	$0.00	$0.00	$0.00
3370-2-110	SUP	HCPCS C1713		3370-2-110  -  SCREW BONE 12MM 110MM GAMA FEM LAG IM NAIL	BOTH IP/OP	$653.13 	$483.32	$0.00	$522.50	$293.91	$293.91	$0.00	$0.00	$0.00	$136.13	$484.75	$484.75	$0.00	$0.00	$136.11	$0.00	$386.32	$386.32	$0.00	$326.56	$517.28	$522.50	$0.00		$0.00	$102.21	$0.00	$0.00	$103.98	$0.00	$0.00	$0.00	$0.00	$0.00
3370-2-120	SUP	HCPCS C1713		3370-2-120  -  SCREW BONE 12MM 120MM GAMA SS FEM LAG IM NAIL	BOTH IP/OP	$653.13 	$483.32	$0.00	$522.50	$293.91	$293.91	$0.00	$0.00	$0.00	$136.13	$484.75	$484.75	$0.00	$0.00	$136.11	$0.00	$386.32	$386.32	$0.00	$326.56	$517.28	$522.50	$0.00		$0.00	$102.21	$0.00	$0.00	$103.98	$0.00	$0.00	$0.00	$0.00	$0.00
3370-2-130	SUP	HCPCS C1713		3370-2-130  -  SCREW BONE 12MM 130MM GAMMA3 SS HIP FEM LAG IM NAIL	BOTH IP/OP	$653.13 	$483.32	$0.00	$522.50	$293.91	$293.91	$0.00	$0.00	$0.00	$136.13	$484.75	$484.75	$0.00	$0.00	$136.11	$0.00	$386.32	$386.32	$0.00	$326.56	$517.28	$522.50	$0.00		$0.00	$102.21	$0.00	$0.00	$103.98	$0.00	$0.00	$0.00	$0.00	$0.00
3370-3-035	SUP	HCPCS C1713		3370-3-035  -  SCREW BONE 6.28MM 35MM GAMMA3 HIP DISTAL NAIL	BOTH IP/OP	$178.75 	$132.28	$0.00	$143.00	$80.44	$80.44	$0.00	$0.00	$0.00	$37.26	$132.67	$132.67	$0.00	$0.00	$37.25	$0.00	$105.73	$105.73	$0.00	$89.38	$141.57	$143.00	$0.00		$0.00	$27.97	$0.00	$0.00	$28.46	$0.00	$0.00	$0.00	$0.00	$0.00
3370-3-040	SUP	HCPCS C1713		3370-3-040  -  SCREW BONE 6.28MM 40MM GAMA DISTAL IM NAIL	BOTH IP/OP	$178.75 	$132.28	$0.00	$143.00	$80.44	$80.44	$0.00	$0.00	$0.00	$37.26	$132.67	$132.67	$0.00	$0.00	$37.25	$0.00	$105.73	$105.73	$0.00	$89.38	$141.57	$143.00	$0.00		$0.00	$27.97	$0.00	$0.00	$28.46	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-025	SUP	HCPCS C1713		3370-6-025  -  NAIL 11MM 34CM HIP LEFT FEM GAMMA3 IM 125D LNG LCK TI	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-030	SUP	HCPCS C1713		3370-6-030  -  NAIL 11MM 34CM HIP LEFT FEM GAMMA3 IM 130D LNG LCK TI	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-035	SUP	HCPCS C1713		3370-6-035  -  NAIL 11MM 34CM LEFT FEM GAMA IM 135D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-125	SUP	HCPCS C1713		3370-6-125  -  NAIL 11MM 36CM LEFT FEM GAMA IM 125D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-130	SUP	HCPCS C1713		3370-6-130  -  NAIL 11MM 360MM LEFT GAMA IM 130D LNG	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-135	SUP	HCPCS C1713		3370-6-135  -  NAIL 11MM 36CM LEFT FEM GAMA IM 135D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-225	SUP	HCPCS C1713		3370-6-225  -  NAIL 11MM 38CM LEFT FEM GAMA IM 125D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-230	SUP	HCPCS C1713		3370-6-230  -  NAIL 11MM 38CM LEFT FEM GAMA IM 130D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-235	SUP	HCPCS C1713		3370-6-235  -  NAIL 11MM 38CM LEFT FEM GAMA IM 135D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-325	SUP	HCPCS C1713		3370-6-325  -  NAIL 11MM 40CM LEFT FEM GAMA IM 125D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-330	SUP	HCPCS C1713		3370-6-330  -  NAIL 11MM 400MM LEFT GAMA IM 130D LNG	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-335	SUP	HCPCS C1713		3370-6-335  -  NAIL 11MM 40CM LEFT FEM GAMA IM 135D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-425	SUP	HCPCS C1713		3370-6-425  -  NAIL 11MM 42CM LEFT FEM GAMA IM 125D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-430	SUP	HCPCS C1713		3370-6-430  -  NAIL 11MM 42CM LEFT FEM GAMA IM 130D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-435	SUP	HCPCS C1713		3370-6-435  -  NAIL 11MM 42CM LEFT FEM GAMA IM 135D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-525	SUP	HCPCS C1713		3370-6-525  -  NAIL 11MM 44CM LEFT FEM GAMA IM 125D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-530	SUP	HCPCS C1713		3370-6-530  -  NAIL 11MM 44CM LEFT FEM GAMA IM 130D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-6-535	SUP	HCPCS C1713		3370-6-535  -  NAIL 11MM 44CM LEFT FEM GAMA IM 135D LNG LCK SS STRL	BOTH IP/OP	"$2,413.13 "	"$1,785.72"	$0.00	"$1,930.50"	"$1,085.91"	"$1,085.91"	$0.00	$0.00	$0.00	$502.96	"$1,791.02"	"$1,791.02"	$0.00	$0.00	$502.90	$0.00	"$1,427.36"	"$1,427.36"	$0.00	"$1,206.56"	"$1,911.20"	"$1,930.50"	$0.00		$0.00	$377.65	$0.00	$0.00	$384.17	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-025	SUP	HCPCS C1713		3370-7-025  -  NAIL 11MM 34CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-030	SUP	HCPCS C1713		3370-7-030  -  NAIL 11MM 34CM RIGHT HIP GAMMA3 IM 130D LNG LCK TI	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-035	SUP	HCPCS C1713		3370-7-035  -  NAIL 11MM 34CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-125	SUP	HCPCS C1713		3370-7-125  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-130	SUP	HCPCS C1713		3370-7-130  -  NAIL 11MM 360MM RIGHT TROC GAMA IM 130D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-135	SUP	HCPCS C1713		3370-7-135  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-225	SUP	HCPCS C1713		3370-7-225  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-230	SUP	HCPCS C1713		3370-7-230  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 130D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-235	SUP	HCPCS C1713		3370-7-235  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-325	SUP	HCPCS C1713		3370-7-325  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-330	SUP	HCPCS C1713		3370-7-330  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 130D LNG LCK STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-335	SUP	HCPCS C1713		3370-7-335  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-425	SUP	HCPCS C1713		3370-7-425  -  NAIL 11MM 42CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-430	SUP	HCPCS C1713		3370-7-430  -  NAIL 11MM 42CM RIGHT FEM GAMA IM 130D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-435	SUP	HCPCS C1713		3370-7-435  -  NAIL 11MM 42CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-525	SUP	HCPCS C1713		3370-7-525  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-530	SUP	HCPCS C1713		3370-7-530  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 130D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-7-535	SUP	HCPCS C1713		3370-7-535  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL	BOTH IP/OP	"$2,293.50 "	"$1,697.19"	$0.00	"$1,834.80"	"$1,032.08"	"$1,032.08"	$0.00	$0.00	$0.00	$478.02	"$1,702.24"	"$1,702.24"	$0.00	$0.00	$477.97	$0.00	"$1,356.61"	"$1,356.61"	$0.00	"$1,146.75"	"$1,816.45"	"$1,834.80"	$0.00		$0.00	$358.93	$0.00	$0.00	$365.13	$0.00	$0.00	$0.00	$0.00	$0.00
3370-8-125	SUP	HCPCS C1713		3370-8-125  -  NAIL 11MM 18CM TROC GAMA IM 125D LCK SS STRL	BOTH IP/OP	"$1,863.13 "	"$1,378.72"	$0.00	"$1,490.50"	$838.41	$838.41	$0.00	$0.00	$0.00	$388.32	"$1,382.81"	"$1,382.81"	$0.00	$0.00	$388.28	$0.00	"$1,102.04"	"$1,102.04"	$0.00	$931.56	"$1,475.60"	"$1,490.50"	$0.00		$0.00	$291.58	$0.00	$0.00	$296.61	$0.00	$0.00	$0.00	$0.00	$0.00
3370-8-130	SUP	HCPCS C1713		3370-8-130  -  NAIL TROC IM 130D	BOTH IP/OP	"$1,863.13 "	"$1,378.72"	$0.00	"$1,490.50"	$838.41	$838.41	$0.00	$0.00	$0.00	$388.32	"$1,382.81"	"$1,382.81"	$0.00	$0.00	$388.28	$0.00	"$1,102.04"	"$1,102.04"	$0.00	$931.56	"$1,475.60"	"$1,490.50"	$0.00		$0.00	$291.58	$0.00	$0.00	$296.61	$0.00	$0.00	$0.00	$0.00	$0.00
3370-8-135	SUP	HCPCS C1713		3370-8-135  -  NAIL 11MM 18CM TROC GAMA IM 135D LCK SS	BOTH IP/OP	"$1,863.13 "	"$1,378.72"	$0.00	"$1,490.50"	$838.41	$838.41	$0.00	$0.00	$0.00	$388.32	"$1,382.81"	"$1,382.81"	$0.00	$0.00	$388.28	$0.00	"$1,102.04"	"$1,102.04"	$0.00	$931.56	"$1,475.60"	"$1,490.50"	$0.00		$0.00	$291.58	$0.00	$0.00	$296.61	$0.00	$0.00	$0.00	$0.00	$0.00
3371-1-015	SUP	HCPCS C1769		3371-1-015  -  GUIDEWIRE ORTH 3MM STRL BLNT TIP PACKAGED	BOTH IP/OP	$233.75 	$172.98	$0.00	$187.00	$126.93	$126.93	$0.00	$0.00	$0.00	$48.72	$173.49	$173.49	$0.00	$0.00	$48.71	$0.00	$138.26	$138.26	$0.00	$116.88	$185.13	$187.00	$0.00		$0.00	$36.58	$0.00	$0.00	$37.21	$0.00	$0.00	$0.00	$0.00	$0.00
3371-1-060	SUP	HCPCS C1713		3371-1-060  -  WIRE FX 3.2MM 450MM KRSH SS GMA NL SYS	BOTH IP/OP	$192.50 	$142.45	$0.00	$154.00	$86.63	$86.63	$0.00	$0.00	$0.00	$40.12	$142.87	$142.87	$0.00	$0.00	$40.12	$0.00	$113.86	$113.86	$0.00	$96.25	$152.46	$154.00	$0.00		$0.00	$30.13	$0.00	$0.00	$30.65	$0.00	$0.00	$0.00	$0.00	$0.00
3371-1-078	SUP	Custom 27203010		3371-1-078  -  HEAD FEM +5MM OFST 36MM V40 LFIT COCR HIP	BOTH IP/OP	"$1,684.38 "	"$1,246.44"	$0.00	"$1,347.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,250.14"	"$1,250.14"	$0.00	$0.00	$351.02	$0.00	$0.00	$0.00	$0.00	$842.19	"$1,334.03"	"$1,347.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3371-1-085	SUP	Custom 27803010		3371-1-085  -  TAP LAG SCR SURG	BOTH IP/OP	"$1,313.13 "	$971.72	$0.00	"$1,050.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$974.60	$974.60	$0.00	$0.00	$273.66	$0.00	$0.00	$0.00	$0.00	$656.56	"$1,040.00"	"$1,050.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3371-1-180	SUP	Custom 27203010		3371-1-180  -  BIT DRILL 5.5MM	BOTH IP/OP	$203.50 	$150.59	$0.00	$162.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.04	$151.04	$0.00	$0.00	$42.41	$0.00	$0.00	$0.00	$0.00	$101.75	$161.17	$162.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3371-1-185	SUP	Custom 27203010		3371-1-185  -  SLEEVE DRILL 5.5MM GAMA GUIDE NAIL	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.98	$346.98	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$233.75	$370.26	$374.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
338 021	SUP	HCPCS C1900		338 021  -  AROX 60 BP LEAD	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
338 022	SUP	HCPCS C1900		338 022  -  AROX 45 JBP LEAD	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
338 023	SUP	HCPCS C1900		338 023  -  AROX 53 BP LEAD	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
33MJ-501	SUP	Custom 27803010		33MJ-501  -  VALVE MTRL 85D 5.18SQ CM 33MM 26.1MM MSTR SER MECH STD CUF	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	$0.00	$0.00	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3420-0260S	SUP	HCPCS C1713		3420-0260S  -  NAIL 10MM 26CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3420-0280S	SUP	HCPCS C1713		3420-0280S  -  NAIL 10MM 28CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3420-0300S	SUP	HCPCS C1713		3420-0300S  -  NAIL 10MM 30CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3420-0320S	SUP	HCPCS C1713		3420-0320S  -  NAIL 10MM 32CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3420-0340S	SUP	HCPCS C1713		3420-0340S  -  NAIL 10MM 34CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3420-0360S	SUP	HCPCS C1713		3420-0360S  -  NAIL 10MM 36CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3420-0380S	SUP	HCPCS C1713		3420-0380S  -  NAIL 10MM 38CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3420-0400S	SUP	HCPCS C1713		3420-0400S  -  NAIL 10MM 40CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3420-0420S	SUP	HCPCS C1713		3420-0420S  -  GAMMA 3 S NAIL RIGHT 10X420MM X 120	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3420-0440S	SUP	HCPCS C1713		3420-0440S  -  NAIL IM 120D 10MM 440MM STRL GAMMA3 RT	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3420-0460S	SUP	HCPCS C1713		3420-0460S  -  NAIL IM 120D 10MM 460MM STRL GAMMA3 RT	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3425-0260S	SUP	HCPCS C1713		3425-0260S  -  NAIL 10MM 26CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3425-0280S	SUP	HCPCS C1713		3425-0280S  -  NAIL 10MM 28CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3425-0300S	SUP	HCPCS C1713		3425-0300S  -  NAIL 10MM 30CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3425-0320S	SUP	HCPCS C1713		3425-0320S  -  NAIL 10MM 32CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3425-0340S	SUP	HCPCS C1713		3425-0340S  -  NAIL 10MM 34CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3425-0360S	SUP	HCPCS C1713		3425-0360S  -  NAIL 10MM 36CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3425-0380S	SUP	HCPCS C1713		3425-0380S  -  NAIL 10MM 38CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3425-0400S	SUP	HCPCS C1713		3425-0400S  -  NAIL 10MM 40CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3425-0420S	SUP	HCPCS C1713		3425-0420S  -  GAMMA 3 S NAIL RIGHT 10X420MM X 125	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3425-0440S	SUP	HCPCS C1713		3425-0440S  -  GAMMA 3 S NAIL RIGHT 10X440MM X 125	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3425-0460S	SUP	HCPCS C1713		3425-0460S  -  NAIL IM 125D 10MM 460MM STRL GAMMA3 RT	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3425-0480S	SUP	HCPCS C1713		3425-0480S  -  NAIL IM 10MM 480MM STRL 125MM GAMMA3 RT	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$3,763.10"	"$2,116.74"	"$2,116.74"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$2,351.94"	"$3,725.47"	"$3,763.10"	$0.00		$0.00	$736.16	$0.00	$0.00	$748.86	$0.00	$0.00	$0.00	$0.00	$0.00
3430-0260S	SUP	HCPCS C1713		3430-0260S  -  NAIL 10MM 26CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3430-0280S	SUP	HCPCS C1713		3430-0280S  -  NAIL 10MM 28CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3430-0300S	SUP	HCPCS C1713		3430-0300S  -  NAIL 10MM 30CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3430-0320S	SUP	HCPCS C1713		3430-0320S  -  NAIL 10MM 32CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3430-0340S	SUP	HCPCS C1713		3430-0340S  -  NAIL 10MM 34CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3430-0360S	SUP	HCPCS C1713		3430-0360S  -  NAIL 10MM 36CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3430-0380S	SUP	HCPCS C1713		3430-0380S  -  NAIL 10MM 38CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3430-0400S	SUP	HCPCS C1713		3430-0400S  -  NAIL 10MM 40CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3430-0420S	SUP	HCPCS C1713		3430-0420S  -  GAMMA 3 S NAIL RIGHT 10X420MM X 130	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3430-0440S	SUP	HCPCS C1713		3430-0440S  -  GAMMA 3 S NAIL RIGHT 10X440MM X 130	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3430-0460S	SUP	HCPCS C1713		3430-0460S  -  NAIL IM 130D 10MM 460MM STRL GAMMA3 RT	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
346 366	SUP	HCPCS C1898		346 366  -  SELOX ST 53 LEAD	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
346 367	SUP	HCPCS C1898		346 367  -  SELOX ST 60 LEAD	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
346 368	SUP	HCPCS C1898		346 368  -  SELOX JT 53 LEAD	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
346 369	SUP	HCPCS C1898		346 369  -  SELOX JT 45 LEAD	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
3460-7-006	SUP	HCPCS C1713		3460-7-006  -  SCREW BONE 8MM 19MM PED HIP OSTMY	BOTH IP/OP	$572.00 	$423.28	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$119.22	$424.54	$424.54	$0.00	$0.00	$119.20	$0.00	$338.34	$338.34	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
3460-7-007	SUP	HCPCS C1713		3460-7-007  -  SCREW BONE 8MM 22MM PED ORTH OSTMY PEDI HIP SYS	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
3460-7-030	SUP	HCPCS C1713		3460-7-030  -  SCREW BONE 8MM 76MM PED PDCL HIP OSTMY	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
349 799	SUP	HCPCS C1900		349 799  -  CYLOS DR WITH CLS AUTONOMIC RESPONSE	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00		$0.00	"$1,330.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
349 811	SUP	HCPCS C1900		349 811  -  CYLOS VR WITH CLS AUTONOMIC RESPONSE	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00		$0.00	"$1,330.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
350 053	SUP	HCPCS C1895		350 053  -  LINOX SD STEROID 65/16	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
350 056	SUP	HCPCS C1895		350 056  -  LINOX SD STEROID 75/18	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
350 975	SUP	HCPCS C1895		350 975  -  SETROX S 60 LEAD	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
35-0002	SUP	Custom 27203010		35-0002  -  PIN FIX 4MM LCK CALCANEUS STNM SS	BOTH IP/OP	$142.50 	$105.45	$0.00	$114.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.76	$105.76	$0.00	$0.00	$29.70	$0.00	$0.00	$0.00	$0.00	$71.25	$112.86	$114.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35-0003	SUP	Custom 27203010		35-0003  -  PIN FIX 5MM ORTH STNM SS	BOTH IP/OP	$142.50 	$105.45	$0.00	$114.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.76	$105.76	$0.00	$0.00	$29.70	$0.00	$0.00	$0.00	$0.00	$71.25	$112.86	$114.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
35-0011	SUP	HCPCS C1769		35-0011  -  GUIDEWIRE ORTHOPEDIC STR .045IN 5.75IN THREAD TITANIUM	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$3.65	$12.99	$12.99	$0.00	$0.00	$3.65	$0.00	$10.35	$10.35	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
350-2001 BC	SUP	HCPCS C1789		350-2001 BC  -  IMPL BRST 200ML GEL SMTH SIL P3.2CM MODEARTE PRFL RND 10.5CM	BOTH IP/OP	"$2,187.50 "	"$1,618.75"	$0.00	"$1,750.00"	$984.38	$984.38	$0.00	$0.00	$0.00	$455.93	"$1,623.56"	"$1,623.56"	$0.00	$0.00	$455.88	$0.00	"$1,293.91"	"$1,293.91"	$0.00	"$1,093.75"	"$1,732.50"	"$1,750.00"	$0.00		$0.00	$342.34	$0.00	$0.00	$348.25	$0.00	$0.00	$0.00	$0.00	$0.00
350-2500	SUP	HCPCS C1789		350-2500  -  IMPL BRST 500-600ML STY 2000 SMTH RND SAL P5.9CM MDRT PLUS	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
350-2501BC	SUP	HCPCS C1789		350-2501BC  -  IMPLANT BRST P3.4CM MDRT + HI PRFL RND 11.3CM 250ML STRL	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
350-3001BC	SUP	HCPCS C1789		350-3001BC  -  IMPLANT BRST P3.6CM RND MDRT + PRFL 12CM 300ML STRL	BOTH IP/OP	"$2,187.50 "	"$1,618.75"	$0.00	"$1,750.00"	$984.38	$984.38	$0.00	$0.00	$0.00	$455.93	"$1,623.56"	"$1,623.56"	$0.00	$0.00	$455.88	$0.00	"$1,293.91"	"$1,293.91"	$0.00	"$1,093.75"	"$1,732.50"	"$1,750.00"	$0.00		$0.00	$342.34	$0.00	$0.00	$348.25	$0.00	$0.00	$0.00	$0.00	$0.00
350-3004BC	SUP	HCPCS C1789		350-3004BC  -  IMPLANT BRST P4.5CM HI PRFL RND NAR BS 11.1CM 300CC	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
350-3501 BC	SUP	HCPCS C1789		350-3501 BC  -  IMPL BRST 350ML GEL SMTH SIL P3.9CM MDRT PLUS PRFL RND 12.5	BOTH IP/OP	"$2,187.50 "	"$1,618.75"	$0.00	"$1,750.00"	$984.38	$984.38	$0.00	$0.00	$0.00	$455.93	"$1,623.56"	"$1,623.56"	$0.00	$0.00	$455.88	$0.00	"$1,293.91"	"$1,293.91"	$0.00	"$1,093.75"	"$1,732.50"	"$1,750.00"	$0.00		$0.00	$342.34	$0.00	$0.00	$348.25	$0.00	$0.00	$0.00	$0.00	$0.00
350-3504BC	SUP	HCPCS C1789		350-3504BC  -  IMPL BRST 350ML GEL SMTH MEMORYGEL SIL P4.8CM HI PRFL RND	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
350-4001 BC	SUP	HCPCS C1789		350-4001 BC  -  IMPLANT BRST P4CM MDRT + PRFL RND 13.1CM 400CC MEMORYGEL	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
350-4004 BC	SUP	HCPCS C1789		350-4004 BC  -  IMPLANT BRST P5CM HI PRFL RND NAR BS 12.2CM 400CC MEMORYGEL	BOTH IP/OP	"$2,325.00 "	"$1,720.50"	$0.00	"$1,860.00"	"$1,046.25"	"$1,046.25"	$0.00	$0.00	$0.00	$484.59	"$1,725.62"	"$1,725.62"	$0.00	$0.00	$484.53	$0.00	"$1,375.24"	"$1,375.24"	$0.00	"$1,162.50"	"$1,841.40"	"$1,860.00"	$0.00		$0.00	$363.86	$0.00	$0.00	$370.14	$0.00	$0.00	$0.00	$0.00	$0.00
350-4501BC	SUP	HCPCS C1789		350-4501BC  -  IMPLANT BRST P4.2CM MDRT + PRFL 13.6CM 450ML CHSV I GEL RND	BOTH IP/OP	"$2,187.50 "	"$1,618.75"	$0.00	"$1,750.00"	$984.38	$984.38	$0.00	$0.00	$0.00	$455.93	"$1,623.56"	"$1,623.56"	$0.00	$0.00	$455.88	$0.00	"$1,293.91"	"$1,293.91"	$0.00	"$1,093.75"	"$1,732.50"	"$1,750.00"	$0.00		$0.00	$342.34	$0.00	$0.00	$348.25	$0.00	$0.00	$0.00	$0.00	$0.00
350-4504BC	SUP	HCPCS C1789		350-4504BC  -  IMPLANT BRST P5.1CM RND 12.8CM 450ML STRL MEMORYGEL SMTH HI	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
350-5001 BC	SUP	HCPCS C1789		350-5001 BC  -  IMPLANT BREAST P4.3CM MODERATE PLUS PROFILE ROUND MODERATE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
350-5004BC	SUP	HCPCS C1789		350-5004BC  -  IMPL BRST 500ML GEL SMTH MEMORYGEL SIL P5.3CM HI PRFL RND	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
350-5501 BC	SUP	HCPCS C1789		350-5501 BC  -  IMPL BRST 550ML GEL SMTH SIL P4.5CM MDRT PRFL RND 14.6CM	BOTH IP/OP	"$2,187.50 "	"$1,618.75"	$0.00	"$1,750.00"	$984.38	$984.38	$0.00	$0.00	$0.00	$455.93	"$1,623.56"	"$1,623.56"	$0.00	$0.00	$455.88	$0.00	"$1,293.91"	"$1,293.91"	$0.00	"$1,093.75"	"$1,732.50"	"$1,750.00"	$0.00		$0.00	$342.34	$0.00	$0.00	$348.25	$0.00	$0.00	$0.00	$0.00	$0.00
350-5504 BC	SUP	HCPCS C1789		350-5504 BC  -  IMPL BRST 550ML GEL SMTH MEMORYGEL SIL P5.5CM HI PRFL RND	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
350-800 1BC	SUP	HCPCS C1789		350-800 1BC  -  IMPLANT BRST P5.1CM MDRT + PRFL RND 16.5CM 800ML STRL CHSV I	BOTH IP/OP	"$2,262.50 "	"$1,674.25"	$0.00	"$1,810.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$471.56	"$1,679.23"	"$1,679.23"	$0.00	$0.00	$471.51	$0.00	"$1,338.27"	"$1,338.27"	$0.00	"$1,131.25"	"$1,791.90"	"$1,810.00"	$0.00		$0.00	$354.08	$0.00	$0.00	$360.19	$0.00	$0.00	$0.00	$0.00	$0.00
351 337	SUP	HCPCS C1895		351 337  -  LINOX TD STEROID 65/16 CM	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
351.16J	SUP	Custom 27203010		351.16J  -  CHUCK DRILL CONCTR CANN QUICK COUPLING JACOBS	BOTH IP/OP	$789.18 	$583.99	$0.00	$612.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$585.73	$585.73	$0.00	$0.00	$164.46	$0.00	$0.00	$0.00	$0.00	$383.10	$606.83	$612.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.27S	SUP	Custom 27203010		351.27S  -  BIT DRL 13MM 300MM STRL CNN	BOTH IP/OP	"$1,212.20 "	$897.03	$0.00	$941.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$899.69	$899.69	$0.00	$0.00	$252.62	$0.00	$0.00	$0.00	$0.00	$588.45	$932.10	$941.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.704S	SUP	Custom 27203010		351.704S  -  ROD REAMER 2.5MM 1150MM BALL TIP EXTN STERILE	BOTH IP/OP	$241.78 	$178.92	$0.00	$187.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.45	$179.45	$0.00	$0.00	$50.39	$0.00	$0.00	$0.00	$0.00	$117.36	$185.91	$187.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.706S	SUP	Custom 27203010		351.706S  -  ROD REAMING 2.5MM 950MM BALL TIP GWIRE STERILE DISPOSABLE	BOTH IP/OP	$223.18 	$165.15	$0.00	$173.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.64	$165.64	$0.00	$0.00	$46.51	$0.00	$0.00	$0.00	$0.00	$108.34	$171.61	$173.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.707S	SUP	Custom 27203010		351.707S  -  ROD REAMING 2.5MM 950MM BALL TIP EXTN STERILE DISPOSABLE	BOTH IP/OP	$223.18 	$165.15	$0.00	$173.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.64	$165.64	$0.00	$0.00	$46.51	$0.00	$0.00	$0.00	$0.00	$108.34	$171.61	$173.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.708S	SUP	Custom 27203010		351.708S  -  ROD REAMING BALL 2.5MM 1150MM STERILE INTRAMEDULLARY NAIL	BOTH IP/OP	$269.88 	$199.71	$0.00	$209.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.30	$200.30	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$131.00	$207.50	$209.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.709S	SUP	Custom 27203010		351.709S  -  ROD REAMER 2.5MM 650MM BALL TIP STERILE	BOTH IP/OP	$237.78 	$175.96	$0.00	$184.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.48	$176.48	$0.00	$0.00	$49.55	$0.00	$0.00	$0.00	$0.00	$115.43	$182.83	$184.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
351.718S	SUP	Custom 27203010		351.718S  -  SEAL DRIVE SHAFT ELASTOMERIC STERILE DISPOSABLE RIA	BOTH IP/OP	$20.96 	$15.51	$0.00	$15.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.56	$15.56	$0.00	$0.00	$4.37	$0.00	$0.00	$0.00	$0.00	$9.88	$15.65	$15.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3515-9-100	SUP	HCPCS C1713		3515-9-100  -  NAIL ORTH IM	BOTH IP/OP	$213.13 	$157.72	$0.00	$170.50	$95.91	$95.91	$0.00	$0.00	$0.00	$44.42	$158.18	$158.18	$0.00	$0.00	$44.42	$0.00	$126.06	$126.06	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$33.35	$0.00	$0.00	$33.93	$0.00	$0.00	$0.00	$0.00	$0.00
352.229S	SUP	Custom 27203010		352.229S  -  FILTER GRAFT PLUNGER GRADUATED 100ML STERILE DISPOSABLE RIA	BOTH IP/OP	$617.05 	$456.62	$0.00	$479.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$457.97	$457.97	$0.00	$0.00	$128.59	$0.00	$0.00	$0.00	$0.00	$299.54	$474.47	$479.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.250S	SUP	Custom 27203010		352.250S  -  REAMER SURG 12MM HEAD STERILE DISPOSABLE RIA	BOTH IP/OP	$684.15 	$506.27	$0.00	$531.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.78	$507.78	$0.00	$0.00	$142.58	$0.00	$0.00	$0.00	$0.00	$332.11	$526.07	$531.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.251S	SUP	Custom 27203010		352.251S  -  REAMER SURG 12.5MM HEAD STERILE DISPOSABLE RIA	BOTH IP/OP	$684.15 	$506.27	$0.00	$531.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.78	$507.78	$0.00	$0.00	$142.58	$0.00	$0.00	$0.00	$0.00	$332.11	$526.07	$531.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.252S	SUP	Custom 27203010		352.252S  -  HEAD RMR DP FLUT 13MM STRL CNCL TIP SHRP EDG SS DISP IRR ASP	BOTH IP/OP	$684.15 	$506.27	$0.00	$531.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.78	$507.78	$0.00	$0.00	$142.58	$0.00	$0.00	$0.00	$0.00	$332.11	$526.07	$531.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.253S	SUP	Custom 27203010		352.253S  -  REAMER SURG 13.5MM HEAD STERILE DISPOSABLE RIA	BOTH IP/OP	$684.15 	$506.27	$0.00	$531.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.78	$507.78	$0.00	$0.00	$142.58	$0.00	$0.00	$0.00	$0.00	$332.11	$526.07	$531.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.254S	SUP	Custom 27203010		352.254S  -  REAMER SURG 14MM HEAD STERILE DISPOSABLE RIA	BOTH IP/OP	$684.15 	$506.27	$0.00	$531.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.78	$507.78	$0.00	$0.00	$142.58	$0.00	$0.00	$0.00	$0.00	$332.11	$526.07	$531.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.255S	SUP	Custom 27203010		352.255S  -  REAMER SURG 14.5MM CONICAL TIP DEEP FLUTE SHARP EDGE	BOTH IP/OP	$684.15 	$506.27	$0.00	$531.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.78	$507.78	$0.00	$0.00	$142.58	$0.00	$0.00	$0.00	$0.00	$332.11	$526.07	$531.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.256S	SUP	Custom 27203010		352.256S  -  HEAD RMR DP FLUT 15MM STRL CNCL TIP SHRP EDG SS DISP IRR ASP	BOTH IP/OP	$684.15 	$506.27	$0.00	$531.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.78	$507.78	$0.00	$0.00	$142.58	$0.00	$0.00	$0.00	$0.00	$332.11	$526.07	$531.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.257S	SUP	HCPCS C1713		352.257S  -  HEAD REAMER 15.5MM STERILE IRRIGATOR ASPIRAT	BOTH IP/OP	$684.15 	$506.27	$0.00	$531.38	$298.90	$298.90	$0.00	$0.00	$0.00	$142.59	$507.78	$507.78	$0.00	$0.00	$142.58	$0.00	$404.67	$404.67	$0.00	$332.11	$526.07	$531.38	$0.00		$0.00	$100.92	$0.00	$0.00	$105.74	$0.00	$0.00	$0.00	$0.00	$0.00
352.258S	SUP	Custom 27203010		352.258S  -  REAMER SURG 16MM HEAD STERILE DISPOSABLE RIA	BOTH IP/OP	$684.15 	$506.27	$0.00	$531.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.78	$507.78	$0.00	$0.00	$142.58	$0.00	$0.00	$0.00	$0.00	$332.11	$526.07	$531.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.259S	SUP	Custom 27203010		352.259S  -  REAMER SURG 16.5MM HEAD STERILE DISPOSABLE RIA	BOTH IP/OP	$684.15 	$506.27	$0.00	$531.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.78	$507.78	$0.00	$0.00	$142.58	$0.00	$0.00	$0.00	$0.00	$332.11	$526.07	$531.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
352.260S	SUP	Custom 27203010		352.260S  -  CLIP LOCKING SECURE ATTCH DRIVE SHAFT TUBE ASMBLY STERILE	BOTH IP/OP	$137.13 	$101.48	$0.00	$106.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.77	$101.77	$0.00	$0.00	$28.58	$0.00	$0.00	$0.00	$0.00	$66.56	$105.44	$106.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3520-0240S	SUP	HCPCS C1713		3520-0240S  -  NAIL IM 120D 10MM 240MM STRL GAMMA3 LT	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3520-0260S	SUP	HCPCS C1713		3520-0260S  -  NAIL 10MM 260MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$3,437.50"	"$1,933.59"	"$1,933.59"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$2,148.44"	"$3,403.13"	"$3,437.50"	$0.00		$0.00	$672.46	$0.00	$0.00	$684.06	$0.00	$0.00	$0.00	$0.00	$0.00
3520-0280S	SUP	HCPCS C1713		3520-0280S  -  NAIL 10MM 280MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3520-0300S	SUP	HCPCS C1713		3520-0300S  -  NAIL 10MM 300MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3520-0320S	SUP	HCPCS C1713		3520-0320S  -  NAIL 10MM 320MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3520-0340S	SUP	HCPCS C1713		3520-0340S  -  NAIL 10MM 340MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3520-0360S	SUP	HCPCS C1713		3520-0360S  -  NAIL 10MM 360MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3520-0380S	SUP	HCPCS C1713		3520-0380S  -  NAIL 10MM 380MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3520-0400S	SUP	HCPCS C1713		3520-0400S  -  NAIL 10MM 400MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3520-0420S	SUP	HCPCS C1713		3520-0420S  -  NAIL IM 120D 10MM 420MM STRL GAMMA3 LT	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3520-0440S	SUP	HCPCS C1713		3520-0440S  -  NAIL IM 120D 10MM 440MM STRL GAMMA3 LT	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3520-0460S	SUP	HCPCS C1713		3520-0460S  -  NAIL IM 120D 10MM 460MM STRL GAMMA3 LT	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3520-9-180	SUP	HCPCS C1713		3520-9-180  -  NAIL 9MM 180MM HUM L/R IM RECON SDL SYS	BOTH IP/OP	"$2,942.50 "	"$2,177.45"	$0.00	"$2,354.00"	"$1,324.13"	"$1,324.13"	$0.00	$0.00	$0.00	$613.29	"$2,183.92"	"$2,183.92"	$0.00	$0.00	$613.22	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,471.25"	"$2,330.46"	"$2,354.00"	$0.00		$0.00	$460.50	$0.00	$0.00	$468.45	$0.00	$0.00	$0.00	$0.00	$0.00
3520-9-200	SUP	HCPCS C1713		3520-9-200  -  NAIL 16MM 48CM HUM IM HUM R/L RECON GRS-K SYS	BOTH IP/OP	"$2,942.50 "	"$2,177.45"	$0.00	"$2,354.00"	"$1,324.13"	"$1,324.13"	$0.00	$0.00	$0.00	$613.29	"$2,183.92"	"$2,183.92"	$0.00	$0.00	$613.22	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,471.25"	"$2,330.46"	"$2,354.00"	$0.00		$0.00	$460.50	$0.00	$0.00	$468.45	$0.00	$0.00	$0.00	$0.00	$0.00
3520-9-220	SUP	HCPCS C1713		3520-9-220  -  NAIL 9MM 220CM IM RECON	BOTH IP/OP	"$2,942.50 "	"$2,177.45"	$0.00	"$2,354.00"	"$1,324.13"	"$1,324.13"	$0.00	$0.00	$0.00	$613.29	"$2,183.92"	"$2,183.92"	$0.00	$0.00	$613.22	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,471.25"	"$2,330.46"	"$2,354.00"	$0.00		$0.00	$460.50	$0.00	$0.00	$468.45	$0.00	$0.00	$0.00	$0.00	$0.00
3520-9-240	SUP	HCPCS C1713		3520-9-240  -  NAIL 9MM 240MM L/R HUM IM RECON SDL SYS STR	BOTH IP/OP	"$2,942.50 "	"$2,177.45"	$0.00	"$2,354.00"	"$1,324.13"	"$1,324.13"	$0.00	$0.00	$0.00	$613.29	"$2,183.92"	"$2,183.92"	$0.00	$0.00	$613.22	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,471.25"	"$2,330.46"	"$2,354.00"	$0.00		$0.00	$460.50	$0.00	$0.00	$468.45	$0.00	$0.00	$0.00	$0.00	$0.00
3520-9-250	SUP	HCPCS C1713		3520-9-250  -  NAIL HUM 250MM 9MM LCK	BOTH IP/OP	"$2,942.50 "	"$2,177.45"	$0.00	"$2,354.00"	"$1,324.13"	"$1,324.13"	$0.00	$0.00	$0.00	$613.29	"$2,183.92"	"$2,183.92"	$0.00	$0.00	$613.22	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,471.25"	"$2,330.46"	"$2,354.00"	$0.00		$0.00	$460.50	$0.00	$0.00	$468.45	$0.00	$0.00	$0.00	$0.00	$0.00
3520-9-260	SUP	HCPCS C1713		3520-9-260  -  NAIL 9MM 260CM HUM IM R/L RECON	BOTH IP/OP	"$2,942.50 "	"$2,177.45"	$0.00	"$2,354.00"	"$1,324.13"	"$1,324.13"	$0.00	$0.00	$0.00	$613.29	"$2,183.92"	"$2,183.92"	$0.00	$0.00	$613.22	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,471.25"	"$2,330.46"	"$2,354.00"	$0.00		$0.00	$460.50	$0.00	$0.00	$468.45	$0.00	$0.00	$0.00	$0.00	$0.00
3520-9-270	SUP	HCPCS C1713		3520-9-270  -  NAIL 9MM 270MM LEFT HUM IM RIGHT RECON SDL SYS	BOTH IP/OP	"$2,942.50 "	"$2,177.45"	$0.00	"$2,354.00"	"$1,324.13"	"$1,324.13"	$0.00	$0.00	$0.00	$613.29	"$2,183.92"	"$2,183.92"	$0.00	$0.00	$613.22	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,471.25"	"$2,330.46"	"$2,354.00"	$0.00		$0.00	$460.50	$0.00	$0.00	$468.45	$0.00	$0.00	$0.00	$0.00	$0.00
3520-9-280	SUP	HCPCS C1713		3520-9-280  -  NAIL 9MM 280MM HUM LEFT IM RIGHT RECON SDL SYS	BOTH IP/OP	"$2,942.50 "	"$2,177.45"	$0.00	"$2,354.00"	"$1,324.13"	"$1,324.13"	$0.00	$0.00	$0.00	$613.29	"$2,183.92"	"$2,183.92"	$0.00	$0.00	$613.22	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,471.25"	"$2,330.46"	"$2,354.00"	$0.00		$0.00	$460.50	$0.00	$0.00	$468.45	$0.00	$0.00	$0.00	$0.00	$0.00
3520-9-300	SUP	HCPCS C1713		3520-9-300  -  NAIL 9MM 300MM HUM IM RECON STRL	BOTH IP/OP	"$2,942.50 "	"$2,177.45"	$0.00	"$2,354.00"	"$1,324.13"	"$1,324.13"	$0.00	$0.00	$0.00	$613.29	"$2,183.92"	"$2,183.92"	$0.00	$0.00	$613.22	$0.00	"$1,450.65"	"$1,450.65"	$0.00	"$1,471.25"	"$2,330.46"	"$2,354.00"	$0.00		$0.00	$460.50	$0.00	$0.00	$468.45	$0.00	$0.00	$0.00	$0.00	$0.00
3520-9-945	SUP	HCPCS C1713		3520-9-945  -  NAIL 5MM 45CM HUM IM LCK SPRD SCR	BOTH IP/OP	$818.13 	$605.42	$0.00	$654.50	$368.16	$368.16	$0.00	$0.00	$0.00	$170.52	$607.21	$607.21	$0.00	$0.00	$170.50	$0.00	$483.92	$483.92	$0.00	$409.06	$647.96	$654.50	$0.00		$0.00	$128.04	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$0.00
3525-0260S	SUP	HCPCS C1713		3525-0260S  -  NAIL 10MM 26CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3525-0280S	SUP	HCPCS C1713		3525-0280S  -  NAIL 10MM 28CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3525-0300S	SUP	HCPCS C1713		3525-0300S  -  NAIL 10MM 30CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3525-0320S	SUP	HCPCS C1713		3525-0320S  -  NAIL 10MM 32CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3525-0340S	SUP	HCPCS C1713		3525-0340S  -  NAIL 10MM 34CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3525-0360S	SUP	HCPCS C1713		3525-0360S  -  NAIL 10MM 36CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3525-0380S	SUP	HCPCS C1713		3525-0380S  -  NAIL 10MM 38CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3525-0400S	SUP	HCPCS C1713		3525-0400S  -  NAIL 10MM 40CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3525-0420S	SUP	HCPCS C1713		3525-0420S  -  GAMMA 3 S NAIL LEFT 10X420MM X 125	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3525-0440S	SUP	HCPCS C1713		3525-0440S  -  GAMMA 3 S NAIL LEFT 10X440MM X 125	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3525-0460S	SUP	HCPCS C1713		3525-0460S  -  NAIL IM 125D 10MM 460MM STRL GAMMA3 LT	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
352506070E	SUP	HCPCS C1880		352506070E  -  SYSTEM EMBOLIC PROTECTION 6.5FR 0-32MM 5FR 70CM FILTER KIT	BOTH IP/OP	"$1,812.50 "	"$1,341.25"	$0.00	"$1,450.00"	$815.63	$815.63	$0.00	$0.00	$0.00	$377.77	"$1,345.24"	"$1,345.24"	$0.00	$0.00	$377.73	$0.00	"$1,072.09"	"$1,072.09"	$0.00	$906.25	"$1,435.50"	"$1,450.00"	$0.00		$0.00	$283.66	$0.00	$0.00	$288.55	$0.00	$0.00	$0.00	$0.00	$0.00
352506100E	SUP	HCPCS C1880		352506100E  -  FILTER EMBL 30- MM 5FR 100CM STRL LF OPTIONELITE INTRO SHTH	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
3530-0260S	SUP	HCPCS C1713		3530-0260S  -  NAIL 10MM 26CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3530-0280S	SUP	HCPCS C1713		3530-0280S  -  NAIL 10MM 28CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3530-0300S	SUP	HCPCS C1713		3530-0300S  -  NAIL 10MM 30CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3530-0320S	SUP	HCPCS C1713		3530-0320S  -  NAIL 10MM 32CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3530-0340S	SUP	HCPCS C1713		3530-0340S  -  NAIL 10MM 34CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3530-0360S	SUP	HCPCS C1713		3530-0360S  -  NAIL 10MM 36CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3530-0380S	SUP	HCPCS C1713		3530-0380S  -  NAIL 10MM 38CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3530-0400S	SUP	HCPCS C1713		3530-0400S  -  NAIL 10MM 40CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3530-0420S	SUP	HCPCS C1713		3530-0420S  -  GAMMA 3 S NAIL LEFT 10X420MM X 130	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3530-0440S	SUP	HCPCS C1713		3530-0440S  -  GAMMA 3 S NAIL LEFT 10X440MM X 130	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
3530-0460S	SUP	HCPCS C1713		3530-0460S  -  NAIL IM 130D 10MM 460MM STRL GAMMA3 LT	BOTH IP/OP	"$3,668.60 "	"$2,714.76"	$0.00	"$2,959.00"	"$1,664.44"	"$1,664.44"	$0.00	$0.00	$0.00	$764.63	"$2,722.83"	"$2,722.83"	$0.00	$0.00	$764.54	$0.00	"$1,808.62"	"$1,808.62"	$0.00	"$1,849.38"	"$2,929.41"	"$2,959.00"	$0.00		$0.00	$578.85	$0.00	$0.00	$588.84	$0.00	$0.00	$0.00	$0.00	$0.00
354 805	SUP	HCPCS C1900		354 805  -  COROX OTW 75 BP LEAD	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
354 807	SUP	HCPCS C1900		354 807  -  COROX OTW 85 BP LEAD	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
354-7212	SUP	HCPCS C1789		354-7212  -  EXPANDER TISS P6.6CM CNTR PRFL 11.7X10CM 350ML SLTX CPX3 STY	BOTH IP/OP	"$3,412.50 "	"$2,525.25"	$0.00	"$2,730.00"	"$1,535.63"	"$1,535.63"	$0.00	$0.00	$0.00	$711.25	"$2,532.76"	"$2,532.76"	$0.00	$0.00	$711.17	$0.00	"$1,682.36"	"$1,682.36"	$0.00	"$1,706.25"	"$2,702.70"	"$2,730.00"	$0.00		$0.00	$534.06	$0.00	$0.00	$543.27	$0.00	$0.00	$0.00	$0.00	$0.00
354-7213	SUP	HCPCS C1789		354-7213  -  EXPANDER TISS P7CM MED HT 12.7X10.8CM 450CC STRL SLTX CNTR	BOTH IP/OP	"$3,312.50 "	"$2,451.25"	$0.00	"$2,650.00"	"$1,490.63"	"$1,490.63"	$0.00	$0.00	$0.00	$690.41	"$2,458.54"	"$2,458.54"	$0.00	$0.00	$690.33	$0.00	"$1,633.06"	"$1,633.06"	$0.00	"$1,656.25"	"$2,623.50"	"$2,650.00"	$0.00		$0.00	$518.41	$0.00	$0.00	$527.35	$0.00	$0.00	$0.00	$0.00	$0.00
354-7214	SUP	HCPCS C1789		354-7214  -  EXPANDER TISS P7.4CM CNTR PRFL 13.5X11.7CM 550ML SLTX CPX3	BOTH IP/OP	"$3,412.50 "	"$2,525.25"	$0.00	"$2,730.00"	"$1,535.63"	"$1,535.63"	$0.00	$0.00	$0.00	$711.25	"$2,532.76"	"$2,532.76"	$0.00	$0.00	$711.17	$0.00	"$1,682.36"	"$1,682.36"	$0.00	"$1,706.25"	"$2,702.70"	"$2,730.00"	$0.00		$0.00	$534.06	$0.00	$0.00	$543.27	$0.00	$0.00	$0.00	$0.00	$0.00
354-7215	SUP	HCPCS C1789		354-7215  -  EXPANDER TISS P7.6CM CNTR PRFL 14.6X12.6CM 650ML SLTX CPX3	BOTH IP/OP	"$3,412.50 "	"$2,525.25"	$0.00	"$2,730.00"	"$1,535.63"	"$1,535.63"	$0.00	$0.00	$0.00	$711.25	"$2,532.76"	"$2,532.76"	$0.00	$0.00	$711.17	$0.00	"$1,682.36"	"$1,682.36"	$0.00	"$1,706.25"	"$2,702.70"	"$2,730.00"	$0.00		$0.00	$534.06	$0.00	$0.00	$543.27	$0.00	$0.00	$0.00	$0.00	$0.00
354-9212	SUP	HCPCS C1789		354-9212  -  EXPANDER TISS P6.6CM CNTR PRFL MED HT 11.7X10CM 350ML CPX4	BOTH IP/OP	"$2,937.50 "	"$2,173.75"	$0.00	"$2,350.00"	"$1,321.88"	"$1,321.88"	$0.00	$0.00	$0.00	$612.25	"$2,180.21"	"$2,180.21"	$0.00	$0.00	$612.18	$0.00	"$1,448.19"	"$1,448.19"	$0.00	"$1,468.75"	"$2,326.50"	"$2,350.00"	$0.00		$0.00	$459.72	$0.00	$0.00	$467.65	$0.00	$0.00	$0.00	$0.00	$0.00
355 148	SUP	HCPCS C1900		355 148  -  COROX OTW 75 BP-S LEAD	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
355.399S	SUP	Custom 27203010		355.399S  -  HOOK EXTRACTION 650MM STERILE CANN INTRAMEDULLARY NAIL	BOTH IP/OP	$650.60 	$481.44	$0.00	$505.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.88	$482.88	$0.00	$0.00	$135.59	$0.00	$0.00	$0.00	$0.00	$315.83	$500.27	$505.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-035	SUP	HCPCS C1713		3550-0-035  -  SCREW BONE 6.5MM 35MM ASNS 2 CORT GD	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$57.24	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-040	SUP	HCPCS C1713		3550-0-040  -  SCREW BONE 6.5MM 40MM ASNS 2 CORT GD	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$57.24	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-045	SUP	HCPCS C1713		3550-0-045  -  SCREW BONE 6.5MM 45MM ASNS 2 CORT GD	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$57.24	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-050	SUP	HCPCS C1713		3550-0-050  -  SCREW BONE 6.5MM 50MM ASNS 2 CORT GD	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$57.24	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-055	SUP	HCPCS C1713		3550-0-055  -  SCREW BONE 6.5MM 55MM ASNS 2 CORT GD	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$57.24	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-060	SUP	HCPCS C1713		3550-0-060  -  SCREW BONE 6.5MM 60MM ASNS 2 CORT GD	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$57.24	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-065	SUP	HCPCS C1713		3550-0-065  -  SCREW BONE 6.5MM 65MM ASNS 2 CORT GD	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$57.24	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-070	SUP	HCPCS C1713		3550-0-070  -  SCREW BONE 6.5MM 70MM ASNS 2 CORT GD	BOTH IP/OP	$365.75 	$270.66	$0.00	$292.60	$164.59	$164.59	$0.00	$0.00	$0.00	$76.23	$271.46	$271.46	$0.00	$0.00	$76.22	$0.00	$216.34	$216.34	$0.00	$182.88	$289.67	$292.60	$0.00		$0.00	$57.24	$0.00	$0.00	$58.23	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-075	SUP	HCPCS C1713		3550-0-075  -  SCREW BONE 6.5MM 75MM ASNS 2 CORT GD	BOTH IP/OP	$402.88 	$298.13	$0.00	$322.30	$181.29	$181.29	$0.00	$0.00	$0.00	$83.97	$299.01	$299.01	$0.00	$0.00	$83.96	$0.00	$238.30	$238.30	$0.00	$201.44	$319.08	$322.30	$0.00		$0.00	$63.05	$0.00	$0.00	$64.14	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-080	SUP	HCPCS C1713		3550-0-080  -  SCREW BONE 6.5MM 80MM ASNS 2 CORT GD	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-085	SUP	HCPCS C1713		3550-0-085  -  SCREW BONE 6.5MM 85MM ASNS 2 CORT GD	BOTH IP/OP	$402.88 	$298.13	$0.00	$322.30	$181.29	$181.29	$0.00	$0.00	$0.00	$83.97	$299.01	$299.01	$0.00	$0.00	$83.96	$0.00	$238.30	$238.30	$0.00	$201.44	$319.08	$322.30	$0.00		$0.00	$63.05	$0.00	$0.00	$64.14	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-090	SUP	HCPCS C1713		3550-0-090  -  SCREW BONE 6.5MM 90MM ASNS 2 CORT GD	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-095	SUP	HCPCS C1713		3550-0-095  -  SCREW BONE 6.5MM 95MM ASNS 2 CORT GD	BOTH IP/OP	$402.88 	$298.13	$0.00	$322.30	$181.29	$181.29	$0.00	$0.00	$0.00	$83.97	$299.01	$299.01	$0.00	$0.00	$83.96	$0.00	$238.30	$238.30	$0.00	$201.44	$319.08	$322.30	$0.00		$0.00	$63.05	$0.00	$0.00	$64.14	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-100	SUP	HCPCS C1713		3550-0-100  -  SCREW BONE 6.5MM 100MM ASNS 2 CORT GD	BOTH IP/OP	$402.88 	$298.13	$0.00	$322.30	$181.29	$181.29	$0.00	$0.00	$0.00	$83.97	$299.01	$299.01	$0.00	$0.00	$83.96	$0.00	$238.30	$238.30	$0.00	$201.44	$319.08	$322.30	$0.00		$0.00	$63.05	$0.00	$0.00	$64.14	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-105	SUP	HCPCS C1713		3550-0-105  -  SCREW BONE 6.5MM 105MM ASNS 2 CORT GD	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-110	SUP	HCPCS C1713		3550-0-110  -  SCREW BONE 6.5MM 110MM ASNS 2 CORT GD	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-115	SUP	HCPCS C1713		3550-0-115  -  SCREW BONE 6.5MM 115MM ASNS 2 CORT GD	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-120	SUP	HCPCS C1713		3550-0-120  -  SCREW BONE 6.5MM 120MM ASNS 2 CORT GD	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-125	SUP	HCPCS C1713		3550-0-125  -  SCREW BONE 6.5MM 125MM ASNS 2 CORT GD	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
3550-0-130	SUP	HCPCS C1713		3550-0-130  -  SCREW BONE 6.5MM 130MM ASNS 2 CORT GD	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-024	SUP	HCPCS C1713		3550-4-024  -  ASNIS2 GUIDED SCREW 5.0CANC 24	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-026	SUP	HCPCS C1713		3550-4-026  -  SCREW BONE 5MM 2MM ASNS 2 CANC GD	BOTH IP/OP	$257.13 	$190.28	$0.00	$205.70	$115.71	$115.71	$0.00	$0.00	$0.00	$53.59	$190.84	$190.84	$0.00	$0.00	$53.58	$0.00	$152.09	$152.09	$0.00	$128.56	$203.65	$205.70	$0.00		$0.00	$40.24	$0.00	$0.00	$40.93	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-028	SUP	HCPCS C1713		3550-4-028  -  ASNIS2 GUIDED SCREW 5.0CANC 28	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-030	SUP	HCPCS C1713		3550-4-030  -  ASNIS2 GUIDED SCREW 5.0CANC 30	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-032	SUP	HCPCS C1713		3550-4-032  -  ASNIS2 GUIDED SCREW 5.0CANC 32	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-034	SUP	HCPCS C1713		3550-4-034  -  SCREW BONE 5MM 34MM ASNS 2 SS PTTHRD GD CANC STRL	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-036	SUP	HCPCS C1713		3550-4-036  -  SCREW BONE 5MM 3MM ASNS 2 CANC GD	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-038	SUP	HCPCS C1713		3550-4-038  -  ASNIS2 GUIDED SCREW 5.0CANC 38	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-040	SUP	HCPCS C1713		3550-4-040  -  ASNIS2 GUIDED SCREW 5.0CANC 40	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-042	SUP	HCPCS C1713		3550-4-042  -  SCREW BONE 5MM 4MM ASNS 2 CANC GD	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-045	SUP	HCPCS C1713		3550-4-045  -  SCREW BONE 5MM 4MM ASNS 2 CANC GD	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-055	SUP	HCPCS C1713		3550-4-055  -  SCREW BONE 5MM 55MM ASNS 2 CANC GD	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-060	SUP	HCPCS C1713		3550-4-060  -  SCREW BONE 5MM 60MM ASNS 2 CANC GD	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-065	SUP	HCPCS C1713		3550-4-065  -  SCREW BONE 5MM 6MM ASNS 2 CANC GD	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-4-070	SUP	HCPCS C1713		3550-4-070  -  ASNIS2 GUIDED SCREW 5.0CANC 70	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$123.13	$123.13	$0.00	$0.00	$0.00	$57.03	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$161.85	$161.85	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$42.82	$0.00	$0.00	$43.56	$0.00	$0.00	$0.00	$0.00	$0.00
3550-5-000	SUP	Custom 27803010		3550-5-000  -  SMALL WASHER	BOTH IP/OP	$64.63 	$47.83	$0.00	$51.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.96	$47.96	$0.00	$0.00	$13.47	$0.00	$0.00	$0.00	$0.00	$32.31	$51.19	$51.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3600-100	SUP	HCPCS C1729		3600-100  -  DRAIN INCISION 1 COLLECT 1 CHAMBER 1 PATIENT TUBE DRY	BOTH IP/OP	$75.13 	$55.60	$0.00	$57.55	$39.06	$39.06	$0.00	$0.00	$0.00	$14.77	$52.60	$52.60	$0.00	$0.00	$14.77	$0.00	$41.92	$41.92	$0.00	$35.97	$56.98	$57.55	$0.00		$0.00	$11.26	$0.00	$0.00	$11.45	$0.00	$0.00	$0.00	$0.00	$0.00
3611ED	SUP	Custom 27203010		MATTRESS COMPLETE UNIT /F	BOTH IP/OP	"$2,006.95 "	"$1,485.14"	$0.00	"$1,605.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,003.48"	"$1,589.50"	"$1,605.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3634LF	SUP	Custom 27203010		STOCKING CMPR THG HI LG SHRT ANEMB INSP TOE TED NYL	BOTH IP/OP	$707.48 	$523.54	$0.00	$565.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$353.74	$560.32	$565.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-0-040	SUP	Custom 27803010		3704-0-040  -  CABLE/SLEEVE ORTHOPEDIC 1.6MM BEAD SET DALL-MILES STAINLESS	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$0.00	$0.00	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-0-050	SUP	Custom 27803010		3704-0-050  -  CABLE/SLEEVE ORTHOPEDIC LP 2MM BEAD SET DALL-MILES STAINLESS	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$0.00	$0.00	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-0-410	SUP	Custom 27803010		3704-0-410  -  CABLE/SLEEVE ORTHOPEDIC FLAT 1.6MM SET LP DALL-MILES	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$0.00	$0.00	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-0-510	SUP	Custom 27803010		3704-0-510  -  CABLE/SLEEVE ORTHOPEDIC 2MM BEAD SET DALL-MILES STAINLESS	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$0.00	$0.00	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-1-100	SUP	Custom 27803010		3704-1-100  -  SLEEVE CABLE SMALL DALL-MILES STAINLESS STEEL HIP	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$0.00	$0.00	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-1-110	SUP	Custom 27803010		3704-1-110  -  SLEEVE CABLE MEDIUM DALL-MILES STAINLESS STEEL HIP	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$0.00	$0.00	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-2-070	SUP	Custom 27803010		3704-2-070  -  GRIP CABLE SMALL 43MM DALL-MILES STAINLESS STEEL HIP TROC	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-2-080	SUP	Custom 27803010		3704-2-080  -  GRIP CABLE MEDIUM 48MM DALL-MILES STAINLESS STEEL HIP TROC	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-2-081	SUP	HCPCS C1713		3704-2-081  -  PLATE BONE MEDIUM 100MM GRIP DALL-MILES STAINLESS STEEL HIP	BOTH IP/OP	"$2,610.00 "	"$1,931.40"	$0.00	"$2,088.00"	"$1,174.50"	"$1,174.50"	$0.00	$0.00	$0.00	$543.99	"$1,937.14"	"$1,937.14"	$0.00	$0.00	$543.92	$0.00	"$1,286.73"	"$1,286.73"	$0.00	"$1,305.00"	"$2,067.12"	"$2,088.00"	$0.00		$0.00	$408.47	$0.00	$0.00	$415.51	$0.00	$0.00	$0.00	$0.00	$0.00
3704-2-082	SUP	Custom 27803010		3704-2-082  -  PLATE BONE MEDIUM 150MM GRIP DALL-MILES STAINLESS STEEL HIP	BOTH IP/OP	"$3,422.50 "	"$2,532.65"	$0.00	"$2,738.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,540.18"	"$2,540.18"	$0.00	$0.00	$713.25	$0.00	$0.00	$0.00	$0.00	"$1,711.25"	"$2,710.62"	"$2,738.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-2-083	SUP	Custom 27803010		3704-2-083  -  PLATE BONE MEDIUM 200MM GRIP DALL-MILES STAINLESS STEEL HIP	BOTH IP/OP	"$4,240.00 "	"$3,137.60"	$0.00	"$3,392.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,146.93"	"$3,146.93"	$0.00	$0.00	$883.62	$0.00	$0.00	$0.00	$0.00	"$2,120.00"	"$3,358.08"	"$3,392.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-2-090	SUP	Custom 27803010		3704-2-090  -  GRIP CABLE LARGE 200MM DALL-MILES STAINLESS STEEL HIP TROC	BOTH IP/OP	"$1,800.00 "	"$1,332.00"	$0.00	"$1,440.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,335.96"	"$1,335.96"	$0.00	$0.00	$375.12	$0.00	$0.00	$0.00	$0.00	$900.00	"$1,425.60"	"$1,440.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-2-091	SUP	Custom 27803010		3704-2-091  -  PLATE BONE LARGE 110MM GRIP DALL-MILES STAINLESS STEEL HIP	BOTH IP/OP	"$2,217.50 "	"$1,640.95"	$0.00	"$1,774.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,645.83"	"$1,645.83"	$0.00	$0.00	$462.13	$0.00	$0.00	$0.00	$0.00	"$1,108.75"	"$1,756.26"	"$1,774.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-2-092	SUP	Custom 27803010		3704-2-092  -  PLATE BONE LARGE 160MM GRIP DALL-MILES STAINLESS STEEL HIP	BOTH IP/OP	"$3,422.50 "	"$2,532.65"	$0.00	"$2,738.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,540.18"	"$2,540.18"	$0.00	$0.00	$713.25	$0.00	$0.00	$0.00	$0.00	"$1,711.25"	"$2,710.62"	"$2,738.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-2-093	SUP	Custom 27803010		3704-2-093  -  PLATE BONE LARGE 210MM GRIP DALL-MILES STAINLESS STEEL HIP	BOTH IP/OP	"$4,240.00 "	"$3,137.60"	$0.00	"$3,392.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,146.93"	"$3,146.93"	$0.00	$0.00	$883.62	$0.00	$0.00	$0.00	$0.00	"$2,120.00"	"$3,358.08"	"$3,392.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-3-100	SUP	HCPCS C1713		3704-3-100  -  PLATE BONE BROAD 6.5IN 5 HOLE 6 GROOVE COMPRESSION ROUND END	BOTH IP/OP	"$1,190.00 "	$880.60	$0.00	$952.00	$535.50	$535.50	$0.00	$0.00	$0.00	$248.03	$883.22	$883.22	$0.00	$0.00	$248.00	$0.00	$703.89	$703.89	$0.00	$595.00	$942.48	$952.00	$0.00		$0.00	$186.24	$0.00	$0.00	$189.45	$0.00	$0.00	$0.00	$0.00	$0.00
3704-3-110	SUP	HCPCS C1713		3704-3-110  -  PLATE BONE BROAD 8IN 7 HOLE 8 GROOVE COMPRESSION ROUND END	BOTH IP/OP	"$1,190.00 "	$880.60	$0.00	$952.00	$535.50	$535.50	$0.00	$0.00	$0.00	$248.03	$883.22	$883.22	$0.00	$0.00	$248.00	$0.00	$703.89	$703.89	$0.00	$595.00	$942.48	$952.00	$0.00		$0.00	$186.24	$0.00	$0.00	$189.45	$0.00	$0.00	$0.00	$0.00	$0.00
3704-3-120	SUP	HCPCS C1713		3704-3-120  -  PLATE BONE BROAD 10IN 9 HOLE 10 GROOVE COMPRESSION ROUND END	BOTH IP/OP	"$1,190.00 "	$880.60	$0.00	$952.00	$535.50	$535.50	$0.00	$0.00	$0.00	$248.03	$883.22	$883.22	$0.00	$0.00	$248.00	$0.00	$703.89	$703.89	$0.00	$595.00	$942.48	$952.00	$0.00		$0.00	$186.24	$0.00	$0.00	$189.45	$0.00	$0.00	$0.00	$0.00	$0.00
3704-3-130	SUP	HCPCS C1713		3704-3-130  -  PLATE BONE BROAD 12IN 11 HOLE 12 GROOVE COMPRESSION ROUND	BOTH IP/OP	"$1,190.00 "	$880.60	$0.00	$952.00	$535.50	$535.50	$0.00	$0.00	$0.00	$248.03	$883.22	$883.22	$0.00	$0.00	$248.00	$0.00	$703.89	$703.89	$0.00	$595.00	$942.48	$952.00	$0.00		$0.00	$186.24	$0.00	$0.00	$189.45	$0.00	$0.00	$0.00	$0.00	$0.00
3704-8-236	SUP	Custom 27803010		3704-8-236  -  CABLE ORTHOPEDIC 1.6MM SLEEVE RECONSTRUCTION TRAUMA	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$0.00	$0.00	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3704-8-240	SUP	Custom 27803010		3704-8-240  -  CABLE ORTHOPEDIC 2MM 650MM DALL-MILES STAINLESS STEEL HIP	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$0.00	$0.00	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
370605.S	SUP	HCPCS A6209		370605.S  -  DRESSING WND THK10MM 6IN 665X802MM STRL LF ABTHERA VSCR PCTV	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$475.13	$475.13	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
370642.S	SUP	HCPCS A6209		370642.S  -  SET TBG ABTHERA QCK ACC STABLIZED	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
37-11068	SUP	Custom 27203010		FORCEPS SURG 45D 5.2IN ANG UP PEAR SHP CUP HRZN	BOTH IP/OP	"$1,722.50 "	"$1,274.65"	$0.00	"$1,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.25	"$1,364.22"	"$1,378.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-535-000	SUP	Custom 27203010		375-535-000  -  BLADE SHVR 3.5MM FRML ARTHRO TOMCAT STRL	BOTH IP/OP	$186.55 	$138.05	$0.00	$149.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.46	$138.46	$0.00	$0.00	$38.88	$0.00	$0.00	$0.00	$0.00	$93.28	$147.75	$149.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-542-000	SUP	Custom 27203010		375-542-000  -  BLADE SHVR 4MM FRML RESCT F LATEX FREE	BOTH IP/OP	$143.43 	$106.14	$0.00	$114.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.45	$106.45	$0.00	$0.00	$29.89	$0.00	$0.00	$0.00	$0.00	$71.72	$113.60	$114.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-544-000	SUP	Custom 27203010		375-544-000  -  BLADE SHVR 4MM FRML STR CTR AGRS+ ARTHRO F STRL LATEX FREE	BOTH IP/OP	$143.43 	$106.14	$0.00	$114.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.45	$106.45	$0.00	$0.00	$29.89	$0.00	$0.00	$0.00	$0.00	$71.72	$113.60	$114.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-545-000	SUP	Custom 27203010		375-545-000  -  BLADE SHAVER 4MM ARTHRO TOMCAT STERILE	BOTH IP/OP	$138.58 	$102.55	$0.00	$110.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.85	$102.85	$0.00	$0.00	$28.88	$0.00	$0.00	$0.00	$0.00	$69.29	$109.76	$110.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-554-000	SUP	Custom 27203010		375-554-000  -  BLADE SHVR 5MM FRML AGRS+ ARTHRO STRL	BOTH IP/OP	$186.55 	$138.05	$0.00	$149.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.46	$138.46	$0.00	$0.00	$38.88	$0.00	$0.00	$0.00	$0.00	$93.28	$147.75	$149.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-555-000	SUP	Custom 27203010		375-555-000  -  CUTTER ENDSCP 5MM TOMCAT FORMULA STERILE	BOTH IP/OP	$134.94 	$99.86	$0.00	$107.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.15	$100.15	$0.00	$0.00	$28.12	$0.00	$0.00	$0.00	$0.00	$67.47	$106.87	$107.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-562-000	SUP	Custom 27203010		375-562-000  -  CUTTER ENDSCP 5.5MM RESECTOR LATEX FREE FORMULA STERILE	BOTH IP/OP	$138.58 	$102.55	$0.00	$110.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.85	$102.85	$0.00	$0.00	$28.88	$0.00	$0.00	$0.00	$0.00	$69.29	$109.76	$110.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-564-000	SUP	Custom 27203010		375-564-000  -  BLADE SURG 5.5MM AGRS+ AGRS+ F SER STRL	BOTH IP/OP	$186.55 	$138.05	$0.00	$149.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.46	$138.46	$0.00	$0.00	$38.88	$0.00	$0.00	$0.00	$0.00	$93.28	$147.75	$149.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-565-000	SUP	Custom 27203010		375-565-000  -  CUTTER ENDSCP ARTHRO FRML STRL 5.5MM	BOTH IP/OP	$186.55 	$138.05	$0.00	$149.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.46	$138.46	$0.00	$0.00	$38.88	$0.00	$0.00	$0.00	$0.00	$93.28	$147.75	$149.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-628-000	SUP	Custom 27203010		375-628-000  -  BLADE SHVR 2.5MM FRML S JNT AGRS STRL	BOTH IP/OP	$143.43 	$106.14	$0.00	$114.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.45	$106.45	$0.00	$0.00	$29.89	$0.00	$0.00	$0.00	$0.00	$71.72	$113.60	$114.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-636-000	SUP	Custom 27203010		375-636-000  -  BLADE SHVR 3.5MM FRML S JNT FULL RAD STRL	BOTH IP/OP	$186.55 	$138.05	$0.00	$149.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.46	$138.46	$0.00	$0.00	$38.88	$0.00	$0.00	$0.00	$0.00	$93.28	$147.75	$149.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-638-000	SUP	Custom 27203010		375-638-000  -  BLADE SHVR 3.5MM FRML S JNT AGRS STRL	BOTH IP/OP	$186.55 	$138.05	$0.00	$149.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.46	$138.46	$0.00	$0.00	$38.88	$0.00	$0.00	$0.00	$0.00	$93.28	$147.75	$149.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-641-000	SUP	Custom 27203010		375-641-000  -  BLADE SHVR 2MM FRML ABRSN HOOD ARTHRO STRL	BOTH IP/OP	$197.05 	$145.82	$0.00	$157.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.25	$146.25	$0.00	$0.00	$41.07	$0.00	$0.00	$0.00	$0.00	$98.53	$156.06	$157.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-647-000	SUP	Custom 27203010		375-647-000  -  BURR SHVR 3MM FRML S JNT ABRSN HOOD ARTHRO STRL	BOTH IP/OP	$197.05 	$145.82	$0.00	$157.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.25	$146.25	$0.00	$0.00	$41.07	$0.00	$0.00	$0.00	$0.00	$98.53	$156.06	$157.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-930-000	SUP	Custom 27203010		375-930-000  -  BURR SHVR 3.5MM FRML RND 6 FLUT ABRSN RPD STRL	BOTH IP/OP	$151.50 	$112.11	$0.00	$121.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.45	$112.45	$0.00	$0.00	$31.57	$0.00	$0.00	$0.00	$0.00	$75.75	$119.99	$121.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-940-000	SUP	Custom 27203010		375-940-000  -  BURR SURG 4MM ROUND 6 FLUTED ARTHRO FORMULA STERILE	BOTH IP/OP	$146.38 	$108.32	$0.00	$117.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.64	$108.64	$0.00	$0.00	$30.51	$0.00	$0.00	$0.00	$0.00	$73.19	$115.93	$117.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-940-012	SUP	Custom 27203010		375-940-012  -  BURR SHVR 4MM FRML RND HLW 12 FLUT ARTHRO STRL	BOTH IP/OP	$151.50 	$112.11	$0.00	$121.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.45	$112.45	$0.00	$0.00	$31.57	$0.00	$0.00	$0.00	$0.00	$75.75	$119.99	$121.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-941-000	SUP	Custom 27203010		375-941-000  -  BURR SRG 6 FLUT BRL 4MM STRL FRML F SER	BOTH IP/OP	$151.50 	$112.11	$0.00	$121.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.45	$112.45	$0.00	$0.00	$31.57	$0.00	$0.00	$0.00	$0.00	$75.75	$119.99	$121.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-941-012	SUP	Custom 27203010		375-941-012  -  BURR SHVR 4MM FRML BRL 12 FLUT ARTHRO STRL	BOTH IP/OP	$197.05 	$145.82	$0.00	$157.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.25	$146.25	$0.00	$0.00	$41.07	$0.00	$0.00	$0.00	$0.00	$98.53	$156.06	$157.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-950-012	SUP	Custom 27203010		375-950-012  -  BURR SHVR 5.5MM FRML 12 FLUT RND ARTHRO STRL	BOTH IP/OP	$197.05 	$145.82	$0.00	$157.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.25	$146.25	$0.00	$0.00	$41.07	$0.00	$0.00	$0.00	$0.00	$98.53	$156.06	$157.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-950-100	SUP	Custom 27203010		375-950-100  -  BURR SHVR 5MM FRML 6 FLUT RND ARTHRO STRL	BOTH IP/OP	$151.50 	$112.11	$0.00	$121.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.45	$112.45	$0.00	$0.00	$31.57	$0.00	$0.00	$0.00	$0.00	$75.75	$119.99	$121.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-950-112	SUP	Custom 27203010		375-950-112  -  BURR SHVR 5MM FRML 12 FLUT RND ARTHRO STRL	BOTH IP/OP	$197.05 	$145.82	$0.00	$157.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.25	$146.25	$0.00	$0.00	$41.07	$0.00	$0.00	$0.00	$0.00	$98.53	$156.06	$157.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-951-000	SUP	Custom 27203010		375-951-000  -  BURR SHAVER 6 FLUTE ROUND BARREL 5.5MM ARTHRO FORMULA	BOTH IP/OP	$146.38 	$108.32	$0.00	$117.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.64	$108.64	$0.00	$0.00	$30.51	$0.00	$0.00	$0.00	$0.00	$73.19	$115.93	$117.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-951-012	SUP	Custom 27203010		375-951-012  -  BURR SHVR 5.5MM FRML BRL 12 FLUT ARTHRO STRL	BOTH IP/OP	$197.05 	$145.82	$0.00	$157.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.25	$146.25	$0.00	$0.00	$41.07	$0.00	$0.00	$0.00	$0.00	$98.53	$156.06	$157.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-951-100	SUP	Custom 27203010		375-951-100  -  BURR SHVR 5MM FRML 6 FLUT BRL ARTHRO STRL	BOTH IP/OP	$197.05 	$145.82	$0.00	$157.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.25	$146.25	$0.00	$0.00	$41.07	$0.00	$0.00	$0.00	$0.00	$98.53	$156.06	$157.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
375-951-112	SUP	Custom 27203010		375-951-112  -  BURR SHVR 5MM FRML 12 FLUT BRL ARTHRO STRL	BOTH IP/OP	$197.05 	$145.82	$0.00	$157.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.25	$146.25	$0.00	$0.00	$41.07	$0.00	$0.00	$0.00	$0.00	$98.53	$156.06	$157.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38-051-65	SUP	Custom 27203010		38-051-65  -  BURR SURG 70MM 2.2MM LNDMN MED NTCH STRL	BOTH IP/OP	$142.50 	$105.45	$0.00	$114.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.76	$105.76	$0.00	$0.00	$29.70	$0.00	$0.00	$0.00	$0.00	$71.25	$112.86	$114.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
380-544-100	SUP	Custom 27203010		380-544-100  -  BLADE SHVR 4MM FRML ANG AGRS+ ARTHRO STRL	BOTH IP/OP	$201.95 	$149.44	$0.00	$161.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.89	$149.89	$0.00	$0.00	$42.09	$0.00	$0.00	$0.00	$0.00	$100.98	$159.94	$161.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
380-545-100	SUP	Custom 27203010		380-545-100  -  BLADE SHVR 4MM TOMCAT ANG TOMCAT STRL	BOTH IP/OP	$201.95 	$149.44	$0.00	$161.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.89	$149.89	$0.00	$0.00	$42.09	$0.00	$0.00	$0.00	$0.00	$100.98	$159.94	$161.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
380-545-150	SUP	Custom 27203010		380-545-150  -  BLADE SHVR 4.5MM TOMCAT ANG TOMCAT STRL LATEX FREE	BOTH IP/OP	$201.95 	$149.44	$0.00	$161.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.89	$149.89	$0.00	$0.00	$42.09	$0.00	$0.00	$0.00	$0.00	$100.98	$159.94	$161.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
380-554-100	SUP	Custom 27203010		380-554-100  -  CUTTER ENDSCP ANG AGRS+ FRML STRL 5MM	BOTH IP/OP	$201.95 	$149.44	$0.00	$161.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.89	$149.89	$0.00	$0.00	$42.09	$0.00	$0.00	$0.00	$0.00	$100.98	$159.94	$161.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
380-555-100	SUP	Custom 27203010		380-555-100  -  CUTTER ENDSCP TOMCAT FRML ANG STRL 5MM	BOTH IP/OP	$201.95 	$149.44	$0.00	$161.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.89	$149.89	$0.00	$0.00	$42.09	$0.00	$0.00	$0.00	$0.00	$100.98	$159.94	$161.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38-130-56	SUP	Custom 27203010		38-130-56  -  PROP MTH PED DNTL SET BLK	BOTH IP/OP	$35.63 	$26.37	$0.00	$28.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.44	$26.44	$0.00	$0.00	$7.42	$0.00	$0.00	$0.00	$0.00	$17.81	$28.22	$28.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3815-8-920	SUP	HCPCS C1713		3815-8-920  -  PIN FIX 4MM STNM	BOTH IP/OP	$68.75 	$50.88	$0.00	$55.00	$30.94	$30.94	$0.00	$0.00	$0.00	$14.33	$51.03	$51.03	$0.00	$0.00	$14.33	$0.00	$40.67	$40.67	$0.00	$34.38	$54.45	$55.00	$0.00		$0.00	$10.76	$0.00	$0.00	$10.95	$0.00	$0.00	$0.00	$0.00	$0.00
3855-4-000	SUP	Custom 27203010		3855-4-000  -  DRILL SURG STP CORT	BOTH IP/OP	$474.38 	$351.04	$0.00	$379.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.08	$352.08	$0.00	$0.00	$98.86	$0.00	$0.00	$0.00	$0.00	$237.19	$375.71	$379.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
38-709-03-07	SUP	HCPCS C1713		38-709-03-07  -  INSTRUMENT RDC LG 5IN BYRD ZYG RDC SCR SS OSTSYN	BOTH IP/OP	$374.38 	$277.04	$0.00	$299.50	$168.47	$168.47	$0.00	$0.00	$0.00	$78.03	$277.86	$277.86	$0.00	$0.00	$78.02	$0.00	$221.44	$221.44	$0.00	$187.19	$296.51	$299.50	$0.00		$0.00	$58.59	$0.00	$0.00	$59.60	$0.00	$0.00	$0.00	$0.00	$0.00
390-110	SUP	Custom 27803010		390-110  -  STONE CONE COIL	BOTH IP/OP	$506.00 	$374.44	$0.00	$404.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$375.55	$375.55	$0.00	$0.00	$105.45	$0.00	$0.00	$0.00	$0.00	$253.00	$400.75	$404.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3910-900-020	SUP	HCPCS C1713		3910-900-020  -  ANCHOR SUTURE 2 FRC FBR NDL STRN 38IN	BOTH IP/OP	$69.38 	$51.34	$0.00	$55.50	$31.22	$31.22	$0.00	$0.00	$0.00	$14.46	$51.49	$51.49	$0.00	$0.00	$14.46	$0.00	$41.04	$41.04	$0.00	$34.69	$54.95	$55.50	$0.00		$0.00	$10.86	$0.00	$0.00	$11.04	$0.00	$0.00	$0.00	$0.00	$0.00
3910-900-050	SUP	HCPCS C1713		3910-900-050  -  SUTURE NABSB 5 3/8 CRC 38IN WHT BLU STRL FRC FBR NDL CO BRD	BOTH IP/OP	$88.30 	$65.34	$0.00	$65.54	$36.00	$36.00	$0.00	$0.00	$0.00	$18.40	$65.54	$65.54	$0.00	$0.00	$18.40	$0.00	$52.23	$52.23	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$12.52	$0.00	$0.00	$12.74	$0.00	$0.00	$0.00	$0.00	$0.00
394500S	SUP	Custom 27203010		394500S  -  HOOK BONE 25MM OMEGA 3 HANSSON HIP SS CMPR SCR TWN STRL	BOTH IP/OP	$178.75 	$132.28	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.67	$132.67	$0.00	$0.00	$37.25	$0.00	$0.00	$0.00	$0.00	$89.38	$141.57	$143.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3A1505	SUP	Custom 27203010		LEADWIRE EKG 5 LEAD SET SNP 40IN	BOTH IP/OP	$26.25 	$19.43	$0.00	$21.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.13	$20.79	$21.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3HSK-3038	SUP	Custom 27203010		3HSK-3038  -  HEARTSTRING III PROXIMAL SEAL SYSTEM 3.8 MM	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3MA005	SUP	Custom 27203010		STANDARD ADV OSMTR CLBRT AMPULE 2ML 3300 SER CHM 50 MOSM/KG	BOTH IP/OP	$11.98 	$8.87	$0.00	$9.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.99	$9.49	$9.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3MA029	SUP	Custom 27203010		CONTROL OSMTR CLNTRL 290 MOSM REF SOL OSM 2ML	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.00	$125.14	$126.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3MA800	SUP	Custom 27203010		SAMPLER ADV CHMBR CLNR SMPL TIP MODL 3300/3320 ANALY	BOTH IP/OP	$767.28 	$567.79	$0.00	$613.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$383.64	$607.69	$613.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3MAXC	SUP	HCPCS C1757		3MAXC  -  CATHETER REPERFUSION 3MAX	BOTH IP/OP	"$3,725.00 "	"$2,756.50"	$0.00	"$4,110.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$776.38	"$2,764.70"	"$2,764.70"	$0.00	$0.00	$776.29	$0.00	"$4,110.93"	"$4,110.93"	$0.00	"$1,612.50"	"$2,554.20"	"$2,580.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3MAXCKIT	SUP	HCPCS C1757		3MAXCKIT  -  CATHETER THROMBECTOMY .014IN 4.7-3.8FR .035IN 153CM 157CM	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3N02A	SUP	Custom 27203010		3N02A  -  SUTURE NONABSORBABLE CV-3 TT-17 36IN 2 ARM MONOFILAMENT	BOTH IP/OP	$677.50 	$501.35	$0.00	$542.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.84	$502.84	$0.00	$0.00	$141.19	$0.00	$0.00	$0.00	$0.00	$338.75	$536.58	$542.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
3X611	SUP	Custom 27203010		BELT 5 56X21/32X7/16IN B53 TYPE	BOTH IP/OP	$48.33 	$35.76	$0.00	$38.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.16	$38.28	$38.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4.0PED	SUP	Custom 27203010		4.0PED  -  TUBE 41MM 5.9MM 4MM UNCUF OBT TRCH PLVN CHLOR PED	BOTH IP/OP	$94.29 	$69.77	$0.00	$75.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.98	$69.98	$0.00	$0.00	$19.65	$0.00	$0.00	$0.00	$0.00	$47.14	$74.68	$75.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4.5PED	SUP	Custom 27203010		4.5PED  -  TUBE 42MM 6.5MM 4.5MM UNCUF OBT TRCH PLVN CHLOR PED	BOTH IP/OP	$94.29 	$69.77	$0.00	$75.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.98	$69.98	$0.00	$0.00	$19.65	$0.00	$0.00	$0.00	$0.00	$47.14	$74.68	$75.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
400.040E	SUP	HCPCS C1713		400.040E  -  SCREW BONE 10MM 1.5MM CORT CRANFCL TI SLFTAP +DR RECESS	BOTH IP/OP	$144.00 	$106.56	$0.00	$115.20	$64.80	$64.80	$0.00	$0.00	$0.00	$30.01	$106.88	$106.88	$0.00	$0.00	$30.01	$0.00	$85.18	$85.18	$0.00	$72.00	$114.05	$115.20	$0.00		$0.00	$22.54	$0.00	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$0.00
400.046E	SUP	HCPCS C1713		400.046E  -  1.5MM TI CORTEX SCR SLF-TPNG WITH PLUSDRIVE(TM) RECESS 16MM	BOTH IP/OP	$144.00 	$106.56	$0.00	$115.20	$64.80	$64.80	$0.00	$0.00	$0.00	$30.01	$106.88	$106.88	$0.00	$0.00	$30.01	$0.00	$85.18	$85.18	$0.00	$72.00	$114.05	$115.20	$0.00		$0.00	$22.54	$0.00	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$0.00
400.048E	SUP	HCPCS C1713		400.048E  -  1.5MM TI CORTEX SCR SLF-TPNG WITH PLUSDRIVE(TM) RECESS 18MM	BOTH IP/OP	$144.00 	$106.56	$0.00	$115.20	$64.80	$64.80	$0.00	$0.00	$0.00	$30.01	$106.88	$106.88	$0.00	$0.00	$30.01	$0.00	$85.18	$85.18	$0.00	$72.00	$114.05	$115.20	$0.00		$0.00	$22.54	$0.00	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$0.00
400.054E	SUP	HCPCS C1713		400.054E  -  SCREW BONE 4MM 1.5MM CORT CRANIOMAXILOFACIAL TI +DR RECESS	BOTH IP/OP	$173.25 	$128.21	$0.00	$138.60	$77.96	$77.96	$0.00	$0.00	$0.00	$36.11	$128.59	$128.59	$0.00	$0.00	$36.11	$0.00	$102.48	$102.48	$0.00	$86.63	$137.21	$138.60	$0.00		$0.00	$27.11	$0.00	$0.00	$27.58	$0.00	$0.00	$0.00	$0.00	$0.00
400.055E	SUP	HCPCS C1713		400.055E  -  SCREW BONE 5MM 1.5MM CRANFCL TI SLFDRILL +DR RECESS STRL	BOTH IP/OP	$173.25 	$128.21	$0.00	$138.60	$77.96	$77.96	$0.00	$0.00	$0.00	$36.11	$128.59	$128.59	$0.00	$0.00	$36.11	$0.00	$102.48	$102.48	$0.00	$86.63	$137.21	$138.60	$0.00		$0.00	$27.11	$0.00	$0.00	$27.58	$0.00	$0.00	$0.00	$0.00	$0.00
400.056E	SUP	HCPCS C1713		400.056E  -  SCREW BONE 6MM 1.5MM CRANFCL TI SLFDRILL +DR RECESS STRL	BOTH IP/OP	$173.25 	$128.21	$0.00	$138.60	$77.96	$77.96	$0.00	$0.00	$0.00	$36.11	$128.59	$128.59	$0.00	$0.00	$36.11	$0.00	$102.48	$102.48	$0.00	$86.63	$137.21	$138.60	$0.00		$0.00	$27.11	$0.00	$0.00	$27.58	$0.00	$0.00	$0.00	$0.00	$0.00
400.280E	SUP	HCPCS C1713		400.280E  -  SCREW BONE 2MM 10MM TI CRNMXF ER +DR RECESS STRL	BOTH IP/OP	$151.88 	$112.39	$0.00	$121.50	$68.34	$68.34	$0.00	$0.00	$0.00	$31.65	$112.72	$112.72	$0.00	$0.00	$31.65	$0.00	$89.83	$89.83	$0.00	$75.94	$120.29	$121.50	$0.00		$0.00	$23.77	$0.00	$0.00	$24.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.282E	SUP	HCPCS C1713		400.282E  -  SCREW BONE 2MM 12MM TI CRNMXF ER +DR RECESS STRL	BOTH IP/OP	$151.88 	$112.39	$0.00	$121.50	$68.34	$68.34	$0.00	$0.00	$0.00	$31.65	$112.72	$112.72	$0.00	$0.00	$31.65	$0.00	$89.83	$89.83	$0.00	$75.94	$120.29	$121.50	$0.00		$0.00	$23.77	$0.00	$0.00	$24.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.284E	SUP	HCPCS C1713		400.284E  -  2.0MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 14MM	BOTH IP/OP	$151.88 	$112.39	$0.00	$121.50	$68.34	$68.34	$0.00	$0.00	$0.00	$31.65	$112.72	$112.72	$0.00	$0.00	$31.65	$0.00	$89.83	$89.83	$0.00	$75.94	$120.29	$121.50	$0.00		$0.00	$23.77	$0.00	$0.00	$24.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.286E	SUP	HCPCS C1713		400.286E  -  2.0MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 16MM	BOTH IP/OP	$151.88 	$112.39	$0.00	$121.50	$68.34	$68.34	$0.00	$0.00	$0.00	$31.65	$112.72	$112.72	$0.00	$0.00	$31.65	$0.00	$89.83	$89.83	$0.00	$75.94	$120.29	$121.50	$0.00		$0.00	$23.77	$0.00	$0.00	$24.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.288E	SUP	HCPCS C1713		400.288E  -  2.0MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 18MM	BOTH IP/OP	$151.88 	$112.39	$0.00	$121.50	$68.34	$68.34	$0.00	$0.00	$0.00	$31.65	$112.72	$112.72	$0.00	$0.00	$31.65	$0.00	$89.83	$89.83	$0.00	$75.94	$120.29	$121.50	$0.00		$0.00	$23.77	$0.00	$0.00	$24.18	$0.00	$0.00	$0.00	$0.00	$0.00
400.404E	SUP	HCPCS C1713		400.404E  -  SCREW BONE STRL GOLD 4MM 1MM CORT CRANFCL TI SLFTAP +DR	BOTH IP/OP	$213.75 	$158.18	$0.00	$171.00	$96.19	$96.19	$0.00	$0.00	$0.00	$44.55	$158.65	$158.65	$0.00	$0.00	$44.55	$0.00	$126.43	$126.43	$0.00	$106.88	$169.29	$171.00	$0.00		$0.00	$33.45	$0.00	$0.00	$34.03	$0.00	$0.00	$0.00	$0.00	$0.00
400.405E	SUP	HCPCS C1713		400.405E  -  SCREW BONE STRL GOLD 5MM 1MM CORT CRANFCL TI SLFTAP +DR	BOTH IP/OP	$213.75 	$158.18	$0.00	$171.00	$96.19	$96.19	$0.00	$0.00	$0.00	$44.55	$158.65	$158.65	$0.00	$0.00	$44.55	$0.00	$126.43	$126.43	$0.00	$106.88	$169.29	$171.00	$0.00		$0.00	$33.45	$0.00	$0.00	$34.03	$0.00	$0.00	$0.00	$0.00	$0.00
400.407E	SUP	HCPCS C1713		400.407E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 7MM	BOTH IP/OP	$191.25 	$141.53	$0.00	$153.00	$86.06	$86.06	$0.00	$0.00	$0.00	$39.86	$141.95	$141.95	$0.00	$0.00	$39.86	$0.00	$113.12	$113.12	$0.00	$95.63	$151.47	$153.00	$0.00		$0.00	$29.93	$0.00	$0.00	$30.45	$0.00	$0.00	$0.00	$0.00	$0.00
400.408E	SUP	HCPCS C1713		400.408E  -  SCREW BONE 1MM 8MM TI CORT SLFTAP NONSTRL	BOTH IP/OP	$213.75 	$158.18	$0.00	$171.00	$96.19	$96.19	$0.00	$0.00	$0.00	$44.55	$158.65	$158.65	$0.00	$0.00	$44.55	$0.00	$126.43	$126.43	$0.00	$106.88	$169.29	$171.00	$0.00		$0.00	$33.45	$0.00	$0.00	$34.03	$0.00	$0.00	$0.00	$0.00	$0.00
400.409E	SUP	HCPCS C1713		400.409E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 9MM	BOTH IP/OP	$191.25 	$141.53	$0.00	$153.00	$86.06	$86.06	$0.00	$0.00	$0.00	$39.86	$141.95	$141.95	$0.00	$0.00	$39.86	$0.00	$113.12	$113.12	$0.00	$95.63	$151.47	$153.00	$0.00		$0.00	$29.93	$0.00	$0.00	$30.45	$0.00	$0.00	$0.00	$0.00	$0.00
400.410E	SUP	HCPCS C1713		400.410E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 10MM	BOTH IP/OP	$213.75 	$158.18	$0.00	$171.00	$96.19	$96.19	$0.00	$0.00	$0.00	$44.55	$158.65	$158.65	$0.00	$0.00	$44.55	$0.00	$126.43	$126.43	$0.00	$106.88	$169.29	$171.00	$0.00		$0.00	$33.45	$0.00	$0.00	$34.03	$0.00	$0.00	$0.00	$0.00	$0.00
400.411E	SUP	HCPCS C1713		400.411E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 11MM	BOTH IP/OP	$191.25 	$141.53	$0.00	$153.00	$86.06	$86.06	$0.00	$0.00	$0.00	$39.86	$141.95	$141.95	$0.00	$0.00	$39.86	$0.00	$113.12	$113.12	$0.00	$95.63	$151.47	$153.00	$0.00		$0.00	$29.93	$0.00	$0.00	$30.45	$0.00	$0.00	$0.00	$0.00	$0.00
400.412E	SUP	HCPCS C1713		400.412E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 12MM	BOTH IP/OP	$213.75 	$158.18	$0.00	$171.00	$96.19	$96.19	$0.00	$0.00	$0.00	$44.55	$158.65	$158.65	$0.00	$0.00	$44.55	$0.00	$126.43	$126.43	$0.00	$106.88	$169.29	$171.00	$0.00		$0.00	$33.45	$0.00	$0.00	$34.03	$0.00	$0.00	$0.00	$0.00	$0.00
400.414E	SUP	HCPCS C1713		400.414E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 14MM	BOTH IP/OP	$213.75 	$158.18	$0.00	$171.00	$96.19	$96.19	$0.00	$0.00	$0.00	$44.55	$158.65	$158.65	$0.00	$0.00	$44.55	$0.00	$126.43	$126.43	$0.00	$106.88	$169.29	$171.00	$0.00		$0.00	$33.45	$0.00	$0.00	$34.03	$0.00	$0.00	$0.00	$0.00	$0.00
400.437E	SUP	HCPCS C1713		400.437E  -  SCREW BONE 7MM 1.3MM CORTEX TI SLFTAP DRV RECESS 3MM	BOTH IP/OP	$178.88 	$132.37	$0.00	$143.10	$80.49	$80.49	$0.00	$0.00	$0.00	$37.28	$132.76	$132.76	$0.00	$0.00	$37.28	$0.00	$105.80	$105.80	$0.00	$89.44	$141.67	$143.10	$0.00		$0.00	$27.99	$0.00	$0.00	$28.48	$0.00	$0.00	$0.00	$0.00	$0.00
400.439E	SUP	HCPCS C1713		400.439E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 9MM	BOTH IP/OP	$178.88 	$132.37	$0.00	$143.10	$80.49	$80.49	$0.00	$0.00	$0.00	$37.28	$132.76	$132.76	$0.00	$0.00	$37.28	$0.00	$105.80	$105.80	$0.00	$89.44	$141.67	$143.10	$0.00		$0.00	$27.99	$0.00	$0.00	$28.48	$0.00	$0.00	$0.00	$0.00	$0.00
400.440E	SUP	HCPCS C1713		400.440E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 10MM	BOTH IP/OP	$199.13 	$147.36	$0.00	$159.30	$89.61	$89.61	$0.00	$0.00	$0.00	$41.50	$147.79	$147.79	$0.00	$0.00	$41.50	$0.00	$117.78	$117.78	$0.00	$99.56	$157.71	$159.30	$0.00		$0.00	$31.16	$0.00	$0.00	$31.70	$0.00	$0.00	$0.00	$0.00	$0.00
400.442E	SUP	HCPCS C1713		400.442E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 12MM	BOTH IP/OP	$199.13 	$147.36	$0.00	$159.30	$89.61	$89.61	$0.00	$0.00	$0.00	$41.50	$147.79	$147.79	$0.00	$0.00	$41.50	$0.00	$117.78	$117.78	$0.00	$99.56	$157.71	$159.30	$0.00		$0.00	$31.16	$0.00	$0.00	$31.70	$0.00	$0.00	$0.00	$0.00	$0.00
400.444E	SUP	HCPCS C1713		400.444E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 14MM	BOTH IP/OP	$199.13 	$147.36	$0.00	$159.30	$89.61	$89.61	$0.00	$0.00	$0.00	$41.50	$147.79	$147.79	$0.00	$0.00	$41.50	$0.00	$117.78	$117.78	$0.00	$99.56	$157.71	$159.30	$0.00		$0.00	$31.16	$0.00	$0.00	$31.70	$0.00	$0.00	$0.00	$0.00	$0.00
400.446E	SUP	HCPCS C1713		400.446E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 16MM	BOTH IP/OP	$199.13 	$147.36	$0.00	$159.30	$89.61	$89.61	$0.00	$0.00	$0.00	$41.50	$147.79	$147.79	$0.00	$0.00	$41.50	$0.00	$117.78	$117.78	$0.00	$99.56	$157.71	$159.30	$0.00		$0.00	$31.16	$0.00	$0.00	$31.70	$0.00	$0.00	$0.00	$0.00	$0.00
400.448E	SUP	HCPCS C1713		400.448E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 18MM	BOTH IP/OP	$199.13 	$147.36	$0.00	$159.30	$89.61	$89.61	$0.00	$0.00	$0.00	$41.50	$147.79	$147.79	$0.00	$0.00	$41.50	$0.00	$117.78	$117.78	$0.00	$99.56	$157.71	$159.30	$0.00		$0.00	$31.16	$0.00	$0.00	$31.70	$0.00	$0.00	$0.00	$0.00	$0.00
400.454E	SUP	HCPCS C1713		400.454E  -  SCREW BONE STRL SLVR 4MM 1.3MM CORT CRANFCL TI SLFDRILL +DR	BOTH IP/OP	$204.75 	$151.52	$0.00	$163.80	$92.14	$92.14	$0.00	$0.00	$0.00	$42.68	$151.97	$151.97	$0.00	$0.00	$42.67	$0.00	$121.11	$121.11	$0.00	$102.38	$162.16	$163.80	$0.00		$0.00	$32.04	$0.00	$0.00	$32.60	$0.00	$0.00	$0.00	$0.00	$0.00
400.455E	SUP	HCPCS C1713		400.455E  -  SCREW BONE SLVR 5MM 1.3MM CRANFCL TI SLFDRILL +DR RECESS	BOTH IP/OP	$204.75 	$151.52	$0.00	$163.80	$92.14	$92.14	$0.00	$0.00	$0.00	$42.68	$151.97	$151.97	$0.00	$0.00	$42.67	$0.00	$121.11	$121.11	$0.00	$102.38	$162.16	$163.80	$0.00		$0.00	$32.04	$0.00	$0.00	$32.60	$0.00	$0.00	$0.00	$0.00	$0.00
400.456E	SUP	HCPCS C1713		400.456E  -  SCREW BONE SLVR 6MM 1.3MM CRANFCL TI SLFDRILL +DR RECESS	BOTH IP/OP	$204.75 	$151.52	$0.00	$163.80	$92.14	$92.14	$0.00	$0.00	$0.00	$42.68	$151.97	$151.97	$0.00	$0.00	$42.67	$0.00	$121.11	$121.11	$0.00	$102.38	$162.16	$163.80	$0.00		$0.00	$32.04	$0.00	$0.00	$32.60	$0.00	$0.00	$0.00	$0.00	$0.00
400.465E	SUP	HCPCS C1713		400.465E  -  SCREW BONE TEAL 5MM 1.2MM CRANFCL TI SLFDRILL +DR RECESS	BOTH IP/OP	$220.50 	$163.17	$0.00	$176.40	$99.23	$99.23	$0.00	$0.00	$0.00	$45.96	$163.66	$163.66	$0.00	$0.00	$45.95	$0.00	$130.43	$130.43	$0.00	$110.25	$174.64	$176.40	$0.00		$0.00	$34.51	$0.00	$0.00	$35.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.467E	SUP	HCPCS C1713		400.467E  -  SCREW BONE 7MM 1.2MM CRNMXF TI NONSTRL	BOTH IP/OP	$195.75 	$144.86	$0.00	$156.60	$88.09	$88.09	$0.00	$0.00	$0.00	$40.80	$145.29	$145.29	$0.00	$0.00	$40.79	$0.00	$115.79	$115.79	$0.00	$97.88	$155.03	$156.60	$0.00		$0.00	$30.63	$0.00	$0.00	$31.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.469E	SUP	HCPCS C1713		400.469E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 9MM	BOTH IP/OP	$195.75 	$144.86	$0.00	$156.60	$88.09	$88.09	$0.00	$0.00	$0.00	$40.80	$145.29	$145.29	$0.00	$0.00	$40.79	$0.00	$115.79	$115.79	$0.00	$97.88	$155.03	$156.60	$0.00		$0.00	$30.63	$0.00	$0.00	$31.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.470E	SUP	HCPCS C1713		400.470E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 10MM	BOTH IP/OP	$220.50 	$163.17	$0.00	$176.40	$99.23	$99.23	$0.00	$0.00	$0.00	$45.96	$163.66	$163.66	$0.00	$0.00	$45.95	$0.00	$130.43	$130.43	$0.00	$110.25	$174.64	$176.40	$0.00		$0.00	$34.51	$0.00	$0.00	$35.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.471E	SUP	HCPCS C1713		400.471E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 11MM	BOTH IP/OP	$195.75 	$144.86	$0.00	$156.60	$88.09	$88.09	$0.00	$0.00	$0.00	$40.80	$145.29	$145.29	$0.00	$0.00	$40.79	$0.00	$115.79	$115.79	$0.00	$97.88	$155.03	$156.60	$0.00		$0.00	$30.63	$0.00	$0.00	$31.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.472E	SUP	HCPCS C1713		400.472E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 12MM	BOTH IP/OP	$220.50 	$163.17	$0.00	$176.40	$99.23	$99.23	$0.00	$0.00	$0.00	$45.96	$163.66	$163.66	$0.00	$0.00	$45.95	$0.00	$130.43	$130.43	$0.00	$110.25	$174.64	$176.40	$0.00		$0.00	$34.51	$0.00	$0.00	$35.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.474E	SUP	HCPCS C1713		400.474E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 14MM	BOTH IP/OP	$220.50 	$163.17	$0.00	$176.40	$99.23	$99.23	$0.00	$0.00	$0.00	$45.96	$163.66	$163.66	$0.00	$0.00	$45.95	$0.00	$130.43	$130.43	$0.00	$110.25	$174.64	$176.40	$0.00		$0.00	$34.51	$0.00	$0.00	$35.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.483E	SUP	HCPCS C1713		400.483E  -  SCREW BONE 3MM 1.7MM CRANFCL TI ER +DR RECESS STRL	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$93.15	$93.15	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$0.00	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00		$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
400.487E	SUP	HCPCS C1713		400.487E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 7MM	BOTH IP/OP	$186.75 	$138.20	$0.00	$149.40	$84.04	$84.04	$0.00	$0.00	$0.00	$38.92	$138.61	$138.61	$0.00	$0.00	$38.92	$0.00	$110.46	$110.46	$0.00	$93.38	$147.91	$149.40	$0.00		$0.00	$29.23	$0.00	$0.00	$29.73	$0.00	$0.00	$0.00	$0.00	$0.00
400.488E	SUP	HCPCS C1713		400.488E  -  SCREW BN 1.5MM 8MM NS TI CORT	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$93.15	$93.15	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$0.00	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00		$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
400.489E	SUP	HCPCS C1713		400.489E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 9MM	BOTH IP/OP	$186.75 	$138.20	$0.00	$149.40	$84.04	$84.04	$0.00	$0.00	$0.00	$38.92	$138.61	$138.61	$0.00	$0.00	$38.92	$0.00	$110.46	$110.46	$0.00	$93.38	$147.91	$149.40	$0.00		$0.00	$29.23	$0.00	$0.00	$29.73	$0.00	$0.00	$0.00	$0.00	$0.00
400.490E	SUP	HCPCS C1713		400.490E  -  SCREW TI 10IN 1.7MM CRANFCL ER +DR RECESS BONE	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$93.15	$93.15	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$0.00	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00		$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
400.492E	SUP	HCPCS C1713		400.492E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 12MM	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$93.15	$93.15	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$0.00	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00		$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
400.494E	SUP	HCPCS C1713		400.494E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 14MM	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$93.15	$93.15	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$0.00	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00		$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
400.496E	SUP	HCPCS C1713		400.496E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 16MM	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$93.15	$93.15	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$0.00	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00		$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
400.498E	SUP	HCPCS C1713		400.498E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 18MM	BOTH IP/OP	$207.00 	$153.18	$0.00	$165.60	$93.15	$93.15	$0.00	$0.00	$0.00	$43.14	$153.64	$153.64	$0.00	$0.00	$43.14	$0.00	$122.44	$122.44	$0.00	$103.50	$163.94	$165.60	$0.00		$0.00	$32.40	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$0.00
400.806.96	SUP	HCPCS C1713		400.806.96  -  SCREW BONE LP 1.5MM 3MM 6MM SELF TAP THREAD TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$14.79	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.807.96	SUP	HCPCS C1713		400.807.96  -  SCREW BONE LP 1.5MM 3MM 7MM SELF TAP THREAD TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.808.96	SUP	HCPCS C1713		400.808.96  -  SCREW BONE 1.5MM 3MM 8MM SLFTAP TITANIUM HAND CORTICAL	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.809.96	SUP	HCPCS C1713		400.809.96  -  SCREW BONE 1.5MM 9MM SLFTAP TITANIUM CORTICAL HAND NONSTRL	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.810.96	SUP	HCPCS C1713		400.810.96  -  SCREW BONE LP 1.5MM 3MM 10MM SELF TAP THREAD TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.811.96	SUP	HCPCS C1713		400.811.96  -  SCREW BONE LP 1.5MM 3MM 11MM SELF TAP THREAD TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.812.96	SUP	HCPCS C1713		400.812.96  -  SCREW BONE 1.5MM 3MM 12MM SLFTAP TITANIUM HAND CORTICAL	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.813.96	SUP	HCPCS C1713		400.813.96  -  SCREW BONE 1.5MM 3MM 13MM SLFTAP LP HEAD THREADED TITANIUM	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.814.96	SUP	HCPCS C1713		400.814.96  -  SCREW BONE LP 1.5MM 3MM 14MM SELF TAP THREAD TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.816.96	SUP	HCPCS C1713		400.816.96  -  SCREW BONE 1.5MM 16MM SLFTAP TITANIUM CORTICAL HAND NONSTRL	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.818.96	SUP	HCPCS C1713		400.818.96  -  SCREW BONE LP 1.5MM 3MM 18MM SELF TAP THREAD TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.820.96	SUP	HCPCS C1713		400.820.96  -  SCREW BONE LP 1.5MM 3MM 20MM SELF TAP THREAD TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.822.96	SUP	HCPCS C1713		400.822.96  -  SCREW BONE LP 1.5MM 3MM 22MM SELF TAP THREAD TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.824.96	SUP	HCPCS C1713		400.824.96  -  SCREW BONE LP 1.5MM 3MM 24MM SELF TAP THREAD TITANIUM HAND	BOTH IP/OP	$65.35 	$48.36	$0.00	$50.76	$28.55	$28.55	$0.00	$0.00	$0.00	$13.62	$48.50	$48.50	$0.00	$0.00	$13.62	$0.00	$38.65	$38.65	$0.00	$31.73	$50.25	$50.76	$0.00		$0.00	$9.64	$0.00	$0.00	$10.10	$0.00	$0.00	$0.00	$0.00	$0.00
400.843E	SUP	HCPCS C1713		400.843E  -  SCREW BONE 3MM 1.6MM CRNMXF TI ALLOY SLFTAP LP STRL	BOTH IP/OP	$196.88 	$145.69	$0.00	$157.50	$88.59	$88.59	$0.00	$0.00	$0.00	$41.03	$146.12	$146.12	$0.00	$0.00	$41.03	$0.00	$116.45	$116.45	$0.00	$98.44	$155.93	$157.50	$0.00		$0.00	$30.81	$0.00	$0.00	$31.34	$0.00	$0.00	$0.00	$0.00	$0.00
400.846E	SUP	HCPCS C1713		400.846E  -  TI LOW PROFILE NEURO SCREW SELF-TAPPING 6MM	BOTH IP/OP	$196.88 	$145.69	$0.00	$157.50	$88.59	$88.59	$0.00	$0.00	$0.00	$41.03	$146.12	$146.12	$0.00	$0.00	$41.03	$0.00	$116.45	$116.45	$0.00	$98.44	$155.93	$157.50	$0.00		$0.00	$30.81	$0.00	$0.00	$31.34	$0.00	$0.00	$0.00	$0.00	$0.00
400.855E	SUP	HCPCS C1713		400.855E  -  SCREW BONE 5MM 2MM CRANFCL TI SLFTAP LP ER STRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
400.856E	SUP	HCPCS C1713		400.856E  -  SCREW BONE 6MM 2MM CRANFCL TI SLFTAP LP ER STRL	BOTH IP/OP	$196.88 	$145.69	$0.00	$157.50	$88.59	$88.59	$0.00	$0.00	$0.00	$41.03	$146.12	$146.12	$0.00	$0.00	$41.03	$0.00	$116.45	$116.45	$0.00	$98.44	$155.93	$157.50	$0.00		$0.00	$30.81	$0.00	$0.00	$31.34	$0.00	$0.00	$0.00	$0.00	$0.00
40-0001-S	SUP	HCPCS C1713		40-0001-S  -  ROD XTRNFX CMPR OLCRN	BOTH IP/OP	"$2,480.00 "	"$1,835.20"	$0.00	"$1,984.00"	"$1,116.00"	"$1,116.00"	$0.00	$0.00	$0.00	$516.89	"$1,840.66"	"$1,840.66"	$0.00	$0.00	$516.83	$0.00	"$1,466.92"	"$1,466.92"	$0.00	"$1,240.00"	"$1,964.16"	"$1,984.00"	$0.00		$0.00	$388.12	$0.00	$0.00	$394.82	$0.00	$0.00	$0.00	$0.00	$0.00
40-0003	SUP	Custom 27203010		40-0003  -  NUT EXFIX OLCRN GUIDE ASMBLY NONSTRL	BOTH IP/OP	"$1,140.00 "	$843.60	$0.00	$912.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$846.11	$846.11	$0.00	$0.00	$237.58	$0.00	$0.00	$0.00	$0.00	$570.00	$902.88	$912.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-0006	SUP	HCPCS C1713		40-0006  -  BOLT LCK OLCRN NONSTRL	BOTH IP/OP	$657.50 	$486.55	$0.00	$526.00	$295.88	$295.88	$0.00	$0.00	$0.00	$137.04	$488.00	$488.00	$0.00	$0.00	$137.02	$0.00	$388.91	$388.91	$0.00	$328.75	$520.74	$526.00	$0.00		$0.00	$102.90	$0.00	$0.00	$104.67	$0.00	$0.00	$0.00	$0.00	$0.00
40-0007	SUP	HCPCS C1713		40-0007  -  CANNU ORTH TRGT ROD NONSTRL OLCRN	BOTH IP/OP	"$1,005.00 "	$743.70	$0.00	$804.00	$452.25	$452.25	$0.00	$0.00	$0.00	$209.47	$745.91	$745.91	$0.00	$0.00	$209.44	$0.00	$594.46	$594.46	$0.00	$502.50	$795.96	$804.00	$0.00		$0.00	$157.28	$0.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-0008	SUP	Custom 27203010		40-0008  -  GUIDE TRGT ASMBLY CMPR NUT SURG OLCRN NONSTRL	BOTH IP/OP	"$1,992.50 "	"$1,474.45"	$0.00	"$1,594.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,478.83"	"$1,478.83"	$0.00	$0.00	$415.24	$0.00	$0.00	$0.00	$0.00	$996.25	"$1,578.06"	"$1,594.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-0012	SUP	Custom 27203010		40-0012  -  DRILL SRG NUT CMPR OLCRN	BOTH IP/OP	$827.50 	$612.35	$0.00	$662.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$614.17	$614.17	$0.00	$0.00	$172.45	$0.00	$0.00	$0.00	$0.00	$413.75	$655.38	$662.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-0013-S	SUP	Custom 27203010		40-0013-S  -  NUT XTRNFX 6MM CMPR OLCRN	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$0.00	$0.00	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-0014-S	SUP	Custom 27203010		40-0014-S  -  NUT XTRNFX 8MM CMPR OLCRN	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$0.00	$0.00	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-0015-S	SUP	Custom 27203010		40-0015-S  -  NUT XTRNFX 10MM CMPR OLCRN	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$0.00	$0.00	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-0016-S	SUP	Custom 27803010		40-0016-S  -  WASHER ORTH SMTH OLCRN	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$398.93	$398.93	$0.00	$0.00	$112.02	$0.00	$0.00	$0.00	$0.00	$268.75	$425.70	$430.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-0021-S	SUP	HCPCS C1713		40-0021-S  -  WASHER ORTH THRD OLCRN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
40-0026-S	SUP	HCPCS C1713		40-0026-S  -  ROD ORTH 110MM 3MM FIB IM IMPL	BOTH IP/OP	"$2,705.00 "	"$2,001.70"	$0.00	"$2,164.00"	"$1,217.25"	"$1,217.25"	$0.00	$0.00	$0.00	$563.79	"$2,007.65"	"$2,007.65"	$0.00	$0.00	$563.72	$0.00	"$1,333.57"	"$1,333.57"	$0.00	"$1,352.50"	"$2,142.36"	"$2,164.00"	$0.00		$0.00	$423.33	$0.00	$0.00	$430.64	$0.00	$0.00	$0.00	$0.00	$0.00
40-0027-S	SUP	HCPCS C1713		40-0027-S  -  ROD ORTH 145MM 3MM FIB ANKL FIB IM IMPL STRL	BOTH IP/OP	"$2,705.00 "	"$2,001.70"	$0.00	"$2,164.00"	"$1,217.25"	"$1,217.25"	$0.00	$0.00	$0.00	$563.79	"$2,007.65"	"$2,007.65"	$0.00	$0.00	$563.72	$0.00	"$1,333.57"	"$1,333.57"	$0.00	"$1,352.50"	"$2,142.36"	"$2,164.00"	$0.00		$0.00	$423.33	$0.00	$0.00	$430.64	$0.00	$0.00	$0.00	$0.00	$0.00
40-0028-S	SUP	HCPCS C1713		40-0028-S  -  ROD ORTH 180MM 3MM FIB FIB IM IMPL STRL	BOTH IP/OP	"$2,705.00 "	"$2,001.70"	$0.00	"$2,164.00"	"$1,217.25"	"$1,217.25"	$0.00	$0.00	$0.00	$563.79	"$2,007.65"	"$2,007.65"	$0.00	$0.00	$563.72	$0.00	"$1,333.57"	"$1,333.57"	$0.00	"$1,352.50"	"$2,142.36"	"$2,164.00"	$0.00		$0.00	$423.33	$0.00	$0.00	$430.64	$0.00	$0.00	$0.00	$0.00	$0.00
40-0029-S	SUP	HCPCS C1713		40-0029-S  -  ROD ORTH 110MM 3.6MM FIB FIB IM IMPL STRL	BOTH IP/OP	"$2,705.00 "	"$2,001.70"	$0.00	"$2,164.00"	"$1,217.25"	"$1,217.25"	$0.00	$0.00	$0.00	$563.79	"$2,007.65"	"$2,007.65"	$0.00	$0.00	$563.72	$0.00	"$1,333.57"	"$1,333.57"	$0.00	"$1,352.50"	"$2,142.36"	"$2,164.00"	$0.00		$0.00	$423.33	$0.00	$0.00	$430.64	$0.00	$0.00	$0.00	$0.00	$0.00
40-0030-S	SUP	HCPCS C1713		40-0030-S  -  ROD XTRNFX 3.6MM 145MM FIB	BOTH IP/OP	"$2,705.00 "	"$2,001.70"	$0.00	"$2,164.00"	"$1,217.25"	"$1,217.25"	$0.00	$0.00	$0.00	$563.79	"$2,007.65"	"$2,007.65"	$0.00	$0.00	$563.72	$0.00	"$1,333.57"	"$1,333.57"	$0.00	"$1,352.50"	"$2,142.36"	"$2,164.00"	$0.00		$0.00	$423.33	$0.00	$0.00	$430.64	$0.00	$0.00	$0.00	$0.00	$0.00
40-0031-S	SUP	Custom 27203010		40-0031-S  -  ROD EXFIX 180MM 3.6MM FIB	BOTH IP/OP	"$2,705.00 "	"$2,001.70"	$0.00	"$2,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,007.65"	"$2,007.65"	$0.00	$0.00	$563.72	$0.00	$0.00	$0.00	$0.00	"$1,352.50"	"$2,142.36"	"$2,164.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-0034	SUP	HCPCS C1713		40-0034  -  BASEPLATE ROD FIB	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
40-0136	SUP	HCPCS C1713		40-0136  -  SCREW BONE 3MM 80MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
40-0137	SUP	HCPCS C1713		40-0137  -  SCREW BONE 3MM 90MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
40-0138	SUP	HCPCS C1713		40-0138  -  SCREW BONE 3MM 100MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
40-0139	SUP	HCPCS C1713		40-0139  -  SCREW BONE 3MM 110MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
400-14	SUP	Custom 27203010		400-14  -  BANDAGE ADH MRDH	BOTH IP/OP	"$2,470.00 "	"$1,827.80"	$0.00	"$1,976.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,833.23"	"$1,833.23"	$0.00	$0.00	$514.75	$0.00	$0.00	$0.00	$0.00	"$1,235.00"	"$1,956.24"	"$1,976.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-0140	SUP	HCPCS C1713		40-0140  -  SCREW BONE 3MM 120MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
40-0143	SUP	HCPCS C1713		40-0143  -  SCREW BONE 3.8MM 80MM DL TRK TI CLVCL DIFF PTCH CUT FLUT	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
40-0144	SUP	HCPCS C1713		40-0144  -  SCREW BONE 3.8MM 90MM CLVCL DL TRK	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
40-0145	SUP	HCPCS C1713		40-0145  -  SCREW BONE 3.8MM 100MM DL TRK TI CLVCL DIFF PTCH CUT FLUT	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
40-0146	SUP	HCPCS C1713		40-0146  -  SCREW BONE 3.8MM 110MM DL TRK TI CLVCL DIFF PTCH CUT FLUT	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
40-0147	SUP	HCPCS C1713		40-0147  -  SCREW BONE 3.8MM 120MM DL TRK TI CLVCL DIFF PTCH CUT FLUT	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0306	SUP	Custom 27803010		4002C0306  -  COIL EMBL .02IN STD CMPLX 3MM 6CM THE PENUMBRA COIL 400	BOTH IP/OP	"$5,525.00 "	"$4,088.50"	$0.00	"$4,420.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,100.66"	"$4,100.66"	$0.00	$0.00	"$1,151.41"	$0.00	$0.00	$0.00	$0.00	"$2,762.50"	"$4,375.80"	"$4,420.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0310	SUP	Custom 27803010		"4002C0310  -  COIL 400 COMPLEX STANDARD, 3 MM X 10 CM"	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,174.88"	"$4,174.88"	$0.00	$0.00	"$1,172.25"	$0.00	$0.00	$0.00	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0408	SUP	Custom 27803010		4002C0408  -  COIL EMBL .02IN STD CMPLX 4MM 8CM THE PENUMBRA COIL 400	BOTH IP/OP	"$5,017.50 "	"$3,712.95"	$0.00	"$4,014.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,723.99"	"$3,723.99"	$0.00	$0.00	"$1,045.65"	$0.00	$0.00	$0.00	$0.00	"$2,508.75"	"$3,973.86"	"$4,014.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0412	SUP	Custom 27803010		"4002C0412  -  COIL 400 COMPLEX STANDARD, 4 MM X 12 CM"	BOTH IP/OP	"$5,675.00 "	"$4,199.50"	$0.00	"$4,540.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,182.67"	$0.00	$0.00	$0.00	$0.00	"$2,837.50"	"$4,494.60"	"$4,540.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0506	SUP	Custom 27803010		4002C0506  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 5MM 6CM COMPLEX THE	BOTH IP/OP	"$4,972.50 "	"$3,679.65"	$0.00	"$3,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,690.59"	"$3,690.59"	$0.00	$0.00	"$1,036.27"	$0.00	$0.00	$0.00	$0.00	"$2,486.25"	"$3,938.22"	"$3,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0510	SUP	Custom 27803010		4002C0510  -  COIL EMBL STD 5MM 10CM PENUMBRA COIL 400 CMPLX	BOTH IP/OP	"$5,062.50 "	"$3,746.25"	$0.00	"$4,050.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,757.39"	"$3,757.39"	$0.00	$0.00	"$1,055.03"	$0.00	$0.00	$0.00	$0.00	"$2,531.25"	"$4,009.50"	"$4,050.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0610	SUP	Custom 27803010		4002C0610  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 6MM 10CM COMPLEX	BOTH IP/OP	"$5,062.50 "	"$3,746.25"	$0.00	"$4,050.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,757.39"	"$3,757.39"	$0.00	$0.00	"$1,055.03"	$0.00	$0.00	$0.00	$0.00	"$2,531.25"	"$4,009.50"	"$4,050.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0615	SUP	Custom 27803010		4002C0615  -  COIL EMBL STD 6MM 15CM PENUMBRA COIL 400 CMPLX	BOTH IP/OP	"$5,175.00 "	"$3,829.50"	$0.00	"$4,140.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,840.89"	"$3,840.89"	$0.00	$0.00	"$1,078.47"	$0.00	$0.00	$0.00	$0.00	"$2,587.50"	"$4,098.60"	"$4,140.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0710	SUP	Custom 27803010		4002C0710  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 7MM 10CM COMPLEX	BOTH IP/OP	"$5,062.50 "	"$3,746.25"	$0.00	"$4,050.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,757.39"	"$3,757.39"	$0.00	$0.00	"$1,055.03"	$0.00	$0.00	$0.00	$0.00	"$2,531.25"	"$4,009.50"	"$4,050.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0715	SUP	Custom 27803010		4002C0715  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 7MM 15CM COMPLEX	BOTH IP/OP	"$5,175.00 "	"$3,829.50"	$0.00	"$4,140.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,840.89"	"$3,840.89"	$0.00	$0.00	"$1,078.47"	$0.00	$0.00	$0.00	$0.00	"$2,587.50"	"$4,098.60"	"$4,140.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0720	SUP	Custom 27803010		4002C0720  -  COIL EMBL STD 7MM 20CM PENUMBRA COIL 400 CMPLX	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0815	SUP	Custom 27803010		"4002C0815  -  COIL 400 COMPLEX STANDARD, 8 MM X 15 CM"	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	$0.00	$0.00	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0820	SUP	Custom 27803010		4002C0820  -  COIL EMBL .02IN STD CMPLX 8MM 20CM THE PENUMBRA COIL 400	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0830	SUP	Custom 27803010		4002C0830  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 8MM 30CM COMPLEX	BOTH IP/OP	"$5,512.50 "	"$4,079.25"	$0.00	"$4,410.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,091.38"	"$4,091.38"	$0.00	$0.00	"$1,148.81"	$0.00	$0.00	$0.00	$0.00	"$2,756.25"	"$4,365.90"	"$4,410.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0915	SUP	Custom 27803010		4002C0915  -  COIL EMBL .02IN STD CMPLX 9MM 15CM THE PENUMBRA COIL 400	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	$0.00	$0.00	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0925	SUP	Custom 27803010		4002C0925  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 9MM 25CM COMPLEX	BOTH IP/OP	"$5,400.00 "	"$3,996.00"	$0.00	"$4,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,007.88"	"$4,007.88"	$0.00	$0.00	"$1,125.36"	$0.00	$0.00	$0.00	$0.00	"$2,700.00"	"$4,276.80"	"$4,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C0935	SUP	Custom 27803010		4002C0935  -  COIL EMBL .02IN STD CMPLX 9MM 35CM THE PENUMBRA COIL 400	BOTH IP/OP	"$5,570.00 "	"$4,121.80"	$0.00	"$4,456.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,134.05"	"$4,134.05"	$0.00	$0.00	"$1,160.79"	$0.00	$0.00	$0.00	$0.00	"$2,785.00"	"$4,411.44"	"$4,456.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1020	SUP	Custom 27803010		4002C1020  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 10MM 20CM COMPLEX	BOTH IP/OP	"$5,287.50 "	"$3,912.75"	$0.00	"$4,230.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,924.38"	"$3,924.38"	$0.00	$0.00	"$1,101.92"	$0.00	$0.00	$0.00	$0.00	"$2,643.75"	"$4,187.70"	"$4,230.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1030	SUP	Custom 27803010		4002C1030  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 10MM 30CM COMPLEX	BOTH IP/OP	"$5,512.50 "	"$4,079.25"	$0.00	"$4,410.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,091.38"	"$4,091.38"	$0.00	$0.00	"$1,148.81"	$0.00	$0.00	$0.00	$0.00	"$2,756.25"	"$4,365.90"	"$4,410.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1040	SUP	Custom 27803010		4002C1040  -  COIL EMBL .02IN STD CMPLX 10MM 40CM THE PENUMBRA COIL 400	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,174.88"	"$4,174.88"	$0.00	$0.00	"$1,172.25"	$0.00	$0.00	$0.00	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1135	SUP	Custom 27803010		4002C1135  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 11MM 35CM COMPLEX	BOTH IP/OP	"$5,570.00 "	"$4,121.80"	$0.00	"$4,456.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,134.05"	"$4,134.05"	$0.00	$0.00	"$1,160.79"	$0.00	$0.00	$0.00	$0.00	"$2,785.00"	"$4,411.44"	"$4,456.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1145	SUP	Custom 27803010		4002C1145  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 11MM 45CM COMPLEX	BOTH IP/OP	"$5,682.50 "	"$4,205.05"	$0.00	"$4,546.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,184.23"	$0.00	$0.00	$0.00	$0.00	"$2,841.25"	"$4,500.54"	"$4,546.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1235	SUP	Custom 27803010		4002C1235  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 12MM 35CM COMPLEX	BOTH IP/OP	"$5,570.00 "	"$4,121.80"	$0.00	"$4,456.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,134.05"	"$4,134.05"	$0.00	$0.00	"$1,160.79"	$0.00	$0.00	$0.00	$0.00	"$2,785.00"	"$4,411.44"	"$4,456.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1245	SUP	Custom 27803010		4002C1245  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 12MM 45CM COMPLEX	BOTH IP/OP	"$5,682.50 "	"$4,205.05"	$0.00	"$4,546.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,184.23"	$0.00	$0.00	$0.00	$0.00	"$2,841.25"	"$4,500.54"	"$4,546.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1335	SUP	Custom 27803010		"4002C1335  -  COIL 400 COMPLEX STANDARD, 13MM X 35CM"	BOTH IP/OP	"$6,187.50 "	"$4,578.75"	$0.00	"$4,950.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,289.48"	$0.00	$0.00	$0.00	$0.00	"$3,093.75"	"$4,900.50"	"$4,950.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1348	SUP	Custom 27803010		4002C1348  -  COIL EMBL STD .02IN 13MM 48CM DTCH CMPLX STRCH RS PLTN	BOTH IP/OP	"$5,715.00 "	"$4,229.10"	$0.00	"$4,572.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,191.01"	$0.00	$0.00	$0.00	$0.00	"$2,857.50"	"$4,526.28"	"$4,572.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1450	SUP	Custom 27803010		4002C1450  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 14MM 50CM COMPLEX	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1557	SUP	Custom 27803010		4002C1557  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 15MM 57CM COMPLEX	BOTH IP/OP	"$5,817.50 "	"$4,304.95"	$0.00	"$4,654.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,212.37"	$0.00	$0.00	$0.00	$0.00	"$2,908.75"	"$4,607.46"	"$4,654.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1660	SUP	Custom 27803010		4002C1660  -  COIL EMBL .02IN STD CMPLX 16MM 60CM THE PENUMBRA COIL 400	BOTH IP/OP	"$5,850.00 "	"$4,329.00"	$0.00	"$4,680.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,219.14"	$0.00	$0.00	$0.00	$0.00	"$2,925.00"	"$4,633.20"	"$4,680.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C1857	SUP	Custom 27803010		4002C1857  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 18MM 57CM COMPLEX	BOTH IP/OP	"$5,817.50 "	"$4,304.95"	$0.00	"$4,654.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,212.37"	$0.00	$0.00	$0.00	$0.00	"$2,908.75"	"$4,607.46"	"$4,654.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C2060	SUP	Custom 27803010		4002C2060  -  COIL EMBL .02IN STD CMPLX 20MM 60CM THE PENUMBRA COIL 400	BOTH IP/OP	"$5,850.00 "	"$4,329.00"	$0.00	"$4,680.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,219.14"	$0.00	$0.00	$0.00	$0.00	"$2,925.00"	"$4,633.20"	"$4,680.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C2260	SUP	Custom 27803010		4002C2260  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 22MM 60CM COMPLEX	BOTH IP/OP	"$5,850.00 "	"$4,329.00"	$0.00	"$4,680.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,219.14"	$0.00	$0.00	$0.00	$0.00	"$2,925.00"	"$4,633.20"	"$4,680.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C2457	SUP	Custom 27803010		4002C2457  -  COIL EMBL .02IN STD CMPLX 24MM 57CM THE PENUMBRA COIL 400	BOTH IP/OP	"$5,817.50 "	"$4,304.95"	$0.00	"$4,654.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,212.37"	$0.00	$0.00	$0.00	$0.00	"$2,908.75"	"$4,607.46"	"$4,654.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C2860	SUP	Custom 27803010		4002C2860  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 28MM 60CM COMPLEX	BOTH IP/OP	"$6,525.00 "	"$4,828.50"	$0.00	"$5,220.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,359.81"	$0.00	$0.00	$0.00	$0.00	"$3,262.50"	"$5,167.80"	"$5,220.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4002C3260	SUP	Custom 27803010		4002C3260  -  COIL EMBL .02IN STD CMPLX 32MM 60CM THE PENUMBRA COIL 400	BOTH IP/OP	"$6,525.00 "	"$4,828.50"	$0.00	"$5,220.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,359.81"	$0.00	$0.00	$0.00	$0.00	"$3,262.50"	"$5,167.80"	"$5,220.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0303	SUP	Custom 27803010		"4004C0303  -  COIL 400 COMPLEX SOFT, 3 MM X 3 CM"	BOTH IP/OP	"$5,950.00 "	"$4,403.00"	$0.00	"$4,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,239.98"	$0.00	$0.00	$0.00	$0.00	"$2,975.00"	"$4,712.40"	"$4,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0304	SUP	Custom 27803010		"4004C0304  -  COIL 400 COMPLEX SOFT, 3 MM X 4 CM"	BOTH IP/OP	"$5,975.00 "	"$4,421.50"	$0.00	"$4,780.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,245.19"	$0.00	$0.00	$0.00	$0.00	"$2,987.50"	"$4,732.20"	"$4,780.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0306	SUP	Custom 27803010		4004C0306  -  COIL EMBL .02IN CMPLX 3MM 6CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$5,422.50 "	"$4,012.65"	$0.00	"$4,338.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,024.58"	"$4,024.58"	$0.00	$0.00	"$1,130.05"	$0.00	$0.00	$0.00	$0.00	"$2,711.25"	"$4,294.62"	"$4,338.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0310	SUP	Custom 27803010		4004C0310  -  COIL EMBOLIZATION .02IN COMPLEX 3MM 10CM SOFT THE PENUMBRA	BOTH IP/OP	"$5,512.50 "	"$4,079.25"	$0.00	"$4,410.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,091.38"	"$4,091.38"	$0.00	$0.00	"$1,148.81"	$0.00	$0.00	$0.00	$0.00	"$2,756.25"	"$4,365.90"	"$4,410.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0404	SUP	Custom 27803010		4004C0404  -  COIL EMBOLIZATION .02IN COMPLEX 4MM 4CM SOFT THE PENUMBRA	BOTH IP/OP	"$5,377.50 "	"$3,979.35"	$0.00	"$4,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,991.18"	"$3,991.18"	$0.00	$0.00	"$1,120.67"	$0.00	$0.00	$0.00	$0.00	"$2,688.75"	"$4,258.98"	"$4,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0406	SUP	Custom 27803010		4004C0406  -  COIL EMBOLIZATION .02IN COMPLEX 4MM 6CM SOFT THE PENUMBRA	BOTH IP/OP	"$5,422.50 "	"$4,012.65"	$0.00	"$4,338.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,024.58"	"$4,024.58"	$0.00	$0.00	"$1,130.05"	$0.00	$0.00	$0.00	$0.00	"$2,711.25"	"$4,294.62"	"$4,338.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0408	SUP	Custom 27803010		4004C0408  -  COIL EMBL .02IN CMPLX 4MM 8CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$5,467.50 "	"$4,045.95"	$0.00	"$4,374.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,057.98"	"$4,057.98"	$0.00	$0.00	"$1,139.43"	$0.00	$0.00	$0.00	$0.00	"$2,733.75"	"$4,330.26"	"$4,374.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0412	SUP	Custom 27803010		4004C0412  -  COIL EMBOLIZATION .02IN COMPLEX 4MM 12CM SOFT THE PENUMBRA	BOTH IP/OP	"$5,557.50 "	"$4,112.55"	$0.00	"$4,446.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,124.78"	"$4,124.78"	$0.00	$0.00	"$1,158.18"	$0.00	$0.00	$0.00	$0.00	"$2,778.75"	"$4,401.54"	"$4,446.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0509	SUP	Custom 27803010		4004C0509  -  COIL EMBL .02IN CMPLX 5MM 9CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$5,490.00 "	"$4,062.60"	$0.00	"$4,392.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,074.68"	"$4,074.68"	$0.00	$0.00	"$1,144.12"	$0.00	$0.00	$0.00	$0.00	"$2,745.00"	"$4,348.08"	"$4,392.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0513	SUP	Custom 27803010		4004C0513  -  COIL EMBOLIZATION .02IN COMPLEX 5MM 13CM SOFT THE PENUMBRA	BOTH IP/OP	"$5,580.00 "	"$4,129.20"	$0.00	"$4,464.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,141.48"	"$4,141.48"	$0.00	$0.00	"$1,162.87"	$0.00	$0.00	$0.00	$0.00	"$2,790.00"	"$4,419.36"	"$4,464.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0610	SUP	Custom 27803010		4004C0610  -  COIL EMBL .02IN CMPLX 6MM 10CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$5,512.50 "	"$4,079.25"	$0.00	"$4,410.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,091.38"	"$4,091.38"	$0.00	$0.00	"$1,148.81"	$0.00	$0.00	$0.00	$0.00	"$2,756.25"	"$4,365.90"	"$4,410.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0615	SUP	Custom 27803010		4004C0615  -  COIL EMBOLIZATION .02IN COMPLEX 6MM 15CM SOFT THE PENUMBRA	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,174.88"	"$4,174.88"	$0.00	$0.00	"$1,172.25"	$0.00	$0.00	$0.00	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0620	SUP	Custom 27803010		4004C0620  -  COIL EMBL .02IN CMPLX 6MM 20CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$6,375.00 "	"$4,717.50"	$0.00	"$5,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,328.55"	$0.00	$0.00	$0.00	$0.00	"$3,187.50"	"$5,049.00"	"$5,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0710	SUP	Custom 27803010		4004C0710  -  COIL EMBL .02IN CMPLX 7MM 10CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$5,512.50 "	"$4,079.25"	$0.00	"$4,410.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,091.38"	"$4,091.38"	$0.00	$0.00	"$1,148.81"	$0.00	$0.00	$0.00	$0.00	"$2,756.25"	"$4,365.90"	"$4,410.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0715	SUP	Custom 27803010		4004C0715  -  COIL EMBL .02IN CMPLX 7MM 15CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,174.88"	"$4,174.88"	$0.00	$0.00	"$1,172.25"	$0.00	$0.00	$0.00	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0720	SUP	Custom 27803010		4004C0720  -  COIL EMBOLIZATION .02IN COMPLEX 7MM 20CM SOFT THE PENUMBRA	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0815	SUP	Custom 27803010		4004C0815  -  COIL EMBL .02IN CMPLX 8MM 15CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,174.88"	"$4,174.88"	$0.00	$0.00	"$1,172.25"	$0.00	$0.00	$0.00	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0820	SUP	Custom 27803010		4004C0820  -  COIL EMBL .02IN CMPLX 8MM 20CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0830	SUP	Custom 27803010		"4004C0830  -  COIL 400 COMPLEX SOFT, 8MM X 30CM"	BOTH IP/OP	"$6,625.00 "	"$4,902.50"	$0.00	"$5,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,380.65"	$0.00	$0.00	$0.00	$0.00	"$3,312.50"	"$5,247.00"	"$5,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0925	SUP	Custom 27803010		4004C0925  -  COIL EMBL .02IN CMPLX 9MM 25CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$5,850.00 "	"$4,329.00"	$0.00	"$4,680.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,219.14"	$0.00	$0.00	$0.00	$0.00	"$2,925.00"	"$4,633.20"	"$4,680.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C0935	SUP	Custom 27803010		"4004C0935  -  COIL 400 COMPLEX SOFT, 9MM X 35CM"	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,406.70"	$0.00	$0.00	$0.00	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C1020	SUP	Custom 27803010		4004C1020  -  COIL EMBL .02IN CMPLX 10MM 20CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C1030	SUP	Custom 27803010		4004C1030  -  COIL EMBOLIZATION .02IN COMPLEX 10MM 30CM SOFT THE PENUMBRA	BOTH IP/OP	"$5,962.50 "	"$4,412.25"	$0.00	"$4,770.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,242.59"	$0.00	$0.00	$0.00	$0.00	"$2,981.25"	"$4,722.30"	"$4,770.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C1040	SUP	Custom 27803010		4004C1040  -  COIL EMBL .02IN CMPLX 10MM 40CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$6,875.00 "	"$5,087.50"	$0.00	"$5,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,432.75"	$0.00	$0.00	$0.00	$0.00	"$3,437.50"	"$5,445.00"	"$5,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C1135	SUP	Custom 27803010		4004C1135  -  COIL EMBOLIZATION .02IN COMPLEX 11MM 35CM SOFT THE PENUMBRA	BOTH IP/OP	"$6,075.00 "	"$4,495.50"	$0.00	"$4,860.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,266.03"	$0.00	$0.00	$0.00	$0.00	"$3,037.50"	"$4,811.40"	"$4,860.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C1145	SUP	Custom 27803010		4004C1145  -  COIL EMBL .02IN CMPLX 11MM 45CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$7,000.00 "	"$5,180.00"	$0.00	"$5,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,458.80"	$0.00	$0.00	$0.00	$0.00	"$3,500.00"	"$5,544.00"	"$5,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C1235	SUP	Custom 27803010		4004C1235  -  COIL EMBL .02IN CMPLX 12MM 35CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$6,075.00 "	"$4,495.50"	$0.00	"$4,860.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,266.03"	$0.00	$0.00	$0.00	$0.00	"$3,037.50"	"$4,811.40"	"$4,860.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C1245	SUP	Custom 27803010		"4004C1245  -  COIL 400 COMPLEX SOFT, 12MM X 45CM"	BOTH IP/OP	"$7,000.00 "	"$5,180.00"	$0.00	"$5,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,458.80"	$0.00	$0.00	$0.00	$0.00	"$3,500.00"	"$5,544.00"	"$5,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C1335	SUP	Custom 27803010		4004C1335  -  COIL EMBOLIZATION .02IN COMPLEX 13MM 35CM SOFT THE PENUMBRA	BOTH IP/OP	"$6,075.00 "	"$4,495.50"	$0.00	"$4,860.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,266.03"	$0.00	$0.00	$0.00	$0.00	"$3,037.50"	"$4,811.40"	"$4,860.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C1348	SUP	Custom 27803010		4004C1348  -  COIL EMBL .02IN CMPLX 13MM 48CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$7,075.00 "	"$5,235.50"	$0.00	"$5,660.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,474.43"	$0.00	$0.00	$0.00	$0.00	"$3,537.50"	"$5,603.40"	"$5,660.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C1440	SUP	Custom 27803010		4004C1440  -  COIL EMBOLIZATION .02IN COMPLEX 14MM 40CM SOFT THE PENUMBRA	BOTH IP/OP	"$6,187.50 "	"$4,578.75"	$0.00	"$4,950.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,289.48"	$0.00	$0.00	$0.00	$0.00	"$3,093.75"	"$4,900.50"	"$4,950.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C1450	SUP	Custom 27803010		4004C1450  -  COIL EMBL .02IN CMPLX 14MM 50CM THE PENUMBRA COIL 400 SFT	BOTH IP/OP	"$7,125.00 "	"$5,272.50"	$0.00	"$5,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,484.85"	$0.00	$0.00	$0.00	$0.00	"$3,562.50"	"$5,643.00"	"$5,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004C1645	SUP	Custom 27803010		4004C1645  -  COIL EMBOLIZATION 16MM 45CM COMPLEX SOFT	BOTH IP/OP	"$6,300.00 "	"$4,662.00"	$0.00	"$5,040.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.92"	$0.00	$0.00	$0.00	$0.00	"$3,150.00"	"$4,989.60"	"$5,040.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004J10	SUP	Custom 27803010		4004J10  -  COIL EMBOLIZATION 10CM J SOFT FILL COIL 400 NITINOL	BOTH IP/OP	"$5,670.00 "	"$4,195.80"	$0.00	"$4,536.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,181.63"	$0.00	$0.00	$0.00	$0.00	"$2,835.00"	"$4,490.64"	"$4,536.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004J15	SUP	Custom 27803010		4004J15  -  COIL EMBOLIZATION 15CM J COIL 400	BOTH IP/OP	"$5,895.00 "	"$4,362.30"	$0.00	"$4,716.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,228.52"	$0.00	$0.00	$0.00	$0.00	"$2,947.50"	"$4,668.84"	"$4,716.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004J25	SUP	Custom 27803010		4004J25  -  COIL EMBL 25CM THE PENUMBRA COIL 400 J SFT FIL NTNL	BOTH IP/OP	"$5,537.50 "	"$4,097.75"	$0.00	"$5,076.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,109.93"	"$4,109.93"	$0.00	$0.00	"$1,154.02"	$0.00	$0.00	$0.00	$0.00	"$3,172.50"	"$5,025.24"	"$5,076.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4004J7	SUP	Custom 27803010		4004J7  -  COIL EMBL 7CM PENUMBRA COIL 400 J SFT FIL NTNL	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	$0.00	$0.00	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0202	SUP	Custom 27803010		4006C0202  -  COIL EMBOLIZATION .02IN COMPLEX 2MM 2CM EXTRA SOFT THE	BOTH IP/OP	"$4,320.00 "	"$3,196.80"	$0.00	"$3,456.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,206.30"	"$3,206.30"	$0.00	$0.00	$900.29	$0.00	$0.00	$0.00	$0.00	"$2,160.00"	"$3,421.44"	"$3,456.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0203	SUP	Custom 27803010		4006C0203  -  COIL EMBOLIZATION .02IN COMPLEX .02IN 2MM 3CM EXTRA SOFT	BOTH IP/OP	"$4,557.50 "	"$3,372.55"	$0.00	"$3,646.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,382.58"	"$3,382.58"	$0.00	$0.00	$949.78	$0.00	$0.00	$0.00	$0.00	"$2,278.75"	"$3,609.54"	"$3,646.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0204	SUP	Custom 27803010		4006C0204  -  COIL EMBOLIZATION .02IN COMPLEX 2MM 4CM XSOFT THE PENUMBRA	BOTH IP/OP	"$4,792.50 "	"$3,546.45"	$0.00	"$3,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,556.99"	"$3,556.99"	$0.00	$0.00	$998.76	$0.00	$0.00	$0.00	$0.00	"$2,396.25"	"$3,795.66"	"$3,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0303	SUP	Custom 27803010		4006C0303  -  COIL EMBL .02IN CMPLX 3MM 3CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$4,557.50 "	"$3,372.55"	$0.00	"$3,646.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,382.58"	"$3,382.58"	$0.00	$0.00	$949.78	$0.00	$0.00	$0.00	$0.00	"$2,278.75"	"$3,609.54"	"$3,646.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0304	SUP	Custom 27803010		4006C0304  -  COIL EMBOLIZATION .02IN COMPLEX 3MM 4CM XSOFT THE PENUMBRA	BOTH IP/OP	"$4,792.50 "	"$3,546.45"	$0.00	"$3,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,556.99"	"$3,556.99"	$0.00	$0.00	$998.76	$0.00	$0.00	$0.00	$0.00	"$2,396.25"	"$3,795.66"	"$3,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0305	SUP	Custom 27803010		4006C0305  -  COIL EMBL .02IN CMPLX 3MM 5CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$5,030.00 "	"$3,722.20"	$0.00	"$4,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,733.27"	"$3,733.27"	$0.00	$0.00	"$1,048.25"	$0.00	$0.00	$0.00	$0.00	"$2,515.00"	"$3,983.76"	"$4,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0306	SUP	Custom 27803010		4006C0306  -  COIL EMBOLIZATION .02IN COMPLEX .02IN 3MM 6CM EXTRA SOFT	BOTH IP/OP	"$5,265.00 "	"$3,896.10"	$0.00	"$4,212.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,907.68"	"$3,907.68"	$0.00	$0.00	"$1,097.23"	$0.00	$0.00	$0.00	$0.00	"$2,632.50"	"$4,169.88"	"$4,212.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0308	SUP	Custom 27803010		4006C0308  -  COIL EMBL .02IN CMPLX 3MM 8CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0310	SUP	Custom 27803010		"4006C0310  -  COIL 400 COMPLEX EXTRA SOFT, 3MM X 10CM"	BOTH IP/OP	"$6,900.00 "	"$5,106.00"	$0.00	"$5,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,437.96"	$0.00	$0.00	$0.00	$0.00	"$3,450.00"	"$5,464.80"	"$5,520.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0404	SUP	Custom 27803010		4006C0404  -  COIL EMBL .02IN CMPLX 4MM 4CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$4,792.50 "	"$3,546.45"	$0.00	"$3,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,556.99"	"$3,556.99"	$0.00	$0.00	$998.76	$0.00	$0.00	$0.00	$0.00	"$2,396.25"	"$3,795.66"	"$3,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0406	SUP	Custom 27803010		4006C0406  -  COIL EMBOLIZATION .02IN COMPLEX 4MM 6CM XSOFT THE PENUMBRA	BOTH IP/OP	"$5,265.00 "	"$3,896.10"	$0.00	"$4,212.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,907.68"	"$3,907.68"	$0.00	$0.00	"$1,097.23"	$0.00	$0.00	$0.00	$0.00	"$2,632.50"	"$4,169.88"	"$4,212.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0408	SUP	Custom 27803010		4006C0408  -  COIL EMBL .02IN CMPLX 4MM 8CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,195.70"	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006C0410	SUP	Custom 27803010		4006C0410  -  COIL EMBL .02IN CMPLX 4MM 10CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$6,210.00 "	"$4,595.40"	$0.00	"$4,968.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.16"	$0.00	$0.00	$0.00	$0.00	"$3,105.00"	"$4,918.32"	"$4,968.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0201	SUP	Custom 27803010		4006U0201  -  COIL EMBOLIZATION CURVE 2MM 1CM XSOFT THE PENUMBRA COIL 400	BOTH IP/OP	"$3,860.00 "	"$2,856.40"	$0.00	"$3,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,864.89"	"$2,864.89"	$0.00	$0.00	$804.42	$0.00	$0.00	$0.00	$0.00	"$1,930.00"	"$3,057.12"	"$3,088.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0202	SUP	Custom 27803010		4006U0202  -  COIL EMBL CRV 2MM 2CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$4,095.00 "	"$3,030.30"	$0.00	"$3,276.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,039.31"	"$3,039.31"	$0.00	$0.00	$853.40	$0.00	$0.00	$0.00	$0.00	"$2,047.50"	"$3,243.24"	"$3,276.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0203	SUP	Custom 27803010		4006U0203  -  COIL EMBOLIZATION CURVE 2MM 3CM XSOFT THE PENUMBRA COIL 400	BOTH IP/OP	"$4,332.50 "	"$3,206.05"	$0.00	"$3,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,215.58"	"$3,215.58"	$0.00	$0.00	$902.89	$0.00	$0.00	$0.00	$0.00	"$2,166.25"	"$3,431.34"	"$3,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0204	SUP	Custom 27803010		4006U0204  -  COIL EMBL CRV 2MM 4CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$4,567.50 "	"$3,379.95"	$0.00	"$3,654.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,390.00"	"$3,390.00"	$0.00	$0.00	$951.87	$0.00	$0.00	$0.00	$0.00	"$2,283.75"	"$3,617.46"	"$3,654.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0302	SUP	Custom 27803010		4006U0302  -  COIL EMBOLIZATION CURVE 3MM 2CM XSOFT THE PENUMBRA COIL 400	BOTH IP/OP	"$4,095.00 "	"$3,030.30"	$0.00	"$3,276.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,039.31"	"$3,039.31"	$0.00	$0.00	$853.40	$0.00	$0.00	$0.00	$0.00	"$2,047.50"	"$3,243.24"	"$3,276.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0303	SUP	Custom 27803010		4006U0303  -  COIL EMBL CRV 3MM 3CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$4,332.50 "	"$3,206.05"	$0.00	"$3,466.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,215.58"	"$3,215.58"	$0.00	$0.00	$902.89	$0.00	$0.00	$0.00	$0.00	"$2,166.25"	"$3,431.34"	"$3,466.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0304	SUP	Custom 27803010		4006U0304  -  COIL EMBOLIZATION CURVE 3MM 4CM XSOFT THE PENUMBRA COIL 400	BOTH IP/OP	"$4,567.50 "	"$3,379.95"	$0.00	"$3,654.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,390.00"	"$3,390.00"	$0.00	$0.00	$951.87	$0.00	$0.00	$0.00	$0.00	"$2,283.75"	"$3,617.46"	"$3,654.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0305	SUP	Custom 27803010		4006U0305  -  COIL EMBL CRV 3MM 5CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$4,805.00 "	"$3,555.70"	$0.00	"$3,844.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,566.27"	"$3,566.27"	$0.00	$0.00	"$1,001.36"	$0.00	$0.00	$0.00	$0.00	"$2,402.50"	"$3,805.56"	"$3,844.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0306	SUP	Custom 27803010		4006U0306  -  COIL EMBOLIZATION CURVE 3MM 6CM XSOFT THE PENUMBRA COIL 400	BOTH IP/OP	"$5,040.00 "	"$3,729.60"	$0.00	"$4,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,740.69"	"$3,740.69"	$0.00	$0.00	"$1,050.34"	$0.00	$0.00	$0.00	$0.00	"$2,520.00"	"$3,991.68"	"$4,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0308	SUP	Custom 27803010		4006U0308  -  COIL EMBOLIZATION CURVE 3MM 8CM XSOFT THE PENUMBRA COIL 400	BOTH IP/OP	"$5,512.50 "	"$4,079.25"	$0.00	"$4,410.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,091.38"	"$4,091.38"	$0.00	$0.00	"$1,148.81"	$0.00	$0.00	$0.00	$0.00	"$2,756.25"	"$4,365.90"	"$4,410.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0310	SUP	Custom 27803010		4006U0310  -  COIL EMBL CRV 3MM 10CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$6,512.50 "	"$4,819.25"	$0.00	"$5,210.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,357.21"	$0.00	$0.00	$0.00	$0.00	"$3,256.25"	"$5,157.90"	"$5,210.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0404	SUP	Custom 27803010		4006U0404  -  COIL EMBOLIZATION CURVE 4MM 4CM XSOFT THE PENUMBRA COIL 400	BOTH IP/OP	"$4,567.50 "	"$3,379.95"	$0.00	"$3,654.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,390.00"	"$3,390.00"	$0.00	$0.00	$951.87	$0.00	$0.00	$0.00	$0.00	"$2,283.75"	"$3,617.46"	"$3,654.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0406	SUP	Custom 27803010		4006U0406  -  COIL EMBL CRV 4MM 6CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$5,040.00 "	"$3,729.60"	$0.00	"$4,032.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,740.69"	"$3,740.69"	$0.00	$0.00	"$1,050.34"	$0.00	$0.00	$0.00	$0.00	"$2,520.00"	"$3,991.68"	"$4,032.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0408	SUP	Custom 27803010		4006U0408  -  COIL EMBOLIZATION CURVE 4MM 8CM XSOFT THE PENUMBRA COIL 400	BOTH IP/OP	"$5,512.50 "	"$4,079.25"	$0.00	"$4,410.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,091.38"	"$4,091.38"	$0.00	$0.00	"$1,148.81"	$0.00	$0.00	$0.00	$0.00	"$2,756.25"	"$4,365.90"	"$4,410.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4006U0410	SUP	Custom 27803010		4006U0410  -  COIL EMBL CRV 4MM 10CM THE PENUMBRA COIL 400 XSFT	BOTH IP/OP	"$5,862.50 "	"$4,338.25"	$0.00	"$4,690.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,221.75"	$0.00	$0.00	$0.00	$0.00	"$2,931.25"	"$4,643.10"	"$4,690.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
401.042E	SUP	HCPCS C1713		401.042E  -  SCREW BONE SLFTAP +DR RECESS GOLD 5MM 2MM CORT CRANFCL TI	BOTH IP/OP	$158.63 	$117.39	$0.00	$126.90	$71.38	$71.38	$0.00	$0.00	$0.00	$33.06	$117.73	$117.73	$0.00	$0.00	$33.06	$0.00	$93.83	$93.83	$0.00	$79.31	$125.63	$126.90	$0.00		$0.00	$24.82	$0.00	$0.00	$25.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.050E	SUP	HCPCS C1713		401.050E  -  2.0MM TI CRTX SCR COARSE PITCH SLF-TPNG W/PLUSDRIVE(TM) 20MM	BOTH IP/OP	$158.63 	$117.39	$0.00	$126.90	$71.38	$71.38	$0.00	$0.00	$0.00	$33.06	$117.73	$117.73	$0.00	$0.00	$33.06	$0.00	$93.83	$93.83	$0.00	$79.31	$125.63	$126.90	$0.00		$0.00	$24.82	$0.00	$0.00	$25.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.051E	SUP	HCPCS C1713		401.051E  -  2.0MM TI CRTX SCR COARSE PITCH SLF-TPNG W/PLUSDRIVE(TM) 22MM	BOTH IP/OP	$158.63 	$117.39	$0.00	$126.90	$71.38	$71.38	$0.00	$0.00	$0.00	$33.06	$117.73	$117.73	$0.00	$0.00	$33.06	$0.00	$93.83	$93.83	$0.00	$79.31	$125.63	$126.90	$0.00		$0.00	$24.82	$0.00	$0.00	$25.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.052E	SUP	HCPCS C1713		401.052E  -  2.0MM TI CRTX SCR COARSE PITCH SLF-TPNG W/PLUSDRIVE(TM) 24MM	BOTH IP/OP	$158.63 	$117.39	$0.00	$126.90	$71.38	$71.38	$0.00	$0.00	$0.00	$33.06	$117.73	$117.73	$0.00	$0.00	$33.06	$0.00	$93.83	$93.83	$0.00	$79.31	$125.63	$126.90	$0.00		$0.00	$24.82	$0.00	$0.00	$25.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.061E	SUP	HCPCS C1713		401.061E  -  SCREW BONE SLVR 4MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL	BOTH IP/OP	$169.88 	$125.71	$0.00	$135.90	$76.44	$76.44	$0.00	$0.00	$0.00	$35.41	$126.08	$126.08	$0.00	$0.00	$35.40	$0.00	$100.48	$100.48	$0.00	$84.94	$134.54	$135.90	$0.00		$0.00	$26.59	$0.00	$0.00	$27.04	$0.00	$0.00	$0.00	$0.00	$0.00
401.062E	SUP	HCPCS C1713		401.062E  -  SCREW BONE SLVR 5MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.063E	SUP	HCPCS C1713		401.063E  -  SCREW BONE SLVR 6MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.064E	SUP	HCPCS C1713		401.064E  -  SCREW BONE SLVR 7MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL	BOTH IP/OP	$169.88 	$125.71	$0.00	$135.90	$76.44	$76.44	$0.00	$0.00	$0.00	$35.41	$126.08	$126.08	$0.00	$0.00	$35.40	$0.00	$100.48	$100.48	$0.00	$84.94	$134.54	$135.90	$0.00		$0.00	$26.59	$0.00	$0.00	$27.04	$0.00	$0.00	$0.00	$0.00	$0.00
401.065E	SUP	HCPCS C1713		401.065E  -  SCREW BONE SLVR 8MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.134.99	SUP	HCPCS C1713		401.134.99  -  SCREW BONE 2MM 4MM ARCH TI CORT SPNL SLFDRILL STARDRIVE	BOTH IP/OP	$101.50 	$75.11	$0.00	$81.20	$45.68	$45.68	$0.00	$0.00	$0.00	$21.16	$75.33	$75.33	$0.00	$0.00	$21.15	$0.00	$60.04	$60.04	$0.00	$50.75	$80.39	$81.20	$0.00		$0.00	$15.88	$0.00	$0.00	$16.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.136.99	SUP	HCPCS C1713		401.136.99  -  SCREW BONE 2MM 6MM ARCH TI CORT SPNL SLFDRILL STARDRIVE	BOTH IP/OP	$101.50 	$75.11	$0.00	$81.20	$45.68	$45.68	$0.00	$0.00	$0.00	$21.16	$75.33	$75.33	$0.00	$0.00	$21.15	$0.00	$60.04	$60.04	$0.00	$50.75	$80.39	$81.20	$0.00		$0.00	$15.88	$0.00	$0.00	$16.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.138.99	SUP	HCPCS C1713		401.138.99  -  SCREW BONE 2MM 8MM ARCH TI CORT SPNL SLFDRILL STARDRIVE	BOTH IP/OP	$101.50 	$75.11	$0.00	$81.20	$45.68	$45.68	$0.00	$0.00	$0.00	$21.16	$75.33	$75.33	$0.00	$0.00	$21.15	$0.00	$60.04	$60.04	$0.00	$50.75	$80.39	$81.20	$0.00		$0.00	$15.88	$0.00	$0.00	$16.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.306E	SUP	HCPCS C1713		401.306E  -  SCREW TI 6MM 2.4MM CRANFCL ER CRCIFRM RECESS BONE STRL TEAL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.307E	SUP	HCPCS C1713		401.307E  -  SCREW BONE TEAL 7MM 2.4MM 2MM CORT CRANFCL TI SLFTAP ER STRP	BOTH IP/OP	$148.50 	$109.89	$0.00	$118.80	$66.83	$66.83	$0.00	$0.00	$0.00	$30.95	$110.22	$110.22	$0.00	$0.00	$30.95	$0.00	$87.84	$87.84	$0.00	$74.25	$117.61	$118.80	$0.00		$0.00	$23.24	$0.00	$0.00	$23.64	$0.00	$0.00	$0.00	$0.00	$0.00
401.308E	SUP	HCPCS C1713		401.308E  -  SCREW TI 8MM 2.4MM CRANFCL ER CRCIFRM RECESS BONE NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.309E	SUP	HCPCS C1713		401.309E  -  SCREW BONE TEAL 9MM 2.4MM 2MM CORT CRANFCL TI SLFTAP ER STRP	BOTH IP/OP	$148.50 	$109.89	$0.00	$118.80	$66.83	$66.83	$0.00	$0.00	$0.00	$30.95	$110.22	$110.22	$0.00	$0.00	$30.95	$0.00	$87.84	$87.84	$0.00	$74.25	$117.61	$118.80	$0.00		$0.00	$23.24	$0.00	$0.00	$23.64	$0.00	$0.00	$0.00	$0.00	$0.00
401.311E	SUP	HCPCS C1713		401.311E  -  SCREW BONE 2.4MM 11MM TI ER STRL	BOTH IP/OP	$148.50 	$109.89	$0.00	$118.80	$66.83	$66.83	$0.00	$0.00	$0.00	$30.95	$110.22	$110.22	$0.00	$0.00	$30.95	$0.00	$87.84	$87.84	$0.00	$74.25	$117.61	$118.80	$0.00		$0.00	$23.24	$0.00	$0.00	$23.64	$0.00	$0.00	$0.00	$0.00	$0.00
401.314E	SUP	HCPCS C1713		401.314E  -  SCREW TI 14MM 2.4MM MANDIB ER CRCIFRM RECESS BONE STRL TEAL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.316E	SUP	HCPCS C1713		401.316E  -  SCREW BONE 16MM 2.4MM CRANFCL TI ER CRCIFRM RECESS NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.318E	SUP	HCPCS C1713		401.318E  -  SCREW BONE 2.4MM 18MM TI ER CRCIFRM RECESS	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.356.97	SUP	HCPCS C1713		401.356.97  -  SCREW BONE 2MM 6MM T6 STARDRIVE RECESS SLFTAP LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.357.97	SUP	HCPCS C1713		401.357.97  -  SCREW BONE 2MM 7MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.358.97	SUP	HCPCS C1713		401.358.97  -  SCREW BONE T6 STARDRIVE 2MM 8MM SELF TAP TITANIUM CORTICAL	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.359.97	SUP	HCPCS C1713		401.359.97  -  SCREW BONE 2MM 9MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.360.97	SUP	HCPCS C1713		401.360.97  -  SCREW BONE T6 2MM 10MM SELF TAP STARDRIVE LCP TITANIUM RAD	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.361.97	SUP	HCPCS C1713		401.361.97  -  SCREW BONE 2MM 11MM SLFTAP SELF RETAINING T6 STARDRIVE	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.362.97	SUP	HCPCS C1713		401.362.97  -  SCREW BONE T6 2MM 12MM SELF TAP STARDRIVE LCP TITANIUM RAD	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.363.97	SUP	HCPCS C1713		401.363.97  -  SCREW BONE T6 2MM 13MM SELF TAP STARDRIVE LCP TITANIUM RAD	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.364.97	SUP	HCPCS C1713		401.364.97  -  SCREW BONE 2MM 14MM T6 STARDRIVE RECESS SLFTAP LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.366.97	SUP	HCPCS C1713		401.366.97  -  SCREW BONE 2MM 16MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.368.97	SUP	HCPCS C1713		401.368.97  -  SCREW BONE 2MM 18MM T6 STARDRIVE RECESS SLFTAP LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.370.97	SUP	HCPCS C1713		401.370.97  -  SCREW BONE 2MM 20MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.372.97	SUP	HCPCS C1713		401.372.97  -  SCREW BONE 2MM 22MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.374.97	SUP	HCPCS C1713		401.374.97  -  SCREW BONE 2MM 24MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.375.97	SUP	HCPCS C1713		401.375.97  -  SCREW BONE 2MM 26MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.376.97	SUP	HCPCS C1713		401.376.97  -  SCREW BONE 2MM 28MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.377.97	SUP	HCPCS C1713		401.377.97  -  SCREW BONE 2MM 30MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.378.97	SUP	HCPCS C1713		401.378.97  -  SCREW BONE 2MM 32MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.379.97	SUP	HCPCS C1713		401.379.97  -  SCREW BONE 2MM 34MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.380.97	SUP	HCPCS C1713		401.380.97  -  SCREW BONE 2MM 36MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.381.97	SUP	HCPCS C1713		401.381.97  -  SCREW BONE 2MM 38MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.382.97	SUP	HCPCS C1713		401.382.97  -  SCREW BONE 2MM 40MM SLFTAP STARDRIVE RECESS LCP TITANIUM	BOTH IP/OP	$66.40 	$49.14	$0.00	$51.58	$29.01	$29.01	$0.00	$0.00	$0.00	$13.84	$49.28	$49.28	$0.00	$0.00	$13.84	$0.00	$39.28	$39.28	$0.00	$32.24	$51.07	$51.58	$0.00		$0.00	$9.80	$0.00	$0.00	$10.26	$0.00	$0.00	$0.00	$0.00	$0.00
401.506.96	SUP	HCPCS C1713		401.506.96  -  SCREW BONE 2.4MM 4MM 6MM SELF TAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.507.96	SUP	HCPCS C1713		401.507.96  -  SCREW BONE 2.4MM 4MM 7MM SELF TAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.508.96	SUP	HCPCS C1713		401.508.96  -  SCREW BONE 2.4MM 4.5MM 8MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.509.96	SUP	HCPCS C1713		401.509.96  -  SCREW BONE 2.4MM 4MM 9MM SELF TAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.510.96	SUP	HCPCS C1713		401.510.96  -  SCREW BONE 2.4MM 4.5MM 10MM SELF TAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.511.96	SUP	HCPCS C1713		401.511.96  -  SCREW BONE 2.4MM 4.5MM 11MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.512.96	SUP	HCPCS C1713		401.512.96  -  SCREW BONE 2.4MM 4.5MM 12MM SELF TAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.513.96	SUP	HCPCS C1713		401.513.96  -  SCREW BONE 2.4MM 4.5MM 13MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.514.96	SUP	HCPCS C1713		401.514.96  -  SCREW BONE 2.4MM 4.5MM 14MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.516.96	SUP	HCPCS C1713		401.516.96  -  SCREW BONE 2.4MM 4.5MM 16MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.518.96	SUP	HCPCS C1713		401.518.96  -  SCREW BONE 2.4MM 4.5MM 18MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.520.96	SUP	HCPCS C1713		401.520.96  -  SCREW BONE 2.4MM 4.5MM 20MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.520E	SUP	HCPCS C1713		401.520E  -  SCREW BONE 20MM SLFTAP CRCIFRM RECESS TITANIUM 2.4MM 4MM	BOTH IP/OP	$231.75 	$171.50	$0.00	$185.40	$104.29	$104.29	$0.00	$0.00	$0.00	$48.30	$172.00	$172.00	$0.00	$0.00	$48.30	$0.00	$137.08	$137.08	$0.00	$115.88	$183.55	$185.40	$0.00		$0.00	$36.27	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$0.00
401.522.96	SUP	HCPCS C1713		401.522.96  -  SCREW BONE 2.4MM 4.5MM 22MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.524.96	SUP	HCPCS C1713		401.524.96  -  SCREW BONE 2.4MM 4.5MM 24MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.524E	SUP	HCPCS C1713		401.524E  -  SCREW BONE 2.4MM 24MM TI CORT HAND SLFTAP NONSTRL	BOTH IP/OP	$231.75 	$171.50	$0.00	$185.40	$104.29	$104.29	$0.00	$0.00	$0.00	$48.30	$172.00	$172.00	$0.00	$0.00	$48.30	$0.00	$137.08	$137.08	$0.00	$115.88	$183.55	$185.40	$0.00		$0.00	$36.27	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$0.00
401.526.96	SUP	HCPCS C1713		401.526.96  -  SCREW BONE 2.4MM 4.5MM 26MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.526E	SUP	HCPCS C1713		401.526E  -  SCREW BONE 2.4MM 26MM TI CORT HAND SLFTAP NONSTRL	BOTH IP/OP	$231.75 	$171.50	$0.00	$185.40	$104.29	$104.29	$0.00	$0.00	$0.00	$48.30	$172.00	$172.00	$0.00	$0.00	$48.30	$0.00	$137.08	$137.08	$0.00	$115.88	$183.55	$185.40	$0.00		$0.00	$36.27	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$0.00
401.528.96	SUP	HCPCS C1713		401.528.96  -  SCREW BONE 2.4MM 4.5MM 28MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.528E	SUP	HCPCS C1713		401.528E  -  SCREW BONE 2.4MM 28MM TI CORT HAND SLFTAP NONSTRL	BOTH IP/OP	$231.75 	$171.50	$0.00	$185.40	$104.29	$104.29	$0.00	$0.00	$0.00	$48.30	$172.00	$172.00	$0.00	$0.00	$48.30	$0.00	$137.08	$137.08	$0.00	$115.88	$183.55	$185.40	$0.00		$0.00	$36.27	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$0.00
401.530.96	SUP	HCPCS C1713		401.530.96  -  SCREW BONE 2.4MM 4.5MM 30MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.530E	SUP	HCPCS C1713		401.530E  -  SCREW BONE GOLD 30MM 2.4MM CRNMXF TI SLFTAP MDLR STRL	BOTH IP/OP	$231.75 	$171.50	$0.00	$185.40	$104.29	$104.29	$0.00	$0.00	$0.00	$48.30	$172.00	$172.00	$0.00	$0.00	$48.30	$0.00	$137.08	$137.08	$0.00	$115.88	$183.55	$185.40	$0.00		$0.00	$36.27	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$0.00
401.532.96	SUP	HCPCS C1713		401.532.96  -  SCREW BONE 2.4MM 4.5MM 32MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.534.96	SUP	HCPCS C1713		401.534.96  -  SCREW BONE 2.4MM 4.5MM 34MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.534E	SUP	HCPCS C1713		401.534E  -  SCREW BONE GOLD 34MM 2.4MM CRNMXF TI SLFTAP MDLR STRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.536.96	SUP	HCPCS C1713		401.536.96  -  SCREW BONE 2.4MM 4.5MM 36MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.538.96	SUP	HCPCS C1713		401.538.96  -  SCREW BONE 2.4MM 4.5MM 38MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.540.96	SUP	HCPCS C1713		401.540.96  -  SCREW BONE 2.4MM 4.5MM 40MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$150.40 	$111.30	$0.00	$116.82	$65.71	$65.71	$0.00	$0.00	$0.00	$31.35	$111.63	$111.63	$0.00	$0.00	$31.34	$0.00	$88.96	$88.96	$0.00	$73.01	$115.66	$116.82	$0.00		$0.00	$22.19	$0.00	$0.00	$23.25	$0.00	$0.00	$0.00	$0.00	$0.00
401.542E	SUP	HCPCS C1713		401.542E  -  SCREW BONE 2.4MM 42MM CORT MANDIB SLFTAP MDLR FIX SYS	BOTH IP/OP	$231.75 	$171.50	$0.00	$185.40	$104.29	$104.29	$0.00	$0.00	$0.00	$48.30	$172.00	$172.00	$0.00	$0.00	$48.30	$0.00	$137.08	$137.08	$0.00	$115.88	$183.55	$185.40	$0.00		$0.00	$36.27	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$0.00
401.544E	SUP	HCPCS C1713		401.544E  -  SCREW TI 44MM 2.4MM CORT MANDIB SLFTAP BONE NONSTRL	BOTH IP/OP	$231.75 	$171.50	$0.00	$185.40	$104.29	$104.29	$0.00	$0.00	$0.00	$48.30	$172.00	$172.00	$0.00	$0.00	$48.30	$0.00	$137.08	$137.08	$0.00	$115.88	$183.55	$185.40	$0.00		$0.00	$36.27	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$0.00
401.546E	SUP	HCPCS C1713		401.546E  -  SCREW TI 46MM 2.4MM CORT MANDIB SLFTAP LCK RECON BONE STRL	BOTH IP/OP	$231.75 	$171.50	$0.00	$185.40	$104.29	$104.29	$0.00	$0.00	$0.00	$48.30	$172.00	$172.00	$0.00	$0.00	$48.30	$0.00	$137.08	$137.08	$0.00	$115.88	$183.55	$185.40	$0.00		$0.00	$36.27	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$0.00
401.548E	SUP	HCPCS C1713		401.548E  -  SCREW TI 48MM 2.4MM CORT MANDIB SLFTAP LCK RECON BONE STRL	BOTH IP/OP	$231.75 	$171.50	$0.00	$185.40	$104.29	$104.29	$0.00	$0.00	$0.00	$48.30	$172.00	$172.00	$0.00	$0.00	$48.30	$0.00	$137.08	$137.08	$0.00	$115.88	$183.55	$185.40	$0.00		$0.00	$36.27	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$0.00
401.558E	SUP	HCPCS C1713		401.558E  -  SCREW TI 8MM 2.7MM MANDIB ER LCK BONE STRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.560E	SUP	HCPCS C1713		401.560E  -  SCREW TI 10MM 2.7MM MANDIB ER LCK BONE STRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.566E	SUP	HCPCS C1713		401.566E  -  SCREW TI 16MM 2.7MM MANDIB ER LCK BONE STRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.568E	SUP	HCPCS C1713		401.568E  -  SCREW TI 18MM 2.7MM MANDIB ER LCK BONE STRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.594E	SUP	HCPCS C1713		401.594E  -  2.0MM TI TENSION BAND SCREW SELF-TAPPING 4MM	BOTH IP/OP	$191.25 	$141.53	$0.00	$153.00	$86.06	$86.06	$0.00	$0.00	$0.00	$39.86	$141.95	$141.95	$0.00	$0.00	$39.86	$0.00	$113.12	$113.12	$0.00	$95.63	$151.47	$153.00	$0.00		$0.00	$29.93	$0.00	$0.00	$30.45	$0.00	$0.00	$0.00	$0.00	$0.00
401.596E	SUP	HCPCS C1713		401.596E  -  2.0MM TI TENSION BAND SCREW SELF-TAPPING 6MM	BOTH IP/OP	$191.25 	$141.53	$0.00	$153.00	$86.06	$86.06	$0.00	$0.00	$0.00	$39.86	$141.95	$141.95	$0.00	$0.00	$39.86	$0.00	$113.12	$113.12	$0.00	$95.63	$151.47	$153.00	$0.00		$0.00	$29.93	$0.00	$0.00	$30.45	$0.00	$0.00	$0.00	$0.00	$0.00
401.797E	SUP	HCPCS C1713		401.797E  -  SCREW BONE TEAL 14MM 2.4MM CRANFCL TI ER +DR RECESS NONSTRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
401.806.96	SUP	HCPCS C1713		401.806.96  -  SCREW BONE 2MM 3.5MM 6MM SLFTAP CRCIFRM RECESS TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.807.96	SUP	HCPCS C1713		401.807.96  -  SCREW BONE 2MM 3.5MM 7MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.808.96	SUP	HCPCS C1713		401.808.96  -  SCREW BONE 2MM 3.5MM 8MM SELF TAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.809.96	SUP	HCPCS C1713		401.809.96  -  SCREW BONE 2MM 3.5MM 9MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$14.70	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.810.96	SUP	HCPCS C1713		401.810.96  -  SCREW BONE 2MM 10MM SLFTAP TITANIUM CORTICAL NONSTRL	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$14.70	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.811.96	SUP	HCPCS C1713		401.811.96  -  SCREW BONE 2MM 3.5MM 11MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.812.96	SUP	HCPCS C1713		401.812.96  -  SCREW BONE 2MM 3.5MM 12MM SELF TAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.813.96	SUP	HCPCS C1713		401.813.96  -  SCREW BONE 2MM 3.5MM 13MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.814.96	SUP	HCPCS C1713		401.814.96  -  SCREW BONE 2MM 3.5MM 14MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$14.70	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.816.96	SUP	HCPCS C1713		401.816.96  -  SCREW BONE 2MM 3.5MM 16MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$14.70	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.818.96	SUP	HCPCS C1713		401.818.96  -  SCREW BONE 2MM 3.5MM 18MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$14.70	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.820.96	SUP	HCPCS C1713		401.820.96  -  SCREW BONE 2MM 3.5MM 20MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.822.96	SUP	HCPCS C1713		401.822.96  -  SCREW BONE 2MM 3.5MM 22MM SLFTAP CRCIFRM RECESS TITANIUM	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.824.96	SUP	HCPCS C1713		401.824.96  -  SCREW BONE 2MM 3.5MM 24MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.826.96	SUP	HCPCS C1713		401.826.96  -  SCREW BONE 2MM 3.5MM 26MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.828.96	SUP	HCPCS C1713		401.828.96  -  SCREW BONE 2MM 3.5MM 28MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.830.96	SUP	HCPCS C1713		401.830.96  -  SCREW BONE 2MM 3.5MM 30MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.832.96	SUP	HCPCS C1713		401.832.96  -  SCREW BONE 2MM 3.5MM 32MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.834.96	SUP	HCPCS C1713		401.834.96  -  SCREW BONE 2MM 3.5MM 34MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.836.96	SUP	HCPCS C1713		401.836.96  -  SCREW BONE 2MM 3.5MM 36MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.838.96	SUP	HCPCS C1713		401.838.96  -  SCREW BONE 2MM 3.5MM 38MM SELF TAP CRCIFRM TITANIUM HAND	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.50	$28.41	$28.41	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.56	$50.00	$50.50	$0.00		$0.00	$9.59	$0.00	$0.00	$10.05	$0.00	$0.00	$0.00	$0.00	$0.00
401.968.96	SUP	Custom 27203010		401.968.96  -  PIN FIX 1.8MM 18MM BUTTRESS TITANIUM HAND NONSTRL	BOTH IP/OP	$114.55 	$84.77	$0.00	$88.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.02	$85.02	$0.00	$0.00	$23.87	$0.00	$0.00	$0.00	$0.00	$55.61	$88.09	$88.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-10102	SUP	HCPCS C1713		40-10102  -  PLATE BN SM NS VARIAX MESH PA LCK LOPRFL TI FT CALCANEUS	BOTH IP/OP	"$1,449.00 "	"$1,072.26"	$0.00	"$1,075.45"	$437.46	$437.46	$0.00	$0.00	$0.00	$302.01	"$1,075.45"	"$1,075.45"	$0.00	$0.00	$301.97	$0.00	$857.08	$857.08	$0.00	$486.06	$769.93	$777.70	$0.00		$0.00	$152.14	$0.00	$0.00	$154.76	$0.00	$0.00	$0.00	$0.00	$0.00
40-10104	SUP	HCPCS C1713		40-10104  -  PLATE BN MED 69MM NS VARIAX MESH PA LCK LOPRFL TI FT	BOTH IP/OP	"$1,449.00 "	"$1,072.26"	$0.00	"$1,075.45"	$437.46	$437.46	$0.00	$0.00	$0.00	$302.01	"$1,075.45"	"$1,075.45"	$0.00	$0.00	$301.97	$0.00	$857.08	$857.08	$0.00	$486.06	$769.93	$777.70	$0.00		$0.00	$152.14	$0.00	$0.00	$154.76	$0.00	$0.00	$0.00	$0.00	$0.00
40-10106	SUP	HCPCS C1713		40-10106  -  PLATE BN LG NS VARIAX MESH PA LCK LOPRFL TI FT CALCANEUS	BOTH IP/OP	"$1,449.00 "	"$1,072.26"	$0.00	"$1,075.45"	$437.46	$437.46	$0.00	$0.00	$0.00	$302.01	"$1,075.45"	"$1,075.45"	$0.00	$0.00	$301.97	$0.00	$857.08	$857.08	$0.00	$486.06	$769.93	$777.70	$0.00		$0.00	$152.14	$0.00	$0.00	$154.76	$0.00	$0.00	$0.00	$0.00	$0.00
40-10112	SUP	HCPCS C1713		40-10112  -  PLATE BN SM STD 1.5MM NS VARIAX PA LCK LOPRFL TI FT	BOTH IP/OP	"$1,449.00 "	"$1,072.26"	$0.00	"$1,075.45"	$437.46	$437.46	$0.00	$0.00	$0.00	$302.01	"$1,075.45"	"$1,075.45"	$0.00	$0.00	$301.97	$0.00	$857.08	$857.08	$0.00	$486.06	$769.93	$777.70	$0.00		$0.00	$152.14	$0.00	$0.00	$154.76	$0.00	$0.00	$0.00	$0.00	$0.00
40-10114	SUP	HCPCS C1713		40-10114  -  PLATE BN MED STD 64MM NS VARIAX PA LCK LOPRFL TI FT	BOTH IP/OP	"$1,449.00 "	"$1,072.26"	$0.00	"$1,075.45"	$437.46	$437.46	$0.00	$0.00	$0.00	$302.01	"$1,075.45"	"$1,075.45"	$0.00	$0.00	$301.97	$0.00	$857.08	$857.08	$0.00	$486.06	$769.93	$777.70	$0.00		$0.00	$152.14	$0.00	$0.00	$154.76	$0.00	$0.00	$0.00	$0.00	$0.00
40-10116	SUP	HCPCS C1713		40-10116  -  PLATE BN LG STD NS VARIAX PA LCK LOPRFL TI FT CALCANEUS	BOTH IP/OP	"$1,449.00 "	"$1,072.26"	$0.00	"$1,075.45"	$437.46	$437.46	$0.00	$0.00	$0.00	$302.01	"$1,075.45"	"$1,075.45"	$0.00	$0.00	$301.97	$0.00	$857.08	$857.08	$0.00	$486.06	$769.93	$777.70	$0.00		$0.00	$152.14	$0.00	$0.00	$154.76	$0.00	$0.00	$0.00	$0.00	$0.00
40-12016S	SUP	HCPCS C1713		40-12016S  -  16MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12018S	SUP	HCPCS C1713		40-12018S  -  18 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12020S	SUP	HCPCS C1713		40-12020S  -  20 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12022S	SUP	HCPCS C1713		40-12022S  -  22 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12024S	SUP	HCPCS C1713		40-12024S  -  24 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12026S	SUP	HCPCS C1713		40-12026S  -  26 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12028S	SUP	HCPCS C1713		40-12028S  -  28 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12030S	SUP	HCPCS C1713		40-12030S  -  30 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12032S	SUP	HCPCS C1713		40-12032S  -  32 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12034S	SUP	HCPCS C1713		40-12034S  -  34 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12036S	SUP	HCPCS C1713		40-12036S  -  36 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12038S	SUP	HCPCS C1713		40-12038S  -  38MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12040S	SUP	HCPCS C1713		40-12040S  -  40MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12042S	SUP	HCPCS C1713		40-12042S  -  42 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12044S	SUP	HCPCS C1713		40-12044S  -  44 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12046S	SUP	HCPCS C1713		40-12046S  -  46 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12048S	SUP	HCPCS C1713		40-12048S  -  48 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-12050S	SUP	HCPCS C1713		40-12050S  -  50 MM LONG THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13010S	SUP	HCPCS C1713		40-13010S  -  10 MM  SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13012S	SUP	HCPCS C1713		40-13012S  -  CANNULATED SCREW PARTIALLY THRD SHORT 4.0 MM X 12 MM	BOTH IP/OP	$185.00 	$136.90	$0.00	$148.00	$83.25	$83.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.50	$146.52	$148.00	$0.00		$0.00	$28.95	$0.00	$0.00	$29.45	$0.00	$0.00	$0.00	$0.00	$0.00
40-13014S	SUP	HCPCS C1713		40-13014S  -  14MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13016S	SUP	HCPCS C1713		40-13016S  -  16MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13018S	SUP	HCPCS C1713		40-13018S  -  18 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13020S	SUP	HCPCS C1713		40-13020S  -  20 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13022S	SUP	HCPCS C1713		40-13022S  -  22 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13024S	SUP	HCPCS C1713		40-13024S  -  24 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13026S	SUP	HCPCS C1713		40-13026S  -  26 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13028S	SUP	HCPCS C1713		40-13028S  -  28 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13030S	SUP	HCPCS C1713		40-13030S  -  30 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13032S	SUP	HCPCS C1713		40-13032S  -  32 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13034S	SUP	HCPCS C1713		40-13034S  -  34 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13036S	SUP	HCPCS C1713		40-13036S  -  36 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13038S	SUP	HCPCS C1713		40-13038S  -  38MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13040S	SUP	HCPCS C1713		40-13040S  -  40MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13042S	SUP	HCPCS C1713		40-13042S  -  42 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13044S	SUP	HCPCS C1713		40-13044S  -  44 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13046S	SUP	HCPCS C1713		40-13046S  -  46 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13048S	SUP	HCPCS C1713		40-13048S  -  48 MM SHORT THREAD	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$87.75	$87.75	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
40-13050S	SUP	HCPCS C1713		40-13050S  -  CANNULATED SCREW PARTIALLY THRD SHORT 4.0 MM X 50 MM	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$110.25	$110.25	$0.00	$0.00	$0.00	$51.06	$181.84	$181.84	$0.00	$0.00	$51.06	$0.00	$144.92	$144.92	$0.00	$122.50	$194.04	$196.00	$0.00		$0.00	$38.34	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-15011	SUP	HCPCS C1713		40-15011  -  PLATE BN CRV NS VARIAX 4 HL PA LCK LOPRFL TI FT	BOTH IP/OP	"$1,082.00 "	$800.68	$0.00	$803.06	$269.16	$269.16	$0.00	$0.00	$0.00	$225.52	$803.06	$803.06	$0.00	$0.00	$225.49	$0.00	$640.00	$640.00	$0.00	$299.06	$473.72	$478.50	$0.00		$0.00	$93.61	$0.00	$0.00	$95.22	$0.00	$0.00	$0.00	$0.00	$0.00
40-15012	SUP	HCPCS C1713		40-15012  -  PLATE BN CRV NS VARIAX 5 HL PA LCK LOPRFL TI FT RT	BOTH IP/OP	"$1,175.00 "	$869.50	$0.00	$872.09	$292.67	$292.67	$0.00	$0.00	$0.00	$244.90	$872.09	$872.09	$0.00	$0.00	$244.87	$0.00	$695.01	$695.01	$0.00	$325.19	$515.10	$520.30	$0.00		$0.00	$101.78	$0.00	$0.00	$103.54	$0.00	$0.00	$0.00	$0.00	$0.00
40-15013	SUP	HCPCS C1713		40-15013  -  PLATE BN CRV NS VARIAX 5 HL PA LCK LOPRFL TI FT LT	BOTH IP/OP	"$1,175.00 "	$869.50	$0.00	$872.09	$292.67	$292.67	$0.00	$0.00	$0.00	$244.90	$872.09	$872.09	$0.00	$0.00	$244.87	$0.00	$695.01	$695.01	$0.00	$325.19	$515.10	$520.30	$0.00		$0.00	$101.78	$0.00	$0.00	$103.54	$0.00	$0.00	$0.00	$0.00	$0.00
40-15014	SUP	HCPCS C1713		40-15014  -  PLATE BN CRV NS VARIAX 6 HL PA LCK LOPRFL TI FT	BOTH IP/OP	"$1,321.00 "	$977.54	$0.00	$980.45	$329.18	$329.18	$0.00	$0.00	$0.00	$275.33	$980.45	$980.45	$0.00	$0.00	$275.30	$0.00	$781.37	$781.37	$0.00	$365.75	$579.35	$585.20	$0.00		$0.00	$114.48	$0.00	$0.00	$116.45	$0.00	$0.00	$0.00	$0.00	$0.00
40-15021	SUP	HCPCS C1713		40-15021  -  PLATE BN SM H NS VARIAX PA LCK LOPRFL TI FT	BOTH IP/OP	$918.00 	$679.32	$0.00	$681.34	$232.03	$232.03	$0.00	$0.00	$0.00	$191.33	$681.34	$681.34	$0.00	$0.00	$191.31	$0.00	$543.00	$543.00	$0.00	$257.81	$408.38	$412.50	$0.00		$0.00	$80.70	$0.00	$0.00	$82.09	$0.00	$0.00	$0.00	$0.00	$0.00
40-15022	SUP	HCPCS C1713		40-15022  -  PLATE BN MED H NS VARIAX PA LCK LOPRFL TI FT	BOTH IP/OP	"$1,297.00 "	$959.78	$0.00	$962.63	$329.18	$329.18	$0.00	$0.00	$0.00	$270.33	$962.63	$962.63	$0.00	$0.00	$270.29	$0.00	$767.18	$767.18	$0.00	$365.75	$579.35	$585.20	$0.00		$0.00	$114.48	$0.00	$0.00	$116.45	$0.00	$0.00	$0.00	$0.00	$0.00
40-15023	SUP	HCPCS C1713		40-15023  -  PLATE BN LG H NS VARIAX PA LCK LOPRFL TI FT	BOTH IP/OP	"$1,097.00 "	$811.78	$0.00	$814.19	$278.44	$278.44	$0.00	$0.00	$0.00	$228.64	$814.19	$814.19	$0.00	$0.00	$228.61	$0.00	$648.88	$648.88	$0.00	$309.38	$490.05	$495.00	$0.00		$0.00	$96.83	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
40-15031	SUP	HCPCS C1713		40-15031  -  PLATE TI RECT CMPR VARIAX BONE FT	BOTH IP/OP	"$1,082.00 "	$800.68	$0.00	$803.06	$274.11	$274.11	$0.00	$0.00	$0.00	$225.52	$803.06	$803.06	$0.00	$0.00	$225.49	$0.00	$640.00	$640.00	$0.00	$304.56	$482.43	$487.30	$0.00		$0.00	$95.33	$0.00	$0.00	$96.97	$0.00	$0.00	$0.00	$0.00	$0.00
40-15032	SUP	HCPCS C1713		40-15032  -  PLATE BN 2 RECT NS VARIAX PA LCK LOPRFL TI FT	BOTH IP/OP	"$1,097.00 "	$811.78	$0.00	$814.19	$278.44	$278.44	$0.00	$0.00	$0.00	$228.64	$814.19	$814.19	$0.00	$0.00	$228.61	$0.00	$648.88	$648.88	$0.00	$309.38	$490.05	$495.00	$0.00		$0.00	$96.83	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
40-15033	SUP	HCPCS C1713		40-15033  -  PLATE BN 2 RECT NS VARIAX PA LCK CMPR LOPRFL TI FT	BOTH IP/OP	"$1,190.00 "	$880.60	$0.00	$883.22	$301.95	$301.95	$0.00	$0.00	$0.00	$248.03	$883.22	$883.22	$0.00	$0.00	$248.00	$0.00	$703.89	$703.89	$0.00	$335.50	$531.43	$536.80	$0.00		$0.00	$105.01	$0.00	$0.00	$106.82	$0.00	$0.00	$0.00	$0.00	$0.00
40-15041	SUP	HCPCS C1713		40-15041  -  PLATE BN SHRT BRD STRG NS VARIAX PA LCK LOPRFL TI FT	BOTH IP/OP	"$1,092.00 "	$808.08	$0.00	$810.48	$259.88	$259.88	$0.00	$0.00	$0.00	$227.60	$810.48	$810.48	$0.00	$0.00	$227.57	$0.00	$645.92	$645.92	$0.00	$288.75	$457.38	$462.00	$0.00		$0.00	$90.38	$0.00	$0.00	$91.94	$0.00	$0.00	$0.00	$0.00	$0.00
40-15042	SUP	HCPCS C1713		40-15042  -  PLATE BN MED BRD STRG NS VARIAX PA LCK LOPRFL TI FT	BOTH IP/OP	"$1,140.00 "	$843.60	$0.00	$846.11	$271.01	$271.01	$0.00	$0.00	$0.00	$237.60	$846.11	$846.11	$0.00	$0.00	$237.58	$0.00	$674.31	$674.31	$0.00	$301.13	$476.98	$481.80	$0.00		$0.00	$94.25	$0.00	$0.00	$95.88	$0.00	$0.00	$0.00	$0.00	$0.00
40-15043	SUP	HCPCS C1713		40-15043  -  PLATE BN LNG BRD STRG NS VARIAX PA LCK LOPRFL TI FT	BOTH IP/OP	"$1,254.00 "	$927.96	$0.00	$930.72	$298.24	$298.24	$0.00	$0.00	$0.00	$261.36	$930.72	$930.72	$0.00	$0.00	$261.33	$0.00	$741.74	$741.74	$0.00	$331.38	$524.90	$530.20	$0.00		$0.00	$103.72	$0.00	$0.00	$105.51	$0.00	$0.00	$0.00	$0.00	$0.00
40-15061	SUP	HCPCS C1713		40-15061  -  PLATE BN 3D NS VARIAX PA LCK LOPRFL TI FT LT	BOTH IP/OP	"$1,384.00 "	"$1,024.16"	$0.00	"$1,027.20"	$329.18	$329.18	$0.00	$0.00	$0.00	$288.46	"$1,027.20"	"$1,027.20"	$0.00	$0.00	$288.43	$0.00	$818.64	$818.64	$0.00	$365.75	$579.35	$585.20	$0.00		$0.00	$114.48	$0.00	$0.00	$116.45	$0.00	$0.00	$0.00	$0.00	$0.00
40-15062	SUP	HCPCS C1713		40-15062  -  PLATE BN 3D NS VARIAX PA LCK LOPRFL TI FT RT	BOTH IP/OP	"$1,384.00 "	"$1,024.16"	$0.00	"$1,027.20"	$329.18	$329.18	$0.00	$0.00	$0.00	$288.46	"$1,027.20"	"$1,027.20"	$0.00	$0.00	$288.43	$0.00	$818.64	$818.64	$0.00	$365.75	$579.35	$585.20	$0.00		$0.00	$114.48	$0.00	$0.00	$116.45	$0.00	$0.00	$0.00	$0.00	$0.00
40-15071	SUP	HCPCS C1713		40-15071  -  PLATE BN T OBLQ NS VARIAX PA LCK LOPRFL TI FT LT	BOTH IP/OP	"$1,101.00 "	$814.74	$0.00	$817.16	$274.11	$274.11	$0.00	$0.00	$0.00	$229.48	$817.16	$817.16	$0.00	$0.00	$229.45	$0.00	$651.24	$651.24	$0.00	$304.56	$482.43	$487.30	$0.00		$0.00	$95.33	$0.00	$0.00	$96.97	$0.00	$0.00	$0.00	$0.00	$0.00
40-15072	SUP	HCPCS C1713		40-15072  -  PLATE BN T OBLQ NS VARIAX PA LCK LOPRFL TI FT RT	BOTH IP/OP	"$1,101.00 "	$814.74	$0.00	$817.16	$274.11	$274.11	$0.00	$0.00	$0.00	$229.48	$817.16	$817.16	$0.00	$0.00	$229.45	$0.00	$651.24	$651.24	$0.00	$304.56	$482.43	$487.30	$0.00		$0.00	$95.33	$0.00	$0.00	$96.97	$0.00	$0.00	$0.00	$0.00	$0.00
40-15081	SUP	HCPCS C1713		40-15081  -  PLATE BN T NS VARIAX PA LCK LOPRFL TI FT	BOTH IP/OP	$778.00 	$575.72	$0.00	$577.43	$193.67	$193.67	$0.00	$0.00	$0.00	$162.15	$577.43	$577.43	$0.00	$0.00	$162.14	$0.00	$460.19	$460.19	$0.00	$215.19	$340.86	$344.30	$0.00		$0.00	$67.35	$0.00	$0.00	$68.52	$0.00	$0.00	$0.00	$0.00	$0.00
40-15091	SUP	HCPCS C1713		40-15091  -  PLATE BN L NS VARIAX PA LCK LOPRFL TI FT LT	BOTH IP/OP	$778.00 	$575.72	$0.00	$577.43	$193.67	$193.67	$0.00	$0.00	$0.00	$162.15	$577.43	$577.43	$0.00	$0.00	$162.14	$0.00	$460.19	$460.19	$0.00	$215.19	$340.86	$344.30	$0.00		$0.00	$67.35	$0.00	$0.00	$68.52	$0.00	$0.00	$0.00	$0.00	$0.00
40-15092	SUP	HCPCS C1713		40-15092  -  PLATE BN L NS VARIAX PA LCK LOPRFL TI FT RT	BOTH IP/OP	$778.00 	$575.72	$0.00	$577.43	$193.67	$193.67	$0.00	$0.00	$0.00	$162.15	$577.43	$577.43	$0.00	$0.00	$162.14	$0.00	$460.19	$460.19	$0.00	$215.19	$340.86	$344.30	$0.00		$0.00	$67.35	$0.00	$0.00	$68.52	$0.00	$0.00	$0.00	$0.00	$0.00
402.110E	SUP	HCPCS C1713		402.110E  -  SCREW TI 10MM 2.7MM CORT MAXFACL HEX SCKT BONE THORP NONSTRL	BOTH IP/OP	$130.50 	$96.57	$0.00	$104.40	$58.73	$58.73	$0.00	$0.00	$0.00	$27.20	$96.86	$96.86	$0.00	$0.00	$27.20	$0.00	$77.19	$77.19	$0.00	$65.25	$103.36	$104.40	$0.00		$0.00	$20.42	$0.00	$0.00	$20.78	$0.00	$0.00	$0.00	$0.00	$0.00
402.112E	SUP	HCPCS C1713		402.112E  -  SCREW TI 12MM 2.7MM CORT MAXFACL HEX SCKT BONE THORP NONSTRL	BOTH IP/OP	$130.50 	$96.57	$0.00	$104.40	$58.73	$58.73	$0.00	$0.00	$0.00	$27.20	$96.86	$96.86	$0.00	$0.00	$27.20	$0.00	$77.19	$77.19	$0.00	$65.25	$103.36	$104.40	$0.00		$0.00	$20.42	$0.00	$0.00	$20.78	$0.00	$0.00	$0.00	$0.00	$0.00
402.114E	SUP	HCPCS C1713		402.114E  -  SCREW TI 14MM 2.7MM CORT MAXFACL HEX SCKT BONE THORP NONSTRL	BOTH IP/OP	$130.50 	$96.57	$0.00	$104.40	$58.73	$58.73	$0.00	$0.00	$0.00	$27.20	$96.86	$96.86	$0.00	$0.00	$27.20	$0.00	$77.19	$77.19	$0.00	$65.25	$103.36	$104.40	$0.00		$0.00	$20.42	$0.00	$0.00	$20.78	$0.00	$0.00	$0.00	$0.00	$0.00
402.116E	SUP	HCPCS C1713		402.116E  -  SCREW TI 16MM 2.7MM CORT MAXFACL BONE THORP NONSTRL	BOTH IP/OP	$130.50 	$96.57	$0.00	$104.40	$58.73	$58.73	$0.00	$0.00	$0.00	$27.20	$96.86	$96.86	$0.00	$0.00	$27.20	$0.00	$77.19	$77.19	$0.00	$65.25	$103.36	$104.40	$0.00		$0.00	$20.42	$0.00	$0.00	$20.78	$0.00	$0.00	$0.00	$0.00	$0.00
402.118E	SUP	HCPCS C1713		402.118E  -  SCREW TI 18MM 2.7MM CORT MAXFACL HEX SCKT BONE THORP NONSTRL	BOTH IP/OP	$130.50 	$96.57	$0.00	$104.40	$58.73	$58.73	$0.00	$0.00	$0.00	$27.20	$96.86	$96.86	$0.00	$0.00	$27.20	$0.00	$77.19	$77.19	$0.00	$65.25	$103.36	$104.40	$0.00		$0.00	$20.42	$0.00	$0.00	$20.78	$0.00	$0.00	$0.00	$0.00	$0.00
4020-005R	SUP	HCPCS C1713		4020-005R  -  CMPNT TIBTRY 5 KNEE RIGHT	BOTH IP/OP	"$1,213.00 "	$897.62	$0.00	$970.40	$545.85	$545.85	$0.00	$0.00	$0.00	$252.82	$900.29	$900.29	$0.00	$0.00	$252.79	$0.00	$717.49	$717.49	$0.00	$606.50	$960.70	$970.40	$0.00		$0.00	$189.83	$0.00	$0.00	$193.11	$0.00	$0.00	$0.00	$0.00	$0.00
40-20108	SUP	HCPCS C1713		40-20108  -  SCREW BONE 2MM 8MM 4MM ASNS TI MIC FT HAND CANN THRD NONSTRL	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20109	SUP	HCPCS C1713		40-20109  -  SCREW BONE 2MM 9MM 4MM ASNS TI MIC FT HAND CANN THRD NONSTRL	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20110	SUP	HCPCS C1713		40-20110  -  SCREW BONE 2MM 10MM 4MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20111	SUP	HCPCS C1713		40-20111  -  SCREW BONE 2MM 11MM 5MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20112	SUP	HCPCS C1713		40-20112  -  SCREW BONE 2MM 12MM 5MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20113	SUP	HCPCS C1713		40-20113  -  SCREW BONE 2MM 13MM 6MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20114	SUP	HCPCS C1713		40-20114  -  SCREW BONE 2MM 14MM 6MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20115	SUP	HCPCS C1713		40-20115  -  SCREW BONE 2MM 15MM 6MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20116	SUP	HCPCS C1713		40-20116  -  SCREW BONE 2MM 16MM 7MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20117	SUP	HCPCS C1713		40-20117  -  SCREW BONE 2MM 17MM 5MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20118	SUP	HCPCS C1713		40-20118  -  SCREW BONE 2MM 18MM 5MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20119	SUP	HCPCS C1713		40-20119  -  SCREW BONE 2MM 19MM 5MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20120	SUP	HCPCS C1713		40-20120  -  SCREW BN MIC RVRS CUT FLUT 2MM 20MM NS 5MM ASNS SLF CUT CNN	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20122	SUP	HCPCS C1713		40-20122  -  SCREW BONE 2MM 22MM 5MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20124	SUP	HCPCS C1713		40-20124  -  SCREW BONE 2MM 24MM 6MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20126	SUP	HCPCS C1713		40-20126  -  SCREW BONE 2MM 26MM 6MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20128	SUP	HCPCS C1713		40-20128  -  SCREW BONE 2MM 28MM 6MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20130	SUP	HCPCS C1713		40-20130  -  SCREW BONE 2MM 32MM 6MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20217	SUP	HCPCS C1713		40-20217  -  SCREW BONE 2MM 17MM 8MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20218	SUP	HCPCS C1713		40-20218  -  SCREW BONE 2MM 18MM 8MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20219	SUP	HCPCS C1713		40-20219  -  SCREW BONE 2MM 19MM 9MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20220	SUP	HCPCS C1713		40-20220  -  SCREW BONE 2MM 20MM 9MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20222	SUP	HCPCS C1713		40-20222  -  SCREW BONE 2MM 22MM 10MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20224	SUP	HCPCS C1713		40-20224  -  SCREW BONE 2MM 24MM 9MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20226	SUP	HCPCS C1713		40-20226  -  SCREW BONE 2MM 26MM 12MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20228	SUP	HCPCS C1713		40-20228  -  SCREW BONE 2MM 28MM 12MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20230	SUP	HCPCS C1713		40-20230  -  SCREW BONE 2MM 30MM 14MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$133.65	$133.65	$0.00	$0.00	$0.00	$61.90	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$175.68	$175.68	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$46.48	$0.00	$0.00	$47.28	$0.00	$0.00	$0.00	$0.00	$0.00
40-20805	SUP	HCPCS C1713		40-20805  -  PLATE BN STRG 72MMX2MM NS VARIAX 5 HL LCK LOPRFL TI FIB	BOTH IP/OP	$780.00 	$577.20	$0.00	$968.00	$544.50	$544.50	$0.00	$0.00	$0.00	$162.57	$578.92	$578.92	$0.00	$0.00	$162.55	$0.00	$461.37	$461.37	$0.00	$605.00	$958.32	$968.00	$0.00		$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
40-20900	SUP	HCPCS C1713		40-20900  -  WASHER 2MM MIC ASNS ORTH NONSTRL	BOTH IP/OP	$98.60 	$72.96	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$20.55	$73.18	$73.18	$0.00	$0.00	$20.55	$0.00	$58.32	$58.32	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
40-20903	SUP	HCPCS C1713		40-20903  -  PLATE BN 77X10X2MM NS 16X1.3MM VARIAX 3 HL LCK LOPRFL TI FIB	BOTH IP/OP	"$1,143.00 "	$845.82	$0.00	$848.33	$393.53	$393.53	$0.00	$0.00	$0.00	$238.23	$848.33	$848.33	$0.00	$0.00	$238.20	$0.00	$676.08	$676.08	$0.00	$437.25	$692.60	$699.60	$0.00		$0.00	$136.86	$0.00	$0.00	$139.22	$0.00	$0.00	$0.00	$0.00	$0.00
40-20904	SUP	HCPCS C1713		40-20904  -  PLATE BN 89X10X2MM NS 16X1.3MM VARIAX 4 HL LCK LOPRFL TI FIB	BOTH IP/OP	"$1,143.00 "	$845.82	$0.00	$848.33	$393.53	$393.53	$0.00	$0.00	$0.00	$238.23	$848.33	$848.33	$0.00	$0.00	$238.20	$0.00	$676.08	$676.08	$0.00	$437.25	$692.60	$699.60	$0.00		$0.00	$136.86	$0.00	$0.00	$139.22	$0.00	$0.00	$0.00	$0.00	$0.00
40-20905	SUP	HCPCS C1713		40-20905  -  PLATE BN 101X10X2MM NS 16X1.3MM VARIAX 5 HL LCK LOPRFL TI	BOTH IP/OP	"$1,143.00 "	$845.82	$0.00	$848.33	$393.53	$393.53	$0.00	$0.00	$0.00	$238.23	$848.33	$848.33	$0.00	$0.00	$238.20	$0.00	$676.08	$676.08	$0.00	$437.25	$692.60	$699.60	$0.00		$0.00	$136.86	$0.00	$0.00	$139.22	$0.00	$0.00	$0.00	$0.00	$0.00
40-20906	SUP	HCPCS C1713		40-20906  -  PLATE BN 113X10X2MM NS 16X1.3MM VARIAX 6 HL LCK LOPRFL TI	BOTH IP/OP	"$1,187.00 "	$878.38	$0.00	$880.99	$393.53	$393.53	$0.00	$0.00	$0.00	$247.40	$880.99	$880.99	$0.00	$0.00	$247.37	$0.00	$702.11	$702.11	$0.00	$437.25	$692.60	$699.60	$0.00		$0.00	$136.86	$0.00	$0.00	$139.22	$0.00	$0.00	$0.00	$0.00	$0.00
40-20907	SUP	HCPCS C1713		40-20907  -  PLATE BN 125X10X2MM NS 16X1.3MM VARIAX 7 HL LCK LOPRFL TI	BOTH IP/OP	"$1,288.00 "	$953.12	$0.00	$955.95	$428.18	$428.18	$0.00	$0.00	$0.00	$268.45	$955.95	$955.95	$0.00	$0.00	$268.42	$0.00	$761.85	$761.85	$0.00	$475.75	$753.59	$761.20	$0.00		$0.00	$148.91	$0.00	$0.00	$151.48	$0.00	$0.00	$0.00	$0.00	$0.00
40-20908	SUP	HCPCS C1713		40-20908  -  PLATE BN 137X10X2MM NS 16X1.3MM VARIAX 8 HL LCK LOPRFL TI	BOTH IP/OP	"$1,288.00 "	$953.12	$0.00	$955.95	$428.18	$428.18	$0.00	$0.00	$0.00	$268.45	$955.95	$955.95	$0.00	$0.00	$268.42	$0.00	$761.85	$761.85	$0.00	$475.75	$753.59	$761.20	$0.00		$0.00	$148.91	$0.00	$0.00	$151.48	$0.00	$0.00	$0.00	$0.00	$0.00
40-20909	SUP	HCPCS C1713		40-20909  -  PLATE BN 149X10X2MM NS 16X1.3MM VARIAX 9 HL LCK LOPRFL TI	BOTH IP/OP	"$1,288.00 "	$953.12	$0.00	$955.95	$428.18	$428.18	$0.00	$0.00	$0.00	$268.45	$955.95	$955.95	$0.00	$0.00	$268.42	$0.00	$761.85	$761.85	$0.00	$475.75	$753.59	$761.20	$0.00		$0.00	$148.91	$0.00	$0.00	$151.48	$0.00	$0.00	$0.00	$0.00	$0.00
40-20910S	SUP	HCPCS C1713		40-20910S  -  PLATE 161MM 10 HOLE VARIAX BONE LAT FIB STRL	BOTH IP/OP	"$1,457.00 "	"$1,078.18"	$0.00	"$1,081.39"	$483.86	$483.86	$0.00	$0.00	$0.00	$303.68	"$1,081.39"	"$1,081.39"	$0.00	$0.00	$303.64	$0.00	$861.82	$861.82	$0.00	$537.63	$851.60	$860.20	$0.00		$0.00	$168.28	$0.00	$0.00	$171.18	$0.00	$0.00	$0.00	$0.00	$0.00
40-20912S	SUP	HCPCS C1713		40-20912S  -  PLATE 185MM 12 HOLE VARIAX BONE LAT FIB STRL	BOTH IP/OP	"$1,457.00 "	"$1,078.18"	$0.00	"$1,081.39"	$483.86	$483.86	$0.00	$0.00	$0.00	$303.68	"$1,081.39"	"$1,081.39"	$0.00	$0.00	$303.64	$0.00	$861.82	$861.82	$0.00	$537.63	$851.60	$860.20	$0.00		$0.00	$168.28	$0.00	$0.00	$171.18	$0.00	$0.00	$0.00	$0.00	$0.00
40-22800	SUP	Custom 27203010		RULER SURG 15MM SIL MCGRD MTRC SCL BKGRND RADIOPQ STRL 30MM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
402609T	SUP	HCPCS C1894		INTRODUCER SHTH 9FR 23CM WO GUIDEWIRE AVNT++ .035IN BLK	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
40-27008	SUP	HCPCS C1713		40-27008  -  SCREW BN T7 2.7MM 8MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27010	SUP	HCPCS C1713		40-27010  -  SCREW BN T7 2.7MM 10MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27012	SUP	HCPCS C1713		40-27012  -  SCREW BN T7 2.7MM 12MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27014	SUP	HCPCS C1713		40-27014  -  SCREW BN T7 2.7MM 14MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27016	SUP	HCPCS C1713		40-27016  -  SCREW BN T7 2.7MM 16MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27018	SUP	HCPCS C1713		40-27018  -  SCREW BN T7 2.7MM 18MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27020	SUP	HCPCS C1713		40-27020  -  SCREW BN T7 2.7MM 20MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27022	SUP	HCPCS C1713		40-27022  -  SCREW BN T7 2.7MM 22MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27024	SUP	HCPCS C1713		40-27024  -  SCREW BN T7 2.7MM 24MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27026	SUP	HCPCS C1713		40-27026  -  SCREW BN T7 2.7MM 26MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27028	SUP	HCPCS C1713		40-27028  -  SCREW BN T7 2.7MM 28MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27030	SUP	HCPCS C1713		40-27030  -  SCREW BN T7 2.7MM 30MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27032	SUP	HCPCS C1713		40-27032  -  SCREW BN T7 2.7MM 32MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27034	SUP	HCPCS C1713		40-27034  -  SCREW BN T7 2.7MM 34MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27036	SUP	HCPCS C1713		40-27036  -  SCREW BN T7 2.7MM 36MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27038	SUP	HCPCS C1713		40-27038  -  SCREW BN T7 2.7MM 38MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27040	SUP	HCPCS C1713		40-27040  -  SCREW BN T7 2.7MM 40MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27045	SUP	HCPCS C1713		40-27045  -  SCREW BN T7 2.7MM 45MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27050	SUP	HCPCS C1713		40-27050  -  SCREW BN T7 2.7MM 50MM YLW NS VARIAX ST TI FT LCK PLT SYS	BOTH IP/OP	$100.80 	$74.59	$0.00	$74.81	$40.22	$40.22	$0.00	$0.00	$0.00	$21.01	$74.81	$74.81	$0.00	$0.00	$21.01	$0.00	$59.62	$59.62	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
40-27608	SUP	HCPCS C1713		40-27608  -  SCREW BN T7 2.7MM 8MM BLU NS VARIAX LCK ST TI FT LCK PLT SYS	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27610	SUP	HCPCS C1713		40-27610  -  SCREW BONE 2.7MM 10MM VARIAX FT LCK T7 NONSTRL	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27612	SUP	HCPCS C1713		40-27612  -  SCREW BN T7 2.7MM 12MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27614	SUP	HCPCS C1713		40-27614  -  SCREW BN T7 2.7MM 14MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27616	SUP	HCPCS C1713		40-27616  -  SCREW BN T7 2.7MM 16MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27618	SUP	HCPCS C1713		40-27618  -  SCREW BN T7 2.7MM 18MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27620	SUP	HCPCS C1713		40-27620  -  SCREW BN T7 2.7MM 20MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27622	SUP	HCPCS C1713		40-27622  -  SCREW BN T7 2.7MM 22MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27624	SUP	HCPCS C1713		40-27624  -  SCREW BN T7 2.7MM 24MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27626	SUP	HCPCS C1713		40-27626  -  SCREW BN T7 2.7MM 26MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27628	SUP	HCPCS C1713		40-27628  -  SCREW BN T7 2.7MM 28MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27630	SUP	HCPCS C1713		40-27630  -  SCREW BN T7 2.7MM 30MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27632	SUP	HCPCS C1713		40-27632  -  SCREW BN T7 2.7MM 32MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27634	SUP	HCPCS C1713		40-27634  -  SCREW BN T7 2.7MM 34MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27636	SUP	HCPCS C1713		40-27636  -  SCREW BN T7 2.7MM 36MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27638	SUP	HCPCS C1713		40-27638  -  SCREW BN T7 2.7MM 38MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27640	SUP	HCPCS C1713		40-27640  -  SCREW BN T7 2.7MM 40MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27645	SUP	HCPCS C1713		40-27645  -  SCREW BN T7 2.7MM 45MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27650	SUP	HCPCS C1713		40-27650  -  SCREW BN T7 2.7MM 50MM BLU NS VARIAX LCK ST TI FT LCK PLT	BOTH IP/OP	$221.20 	$163.69	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
40-27900	SUP	HCPCS C1713		40-27900  -  WASHER ORTH 2.7 MM SCR	BOTH IP/OP	$124.10 	$91.83	$0.00	$100.10	$56.31	$56.31	$0.00	$0.00	$0.00	$25.87	$92.11	$92.11	$0.00	$0.00	$25.86	$0.00	$73.41	$73.41	$0.00	$62.56	$99.10	$100.10	$0.00		$0.00	$19.58	$0.00	$0.00	$19.92	$0.00	$0.00	$0.00	$0.00	$0.00
403.318E	SUP	HCPCS C1713		403.318E  -  3.2MM TI EMERGENCY SCREW 18MM	BOTH IP/OP	$200.25 	$148.19	$0.00	$160.20	$90.11	$90.11	$0.00	$0.00	$0.00	$41.74	$148.63	$148.63	$0.00	$0.00	$41.73	$0.00	$118.45	$118.45	$0.00	$100.13	$158.60	$160.20	$0.00		$0.00	$31.34	$0.00	$0.00	$31.88	$0.00	$0.00	$0.00	$0.00	$0.00
40-30108	SUP	HCPCS C1713		40-30108  -  SCREW BONE 3MM 8MM 4MM ASNS TI MIC FT HAND CANN THRD NONSTRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30109	SUP	HCPCS C1713		40-30109  -  SCREW BONE 3MM ASNS MIC CANN	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30110	SUP	HCPCS C1713		40-30110  -  SCREW BONE 3MM 10MM 4MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30111	SUP	HCPCS C1713		40-30111  -  SCREW BONE 3MM 11MM 4MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30112	SUP	HCPCS C1713		40-30112  -  SCREW BONE 3MM 12MM 4MM ASNS TI MIC HAND FT CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30113	SUP	HCPCS C1713		40-30113  -  SCREW BONE 3MM 13MM 4MM ASNS TI MIC HAND FT CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30114	SUP	HCPCS C1713		40-30114  -  SCREW BONE 3MM 14MM 4MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30115	SUP	HCPCS C1713		40-30115  -  SCREW BONE 3MM 15MM 4MM ASNS TI MIC HAND FT CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30116	SUP	HCPCS C1713		40-30116  -  SCREW BONE 3MM 16MM 4MM ASNS TI MIC HAND FT CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30117	SUP	HCPCS C1713		40-30117  -  SCREW BONE 3MM 17MM 4MM ASNS TI MIC HAND FT CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30118	SUP	HCPCS C1713		40-30118  -  SCREW BONE 3MM 18MM 5MM ASNS TI MIC HAND FT CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30119	SUP	HCPCS C1713		40-30119  -  SCREW BONE 3MM 19MM 5MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30120	SUP	HCPCS C1713		40-30120  -  SCREW BONE 3MM 20MM 5MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30121	SUP	HCPCS C1713		40-30121  -  SCREW BONE 3MM 21MM 5MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30122	SUP	HCPCS C1713		40-30122  -  SCREW BONE 3MM 22MM 5MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30123	SUP	HCPCS C1713		40-30123  -  SCREW BONE 3MM 23MM 5MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30124	SUP	HCPCS C1713		40-30124  -  SCREW BONE 3MM 24MM 6MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30125	SUP	HCPCS C1713		40-30125  -  SCREW BONE 3MM 25MM 6MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30126	SUP	HCPCS C1713		40-30126  -  SCREW BONE 3MM 26MM 6MM ASNS MIC CANN NONSTRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30127	SUP	HCPCS C1713		40-30127  -  SCREW BONE 3MM 27MM 6MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30128	SUP	HCPCS C1713		40-30128  -  SCREW BONE 3MM 28MM 6MM ASNS TI MIC FT HAND CANN NONSTRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30129	SUP	HCPCS C1713		40-30129  -  SCREW BONE 3MM 29MM 6MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30130	SUP	HCPCS C1713		40-30130  -  SCREW BONE 3MM 30MM 6MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30132	SUP	HCPCS C1713		40-30132  -  SCREW BONE 3MM 32MM 6MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30134	SUP	HCPCS C1713		40-30134  -  SCREW BONE 3MM 34MM 7MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30136	SUP	HCPCS C1713		40-30136  -  SCREW BONE 3MM 36MM 7MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30138	SUP	HCPCS C1713		40-30138  -  SCREW BONE 3MM 38MM 8MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30140	SUP	HCPCS C1713		40-30140  -  SCREW BN MIC RVRS CUT FLUT 3MM 40MM NS 8MM ASNS SLF CUT CNN	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30214	SUP	HCPCS C1713		40-30214  -  SCREW BONE 3MM 14MM 6MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30215	SUP	HCPCS C1713		40-30215  -  SCREW BONE 3MM 15MM 7MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30216	SUP	HCPCS C1713		40-30216  -  SCREW BONE 3MM 16MM 7MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30217	SUP	HCPCS C1713		40-30217  -  SCREW BONE 3MM 17MM 8MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30218	SUP	HCPCS C1713		40-30218  -  SCREW BONE 3MM 18MM 8MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30219	SUP	HCPCS C1713		40-30219  -  SCREW BONE 3MM 21MM 5MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30220	SUP	HCPCS C1713		40-30220  -  SCREW BONE 3MM 20MM 9MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30221	SUP	HCPCS C1713		40-30221  -  SCREW BONE 3MM 21MM 9MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30222	SUP	HCPCS C1713		40-30222  -  SCREW BN MIC RVRS CUT FLUT 3MM 22MM NS 10MM ASNS SLF CUT CNN	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30223	SUP	HCPCS C1713		40-30223  -  SCREW BONE 3MM 23MM 10MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30224	SUP	HCPCS C1713		40-30224  -  SCREW BONE 3MM 24MM 10MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30225	SUP	HCPCS C1713		40-30225  -  SCREW BONE 3MM 25MM 10MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30226	SUP	HCPCS C1713		40-30226  -  SCREW BONE 3MM 26MM 12MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30227	SUP	HCPCS C1713		40-30227  -  SCREW BONE 3MM 27MM 12MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30228	SUP	HCPCS C1713		40-30228  -  SCREW BONE 3MM 28MM 12MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30229	SUP	HCPCS C1713		40-30229  -  SCREW BONE 3MM 29MM 12MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30230	SUP	HCPCS C1713		40-30230  -  SCREW BONE 3MM 30MM 14MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30232	SUP	HCPCS C1713		40-30232  -  SCREW BONE 32MM 14MM TI MIC CANC	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30234	SUP	HCPCS C1713		40-30234  -  SCREW BONE 3MM 34MM 16MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30236	SUP	HCPCS C1713		40-30236  -  SCREW BONE 3MM 36MM 16MM ASNS TI MIC FT HAND CANN THRD STRL	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30238	SUP	HCPCS C1713		40-30238  -  SCREW BONE 2MM 38MM 16MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30240	SUP	HCPCS C1713		40-30240  -  SCREW BONE 3MM 40MM 18MM ASNS TI MIC FT HAND CANN THRD	BOTH IP/OP	$295.63 	$218.77	$0.00	$236.50	$133.03	$133.03	$0.00	$0.00	$0.00	$61.62	$219.41	$219.41	$0.00	$0.00	$61.61	$0.00	$174.86	$174.86	$0.00	$147.81	$234.14	$236.50	$0.00		$0.00	$46.27	$0.00	$0.00	$47.06	$0.00	$0.00	$0.00	$0.00	$0.00
40-30900	SUP	Custom 27803010		40-30900  -  WASHER ORTH MIC 3MM ASNS	BOTH IP/OP	$109.65 	$81.14	$0.00	$102.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.38	$81.38	$0.00	$0.00	$22.85	$0.00	$0.00	$0.00	$0.00	$63.94	$101.28	$102.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-35010	SUP	HCPCS C1713		40-35010  -  SCREW BN T10 FT 3.5MM 10MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35012	SUP	HCPCS C1713		40-35012  -  SCREW BN T10 FT 3.5MM 12MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35014	SUP	HCPCS C1713		40-35014  -  SCREW BN T10 FT 3.5MM 14MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35016	SUP	HCPCS C1713		40-35016  -  SCREW BN T10 FT 3.5MM 16MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35018	SUP	HCPCS C1713		40-35018  -  SCREW BN T10 FT 3.5MM 18MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35020	SUP	HCPCS C1713		40-35020  -  SCREW BN T10 FT 3.5MM 20MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35022	SUP	HCPCS C1713		40-35022  -  SCREW BN T10 FT 3.5MM 22MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35024	SUP	HCPCS C1713		40-35024  -  SCREW BN T10 FT 3.5MM 24MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35026	SUP	HCPCS C1713		40-35026  -  SCREW BN T10 FT 3.5MM 26MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35028	SUP	HCPCS C1713		40-35028  -  SCREW BN T10 FT 3.5MM 28MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35030	SUP	HCPCS C1713		40-35030  -  SCREW BN T10 FT 3.5MM 30MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35032	SUP	HCPCS C1713		40-35032  -  SCREW BN T10 FT 3.5MM 32MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35034	SUP	HCPCS C1713		40-35034  -  SCREW BN T10 FT 3.5MM 34MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35036	SUP	HCPCS C1713		40-35036  -  SCREW BN T10 FT 3.5MM 36MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35038	SUP	HCPCS C1713		40-35038  -  SCREW BN T10 FT 3.5MM 38MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35040	SUP	HCPCS C1713		40-35040  -  SCREW BN T10 FT 3.5MM 40MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35042	SUP	HCPCS C1713		40-35042  -  SCREW BN T10 FT 3.5MM 42MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35044	SUP	HCPCS C1713		40-35044  -  SCREW BN T10 FT 3.5MM 44MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35046	SUP	HCPCS C1713		40-35046  -  SCREW BN T10 FT 3.5MM 46MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35048	SUP	HCPCS C1713		40-35048  -  SCREW BN T10 FT 3.5MM 48MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35050	SUP	HCPCS C1713		40-35050  -  SCREW BN T10 FT 3.5MM 50MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35055	SUP	HCPCS C1713		40-35055  -  SCREW BN T10 FT 3.5MM 55MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35060	SUP	HCPCS C1713		40-35060  -  SCREW BN T10 FT 3.5MM 60MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35065	SUP	HCPCS C1713		40-35065  -  SCREW BN T10 FT 3.5MM 65MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35070	SUP	HCPCS C1713		40-35070  -  SCREW BN T10 FT 3.5MM 70MM YLW NS VARIAX ST TI FT/ANKL LCK	BOTH IP/OP	$112.00 	$82.88	$0.00	$83.13	$46.41	$46.41	$0.00	$0.00	$0.00	$23.34	$83.13	$83.13	$0.00	$0.00	$23.34	$0.00	$66.25	$66.25	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$16.14	$0.00	$0.00	$16.42	$0.00	$0.00	$0.00	$0.00	$0.00
40-35610	SUP	HCPCS C1713		40-35610  -  SCREW BN T10 FT 3.5MM 10MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35612	SUP	HCPCS C1713		40-35612  -  SCREW BN T10 FT 3.5MM 12MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35614	SUP	HCPCS C1713		40-35614  -  SCREW BN T10 FT 3.5MM 14MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35616	SUP	HCPCS C1713		40-35616  -  SCREW BN T10 FT 3.5MM 16MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35618	SUP	HCPCS C1713		40-35618  -  SCREW BN T10 FT 3.5MM 18MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35620	SUP	HCPCS C1713		40-35620  -  SCREW BN T10 FT 3.5MM 20MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35622	SUP	HCPCS C1713		40-35622  -  SCREW BN T10 FT 3.5MM 22MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35624	SUP	HCPCS C1713		40-35624  -  SCREW BN T10 FT 3.5MM 24MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35626	SUP	HCPCS C1713		40-35626  -  SCREW BN T10 FT 3.5MM 26MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35628	SUP	HCPCS C1713		40-35628  -  SCREW BN T10 FT 3.5MM 28MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35630	SUP	HCPCS C1713		40-35630  -  SCREW BN T10 FT 3.5MM 30MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35632	SUP	HCPCS C1713		40-35632  -  SCREW BN T10 FT 3.5MM 32MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35634	SUP	HCPCS C1713		40-35634  -  SCREW BONE 3.5MM 34MM VARIAX TI FT T10 LCK NONSTRL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35636	SUP	HCPCS C1713		40-35636  -  SCREW BN T10 FT 3.5MM 36MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35638	SUP	HCPCS C1713		40-35638  -  SCREW BN T10 FT 3.5MM 38MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35640	SUP	HCPCS C1713		40-35640  -  SCREW BN T10 FT 3.5MM 40MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35642	SUP	HCPCS C1713		40-35642  -  SCREW BN T10 FT 3.5MM 42MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35644	SUP	HCPCS C1713		40-35644  -  SCREW BN T10 FT 3.5MM 44MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35646	SUP	HCPCS C1713		40-35646  -  SCREW BN T10 FT 3.5MM 46MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35648	SUP	HCPCS C1713		40-35648  -  SCREW BN T10 FT 3.5MM 48MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35650	SUP	HCPCS C1713		40-35650  -  SCREW BN T10 FT 3.5MM 50MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35655	SUP	HCPCS C1713		40-35655  -  SCREW BN T10 FT 3.5MM 55MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35660	SUP	HCPCS C1713		40-35660  -  SCREW BN T10 FT 3.5MM 60MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35665	SUP	HCPCS C1713		40-35665  -  SCREW BN T10 FT 3.5MM 65MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35670	SUP	HCPCS C1713		40-35670  -  SCREW BN T10 FT 3.5MM 70MM BLU NS VARIAX LCK ST TI FT/ANKL	BOTH IP/OP	$221.20 	$163.69	$0.00	$167.20	$94.05	$94.05	$0.00	$0.00	$0.00	$46.10	$164.17	$164.17	$0.00	$0.00	$46.10	$0.00	$130.84	$130.84	$0.00	$104.50	$165.53	$167.20	$0.00		$0.00	$32.71	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$0.00
40-35900	SUP	HCPCS C1713		40-35900  -  WASHER ORTH 3.5 MM SCR	BOTH IP/OP	$139.40 	$103.16	$0.00	$114.40	$64.35	$64.35	$0.00	$0.00	$0.00	$29.05	$103.46	$103.46	$0.00	$0.00	$29.05	$0.00	$82.46	$82.46	$0.00	$71.50	$113.26	$114.40	$0.00		$0.00	$22.38	$0.00	$0.00	$22.77	$0.00	$0.00	$0.00	$0.00	$0.00
4040-0510R	SUP	Custom 27803010		4040-0510R  -  INSERT TIB 5 10MM RIGHT KNEE	BOTH IP/OP	$858.00 	$634.92	$0.00	$686.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$636.81	$636.81	$0.00	$0.00	$178.81	$0.00	$0.00	$0.00	$0.00	$429.00	$679.54	$686.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4040-0908R	SUP	Custom 27803010		4040-0908R  -  INSERT TIB 9 RIGHT KNEE MDLR UNICOMP 8MM	BOTH IP/OP	$894.00 	$661.56	$0.00	$715.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$663.53	$663.53	$0.00	$0.00	$186.31	$0.00	$0.00	$0.00	$0.00	$447.00	$708.05	$715.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40-5011	SUP	HCPCS C1725		40-5011  -  CATH ANGIO RADIALTIGER CURVE 5FR 4MM 100CM CORON 1 SH DX	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$47.51	$47.51	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
40-5012	SUP	HCPCS C1725		40-5012  -  CATH ANGIO RADIALTIGER CURVE 5FR 4.5MM 100CM CORON 1 SH DX	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$47.51	$47.51	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
4076-STDJ-185	SUP	HCPCS C1769		4076-STDJ-185  -  4076-STDJ-185	BOTH IP/OP	$183.75 	$135.98	$0.00	$147.00	$99.78	$99.78	$0.00	$0.00	$0.00	$38.30	$136.38	$136.38	$0.00	$0.00	$38.29	$0.00	$108.69	$108.69	$0.00	$91.88	$145.53	$147.00	$0.00		$0.00	$28.76	$0.00	$0.00	$29.25	$0.00	$0.00	$0.00	$0.00	$0.00
4076-STDJ-300	SUP	HCPCS C1769		4076-STDJ-300  -  4076-STDJ-300	BOTH IP/OP	$183.75 	$135.98	$0.00	$147.00	$99.78	$99.78	$0.00	$0.00	$0.00	$38.30	$136.38	$136.38	$0.00	$0.00	$38.29	$0.00	$108.69	$108.69	$0.00	$91.88	$145.53	$147.00	$0.00		$0.00	$28.76	$0.00	$0.00	$29.25	$0.00	$0.00	$0.00	$0.00	$0.00
40A002	SUP	HCPCS C1762		40A002  -  GRAFT BONE SMALL 25X9X14MM WEDGE ILIAC CREST	BOTH IP/OP	"$2,005.00 "	"$1,483.70"	$0.00	"$1,604.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$417.89	"$1,488.11"	"$1,488.11"	$0.00	$0.00	$417.84	$0.00	"$1,185.96"	"$1,185.96"	$0.00	"$1,002.50"	"$1,587.96"	"$1,604.00"	$0.00		$0.00	$313.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
40A74	SUP	HCPCS C1768		40A74  -  GRAFT VASC 40CM 7-4MM IMPR CBFL PTFE HMDIAL ACCES SHRT TPR	BOTH IP/OP	"$1,317.85 "	$975.21	$0.00	"$1,054.28"	$593.03	$593.03	$0.00	$0.00	$0.00	$274.67	$978.11	$978.11	$0.00	$0.00	$274.64	$0.00	$779.51	$779.51	$0.00	$658.93	"$1,043.74"	"$1,054.28"	$0.00		$0.00	$206.24	$0.00	$0.00	$209.80	$0.00	$0.00	$0.00	$0.00	$0.00
40S08	SUP	HCPCS C1768		40S08  -  GRAFT VASC 8MM 40CM IMPRA CARBOFLO PTFE	BOTH IP/OP	$955.50 	$707.07	$0.00	$764.40	$429.98	$429.98	$0.00	$0.00	$0.00	$199.15	$709.17	$709.17	$0.00	$0.00	$199.13	$0.00	$565.18	$565.18	$0.00	$477.75	$756.76	$764.40	$0.00		$0.00	$149.54	$0.00	$0.00	$152.12	$0.00	$0.00	$0.00	$0.00	$0.00
4100M24	SUP	Custom 27803010		4100M24  -  RING ANLPLS 24MM MTRL C-M-A IMR E TI	BOTH IP/OP	"$9,112.50 "	"$6,743.25"	$0.00	"$7,290.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,899.05"	$0.00	$0.00	$0.00	$0.00	"$4,556.25"	"$7,217.10"	"$7,290.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4100M34	SUP	Custom 27803010		4100M34  -  RING ANLPLS 34MM MTRL C-M-A IMR E TI SIL PLSTR	BOTH IP/OP	"$9,112.50 "	"$6,743.25"	$0.00	"$7,290.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,899.05"	$0.00	$0.00	$0.00	$0.00	"$4,556.25"	"$7,217.10"	"$7,290.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41045-01	SUP	HCPCS C1887		41045-01  -  CATH INFUS 5FR 40CM 20CM VLV DRG DLV CRGG-MCNAM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$109.96	$109.96	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
41046-01	SUP	HCPCS C1887		41046-01  -  CATH INFUS .038IN 5FR 100CM 20CM PERI VLV CRGG-MCNAM	BOTH IP/OP	$202.50 	$149.85	$0.00	$239.56	$109.96	$109.96	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$239.56	$239.56	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
41050-01	SUP	HCPCS C1769		41050-01  -  CATHETER INFS 5FR 100CM 10CM CRGG-MCNAM CRGG MICROVALVE 1	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$142.54	$142.54	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
41053-01	SUP	HCPCS C1769		41053-01  -  CATHETER INFS .038IN 5FR 100CM 40CM CRGG-MCNAM CRGG	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$160.19	$160.19	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
41055-01	SUP	HCPCS C1887		41055-01  -  CATHETER INFS 5FR 135CM 5CM CRGG-MCNAM CRGG-MICROVALVE 1 LUM	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$142.54	$142.54	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
4105535XL	SUP	HCPCS C1713		4105535XL  -  SCREW BONE 5.5MM 35MM XL SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
4105540XL	SUP	HCPCS C1713		4105540XL  -  SCREW BONE 5.5MM 40MM XL SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
4105545XL	SUP	HCPCS C1713		4105545XL  -  SCREW BONE 5.5MM 45MM XL SPNL	BOTH IP/OP	"$1,520.88 "	"$1,125.45"	$0.00	"$1,216.70"	$684.39	$684.39	$0.00	$0.00	$0.00	$316.99	"$1,128.79"	"$1,128.79"	$0.00	$0.00	$316.95	$0.00	$899.60	$899.60	$0.00	$760.44	"$1,204.54"	"$1,216.70"	$0.00		$0.00	$238.02	$0.00	$0.00	$242.12	$0.00	$0.00	$0.00	$0.00	$0.00
41057-01	SUP	HCPCS C1769		41057-01  -  CATHETER IV .038IN 5FR 135CM 20CM CRGG-MCNAM CRGG MICROVALVE	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$109.96	$109.96	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
41059-01	SUP	HCPCS C1887		41059-01  -  CATH INFUS .038IN 5FR 135CM 40CM VLV CRGG-MCNAM	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$160.19	$160.19	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
4106545XL	SUP	HCPCS C1713		4106545XL  -  SCREW BONE 6.5IN 45IN XL SPNL	BOTH IP/OP	"$1,734.30 "	"$1,283.38"	$0.00	"$1,387.44"	$780.44	$780.44	$0.00	$0.00	$0.00	$361.47	"$1,287.20"	"$1,287.20"	$0.00	$0.00	$361.43	$0.00	"$1,025.84"	"$1,025.84"	$0.00	$867.15	"$1,373.57"	"$1,387.44"	$0.00		$0.00	$271.42	$0.00	$0.00	$276.10	$0.00	$0.00	$0.00	$0.00	$0.00
4106550XL	SUP	HCPCS C1713		4106550XL  -  SCREW BONE 6.5MM 50MM XL SPNL	BOTH IP/OP	"$1,651.18 "	"$1,221.87"	$0.00	"$1,320.94"	$743.03	$743.03	$0.00	$0.00	$0.00	$344.15	"$1,225.50"	"$1,225.50"	$0.00	$0.00	$344.10	$0.00	$976.67	$976.67	$0.00	$825.59	"$1,307.73"	"$1,320.94"	$0.00		$0.00	$258.41	$0.00	$0.00	$262.87	$0.00	$0.00	$0.00	$0.00	$0.00
4107540XL	SUP	HCPCS C1713		4107540XL  -  SCREW BONE 7.5MM 40MM XL SPNL	BOTH IP/OP	"$1,651.18 "	"$1,221.87"	$0.00	"$1,320.94"	$743.03	$743.03	$0.00	$0.00	$0.00	$344.15	"$1,225.50"	"$1,225.50"	$0.00	$0.00	$344.10	$0.00	$976.67	$976.67	$0.00	$825.59	"$1,307.73"	"$1,320.94"	$0.00		$0.00	$258.41	$0.00	$0.00	$262.87	$0.00	$0.00	$0.00	$0.00	$0.00
4107545XL	SUP	HCPCS C1713		4107545XL  -  SCREW BONE 7.5MM 45MM XL SPNL	BOTH IP/OP	"$1,734.30 "	"$1,283.38"	$0.00	"$1,387.44"	$780.44	$780.44	$0.00	$0.00	$0.00	$361.47	"$1,287.20"	"$1,287.20"	$0.00	$0.00	$361.43	$0.00	"$1,025.84"	"$1,025.84"	$0.00	$867.15	"$1,373.57"	"$1,387.44"	$0.00		$0.00	$271.42	$0.00	$0.00	$276.10	$0.00	$0.00	$0.00	$0.00	$0.00
4108540XL	SUP	HCPCS C1713		4108540XL  -  SCREW BONE 8.5MM 40MM XL SPNL	BOTH IP/OP	"$1,651.18 "	"$1,221.87"	$0.00	"$1,320.94"	$743.03	$743.03	$0.00	$0.00	$0.00	$344.15	"$1,225.50"	"$1,225.50"	$0.00	$0.00	$344.10	$0.00	$976.67	$976.67	$0.00	$825.59	"$1,307.73"	"$1,320.94"	$0.00		$0.00	$258.41	$0.00	$0.00	$262.87	$0.00	$0.00	$0.00	$0.00	$0.00
4108545XL	SUP	HCPCS C1713		4108545XL  -  SCREW BONE 8.5MM 45MM XL SPNL	BOTH IP/OP	"$1,651.18 "	"$1,221.87"	$0.00	"$1,320.94"	$743.03	$743.03	$0.00	$0.00	$0.00	$344.15	"$1,225.50"	"$1,225.50"	$0.00	$0.00	$344.10	$0.00	$976.67	$976.67	$0.00	$825.59	"$1,307.73"	"$1,320.94"	$0.00		$0.00	$258.41	$0.00	$0.00	$262.87	$0.00	$0.00	$0.00	$0.00	$0.00
412.113S	SUP	HCPCS C1713		412.113S  -  SCREW BN SD15 FT 3.5MM 2.9MM 34MM GRN STRL MULTILOC LCK	BOTH IP/OP	$326.13 	$241.34	$0.00	$253.30	$142.48	$142.48	$0.00	$0.00	$0.00	$67.97	$242.05	$242.05	$0.00	$0.00	$67.96	$0.00	$192.90	$192.90	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$48.11	$0.00	$0.00	$50.41	$0.00	$0.00	$0.00	$0.00	$0.00
41-2005	SUP	HCPCS C1713		41-2005  -  SCREW 5MM 2MM MANDIB XDR NLCKG BONE LORENZ SLVR	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$72.00	$72.00	$0.00	$0.00	$0.00	$33.35	$118.75	$118.75	$0.00	$0.00	$33.34	$0.00	$94.64	$94.64	$0.00	$80.00	$126.72	$128.00	$0.00		$0.00	$25.04	$0.00	$0.00	$25.47	$0.00	$0.00	$0.00	$0.00	$0.00
41-2006	SUP	HCPCS C1713		41-2006  -  SCREW BN 2MM 6MM BLU SLVR X-DRV NONLOCK XDR MNDB LORENZ	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
41-2008	SUP	HCPCS C1713		41-2008  -  SCREW BONE 2MM 8MM X DRIVE TRAUMAONE SILVER MANDIB	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
41-2010	SUP	HCPCS C1713		41-2010  -  SCREW BONE 2MM 10MM NONLOCKING XDRIVE LORENZ SILVER MANDIB	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
41-2012	SUP	HCPCS C1713		41-2012  -  SCREW BONE 2MM 12MM X DRIVE TRAUMAONE SILVER MANDIB	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
41-2014	SUP	HCPCS C1713		41-2014  -  SCREW BONE 2MM 14MM CROSS DRIVE NONLOCKING TRAUMAONE SILVER	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
41-2016	SUP	HCPCS C1713		41-2016  -  SCREW BONE 2MM 16MM NONLOCKING CROSS DRIVE TRAUMAONE SILVER	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
41-2018	SUP	HCPCS C1713		41-2018  -  SCREW BONE 2MM 18MM NONLOCKING CROSS DRIVE TRAUMAONE SILVER	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
41-2106	SUP	HCPCS C1713		41-2106  -  SCREW BN 2.3MM 6MM SLVR X-DRV LCK	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$175.50	$175.50	$0.00	$0.00	$0.00	$81.29	$289.46	$289.46	$0.00	$0.00	$81.28	$0.00	$230.69	$230.69	$0.00	$195.00	$308.88	$312.00	$0.00		$0.00	$61.04	$0.00	$0.00	$62.09	$0.00	$0.00	$0.00	$0.00	$0.00
41-2108	SUP	HCPCS C1713		41-2108  -  SCREW BONE 2MM 8MM CROSS DRIVE LOCKING TRAUMAONE SILVER	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$175.50	$175.50	$0.00	$0.00	$0.00	$81.29	$289.46	$289.46	$0.00	$0.00	$81.28	$0.00	$230.69	$230.69	$0.00	$195.00	$308.88	$312.00	$0.00		$0.00	$61.04	$0.00	$0.00	$62.09	$0.00	$0.00	$0.00	$0.00	$0.00
41-2110	SUP	HCPCS C1713		41-2110  -  SCREW BONE 2MM 10MM LOCKING CROSS DRIVE TRAUMAONE LORENZ	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$175.50	$175.50	$0.00	$0.00	$0.00	$81.29	$289.46	$289.46	$0.00	$0.00	$81.28	$0.00	$230.69	$230.69	$0.00	$195.00	$308.88	$312.00	$0.00		$0.00	$61.04	$0.00	$0.00	$62.09	$0.00	$0.00	$0.00	$0.00	$0.00
41-2112	SUP	HCPCS C1713		41-2112  -  SCREW BONE 2MM 12MM CROSS DRIVE LOCKING TRAUMAONE SILVER	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$175.50	$175.50	$0.00	$0.00	$0.00	$81.29	$289.46	$289.46	$0.00	$0.00	$81.28	$0.00	$230.69	$230.69	$0.00	$195.00	$308.88	$312.00	$0.00		$0.00	$61.04	$0.00	$0.00	$62.09	$0.00	$0.00	$0.00	$0.00	$0.00
41-2114	SUP	HCPCS C1713		41-2114  -  SCREW BONE 2MM 14MM CROSS DRIVE LOCKING TRAUMAONE SILVER	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$175.50	$175.50	$0.00	$0.00	$0.00	$81.29	$289.46	$289.46	$0.00	$0.00	$81.28	$0.00	$230.69	$230.69	$0.00	$195.00	$308.88	$312.00	$0.00		$0.00	$61.04	$0.00	$0.00	$62.09	$0.00	$0.00	$0.00	$0.00	$0.00
41-2116	SUP	HCPCS C1713		41-2116  -  SCREW BONE 2MM 16MM X-DRIVE LOCKING TRAUMAONE SILVER MANDIB	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$175.50	$175.50	$0.00	$0.00	$0.00	$81.29	$289.46	$289.46	$0.00	$0.00	$81.28	$0.00	$230.69	$230.69	$0.00	$195.00	$308.88	$312.00	$0.00		$0.00	$61.04	$0.00	$0.00	$62.09	$0.00	$0.00	$0.00	$0.00	$0.00
41-2118	SUP	HCPCS C1713		41-2118  -  SCREW BONE 2MM 18MM LOCKING CROSS DRIVE MANDUBULAR	BOTH IP/OP	$390.00 	$288.60	$0.00	$312.00	$175.50	$175.50	$0.00	$0.00	$0.00	$81.29	$289.46	$289.46	$0.00	$0.00	$81.28	$0.00	$230.69	$230.69	$0.00	$195.00	$308.88	$312.00	$0.00		$0.00	$61.04	$0.00	$0.00	$62.09	$0.00	$0.00	$0.00	$0.00	$0.00
41-2205	SUP	HCPCS C1713		41-2205  -  SCREW 5MM 2MM MANDIB SLFDRILL XDR NLCKG BONE TRAUMAONE BLUE	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$90.00	$90.00	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
41-2305	SUP	HCPCS C1713		41-2305  -  SCREW BONE 2.3MM 5MM CROSS DRIVE NONLOCKING TRAUMAONE GOLD	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
41-2306	SUP	HCPCS C1713		41-2306  -  SCREW BN 2.3MM 6MM AU X-DRV NONLOCK	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
41-2308	SUP	HCPCS C1713		41-2308  -  SCREW BONE 2.3MM 8MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
41-2310	SUP	HCPCS C1713		41-2310  -  SCREW BONE 2.3MM 10MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
41-2312	SUP	HCPCS C1713		41-2312  -  SCREW BONE 2.3MM 12MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
41-2314	SUP	HCPCS C1713		41-2314  -  SCREW BONE 2.3MM 14MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
41-2316	SUP	HCPCS C1713		41-2316  -  SCREW BONE 2.3MM 16MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
41-2318	SUP	HCPCS C1713		41-2318  -  SCREW BONE 2.3MM 18MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD	BOTH IP/OP	$295.00 	$218.30	$0.00	$236.00	$132.75	$132.75	$0.00	$0.00	$0.00	$61.49	$218.95	$218.95	$0.00	$0.00	$61.48	$0.00	$174.49	$174.49	$0.00	$147.50	$233.64	$236.00	$0.00		$0.00	$46.17	$0.00	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00
41-2406	SUP	HCPCS C1713		41-2406  -  SCREW BONE 2.3MM 6MM LOCK CROSS DRIVE TRAUMAONE LORENZ GOLD	BOTH IP/OP	$340.00 	$251.60	$0.00	$272.00	$153.00	$153.00	$0.00	$0.00	$0.00	$70.86	$252.35	$252.35	$0.00	$0.00	$70.86	$0.00	$201.11	$201.11	$0.00	$170.00	$269.28	$272.00	$0.00		$0.00	$53.21	$0.00	$0.00	$54.13	$0.00	$0.00	$0.00	$0.00	$0.00
41-2408	SUP	HCPCS C1713		41-2408  -  SCREW BONE 2.3MM 8MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$210.38	$210.38	$0.00	$0.00	$0.00	$97.44	$346.98	$346.98	$0.00	$0.00	$97.43	$0.00	$276.53	$276.53	$0.00	$233.75	$370.26	$374.00	$0.00		$0.00	$73.16	$0.00	$0.00	$74.43	$0.00	$0.00	$0.00	$0.00	$0.00
41-2410	SUP	HCPCS C1713		41-2410  -  SCREW BONE 2.3MM 10MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$210.38	$210.38	$0.00	$0.00	$0.00	$97.44	$346.98	$346.98	$0.00	$0.00	$97.43	$0.00	$276.53	$276.53	$0.00	$233.75	$370.26	$374.00	$0.00		$0.00	$73.16	$0.00	$0.00	$74.43	$0.00	$0.00	$0.00	$0.00	$0.00
41-2412	SUP	HCPCS C1713		41-2412  -  SCREW BONE 2.3MM 12MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$210.38	$210.38	$0.00	$0.00	$0.00	$97.44	$346.98	$346.98	$0.00	$0.00	$97.43	$0.00	$276.53	$276.53	$0.00	$233.75	$370.26	$374.00	$0.00		$0.00	$73.16	$0.00	$0.00	$74.43	$0.00	$0.00	$0.00	$0.00	$0.00
41-2414	SUP	HCPCS C1713		41-2414  -  SCREW BONE 2.3MM 14MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$210.38	$210.38	$0.00	$0.00	$0.00	$97.44	$346.98	$346.98	$0.00	$0.00	$97.43	$0.00	$276.53	$276.53	$0.00	$233.75	$370.26	$374.00	$0.00		$0.00	$73.16	$0.00	$0.00	$74.43	$0.00	$0.00	$0.00	$0.00	$0.00
41-2416	SUP	HCPCS C1713		41-2416  -  SCREW BONE 2.3MM 16MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$210.38	$210.38	$0.00	$0.00	$0.00	$97.44	$346.98	$346.98	$0.00	$0.00	$97.43	$0.00	$276.53	$276.53	$0.00	$233.75	$370.26	$374.00	$0.00		$0.00	$73.16	$0.00	$0.00	$74.43	$0.00	$0.00	$0.00	$0.00	$0.00
41-2418	SUP	HCPCS C1713		41-2418  -  SCREW BN 2.3MM 18MM AU X-DRV LCK	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$210.38	$210.38	$0.00	$0.00	$0.00	$97.44	$346.98	$346.98	$0.00	$0.00	$97.43	$0.00	$276.53	$276.53	$0.00	$233.75	$370.26	$374.00	$0.00		$0.00	$73.16	$0.00	$0.00	$74.43	$0.00	$0.00	$0.00	$0.00	$0.00
4125-127-100	SUP	Custom 27203010		4125-127-100  -  BLADE SAW THK.05IN MEDIUM 3.937X.984IN 2 CUT SAGITTAL	BOTH IP/OP	$116.85 	$86.47	$0.00	$93.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.73	$86.73	$0.00	$0.00	$24.35	$0.00	$0.00	$0.00	$0.00	$58.43	$92.55	$93.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41-2708	SUP	HCPCS C1713		41-2708  -  SCREW BONE 2.7MM 8MM EMERGENCY CROSS DRIVE TRAUMAONE MAGENTA	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
41-2710	SUP	HCPCS C1713		41-2710  -  SCREW BN 2.7MM 10MM MAG NLCKG X DRV	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
41-2712	SUP	HCPCS C1713		41-2712  -  SCREW BONE 2.7MM 12MM NONLOCKING X DRIVE LORENZ MAGENTA	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
41-2714	SUP	HCPCS C1713		41-2714  -  SCREW BONE 2.7MM 14MM NONLOCKING X DRIVE LORENZ MAGENTA	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
41-2716	SUP	HCPCS C1713		41-2716  -  SCREW BN 2.7MM 17MM LCK XDR ER	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
41-2718	SUP	HCPCS C1713		41-2718  -  SCREW BONE 2.7MM 18MM NONLOCKING X DRIVE LORENZ MAGENTA	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
413.590E	SUP	HCPCS C1713		413.590E  -  SCREW BONE 3MM 20MM LOCK TITANIUM STERNUM NONSTRL	BOTH IP/OP	$505.00 	$373.70	$0.00	$404.00	$227.25	$227.25	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$252.50	$399.96	$404.00	$0.00		$0.00	$79.03	$0.00	$0.00	$80.40	$0.00	$0.00	$0.00	$0.00	$0.00
413.592E	SUP	HCPCS C1713		413.592E  -  SCREW BONE 3MM 22MM LOCK TITANIUM STERNUM NONSTRL	BOTH IP/OP	$505.00 	$373.70	$0.00	$404.00	$227.25	$227.25	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$252.50	$399.96	$404.00	$0.00		$0.00	$79.03	$0.00	$0.00	$80.40	$0.00	$0.00	$0.00	$0.00	$0.00
413.594E	SUP	HCPCS C1713		413.594E  -  SCREW BONE 3MM 24MM LOCK TITANIUM STERNUM STERILE	BOTH IP/OP	$505.00 	$373.70	$0.00	$404.00	$227.25	$227.25	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$252.50	$399.96	$404.00	$0.00		$0.00	$79.03	$0.00	$0.00	$80.40	$0.00	$0.00	$0.00	$0.00	$0.00
416-022A	SUP	Custom 27203010		KIT BINAXNOW FLU A B CLIA WVD NASO SWB CNTRL VIR TST 22 TST	BOTH IP/OP	$660.75 	$488.96	$0.00	$528.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$330.38	$523.31	$528.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
41645B	SUP	Custom 27803010		41645B  -  RELOAD STPLR 3.5MM 45MM BLU STRL LF DVNC SI EWRST REG TISS	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$333.99	$333.99	$0.00	$0.00	$93.78	$0.00	$0.00	$0.00	$0.00	$225.00	$356.40	$360.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4170-223	SUP	Custom 27203010		4170-223  -  TUBING SUCT/IRR FLD MNG INFL STRL DISP	BOTH IP/OP	$72.94 	$53.98	$0.00	$58.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.13	$54.13	$0.00	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$36.47	$57.77	$58.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
419.952S	SUP	Custom 27803010		419.952S  -  WASHER OVL SM ORTH TI 6.5/7.3MM CANN SCR STRL	BOTH IP/OP	$328.50 	$243.09	$0.00	$262.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$243.81	$243.81	$0.00	$0.00	$68.46	$0.00	$0.00	$0.00	$0.00	$164.25	$260.17	$262.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
419.953S	SUP	Custom 27803010		419.953S  -  WASHER ORTHOPEDIC LARGE ROUND TITANIUM STERILE 6.5/7.3MM	BOTH IP/OP	$369.70 	$273.58	$0.00	$287.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$274.39	$274.39	$0.00	$0.00	$77.05	$0.00	$0.00	$0.00	$0.00	$179.46	$284.27	$287.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4195-78	SUP	HCPCS C1898		4195-78  -  LEAD PACING 5FR 78CM IS-1 UNIPOLAR DEPLOYABLE LOBE FIX	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
4200-10	SUP	Custom 27203010		4200-10  -  DISSECTOR SURG MODELING CATHETER MARTIN UNBALLOON	BOTH IP/OP	"$3,987.50 "	"$2,950.75"	$0.00	"$3,190.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.52"	"$2,959.52"	$0.00	$0.00	$831.00	$0.00	$0.00	$0.00	$0.00	"$1,993.75"	"$3,158.10"	"$3,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4200-20	SUP	HCPCS C1773		4200-20  -  DEVICE RETRIEVAL REMOVAL ENDSCP HELIX	BOTH IP/OP	"$5,237.50 "	"$3,875.75"	$0.00	"$4,190.00"	"$2,843.96"	"$2,843.96"	$0.00	$0.00	$0.00	"$1,091.63"	"$3,887.27"	"$3,887.27"	$0.00	$0.00	"$1,091.50"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,618.75"	"$4,148.10"	"$4,190.00"	$0.00		$0.00	$819.67	$0.00	$0.00	$833.81	$0.00	$0.00	$0.00	$0.00	$0.00
4200927F	SUP	Custom 27803010		4200927F  -  CAGE SPNL 0D 9MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4201127F	SUP	Custom 27803010		4201127F  -  CAGE SPNL 0D 11MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4201327F	SUP	Custom 27803010		4201327F  -  CAGE SPNL 0D 13MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4201527F	SUP	Custom 27803010		4201527F  -  CAGE SPNL 0D 15MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4201727F	SUP	Custom 27803010		4201727F  -  CAGE SPNL 0D 17MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
420404F	SUP	Custom 27203010		420404F  -  CATHETER CHLGM 4FR 40CM STRL 3W LL BVL BIL	BOTH IP/OP	$67.65 	$50.06	$0.00	$54.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.21	$50.21	$0.00	$0.00	$14.10	$0.00	$0.00	$0.00	$0.00	$33.83	$53.58	$54.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
420406F	SUP	Custom 27203010		420406F  -  CATHETER CHLGM 6FR 40CM BIL	BOTH IP/OP	$67.65 	$50.06	$0.00	$54.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.21	$50.21	$0.00	$0.00	$14.10	$0.00	$0.00	$0.00	$0.00	$33.83	$53.58	$54.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42-1002	SUP	HCPCS C1713		42-1002  -  PLATE LNG 1MM MANDIB 6 HOLE Y 2MM/2.3MM SCR BONE TRAUMAONE	BOTH IP/OP	"$1,402.50 "	"$1,037.85"	$0.00	"$1,122.00"	$631.13	$631.13	$0.00	$0.00	$0.00	$292.32	"$1,040.94"	"$1,040.94"	$0.00	$0.00	$292.28	$0.00	$829.58	$829.58	$0.00	$701.25	"$1,110.78"	"$1,122.00"	$0.00		$0.00	$219.49	$0.00	$0.00	$223.28	$0.00	$0.00	$0.00	$0.00	$0.00
42-1003	SUP	HCPCS C1713		42-1003  -  PLATE 1MM MANDIB 7 HOLE CVD 2MM/2.3MM SCR BONE TRAUMAONE TI	BOTH IP/OP	"$1,402.50 "	"$1,037.85"	$0.00	"$1,122.00"	$631.13	$631.13	$0.00	$0.00	$0.00	$292.32	"$1,040.94"	"$1,040.94"	$0.00	$0.00	$292.28	$0.00	$829.58	$829.58	$0.00	$701.25	"$1,110.78"	"$1,122.00"	$0.00		$0.00	$219.49	$0.00	$0.00	$223.28	$0.00	$0.00	$0.00	$0.00	$0.00
42-1004	SUP	HCPCS C1713		42-1004  -  PLATE BONE STR 1MM 4 HOLE GAP TRAUMAONE SILVER TITANIUM	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$868.50	$868.50	$0.00	$0.00	$0.00	$402.26	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	"$1,141.60"	"$1,141.60"	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$302.05	$0.00	$0.00	$307.26	$0.00	$0.00	$0.00	$0.00	$0.00
42-1005	SUP	HCPCS C1713		42-1005  -  PLATE 1MM MANDIB 2X7 HOLE MTRX STR BONE TRAUMAONE SLVR	BOTH IP/OP	"$1,402.50 "	"$1,037.85"	$0.00	"$1,122.00"	$631.13	$631.13	$0.00	$0.00	$0.00	$292.32	"$1,040.94"	"$1,040.94"	$0.00	$0.00	$292.28	$0.00	$829.58	$829.58	$0.00	$701.25	"$1,110.78"	"$1,122.00"	$0.00		$0.00	$219.49	$0.00	$0.00	$223.28	$0.00	$0.00	$0.00	$0.00	$0.00
42-1006	SUP	HCPCS C1713		42-1006  -  PLATE  2X7 CRVD MATRIX  1.0MM	BOTH IP/OP	"$1,402.50 "	"$1,037.85"	$0.00	"$1,122.00"	$631.13	$631.13	$0.00	$0.00	$0.00	$292.32	"$1,040.94"	"$1,040.94"	$0.00	$0.00	$292.28	$0.00	$829.58	$829.58	$0.00	$701.25	"$1,110.78"	"$1,122.00"	$0.00		$0.00	$219.49	$0.00	$0.00	$223.28	$0.00	$0.00	$0.00	$0.00	$0.00
42-1007	SUP	HCPCS C1713		42-1007  -  PLATE BONE STR 1MM 7 HOLE TRAUMAONE LORENZ TITANIUM MANDIB	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$868.50	$868.50	$0.00	$0.00	$0.00	$402.26	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	"$1,141.60"	"$1,141.60"	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$302.05	$0.00	$0.00	$307.26	$0.00	$0.00	$0.00	$0.00	$0.00
42-1016	SUP	HCPCS C1713		42-1016  -  PLATE  16 HOLE STR  1.0MM	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	"$1,032.75"	"$1,032.75"	$0.00	$0.00	$0.00	$478.34	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	"$1,357.49"	"$1,357.49"	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$359.17	$0.00	$0.00	$365.36	$0.00	$0.00	$0.00	$0.00	$0.00
4241327F	SUP	Custom 27803010		4241327F  -  CAGE SPNL 4D 13MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4241521F	SUP	Custom 27803010		4241521F  -  CAGE SPNL 4D 15MM 21MM FRNTL STNDALN	BOTH IP/OP	"$2,021.88 "	"$1,496.19"	$0.00	"$1,617.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,500.64"	"$1,500.64"	$0.00	$0.00	$421.36	$0.00	$0.00	$0.00	$0.00	"$1,010.94"	"$1,601.33"	"$1,617.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4241527B	SUP	Custom 27803010		4241527B  -  CAGE SPNL 4D 15MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4241527F	SUP	Custom 27803010		4241527F  -  CAGE SPNL 4D 15MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4241727B	SUP	Custom 27803010		4241727B  -  CAGE SPNL 4D 17MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4241727F	SUP	Custom 27803010		4241727F  -  CAGE SPNL 4D 17MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
426.702S	SUP	HCPCS C1713		426.702S  -  PLATE BONE BROAD 372MM 20 HOLE CVD LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$2,443.10 "	"$1,807.89"	$0.00	"$1,897.54"	"$1,067.37"	"$1,067.37"	$0.00	$0.00	$0.00	$509.20	"$1,813.27"	"$1,813.27"	$0.00	$0.00	$509.14	$0.00	"$1,445.09"	"$1,445.09"	$0.00	"$1,185.96"	"$1,878.57"	"$1,897.54"	$0.00		$0.00	$360.40	$0.00	$0.00	$377.61	$0.00	$0.00	$0.00	$0.00	$0.00
426.722S	SUP	HCPCS C1713		426.722S  -  PLATE BONE BROAD 408MM 22 HOLE CVD LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$2,669.40 "	"$1,975.36"	$0.00	"$2,073.32"	"$1,166.24"	"$1,166.24"	$0.00	$0.00	$0.00	$556.37	"$1,981.23"	"$1,981.23"	$0.00	$0.00	$556.30	$0.00	"$1,316.01"	"$1,316.01"	$0.00	"$1,295.83"	"$2,052.59"	"$2,073.32"	$0.00		$0.00	$393.78	$0.00	$0.00	$412.59	$0.00	$0.00	$0.00	$0.00	$0.00
426.742S	SUP	HCPCS C1713		426.742S  -  PLATE BONE BROAD 443MM 24 HOLE CVD LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$2,897.13 "	"$2,143.88"	$0.00	"$2,250.20"	"$1,265.74"	"$1,265.74"	$0.00	$0.00	$0.00	$603.83	"$2,150.25"	"$2,150.25"	$0.00	$0.00	$603.76	$0.00	"$1,428.28"	"$1,428.28"	$0.00	"$1,406.38"	"$2,227.70"	"$2,250.20"	$0.00		$0.00	$427.37	$0.00	$0.00	$447.79	$0.00	$0.00	$0.00	$0.00	$0.00
426.762S	SUP	HCPCS C1713		426.762S  -  PLATE BONE BROAD 479MM 26 HOLE CVD LCP TITANIUM ORTHOPEDIC	BOTH IP/OP	"$3,129.08 "	"$2,315.52"	$0.00	"$2,430.34"	"$1,367.07"	"$1,367.07"	$0.00	$0.00	$0.00	$652.18	"$2,322.40"	"$2,322.40"	$0.00	$0.00	$652.10	$0.00	"$1,542.63"	"$1,542.63"	$0.00	"$1,518.96"	"$2,406.04"	"$2,430.34"	$0.00		$0.00	$461.59	$0.00	$0.00	$483.64	$0.00	$0.00	$0.00	$0.00	$0.00
42615-05	SUP	Custom 27203010		42615-05  -  KIT PRESSURE MONITR 3ML/HR 48IN 2 LINE TRANSDUCER MALE TO	BOTH IP/OP	$36.36 	$26.91	$0.00	$29.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.99	$26.99	$0.00	$0.00	$7.58	$0.00	$0.00	$0.00	$0.00	$18.18	$28.80	$29.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42650-06	SUP	Custom 27203010		42650-06  -  KIT PRESSURE MONITR 84IN TRANSDUCER FLUSH DEVICE TUBE	BOTH IP/OP	$73.16 	$54.14	$0.00	$58.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.30	$54.30	$0.00	$0.00	$15.25	$0.00	$0.00	$0.00	$0.00	$36.58	$57.94	$58.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
427022S	SUP	HCPCS C1713		427022S  -  PLATE BN 292MM STRL 22 HL CMPR LCK	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
427069S	SUP	HCPCS C1713		427069S  -  PLATE 3MM 115MM SS 9 HOLE 1/3 TBLR SM FRAG IMPL AXSOS BONE	BOTH IP/OP	$236.80 	$175.23	$0.00	$189.20	$106.43	$106.43	$0.00	$0.00	$0.00	$49.36	$175.75	$175.75	$0.00	$0.00	$49.35	$0.00	$140.07	$140.07	$0.00	$118.25	$187.31	$189.20	$0.00		$0.00	$37.01	$0.00	$0.00	$37.65	$0.00	$0.00	$0.00	$0.00	$0.00
4281127B	SUP	Custom 27803010		4281127B  -  CAGE SPNL 8D 11MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4281127F	SUP	Custom 27803010		4281127F  -  CAGE SPNL 8D 11MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4281327B	SUP	Custom 27803010		4281327B  -  CAGE SPNL 8D 13MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4281327F	SUP	Custom 27803010		4281327F  -  CAGE SPNL 8D 13MM 27MM WHL BD STNDALN	BOTH IP/OP	"$4,245.88 "	"$3,141.95"	$0.00	"$3,396.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,151.29"	"$3,151.29"	$0.00	$0.00	$884.84	$0.00	$0.00	$0.00	$0.00	"$2,122.94"	"$3,362.74"	"$3,396.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4296-78	SUP	HCPCS C1900		4296-78  -  LEAD PACING 2 CURVE 5.3FR 78CM BIPOL 2 ELECTRODE 2 FIX IS-1	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,850.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,781.25"	"$2,821.50"	"$2,850.00"	$0.00		$0.00	$557.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43-1001	SUP	HCPCS C1713		43-1001  -  PLATE BONE SMALL 1MM ANGLED TRAUMAONE GOLD TITANIUM MANDIB 2	BOTH IP/OP	"$3,127.50 "	"$2,314.35"	$0.00	"$2,502.00"	"$1,407.38"	"$1,407.38"	$0.00	$0.00	$0.00	$651.85	"$2,321.23"	"$2,321.23"	$0.00	$0.00	$651.77	$0.00	"$1,541.86"	"$1,541.86"	$0.00	"$1,563.75"	"$2,476.98"	"$2,502.00"	$0.00		$0.00	$489.45	$0.00	$0.00	$497.90	$0.00	$0.00	$0.00	$0.00	$0.00
43-1004	SUP	HCPCS C1713		43-1004  -  PLATE BONE STR 4 HOLE GAP CRANIOMAXILLOFACIAL	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$868.50	$868.50	$0.00	$0.00	$0.00	$402.26	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	"$1,141.60"	"$1,141.60"	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$302.05	$0.00	$0.00	$307.26	$0.00	$0.00	$0.00	$0.00	$0.00
43-1005	SUP	HCPCS C1713		43-1005  -  PLATE BONE 1MM 4 HOLE STR TRAUMAONE GOLD TITANIUM MANDIB	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$868.50	$868.50	$0.00	$0.00	$0.00	$402.26	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	"$1,141.60"	"$1,141.60"	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$302.05	$0.00	$0.00	$307.26	$0.00	$0.00	$0.00	$0.00	$0.00
43-1007	SUP	HCPCS C1713		43-1007  -  PLATE BONE 1.6MM 7 HOLE STR	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	"$1,032.75"	"$1,032.75"	$0.00	$0.00	$0.00	$478.34	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	"$1,357.49"	"$1,357.49"	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$359.17	$0.00	$0.00	$365.36	$0.00	$0.00	$0.00	$0.00	$0.00
43-1008	SUP	HCPCS C1713		43-1008  -  PLATE BONE THK1.6MM CVD 7 HOLE LORENZ GOLD MANDIB	BOTH IP/OP	"$3,127.50 "	"$2,314.35"	$0.00	"$2,502.00"	"$1,407.38"	"$1,407.38"	$0.00	$0.00	$0.00	$651.85	"$2,321.23"	"$2,321.23"	$0.00	$0.00	$651.77	$0.00	"$1,541.86"	"$1,541.86"	$0.00	"$1,563.75"	"$2,476.98"	"$2,502.00"	$0.00		$0.00	$489.45	$0.00	$0.00	$497.90	$0.00	$0.00	$0.00	$0.00	$0.00
43-1016	SUP	HCPCS C1713		43-1016  -  PLATE BONE 1.6MM 16 HOLE STR TRAUMAONE GOLD MANDIB	BOTH IP/OP	"$3,552.50 "	"$2,628.85"	$0.00	"$2,842.00"	"$1,598.63"	"$1,598.63"	$0.00	$0.00	$0.00	$740.43	"$2,636.67"	"$2,636.67"	$0.00	$0.00	$740.34	$0.00	"$1,751.38"	"$1,751.38"	$0.00	"$1,776.25"	"$2,813.58"	"$2,842.00"	$0.00		$0.00	$555.97	$0.00	$0.00	$565.56	$0.00	$0.00	$0.00	$0.00	$0.00
43-1280	SUP	Custom 27203010		43-1280  -  KIT RSN REPR 75 PPM CRNPLST CMPLT SET TY 2 PWDR CRNL	BOTH IP/OP	"$4,296.40 "	"$3,179.34"	$0.00	"$3,437.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,188.79"	"$3,188.79"	$0.00	$0.00	$895.37	$0.00	$0.00	$0.00	$0.00	"$2,148.20"	"$3,402.75"	"$3,437.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
43154-060	SUP	Custom 27203010		43154-060  -  TUBE ENDOTRAC 6MM NSL/ORL TRK REINF CUF MRPH SIL SS	BOTH IP/OP	$312.93 	$231.57	$0.00	$250.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.47	$247.84	$250.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4324A	SUP	Custom 27203010		4324A  -  TRAY PROCEDURE 20GA 3.5IN MYELOGRAM PH WATER SOLUBLE CLEAR	BOTH IP/OP	$24.70 	$18.28	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.33	$18.33	$0.00	$0.00	$5.15	$0.00	$0.00	$0.00	$0.00	$12.54	$19.86	$20.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
433-01	SUP	Custom 27203010		433-01  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,064.63 "	$787.83	$0.00	$851.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$790.16	$790.16	$0.00	$0.00	$221.87	$0.00	$0.00	$0.00	$0.00	$532.31	$843.19	$851.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
435002S	SUP	HCPCS C1713		435002S  -  PLATE 34MM SS 3.5/4MM SCR 2 HOLE BONE LEFT PERIART TIB STRL	BOTH IP/OP	"$1,113.75 "	$824.18	$0.00	$891.00	$501.19	$501.19	$0.00	$0.00	$0.00	$232.13	$826.63	$826.63	$0.00	$0.00	$232.11	$0.00	$658.78	$658.78	$0.00	$556.88	$882.09	$891.00	$0.00		$0.00	$174.30	$0.00	$0.00	$177.31	$0.00	$0.00	$0.00	$0.00	$0.00
435004S	SUP	HCPCS C1713		435004S  -  PLATE 60MM SS 3.5/4MM SCR 4 HOLE BONE LEFT PERIART TIB STRL	BOTH IP/OP	"$1,113.75 "	$824.18	$0.00	$891.00	$501.19	$501.19	$0.00	$0.00	$0.00	$232.13	$826.63	$826.63	$0.00	$0.00	$232.11	$0.00	$658.78	$658.78	$0.00	$556.88	$882.09	$891.00	$0.00		$0.00	$174.30	$0.00	$0.00	$177.31	$0.00	$0.00	$0.00	$0.00	$0.00
435006S	SUP	HCPCS C1713		435006S  -  PLATE 86MM SS 3.5/4MM SCR 6 HOLE BONE LEFT PERIART TIB STRL	BOTH IP/OP	"$1,113.75 "	$824.18	$0.00	$891.00	$501.19	$501.19	$0.00	$0.00	$0.00	$232.13	$826.63	$826.63	$0.00	$0.00	$232.11	$0.00	$658.78	$658.78	$0.00	$556.88	$882.09	$891.00	$0.00		$0.00	$174.30	$0.00	$0.00	$177.31	$0.00	$0.00	$0.00	$0.00	$0.00
435008S	SUP	HCPCS C1713		435008S  -  PLATE 112MM SS 3.5/4MM SCR 8 HOLE BONE LEFT PERIART TIB STRL	BOTH IP/OP	"$1,113.75 "	$824.18	$0.00	$891.00	$501.19	$501.19	$0.00	$0.00	$0.00	$232.13	$826.63	$826.63	$0.00	$0.00	$232.11	$0.00	$658.78	$658.78	$0.00	$556.88	$882.09	$891.00	$0.00		$0.00	$174.30	$0.00	$0.00	$177.31	$0.00	$0.00	$0.00	$0.00	$0.00
435010S	SUP	HCPCS C1713		435010S  -  PLATE 138MM SS 3.5/4MM SCR 10 HOLE BONE LEFT PERIART TIB	BOTH IP/OP	"$1,149.50 "	$850.63	$0.00	$919.60	$517.28	$517.28	$0.00	$0.00	$0.00	$239.58	$853.16	$853.16	$0.00	$0.00	$239.56	$0.00	$679.93	$679.93	$0.00	$574.75	$910.40	$919.60	$0.00		$0.00	$179.90	$0.00	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00
435012S	SUP	HCPCS C1713		435012S  -  PLATE 164MM SS 3.5/4MM SCR 12 HOLE BONE LEFT PERIART TIB	BOTH IP/OP	"$1,149.50 "	$850.63	$0.00	$919.60	$517.28	$517.28	$0.00	$0.00	$0.00	$239.58	$853.16	$853.16	$0.00	$0.00	$239.56	$0.00	$679.93	$679.93	$0.00	$574.75	$910.40	$919.60	$0.00		$0.00	$179.90	$0.00	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00
435014S	SUP	HCPCS C1713		435014S  -  PLATE 190MM SS 3.5/4MM SCR 14 HOLE BONE LEFT PERIART TIB	BOTH IP/OP	"$1,193.50 "	$883.19	$0.00	$954.80	$537.08	$537.08	$0.00	$0.00	$0.00	$248.76	$885.82	$885.82	$0.00	$0.00	$248.73	$0.00	$705.96	$705.96	$0.00	$596.75	$945.25	$954.80	$0.00		$0.00	$186.78	$0.00	$0.00	$190.01	$0.00	$0.00	$0.00	$0.00	$0.00
435022S	SUP	HCPCS C1713		435022S  -  PLATE 34MM SS 3.5/4MM SCR 2 HOLE BONE RIGHT PERIART TIB STRL	BOTH IP/OP	"$1,113.75 "	$824.18	$0.00	$891.00	$501.19	$501.19	$0.00	$0.00	$0.00	$232.13	$826.63	$826.63	$0.00	$0.00	$232.11	$0.00	$658.78	$658.78	$0.00	$556.88	$882.09	$891.00	$0.00		$0.00	$174.30	$0.00	$0.00	$177.31	$0.00	$0.00	$0.00	$0.00	$0.00
435024S	SUP	HCPCS C1713		435024S  -  PLATE 60MM SS 3.5/4MM SCR 4 HOLE BONE RIGHT PERIART TIB STRL	BOTH IP/OP	"$1,113.75 "	$824.18	$0.00	$891.00	$501.19	$501.19	$0.00	$0.00	$0.00	$232.13	$826.63	$826.63	$0.00	$0.00	$232.11	$0.00	$658.78	$658.78	$0.00	$556.88	$882.09	$891.00	$0.00		$0.00	$174.30	$0.00	$0.00	$177.31	$0.00	$0.00	$0.00	$0.00	$0.00
435026S	SUP	HCPCS C1713		435026S  -  PLATE 86MM SS 3.5/4MM SCR 6 HOLE BONE RIGHT PERIART TIB STRL	BOTH IP/OP	"$1,113.75 "	$824.18	$0.00	$891.00	$501.19	$501.19	$0.00	$0.00	$0.00	$232.13	$826.63	$826.63	$0.00	$0.00	$232.11	$0.00	$658.78	$658.78	$0.00	$556.88	$882.09	$891.00	$0.00		$0.00	$174.30	$0.00	$0.00	$177.31	$0.00	$0.00	$0.00	$0.00	$0.00
435028S	SUP	HCPCS C1713		435028S  -  PLATE 112MM SS 3.5/4MM SCR 8 HOLE BONE RIGHT PERIART TIB	BOTH IP/OP	"$1,113.75 "	$824.18	$0.00	$891.00	$501.19	$501.19	$0.00	$0.00	$0.00	$232.13	$826.63	$826.63	$0.00	$0.00	$232.11	$0.00	$658.78	$658.78	$0.00	$556.88	$882.09	$891.00	$0.00		$0.00	$174.30	$0.00	$0.00	$177.31	$0.00	$0.00	$0.00	$0.00	$0.00
435030S	SUP	HCPCS C1713		435030S  -  PLATE 138MM SS 3.5/4MM SCR 10 HOLE BONE RIGHT PERIART TIB	BOTH IP/OP	"$1,149.50 "	$850.63	$0.00	$919.60	$517.28	$517.28	$0.00	$0.00	$0.00	$239.58	$853.16	$853.16	$0.00	$0.00	$239.56	$0.00	$679.93	$679.93	$0.00	$574.75	$910.40	$919.60	$0.00		$0.00	$179.90	$0.00	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00
435032S	SUP	HCPCS C1713		435032S  -  PLATE 164MM SS 3.5/4MM SCR 12 HOLE BONE RIGHT PERIART TIB	BOTH IP/OP	"$1,149.50 "	$850.63	$0.00	$919.60	$517.28	$517.28	$0.00	$0.00	$0.00	$239.58	$853.16	$853.16	$0.00	$0.00	$239.56	$0.00	$679.93	$679.93	$0.00	$574.75	$910.40	$919.60	$0.00		$0.00	$179.90	$0.00	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00
435034S	SUP	HCPCS C1713		435034S  -  PLATE 190MM SS 3.5/4MM SCR 14 HOLE BONE RIGHT PERIART TIB	BOTH IP/OP	"$1,193.50 "	$883.19	$0.00	$954.80	$537.08	$537.08	$0.00	$0.00	$0.00	$248.76	$885.82	$885.82	$0.00	$0.00	$248.73	$0.00	$705.96	$705.96	$0.00	$596.75	$945.25	$954.80	$0.00		$0.00	$186.78	$0.00	$0.00	$190.01	$0.00	$0.00	$0.00	$0.00	$0.00
435506S	SUP	HCPCS C1713		435506S  -  PLATE SS 6 HL SHFT BONE LEFT PERIART FEM STRL	BOTH IP/OP	"$1,080.75 "	$799.76	$0.00	$864.60	$486.34	$486.34	$0.00	$0.00	$0.00	$225.26	$802.13	$802.13	$0.00	$0.00	$225.23	$0.00	$639.26	$639.26	$0.00	$540.38	$855.95	$864.60	$0.00		$0.00	$169.14	$0.00	$0.00	$172.06	$0.00	$0.00	$0.00	$0.00	$0.00
435508S	SUP	HCPCS C1713		435508S  -  PLATE 193MM SS 4.5/6.5MM SCR 8 HOLE BONE LEFT PERIART FEM	BOTH IP/OP	"$1,080.75 "	$799.76	$0.00	$864.60	$486.34	$486.34	$0.00	$0.00	$0.00	$225.26	$802.13	$802.13	$0.00	$0.00	$225.23	$0.00	$639.26	$639.26	$0.00	$540.38	$855.95	$864.60	$0.00		$0.00	$169.14	$0.00	$0.00	$172.06	$0.00	$0.00	$0.00	$0.00	$0.00
435526S	SUP	HCPCS C1713		435526S  -  PLATE 157MM SS 4.5/6.5MM SCR 6 HOLE BONE RIGHT PERIART FEM	BOTH IP/OP	"$1,080.75 "	$799.76	$0.00	$864.60	$486.34	$486.34	$0.00	$0.00	$0.00	$225.26	$802.13	$802.13	$0.00	$0.00	$225.23	$0.00	$639.26	$639.26	$0.00	$540.38	$855.95	$864.60	$0.00		$0.00	$169.14	$0.00	$0.00	$172.06	$0.00	$0.00	$0.00	$0.00	$0.00
435528S	SUP	HCPCS C1713		435528S  -  PLATE 193MM SS 4.5/6.5MM SCR 8 HOLE BONE RIGHT PERIART FEM	BOTH IP/OP	"$1,080.75 "	$799.76	$0.00	$864.60	$486.34	$486.34	$0.00	$0.00	$0.00	$225.26	$802.13	$802.13	$0.00	$0.00	$225.23	$0.00	$639.26	$639.26	$0.00	$540.38	$855.95	$864.60	$0.00		$0.00	$169.14	$0.00	$0.00	$172.06	$0.00	$0.00	$0.00	$0.00	$0.00
435604S	SUP	HCPCS C1713		435604S  -  PLATE 78MM SS 4.5/6.5MM SCR 4 HOLE BONE LEFT PERIART TIB	BOTH IP/OP	"$1,127.50 "	$834.35	$0.00	$902.00	$507.38	$507.38	$0.00	$0.00	$0.00	$235.00	$836.83	$836.83	$0.00	$0.00	$234.97	$0.00	$666.92	$666.92	$0.00	$563.75	$892.98	$902.00	$0.00		$0.00	$176.45	$0.00	$0.00	$179.50	$0.00	$0.00	$0.00	$0.00	$0.00
435606S	SUP	HCPCS C1713		435606S  -  PLATE 114MM SS 4.5/6.5MM SCR 6 HOLE BONE LEFT PERIART TIB	BOTH IP/OP	"$1,056.00 "	$781.44	$0.00	$902.00	$507.38	$507.38	$0.00	$0.00	$0.00	$220.10	$783.76	$783.76	$0.00	$0.00	$220.07	$0.00	$624.62	$624.62	$0.00	$563.75	$892.98	$902.00	$0.00		$0.00	$176.45	$0.00	$0.00	$179.50	$0.00	$0.00	$0.00	$0.00	$0.00
435608S	SUP	HCPCS C1713		435608S  -  PLATE 150MM SS 4.5/6.5MM SCR 8 HOLE BONE LEFT PERIART TIB	BOTH IP/OP	"$1,171.50 "	$866.91	$0.00	$937.20	$527.18	$527.18	$0.00	$0.00	$0.00	$244.17	$869.49	$869.49	$0.00	$0.00	$244.14	$0.00	$692.94	$692.94	$0.00	$585.75	$927.83	$937.20	$0.00		$0.00	$183.34	$0.00	$0.00	$186.50	$0.00	$0.00	$0.00	$0.00	$0.00
435624S	SUP	HCPCS C1713		435624S  -  PLATE 78MM SS 4.5/6.5MM SCR 4 HOLE BONE RIGHT PERIART TIB	BOTH IP/OP	"$1,127.50 "	$834.35	$0.00	$902.00	$507.38	$507.38	$0.00	$0.00	$0.00	$235.00	$836.83	$836.83	$0.00	$0.00	$234.97	$0.00	$666.92	$666.92	$0.00	$563.75	$892.98	$902.00	$0.00		$0.00	$176.45	$0.00	$0.00	$179.50	$0.00	$0.00	$0.00	$0.00	$0.00
435626S	SUP	HCPCS C1713		435626S  -  PLATE 114MM SS 4.5/6.5MM SCR 6 HOLE BONE RIGHT PERIART TIB	BOTH IP/OP	"$1,127.50 "	$834.35	$0.00	$902.00	$507.38	$507.38	$0.00	$0.00	$0.00	$235.00	$836.83	$836.83	$0.00	$0.00	$234.97	$0.00	$666.92	$666.92	$0.00	$563.75	$892.98	$902.00	$0.00		$0.00	$176.45	$0.00	$0.00	$179.50	$0.00	$0.00	$0.00	$0.00	$0.00
435628S	SUP	HCPCS C1713		435628S  -  PLATE 150MM SS 4.5/6.5MM SCR 8 HOLE BONE RIGHT PERIART TIB	BOTH IP/OP	"$1,171.50 "	$866.91	$0.00	$937.20	$527.18	$527.18	$0.00	$0.00	$0.00	$244.17	$869.49	$869.49	$0.00	$0.00	$244.14	$0.00	$692.94	$692.94	$0.00	$585.75	$927.83	$937.20	$0.00		$0.00	$183.34	$0.00	$0.00	$186.50	$0.00	$0.00	$0.00	$0.00	$0.00
436.504S	SUP	HCPCS C1713		436.504S  -  PLATE BONE 4 LCP TITANIUM OLECRANON STERILE 3.5MM SCREWS	BOTH IP/OP	"$1,865.35 "	"$1,380.36"	$0.00	"$1,448.82"	$814.96	$814.96	$0.00	$0.00	$0.00	$388.79	"$1,384.46"	"$1,384.46"	$0.00	$0.00	$388.74	$0.00	"$1,103.35"	"$1,103.35"	$0.00	$905.51	"$1,434.34"	"$1,448.82"	$0.00		$0.00	$275.17	$0.00	$0.00	$288.32	$0.00	$0.00	$0.00	$0.00	$0.00
436.505S	SUP	HCPCS C1713		436.505S  -  PLATE BONE 112MM 4 HOLE LCP TITANIUM LEFT OLECRANON STERILE	BOTH IP/OP	"$1,865.35 "	"$1,380.36"	$0.00	"$1,448.82"	$814.96	$814.96	$0.00	$0.00	$0.00	$388.79	"$1,384.46"	"$1,384.46"	$0.00	$0.00	$388.74	$0.00	"$1,103.35"	"$1,103.35"	$0.00	$905.51	"$1,434.34"	"$1,448.82"	$0.00		$0.00	$275.17	$0.00	$0.00	$288.32	$0.00	$0.00	$0.00	$0.00	$0.00
436.508S	SUP	HCPCS C1713		436.508S  -  PLATE BONE 164MM 8 HOLE LCP TITANIUM RIGHT OLECRANON STERILE	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
436.509S	SUP	HCPCS C1713		436.509S  -  PLATE BONE 164MM 8 HOLE LCP TITANIUM LEFT OLECRANON STERILE	BOTH IP/OP	"$2,015.78 "	"$1,491.68"	$0.00	"$1,565.64"	$880.67	$880.67	$0.00	$0.00	$0.00	$420.14	"$1,496.11"	"$1,496.11"	$0.00	$0.00	$420.09	$0.00	"$1,192.33"	"$1,192.33"	$0.00	$978.53	"$1,549.98"	"$1,565.64"	$0.00		$0.00	$297.36	$0.00	$0.00	$311.56	$0.00	$0.00	$0.00	$0.00	$0.00
436013B	SUP	HCPCS C1713		436013B  -  CENTERPIECE 436013B 13MM B-SIZE	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436013C	SUP	HCPCS C1713		436013C  -  CENTERPIECE 436013C 13MM C-SIZE	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436013D	SUP	HCPCS C1713		436013D  -  CENTERPIECE 436013D 13MM D-SIZE	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436013E	SUP	HCPCS C1713		436013E  -  CENTERPIECE 436013E 13MM E-SIZE	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436020A	SUP	HCPCS C1713		436020A  -  CENTERPIECE 436020A 20MM A-SIZE	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
436020B	SUP	HCPCS C1713		436020B  -  CENTERPIECE 436020B 20MM B-SIZE	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
436020C	SUP	HCPCS C1713		436020C  -  CENTERPIECE 436020C 20MM C-SIZE	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
436020D	SUP	HCPCS C1713		436020D  -  CENTERPIECE 436020D 20MM D-SIZE	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
436020E	SUP	HCPCS C1713		436020E  -  CENTERPIECE 436020E 20MM E-SIZE	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
436025A	SUP	HCPCS C1713		436025A  -  CENTERPIECE 436025A 25MM A-SIZE	BOTH IP/OP	"$14,500.00 "	"$10,730.00"	$0.00	"$11,600.00"	"$6,525.00"	"$6,525.00"	$0.00	$0.00	$0.00	"$3,022.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,021.80"	$0.00	"$7,148.50"	"$7,148.50"	$0.00	"$7,250.00"	"$11,484.00"	"$11,600.00"	$0.00		$0.00	"$2,269.25"	$0.00	$0.00	"$2,308.40"	$0.00	$0.00	$0.00	$0.00	$0.00
436025B	SUP	HCPCS C1713		436025B  -  CENTERPIECE 436025B 25MM B-SIZE	BOTH IP/OP	"$14,500.00 "	"$10,730.00"	$0.00	"$11,600.00"	"$6,525.00"	"$6,525.00"	$0.00	$0.00	$0.00	"$3,022.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,021.80"	$0.00	"$7,148.50"	"$7,148.50"	$0.00	"$7,250.00"	"$11,484.00"	"$11,600.00"	$0.00		$0.00	"$2,269.25"	$0.00	$0.00	"$2,308.40"	$0.00	$0.00	$0.00	$0.00	$0.00
436025C	SUP	HCPCS C1713		436025C  -  CENTERPIECE 436025C 25MM C-SIZE	BOTH IP/OP	"$14,500.00 "	"$10,730.00"	$0.00	"$11,600.00"	"$6,525.00"	"$6,525.00"	$0.00	$0.00	$0.00	"$3,022.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,021.80"	$0.00	"$7,148.50"	"$7,148.50"	$0.00	"$7,250.00"	"$11,484.00"	"$11,600.00"	$0.00		$0.00	"$2,269.25"	$0.00	$0.00	"$2,308.40"	$0.00	$0.00	$0.00	$0.00	$0.00
436025D	SUP	HCPCS C1713		436025D  -  CENTERPIECE 436025D 25MM D-SIZE	BOTH IP/OP	"$14,500.00 "	"$10,730.00"	$0.00	"$11,600.00"	"$6,525.00"	"$6,525.00"	$0.00	$0.00	$0.00	"$3,022.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,021.80"	$0.00	"$7,148.50"	"$7,148.50"	$0.00	"$7,250.00"	"$11,484.00"	"$11,600.00"	$0.00		$0.00	"$2,269.25"	$0.00	$0.00	"$2,308.40"	$0.00	$0.00	$0.00	$0.00	$0.00
436025E	SUP	HCPCS C1713		436025E  -  CENTERPIECE 436025E 25MM E-SIZE	BOTH IP/OP	"$14,500.00 "	"$10,730.00"	$0.00	"$11,600.00"	"$6,525.00"	"$6,525.00"	$0.00	$0.00	$0.00	"$3,022.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,021.80"	$0.00	"$7,148.50"	"$7,148.50"	$0.00	"$7,250.00"	"$11,484.00"	"$11,600.00"	$0.00		$0.00	"$2,269.25"	$0.00	$0.00	"$2,308.40"	$0.00	$0.00	$0.00	$0.00	$0.00
436113A	SUP	HCPCS C1713		436113A  -  CAGE 436113A 13MM A-SIZE STERILE	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436113B	SUP	HCPCS C1713		436113B  -  CAGE 436113B 13MM B-SIZE STERILE	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436113C	SUP	HCPCS C1713		436113C  -  CAGE 436113C 13MM C-SIZE STERILE	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436113D	SUP	HCPCS C1713		436113D  -  CAGE 436113D 13MM D-SIZE STERILE	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436113E	SUP	HCPCS C1713		436113E  -  CAGE 436113E 13MM E-SIZE STERILE	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436120A	SUP	HCPCS C1713		436120A  -  CAGE 436120A 20MM A-SIZE STERILE	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
436120B	SUP	HCPCS C1713		436120B  -  CAGE 436120B 20MM B-SIZE STERILE	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
436120C	SUP	HCPCS C1713		436120C  -  CAGE 436120C 20MM C-SIZE STERILE	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
436120D	SUP	HCPCS C1713		436120D  -  CAGE 436120D 20MM D-SIZE STERILE	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
436120E	SUP	HCPCS C1713		436120E  -  CAGE 436120E 20MM E-SIZE STERILE	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
436125A	SUP	HCPCS C1713		436125A  -  CAGE 436125A 25MM A-SIZE STERILE	BOTH IP/OP	"$14,500.00 "	"$10,730.00"	$0.00	"$11,600.00"	"$6,525.00"	"$6,525.00"	$0.00	$0.00	$0.00	"$3,022.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,021.80"	$0.00	"$7,148.50"	"$7,148.50"	$0.00	"$7,250.00"	"$11,484.00"	"$11,600.00"	$0.00		$0.00	"$2,269.25"	$0.00	$0.00	"$2,308.40"	$0.00	$0.00	$0.00	$0.00	$0.00
436125B	SUP	HCPCS C1713		436125B  -  CAGE 436125B 25MM B-SIZE STERILE	BOTH IP/OP	"$14,500.00 "	"$10,730.00"	$0.00	"$11,600.00"	"$6,525.00"	"$6,525.00"	$0.00	$0.00	$0.00	"$3,022.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,021.80"	$0.00	"$7,148.50"	"$7,148.50"	$0.00	"$7,250.00"	"$11,484.00"	"$11,600.00"	$0.00		$0.00	"$2,269.25"	$0.00	$0.00	"$2,308.40"	$0.00	$0.00	$0.00	$0.00	$0.00
436125C	SUP	HCPCS C1713		436125C  -  CAGE 436125C 25MM C-SIZE STERILE	BOTH IP/OP	"$14,500.00 "	"$10,730.00"	$0.00	"$11,600.00"	"$6,525.00"	"$6,525.00"	$0.00	$0.00	$0.00	"$3,022.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,021.80"	$0.00	"$7,148.50"	"$7,148.50"	$0.00	"$7,250.00"	"$11,484.00"	"$11,600.00"	$0.00		$0.00	"$2,269.25"	$0.00	$0.00	"$2,308.40"	$0.00	$0.00	$0.00	$0.00	$0.00
436125D	SUP	HCPCS C1713		436125D  -  CAGE 436125D 25MM D-SIZE STERILE	BOTH IP/OP	"$14,500.00 "	"$10,730.00"	$0.00	"$11,600.00"	"$6,525.00"	"$6,525.00"	$0.00	$0.00	$0.00	"$3,022.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,021.80"	$0.00	"$7,148.50"	"$7,148.50"	$0.00	"$7,250.00"	"$11,484.00"	"$11,600.00"	$0.00		$0.00	"$2,269.25"	$0.00	$0.00	"$2,308.40"	$0.00	$0.00	$0.00	$0.00	$0.00
436125E	SUP	HCPCS C1713		436125E  -  CAGE 436125E 25MM E-SIZE STERILE	BOTH IP/OP	"$14,500.00 "	"$10,730.00"	$0.00	"$11,600.00"	"$6,525.00"	"$6,525.00"	$0.00	$0.00	$0.00	"$3,022.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,021.80"	$0.00	"$7,148.50"	"$7,148.50"	$0.00	"$7,250.00"	"$11,484.00"	"$11,600.00"	$0.00		$0.00	"$2,269.25"	$0.00	$0.00	"$2,308.40"	$0.00	$0.00	$0.00	$0.00	$0.00
436213A	SUP	HCPCS C1713		436213A  -  CENTERPIECE 436213A 13MM A-SIZE CERVICAL	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436213B	SUP	HCPCS C1713		436213B  -  CENTERPIECE 436213B 13MM B-SIZE CERVICAL	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436213C	SUP	HCPCS C1713		436213C  -  CENTERPIECE 436213C 13MM C-SIZE CERVICAL	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436213D	SUP	HCPCS C1713		436213D  -  CENTERPIECE 436213D 13MM D-SIZE CERVICAL	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436213E	SUP	HCPCS C1713		436213E  -  CENTERPIECE 436213E 13MM E-SIZE CERVICAL	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436313A	SUP	HCPCS C1713		436313A  -  CENTERPIECE 436313A 13MM A-SIZE CRV STER	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436313B	SUP	HCPCS C1713		436313B  -  CENTERPIECE 436313B 13MM B-SIZE CRV STER	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436313C	SUP	HCPCS C1713		436313C  -  CENTERPIECE 436313C 13MM C-SIZE CRV STER	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436313D	SUP	HCPCS C1713		436313D  -  CENTERPIECE 436313D 13MM D-SIZE CRV STER	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
436313E	SUP	HCPCS C1713		436313E  -  CENTERPIECE 436313E 13MM E-SIZE CRV STER	BOTH IP/OP	"$11,500.00 "	"$8,510.00"	$0.00	"$9,200.00"	"$5,175.00"	"$5,175.00"	$0.00	$0.00	$0.00	"$2,396.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,396.60"	$0.00	"$5,669.50"	"$5,669.50"	$0.00	"$5,750.00"	"$9,108.00"	"$9,200.00"	$0.00		$0.00	"$1,799.75"	$0.00	$0.00	"$1,830.80"	$0.00	$0.00	$0.00	$0.00	$0.00
437.043S	SUP	HCPCS C1713		437.043S  -  PLATE BONE 90D 30MM 4 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
437.044S	SUP	HCPCS C1713		437.044S  -  PLATE BONE 90D 40MM 4 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
437.053S	SUP	HCPCS C1713		437.053S  -  PLATE BONE 90D 30MM 5 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
437.054S	SUP	HCPCS C1713		437.054S  -  PLATE BONE 90D 40MM 5 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
437.063S	SUP	HCPCS C1713		437.063S  -  PLATE BONE 90D 30MM 6 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
437.064S	SUP	HCPCS C1713		437.064S  -  PLATE BONE 90D 40MM 6 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
437.083S	SUP	HCPCS C1713		437.083S  -  PLATE BONE 90D 30MM 8 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
437.084S	SUP	HCPCS C1713		437.084S  -  PLATE BONE 90D 40MM 8 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
437.085S	SUP	HCPCS C1713		437.085S  -  PLATE BONE 90D 50MM 8 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
437.086S	SUP	HCPCS C1713		437.086S  -  PLATE BONE 90D 60MM 8 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$1,629.75 "	"$1,206.02"	$0.00	"$1,303.80"	$733.39	$733.39	$0.00	$0.00	$0.00	$339.68	"$1,209.60"	"$1,209.60"	$0.00	$0.00	$339.64	$0.00	$964.00	$964.00	$0.00	$814.88	"$1,290.76"	"$1,303.80"	$0.00		$0.00	$255.06	$0.00	$0.00	$259.46	$0.00	$0.00	$0.00	$0.00	$0.00
437.103S	SUP	HCPCS C1713		437.103S  -  PLATE BONE 90D 30MM 10 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$2,126.63 "	"$1,573.71"	$0.00	"$1,701.30"	$956.98	$956.98	$0.00	$0.00	$0.00	$443.24	"$1,578.38"	"$1,578.38"	$0.00	$0.00	$443.19	$0.00	"$1,257.90"	"$1,257.90"	$0.00	"$1,063.31"	"$1,684.29"	"$1,701.30"	$0.00		$0.00	$332.82	$0.00	$0.00	$338.56	$0.00	$0.00	$0.00	$0.00	$0.00
437.104S	SUP	HCPCS C1713		437.104S  -  PLATE BONE 90D 40MM 10 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$2,126.63 "	"$1,573.71"	$0.00	"$1,701.30"	$956.98	$956.98	$0.00	$0.00	$0.00	$443.24	"$1,578.38"	"$1,578.38"	$0.00	$0.00	$443.19	$0.00	"$1,257.90"	"$1,257.90"	$0.00	"$1,063.31"	"$1,684.29"	"$1,701.30"	$0.00		$0.00	$332.82	$0.00	$0.00	$338.56	$0.00	$0.00	$0.00	$0.00	$0.00
437.105S	SUP	HCPCS C1713		437.105S  -  PLATE BONE 90D 50MM 10 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$2,126.63 "	"$1,573.71"	$0.00	"$1,701.30"	$956.98	$956.98	$0.00	$0.00	$0.00	$443.24	"$1,578.38"	"$1,578.38"	$0.00	$0.00	$443.19	$0.00	"$1,257.90"	"$1,257.90"	$0.00	"$1,063.31"	"$1,684.29"	"$1,701.30"	$0.00		$0.00	$332.82	$0.00	$0.00	$338.56	$0.00	$0.00	$0.00	$0.00	$0.00
437.106S	SUP	HCPCS C1713		437.106S  -  PLATE BONE 90D 60MM 10 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$2,126.63 "	"$1,573.71"	$0.00	"$1,701.30"	$956.98	$956.98	$0.00	$0.00	$0.00	$443.24	"$1,578.38"	"$1,578.38"	$0.00	$0.00	$443.19	$0.00	"$1,257.90"	"$1,257.90"	$0.00	"$1,063.31"	"$1,684.29"	"$1,701.30"	$0.00		$0.00	$332.82	$0.00	$0.00	$338.56	$0.00	$0.00	$0.00	$0.00	$0.00
437.123S	SUP	HCPCS C1713		437.123S  -  PLATE BONE 90D 30MM 12 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$2,126.63 "	"$1,573.71"	$0.00	"$1,701.30"	$956.98	$956.98	$0.00	$0.00	$0.00	$443.24	"$1,578.38"	"$1,578.38"	$0.00	$0.00	$443.19	$0.00	"$1,257.90"	"$1,257.90"	$0.00	"$1,063.31"	"$1,684.29"	"$1,701.30"	$0.00		$0.00	$332.82	$0.00	$0.00	$338.56	$0.00	$0.00	$0.00	$0.00	$0.00
437.124S	SUP	HCPCS C1713		437.124S  -  PLATE BONE 90D 40MM 12 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$2,126.63 "	"$1,573.71"	$0.00	"$1,701.30"	$956.98	$956.98	$0.00	$0.00	$0.00	$443.24	"$1,578.38"	"$1,578.38"	$0.00	$0.00	$443.19	$0.00	"$1,257.90"	"$1,257.90"	$0.00	"$1,063.31"	"$1,684.29"	"$1,701.30"	$0.00		$0.00	$332.82	$0.00	$0.00	$338.56	$0.00	$0.00	$0.00	$0.00	$0.00
437.125S	SUP	HCPCS C1713		437.125S  -  PLATE BONE 90D 50MM 12 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$2,126.63 "	"$1,573.71"	$0.00	"$1,701.30"	$956.98	$956.98	$0.00	$0.00	$0.00	$443.24	"$1,578.38"	"$1,578.38"	$0.00	$0.00	$443.19	$0.00	"$1,257.90"	"$1,257.90"	$0.00	"$1,063.31"	"$1,684.29"	"$1,701.30"	$0.00		$0.00	$332.82	$0.00	$0.00	$338.56	$0.00	$0.00	$0.00	$0.00	$0.00
437.126S	SUP	HCPCS C1713		437.126S  -  PLATE BONE 90D 60MM 12 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$2,126.63 "	"$1,573.71"	$0.00	"$1,701.30"	$956.98	$956.98	$0.00	$0.00	$0.00	$443.24	"$1,578.38"	"$1,578.38"	$0.00	$0.00	$443.19	$0.00	"$1,257.90"	"$1,257.90"	$0.00	"$1,063.31"	"$1,684.29"	"$1,701.30"	$0.00		$0.00	$332.82	$0.00	$0.00	$338.56	$0.00	$0.00	$0.00	$0.00	$0.00
437.143S	SUP	HCPCS C1713		437.143S  -  PLATE BONE 90D 30MM 14 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$2,705.65 "	"$2,002.18"	$0.00	"$2,164.52"	"$1,217.54"	"$1,217.54"	$0.00	$0.00	$0.00	$563.93	"$2,008.13"	"$2,008.13"	$0.00	$0.00	$563.86	$0.00	"$1,333.89"	"$1,333.89"	$0.00	"$1,352.83"	"$2,142.87"	"$2,164.52"	$0.00		$0.00	$423.43	$0.00	$0.00	$430.74	$0.00	$0.00	$0.00	$0.00	$0.00
437.144S	SUP	HCPCS C1713		437.144S  -  PLATE BONE 90D 40MM 14 HOLE CANN LC ANGLED TITANIUM	BOTH IP/OP	"$2,705.65 "	"$2,002.18"	$0.00	"$2,164.52"	"$1,217.54"	"$1,217.54"	$0.00	$0.00	$0.00	$563.93	"$2,008.13"	"$2,008.13"	$0.00	$0.00	$563.86	$0.00	"$1,333.89"	"$1,333.89"	$0.00	"$1,352.83"	"$2,142.87"	"$2,164.52"	$0.00		$0.00	$423.43	$0.00	$0.00	$430.74	$0.00	$0.00	$0.00	$0.00	$0.00
437.146S	SUP	HCPCS C1713		437.146S  -  PLATE BONE 90D 256MM 60X11.7MM 14 HOLE CANN LC ANGLED BLADE	BOTH IP/OP	"$2,705.65 "	"$2,002.18"	$0.00	"$2,164.52"	"$1,217.54"	"$1,217.54"	$0.00	$0.00	$0.00	$563.93	"$2,008.13"	"$2,008.13"	$0.00	$0.00	$563.86	$0.00	"$1,333.89"	"$1,333.89"	$0.00	"$1,352.83"	"$2,142.87"	"$2,164.52"	$0.00		$0.00	$423.43	$0.00	$0.00	$430.74	$0.00	$0.00	$0.00	$0.00	$0.00
4396-78	SUP	HCPCS C1900		4396-78  -  LEAD PACING STR 4FR 78CM 2 ELECTRODE TINES IS-1 ATTAIN	BOTH IP/OP	"$3,562.50 "	"$2,636.25"	$0.00	"$2,850.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$742.51	"$2,644.09"	"$2,644.09"	$0.00	$0.00	$742.43	$0.00	"$1,756.31"	"$1,756.31"	$0.00	"$1,781.25"	"$2,821.50"	"$2,850.00"	$0.00		$0.00	$557.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4396-88	SUP	HCPCS C1900		4396-88  -  LEAD PACING STR 4FR 88CM 2 ELECTRODE TINES IS-1 ATTAIN	BOTH IP/OP	"$3,562.50 "	"$2,636.25"	$0.00	"$2,850.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$742.51	"$2,644.09"	"$2,644.09"	$0.00	$0.00	$742.43	$0.00	"$1,756.31"	"$1,756.31"	$0.00	"$1,781.25"	"$2,821.50"	"$2,850.00"	$0.00		$0.00	$557.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.072S	SUP	HCPCS C1713		441.072S  -  PLATE BONE 12MM 4 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE	BOTH IP/OP	"$1,513.93 "	"$1,120.31"	$0.00	"$1,175.86"	$661.42	$661.42	$0.00	$0.00	$0.00	$315.54	"$1,123.64"	"$1,123.64"	$0.00	$0.00	$315.50	$0.00	$895.49	$895.49	$0.00	$734.91	"$1,164.11"	"$1,175.86"	$0.00		$0.00	$223.33	$0.00	$0.00	$234.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.073S	SUP	HCPCS C1713		441.073S  -  PLATE BONE 12MM 4 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,513.93 "	"$1,120.31"	$0.00	"$1,175.86"	$661.42	$661.42	$0.00	$0.00	$0.00	$315.54	"$1,123.64"	"$1,123.64"	$0.00	$0.00	$315.50	$0.00	$895.49	$895.49	$0.00	$734.91	"$1,164.11"	"$1,175.86"	$0.00		$0.00	$223.33	$0.00	$0.00	$234.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.074S	SUP	HCPCS C1713		441.074S  -  PLATE BN 15MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT	BOTH IP/OP	"$1,513.93 "	"$1,120.31"	$0.00	"$1,175.86"	$661.42	$661.42	$0.00	$0.00	$0.00	$315.54	"$1,123.64"	"$1,123.64"	$0.00	$0.00	$315.50	$0.00	$895.49	$895.49	$0.00	$734.91	"$1,164.11"	"$1,175.86"	$0.00		$0.00	$223.33	$0.00	$0.00	$234.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.075S	SUP	HCPCS C1713		441.075S  -  PLATE BONE 15MM 4 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,513.93 "	"$1,120.31"	$0.00	"$1,175.86"	$661.42	$661.42	$0.00	$0.00	$0.00	$315.54	"$1,123.64"	"$1,123.64"	$0.00	$0.00	$315.50	$0.00	$895.49	$895.49	$0.00	$734.91	"$1,164.11"	"$1,175.86"	$0.00		$0.00	$223.33	$0.00	$0.00	$234.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.076S	SUP	HCPCS C1713		441.076S  -  PLATE BONE 18MM 4 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE	BOTH IP/OP	"$1,513.93 "	"$1,120.31"	$0.00	"$1,175.86"	$661.42	$661.42	$0.00	$0.00	$0.00	$315.54	"$1,123.64"	"$1,123.64"	$0.00	$0.00	$315.50	$0.00	$895.49	$895.49	$0.00	$734.91	"$1,164.11"	"$1,175.86"	$0.00		$0.00	$223.33	$0.00	$0.00	$234.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.077S	SUP	HCPCS C1713		441.077S  -  PLATE BONE 18MM 4 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,513.93 "	"$1,120.31"	$0.00	"$1,175.86"	$661.42	$661.42	$0.00	$0.00	$0.00	$315.54	"$1,123.64"	"$1,123.64"	$0.00	$0.00	$315.50	$0.00	$895.49	$895.49	$0.00	$734.91	"$1,164.11"	"$1,175.86"	$0.00		$0.00	$223.33	$0.00	$0.00	$234.00	$0.00	$0.00	$0.00	$0.00	$0.00
441.082S	SUP	HCPCS C1713		441.082S  -  PLATE BONE 12MM 5 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE	BOTH IP/OP	"$1,584.23 "	"$1,172.33"	$0.00	"$1,230.46"	$692.13	$692.13	$0.00	$0.00	$0.00	$330.19	"$1,175.81"	"$1,175.81"	$0.00	$0.00	$330.15	$0.00	$937.07	$937.07	$0.00	$769.04	"$1,218.16"	"$1,230.46"	$0.00		$0.00	$233.70	$0.00	$0.00	$244.86	$0.00	$0.00	$0.00	$0.00	$0.00
441.083S	SUP	HCPCS C1713		441.083S  -  PLATE BONE 12MM 5 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,584.23 "	"$1,172.33"	$0.00	"$1,230.46"	$692.13	$692.13	$0.00	$0.00	$0.00	$330.19	"$1,175.81"	"$1,175.81"	$0.00	$0.00	$330.15	$0.00	$937.07	$937.07	$0.00	$769.04	"$1,218.16"	"$1,230.46"	$0.00		$0.00	$233.70	$0.00	$0.00	$244.86	$0.00	$0.00	$0.00	$0.00	$0.00
441.084S	SUP	HCPCS C1713		441.084S  -  PLATE BONE 15MM 5 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE	BOTH IP/OP	"$1,584.23 "	"$1,172.33"	$0.00	"$1,230.46"	$692.13	$692.13	$0.00	$0.00	$0.00	$330.19	"$1,175.81"	"$1,175.81"	$0.00	$0.00	$330.15	$0.00	$937.07	$937.07	$0.00	$769.04	"$1,218.16"	"$1,230.46"	$0.00		$0.00	$233.70	$0.00	$0.00	$244.86	$0.00	$0.00	$0.00	$0.00	$0.00
441.085S	SUP	HCPCS C1713		441.085S  -  PLATE BONE 15MM 5 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,584.23 "	"$1,172.33"	$0.00	"$1,230.46"	$692.13	$692.13	$0.00	$0.00	$0.00	$330.19	"$1,175.81"	"$1,175.81"	$0.00	$0.00	$330.15	$0.00	$937.07	$937.07	$0.00	$769.04	"$1,218.16"	"$1,230.46"	$0.00		$0.00	$233.70	$0.00	$0.00	$244.86	$0.00	$0.00	$0.00	$0.00	$0.00
441.086S	SUP	HCPCS C1713		441.086S  -  PLATE BONE 18MM 5 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE	BOTH IP/OP	"$1,584.23 "	"$1,172.33"	$0.00	"$1,230.46"	$692.13	$692.13	$0.00	$0.00	$0.00	$330.19	"$1,175.81"	"$1,175.81"	$0.00	$0.00	$330.15	$0.00	$937.07	$937.07	$0.00	$769.04	"$1,218.16"	"$1,230.46"	$0.00		$0.00	$233.70	$0.00	$0.00	$244.86	$0.00	$0.00	$0.00	$0.00	$0.00
441.087S	SUP	HCPCS C1713		441.087S  -  PLATE BONE 18MM 5 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,584.23 "	"$1,172.33"	$0.00	"$1,230.46"	$692.13	$692.13	$0.00	$0.00	$0.00	$330.19	"$1,175.81"	"$1,175.81"	$0.00	$0.00	$330.15	$0.00	$937.07	$937.07	$0.00	$769.04	"$1,218.16"	"$1,230.46"	$0.00		$0.00	$233.70	$0.00	$0.00	$244.86	$0.00	$0.00	$0.00	$0.00	$0.00
441.094S	SUP	HCPCS C1713		441.094S  -  PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE	BOTH IP/OP	"$1,629.20 "	"$1,205.61"	$0.00	"$1,265.40"	$711.79	$711.79	$0.00	$0.00	$0.00	$339.57	"$1,209.19"	"$1,209.19"	$0.00	$0.00	$339.53	$0.00	$963.67	$963.67	$0.00	$790.88	"$1,252.75"	"$1,265.40"	$0.00		$0.00	$240.33	$0.00	$0.00	$251.81	$0.00	$0.00	$0.00	$0.00	$0.00
441.095S	SUP	HCPCS C1713		441.095S  -  PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,629.20 "	"$1,205.61"	$0.00	"$1,265.40"	$711.79	$711.79	$0.00	$0.00	$0.00	$339.57	"$1,209.19"	"$1,209.19"	$0.00	$0.00	$339.53	$0.00	$963.67	$963.67	$0.00	$790.88	"$1,252.75"	"$1,265.40"	$0.00		$0.00	$240.33	$0.00	$0.00	$251.81	$0.00	$0.00	$0.00	$0.00	$0.00
441.096S	SUP	HCPCS C1713		441.096S  -  PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE	BOTH IP/OP	"$1,629.20 "	"$1,205.61"	$0.00	"$1,265.40"	$711.79	$711.79	$0.00	$0.00	$0.00	$339.57	"$1,209.19"	"$1,209.19"	$0.00	$0.00	$339.53	$0.00	$963.67	$963.67	$0.00	$790.88	"$1,252.75"	"$1,265.40"	$0.00		$0.00	$240.33	$0.00	$0.00	$251.81	$0.00	$0.00	$0.00	$0.00	$0.00
441.097S	SUP	HCPCS C1713		441.097S  -  PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,629.20 "	"$1,205.61"	$0.00	"$1,265.40"	$711.79	$711.79	$0.00	$0.00	$0.00	$339.57	"$1,209.19"	"$1,209.19"	$0.00	$0.00	$339.53	$0.00	$963.67	$963.67	$0.00	$790.88	"$1,252.75"	"$1,265.40"	$0.00		$0.00	$240.33	$0.00	$0.00	$251.81	$0.00	$0.00	$0.00	$0.00	$0.00
441.104S	SUP	HCPCS C1713		441.104S  -  PLATE BONE 15MM 7 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE	BOTH IP/OP	"$1,698.08 "	"$1,256.58"	$0.00	"$1,318.90"	$741.88	$741.88	$0.00	$0.00	$0.00	$353.92	"$1,260.31"	"$1,260.31"	$0.00	$0.00	$353.88	$0.00	"$1,004.41"	"$1,004.41"	$0.00	$824.31	"$1,305.71"	"$1,318.90"	$0.00		$0.00	$250.49	$0.00	$0.00	$262.46	$0.00	$0.00	$0.00	$0.00	$0.00
441.105S	SUP	HCPCS C1713		441.105S  -  PLATE BONE 15MM 7 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,698.08 "	"$1,256.58"	$0.00	"$1,318.90"	$741.88	$741.88	$0.00	$0.00	$0.00	$353.92	"$1,260.31"	"$1,260.31"	$0.00	$0.00	$353.88	$0.00	"$1,004.41"	"$1,004.41"	$0.00	$824.31	"$1,305.71"	"$1,318.90"	$0.00		$0.00	$250.49	$0.00	$0.00	$262.46	$0.00	$0.00	$0.00	$0.00	$0.00
441.106S	SUP	HCPCS C1713		441.106S  -  PLATE BONE 18MM 7 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE	BOTH IP/OP	"$1,698.08 "	"$1,256.58"	$0.00	"$1,318.90"	$741.88	$741.88	$0.00	$0.00	$0.00	$353.92	"$1,260.31"	"$1,260.31"	$0.00	$0.00	$353.88	$0.00	"$1,004.41"	"$1,004.41"	$0.00	$824.31	"$1,305.71"	"$1,318.90"	$0.00		$0.00	$250.49	$0.00	$0.00	$262.46	$0.00	$0.00	$0.00	$0.00	$0.00
441.107S	SUP	HCPCS C1713		441.107S  -  PLATE BONE 18MM 7 HOLE HOOK LCP TITANIUM LEFT CLAVICLE	BOTH IP/OP	"$1,698.08 "	"$1,256.58"	$0.00	"$1,318.90"	$741.88	$741.88	$0.00	$0.00	$0.00	$353.92	"$1,260.31"	"$1,260.31"	$0.00	$0.00	$353.88	$0.00	"$1,004.41"	"$1,004.41"	$0.00	$824.31	"$1,305.71"	"$1,318.90"	$0.00		$0.00	$250.49	$0.00	$0.00	$262.46	$0.00	$0.00	$0.00	$0.00	$0.00
44-1001	SUP	HCPCS C1713		44-1001  -  PLATE BONE LARGE 2MM ANGLED TRAUMAONE BLUE TITANIUM MANDIB 2	BOTH IP/OP	"$6,255.00 "	"$4,628.70"	$0.00	"$5,004.00"	"$2,814.75"	"$2,814.75"	$0.00	$0.00	$0.00	"$1,303.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,303.54"	$0.00	"$3,083.72"	"$3,083.72"	$0.00	"$3,127.50"	"$4,953.96"	"$5,004.00"	$0.00		$0.00	$978.91	$0.00	$0.00	$995.80	$0.00	$0.00	$0.00	$0.00	$0.00
44-1002	SUP	HCPCS C1713		44-1002  -  PLATE BONE SMALL 2MM 2 ANGLED TRAUMAONE BLUE TITANIUM MANDIB	BOTH IP/OP	"$7,630.00 "	"$5,646.20"	$0.00	"$6,104.00"	"$3,433.50"	"$3,433.50"	$0.00	$0.00	$0.00	"$1,590.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,590.09"	$0.00	"$3,761.59"	"$3,761.59"	$0.00	"$3,815.00"	"$6,042.96"	"$6,104.00"	$0.00		$0.00	"$1,194.10"	$0.00	$0.00	"$1,214.70"	$0.00	$0.00	$0.00	$0.00	$0.00
44-1003	SUP	HCPCS C1713		44-1003  -  PLATE BONE THK2MM MEDIUM 2 ANGLED LORENZ BLUE MANDIB	BOTH IP/OP	"$8,075.00 "	"$5,975.50"	$0.00	"$6,460.00"	"$3,633.75"	"$3,633.75"	$0.00	$0.00	$0.00	"$1,683.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,682.83"	$0.00	"$3,980.98"	"$3,980.98"	$0.00	"$4,037.50"	"$6,395.40"	"$6,460.00"	$0.00		$0.00	"$1,263.74"	$0.00	$0.00	"$1,285.54"	$0.00	$0.00	$0.00	$0.00	$0.00
44-1005	SUP	HCPCS C1713		44-1005  -  PLATE BONE LARGE 2.6MM ANGLED TRAUMAONE MAGENTA TITANIUM	BOTH IP/OP	"$6,727.50 "	"$4,978.35"	$0.00	"$5,382.00"	"$3,027.38"	"$3,027.38"	$0.00	$0.00	$0.00	"$1,402.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,402.01"	$0.00	"$3,316.66"	"$3,316.66"	$0.00	"$3,363.75"	"$5,328.18"	"$5,382.00"	$0.00		$0.00	"$1,052.85"	$0.00	$0.00	"$1,071.02"	$0.00	$0.00	$0.00	$0.00	$0.00
44-1012	SUP	HCPCS C1713		44-1012  -  PLATE BONE 2MM 12 HOLE STR TRAUMAONE BLUE TITANIUM MANDIB 2	BOTH IP/OP	"$2,765.00 "	"$2,046.10"	$0.00	"$2,212.00"	"$1,244.25"	"$1,244.25"	$0.00	$0.00	$0.00	$576.30	"$2,052.18"	"$2,052.18"	$0.00	$0.00	$576.23	$0.00	"$1,363.15"	"$1,363.15"	$0.00	"$1,382.50"	"$2,189.88"	"$2,212.00"	$0.00		$0.00	$432.72	$0.00	$0.00	$440.19	$0.00	$0.00	$0.00	$0.00	$0.00
44-1022	SUP	HCPCS C1713		44-1022  -  PLATE BN MED 2 ANG 2MM BLU TRAUMAONE STRG TI MNDB 2MM/2.3MM	BOTH IP/OP	"$8,072.50 "	"$5,973.65"	$0.00	"$4,692.00"	"$2,639.25"	"$2,639.25"	$0.00	$0.00	$0.00	"$1,682.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,682.31"	$0.00	"$3,979.74"	"$3,979.74"	$0.00	"$2,932.50"	"$4,645.08"	"$4,692.00"	$0.00		$0.00	$917.87	$0.00	$0.00	$933.71	$0.00	$0.00	$0.00	$0.00	$0.00
44-1023	SUP	HCPCS C1713		44-1023  -  PLATE BN LG ANG 2.6MM MAG TRAUMAONE STRG TI MNDB 2MM/2.3MM	BOTH IP/OP	"$6,727.50 "	"$4,978.35"	$0.00	"$5,382.00"	"$3,027.38"	"$3,027.38"	$0.00	$0.00	$0.00	"$1,402.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,402.01"	$0.00	"$3,316.66"	"$3,316.66"	$0.00	"$3,363.75"	"$5,328.18"	"$5,382.00"	$0.00		$0.00	"$1,052.85"	$0.00	$0.00	"$1,071.02"	$0.00	$0.00	$0.00	$0.00	$0.00
44-1024	SUP	HCPCS C1713		44-1024  -  PLATE BONE 2MM 24 HOLE STR TRAUMAONE BLUE TITANIUM MANDIB 2	BOTH IP/OP	"$3,805.00 "	"$2,815.70"	$0.00	"$3,044.00"	"$1,712.25"	"$1,712.25"	$0.00	$0.00	$0.00	$793.06	"$2,824.07"	"$2,824.07"	$0.00	$0.00	$792.96	$0.00	"$1,875.87"	"$1,875.87"	$0.00	"$1,902.50"	"$3,013.56"	"$3,044.00"	$0.00		$0.00	$595.48	$0.00	$0.00	$605.76	$0.00	$0.00	$0.00	$0.00	$0.00
442.458TM	SUP	HCPCS C1713		442.458TM  -  PLATE 48MM TI 2.4MM SCR 5 HLE/HD 3 HL SHFT LCP BONE RIGHT	BOTH IP/OP	"$1,819.53 "	"$1,346.45"	$0.00	"$1,455.62"	$818.79	$818.79	$0.00	$0.00	$0.00	$379.23	"$1,350.45"	"$1,350.45"	$0.00	$0.00	$379.19	$0.00	"$1,076.25"	"$1,076.25"	$0.00	$909.76	"$1,441.07"	"$1,455.62"	$0.00		$0.00	$284.76	$0.00	$0.00	$289.67	$0.00	$0.00	$0.00	$0.00	$0.00
442.459TM	SUP	HCPCS C1713		442.459TM  -  PLATE 66MM TI 2.4MM SCR 5 HLE/HD 5 HL SHFT LCP BONE RIGHT	BOTH IP/OP	"$1,928.98 "	"$1,427.45"	$0.00	"$1,543.18"	$868.04	$868.04	$0.00	$0.00	$0.00	$402.05	"$1,431.69"	"$1,431.69"	$0.00	$0.00	$402.00	$0.00	"$1,140.99"	"$1,140.99"	$0.00	$964.49	"$1,527.75"	"$1,543.18"	$0.00		$0.00	$301.88	$0.00	$0.00	$307.09	$0.00	$0.00	$0.00	$0.00	$0.00
442.461TM	SUP	HCPCS C1713		442.461TM  -  PLATE 48MM TI 2.4MM SCR 5X3 HOLE LCP BONE LEFT DISTAL VOLR	BOTH IP/OP	"$1,819.53 "	"$1,346.45"	$0.00	"$1,455.62"	$818.79	$818.79	$0.00	$0.00	$0.00	$379.23	"$1,350.45"	"$1,350.45"	$0.00	$0.00	$379.19	$0.00	"$1,076.25"	"$1,076.25"	$0.00	$909.76	"$1,441.07"	"$1,455.62"	$0.00		$0.00	$284.76	$0.00	$0.00	$289.67	$0.00	$0.00	$0.00	$0.00	$0.00
442.462TM	SUP	HCPCS C1713		442.462TM  -  PLATE 66MM TI 2.4MM SCR 5 HLE/HD 5 HL SHFT LCP BONE LEFT	BOTH IP/OP	"$1,928.98 "	"$1,427.45"	$0.00	"$1,543.18"	$868.04	$868.04	$0.00	$0.00	$0.00	$402.05	"$1,431.69"	"$1,431.69"	$0.00	$0.00	$402.00	$0.00	"$1,140.99"	"$1,140.99"	$0.00	$964.49	"$1,527.75"	"$1,543.18"	$0.00		$0.00	$301.88	$0.00	$0.00	$307.09	$0.00	$0.00	$0.00	$0.00	$0.00
442.464TM	SUP	HCPCS C1713		442.464TM  -  PLATE BN 47X6.3X1.6MM LCP 4 HLE/HD 3 HL SHFT TI RDS RT DIST	BOTH IP/OP	"$1,819.53 "	"$1,346.45"	$0.00	"$1,455.62"	$818.79	$818.79	$0.00	$0.00	$0.00	$379.23	"$1,350.45"	"$1,350.45"	$0.00	$0.00	$379.19	$0.00	"$1,076.25"	"$1,076.25"	$0.00	$909.76	"$1,441.07"	"$1,455.62"	$0.00		$0.00	$284.76	$0.00	$0.00	$289.67	$0.00	$0.00	$0.00	$0.00	$0.00
442.465TM	SUP	HCPCS C1713		442.465TM  -  PLATE 65MM TI 2.4MM SCR 4 HLE/HD 5 HL SHFT LCP BONE RIGHT	BOTH IP/OP	"$1,928.98 "	"$1,427.45"	$0.00	"$1,543.18"	$868.04	$868.04	$0.00	$0.00	$0.00	$402.05	"$1,431.69"	"$1,431.69"	$0.00	$0.00	$402.00	$0.00	"$1,140.99"	"$1,140.99"	$0.00	$964.49	"$1,527.75"	"$1,543.18"	$0.00		$0.00	$301.88	$0.00	$0.00	$307.09	$0.00	$0.00	$0.00	$0.00	$0.00
442.467TM	SUP	HCPCS C1713		442.467TM  -  PLATE 47MM TI 2.4MM SCR 3X4 HOLE LCP BONE LEFT DISTAL EXTART	BOTH IP/OP	"$1,819.53 "	"$1,346.45"	$0.00	"$1,455.62"	$818.79	$818.79	$0.00	$0.00	$0.00	$379.23	"$1,350.45"	"$1,350.45"	$0.00	$0.00	$379.19	$0.00	"$1,076.25"	"$1,076.25"	$0.00	$909.76	"$1,441.07"	"$1,455.62"	$0.00		$0.00	$284.76	$0.00	$0.00	$289.67	$0.00	$0.00	$0.00	$0.00	$0.00
442.468TM	SUP	HCPCS C1713		442.468TM  -  PLATE 65MM TI 4 HOLE LCK LCP BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$1,928.98 "	"$1,427.45"	$0.00	"$1,543.18"	$868.04	$868.04	$0.00	$0.00	$0.00	$402.05	"$1,431.69"	"$1,431.69"	$0.00	$0.00	$402.00	$0.00	"$1,140.99"	"$1,140.99"	$0.00	$964.49	"$1,527.75"	"$1,543.18"	$0.00		$0.00	$301.88	$0.00	$0.00	$307.09	$0.00	$0.00	$0.00	$0.00	$0.00
442.531S	SUP	HCPCS C1713		442.531S  -  PLATE BONE 46MM 7 HOLE LCP TITANIUM DISTAL ULNAR STERILE 2MM	BOTH IP/OP	"$1,591.25 "	"$1,177.53"	$0.00	"$1,235.92"	$695.21	$695.21	$0.00	$0.00	$0.00	$331.66	"$1,181.03"	"$1,181.03"	$0.00	$0.00	$331.62	$0.00	$941.22	$941.22	$0.00	$772.45	"$1,223.56"	"$1,235.92"	$0.00		$0.00	$234.73	$0.00	$0.00	$245.95	$0.00	$0.00	$0.00	$0.00	$0.00
443.61.96	SUP	HCPCS C1713		443.61.96  -  PLATE BN 39X5X1.2MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDYL	BOTH IP/OP	$567.90 	$420.25	$0.00	$441.08	$248.11	$248.11	$0.00	$0.00	$0.00	$118.36	$421.50	$421.50	$0.00	$0.00	$118.35	$0.00	$335.91	$335.91	$0.00	$275.68	$436.67	$441.08	$0.00		$0.00	$107.41	$0.00	$0.00	$87.77	$0.00	$0.00	$0.00	$0.00	$0.00
443.62.96	SUP	HCPCS C1713		443.62.96  -  PLATE BN 39X5X1.2MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDRL	BOTH IP/OP	$567.90 	$420.25	$0.00	$441.08	$248.11	$248.11	$0.00	$0.00	$0.00	$118.36	$421.50	$421.50	$0.00	$0.00	$118.35	$0.00	$335.91	$335.91	$0.00	$275.68	$436.67	$441.08	$0.00		$0.00	$107.41	$0.00	$0.00	$87.77	$0.00	$0.00	$0.00	$0.00	$0.00
4450M26	SUP	Custom 27803010		4450M26  -  RING ANNULOPLASTY KIDNEY 26MM 30.7MM 24.9MM FLEXIBLE HOLDER	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4450M28	SUP	Custom 27803010		4450M28  -  RING ANLPLS 28MM C-E PH	BOTH IP/OP	"$8,295.00 "	"$6,138.30"	$0.00	"$6,636.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,728.68"	$0.00	$0.00	$0.00	$0.00	"$4,147.50"	"$6,569.64"	"$6,636.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4450M30	SUP	Custom 27803010		4450M30  -  RING ANLPLS 30MM C-E PH	BOTH IP/OP	"$8,295.00 "	"$6,138.30"	$0.00	"$6,636.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,728.68"	$0.00	$0.00	$0.00	$0.00	"$4,147.50"	"$6,569.64"	"$6,636.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4450M32	SUP	Custom 27803010		4450M32  -  RING ANLPLS 32MM C-E PH	BOTH IP/OP	"$8,295.00 "	"$6,138.30"	$0.00	"$6,636.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,728.68"	$0.00	$0.00	$0.00	$0.00	"$4,147.50"	"$6,569.64"	"$6,636.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4450M34	SUP	Custom 27803010		4450M34  -  RING ANLPLS 34MM C-E PH	BOTH IP/OP	"$8,295.00 "	"$6,138.30"	$0.00	"$6,636.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,728.68"	$0.00	$0.00	$0.00	$0.00	"$4,147.50"	"$6,569.64"	"$6,636.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4450M36	SUP	Custom 27803010		4450M36  -  RING ANLPLS KNDY 36MM 41.2MM 34.8MM STRL C-E PH FLXB HLDR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
446.354S	SUP	HCPCS C1713		446.354S  -  PLATE BONE 27MM 2 HOLE HEAD 4 HOLE SHAFT ROTATION CORRECTION	BOTH IP/OP	"$1,544.90 "	"$1,143.23"	$0.00	"$1,235.92"	$695.21	$695.21	$0.00	$0.00	$0.00	$322.00	"$1,146.62"	"$1,146.62"	$0.00	$0.00	$321.96	$0.00	$913.81	$913.81	$0.00	$772.45	"$1,223.56"	"$1,235.92"	$0.00		$0.00	$234.73	$0.00	$0.00	$245.95	$0.00	$0.00	$0.00	$0.00	$0.00
446.355S	SUP	HCPCS C1713		446.355S  -  PLATE BONE 32MM 2 HOLE HEAD 5 HOLE SHAFT ROTATION CORRECTION	BOTH IP/OP	"$1,544.90 "	"$1,143.23"	$0.00	"$1,235.92"	$695.21	$695.21	$0.00	$0.00	$0.00	$322.00	"$1,146.62"	"$1,146.62"	$0.00	$0.00	$321.96	$0.00	$913.81	$913.81	$0.00	$772.45	"$1,223.56"	"$1,235.92"	$0.00		$0.00	$234.73	$0.00	$0.00	$245.95	$0.00	$0.00	$0.00	$0.00	$0.00
446.63.96	SUP	HCPCS C1713		446.63.96  -  PLATE BN 36X3.5X.9MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDYL	BOTH IP/OP	$539.78 	$399.44	$0.00	$419.26	$235.83	$235.83	$0.00	$0.00	$0.00	$112.50	$400.62	$400.62	$0.00	$0.00	$112.49	$0.00	$319.28	$319.28	$0.00	$262.04	$415.07	$419.26	$0.00		$0.00	$79.63	$0.00	$0.00	$83.43	$0.00	$0.00	$0.00	$0.00	$0.00
446.64.96	SUP	HCPCS C1713		446.64.96  -  PLATE BN 36X3.5X.9MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDYL	BOTH IP/OP	$539.78 	$399.44	$0.00	$419.26	$235.83	$235.83	$0.00	$0.00	$0.00	$112.50	$400.62	$400.62	$0.00	$0.00	$112.49	$0.00	$319.28	$319.28	$0.00	$262.04	$415.07	$419.26	$0.00		$0.00	$79.63	$0.00	$0.00	$83.43	$0.00	$0.00	$0.00	$0.00	$0.00
447.354S	SUP	HCPCS C1713		447.354S  -  PLATE BONE 34MM 2 HOLE HEAD 4 HOLE SHAFT ROTATION CORRECTION	BOTH IP/OP	"$1,591.25 "	"$1,177.53"	$0.00	"$1,235.92"	$695.21	$695.21	$0.00	$0.00	$0.00	$331.66	"$1,181.03"	"$1,181.03"	$0.00	$0.00	$331.62	$0.00	$941.22	$941.22	$0.00	$772.45	"$1,223.56"	"$1,235.92"	$0.00		$0.00	$234.73	$0.00	$0.00	$245.95	$0.00	$0.00	$0.00	$0.00	$0.00
447.355S	SUP	HCPCS C1713		447.355S  -  PLATE BONE 40MM 2 HOLE HEAD 2 HOLE SHAFT ROTATION CORRECTION	BOTH IP/OP	"$1,591.25 "	"$1,177.53"	$0.00	"$1,235.92"	$695.21	$695.21	$0.00	$0.00	$0.00	$331.66	"$1,181.03"	"$1,181.03"	$0.00	$0.00	$331.62	$0.00	$941.22	$941.22	$0.00	$772.45	"$1,223.56"	"$1,235.92"	$0.00		$0.00	$234.73	$0.00	$0.00	$245.95	$0.00	$0.00	$0.00	$0.00	$0.00
450.701S	SUP	HCPCS C1713		450.701S  -  NAIL INTRAMEDULLARY 9MM 16CM SOLID AQUA TITANIUM FEMUR	BOTH IP/OP	"$3,324.75 "	"$2,460.32"	$0.00	"$2,659.80"	"$1,496.14"	"$1,496.14"	$0.00	$0.00	$0.00	$692.96	"$2,467.63"	"$2,467.63"	$0.00	$0.00	$692.88	$0.00	"$1,639.10"	"$1,639.10"	$0.00	"$1,662.38"	"$2,633.20"	"$2,659.80"	$0.00		$0.00	$520.32	$0.00	$0.00	$529.30	$0.00	$0.00	$0.00	$0.00	$0.00
450.702S	SUP	HCPCS C1713		450.702S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 20CM SOLID EXPERT AQUA	BOTH IP/OP	"$3,324.75 "	"$2,460.32"	$0.00	"$2,659.80"	"$1,496.14"	"$1,496.14"	$0.00	$0.00	$0.00	$692.96	"$2,467.63"	"$2,467.63"	$0.00	$0.00	$692.88	$0.00	"$1,639.10"	"$1,639.10"	$0.00	"$1,662.38"	"$2,633.20"	"$2,659.80"	$0.00		$0.00	$520.32	$0.00	$0.00	$529.30	$0.00	$0.00	$0.00	$0.00	$0.00
450.703S	SUP	HCPCS C1713		450.703S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 24CM SOLID EXPERT AQUA	BOTH IP/OP	"$3,299.98 "	"$2,441.99"	$0.00	"$2,639.98"	"$1,484.99"	"$1,484.99"	$0.00	$0.00	$0.00	$687.80	"$2,449.24"	"$2,449.24"	$0.00	$0.00	$687.71	$0.00	"$1,626.89"	"$1,626.89"	$0.00	"$1,649.99"	"$2,613.58"	"$2,639.98"	$0.00		$0.00	$599.36	$0.00	$0.00	$525.36	$0.00	$0.00	$0.00	$0.00	$0.00
450.704S	SUP	HCPCS C1713		450.704S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 28CM SOLID EXPERT AQUA	BOTH IP/OP	"$3,324.75 "	"$2,460.32"	$0.00	"$2,659.80"	"$1,496.14"	"$1,496.14"	$0.00	$0.00	$0.00	$692.96	"$2,467.63"	"$2,467.63"	$0.00	$0.00	$692.88	$0.00	"$1,639.10"	"$1,639.10"	$0.00	"$1,662.38"	"$2,633.20"	"$2,659.80"	$0.00		$0.00	$520.32	$0.00	$0.00	$529.30	$0.00	$0.00	$0.00	$0.00	$0.00
450.705S	SUP	HCPCS C1713		450.705S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 30CM SOLID EXPERT AQUA	BOTH IP/OP	"$3,299.98 "	"$2,441.99"	$0.00	"$2,639.98"	"$1,484.99"	"$1,484.99"	$0.00	$0.00	$0.00	$687.80	"$2,449.24"	"$2,449.24"	$0.00	$0.00	$687.71	$0.00	"$1,626.89"	"$1,626.89"	$0.00	"$1,649.99"	"$2,613.58"	"$2,639.98"	$0.00		$0.00	$599.36	$0.00	$0.00	$525.36	$0.00	$0.00	$0.00	$0.00	$0.00
450.706S	SUP	HCPCS C1713		450.706S  -  NAIL 9MM 32CM DISTAL FEM IM SLD TI STRL	BOTH IP/OP	"$3,829.78 "	"$2,834.04"	$0.00	"$3,063.82"	"$1,723.40"	"$1,723.40"	$0.00	$0.00	$0.00	$798.22	"$2,842.46"	"$2,842.46"	$0.00	$0.00	$798.13	$0.00	"$1,888.08"	"$1,888.08"	$0.00	"$1,914.89"	"$3,033.19"	"$3,063.82"	$0.00		$0.00	$599.36	$0.00	$0.00	$609.70	$0.00	$0.00	$0.00	$0.00	$0.00
450.707S	SUP	HCPCS C1713		450.707S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 34CM SOLID EXPERT AQUA	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.708S	SUP	HCPCS C1713		450.708S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 360MM SOLID ROUND BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$506.12	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.709S	SUP	HCPCS C1713		450.709S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 380MM SOLID ROUND BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.710S	SUP	HCPCS C1713		450.710S  -  NAIL 9MM 40CM DISTAL FEM IM SLD TI STRL AQ	BOTH IP/OP	"$3,829.78 "	"$2,834.04"	$0.00	"$3,063.82"	"$1,723.40"	"$1,723.40"	$0.00	$0.00	$0.00	$798.22	"$2,842.46"	"$2,842.46"	$0.00	$0.00	$798.13	$0.00	"$1,888.08"	"$1,888.08"	$0.00	"$1,914.89"	"$3,033.19"	"$3,063.82"	$0.00		$0.00	$599.36	$0.00	$0.00	$609.70	$0.00	$0.00	$0.00	$0.00	$0.00
450.711S	SUP	HCPCS C1713		450.711S  -  NAIL INTRAMEDULLARY 9MM 42CM SOLID AQUA TITANIUM FEMUR	BOTH IP/OP	"$3,324.75 "	"$2,460.32"	$0.00	"$2,659.80"	"$1,496.14"	"$1,496.14"	$0.00	$0.00	$0.00	$692.96	"$2,467.63"	"$2,467.63"	$0.00	$0.00	$692.88	$0.00	"$1,639.10"	"$1,639.10"	$0.00	"$1,662.38"	"$2,633.20"	"$2,659.80"	$0.00		$0.00	$520.32	$0.00	$0.00	$529.30	$0.00	$0.00	$0.00	$0.00	$0.00
450.712S	SUP	HCPCS C1713		450.712S  -  NAIL INTRAMEDULLARY 9MM 44CM SOLID AQUA TITANIUM FEMUR	BOTH IP/OP	"$3,299.98 "	"$2,441.99"	$0.00	"$2,639.98"	"$1,484.99"	"$1,484.99"	$0.00	$0.00	$0.00	$687.80	"$2,449.24"	"$2,449.24"	$0.00	$0.00	$687.71	$0.00	"$1,626.89"	"$1,626.89"	$0.00	"$1,649.99"	"$2,613.58"	"$2,639.98"	$0.00		$0.00	$599.36	$0.00	$0.00	$525.36	$0.00	$0.00	$0.00	$0.00	$0.00
450.713S	SUP	HCPCS C1713		450.713S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 460MM SOLID ROUND BARREL	BOTH IP/OP	"$3,324.75 "	"$2,460.32"	$0.00	"$2,659.80"	"$1,496.14"	"$1,496.14"	$0.00	$0.00	$0.00	$692.96	"$2,467.63"	"$2,467.63"	$0.00	$0.00	$692.88	$0.00	"$1,639.10"	"$1,639.10"	$0.00	"$1,662.38"	"$2,633.20"	"$2,659.80"	$0.00		$0.00	$520.32	$0.00	$0.00	$529.30	$0.00	$0.00	$0.00	$0.00	$0.00
450.714S	SUP	HCPCS C1713		450.714S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 180MM SOLID ROUND BARREL	BOTH IP/OP	"$3,324.75 "	"$2,460.32"	$0.00	"$2,659.80"	"$1,496.14"	"$1,496.14"	$0.00	$0.00	$0.00	$692.96	"$2,467.63"	"$2,467.63"	$0.00	$0.00	$692.88	$0.00	"$1,639.10"	"$1,639.10"	$0.00	"$1,662.38"	"$2,633.20"	"$2,659.80"	$0.00		$0.00	$520.32	$0.00	$0.00	$529.30	$0.00	$0.00	$0.00	$0.00	$0.00
450.715S	SUP	HCPCS C1713		450.715S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 220MM SOLID ROUND BARREL	BOTH IP/OP	"$3,324.75 "	"$2,460.32"	$0.00	"$2,659.80"	"$1,496.14"	"$1,496.14"	$0.00	$0.00	$0.00	$692.96	"$2,467.63"	"$2,467.63"	$0.00	$0.00	$692.88	$0.00	"$1,639.10"	"$1,639.10"	$0.00	"$1,662.38"	"$2,633.20"	"$2,659.80"	$0.00		$0.00	$520.32	$0.00	$0.00	$529.30	$0.00	$0.00	$0.00	$0.00	$0.00
450.716S	SUP	HCPCS C1713		450.716S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 260MM SOLID ROUND BARREL	BOTH IP/OP	"$3,324.75 "	"$2,460.32"	$0.00	"$2,659.80"	"$1,496.14"	"$1,496.14"	$0.00	$0.00	$0.00	$692.96	"$2,467.63"	"$2,467.63"	$0.00	$0.00	$692.88	$0.00	"$1,639.10"	"$1,639.10"	$0.00	"$1,662.38"	"$2,633.20"	"$2,659.80"	$0.00		$0.00	$520.32	$0.00	$0.00	$529.30	$0.00	$0.00	$0.00	$0.00	$0.00
450.781S	SUP	HCPCS C1713		450.781S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 160MM CANN ROUND BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.782S	SUP	HCPCS C1713		450.782S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 200MM CANN ROUND BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.783S	SUP	HCPCS C1713		450.783S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 240MM CANN ROUND BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.784S	SUP	HCPCS C1713		450.784S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 280MM CANN ROUND BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.785S	SUP	HCPCS C1713		450.785S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM CANN ROUND BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.786S	SUP	HCPCS C1713		450.786S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM CANN ROUND BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.787S	SUP	HCPCS C1713		450.787S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 340MM CANN ROUND BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.788S	SUP	HCPCS C1713		450.788S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.789S	SUP	HCPCS C1713		450.789S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM CANN ROUND BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.790S	SUP	HCPCS C1713		450.790S  -  NAIL 10MM 40CM DISTAL FEM IM CANN TI STRL AQ	BOTH IP/OP	"$3,829.78 "	"$2,834.04"	$0.00	"$3,063.82"	"$1,723.40"	"$1,723.40"	$0.00	$0.00	$0.00	$798.22	"$2,842.46"	"$2,842.46"	$0.00	$0.00	$798.13	$0.00	"$1,888.08"	"$1,888.08"	$0.00	"$1,914.89"	"$3,033.19"	"$3,063.82"	$0.00		$0.00	$599.36	$0.00	$0.00	$609.70	$0.00	$0.00	$0.00	$0.00	$0.00
450.791S	SUP	HCPCS C1713		450.791S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN ROUND BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.792S	SUP	HCPCS C1713		450.792S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 440MM CANN ROUND BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.793S	SUP	HCPCS C1713		450.793S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 460MM CANN ROUND BARREL	BOTH IP/OP	"$3,324.75 "	"$2,460.32"	$0.00	"$2,659.80"	"$1,496.14"	"$1,496.14"	$0.00	$0.00	$0.00	$692.96	"$2,467.63"	"$2,467.63"	$0.00	$0.00	$692.88	$0.00	"$1,639.10"	"$1,639.10"	$0.00	"$1,662.38"	"$2,633.20"	"$2,659.80"	$0.00		$0.00	$520.32	$0.00	$0.00	$529.30	$0.00	$0.00	$0.00	$0.00	$0.00
450.794S	SUP	HCPCS C1713		450.794S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 180MM CANN ROUND BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.795S	SUP	HCPCS C1713		450.795S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 220MM CANN ROUND BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.796S	SUP	HCPCS C1713		450.796S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 260MM CANN ROUND BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.801S	SUP	HCPCS C1713		450.801S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 160MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.802S	SUP	HCPCS C1713		450.802S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 200MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.803S	SUP	HCPCS C1713		450.803S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 240MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.804S	SUP	HCPCS C1713		450.804S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 280MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.805S	SUP	HCPCS C1713		450.805S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.806S	SUP	HCPCS C1713		450.806S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 320MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.807S	SUP	HCPCS C1713		450.807S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.808S	SUP	HCPCS C1713		450.808S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.809S	SUP	HCPCS C1713		450.809S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.810S	SUP	HCPCS C1713		450.810S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 400MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.811S	SUP	HCPCS C1713		450.811S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.812S	SUP	HCPCS C1713		450.812S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.813S	SUP	HCPCS C1713		450.813S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 460MM CANN FLUTED BARREL	BOTH IP/OP	"$3,324.75 "	"$2,460.32"	$0.00	"$2,659.80"	"$1,496.14"	"$1,496.14"	$0.00	$0.00	$0.00	$692.96	"$2,467.63"	"$2,467.63"	$0.00	$0.00	$692.88	$0.00	"$1,639.10"	"$1,639.10"	$0.00	"$1,662.38"	"$2,633.20"	"$2,659.80"	$0.00		$0.00	$520.32	$0.00	$0.00	$529.30	$0.00	$0.00	$0.00	$0.00	$0.00
450.814S	SUP	HCPCS C1713		450.814S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 180MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.815S	SUP	HCPCS C1713		450.815S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 220MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.816S	SUP	HCPCS C1713		450.816S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 260MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.821S	SUP	HCPCS C1713		450.821S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 160MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.822S	SUP	HCPCS C1713		450.822S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 200MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.823S	SUP	HCPCS C1713		450.823S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 240MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.824S	SUP	HCPCS C1713		450.824S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 280MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.825S	SUP	HCPCS C1713		450.825S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 30CM CANN EXPERT AQUA	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.826S	SUP	HCPCS C1713		450.826S  -  NAIL 12MM 32CM DISTAL FEM IM CANN TI STRL AQ	BOTH IP/OP	"$3,829.78 "	"$2,834.04"	$0.00	"$3,063.82"	"$1,723.40"	"$1,723.40"	$0.00	$0.00	$0.00	$798.22	"$2,842.46"	"$2,842.46"	$0.00	$0.00	$798.13	$0.00	"$1,888.08"	"$1,888.08"	$0.00	"$1,914.89"	"$3,033.19"	"$3,063.82"	$0.00		$0.00	$599.36	$0.00	$0.00	$609.70	$0.00	$0.00	$0.00	$0.00	$0.00
450.827S	SUP	HCPCS C1713		450.827S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 340MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.828S	SUP	HCPCS C1713		450.828S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.829S	SUP	HCPCS C1713		450.829S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.830S	SUP	HCPCS C1713		450.830S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 400MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.831S	SUP	HCPCS C1713		450.831S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.832S	SUP	HCPCS C1713		450.832S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 440MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.833S	SUP	HCPCS C1713		450.833S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 460MM CANN FLUTED BARREL	BOTH IP/OP	"$3,324.75 "	"$2,460.32"	$0.00	"$2,659.80"	"$1,496.14"	"$1,496.14"	$0.00	$0.00	$0.00	$692.96	"$2,467.63"	"$2,467.63"	$0.00	$0.00	$692.88	$0.00	"$1,639.10"	"$1,639.10"	$0.00	"$1,662.38"	"$2,633.20"	"$2,659.80"	$0.00		$0.00	$520.32	$0.00	$0.00	$529.30	$0.00	$0.00	$0.00	$0.00	$0.00
450.834S	SUP	HCPCS C1713		450.834S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 180MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.835S	SUP	HCPCS C1713		450.835S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 220MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.836S	SUP	HCPCS C1713		450.836S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 260MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.841S	SUP	HCPCS C1713		450.841S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 160MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.842S	SUP	HCPCS C1713		450.842S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 200MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.843S	SUP	HCPCS C1713		450.843S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 240MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.844S	SUP	HCPCS C1713		450.844S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 280MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.845S	SUP	HCPCS C1713		450.845S  -  NAIL 13MM 30CM DISTAL FEM IM CANN TI STRL AQ	BOTH IP/OP	"$3,829.78 "	"$2,834.04"	$0.00	"$3,063.82"	"$1,723.40"	"$1,723.40"	$0.00	$0.00	$0.00	$798.22	"$2,842.46"	"$2,842.46"	$0.00	$0.00	$798.13	$0.00	"$1,888.08"	"$1,888.08"	$0.00	"$1,914.89"	"$3,033.19"	"$3,063.82"	$0.00		$0.00	$599.36	$0.00	$0.00	$609.70	$0.00	$0.00	$0.00	$0.00	$0.00
450.846S	SUP	HCPCS C1713		450.846S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.847S	SUP	HCPCS C1713		450.847S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 340MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.848S	SUP	HCPCS C1713		450.848S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.849S	SUP	HCPCS C1713		450.849S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 380MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.850S	SUP	HCPCS C1713		450.850S  -  NAIL 13MM 40CM DISTAL FEM IM CANN TI STRL AQ	BOTH IP/OP	"$3,829.78 "	"$2,834.04"	$0.00	"$3,063.82"	"$1,723.40"	"$1,723.40"	$0.00	$0.00	$0.00	$798.22	"$2,842.46"	"$2,842.46"	$0.00	$0.00	$798.13	$0.00	"$1,888.08"	"$1,888.08"	$0.00	"$1,914.89"	"$3,033.19"	"$3,063.82"	$0.00		$0.00	$599.36	$0.00	$0.00	$609.70	$0.00	$0.00	$0.00	$0.00	$0.00
450.851S	SUP	HCPCS C1713		450.851S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 420MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$599.36	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.852S	SUP	HCPCS C1713		450.852S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 440MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.853S	SUP	HCPCS C1713		450.853S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 460MM CANN FLUTED BARREL	BOTH IP/OP	"$3,324.75 "	"$2,460.32"	$0.00	"$2,659.80"	"$1,496.14"	"$1,496.14"	$0.00	$0.00	$0.00	$692.96	"$2,467.63"	"$2,467.63"	$0.00	$0.00	$692.88	$0.00	"$1,639.10"	"$1,639.10"	$0.00	"$1,662.38"	"$2,633.20"	"$2,659.80"	$0.00		$0.00	$520.32	$0.00	$0.00	$529.30	$0.00	$0.00	$0.00	$0.00	$0.00
450.854S	SUP	HCPCS C1713		450.854S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 180MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.855S	SUP	HCPCS C1713		450.855S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 220MM CANN FLUTED BARREL	BOTH IP/OP	"$3,209.90 "	"$2,375.33"	$0.00	"$2,567.92"	"$1,444.46"	"$1,444.46"	$0.00	$0.00	$0.00	$669.02	"$2,382.39"	"$2,382.39"	$0.00	$0.00	$668.94	$0.00	"$1,582.48"	"$1,582.48"	$0.00	"$1,604.95"	"$2,542.24"	"$2,567.92"	$0.00		$0.00	$506.12	$0.00	$0.00	$511.02	$0.00	$0.00	$0.00	$0.00	$0.00
450.856S	SUP	HCPCS C1713		450.856S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 260MM CANN FLUTED BARREL	BOTH IP/OP	"$3,234.00 "	"$2,393.16"	$0.00	"$2,587.20"	"$1,455.30"	"$1,455.30"	$0.00	$0.00	$0.00	$674.05	"$2,400.27"	"$2,400.27"	$0.00	$0.00	$673.97	$0.00	"$1,594.36"	"$1,594.36"	$0.00	"$1,617.00"	"$2,561.33"	"$2,587.20"	$0.00		$0.00	$506.12	$0.00	$0.00	$514.85	$0.00	$0.00	$0.00	$0.00	$0.00
450.896S	SUP	Custom 27803010		450.896S  -  CAP END DISTAL FEM IM NAIL TI STRL AQ	BOTH IP/OP	$518.33 	$383.56	$0.00	$414.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$384.70	$384.70	$0.00	$0.00	$108.02	$0.00	$0.00	$0.00	$0.00	$259.16	$410.52	$414.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-0010	SUP	Custom 27203010		REAGENT BLOOD LEAD METEXCHANGE KT ANALY	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-0032	SUP	Custom 27203010		REAGENT NA CHLOR SOL CHM	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-0058	SUP	Custom 27203010		REAGENT PLT SOL LEAD POISONING ANALY	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
450120-20	SUP	Custom 27203010		CONTROL PRTN IMG VGL LVL 1 5ML IMMUN	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
450125-20	SUP	Custom 27203010		CONTROL PRTN IMG VGL LVL 2 5ML IMMUN	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
450-1329	SUP	HCPCS L8699		450-1329  -  PROSTHESIS TESTICULAR 4.9X2.9CM INFUS LINE NEEDLE LARGE	BOTH IP/OP	"$4,622.50 "	"$3,420.65"	$0.00	"$3,698.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,430.82"	"$3,430.82"	$0.00	$0.00	$963.33	$0.00	$0.00	$0.00	$0.00	"$2,311.25"	"$3,661.02"	"$3,698.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
450162-20	SUP	Custom 27203010		CONTROL ASO CRP RF VIGIL LVL 1 5ML SERO	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$412.50	$653.40	$660.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
450163-20	SUP	Custom 27203010		CONTROL ASO CRP RF VIGIL LVL 2 5ML SERO	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$412.50	$653.40	$660.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
450164-20	SUP	Custom 27203010		VIGIL SEROLOGY ASO/CRP/RHF CNTRL LEVEL 3	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$412.50	$653.40	$660.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-018-E2S	SUP	Custom 27203010		45-018-E2S  -  CATHETER INFS 2 2/3FR 45CM CLARIVEIN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-0225	SUP	Custom 27203010		CALIBRATOR CHM 68 TST LOW BLOOD METEXCHANGE SA	BOTH IP/OP	$717.50 	$530.95	$0.00	$574.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$358.75	$568.26	$574.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-0230	SUP	Custom 27203010		CALIBRATOR CHM 68 TST HI BLOOD METEXCHANGE SA	BOTH IP/OP	$717.50 	$530.95	$0.00	$574.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$358.75	$568.26	$574.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-0250A	SUP	Custom 27203010		CONTROL LINEAR VRF KT TOX	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.00	$332.64	$336.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
450-4251-1	SUP	Custom 27803010		450-4251-1  -  CLAMP SURG HALIFAX SPNL THRD C1	BOTH IP/OP	$483.00 	$357.42	$0.00	$386.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$358.48	$358.48	$0.00	$0.00	$100.66	$0.00	$0.00	$0.00	$0.00	$241.50	$382.54	$386.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
450-4253-1	SUP	Custom 27803010		450-4253-1  -  CLAMP SURG HALIFAX 7MM SPNL THRD	BOTH IP/OP	$483.00 	$357.42	$0.00	$386.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$358.48	$358.48	$0.00	$0.00	$100.66	$0.00	$0.00	$0.00	$0.00	$241.50	$382.54	$386.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
451514H0	SUP	HCPCS C1725		451514H0  -  CATHETER ANGIO VERT CRV 5FR .042IN 100CM CRDS TMP RADOPQ BRD	BOTH IP/OP	$44.85 	$33.19	$0.00	$35.88	$24.35	$24.35	$0.00	$0.00	$0.00	$9.35	$33.29	$33.29	$0.00	$0.00	$9.35	$0.00	$26.53	$26.53	$0.00	$22.43	$35.52	$35.88	$0.00		$0.00	$7.02	$0.00	$0.00	$7.14	$0.00	$0.00	$0.00	$0.00	$0.00
45-20005	SUP	Custom 27203010		45-20005  -  BIT DRILL 1.7MM ASNS MIC AO CPLNG CANN STRL DISP	BOTH IP/OP	$336.75 	$249.20	$0.00	$249.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.94	$249.94	$0.00	$0.00	$70.18	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-20006	SUP	Custom 27803010		45-20006  -  TAP 2MM MIC CANN AO CPLNG SURG ASNS DISP	BOTH IP/OP	$333.00 	$246.42	$0.00	$247.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.15	$247.15	$0.00	$0.00	$69.40	$0.00	$0.00	$0.00	$0.00	$77.00	$121.97	$123.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-20007	SUP	Custom 27203010		45-20007  -  CNTRSNK DRILL 2MM ASNS MIC CANN AO CPLNG DISP	BOTH IP/OP	$419.90 	$310.73	$0.00	$350.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.65	$311.65	$0.00	$0.00	$87.51	$0.00	$0.00	$0.00	$0.00	$219.31	$347.39	$350.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-20008	SUP	Custom 27203010		45-20008  -  SLEEVE DRILL ASNS MIC HLD 2MM SCR	BOTH IP/OP	$273.63 	$202.49	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$203.08	$203.08	$0.00	$0.00	$57.02	$0.00	$0.00	$0.00	$0.00	$136.81	$216.71	$218.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-20009	SUP	Custom 27203010		45-20009  -  GUIDE DRILL .8MM 1.7MM ASNS MIC DBL	BOTH IP/OP	$672.38 	$497.56	$0.00	$537.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$499.04	$499.04	$0.00	$0.00	$140.12	$0.00	$0.00	$0.00	$0.00	$336.19	$532.52	$537.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-20011	SUP	Custom 27203010		45-20011  -  BIT DRILL 1.7MM ASNS 2MM AO CPLNG SLD NONSTRL	BOTH IP/OP	$121.55 	$89.95	$0.00	$100.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.21	$90.21	$0.00	$0.00	$25.33	$0.00	$0.00	$0.00	$0.00	$62.56	$99.10	$100.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-20014	SUP	Custom 27203010		45-20014  -  STYLET SURG INSTR .8MM ASNS CLEAN	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-20015	SUP	HCPCS C1713		45-20015  -  WIRE FX .8MM 100MM NS KRSH DISP 2MM ASNS MIC SCR	BOTH IP/OP	$68.75 	$50.88	$0.00	$51.03	$16.09	$16.09	$0.00	$0.00	$0.00	$14.33	$51.03	$51.03	$0.00	$0.00	$14.33	$0.00	$40.67	$40.67	$0.00	$17.88	$28.31	$28.60	$0.00		$0.00	$5.59	$0.00	$0.00	$5.69	$0.00	$0.00	$0.00	$0.00	$0.00
45-27005	SUP	Custom 27803010		45-27005  -  TAP 50MM SURG 2.7MM SCR	BOTH IP/OP	$159.75 	$118.22	$0.00	$125.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.57	$118.57	$0.00	$0.00	$33.29	$0.00	$0.00	$0.00	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-27010	SUP	Custom 27203010		45-27010  -  DRILL TWST 102MM 2MM VARIAX AO SHFT END 50MM NONSTRL	BOTH IP/OP	$159.75 	$118.22	$0.00	$125.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.57	$118.57	$0.00	$0.00	$33.29	$0.00	$0.00	$0.00	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-30005	SUP	Custom 27203010		45-30005  -  DRILL SRG MIC 2.1MM STRL AO CPLNG CNN HND FT DISP 3MM ASNS	BOTH IP/OP	$416.50 	$308.21	$0.00	$347.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$309.13	$309.13	$0.00	$0.00	$86.80	$0.00	$0.00	$0.00	$0.00	$217.25	$344.12	$347.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-30006	SUP	Custom 27803010		45-30006  -  TAP 3MM MIC CANN AO CPLNG SURG ASNS DISP	BOTH IP/OP	$319.50 	$236.43	$0.00	$237.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$237.13	$237.13	$0.00	$0.00	$66.58	$0.00	$0.00	$0.00	$0.00	$80.44	$127.42	$128.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-30007	SUP	Custom 27203010		45-30007  -  CNTRSNK DRILL 3MM AO CPLNG CANN DISP	BOTH IP/OP	$391.00 	$289.34	$0.00	$324.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.20	$290.20	$0.00	$0.00	$81.48	$0.00	$0.00	$0.00	$0.00	$202.81	$321.26	$324.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-30008	SUP	Custom 27203010		45-30008  -  SLEEVE DRILL ASNS MIC HLD 3MM SCR	BOTH IP/OP	$270.88 	$200.45	$0.00	$216.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.04	$201.04	$0.00	$0.00	$56.45	$0.00	$0.00	$0.00	$0.00	$135.44	$214.54	$216.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-30009	SUP	Custom 27203010		45-30009  -  GUIDE DRILL 1.2MM 2.1MM ASNS DBL	BOTH IP/OP	$334.13 	$247.26	$0.00	$267.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.99	$247.99	$0.00	$0.00	$69.63	$0.00	$0.00	$0.00	$0.00	$167.06	$264.63	$267.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-30011	SUP	Custom 27203010		45-30011  -  BIT DRILL 2.1MM ASNS MIC SLD AO CPLNG NONSTRL	BOTH IP/OP	$123.25 	$91.21	$0.00	$102.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.48	$91.48	$0.00	$0.00	$25.69	$0.00	$0.00	$0.00	$0.00	$63.94	$101.28	$102.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-30014	SUP	Custom 27203010		45-30014  -  STYLET SURG INSTR 1.2MM ASNS CLEAN	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-30015	SUP	HCPCS C1713		45-30015  -  WIRE FX 1.2MM 100MM NS KRSH 3MM ASNS MIC SCR	BOTH IP/OP	$68.75 	$50.88	$0.00	$51.03	$17.94	$17.94	$0.00	$0.00	$0.00	$14.33	$51.03	$51.03	$0.00	$0.00	$14.33	$0.00	$40.67	$40.67	$0.00	$19.94	$31.58	$31.90	$0.00		$0.00	$6.24	$0.00	$0.00	$6.35	$0.00	$0.00	$0.00	$0.00	$0.00
45-35001	SUP	Custom 27203010		45-35001  -  GAUGE DEPTH MSR 3.5 MM SCR	BOTH IP/OP	$760.38 	$562.68	$0.00	$608.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$564.35	$564.35	$0.00	$0.00	$158.46	$0.00	$0.00	$0.00	$0.00	$380.19	$602.22	$608.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-35005	SUP	Custom 27803010		45-35005  -  TAP 70MM SURG 3.5MM SCR	BOTH IP/OP	$188.25 	$139.31	$0.00	$148.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.72	$139.72	$0.00	$0.00	$39.23	$0.00	$0.00	$0.00	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-35010	SUP	Custom 27203010		45-35010  -  DRILL TWST 122MM 2.6MM VARIAX AO SHFT END 70MM NONSTRL	BOTH IP/OP	$188.25 	$139.31	$0.00	$148.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.72	$139.72	$0.00	$0.00	$39.23	$0.00	$0.00	$0.00	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-35015	SUP	Custom 27203010		45-35015  -  BLADE AO FIT ASNS SCRDRVR T10	BOTH IP/OP	$297.00 	$219.78	$0.00	$237.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.43	$220.43	$0.00	$0.00	$61.89	$0.00	$0.00	$0.00	$0.00	$148.50	$235.22	$237.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-35030	SUP	Custom 27203010		45-35030  -  SLEEVE DRILL ASNS MIC HLD INSTR 3.5MM SCR	BOTH IP/OP	$664.13 	$491.46	$0.00	$531.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$492.91	$492.91	$0.00	$0.00	$138.40	$0.00	$0.00	$0.00	$0.00	$332.06	$525.99	$531.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.010S	SUP	HCPCS C1713		456.010S  -  SLEEVE LCK 100D 15MM LGHT BLU STRL TI FEM 9-12MM IM NL SPRL	BOTH IP/OP	$756.25 	$559.63	$0.00	$605.00	$340.31	$340.31	$0.00	$0.00	$0.00	$157.62	$561.29	$561.29	$0.00	$0.00	$157.60	$0.00	$447.32	$447.32	$0.00	$378.13	$598.95	$605.00	$0.00		$0.00	$118.35	$0.00	$0.00	$120.40	$0.00	$0.00	$0.00	$0.00	$0.00
456.011S	SUP	HCPCS C1713		456.011S  -  SLEEVE LOCKING 110D 15MM LIGHT BLUE TITANIUM FEMUR STERILE	BOTH IP/OP	$756.25 	$559.63	$0.00	$605.00	$340.31	$340.31	$0.00	$0.00	$0.00	$157.62	$561.29	$561.29	$0.00	$0.00	$157.60	$0.00	$447.32	$447.32	$0.00	$378.13	$598.95	$605.00	$0.00		$0.00	$118.35	$0.00	$0.00	$120.40	$0.00	$0.00	$0.00	$0.00	$0.00
456.012S	SUP	HCPCS C1713		456.012S  -  SLEEVE LCK 120D 15MM LGHT BLU STRL TI FEM 9-12MM IM NL SPRL	BOTH IP/OP	$756.25 	$559.63	$0.00	$605.00	$340.31	$340.31	$0.00	$0.00	$0.00	$157.62	$561.29	$561.29	$0.00	$0.00	$157.60	$0.00	$447.32	$447.32	$0.00	$378.13	$598.95	$605.00	$0.00		$0.00	$118.35	$0.00	$0.00	$120.40	$0.00	$0.00	$0.00	$0.00	$0.00
456.013S	SUP	HCPCS C1713		456.013S  -  SLEEVE LOCKING 130D 15MM PINK TITANIUM FEMUR STERILE SPIRAL	BOTH IP/OP	$756.25 	$559.63	$0.00	$605.00	$340.31	$340.31	$0.00	$0.00	$0.00	$157.62	$561.29	$561.29	$0.00	$0.00	$157.60	$0.00	$447.32	$447.32	$0.00	$378.13	$598.95	$605.00	$0.00		$0.00	$118.35	$0.00	$0.00	$120.40	$0.00	$0.00	$0.00	$0.00	$0.00
456.100S	SUP	Custom 27803010		456.100S  -  BLADE FIX 100MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY	BOTH IP/OP	"$1,326.88 "	$981.89	$0.00	"$1,061.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.81	$984.81	$0.00	$0.00	$276.52	$0.00	$0.00	$0.00	$0.00	$663.44	"$1,050.89"	"$1,061.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.105S	SUP	Custom 27803010		456.105S  -  BLADE FIX 105MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY	BOTH IP/OP	"$1,326.88 "	$981.89	$0.00	"$1,061.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.81	$984.81	$0.00	$0.00	$276.52	$0.00	$0.00	$0.00	$0.00	$663.44	"$1,050.89"	"$1,061.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.110S	SUP	Custom 27803010		456.110S  -  BLADE FIX 110MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY	BOTH IP/OP	"$1,326.88 "	$981.89	$0.00	"$1,061.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.81	$984.81	$0.00	$0.00	$276.52	$0.00	$0.00	$0.00	$0.00	$663.44	"$1,050.89"	"$1,061.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.115S	SUP	Custom 27803010		456.115S  -  BLADE FIX 115MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY	BOTH IP/OP	"$1,326.88 "	$981.89	$0.00	"$1,061.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.81	$984.81	$0.00	$0.00	$276.52	$0.00	$0.00	$0.00	$0.00	$663.44	"$1,050.89"	"$1,061.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.120S	SUP	Custom 27803010		456.120S  -  BLADE FIX 120MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY	BOTH IP/OP	"$1,326.88 "	$981.89	$0.00	"$1,061.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.81	$984.81	$0.00	$0.00	$276.52	$0.00	$0.00	$0.00	$0.00	$663.44	"$1,050.89"	"$1,061.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.300S	SUP	Custom 27803010		456.300S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 75MM HELICAL GOLD	BOTH IP/OP	"$1,257.43 "	$930.50	$0.00	$976.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.26	$933.26	$0.00	$0.00	$262.05	$0.00	$0.00	$0.00	$0.00	$610.40	$966.87	$976.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.301S	SUP	Custom 27803010		456.301S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 80MM GOLD TITANIUM	BOTH IP/OP	"$1,257.43 "	$930.50	$0.00	$976.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.26	$933.26	$0.00	$0.00	$262.05	$0.00	$0.00	$0.00	$0.00	$610.40	$966.87	$976.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.302S	SUP	Custom 27803010		456.302S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 85MM CANN GOLD TITANIUM	BOTH IP/OP	"$1,257.43 "	$930.50	$0.00	$976.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.26	$933.26	$0.00	$0.00	$262.05	$0.00	$0.00	$0.00	$0.00	$610.40	$966.87	$976.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.303S	SUP	Custom 27803010		456.303S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 90MM GOLD TITANIUM	BOTH IP/OP	"$1,257.43 "	$930.50	$0.00	$976.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.26	$933.26	$0.00	$0.00	$262.05	$0.00	$0.00	$0.00	$0.00	$610.40	$966.87	$976.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.304S	SUP	Custom 27803010		456.304S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 95MM GOLD TITANIUM	BOTH IP/OP	"$1,257.43 "	$930.50	$0.00	$976.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.26	$933.26	$0.00	$0.00	$262.05	$0.00	$0.00	$0.00	$0.00	$610.40	$966.87	$976.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.305S	SUP	Custom 27803010		456.305S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 100MM GOLD TITANIUM	BOTH IP/OP	"$1,257.43 "	$930.50	$0.00	$976.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.26	$933.26	$0.00	$0.00	$262.05	$0.00	$0.00	$0.00	$0.00	$610.40	$966.87	$976.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.306S	SUP	HCPCS C1713		456.306S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 105MM CANN GOLD TITANIUM	BOTH IP/OP	"$1,257.43 "	$930.50	$0.00	$976.64	$549.36	$549.36	$0.00	$0.00	$0.00	$262.08	$933.26	$933.26	$0.00	$0.00	$262.05	$0.00	$743.77	$743.77	$0.00	$610.40	$966.87	$976.64	$0.00		$0.00	$185.49	$0.00	$0.00	$194.35	$0.00	$0.00	$0.00	$0.00	$0.00
456.307S	SUP	Custom 27803010		456.307S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 110MM CANN GOLD TITANIUM	BOTH IP/OP	"$1,257.43 "	$930.50	$0.00	$976.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.26	$933.26	$0.00	$0.00	$262.05	$0.00	$0.00	$0.00	$0.00	$610.40	$966.87	$976.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.308S	SUP	Custom 27803010		456.308S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 115MM GOLD TITANIUM	BOTH IP/OP	"$1,257.43 "	$930.50	$0.00	$976.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.26	$933.26	$0.00	$0.00	$262.05	$0.00	$0.00	$0.00	$0.00	$610.40	$966.87	$976.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.309S	SUP	Custom 27803010		456.309S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 120MM GOLD TITANIUM	BOTH IP/OP	"$1,257.43 "	$930.50	$0.00	$976.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.26	$933.26	$0.00	$0.00	$262.05	$0.00	$0.00	$0.00	$0.00	$610.40	$966.87	$976.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.310S	SUP	Custom 27803010		456.310S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 125MM HELICAL GOLD	BOTH IP/OP	"$1,257.43 "	$930.50	$0.00	$976.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.26	$933.26	$0.00	$0.00	$262.05	$0.00	$0.00	$0.00	$0.00	$610.40	$966.87	$976.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.311S	SUP	Custom 27803010		456.311S  -  CAP END 0MM GREEN TITANIUM STERILE	BOTH IP/OP	$404.08 	$299.02	$0.00	$313.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$299.90	$299.90	$0.00	$0.00	$84.21	$0.00	$0.00	$0.00	$0.00	$196.15	$310.70	$313.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.312S	SUP	Custom 27803010		456.312S  -  CAP END 5MM EXTEND GREEN TITANIUM TROC STERILE	BOTH IP/OP	$404.08 	$299.02	$0.00	$313.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$299.90	$299.90	$0.00	$0.00	$84.21	$0.00	$0.00	$0.00	$0.00	$196.15	$310.70	$313.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.313S	SUP	Custom 27803010		456.313S  -  CAP END 10MM EXTEND GREEN TITANIUM TROC STERILE CANN	BOTH IP/OP	$404.08 	$299.02	$0.00	$313.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$299.90	$299.90	$0.00	$0.00	$84.21	$0.00	$0.00	$0.00	$0.00	$196.15	$310.70	$313.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.314S	SUP	HCPCS C1713		456.314S  -  NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 10MM 170MM CANN	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.315S	SUP	HCPCS C1713		456.315S  -  NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 10MM 170MM CANN	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$497.96	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.316S	SUP	HCPCS C1713		456.316S  -  NAIL FIX 135D 10MM 17CM CANN GREEN TITANIUM TROCHANTER	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.317S	SUP	HCPCS C1713		456.317S  -  NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 11MM 170MM CANN	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.318S	SUP	HCPCS C1713		456.318S  -  NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 11MM 170MM CANN	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.319S	SUP	HCPCS C1713		456.319S  -  NAIL INTRAMEDULLARY 135D SHORT UNIVERSAL 11MM 170MM CANN	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.321S	SUP	HCPCS C1713		456.321S  -  NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 12MM 170MM CANN	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.322S	SUP	HCPCS C1713		456.322S  -  NAIL INTRAMEDULLARY 130D SHORT 12MM 170MM CANN STATIC INTLCK	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.323S	SUP	HCPCS C1713		456.323S  -  NAIL FIX 135D SHORT 12MM 170MM CANN STATIC INTLCK GREEN	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.324S	SUP	HCPCS C1713		456.324S  -  NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 10MM 235MM CANN	BOTH IP/OP	"$2,719.08 "	"$2,012.12"	$0.00	"$2,111.92"	"$1,187.96"	"$1,187.96"	$0.00	$0.00	$0.00	$566.72	"$2,018.10"	"$2,018.10"	$0.00	$0.00	$566.66	$0.00	"$1,340.50"	"$1,340.50"	$0.00	"$1,319.95"	"$2,090.80"	"$2,111.92"	$0.00		$0.00	$401.11	$0.00	$0.00	$420.27	$0.00	$0.00	$0.00	$0.00	$0.00
456.325S	SUP	HCPCS C1713		456.325S  -  NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 10MM 235MM CANN	BOTH IP/OP	"$2,719.08 "	"$2,012.12"	$0.00	"$2,111.92"	"$1,187.96"	"$1,187.96"	$0.00	$0.00	$0.00	$566.72	"$2,018.10"	"$2,018.10"	$0.00	$0.00	$566.66	$0.00	"$1,340.50"	"$1,340.50"	$0.00	"$1,319.95"	"$2,090.80"	"$2,111.92"	$0.00		$0.00	$401.11	$0.00	$0.00	$420.27	$0.00	$0.00	$0.00	$0.00	$0.00
456.326S	SUP	HCPCS C1713		456.326S  -  NAIL FIX 135D SHORT 10MM 23.5CM CANN GREEN TITANIUM TROC	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.327S	SUP	HCPCS C1713		456.327S  -  NAIL FIX 125D SHORT 11MM 23.5CM CANN GREEN TITANIUM	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.328S	SUP	HCPCS C1713		456.328S  -  NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 11MM 235MM CANN	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.329S	SUP	HCPCS C1713		456.329S  -  NAIL FIX 135D SHORT 11MM 23.5CM CANN GREEN TITANIUM	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.330S	SUP	HCPCS C1713		456.330S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 30CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.331S	SUP	HCPCS C1713		456.331S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 30CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.332S	SUP	HCPCS C1713		456.332S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 32CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.333S	SUP	HCPCS C1713		456.333S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 32CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.334S	SUP	HCPCS C1713		456.334S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 34CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.335S	SUP	HCPCS C1713		456.335S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 34CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.336S	SUP	HCPCS C1713		456.336S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 36CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.337S	SUP	HCPCS C1713		456.337S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 36CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.338S	SUP	HCPCS C1713		456.338S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 38CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.339S	SUP	HCPCS C1713		456.339S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 38CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.340S	SUP	HCPCS C1713		456.340S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 40CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.341S	SUP	HCPCS C1713		456.341S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 40CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.342S	SUP	HCPCS C1713		456.342S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 42CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.343S	SUP	HCPCS C1713		456.343S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 42CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.344S	SUP	HCPCS C1713		456.344S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 44CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.345S	SUP	HCPCS C1713		456.345S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 44CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.346S	SUP	HCPCS C1713		456.346S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 46CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.347S	SUP	HCPCS C1713		456.347S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 46CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.350S	SUP	HCPCS C1713		456.350S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 30CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.351S	SUP	HCPCS C1713		456.351S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 30CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.352S	SUP	HCPCS C1713		456.352S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 32CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.353S	SUP	HCPCS C1713		456.353S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 320MM CANN PREASSEMBLED	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.354S	SUP	HCPCS C1713		456.354S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 34CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.355S	SUP	HCPCS C1713		456.355S  -  NAIL INTRAMEDULLARY 130D 10MM 34CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.356S	SUP	HCPCS C1713		456.356S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 36CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.357S	SUP	HCPCS C1713		456.357S  -  NAIL FIX 130D 10MM 360MM CANN STATIC INTLCK GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.358S	SUP	HCPCS C1713		456.358S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 38CM CANN INTERLOCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.359S	SUP	HCPCS C1713		456.359S  -  NAIL INTRAMEDULLARY 130D 10MM 380MM CANN STATIC INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.360S	SUP	HCPCS C1713		456.360S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 40CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.361S	SUP	HCPCS C1713		456.361S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 400MM CANN PREASSEMBLED	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.362S	SUP	HCPCS C1713		456.362S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 42CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.363S	SUP	HCPCS C1713		456.363S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 42CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.364S	SUP	HCPCS C1713		456.364S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 44CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.365S	SUP	HCPCS C1713		456.365S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 44CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.366S	SUP	HCPCS C1713		456.366S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 46CM CANN INTLCK GREEN	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.367S	SUP	HCPCS C1713		456.367S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 46CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.370S	SUP	HCPCS C1713		456.370S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 33CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.371S	SUP	HCPCS C1713		456.371S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 33CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.372S	SUP	HCPCS C1713		456.372S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 320MM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.373S	SUP	HCPCS C1713		456.373S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 32CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.374S	SUP	HCPCS C1713		456.374S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 34CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.375S	SUP	HCPCS C1713		456.375S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 34CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.376S	SUP	HCPCS C1713		456.376S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 36CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.377S	SUP	HCPCS C1713		456.377S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 36CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.378S	SUP	HCPCS C1713		456.378S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 38CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.379S	SUP	HCPCS C1713		456.379S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 38CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.380S	SUP	HCPCS C1713		456.380S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 40CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.381S	SUP	HCPCS C1713		456.381S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 40CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.382S	SUP	HCPCS C1713		456.382S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 42CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.383S	SUP	HCPCS C1713		456.383S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 42CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.384S	SUP	HCPCS C1713		456.384S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 44CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.385S	SUP	HCPCS C1713		456.385S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 44CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.386S	SUP	HCPCS C1713		456.386S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 46CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.387S	SUP	HCPCS C1713		456.387S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 46CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,578.28 "	"$2,647.93"	$0.00	"$2,779.24"	"$1,563.32"	"$1,563.32"	$0.00	$0.00	$0.00	$745.80	"$2,655.80"	"$2,655.80"	$0.00	$0.00	$745.71	$0.00	"$1,764.09"	"$1,764.09"	$0.00	"$1,737.03"	"$2,751.45"	"$2,779.24"	$0.00		$0.00	$527.85	$0.00	$0.00	$553.07	$0.00	$0.00	$0.00	$0.00	$0.00
456.390S	SUP	HCPCS C1713		456.390S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 33CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.391S	SUP	HCPCS C1713		456.391S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 33CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.392S	SUP	HCPCS C1713		456.392S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 32CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.393S	SUP	HCPCS C1713		456.393S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 32CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.394S	SUP	HCPCS C1713		456.394S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 34CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.395S	SUP	HCPCS C1713		456.395S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 34CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.396S	SUP	HCPCS C1713		456.396S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 36CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.397S	SUP	HCPCS C1713		456.397S  -  NAIL INTRAMEDULLARY 125D 11MM 36CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.398S	SUP	HCPCS C1713		456.398S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 38CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.399S	SUP	HCPCS C1713		456.399S  -  NAIL INTRAMEDULLARY 125D 11MM 38CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.400S	SUP	HCPCS C1713		456.400S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 40CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.401S	SUP	HCPCS C1713		456.401S  -  NAIL INTRAMEDULLARY 125D 11MM 40CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.402S	SUP	HCPCS C1713		456.402S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 42CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.403S	SUP	HCPCS C1713		456.403S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 42CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.404S	SUP	HCPCS C1713		456.404S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 44CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.405S	SUP	HCPCS C1713		456.405S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 44CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.406S	SUP	HCPCS C1713		456.406S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 46CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.407S	SUP	HCPCS C1713		456.407S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 46CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.410S	SUP	HCPCS C1713		456.410S  -  NAIL INTRAMEDULLARY 130D LONG 11MM 30CM CANN PREASSEMBLE	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.411S	SUP	HCPCS C1713		456.411S  -  NAIL FIX 130D SHORT 11MM 300MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.412S	SUP	HCPCS C1713		456.412S  -  NAIL FIX 130D SHORT 11MM 320MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.413S	SUP	HCPCS C1713		456.413S  -  NAIL FIX 130D SHORT 11MM 320MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.414S	SUP	HCPCS C1713		456.414S  -  NAIL FIX 130D 11MM 340MM CANN TITANIUM RIGHT TROCHANTER	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.415S	SUP	HCPCS C1713		456.415S  -  NAIL FIX 130D SHORT 11MM 340MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.416S	SUP	HCPCS C1713		456.416S  -  NAIL FIX 130D SHORT 11MM 360MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.417S	SUP	HCPCS C1713		456.417S  -  NAIL FIX 130D SHORT 11MM 360MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.418S	SUP	HCPCS C1713		456.418S  -  NAIL FIX 130D SHORT 11MM 380MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.419S	SUP	HCPCS C1713		456.419S  -  NAIL FIX 130D SHORT 11MM 380MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.420S	SUP	HCPCS C1713		456.420S  -  NAIL FIX 130D SHORT 11MM 400MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.421S	SUP	HCPCS C1713		456.421S  -  NAIL FIX 130D SHORT 11MM 400MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.422S	SUP	HCPCS C1713		456.422S  -  NAIL FIX 130D SHORT 11MM 420MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.423S	SUP	HCPCS C1713		456.423S  -  NAIL FIX 130D SHORT 11MM 420MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.424S	SUP	HCPCS C1713		456.424S  -  NAIL FIX 130D SHORT 11MM 440MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.425S	SUP	HCPCS C1713		456.425S  -  NAIL INTRAMEDULLARY 130D LONG 11MM 440MM CANN PREASSEMBLED	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.426S	SUP	HCPCS C1713		456.426S  -  NAIL FIX 130D LONG 11MM 460MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.427S	SUP	HCPCS C1713		456.427S  -  NAIL FIX 130D LONG 11MM 460MM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.430S	SUP	HCPCS C1713		456.430S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 33CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.431S	SUP	HCPCS C1713		456.431S  -  NAIL INTRAMEDULLARY 135D LONG 11MM 33CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.432S	SUP	HCPCS C1713		456.432S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 32CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.433S	SUP	HCPCS C1713		456.433S  -  NAIL INTRAMEDULLARY 135D LONG 11MM 32CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.434S	SUP	HCPCS C1713		456.434S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 34CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.435S	SUP	HCPCS C1713		456.435S  -  NAIL INTRAMEDULLARY 135D 11MM 34CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.436S	SUP	HCPCS C1713		456.436S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 36CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.437S	SUP	HCPCS C1713		456.437S  -  NAIL INTRAMEDULLARY 135D 11MM 36CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.438S	SUP	HCPCS C1713		456.438S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 38CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.439S	SUP	HCPCS C1713		456.439S  -  NAIL INTRAMEDULLARY 135D 11MM 38CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.440S	SUP	HCPCS C1713		456.440S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 40CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.441S	SUP	HCPCS C1713		456.441S  -  NAIL INTRAMEDULLARY 135D 11MM 40CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.442S	SUP	HCPCS C1713		456.442S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 42CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.443S	SUP	HCPCS C1713		456.443S  -  NAIL INTRAMEDULLARY 135D 11MM 42CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.444S	SUP	HCPCS C1713		456.444S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 44CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.445S	SUP	HCPCS C1713		456.445S  -  NAIL INTRAMEDULLARY 135D LONG 11MM 44CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.446S	SUP	HCPCS C1713		456.446S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 46CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.447S	SUP	HCPCS C1713		456.447S  -  NAIL INTRAMEDULLARY 135D LONG 11MM 46CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.450S	SUP	HCPCS C1713		456.450S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 30CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.451S	SUP	HCPCS C1713		456.451S  -  NAIL INTRAMEDULLARY 125D 12MM 30CM CANN TITANIUM LEFT TROC	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.452S	SUP	HCPCS C1713		456.452S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 32CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.453S	SUP	HCPCS C1713		456.453S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 32CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.454S	SUP	HCPCS C1713		456.454S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 34CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.455S	SUP	HCPCS C1713		456.455S  -  NAIL INTRAMEDULLARY 125D 12MM 34CM CANN TITANIUM LEFT TROC	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.456S	SUP	HCPCS C1713		456.456S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 36CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.457S	SUP	HCPCS C1713		456.457S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 36CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.458S	SUP	HCPCS C1713		456.458S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 38CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.459S	SUP	HCPCS C1713		456.459S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 38CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.460S	SUP	HCPCS C1713		456.460S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 40CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.461S	SUP	HCPCS C1713		456.461S  -  NAIL INTRAMEDULLARY 125D 12MM 40CM CANN TITANIUM LEFT TROC	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.462S	SUP	HCPCS C1713		456.462S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 42CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.463S	SUP	HCPCS C1713		456.463S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 42CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.464S	SUP	HCPCS C1713		456.464S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 44CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.465S	SUP	HCPCS C1713		456.465S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 44CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.466S	SUP	HCPCS C1713		456.466S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 46CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.467S	SUP	HCPCS C1713		456.467S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 46CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.470S	SUP	HCPCS C1713		456.470S  -  NAIL INTRAMEDULLARY 130D LONG 17-12MM 30CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.471S	SUP	HCPCS C1713		456.471S  -  NAIL INTRAMEDULLARY 130D 12MM 30CM CANN TITANIUM LEFT TROC	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.472S	SUP	HCPCS C1713		456.472S  -  NAIL INTRAMEDULLARY 130D LONG 17-12MM 32CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.473S	SUP	HCPCS C1713		456.473S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 32CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.474S	SUP	HCPCS C1713		456.474S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 34CM CANN PREASSEMBLE	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.475S	SUP	HCPCS C1713		456.475S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 34CM CANN PREASSEMBLE	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.476S	SUP	HCPCS C1713		456.476S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 36CM CANN PREASSEMBLE	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.477S	SUP	HCPCS C1713		456.477S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 36CM CANN PREASSEMBLE	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.478S	SUP	HCPCS C1713		456.478S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 380MM CANN PREASSEMBLE	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.479S	SUP	HCPCS C1713		456.479S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 380MM CANN PREASSEMBLED	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.480S	SUP	HCPCS C1713		456.480S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 400MM CANN PREASSEMBLE	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.481S	SUP	HCPCS C1713		456.481S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 40CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.482S	SUP	HCPCS C1713		456.482S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 420MM CANN PREASSEMBLE	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.483S	SUP	HCPCS C1713		456.483S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 420MM CANN PREASSEMBLE	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.484S	SUP	HCPCS C1713		456.484S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 440MM CANN PREASSEMBLE	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.485S	SUP	HCPCS C1713		456.485S  -  NAIL INTRAMEDULLARY 130D 12MM 44CM CANN TITANIUM LEFT TROC	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.486S	SUP	HCPCS C1713		456.486S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 460MM CANN PREASSEMBLE	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.487S	SUP	HCPCS C1713		456.487S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 46CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.490S	SUP	HCPCS C1713		456.490S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 30CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.491S	SUP	HCPCS C1713		456.491S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 33CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.492S	SUP	HCPCS C1713		456.492S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 32CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.493S	SUP	HCPCS C1713		456.493S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 32CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.494S	SUP	HCPCS C1713		456.494S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 34CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.495S	SUP	HCPCS C1713		456.495S  -  NAIL INTRAMEDULLARY 135D 12MM 34CM CANN TITANIUM LEFT TROC	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.496S	SUP	HCPCS C1713		456.496S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 36CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.497S	SUP	HCPCS C1713		456.497S  -  NAIL INTRAMEDULLARY 135D 12MM 36CM CANN TITANIUM LEFT TROC	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.498S	SUP	HCPCS C1713		456.498S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 38CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.499S	SUP	HCPCS C1713		456.499S  -  NAIL INTRAMEDULLARY 135D 12MM 38CM CANN TITANIUM LEFT TROC	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.500S	SUP	HCPCS C1713		456.500S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 40CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.501S	SUP	HCPCS C1713		456.501S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 40CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.502S	SUP	HCPCS C1713		456.502S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 42CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.503S	SUP	HCPCS C1713		456.503S  -  NAIL INTRAMEDULLARY 135D 12MM 42CM CANN TITANIUM LEFT TROC	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.504S	SUP	HCPCS C1713		456.504S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 44CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.505S	SUP	HCPCS C1713		456.505S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 44CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.506S	SUP	HCPCS C1713		456.506S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 46CM CANN INTLCK GREEN	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.507S	SUP	HCPCS C1713		456.507S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 46CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,461.58 "	"$2,561.57"	$0.00	"$2,688.60"	"$1,512.34"	"$1,512.34"	$0.00	$0.00	$0.00	$721.48	"$2,569.18"	"$2,569.18"	$0.00	$0.00	$721.39	$0.00	"$1,706.56"	"$1,706.56"	$0.00	"$1,680.38"	"$2,661.71"	"$2,688.60"	$0.00		$0.00	$510.64	$0.00	$0.00	$535.03	$0.00	$0.00	$0.00	$0.00	$0.00
456.510S	SUP	HCPCS C1713		456.510S  -  NAIL FIX 125D SHORT 12MM 23.5CM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.511S	SUP	HCPCS C1713		456.511S  -  NAIL FIX 130D SHORT 12MM 23.5CM CANN PREASSEMBLED LOCKING	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.512S	SUP	HCPCS C1713		456.512S  -  NAIL FIX 135D SHORT 12MM 23.5CM CANN GREEN TITANIUM TROC	BOTH IP/OP	"$2,630.10 "	"$1,946.27"	$0.00	"$2,042.80"	"$1,149.08"	"$1,149.08"	$0.00	$0.00	$0.00	$548.18	"$1,952.06"	"$1,952.06"	$0.00	$0.00	$548.11	$0.00	"$1,296.64"	"$1,296.64"	$0.00	"$1,276.75"	"$2,022.37"	"$2,042.80"	$0.00		$0.00	$387.98	$0.00	$0.00	$406.52	$0.00	$0.00	$0.00	$0.00	$0.00
456.630S	SUP	HCPCS C1713		456.630S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 30CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.631S	SUP	HCPCS C1713		456.631S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 30CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.632S	SUP	HCPCS C1713		456.632S  -  NAIL INTRAMEDULLARY 130D 14MM 32CM CANN GREEN TITANIUM RIGHT	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.633S	SUP	HCPCS C1713		456.633S  -  NAIL INTRAMEDULLARY 130D 14MM 32CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.634S	SUP	HCPCS C1713		456.634S  -  NAIL INTRAMEDULLARY 130D 14MM 130MM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.635S	SUP	HCPCS C1713		456.635S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 34CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.636S	SUP	HCPCS C1713		456.636S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 36CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.637S	SUP	HCPCS C1713		456.637S  -  NAIL INTRAMEDULLARY 130D 14MM 360MM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.638S	SUP	HCPCS C1713		456.638S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 38CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.639S	SUP	HCPCS C1713		456.639S  -  NAIL INTRAMEDULLARY 130D 14MM 380MM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.640S	SUP	HCPCS C1713		456.640S  -  NAIL INTRAMEDULLARY 130D 14MM 40CM CANN GREEN TITANIUM RIGHT	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.641S	SUP	HCPCS C1713		456.641S  -  NAIL INTRAMEDULLARY 130D 14MM 40CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.642S	SUP	HCPCS C1713		456.642S  -  NAIL INTRAMEDULLARY 130D 14MM 42CM CANN GREEN TITANIUM RIGHT	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.643S	SUP	HCPCS C1713		456.643S  -  NAIL INTRAMEDULLARY 130D 14MM 42CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.644S	SUP	HCPCS C1713		456.644S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 44CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.645S	SUP	HCPCS C1713		456.645S  -  NAIL INTRAMEDULLARY 130D 14MM 44CM CANN GREEN TITANIUM LEFT	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.646S	SUP	HCPCS C1713		456.646S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 46CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.647S	SUP	HCPCS C1713		456.647S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 46CM CANN GREEN TITANIUM	BOTH IP/OP	"$3,687.70 "	"$2,728.90"	$0.00	"$2,864.22"	"$1,611.12"	"$1,611.12"	$0.00	$0.00	$0.00	$768.61	"$2,737.01"	"$2,737.01"	$0.00	$0.00	$768.52	$0.00	"$1,818.04"	"$1,818.04"	$0.00	"$1,790.14"	"$2,835.58"	"$2,864.22"	$0.00		$0.00	$543.99	$0.00	$0.00	$569.98	$0.00	$0.00	$0.00	$0.00	$0.00
456.650S	SUP	Custom 27803010		456.650S  -  BLADE FIX 11MM 130MM HELICAL TITANIUM TROC STERILE	BOTH IP/OP	"$1,254.53 "	$928.35	$0.00	$974.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$931.11	$931.11	$0.00	$0.00	$261.44	$0.00	$0.00	$0.00	$0.00	$608.99	$964.64	$974.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.70S	SUP	Custom 27803010		456.70S  -  BLADE FIX 70MM SPIRAL TITANIUM TROC STERILE INTRAMEDULLARY	BOTH IP/OP	"$1,326.88 "	$981.89	$0.00	"$1,061.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.81	$984.81	$0.00	$0.00	$276.52	$0.00	$0.00	$0.00	$0.00	$663.44	"$1,050.89"	"$1,061.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.75S	SUP	Custom 27803010		456.75S  -  BLADE INTRAMEDULLARY FIX 75MM SPIRAL TITANIUM FEMUR STERILE	BOTH IP/OP	"$1,326.88 "	$981.89	$0.00	"$1,061.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.81	$984.81	$0.00	$0.00	$276.52	$0.00	$0.00	$0.00	$0.00	$663.44	"$1,050.89"	"$1,061.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.80S	SUP	Custom 27803010		456.80S  -  BLADE INTRAMEDULLARY FIX 80MM SPIRAL TITANIUM FEMUR STERILE	BOTH IP/OP	"$1,326.88 "	$981.89	$0.00	"$1,061.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.81	$984.81	$0.00	$0.00	$276.52	$0.00	$0.00	$0.00	$0.00	$663.44	"$1,050.89"	"$1,061.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.85S	SUP	Custom 27803010		456.85S  -  BLADE INTRAMEDULLARY FIX 85MM SPIRAL TITANIUM FEMUR STERILE	BOTH IP/OP	"$1,326.88 "	$981.89	$0.00	"$1,061.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.81	$984.81	$0.00	$0.00	$276.52	$0.00	$0.00	$0.00	$0.00	$663.44	"$1,050.89"	"$1,061.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.90S	SUP	Custom 27803010		456.90S  -  BLADE INTRAMEDULLARY FIX 90MM SPIRAL TITANIUM FEMUR STERILE	BOTH IP/OP	"$1,326.88 "	$981.89	$0.00	"$1,061.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.81	$984.81	$0.00	$0.00	$276.52	$0.00	$0.00	$0.00	$0.00	$663.44	"$1,050.89"	"$1,061.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
456.95S	SUP	Custom 27803010		456.95S  -  BLADE INTRAMEDULLARY FIX 95MM SPIRAL TITANIUM FEMUR STERILE	BOTH IP/OP	"$1,326.88 "	$981.89	$0.00	"$1,061.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.81	$984.81	$0.00	$0.00	$276.52	$0.00	$0.00	$0.00	$0.00	$663.44	"$1,050.89"	"$1,061.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-600	SUP	HCPCS C1769		45-600  -  CATH CEN VEN 5FR 50CM 1 LUM GWIRE VXCL PU .035IN	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
457.010S	SUP	Custom 27803010		457.010S  -  CAP END 0MM 15MM FEM XTD IM NAIL SPRL BLDE TI STRL LBLU	BOTH IP/OP	$542.30 	$401.30	$0.00	$433.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$402.50	$402.50	$0.00	$0.00	$113.02	$0.00	$0.00	$0.00	$0.00	$271.15	$429.50	$433.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
457.011S	SUP	Custom 27803010		457.011S  -  CAP END 10MM EXTEND LIGHT BLUE TITANIUM FEMUR STERILE SPIRAL	BOTH IP/OP	$470.25 	$347.99	$0.00	$376.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$349.02	$349.02	$0.00	$0.00	$98.00	$0.00	$0.00	$0.00	$0.00	$235.13	$372.44	$376.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
457.012S	SUP	Custom 27803010		457.012S  -  CAP END 20MM 15MM EXTEND LIGHT BLUE TITANIUM FEMUR STERILE	BOTH IP/OP	$470.25 	$347.99	$0.00	$376.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$349.02	$349.02	$0.00	$0.00	$98.00	$0.00	$0.00	$0.00	$0.00	$235.13	$372.44	$376.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
457.210S	SUP	Custom 27803010		457.210S  -  CAP END 0MM FEM XTD LCK IM NAIL TI STRL PNK 15MM	BOTH IP/OP	$513.53 	$380.01	$0.00	$410.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$381.14	$381.14	$0.00	$0.00	$107.02	$0.00	$0.00	$0.00	$0.00	$256.76	$406.72	$410.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
457.211S	SUP	Custom 27803010		457.211S  -  CAP END 130D 10MM 15MM LOCK PINK TITANIUM FEMUR STERILE	BOTH IP/OP	$446.88 	$330.69	$0.00	$357.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.67	$331.67	$0.00	$0.00	$93.13	$0.00	$0.00	$0.00	$0.00	$223.44	$353.93	$357.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
457.212S	SUP	Custom 27803010		457.212S  -  CAP END 130D 20MM 15MM LOCK PINK TITANIUM FEMUR STERILE	BOTH IP/OP	$446.88 	$330.69	$0.00	$357.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.67	$331.67	$0.00	$0.00	$93.13	$0.00	$0.00	$0.00	$0.00	$223.44	$353.93	$357.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
458.10S	SUP	Custom 27803010		458.10S  -  CAP END 6MM 15MM EXTEND BLUE TITANIUM TIBIA STERILE SOLID	BOTH IP/OP	$331.38 	$245.22	$0.00	$265.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$245.95	$245.95	$0.00	$0.00	$69.06	$0.00	$0.00	$0.00	$0.00	$165.69	$262.45	$265.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
458.110S	SUP	Custom 27803010		458.110S  -  CAP END 15MM 15MM EXTN BLUE TITANIUM TIBIA STERILE SOLID	BOTH IP/OP	$541.75 	$400.90	$0.00	$433.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$402.09	$402.09	$0.00	$0.00	$112.90	$0.00	$0.00	$0.00	$0.00	$270.88	$429.07	$433.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
458.120S	SUP	Custom 27803010		458.120S  -  CAP END 8MM 15MM TIB XTD HEX DRV CANN IM NAIL TI STRL GRN 8	BOTH IP/OP	$307.65 	$227.66	$0.00	$246.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.34	$228.34	$0.00	$0.00	$64.11	$0.00	$0.00	$0.00	$0.00	$153.83	$243.66	$246.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
458.926S	SUP	HCPCS C1713		458.926S  -  SCREW BN 3.5MM FT 5MM 8MM 26MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.928S	SUP	HCPCS C1713		458.928S  -  SCREW BN 3.5MM FT 5MM 8MM 28MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.930S	SUP	HCPCS C1713		458.930S  -  SCREW BN 3.5MM FT 5MM 8MM 30MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.932S	SUP	HCPCS C1713		458.932S  -  SCREW BN 3.5MM FT 5MM 8MM 32MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.934S	SUP	HCPCS C1713		458.934S  -  SCREW BN 3.5MM FT 5MM 8MM 34MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.936S	SUP	HCPCS C1713		458.936S  -  SCREW BN 3.5MM FT 5MM 8MM 36MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.938S	SUP	HCPCS C1713		458.938S  -  SCREW BN 3.5MM FT 5MM 8MM 38MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.940S	SUP	HCPCS C1713		458.940S  -  SCREW BN 3.5MM FT 5MM 8MM 40MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.942S	SUP	HCPCS C1713		458.942S  -  SCREW BN 3.5MM FT 5MM 8MM 42MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.944S	SUP	HCPCS C1713		458.944S  -  SCREW BN 3.5MM FT 5MM 8MM 44MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.946S	SUP	HCPCS C1713		458.946S  -  SCREW BN 3.5MM FT 5MM 8MM 46MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.948S	SUP	HCPCS C1713		458.948S  -  SCREW BN 3.5MM FT 5MM 8MM 48MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.950S	SUP	HCPCS C1713		458.950S  -  SCREW BN 3.5MM FT 5MM 8MM 50MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.952S	SUP	HCPCS C1713		458.952S  -  SCREW BN 3.5MM FT 5MM 8MM 52MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.954S	SUP	HCPCS C1713		458.954S  -  SCREW BN 3.5MM FT 5MM 8MM 54MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.956S	SUP	HCPCS C1713		458.956S  -  SCREW BN 3.5MM FT 5MM 8MM 56MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.958S	SUP	HCPCS C1713		458.958S  -  SCREW BN 3.5MM FT 5MM 8MM 58MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.960S	SUP	HCPCS C1713		458.960S  -  SCREW BN 3.5MM FT 5MM 8MM 60MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.964S	SUP	HCPCS C1713		458.964S  -  SCREW BN 3.5MM FT 5MM 8MM 64MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.968S	SUP	HCPCS C1713		458.968S  -  SCREW BN 3.5MM FT 5MM 8MM 68MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.972S	SUP	HCPCS C1713		458.972S  -  SCREW BN 3.5MM FT 5MM 8MM 72MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.976S	SUP	HCPCS C1713		458.976S  -  SCREW BN 3.5MM FT 5MM 8MM 76MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.980S	SUP	HCPCS C1713		458.980S  -  SCREW BN 3.5MM FT 5MM 8MM 80MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.985S	SUP	HCPCS C1713		458.985S  -  SCREW BN 3.5MM FT 5MM 8MM 85MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.990S	SUP	HCPCS C1713		458.990S  -  SCREW BN 3.5MM FT 5MM 8MM 90MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.995S	SUP	HCPCS C1713		458.995S  -  SCREW BN 3.5MM FT 5MM 8MM 95MM GRN STRL ST LCK 2 LD HEX TI	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
458.999S	SUP	HCPCS C1713		458.999S  -  SCREW BN 5MM 100MM GRN STRL NLEX LCK HEX RCS TI FEM TIB	BOTH IP/OP	$444.93 	$329.25	$0.00	$345.56	$194.38	$194.38	$0.00	$0.00	$0.00	$92.73	$330.22	$330.22	$0.00	$0.00	$92.72	$0.00	$263.17	$263.17	$0.00	$215.98	$342.10	$345.56	$0.00		$0.00	$65.63	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$0.00
45-80001	SUP	Custom 27203010		45-80001  -  GUIDE DRILL CIRC LCK HOLE	BOTH IP/OP	$851.13 	$629.84	$0.00	$680.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$631.70	$631.70	$0.00	$0.00	$177.37	$0.00	$0.00	$0.00	$0.00	$425.56	$674.09	$680.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-80005	SUP	Custom 27203010		45-80005  -  GUIDE DRILL OVL CMPR HOLE	BOTH IP/OP	$955.63 	$707.17	$0.00	$764.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$709.26	$709.26	$0.00	$0.00	$199.15	$0.00	$0.00	$0.00	$0.00	$477.81	$756.86	$764.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
45-80010	SUP	HCPCS C1713		45-80010  -  PLATE BNDRG PLR BONE	BOTH IP/OP	$907.50 	$671.55	$0.00	$726.00	$408.38	$408.38	$0.00	$0.00	$0.00	$189.15	$673.55	$673.55	$0.00	$0.00	$189.12	$0.00	$536.79	$536.79	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
45-80100	SUP	HCPCS C1713		45-80100  -  WIRE FX FT 1.6MM 200MM NS KRSH VARIAX FT LCK PLT SYS	BOTH IP/OP	$69.00 	$51.06	$0.00	$51.21	$19.18	$19.18	$0.00	$0.00	$0.00	$14.38	$51.21	$51.21	$0.00	$0.00	$14.38	$0.00	$40.81	$40.81	$0.00	$21.31	$33.76	$34.10	$0.00		$0.00	$6.67	$0.00	$0.00	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00
45-80200	SUP	HCPCS C1713		45-80200  -  WIRE FX 1.4MM 100MM NS KRSH SMTH VARIAX FT LCK PLT SYS	BOTH IP/OP	$29.25 	$21.65	$0.00	$22.00	$12.38	$12.38	$0.00	$0.00	$0.00	$6.10	$21.71	$21.71	$0.00	$0.00	$6.10	$0.00	$17.30	$17.30	$0.00	$13.75	$21.78	$22.00	$0.00		$0.00	$4.30	$0.00	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$0.00
45-80300	SUP	Custom 27203010		45-80300  -  PIN FIX 100MM 2.5MM STNM SS SMTH NONSTRL	BOTH IP/OP	$55.50 	$41.07	$0.00	$41.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.19	$41.19	$0.00	$0.00	$11.57	$0.00	$0.00	$0.00	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
459.012S	SUP	Custom 27803010		459.012S  -  CAP END 0MM XTD 9-12MM IM NAIL STD LCK TI STRL GRN 12MM	BOTH IP/OP	$494.33 	$365.80	$0.00	$395.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$366.89	$366.89	$0.00	$0.00	$103.02	$0.00	$0.00	$0.00	$0.00	$247.16	$391.51	$395.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
459.013S	SUP	Custom 27803010		459.013S  -  CAP END 10MM 12MM 12MM EXTENDED STANDARD LOCKING GREEN	BOTH IP/OP	$433.13 	$320.52	$0.00	$346.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$321.47	$321.47	$0.00	$0.00	$90.26	$0.00	$0.00	$0.00	$0.00	$216.56	$343.04	$346.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
459.014S	SUP	Custom 27803010		459.014S  -  CAP END 20MM 12MM 12MM EXTENDED STANDARD LOCKING GREEN	BOTH IP/OP	$433.13 	$320.52	$0.00	$346.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$321.47	$321.47	$0.00	$0.00	$90.26	$0.00	$0.00	$0.00	$0.00	$216.56	$343.04	$346.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
460.001.01S	SUP	Custom 27803010		460.001.01S  -  CLAMP TUBE 13MM CRANIAL FLP TI STRL	BOTH IP/OP	$940.50 	$695.97	$0.00	$752.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$698.04	$698.04	$0.00	$0.00	$196.00	$0.00	$0.00	$0.00	$0.00	$470.25	$744.88	$752.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
460.002.01S	SUP	Custom 27803010		460.002.01S  -  CLAMP TUBE 18MM CRANIAL FLP TI STRL	BOTH IP/OP	$974.25 	$720.95	$0.00	$779.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.09	$723.09	$0.00	$0.00	$203.03	$0.00	$0.00	$0.00	$0.00	$487.13	$771.61	$779.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
460.003.01S	SUP	Custom 27803010		460.003.01S  -  CLAMP TUBE 22MM CRANIAL FLP TI STRL	BOTH IP/OP	"$1,010.25 "	$747.59	$0.00	$808.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$749.81	$749.81	$0.00	$0.00	$210.54	$0.00	$0.00	$0.00	$0.00	$505.13	$800.12	$808.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
460.008.01S	SUP	Custom 27803010		460.008.01S  -  CLAMP TUBE 13MM CRANIAL FLP TI TXTR STRL	BOTH IP/OP	$974.25 	$720.95	$0.00	$779.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.09	$723.09	$0.00	$0.00	$203.03	$0.00	$0.00	$0.00	$0.00	$487.13	$771.61	$779.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
460.009.01S	SUP	Custom 27803010		460.009.01S  -  CLAMP TUBE 18MM CRANIAL FLP TI TXTR STRL	BOTH IP/OP	"$1,010.25 "	$747.59	$0.00	$808.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$749.81	$749.81	$0.00	$0.00	$210.54	$0.00	$0.00	$0.00	$0.00	$505.13	$800.12	$808.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
460.010.01S	SUP	Custom 27803010		460.010.01S  -  CLAMP TUBE 22MM CRANIAL FLP TI TXTR STRL	BOTH IP/OP	"$1,050.75 "	$777.56	$0.00	$840.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$779.87	$779.87	$0.00	$0.00	$218.98	$0.00	$0.00	$0.00	$0.00	$525.38	$832.19	$840.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
460.022.05S	SUP	HCPCS C1713		460.022.05S  -  PIN ER RELS STRNL TI STRL	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$98.10	$98.10	$0.00	$0.00	$0.00	$45.44	$161.80	$161.80	$0.00	$0.00	$45.43	$0.00	$128.95	$128.95	$0.00	$109.00	$172.66	$174.40	$0.00		$0.00	$34.12	$0.00	$0.00	$34.71	$0.00	$0.00	$0.00	$0.00	$0.00
460.100.01S	SUP	Custom 27803010		460.100.01S  -  TI CRANIAL FLAP TUBE CLAMP 11MM DIA-STERILE	BOTH IP/OP	$893.25 	$661.01	$0.00	$714.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$662.97	$662.97	$0.00	$0.00	$186.15	$0.00	$0.00	$0.00	$0.00	$446.63	$707.45	$714.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
460.107.01S	SUP	Custom 27803010		460.107.01S  -  TI CRANIAL FLAP TUBE CLAMP TEXTURED 11MM DIA-STERILE	BOTH IP/OP	$924.75 	$684.32	$0.00	$739.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$686.35	$686.35	$0.00	$0.00	$192.72	$0.00	$0.00	$0.00	$0.00	$462.38	$732.40	$739.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-1001T	SUP	Custom 27203010		46-1001T  -  TEMPLATE SZ LG ANG PLT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-1002T	SUP	Custom 27203010		46-1002T  -  TEMPLATE SZ 2 ANG LCK PLT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-1003T	SUP	Custom 27203010		46-1003T  -  TEMPLATE SZ ANG LCK PLT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-1004	SUP	Custom 27203010		46-1004  -  DRILL TWIST 1.8MM MICRO 26MM 115MM STOP	BOTH IP/OP	$632.50 	$468.05	$0.00	$506.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$469.44	$469.44	$0.00	$0.00	$131.81	$0.00	$0.00	$0.00	$0.00	$316.25	$500.94	$506.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-1006	SUP	Custom 27203010		46-1006  -  BIT DRL 1.6MM 50MM 22MM TWST STP LORENZ TRAUMAONE	BOTH IP/OP	$632.50 	$468.05	$0.00	$506.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$469.44	$469.44	$0.00	$0.00	$131.81	$0.00	$0.00	$0.00	$0.00	$316.25	$500.94	$506.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-1007	SUP	Custom 27203010		46-1007  -  DRILL SURG 1.6MM 115MM 26MM STOP TRAUMAONE MANDIB	BOTH IP/OP	$632.50 	$468.05	$0.00	$506.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$469.44	$469.44	$0.00	$0.00	$131.81	$0.00	$0.00	$0.00	$0.00	$316.25	$500.94	$506.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-1024T	SUP	Custom 27203010		46-1024T  -  TEMPLATE SZ STRG 24 HL PLT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-123	SUP	Custom 27203010		46-123  -  DRESSING WOUND LARGE ABSORBENT VEST NONADHERENT MULTILAYER	BOTH IP/OP	$26.47 	$19.59	$0.00	$21.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.65	$19.65	$0.00	$0.00	$5.52	$0.00	$0.00	$0.00	$0.00	$13.30	$21.07	$21.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-130	SUP	Custom 27203010		46-130  -  DRESSING HYDROCOLLOID XL ABSORBENT LATEX FREE SOFSORB	BOTH IP/OP	$750.02 	$555.01	$0.00	$556.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.66	$556.66	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$25.12	$39.79	$40.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-133	SUP	Custom 27203010		46-133  -  DRESSING BURN ABSORBENT HIP LEG	BOTH IP/OP	$52.10 	$38.55	$0.00	$51.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.67	$38.67	$0.00	$0.00	$10.86	$0.00	$0.00	$0.00	$0.00	$31.94	$50.60	$51.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-138	SUP	Custom 27203010		DRESSING BURN 17 PLY GZE 36X36IN	BOTH IP/OP	$56.63 	$41.91	$0.00	$45.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.31	$44.85	$45.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-152	SUP	Custom 27203010		46-152  -  DRESSING WOUND XL ABSORBENT VEST HIGH PERFORMANCE	BOTH IP/OP	$28.03 	$20.74	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.80	$20.80	$0.00	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$14.22	$22.52	$22.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-155	SUP	Custom 27203010		46-155  -  DRESSING WND STRL LF SFSRB ABS STDR LINR ADLT HIP LG	BOTH IP/OP	$31.02 	$22.95	$0.00	$24.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.02	$23.02	$0.00	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$15.51	$24.57	$24.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
462.634S	SUP	Custom 27803010		462.634S  -  BLADE FIX 34MM SPIRAL SOLID TITANIUM HUMERUS STERILE	BOTH IP/OP	"$1,226.80 "	$907.83	$0.00	$952.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$910.53	$910.53	$0.00	$0.00	$255.67	$0.00	$0.00	$0.00	$0.00	$595.54	$943.34	$952.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
462.636S	SUP	Custom 27803010		462.636S  -  BLADE INTRAMEDULLARY FIX 13MM 36MMX3.9MM SPIRAL CUTTING	BOTH IP/OP	"$1,226.80 "	$907.83	$0.00	$952.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$910.53	$910.53	$0.00	$0.00	$255.67	$0.00	$0.00	$0.00	$0.00	$595.54	$943.34	$952.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
462.638S	SUP	Custom 27803010		462.638S  -  BLADE FIX 38MM SPIRAL SOLID TITANIUM HUMERUS STERILE	BOTH IP/OP	"$1,226.80 "	$907.83	$0.00	$952.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$910.53	$910.53	$0.00	$0.00	$255.67	$0.00	$0.00	$0.00	$0.00	$595.54	$943.34	$952.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
462.640S	SUP	HCPCS C1713		462.640S  -  NAIL INTRAMEDULLARY 40MM SPIRAL BLADE TITANIUM STERILE	BOTH IP/OP	"$1,226.80 "	$907.83	$0.00	$952.86	$535.98	$535.98	$0.00	$0.00	$0.00	$255.70	$910.53	$910.53	$0.00	$0.00	$255.67	$0.00	$725.65	$725.65	$0.00	$595.54	$943.34	$952.86	$0.00		$0.00	$180.97	$0.00	$0.00	$189.62	$0.00	$0.00	$0.00	$0.00	$0.00
462.642S	SUP	HCPCS C1713		462.642S  -  BLADE INTRAMEDULLARY FIX 13MM 42MMX3.9MM SPIRAL CUTTING	BOTH IP/OP	"$1,226.80 "	$907.83	$0.00	$952.86	$535.98	$535.98	$0.00	$0.00	$0.00	$255.70	$910.53	$910.53	$0.00	$0.00	$255.67	$0.00	$725.65	$725.65	$0.00	$595.54	$943.34	$952.86	$0.00		$0.00	$180.97	$0.00	$0.00	$189.62	$0.00	$0.00	$0.00	$0.00	$0.00
462.644S	SUP	HCPCS C1713		462.644S  -  BLADE INTRAMEDULLARY FIX 44MM SPIRAL GOLD TITANIUM ALUMINUM	BOTH IP/OP	"$1,226.80 "	$907.83	$0.00	$952.86	$535.98	$535.98	$0.00	$0.00	$0.00	$255.70	$910.53	$910.53	$0.00	$0.00	$255.67	$0.00	$725.65	$725.65	$0.00	$595.54	$943.34	$952.86	$0.00		$0.00	$180.97	$0.00	$0.00	$189.62	$0.00	$0.00	$0.00	$0.00	$0.00
462.646S	SUP	HCPCS C1713		462.646S  -  BLADE INTRAMEDULLARY FIX 13MM 46MMX3.9MM SPIRAL CUTTING	BOTH IP/OP	"$1,226.80 "	$907.83	$0.00	$952.86	$535.98	$535.98	$0.00	$0.00	$0.00	$255.70	$910.53	$910.53	$0.00	$0.00	$255.67	$0.00	$725.65	$725.65	$0.00	$595.54	$943.34	$952.86	$0.00		$0.00	$180.97	$0.00	$0.00	$189.62	$0.00	$0.00	$0.00	$0.00	$0.00
462.648S	SUP	HCPCS C1713		462.648S  -  BLADE INTRAMEDULLARY FIX 48MM SPIRAL NAIL-EX TITANIUM	BOTH IP/OP	"$1,226.80 "	$907.83	$0.00	$952.86	$535.98	$535.98	$0.00	$0.00	$0.00	$255.70	$910.53	$910.53	$0.00	$0.00	$255.67	$0.00	$725.65	$725.65	$0.00	$595.54	$943.34	$952.86	$0.00		$0.00	$180.97	$0.00	$0.00	$189.62	$0.00	$0.00	$0.00	$0.00	$0.00
462.650S	SUP	HCPCS C1713		462.650S  -  BLADE INTRAMEDULLARY FIX 50MM SPIRAL GOLD TITANIUM ALUMINUM	BOTH IP/OP	"$1,226.80 "	$907.83	$0.00	$952.86	$535.98	$535.98	$0.00	$0.00	$0.00	$255.70	$910.53	$910.53	$0.00	$0.00	$255.67	$0.00	$725.65	$725.65	$0.00	$595.54	$943.34	$952.86	$0.00		$0.00	$180.97	$0.00	$0.00	$189.62	$0.00	$0.00	$0.00	$0.00	$0.00
462.652S	SUP	HCPCS C1713		462.652S  -  BLADE FIX 52MM CANN SPIRAL SOLID GOLD TITANIUM HUMERUS	BOTH IP/OP	"$1,226.80 "	$907.83	$0.00	$952.86	$535.98	$535.98	$0.00	$0.00	$0.00	$255.70	$910.53	$910.53	$0.00	$0.00	$255.67	$0.00	$725.65	$725.65	$0.00	$595.54	$943.34	$952.86	$0.00		$0.00	$180.97	$0.00	$0.00	$189.62	$0.00	$0.00	$0.00	$0.00	$0.00
462.654S	SUP	HCPCS C1713		462.654S  -  BLADE FIX 54MM CANN SPIRAL NAIL-EX TITANIUM HUMERUS STERILE	BOTH IP/OP	"$1,226.80 "	$907.83	$0.00	$952.86	$535.98	$535.98	$0.00	$0.00	$0.00	$255.70	$910.53	$910.53	$0.00	$0.00	$255.67	$0.00	$725.65	$725.65	$0.00	$595.54	$943.34	$952.86	$0.00		$0.00	$180.97	$0.00	$0.00	$189.62	$0.00	$0.00	$0.00	$0.00	$0.00
462.660S	SUP	HCPCS C1713		462.660S  -  CAP END 0MM T25 STARDRIVE RECESS GOLD TITANIUM HUMERUS	BOTH IP/OP	$433.13 	$320.52	$0.00	$346.50	$194.91	$194.91	$0.00	$0.00	$0.00	$90.27	$321.47	$321.47	$0.00	$0.00	$90.26	$0.00	$256.19	$256.19	$0.00	$216.56	$343.04	$346.50	$0.00		$0.00	$67.78	$0.00	$0.00	$68.95	$0.00	$0.00	$0.00	$0.00	$0.00
462.665S	SUP	HCPCS C1713		462.665S  -  CAP END 5MM HUM XTD IM NAIL SPRL BLDE TI STRL	BOTH IP/OP	$494.33 	$365.80	$0.00	$395.46	$222.45	$222.45	$0.00	$0.00	$0.00	$103.03	$366.89	$366.89	$0.00	$0.00	$103.02	$0.00	$292.39	$292.39	$0.00	$247.16	$391.51	$395.46	$0.00		$0.00	$77.36	$0.00	$0.00	$78.70	$0.00	$0.00	$0.00	$0.00	$0.00
462.666S	SUP	HCPCS C1713		462.666S  -  CAP END 10MM 3.5MM HEXAGONAL RECESS GOLD TITANIUM HUMERUS	BOTH IP/OP	$433.13 	$320.52	$0.00	$346.50	$194.91	$194.91	$0.00	$0.00	$0.00	$90.27	$321.47	$321.47	$0.00	$0.00	$90.26	$0.00	$256.19	$256.19	$0.00	$216.56	$343.04	$346.50	$0.00		$0.00	$67.78	$0.00	$0.00	$68.95	$0.00	$0.00	$0.00	$0.00	$0.00
462.667S	SUP	HCPCS C1713		462.667S  -  CAP END 15MM 3.5MM HEXAGONAL RECESS GOLD TITANIUM HUMERUS	BOTH IP/OP	$433.13 	$320.52	$0.00	$346.50	$194.91	$194.91	$0.00	$0.00	$0.00	$90.27	$321.47	$321.47	$0.00	$0.00	$90.26	$0.00	$256.19	$256.19	$0.00	$216.56	$343.04	$346.50	$0.00		$0.00	$67.78	$0.00	$0.00	$68.95	$0.00	$0.00	$0.00	$0.00	$0.00
462.719S	SUP	HCPCS C1713		462.719S  -  NAIL INTRAMEDULLARY UNIVERSAL 7.5MM 19CM SOLID ROUND CROSS	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.723S	SUP	HCPCS C1713		462.723S  -  NAIL 7.5MM 23CM HUM IM SLD TI STRL	BOTH IP/OP	"$3,802.15 "	"$2,813.59"	$0.00	"$3,041.72"	"$1,710.97"	"$1,710.97"	$0.00	$0.00	$0.00	$792.46	"$2,821.96"	"$2,821.96"	$0.00	$0.00	$792.37	$0.00	"$1,874.46"	"$1,874.46"	$0.00	"$1,901.08"	"$3,011.30"	"$3,041.72"	$0.00		$0.00	$595.04	$0.00	$0.00	$605.30	$0.00	$0.00	$0.00	$0.00	$0.00
462.728S	SUP	HCPCS C1713		462.728S  -  NAIL INTRAMEDULLARY 7.5MM 280MM SOLID ROUND CROSS SECTION	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.729S	SUP	HCPCS C1713		462.729S  -  NAIL INTRAMEDULLARY 7.5MM 29.5CM SOLID BLUE TITANIUM HUMERUS	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.731S	SUP	HCPCS C1713		462.731S  -  NAIL INTRAMEDULLARY 7.5MM 31CM SOLID TITANIUM HUMERUS	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.732S	SUP	HCPCS C1713		462.732S  -  NAIL INTRAMEDULLARY 7.5MM 32.5CM SOLID TITANIUM HUMERUS	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.919S	SUP	HCPCS C1713		462.919S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 19CM SOLID FLUTED CROSS	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.920S	SUP	HCPCS C1713		462.920S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 20.5CM SOLID FLUTED	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.922S	SUP	HCPCS C1713		462.922S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 22CM SOLID FLUTED CROSS	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.923S	SUP	HCPCS C1713		462.923S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 23CM SOLID FLUTED CROSS	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.924S	SUP	HCPCS C1713		462.924S  -  NAIL INTRAMEDULLARY 9.5MM 240MM SOLID FLUTED CROSS SECTION	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.925S	SUP	HCPCS C1713		462.925S  -  NAIL 9.5MM 25CM HUM IM SLD TI STRL	BOTH IP/OP	"$3,802.15 "	"$2,813.59"	$0.00	"$3,041.72"	"$1,710.97"	"$1,710.97"	$0.00	$0.00	$0.00	$792.46	"$2,821.96"	"$2,821.96"	$0.00	$0.00	$792.37	$0.00	"$1,874.46"	"$1,874.46"	$0.00	"$1,901.08"	"$3,011.30"	"$3,041.72"	$0.00		$0.00	$595.04	$0.00	$0.00	$605.30	$0.00	$0.00	$0.00	$0.00	$0.00
462.927S	SUP	HCPCS C1713		462.927S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 27CM SOLID FLUTED CROSS	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.928S	SUP	HCPCS C1713		462.928S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 28CM SOLID FLUTED CROSS	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.929S	SUP	HCPCS C1713		462.929S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 29.5CM SOLID FLUTED	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.931S	SUP	HCPCS C1713		462.931S  -  NAIL INTRAMEDULLARY 9.5MM 31CM SOLID TITANIUM HUMERUS	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.932S	SUP	HCPCS C1713		462.932S  -  NAIL INTRAMEDULLARY 9.5MM 32.5CM SOLID TITANIUM HUMERUS	BOTH IP/OP	"$3,261.50 "	"$2,413.51"	$0.00	"$2,609.20"	"$1,467.68"	"$1,467.68"	$0.00	$0.00	$0.00	$679.78	"$2,420.69"	"$2,420.69"	$0.00	$0.00	$679.70	$0.00	"$1,607.92"	"$1,607.92"	$0.00	"$1,630.75"	"$2,583.11"	"$2,609.20"	$0.00		$0.00	$510.42	$0.00	$0.00	$519.23	$0.00	$0.00	$0.00	$0.00	$0.00
462.950S	SUP	Custom 27803010		462.950S  -  CAP END 5MM 2.5MM HEXAGONAL RECESS BLUE TITANIUM HUMERUS	BOTH IP/OP	$484.00 	$358.16	$0.00	$387.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.22	$359.22	$0.00	$0.00	$100.87	$0.00	$0.00	$0.00	$0.00	$242.00	$383.33	$387.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
462.955S	SUP	Custom 27803010		462.955S  -  CAP END 5MM HUM XTD IM NAIL TI STRL	BOTH IP/OP	$559.10 	$413.73	$0.00	$447.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$414.96	$414.96	$0.00	$0.00	$116.52	$0.00	$0.00	$0.00	$0.00	$279.55	$442.81	$447.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
462.960S	SUP	Custom 27803010		462.960S  -  CAP END HUM SLD IM NAIL TI STRL 10MM	BOTH IP/OP	$559.10 	$413.73	$0.00	$447.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$414.96	$414.96	$0.00	$0.00	$116.52	$0.00	$0.00	$0.00	$0.00	$279.55	$442.81	$447.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
462.965S	SUP	Custom 27803010		462.965S  -  CAP END 15MM 3.5MM HEXAGONAL RECESS BLUE TITANIUM HUMERUS	BOTH IP/OP	$484.00 	$358.16	$0.00	$387.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.22	$359.22	$0.00	$0.00	$100.87	$0.00	$0.00	$0.00	$0.00	$242.00	$383.33	$387.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
46-305	SUP	HCPCS C1769		46-305  -  GWIRE VASC STD .035IN 150CM 3CM ANG TIP STF SHFT GLDWR	BOTH IP/OP	$118.75 	$87.88	$0.00	$95.00	$64.48	$64.48	$0.00	$0.00	$0.00	$24.75	$88.14	$88.14	$0.00	$0.00	$24.75	$0.00	$70.24	$70.24	$0.00	$59.38	$94.05	$95.00	$0.00		$0.00	$18.58	$0.00	$0.00	$18.91	$0.00	$0.00	$0.00	$0.00	$0.00
464.30S	SUP	HCPCS C1713		464.30S  -  NAIL INTRAMEDULLARY 9MM 30CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
464.32S	SUP	HCPCS C1713		464.32S  -  NAIL INTRAMEDULLARY 9MM 32CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
464.34S	SUP	HCPCS C1713		464.34S  -  NAIL INTRAMEDULLARY 9MM 34CM SOLID TITANIUM FEMUR STERILE	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
464.36S	SUP	HCPCS C1713		464.36S  -  NAIL INTRAMEDULLARY 9MM 36CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
464.38S	SUP	HCPCS C1713		464.38S  -  NAIL INTRAMEDULLARY 9MM 38CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
464.40S	SUP	HCPCS C1713		464.40S  -  NAIL 9MM 40CM FEM IM SLD TI STRL GRN	BOTH IP/OP	"$2,344.43 "	"$1,734.88"	$0.00	"$1,875.54"	"$1,054.99"	"$1,054.99"	$0.00	$0.00	$0.00	$488.64	"$1,740.03"	"$1,740.03"	$0.00	$0.00	$488.58	$0.00	"$1,386.73"	"$1,386.73"	$0.00	"$1,172.21"	"$1,856.79"	"$1,875.54"	$0.00		$0.00	$366.90	$0.00	$0.00	$373.23	$0.00	$0.00	$0.00	$0.00	$0.00
464.42S	SUP	HCPCS C1713		464.42S  -  NAIL INTRAMEDULLARY 9MM 420MM CANN SOLID TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
464.44S	SUP	HCPCS C1713		464.44S  -  NAIL 9MM 44CM FEM IM SLD TI STRL	BOTH IP/OP	"$2,344.43 "	"$1,734.88"	$0.00	"$1,875.54"	"$1,054.99"	"$1,054.99"	$0.00	$0.00	$0.00	$488.64	"$1,740.03"	"$1,740.03"	$0.00	$0.00	$488.58	$0.00	"$1,386.73"	"$1,386.73"	$0.00	"$1,172.21"	"$1,856.79"	"$1,875.54"	$0.00		$0.00	$366.90	$0.00	$0.00	$373.23	$0.00	$0.00	$0.00	$0.00	$0.00
464.46S	SUP	HCPCS C1713		464.46S  -  NAIL INTRAMEDULLARY 9MM 46CM SOLID TITANIUM FEMUR STERILE	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
464.48S	SUP	HCPCS C1713		464.48S  -  NAIL INTRAMEDULLARY 9MM 48CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
465.30S	SUP	HCPCS C1713		465.30S  -  NAIL 10MM 30CM FEM IM SLD TI STRL GRN	BOTH IP/OP	"$2,344.43 "	"$1,734.88"	$0.00	"$1,875.54"	"$1,054.99"	"$1,054.99"	$0.00	$0.00	$0.00	$488.64	"$1,740.03"	"$1,740.03"	$0.00	$0.00	$488.58	$0.00	"$1,386.73"	"$1,386.73"	$0.00	"$1,172.21"	"$1,856.79"	"$1,875.54"	$0.00		$0.00	$366.90	$0.00	$0.00	$373.23	$0.00	$0.00	$0.00	$0.00	$0.00
465.32S	SUP	HCPCS C1713		465.32S  -  NAIL INTRAMEDULLARY 10MM 32CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
465.34S	SUP	HCPCS C1713		465.34S  -  NAIL INTRAMEDULLARY 10MM 34CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
465.36S	SUP	HCPCS C1713		465.36S  -  NAIL INTRAMEDULLARY 10MM 36CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
465.38S	SUP	HCPCS C1713		465.38S  -  NAIL 10MM 380MM FEM IM SLD TI STRL GRN	BOTH IP/OP	"$2,344.43 "	"$1,734.88"	$0.00	"$1,875.54"	"$1,054.99"	"$1,054.99"	$0.00	$0.00	$0.00	$488.64	"$1,740.03"	"$1,740.03"	$0.00	$0.00	$488.58	$0.00	"$1,386.73"	"$1,386.73"	$0.00	"$1,172.21"	"$1,856.79"	"$1,875.54"	$0.00		$0.00	$366.90	$0.00	$0.00	$373.23	$0.00	$0.00	$0.00	$0.00	$0.00
465.40S	SUP	HCPCS C1713		465.40S  -  NAIL INTRAMEDULLARY 10MM 40CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
465.42S	SUP	HCPCS C1713		465.42S  -  NAIL INTRAMEDULLARY 10MM 42CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
465.44S	SUP	HCPCS C1713		465.44S  -  NAIL INTRAMEDULLARY 10MM 44CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
465.46S	SUP	HCPCS C1713		465.46S  -  NAIL 10MM 46CM FEM IM SLD TI STRL GRN	BOTH IP/OP	"$2,344.43 "	"$1,734.88"	$0.00	"$1,875.54"	"$1,054.99"	"$1,054.99"	$0.00	$0.00	$0.00	$488.64	"$1,740.03"	"$1,740.03"	$0.00	$0.00	$488.58	$0.00	"$1,386.73"	"$1,386.73"	$0.00	"$1,172.21"	"$1,856.79"	"$1,875.54"	$0.00		$0.00	$366.90	$0.00	$0.00	$373.23	$0.00	$0.00	$0.00	$0.00	$0.00
465.48S	SUP	HCPCS C1713		465.48S  -  NAIL INTRAMEDULLARY 10MM 48CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
465440-20	SUP	Custom 27203010		CONTROL CRP SYN VIGIL HI SNS LVL C LOW MDLR DATA RDC 5ML LX	BOTH IP/OP	$366.68 	$271.34	$0.00	$293.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.34	$290.41	$293.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4655-03	SUP	HCPCS C1776		4655-03  -  HEAD FEM +5 UNV 32MM	BOTH IP/OP	"$2,607.50 "	"$1,929.55"	$0.00	"$2,086.00"	"$1,173.38"	"$1,173.38"	$0.00	$0.00	$0.00	$543.47	"$1,935.29"	"$1,935.29"	$0.00	$0.00	$543.40	$0.00	"$1,285.50"	"$1,285.50"	$0.00	"$1,303.75"	"$2,065.14"	"$2,086.00"	$0.00		$0.00	$408.07	$0.00	$0.00	$415.11	$0.00	$0.00	$0.00	$0.00	$0.00
466.30S	SUP	HCPCS C1713		466.30S  -  NAIL INTRAMEDULLARY 11MM 30CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
466.32S	SUP	HCPCS C1713		466.32S  -  NAIL INTRAMEDULLARY 11MM 32CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
466.34S	SUP	HCPCS C1713		466.34S  -  NAIL INTRAMEDULLARY 11MM 34CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
466.36S	SUP	HCPCS C1713		466.36S  -  NAIL 11MM 36CM FEM IM SLD TI STRL GRN	BOTH IP/OP	"$2,344.43 "	"$1,734.88"	$0.00	"$1,875.54"	"$1,054.99"	"$1,054.99"	$0.00	$0.00	$0.00	$488.64	"$1,740.03"	"$1,740.03"	$0.00	$0.00	$488.58	$0.00	"$1,386.73"	"$1,386.73"	$0.00	"$1,172.21"	"$1,856.79"	"$1,875.54"	$0.00		$0.00	$366.90	$0.00	$0.00	$373.23	$0.00	$0.00	$0.00	$0.00	$0.00
466.38S	SUP	HCPCS C1713		466.38S  -  NAIL INTRAMEDULLARY 11MM 38CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
466.40S	SUP	HCPCS C1713		466.40S  -  NAIL 11MM 40CM FEM IM SLD TI STRL GRN	BOTH IP/OP	"$2,344.43 "	"$1,734.88"	$0.00	"$1,875.54"	"$1,054.99"	"$1,054.99"	$0.00	$0.00	$0.00	$488.64	"$1,740.03"	"$1,740.03"	$0.00	$0.00	$488.58	$0.00	"$1,386.73"	"$1,386.73"	$0.00	"$1,172.21"	"$1,856.79"	"$1,875.54"	$0.00		$0.00	$366.90	$0.00	$0.00	$373.23	$0.00	$0.00	$0.00	$0.00	$0.00
466.42S	SUP	HCPCS C1713		466.42S  -  NAIL INTRAMEDULLARY 11MM 42CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
466.44S	SUP	HCPCS C1713		466.44S  -  NAIL INTRAMEDULLARY 11MM 44CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
466.46S	SUP	HCPCS C1713		466.46S  -  NAIL INTRAMEDULLARY 11MM 46CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
466.48S	SUP	HCPCS C1713		466.48S  -  NAIL INTRAMEDULLARY 11MM 48CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
46-605	SUP	HCPCS C1769		46-605  -  GWIRE VASC .018IN 260CM 3CM TIP SHRT TPR SPCL PLTN PLUS GLDX	BOTH IP/OP	$45.18 	$33.43	$0.00	$36.14	$24.53	$24.53	$0.00	$0.00	$0.00	$9.42	$33.53	$33.53	$0.00	$0.00	$9.41	$0.00	$26.72	$26.72	$0.00	$22.59	$35.78	$36.14	$0.00		$0.00	$7.07	$0.00	$0.00	$7.19	$0.00	$0.00	$0.00	$0.00	$0.00
466P306A	SUP	HCPCS C1884		466P306A  -  FILTER EMBL 55CM LF TRPS CATH SHTH INTRO KT	BOTH IP/OP	"$3,112.50 "	"$2,303.25"	$0.00	"$2,490.00"	"$1,400.63"	"$1,400.63"	$0.00	$0.00	$0.00	$648.72	"$2,310.10"	"$2,310.10"	$0.00	$0.00	$648.65	$0.00	"$1,534.46"	"$1,534.46"	$0.00	"$1,556.25"	"$2,465.10"	"$2,490.00"	$0.00		$0.00	$487.11	$0.00	$0.00	$495.51	$0.00	$0.00	$0.00	$0.00	$0.00
467.30S	SUP	HCPCS C1713		467.30S  -  NAIL 12MM 30CM FEM IM SLD TI STRL GRN	BOTH IP/OP	"$2,344.43 "	"$1,734.88"	$0.00	"$1,875.54"	"$1,054.99"	"$1,054.99"	$0.00	$0.00	$0.00	$488.64	"$1,740.03"	"$1,740.03"	$0.00	$0.00	$488.58	$0.00	"$1,386.73"	"$1,386.73"	$0.00	"$1,172.21"	"$1,856.79"	"$1,875.54"	$0.00		$0.00	$366.90	$0.00	$0.00	$373.23	$0.00	$0.00	$0.00	$0.00	$0.00
467.32S	SUP	HCPCS C1713		467.32S  -  NAIL INTRAMEDULLARY 12MM 32CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
467.34S	SUP	HCPCS C1713		467.34S  -  NAIL INTRAMEDULLARY 12MM 34CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
467.36S	SUP	HCPCS C1713		467.36S  -  NAIL INTRAMEDULLARY 12MM 36CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
467.38S	SUP	HCPCS C1713		467.38S  -  NAIL INTRAMEDULLARY 12MM 38CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
467.40S	SUP	HCPCS C1713		467.40S  -  NAIL 12MM 40CM FEM IM SLD TI STRL GRN	BOTH IP/OP	"$2,344.43 "	"$1,734.88"	$0.00	"$1,875.54"	"$1,054.99"	"$1,054.99"	$0.00	$0.00	$0.00	$488.64	"$1,740.03"	"$1,740.03"	$0.00	$0.00	$488.58	$0.00	"$1,386.73"	"$1,386.73"	$0.00	"$1,172.21"	"$1,856.79"	"$1,875.54"	$0.00		$0.00	$366.90	$0.00	$0.00	$373.23	$0.00	$0.00	$0.00	$0.00	$0.00
467.42S	SUP	HCPCS C1713		467.42S  -  NAIL INTRAMEDULLARY 12MM 420MM SOLID GREEN TITANIUM FEMORAL	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
467.44S	SUP	HCPCS C1713		467.44S  -  NAIL INTRAMEDULLARY 12MM 44CM SOLID GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,054.25 "	"$1,520.15"	$0.00	"$1,643.40"	$924.41	$924.41	$0.00	$0.00	$0.00	$428.16	"$1,524.66"	"$1,524.66"	$0.00	$0.00	$428.11	$0.00	"$1,215.09"	"$1,215.09"	$0.00	"$1,027.13"	"$1,626.97"	"$1,643.40"	$0.00		$0.00	$321.49	$0.00	$0.00	$327.04	$0.00	$0.00	$0.00	$0.00	$0.00
467.46S	SUP	HCPCS C1713		467.46S  -  NAIL 12MM 46CM FEM IM SLD TI STRL GRN	BOTH IP/OP	"$2,344.43 "	"$1,734.88"	$0.00	"$1,875.54"	"$1,054.99"	"$1,054.99"	$0.00	$0.00	$0.00	$488.64	"$1,740.03"	"$1,740.03"	$0.00	$0.00	$488.58	$0.00	"$1,386.73"	"$1,386.73"	$0.00	"$1,172.21"	"$1,856.79"	"$1,875.54"	$0.00		$0.00	$366.90	$0.00	$0.00	$373.23	$0.00	$0.00	$0.00	$0.00	$0.00
467.48S	SUP	HCPCS C1713		467.48S  -  NAIL 12MM 48CM FEM IM SLD TI STRL GRN	BOTH IP/OP	"$2,344.43 "	"$1,734.88"	$0.00	"$1,875.54"	"$1,054.99"	"$1,054.99"	$0.00	$0.00	$0.00	$488.64	"$1,740.03"	"$1,740.03"	$0.00	$0.00	$488.58	$0.00	"$1,386.73"	"$1,386.73"	$0.00	"$1,172.21"	"$1,856.79"	"$1,875.54"	$0.00		$0.00	$366.90	$0.00	$0.00	$373.23	$0.00	$0.00	$0.00	$0.00	$0.00
46-804	SUP	HCPCS C1769		46-804  -  GUIDEWIRE TRANSEND EX .014	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$509.06	$509.06	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
46-806	SUP	HCPCS C1769		GUIDEWIRE VASC .014IN 205CM 2CM SHP TIP SFTP TRNSD EX HYDPHI	BOTH IP/OP	$20.30 	$15.02	$0.00	$16.24	$11.02	$11.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.15	$16.08	$16.24	$0.00		$0.00	$3.18	$0.00	$0.00	$3.23	$0.00	$0.00	$0.00	$0.00	$0.00
46B005	SUP	HCPCS V2790		46B005  -  GRAFT SFT TIS 25X15X15MM PATLR TNDN TIB STRUT WHL	BOTH IP/OP	"$8,265.00 "	"$6,116.10"	$0.00	"$6,612.00"	"$3,719.25"	"$3,719.25"	$0.00	$0.00	$0.00	"$1,722.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,722.43"	$0.00	"$4,074.65"	"$4,074.65"	$0.00	"$4,132.50"	"$6,545.88"	"$6,612.00"	$0.00		$0.00	"$1,293.47"	$0.00	$0.00	"$1,315.79"	$0.00	$0.00	$0.00	$0.00	$0.00
47-2255-008-01	SUP	Custom 27203010		47-2255-008-01  -  GWIRE ORTH 100CM 3MM SS ANTGRD IM FIX SYS STRL	BOTH IP/OP	$251.25 	$185.93	$0.00	$201.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.48	$186.48	$0.00	$0.00	$52.36	$0.00	$0.00	$0.00	$0.00	$125.63	$198.99	$201.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
47-2483-060-50	SUP	HCPCS C1713		47-2483-060-50  -  SCREW BONE 3.5MM 5MM 60MM NTR NAIL TI6AL4V ALLOY CORT PTTHRD	BOTH IP/OP	$381.35 	$282.20	$0.00	$305.08	$171.61	$171.61	$0.00	$0.00	$0.00	$79.48	$283.04	$283.04	$0.00	$0.00	$79.47	$0.00	$225.57	$225.57	$0.00	$190.68	$302.03	$305.08	$0.00		$0.00	$59.68	$0.00	$0.00	$60.71	$0.00	$0.00	$0.00	$0.00	$0.00
47-2483-095-60	SUP	HCPCS C1713		47-2483-095-60  -  SCREW BONE 6MM 3.5MM 95MM NTR NAIL TI6AL4V ALLOY CANC PTTHRD	BOTH IP/OP	$426.30 	$315.46	$0.00	$341.04	$191.84	$191.84	$0.00	$0.00	$0.00	$88.85	$316.40	$316.40	$0.00	$0.00	$88.84	$0.00	$252.16	$252.16	$0.00	$213.15	$337.63	$341.04	$0.00		$0.00	$66.72	$0.00	$0.00	$67.87	$0.00	$0.00	$0.00	$0.00	$0.00
47-2484-042-50	SUP	HCPCS C1713		47-2484-042-50  -  SCREW BONE 5MM 42.5MM NTR NAIL TI6AL4V ALLOY FULTHD CORT	BOTH IP/OP	$381.35 	$282.20	$0.00	$305.08	$171.61	$171.61	$0.00	$0.00	$0.00	$79.48	$283.04	$283.04	$0.00	$0.00	$79.47	$0.00	$225.57	$225.57	$0.00	$190.68	$302.03	$305.08	$0.00		$0.00	$59.68	$0.00	$0.00	$60.71	$0.00	$0.00	$0.00	$0.00	$0.00
47-2484-045-50	SUP	HCPCS C1713		47-2484-045-50  -  SCREW BONE 5MM 45MM TI 3.5MM CORT FIXANG HX HD	BOTH IP/OP	$381.35 	$282.20	$0.00	$305.08	$171.61	$171.61	$0.00	$0.00	$0.00	$79.48	$283.04	$283.04	$0.00	$0.00	$79.47	$0.00	$225.57	$225.57	$0.00	$190.68	$302.03	$305.08	$0.00		$0.00	$59.68	$0.00	$0.00	$60.71	$0.00	$0.00	$0.00	$0.00	$0.00
47-2484-070-60	SUP	HCPCS C1713		47-2484-070-60  -  SCREW BONE 6MM 3.5MM 70MM NTR NAIL TI6AL4V ALLOY CANC FIXANG	BOTH IP/OP	$395.85 	$292.93	$0.00	$316.68	$178.13	$178.13	$0.00	$0.00	$0.00	$82.51	$293.80	$293.80	$0.00	$0.00	$82.50	$0.00	$234.15	$234.15	$0.00	$197.93	$313.51	$316.68	$0.00		$0.00	$61.95	$0.00	$0.00	$63.02	$0.00	$0.00	$0.00	$0.00	$0.00
47-2484-075-50	SUP	HCPCS C1713		47-2484-075-50  -  SCREW BONE 5MM 3.5MM 75MM NTR NAIL TI6AL4V ALLOY CORT FIXANG	BOTH IP/OP	$381.35 	$282.20	$0.00	$305.08	$171.61	$171.61	$0.00	$0.00	$0.00	$79.48	$283.04	$283.04	$0.00	$0.00	$79.47	$0.00	$225.57	$225.57	$0.00	$190.68	$302.03	$305.08	$0.00		$0.00	$59.68	$0.00	$0.00	$60.71	$0.00	$0.00	$0.00	$0.00	$0.00
47-2484-075-60	SUP	HCPCS C1713		47-2484-075-60  -  SCREW BONE 6MM 3.5MM 75MM NTR NAIL TI CANC FIXANG HEX HEAD	BOTH IP/OP	$395.85 	$292.93	$0.00	$316.68	$178.13	$178.13	$0.00	$0.00	$0.00	$82.51	$293.80	$293.80	$0.00	$0.00	$82.50	$0.00	$234.15	$234.15	$0.00	$197.93	$313.51	$316.68	$0.00		$0.00	$61.95	$0.00	$0.00	$63.02	$0.00	$0.00	$0.00	$0.00	$0.00
47-2484-095-60	SUP	HCPCS C1713		47-2484-095-60  -  SCREW BONE 6MM 3.5MM 95MM NTR NAIL TI CANC FIXANG HEX HEAD	BOTH IP/OP	$395.85 	$292.93	$0.00	$316.68	$178.13	$178.13	$0.00	$0.00	$0.00	$82.51	$293.80	$293.80	$0.00	$0.00	$82.50	$0.00	$234.15	$234.15	$0.00	$197.93	$313.51	$316.68	$0.00		$0.00	$61.95	$0.00	$0.00	$63.02	$0.00	$0.00	$0.00	$0.00	$0.00
47-2485-095-10	SUP	HCPCS C1713		47-2485-095-10  -  SCREW BONE 10.5MM 95MM NTR NAIL TI6AL4V ALLOY LAG	BOTH IP/OP	"$1,074.45 "	$795.09	$0.00	$859.56	$483.50	$483.50	$0.00	$0.00	$0.00	$223.94	$797.46	$797.46	$0.00	$0.00	$223.92	$0.00	$635.54	$635.54	$0.00	$537.23	$850.96	$859.56	$0.00		$0.00	$168.15	$0.00	$0.00	$171.05	$0.00	$0.00	$0.00	$0.00	$0.00
47-2487-001-00	SUP	HCPCS C1713		47-2487-001-00  -  NAIL FEM IM 0MM ANTGRD CAP	BOTH IP/OP	$411.80 	$304.73	$0.00	$329.44	$185.31	$185.31	$0.00	$0.00	$0.00	$85.83	$305.64	$305.64	$0.00	$0.00	$85.82	$0.00	$243.58	$243.58	$0.00	$205.90	$326.15	$329.44	$0.00		$0.00	$64.45	$0.00	$0.00	$65.56	$0.00	$0.00	$0.00	$0.00	$0.00
47-2487-002-00	SUP	HCPCS C1713		47-2487-002-00  -  CAP END 0MM CEPHALOMEDULLARY NAIL TI6AL4V ALLOY NTR NAIL	BOTH IP/OP	$395.85 	$292.93	$0.00	$316.68	$178.13	$178.13	$0.00	$0.00	$0.00	$82.51	$293.80	$293.80	$0.00	$0.00	$82.50	$0.00	$234.15	$234.15	$0.00	$197.93	$313.51	$316.68	$0.00		$0.00	$61.95	$0.00	$0.00	$63.02	$0.00	$0.00	$0.00	$0.00	$0.00
47-2487-005-00	SUP	HCPCS C1713		47-2487-005-00  -  CAP END 0MM TIB Z NTR NAIL	BOTH IP/OP	$411.80 	$304.73	$0.00	$329.44	$185.31	$185.31	$0.00	$0.00	$0.00	$85.83	$305.64	$305.64	$0.00	$0.00	$85.82	$0.00	$243.58	$243.58	$0.00	$205.90	$326.15	$329.44	$0.00		$0.00	$64.45	$0.00	$0.00	$65.56	$0.00	$0.00	$0.00	$0.00	$0.00
47-2487-008-00	SUP	HCPCS C1713		47-2487-008-00  -  CAP END 0MM FEM RTRGRD TI ALLOY NTR NAIL	BOTH IP/OP	$411.80 	$304.73	$0.00	$329.44	$185.31	$185.31	$0.00	$0.00	$0.00	$85.83	$305.64	$305.64	$0.00	$0.00	$85.82	$0.00	$243.58	$243.58	$0.00	$205.90	$326.15	$329.44	$0.00		$0.00	$64.45	$0.00	$0.00	$65.56	$0.00	$0.00	$0.00	$0.00	$0.00
47-2488-000-01	SUP	HCPCS C1713		47-2488-000-01  -  NUT ORTH CORT FEM KNEE TI RTRGRD 6 MM CANC SCR NTR NAIL SYS	BOTH IP/OP	$208.00 	$153.92	$0.00	$166.40	$93.60	$93.60	$0.00	$0.00	$0.00	$43.35	$154.38	$154.38	$0.00	$0.00	$43.35	$0.00	$123.03	$123.03	$0.00	$104.00	$164.74	$166.40	$0.00		$0.00	$32.55	$0.00	$0.00	$33.11	$0.00	$0.00	$0.00	$0.00	$0.00
47-2488-000-02	SUP	HCPCS C1713		47-2488-000-02  -  WASHER CORT NTR NAIL ORTH TI ALLOY STRL	BOTH IP/OP	$175.50 	$129.87	$0.00	$140.40	$78.98	$78.98	$0.00	$0.00	$0.00	$36.58	$130.26	$130.26	$0.00	$0.00	$36.57	$0.00	$103.81	$103.81	$0.00	$87.75	$139.00	$140.40	$0.00		$0.00	$27.47	$0.00	$0.00	$27.94	$0.00	$0.00	$0.00	$0.00	$0.00
47-2491-360-12	SUP	HCPCS C1713		47-2491-360-12  -  NAIL 12MM 36CM PIRIFORMIS FOSSA FEM NTR NAIL IM UNV ANTGRD	BOTH IP/OP	"$3,408.95 "	"$2,522.62"	$0.00	"$2,727.16"	"$1,534.03"	"$1,534.03"	$0.00	$0.00	$0.00	$710.51	"$2,530.12"	"$2,530.12"	$0.00	$0.00	$710.43	$0.00	"$1,680.61"	"$1,680.61"	$0.00	"$1,704.48"	"$2,699.89"	"$2,727.16"	$0.00		$0.00	$533.50	$0.00	$0.00	$542.70	$0.00	$0.00	$0.00	$0.00	$0.00
47-2492-360-12	SUP	HCPCS C1713		47-2492-360-12  -  NAIL 12MM 36CM RIGHT GT IM	BOTH IP/OP	"$3,408.95 "	"$2,522.62"	$0.00	"$2,727.16"	"$1,534.03"	"$1,534.03"	$0.00	$0.00	$0.00	$710.51	"$2,530.12"	"$2,530.12"	$0.00	$0.00	$710.43	$0.00	"$1,680.61"	"$1,680.61"	$0.00	"$1,704.48"	"$2,699.89"	"$2,727.16"	$0.00		$0.00	$533.50	$0.00	$0.00	$542.70	$0.00	$0.00	$0.00	$0.00	$0.00
47-2493-210-11	SUP	HCPCS C1713		47-2493-210-11  -  NAIL 11.5MM 21.5CM RIGHT DPHSL CEPHALOMEDULLARY NTR NAIL IM	BOTH IP/OP	"$2,965.25 "	"$2,194.29"	$0.00	"$2,372.20"	"$1,334.36"	"$1,334.36"	$0.00	$0.00	$0.00	$618.03	"$2,200.81"	"$2,200.81"	$0.00	$0.00	$617.96	$0.00	"$1,461.87"	"$1,461.87"	$0.00	"$1,482.63"	"$2,348.48"	"$2,372.20"	$0.00		$0.00	$464.06	$0.00	$0.00	$472.07	$0.00	$0.00	$0.00	$0.00	$0.00
47-2493-360-11	SUP	HCPCS C1713		47-2493-360-11  -  NAIL 11.5MM 36CM RIGHT DPHSL CEPHALOMEDULLARY NTR NAIL IM	BOTH IP/OP	"$4,463.10 "	"$3,302.69"	$0.00	"$3,570.48"	"$2,008.40"	"$2,008.40"	$0.00	$0.00	$0.00	$930.22	"$3,312.51"	"$3,312.51"	$0.00	$0.00	$930.11	$0.00	"$2,200.31"	"$2,200.31"	$0.00	"$2,231.55"	"$3,534.78"	"$3,570.48"	$0.00		$0.00	$698.48	$0.00	$0.00	$710.53	$0.00	$0.00	$0.00	$0.00	$0.00
47-2494-200-11	SUP	HCPCS C1713		47-2494-200-11  -  NAIL 11.5MM 20CM FEM NTR NAIL IM UNV SHRT RTRGRD TI ALLOY	BOTH IP/OP	"$4,218.05 "	"$3,121.36"	$0.00	"$3,374.44"	"$1,898.12"	"$1,898.12"	$0.00	$0.00	$0.00	$879.15	"$3,130.64"	"$3,130.64"	$0.00	$0.00	$879.04	$0.00	"$2,079.50"	"$2,079.50"	$0.00	"$2,109.03"	"$3,340.70"	"$3,374.44"	$0.00		$0.00	$660.12	$0.00	$0.00	$671.51	$0.00	$0.00	$0.00	$0.00	$0.00
47-2494-360-11	SUP	HCPCS C1713		47-2494-360-11  -  NAIL 11.5MM 36CM FEM NTR NAIL IM UNV LNG RTRGRD TI	BOTH IP/OP	"$4,218.05 "	"$3,121.36"	$0.00	"$3,374.44"	"$1,898.12"	"$1,898.12"	$0.00	$0.00	$0.00	$879.15	"$3,130.64"	"$3,130.64"	$0.00	$0.00	$879.04	$0.00	"$2,079.50"	"$2,079.50"	$0.00	"$2,109.03"	"$3,340.70"	"$3,374.44"	$0.00		$0.00	$660.12	$0.00	$0.00	$671.51	$0.00	$0.00	$0.00	$0.00	$0.00
47-2495-320-12	SUP	HCPCS C1713		47-2495-320-12  -  NAIL 12MM 32CM TIB NTR NAIL IM UNV TI6AL4V	BOTH IP/OP	"$3,240.75 "	"$2,398.16"	$0.00	"$2,592.60"	"$1,458.34"	"$1,458.34"	$0.00	$0.00	$0.00	$675.45	"$2,405.28"	"$2,405.28"	$0.00	$0.00	$675.37	$0.00	"$1,597.69"	"$1,597.69"	$0.00	"$1,620.38"	"$2,566.67"	"$2,592.60"	$0.00		$0.00	$507.18	$0.00	$0.00	$515.93	$0.00	$0.00	$0.00	$0.00	$0.00
474.031S	SUP	HCPCS C1713		474.031S  -  NAIL 10MM 30CM FEM IM CANN TI STRL GRN	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.032S	SUP	HCPCS C1713		474.032S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM CANN ROUND BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.034S	SUP	HCPCS C1713		474.034S  -  NAIL INTRAMEDULLARY 10MM 34CM CANN GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.036S	SUP	HCPCS C1713		474.036S  -  NAIL 10MM 36CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.038S	SUP	HCPCS C1713		474.038S  -  NAIL 10MM 38CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.041S	SUP	HCPCS C1713		474.041S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM CANN ROUND BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.042S	SUP	HCPCS C1713		474.042S  -  NAIL 10MM 42CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.044S	SUP	HCPCS C1713		474.044S  -  NAIL 10MM 44CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.046S	SUP	HCPCS C1713		474.046S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 460MM CANN ROUND BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.048S	SUP	HCPCS C1713		474.048S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 480MM CANN ROUND BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.131S	SUP	HCPCS C1713		474.131S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.132S	SUP	HCPCS C1713		474.132S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 320MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.134S	SUP	HCPCS C1713		474.134S  -  NAIL 11MM 34CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.136S	SUP	HCPCS C1713		474.136S  -  NAIL 11MM 36CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.138S	SUP	HCPCS C1713		474.138S  -  NAIL 11MM 38CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.141S	SUP	HCPCS C1713		474.141S  -  NAIL 11MM 41CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.142S	SUP	HCPCS C1713		474.142S  -  NAIL 11MM 42CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.144S	SUP	HCPCS C1713		474.144S  -  NAIL 11MM 44CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.146S	SUP	HCPCS C1713		474.146S  -  NAIL 11MM 46CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.148S	SUP	HCPCS C1713		474.148S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 480MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.231S	SUP	HCPCS C1713		474.231S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.232S	SUP	HCPCS C1713		474.232S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 320MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.234S	SUP	HCPCS C1713		474.234S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 340MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.236S	SUP	HCPCS C1713		474.236S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.238S	SUP	HCPCS C1713		474.238S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.241S	SUP	HCPCS C1713		474.241S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 400MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.242S	SUP	HCPCS C1713		474.242S  -  NAIL 12MM 42CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.244S	SUP	HCPCS C1713		474.244S  -  NAIL 12MM 44CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.246S	SUP	HCPCS C1713		474.246S  -  NAIL INTRAMEDULLARY 12MM 460MM CANN GREEN TITANIUM FEMUR	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.248S	SUP	HCPCS C1713		474.248S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 480MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.331S	SUP	HCPCS C1713		474.331S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.332S	SUP	HCPCS C1713		474.332S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.334S	SUP	HCPCS C1713		474.334S  -  NAIL 13MM 34CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.336S	SUP	HCPCS C1713		474.336S  -  NAIL 13MM 36CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.338S	SUP	HCPCS C1713		474.338S  -  NAIL 13MM 38CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.341S	SUP	HCPCS C1713		474.341S  -  NAIL 13MM 40CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.342S	SUP	HCPCS C1713		474.342S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 420MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.344S	SUP	HCPCS C1713		474.344S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 440MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.346S	SUP	HCPCS C1713		474.346S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 460MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.348S	SUP	HCPCS C1713		474.348S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 480MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.431S	SUP	HCPCS C1713		474.431S  -  NAIL 14MM 30CM FEM IM CANN TI STRL GRN	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.432S	SUP	HCPCS C1713		474.432S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 320MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.434S	SUP	HCPCS C1713		474.434S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 340MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.436S	SUP	HCPCS C1713		474.436S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 360MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.438S	SUP	HCPCS C1713		474.438S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 380MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.441S	SUP	HCPCS C1713		474.441S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 400MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.442S	SUP	HCPCS C1713		474.442S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 420MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.444S	SUP	HCPCS C1713		474.444S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 440MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.446S	SUP	HCPCS C1713		474.446S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 460MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.448S	SUP	HCPCS C1713		474.448S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 480MM CANN FLUTED BARREL	BOTH IP/OP	"$2,492.88 "	"$1,844.73"	$0.00	"$1,994.30"	"$1,121.79"	"$1,121.79"	$0.00	$0.00	$0.00	$519.58	"$1,850.21"	"$1,850.21"	$0.00	$0.00	$519.52	$0.00	"$1,474.54"	"$1,474.54"	$0.00	"$1,246.44"	"$1,974.36"	"$1,994.30"	$0.00		$0.00	$390.13	$0.00	$0.00	$396.87	$0.00	$0.00	$0.00	$0.00	$0.00
474.531S	SUP	HCPCS C1713		474.531S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 300MM CANN FLUTED BARREL	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	"$1,158.30"	"$1,158.30"	$0.00	$0.00	$0.00	$536.49	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	"$1,268.98"	"$1,268.98"	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$402.83	$0.00	$0.00	$409.78	$0.00	$0.00	$0.00	$0.00	$0.00
474.532S	SUP	HCPCS C1713		474.532S  -  NAIL 15MM 32CM FEM IM CANN TI STRL GRN	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.534S	SUP	HCPCS C1713		474.534S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 340MM CANN FLUTED BARREL	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	"$1,158.30"	"$1,158.30"	$0.00	$0.00	$0.00	$536.49	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	"$1,268.98"	"$1,268.98"	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$402.83	$0.00	$0.00	$409.78	$0.00	$0.00	$0.00	$0.00	$0.00
474.536S	SUP	HCPCS C1713		474.536S  -  NAIL 15MM 36CM FEM IM CANN TI STRL GRN	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.538S	SUP	HCPCS C1713		474.538S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 380MM CANN FLUTED BARREL	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	"$1,158.30"	"$1,158.30"	$0.00	$0.00	$0.00	$536.49	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	"$1,268.98"	"$1,268.98"	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$402.83	$0.00	$0.00	$409.78	$0.00	$0.00	$0.00	$0.00	$0.00
474.541S	SUP	HCPCS C1713		474.541S  -  NAIL 15MM 40CM FEM IM CANN TI STRL	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.542S	SUP	HCPCS C1713		474.542S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 420MM CANN FLUTED BARREL	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	"$1,158.30"	"$1,158.30"	$0.00	$0.00	$0.00	$536.49	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	"$1,268.98"	"$1,268.98"	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$402.83	$0.00	$0.00	$409.78	$0.00	$0.00	$0.00	$0.00	$0.00
474.544S	SUP	HCPCS C1713		474.544S  -  NAIL 15MM 44CM FEM IM CANN TI STRL GRN	BOTH IP/OP	"$2,956.30 "	"$2,187.66"	$0.00	"$2,365.04"	"$1,330.34"	"$1,330.34"	$0.00	$0.00	$0.00	$616.17	"$2,194.17"	"$2,194.17"	$0.00	$0.00	$616.09	$0.00	"$1,457.46"	"$1,457.46"	$0.00	"$1,478.15"	"$2,341.39"	"$2,365.04"	$0.00		$0.00	$462.66	$0.00	$0.00	$470.64	$0.00	$0.00	$0.00	$0.00	$0.00
474.546S	SUP	HCPCS C1713		474.546S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 460MM CANN FLUTED BARREL	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	"$1,158.30"	"$1,158.30"	$0.00	$0.00	$0.00	$536.49	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	"$1,268.98"	"$1,268.98"	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$402.83	$0.00	$0.00	$409.78	$0.00	$0.00	$0.00	$0.00	$0.00
474.548S	SUP	HCPCS C1713		474.548S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 480MM CANN FLUTED BARREL	BOTH IP/OP	"$2,574.00 "	"$1,904.76"	$0.00	"$2,059.20"	"$1,158.30"	"$1,158.30"	$0.00	$0.00	$0.00	$536.49	"$1,910.42"	"$1,910.42"	$0.00	$0.00	$536.42	$0.00	"$1,268.98"	"$1,268.98"	$0.00	"$1,287.00"	"$2,038.61"	"$2,059.20"	$0.00		$0.00	$402.83	$0.00	$0.00	$409.78	$0.00	$0.00	$0.00	$0.00	$0.00
474.900S	SUP	HCPCS C1713		474.900S  -  SLEEVE LCK STD GRN STRL TI FEM 13-15MM NL	BOTH IP/OP	$669.63 	$495.53	$0.00	$535.70	$301.33	$301.33	$0.00	$0.00	$0.00	$139.57	$497.00	$497.00	$0.00	$0.00	$139.55	$0.00	$396.08	$396.08	$0.00	$334.81	$530.35	$535.70	$0.00		$0.00	$104.80	$0.00	$0.00	$106.60	$0.00	$0.00	$0.00	$0.00	$0.00
474.910S	SUP	HCPCS C1713		474.910S  -  SLEEVE LOCKING 100D BLUE TITANIUM FEMUR STERILE 13-15MM CANN	BOTH IP/OP	$756.25 	$559.63	$0.00	$605.00	$340.31	$340.31	$0.00	$0.00	$0.00	$157.62	$561.29	$561.29	$0.00	$0.00	$157.60	$0.00	$447.32	$447.32	$0.00	$378.13	$598.95	$605.00	$0.00		$0.00	$118.35	$0.00	$0.00	$120.40	$0.00	$0.00	$0.00	$0.00	$0.00
474.911S	SUP	HCPCS C1713		474.911S  -  SLEEVE LOCKING 110D BLUE TITANIUM FEMUR STERILE 13-15MM CANN	BOTH IP/OP	$756.25 	$559.63	$0.00	$605.00	$340.31	$340.31	$0.00	$0.00	$0.00	$157.62	$561.29	$561.29	$0.00	$0.00	$157.60	$0.00	$447.32	$447.32	$0.00	$378.13	$598.95	$605.00	$0.00		$0.00	$118.35	$0.00	$0.00	$120.40	$0.00	$0.00	$0.00	$0.00	$0.00
474.912S	SUP	HCPCS C1713		474.912S  -  SLEEVE LOCKING 120D BLUE TITANIUM FEMUR STERILE 13-15MM CANN	BOTH IP/OP	$756.25 	$559.63	$0.00	$605.00	$340.31	$340.31	$0.00	$0.00	$0.00	$157.62	$561.29	$561.29	$0.00	$0.00	$157.60	$0.00	$447.32	$447.32	$0.00	$378.13	$598.95	$605.00	$0.00		$0.00	$118.35	$0.00	$0.00	$120.40	$0.00	$0.00	$0.00	$0.00	$0.00
474.913S	SUP	HCPCS C1713		474.913S  -  SLEEVE LOCKING 130D ANTEGRADE PINK TITANIUM FEMUR STERILE	BOTH IP/OP	$756.25 	$559.63	$0.00	$605.00	$340.31	$340.31	$0.00	$0.00	$0.00	$157.62	$561.29	$561.29	$0.00	$0.00	$157.60	$0.00	$447.32	$447.32	$0.00	$378.13	$598.95	$605.00	$0.00		$0.00	$118.35	$0.00	$0.00	$120.40	$0.00	$0.00	$0.00	$0.00	$0.00
474.920S	SUP	Custom 27803010		474.920S  -  CAP END 0MM 15MM EXTEND GREEN TITANIUM FEMUR STERILE 13-15MM	BOTH IP/OP	$446.88 	$330.69	$0.00	$357.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.67	$331.67	$0.00	$0.00	$93.13	$0.00	$0.00	$0.00	$0.00	$223.44	$353.93	$357.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
474.921S	SUP	Custom 27803010		474.921S  -  CAP END 10MM 15MM EXTEND GREEN TITANIUM FEMUR STERILE 13-15	BOTH IP/OP	$446.88 	$330.69	$0.00	$357.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.67	$331.67	$0.00	$0.00	$93.13	$0.00	$0.00	$0.00	$0.00	$223.44	$353.93	$357.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
474.922S	SUP	Custom 27803010		474.922S  -  CAP END 20MM 15MM EXTEND GREEN TITANIUM FEMUR STERILE 13-15	BOTH IP/OP	$446.88 	$330.69	$0.00	$357.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.67	$331.67	$0.00	$0.00	$93.13	$0.00	$0.00	$0.00	$0.00	$223.44	$353.93	$357.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
475.900S	SUP	Custom 27803010		475.900S  -  CAP END GREEN TITANIUM STERILE 3-4MM ELAST INTRAMEDULLARY	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$0.00	$0.00	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
475.905S	SUP	Custom 27803010		475.905S  -  CAP END ROSE RED TAN STERILE TEN SYSTEM	BOTH IP/OP	$247.40 	$183.08	$0.00	$192.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.62	$183.62	$0.00	$0.00	$51.56	$0.00	$0.00	$0.00	$0.00	$120.10	$190.24	$192.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
475.915S	SUP	HCPCS C1713		475.915S  -  NAIL INTRAMEDULLARY 1.5MM 300MM ELAST PURPLE TITANIUM	BOTH IP/OP	$572.13 	$423.38	$0.00	$444.36	$249.95	$249.95	$0.00	$0.00	$0.00	$119.25	$424.63	$424.63	$0.00	$0.00	$119.23	$0.00	$338.41	$338.41	$0.00	$277.73	$439.92	$444.36	$0.00		$0.00	$84.40	$0.00	$0.00	$88.43	$0.00	$0.00	$0.00	$0.00	$0.00
475.920S	SUP	HCPCS C1713		475.920S  -  NAIL INTRAMEDULLARY 2MM 440MM ELAST GREEN TITANIUM OLECRANON	BOTH IP/OP	$604.45 	$447.29	$0.00	$469.48	$264.08	$264.08	$0.00	$0.00	$0.00	$125.98	$448.62	$448.62	$0.00	$0.00	$125.97	$0.00	$357.53	$357.53	$0.00	$293.43	$464.79	$469.48	$0.00		$0.00	$89.17	$0.00	$0.00	$93.43	$0.00	$0.00	$0.00	$0.00	$0.00
475.925S	SUP	HCPCS C1713		475.925S  -  NAIL INTRAMEDULLARY 2.5MM 440MM ELAST PINK TITANIUM	BOTH IP/OP	$642.40 	$475.38	$0.00	$498.96	$280.67	$280.67	$0.00	$0.00	$0.00	$133.89	$476.79	$476.79	$0.00	$0.00	$133.88	$0.00	$379.98	$379.98	$0.00	$311.85	$493.97	$498.96	$0.00		$0.00	$94.76	$0.00	$0.00	$99.29	$0.00	$0.00	$0.00	$0.00	$0.00
475.930S	SUP	HCPCS C1713		475.930S  -  NAIL INTRAMEDULLARY 3MM 440MM ELAST GOLD TITANIUM OLECRANON	BOTH IP/OP	$674.73 	$499.30	$0.00	$524.06	$294.78	$294.78	$0.00	$0.00	$0.00	$140.63	$500.78	$500.78	$0.00	$0.00	$140.61	$0.00	$399.10	$399.10	$0.00	$327.54	$518.82	$524.06	$0.00		$0.00	$99.53	$0.00	$0.00	$104.29	$0.00	$0.00	$0.00	$0.00	$0.00
475.935S	SUP	HCPCS C1713		475.935S  -  NAIL INTRAMEDULLARY 3.5MM 440MM ELAST BLUE TITANIUM	BOTH IP/OP	$707.08 	$523.24	$0.00	$549.18	$308.91	$308.91	$0.00	$0.00	$0.00	$147.37	$524.79	$524.79	$0.00	$0.00	$147.35	$0.00	$418.23	$418.23	$0.00	$343.24	$543.69	$549.18	$0.00		$0.00	$104.30	$0.00	$0.00	$109.29	$0.00	$0.00	$0.00	$0.00	$0.00
475.940S	SUP	HCPCS C1713		475.940S  -  NAIL INTRAMEDULLARY 4MM 440MM ELAST PURPLE TITANIUM	BOTH IP/OP	$752.05 	$556.52	$0.00	$584.12	$328.57	$328.57	$0.00	$0.00	$0.00	$156.75	$558.17	$558.17	$0.00	$0.00	$156.73	$0.00	$444.84	$444.84	$0.00	$365.08	$578.28	$584.12	$0.00		$0.00	$110.94	$0.00	$0.00	$116.24	$0.00	$0.00	$0.00	$0.00	$0.00
47525P	SUP	HCPCS C1713		47525P  -  SCREW BN 4.75MM 25MM SPRL R90D MULTIANGLE LCK TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47525S	SUP	HCPCS C1713		47525S  -  SCREW BN STD 4.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47530P	SUP	HCPCS C1713		47530P  -  SCREW BN 4.75MM 30MM SPRL R90D MULTIANGLE LCK TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47530S	SUP	HCPCS C1713		47530S  -  SCREW BN STD 4.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47535P	SUP	HCPCS C1713		47535P  -  SCREW BN 4.75MM 35MM SPRL R90D MULTIANGLE LCK TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47535S	SUP	HCPCS C1713		47535S  -  SCREW BN STD 4.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47540P	SUP	HCPCS C1713		47540P  -  SCREW BN 4.75MM 40MM SPRL R90D MULTIANGLE LCK TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47540S	SUP	HCPCS C1713		47540S  -  SCREW BN STD 4.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47545P	SUP	HCPCS C1713		47545P  -  SCREW BN 4.75MM 45MM SPRL R90D MULTIANGLE LCK TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47545S	SUP	HCPCS C1713		47545S  -  SCREW BN STD 4.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47550P	SUP	HCPCS C1713		47550P  -  SCREW BN 4.75MM 50MM SPRL R90D MULTIANGLE LCK TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47550S	SUP	HCPCS C1713		47550S  -  SCREW BN STD 4.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47555P	SUP	HCPCS C1713		47555P  -  SCREW BN 4.75MM 55MM SPRL R90D MULTIANGLE LCK TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
47555S	SUP	HCPCS C1713		47555S  -  SCREW BN STD 4.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
476.25S	SUP	HCPCS C1713		476.25S  -  NAIL INTRAMEDULLARY 10MM 25.5CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
476.27S	SUP	HCPCS C1713		476.27S  -  NAIL INTRAMEDULLARY 10MM 27CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
476.28S	SUP	HCPCS C1713		476.28S  -  NAIL INTRAMEDULLARY 10MM 28.5CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
476.30S	SUP	HCPCS C1713		476.30S  -  NAIL INTRAMEDULLARY 10MM 30CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
476.31S	SUP	HCPCS C1713		476.31S  -  NAIL INTRAMEDULLARY 10MM 31.5CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
476.33S	SUP	HCPCS C1713		476.33S  -  NAIL INTRAMEDULLARY 10MM 33CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
476.34S	SUP	HCPCS C1713		476.34S  -  NAIL INTRAMEDULLARY 10MM 34.5CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
476.36S	SUP	HCPCS C1713		476.36S  -  NAIL INTRAMEDULLARY 10MM 36CM SOLID BLUE TITANIUM TIBIA	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
476.38S	SUP	HCPCS C1713		476.38S  -  NAIL INTRAMEDULLARY 10MM 38CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
476.40S	SUP	HCPCS C1713		476.40S  -  NAIL INTRAMEDULLARY 10MM 40CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
476.42S	SUP	HCPCS C1713		476.42S  -  NAIL INTRAMEDULLARY 10MM 42CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
478.25S	SUP	HCPCS C1713		478.25S  -  NAIL INTRAMEDULLARY 8MM 25.5CM SOLID BLUE TITANIUM TIBIA	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
478.27S	SUP	HCPCS C1713		478.27S  -  NAIL 8MM 27CM TIB IM SLD TI STRL	BOTH IP/OP	"$2,814.73 "	"$2,082.90"	$0.00	"$2,251.78"	"$1,266.63"	"$1,266.63"	$0.00	$0.00	$0.00	$586.66	"$2,089.09"	"$2,089.09"	$0.00	$0.00	$586.59	$0.00	"$1,387.66"	"$1,387.66"	$0.00	"$1,407.36"	"$2,229.27"	"$2,251.78"	$0.00		$0.00	$440.50	$0.00	$0.00	$448.10	$0.00	$0.00	$0.00	$0.00	$0.00
478.28S	SUP	HCPCS C1713		478.28S  -  NAIL INTRAMEDULLARY 8MM 28.5CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,450.25 "	"$1,813.19"	$0.00	"$1,960.20"	"$1,102.61"	"$1,102.61"	$0.00	$0.00	$0.00	$510.69	"$1,818.58"	"$1,818.58"	$0.00	$0.00	$510.63	$0.00	"$1,449.32"	"$1,449.32"	$0.00	"$1,225.13"	"$1,940.60"	"$1,960.20"	$0.00		$0.00	$383.46	$0.00	$0.00	$390.08	$0.00	$0.00	$0.00	$0.00	$0.00
478.30S	SUP	HCPCS C1713		478.30S  -  NAIL INTRAMEDULLARY 8MM 30CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,450.25 "	"$1,813.19"	$0.00	"$1,960.20"	"$1,102.61"	"$1,102.61"	$0.00	$0.00	$0.00	$510.69	"$1,818.58"	"$1,818.58"	$0.00	$0.00	$510.63	$0.00	"$1,449.32"	"$1,449.32"	$0.00	"$1,225.13"	"$1,940.60"	"$1,960.20"	$0.00		$0.00	$383.46	$0.00	$0.00	$390.08	$0.00	$0.00	$0.00	$0.00	$0.00
478.31S	SUP	HCPCS C1713		478.31S  -  NAIL 8MM 31.5CM TIB IM SLD TI STRL	BOTH IP/OP	"$2,814.73 "	"$2,082.90"	$0.00	"$2,251.78"	"$1,266.63"	"$1,266.63"	$0.00	$0.00	$0.00	$586.66	"$2,089.09"	"$2,089.09"	$0.00	$0.00	$586.59	$0.00	"$1,387.66"	"$1,387.66"	$0.00	"$1,407.36"	"$2,229.27"	"$2,251.78"	$0.00		$0.00	$440.50	$0.00	$0.00	$448.10	$0.00	$0.00	$0.00	$0.00	$0.00
478.33S	SUP	HCPCS C1713		478.33S  -  NAIL 8MM 33CM TIB IM SLD TI STRL	BOTH IP/OP	"$2,814.73 "	"$2,082.90"	$0.00	"$2,251.78"	"$1,266.63"	"$1,266.63"	$0.00	$0.00	$0.00	$586.66	"$2,089.09"	"$2,089.09"	$0.00	$0.00	$586.59	$0.00	"$1,387.66"	"$1,387.66"	$0.00	"$1,407.36"	"$2,229.27"	"$2,251.78"	$0.00		$0.00	$440.50	$0.00	$0.00	$448.10	$0.00	$0.00	$0.00	$0.00	$0.00
478.34S	SUP	HCPCS C1713		478.34S  -  NAIL 8MM 34.5CM TIB IM SLD TI STRL	BOTH IP/OP	"$2,814.73 "	"$2,082.90"	$0.00	"$2,251.78"	"$1,266.63"	"$1,266.63"	$0.00	$0.00	$0.00	$586.66	"$2,089.09"	"$2,089.09"	$0.00	$0.00	$586.59	$0.00	"$1,387.66"	"$1,387.66"	$0.00	"$1,407.36"	"$2,229.27"	"$2,251.78"	$0.00		$0.00	$440.50	$0.00	$0.00	$448.10	$0.00	$0.00	$0.00	$0.00	$0.00
478.36S	SUP	HCPCS C1713		478.36S  -  NAIL 8MM 36CM TIB IM SLD TI STRL	BOTH IP/OP	"$2,814.73 "	"$2,082.90"	$0.00	"$2,251.78"	"$1,266.63"	"$1,266.63"	$0.00	$0.00	$0.00	$586.66	"$2,089.09"	"$2,089.09"	$0.00	$0.00	$586.59	$0.00	"$1,387.66"	"$1,387.66"	$0.00	"$1,407.36"	"$2,229.27"	"$2,251.78"	$0.00		$0.00	$440.50	$0.00	$0.00	$448.10	$0.00	$0.00	$0.00	$0.00	$0.00
478.38S	SUP	HCPCS C1713		478.38S  -  NAIL INTRAMEDULLARY 8MM 38CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,450.25 "	"$1,813.19"	$0.00	"$1,960.20"	"$1,102.61"	"$1,102.61"	$0.00	$0.00	$0.00	$510.69	"$1,818.58"	"$1,818.58"	$0.00	$0.00	$510.63	$0.00	"$1,449.32"	"$1,449.32"	$0.00	"$1,225.13"	"$1,940.60"	"$1,960.20"	$0.00		$0.00	$383.46	$0.00	$0.00	$390.08	$0.00	$0.00	$0.00	$0.00	$0.00
478.40S	SUP	HCPCS C1713		478.40S  -  NAIL 8MM 40CM TIB IM SLD TI STRL	BOTH IP/OP	"$2,814.73 "	"$2,082.90"	$0.00	"$2,251.78"	"$1,266.63"	"$1,266.63"	$0.00	$0.00	$0.00	$586.66	"$2,089.09"	"$2,089.09"	$0.00	$0.00	$586.59	$0.00	"$1,387.66"	"$1,387.66"	$0.00	"$1,407.36"	"$2,229.27"	"$2,251.78"	$0.00		$0.00	$440.50	$0.00	$0.00	$448.10	$0.00	$0.00	$0.00	$0.00	$0.00
478.42S	SUP	HCPCS C1713		478.42S  -  NAIL INTRAMEDULLARY 8MM 42CM SOLID BLUE TITANIUM TIBIA	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
479.25S	SUP	HCPCS C1713		479.25S  -  NAIL INTRAMEDULLARY 9MM 25.5CM SOLID BLUE TITANIUM TIBIA	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
479.27S	SUP	HCPCS C1713		479.27S  -  NAIL INTRAMEDULLARY 9MM 27CM SOLID BLUE TITANIUM TIBIA	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
479.28S	SUP	HCPCS C1713		479.28S  -  NAIL INTRAMEDULLARY 9MM 28.5CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
479.30S	SUP	HCPCS C1713		479.30S  -  NAIL INTRAMEDULLARY 9MM 30CM SOLID BLUE TITANIUM TIBIA	BOTH IP/OP	"$2,450.25 "	"$1,813.19"	$0.00	"$1,960.20"	"$1,102.61"	"$1,102.61"	$0.00	$0.00	$0.00	$510.69	"$1,818.58"	"$1,818.58"	$0.00	$0.00	$510.63	$0.00	"$1,449.32"	"$1,449.32"	$0.00	"$1,225.13"	"$1,940.60"	"$1,960.20"	$0.00		$0.00	$383.46	$0.00	$0.00	$390.08	$0.00	$0.00	$0.00	$0.00	$0.00
479.31S	SUP	HCPCS C1713		479.31S  -  NAIL INTRAMEDULLARY 9MM 315MM SOLID BLUE TITANIUM TIBIAL	BOTH IP/OP	"$2,450.25 "	"$1,813.19"	$0.00	"$1,960.20"	"$1,102.61"	"$1,102.61"	$0.00	$0.00	$0.00	$510.69	"$1,818.58"	"$1,818.58"	$0.00	$0.00	$510.63	$0.00	"$1,449.32"	"$1,449.32"	$0.00	"$1,225.13"	"$1,940.60"	"$1,960.20"	$0.00		$0.00	$383.46	$0.00	$0.00	$390.08	$0.00	$0.00	$0.00	$0.00	$0.00
479.33S	SUP	HCPCS C1713		479.33S  -  NAIL INTRAMEDULLARY 9MM 330MM SOLID BLUE TITANIUM TIBIAL	BOTH IP/OP	"$2,450.25 "	"$1,813.19"	$0.00	"$1,960.20"	"$1,102.61"	"$1,102.61"	$0.00	$0.00	$0.00	$510.69	"$1,818.58"	"$1,818.58"	$0.00	$0.00	$510.63	$0.00	"$1,449.32"	"$1,449.32"	$0.00	"$1,225.13"	"$1,940.60"	"$1,960.20"	$0.00		$0.00	$383.46	$0.00	$0.00	$390.08	$0.00	$0.00	$0.00	$0.00	$0.00
479.34S	SUP	HCPCS C1713		479.34S  -  NAIL INTRAMEDULLARY 9MM 34.5CM SOLID BLUE TITANIUM TIBIA	BOTH IP/OP	"$2,450.25 "	"$1,813.19"	$0.00	"$1,960.20"	"$1,102.61"	"$1,102.61"	$0.00	$0.00	$0.00	$510.69	"$1,818.58"	"$1,818.58"	$0.00	$0.00	$510.63	$0.00	"$1,449.32"	"$1,449.32"	$0.00	"$1,225.13"	"$1,940.60"	"$1,960.20"	$0.00		$0.00	$383.46	$0.00	$0.00	$390.08	$0.00	$0.00	$0.00	$0.00	$0.00
479.36S	SUP	HCPCS C1713		479.36S  -  NAIL INTRAMEDULLARY 9MM 36CM SOLID BLUE TITANIUM TIBIA	BOTH IP/OP	"$2,450.25 "	"$1,813.19"	$0.00	"$1,960.20"	"$1,102.61"	"$1,102.61"	$0.00	$0.00	$0.00	$510.69	"$1,818.58"	"$1,818.58"	$0.00	$0.00	$510.63	$0.00	"$1,449.32"	"$1,449.32"	$0.00	"$1,225.13"	"$1,940.60"	"$1,960.20"	$0.00		$0.00	$383.46	$0.00	$0.00	$390.08	$0.00	$0.00	$0.00	$0.00	$0.00
479.38S	SUP	HCPCS C1713		479.38S  -  NAIL INTRAMEDULLARY 9MM 38CM SOLID TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,450.25 "	"$1,813.19"	$0.00	"$1,960.20"	"$1,102.61"	"$1,102.61"	$0.00	$0.00	$0.00	$510.69	"$1,818.58"	"$1,818.58"	$0.00	$0.00	$510.63	$0.00	"$1,449.32"	"$1,449.32"	$0.00	"$1,225.13"	"$1,940.60"	"$1,960.20"	$0.00		$0.00	$383.46	$0.00	$0.00	$390.08	$0.00	$0.00	$0.00	$0.00	$0.00
479.40S	SUP	HCPCS C1713		479.40S  -  NAIL INTRAMEDULLARY 9MM 40CM SOLID BLUE TITANIUM TIBIA	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
479.42S	SUP	HCPCS C1713		479.42S  -  NAIL INTRAMEDULLARY 9MM 42CM SOLID BLUE TITANIUM TIBIA	BOTH IP/OP	"$2,517.63 "	"$1,863.05"	$0.00	"$2,014.10"	"$1,132.93"	"$1,132.93"	$0.00	$0.00	$0.00	$524.74	"$1,868.58"	"$1,868.58"	$0.00	$0.00	$524.67	$0.00	"$1,241.19"	"$1,241.19"	$0.00	"$1,258.81"	"$1,993.96"	"$2,014.10"	$0.00		$0.00	$394.01	$0.00	$0.00	$400.81	$0.00	$0.00	$0.00	$0.00	$0.00
4806-100-20	SUP	Custom 27203010		4806-100-20  -  BIT DRL 2MM 100MM QCK CNCT	BOTH IP/OP	$136.85 	$101.27	$0.00	$109.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.57	$101.57	$0.00	$0.00	$28.52	$0.00	$0.00	$0.00	$0.00	$68.43	$108.39	$109.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4806-100-27	SUP	Custom 27203010		4806-100-27  -  BIT DRL 2.7MM	BOTH IP/OP	$136.85 	$101.27	$0.00	$109.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.57	$101.57	$0.00	$0.00	$28.52	$0.00	$0.00	$0.00	$0.00	$68.43	$108.39	$109.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4806-110-25	SUP	Custom 27203010		4806-110-25  -  BIT DRL 2.5MM 110MM QCK CNCT	BOTH IP/OP	$136.85 	$101.27	$0.00	$109.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.57	$101.57	$0.00	$0.00	$28.52	$0.00	$0.00	$0.00	$0.00	$68.43	$108.39	$109.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4806-110-35	SUP	Custom 27203010		4806-110-35  -  BIT DRL 3.5MM	BOTH IP/OP	$136.85 	$101.27	$0.00	$109.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.57	$101.57	$0.00	$0.00	$28.52	$0.00	$0.00	$0.00	$0.00	$68.43	$108.39	$109.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4807-180-25	SUP	Custom 27203010		4807-180-25  -  BIT DRILL 180MM 2.5MM SS QC NONSTRL	BOTH IP/OP	$136.85 	$101.27	$0.00	$109.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.57	$101.57	$0.00	$0.00	$28.52	$0.00	$0.00	$0.00	$0.00	$68.43	$108.39	$109.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4809-27	SUP	Custom 27203010		"4809-27  -  COUNTERSINK, Q-C, FOR 2.7MM SCREWS"	BOTH IP/OP	$211.60 	$156.58	$0.00	$169.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.05	$157.05	$0.00	$0.00	$44.10	$0.00	$0.00	$0.00	$0.00	$105.80	$167.59	$169.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4811-100-27	SUP	Custom 27203010		4811-100-27  -  TAP 100MM QC SURG SS PERIART 2.7MM SCR NONSTRL	BOTH IP/OP	$163.30 	$120.84	$0.00	$130.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.20	$121.20	$0.00	$0.00	$34.03	$0.00	$0.00	$0.00	$0.00	$81.65	$129.33	$130.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4811-110-35	SUP	Custom 27203010		4811-110-35  -  TAP 110MM QC SURG SS PERIART 3.5MM SCR NONSTRL	BOTH IP/OP	$163.30 	$120.84	$0.00	$130.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.20	$121.20	$0.00	$0.00	$34.03	$0.00	$0.00	$0.00	$0.00	$81.65	$129.33	$130.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4811-110-40	SUP	Custom 27203010		4811-110-40  -  TAP 110MM QC SURG SS PERIART 4MM SCR NONSTRL	BOTH IP/OP	$163.30 	$120.84	$0.00	$130.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.20	$121.20	$0.00	$0.00	$34.03	$0.00	$0.00	$0.00	$0.00	$81.65	$129.33	$130.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48210-025	SUP	Custom 27203010		48210-025  -  TAPE DRSG 72YDX.5IN TWL BLCH CTTN WHT	BOTH IP/OP	$156.02 	$115.45	$0.00	$124.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$115.80	$115.80	$0.00	$0.00	$32.51	$0.00	$0.00	$0.00	$0.00	$78.01	$123.57	$124.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
48230260R	SUP	Custom 27803010		48230260R  -  HOOK SPNL XIA 3 TI AL VNDM SCRL RT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0101	SUP	HCPCS C1776		4845-0101  -  STEM FEM 1 8.5MM 100MM ABG II V40 TMZF HA HIP RT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0102	SUP	HCPCS C1776		4845-0102  -  STEM FEM 2 8.5MM 100MM ABG II V40 TMZF HA HIP RT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0103	SUP	HCPCS C1776		4845-0103  -  STEM FEM 3 9MM 110MM ABG II V40 TMZF HA HIP RT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0104	SUP	HCPCS C1776		4845-0104  -  STEM FEM 4 10MM 115MM ABG II V40 TMZF HA HIP RT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0105	SUP	HCPCS C1776		4845-0105  -  STEM FEM 5 11MM 120MM ABG II V40 TMZF HA HIP RT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0106	SUP	HCPCS C1776		4845-0106  -  STEM FEM 6 12MM 125MM ABG II V40 TMZF HA HIP RT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0107	SUP	HCPCS C1776		4845-0107  -  STEM FEM 7 13MM 135MM ABG II V40 TMZF HA HIP RT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0108	SUP	HCPCS C1776		4845-0108  -  STEM FEM 8 14MM 145MM ABG II V40 TMZF HA HIP RT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0201	SUP	HCPCS C1776		4845-0201  -  STEM FEM 1 8.5MM 100MM ABG II V40 TMZF HA HIP LT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0202	SUP	HCPCS C1776		4845-0202  -  STEM FEM 2 8.5MM 100MM ABG II V40 TMZF HA HIP LT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0203	SUP	HCPCS C1776		4845-0203  -  STEM FEM 3 9MM 110MM ABG II V40 TMZF HA HIP LT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0204	SUP	HCPCS C1776		4845-0204  -  STEM FEM 4 10MM 115MM ABG II V40 TMZF HA HIP LT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0205	SUP	HCPCS C1776		4845-0205  -  STEM FEM 5 11MM 120MM ABG II V40 TMZF HA HIP LT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0206	SUP	HCPCS C1776		4845-0206  -  STEM FEM 6 12MM 125MM ABG II V40 TMZF HA HIP LT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0207	SUP	HCPCS C1776		4845-0207  -  STEM FEM 7 13MM 135MM ABG II V40 TMZF HA HIP LT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-0208	SUP	HCPCS C1776		4845-0208  -  STEM FEM 8 14MM 145MM ABG II V40 TMZF HA HIP LT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-101	SUP	HCPCS C1776		4845-7-101  -  STEM FEM 130D 1 37MM OFST 99MM STRL ANATO ANTEVERT HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-102	SUP	HCPCS C1776		4845-7-102  -  STEM FEM 130D 2 39MM OFST 99MM STRL ANATO ANTEVERT HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-103	SUP	HCPCS C1776		4845-7-103  -  STEM FEM 130D 3 42MM OFST 110MM STRL ANATO ANTEVERT HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-104	SUP	HCPCS C1776		4845-7-104  -  STEM FEM 130D 4 44MM OFST 115MM STRL ANATO ANTEVERT HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-105	SUP	HCPCS C1776		4845-7-105  -  STEM FEM 130D 5 44MM OFST 120MM STRL ANATO ANTEVERT HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-106	SUP	HCPCS C1776		4845-7-106  -  STEM FEM 130D 6 47MM OFST 120MM STRL ANATO ANTEVERT HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-107	SUP	HCPCS C1776		4845-7-107  -  STEM FEM 130D 7 50MM OFST 120MM STRL ANATO ANTEVERT HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-108	SUP	HCPCS C1776		4845-7-108  -  STEM FEM 130D 8 53MM OFST 120MM STRL ANATO ANTEVERT HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-111	SUP	HCPCS C1776		4845-7-111  -  STEM FEM 130D 1 37MM OFST 99MM STRL ANATO HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-112	SUP	HCPCS C1776		4845-7-112  -  STEM FEM 130D 2 39MM OFST 99MM STRL ANATO HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-114	SUP	HCPCS C1776		4845-7-114  -  STEM FEM 130D 4 44MM OFST 115MM STRL ANATO HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-115	SUP	HCPCS C1776		4845-7-115  -  STEM FEM 130D 5 44MM OFST 120MM STRL ANATO HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-116	SUP	HCPCS C1776		4845-7-116  -  STEM FEM 130D 6 47MM OFST 120MM STRL ANATO HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-117	SUP	HCPCS C1776		4845-7-117  -  STEM FEM 130D 7 50MM OFST 120MM STRL ANATO HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-118	SUP	HCPCS C1776		4845-7-118  -  STEM FEM 130D 8 53MM OFST 120MM STRL ANATO HIP RT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-201	SUP	HCPCS C1776		4845-7-201  -  STEM FEM 130D 1 37MM OFST 99MM STRL ANATO ANTEVERT HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-202	SUP	HCPCS C1776		4845-7-202  -  STEM FEM 130D 2 39MM OFST 99MM STRL ANATO ANTEVERT HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-203	SUP	HCPCS C1776		4845-7-203  -  STEM FEM 130D 3 42MM OFST 110MM STRL ANATO ANTEVERT HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-204	SUP	HCPCS C1776		4845-7-204  -  STEM FEM 130D 4 44MM OFST 115MM STRL ANATO ANTEVERT HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-205	SUP	HCPCS C1776		4845-7-205  -  STEM FEM 130D 5 44MM OFST 120MM STRL ANATO ANTEVERT HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-206	SUP	HCPCS C1776		4845-7-206  -  STEM FEM 130D 6 47MM OFST 120MM STRL ANATO ANTEVERT HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-207	SUP	HCPCS C1776		4845-7-207  -  STEM FEM 130D 7 50MM OFST 120MM STRL ANATO ANTEVERT HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-208	SUP	HCPCS C1776		4845-7-208  -  STEM FEM 130D 8 53MM OFST 120MM STRL ANATO ANTEVERT HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-211	SUP	HCPCS C1776		4845-7-211  -  STEM FEM 130D 1 37MM OFST 99MM STRL ANATO HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-212	SUP	HCPCS C1776		4845-7-212  -  STEM FEM 130D 2 39MM OFST 99MM STRL ANATO HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-213	SUP	HCPCS C1776		4845-7-213  -  STEM FEM 130D 3 42MM OFST 110MM STRL ANATO HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-214	SUP	HCPCS C1776		4845-7-214  -  STEM FEM 130D 4 44MM OFST 115MM STRL ANATO HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-215	SUP	HCPCS C1776		4845-7-215  -  STEM FEM 130D 5 44MM OFST 120MM STRL ANATO HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-216	SUP	HCPCS C1776		4845-7-216  -  STEM FEM 130D 6 47MM OFST 120MM STRL ANATO HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-217	SUP	HCPCS C1776		4845-7-217  -  STEM FEM 130D 7 50MM OFST 120MM STRL ANATO HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
4845-7-218	SUP	HCPCS C1776		4845-7-218  -  STEM FEM 130D 8 53MM OFST 120MM STRL ANATO HIP LT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
48485540XL	SUP	HCPCS C1713		48485540XL  -  SCREW BONE 5.5MM 40MM DIAPASON OSS THOR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48485545XL	SUP	HCPCS C1713		48485545XL  -  SCREW BONE 5.5MM 45MM DIAPASON OSS THOR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486735XL	SUP	HCPCS C1713		48486735XL  -  SCREW BONE 6.7MM 35MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486740XL	SUP	HCPCS C1713		48486740XL  -  SCREW BONE 6.7MM 40MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486745XL	SUP	HCPCS C1713		48486745XL  -  SCREW BONE 6.7MM 45MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486750XL	SUP	HCPCS C1713		48486750XL  -  SCREW BONE 6.7MM 50MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486755XL	SUP	HCPCS C1713		48486755XL  -  SCREW BONE 6.7MM 55MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48486760XL	SUP	HCPCS C1713		48486760XL  -  SCREW BONE 6.7MM 60MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48487740XL	SUP	HCPCS C1713		48487740XL  -  SCREW BONE 7.7MM 40MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48487745XL	SUP	HCPCS C1713		48487745XL  -  SCREW BONE 7.7MM 45MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48487750XL	SUP	HCPCS C1713		48487750XL  -  SCREW BONE 7.7MM 50MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48487755XL	SUP	HCPCS C1713		48487755XL  -  SCREW BONE 7.7MM 55MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48487760XL	SUP	HCPCS C1713		48487760XL  -  SCREW BONE 7.7MM 60MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48488050XL	SUP	HCPCS C1713		48488050XL  -  SCREW BONE 8MM 50MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48488055XL	SUP	HCPCS C1713		48488055XL  -  SCREW BONE 8MM 55MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
48488060XL	SUP	HCPCS C1713		48488060XL  -  SCREW BONE 8MM 60MM DIAPASON OSS LMBR SPN LNG ARM	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
485.025S	SUP	HCPCS C1713		485.025S  -  NAIL INTRAMEDULLARY 10MM 25.5CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.027S	SUP	HCPCS C1713		485.027S  -  NAIL INTRAMEDULLARY 10MM 27CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.028S	SUP	HCPCS C1713		485.028S  -  NAIL INTRAMEDULLARY 10MM 28.5CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.030S	SUP	HCPCS C1713		485.030S  -  NAIL INTRAMEDULLARY 10MM 30CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.031S	SUP	HCPCS C1713		485.031S  -  NAIL INTRAMEDULLARY 10MM 31.5CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.033S	SUP	HCPCS C1713		485.033S  -  NAIL INTRAMEDULLARY 10MM 33CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.034S	SUP	HCPCS C1713		485.034S  -  NAIL INTRAMEDULLARY 10MM 34.5CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.036S	SUP	HCPCS C1713		485.036S  -  NAIL 10MM 36CM TIB IM CANN TI STRL	BOTH IP/OP	"$2,853.10 "	"$2,111.29"	$0.00	"$2,282.48"	"$1,283.90"	"$1,283.90"	$0.00	$0.00	$0.00	$594.66	"$2,117.57"	"$2,117.57"	$0.00	$0.00	$594.59	$0.00	"$1,406.58"	"$1,406.58"	$0.00	"$1,426.55"	"$2,259.66"	"$2,282.48"	$0.00		$0.00	$446.51	$0.00	$0.00	$454.21	$0.00	$0.00	$0.00	$0.00	$0.00
485.038S	SUP	HCPCS C1713		485.038S  -  NAIL INTRAMEDULLARY 10MM 380MM CANN TITANIUM TIBIA STERILE	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.040S	SUP	HCPCS C1713		485.040S  -  NAIL INTRAMEDULLARY 10MM 40CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.042S	SUP	HCPCS C1713		485.042S  -  NAIL INTRAMEDULLARY 10MM 42CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,553.38 "	"$1,889.50"	$0.00	"$2,042.70"	"$1,149.02"	"$1,149.02"	$0.00	$0.00	$0.00	$532.19	"$1,895.11"	"$1,895.11"	$0.00	$0.00	$532.12	$0.00	"$1,258.81"	"$1,258.81"	$0.00	"$1,276.69"	"$2,022.28"	"$2,042.70"	$0.00		$0.00	$399.60	$0.00	$0.00	$406.50	$0.00	$0.00	$0.00	$0.00	$0.00
485.125S	SUP	HCPCS C1713		485.125S  -  NAIL INTRAMEDULLARY 11MM 25.5CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.127S	SUP	HCPCS C1713		485.127S  -  NAIL INTRAMEDULLARY 11MM 27CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.128S	SUP	HCPCS C1713		485.128S  -  NAIL INTRAMEDULLARY 11MM 28.5CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.130S	SUP	HCPCS C1713		485.130S  -  NAIL INTRAMEDULLARY 11MM 30CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.131S	SUP	HCPCS C1713		485.131S  -  NAIL INTRAMEDULLARY 11MM 315MM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.133S	SUP	HCPCS C1713		485.133S  -  NAIL INTRAMEDULLARY 11MM 330MM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.134S	SUP	HCPCS C1713		485.134S  -  NAIL INTRAMEDULLARY 11MM 34.5CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.136S	SUP	HCPCS C1713		485.136S  -  NAIL INTRAMEDULLARY 11MM 360MM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.138S	SUP	HCPCS C1713		485.138S  -  NAIL INTRAMEDULLARY 11MM 38CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.140S	SUP	HCPCS C1713		485.140S  -  NAIL INTRAMEDULLARY 11MM 400MM CANN GREEN TITANIUM TIBIAL	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.142S	SUP	HCPCS C1713		485.142S  -  NAIL INTRAMEDULLARY 11MM 42CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,553.38 "	"$1,889.50"	$0.00	"$2,042.70"	"$1,149.02"	"$1,149.02"	$0.00	$0.00	$0.00	$532.19	"$1,895.11"	"$1,895.11"	$0.00	$0.00	$532.12	$0.00	"$1,258.81"	"$1,258.81"	$0.00	"$1,276.69"	"$2,022.28"	"$2,042.70"	$0.00		$0.00	$399.60	$0.00	$0.00	$406.50	$0.00	$0.00	$0.00	$0.00	$0.00
485.225S	SUP	HCPCS C1713		485.225S  -  NAIL INTRAMEDULLARY 12MM 25.5CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,553.38 "	"$1,889.50"	$0.00	"$2,042.70"	"$1,149.02"	"$1,149.02"	$0.00	$0.00	$0.00	$532.19	"$1,895.11"	"$1,895.11"	$0.00	$0.00	$532.12	$0.00	"$1,258.81"	"$1,258.81"	$0.00	"$1,276.69"	"$2,022.28"	"$2,042.70"	$0.00		$0.00	$399.60	$0.00	$0.00	$406.50	$0.00	$0.00	$0.00	$0.00	$0.00
485.227S	SUP	HCPCS C1713		485.227S  -  NAIL INTRAMEDULLARY 12MM 27CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,553.38 "	"$1,889.50"	$0.00	"$2,042.70"	"$1,149.02"	"$1,149.02"	$0.00	$0.00	$0.00	$532.19	"$1,895.11"	"$1,895.11"	$0.00	$0.00	$532.12	$0.00	"$1,258.81"	"$1,258.81"	$0.00	"$1,276.69"	"$2,022.28"	"$2,042.70"	$0.00		$0.00	$399.60	$0.00	$0.00	$406.50	$0.00	$0.00	$0.00	$0.00	$0.00
485.228S	SUP	HCPCS C1713		485.228S  -  NAIL INTRAMEDULLARY 12MM 285MM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,553.38 "	"$1,889.50"	$0.00	"$2,042.70"	"$1,149.02"	"$1,149.02"	$0.00	$0.00	$0.00	$532.19	"$1,895.11"	"$1,895.11"	$0.00	$0.00	$532.12	$0.00	"$1,258.81"	"$1,258.81"	$0.00	"$1,276.69"	"$2,022.28"	"$2,042.70"	$0.00		$0.00	$399.60	$0.00	$0.00	$406.50	$0.00	$0.00	$0.00	$0.00	$0.00
485.230S	SUP	HCPCS C1713		485.230S  -  NAIL INTRAMEDULLARY 12MM 30CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.231S	SUP	HCPCS C1713		485.231S  -  NAIL INTRAMEDULLARY 12MM 31.5CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.233S	SUP	HCPCS C1713		485.233S  -  NAIL INTRAMEDULLARY 12MM 33CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.234S	SUP	HCPCS C1713		485.234S  -  NAIL INTRAMEDULLARY 12MM 34.5CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.236S	SUP	HCPCS C1713		485.236S  -  NAIL INTRAMEDULLARY 12MM 36CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.238S	SUP	HCPCS C1713		485.238S  -  NAIL INTRAMEDULLARY 12MM 38CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.240S	SUP	HCPCS C1713		485.240S  -  NAIL INTRAMEDULLARY 12MM 40CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.242S	SUP	HCPCS C1713		485.242S  -  NAIL INTRAMEDULLARY 12MM 42CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,553.38 "	"$1,889.50"	$0.00	"$2,042.70"	"$1,149.02"	"$1,149.02"	$0.00	$0.00	$0.00	$532.19	"$1,895.11"	"$1,895.11"	$0.00	$0.00	$532.12	$0.00	"$1,258.81"	"$1,258.81"	$0.00	"$1,276.69"	"$2,022.28"	"$2,042.70"	$0.00		$0.00	$399.60	$0.00	$0.00	$406.50	$0.00	$0.00	$0.00	$0.00	$0.00
485.325S	SUP	HCPCS C1713		485.325S  -  NAIL INTRAMEDULLARY 13MM 25.5CM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,553.38 "	"$1,889.50"	$0.00	"$2,042.70"	"$1,149.02"	"$1,149.02"	$0.00	$0.00	$0.00	$532.19	"$1,895.11"	"$1,895.11"	$0.00	$0.00	$532.12	$0.00	"$1,258.81"	"$1,258.81"	$0.00	"$1,276.69"	"$2,022.28"	"$2,042.70"	$0.00		$0.00	$399.60	$0.00	$0.00	$406.50	$0.00	$0.00	$0.00	$0.00	$0.00
485.327S	SUP	HCPCS C1713		485.327S  -  NAIL 13MM 27CM TIB IM CANN TI STRL BLUE	BOTH IP/OP	"$2,853.10 "	"$2,111.29"	$0.00	"$2,282.48"	"$1,283.90"	"$1,283.90"	$0.00	$0.00	$0.00	$594.66	"$2,117.57"	"$2,117.57"	$0.00	$0.00	$594.59	$0.00	"$1,406.58"	"$1,406.58"	$0.00	"$1,426.55"	"$2,259.66"	"$2,282.48"	$0.00		$0.00	$446.51	$0.00	$0.00	$454.21	$0.00	$0.00	$0.00	$0.00	$0.00
485.328S	SUP	HCPCS C1713		485.328S  -  NAIL INTRAMEDULLARY 13MM 285MM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,553.38 "	"$1,889.50"	$0.00	"$2,042.70"	"$1,149.02"	"$1,149.02"	$0.00	$0.00	$0.00	$532.19	"$1,895.11"	"$1,895.11"	$0.00	$0.00	$532.12	$0.00	"$1,258.81"	"$1,258.81"	$0.00	"$1,276.69"	"$2,022.28"	"$2,042.70"	$0.00		$0.00	$399.60	$0.00	$0.00	$406.50	$0.00	$0.00	$0.00	$0.00	$0.00
485.330S	SUP	HCPCS C1713		485.330S  -  NAIL INTRAMEDULLARY 13MM 300MM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.331S	SUP	HCPCS C1713		485.331S  -  NAIL INTRAMEDULLARY 13MM 315MM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.333S	SUP	HCPCS C1713		485.333S  -  NAIL INTRAMEDULLARY 13MM 330MM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.334S	SUP	HCPCS C1713		485.334S  -  NAIL INTRAMEDULLARY 13MM 345MM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.336S	SUP	HCPCS C1713		485.336S  -  NAIL 13MM 36CM TIB IM CANN TI STRL	BOTH IP/OP	"$2,853.10 "	"$2,111.29"	$0.00	"$2,282.48"	"$1,283.90"	"$1,283.90"	$0.00	$0.00	$0.00	$594.66	"$2,117.57"	"$2,117.57"	$0.00	$0.00	$594.59	$0.00	"$1,406.58"	"$1,406.58"	$0.00	"$1,426.55"	"$2,259.66"	"$2,282.48"	$0.00		$0.00	$446.51	$0.00	$0.00	$454.21	$0.00	$0.00	$0.00	$0.00	$0.00
485.338S	SUP	HCPCS C1713		485.338S  -  NAIL INTRAMEDULLARY 13MM 380MM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,484.63 "	"$1,838.63"	$0.00	"$1,987.70"	"$1,118.08"	"$1,118.08"	$0.00	$0.00	$0.00	$517.86	"$1,844.09"	"$1,844.09"	$0.00	$0.00	$517.80	$0.00	"$1,469.66"	"$1,469.66"	$0.00	"$1,242.31"	"$1,967.83"	"$1,987.70"	$0.00		$0.00	$388.84	$0.00	$0.00	$395.55	$0.00	$0.00	$0.00	$0.00	$0.00
485.340S	SUP	HCPCS C1713		485.340S  -  NAIL 13MM 40CM TIB IM CANN TI STRL BLUE	BOTH IP/OP	"$2,853.10 "	"$2,111.29"	$0.00	"$2,282.48"	"$1,283.90"	"$1,283.90"	$0.00	$0.00	$0.00	$594.66	"$2,117.57"	"$2,117.57"	$0.00	$0.00	$594.59	$0.00	"$1,406.58"	"$1,406.58"	$0.00	"$1,426.55"	"$2,259.66"	"$2,282.48"	$0.00		$0.00	$446.51	$0.00	$0.00	$454.21	$0.00	$0.00	$0.00	$0.00	$0.00
485.342S	SUP	HCPCS C1713		485.342S  -  NAIL INTRAMEDULLARY 13MM 420MM CANN GREEN TITANIUM TIBIA	BOTH IP/OP	"$2,553.38 "	"$1,889.50"	$0.00	"$2,042.70"	"$1,149.02"	"$1,149.02"	$0.00	$0.00	$0.00	$532.19	"$1,895.11"	"$1,895.11"	$0.00	$0.00	$532.12	$0.00	"$1,258.81"	"$1,258.81"	$0.00	"$1,276.69"	"$2,022.28"	"$2,042.70"	$0.00		$0.00	$399.60	$0.00	$0.00	$406.50	$0.00	$0.00	$0.00	$0.00	$0.00
48551041L	SUP	HCPCS C1713		48551041L  -  PLATE BONE 130D PRECONTOUR OASYS TITANIUM SPN LEFT THORACIC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
48551041R	SUP	HCPCS C1713		48551041R  -  PLATE BONE 130D PRECONTOUR OASYS TITANIUM SPN RIGHT THORACIC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
48551043L	SUP	HCPCS C1713		48551043L  -  PLATE BONE 100D PRECONTOUR OASYS TITANIUM SPN LEFT THORACIC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
48551043R	SUP	HCPCS C1713		48551043R  -  PLATE BONE 100D PRECONTOUR OASYS TITANIUM SPN RIGHT THORACIC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
4900-40-51	SUP	HCPCS C1713		4900-40-51  -  WASHER 7MM SM ORTH 2.7-4MM SCR NONSTRL	BOTH IP/OP	$71.30 	$52.76	$0.00	$57.04	$32.09	$32.09	$0.00	$0.00	$0.00	$14.86	$52.92	$52.92	$0.00	$0.00	$14.86	$0.00	$42.17	$42.17	$0.00	$35.65	$56.47	$57.04	$0.00		$0.00	$11.16	$0.00	$0.00	$11.35	$0.00	$0.00	$0.00	$0.00	$0.00
4900T26	SUP	Custom 27803010		4900T26  -  RING ANLPLS 26MM STRL ED MC3 SEAM 2 WRP TI PLSTR SIL RBR	BOTH IP/OP	"$7,995.00 "	"$5,916.30"	$0.00	"$6,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,666.16"	$0.00	$0.00	$0.00	$0.00	"$3,997.50"	"$6,332.04"	"$6,396.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4900T28	SUP	Custom 27803010		4900T28  -  RING ANLPLS 28MM STRL ED MC3 SEAM 2 WRP TI PLSTR SIL RBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4900T30	SUP	Custom 27803010		4900T30  -  RING ANLPLS 30MM STRL ED MC3 1 SEAM 2 WRP ANTM TI SIL RBR	BOTH IP/OP	"$7,995.00 "	"$5,916.30"	$0.00	"$6,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,666.16"	$0.00	$0.00	$0.00	$0.00	"$3,997.50"	"$6,332.04"	"$6,396.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4900T32	SUP	Custom 27803010		4900T32  -  RING ANLPLS 3D ANG DNWRD 32MM ED MC3 RGD TRCSD	BOTH IP/OP	"$7,995.00 "	"$5,916.30"	$0.00	"$6,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,666.16"	$0.00	$0.00	$0.00	$0.00	"$3,997.50"	"$6,332.04"	"$6,396.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4900T34	SUP	Custom 27803010		4900T34  -  RING ANLPLS 34MM TRCSD ED MC3	BOTH IP/OP	"$7,995.00 "	"$5,916.30"	$0.00	"$6,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,666.16"	$0.00	$0.00	$0.00	$0.00	"$3,997.50"	"$6,332.04"	"$6,396.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4900T36	SUP	HCPCS C1713		4900T36  -  RING ANLPLS 36MM STRL ED MC3 1 SEAM 2 WRP ANTM TI SIL RBR	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	"$3,937.50"	"$3,937.50"	$0.00	$0.00	$0.00	"$1,823.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	"$4,313.75"	"$4,313.75"	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	"$1,369.38"	$0.00	$0.00	"$1,393.00"	$0.00	$0.00	$0.00	$0.00	$0.00
491B	SUP	Custom 27203010		491B  -  PROBE THRMTR SM STAT STRL STRPRB TEMP ESPH RCTM DISP	BOTH IP/OP	$12.74 	$9.43	$0.00	$10.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.37	$10.09	$10.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-0-000	SUP	Custom 27203010		4920-0-000  -  ROD EXFIX HFMN2 DYN	BOTH IP/OP	"$3,734.50 "	"$2,763.53"	$0.00	"$2,987.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,771.75"	"$2,771.75"	$0.00	$0.00	$778.27	$0.00	$0.00	$0.00	$0.00	"$1,867.25"	"$2,957.72"	"$2,987.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-0-015	SUP	Custom 27203010		4920-0-015  -  TUBE XTRNFX STD 40MM HFMN2 CMPR DSTRCT	BOTH IP/OP	$965.25 	$714.29	$0.00	$772.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$716.41	$716.41	$0.00	$0.00	$201.16	$0.00	$0.00	$0.00	$0.00	$482.63	$764.48	$772.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-1-010	SUP	Custom 27203010		4920-1-010  -  CLAMP EXFIX HFMN2 STD CARFBR NONMRI SAFE	BOTH IP/OP	$853.88 	$631.87	$0.00	$683.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$633.75	$633.75	$0.00	$0.00	$177.95	$0.00	$0.00	$0.00	$0.00	$426.94	$676.27	$683.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-1-010R	SUP	Custom 27203010		4920-1-010R  -  HOFF2 COUPLING 8/8MM RECERT	BOTH IP/OP	$853.88 	$631.87	$0.00	$683.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$633.75	$633.75	$0.00	$0.00	$177.95	$0.00	$0.00	$0.00	$0.00	$426.94	$676.27	$683.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-1-020	SUP	Custom 27203010		4920-1-020  -  CPLNG EXFIX HFMN2 4-5MM 8MM ARTC	BOTH IP/OP	$853.88 	$631.87	$0.00	$683.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$633.75	$633.75	$0.00	$0.00	$177.95	$0.00	$0.00	$0.00	$0.00	$426.94	$676.27	$683.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-1-020R	SUP	Custom 27203010		4920-1-020R  -  HOFF2 ARTIC COUPLING 8/4+5MM	BOTH IP/OP	$853.88 	$631.87	$0.00	$683.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$633.75	$633.75	$0.00	$0.00	$177.95	$0.00	$0.00	$0.00	$0.00	$426.94	$676.27	$683.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-1-030	SUP	Custom 27203010		4920-1-030  -  COUPLING XTRNFX 4 5/8MM HFMN2 INVERT PIN TO ROD	BOTH IP/OP	$853.88 	$631.87	$0.00	$683.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$633.75	$633.75	$0.00	$0.00	$177.95	$0.00	$0.00	$0.00	$0.00	$426.94	$676.27	$683.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-1-030R	SUP	Custom 27203010		4920-1-030R  -  HOFF2 INVERT COUPLING 8/4+5MM	BOTH IP/OP	$853.88 	$631.87	$0.00	$683.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$633.75	$633.75	$0.00	$0.00	$177.95	$0.00	$0.00	$0.00	$0.00	$426.94	$676.27	$683.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-1-100	SUP	Custom 27203010		4920-1-100  -  COUPLING XTRNFX STD 20MM 8MM HFMN2 TUBE TO ROD DYN	BOTH IP/OP	$948.75 	$702.08	$0.00	$759.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$704.16	$704.16	$0.00	$0.00	$197.72	$0.00	$0.00	$0.00	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-2-020	SUP	Custom 27203010		4920-2-020  -  CLAMP EXFIX HFMN2 8MM 4-5MM CARFBR PIN ASMBLY 5 HOLE W/O	BOTH IP/OP	$900.63 	$666.47	$0.00	$720.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$668.44	$668.44	$0.00	$0.00	$187.69	$0.00	$0.00	$0.00	$0.00	$450.31	$713.30	$720.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-2-060	SUP	Custom 27203010		4920-2-060  -  CLAMP EXFIX HFMN2 10 HOLE	BOTH IP/OP	"$1,516.63 "	"$1,122.31"	$0.00	"$1,213.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.64"	"$1,125.64"	$0.00	$0.00	$316.06	$0.00	$0.00	$0.00	$0.00	$758.31	"$1,201.17"	"$1,213.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-2-060R	SUP	Custom 27203010		4920-2-060R  -  HOFF2 10 HOLE CLAMP	BOTH IP/OP	"$1,516.63 "	"$1,122.31"	$0.00	"$1,213.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,125.64"	"$1,125.64"	$0.00	$0.00	$316.06	$0.00	$0.00	$0.00	$0.00	$758.31	"$1,201.17"	"$1,213.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-2-080	SUP	Custom 27203010		4920-2-080  -  CLAMP EXFIX HFMN2 PLVC CMPNT 4 MM 5 MM 6 MM PIN	BOTH IP/OP	"$1,328.25 "	$982.91	$0.00	"$1,062.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$985.83	$985.83	$0.00	$0.00	$276.81	$0.00	$0.00	$0.00	$0.00	$664.13	"$1,051.97"	"$1,062.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-2-120	SUP	Custom 27203010		4920-2-120  -  POST XTRNFX STRG 8MM NS LF HFMN2 CMPNT SS DISP	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.57	$127.57	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-2-120R	SUP	Custom 27203010		4920-2-120R  -  POST XTRNFX STRG 8MM NS LF HFMN2 CMPNT SS DISP REPRO	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.57	$127.57	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-2-140	SUP	Custom 27203010		4920-2-140  -  POST XTRNFX 30D HFMN2 AL SS CFBR	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.57	$127.57	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-2-140R	SUP	Custom 27203010		4920-2-140R  -  POST XTRNFX 30D 8MM NS LF HFMN2 CMPNT SS DISP REPRO	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.57	$127.57	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-2-160	SUP	Custom 27203010		4920-2-160  -  POST EXFIX HFMN2 90D 8MM SS ANG CMPNT	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$0.00	$0.00	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-2-160R	SUP	Custom 27203010		4920-2-160R  -  POST XTRNFX 90D NS LF HFMN2 CMPNT SS DISP REPRO	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$0.00	$0.00	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-2-180	SUP	Custom 27203010		4920-2-180  -  POST EXFIX HFMN2 MI	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$0.00	$0.00	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-3-010	SUP	Custom 27203010		4920-3-010  -  COUPLING XTRNFX ROD TO WRE	BOTH IP/OP	$936.38 	$692.92	$0.00	$749.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$694.98	$694.98	$0.00	$0.00	$195.14	$0.00	$0.00	$0.00	$0.00	$468.19	$741.61	$749.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-9-810	SUP	Custom 27203010		4920-9-810  -  SET EXFIX HFMN2 ANKL KIT ROD TO ROD CPLNG MLPN CLMP SFT TIS	BOTH IP/OP	"$6,227.38 "	"$4,608.26"	$0.00	"$4,981.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,297.78"	$0.00	$0.00	$0.00	$0.00	"$3,113.69"	"$4,932.08"	"$4,981.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-9-830	SUP	Custom 27203010		4920-9-830  -  SET EXFIX HFMN2 430MMX307MMX65MM TIB KIT ROD TO ROD CPLNG	BOTH IP/OP	"$6,539.50 "	"$4,839.23"	$0.00	"$5,231.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.83"	$0.00	$0.00	$0.00	$0.00	"$3,269.75"	"$5,179.28"	"$5,231.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-9-900	SUP	Custom 27203010		4920-9-900  -  KIT EXFIX HFMN2 STRL	BOTH IP/OP	"$4,116.75 "	"$3,046.40"	$0.00	"$3,293.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,055.45"	"$3,055.45"	$0.00	$0.00	$857.93	$0.00	$0.00	$0.00	$0.00	"$2,058.38"	"$3,260.47"	"$3,293.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-9-920	SUP	Custom 27203010		4920-9-920  -  KIT EXFIX HFMN2 STRL	BOTH IP/OP	"$3,430.63 "	"$2,538.67"	$0.00	"$2,744.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,546.21"	"$2,546.21"	$0.00	$0.00	$714.94	$0.00	$0.00	$0.00	$0.00	"$1,715.31"	"$2,717.06"	"$2,744.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-9-930	SUP	Custom 27203010		4920-9-930  -  SET EXFIX HFMN2 PLVC KIT ROD TO ROD CPLNG MLPN CLMP SFT TIS	BOTH IP/OP	"$8,417.75 "	"$6,229.14"	$0.00	"$6,734.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.26"	$0.00	$0.00	$0.00	$0.00	"$4,208.88"	"$6,666.86"	"$6,734.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4920-9-952	SUP	Custom 27203010		4920-9-952  -  SET EXFIX HFMN2 KIT MLTR MUL PIN CLMP SLFDRILL APEX PIN ANG	BOTH IP/OP	"$4,138.75 "	"$3,062.68"	$0.00	"$3,311.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,071.78"	"$3,071.78"	$0.00	$0.00	$862.52	$0.00	$0.00	$0.00	$0.00	"$2,069.38"	"$3,277.89"	"$3,311.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-0-000	SUP	Custom 27203010		4921-0-000  -  TUBE XTRNFX HFMN 3 DYN MRI SAFE	BOTH IP/OP	"$4,233.63 "	"$3,132.89"	$0.00	"$3,386.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,142.20"	"$3,142.20"	$0.00	$0.00	$882.29	$0.00	$0.00	$0.00	$0.00	"$2,116.81"	"$3,353.03"	"$3,386.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-0-015	SUP	Custom 27203010		4921-0-015  -  TUBE XTRNFX 20MM HFMN2 CMPR DSTRCT MRI SAFE	BOTH IP/OP	$946.00 	$700.04	$0.00	$756.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$702.12	$702.12	$0.00	$0.00	$197.15	$0.00	$0.00	$0.00	$0.00	$473.00	$749.23	$756.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-1-010	SUP	Custom 27203010		4921-1-010  -  CPLNG EXFIX HFMN2 ROD TO ROD	BOTH IP/OP	$975.88 	$722.15	$0.00	"$1,268.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$724.29	$724.29	$0.00	$0.00	$203.37	$0.00	$0.00	$0.00	$0.00	$793.00	"$1,256.11"	"$1,268.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-1-020	SUP	Custom 27203010		4921-1-020  -  CLAMP EXFIX HFMN2 CLR CD REASSEMBLE GOLD HEAD BOLT	BOTH IP/OP	$909.28 	$672.87	$0.00	"$1,182.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$674.86	$674.86	$0.00	$0.00	$189.49	$0.00	$0.00	$0.00	$0.00	$739.00	"$1,170.58"	"$1,182.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-1-030	SUP	Custom 27203010		4921-1-030  -  COUPLING XTRNFX HFMN2 INVERT PIN TO ROD MRI CLR CD 4-5 MM	BOTH IP/OP	$875.88 	$648.15	$0.00	$700.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$650.07	$650.07	$0.00	$0.00	$182.53	$0.00	$0.00	$0.00	$0.00	$437.94	$693.70	$700.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-1-100	SUP	Custom 27203010		4921-1-100  -  DEVICE EXFIX YLW HFMN2 MRI FRM 6 PIN	BOTH IP/OP	$875.88 	$648.15	$0.00	$700.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$650.07	$650.07	$0.00	$0.00	$182.53	$0.00	$0.00	$0.00	$0.00	$437.94	$693.70	$700.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-1-140	SUP	Custom 27203010		4921-1-140  -  POST EXFIX 8MM HFMN2 30D MRI SAFE CMPNT GOLD TIP	BOTH IP/OP	$166.38 	$123.12	$0.00	$133.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.48	$123.48	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$83.19	$131.77	$133.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-2-020	SUP	Custom 27203010		4921-2-020  -  CLAMP EXFIX 6MM HFMN2 5 HOLE PIN MRI SAFE	BOTH IP/OP	"$1,035.08 "	$765.96	$0.00	"$1,347.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.23	$768.23	$0.00	$0.00	$215.71	$0.00	$0.00	$0.00	$0.00	$842.00	"$1,333.73"	"$1,347.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-2-060	SUP	Custom 27203010		4921-2-060  -  CLAMP EXFIX HFMN2 C 10 HOLE PIN	BOTH IP/OP	"$1,379.18 "	"$1,020.59"	$0.00	"$1,796.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,023.62"	"$1,023.62"	$0.00	$0.00	$287.42	$0.00	$0.00	$0.00	$0.00	"$1,123.00"	"$1,778.83"	"$1,796.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-2-080	SUP	Custom 27203010		4921-2-080  -  CLAMP EXFIX HFMN2 MRI PLVC	BOTH IP/OP	"$1,496.00 "	"$1,107.04"	$0.00	"$1,110.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,110.33"	"$1,110.33"	$0.00	$0.00	$311.77	$0.00	$0.00	$0.00	$0.00	$565.13	$895.16	$904.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-2-120	SUP	Custom 27203010		4921-2-120  -  POST XTRNFX STRG 8MM HFMN 3 CLR CD MRI SAFE	BOTH IP/OP	$225.70 	$167.02	$0.00	$292.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.51	$167.51	$0.00	$0.00	$47.04	$0.00	$0.00	$0.00	$0.00	$183.00	$289.87	$292.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-2-140	SUP	Custom 27203010		4921-2-140  -  POST XTRNFX 30D 8MM HFMN2 CLR CD MRI SAFE	BOTH IP/OP	$172.98 	$128.01	$0.00	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$128.38	$128.38	$0.00	$0.00	$36.05	$0.00	$0.00	$0.00	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-2-160	SUP	Custom 27203010		4921-2-160  -  POST XTRNFX 90D 8MM HFMN2 MRI SAFE H	BOTH IP/OP	$264.55 	$195.77	$0.00	$347.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.35	$196.35	$0.00	$0.00	$55.13	$0.00	$0.00	$0.00	$0.00	$217.00	$343.73	$347.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4921-9-985	SUP	Custom 27203010		4921-9-985  -  BAR XTRNFX 30D HFMN2 STOR LWR	BOTH IP/OP	$779.63 	$576.93	$0.00	$623.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$578.64	$578.64	$0.00	$0.00	$162.47	$0.00	$0.00	$0.00	$0.00	$389.81	$617.47	$623.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-1-010	SUP	Custom 27203010		4922-1-010  -  COUPLING EXFIX 5MM 8MM ROD TO ROD	BOTH IP/OP	"$1,360.45 "	"$1,006.73"	$0.00	"$1,349.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,009.73"	"$1,009.73"	$0.00	$0.00	$283.52	$0.00	$0.00	$0.00	$0.00	$843.48	"$1,336.06"	"$1,349.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-1-020	SUP	Custom 27203010		4922-1-020  -  COUPLING EXFIX 5/8IN 4IN 5 HOLE PIN TO ROD APEX PIN CLMP	BOTH IP/OP	"$1,245.45 "	$921.63	$0.00	"$1,349.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.37	$924.37	$0.00	$0.00	$259.55	$0.00	$0.00	$0.00	$0.00	$843.48	"$1,336.06"	"$1,349.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-1-030	SUP	Custom 27203010		4922-1-030  -  COUPLING EXFIX 5MM 8MM PIN TO ROD	BOTH IP/OP	"$1,360.45 "	"$1,006.73"	$0.00	"$1,349.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,009.73"	"$1,009.73"	$0.00	$0.00	$283.52	$0.00	$0.00	$0.00	$0.00	$843.48	"$1,336.06"	"$1,349.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-2-020	SUP	Custom 27203010		4922-2-020  -  CLAMP EXFIX 4/5/6MM 5 HOLE MULTIPIN MODULAR HOFFMANN III	BOTH IP/OP	"$1,401.85 "	"$1,037.37"	$0.00	"$1,416.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,040.45"	"$1,040.45"	$0.00	$0.00	$292.15	$0.00	$0.00	$0.00	$0.00	$885.06	"$1,401.94"	"$1,416.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-2-140	SUP	Custom 27203010		4922-2-140  -  POST XTRNFX 30D 11MM HFMN 3	BOTH IP/OP	$246.10 	$182.11	$0.00	$247.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.66	$182.66	$0.00	$0.00	$51.29	$0.00	$0.00	$0.00	$0.00	$154.44	$244.63	$247.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-2-240	SUP	Custom 27203010		4922-2-240  -  CLAMP EXFIX 30D 11MM 5 HOLE PIN POST MODULAR HOFFMANN III	BOTH IP/OP	"$1,481.70 "	"$1,096.46"	$0.00	"$1,566.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,099.72"	"$1,099.72"	$0.00	$0.00	$308.79	$0.00	$0.00	$0.00	$0.00	$979.11	"$1,550.92"	"$1,566.58"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-8-150	SUP	Custom 27203010		4922-8-150  -  ROD EXFIX 11MM 150MM CONNCTNG	BOTH IP/OP	$645.70 	$477.82	$0.00	$714.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$479.24	$479.24	$0.00	$0.00	$134.56	$0.00	$0.00	$0.00	$0.00	$446.49	$707.24	$714.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-8-200	SUP	Custom 27203010		4922-8-200  -  ROD EXFIX 11MM 200MM CONNCTNG MRI HOFFMANN 3 CARB	BOTH IP/OP	$662.20 	$490.03	$0.00	$734.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$491.48	$491.48	$0.00	$0.00	$138.00	$0.00	$0.00	$0.00	$0.00	$459.36	$727.63	$734.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-8-250	SUP	Custom 27203010		4922-8-250  -  ROD EXFIX 11MM 250MM CONNCTNG	BOTH IP/OP	$662.20 	$490.03	$0.00	$734.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$491.48	$491.48	$0.00	$0.00	$138.00	$0.00	$0.00	$0.00	$0.00	$459.36	$727.63	$734.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-8-300	SUP	Custom 27203010		4922-8-300  -  ROD EXFIX 11MM 300MM CONNCTNG MRI SAFE HOFFMANN III CARB	BOTH IP/OP	$679.80 	$503.05	$0.00	$752.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$504.55	$504.55	$0.00	$0.00	$141.67	$0.00	$0.00	$0.00	$0.00	$470.25	$744.88	$752.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-8-350	SUP	Custom 27203010		4922-8-350  -  ROD EXFIX 11MM 350MM CONNCTNG MRI HOFFMANN 3 CARB	BOTH IP/OP	$679.80 	$503.05	$0.00	$752.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$504.55	$504.55	$0.00	$0.00	$141.67	$0.00	$0.00	$0.00	$0.00	$470.25	$744.88	$752.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-8-400	SUP	Custom 27203010		4922-8-400  -  ROD EXFIX 11MM 400MM CONNCTNG MRI HOFFMANN 3 CARB	BOTH IP/OP	$777.70 	$575.50	$0.00	$820.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$577.21	$577.21	$0.00	$0.00	$162.07	$0.00	$0.00	$0.00	$0.00	$512.83	$812.31	$820.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4922-8-500	SUP	HCPCS C1713		4922-8-500  -  ROD EXFIX 11MM 500MM CONNECT MRI SAFE MODULAR HOFFMANN III	BOTH IP/OP	$887.70 	$656.90	$0.00	$902.88	$507.87	$507.87	$0.00	$0.00	$0.00	$185.02	$658.85	$658.85	$0.00	$0.00	$185.00	$0.00	$525.07	$525.07	$0.00	$564.30	$893.85	$902.88	$0.00		$0.00	$176.63	$0.00	$0.00	$179.67	$0.00	$0.00	$0.00	$0.00	$0.00
493.100.01S	SUP	Custom 27803010		493.100.01S  -  WIRE FX 26GA 500MM STRL NDL TI	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$0.00	$0.00	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
493.101.01S	SUP	Custom 27803010		493.101.01S  -  WIRE FX 28GA 500MM STRL NDL TI	BOTH IP/OP	$229.50 	$169.83	$0.00	$183.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.33	$170.33	$0.00	$0.00	$47.83	$0.00	$0.00	$0.00	$0.00	$114.75	$181.76	$183.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
493.102.01S	SUP	Custom 27803010		493.102.01S  -  WIRE SPINAL .25MM 500MM NEEDLE TITANIUM STERILE	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$0.00	$0.00	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
493.103.01S	SUP	Custom 27803010		493.103.01S  -  WIRE SPINAL .2MM 500MM NEEDLE TITANIUM STERILE	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$0.00	$0.00	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
493.104.01S	SUP	Custom 27803010		493.104.01S  -  WIRE FX 28GA 500MM STRL BRB NDL TI	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$0.00	$0.00	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
49-36-1550	SUP	Custom 27203010		PAD FLRMCHN FOAM THK2IN 8IN CMPD MILWAUKEE	BOTH IP/OP	$42.58 	$31.51	$0.00	$34.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.29	$33.72	$34.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
494.771SHA	SUP	HCPCS C1713		494.771SHA  -  SCREW BONE 4/3MM 80MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC	BOTH IP/OP	$337.53 	$249.77	$0.00	$262.16	$147.47	$147.47	$0.00	$0.00	$0.00	$70.35	$250.51	$250.51	$0.00	$0.00	$70.34	$0.00	$199.65	$199.65	$0.00	$163.85	$259.54	$262.16	$0.00		$0.00	$49.79	$0.00	$0.00	$52.17	$0.00	$0.00	$0.00	$0.00	$0.00
494.784SHA	SUP	HCPCS C1713		494.784SHA  -  SCREW BONE 5MM 150MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC	BOTH IP/OP	$382.08 	$282.74	$0.00	$296.76	$166.93	$166.93	$0.00	$0.00	$0.00	$79.63	$283.58	$283.58	$0.00	$0.00	$79.62	$0.00	$226.00	$226.00	$0.00	$185.48	$293.79	$296.76	$0.00		$0.00	$56.36	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
494.785SHA	SUP	HCPCS C1713		494.785SHA  -  SCREW BONE 5MM 175MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC	BOTH IP/OP	$382.08 	$282.74	$0.00	$296.76	$166.93	$166.93	$0.00	$0.00	$0.00	$79.63	$283.58	$283.58	$0.00	$0.00	$79.62	$0.00	$226.00	$226.00	$0.00	$185.48	$293.79	$296.76	$0.00		$0.00	$56.36	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
494.786SHA	SUP	HCPCS C1713		494.786SHA  -  SCREW BONE 5MM 200MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC	BOTH IP/OP	$382.08 	$282.74	$0.00	$296.76	$166.93	$166.93	$0.00	$0.00	$0.00	$79.63	$283.58	$283.58	$0.00	$0.00	$79.62	$0.00	$226.00	$226.00	$0.00	$185.48	$293.79	$296.76	$0.00		$0.00	$56.36	$0.00	$0.00	$59.06	$0.00	$0.00	$0.00	$0.00	$0.00
4940-0-015	SUP	Custom 27203010		4940-0-015  -  TUBE XTRNFX SM 15MM 5MM HFMN2 C CMPR DSTRCT C	BOTH IP/OP	$844.25 	$624.75	$0.00	$675.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$626.60	$626.60	$0.00	$0.00	$175.94	$0.00	$0.00	$0.00	$0.00	$422.13	$668.65	$675.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4940-1-010	SUP	Custom 27203010		4940-1-010  -  COUPLING XTRNFX NS HFMN2 C ROD TO ROD 5 MM ROD/POST	BOTH IP/OP	$522.50 	$386.65	$0.00	$418.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$387.80	$387.80	$0.00	$0.00	$108.89	$0.00	$0.00	$0.00	$0.00	$261.25	$413.82	$418.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4940-1-015	SUP	Custom 27203010		4940-1-015  -  CLAMP EXFIX HFMN2 C KNEE CPLNG	BOTH IP/OP	$584.38 	$432.44	$0.00	$467.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$433.72	$433.72	$0.00	$0.00	$121.78	$0.00	$0.00	$0.00	$0.00	$292.19	$462.83	$467.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4940-1-020	SUP	Custom 27203010		4940-1-020  -  CPLNG EXFIX 5MM HFMN2 C 5MM 3-4MM PIN TO ROD	BOTH IP/OP	$522.50 	$386.65	$0.00	$418.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$387.80	$387.80	$0.00	$0.00	$108.89	$0.00	$0.00	$0.00	$0.00	$261.25	$413.82	$418.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4940-1-058	SUP	Custom 27203010		4940-1-058  -  CPLNG EXFIX 5MM HFMN2 C 5MM 8-8MM PIN TO ROD	BOTH IP/OP	$807.13 	$597.28	$0.00	$645.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.05	$599.05	$0.00	$0.00	$168.20	$0.00	$0.00	$0.00	$0.00	$403.56	$639.25	$645.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4940-1-100	SUP	Custom 27203010		4940-1-100  -  DEVICE EXFIX HFMN2 C CMPR DSTRCT ROD TO TUBE CPLNG	BOTH IP/OP	$522.50 	$386.65	$0.00	$418.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$387.80	$387.80	$0.00	$0.00	$108.89	$0.00	$0.00	$0.00	$0.00	$261.25	$413.82	$418.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4940-2-020	SUP	Custom 27203010		4940-2-020  -  CLAMP EXFIX HFMN2 4 HOLE MLPN	BOTH IP/OP	"$1,575.90 "	"$1,166.17"	$0.00	"$1,169.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,169.63"	"$1,169.63"	$0.00	$0.00	$328.42	$0.00	$0.00	$0.00	$0.00	$308.69	$488.96	$493.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4940-2-120	SUP	Custom 27203010		4940-2-120  -  POST XTRNFX STRG 5MM HFMN2 C SS	BOTH IP/OP	$298.70 	$221.04	$0.00	$221.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.70	$221.70	$0.00	$0.00	$62.25	$0.00	$0.00	$0.00	$0.00	$57.75	$91.48	$92.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4940-2-140	SUP	Custom 27203010		4940-2-140  -  POST XTRNFX 30D 5MM HFMN2 C SS	BOTH IP/OP	$298.70 	$221.04	$0.00	$221.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.70	$221.70	$0.00	$0.00	$62.25	$0.00	$0.00	$0.00	$0.00	$57.75	$91.48	$92.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4941-0-015	SUP	Custom 27203010		4941-0-015  -  TUBE XTRNFX 15MM 350MM YLW HFMN2 C CMPR DSTRCT MRI SAFE C	BOTH IP/OP	$737.00 	$545.38	$0.00	$589.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.00	$547.00	$0.00	$0.00	$153.59	$0.00	$0.00	$0.00	$0.00	$368.50	$583.70	$589.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4941-1-010	SUP	Custom 27203010		4941-1-010  -  CPLNG EXFIX HFMN2 ROD TO ROD CMPCT 5 MM ROD OR POST	BOTH IP/OP	$514.25 	$380.55	$0.00	$411.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$381.68	$381.68	$0.00	$0.00	$107.17	$0.00	$0.00	$0.00	$0.00	$257.13	$407.29	$411.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4941-1-020	SUP	Custom 27203010		4941-1-020  -  CLAMP EXFIX HFMN2 MRI PIN TO ROD CPLNG MRI 5 MM ROD OR POST	BOTH IP/OP	$514.25 	$380.55	$0.00	$411.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$381.68	$381.68	$0.00	$0.00	$107.17	$0.00	$0.00	$0.00	$0.00	$257.13	$407.29	$411.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4941-1-058	SUP	Custom 27203010		4941-1-058  -  COUPLING XTRNFX HFMN2 C MR SF 5 MM 8 MM ROD	BOTH IP/OP	$746.63 	$552.51	$0.00	$597.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$554.15	$554.15	$0.00	$0.00	$155.60	$0.00	$0.00	$0.00	$0.00	$373.31	$591.33	$597.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4941-1-100	SUP	Custom 27203010		4941-1-100  -  SYSTEM EXFIX 15MM 5MM DSTRCT TUBE ROD CPLNG POSTS	BOTH IP/OP	$456.50 	$337.81	$0.00	$365.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$338.81	$338.81	$0.00	$0.00	$95.13	$0.00	$0.00	$0.00	$0.00	$228.25	$361.55	$365.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4941-2-020	SUP	Custom 27203010		4941-2-020  -  CLAMP EXFIX HFMN2 C 4 HOLE PIN 3-4 MM PIN	BOTH IP/OP	$621.50 	$459.91	$0.00	$497.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$461.28	$461.28	$0.00	$0.00	$129.52	$0.00	$0.00	$0.00	$0.00	$310.75	$492.23	$497.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4941-2-120	SUP	Custom 27203010		4941-2-120  -  POST XTRNFX 30D STRG AU HFMN2 C MDLR MRI SAFE AL TI	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$0.00	$0.00	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4941-2-140	SUP	Custom 27203010		4941-2-140  -  POST XTRNFX 30D HFMN2 C MRI SAFE	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$0.00	$0.00	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4941-2-200	SUP	Custom 27203010		4941-2-200  -  CLAMP EXFIX HFMN2 MRI PERIART PIN CMPCT	BOTH IP/OP	$621.50 	$459.91	$0.00	$497.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$461.28	$461.28	$0.00	$0.00	$129.52	$0.00	$0.00	$0.00	$0.00	$310.75	$492.23	$497.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4960-1-010	SUP	Custom 27203010		4960-1-010  -  CPLNG EXFIX 3MM 3MM HFMN2 ROD TO ROD	BOTH IP/OP	$841.50 	$622.71	$0.00	$624.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$624.56	$624.56	$0.00	$0.00	$175.37	$0.00	$0.00	$0.00	$0.00	$367.13	$581.53	$587.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4960-1-020	SUP	Custom 27203010		4960-1-020  -  CPLNG EXFIX 1.65-2MM 3MM HFMN2 MIC HAND PIN TO ROD	BOTH IP/OP	$734.25 	$543.35	$0.00	$587.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$544.96	$544.96	$0.00	$0.00	$153.02	$0.00	$0.00	$0.00	$0.00	$367.13	$581.53	$587.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4960-1-060	SUP	Custom 27203010		4960-1-060  -  CPLNG EXFIX 5MM 3MM HFMN2 ROD TO ROD	BOTH IP/OP	$855.75 	$633.26	$0.00	$635.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$635.14	$635.14	$0.00	$0.00	$178.34	$0.00	$0.00	$0.00	$0.00	$373.31	$591.33	$597.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4960-2-020	SUP	Custom 27203010		4960-2-020  -  CLAMP EXFIX HFMN2 STR MLPN	BOTH IP/OP	$855.75 	$633.26	$0.00	$635.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$635.14	$635.14	$0.00	$0.00	$178.34	$0.00	$0.00	$0.00	$0.00	$373.31	$591.33	$597.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4960-3-000	SUP	Custom 27203010		4960-3-000  -  DEVICE EXFIX HFMN2 MIC LNTHNR	BOTH IP/OP	"$4,581.00 "	"$3,389.94"	$0.00	"$3,559.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,400.02"	"$3,400.02"	$0.00	$0.00	$954.68	$0.00	$0.00	$0.00	$0.00	"$2,224.75"	"$3,524.00"	"$3,559.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4960-3-015	SUP	Custom 27203010		4960-3-015  -  CLAMP EXFIX HFMN2 MIC MLPN LNTHNR CMPNT	BOTH IP/OP	$64.50 	$47.73	$0.00	$47.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.87	$47.87	$0.00	$0.00	$13.44	$0.00	$0.00	$0.00	$0.00	$29.56	$46.83	$47.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4960-3-020	SUP	Custom 27203010		4960-3-020  -  CLAMP EXFIX HFMN2 MIC MLPN LNTHNR CMPNT	BOTH IP/OP	"$1,524.00 "	"$1,127.76"	$0.00	"$1,131.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,131.11"	"$1,131.11"	$0.00	$0.00	$317.60	$0.00	$0.00	$0.00	$0.00	$325.88	$516.19	$521.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4960-3-025	SUP	Custom 27203010		4960-3-025  -  CLAMP EXFIX HFMN2 PERIART MLPN LNTHNR	BOTH IP/OP	"$1,524.00 "	"$1,127.76"	$0.00	"$1,131.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,131.11"	"$1,131.11"	$0.00	$0.00	$317.60	$0.00	$0.00	$0.00	$0.00	$325.88	$516.19	$521.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4960-3-030	SUP	Custom 27203010		4960-3-030  -  HII MICRO LENGTHENER THUMBWHEEL	BOTH IP/OP	$238.50 	$176.49	$0.00	$177.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.01	$177.01	$0.00	$0.00	$49.70	$0.00	$0.00	$0.00	$0.00	$87.31	$138.31	$139.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
497.668E	SUP	HCPCS C1713		497.668E  -  SCREW TI 8MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
497.670E	SUP	HCPCS C1713		497.670E  -  SCREW TI 10MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
497.672E	SUP	HCPCS C1713		497.672E  -  SCREW TI 12MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
497.674E	SUP	HCPCS C1713		497.674E  -  SCREW TI 14MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
497.676E	SUP	HCPCS C1713		497.676E  -  SCREW TI 16MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
497.678E	SUP	HCPCS C1713		497.678E  -  SCREW TI 18MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
497.680E	SUP	HCPCS C1713		497.680E  -  2.4MM TI LOCKING SCREW 20MM F/LOCKING RECONSTRUCTION PLATE	BOTH IP/OP	$389.25 	$288.05	$0.00	$311.40	$175.16	$175.16	$0.00	$0.00	$0.00	$81.13	$288.90	$288.90	$0.00	$0.00	$81.12	$0.00	$230.24	$230.24	$0.00	$194.63	$308.29	$311.40	$0.00		$0.00	$60.92	$0.00	$0.00	$61.97	$0.00	$0.00	$0.00	$0.00	$0.00
497.682E	SUP	HCPCS C1713		497.682E  -  2.4MM TI LOCKING SCREW 22MM F/LOCKING RECONSTRUCTION PLATE	BOTH IP/OP	$389.25 	$288.05	$0.00	$311.40	$175.16	$175.16	$0.00	$0.00	$0.00	$81.13	$288.90	$288.90	$0.00	$0.00	$81.12	$0.00	$230.24	$230.24	$0.00	$194.63	$308.29	$311.40	$0.00		$0.00	$60.92	$0.00	$0.00	$61.97	$0.00	$0.00	$0.00	$0.00	$0.00
497.684E	SUP	HCPCS C1713		497.684E  -  2.4MM TI LOCKING SCREW 24MM F/LOCKING RECONSTRUCTION PLATE	BOTH IP/OP	$389.25 	$288.05	$0.00	$311.40	$175.16	$175.16	$0.00	$0.00	$0.00	$81.13	$288.90	$288.90	$0.00	$0.00	$81.12	$0.00	$230.24	$230.24	$0.00	$194.63	$308.29	$311.40	$0.00		$0.00	$60.92	$0.00	$0.00	$61.97	$0.00	$0.00	$0.00	$0.00	$0.00
497.689E	SUP	HCPCS C1713		497.689E  -  TI BENDING INSERT SCREW F/LOCKING RECONSTRUCTION PLATE	BOTH IP/OP	$113.63 	$84.09	$0.00	$90.90	$51.13	$51.13	$0.00	$0.00	$0.00	$23.68	$84.33	$84.33	$0.00	$0.00	$23.68	$0.00	$67.21	$67.21	$0.00	$56.81	$89.99	$90.90	$0.00		$0.00	$17.78	$0.00	$0.00	$18.09	$0.00	$0.00	$0.00	$0.00	$0.00
497.690E	SUP	HCPCS C1713		497.690E  -  SCREW TI 8MM 3MM MANDIB SLFTAP LCK BONE STRL RECON PLT	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
497.691E	SUP	HCPCS C1713		497.691E  -  SCREW TI 10MM 3MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
497.692E	SUP	HCPCS C1713		497.692E  -  SCREW TI 12MM 3MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
497.693E	SUP	HCPCS C1713		497.693E  -  SCREW TI 14MM 3MM MANDIB SLFTAP LCK BONE STRL RECON PLT	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
497.694E	SUP	HCPCS C1713		497.694E  -  SCREW BONE 16MM 3MM CRNMXF TI SLFTAP LCK RECON PLT STRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
497.695E	SUP	HCPCS C1713		497.695E  -  SCREW BONE 18MM 3MM CRNMXF TI SLFTAP LCK RECON PLT STRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.45	$0.45	$0.00	$0.00	$0.00	$0.21	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.59	$0.59	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.16	$0.00	$0.00	$0.16	$0.00	$0.00	$0.00	$0.00	$0.00
497.696E	SUP	HCPCS C1713		497.696E  -  SCREW TI 20MM 3MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
497.697E	SUP	HCPCS C1713		497.697E  -  SCREW BONE 3MM 22MM TI ORTH LCK NONSTRL	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
497.698E	SUP	HCPCS C1713		497.698E  -  3.0MM TI LOCKING SCREW 24MM F/LOCKING RECONSTRUCTION PLATE	BOTH IP/OP	$452.25 	$334.67	$0.00	$361.80	$203.51	$203.51	$0.00	$0.00	$0.00	$94.26	$335.66	$335.66	$0.00	$0.00	$94.25	$0.00	$267.51	$267.51	$0.00	$226.13	$358.18	$361.80	$0.00		$0.00	$70.78	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00
497.78.98	SUP	HCPCS C1713		497.78.98  -  SCREW TI 5MM 1.8MM MAXFACL LCK BONE THORP NONSTRL	BOTH IP/OP	$85.50 	$63.27	$0.00	$68.40	$38.48	$38.48	$0.00	$0.00	$0.00	$17.82	$63.46	$63.46	$0.00	$0.00	$17.82	$0.00	$50.57	$50.57	$0.00	$42.75	$67.72	$68.40	$0.00		$0.00	$13.38	$0.00	$0.00	$13.61	$0.00	$0.00	$0.00	$0.00	$0.00
497-670	SUP	HCPCS C1713		497-670  -  SCREW TI 10MM 2.4MM MANDIB SLFTAP LCK RECON BONE NONSTRL	BOTH IP/OP	$272.25 	$201.47	$0.00	$217.80	$122.51	$122.51	$0.00	$0.00	$0.00	$56.74	$202.06	$202.06	$0.00	$0.00	$56.74	$0.00	$161.04	$161.04	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$42.61	$0.00	$0.00	$43.34	$0.00	$0.00	$0.00	$0.00	$0.00
498.800.01S	SUP	Custom 27803010		498.800.01S  -  CABLE ORTHOPEDIC 1MM 750MM CRIMP TITANIUM STERILE	BOTH IP/OP	$919.33 	$680.30	$0.00	$714.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$682.32	$682.32	$0.00	$0.00	$191.59	$0.00	$0.00	$0.00	$0.00	$446.28	$706.90	$714.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
498.803S	SUP	Custom 27203010		498.803S  -  POSITIONER IMPLANT 4.5MM THREAD CERCLAGE TITANIUM STERILE	BOTH IP/OP	$343.00 	$253.82	$0.00	$266.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.57	$254.57	$0.00	$0.00	$71.48	$0.00	$0.00	$0.00	$0.00	$166.50	$263.74	$266.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
498.806S	SUP	Custom 27803010		498.806S  -  SYSTEM CABLE STANDARD REATTACHMENT DEVICE TITANIUM COCR	BOTH IP/OP	"$3,644.95 "	"$2,697.26"	$0.00	"$2,831.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,705.28"	"$2,705.28"	$0.00	$0.00	$759.61	$0.00	$0.00	$0.00	$0.00	"$1,769.40"	"$2,802.73"	"$2,831.04"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
498.807S	SUP	Custom 27803010		498.807S  -  SYSTEM CABLE LONG TITANIUM COCR TROC STERILE REATTACHMENT	BOTH IP/OP	"$5,251.68 "	"$3,886.24"	$0.00	"$4,078.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,897.79"	"$3,897.79"	$0.00	$0.00	"$1,094.45"	$0.00	$0.00	$0.00	$0.00	"$2,549.35"	"$4,038.17"	"$4,078.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
498.821S	SUP	Custom 27803010		498.821S  -  CABLE ORTHOPEDIC 1MM 750MM NEEDLE CRIMP TITANIUM STERILE	BOTH IP/OP	"$1,031.78 "	$763.52	$0.00	$801.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$765.78	$765.78	$0.00	$0.00	$215.02	$0.00	$0.00	$0.00	$0.00	$500.86	$793.37	$801.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
498.822S	SUP	Custom 27803010		498.822S  -  CABLE ORTHOPEDIC CRIMP TITANIUM STERILE	BOTH IP/OP	$67.83 	$50.19	$0.00	$52.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.34	$50.34	$0.00	$0.00	$14.13	$0.00	$0.00	$0.00	$0.00	$32.93	$52.15	$52.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
498.837S	SUP	Custom 27203010		498.837S  -  PIN FIX 3.5MM CERCLAGE POSITION STR TITANIUM ORTHOPEDIC	BOTH IP/OP	$343.00 	$253.82	$0.00	$266.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.57	$254.57	$0.00	$0.00	$71.48	$0.00	$0.00	$0.00	$0.00	$166.50	$263.74	$266.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
498.838S	SUP	HCPCS C1713		498.838S  -  PIN FIX 3.5MM THREADED CERCLAGE POSITIONING TITANIUM	BOTH IP/OP	$343.00 	$253.82	$0.00	$266.40	$149.85	$149.85	$0.00	$0.00	$0.00	$71.49	$254.57	$254.57	$0.00	$0.00	$71.48	$0.00	$202.88	$202.88	$0.00	$166.50	$263.74	$266.40	$0.00		$0.00	$50.60	$0.00	$0.00	$53.01	$0.00	$0.00	$0.00	$0.00	$0.00
498.839S	SUP	Custom 27203010		498.839S  -  POSITIONER SURG 4.5MM CERCLAGE NONTHREADED PIN TITANIUM	BOTH IP/OP	$343.00 	$253.82	$0.00	$266.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.57	$254.57	$0.00	$0.00	$71.48	$0.00	$0.00	$0.00	$0.00	$166.50	$263.74	$266.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4981-1-010S	SUP	Custom 27203010		4981-1-010S  -  CPLNG EXFIX 15/15MM 4 5/15MM HFMN XPRESS UNV STRL	BOTH IP/OP	$696.50 	$515.41	$0.00	$632.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$516.94	$516.94	$0.00	$0.00	$145.15	$0.00	$0.00	$0.00	$0.00	$395.31	$626.18	$632.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4981-1-020S	SUP	Custom 27203010		4981-1-020S  -  COUPLING XTRNFX UNV 5MM 6MM	BOTH IP/OP	$845.63 	$625.77	$0.00	$676.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$627.62	$627.62	$0.00	$0.00	$176.23	$0.00	$0.00	$0.00	$0.00	$422.81	$669.74	$676.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4A0002	SUP	HCPCS C1725		4A0002  -  CATHETER ANGIO JR4 CRV 4FR 100CM STSR	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
4A0004	SUP	HCPCS C1887		4A0004  -  CATHETER ANGIOGRAPHIC JR5 CURVE 4FR 100CM SITESEER	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
4A001	SUP	HCPCS C1725		CATHETER 4FR JR 3.5	BOTH IP/OP	$0.80 	$0.59	$0.00	$0.64	$0.43	$0.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.40	$0.63	$0.64	$0.00		$0.00	$0.13	$0.00	$0.00	$0.13	$0.00	$0.00	$0.00	$0.00	$0.00
4A0010	SUP	HCPCS C1725		4A0010  -  CATHETER ANGIOGRAPHIC JL3.5 CURVE 4FR 100CM SITESEER	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
4A0011	SUP	HCPCS C1725		4A0011  -  CATHETER ANGIO JL4 CRV 4FR 100CM STSR	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
4A0012	SUP	HCPCS C1725		4A0012  -  CATHETER ANGIOGRAPHIC JL5 CURVE 4FR 100CM SITESEER	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
4A002	SUP	HCPCS C1887		4A002  -  CATHETER GD JR CRV 4FR	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$3.65	$12.99	$12.99	$0.00	$0.00	$3.65	$0.00	$10.35	$10.35	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
4A0022	SUP	HCPCS C1725		4A0022  -  CATHETER ANGIOGRAPHIC MPA2 CURVE 4FR 100CM 2 SIDEHOLE	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
4A101	SUP	Custom 27203010		HAMMER TL 12.25IN 1.25IN NUPLA FBGLS PLMR DEAD BLOW 4IN 16OZ	BOTH IP/OP	$62.90 	$46.55	$0.00	$50.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.45	$49.82	$50.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4DCFN	SUP	Custom 27203010		4DCFN  -  TUBE TRCH 4 9.4MM 5MM 62MM STRL LF SHLY CUFLS DISP INR CNN	BOTH IP/OP	$83.74 	$61.97	$0.00	$66.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.15	$62.15	$0.00	$0.00	$17.45	$0.00	$0.00	$0.00	$0.00	$41.87	$66.32	$66.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4DCFS	SUP	Custom 27203010		4DCFS  -  TUBE TRCH 4 9.4MM 5MM 62MM STRL LF SHLY CUFLS DISP INR CNN	BOTH IP/OP	$89.90 	$66.53	$0.00	$71.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.95	$71.20	$71.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4DFEN	SUP	Custom 27203010		4DFEN  -  TUBE TRCH 4 9.4MM 5MM 62MM STRL LF SHLY CUF DISP INR CNN RND	BOTH IP/OP	$99.43 	$73.58	$0.00	$80.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.79	$73.79	$0.00	$0.00	$20.72	$0.00	$0.00	$0.00	$0.00	$50.46	$79.93	$80.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4MAXC	SUP	HCPCS C1757		4MAXC  -  CATHETER REPERFUSION 4MAX	BOTH IP/OP	"$3,725.00 "	"$2,756.50"	$0.00	"$4,110.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$776.38	"$2,764.70"	"$2,764.70"	$0.00	$0.00	$776.29	$0.00	"$4,110.93"	"$4,110.93"	$0.00	"$1,612.50"	"$2,554.20"	"$2,580.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4MAXCKIT	SUP	HCPCS C1757		4MAXCKIT  -  CATHETER REPERFUSION 4MAX	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4N06A	SUP	Custom 27803010		4N06A  -  SUTURE NABSB CV-4 TH-26 36IN WHT 2 ARM MFL GRTX	BOTH IP/OP	$67.50 	$49.95	$0.00	$53.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.10	$50.10	$0.00	$0.00	$14.07	$0.00	$0.00	$0.00	$0.00	$33.23	$52.64	$53.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
4R5126	SUP	Custom 27203010		DEVICE HMTP SEG NDL PRTC BLOOD BANK STRL	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50000LTS	SUP	HCPCS C1713		50000LTS  -  CAP LCK SPRL R90D TI SPNE WDG LCK CLSR MECH	BOTH IP/OP	$696.43 	$515.36	$0.00	$557.14	$313.39	$313.39	$0.00	$0.00	$0.00	$145.15	$516.89	$516.89	$0.00	$0.00	$145.13	$0.00	$411.94	$411.94	$0.00	$348.21	$551.57	$557.14	$0.00		$0.00	$108.99	$0.00	$0.00	$110.87	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-42A	SUP	Custom 27803010		500-01-42A  -  SHELL ACETAB A HEMISPHERICAL 42MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-44B	SUP	Custom 27803010		500-01-44B  -  SHELL ACETAB B HEMISPHERICAL 44MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-46C	SUP	Custom 27803010		500-01-46C  -  SHELL ACETAB C HEMISPHERICAL 46MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-48D	SUP	Custom 27803010		500-01-48D  -  SHELL ACETAB D HEMISPHERICAL 48MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-50D	SUP	Custom 27803010		500-01-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-52E	SUP	Custom 27803010		500-01-52E  -  SHELL ACETAB E HEMISPHERICAL 52MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-54E	SUP	Custom 27803010		500-01-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-56F	SUP	Custom 27803010		500-01-56F  -  SHELL ACETAB F HEMISPHERICAL 56MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-58F	SUP	Custom 27803010		500-01-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-60G	SUP	Custom 27803010		500-01-60G  -  SHELL ACETAB G HEMISPHERICAL 60MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-62G	SUP	Custom 27803010		500-01-62G  -  SHELL ACETAB G HEMISPHERICAL 62MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-64H	SUP	Custom 27803010		500-01-64H  -  SHELL ACETAB H HEMISPHERICAL 64MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-66H	SUP	Custom 27803010		500-01-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-68I	SUP	Custom 27803010		500-01-68I  -  SHELL ACETAB I HEMISPHERICAL 68MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-70I	SUP	Custom 27803010		500-01-70I  -  SHELL ACETAB I HEMISPHERICAL 70MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-72J	SUP	Custom 27803010		500-01-72J  -  SHELL ACETAB J HEMISPHERICAL 72MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-01-74J	SUP	Custom 27803010		500-01-74J  -  SHELL ACETAB J HEMISPHERICAL 74MM SOLID BACK TRIDENT HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-03-44A	SUP	Custom 27803010		500-03-44A  -  SHELL ACETAB A HEMISPHERICAL 44MM SOLID BACK TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-03-46B	SUP	Custom 27803010		500-03-46B  -  SHELL ACETAB B HEMISPHERICAL 46MM SOLID BACK TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-03-48C	SUP	Custom 27803010		500-03-48C  -  SHELL ACETAB C HEMISPHERICAL 48MM SOLID BACK TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-03-50D	SUP	Custom 27803010		500-03-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM SOLID BACK TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-03-52D	SUP	Custom 27803010		500-03-52D  -  SHELL ACETAB D HEMISPHERICAL 52MM SOLID BACK TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-03-54E	SUP	Custom 27803010		500-03-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM SOLID BACK PRIM TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-03-56E	SUP	Custom 27803010		500-03-56E  -  SHELL ACETAB E HEMISPHERICAL 56MM SOLID BACK PRIM TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-03-58F	SUP	Custom 27803010		500-03-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM SOLID BACK PRIM TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-03-60F	SUP	Custom 27803010		500-03-60F  -  SHELL ACETAB F HEMISPHERICAL 60MM SOLID BACK PRIM TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-03-62G	SUP	Custom 27803010		500-03-62G  -  SHELL ACETAB F HEMISPHERICAL 60MM SOLID BACK PRIM TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-03-64G	SUP	Custom 27803010		500-03-64G  -  SHELL ACETAB G HEMISPHERICAL 64MM SOLID BACK PRIM TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-03-66H	SUP	Custom 27803010		500-03-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM SOLID BACK PRIM TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5000L	SUP	Custom 27803010		5000L  -  CONNECTOR ROD LNG SPRL R90D VAR CX TI SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5000M	SUP	Custom 27803010		5000M  -  CONNECTOR ROD MED SPRL R90D VAR CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5000S	SUP	Custom 27803010		5000S  -  CONNECTOR ROD SM SPRL R90D VAR CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50010X	SUP	Custom 27803010		50010X  -  CONNECTOR ROD 10MM SPRL R90D FX CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-42A	SUP	Custom 27803010		500-11-42A  -  SHELL ACETAB A HEMISPHERICAL 42MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-44B	SUP	Custom 27803010		500-11-44B  -  SHELL ACETAB B HEMISPHERICAL 44MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-46C	SUP	Custom 27803010		500-11-46C  -  SHELL ACETAB C HEMISPHERICAL 46MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-48D	SUP	Custom 27803010		500-11-48D  -  SHELL ACETAB D HEMISPHERICAL 48MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-50D	SUP	Custom 27803010		500-11-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-52E	SUP	Custom 27803010		500-11-52E  -  SHELL ACETAB E HEMISPHERICAL 52MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-54E	SUP	Custom 27803010		500-11-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-56F	SUP	Custom 27803010		500-11-56F  -  SHELL ACETAB F HEMISPHERICAL 56MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-58F	SUP	Custom 27803010		500-11-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-60G	SUP	Custom 27803010		500-11-60G  -  SHELL ACETAB G HEMISPHERICAL 60MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-62G	SUP	Custom 27803010		500-11-62G  -  SHELL ACETAB G HEMISPHERICAL 62MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-64H	SUP	Custom 27803010		500-11-64H  -  SHELL ACETAB H HEMISPHERICAL 64MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-66H	SUP	Custom 27803010		500-11-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-68I	SUP	Custom 27803010		500-11-68I  -  SHELL ACETAB I HEMISPHERICAL 68MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-70I	SUP	Custom 27803010		500-11-70I  -  SHELL ACETAB I HEMISPHERICAL 70MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-72J	SUP	Custom 27803010		500-11-72J  -  SHELL ACETAB J HEMISPHERICAL 72MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-11-74J	SUP	Custom 27803010		500-11-74J  -  SHELL ACETAB J HEMISPHERICAL 74MM SOLID BACK TRIDENT METAL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50012X	SUP	Custom 27803010		50012X  -  CONNECTOR ROD 12MM SPRL R90D FX CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50014X	SUP	Custom 27803010		50014X  -  CONNECTOR ROD 14MM SPRL R90D FX CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50016X	SUP	Custom 27803010		50016X  -  CONNECTOR ROD 16MM SPRL R90D FX CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50018X	SUP	Custom 27803010		50018X  -  CONNECTOR ROD 18MM SPRL R90D FX CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50020X	SUP	Custom 27803010		50020X  -  CONNECTOR ROD 20MM SPRL R90D VAR CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-022-01-07	SUP	Custom 27100030		50-022-01-07  -  DRILL TWIST 2.7MM 2.2MM 70MM J NOTCH GLIDING 2.7MM SCREW 2.1	BOTH IP/OP	$290.05 	$214.64	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.28	$215.28	$0.00	$0.00	$60.45	$0.00	$0.00	$0.00	$0.00	$145.03	$229.72	$232.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-022-15-07	SUP	Custom 27100030		50-022-15-07  -  DRILL TWIST 2.2MM 115MM STERILE	BOTH IP/OP	$290.05 	$214.64	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.28	$215.28	$0.00	$0.00	$60.45	$0.00	$0.00	$0.00	$0.00	$145.03	$229.72	$232.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50022X	SUP	Custom 27803010		50022X  -  CONNECTOR ROD 22MM SPRL R90D VAR CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50024X	SUP	Custom 27803010		50024X  -  CONNECTOR ROD 24MM SPRL R90D VAR CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50026X	SUP	Custom 27803010		50026X  -  CONNECTOR ROD 26MM SPRL R90D CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50028X	SUP	Custom 27803010		50028X  -  CONNECTOR ROD 28MM SPRL R90D CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50030X	SUP	Custom 27803010		50030X  -  CONNECTOR ROD 30MM SPRL R90D CX TI THORLMBR SPNE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005 A	SUP	Custom 27803010		5005 A  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005 B	SUP	Custom 27803010		5005 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005 C	SUP	Custom 27803010		5005 C  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005 E	SUP	Custom 27803010		5005 E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005 F	SUP	Custom 27803010		5005 F  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005 G	SUP	Custom 27803010		5005 G  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005 H	SUP	Custom 27803010		5005 H  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5005 I	SUP	Custom 27803010		5005 I  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
500-580C-10U	SUP	Custom 27803010		500-580C-10U  -  CLIP HMSTS 5FR BMRNG CTLST 2 SYS ART VASC CATH ACCES ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50100-1500	SUP	HCPCS C1884		50100-1500  -  SHEATH RTRVL 4FR F EZ .014IN BNTP	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$90.00	$90.00	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
50-12003	SUP	HCPCS C1713		50-12003  -  SCREW BONE 1.2MM 3MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL	BOTH IP/OP	$27.75 	$20.54	$0.00	$22.20	$12.49	$12.49	$0.00	$0.00	$0.00	$5.78	$20.60	$20.60	$0.00	$0.00	$5.78	$0.00	$16.41	$16.41	$0.00	$13.88	$21.98	$22.20	$0.00		$0.00	$4.34	$0.00	$0.00	$4.42	$0.00	$0.00	$0.00	$0.00	$0.00
50-12004	SUP	HCPCS C1713		50-12004  -  SCREW BONE 1.2MM 4MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$57.84	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$164.14	$164.14	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
50-12005	SUP	HCPCS C1713		50-12005  -  SCREW BONE 1.2MM 5MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$57.84	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$164.14	$164.14	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
50-12006	SUP	HCPCS C1713		50-12006  -  SCREW BONE 1.2MM 6MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$57.84	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$164.14	$164.14	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
50-12007	SUP	HCPCS C1713		50-12007  -  SCREW BONE 1.2MM 7MM SLFTAP TITANIUM UPPERFACIAL	BOTH IP/OP	$111.25 	$82.33	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$23.19	$82.57	$82.57	$0.00	$0.00	$23.18	$0.00	$65.80	$65.80	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
50-12008	SUP	HCPCS C1713		50-12008  -  SCREW BONE 1.2MM 8MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL	BOTH IP/OP	$111.25 	$82.33	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$23.19	$82.57	$82.57	$0.00	$0.00	$23.18	$0.00	$65.80	$65.80	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
50-12010	SUP	HCPCS C1713		50-12010  -  SCREW BONE 1.2MM 10MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL	BOTH IP/OP	$111.25 	$82.33	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$23.19	$82.57	$82.57	$0.00	$0.00	$23.18	$0.00	$65.80	$65.80	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
50-12012	SUP	HCPCS C1713		50-12012  -  SCREW BONE 1.2MM 12MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL	BOTH IP/OP	$111.25 	$82.33	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$23.19	$82.57	$82.57	$0.00	$0.00	$23.18	$0.00	$65.80	$65.80	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
50-12903	SUP	HCPCS C1713		50-12903  -  SCREW BONE 1.2MM 3MM SLFDRILL XPIN HEAD LEIBINGER UNIVERSAL	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
50-12904	SUP	HCPCS C1713		50-12904  -  SCREW BONE 1.2MM 4MM SELF DRILL XPIN TITANIUM UPPERFACIAL	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$28.13	$28.13	$0.00	$0.00	$0.00	$13.03	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$36.97	$36.97	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
5013-2-120S	SUP	HCPCS C1713		5013-2-120S  -  PIN 120MM 4MM APEX HA SS SLFTAP DRL THRD SHFT 20MM STRL	BOTH IP/OP	$228.65 	$169.20	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$47.66	$169.70	$169.70	$0.00	$0.00	$47.65	$0.00	$135.25	$135.25	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
5013-3-090S	SUP	HCPCS C1713		5013-3-090S  -  PIN 90MM 4MM APEX HA SS SLFTAP DRL THRD SHFT 30MM STRL	BOTH IP/OP	$228.65 	$169.20	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$47.66	$169.70	$169.70	$0.00	$0.00	$47.65	$0.00	$135.25	$135.25	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
50-14003	SUP	HCPCS C1713		50-14003  -  SCREW BONE 1.4MM 3MM SELF TAP XPIN EMERGENCY TITANIUM	BOTH IP/OP	$282.50 	$209.05	$0.00	$226.00	$127.13	$127.13	$0.00	$0.00	$0.00	$58.88	$209.67	$209.67	$0.00	$0.00	$58.87	$0.00	$167.10	$167.10	$0.00	$141.25	$223.74	$226.00	$0.00		$0.00	$44.21	$0.00	$0.00	$44.97	$0.00	$0.00	$0.00	$0.00	$0.00
50-14005	SUP	HCPCS C1713		50-14005  -  SCREW BONE 1.4MM 5MM SELF TAP XPIN HEAD EMERGENCY LEIBINGER	BOTH IP/OP	$282.50 	$209.05	$0.00	$226.00	$127.13	$127.13	$0.00	$0.00	$0.00	$58.88	$209.67	$209.67	$0.00	$0.00	$58.87	$0.00	$167.10	$167.10	$0.00	$141.25	$223.74	$226.00	$0.00		$0.00	$44.21	$0.00	$0.00	$44.97	$0.00	$0.00	$0.00	$0.00	$0.00
50-14007	SUP	HCPCS C1713		50-14007  -  SCREW BONE 1.4MM 7MM SLFTAP XPIN EMERGENCY TITANIUM	BOTH IP/OP	$120.38 	$89.08	$0.00	$226.00	$127.13	$127.13	$0.00	$0.00	$0.00	$25.09	$89.34	$89.34	$0.00	$0.00	$25.09	$0.00	$71.20	$71.20	$0.00	$141.25	$223.74	$226.00	$0.00		$0.00	$44.21	$0.00	$0.00	$44.97	$0.00	$0.00	$0.00	$0.00	$0.00
50-14009	SUP	HCPCS C1713		50-14009  -  SCREW BONE 1.4MM 9MM SLFTAP XPIN EMERGENCY TITANIUM	BOTH IP/OP	$120.38 	$89.08	$0.00	$226.00	$127.13	$127.13	$0.00	$0.00	$0.00	$25.09	$89.34	$89.34	$0.00	$0.00	$25.09	$0.00	$71.20	$71.20	$0.00	$141.25	$223.74	$226.00	$0.00		$0.00	$44.21	$0.00	$0.00	$44.97	$0.00	$0.00	$0.00	$0.00	$0.00
5014-2-120S	SUP	HCPCS C1713		5014-2-120S  -  PIN 6MM SLFTAP/DRL THRD SHFT 120MM APEX HA SS 30MM STRL	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$116.94	$116.94	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
5014-3-150S	SUP	HCPCS C1713		5014-3-150S  -  PIN 6MM SLFTAP/DRL THRD SHFT 150MM APEX HA SS 30MM STRL	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$116.94	$116.94	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
5014-3-180S	SUP	HCPCS C1713		5014-3-180S  -  PIN HALF 180MM 6MM APEX HA SS SLFDRILL SLFTAP THRD SHFT 30MM	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$116.94	$116.94	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
5014-3-200S	SUP	HCPCS C1713		5014-3-200S  -  PIN 6MM SLFTAP/DRL THRD SHFT 200MM APEX HA SS 30MM STRL	BOTH IP/OP	$268.13 	$198.42	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$55.88	$199.00	$199.00	$0.00	$0.00	$55.88	$0.00	$158.60	$158.60	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
5014-4-150S	SUP	HCPCS C1713		5014-4-150S  -  PIN 6MM SLFTAP/DRL THRD SHFT 150MM APEX HA SS 40MM STRL	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$116.94	$116.94	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
5014-4-180S	SUP	HCPCS C1713		5014-4-180S  -  PIN 6MM SLFTAP/DRL THRD SHFT 180MM APEX HA SS 40MM STRL	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$116.94	$116.94	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
5014-4-200S	SUP	HCPCS C1713		5014-4-200S  -  PIN 6MM SLFTAP/DRL THRD SHFT 200MM APEX HA SS 40MM STRL	BOTH IP/OP	$268.13 	$198.42	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$55.88	$199.00	$199.00	$0.00	$0.00	$55.88	$0.00	$158.60	$158.60	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
5014-5-150S	SUP	HCPCS C1713		5014-5-150S  -  PIN HALF 150MM 6MM APEX HA SS SLFDRILL SLFTAP 50MM FIX SYS	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$116.94	$116.94	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
5014-5-180S	SUP	HCPCS C1713		5014-5-180S  -  PIN HALF 180MM 6MM APEX HA SS SLFDRILL SLFTAP THRD SHFT 50MM	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$116.94	$116.94	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
5014-5-200S	SUP	HCPCS C1713		5014-5-200S  -  PIN 6MM SLFTAP/DRL THRD SHFT 200MM APEX HA SS 50MM STRL	BOTH IP/OP	$268.13 	$198.42	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$55.88	$199.00	$199.00	$0.00	$0.00	$55.88	$0.00	$158.60	$158.60	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
5014-6-150S	SUP	HCPCS C1713		5014-6-150S  -  PIN 6MM SLFTAP/DRL THRD SHFT 150MM APEX HA SS 60MM STRL	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$116.94	$116.94	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
5014-6-180S	SUP	HCPCS C1713		5014-6-180S  -  PIN 6MM SLFTAP/DRL THRD SHFT 180MM APEX HA SS 60MM STRL	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$116.94	$116.94	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
5014-6-200S	SUP	HCPCS C1713		5014-6-200S  -  PIN 6MM SLFTAP/DRL THRD SHFT 200MM APEX HA SS 60MM STRL	BOTH IP/OP	$268.13 	$198.42	$0.00	$214.50	$120.66	$120.66	$0.00	$0.00	$0.00	$55.88	$199.00	$199.00	$0.00	$0.00	$55.88	$0.00	$158.60	$158.60	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$41.96	$0.00	$0.00	$42.69	$0.00	$0.00	$0.00	$0.00	$0.00
5014-7-250S	SUP	HCPCS C1713		5014-7-250S  -  PIN HALF 250MM 6MM APEX SS HA SLFDRILL SLFTAP THRD 70MM STRL	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
5014-8-150S	SUP	HCPCS C1713		5014-8-150S  -  PIN 6MM SLFDRILL SLFTAP THRD SHFT 150MM APEX HA SS 25MM STRL	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$116.94	$116.94	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
5014-8-250S	SUP	HCPCS C1713		5014-8-250S  -  PIN 6MM SLFDRILL SLFTAP THRD SHFT 150MM APEX HA SS 80MM STRL	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
5014-9-250S	SUP	HCPCS C1713		5014-9-250S  -  PIN 6MM SLFDRILL SLFTAP THRD SHFT 250MM APEX HA SS 90MM STRL	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
50-15006	SUP	HCPCS C1713		50-15006  -  SCREW BN 1.5MM 6MM ST CROSSPIN TI CRNMXF	BOTH IP/OP	$140.68 	$104.10	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$29.32	$104.41	$104.41	$0.00	$0.00	$29.32	$0.00	$83.21	$83.21	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
5015-3-120	SUP	HCPCS C1713		5015-3-120  -  SCREW BONE 5MM 120MM 35MM APEX THRD CANC	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
5015-4-150	SUP	HCPCS C1713		5015-4-150  -  PIN 5MM 150MM CANC APEX TI 40MM	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
5015-5-150	SUP	HCPCS C1713		5015-5-150  -  SCREW BONE 5MM 150MM 50MM APEX THRD CANC	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
5015-6-180	SUP	HCPCS C1713		5015-6-180  -  SCREW BONE 5MM 180MM 60MM APEX SS CANC	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
5015-7-250	SUP	HCPCS C1713		5015-7-250  -  PIN HALF 250MM 5MM APEX HFMN2 CANC SS THRD 70MM	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
50-15904	SUP	HCPCS C1713		50-15904  -  SCREW BONE 1.5MM 4MM SELF DRILL XPIN HEAD TITANIUM	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
50-15905	SUP	HCPCS C1713		50-15905  -  SCREW BONE 1.5MM 5MM SELF DRILL XPIN HEAD TITANIUM	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
5016-5-111	SUP	HCPCS C1713		5016-5-111  -  PIN HALF HFMN 5MMX120MM 35MM THRD TI SLFDRL ST F/EXFIX	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$95.91	$95.91	$0.00	$0.00	$0.00	$49.43	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$140.27	$140.27	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$33.35	$0.00	$0.00	$33.93	$0.00	$0.00	$0.00	$0.00	$0.00
5016-5-117	SUP	HCPCS C1713		5016-5-117  -  PIN 5MM SLFDRILL SLFTAP 150MM APEX TI 40MM	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$95.91	$95.91	$0.00	$0.00	$0.00	$49.43	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$140.27	$140.27	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$33.35	$0.00	$0.00	$33.93	$0.00	$0.00	$0.00	$0.00	$0.00
5016-5-118	SUP	HCPCS C1713		5016-5-118  -  PIN HALF HFMN 50MM 5MMX150MM TI SLFDRL ST F/EXFIX	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$95.91	$95.91	$0.00	$0.00	$0.00	$49.43	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$140.27	$140.27	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$33.35	$0.00	$0.00	$33.93	$0.00	$0.00	$0.00	$0.00	$0.00
5016-5-122	SUP	HCPCS C1713		5016-5-122  -  PIN HALF HFMN 50MM 5MMX180MM TI SLFDRL ST F/EXFIX	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$95.91	$95.91	$0.00	$0.00	$0.00	$49.43	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$140.27	$140.27	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$33.35	$0.00	$0.00	$33.93	$0.00	$0.00	$0.00	$0.00	$0.00
50-17003	SUP	HCPCS C1713		50-17003  -  SCREW BONE 1.7MM 3MM SLFTAP XPIN TITANIUM MIDFAC	BOTH IP/OP	$49.50 	$36.63	$0.00	$39.60	$22.28	$22.28	$0.00	$0.00	$0.00	$10.32	$36.74	$36.74	$0.00	$0.00	$10.32	$0.00	$29.28	$29.28	$0.00	$24.75	$39.20	$39.60	$0.00		$0.00	$7.75	$0.00	$0.00	$7.88	$0.00	$0.00	$0.00	$0.00	$0.00
50-17004	SUP	HCPCS C1713		50-17004  -  SCREW BONE 1.7MM 4MM SLFTAP XPIN TITANIUM MIDFAC	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
50-17006	SUP	HCPCS C1713		50-17006  -  SCREW BONE 1.7MM 6MM SLFTAP XPIN TITANIUM MIDFAC	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
50-17007	SUP	HCPCS C1713		50-17007  -  SCREW BONE 1.7MM 7MM SLFTAP XPIN TITANIUM MIDFAC	BOTH IP/OP	$94.25 	$69.75	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$19.64	$69.95	$69.95	$0.00	$0.00	$19.64	$0.00	$55.75	$55.75	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
50-17008	SUP	HCPCS C1713		50-17008  -  SCREW BONE 1.7MM 8MM SELF TAP XPIN TITANIUM MIDFAC	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
50-17010	SUP	HCPCS C1713		50-17010  -  SCREW BONE 1.7MM 10MM SELF TAP XPIN TITANIUM MIDFAC	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
50-17012	SUP	HCPCS C1713		50-17012  -  SCREW BONE 1.7MM 12MM SLFTAP XPIN TITANIUM MIDFAC	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
5017-2-150S	SUP	HCPCS C1713		5017-2-150S  -  PIN 5MM SLFDRILL SLFTAP THRD SHFT 150MM APEX HA SS 20MM STRL	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$113.85	$113.85	$0.00	$0.00	$0.00	$52.73	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$149.65	$149.65	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$39.59	$0.00	$0.00	$40.28	$0.00	$0.00	$0.00	$0.00	$0.00
50-17304	SUP	HCPCS C1713		50-17304  -  SCREW BN 1.7MM 4MM NS UNV NEURO 2 ST XPN ER CRNMXF	BOTH IP/OP	$125.70 	$93.02	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$26.20	$93.29	$93.29	$0.00	$0.00	$26.20	$0.00	$74.35	$74.35	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
5017-3-150S	SUP	Custom 27203010		5017-3-150S  -  PIN XTRNFX 5MM 150MM STRL 30MM APX SLF DRL ST SS HA	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$0.00	$0.00	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5017-3-180S	SUP	HCPCS C1713		5017-3-180S  -  PIN HALF 180MM 5MM APEX HA SS SLFDRILL SLFTAP THRD SHFT 30MM	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$113.85	$113.85	$0.00	$0.00	$0.00	$52.73	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$149.65	$149.65	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$39.59	$0.00	$0.00	$40.28	$0.00	$0.00	$0.00	$0.00	$0.00
50-174-01-09	SUP	HCPCS C1713		50-174-01-09  -  IMPLANT PRT JNT TI RT CNDYL 3 MM RECON PLT	BOTH IP/OP	"$3,141.33 "	"$2,324.58"	$0.00	"$2,513.06"	"$1,413.60"	"$1,413.60"	$0.00	$0.00	$0.00	$654.73	"$2,331.49"	"$2,331.49"	$0.00	$0.00	$654.65	$0.00	"$1,548.67"	"$1,548.67"	$0.00	"$1,570.66"	"$2,487.93"	"$2,513.06"	$0.00		$0.00	$491.62	$0.00	$0.00	$500.10	$0.00	$0.00	$0.00	$0.00	$0.00
50-174-03-09	SUP	HCPCS C1713		50-174-03-09  -  SCREW BN FX XDR TI CNDYL 3 MM RECON PLT	BOTH IP/OP	"$1,008.13 "	$746.02	$0.00	$806.50	$453.66	$453.66	$0.00	$0.00	$0.00	$210.12	$748.23	$748.23	$0.00	$0.00	$210.09	$0.00	$596.31	$596.31	$0.00	$504.06	$798.44	$806.50	$0.00		$0.00	$157.77	$0.00	$0.00	$160.49	$0.00	$0.00	$0.00	$0.00	$0.00
5017-4-150S	SUP	HCPCS C1713		5017-4-150S  -  PIN HALF STRL 150MM 5MM APEX SS SLFTAP SLFDRILL 40MM EXFIX	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$113.85	$113.85	$0.00	$0.00	$0.00	$52.73	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$149.65	$149.65	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$39.59	$0.00	$0.00	$40.28	$0.00	$0.00	$0.00	$0.00	$0.00
5017-4-180S	SUP	HCPCS C1713		5017-4-180S  -  PIN HALF 180MM 5MM APEX HYDRXAPT EXFIX	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$113.85	$113.85	$0.00	$0.00	$0.00	$52.73	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$149.65	$149.65	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$39.59	$0.00	$0.00	$40.28	$0.00	$0.00	$0.00	$0.00	$0.00
50-17504	SUP	HCPCS C1713		50-17504  -  SCREW BONE 1.7MM 4MM LOCK GRAY TITANIUM MIDFAC	BOTH IP/OP	$139.70 	$103.38	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$29.12	$103.69	$103.69	$0.00	$0.00	$29.11	$0.00	$82.63	$82.63	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
50-17505	SUP	HCPCS C1713		50-17505  -  SCREW BONE 1.7MM 5MM LOCKING XPIN GRAY TITANIUM MIDFAC	BOTH IP/OP	$139.70 	$103.38	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$29.12	$103.69	$103.69	$0.00	$0.00	$29.11	$0.00	$82.63	$82.63	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
50-17506	SUP	HCPCS C1713		50-17506  -  SCREW BONE 1.7MM 6MM SLFDRILL SLFTAP LOCKING XPIN TITANIUM	BOTH IP/OP	$139.70 	$103.38	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$29.12	$103.69	$103.69	$0.00	$0.00	$29.11	$0.00	$82.63	$82.63	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
5017-5-150S	SUP	HCPCS C1713		5017-5-150S  -  PIN HLF SLFDRL ORTH	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$113.85	$113.85	$0.00	$0.00	$0.00	$52.73	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$149.65	$149.65	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$39.59	$0.00	$0.00	$40.28	$0.00	$0.00	$0.00	$0.00	$0.00
5017-5-180S	SUP	HCPCS C1713		5017-5-180S  -  PIN HALF 180MM 5MM APEX SS HA SLFDRILL SLFTAP THRD 50MM STRL	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$113.85	$113.85	$0.00	$0.00	$0.00	$52.73	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$149.65	$149.65	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$39.59	$0.00	$0.00	$40.28	$0.00	$0.00	$0.00	$0.00	$0.00
5017-6-150S	SUP	HCPCS C1713		5017-6-150S  -  PIN 5MM SLFTAP/DRL THRD SHFT 150MM APEX HA SS 60MM STRL	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$113.85	$113.85	$0.00	$0.00	$0.00	$52.73	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$149.65	$149.65	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$39.59	$0.00	$0.00	$40.28	$0.00	$0.00	$0.00	$0.00	$0.00
5017-6-200S	SUP	HCPCS C1713		5017-6-200S  -  PIN HALF 200MM 5MM APEX ORTH SS SLFTAP SLFDRILL 60MM EXFIX	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$116.94	$116.94	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
5017-7-200S	SUP	HCPCS C1713		5017-7-200S  -  PIN HALF 200MM 5MM APEX ORTH SS SLFTAP SLFDRILL 70MM EXFIX	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$116.94	$116.94	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
5017-8-150S	SUP	HCPCS C1713		5017-8-150S  -  PIN HALF 150MM 5MM APEX HA SS SLFDRILL SLFTAP THRD SHFT 25MM	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$113.85	$113.85	$0.00	$0.00	$0.00	$52.73	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$149.65	$149.65	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$39.59	$0.00	$0.00	$40.28	$0.00	$0.00	$0.00	$0.00	$0.00
50-17903	SUP	HCPCS C1713		50-17903  -  SCREW BONE 1.7MM 3MM SELF DRILL XPIN TITANIUM MIDFAC	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,120.00"	$630.00	$630.00	$0.00	$0.00	$0.00	$291.80	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$828.10	$828.10	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00		$0.00	$219.10	$0.00	$0.00	$222.88	$0.00	$0.00	$0.00	$0.00	$0.00
50-17904	SUP	HCPCS C1713		50-17904  -  SCREW BONE 1.7MM 4MM SELF DRILL XPIN TITANIUM MIDFAC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
50-17905	SUP	HCPCS C1713		50-17905  -  SCREW BONE 1.7MM 5MM SLFDRILL XPIN TITANIUM MIDFAC	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,120.00"	$630.00	$630.00	$0.00	$0.00	$0.00	$291.80	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$828.10	$828.10	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00		$0.00	$219.10	$0.00	$0.00	$222.88	$0.00	$0.00	$0.00	$0.00	$0.00
50-17906	SUP	HCPCS C1713		50-17906  -  SCREW BONE 1.7MM 6MM SLFDRILL XPIN TITANIUM MIDFAC	BOTH IP/OP	$103.40 	$76.52	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$21.55	$76.74	$76.74	$0.00	$0.00	$21.55	$0.00	$61.16	$61.16	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
5017-9-120S	SUP	HCPCS C1713		5017-9-120S  -  PIN 5MM SLFDRILL SLFTAP THRD SHFT 120MM APEX HA SS 35MM STRL	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$113.85	$113.85	$0.00	$0.00	$0.00	$52.73	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$149.65	$149.65	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$39.59	$0.00	$0.00	$40.28	$0.00	$0.00	$0.00	$0.00	$0.00
5017-9-150S	SUP	HCPCS C1713		5017-9-150S  -  PIN HALF 150MM 5MM APEX HYDRXAPT SLFDRILL EXFIX	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$113.85	$113.85	$0.00	$0.00	$0.00	$52.73	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$149.65	$149.65	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$39.59	$0.00	$0.00	$40.28	$0.00	$0.00	$0.00	$0.00	$0.00
5018-3-120	SUP	Custom 27203010		5018-3-120  -  PIN HLF 5MM 120MM 30MM APX ST SLFDRL THRD SS FT/ANKL	BOTH IP/OP	$209.25 	$154.85	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5018-3-180	SUP	HCPCS C1713		5018-3-180  -  PIN HALF 180MM 5MM APEX ORTH SS SLFDRILL	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$92.81	$92.81	$0.00	$0.00	$0.00	$49.43	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$140.27	$140.27	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
5018-5-120	SUP	Custom 27203010		5018-5-120  -  PIN HALF 120MM 5MM APEX SS SLFTAP SLFDRILL 35MM EXFIX SYS	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5018-5-150	SUP	Custom 27203010		5018-5-150  -  PIN HALF 150MM 5MM APEX SS SLFTAP SLFDRILL 40MM EXFIX SYS	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5018-5-200	SUP	Custom 27203010		5018-5-200  -  PIN HALF 200MM 5MM APEX SS SLFTAP SLFDRILL 50MM EXFIX SYS	BOTH IP/OP	$209.25 	$154.85	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5018-5-250	SUP	Custom 27203010		5018-5-250  -  PIN HALF 250MM 5MM APEX SS SLFTAP SLFDRILL 50MM EXFIX SYS	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5018-6-150	SUP	Custom 27203010		5018-6-150  -  PIN HALF 150MM 5MM APEX SS SLFTAP SLFDRILL 50MM EXFIX SYS	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5018-6-180S	SUP	HCPCS C1713		5018-6-180S  -  PIN HALF 180MM 5MM APEX ORTH SS SLFTAP SLFDRILL 50MM STRL	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$98.38	$98.38	$0.00	$0.00	$0.00	$49.43	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$140.27	$140.27	$0.00	$109.31	$173.15	$174.90	$0.00		$0.00	$34.21	$0.00	$0.00	$34.81	$0.00	$0.00	$0.00	$0.00	$0.00
5018-6-200	SUP	Custom 27203010		5018-6-200  -  PIN HALF 200MM 5MM APEX SS SLFTAP SLFDRILL 60MM EXFIX SYS	BOTH IP/OP	$205.70 	$152.22	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.67	$152.67	$0.00	$0.00	$42.87	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5018-7-250	SUP	Custom 27203010		5018-7-250  -  PIN HALF 250MM 5MM APEX SS SLFTAP SLFDRILL 70MM EXFIX SYS	BOTH IP/OP	$209.25 	$154.85	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5018-8-180	SUP	Custom 27203010		5018-8-180  -  PIN HALF 180MM 5MM APEX SS SLFTAP SLFDRILL 60MM EXFIX SYS	BOTH IP/OP	$209.25 	$154.85	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-19003	SUP	HCPCS C1713		50-19003  -  SCREW BONE 1.9MM 3MM EMERGENCY TITANIUM MIDFAC	BOTH IP/OP	"$1,362.50 "	"$1,008.25"	$0.00	"$1,090.00"	$613.13	$613.13	$0.00	$0.00	$0.00	$283.98	"$1,011.25"	"$1,011.25"	$0.00	$0.00	$283.95	$0.00	$805.92	$805.92	$0.00	$681.25	"$1,079.10"	"$1,090.00"	$0.00		$0.00	$213.23	$0.00	$0.00	$216.91	$0.00	$0.00	$0.00	$0.00	$0.00
50-19005	SUP	HCPCS C1713		50-19005  -  SCREW BONE 1.9MM 5MM EMERGENCY TITANIUM MIDFAC	BOTH IP/OP	$54.50 	$40.33	$0.00	$43.60	$24.53	$24.53	$0.00	$0.00	$0.00	$11.36	$40.45	$40.45	$0.00	$0.00	$11.36	$0.00	$32.24	$32.24	$0.00	$27.25	$43.16	$43.60	$0.00		$0.00	$8.53	$0.00	$0.00	$8.68	$0.00	$0.00	$0.00	$0.00	$0.00
50-19007	SUP	HCPCS C1713		50-19007  -  SCREW BONE 1.9MM 7MM SLFTAP XPIN EMERGENCY TITANIUM MAXFACL	BOTH IP/OP	$106.93 	$79.13	$0.00	$218.00	$122.63	$122.63	$0.00	$0.00	$0.00	$22.29	$79.36	$79.36	$0.00	$0.00	$22.28	$0.00	$63.25	$63.25	$0.00	$136.25	$215.82	$218.00	$0.00		$0.00	$42.65	$0.00	$0.00	$43.38	$0.00	$0.00	$0.00	$0.00	$0.00
50-19009	SUP	HCPCS C1713		50-19009  -  SCREW BONE 1.9MM 9MM SLFTAP XPIN EMERGENCY TITANIUM MAXFACL	BOTH IP/OP	$106.93 	$79.13	$0.00	$218.00	$122.63	$122.63	$0.00	$0.00	$0.00	$22.29	$79.36	$79.36	$0.00	$0.00	$22.28	$0.00	$63.25	$63.25	$0.00	$136.25	$215.82	$218.00	$0.00		$0.00	$42.65	$0.00	$0.00	$43.38	$0.00	$0.00	$0.00	$0.00	$0.00
5019-1-180	SUP	HCPCS C1713		5019-1-180  -  PIN HALF 120MM 5MM APEX SS SLFTAP CONTIN THRD 50MM	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$87.86	$87.86	$0.00	$0.00	$0.00	$49.43	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$140.27	$140.27	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
5019-7-120	SUP	HCPCS C1713		5019-7-120  -  PIN HALF 120MM 6MM APEX SS SLFTAP CONTIN THRD 50MM	BOTH IP/OP	$258.50 	$191.29	$0.00	$206.80	$116.33	$116.33	$0.00	$0.00	$0.00	$53.88	$191.86	$191.86	$0.00	$0.00	$53.87	$0.00	$152.90	$152.90	$0.00	$129.25	$204.73	$206.80	$0.00		$0.00	$40.46	$0.00	$0.00	$41.15	$0.00	$0.00	$0.00	$0.00	$0.00
5019-7-150	SUP	HCPCS C1713		5019-7-150  -  PIN HALF 150MM 6MM APEX SS CONTIN THRD BLNT TIP 50MM EXFIX	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$92.81	$92.81	$0.00	$0.00	$0.00	$49.43	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$140.27	$140.27	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-42A	SUP	Custom 27803010		502-01-42A  -  SHELL ACETAB A HEMISPHERICAL 42MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-44B	SUP	Custom 27803010		502-01-44B  -  SHELL ACETAB B HEMISPHERICAL 44MM 3 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-46C	SUP	Custom 27803010		502-01-46C  -  SHELL ACETAB C HEMISPHERICAL 46MM 3 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-48D	SUP	Custom 27803010		502-01-48D  -  SHELL ACETAB 48MM HIP HMSPHR CLSTR TRDNT D	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-50D	SUP	Custom 27803010		502-01-50D  -  SHELL ACETAB 50MM HIP HMSPHR CLSTR TRDNT D	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-52E	SUP	Custom 27803010		502-01-52E  -  SHELL ACETAB 52MM HIP HMSPHR CLSTR TRDNT E	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-54E	SUP	Custom 27803010		502-01-54E  -  SHELL ACETAB 54MM HIP HMSPHR CLSTR TRDNT E	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-56F	SUP	Custom 27803010		502-01-56F  -  SHELL ACETAB F HEMISPHERICAL 56MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-58F	SUP	Custom 27803010		502-01-58F  -  SHELL ACETAB 58MM HIP HMSPHR CLSTR TRDNT F	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-60G	SUP	Custom 27803010		502-01-60G  -  SHELL ACETAB G HEMISPHERICAL 60MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-62G	SUP	Custom 27803010		502-01-62G  -  SHELL ACETAB G HEMISPHERICAL 62MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-64H	SUP	Custom 27803010		502-01-64H  -  SHELL ACETAB H HEMISPHERICAL 64MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-66H	SUP	Custom 27803010		502-01-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-68I	SUP	Custom 27803010		502-01-68I  -  SHELL ACTB I HMSPHR 68MM TRDNT 5 SCR HL CLSTR MTL HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-70I	SUP	Custom 27803010		502-01-70I  -  SHELL ACETAB I HEMISPHERICAL 70MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-72J	SUP	Custom 27803010		502-01-72J  -  SHELL ACETAB J HEMISPHERICAL 72MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-01-74J	SUP	Custom 27803010		502-01-74J  -  SHELL ACETAB J HEMISPHERICAL 74MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5020-2-150	SUP	Custom 27203010		5020-2-150  -  PIN HLF 5MM 150MM 20MM APX BLNT	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$0.00	$0.00	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5020-2-180	SUP	Custom 27203010		5020-2-180  -  PIN HLF 5MM 180MM 20MM APX BLNT	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$0.00	$0.00	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5020-2-200	SUP	Custom 27203010		5020-2-200  -  PIN HLF 5MM 200MM 20MM APX BLNT	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$0.00	$0.00	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5020-2-250	SUP	Custom 27203010		5020-2-250  -  PIN HLF 5MM 250MM 20MM APX BLNT	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$0.00	$0.00	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5020-3-120	SUP	Custom 27203010		5020-3-120  -  PIN HALF 120MM 5MM APEX SS CONTIN THRD BLNT TIP 30MM EXFIX	BOTH IP/OP	$209.25 	$154.85	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5020-3-150	SUP	Custom 27203010		5020-3-150  -  PIN HALF 150MM 5MM APEX SS CONTIN THRD BLNT TIP 40MM EXFIX	BOTH IP/OP	$209.25 	$154.85	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-03-44A	SUP	Custom 27803010		502-03-44A  -  SHELL ACETAB A HEMISPHERICAL 44MM PRIM RIM CLSHOLE TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-03-46B	SUP	Custom 27803010		502-03-46B  -  SHELL ACETAB B HEMISPHERICAL 46MM PRIM RIM CLSHOLE TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-03-48C	SUP	Custom 27803010		502-03-48C  -  SHELL ACETAB C HEMISPHERICAL 48MM PRIM RIM CLSHOLE TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-03-50D	SUP	Custom 27803010		502-03-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM PRIM RIM CLSHOLE TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-03-52D	SUP	Custom 27803010		502-03-52D  -  SHELL ACETAB D 52MM PRIM HEMISPHERICAL CLSHOLE TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-03-54E	SUP	Custom 27803010		502-03-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM PRIM RIM CLSHOLE TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-03-56E	SUP	Custom 27803010		502-03-56E  -  SHELL ACETAB E HEMISPHERICAL 56MM PRIM RIM CLSHOLE TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-20358	SUP	HCPCS C1713		50-20358  -  SCREW BN 2MM 8MM NS LEIBINGER UNV 2 MMF SLF DRL XPN LGT WRE	BOTH IP/OP	$560.00 	$414.40	$0.00	$448.00	$252.00	$252.00	$0.00	$0.00	$0.00	$116.72	$415.63	$415.63	$0.00	$0.00	$116.70	$0.00	$331.24	$331.24	$0.00	$280.00	$443.52	$448.00	$0.00		$0.00	$87.64	$0.00	$0.00	$89.15	$0.00	$0.00	$0.00	$0.00	$0.00
502-03-58F	SUP	Custom 27803010		502-03-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM PRIM RIM CLSHOLE TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-03-60F	SUP	Custom 27803010		502-03-60F  -  SHELL ACETAB F HEMISPHERICAL 60MM PRIM RIM CLSHOLE TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-20362	SUP	HCPCS C1713		50-20362  -  SCREW BONE 2MM 12MM SELF DRILL TITANIUM MANDIB	BOTH IP/OP	$560.00 	$414.40	$0.00	$448.00	$252.00	$252.00	$0.00	$0.00	$0.00	$116.72	$415.63	$415.63	$0.00	$0.00	$116.70	$0.00	$331.24	$331.24	$0.00	$280.00	$443.52	$448.00	$0.00		$0.00	$87.64	$0.00	$0.00	$89.15	$0.00	$0.00	$0.00	$0.00	$0.00
502-03-62G	SUP	Custom 27803010		502-03-62G  -  SHELL ACETAB G 62MM PRIM HEMISPHERICAL CLSHOLE TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-03-64G	SUP	Custom 27803010		502-03-64G  -  SHELL ACETAB G HEMISPHERICAL 64MM PRIM RIM CLSHOLE TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-03-66H	SUP	Custom 27803010		502-03-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM PRIM RIM CLSHOLE TRITANIUM	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	$0.00	$0.00	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-20404	SUP	HCPCS C1713		50-20404  -  SCREW BONE 2MM 4MM XPIN TITANIUM MAXFACL	BOTH IP/OP	$125.93 	$93.19	$0.00	$100.74	$56.67	$56.67	$0.00	$0.00	$0.00	$26.25	$93.46	$93.46	$0.00	$0.00	$26.24	$0.00	$74.48	$74.48	$0.00	$62.96	$99.74	$100.74	$0.00		$0.00	$19.71	$0.00	$0.00	$20.05	$0.00	$0.00	$0.00	$0.00	$0.00
50-20405	SUP	HCPCS C1713		50-20405  -  SCREW BONE 2MM 5MM XPIN TITANIUM MAXFACL	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$108.00	$108.00	$0.00	$0.00	$0.00	$50.02	$178.13	$178.13	$0.00	$0.00	$50.02	$0.00	$141.96	$141.96	$0.00	$120.00	$190.08	$192.00	$0.00		$0.00	$37.56	$0.00	$0.00	$38.21	$0.00	$0.00	$0.00	$0.00	$0.00
50-20407	SUP	HCPCS C1713		50-20407  -  SCREW BONE 2MM 7MM XPIN TITANIUM MAXFACL	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$108.00	$108.00	$0.00	$0.00	$0.00	$50.02	$178.13	$178.13	$0.00	$0.00	$50.02	$0.00	$141.96	$141.96	$0.00	$120.00	$190.08	$192.00	$0.00		$0.00	$37.56	$0.00	$0.00	$38.21	$0.00	$0.00	$0.00	$0.00	$0.00
50-20408	SUP	HCPCS C1713		50-20408  -  SCREW BONE 2MM 8MM XPIN TITANIUM MAXFACL	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$108.00	$108.00	$0.00	$0.00	$0.00	$50.02	$178.13	$178.13	$0.00	$0.00	$50.02	$0.00	$141.96	$141.96	$0.00	$120.00	$190.08	$192.00	$0.00		$0.00	$37.56	$0.00	$0.00	$38.21	$0.00	$0.00	$0.00	$0.00	$0.00
50-20410	SUP	HCPCS C1713		50-20410  -  SCREW BN 2MM 10MM AU NS LEIBINGER UNV 2 ST XPN TI MXLFCL	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$108.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.00	$190.08	$192.00	$0.00		$0.00	$37.56	$0.00	$0.00	$38.21	$0.00	$0.00	$0.00	$0.00	$0.00
50-20412	SUP	HCPCS C1713		50-20412  -  SCREW BONE 2MM 12MM XPIN TITANIUM MAXFACL	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$108.00	$108.00	$0.00	$0.00	$0.00	$50.02	$178.13	$178.13	$0.00	$0.00	$50.02	$0.00	$141.96	$141.96	$0.00	$120.00	$190.08	$192.00	$0.00		$0.00	$37.56	$0.00	$0.00	$38.21	$0.00	$0.00	$0.00	$0.00	$0.00
50-20414	SUP	HCPCS C1713		50-20414  -  SCREW BONE 2MM 14MM XPIN TITANIUM MANDIB	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$108.00	$108.00	$0.00	$0.00	$0.00	$50.02	$178.13	$178.13	$0.00	$0.00	$50.02	$0.00	$141.96	$141.96	$0.00	$120.00	$190.08	$192.00	$0.00		$0.00	$37.56	$0.00	$0.00	$38.21	$0.00	$0.00	$0.00	$0.00	$0.00
50-20416	SUP	HCPCS C1713		50-20416  -  SCREW BONE 2MM 16MM XPIN TITANIUM MANDIB	BOTH IP/OP	$89.60 	$66.30	$0.00	$192.00	$108.00	$108.00	$0.00	$0.00	$0.00	$18.67	$66.50	$66.50	$0.00	$0.00	$18.67	$0.00	$53.00	$53.00	$0.00	$120.00	$190.08	$192.00	$0.00		$0.00	$37.56	$0.00	$0.00	$38.21	$0.00	$0.00	$0.00	$0.00	$0.00
50-20418	SUP	HCPCS C1713		50-20418  -  SCREW BONE 2MM 18MM XPIN TITANIUM MANDIB	BOTH IP/OP	$113.30 	$83.84	$0.00	$214.00	$120.38	$120.38	$0.00	$0.00	$0.00	$23.61	$84.09	$84.09	$0.00	$0.00	$23.61	$0.00	$67.02	$67.02	$0.00	$133.75	$211.86	$214.00	$0.00		$0.00	$41.86	$0.00	$0.00	$42.59	$0.00	$0.00	$0.00	$0.00	$0.00
50-20420	SUP	HCPCS C1713		50-20420  -  SCREW BONE 2MM 20MM SLFTAP XPIN TITANIUM MANDIB	BOTH IP/OP	$113.30 	$83.84	$0.00	$214.00	$120.38	$120.38	$0.00	$0.00	$0.00	$23.61	$84.09	$84.09	$0.00	$0.00	$23.61	$0.00	$67.02	$67.02	$0.00	$133.75	$211.86	$214.00	$0.00		$0.00	$41.86	$0.00	$0.00	$42.59	$0.00	$0.00	$0.00	$0.00	$0.00
50-20504	SUP	HCPCS C1713		50-20504  -  SCREW BONE 2MM 4MM LOCKING XPIN TITANIUM MAXFACL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
50-20505	SUP	HCPCS C1713		50-20505  -  SCREW BN 2MM 5MM GRY NS LEIBINGER UNV 2 LCK XPN TI MXLFCL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
50-20506	SUP	HCPCS C1713		50-20506  -  SCREW BONE 2MM 6MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
50-20507	SUP	HCPCS C1713		50-20507  -  SCREW BONE 2MM 7MM LOCKING XPIN TITANIUM MAXFACL	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$192.38	$192.38	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
50-20508	SUP	HCPCS C1713		50-20508  -  SCREW BN 2MM 8MM GRY NS LEIBINGER UNV 2 LCK XPN TI MNDB	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
50-20510	SUP	HCPCS C1713		50-20510  -  SCREW BONE 2MM 10MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
50-20512	SUP	HCPCS C1713		50-20512  -  SCREW BONE 2MM 12MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
50-20514	SUP	HCPCS C1713		50-20514  -  SCREW BONE 2MM 14MM LOCKING XPIN TITANIUM MAXFACL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
5020-5-150	SUP	Custom 27203010		5020-5-150  -  PIN HALF 150MM 5MM APEX ORTH BLNT TIP 25MM	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-20516	SUP	HCPCS C1713		50-20516  -  SCREW BONE 2MM 16MM LOCKING XPIN LEIBINGER UNIVERSAL 2	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
50-205-16	SUP	Custom 27203010		50-205-16  -  FORCEPS SURG UNV PLT HLD 2 BALLS	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-20518	SUP	HCPCS C1713		50-20518  -  SCREW BONE 2MM 18MM LOCKING XPIN TITANIUM MANDIB	BOTH IP/OP	$162.23 	$120.05	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$33.81	$120.40	$120.40	$0.00	$0.00	$33.81	$0.00	$95.96	$95.96	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
50-20520	SUP	HCPCS C1713		50-20520  -  SCREW BONE 2MM 20MM LOCKING XPIN TITANIUM MAXFACL	BOTH IP/OP	$162.23 	$120.05	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$33.81	$120.40	$120.40	$0.00	$0.00	$33.81	$0.00	$95.96	$95.96	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
50-20596	SUP	HCPCS C1713		50-20596  -  SCREW BN 2MM 6MM NS LEIBINGER UNV 2 SMARTLOCK SLF DRL LCK TI	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
50-20598	SUP	HCPCS C1713		50-20598  -  SCREW BN 2MM 8MM NS LEIBINGER UNV 2 SMARTLOCK SLF DRL LCK TI	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
5020-6-120	SUP	Custom 27203010		5020-6-120  -  PIN HALF 120MM 5MM APEX SS THRD SHFT BLNT PREDRILLING 35MM	BOTH IP/OP	$209.25 	$154.85	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5020-6-200	SUP	Custom 27203010		5020-6-200  -  PIN HALF 200MM 5MM APEX SS THRD SHFT BLNT PREDRILLING 60MM	BOTH IP/OP	$209.25 	$154.85	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-20704	SUP	HCPCS C1713		50-20704  -  SCREW BONE 2MM 4MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$118.13 	$87.42	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$24.62	$87.67	$87.67	$0.00	$0.00	$24.62	$0.00	$69.87	$69.87	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
50-20705	SUP	HCPCS C1713		50-20705  -  SCREW BONE 2MM 5MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
50-20706	SUP	HCPCS C1713		50-20706  -  SCREW BONE 2MM 6MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$118.13 	$87.42	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$24.62	$87.67	$87.67	$0.00	$0.00	$24.62	$0.00	$69.87	$69.87	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
50-20708	SUP	HCPCS C1713		50-20708  -  SCREW BONE 2MM 8MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$118.13 	$87.42	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$24.62	$87.67	$87.67	$0.00	$0.00	$24.62	$0.00	$69.87	$69.87	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
50-20710	SUP	HCPCS C1713		50-20710  -  SCREW BONE 2MM 10MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$118.13 	$87.42	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$24.62	$87.67	$87.67	$0.00	$0.00	$24.62	$0.00	$69.87	$69.87	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
50-20712	SUP	HCPCS C1713		50-20712  -  SCREW BONE 2MM 12MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$118.13 	$87.42	$0.00	$87.67	$25.88	$25.88	$0.00	$0.00	$0.00	$24.62	$87.67	$87.67	$0.00	$0.00	$24.62	$0.00	$69.87	$69.87	$0.00	$28.75	$45.54	$46.00	$0.00		$0.00	$9.00	$0.00	$0.00	$9.15	$0.00	$0.00	$0.00	$0.00	$0.00
50-20714	SUP	HCPCS C1713		50-20714  -  SCREW BONE 2MM 14MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$118.13 	$87.42	$0.00	$119.93	$67.46	$67.46	$0.00	$0.00	$0.00	$24.62	$87.67	$87.67	$0.00	$0.00	$24.62	$0.00	$69.87	$69.87	$0.00	$74.96	$118.74	$119.93	$0.00		$0.00	$23.46	$0.00	$0.00	$23.87	$0.00	$0.00	$0.00	$0.00	$0.00
5020-7-150	SUP	Custom 27203010		5020-7-150  -  PIN HALF 150MM 5MM APEX SS CONTIN THRD 50MM EXFIX SYS	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-20716	SUP	HCPCS C1713		50-20716  -  SCREW BONE 2MM 16MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$118.13 	$87.42	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$24.62	$87.67	$87.67	$0.00	$0.00	$24.62	$0.00	$69.87	$69.87	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
50-20718	SUP	HCPCS C1713		50-20718  -  SCREW BONE 2MM 18MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$118.13 	$87.42	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$24.62	$87.67	$87.67	$0.00	$0.00	$24.62	$0.00	$69.87	$69.87	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
5020-7-180	SUP	Custom 27203010		5020-7-180  -  PIN HALF 180MM 5MM APEX SS CONTIN THRD 50MM EXFIX SYS	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-20720	SUP	HCPCS C1713		50-20720  -  SCREW BONE 2MM 20MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$118.13 	$87.42	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$24.62	$87.67	$87.67	$0.00	$0.00	$24.62	$0.00	$69.87	$69.87	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
5020-7-200	SUP	Custom 27203010		5020-7-200  -  PIN HALF 200MM 5MM APEX SS CONTIN THRD 50MM EXFIX SYS	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5020-7-250	SUP	Custom 27203010		5020-7-250  -  PIN HALF 250MM 5MM APEX SS CONTIN THRD 50MM EXFIX SYS	BOTH IP/OP	$237.15 	$175.49	$0.00	$176.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.01	$176.01	$0.00	$0.00	$49.42	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5020-8-180	SUP	Custom 27203010		5020-8-180  -  PIN HALF 180MM 5MM APEX SS BLNT TIP 60MM EXFIX SYS	BOTH IP/OP	$209.25 	$154.85	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5020-8-250	SUP	Custom 27203010		5020-8-250  -  PIN HALF 250MM 5MM APEX SS BLNT TIP 70MM EXFIX SYS	BOTH IP/OP	$209.25 	$154.85	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-20904	SUP	HCPCS C1713		50-20904  -  SCREW BONE 2MM 4MM SLFDRILL XPIN TITANIUM MAXFACL	BOTH IP/OP	$144.50 	$106.93	$0.00	$274.00	$154.13	$154.13	$0.00	$0.00	$0.00	$30.12	$107.25	$107.25	$0.00	$0.00	$30.11	$0.00	$85.47	$85.47	$0.00	$171.25	$271.26	$274.00	$0.00		$0.00	$53.60	$0.00	$0.00	$54.53	$0.00	$0.00	$0.00	$0.00	$0.00
50-20905	SUP	HCPCS C1713		50-20905  -  SCREW BONE 2MM 5MM SLFDRILL XPIN TITANIUM MAXFACL	BOTH IP/OP	$342.50 	$253.45	$0.00	$274.00	$154.13	$154.13	$0.00	$0.00	$0.00	$71.39	$254.20	$254.20	$0.00	$0.00	$71.38	$0.00	$202.59	$202.59	$0.00	$171.25	$271.26	$274.00	$0.00		$0.00	$53.60	$0.00	$0.00	$54.53	$0.00	$0.00	$0.00	$0.00	$0.00
50-20906	SUP	HCPCS C1713		50-20906  -  SCREW BONE 2MM 6MM SLFDRILL XPIN TITANIUM MAXFACL	BOTH IP/OP	$126.35 	$93.50	$0.00	$274.00	$154.13	$154.13	$0.00	$0.00	$0.00	$26.33	$93.78	$93.78	$0.00	$0.00	$26.33	$0.00	$74.74	$74.74	$0.00	$171.25	$271.26	$274.00	$0.00		$0.00	$53.60	$0.00	$0.00	$54.53	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-42A	SUP	Custom 27803010		502-11-42A  -  SHELL ACETAB A HEMISPHERICAL 42MM 3 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-44B	SUP	Custom 27803010		502-11-44B  -  SHELL ACETAB B HEMISPHERICAL 44MM 3 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-46C	SUP	Custom 27803010		502-11-46C  -  SHELL ACETAB C HEMISPHERICAL 46MM 3 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-48D	SUP	Custom 27803010		502-11-48D  -  SHELL ACETAB D HEMISPHERICAL 48MM 3 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-50D	SUP	Custom 27803010		502-11-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM 3 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-52E	SUP	Custom 27803010		502-11-52E  -  SHELL ACETAB E HEMISPHERICAL 52MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-54E	SUP	Custom 27803010		502-11-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-56F	SUP	Custom 27803010		502-11-56F  -  SHELL ACTB F HMSPHR 56MM TRDNT CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-58F	SUP	Custom 27803010		502-11-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-60G	SUP	Custom 27803010		502-11-60G  -  SHELL ACETAB G HEMISPHERICAL 60MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-62G	SUP	Custom 27803010		502-11-62G  -  SHELL ACETAB G HEMISPHERICAL 62MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-64H	SUP	Custom 27803010		502-11-64H  -  SHELL ACETAB H HEMISPHERICAL 64MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-66H	SUP	Custom 27803010		502-11-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-68I	SUP	Custom 27803010		502-11-68I  -  SHELL ACETAB I HEMISPHERICAL 68MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-70I	SUP	Custom 27803010		502-11-70I  -  SHELL ACETAB I HEMISPHERICAL 70MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-72J	SUP	Custom 27803010		502-11-72J  -  SHELL ACETAB D HEMISPHERICAL 72MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-74J	SUP	Custom 27803010		502-11-74J  -  SHELL ACETAB J HEMISPHERICAL 74MM 5 SCREW HOLE CLUSTER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-80L	SUP	Custom 27803010		502-11-80L  -  SHELL ACETAB 80MM HIP CLSHOLE HMSPHR TRDNT L	BOTH IP/OP	"$2,506.00 "	"$1,854.44"	$0.00	"$2,004.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.95"	"$1,859.95"	$0.00	$0.00	$522.25	$0.00	$0.00	$0.00	$0.00	"$1,253.00"	"$1,984.75"	"$2,004.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
502-11-82L	SUP	Custom 27803010		502-11-82L  -  SHELL ACETAB 82MM HIP CLSHOLE HMSPHR TRDNT L	BOTH IP/OP	"$2,506.00 "	"$1,854.44"	$0.00	"$2,004.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,859.95"	"$1,859.95"	$0.00	$0.00	$522.25	$0.00	$0.00	$0.00	$0.00	"$1,253.00"	"$1,984.75"	"$2,004.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5021-7-150	SUP	Custom 27203010		5021-7-150  -  PIN HALF 150MM 6MM APEX SS SLFDRILL THRD SHFT SLFTAP 50MM	BOTH IP/OP	$213.13 	$157.72	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.18	$158.18	$0.00	$0.00	$44.42	$0.00	$0.00	$0.00	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5021-7-200	SUP	Custom 27203010		5021-7-200  -  PIN HALF 200MM 6MM APEX SS SLFDRILL THRD 60MM	BOTH IP/OP	$209.25 	$154.85	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.31	$155.31	$0.00	$0.00	$43.61	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5023-1-090	SUP	Custom 27203010		5023-1-090  -  PIN HALF 90MM 4MM APEX SS SLFTAP SLFDRILL THRD 10MM EXFIX	BOTH IP/OP	$169.50 	$125.43	$0.00	$135.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.80	$125.80	$0.00	$0.00	$35.32	$0.00	$0.00	$0.00	$0.00	$84.56	$133.95	$135.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5023-2-090	SUP	Custom 27203010		5023-2-090  -  PIN HALF 90MM 4MM APEX SS SLFTAP SLFDRILL THRD 20MM EXFIX	BOTH IP/OP	$169.50 	$125.43	$0.00	$135.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.80	$125.80	$0.00	$0.00	$35.32	$0.00	$0.00	$0.00	$0.00	$84.56	$133.95	$135.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5023-3-090	SUP	Custom 27203010		5023-3-090  -  PIN HALF 90MM 4MM APEX SS SLFTAP SLFDRILL THRD 30MM EXFIX	BOTH IP/OP	$169.50 	$125.43	$0.00	$135.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.80	$125.80	$0.00	$0.00	$35.32	$0.00	$0.00	$0.00	$0.00	$84.56	$133.95	$135.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5023-3-120	SUP	Custom 27203010		5023-3-120  -  PIN HALF 120MM 4MM APEX SS SLFDRILL SLFTAP THRD 30MM EXFIX	BOTH IP/OP	$169.50 	$125.43	$0.00	$135.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.80	$125.80	$0.00	$0.00	$35.32	$0.00	$0.00	$0.00	$0.00	$84.56	$133.95	$135.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-23404	SUP	HCPCS C1713		50-23404  -  SCREW BONE 2.3MM 4MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
50-23406	SUP	HCPCS C1713		50-23406  -  SCREW BONE 2.3MM 6MM SELF TAP XPIN TITANIUM MAXFACL NONSTRL	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
50-23408	SUP	HCPCS C1713		50-23408  -  SCREW BONE 2.3MM 8MM SELF TAP XPIN TITANIUM MANDIB	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
50-23410	SUP	HCPCS C1713		50-23410  -  SCREW BONE 2.3MM 10MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
50-23412	SUP	HCPCS C1713		50-23412  -  SCREW BONE 2.3MM 12MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
5023-4-120	SUP	Custom 27203010		5023-4-120  -  PIN HALF 120MM 4MM APEX ORTH SS 45MM	BOTH IP/OP	$169.50 	$125.43	$0.00	$128.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.80	$125.80	$0.00	$0.00	$35.32	$0.00	$0.00	$0.00	$0.00	$80.44	$127.42	$128.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-23414	SUP	HCPCS C1713		50-23414  -  SCREW TI 14MM 2.3MM MANDIB SLFTAP XPIN BONE	BOTH IP/OP	$115.50 	$85.47	$0.00	$121.54	$68.37	$68.37	$0.00	$0.00	$0.00	$24.07	$85.72	$85.72	$0.00	$0.00	$24.07	$0.00	$68.32	$68.32	$0.00	$75.96	$120.33	$121.54	$0.00		$0.00	$23.78	$0.00	$0.00	$24.19	$0.00	$0.00	$0.00	$0.00	$0.00
50-23416	SUP	HCPCS C1713		50-23416  -  SCREW BONE 2.3MM 16MM SELF TAP XPIN TITANIUM MANDIB	BOTH IP/OP	$115.50 	$85.47	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$24.07	$85.72	$85.72	$0.00	$0.00	$24.07	$0.00	$68.32	$68.32	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
50-23418	SUP	HCPCS C1713		50-23418  -  SCREW BONE 2.3MM 18MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$118.45 	$87.65	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$24.69	$87.91	$87.91	$0.00	$0.00	$24.68	$0.00	$70.06	$70.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
5023-4-180	SUP	Custom 27203010		5023-4-180  -  PIN HLF 4MM 180MM 40MM HFMN2 APX SLF DRL ST THRD SS FT/ANKL	BOTH IP/OP	$169.50 	$125.43	$0.00	$135.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.80	$125.80	$0.00	$0.00	$35.32	$0.00	$0.00	$0.00	$0.00	$84.56	$133.95	$135.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-23420	SUP	HCPCS C1713		50-23420  -  SCREW BONE 2.3MM 20MM SLFTAP XPIN TITANIUM MANDIB	BOTH IP/OP	$118.45 	$87.65	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$24.69	$87.91	$87.91	$0.00	$0.00	$24.68	$0.00	$70.06	$70.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
50-23504	SUP	HCPCS C1713		50-23504  -  SCREW BONE 2.3MM 4MM LOCKING XPIN TITANIUM MAXFACL	BOTH IP/OP	"$1,299.22 "	$961.42	$0.00	"$1,039.37"	$584.65	$584.65	$0.00	$0.00	$0.00	$270.79	$964.28	$964.28	$0.00	$0.00	$270.76	$0.00	$768.49	$768.49	$0.00	$649.61	"$1,028.98"	"$1,039.37"	$0.00		$0.00	$203.33	$0.00	$0.00	$206.84	$0.00	$0.00	$0.00	$0.00	$0.00
50-23506	SUP	HCPCS C1713		50-23506  -  SCREW BONE 2.3MM 6MM LOCKING XPIN LEIBINGER UNIVERSAL 2	BOTH IP/OP	$197.35 	$146.04	$0.00	"$1,900.00"	"$1,068.75"	"$1,068.75"	$0.00	$0.00	$0.00	$41.13	$146.47	$146.47	$0.00	$0.00	$41.13	$0.00	$116.73	$116.73	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
50-23508	SUP	HCPCS C1713		50-23508  -  SCREW BONE 2.3MM 8MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
5023-5-090	SUP	Custom 27203010		5023-5-090  -  PIN HALF 90MM 4MM ORTH MDLR 40MM	BOTH IP/OP	$192.10 	$142.15	$0.00	$159.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.58	$142.58	$0.00	$0.00	$40.03	$0.00	$0.00	$0.00	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-23510	SUP	HCPCS C1713		50-23510  -  SCREW BONE 2.3MM 10MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
50-23512	SUP	HCPCS C1713		50-23512  -  SCREW BONE 2.3MM 12MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
5023-5-120	SUP	Custom 27203010		5023-5-120  -  PIN HALF 120MM 4MM APEX SS SLFTAP SLFDRILL THRD 35MM EXFIX	BOTH IP/OP	$169.50 	$125.43	$0.00	$135.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.80	$125.80	$0.00	$0.00	$35.32	$0.00	$0.00	$0.00	$0.00	$84.56	$133.95	$135.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-23514	SUP	HCPCS C1713		50-23514  -  SCREW BONE 2.3MM 14MM LOCKING XPIN LEIBINGER UNIVERSAL 2	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
5023-5-150	SUP	Custom 27203010		5023-5-150  -  PIN HALF 150MM 4MM APEX SS SLFTAP SLFDRILL THRD 40MM EXFIX	BOTH IP/OP	$169.50 	$125.43	$0.00	$135.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.80	$125.80	$0.00	$0.00	$35.32	$0.00	$0.00	$0.00	$0.00	$84.56	$133.95	$135.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-23516	SUP	HCPCS C1713		50-23516  -  SCREW BONE 2.3MM 16MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
50-23518	SUP	HCPCS C1713		50-23518  -  SCREW BONE 2.3MM 18MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2	BOTH IP/OP	$197.35 	$146.04	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$41.13	$146.47	$146.47	$0.00	$0.00	$41.13	$0.00	$116.73	$116.73	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
50-23520	SUP	HCPCS C1713		50-23520  -  SCREW BONE 2.3MM 20MM LOCKING XPIN TITANIUM MAXFACL	BOTH IP/OP	$197.35 	$146.04	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$41.13	$146.47	$146.47	$0.00	$0.00	$41.13	$0.00	$116.73	$116.73	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
5023-6-150	SUP	Custom 27203010		5023-6-150  -  PIN HALF 150MM 4MM APEX SS SLFTAP SLFDRILL THRD 50MM EXFIX	BOTH IP/OP	$169.50 	$125.43	$0.00	$135.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.80	$125.80	$0.00	$0.00	$35.32	$0.00	$0.00	$0.00	$0.00	$84.56	$133.95	$135.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5023-6-180	SUP	Custom 27203010		5023-6-180  -  PIN 4MM TROCAR PNT 1 END THRD 180X50MM APEX SS 50MM XTRN	BOTH IP/OP	$169.50 	$125.43	$0.00	$135.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.80	$125.80	$0.00	$0.00	$35.32	$0.00	$0.00	$0.00	$0.00	$84.56	$133.95	$135.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5023-6-200	SUP	Custom 27203010		5023-6-200  -  PIN HALF 200MM 4MM APEX HFMN2 ORTH SS MDLR CNT THRD 40MM	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5023-6-250	SUP	Custom 27203010		5023-6-250  -  PIN HALF 250MM 4MM APEX HFMN2 ORTH SS MDLR CNT THRD 50MM	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$0.00	$0.00	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-23706	SUP	HCPCS C1713		50-23706  -  SCREW BONE 2.3MM 6MM SLFTAP XFIT TITANIUM MAXFACL	BOTH IP/OP	$132.03 	$97.70	$0.00	$246.00	$138.38	$138.38	$0.00	$0.00	$0.00	$27.52	$97.99	$97.99	$0.00	$0.00	$27.51	$0.00	$78.09	$78.09	$0.00	$153.75	$243.54	$246.00	$0.00		$0.00	$48.12	$0.00	$0.00	$48.95	$0.00	$0.00	$0.00	$0.00	$0.00
50-23708	SUP	HCPCS C1713		50-23708  -  SCREW BONE 2.3MM 8MM SLFTAP XPIN EMERGENCY TITANIUM MAXFACL	BOTH IP/OP	$132.03 	$97.70	$0.00	$246.00	$138.38	$138.38	$0.00	$0.00	$0.00	$27.52	$97.99	$97.99	$0.00	$0.00	$27.51	$0.00	$78.09	$78.09	$0.00	$153.75	$243.54	$246.00	$0.00		$0.00	$48.12	$0.00	$0.00	$48.95	$0.00	$0.00	$0.00	$0.00	$0.00
50-23710	SUP	HCPCS C1713		50-23710  -  SCREW BONE 2.3MM 10MM SLFTAP EMERGENCY XPIN TITANIUM MAXFACL	BOTH IP/OP	$132.03 	$97.70	$0.00	$246.00	$138.38	$138.38	$0.00	$0.00	$0.00	$27.52	$97.99	$97.99	$0.00	$0.00	$27.51	$0.00	$78.09	$78.09	$0.00	$153.75	$243.54	$246.00	$0.00		$0.00	$48.12	$0.00	$0.00	$48.95	$0.00	$0.00	$0.00	$0.00	$0.00
50-23712	SUP	HCPCS C1713		50-23712  -  SCREW BONE 2.3MM 12MM SLFTAP EMERGENCY XPIN TITANIUM MAXFACL	BOTH IP/OP	$132.03 	$97.70	$0.00	$246.00	$138.38	$138.38	$0.00	$0.00	$0.00	$27.52	$97.99	$97.99	$0.00	$0.00	$27.51	$0.00	$78.09	$78.09	$0.00	$153.75	$243.54	$246.00	$0.00		$0.00	$48.12	$0.00	$0.00	$48.95	$0.00	$0.00	$0.00	$0.00	$0.00
50-23714	SUP	HCPCS C1713		50-23714  -  SCREW BONE 2.3MM 14MM SLFTAP EMERGENCY XPIN TITANIUM MAXFACL	BOTH IP/OP	$132.03 	$97.70	$0.00	$246.00	$138.38	$138.38	$0.00	$0.00	$0.00	$27.52	$97.99	$97.99	$0.00	$0.00	$27.51	$0.00	$78.09	$78.09	$0.00	$153.75	$243.54	$246.00	$0.00		$0.00	$48.12	$0.00	$0.00	$48.95	$0.00	$0.00	$0.00	$0.00	$0.00
50-23716	SUP	HCPCS C1713		50-23716  -  SCREW BONE 2.3MM 16MM EMERGENCY XPIN TITANIUM MAXFACL	BOTH IP/OP	$132.03 	$97.70	$0.00	$246.00	$138.38	$138.38	$0.00	$0.00	$0.00	$27.52	$97.99	$97.99	$0.00	$0.00	$27.51	$0.00	$78.09	$78.09	$0.00	$153.75	$243.54	$246.00	$0.00		$0.00	$48.12	$0.00	$0.00	$48.95	$0.00	$0.00	$0.00	$0.00	$0.00
5023-7-250	SUP	Custom 27203010		5023-7-250  -  PIN HALF 250MM 4MM APEX HFMN2 ORTH SS MDLR CNT THRD 70MM	BOTH IP/OP	$96.25 	$71.23	$0.00	$77.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.44	$71.44	$0.00	$0.00	$20.06	$0.00	$0.00	$0.00	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5027-1-040	SUP	Custom 27803010		5027-1-040  -  CAP PCTV HFMN XPRESS NONSTRL TIP WHT 4MM 4MM 4MM DISP	BOTH IP/OP	$69.70 	$51.58	$0.00	$58.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.73	$51.73	$0.00	$0.00	$14.53	$0.00	$0.00	$0.00	$0.00	$36.44	$57.72	$58.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5027-1-050	SUP	Custom 27803010		5027-1-050  -  CAP PCTV TIP BLUE 5MM	BOTH IP/OP	$72.25 	$53.47	$0.00	$59.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.62	$53.62	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$37.13	$58.81	$59.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5027-1-090	SUP	Custom 27203010		5027-1-090  -  PIN HALF 90MM 4MM APEX SS BLNT TIP 10MM EXFIX SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5027-2-090	SUP	Custom 27203010		5027-2-090  -  PIN HALF 90MM 4MM APEX SS BLNT TIP 20MM EXFIX SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5027-3-090	SUP	Custom 27203010		5027-3-090  -  PIN HALF 90MM 4MM APEX SS BLNT TIP 30MM EXFIX SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5027-3-120	SUP	Custom 27203010		5027-3-120  -  PIN HALF 120MM 4MM APEX SS BLNT TIP 30MM EXFIX SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-27405	SUP	HCPCS C1713		50-27405  -  SCREW BONE 2.7MM 5MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$327.50 	$242.35	$0.00	$262.00	$147.38	$147.38	$0.00	$0.00	$0.00	$68.26	$243.07	$243.07	$0.00	$0.00	$68.25	$0.00	$193.72	$193.72	$0.00	$163.75	$259.38	$262.00	$0.00		$0.00	$51.25	$0.00	$0.00	$52.14	$0.00	$0.00	$0.00	$0.00	$0.00
50-27408	SUP	HCPCS C1713		50-27408  -  SCREW BONE 2.7MM 8MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$65.50 	$48.47	$0.00	$52.40	$29.48	$29.48	$0.00	$0.00	$0.00	$13.65	$48.61	$48.61	$0.00	$0.00	$13.65	$0.00	$38.74	$38.74	$0.00	$32.75	$51.88	$52.40	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
50-27410	SUP	HCPCS C1713		50-27410  -  SCREW BONE 2.7MM 10MM SELF TAP XPIN EMERGENCY TITANIUM	BOTH IP/OP	$139.88 	$103.51	$0.00	$262.00	$147.38	$147.38	$0.00	$0.00	$0.00	$29.15	$103.82	$103.82	$0.00	$0.00	$29.15	$0.00	$82.74	$82.74	$0.00	$163.75	$259.38	$262.00	$0.00		$0.00	$51.25	$0.00	$0.00	$52.14	$0.00	$0.00	$0.00	$0.00	$0.00
50-27412	SUP	HCPCS C1713		50-27412  -  SCREW BONE 2 UNIVERSAL 2.7MM 12MM SELF TAP XPIN EMERGENCY	BOTH IP/OP	$327.50 	$242.35	$0.00	$262.00	$147.38	$147.38	$0.00	$0.00	$0.00	$68.26	$243.07	$243.07	$0.00	$0.00	$68.25	$0.00	$193.72	$193.72	$0.00	$163.75	$259.38	$262.00	$0.00		$0.00	$51.25	$0.00	$0.00	$52.14	$0.00	$0.00	$0.00	$0.00	$0.00
5027-4-120	SUP	Custom 27203010		5027-4-120  -  PIN HALF 120MM 4MM APEX SS BLNT TIP 35MM EXFIX SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-27414	SUP	HCPCS C1713		50-27414  -  SCREW BONE 2.7MM 14MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$327.50 	$242.35	$0.00	$262.00	$147.38	$147.38	$0.00	$0.00	$0.00	$68.26	$243.07	$243.07	$0.00	$0.00	$68.25	$0.00	$193.72	$193.72	$0.00	$163.75	$259.38	$262.00	$0.00		$0.00	$51.25	$0.00	$0.00	$52.14	$0.00	$0.00	$0.00	$0.00	$0.00
5027-4-150	SUP	Custom 27203010		5027-4-150  -  PIN HALF 150MM 4MM APEX SS BLNT TIP 40MM EXFIX SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-27416	SUP	HCPCS C1713		50-27416  -  SCREW BONE 2.7MM 16MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$139.88 	$103.51	$0.00	$262.00	$147.38	$147.38	$0.00	$0.00	$0.00	$29.15	$103.82	$103.82	$0.00	$0.00	$29.15	$0.00	$82.74	$82.74	$0.00	$163.75	$259.38	$262.00	$0.00		$0.00	$51.25	$0.00	$0.00	$52.14	$0.00	$0.00	$0.00	$0.00	$0.00
50-27418	SUP	HCPCS C1713		50-27418  -  SCREW BONE 2.7MM 18MM SLFTAP XPIN TITANIUM MAXFACL	BOTH IP/OP	$139.88 	$103.51	$0.00	$103.82	$29.48	$29.48	$0.00	$0.00	$0.00	$29.15	$103.82	$103.82	$0.00	$0.00	$29.15	$0.00	$82.74	$82.74	$0.00	$32.75	$51.88	$52.40	$0.00		$0.00	$10.25	$0.00	$0.00	$10.43	$0.00	$0.00	$0.00	$0.00	$0.00
5027-4-180	SUP	Custom 27203010		5027-4-180  -  PIN HALF 180MM 4MM APEX SS BLNT TIP 40MM EXFIX SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-27420	SUP	HCPCS C1713		50-27420  -  SCREW BONE 2.7MM 20MM XPIN EMERGENCY TITANIUM MAXFACL	BOTH IP/OP	$139.88 	$103.51	$0.00	$262.00	$147.38	$147.38	$0.00	$0.00	$0.00	$29.15	$103.82	$103.82	$0.00	$0.00	$29.15	$0.00	$82.74	$82.74	$0.00	$163.75	$259.38	$262.00	$0.00		$0.00	$51.25	$0.00	$0.00	$52.14	$0.00	$0.00	$0.00	$0.00	$0.00
50-27505	SUP	HCPCS C1713		50-27505  -  SCREW BONE 2.7MM 5MM LOCKING XPIN EMERGENCY TITANIUM MAXFACL	BOTH IP/OP	$233.85 	$173.05	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$48.74	$173.56	$173.56	$0.00	$0.00	$48.73	$0.00	$138.32	$138.32	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
50-27508	SUP	HCPCS C1713		50-27508  -  SCREW BONE 2.7MM 8MM LOCKING XPIN EMERGENCY TITANIUM MAXFACL	BOTH IP/OP	$233.85 	$173.05	$0.00	$173.56	$47.25	$47.25	$0.00	$0.00	$0.00	$48.74	$173.56	$173.56	$0.00	$0.00	$48.73	$0.00	$138.32	$138.32	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$16.43	$0.00	$0.00	$16.72	$0.00	$0.00	$0.00	$0.00	$0.00
50-27510	SUP	HCPCS C1713		50-27510  -  SCREW BONE 2.7MM 10MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2	BOTH IP/OP	$233.85 	$173.05	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$48.74	$173.56	$173.56	$0.00	$0.00	$48.73	$0.00	$138.32	$138.32	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
50-27512	SUP	HCPCS C1713		50-27512  -  SCREW BONE 2.7MM 12MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2	BOTH IP/OP	$233.85 	$173.05	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$48.74	$173.56	$173.56	$0.00	$0.00	$48.73	$0.00	$138.32	$138.32	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
50-27514	SUP	HCPCS C1713		50-27514  -  SCREW BONE 2.7MM 14MM LOCKING XPIN EMERGENCY TITANIUM	BOTH IP/OP	$233.85 	$173.05	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$48.74	$173.56	$173.56	$0.00	$0.00	$48.73	$0.00	$138.32	$138.32	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
5027-5-150	SUP	Custom 27203010		5027-5-150  -  PIN HALF 150MM 4MM APEX SS BLNT TIP 50MM EXFIX SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-27516	SUP	HCPCS C1713		50-27516  -  SCREW BONE 2.7MM 16MM LOCKING XPIN EMERGENCY TITANIUM	BOTH IP/OP	$233.85 	$173.05	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$48.74	$173.56	$173.56	$0.00	$0.00	$48.73	$0.00	$138.32	$138.32	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
50-27518	SUP	HCPCS C1713		50-27518  -  SCREW BONE 2.7MM 18MM LOCKING XPIN EMERGENCY TITANIUM	BOTH IP/OP	$233.85 	$173.05	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$48.74	$173.56	$173.56	$0.00	$0.00	$48.73	$0.00	$138.32	$138.32	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
5027-5-180	SUP	Custom 27203010		5027-5-180  -  PIN HALF 180MM 4MM APEX CONTIN THRD 50MM	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-27520	SUP	HCPCS C1713		50-27520  -  SCREW BONE 2.7MM 20MM LOCKING XPIN EMERGENCY TITANIUM	BOTH IP/OP	$233.85 	$173.05	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$48.74	$173.56	$173.56	$0.00	$0.00	$48.73	$0.00	$138.32	$138.32	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
5028-7-030	SUP	Custom 27203010		5028-7-030  -  ROD EXFIX 174MM 8MM HFMN2 CARFBR CONNCTNG	BOTH IP/OP	$595.10 	$440.37	$0.00	$441.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$441.68	$441.68	$0.00	$0.00	$124.02	$0.00	$0.00	$0.00	$0.00	$222.06	$351.75	$355.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5028-8-065	SUP	Custom 27203010		5028-8-065  -  ROD EXFIX 65MM 8MM HFMN2 CARFBR CONNCTNG	BOTH IP/OP	$415.50 	$307.47	$0.00	$308.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.38	$308.38	$0.00	$0.00	$86.59	$0.00	$0.00	$0.00	$0.00	$156.06	$247.21	$249.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5028-8-100	SUP	HCPCS C1713		ROD 100MM 8MM CONNCTNG HFMN2 MRI CARB FBR EXFIXA	BOTH IP/OP	$312.13 	$230.98	$0.00	$249.70	$140.46	$140.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.06	$247.21	$249.70	$0.00		$0.00	$48.85	$0.00	$0.00	$49.69	$0.00	$0.00	$0.00	$0.00	$0.00
5028-8-150	SUP	Custom 27203010		5028-8-150  -  ROD EXFIX 150MM 8MM HFMN2 CARFBR CONNCTNG	BOTH IP/OP	$415.50 	$307.47	$0.00	$308.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.38	$308.38	$0.00	$0.00	$86.59	$0.00	$0.00	$0.00	$0.00	$156.06	$247.21	$249.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5028-8-200	SUP	Custom 27203010		5028-8-200  -  ROD EXFIX 200MM 8MM HFMN2 CARFBR CONNCTNG	BOTH IP/OP	$426.75 	$315.80	$0.00	$316.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$316.73	$316.73	$0.00	$0.00	$88.93	$0.00	$0.00	$0.00	$0.00	$160.19	$253.74	$256.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5028-8-250	SUP	Custom 27203010		5028-8-250  -  ROD EXFIX 250MM 8MM HFMN2 CARFBR CONNCTNG	BOTH IP/OP	$426.75 	$315.80	$0.00	$316.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$316.73	$316.73	$0.00	$0.00	$88.93	$0.00	$0.00	$0.00	$0.00	$160.19	$253.74	$256.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5028-8-350	SUP	Custom 27203010		5028-8-350  -  ROD EXFIX 350MM 8MM HFMN2 CARFBR CONNCTNG	BOTH IP/OP	$439.50 	$325.23	$0.00	$326.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$326.20	$326.20	$0.00	$0.00	$91.59	$0.00	$0.00	$0.00	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5029-8-720	SUP	Custom 27203010		5029-8-720  -  ROD EXFIX 200MM 8MM HFMN2 CARB CONNCTNG	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$0.00	$0.00	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5029-8-725	SUP	Custom 27203010		5029-8-725  -  ROD EXFIX 250MM 8MM HFMN2 CARB CONNCTNG	BOTH IP/OP	$253.00 	$187.22	$0.00	$202.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.78	$187.78	$0.00	$0.00	$52.73	$0.00	$0.00	$0.00	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5029-8-805	SUP	Custom 27203010		5029-8-805  -  ROD EXFIX 65MM 8MM HFMN2 CARFBR CONNCTNG BRAID	BOTH IP/OP	$302.25 	$223.67	$0.00	$224.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.33	$224.33	$0.00	$0.00	$62.99	$0.00	$0.00	$0.00	$0.00	$116.88	$185.13	$187.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5029-8-810	SUP	Custom 27203010		5029-8-810  -  ROD EXFIX 100MM 8MM HFMN2 CARFBR CONNCTNG BRAID	BOTH IP/OP	$302.25 	$223.67	$0.00	$224.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.33	$224.33	$0.00	$0.00	$62.99	$0.00	$0.00	$0.00	$0.00	$116.88	$185.13	$187.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5029-8-815	SUP	Custom 27203010		5029-8-815  -  ROD EXFIX 150MM 8MM HFMN2 CARFBR CONNCTNG BRAID	BOTH IP/OP	$302.25 	$223.67	$0.00	$224.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.33	$224.33	$0.00	$0.00	$62.99	$0.00	$0.00	$0.00	$0.00	$116.88	$185.13	$187.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5029-8-820	SUP	Custom 27203010		5029-8-820  -  ROD EXFIX 200MM 8MM HFMN2 CARFBR CONNCTNG BRAID	BOTH IP/OP	$329.25 	$243.65	$0.00	$244.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.37	$244.37	$0.00	$0.00	$68.62	$0.00	$0.00	$0.00	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5029-8-825	SUP	Custom 27203010		5029-8-825  -  ROD EXFIX 250MM 8MM HFMN2 CARFBR CONNCTNG BRAID	BOTH IP/OP	$329.25 	$243.65	$0.00	$244.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.37	$244.37	$0.00	$0.00	$68.62	$0.00	$0.00	$0.00	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5029-8-830	SUP	Custom 27203010		5029-8-830  -  ROD EXFIX 300MM 8MM HFMN2 CARFBR CONNCTNG BRAID	BOTH IP/OP	$329.25 	$243.65	$0.00	$244.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.37	$244.37	$0.00	$0.00	$68.62	$0.00	$0.00	$0.00	$0.00	$126.50	$200.38	$202.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5029-8-835	SUP	Custom 27203010		5029-8-835  -  ROD XTRNFX 8MM 350MM HFMN2 CNCT BRD CFBR	BOTH IP/OP	$353.25 	$261.41	$0.00	$262.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.18	$262.18	$0.00	$0.00	$73.62	$0.00	$0.00	$0.00	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5029-8-840	SUP	Custom 27203010		5029-8-840  -  ROD EXFIX 400MM 8MM HFMN2 CARFBR CONNCTNG	BOTH IP/OP	$353.25 	$261.41	$0.00	$262.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.18	$262.18	$0.00	$0.00	$73.62	$0.00	$0.00	$0.00	$0.00	$136.13	$215.62	$217.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5029-8-845	SUP	Custom 27203010		5029-8-845  -  ROD EXFIX 450MM 8MM HFMN2 CARFBR CONNCTNG BRAID	BOTH IP/OP	$403.50 	$298.59	$0.00	$299.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$299.48	$299.48	$0.00	$0.00	$84.09	$0.00	$0.00	$0.00	$0.00	$156.75	$248.29	$250.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5029-8-850	SUP	Custom 27203010		5029-8-850  -  ROD EXFIX 500MM 8MM HFMN2 CARFBR CONNCTNG BRAID	BOTH IP/OP	$403.50 	$298.59	$0.00	$299.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$299.48	$299.48	$0.00	$0.00	$84.09	$0.00	$0.00	$0.00	$0.00	$156.75	$248.29	$250.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5030-3-200	SUP	Custom 27203010		5030-3-200  -  PIN HALF 200MM 4MM APEX SS MDLR THRD TRNFX 35MM EXFIX SYS	BOTH IP/OP	$221.00 	$163.54	$0.00	$164.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.03	$164.03	$0.00	$0.00	$46.06	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5030-3-250	SUP	Custom 27203010		5030-3-250  -  PIN HALF 250MM 4MM APEX SS MDLR THRD TRNFX 35MM EXFIX SYS	BOTH IP/OP	$221.00 	$163.54	$0.00	$164.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.03	$164.03	$0.00	$0.00	$46.06	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5030-4-200	SUP	Custom 27203010		5030-4-200  -  PIN HALF 200MM 4MM APEX SS MDLR THRD TRNFX 40MM EXFIX SYS	BOTH IP/OP	$221.00 	$163.54	$0.00	$164.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.03	$164.03	$0.00	$0.00	$46.06	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5030-4-250	SUP	Custom 27203010		5030-4-250  -  PIN HALF 250MM 4MM APEX SS MDLR THRD TRNFX 40MM EXFIX SYS	BOTH IP/OP	$221.00 	$163.54	$0.00	$164.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.03	$164.03	$0.00	$0.00	$46.06	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5030-4-300	SUP	Custom 27203010		5030-4-300  -  PIN HLF 5MM 4MM 300MM NS 50MM APX TRNFX ST SLF DRL CNTR THRD	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5030-5-200	SUP	Custom 27203010		5030-5-200  -  PIN HALF 200MM 4MM APEX SS MDLR THRD TRNFX 50MM EXFIX SYS	BOTH IP/OP	$221.00 	$163.54	$0.00	$164.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.03	$164.03	$0.00	$0.00	$46.06	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5030-5-250	SUP	HCPCS C1713		5030-5-250  -  TRAY STRL MDLR TRNFX 4 MM 250 MM PIN THRD	BOTH IP/OP	$221.00 	$163.54	$0.00	$164.03	$89.10	$89.10	$0.00	$0.00	$0.00	$46.06	$164.03	$164.03	$0.00	$0.00	$46.06	$0.00	$130.72	$130.72	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$30.99	$0.00	$0.00	$31.52	$0.00	$0.00	$0.00	$0.00	$0.00
5030-5-300	SUP	Custom 27203010		5030-5-300  -  PIN HLF 5MM 4MM 300MM NS 50MM HFMN2 APX TRNFX ST SLF DRL	BOTH IP/OP	$221.00 	$163.54	$0.00	$204.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.03	$164.03	$0.00	$0.00	$46.06	$0.00	$0.00	$0.00	$0.00	$127.88	$202.55	$204.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5030-6-250	SUP	Custom 27203010		5030-6-250  -  PIN HALF 250MM 4MM APEX SS MDLR THRD TRNFX 60MM EXFIX SYS	BOTH IP/OP	$221.00 	$163.54	$0.00	$164.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.03	$164.03	$0.00	$0.00	$46.06	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-306-40-04	SUP	Custom 27803010		50-306-40-04  -  RESORB MESH ORBITAL	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5030-7-300	SUP	Custom 27203010		5030-7-300  -  PIN FX 5MM 4MM 300MM 70MM APX TRNFX SS FT/ANKL CANC	BOTH IP/OP	$221.00 	$163.54	$0.00	$164.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.03	$164.03	$0.00	$0.00	$46.06	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-310-27-09	SUP	Custom 27803010		50-310-27-09  -  COVER BURR HOLE 17MM .3MM CNTOUR TITANIUM CRANIUM 1.5MM	BOTH IP/OP	$465.18 	$344.23	$0.00	$372.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.25	$345.25	$0.00	$0.00	$96.94	$0.00	$0.00	$0.00	$0.00	$232.59	$368.42	$372.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-320-08-09	SUP	HCPCS C1713		50-320-08-09  -  PLATE BONE MINI REGULAR 1MM 8 HOLE RIGID LIGHTWEIGHT BLUE	BOTH IP/OP	$271.95 	$201.24	$0.00	$217.56	$122.38	$122.38	$0.00	$0.00	$0.00	$56.68	$201.84	$201.84	$0.00	$0.00	$56.67	$0.00	$160.86	$160.86	$0.00	$135.98	$215.38	$217.56	$0.00		$0.00	$42.56	$0.00	$0.00	$43.29	$0.00	$0.00	$0.00	$0.00	$0.00
50-321-04-09	SUP	HCPCS C1713		50-321-04-09  -  PLATE BONE MINI MEDIUM 1MM 4 HOLE RIGID LIGHTWEIGHT BLUE	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
50-322-04-09	SUP	HCPCS C1713		50-322-04-09  -  PLATE BONE LONG 1MM 4 HOLE RIGID LIGHTWEIGHT BLUE TITANIUM	BOTH IP/OP	$222.75 	$164.84	$0.00	$178.20	$100.24	$100.24	$0.00	$0.00	$0.00	$46.43	$165.33	$165.33	$0.00	$0.00	$46.42	$0.00	$131.76	$131.76	$0.00	$111.38	$176.42	$178.20	$0.00		$0.00	$34.86	$0.00	$0.00	$35.46	$0.00	$0.00	$0.00	$0.00	$0.00
50-325-01-07	SUP	Custom 27100030		50-325-01-07  -  CLAMP SURG 6IN SHARP STAINLESS STEEL	BOTH IP/OP	$576.23 	$426.41	$0.00	$460.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.67	$427.67	$0.00	$0.00	$120.09	$0.00	$0.00	$0.00	$0.00	$288.11	$456.37	$460.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-330-06-09	SUP	HCPCS C1713		50-330-06-09  -  PLATE BONE MINI MEDIUM CVD FLAT 1MM 6 HOLE SAGITTAL RIGID	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$174.83	$174.83	$0.00	$0.00	$0.00	$80.97	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$229.80	$229.80	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$60.80	$0.00	$0.00	$61.85	$0.00	$0.00	$0.00	$0.00	$0.00
50-331-06-09	SUP	HCPCS C1713		50-331-06-09  -  PLATE BONE LONG CVD FLAT 1MM 6 HOLE SAGITTAL RIGID	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$174.83	$174.83	$0.00	$0.00	$0.00	$80.97	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$229.80	$229.80	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$60.80	$0.00	$0.00	$61.85	$0.00	$0.00	$0.00	$0.00	$0.00
50-332-06-09	SUP	HCPCS C1713		50-332-06-09  -  PLATE BONE XLONG CVD FLAT 1MM 6 HOLE SAGITTAL RIGID	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$174.83	$174.83	$0.00	$0.00	$0.00	$80.97	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$229.80	$229.80	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$60.80	$0.00	$0.00	$61.85	$0.00	$0.00	$0.00	$0.00	$0.00
5036-1-080	SUP	Custom 27203010		5036-1-080  -  PIN HALF 80MM 3MM APEX SS BLNT TIP 10MM EXFIX SYS	BOTH IP/OP	$312.00 	$230.88	$0.00	$231.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.57	$231.57	$0.00	$0.00	$65.02	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5036-1-110	SUP	Custom 27203010		5036-1-110  -  PIN HALF 110MM 3MM APEX SS BLNT TIP 10MM EXFIX SYS	BOTH IP/OP	$312.00 	$230.88	$0.00	$231.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.57	$231.57	$0.00	$0.00	$65.02	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5036-1-580	SUP	Custom 27203010		5036-1-580  -  PIN HALF 80MM 3MM APEX SS BLNT TIP 15MM EXFIX SYS	BOTH IP/OP	$312.00 	$230.88	$0.00	$231.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.57	$231.57	$0.00	$0.00	$65.02	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5036-2-060	SUP	Custom 27203010		5036-2-060  -  PIN HALF 60MM 3MM APEX SS BLNT TIP 10MM EXFIX SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5036-2-080	SUP	Custom 27203010		5036-2-080  -  PIN HALF 80MM 3MM APEX SS BLNT TIP 20MM EXFIX SYS	BOTH IP/OP	$312.00 	$230.88	$0.00	$231.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.57	$231.57	$0.00	$0.00	$65.02	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5036-2-110	SUP	Custom 27203010		5036-2-110  -  PIN HLF 3MM 110MM 25MM HFMN2 APX BLNT TIP SS	BOTH IP/OP	$312.00 	$230.88	$0.00	$231.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.57	$231.57	$0.00	$0.00	$65.02	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-368-16-91	SUP	HCPCS C1713		50-368-16-91  -  PLATE BONE MINI REGULAR .6MM 16 HOLE LP TITANIUM MANDIB 2MM	BOTH IP/OP	$323.75 	$239.58	$0.00	$259.00	$145.69	$145.69	$0.00	$0.00	$0.00	$67.48	$240.29	$240.29	$0.00	$0.00	$67.47	$0.00	$191.50	$191.50	$0.00	$161.88	$256.41	$259.00	$0.00		$0.00	$50.67	$0.00	$0.00	$51.54	$0.00	$0.00	$0.00	$0.00	$0.00
50-369-06	SUP	HCPCS C1713		50-369-06  -  X PLATE	BOTH IP/OP	$348.75 	$258.08	$0.00	$279.00	$156.94	$156.94	$0.00	$0.00	$0.00	$72.69	$258.84	$258.84	$0.00	$0.00	$72.68	$0.00	$206.29	$206.29	$0.00	$174.38	$276.21	$279.00	$0.00		$0.00	$54.58	$0.00	$0.00	$55.52	$0.00	$0.00	$0.00	$0.00	$0.00
50-375-04-91	SUP	HCPCS C1713		50-375-04-91  -  PLATE BN MED MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
50-377-04-91	SUP	HCPCS C1713		50-377-04-91  -  PLATE BN MED MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
50-379-04-91	SUP	HCPCS C1713		50-379-04-91  -  PLATE BN LNG MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
50-381-04-91	SUP	HCPCS C1713		50-381-04-91  -  PLATE BN LNG MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
50-381-05-09	SUP	HCPCS C1713		50-381-05-09  -  PLATE BN LNG MN L .7MM NS THREADLOCK TS 5 HL LOPRFL TI	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
5038-1-080	SUP	Custom 27203010		5038-1-080  -  PIN 3MM SLFDRILL SLFTAP THRD 80MM APEX SS 10MM	BOTH IP/OP	$214.83 	$158.97	$0.00	$159.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.44	$159.44	$0.00	$0.00	$44.77	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5038-1-110	SUP	Custom 27203010		5038-1-110  -  PIN HALF 110MM 3MM APEX SS SLFDRILL SLFTAP THRD 10MM EXFIX	BOTH IP/OP	$214.83 	$158.97	$0.00	$159.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.44	$159.44	$0.00	$0.00	$44.77	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5038-2-080	SUP	Custom 27203010		5038-2-080  -  PIN HALF 80MM 3MM APEX SS SLFDRILL SLFTAP THRD 15MM EXFIX	BOTH IP/OP	$214.83 	$158.97	$0.00	$159.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.44	$159.44	$0.00	$0.00	$44.77	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5038-2-110	SUP	Custom 27203010		5038-2-110  -  PIN HALF 110MM 3MM APEX SS SLFDRILL SLFTAP THRD 25MM EXFIX	BOTH IP/OP	$214.83 	$158.97	$0.00	$159.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.44	$159.44	$0.00	$0.00	$44.77	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-383-05-09	SUP	HCPCS C1713		50-383-05-09  -  PLATE BN LNG MN L .7MM NS THREADLOCK TS 5 HL LOPRFL TI	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
5038-5-060	SUP	Custom 27203010		5038-5-060  -  PIN HALF 60MM 3MM APEX SS SLFDRILL SLFTAP THRD 10MM EXFIX	BOTH IP/OP	$214.83 	$158.97	$0.00	$159.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.44	$159.44	$0.00	$0.00	$44.77	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5038-5-080	SUP	Custom 27203010		5038-5-080  -  PIN HALF 80MM 3MM APEX SS SLFDRILL SLFTAP THRD 20MM EXFIX	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5038-5-110	SUP	Custom 27203010		5038-5-110  -  PIN HALF 11CM 3MM APEX HFMN2 ORTH CONTIN THRD 22MM EXFIX SYS	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$0.00	$0.00	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-386-06-91	SUP	HCPCS C1713		50-386-06-91  -  PLATE BONE T MINI REGULAR .6MM LP TITANIUM MANDIB 2MM SCREW	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
50-390-05-91	SUP	HCPCS C1713		50-390-05-91  -  PLATE BN MN SHRT Y .6MM THREADLOCK TS 5 HL LOPRFL TI MXLFCL	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
50-395-04	SUP	HCPCS C1713		50-395-04  -  L PLATE RIGHT	BOTH IP/OP	$325.50 	$240.87	$0.00	$260.40	$146.48	$146.48	$0.00	$0.00	$0.00	$67.84	$241.59	$241.59	$0.00	$0.00	$67.83	$0.00	$192.53	$192.53	$0.00	$162.75	$257.80	$260.40	$0.00		$0.00	$50.94	$0.00	$0.00	$51.82	$0.00	$0.00	$0.00	$0.00	$0.00
50-396-06-91	SUP	HCPCS C1713		50-396-06-91  -  PLATE BONE MINI REGULAR Y LP .6MM 2 TITANIUM MANDIB 2MM	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$174.83	$174.83	$0.00	$0.00	$0.00	$80.97	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$229.80	$229.80	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$60.80	$0.00	$0.00	$61.85	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-54C-L	SUP	HCPCS C1776		504-02-54C-L  -  SHELL ACTB 54MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-54C-R	SUP	HCPCS C1776		504-02-54C-R  -  SHELL ACTB 54MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-56D-L	SUP	HCPCS C1776		504-02-56D-L  -  SHELL ACTB 56MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-56D-R	SUP	HCPCS C1776		504-02-56D-R  -  SHELL ACTB 56MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-58D-L	SUP	HCPCS C1776		504-02-58D-L  -  SHELL ACTB 58MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-58D-R	SUP	HCPCS C1776		504-02-58D-R  -  SHELL ACTB 58MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-60D-L	SUP	HCPCS C1776		504-02-60D-L  -  SHELL ACTB 60MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-60D-R	SUP	HCPCS C1776		504-02-60D-R  -  SHELL ACTB 60MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-62E-L	SUP	HCPCS C1776		504-02-62E-L  -  SHELL ACTB 62MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-62E-R	SUP	HCPCS C1776		504-02-62E-R  -  SHELL ACTB 62MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-64E-L	SUP	HCPCS C1776		504-02-64E-L  -  SHELL ACTB 64MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-64E-R	SUP	HCPCS C1776		504-02-64E-R  -  SHELL ACTB 64MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-66F-L	SUP	HCPCS C1776		504-02-66F-L  -  SHELL ACTB 66MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-66F-R	SUP	HCPCS C1776		504-02-66F-R  -  SHELL ACTB 66MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-68F-L	SUP	HCPCS C1776		504-02-68F-L  -  SHELL ACTB 68MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-68F-R	SUP	HCPCS C1776		504-02-68F-R  -  SHELL ACTB 68MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-70G-L	SUP	HCPCS C1776		504-02-70G-L  -  SHELL ACTB 70MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-70G-R	SUP	HCPCS C1776		504-02-70G-R  -  SHELL ACTB 70MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-72G-L	SUP	HCPCS C1776		504-02-72G-L  -  SHELL ACTB 72MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-72G-R	SUP	HCPCS C1776		504-02-72G-R  -  SHELL ACTB 72MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-74H-L	SUP	HCPCS C1776		504-02-74H-L  -  SHELL ACTB 74MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-74H-R	SUP	HCPCS C1776		504-02-74H-R  -  SHELL ACTB 74MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-76H-L	SUP	HCPCS C1776		504-02-76H-L  -  SHELL ACTB 76MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-76H-R	SUP	HCPCS C1776		504-02-76H-R  -  SHELL ACTB 76MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-78H-L	SUP	HCPCS C1776		504-02-78H-L  -  SHELL ACTB 78MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-78H-R	SUP	HCPCS C1776		504-02-78H-R  -  SHELL ACTB 78MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-80H-L	SUP	HCPCS C1776		504-02-80H-L  -  SHELL ACTB 80MM RSTR ANTM HIP LT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
504-02-80H-R	SUP	HCPCS C1776		504-02-80H-R  -  SHELL ACTB 80MM RSTR ANTM HIP RT	BOTH IP/OP	"$9,457.50 "	"$6,998.55"	$0.00	"$7,566.00"	"$4,255.88"	"$4,255.88"	$0.00	$0.00	$0.00	"$1,971.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,970.94"	$0.00	"$4,662.55"	"$4,662.55"	$0.00	"$4,728.75"	"$7,490.34"	"$7,566.00"	$0.00		$0.00	"$1,480.10"	$0.00	$0.00	"$1,505.63"	$0.00	$0.00	$0.00	$0.00	$0.00
50-405-07-09	SUP	HCPCS C1713		50-405-07-09  -  PLATE BONE 100D L MINI .7MM 7 HOLE TITANIUM MANDIB 2MM SCREW	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
50-405-09-09	SUP	HCPCS C1713		50-405-09-09  -  PLATE BONE 100D L MINI .7MM 9 HOLE INSERT FRAC TITANIUM	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
50-405-12-09	SUP	HCPCS C1713		50-405-12-09  -  PLATE BN MN .7MM THREADLOCK TS 12 HL LOPRFL TI ORBT FLR 2MM	BOTH IP/OP	$401.43 	$297.06	$0.00	$321.14	$180.64	$180.64	$0.00	$0.00	$0.00	$83.67	$297.94	$297.94	$0.00	$0.00	$83.66	$0.00	$237.44	$237.44	$0.00	$200.71	$317.93	$321.14	$0.00		$0.00	$62.82	$0.00	$0.00	$63.91	$0.00	$0.00	$0.00	$0.00	$0.00
50-405-17-09	SUP	HCPCS C1713		50-405-17-09  -  PLATE BN MN STRG 1MM NS THREADLOCK TS 20 HL LOPRFL CMPR TI	BOTH IP/OP	$569.80 	$421.65	$0.00	$455.84	$256.41	$256.41	$0.00	$0.00	$0.00	$118.76	$422.91	$422.91	$0.00	$0.00	$118.75	$0.00	$337.04	$337.04	$0.00	$284.90	$451.28	$455.84	$0.00		$0.00	$89.17	$0.00	$0.00	$90.71	$0.00	$0.00	$0.00	$0.00	$0.00
50-406-04-91	SUP	HCPCS C1713		50-406-04-91  -  PLATE BONE Z MINI 6MM LP TITANIUM LEFT MANDIB 2MM SCREW	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
50-406-17-09	SUP	HCPCS C1713		50-406-17-09  -  PLATE BONE STR 1MM 17 HOLE RIGID LIGHTWEIGHT LP BLUE	BOTH IP/OP	$530.95 	$392.90	$0.00	$424.76	$238.93	$238.93	$0.00	$0.00	$0.00	$110.66	$394.07	$394.07	$0.00	$0.00	$110.65	$0.00	$314.06	$314.06	$0.00	$265.48	$420.51	$424.76	$0.00		$0.00	$83.09	$0.00	$0.00	$84.53	$0.00	$0.00	$0.00	$0.00	$0.00
50-407-07-09	SUP	HCPCS C1713		50-407-07-09  -  PLATE BN MN STRG L .7MM THREADLOCK TS 20 HL LOPRFL TI MXLFCL	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
50-407-09-09	SUP	HCPCS C1713		50-407-09-09  -  PLATE BONE 100D L MINI 9 HOLE INSERT FRAC TITANIUM MANDIB 2	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
50-408-04-91	SUP	HCPCS C1713		50-408-04-91  -  PLATE BONE Z LEFT ANGLE LONG .6MM LP FRAC TITANIUM MANDIB	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
50-409-04-91	SUP	HCPCS C1713		50-409-04-91  -  PLATE BN 100D LNG MN Z .6MM THREADLOCK TS 4 HL LOPRFL TI	BOTH IP/OP	$362.60 	$268.32	$0.00	$290.08	$163.17	$163.17	$0.00	$0.00	$0.00	$75.57	$269.12	$269.12	$0.00	$0.00	$75.57	$0.00	$214.48	$214.48	$0.00	$181.30	$287.18	$290.08	$0.00		$0.00	$56.75	$0.00	$0.00	$57.73	$0.00	$0.00	$0.00	$0.00	$0.00
5045-5-150	SUP	Custom 27203010		5045-5-150  -  PIN HALF 150MM 3MM APEX SMTH TRNFX EXFIX SYS	BOTH IP/OP	$213.13 	$157.72	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.18	$158.18	$0.00	$0.00	$44.42	$0.00	$0.00	$0.00	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5045-5-200	SUP	Custom 27203010		5045-5-200  -  PIN HLF 3MM 200MM NS APX TRNFX ST SLF DRL THRD SS	BOTH IP/OP	$207.63 	$153.65	$0.00	$166.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.10	$154.10	$0.00	$0.00	$43.27	$0.00	$0.00	$0.00	$0.00	$103.81	$164.44	$166.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-4561	SUP	Custom 27203010		BLADE RTRCTR 6X2IN BKWLTR MLBL	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-4567	SUP	Custom 27203010		BLADE RTRCTR 6X3IN BKWLTR MLBL	BOTH IP/OP	"$1,307.50 "	$967.55	$0.00	"$1,046.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$653.75	"$1,035.54"	"$1,046.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
504605A	SUP	HCPCS C1894		504605A  -  INTRODUCER SHTH STD HEXACUSPID 5FR 11CM GRY AVNT+ ROT SUT	BOTH IP/OP	$19.88 	$14.71	$0.00	$15.90	$10.79	$10.79	$0.00	$0.00	$0.00	$4.14	$14.75	$14.75	$0.00	$0.00	$4.14	$0.00	$11.76	$11.76	$0.00	$9.94	$15.74	$15.90	$0.00		$0.00	$3.11	$0.00	$0.00	$3.16	$0.00	$0.00	$0.00	$0.00	$0.00
504606A	SUP	HCPCS C1894		504606A  -  INTROD SHTH 6FR 11CM W/O MINI GWIRE NO OBT AVNT+ .038IN GRN	BOTH IP/OP	$99.38 	$73.54	$0.00	$79.50	$53.96	$53.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.69	$78.71	$79.50	$0.00		$0.00	$15.55	$0.00	$0.00	$15.82	$0.00	$0.00	$0.00	$0.00	$0.00
504606T	SUP	HCPCS C1894		504606T  -  INTRODUCER SHTH MID LGTH 6FR 23CM GRN AVNT+ NO MN GW NO OBT	BOTH IP/OP	$54.88 	$40.61	$0.00	$43.90	$29.80	$29.80	$0.00	$0.00	$0.00	$11.44	$40.73	$40.73	$0.00	$0.00	$11.44	$0.00	$32.46	$32.46	$0.00	$27.44	$43.46	$43.90	$0.00		$0.00	$8.59	$0.00	$0.00	$8.74	$0.00	$0.00	$0.00	$0.00	$0.00
5047-1-030	SUP	Custom 27203010		5047-1-030  -  CAP END ORTH 3MM DISP	BOTH IP/OP	$70.55 	$52.21	$0.00	$58.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.36	$52.36	$0.00	$0.00	$14.70	$0.00	$0.00	$0.00	$0.00	$36.44	$57.72	$58.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5048-5-065	SUP	Custom 27203010		5048-5-065  -  ROD EXFIX 65MM 5MM HFMN2 MRI CMPCT CARB CONNCTNG STRL	BOTH IP/OP	$166.38 	$123.12	$0.00	$133.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.48	$123.48	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$83.19	$131.77	$133.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5048-5-100	SUP	Custom 27203010		5048-5-100  -  ROD EXFIX YLW 100MM 5MM HFMN2 C CARB CONNCTNG MRI SAFE	BOTH IP/OP	$166.38 	$123.12	$0.00	$133.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.48	$123.48	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$83.19	$131.77	$133.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5048-5-150	SUP	Custom 27203010		5048-5-150  -  ROD EXFIX YLW 150MM 5MM HFMN2 C CARB CONNCTNG MRI SAFE	BOTH IP/OP	$166.38 	$123.12	$0.00	$133.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.48	$123.48	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$83.19	$131.77	$133.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5048-5-200	SUP	Custom 27203010		5048-5-200  -  ROD EXFIX YLW 200MM 5MM HFMN2 C CARB CONNCTNG MRI SAFE	BOTH IP/OP	$166.38 	$123.12	$0.00	$133.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.48	$123.48	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$83.19	$131.77	$133.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5048-5-250	SUP	Custom 27203010		5048-5-250  -  ROD EXFIX 250MM 5MM HFMN2 MRI CMPCT CONNCTNG MRI SAFE	BOTH IP/OP	$166.38 	$123.12	$0.00	$133.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.48	$123.48	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$83.19	$131.77	$133.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5048-5-300	SUP	Custom 27203010		5048-5-300  -  ROD EXFIX 100MM 8MM HFMN2 C MRI CONNCTNG	BOTH IP/OP	$200.75 	$148.56	$0.00	$160.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.00	$149.00	$0.00	$0.00	$41.84	$0.00	$0.00	$0.00	$0.00	$100.38	$158.99	$160.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5049-5-505	SUP	Custom 27203010		5049-5-505  -  ROD EXFIX 100MM 5MM HFMN2 C CARFBR CONNCTNG	BOTH IP/OP	$177.00 	$130.98	$0.00	$131.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.37	$131.37	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5049-5-510	SUP	Custom 27203010		5049-5-510  -  ROD EXFIX 150MM 5MM HFMN2 C CARFBR CONNCTNG	BOTH IP/OP	$177.00 	$130.98	$0.00	$131.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.37	$131.37	$0.00	$0.00	$36.89	$0.00	$0.00	$0.00	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5049-5-515	SUP	Custom 27203010		5049-5-515  -  ROD EXFIX 150MM 5MM HFMN2 C CARFBR CONNCTNG	BOTH IP/OP	$199.50 	$147.63	$0.00	$148.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.07	$148.07	$0.00	$0.00	$41.58	$0.00	$0.00	$0.00	$0.00	$57.75	$91.48	$92.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5049-5-520	SUP	Custom 27203010		5049-5-520  -  ROD EXFIX 200MM 5MM HFMN2 C CARFBR CONNCTNG	BOTH IP/OP	$199.50 	$147.63	$0.00	$148.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.07	$148.07	$0.00	$0.00	$41.58	$0.00	$0.00	$0.00	$0.00	$57.75	$91.48	$92.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5049-5-525	SUP	Custom 27803010		5049-5-525  -  CONCTR ROD 250MM 5MM CMPCT CARB	BOTH IP/OP	$301.28 	$222.95	$0.00	$223.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$223.61	$223.61	$0.00	$0.00	$62.79	$0.00	$0.00	$0.00	$0.00	$57.75	$91.48	$92.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5049-5-530	SUP	Custom 27203010		5049-5-530  -  ROD EXFIX 300MM 5MM HFMN2 C CARFBR CONNCTNG	BOTH IP/OP	$375.95 	$278.20	$0.00	$279.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.03	$279.03	$0.00	$0.00	$78.35	$0.00	$0.00	$0.00	$0.00	$62.56	$99.10	$100.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5049-7-018	SUP	Custom 27203010		5049-7-018  -  ROD EXFIX 111MM HFMN2 C CVD SEM CIR CARFBR	BOTH IP/OP	$367.13 	$271.68	$0.00	$272.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.48	$272.48	$0.00	$0.00	$76.51	$0.00	$0.00	$0.00	$0.00	$95.56	$151.37	$152.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5049-7-020	SUP	Custom 27203010		5049-7-020  -  ROD EXFIX 146MM HFMN2 C CVD SEM CIR CARFBR	BOTH IP/OP	$178.75 	$132.28	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.67	$132.67	$0.00	$0.00	$37.25	$0.00	$0.00	$0.00	$0.00	$89.38	$141.57	$143.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-501-31-07	SUP	HCPCS C1713		50-501-31-07  -  GUIDE DRILL LONG 2.7MM RECONSTRUCTION THREADLOCK TS	BOTH IP/OP	$348.13 	$257.62	$0.00	$278.50	$156.66	$156.66	$0.00	$0.00	$0.00	$72.56	$258.38	$258.38	$0.00	$0.00	$72.55	$0.00	$205.92	$205.92	$0.00	$174.06	$275.72	$278.50	$0.00		$0.00	$54.48	$0.00	$0.00	$55.42	$0.00	$0.00	$0.00	$0.00	$0.00
50-504-23-07	SUP	HCPCS C1713		50-504-23-07  -  CUTTER SURG 8.5MM BENDER STAINLESS STEEL 1.5/2/3MM THICK	BOTH IP/OP	"$2,478.55 "	"$1,834.13"	$0.00	"$1,982.84"	"$1,115.35"	"$1,115.35"	$0.00	$0.00	$0.00	$516.59	"$1,839.58"	"$1,839.58"	$0.00	$0.00	$516.53	$0.00	"$1,466.06"	"$1,466.06"	$0.00	"$1,239.28"	"$1,963.01"	"$1,982.84"	$0.00		$0.00	$387.89	$0.00	$0.00	$394.59	$0.00	$0.00	$0.00	$0.00	$0.00
50-504-24-07	SUP	HCPCS C1713		50-504-24-07  -  CUTTER SURG 8.5MM BENDER STAINLESS STEEL 1.5/2/3MM THICK	BOTH IP/OP	"$2,562.08 "	"$1,895.94"	$0.00	"$2,049.66"	"$1,152.93"	"$1,152.93"	$0.00	$0.00	$0.00	$534.00	"$1,901.57"	"$1,901.57"	$0.00	$0.00	$533.94	$0.00	"$1,263.10"	"$1,263.10"	$0.00	"$1,281.04"	"$2,029.17"	"$2,049.66"	$0.00		$0.00	$400.96	$0.00	$0.00	$407.88	$0.00	$0.00	$0.00	$0.00	$0.00
5050-4-300	SUP	HCPCS C1713		5050-4-300  -  PIN FIX 5/6MM 300MM 40MM SLFDRILL THREAD APEX TRANSFIX	BOTH IP/OP	$221.00 	$163.54	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$46.06	$164.03	$164.03	$0.00	$0.00	$46.06	$0.00	$130.72	$130.72	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
5050-5-250	SUP	Custom 27203010		5050-5-250  -  PIN HALF 250MM 5MM 4MM APEX SS TRNFX 50MM NONSTRL	BOTH IP/OP	$262.65 	$194.36	$0.00	$206.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.94	$194.94	$0.00	$0.00	$54.74	$0.00	$0.00	$0.00	$0.00	$129.25	$204.73	$206.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5050-5-300	SUP	Custom 27203010		5050-5-300  -  PIN EXFIX 300MM 5MM HFMN2 THRD TRNFX 50MM NONSTRL	BOTH IP/OP	$249.05 	$184.30	$0.00	$195.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.84	$184.84	$0.00	$0.00	$51.90	$0.00	$0.00	$0.00	$0.00	$122.38	$193.84	$195.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-519-15-07	SUP	Custom 27100030		50-519-15-07  -  DRILL TWIST 1.9MM 115MM J NOTCH STEEL 2/2.3MM SCREW	BOTH IP/OP	$290.05 	$214.64	$0.00	$232.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.28	$215.28	$0.00	$0.00	$60.45	$0.00	$0.00	$0.00	$0.00	$145.03	$229.72	$232.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5054-2-001	SUP	Custom 27203010		5054-2-001  -  INSRTR SURG THDL PIN	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5054-2-002	SUP	Custom 27203010		5054-2-002  -  SET EXFIX 2 DRLBT W/O CHK REUSE	BOTH IP/OP	$804.38 	$595.24	$0.00	$643.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$597.01	$597.01	$0.00	$0.00	$167.63	$0.00	$0.00	$0.00	$0.00	$402.19	$637.07	$643.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5054-3-080	SUP	Custom 27203010		5054-3-080  -  SLEEVE XTRNFX 3MM 80MM HFMN2 2 TROC	BOTH IP/OP	$433.13 	$320.52	$0.00	$346.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$321.47	$321.47	$0.00	$0.00	$90.26	$0.00	$0.00	$0.00	$0.00	$216.56	$343.04	$346.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5054-3-093	SUP	Custom 27203010		5054-3-093  -  TROCAR 3MM 93MM 2 SLV ASMBLY SURG	BOTH IP/OP	$378.13 	$279.82	$0.00	$302.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.64	$280.64	$0.00	$0.00	$78.80	$0.00	$0.00	$0.00	$0.00	$189.06	$299.48	$302.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5054-4-120	SUP	Custom 27203010		5054-4-120  -  SLEEVE XTRNFX 4MM 120MM HFMN2 2 TROC	BOTH IP/OP	$426.25 	$315.43	$0.00	$341.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$316.36	$316.36	$0.00	$0.00	$88.83	$0.00	$0.00	$0.00	$0.00	$213.13	$337.59	$341.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5054-4-150	SUP	Custom 27203010		5054-4-150  -  SLEEVE XTRNFX 4MM 150MM HFMN2 2 TROC	BOTH IP/OP	$422.13 	$312.38	$0.00	$337.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$313.30	$313.30	$0.00	$0.00	$87.97	$0.00	$0.00	$0.00	$0.00	$211.06	$334.33	$337.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5054-4-180	SUP	Custom 27203010		5054-4-180  -  SLEEVE XTRNFX 4MM 180MM HFMN2 2 TROC	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.57	$127.57	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5054-6-120	SUP	Custom 27203010		5054-6-120  -  SET EXFIX 6MM HFMN2 TROCAR DUAL SLV ASMBLY	BOTH IP/OP	$479.88 	$355.11	$0.00	$383.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$356.16	$356.16	$0.00	$0.00	$100.01	$0.00	$0.00	$0.00	$0.00	$239.94	$380.06	$383.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5054-6-150	SUP	Custom 27203010		5054-6-150  -  TROCAR 6MM 150MM 2 SLV ASMBLY SURG	BOTH IP/OP	$479.88 	$355.11	$0.00	$383.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$356.16	$356.16	$0.00	$0.00	$100.01	$0.00	$0.00	$0.00	$0.00	$239.94	$380.06	$383.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5054-6-180	SUP	Custom 27203010		5054-6-180  -  TROCAR 6MM 180MM 2 SLV ASMBLY SURG	BOTH IP/OP	$479.88 	$355.11	$0.00	$383.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$356.16	$356.16	$0.00	$0.00	$100.01	$0.00	$0.00	$0.00	$0.00	$239.94	$380.06	$383.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5054-6-200	SUP	Custom 27203010		5054-6-200  -  TROCAR 6MM 200MM 2 SLV ASMBLY SURG	BOTH IP/OP	$479.88 	$355.11	$0.00	$383.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$356.16	$356.16	$0.00	$0.00	$100.01	$0.00	$0.00	$0.00	$0.00	$239.94	$380.06	$383.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-0-100	SUP	Custom 27203010		5057-0-100  -  GUIDE DRILL APEX ASMBLY	BOTH IP/OP	$173.25 	$128.21	$0.00	$138.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$128.59	$128.59	$0.00	$0.00	$36.11	$0.00	$0.00	$0.00	$0.00	$86.63	$137.21	$138.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-0-200	SUP	Custom 27203010		5057-0-200  -  ASMBLY DRILL BRC APEX	BOTH IP/OP	$816.75 	$604.40	$0.00	$653.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$606.19	$606.19	$0.00	$0.00	$170.21	$0.00	$0.00	$0.00	$0.00	$408.38	$646.87	$653.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-0-300	SUP	Custom 27203010		5057-0-300  -  ASMBLY DRILL 3-6MM BRC APEX	BOTH IP/OP	$765.88 	$566.75	$0.00	$612.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$568.43	$568.43	$0.00	$0.00	$159.61	$0.00	$0.00	$0.00	$0.00	$382.94	$606.58	$612.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-1-117	SUP	Custom 27203010		5057-1-117  -  GUIDE DRILL HFMN2 4 HOLE BLOCK CMPCT	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$367.39	$367.39	$0.00	$0.00	$103.16	$0.00	$0.00	$0.00	$0.00	$247.50	$392.04	$396.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-1-118	SUP	Custom 27203010		5057-1-118  -  GUIDE DRILL HFMN2 C PERIART 4 HOLE BLOCK CLMP	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$367.39	$367.39	$0.00	$0.00	$103.16	$0.00	$0.00	$0.00	$0.00	$247.50	$392.04	$396.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-1-119	SUP	Custom 27203010		5057-1-119  -  GUIDE DRILL BLUE RED MNTB TRX APEX 4 HOLE BLOCK	BOTH IP/OP	$468.88 	$346.97	$0.00	$375.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.00	$348.00	$0.00	$0.00	$97.71	$0.00	$0.00	$0.00	$0.00	$234.44	$371.35	$375.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-1-120	SUP	Custom 27203010		5057-1-120  -  GUIDE DRILL YLW MNTB TRX APEX 2 HOLE BLOCK	BOTH IP/OP	$468.88 	$346.97	$0.00	$375.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.00	$348.00	$0.00	$0.00	$97.71	$0.00	$0.00	$0.00	$0.00	$234.44	$371.35	$375.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-3-000	SUP	Custom 27203010		5057-3-000  -  ASSEMBLY DRL XSH 3MM PREDRILLING	BOTH IP/OP	$218.63 	$161.79	$0.00	$174.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.26	$162.26	$0.00	$0.00	$45.56	$0.00	$0.00	$0.00	$0.00	$109.31	$173.15	$174.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-3-100	SUP	Custom 27203010		5057-3-100  -  SLEEVE DRILL 3MM APEX SHRT PREDRILL	BOTH IP/OP	$511.43 	$378.46	$0.00	$379.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$379.58	$379.58	$0.00	$0.00	$106.58	$0.00	$0.00	$0.00	$0.00	$115.50	$182.95	$184.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-3-200	SUP	Custom 27203010		5057-3-200  -  SLEEVE DRILL 3MM APEX LNG PREDRILL	BOTH IP/OP	$511.43 	$378.46	$0.00	$379.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$379.58	$379.58	$0.00	$0.00	$106.58	$0.00	$0.00	$0.00	$0.00	$115.50	$182.95	$184.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-4-000	SUP	Custom 27203010		5057-4-000  -  GUIDE DRILL 35MM 4MM APEX XSH HYDRXAPT PREDRILLING ASMBLY	BOTH IP/OP	$235.13 	$174.00	$0.00	$188.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.51	$174.51	$0.00	$0.00	$49.00	$0.00	$0.00	$0.00	$0.00	$117.56	$186.22	$188.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-4-100	SUP	Custom 27203010		5057-4-100  -  SLEEVE DRILL 4MM APEX SHRT PREDRILL	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$171.45	$171.45	$0.00	$0.00	$48.14	$0.00	$0.00	$0.00	$0.00	$115.50	$182.95	$184.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-4-200	SUP	Custom 27203010		5057-4-200  -  GUIDE DRILL 100MM 4MM APEX LNG HA PREDRILLING ASMBLY PRTC	BOTH IP/OP	$231.00 	$170.94	$0.00	$184.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$171.45	$171.45	$0.00	$0.00	$48.14	$0.00	$0.00	$0.00	$0.00	$115.50	$182.95	$184.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-5-000	SUP	Custom 27203010		5057-5-000  -  ASMBLY DRILL XSH 50MM PREDRILLING PRTC LGTH 5MM	BOTH IP/OP	$250.25 	$185.19	$0.00	$200.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.74	$185.74	$0.00	$0.00	$52.15	$0.00	$0.00	$0.00	$0.00	$125.13	$198.20	$200.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-5-100	SUP	Custom 27203010		5057-5-100  -  GUIDE 5MM SHRT PREDRILL TROCAR ASMBLY APEX SURG	BOTH IP/OP	$250.25 	$185.19	$0.00	$200.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.74	$185.74	$0.00	$0.00	$52.15	$0.00	$0.00	$0.00	$0.00	$125.13	$198.20	$200.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-5-200	SUP	Custom 27203010		5057-5-200  -  ASMBLY DRILL LNG 5MM	BOTH IP/OP	$250.25 	$185.19	$0.00	$200.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.74	$185.74	$0.00	$0.00	$52.15	$0.00	$0.00	$0.00	$0.00	$125.13	$198.20	$200.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-6-000	SUP	Custom 27203010		5057-6-000  -  ASMBLY DRILL XSH 60MM PREDRILLING PRTC LGTH 6MM	BOTH IP/OP	$266.75 	$197.40	$0.00	$213.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.98	$197.98	$0.00	$0.00	$55.59	$0.00	$0.00	$0.00	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-6-100	SUP	Custom 27203010		5057-6-100  -  ASMBLY DRILL 6MM SHRT PREDRILLING	BOTH IP/OP	$266.75 	$197.40	$0.00	$213.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.98	$197.98	$0.00	$0.00	$55.59	$0.00	$0.00	$0.00	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-6-200	SUP	Custom 27203010		5057-6-200  -  GUIDE DRILL 120MM 6MM APEX LNG HA PREDRILLING ASMBLY	BOTH IP/OP	$266.75 	$197.40	$0.00	$213.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.98	$197.98	$0.00	$0.00	$55.59	$0.00	$0.00	$0.00	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-6-300	SUP	Custom 27203010		5057-6-300  -  CUTTER PIN APEX 4-6MM EXTN HNDL	BOTH IP/OP	"$3,898.13 "	"$2,884.62"	$0.00	"$3,118.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,893.19"	"$2,893.19"	$0.00	$0.00	$812.37	$0.00	$0.00	$0.00	$0.00	"$1,949.06"	"$3,087.32"	"$3,118.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5057-9-900	SUP	Custom 27203010		5057-9-900  -  TRAY STRL PIN AND INSTRUMENTATION STOR APEX	BOTH IP/OP	"$3,267.00 "	"$2,417.58"	$0.00	"$2,613.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,424.77"	"$2,424.77"	$0.00	$0.00	$680.84	$0.00	$0.00	$0.00	$0.00	"$1,633.50"	"$2,587.46"	"$2,613.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50638-311	SUP	Custom 27203010		50638-311  -  BRACE PSTN GTT STOP ECON SPAN+AIDS 300 SER ANKL FT LATEX	BOTH IP/OP	$37.23 	$27.55	$0.00	$30.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.63	$27.63	$0.00	$0.00	$7.76	$0.00	$0.00	$0.00	$0.00	$18.99	$30.07	$30.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5065-3-312	SUP	Custom 27203010		5065-3-312  -  PIN HALF 12MM 2MM APEX SM BONE SS BLNT SLFTAP CONTIN THRD	BOTH IP/OP	$111.00 	$82.14	$0.00	$82.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$0.00	$0.00	$0.00	$46.75	$74.05	$74.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5065-3-615	SUP	Custom 27203010		5065-3-615  -  PIN HALF 36MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 15MM	BOTH IP/OP	$111.00 	$82.14	$0.00	$82.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$0.00	$0.00	$0.00	$46.75	$74.05	$74.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5065-3-918	SUP	Custom 27203010		5065-3-918  -  PIN HALF 39MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 18MM	BOTH IP/OP	$111.00 	$82.14	$0.00	$82.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$0.00	$0.00	$0.00	$46.75	$74.05	$74.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5065-4-520	SUP	Custom 27203010		5065-4-520  -  PIN HALF 45MM 2MM APEX MINI SS BLNT SLFTAP CONTIN THRD 20MM	BOTH IP/OP	$111.00 	$82.14	$0.00	$82.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$0.00	$0.00	$0.00	$46.75	$74.05	$74.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5065-5-020	SUP	Custom 27203010		5065-5-020  -  PIN HALF 50MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 20MM	BOTH IP/OP	$111.00 	$82.14	$0.00	$82.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$0.00	$0.00	$0.00	$46.75	$74.05	$74.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5065-6-020	SUP	Custom 27203010		5065-6-020  -  PIN HALF 60MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 20MM	BOTH IP/OP	$111.00 	$82.14	$0.00	$82.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$0.00	$0.00	$0.00	$46.75	$74.05	$74.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5065-9-015	SUP	Custom 27203010		5065-9-015  -  PIN HALF 90MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 15MM	BOTH IP/OP	$111.00 	$82.14	$0.00	$82.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$0.00	$0.00	$0.00	$46.75	$74.05	$74.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-7000B	SUP	HCPCS A7042		50-7000B  -  KIT DRAIN 15.5FR PLEURAL CATHETER CHLORAPREP APPLICATOR	BOTH IP/OP	"$2,412.70 "	"$1,785.40"	$0.00	"$1,930.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,790.71"	"$1,790.71"	$0.00	$0.00	$502.81	$0.00	$0.00	$0.00	$0.00	"$1,206.35"	"$1,910.87"	"$1,930.16"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5070-3-310	SUP	Custom 27203010		5070-3-310  -  PIN EXFIX 33MM 2MM TRNFX SS SMTH 10MM	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5070-3-810	SUP	Custom 27203010		5070-3-810  -  PIN XTRNFX 2MM 38MM 10MM TRNFX SMTH SS	BOTH IP/OP	$130.63 	$96.67	$0.00	$104.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.95	$96.95	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$65.31	$103.46	$104.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5070-4-312	SUP	Custom 27203010		5070-4-312  -  PIN EXFIX 43MM 2MM TRNFX SS SMTH 13MM	BOTH IP/OP	$130.63 	$96.67	$0.00	$104.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.95	$96.95	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$65.31	$103.46	$104.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5070-4-812	SUP	Custom 27203010		5070-4-812  -  PIN EXFIX 48MM 2MM TRNFX SS SMTH 13MM	BOTH IP/OP	$130.63 	$96.67	$0.00	$104.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.95	$96.95	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$65.31	$103.46	$104.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5070-5-312	SUP	Custom 27203010		5070-5-312  -  PIN EXFIX 53MM 2MM TRNFX SS SMTH 13MM	BOTH IP/OP	$130.63 	$96.67	$0.00	$104.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.95	$96.95	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$65.31	$103.46	$104.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5070-5-815	SUP	Custom 27203010		5070-5-815  -  PIN EXFIX 58MM 2MM TRNFX SS SMTH 16MM	BOTH IP/OP	$130.63 	$96.67	$0.00	$104.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.95	$96.95	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$65.31	$103.46	$104.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5070-6-315	SUP	Custom 27203010		5070-6-315  -  PIN EXFIX 63MM 2MM TRNFX SS SMTH 16MM	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5070-7-820	SUP	Custom 27203010		5070-7-820  -  PIN EXFIX 78MM 2MM TRNFX SS SMTH 20MM	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-712-04-09	SUP	HCPCS C1713		50-712-04-09  -  PLATE BONE 28MM 4 HOLE LOCKING FRAC TITANIUM MANDIB STERILE	BOTH IP/OP	$932.93 	$690.37	$0.00	$746.34	$419.82	$419.82	$0.00	$0.00	$0.00	$194.44	$692.42	$692.42	$0.00	$0.00	$194.42	$0.00	$551.83	$551.83	$0.00	$466.46	$738.88	$746.34	$0.00		$0.00	$146.00	$0.00	$0.00	$148.52	$0.00	$0.00	$0.00	$0.00	$0.00
5071-35	SUP	HCPCS C1898		5071-35  -  LEAD PCNG 6.6FR 35CM IS-1 UNPLR FX SCR SIL MYOCARDIUM	BOTH IP/OP	$992.50 	$734.45	$0.00	$810.00	$455.63	$455.63	$0.00	$0.00	$0.00	$206.86	$736.63	$736.63	$0.00	$0.00	$206.84	$0.00	$587.06	$587.06	$0.00	$506.25	$801.90	$810.00	$0.00		$0.00	$158.46	$0.00	$0.00	$161.19	$0.00	$0.00	$0.00	$0.00	$0.00
50-714-04-09	SUP	HCPCS C1713		50-714-04-09  -  PLATE BONE 33MM 4 HOLE FRAC TITANIUM MANDIB STERILE	BOTH IP/OP	$974.73 	$721.30	$0.00	$779.78	$438.63	$438.63	$0.00	$0.00	$0.00	$203.16	$723.44	$723.44	$0.00	$0.00	$203.13	$0.00	$576.55	$576.55	$0.00	$487.36	$771.99	$779.78	$0.00		$0.00	$152.54	$0.00	$0.00	$155.18	$0.00	$0.00	$0.00	$0.00	$0.00
50-716-06-09	SUP	HCPCS C1713		50-716-06-09  -  PLATE BONE 16MMX1.5IN 6 HOLE FRAC TITANIUM MANDIB	BOTH IP/OP	"$1,127.88 "	$834.63	$0.00	$902.30	$507.54	$507.54	$0.00	$0.00	$0.00	$235.08	$837.11	$837.11	$0.00	$0.00	$235.05	$0.00	$667.14	$667.14	$0.00	$563.94	$893.28	$902.30	$0.00		$0.00	$176.51	$0.00	$0.00	$179.56	$0.00	$0.00	$0.00	$0.00	$0.00
50-722-12-09	SUP	HCPCS C1713		50-722-12-09  -  PLATE BONE 1.5IN 2X6 HOLE LOCKING FRAC TITANIUM MANDIB	BOTH IP/OP	"$1,072.18 "	$793.41	$0.00	$857.74	$482.48	$482.48	$0.00	$0.00	$0.00	$223.47	$795.77	$795.77	$0.00	$0.00	$223.44	$0.00	$634.19	$634.19	$0.00	$536.09	$849.17	$857.74	$0.00		$0.00	$167.80	$0.00	$0.00	$170.69	$0.00	$0.00	$0.00	$0.00	$0.00
50-723-12-09	SUP	HCPCS C1713		50-723-12-09  -  PLATE BONE MINI CVD 1MM 12 HOLE LOCKING THREADLOCK TITANIUM	BOTH IP/OP	"$1,100.03 "	$814.02	$0.00	$880.02	$495.01	$495.01	$0.00	$0.00	$0.00	$229.27	$816.44	$816.44	$0.00	$0.00	$229.25	$0.00	$650.66	$650.66	$0.00	$550.01	$871.22	$880.02	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
50-730-04-09	SUP	HCPCS C1713		50-730-04-09  -  PLATE BONE CVD SHORT 1.5MM LOCKING FRAC TITANIUM MANDIB	BOTH IP/OP	"$1,281.03 "	$947.96	$0.00	"$1,024.82"	$576.46	$576.46	$0.00	$0.00	$0.00	$267.00	$950.78	$950.78	$0.00	$0.00	$266.97	$0.00	$757.73	$757.73	$0.00	$640.51	"$1,014.58"	"$1,024.82"	$0.00		$0.00	$200.48	$0.00	$0.00	$203.94	$0.00	$0.00	$0.00	$0.00	$0.00
50-730-06-09	SUP	HCPCS C1713		50-730-06-09  -  PLATE BONE CVD MEDIUM 1MM 6 HOLE LOCKING FRAC TITANIUM	BOTH IP/OP	$877.23 	$649.15	$0.00	$701.78	$394.75	$394.75	$0.00	$0.00	$0.00	$182.84	$651.08	$651.08	$0.00	$0.00	$182.81	$0.00	$518.88	$518.88	$0.00	$438.61	$694.77	$701.78	$0.00		$0.00	$137.29	$0.00	$0.00	$139.65	$0.00	$0.00	$0.00	$0.00	$0.00
50-731-06-09	SUP	HCPCS C1713		50-731-06-09  -  PLATE BN CRV LNG 1MM THREADLOCK TS 6 HL LCK TI MNDB 2MM SCR	BOTH IP/OP	$877.23 	$649.15	$0.00	$701.78	$394.75	$394.75	$0.00	$0.00	$0.00	$182.84	$651.08	$651.08	$0.00	$0.00	$182.81	$0.00	$518.88	$518.88	$0.00	$438.61	$694.77	$701.78	$0.00		$0.00	$137.29	$0.00	$0.00	$139.65	$0.00	$0.00	$0.00	$0.00	$0.00
50-732-04-09	SUP	HCPCS C1713		50-732-04-09  -  PLATE BONE CVD LONG 1.5MM 6 HOLE LOCKING FRAC TITANIUM	BOTH IP/OP	"$1,281.03 "	$947.96	$0.00	"$1,024.82"	$576.46	$576.46	$0.00	$0.00	$0.00	$267.00	$950.78	$950.78	$0.00	$0.00	$266.97	$0.00	$757.73	$757.73	$0.00	$640.51	"$1,014.58"	"$1,024.82"	$0.00		$0.00	$200.48	$0.00	$0.00	$203.94	$0.00	$0.00	$0.00	$0.00	$0.00
50-732-06-09	SUP	HCPCS C1713		50-732-06-09  -  PLATE BONE CVD XLONG 1MM 6 HOLE LOCKING FRAC TITANIUM MANDIB	BOTH IP/OP	$877.23 	$649.15	$0.00	$701.78	$394.75	$394.75	$0.00	$0.00	$0.00	$182.84	$651.08	$651.08	$0.00	$0.00	$182.81	$0.00	$518.88	$518.88	$0.00	$438.61	$694.77	$701.78	$0.00		$0.00	$137.29	$0.00	$0.00	$139.65	$0.00	$0.00	$0.00	$0.00	$0.00
50-746-22-09	SUP	HCPCS C1713		50-746-22-09  -  PLATE SM 2.8MM SMRT BONE RIGHT	BOTH IP/OP	"$7,531.88 "	"$5,573.59"	$0.00	"$6,025.50"	"$3,389.34"	"$3,389.34"	$0.00	$0.00	$0.00	"$1,569.83"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,569.64"	$0.00	"$3,713.21"	"$3,713.21"	$0.00	"$3,765.94"	"$5,965.25"	"$6,025.50"	$0.00		$0.00	"$1,178.74"	$0.00	$0.00	"$1,199.07"	$0.00	$0.00	$0.00	$0.00	$0.00
50-747-22-09	SUP	HCPCS C1713		50-747-22-09  -  PLATE BN SM 2.8MM SMRT LT	BOTH IP/OP	"$7,531.88 "	"$5,573.59"	$0.00	"$6,025.50"	"$3,389.34"	"$3,389.34"	$0.00	$0.00	$0.00	"$1,569.83"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,569.64"	$0.00	"$3,713.21"	"$3,713.21"	$0.00	"$3,765.94"	"$5,965.25"	"$6,025.50"	$0.00		$0.00	"$1,178.74"	$0.00	$0.00	"$1,199.07"	$0.00	$0.00	$0.00	$0.00	$0.00
50-750-06-09	SUP	HCPCS C1713		50-750-06-09  -  PLATE BONE ANGLED 1.5MM 3X3 HOLE LOCKING FRAC TITANIUM	BOTH IP/OP	"$1,782.30 "	"$1,318.90"	$0.00	"$1,425.84"	$802.04	$802.04	$0.00	$0.00	$0.00	$371.48	"$1,322.82"	"$1,322.82"	$0.00	$0.00	$371.43	$0.00	"$1,054.23"	"$1,054.23"	$0.00	$891.15	"$1,411.58"	"$1,425.84"	$0.00		$0.00	$278.93	$0.00	$0.00	$283.74	$0.00	$0.00	$0.00	$0.00	$0.00
50-750-08-09	SUP	HCPCS C1713		50-750-08-09  -  PLATE BONE ANGLED 1.5MM 4X4 HOLE LOCKING FRAC TITANIUM	BOTH IP/OP	"$1,810.18 "	"$1,339.53"	$0.00	"$1,448.14"	$814.58	$814.58	$0.00	$0.00	$0.00	$377.29	"$1,343.51"	"$1,343.51"	$0.00	$0.00	$377.24	$0.00	"$1,070.72"	"$1,070.72"	$0.00	$905.09	"$1,433.66"	"$1,448.14"	$0.00		$0.00	$283.29	$0.00	$0.00	$288.18	$0.00	$0.00	$0.00	$0.00	$0.00
50-7505	SUP	Custom 27203010		50-7505  -  DILATOR LARYNGEAL METAL 20F	BOTH IP/OP	$346.25 	$256.23	$0.00	$277.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.13	$274.23	$277.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-7507	SUP	Custom 27203010		50-7507  -  DILATOR LARYNGEAL METAL 24F	BOTH IP/OP	$332.60 	$246.12	$0.00	$266.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.30	$263.42	$266.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-7509	SUP	Custom 27203010		50-7509  -  DILATOR LARYNGEAL METAL 28F	BOTH IP/OP	$374.90 	$277.43	$0.00	$299.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.45	$296.92	$299.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-7511	SUP	Custom 27203010		50-7511  -  DILATOR LARYNGEAL METAL 32F	BOTH IP/OP	$355.73 	$263.24	$0.00	$284.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.86	$281.74	$284.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-7513	SUP	Custom 27203010		50-7513  -  DILATOR LARYNGEAL METAL 36F	BOTH IP/OP	$350.88 	$259.65	$0.00	$280.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.44	$277.90	$280.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-7515	SUP	Custom 27203010		50-7515  -  DILATOR LARYNGEAL METAL 40F	BOTH IP/OP	$337.20 	$249.53	$0.00	$269.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.60	$267.06	$269.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-7517	SUP	Custom 27203010		50-7517  -  DILATOR LARYNGEAL METAL 44F	BOTH IP/OP	$336.10 	$248.71	$0.00	$268.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.05	$266.19	$268.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-754-05-09	SUP	HCPCS C1713		50-754-05-09  -  PLATE BN MN LNG 110MM THREADLOCK TS LVL 1 4 HL LCK BAR TI	BOTH IP/OP	$854.95 	$632.66	$0.00	$683.96	$384.73	$384.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.48	$677.12	$683.96	$0.00		$0.00	$133.80	$0.00	$0.00	$136.11	$0.00	$0.00	$0.00	$0.00	$0.00
50-760-12-09	SUP	HCPCS C1713		50-760-12-09  -  PLATE BONE STR 2.5MM LOCK 12 HOLE TITANIUM	BOTH IP/OP	"$2,796.00 "	"$2,069.04"	$0.00	"$2,236.80"	"$1,258.20"	"$1,258.20"	$0.00	$0.00	$0.00	$582.76	"$2,075.19"	"$2,075.19"	$0.00	$0.00	$582.69	$0.00	"$1,378.43"	"$1,378.43"	$0.00	"$1,398.00"	"$2,214.43"	"$2,236.80"	$0.00		$0.00	$437.57	$0.00	$0.00	$445.12	$0.00	$0.00	$0.00	$0.00	$0.00
50-760-20-09	SUP	HCPCS C1713		50-760-20-09  -  PLATE BN STRG 2.5MM 20 HL LCK TI	BOTH IP/OP	"$4,074.25 "	"$3,014.95"	$0.00	"$3,259.40"	"$1,833.41"	"$1,833.41"	$0.00	$0.00	$0.00	$849.18	"$3,023.91"	"$3,023.91"	$0.00	$0.00	$849.07	$0.00	"$2,008.61"	"$2,008.61"	$0.00	"$2,037.13"	"$3,226.81"	"$3,259.40"	$0.00		$0.00	$637.62	$0.00	$0.00	$648.62	$0.00	$0.00	$0.00	$0.00	$0.00
50-764-04-09	SUP	HCPCS C1713		50-764-04-09  -  LOCKING FRACTURE PLATE  4 HOLE  33MM  NON-COMPRESSION  2.0MM	BOTH IP/OP	"$1,241.75 "	$918.90	$0.00	$993.40	$558.79	$558.79	$0.00	$0.00	$0.00	$258.81	$921.63	$921.63	$0.00	$0.00	$258.78	$0.00	$734.50	$734.50	$0.00	$620.88	$983.47	$993.40	$0.00		$0.00	$194.33	$0.00	$0.00	$197.69	$0.00	$0.00	$0.00	$0.00	$0.00
5076-52	SUP	HCPCS C1898		5076-52  -  LEAD PACING 10MM SPACE SMALL STR 6.2FR 2MM 52CM 20-110CM	BOTH IP/OP	$992.50 	$734.45	$0.00	$810.00	$455.63	$455.63	$0.00	$0.00	$0.00	$206.86	$736.63	$736.63	$0.00	$0.00	$206.84	$0.00	$587.06	$587.06	$0.00	$506.25	$801.90	$810.00	$0.00		$0.00	$158.46	$0.00	$0.00	$161.19	$0.00	$0.00	$0.00	$0.00	$0.00
5076-58	SUP	HCPCS C1898		5076-58  -  LEAD PACING 10MM SPACE SMALL STR 6.2FR 2MM 58CM 20-110CM	BOTH IP/OP	$992.50 	$734.45	$0.00	$810.00	$455.63	$455.63	$0.00	$0.00	$0.00	$206.86	$736.63	$736.63	$0.00	$0.00	$206.84	$0.00	$587.06	$587.06	$0.00	$506.25	$801.90	$810.00	$0.00		$0.00	$158.46	$0.00	$0.00	$161.19	$0.00	$0.00	$0.00	$0.00	$0.00
50-766-06-09	SUP	HCPCS C1713		50-766-06-09  -  PLATE BN 43MMX2MM NS LVL 1 6 HL LCK TI CRNMXF 2MM SCR	BOTH IP/OP	"$1,241.75 "	$918.90	$0.00	$993.40	$558.79	$558.79	$0.00	$0.00	$0.00	$258.81	$921.63	$921.63	$0.00	$0.00	$258.78	$0.00	$734.50	$734.50	$0.00	$620.88	$983.47	$993.40	$0.00		$0.00	$194.33	$0.00	$0.00	$197.69	$0.00	$0.00	$0.00	$0.00	$0.00
50-771-26-09	SUP	HCPCS C1713		50-771-26-09  -  PLATE BONE PREBENT ANGLED 2MM 26 HOLE RECONSTRUCTION LOCKING	BOTH IP/OP	"$3,550.70 "	"$2,627.52"	$0.00	"$2,840.56"	"$1,597.82"	"$1,597.82"	$0.00	$0.00	$0.00	$740.05	"$2,635.33"	"$2,635.33"	$0.00	$0.00	$739.97	$0.00	"$1,750.50"	"$1,750.50"	$0.00	"$1,775.35"	"$2,812.15"	"$2,840.56"	$0.00		$0.00	$555.68	$0.00	$0.00	$565.27	$0.00	$0.00	$0.00	$0.00	$0.00
50-773-26-09	SUP	HCPCS C1713		50-773-26-09  -  PLATE BONE PREBENT ANGLED 2MM 26 HOLE RECONSTRUCTION LOCKING	BOTH IP/OP	"$3,550.70 "	"$2,627.52"	$0.00	"$2,840.56"	"$1,597.82"	"$1,597.82"	$0.00	$0.00	$0.00	$740.05	"$2,635.33"	"$2,635.33"	$0.00	$0.00	$739.97	$0.00	"$1,750.50"	"$1,750.50"	$0.00	"$1,775.35"	"$2,812.15"	"$2,840.56"	$0.00		$0.00	$555.68	$0.00	$0.00	$565.27	$0.00	$0.00	$0.00	$0.00	$0.00
50-774-20-09	SUP	HCPCS C1713		50-774-20-09  -  PLATE BN STRG 2MM THREADLOCK TS 20 HL RECON BRDG LCK TI MNDB	BOTH IP/OP	"$2,186.13 "	"$1,617.74"	$0.00	"$1,748.90"	$983.76	$983.76	$0.00	$0.00	$0.00	$455.64	"$1,622.54"	"$1,622.54"	$0.00	$0.00	$455.59	$0.00	"$1,293.09"	"$1,293.09"	$0.00	"$1,093.06"	"$1,731.41"	"$1,748.90"	$0.00		$0.00	$342.13	$0.00	$0.00	$348.03	$0.00	$0.00	$0.00	$0.00	$0.00
50-775-26-09	SUP	HCPCS C1713		50-775-26-09  -  PLATE BONE 2MM 26 HOLE PRIM RECONSTRUCTION THREADLOCK GREEN	BOTH IP/OP	"$3,481.10 "	"$2,576.01"	$0.00	"$2,784.88"	"$1,566.50"	"$1,566.50"	$0.00	$0.00	$0.00	$725.55	"$2,583.67"	"$2,583.67"	$0.00	$0.00	$725.46	$0.00	"$1,716.18"	"$1,716.18"	$0.00	"$1,740.55"	"$2,757.03"	"$2,784.88"	$0.00		$0.00	$544.79	$0.00	$0.00	$554.19	$0.00	$0.00	$0.00	$0.00	$0.00
50-777-26-09	SUP	HCPCS C1713		50-777-26-09  -  PLATE BONE LEFT ANGLE 2MM 26 HOLE LOCKING RECONSTRUCTION	BOTH IP/OP	"$3,481.10 "	"$2,576.01"	$0.00	"$2,784.88"	"$1,566.50"	"$1,566.50"	$0.00	$0.00	$0.00	$725.55	"$2,583.67"	"$2,583.67"	$0.00	$0.00	$725.46	$0.00	"$1,716.18"	"$1,716.18"	$0.00	"$1,740.55"	"$2,757.03"	"$2,784.88"	$0.00		$0.00	$544.79	$0.00	$0.00	$554.19	$0.00	$0.00	$0.00	$0.00	$0.00
50-781-76-09	SUP	HCPCS C1713		50-781-76-09  -  TEMPLATE SIZING PREBENT 26 HOLE RECONSTRUCTION LOCKING	BOTH IP/OP	$139.25 	$103.05	$0.00	$111.40	$62.66	$62.66	$0.00	$0.00	$0.00	$29.02	$103.35	$103.35	$0.00	$0.00	$29.02	$0.00	$82.37	$82.37	$0.00	$69.63	$110.29	$111.40	$0.00		$0.00	$21.79	$0.00	$0.00	$22.17	$0.00	$0.00	$0.00	$0.00	$0.00
50-784-70-09	SUP	HCPCS C1713		50-784-70-09  -  TEMPLATE BNDRG 20MMX2.3MM LCK PLT	BOTH IP/OP	$139.25 	$103.05	$0.00	$111.40	$62.66	$62.66	$0.00	$0.00	$0.00	$29.02	$103.35	$103.35	$0.00	$0.00	$29.02	$0.00	$82.37	$82.37	$0.00	$69.63	$110.29	$111.40	$0.00		$0.00	$21.79	$0.00	$0.00	$22.17	$0.00	$0.00	$0.00	$0.00	$0.00
50-785-76-09	SUP	HCPCS C1713		50-785-76-09  -  TEMPLATE BENDING 26 HOLE PRIM PLATE RECONSTRUCTION TITANIUM	BOTH IP/OP	$139.25 	$103.05	$0.00	$111.40	$62.66	$62.66	$0.00	$0.00	$0.00	$29.02	$103.35	$103.35	$0.00	$0.00	$29.02	$0.00	$82.37	$82.37	$0.00	$69.63	$110.29	$111.40	$0.00		$0.00	$21.79	$0.00	$0.00	$22.17	$0.00	$0.00	$0.00	$0.00	$0.00
50-790-06-09	SUP	HCPCS C1713		50-790-06-09  -  PLATE BN 155D 3MM GRN NS THREADLOCK TS 6 HL RECON CX TI MNDB	BOTH IP/OP	"$2,339.28 "	"$1,731.07"	$0.00	"$1,871.42"	"$1,052.67"	"$1,052.67"	$0.00	$0.00	$0.00	$487.56	"$1,736.21"	"$1,736.21"	$0.00	$0.00	$487.50	$0.00	"$1,383.68"	"$1,383.68"	$0.00	"$1,169.64"	"$1,852.71"	"$1,871.42"	$0.00		$0.00	$366.10	$0.00	$0.00	$372.41	$0.00	$0.00	$0.00	$0.00	$0.00
5079-1-010	SUP	Custom 27203010		5079-1-010  -  CLAMP EXFIX HFMN2 MINI SS SWVL	BOTH IP/OP	"$1,339.50 "	$991.23	$0.00	"$1,028.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$994.18	$994.18	$0.00	$0.00	$279.15	$0.00	$0.00	$0.00	$0.00	$642.81	"$1,018.22"	"$1,028.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-1-020	SUP	Custom 27203010		5079-1-020  -  CLAMP EXFIX HFMN MINI SMPL HM20	BOTH IP/OP	$970.50 	$718.17	$0.00	$759.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$720.31	$720.31	$0.00	$0.00	$202.25	$0.00	$0.00	$0.00	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-791-26-09	SUP	HCPCS C1713		50-791-26-09  -  PLATE BONE RIGHT ANG 3MM 26 HOLE RECONSTRUCTION TITANIUM	BOTH IP/OP	"$4,177.30 "	"$3,091.20"	$0.00	"$3,341.84"	"$1,879.79"	"$1,879.79"	$0.00	$0.00	$0.00	$870.65	"$3,100.39"	"$3,100.39"	$0.00	$0.00	$870.55	$0.00	"$2,059.41"	"$2,059.41"	$0.00	"$2,088.65"	"$3,308.42"	"$3,341.84"	$0.00		$0.00	$653.75	$0.00	$0.00	$665.03	$0.00	$0.00	$0.00	$0.00	$0.00
50-791-76-09	SUP	HCPCS C1713		50-791-76-09  -  TEMPLATE BENDING PREBENT 26 HOLE THREADLOCK TITANIUM MANDIB	BOTH IP/OP	$139.25 	$103.05	$0.00	$111.40	$62.66	$62.66	$0.00	$0.00	$0.00	$29.02	$103.35	$103.35	$0.00	$0.00	$29.02	$0.00	$82.37	$82.37	$0.00	$69.63	$110.29	$111.40	$0.00		$0.00	$21.79	$0.00	$0.00	$22.17	$0.00	$0.00	$0.00	$0.00	$0.00
5079-2-031	SUP	Custom 27203010		5079-2-031  -  FXTR EXFIX HFMN 31MM MINI HIP INSL VISE SMTH	BOTH IP/OP	$264.75 	$195.92	$0.00	$203.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.50	$196.50	$0.00	$0.00	$55.17	$0.00	$0.00	$0.00	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-2-032	SUP	Custom 27203010		5079-2-032  -  PIN XTRNFX 32MM MN HFMN INSL	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$0.00	$0.00	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-2-034	SUP	Custom 27203010		5079-2-034  -  FIXATOR XTRNFX MN HFMN2 INSL	BOTH IP/OP	$178.75 	$132.28	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.67	$132.67	$0.00	$0.00	$37.25	$0.00	$0.00	$0.00	$0.00	$89.38	$141.57	$143.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-2-035	SUP	Custom 27203010		5079-2-035  -  VISE XTRNFX 35MM HFMN2 ROD 3 HL MDLR HM	BOTH IP/OP	$393.75 	$291.38	$0.00	$302.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$0.00	$0.00	$0.00	$189.06	$299.48	$302.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-2-036	SUP	Custom 27203010		5079-2-036  -  DEVICE EXFIX HFMN2 MINI 3 HOLE VISE 2 ROD	BOTH IP/OP	$378.13 	$279.82	$0.00	$302.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.64	$280.64	$0.00	$0.00	$78.80	$0.00	$0.00	$0.00	$0.00	$189.06	$299.48	$302.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-792-06-09	SUP	HCPCS C1713		50-792-06-09  -  PLATE BONE 120D 3MM 6 HOLE RECONSTRUCTION THREADLOCK GREEN	BOTH IP/OP	"$2,339.28 "	"$1,731.07"	$0.00	"$1,871.42"	"$1,052.67"	"$1,052.67"	$0.00	$0.00	$0.00	$487.56	"$1,736.21"	"$1,736.21"	$0.00	$0.00	$487.50	$0.00	"$1,383.68"	"$1,383.68"	$0.00	"$1,169.64"	"$1,852.71"	"$1,871.42"	$0.00		$0.00	$366.10	$0.00	$0.00	$372.41	$0.00	$0.00	$0.00	$0.00	$0.00
50-792-08-09	SUP	HCPCS C1713		50-792-08-09  -  PLATE BONE 120D 3MM 8 HOLE RECONSTRUCTION THREADLOCK GREEN	BOTH IP/OP	"$2,422.85 "	"$1,792.91"	$0.00	"$1,938.28"	"$1,090.28"	"$1,090.28"	$0.00	$0.00	$0.00	$504.98	"$1,798.24"	"$1,798.24"	$0.00	$0.00	$504.92	$0.00	"$1,433.12"	"$1,433.12"	$0.00	"$1,211.43"	"$1,918.90"	"$1,938.28"	$0.00		$0.00	$379.18	$0.00	$0.00	$385.72	$0.00	$0.00	$0.00	$0.00	$0.00
5079-2-113	SUP	Custom 27203010		5079-2-113  -  CPLNG EXFIX 3X3MM HFMN 13MM LCK	BOTH IP/OP	$787.50 	$582.75	$0.00	$605.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$0.00	$0.00	$0.00	$378.13	$598.95	$605.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-2-123	SUP	Custom 27203010		5079-2-123  -  COUPLING XTRNFX 2MM MN 3MM HFMN ARTC CPL	BOTH IP/OP	$797.50 	$590.15	$0.00	$638.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$591.90	$591.90	$0.00	$0.00	$166.20	$0.00	$0.00	$0.00	$0.00	$398.75	$631.62	$638.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-3-040	SUP	Custom 27203010		5079-3-040  -  HOLDER IMPL HFMN2 PIN STR HM40 STRL	BOTH IP/OP	$273.00 	$202.02	$0.00	$209.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.62	$202.62	$0.00	$0.00	$56.89	$0.00	$0.00	$0.00	$0.00	$130.63	$206.91	$209.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-3-041	SUP	Custom 27203010		5079-3-041  -  HOLDER IMPL HFMN MINI OFFST HM41	BOTH IP/OP	$336.88 	$249.29	$0.00	$269.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.03	$250.03	$0.00	$0.00	$70.20	$0.00	$0.00	$0.00	$0.00	$168.44	$266.81	$269.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-3-042	SUP	Custom 27203010		5079-3-042  -  HOLDER IMPL HFMN2 MINI PIN OFFST STR	BOTH IP/OP	$336.88 	$249.29	$0.00	$269.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.03	$250.03	$0.00	$0.00	$70.20	$0.00	$0.00	$0.00	$0.00	$168.44	$266.81	$269.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-793-26-09	SUP	HCPCS C1713		50-793-26-09  -  PLATE BONE PREBENT ANGLED 3MM 26 HOLE RECONSTRUCTION LOCKING	BOTH IP/OP	"$4,177.30 "	"$3,091.20"	$0.00	"$3,341.84"	"$1,879.79"	"$1,879.79"	$0.00	$0.00	$0.00	$870.65	"$3,100.39"	"$3,100.39"	$0.00	$0.00	$870.55	$0.00	"$2,059.41"	"$2,059.41"	$0.00	"$2,088.65"	"$3,308.42"	"$3,341.84"	$0.00		$0.00	$653.75	$0.00	$0.00	$665.03	$0.00	$0.00	$0.00	$0.00	$0.00
5079-3-413	SUP	Custom 27203010		5079-3-413  -  BURR SURG 3MM HFMN MINI SHNK OFST HLD STRL	BOTH IP/OP	$351.75 	$260.30	$0.00	$269.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$261.07	$261.07	$0.00	$0.00	$73.30	$0.00	$0.00	$0.00	$0.00	$168.44	$266.81	$269.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-4-012	SUP	Custom 27203010		5079-4-012  -  DEVICE EXFIX HFMN2 2MMX3MM MINI PVT LINKING	BOTH IP/OP	$294.00 	$217.56	$0.00	$225.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.21	$218.21	$0.00	$0.00	$61.27	$0.00	$0.00	$0.00	$0.00	$140.94	$223.25	$225.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-4-050	SUP	Custom 27203010		5079-4-050  -  SOCKET XTRNFX 4MM MN 5MM HFMN INSL	BOTH IP/OP	$178.75 	$132.28	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.67	$132.67	$0.00	$0.00	$37.25	$0.00	$0.00	$0.00	$0.00	$89.38	$141.57	$143.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-794-20-09	SUP	HCPCS C1713		50-794-20-09  -  PLATE BONE STR 3MM 20 HOLE RECONSTRUCTION THREADLOCK GREEN	BOTH IP/OP	"$2,770.93 "	"$2,050.49"	$0.00	"$2,216.74"	"$1,246.92"	"$1,246.92"	$0.00	$0.00	$0.00	$577.53	"$2,056.58"	"$2,056.58"	$0.00	$0.00	$577.46	$0.00	"$1,366.07"	"$1,366.07"	$0.00	"$1,385.46"	"$2,194.58"	"$2,216.74"	$0.00		$0.00	$433.65	$0.00	$0.00	$441.13	$0.00	$0.00	$0.00	$0.00	$0.00
50-794-70-09	SUP	HCPCS C1713		50-794-70-09  -  TEMPLATE BENDING STR 20 HOLE THREADLOCK TITANIUM	BOTH IP/OP	$139.25 	$103.05	$0.00	$111.40	$62.66	$62.66	$0.00	$0.00	$0.00	$29.02	$103.35	$103.35	$0.00	$0.00	$29.02	$0.00	$82.37	$82.37	$0.00	$69.63	$110.29	$111.40	$0.00		$0.00	$21.79	$0.00	$0.00	$22.17	$0.00	$0.00	$0.00	$0.00	$0.00
5079-5-030	SUP	Custom 27203010		5079-5-030  -  ROD EXFIX 30MM 3MM HFMN2 MIC SS CONNCTNG	BOTH IP/OP	$70.13 	$51.90	$0.00	$56.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.05	$52.05	$0.00	$0.00	$14.61	$0.00	$0.00	$0.00	$0.00	$35.06	$55.54	$56.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-5-040	SUP	Custom 27203010		5079-5-040  -  ROD EXFIX 40MM 3MM HFMN2 MIC SS CONNCTNG	BOTH IP/OP	$70.13 	$51.90	$0.00	$56.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.05	$52.05	$0.00	$0.00	$14.61	$0.00	$0.00	$0.00	$0.00	$35.06	$55.54	$56.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-5-050	SUP	Custom 27203010		5079-5-050  -  ROD EXFIX 50MM 3MM HFMN2 MIC SS CONNCTNG	BOTH IP/OP	$70.13 	$51.90	$0.00	$56.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.05	$52.05	$0.00	$0.00	$14.61	$0.00	$0.00	$0.00	$0.00	$35.06	$55.54	$56.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-5-060	SUP	Custom 27203010		5079-5-060  -  ROD EXFIX 60MM 3MM HFMN2 MIC SS CONNCTNG	BOTH IP/OP	$68.25 	$50.51	$0.00	$50.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.66	$50.66	$0.00	$0.00	$14.22	$0.00	$0.00	$0.00	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-5-070	SUP	Custom 27203010		5079-5-070  -  ROD EXFIX 70MM 3MM HFMN2 MIC SS CONNCTNG	BOTH IP/OP	$70.13 	$51.90	$0.00	$56.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.05	$52.05	$0.00	$0.00	$14.61	$0.00	$0.00	$0.00	$0.00	$35.06	$55.54	$56.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-5-080	SUP	Custom 27203010		5079-5-080  -  HM33/80 3MMX80MM	BOTH IP/OP	$68.25 	$50.51	$0.00	$50.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.66	$50.66	$0.00	$0.00	$14.22	$0.00	$0.00	$0.00	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-5-090	SUP	Custom 27203010		5079-5-090  -  ROD EXFIX 90MM 3MM HFMN2 MIC SS CONNCTNG	BOTH IP/OP	$70.13 	$51.90	$0.00	$56.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.05	$52.05	$0.00	$0.00	$14.61	$0.00	$0.00	$0.00	$0.00	$35.06	$55.54	$56.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-5-120	SUP	Custom 27203010		5079-5-120  -  ROD EXFIX 120MM 3MM HFMN2 MIC SS CONNCTNG	BOTH IP/OP	$70.13 	$51.90	$0.00	$56.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.05	$52.05	$0.00	$0.00	$14.61	$0.00	$0.00	$0.00	$0.00	$35.06	$55.54	$56.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-5-150	SUP	Custom 27203010		5079-5-150  -  ROD EXFIX 150MM 3MM HFMN2 MIC SS CONNCTNG	BOTH IP/OP	$70.13 	$51.90	$0.00	$56.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.05	$52.05	$0.00	$0.00	$14.61	$0.00	$0.00	$0.00	$0.00	$35.06	$55.54	$56.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-5-180	SUP	Custom 27203010		5079-5-180  -  3X180MM CONNECTING ROD	BOTH IP/OP	$70.13 	$51.90	$0.00	$56.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.05	$52.05	$0.00	$0.00	$14.61	$0.00	$0.00	$0.00	$0.00	$35.06	$55.54	$56.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-5-250	SUP	Custom 27203010		5079-5-250  -  ROD EXFIX 250MM 3MM HFMN2 MIC SS CONNCTNG	BOTH IP/OP	$78.00 	$57.72	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.89	$57.89	$0.00	$0.00	$16.26	$0.00	$0.00	$0.00	$0.00	$37.81	$59.90	$60.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-795-26-09	SUP	HCPCS C1713		50-795-26-09  -  PLATE BONE RIGHT ANG 3MM 26 HOLE RECONSTRUCTION THREADLOCK	BOTH IP/OP	"$4,274.75 "	"$3,163.32"	$0.00	"$3,419.80"	"$1,923.64"	"$1,923.64"	$0.00	$0.00	$0.00	$890.96	"$3,172.72"	"$3,172.72"	$0.00	$0.00	$890.86	$0.00	"$2,107.45"	"$2,107.45"	$0.00	"$2,137.38"	"$3,385.60"	"$3,419.80"	$0.00		$0.00	$669.00	$0.00	$0.00	$680.54	$0.00	$0.00	$0.00	$0.00	$0.00
5079-5-300	SUP	Custom 27203010		5079-5-300  -  ROD EXFIX 300MM 3MM HFMN2 MIC SS CONNCTNG	BOTH IP/OP	$78.00 	$57.72	$0.00	$57.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.89	$57.89	$0.00	$0.00	$16.26	$0.00	$0.00	$0.00	$0.00	$34.38	$54.45	$55.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-795-76-09	SUP	Custom 27203010		50-795-76-09  -  TEMPLATE BENDING 26 HOLE THREADLOCK TITANIUM MANDIB	BOTH IP/OP	$139.25 	$103.05	$0.00	$111.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.35	$103.35	$0.00	$0.00	$29.02	$0.00	$0.00	$0.00	$0.00	$69.63	$110.29	$111.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-6-030	SUP	Custom 27203010		5079-6-030  -  ROD EXFIX 30MM 3MM HFMN2 MIC CARB CONNCTNG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$0.00	$0.00	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-6-040	SUP	Custom 27203010		5079-6-040  -  ROD EXFIX 40MM 3MM HFMN2 MIC CARB CONNCTNG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$0.00	$0.00	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-6-050	SUP	Custom 27203010		5079-6-050  -  ROD EXFIX 50MM 3MM HFMN2 MIC CARB CONNCTNG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$0.00	$0.00	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-6-060	SUP	Custom 27203010		5079-6-060  -  ROD EXFIX 60MM 3MM HFMN2 MIC CARB CONNCTNG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$0.00	$0.00	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-796-06-09	SUP	HCPCS C1713		50-796-06-09  -  PLATE BN STRG 3MM GRN NS THREADLOCK TS 6 HL RECON BAR CX TI	BOTH IP/OP	"$1,991.18 "	"$1,473.47"	$0.00	"$1,592.94"	$896.03	$896.03	$0.00	$0.00	$0.00	$415.01	"$1,477.85"	"$1,477.85"	$0.00	$0.00	$414.96	$0.00	"$1,177.78"	"$1,177.78"	$0.00	$995.59	"$1,577.01"	"$1,592.94"	$0.00		$0.00	$311.62	$0.00	$0.00	$317.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-6-090	SUP	Custom 27203010		5079-6-090  -  ROD EXFIX 90MM 3MM HFMN2 MIC CARB CONNCTNG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$0.00	$0.00	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-6-120	SUP	Custom 27203010		5079-6-120  -  ROD EXFIX 120MM 3MM HFMN2 MIC CARB CONNCTNG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$0.00	$0.00	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5079-6-150	SUP	Custom 27203010		5079-6-150  -  ROD EXFIX 150MM 3MM HFMN2 MIC CARB CONNCTNG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$0.00	$0.00	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-797-26-09	SUP	HCPCS C1713		50-797-26-09  -  PLATE BONE 3MM RECONSTRUCTION THREADLOCK GREEN TITANIUM LEFT	BOTH IP/OP	"$4,274.75 "	"$3,163.32"	$0.00	"$3,419.80"	"$1,923.64"	"$1,923.64"	$0.00	$0.00	$0.00	$890.96	"$3,172.72"	"$3,172.72"	$0.00	$0.00	$890.86	$0.00	"$2,107.45"	"$2,107.45"	$0.00	"$2,137.38"	"$3,385.60"	"$3,419.80"	$0.00		$0.00	$669.00	$0.00	$0.00	$680.54	$0.00	$0.00	$0.00	$0.00	$0.00
50-799-32-09	SUP	HCPCS C1713		50-799-32-09  -  PLATE BONE 3MM 32 HOLE LOCKING RECONSTRUCTION TITANIUM	BOTH IP/OP	"$4,748.20 "	"$3,513.67"	$0.00	"$3,798.56"	"$2,136.69"	"$2,136.69"	$0.00	$0.00	$0.00	$989.64	"$3,524.11"	"$3,524.11"	$0.00	$0.00	$989.52	$0.00	"$2,340.86"	"$2,340.86"	$0.00	"$2,374.10"	"$3,760.57"	"$3,798.56"	$0.00		$0.00	$743.09	$0.00	$0.00	$755.91	$0.00	$0.00	$0.00	$0.00	$0.00
50-799-34-09	SUP	HCPCS C1713		50-799-34-09  -  PLATE BN ANG 3MM LVL 1 34 HL LCK RECON TI CRNMXF 2.7MM SCR	BOTH IP/OP	"$5,082.38 "	"$3,760.96"	$0.00	"$4,065.90"	"$2,287.07"	"$2,287.07"	$0.00	$0.00	$0.00	"$1,059.29"	"$3,772.14"	"$3,772.14"	$0.00	$0.00	"$1,059.17"	$0.00	"$2,505.61"	"$2,505.61"	$0.00	"$2,541.19"	"$4,025.24"	"$4,065.90"	$0.00		$0.00	$795.39	$0.00	$0.00	$809.11	$0.00	$0.00	$0.00	$0.00	$0.00
50-8001	SUP	Custom 27011340		50-8001  -  OXYGEN DELIVERY SYSTEM W/ADLT MASK 10/CS	BOTH IP/OP	$40.81 	$30.20	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.29	$30.29	$0.00	$0.00	$8.50	$0.00	$0.00	$0.00	$0.00	$20.40	$32.32	$32.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5080-1-612	SUP	Custom 27203010		5080-1-612  -  PIN HALF 12MM 45MM 1.65MM HFMN2 APEX MIC SS SLFDRILL SLFTAP	BOTH IP/OP	$129.00 	$95.46	$0.00	$95.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.74	$95.74	$0.00	$0.00	$26.88	$0.00	$0.00	$0.00	$0.00	$57.75	$91.48	$92.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5080-1-620	SUP	Custom 27203010		5080-1-620  -  PIN HALF 20MM 45MM 1.65MM HFMN2 APEX MIC SS SLFDRILL SLFTAP	BOTH IP/OP	$129.00 	$95.46	$0.00	$95.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.74	$95.74	$0.00	$0.00	$26.88	$0.00	$0.00	$0.00	$0.00	$57.75	$91.48	$92.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5080-2-012	SUP	Custom 27203010		5080-2-012  -  PIN HALF 45MM 2MM HFMN2 APEX MIC SS SLFDRILL SLFTAP THRD 12	BOTH IP/OP	$129.00 	$95.46	$0.00	$95.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.74	$95.74	$0.00	$0.00	$26.88	$0.00	$0.00	$0.00	$0.00	$57.75	$91.48	$92.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5080-2-020	SUP	Custom 27203010		5080-2-020  -  PIN HALF 45MM 2MM HFMN2 APEX MIC SS SLFDRILL SLFTAP THRD 20	BOTH IP/OP	$129.00 	$95.46	$0.00	$95.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.74	$95.74	$0.00	$0.00	$26.88	$0.00	$0.00	$0.00	$0.00	$57.75	$91.48	$92.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-42A	SUP	Custom 27803010		508-11-42A  -  SHELL ACETAB A HEMISPHERE 42MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-44B	SUP	Custom 27803010		508-11-44B  -  SHELL ACETAB B HEMISPHERE 44MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-46C	SUP	Custom 27803010		508-11-46C  -  SHELL ACETAB C HEMISPHERE 46MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-48D	SUP	Custom 27803010		508-11-48D  -  SHELL ACETAB D HEMISPHERE 48MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-50D	SUP	Custom 27803010		508-11-50D  -  SHELL ACETAB D HEMISPHERE 50MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-52E	SUP	Custom 27803010		508-11-52E  -  SHELL ACETAB E HEMISPHERE 52MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-54E	SUP	Custom 27803010		508-11-54E  -  SHELL ACETAB E HEMISPHERE 54MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-56F	SUP	Custom 27803010		508-11-56F  -  SHELL ACETAB F HEMISPHERE 56MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-58F	SUP	Custom 27803010		508-11-58F  -  SHELL ACETAB F HEMISPHERE 58MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-60G	SUP	Custom 27803010		508-11-60G  -  SHELL ACETAB G HEMISPHERE 60MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-62G	SUP	Custom 27803010		508-11-62G  -  SHELL ACETAB G HEMISPHERE 62MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-64H	SUP	Custom 27803010		508-11-64H  -  SHELL ACETAB H HEMISPHERE 64MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-66H	SUP	Custom 27803010		508-11-66H  -  SHELL ACETAB H HEMISPHERE 66MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-68I	SUP	Custom 27803010		508-11-68I  -  SHELL ACETAB I HEMISPHERE 68MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-70I	SUP	Custom 27803010		508-11-70I  -  SHELL ACETAB I HEMISPHERE 70MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-72J	SUP	Custom 27803010		508-11-72J  -  SHELL ACETAB J HEMISPHERE 72MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
508-11-74J	SUP	Custom 27803010		508-11-74J  -  SHELL ACETAB J HEMISPHERE 74MM MULTIHOLE TRIDENT HIP	BOTH IP/OP	"$4,207.50 "	"$3,113.55"	$0.00	"$3,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,122.81"	"$3,122.81"	$0.00	$0.00	$876.84	$0.00	$0.00	$0.00	$0.00	"$2,103.75"	"$3,332.34"	"$3,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50-820-07-07	SUP	Custom 27100030		50-820-07-07  -  DRILL TWIST 1.5MM 40MM 7MM HEXAGONAL ATTCH STOP STAINLESS	BOTH IP/OP	$311.90 	$230.81	$0.00	$249.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.49	$231.49	$0.00	$0.00	$65.00	$0.00	$0.00	$0.00	$0.00	$155.95	$247.02	$249.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5082-200	SUP	Custom 27203010		5082-200  -  BLOOD PRESSURE CONNECTOR/MALE	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.11	$37.11	$0.00	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$25.00	$39.60	$40.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5084-1-100	SUP	Custom 27203010		5084-1-100  -  GUIDE DRILL 1.5-2MM MINI	BOTH IP/OP	$515.63 	$381.57	$0.00	$412.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.70	$382.70	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$257.81	$408.38	$412.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5085-2-015	SUP	Custom 27203010		5085-2-015  -  BIT DRILL 75MM 1.5MM STRL	BOTH IP/OP	$86.70 	$64.16	$0.00	$70.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.35	$64.35	$0.00	$0.00	$18.07	$0.00	$0.00	$0.00	$0.00	$44.00	$69.70	$70.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5090-2-120	SUP	Custom 27203010		5090-2-120  -  PIN HALF 120MM 3MM 4MM APEX SLFDRILL	BOTH IP/OP	$146.20 	$108.19	$0.00	$166.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.51	$108.51	$0.00	$0.00	$30.47	$0.00	$0.00	$0.00	$0.00	$103.81	$164.44	$166.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-54E	SUP	Custom 27803010		509-02-54E  -  SHELL ACETAB E HEMISPHERE 54MM MULTIHOLE RIM MDM TRIDENT	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-56E	SUP	Custom 27803010		509-02-56E  -  SHELL ACETAB E HEMISPHERE 56MM MULTIHOLE RIM MDM TRIDENT	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-58F	SUP	Custom 27803010		509-02-58F  -  SHELL ACETAB F HEMISPHERE 58MM MULTIHOLE RIM MDM TRIDENT	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-60F	SUP	Custom 27803010		509-02-60F  -  SHELL ACETAB F HEMISPHERE 60MM MULTIHOLE RIM MDM TRIDENT	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-62G	SUP	Custom 27803010		509-02-62G  -  SHELL ACETAB G HEMISPHERE 62MM MULTIHOLE RIM MDM TRIDENT	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-64G	SUP	Custom 27803010		509-02-64G  -  SHELL ACETAB G HEMISPHERE 64MM MULTIHOLE RIM MDM TRIDENT	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-66H	SUP	Custom 27803010		509-02-66H  -  SHELL ACETAB H HEMISPHERE 66MM MULTIHOLE RIM MDM TRIDENT	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-68H	SUP	Custom 27803010		509-02-68H  -  SHELL ACETAB H HEMISPHERE 68MM MULTIHOLE RIM MDM TRIDENT	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-70I	SUP	Custom 27803010		509-02-70I  -  SHELL ACETAB I HEMISPHERE 70MM MULTIHOLE RIM MDM TRIDENT	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-72I	SUP	Custom 27803010		509-02-72I  -  SHELL ACETAB I HEMISPHERE 72MM MULTIHOLE RIM MDM TRIDENT	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-74J	SUP	Custom 27803010		509-02-74J  -  SHELL ACETAB J HEMISPHERE 74MM MULTIHOLE RIM MDM TRIDENT	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-76J	SUP	Custom 27803010		509-02-76J  -  SHELL ACETAB 76MM MULTIHOLE REVISION TRITANIUM	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-78J	SUP	Custom 27803010		509-02-78J  -  SHELL ACETAB 78MM MULTIHOLE REVISION TRITANIUM	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-02-80J	SUP	Custom 27803010		509-02-80J  -  SHELL ACETAB 80MM MULTIHOLE REVISION TRITANIUM	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	$0.00	$0.00	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
509-250-605	SUP	Custom 27203010		SPECULUM 7X1.75IN GRV 2XL RT OPN VAG LTX	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5094-0-202	SUP	Custom 27203010		5094-0-202  -  FIXATOR XTRNFX HFMN2 LENGTHEN SS	BOTH IP/OP	"$4,054.50 "	"$3,000.33"	$0.00	"$3,179.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,009.25"	"$3,009.25"	$0.00	$0.00	$844.96	$0.00	$0.00	$0.00	$0.00	"$1,986.88"	"$3,147.21"	"$3,179.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50960-584	SUP	Custom 27203010		MATTRESS OVRLY 72X34X3.5IN FULL SFT SKN COVER LF GM	BOTH IP/OP	$108.83 	$80.53	$0.00	$87.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.41	$86.19	$87.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5096-4615	SUP	HCPCS C1776		5096-4615  -  AUGMENT ACTB WDG 46MM 15MM RSTR HIP	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5096-4620	SUP	HCPCS C1776		5096-4620  -  AUGMENT ACTB WDG 46MM 20MM RSTR HIP	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5096-5015	SUP	HCPCS C1776		5096-5015  -  AUGMENT ACTB WDG 50MM 15MM RSTR HIP	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5096-5020	SUP	HCPCS C1776		5096-5020  -  AUGMENT ACTB WDG 50MM 20MM RSTR HIP	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5096-5025	SUP	HCPCS C1776		5096-5025  -  AUGMENT ACTB WDG 50MM 25MM RSTR HIP	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5096-5415	SUP	HCPCS C1776		5096-5415  -  AUGMENT ACTB WDG 54MM 15MM RSTR HIP	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5096-5815	SUP	HCPCS C1776		5096-5815  -  AUGMENT ACTB WDG 58MM 15MM RSTR HIP	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5096-5825	SUP	HCPCS C1776		5096-5825  -  AUGMENT ACTB WDG 58MM 25MM RSTR HIP	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5096-6220	SUP	HCPCS C1776		5096-6220  -  AUGMENT ACTB WDG 62MM 20MM RSTR HIP	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5096-6225	SUP	HCPCS C1776		5096-6225  -  AUGMENT ACTB WDG 62MM 25MM RSTR HIP	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5096-6615	SUP	HCPCS C1776		5096-6615  -  AUGMENT ACTB WDG 66MM 15MM RSTR HIP	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5096-6620	SUP	HCPCS C1776		5096-6620  -  AUGMENT ACTB WDG 66MM 20MM RSTR	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5096-6625	SUP	HCPCS C1776		5096-6625  -  AUGMENT ACTB WDG 66MM 25MM RSTR HIP	BOTH IP/OP	"$4,817.50 "	"$3,564.95"	$0.00	"$3,854.00"	"$2,167.88"	"$2,167.88"	$0.00	$0.00	$0.00	"$1,004.09"	"$3,575.55"	"$3,575.55"	$0.00	$0.00	"$1,003.97"	$0.00	"$2,375.03"	"$2,375.03"	$0.00	"$2,408.75"	"$3,815.46"	"$3,854.00"	$0.00		$0.00	$753.94	$0.00	$0.00	$766.95	$0.00	$0.00	$0.00	$0.00	$0.00
5100-001	SUP	HCPCS Q4116		5100-001  -  GRAFT SKIN 0-175SQ CM CRYOPRESERVED SPLIT NONMESHED	BOTH IP/OP	"$1,184.05 "	$876.20	$0.00	$878.80	$425.25	$425.25	$0.00	$0.00	$0.00	$246.79	$878.80	$878.80	$0.00	$0.00	$246.76	$0.00	$700.37	$700.37	$0.00	$472.50	$748.44	$756.00	$0.00		$0.00	$147.89	$0.00	$0.00	$150.44	$0.00	$0.00	$0.00	$0.00	$0.00
5100-037-012	SUP	Custom 27203010		5100-037-012  -  BLADE SAW SHORT LONG MICRO 33.5X.64MM RECIPROCATE TPS	BOTH IP/OP	$196.10 	$145.11	$0.00	$156.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.55	$145.55	$0.00	$0.00	$40.87	$0.00	$0.00	$0.00	$0.00	$98.05	$155.31	$156.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5100-137-233	SUP	Custom 27203010		5100-137-233  -  BLADE SAW SHORT 27X.38MM RECIPROCATING TAPERED PRECISION	BOTH IP/OP	$196.10 	$145.11	$0.00	$156.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.55	$145.55	$0.00	$0.00	$40.87	$0.00	$0.00	$0.00	$0.00	$98.05	$155.31	$156.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
510038SIM2	SUP	HCPCS C1725		510038SIM2  -  CATHETER ANGIOGRAPHIC SIDEWINDER SIMMONS TECHNIQUE 2 CURVE 5	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
5101-1-450	SUP	HCPCS C1713		5101-1-450  -  WIRE XTRNFX 1.5MM 450MM KRSH	BOTH IP/OP	$103.70 	$76.74	$0.00	$86.90	$48.88	$48.88	$0.00	$0.00	$0.00	$21.61	$76.97	$76.97	$0.00	$0.00	$21.61	$0.00	$61.34	$61.34	$0.00	$54.31	$86.03	$86.90	$0.00		$0.00	$17.00	$0.00	$0.00	$17.29	$0.00	$0.00	$0.00	$0.00	$0.00
5101-2-450	SUP	HCPCS C1713		5101-2-450  -  WIRE XTRNFX 2MM 450MM KRSH	BOTH IP/OP	$103.70 	$76.74	$0.00	$86.90	$48.88	$48.88	$0.00	$0.00	$0.00	$21.61	$76.97	$76.97	$0.00	$0.00	$21.61	$0.00	$61.34	$61.34	$0.00	$54.31	$86.03	$86.90	$0.00		$0.00	$17.00	$0.00	$0.00	$17.29	$0.00	$0.00	$0.00	$0.00	$0.00
5101302P2	SUP	HCPCS C1713		5101302P2  -  CAGE SPNL 12D 30X10X11MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5101308P2	SUP	HCPCS C1713		5101308P2  -  CAGE SPNL 8D 30X10X11MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5102-1-246	SUP	Custom 27203010		5102-1-246  -  HOLDER IMPL M-S KWR SPCR KWR	BOTH IP/OP	$383.63 	$283.89	$0.00	$306.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$284.73	$284.73	$0.00	$0.00	$79.95	$0.00	$0.00	$0.00	$0.00	$191.81	$303.83	$306.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5102-1-250	SUP	Custom 27203010		5102-1-250  -  CLAMP XTRNFX M-S HBRD	BOTH IP/OP	"$1,218.25 "	$901.51	$0.00	$974.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$904.19	$904.19	$0.00	$0.00	$253.88	$0.00	$0.00	$0.00	$0.00	$609.13	$964.85	$974.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5102-1-260	SUP	Custom 27203010		5102-1-260  -  HOLDER KWR 60MM M-S 2	BOTH IP/OP	"$1,215.50 "	$899.47	$0.00	$972.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$902.14	$902.14	$0.00	$0.00	$253.31	$0.00	$0.00	$0.00	$0.00	$607.75	$962.68	$972.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5102-1-270	SUP	Custom 27203010		5102-1-270  -  HOLDER KWR 80MM M-S 2	BOTH IP/OP	"$1,215.50 "	$899.47	$0.00	$972.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$902.14	$902.14	$0.00	$0.00	$253.31	$0.00	$0.00	$0.00	$0.00	$607.75	$962.68	$972.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5102-1-330	SUP	Custom 27203010		5102-1-330  -  FIXATOR XTRNFX 70D M-S BALL JNT	BOTH IP/OP	$803.00 	$594.22	$0.00	$642.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$595.99	$595.99	$0.00	$0.00	$167.35	$0.00	$0.00	$0.00	$0.00	$401.50	$635.98	$642.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5102-8-330	SUP	Custom 27203010		5102-8-330  -  ROD EXFIX 330MM 8MM MNTB CONNCTNG THRD	BOTH IP/OP	$81.13 	$60.04	$0.00	$64.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.21	$60.21	$0.00	$0.00	$16.91	$0.00	$0.00	$0.00	$0.00	$40.56	$64.25	$64.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5102-8-395	SUP	Custom 27203010		5102-8-395  -  FXTR EXFIX 395MM 8MM M-S CONNCTNG ROD THRD	BOTH IP/OP	$82.50 	$61.05	$0.00	$66.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.23	$61.23	$0.00	$0.00	$17.19	$0.00	$0.00	$0.00	$0.00	$41.25	$65.34	$66.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
510410R	SUP	HCPCS C1758		510410R  -  CATHETER URETHRAL 10FR LATEX ROBINSON RED RUBBER STERILE RRL	BOTH IP/OP	$10.58 	$7.83	$0.00	$8.46	$5.74	$5.74	$0.00	$0.00	$0.00	$2.20	$7.85	$7.85	$0.00	$0.00	$2.20	$0.00	$6.26	$6.26	$0.00	$5.29	$8.38	$8.46	$0.00		$0.00	$1.65	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00
510420R	SUP	HCPCS C1758		510420R  -  CATHETER URTH RBNSN 20FR 16IN 2 STGR EYLT XRY	BOTH IP/OP	$10.58 	$7.83	$0.00	$8.46	$5.74	$5.74	$0.00	$0.00	$0.00	$2.20	$7.85	$7.85	$0.00	$0.00	$2.20	$0.00	$6.26	$6.26	$0.00	$5.29	$8.38	$8.46	$0.00		$0.00	$1.65	$0.00	$0.00	$1.68	$0.00	$0.00	$0.00	$0.00	$0.00
5104308P2	SUP	HCPCS C1713		5104308P2  -  CAGE SPNL 8D 30X10X14MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5109302P2	SUP	HCPCS C1713		5109302P2  -  CAGE SPNL 12D 30X10X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5109308P2	SUP	HCPCS C1713		5109308P2  -  CAGE SPNL 8D 30X10X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5111302P2	SUP	HCPCS C1713		5111302P2  -  CAGE SPNL 12D 30X11X11MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5111308P2	SUP	HCPCS C1713		5111308P2  -  CAGE SPNL 8D 30X11X11MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
51114V	SUP	Custom 27203010		51114V  -  CLIP INTNL MED LG SMTR VESOLOCK	BOTH IP/OP	$851.23 	$629.91	$0.00	$680.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$631.78	$631.78	$0.00	$0.00	$177.40	$0.00	$0.00	$0.00	$0.00	$425.61	$674.17	$680.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51-17304	SUP	HCPCS C1713		51-17304  -  SCREW BONE 1.7MM 4MM EMERGENCY TITANIUM CRANIOMAXILLOFACIAL	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-300	SUP	Custom 27203010		5118-1-300  -  RING XTRNFX SM 147MM BLU M-S .75 HP	BOTH IP/OP	$642.13 	$475.18	$0.00	$513.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$476.59	$476.59	$0.00	$0.00	$133.82	$0.00	$0.00	$0.00	$0.00	$321.06	$508.57	$513.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-301	SUP	Custom 27203010		5118-1-301  -  RING XTRNFX SM 165MM GRN M-S .75 HP	BOTH IP/OP	$738.38 	$546.40	$0.00	$590.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$548.02	$548.02	$0.00	$0.00	$153.88	$0.00	$0.00	$0.00	$0.00	$369.19	$584.80	$590.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-302	SUP	Custom 27203010		5118-1-302  -  RING XTRNFX SM 187MM WHT M-S .75 HP	BOTH IP/OP	$796.13 	$589.14	$0.00	$636.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$590.88	$590.88	$0.00	$0.00	$165.91	$0.00	$0.00	$0.00	$0.00	$398.06	$630.53	$636.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-303	SUP	Custom 27203010		5118-1-303  -  RING XTRNFX SM 147MM BLU M-S .25 HP	BOTH IP/OP	$374.00 	$276.76	$0.00	$299.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$277.58	$277.58	$0.00	$0.00	$77.94	$0.00	$0.00	$0.00	$0.00	$187.00	$296.21	$299.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-304	SUP	Custom 27203010		5118-1-304  -  RING XTRNFX MED 165MM GRN M-S .25 HP	BOTH IP/OP	$441.38 	$326.62	$0.00	$353.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$327.59	$327.59	$0.00	$0.00	$91.98	$0.00	$0.00	$0.00	$0.00	$220.69	$349.57	$353.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-305	SUP	Custom 27203010		5118-1-305  -  RING XTRNFX LG 187MM WHT M-S .25 HP	BOTH IP/OP	$566.50 	$419.21	$0.00	$453.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$420.46	$420.46	$0.00	$0.00	$118.06	$0.00	$0.00	$0.00	$0.00	$283.25	$448.67	$453.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-306	SUP	Custom 27203010		5118-1-306  -  PIN XTRNFX 50MM KRSH M-S RECON CLP WRE HLDR	BOTH IP/OP	$265.38 	$196.38	$0.00	$212.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.96	$196.96	$0.00	$0.00	$55.30	$0.00	$0.00	$0.00	$0.00	$132.69	$210.18	$212.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-307	SUP	Custom 27203010		5118-1-307  -  PIN EXFIX 100MM CLMP	BOTH IP/OP	$320.38 	$237.08	$0.00	$256.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$237.78	$237.78	$0.00	$0.00	$66.77	$0.00	$0.00	$0.00	$0.00	$160.19	$253.74	$256.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-308	SUP	Custom 27203010		5118-1-308  -  CPLNG EXFIX ARTC	BOTH IP/OP	$735.63 	$544.37	$0.00	$588.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.98	$545.98	$0.00	$0.00	$153.30	$0.00	$0.00	$0.00	$0.00	$367.81	$582.62	$588.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-311	SUP	Custom 27203010		5118-1-311  -  HOLDER XTRNFX KRSH M-S ARTC CPLNG	BOTH IP/OP	$948.75 	$702.08	$0.00	$759.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$704.16	$704.16	$0.00	$0.00	$197.72	$0.00	$0.00	$0.00	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-320	SUP	HCPCS C1713		5118-1-320  -  WIRE XTRNFX OLV 1.5MM 450MM KRSH STP NUT SS	BOTH IP/OP	$216.75 	$160.40	$0.00	$173.80	$97.76	$97.76	$0.00	$0.00	$0.00	$45.18	$160.87	$160.87	$0.00	$0.00	$45.17	$0.00	$128.21	$128.21	$0.00	$108.63	$172.06	$173.80	$0.00		$0.00	$34.00	$0.00	$0.00	$34.59	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-340	SUP	HCPCS C1713		5118-1-340  -  WIRE XTRNFX OLV 2MM 450MM KRSH STP SS	BOTH IP/OP	$216.75 	$160.40	$0.00	$173.80	$97.76	$97.76	$0.00	$0.00	$0.00	$45.18	$160.87	$160.87	$0.00	$0.00	$45.17	$0.00	$128.21	$128.21	$0.00	$108.63	$172.06	$173.80	$0.00		$0.00	$34.00	$0.00	$0.00	$34.59	$0.00	$0.00	$0.00	$0.00	$0.00
5118-1-350	SUP	Custom 27203010		5118-1-350  -  HINGE XTRNFX M-S	BOTH IP/OP	$481.25 	$356.13	$0.00	$385.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$357.18	$357.18	$0.00	$0.00	$100.29	$0.00	$0.00	$0.00	$0.00	$240.63	$381.15	$385.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5119302P2	SUP	HCPCS C1713		5119302P2  -  CAGE SPNL 12D 30X11X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5119308P2	SUP	HCPCS C1713		5119308P2  -  CAGE SPNL 8D 30X11X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5120-0-010	SUP	Custom 27203010		5120-0-010  -  RING EXFIX GRY 100MM M-S .75 RING	BOTH IP/OP	$515.63 	$381.57	$0.00	$412.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.70	$382.70	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$257.81	$408.38	$412.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5120-0-040	SUP	Custom 27203010		5120-0-040  -  RING EXFIX 115MM M-S .25	BOTH IP/OP	$323.13 	$239.12	$0.00	$258.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.82	$239.82	$0.00	$0.00	$67.34	$0.00	$0.00	$0.00	$0.00	$161.56	$255.92	$258.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5120-0-050	SUP	Custom 27203010		5120-0-050  -  RING EXFIX 130MM M-S .75	BOTH IP/OP	$591.25 	$437.53	$0.00	$473.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$438.83	$438.83	$0.00	$0.00	$123.22	$0.00	$0.00	$0.00	$0.00	$295.63	$468.27	$473.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5120-0-060	SUP	Custom 27203010		5120-0-060  -  RING EXFIX RED 130MM M-S .25 RING	BOTH IP/OP	$367.13 	$271.68	$0.00	$293.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.48	$272.48	$0.00	$0.00	$76.51	$0.00	$0.00	$0.00	$0.00	$183.56	$290.77	$293.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5120-0-070	SUP	Custom 27203010		5120-0-070  -  RING EXFIX BRNZ 210MM M-S .75 RING	BOTH IP/OP	$782.38 	$578.96	$0.00	$625.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$580.68	$580.68	$0.00	$0.00	$163.05	$0.00	$0.00	$0.00	$0.00	$391.19	$619.64	$625.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5120-0-080	SUP	Custom 27203010		5120-0-080  -  RING EXFIX BRNZ 210MM M-S .25 RING	BOTH IP/OP	$622.88 	$460.93	$0.00	$498.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$462.30	$462.30	$0.00	$0.00	$129.81	$0.00	$0.00	$0.00	$0.00	$311.44	$493.32	$498.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5121302P2	SUP	HCPCS C1713		5121302P2  -  CAGE SPNL 12D 30X12X11MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5121308P2	SUP	HCPCS C1713		5121308P2  -  CAGE SPNL 8D 30X12X11MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5124308P2	SUP	HCPCS C1713		5124308P2  -  CAGE SPNL 8D 30X12X14MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5128-1220	SUP	Custom 27203010		REAGENT MOL BIO HC2 TRNSPT MED 30ML	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5129302P2	SUP	HCPCS C1713		5129302P2  -  CAGE SPNL 12D 30X12X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5129308P2	SUP	HCPCS C1713		5129308P2  -  CAGE SPNL 8D 30X12X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5130-080-030	SUP	Custom 27203010		5130-080-030  -  RASP SURG LONG 3.2MM HELICOIDAL 3.2MM 18.3MM	BOTH IP/OP	$316.25 	$234.03	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$234.72	$234.72	$0.00	$0.00	$65.91	$0.00	$0.00	$0.00	$0.00	$158.13	$250.47	$253.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5141302P2	SUP	HCPCS C1713		5141302P2  -  CAGE SPNL 12D 30X14X11MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5141308P2	SUP	HCPCS C1713		5141308P2  -  CAGE SPNL 8D 30X14X11MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5144308P2	SUP	HCPCS C1713		5144308P2  -  CAGE SPNL 8D 30X14X14MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5149302P2	SUP	HCPCS C1713		5149302P2  -  CAGE SPNL 12D 30X14X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5149308P2	SUP	HCPCS C1713		5149308P2  -  CAGE SPNL 8D 30X9X14MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5150-0-400	SUP	Custom 27203010		5150-0-400  -  TUBE XTRNFX 25MM RD MNTB TRX XTD DYNMC C	BOTH IP/OP	"$2,083.13 "	"$1,541.52"	$0.00	"$1,666.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,546.10"	"$1,546.10"	$0.00	$0.00	$434.12	$0.00	$0.00	$0.00	$0.00	"$1,041.56"	"$1,649.84"	"$1,666.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-0-410	SUP	Custom 27203010		5150-0-410  -  TUBE XTRNFX 20MM RD MNTB TRX XTD DYNMC C	BOTH IP/OP	"$2,186.25 "	"$1,617.83"	$0.00	"$1,749.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,622.63"	"$1,622.63"	$0.00	$0.00	$455.61	$0.00	$0.00	$0.00	$0.00	"$1,093.13"	"$1,731.51"	"$1,749.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-0-420	SUP	Custom 27203010		5150-0-420  -  TUBE XTRNFX 15MM RD MNTB TRX XTD DYNMC C	BOTH IP/OP	"$2,186.25 "	"$1,617.83"	$0.00	"$1,749.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,622.63"	"$1,622.63"	$0.00	$0.00	$455.61	$0.00	$0.00	$0.00	$0.00	"$1,093.13"	"$1,731.51"	"$1,749.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-0-465	SUP	Custom 27203010		5150-0-465  -  TUBE XTRNFX SM 15MM YLW MNTB TRX DYNMC SNPFT C	BOTH IP/OP	"$2,844.88 "	"$2,105.21"	$0.00	"$2,275.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,111.47"	"$2,111.47"	$0.00	$0.00	$592.87	$0.00	$0.00	$0.00	$0.00	"$1,422.44"	"$2,253.14"	"$2,275.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-0-470	SUP	Custom 27203010		5150-0-470  -  TUBE XTRNFX MED 20MM BLU MNTB TRX DYNMC C	BOTH IP/OP	"$2,996.88 "	"$2,217.69"	$0.00	"$2,409.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,224.28"	"$2,224.28"	$0.00	$0.00	$624.55	$0.00	$0.00	$0.00	$0.00	"$1,505.63"	"$2,384.91"	"$2,409.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-0-475	SUP	Custom 27203010		5150-0-475  -  TUBE XTRNFX 25MM RD MNTB TRX DYNMC C	BOTH IP/OP	"$3,067.75 "	"$2,270.14"	$0.00	"$2,465.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,276.88"	"$2,276.88"	$0.00	$0.00	$639.32	$0.00	$0.00	$0.00	$0.00	"$1,540.69"	"$2,440.45"	"$2,465.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-0-575	SUP	Custom 27203010		5150-0-575  -  TUBE XTRNFX 25MM RD MNTB TRX XTD DYNMC C	BOTH IP/OP	"$3,650.63 "	"$2,701.47"	$0.00	"$2,920.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,709.49"	"$2,709.49"	$0.00	$0.00	$760.79	$0.00	$0.00	$0.00	$0.00	"$1,825.31"	"$2,891.30"	"$2,920.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-2-520	SUP	HCPCS C1713		5150-2-520  -  CAP END SPR 20MM TUBE MNTB TRX BLUE	BOTH IP/OP	$88.00 	$65.12	$0.00	$70.40	$39.60	$39.60	$0.00	$0.00	$0.00	$18.34	$65.31	$65.31	$0.00	$0.00	$18.34	$0.00	$52.05	$52.05	$0.00	$44.00	$69.70	$70.40	$0.00		$0.00	$13.77	$0.00	$0.00	$14.01	$0.00	$0.00	$0.00	$0.00	$0.00
5150-2-615	SUP	Custom 27203010		5150-2-615  -  TUBE XTRNFX 15MM YLW MNTB TRX END CAP UNLAT C	BOTH IP/OP	$38.25 	$28.31	$0.00	$28.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.39	$28.39	$0.00	$0.00	$7.97	$0.00	$0.00	$0.00	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-2-620	SUP	Custom 27203010		5150-2-620  -  SET EXFIX BLUE 20MM CARB TUBE END CAP ASMBLY	BOTH IP/OP	$35.75 	$26.46	$0.00	$28.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.53	$26.53	$0.00	$0.00	$7.45	$0.00	$0.00	$0.00	$0.00	$17.88	$28.31	$28.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-2-625	SUP	Custom 27203010		5150-2-625  -  SET EXFIX RED CAP ASMBLY CARB TUBE	BOTH IP/OP	$38.50 	$28.49	$0.00	$35.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.57	$28.57	$0.00	$0.00	$8.02	$0.00	$0.00	$0.00	$0.00	$22.00	$34.85	$35.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-015	SUP	Custom 27203010		5150-3-015  -  CLAMP SURG 15MM PIN YLW	BOTH IP/OP	$823.63 	$609.49	$0.00	$658.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.29	$611.29	$0.00	$0.00	$171.64	$0.00	$0.00	$0.00	$0.00	$411.81	$652.31	$658.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-020	SUP	Custom 27203010		5150-3-020  -  CLAMP EXFIX BLUE 20MM MNTB TRX PIN	BOTH IP/OP	"$1,154.13 "	$854.06	$0.00	$926.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$856.59	$856.59	$0.00	$0.00	$240.52	$0.00	$0.00	$0.00	$0.00	$578.88	$916.94	$926.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-025	SUP	Custom 27203010		5150-3-025  -  CLAMP EXFIX RED 25MM MNTB TRX PIN	BOTH IP/OP	"$1,273.25 "	$942.21	$0.00	"$1,018.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$945.01	$945.01	$0.00	$0.00	$265.35	$0.00	$0.00	$0.00	$0.00	$636.63	"$1,008.41"	"$1,018.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-065	SUP	Custom 27203010		5150-3-065  -  CLAMP EXFIX YLW 15MM MNTB TRX 1 PIN	BOTH IP/OP	$969.38 	$717.34	$0.00	$775.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$719.47	$719.47	$0.00	$0.00	$202.02	$0.00	$0.00	$0.00	$0.00	$484.69	$767.75	$775.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-070	SUP	Custom 27203010		5150-3-070  -  CLAMP EXFIX BLUE 20MM MNTB TRX 1 PIN	BOTH IP/OP	"$1,687.00 "	"$1,248.38"	$0.00	"$1,354.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,252.09"	"$1,252.09"	$0.00	$0.00	$351.57	$0.00	$0.00	$0.00	$0.00	$846.31	"$1,340.56"	"$1,354.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-075	SUP	Custom 27203010		5150-3-075  -  CLAMP EXFIX RED 25MM MNTB TRX 1 PIN	BOTH IP/OP	"$1,992.38 "	"$1,474.36"	$0.00	"$1,600.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,478.74"	"$1,478.74"	$0.00	$0.00	$415.21	$0.00	$0.00	$0.00	$0.00	"$1,000.31"	"$1,584.50"	"$1,600.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-165	SUP	Custom 27203010		5150-3-165  -  CLAMP EXFIX YLW 15MM MNTB TRX 1 PIN	BOTH IP/OP	"$1,045.00 "	$773.30	$0.00	$836.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$775.60	$775.60	$0.00	$0.00	$217.78	$0.00	$0.00	$0.00	$0.00	$522.50	$827.64	$836.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-170	SUP	Custom 27203010		5150-3-170  -  CLAMP EXFIX BLUE 20MM MNTB TRX 1 PIN	BOTH IP/OP	"$1,069.25 "	$791.25	$0.00	$859.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$793.60	$793.60	$0.00	$0.00	$222.83	$0.00	$0.00	$0.00	$0.00	$536.94	$850.51	$859.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-175	SUP	Custom 27203010		5150-3-175  -  CLAMP EXFIX RED 25MM MNTB TRX 1 PIN	BOTH IP/OP	"$1,101.63 "	$815.21	$0.00	$884.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$817.63	$817.63	$0.00	$0.00	$229.58	$0.00	$0.00	$0.00	$0.00	$552.75	$875.56	$884.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-315	SUP	Custom 27203010		5150-3-315  -  CLAMP EXFIX YLW MNTB TRX SM T ASMBLY	BOTH IP/OP	"$1,278.75 "	$946.28	$0.00	"$1,023.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$949.09	$949.09	$0.00	$0.00	$266.49	$0.00	$0.00	$0.00	$0.00	$639.38	"$1,012.77"	"$1,023.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-320	SUP	Custom 27203010		5150-3-320  -  T-CLAMP ASSEMBLY MED. (BLUE)	BOTH IP/OP	"$1,362.63 "	"$1,008.35"	$0.00	"$1,090.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.34"	"$1,011.34"	$0.00	$0.00	$283.97	$0.00	$0.00	$0.00	$0.00	$681.31	"$1,079.20"	"$1,090.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-415	SUP	Custom 27203010		5150-3-415  -  CPLNG EXFIX YLW SM TUBE TO TUBE	BOTH IP/OP	"$1,344.75 "	$995.12	$0.00	"$1,075.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$998.07	$998.07	$0.00	$0.00	$280.25	$0.00	$0.00	$0.00	$0.00	$672.38	"$1,065.04"	"$1,075.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-420	SUP	Custom 27203010		5150-3-420  -  CPLNG EXFIX BLUE MED TUBE TO TUBE	BOTH IP/OP	"$1,393.88 "	"$1,031.47"	$0.00	"$1,118.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,034.53"	"$1,034.53"	$0.00	$0.00	$290.48	$0.00	$0.00	$0.00	$0.00	$699.19	"$1,107.52"	"$1,118.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-425	SUP	Custom 27203010		5150-3-425  -  CPLNG EXFIX RED LG TUBE TO TUBE	BOTH IP/OP	"$1,408.75 "	"$1,042.48"	$0.00	"$1,131.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,045.57"	"$1,045.57"	$0.00	$0.00	$293.58	$0.00	$0.00	$0.00	$0.00	$707.44	"$1,120.58"	"$1,131.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-435	SUP	Custom 27203010		5150-3-435  -  CPLNG EXFIX BLUE YLW S/MED TUBE TO TUBE	BOTH IP/OP	"$1,398.38 "	"$1,034.80"	$0.00	"$1,118.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,037.87"	"$1,037.87"	$0.00	$0.00	$291.42	$0.00	$0.00	$0.00	$0.00	$699.19	"$1,107.52"	"$1,118.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-3-445	SUP	Custom 27203010		5150-3-445  -  CPLNG EXFIX BLUE RED MED LG TUBE TO TUBE	BOTH IP/OP	"$1,408.75 "	"$1,042.48"	$0.00	"$1,131.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,045.57"	"$1,045.57"	$0.00	$0.00	$293.58	$0.00	$0.00	$0.00	$0.00	$707.44	"$1,120.58"	"$1,131.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-4-065	SUP	Custom 27203010		5150-4-065  -  ADAPTER XTRNFX T 15MM YLW MNTB TRX PIN CLP	BOTH IP/OP	$676.50 	$500.61	$0.00	$541.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.10	$502.10	$0.00	$0.00	$140.98	$0.00	$0.00	$0.00	$0.00	$338.25	$535.79	$541.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-4-070	SUP	Custom 27203010		5150-4-070  -  CLAMP EXFIX BLUE 20MM MNTB TRX T ADPR	BOTH IP/OP	$694.75 	$514.12	$0.00	$562.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$515.64	$515.64	$0.00	$0.00	$144.79	$0.00	$0.00	$0.00	$0.00	$351.31	$556.48	$562.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-4-075	SUP	Custom 27203010		5150-4-075  -  CLAMP EXFIX RED 25MM MNTB TRX T ADPR	BOTH IP/OP	$710.50 	$525.77	$0.00	$575.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.33	$527.33	$0.00	$0.00	$148.07	$0.00	$0.00	$0.00	$0.00	$359.56	$569.55	$575.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-5-020	SUP	Custom 27203010		5150-5-020  -  HOLDER XTRNFX 20MM BLU MNTB TRX PIN	BOTH IP/OP	"$2,864.13 "	"$2,119.46"	$0.00	"$2,291.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,125.75"	"$2,125.75"	$0.00	$0.00	$596.88	$0.00	$0.00	$0.00	$0.00	"$1,432.06"	"$2,268.39"	"$2,291.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-5-025	SUP	Custom 27203010		5150-5-025  -  HOLDER XTRNFX 25MM RD MNTB TRX PIN	BOTH IP/OP	"$2,864.13 "	"$2,119.46"	$0.00	"$2,291.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,125.75"	"$2,125.75"	$0.00	$0.00	$596.88	$0.00	$0.00	$0.00	$0.00	"$1,432.06"	"$2,268.39"	"$2,291.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-7-020	SUP	Custom 27203010		5150-7-020  -  O RING XTRNFX YLW MNTB TRX	BOTH IP/OP	$24.08 	$17.82	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.87	$17.87	$0.00	$0.00	$5.02	$0.00	$0.00	$0.00	$0.00	$12.04	$19.07	$19.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-9-465	SUP	Custom 27203010		5150-9-465  -  DEVICE CMPR DSTRCT 15MM MNTB TRX YLW	BOTH IP/OP	"$1,696.75 "	"$1,255.60"	$0.00	"$1,357.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,259.33"	"$1,259.33"	$0.00	$0.00	$353.60	$0.00	$0.00	$0.00	$0.00	$848.38	"$1,343.83"	"$1,357.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-9-535	SUP	Custom 27203010		5150-9-535  -  SLEEVE DRILL MNTB SM 3 MMBLOCKS	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-9-545	SUP	Custom 27203010		5150-9-545  -  SLEEVE DRILL MNTB SM 4 MMBLOCKS	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-9-950	SUP	Custom 27203010		5150-9-950  -  KIT EXFIX YLW MNTB STRL	BOTH IP/OP	"$2,715.63 "	"$2,009.57"	$0.00	"$2,172.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,015.54"	"$2,015.54"	$0.00	$0.00	$565.94	$0.00	$0.00	$0.00	$0.00	"$1,357.81"	"$2,150.78"	"$2,172.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5150-9-960	SUP	Custom 27203010		5150-9-960  -  SET EXFIX YLW 310X130X36MM 15MM MNTB TRX 310MMX130MMX36MM	BOTH IP/OP	"$2,570.25 "	"$1,901.99"	$0.00	"$2,007.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,907.64"	"$1,907.64"	$0.00	$0.00	$535.64	$0.00	$0.00	$0.00	$0.00	"$1,254.69"	"$1,987.43"	"$2,007.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
515-203	SUP	HCPCS C1713		515-203  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$91.73 	$67.88	$0.00	$73.38	$41.28	$41.28	$0.00	$0.00	$0.00	$19.12	$68.08	$68.08	$0.00	$0.00	$19.12	$0.00	$54.26	$54.26	$0.00	$45.86	$72.65	$73.38	$0.00		$0.00	$14.35	$0.00	$0.00	$14.60	$0.00	$0.00	$0.00	$0.00	$0.00
515-204	SUP	HCPCS C1713		515-204  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$91.73 	$67.88	$0.00	$73.38	$41.28	$41.28	$0.00	$0.00	$0.00	$19.12	$68.08	$68.08	$0.00	$0.00	$19.12	$0.00	$54.26	$54.26	$0.00	$45.86	$72.65	$73.38	$0.00		$0.00	$14.35	$0.00	$0.00	$14.60	$0.00	$0.00	$0.00	$0.00	$0.00
515-205	SUP	HCPCS C1713		515-205  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$96.33 	$71.28	$0.00	$77.06	$43.35	$43.35	$0.00	$0.00	$0.00	$20.08	$71.49	$71.49	$0.00	$0.00	$20.07	$0.00	$56.98	$56.98	$0.00	$48.16	$76.29	$77.06	$0.00		$0.00	$15.07	$0.00	$0.00	$15.33	$0.00	$0.00	$0.00	$0.00	$0.00
515-206	SUP	HCPCS C1713		515-206  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$97.75 	$72.34	$0.00	$78.20	$43.99	$43.99	$0.00	$0.00	$0.00	$20.37	$72.55	$72.55	$0.00	$0.00	$20.37	$0.00	$57.82	$57.82	$0.00	$48.88	$77.42	$78.20	$0.00		$0.00	$15.30	$0.00	$0.00	$15.56	$0.00	$0.00	$0.00	$0.00	$0.00
515-633	SUP	HCPCS C1781		515-633  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$813.88 	$602.27	$0.00	$651.10	$366.24	$366.24	$0.00	$0.00	$0.00	$169.63	$604.06	$604.06	$0.00	$0.00	$169.61	$0.00	$481.41	$481.41	$0.00	$406.94	$644.59	$651.10	$0.00		$0.00	$127.37	$0.00	$0.00	$129.57	$0.00	$0.00	$0.00	$0.00	$0.00
5157M/S	SUP	HCPCS C1786		5157M/S  -  PACEMAKER CARDIAC THK6MM 52X42MM 1 CHAMBER RATE RESPONSIVE	BOTH IP/OP	"$7,425.00 "	"$5,494.50"	$0.00	"$5,940.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,547.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,547.37"	$0.00	"$3,660.53"	"$3,660.53"	$0.00	"$3,712.50"	"$5,880.60"	"$5,940.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51-672-01-09	SUP	Custom 27803010		51-672-01-09  -  ROD EXFIX FULL PREBENT MANDIB	BOTH IP/OP	"$1,843.58 "	"$1,364.25"	$0.00	"$1,474.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.30"	"$1,368.30"	$0.00	$0.00	$384.20	$0.00	$0.00	$0.00	$0.00	$921.79	"$1,460.12"	"$1,474.86"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51-672-05-09	SUP	Custom 27803010		51-672-05-09  -  ROD EXFIX .5 PREBENT MANDIB	BOTH IP/OP	"$1,317.25 "	$974.77	$0.00	"$1,053.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$977.66	$977.66	$0.00	$0.00	$274.51	$0.00	$0.00	$0.00	$0.00	$658.63	"$1,043.26"	"$1,053.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51-673-09-09	SUP	Custom 27803010		51-673-09-09  -  PIN XTRNFX 4MM 2.7MM 80MM LF 9MM X-FX THRD TI CRNMXF	BOTH IP/OP	$543.05 	$401.86	$0.00	$434.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$403.05	$403.05	$0.00	$0.00	$113.17	$0.00	$0.00	$0.00	$0.00	$271.53	$430.10	$434.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
51-673-13-09	SUP	Custom 27803010		51-673-13-09  -  PIN XTRNFX 4MM 2.7MM 80MM LF 13MM X-FX THRD TI CRNMXF	BOTH IP/OP	$543.05 	$401.86	$0.00	$434.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$403.05	$403.05	$0.00	$0.00	$113.17	$0.00	$0.00	$0.00	$0.00	$271.53	$430.10	$434.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
518-032	SUP	HCPCS C1887		518-032  -  CATH GUID .014IN 6FR 5MM 135CM GWIRE RADIOPQ MRKR STRL QKCRS	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$233.49	$233.49	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$215.00	$340.56	$344.00	$0.00		$0.00	$67.30	$0.00	$0.00	$68.46	$0.00	$0.00	$0.00	$0.00	$0.00
518-033	SUP	HCPCS C1887		518-033  -  CATH GUID .018IN 3.4-2.2FR 90CM LOW CX PRFL 3 RADIOPQ MRKR	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$233.49	$233.49	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$215.00	$340.56	$344.00	$0.00		$0.00	$67.30	$0.00	$0.00	$68.46	$0.00	$0.00	$0.00	$0.00	$0.00
518-034	SUP	HCPCS C1887		518-034  -  CATH GUID .018IN 3.4-2.3FR 135CM RADIOPQ MRKR GWIRE SHFT	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$233.49	$233.49	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$215.00	$340.56	$344.00	$0.00		$0.00	$67.30	$0.00	$0.00	$68.46	$0.00	$0.00	$0.00	$0.00	$0.00
518-035	SUP	HCPCS C1887		518-035  -  CATH GUID .018IN 15MM SPC 1.8FR 150CM RADIOPQ MRKR SMLS LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$233.49	$233.49	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$215.00	$340.56	$344.00	$0.00		$0.00	$67.30	$0.00	$0.00	$68.46	$0.00	$0.00	$0.00	$0.00	$0.00
518-036	SUP	HCPCS C1887		518-036  -  CATHETER GUID .035IN 4.8-3.7FR 90CM LOW CROSSING PROFILE 3	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
518-037	SUP	HCPCS C1887		518-037  -  CATH GUID .035IN 50MM SPC 3.1FR 135CM RADIOPQ MRKR SMLS LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$233.49	$233.49	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$215.00	$340.56	$344.00	$0.00		$0.00	$67.30	$0.00	$0.00	$68.46	$0.00	$0.00	$0.00	$0.00	$0.00
518-038	SUP	HCPCS C1887		518-038  -  CATHETER GUID .035IN 5MM SPACING 3.1FR 150CM LP TAPERED TIP	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
518-065	SUP	HCPCS C1887		518-065  -  CATH GUID .014IN 3-1.9FR 150CM 3 RADIOPQ MRKR LOW CX PRFL	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$233.49	$233.49	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$215.00	$340.56	$344.00	$0.00		$0.00	$67.30	$0.00	$0.00	$68.46	$0.00	$0.00	$0.00	$0.00	$0.00
518-066	SUP	HCPCS C1887		518-066  -  CATH GUID .035IN 4.8-3.7FR 65CM LOW CX PRFL 3 RADIOPQ MRKR	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$233.49	$233.49	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$215.00	$340.56	$344.00	$0.00		$0.00	$67.30	$0.00	$0.00	$68.46	$0.00	$0.00	$0.00	$0.00	$0.00
518-076	SUP	HCPCS C1887		518-076  -  CATH GUID .035IN 50MM SPC 4.5FR 65CM STR TIP RADIOPQ MRKR	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-077	SUP	HCPCS C1887		518-077  -  CATH GUID .035IN 4FR 65CM ANG TIP QKCRS	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-078	SUP	HCPCS C1887		518-078  -  CATH GUID .035IN 50MM SPC 4.5FR 90CM 70CM STR TIP RADIOPQ	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-079	SUP	HCPCS C1887		518-079  -  CATH GUID .035IN 4FR 90CM SPRT ANG TIP QKCRS	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-080	SUP	HCPCS C1887		518-080  -  CATHETER SPRT .035IN STRG 135CM QKCRS	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-081	SUP	HCPCS C1887		518-081  -  CATH GUID 45D 50MM SPC LP .052-.059IN 135CM 7MM LV 3 RADIOPQ	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-082	SUP	HCPCS C1887		518-082  -  CATH GUID .035IN 50MM SPC 4.5FR 150CM 130CM STR TIP RADIOPQ	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-083	SUP	HCPCS C1887		518-083  -  CATH GUID .035IN 4FR 150CM 3 RADIOPQ MRKR SPRT ANG TIP	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-084	SUP	HCPCS C1887		518-084  -  CATHETER GD 15MM SPC 1.9FR 135CM STRL QKCRS XTRM RADOPQ	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-085	SUP	HCPCS C1887		518-085  -  CATH GUID 45D .014IN 15MM SPC 3.2FR 135CM 100CM ANG TIP	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-086	SUP	HCPCS C1887		518-086  -  CATH GUID .014IN 15MM SPC 3.2FR 150CM 100CM STR TIP RADIOPQ	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-087	SUP	HCPCS C1887		518-087  -  CATH GUID .014IN 150CM 3 RADIOPQ MRKR LOW CX PRFL SPRT QKCRS	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-088	SUP	HCPCS C1887		518-088  -  CATH GUID .018IN 15MM SPC 3.4FR 90CM 60CM STR TIP RADIOPQ	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-089	SUP	HCPCS C1887		518-089  -  CATH GUID .018IN 15MM SPC 3.4FR 90CM 60CM ANG TIP RADIOPQ	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-090	SUP	HCPCS C1887		518-090  -  CATH GUID .018IN 15MM SPC 3.2FR 135CM 100CM STR TIP RADIOPQ	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-091	SUP	HCPCS C1887		518-091  -  CATH GUID .018IN 15MM SPC 3.4FR 135CM 100CM ANG TIP RADIOPQ	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
518-092	SUP	HCPCS C1887		518-092  -  CATH GUID .018IN 15MM SPC 3.4FR 150CM 100CM STR TIP RADIOPQ	BOTH IP/OP	$507.50 	$375.55	$0.00	$406.00	$275.57	$275.57	$0.00	$0.00	$0.00	$105.78	$376.67	$376.67	$0.00	$0.00	$105.76	$0.00	$300.19	$300.19	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$79.42	$0.00	$0.00	$80.79	$0.00	$0.00	$0.00	$0.00	$0.00
5181302P2	SUP	HCPCS C1713		5181302P2  -  CAGE SPNL 12D 30X8X11MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5181308P2	SUP	HCPCS C1713		5181308P2  -  CAGE SPNL 8D 30X8X11MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
518-203	SUP	HCPCS C1713		518-203  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$96.33 	$71.28	$0.00	$77.06	$43.35	$43.35	$0.00	$0.00	$0.00	$20.08	$71.49	$71.49	$0.00	$0.00	$20.07	$0.00	$56.98	$56.98	$0.00	$48.16	$76.29	$77.06	$0.00		$0.00	$15.07	$0.00	$0.00	$15.33	$0.00	$0.00	$0.00	$0.00	$0.00
518-205	SUP	HCPCS C1713		518-205  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$96.33 	$71.28	$0.00	$77.06	$43.35	$43.35	$0.00	$0.00	$0.00	$20.08	$71.49	$71.49	$0.00	$0.00	$20.07	$0.00	$56.98	$56.98	$0.00	$48.16	$76.29	$77.06	$0.00		$0.00	$15.07	$0.00	$0.00	$15.33	$0.00	$0.00	$0.00	$0.00	$0.00
518-306	SUP	HCPCS C1713		518-306  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$79.70 	$58.98	$0.00	$63.76	$35.87	$35.87	$0.00	$0.00	$0.00	$16.61	$59.15	$59.15	$0.00	$0.00	$16.61	$0.00	$47.14	$47.14	$0.00	$39.85	$63.12	$63.76	$0.00		$0.00	$12.47	$0.00	$0.00	$12.69	$0.00	$0.00	$0.00	$0.00	$0.00
5184308P2	SUP	HCPCS C1713		5184308P2  -  CAGE SPNL 8D 30X8X14MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5189302P2	SUP	HCPCS C1713		5189302P2  -  CAGE SPNL 12D 30X8X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5189308P2	SUP	HCPCS C1713		5189308P2  -  CAGE SPNL 8D 30X8X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5190-0-010	SUP	Custom 27203010		5190-0-010  -  SET ORTH Y BODY ASMBLY	BOTH IP/OP	"$1,588.13 "	"$1,175.22"	$0.00	"$1,270.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,178.71"	"$1,178.71"	$0.00	$0.00	$330.97	$0.00	$0.00	$0.00	$0.00	$794.06	"$1,257.80"	"$1,270.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5190-0-020	SUP	Custom 27203010		5190-0-020  -  CPLNG EXFIX PIN TO ROD	BOTH IP/OP	$598.13 	$442.62	$0.00	$478.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$443.93	$443.93	$0.00	$0.00	$124.65	$0.00	$0.00	$0.00	$0.00	$299.06	$473.72	$478.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5190-0-110	SUP	Custom 27203010		5190-0-110  -  SET ORTH STR BODY ASMBLY	BOTH IP/OP	"$1,051.88 "	$778.39	$0.00	$841.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$780.70	$780.70	$0.00	$0.00	$219.21	$0.00	$0.00	$0.00	$0.00	$525.94	$833.09	$841.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5190-0-200	SUP	HCPCS C1713		5190-0-200  -  PIN STOP COLLAR DSTRCT	BOTH IP/OP	$240.63 	$178.07	$0.00	$192.50	$108.28	$108.28	$0.00	$0.00	$0.00	$50.15	$178.59	$178.59	$0.00	$0.00	$50.15	$0.00	$142.33	$142.33	$0.00	$120.31	$190.58	$192.50	$0.00		$0.00	$37.66	$0.00	$0.00	$38.31	$0.00	$0.00	$0.00	$0.00	$0.00
5190-0-210	SUP	Custom 27203010		5190-0-210  -  ROD EXFIX STR THRD	BOTH IP/OP	$130.63 	$96.67	$0.00	$104.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.95	$96.95	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$65.31	$103.46	$104.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5191302P2	SUP	HCPCS C1713		5191302P2  -  CAGE SPNL 12D 30X11X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5191308P2	SUP	HCPCS C1713		5191308P2  -  CAGE SPNL 8D 30X11X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5195-000-010	SUP	Custom 27203010		5195-000-010  -  BODY XTRNFX NS DJD II CMPNT	BOTH IP/OP	"$3,081.38 "	"$2,280.22"	$0.00	"$2,465.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,287.00"	"$2,287.00"	$0.00	$0.00	$642.16	$0.00	$0.00	$0.00	$0.00	"$1,540.69"	"$2,440.45"	"$2,465.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5195-1-011	SUP	Custom 27203010		5195-1-011  -  SCREW XTRNFX DJD II GD HUM	BOTH IP/OP	$70.13 	$51.90	$0.00	$56.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.05	$52.05	$0.00	$0.00	$14.61	$0.00	$0.00	$0.00	$0.00	$35.06	$55.54	$56.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5195-1-020	SUP	Custom 27203010		5195-1-020  -  DRILL SURG OSTEOSTAT STRL	BOTH IP/OP	$158.13 	$117.02	$0.00	$126.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.36	$117.36	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$79.06	$125.24	$126.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5195-1-030	SUP	Custom 27203010		5195-1-030  -  GUIDE 4MM HING INS DJD 2 SURG DYNMC ELB JNT DISTRCT	BOTH IP/OP	$158.13 	$117.02	$0.00	$126.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.36	$117.36	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$79.06	$125.24	$126.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5195-1-035	SUP	Custom 27203010		5195-1-035  -  GUIDE FOR HALF-PINS	BOTH IP/OP	$158.13 	$117.02	$0.00	$126.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.36	$117.36	$0.00	$0.00	$32.95	$0.00	$0.00	$0.00	$0.00	$79.06	$125.24	$126.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5199302P2	SUP	HCPCS C1713		5199302P2  -  CAGE SPNL 12D 30X9X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5199308P2	SUP	HCPCS C1713		5199308P2  -  CAGE SPNL 8D 30X9X9MM NS CRNT PEEK ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5201300P2	SUP	HCPCS C1713		5201300P2  -  CAGE SPNL 0D 30X10X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5201302P2	SUP	HCPCS C1713		5201302P2  -  CAGE SPNL 12D 30X10X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5201308P2	SUP	HCPCS C1713		5201308P2  -  CAGE SPNL 8D 30X10X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
52-022-01	SUP	Custom 27203010		52-022-01  -  DRILL BIT 2.7	BOTH IP/OP	$260.40 	$192.70	$0.00	$208.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$193.27	$193.27	$0.00	$0.00	$54.27	$0.00	$0.00	$0.00	$0.00	$130.20	$206.24	$208.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5204300P2	SUP	HCPCS C1713		5204300P2  -  CAGE SPNL 0D 30X10X14MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5204308P2	SUP	HCPCS C1713		5204308P2  -  CAGE SPNL 8D 30X10X14MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5209300P2	SUP	HCPCS C1713		5209300P2  -  CAGE SPNL 0D 30X10X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5209302P2	SUP	HCPCS C1713		5209302P2  -  CAGE SPNL 12D 30X10X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5209308P2	SUP	HCPCS C1713		5209308P2  -  CAGE SPNL 8D 30X10X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5210-3-165	SUP	HCPCS C1713		5210-3-165  -  SCREW BONE 5MM 65MM FULTHD	BOTH IP/OP	$203.50 	$150.59	$0.00	$162.80	$91.58	$91.58	$0.00	$0.00	$0.00	$42.41	$151.04	$151.04	$0.00	$0.00	$42.41	$0.00	$120.37	$120.37	$0.00	$101.75	$161.17	$162.80	$0.00		$0.00	$31.85	$0.00	$0.00	$32.40	$0.00	$0.00	$0.00	$0.00	$0.00
5210-3-190	SUP	HCPCS C1713		5210-3-190  -  SCREW BONE 5MM 90MM FULTHD	BOTH IP/OP	$203.50 	$150.59	$0.00	$162.80	$91.58	$91.58	$0.00	$0.00	$0.00	$42.41	$151.04	$151.04	$0.00	$0.00	$42.41	$0.00	$120.37	$120.37	$0.00	$101.75	$161.17	$162.80	$0.00		$0.00	$31.85	$0.00	$0.00	$32.40	$0.00	$0.00	$0.00	$0.00	$0.00
5211300P2	SUP	HCPCS C1713		5211300P2  -  CAGE SPNL 0D 30X11X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5211302P2	SUP	HCPCS C1713		5211302P2  -  CAGE SPNL 12D 30X11X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5211308P2	SUP	HCPCS C1713		5211308P2  -  CAGE SPNL 8D 30X11X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5213-42	SUP	HCPCS C1776		5213-42  -  COMPONENT GLENOID 40MM 42MM UHMWPE STERILE	BOTH IP/OP	"$2,055.08 "	"$1,520.76"	$0.00	"$1,644.06"	$924.78	$924.78	$0.00	$0.00	$0.00	$428.33	"$1,525.28"	"$1,525.28"	$0.00	$0.00	$428.28	$0.00	"$1,215.58"	"$1,215.58"	$0.00	"$1,027.54"	"$1,627.62"	"$1,644.06"	$0.00		$0.00	$321.62	$0.00	$0.00	$327.17	$0.00	$0.00	$0.00	$0.00	$0.00
5213-44	SUP	HCPCS C1776		5213-44  -  SOCKET GLENOID 44MM SHOULDER STERILE	BOTH IP/OP	"$2,055.08 "	"$1,520.76"	$0.00	"$1,644.06"	$924.78	$924.78	$0.00	$0.00	$0.00	$428.33	"$1,525.28"	"$1,525.28"	$0.00	$0.00	$428.28	$0.00	"$1,215.58"	"$1,215.58"	$0.00	"$1,027.54"	"$1,627.62"	"$1,644.06"	$0.00		$0.00	$321.62	$0.00	$0.00	$327.17	$0.00	$0.00	$0.00	$0.00	$0.00
5213-46	SUP	HCPCS C1776		5213-46  -  COMPONENT GLENOID 46MM UHMWPE STERILE	BOTH IP/OP	"$2,055.08 "	"$1,520.76"	$0.00	"$1,644.06"	$924.78	$924.78	$0.00	$0.00	$0.00	$428.33	"$1,525.28"	"$1,525.28"	$0.00	$0.00	$428.28	$0.00	"$1,215.58"	"$1,215.58"	$0.00	"$1,027.54"	"$1,627.62"	"$1,644.06"	$0.00		$0.00	$321.62	$0.00	$0.00	$327.17	$0.00	$0.00	$0.00	$0.00	$0.00
5213-48	SUP	HCPCS C1776		5213-48  -  COMPONENT GLENOID 48MM UHMWPE NONSTRL	BOTH IP/OP	"$2,055.08 "	"$1,520.76"	$0.00	"$1,644.06"	$924.78	$924.78	$0.00	$0.00	$0.00	$428.33	"$1,525.28"	"$1,525.28"	$0.00	$0.00	$428.28	$0.00	"$1,215.58"	"$1,215.58"	$0.00	"$1,027.54"	"$1,627.62"	"$1,644.06"	$0.00		$0.00	$321.62	$0.00	$0.00	$327.17	$0.00	$0.00	$0.00	$0.00	$0.00
5213-50	SUP	HCPCS C1776		5213-50  -  COMPONENT GLENOID 50MM UHMWPE NONSTRL	BOTH IP/OP	"$2,055.08 "	"$1,520.76"	$0.00	"$1,644.06"	$924.78	$924.78	$0.00	$0.00	$0.00	$428.33	"$1,525.28"	"$1,525.28"	$0.00	$0.00	$428.28	$0.00	"$1,215.58"	"$1,215.58"	$0.00	"$1,027.54"	"$1,627.62"	"$1,644.06"	$0.00		$0.00	$321.62	$0.00	$0.00	$327.17	$0.00	$0.00	$0.00	$0.00	$0.00
5213-52	SUP	HCPCS C1776		5213-52  -  COMPONENT GLENOID 52MM UHMWPE STERILE	BOTH IP/OP	"$2,055.08 "	"$1,520.76"	$0.00	"$1,644.06"	$924.78	$924.78	$0.00	$0.00	$0.00	$428.33	"$1,525.28"	"$1,525.28"	$0.00	$0.00	$428.28	$0.00	"$1,215.58"	"$1,215.58"	$0.00	"$1,027.54"	"$1,627.62"	"$1,644.06"	$0.00		$0.00	$321.62	$0.00	$0.00	$327.17	$0.00	$0.00	$0.00	$0.00	$0.00
5213-54	SUP	HCPCS C1776		5213-54  -  SOCKET GLENOID 54MM SHOULDER STERILE	BOTH IP/OP	"$2,094.83 "	"$1,550.17"	$0.00	"$1,675.86"	$942.67	$942.67	$0.00	$0.00	$0.00	$436.61	"$1,554.78"	"$1,554.78"	$0.00	$0.00	$436.56	$0.00	"$1,239.09"	"$1,239.09"	$0.00	"$1,047.41"	"$1,659.11"	"$1,675.86"	$0.00		$0.00	$327.84	$0.00	$0.00	$333.50	$0.00	$0.00	$0.00	$0.00	$0.00
5213-56	SUP	HCPCS C1776		5213-56  -  COMPONENT GLENOID 56MM UHMWPE STERILE	BOTH IP/OP	"$2,094.83 "	"$1,550.17"	$0.00	"$1,675.86"	$942.67	$942.67	$0.00	$0.00	$0.00	$436.61	"$1,554.78"	"$1,554.78"	$0.00	$0.00	$436.56	$0.00	"$1,239.09"	"$1,239.09"	$0.00	"$1,047.41"	"$1,659.11"	"$1,675.86"	$0.00		$0.00	$327.84	$0.00	$0.00	$333.50	$0.00	$0.00	$0.00	$0.00	$0.00
5213-58	SUP	HCPCS C1776		5213-58  -  COMPONENT GLENOID 58MM UHMWPE STERILE	BOTH IP/OP	"$2,094.83 "	"$1,550.17"	$0.00	"$1,675.86"	$942.67	$942.67	$0.00	$0.00	$0.00	$436.61	"$1,554.78"	"$1,554.78"	$0.00	$0.00	$436.56	$0.00	"$1,239.09"	"$1,239.09"	$0.00	"$1,047.41"	"$1,659.11"	"$1,675.86"	$0.00		$0.00	$327.84	$0.00	$0.00	$333.50	$0.00	$0.00	$0.00	$0.00	$0.00
5219300P2	SUP	HCPCS C1713		5219300P2  -  CAGE SPNL 0D 30X11X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5219302P2	SUP	HCPCS C1713		5219302P2  -  CAGE SPNL 12D 30X11X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5219308P2	SUP	HCPCS C1713		5219308P2  -  CAGE SPNL 8D 30X11X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
52-20358	SUP	HCPCS C1713		52-20358  -  SCREW BONE 2MM 8MM SLFTAP XFIT TITANIUM INTERMAXILLARY	BOTH IP/OP	$221.15 	$163.65	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$46.09	$164.14	$164.14	$0.00	$0.00	$46.09	$0.00	$130.81	$130.81	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
52-20364	SUP	HCPCS C1713		52-20364  -  SCREW BONE 2MM 14MM SLFTAP XFIT CROSS-FIT TITANIUM	BOTH IP/OP	$221.15 	$163.65	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$46.09	$164.14	$164.14	$0.00	$0.00	$46.09	$0.00	$130.81	$130.81	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
52-20616	SUP	HCPCS C1713		52-20616  -  PEG 2MM 16MM DISTAL RADL LCK XPIN TI VARIAX NONSTRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-20618	SUP	HCPCS C1713		52-20618  -  PEG FIX 2MM 18MM DISTAL RADL LCK VARIAX	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-20618E	SUP	HCPCS C1713		52-20618E  -  PEG 2MM 18MM DISTAL RADL LCK XPIN TI VARIAX STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-20620	SUP	HCPCS C1713		52-20620  -  PEG FIX 2MM 20MM DISTAL RADL LCK VARIAX	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-20622	SUP	HCPCS C1713		52-20622  -  PEG 2MM 22MM RADL LCK TI	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-20624	SUP	HCPCS C1713		52-20624  -  PEG 2MM 24MM DISTAL RADL LCK XPIN TI VARIAX NONSTRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-20626	SUP	HCPCS C1713		52-20626  -  PEG 2MM 26MM RADL LCK TI	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
5221300P2	SUP	HCPCS C1713		5221300P2  -  CAGE SPNL 0D 30X12X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5221302P2	SUP	HCPCS C1713		5221302P2  -  CAGE SPNL 12D 30X12X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5221308P2	SUP	HCPCS C1713		5221308P2  -  CAGE SPNL 8D 30X12X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
52-23010	SUP	HCPCS C1713		52-23010  -  SCREW BN 2.3MM 10MM VARIAX ST XPN TI DIST RDS LCK PLT SYS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23010E	SUP	HCPCS C1713		52-23010E  -  SCREW BONE 2.3MM 10MM VARIAX TI DISTAL RADL HAND XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23012	SUP	HCPCS C1713		52-23012  -  SCREW BONE 2.3MM 12MM TI RADL SLFTAP XPIN	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23012E	SUP	HCPCS C1713		52-23012E  -  SCREW BONE 2.3MM 12MM VARIAX TI DISTAL RADL HAND XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23014	SUP	HCPCS C1713		52-23014  -  SCREW BONE 2.3MM 14MM SMARTLOCK VARIAX TI DISTAL RADL SLFTAP	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23016	SUP	HCPCS C1713		52-23016  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RAD XPIN	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23016E	SUP	HCPCS C1713		52-23016E  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RADL HAND XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23018	SUP	HCPCS C1713		52-23018  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23018E	SUP	HCPCS C1713		52-23018E  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL HAND XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23020E	SUP	HCPCS C1713		52-23020E  -  SCREW BONE 2.3MM 20MM VARIAX TI DISTAL RADL HAND XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23022	SUP	HCPCS C1713		52-23022  -  SCREW BONE 2.3MM 22MM VARIAX TI DISTAL RAD LCK XPIN	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23022E	SUP	HCPCS C1713		52-23022E  -  SCREW BONE 2.3MM 22MM VARIAX TI ORTH LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23024	SUP	HCPCS C1713		52-23024  -  SCREW TI 24MM 2.3MM MAXFACL LCK XPIN BONE VARIAX DISTAL RAD	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23024E	SUP	HCPCS C1713		52-23024E  -  SCREW BONE 2.3MM 24MM VARIAX TI LCK STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23026	SUP	HCPCS C1713		52-23026  -  SCREW BONE 2.3MM 26MM SMARTLOCK TI RADL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23028	SUP	HCPCS C1713		52-23028  -  SCREW BN 2.3MM 28MM VARIAX LCK TI DIST RADL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23028E	SUP	HCPCS C1713		52-23028E  -  SCREW BN XPN BLNT 2.3MM 28MM STRL VARIAX OPTM AX STAB TI RDS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23030	SUP	HCPCS C1713		52-23030  -  SCREW BONE 2.3MM 30MM VARIAX TI DISTAL RADL LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23030E	SUP	HCPCS C1713		52-23030E  -  SCREW BONE 2.3MM 30MM VARIAX TI LCK STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23032	SUP	HCPCS C1713		52-23032  -  SCREW BONE 2.3MM 32MM VARIAX TI DISTAL RADL LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23032E	SUP	HCPCS C1713		52-23032E  -  SCREW BONE 2.3MM 32MM VARIAX TI RADL XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23034	SUP	HCPCS C1713		52-23034  -  SCREW BONE 2.3MM 34MM VARIAX TI DISTAL RADL LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23034E	SUP	HCPCS C1713		52-23034E  -  SCREW BONE 2.3MM 34MM VARIAX TI RADL XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23036	SUP	HCPCS C1713		52-23036  -  SCREW BONE 2.3MM 36MM VARIAX TI DISTAL RADL LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23036E	SUP	HCPCS C1713		52-23036E  -  SCREW BONE 2.3MM 36MM VARIAX TI RADL XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23038	SUP	HCPCS C1713		52-23038  -  SCREW BONE 2.3MM 38MM VARIAX TI DISTAL RADL LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23038E	SUP	HCPCS C1713		52-23038E  -  SCREW BONE 2.3MM 38MM VARIAX TI RADL XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-23610	SUP	HCPCS C1713		52-23610  -  SCREW BONE 2.3MM 10MM SMARTLOCK TI RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23610E	SUP	HCPCS C1713		52-23610E  -  SCREW BONE 2.3MM 10MM TI LCK STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23612	SUP	HCPCS C1713		52-23612  -  SCREW BONE 2.3MM 12MM SMARTLOCK TI RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23612E	SUP	HCPCS C1713		52-23612E  -  SCREW BONE 2.3MM 12MM LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23614	SUP	HCPCS C1713		52-23614  -  SCREW BONE 2.3MM 14MM VARIAX TI DISTAL RADL LCK XPIN	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23614E	SUP	HCPCS C1713		52-23614E  -  SCREW BONE 2.3MM 14MM VARIAX TI DISTAL RADL XPIN LCK PLT SYS	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23616	SUP	HCPCS C1713		52-23616  -  SCREW BONE 2.3MM 16MM SMARTLOCK TI DISTAL RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23616E	SUP	HCPCS C1713		52-23616E  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RADL LCK XPIN	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23618	SUP	HCPCS C1713		52-23618  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL LCK XPIN	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23618E	SUP	HCPCS C1713		52-23618E  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL LCK XPIN	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23620	SUP	HCPCS C1713		52-23620  -  SCREW BONE 2.3MM 20MM SMARTLOCK VARIAX TI DISTAL RADL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23620E	SUP	HCPCS C1713		52-23620E  -  SCREW BONE 2.3MM 20MM VARIAX TI DISTAL RADL XPIN LCK STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23622	SUP	HCPCS C1713		52-23622  -  SCREW BONE 2.3MM 22MM SMARTLOCK VARIAX TI RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23624	SUP	HCPCS C1713		52-23624  -  SCREW BONE 2.3MM 24MM SMARTLOCK VARIAX TI RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23626	SUP	HCPCS C1713		52-23626  -  SCREW BONE 2.3MM 26MM SMARTLOCK TI DISTAL RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23626E	SUP	HCPCS C1713		52-23626E  -  SCREW BONE 2.3MM 26MM VARIAX TI DISTAL RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23628	SUP	HCPCS C1713		52-23628  -  SCREW BONE 2.3MM 28MM SMARTLOCK VARIAX TI DISTAL RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23628E	SUP	HCPCS C1713		52-23628E  -  PLATE 28MM TI LCK SYS VARIAX BONE 2.3MM DISTAL RADL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23630	SUP	HCPCS C1713		52-23630  -  SCREW BONE 2.3MM 30MM VARIAX TI DISTAL RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23632	SUP	HCPCS C1713		52-23632  -  SCREW BONE 2.3MM 32MM SMARTLOCK TI RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23634	SUP	HCPCS C1713		52-23634  -  SCREW BONE 2.3MM 34MM VARIAX TI DISTAL RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23636	SUP	HCPCS C1713		52-23636  -  SCREW BONE 2.3MM 36MM TI RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-23638	SUP	HCPCS C1713		52-23638  -  SCREW BONE 2.3MM 38MM TI RADL LCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
5224300P2	SUP	HCPCS C1713		5224300P2  -  CAGE SPNL 0D 30X12X14MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5224308P2	SUP	HCPCS C1713		5224308P2  -  CAGE SPNL 8D 30X12X14MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
52-27010	SUP	HCPCS C1713		52-27010  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL XPIN NONSTRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27010E	SUP	HCPCS C1713		52-27010E  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27012	SUP	HCPCS C1713		52-27012  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27012E	SUP	HCPCS C1713		52-27012E  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27014	SUP	HCPCS C1713		52-27014  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL WR HND XPIN	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27014E	SUP	HCPCS C1713		52-27014E  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL WR HND XPIN	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27016	SUP	HCPCS C1713		52-27016  -  2.7X16MM BONE SCREW_ RADIUS	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27016E	SUP	HCPCS C1713		52-27016E  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL WR HND XPIN	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27018	SUP	HCPCS C1713		52-27018  -  SCREW BN 2.7MM 18MM VARIAX LCK TI DIST RADL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27018E	SUP	HCPCS C1713		52-27018E  -  SCREW BN 2.7MM 18MM STRL VARIAX XPN NLCKG TI DIST RADL WR	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27020	SUP	HCPCS C1713		52-27020  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27022	SUP	HCPCS C1713		52-27022  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL XPIN NONSTRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27022E	SUP	HCPCS C1713		52-27022E  -  SCREW BONE 2.7MM 22MM SMARTLOCK TI CORT RADL LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27024	SUP	HCPCS C1713		52-27024  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL XPIN NONSTRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27024E	SUP	HCPCS C1713		52-27024E  -  SCREW BONE 2.7MM 24MM SMARTLOCK TI CORT RADL LCK	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27026	SUP	HCPCS C1713		52-27026  -  SCREW BONE 2.7MM 26MM SMARTLOCK TI RADL XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27026E	SUP	HCPCS C1713		52-27026E  -  SCREW BONE 2.7MM 26MM VARIAX TI DISTAL RADL XPIN STRL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$55.69	$55.69	$0.00	$0.00	$0.00	$25.79	$91.85	$91.85	$0.00	$0.00	$25.79	$0.00	$73.20	$73.20	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
52-27116	SUP	HCPCS C1713		52-27116  -  SCREW BN 2.7MM 16MM VARIAX LCK P/T TI DIST RADL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27116E	SUP	HCPCS C1713		52-27116E  -  SCREW BN P/T 2.7MM 16MM VARIAX NLCKG XPN TI DIST RDS	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27118	SUP	HCPCS C1713		52-27118  -  SCREW BONE 2.7MM 18MM VARIAX TI DISTAL RADL PTTHRD XPIN	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27120	SUP	HCPCS C1713		52-27120  -  SCREW BN 2.7MM 20MM VARIAX LCK P/T TI DIST RADL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27120E	SUP	HCPCS C1713		52-27120E  -  SCREW BN P/T 2.7MM 20MM VARIAX NLCKG XPN TI DIST RDS	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27122	SUP	HCPCS C1713		52-27122  -  SCREW BN 2.7MM 22MM VARIAX LCK P/T TI DIST RADL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27122E	SUP	HCPCS C1713		52-27122E  -  SCREW BN P/T 2.7MM 22MM VARIAX NLCKG XPN TI DIST RDS	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27124	SUP	HCPCS C1713		52-27124  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL PTTHRD XPIN	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27126	SUP	HCPCS C1713		52-27126  -  SCREW BONE 2.7MM 26MM VARIAX TI DISTAL RADL PTTHRD XPIN STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27208	SUP	HCPCS C1713		52-27208  -  SCREW BONE 2.7MM 8MM TI RADL SLFTAP XFIT	BOTH IP/OP	$132.30 	$97.90	$0.00	$104.50	$58.78	$58.78	$0.00	$0.00	$0.00	$27.57	$98.19	$98.19	$0.00	$0.00	$27.57	$0.00	$78.26	$78.26	$0.00	$65.31	$103.46	$104.50	$0.00		$0.00	$20.44	$0.00	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00
52-27210	SUP	HCPCS C1713		52-27210  -  SCREW BONE 2.7MM 10MM TI RADL SLFTAP XFIT	BOTH IP/OP	$132.30 	$97.90	$0.00	$104.50	$58.78	$58.78	$0.00	$0.00	$0.00	$27.57	$98.19	$98.19	$0.00	$0.00	$27.57	$0.00	$78.26	$78.26	$0.00	$65.31	$103.46	$104.50	$0.00		$0.00	$20.44	$0.00	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00
52-27212	SUP	HCPCS C1713		52-27212  -  SCREW BONE 2.7MM 12MM MTRX-SMARTLOCK DISTAL RADL SLFTAP	BOTH IP/OP	$132.30 	$97.90	$0.00	$104.50	$58.78	$58.78	$0.00	$0.00	$0.00	$27.57	$98.19	$98.19	$0.00	$0.00	$27.57	$0.00	$78.26	$78.26	$0.00	$65.31	$103.46	$104.50	$0.00		$0.00	$20.44	$0.00	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00
52-27214	SUP	HCPCS C1713		52-27214  -  SCREW BONE 2.7MM 14MM MTRX-SMARTLOCK DISTAL RADL SLFTAP	BOTH IP/OP	$132.30 	$97.90	$0.00	$104.50	$58.78	$58.78	$0.00	$0.00	$0.00	$27.57	$98.19	$98.19	$0.00	$0.00	$27.57	$0.00	$78.26	$78.26	$0.00	$65.31	$103.46	$104.50	$0.00		$0.00	$20.44	$0.00	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00
52-27216	SUP	HCPCS C1713		52-27216  -  SCREW BONE 2.7MM 16MM MTRX-SMARTLOCK DISTAL RADL SLFTAP	BOTH IP/OP	$132.30 	$97.90	$0.00	$104.50	$58.78	$58.78	$0.00	$0.00	$0.00	$27.57	$98.19	$98.19	$0.00	$0.00	$27.57	$0.00	$78.26	$78.26	$0.00	$65.31	$103.46	$104.50	$0.00		$0.00	$20.44	$0.00	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00
52-27218	SUP	HCPCS C1713		52-27218  -  SCREW BONE 2.7MM 18MM MTRX-SMARTLOCK DISTAL RADL SLFTAP	BOTH IP/OP	$151.25 	$111.93	$0.00	$121.00	$68.06	$68.06	$0.00	$0.00	$0.00	$31.52	$112.26	$112.26	$0.00	$0.00	$31.52	$0.00	$89.46	$89.46	$0.00	$75.63	$119.79	$121.00	$0.00		$0.00	$23.67	$0.00	$0.00	$24.08	$0.00	$0.00	$0.00	$0.00	$0.00
52-27220	SUP	HCPCS C1713		52-27220  -  SCREW BONE 2.7MM 20MM MTRX-SMARTLOCK DISTAL RADL SLFTAP	BOTH IP/OP	$151.25 	$111.93	$0.00	$121.00	$68.06	$68.06	$0.00	$0.00	$0.00	$31.52	$112.26	$112.26	$0.00	$0.00	$31.52	$0.00	$89.46	$89.46	$0.00	$75.63	$119.79	$121.00	$0.00		$0.00	$23.67	$0.00	$0.00	$24.08	$0.00	$0.00	$0.00	$0.00	$0.00
52-27222	SUP	HCPCS C1713		52-27222  -  SCREW BONE 2.7MM 22MM MTRX-SMARTLOCK DISTAL RADL SLFTAP	BOTH IP/OP	$151.25 	$111.93	$0.00	$121.00	$68.06	$68.06	$0.00	$0.00	$0.00	$31.52	$112.26	$112.26	$0.00	$0.00	$31.52	$0.00	$89.46	$89.46	$0.00	$75.63	$119.79	$121.00	$0.00		$0.00	$23.67	$0.00	$0.00	$24.08	$0.00	$0.00	$0.00	$0.00	$0.00
52-27224	SUP	HCPCS C1713		52-27224  -  SCREW BONE 2.7MM 24MM MTRX-SMARTLOCK DISTAL RADL SLFTAP	BOTH IP/OP	$151.25 	$111.93	$0.00	$121.00	$68.06	$68.06	$0.00	$0.00	$0.00	$31.52	$112.26	$112.26	$0.00	$0.00	$31.52	$0.00	$89.46	$89.46	$0.00	$75.63	$119.79	$121.00	$0.00		$0.00	$23.67	$0.00	$0.00	$24.08	$0.00	$0.00	$0.00	$0.00	$0.00
52-27226	SUP	HCPCS C1713		52-27226  -  SCREW BONE 2.7MM 26MM MTRX-SMARTLOCK DISTAL RADL SLFTAP	BOTH IP/OP	$151.25 	$111.93	$0.00	$121.00	$68.06	$68.06	$0.00	$0.00	$0.00	$31.52	$112.26	$112.26	$0.00	$0.00	$31.52	$0.00	$89.46	$89.46	$0.00	$75.63	$119.79	$121.00	$0.00		$0.00	$23.67	$0.00	$0.00	$24.08	$0.00	$0.00	$0.00	$0.00	$0.00
52-27228	SUP	HCPCS C1713		52-27228  -  SCREW BONE 2.7MM 28MM MTRX-SMARTLOCK DISTAL RADL SLFTAP	BOTH IP/OP	$151.25 	$111.93	$0.00	$121.00	$68.06	$68.06	$0.00	$0.00	$0.00	$31.52	$112.26	$112.26	$0.00	$0.00	$31.52	$0.00	$89.46	$89.46	$0.00	$75.63	$119.79	$121.00	$0.00		$0.00	$23.67	$0.00	$0.00	$24.08	$0.00	$0.00	$0.00	$0.00	$0.00
52-27230	SUP	HCPCS C1713		52-27230  -  SCREW BONE 2.7MM 30MM TI RADL SLFTAP XFIT	BOTH IP/OP	$151.25 	$111.93	$0.00	$121.00	$68.06	$68.06	$0.00	$0.00	$0.00	$31.52	$112.26	$112.26	$0.00	$0.00	$31.52	$0.00	$89.46	$89.46	$0.00	$75.63	$119.79	$121.00	$0.00		$0.00	$23.67	$0.00	$0.00	$24.08	$0.00	$0.00	$0.00	$0.00	$0.00
52-27232	SUP	HCPCS C1713		52-27232  -  SCREW BONE 2.7MM 32MM TI RADL SLFTAP XFIT	BOTH IP/OP	$151.25 	$111.93	$0.00	$121.00	$68.06	$68.06	$0.00	$0.00	$0.00	$31.52	$112.26	$112.26	$0.00	$0.00	$31.52	$0.00	$89.46	$89.46	$0.00	$75.63	$119.79	$121.00	$0.00		$0.00	$23.67	$0.00	$0.00	$24.08	$0.00	$0.00	$0.00	$0.00	$0.00
52-27234	SUP	HCPCS C1713		52-27234  -  SCREW BONE 2.7MM 34MM MTRX-SMARTLOCK DISTAL RADL SLFTAP	BOTH IP/OP	$160.65 	$118.88	$0.00	$132.00	$74.25	$74.25	$0.00	$0.00	$0.00	$33.48	$119.23	$119.23	$0.00	$0.00	$33.48	$0.00	$95.02	$95.02	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
52-27236	SUP	HCPCS C1713		52-27236  -  SCREW BONE 2.7MM 36MM TI RADL SLFTAP XFIT	BOTH IP/OP	$160.65 	$118.88	$0.00	$132.00	$74.25	$74.25	$0.00	$0.00	$0.00	$33.48	$119.23	$119.23	$0.00	$0.00	$33.48	$0.00	$95.02	$95.02	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
52-27238	SUP	HCPCS C1713		52-27238  -  SCREW BONE 2.7MM 38MM TI RADL SLFTAP XFIT	BOTH IP/OP	$160.65 	$118.88	$0.00	$132.00	$74.25	$74.25	$0.00	$0.00	$0.00	$33.48	$119.23	$119.23	$0.00	$0.00	$33.48	$0.00	$95.02	$95.02	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
52-27610	SUP	HCPCS C1713		52-27610  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL PTTHRD LCK STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27610E	SUP	HCPCS C1713		52-27610E  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL PTTHRD LCK STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27612	SUP	HCPCS C1713		52-27612  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL LCK STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27614	SUP	HCPCS C1713		52-27614  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL XPIN LCK STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27614E	SUP	HCPCS C1713		52-27614E  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL XPIN LCK STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27616	SUP	HCPCS C1713		52-27616  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL XPIN LCK PLT SYS	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27618	SUP	HCPCS C1713		52-27618  -  SCREW BN 2.7MM 18MM VARIAX LCK TI DIST RADL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27618E	SUP	HCPCS C1713		52-27618E  -  SCREW BN 2.7MM 18MM STRL LCK XPN TI RDS DIST VARIAX LCK PLT	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27620	SUP	HCPCS C1713		52-27620  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL PTTHRD LCK STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27620E	SUP	HCPCS C1713		52-27620E  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL XPIN LCK STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27622	SUP	HCPCS C1713		52-27622  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL XPIN LCK PLT SYS	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27624	SUP	HCPCS C1713		52-27624  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL XPIN LCK PLT SYS	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27626	SUP	HCPCS C1713		52-27626  -  SCREW BN 2.7MM 26MM VARIAX LCK TI DIST RADL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27626E	SUP	HCPCS C1713		52-27626E  -  SCREW BN 2.7MM 26MM STRL LCK XPN TI RDS DIST VARIAX LCK PLT	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27716	SUP	HCPCS C1713		52-27716  -  PEG 2.7MM 16MM DISTAL RADL PTTHRD LCK TI VARIAX NONSTRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27716E	SUP	HCPCS C1713		52-27716E  -  PEG 2.7MM 16MM DISTAL RADL PTTHRD LCK TI VARIAX STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27718	SUP	HCPCS C1713		52-27718  -  PEG 2.7MM 18MM DISTAL RADL PTTHRD LCK TI VARIAX NONSTRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27718E	SUP	HCPCS C1713		52-27718E  -  PEG 2.7MM 18MM DISTAL RADL PTTHRD LCK TI VARIAX STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27720	SUP	HCPCS C1713		52-27720  -  PEG 2.7MM 20MM DISTAL RADL PTTHRD LCK TI VARIAX STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27722	SUP	HCPCS C1713		52-27722  -  PEG 2.7MM 22MM ORTH LCK PTHRD TI SMARTLOCK	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27722E	SUP	HCPCS C1713		52-27722E  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL PTTHRD LCK STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27724	SUP	HCPCS C1713		52-27724  -  PEG 2.7MM 24MM DISTAL RADL PTTHRD LCK TI VARIAX NONSTRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27724E	SUP	HCPCS C1713		52-27724E  -  PEG 2.7MM 24MM DISTAL RADL PTTHRD LCK TI VARIAX STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27726	SUP	HCPCS C1713		52-27726  -  PEG 2.7MM 26MM DISTAL RADL PTTHRD LCK TI VARIAX NONSTRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27726E	SUP	HCPCS C1713		52-27726E  -  PEG 2.7MM 24MM DISTAL RADL PTTHRD LCK TI VARIAX STRL	BOTH IP/OP	$144.38 	$106.84	$0.00	$115.50	$64.97	$64.97	$0.00	$0.00	$0.00	$30.09	$107.16	$107.16	$0.00	$0.00	$30.09	$0.00	$85.40	$85.40	$0.00	$72.19	$114.35	$115.50	$0.00		$0.00	$22.59	$0.00	$0.00	$22.98	$0.00	$0.00	$0.00	$0.00	$0.00
52-27844	SUP	HCPCS C1713		52-27844  -  SCREW BONE 2.7MM 14MM TI FRFT HEX	BOTH IP/OP	$125.13 	$92.60	$0.00	$100.10	$56.31	$56.31	$0.00	$0.00	$0.00	$26.08	$92.87	$92.87	$0.00	$0.00	$26.08	$0.00	$74.01	$74.01	$0.00	$62.56	$99.10	$100.10	$0.00		$0.00	$19.58	$0.00	$0.00	$19.92	$0.00	$0.00	$0.00	$0.00	$0.00
52-27846	SUP	HCPCS C1713		52-27846  -  SCREW BONE 2.7MM 16MM TI FRFT HEX	BOTH IP/OP	$125.13 	$92.60	$0.00	$100.10	$56.31	$56.31	$0.00	$0.00	$0.00	$26.08	$92.87	$92.87	$0.00	$0.00	$26.08	$0.00	$74.01	$74.01	$0.00	$62.56	$99.10	$100.10	$0.00		$0.00	$19.58	$0.00	$0.00	$19.92	$0.00	$0.00	$0.00	$0.00	$0.00
52-27850	SUP	HCPCS C1713		52-27850  -  SCREW BONE 2.7MM 20MM TI FRFT HEX	BOTH IP/OP	$125.13 	$92.60	$0.00	$100.10	$56.31	$56.31	$0.00	$0.00	$0.00	$26.08	$92.87	$92.87	$0.00	$0.00	$26.08	$0.00	$74.01	$74.01	$0.00	$62.56	$99.10	$100.10	$0.00		$0.00	$19.58	$0.00	$0.00	$19.92	$0.00	$0.00	$0.00	$0.00	$0.00
52-27852	SUP	HCPCS C1713		52-27852  -  SCREW BONE 2.7MM 22MM TI FRFT HEX BUN TIAL	BOTH IP/OP	$121.00 	$89.54	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$25.22	$89.81	$89.81	$0.00	$0.00	$25.22	$0.00	$71.57	$71.57	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
5229300P2	SUP	HCPCS C1713		5229300P2  -  CAGE SPNL 0D 30X12X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5229302P2	SUP	HCPCS C1713		5229302P2  -  CAGE SPNL 12D 30X12X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5229308P2	SUP	HCPCS C1713		5229308P2  -  CAGE SPNL 8D 30X12X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
52-30056	SUP	HCPCS C1713		52-30056  -  SCREW BONE 3MM 16MM TI FRFT HEX	BOTH IP/OP	$125.13 	$92.60	$0.00	$100.10	$56.31	$56.31	$0.00	$0.00	$0.00	$26.08	$92.87	$92.87	$0.00	$0.00	$26.08	$0.00	$74.01	$74.01	$0.00	$62.56	$99.10	$100.10	$0.00		$0.00	$19.58	$0.00	$0.00	$19.92	$0.00	$0.00	$0.00	$0.00	$0.00
52-30308	SUP	HCPCS C1713		52-30308  -  SCREW BONE 3MM 8MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$165.90 	$122.77	$0.00	$132.00	$74.25	$74.25	$0.00	$0.00	$0.00	$34.58	$123.13	$123.13	$0.00	$0.00	$34.57	$0.00	$98.13	$98.13	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
52-30310	SUP	HCPCS C1713		52-30310  -  SCREW BONE 3MM 10MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
52-30312	SUP	HCPCS C1713		52-30312  -  SCREW BONE 3MM 12MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
52-30314	SUP	HCPCS C1713		52-30314  -  SCREW BONE 3MM 14MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
52-30316	SUP	HCPCS C1713		52-30316  -  SCREW BONE 3MM 16MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
52-30318	SUP	HCPCS C1713		52-30318  -  SCREW BONE 3MM 18MM CANC	BOTH IP/OP	$206.25 	$152.63	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$42.99	$153.08	$153.08	$0.00	$0.00	$42.98	$0.00	$122.00	$122.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
52-30320	SUP	HCPCS C1713		52-30320  -  SCREW BONE 3MM 20MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$206.25 	$152.63	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$42.99	$153.08	$153.08	$0.00	$0.00	$42.98	$0.00	$122.00	$122.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
52-30322	SUP	HCPCS C1713		52-30322  -  SCREW BONE 3MM 22MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$206.25 	$152.63	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$42.99	$153.08	$153.08	$0.00	$0.00	$42.98	$0.00	$122.00	$122.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
52-30324	SUP	HCPCS C1713		52-30324  -  SCREW BONE 3MM 24MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$206.25 	$152.63	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$42.99	$153.08	$153.08	$0.00	$0.00	$42.98	$0.00	$122.00	$122.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
52-30326	SUP	HCPCS C1713		52-30326  -  SCREW BONE 3MM 26MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$199.75 	$147.82	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$41.63	$148.25	$148.25	$0.00	$0.00	$41.63	$0.00	$118.15	$118.15	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
52-30328	SUP	HCPCS C1713		52-30328  -  SCREW BONE 3MM 28MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$199.75 	$147.82	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$41.63	$148.25	$148.25	$0.00	$0.00	$41.63	$0.00	$118.15	$118.15	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
52-30330	SUP	HCPCS C1713		52-30330  -  SCREW BONE 3MM 30MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$199.75 	$147.82	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$41.63	$148.25	$148.25	$0.00	$0.00	$41.63	$0.00	$118.15	$118.15	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
52-30332	SUP	HCPCS C1713		52-30332  -  SCREW BONE 3MM 32MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$199.75 	$147.82	$0.00	$165.00	$92.81	$92.81	$0.00	$0.00	$0.00	$41.63	$148.25	$148.25	$0.00	$0.00	$41.63	$0.00	$118.15	$118.15	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$32.28	$0.00	$0.00	$32.84	$0.00	$0.00	$0.00	$0.00	$0.00
52-30334	SUP	HCPCS C1713		52-30334  -  SCREW BONE 3MM 34MM TI CANC RADL SLFTAP XFIT	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
52-306-23	SUP	HCPCS C1781		52-306-23  -  MESH SURG 26.2X.6MM PRFL 3ANG RX ORBTL FLR	BOTH IP/OP	"$1,416.25 "	"$1,048.03"	$0.00	"$1,133.00"	$637.31	$637.31	$0.00	$0.00	$0.00	$295.18	"$1,051.14"	"$1,051.14"	$0.00	$0.00	$295.15	$0.00	$837.71	$837.71	$0.00	$708.13	"$1,121.67"	"$1,133.00"	$0.00		$0.00	$221.64	$0.00	$0.00	$225.47	$0.00	$0.00	$0.00	$0.00	$0.00
52-306-23-04	SUP	HCPCS C1781		52-306-23-04  -  MESH CRNL 3ANG 23MMX.6MM STRL RSRBX PDLLA ORBT FLR	BOTH IP/OP	"$1,531.68 "	"$1,133.44"	$0.00	"$1,225.34"	$689.25	$689.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$765.84	"$1,213.09"	"$1,225.34"	$0.00		$0.00	$239.71	$0.00	$0.00	$243.84	$0.00	$0.00	$0.00	$0.00	$0.00
52-306-40-04	SUP	HCPCS C1713		52-306-40-04  -  MESH SURG 40X40X.6MM RX ORBTL FLOOR	BOTH IP/OP	"$1,670.93 "	"$1,236.49"	$0.00	"$1,336.74"	$751.92	$751.92	$0.00	$0.00	$0.00	$348.26	"$1,240.16"	"$1,240.16"	$0.00	$0.00	$348.22	$0.00	$988.35	$988.35	$0.00	$835.46	"$1,323.38"	"$1,336.74"	$0.00		$0.00	$261.50	$0.00	$0.00	$266.01	$0.00	$0.00	$0.00	$0.00	$0.00
52-306-51-04	SUP	HCPCS C1781		52-306-51-04  -  MESH DYNAMIC 51X51X.6MM RESORB LARGE GRID FLEXIBLE ROUNDED	BOTH IP/OP	"$2,227.90 "	"$1,648.65"	$0.00	"$1,782.32"	"$1,002.56"	"$1,002.56"	$0.00	$0.00	$0.00	$464.35	"$1,653.55"	"$1,653.55"	$0.00	$0.00	$464.29	$0.00	"$1,317.80"	"$1,317.80"	$0.00	"$1,113.95"	"$1,764.50"	"$1,782.32"	$0.00		$0.00	$348.67	$0.00	$0.00	$354.68	$0.00	$0.00	$0.00	$0.00	$0.00
52-310-31-04	SUP	HCPCS C1713		52-310-31-04  -  MESH CRANIAL 106X31X1MM RESORB SMALL GRID RESORB-X SONICWELD	BOTH IP/OP	"$3,202.60 "	"$2,369.92"	$0.00	"$2,562.08"	"$1,441.17"	"$1,441.17"	$0.00	$0.00	$0.00	$667.50	"$2,376.97"	"$2,376.97"	$0.00	$0.00	$667.42	$0.00	"$1,578.88"	"$1,578.88"	$0.00	"$1,601.30"	"$2,536.46"	"$2,562.08"	$0.00		$0.00	$501.21	$0.00	$0.00	$509.85	$0.00	$0.00	$0.00	$0.00	$0.00
5235-1-846	SUP	Custom 27203010		5235-1-846  -  BIT DRILL 250MM 4.3MM ALTA TRFLT	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$0.00	$0.00	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5235-1-916	SUP	Custom 27203010		5235-1-916  -  GUIDE DRILL 4.3MM SLV	BOTH IP/OP	$468.88 	$346.97	$0.00	$375.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.00	$348.00	$0.00	$0.00	$97.71	$0.00	$0.00	$0.00	$0.00	$234.44	$371.35	$375.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5235-7-110	SUP	HCPCS C1713		5235-7-110  -  SCREW BONE ALTA LAG RMR ASSY	BOTH IP/OP	"$5,328.13 "	"$3,942.82"	$0.00	"$4,262.50"	"$2,397.66"	"$2,397.66"	$0.00	$0.00	$0.00	"$1,110.51"	"$3,954.53"	"$3,954.53"	$0.00	$0.00	"$1,110.38"	$0.00	"$2,626.77"	"$2,626.77"	$0.00	"$2,664.06"	"$4,219.88"	"$4,262.50"	$0.00		$0.00	$833.85	$0.00	$0.00	$848.24	$0.00	$0.00	$0.00	$0.00	$0.00
52-400-00	SUP	Custom 27203010		52-400-00  -  PEN MRKNG TIP HEAT RSRBX	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5241300P2	SUP	HCPCS C1713		5241300P2  -  CAGE SPNL 0D 30X14X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5241302P2	SUP	HCPCS C1713		5241302P2  -  CAGE SPNL 12D 30X14X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5241308P2	SUP	HCPCS C1713		5241308P2  -  CAGE SPNL 8D 30X14X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
52432-U	SUP	Custom 27203010		SPECULUM OTSCP KLNSPC 2.75MM UNV 2.75MM PLST DX DISP	BOTH IP/OP	$0.05 	$0.04	$0.00	$0.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.03	$0.04	$0.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5244300P2	SUP	HCPCS C1713		5244300P2  -  CAGE SPNL 0D 30X14X14MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5244308P2	SUP	HCPCS C1713		5244308P2  -  CAGE SPNL 8D 30X14X14MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5249300P2	SUP	HCPCS C1713		5249300P2  -  CAGE SPNL 0D 30X14X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5249302P2	SUP	HCPCS C1713		5249302P2  -  CAGE SPNL 12D 30X14X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5249308P2	SUP	HCPCS C1713		5249308P2  -  CAGE SPNL 8D 30X14X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5255-1-255	SUP	Custom 27203010		5255-1-255  -  BIT DRILL 250MM 3.2MM AO	BOTH IP/OP	$188.38 	$139.40	$0.00	$150.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.81	$139.81	$0.00	$0.00	$39.26	$0.00	$0.00	$0.00	$0.00	$94.19	$149.20	$150.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5260-4-000	SUP	Custom 27803010		5260-4-000  -  SHELL ACETAB HIP SCR PLUG OSTLK APCL	BOTH IP/OP	$141.00 	$104.34	$0.00	$112.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$104.65	$104.65	$0.00	$0.00	$29.38	$0.00	$0.00	$0.00	$0.00	$70.50	$111.67	$112.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-012	SUP	HCPCS C1713		5260-5-012  -  SCREW ACETAB 6.5MM 12MM HEXAGON OSTEOLOCK TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-014	SUP	HCPCS C1713		5260-5-014  -  SCREW ACETAB 6.5MM 14MM HEXAGON OSTEOLOCK TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-016	SUP	HCPCS C1713		5260-5-016  -  SCREW BN 6.5MM 16MM OSTLK CANC	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-018	SUP	HCPCS C1713		5260-5-018  -  SCREW ACETAB 6.5MM 18MM HEXAGON OSTEOLOCK TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-020	SUP	HCPCS C1713		5260-5-020  -  SCREW ACETAB 6.5MM 20MM HEXAGON OSTEOLOCK TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-022	SUP	HCPCS C1713		5260-5-022  -  SCREW ACETAB 6.5MM 22MM HEXAGON OSTEOLOCK TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-024	SUP	HCPCS C1713		5260-5-024  -  SCREW ACETAB 6.5MM 24MM HEXAGON OSTEOLOCK TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-026	SUP	HCPCS C1713		5260-5-026  -  SCREW BONE HEXAGON 6.5MM 26MM WEDGE RSTOR OSTEOLOCK TITANIUM	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-028	SUP	HCPCS C1713		5260-5-028  -  SCREW BONE HEXAGON 6.5MM 28MM WEDGE RSTOR OSTEOLOCK TITANIUM	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-030	SUP	HCPCS C1713		5260-5-030  -  SCREW BONE HEXAGON 6.5MM 30MM WEDGE RSTOR OSTEOLOCK TITANIUM	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-035	SUP	HCPCS C1713		5260-5-035  -  SCREW BONE HEXAGON 6.5MM 35MM WEDGE RSTOR OSTEOLOCK TITANIUM	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-040	SUP	HCPCS C1713		5260-5-040  -  SCREW BONE HEXAGON 6.5MM 40MM WEDGE RSTOR OSTEOLOCK TITANIUM	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-045	SUP	HCPCS C1713		5260-5-045  -  SCREW BONE HEXAGON 6.5MM 45MM WEDGE RSTOR OSTEOLOCK TITANIUM	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5260-5-050	SUP	HCPCS C1713		5260-5-050  -  SCREW BONE HEXAGON 6.5MM 50MM WEDGE RSTOR OSTEOLOCK TITANIUM	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5281300P2	SUP	HCPCS C1713		5281300P2  -  CAGE SPNL 0D 30X8X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5281302P2	SUP	HCPCS C1713		5281302P2  -  CAGE SPNL 12D 30X8X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5281308P2	SUP	HCPCS C1713		5281308P2  -  CAGE SPNL 8D 30X8X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5284300P2	SUP	HCPCS C1713		5284300P2  -  CAGE SPNL 0D 30X8X14MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5284308P2	SUP	HCPCS C1713		5284308P2  -  CAGE SPNL 8D 30X8X14MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5289300P2	SUP	HCPCS C1713		5289300P2  -  CAGE SPNL 0D 30X8X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5289302P2	SUP	HCPCS C1713		5289302P2  -  CAGE SPNL 12D 30X8X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5289308P2	SUP	HCPCS C1713		5289308P2  -  CAGE SPNL 8D 30X8X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5291300P2	SUP	HCPCS C1713		5291300P2  -  CAGE SPNL 0D 30X9X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5291302P2	SUP	HCPCS C1713		5291302P2  -  CAGE SPNL 12D 30X9X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5291308P2	SUP	HCPCS C1713		5291308P2  -  CAGE SPNL 8D 30X9X11MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5299300P2	SUP	HCPCS C1713		5299300P2  -  CAGE SPNL 0D 30X9X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5299302P2	SUP	HCPCS C1713		5299302P2  -  CAGE SPNL 12D 30X9X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5299308P2	SUP	HCPCS C1713		5299308P2  -  CAGE SPNL 8D 30X9X9MM NS CRNT TI ANT TLIF	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
5300-010-941	SUP	Custom 27203010		5300-010-941  -  DERMABRADER SURG MEDIUM STR 4MM STR TPS STERILE	BOTH IP/OP	$190.80 	$141.19	$0.00	$152.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.61	$141.61	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$95.40	$151.11	$152.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5300-010-943	SUP	Custom 27203010		5300-010-943  -  DERMABRADER SURG MEDIUM STR 7MM STR X-CHANGE III	BOTH IP/OP	$190.80 	$141.19	$0.00	$152.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.61	$141.61	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$95.40	$151.11	$152.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5300-010-945	SUP	Custom 27203010		5300-010-945  -  DERMABRADER SURG MEDIUM STR 12MM 50MM BUR STR TPS STERILE	BOTH IP/OP	$190.80 	$141.19	$0.00	$152.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.61	$141.61	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$95.40	$151.11	$152.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5300-010-947	SUP	Custom 27203010		5300-010-947  -  DERMABRADER SURG MEDIUM 10MM TAPERED TPS STERILE	BOTH IP/OP	$190.80 	$141.19	$0.00	$152.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.61	$141.61	$0.00	$0.00	$39.76	$0.00	$0.00	$0.00	$0.00	$95.40	$151.11	$152.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
53-00324	SUP	HCPCS C1713		53-00324  -  PLATE BN 47X29X.3MM UNV NEURO III CLS OUTR FRM TI TMPR 1.5MM	BOTH IP/OP	"$3,067.50 "	"$2,269.95"	$0.00	"$2,454.00"	"$1,380.38"	"$1,380.38"	$0.00	$0.00	$0.00	$639.34	"$2,276.70"	"$2,276.70"	$0.00	$0.00	$639.27	$0.00	"$1,512.28"	"$1,512.28"	$0.00	"$1,533.75"	"$2,429.46"	"$2,454.00"	$0.00		$0.00	$480.06	$0.00	$0.00	$488.35	$0.00	$0.00	$0.00	$0.00	$0.00
53-00466	SUP	HCPCS C1713		53-00466  -  PLATE BN LG RND 58MM .4MM NS UNV NEURO III CLS OUTR FRM RGD	BOTH IP/OP	"$3,675.00 "	"$2,719.50"	$0.00	"$2,940.00"	"$1,653.75"	"$1,653.75"	$0.00	$0.00	$0.00	$765.96	"$2,727.59"	"$2,727.59"	$0.00	$0.00	$765.87	$0.00	"$1,811.78"	"$1,811.78"	$0.00	"$1,837.50"	"$2,910.60"	"$2,940.00"	$0.00		$0.00	$575.14	$0.00	$0.00	$585.06	$0.00	$0.00	$0.00	$0.00	$0.00
53-05164	SUP	HCPCS C1713		53-05164  -  PLATE BONE STR LP 16 HOLE TITANIUM CRANIOMAXILLOFACIAL	BOTH IP/OP	$478.13 	$353.82	$0.00	$864.00	$486.00	$486.00	$0.00	$0.00	$0.00	$99.65	$354.86	$354.86	$0.00	$0.00	$99.64	$0.00	$282.81	$282.81	$0.00	$540.00	$855.36	$864.00	$0.00		$0.00	$169.02	$0.00	$0.00	$171.94	$0.00	$0.00	$0.00	$0.00	$0.00
53-05212	SUP	HCPCS C1713		53-05212  -  PLATE BN 12MM NS UNV NEURO II 2 HL LOPRFL BAR TI CRNMXF 1.5	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$187.88	$187.88	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
53-05216	SUP	HCPCS C1713		53-05216  -  PLATE BN 16MM NS UNV NEURO II 2 HL LOPRFL BAR TI CRNMXF 1.5	BOTH IP/OP	$205.00 	$151.70	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
53-05228	SUP	HCPCS C1713		53-05228  -  PLATE BN 3D BX 28MM NS UNV NEURO II 2X2 HL LOPRFL TI CRNMXF	BOTH IP/OP	$327.38 	$242.26	$0.00	$544.00	$306.00	$306.00	$0.00	$0.00	$0.00	$68.23	$242.98	$242.98	$0.00	$0.00	$68.22	$0.00	$193.64	$193.64	$0.00	$340.00	$538.56	$544.00	$0.00		$0.00	$106.42	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00
53-05240	SUP	HCPCS C1713		53-05240  -  PLATE BN 3D LG BX 40MM NS UNV NEURO II 2X2 HL LOPRFL TI	BOTH IP/OP	"$1,012.50 "	$749.25	$0.00	$810.00	$455.63	$455.63	$0.00	$0.00	$0.00	$211.03	$751.48	$751.48	$0.00	$0.00	$211.01	$0.00	$598.89	$598.89	$0.00	$506.25	$801.90	$810.00	$0.00		$0.00	$158.46	$0.00	$0.00	$161.19	$0.00	$0.00	$0.00	$0.00	$0.00
53-05406	SUP	HCPCS C1713		53-05406  -  PLATE BONE 6MM 4 HOLE LP BAR TITANIUM CRANIUM NONSTRL 1.5MM	BOTH IP/OP	$199.50 	$147.63	$0.00	$364.00	$204.75	$204.75	$0.00	$0.00	$0.00	$41.58	$148.07	$148.07	$0.00	$0.00	$41.58	$0.00	$118.00	$118.00	$0.00	$227.50	$360.36	$364.00	$0.00		$0.00	$71.21	$0.00	$0.00	$72.44	$0.00	$0.00	$0.00	$0.00	$0.00
53-05507	SUP	Custom 27803010		53-05507  -  COVER BURR HOLE 7MM LP TAB TITANIUM CRANIOMAXILLOFACIAL	BOTH IP/OP	$807.50 	$597.55	$0.00	$646.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.33	$599.33	$0.00	$0.00	$168.28	$0.00	$0.00	$0.00	$0.00	$403.75	$639.54	$646.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
53-05510	SUP	Custom 27803010		53-05510  -  COVER BURR HOLE MEDIUM 10MM LP TAB TITANIUM CRANIAL NONSTRL	BOTH IP/OP	$807.50 	$597.55	$0.00	$646.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.33	$599.33	$0.00	$0.00	$168.28	$0.00	$0.00	$0.00	$0.00	$403.75	$639.54	$646.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
53-05514	SUP	Custom 27803010		53-05514  -  COVER BURR HOLE LP 14MM TAB TITANIUM CRANIOMAXILLOFACIAL	BOTH IP/OP	$807.50 	$597.55	$0.00	$646.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.33	$599.33	$0.00	$0.00	$168.28	$0.00	$0.00	$0.00	$0.00	$403.75	$639.54	$646.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
53-05520	SUP	Custom 27803010		53-05520  -  COVER BURR HOLE 20MM LP TAB TITANIUM CRANIOMAXILLOFACIAL	BOTH IP/OP	$892.50 	$660.45	$0.00	$714.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$662.41	$662.41	$0.00	$0.00	$186.00	$0.00	$0.00	$0.00	$0.00	$446.25	$706.86	$714.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
53-05608	SUP	HCPCS C1713		53-05608  -  PLATE BONE 2Y LP 8MM 6 HOLE GAP TITANIUM CRANIOMAXILLOFACIAL	BOTH IP/OP	$965.00 	$714.10	$0.00	$772.00	$434.25	$434.25	$0.00	$0.00	$0.00	$201.13	$716.22	$716.22	$0.00	$0.00	$201.11	$0.00	$570.80	$570.80	$0.00	$482.50	$764.28	$772.00	$0.00		$0.00	$151.02	$0.00	$0.00	$153.63	$0.00	$0.00	$0.00	$0.00	$0.00
53-05612	SUP	HCPCS C1713		53-05612  -  PLATE BONE SMALL LP GAP TITANIUM CRANIOMAXILLOFACIAL NONSTRL	BOTH IP/OP	$493.53 	$365.21	$0.00	$910.00	$511.88	$511.88	$0.00	$0.00	$0.00	$102.86	$366.29	$366.29	$0.00	$0.00	$102.85	$0.00	$291.92	$291.92	$0.00	$568.75	$900.90	$910.00	$0.00		$0.00	$178.02	$0.00	$0.00	$181.09	$0.00	$0.00	$0.00	$0.00	$0.00
53-05622	SUP	HCPCS C1713		53-05622  -  PLATE BN LG GAP 22MM NS UNV NEURO II LOPRFL TI CRNMXF 1.5MM	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$561.38	$561.38	$0.00	$0.00	$0.00	$260.01	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$737.90	$737.90	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$195.23	$0.00	$0.00	$198.60	$0.00	$0.00	$0.00	$0.00	$0.00
53-05630	SUP	HCPCS C1713		53-05630  -  PLATE BONE X LP TITANIUM CRANIOMAXILLOFACIAL NONSTRL	BOTH IP/OP	$965.00 	$714.10	$0.00	$772.00	$434.25	$434.25	$0.00	$0.00	$0.00	$201.13	$716.22	$716.22	$0.00	$0.00	$201.11	$0.00	$570.80	$570.80	$0.00	$482.50	$764.28	$772.00	$0.00		$0.00	$151.02	$0.00	$0.00	$153.63	$0.00	$0.00	$0.00	$0.00	$0.00
53-05804	SUP	HCPCS C1713		53-05804  -  PLATE BONE STR LP 8 HOLE TITANIUM CRANIOMAXILLOFACIAL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
53-06212	SUP	HCPCS C1713		53-06212  -  PLATE BN 12MM NS UNV NEURO II QUIKFLAP 2 HL BAR X RGD LOPRFL	BOTH IP/OP	$141.25 	$104.53	$0.00	$199.88	$112.43	$112.43	$0.00	$0.00	$0.00	$29.44	$104.84	$104.84	$0.00	$0.00	$29.44	$0.00	$83.55	$83.55	$0.00	$124.93	$197.88	$199.88	$0.00		$0.00	$39.10	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00
53-1125	SUP	Custom 27203010		RONGUER SURG 9IN LKSL 5MM CURVE REG DBL ACT LMI	BOTH IP/OP	"$2,175.23 "	"$1,609.67"	$0.00	"$1,740.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,087.61"	"$1,722.78"	"$1,740.18"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
53-17005	SUP	HCPCS C1713		53-17005  -  SCREW BONE 1.7MM 5MM LCK SLFTAP CROSSPIN	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17005E	SUP	HCPCS C1713		53-17005E  -  SCREW BONE 1.7MM 5MM VARIAX TI HAND LCK SLFTAP CROSSPIN STRL	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17006E	SUP	HCPCS C1713		53-17006E  -  SCREW BONE 1.7MM 6MM HAND LCK SLFTAP CROSSPIN STRL	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17007E	SUP	HCPCS C1713		53-17007E  -  SCREW BONE 1.7MM 7MM LCK SLFTAP CROSSPIN	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17008E	SUP	HCPCS C1713		53-17008E  -  SCREW BONE 1.7MM 8MM CANC HIP LCK SLFTAP CROSSPIN	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17009E	SUP	HCPCS C1713		53-17009E  -  SCREW BONE 1.7MM 9MM LCK SLFTAP CROSSPIN	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17010	SUP	HCPCS C1713		53-17010  -  1.7X10MM LOCKING SCREWS_CROSS-PIN_SELF-T	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17010E	SUP	HCPCS C1713		53-17010E  -  SCREW BONE 1.7MM 10MM VARIAX HAND SLFTAP LCK	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17011E	SUP	HCPCS C1713		53-17011E  -  SCREW BONE 1.7MM 11MM ORTH LCK	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17012E	SUP	HCPCS C1713		53-17012E  -  SCREW BONE 1.7MM 12MM LCK SLFTAP CROSSPIN	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17013E	SUP	HCPCS C1713		53-17013E  -  SCREW BONE 1.7MM 13MM ORTH SLFTAP LCK	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17014E	SUP	HCPCS C1713		53-17014E  -  SCREW BONE 1.7MM 14MM LCK SLFTAP CROSSPIN	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17015	SUP	HCPCS C1713		53-17015  -  SCREW BONE 1.7MM 15MM LCK	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17015E	SUP	HCPCS C1713		53-17015E  -  SCREW BONE 1.7MM 15MM LCK SLFTAP CROSSPIN	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17016	SUP	HCPCS C1713		53-17016  -  SCREW BONE 1.7MM 16MM LCK	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17016E	SUP	HCPCS C1713		53-17016E  -  SCREW BONE 1.7MM 16MM ORTH SLFTAP LCK	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17018	SUP	HCPCS C1713		53-17018  -  SCREW BONE 1.7MM 18MM LCK	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17018E	SUP	HCPCS C1713		53-17018E  -  SCREW BONE 1.7MM 18MM VARIAX HAND SLFTAP LCK	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17020	SUP	HCPCS C1713		53-17020  -  SCREW BONE 1.7MM 20MM LCK	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17020E	SUP	HCPCS C1713		53-17020E  -  SCREW BONE 1.7MM 20MM ORTH SLFTAP LCK	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17022	SUP	HCPCS C1713		53-17022  -  SCREW BN 1.7MM 22MM NS VARIAX ST LCK XPN	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17022E	SUP	HCPCS C1713		53-17022E  -  SCREW BONE 1.7MM 22MM ORTH SLFTAP LCK	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17024	SUP	HCPCS C1713		53-17024  -  SCREW BN 1.7MM 24MM NS VARIAX ST LCK XPN	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-17024E	SUP	HCPCS C1713		53-17024E  -  SCREW BONE 1.7MM 24MM ORTH SLFTAP LCK	BOTH IP/OP	$140.70 	$104.12	$0.00	$104.43	$52.59	$52.59	$0.00	$0.00	$0.00	$29.33	$104.43	$104.43	$0.00	$0.00	$29.32	$0.00	$83.22	$83.22	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-20424	SUP	HCPCS C1713		53-20424  -  SCREW BONE 2MM 24MM SLFTAP XPIN LAG TITANIUM MAXFACL	BOTH IP/OP	$117.00 	$86.58	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$24.39	$86.84	$86.84	$0.00	$0.00	$24.38	$0.00	$69.21	$69.21	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
53-20427	SUP	HCPCS C1713		53-20427  -  SCREW BONE 2MM 27MM SLFTAP XPIN LAG CRANIOMAXILLOFACIAL	BOTH IP/OP	$117.00 	$86.58	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$24.39	$86.84	$86.84	$0.00	$0.00	$24.38	$0.00	$69.21	$69.21	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
53-20430	SUP	HCPCS C1713		53-20430  -  SCREW BONE 2MM 30MM SLFTAP XPIN LAG TITANIUM MAXFACL	BOTH IP/OP	$117.00 	$86.58	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$24.39	$86.84	$86.84	$0.00	$0.00	$24.38	$0.00	$69.21	$69.21	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
53-20433	SUP	HCPCS C1713		53-20433  -  SCREW BONE 2MM 33MM SLFTAP XPIN LAG MAXFACL	BOTH IP/OP	$117.00 	$86.58	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$24.39	$86.84	$86.84	$0.00	$0.00	$24.38	$0.00	$69.21	$69.21	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
53-20436	SUP	HCPCS C1713		53-20436  -  SCREW BONE 2MM 36MM SLFTAP XPIN LAG TITANIUM MAXFACL	BOTH IP/OP	$117.00 	$86.58	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$24.39	$86.84	$86.84	$0.00	$0.00	$24.38	$0.00	$69.21	$69.21	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
53-20439	SUP	HCPCS C1713		53-20439  -  SCREW BONE 2MM 39MM SLFTAP XPIN LAG MANDIB NONSTRL	BOTH IP/OP	$117.00 	$86.58	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$24.39	$86.84	$86.84	$0.00	$0.00	$24.38	$0.00	$69.21	$69.21	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
53-20442	SUP	HCPCS C1713		53-20442  -  SCREW BONE 2MM 42MM SLFTAP XPIN LAG MANDIB NONSTRL	BOTH IP/OP	$117.00 	$86.58	$0.00	$222.00	$124.88	$124.88	$0.00	$0.00	$0.00	$24.39	$86.84	$86.84	$0.00	$0.00	$24.38	$0.00	$69.21	$69.21	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$43.43	$0.00	$0.00	$44.18	$0.00	$0.00	$0.00	$0.00	$0.00
53-20616E	SUP	HCPCS C1713		53-20616E  -  SCREW BONE 2MM 16MM TI LCK PG T7 DRV	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$35.82	$127.57	$127.57	$0.00	$0.00	$35.82	$0.00	$101.66	$101.66	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-20618E	SUP	HCPCS C1713		53-20618E  -  SCREW BONE 2MM 18MM TI LCK PG T7 DRV	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$35.82	$127.57	$127.57	$0.00	$0.00	$35.82	$0.00	$101.66	$101.66	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-20620E	SUP	HCPCS C1713		53-20620E  -  SCREW BONE 2MM 20MM TI LCK PG T7 DRV	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$35.82	$127.57	$127.57	$0.00	$0.00	$35.82	$0.00	$101.66	$101.66	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-20622E	SUP	HCPCS C1713		53-20622E  -  SCREW BONE 2MM 22MM TI LCK PG T7 DRV	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$35.82	$127.57	$127.57	$0.00	$0.00	$35.82	$0.00	$101.66	$101.66	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-20624E	SUP	HCPCS C1713		53-20624E  -  SCREW BONE 2MM 24MM TI LCK PG T7 DRV STRL	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$35.82	$127.57	$127.57	$0.00	$0.00	$35.82	$0.00	$101.66	$101.66	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-20626E	SUP	HCPCS C1713		53-20626E  -  SCREW BONE 2MM 26MM TI LCK PG T7 DRV STRL	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$35.82	$127.57	$127.57	$0.00	$0.00	$35.82	$0.00	$101.66	$101.66	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23006	SUP	HCPCS C1713		53-23006  -  SCREW BONE 2.3MM 6MM HAND LCK	BOTH IP/OP	$145.60 	$107.74	$0.00	$108.06	$52.59	$52.59	$0.00	$0.00	$0.00	$30.35	$108.06	$108.06	$0.00	$0.00	$30.34	$0.00	$86.12	$86.12	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23006E	SUP	HCPCS C1713		53-23006E  -  SCREW BONE 2.3MM 6MM CANC LCK SLFTAP CROSSPIN	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23008	SUP	HCPCS C1713		53-23008  -  SCREW BONE 2.3MM 8MM VARIAX HAND SLFTAP XPIN	BOTH IP/OP	$145.60 	$107.74	$0.00	$108.06	$52.59	$52.59	$0.00	$0.00	$0.00	$30.35	$108.06	$108.06	$0.00	$0.00	$30.34	$0.00	$86.12	$86.12	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23008E	SUP	HCPCS C1713		53-23008E  -  SCREW BN 2.3MM 8MM STRL VARIAX ST LCK LOPRFL XPN HD TI HND	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23009	SUP	HCPCS C1713		53-23009  -  SCREW BN BLNT 2.3MM 9MM LCK ST XPN HD LOPRFL HND	BOTH IP/OP	$145.60 	$107.74	$0.00	$108.06	$52.59	$52.59	$0.00	$0.00	$0.00	$30.35	$108.06	$108.06	$0.00	$0.00	$30.34	$0.00	$86.12	$86.12	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23009E	SUP	HCPCS C1713		53-23009E  -  SCREW BN LOPRFL 2.3MM 9MM NS VARIAX ST LCK XPN HD TI HND	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23010	SUP	HCPCS C1713		53-23010  -  SCREW BONE 2.3MM 10MM HAND LCK SLFTAP CROSSPIN	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23010E	SUP	HCPCS C1713		53-23010E  -  SCREW BN 2.3MM 10MM STRL VARIAX ST LCK LOPRFL XPN HD TI HND	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23011	SUP	HCPCS C1713		53-23011  -  SCREW BONE 2.3MM 11MM VARIAX HAND SLFTAP XPIN	BOTH IP/OP	$145.60 	$107.74	$0.00	$108.06	$52.59	$52.59	$0.00	$0.00	$0.00	$30.35	$108.06	$108.06	$0.00	$0.00	$30.34	$0.00	$86.12	$86.12	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23011E	SUP	HCPCS C1713		53-23011E  -  SCREW BONE 2.3MM 11MM LCK SLFTAP CROSSPIN	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23012	SUP	HCPCS C1713		53-23012  -  SCREW BONE 2.3MM 12MM VARIAX HAND LCK XPIN	BOTH IP/OP	$145.60 	$107.74	$0.00	$108.06	$52.59	$52.59	$0.00	$0.00	$0.00	$30.35	$108.06	$108.06	$0.00	$0.00	$30.34	$0.00	$86.12	$86.12	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23012E	SUP	HCPCS C1713		53-23012E  -  SCREW BN 2.3MM 12MM STRL VARIAX ST LCK LOPRFL CROSSPIN HD TI	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23013E	SUP	HCPCS C1713		53-23013E  -  SCREW BONE 2.3MM 13MM VARIAX TI HAND LCK SLFTAP CROSSPIN	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23014	SUP	HCPCS C1713		53-23014  -  SCREW BONE 2.3MM 14MM HAND LCK SLFTAP CROSSPIN	BOTH IP/OP	$145.60 	$107.74	$0.00	$108.06	$52.59	$52.59	$0.00	$0.00	$0.00	$30.35	$108.06	$108.06	$0.00	$0.00	$30.34	$0.00	$86.12	$86.12	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23015E	SUP	HCPCS C1713		53-23015E  -  SCREW BONE 2.3MM 15MM HAND LCK SLFTAP CROSSPIN	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23016	SUP	HCPCS C1713		53-23016  -  SCREW BONE 2.3MM 16MM HAND LCK SLFTAP CROSSPIN	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23016E	SUP	HCPCS C1713		53-23016E  -  SCREW BONE 2.3MM 16MM HAND LCK SLFTAP CROSSPIN	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23018	SUP	HCPCS C1713		53-23018  -  SCREW BONE 2.3MM 18MM VARIAX HAND LCK SLFTAP XPIN	BOTH IP/OP	$145.60 	$107.74	$0.00	$108.06	$52.59	$52.59	$0.00	$0.00	$0.00	$30.35	$108.06	$108.06	$0.00	$0.00	$30.34	$0.00	$86.12	$86.12	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23018E	SUP	HCPCS C1713		53-23018E  -  SCREW BONE 2.3MM 18MM HAND LCK SLFTAP CROSSPIN	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23020	SUP	HCPCS C1713		53-23020  -  SCREW BONE 2.3MM 20MM LCK	BOTH IP/OP	$145.60 	$107.74	$0.00	$108.06	$52.59	$52.59	$0.00	$0.00	$0.00	$30.35	$108.06	$108.06	$0.00	$0.00	$30.34	$0.00	$86.12	$86.12	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23020E	SUP	HCPCS C1713		53-23020E  -  SCREW BONE 2.3MM 20MM LCK SLFTAP CROSSPIN	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23022	SUP	HCPCS C1713		53-23022  -  SCREW BONE 2MM 22MM RADL	BOTH IP/OP	$145.60 	$107.74	$0.00	$108.06	$52.59	$52.59	$0.00	$0.00	$0.00	$30.35	$108.06	$108.06	$0.00	$0.00	$30.34	$0.00	$86.12	$86.12	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23022E	SUP	HCPCS C1713		53-23022E  -  SCREW BONE 2.3MM 22MM VARIAX HAND SLFTAP LCK	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23024	SUP	HCPCS C1713		53-23024  -  SCREW BN LOPRFL BLNT RND 2.3MM 24MM GRN VARIAX PRFL 1 STP	BOTH IP/OP	$145.60 	$107.74	$0.00	$108.06	$52.59	$52.59	$0.00	$0.00	$0.00	$30.35	$108.06	$108.06	$0.00	$0.00	$30.34	$0.00	$86.12	$86.12	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23024E	SUP	HCPCS C1713		53-23024E  -  SCREW BN 2.3MM 24MM VARIAX LCK ST XPN HD LOPRFL TI WR HND	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23026	SUP	HCPCS C1713		53-23026  -  SCREW BONE 2.3MM 26MM LCK	BOTH IP/OP	$145.60 	$107.74	$0.00	$108.06	$52.59	$52.59	$0.00	$0.00	$0.00	$30.35	$108.06	$108.06	$0.00	$0.00	$30.34	$0.00	$86.12	$86.12	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23026E	SUP	HCPCS C1713		53-23026E  -  SCREW BONE 2.3MM 26MM VARIAX HAND SLFTAP LCK	BOTH IP/OP	$141.40 	$104.64	$0.00	$104.95	$52.59	$52.59	$0.00	$0.00	$0.00	$29.47	$104.95	$104.95	$0.00	$0.00	$29.47	$0.00	$83.64	$83.64	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
53-23210E	SUP	HCPCS C1713		53-23210E  -  SCREW BONE 2.3MM 10MM TI LCK PG T7 DRV STRL	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23212E	SUP	HCPCS C1713		53-23212E  -  SCREW BONE 2.3MM 12MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23214E	SUP	HCPCS C1713		53-23214E  -  SCREW BONE 2.3MM 14MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23216E	SUP	HCPCS C1713		53-23216E  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23218E	SUP	HCPCS C1713		53-23218E  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23220E	SUP	HCPCS C1713		53-23220E  -  SCREW BONE 2.3MM 20MM VARIAX TI DISTAL RADL WR HND NLCKG T7	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23222E	SUP	HCPCS C1713		53-23222E  -  SCREW BONE 2.3MM 22MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23224E	SUP	HCPCS C1713		53-23224E  -  SCREW BONE 2.3MM 24MM VARIAX TI DISTAL RADL LCK T7 DRV STRL	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23226E	SUP	HCPCS C1713		53-23226E  -  SCREW BONE 2.3MM 26MM VARIAX TI DISTAL RADL NLCKG T7 DRV	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23228E	SUP	HCPCS C1713		53-23228E  -  SCREW BONE 2.3MM 28MM VARIAX TI T7 DRV STRL	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23230E	SUP	HCPCS C1713		53-23230E  -  SCREW BONE 2.3MM 30MM TI LCK PG T7 DRV STRL	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23232E	SUP	HCPCS C1713		53-23232E  -  SCREW BONE 2.3MM 32MM TI LCK PG T7 DRV STRL	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23234E	SUP	HCPCS C1713		53-23234E  -  SCREW BONE 2.3MM 34MM TI LCK PG T7 DRV STRL	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23236E	SUP	HCPCS C1713		53-23236E  -  SCREW BONE 2.3MM 36MM TI LCK PG T7 DRV STRL	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23238E	SUP	HCPCS C1713		53-23238E  -  SCREW BONE 2.3MM 38MM TI LCK PG T7 DRV STRL	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-23610E	SUP	HCPCS C1713		53-23610E  -  SCREW BONE 2.3MM 10MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23612E	SUP	HCPCS C1713		53-23612E  -  SCREW BONE 2.3MM 12MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23614E	SUP	HCPCS C1713		53-23614E  -  SCREW BONE 2.3MM 14MM VARIAX TI DISTAL RADL WR HND LCK T7	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23616E	SUP	HCPCS C1713		53-23616E  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23618E	SUP	HCPCS C1713		53-23618E  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23620E	SUP	HCPCS C1713		53-23620E  -  SCREW BONE 2.3MM 20MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23622E	SUP	HCPCS C1713		53-23622E  -  SCREW BONE 2.3MM 22MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23624E	SUP	HCPCS C1713		53-23624E  -  SCREW BONE 2.3MM 24MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23626E	SUP	HCPCS C1713		53-23626E  -  SCREW BONE 2.3MM 26MM VARIAX TI LCK T7 DRV STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23628E	SUP	HCPCS C1713		53-23628E  -  SCREW BONE 2.3MM 28MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23630E	SUP	HCPCS C1713		53-23630E  -  SCREW BONE 2.3MM 30MM TI LCK T7 DRV STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23632E	SUP	HCPCS C1713		53-23632E  -  SCREW BONE 2.3MM 32MM TI LCK T7 DRV STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23634E	SUP	HCPCS C1713		53-23634E  -  SCREW BONE 2.3MM 34MM TI LCK T7 DRV STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23636E	SUP	HCPCS C1713		53-23636E  -  SCREW BONE 2.3MM 36MM TI LCK T7 DRV STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-23638E	SUP	HCPCS C1713		53-23638E  -  SCREW BONE 2.3MM 38MM TI LCK T7 DRV STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
532650S	SUP	HCPCS C1725		532650S  -  CATHETER ANGIO PGTL CRV 6FR 110CM ST 6 SH BRD PU VNTRC ACPT	BOTH IP/OP	$105.63 	$78.17	$0.00	$84.50	$57.35	$57.35	$0.00	$0.00	$0.00	$22.01	$78.39	$78.39	$0.00	$0.00	$22.01	$0.00	$62.48	$62.48	$0.00	$52.81	$83.66	$84.50	$0.00		$0.00	$16.53	$0.00	$0.00	$16.82	$0.00	$0.00	$0.00	$0.00	$0.00
53-27116E	SUP	HCPCS C1713		53-27116E  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL PTTHRD T7 DRV	BOTH IP/OP	$174.25 	$128.95	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$36.32	$129.33	$129.33	$0.00	$0.00	$36.31	$0.00	$103.07	$103.07	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27118E	SUP	HCPCS C1713		53-27118E  -  SCREW BONE 2.7MM 18MM VARIAX TI DISTAL RADL PTTHRD T7 DRV	BOTH IP/OP	$174.25 	$128.95	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$36.32	$129.33	$129.33	$0.00	$0.00	$36.31	$0.00	$103.07	$103.07	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27120E	SUP	HCPCS C1713		53-27120E  -  SCREW BONE 2.7MM 20MM TI PTHRD T7 DRV	BOTH IP/OP	$174.25 	$128.95	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$36.32	$129.33	$129.33	$0.00	$0.00	$36.31	$0.00	$103.07	$103.07	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27122E	SUP	HCPCS C1713		53-27122E  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL PTTHRD T7 DRV	BOTH IP/OP	$174.25 	$128.95	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$36.32	$129.33	$129.33	$0.00	$0.00	$36.31	$0.00	$103.07	$103.07	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27124E	SUP	HCPCS C1713		53-27124E  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL PTTHRD T7 DRV	BOTH IP/OP	$174.25 	$128.95	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$36.32	$129.33	$129.33	$0.00	$0.00	$36.31	$0.00	$103.07	$103.07	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27126E	SUP	HCPCS C1713		53-27126E  -  SCREW BONE 2.7MM 26MM VARIAX TI DISTAL RADL PTTHRD T7 DRV	BOTH IP/OP	$174.25 	$128.95	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$36.32	$129.33	$129.33	$0.00	$0.00	$36.31	$0.00	$103.07	$103.07	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27210E	SUP	HCPCS C1713		53-27210E  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-27212E	SUP	HCPCS C1713		53-27212E  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL WR HND NLCKG T7	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-27214E	SUP	HCPCS C1713		53-27214E  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL WR HND NLCKG T7	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-27216E	SUP	HCPCS C1713		53-27216E  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-27218E	SUP	HCPCS C1713		53-27218E  -  SCREW BONE 2.7MM 18MM VARIAX TI DISTAL RADL LCK T7 DRV STRL	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-27220E	SUP	HCPCS C1713		53-27220E  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-27222E	SUP	HCPCS C1713		53-27222E  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL NLCKG T7 DRV	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-27224E	SUP	HCPCS C1713		53-27224E  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL LCK T7 DRV STRL	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-27226E	SUP	HCPCS C1713		53-27226E  -  SCREW BONE 2.7MM 26MM VARIAX TI DISTAL RADL LCK T7 DRV STRL	BOTH IP/OP	$134.30 	$99.38	$0.00	$137.50	$77.34	$77.34	$0.00	$0.00	$0.00	$27.99	$99.68	$99.68	$0.00	$0.00	$27.99	$0.00	$79.44	$79.44	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$26.90	$0.00	$0.00	$27.36	$0.00	$0.00	$0.00	$0.00	$0.00
53-27610E	SUP	HCPCS C1713		53-27610E  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27612E	SUP	HCPCS C1713		53-27612E  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27614E	SUP	HCPCS C1713		53-27614E  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL LCK T7 DRV STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27616E	SUP	HCPCS C1713		53-27616E  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27618E	SUP	HCPCS C1713		53-27618E  -  SCREW BONE 2.7MM 18MM VARIAX TI DISTAL RADL T7 DRV STRL LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27620E	SUP	HCPCS C1713		53-27620E  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL LCK T7 DRV STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27622E	SUP	HCPCS C1713		53-27622E  -  SCREW BN T7 FT 2.7MM 22MM NS VARIAX LCK TI DIST RDS LCK PLT	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27624E	SUP	HCPCS C1713		53-27624E  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL T7 DRV LCK	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27626E	SUP	HCPCS C1713		53-27626E  -  SCREW BONE 2.7MM 26MM TI T7 DRV	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27716E	SUP	HCPCS C1713		53-27716E  -  PEG 2.7MM 16MM PTTHRD LCK TI NONSTRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27718E	SUP	HCPCS C1713		53-27718E  -  PEG 2.7MM 18MM DISTAL RADL PTTHRD LCK TI VARIAX STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27720E	SUP	HCPCS C1713		53-27720E  -  PEG 2.7MM 20MM DISTAL RADL PTTHRD LCK TI VARIAX STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27722E	SUP	HCPCS C1713		53-27722E  -  PEG 2.7MM 22MM DISTAL RADL PTTHRD LCK TI VARIAX STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27724E	SUP	HCPCS C1713		53-27724E  -  PEG 2.7MM 24MM DISTAL RADL PTTHRD LCK TI VARIAX STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
53-27726E	SUP	HCPCS C1713		53-27726E  -  PEG 2.7MM 26MM DISTAL RADL PTTHRD LCK TI VARIAX STRL	BOTH IP/OP	$179.35 	$132.72	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$37.38	$133.11	$133.11	$0.00	$0.00	$37.38	$0.00	$106.09	$106.09	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
5331-40/15	SUP	HCPCS C1776		5331-40/15  -  HEAD HUMERAL 40MM 15MM EPOCA COCR ALLOY SHOULDER STERILE	BOTH IP/OP	"$4,287.70 "	"$3,172.90"	$0.00	"$3,430.16"	"$1,929.47"	"$1,929.47"	$0.00	$0.00	$0.00	$893.66	"$3,182.33"	"$3,182.33"	$0.00	$0.00	$893.56	$0.00	"$2,113.84"	"$2,113.84"	$0.00	"$2,143.85"	"$3,395.86"	"$3,430.16"	$0.00		$0.00	$671.03	$0.00	$0.00	$682.60	$0.00	$0.00	$0.00	$0.00	$0.00
5331-42/15	SUP	HCPCS C1776		5331-42/15  -  HEAD HUMERAL 42MM 15.75MM COCR SHOULDER NONSTRL	BOTH IP/OP	"$4,287.70 "	"$3,172.90"	$0.00	"$3,430.16"	"$1,929.47"	"$1,929.47"	$0.00	$0.00	$0.00	$893.66	"$3,182.33"	"$3,182.33"	$0.00	$0.00	$893.56	$0.00	"$2,113.84"	"$2,113.84"	$0.00	"$2,143.85"	"$3,395.86"	"$3,430.16"	$0.00		$0.00	$671.03	$0.00	$0.00	$682.60	$0.00	$0.00	$0.00	$0.00	$0.00
5331-44/16	SUP	HCPCS C1776		5331-44/16  -  HEAD HUM 44MM 16.5MM STRL COCR SHLDR	BOTH IP/OP	"$4,287.70 "	"$3,172.90"	$0.00	"$3,430.16"	"$1,929.47"	"$1,929.47"	$0.00	$0.00	$0.00	$893.66	"$3,182.33"	"$3,182.33"	$0.00	$0.00	$893.56	$0.00	"$2,113.84"	"$2,113.84"	$0.00	"$2,143.85"	"$3,395.86"	"$3,430.16"	$0.00		$0.00	$671.03	$0.00	$0.00	$682.60	$0.00	$0.00	$0.00	$0.00	$0.00
5331-46/17	SUP	HCPCS C1776		5331-46/17  -  HEAD HUM 46MM 17.25MM STRL COCR SHLDR	BOTH IP/OP	"$4,287.70 "	"$3,172.90"	$0.00	"$3,430.16"	"$1,929.47"	"$1,929.47"	$0.00	$0.00	$0.00	$893.66	"$3,182.33"	"$3,182.33"	$0.00	$0.00	$893.56	$0.00	"$2,113.84"	"$2,113.84"	$0.00	"$2,143.85"	"$3,395.86"	"$3,430.16"	$0.00		$0.00	$671.03	$0.00	$0.00	$682.60	$0.00	$0.00	$0.00	$0.00	$0.00
5331-48/18	SUP	HCPCS C1776		5331-48/18  -  HEAD HUM 48MM 18MM STRL COCR SHLDR	BOTH IP/OP	"$4,287.70 "	"$3,172.90"	$0.00	"$3,430.16"	"$1,929.47"	"$1,929.47"	$0.00	$0.00	$0.00	$893.66	"$3,182.33"	"$3,182.33"	$0.00	$0.00	$893.56	$0.00	"$2,113.84"	"$2,113.84"	$0.00	"$2,143.85"	"$3,395.86"	"$3,430.16"	$0.00		$0.00	$671.03	$0.00	$0.00	$682.60	$0.00	$0.00	$0.00	$0.00	$0.00
5331-50/18	SUP	HCPCS C1776		5331-50/18  -  HEAD HUM 50MM 18.75MM STRL COCR SHLDR	BOTH IP/OP	"$4,287.70 "	"$3,172.90"	$0.00	"$3,430.16"	"$1,929.47"	"$1,929.47"	$0.00	$0.00	$0.00	$893.66	"$3,182.33"	"$3,182.33"	$0.00	$0.00	$893.56	$0.00	"$2,113.84"	"$2,113.84"	$0.00	"$2,143.85"	"$3,395.86"	"$3,430.16"	$0.00		$0.00	$671.03	$0.00	$0.00	$682.60	$0.00	$0.00	$0.00	$0.00	$0.00
5331-52/19	SUP	HCPCS C1776		5331-52/19  -  HEAD HUMERAL 52MM 19.5MM EPOCA COCR SHOULDER STERILE	BOTH IP/OP	"$4,287.70 "	"$3,172.90"	$0.00	"$3,430.16"	"$1,929.47"	"$1,929.47"	$0.00	$0.00	$0.00	$893.66	"$3,182.33"	"$3,182.33"	$0.00	$0.00	$893.56	$0.00	"$2,113.84"	"$2,113.84"	$0.00	"$2,143.85"	"$3,395.86"	"$3,430.16"	$0.00		$0.00	$671.03	$0.00	$0.00	$682.60	$0.00	$0.00	$0.00	$0.00	$0.00
5331-54/20	SUP	HCPCS C1776		5331-54/20  -  HEAD HUMERAL 54MM 20.25MM COCR SHOULDER NONSTRL	BOTH IP/OP	"$4,287.70 "	"$3,172.90"	$0.00	"$3,430.16"	"$1,929.47"	"$1,929.47"	$0.00	$0.00	$0.00	$893.66	"$3,182.33"	"$3,182.33"	$0.00	$0.00	$893.56	$0.00	"$2,113.84"	"$2,113.84"	$0.00	"$2,143.85"	"$3,395.86"	"$3,430.16"	$0.00		$0.00	$671.03	$0.00	$0.00	$682.60	$0.00	$0.00	$0.00	$0.00	$0.00
5331-56/21	SUP	HCPCS C1776		5331-56/21  -  HEAD FEMORAL 56MM 21MM COCR HIP STERILE	BOTH IP/OP	"$4,287.70 "	"$3,172.90"	$0.00	"$3,430.16"	"$1,929.47"	"$1,929.47"	$0.00	$0.00	$0.00	$893.66	"$3,182.33"	"$3,182.33"	$0.00	$0.00	$893.56	$0.00	"$2,113.84"	"$2,113.84"	$0.00	"$2,143.85"	"$3,395.86"	"$3,430.16"	$0.00		$0.00	$671.03	$0.00	$0.00	$682.60	$0.00	$0.00	$0.00	$0.00	$0.00
5331-58/22	SUP	HCPCS C1776		5331-58/22  -  HEAD FEMORAL 58MM 21.75MM COCR HIP STERILE	BOTH IP/OP	"$4,287.70 "	"$3,172.90"	$0.00	"$3,430.16"	"$1,929.47"	"$1,929.47"	$0.00	$0.00	$0.00	$893.66	"$3,182.33"	"$3,182.33"	$0.00	$0.00	$893.56	$0.00	"$2,113.84"	"$2,113.84"	$0.00	"$2,143.85"	"$3,395.86"	"$3,430.16"	$0.00		$0.00	$671.03	$0.00	$0.00	$682.60	$0.00	$0.00	$0.00	$0.00	$0.00
53-34164	SUP	HCPCS C1713		53-34164  -  PLATE BN STRG .4MM NS UNV NEURO III 16 HL LOPRFL TI CRNMXF	BOTH IP/OP	"$1,147.50 "	$849.15	$0.00	$918.00	$516.38	$516.38	$0.00	$0.00	$0.00	$239.17	$851.67	$851.67	$0.00	$0.00	$239.14	$0.00	$678.75	$678.75	$0.00	$573.75	$908.82	$918.00	$0.00		$0.00	$179.58	$0.00	$0.00	$182.68	$0.00	$0.00	$0.00	$0.00	$0.00
53-34212	SUP	HCPCS C1713		53-34212  -  PLATE BN STRG .4MM NS UNV NEURO III 2 HL LOPRFL BAR TAB TI	BOTH IP/OP	$457.50 	$338.55	$0.00	$366.00	$205.88	$205.88	$0.00	$0.00	$0.00	$95.35	$339.56	$339.56	$0.00	$0.00	$95.34	$0.00	$270.61	$270.61	$0.00	$228.75	$362.34	$366.00	$0.00		$0.00	$71.60	$0.00	$0.00	$72.83	$0.00	$0.00	$0.00	$0.00	$0.00
53-34216	SUP	HCPCS C1713		53-34216  -  PLATE BN DOG 16MMX.4MM NS UNV NEURO III 2 HL LOPRFL BAR TI	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
53-34228	SUP	HCPCS C1713		53-34228  -  PLATE BN SM BX .4MM NS UNV NEURO III 2X2 HL LOPRFL TI CRNMXF	BOTH IP/OP	$717.50 	$530.95	$0.00	$574.00	$322.88	$322.88	$0.00	$0.00	$0.00	$149.54	$532.53	$532.53	$0.00	$0.00	$149.53	$0.00	$424.40	$424.40	$0.00	$358.75	$568.26	$574.00	$0.00		$0.00	$112.29	$0.00	$0.00	$114.23	$0.00	$0.00	$0.00	$0.00	$0.00
53-34240	SUP	HCPCS C1713		53-34240  -  PLATE BN LG BX .4MM NS UNV NEURO III 2X2 HL LOPRFL TI CRNMXF	BOTH IP/OP	"$1,112.50 "	$823.25	$0.00	$890.00	$500.63	$500.63	$0.00	$0.00	$0.00	$231.87	$825.70	$825.70	$0.00	$0.00	$231.85	$0.00	$658.04	$658.04	$0.00	$556.25	$881.10	$890.00	$0.00		$0.00	$174.11	$0.00	$0.00	$177.11	$0.00	$0.00	$0.00	$0.00	$0.00
53-34300	SUP	HCPCS C1713		53-34300  -  PLATE BN RECT .4MM NS UNV NEURO III 2X2 HL LOPRFL TI CRNMXF	BOTH IP/OP	"$1,092.50 "	$808.45	$0.00	$874.00	$491.63	$491.63	$0.00	$0.00	$0.00	$227.70	$810.85	$810.85	$0.00	$0.00	$227.68	$0.00	$646.21	$646.21	$0.00	$546.25	$865.26	$874.00	$0.00		$0.00	$170.98	$0.00	$0.00	$173.93	$0.00	$0.00	$0.00	$0.00	$0.00
53-34406	SUP	HCPCS C1713		53-34406  -  PLATE BN STRG 6MMX.4MM NS UNV NEURO III 4 HL LOPRFL BAR TI	BOTH IP/OP	$505.00 	$373.70	$0.00	$404.00	$227.25	$227.25	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$252.50	$399.96	$404.00	$0.00		$0.00	$79.03	$0.00	$0.00	$80.40	$0.00	$0.00	$0.00	$0.00	$0.00
53-34507	SUP	HCPCS C1713		53-34507  -  COVER BUR HL LOPRFL 7MM STRL MDPR TAB TI	BOTH IP/OP	$915.00 	$677.10	$0.00	$732.00	$411.75	$411.75	$0.00	$0.00	$0.00	$190.71	$679.11	$679.11	$0.00	$0.00	$190.69	$0.00	$541.22	$541.22	$0.00	$457.50	$724.68	$732.00	$0.00		$0.00	$143.20	$0.00	$0.00	$145.67	$0.00	$0.00	$0.00	$0.00	$0.00
53-34510	SUP	HCPCS C1713		53-34510  -  COVER BURR HOLE LP 10MM TAB UNIVERSAL NEURO III	BOTH IP/OP	$915.00 	$677.10	$0.00	$732.00	$411.75	$411.75	$0.00	$0.00	$0.00	$190.71	$679.11	$679.11	$0.00	$0.00	$190.69	$0.00	$541.22	$541.22	$0.00	$457.50	$724.68	$732.00	$0.00		$0.00	$143.20	$0.00	$0.00	$145.67	$0.00	$0.00	$0.00	$0.00	$0.00
53-34514	SUP	HCPCS C1713		53-34514  -  COVER BURR HOLE LP 14MM TAB UNIVERSAL NEURO III	BOTH IP/OP	$915.00 	$677.10	$0.00	$732.00	$411.75	$411.75	$0.00	$0.00	$0.00	$190.71	$679.11	$679.11	$0.00	$0.00	$190.69	$0.00	$541.22	$541.22	$0.00	$457.50	$724.68	$732.00	$0.00		$0.00	$143.20	$0.00	$0.00	$145.67	$0.00	$0.00	$0.00	$0.00	$0.00
53-34608	SUP	HCPCS C1713		53-34608  -  PLATE BN 2Y .4MM NS UNV NEURO III 6 HL LOPRFL BAR TI CRNMXF	BOTH IP/OP	"$1,002.50 "	$741.85	$0.00	$802.00	$451.13	$451.13	$0.00	$0.00	$0.00	$208.95	$744.06	$744.06	$0.00	$0.00	$208.92	$0.00	$592.98	$592.98	$0.00	$501.25	$793.98	$802.00	$0.00		$0.00	$156.89	$0.00	$0.00	$159.60	$0.00	$0.00	$0.00	$0.00	$0.00
53-34612	SUP	HCPCS C1713		53-34612  -  PLATE BN SM GAP .4MM NS UNV NEURO III 6 HL LOPRFL TI CRNMXF	BOTH IP/OP	"$1,240.00 "	$917.60	$0.00	$992.00	$558.00	$558.00	$0.00	$0.00	$0.00	$258.45	$920.33	$920.33	$0.00	$0.00	$258.42	$0.00	$733.46	$733.46	$0.00	$620.00	$982.08	$992.00	$0.00		$0.00	$194.06	$0.00	$0.00	$197.41	$0.00	$0.00	$0.00	$0.00	$0.00
53-34614	SUP	HCPCS C1713		53-34614  -  COVER BUR HL 14MMX.4MM NS UNV NEURO III LOPRFL SHNT TAB TI	BOTH IP/OP	"$1,002.50 "	$741.85	$0.00	$802.00	$451.13	$451.13	$0.00	$0.00	$0.00	$208.95	$744.06	$744.06	$0.00	$0.00	$208.92	$0.00	$592.98	$592.98	$0.00	$501.25	$793.98	$802.00	$0.00		$0.00	$156.89	$0.00	$0.00	$159.60	$0.00	$0.00	$0.00	$0.00	$0.00
53-34620	SUP	HCPCS C1713		53-34620  -  COVER BUR HL 20MMX.4MM NS UNV NEURO III LOPRFL SHNT TAB TI	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
53-34622	SUP	HCPCS C1713		53-34622  -  PLATE BN LG GAP .4MM NS UNV NEURO III 6 HL LOPRFL TI CRNMXF	BOTH IP/OP	"$1,320.00 "	$976.80	$0.00	"$1,056.00"	$594.00	$594.00	$0.00	$0.00	$0.00	$275.12	$979.70	$979.70	$0.00	$0.00	$275.09	$0.00	$780.78	$780.78	$0.00	$660.00	"$1,045.44"	"$1,056.00"	$0.00		$0.00	$206.58	$0.00	$0.00	$210.14	$0.00	$0.00	$0.00	$0.00	$0.00
53-34804	SUP	HCPCS C1713		53-34804  -  PLATE BN STRG .4MM NS UNV NEURO III 8 HL LOPRFL TI CRNMXF	BOTH IP/OP	$655.00 	$484.70	$0.00	$524.00	$294.75	$294.75	$0.00	$0.00	$0.00	$136.52	$486.14	$486.14	$0.00	$0.00	$136.50	$0.00	$387.43	$387.43	$0.00	$327.50	$518.76	$524.00	$0.00		$0.00	$102.51	$0.00	$0.00	$104.28	$0.00	$0.00	$0.00	$0.00	$0.00
53-36212	SUP	HCPCS C1713		53-36212  -  PLATE BN DOG 12MMX.6MM NS UNV NEURO III 2 HL LOPRFL RGD TI	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
5-34-002	SUP	Custom 27203010		CHEMICAL ALGAECIDE LQ 4OZ	BOTH IP/OP	$37.50 	$27.75	$0.00	$30.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.75	$29.70	$30.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5357M/S	SUP	HCPCS C1785		5357M/S  -  PACEMAKER CRD 11ML VR XL 2 CHMBR	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
539G	SUP	Custom 27203010		539G  -  SUTURE SS 4-0 5-26 TS 14IN MFL DBL ARM BLK NABSB	BOTH IP/OP	$22.74 	$16.83	$0.00	$18.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.88	$16.88	$0.00	$0.00	$4.74	$0.00	$0.00	$0.00	$0.00	$11.37	$18.01	$18.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
54-00261	SUP	HCPCS C1713		54-00261  -  PLATE BONE 120X60X.1MM MICROMESH TITANIUM	BOTH IP/OP	"$1,872.65 "	"$1,385.76"	$0.00	"$2,644.00"	"$1,487.25"	"$1,487.25"	$0.00	$0.00	$0.00	$390.31	"$1,389.88"	"$1,389.88"	$0.00	$0.00	$390.26	$0.00	"$1,107.67"	"$1,107.67"	$0.00	"$1,652.50"	"$2,617.56"	"$2,644.00"	$0.00		$0.00	$517.23	$0.00	$0.00	$526.16	$0.00	$0.00	$0.00	$0.00	$0.00
54-00262	SUP	HCPCS C1713		54-00262  -  MESH DYNAMIC MICRO ULTRA-THIN 60X60X.1MM MALBLE UNIVERSAL	BOTH IP/OP	"$1,085.40 "	$803.20	$0.00	"$1,756.00"	$987.75	$987.75	$0.00	$0.00	$0.00	$226.22	$805.58	$805.58	$0.00	$0.00	$226.20	$0.00	$642.01	$642.01	$0.00	"$1,097.50"	"$1,738.44"	"$1,756.00"	$0.00		$0.00	$343.52	$0.00	$0.00	$349.44	$0.00	$0.00	$0.00	$0.00	$0.00
54-00272	SUP	HCPCS C1713		54-00272  -  MESH CRNL MIC 60X60X.2MM NS UNV NEURO III TI CRNMXF 1.2MM	BOTH IP/OP	"$1,085.40 "	$803.20	$0.00	"$1,756.00"	$987.75	$987.75	$0.00	$0.00	$0.00	$226.22	$805.58	$805.58	$0.00	$0.00	$226.20	$0.00	$642.01	$642.01	$0.00	"$1,097.50"	"$1,738.44"	"$1,756.00"	$0.00		$0.00	$343.52	$0.00	$0.00	$349.44	$0.00	$0.00	$0.00	$0.00	$0.00
54-00345	SUP	HCPCS C1713		54-00345  -  MESH DYNAMIC LP 120X120X.3MM MALBLE BLUE TITANIUM	BOTH IP/OP	"$10,045.00 "	"$7,433.30"	$0.00	"$8,036.00"	"$4,520.25"	"$4,520.25"	$0.00	$0.00	$0.00	"$2,093.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,093.38"	$0.00	"$4,952.19"	"$4,952.19"	$0.00	"$5,022.50"	"$7,955.64"	"$8,036.00"	$0.00		$0.00	"$1,572.04"	$0.00	$0.00	"$1,599.16"	$0.00	$0.00	$0.00	$0.00	$0.00
54-00346	SUP	HCPCS C1713		54-00346  -  MESH DYNAMIC LP 90X90X.3MM MALBLE BLUE TITANIUM	BOTH IP/OP	"$2,448.48 "	"$1,811.88"	$0.00	"$5,100.00"	"$2,868.75"	"$2,868.75"	$0.00	$0.00	$0.00	$510.32	"$1,817.26"	"$1,817.26"	$0.00	$0.00	$510.26	$0.00	"$1,448.27"	"$1,448.27"	$0.00	"$3,187.50"	"$5,049.00"	"$5,100.00"	$0.00		$0.00	$997.69	$0.00	$0.00	"$1,014.90"	$0.00	$0.00	$0.00	$0.00	$0.00
54-00642	SUP	HCPCS C1713		54-00642  -  PLATE BONE 90X90X.6MM DYNAMIC MESH TITANIUM	BOTH IP/OP	"$2,989.85 "	"$2,212.49"	$0.00	"$5,106.00"	"$2,872.13"	"$2,872.13"	$0.00	$0.00	$0.00	$623.16	"$2,219.07"	"$2,219.07"	$0.00	$0.00	$623.08	$0.00	"$1,474.00"	"$1,474.00"	$0.00	"$3,191.25"	"$5,054.94"	"$5,106.00"	$0.00		$0.00	$998.86	$0.00	$0.00	"$1,016.09"	$0.00	$0.00	$0.00	$0.00	$0.00
54-00643	SUP	HCPCS C1713		54-00643  -  PLATE BONE STANDARD 120X120X.6MM DYNAMIC MESH TITANIUM	BOTH IP/OP	"$5,197.40 "	"$3,846.08"	$0.00	"$8,292.00"	"$4,664.25"	"$4,664.25"	$0.00	$0.00	$0.00	"$1,083.27"	"$3,857.51"	"$3,857.51"	$0.00	$0.00	"$1,083.14"	$0.00	"$2,562.32"	"$2,562.32"	$0.00	"$5,182.50"	"$8,209.08"	"$8,292.00"	$0.00		$0.00	"$1,622.12"	$0.00	$0.00	"$1,650.11"	$0.00	$0.00	$0.00	$0.00	$0.00
54-00645	SUP	HCPCS C1713		54-00645  -  MESH DYNAMIC STANDARD 120X120X.6MM GOLD TITANIUM	BOTH IP/OP	"$10,365.00 "	"$7,670.10"	$0.00	"$8,292.00"	"$4,664.25"	"$4,664.25"	$0.00	$0.00	$0.00	"$2,160.33"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,160.07"	$0.00	"$5,109.95"	"$5,109.95"	$0.00	"$5,182.50"	"$8,209.08"	"$8,292.00"	$0.00		$0.00	"$1,622.12"	$0.00	$0.00	"$1,650.11"	$0.00	$0.00	$0.00	$0.00	$0.00
54-00646	SUP	HCPCS C1713		54-00646  -  MESH DYNAMIC STANDARD 90X90X.6MM GOLD TITANIUM	BOTH IP/OP	"$2,448.48 "	"$1,811.88"	$0.00	"$5,106.00"	"$2,872.13"	"$2,872.13"	$0.00	$0.00	$0.00	$510.32	"$1,817.26"	"$1,817.26"	$0.00	$0.00	$510.26	$0.00	"$1,448.27"	"$1,448.27"	$0.00	"$3,191.25"	"$5,054.94"	"$5,106.00"	$0.00		$0.00	$998.86	$0.00	$0.00	"$1,016.09"	$0.00	$0.00	$0.00	$0.00	$0.00
54-00647	SUP	HCPCS C1713		54-00647  -  MESH DYNAMIC STANDARD 200X200X.6MM GOLD TITANIUM	BOTH IP/OP	"$13,363.95 "	"$9,889.32"	$0.00	"$23,464.00"	"$13,198.50"	"$13,198.50"	$0.00	$0.00	$0.00	"$2,785.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,785.05"	$0.00	"$6,588.43"	"$6,588.43"	$0.00	"$14,665.00"	"$23,229.36"	"$23,464.00"	$0.00		$0.00	"$4,590.15"	$0.00	$0.00	"$4,669.34"	$0.00	$0.00	$0.00	$0.00	$0.00
5400-701-000	SUP	Custom 27203010		5400-701-000  -  MILL BONE BIOP MED BIOP DISP	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-40A	SUP	Custom 27803010		540-11-40A  -  SHELL ACETAB A 40MM 41.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-42B	SUP	Custom 27803010		540-11-42B  -  SHELL ACETAB B 42MM 43.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-44C	SUP	Custom 27803010		540-11-44C  -  SHELL ACETAB C 44MM 45.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-46D	SUP	Custom 27803010		540-11-46D  -  SHELL ACETAB D 46MM 47.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-48D	SUP	Custom 27803010		540-11-48D  -  SHELL ACETAB D 48MM 49.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-50E	SUP	Custom 27803010		540-11-50E  -  SHELL ACETAB E 50MM 51.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-52E	SUP	Custom 27803010		540-11-52E  -  SHELL ACETAB E 52MM SOLID BACK DOME HOLE PLUG TRIDENT PSL HA	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-54F	SUP	Custom 27803010		540-11-54F  -  SHELL ACETAB F 54MM 55.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-56F	SUP	Custom 27803010		540-11-56F  -  SHELL ACETAB F 56MM 57.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-58G	SUP	Custom 27803010		540-11-58G  -  SHELL ACETAB G 58MM 59.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-60G	SUP	Custom 27803010		540-11-60G  -  SHELL ACETAB G 60MM 61.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-62H	SUP	Custom 27803010		540-11-62H  -  SHELL ACETAB H 62MM 63.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-64H	SUP	Custom 27803010		540-11-64H  -  SHELL ACETAB H 64MM 65.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-66I	SUP	Custom 27803010		540-11-66I  -  SHELL ACETAB I 66MM 67.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-68I	SUP	Custom 27803010		540-11-68I  -  SHELL ACETAB I 68MM 69.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-70J	SUP	Custom 27803010		540-11-70J  -  SHELL ACETAB J 70MM 71.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
540-11-72J	SUP	Custom 27803010		540-11-72J  -  SHELL ACETAB J 72MM 73.8MM SOLID BACK RIM TRIDENT PSL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
54-03000	SUP	HCPCS C1713		54-03000  -  TEMPLATE SZ SM STD 1.2MM CMBN ORBT PLT	BOTH IP/OP	$101.80 	$75.33	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$21.22	$75.56	$75.56	$0.00	$0.00	$21.22	$0.00	$60.21	$60.21	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
54-03001	SUP	HCPCS C1713		54-03001  -  PLATE BONE LARGE 39X34X.3MM COMPLEX TITANIUM ORBTL FLOOR 1.2	BOTH IP/OP	"$1,618.33 "	"$1,197.56"	$0.00	"$2,964.00"	"$1,667.25"	"$1,667.25"	$0.00	$0.00	$0.00	$337.30	"$1,201.12"	"$1,201.12"	$0.00	$0.00	$337.26	$0.00	$957.24	$957.24	$0.00	"$1,852.50"	"$2,934.36"	"$2,964.00"	$0.00		$0.00	$579.83	$0.00	$0.00	$589.84	$0.00	$0.00	$0.00	$0.00	$0.00
54-03002	SUP	HCPCS C1713		54-03002  -  PLATE BONE MEDIUM .3MM MALBLE BASIC UPPER FACE ORBTL FLOOR	BOTH IP/OP	"$3,477.50 "	"$2,573.35"	$0.00	"$2,782.00"	"$1,564.88"	"$1,564.88"	$0.00	$0.00	$0.00	$724.80	"$2,581.00"	"$2,581.00"	$0.00	$0.00	$724.71	$0.00	"$1,714.41"	"$1,714.41"	$0.00	"$1,738.75"	"$2,754.18"	"$2,782.00"	$0.00		$0.00	$544.23	$0.00	$0.00	$553.62	$0.00	$0.00	$0.00	$0.00	$0.00
54-03003	SUP	HCPCS C1713		54-03003  -  PLATE BONE SMALL 20X18X.3MM ISOLATED TITANIUM ORBTL FLOOR	BOTH IP/OP	"$3,260.00 "	"$2,412.40"	$0.00	"$2,608.00"	"$1,467.00"	"$1,467.00"	$0.00	$0.00	$0.00	$679.47	"$2,419.57"	"$2,419.57"	$0.00	$0.00	$679.38	$0.00	"$1,607.18"	"$1,607.18"	$0.00	"$1,630.00"	"$2,581.92"	"$2,608.00"	$0.00		$0.00	$510.19	$0.00	$0.00	$518.99	$0.00	$0.00	$0.00	$0.00	$0.00
54-04000	SUP	HCPCS C1713		54-04000  -  TEMPLATE SZ LG STD 1.2MM CMBN ORBT PLT	BOTH IP/OP	$97.45 	$72.11	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$20.31	$72.33	$72.33	$0.00	$0.00	$20.31	$0.00	$57.64	$57.64	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
54-04001	SUP	HCPCS C1713		54-04001  -  PLATE BONE LARGE 30X32X.4MM COMPLEX TITANIUM ORBTL FLOOR 1.2	BOTH IP/OP	"$3,705.00 "	"$2,741.70"	$0.00	"$2,964.00"	"$1,667.25"	"$1,667.25"	$0.00	$0.00	$0.00	$772.21	"$2,749.85"	"$2,749.85"	$0.00	$0.00	$772.12	$0.00	"$1,826.57"	"$1,826.57"	$0.00	"$1,852.50"	"$2,934.36"	"$2,964.00"	$0.00		$0.00	$579.83	$0.00	$0.00	$589.84	$0.00	$0.00	$0.00	$0.00	$0.00
54-04002	SUP	HCPCS C1713		54-04002  -  PLATE BN MED BSC STD .4MM NS LEIBINGER UNV 2 TI ORBT FLR 1.2	BOTH IP/OP	"$1,517.68 "	"$1,123.08"	$0.00	"$2,782.00"	"$1,564.88"	"$1,564.88"	$0.00	$0.00	$0.00	$316.32	"$1,126.42"	"$1,126.42"	$0.00	$0.00	$316.28	$0.00	$897.70	$897.70	$0.00	"$1,738.75"	"$2,754.18"	"$2,782.00"	$0.00		$0.00	$544.23	$0.00	$0.00	$553.62	$0.00	$0.00	$0.00	$0.00	$0.00
54-04004	SUP	HCPCS C1713		54-04004  -  PLATE BONE 3D SMALL PREBENT ORBTL FLOOR RIGHT	BOTH IP/OP	"$3,482.20 "	"$2,576.83"	$0.00	"$3,316.00"	"$1,865.25"	"$1,865.25"	$0.00	$0.00	$0.00	$725.78	"$2,584.49"	"$2,584.49"	$0.00	$0.00	$725.69	$0.00	"$1,716.72"	"$1,716.72"	$0.00	"$2,072.50"	"$3,282.84"	"$3,316.00"	$0.00		$0.00	$648.69	$0.00	$0.00	$659.88	$0.00	$0.00	$0.00	$0.00	$0.00
54-04007	SUP	HCPCS C1713		54-04007  -  PLATE BONE 3D LARGE PREBENT ORBTL FLOOR LEFT	BOTH IP/OP	"$3,482.20 "	"$2,576.83"	$0.00	"$3,316.00"	"$1,865.25"	"$1,865.25"	$0.00	$0.00	$0.00	$725.78	"$2,584.49"	"$2,584.49"	$0.00	$0.00	$725.69	$0.00	"$1,716.72"	"$1,716.72"	$0.00	"$2,072.50"	"$3,282.84"	"$3,316.00"	$0.00		$0.00	$648.69	$0.00	$0.00	$659.88	$0.00	$0.00	$0.00	$0.00	$0.00
54-05100	SUP	Custom 27803010		54-05100  -  CLIP FIX TITANIUM CRANIAL 1.5 MM 1.7 MM SCREW	BOTH IP/OP	$351.80 	$260.33	$0.00	$281.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$261.10	$261.10	$0.00	$0.00	$73.31	$0.00	$0.00	$0.00	$0.00	$175.90	$278.63	$281.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
54051T	SUP	HCPCS Q4108		54051T  -  DRESSING WND THN 5X4IN STRL BVN CLGN GAG DISP	BOTH IP/OP	$457.19 	$338.32	$0.00	$365.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.60	$362.09	$365.75	$0.00		$0.00	$39.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5407FA1015	SUP	Custom 27203010		5407FA1015  -  ROUTER POWER TAPER 1.5MM 12MM LATEX FREE	BOTH IP/OP	$301.68 	$223.24	$0.00	$241.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$223.90	$223.90	$0.00	$0.00	$62.87	$0.00	$0.00	$0.00	$0.00	$150.84	$238.93	$241.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5407FA2023	SUP	Custom 27203010		5407FA2023  -  ROUTER POWER TAPER 2.3MM LATEX FREE	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$0.00	$0.00	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5407FA3030	SUP	Custom 27203010		5407FA3030  -  BURR SRG TPR 3MM WHT ROUT	BOTH IP/OP	$288.78 	$213.70	$0.00	$231.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.33	$214.33	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.39	$228.71	$231.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5413-20/5	SUP	HCPCS C1713		5413-20/5  -  COMPONENT HUM STD ECCENTER STRL EPOCA TI SHLDR	BOTH IP/OP	"$1,004.35 "	$743.22	$0.00	$803.48	$451.96	$451.96	$0.00	$0.00	$0.00	$209.33	$745.43	$745.43	$0.00	$0.00	$209.31	$0.00	$594.07	$594.07	$0.00	$502.18	$795.45	$803.48	$0.00		$0.00	$157.18	$0.00	$0.00	$159.89	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-40A	SUP	Custom 27803010		542-11-40A  -  SHELL ACETAB A 40MM 41.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-42B	SUP	Custom 27803010		542-11-42B  -  SHELL ACETAB B 42MM 43.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-44C	SUP	Custom 27803010		542-11-44C  -  SHELL ACETAB C 44MM 45.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-46D	SUP	Custom 27803010		542-11-46D  -  SHELL ACETAB D 46MM 47.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-48D	SUP	Custom 27803010		542-11-48D  -  SHELL ACETAB D 48MM 49.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-50E	SUP	Custom 27803010		542-11-50E  -  SHELL ACETAB E 50MM 51.8MM 5 HOLE CLUSTER TRIDENT PSL	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-52E	SUP	Custom 27803010		542-11-52E  -  SHELL ACETAB E 52MM 53.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-54F	SUP	Custom 27803010		542-11-54F  -  SHELL ACETAB F 54MM 55.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-56F	SUP	Custom 27803010		542-11-56F  -  SHELL ACETAB F 56MM 57.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-58G	SUP	Custom 27803010		542-11-58G  -  SHELL ACETAB G 58MM 59.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-60G	SUP	Custom 27803010		542-11-60G  -  SHELL ACETAB G 60MM 61.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-62H	SUP	Custom 27803010		542-11-62H  -  SHELL ACETAB H 62MM 63.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-64H	SUP	Custom 27803010		542-11-64H  -  SHELL ACETAB H 64MM 65.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-66I	SUP	Custom 27803010		542-11-66I  -  SHELL ACETAB I 66MM 67.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-68I	SUP	Custom 27803010		542-11-68I  -  SHELL ACETAB I 68MM 69.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-70J	SUP	Custom 27803010		542-11-70J  -  SHELL ACETAB J 70MM 71.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542-11-72J	SUP	Custom 27803010		542-11-72J  -  SHELL ACETAB J 72MM 73.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
54-25240	SUP	HCPCS C1713		54-25240  -  PLATE SHRT 2.7MM SCR 8 HOLE RECON BONE RIGHT RADL	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$222.75	$222.75	$0.00	$0.00	$0.00	$103.17	$367.39	$367.39	$0.00	$0.00	$103.16	$0.00	$292.79	$292.79	$0.00	$247.50	$392.04	$396.00	$0.00		$0.00	$77.47	$0.00	$0.00	$78.80	$0.00	$0.00	$0.00	$0.00	$0.00
54-25241	SUP	HCPCS C1713		54-25241  -  PLATE SM 2.7MM SCR 8 HOLE RECON BONE RIGHT RADL	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$222.75	$222.75	$0.00	$0.00	$0.00	$103.17	$367.39	$367.39	$0.00	$0.00	$103.16	$0.00	$292.79	$292.79	$0.00	$247.50	$392.04	$396.00	$0.00		$0.00	$77.47	$0.00	$0.00	$78.80	$0.00	$0.00	$0.00	$0.00	$0.00
54-25242	SUP	HCPCS C1713		54-25242  -  PLATE SHRT 2.7MM SCR 8 HOLE RECON BONE LEFT RADL	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$222.75	$222.75	$0.00	$0.00	$0.00	$103.17	$367.39	$367.39	$0.00	$0.00	$103.16	$0.00	$292.79	$292.79	$0.00	$247.50	$392.04	$396.00	$0.00		$0.00	$77.47	$0.00	$0.00	$78.80	$0.00	$0.00	$0.00	$0.00	$0.00
54-25243	SUP	HCPCS C1713		54-25243  -  PLATE SM 2.7MM SCR 8 HOLE RECON BONE LEFT RADL	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$222.75	$222.75	$0.00	$0.00	$0.00	$103.17	$367.39	$367.39	$0.00	$0.00	$103.16	$0.00	$292.79	$292.79	$0.00	$247.50	$392.04	$396.00	$0.00		$0.00	$77.47	$0.00	$0.00	$78.80	$0.00	$0.00	$0.00	$0.00	$0.00
54-25244	SUP	HCPCS C1713		54-25244  -  PLATE LNG 2.7MM SCR 11 HOLE RECON BONE RIGHT RADL	BOTH IP/OP	$591.25 	$437.53	$0.00	$473.00	$266.06	$266.06	$0.00	$0.00	$0.00	$123.23	$438.83	$438.83	$0.00	$0.00	$123.22	$0.00	$349.72	$349.72	$0.00	$295.63	$468.27	$473.00	$0.00		$0.00	$92.53	$0.00	$0.00	$94.13	$0.00	$0.00	$0.00	$0.00	$0.00
54-25246	SUP	HCPCS C1713		54-25246  -  PLATE LNG 2.7MM SCR 11 HOLE RECON BONE LEFT RADL	BOTH IP/OP	$591.25 	$437.53	$0.00	$473.00	$266.06	$266.06	$0.00	$0.00	$0.00	$123.23	$438.83	$438.83	$0.00	$0.00	$123.22	$0.00	$349.72	$349.72	$0.00	$295.63	$468.27	$473.00	$0.00		$0.00	$92.53	$0.00	$0.00	$94.13	$0.00	$0.00	$0.00	$0.00	$0.00
54-25250	SUP	HCPCS C1713		54-25250  -  PLATE REG 2.7MM SCR 6 HOLE RECON BONE RIGHT RADL	BOTH IP/OP	$433.13 	$320.52	$0.00	$346.50	$194.91	$194.91	$0.00	$0.00	$0.00	$90.27	$321.47	$321.47	$0.00	$0.00	$90.26	$0.00	$256.19	$256.19	$0.00	$216.56	$343.04	$346.50	$0.00		$0.00	$67.78	$0.00	$0.00	$68.95	$0.00	$0.00	$0.00	$0.00	$0.00
54-25251	SUP	HCPCS C1713		54-25251  -  PLATE REG 2.7MM SCR 6 HOLE RECON BONE LEFT RADL	BOTH IP/OP	$433.13 	$320.52	$0.00	$346.50	$194.91	$194.91	$0.00	$0.00	$0.00	$90.27	$321.47	$321.47	$0.00	$0.00	$90.26	$0.00	$256.19	$256.19	$0.00	$216.56	$343.04	$346.50	$0.00		$0.00	$67.78	$0.00	$0.00	$68.95	$0.00	$0.00	$0.00	$0.00	$0.00
54-25252	SUP	HCPCS C1713		54-25252  -  PLATE REG 2.7MM SCR 7 HOLE RECON BONE RIGHT RADL	BOTH IP/OP	$474.38 	$351.04	$0.00	$379.50	$213.47	$213.47	$0.00	$0.00	$0.00	$98.87	$352.08	$352.08	$0.00	$0.00	$98.86	$0.00	$280.59	$280.59	$0.00	$237.19	$375.71	$379.50	$0.00		$0.00	$74.24	$0.00	$0.00	$75.52	$0.00	$0.00	$0.00	$0.00	$0.00
54-25253	SUP	HCPCS C1713		54-25253  -  PLATE REG 2.7MM SCR 7 HOLE RECON BONE LEFT RADL	BOTH IP/OP	$474.38 	$351.04	$0.00	$379.50	$213.47	$213.47	$0.00	$0.00	$0.00	$98.87	$352.08	$352.08	$0.00	$0.00	$98.86	$0.00	$280.59	$280.59	$0.00	$237.19	$375.71	$379.50	$0.00		$0.00	$74.24	$0.00	$0.00	$75.52	$0.00	$0.00	$0.00	$0.00	$0.00
54-25254	SUP	HCPCS C1713		54-25254  -  PLATE REG 2.7MM SCR 8 HOLE RECON BONE RIGHT RADL	BOTH IP/OP	$577.50 	$427.35	$0.00	$462.00	$259.88	$259.88	$0.00	$0.00	$0.00	$120.37	$428.62	$428.62	$0.00	$0.00	$120.35	$0.00	$341.59	$341.59	$0.00	$288.75	$457.38	$462.00	$0.00		$0.00	$90.38	$0.00	$0.00	$91.94	$0.00	$0.00	$0.00	$0.00	$0.00
54-25255	SUP	HCPCS C1713		54-25255  -  PLATE REG 2.7MM SCR 8 HOLE RECON BONE LEFT RADL	BOTH IP/OP	$577.50 	$427.35	$0.00	$462.00	$259.88	$259.88	$0.00	$0.00	$0.00	$120.37	$428.62	$428.62	$0.00	$0.00	$120.35	$0.00	$341.59	$341.59	$0.00	$288.75	$457.38	$462.00	$0.00		$0.00	$90.38	$0.00	$0.00	$91.94	$0.00	$0.00	$0.00	$0.00	$0.00
54-25270	SUP	HCPCS C1713		54-25270  -  PLATE MED BONE PLMR RADL	BOTH IP/OP	$790.63 	$585.07	$0.00	$632.50	$355.78	$355.78	$0.00	$0.00	$0.00	$164.79	$586.80	$586.80	$0.00	$0.00	$164.77	$0.00	$467.65	$467.65	$0.00	$395.31	$626.18	$632.50	$0.00		$0.00	$123.73	$0.00	$0.00	$125.87	$0.00	$0.00	$0.00	$0.00	$0.00
54-25271	SUP	HCPCS C1713		54-25271  -  PLATE MED BONE LEFT DORSAL RADL	BOTH IP/OP	$790.63 	$585.07	$0.00	$632.50	$355.78	$355.78	$0.00	$0.00	$0.00	$164.79	$586.80	$586.80	$0.00	$0.00	$164.77	$0.00	$467.65	$467.65	$0.00	$395.31	$626.18	$632.50	$0.00		$0.00	$123.73	$0.00	$0.00	$125.87	$0.00	$0.00	$0.00	$0.00	$0.00
54-25272	SUP	HCPCS C1713		54-25272  -  PLATE MED BONE LEFT DORSAL RADL	BOTH IP/OP	$790.63 	$585.07	$0.00	$632.50	$355.78	$355.78	$0.00	$0.00	$0.00	$164.79	$586.80	$586.80	$0.00	$0.00	$164.77	$0.00	$467.65	$467.65	$0.00	$395.31	$626.18	$632.50	$0.00		$0.00	$123.73	$0.00	$0.00	$125.87	$0.00	$0.00	$0.00	$0.00	$0.00
54-25273	SUP	HCPCS C1713		54-25273  -  PLATE LG BONE LEFT DORSAL RADL	BOTH IP/OP	$790.63 	$585.07	$0.00	$632.50	$355.78	$355.78	$0.00	$0.00	$0.00	$164.79	$586.80	$586.80	$0.00	$0.00	$164.77	$0.00	$467.65	$467.65	$0.00	$395.31	$626.18	$632.50	$0.00		$0.00	$123.73	$0.00	$0.00	$125.87	$0.00	$0.00	$0.00	$0.00	$0.00
54-25274	SUP	HCPCS C1713		54-25274  -  PLATE MED BONE RIGHT DORSAL RADL	BOTH IP/OP	$790.63 	$585.07	$0.00	$632.50	$355.78	$355.78	$0.00	$0.00	$0.00	$164.79	$586.80	$586.80	$0.00	$0.00	$164.77	$0.00	$467.65	$467.65	$0.00	$395.31	$626.18	$632.50	$0.00		$0.00	$123.73	$0.00	$0.00	$125.87	$0.00	$0.00	$0.00	$0.00	$0.00
54-25275	SUP	HCPCS C1713		54-25275  -  PLATE LG BONE RIGHT DORSAL RADL	BOTH IP/OP	$790.63 	$585.07	$0.00	$632.50	$355.78	$355.78	$0.00	$0.00	$0.00	$164.79	$586.80	$586.80	$0.00	$0.00	$164.77	$0.00	$467.65	$467.65	$0.00	$395.31	$626.18	$632.50	$0.00		$0.00	$123.73	$0.00	$0.00	$125.87	$0.00	$0.00	$0.00	$0.00	$0.00
54-25290	SUP	HCPCS C1713		54-25290  -  PLATE BN STD VARIAX LCK TI RDS RT DIST DRSL	BOTH IP/OP	"$1,656.00 "	"$1,225.44"	$0.00	"$1,229.08"	$511.09	$511.09	$0.00	$0.00	$0.00	$345.15	"$1,229.08"	"$1,229.08"	$0.00	$0.00	$345.11	$0.00	$979.52	$979.52	$0.00	$567.88	$899.51	$908.60	$0.00		$0.00	$177.74	$0.00	$0.00	$180.81	$0.00	$0.00	$0.00	$0.00	$0.00
54-25291	SUP	HCPCS C1713		54-25291  -  PLATE MED STD ORBTL FLR BONE SMARTLOCK TI	BOTH IP/OP	"$1,656.00 "	"$1,225.44"	$0.00	"$1,229.08"	$511.09	$511.09	$0.00	$0.00	$0.00	$345.15	"$1,229.08"	"$1,229.08"	$0.00	$0.00	$345.11	$0.00	$979.52	$979.52	$0.00	$567.88	$899.51	$908.60	$0.00		$0.00	$177.74	$0.00	$0.00	$180.81	$0.00	$0.00	$0.00	$0.00	$0.00
54-25292	SUP	HCPCS C1713		54-25292  -  PLATE W TI LCK VARIAX BONE RIGHT DISTAL DORSAL RADL	BOTH IP/OP	"$1,656.00 "	"$1,225.44"	$0.00	"$1,229.08"	$511.09	$511.09	$0.00	$0.00	$0.00	$345.15	"$1,229.08"	"$1,229.08"	$0.00	$0.00	$345.11	$0.00	$979.52	$979.52	$0.00	$567.88	$899.51	$908.60	$0.00		$0.00	$177.74	$0.00	$0.00	$180.81	$0.00	$0.00	$0.00	$0.00	$0.00
54-25293	SUP	HCPCS C1713		54-25293  -  PLATE W LCK VARIAX BONE LEFT DISTAL DORSAL RADL	BOTH IP/OP	"$1,656.00 "	"$1,225.44"	$0.00	"$1,229.08"	$511.09	$511.09	$0.00	$0.00	$0.00	$345.15	"$1,229.08"	"$1,229.08"	$0.00	$0.00	$345.11	$0.00	$979.52	$979.52	$0.00	$567.88	$899.51	$908.60	$0.00		$0.00	$177.74	$0.00	$0.00	$180.81	$0.00	$0.00	$0.00	$0.00	$0.00
54-25294	SUP	HCPCS C1713		54-25294  -  PLATE STD XLNG LCK VARIAX BONE RIGHT DISTAL DORSAL RADL	BOTH IP/OP	"$1,911.00 "	"$1,414.14"	$0.00	"$1,418.34"	$581.01	$581.01	$0.00	$0.00	$0.00	$398.30	"$1,418.34"	"$1,418.34"	$0.00	$0.00	$398.25	$0.00	"$1,130.36"	"$1,130.36"	$0.00	$645.56	"$1,022.57"	"$1,032.90"	$0.00		$0.00	$202.06	$0.00	$0.00	$205.55	$0.00	$0.00	$0.00	$0.00	$0.00
54-25295	SUP	HCPCS C1713		54-25295  -  PLATE STD XLNG LCK VARIAX BONE LEFT DISTAL DORSAL RADL	BOTH IP/OP	"$1,911.00 "	"$1,414.14"	$0.00	"$1,418.34"	$581.01	$581.01	$0.00	$0.00	$0.00	$398.30	"$1,418.34"	"$1,418.34"	$0.00	$0.00	$398.25	$0.00	"$1,130.36"	"$1,130.36"	$0.00	$645.56	"$1,022.57"	"$1,032.90"	$0.00		$0.00	$202.06	$0.00	$0.00	$205.55	$0.00	$0.00	$0.00	$0.00	$0.00
54-25296	SUP	HCPCS C1713		54-25296  -  PLATE XLNG LCK W VARIAX BONE RIGHT DISTAL DORSAL RADL	BOTH IP/OP	"$1,911.00 "	"$1,414.14"	$0.00	"$1,418.34"	$581.01	$581.01	$0.00	$0.00	$0.00	$398.30	"$1,418.34"	"$1,418.34"	$0.00	$0.00	$398.25	$0.00	"$1,130.36"	"$1,130.36"	$0.00	$645.56	"$1,022.57"	"$1,032.90"	$0.00		$0.00	$202.06	$0.00	$0.00	$205.55	$0.00	$0.00	$0.00	$0.00	$0.00
54-25297	SUP	HCPCS C1713		54-25297  -  PLATE XLNG LCK W VARIAX BONE LEFT DISTAL DORSAL RADL	BOTH IP/OP	"$1,911.00 "	"$1,414.14"	$0.00	"$1,418.34"	$581.01	$581.01	$0.00	$0.00	$0.00	$398.30	"$1,418.34"	"$1,418.34"	$0.00	$0.00	$398.25	$0.00	"$1,130.36"	"$1,130.36"	$0.00	$645.56	"$1,022.57"	"$1,032.90"	$0.00		$0.00	$202.06	$0.00	$0.00	$205.55	$0.00	$0.00	$0.00	$0.00	$0.00
54-25374	SUP	HCPCS C1713		54-25374  -  PLATE NAR LCK PLT SYS ANTM VARIAX BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,206.08"	$618.13	$618.13	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$686.81	"$1,087.91"	"$1,098.90"	$0.00		$0.00	$214.97	$0.00	$0.00	$218.68	$0.00	$0.00	$0.00	$0.00	$0.00
54-25375	SUP	HCPCS C1713		54-25375  -  PLATE NAR LNG LCK ANTM VARIAX BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$1,877.00 "	"$1,388.98"	$0.00	"$1,393.11"	$618.13	$618.13	$0.00	$0.00	$0.00	$391.21	"$1,393.11"	"$1,393.11"	$0.00	$0.00	$391.17	$0.00	"$1,110.25"	"$1,110.25"	$0.00	$686.81	"$1,087.91"	"$1,098.90"	$0.00		$0.00	$214.97	$0.00	$0.00	$218.68	$0.00	$0.00	$0.00	$0.00	$0.00
54-25376	SUP	HCPCS C1713		54-25376  -  PLATE STD LCK SYS ANTM VARIAX BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,206.08"	$618.13	$618.13	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$686.81	"$1,087.91"	"$1,098.90"	$0.00		$0.00	$214.97	$0.00	$0.00	$218.68	$0.00	$0.00	$0.00	$0.00	$0.00
54-25377	SUP	HCPCS C1713		54-25377  -  PLATE STD LNG LCK PLT SYS ANTM VARIAX BONE LEFT DISTAL VOLR	BOTH IP/OP	"$1,877.00 "	"$1,388.98"	$0.00	"$1,393.11"	$618.13	$618.13	$0.00	$0.00	$0.00	$391.21	"$1,393.11"	"$1,393.11"	$0.00	$0.00	$391.17	$0.00	"$1,110.25"	"$1,110.25"	$0.00	$686.81	"$1,087.91"	"$1,098.90"	$0.00		$0.00	$214.97	$0.00	$0.00	$218.68	$0.00	$0.00	$0.00	$0.00	$0.00
54-25384	SUP	HCPCS C1713		54-25384  -  PLATE NAR LCK SYS ANTM VARIAX BONE RIGHT DISTAL VOLR RADL	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,206.08"	$618.13	$618.13	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$686.81	"$1,087.91"	"$1,098.90"	$0.00		$0.00	$214.97	$0.00	$0.00	$218.68	$0.00	$0.00	$0.00	$0.00	$0.00
54-25385	SUP	HCPCS C1713		54-25385  -  PLATE BN NAR LNG VARIAX ANTM LCK TI RADL RT DIST VOLR	BOTH IP/OP	"$1,877.00 "	"$1,388.98"	$0.00	"$1,393.11"	$618.13	$618.13	$0.00	$0.00	$0.00	$391.21	"$1,393.11"	"$1,393.11"	$0.00	$0.00	$391.17	$0.00	"$1,110.25"	"$1,110.25"	$0.00	$686.81	"$1,087.91"	"$1,098.90"	$0.00		$0.00	$214.97	$0.00	$0.00	$218.68	$0.00	$0.00	$0.00	$0.00	$0.00
54-25386	SUP	HCPCS C1713		54-25386  -  PLATE STD LCK SYS ANTM VARIAX BONE RIGHT DISTAL VOLR RADL	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,206.08"	$618.13	$618.13	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$686.81	"$1,087.91"	"$1,098.90"	$0.00		$0.00	$214.97	$0.00	$0.00	$218.68	$0.00	$0.00	$0.00	$0.00	$0.00
54-25387	SUP	HCPCS C1713		54-25387  -  PLATE STD LNG LCK SYS ANTM VARIAX BONE RIGHT DISTAL VOLR	BOTH IP/OP	"$1,877.00 "	"$1,388.98"	$0.00	"$1,393.11"	$618.13	$618.13	$0.00	$0.00	$0.00	$391.21	"$1,393.11"	"$1,393.11"	$0.00	$0.00	$391.17	$0.00	"$1,110.25"	"$1,110.25"	$0.00	$686.81	"$1,087.91"	"$1,098.90"	$0.00		$0.00	$214.97	$0.00	$0.00	$218.68	$0.00	$0.00	$0.00	$0.00	$0.00
54-25391	SUP	HCPCS C1713		54-25391  -  PLATE NAR XLNG UNV TI LCK VARIAX BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$1,469.00 "	"$1,087.06"	$0.00	"$1,098.90"	$618.13	$618.13	$0.00	$0.00	$0.00	$306.18	"$1,090.29"	"$1,090.29"	$0.00	$0.00	$306.14	$0.00	$868.91	$868.91	$0.00	$686.81	"$1,087.91"	"$1,098.90"	$0.00		$0.00	$214.97	$0.00	$0.00	$218.68	$0.00	$0.00	$0.00	$0.00	$0.00
54-25392	SUP	HCPCS C1713		54-25392  -  PLATE XLNG STD UNV TI LCK VARIAX BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$1,469.00 "	"$1,087.06"	$0.00	"$1,098.90"	$618.13	$618.13	$0.00	$0.00	$0.00	$306.18	"$1,090.29"	"$1,090.29"	$0.00	$0.00	$306.14	$0.00	$868.91	$868.91	$0.00	$686.81	"$1,087.91"	"$1,098.90"	$0.00		$0.00	$214.97	$0.00	$0.00	$218.68	$0.00	$0.00	$0.00	$0.00	$0.00
54-25393	SUP	HCPCS C1713		54-25393  -  PLATE XLNG UNV TI LCK W VARIAX BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$1,469.00 "	"$1,087.06"	$0.00	"$1,098.90"	$618.13	$618.13	$0.00	$0.00	$0.00	$306.18	"$1,090.29"	"$1,090.29"	$0.00	$0.00	$306.14	$0.00	$868.91	$868.91	$0.00	$686.81	"$1,087.91"	"$1,098.90"	$0.00		$0.00	$214.97	$0.00	$0.00	$218.68	$0.00	$0.00	$0.00	$0.00	$0.00
54-25394	SUP	HCPCS C1713		54-25394  -  PLATE NAR SHRT TI LCK VARIAX BONE DISTAL VOLR RADL	BOTH IP/OP	"$1,373.00 "	"$1,016.02"	$0.00	"$1,032.90"	$581.01	$581.01	$0.00	$0.00	$0.00	$286.17	"$1,019.04"	"$1,019.04"	$0.00	$0.00	$286.13	$0.00	$812.13	$812.13	$0.00	$645.56	"$1,022.57"	"$1,032.90"	$0.00		$0.00	$202.06	$0.00	$0.00	$205.55	$0.00	$0.00	$0.00	$0.00	$0.00
54-25395	SUP	HCPCS C1713		54-25395  -  PLATE NAR LNG UNV TI LCK VARIAX BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$1,373.00 "	"$1,016.02"	$0.00	"$1,032.90"	$581.01	$581.01	$0.00	$0.00	$0.00	$286.17	"$1,019.04"	"$1,019.04"	$0.00	$0.00	$286.13	$0.00	$812.13	$812.13	$0.00	$645.56	"$1,022.57"	"$1,032.90"	$0.00		$0.00	$202.06	$0.00	$0.00	$205.55	$0.00	$0.00	$0.00	$0.00	$0.00
54-25396	SUP	HCPCS C1713		54-25396  -  PLATE UNV STD SHRT LCK VARIAX BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$1,373.00 "	"$1,016.02"	$0.00	"$1,032.90"	$581.01	$581.01	$0.00	$0.00	$0.00	$286.17	"$1,019.04"	"$1,019.04"	$0.00	$0.00	$286.13	$0.00	$812.13	$812.13	$0.00	$645.56	"$1,022.57"	"$1,032.90"	$0.00		$0.00	$202.06	$0.00	$0.00	$205.55	$0.00	$0.00	$0.00	$0.00	$0.00
54-25397	SUP	HCPCS C1713		54-25397  -  PLATE UNV STD LNG LCK VARIAX BONE RADL DISTAL VOLR	BOTH IP/OP	"$1,373.00 "	"$1,016.02"	$0.00	"$1,032.90"	$581.01	$581.01	$0.00	$0.00	$0.00	$286.17	"$1,019.04"	"$1,019.04"	$0.00	$0.00	$286.13	$0.00	$812.13	$812.13	$0.00	$645.56	"$1,022.57"	"$1,032.90"	$0.00		$0.00	$202.06	$0.00	$0.00	$205.55	$0.00	$0.00	$0.00	$0.00	$0.00
54-25398	SUP	HCPCS C1713		54-25398  -  PLATE UNV W SHRT LCK VARIAX BONE RADL DISTAL VOLR	BOTH IP/OP	"$1,373.00 "	"$1,016.02"	$0.00	"$1,032.90"	$581.01	$581.01	$0.00	$0.00	$0.00	$286.17	"$1,019.04"	"$1,019.04"	$0.00	$0.00	$286.13	$0.00	$812.13	$812.13	$0.00	$645.56	"$1,022.57"	"$1,032.90"	$0.00		$0.00	$202.06	$0.00	$0.00	$205.55	$0.00	$0.00	$0.00	$0.00	$0.00
54-25399	SUP	HCPCS C1713		54-25399  -  PLATE UNV W LNG LCK VARIAX BONE RADL DISTAL VOLR	BOTH IP/OP	"$1,373.00 "	"$1,016.02"	$0.00	"$1,032.90"	$581.01	$581.01	$0.00	$0.00	$0.00	$286.17	"$1,019.04"	"$1,019.04"	$0.00	$0.00	$286.13	$0.00	$812.13	$812.13	$0.00	$645.56	"$1,022.57"	"$1,032.90"	$0.00		$0.00	$202.06	$0.00	$0.00	$205.55	$0.00	$0.00	$0.00	$0.00	$0.00
54-25400	SUP	HCPCS C1713		54-25400  -  PLATE SHRT TI CLMN FRAG SPC VARIAX BONE RADL	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$898.06	$417.66	$417.66	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$464.06	$735.08	$742.50	$0.00		$0.00	$145.25	$0.00	$0.00	$147.76	$0.00	$0.00	$0.00	$0.00	$0.00
54-25401	SUP	HCPCS C1713		54-25401  -  PLATE LNG TI CLMN SMARTLOCK BONE VOLR RADL	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$898.06	$417.66	$417.66	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$464.06	$735.08	$742.50	$0.00		$0.00	$145.25	$0.00	$0.00	$147.76	$0.00	$0.00	$0.00	$0.00	$0.00
54-25402	SUP	HCPCS C1713		54-25402  -  PLATE SHRT TI CLMN SMARTLOCK BONE RIGHT DISTAL ULN	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$898.06	$417.66	$417.66	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$464.06	$735.08	$742.50	$0.00		$0.00	$145.25	$0.00	$0.00	$147.76	$0.00	$0.00	$0.00	$0.00	$0.00
54-25403	SUP	HCPCS C1713		54-25403  -  PLATE BN SHRT 40MMX1MM VARIAX LCK CLMN TI ULNA LT FRAG SPC	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$898.06	$417.66	$417.66	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$464.06	$735.08	$742.50	$0.00		$0.00	$145.25	$0.00	$0.00	$147.76	$0.00	$0.00	$0.00	$0.00	$0.00
54-25404	SUP	HCPCS C1713		54-25404  -  PLATE LNG LCK CLMN FRAG SPC VARIAX BONE RIGHT RADL DISTAL	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$898.06	$417.66	$417.66	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$464.06	$735.08	$742.50	$0.00		$0.00	$145.25	$0.00	$0.00	$147.76	$0.00	$0.00	$0.00	$0.00	$0.00
54-25405	SUP	HCPCS C1713		54-25405  -  PLATE LNG TI CLMN SMARTLOCK BONE LEFT RADL DISTAL ULN	BOTH IP/OP	"$1,210.00 "	$895.40	$0.00	$898.06	$417.66	$417.66	$0.00	$0.00	$0.00	$252.19	$898.06	$898.06	$0.00	$0.00	$252.16	$0.00	$715.72	$715.72	$0.00	$464.06	$735.08	$742.50	$0.00		$0.00	$145.25	$0.00	$0.00	$147.76	$0.00	$0.00	$0.00	$0.00	$0.00
54-25420S	SUP	HCPCS C1713		54-25420S  -  PLATE 2XL THK3MM 189MM 15 HOLE ANTM STND BONE 2.7MM LEFT	BOTH IP/OP	"$3,145.00 "	"$2,327.30"	$0.00	"$2,334.22"	"$1,218.94"	"$1,218.94"	$0.00	$0.00	$0.00	$655.50	"$2,334.22"	"$2,334.22"	$0.00	$0.00	$655.42	$0.00	"$1,550.49"	"$1,550.49"	$0.00	"$1,354.38"	"$2,145.33"	"$2,167.00"	$0.00		$0.00	$423.92	$0.00	$0.00	$431.23	$0.00	$0.00	$0.00	$0.00	$0.00
54-25422S	SUP	HCPCS C1713		54-25422S  -  PLATE 2XL THK3MM 189MM 15 HOLE ANTM STND BONE 2.7MM RIGHT	BOTH IP/OP	"$3,145.00 "	"$2,327.30"	$0.00	"$2,334.22"	"$1,218.94"	"$1,218.94"	$0.00	$0.00	$0.00	$655.50	"$2,334.22"	"$2,334.22"	$0.00	$0.00	$655.42	$0.00	"$1,550.49"	"$1,550.49"	$0.00	"$1,354.38"	"$2,145.33"	"$2,167.00"	$0.00		$0.00	$423.92	$0.00	$0.00	$431.23	$0.00	$0.00	$0.00	$0.00	$0.00
54-25424S	SUP	HCPCS C1713		54-25424S  -  PLATE BN 2XL 189MMX3MM STRL 15 HL ANTM STND RADL RT DIST	BOTH IP/OP	"$3,145.00 "	"$2,327.30"	$0.00	"$2,334.22"	"$1,163.25"	"$1,163.25"	$0.00	$0.00	$0.00	$655.50	"$2,334.22"	"$2,334.22"	$0.00	$0.00	$655.42	$0.00	"$1,550.49"	"$1,550.49"	$0.00	"$1,292.50"	"$2,047.32"	"$2,068.00"	$0.00		$0.00	$404.55	$0.00	$0.00	$411.53	$0.00	$0.00	$0.00	$0.00	$0.00
54-25426S	SUP	HCPCS C1713		54-25426S  -  PLATE STD 145MM 2.7MM SCR 11 HOLE BONE RIGHT DISTAL VOLR	BOTH IP/OP	"$3,145.00 "	"$2,327.30"	$0.00	"$2,334.22"	"$1,163.25"	"$1,163.25"	$0.00	$0.00	$0.00	$655.50	"$2,334.22"	"$2,334.22"	$0.00	$0.00	$655.42	$0.00	"$1,550.49"	"$1,550.49"	$0.00	"$1,292.50"	"$2,047.32"	"$2,068.00"	$0.00		$0.00	$404.55	$0.00	$0.00	$411.53	$0.00	$0.00	$0.00	$0.00	$0.00
54-25428S	SUP	HCPCS C1713		54-25428S  -  PLATE 2XL THK3MM STD 100MM 8 HOLE ANTM BONE LEFT DISTAL VOLR	BOTH IP/OP	"$2,751.00 "	"$2,035.74"	$0.00	"$2,041.79"	"$1,126.13"	"$1,126.13"	$0.00	$0.00	$0.00	$573.38	"$2,041.79"	"$2,041.79"	$0.00	$0.00	$573.31	$0.00	"$1,356.24"	"$1,356.24"	$0.00	"$1,251.25"	"$1,981.98"	"$2,002.00"	$0.00		$0.00	$391.64	$0.00	$0.00	$398.40	$0.00	$0.00	$0.00	$0.00	$0.00
54-25430S	SUP	HCPCS C1713		54-25430S  -  PLATE 2XL STD 100MMX3MM 2.7MM SCR 8 HOLE ANTM BONE RIGHT	BOTH IP/OP	"$2,751.00 "	"$2,035.74"	$0.00	"$2,041.79"	"$1,126.13"	"$1,126.13"	$0.00	$0.00	$0.00	$573.38	"$2,041.79"	"$2,041.79"	$0.00	$0.00	$573.31	$0.00	"$1,356.24"	"$1,356.24"	$0.00	"$1,251.25"	"$1,981.98"	"$2,002.00"	$0.00		$0.00	$391.64	$0.00	$0.00	$398.40	$0.00	$0.00	$0.00	$0.00	$0.00
54-25432S	SUP	HCPCS C1713		54-25432S  -  PLATE 2XL THK3MM 74MM 2.7MM SCR 5 HOLE VARIAX BONE 2.7MM	BOTH IP/OP	"$2,751.00 "	"$2,035.74"	$0.00	"$2,041.79"	"$1,089.00"	"$1,089.00"	$0.00	$0.00	$0.00	$573.38	"$2,041.79"	"$2,041.79"	$0.00	$0.00	$573.31	$0.00	"$1,356.24"	"$1,356.24"	$0.00	"$1,210.00"	"$1,916.64"	"$1,936.00"	$0.00		$0.00	$378.73	$0.00	$0.00	$385.26	$0.00	$0.00	$0.00	$0.00	$0.00
54-25434S	SUP	HCPCS C1713		54-25434S  -  PLATE 2XL THK3MM 74MM 5 HOLE ANTM STND BONE 2.7MM RIGHT VOLR	BOTH IP/OP	"$2,751.00 "	"$2,035.74"	$0.00	"$2,041.79"	"$1,089.00"	"$1,089.00"	$0.00	$0.00	$0.00	$573.38	"$2,041.79"	"$2,041.79"	$0.00	$0.00	$573.31	$0.00	"$1,356.24"	"$1,356.24"	$0.00	"$1,210.00"	"$1,916.64"	"$1,936.00"	$0.00		$0.00	$378.73	$0.00	$0.00	$385.26	$0.00	$0.00	$0.00	$0.00	$0.00
54-25436S	SUP	HCPCS C1713		54-25436S  -  PLATE 2XL THK3MM 189MM 15 HOLE ANTM NAR BONE 2.7MM LEFT VOLR	BOTH IP/OP	"$3,145.00 "	"$2,327.30"	$0.00	"$2,334.22"	"$1,188.00"	"$1,188.00"	$0.00	$0.00	$0.00	$655.50	"$2,334.22"	"$2,334.22"	$0.00	$0.00	$655.42	$0.00	"$1,550.49"	"$1,550.49"	$0.00	"$1,320.00"	"$2,090.88"	"$2,112.00"	$0.00		$0.00	$413.16	$0.00	$0.00	$420.29	$0.00	$0.00	$0.00	$0.00	$0.00
54-25438S	SUP	HCPCS C1713		54-25438S  -  PLATE 2XL THK3MM 189MM 15 HOLE ANTM NAR BONE 2.7MM RIGHT	BOTH IP/OP	"$3,145.00 "	"$2,327.30"	$0.00	"$2,334.22"	"$1,188.00"	"$1,188.00"	$0.00	$0.00	$0.00	$655.50	"$2,334.22"	"$2,334.22"	$0.00	$0.00	$655.42	$0.00	"$1,550.49"	"$1,550.49"	$0.00	"$1,320.00"	"$2,090.88"	"$2,112.00"	$0.00		$0.00	$413.16	$0.00	$0.00	$420.29	$0.00	$0.00	$0.00	$0.00	$0.00
54-25440S	SUP	HCPCS C1713		54-25440S  -  PLATE 2XL THK3MM 145MM 11 HOLE ANTM NAR BONE 2.7MM LEFT VOLR	BOTH IP/OP	"$3,145.00 "	"$2,327.30"	$0.00	"$2,334.22"	"$1,132.31"	"$1,132.31"	$0.00	$0.00	$0.00	$655.50	"$2,334.22"	"$2,334.22"	$0.00	$0.00	$655.42	$0.00	"$1,550.49"	"$1,550.49"	$0.00	"$1,258.13"	"$1,992.87"	"$2,013.00"	$0.00		$0.00	$393.79	$0.00	$0.00	$400.59	$0.00	$0.00	$0.00	$0.00	$0.00
54-25442S	SUP	HCPCS C1713		54-25442S  -  PLATE 2XL 145MMX3MM 2.7MM SCR 11 HOLE ANTM NAR VARIAX BONE	BOTH IP/OP	"$3,145.00 "	"$2,327.30"	$0.00	"$2,334.22"	"$1,132.31"	"$1,132.31"	$0.00	$0.00	$0.00	$655.50	"$2,334.22"	"$2,334.22"	$0.00	$0.00	$655.42	$0.00	"$1,550.49"	"$1,550.49"	$0.00	"$1,258.13"	"$1,992.87"	"$2,013.00"	$0.00		$0.00	$393.79	$0.00	$0.00	$400.59	$0.00	$0.00	$0.00	$0.00	$0.00
54-25444S	SUP	HCPCS C1713		54-25444S  -  PLATE 2XL NAR 2.7MM SCR 8 HOLE ANTM BONE LEFT DISTAL VOLR	BOTH IP/OP	"$2,751.00 "	"$2,035.74"	$0.00	"$2,041.79"	"$1,095.19"	"$1,095.19"	$0.00	$0.00	$0.00	$573.38	"$2,041.79"	"$2,041.79"	$0.00	$0.00	$573.31	$0.00	"$1,356.24"	"$1,356.24"	$0.00	"$1,216.88"	"$1,927.53"	"$1,947.00"	$0.00		$0.00	$380.88	$0.00	$0.00	$387.45	$0.00	$0.00	$0.00	$0.00	$0.00
54-25446S	SUP	HCPCS C1713		54-25446S  -  PLATE 2XL 100MMX3MM 2.7MM SCR 8 HOLE ANTM NAR VARIAX BONE	BOTH IP/OP	"$2,751.00 "	"$2,035.74"	$0.00	"$2,041.79"	"$1,095.19"	"$1,095.19"	$0.00	$0.00	$0.00	$573.38	"$2,041.79"	"$2,041.79"	$0.00	$0.00	$573.31	$0.00	"$1,356.24"	"$1,356.24"	$0.00	"$1,216.88"	"$1,927.53"	"$1,947.00"	$0.00		$0.00	$380.88	$0.00	$0.00	$387.45	$0.00	$0.00	$0.00	$0.00	$0.00
54-25448S	SUP	HCPCS C1713		54-25448S  -  PLATE 2XL NAR 2.7MM SCR 5 HOLE ANTM BONE LEFT DISTAL VOLR	BOTH IP/OP	"$2,751.00 "	"$2,035.74"	$0.00	"$2,041.79"	"$1,058.06"	"$1,058.06"	$0.00	$0.00	$0.00	$573.38	"$2,041.79"	"$2,041.79"	$0.00	$0.00	$573.31	$0.00	"$1,356.24"	"$1,356.24"	$0.00	"$1,175.63"	"$1,862.19"	"$1,881.00"	$0.00		$0.00	$367.97	$0.00	$0.00	$374.32	$0.00	$0.00	$0.00	$0.00	$0.00
54-25450S	SUP	HCPCS C1713		54-25450S  -  PLATE 2XL 74MMX3MM 2.7MM SCR 5 HOLE ANTM NAR VARIAX BONE	BOTH IP/OP	"$2,751.00 "	"$2,035.74"	$0.00	"$2,041.79"	"$1,058.06"	"$1,058.06"	$0.00	$0.00	$0.00	$573.38	"$2,041.79"	"$2,041.79"	$0.00	$0.00	$573.31	$0.00	"$1,356.24"	"$1,356.24"	$0.00	"$1,175.63"	"$1,862.19"	"$1,881.00"	$0.00		$0.00	$367.97	$0.00	$0.00	$374.32	$0.00	$0.00	$0.00	$0.00	$0.00
542T-11-42A	SUP	Custom 27803010		542T-11-42A  -  SHELL ACETAB HYDRXAPT TR PSL T	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542T-11-44B	SUP	Custom 27803010		542T-11-44B  -  SHELL ACETAB HYDRXAPT TR PSL T	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542T-11-46C	SUP	Custom 27803010		542T-11-46C  -  SHELL ACETAB HYDRXAPT TR PSL T	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542T-11-50D	SUP	Custom 27803010		542T-11-50D  -  SHELL ACETAB HYDRXAPT TR PSL T	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542T-11-54E	SUP	Custom 27803010		542T-11-54E  -  SHELL ACETAB HYDRXAPT TR PSL T	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542T-11-58F	SUP	Custom 27803010		542T-11-58F  -  SHELL ACETAB HYDRXAPT TR PSL T	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542T-11-62G	SUP	Custom 27803010		542T-11-62G  -  SHELL ACETAB HYDRXAPT TR PSL T	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542T-11-66H	SUP	Custom 27803010		542T-11-66H  -  SHELL ACETAB HYDRXAPT TR PSL T	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
542T-11-70I	SUP	Custom 27803010		542T-11-70I  -  SHELL ACETAB HYDRXAPT TR PSL T	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5444-0-110	SUP	HCPCS C1895		5444-0-110  -  GRAFT SYNTH TISSUE SMALL CUSTOMIZE MEDPOR	BOTH IP/OP	"$25,393.75 "	"$18,791.38"	$0.00	"$25,726.00"	"$14,470.88"	"$14,470.88"	$0.00	$0.00	$0.00	"$5,292.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,292.06"	$0.00	"$12,519.12"	"$12,519.12"	$0.00	"$16,078.75"	"$25,468.74"	"$25,726.00"	$0.00		$0.00	"$5,032.65"	$0.00	$0.00	"$5,119.47"	$0.00	$0.00	$0.00	$0.00	$0.00
5444-0-210	SUP	HCPCS C1895		5444-0-210  -  GRAFT SYNTH TISSUE MEDIUM CUSTOMIZE MEDPOR	BOTH IP/OP	"$38,395.00 "	"$28,412.30"	$0.00	"$30,716.00"	"$17,277.75"	"$17,277.75"	$0.00	$0.00	$0.00	"$8,002.48"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,001.52"	$0.00	"$18,928.74"	"$18,928.74"	$0.00	"$19,197.50"	"$30,408.84"	"$30,716.00"	$0.00		$0.00	"$6,008.82"	$0.00	$0.00	"$6,112.48"	$0.00	$0.00	$0.00	$0.00	$0.00
5444-0-310	SUP	HCPCS C1895		5444-0-310  -  GRAFT SYNTH TISSUE LARGE CUSTOMIZE MEDPOR	BOTH IP/OP	"$45,842.50 "	"$33,923.45"	$0.00	"$36,674.00"	"$20,629.13"	"$20,629.13"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,553.58"	$0.00	"$22,600.35"	"$22,600.35"	$0.00	"$22,921.25"	"$36,307.26"	"$36,674.00"	$0.00		$0.00	"$7,174.35"	$0.00	$0.00	"$7,298.13"	$0.00	$0.00	$0.00	$0.00	$0.00
5444-0-410	SUP	HCPCS C1895		5444-0-410  -  GRAFT SYNTH TISSUE XL CUSTOMIZE MEDPOR	BOTH IP/OP	"$54,737.50 "	"$40,505.75"	$0.00	"$43,790.00"	"$24,631.88"	"$24,631.88"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$11,407.30"	$0.00	"$26,985.59"	"$26,985.59"	$0.00	"$27,368.75"	"$43,352.10"	"$43,790.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
5444-0-510	SUP	HCPCS C1895		5444-0-510  -  GRAFT SYNTH TISSUE CUSTOMIZE MEDPOR MIDFAC	BOTH IP/OP	"$42,120.00 "	"$31,168.80"	$0.00	"$33,696.00"	"$18,954.00"	"$18,954.00"	$0.00	$0.00	$0.00	"$8,778.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,777.81"	$0.00	"$20,765.16"	"$20,765.16"	$0.00	"$21,060.00"	"$33,359.04"	"$33,696.00"	$0.00		$0.00	"$6,591.78"	$0.00	$0.00	"$6,705.50"	$0.00	$0.00	$0.00	$0.00	$0.00
5444-0-610	SUP	HCPCS C1895		5444-0-610  -  GRAFT SYNTH TISSUE CUSTOMIZE AUGMENTATION LATEX FREE MEDPOR	BOTH IP/OP	"$20,182.50 "	"$14,935.05"	$0.00	"$16,146.00"	"$9,082.13"	"$9,082.13"	$0.00	$0.00	$0.00	"$4,206.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,206.03"	$0.00	"$9,949.97"	"$9,949.97"	$0.00	"$10,091.25"	"$15,984.54"	"$16,146.00"	$0.00		$0.00	"$3,158.56"	$0.00	$0.00	"$3,213.05"	$0.00	$0.00	$0.00	$0.00	$0.00
5450-800-315	SUP	Custom 27203010		5450-800-315  -  TIP ASP LNG 4.6IN STRL LF SPTZLR MIC CLW MIC CLW BN DISP	BOTH IP/OP	"$8,925.00 "	"$6,604.50"	$0.00	"$7,140.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,859.97"	$0.00	$0.00	$0.00	$0.00	"$4,462.50"	"$7,068.60"	"$7,140.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
55.26.25E	SUP	Custom 27203010		55.26.25E  -  PROBE LSR 25GA STRL DRCT XTD DISP	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$0.00	$0.00	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
55-0001	SUP	HCPCS C1713		55-0001  -  NAIL HELICAL 20 MM IMPLANT	BOTH IP/OP	$657.50 	$486.55	$0.00	$526.00	$295.88	$295.88	$0.00	$0.00	$0.00	$137.04	$488.00	$488.00	$0.00	$0.00	$137.02	$0.00	$388.91	$388.91	$0.00	$328.75	$520.74	$526.00	$0.00		$0.00	$102.90	$0.00	$0.00	$104.67	$0.00	$0.00	$0.00	$0.00	$0.00
55-0002	SUP	HCPCS C1713		55-0002  -  NAIL HELICAL 30 MM IMPLANT	BOTH IP/OP	$657.50 	$486.55	$0.00	$526.00	$295.88	$295.88	$0.00	$0.00	$0.00	$137.04	$488.00	$488.00	$0.00	$0.00	$137.02	$0.00	$388.91	$388.91	$0.00	$328.75	$520.74	$526.00	$0.00		$0.00	$102.90	$0.00	$0.00	$104.67	$0.00	$0.00	$0.00	$0.00	$0.00
55-0003	SUP	HCPCS C1713		55-0003  -  NAIL HELICAL 40 MM IMPLANT	BOTH IP/OP	$657.50 	$486.55	$0.00	$526.00	$295.88	$295.88	$0.00	$0.00	$0.00	$137.04	$488.00	$488.00	$0.00	$0.00	$137.02	$0.00	$388.91	$388.91	$0.00	$328.75	$520.74	$526.00	$0.00		$0.00	$102.90	$0.00	$0.00	$104.67	$0.00	$0.00	$0.00	$0.00	$0.00
550-120	SUP	HCPCS C1713		550-120  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$242.25 	$179.27	$0.00	$193.80	$109.01	$109.01	$0.00	$0.00	$0.00	$50.49	$179.80	$179.80	$0.00	$0.00	$50.48	$0.00	$143.29	$143.29	$0.00	$121.13	$191.86	$193.80	$0.00		$0.00	$37.91	$0.00	$0.00	$38.57	$0.00	$0.00	$0.00	$0.00	$0.00
55-02950	SUP	HCPCS C1713		55-02950  -  PLATE BN NS HBRD MMF MXLMNDB	BOTH IP/OP	$870.00 	$643.80	$0.00	$696.00	$391.50	$391.50	$0.00	$0.00	$0.00	$181.33	$645.71	$645.71	$0.00	$0.00	$181.31	$0.00	$514.61	$514.61	$0.00	$435.00	$689.04	$696.00	$0.00		$0.00	$136.16	$0.00	$0.00	$138.50	$0.00	$0.00	$0.00	$0.00	$0.00
55-02951	SUP	HCPCS C1713		55-02951  -  PLATE BONE SMARTLOCK SMALL MAXILLOFACIAL HYBRID	BOTH IP/OP	$870.00 	$643.80	$0.00	$696.00	$391.50	$391.50	$0.00	$0.00	$0.00	$181.33	$645.71	$645.71	$0.00	$0.00	$181.31	$0.00	$514.61	$514.61	$0.00	$435.00	$689.04	$696.00	$0.00		$0.00	$136.16	$0.00	$0.00	$138.50	$0.00	$0.00	$0.00	$0.00	$0.00
55-03731	SUP	HCPCS C1713		55-03731  -  PLATE BONE 3D LP .55MM 2X2 HOLE MALBLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$767.50 	$567.95	$0.00	$614.00	$345.38	$345.38	$0.00	$0.00	$0.00	$159.97	$569.64	$569.64	$0.00	$0.00	$159.95	$0.00	$453.98	$453.98	$0.00	$383.75	$607.86	$614.00	$0.00		$0.00	$120.11	$0.00	$0.00	$122.19	$0.00	$0.00	$0.00	$0.00	$0.00
55-03733	SUP	HCPCS C1713		55-03733  -  PLATE BONE 3D LP .55MM 6X2 HOLE MALBLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$947.50 	$701.15	$0.00	"$1,576.00"	$886.50	$886.50	$0.00	$0.00	$0.00	$197.48	$703.23	$703.23	$0.00	$0.00	$197.46	$0.00	$560.45	$560.45	$0.00	$985.00	"$1,560.24"	"$1,576.00"	$0.00		$0.00	$308.31	$0.00	$0.00	$313.62	$0.00	$0.00	$0.00	$0.00	$0.00
55-04218	SUP	HCPCS C1713		55-04218  -  PLATE BONE STR LP .5MM 18 HOLE MALBLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$958.35 	$709.18	$0.00	"$1,694.00"	$952.88	$952.88	$0.00	$0.00	$0.00	$199.74	$711.29	$711.29	$0.00	$0.00	$199.72	$0.00	$566.86	$566.86	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$331.39	$0.00	$0.00	$337.11	$0.00	$0.00	$0.00	$0.00	$0.00
55-04231	SUP	HCPCS C1713		55-04231  -  PLATE BONE 3D .5MM 2X2 HOLE MALBLE 3D TITANIUM UPPERFACIAL	BOTH IP/OP	$439.13 	$324.96	$0.00	$774.00	$435.38	$435.38	$0.00	$0.00	$0.00	$91.52	$325.92	$325.92	$0.00	$0.00	$91.51	$0.00	$259.74	$259.74	$0.00	$483.75	$766.26	$774.00	$0.00		$0.00	$151.41	$0.00	$0.00	$154.03	$0.00	$0.00	$0.00	$0.00	$0.00
55-04233	SUP	HCPCS C1713		55-04233  -  PLATE BONE .5MM 6X2 HOLE MALBLE 3D TITANIUM UPPERFACIAL 1.2	BOTH IP/OP	$789.25 	$584.05	$0.00	"$1,394.00"	$784.13	$784.13	$0.00	$0.00	$0.00	$164.50	$585.78	$585.78	$0.00	$0.00	$164.48	$0.00	$466.84	$466.84	$0.00	$871.25	"$1,380.06"	"$1,394.00"	$0.00		$0.00	$272.70	$0.00	$0.00	$277.41	$0.00	$0.00	$0.00	$0.00	$0.00
55-04235	SUP	HCPCS C1713		55-04235  -  PLATE BONE 3D .5MM 6X6 HOLE MALBLE 3D UNIVERSAL2 TITANIUM	BOTH IP/OP	"$1,818.43 "	"$1,345.64"	$0.00	"$3,208.00"	"$1,804.50"	"$1,804.50"	$0.00	$0.00	$0.00	$379.01	"$1,349.64"	"$1,349.64"	$0.00	$0.00	$378.96	$0.00	"$1,075.60"	"$1,075.60"	$0.00	"$2,005.00"	"$3,175.92"	"$3,208.00"	$0.00		$0.00	$627.57	$0.00	$0.00	$638.39	$0.00	$0.00	$0.00	$0.00	$0.00
55-04237	SUP	HCPCS C1713		55-04237  -  PLATE BONE .5MM 10X10 HOLE MALBLE 3D TITANIUM UPPERFACIAL	BOTH IP/OP	"$2,480.68 "	"$1,835.70"	$0.00	"$4,380.00"	"$2,463.75"	"$2,463.75"	$0.00	$0.00	$0.00	$517.03	"$1,841.16"	"$1,841.16"	$0.00	$0.00	$516.97	$0.00	"$1,467.32"	"$1,467.32"	$0.00	"$2,737.50"	"$4,336.20"	"$4,380.00"	$0.00		$0.00	$856.84	$0.00	$0.00	$871.62	$0.00	$0.00	$0.00	$0.00	$0.00
55-04240	SUP	HCPCS C1713		55-04240  -  PLATE BONE 2Y LP .5MM 7 HOLE MALBLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$837.50 	$619.75	$0.00	$670.00	$376.88	$376.88	$0.00	$0.00	$0.00	$174.56	$621.59	$621.59	$0.00	$0.00	$174.54	$0.00	$495.38	$495.38	$0.00	$418.75	$663.30	$670.00	$0.00		$0.00	$131.07	$0.00	$0.00	$133.33	$0.00	$0.00	$0.00	$0.00	$0.00
55-04250	SUP	HCPCS C1713		55-04250  -  PLATE BONE CURVE .5MM 10 HOLE MALBLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$426.33 	$315.48	$0.00	$758.00	$426.38	$426.38	$0.00	$0.00	$0.00	$88.86	$316.42	$316.42	$0.00	$0.00	$88.85	$0.00	$252.17	$252.17	$0.00	$473.75	$750.42	$758.00	$0.00		$0.00	$148.28	$0.00	$0.00	$150.84	$0.00	$0.00	$0.00	$0.00	$0.00
55-04424	SUP	HCPCS C1713		55-04424  -  PLATE BONE .5MM 24 HOLE STR MALBLE CONDENSED TITANIUM	BOTH IP/OP	"$1,021.25 "	$755.73	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$212.85	$757.97	$757.97	$0.00	$0.00	$212.83	$0.00	$604.07	$604.07	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
55-04720	SUP	HCPCS C1713		55-04720  -  PLATE BONE STR .5MM 20 HOLE MALBLE TITANIUM MIDFAC 1.7MM	BOTH IP/OP	"$1,002.25 "	$741.67	$0.00	"$1,798.00"	"$1,011.38"	"$1,011.38"	$0.00	$0.00	$0.00	$208.89	$743.87	$743.87	$0.00	$0.00	$208.87	$0.00	$592.83	$592.83	$0.00	"$1,123.75"	"$1,780.02"	"$1,798.00"	$0.00		$0.00	$351.73	$0.00	$0.00	$357.80	$0.00	$0.00	$0.00	$0.00	$0.00
55-04724	SUP	HCPCS C1713		55-04724  -  PLATE BONE 24 HOLE STR MALBLE CONDENSED TITANIUM MIDFAC 1.7	BOTH IP/OP	"$1,037.18 "	$767.51	$0.00	"$1,856.00"	"$1,044.00"	"$1,044.00"	$0.00	$0.00	$0.00	$216.17	$769.79	$769.79	$0.00	$0.00	$216.15	$0.00	$613.49	$613.49	$0.00	"$1,160.00"	"$1,837.44"	"$1,856.00"	$0.00		$0.00	$363.08	$0.00	$0.00	$369.34	$0.00	$0.00	$0.00	$0.00	$0.00
55-04760	SUP	HCPCS C1713		55-04760  -  PLATE BONE 100D 2MM ADVANCEMENT 5 HOLE L MALBLE TITANIUM	BOTH IP/OP	$391.20 	$289.49	$0.00	$692.00	$389.25	$389.25	$0.00	$0.00	$0.00	$81.54	$290.35	$290.35	$0.00	$0.00	$81.53	$0.00	$231.39	$231.39	$0.00	$432.50	$685.08	$692.00	$0.00		$0.00	$135.37	$0.00	$0.00	$137.71	$0.00	$0.00	$0.00	$0.00	$0.00
55-04761	SUP	HCPCS C1713		55-04761  -  PLATE BONE 100D 2MM ADVANCEMENT L 5 HOLE MALBLE RIGHT ANGLED	BOTH IP/OP	$391.20 	$289.49	$0.00	$692.00	$389.25	$389.25	$0.00	$0.00	$0.00	$81.54	$290.35	$290.35	$0.00	$0.00	$81.53	$0.00	$231.39	$231.39	$0.00	$432.50	$685.08	$692.00	$0.00		$0.00	$135.37	$0.00	$0.00	$137.71	$0.00	$0.00	$0.00	$0.00	$0.00
55-04762	SUP	HCPCS C1713		55-04762  -  PLATE BONE 100D LEFT 5MM L 5 HOLE MALBLE TITANIUM MIDFAC 1.7	BOTH IP/OP	$402.00 	$297.48	$0.00	$712.00	$400.50	$400.50	$0.00	$0.00	$0.00	$83.79	$298.36	$298.36	$0.00	$0.00	$83.78	$0.00	$237.78	$237.78	$0.00	$445.00	$704.88	$712.00	$0.00		$0.00	$139.29	$0.00	$0.00	$141.69	$0.00	$0.00	$0.00	$0.00	$0.00
55-04763	SUP	HCPCS C1713		55-04763  -  PLATE BONE 100D 5MM ADVANCEMENT L 5 HOLE MALBLE RIGHT ANGLED	BOTH IP/OP	$402.00 	$297.48	$0.00	$712.00	$400.50	$400.50	$0.00	$0.00	$0.00	$83.79	$298.36	$298.36	$0.00	$0.00	$83.78	$0.00	$237.78	$237.78	$0.00	$445.00	$704.88	$712.00	$0.00		$0.00	$139.29	$0.00	$0.00	$141.69	$0.00	$0.00	$0.00	$0.00	$0.00
55-04764	SUP	HCPCS C1713		55-04764  -  PLATE BONE 100D 8MM ADVANCEMENT 6 HOLE L MALBLE TITANIUM	BOTH IP/OP	$415.20 	$307.25	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$86.54	$308.16	$308.16	$0.00	$0.00	$86.53	$0.00	$245.59	$245.59	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
55-04765	SUP	HCPCS C1713		55-04765  -  PLATE BONE 100D 8MM L 6 HOLE MALBLE TITANIUM MIDFAC RIGHT	BOTH IP/OP	$415.20 	$307.25	$0.00	$734.00	$412.88	$412.88	$0.00	$0.00	$0.00	$86.54	$308.16	$308.16	$0.00	$0.00	$86.53	$0.00	$245.59	$245.59	$0.00	$458.75	$726.66	$734.00	$0.00		$0.00	$143.59	$0.00	$0.00	$146.07	$0.00	$0.00	$0.00	$0.00	$0.00
55-04766	SUP	HCPCS C1713		55-04766  -  PLATE BONE 100D 12MM ADVANCEMENT 6 HOLE L MALBLE TITANIUM	BOTH IP/OP	$426.00 	$315.24	$0.00	$754.00	$424.13	$424.13	$0.00	$0.00	$0.00	$88.79	$316.18	$316.18	$0.00	$0.00	$88.78	$0.00	$251.98	$251.98	$0.00	$471.25	$746.46	$754.00	$0.00		$0.00	$147.50	$0.00	$0.00	$150.05	$0.00	$0.00	$0.00	$0.00	$0.00
55-04767	SUP	HCPCS C1713		55-04767  -  PLATE BONE 100D 12MM ADVANCEMENT 6 HOLE L MALBLE TITANIUM	BOTH IP/OP	$426.00 	$315.24	$0.00	$754.00	$424.13	$424.13	$0.00	$0.00	$0.00	$88.79	$316.18	$316.18	$0.00	$0.00	$88.78	$0.00	$251.98	$251.98	$0.00	$471.25	$746.46	$754.00	$0.00		$0.00	$147.50	$0.00	$0.00	$150.05	$0.00	$0.00	$0.00	$0.00	$0.00
55-05151	SUP	HCPCS C1713		55-05151  -  PLATE BONE STANDARD Y 4MMX.6MM 5 HOLE BAR UNIVERSAL 2	BOTH IP/OP	$329.15 	$243.57	$0.00	$596.00	$335.25	$335.25	$0.00	$0.00	$0.00	$68.60	$244.30	$244.30	$0.00	$0.00	$68.59	$0.00	$194.69	$194.69	$0.00	$372.50	$590.04	$596.00	$0.00		$0.00	$116.59	$0.00	$0.00	$118.60	$0.00	$0.00	$0.00	$0.00	$0.00
55-05152	SUP	HCPCS C1713		55-05152  -  PLATE BONE STANDARD Y 8MMX.6MM 5 HOLE BAR UNIVERSAL 2	BOTH IP/OP	$349.63 	$258.73	$0.00	$618.00	$347.63	$347.63	$0.00	$0.00	$0.00	$72.87	$259.49	$259.49	$0.00	$0.00	$72.86	$0.00	$206.80	$206.80	$0.00	$386.25	$611.82	$618.00	$0.00		$0.00	$120.90	$0.00	$0.00	$122.98	$0.00	$0.00	$0.00	$0.00	$0.00
55-05164	SUP	HCPCS C1713		55-05164  -  PLATE BONE UNIVERSAL STANDARD 2Y .6MM 7 HOLE MALBLE TITANIUM	BOTH IP/OP	$877.50 	$649.35	$0.00	$702.00	$394.88	$394.88	$0.00	$0.00	$0.00	$182.89	$651.28	$651.28	$0.00	$0.00	$182.87	$0.00	$519.04	$519.04	$0.00	$438.75	$694.98	$702.00	$0.00		$0.00	$137.33	$0.00	$0.00	$139.70	$0.00	$0.00	$0.00	$0.00	$0.00
55-05188	SUP	HCPCS C1713		55-05188  -  PLATE BONE STANDARD CURVE .6MM 6 HOLE BAR UNIVERSAL 2	BOTH IP/OP	$982.50 	$727.05	$0.00	$786.00	$442.13	$442.13	$0.00	$0.00	$0.00	$204.78	$729.21	$729.21	$0.00	$0.00	$204.75	$0.00	$581.15	$581.15	$0.00	$491.25	$778.14	$786.00	$0.00		$0.00	$153.76	$0.00	$0.00	$156.41	$0.00	$0.00	$0.00	$0.00	$0.00
55-05716	SUP	HCPCS C1713		55-05716  -  PLATE BONE 16 HOLE LOCKING TITANIUM MIDFAC 1.7 MM SCREW	BOTH IP/OP	$730.50 	$540.57	$0.00	"$1,332.00"	$749.25	$749.25	$0.00	$0.00	$0.00	$152.25	$542.18	$542.18	$0.00	$0.00	$152.24	$0.00	$432.09	$432.09	$0.00	$832.50	"$1,318.68"	"$1,332.00"	$0.00		$0.00	$260.57	$0.00	$0.00	$265.07	$0.00	$0.00	$0.00	$0.00	$0.00
55-05731	SUP	HCPCS C1713		55-05731  -  PLATE BONE 3D .8MM 2X2 HOLE LOCK UNIVERSAL 2 TITANIUM MIDFAC	BOTH IP/OP	$502.08 	$371.54	$0.00	$936.00	$526.50	$526.50	$0.00	$0.00	$0.00	$104.64	$372.64	$372.64	$0.00	$0.00	$104.63	$0.00	$296.98	$296.98	$0.00	$585.00	$926.64	$936.00	$0.00		$0.00	$183.11	$0.00	$0.00	$186.26	$0.00	$0.00	$0.00	$0.00	$0.00
55-05733	SUP	HCPCS C1713		55-05733  -  PLATE BONE 2X6 HOLE LOCKING 3D TITANIUM MIDFAC 1.7 MM SCREW	BOTH IP/OP	"$1,159.48 "	$858.02	$0.00	"$2,098.00"	"$1,180.13"	"$1,180.13"	$0.00	$0.00	$0.00	$241.66	$860.56	$860.56	$0.00	$0.00	$241.63	$0.00	$685.83	$685.83	$0.00	"$1,311.25"	"$2,077.02"	"$2,098.00"	$0.00		$0.00	$410.42	$0.00	$0.00	$417.50	$0.00	$0.00	$0.00	$0.00	$0.00
55-05742	SUP	HCPCS C1713		55-05742  -  PLATE BONE 2Y .8MM 7 HOLE LOCK UNIVERSAL 2 TITANIUM MIDFAC	BOTH IP/OP	$574.08 	$424.82	$0.00	"$1,048.00"	$589.50	$589.50	$0.00	$0.00	$0.00	$119.65	$426.08	$426.08	$0.00	$0.00	$119.64	$0.00	$339.57	$339.57	$0.00	$655.00	"$1,037.52"	"$1,048.00"	$0.00		$0.00	$205.02	$0.00	$0.00	$208.55	$0.00	$0.00	$0.00	$0.00	$0.00
55-05751	SUP	HCPCS C1713		55-05751  -  PLATE BONE Y 4MMX.8MM 5 HOLE LOCK BAR UNIVERSAL 2 TITANIUM	BOTH IP/OP	$450.88 	$333.65	$0.00	$826.00	$464.63	$464.63	$0.00	$0.00	$0.00	$93.97	$334.64	$334.64	$0.00	$0.00	$93.96	$0.00	$266.69	$266.69	$0.00	$516.25	$817.74	$826.00	$0.00		$0.00	$161.59	$0.00	$0.00	$164.37	$0.00	$0.00	$0.00	$0.00	$0.00
55-05752	SUP	HCPCS C1713		55-05752  -  PLATE BONE 8MM ADVANCEMENT 8MM 5 HOLE Y LOCKING BAR TITANIUM	BOTH IP/OP	$450.88 	$333.65	$0.00	$826.00	$464.63	$464.63	$0.00	$0.00	$0.00	$93.97	$334.64	$334.64	$0.00	$0.00	$93.96	$0.00	$266.69	$266.69	$0.00	$516.25	$817.74	$826.00	$0.00		$0.00	$161.59	$0.00	$0.00	$164.37	$0.00	$0.00	$0.00	$0.00	$0.00
55-05758	SUP	HCPCS C1713		55-05758  -  PLATE BONE 8 HOLE CVD LOCKING TITANIUM MIDFAC 1.7 MM SCREW	BOTH IP/OP	$354.80 	$262.55	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$73.95	$263.33	$263.33	$0.00	$0.00	$73.94	$0.00	$209.86	$209.86	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
55-05761	SUP	HCPCS C1713		55-05761  -  PLATE BONE 2MM ADVANCEMENT 2MMX.8MM 5 HOLE L LOCKING	BOTH IP/OP	$413.55 	$306.03	$0.00	$754.00	$424.13	$424.13	$0.00	$0.00	$0.00	$86.19	$306.94	$306.94	$0.00	$0.00	$86.18	$0.00	$244.61	$244.61	$0.00	$471.25	$746.46	$754.00	$0.00		$0.00	$147.50	$0.00	$0.00	$150.05	$0.00	$0.00	$0.00	$0.00	$0.00
55-05763	SUP	HCPCS C1713		55-05763  -  PLATE BONE 5MM ADVANCEMENT L 5MMX.8MM 5 HOLE LOCK TITANIUM	BOTH IP/OP	$439.13 	$324.96	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$91.52	$325.92	$325.92	$0.00	$0.00	$91.51	$0.00	$259.74	$259.74	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
55-05765	SUP	HCPCS C1713		55-05765  -  PLATE BONE 100D L 8MMX.8MM 6 HOLE LOCK BAR UNIVERSAL 2	BOTH IP/OP	$463.73 	$343.16	$0.00	$844.00	$474.75	$474.75	$0.00	$0.00	$0.00	$96.65	$344.18	$344.18	$0.00	$0.00	$96.64	$0.00	$274.29	$274.29	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$165.11	$0.00	$0.00	$167.96	$0.00	$0.00	$0.00	$0.00	$0.00
55-05767	SUP	HCPCS C1713		55-05767  -  PLATE BONE 100D L 12MMX.8MM 6 HOLE LOCK BAR UNIVERSAL 2	BOTH IP/OP	$474.80 	$351.35	$0.00	$866.00	$487.13	$487.13	$0.00	$0.00	$0.00	$98.96	$352.40	$352.40	$0.00	$0.00	$98.95	$0.00	$280.84	$280.84	$0.00	$541.25	$857.34	$866.00	$0.00		$0.00	$169.41	$0.00	$0.00	$172.33	$0.00	$0.00	$0.00	$0.00	$0.00
55-05779	SUP	HCPCS C1713		55-05779  -  PLATE BONE Y .8MM 8 HOLE LOCK UNIVERSAL 2 TITANIUM MIDFAC	BOTH IP/OP	$523.88 	$387.67	$0.00	$958.00	$538.88	$538.88	$0.00	$0.00	$0.00	$109.19	$388.82	$388.82	$0.00	$0.00	$109.18	$0.00	$309.87	$309.87	$0.00	$598.75	$948.42	$958.00	$0.00		$0.00	$187.41	$0.00	$0.00	$190.64	$0.00	$0.00	$0.00	$0.00	$0.00
55-06208	SUP	HCPCS C1713		55-06208  -  PLATE BONE STANDARD STR .6MM 8 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$474.75	$474.75	$0.00	$0.00	$0.00	$219.89	$783.02	$783.02	$0.00	$0.00	$219.86	$0.00	$624.03	$624.03	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$165.11	$0.00	$0.00	$167.96	$0.00	$0.00	$0.00	$0.00	$0.00
55-06224	SUP	HCPCS C1713		55-06224  -  PLATE BONE STANDARD STR .6MM 24 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$883.38 	$653.70	$0.00	"$1,576.00"	$886.50	$886.50	$0.00	$0.00	$0.00	$184.12	$655.64	$655.64	$0.00	$0.00	$184.10	$0.00	$522.52	$522.52	$0.00	$985.00	"$1,560.24"	"$1,576.00"	$0.00		$0.00	$308.31	$0.00	$0.00	$313.62	$0.00	$0.00	$0.00	$0.00	$0.00
55-06231	SUP	HCPCS C1713		55-06231  -  PLATE BONE STANDARD 3D .6MM 2X2 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
55-06233	SUP	HCPCS C1713		55-06233  -  PLATE BONE STANDARD .6MM 6X2 HOLE 3D TITANIUM UPPERFACIAL	BOTH IP/OP	$735.58 	$544.33	$0.00	"$1,288.00"	$724.50	$724.50	$0.00	$0.00	$0.00	$153.31	$545.94	$545.94	$0.00	$0.00	$153.29	$0.00	$435.09	$435.09	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$251.97	$0.00	$0.00	$256.31	$0.00	$0.00	$0.00	$0.00	$0.00
55-06235	SUP	HCPCS C1713		55-06235  -  PLATE BONE STANDARD 3D .6MM 6X6 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	"$1,788.75 "	"$1,323.68"	$0.00	"$3,112.00"	"$1,750.50"	"$1,750.50"	$0.00	$0.00	$0.00	$372.82	"$1,327.61"	"$1,327.61"	$0.00	$0.00	$372.78	$0.00	"$1,058.05"	"$1,058.05"	$0.00	"$1,945.00"	"$3,080.88"	"$3,112.00"	$0.00		$0.00	$608.79	$0.00	$0.00	$619.29	$0.00	$0.00	$0.00	$0.00	$0.00
55-06237	SUP	HCPCS C1713		55-06237  -  PLATE BONE 10X10 HOLE 3D TITANIUM UPPERFACIAL 1.2 MM SCREW	BOTH IP/OP	"$2,420.00 "	"$1,790.80"	$0.00	"$4,208.00"	"$2,367.00"	"$2,367.00"	$0.00	$0.00	$0.00	$504.39	"$1,796.12"	"$1,796.12"	$0.00	$0.00	$504.33	$0.00	"$1,431.43"	"$1,431.43"	$0.00	"$2,630.00"	"$4,165.92"	"$4,208.00"	$0.00		$0.00	$823.19	$0.00	$0.00	$837.39	$0.00	$0.00	$0.00	$0.00	$0.00
55-06240	SUP	HCPCS C1713		55-06240  -  PLATE BONE STANDARD 2Y .6MM 7 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$760.00 	$562.40	$0.00	$608.00	$342.00	$342.00	$0.00	$0.00	$0.00	$158.40	$564.07	$564.07	$0.00	$0.00	$158.38	$0.00	$449.54	$449.54	$0.00	$380.00	$601.92	$608.00	$0.00		$0.00	$118.94	$0.00	$0.00	$120.99	$0.00	$0.00	$0.00	$0.00	$0.00
55-06250	SUP	HCPCS C1713		55-06250  -  PLATE BONE STANDARD CURVE .6MM 10 HOLE LEIBINGER UNIVERSAL 2	BOTH IP/OP	$947.50 	$701.15	$0.00	$758.00	$426.38	$426.38	$0.00	$0.00	$0.00	$197.48	$703.23	$703.23	$0.00	$0.00	$197.46	$0.00	$560.45	$560.45	$0.00	$473.75	$750.42	$758.00	$0.00		$0.00	$148.28	$0.00	$0.00	$150.84	$0.00	$0.00	$0.00	$0.00	$0.00
55-06254	SUP	HCPCS C1713		55-06254  -  PLATE BONE STANDARD CURVE .6MM 4 HOLE LEIBINGER UNIVERSAL 2	BOTH IP/OP	$470.00 	$347.80	$0.00	$376.00	$211.50	$211.50	$0.00	$0.00	$0.00	$97.96	$348.83	$348.83	$0.00	$0.00	$97.95	$0.00	$278.01	$278.01	$0.00	$235.00	$372.24	$376.00	$0.00		$0.00	$73.56	$0.00	$0.00	$74.82	$0.00	$0.00	$0.00	$0.00	$0.00
55-06260	SUP	HCPCS C1713		55-06260  -  PLATE BONE 90D .6MM 8 HOLE L TITANIUM LEFT UPPERFACIAL 1.2MM	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
55-06261	SUP	HCPCS C1713		55-06261  -  PLATE BONE 90D STANDARD L .6MM 8 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$331.35 	$245.20	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$69.06	$245.93	$245.93	$0.00	$0.00	$69.05	$0.00	$195.99	$195.99	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
55-06270	SUP	HCPCS C1713		55-06270  -  PLATE BONE STANDARD T .6MM 7 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$336.65 	$249.12	$0.00	$598.00	$336.38	$336.38	$0.00	$0.00	$0.00	$70.17	$249.86	$249.86	$0.00	$0.00	$70.16	$0.00	$199.13	$199.13	$0.00	$373.75	$592.02	$598.00	$0.00		$0.00	$116.98	$0.00	$0.00	$119.00	$0.00	$0.00	$0.00	$0.00	$0.00
55-06310	SUP	HCPCS C1713		55-06310  -  PLATE BONE MINI 3D SQUARE .6MM 2X2 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$398.25 	$294.71	$0.00	$770.00	$433.13	$433.13	$0.00	$0.00	$0.00	$83.01	$295.58	$295.58	$0.00	$0.00	$83.00	$0.00	$235.56	$235.56	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$150.63	$0.00	$0.00	$153.23	$0.00	$0.00	$0.00	$0.00	$0.00
55-06312	SUP	HCPCS C1713		55-06312  -  PLATE BONE MINI 3D RECTANGLE .6MM 2X2 HOLE UNIVERSAL 2	BOTH IP/OP	$398.25 	$294.71	$0.00	$770.00	$433.13	$433.13	$0.00	$0.00	$0.00	$83.01	$295.58	$295.58	$0.00	$0.00	$83.00	$0.00	$235.56	$235.56	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$150.63	$0.00	$0.00	$153.23	$0.00	$0.00	$0.00	$0.00	$0.00
55-06320	SUP	HCPCS C1713		55-06320  -  PLATE BONE MINI 3D SQUARE .6MM 3X2 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$442.13 	$327.18	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$92.15	$328.15	$328.15	$0.00	$0.00	$92.14	$0.00	$261.52	$261.52	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
55-06370	SUP	HCPCS C1713		55-06370  -  PLATE BONE STANDARD 14MM BURR HOLE COVER TITANIUM MAXFACL	BOTH IP/OP	$405.25 	$299.89	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$84.46	$300.78	$300.78	$0.00	$0.00	$84.45	$0.00	$239.71	$239.71	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
55-06371	SUP	HCPCS C1713		55-06371  -  PLATE BONE 20MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2	BOTH IP/OP	$452.18 	$334.61	$0.00	$804.00	$452.25	$452.25	$0.00	$0.00	$0.00	$94.24	$335.60	$335.60	$0.00	$0.00	$94.23	$0.00	$267.46	$267.46	$0.00	$502.50	$795.96	$804.00	$0.00		$0.00	$157.28	$0.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00
55-06372	SUP	HCPCS C1713		55-06372  -  PLATE BONE STANDARD 10MM .6MM BURR HOLE COVER UNIVERSAL 2	BOTH IP/OP	$405.25 	$299.89	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$84.46	$300.78	$300.78	$0.00	$0.00	$84.45	$0.00	$239.71	$239.71	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
55-06373	SUP	HCPCS C1713		55-06373  -  PLATE BONE 14MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2	BOTH IP/OP	$454.05 	$336.00	$0.00	$804.00	$452.25	$452.25	$0.00	$0.00	$0.00	$94.64	$337.00	$337.00	$0.00	$0.00	$94.62	$0.00	$268.57	$268.57	$0.00	$502.50	$795.96	$804.00	$0.00		$0.00	$157.28	$0.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00
55-06374	SUP	HCPCS C1713		55-06374  -  PLATE BONE 10MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2	BOTH IP/OP	$454.05 	$336.00	$0.00	$804.00	$452.25	$452.25	$0.00	$0.00	$0.00	$94.64	$337.00	$337.00	$0.00	$0.00	$94.62	$0.00	$268.57	$268.57	$0.00	$502.50	$795.96	$804.00	$0.00		$0.00	$157.28	$0.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00
55-06375	SUP	HCPCS C1713		55-06375  -  PLATE BONE STANDARD 7MM BURR HOLE COVER TITANIUM MAXFACL 1.2	BOTH IP/OP	$405.25 	$299.89	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$84.46	$300.78	$300.78	$0.00	$0.00	$84.45	$0.00	$239.71	$239.71	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
55-06376	SUP	HCPCS C1713		55-06376  -  PLATE BONE 7MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2MM	BOTH IP/OP	$450.88 	$333.65	$0.00	$770.00	$433.13	$433.13	$0.00	$0.00	$0.00	$93.97	$334.64	$334.64	$0.00	$0.00	$93.96	$0.00	$266.69	$266.69	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$150.63	$0.00	$0.00	$153.23	$0.00	$0.00	$0.00	$0.00	$0.00
55-06704	SUP	HCPCS C1713		55-06704  -  PLATE BONE STANDARD STR .55MM 4 HOLE BAR UNIVERSAL 2	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$222.75	$222.75	$0.00	$0.00	$0.00	$103.17	$367.39	$367.39	$0.00	$0.00	$103.16	$0.00	$292.79	$292.79	$0.00	$247.50	$392.04	$396.00	$0.00		$0.00	$77.47	$0.00	$0.00	$78.80	$0.00	$0.00	$0.00	$0.00	$0.00
55-06708	SUP	HCPCS C1713		55-06708  -  PLATE BONE STANDARD STR 8 HOLE UNIVERSAL 2 TITANIUM MIDFAC	BOTH IP/OP	"$1,090.00 "	$806.60	$0.00	$872.00	$490.50	$490.50	$0.00	$0.00	$0.00	$227.18	$809.00	$809.00	$0.00	$0.00	$227.16	$0.00	$644.74	$644.74	$0.00	$545.00	$863.28	$872.00	$0.00		$0.00	$170.59	$0.00	$0.00	$173.53	$0.00	$0.00	$0.00	$0.00	$0.00
55-06724	SUP	HCPCS C1713		55-06724  -  PLATE BONE STANDARD .6MM 24 HOLE STR TITANIUM MIDFAC 1.7MM	BOTH IP/OP	"$2,080.00 "	"$1,539.20"	$0.00	"$1,664.00"	$936.00	$936.00	$0.00	$0.00	$0.00	$433.52	"$1,543.78"	"$1,543.78"	$0.00	$0.00	$433.47	$0.00	"$1,230.32"	"$1,230.32"	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00		$0.00	$325.52	$0.00	$0.00	$331.14	$0.00	$0.00	$0.00	$0.00	$0.00
55-06731	SUP	HCPCS C1713		55-06731  -  PLATE BONE STANDARD .6MM 2X2 HOLE 3D TITANIUM MIDFAC 1.7MM	BOTH IP/OP	$480.98 	$355.93	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$100.25	$356.98	$356.98	$0.00	$0.00	$100.24	$0.00	$284.50	$284.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
55-06733	SUP	HCPCS C1713		55-06733  -  PLATE BONE STANDARD .6MM 2X6 HOLE 3D TITANIUM MIDFAC 1.7MM	BOTH IP/OP	"$1,810.00 "	"$1,339.40"	$0.00	"$1,448.00"	$814.50	$814.50	$0.00	$0.00	$0.00	$377.25	"$1,343.38"	"$1,343.38"	$0.00	$0.00	$377.20	$0.00	"$1,070.62"	"$1,070.62"	$0.00	$905.00	"$1,433.52"	"$1,448.00"	$0.00		$0.00	$283.27	$0.00	$0.00	$288.15	$0.00	$0.00	$0.00	$0.00	$0.00
55-06750	SUP	HCPCS C1713		55-06750  -  PLATE BONE STANDARD CURVE .6MM 10 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$517.50	$517.50	$0.00	$0.00	$0.00	$239.69	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$680.23	$680.23	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$179.98	$0.00	$0.00	$183.08	$0.00	$0.00	$0.00	$0.00	$0.00
55-06754	SUP	HCPCS C1713		55-06754  -  PLATE BONE STANDARD 4 HOLE CVD BAR TITANIUM MIDFAC 1.7MM	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$274.50	$274.50	$0.00	$0.00	$0.00	$127.14	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$360.82	$360.82	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$95.47	$0.00	$0.00	$97.11	$0.00	$0.00	$0.00	$0.00	$0.00
55-06760	SUP	HCPCS C1713		55-06760  -  PLATE BONE 100D STANDARD 2MM ADVANCEMENT 5 HOLE L TITANIUM	BOTH IP/OP	$349.60 	$258.70	$0.00	$636.00	$357.75	$357.75	$0.00	$0.00	$0.00	$72.87	$259.47	$259.47	$0.00	$0.00	$72.86	$0.00	$206.79	$206.79	$0.00	$397.50	$629.64	$636.00	$0.00		$0.00	$124.42	$0.00	$0.00	$126.56	$0.00	$0.00	$0.00	$0.00	$0.00
55-06761	SUP	HCPCS C1713		55-06761  -  PLATE BONE 100D STANDARD 2MM ADVANCEMENT 5 HOLE L TITANIUM	BOTH IP/OP	$349.60 	$258.70	$0.00	$636.00	$357.75	$357.75	$0.00	$0.00	$0.00	$72.87	$259.47	$259.47	$0.00	$0.00	$72.86	$0.00	$206.79	$206.79	$0.00	$397.50	$629.64	$636.00	$0.00		$0.00	$124.42	$0.00	$0.00	$126.56	$0.00	$0.00	$0.00	$0.00	$0.00
55-06762	SUP	HCPCS C1713		55-06762  -  PLATE BONE 100D 5 HOLE L TITANIUM LEFT MIDFAC	BOTH IP/OP	$361.10 	$267.21	$0.00	$658.00	$370.13	$370.13	$0.00	$0.00	$0.00	$75.26	$268.01	$268.01	$0.00	$0.00	$75.25	$0.00	$213.59	$213.59	$0.00	$411.25	$651.42	$658.00	$0.00		$0.00	$128.72	$0.00	$0.00	$130.94	$0.00	$0.00	$0.00	$0.00	$0.00
55-06763	SUP	HCPCS C1713		55-06763  -  PLATE BONE 100D STANDARD 5MM 5 HOLE L BAR TITANIUM RIGHT	BOTH IP/OP	$361.10 	$267.21	$0.00	$658.00	$370.13	$370.13	$0.00	$0.00	$0.00	$75.26	$268.01	$268.01	$0.00	$0.00	$75.25	$0.00	$213.59	$213.59	$0.00	$411.25	$651.42	$658.00	$0.00		$0.00	$128.72	$0.00	$0.00	$130.94	$0.00	$0.00	$0.00	$0.00	$0.00
55-06764	SUP	HCPCS C1713		55-06764  -  PLATE BONE 100D 6 HOLE L TITANIUM LEFT MIDFAC 1.7MM SCREW	BOTH IP/OP	$384.10 	$284.23	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$80.06	$285.08	$285.08	$0.00	$0.00	$80.05	$0.00	$227.20	$227.20	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
55-06765	SUP	HCPCS C1713		55-06765  -  PLATE BONE 100D 8MM 6 HOLE L TITANIUM RIGHT MAXFACL 1.7MM	BOTH IP/OP	$384.10 	$284.23	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$80.06	$285.08	$285.08	$0.00	$0.00	$80.05	$0.00	$227.20	$227.20	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
55-06766	SUP	HCPCS C1713		55-06766  -  PLATE BONE 100D STANDARD 12MM ADVANCEMENT 12MM 6 HOLE LEFT L	BOTH IP/OP	$392.15 	$290.19	$0.00	$736.00	$414.00	$414.00	$0.00	$0.00	$0.00	$81.73	$291.05	$291.05	$0.00	$0.00	$81.72	$0.00	$231.96	$231.96	$0.00	$460.00	$728.64	$736.00	$0.00		$0.00	$143.98	$0.00	$0.00	$146.46	$0.00	$0.00	$0.00	$0.00	$0.00
55-06767	SUP	HCPCS C1713		55-06767  -  PLATE BONE 100D STANDARD 12MM BAR L .6MM 6 HOLE LEIBINGER	BOTH IP/OP	$392.15 	$290.19	$0.00	$736.00	$414.00	$414.00	$0.00	$0.00	$0.00	$81.73	$291.05	$291.05	$0.00	$0.00	$81.72	$0.00	$231.96	$231.96	$0.00	$460.00	$728.64	$736.00	$0.00		$0.00	$143.98	$0.00	$0.00	$146.46	$0.00	$0.00	$0.00	$0.00	$0.00
55-06771	SUP	HCPCS C1713		55-06771  -  PLATE BONE STANDARD T 5 HOLE T TITANIUM MIDFAC 1.7MM SCREWS	BOTH IP/OP	$293.25 	$217.01	$0.00	$556.00	$312.75	$312.75	$0.00	$0.00	$0.00	$61.12	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$173.46	$173.46	$0.00	$347.50	$550.44	$556.00	$0.00		$0.00	$108.77	$0.00	$0.00	$110.64	$0.00	$0.00	$0.00	$0.00	$0.00
55-07760	SUP	HCPCS C1713		55-07760  -  PLATE BONE 100D 2MM ADVANCEMENT .6MM 5 HOLE L TITANIUM LEFT	BOTH IP/OP	$382.30 	$282.90	$0.00	$690.00	$388.13	$388.13	$0.00	$0.00	$0.00	$79.68	$283.74	$283.74	$0.00	$0.00	$79.67	$0.00	$226.13	$226.13	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
55-07761	SUP	HCPCS C1713		55-07761  -  PLATE BONE 100D 2MM ADVANCEMENT .6MM 5 HOLE L TITANIUM RIGHT	BOTH IP/OP	$382.30 	$282.90	$0.00	$690.00	$388.13	$388.13	$0.00	$0.00	$0.00	$79.68	$283.74	$283.74	$0.00	$0.00	$79.67	$0.00	$226.13	$226.13	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
55-07762	SUP	HCPCS C1713		55-07762  -  PLATE BONE 100D 5MM ADVANCEMENT .6MM 5 HOLE L TITANIUM LEFT	BOTH IP/OP	$393.75 	$291.38	$0.00	$710.00	$399.38	$399.38	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$443.75	$702.90	$710.00	$0.00		$0.00	$138.89	$0.00	$0.00	$141.29	$0.00	$0.00	$0.00	$0.00	$0.00
55-07763	SUP	HCPCS C1713		55-07763  -  PLATE BONE 100D 5MM ADVANCEMENT .6MM 5 HOLE L TITANIUM RIGHT	BOTH IP/OP	$393.75 	$291.38	$0.00	$710.00	$399.38	$399.38	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$443.75	$702.90	$710.00	$0.00		$0.00	$138.89	$0.00	$0.00	$141.29	$0.00	$0.00	$0.00	$0.00	$0.00
55-07764	SUP	HCPCS C1713		55-07764  -  PLATE BONE 100D 8MM ADVANCEMENT .8MM 6 HOLE L TITANIUM LEFT	BOTH IP/OP	$409.73 	$303.20	$0.00	$736.00	$414.00	$414.00	$0.00	$0.00	$0.00	$85.40	$304.10	$304.10	$0.00	$0.00	$85.39	$0.00	$242.35	$242.35	$0.00	$460.00	$728.64	$736.00	$0.00		$0.00	$143.98	$0.00	$0.00	$146.46	$0.00	$0.00	$0.00	$0.00	$0.00
55-07765	SUP	HCPCS C1713		55-07765  -  PLATE BONE 100D 8MM ADVANCEMENT .8MM 6 HOLE L TITANIUM RIGHT	BOTH IP/OP	$409.73 	$303.20	$0.00	$736.00	$414.00	$414.00	$0.00	$0.00	$0.00	$85.40	$304.10	$304.10	$0.00	$0.00	$85.39	$0.00	$242.35	$242.35	$0.00	$460.00	$728.64	$736.00	$0.00		$0.00	$143.98	$0.00	$0.00	$146.46	$0.00	$0.00	$0.00	$0.00	$0.00
55-07766	SUP	HCPCS C1713		55-07766  -  PLATE BONE 100D 12MM ADVANCEMENT .55MM 6 HOLE L TITANIUM	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
55-07767	SUP	HCPCS C1713		55-07767  -  PLATE BONE 100D 12MM ADVANCEMENT .55MM 6 HOLE L TITANIUM	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
55-08203	SUP	HCPCS C1713		55-08203  -  PLATE BONE MINI STR 4MMX1MM 4 HOLE BAR UNIVERSAL 2 TITANIUM	BOTH IP/OP	$308.13 	$228.02	$0.00	$594.00	$334.13	$334.13	$0.00	$0.00	$0.00	$64.22	$228.69	$228.69	$0.00	$0.00	$64.21	$0.00	$182.26	$182.26	$0.00	$371.25	$588.06	$594.00	$0.00		$0.00	$116.20	$0.00	$0.00	$118.21	$0.00	$0.00	$0.00	$0.00	$0.00
55-08204	SUP	HCPCS C1713		55-08204  -  PLATE BONE MINI REGULAR STR 1MM 4 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$255.38 	$188.98	$0.00	$508.00	$285.75	$285.75	$0.00	$0.00	$0.00	$53.23	$189.54	$189.54	$0.00	$0.00	$53.22	$0.00	$151.05	$151.05	$0.00	$317.50	$502.92	$508.00	$0.00		$0.00	$99.38	$0.00	$0.00	$101.09	$0.00	$0.00	$0.00	$0.00	$0.00
55-08205	SUP	HCPCS C1713		55-08205  -  PLATE BONE MINI STR 8MMX1MM 4 HOLE BAR UNIVERSAL 2 TITANIUM	BOTH IP/OP	$308.13 	$228.02	$0.00	$594.00	$334.13	$334.13	$0.00	$0.00	$0.00	$64.22	$228.69	$228.69	$0.00	$0.00	$64.21	$0.00	$182.26	$182.26	$0.00	$371.25	$588.06	$594.00	$0.00		$0.00	$116.20	$0.00	$0.00	$118.21	$0.00	$0.00	$0.00	$0.00	$0.00
55-08206	SUP	HCPCS C1713		55-08206  -  PLATE BONE MINI STR 6 HOLE STR TITANIUM LEFT	BOTH IP/OP	$465.68 	$344.60	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$97.06	$345.62	$345.62	$0.00	$0.00	$97.05	$0.00	$275.45	$275.45	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
55-08216	SUP	HCPCS C1713		55-08216  -  PLATE BONE MINI REGULAR STR 1MM 16 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$905.70 	$670.22	$0.00	"$1,664.00"	$936.00	$936.00	$0.00	$0.00	$0.00	$188.77	$672.21	$672.21	$0.00	$0.00	$188.75	$0.00	$535.72	$535.72	$0.00	"$1,040.00"	"$1,647.36"	"$1,664.00"	$0.00		$0.00	$325.52	$0.00	$0.00	$331.14	$0.00	$0.00	$0.00	$0.00	$0.00
55-08230	SUP	HCPCS C1713		55-08230  -  PLATE BONE MINI REGULAR L 1MM 4 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$382.13 	$282.78	$0.00	$702.00	$394.88	$394.88	$0.00	$0.00	$0.00	$79.64	$283.61	$283.61	$0.00	$0.00	$79.63	$0.00	$226.03	$226.03	$0.00	$438.75	$694.98	$702.00	$0.00		$0.00	$137.33	$0.00	$0.00	$139.70	$0.00	$0.00	$0.00	$0.00	$0.00
55-08231	SUP	HCPCS C1713		55-08231  -  PLATE BONE MINI REGULAR L 1MM 4 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$382.13 	$282.78	$0.00	$702.00	$394.88	$394.88	$0.00	$0.00	$0.00	$79.64	$283.61	$283.61	$0.00	$0.00	$79.63	$0.00	$226.03	$226.03	$0.00	$438.75	$694.98	$702.00	$0.00		$0.00	$137.33	$0.00	$0.00	$139.70	$0.00	$0.00	$0.00	$0.00	$0.00
55-08232	SUP	HCPCS C1713		55-08232  -  PLATE BONE 8MM 4 HOLE L BAR TITANIUM RIGHT	BOTH IP/OP	$391.00 	$289.34	$0.00	$738.00	$415.13	$415.13	$0.00	$0.00	$0.00	$81.49	$290.20	$290.20	$0.00	$0.00	$81.48	$0.00	$231.28	$231.28	$0.00	$461.25	$730.62	$738.00	$0.00		$0.00	$144.37	$0.00	$0.00	$146.86	$0.00	$0.00	$0.00	$0.00	$0.00
55-08233	SUP	HCPCS C1713		55-08233  -  PLATE BONE 8MM 4 HOLE L BAR TITANIUM LEFT	BOTH IP/OP	$391.00 	$289.34	$0.00	$738.00	$415.13	$415.13	$0.00	$0.00	$0.00	$81.49	$290.20	$290.20	$0.00	$0.00	$81.48	$0.00	$231.28	$231.28	$0.00	$461.25	$730.62	$738.00	$0.00		$0.00	$144.37	$0.00	$0.00	$146.86	$0.00	$0.00	$0.00	$0.00	$0.00
55-08234	SUP	HCPCS C1713		55-08234  -  PLATE BONE MINI L 4MMX1MM 4 HOLE BAR UNIVERSAL 2 TITANIUM	BOTH IP/OP	$406.90 	$301.11	$0.00	$770.00	$433.13	$433.13	$0.00	$0.00	$0.00	$84.81	$302.00	$302.00	$0.00	$0.00	$84.80	$0.00	$240.68	$240.68	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$150.63	$0.00	$0.00	$153.23	$0.00	$0.00	$0.00	$0.00	$0.00
55-08235	SUP	HCPCS C1713		55-08235  -  PLATE BONE 4MM 4 HOLE L BAR TITANIUM LEFT	BOTH IP/OP	$406.90 	$301.11	$0.00	$770.00	$433.13	$433.13	$0.00	$0.00	$0.00	$84.81	$302.00	$302.00	$0.00	$0.00	$84.80	$0.00	$240.68	$240.68	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$150.63	$0.00	$0.00	$153.23	$0.00	$0.00	$0.00	$0.00	$0.00
55-08236	SUP	HCPCS C1713		55-08236  -  PLATE BONE MINI L 8MMX1MM 5 HOLE BAR UNIVERSAL 2 TITANIUM	BOTH IP/OP	$421.83 	$312.15	$0.00	$802.00	$451.13	$451.13	$0.00	$0.00	$0.00	$87.92	$313.08	$313.08	$0.00	$0.00	$87.91	$0.00	$249.51	$249.51	$0.00	$501.25	$793.98	$802.00	$0.00		$0.00	$156.89	$0.00	$0.00	$159.60	$0.00	$0.00	$0.00	$0.00	$0.00
55-08237	SUP	HCPCS C1713		55-08237  -  PLATE BONE MINI L 8MMX1MM 5 HOLE BAR UNIVERSAL 2 TITANIUM	BOTH IP/OP	$421.83 	$312.15	$0.00	$802.00	$451.13	$451.13	$0.00	$0.00	$0.00	$87.92	$313.08	$313.08	$0.00	$0.00	$87.91	$0.00	$249.51	$249.51	$0.00	$501.25	$793.98	$802.00	$0.00		$0.00	$156.89	$0.00	$0.00	$159.60	$0.00	$0.00	$0.00	$0.00	$0.00
55-08240	SUP	HCPCS C1713		55-08240  -  PLATE BONE MINI REGULAR T 1MM 6 HOLE UNIVERSAL 2 TITANIUM	BOTH IP/OP	$319.73 	$236.60	$0.00	$572.00	$321.75	$321.75	$0.00	$0.00	$0.00	$66.64	$237.30	$237.30	$0.00	$0.00	$66.63	$0.00	$189.12	$189.12	$0.00	$357.50	$566.28	$572.00	$0.00		$0.00	$111.90	$0.00	$0.00	$113.83	$0.00	$0.00	$0.00	$0.00	$0.00
55-08250	SUP	HCPCS C1713		55-08250  -  PLATE BONE MINI 5 HOLE Y W/O BAR TITANIUM MAXFACL	BOTH IP/OP	$364.98 	$270.09	$0.00	$676.00	$380.25	$380.25	$0.00	$0.00	$0.00	$76.07	$270.88	$270.88	$0.00	$0.00	$76.06	$0.00	$215.88	$215.88	$0.00	$422.50	$669.24	$676.00	$0.00		$0.00	$132.24	$0.00	$0.00	$134.52	$0.00	$0.00	$0.00	$0.00	$0.00
55-08251	SUP	HCPCS C1713		55-08251  -  PLATE BONE MINI Y 8MMX1MM 5 HOLE BAR UNIVERSAL 2 TITANIUM	BOTH IP/OP	$364.98 	$270.09	$0.00	$676.00	$380.25	$380.25	$0.00	$0.00	$0.00	$76.07	$270.88	$270.88	$0.00	$0.00	$76.06	$0.00	$215.88	$215.88	$0.00	$422.50	$669.24	$676.00	$0.00		$0.00	$132.24	$0.00	$0.00	$134.52	$0.00	$0.00	$0.00	$0.00	$0.00
55-08260	SUP	HCPCS C1713		55-08260  -  PLATE BONE 2Y 6 HOLE TITANIUM MAXFACL 2MM SCREW	BOTH IP/OP	$397.25 	$293.97	$0.00	$754.00	$424.13	$424.13	$0.00	$0.00	$0.00	$82.80	$294.84	$294.84	$0.00	$0.00	$82.79	$0.00	$234.97	$234.97	$0.00	$471.25	$746.46	$754.00	$0.00		$0.00	$147.50	$0.00	$0.00	$150.05	$0.00	$0.00	$0.00	$0.00	$0.00
55-08262	SUP	HCPCS C1713		55-08262  -  PLATE BONE MINI 2Y 8MMX1MM 6 HOLE BAR UNIVERSAL 2 TITANIUM	BOTH IP/OP	$397.25 	$293.97	$0.00	$754.00	$424.13	$424.13	$0.00	$0.00	$0.00	$82.80	$294.84	$294.84	$0.00	$0.00	$82.79	$0.00	$234.97	$234.97	$0.00	$471.25	$746.46	$754.00	$0.00		$0.00	$147.50	$0.00	$0.00	$150.05	$0.00	$0.00	$0.00	$0.00	$0.00
55-08510	SUP	HCPCS C1713		55-08510  -  PLATE BONE .75MM 30 HOLE STR LP TITANIUM MAXFACL	BOTH IP/OP	"$1,029.93 "	$762.15	$0.00	"$1,882.00"	"$1,058.63"	"$1,058.63"	$0.00	$0.00	$0.00	$214.66	$764.41	$764.41	$0.00	$0.00	$214.64	$0.00	$609.20	$609.20	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$368.17	$0.00	$0.00	$374.52	$0.00	$0.00	$0.00	$0.00	$0.00
55-08520	SUP	HCPCS C1713		55-08520  -  PLATE BONE 100D L .75MM 9 HOLE LP RIGHT ANGLED TITANIUM	BOTH IP/OP	$488.65 	$361.60	$0.00	$894.00	$502.88	$502.88	$0.00	$0.00	$0.00	$101.85	$362.68	$362.68	$0.00	$0.00	$101.83	$0.00	$289.04	$289.04	$0.00	$558.75	$885.06	$894.00	$0.00		$0.00	$174.89	$0.00	$0.00	$177.91	$0.00	$0.00	$0.00	$0.00	$0.00
55-08521	SUP	HCPCS C1713		55-08521  -  PLATE BONE 100D L .75MM 9 HOLE LP LEFT ANGLED TITANIUM	BOTH IP/OP	$488.65 	$361.60	$0.00	$894.00	$502.88	$502.88	$0.00	$0.00	$0.00	$101.85	$362.68	$362.68	$0.00	$0.00	$101.83	$0.00	$289.04	$289.04	$0.00	$558.75	$885.06	$894.00	$0.00		$0.00	$174.89	$0.00	$0.00	$177.91	$0.00	$0.00	$0.00	$0.00	$0.00
55-08542	SUP	HCPCS C1713		55-08542  -  PLATE BONE .75MM 8 HOLE T LP TITANIUM MAXFACL	BOTH IP/OP	$480.75 	$355.76	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$100.20	$356.81	$356.81	$0.00	$0.00	$100.19	$0.00	$284.36	$284.36	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
55-08579	SUP	HCPCS C1713		55-08579  -  PLATE BONE .75MM 8 HOLE Y TITANIUM MAXFACL	BOTH IP/OP	$480.75 	$355.76	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$100.20	$356.81	$356.81	$0.00	$0.00	$100.19	$0.00	$284.36	$284.36	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
55-08586	SUP	HCPCS C1713		55-08586  -  PLATE BONE CURVE .75MM 12 HOLE LP TITANIUM MAXFACL	BOTH IP/OP	$488.65 	$361.60	$0.00	$920.00	$517.50	$517.50	$0.00	$0.00	$0.00	$101.85	$362.68	$362.68	$0.00	$0.00	$101.83	$0.00	$289.04	$289.04	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$179.98	$0.00	$0.00	$183.08	$0.00	$0.00	$0.00	$0.00	$0.00
55-09104	SUP	HCPCS C1713		55-09104  -  PLATE BONE 4MM BAR TITANIUM CHIN 2MM SCREW	BOTH IP/OP	$480.75 	$355.76	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$100.20	$356.81	$356.81	$0.00	$0.00	$100.19	$0.00	$284.36	$284.36	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
55-09106	SUP	HCPCS C1713		55-09106  -  PLATE BONE 6MM BAR TITANIUM CHIN	BOTH IP/OP	$488.65 	$361.60	$0.00	$920.00	$517.50	$517.50	$0.00	$0.00	$0.00	$101.85	$362.68	$362.68	$0.00	$0.00	$101.83	$0.00	$289.04	$289.04	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$179.98	$0.00	$0.00	$183.08	$0.00	$0.00	$0.00	$0.00	$0.00
55-09108	SUP	HCPCS C1713		55-09108  -  PLATE BONE 8MM BAR TITANIUM CHIN 2MM SCREW	BOTH IP/OP	$527.33 	$390.22	$0.00	$968.00	$544.50	$544.50	$0.00	$0.00	$0.00	$109.91	$391.38	$391.38	$0.00	$0.00	$109.89	$0.00	$311.91	$311.91	$0.00	$605.00	$958.32	$968.00	$0.00		$0.00	$189.37	$0.00	$0.00	$192.63	$0.00	$0.00	$0.00	$0.00	$0.00
55-09110	SUP	HCPCS C1713		55-09110  -  PLATE BONE 10MM BAR TITANIUM CHIN 2MM SCREW	BOTH IP/OP	$550.78 	$407.58	$0.00	$992.00	$558.00	$558.00	$0.00	$0.00	$0.00	$114.80	$408.79	$408.79	$0.00	$0.00	$114.78	$0.00	$325.78	$325.78	$0.00	$620.00	$982.08	$992.00	$0.00		$0.00	$194.06	$0.00	$0.00	$197.41	$0.00	$0.00	$0.00	$0.00	$0.00
55-10503	SUP	HCPCS C1713		55-10503  -  PLATE BONE LONG 4 HOLE LOCKING STR BAR TITANIUM MANDIB 2MM	BOTH IP/OP	$595.00 	$440.30	$0.00	$476.00	$267.75	$267.75	$0.00	$0.00	$0.00	$124.01	$441.61	$441.61	$0.00	$0.00	$124.00	$0.00	$351.94	$351.94	$0.00	$297.50	$471.24	$476.00	$0.00		$0.00	$93.12	$0.00	$0.00	$94.72	$0.00	$0.00	$0.00	$0.00	$0.00
55-10504	SUP	HCPCS C1713		55-10504  -  PLATE BN MN STRG 1MM BLU SMRT LCK LEIBINGER UNV 2 4 HL TI	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
55-10505	SUP	HCPCS C1713		55-10505  -  PLATE BN MN STRG 4MMX1MM BLU SMRT LCK LEIBINGER UNV 2 4 HL	BOTH IP/OP	$452.50 	$334.85	$0.00	$362.00	$203.63	$203.63	$0.00	$0.00	$0.00	$94.31	$335.85	$335.85	$0.00	$0.00	$94.30	$0.00	$267.65	$267.65	$0.00	$226.25	$358.38	$362.00	$0.00		$0.00	$70.82	$0.00	$0.00	$72.04	$0.00	$0.00	$0.00	$0.00	$0.00
55-10506	SUP	HCPCS C1713		55-10506  -  PLATE BN MN STRG 1MM BLU SMRT LCK LEIBINGER UNV 2 6 HL TI	BOTH IP/OP	$517.50 	$382.95	$0.00	$414.00	$232.88	$232.88	$0.00	$0.00	$0.00	$107.86	$384.09	$384.09	$0.00	$0.00	$107.85	$0.00	$306.10	$306.10	$0.00	$258.75	$409.86	$414.00	$0.00		$0.00	$80.99	$0.00	$0.00	$82.39	$0.00	$0.00	$0.00	$0.00	$0.00
55-10507	SUP	HCPCS C1713		55-10507  -  PLATE BN MN STRG 8MMX1MM BLU SMRT LCK LEIBINGER UNV 2 6 HL	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
55-10515	SUP	HCPCS C1713		55-10515  -  PLATE BONE MINI 8MM 16 HOLE STR CONDENSED TITANIUM MANDIB 2	BOTH IP/OP	$755.75 	$559.26	$0.00	"$1,442.00"	$811.13	$811.13	$0.00	$0.00	$0.00	$157.52	$560.92	$560.92	$0.00	$0.00	$157.50	$0.00	$447.03	$447.03	$0.00	$901.25	"$1,427.58"	"$1,442.00"	$0.00		$0.00	$282.09	$0.00	$0.00	$286.96	$0.00	$0.00	$0.00	$0.00	$0.00
55-10516	SUP	HCPCS C1713		55-10516  -  PLATE BONE STR MINI 16 HOLE LOCK TITANIUM MAXFACL 2/2.3MM	BOTH IP/OP	$302.88 	$224.13	$0.00	$566.00	$318.38	$318.38	$0.00	$0.00	$0.00	$63.13	$224.79	$224.79	$0.00	$0.00	$63.12	$0.00	$179.15	$179.15	$0.00	$353.75	$560.34	$566.00	$0.00		$0.00	$110.72	$0.00	$0.00	$112.63	$0.00	$0.00	$0.00	$0.00	$0.00
55-10532	SUP	HCPCS C1713		55-10532  -  PLATE BONE MINI RECTANGLE 3X2 HOLE RECTANGULAR 3D TITANIUM	BOTH IP/OP	$612.18 	$453.01	$0.00	"$1,108.00"	$623.25	$623.25	$0.00	$0.00	$0.00	$127.59	$454.36	$454.36	$0.00	$0.00	$127.58	$0.00	$362.10	$362.10	$0.00	$692.50	"$1,096.92"	"$1,108.00"	$0.00		$0.00	$216.75	$0.00	$0.00	$220.49	$0.00	$0.00	$0.00	$0.00	$0.00
55-10542	SUP	HCPCS C1713		55-10542  -  PLATE BONE 4X2 HOLE 3D LOCKING TITANIUM MAXFACL 2/2.3 MM	BOTH IP/OP	$688.55 	$509.53	$0.00	"$1,280.00"	$720.00	$720.00	$0.00	$0.00	$0.00	$143.51	$511.04	$511.04	$0.00	$0.00	$143.49	$0.00	$407.28	$407.28	$0.00	$800.00	"$1,267.20"	"$1,280.00"	$0.00		$0.00	$250.40	$0.00	$0.00	$254.72	$0.00	$0.00	$0.00	$0.00	$0.00
55-10562	SUP	HCPCS C1713		55-10562  -  PLATE BONE MINI CVD 6X2 HOLE 3D LOCKING CVD TITANIUM MAXFACL	BOTH IP/OP	$769.63 	$569.53	$0.00	"$1,394.00"	$784.13	$784.13	$0.00	$0.00	$0.00	$160.41	$571.22	$571.22	$0.00	$0.00	$160.39	$0.00	$455.23	$455.23	$0.00	$871.25	"$1,380.06"	"$1,394.00"	$0.00		$0.00	$272.70	$0.00	$0.00	$277.41	$0.00	$0.00	$0.00	$0.00	$0.00
55-10563	SUP	HCPCS C1713		55-10563  -  PLATE BONE MINI 4 HOLE REINFORCED BAR TITANIUM MANDIB 2/2.3	BOTH IP/OP	$709.10 	$524.73	$0.00	"$1,302.00"	$732.38	$732.38	$0.00	$0.00	$0.00	$147.79	$526.29	$526.29	$0.00	$0.00	$147.78	$0.00	$419.43	$419.43	$0.00	$813.75	"$1,288.98"	"$1,302.00"	$0.00		$0.00	$254.70	$0.00	$0.00	$259.10	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-101	SUP	HCPCS C1776		5510-F-101  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-102	SUP	HCPCS C1776		5510-F-102  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-201	SUP	HCPCS C1776		5510-F-201  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-202	SUP	HCPCS C1776		5510-F-202  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-301	SUP	HCPCS C1776		5510-F-301  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-302	SUP	HCPCS C1776		5510-F-302  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-401	SUP	HCPCS C1776		5510-F-401  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-402	SUP	HCPCS C1776		5510-F-402  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-501	SUP	HCPCS C1776		5510-F-501  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-502	SUP	HCPCS C1776		5510-F-502  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-601	SUP	HCPCS C1776		5510-F-601  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-602	SUP	HCPCS C1776		5510-F-602  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-701	SUP	HCPCS C1776		5510-F-701  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-702	SUP	HCPCS C1776		5510-F-702  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-801	SUP	HCPCS C1776		5510-F-801  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5510-F-802	SUP	HCPCS C1776		5510-F-802  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-101	SUP	HCPCS C1776		5512-F-101  -  COMPONENT FEMORAL 1 TOT STABILIZE TRIATHLON COCR KNEE LEFT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-102	SUP	HCPCS C1776		5512-F-102  -  COMPONENT FEMORAL 1 TOT STABILIZE TRIATHLON COCR KNEE RIGHT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-201	SUP	HCPCS C1776		5512-F-201  -  COMPONENT FEMORAL 2 TOT STABILIZE TRIATHLON COCR KNEE LEFT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-202	SUP	HCPCS C1776		5512-F-202  -  COMPONENT FEMORAL 2 TOT STABILIZE TRIATHLON COCR KNEE RIGHT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-301	SUP	HCPCS C1776		5512-F-301  -  COMPONENT FEMORAL 3 TOT STABILIZER TRIATHLON COCR KNEE LEFT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-302	SUP	HCPCS C1776		5512-F-302  -  COMPONENT FEMORAL 3 TOT STABILIZER TRIATHLON COCR KNEE RIGHT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-401	SUP	HCPCS C1776		5512-F-401  -  COMPONENT FEMORAL 4 TOT STABILIZER TRIATHLON COCR KNEE LEFT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-402	SUP	HCPCS C1776		5512-F-402  -  COMPONENT FEMORAL 4 TOT STABILIZER TRIATHLON COCR KNEE RIGHT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-501	SUP	HCPCS C1776		5512-F-501  -  COMPONENT FEMORAL 5 TOT STABILIZE TRIATHLON COCR KNEE LEFT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-502	SUP	HCPCS C1776		5512-F-502  -  COMPONENT FEMORAL 5 TOT STABILIZER TRIATHLON COCR KNEE RIGHT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-601	SUP	HCPCS C1776		5512-F-601  -  COMPONENT FEMORAL 6 TOT STABILIZE TRIATHLON COCR KNEE LEFT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-602	SUP	HCPCS C1776		5512-F-602  -  COMPONENT FEMORAL 6 TOT STABILIZE TRIATHLON COCR KNEE RIGHT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-701	SUP	HCPCS C1776		5512-F-701  -  COMPONENT FEMORAL 7 TOT STABILIZE TRIATHLON COCR KNEE LEFT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-702	SUP	HCPCS C1776		5512-F-702  -  COMPONENT FEMORAL 7 TOT STABILIZE TRIATHLON COCR KNEE RIGHT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-801	SUP	HCPCS C1776		5512-F-801  -  COMPONENT FEMORAL 8 TOT STABILIZE TRIATHLON COCR KNEE LEFT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5512-F-802	SUP	HCPCS C1776		5512-F-802  -  COMPONENT FEMORAL 8 TOT STABILIZE TRIATHLON COCR KNEE RIGHT	BOTH IP/OP	"$13,967.50 "	"$10,335.95"	$0.00	"$11,174.00"	"$6,285.38"	"$6,285.38"	$0.00	$0.00	$0.00	"$2,911.18"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,910.83"	$0.00	"$6,885.98"	"$6,885.98"	$0.00	"$6,983.75"	"$11,062.26"	"$11,174.00"	$0.00		$0.00	"$2,185.91"	$0.00	$0.00	"$2,223.63"	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-101	SUP	HCPCS C1776		5513-F-101  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-102	SUP	HCPCS C1776		5513-F-102  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-201	SUP	HCPCS C1776		5513-F-201  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-202	SUP	HCPCS C1776		5513-F-202  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-301	SUP	HCPCS C1776		5513-F-301  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-302	SUP	HCPCS C1776		5513-F-302  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-401	SUP	HCPCS C1776		5513-F-401  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-402	SUP	HCPCS C1776		5513-F-402  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-501	SUP	HCPCS C1776		5513-F-501  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-502	SUP	HCPCS C1776		5513-F-502  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-601	SUP	HCPCS C1776		5513-F-601  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-602	SUP	HCPCS C1776		5513-F-602  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-701	SUP	HCPCS C1776		5513-F-701  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-702	SUP	HCPCS C1776		5513-F-702  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-801	SUP	HCPCS C1776		5513-F-801  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5513-F-802	SUP	HCPCS C1776		5513-F-802  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-101	SUP	HCPCS C1776		5514-F-101  -  COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-102	SUP	HCPCS C1776		5514-F-102  -  COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-201	SUP	HCPCS C1776		5514-F-201  -  COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-202	SUP	HCPCS C1776		5514-F-202  -  COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-301	SUP	HCPCS C1776		5514-F-301  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-302	SUP	HCPCS C1776		5514-F-302  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-401	SUP	HCPCS C1776		5514-F-401  -  COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-402	SUP	HCPCS C1776		5514-F-402  -  COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-501	SUP	HCPCS C1776		5514-F-501  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-502	SUP	HCPCS C1776		5514-F-502  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-601	SUP	HCPCS C1776		5514-F-601  -  COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-602	SUP	HCPCS C1776		5514-F-602  -  COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-701	SUP	HCPCS C1776		5514-F-701  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-702	SUP	HCPCS C1776		5514-F-702  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-801	SUP	HCPCS C1776		5514-F-801  -  COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5514-F-802	SUP	HCPCS C1776		5514-F-802  -  COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
55-15504	SUP	HCPCS C1713		55-15504  -  PLATE BONE STR MINI 1.5MM 4 HOLE TITANIUM MAXFACL 2.3MM	BOTH IP/OP	"$1,600.00 "	"$1,184.00"	$0.00	"$1,280.00"	$720.00	$720.00	$0.00	$0.00	$0.00	$333.48	"$1,187.52"	"$1,187.52"	$0.00	$0.00	$333.44	$0.00	$946.40	$946.40	$0.00	$800.00	"$1,267.20"	"$1,280.00"	$0.00		$0.00	$250.40	$0.00	$0.00	$254.72	$0.00	$0.00	$0.00	$0.00	$0.00
55-15505	SUP	HCPCS C1713		55-15505  -  PLATE BONE 4 HOLE BAR LOCKING TITANIUM MAXFACL	BOTH IP/OP	"$1,610.00 "	"$1,191.40"	$0.00	"$1,288.00"	$724.50	$724.50	$0.00	$0.00	$0.00	$335.56	"$1,194.94"	"$1,194.94"	$0.00	$0.00	$335.52	$0.00	$952.32	$952.32	$0.00	$805.00	"$1,275.12"	"$1,288.00"	$0.00		$0.00	$251.97	$0.00	$0.00	$256.31	$0.00	$0.00	$0.00	$0.00	$0.00
55-15506	SUP	HCPCS C1713		55-15506  -  PLATE BONE 6 HOLE LOCKING TITANIUM MANDIB 2 MM SCREW	BOTH IP/OP	"$1,887.50 "	"$1,396.75"	$0.00	"$1,510.00"	$849.38	$849.38	$0.00	$0.00	$0.00	$393.40	"$1,400.90"	"$1,400.90"	$0.00	$0.00	$393.36	$0.00	"$1,116.46"	"$1,116.46"	$0.00	$943.75	"$1,494.90"	"$1,510.00"	$0.00		$0.00	$295.39	$0.00	$0.00	$300.49	$0.00	$0.00	$0.00	$0.00	$0.00
55-15507	SUP	HCPCS C1713		55-15507  -  PLATE BONE 6 HOLE BAR TITANIUM MANDIB 2.3/2.7 MM SCREW	BOTH IP/OP	"$2,045.00 "	"$1,513.30"	$0.00	"$1,636.00"	$920.25	$920.25	$0.00	$0.00	$0.00	$426.23	"$1,517.80"	"$1,517.80"	$0.00	$0.00	$426.18	$0.00	"$1,209.62"	"$1,209.62"	$0.00	"$1,022.50"	"$1,619.64"	"$1,636.00"	$0.00		$0.00	$320.04	$0.00	$0.00	$325.56	$0.00	$0.00	$0.00	$0.00	$0.00
55-15514	SUP	HCPCS C1713		55-15514  -  PLATE BONE 14 HOLE LOCKING TITANIUM MAXFACL 2.3/2.7 MM SCREW	BOTH IP/OP	"$1,270.23 "	$939.97	$0.00	"$2,408.00"	"$1,354.50"	"$1,354.50"	$0.00	$0.00	$0.00	$264.75	$942.76	$942.76	$0.00	$0.00	$264.71	$0.00	$751.34	$751.34	$0.00	"$1,505.00"	"$2,383.92"	"$2,408.00"	$0.00		$0.00	$471.07	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	$0.00
55-15524	SUP	HCPCS C1713		55-15524  -  PLATE BONE 4 HOLE TITANIUM MAXFACL	BOTH IP/OP	"$1,710.00 "	"$1,265.40"	$0.00	"$1,368.00"	$769.50	$769.50	$0.00	$0.00	$0.00	$356.41	"$1,269.16"	"$1,269.16"	$0.00	$0.00	$356.36	$0.00	"$1,011.47"	"$1,011.47"	$0.00	$855.00	"$1,354.32"	"$1,368.00"	$0.00		$0.00	$267.62	$0.00	$0.00	$272.23	$0.00	$0.00	$0.00	$0.00	$0.00
55-15526	SUP	HCPCS C1713		55-15526  -  PLATE BONE 115D 1.5MM 4 HOLE ANGLED TITANIUM MANDIB 2MM	BOTH IP/OP	"$2,840.00 "	"$2,101.60"	$0.00	"$2,272.00"	"$1,278.00"	"$1,278.00"	$0.00	$0.00	$0.00	$591.93	"$2,107.85"	"$2,107.85"	$0.00	$0.00	$591.86	$0.00	"$1,400.12"	"$1,400.12"	$0.00	"$1,420.00"	"$2,249.28"	"$2,272.00"	$0.00		$0.00	$444.46	$0.00	$0.00	$452.13	$0.00	$0.00	$0.00	$0.00	$0.00
55-15536	SUP	HCPCS C1713		55-15536  -  PLATE BN 140D 1.5MM NS LEIBINGER UNV 2 6 HL BAR TI MNDB	BOTH IP/OP	"$2,820.00 "	"$2,086.80"	$0.00	"$2,256.00"	"$1,269.00"	"$1,269.00"	$0.00	$0.00	$0.00	$587.76	"$2,093.00"	"$2,093.00"	$0.00	$0.00	$587.69	$0.00	"$1,390.26"	"$1,390.26"	$0.00	"$1,410.00"	"$2,233.44"	"$2,256.00"	$0.00		$0.00	$441.33	$0.00	$0.00	$448.94	$0.00	$0.00	$0.00	$0.00	$0.00
55-15570	SUP	HCPCS C1713		55-15570  -  PLATE BONE UNIVERSAL 1.5MM 4 HOLE COMPRESSION TITANIUM	BOTH IP/OP	$586.33 	$433.88	$0.00	"$1,060.00"	$596.25	$596.25	$0.00	$0.00	$0.00	$122.20	$435.17	$435.17	$0.00	$0.00	$122.19	$0.00	$346.81	$346.81	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00		$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
55-15575	SUP	HCPCS C1713		55-15575  -  PLATE BONE 4 HOLE COMPRESSION TITANIUM MANDIB 2.3 MM SCREWS	BOTH IP/OP	$586.33 	$433.88	$0.00	"$1,060.00"	$596.25	$596.25	$0.00	$0.00	$0.00	$122.20	$435.17	$435.17	$0.00	$0.00	$122.19	$0.00	$346.81	$346.81	$0.00	$662.50	"$1,049.40"	"$1,060.00"	$0.00		$0.00	$207.36	$0.00	$0.00	$210.94	$0.00	$0.00	$0.00	$0.00	$0.00
55-15580	SUP	HCPCS C1713		55-15580  -  PLATE BONE STR 6 HOLE COMPRESSION TITANIUM MAXFACL 2MM SCREW	BOTH IP/OP	$893.03 	$660.84	$0.00	"$1,592.00"	$895.50	$895.50	$0.00	$0.00	$0.00	$186.13	$662.80	$662.80	$0.00	$0.00	$186.11	$0.00	$528.22	$528.22	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$311.44	$0.00	$0.00	$316.81	$0.00	$0.00	$0.00	$0.00	$0.00
55-15585	SUP	HCPCS C1713		55-15585  -  PLATE BONE 6 HOLE COMPRESSION TITANIUM MANDIB 2.3 MM SCREWS	BOTH IP/OP	$893.03 	$660.84	$0.00	"$1,592.00"	$895.50	$895.50	$0.00	$0.00	$0.00	$186.13	$662.80	$662.80	$0.00	$0.00	$186.11	$0.00	$528.22	$528.22	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$311.44	$0.00	$0.00	$316.81	$0.00	$0.00	$0.00	$0.00	$0.00
55-15911	SUP	HCPCS C1713		55-15911  -  PLATE BONE STR 11 HOLE PRIM RECONSTRUCTION TITANIUM MANDIB	BOTH IP/OP	"$1,365.68 "	"$1,010.60"	$0.00	"$2,466.00"	"$1,387.13"	"$1,387.13"	$0.00	$0.00	$0.00	$284.64	"$1,013.60"	"$1,013.60"	$0.00	$0.00	$284.61	$0.00	$807.80	$807.80	$0.00	"$1,541.25"	"$2,441.34"	"$2,466.00"	$0.00		$0.00	$482.41	$0.00	$0.00	$490.73	$0.00	$0.00	$0.00	$0.00	$0.00
55-15917	SUP	HCPCS C1713		55-15917  -  PLATE BONE STR 17 HOLE PRIM RECONSTRUCTION TEMPLATE TITANIUM	BOTH IP/OP	"$1,735.33 "	"$1,284.14"	$0.00	"$3,130.00"	"$1,760.63"	"$1,760.63"	$0.00	$0.00	$0.00	$361.69	"$1,287.96"	"$1,287.96"	$0.00	$0.00	$361.64	$0.00	"$1,026.44"	"$1,026.44"	$0.00	"$1,956.25"	"$3,098.70"	"$3,130.00"	$0.00		$0.00	$612.31	$0.00	$0.00	$622.87	$0.00	$0.00	$0.00	$0.00	$0.00
55-15920	SUP	HCPCS C1713		55-15920  -  PLATE BN HMSPHR 1.5MM AU SMRT LCK LEIBINGER UNV 2 5X17 HL TI	BOTH IP/OP	"$2,445.23 "	"$1,809.47"	$0.00	"$4,244.00"	"$2,387.25"	"$2,387.25"	$0.00	$0.00	$0.00	$509.65	"$1,814.85"	"$1,814.85"	$0.00	$0.00	$509.58	$0.00	"$1,446.35"	"$1,446.35"	$0.00	"$2,652.50"	"$4,201.56"	"$4,244.00"	$0.00		$0.00	$830.23	$0.00	$0.00	$844.56	$0.00	$0.00	$0.00	$0.00	$0.00
55-15922	SUP	HCPCS C1713		55-15922  -  PLATE BN HMSPHR 1.5MM SMRT LCK LEIBINGER UNV 2 5X17 HL TI	BOTH IP/OP	"$2,445.23 "	"$1,809.47"	$0.00	"$4,244.00"	"$2,387.25"	"$2,387.25"	$0.00	$0.00	$0.00	$509.65	"$1,814.85"	"$1,814.85"	$0.00	$0.00	$509.58	$0.00	"$1,446.35"	"$1,446.35"	$0.00	"$2,652.50"	"$4,201.56"	"$4,244.00"	$0.00		$0.00	$830.23	$0.00	$0.00	$844.56	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-101	SUP	HCPCS C1776		5515-F-101  -  COMPONENT FEMORAL 1 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-102	SUP	HCPCS C1776		5515-F-102  -  COMPONENT FEMORAL 1 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-201	SUP	HCPCS C1776		5515-F-201  -  COMPONENT FEMORAL 2 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-202	SUP	HCPCS C1776		5515-F-202  -  COMPONENT FEMORAL 2 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-301	SUP	HCPCS C1776		5515-F-301  -  COMPONENT FEMORAL 3 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-302	SUP	HCPCS C1776		5515-F-302  -  COMPONENT FEMORAL 3 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-401	SUP	HCPCS C1776		5515-F-401  -  COMPONENT FEMORAL 4 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-402	SUP	HCPCS C1776		5515-F-402  -  COMPONENT FEMORAL 4 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-501	SUP	HCPCS C1776		5515-F-501  -  COMPONENT FEMORAL 5 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-502	SUP	HCPCS C1776		5515-F-502  -  COMPONENT FEMORAL 5 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-601	SUP	HCPCS C1776		5515-F-601  -  COMPONENT FEMORAL 6 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-602	SUP	HCPCS C1776		5515-F-602  -  COMPONENT FEMORAL 6 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-701	SUP	HCPCS C1776		5515-F-701  -  COMPONENT FEMORAL 7 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-702	SUP	HCPCS C1776		5515-F-702  -  COMPONENT FEMORAL 7 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-801	SUP	HCPCS C1776		5515-F-801  -  COMPONENT FEMORAL 8 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5515-F-802	SUP	HCPCS C1776		5515-F-802  -  COMPONENT FEMORAL 8 CEMENTED POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-101	SUP	HCPCS C1776		5516-F-101  -  COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-102	SUP	HCPCS C1776		5516-F-102  -  COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-201	SUP	HCPCS C1776		5516-F-201  -  COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-202	SUP	HCPCS C1776		5516-F-202  -  COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-301	SUP	HCPCS C1776		5516-F-301  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-302	SUP	HCPCS C1776		5516-F-302  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-401	SUP	HCPCS C1776		5516-F-401  -  COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-402	SUP	HCPCS C1776		5516-F-402  -  COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-501	SUP	HCPCS C1776		5516-F-501  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-502	SUP	HCPCS C1776		5516-F-502  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-601	SUP	HCPCS C1776		5516-F-601  -  COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-602	SUP	HCPCS C1776		5516-F-602  -  COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-701	SUP	HCPCS C1776		5516-F-701  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-702	SUP	HCPCS C1776		5516-F-702  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-801	SUP	HCPCS C1776		5516-F-801  -  COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5516-F-802	SUP	HCPCS C1776		5516-F-802  -  COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON PA	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-101	SUP	HCPCS C1776		5517-F-101  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-102	SUP	HCPCS C1776		5517-F-102  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-201	SUP	HCPCS C1776		5517-F-201  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-202	SUP	HCPCS C1776		5517-F-202  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-301	SUP	HCPCS C1776		5517-F-301  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-302	SUP	HCPCS C1776		5517-F-302  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-401	SUP	HCPCS C1776		5517-F-401  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-402	SUP	HCPCS C1776		5517-F-402  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-501	SUP	HCPCS C1776		5517-F-501  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-502	SUP	HCPCS C1776		5517-F-502  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-601	SUP	HCPCS C1776		5517-F-601  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-602	SUP	HCPCS C1776		5517-F-602  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-701	SUP	HCPCS C1776		5517-F-701  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-702	SUP	HCPCS C1776		5517-F-702  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-801	SUP	HCPCS C1776		5517-F-801  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5517-F-802	SUP	HCPCS C1776		5517-F-802  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
5520-B-100	SUP	HCPCS C1776		5520-B-100  -  BASEPLATE TIBIAL 1 PRIM CEMENT TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-B-200	SUP	HCPCS C1776		5520-B-200  -  BASEPLATE TIBIAL 2 PRIM CEMENT TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-B-300	SUP	HCPCS C1776		5520-B-300  -  BASEPLATE TIB 3 TRTHLN PRM CMNT KN	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-B-400	SUP	HCPCS C1776		5520-B-400  -  BASEPLATE TIBIAL 4 PRIM CEMENT TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-B-500	SUP	HCPCS C1776		5520-B-500  -  BASEPLATE TIBIAL 5 PRIM CEMENT TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-B-600	SUP	HCPCS C1776		5520-B-600  -  BASEPLATE TIBIAL 6 PRIM CEMENT TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-B-700	SUP	HCPCS C1776		5520-B-700  -  BASEPLATE TIBIAL 7 PRIM CEMENT TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-B-800	SUP	HCPCS C1776		5520-B-800  -  BASEPLATE TIBIAL 8 PRIM CEMENT TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-M-100	SUP	HCPCS C1776		5520-M-100  -  BASEPLATE TIBIAL 1 LP TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-M-200	SUP	HCPCS C1776		5520-M-200  -  BASEPLATE TIBIAL 2 LP TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-M-300	SUP	HCPCS C1776		5520-M-300  -  BASEPLATE TIBIAL 3 LP TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-M-400	SUP	HCPCS C1776		5520-M-400  -  BASEPLATE TIBIAL 4 LP TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-M-500	SUP	HCPCS C1776		5520-M-500  -  BASEPLATE TIBIAL 5 LP TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-M-600	SUP	HCPCS C1776		5520-M-600  -  BASEPLATE TIBIAL 6 LP TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-M-700	SUP	HCPCS C1776		5520-M-700  -  BASEPLATE TIBIAL 7 LP TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5520-M-800	SUP	HCPCS C1776		5520-M-800  -  BASEPLATE TIBIAL 8 LP TRIATHLON KNEE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
5521-B-100	SUP	HCPCS C1776		5521-B-100  -  BASEPLATE TIB 1 UNV TRTHLN COCR KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5521-B-200	SUP	HCPCS C1776		5521-B-200  -  BASEPLATE TIB 2 UNV TRTHLN COCR KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5521-B-300	SUP	HCPCS C1776		5521-B-300  -  BASEPLATE TIB 3 UNV TRTHLN COCR KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5521-B-400	SUP	HCPCS C1776		5521-B-400  -  BASEPLATE TIB 4 UNV TRTHLN COCR KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5521-B-500	SUP	HCPCS C1776		5521-B-500  -  BASEPLATE TIB 5 UNV TRTHLN COCR KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5521-B-600	SUP	HCPCS C1776		5521-B-600  -  BASEPLATE TIB 6 UNV TRTHLN COCR KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5521-B-700	SUP	HCPCS C1776		5521-B-700  -  BASEPLATE TIB 7 UNV TRTHLN COCR KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5521-B-800	SUP	HCPCS C1776		5521-B-800  -  BASEPLATE TIB 8 UNV TRTHLN COCR KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5523-B-100	SUP	HCPCS C1776		5523-B-100  -  BASEPLATE TIBIAL 1 PRIM BEADED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5523-B-200	SUP	HCPCS C1776		5523-B-200  -  BASEPLATE TIBIAL 2 PRIM BEADED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5523-B-300	SUP	HCPCS C1776		5523-B-300  -  BASEPLATE TIBIAL 3 PRIM BEADED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5523-B-400	SUP	HCPCS C1776		5523-B-400  -  BASEPLATE TIBIAL 4 PRIM BEADED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5523-B-500	SUP	HCPCS C1776		5523-B-500  -  BASEPLATE TIBIAL 5 PRIM BEADED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5523-B-600	SUP	HCPCS C1776		5523-B-600  -  BASEPLATE TIBIAL 6 PRIM BEADED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5523-B-700	SUP	HCPCS C1776		5523-B-700  -  BASEPLATE TIBIAL 7 PRIM BEADED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5523-B-800	SUP	HCPCS C1776		5523-B-800  -  BASEPLATE TIBIAL 8 PRIM BEADED TRIATHLON KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5524-B-100	SUP	HCPCS C1776		5524-B-100  -  BASEPLATE TIBIAL 1 CEMENTLESS TRIATHLON KNEE SCREW FIX	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5524-B-200	SUP	HCPCS C1776		5524-B-200  -  BASEPLATE TIBIAL 2 CEMENTLESS TRIATHLON KNEE SCREW FIX	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5524-B-300	SUP	HCPCS C1776		5524-B-300  -  BASEPLATE TIBIAL 3 BEAD TRIATHLON VITALLIUM KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5524-B-400	SUP	HCPCS C1776		5524-B-400  -  BASEPLATE TIBIAL 4 CEMENTLESS TRIATHLON KNEE SCREW FIX	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5524-B-500	SUP	HCPCS C1776		5524-B-500  -  BASEPLATE TIBIAL 5 CEMENTLESS TRIATHLON KNEE SCREW FIX	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5524-B-600	SUP	HCPCS C1776		5524-B-600  -  BASEPLATE TIBIAL 6 CEMENTLESS TRIATHLON KNEE SCREW FIX	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5524-B-700	SUP	HCPCS C1776		5524-B-700  -  BASEPLATE TIBIAL 7 CEMENTLESS TRIATHLON KNEE SCREW FIX	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5524-B-800	SUP	HCPCS C1776		5524-B-800  -  BASEPLATE TIBIAL 8 CEMENTLESS TRIATHLON KNEE SCREW FIX	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5526-B-100	SUP	HCPCS C1776		5526-B-100  -  BASEPLATE TIBIAL 1 PRIM BEADED TRIATHLON PERIAPT KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5526-B-200	SUP	HCPCS C1776		5526-B-200  -  BASEPLATE TIBIAL 2 PRIM BEADED TRIATHLON PERIAPT KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5526-B-300	SUP	HCPCS C1776		5526-B-300  -  BASEPLATE TIBIAL 3 PRIM BEADED TRIATHLON PERIAPT KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5526-B-400	SUP	HCPCS C1776		5526-B-400  -  BASEPLATE TIBIAL 4 PRIM BEADED TRIATHLON PERIAPT KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5526-B-500	SUP	HCPCS C1776		5526-B-500  -  BASEPLATE TIBIAL 5 PRIM BEADED TRIATHLON PERIAPT KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5526-B-600	SUP	HCPCS C1776		5526-B-600  -  BASEPLATE TIBIAL 6 PRIM BEADED TRIATHLON PERIAPT KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5526-B-700	SUP	HCPCS C1776		5526-B-700  -  BASEPLATE TIBIAL 7 PRIM BEADED TRIATHLON PERIAPT KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5526-B-800	SUP	HCPCS C1776		5526-B-800  -  BASEPLATE TIBIAL 8 PRIM BEADED TRIATHLON PERIAPT KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5527-B-100	SUP	HCPCS C1776		5527-B-100  -  BASEPLATE TIBIAL 1 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5527-B-200	SUP	HCPCS C1776		5527-B-200  -  BASEPLATE TIBIAL 2 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5527-B-300	SUP	HCPCS C1776		5527-B-300  -  BASEPLATE TIBIAL 3 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5527-B-400	SUP	HCPCS C1776		5527-B-400  -  BASEPLATE TIBIAL 4 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5527-B-500	SUP	HCPCS C1776		5527-B-500  -  BASEPLATE TIBIAL 5 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5527-B-600	SUP	HCPCS C1776		5527-B-600  -  BASEPLATE TIBIAL 6 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5527-B-700	SUP	HCPCS C1776		5527-B-700  -  BASEPLATE TIBIAL 7 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5527-B-800	SUP	HCPCS C1776		5527-B-800  -  BASEPLATE TIBIAL 8 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
55-28911	SUP	HCPCS C1713		55-28911  -  PLATE BONE 11 HOLE RECONSTRUCTION TEMPLATE TITANIUM MAXFACL	BOTH IP/OP	"$1,609.38 "	"$1,190.94"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$335.43	"$1,194.48"	"$1,194.48"	$0.00	$0.00	$335.39	$0.00	$951.95	$951.95	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
55-28917	SUP	HCPCS C1713		55-28917  -  PLATE BONE 17 HOLE RECONSTRUCTION TEMPLATE TITANIUM MAXFACL	BOTH IP/OP	"$2,167.63 "	"$1,604.05"	$0.00	"$4,316.00"	"$2,427.75"	"$2,427.75"	$0.00	$0.00	$0.00	$451.79	"$1,608.81"	"$1,608.81"	$0.00	$0.00	$451.73	$0.00	"$1,282.15"	"$1,282.15"	$0.00	"$2,697.50"	"$4,272.84"	"$4,316.00"	$0.00		$0.00	$844.32	$0.00	$0.00	$858.88	$0.00	$0.00	$0.00	$0.00	$0.00
55-28920	SUP	HCPCS C1713		55-28920  -  PLATE BONE 6X17 HOLE RECONSTRUCTION HEMISPHERE TEMPLATE	BOTH IP/OP	"$2,724.95 "	"$2,016.46"	$0.00	"$4,726.00"	"$2,658.38"	"$2,658.38"	$0.00	$0.00	$0.00	$567.95	"$2,022.46"	"$2,022.46"	$0.00	$0.00	$567.88	$0.00	"$1,343.40"	"$1,343.40"	$0.00	"$2,953.75"	"$4,678.74"	"$4,726.00"	$0.00		$0.00	$924.52	$0.00	$0.00	$940.47	$0.00	$0.00	$0.00	$0.00	$0.00
55-28922	SUP	HCPCS C1713		55-28922  -  PLATE BONE 6X17 HOLE RECONSTRUCTION HEMISPHERE TEMPLATE	BOTH IP/OP	"$2,724.95 "	"$2,016.46"	$0.00	"$4,726.00"	"$2,658.38"	"$2,658.38"	$0.00	$0.00	$0.00	$567.95	"$2,022.46"	"$2,022.46"	$0.00	$0.00	$567.88	$0.00	"$1,343.40"	"$1,343.40"	$0.00	"$2,953.75"	"$4,678.74"	"$4,726.00"	$0.00		$0.00	$924.52	$0.00	$0.00	$940.47	$0.00	$0.00	$0.00	$0.00	$0.00
55-28925	SUP	HCPCS C1713		55-28925  -  PLATE BN HMSPHR 1.5MM SMRT LCK LEIBINGER UNV 2 6X17 HL TI	BOTH IP/OP	"$5,907.50 "	"$4,371.55"	$0.00	"$4,726.00"	"$2,658.38"	"$2,658.38"	$0.00	$0.00	$0.00	"$1,231.27"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,231.12"	$0.00	"$2,912.40"	"$2,912.40"	$0.00	"$2,953.75"	"$4,678.74"	"$4,726.00"	$0.00		$0.00	$924.52	$0.00	$0.00	$940.47	$0.00	$0.00	$0.00	$0.00	$0.00
55-28926	SUP	HCPCS C1713		55-28926  -  PLATE BN HMSPHR 1.5MM SMRT LCK LEIBINGER UNV 2 6X17 HL TI	BOTH IP/OP	"$5,907.50 "	"$4,371.55"	$0.00	"$4,726.00"	"$2,658.38"	"$2,658.38"	$0.00	$0.00	$0.00	"$1,231.27"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,231.12"	$0.00	"$2,912.40"	"$2,912.40"	$0.00	"$2,953.75"	"$4,678.74"	"$4,726.00"	$0.00		$0.00	$924.52	$0.00	$0.00	$940.47	$0.00	$0.00	$0.00	$0.00	$0.00
55-28930	SUP	HCPCS C1713		55-28930  -  PLATE BONE 6+17+6 HOLE FULL TITANIUM MANDIB	BOTH IP/OP	"$3,495.70 "	"$2,586.82"	$0.00	"$5,792.00"	"$3,258.00"	"$3,258.00"	$0.00	$0.00	$0.00	$728.59	"$2,594.51"	"$2,594.51"	$0.00	$0.00	$728.50	$0.00	"$1,723.38"	"$1,723.38"	$0.00	"$3,620.00"	"$5,734.08"	"$5,792.00"	$0.00		$0.00	"$1,133.06"	$0.00	$0.00	"$1,152.61"	$0.00	$0.00	$0.00	$0.00	$0.00
55-28932	SUP	HCPCS C1713		55-28932  -  PLATE BONE 6X15X6 HOLE FULL RECONSTRUCTION TEMPLATE TITANIUM	BOTH IP/OP	"$3,369.60 "	"$2,493.50"	$0.00	"$5,582.00"	"$3,139.88"	"$3,139.88"	$0.00	$0.00	$0.00	$702.31	"$2,500.92"	"$2,500.92"	$0.00	$0.00	$702.22	$0.00	"$1,661.21"	"$1,661.21"	$0.00	"$3,488.75"	"$5,526.18"	"$5,582.00"	$0.00		$0.00	"$1,091.98"	$0.00	$0.00	"$1,110.82"	$0.00	$0.00	$0.00	$0.00	$0.00
55-28934	SUP	HCPCS C1713		55-28934  -  PLATE BONE 6+13+6 HOLE SECONDARY RECONSTRUCTION FULL	BOTH IP/OP	"$3,304.78 "	"$2,445.54"	$0.00	"$5,098.00"	"$2,867.63"	"$2,867.63"	$0.00	$0.00	$0.00	$688.80	"$2,452.80"	"$2,452.80"	$0.00	$0.00	$688.72	$0.00	"$1,629.25"	"$1,629.25"	$0.00	"$3,186.25"	"$5,047.02"	"$5,098.00"	$0.00		$0.00	$997.30	$0.00	$0.00	"$1,014.50"	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-109	SUP	Custom 27803010		5530-G-109  -  INSERT TIBIAL 1 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-109-E	SUP	HCPCS C1776		5530-G-109-E  -  INSERT TIB 1 9MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-110-E	SUP	HCPCS C1776		5530-G-110-E  -  INSERT TIB 1 10MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-111	SUP	Custom 27803010		5530-G-111  -  INSERT TIBIAL 1 11MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-111-E	SUP	HCPCS C1776		5530-G-111-E  -  INSERT TIB 1 11MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-112-E	SUP	HCPCS C1776		5530-G-112-E  -  INSERT TIB 1 12MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-113	SUP	Custom 27803010		5530-G-113  -  INSERT TIBIAL 1 13MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-113-E	SUP	HCPCS C1776		5530-G-113-E  -  INSERT TIB 1 13MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-114-E	SUP	HCPCS C1776		5530-G-114-E  -  INSERT TIB 1 14MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-116	SUP	Custom 27803010		5530-G-116  -  INSERT TIBIAL 1 16MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-116-E	SUP	HCPCS C1776		5530-G-116-E  -  INSERT TIB 1 16MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-119	SUP	Custom 27803010		5530-G-119  -  INSERT TIBIAL 1 19MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-119-E	SUP	HCPCS C1776		5530-G-119-E  -  INSERT TIB 1 19MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-209	SUP	Custom 27803010		5530-G-209  -  INSERT TIBIAL 2 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-209-E	SUP	HCPCS C1776		5530-G-209-E  -  INSERT TIB 2 9MM STRL TRTHLN BRNG CRCTE RTN CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-210-E	SUP	HCPCS C1776		5530-G-210-E  -  INSERT TIB 2 10MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-211	SUP	Custom 27803010		5530-G-211  -  INSERT TIBIAL 2 11MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-211-E	SUP	HCPCS C1776		5530-G-211-E  -  INSERT TIB 2 11MM STRL TRTHLN BRNG CRCTE RTN CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-212-E	SUP	HCPCS C1776		5530-G-212-E  -  INSERT TIB 2 12MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-213	SUP	Custom 27803010		5530-G-213  -  INSERT TIBIAL 2 13MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-213-E	SUP	HCPCS C1776		5530-G-213-E  -  INSERT TIB 2 13MM STRL TRTHLN BRNG CRCTE RTN CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-214-E	SUP	HCPCS C1776		5530-G-214-E  -  INSERT TIB 2 14MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-216	SUP	Custom 27803010		5530-G-216  -  INSERT TIBIAL 2 16MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-216-E	SUP	HCPCS C1776		5530-G-216-E  -  INSERT TIB 2 16MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-219	SUP	Custom 27803010		5530-G-219  -  INSERT TIBIAL 2 19MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-219-E	SUP	HCPCS C1776		5530-G-219-E  -  INSERT TIB 2 19MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-309	SUP	Custom 27803010		5530-G-309  -  INSERT TIBIAL 3 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-309-E	SUP	HCPCS C1776		5530-G-309-E  -  INSERT TIB 3 9MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-310-E	SUP	HCPCS C1776		5530-G-310-E  -  INSERT TIB 3 10MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-311	SUP	Custom 27803010		5530-G-311  -  INSERT TIBIAL 3 11MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-311-E	SUP	HCPCS C1776		5530-G-311-E  -  INSERT TIB 3 11MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-312-E	SUP	HCPCS C1776		5530-G-312-E  -  INSERT TIB 3 12MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-313	SUP	Custom 27803010		5530-G-313  -  INSERT TIBIAL 3 13MM CRUCIATE RETAIN TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-313-E	SUP	HCPCS C1776		5530-G-313-E  -  INSERT TIB 3 13MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-314-E	SUP	HCPCS C1776		5530-G-314-E  -  INSERT TIB 3 14MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-316	SUP	Custom 27803010		5530-G-316  -  INSERT TIBIAL 3 16MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-316-E	SUP	HCPCS C1776		5530-G-316-E  -  INSERT TIB 3 16MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-319	SUP	Custom 27803010		5530-G-319  -  INSERT TIBIAL 3 19MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-319-E	SUP	HCPCS C1776		5530-G-319-E  -  INSERT TIB 3 19MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-409	SUP	Custom 27803010		5530-G-409  -  INSERT TIBIAL 4 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-409-E	SUP	HCPCS C1776		5530-G-409-E  -  INSERT TIB 4 9MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-410-E	SUP	HCPCS C1776		5530-G-410-E  -  INSERT TIB 4 10MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-411	SUP	Custom 27803010		5530-G-411  -  INSERT TIBIAL 4 11MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-411-E	SUP	HCPCS C1776		5530-G-411-E  -  INSERT TIB 4 11MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-412-E	SUP	HCPCS C1776		5530-G-412-E  -  INSERT TIB 4 12MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-413	SUP	Custom 27803010		5530-G-413  -  INSERT TIBIAL 4 13MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-413-E	SUP	HCPCS C1776		5530-G-413-E  -  INSERT TIB 4 13MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-414-E	SUP	HCPCS C1776		5530-G-414-E  -  INSERT TIB 4 14MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-416	SUP	Custom 27803010		5530-G-416  -  INSERT TIBIAL 4 16MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-416-E	SUP	HCPCS C1776		5530-G-416-E  -  INSERT TIB 4 16MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-419	SUP	Custom 27803010		5530-G-419  -  INSERT TIBIAL 4 19MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-419-E	SUP	HCPCS C1776		5530-G-419-E  -  INSERT TIB 4 19MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-509	SUP	Custom 27803010		5530-G-509  -  INSERT TIBIAL 5 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-509-E	SUP	HCPCS C1776		5530-G-509-E  -  INSERT TIB 5 9MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-510-E	SUP	HCPCS C1776		5530-G-510-E  -  INSERT TIB 5 10MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-511	SUP	Custom 27803010		5530-G-511  -  INSERT TIBIAL 5 11MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-511-E	SUP	HCPCS C1776		5530-G-511-E  -  INSERT TIB 5 11MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-512-E	SUP	HCPCS C1776		5530-G-512-E  -  INSERT TIB 5 12MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-513	SUP	Custom 27803010		5530-G-513  -  INSERT TIBIAL 5 13MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-513-E	SUP	HCPCS C1776		5530-G-513-E  -  INSERT TIB 5 13MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-514-E	SUP	HCPCS C1776		5530-G-514-E  -  INSERT TIB 5 14MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-516	SUP	Custom 27803010		5530-G-516  -  INSERT TIBIAL 5 16MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-516-E	SUP	HCPCS C1776		5530-G-516-E  -  INSERT TIB 5 16MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-519	SUP	Custom 27803010		5530-G-519  -  INSERT TIBIAL 5 19MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-519-E	SUP	HCPCS C1776		5530-G-519-E  -  INSERT TIB 5 19MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-609	SUP	Custom 27803010		5530-G-609  -  INSERT TIBIAL 6 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-609-E	SUP	HCPCS C1776		5530-G-609-E  -  INSERT TIB 6 9MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-610-E	SUP	HCPCS C1776		5530-G-610-E  -  INSERT TIB 6 10MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-611	SUP	Custom 27803010		5530-G-611  -  INSERT TIBIAL 6 11MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-611-E	SUP	HCPCS C1776		5530-G-611-E  -  INSERT TIB 6 11MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-612-E	SUP	HCPCS C1776		5530-G-612-E  -  INSERT TIB 6 12MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-613	SUP	Custom 27803010		5530-G-613  -  INSERT TIBIAL 6 13MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-613-E	SUP	HCPCS C1776		5530-G-613-E  -  INSERT TIB 6 13MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-614-E	SUP	HCPCS C1776		5530-G-614-E  -  INSERT TIB 6 14MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-616	SUP	Custom 27803010		5530-G-616  -  INSERT TIBIAL 6 16MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-616-E	SUP	HCPCS C1776		5530-G-616-E  -  INSERT TIB 6 16MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-619	SUP	Custom 27803010		5530-G-619  -  INSERT TIBIAL 6 19MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-619-E	SUP	HCPCS C1776		5530-G-619-E  -  INSERT TIB 6 19MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-709	SUP	Custom 27803010		5530-G-709  -  INSERT TIBIAL 7 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-709-E	SUP	HCPCS C1776		5530-G-709-E  -  INSERT TIB 7 9MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-710-E	SUP	HCPCS C1776		5530-G-710-E  -  INSERT TIB 7 10MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-711	SUP	Custom 27803010		5530-G-711  -  INSERT TIBIAL 7 11MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-711-E	SUP	HCPCS C1776		5530-G-711-E  -  INSERT TIB 7 11MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-712-E	SUP	HCPCS C1776		5530-G-712-E  -  INSERT TIB 7 12MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-713	SUP	Custom 27803010		5530-G-713  -  INSERT TIBIAL 7 13MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-713-E	SUP	HCPCS C1776		5530-G-713-E  -  INSERT TIB 7 13MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-714-E	SUP	HCPCS C1776		5530-G-714-E  -  INSERT TIB 7 14MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-716	SUP	Custom 27803010		5530-G-716  -  INSERT TIBIAL 7 16MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-716-E	SUP	HCPCS C1776		5530-G-716-E  -  INSERT TIB 7 16MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-719	SUP	Custom 27803010		5530-G-719  -  INSERT TIBIAL 7 19MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-719-E	SUP	HCPCS C1776		5530-G-719-E  -  INSERT TIB 7 19MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-809	SUP	Custom 27803010		5530-G-809  -  INSERT TIBIAL 8 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-809-E	SUP	HCPCS C1776		5530-G-809-E  -  INSERT TIB 8 9MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-810-E	SUP	HCPCS C1776		5530-G-810-E  -  INSERT TIB 8 10MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-811	SUP	Custom 27803010		5530-G-811  -  INSERT TIBIAL 8 11MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-811-E	SUP	HCPCS C1776		5530-G-811-E  -  INSERT TIB 8 11MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-812-E	SUP	HCPCS C1776		5530-G-812-E  -  INSERT TIB 8 12MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-813	SUP	Custom 27803010		5530-G-813  -  INSERT TIBIAL 8 13MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-813-E	SUP	HCPCS C1776		5530-G-813-E  -  INSERT TIB 8 13MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-814-E	SUP	HCPCS C1776		5530-G-814-E  -  INSERT TIB 8 14MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-816	SUP	Custom 27803010		5530-G-816  -  INSERT TIBIAL 8 16MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-816-E	SUP	HCPCS C1776		5530-G-816-E  -  INSERT TIB 8 16MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-819	SUP	Custom 27803010		5530-G-819  -  INSERT TIBIAL 8 19MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-G-819-E	SUP	HCPCS C1776		5530-G-819-E  -  INSERT TIB 8 19MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-109	SUP	Custom 27803010		5530-P-109  -  INSERT TIBIAL 1 9MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-110	SUP	HCPCS C1776		5530-P-110  -  INSERT TIB 1 10MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-111	SUP	Custom 27803010		5530-P-111  -  INSERT TIBIAL 1 11MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-112	SUP	HCPCS C1776		5530-P-112  -  INSERT TIB 1 12MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-113	SUP	Custom 27803010		5530-P-113  -  INSERT TIBIAL 1 13MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-114	SUP	HCPCS C1776		5530-P-114  -  INSERT TIB 1 14MM STRL TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-116	SUP	Custom 27803010		5530-P-116  -  INSERT TIBIAL 1 P 16MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-119	SUP	Custom 27803010		5530-P-119  -  INSERT TIBIAL 1 P 19MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-209	SUP	Custom 27803010		5530-P-209  -  INSERT TIBIAL 2 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-210	SUP	HCPCS C1776		5530-P-210  -  INSERT TIB 2 10MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-211	SUP	Custom 27803010		5530-P-211  -  INSERT TIBIAL 2 11MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-212	SUP	HCPCS C1776		5530-P-212  -  INSERT TIB 2 12MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-213	SUP	Custom 27803010		5530-P-213  -  INSERT TIBIAL 2 13MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-214	SUP	HCPCS C1776		5530-P-214  -  INSERT TIB 2 14MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-216	SUP	Custom 27803010		5530-P-216  -  INSERT TIBIAL 2 16MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-219	SUP	Custom 27803010		5530-P-219  -  INSERT TIBIAL 2 P 19MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-309	SUP	Custom 27803010		5530-P-309  -  INSERT TIBIAL 3 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-310	SUP	HCPCS C1776		5530-P-310  -  INSERT TIB 3 10MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-311	SUP	Custom 27803010		5530-P-311  -  INSERT TIBIAL 3 11MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-312	SUP	HCPCS C1776		5530-P-312  -  INSERT TIB 3 12MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-313	SUP	Custom 27803010		5530-P-313  -  INSERT TIBIAL 3 13MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-314	SUP	HCPCS C1776		5530-P-314  -  INSERT TIB 3 14MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-316	SUP	Custom 27803010		5530-P-316  -  INSERT TIBIAL 3 16MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-319	SUP	Custom 27803010		5530-P-319  -  INSERT TIBIAL 3 19MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-409	SUP	Custom 27803010		5530-P-409  -  INSERT TIBIAL 4 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-410	SUP	HCPCS C1776		5530-P-410  -  INSERT TIB 4 10MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-411	SUP	Custom 27803010		5530-P-411  -  INSERT TIBIAL 4 11MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-412	SUP	HCPCS C1776		5530-P-412  -  INSERT TIB 4 12MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-413	SUP	Custom 27803010		5530-P-413  -  INSERT TIBIAL 4 13MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-414	SUP	HCPCS C1776		5530-P-414  -  INSERT TIB 4 14MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-416	SUP	Custom 27803010		5530-P-416  -  INSERT TIBIAL 4 16MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-419	SUP	Custom 27803010		5530-P-419  -  INSERT TIBIAL 4 19MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-509	SUP	Custom 27803010		5530-P-509  -  INSERT TIBIAL 5 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-510	SUP	HCPCS C1776		5530-P-510  -  INSERT TIB 5 10MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-511	SUP	Custom 27803010		5530-P-511  -  INSERT TIBIAL 5 11MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-512	SUP	HCPCS C1776		5530-P-512  -  INSERT TIB 5 12MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-513	SUP	Custom 27803010		5530-P-513  -  INSERT TIBIAL 5 13MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-514	SUP	HCPCS C1776		5530-P-514  -  INSERT TIB 5 14MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-516	SUP	Custom 27803010		5530-P-516  -  INSERT TIBIAL 5 16MM CRUCIATE RETAIN TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-519	SUP	Custom 27803010		5530-P-519  -  INSERT TIBIAL 5 19MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-609	SUP	Custom 27803010		5530-P-609  -  INSERT TIBIAL 6 9MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-610	SUP	HCPCS C1776		5530-P-610  -  INSERT TIB 6 10MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-611	SUP	Custom 27803010		5530-P-611  -  INSERT TIBIAL 6 11MM CRUC RET TRIATHLON X3 KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-612	SUP	HCPCS C1776		5530-P-612  -  INSERT TIB 6 12MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-613	SUP	Custom 27803010		5530-P-613  -  INSERT TIBIAL 6 13MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-614	SUP	HCPCS C1776		5530-P-614  -  INSERT TIB 6 14MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-616	SUP	Custom 27803010		5530-P-616  -  INSERT TIBIAL 6 16MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-619	SUP	Custom 27803010		5530-P-619  -  INSERT TIBIAL 6 19MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-709	SUP	Custom 27803010		5530-P-709  -  INSERT TIBIAL 7 9MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-710	SUP	HCPCS C1776		5530-P-710  -  INSERT TIB 7 10MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-711	SUP	Custom 27803010		5530-P-711  -  INSERT TIBIAL 7 11MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-712	SUP	HCPCS C1776		5530-P-712  -  INSERT TIB 7 12MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-713	SUP	Custom 27803010		5530-P-713  -  INSERT TIBIAL 7 13MM CRUCIATE RETAIN TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-714	SUP	HCPCS C1776		5530-P-714  -  INSERT TIB 7 14MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-716	SUP	Custom 27803010		5530-P-716  -  INSERT TIBIAL 7 16MM CRUCIATE RETAIN TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-719	SUP	Custom 27803010		5530-P-719  -  INSERT TIBIAL 7 19MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-809	SUP	Custom 27803010		5530-P-809  -  INSERT TIBIAL 8 9MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-810	SUP	HCPCS C1776		5530-P-810  -  INSERT TIB 8 10MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-811	SUP	Custom 27803010		5530-P-811  -  INSERT TIBIAL 8 11MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-812	SUP	HCPCS C1776		5530-P-812  -  INSERT TIB 8 12MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-813	SUP	Custom 27803010		5530-P-813  -  INSERT TIBIAL 8 13MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-814	SUP	HCPCS C1776		5530-P-814  -  INSERT TIB 8 14MM STRL LF TRTHLN BRNG CRCTE RTN KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-816	SUP	Custom 27803010		5530-P-816  -  INSERT TIBIAL 8 16MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5530-P-819	SUP	Custom 27803010		5530-P-819  -  INSERT TIBIAL 8 19MM CRUC RET TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-109	SUP	Custom 27803010		5531-G-109  -  INSERT TIBIAL 1 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-109-E	SUP	HCPCS C1776		5531-G-109-E  -  INSERT TIB 1 9MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-110-E	SUP	HCPCS C1776		5531-G-110-E  -  INSERT TIB 1 10MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-111	SUP	Custom 27803010		5531-G-111  -  INSERT TIBIAL 1 G 11MM TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-111-E	SUP	HCPCS C1776		5531-G-111-E  -  INSERT TIB 1 11MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-112-E	SUP	HCPCS C1776		5531-G-112-E  -  INSERT TIB 1 12MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-113	SUP	Custom 27803010		5531-G-113  -  INSERT TIBIAL 1 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-113-E	SUP	HCPCS C1776		5531-G-113-E  -  INSERT TIB 1 13MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-114-E	SUP	HCPCS C1776		5531-G-114-E  -  INSERT TIB 1 14MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-116	SUP	Custom 27803010		5531-G-116  -  INSERT TIBIAL 1 16MM CRUC SUB TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-116-E	SUP	HCPCS C1776		5531-G-116-E  -  INSERT TIB 1 16MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-119	SUP	Custom 27803010		5531-G-119  -  INSERT TIBIAL 1 19MM CRUC SUB TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-119-E	SUP	HCPCS C1776		5531-G-119-E  -  INSERT TIB 1 19MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-122	SUP	Custom 27803010		5531-G-122  -  INSERT TIBIAL 1 22MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-122-E	SUP	HCPCS C1776		5531-G-122-E  -  INSERT TIB 1 22MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-125	SUP	Custom 27803010		5531-G-125  -  INSERT TIBIAL 1 25MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-209	SUP	Custom 27803010		5531-G-209  -  INSERT TIBIAL 2 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-209-E	SUP	HCPCS C1776		5531-G-209-E  -  INSERT TIB 2 9MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-210-E	SUP	HCPCS C1776		5531-G-210-E  -  INSERT TIB 2 10MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-211	SUP	Custom 27803010		5531-G-211  -  INSERT TIBIAL 2 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-211-E	SUP	HCPCS C1776		5531-G-211-E  -  INSERT TIB 2 11MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-212-E	SUP	HCPCS C1776		5531-G-212-E  -  INSERT TIB 2 12MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-213	SUP	Custom 27803010		5531-G-213  -  INSERT TIBIAL 2 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-213-E	SUP	HCPCS C1776		5531-G-213-E  -  INSERT TIB 2 13MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-214-E	SUP	HCPCS C1776		5531-G-214-E  -  INSERT TIB 2 14MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-216	SUP	Custom 27803010		5531-G-216  -  INSERT TIBIAL 2 16MM CRUC SUB REVISION FLEXION TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-216-E	SUP	HCPCS C1776		5531-G-216-E  -  INSERT TIB 2 16MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-219	SUP	Custom 27803010		5531-G-219  -  INSERT TIBIAL 2 19MM CRUC SUB TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-219-E	SUP	HCPCS C1776		5531-G-219-E  -  INSERT TIB 2 19MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-222	SUP	Custom 27803010		5531-G-222  -  INSERT TIBIAL 2 22MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-222-E	SUP	HCPCS C1776		5531-G-222-E  -  INSERT TIB 2 22MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-225	SUP	Custom 27803010		5531-G-225  -  INSERT TIBIAL 2 25MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-309	SUP	Custom 27803010		5531-G-309  -  INSERT TIBIAL 3 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-309-E	SUP	HCPCS C1776		5531-G-309-E  -  INSERT TIB 3 9MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-310-E	SUP	HCPCS C1776		5531-G-310-E  -  INSERT TIB 3 10MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-311	SUP	Custom 27803010		5531-G-311  -  INSERT TIBIAL 3 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-311-E	SUP	HCPCS C1776		5531-G-311-E  -  INSERT TIB 3 11MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-312-E	SUP	HCPCS C1776		5531-G-312-E  -  INSERT TIB 3 12MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-313	SUP	Custom 27803010		5531-G-313  -  INSERT TIBIAL 3 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-313-E	SUP	HCPCS C1776		5531-G-313-E  -  INSERT TIB 3 13MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-314-E	SUP	HCPCS C1776		5531-G-314-E  -  INSERT TIB 3 14MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-316	SUP	Custom 27803010		5531-G-316  -  INSERT TIBIAL 3 16MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-316-E	SUP	HCPCS C1776		5531-G-316-E  -  INSERT TIB 3 16MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-319	SUP	Custom 27803010		5531-G-319  -  INSERT TIBIAL 3 19MM CNDYLR STABILIZED PRIM TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-319-E	SUP	HCPCS C1776		5531-G-319-E  -  INSERT TIB 3 19MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-322	SUP	Custom 27803010		5531-G-322  -  INSERT TIBIAL 3 22MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-322-E	SUP	HCPCS C1776		5531-G-322-E  -  INSERT TIB 3 22MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-325	SUP	Custom 27803010		5531-G-325  -  INSERT TIBIAL 3 25MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-409	SUP	Custom 27803010		5531-G-409  -  INSERT TIBIAL 4 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-409-E	SUP	HCPCS C1776		5531-G-409-E  -  INSERT TIB 4 9MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-410-E	SUP	HCPCS C1776		5531-G-410-E  -  INSERT TIB 4 10MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-411	SUP	Custom 27803010		5531-G-411  -  INSERT TIBIAL 4 11MM CNDYLR STABILIZED PRIM TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-411-E	SUP	HCPCS C1776		5531-G-411-E  -  INSERT TIB 4 11MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-412-E	SUP	HCPCS C1776		5531-G-412-E  -  INSERT TIB 4 12MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-413	SUP	Custom 27803010		5531-G-413  -  INSERT TIBIAL 4 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-413-E	SUP	HCPCS C1776		5531-G-413-E  -  INSERT TIB 4 13MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-414-E	SUP	HCPCS C1776		5531-G-414-E  -  INSERT TIB 4 14MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-416	SUP	Custom 27803010		5531-G-416  -  INSERT TIBIAL 4 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-416-E	SUP	HCPCS C1776		5531-G-416-E  -  INSERT TIB 4 16MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-419	SUP	Custom 27803010		5531-G-419  -  INSERT TIBIAL 4 19MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-419-E	SUP	HCPCS C1776		5531-G-419-E  -  INSERT TIB 4 19MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-422	SUP	Custom 27803010		5531-G-422  -  INSERT TIBIAL 4 22MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-422-E	SUP	HCPCS C1776		5531-G-422-E  -  INSERT TIB 4 22MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-425	SUP	Custom 27803010		5531-G-425  -  INSERT TIBIAL 4 25MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-509	SUP	Custom 27803010		5531-G-509  -  INSERT TIBIAL 5 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-509-E	SUP	HCPCS C1776		5531-G-509-E  -  INSERT TIB 5 9MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-510-E	SUP	HCPCS C1776		5531-G-510-E  -  INSERT TIB 5 10MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-511	SUP	Custom 27803010		5531-G-511  -  INSERT TIBIAL 5 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-511-E	SUP	HCPCS C1776		5531-G-511-E  -  INSERT TIB 5 11MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-512-E	SUP	HCPCS C1776		5531-G-512-E  -  INSERT TIB 5 12MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-513	SUP	Custom 27803010		5531-G-513  -  INSERT TIBIAL 5 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-513-E	SUP	HCPCS C1776		5531-G-513-E  -  INSERT TIB 5 13MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-514-E	SUP	HCPCS C1776		5531-G-514-E  -  INSERT TIB 5 14MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-516	SUP	Custom 27803010		5531-G-516  -  INSERT TIBIAL 5 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-516-E	SUP	HCPCS C1776		5531-G-516-E  -  INSERT TIB 5 16MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-519	SUP	Custom 27803010		5531-G-519  -  INSERT TIBIAL 5 19MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-519-E	SUP	HCPCS C1776		5531-G-519-E  -  INSERT TIB 5 19MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-522	SUP	Custom 27803010		5531-G-522  -  INSERT TIBIAL 5 22MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-522-E	SUP	HCPCS C1776		5531-G-522-E  -  INSERT TIB 5 22MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-525	SUP	Custom 27803010		5531-G-525  -  INSERT TIBIAL 5 25MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-609	SUP	Custom 27803010		5531-G-609  -  INSERT TIBIAL 6 9MM CNDYLR STABILIZED PRIM TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-609-E	SUP	HCPCS C1776		5531-G-609-E  -  INSERT TIB 6 9MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-610-E	SUP	HCPCS C1776		5531-G-610-E  -  INSERT TIB 6 10MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-611	SUP	Custom 27803010		5531-G-611  -  INSERT TIBIAL 6 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-611-E	SUP	HCPCS C1776		5531-G-611-E  -  INSERT TIB 6 11MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-612-E	SUP	HCPCS C1776		5531-G-612-E  -  INSERT TIB 6 12MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-613	SUP	Custom 27803010		5531-G-613  -  INSERT TIBIAL 6 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-613-E	SUP	HCPCS C1776		5531-G-613-E  -  INSERT TIB 6 13MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-614-E	SUP	HCPCS C1776		5531-G-614-E  -  INSERT TIB 6 14MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-616	SUP	Custom 27803010		5531-G-616  -  INSERT TIBIAL 6 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-616-E	SUP	HCPCS C1776		5531-G-616-E  -  INSERT TIB 6 16MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-619	SUP	Custom 27803010		5531-G-619  -  INSERT TIBIAL 6 19MM CRUC SUB TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-619-E	SUP	HCPCS C1776		5531-G-619-E  -  INSERT TIB 6 19MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-622	SUP	Custom 27803010		5531-G-622  -  INSERT TIBIAL 6 22MM CRUC SUB TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-622-E	SUP	HCPCS C1776		5531-G-622-E  -  INSERT TIB 6 22MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-625	SUP	Custom 27803010		5531-G-625  -  INSERT TIBIAL 6 25MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-709	SUP	Custom 27803010		5531-G-709  -  INSERT TIBIAL 7 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-709-E	SUP	HCPCS C1776		5531-G-709-E  -  INSERT TIB 7 9MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-710-E	SUP	HCPCS C1776		5531-G-710-E  -  INSERT TIB 7 10MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-711	SUP	Custom 27803010		5531-G-711  -  INSERT TIBIAL 7 11MM CNDYLR STABILIZED PRIM TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-711-E	SUP	HCPCS C1776		5531-G-711-E  -  INSERT TIB 7 11MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-712-E	SUP	HCPCS C1776		5531-G-712-E  -  INSERT TIB 7 12MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-713	SUP	Custom 27803010		5531-G-713  -  INSERT TIBIAL 7 13MM CRUC SUB TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-713-E	SUP	HCPCS C1776		5531-G-713-E  -  INSERT TIB 7 13MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-714-E	SUP	HCPCS C1776		5531-G-714-E  -  INSERT TIB 7 14MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-716	SUP	Custom 27803010		5531-G-716  -  INSERT TIBIAL 7 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-716-E	SUP	HCPCS C1776		5531-G-716-E  -  INSERT TIB 7 16MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-719	SUP	Custom 27803010		5531-G-719  -  INSERT TIBIAL 7 19MM CRUC SUB TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-719-E	SUP	HCPCS C1776		5531-G-719-E  -  INSERT TIB 7 19MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-722	SUP	Custom 27803010		5531-G-722  -  INSERT TIBIAL 7 22MM CRUC SUB TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-722-E	SUP	HCPCS C1776		5531-G-722-E  -  INSERT TIB 7 22MM STRL TRTHLN CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-725	SUP	Custom 27803010		5531-G-725  -  INSERT TIBIAL 7 25MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-809	SUP	Custom 27803010		5531-G-809  -  INSERT TIBIAL 8 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-809-E	SUP	HCPCS C1776		5531-G-809-E  -  INSERT TIB 8 9MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-810-E	SUP	HCPCS C1776		5531-G-810-E  -  INSERT TIB 8 10MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-811	SUP	Custom 27803010		5531-G-811  -  INSERT TIBIAL 8 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-811-E	SUP	HCPCS C1776		5531-G-811-E  -  INSERT TIB 8 11MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-812-E	SUP	HCPCS C1776		5531-G-812-E  -  INSERT TIB 8 12MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-813	SUP	Custom 27803010		5531-G-813  -  INSERT TIBIAL 8 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-813-E	SUP	HCPCS C1776		5531-G-813-E  -  INSERT TIB 8 13MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-814-E	SUP	HCPCS C1776		5531-G-814-E  -  INSERT TIB 8 14MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-816	SUP	Custom 27803010		5531-G-816  -  INSERT TIBIAL 8 16MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-816-E	SUP	HCPCS C1776		5531-G-816-E  -  INSERT TIB 8 16MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-819	SUP	Custom 27803010		5531-G-819  -  INSERT TIBIAL 8 19MM CRUC SUB TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-819-E	SUP	HCPCS C1776		5531-G-819-E  -  INSERT TIB 8 19MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-822	SUP	Custom 27803010		5531-G-822  -  INSERT TIBIAL 8 22MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-822-E	SUP	HCPCS C1776		5531-G-822-E  -  INSERT TIB 8 22MM STRL TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5531-G-825	SUP	Custom 27803010		5531-G-825  -  INSERT TIBIAL 8 25MM CRUC SUB TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-109	SUP	Custom 27803010		5531-P-109  -  INSERT TIBIAL 1 9MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-110	SUP	HCPCS C1776		5531-P-110  -  INSERT TIB 1 10MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-111	SUP	Custom 27803010		5531-P-111  -  INSERT TIBIAL 1 11MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-112	SUP	HCPCS C1776		5531-P-112  -  INSERT TIB 1 12MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-113	SUP	Custom 27803010		5531-P-113  -  INSERT TIBIAL 1 13MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-114	SUP	HCPCS C1776		5531-P-114  -  INSERT TIB 1 14MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-116	SUP	Custom 27803010		5531-P-116  -  INSERT TIBIAL 1 16MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-119	SUP	Custom 27803010		5531-P-119  -  INSERT TIBIAL 1 19MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-122	SUP	Custom 27803010		5531-P-122  -  INSERT TIBIAL 1 22MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-125	SUP	Custom 27803010		5531-P-125  -  INSERT TIBIAL 1 25MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-209	SUP	Custom 27803010		5531-P-209  -  INSERT TIBIAL 2 9MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-210	SUP	HCPCS C1776		5531-P-210  -  INSERT TIB 2 10MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-211	SUP	Custom 27803010		5531-P-211  -  INSERT TIBIAL 2 11MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-212	SUP	HCPCS C1776		5531-P-212  -  INSERT TIB 2 12MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-213	SUP	Custom 27803010		5531-P-213  -  INSERT TIBIAL 2 13MM CRUC SUB TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-214	SUP	HCPCS C1776		5531-P-214  -  INSERT TIB 2 14MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-216	SUP	Custom 27803010		5531-P-216  -  INSERT TIBIAL 2 16MM CRUC SUB TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-219	SUP	Custom 27803010		5531-P-219  -  INSERT TIBIAL 2 19MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-222	SUP	Custom 27803010		5531-P-222  -  INSERT TIBIAL 2 22MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-225	SUP	Custom 27803010		5531-P-225  -  INSERT TIBIAL 2 25MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-309	SUP	Custom 27803010		5531-P-309  -  INSERT TIBIAL 3 8-9MM TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-310	SUP	HCPCS C1776		5531-P-310  -  INSERT TIB 3 10MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-311	SUP	Custom 27803010		5531-P-311  -  INSERT TIBIAL 3 11MM BEARING TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-312	SUP	HCPCS C1776		5531-P-312  -  INSERT TIB 3 13MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-313	SUP	Custom 27803010		5531-P-313  -  INSERT TIBIAL 3 13MM TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-314	SUP	HCPCS C1776		5531-P-314  -  INSERT TIB 3 14MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-316	SUP	Custom 27803010		5531-P-316  -  INSERT TIBIAL 3 16MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-319	SUP	Custom 27803010		5531-P-319  -  INSERT TIBIAL 3 19MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-322	SUP	Custom 27803010		5531-P-322  -  INSERT TIBIAL 3 22MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-325	SUP	Custom 27803010		5531-P-325  -  INSERT TIBIAL 3 25MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-409	SUP	Custom 27803010		5531-P-409  -  INSERT TIBIAL 4 9MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-410	SUP	HCPCS C1776		5531-P-410  -  INSERT TIB 4 10MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-411	SUP	Custom 27803010		5531-P-411  -  INSERT TIBIAL 4 11MM CRUC SUB TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-412	SUP	HCPCS C1776		5531-P-412  -  INSERT TIB 4 12MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-413	SUP	Custom 27803010		5531-P-413  -  INSERT TIBIAL 4 13MM CRUC SUB TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-414	SUP	HCPCS C1776		5531-P-414  -  INSERT TIB 4 14MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-416	SUP	Custom 27803010		5531-P-416  -  INSERT TIBIAL 4 16MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-419	SUP	Custom 27803010		5531-P-419  -  INSERT TIBIAL 4 19MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-422	SUP	Custom 27803010		5531-P-422  -  INSERT TIBIAL 4 22MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-425	SUP	Custom 27803010		5531-P-425  -  INSERT TIBIAL 4 25MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-509	SUP	Custom 27803010		5531-P-509  -  INSERT TIBIAL 5 9MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-510	SUP	HCPCS C1776		5531-P-510  -  INSERT TIB 5 10MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-511	SUP	Custom 27803010		5531-P-511  -  INSERT TIBIAL 5 11MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-512	SUP	HCPCS C1776		5531-P-512  -  INSERT TIB 5 12MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-513	SUP	Custom 27803010		5531-P-513  -  INSERT TIBIAL 5 13MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-514	SUP	HCPCS C1776		5531-P-514  -  INSERT TIB 5 14MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-516	SUP	Custom 27803010		5531-P-516  -  INSERT TIBIAL 5 16MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-519	SUP	Custom 27803010		5531-P-519  -  INSERT TIBIAL 5 19MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-522	SUP	Custom 27803010		5531-P-522  -  INSERT TIBIAL 5 22MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-525	SUP	Custom 27803010		5531-P-525  -  INSERT TIBIAL 5 25MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-609	SUP	Custom 27803010		5531-P-609  -  INSERT TIBIAL 6 9MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-610	SUP	HCPCS C1776		5531-P-610  -  INSERT TIB 6 10MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-611	SUP	Custom 27803010		5531-P-611  -  INSERT TIBIAL 6 11MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-612	SUP	HCPCS C1776		5531-P-612  -  INSERT TIB 6 12MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-613	SUP	Custom 27803010		5531-P-613  -  INSERT TIBIAL 6 13MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-614	SUP	HCPCS C1776		5531-P-614  -  INSERT TIB 6 14MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-616	SUP	Custom 27803010		5531-P-616  -  INSERT TIBIAL 6 16MM CRUC SUB TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-619	SUP	Custom 27803010		5531-P-619  -  INSERT TIBIAL 6 19MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-622	SUP	Custom 27803010		5531-P-622  -  INSERT TIBIAL 6 22MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-625	SUP	Custom 27803010		5531-P-625  -  INSERT TIBIAL 6 25MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-709	SUP	Custom 27803010		5531-P-709  -  INSERT TIBIAL 7 9MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-710	SUP	HCPCS C1776		5531-P-710  -  INSERT TIB 7 10MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-711	SUP	Custom 27803010		5531-P-711  -  INSERT TIBIAL 7 11MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-712	SUP	HCPCS C1776		5531-P-712  -  INSERT TIB 7 12MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-713	SUP	Custom 27803010		5531-P-713  -  INSERT TIBIAL 7 13MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-714	SUP	HCPCS C1776		5531-P-714  -  INSERT TIB 7 14MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-716	SUP	Custom 27803010		5531-P-716  -  INSERT TIBIAL 7 16MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-719	SUP	Custom 27803010		5531-P-719  -  INSERT TIBIAL 7 19MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-722	SUP	Custom 27803010		5531-P-722  -  INSERT TIBIAL 7 22MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-725	SUP	Custom 27803010		5531-P-725  -  INSERT TIBIAL 7 25MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-809	SUP	Custom 27803010		5531-P-809  -  INSERT TIBIAL 8 9MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-810	SUP	HCPCS C1776		5531-P-810  -  INSERT TIB 8 10MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-811	SUP	Custom 27803010		5531-P-811  -  INSERT TIBIAL 8 11MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-812	SUP	HCPCS C1776		5531-P-812  -  INSERT TIB 8 12MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-813	SUP	Custom 27803010		5531-P-813  -  INSERT TIBIAL 8 13MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-814	SUP	HCPCS C1776		5531-P-814  -  INSERT TIB 8 14MM STRL LF TRTHLN BRNG CNDRL STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-816	SUP	Custom 27803010		5531-P-816  -  INSERT TIBIAL 8 16MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-819	SUP	Custom 27803010		5531-P-819  -  INSERT TIBIAL 8 19MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-822	SUP	Custom 27803010		5531-P-822  -  INSERT TIBIAL 8 22MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5531-P-825	SUP	Custom 27803010		5531-P-825  -  INSERT TIBIAL 8 25MM STABILIZE TRIATHLON KNEE CONDYLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-109	SUP	Custom 27803010		5532-G-109  -  INSERT TIBIAL 1 9MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-109-E	SUP	HCPCS C1776		5532-G-109-E  -  INSERT TIB 1 9MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-110-E	SUP	HCPCS C1776		5532-G-110-E  -  INSERT TIB 1 10MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-111	SUP	Custom 27803010		5532-G-111  -  INSERT TIBIAL 1 11MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-111-E	SUP	HCPCS C1776		5532-G-111-E  -  INSERT TIB 1 11MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-112-E	SUP	HCPCS C1776		5532-G-112-E  -  INSERT TIB 1 12MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-113	SUP	Custom 27803010		5532-G-113  -  INSERT TIBIAL 1 13MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-113-E	SUP	HCPCS C1776		5532-G-113-E  -  INSERT TIB 1 13MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-114-E	SUP	HCPCS C1776		5532-G-114-E  -  INSERT TIB 1 14MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-116	SUP	Custom 27803010		5532-G-116  -  INSERT TIBIAL 1 16MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-116-E	SUP	HCPCS C1776		5532-G-116-E  -  INSERT TIB 1 16MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-119	SUP	Custom 27803010		5532-G-119  -  INSERT TIBIAL 1 19MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-119-E	SUP	HCPCS C1776		5532-G-119-E  -  INSERT TIB 1 19MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-122	SUP	Custom 27803010		5532-G-122  -  INSERT TIBIAL 1 22MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-122-E	SUP	HCPCS C1776		5532-G-122-E  -  INSERT TIB 1 22MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-125	SUP	Custom 27803010		5532-G-125  -  INSERT TIBIAL 1 25MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-209	SUP	Custom 27803010		5532-G-209  -  INSERT TIBIAL 2 9MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-209-E	SUP	HCPCS C1776		5532-G-209-E  -  INSERT TIB 2 9MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-210-E	SUP	HCPCS C1776		5532-G-210-E  -  INSERT TIB 2 10MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-211	SUP	Custom 27803010		5532-G-211  -  INSERT TIBIAL 2 11MM POSTERIOR STABILIZE TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-211-E	SUP	HCPCS C1776		5532-G-211-E  -  INSERT TIB 2 11MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-212-E	SUP	HCPCS C1776		5532-G-212-E  -  INSERT TIB 2 12MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-213	SUP	Custom 27803010		5532-G-213  -  INSERT TIBIAL 2 13MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-213-E	SUP	HCPCS C1776		5532-G-213-E  -  INSERT TIB 2 13MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-214-E	SUP	HCPCS C1776		5532-G-214-E  -  INSERT TIB 2 14MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-216	SUP	Custom 27803010		5532-G-216  -  INSERT TIBIAL 2 16MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-216-E	SUP	HCPCS C1776		5532-G-216-E  -  INSERT TIB 2 16MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-219	SUP	Custom 27803010		5532-G-219  -  INSERT TIBIAL 2 19MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-219-E	SUP	HCPCS C1776		5532-G-219-E  -  INSERT TIB 2 19MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-222	SUP	Custom 27803010		5532-G-222  -  INSERT TIBIAL 2 22MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-222-E	SUP	HCPCS C1776		5532-G-222-E  -  INSERT TIB 2 22MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-225	SUP	Custom 27803010		5532-G-225  -  INSERT TIBIAL 2 25MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-309	SUP	Custom 27803010		5532-G-309  -  INSERT TIBIAL 3 9MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-309-E	SUP	HCPCS C1776		5532-G-309-E  -  INSERT TIB 3 9MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-310-E	SUP	HCPCS C1776		5532-G-310-E  -  INSERT TIB 3 10MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-311	SUP	Custom 27803010		5532-G-311  -  INSERT TIBIAL 3 11MM POSTERIOR STABILIZED PRIM TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-311-E	SUP	HCPCS C1776		5532-G-311-E  -  INSERT TIB 3 11MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-312-E	SUP	HCPCS C1776		5532-G-312-E  -  INSERT TIB 3 12MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-313	SUP	Custom 27803010		5532-G-313  -  INSERT TIBIAL 3 13MM BEARING POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-313-E	SUP	HCPCS C1776		5532-G-313-E  -  INSERT TIB 3 13MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-314-E	SUP	HCPCS C1776		5532-G-314-E  -  INSERT TIB 3 14MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-316	SUP	Custom 27803010		5532-G-316  -  INSERT TIBIAL 3 16MM BEARING POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-316-E	SUP	HCPCS C1776		5532-G-316-E  -  INSERT TIB 3 16MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-319	SUP	Custom 27803010		5532-G-319  -  INSERT TIBIAL 3 19MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-319-E	SUP	HCPCS C1776		5532-G-319-E  -  INSERT TIB 3 19MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-322	SUP	Custom 27803010		5532-G-322  -  INSERT TIBIAL 3 22MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-322-E	SUP	HCPCS C1776		5532-G-322-E  -  INSERT TIB 3 22MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-325	SUP	Custom 27803010		5532-G-325  -  INSERT TIBIAL 3 25MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-409	SUP	Custom 27803010		5532-G-409  -  INSERT TIBIAL 4 9MM POSTERIOR STABILIZE TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-409-E	SUP	HCPCS C1776		5532-G-409-E  -  INSERT TIB 4 9MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-410-E	SUP	HCPCS C1776		5532-G-410-E  -  INSERT TIB 4 10MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-411	SUP	Custom 27803010		5532-G-411  -  INSERT TIBIAL 4 11MM BEARING POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-411-E	SUP	HCPCS C1776		5532-G-411-E  -  INSERT TIB 4 11MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-412-E	SUP	HCPCS C1776		5532-G-412-E  -  INSERT TIB 4 12MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-413	SUP	Custom 27803010		5532-G-413  -  INSERT TIBIAL 4 13MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-413-E	SUP	HCPCS C1776		5532-G-413-E  -  INSERT TIB 4 13MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-414-E	SUP	HCPCS C1776		5532-G-414-E  -  INSERT TIB 4 14MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-416	SUP	Custom 27803010		5532-G-416  -  INSERT TIBIAL 4 16MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-416-E	SUP	HCPCS C1776		5532-G-416-E  -  INSERT TIB 4 16MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-419	SUP	Custom 27803010		5532-G-419  -  INSERT TIBIAL 4 19MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-419-E	SUP	HCPCS C1776		5532-G-419-E  -  INSERT TIB 4 19MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-422	SUP	Custom 27803010		5532-G-422  -  INSERT TIBIAL 4 22MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-422-E	SUP	HCPCS C1776		5532-G-422-E  -  INSERT TIB 4 22MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-425	SUP	Custom 27803010		5532-G-425  -  INSERT TIBIAL 4 25MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-509	SUP	Custom 27803010		5532-G-509  -  INSERT TIBIAL 5 9MM BEARING POSTERIOR STABILIZE TRIATHLON X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-509-E	SUP	HCPCS C1776		5532-G-509-E  -  INSERT TIB 5 9MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-510-E	SUP	HCPCS C1776		5532-G-510-E  -  INSERT TIB 5 10MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-511	SUP	Custom 27803010		5532-G-511  -  INSERT TIBIAL 5 11MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-511-E	SUP	HCPCS C1776		5532-G-511-E  -  INSERT TIB 5 11MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-512-E	SUP	HCPCS C1776		5532-G-512-E  -  INSERT TIB 5 12MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-513	SUP	Custom 27803010		5532-G-513  -  INSERT TIBIAL 5 13MM POSTERIOR STABILIZE BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-513-E	SUP	HCPCS C1776		5532-G-513-E  -  INSERT TIB 5 13MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-514-E	SUP	HCPCS C1776		5532-G-514-E  -  INSERT TIB 5 14MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-516	SUP	Custom 27803010		5532-G-516  -  INSERT TIBIAL 5 16MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-516-E	SUP	HCPCS C1776		5532-G-516-E  -  INSERT TIB 5 16MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-519	SUP	Custom 27803010		5532-G-519  -  INSERT TIBIAL 5 19MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-519-E	SUP	HCPCS C1776		5532-G-519-E  -  INSERT TIB 5 19MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-522	SUP	Custom 27803010		5532-G-522  -  INSERT TIBIAL 5 22MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-522-E	SUP	HCPCS C1776		5532-G-522-E  -  INSERT TIB 5 22MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-525	SUP	Custom 27803010		5532-G-525  -  INSERT TIBIAL 5 25MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-609	SUP	Custom 27803010		5532-G-609  -  INSERT TIBIAL 6 9MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-609-E	SUP	HCPCS C1776		5532-G-609-E  -  INSERT TIB 6 9MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-610-E	SUP	HCPCS C1776		5532-G-610-E  -  INSERT TIB 6 10MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-611	SUP	Custom 27803010		5532-G-611  -  INSERT TIBIAL 6 11MM BEARING POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-611-E	SUP	HCPCS C1776		5532-G-611-E  -  INSERT TIB 6 11MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-612-E	SUP	HCPCS C1776		5532-G-612-E  -  INSERT TIB 6 12MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-613	SUP	Custom 27803010		5532-G-613  -  INSERT TIBIAL 6 13MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-613-E	SUP	HCPCS C1776		5532-G-613-E  -  INSERT TIB 6 13MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-614-E	SUP	HCPCS C1776		5532-G-614-E  -  INSERT TIB 6 14MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-616	SUP	Custom 27803010		5532-G-616  -  INSERT TIBIAL 6 16MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-616-E	SUP	HCPCS C1776		5532-G-616-E  -  INSERT TIB 6 16MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-619	SUP	Custom 27803010		5532-G-619  -  INSERT TIBIAL 6 19MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-619-E	SUP	HCPCS C1776		5532-G-619-E  -  INSERT TIB 6 19MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-622	SUP	Custom 27803010		5532-G-622  -  INSERT TIBIAL 6 22MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-622-E	SUP	HCPCS C1776		5532-G-622-E  -  INSERT TIB 6 22MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-625	SUP	Custom 27803010		5532-G-625  -  INSERT TIBIAL 6 25MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-709	SUP	Custom 27803010		5532-G-709  -  INSERT TIBIAL 7 9MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-709-E	SUP	HCPCS C1776		5532-G-709-E  -  INSERT TIB 7 9MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-710-E	SUP	HCPCS C1776		5532-G-710-E  -  INSERT TIB 7 10MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-711	SUP	Custom 27803010		5532-G-711  -  INSERT TIBIAL 7 11MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-711-E	SUP	HCPCS C1776		5532-G-711-E  -  INSERT TIB 7 11MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-712-E	SUP	HCPCS C1776		5532-G-712-E  -  INSERT TIB 7 12MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-713	SUP	Custom 27803010		5532-G-713  -  INSERT TIBIAL 7 13MM POSTERIOR STABILIZE TRIATHLON X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-713-E	SUP	HCPCS C1776		5532-G-713-E  -  INSERT TIB 7 13MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-714-E	SUP	HCPCS C1776		5532-G-714-E  -  INSERT TIB 7 14MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-716	SUP	Custom 27803010		5532-G-716  -  INSERT TIBIAL 7 16MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-716-E	SUP	HCPCS C1776		5532-G-716-E  -  INSERT TIB 7 16MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-719	SUP	Custom 27803010		5532-G-719  -  INSERT TIBIAL 7 19MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-719-E	SUP	HCPCS C1776		5532-G-719-E  -  INSERT TIB 7 19MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-722	SUP	Custom 27803010		5532-G-722  -  INSERT TIBIAL 7 22MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-722-E	SUP	HCPCS C1776		5532-G-722-E  -  INSERT TIB 7 22MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-725	SUP	Custom 27803010		5532-G-725  -  INSERT TIBIAL 7 25MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-809	SUP	Custom 27803010		5532-G-809  -  INSERT TIBIAL 8 9MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-809-E	SUP	HCPCS C1776		5532-G-809-E  -  INSERT TIB 8 9MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-810-E	SUP	HCPCS C1776		5532-G-810-E  -  INSERT TIB 8 10MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-811	SUP	Custom 27803010		5532-G-811  -  INSERT TIBIAL 8 11MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-811-E	SUP	HCPCS C1776		5532-G-811-E  -  INSERT TIB 8 11MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-812-E	SUP	HCPCS C1776		5532-G-812-E  -  INSERT TIB 8 12MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-813	SUP	Custom 27803010		5532-G-813  -  INSERT TIBIAL 8 13MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-813-E	SUP	HCPCS C1776		5532-G-813-E  -  INSERT TIB 8 13MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-814-E	SUP	HCPCS C1776		5532-G-814-E  -  INSERT TIB 8 14MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-816	SUP	Custom 27803010		5532-G-816  -  INSERT TIBIAL 8 16MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-816-E	SUP	HCPCS C1776		5532-G-816-E  -  INSERT TIB 8 16MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-819	SUP	Custom 27803010		5532-G-819  -  INSERT TIBIAL 8 19MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-819-E	SUP	HCPCS C1776		5532-G-819-E  -  INSERT TIB 8 19MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-822	SUP	Custom 27803010		5532-G-822  -  INSERT TIBIAL 8 22MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-822-E	SUP	HCPCS C1776		5532-G-822-E  -  INSERT TIB 8 22MM STRL TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
5532-G-825	SUP	Custom 27803010		5532-G-825  -  INSERT TIBIAL 8 25MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-109	SUP	Custom 27803010		5532-P-109  -  INSERT TIBIAL 1 9MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-110	SUP	HCPCS C1776		5532-P-110  -  INSERT TIB 1 10MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-111	SUP	Custom 27803010		5532-P-111  -  INSERT TIBIAL 1 11MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-112	SUP	HCPCS C1776		5532-P-112  -  INSERT TIB 1 12MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-113	SUP	Custom 27803010		5532-P-113  -  INSERT TIBIAL 1 13MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-114	SUP	HCPCS C1776		5532-P-114  -  INSERT TIB 1 14MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-116	SUP	Custom 27803010		5532-P-116  -  INSERT TIBIAL 1 16MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-119	SUP	Custom 27803010		5532-P-119  -  INSERT TIBIAL 1 19MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-122	SUP	Custom 27803010		5532-P-122  -  INSERT TIBIAL 1 22MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-125	SUP	Custom 27803010		5532-P-125  -  INSERT TIBIAL 1 25MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-209	SUP	Custom 27803010		5532-P-209  -  INSERT TIBIAL 2 9MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-210	SUP	HCPCS C1776		5532-P-210  -  INSERT TIB 2 10MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-211	SUP	Custom 27803010		5532-P-211  -  INSERT TIBIAL 2 11MM POSTERIOR STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-212	SUP	HCPCS C1776		5532-P-212  -  INSERT TIB 2 12MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-213	SUP	Custom 27803010		5532-P-213  -  INSERT TIBIAL 2 13MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-214	SUP	HCPCS C1776		5532-P-214  -  INSERT TIB 2 14MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-216	SUP	Custom 27803010		5532-P-216  -  INSERT TIBIAL 2 16MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-219	SUP	Custom 27803010		5532-P-219  -  INSERT TIBIAL 2 P 19MM POSTERIOR STABILIZE TRIATHLON X3 KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-222	SUP	Custom 27803010		5532-P-222  -  INSERT TIBIAL 2 22MM POSTERIOR STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-225	SUP	Custom 27803010		5532-P-225  -  INSERT TIBIAL 2 25MM POSTERIOR STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-309	SUP	Custom 27803010		5532-P-309  -  INSERT TIBIAL 3 9MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-310	SUP	HCPCS C1776		5532-P-310  -  INSERT TIB 3 10MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-311	SUP	Custom 27803010		5532-P-311  -  INSERT TIBIAL 3 11MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-312	SUP	HCPCS C1776		5532-P-312  -  INSERT TIB 3 12MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-313	SUP	Custom 27803010		5532-P-313  -  INSERT TIBIAL 3 13MM POSTERIOR STABILIZED PRIM TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-314	SUP	HCPCS C1776		5532-P-314  -  INSERT TIB 3 14MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-316	SUP	Custom 27803010		5532-P-316  -  INSERT TIBIAL 3 16MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-319	SUP	Custom 27803010		5532-P-319  -  INSERT TIBIAL 3 19MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-322	SUP	Custom 27803010		5532-P-322  -  INSERT TIBIAL 3 22MM POSTERIOR STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-325	SUP	Custom 27803010		5532-P-325  -  INSERT TIBIAL 3 25MM POSTERIOR STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-409	SUP	Custom 27803010		5532-P-409  -  INSERT TIBIAL 4 9MM POSTERIOR STABILIZE BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-410	SUP	HCPCS C1776		5532-P-410  -  INSERT TIB 4 10MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-411	SUP	Custom 27803010		5532-P-411  -  INSERT TIBIAL 4 11MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-412	SUP	HCPCS C1776		5532-P-412  -  INSERT TIB 4 12MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-413	SUP	Custom 27803010		5532-P-413  -  INSERT TIBIAL 4 13MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-416	SUP	Custom 27803010		5532-P-416  -  INSERT TIBIAL 4 16MM POSTERIOR STABILIZE BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-419	SUP	Custom 27803010		5532-P-419  -  INSERT TIBIAL 4 19MM POSTERIOR STABILIZE BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-422	SUP	Custom 27803010		5532-P-422  -  INSERT TIBIAL 4 22MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-425	SUP	Custom 27803010		5532-P-425  -  INSERT TIBIAL 4 25MM POSTERIOR STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-509	SUP	Custom 27803010		5532-P-509  -  INSERT TIBIAL 5 9MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-510	SUP	HCPCS C1776		5532-P-510  -  INSERT TIB 5 10MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-511	SUP	Custom 27803010		5532-P-511  -  INSERT TIBIAL 5 11MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-512	SUP	HCPCS C1776		5532-P-512  -  INSERT TIB 5 12MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-513	SUP	Custom 27803010		5532-P-513  -  INSERT TIBIAL 5 13MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-514	SUP	HCPCS C1776		5532-P-514  -  INSERT TIB 5 14MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-516	SUP	Custom 27803010		5532-P-516  -  INSERT TIBIAL 5 16MM POSTERIOR STABILIZED PRIM TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-519	SUP	Custom 27803010		5532-P-519  -  INSERT TIBIAL 5 P 19MM POSTERIOR STABILIZE TRIATHLON N2/VAC	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-522	SUP	Custom 27803010		5532-P-522  -  INSERT TIBIAL 5 22MM POSTERIOR STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-525	SUP	Custom 27803010		5532-P-525  -  INSERT TIBIAL 5 25MM POSTERIOR STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-609	SUP	Custom 27803010		5532-P-609  -  INSERT TIBIAL 6 9IN POSTERIOR STABILIZED PLASMA SPRAY	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-610	SUP	HCPCS C1776		5532-P-610  -  INSERT TIB 6 10MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-611	SUP	Custom 27803010		5532-P-611  -  INSERT TIBIAL 6 11MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-612	SUP	HCPCS C1776		5532-P-612  -  INSERT TIB 6 12MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-613	SUP	Custom 27803010		5532-P-613  -  INSERT TIBIAL 6 13MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-614	SUP	HCPCS C1776		5532-P-614  -  INSERT TIB 6 14MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-616	SUP	Custom 27803010		5532-P-616  -  INSERT TIBIAL 6 16MM POSTERIOR STABILIZE BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-619	SUP	Custom 27803010		5532-P-619  -  INSERT TIBIAL 6 19MM POSTERIOR STABILIZE TRIATHLON NONSTRL	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-622	SUP	Custom 27803010		5532-P-622  -  INSERT TIBIAL 6 22MM POSTERIOR STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-625	SUP	Custom 27803010		5532-P-625  -  INSERT TIBIAL POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-709	SUP	Custom 27803010		5532-P-709  -  INSERT TIBIAL 7 9MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-710	SUP	HCPCS C1776		5532-P-710  -  INSERT TIB 7 10MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-711	SUP	Custom 27803010		5532-P-711  -  INSERT TIBIAL 7 11MM POSTERIOR STABILIZE BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-712	SUP	HCPCS C1776		5532-P-712  -  INSERT TIB 7 12MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-713	SUP	Custom 27803010		5532-P-713  -  INSERT TIBIAL 13MM POSTERIOR STABILIZE TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-714	SUP	HCPCS C1776		5532-P-714  -  INSERT TIB 7 14MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-716	SUP	Custom 27803010		5532-P-716  -  INSERT TIBIAL 7 16MM POSTERIOR STABILIZE BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-719	SUP	Custom 27803010		5532-P-719  -  INSERT TIBIAL 7 19MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-722	SUP	Custom 27803010		5532-P-722  -  INSERT TIBIAL 7 22MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-725	SUP	Custom 27803010		5532-P-725  -  INSERT TIBIAL 7 25MM POSTERIOR STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-809	SUP	Custom 27803010		5532-P-809  -  INSERT TIBIAL 8 9MM POSTERIOR STABILIZE BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-810	SUP	HCPCS C1776		5532-P-810  -  INSERT TIB 8 10MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-811	SUP	Custom 27803010		5532-P-811  -  INSERT TIBIAL 8 11MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-812	SUP	HCPCS C1776		5532-P-812  -  INSERT TIB 8 12MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-813	SUP	Custom 27803010		5532-P-813  -  INSERT TIBIAL 8 13MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-814	SUP	HCPCS C1776		5532-P-814  -  INSERT TIB 8 14MM STRL LF TRTHLN BRNG POST STAB KN	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$540.00	$540.00	$0.00	$0.00	$0.00	$250.11	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$709.80	$709.80	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$187.80	$0.00	$0.00	$191.04	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-816	SUP	Custom 27803010		5532-P-816  -  INSERT TIBIAL 8 16MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-819	SUP	Custom 27803010		5532-P-819  -  INSERT TIBIAL 8 19MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-822	SUP	Custom 27803010		5532-P-822  -  INSERT TIBIAL 8 22MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5532-P-825	SUP	Custom 27803010		5532-P-825  -  INSERT TIBIAL 8 25MM POSTERIOR STABILIZED BEARING TRIATHLON	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-109	SUP	HCPCS C1776		5534-A-109  -  COMPONENT TIB 1 9MM CRCTE STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-111	SUP	HCPCS C1776		5534-A-111  -  INSERT TIB 1 11MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-113	SUP	HCPCS C1776		5534-A-113  -  INSERT TIB 1 13MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-116	SUP	HCPCS C1776		5534-A-116  -  INSERT TIB 1 16MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-209	SUP	HCPCS C1776		5534-A-209  -  INSERT TIB 2 9MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-211	SUP	HCPCS C1776		5534-A-211  -  INSERT TIB 2 11MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-213	SUP	HCPCS C1776		5534-A-213  -  INSERT TIB 2 13MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-216	SUP	HCPCS C1776		5534-A-216  -  INSERT TIB 2 16MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-309	SUP	HCPCS C1776		5534-A-309  -  INSERT TIB 3 9MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-311	SUP	HCPCS C1776		5534-A-311  -  INSERT TIB 3 11MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-313	SUP	HCPCS C1776		5534-A-313  -  COMPONENT TIB 3 13MM CRCTE STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-316	SUP	HCPCS C1776		5534-A-316  -  COMPONENT TIB 3 16MM CRCTE STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-409	SUP	HCPCS C1776		5534-A-409  -  INSERT TIB 4 9MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-411	SUP	HCPCS C1776		5534-A-411  -  INSERT TIB 4 11MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-413	SUP	HCPCS C1776		5534-A-413  -  INSERT TIB 4 13MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-416	SUP	HCPCS C1776		5534-A-416  -  COMPONENT TIB 4 16MM CRCTE STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-509	SUP	HCPCS C1776		5534-A-509  -  INSERT TIB 5 9MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-511	SUP	HCPCS C1776		5534-A-511  -  INSERT TIB 5 11MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-513	SUP	HCPCS C1776		5534-A-513  -  TRAY TIB 5 13MM STRL TRTHLN CNDRL STAB ALPLY KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-516	SUP	HCPCS C1776		5534-A-516  -  INSERT TIB 5 16MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-609	SUP	HCPCS C1776		5534-A-609  -  INSERT TIB 6 9MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-611	SUP	HCPCS C1776		5534-A-611  -  INSERT TIB 6 11MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-613	SUP	HCPCS C1776		5534-A-613  -  INSERT TIB 6 13MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-616	SUP	HCPCS C1776		5534-A-616  -  INSERT TIB 6 16MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-709	SUP	HCPCS C1776		5534-A-709  -  INSERT TIB 7 9MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-711	SUP	HCPCS C1776		5534-A-711  -  INSERT TIB 7 11MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-713	SUP	HCPCS C1776		5534-A-713  -  INSERT TIB 7 13MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-716	SUP	HCPCS C1776		5534-A-716  -  TRAY TIB 7 16MM STRL TRTHLN CNDRL STAB ALPLY KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-809	SUP	HCPCS C1776		5534-A-809  -  INSERT TIB 8 9MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-811	SUP	HCPCS C1776		5534-A-811  -  INSERT TIB 8 11MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-813	SUP	HCPCS C1776		5534-A-813  -  INSERT TIB 8 13MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5534-A-816	SUP	HCPCS C1776		5534-A-816  -  INSERT TIB 8 16MM CNDRL STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-109	SUP	HCPCS C1776		5535-A-109  -  INSERT TIB 1 9MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-111	SUP	HCPCS C1776		5535-A-111  -  INSERT TIB 1 11MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-113	SUP	HCPCS C1776		5535-A-113  -  INSERT TIB 1 13MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-116	SUP	HCPCS C1776		5535-A-116  -  INSERT TIB 1 16MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-209	SUP	HCPCS C1776		5535-A-209  -  INSERT TIB 2 9MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-211	SUP	HCPCS C1776		5535-A-211  -  INSERT TIB 2 11MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-213	SUP	HCPCS C1776		5535-A-213  -  INSERT TIB 2 13MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-216	SUP	HCPCS C1776		5535-A-216  -  INSERT TIB 2 16MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-309	SUP	HCPCS C1776		5535-A-309  -  INSERT TIB 3 9MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-311	SUP	HCPCS C1776		5535-A-311  -  COMPONENT TIB 3 11MM POST STAB PE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-313	SUP	HCPCS C1776		5535-A-313  -  INSERT TIB 3 13MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-316	SUP	HCPCS C1776		5535-A-316  -  INSERT TIB 3 16MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-409	SUP	HCPCS C1776		5535-A-409  -  INSERT TIB 4 9MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-411	SUP	HCPCS C1776		5535-A-411  -  COMPONENT TIB 4 11MM POST STAB ALPLY KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-413	SUP	HCPCS C1776		5535-A-413  -  TRAY TIB 4 13MM STRL TRTHLN POST STAB ALPLY KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-416	SUP	HCPCS C1776		5535-A-416  -  INSERT TIB 4 16MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-509	SUP	HCPCS C1776		5535-A-509  -  INSERT TIB 5 9MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-511	SUP	HCPCS C1776		5535-A-511  -  COMPONENT TIB 5 11MM POST STAB ALPLY KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-513	SUP	HCPCS C1776		5535-A-513  -  INSERT TIB 5 13MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-516	SUP	HCPCS C1776		5535-A-516  -  INSERT TIB 5 16MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-609	SUP	HCPCS C1776		5535-A-609  -  COMPONENT TIB 6 9MM POST STAB PE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-611	SUP	HCPCS C1776		5535-A-611  -  COMPONENT TIB 6 11MM POST STAB PE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-613	SUP	HCPCS C1776		5535-A-613  -  INSERT TIB 6 13MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-616	SUP	HCPCS C1776		5535-A-616  -  INSERT TIB 6 16MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-709	SUP	HCPCS C1776		5535-A-709  -  TRAY TIB 7 9MM STRL TRTHLN POST STAB ALPLY KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-711	SUP	HCPCS C1776		5535-A-711  -  INSERT TIB 7 11MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-713	SUP	HCPCS C1776		5535-A-713  -  INSERT TIB 7 13MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-716	SUP	HCPCS C1776		5535-A-716  -  INSERT TIB 7 16MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-809	SUP	HCPCS C1776		5535-A-809  -  INSERT TIB 8 9MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-811	SUP	HCPCS C1776		5535-A-811  -  INSERT TIB 8 11MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-813	SUP	HCPCS C1776		5535-A-813  -  INSERT TIB 8 13MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5535-A-816	SUP	HCPCS C1776		5535-A-816  -  INSERT TIB 8 16MM POST STAB ALL PE KN	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
5536-B-100	SUP	HCPCS C1776		5536-B-100  -  BASEPLATE TIB 1 7MM 40X40MM 61MM TRTHLN 4 CRFRM PG KEEL	BOTH IP/OP	"$3,602.50 "	"$2,665.85"	$0.00	"$2,882.00"	"$1,621.13"	"$1,621.13"	$0.00	$0.00	$0.00	$750.85	"$2,673.78"	"$2,673.78"	$0.00	$0.00	$750.76	$0.00	"$1,776.03"	"$1,776.03"	$0.00	"$1,801.25"	"$2,853.18"	"$2,882.00"	$0.00		$0.00	$563.79	$0.00	$0.00	$573.52	$0.00	$0.00	$0.00	$0.00	$0.00
5536-B-200	SUP	HCPCS C1776		5536-B-200  -  COMPONENT TIB 2 STRL LF TRTHLN KN	BOTH IP/OP	"$3,602.50 "	"$2,665.85"	$0.00	"$2,882.00"	"$1,621.13"	"$1,621.13"	$0.00	$0.00	$0.00	$750.85	"$2,673.78"	"$2,673.78"	$0.00	$0.00	$750.76	$0.00	"$1,776.03"	"$1,776.03"	$0.00	"$1,801.25"	"$2,853.18"	"$2,882.00"	$0.00		$0.00	$563.79	$0.00	$0.00	$573.52	$0.00	$0.00	$0.00	$0.00	$0.00
5536-B-300	SUP	HCPCS C1776		5536-B-300  -  BASEPLATE TIB 3 TRTHLN TRITANIUM KN	BOTH IP/OP	"$3,602.50 "	"$2,665.85"	$0.00	"$2,882.00"	"$1,621.13"	"$1,621.13"	$0.00	$0.00	$0.00	$750.85	"$2,673.78"	"$2,673.78"	$0.00	$0.00	$750.76	$0.00	"$1,776.03"	"$1,776.03"	$0.00	"$1,801.25"	"$2,853.18"	"$2,882.00"	$0.00		$0.00	$563.79	$0.00	$0.00	$573.52	$0.00	$0.00	$0.00	$0.00	$0.00
5536-B-400	SUP	HCPCS C1776		5536-B-400  -  BASEPLATE TIB 4 TRTHLN TRITANIUM KN	BOTH IP/OP	"$3,602.50 "	"$2,665.85"	$0.00	"$2,882.00"	"$1,621.13"	"$1,621.13"	$0.00	$0.00	$0.00	$750.85	"$2,673.78"	"$2,673.78"	$0.00	$0.00	$750.76	$0.00	"$1,776.03"	"$1,776.03"	$0.00	"$1,801.25"	"$2,853.18"	"$2,882.00"	$0.00		$0.00	$563.79	$0.00	$0.00	$573.52	$0.00	$0.00	$0.00	$0.00	$0.00
5536-B-500	SUP	HCPCS C1776		5536-B-500  -  BASEPLATE TIB 5 TRTHLN TRITANIUM KN	BOTH IP/OP	"$3,602.50 "	"$2,665.85"	$0.00	"$2,882.00"	"$1,621.13"	"$1,621.13"	$0.00	$0.00	$0.00	$750.85	"$2,673.78"	"$2,673.78"	$0.00	$0.00	$750.76	$0.00	"$1,776.03"	"$1,776.03"	$0.00	"$1,801.25"	"$2,853.18"	"$2,882.00"	$0.00		$0.00	$563.79	$0.00	$0.00	$573.52	$0.00	$0.00	$0.00	$0.00	$0.00
5536-B-600	SUP	HCPCS C1776		5536-B-600  -  BASEPLATE TIB 6 TRTHLN TRITANIUM KN	BOTH IP/OP	"$3,602.50 "	"$2,665.85"	$0.00	"$2,882.00"	"$1,621.13"	"$1,621.13"	$0.00	$0.00	$0.00	$750.85	"$2,673.78"	"$2,673.78"	$0.00	$0.00	$750.76	$0.00	"$1,776.03"	"$1,776.03"	$0.00	"$1,801.25"	"$2,853.18"	"$2,882.00"	$0.00		$0.00	$563.79	$0.00	$0.00	$573.52	$0.00	$0.00	$0.00	$0.00	$0.00
5536-B-700	SUP	HCPCS C1776		5536-B-700  -  BASEPLATE TIB 7 TRTHLN TRITANIUM KN	BOTH IP/OP	"$3,602.50 "	"$2,665.85"	$0.00	"$2,882.00"	"$1,621.13"	"$1,621.13"	$0.00	$0.00	$0.00	$750.85	"$2,673.78"	"$2,673.78"	$0.00	$0.00	$750.76	$0.00	"$1,776.03"	"$1,776.03"	$0.00	"$1,801.25"	"$2,853.18"	"$2,882.00"	$0.00		$0.00	$563.79	$0.00	$0.00	$573.52	$0.00	$0.00	$0.00	$0.00	$0.00
5536-B-800	SUP	HCPCS C1776		5536-B-800  -  BASEPLATE TIB 8 TRTHLN TRITANIUM KN	BOTH IP/OP	"$3,602.50 "	"$2,665.85"	$0.00	"$2,882.00"	"$1,621.13"	"$1,621.13"	$0.00	$0.00	$0.00	$750.85	"$2,673.78"	"$2,673.78"	$0.00	$0.00	$750.76	$0.00	"$1,776.03"	"$1,776.03"	$0.00	"$1,801.25"	"$2,853.18"	"$2,882.00"	$0.00		$0.00	$563.79	$0.00	$0.00	$573.52	$0.00	$0.00	$0.00	$0.00	$0.00
5537-14/13	SUP	HCPCS C1776		5537-14/13  -  STEM HUMERAL 14MM 135MM PRESS FIT HUMERAL TITANIUM SHOULDER	BOTH IP/OP	"$6,566.70 "	"$4,859.36"	$0.00	"$5,253.36"	"$2,955.02"	"$2,955.02"	$0.00	$0.00	$0.00	"$1,368.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,368.50"	$0.00	"$3,237.38"	"$3,237.38"	$0.00	"$3,283.35"	"$5,200.83"	"$5,253.36"	$0.00		$0.00	"$1,027.69"	$0.00	$0.00	"$1,045.42"	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-109	SUP	HCPCS C1776		5537-G-109  -  INSERT TIBIAL 1 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-109-E	SUP	HCPCS C1776		5537-G-109-E  -  INSERT TIB 1 9MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-111	SUP	HCPCS C1776		5537-G-111  -  INSERT TIBIAL 1 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-111-E	SUP	HCPCS C1776		5537-G-111-E  -  INSERT TIB 1 11MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-113	SUP	HCPCS C1776		5537-G-113  -  INSERT TIBIAL 1 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-113-E	SUP	HCPCS C1776		5537-G-113-E  -  INSERT TIB 1 13MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-116	SUP	HCPCS C1776		5537-G-116  -  INSERT TIBIAL 1 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-116-E	SUP	HCPCS C1776		5537-G-116-E  -  INSERT TIB 1 16MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-119	SUP	HCPCS C1776		5537-G-119  -  INSERT TIBIAL 1 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-119-E	SUP	HCPCS C1776		5537-G-119-E  -  INSERT TIB 1 19MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-122	SUP	HCPCS C1776		5537-G-122  -  INSERT TIBIAL 1 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-122-E	SUP	HCPCS C1776		5537-G-122-E  -  INSERT TIB 1 22MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-125	SUP	HCPCS C1776		5537-G-125  -  INSERT TIBIAL 1 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-125-E	SUP	HCPCS C1776		5537-G-125-E  -  INSERT TIB 1 25MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-128	SUP	HCPCS C1776		5537-G-128  -  INSERT TIBIAL 1 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-128-E	SUP	HCPCS C1776		5537-G-128-E  -  INSERT TIB 1 28MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-131	SUP	HCPCS C1776		5537-G-131  -  INSERT TIBIAL 1 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-131-E	SUP	HCPCS C1776		5537-G-131-E  -  INSERT TIB 1 31MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-209	SUP	HCPCS C1776		5537-G-209  -  INSERT TIBIAL 2 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-209-E	SUP	HCPCS C1776		5537-G-209-E  -  INSERT TIB 2 9MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-211	SUP	HCPCS C1776		5537-G-211  -  INSERT TIBIAL 2 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-211-E	SUP	HCPCS C1776		5537-G-211-E  -  INSERT TIB 2 11MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-213	SUP	HCPCS C1776		5537-G-213  -  INSERT TIBIAL 2 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-213-E	SUP	HCPCS C1776		5537-G-213-E  -  INSERT TIB 2 13MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-216	SUP	HCPCS C1776		5537-G-216  -  INSERT TIBIAL 2 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-216-E	SUP	HCPCS C1776		5537-G-216-E  -  INSERT TIB 2 16MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-219	SUP	HCPCS C1776		5537-G-219  -  INSERT TIBIAL 2 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-219-E	SUP	HCPCS C1776		5537-G-219-E  -  INSERT TIB 2 19MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-222	SUP	HCPCS C1776		5537-G-222  -  INSERT TIBIAL 2 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-222-E	SUP	HCPCS C1776		5537-G-222-E  -  INSERT TIB 2 22MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-225	SUP	HCPCS C1776		5537-G-225  -  INSERT TIBIAL 2 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-225-E	SUP	HCPCS C1776		5537-G-225-E  -  INSERT TIB 2 25MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-228	SUP	HCPCS C1776		5537-G-228  -  INSERT TIBIAL 2 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-228-E	SUP	HCPCS C1776		5537-G-228-E  -  INSERT TIB 2 28MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-231	SUP	HCPCS C1776		5537-G-231  -  INSERT TIBIAL 2 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-231-E	SUP	HCPCS C1776		5537-G-231-E  -  INSERT TIB 2 31MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-309	SUP	HCPCS C1776		5537-G-309  -  INSERT TIBIAL 2 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-309-E	SUP	HCPCS C1776		5537-G-309-E  -  INSERT TIB 3 9MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-311	SUP	HCPCS C1776		5537-G-311  -  INSERT TIBIAL 3 11MM TOT STABILIZED PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-311-E	SUP	HCPCS C1776		5537-G-311-E  -  INSERT TIB 3 11MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-313	SUP	HCPCS C1776		5537-G-313  -  INSERT TIBIAL 3 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-313-E	SUP	HCPCS C1776		5537-G-313-E  -  INSERT TIB 3 13MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-316	SUP	HCPCS C1776		5537-G-316  -  INSERT TIBIAL 3 16MM TOT STABILIZED PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-316-E	SUP	HCPCS C1776		5537-G-316-E  -  INSERT TIB 3 16MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-319	SUP	HCPCS C1776		5537-G-319  -  INSERT TIBIAL 3 19MM TOT STABILIZED PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-319-E	SUP	HCPCS C1776		5537-G-319-E  -  INSERT TIB 3 19MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-322	SUP	HCPCS C1776		5537-G-322  -  INSERT TIBIAL 3 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-322-E	SUP	HCPCS C1776		5537-G-322-E  -  INSERT TIB 3 22MM STRL TRTHLN TS + X3 KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-325	SUP	HCPCS C1776		5537-G-325  -  INSERT TIBIAL 3 25MM TOT STABILIZED PLUS TRIATHLON X3	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-325-E	SUP	HCPCS C1776		5537-G-325-E  -  INSERT TIB 3 25MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-328	SUP	HCPCS C1776		5537-G-328  -  INSERT TIBIAL 3 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-328-E	SUP	HCPCS C1776		5537-G-328-E  -  INSERT TIB 3 28MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-331	SUP	HCPCS C1776		5537-G-331  -  INSERT TIBIAL 3 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-331-E	SUP	HCPCS C1776		5537-G-331-E  -  INSERT TIB 3 31MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-409	SUP	HCPCS C1776		5537-G-409  -  INSERT TIBIAL 4 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-409-E	SUP	HCPCS C1776		5537-G-409-E  -  INSERT TIB 4 9MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-411	SUP	HCPCS C1776		5537-G-411  -  INSERT TIBIAL 4 11MM TOT STABILIZED PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-411-E	SUP	HCPCS C1776		5537-G-411-E  -  INSERT TIB 4 11MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-413	SUP	HCPCS C1776		5537-G-413  -  INSERT TIBIAL 4 13MM TOT STABILIZED PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-413-E	SUP	HCPCS C1776		5537-G-413-E  -  INSERT TIB 4 13MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-416	SUP	HCPCS C1776		5537-G-416  -  INSERT TIBIAL 4 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-416-E	SUP	HCPCS C1776		5537-G-416-E  -  INSERT TIB 4 16MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-419	SUP	HCPCS C1776		5537-G-419  -  INSERT TIBIAL 4 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-419-E	SUP	HCPCS C1776		5537-G-419-E  -  INSERT TIB 4 19MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-422	SUP	HCPCS C1776		5537-G-422  -  INSERT TIBIAL 4 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-422-E	SUP	HCPCS C1776		5537-G-422-E  -  INSERT TIB 4 22MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-425	SUP	HCPCS C1776		5537-G-425  -  INSERT TIBIAL 4 25MM TOT STABILIZED PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-425-E	SUP	HCPCS C1776		5537-G-425-E  -  INSERT TIB 4 25MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-428	SUP	HCPCS C1776		5537-G-428  -  INSERT TIBIAL 4 28MM TOT STABILIZED PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-428-E	SUP	HCPCS C1776		5537-G-428-E  -  INSERT TIB 4 28MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-431	SUP	HCPCS C1776		5537-G-431  -  INSERT TIBIAL 4 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-431-E	SUP	HCPCS C1776		5537-G-431-E  -  INSERT TIB 4 31MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-509	SUP	HCPCS C1776		5537-G-509  -  INSERT TIBIAL 5 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-509-E	SUP	HCPCS C1776		5537-G-509-E  -  INSERT TIB 5 9MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-511	SUP	HCPCS C1776		5537-G-511  -  INSERT TIBIAL 5 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-511-E	SUP	HCPCS C1776		5537-G-511-E  -  INSERT TIB 5 11MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-513	SUP	HCPCS C1776		5537-G-513  -  INSERT TIBIAL 5 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-513-E	SUP	HCPCS C1776		5537-G-513-E  -  INSERT TIB 5 13MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-516	SUP	HCPCS C1776		5537-G-516  -  INSERT TIBIAL 5 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-516-E	SUP	HCPCS C1776		5537-G-516-E  -  INSERT TIB 5 16MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-519	SUP	HCPCS C1776		5537-G-519  -  INSERT TIBIAL 5 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-519-E	SUP	HCPCS C1776		5537-G-519-E  -  INSERT TIB 5 19MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-522	SUP	HCPCS C1776		5537-G-522  -  INSERT TIBIAL 5 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-522-E	SUP	HCPCS C1776		5537-G-522-E  -  INSERT TIB 5 22MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-525	SUP	HCPCS C1776		5537-G-525  -  INSERT TIBIAL 5 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-525-E	SUP	HCPCS C1776		5537-G-525-E  -  INSERT TIB 5 25MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-528	SUP	HCPCS C1776		5537-G-528  -  INSERT TIBIAL 5 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-528-E	SUP	HCPCS C1776		5537-G-528-E  -  INSERT TIB 5 28MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-531	SUP	HCPCS C1776		5537-G-531  -  INSERT TIBIAL 5 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-531-E	SUP	HCPCS C1776		5537-G-531-E  -  INSERT TIB 5 31MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-609	SUP	HCPCS C1776		5537-G-609  -  INSERT TIBIAL 6 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-609-E	SUP	HCPCS C1776		5537-G-609-E  -  INSERT TIB 6 9MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-611	SUP	HCPCS C1776		5537-G-611  -  INSERT TIBIAL 6 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-611-E	SUP	HCPCS C1776		5537-G-611-E  -  INSERT TIB 6 11MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-613	SUP	HCPCS C1776		5537-G-613  -  INSERT TIBIAL 6 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-613-E	SUP	HCPCS C1776		5537-G-613-E  -  INSERT TIB 6 13MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-616	SUP	HCPCS C1776		5537-G-616  -  INSERT TIBIAL 6 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-616-E	SUP	HCPCS C1776		5537-G-616-E  -  INSERT TIB 6 16MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-619	SUP	HCPCS C1776		5537-G-619  -  INSERT TIBIAL 6 19MM TOT STABILIZED PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-619-E	SUP	HCPCS C1776		5537-G-619-E  -  INSERT TIB 6 19MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-622	SUP	HCPCS C1776		5537-G-622  -  INSERT TIBIAL 6 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-622-E	SUP	HCPCS C1776		5537-G-622-E  -  INSERT TIB 6 22MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-625	SUP	HCPCS C1776		5537-G-625  -  INSERT TIBIAL 6 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-625-E	SUP	HCPCS C1776		5537-G-625-E  -  INSERT TIB 6 25MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-628	SUP	HCPCS C1776		5537-G-628  -  INSERT TIBIAL 6 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-628-E	SUP	HCPCS C1776		5537-G-628-E  -  INSERT TIB 6 28MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-631	SUP	HCPCS C1776		5537-G-631  -  INSERT TIBIAL 6 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-631-E	SUP	HCPCS C1776		5537-G-631-E  -  INSERT TIB 6 31MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-709	SUP	HCPCS C1776		5537-G-709  -  INSERT TIBIAL 7 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-709-E	SUP	HCPCS C1776		5537-G-709-E  -  INSERT TIB 7 9MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-711	SUP	HCPCS C1776		5537-G-711  -  INSERT TIBIAL 7 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-711-E	SUP	HCPCS C1776		5537-G-711-E  -  INSERT TIB 7 11MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-713	SUP	HCPCS C1776		5537-G-713  -  INSERT TIBIAL 7 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-713-E	SUP	HCPCS C1776		5537-G-713-E  -  INSERT TIB 7 13MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-716	SUP	HCPCS C1776		5537-G-716  -  INSERT TIBIAL 7 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-716-E	SUP	HCPCS C1776		5537-G-716-E  -  INSERT TIB 7 16MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-719	SUP	HCPCS C1776		5537-G-719  -  INSERT TIBIAL 7 19MM TOT STABILIZE TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-719-E	SUP	HCPCS C1776		5537-G-719-E  -  INSERT TIB 7 19MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-722	SUP	HCPCS C1776		5537-G-722  -  INSERT TIBIAL 7 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-722-E	SUP	HCPCS C1776		5537-G-722-E  -  INSERT TIB 7 22MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-725	SUP	HCPCS C1776		5537-G-725  -  INSERT TIBIAL 7 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-725-E	SUP	HCPCS C1776		5537-G-725-E  -  INSERT TIB 7 25MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-728	SUP	HCPCS C1776		5537-G-728  -  INSERT TIBIAL 7 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-728-E	SUP	HCPCS C1776		5537-G-728-E  -  INSERT TIB 7 28MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-731	SUP	HCPCS C1776		5537-G-731  -  INSERT TIBIAL 7 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-731-E	SUP	HCPCS C1776		5537-G-731-E  -  INSERT TIB 7 31MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-809	SUP	HCPCS C1776		5537-G-809  -  INSERT TIBIAL 8 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-809-E	SUP	HCPCS C1776		5537-G-809-E  -  INSERT TIB 8 9MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-811	SUP	HCPCS C1776		5537-G-811  -  INSERT TIBIAL 8 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-811-E	SUP	HCPCS C1776		5537-G-811-E  -  INSERT TIB 8 11MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-813	SUP	HCPCS C1776		5537-G-813  -  INSERT TIBIAL 8 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-813-E	SUP	HCPCS C1776		5537-G-813-E  -  INSERT TIB 8 13MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-816	SUP	HCPCS C1776		5537-G-816  -  INSERT TIBIAL 8 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-816-E	SUP	HCPCS C1776		5537-G-816-E  -  INSERT TIB 8 16MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-819	SUP	HCPCS C1776		5537-G-819  -  INSERT TIBIAL 8 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-819-E	SUP	HCPCS C1776		5537-G-819-E  -  INSERT TIB 8 19MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-822	SUP	HCPCS C1776		5537-G-822  -  INSERT TIBIAL 8 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-822-E	SUP	HCPCS C1776		5537-G-822-E  -  INSERT TIB 8 22MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-825	SUP	HCPCS C1776		5537-G-825  -  INSERT TIBIAL 8 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-825-E	SUP	HCPCS C1776		5537-G-825-E  -  INSERT TIB 8 25MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-828	SUP	HCPCS C1776		5537-G-828  -  INSERT TIBIAL 8 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-828-E	SUP	HCPCS C1776		5537-G-828-E  -  INSERT TIB 8 28MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-831	SUP	HCPCS C1776		5537-G-831  -  INSERT TIBIAL 8 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5537-G-831-E	SUP	HCPCS C1776		5537-G-831-E  -  INSERT TIB 8 31MM STRL TRTHLN TS + KN	BOTH IP/OP	"$5,255.00 "	"$3,888.70"	$0.00	"$4,204.00"	"$2,364.75"	"$2,364.75"	$0.00	$0.00	$0.00	"$1,095.27"	"$3,900.26"	"$3,900.26"	$0.00	$0.00	"$1,095.14"	$0.00	"$2,590.72"	"$2,590.72"	$0.00	"$2,627.50"	"$4,161.96"	"$4,204.00"	$0.00		$0.00	$822.41	$0.00	$0.00	$836.60	$0.00	$0.00	$0.00	$0.00	$0.00
5539-91	SUP	HCPCS C1725		CATHETER ANGIO .035IN 5FR .052IN 90CM PGTL FLSH 10 SDPRT	BOTH IP/OP	$33.75 	$24.98	$0.00	$27.00	$18.33	$18.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.88	$26.73	$27.00	$0.00		$0.00	$5.28	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00
5540-14/13	SUP	HCPCS C1776		5540-14/13  -  STEM HUMERAL 14MM 135MM PRESS FIT TITANIUM HA STERILE	BOTH IP/OP	"$6,943.00 "	"$5,137.82"	$0.00	"$5,554.40"	"$3,124.35"	"$3,124.35"	$0.00	$0.00	$0.00	"$1,447.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,446.92"	$0.00	"$3,422.90"	"$3,422.90"	$0.00	"$3,471.50"	"$5,498.86"	"$5,554.40"	$0.00		$0.00	"$1,086.58"	$0.00	$0.00	"$1,105.33"	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-101	SUP	Custom 27803010		5540-A-101  -  AUGMENT FEMORAL 1 5MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-102	SUP	Custom 27803010		5540-A-102  -  AUGMENT FEMORAL 1 5MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-201	SUP	Custom 27803010		5540-A-201  -  AUGMENT FEMORAL 2 5MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-202	SUP	Custom 27803010		5540-A-202  -  AUGMENT FEMORAL 2 5MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-301	SUP	Custom 27803010		5540-A-301  -  AUGMENT FEMORAL 3 5MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-302	SUP	Custom 27803010		5540-A-302  -  AUGMENT FEMORAL 3 5MM TOT STABILIZED TRIATHLON RIGHT DISTAL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-401	SUP	Custom 27803010		5540-A-401  -  AUGMENT FEMORAL 4 5MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-402	SUP	Custom 27803010		5540-A-402  -  AUGMENT FEMORAL 4 5MM TOT STABILIZED TRIATHLON RIGHT DISTAL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-501	SUP	Custom 27803010		5540-A-501  -  AUGMENT FEMORAL 5 5MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-502	SUP	Custom 27803010		5540-A-502  -  AUGMENT FEMORAL 5 5MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-601	SUP	Custom 27803010		5540-A-601  -  AUGMENT FEMORAL 6 5MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-602	SUP	Custom 27803010		5540-A-602  -  AUGMENT FEMORAL 6 5MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-701	SUP	Custom 27803010		5540-A-701  -  AUGMENT FEMORAL 7 5MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-702	SUP	Custom 27803010		5540-A-702  -  AUGMENT FEMORAL 7 5MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-801	SUP	Custom 27803010		5540-A-801  -  AUGMENT FEMORAL 8 5MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5540-A-802	SUP	Custom 27803010		5540-A-802  -  AUGMENT FEMORAL 8 5MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-101	SUP	Custom 27803010		5541-A-101  -  AUGMENT FEMORAL 1 10MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-102	SUP	Custom 27803010		5541-A-102  -  AUGMENT FEMORAL 1 10MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-201	SUP	Custom 27803010		5541-A-201  -  AUGMENT FEMORAL 2 10MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-202	SUP	Custom 27803010		5541-A-202  -  AUGMENT FEMORAL 2 10MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-301	SUP	Custom 27803010		5541-A-301  -  AUGMENT FEMORAL 3 10MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-302	SUP	Custom 27803010		5541-A-302  -  AUGMENT FEMORAL 3 10MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-401	SUP	Custom 27803010		5541-A-401  -  AUGMENT FEMORAL 4 10MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-402	SUP	Custom 27803010		5541-A-402  -  AUGMENT FEMORAL 4 10MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-501	SUP	Custom 27803010		5541-A-501  -  AUGMENT FEMORAL 5 10MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-502	SUP	Custom 27803010		5541-A-502  -  AUGMENT FEMORAL 5 10MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-601	SUP	Custom 27803010		5541-A-601  -  AUGMENT FEMORAL 6 10MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-602	SUP	Custom 27803010		5541-A-602  -  AUGMENT FEMORAL 6 10MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-701	SUP	Custom 27803010		5541-A-701  -  AUGMENT FEMORAL 7 10MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-702	SUP	Custom 27803010		5541-A-702  -  AUGMENT FEMORAL 7 10MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-801	SUP	Custom 27803010		5541-A-801  -  AUGMENT FEMORAL 8 10MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5541-A-802	SUP	Custom 27803010		5541-A-802  -  AUGMENT FEMORAL 8 10MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-101	SUP	Custom 27803010		5542-A-101  -  AUGMENT FEMORAL 1 15MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-102	SUP	Custom 27803010		5542-A-102  -  AUGMENT FEMORAL 1 15MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-201	SUP	Custom 27803010		5542-A-201  -  AUGMENT FEMORAL 2 15MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-202	SUP	Custom 27803010		5542-A-202  -  AUGMENT FEMORAL 2 15MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-301	SUP	Custom 27803010		5542-A-301  -  AUGMENT FEMORAL 3 15MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-302	SUP	Custom 27803010		5542-A-302  -  AUGMENT FEMORAL 3 15MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-401	SUP	Custom 27803010		5542-A-401  -  AUGMENT FEMORAL 4 15MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-402	SUP	Custom 27803010		5542-A-402  -  AUGMENT FEMORAL 4 15MM TOT STABILIZE TRIATHLON KNEEL RIGHT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-501	SUP	Custom 27803010		5542-A-501  -  AUGMENT FEMORAL 5 15MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-502	SUP	Custom 27803010		5542-A-502  -  AUGMENT FEMORAL 5 15MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-601	SUP	Custom 27803010		5542-A-601  -  AUGMENT FEMORAL 6 15MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-602	SUP	Custom 27803010		5542-A-602  -  AUGMENT FEMORAL 6 15MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-701	SUP	Custom 27803010		5542-A-701  -  AUGMENT FEMORAL 7 15MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-702	SUP	Custom 27803010		5542-A-702  -  AUGMENT FEMORAL 7 15MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-801	SUP	Custom 27803010		5542-A-801  -  AUGMENT FEMORAL 8 15MM TOT STABILIZE TRIATHLON KNEE LEFT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5542-A-802	SUP	Custom 27803010		5542-A-802  -  AUGMENT FEMORAL 8 15MM TOT STABILIZE TRIATHLON KNEE RIGHT	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,831.38"	"$1,831.38"	$0.00	$0.00	$514.23	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5543-A-100	SUP	Custom 27803010		5543-A-100  -  AUGMENT FEMORAL 1 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5543-A-200	SUP	Custom 27803010		5543-A-200  -  AUGMENT FEMORAL 2 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5543-A-300	SUP	Custom 27803010		5543-A-300  -  AUGMENT FEMORAL 3 5MM TOT STABILIZED TRIATHLON POSTERIOR	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5543-A-400	SUP	Custom 27803010		5543-A-400  -  AUGMENT FEMORAL 4 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5543-A-500	SUP	Custom 27803010		5543-A-500  -  AUGMENT FEMORAL 5 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5543-A-600	SUP	Custom 27803010		5543-A-600  -  AUGMENT FEMORAL 6 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5543-A-700	SUP	Custom 27803010		5543-A-700  -  AUGMENT FEMORAL 7 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5543-A-800	SUP	Custom 27803010		5543-A-800  -  AUGMENT FEMORAL 8 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5544-A-100	SUP	Custom 27803010		5544-A-100  -  AUGMENT FEMORAL 1 10MM TOT STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5544-A-200	SUP	Custom 27803010		5544-A-200  -  AUGMENT FEMORAL 2 10MM TOT STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5544-A-300	SUP	Custom 27803010		5544-A-300  -  AUGMENT FEMORAL 3 10MM TOT STABILIZED BACKWARD BLOCK	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5544-A-400	SUP	Custom 27803010		5544-A-400  -  AUGMENT FEMORAL 4 10MM TOT STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5544-A-500	SUP	Custom 27803010		5544-A-500  -  AUGMENT FEMORAL 5 10MM TOT STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5544-A-600	SUP	Custom 27803010		5544-A-600  -  AUGMENT FEMORAL 6 10MM TOT STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5544-A-700	SUP	Custom 27803010		5544-A-700  -  AUGMENT FEMORAL 7 10MM TOT STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5544-A-800	SUP	Custom 27803010		5544-A-800  -  AUGMENT FEMORAL 8 10MM TOT STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$2,352.50 "	"$1,740.85"	$0.00	"$1,882.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,746.03"	"$1,746.03"	$0.00	$0.00	$490.26	$0.00	$0.00	$0.00	$0.00	"$1,176.25"	"$1,863.18"	"$1,882.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-101	SUP	Custom 27803010		5545-A-101  -  AUGMENT TIBIAL 1 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-102	SUP	Custom 27803010		5545-A-102  -  AUGMENT TIBIAL 1 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-201	SUP	Custom 27803010		5545-A-201  -  AUGMENT TIBIAL 2 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-202	SUP	Custom 27803010		5545-A-202  -  AUGMENT TIBIAL 2 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-301	SUP	Custom 27803010		5545-A-301  -  AUGMENT TIBIAL 3 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-302	SUP	Custom 27803010		5545-A-302  -  AUGMENT TIBIAL 3 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-401	SUP	Custom 27803010		5545-A-401  -  AUGMENT TIBIAL 4 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-402	SUP	Custom 27803010		5545-A-402  -  AUGMENT TIBIAL 4 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-501	SUP	Custom 27803010		5545-A-501  -  AUGMENT TIBIAL 5 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-502	SUP	Custom 27803010		5545-A-502  -  AUGMENT TIBIAL 5 5MM TRIATHLON RIGHT MEDIAL LEFT LATERAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-601	SUP	Custom 27803010		5545-A-601  -  AUGMENT TIBIAL 6 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-602	SUP	Custom 27803010		5545-A-602  -  AUGMENT TIBIAL 6 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-701	SUP	Custom 27803010		5545-A-701  -  AUGMENT TIBIAL 7 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-702	SUP	Custom 27803010		5545-A-702  -  AUGMENT TIBIAL 7 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-801	SUP	Custom 27803010		5545-A-801  -  AUGMENT TIBIAL 8 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5545-A-802	SUP	Custom 27803010		5545-A-802  -  AUGMENT TIBIAL 8 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	$0.00	$0.00	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-101	SUP	Custom 27803010		5546-A-101  -  AUGMENT TIBIAL 1 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-102	SUP	Custom 27803010		5546-A-102  -  AUGMENT TIBIAL 1 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-201	SUP	Custom 27803010		5546-A-201  -  AUGMENT TIBIAL 2 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-202	SUP	Custom 27803010		5546-A-202  -  AUGMENT TIBIAL 2 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-301	SUP	Custom 27803010		5546-A-301  -  AUGMENT TIBIAL 3 10MM TOT STABILIZED FIXING SCREW TRIATHLON	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-302	SUP	Custom 27803010		5546-A-302  -  AUGMENT TIBIAL 3 10MM TOAL STABILIZED TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-401	SUP	Custom 27803010		5546-A-401  -  AUGMENT TIBIAL 4 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-402	SUP	Custom 27803010		5546-A-402  -  AUGMENT TIBIAL 4 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-501	SUP	Custom 27803010		5546-A-501  -  AUGMENT TIBIAL 5 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-502	SUP	Custom 27803010		5546-A-502  -  AUGMENT TIBIAL 5 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-601	SUP	Custom 27803010		5546-A-601  -  AUGMENT TIBIAL 6 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-602	SUP	Custom 27803010		5546-A-602  -  AUGMENT TIBIAL 6 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-701	SUP	Custom 27803010		5546-A-701  -  AUGMENT TIBIAL 7 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-702	SUP	Custom 27803010		5546-A-702  -  AUGMENT TIBIAL 7 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-801	SUP	Custom 27803010		5546-A-801  -  AUGMENT TIBIAL 8 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5546-A-802	SUP	Custom 27803010		5546-A-802  -  AUGMENT TIBIAL 8 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL	BOTH IP/OP	"$2,095.00 "	"$1,550.30"	$0.00	"$1,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.91"	"$1,554.91"	$0.00	$0.00	$436.60	$0.00	$0.00	$0.00	$0.00	"$1,047.50"	"$1,659.24"	"$1,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-110	SUP	HCPCS C1776		5549-A-110  -  AUGMENT TIB A CONE STRL LF TRTHLN SMTR TRITANIUM	BOTH IP/OP	"$8,495.00 "	"$6,286.30"	$0.00	"$6,796.00"	"$3,822.75"	"$3,822.75"	$0.00	$0.00	$0.00	"$1,770.57"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,770.36"	$0.00	"$4,188.04"	"$4,188.04"	$0.00	"$4,247.50"	"$6,728.04"	"$6,796.00"	$0.00		$0.00	"$1,329.47"	$0.00	$0.00	"$1,352.40"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-120	SUP	HCPCS C1776		5549-A-120  -  AUGMENT TIB B CONE STRL LF TRTHLN SMTR TRITANIUM	BOTH IP/OP	"$8,495.00 "	"$6,286.30"	$0.00	"$6,796.00"	"$3,822.75"	"$3,822.75"	$0.00	$0.00	$0.00	"$1,770.57"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,770.36"	$0.00	"$4,188.04"	"$4,188.04"	$0.00	"$4,247.50"	"$6,728.04"	"$6,796.00"	$0.00		$0.00	"$1,329.47"	$0.00	$0.00	"$1,352.40"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-140	SUP	HCPCS C1776		5549-A-140  -  AUGMENT TIB D CONE TRTHLN SMTR REV TRITANIUM KN	BOTH IP/OP	"$8,495.00 "	"$6,286.30"	$0.00	"$6,796.00"	"$3,822.75"	"$3,822.75"	$0.00	$0.00	$0.00	"$1,770.57"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,770.36"	$0.00	"$4,188.04"	"$4,188.04"	$0.00	"$4,247.50"	"$6,728.04"	"$6,796.00"	$0.00		$0.00	"$1,329.47"	$0.00	$0.00	"$1,352.40"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-150	SUP	HCPCS C1776		5549-A-150  -  AUGMENT TIB E CONE TRTHLN SMTR REV TRITANIUM KN	BOTH IP/OP	"$8,495.00 "	"$6,286.30"	$0.00	"$6,796.00"	"$3,822.75"	"$3,822.75"	$0.00	$0.00	$0.00	"$1,770.57"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,770.36"	$0.00	"$4,188.04"	"$4,188.04"	$0.00	"$4,247.50"	"$6,728.04"	"$6,796.00"	$0.00		$0.00	"$1,329.47"	$0.00	$0.00	"$1,352.40"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-221	SUP	HCPCS C1776		5549-A-221  -  AUGMENT TIB B CONE TRTHLN ASYM TRITANIUM KN LT MDL RL REV	BOTH IP/OP	"$9,085.00 "	"$6,722.90"	$0.00	"$7,268.00"	"$4,088.25"	"$4,088.25"	$0.00	$0.00	$0.00	"$1,893.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,893.31"	$0.00	"$4,478.91"	"$4,478.91"	$0.00	"$4,542.50"	"$7,195.32"	"$7,268.00"	$0.00		$0.00	"$1,421.80"	$0.00	$0.00	"$1,446.33"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-222	SUP	HCPCS C1776		5549-A-222  -  AUGMENT TIB B CONE STRL TRTHLN ASYM TRITANIUM KN RMLL	BOTH IP/OP	"$9,085.00 "	"$6,722.90"	$0.00	"$7,268.00"	"$4,088.25"	"$4,088.25"	$0.00	$0.00	$0.00	"$1,893.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,893.31"	$0.00	"$4,478.91"	"$4,478.91"	$0.00	"$4,542.50"	"$7,195.32"	"$7,268.00"	$0.00		$0.00	"$1,421.80"	$0.00	$0.00	"$1,446.33"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-231	SUP	HCPCS C1776		5549-A-231  -  AUGMENT TIB C CONE TRTHLN ASYM TRITANIUM KN LT MDL RL REV	BOTH IP/OP	"$9,085.00 "	"$6,722.90"	$0.00	"$7,268.00"	"$4,088.25"	"$4,088.25"	$0.00	$0.00	$0.00	"$1,893.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,893.31"	$0.00	"$4,478.91"	"$4,478.91"	$0.00	"$4,542.50"	"$7,195.32"	"$7,268.00"	$0.00		$0.00	"$1,421.80"	$0.00	$0.00	"$1,446.33"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-232	SUP	HCPCS C1776		5549-A-232  -  AUGMENT TIB C CONE TRTHLN ASYM REV TRITANIUM KN RMLL	BOTH IP/OP	"$9,085.00 "	"$6,722.90"	$0.00	"$7,268.00"	"$4,088.25"	"$4,088.25"	$0.00	$0.00	$0.00	"$1,893.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,893.31"	$0.00	"$4,478.91"	"$4,478.91"	$0.00	"$4,542.50"	"$7,195.32"	"$7,268.00"	$0.00		$0.00	"$1,421.80"	$0.00	$0.00	"$1,446.33"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-241	SUP	HCPCS C1776		5549-A-241  -  AUGMENT TIB D CONE TRTHLN ASYM TRITANIUM KN LT MDL RL REV	BOTH IP/OP	"$9,085.00 "	"$6,722.90"	$0.00	"$7,268.00"	"$4,088.25"	"$4,088.25"	$0.00	$0.00	$0.00	"$1,893.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,893.31"	$0.00	"$4,478.91"	"$4,478.91"	$0.00	"$4,542.50"	"$7,195.32"	"$7,268.00"	$0.00		$0.00	"$1,421.80"	$0.00	$0.00	"$1,446.33"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-242	SUP	HCPCS C1776		5549-A-242  -  AUGMENT TIB D CONE TRTHLN ASYM TRITANIUM KN RMLL REV SYS	BOTH IP/OP	"$9,085.00 "	"$6,722.90"	$0.00	"$7,268.00"	"$4,088.25"	"$4,088.25"	$0.00	$0.00	$0.00	"$1,893.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,893.31"	$0.00	"$4,478.91"	"$4,478.91"	$0.00	"$4,542.50"	"$7,195.32"	"$7,268.00"	$0.00		$0.00	"$1,421.80"	$0.00	$0.00	"$1,446.33"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-251	SUP	HCPCS C1776		5549-A-251  -  AUGMENT TIB E CONE TRTHLN ASYM REV TRITANIUM KN LT MDL RL	BOTH IP/OP	"$9,085.00 "	"$6,722.90"	$0.00	"$7,268.00"	"$4,088.25"	"$4,088.25"	$0.00	$0.00	$0.00	"$1,893.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,893.31"	$0.00	"$4,478.91"	"$4,478.91"	$0.00	"$4,542.50"	"$7,195.32"	"$7,268.00"	$0.00		$0.00	"$1,421.80"	$0.00	$0.00	"$1,446.33"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-252	SUP	HCPCS C1776		5549-A-252  -  AUGMENT TIB E CONE TRTHLN ASYM REV TRITANIUM KN RMLL	BOTH IP/OP	"$9,085.00 "	"$6,722.90"	$0.00	"$7,268.00"	"$4,088.25"	"$4,088.25"	$0.00	$0.00	$0.00	"$1,893.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,893.31"	$0.00	"$4,478.91"	"$4,478.91"	$0.00	"$4,542.50"	"$7,195.32"	"$7,268.00"	$0.00		$0.00	"$1,421.80"	$0.00	$0.00	"$1,446.33"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-321	SUP	HCPCS C1776		5549-A-321  -  AUGMENT FEM 1 2 CONE TRTHLN TRITANIUM KN LT REV SYS	BOTH IP/OP	"$9,675.00 "	"$7,159.50"	$0.00	"$7,740.00"	"$4,353.75"	"$4,353.75"	$0.00	$0.00	$0.00	"$2,016.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.27"	$0.00	"$4,769.78"	"$4,769.78"	$0.00	"$4,837.50"	"$7,662.60"	"$7,740.00"	$0.00		$0.00	"$1,514.14"	$0.00	$0.00	"$1,540.26"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-322	SUP	HCPCS C1776		5549-A-322  -  AUGMENT FEM 1 2 CONE TRTHLN REV TRITANIUM KN RT	BOTH IP/OP	"$9,675.00 "	"$7,159.50"	$0.00	"$7,740.00"	"$4,353.75"	"$4,353.75"	$0.00	$0.00	$0.00	"$2,016.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.27"	$0.00	"$4,769.78"	"$4,769.78"	$0.00	"$4,837.50"	"$7,662.60"	"$7,740.00"	$0.00		$0.00	"$1,514.14"	$0.00	$0.00	"$1,540.26"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-331	SUP	HCPCS C1776		5549-A-331  -  AUGMENT FEM 3 CONE TRTHLN REV TRITANIUM KN LT	BOTH IP/OP	"$9,675.00 "	"$7,159.50"	$0.00	"$7,740.00"	"$4,353.75"	"$4,353.75"	$0.00	$0.00	$0.00	"$2,016.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.27"	$0.00	"$4,769.78"	"$4,769.78"	$0.00	"$4,837.50"	"$7,662.60"	"$7,740.00"	$0.00		$0.00	"$1,514.14"	$0.00	$0.00	"$1,540.26"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-332	SUP	HCPCS C1776		5549-A-332  -  AUGMENT FEM 3 CONE TRTHLN TRITANIUM KN RT REV SYS	BOTH IP/OP	"$9,675.00 "	"$7,159.50"	$0.00	"$7,740.00"	"$4,353.75"	"$4,353.75"	$0.00	$0.00	$0.00	"$2,016.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.27"	$0.00	"$4,769.78"	"$4,769.78"	$0.00	"$4,837.50"	"$7,662.60"	"$7,740.00"	$0.00		$0.00	"$1,514.14"	$0.00	$0.00	"$1,540.26"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-341	SUP	HCPCS C1776		5549-A-341  -  AUGMENT FEM 4 CONE TRTHLN REV TRITANIUM KN LT	BOTH IP/OP	"$9,675.00 "	"$7,159.50"	$0.00	"$7,740.00"	"$4,353.75"	"$4,353.75"	$0.00	$0.00	$0.00	"$2,016.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.27"	$0.00	"$4,769.78"	"$4,769.78"	$0.00	"$4,837.50"	"$7,662.60"	"$7,740.00"	$0.00		$0.00	"$1,514.14"	$0.00	$0.00	"$1,540.26"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-342	SUP	HCPCS C1776		5549-A-342  -  AUGMENT FEM 4 CONE TRTHLN TRITANIUM KN RT REV SYS	BOTH IP/OP	"$9,675.00 "	"$7,159.50"	$0.00	"$7,740.00"	"$4,353.75"	"$4,353.75"	$0.00	$0.00	$0.00	"$2,016.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.27"	$0.00	"$4,769.78"	"$4,769.78"	$0.00	"$4,837.50"	"$7,662.60"	"$7,740.00"	$0.00		$0.00	"$1,514.14"	$0.00	$0.00	"$1,540.26"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-351	SUP	HCPCS C1776		5549-A-351  -  AUGMENT FEM 5 CONE TRTHLN TRITANIUM KN LT REV SYS	BOTH IP/OP	"$9,675.00 "	"$7,159.50"	$0.00	"$7,740.00"	"$4,353.75"	"$4,353.75"	$0.00	$0.00	$0.00	"$2,016.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.27"	$0.00	"$4,769.78"	"$4,769.78"	$0.00	"$4,837.50"	"$7,662.60"	"$7,740.00"	$0.00		$0.00	"$1,514.14"	$0.00	$0.00	"$1,540.26"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-352	SUP	HCPCS C1776		5549-A-352  -  AUGMENT FEM 5 CONE TRTHLN REV TRITANIUM KN RT	BOTH IP/OP	"$9,675.00 "	"$7,159.50"	$0.00	"$7,740.00"	"$4,353.75"	"$4,353.75"	$0.00	$0.00	$0.00	"$2,016.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.27"	$0.00	"$4,769.78"	"$4,769.78"	$0.00	"$4,837.50"	"$7,662.60"	"$7,740.00"	$0.00		$0.00	"$1,514.14"	$0.00	$0.00	"$1,540.26"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-361	SUP	HCPCS C1776		5549-A-361  -  AUGMENT FEM 6 CONE TRTHLN REV TRITANIUM KN LT	BOTH IP/OP	"$9,675.00 "	"$7,159.50"	$0.00	"$7,740.00"	"$4,353.75"	"$4,353.75"	$0.00	$0.00	$0.00	"$2,016.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.27"	$0.00	"$4,769.78"	"$4,769.78"	$0.00	"$4,837.50"	"$7,662.60"	"$7,740.00"	$0.00		$0.00	"$1,514.14"	$0.00	$0.00	"$1,540.26"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-362	SUP	HCPCS C1776		5549-A-362  -  AUGMENT FEM 6 CONE TRTHLN REV TRITANIUM KN RT	BOTH IP/OP	"$9,675.00 "	"$7,159.50"	$0.00	"$7,740.00"	"$4,353.75"	"$4,353.75"	$0.00	$0.00	$0.00	"$2,016.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.27"	$0.00	"$4,769.78"	"$4,769.78"	$0.00	"$4,837.50"	"$7,662.60"	"$7,740.00"	$0.00		$0.00	"$1,514.14"	$0.00	$0.00	"$1,540.26"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-371	SUP	HCPCS C1776		5549-A-371  -  AUGMENT FEM 7 8 CONE TRTHLN TRITANIUM KN LT REV SYS	BOTH IP/OP	"$9,675.00 "	"$7,159.50"	$0.00	"$7,740.00"	"$4,353.75"	"$4,353.75"	$0.00	$0.00	$0.00	"$2,016.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.27"	$0.00	"$4,769.78"	"$4,769.78"	$0.00	"$4,837.50"	"$7,662.60"	"$7,740.00"	$0.00		$0.00	"$1,514.14"	$0.00	$0.00	"$1,540.26"	$0.00	$0.00	$0.00	$0.00	$0.00
5549-A-372	SUP	HCPCS C1776		5549-A-372  -  AUGMENT FEM 7 8 CONE TRTHLN REV TRITANIUM KN RT	BOTH IP/OP	"$9,675.00 "	"$7,159.50"	$0.00	"$7,740.00"	"$4,353.75"	"$4,353.75"	$0.00	$0.00	$0.00	"$2,016.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,016.27"	$0.00	"$4,769.78"	"$4,769.78"	$0.00	"$4,837.50"	"$7,662.60"	"$7,740.00"	$0.00		$0.00	"$1,514.14"	$0.00	$0.00	"$1,540.26"	$0.00	$0.00	$0.00	$0.00	$0.00
5550-G-278	SUP	Custom 27803010		5550-G-278  -  COMPONENT PATLR 27MM 8MM SYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5550-G-278-E	SUP	HCPCS C1776		5550-G-278-E  -  COMPONENT PTLR 27MM 8MM STRL TRTHLN SMTR KN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
5550-G-298	SUP	Custom 27803010		5550-G-298  -  COMPONENT PATLR 29MM 8MM SYMMETRIC TRIATHLON X3 TOT KNEE	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5550-G-298-E	SUP	HCPCS C1776		5550-G-298-E  -  COMPONENT PTLR 29MM 8MM STRL TRTHLN SMTR KN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
5550-G-319	SUP	Custom 27803010		5550-G-319  -  COMPONENT PATLR 31MM 9MM SYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5550-G-319-E	SUP	HCPCS C1776		5550-G-319-E  -  COMPONENT PTLR 31MM 9MM STRL TRTHLN SMTR KN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
5550-G-339	SUP	Custom 27803010		5550-G-339  -  COMPONENT PATLR 33MM 9MM SYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5550-G-339-E	SUP	HCPCS C1776		5550-G-339-E  -  COMPONENT PTLR 33MM 9MM STRL TRTHLN SMTR KN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
5550-G-360	SUP	Custom 27803010		5550-G-360  -  COMPONENT PATLR 36MM 10MM SYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5550-G-360-E	SUP	HCPCS C1776		5550-G-360-E  -  COMPONENT PTLR 36MM 10MM STRL TRTHLN SMTR KN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
5550-G-391	SUP	Custom 27803010		5550-G-391  -  COMPONENT PATLR 39MM 11MM SYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5550-G-391-E	SUP	HCPCS C1776		5550-G-391-E  -  COMPONENT PTLR 39MM 11MM STRL TRTHLN SMTR KN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
5550-L-278	SUP	Custom 27803010		5550-L-278  -  COMPONENT PATLR 27MM 8MM SYMMETRIC TRIATHLON KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5550-L-298	SUP	Custom 27803010		5550-L-298  -  COMPONENT PATLR 29MM 8MM SYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5550-L-319	SUP	Custom 27803010		5550-L-319  -  COMPONENT PATLR 31MM 9MM SYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5550-L-339	SUP	Custom 27803010		5550-L-339  -  COMPONENT PATLR 33MM 9MM SYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5550-L-360	SUP	Custom 27803010		5550-L-360  -  COMPONENT PATLR 36MM 10MM SYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5550-L-391	SUP	Custom 27803010		5550-L-391  -  COMPONENT PATLR 39MM 11MM SYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5551-G-299	SUP	Custom 27803010		5551-G-299  -  COMPONENT PATLR ASYMMETRIC 29MM 9MM TRIATHLON X3 TOT KNEE	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5551-G-299-E	SUP	HCPCS C1776		5551-G-299-E  -  COMPONENT PTLR 29MM 9MM STRL TRTHLN ASYM KN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
5551-G-320	SUP	Custom 27803010		5551-G-320  -  COMPONENT PATLR ASYMMETRIC 32MM 10MM TRIATHLON X3 KNEE	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5551-G-320-E	SUP	HCPCS C1776		5551-G-320-E  -  COMPONENT PTLR 32MM 10MM STRL TRTHLN ASYM KN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
5551-G-350	SUP	Custom 27803010		5551-G-350  -  COMPONENT PATLR 35MM 10MM ASYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5551-G-350-E	SUP	HCPCS C1776		5551-G-350-E  -  COMPONENT PTLR 35MM 10MM STRL TRTHLN ASYM KN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
5551-G-381	SUP	Custom 27803010		5551-G-381  -  COMPONENT PATLR 38MM 11MM ASYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5551-G-381-E	SUP	HCPCS C1776		5551-G-381-E  -  COMPONENT PTLR 38MM 11MM STRL TRTHLN ASYM KN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
5551-G-401	SUP	Custom 27803010		5551-G-401  -  COMPONENT PATLR 40MM 11MM ASYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5551-G-401-E	SUP	HCPCS C1776		5551-G-401-E  -  COMPONENT PTLR 40MM 11MM STRL TRTHLN ASYM KN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
5551-L-299	SUP	Custom 27803010		5551-L-299  -  COMPONENT PATLR 29MM 9MM ASYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5551-L-320	SUP	Custom 27803010		5551-L-320  -  COMPONENT PATLR 32MM 10MM ASYMMETRIC TRIATHLON KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5551-L-350	SUP	Custom 27803010		5551-L-350  -  COMPONENT PATLR 35MM 10MM ASYMMETRIC TRIATHLON KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5551-L-381	SUP	Custom 27803010		5551-L-381  -  COMPONENT PATLR 38MM 11MM ASYMMETRIC TRIATHLON	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5551-L-401	SUP	Custom 27803010		5551-L-401  -  COMPONENT PATLR 40MM 11MM ASYMMETRIC TRIATHLON X3 KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5552-L-299	SUP	HCPCS C1776		5552-L-299  -  COMPONENT PTLR 29MM 9MM TRITANIUM ASYM MTL KN	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
5552-L-320	SUP	HCPCS C1776		5552-L-320  -  COMPONENT PTLR 32MM 10MM ASYM TRITANIUM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
5552-L-350	SUP	HCPCS C1776		5552-L-350  -  COMPONENT PTLR 35MM 10MM ASYM TRITANIUM MTL KN	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
5552-L-381	SUP	HCPCS C1776		5552-L-381  -  COMPONENT PTLR 38MM 11MM TRITANIUM ASYM MTL KN	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
5552-L-401	SUP	HCPCS C1776		5552-L-401  -  COMPONENT PTLR 40MM 11MM TRITANIUM ASYM MTL KN	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
5554-L-320	SUP	Custom 27803010		5554-L-320  -  COMPONENT PATLR 32MM 10MM ASYMMETRIC METAL BACKED BEADED	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5554-L-350	SUP	Custom 27803010		5554-L-350  -  COMPONENT PATLR 35MM BEAD	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5554-L-381	SUP	Custom 27803010		5554-L-381  -  COMPONENT PATLR 38MM 11MM ASYMMETRIC METAL BACKED BEADED	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5554-L-401	SUP	Custom 27803010		5554-L-401  -  COMPONENT PATLR 40MM BEAD TRIATHLON PERI-APATITE KNEE	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-2901	SUP	Custom 27203010		5555-2901  -  BLOCK CUT TRTHLN PRCS	BOTH IP/OP	$89.00 	$65.86	$0.00	$71.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.06	$66.06	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$44.50	$70.49	$71.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-2902	SUP	Custom 27203010		5555-2902  -  BLOCK CUT TRTHLN PRCS	BOTH IP/OP	$89.00 	$65.86	$0.00	$71.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.06	$66.06	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$44.50	$70.49	$71.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-2903	SUP	Custom 27203010		5555-2903  -  BLOCK CUT TRTHLN PRCS	BOTH IP/OP	$89.00 	$65.86	$0.00	$71.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.06	$66.06	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$44.50	$70.49	$71.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-2904	SUP	Custom 27203010		5555-2904  -  BLOCK CUT TRTHLN PRCS	BOTH IP/OP	$89.00 	$65.86	$0.00	$71.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.06	$66.06	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$44.50	$70.49	$71.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-2905	SUP	Custom 27203010		5555-2905  -  BLOCK CUT TRTHLN PRCS	BOTH IP/OP	$89.00 	$65.86	$0.00	$71.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.06	$66.06	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$44.50	$70.49	$71.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-2906	SUP	Custom 27203010		5555-2906  -  BLOCK CUT TRTHLN PRCS	BOTH IP/OP	$89.00 	$65.86	$0.00	$71.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.06	$66.06	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$44.50	$70.49	$71.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-2907	SUP	Custom 27203010		5555-2907  -  BLOCK CUT TRTHLN PRCS	BOTH IP/OP	$89.00 	$65.86	$0.00	$71.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.06	$66.06	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$44.50	$70.49	$71.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-2908	SUP	Custom 27203010		5555-2908  -  BLOCK CUT TRTHLN PRCS	BOTH IP/OP	$89.00 	$65.86	$0.00	$71.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.06	$66.06	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$44.50	$70.49	$71.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3201	SUP	Custom 27203010		5555-3201  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.69	$124.69	$0.00	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3202	SUP	Custom 27203010		5555-3202  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.69	$124.69	$0.00	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3203	SUP	Custom 27203010		5555-3203  -  SET TRAUMA FIX 3 TIB PRCS PREP KIT CR STD	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.69	$124.69	$0.00	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3204	SUP	Custom 27203010		5555-3204  -  SET TRAUMA FIX 4 STD TIB CRUC RET PRCS PREP KIT TRTHLN	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.69	$124.69	$0.00	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3205	SUP	Custom 27203010		5555-3205  -  SET ORTH TRTHLN 5 PRP	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.69	$124.69	$0.00	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3206	SUP	Custom 27203010		5555-3206  -  KIT PRP TRTHLN 6 PRCS TIB CRUC RET STD	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.69	$124.69	$0.00	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3207	SUP	Custom 27203010		5555-3207  -  SET TRAUMA FIX 7 STD TIB CRUC RET PRCS PREP KIT TRTHLN	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.69	$124.69	$0.00	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3208	SUP	HCPCS C1713		5555-3208  -  SYSTEM BONE CMNT PRP KIT TIB BIOPREP	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$75.60	$75.60	$0.00	$0.00	$0.00	$35.02	$124.69	$124.69	$0.00	$0.00	$35.01	$0.00	$99.37	$99.37	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$26.29	$0.00	$0.00	$26.75	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3301	SUP	Custom 27203010		5555-3301  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3302	SUP	Custom 27203010		5555-3302  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3303	SUP	Custom 27203010		5555-3303  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3305	SUP	Custom 27203010		5555-3305  -  SET ORTH TRTHLN ECT 5 PRP	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3306	SUP	Custom 27203010		5555-3306  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3307	SUP	Custom 27203010		5555-3307  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3308	SUP	Custom 27203010		5555-3308  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN	BOTH IP/OP	$126.00 	$93.24	$0.00	$100.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$0.00	$0.00	$0.00	$63.00	$99.79	$100.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3501	SUP	Custom 27203010		5555-3501  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN	BOTH IP/OP	$184.00 	$136.16	$0.00	$147.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.56	$136.56	$0.00	$0.00	$38.35	$0.00	$0.00	$0.00	$0.00	$92.00	$145.73	$147.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3502	SUP	Custom 27203010		5555-3502  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN	BOTH IP/OP	$184.00 	$136.16	$0.00	$147.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.56	$136.56	$0.00	$0.00	$38.35	$0.00	$0.00	$0.00	$0.00	$92.00	$145.73	$147.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3503	SUP	HCPCS C1713		5555-3503  -  SYSTEM BONE CMNT PREP KIT TIB 3	BOTH IP/OP	$184.00 	$136.16	$0.00	$147.20	$82.80	$82.80	$0.00	$0.00	$0.00	$38.35	$136.56	$136.56	$0.00	$0.00	$38.35	$0.00	$108.84	$108.84	$0.00	$92.00	$145.73	$147.20	$0.00		$0.00	$28.80	$0.00	$0.00	$29.29	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3504	SUP	Custom 27203010		5555-3504  -  SET TRAUMA FIX 4 STD TIB PS PRCS PREP KIT TRTHLN	BOTH IP/OP	$184.00 	$136.16	$0.00	$147.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.56	$136.56	$0.00	$0.00	$38.35	$0.00	$0.00	$0.00	$0.00	$92.00	$145.73	$147.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3505	SUP	Custom 27203010		5555-3505  -  SET TRAUMA FIX 5 STD TIB PS PRCS PREP KIT TRTHLN	BOTH IP/OP	$184.00 	$136.16	$0.00	$147.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.56	$136.56	$0.00	$0.00	$38.35	$0.00	$0.00	$0.00	$0.00	$92.00	$145.73	$147.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3506	SUP	Custom 27203010		5555-3506  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN	BOTH IP/OP	$184.00 	$136.16	$0.00	$147.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.56	$136.56	$0.00	$0.00	$38.35	$0.00	$0.00	$0.00	$0.00	$92.00	$145.73	$147.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3507	SUP	Custom 27203010		5555-3507  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN	BOTH IP/OP	$184.00 	$136.16	$0.00	$147.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.56	$136.56	$0.00	$0.00	$38.35	$0.00	$0.00	$0.00	$0.00	$92.00	$145.73	$147.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3508	SUP	HCPCS C1713		5555-3508  -  SYSTEM BONE CMNT PREP KIT TIB 8	BOTH IP/OP	$184.00 	$136.16	$0.00	$147.20	$82.80	$82.80	$0.00	$0.00	$0.00	$38.35	$136.56	$136.56	$0.00	$0.00	$38.35	$0.00	$108.84	$108.84	$0.00	$92.00	$145.73	$147.20	$0.00		$0.00	$28.80	$0.00	$0.00	$29.29	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3701	SUP	Custom 27803010		5555-3701  -  CMPNT TIB TRTHLN KNEE PS	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.27	$117.27	$0.00	$0.00	$32.93	$0.00	$0.00	$0.00	$0.00	$79.00	$125.14	$126.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3702	SUP	Custom 27803010		5555-3702  -  CMPNT TIB TRTHLN KNEE PS	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.27	$117.27	$0.00	$0.00	$32.93	$0.00	$0.00	$0.00	$0.00	$79.00	$125.14	$126.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3703	SUP	Custom 27203010		5555-3703  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.27	$117.27	$0.00	$0.00	$32.93	$0.00	$0.00	$0.00	$0.00	$79.00	$125.14	$126.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3704	SUP	Custom 27203010		5555-3704  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.27	$117.27	$0.00	$0.00	$32.93	$0.00	$0.00	$0.00	$0.00	$79.00	$125.14	$126.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3705	SUP	Custom 27203010		5555-3705  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.27	$117.27	$0.00	$0.00	$32.93	$0.00	$0.00	$0.00	$0.00	$79.00	$125.14	$126.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3706	SUP	Custom 27203010		5555-3706  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.27	$117.27	$0.00	$0.00	$32.93	$0.00	$0.00	$0.00	$0.00	$79.00	$125.14	$126.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3707	SUP	Custom 27203010		5555-3707  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.27	$117.27	$0.00	$0.00	$32.93	$0.00	$0.00	$0.00	$0.00	$79.00	$125.14	$126.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-3708	SUP	Custom 27803010		5555-3708  -  CMPNT TIB TRTHLN KNEE PS	BOTH IP/OP	$158.00 	$116.92	$0.00	$126.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.27	$117.27	$0.00	$0.00	$32.93	$0.00	$0.00	$0.00	$0.00	$79.00	$125.14	$126.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4201	SUP	Custom 27203010		5555-4201  -  SET TRAUMA FIX FEM KNEE CRUC RET PRCS TRTHLN	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.79	$233.79	$0.00	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4202	SUP	Custom 27203010		5555-4202  -  KIT THR TRTHLN 2 CRUC RET	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.79	$233.79	$0.00	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4203	SUP	Custom 27203010		5555-4203  -  SET ORTH TRTHLN 3 FEM PRP	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.79	$233.79	$0.00	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4204	SUP	Custom 27203010		5555-4204  -  SET TRAUMA FIX 4 FEM CRUC RET PRCS PREP KIT TRTHLN	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.79	$233.79	$0.00	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4205	SUP	Custom 27203010		5555-4205  -  SET ORTH TRTHLN 5 TIB PRP	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.79	$233.79	$0.00	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4206	SUP	Custom 27203010		5555-4206  -  SET TRAUMA FIX 6 FEM CRUC RET PRCS PREP KIT TRTHLN	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.79	$233.79	$0.00	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4207	SUP	Custom 27203010		5555-4207  -  KIT PRP TRTHLN 7 PRCS FEM CRUC RET STD	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.79	$233.79	$0.00	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4208	SUP	HCPCS C1713		5555-4208  -  SYSTEM BONE CMNT PRP KIT FEM BIOPREP	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$141.75	$141.75	$0.00	$0.00	$0.00	$65.65	$233.79	$233.79	$0.00	$0.00	$65.65	$0.00	$186.32	$186.32	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$49.30	$0.00	$0.00	$50.15	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4301	SUP	Custom 27203010		5555-4301  -  TRIATHLON PS PRECISION FEMORAL PREP KIT SIZE 1	BOTH IP/OP	$341.00 	$252.34	$0.00	$272.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.09	$253.09	$0.00	$0.00	$71.06	$0.00	$0.00	$0.00	$0.00	$170.50	$270.07	$272.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4302	SUP	Custom 27203010		5555-4302  -  SET TRAUMA FIX FEM KNEE PS PRCS TRTHLN	BOTH IP/OP	$341.00 	$252.34	$0.00	$272.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.09	$253.09	$0.00	$0.00	$71.06	$0.00	$0.00	$0.00	$0.00	$170.50	$270.07	$272.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4303	SUP	HCPCS C1713		5555-4303  -  SYSTEM BONE CMNT PREP KIT FEM 3	BOTH IP/OP	$341.00 	$252.34	$0.00	$272.80	$153.45	$153.45	$0.00	$0.00	$0.00	$71.07	$253.09	$253.09	$0.00	$0.00	$71.06	$0.00	$201.70	$201.70	$0.00	$170.50	$270.07	$272.80	$0.00		$0.00	$53.37	$0.00	$0.00	$54.29	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4304	SUP	Custom 27203010		5555-4304  -  SET TRAUMA FIX 4 FEM PS PRCS PREP KIT TRTHLN	BOTH IP/OP	$341.00 	$252.34	$0.00	$272.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.09	$253.09	$0.00	$0.00	$71.06	$0.00	$0.00	$0.00	$0.00	$170.50	$270.07	$272.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4305	SUP	Custom 27203010		5555-4305  -  SET TRAUMA FIX 5 FEM PS PRCS PREP KIT TRTHLN	BOTH IP/OP	$341.00 	$252.34	$0.00	$272.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.09	$253.09	$0.00	$0.00	$71.06	$0.00	$0.00	$0.00	$0.00	$170.50	$270.07	$272.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4306	SUP	HCPCS C1713		5555-4306  -  SYSTEM BONE CMNT PREP KIT FEM 6	BOTH IP/OP	$341.00 	$252.34	$0.00	$272.80	$153.45	$153.45	$0.00	$0.00	$0.00	$71.07	$253.09	$253.09	$0.00	$0.00	$71.06	$0.00	$201.70	$201.70	$0.00	$170.50	$270.07	$272.80	$0.00		$0.00	$53.37	$0.00	$0.00	$54.29	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4307	SUP	Custom 27203010		5555-4307  -  SET TRAUMA FIX FEM KNEE PS PRCS TRTHLN	BOTH IP/OP	$341.00 	$252.34	$0.00	$272.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.09	$253.09	$0.00	$0.00	$71.06	$0.00	$0.00	$0.00	$0.00	$170.50	$270.07	$272.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4308	SUP	HCPCS C1713		5555-4308  -  SYSTEM BONE CMNT PREP KIT FEM 8	BOTH IP/OP	$341.00 	$252.34	$0.00	$272.80	$153.45	$153.45	$0.00	$0.00	$0.00	$71.07	$253.09	$253.09	$0.00	$0.00	$71.06	$0.00	$201.70	$201.70	$0.00	$170.50	$270.07	$272.80	$0.00		$0.00	$53.37	$0.00	$0.00	$54.29	$0.00	$0.00	$0.00	$0.00	$0.00
5555-4600	SUP	Custom 27203010		5555-4600  -  SYSTEM KN TRL 1-8 TRTHLN TIB	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.22	$74.22	$0.00	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5556-L-319	SUP	HCPCS C1776		5556-L-319  -  COMPONENT PTLR S 31X9MM STRL LF TRITANIUM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
5556-L-339	SUP	HCPCS C1776		5556-L-339  -  COMPONENT PTLR 33MM 9MM SMTR TRITANIUM KN	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
5556-L-360	SUP	HCPCS C1776		5556-L-360  -  COMPONENT PTLR 36MM 10MM TRITANIUM SMTR MTL KN	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
5556-L-391	SUP	HCPCS C1776		5556-L-391  -  COMPONENT PTLR 39MM 11MM TRITANIUM SMTR MTL KN	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
5560-S-109	SUP	Custom 27803010		5560-S-109  -  STEM FEMORAL 9MM 50MM CEMENTED TOT STABILIZE TRIATHLON COCR	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5560-S-112	SUP	Custom 27803010		5560-S-112  -  STEM FEMORAL 12MM 50MM CEMENTED TOT STABILIZED TRIATHLON	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5560-S-115	SUP	Custom 27803010		5560-S-115  -  STEM FEMORAL 15MM 50MM CEMENTED TOT STABILIZE TRIATHLON COCR	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5560-S-209	SUP	Custom 27803010		5560-S-209  -  STEM FEMORAL 9MM 100MM CEMENTED TOT STABILIZE TRIATHLON COCR	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5560-S-212	SUP	Custom 27803010		5560-S-212  -  STEM FEMORAL 12MM 100MM CEMENTED TOT STABILIZED TRIATHLON	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5560-S-215	SUP	Custom 27803010		5560-S-215  -  STEM FEMORAL 15MM 100MM CEMENTED TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5560-S-309	SUP	Custom 27803010		5560-S-309  -  STEM FEMORAL 9MM 150MM CEMENTED TOT STABILIZE TRIATHLON COCR	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5560-S-312	SUP	Custom 27803010		5560-S-312  -  STEM FEMORAL 12MM 150MM CEMENTED TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5560-S-315	SUP	Custom 27803010		5560-S-315  -  STEM FEMORAL 15MM 150MM CEMENTED TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
556-25890	SUP	HCPCS C1887		556-25890  -  CATH GUID MPD CURVE 5FR .056IN 90CM PTFE ENV	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$447.98	$447.98	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$0.00	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$412.50	$653.40	$660.00	$0.00		$0.00	$129.11	$0.00	$0.00	$131.34	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-010	SUP	Custom 27803010		5565-S-010  -  STEM FEMORAL 10MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-011	SUP	Custom 27803010		5565-S-011  -  STEM FEMORAL 11MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-012	SUP	Custom 27803010		5565-S-012  -  STEM FEMORAL 12MM 100MM CEMENTLESS TOT STABILIZED TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-013	SUP	Custom 27803010		5565-S-013  -  STEM FEMORAL 13MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-014	SUP	Custom 27803010		5565-S-014  -  STEM FEMORAL 14MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-015	SUP	Custom 27803010		5565-S-015  -  STEM FEMORAL 15MM 100MM CEMENTLESS TOT STABILIZED TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-016	SUP	Custom 27803010		5565-S-016  -  STEM FEMORAL 16MM 105MM CEMENTLESS TOT STABILIZED TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-017	SUP	Custom 27803010		5565-S-017  -  STEM FEMORAL 17MM 100MM CEMENTLESS TOT STABILIZED TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-018	SUP	Custom 27803010		5565-S-018  -  STEM FEMORAL 18MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-019	SUP	Custom 27803010		5565-S-019  -  STEM FEMORAL 19MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-020	SUP	Custom 27803010		5565-S-020  -  STEM FEMORAL 20MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-021	SUP	Custom 27803010		5565-S-021  -  STEM FEMORAL 21MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-022	SUP	Custom 27803010		5565-S-022  -  STEM FEMORAL 22MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-023	SUP	Custom 27803010		5565-S-023  -  STEM FEMORAL 23MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-024	SUP	Custom 27803010		5565-S-024  -  STEM FEMORAL 24MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5565-S-025	SUP	Custom 27803010		5565-S-025  -  STEM FEMORAL 25MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,530.00 "	"$1,872.20"	$0.00	"$2,024.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,877.77"	"$1,877.77"	$0.00	$0.00	$527.25	$0.00	$0.00	$0.00	$0.00	"$1,265.00"	"$2,003.76"	"$2,024.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-010	SUP	Custom 27803010		5566-S-010  -  STEM FEMORAL 20MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-011	SUP	Custom 27803010		5566-S-011  -  STEM FEMORAL 11MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-012	SUP	Custom 27803010		5566-S-012  -  STEM FEMORAL 12MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-013	SUP	Custom 27803010		5566-S-013  -  STEM FEMORAL 13MM 150MM CEMENTLESS TOT STABILIZED TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-014	SUP	Custom 27803010		5566-S-014  -  STEM FEMORAL 14MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-015	SUP	Custom 27803010		5566-S-015  -  STEM FEMORAL 15MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-016	SUP	Custom 27803010		5566-S-016  -  STEM FEMORAL 16MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-017	SUP	Custom 27803010		5566-S-017  -  STEM FEMORAL 17MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-018	SUP	Custom 27803010		5566-S-018  -  STEM FEMORAL 18MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-019	SUP	Custom 27803010		5566-S-019  -  STEM FEMORAL 19MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-020	SUP	Custom 27803010		5566-S-020  -  STEM FEMORAL 20MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-021	SUP	Custom 27803010		5566-S-021  -  STEM FEMORAL 21MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-022	SUP	Custom 27803010		5566-S-022  -  STEM FEMORAL 22MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-023	SUP	Custom 27803010		5566-S-023  -  STEM FEMORAL 23MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-024	SUP	Custom 27803010		5566-S-024  -  STEM FEMORAL 24MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5566-S-025	SUP	Custom 27803010		5566-S-025  -  STEM FEMORAL 25MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	$0.00	$0.00	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5570-S-020	SUP	Custom 27803010		5570-S-020  -  ADAPTER FEMORAL 2MM OFFST TOT STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$2,582.50 "	"$1,911.05"	$0.00	"$2,066.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,916.73"	"$1,916.73"	$0.00	$0.00	$538.19	$0.00	$0.00	$0.00	$0.00	"$1,291.25"	"$2,045.34"	"$2,066.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5570-S-040	SUP	Custom 27803010		5570-S-040  -  ADAPTER FEMORAL 4MM OFFST TOT STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$2,582.50 "	"$1,911.05"	$0.00	"$2,066.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,916.73"	"$1,916.73"	$0.00	$0.00	$538.19	$0.00	$0.00	$0.00	$0.00	"$1,291.25"	"$2,045.34"	"$2,066.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5570-S-060	SUP	Custom 27803010		5570-S-060  -  ADAPTER FEMORAL 6MM OFFST TOT STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$2,582.50 "	"$1,911.05"	$0.00	"$2,066.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,916.73"	"$1,916.73"	$0.00	$0.00	$538.19	$0.00	$0.00	$0.00	$0.00	"$1,291.25"	"$2,045.34"	"$2,066.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5570-S-080	SUP	Custom 27803010		5570-S-080  -  ADAPTER FEMORAL 8MM OFFST TOT STABILIZE TRIATHLON KNEE	BOTH IP/OP	"$2,582.50 "	"$1,911.05"	$0.00	"$2,066.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,916.73"	"$1,916.73"	$0.00	$0.00	$538.19	$0.00	$0.00	$0.00	$0.00	"$1,291.25"	"$2,045.34"	"$2,066.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5571-S-025	SUP	Custom 27803010		5571-S-025  -  EXTENSION STEM 25MM TOT STABILIZE TRIATHLON KNEE FEMUR	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	$0.00	$0.00	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5571-S-050	SUP	Custom 27803010		5571-S-050  -  EXTENSION STEM 50MM TOT STABILIZE TRIATHLON KNEE FEMUR	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	$0.00	$0.00	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5575-X-000	SUP	HCPCS C1713		5575-X-000  -  PEG FIX MODULAR TRIATHLON DISTAL FEMUR KNEE	BOTH IP/OP	$880.00 	$651.20	$0.00	$704.00	$396.00	$396.00	$0.00	$0.00	$0.00	$183.41	$653.14	$653.14	$0.00	$0.00	$183.39	$0.00	$520.52	$520.52	$0.00	$440.00	$696.96	$704.00	$0.00		$0.00	$137.72	$0.00	$0.00	$140.10	$0.00	$0.00	$0.00	$0.00	$0.00
558-10-48D	SUP	Custom 27803010		558-10-48D  -  SHELL ACETAB 48MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT D	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
558-10-50D	SUP	Custom 27803010		558-10-50D  -  SHELL ACETAB 50MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT D	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
558-10-52E	SUP	Custom 27803010		558-10-52E  -  SHELL ACETAB 52MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT E	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
558-10-54E	SUP	Custom 27803010		558-10-54E  -  SHELL ACETAB 54MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT E	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
558-10-56F	SUP	Custom 27803010		558-10-56F  -  SHELL ACETAB 56MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT F	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
558-10-58F	SUP	Custom 27803010		558-10-58F  -  SHELL ACETAB 58MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT F	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
558-10-60G	SUP	Custom 27803010		558-10-60G  -  SHELL ACETAB 60MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT G	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
558-10-62G	SUP	Custom 27803010		558-10-62G  -  SHELL ACETAB 62MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT G	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
558-10-64H	SUP	Custom 27803010		558-10-64H  -  SHELL ACETAB 62MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT H	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
558-10-66H	SUP	Custom 27803010		558-10-66H  -  SHELL ACETAB 66MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT H	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
558-10-68I	SUP	Custom 27803010		558-10-68I  -  SHELL ACETAB 68MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT 1	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
558-10-70I	SUP	Custom 27803010		558-10-70I  -  SHELL ACETAB 70MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT 1	BOTH IP/OP	"$2,409.00 "	"$1,782.66"	$0.00	"$1,927.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.96"	"$1,787.96"	$0.00	$0.00	$502.04	$0.00	$0.00	$0.00	$0.00	"$1,204.50"	"$1,907.93"	"$1,927.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5583-A3	SUP	HCPCS C1725		5583-A3  -  CATH ANGIO .035IN VERT CURVE 5FR .044IN 100CM BRAID SFTCH	BOTH IP/OP	$30.50 	$22.57	$0.00	$24.40	$16.56	$16.56	$0.00	$0.00	$0.00	$6.36	$22.64	$22.64	$0.00	$0.00	$6.36	$0.00	$18.04	$18.04	$0.00	$15.25	$24.16	$24.40	$0.00		$0.00	$4.77	$0.00	$0.00	$4.86	$0.00	$0.00	$0.00	$0.00	$0.00
5585-C-016	SUP	HCPCS C1713		5585-C-016  -  SCREW BN 6.5MM 16MM TRTHLN VIT CANC T/K SYS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5585-C-020	SUP	HCPCS C1713		5585-C-020  -  SCREW BASEPLATE 6.5MM 20MM TRIATHLON VITALLIUM KNEE TIBIA	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5585-C-025	SUP	HCPCS C1713		5585-C-025  -  SCREW BASEPLATE 6.5MM 25MM TRIATHLON VITALLIUM KNEE TIBIA	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5585-C-030	SUP	HCPCS C1713		5585-C-030  -  SCREW BASEPLATE 6.5MM 30MM TRIATHLON VITALLIUM KNEE TIBIA	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5585-C-035	SUP	HCPCS C1713		5585-C-035  -  SCREW BASEPLATE 6.5MM 35MM TRIATHLON VITALLIUM KNEE TIBIA	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5585-C-040	SUP	HCPCS C1713		5585-C-040  -  SCREW BASEPLATE 6.5MM 40MM TRIATHLON VITALLIUM KNEE TIBIA	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5585-C-045	SUP	HCPCS C1713		5585-C-045  -  SCREW BASEPLATE 6.5MM 45MM TRIATHLON VITALLIUM KNEE TIBIA	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5585-C-050	SUP	HCPCS C1713		5585-C-050  -  SCREW BASEPLATE 6.5MM 50MM TRIATHLON VITALLIUM KNEE TIBIA	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5585-C-055	SUP	HCPCS C1713		5585-C-055  -  SCREW BN 6.5MM 55MM TRTHLN VIT CANC	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5585-C-060	SUP	HCPCS C1713		5585-C-060  -  SCREW BN 6.5MM 60MM TRTHLN VIT CANC	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
5591-B3	SUP	HCPCS C1725		5591-B3  -  CATHETER ANGIOGRAPHIC MOTARJEME CURVE 5FR .046IN 100CM BRAID	BOTH IP/OP	$29.65 	$21.94	$0.00	$23.72	$16.10	$16.10	$0.00	$0.00	$0.00	$6.18	$22.01	$22.01	$0.00	$0.00	$6.18	$0.00	$17.54	$17.54	$0.00	$14.83	$23.48	$23.72	$0.00		$0.00	$4.64	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
55-969-30-04	SUP	HCPCS C1713		55-969-30-04  -  TRAY 30CM X30CM W/O LID FOR LEV 1 INST	BOTH IP/OP	"$2,412.78 "	"$1,785.46"	$0.00	"$1,930.22"	"$1,085.75"	"$1,085.75"	$0.00	$0.00	$0.00	$502.88	"$1,790.76"	"$1,790.76"	$0.00	$0.00	$502.82	$0.00	"$1,427.16"	"$1,427.16"	$0.00	"$1,206.39"	"$1,910.92"	"$1,930.22"	$0.00		$0.00	$377.60	$0.00	$0.00	$384.11	$0.00	$0.00	$0.00	$0.00	$0.00
55-969-98-04	SUP	Custom 27803010		55-969-98-04  -  LOCK MOD 3 STACK LEFT LEVEL 1 SYSTEM	BOTH IP/OP	$579.38 	$428.74	$0.00	$463.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$430.01	$430.01	$0.00	$0.00	$120.74	$0.00	$0.00	$0.00	$0.00	$289.69	$458.87	$463.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
55-969-99-04	SUP	Custom 27803010		55-969-99-04  -  LOCK MOD 3 STACK RIGHT LEVEL 1 SYSTEM	BOTH IP/OP	$579.38 	$428.74	$0.00	$463.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$430.01	$430.01	$0.00	$0.00	$120.74	$0.00	$0.00	$0.00	$0.00	$289.69	$458.87	$463.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
56-00400	SUP	HCPCS C1713		56-00400  -  WASHER SPINAL BICONCAVE 4MM SALZBURG TITANIUM	BOTH IP/OP	$74.08 	$54.82	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$15.44	$54.98	$54.98	$0.00	$0.00	$15.44	$0.00	$43.82	$43.82	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
5601-0-901	SUP	HCPCS C1713		5601-0-901  -  TRAY STRL ICS SMTB PLT	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
5601-0-902	SUP	HCPCS C1713		5601-0-902  -  TRAY STRL ICS NAR PLT	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
5601-0-903	SUP	HCPCS C1713		5601-0-903  -  TRAY STRL ICS BRD PLT	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$136.13	$136.13	$0.00	$0.00	$0.00	$63.05	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$178.93	$178.93	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$47.34	$0.00	$0.00	$48.16	$0.00	$0.00	$0.00	$0.00	$0.00
5601-0-904	SUP	Custom 27203010		5601-0-904  -  CASE STRL LG SCR	BOTH IP/OP	$459.25 	$339.85	$0.00	$367.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.86	$340.86	$0.00	$0.00	$95.71	$0.00	$0.00	$0.00	$0.00	$229.63	$363.73	$367.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5601-0-908	SUP	Custom 27203010		5601-0-908  -  TRAY STRL ICS DRILL TAPS	BOTH IP/OP	$481.25 	$356.13	$0.00	$385.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$357.18	$357.18	$0.00	$0.00	$100.29	$0.00	$0.00	$0.00	$0.00	$240.63	$381.15	$385.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5601-0-909	SUP	Custom 27203010		5601-0-909  -  TRAY STRL ICS DRILL GD	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5601-1-900	SUP	Custom 27203010		5601-1-900  -  CASE STRL ICS FRAGMENTATION	BOTH IP/OP	$460.63 	$340.87	$0.00	$368.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.88	$341.88	$0.00	$0.00	$95.99	$0.00	$0.00	$0.00	$0.00	$230.31	$364.82	$368.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5601-1-901	SUP	Custom 27203010		5601-1-901  -  RACK STRL SCR ICS SM	BOTH IP/OP	$726.00 	$537.24	$0.00	$580.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$538.84	$538.84	$0.00	$0.00	$151.30	$0.00	$0.00	$0.00	$0.00	$363.00	$574.99	$580.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5601-1-902	SUP	HCPCS C1713		5601-1-902  -  TRAY STRL ICS SM PLT	BOTH IP/OP	$481.25 	$356.13	$0.00	$385.00	$216.56	$216.56	$0.00	$0.00	$0.00	$100.30	$357.18	$357.18	$0.00	$0.00	$100.29	$0.00	$284.66	$284.66	$0.00	$240.63	$381.15	$385.00	$0.00		$0.00	$75.32	$0.00	$0.00	$76.62	$0.00	$0.00	$0.00	$0.00	$0.00
5601-1-911	SUP	Custom 27203010		5601-1-911  -  TRAY STRL ICS SM TAP DRILL SLV	BOTH IP/OP	$357.50 	$264.55	$0.00	$286.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$265.34	$265.34	$0.00	$0.00	$74.50	$0.00	$0.00	$0.00	$0.00	$178.75	$283.14	$286.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5601-1-912	SUP	Custom 27203010		5601-1-912  -  TRAY STRL ICS FORCEP	BOTH IP/OP	$357.50 	$264.55	$0.00	$286.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$265.34	$265.34	$0.00	$0.00	$74.50	$0.00	$0.00	$0.00	$0.00	$178.75	$283.14	$286.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5601-1-913	SUP	Custom 27203010		5601-1-913  -  TRAY STRL ICS SM DRILL TAPS	BOTH IP/OP	$357.50 	$264.55	$0.00	$286.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$265.34	$265.34	$0.00	$0.00	$74.50	$0.00	$0.00	$0.00	$0.00	$178.75	$283.14	$286.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5610-F-101	SUP	HCPCS C1776		5610-F-101  -  COMPONENT FEM 1 TRTHLN PRT KN RSRFC KN LT MDL RL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
5610-F-102	SUP	HCPCS C1776		5610-F-102  -  COMPONENT FEM 1 TRTHLN RMLL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
5610-F-201	SUP	HCPCS C1776		5610-F-201  -  COMPONENT FEM 2 TRTHLN PRT KN RSRFC LT MDL RL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
5610-F-202	SUP	HCPCS C1776		5610-F-202  -  COMPONENT FEM 2 TRTHLN PRT KN RSRFC RMLL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
5610-F-301	SUP	HCPCS C1776		5610-F-301  -  COMPONENT FEM 3 TRTHLN PRT KN RSRFC LT MDL RL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
5610-F-302	SUP	HCPCS C1776		5610-F-302  -  COMPONENT FEM 3 TRTHLN PRT KN RSRFC RMLL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
5610-F-401	SUP	HCPCS C1776		5610-F-401  -  COMPONENT FEM 4 TRTHLN PRT KN RSRFC LT MDL RL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
5610-F-402	SUP	HCPCS C1776		5610-F-402  -  COMPONENT FEM 4 TRTHLN PRT KN RSRFC RMLL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
5610-F-501	SUP	HCPCS C1776		5610-F-501  -  COMPONENT FEM 5 TRTHLN PRT KN RSRFC LT MDL RL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
5610-F-502	SUP	HCPCS C1776		5610-F-502  -  COMPONENT FEM 5 TRTHLN PRT KN RSRFC RMLL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
5610-F-601	SUP	HCPCS C1776		5610-F-601  -  COMPONENT FEM 6 TRTHLN PRT KN RSRFC LT MDL RL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
5610-F-602	SUP	HCPCS C1776		5610-F-602  -  COMPONENT FEM 6 TRTHLN PRT KN RSRFC RMLL	BOTH IP/OP	"$3,302.50 "	"$2,443.85"	$0.00	"$2,642.00"	"$1,486.13"	"$1,486.13"	$0.00	$0.00	$0.00	$688.32	"$2,451.12"	"$2,451.12"	$0.00	$0.00	$688.24	$0.00	"$1,628.13"	"$1,628.13"	$0.00	"$1,651.25"	"$2,615.58"	"$2,642.00"	$0.00		$0.00	$516.84	$0.00	$0.00	$525.76	$0.00	$0.00	$0.00	$0.00	$0.00
56-15904	SUP	HCPCS C1713		56-15904  -  SCREW BONE 1.5MM 4MM SELF DRILL UN3 CRANIOMAXILLOFACIAL	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
56-15934	SUP	HCPCS C1713		56-15934  -  SCREW BN 1.5MM 4MM NS LF UNV NEURO 3 SLF DRL AX STAB	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
56-15935	SUP	HCPCS C1713		56-15935  -  SCREW BN 1.5MM 5MM NS LF UNV NEURO 3 SLF DRL AX STAB	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
56-17005	SUP	HCPCS C1713		56-17005  -  SCREW BN 1.7MM 5MM ST AX STAB LWR PRFL	BOTH IP/OP	$120.38 	$89.08	$0.00	$218.00	$122.63	$122.63	$0.00	$0.00	$0.00	$25.09	$89.34	$89.34	$0.00	$0.00	$25.09	$0.00	$71.20	$71.20	$0.00	$136.25	$215.82	$218.00	$0.00		$0.00	$42.65	$0.00	$0.00	$43.38	$0.00	$0.00	$0.00	$0.00	$0.00
56-17904	SUP	HCPCS C1713		56-17904  -  SCREW BN 1.9MM 5MM ER AX STAB LWR PRFL	BOTH IP/OP	$135.00 	$99.90	$0.00	$244.00	$137.25	$137.25	$0.00	$0.00	$0.00	$28.14	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$79.85	$79.85	$0.00	$152.50	$241.56	$244.00	$0.00		$0.00	$47.73	$0.00	$0.00	$48.56	$0.00	$0.00	$0.00	$0.00	$0.00
56-19005	SUP	HCPCS C1713		56-19005  -  NAIL IM 11.5MM 36CM STRL TRGN 2M POST BW RT HINDFOOT FSN	BOTH IP/OP	$132.75 	$98.24	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$27.67	$98.53	$98.53	$0.00	$0.00	$27.67	$0.00	$78.52	$78.52	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
5620-B-101	SUP	HCPCS C1776		5620-B-101  -  BASEPLATE TIB 1 TRTHLN PRT KN RSRFC LT MDL RL	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
5620-B-102	SUP	HCPCS C1776		5620-B-102  -  BASEPLATE TIB 1 TRTHLN PRT KN RSRFC RMLL	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
5620-B-201	SUP	HCPCS C1776		5620-B-201  -  BASEPLATE TIB 2 TRTHLN PRT KN RSRFC LT MDL RL	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
5620-B-202	SUP	HCPCS C1776		5620-B-202  -  BASEPLATE TIB 2 TRTHLN PRT KN RSRFC RMLL	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
5620-B-301	SUP	HCPCS C1776		5620-B-301  -  BASEPLATE TIB 3 TRTHLN PRT KN RSRFC LT MDL RL	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
5620-B-302	SUP	HCPCS C1776		5620-B-302  -  BASEPLATE TIB 3 TRTHLN PRT KN RSRFC RMLL	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
5620-B-401	SUP	HCPCS C1776		5620-B-401  -  BASEPLATE TIB 4 TRTHLN PRT KN RSRFC LT MDL RL	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
5620-B-402	SUP	HCPCS C1776		5620-B-402  -  BASEPLATE TIB 4 TRTHLN PRT KN RSRFC RMLL	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
5620-B-501	SUP	HCPCS C1776		5620-B-501  -  BASEPLATE TIB 5 TRTHLN PRT KN RSRFC LT MDL RL	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
5620-B-502	SUP	HCPCS C1776		5620-B-502  -  BASEPLATE TIB 5 TRTHLN PRT KN RSRFC RMLL	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
5620-B-601	SUP	HCPCS C1776		5620-B-601  -  BASEPLATE TIB 6 TRTHLN PRT KN RSRFC LT MDL RL	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
5620-B-602	SUP	HCPCS C1776		5620-B-602  -  BASEPLATE TIB 6 TRTHLN PRT KN RSRFC RMLL	BOTH IP/OP	"$2,402.50 "	"$1,777.85"	$0.00	"$1,922.00"	"$1,081.13"	"$1,081.13"	$0.00	$0.00	$0.00	$500.74	"$1,783.14"	"$1,783.14"	$0.00	$0.00	$500.68	$0.00	"$1,421.08"	"$1,421.08"	$0.00	"$1,201.25"	"$1,902.78"	"$1,922.00"	$0.00		$0.00	$375.99	$0.00	$0.00	$382.48	$0.00	$0.00	$0.00	$0.00	$0.00
5624-10/16L	SUP	HCPCS C1776		5624-10/16L  -  STEM HUMERAL 10MM 165MM CEMENTED IMPLANT COCR STERILE	BOTH IP/OP	"$6,511.05 "	"$4,818.18"	$0.00	"$5,208.84"	"$2,929.97"	"$2,929.97"	$0.00	$0.00	$0.00	"$1,357.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,356.90"	$0.00	"$3,209.95"	"$3,209.95"	$0.00	"$3,255.53"	"$5,156.75"	"$5,208.84"	$0.00		$0.00	"$1,018.98"	$0.00	$0.00	"$1,036.56"	$0.00	$0.00	$0.00	$0.00	$0.00
5624-10/20XL	SUP	HCPCS C1776		5624-10/20XL  -  STEM HUMERAL 10MM 205MM CEMENTED IMPLANT COCR STERILE	BOTH IP/OP	"$7,003.95 "	"$5,182.92"	$0.00	"$5,603.16"	"$3,151.78"	"$3,151.78"	$0.00	$0.00	$0.00	"$1,459.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,459.62"	$0.00	"$3,452.95"	"$3,452.95"	$0.00	"$3,501.98"	"$5,547.13"	"$5,603.16"	$0.00		$0.00	"$1,096.12"	$0.00	$0.00	"$1,115.03"	$0.00	$0.00	$0.00	$0.00	$0.00
5624-12/17L	SUP	HCPCS C1776		5624-12/17L  -  STEM HUMERAL 12MM 170MM CEMENTED IMPLANT COCR STERILE	BOTH IP/OP	"$6,511.05 "	"$4,818.18"	$0.00	"$5,208.84"	"$2,929.97"	"$2,929.97"	$0.00	$0.00	$0.00	"$1,357.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,356.90"	$0.00	"$3,209.95"	"$3,209.95"	$0.00	"$3,255.53"	"$5,156.75"	"$5,208.84"	$0.00		$0.00	"$1,018.98"	$0.00	$0.00	"$1,036.56"	$0.00	$0.00	$0.00	$0.00	$0.00
5624-12/21XL	SUP	HCPCS C1776		5624-12/21XL  -  STEM HUMERAL 12MM 210MM CEMENTED IMPLANT COCR STERILE	BOTH IP/OP	"$7,003.95 "	"$5,182.92"	$0.00	"$5,603.16"	"$3,151.78"	"$3,151.78"	$0.00	$0.00	$0.00	"$1,459.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,459.62"	$0.00	"$3,452.95"	"$3,452.95"	$0.00	"$3,501.98"	"$5,547.13"	"$5,603.16"	$0.00		$0.00	"$1,096.12"	$0.00	$0.00	"$1,115.03"	$0.00	$0.00	$0.00	$0.00	$0.00
5624-14/13	SUP	HCPCS C1776		5624-14/13  -  STEM HUMERAL 14 135MM CEMENTED ANATOMICAL COCR STERILE	BOTH IP/OP	"$5,769.05 "	"$4,269.10"	$0.00	"$4,615.24"	"$2,596.07"	"$2,596.07"	$0.00	$0.00	$0.00	"$1,202.41"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,202.27"	$0.00	"$2,844.14"	"$2,844.14"	$0.00	"$2,884.53"	"$4,569.09"	"$4,615.24"	$0.00		$0.00	$902.86	$0.00	$0.00	$918.43	$0.00	$0.00	$0.00	$0.00	$0.00
5624-14/17L	SUP	HCPCS C1776		5624-14/17L  -  STEM HUMERAL 14MM 175MM CEMENTED IMPLANT COCR STERILE	BOTH IP/OP	"$6,511.05 "	"$4,818.18"	$0.00	"$5,208.84"	"$2,929.97"	"$2,929.97"	$0.00	$0.00	$0.00	"$1,357.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,356.90"	$0.00	"$3,209.95"	"$3,209.95"	$0.00	"$3,255.53"	"$5,156.75"	"$5,208.84"	$0.00		$0.00	"$1,018.98"	$0.00	$0.00	"$1,036.56"	$0.00	$0.00	$0.00	$0.00	$0.00
5624-14/21XL	SUP	HCPCS C1776		5624-14/21XL  -  STEM HUMERAL 14MM 215MM CEMENTED IMPLANT COCR STERILE	BOTH IP/OP	"$7,003.95 "	"$5,182.92"	$0.00	"$5,603.16"	"$3,151.78"	"$3,151.78"	$0.00	$0.00	$0.00	"$1,459.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,459.62"	$0.00	"$3,452.95"	"$3,452.95"	$0.00	"$3,501.98"	"$5,547.13"	"$5,603.16"	$0.00		$0.00	"$1,096.12"	$0.00	$0.00	"$1,115.03"	$0.00	$0.00	$0.00	$0.00	$0.00
5624-6/15L	SUP	HCPCS C1776		5624-6/15L  -  STEM HUMERAL 6MM 155MM CEMENTED IMPLANT COCR STERILE	BOTH IP/OP	"$6,511.05 "	"$4,818.18"	$0.00	"$5,208.84"	"$2,929.97"	"$2,929.97"	$0.00	$0.00	$0.00	"$1,357.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,356.90"	$0.00	"$3,209.95"	"$3,209.95"	$0.00	"$3,255.53"	"$5,156.75"	"$5,208.84"	$0.00		$0.00	"$1,018.98"	$0.00	$0.00	"$1,036.56"	$0.00	$0.00	$0.00	$0.00	$0.00
5624-6/19XL	SUP	HCPCS C1776		5624-6/19XL  -  STEM HUMERAL 6MM 195MM CEMENTED IMPLANT COCR STERILE	BOTH IP/OP	"$7,003.95 "	"$5,182.92"	$0.00	"$5,603.16"	"$3,151.78"	"$3,151.78"	$0.00	$0.00	$0.00	"$1,459.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,459.62"	$0.00	"$3,452.95"	"$3,452.95"	$0.00	"$3,501.98"	"$5,547.13"	"$5,603.16"	$0.00		$0.00	"$1,096.12"	$0.00	$0.00	"$1,115.03"	$0.00	$0.00	$0.00	$0.00	$0.00
5624-8/16L	SUP	HCPCS C1776		5624-8/16L  -  STEM HUMERAL 8MM 160MM CEMENTED IMPLANT COCR STERILE	BOTH IP/OP	"$6,511.05 "	"$4,818.18"	$0.00	"$5,208.84"	"$2,929.97"	"$2,929.97"	$0.00	$0.00	$0.00	"$1,357.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,356.90"	$0.00	"$3,209.95"	"$3,209.95"	$0.00	"$3,255.53"	"$5,156.75"	"$5,208.84"	$0.00		$0.00	"$1,018.98"	$0.00	$0.00	"$1,036.56"	$0.00	$0.00	$0.00	$0.00	$0.00
5624-8/20XL	SUP	HCPCS C1776		5624-8/20XL  -  STEM HUMERAL 8MM 200MM CEMENTED IMPLANT COCR STERILE	BOTH IP/OP	"$7,003.95 "	"$5,182.92"	$0.00	"$5,603.16"	"$3,151.78"	"$3,151.78"	$0.00	$0.00	$0.00	"$1,459.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,459.62"	$0.00	"$3,452.95"	"$3,452.95"	$0.00	"$3,501.98"	"$5,547.13"	"$5,603.16"	$0.00		$0.00	"$1,096.12"	$0.00	$0.00	"$1,115.03"	$0.00	$0.00	$0.00	$0.00	$0.00
56-25000	SUP	HCPCS C1713		56-25000  -  SCREW BONE FASTENING TITANIUM CONDYLE MANDIB	BOTH IP/OP	$246.50 	$182.41	$0.00	$448.00	$252.00	$252.00	$0.00	$0.00	$0.00	$51.38	$182.95	$182.95	$0.00	$0.00	$51.37	$0.00	$145.80	$145.80	$0.00	$280.00	$443.52	$448.00	$0.00		$0.00	$87.64	$0.00	$0.00	$89.15	$0.00	$0.00	$0.00	$0.00	$0.00
56-25001	SUP	Custom 27803010		56-25001  -  PROSTHESIS TEMPORARY MARX CONDYLE LEFT	BOTH IP/OP	"$2,382.23 "	"$1,762.85"	$0.00	"$3,816.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,768.09"	"$1,768.09"	$0.00	$0.00	$496.46	$0.00	$0.00	$0.00	$0.00	"$2,385.00"	"$3,777.84"	"$3,816.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
56-25002	SUP	Custom 27803010		56-25002  -  PROSTHESIS TEMPORARY MARX CONDYLE RIGHT	BOTH IP/OP	"$2,382.23 "	"$1,762.85"	$0.00	"$3,816.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,768.09"	"$1,768.09"	$0.00	$0.00	$496.46	$0.00	$0.00	$0.00	$0.00	"$2,385.00"	"$3,777.84"	"$3,816.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-108	SUP	HCPCS C1776		5630-G-108  -  INSERT TIB 1 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-109	SUP	HCPCS C1776		5630-G-109  -  INSERT TIB 1 9MM TRTHLN X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-110	SUP	HCPCS C1776		5630-G-110  -  INSERT TIB 1 10MM TRTHLN X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-112	SUP	HCPCS C1776		5630-G-112  -  INSERT TIB 1 12MM TRTHLN X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-120	SUP	HCPCS C1776		5630-G-120  -  INSERT TIB 1 10MM TRTHLN X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-122	SUP	HCPCS C1776		5630-G-122  -  INSERT TIB 1 12MM TRTHLN X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-128	SUP	HCPCS C1776		5630-G-128  -  INSERT TIB 1 8MM TRTHLN X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-129	SUP	HCPCS C1776		5630-G-129  -  INSERT TIB 1 9MM TRTHLN X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-208	SUP	HCPCS C1776		5630-G-208  -  INSERT TIB 2 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-209	SUP	HCPCS C1776		5630-G-209  -  INSERT TIB 2 9MM TRTHLN STRG KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-210	SUP	HCPCS C1776		5630-G-210  -  INSERT TIB 2 10MM TRTHLN PRT KN RSRFC X3 LT MDL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-212	SUP	HCPCS C1776		5630-G-212  -  INSERT TIB 2 12MM TRTHLN X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-220	SUP	HCPCS C1776		5630-G-220  -  INSERT TIB 2 10MM TRTHLN X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-222	SUP	HCPCS C1776		5630-G-222  -  INSERT TIB 2 12MM TRTHLN X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-228	SUP	HCPCS C1776		5630-G-228  -  INSERT TIB 2 8MM TRTHLN PRT KN RSRFC X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-229	SUP	HCPCS C1776		5630-G-229  -  INSERT TIB 2 29MM TRTHLN PRT RSRFC X3 KN RT MDL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-308	SUP	HCPCS C1776		5630-G-308  -  INSERT TIB 3 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-309	SUP	HCPCS C1776		5630-G-309  -  INSERT TIB 3 9MM TRTHLN PRT KN RSRFC X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-310	SUP	HCPCS C1776		5630-G-310  -  INSERT TIB 3 10MM TRTHLN X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-312	SUP	HCPCS C1776		5630-G-312  -  INSERT TIB 3 12MM TRTHLN X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-320	SUP	HCPCS C1776		5630-G-320  -  INSERT TIB 3 20MM TRTHLN PRT RSRFC X3 KN RT MDL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-322	SUP	HCPCS C1776		5630-G-322  -  INSERT TIB 3 12MM TRTHLN X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-328	SUP	HCPCS C1776		5630-G-328  -  INSERT TIB 3 8MM TRTHLN PRT KN RSRFC X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-329	SUP	HCPCS C1776		5630-G-329  -  INSERT TIB 3 29MM TRTHLN PRT RSRFC X3 KN RT MDL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-408	SUP	HCPCS C1776		5630-G-408  -  INSERT TIB 4 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-409	SUP	HCPCS C1776		5630-G-409  -  INSERT TIB 4 9MM TRTHLN PRT KN RSRFC X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-410	SUP	HCPCS C1776		5630-G-410  -  INSERT TIB 4 10MM TRTHLN X3 LT MDL RL KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-412	SUP	HCPCS C1776		5630-G-412  -  INSERT TIB 4 12MM TRTHLN X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-420	SUP	HCPCS C1776		5630-G-420  -  INSERT TIB 4 10MM TRTHLN X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-422	SUP	HCPCS C1776		5630-G-422  -  INSERT TIB 4 12MM TRTHLN X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-428	SUP	HCPCS C1776		5630-G-428  -  INSERT TIB 4 8MM TRTHLN PRT KN RSRFC X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-429	SUP	HCPCS C1776		5630-G-429  -  INSERT TIB 4 9MM TRTHLN PRT KN RSRFC X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-508	SUP	HCPCS C1776		5630-G-508  -  INSERT TIB 5 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-509	SUP	HCPCS C1776		5630-G-509  -  INSERT TIB 5 9MM TRTHLN X3 LT MDL RL KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-510	SUP	HCPCS C1776		5630-G-510  -  INSERT TIB 5 10MM TRTHLN X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-512	SUP	HCPCS C1776		5630-G-512  -  INSERT TIB 5 12MM TRTHLN X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-520	SUP	HCPCS C1776		5630-G-520  -  INSERT TIB 5 10MM TRTHLN X3 RMLL KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-522	SUP	HCPCS C1776		5630-G-522  -  INSERT TIB 5 12MM TRTHLN X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-528	SUP	HCPCS C1776		5630-G-528  -  INSERT TIB 5 8MM TRTHLN PRT KN RSRFC X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-529	SUP	HCPCS C1776		5630-G-529  -  INSERT TIB 5 9MM TRTHLN X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-608	SUP	HCPCS C1776		5630-G-608  -  INSERT TIB 6 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-609	SUP	HCPCS C1776		5630-G-609  -  INSERT TIB 9 60MM TRTHLN STRG KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-610	SUP	HCPCS C1776		5630-G-610  -  INSERT TIB 6 10MM TRTHLN X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-612	SUP	HCPCS C1776		5630-G-612  -  INSERT TIB 6 12MM TRTHLN X3 LT MDL RL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-620	SUP	HCPCS C1776		5630-G-620  -  INSERT TIB 62MM TRTHLN STRG KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-622	SUP	HCPCS C1776		5630-G-622  -  INSERT TIB 6 12MM TRTHLN X3 RMLL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-628	SUP	HCPCS C1776		5630-G-628  -  INSERT TIB 6 TRTHLN PRT RSRFC X3 KN RT MDL	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5630-G-629	SUP	HCPCS C1776		5630-G-629  -  INSERT TIB 6 9MM TRTHLN KN	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-010	SUP	HCPCS C1713		5639-0-010  -  SCREW BONE 4MM 10MM 5MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-012	SUP	HCPCS C1713		5639-0-012  -  SCREW BONE 4MM 12MM 5MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-014	SUP	HCPCS C1713		5639-0-014  -  SCREW BONE 4MM 14MM 5MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-016	SUP	HCPCS C1713		5639-0-016  -  SCREW BONE 4MM 16MM 6MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-018	SUP	HCPCS C1713		5639-0-018  -  SCREW BONE 4MM 18MM 7MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-020	SUP	HCPCS C1713		5639-0-020  -  SCREW BONE 4MM 20MM 8MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-022	SUP	HCPCS C1713		5639-0-022  -  SCREW BONE 4MM 22MM 9MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-024	SUP	HCPCS C1713		5639-0-024  -  SCREW BONE 4MM 24MM 10MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-026	SUP	HCPCS C1713		5639-0-026  -  SCREW BONE 4MM 26MM 12MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-028	SUP	HCPCS C1713		5639-0-028  -  SCREW BONE 4MM 28MM 14MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-030	SUP	HCPCS C1713		5639-0-030  -  SCREW BONE 4MM 30MM 14MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-035	SUP	HCPCS C1713		5639-0-035  -  SCREW BONE 4MM 35MM 14MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-040	SUP	HCPCS C1713		5639-0-040  -  SCREW BONE 4MM 40MM 14MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-045	SUP	HCPCS C1713		5639-0-045  -  SCREW BONE 4MM 45MM 15MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
5639-0-050	SUP	HCPCS C1713		5639-0-050  -  SCREW BONE 4MM 50MM 15MM PTHRD CANC HEX HEAD	BOTH IP/OP	$34.38 	$25.44	$0.00	$27.50	$15.47	$15.47	$0.00	$0.00	$0.00	$7.16	$25.51	$25.51	$0.00	$0.00	$7.16	$0.00	$20.33	$20.33	$0.00	$17.19	$27.23	$27.50	$0.00		$0.00	$5.38	$0.00	$0.00	$5.47	$0.00	$0.00	$0.00	$0.00	$0.00
563CAL	SUP	Custom 27203010		MATTRESS COMPLETE UNIT /5	BOTH IP/OP	$712.00 	$526.88	$0.00	$569.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$356.00	$563.90	$569.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
56-40281	SUP	Custom 27803010		56-40281  -  WIRE FX 1.4MM 17MM KRSH OLV STP DIST RDS LCK PLT SYS	BOTH IP/OP	$45.75 	$33.86	$0.00	$33.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.96	$33.96	$0.00	$0.00	$9.53	$0.00	$0.00	$0.00	$0.00	$19.25	$30.49	$30.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5645-0-0160	SUP	HCPCS C1713		5645-0-0160  -  SCREW BONE 4.5MM 16MM SLFTAP CORTICAL	BOTH IP/OP	$22.00 	$16.28	$0.00	$17.60	$9.90	$9.90	$0.00	$0.00	$0.00	$4.59	$16.33	$16.33	$0.00	$0.00	$4.58	$0.00	$13.01	$13.01	$0.00	$11.00	$17.42	$17.60	$0.00		$0.00	$3.44	$0.00	$0.00	$3.50	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-014	SUP	HCPCS C1713		5645-1-014  -  SCREW BONE 4.5MM 14MM TI CORTEX ORTH FULTHRD HEX HEAD SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-016	SUP	HCPCS C1713		5645-1-016  -  SCREW BONE 4.5MM 16MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-018	SUP	HCPCS C1713		5645-1-018  -  SCREW BONE 4.5MM 18MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-020	SUP	HCPCS C1713		5645-1-020  -  SCREW BONE 4.5MM 20MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-022	SUP	HCPCS C1713		5645-1-022  -  SCREW BONE 4.5MM 22MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-024	SUP	HCPCS C1713		5645-1-024  -  SCREW BONE 4.5MM 24MM FULTHD CORTEX SLFTAP HEX HEAD	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-026	SUP	HCPCS C1713		5645-1-026  -  SCREW BONE 4.5MM 26MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-028	SUP	HCPCS C1713		5645-1-028  -  SCREW BONE 4.5MM 28MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-030	SUP	HCPCS C1713		5645-1-030  -  SCREW BONE 4.5MM 30MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-032	SUP	HCPCS C1713		5645-1-032  -  SCREW BONE 4.5MM 32MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-034	SUP	HCPCS C1713		5645-1-034  -  SCREW BONE 4.5MM 34MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-036	SUP	HCPCS C1713		5645-1-036  -  SCREW BONE 4.5MM 36MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-038	SUP	HCPCS C1713		5645-1-038  -  SCREW BONE 4.5MM 38MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-040	SUP	HCPCS C1713		5645-1-040  -  SCREW BONE 4.5MM 40MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-042	SUP	HCPCS C1713		5645-1-042  -  SCREW BONE 4.5MM 42MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-044	SUP	HCPCS C1713		5645-1-044  -  SCREW BONE 4.5MM 44MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-046	SUP	HCPCS C1713		5645-1-046  -  SCREW BONE 4.5MM 46MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-048	SUP	HCPCS C1713		5645-1-048  -  SCREW BONE 4.5MM 48MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-050	SUP	HCPCS C1713		5645-1-050  -  SCREW BONE 4.5MM 50MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-052	SUP	HCPCS C1713		5645-1-052  -  SCREW BONE 4.5MM 52MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-054	SUP	HCPCS C1713		5645-1-054  -  SCREW BONE 4.5MM 54MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-056	SUP	HCPCS C1713		5645-1-056  -  SCREW BONE 4.5MM 56MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-058	SUP	HCPCS C1713		5645-1-058  -  SCREW BONE 4.5MM 58MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-060	SUP	HCPCS C1713		5645-1-060  -  SCREW BONE 4.5MM 60MM CORT SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-064	SUP	HCPCS C1713		5645-1-064  -  SCREW BONE 4.5MM 64MM CORTEX HEX HEAD FULTHD SLFTAP	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5645-1-070	SUP	HCPCS C1713		5645-1-070  -  SCREW BONE 4.5MM 70MM FULTHD CORTEX SLFTAP HEX HEAD	BOTH IP/OP	$39.20 	$29.01	$0.00	$37.40	$21.04	$21.04	$0.00	$0.00	$0.00	$8.17	$29.09	$29.09	$0.00	$0.00	$8.17	$0.00	$23.19	$23.19	$0.00	$23.38	$37.03	$37.40	$0.00		$0.00	$7.32	$0.00	$0.00	$7.44	$0.00	$0.00	$0.00	$0.00	$0.00
5678-1-005	SUP	HCPCS C1713		5678-1-005  -  PLATE 3.5 MM SCR 5 HOLE BONE CORT	BOTH IP/OP	$391.88 	$289.99	$0.00	$313.50	$176.34	$176.34	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
5678-1-010	SUP	HCPCS C1713		5678-1-010  -  PLATE 3.5 MM SCR 10 HOLE BONE CORT	BOTH IP/OP	$156.75 	$116.00	$0.00	$125.40	$70.54	$70.54	$0.00	$0.00	$0.00	$32.67	$116.34	$116.34	$0.00	$0.00	$32.67	$0.00	$92.72	$92.72	$0.00	$78.38	$124.15	$125.40	$0.00		$0.00	$24.53	$0.00	$0.00	$24.95	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-025	SUP	HCPCS C1713		5680-0-025  -  SCREW BONE 6.5MM 25MM 16MM CANC CANC HEX HEAD PTTHRD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-030	SUP	HCPCS C1713		5680-0-030  -  SCREW BONE 6.5MM 30MM 16MM CANC HEX HEAD PTHRD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-035	SUP	HCPCS C1713		5680-0-035  -  SCREW BONE 6.5MM 35MM 16MM CANC HEX HEAD PTTHRD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-040	SUP	HCPCS C1713		5680-0-040  -  SCREW BONE 6.5MM 40MM 16MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-045	SUP	HCPCS C1713		5680-0-045  -  SCREW BONE 6.5MM 45MM 16MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-050	SUP	HCPCS C1713		5680-0-050  -  SCREW BONE 6.5MM 50MM 16MM PTHRD CANC HEX HEAD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-055	SUP	HCPCS C1713		5680-0-055  -  SCREW BONE 6.5MM 55MM 16MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-060	SUP	HCPCS C1713		5680-0-060  -  SCREW BONE 6.5MM 60MM 16MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-065	SUP	HCPCS C1713		5680-0-065  -  SCREW BONE 6.5MM 65MM 16MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-070	SUP	HCPCS C1713		5680-0-070  -  SCREW BONE 6.5MM 70MM 16MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-075	SUP	HCPCS C1713		5680-0-075  -  SCREW BONE 6.5MM 75MM 16MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-080	SUP	HCPCS C1713		5680-0-080  -  SCREW BONE 6.5MM 80MM 16MM PTHRD CANC HEX HEAD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-085	SUP	HCPCS C1713		5680-0-085  -  SCREW BONE 6.5MM 85MM 16MM CANC HX HD PRTL THRED	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-090	SUP	HCPCS C1713		5680-0-090  -  SCREW BONE 6.5MM 90MM 16MM CANC PTHRD HX HD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-095	SUP	HCPCS C1713		5680-0-095  -  SCREW BONE 6.5MM 95MM 16MM CANC HEX HEAD PTHRD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-100	SUP	HCPCS C1713		5680-0-100  -  SCREW BONE 6.5MM 110MM 16MM ALTA CANC HEX HEAD PTHRD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-105	SUP	HCPCS C1713		5680-0-105  -  SCREW BONE 6.5MM 105MM 16MM CANC PTHRD HEX THRD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5680-0-110	SUP	HCPCS C1713		5680-0-110  -  SCREW BONE 6.5MM 110MM 16MM TI CANC HEX HEAD PTTHRD STRYK	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-030	SUP	HCPCS C1713		5681-0-030  -  SCREW BONE 6.5MM 30MM 20MM CANC HX HD PTHRD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-035	SUP	HCPCS C1713		5681-0-035  -  SCREW BONE 6.5MM 27MM CANC HEX HEAD PRTL THRD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-040	SUP	HCPCS C1713		5681-0-040  -  SCREW BONE 6.5MM 40MM 32MM CANC HX HD PTHRD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-045	SUP	HCPCS C1713		5681-0-045  -  SCREW BONE 6.5MM 45MM 32MM CANC PTTHRD HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-050	SUP	HCPCS C1713		5681-0-050  -  SCREW BONE 6.5MM 50MM 32MM CANC CANC HAEXGONAL HEAD PRTL	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-055	SUP	HCPCS C1713		5681-0-055  -  SCREW BONE 6.5MM 55MM 32MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-060	SUP	HCPCS C1713		5681-0-060  -  SCREW BONE 6.5MM 60MM 32MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-065	SUP	HCPCS C1713		5681-0-065  -  SCREW BONE 6.5MM 65MM 32MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-070	SUP	HCPCS C1713		5681-0-070  -  SCREW BONE 6.5MM 70MM 32MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-075	SUP	HCPCS C1713		5681-0-075  -  SCREW BONE 6.5MM 75MM 32MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-080	SUP	HCPCS C1713		5681-0-080  -  SCREW BONE 6.5MM 80MM 32MM PTHRD CANC HEX HEAD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-085	SUP	HCPCS C1713		5681-0-085  -  SCREW BONE 6.5MM 85MM 32MM CANC HX HD PTHRD	BOTH IP/OP	$54.40 	$40.26	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-090	SUP	HCPCS C1713		5681-0-090  -  SCREW BONE 6.5MM 90MM 32MM CANC HX HD PTTHRD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-095	SUP	HCPCS C1713		5681-0-095  -  SCREW BONE 6.5MM 95MM 32MM TI CANC PTTHRD HX HD SLFTAP	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-100	SUP	HCPCS C1713		5681-0-100  -  SCREW BONE 4.2MM 100MM 32MM TI CANC HEX HEAD PTTHRD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-105	SUP	HCPCS C1713		5681-0-105  -  SCREW BONE 6.5MM 32MM 32MM CANC HX HD PRTL THRD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
5681-0-110	SUP	HCPCS C1713		5681-0-110  -  SCREW BONE 6.5MM 110MM 32MM CANC HEX HEAD PTHRD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
57-05101	SUP	HCPCS C1713		57-05101  -  PLATE XS HYDRXAPT TI 1.2MM SCR 4 HOLE STR PRFL BONE	BOTH IP/OP	$321.30 	$237.76	$0.00	$238.47	$97.14	$97.14	$0.00	$0.00	$0.00	$66.97	$238.47	$238.47	$0.00	$0.00	$66.96	$0.00	$190.05	$190.05	$0.00	$107.94	$170.98	$172.70	$0.00		$0.00	$33.78	$0.00	$0.00	$34.37	$0.00	$0.00	$0.00	$0.00	$0.00
57-05116	SUP	HCPCS C1713		57-05116  -  PLATE XS .55MM TI 1.2MM SCR 16 HOLE STR PRFL BONE HAND	BOTH IP/OP	$518.70 	$383.84	$0.00	$386.10	$217.18	$217.18	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$241.31	$382.24	$386.10	$0.00		$0.00	$75.53	$0.00	$0.00	$76.83	$0.00	$0.00	$0.00	$0.00	$0.00
57-05140	SUP	HCPCS C1713		57-05140  -  PLATE XS NAR STD .55MM TI 1.2MM SCR 5 HOLE T PRFL BONE HAND	BOTH IP/OP	$321.30 	$237.76	$0.00	$238.47	$129.32	$129.32	$0.00	$0.00	$0.00	$66.97	$238.47	$238.47	$0.00	$0.00	$66.96	$0.00	$190.05	$190.05	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$44.97	$0.00	$0.00	$45.75	$0.00	$0.00	$0.00	$0.00	$0.00
57-05142	SUP	HCPCS C1713		57-05142  -  PLATE XS NAR STD .55MM 1.2MM SCR 8 HOLE T PRFL PRFL BONE	BOTH IP/OP	$371.00 	$274.54	$0.00	$278.30	$156.54	$156.54	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$0.00	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$173.94	$275.52	$278.30	$0.00		$0.00	$54.44	$0.00	$0.00	$55.38	$0.00	$0.00	$0.00	$0.00	$0.00
57-05150	SUP	HCPCS C1713		57-05150  -  PLATE XS STD .55MM TI 1.2MM SCR T 5 HOLE OBLQ PRFL PRFL BONE	BOTH IP/OP	$371.00 	$274.54	$0.00	$275.36	$147.88	$147.88	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$0.00	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$51.43	$0.00	$0.00	$52.32	$0.00	$0.00	$0.00	$0.00	$0.00
57-05151	SUP	HCPCS C1713		57-05151  -  PLATE XS STD .55MM TI 1.2MM SCR 5 HOLE T OBLQ PRFL BONE LEFT	BOTH IP/OP	$371.00 	$274.54	$0.00	$275.36	$147.88	$147.88	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$0.00	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$51.43	$0.00	$0.00	$52.32	$0.00	$0.00	$0.00	$0.00	$0.00
57-05170	SUP	HCPCS C1713		57-05170  -  PLATE XS STD NAR .55MM TI 1.2MM SCR 5 HOLE Y PRFL BONE HAND	BOTH IP/OP	$371.00 	$274.54	$0.00	$275.36	$138.60	$138.60	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$0.00	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
57-05190	SUP	HCPCS C1713		57-05190  -  PLATE XS TI SM FRAG SYS 2X2 HOLE 3D MDLR FIX PRFL BONE HAND	BOTH IP/OP	$518.70 	$383.84	$0.00	$384.98	$165.83	$165.83	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$184.25	$291.85	$294.80	$0.00		$0.00	$57.67	$0.00	$0.00	$58.67	$0.00	$0.00	$0.00	$0.00	$0.00
57-05191	SUP	HCPCS C1713		57-05191  -  PLATE XS STD .55MM TI 1.2MM SCR 3D 3X2HOLE PRFL PRFL BONE	BOTH IP/OP	$554.13 	$410.06	$0.00	$443.30	$249.36	$249.36	$0.00	$0.00	$0.00	$115.49	$411.27	$411.27	$0.00	$0.00	$115.48	$0.00	$327.76	$327.76	$0.00	$277.06	$438.87	$443.30	$0.00		$0.00	$86.72	$0.00	$0.00	$88.22	$0.00	$0.00	$0.00	$0.00	$0.00
57-05192	SUP	HCPCS C1713		57-05192  -  PLATE XS STD .55MM TI 1.2MM SCR 4X2 HOLE 3D PRFL BONE HAND	BOTH IP/OP	$555.75 	$411.26	$0.00	$533.50	$300.09	$300.09	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$333.44	$528.17	$533.50	$0.00		$0.00	$104.37	$0.00	$0.00	$106.17	$0.00	$0.00	$0.00	$0.00	$0.00
57-05195	SUP	HCPCS C1713		57-05195  -  PLATE XS STD .55MM TI 1.2MM SCR 3D 4X2 HOLE REPLANTATION	BOTH IP/OP	$555.75 	$411.26	$0.00	$500.50	$281.53	$281.53	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$312.81	$495.50	$500.50	$0.00		$0.00	$97.91	$0.00	$0.00	$99.60	$0.00	$0.00	$0.00	$0.00	$0.00
57-05197	SUP	HCPCS C1713		57-05197  -  PLATE XS TI 1.2MM SCR 2X2+2 HOLE 3D PRFL PRFL BONE HAND WRST	BOTH IP/OP	$554.13 	$410.06	$0.00	$443.30	$249.36	$249.36	$0.00	$0.00	$0.00	$115.49	$411.27	$411.27	$0.00	$0.00	$115.48	$0.00	$327.76	$327.76	$0.00	$277.06	$438.87	$443.30	$0.00		$0.00	$86.72	$0.00	$0.00	$88.22	$0.00	$0.00	$0.00	$0.00	$0.00
57-05201	SUP	HCPCS C1713		57-05201  -  PLATE SM .55MM TI 1.7MM SCR FRAG SYS 4 HOLE FIX STR MDLR	BOTH IP/OP	$321.30 	$237.76	$0.00	$238.47	$102.09	$102.09	$0.00	$0.00	$0.00	$66.97	$238.47	$238.47	$0.00	$0.00	$66.96	$0.00	$190.05	$190.05	$0.00	$113.44	$179.69	$181.50	$0.00		$0.00	$35.51	$0.00	$0.00	$36.12	$0.00	$0.00	$0.00	$0.00	$0.00
57-05202	SUP	HCPCS C1713		57-05202  -  PLATE SM .55MM TI 1.7MM SCR FRAG SYS 4 HOLE FIX STR BAR MDLR	BOTH IP/OP	$321.30 	$237.76	$0.00	$238.47	$102.09	$102.09	$0.00	$0.00	$0.00	$66.97	$238.47	$238.47	$0.00	$0.00	$66.96	$0.00	$190.05	$190.05	$0.00	$113.44	$179.69	$181.50	$0.00		$0.00	$35.51	$0.00	$0.00	$36.12	$0.00	$0.00	$0.00	$0.00	$0.00
57-05210	SUP	HCPCS C1713		57-05210  -  PLATE W STD .55MM 1.7MM SCR 8 HOLE T S MOD PRFL BONE HAND	BOTH IP/OP	$489.00 	$361.86	$0.00	$362.94	$167.06	$167.06	$0.00	$0.00	$0.00	$101.92	$362.94	$362.94	$0.00	$0.00	$101.91	$0.00	$289.24	$289.24	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$58.10	$0.00	$0.00	$59.10	$0.00	$0.00	$0.00	$0.00	$0.00
57-05216	SUP	HCPCS C1713		57-05216  -  PLATE SM .55MM 1.7MM SCR FRAG SYS 16 HOLE FIX STR MDLR PRFL	BOTH IP/OP	$518.70 	$383.84	$0.00	$393.80	$221.51	$221.51	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$246.13	$389.86	$393.80	$0.00		$0.00	$77.04	$0.00	$0.00	$78.37	$0.00	$0.00	$0.00	$0.00	$0.00
57-05220	SUP	HCPCS C1713		57-05220  -  PLATE 90D REG SM HYDRXAPT TI 1.7MM SCR 6 HOLE RIGHT L PRFL	BOTH IP/OP	$321.30 	$237.76	$0.00	$238.70	$134.27	$134.27	$0.00	$0.00	$0.00	$66.97	$238.47	$238.47	$0.00	$0.00	$66.96	$0.00	$190.05	$190.05	$0.00	$149.19	$236.32	$238.70	$0.00		$0.00	$46.70	$0.00	$0.00	$47.50	$0.00	$0.00	$0.00	$0.00	$0.00
57-05221	SUP	HCPCS C1713		57-05221  -  PLATE SM .55MM TI 1.7MM SCR FRAG SYS 6 HOLE FIX L MDLR PRFL	BOTH IP/OP	$321.30 	$237.76	$0.00	$238.70	$134.27	$134.27	$0.00	$0.00	$0.00	$66.97	$238.47	$238.47	$0.00	$0.00	$66.96	$0.00	$190.05	$190.05	$0.00	$149.19	$236.32	$238.70	$0.00		$0.00	$46.70	$0.00	$0.00	$47.50	$0.00	$0.00	$0.00	$0.00	$0.00
57-05230	SUP	HCPCS C1713		57-05230  -  PLATE SM .55MM TI 1.7MM SCR 6 HOLE L OBLQ PRFL BONE RIGHT	BOTH IP/OP	$366.10 	$270.91	$0.00	$271.72	$134.27	$134.27	$0.00	$0.00	$0.00	$76.30	$271.72	$271.72	$0.00	$0.00	$76.30	$0.00	$216.55	$216.55	$0.00	$149.19	$236.32	$238.70	$0.00		$0.00	$46.70	$0.00	$0.00	$47.50	$0.00	$0.00	$0.00	$0.00	$0.00
57-05231	SUP	HCPCS C1713		57-05231  -  PLATE SM .55MM TI 1.7MM SCR 6 HOLE PRFL BONE LEFT OBLQ	BOTH IP/OP	$366.10 	$270.91	$0.00	$271.72	$134.27	$134.27	$0.00	$0.00	$0.00	$76.30	$271.72	$271.72	$0.00	$0.00	$76.30	$0.00	$216.55	$216.55	$0.00	$149.19	$236.32	$238.70	$0.00		$0.00	$46.70	$0.00	$0.00	$47.50	$0.00	$0.00	$0.00	$0.00	$0.00
57-05240	SUP	HCPCS C1713		57-05240  -  PLATE SM TI 1.7MM SCR SM FRAG SYS 6 HOLE T MDLR FIX PRFL	BOTH IP/OP	$328.63 	$243.19	$0.00	$262.90	$147.88	$147.88	$0.00	$0.00	$0.00	$68.49	$243.91	$243.91	$0.00	$0.00	$68.49	$0.00	$194.38	$194.38	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$51.43	$0.00	$0.00	$52.32	$0.00	$0.00	$0.00	$0.00	$0.00
57-05250	SUP	HCPCS C1713		57-05250  -  PLATE SM TI SM FRAG SYS 6 HOLE T FX MDLR PRFL BONE HAND	BOTH IP/OP	$371.00 	$274.54	$0.00	$275.36	$147.88	$147.88	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$0.00	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$51.43	$0.00	$0.00	$52.32	$0.00	$0.00	$0.00	$0.00	$0.00
57-05251	SUP	HCPCS C1713		57-05251  -  PLATE SM NAR TI 1.7MM SCR 6 HOLE T OBLQ PRFL BONE LEFT HAND	BOTH IP/OP	$371.00 	$274.54	$0.00	$275.36	$147.88	$147.88	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$0.00	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$51.43	$0.00	$0.00	$52.32	$0.00	$0.00	$0.00	$0.00	$0.00
57-05260	SUP	HCPCS C1713		57-05260  -  PLATE STD TI 1.7MM SCR 7 HOLE T PRFL BONE HAND	BOTH IP/OP	$371.00 	$274.54	$0.00	$275.36	$147.88	$147.88	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$0.00	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$164.31	$260.27	$262.90	$0.00		$0.00	$51.43	$0.00	$0.00	$52.32	$0.00	$0.00	$0.00	$0.00	$0.00
57-05262	SUP	HCPCS C1713		57-05262  -  PLATE SM STD NAR .55MM TI 1.7MM SCR 10 HOLE T FX PRFL BONE	BOTH IP/OP	$371.00 	$274.54	$0.00	$278.30	$156.54	$156.54	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$0.00	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$173.94	$275.52	$278.30	$0.00		$0.00	$54.44	$0.00	$0.00	$55.38	$0.00	$0.00	$0.00	$0.00	$0.00
57-05270	SUP	HCPCS C1713		57-05270  -  PLATE SM .55MM TI 1.7MM SCR FRAG SYS 7 HOLE FIX Y MDLR PRFL	BOTH IP/OP	$371.00 	$274.54	$0.00	$288.20	$162.11	$162.11	$0.00	$0.00	$0.00	$77.33	$275.36	$275.36	$0.00	$0.00	$77.32	$0.00	$219.45	$219.45	$0.00	$180.13	$285.32	$288.20	$0.00		$0.00	$56.38	$0.00	$0.00	$57.35	$0.00	$0.00	$0.00	$0.00	$0.00
57-05279	SUP	HCPCS C1713		57-05279  -  PLATE SM .55MM TI 1.7MM SCR 9 HOLE Z FIX PRFL BONE HAND	BOTH IP/OP	$518.70 	$383.84	$0.00	$384.98	$193.67	$193.67	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$215.19	$340.86	$344.30	$0.00		$0.00	$67.35	$0.00	$0.00	$68.52	$0.00	$0.00	$0.00	$0.00	$0.00
57-05280	SUP	HCPCS C1713		57-05280  -  PLATE SM RIGHT CNDYLR HAND .55MM TI 1.7MM SCR FRAG SYS 5	BOTH IP/OP	$518.70 	$383.84	$0.00	$384.98	$156.54	$156.54	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$173.94	$275.52	$278.30	$0.00		$0.00	$54.44	$0.00	$0.00	$55.38	$0.00	$0.00	$0.00	$0.00	$0.00
57-05281	SUP	HCPCS C1713		57-05281  -  PLATE SM LEFT CNDYLR HAND .55MM TI 1.7MM SCR FRAG SYS 5 HOLE	BOTH IP/OP	$518.70 	$383.84	$0.00	$384.98	$156.54	$156.54	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$173.94	$275.52	$278.30	$0.00		$0.00	$54.44	$0.00	$0.00	$55.38	$0.00	$0.00	$0.00	$0.00	$0.00
57-05282	SUP	HCPCS C1713		57-05282  -  PLATE SM STD .55MM TI 1.7MM SCR 5 HOLE BLADE PRFL BONE RIGHT	BOTH IP/OP	$518.70 	$383.84	$0.00	$384.98	$156.54	$156.54	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$173.94	$275.52	$278.30	$0.00		$0.00	$54.44	$0.00	$0.00	$55.38	$0.00	$0.00	$0.00	$0.00	$0.00
57-05283	SUP	HCPCS C1713		57-05283  -  PLATE SM STD .55MM TI 1.7MM SCR 5 HOLE BLADE PRFL BONE LEFT	BOTH IP/OP	$518.70 	$383.84	$0.00	$384.98	$156.54	$156.54	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$173.94	$275.52	$278.30	$0.00		$0.00	$54.44	$0.00	$0.00	$55.38	$0.00	$0.00	$0.00	$0.00	$0.00
57-05285	SUP	HCPCS C1713		57-05285  -  PLATE SM STD .55MM TI 1.7MM SCR 1 HOLE PR PRFL BONE HAND	BOTH IP/OP	$518.70 	$383.84	$0.00	$384.98	$162.11	$162.11	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$180.13	$285.32	$288.20	$0.00		$0.00	$56.38	$0.00	$0.00	$57.35	$0.00	$0.00	$0.00	$0.00	$0.00
57-05290	SUP	HCPCS C1713		57-05290  -  PLATE SM HYDRXAPT TI 1.7MM SCR 2X2 HOLE 3D PRFL BONE	BOTH IP/OP	$518.70 	$383.84	$0.00	$384.98	$170.78	$170.78	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$189.75	$300.56	$303.60	$0.00		$0.00	$59.39	$0.00	$0.00	$60.42	$0.00	$0.00	$0.00	$0.00	$0.00
57-05291	SUP	HCPCS C1713		57-05291  -  PLATE SM STD .55MM TI 1.7MM SCR 3X2 HOLE 3D PRFL BONE HAND	BOTH IP/OP	$555.75 	$411.26	$0.00	$451.00	$253.69	$253.69	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$281.88	$446.49	$451.00	$0.00		$0.00	$88.23	$0.00	$0.00	$89.75	$0.00	$0.00	$0.00	$0.00	$0.00
57-05292	SUP	HCPCS C1713		57-05292  -  PLATE SM STD .55MM TI 1.7MM SCR 4X2 HOLE 3D PRFL BONE HAND	BOTH IP/OP	$555.75 	$411.26	$0.00	$542.30	$305.04	$305.04	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$338.94	$536.88	$542.30	$0.00		$0.00	$106.09	$0.00	$0.00	$107.92	$0.00	$0.00	$0.00	$0.00	$0.00
57-05295	SUP	HCPCS C1713		57-05295  -  PLATE SM STD .55MM TI 1.7MM SCR 4X2 HOLE 3D REPLANTATION	BOTH IP/OP	$555.75 	$411.26	$0.00	$542.30	$305.04	$305.04	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$338.94	$536.88	$542.30	$0.00		$0.00	$106.09	$0.00	$0.00	$107.92	$0.00	$0.00	$0.00	$0.00	$0.00
57-05297	SUP	HCPCS C1713		57-05297  -  PLATE SM STD .55MM TI 1.7MM SCR 2X2+ 2 HOLE 3D PRFL BONE	BOTH IP/OP	$555.75 	$411.26	$0.00	$451.00	$253.69	$253.69	$0.00	$0.00	$0.00	$115.83	$412.48	$412.48	$0.00	$0.00	$115.82	$0.00	$328.73	$328.73	$0.00	$281.88	$446.49	$451.00	$0.00		$0.00	$88.23	$0.00	$0.00	$89.75	$0.00	$0.00	$0.00	$0.00	$0.00
57-08212	SUP	HCPCS C1713		57-08212  -  PLATE TI 1.7 MM SCR 12 HOLE STR PRFL BONE RIGHT HAND	BOTH IP/OP	$518.70 	$383.84	$0.00	$386.10	$217.18	$217.18	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$241.31	$382.24	$386.10	$0.00		$0.00	$75.53	$0.00	$0.00	$76.83	$0.00	$0.00	$0.00	$0.00	$0.00
57-08213	SUP	HCPCS C1713		57-08213  -  PLATE TI 1.7 MM SCR 12 HOLE STR PRFL BONE LEFT HAND	BOTH IP/OP	$518.70 	$383.84	$0.00	$386.10	$217.18	$217.18	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$241.31	$382.24	$386.10	$0.00		$0.00	$75.53	$0.00	$0.00	$76.83	$0.00	$0.00	$0.00	$0.00	$0.00
57-08216	SUP	HCPCS C1713		57-08216  -  PLATE TI 1.7 MM SCR 16 HOLE STR PRFL BONE HAND	BOTH IP/OP	$518.70 	$383.84	$0.00	$402.60	$226.46	$226.46	$0.00	$0.00	$0.00	$108.11	$384.98	$384.98	$0.00	$0.00	$108.10	$0.00	$306.81	$306.81	$0.00	$251.63	$398.57	$402.60	$0.00		$0.00	$78.76	$0.00	$0.00	$80.12	$0.00	$0.00	$0.00	$0.00	$0.00
57-10101	SUP	HCPCS C1713		57-10101  -  PLATE MED STD 1MM 2.3MM SCR 4 HOLE STR PRFL BONE HAND	BOTH IP/OP	$459.00 	$339.66	$0.00	$340.67	$87.86	$87.86	$0.00	$0.00	$0.00	$95.67	$340.67	$340.67	$0.00	$0.00	$95.66	$0.00	$271.50	$271.50	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
57-10102	SUP	HCPCS C1713		57-10102  -  PLATE TI SM FRAG SYS 4 HOLE STR BAR FIX MDLR PRFL BONE HAND	BOTH IP/OP	$459.00 	$339.66	$0.00	$340.67	$87.86	$87.86	$0.00	$0.00	$0.00	$95.67	$340.67	$340.67	$0.00	$0.00	$95.66	$0.00	$271.50	$271.50	$0.00	$97.63	$154.64	$156.20	$0.00		$0.00	$30.56	$0.00	$0.00	$31.08	$0.00	$0.00	$0.00	$0.00	$0.00
57-10116	SUP	HCPCS C1713		57-10116  -  PLATE MED STD 1MM TI 2.3MM SCR 16 HOLE STR PRFL BONE HAND	BOTH IP/OP	$741.00 	$548.34	$0.00	$549.97	$230.79	$230.79	$0.00	$0.00	$0.00	$154.44	$549.97	$549.97	$0.00	$0.00	$154.42	$0.00	$438.30	$438.30	$0.00	$256.44	$406.20	$410.30	$0.00		$0.00	$80.26	$0.00	$0.00	$81.65	$0.00	$0.00	$0.00	$0.00	$0.00
57-10120	SUP	HCPCS C1713		57-10120  -  PLATE MED STD 1MM TI 2.3MM SCR 6 HOLE L PRFL PRFL BONE RIGHT	BOTH IP/OP	$530.00 	$392.20	$0.00	$393.37	$134.27	$134.27	$0.00	$0.00	$0.00	$110.47	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$313.50	$313.50	$0.00	$149.19	$236.32	$238.70	$0.00		$0.00	$46.70	$0.00	$0.00	$47.50	$0.00	$0.00	$0.00	$0.00	$0.00
57-10121	SUP	HCPCS C1713		57-10121  -  PLATE MED STD 1MM TI 2.3MM SCR 6 HOLE L PRFL BONE LEFT HAND	BOTH IP/OP	$530.00 	$392.20	$0.00	$393.37	$134.27	$134.27	$0.00	$0.00	$0.00	$110.47	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$313.50	$313.50	$0.00	$149.19	$236.32	$238.70	$0.00		$0.00	$46.70	$0.00	$0.00	$47.50	$0.00	$0.00	$0.00	$0.00	$0.00
57-10130	SUP	HCPCS C1713		57-10130  -  PLATE MED 1MM 2.3MM SCR SM FRAG SYS 6 HOLE L PRFL BONE HAND	BOTH IP/OP	$530.00 	$392.20	$0.00	$393.37	$134.27	$134.27	$0.00	$0.00	$0.00	$110.47	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$313.50	$313.50	$0.00	$149.19	$236.32	$238.70	$0.00		$0.00	$46.70	$0.00	$0.00	$47.50	$0.00	$0.00	$0.00	$0.00	$0.00
57-10131	SUP	HCPCS C1713		57-10131  -  PLATE MED TI 2.3MM SCR 6 HOLE L OBLQ PRFL BONE LEFT HAND	BOTH IP/OP	$530.00 	$392.20	$0.00	$393.37	$134.27	$134.27	$0.00	$0.00	$0.00	$110.47	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$313.50	$313.50	$0.00	$149.19	$236.32	$238.70	$0.00		$0.00	$46.70	$0.00	$0.00	$47.50	$0.00	$0.00	$0.00	$0.00	$0.00
57-10140	SUP	HCPCS C1713		57-10140  -  PLATE MED STD NAR 1MM 2.3MM SCR SM FRAG SYS 6 HOLE T PRFL	BOTH IP/OP	$530.00 	$392.20	$0.00	$393.37	$138.60	$138.60	$0.00	$0.00	$0.00	$110.47	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$313.50	$313.50	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
57-10150	SUP	HCPCS C1713		57-10150  -  PLATE MED 1MM 2.3MM SCR SM FRAG SYS 6 HOLE T PRFL BONE HAND	BOTH IP/OP	$530.00 	$392.20	$0.00	$393.37	$138.60	$138.60	$0.00	$0.00	$0.00	$110.47	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$313.50	$313.50	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
57-10151	SUP	HCPCS C1713		57-10151  -  PLATE MED NAR TI 2.3MM SCR 6 HOLE T OBLQ PRFL BONE LEFT HAND	BOTH IP/OP	$530.00 	$392.20	$0.00	$393.37	$138.60	$138.60	$0.00	$0.00	$0.00	$110.47	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$313.50	$313.50	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
57-10160	SUP	HCPCS C1713		57-10160  -  PLATE MED STD 1MM 2.3MM SCR SM FRAG SYS 7 HOLE T PRFL BONE	BOTH IP/OP	$530.00 	$392.20	$0.00	$393.37	$152.83	$152.83	$0.00	$0.00	$0.00	$110.47	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$313.50	$313.50	$0.00	$169.81	$268.99	$271.70	$0.00		$0.00	$53.15	$0.00	$0.00	$54.07	$0.00	$0.00	$0.00	$0.00	$0.00
57-10161	SUP	HCPCS C1713		57-10161  -  PLATE MED W STD 1MM 2.3MM SCR 8 HOLE T PRFL PRFL BONE HAND	BOTH IP/OP	$489.00 	$361.86	$0.00	$362.94	$167.06	$167.06	$0.00	$0.00	$0.00	$101.92	$362.94	$362.94	$0.00	$0.00	$101.91	$0.00	$289.24	$289.24	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$58.10	$0.00	$0.00	$59.10	$0.00	$0.00	$0.00	$0.00	$0.00
57-10170	SUP	HCPCS C1713		57-10170  -  PLATE MED STD NAR 1MM 2.3MM SCR SM FRAG SYS 7 HOLE Y PRFL	BOTH IP/OP	$530.00 	$392.20	$0.00	$393.37	$175.11	$175.11	$0.00	$0.00	$0.00	$110.47	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$313.50	$313.50	$0.00	$194.56	$308.19	$311.30	$0.00		$0.00	$60.90	$0.00	$0.00	$61.95	$0.00	$0.00	$0.00	$0.00	$0.00
57-10179	SUP	HCPCS C1713		57-10179  -  PLATE MED STD NAR 1MM 2.3MM SCR SM FRAG SYS 13 HOLE Z PRFL	BOTH IP/OP	$741.00 	$548.34	$0.00	$549.97	$193.67	$193.67	$0.00	$0.00	$0.00	$154.44	$549.97	$549.97	$0.00	$0.00	$154.42	$0.00	$438.30	$438.30	$0.00	$215.19	$340.86	$344.30	$0.00		$0.00	$67.35	$0.00	$0.00	$68.52	$0.00	$0.00	$0.00	$0.00	$0.00
57-10180	SUP	HCPCS C1713		57-10180  -  PLATE MED TI OBLQ FRAC M ROT PRFL BONE PHLNG MTCRPL	BOTH IP/OP	$734.00 	$543.16	$0.00	$647.90	$364.44	$364.44	$0.00	$0.00	$0.00	$152.98	$544.77	$544.77	$0.00	$0.00	$152.97	$0.00	$434.16	$434.16	$0.00	$404.94	$641.42	$647.90	$0.00		$0.00	$126.75	$0.00	$0.00	$128.93	$0.00	$0.00	$0.00	$0.00	$0.00
57-10185	SUP	HCPCS C1713		57-10185  -  PLATE STD MED 1MM 2.3MM SCR 5 HOLE ROT PRFL BONE HAND	BOTH IP/OP	$944.00 	$698.56	$0.00	$700.64	$324.84	$324.84	$0.00	$0.00	$0.00	$196.75	$700.64	$700.64	$0.00	$0.00	$196.73	$0.00	$558.38	$558.38	$0.00	$360.94	$571.73	$577.50	$0.00		$0.00	$112.97	$0.00	$0.00	$114.92	$0.00	$0.00	$0.00	$0.00	$0.00
57-10190	SUP	HCPCS C1713		57-10190  -  PLATE MED STD 1MM 2.3MM SCR SM FRAG SYS 2X2 HOLE 3D PRFL	BOTH IP/OP	$530.00 	$392.20	$0.00	$393.37	$170.78	$170.78	$0.00	$0.00	$0.00	$110.47	$393.37	$393.37	$0.00	$0.00	$110.45	$0.00	$313.50	$313.50	$0.00	$189.75	$300.56	$303.60	$0.00		$0.00	$59.39	$0.00	$0.00	$60.42	$0.00	$0.00	$0.00	$0.00	$0.00
57-10191	SUP	HCPCS C1713		57-10191  -  PLATE MED STD 1MM 2.3MM SCR SM FRAG SYS 3X2 HOLE 3D PRFL	BOTH IP/OP	$741.00 	$548.34	$0.00	$549.97	$253.69	$253.69	$0.00	$0.00	$0.00	$154.44	$549.97	$549.97	$0.00	$0.00	$154.42	$0.00	$438.30	$438.30	$0.00	$281.88	$446.49	$451.00	$0.00		$0.00	$88.23	$0.00	$0.00	$89.75	$0.00	$0.00	$0.00	$0.00	$0.00
57-10192	SUP	HCPCS C1713		57-10192  -  PLATE MED HYDRXAPT TI 2.3MM SCR 4X2 HOLE 3D PRFL BONE	BOTH IP/OP	$741.00 	$548.34	$0.00	$549.97	$305.04	$305.04	$0.00	$0.00	$0.00	$154.44	$549.97	$549.97	$0.00	$0.00	$154.42	$0.00	$438.30	$438.30	$0.00	$338.94	$536.88	$542.30	$0.00		$0.00	$106.09	$0.00	$0.00	$107.92	$0.00	$0.00	$0.00	$0.00	$0.00
57-10193	SUP	HCPCS C1713		57-10193  -  PLATE MED TI 2.3MM SCR 3D PRFL BONE HAND WRST	BOTH IP/OP	$741.00 	$548.34	$0.00	$549.97	$305.04	$305.04	$0.00	$0.00	$0.00	$154.44	$549.97	$549.97	$0.00	$0.00	$154.42	$0.00	$438.30	$438.30	$0.00	$338.94	$536.88	$542.30	$0.00		$0.00	$106.09	$0.00	$0.00	$107.92	$0.00	$0.00	$0.00	$0.00	$0.00
57-10195	SUP	HCPCS C1713		57-10195  -  PLATE MED 1MM TI 2.3MM SCR SM FRAG SYS 4X2 HOLE 3D FIX PRFL	BOTH IP/OP	$741.00 	$548.34	$0.00	$549.97	$286.48	$286.48	$0.00	$0.00	$0.00	$154.44	$549.97	$549.97	$0.00	$0.00	$154.42	$0.00	$438.30	$438.30	$0.00	$318.31	$504.21	$509.30	$0.00		$0.00	$99.63	$0.00	$0.00	$101.35	$0.00	$0.00	$0.00	$0.00	$0.00
57-10197	SUP	HCPCS C1713		57-10197  -  PLATE MED 1MM TI 2.3MM SCR SM FRAG SYS 2X2+ 2 HOLE 3D FIX	BOTH IP/OP	$741.00 	$548.34	$0.00	$549.97	$253.69	$253.69	$0.00	$0.00	$0.00	$154.44	$549.97	$549.97	$0.00	$0.00	$154.42	$0.00	$438.30	$438.30	$0.00	$281.88	$446.49	$451.00	$0.00		$0.00	$88.23	$0.00	$0.00	$89.75	$0.00	$0.00	$0.00	$0.00	$0.00
57-10201	SUP	HCPCS C1713		57-10201  -  PLATE MED TI 2.3MM SCR 4 HOLE STR CMPR PRFL BONE HAND WRST	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$111.38	$111.38	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
57-10202	SUP	HCPCS C1713		57-10202  -  PLATE MED TI 2.3MM SCR 4 HOLE STR CMPR BAR PRFL BONE HAND	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$111.38	$111.38	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
57-10204	SUP	HCPCS C1713		57-10204  -  PLATE MED 1MM TI SM FRAG SYS 5 HOLE CMPR STR PRFL BONE HAND	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$111.38	$111.38	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
57-10207	SUP	HCPCS C1713		57-10207  -  PLATE MED 1MM TI SM FRAG SYS 6 HOLE CMPR STR PRFL BONE HAND	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$138.60	$138.60	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
57-10208	SUP	HCPCS C1713		57-10208  -  PLATE MED TI 2.3MM SCR 7 HOLE STR CMPR PRFL BONE HAND	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$138.60	$138.60	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
57-10220	SUP	HCPCS C1713		57-10220  -  PLATE 90D MED TI 2.3MM SCR 6 HOLE L CMPR PRFL BONE RIGHT	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$138.60	$138.60	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
57-10221	SUP	HCPCS C1713		57-10221  -  PLATE 90D MED TI 2.3MM SCR 6 HOLE L CMPR PRFL BONE LEFT HAND	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$138.60	$138.60	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
57-10230	SUP	HCPCS C1713		57-10230  -  PLATE MED TI 2.3MM SCR 6 HOLE L OBLQ CMPR PRFL BONE RIGHT	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$138.60	$138.60	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
57-10231	SUP	HCPCS C1713		57-10231  -  PLATE MED TI 2.3MM SCR 6 HOLE L OBLQ CMPR PRFL BONE LEFT	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$138.60	$138.60	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
57-10240	SUP	HCPCS C1713		57-10240  -  PLATE MED 1MM TI SM FRAG SYS 6 HOLE CMPR T PRFL BONE HAND	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$152.83	$152.83	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$169.81	$268.99	$271.70	$0.00		$0.00	$53.15	$0.00	$0.00	$54.07	$0.00	$0.00	$0.00	$0.00	$0.00
57-10250	SUP	HCPCS C1713		57-10250  -  PLATE MED NAR TI 2.3MM SCR 6 HOLE T OBLQ CMPR PRFL BONE	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$152.83	$152.83	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$169.81	$268.99	$271.70	$0.00		$0.00	$53.15	$0.00	$0.00	$54.07	$0.00	$0.00	$0.00	$0.00	$0.00
57-10251	SUP	HCPCS C1713		57-10251  -  PLATE MED NAR TI 2.3MM SCR 6 HOLE T OBLQ CMPR PRFL BONE LEFT	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$152.83	$152.83	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$169.81	$268.99	$271.70	$0.00		$0.00	$53.15	$0.00	$0.00	$54.07	$0.00	$0.00	$0.00	$0.00	$0.00
57-10260	SUP	HCPCS C1713		57-10260  -  PLATE 90D MED REG TI 2.3MM SCR 7 HOLE T CMPR PRFL BONE HAND	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$162.11	$162.11	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$180.13	$285.32	$288.20	$0.00		$0.00	$56.38	$0.00	$0.00	$57.35	$0.00	$0.00	$0.00	$0.00	$0.00
57-10262	SUP	HCPCS C1713		57-10262  -  PLATE 90D REG TI 2.3MM SCR 10 HOLE T CMPR PRFL BONE HAND	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$180.06	$180.06	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$200.06	$316.90	$320.10	$0.00		$0.00	$62.62	$0.00	$0.00	$63.70	$0.00	$0.00	$0.00	$0.00	$0.00
57-10270	SUP	HCPCS C1713		57-10270  -  PLATE MED 1MM TI SM FRAG SYS 7 HOLE CMPR Y PRFL BONE HAND	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$180.06	$180.06	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$200.06	$316.90	$320.10	$0.00		$0.00	$62.62	$0.00	$0.00	$63.70	$0.00	$0.00	$0.00	$0.00	$0.00
57-10280	SUP	HCPCS C1713		57-10280  -  PLATE MED TI 2.3MM SCR 5 HOLE PRFL BONE RIGHT CNDYLR	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$152.83	$152.83	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$169.81	$268.99	$271.70	$0.00		$0.00	$53.15	$0.00	$0.00	$54.07	$0.00	$0.00	$0.00	$0.00	$0.00
57-10281	SUP	HCPCS C1713		57-10281  -  PLATE MED TI 2.3MM SCR 5 HOLE PRFL BONE LEFT CNDYLR	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$152.83	$152.83	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$169.81	$268.99	$271.70	$0.00		$0.00	$53.15	$0.00	$0.00	$54.07	$0.00	$0.00	$0.00	$0.00	$0.00
57-10282	SUP	HCPCS C1713		57-10282  -  PLATE MED TI 2.3MM SCR 6 HOLE PRFL BONE RIGHT CNDYLR	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$152.83	$152.83	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$169.81	$268.99	$271.70	$0.00		$0.00	$53.15	$0.00	$0.00	$54.07	$0.00	$0.00	$0.00	$0.00	$0.00
57-10283	SUP	HCPCS C1713		57-10283  -  PLATE MED TI 2.3MM SCR 6 HOLE PRFL BONE LEFT CNDYLR	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$152.83	$152.83	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$169.81	$268.99	$271.70	$0.00		$0.00	$53.15	$0.00	$0.00	$54.07	$0.00	$0.00	$0.00	$0.00	$0.00
57-10284	SUP	HCPCS C1713		57-10284  -  PLATE MED TI 2.3MM SCR 6 HOLE LNG PIN PRFL BONE RIGHT CNDYLR	BOTH IP/OP	$630.00 	$466.20	$0.00	$467.59	$175.11	$175.11	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$194.56	$308.19	$311.30	$0.00		$0.00	$60.90	$0.00	$0.00	$61.95	$0.00	$0.00	$0.00	$0.00	$0.00
57-10285	SUP	HCPCS C1713		57-10285  -  PLATE MED TI 2.3MM SCR 6 HOLE LNG PIN PRFL BONE LEFT CNDYLR	BOTH IP/OP	$630.00 	$466.20	$0.00	$467.59	$175.11	$175.11	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$194.56	$308.19	$311.30	$0.00		$0.00	$60.90	$0.00	$0.00	$61.95	$0.00	$0.00	$0.00	$0.00	$0.00
57-10304	SUP	HCPCS C1713		57-10304  -  PLATE SM 1MM 1.7MM SCR 4 HOLE STR LCK VARIAX BONE HAND	BOTH IP/OP	$725.00 	$536.50	$0.00	$538.10	$114.47	$114.47	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$127.19	$201.47	$203.50	$0.00		$0.00	$39.81	$0.00	$0.00	$40.50	$0.00	$0.00	$0.00	$0.00	$0.00
57-10310	SUP	HCPCS C1713		57-10310  -  PLATE SM NAR 1MM 1.7MM SCR 10 HOLE T LCK PRFL VARIAX BONE	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$176.34	$176.34	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$195.94	$310.37	$313.50	$0.00		$0.00	$61.33	$0.00	$0.00	$62.39	$0.00	$0.00	$0.00	$0.00	$0.00
57-10316	SUP	HCPCS C1713		57-10316  -  PLATE SM 1MM 1.7MM SCR 16 HOLE STR LCK PRFL VARIAX BONE HAND	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$250.59	$250.59	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$278.44	$441.05	$445.50	$0.00		$0.00	$87.15	$0.00	$0.00	$88.65	$0.00	$0.00	$0.00	$0.00	$0.00
57-10320	SUP	HCPCS C1713		57-10320  -  PLATE SM 1MM 1.7MM SCR 6 HOLE L LCK VARIAX BONE 1.7MM RIGHT	BOTH IP/OP	$725.00 	$536.50	$0.00	$538.10	$151.59	$151.59	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$168.44	$266.81	$269.50	$0.00		$0.00	$52.72	$0.00	$0.00	$53.63	$0.00	$0.00	$0.00	$0.00	$0.00
57-10321	SUP	HCPCS C1713		57-10321  -  PLATE SM 1MM 1.7MM SCR 6 HOLE L LCK VARIAX BONE 1.7MM LEFT	BOTH IP/OP	$725.00 	$536.50	$0.00	$538.10	$151.59	$151.59	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$168.44	$266.81	$269.50	$0.00		$0.00	$52.72	$0.00	$0.00	$53.63	$0.00	$0.00	$0.00	$0.00	$0.00
57-10340	SUP	HCPCS C1713		57-10340  -  PLATE SM NAR 1MM 1.7MM SCR 6 HOLE T LCK PRFL VARIAX BONE	BOTH IP/OP	$725.00 	$536.50	$0.00	$538.10	$167.06	$167.06	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$58.10	$0.00	$0.00	$59.10	$0.00	$0.00	$0.00	$0.00	$0.00
57-10360	SUP	HCPCS C1713		57-10360  -  PLATE SM 1MM 1.7MM SCR 7 HOLE T LCK PRFL VARIAX BONE HAND	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$167.06	$167.06	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$58.10	$0.00	$0.00	$59.10	$0.00	$0.00	$0.00	$0.00	$0.00
57-10368	SUP	HCPCS C1713		57-10368  -  PLATE SM W 1MM 1.7MM SCR 8 HOLE T LCK PRFL VARIAX BONE HAND	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$182.53	$182.53	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$202.81	$321.26	$324.50	$0.00		$0.00	$63.48	$0.00	$0.00	$64.58	$0.00	$0.00	$0.00	$0.00	$0.00
57-10379	SUP	HCPCS C1713		57-10379  -  PLATE SM NAR 1MM 1.7MM SCR 9 HOLE Z LCK PRFL VARIAX BONE	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$219.66	$219.66	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$244.06	$386.60	$390.50	$0.00		$0.00	$76.39	$0.00	$0.00	$77.71	$0.00	$0.00	$0.00	$0.00	$0.00
57-10380	SUP	HCPCS C1713		57-10380  -  PLATE SM 1MM 1.7MM SCR 5 HOLE ROT LCK VARIAX BONE HAND	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$343.41	$343.41	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$381.56	$604.40	$610.50	$0.00		$0.00	$119.43	$0.00	$0.00	$121.49	$0.00	$0.00	$0.00	$0.00	$0.00
57-10390	SUP	HCPCS C1713		57-10390  -  PLATE SM 1MM 1.7MM SCR 2X2 HOLE 3D LCK VARIAX BONE 1.7MM	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$191.81	$191.81	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$213.13	$337.59	$341.00	$0.00		$0.00	$66.71	$0.00	$0.00	$67.86	$0.00	$0.00	$0.00	$0.00	$0.00
57-10391	SUP	HCPCS C1713		57-10391  -  PLATE 1MM 3X2 HOLE 3D VARIAX BONE 1.7MM HAND WRST	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$284.63	$284.63	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$316.25	$500.94	$506.00	$0.00		$0.00	$98.99	$0.00	$0.00	$100.69	$0.00	$0.00	$0.00	$0.00	$0.00
57-10392	SUP	HCPCS C1713		57-10392  -  PLATE SM 1MM 1.7MM SCR 4X2 HOLE 3D LCK VARIAX BONE 1.7MM	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$343.41	$343.41	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$381.56	$604.40	$610.50	$0.00		$0.00	$119.43	$0.00	$0.00	$121.49	$0.00	$0.00	$0.00	$0.00	$0.00
57-10395	SUP	HCPCS C1713		57-10395  -  PLATE SM 1MM 1.7MM SCR 8 HOLE 3D LCK PRFL REPLANTATION	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$343.41	$343.41	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$381.56	$604.40	$610.50	$0.00		$0.00	$119.43	$0.00	$0.00	$121.49	$0.00	$0.00	$0.00	$0.00	$0.00
57-10397	SUP	HCPCS C1713		57-10397  -  PLATE SM 1MM 1.7MM SCR 2X2+2 HOLE 3D LCK VARIAX BONE HAND	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$284.63	$284.63	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$316.25	$500.94	$506.00	$0.00		$0.00	$98.99	$0.00	$0.00	$100.69	$0.00	$0.00	$0.00	$0.00	$0.00
57-10402	SUP	HCPCS C1713		57-10402  -  PLATE MED 1MM 2.3MM SCR 4 HOLE STR CMPR PRFL BONE HAND	BOTH IP/OP	$630.00 	$466.20	$0.00	$467.59	$126.84	$126.84	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$140.94	$223.25	$225.50	$0.00		$0.00	$44.11	$0.00	$0.00	$44.87	$0.00	$0.00	$0.00	$0.00	$0.00
57-10407	SUP	HCPCS C1713		57-10407  -  PLATE MED 1MM 2.3MM SCR 6 HOLE STR CMPR PRFL PRFL BONE HAND	BOTH IP/OP	$630.00 	$466.20	$0.00	$467.59	$157.78	$157.78	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$54.87	$0.00	$0.00	$55.82	$0.00	$0.00	$0.00	$0.00	$0.00
57-10420	SUP	HCPCS C1713		57-10420  -  PLATE MED 1MM 2.3MM SCR 6 HOLE L CMPR PRFL BONE RIGHT HAND	BOTH IP/OP	$630.00 	$466.20	$0.00	$467.59	$157.78	$157.78	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$54.87	$0.00	$0.00	$55.82	$0.00	$0.00	$0.00	$0.00	$0.00
57-10421	SUP	HCPCS C1713		57-10421  -  PLATE MED 1MM 2.3MM SCR 6 HOLE L CMPR PRFL BONE LEFT HAND	BOTH IP/OP	$630.00 	$466.20	$0.00	$467.59	$157.78	$157.78	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$54.87	$0.00	$0.00	$55.82	$0.00	$0.00	$0.00	$0.00	$0.00
57-10440	SUP	HCPCS C1713		57-10440  -  PLATE MED NAR 1MM 2.3MM SCR 6 HOLE T CMPR PRFL BONE HAND	BOTH IP/OP	$630.00 	$466.20	$0.00	$467.59	$173.25	$173.25	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
57-10460	SUP	HCPCS C1713		57-10460  -  PLATE MED 1MM 2.3MM SCR 7 HOLE T CMPR PRFL BONE HAND	BOTH IP/OP	$630.00 	$466.20	$0.00	$467.59	$182.53	$182.53	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$202.81	$321.26	$324.50	$0.00		$0.00	$63.48	$0.00	$0.00	$64.58	$0.00	$0.00	$0.00	$0.00	$0.00
57-10470	SUP	HCPCS C1713		57-10470  -  PLATE NAR MED 1MM 2.3MM SCR 7 HOLE Y CMPR PRFL BONE HAND	BOTH IP/OP	$630.00 	$466.20	$0.00	$467.59	$204.19	$204.19	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$226.88	$359.37	$363.00	$0.00		$0.00	$71.01	$0.00	$0.00	$72.24	$0.00	$0.00	$0.00	$0.00	$0.00
57-10482	SUP	HCPCS C1713		57-10482  -  PLATE MED 1MM 2.3MM SCR 6 HOLE BLADE CMPR PRFL BONE 2.3MM	BOTH IP/OP	$630.00 	$466.20	$0.00	$467.59	$173.25	$173.25	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
57-10483	SUP	HCPCS C1713		57-10483  -  PLATE MED 1MM 2.3MM SCR 6 HOLE BLADE CMPR PRFL BONE LEFT	BOTH IP/OP	$630.00 	$466.20	$0.00	$467.59	$173.25	$173.25	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
57-13102	SUP	HCPCS C1713		57-13102  -  PLATE LG 1.3MM TI SM FRAG SYS 4 HOLE STR BAR CMPR PRFL BONE	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$129.32	$129.32	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$44.97	$0.00	$0.00	$45.75	$0.00	$0.00	$0.00	$0.00	$0.00
57-13105	SUP	HCPCS C1713		57-13105  -  PLATE LG 1.3MM TI SM FRAG SYS 5 HOLE STR BAR CMPR PRFL BONE	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$138.60	$138.60	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
57-13108	SUP	HCPCS C1713		57-13108  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE STR BAR CMPR PRFL BONE	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$162.11	$162.11	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$180.13	$285.32	$288.20	$0.00		$0.00	$56.38	$0.00	$0.00	$57.35	$0.00	$0.00	$0.00	$0.00	$0.00
57-13109	SUP	HCPCS C1713		57-13109  -  PLATE LG 1.3MM TI SM FRAG SYS 7 HOLE STR BAR CMPR PRFL BONE	BOTH IP/OP	$634.00 	$469.16	$0.00	$470.55	$175.11	$175.11	$0.00	$0.00	$0.00	$132.14	$470.55	$470.55	$0.00	$0.00	$132.13	$0.00	$375.01	$375.01	$0.00	$194.56	$308.19	$311.30	$0.00		$0.00	$60.90	$0.00	$0.00	$61.95	$0.00	$0.00	$0.00	$0.00	$0.00
57-13110	SUP	HCPCS C1713		57-13110  -  PLATE LG 1.3MM TI SM FRAG SYS 8 HOLE STR BAR CMPR PRFL BONE	BOTH IP/OP	$443.80 	$328.41	$0.00	$336.60	$189.34	$189.34	$0.00	$0.00	$0.00	$92.50	$329.39	$329.39	$0.00	$0.00	$92.49	$0.00	$262.51	$262.51	$0.00	$210.38	$333.23	$336.60	$0.00		$0.00	$65.85	$0.00	$0.00	$66.98	$0.00	$0.00	$0.00	$0.00	$0.00
57-13120	SUP	HCPCS C1713		57-13120  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE L CMPR PRFL BONE HAND	BOTH IP/OP	$443.80 	$328.41	$0.00	$329.39	$165.83	$165.83	$0.00	$0.00	$0.00	$92.50	$329.39	$329.39	$0.00	$0.00	$92.49	$0.00	$262.51	$262.51	$0.00	$184.25	$291.85	$294.80	$0.00		$0.00	$57.67	$0.00	$0.00	$58.67	$0.00	$0.00	$0.00	$0.00	$0.00
57-13121	SUP	HCPCS C1713		57-13121  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE L CMPR PRFL BONE HAND	BOTH IP/OP	$443.80 	$328.41	$0.00	$329.39	$165.83	$165.83	$0.00	$0.00	$0.00	$92.50	$329.39	$329.39	$0.00	$0.00	$92.49	$0.00	$262.51	$262.51	$0.00	$184.25	$291.85	$294.80	$0.00		$0.00	$57.67	$0.00	$0.00	$58.67	$0.00	$0.00	$0.00	$0.00	$0.00
57-13140	SUP	HCPCS C1713		57-13140  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE T CMPR PRFL BONE HAND	BOTH IP/OP	$443.80 	$328.41	$0.00	$329.39	$165.83	$165.83	$0.00	$0.00	$0.00	$92.50	$329.39	$329.39	$0.00	$0.00	$92.49	$0.00	$262.51	$262.51	$0.00	$184.25	$291.85	$294.80	$0.00		$0.00	$57.67	$0.00	$0.00	$58.67	$0.00	$0.00	$0.00	$0.00	$0.00
57-13142	SUP	HCPCS C1713		57-13142  -  PLATE LG 1.3MM TI SM FRAG SYS 10 HOLE T BAR CMPR PRFL BONE	BOTH IP/OP	$443.80 	$328.41	$0.00	$329.39	$180.06	$180.06	$0.00	$0.00	$0.00	$92.50	$329.39	$329.39	$0.00	$0.00	$92.49	$0.00	$262.51	$262.51	$0.00	$200.06	$316.90	$320.10	$0.00		$0.00	$62.62	$0.00	$0.00	$63.70	$0.00	$0.00	$0.00	$0.00	$0.00
57-13150	SUP	HCPCS C1713		57-13150  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE T CMPR PRFL BONE HAND	BOTH IP/OP	$443.80 	$328.41	$0.00	$329.39	$165.83	$165.83	$0.00	$0.00	$0.00	$92.50	$329.39	$329.39	$0.00	$0.00	$92.49	$0.00	$262.51	$262.51	$0.00	$184.25	$291.85	$294.80	$0.00		$0.00	$57.67	$0.00	$0.00	$58.67	$0.00	$0.00	$0.00	$0.00	$0.00
57-13151	SUP	HCPCS C1713		57-13151  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE T CMPR PRFL BONE HAND	BOTH IP/OP	$443.80 	$328.41	$0.00	$329.39	$165.83	$165.83	$0.00	$0.00	$0.00	$92.50	$329.39	$329.39	$0.00	$0.00	$92.49	$0.00	$262.51	$262.51	$0.00	$184.25	$291.85	$294.80	$0.00		$0.00	$57.67	$0.00	$0.00	$58.67	$0.00	$0.00	$0.00	$0.00	$0.00
57-13180	SUP	HCPCS C1713		57-13180  -  PLATE LG TI SM FRAG SET 5 HOLE MDLR ROT PRFL BONE HAND	BOTH IP/OP	$550.50 	$407.37	$0.00	$647.90	$364.44	$364.44	$0.00	$0.00	$0.00	$114.74	$408.58	$408.58	$0.00	$0.00	$114.72	$0.00	$325.62	$325.62	$0.00	$404.94	$641.42	$647.90	$0.00		$0.00	$126.75	$0.00	$0.00	$128.93	$0.00	$0.00	$0.00	$0.00	$0.00
57-13185	SUP	HCPCS C1713		57-13185  -  PLATE STD W MED 1MM 5 HOLE ROT PRFL PRFL BONE 2.3MM HAND	BOTH IP/OP	$944.00 	$698.56	$0.00	$700.64	$324.84	$324.84	$0.00	$0.00	$0.00	$196.75	$700.64	$700.64	$0.00	$0.00	$196.73	$0.00	$558.38	$558.38	$0.00	$360.94	$571.73	$577.50	$0.00		$0.00	$112.97	$0.00	$0.00	$114.92	$0.00	$0.00	$0.00	$0.00	$0.00
57-13402	SUP	HCPCS C1713		57-13402  -  PLATE 1.3MM 2.3MM SCR 4 HOLE L CMPR STR PRFL BONE HAND	BOTH IP/OP	$441.00 	$326.34	$0.00	$327.31	$148.50	$148.50	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
57-13405	SUP	HCPCS C1713		57-13405  -  PLATE 1.3MM 2.3MM SCR 5 HOLE L CMPR STR PRFL BONE HAND	BOTH IP/OP	$441.00 	$326.34	$0.00	$327.31	$157.78	$157.78	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$54.87	$0.00	$0.00	$55.82	$0.00	$0.00	$0.00	$0.00	$0.00
57-13408	SUP	HCPCS C1713		57-13408  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE L CMPR STR PRFL BONE 2.3MM	BOTH IP/OP	$441.00 	$326.34	$0.00	$327.31	$182.53	$182.53	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$202.81	$321.26	$324.50	$0.00		$0.00	$63.48	$0.00	$0.00	$64.58	$0.00	$0.00	$0.00	$0.00	$0.00
57-13410	SUP	HCPCS C1713		57-13410  -  PLATE LG 1.3MM 2.3MM SCR 8 HOLE L CMPR STR PRFL BONE HAND	BOTH IP/OP	$441.00 	$326.34	$0.00	$352.00	$198.00	$198.00	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$220.00	$348.48	$352.00	$0.00		$0.00	$68.86	$0.00	$0.00	$70.05	$0.00	$0.00	$0.00	$0.00	$0.00
57-13420	SUP	HCPCS C1713		57-13420  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE L CMPR PRFL BONE RIGHT	BOTH IP/OP	$441.00 	$326.34	$0.00	$335.50	$188.72	$188.72	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$209.69	$332.15	$335.50	$0.00		$0.00	$65.63	$0.00	$0.00	$66.76	$0.00	$0.00	$0.00	$0.00	$0.00
57-13421	SUP	HCPCS C1713		57-13421  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE L CMPR PRFL BONE LEFT	BOTH IP/OP	$441.00 	$326.34	$0.00	$335.50	$188.72	$188.72	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$209.69	$332.15	$335.50	$0.00		$0.00	$65.63	$0.00	$0.00	$66.76	$0.00	$0.00	$0.00	$0.00	$0.00
57-13440	SUP	HCPCS C1713		57-13440  -  PLATE NAR 1.3MM 2.3MM SCR 6 HOLE T CMPR PRFL BONE HAND	BOTH IP/OP	$441.00 	$326.34	$0.00	$335.50	$188.72	$188.72	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$209.69	$332.15	$335.50	$0.00		$0.00	$65.63	$0.00	$0.00	$66.76	$0.00	$0.00	$0.00	$0.00	$0.00
57-13442	SUP	HCPCS C1713		57-13442  -  PLATE NAR 1.3MM 2.3MM SCR 10 HOLE T CMPR PRFL BONE 2.3MM	BOTH IP/OP	$453.75 	$335.78	$0.00	$363.00	$204.19	$204.19	$0.00	$0.00	$0.00	$94.57	$336.77	$336.77	$0.00	$0.00	$94.56	$0.00	$268.39	$268.39	$0.00	$226.88	$359.37	$363.00	$0.00		$0.00	$71.01	$0.00	$0.00	$72.24	$0.00	$0.00	$0.00	$0.00	$0.00
57-13450	SUP	HCPCS C1713		57-13450  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE T CMPR OBLQ PRFL BONE RIGHT	BOTH IP/OP	$441.00 	$326.34	$0.00	$335.50	$188.72	$188.72	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$209.69	$332.15	$335.50	$0.00		$0.00	$65.63	$0.00	$0.00	$66.76	$0.00	$0.00	$0.00	$0.00	$0.00
57-13451	SUP	HCPCS C1713		57-13451  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE T CMPR OBLQ PRFL BONE LEFT	BOTH IP/OP	$441.00 	$326.34	$0.00	$335.50	$188.72	$188.72	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$209.69	$332.15	$335.50	$0.00		$0.00	$65.63	$0.00	$0.00	$66.76	$0.00	$0.00	$0.00	$0.00	$0.00
57-13906	SUP	HCPCS C1713		57-13906  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE T CMPR PRFL BONE HAND	BOTH IP/OP	$441.00 	$326.34	$0.00	$335.50	$188.72	$188.72	$0.00	$0.00	$0.00	$91.92	$327.31	$327.31	$0.00	$0.00	$91.90	$0.00	$260.85	$260.85	$0.00	$209.69	$332.15	$335.50	$0.00		$0.00	$65.63	$0.00	$0.00	$66.76	$0.00	$0.00	$0.00	$0.00	$0.00
57-15301	SUP	HCPCS C1713		57-15301  -  PLATE BN MED STRG 1.5MM VARIAX 4 HL LCK PRECONTOUR HND 2.3MM	BOTH IP/OP	$725.00 	$536.50	$0.00	$538.10	$123.75	$123.75	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
57-15302	SUP	HCPCS C1713		57-15302  -  PLATE MED 1.5MM 2.3MM SCR 4 HOLE LCK STR BAR VARIAX BONE	BOTH IP/OP	$725.00 	$536.50	$0.00	$538.10	$126.84	$126.84	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$140.94	$223.25	$225.50	$0.00		$0.00	$44.11	$0.00	$0.00	$44.87	$0.00	$0.00	$0.00	$0.00	$0.00
57-15316	SUP	HCPCS C1713		57-15316  -  PLATE MED 1.5MM 2.3MM SCR 16 HOLE LCK STR PRFL VARIAX BONE	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$259.88	$259.88	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$288.75	$457.38	$462.00	$0.00		$0.00	$90.38	$0.00	$0.00	$91.94	$0.00	$0.00	$0.00	$0.00	$0.00
57-15320	SUP	HCPCS C1713		57-15320  -  PLATE MED RIGHT HAND 1.5MM 2.3MM SCR 6 HOLE L LCK VARIAX	BOTH IP/OP	$725.00 	$536.50	$0.00	$538.10	$151.59	$151.59	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$168.44	$266.81	$269.50	$0.00		$0.00	$52.72	$0.00	$0.00	$53.63	$0.00	$0.00	$0.00	$0.00	$0.00
57-15321	SUP	HCPCS C1713		57-15321  -  PLATE MED LEFT HAND 1.5MM 2.3MM SCR 6 HOLE L LCK VARIAX BONE	BOTH IP/OP	$725.00 	$536.50	$0.00	$538.10	$151.59	$151.59	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$168.44	$266.81	$269.50	$0.00		$0.00	$52.72	$0.00	$0.00	$53.63	$0.00	$0.00	$0.00	$0.00	$0.00
57-15324	SUP	HCPCS C1713		57-15324  -  PLATE 1.5MM 5 HOLE 5 VARIAX BONE 2.3MM LEFT HAND WRST	BOTH IP/OP	$979.00 	$724.46	$0.00	$731.50	$411.47	$411.47	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$457.19	$724.19	$731.50	$0.00		$0.00	$143.10	$0.00	$0.00	$145.57	$0.00	$0.00	$0.00	$0.00	$0.00
57-15325	SUP	HCPCS C1713		57-15325  -  PLATE MED 1.5MM 2.3MM SCR 5 HOLE MC5 LCK VARIAX BONE 2.3MM	BOTH IP/OP	$979.00 	$724.46	$0.00	$731.50	$411.47	$411.47	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$457.19	$724.19	$731.50	$0.00		$0.00	$143.10	$0.00	$0.00	$145.57	$0.00	$0.00	$0.00	$0.00	$0.00
57-15340	SUP	HCPCS C1713		57-15340  -  PLATE BN MED NAR T 1.5MM VARIAX 6 HL LCK PRECONTOUR HND 2.3	BOTH IP/OP	$725.00 	$536.50	$0.00	$538.10	$157.78	$157.78	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$54.87	$0.00	$0.00	$55.82	$0.00	$0.00	$0.00	$0.00	$0.00
57-15360	SUP	HCPCS C1713		57-15360  -  PLATE MED 1.5MM 2.3MM SCR 7 HOLE T LCK VARIAX BONE HAND	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$173.25	$173.25	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
57-15361	SUP	HCPCS C1713		57-15361  -  PLATE MED W 1.5MM 2.3MM SCR 8 HOLE T LCK VARIAX BONE HAND	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$182.53	$182.53	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$202.81	$321.26	$324.50	$0.00		$0.00	$63.48	$0.00	$0.00	$64.58	$0.00	$0.00	$0.00	$0.00	$0.00
57-15370	SUP	HCPCS C1713		57-15370  -  PLATE BN MED NAR T 1.5MM VARIAX 7 HL LCK PRECONTOUR HND 2.3	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$198.00	$198.00	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$220.00	$348.48	$352.00	$0.00		$0.00	$68.86	$0.00	$0.00	$70.05	$0.00	$0.00	$0.00	$0.00	$0.00
57-15379	SUP	HCPCS C1713		57-15379  -  PLATE MED NAR 1.5MM 2.3MM SCR 13 HOLE Z LCK PRFL VARIAX BONE	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$219.66	$219.66	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$244.06	$386.60	$390.50	$0.00		$0.00	$76.39	$0.00	$0.00	$77.71	$0.00	$0.00	$0.00	$0.00	$0.00
57-15385	SUP	HCPCS C1713		57-15385  -  PLATE MED 1.5MM 2.3MM SCR 5 HOLE LCK ROT PRFL VARIAX BONE	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$408.38	$408.38	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$453.75	$718.74	$726.00	$0.00		$0.00	$142.02	$0.00	$0.00	$144.47	$0.00	$0.00	$0.00	$0.00	$0.00
57-15390	SUP	HCPCS C1713		57-15390  -  PLATE MED 1.5MM 2.3MM SCR 2X2 HOLE 3D LCK VARIAX BONE 2.3MM	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$266.06	$266.06	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$295.63	$468.27	$473.00	$0.00		$0.00	$92.53	$0.00	$0.00	$94.13	$0.00	$0.00	$0.00	$0.00	$0.00
57-15391	SUP	HCPCS C1713		57-15391  -  PLATE MED 1.5MM 2.3MM SCR 3X2 HOLE 3D LCK VARIAX BONE 2.3MM	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$284.63	$284.63	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$316.25	$500.94	$506.00	$0.00		$0.00	$98.99	$0.00	$0.00	$100.69	$0.00	$0.00	$0.00	$0.00	$0.00
57-15392	SUP	HCPCS C1713		57-15392  -  PLATE MED 1.5MM 2.3MM SCR 4X2 HOLE 3D LCK PRFL VARIAX BONE	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$343.41	$343.41	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$381.56	$604.40	$610.50	$0.00		$0.00	$119.43	$0.00	$0.00	$121.49	$0.00	$0.00	$0.00	$0.00	$0.00
57-15395	SUP	HCPCS C1713		57-15395  -  PLATE MED 1.5MM 2.3MM SCR 4X2 HOLE 3D LCK REPLANTATION PRFL	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$321.75	$321.75	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$357.50	$566.28	$572.00	$0.00		$0.00	$111.90	$0.00	$0.00	$113.83	$0.00	$0.00	$0.00	$0.00	$0.00
57-15397	SUP	HCPCS C1713		57-15397  -  PLATE MED 1.5MM 2.3MM SCR 2X2+ 2 HOLE 3D LCK VARIAX BONE 2.3	BOTH IP/OP	$979.00 	$724.46	$0.00	$726.61	$284.63	$284.63	$0.00	$0.00	$0.00	$204.05	$726.61	$726.61	$0.00	$0.00	$204.02	$0.00	$579.08	$579.08	$0.00	$316.25	$500.94	$506.00	$0.00		$0.00	$98.99	$0.00	$0.00	$100.69	$0.00	$0.00	$0.00	$0.00	$0.00
57525P	SUP	HCPCS C1713		57525P  -  SCREW BN 5.75MM 25MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57525S	SUP	HCPCS C1713		57525S  -  SCREW BN STD 5.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57530P	SUP	HCPCS C1713		57530P  -  SCREW BN 5.75MM 30MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57530S	SUP	HCPCS C1713		57530S  -  SCREW BN STD 5.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57535P	SUP	HCPCS C1713		57535P  -  SCREW BN 5.75MM 35MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57535S	SUP	HCPCS C1713		57535S  -  SCREW BN STD 5.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57540P	SUP	HCPCS C1713		57540P  -  SCREW BN 5.75MM 40MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57540S	SUP	HCPCS C1713		57540S  -  SCREW BN STD 5.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57545P	SUP	HCPCS C1713		57545P  -  SCREW BN 5.75MM 45MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57545S	SUP	HCPCS C1713		57545S  -  SCREW BN STD 5.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57550P	SUP	HCPCS C1713		57550P  -  SCREW BN 5.75MM 50MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57550S	SUP	HCPCS C1713		57550S  -  SCREW BN STD 5.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57555P	SUP	HCPCS C1713		57555P  -  SCREW BN 5.75MM 55MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57555S	SUP	HCPCS C1713		57555S  -  SCREW BN STD 5.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57560P	SUP	HCPCS C1713		57560P  -  SCREW BN 5.75MM 60MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
57560S	SUP	HCPCS C1713		57560S  -  SCREW BN STD 5.75MM 60MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$1,233.33 "	$912.66	$0.00	$986.66	$555.00	$555.00	$0.00	$0.00	$0.00	$257.06	$915.37	$915.37	$0.00	$0.00	$257.02	$0.00	$729.51	$729.51	$0.00	$616.66	$976.80	$986.66	$0.00		$0.00	$193.02	$0.00	$0.00	$196.35	$0.00	$0.00	$0.00	$0.00	$0.00
57565P	SUP	HCPCS C1713		57565P  -  SCREW BN 5.75MM 65MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$1,621.98 "	"$1,200.27"	$0.00	"$1,297.58"	$729.89	$729.89	$0.00	$0.00	$0.00	$338.06	"$1,203.83"	"$1,203.83"	$0.00	$0.00	$338.02	$0.00	$959.40	$959.40	$0.00	$810.99	"$1,284.61"	"$1,297.58"	$0.00		$0.00	$253.84	$0.00	$0.00	$258.22	$0.00	$0.00	$0.00	$0.00	$0.00
57565S	SUP	HCPCS C1713		57565S  -  SCREW BN STD 5.75MM 65MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$1,233.33 "	$912.66	$0.00	$986.66	$555.00	$555.00	$0.00	$0.00	$0.00	$257.06	$915.37	$915.37	$0.00	$0.00	$257.02	$0.00	$729.51	$729.51	$0.00	$616.66	$976.80	$986.66	$0.00		$0.00	$193.02	$0.00	$0.00	$196.35	$0.00	$0.00	$0.00	$0.00	$0.00
5770-1-000	SUP	Custom 27203010		5770-1-000  -  SET ORTH 3.2MM DRILL GUIDE	BOTH IP/OP	$382.25 	$282.87	$0.00	$305.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.71	$283.71	$0.00	$0.00	$79.66	$0.00	$0.00	$0.00	$0.00	$191.13	$302.74	$305.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5770-3-000	SUP	Custom 27203010		5770-3-000  -  SET ORTH 3.2MM DRILL GUIDE NTRL	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5770-4-000	SUP	Custom 27203010		5770-4-000  -  SET ORTH 3.6MM DRILL GUIDE	BOTH IP/OP	$493.63 	$365.29	$0.00	$394.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$366.37	$366.37	$0.00	$0.00	$102.87	$0.00	$0.00	$0.00	$0.00	$246.81	$390.95	$394.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5770-5-000	SUP	Custom 27203010		5770-5-000  -  SET ORTH 2MM DRILL GUIDE	BOTH IP/OP	$422.13 	$312.38	$0.00	$337.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$313.30	$313.30	$0.00	$0.00	$87.97	$0.00	$0.00	$0.00	$0.00	$211.06	$334.33	$337.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5780-0-035	SUP	HCPCS C1713		5780-0-035  -  SCREW BONE CORT TAP	BOTH IP/OP	$105.88 	$78.35	$0.00	$84.70	$47.64	$47.64	$0.00	$0.00	$0.00	$22.07	$78.58	$78.58	$0.00	$0.00	$22.06	$0.00	$62.63	$62.63	$0.00	$52.94	$83.86	$84.70	$0.00		$0.00	$16.57	$0.00	$0.00	$16.86	$0.00	$0.00	$0.00	$0.00	$0.00
5780-0-045	SUP	HCPCS C1713		5780-0-045  -  SCREW BONE CORT TAP	BOTH IP/OP	$411.13 	$304.24	$0.00	$328.90	$185.01	$185.01	$0.00	$0.00	$0.00	$85.69	$305.14	$305.14	$0.00	$0.00	$85.68	$0.00	$243.18	$243.18	$0.00	$205.56	$325.61	$328.90	$0.00		$0.00	$64.34	$0.00	$0.00	$65.45	$0.00	$0.00	$0.00	$0.00	$0.00
5780-1-045	SUP	Custom 27803010		5780-1-045  -  TAP CORTICAL BONE SCREW	BOTH IP/OP	$411.13 	$304.24	$0.00	$328.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.14	$305.14	$0.00	$0.00	$85.68	$0.00	$0.00	$0.00	$0.00	$205.56	$325.61	$328.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5781-0-014	SUP	Custom 27203010		5781-0-014  -  SLEEVE DRILL 1.4-2MM ICS	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$0.00	$0.00	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5781-0-027	SUP	Custom 27203010		5781-0-027  -  SLEEVE DRILL 2MM INS	BOTH IP/OP	$103.13 	$76.32	$0.00	$82.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.54	$76.54	$0.00	$0.00	$21.49	$0.00	$0.00	$0.00	$0.00	$51.56	$81.68	$82.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5781-0-045	SUP	Custom 27203010		5781-0-045  -  SLEEVE DRILL 4.5MM TAP	BOTH IP/OP	$180.13 	$133.30	$0.00	$144.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.69	$133.69	$0.00	$0.00	$37.54	$0.00	$0.00	$0.00	$0.00	$90.06	$142.66	$144.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5781-0-480	SUP	Custom 27203010		5781-0-480  -  SLEEVE DRILL 48MM	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$0.00	$0.00	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5781-0-530	SUP	Custom 27203010		5781-0-530  -  SLEEVE DRILL 53MM	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$0.00	$0.00	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5781-3-035	SUP	Custom 27203010		5781-3-035  -  GUIDE DRILL SM PNT	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5781-3-045	SUP	Custom 27203010		5781-3-045  -  GUIDE DRILL PNT	BOTH IP/OP	$240.63 	$178.07	$0.00	$192.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.59	$178.59	$0.00	$0.00	$50.15	$0.00	$0.00	$0.00	$0.00	$120.31	$190.58	$192.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5785-0-002	SUP	Custom 27203010		5785-0-002  -  FORCEP SURG LNG SCR	BOTH IP/OP	$67.38 	$49.86	$0.00	$53.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.01	$50.01	$0.00	$0.00	$14.04	$0.00	$0.00	$0.00	$0.00	$33.69	$53.36	$53.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5785-0-003	SUP	Custom 27203010		5785-0-003  -  FORCEP SURG ICS PLT	BOTH IP/OP	$287.38 	$212.66	$0.00	$229.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.29	$213.29	$0.00	$0.00	$59.89	$0.00	$0.00	$0.00	$0.00	$143.69	$227.60	$229.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
58-12004E	SUP	HCPCS C1713		58-12004E  -  SCREW BONE 1.2MM 4MM HAND WRST STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-12005E	SUP	HCPCS C1713		58-12005E  -  SCREW BONE 1.2MM 5MM HAND WRST STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-12006E	SUP	HCPCS C1713		58-12006E  -  SCREW BONE 1.2MM 6MM HAND WRST STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-12007E	SUP	HCPCS C1713		58-12007E  -  SCREW BONE 1.2MM 7MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-12008E	SUP	HCPCS C1713		58-12008E  -  SCREW BONE 1.2MM 8MM HAND	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-12009E	SUP	HCPCS C1713		58-12009E  -  SCREW BONE 1.2MM 9MM STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-12010E	SUP	HCPCS C1713		58-12010E  -  SCREW BONE 1.2MM 10MM	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-12012E	SUP	HCPCS C1713		58-12012E  -  SCREW BONE 1.2MM 12MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-12014E	SUP	HCPCS C1713		58-12014E  -  SCREW BONE 1.2MM 14MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-12016E	SUP	HCPCS C1713		58-12016E  -  SCREW BONE 1.2MM 16MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-12018E	SUP	HCPCS C1713		58-12018E  -  SCREW BONE 1.2MM 18MM WR HND NLCKG STR CROSSPIN STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-12020E	SUP	HCPCS C1713		58-12020E  -  SCREW BONE 1.2MM 20MM WR HND NLCKG STR CROSSPIN STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-14003E	SUP	HCPCS C1713		58-14003E  -  SCREW BONE 1.4MM 3MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
58-14005E	SUP	HCPCS C1713		58-14005E  -  SCREW BONE 1.4MM 5MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
58-14007E	SUP	HCPCS C1713		58-14007E  -  SCREW BONE 1.4MM 7MM WR HND ER NLCKG STR CROSSPIN STRL	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
58-14009E	SUP	HCPCS C1713		58-14009E  -  SCREW BONE 1.4MM 9MM IMPL ER STRL	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
58-17005	SUP	HCPCS C1713		58-17005  -  SCREW BONE 1.7MM 5MM HAND	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17005E	SUP	HCPCS C1713		58-17005E  -  SCREW BONE 1.7MM 5MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-17006	SUP	HCPCS C1713		58-17006  -  SCREW BONE 1.7MM 6MM	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17007	SUP	HCPCS C1713		58-17007  -  SCREW BN 1.7MM 7MM HND	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17008	SUP	HCPCS C1713		58-17008  -  SCREW BONE 1.7MM 8MM HAND	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17008E	SUP	HCPCS C1713		58-17008E  -  SCREW BONE 1.7MM 8MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$110.00 	$81.40	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$22.93	$81.64	$81.64	$0.00	$0.00	$22.92	$0.00	$65.07	$65.07	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-17009	SUP	HCPCS C1713		58-17009  -  SCREW BONE 1.7MM 9MM	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17010	SUP	HCPCS C1713		58-17010  -  SCREW BONE 1.7MM 10MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17011	SUP	HCPCS C1713		58-17011  -  SCREW BONE 1.7MM 11MM HAND	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17012	SUP	HCPCS C1713		58-17012  -  SCREW BONE 1.7MM 12MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17013	SUP	HCPCS C1713		58-17013  -  SCREW BONE 1.7MM 13MM	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17013E	SUP	HCPCS C1713		58-17013E  -  SCREW BONE 1.7MM 13MM HAND WRST SLFTAP STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-17014	SUP	HCPCS C1713		58-17014  -  SCREW BONE 1.7MM 14MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17015	SUP	HCPCS C1713		58-17015  -  SCREW BONE 1.7MM 15MM XPIN	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17015E	SUP	HCPCS C1713		58-17015E  -  SCREW BONE 1.7MM 15MM HAND WRST SLFTAP STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-17016	SUP	HCPCS C1713		58-17016  -  SCREW BONE 1.7MM 16MM XPIN	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17018	SUP	HCPCS C1713		58-17018  -  SCREW BONE 1.7MM 18MM HAND	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17018E	SUP	HCPCS C1713		58-17018E  -  SCREW BONE 1.7MM 18MM HAND WRST SLFTAP STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-17020	SUP	HCPCS C1713		58-17020  -  SCREW BN 1.7MM 20MM NS VARIAX ST XPN	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17020E	SUP	HCPCS C1713		58-17020E  -  SCREW BONE 1.7MM 20MM HAND WRST SLFTAP STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-17022	SUP	HCPCS C1713		58-17022  -  SCREW BONE 1.7MM 22MM HAND	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17022E	SUP	HCPCS C1713		58-17022E  -  SCREW BONE 1.7MM 22MM HAND WRST SLFTAP STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-17024	SUP	HCPCS C1713		58-17024  -  SCREW BONE 1.7MM 24MM	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-17024E	SUP	HCPCS C1713		58-17024E  -  SCREW BONE 1.7MM 24MM HAND WRST SLFTAP STRL	BOTH IP/OP	$116.20 	$85.99	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.22	$86.24	$86.24	$0.00	$0.00	$24.22	$0.00	$68.73	$68.73	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-19005	SUP	HCPCS C1713		58-19005  -  SCREW BONE 1.9MM 5MM ER	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-19005E	SUP	HCPCS C1713		58-19005E  -  SCREW BONE 1.9MM 5MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
58-19008	SUP	HCPCS C1713		58-19008  -  SCREW BONE 1.9MM 8MM ER	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-19008E	SUP	HCPCS C1713		58-19008E  -  SCREW BONE 1.9MM 8MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
58-19010	SUP	HCPCS C1713		58-19010  -  SCREW BONE 2.5MM 10MM	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
58-19010E	SUP	HCPCS C1713		58-19010E  -  SCREW BONE 1.9MM 10MM CANC WR HND ER NLCKG STR CROSSPIN STRL	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
58-19012	SUP	HCPCS C1713		58-19012  -  SCREW BONE 1.9MM 12MM ER	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$43.31	$43.31	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
5820-009-030	SUP	Custom 27203010		5820-009-030  -  BURR SURG 3MM PRECISION	BOTH IP/OP	$505.88 	$374.35	$0.00	$404.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$375.46	$375.46	$0.00	$0.00	$105.42	$0.00	$0.00	$0.00	$0.00	$252.94	$400.66	$404.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820-009-040	SUP	Custom 27203010		5820-009-040  -  BURR SURG 4MM PRECISION	BOTH IP/OP	$505.88 	$374.35	$0.00	$404.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$375.46	$375.46	$0.00	$0.00	$105.42	$0.00	$0.00	$0.00	$0.00	$252.94	$400.66	$404.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820-009-050	SUP	Custom 27203010		5820-009-050  -  BURR SURG 5MM PRECISION	BOTH IP/OP	$505.88 	$374.35	$0.00	$404.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$375.46	$375.46	$0.00	$0.00	$105.42	$0.00	$0.00	$0.00	$0.00	$252.94	$400.66	$404.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820-010-120	SUP	Custom 27203010		5820-010-120  -  BURR SURG ROUND FLUTE 2MM 5 NOTCH SOFT TOUCH SMOOTH CUT GOOD	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820-010-130	SUP	Custom 27203010		5820-010-130  -  BURR SURG ROUND FLUTE 3MM 5 NOTCH SOFT TOUCH SMOOTH CUT GOOD	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820-010-140	SUP	Custom 27203010		5820-010-140  -  BURR SURG ROUND 4MM ROUND SOFT TOUCH LATEX FREE ELITE	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820-012-030	SUP	Custom 27203010		5820-012-030  -  BURR SURG ROUND DIAMOND 3MM 5 STEP NOTCH NUMBERED SAFETY	BOTH IP/OP	$303.78 	$224.80	$0.00	$225.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.46	$225.46	$0.00	$0.00	$63.31	$0.00	$0.00	$0.00	$0.00	$132.21	$209.43	$211.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820-012-040	SUP	Custom 27203010		5820-012-040  -  BURR SURG ROUND DIAMOND 4MM 5 NOTCH SMOOTH CUT GOOD CONTROL	BOTH IP/OP	$303.78 	$224.80	$0.00	$243.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.46	$225.46	$0.00	$0.00	$63.31	$0.00	$0.00	$0.00	$0.00	$151.89	$240.59	$243.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820-015-050	SUP	Custom 27203010		5820-015-050  -  BURR 5.0MM EGG BURR	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820-015-060	SUP	Custom 27203010		5820-015-060  -  BURR 6.0MM EGG	BOTH IP/OP	$310.50 	$229.77	$0.00	$248.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.45	$230.45	$0.00	$0.00	$64.71	$0.00	$0.00	$0.00	$0.00	$155.25	$245.92	$248.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820107430S1	SUP	Custom 27203010		5820107430S1  -  BIT DRILL 3MM 3.8MM LESS AGGRESSIVE NEURO STERILE	BOTH IP/OP	$300.30 	$222.22	$0.00	$240.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.88	$222.88	$0.00	$0.00	$62.58	$0.00	$0.00	$0.00	$0.00	$150.15	$237.84	$240.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5820107530S3	SUP	Custom 27203010		5820107530S3  -  BIT DRILL 1.7MM NEURO	BOTH IP/OP	$288.75 	$213.68	$0.00	$231.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.31	$214.31	$0.00	$0.00	$60.18	$0.00	$0.00	$0.00	$0.00	$144.38	$228.69	$231.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
58-23006	SUP	HCPCS C1713		58-23006  -  SCREW BONE 2.3MM 6MM HAND NLCKG SLFTAP CROSSPIN	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23008	SUP	HCPCS C1713		58-23008  -  SCREW BONE 2.3MM 8MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23009	SUP	HCPCS C1713		58-23009  -  SCREW BONE 2.3MM 9MM HAND	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23009E	SUP	HCPCS C1713		58-23009E  -  SCREW BONE 2.3MM 9MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.90 	$86.51	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.36	$86.76	$86.76	$0.00	$0.00	$24.36	$0.00	$69.15	$69.15	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23010	SUP	HCPCS C1713		58-23010  -  SCREW BONE 2.3MM 10MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23011	SUP	HCPCS C1713		58-23011  -  SCREW BONE 2.3MM 11MM HAND	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23011E	SUP	HCPCS C1713		58-23011E  -  SCREW BONE 2.3MM 11MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.90 	$86.51	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.36	$86.76	$86.76	$0.00	$0.00	$24.36	$0.00	$69.15	$69.15	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23012	SUP	HCPCS C1713		58-23012  -  SCREW BONE 2.3MM 12MM HAND NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23012E	SUP	HCPCS C1713		58-23012E  -  SCREW BN 2.3MM 12MM STRL VARIAX PRFL ST LOPRFL RND XPN HD TI	BOTH IP/OP	$116.90 	$86.51	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.36	$86.76	$86.76	$0.00	$0.00	$24.36	$0.00	$69.15	$69.15	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23013E	SUP	HCPCS C1713		58-23013E  -  SCREW BONE 2.3MM 13MM NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.90 	$86.51	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.36	$86.76	$86.76	$0.00	$0.00	$24.36	$0.00	$69.15	$69.15	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23014	SUP	HCPCS C1713		58-23014  -  SCREW BONE 2.3MM 14MM NLCKG XPIN	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23014E	SUP	HCPCS C1713		58-23014E  -  SCREW BN 2.3MM 14MM STRL VARIAX PRFL ST LOPRFL RND XPN HD TI	BOTH IP/OP	$116.90 	$86.51	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.36	$86.76	$86.76	$0.00	$0.00	$24.36	$0.00	$69.15	$69.15	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23015	SUP	HCPCS C1713		58-23015  -  SCREW BONE 2.3MM 15MM NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$110.00 	$81.40	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$22.93	$81.64	$81.64	$0.00	$0.00	$22.92	$0.00	$65.07	$65.07	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23015E	SUP	HCPCS C1713		58-23015E  -  SCREW BONE 2.3MM 15MM NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.90 	$86.51	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.36	$86.76	$86.76	$0.00	$0.00	$24.36	$0.00	$69.15	$69.15	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23016	SUP	HCPCS C1713		58-23016  -  SCREW BONE 2.3MM 16MM NLCKG XPIN	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23016E	SUP	HCPCS C1713		58-23016E  -  SCREW BONE 2.3MM 16MM NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.90 	$86.51	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.36	$86.76	$86.76	$0.00	$0.00	$24.36	$0.00	$69.15	$69.15	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23018	SUP	HCPCS C1713		58-23018  -  SCREW BONE 2.3MM 18MM HAND NLCKG SLFTAP CROSSPIN	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23018E	SUP	HCPCS C1713		58-23018E  -  SCREW BONE 2.3MM 18MM NLCKG SLFTAP CROSSPIN	BOTH IP/OP	$116.90 	$86.51	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.36	$86.76	$86.76	$0.00	$0.00	$24.36	$0.00	$69.15	$69.15	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23020	SUP	HCPCS C1713		58-23020  -  SCREW BONE 2.3MM 20MM HAND	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23020E	SUP	HCPCS C1713		58-23020E  -  SCREW BONE 2.3MM 20MM WR HND NLCKG STR CROSSPIN STRL	BOTH IP/OP	$116.90 	$86.51	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.36	$86.76	$86.76	$0.00	$0.00	$24.36	$0.00	$69.15	$69.15	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23022	SUP	HCPCS C1713		58-23022  -  SCREW BONE 2.3MM 22MM ORTH	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23022E	SUP	HCPCS C1713		58-23022E  -  SCREW BONE 2.3MM 22MM HAND WRST SLFTAP STRL	BOTH IP/OP	$116.90 	$86.51	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.36	$86.76	$86.76	$0.00	$0.00	$24.36	$0.00	$69.15	$69.15	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23024	SUP	HCPCS C1713		58-23024  -  SCREW BONE 2.3MM 24MM	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23024E	SUP	HCPCS C1713		58-23024E  -  SCREW BONE 2.3MM 24MM HAND WRST SLFTAP STRL	BOTH IP/OP	$116.90 	$86.51	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.36	$86.76	$86.76	$0.00	$0.00	$24.36	$0.00	$69.15	$69.15	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23026	SUP	HCPCS C1713		58-23026  -  SCREW BONE 2.3MM 26MM	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-23026E	SUP	HCPCS C1713		58-23026E  -  SCREW BONE 2.3MM 26MM WR HND NLCKG STR CROSSPIN STRL	BOTH IP/OP	$116.90 	$86.51	$0.00	$88.00	$49.50	$49.50	$0.00	$0.00	$0.00	$24.36	$86.76	$86.76	$0.00	$0.00	$24.36	$0.00	$69.15	$69.15	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-25006	SUP	HCPCS C1713		58-25006  -  SCREW BONE 2.5MM 6MM ER	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-25006E	SUP	HCPCS C1713		58-25006E  -  SCREW BONE 2.5MM 6MM CANC WR HND ER NLCKG STR CROSSPIN STRL	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
58-25008	SUP	HCPCS C1713		58-25008  -  SCREW BONE 2.5MM 8MM ER	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-25008E	SUP	HCPCS C1713		58-25008E  -  SCREW BONE 2.5MM 8MM CANC WR HND ER NLCKG STR CROSSPIN STRL	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
58-25010	SUP	HCPCS C1713		58-25010  -  SCREW BONE 2.5MM 10MM ER	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-25010E	SUP	HCPCS C1713		58-25010E  -  SCREW BONE 2.5MM 10MM NLCKG SLFTAP CROSSPIN STRL	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
58-25012	SUP	HCPCS C1713		58-25012  -  SCREW BONE 2.5MM 12MM ER	BOTH IP/OP	$120.40 	$89.10	$0.00	$89.36	$49.50	$49.50	$0.00	$0.00	$0.00	$25.09	$89.36	$89.36	$0.00	$0.00	$25.09	$0.00	$71.22	$71.22	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$17.22	$0.00	$0.00	$17.51	$0.00	$0.00	$0.00	$0.00	$0.00
58-25012E	SUP	HCPCS C1713		58-25012E  -  SCREW BONE 2.5MM 12MM CANC WR HND ER NLCKG STR CROSSPIN STRL	BOTH IP/OP	$116.88 	$86.49	$0.00	$93.50	$52.59	$52.59	$0.00	$0.00	$0.00	$24.36	$86.74	$86.74	$0.00	$0.00	$24.36	$0.00	$69.13	$69.13	$0.00	$58.44	$92.57	$93.50	$0.00		$0.00	$18.29	$0.00	$0.00	$18.61	$0.00	$0.00	$0.00	$0.00	$0.00
5858-0-000	SUP	Custom 27203010		5858-0-000  -  GAUGE DEPTH SCR	BOTH IP/OP	"$1,024.38 "	$758.04	$0.00	$819.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$760.29	$760.29	$0.00	$0.00	$213.48	$0.00	$0.00	$0.00	$0.00	$512.19	$811.31	$819.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5866-45	SUP	Custom 27203010		5866-45  -  SLEEVE LEAD ACCES	BOTH IP/OP	$47.50 	$35.15	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.25	$35.25	$0.00	$0.00	$9.90	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5867-3M	SUP	Custom 27203010		5867-3M  -  CAP LEAD 4.6-8.4FR 5MM 3.2MM IMPLTABLE PIN LOW PROFILE IS-1	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
59-12004	SUP	HCPCS C1713		59-12004  -  SCREW BONE 1.2MM 4MM PRFL TI HAND MDLR SM FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12005	SUP	HCPCS C1713		59-12005  -  SCREW BONE 1.2MM 5MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12006	SUP	HCPCS C1713		59-12006  -  SCREW BONE 1.2MM 6MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12007	SUP	HCPCS C1713		59-12007  -  SCREW BONE 1.2MM 7MM PRFL TI HAND MDLR SM FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12008	SUP	HCPCS C1713		59-12008  -  SCREW BONE 1.2MM 8MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12009	SUP	HCPCS C1713		59-12009  -  SCREW BONE 1.2MM 9MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12010	SUP	HCPCS C1713		59-12010  -  SCREW BONE 1.2MM 10MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12011	SUP	HCPCS C1713		59-12011  -  SCREW BONE 1.2MM 11MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12012	SUP	HCPCS C1713		59-12012  -  SCREW BONE 1.2MM 12MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12013	SUP	HCPCS C1713		59-12013  -  SCREW BONE 1.2MM 13MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12014	SUP	HCPCS C1713		59-12014  -  SCREW BONE 1.2MM 14MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$50.74	$50.74	$0.00	$0.00	$0.00	$23.50	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$66.69	$66.69	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12016	SUP	HCPCS C1713		59-12016  -  SCREW BONE 1.2MM 16MM PRFL TI HAND WRST SLFTAP XFIT SM FRAG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$50.74	$50.74	$0.00	$0.00	$0.00	$23.50	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$66.69	$66.69	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12018	SUP	HCPCS C1713		59-12018  -  PLATE 18MM TI SLFTAP XFIT PRFL BONE 1.2MM HAND	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$50.74	$50.74	$0.00	$0.00	$0.00	$23.50	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$66.69	$66.69	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12020	SUP	HCPCS C1713		59-12020  -  PLATE 20MM TI SLFTAP XFIT PRFL BONE 1.2MM HAND	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$50.74	$50.74	$0.00	$0.00	$0.00	$23.50	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$66.69	$66.69	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-12049	SUP	HCPCS C1713		59-12049  -  WASHER 1.2MM WRST PRFL ORTH	BOTH IP/OP	$53.20 	$39.37	$0.00	$39.49	$21.66	$21.66	$0.00	$0.00	$0.00	$11.09	$39.49	$39.49	$0.00	$0.00	$11.09	$0.00	$31.47	$31.47	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
59-12049E	SUP	HCPCS C1713		59-12049E  -  WASHER FOR 1.2 MM BONE SCREWS	BOTH IP/OP	$53.20 	$39.37	$0.00	$39.49	$18.56	$18.56	$0.00	$0.00	$0.00	$11.09	$39.49	$39.49	$0.00	$0.00	$11.09	$0.00	$31.47	$31.47	$0.00	$20.63	$32.67	$33.00	$0.00		$0.00	$6.46	$0.00	$0.00	$6.57	$0.00	$0.00	$0.00	$0.00	$0.00
59-14003	SUP	HCPCS C1713		59-14003  -  SCREW BONE 1.4MM 3MM PRFL TI HAND SLFTAP XFIT ER SM FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
59-14005	SUP	HCPCS C1713		59-14005  -  SCREW BONE 1.4MM 5MM PRFL TI HAND SLFTAP XFIT ER SM FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
59-14007	SUP	HCPCS C1713		59-14007  -  SCREW BONE 1.4MM 7MM PRFL TI HAND SLFTAP XFIT ER SM FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
59-14009	SUP	HCPCS C1713		59-14009  -  SCREW BONE 1.4MM 9MM PRFL TI HAND SLFTAP XFIT ER SM FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
59-17005	SUP	HCPCS C1713		59-17005  -  SCREW BONE 1.7MM 5MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17006	SUP	HCPCS C1713		59-17006  -  SCREW BONE 1.7MM 6MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17007	SUP	HCPCS C1713		59-17007  -  SCREW BONE 1.7MM 7MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$50.74	$50.74	$0.00	$0.00	$0.00	$23.50	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$66.69	$66.69	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17008	SUP	HCPCS C1713		59-17008  -  SCREW BONE 1.7MM 8MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$50.74	$50.74	$0.00	$0.00	$0.00	$23.50	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$66.69	$66.69	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17009	SUP	HCPCS C1713		59-17009  -  SCREW BONE 1.7MM 9MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$50.74	$50.74	$0.00	$0.00	$0.00	$23.50	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$66.69	$66.69	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17010	SUP	HCPCS C1713		59-17010  -  SCREW BONE 1.7MM 10MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$50.74	$50.74	$0.00	$0.00	$0.00	$23.50	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$66.69	$66.69	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17011	SUP	HCPCS C1713		59-17011  -  SCREW BONE 1.7MM 11MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$50.74	$50.74	$0.00	$0.00	$0.00	$23.50	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$66.69	$66.69	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17012	SUP	HCPCS C1713		59-17012  -  SCREW BONE 1.7MM 12MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$112.75 	$83.44	$0.00	$90.20	$50.74	$50.74	$0.00	$0.00	$0.00	$23.50	$83.68	$83.68	$0.00	$0.00	$23.50	$0.00	$66.69	$66.69	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17013	SUP	HCPCS C1713		59-17013  -  SCREW BONE 1.7MM 13MM PRFL TI HAND MDLR	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17014	SUP	HCPCS C1713		59-17014  -  SCREW BONE 1.7MM 14MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17015	SUP	HCPCS C1713		59-17015  -  SCREW BONE 1.7MM 15MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$43.31	$43.31	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$48.13	$76.23	$77.00	$0.00		$0.00	$15.06	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$0.00
59-17016	SUP	HCPCS C1713		59-17016  -  SCREW BONE 1.7MM 16MM PRFL TI HAND MDLR SM FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17017	SUP	HCPCS C1713		59-17017  -  SCREW BONE 1.7MM 17MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17018	SUP	HCPCS C1713		59-17018  -  SCREW BONE 1.7MM 18MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17019	SUP	HCPCS C1713		59-17019  -  SCREW BONE 1.7MM 19MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17020	SUP	HCPCS C1713		59-17020  -  SCREW BONE 1.7MM 20MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17021	SUP	HCPCS C1713		59-17021  -  SCREW BONE 1.7MM 21MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17022	SUP	HCPCS C1713		59-17022  -  SCREW BONE 1.7MM 22MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17023	SUP	HCPCS C1713		59-17023  -  SCREW BONE 1.7MM 23MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17024	SUP	HCPCS C1713		59-17024  -  SCREW BONE 1.7MM 24MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-17049	SUP	HCPCS C1713		59-17049  -  WASHER 1.7MM PRFL ORTH TI	BOTH IP/OP	$53.20 	$39.37	$0.00	$39.49	$21.66	$21.66	$0.00	$0.00	$0.00	$11.09	$39.49	$39.49	$0.00	$0.00	$11.09	$0.00	$31.47	$31.47	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
59-17049E	SUP	HCPCS C1713		59-17049E  -  WASHER HAND WRST ORTH 1.7 MM SCR STRL	BOTH IP/OP	$53.20 	$39.37	$0.00	$39.49	$18.56	$18.56	$0.00	$0.00	$0.00	$11.09	$39.49	$39.49	$0.00	$0.00	$11.09	$0.00	$31.47	$31.47	$0.00	$20.63	$32.67	$33.00	$0.00		$0.00	$6.46	$0.00	$0.00	$6.57	$0.00	$0.00	$0.00	$0.00	$0.00
59-19005	SUP	HCPCS C1713		59-19005  -  SCREW BONE 1.9MM 5MM PRFL TI HAND XFIT SLFTAP ER SM FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
59-19008	SUP	HCPCS C1713		59-19008  -  SCREW BONE 1.9MM 8MM PRFL TI HAND XFIT SLFTAP ER SM FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
59-19010	SUP	HCPCS C1713		59-19010  -  SCREW BONE 1.9MM 10MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
59-19012	SUP	HCPCS C1713		59-19012  -  SCREW BONE 1.9MM 12MM PRFL TI HAND XFIT SLFTAP ER SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
59-23006	SUP	HCPCS C1713		59-23006  -  SCREW BONE 2.3MM 6MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23007	SUP	HCPCS C1713		59-23007  -  SCREW BONE 2.3MM 7MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23008	SUP	HCPCS C1713		59-23008  -  SCREW BONE 2.3MM 8MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23009	SUP	HCPCS C1713		59-23009  -  SCREW BONE 2.3MM 9MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23010	SUP	HCPCS C1713		59-23010  -  SCREW BONE 2.3MM 10MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23011	SUP	HCPCS C1713		59-23011  -  SCREW BONE 2.3MM 11MM PRFL TI HAND SLFTAP XFIT SM FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23012	SUP	HCPCS C1713		59-23012  -  SCREW BONE 2.3MM 12MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23013	SUP	HCPCS C1713		59-23013  -  SCREW BONE 2.3MM 13MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23014	SUP	HCPCS C1713		59-23014  -  SCREW BONE 2.3MM 14MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23015	SUP	HCPCS C1713		59-23015  -  SCREW BONE 2.3MM 15MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23016	SUP	HCPCS C1713		59-23016  -  SCREW BONE 2.3MM 16MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23017	SUP	HCPCS C1713		59-23017  -  SCREW BONE 2.3MM 17MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23018	SUP	HCPCS C1713		59-23018  -  SCREW BONE 2.3MM 18MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23019	SUP	HCPCS C1713		59-23019  -  SCREW BONE 2.3MM 19MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23020	SUP	HCPCS C1713		59-23020  -  SCREW BONE 2.3MM 20MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23021	SUP	HCPCS C1713		59-23021  -  SCREW BONE 2.3MM 21MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23022	SUP	HCPCS C1713		59-23022  -  SCREW BONE 2.3MM 22MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23023	SUP	HCPCS C1713		59-23023  -  SCREW BONE 2.3MM 23MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23024	SUP	HCPCS C1713		59-23024  -  SCREW BONE 2.3MM 24MM PRFL TI HAND SLFTAP XFIT	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23026	SUP	HCPCS C1713		59-23026  -  SCREW BONE 2.3MM 26MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23028	SUP	HCPCS C1713		59-23028  -  SCREW BONE 2.3MM 28MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23030	SUP	HCPCS C1713		59-23030  -  SCREW BONE 2.3MM 30MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23032	SUP	HCPCS C1713		59-23032  -  SCREW BONE 2.3MM 32MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23034	SUP	HCPCS C1713		59-23034  -  SCREW BONE 2.3MM 34MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23036	SUP	HCPCS C1713		59-23036  -  SCREW BONE 2.3MM 36MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23038	SUP	HCPCS C1713		59-23038  -  SCREW BONE 2.3MM 38MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$93.52	$50.74	$50.74	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$56.38	$89.30	$90.20	$0.00		$0.00	$17.65	$0.00	$0.00	$17.95	$0.00	$0.00	$0.00	$0.00	$0.00
59-23049	SUP	HCPCS C1713		59-23049  -  WASHER 2.3MM PLT PRFL ORTH NONSTRL	BOTH IP/OP	$53.20 	$39.37	$0.00	$39.49	$21.66	$21.66	$0.00	$0.00	$0.00	$11.09	$39.49	$39.49	$0.00	$0.00	$11.09	$0.00	$31.47	$31.47	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
59-23049E	SUP	HCPCS C1713		59-23049E  -  WASHER BONE ORTH 2.3 MM SCR STRL	BOTH IP/OP	$53.20 	$39.37	$0.00	$39.49	$18.56	$18.56	$0.00	$0.00	$0.00	$11.09	$39.49	$39.49	$0.00	$0.00	$11.09	$0.00	$31.47	$31.47	$0.00	$20.63	$32.67	$33.00	$0.00		$0.00	$6.46	$0.00	$0.00	$6.57	$0.00	$0.00	$0.00	$0.00	$0.00
59-25006	SUP	HCPCS C1713		59-25006  -  SCREW BONE 2.5MM 6MM PRFL TI HAND MDLR XFIT SLFTAP ER SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
59-25008	SUP	HCPCS C1713		59-25008  -  SCREW BONE 2.5MM 8MM PRFL TI HAND ER SM FRAG SYS	BOTH IP/OP	$126.00 	$93.24	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
59-25010	SUP	HCPCS C1713		59-25010  -  SCREW BONE 2.5MM 10MM PRFL TI HAND MDLR XFIT SLFTAP ER SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
59-25012	SUP	HCPCS C1713		59-25012  -  SCREW BONE 2.5MM 12MM PRFL TI HAND MDLR XFIT SLFTAP ER SM	BOTH IP/OP	$126.00 	$93.24	$0.00	$96.80	$54.45	$54.45	$0.00	$0.00	$0.00	$26.26	$93.52	$93.52	$0.00	$0.00	$26.26	$0.00	$74.53	$74.53	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
595000S	SUP	HCPCS C1713		595000S  -  SCREW BONE OHS OCS ORTH HIP CMPR	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$44.55	$44.55	$0.00	$0.00	$0.00	$20.63	$73.48	$73.48	$0.00	$0.00	$20.63	$0.00	$58.56	$58.56	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$15.49	$0.00	$0.00	$15.76	$0.00	$0.00	$0.00	$0.00	$0.00
596001S	SUP	HCPCS C1713		596001S  -  SCREW BONE 3MM 32.2MM OMEGA 2 SS ORTH HIP CMPR STRL	BOTH IP/OP	$116.80 	$86.43	$0.00	$104.50	$58.78	$58.78	$0.00	$0.00	$0.00	$24.34	$86.69	$86.69	$0.00	$0.00	$24.34	$0.00	$69.09	$69.09	$0.00	$65.31	$103.46	$104.50	$0.00		$0.00	$20.44	$0.00	$0.00	$20.80	$0.00	$0.00	$0.00	$0.00	$0.00
597002S	SUP	HCPCS C1713		597002S  -  PLATE 130D STD BRL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597003S	SUP	HCPCS C1713		597003S  -  SCREW BONE 47MM OMEGA 3 130D STD BRL HIP 3 HOLE CMPR KEY	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597004S	SUP	HCPCS C1713		597004S  -  PLATE 130D STD BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597005S	SUP	HCPCS C1713		597005S  -  PLATE 130D STD BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597006S	SUP	HCPCS C1713		597006S  -  PLATE 130D 111MM SS 6 HOLE STD BRL KEY OMEGA 3 BONE HIP	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597008S	SUP	HCPCS C1713		597008S  -  PLATE 130D STD BRL 143MM SS 8 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597010S	SUP	HCPCS C1713		597010S  -  PLATE 130D STD BRL 175MM SS 10 HOLE KEY OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597012S	SUP	HCPCS C1713		597012S  -  PLATE 130D STD BRL 207MM SS 12 HOLE KEY OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597022S	SUP	HCPCS C1713		597022S  -  PLATE 135D STD BRL 47MM SS SYS 2 HOLE KEY LP OMEGA3 CHS BONE	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597023S	SUP	HCPCS C1713		597023S  -  PLATE 135D STD BRL 63MM SS 3 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597024S	SUP	HCPCS C1713		597024S  -  PLATE 130D STD BRL OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597025S	SUP	HCPCS C1713		597025S  -  PLATE 135D STD BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597026S	SUP	HCPCS C1713		597026S  -  PLATE 135D STD BRL 111MM SS 6 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597028S	SUP	HCPCS C1713		597028S  -  PLATE 135D STD BRL 143MM SS 8 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597030S	SUP	HCPCS C1713		597030S  -  PLATE 135D STD BRL 175MM SS 10 HOLE KEY OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597032S	SUP	HCPCS C1713		597032S  -  PLATE 135D STD BRL 207MM SS 12 HOLE KEY OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597042S	SUP	HCPCS C1713		597042S  -  PLATE 140D STD BRL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597043S	SUP	HCPCS C1713		597043S  -  PLATE 140D STD BRL 63MM SS 3 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597044S	SUP	HCPCS C1713		597044S  -  PLATE 140D STD BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597045S	SUP	HCPCS C1713		597045S  -  PLATE 140D STD BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597046S	SUP	HCPCS C1713		597046S  -  PLATE 140D STD BRL 111MM SS 6 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597048S	SUP	HCPCS C1713		597048S  -  PLATE 140D STD BRL 143MM SS 8 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597050S	SUP	HCPCS C1713		597050S  -  PLATE 140D STD BRL 175MM SS 10 HOLE KEY OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597052S	SUP	HCPCS C1713		597052S  -  PLATE 140D STD BRL 207MM SS 12 HOLE KEY OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597062S	SUP	HCPCS C1713		597062S  -  PLATE 145D STD BRL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597063S	SUP	HCPCS C1713		597063S  -  PLATE 145D STD BRL 63MM SS 3 HOLE ANG KYLS CMPR OMEGA 3 BONE	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597064S	SUP	HCPCS C1713		597064S  -  PLATE 145D STD BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597065S	SUP	HCPCS C1713		597065S  -  PLATE 145D STD BRL 95MM 5 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597066S	SUP	HCPCS C1713		597066S  -  PLATE 145D STD BRL 111MM SS 6 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597068S	SUP	HCPCS C1713		597068S  -  PLATE 145D STD BRL 143MM SS 8 HOLE ANG KYLS CMPR OMEGA 3	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597070S	SUP	HCPCS C1713		597070S  -  PLATE 145D STD BRL 175MM SS 10 HOLE ANG KYLS CMPR OMEGA 3	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597072S	SUP	HCPCS C1713		597072S  -  PLATE 145D STD BRL 207MM SS 12 HOLE ANG KYLS CMPR OMEGA 3	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597082S	SUP	HCPCS C1713		597082S  -  PLATE 150D STD BRL 47MM SS 2 HOLE ANG KYLS CMPR OMEGA 3 BONE	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597083S	SUP	HCPCS C1713		597083S  -  PLATE 150D STD BRL 63MM SS 3 HOLE ANG KYLS CMPR OMEGA 3 BONE	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597084S	SUP	HCPCS C1713		597084S  -  PLATE 150D STD BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597085S	SUP	HCPCS C1713		597085S  -  PLATE 150D STD BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597086S	SUP	HCPCS C1713		597086S  -  PLATE 150D STD BRL 111MM SS 6 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597088S	SUP	HCPCS C1713		597088S  -  PLATE 150D STD BRL 143MM SS 8 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597090S	SUP	HCPCS C1713		597090S  -  PLATE 150D STD BRL 175MM SS 10 HOLE ANG KYLS CMPR OMEGA 3	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597092S	SUP	HCPCS C1713		597092S  -  PLATE 150D STD BRL 207MM SS 12 HOLE ANG KYLS CMPR OMEGA 3	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597102S	SUP	HCPCS C1713		597102S  -  PLATE 130D STD BRL 47MM SS 2 HOLE KYLS LP OMEGA 3 BONE HIP	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597103S	SUP	HCPCS C1713		597103S  -  PLATE 130D STD BRL SS 3 HOLE OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597104S	SUP	HCPCS C1713		597104S  -  PLATE 135D STD BRL 32MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597105S	SUP	HCPCS C1713		597105S  -  PLATE 130D STD BRL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597106S	SUP	HCPCS C1713		597106S  -  PLATE 130D STD BRL 111MM SS 6 HOLE KYLS LP OMEGA 3 BONE HIP	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597108S	SUP	HCPCS C1713		597108S  -  PLATE 130D STD BRL 143MM SS 8 HOLE LP KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597110S	SUP	HCPCS C1713		597110S  -  PLATE 130D STD BRL 10 HOLE KYLS OMEGA 3 BONE HIP STRL	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597112S	SUP	HCPCS C1713		597112S  -  PLATE 130D STD BRL 207MM SS 12 HOLE ANG KYLS CMPR OMEGA 3	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597122S	SUP	HCPCS C1713		597122S  -  PLATE 135D STD BRL 47MM SS 2 HOLE KYLS LP OMEGA 3 BONE HIP	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597123S	SUP	HCPCS C1713		597123S  -  PLATE 135D 3 HOLE OMEGA 3 BONE KNEE STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597124S	SUP	HCPCS C1713		597124S  -  PLATE 135D STD BRL 79MM SS 4 HOLE KYLS OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597125S	SUP	HCPCS C1713		597125S  -  PLATE 135D 5 HOLE OMEGA 3 BONE STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597126S	SUP	HCPCS C1713		597126S  -  PLATE STD BRL KYLS OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597128S	SUP	HCPCS C1713		597128S  -  PLATE 8 HOLE OMEGA 3 BONE HIP STRL	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597130S	SUP	HCPCS C1713		597130S  -  PLATE 135D STD BRL 175MM SS 10 HOLE KYLS LP OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597132S	SUP	HCPCS C1713		597132S  -  PLATE 135D STD BRL 135MM 12 HOLE KYLS LP OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597142S	SUP	HCPCS C1713		597142S  -  PLATE 140D STD BRL 47MM SS 2 HOLE ANG KYLS CMPR OMEGA 3 BONE	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597143S	SUP	HCPCS C1713		597143S  -  PLATE 140D STD BRL 63MM SS 3 HOLE KYLS OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597144S	SUP	HCPCS C1713		597144S  -  PLATE 140D STD BRL 79MM 4 HOLE KYLS OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597145S	SUP	HCPCS C1713		597145S  -  PLATE 140D STD BRL SS 5 HOLE OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597146S	SUP	HCPCS C1713		597146S  -  PLATE 140D STD BRL 111MM 6 HOLE KYLS LP OMEGA 3 BONE HIP	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597148S	SUP	HCPCS C1713		597148S  -  PLATE 140D STD BRL 143MM 8 HOLE KYLS LP OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597150S	SUP	HCPCS C1713		597150S  -  PLATE 140D STD BRL 175MM SS 10 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597152S	SUP	HCPCS C1713		597152S  -  PLATE 140D STD BRL 207MM SS 12 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597162S	SUP	HCPCS C1713		597162S  -  PLATE 145D STD BRL 47MM SS 2 HOLE KYLS OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597163S	SUP	HCPCS C1713		597163S  -  PLATE 145D STD BRL 63MM SS 3 HOLE KYLS OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597164S	SUP	HCPCS C1713		597164S  -  PLATE STD BRL 4 HOLE KYLS OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597165S	SUP	HCPCS C1713		597165S  -  PLATE 145D STD BRL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597166S	SUP	HCPCS C1713		597166S  -  PLATE 145D STD BRL 111MM 6 HOLE KYLS LP OMEGA 3 BONE HIP	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597168S	SUP	HCPCS C1713		597168S  -  PLATE 145D STD BRL 143MM SS 8 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597170S	SUP	HCPCS C1713		597170S  -  PLATE 145D STD BRL 175MM SS 10 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597172S	SUP	HCPCS C1713		597172S  -  PLATE 145D STD BRL 207MM SS 12 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597182S	SUP	HCPCS C1713		597182S  -  PLATE 150D STD BRL 47MM SS 2 HOLE KYLS OMEGA 3 BONE HIP STRL	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597183S	SUP	HCPCS C1713		597183S  -  PLATE 150D STD BARRREL 63MM SS 3 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597184S	SUP	HCPCS C1713		597184S  -  PLATE 150D STD BARRREL 79MM SS 4 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597185S	SUP	HCPCS C1713		597185S  -  PLATE 150D STD BARRREL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597186S	SUP	HCPCS C1713		597186S  -  PLATE 150D STD BRL 111MM 6 HOLE KYLS LP OMEGA 3 BONE HIP	BOTH IP/OP	$749.38 	$554.54	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$156.19	$556.19	$556.19	$0.00	$0.00	$156.17	$0.00	$443.26	$443.26	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597188S	SUP	HCPCS C1713		597188S  -  PLATE 150D STD BARRREL 143MM SS 8 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597190S	SUP	HCPCS C1713		597190S  -  PLATE 150D STD BARRREL 175MM SS 10 HOLE KYLS OMEGA 3 BONE	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597192S	SUP	HCPCS C1713		597192S  -  PLATE 150D STD BARRREL 207MM SS 12 HOLE KYLS OMEGA 3 BONE	BOTH IP/OP	$916.00 	$677.84	$0.00	$759.00	$426.94	$426.94	$0.00	$0.00	$0.00	$190.92	$679.86	$679.86	$0.00	$0.00	$190.89	$0.00	$541.81	$541.81	$0.00	$474.38	$751.41	$759.00	$0.00		$0.00	$148.48	$0.00	$0.00	$151.04	$0.00	$0.00	$0.00	$0.00	$0.00
597202S	SUP	HCPCS C1713		597202S  -  PLATE 130D SHRT BRL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597203S	SUP	HCPCS C1713		597203S  -  PLATE 130D SHRT BRL SS 3 HOLE ANG KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597204S	SUP	HCPCS C1713		597204S  -  PLATE 130D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597205S	SUP	HCPCS C1713		597205S  -  PLATE 130D SHRT BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597212S	SUP	HCPCS C1713		597212S  -  PLATE 135D SHRT BRL SS 2 HOLE ANG KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597213S	SUP	HCPCS C1713		597213S  -  PLATE 135D SHRT BRL SS 3 HOLE ANG KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597214S	SUP	HCPCS C1713		597214S  -  PLATE 135D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597215S	SUP	HCPCS C1713		597215S  -  PLATE 135D SHRT BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597222S	SUP	HCPCS C1713		597222S  -  PLATE 140D SHRT BARRREL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597223S	SUP	HCPCS C1713		597223S  -  PLATE 140D SHRT BARRREL 63MM SS 3 HOLE KEY OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597224S	SUP	HCPCS C1713		597224S  -  PLATE 140D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597225S	SUP	HCPCS C1713		597225S  -  PLATE 140D SHRT BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597232S	SUP	HCPCS C1713		597232S  -  PLATE 145D SHRT BARRREL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597233S	SUP	HCPCS C1713		597233S  -  PLATE 145D SHRT BARRREL 63MM SS 3 HOLE KEY OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597234S	SUP	HCPCS C1713		597234S  -  PLATE 145D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597235S	SUP	HCPCS C1713		597235S  -  PLATE 145D SHRT BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597242S	SUP	HCPCS C1713		597242S  -  PLATE 150D SHRT BARRREL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597243S	SUP	HCPCS C1713		597243S  -  PLATE 150D SHRT BARRREL 63MM SS 3 HOLE KEY OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597244S	SUP	HCPCS C1713		597244S  -  PLATE 150D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597245S	SUP	HCPCS C1713		597245S  -  PLATE 150D SHRT BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597254S	SUP	HCPCS C1713		597254S  -  PLATE 130D SHRT BRL KYLS BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597255S	SUP	HCPCS C1713		597255S  -  PLATE 130D SHRT BRL 95MM SS 5 HOLE KYLS CMPR OMEGA 3 BONE	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597264S	SUP	HCPCS C1713		597264S  -  PLATE 135D SHRT BRL 79MM 5 HOLE KYLS LP OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597265S	SUP	HCPCS C1713		597265S  -  PLATE 135D SHRT BRL 95MM SS 5 HOLE KYLS LP OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597274S	SUP	HCPCS C1713		597274S  -  PLATE 140D SHRT BRL SS 4 HOLE OMEGA 3 BONE HIP STRL	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597275S	SUP	HCPCS C1713		597275S  -  PLATE 140D SHRT BARRREL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597284S	SUP	HCPCS C1713		597284S  -  PLATE 145D SHRT BRL 79MM SS 4 HOLE KYLS LP OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597285S	SUP	HCPCS C1713		597285S  -  PLATE 145D SHRT BARRREL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597294S	SUP	HCPCS C1713		597294S  -  PLATE 150D SHRT BARRREL 79MM SS 4 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597295S	SUP	HCPCS C1713		597295S  -  PLATE 150D SHRT BARRREL 25MM SS 5 HOLE KYLS OMEGA 3 BONE HIP	BOTH IP/OP	$724.00 	$535.76	$0.00	$599.50	$337.22	$337.22	$0.00	$0.00	$0.00	$150.90	$537.35	$537.35	$0.00	$0.00	$150.88	$0.00	$428.25	$428.25	$0.00	$374.69	$593.51	$599.50	$0.00		$0.00	$117.28	$0.00	$0.00	$119.30	$0.00	$0.00	$0.00	$0.00	$0.00
597404S	SUP	HCPCS C1713		597404S  -  PLATE 135D 150MM SS 4 HOLE STAB OMEGA 3 BONE HIP STRL	BOTH IP/OP	"$1,228.00 "	$908.72	$0.00	"$1,017.50"	$572.34	$572.34	$0.00	$0.00	$0.00	$255.95	$911.42	$911.42	$0.00	$0.00	$255.92	$0.00	$726.36	$726.36	$0.00	$635.94	"$1,007.33"	"$1,017.50"	$0.00		$0.00	$199.05	$0.00	$0.00	$202.48	$0.00	$0.00	$0.00	$0.00	$0.00
5A0002	SUP	HCPCS C1725		5A0002  -  CATHETER ANGIO JR4 CRV 5FR 100CM STSR	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
5A0007	SUP	HCPCS C1725		5A0007  -  CATHETER ANGIOGRAPHIC 3DRCB CURVE 5FR 100CM SITESEER	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
5A0018	SUP	HCPCS C1725		5A0018  -  CATHETER ANGIO AL1 CRV 5FR 100CM STSR	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
5A0021	SUP	HCPCS C1725		5A0021  -  CATHETER ANGIOGRAPHIC MPA1 CURVE 5FR 100CM SITESEER	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
5A0031	SUP	HCPCS C1725		5A0031  -  CATHETER ANGIOGRAPHIC IM CURVE 5FR 100CM SITESEER	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
5A0070	SUP	HCPCS C1725		5A0070  -  CATHETER ANGIOGRAPHIC PIGTAIL 145 CURVE 5FR 110CM 6 SIDEHOLE	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
5A0084	SUP	HCPCS C1725		5A0084  -  CATHETER ANGIO JL3.5 CRV 5FR 100CM STSR	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
5A0085	SUP	HCPCS C1725		5A0085  -  CATHETER ANGIOGRAPHIC JL4 CURVE 5FR 100CM SITESEER	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
5A0087	SUP	HCPCS C1725		5A0087  -  CATHETER ANGIOGRAPHIC JL5 CURVE 5FR 100CM SITESEER	BOTH IP/OP	$21.88 	$16.19	$0.00	$17.50	$11.88	$11.88	$0.00	$0.00	$0.00	$4.56	$16.24	$16.24	$0.00	$0.00	$4.56	$0.00	$12.94	$12.94	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
5B5136	SUP	Custom 25803010		SOLUTION IV PERITONEAL	BOTH IP/OP	$123.75 	$91.58	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.88	$98.01	$99.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
5MAXACE132	SUP	HCPCS C1887		5MAXACE132  -  CATHETER REPERFUSION	BOTH IP/OP	"$5,725.00 "	"$4,236.50"	$0.00	"$6,189.46"	"$3,353.03"	"$3,353.03"	$0.00	$0.00	$0.00	"$1,193.23"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,193.09"	$0.00	"$6,189.46"	"$6,189.46"	$0.00	"$3,087.50"	"$4,890.60"	"$4,940.00"	$0.00		$0.00	$966.39	$0.00	$0.00	$983.06	$0.00	$0.00	$0.00	$0.00	$0.00
5MAXACE132KIT	SUP	HCPCS C1887		5MAXACE132KIT  -  CATHETER REPERFUSION	BOTH IP/OP	"$6,062.50 "	"$4,486.25"	$0.00	"$4,850.00"	"$3,291.94"	"$3,291.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,031.25"	"$4,801.50"	"$4,850.00"	$0.00		$0.00	$948.78	$0.00	$0.00	$965.15	$0.00	$0.00	$0.00	$0.00	$0.00
6 LGT	SUP	Custom 27203010		6 LGT  -  TUBE 50MM 11.1MM 6.4MM UNCUF LRNTMY SHLY TRCH 6 STRL LATEX	BOTH IP/OP	$143.01 	$105.83	$0.00	$114.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.51	$113.26	$114.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60.116.521	SUP	HCPCS C1713		60.116.521  -  PIN PUSH SCREW TYPE VAR ANG LOCKING GRAPHIC CASES NONSTRL	BOTH IP/OP	$113.25 	$83.81	$0.00	$90.60	$50.96	$50.96	$0.00	$0.00	$0.00	$23.60	$84.05	$84.05	$0.00	$0.00	$23.60	$0.00	$66.99	$66.99	$0.00	$56.63	$89.69	$90.60	$0.00		$0.00	$17.72	$0.00	$0.00	$18.03	$0.00	$0.00	$0.00	$0.00	$0.00
60-00120	SUP	Custom 27203010		60-00120  -  GUIDE DRILL 14.5CM 2 END	BOTH IP/OP	$646.25 	$478.23	$0.00	$517.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$479.65	$479.65	$0.00	$0.00	$134.68	$0.00	$0.00	$0.00	$0.00	$323.13	$511.83	$517.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6000-215	SUP	HCPCS C1713		6000-215  -  SUB BNGFT 40X15MM PLEXUR 15D BCMPS VOID FILR WDG RESORB	BOTH IP/OP	"$1,370.00 "	"$1,013.80"	$0.00	"$1,096.00"	$616.50	$616.50	$0.00	$0.00	$0.00	$285.54	"$1,016.81"	"$1,016.81"	$0.00	$0.00	$285.51	$0.00	$810.36	$810.36	$0.00	$685.00	"$1,085.04"	"$1,096.00"	$0.00		$0.00	$214.41	$0.00	$0.00	$218.10	$0.00	$0.00	$0.00	$0.00	$0.00
6000BL	SUP	Custom 27803010		6000BL  -  HOOK SPNL SPRL R90D LT OBLQ TI	BOTH IP/OP	"$1,662.43 "	"$1,230.20"	$0.00	"$1,329.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,233.85"	"$1,233.85"	$0.00	$0.00	$346.45	$0.00	$0.00	$0.00	$0.00	$831.21	"$1,316.64"	"$1,329.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6000BR	SUP	Custom 27803010		6000BR  -  HOOK SPNL SPRL R90D RT OBLQ TI	BOTH IP/OP	"$1,662.43 "	"$1,230.20"	$0.00	"$1,329.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,233.85"	"$1,233.85"	$0.00	$0.00	$346.45	$0.00	$0.00	$0.00	$0.00	$831.21	"$1,316.64"	"$1,329.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6000LL	SUP	Custom 27803010		6000LL  -  HOOK SPNL LG SPRL R90D TI LMR	BOTH IP/OP	"$1,662.43 "	"$1,230.20"	$0.00	"$1,329.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,233.85"	"$1,233.85"	$0.00	$0.00	$346.45	$0.00	$0.00	$0.00	$0.00	$831.21	"$1,316.64"	"$1,329.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6000LP	SUP	Custom 27803010		6000LP  -  HOOK SPNL LG SPRL R90D TI PDCL	BOTH IP/OP	"$1,662.43 "	"$1,230.20"	$0.00	"$1,329.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,233.85"	"$1,233.85"	$0.00	$0.00	$346.45	$0.00	$0.00	$0.00	$0.00	$831.21	"$1,316.64"	"$1,329.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6000ME	SUP	Custom 27803010		6000ME  -  HOOK SPNL MED SPRL R90D XTD TI LMR THOR	BOTH IP/OP	"$1,745.55 "	"$1,291.71"	$0.00	"$1,396.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,295.55"	"$1,295.55"	$0.00	$0.00	$363.77	$0.00	$0.00	$0.00	$0.00	$872.78	"$1,382.48"	"$1,396.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6000ML	SUP	Custom 27803010		6000ML  -  HOOK SPNL MED SPRL R90D TI LMR	BOTH IP/OP	"$1,662.43 "	"$1,230.20"	$0.00	"$1,329.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,233.85"	"$1,233.85"	$0.00	$0.00	$346.45	$0.00	$0.00	$0.00	$0.00	$831.21	"$1,316.64"	"$1,329.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6000MW	SUP	Custom 27803010		6000MW  -  HOOK SPNL MED SPRL R90D W TI LMR	BOTH IP/OP	"$1,662.43 "	"$1,230.20"	$0.00	"$1,329.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,233.85"	"$1,233.85"	$0.00	$0.00	$346.45	$0.00	$0.00	$0.00	$0.00	$831.21	"$1,316.64"	"$1,329.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6000SE	SUP	Custom 27803010		6000SE  -  HOOK SPNL SM SPRL R90D XTD TI LMR	BOTH IP/OP	"$1,745.55 "	"$1,291.71"	$0.00	"$1,396.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,295.55"	"$1,295.55"	$0.00	$0.00	$363.77	$0.00	$0.00	$0.00	$0.00	$872.78	"$1,382.48"	"$1,396.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6000SL	SUP	Custom 27803010		6000SL  -  HOOK SPNL SM SPRL R90D TI LMR	BOTH IP/OP	"$1,662.43 "	"$1,230.20"	$0.00	"$1,329.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,233.85"	"$1,233.85"	$0.00	$0.00	$346.45	$0.00	$0.00	$0.00	$0.00	$831.21	"$1,316.64"	"$1,329.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6000SP	SUP	Custom 27803010		6000SP  -  HOOK SPNL SM SPRL R90D TI PDCL	BOTH IP/OP	"$1,662.43 "	"$1,230.20"	$0.00	"$1,329.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,233.85"	"$1,233.85"	$0.00	$0.00	$346.45	$0.00	$0.00	$0.00	$0.00	$831.21	"$1,316.64"	"$1,329.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6000SW	SUP	Custom 27803010		6000SW  -  HOOK SPNL SM SPRL R90D W TI LMR	BOTH IP/OP	"$1,662.43 "	"$1,230.20"	$0.00	"$1,329.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,233.85"	"$1,233.85"	$0.00	$0.00	$346.45	$0.00	$0.00	$0.00	$0.00	$831.21	"$1,316.64"	"$1,329.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6000TH	SUP	Custom 27803010		6000TH  -  HOOK SPNL SPRL R90D TI LMR THOR	BOTH IP/OP	"$1,662.43 "	"$1,230.20"	$0.00	"$1,329.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,233.85"	"$1,233.85"	$0.00	$0.00	$346.45	$0.00	$0.00	$0.00	$0.00	$831.21	"$1,316.64"	"$1,329.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6001-2200	SUP	Custom 27803010		6001-2200  -  HEAD FEMORAL +0MM C TAPER 22MM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6001-2205	SUP	Custom 27803010		6001-2205  -  HEAD FEMORAL +5MM C TAPER 22MM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6001-2600	SUP	Custom 27803010		6001-2600  -  HEAD FEMORAL +0MM C TAPER 26MM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6001-2605	SUP	Custom 27803010		6001-2605  -  HEAD FEMORAL +5MM C TAPER 26MM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6001-2610	SUP	Custom 27803010		6001-2610  -  HEAD FEMORAL +10MM C TAPER 26MM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6001-2800	SUP	Custom 27803010		6001-2800  -  HEAD FEMORAL +0MM C TAPER 28MM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6001-2805	SUP	Custom 27803010		6001-2805  -  HEAD FEMORAL +5MM C TAPER 28MM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6001-2810	SUP	Custom 27803010		6001-2810  -  HEAD FEMORAL +10MM C TAPER 28MM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6001-3200	SUP	Custom 27803010		6001-3200  -  HEAD FEMORAL +0MM C TAPER 32MM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6001-3205	SUP	Custom 27803010		6001-3205  -  HEAD FEMORAL +5MM C TAPER 32MM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6001-3210	SUP	Custom 27803010		6001-3210  -  HEAD FEMORAL +10MM C TAPER 32MM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6001-3299	SUP	Custom 27803010		6001-3299  -  HEAD FEMORAL -5MM C TAPER 32MM COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6003-003-090	SUP	HCPCS C1713		6003-003-090  -  PIN FIX .125IN 3.54IN PRELOADED PINABALL NONSTRL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
6005LO	SUP	Custom 27803010		6005LO  -  HOOK SPNL 5MM SPRL R90D LT OFST TI	BOTH IP/OP	"$1,745.55 "	"$1,291.71"	$0.00	"$1,396.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,295.55"	"$1,295.55"	$0.00	$0.00	$363.77	$0.00	$0.00	$0.00	$0.00	$872.78	"$1,382.48"	"$1,396.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6005RO	SUP	Custom 27803010		6005RO  -  HOOK SPNL 5MM SPRL R90D RT OFST TI	BOTH IP/OP	"$1,745.55 "	"$1,291.71"	$0.00	"$1,396.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,295.55"	"$1,295.55"	$0.00	$0.00	$363.77	$0.00	$0.00	$0.00	$0.00	$872.78	"$1,382.48"	"$1,396.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-09504	SUP	Custom 27100030		60-09504  -  DRILL TWST .9MM 46MM 4MM STRYK SHFT 1.2MM SCR	BOTH IP/OP	$555.00 	$410.70	$0.00	$444.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$411.92	$411.92	$0.00	$0.00	$115.66	$0.00	$0.00	$0.00	$0.00	$277.50	$439.56	$444.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-10115	SUP	Custom 27203010		60-10115  -  BIT DRILL 83MM 1MM TWST STRL	BOTH IP/OP	$161.50 	$119.51	$0.00	$130.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.87	$119.87	$0.00	$0.00	$33.66	$0.00	$0.00	$0.00	$0.00	$81.81	$129.59	$130.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-10122	SUP	Custom 27203010		60-10122  -  BIT DRILL 90MM 1MM TWST STOP SHFT END 22MM STRL	BOTH IP/OP	$159.50 	$118.03	$0.00	$127.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.38	$118.38	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$79.75	$126.32	$127.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-10315	SUP	Custom 27203010		60-10315  -  BIT DRILL 76MM 1MM TWST AO STRL	BOTH IP/OP	$163.63 	$121.09	$0.00	$130.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.44	$121.44	$0.00	$0.00	$34.10	$0.00	$0.00	$0.00	$0.00	$81.81	$129.59	$130.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-10322	SUP	Custom 27203010		60-10322  -  BIT DRL 22MM AO SHFT QCK 1.2MM SCR	BOTH IP/OP	$168.30 	$124.54	$0.00	$137.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$0.00	$0.00	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-10415	SUP	Custom 27203010		60-10415  -  DRILL DNTL 1MM 16MM BIT TWST STOP	BOTH IP/OP	$163.63 	$121.09	$0.00	$130.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.44	$121.44	$0.00	$0.00	$34.10	$0.00	$0.00	$0.00	$0.00	$81.81	$129.59	$130.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-10422	SUP	Custom 27203010		60-10422  -  BIT DRILL 73MM 1MM 22MM STOP TWST DNTL SHFT END STRL	BOTH IP/OP	$159.50 	$118.03	$0.00	$127.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.38	$118.38	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$79.75	$126.32	$127.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-10506	SUP	Custom 27100030		60-10506  -  BIT DRILL TWIST 1MM 50MM 6MM STOP PROFYLE HAND STERILE SMALL	BOTH IP/OP	$224.18 	$165.89	$0.00	$432.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.38	$166.38	$0.00	$0.00	$46.72	$0.00	$0.00	$0.00	$0.00	$270.00	$427.68	$432.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-10512	SUP	Custom 27100030		60-10512  -  BIT DRILL 12MM STOP 1MM 54MM 12MM TWIST STOP STERILE	BOTH IP/OP	$224.18 	$165.89	$0.00	$444.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.38	$166.38	$0.00	$0.00	$46.72	$0.00	$0.00	$0.00	$0.00	$277.50	$439.56	$444.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6010LO	SUP	Custom 27803010		6010LO  -  HOOK SPNL 10MM SPRL R90D LT OFST TI	BOTH IP/OP	"$1,745.55 "	"$1,291.71"	$0.00	"$1,396.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,295.55"	"$1,295.55"	$0.00	$0.00	$363.77	$0.00	$0.00	$0.00	$0.00	$872.78	"$1,382.48"	"$1,396.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6010RO	SUP	Custom 27803010		6010RO  -  HOOK SPNL 10MM SPRL R90D RT OFST TI	BOTH IP/OP	"$1,745.55 "	"$1,291.71"	$0.00	"$1,396.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,295.55"	"$1,295.55"	$0.00	$0.00	$363.77	$0.00	$0.00	$0.00	$0.00	$872.78	"$1,382.48"	"$1,396.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6012-0711	SUP	HCPCS C1776		6012-0711  -  STEM FEMORAL 7 11MM 155MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6012-0713	SUP	HCPCS C1776		6012-0713  -  STEM FEMORAL 7 13MM 155MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6012-0812	SUP	HCPCS C1776		6012-0812  -  STEM FEMORAL 8 12MM 155MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6012-0814	SUP	HCPCS C1776		6012-0814  -  STEM FEMORAL 8 14MM 155MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6012-0913	SUP	HCPCS C1776		6012-0913  -  STEM FEMORAL 9 13MM 155MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6012-0915	SUP	HCPCS C1776		6012-0915  -  STEM FEMORAL 9 15MM 155MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6012-1014	SUP	HCPCS C1776		6012-1014  -  STEM FEMORAL 10 14MM 155MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6012-1016	SUP	HCPCS C1776		6012-1016  -  STEM FEMORAL 10 16MM 155MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6012-1115	SUP	HCPCS C1776		6012-1115  -  STEM FEMORAL 11 15MM 155MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6012-1117	SUP	HCPCS C1776		6012-1117  -  STEM FEMORAL 11 17MM 155MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6012-1216	SUP	HCPCS C1776		6012-1216  -  STEM FEMORAL 12 16MM 155MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6012-1218	SUP	HCPCS C1776		6012-1218  -  STEM FEMORAL 12 18MM 155MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
601-251	SUP	HCPCS C1887		MICROCATHETER RAPIDTRANSIT 150CM	BOTH IP/OP	"$1,760.00 "	"$1,302.40"	$0.00	"$1,408.00"	$955.68	$955.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$880.00	"$1,393.92"	"$1,408.00"	$0.00		$0.00	$275.44	$0.00	$0.00	$280.19	$0.00	$0.00	$0.00	$0.00	$0.00
601251X	SUP	HCPCS C1751		601251X  -  MICROCATHETER CRBRVASC 2.3-2.8FR .021IN 150CM 50CM	BOTH IP/OP	"$1,775.10 "	"$1,313.57"	$0.00	"$1,420.08"	$798.80	$798.80	$0.00	$0.00	$0.00	$369.98	"$1,317.48"	"$1,317.48"	$0.00	$0.00	$369.93	$0.00	"$1,049.97"	"$1,049.97"	$0.00	$887.55	"$1,405.88"	"$1,420.08"	$0.00		$0.00	$277.80	$0.00	$0.00	$282.60	$0.00	$0.00	$0.00	$0.00	$0.00
6013-0812	SUP	HCPCS C1776		6013-0812  -  STEM FEMORAL 8 12MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-0814	SUP	HCPCS C1776		6013-0814  -  STEM FEMORAL 8 14MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-0913	SUP	HCPCS C1776		6013-0913  -  STEM FEMORAL 9 13MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-0915	SUP	HCPCS C1776		6013-0915  -  STEM FEMORAL 9 15MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-1014	SUP	HCPCS C1776		6013-1014  -  STEM FEMORAL 10 14MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-1016	SUP	HCPCS C1776		6013-1016  -  STEM FEMORAL 10 16MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-1115	SUP	HCPCS C1776		6013-1115  -  STEM FEMORAL 11 15MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-1117	SUP	HCPCS C1776		6013-1117  -  STEM FEMORAL 11 17MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-1216	SUP	HCPCS C1776		6013-1216  -  STEM FEMORAL 12 16MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-1218	SUP	HCPCS C1776		6013-1218  -  STEM FEMORAL 12 18MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-1317	SUP	HCPCS C1776		6013-1317  -  STEM FEMORAL 13 17MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-1319	SUP	HCPCS C1776		6013-1319  -  STEM FEMORAL 13 19MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-1418	SUP	HCPCS C1776		6013-1418  -  STEM FEMORAL 14 18MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
6013-1420	SUP	HCPCS C1776		6013-1420  -  STEM FEMORAL 14 20MM 205MM RSTOR TITANIUM HA HIP	BOTH IP/OP	"$12,550.00 "	"$9,287.00"	$0.00	"$10,040.00"	"$5,647.50"	"$5,647.50"	$0.00	$0.00	$0.00	"$2,615.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,615.42"	$0.00	"$6,187.15"	"$6,187.15"	$0.00	"$6,275.00"	"$9,939.60"	"$10,040.00"	$0.00		$0.00	"$1,964.08"	$0.00	$0.00	"$1,997.96"	$0.00	$0.00	$0.00	$0.00	$0.00
60-13506	SUP	Custom 27100030		60-13506  -  BIT DRILL 6MM STOP 1.3MM 50MM 6MM TWIST STOP STERILE	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.21	$408.21	$0.00	$0.00	$114.62	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-13512	SUP	Custom 27100030		60-13512  -  DRILL TWST 1.3MM 54MM STRL 12MM LEIBINGER UNV 2 12MM SCR	BOTH IP/OP	$236.25 	$174.83	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.34	$175.34	$0.00	$0.00	$49.23	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-13570	SUP	Custom 27100030		60-13570  -  BIT DRILL 12MM STOP 1.3MM 79MM TWIST STERILE	BOTH IP/OP	$242.15 	$179.19	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.72	$179.72	$0.00	$0.00	$50.46	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-13712	SUP	Custom 27100030		60-13712  -  BIT DRILL STERILE 12 MM SCREW	BOTH IP/OP	$272.60 	$201.72	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.32	$202.32	$0.00	$0.00	$56.81	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-14008	SUP	Custom 27100030		60-14008  -  BIT DRILL 1.4MM 8MM TWIST STERILE	BOTH IP/OP	$254.80 	$188.55	$0.00	$490.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.11	$189.11	$0.00	$0.00	$53.10	$0.00	$0.00	$0.00	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6014-0812L	SUP	HCPCS C1776		6014-0812L  -  STEM FEM 255MM 12MM BW RSTOR HYDRXAPT 8 LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6014-0812R	SUP	HCPCS C1776		6014-0812R  -  STEM FEM 255MM 12MM RSTOR HYDRXAPT 8 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6014-0913L	SUP	HCPCS C1776		6014-0913L  -  STEM FEM 255MM 13MM BW RSTOR HYDRXAPT 9 LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6014-0913R	SUP	HCPCS C1776		6014-0913R  -  STEM FEM 255MM 13MM BW RSTOR HYDRXAPT 9 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6014-1014L	SUP	HCPCS C1776		6014-1014L  -  STEM FEM 255MM 14MM BW RSTOR HYDRXAPT 10 LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6014-1014R	SUP	HCPCS C1776		6014-1014R  -  STEM FEM 255MM 14MM BW RSTOR HYDRXAPT 10 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6014-1115L	SUP	HCPCS C1776		6014-1115L  -  STEM FEM 255MM 15MM BW RSTOR HYDRXAPT 11 LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6014-1115R	SUP	HCPCS C1776		6014-1115R  -  STEM FEM 255MM 15MM BW RSTOR HYDRXAPT 11 RIGHT	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6014-1216L	SUP	HCPCS C1776		6014-1216L  -  STEM FEM 255MM 16MM BW RSTOR HA 12 LNG LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6014-1216R	SUP	HCPCS C1776		6014-1216R  -  STEM FEM 255MM 16MM BW RSTOR HYDRXAPT 12 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
60-14126	SUP	Custom 27203010		60-14126  -  BIT DRILL 94MM 1.4MM TWST STOP SHFT END 27MM STRL	BOTH IP/OP	$159.50 	$118.03	$0.00	$127.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.38	$118.38	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$79.75	$126.32	$127.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6014-1317L	SUP	HCPCS C1776		6014-1317L  -  STEM FEM 255MM 17MM BW RSTOR HYDRXAPT 13 LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6014-1317R	SUP	HCPCS C1776		6014-1317R  -  STEM FEM 255MM 17MM BW RSTOR HYDRXAPT 13 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6014-1418L	SUP	HCPCS C1776		6014-1418L  -  STEM FEM 255MM 18MM BW RSTOR HYDRXAPT 14 LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6014-1418R	SUP	HCPCS C1776		6014-1418R  -  STEM FEM 255MM 18MM BW RSTOR HYDRXAPT 14 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
60-14326	SUP	Custom 27203010		60-14326  -  BIT DRILL 87MM 1.4MM TWST AO STRL	BOTH IP/OP	$159.50 	$118.03	$0.00	$127.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.38	$118.38	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$79.75	$126.32	$127.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-14426	SUP	Custom 27203010		60-14426  -  BIT DRILL 77MM 1.4MM 27MM STOP TWST DNTL SHFT END STRL	BOTH IP/OP	$159.50 	$118.03	$0.00	$127.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.38	$118.38	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$79.75	$126.32	$127.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-15008	SUP	Custom 27100030		60-15008  -  BIT DRILL 1.5MM 50MM 8MM TWIST STOP STERILE	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-15020	SUP	Custom 27100030		60-15020  -  BIT DRILL TWIST 1.5MM 58MM 20MM STOP STERILE 20MM SCREW	BOTH IP/OP	$265.50 	$196.47	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6015-0814L	SUP	HCPCS C1776		6015-0814L  -  STEM FEM 205MM 14MM BW RSTOR HYDRXAPT 8 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6015-0814R	SUP	HCPCS C1776		6015-0814R  -  STEM FEM 205MM 14MM BW RSTOR HYDRXAPT 8 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6015-0915L	SUP	HCPCS C1776		6015-0915L  -  STEM FEM 205MM 15MM BW RSTOR HYDRXAPT 9 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6015-0915R	SUP	HCPCS C1776		6015-0915R  -  STEM FEM 205MM 15MM BW RSTOR HYDRXAPT 9 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6015-1016L	SUP	HCPCS C1776		6015-1016L  -  STEM FEM 205MM 16MM BW RSTOR HYDRXAPT 10 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6015-1016R	SUP	HCPCS C1776		6015-1016R  -  STEM FEM 205MM 16MM BW RSTOR HYDRXAPT 10 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
60-15105	SUP	Custom 27100030		60-15105  -  BIT DRILL 5MM STOP 1.5MM 50MM 5MM TWIST STERILE 5MM SCREW	BOTH IP/OP	$265.50 	$196.47	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6015-1117L	SUP	HCPCS C1776		6015-1117L  -  STEM FEM 205MM 17MM BW RSTOR HYDRXAPT 11 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6015-1117R	SUP	HCPCS C1776		6015-1117R  -  STEM FEM 205MM 17MM BW RSTOR HYDRXAPT 11 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6015-1218L	SUP	HCPCS C1776		6015-1218L  -  STEM FEM 205MM 18MM BW RSTOR HYDRXAPT 12 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6015-1218R	SUP	HCPCS C1776		6015-1218R  -  STEM FEM 205 18MM BW RSTOR HYDRXAPT 12 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6015-1319L	SUP	HCPCS C1776		6015-1319L  -  STEM FEM 205MM 19MM BW RSTOR HYDRXAPT 13 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6015-1319R	SUP	HCPCS C1776		6015-1319R  -  STEM FEM 205MM 19MM BW RSTOR HYDRXAPT 13 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6015-1420L	SUP	HCPCS C1776		6015-1420L  -  STEM FEM 205MM 20MM BW RSTOR HYDRXAPT 14 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6015-1420R	SUP	HCPCS C1776		6015-1420R  -  STEM FEM 205MM 20MM BW RSTOR HYDRXAPT 14 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
60-15920	SUP	Custom 27100030		60-15920  -  BIT DRILL 20MM STOP 1.5MM 107MM TWIST STERILE	BOTH IP/OP	$334.28 	$247.37	$0.00	$610.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.10	$248.10	$0.00	$0.00	$69.66	$0.00	$0.00	$0.00	$0.00	$381.25	$603.90	$610.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-15998	SUP	Custom 27203010		60-15998  -  DRILL TWST 1.5MM 19MM 8MM	BOTH IP/OP	$827.50 	$612.35	$0.00	$662.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$614.17	$614.17	$0.00	$0.00	$172.45	$0.00	$0.00	$0.00	$0.00	$413.75	$655.38	$662.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-16005	SUP	Custom 27203010		60-16005  -  BIT DRILL 50MM 1.6MM 5MM STOP TWST 5MM STRL	BOTH IP/OP	$532.50 	$394.05	$0.00	$395.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$395.22	$395.22	$0.00	$0.00	$110.97	$0.00	$0.00	$0.00	$0.00	$134.06	$212.36	$214.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-16007	SUP	Custom 27203010		60-16007  -  DRILL TWST 1.6MM 50MM STRL 7MM STP	BOTH IP/OP	$570.00 	$421.80	$0.00	$456.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$423.05	$423.05	$0.00	$0.00	$118.79	$0.00	$0.00	$0.00	$0.00	$285.00	$451.44	$456.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-16035	SUP	Custom 27100030		60-16035  -  BIT DRILL 1.6MM 115MM TWIST NONSTRL 20MM SCREW	BOTH IP/OP	$642.50 	$475.45	$0.00	$514.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$476.86	$476.86	$0.00	$0.00	$133.90	$0.00	$0.00	$0.00	$0.00	$321.25	$508.86	$514.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-16050	SUP	Custom 27100030		60-16050  -  BIT DRILL 1.6MM 125MM PILOT SHAFT END STERILE 50MM SCREW	BOTH IP/OP	$307.55 	$227.59	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.26	$228.26	$0.00	$0.00	$64.09	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-16407	SUP	Custom 27100030		60-16407  -  BIT DRL 1.6MM 50MM NS 7MM DNTL SHFT END 2/2.3MM SCR	BOTH IP/OP	$255.85 	$189.33	$0.00	$474.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.89	$189.89	$0.00	$0.00	$53.32	$0.00	$0.00	$0.00	$0.00	$296.25	$469.26	$474.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-16435	SUP	Custom 27100030		60-16435  -  BIT DRL 1.6MM 115MM NS 20MM DNTL SHFT END 2/2.3MM SCR	BOTH IP/OP	$296.43 	$219.36	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.01	$220.01	$0.00	$0.00	$61.77	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-16526	SUP	Custom 27203010		60-16526  -  BIT DRILL TWIST 1.6MM 58MM 20MM STOP LEIBINGER HAND STERILE	BOTH IP/OP	$249.38 	$184.54	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.09	$185.09	$0.00	$0.00	$51.97	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-16535	SUP	Custom 27100030		60-16535  -  BIT DRILL TWIST 1.6MM 85MM 26MM STOP STERILE 20MM SCREW	BOTH IP/OP	$258.33 	$191.16	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.73	$191.73	$0.00	$0.00	$53.83	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-16908	SUP	Custom 27100030		60-16908  -  BIT DRILL 90D 8MM STOP 1.6MM 19MM 8MM DENTAL END STERILE 8MM	BOTH IP/OP	$238.75 	$176.68	$0.00	$406.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.20	$177.20	$0.00	$0.00	$49.76	$0.00	$0.00	$0.00	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-16918	SUP	Custom 27100030		60-16918  -  BIT DRL 1.6MM 29MM NS 18MM DNTL SHFT END 2/2.3MM SCR	BOTH IP/OP	$238.75 	$176.68	$0.00	$406.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.20	$177.20	$0.00	$0.00	$49.76	$0.00	$0.00	$0.00	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6017-0425A	SUP	HCPCS C1776		6017-0425A  -  STEM FEMORAL 4 25MM C TAPER OMNIFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6017-0525A	SUP	HCPCS C1776		6017-0525A  -  STEM FEMORAL 5 25MM C TAPER OMNIFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6017-0625A	SUP	HCPCS C1776		6017-0625A  -  STEM FEMORAL 6 25MM C TAPER OMNIFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6017-0730A	SUP	HCPCS C1776		6017-0730A  -  STEM FEMORAL 7 30MM C TAPER OMNIFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6017-0830A	SUP	HCPCS C1776		6017-0830A  -  STEM FEMORAL 8 30MM C TAPER OMNIFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6017-0935A	SUP	HCPCS C1776		6017-0935A  -  STEM FEMORAL 9 35MM C TAPER OMNIFIT HA HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6017-1035A	SUP	HCPCS C1776		6017-1035A  -  STEM FEMORAL 10 35MM C TAPER OMNIFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6017-1140A	SUP	HCPCS C1776		6017-1140A  -  STEM FEMORAL 11 40MM C TAPER OMNIFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6017-1240A	SUP	HCPCS C1776		6017-1240A  -  STEM FEMORAL 12 40MM C TAPER OMNIFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6017-1340A	SUP	HCPCS C1776		6017-1340A  -  STEM FEMORAL 13 40MM C TAPER OMNIFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6017-1440A	SUP	HCPCS C1776		6017-1440A  -  STEM FEMORAL 14 40MM C TAPER OMNIFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6018-0814	SUP	HCPCS C1776		6018-0814  -  STEM FEMORAL 1.5 14MM 205MM RSTOR HYDRXAPT CALCAR HIP	BOTH IP/OP	"$15,140.00 "	"$11,203.60"	$0.00	"$12,112.00"	"$6,813.00"	"$6,813.00"	$0.00	$0.00	$0.00	"$3,155.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,155.18"	$0.00	"$7,464.02"	"$7,464.02"	$0.00	"$7,570.00"	"$11,990.88"	"$12,112.00"	$0.00		$0.00	"$2,369.41"	$0.00	$0.00	"$2,410.29"	$0.00	$0.00	$0.00	$0.00	$0.00
6018-0915	SUP	HCPCS C1776		6018-0915  -  STEM FEMORAL 9 15MM 205MM REPLACEMENT RESECTION LEVEL SYSTEM	BOTH IP/OP	"$15,140.00 "	"$11,203.60"	$0.00	"$12,112.00"	"$6,813.00"	"$6,813.00"	$0.00	$0.00	$0.00	"$3,155.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,155.18"	$0.00	"$7,464.02"	"$7,464.02"	$0.00	"$7,570.00"	"$11,990.88"	"$12,112.00"	$0.00		$0.00	"$2,369.41"	$0.00	$0.00	"$2,410.29"	$0.00	$0.00	$0.00	$0.00	$0.00
6018-1016	SUP	HCPCS C1776		6018-1016  -  STEM FEMORAL 10 16MM 205MM REPLACEMENT RESECTION LEVEL	BOTH IP/OP	"$15,140.00 "	"$11,203.60"	$0.00	"$12,112.00"	"$6,813.00"	"$6,813.00"	$0.00	$0.00	$0.00	"$3,155.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,155.18"	$0.00	"$7,464.02"	"$7,464.02"	$0.00	"$7,570.00"	"$11,990.88"	"$12,112.00"	$0.00		$0.00	"$2,369.41"	$0.00	$0.00	"$2,410.29"	$0.00	$0.00	$0.00	$0.00	$0.00
6018-1117	SUP	HCPCS C1776		6018-1117  -  STEM FEMORAL 11 17MM 205MM REVISION RSTOR HYDRXAPT CALCAR	BOTH IP/OP	"$15,140.00 "	"$11,203.60"	$0.00	"$12,112.00"	"$6,813.00"	"$6,813.00"	$0.00	$0.00	$0.00	"$3,155.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,155.18"	$0.00	"$7,464.02"	"$7,464.02"	$0.00	"$7,570.00"	"$11,990.88"	"$12,112.00"	$0.00		$0.00	"$2,369.41"	$0.00	$0.00	"$2,410.29"	$0.00	$0.00	$0.00	$0.00	$0.00
6018-1218	SUP	HCPCS C1776		6018-1218  -  STEM FEMORAL 12 18MM 205MM RSTOR HYDRXAPT CALCAR HIP	BOTH IP/OP	"$15,140.00 "	"$11,203.60"	$0.00	"$12,112.00"	"$6,813.00"	"$6,813.00"	$0.00	$0.00	$0.00	"$3,155.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,155.18"	$0.00	"$7,464.02"	"$7,464.02"	$0.00	"$7,570.00"	"$11,990.88"	"$12,112.00"	$0.00		$0.00	"$2,369.41"	$0.00	$0.00	"$2,410.29"	$0.00	$0.00	$0.00	$0.00	$0.00
6018-1319	SUP	HCPCS C1776		6018-1319  -  STEM FEMORAL 13 19MM 205MM REVISION RSTOR HYDRXAPT CALCAR	BOTH IP/OP	"$15,140.00 "	"$11,203.60"	$0.00	"$12,112.00"	"$6,813.00"	"$6,813.00"	$0.00	$0.00	$0.00	"$3,155.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,155.18"	$0.00	"$7,464.02"	"$7,464.02"	$0.00	"$7,570.00"	"$11,990.88"	"$12,112.00"	$0.00		$0.00	"$2,369.41"	$0.00	$0.00	"$2,410.29"	$0.00	$0.00	$0.00	$0.00	$0.00
6018-1420	SUP	HCPCS C1776		6018-1420  -  STEM FEMORAL 14 20MM 205MM REVISION RSTOR HYDRXAPT CALCAR	BOTH IP/OP	"$15,140.00 "	"$11,203.60"	$0.00	"$12,112.00"	"$6,813.00"	"$6,813.00"	$0.00	$0.00	$0.00	"$3,155.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,155.18"	$0.00	"$7,464.02"	"$7,464.02"	$0.00	"$7,570.00"	"$11,990.88"	"$12,112.00"	$0.00		$0.00	"$2,369.41"	$0.00	$0.00	"$2,410.29"	$0.00	$0.00	$0.00	$0.00	$0.00
60-19035	SUP	Custom 27100030		60-19035  -  BIT DRILL TWIST 1.9MM 115MM 35MM SHAFT END STOP STERILE	BOTH IP/OP	$322.43 	$238.60	$0.00	$574.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.30	$239.30	$0.00	$0.00	$67.19	$0.00	$0.00	$0.00	$0.00	$358.75	$568.26	$574.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6019-0814	SUP	HCPCS C1776		6019-0814  -  STEM FEM 205MM 14MM RSTOR HYDRXAPT 3 CLCR HIP	BOTH IP/OP	"$13,979.88 "	"$10,345.11"	$0.00	"$11,183.90"	"$6,290.94"	"$6,290.94"	$0.00	$0.00	$0.00	"$2,913.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,913.41"	$0.00	"$6,892.08"	"$6,892.08"	$0.00	"$6,989.94"	"$11,072.06"	"$11,183.90"	$0.00		$0.00	"$2,187.85"	$0.00	$0.00	"$2,225.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6019-0915	SUP	HCPCS C1776		6019-0915  -  STEM FEM RSTOR HYDRXAPT 3 CLCR	BOTH IP/OP	"$13,979.88 "	"$10,345.11"	$0.00	"$11,183.90"	"$6,290.94"	"$6,290.94"	$0.00	$0.00	$0.00	"$2,913.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,913.41"	$0.00	"$6,892.08"	"$6,892.08"	$0.00	"$6,989.94"	"$11,072.06"	"$11,183.90"	$0.00		$0.00	"$2,187.85"	$0.00	$0.00	"$2,225.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6019-1016	SUP	HCPCS C1776		6019-1016  -  STEM FEM 205MM 16MM RSTOR HYDRXAPT 3 CLCR HIP	BOTH IP/OP	"$13,979.88 "	"$10,345.11"	$0.00	"$11,183.90"	"$6,290.94"	"$6,290.94"	$0.00	$0.00	$0.00	"$2,913.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,913.41"	$0.00	"$6,892.08"	"$6,892.08"	$0.00	"$6,989.94"	"$11,072.06"	"$11,183.90"	$0.00		$0.00	"$2,187.85"	$0.00	$0.00	"$2,225.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6019-1117	SUP	HCPCS C1776		6019-1117  -  STEM FEM 205MM 17MM REV RSTOR HYDRXAPT 11 CLCR HIP	BOTH IP/OP	"$13,979.88 "	"$10,345.11"	$0.00	"$11,183.90"	"$6,290.94"	"$6,290.94"	$0.00	$0.00	$0.00	"$2,913.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,913.41"	$0.00	"$6,892.08"	"$6,892.08"	$0.00	"$6,989.94"	"$11,072.06"	"$11,183.90"	$0.00		$0.00	"$2,187.85"	$0.00	$0.00	"$2,225.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6019-1218	SUP	HCPCS C1776		6019-1218  -  STEM FEM 205MM 18MM REV RSTOR HYDRXAPT 12 CLCR HIP	BOTH IP/OP	"$13,979.88 "	"$10,345.11"	$0.00	"$11,183.90"	"$6,290.94"	"$6,290.94"	$0.00	$0.00	$0.00	"$2,913.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,913.41"	$0.00	"$6,892.08"	"$6,892.08"	$0.00	"$6,989.94"	"$11,072.06"	"$11,183.90"	$0.00		$0.00	"$2,187.85"	$0.00	$0.00	"$2,225.60"	$0.00	$0.00	$0.00	$0.00	$0.00
60-19126	SUP	Custom 27203010		60-19126  -  DRILL TWST 1.9MM 27MM STRYK END	BOTH IP/OP	$159.50 	$118.03	$0.00	$127.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.38	$118.38	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$79.75	$126.32	$127.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6019-1319	SUP	HCPCS C1776		6019-1319  -  STEM FEM 205MM 19MM REV RSTOR HYDRXAPT 13 CLCR HIP	BOTH IP/OP	"$13,979.88 "	"$10,345.11"	$0.00	"$11,183.90"	"$6,290.94"	"$6,290.94"	$0.00	$0.00	$0.00	"$2,913.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,913.41"	$0.00	"$6,892.08"	"$6,892.08"	$0.00	"$6,989.94"	"$11,072.06"	"$11,183.90"	$0.00		$0.00	"$2,187.85"	$0.00	$0.00	"$2,225.60"	$0.00	$0.00	$0.00	$0.00	$0.00
60-19140	SUP	Custom 27203010		60-19140  -  BIT DRILL 108MM 1.9MM VARIAX TWST SHFT END	BOTH IP/OP	$166.38 	$123.12	$0.00	$133.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.48	$123.48	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$83.19	$131.77	$133.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6019-1420	SUP	HCPCS C1776		6019-1420  -  STEM FEM 205MM 20MM REV RSTOR HYDRXAPT 14 CLCR HIP	BOTH IP/OP	"$13,979.88 "	"$10,345.11"	$0.00	"$11,183.90"	"$6,290.94"	"$6,290.94"	$0.00	$0.00	$0.00	"$2,913.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,913.41"	$0.00	"$6,892.08"	"$6,892.08"	$0.00	"$6,989.94"	"$11,072.06"	"$11,183.90"	$0.00		$0.00	"$2,187.85"	$0.00	$0.00	"$2,225.60"	$0.00	$0.00	$0.00	$0.00	$0.00
60-19326	SUP	Custom 27203010		60-19326  -  BIT DRILL 87MM 1.9MM 27MM STOP TWST AO SHFT END STRL	BOTH IP/OP	$159.50 	$118.03	$0.00	$127.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.38	$118.38	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$79.75	$126.32	$127.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-19340	SUP	Custom 27203010		60-19340  -  BIT DRILL 105MM 1.9MM VARIAX DISTAL AO SHFT END RAD NONSTRL	BOTH IP/OP	$166.38 	$123.12	$0.00	$133.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.48	$123.48	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$83.19	$131.77	$133.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-19426	SUP	Custom 27203010		60-19426  -  BIT DRILL 77MM 1.9MM TWST DNTL SHFT END DISP	BOTH IP/OP	$159.50 	$118.03	$0.00	$127.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.38	$118.38	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$79.75	$126.32	$127.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-19435	SUP	Custom 27100030		60-19435  -  DRILL TWIST 1.9MM 115MM 35MM STOP STERILE 2.3MM SCREW	BOTH IP/OP	$335.40 	$248.20	$0.00	$612.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.93	$248.93	$0.00	$0.00	$69.90	$0.00	$0.00	$0.00	$0.00	$382.50	$605.88	$612.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-19440	SUP	Custom 27203010		60-19440  -  BIT DRILL 91MM 1.9MM 41MM STOP TWST DNTL SHFT END STRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$148.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$0.00	$0.00	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-19526	SUP	Custom 27203010		60-19526  -  BIT DRILL 1.9MM 58MM SHAFT END STERILE 20MM SCREW	BOTH IP/OP	$321.25 	$237.73	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.43	$238.43	$0.00	$0.00	$66.95	$0.00	$0.00	$0.00	$0.00	$355.00	$562.32	$568.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-19535	SUP	Custom 27100030		60-19535  -  BIT DRILL 1.9MM 85MM SHAFT END STERILE 20MM SCREW	BOTH IP/OP	$245.85 	$181.93	$0.00	$442.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.47	$182.47	$0.00	$0.00	$51.24	$0.00	$0.00	$0.00	$0.00	$276.25	$437.58	$442.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-19908	SUP	Custom 27100030		60-19908  -  BIT DRILL 90D 8MM STOP 1.9MM 19MM DENTAL END STERILE 8MM	BOTH IP/OP	$238.75 	$176.68	$0.00	$406.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.20	$177.20	$0.00	$0.00	$49.76	$0.00	$0.00	$0.00	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-19918	SUP	Custom 27100030		60-19918  -  BIT DRILL 90D 18MM STOP 1.9MM 29MM DENTAL END STERILE 18MM	BOTH IP/OP	$238.75 	$176.68	$0.00	$406.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.20	$177.20	$0.00	$0.00	$49.76	$0.00	$0.00	$0.00	$0.00	$253.75	$401.94	$406.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6020-0030	SUP	HCPCS C1776		6020-0030  -  STEM FEMORAL 132D 0 33MM OFFST 86MM 30MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
60-20012	SUP	Custom 27100030		60-20012  -  BIT DRILL TWIST 2MM 62MM 13MM REPOSITION PIN STOP STERILE	BOTH IP/OP	$670.00 	$495.80	$0.00	$536.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$497.27	$497.27	$0.00	$0.00	$139.63	$0.00	$0.00	$0.00	$0.00	$335.00	$530.64	$536.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6020-0130	SUP	HCPCS C1776		6020-0130  -  STEM FEMORAL 132D 1 34MM OFFST 110MM 30MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6020-0230	SUP	HCPCS C1776		6020-0230  -  STEM FEMORAL 130D 2 35MM OFFST 115MM 30MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6020-0335	SUP	HCPCS C1776		6020-0335  -  STEM FEMORAL 132D 3 39MM OFFST 120MM 35MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6020-0435	SUP	HCPCS C1776		6020-0435  -  STEM FEMORAL 132D 4 40MM OFFST 125MM 35MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
60-20050	SUP	Custom 27100030		60-20050  -  BIT DRL 2MM 125MM NS 50MM STRYK SHFT END 2MM LG SCR	BOTH IP/OP	$368.75 	$272.88	$0.00	$628.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$273.69	$273.69	$0.00	$0.00	$76.85	$0.00	$0.00	$0.00	$0.00	$392.50	$621.72	$628.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6020-0537	SUP	HCPCS C1776		6020-0537  -  STEM FEMORAL 132D 5 44MM OFFST 130MM 37MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6020-0637	SUP	HCPCS C1776		6020-0637  -  STEM FEMORAL 132D 6 45MM OFFST 135MM 37MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6020-0740	SUP	HCPCS C1776		6020-0740  -  STEM FEMORAL 132D 7 48MM OFFST 140MM 40MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6020-0840	SUP	HCPCS C1776		6020-0840  -  STEM FEMORAL 132D 8 49MM OFFST 145MM 40MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
60-20185	SUP	Custom 27203010		60-20185  -  BIT DRILL 100MM 2MM 40MM STOP TWST DNTL SHFT END STRL	BOTH IP/OP	$166.38 	$123.12	$0.00	$133.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.48	$123.48	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$83.19	$131.77	$133.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6020-2530	SUP	HCPCS C1776		6020-2530  -  STEM FEMORAL 132D 2.5 36MM OFFST 118MM 30MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6020-3535	SUP	HCPCS C1776		6020-3535  -  STEM FEMORAL 132D 3.5 39MM OFFST 124MM 35MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
60-20385	SUP	Custom 27203010		60-20385  -  DRILL TWST 2MM 105MM STRL 40MM AO SHFT END STP DIST VARIAX	BOTH IP/OP	$166.38 	$123.12	$0.00	$133.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.48	$123.48	$0.00	$0.00	$34.67	$0.00	$0.00	$0.00	$0.00	$83.19	$131.77	$133.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6020-4535	SUP	HCPCS C1776		6020-4535  -  STEM FEMORAL 132D 4.5 41MM OFFST 129MM 35MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
60-20485	SUP	Custom 27203010		60-20485  -  BIT DRILL 100MM 2MM 40MM STOP TWST DNTL SHFT END STRL	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6020-5537	SUP	HCPCS C1776		6020-5537  -  STEM FEMORAL 132D 5.5 45MM OFFST 133MM 37MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-0030	SUP	HCPCS C1776		6021-0030  -  STEM FEMORAL 127D 0 37MM OFFST 86MM 30MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-0130	SUP	HCPCS C1776		6021-0130  -  STEM FEMORAL 127D 1 38MM OFFST 110MM 30MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-0230	SUP	HCPCS C1776		6021-0230  -  STEM FEMORAL 127D 2 39MM OFFST 115MM 30MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-0335	SUP	HCPCS C1776		6021-0335  -  STEM FEMORAL 127D 3 43MM OFFST 120MM 35MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-0435	SUP	HCPCS C1776		6021-0435  -  STEM FEMORAL 127D 4 44MM OFFST 125MM 35MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-0537	SUP	HCPCS C1776		6021-0537  -  STEM FEMORAL 127D 5 48MM OFFST 130MM 37MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-0637	SUP	HCPCS C1776		6021-0637  -  STEM FEMORAL 127D 6 49MM OFFST 135MM 37MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-0740	SUP	HCPCS C1776		6021-0740  -  STEM FEMORAL 127D 7 53MM OFFST 140MM 40MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-0840	SUP	HCPCS C1776		6021-0840  -  STEM FEMORAL 127D 8 54MM OFFST 145MM 40MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-2530	SUP	HCPCS C1776		6021-2530  -  STEM FEMORAL 127D 2.5 40MM OFFST 118MM 30MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-3535	SUP	HCPCS C1776		6021-3535  -  STEM FEMORAL 127D 3.5 43MM OFFST 124MM 35MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-4535	SUP	HCPCS C1776		6021-4535  -  STEM FEMORAL 127D 4.5 45MM OFFST 129MM 35MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6021-5537	SUP	HCPCS C1776		6021-5537  -  STEM FEMORAL 127D 5.5 49MM OFFST 133MM 37MM CEMENTLESS NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
60-23141	SUP	Custom 27203010		60-23141  -  DRILL TWST 2.3MM	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-23341	SUP	Custom 27203010		60-23341  -  DRILL TWST 2.3MM VARIAX DISTAL AO SHFT END RAD STRL	BOTH IP/OP	$168.30 	$124.54	$0.00	$137.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.91	$124.91	$0.00	$0.00	$35.07	$0.00	$0.00	$0.00	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-23441	SUP	Custom 27203010		60-23441  -  DRILL TWST 2.3MM DNTL SHFT END	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-25126	SUP	Custom 27203010		60-25126  -  BIT DRILL 94MM 2.5MM 26MM STOP TWST STRL	BOTH IP/OP	$159.50 	$118.03	$0.00	$127.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.38	$118.38	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$79.75	$126.32	$127.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-25326	SUP	Custom 27203010		60-25326  -  BIT DRILL 87MM 2.5MM PRFL HAND MDLR AO SHFT END 26MM SM FRAG	BOTH IP/OP	$159.50 	$118.03	$0.00	$127.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.38	$118.38	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$79.75	$126.32	$127.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-25426	SUP	Custom 27203010		60-25426  -  DRILL TWST 25MM 27MM WKG LN	BOTH IP/OP	$159.50 	$118.03	$0.00	$127.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.38	$118.38	$0.00	$0.00	$33.24	$0.00	$0.00	$0.00	$0.00	$79.75	$126.32	$127.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
602640S	SUP	HCPCS C1713		602640S  -  SCREW BN THRD 6.5MM 40MM STRL 20MM ASNS III CNN THRD TI HIP	BOTH IP/OP	$391.88 	$289.99	$0.00	$483.20	$271.80	$271.80	$0.00	$0.00	$0.00	$81.68	$290.85	$290.85	$0.00	$0.00	$81.67	$0.00	$231.79	$231.79	$0.00	$302.00	$478.37	$483.20	$0.00		$0.00	$94.53	$0.00	$0.00	$96.16	$0.00	$0.00	$0.00	$0.00	$0.00
6033-0425	SUP	HCPCS C1776		6033-0425  -  STEM FEMORAL 4 25MM CEMENTED COLLARLESS NORMALIZE OMNIFIT	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6033-0525	SUP	HCPCS C1776		6033-0525  -  STEM FEMORAL 5 25MM CEMENTED COLLARLESS NORMALIZE OMNIFIT	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6033-0625	SUP	HCPCS C1776		6033-0625  -  STEM FEMORAL 6 25MM CEMENTED COLLARLESS NORMALIZE OMNIFIT	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6033-0730	SUP	HCPCS C1776		6033-0730  -  STEM FEMORAL 7 30MM CEMENTED COLLARLESS NORMALIZE OMNIFIT	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6033-0830	SUP	HCPCS C1776		6033-0830  -  STEM FEMORAL 8 30MM CEMENTED COLLARLESS NORMALIZE OMNIFIT	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6033-0935	SUP	HCPCS C1776		6033-0935  -  STEM FEMORAL 9 35MM CEMENTED COLLARLESS NORMALIZE OMNIFIT	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6033-1035	SUP	HCPCS C1776		6033-1035  -  STEM FEMORAL 10 35MM CEMENTED COLLARLESS NORMALIZE OMNIFIT	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6033-1140	SUP	HCPCS C1776		6033-1140  -  STEM FEMORAL 11 40MM CEMENTED COLLARLESS NORMALIZE OMNIFIT	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6033-1240	SUP	HCPCS C1776		6033-1240  -  STEM FEMORAL 12 40MM CEMENTED COLLARLESS NORMALIZE OMNIFIT	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6033-1340	SUP	HCPCS C1776		6033-1340  -  STEM FEMORAL 13 40MM CEMENTED COLLARLESS NORMALIZE OMNIFIT	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6034-0425	SUP	HCPCS C1776		6034-0425  -  STEM FEMORAL 4 25MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6034-0525	SUP	HCPCS C1776		6034-0525  -  STEM FEMORAL 5 25MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6034-0625	SUP	HCPCS C1776		6034-0625  -  STEM FEMORAL 6 25MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6034-0730	SUP	HCPCS C1776		6034-0730  -  STEM FEMORAL 7 30MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6034-0830	SUP	HCPCS C1776		6034-0830  -  STEM FEMORAL 8 30MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6034-0935	SUP	HCPCS C1776		6034-0935  -  STEM FEMORAL 9 35MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6034-1035	SUP	HCPCS C1776		6034-1035  -  STEM FEMORAL 10 35MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6034-1140	SUP	HCPCS C1776		6034-1140  -  STEM FEMORAL 11 40MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6034-1240	SUP	HCPCS C1776		6034-1240  -  STEM FEMORAL 12 40MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6034-1340	SUP	HCPCS C1776		6034-1340  -  STEM FEMORAL 13 40MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6041-1140	SUP	HCPCS C1776		6041-1140  -  STEM FEM 40MM OMFT HYDRXAPT 11 HIP	BOTH IP/OP	"$5,592.00 "	"$4,138.08"	$0.00	"$4,473.60"	"$2,516.40"	"$2,516.40"	$0.00	$0.00	$0.00	"$1,165.51"	"$4,150.38"	"$4,150.38"	$0.00	$0.00	"$1,165.37"	$0.00	"$2,756.86"	"$2,756.86"	$0.00	"$2,796.00"	"$4,428.86"	"$4,473.60"	$0.00		$0.00	$875.15	$0.00	$0.00	$890.25	$0.00	$0.00	$0.00	$0.00	$0.00
6041-1240	SUP	HCPCS C1776		6041-1240  -  STEM FEM 40MM 12MM MRS TPR OSTNC HYDRXAPT HIP	BOTH IP/OP	"$5,592.00 "	"$4,138.08"	$0.00	"$4,473.60"	"$2,516.40"	"$2,516.40"	$0.00	$0.00	$0.00	"$1,165.51"	"$4,150.38"	"$4,150.38"	$0.00	$0.00	"$1,165.37"	$0.00	"$2,756.86"	"$2,756.86"	$0.00	"$2,796.00"	"$4,428.86"	"$4,473.60"	$0.00		$0.00	$875.15	$0.00	$0.00	$890.25	$0.00	$0.00	$0.00	$0.00	$0.00
6046-0625	SUP	HCPCS C1776		6046-0625  -  STEM FEM OMFLX HYDRXAPT 6 HIP	BOTH IP/OP	"$6,546.00 "	"$4,844.04"	$0.00	"$5,236.80"	"$2,945.70"	"$2,945.70"	$0.00	$0.00	$0.00	"$1,364.35"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,364.19"	$0.00	"$3,227.18"	"$3,227.18"	$0.00	"$3,273.00"	"$5,184.43"	"$5,236.80"	$0.00		$0.00	"$1,024.45"	$0.00	$0.00	"$1,042.12"	$0.00	$0.00	$0.00	$0.00	$0.00
6046-0830	SUP	HCPCS C1776		6046-0830  -  STEM FEM OMFLX HYDRXAPT 8 HIP	BOTH IP/OP	"$6,546.00 "	"$4,844.04"	$0.00	"$5,236.80"	"$2,945.70"	"$2,945.70"	$0.00	$0.00	$0.00	"$1,364.35"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,364.19"	$0.00	"$3,227.18"	"$3,227.18"	$0.00	"$3,273.00"	"$5,184.43"	"$5,236.80"	$0.00		$0.00	"$1,024.45"	$0.00	$0.00	"$1,042.12"	$0.00	$0.00	$0.00	$0.00	$0.00
6046-1440	SUP	HCPCS C1776		6046-1440  -  STEM FEM OMFLX HYDRXAPT 14 HIP	BOTH IP/OP	"$6,546.00 "	"$4,844.04"	$0.00	"$5,236.80"	"$2,945.70"	"$2,945.70"	$0.00	$0.00	$0.00	"$1,364.35"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,364.19"	$0.00	"$3,227.18"	"$3,227.18"	$0.00	"$3,273.00"	"$5,184.43"	"$5,236.80"	$0.00		$0.00	"$1,024.45"	$0.00	$0.00	"$1,042.12"	$0.00	$0.00	$0.00	$0.00	$0.00
6048-58	SUP	Custom 27203010		6048-58  -  KIT STYLET BLUNT STR .014IN 58CM LEAD KNOB GREEN	BOTH IP/OP	$77.50 	$57.35	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.52	$57.52	$0.00	$0.00	$16.15	$0.00	$0.00	$0.00	$0.00	$38.75	$61.38	$62.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6050-0530	SUP	HCPCS C1776		6050-0530  -  STEM FEMORAL 5 30MM HEAD NECK OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6050-0735	SUP	HCPCS C1776		6050-0735  -  IMPLANT KN 69 68.9MM ANT/POSTERIORX70.1MM MEDI STRL IB2MKS	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6050-0745	SUP	HCPCS C1776		6050-0745  -  STEM FEMORAL 7 45MM CEMENTED HEAD/NECK OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6050-0935	SUP	HCPCS C1776		6050-0935  -  STEM FEMORAL 9 C TAPER 12MM 160MM 35MM OMNIFIT HEAD NECK HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6050-0945	SUP	HCPCS C1776		6050-0945  -  STEM FEMORAL 9 45MM 160MM CEMENTED HEAD/NECK OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6050-0955	SUP	HCPCS C1776		6050-0955  -  STEM FEMORAL 55MM 55MM 9MM HEAD NECK OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6050-1135	SUP	HCPCS C1776		6050-1135  -  STEM FEMORAL 11 CEMENT OMNIFIT HIP	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6051-0425A	SUP	HCPCS C1776		6051-0425A  -  STEM FEM 100MM 8.1MM CMNTLS SECFIT HYDRXAPT 4 25MM HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6051-0425S	SUP	HCPCS C1776		6051-0425S  -  STEM FEMORAL 132D 4 29MM OFFST 8.1MM 100MM 25MM NECK SECFIT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6051-0525A	SUP	HCPCS C1776		6051-0525A  -  STEM FEM 110MM 8.9MM CMNTLS SECFIT HYDRXAPT 5 25MM HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6051-0525S	SUP	HCPCS C1776		6051-0525S  -  STEM FEMORAL 132D 5 29MM OFFST 8.9MM 110MM 25MM NECK SECFIT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6051-0625A	SUP	HCPCS C1776		6051-0625A  -  STEM FEM CMNTLS CTPR CLRLS SECFIT HYDRXAPT 6 25MM HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6051-0625S	SUP	HCPCS C1776		6051-0625S  -  STEM FEMORAL 132D 6 30MM OFFST 9.6MM 120MM 25MM NECK SECFIT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6051-0730A	SUP	HCPCS C1776		6051-0730A  -  STEM FEM 7 10.4MM 13CM 30MM SCRFT BS NK DIST TIP HA HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6051-0730S	SUP	HCPCS C1776		6051-0730S  -  STEM FEMORAL 132D 7 35MM OFFST 10.4MM 130MM 30MM NECK SECFIT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6051-0830A	SUP	HCPCS C1776		6051-0830A  -  STEM FEM 140MM 11.2MM CMNTLS SECFIT HYDRXAPT 8 30MM HIP STRL	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6051-0830S	SUP	HCPCS C1776		6051-0830S  -  STEM FEMORAL 132D 8 36MM OFFST 11.2MM 140MM 30MM NECK SECFIT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6051-0935A	SUP	HCPCS C1776		6051-0935A  -  STEM FEM 11.9MM SECFIT HYDRXAPT 9 35MM HIP STRL	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6051-0935S	SUP	HCPCS C1776		6051-0935S  -  STEM FEMORAL 132D 9 40.8MM 11.9MM 15CM 35MM SECFIT MAX HA	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6051-1035A	SUP	HCPCS C1776		6051-1035A  -  STEM FEM 160MM 12.7MM CMNTLS SECFIT HYDRXAPT 10 35MM HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6051-1035S	SUP	HCPCS C1776		6051-1035S  -  STEM FEMORAL 132D 10 42MM OFFST 12.7MM 160MM 35MM NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6051-1140A	SUP	HCPCS C1776		6051-1140A  -  STEM FEM 40MM SECFIT MXHYDRXAPT 11 40MM HIP STRL	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6051-1140S	SUP	HCPCS C1776		6051-1140S  -  STEM FEMORAL 132D 11 46.5MM 13.5MM 17CM 40MM SECFIT MAX HA	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6051-1240A	SUP	HCPCS C1776		6051-1240A  -  STEM FEM 170MM 14.7MM CMNTLS SECFIT HYDRXAPT 12 40MM HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6051-1240S	SUP	HCPCS C1776		6051-1240S  -  STEM FEMORAL 132D 12 47MM OFFST 14.7MM 170MM 40MM NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6051-1340A	SUP	HCPCS C1776		6051-1340A  -  STEM FEM 13 48.2MM OFST 16MM 17CM 40MM SCRFT HA HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6051-1340S	SUP	HCPCS C1776		6051-1340S  -  STEM FEM 13 16MM 17CM 40MM SCRFT BS OFST HAP HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6051-1440A	SUP	HCPCS C1776		6051-1440A  -  STEM FEM 170MM 17.2MM CMNTLS SECFIT HYDRXAPT 14 40MM HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6051-1440S	SUP	HCPCS C1776		6051-1440S  -  STEM FEMORAL 132D 14 49MM OFFST 17.2MM 170MM 40MM NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6052-0625A	SUP	HCPCS C1776		6052-0625A  -  STEM FEM CMNTLS SECFIT HYDRXAPT 6 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6052-0625S	SUP	HCPCS C1776		6052-0625S  -  STEM FEMORAL 127D 6 33MM OFFST 9.6MM 120MM 25MM NECK SECFIT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6052-0730A	SUP	HCPCS C1776		6052-0730A  -  STEM FEM 30MM SECFIT MXHYDRXAPT 7 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6052-0730S	SUP	HCPCS C1776		6052-0730S  -  STEM FEMORAL 127D 7 39MM OFFST 10.4MM 130MM 30MM NECK SECFIT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6052-0830A	SUP	HCPCS C1776		6052-0830A  -  STEM FEM SECFIT HYDRXAPT 8 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6052-0830S	SUP	HCPCS C1776		6052-0830S  -  STEM FEMORAL 127D 8 40MM OFFST 11.2MM 140MM 30MM NECK SECFIT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6052-0935A	SUP	HCPCS C1776		6052-0935A  -  STEM FEM SECFIT HYDRXAPT 127D 9 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6052-0935S	SUP	HCPCS C1776		6052-0935S  -  STEM FEMORAL 127D 9 45MM OFFST 11.9MM 150MM 35MM NECK SECFIT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6052-1035A	SUP	HCPCS C1776		6052-1035A  -  STEM FEM SECFIT HYDRXAPT 127D 10 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6052-1035S	SUP	HCPCS C1776		6052-1035S  -  STEM FEMORAL 127D 10 46MM OFFST 12.7MM 160MM 35MM NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6052-1140A	SUP	HCPCS C1776		6052-1140A  -  STEM FEM SECFIT HYDRXAPT 127D 11 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6052-1140S	SUP	HCPCS C1776		6052-1140S  -  STEM FEMORAL 127D 11 51MM OFFST 13.5MM 170MM 40MM NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6052-1240A	SUP	HCPCS C1776		6052-1240A  -  STEM FEM CMNTLS SECFIT HYDRXAPT 127D 12 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6052-1240S	SUP	HCPCS C1776		6052-1240S  -  STEM FEMORAL 127D 12 52MM OFFST 14.7MM 170MM 40MM NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6052-1340A	SUP	HCPCS C1776		6052-1340A  -  STEM FEM CMNTLS SECFIT HYDRXAPT 127D 13 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6052-1340S	SUP	HCPCS C1776		6052-1340S  -  STEM FEMORAL 127D 13 53MM OFFST 16MM 170MM 40MM NECK SECFIT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0509A	SUP	HCPCS C1776		6054-0509A  -  STEM FEM 5 32MM OFST 9MM 110MM 25MM SCRFT + PRM HA HIP	BOTH IP/OP	"$6,861.00 "	"$5,077.14"	$0.00	"$5,488.80"	"$3,087.45"	"$3,087.45"	$0.00	$0.00	$0.00	"$1,430.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,429.83"	$0.00	"$3,382.47"	"$3,382.47"	$0.00	"$3,430.50"	"$5,433.91"	"$5,488.80"	$0.00		$0.00	"$1,073.75"	$0.00	$0.00	"$1,092.27"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0509S	SUP	HCPCS C1776		6054-0509S  -  STEM FEM 127D 5 32MM OFST 9MM 110MM 25MM SCRFT+ MX PLSH NK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0511A	SUP	HCPCS C1776		6054-0511A  -  STEM FEM 5 32MM OFST 11MM 110MM 25MM SCRFT + PRM HA HIP	BOTH IP/OP	"$6,861.00 "	"$5,077.14"	$0.00	"$5,488.80"	"$3,087.45"	"$3,087.45"	$0.00	$0.00	$0.00	"$1,430.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,429.83"	$0.00	"$3,382.47"	"$3,382.47"	$0.00	"$3,430.50"	"$5,433.91"	"$5,488.80"	$0.00		$0.00	"$1,073.75"	$0.00	$0.00	"$1,092.27"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0511S	SUP	HCPCS C1776		6054-0511S  -  STEM FEM 5 11MM STRL SCRFT + HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0610A	SUP	HCPCS C1776		6054-0610A  -  STEM FEM 10MM PRIM SECFIT PLUS HYDRXAPT 6 HIP	BOTH IP/OP	"$6,861.00 "	"$5,077.14"	$0.00	"$5,488.80"	"$3,087.45"	"$3,087.45"	$0.00	$0.00	$0.00	"$1,430.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,429.83"	$0.00	"$3,382.47"	"$3,382.47"	$0.00	"$3,430.50"	"$5,433.91"	"$5,488.80"	$0.00		$0.00	"$1,073.75"	$0.00	$0.00	"$1,092.27"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0610S	SUP	HCPCS C1776		6054-0610S  -  STEM FEMORAL 127D 6 33MM OFFST 10MM 120MM 25MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0612A	SUP	HCPCS C1776		6054-0612A  -  STEM FEM 12MM CMNTLS PRIM SECFIT PLUS HYDRXAPT 6 HIP	BOTH IP/OP	"$6,861.00 "	"$5,077.14"	$0.00	"$5,488.80"	"$3,087.45"	"$3,087.45"	$0.00	$0.00	$0.00	"$1,430.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,429.83"	$0.00	"$3,382.47"	"$3,382.47"	$0.00	"$3,430.50"	"$5,433.91"	"$5,488.80"	$0.00		$0.00	"$1,073.75"	$0.00	$0.00	"$1,092.27"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0612S	SUP	HCPCS C1776		6054-0612S  -  STEM FEMORAL 127D 6 33MM OFFST 12MM 120MM 25MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0711A	SUP	HCPCS C1776		6054-0711A  -  STEM FEM 11MM PRIM SECFIT MXHYDRXAPT 7 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0711S	SUP	HCPCS C1776		6054-0711S  -  STEM FEMORAL 127D 7 39MM OFFST 11MM 130MM 30MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0713A	SUP	HCPCS C1776		6054-0713A  -  STEM FEM 13MM PRIM SECFIT PLUS HYDRXAPT 7 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0713S	SUP	HCPCS C1776		6054-0713S  -  STEM FEMORAL 127D 7 39MM OFFST 13MM 130MM 30MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0812A	SUP	HCPCS C1776		6054-0812A  -  STEM FEM 12MM PRIM SECFIT PLUS HYDRXAPT 8 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0812S	SUP	HCPCS C1776		6054-0812S  -  STEM FEMORAL 127D 8 40MM OFFST 12MM 140MM 30MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0814A	SUP	HCPCS C1776		6054-0814A  -  STEM FEM SECFIT PLUS 8 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0814S	SUP	HCPCS C1776		6054-0814S  -  STEM FEMORAL 127D 8 40MM OFFST 14MM 140MM 30MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0913A	SUP	HCPCS C1776		6054-0913A  -  STEM FEM 13MM PRIM SECFIT MXHYDRXAPT 9 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0913S	SUP	HCPCS C1776		6054-0913S  -  STEM FEMORAL 127D 9 45MM OFFST 13MM 150MM 35MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0915A	SUP	HCPCS C1776		6054-0915A  -  STEM FEM PRIM CMNTLS SECFIT PLUS 9 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-0915S	SUP	HCPCS C1776		6054-0915S  -  STEM FEMORAL 127D 9 45MM OFFST 15MM 150MM 35MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1014A	SUP	HCPCS C1776		6054-1014A  -  STEM FEM 14MM PRIM SECFIT PLUS HYDRXAPT 10 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1014S	SUP	HCPCS C1776		6054-1014S  -  STEM FEMORAL 127D 10 46MM OFFST 14MM 160MM 35MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1016A	SUP	HCPCS C1776		6054-1016A  -  STEM FEM 16MM PRIM SECFIT PLUS HYDRXAPT 10 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1016S	SUP	HCPCS C1776		6054-1016S  -  STEM FEMORAL 127D 10 46MM OFFST 16MM 160MM 35MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1115A	SUP	HCPCS C1776		6054-1115A  -  STEM FEM 15MM PRIM SECFIT PLUS HYDRXAPT 11 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1115S	SUP	HCPCS C1776		6054-1115S  -  STEM FEMORAL 127D 11 51MM OFFST 15MM 170MM 40MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1117A	SUP	HCPCS C1776		6054-1117A  -  STEM FEM 17MM PRIM SECFIT PLUS HYDRXAPT 11 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1117S	SUP	HCPCS C1776		6054-1117S  -  STEM FEMORAL 127D 11 51MM OFFST 17MM 170MM 40MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1216S	SUP	HCPCS C1776		6054-1216S  -  STEM FEMORAL 127D 12 52MM OFFST 16MM 170MM 40MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1218A	SUP	HCPCS C1776		6054-1218A  -  STEM FEM 18MM CMNTLS PRIM SECFIT PLUS HYDRXAPT 12 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1218S	SUP	HCPCS C1776		6054-1218S  -  STEM FEMORAL 127D 12 52MM OFFST 18MM 170MM 40MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1317S	SUP	HCPCS C1776		6054-1317S  -  STEM FEMORAL 13 17MM PRIM SECFIT PLUS HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1319S	SUP	HCPCS C1776		6054-1319S  -  STEM FEMORAL 127D 13 53MM OFFST 19MM 170MM 40MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1418S	SUP	HCPCS C1776		6054-1418S  -  STEM FEMORAL 14 18MM CEMENTLESS PRIM SECFIT PLUS HYDRXAPT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-1420S	SUP	HCPCS C1776		6054-1420S  -  STEM FEMORAL 127D 14 54MM OFFST 20MM 170MM 40MM POLISH NECK	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6054-58	SUP	HCPCS C1765		6054-58  -  STYLET LEAD KT BALL TIP TPR	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$15.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6057-0230D	SUP	HCPCS C1776		6057-0230D  -  STEM FEMORAL 127D 2 39MM OFFST 124MM 30MM CEMENTED NECK	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6057-0335D	SUP	HCPCS C1776		6057-0335D  -  STEM FEMORAL 127D 3 43MM OFFST 131MM 35MM CEMENTED NECK	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6057-0435D	SUP	HCPCS C1776		6057-0435D  -  STEM FEMORAL 127D 4 46MM OFFST 137MM 35MM CEMENTED NECK	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6057-0537D	SUP	HCPCS C1776		6057-0537D  -  STEM FEMORAL 127D 5 48MM OFFST 145MM 37MM NECK CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6057-0637D	SUP	HCPCS C1776		6057-0637D  -  STEM FEMORAL 127D 6 49MM OFFST 158MM 37MM CEMENTED NECK	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6057-0740D	SUP	HCPCS C1776		6057-0740D  -  STEM FEMORAL 127D 7 52MM OFFST 158MM 40MM CEMENTED NECK	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6057-52	SUP	Custom 27203010		6057-52  -  STYLET LEAD STR BALL .014IN 52CM KIT EXTENDED TAPER BLUE	BOTH IP/OP	$77.50 	$57.35	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.52	$57.52	$0.00	$0.00	$16.15	$0.00	$0.00	$0.00	$0.00	$38.75	$61.38	$62.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6057-58	SUP	HCPCS C1765		6057-58  -  STYLET LEAD 58CM .014IN KT BALL TIP BLUE KNOB	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$15.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6058-0230D	SUP	HCPCS C1776		6058-0230D  -  STEM FEMORAL 132D 2 35MM OFFST 124MM 30MM CEMENTED NECK	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6058-0335D	SUP	HCPCS C1776		6058-0335D  -  STEM FEMORAL 132D 3 39MM OFFST 131MM 35MM CEMENTED NECK	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6058-0435D	SUP	HCPCS C1776		6058-0435D  -  STEM FEMORAL 132D 4 42MM OFFST 137MM 35MM CEMENTED NECK	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6058-0537D	SUP	HCPCS C1776		6058-0537D  -  STEM FEMORAL 132D 5 44MM OFFST 145MM 37MM CEMENTED NECK	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6058-0637D	SUP	HCPCS C1776		6058-0637D  -  STEM FEMORAL 132D 6 45MM OFFST 158MM 37MM CEMENTED NECK	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6058-0740D	SUP	HCPCS C1776		6058-0740D  -  STEM FEMORAL 132D 4 48MM OFFST 158MM 40MM CEMENTED NECK	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
606-004-103	SUP	HCPCS Q4130		606-004-103  -  MATRIX TISS THK1MM SEMIOVAL 16X8CM STRL SURGIMEND PRS	BOTH IP/OP	"$5,760.00 "	"$4,262.40"	$0.00	"$6,016.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,200.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.38"	$0.00	"$2,839.68"	"$2,839.68"	$0.00	"$3,760.00"	"$5,955.84"	"$6,016.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-6085-200A	SUP	Custom 27203010		60-6085-200A  -  RETRACTOR/ELEVATOR LAPSCP SM 32MM STRL LF VCARE 2 CUP LCK	BOTH IP/OP	$233.40 	$172.72	$0.00	$186.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.23	$173.23	$0.00	$0.00	$48.64	$0.00	$0.00	$0.00	$0.00	$116.70	$184.85	$186.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-6085-201A	SUP	Custom 27203010		60-6085-201A  -  RETRACTOR/ELEVATOR LAPSCOP MEDIUM 34MM 2 CUP LOCK SCREW HOLE	BOTH IP/OP	$233.40 	$172.72	$0.00	$186.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.23	$173.23	$0.00	$0.00	$48.64	$0.00	$0.00	$0.00	$0.00	$116.70	$184.85	$186.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-6085-202	SUP	Custom 27203010		60-6085-202  -  RETRACTOR/ELEVATOR LAPSCOP LARGE 37MM 2 CUP HOLE MANIPULATOR	BOTH IP/OP	$196.05 	$145.08	$0.00	$159.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.51	$145.51	$0.00	$0.00	$40.86	$0.00	$0.00	$0.00	$0.00	$99.50	$157.60	$159.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
606-151X	SUP	HCPCS C1729		CATHETER INFUS .014IN STRG 2.3-1.9FR .0165IN 150CM 50CM MCTH	BOTH IP/OP	"$1,747.50 "	"$1,293.15"	$0.00	"$1,398.00"	$948.89	$948.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$873.75	"$1,384.02"	"$1,398.00"	$0.00		$0.00	$273.48	$0.00	$0.00	$278.20	$0.00	$0.00	$0.00	$0.00	$0.00
606-200-004	SUP	HCPCS C9360		606-200-004  -  MATRIX TISSUE SURGIMEND BOVINE COLLAGEN THK2 MM RECTANGLE L1	BOTH IP/OP	"$2,700.00 "	"$1,998.00"	$0.00	"$3,312.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,003.94"	"$2,003.94"	$0.00	$0.00	$562.68	$0.00	$0.00	$0.00	$0.00	"$2,070.00"	"$3,278.88"	"$3,312.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-660-01-04	SUP	HCPCS C1713		60-660-01-04  -  PLATE BONE CSTM PROPHYLACTIC CRANIAL IRR	BOTH IP/OP	"$17,487.50 "	"$12,940.75"	$0.00	"$13,990.00"	"$7,869.38"	"$7,869.38"	$0.00	$0.00	$0.00	"$3,644.83"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,644.40"	$0.00	"$8,621.34"	"$8,621.34"	$0.00	"$8,743.75"	"$13,850.10"	"$13,990.00"	$0.00		$0.00	"$2,736.79"	$0.00	$0.00	"$2,784.01"	$0.00	$0.00	$0.00	$0.00	$0.00
606S255MX	SUP	HCPCS C1725		606S255MX  -  MICROCATHETER CRBRVASC 90D 2.3-2.8FR .021IN 150CM 5CM PRWLR	BOTH IP/OP	"$2,175.25 "	"$1,609.69"	$0.00	"$1,621.84"	"$1,100.82"	"$1,100.82"	$0.00	$0.00	$0.00	$453.38	"$1,614.47"	"$1,614.47"	$0.00	$0.00	$453.32	$0.00	"$1,286.66"	"$1,286.66"	$0.00	"$1,013.65"	"$1,605.62"	"$1,621.84"	$0.00		$0.00	$317.27	$0.00	$0.00	$322.75	$0.00	$0.00	$0.00	$0.00	$0.00
606-S255X	SUP	HCPCS C1729		CATHETER INFUS 2.8-2.3FR .021IN 150CM 5CM MCTH DUAL MRKR	BOTH IP/OP	"$1,965.00 "	"$1,454.10"	$0.00	"$1,572.00"	"$1,067.00"	"$1,067.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$982.50	"$1,556.28"	"$1,572.00"	$0.00		$0.00	$307.52	$0.00	$0.00	$312.83	$0.00	$0.00	$0.00	$0.00	$0.00
6070-0525A	SUP	Custom 27803010		6070-0525A  -  STEM FEMORAL 132D 5 25MM PRIM OMNIFIT HFX HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6070-0625A	SUP	Custom 27803010		6070-0625A  -  STEM FEMORAL 132D 6 30MM OFFST 120MM 25MM CEMENTED NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6070-0730A	SUP	Custom 27803010		6070-0730A  -  STEM FEMORAL 132D 7 35MM OFFST 130MM 30MM CEMENTED NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6070-0830A	SUP	Custom 27803010		6070-0830A  -  STEM FEMORAL 132D 8 36MM OFFST 140MM 30MM CEMENTED NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6070-0935A	SUP	Custom 27803010		6070-0935A  -  STEM FEMORAL 132D 9 41MM OFFST 150MM 35MM CEMENTED NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6070-1035A	SUP	Custom 27803010		6070-1035A  -  STEM FEMORAL 132D 10 35MM CEMENT OMNIFIT HFX HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6070-1140A	SUP	Custom 27803010		6070-1140A  -  STEM FEMORAL 132D 11 46MM OFFST 170MM 40MM CEMENTED NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6072-0625	SUP	Custom 27803010		6072-0625  -  STEM FEM CMNT ODC-FX 6 HIP	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6072-0730	SUP	Custom 27803010		6072-0730  -  STEM FEM CMNT ODC-FX 7 HIP	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6072-0830	SUP	Custom 27803010		6072-0830  -  STEM FEM CMNT ODC-FX 8 HIP	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6072-0935	SUP	Custom 27803010		6072-0935  -  STEM FEM CMNT ODC-FX 9 HIP	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6072-1035	SUP	Custom 27803010		6072-1035  -  STEM FEM CMNT OMFT 10 HIP	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6073-0525	SUP	Custom 27803010		6073-0525  -  STEM FEM ODC HIP	BOTH IP/OP	"$2,024.00 "	"$1,497.76"	$0.00	"$1,619.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,502.21"	"$1,502.21"	$0.00	$0.00	$421.80	$0.00	$0.00	$0.00	$0.00	"$1,012.00"	"$1,603.01"	"$1,619.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6073-0625	SUP	Custom 27803010		6073-0625  -  STEM FEM ODC HIP	BOTH IP/OP	"$2,024.00 "	"$1,497.76"	$0.00	"$1,619.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,502.21"	"$1,502.21"	$0.00	$0.00	$421.80	$0.00	$0.00	$0.00	$0.00	"$1,012.00"	"$1,603.01"	"$1,619.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6073-0730	SUP	Custom 27803010		6073-0730  -  STEM FEM ODC HIP	BOTH IP/OP	"$2,024.00 "	"$1,497.76"	$0.00	"$1,619.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,502.21"	"$1,502.21"	$0.00	$0.00	$421.80	$0.00	$0.00	$0.00	$0.00	"$1,012.00"	"$1,603.01"	"$1,619.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6073-0830	SUP	Custom 27803010		6073-0830  -  STEM FEM ODC HIP	BOTH IP/OP	"$2,024.00 "	"$1,497.76"	$0.00	"$1,619.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,502.21"	"$1,502.21"	$0.00	$0.00	$421.80	$0.00	$0.00	$0.00	$0.00	"$1,012.00"	"$1,603.01"	"$1,619.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6073-0935	SUP	Custom 27803010		6073-0935  -  STEM FEM ODC HIP	BOTH IP/OP	"$2,024.00 "	"$1,497.76"	$0.00	"$1,619.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,502.21"	"$1,502.21"	$0.00	$0.00	$421.80	$0.00	$0.00	$0.00	$0.00	"$1,012.00"	"$1,603.01"	"$1,619.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6073-1035	SUP	Custom 27803010		6073-1035  -  STEM FEM ODC HIP	BOTH IP/OP	"$2,024.00 "	"$1,497.76"	$0.00	"$1,619.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,502.21"	"$1,502.21"	$0.00	$0.00	$421.80	$0.00	$0.00	$0.00	$0.00	"$1,012.00"	"$1,603.01"	"$1,619.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6073-1140	SUP	Custom 27803010		6073-1140  -  STEM FEM ODC HIP	BOTH IP/OP	"$2,024.00 "	"$1,497.76"	$0.00	"$1,619.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,502.21"	"$1,502.21"	$0.00	$0.00	$421.80	$0.00	$0.00	$0.00	$0.00	"$1,012.00"	"$1,603.01"	"$1,619.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6076-0525A	SUP	Custom 27803010		6076-0525A  -  STEM FEMORAL 127D 5 35MM 110MM 25MM CEMENT HFX OMNIFIT HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6076-0625A	SUP	Custom 27803010		6076-0625A  -  STEM FEMORAL 127D 6 120MM 25MM CEMENT OMNIFIT HFX HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6076-0730A	SUP	Custom 27803010		6076-0730A  -  STEM FEMORAL 7 OMNIFIT HFX HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6076-0830A	SUP	Custom 27803010		6076-0830A  -  STEM FEMORAL 127D 8 135MM 30MM CEMENT OMNIFIT HFX HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6076-0935A	SUP	Custom 27803010		6076-0935A  -  STEM FEMORAL 127D 9 140MM 35MM CEMENT OMNIFIT HFX HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6076-1035A	SUP	Custom 27803010		6076-1035A  -  STEM FEMORAL 127D 10 145MM 35MM CEMENT OMNIFIT HFX HIP	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6077-0130	SUP	Custom 27803010		6077-0130  -  STEM FEMORAL 127D 1 38MM OFFST 110MM 30MM CEMENTLESS NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6077-0230	SUP	Custom 27803010		6077-0230  -  STEM FEMORAL 127D 2 39MM OFFST 115MM 30MM CEMENTLESS NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6077-0335	SUP	Custom 27803010		6077-0335  -  STEM FEMORAL 127D 3 43MM OFFST 120MM 35MM CEMENTLESS NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6077-0435	SUP	Custom 27803010		6077-0435  -  STEM FEMORAL 127D 4 44MM OFFST 125MM 35MM CEMENTLESS NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6077-0537	SUP	Custom 27803010		6077-0537  -  STEM FEMORAL 127D 5 48MM OFFST 130MM 37MM CEMENTLESS NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6077-0637	SUP	Custom 27803010		6077-0637  -  STEM FEMORAL 127D 6 49MM OFFST 135MM 37MM CEMENTLESS NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6077-0740	SUP	Custom 27803010		6077-0740  -  STEM FEMORAL 127D 7 53MM OFFST 140MM 40MM CEMENTLESS NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6077-0840	SUP	Custom 27803010		6077-0840  -  STEM FEMORAL 127D 8 54MM OFFST 145MM 40MM CEMENTLESS NECK	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6080-0530-200L	SUP	HCPCS C1776		6080-0530-200L  -  STEM FEM OMFT LNG LEFT HDNK	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6080-0530-200R	SUP	HCPCS C1776		6080-0530-200R  -  STEM FEM 200MM 12MM HDNK OMFT 5 LNG 30MM RIGHT	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6080-0735-200L	SUP	HCPCS C1776		6080-0735-200L  -  STEM FEM 200MM 14.5MM HDNK PRTCL ADD SYS OMFT 7 LNG 35MM	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6080-0735-200R	SUP	HCPCS C1776		6080-0735-200R  -  STEM FEM 200MM 12.4MM CMNT HDNK OMFT 7 LNG 35MM RIGHT HIP	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6080-0745-200L	SUP	HCPCS C1776		6080-0745-200L  -  STEM FEM 200MM CMNT HDNK OMFT 12.4MM 7 LNG 45MM LEFT HIP	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6080-0745-200R	SUP	HCPCS C1776		6080-0745-200R  -  STEM FEM 200MM 14.5MM HDNK PRTCL ADD SYS OMFT 7 LNG 45MM	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6080-0935-250L	SUP	HCPCS C1776		6080-0935-250L  -  STEM FEM 250MM OMFT 9 LNG 35MM HDNK	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6080-0935-250R	SUP	HCPCS C1776		6080-0935-250R  -  STEM FEM 200MM 14MM CMNT HDNK OMFT 9 LNG 35MM RIGHT HIP	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6080-0945-250L	SUP	HCPCS C1776		6080-0945-250L  -  STEM FEM 250MM 14MM CMNT HDNK OMFT 9 LNG 45MM LEFT HIP	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6080-0945-250R	SUP	HCPCS C1776		6080-0945-250R  -  STEM FEM 250MM 14MM CMNT HDNK OMFT 9 LNG 45MM RIGHT HIP	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
60-80317	SUP	Custom 27203010		60-80317  -  CNTRSNK DRILL 47 AO SHFT END	BOTH IP/OP	$213.13 	$157.72	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.18	$158.18	$0.00	$0.00	$44.42	$0.00	$0.00	$0.00	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60-80323	SUP	Custom 27203010		60-80323  -  CNTRSNK DRILL 48MM AO SHFT END STRL	BOTH IP/OP	$213.13 	$157.72	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.18	$158.18	$0.00	$0.00	$44.42	$0.00	$0.00	$0.00	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6082-52	SUP	Custom 27203010		6082-52  -  STYLET LEAD .014IN 52CM KIT STR BALL TIP EXTENDED TAPER GRAY	BOTH IP/OP	$77.50 	$57.35	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.52	$57.52	$0.00	$0.00	$16.15	$0.00	$0.00	$0.00	$0.00	$38.75	$61.38	$62.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6082-65	SUP	Custom 27203010		6082-65  -  KIT STY STRG XTD TPR .014IN 65CM GRY BALL TIP KNOB	BOTH IP/OP	$77.50 	$57.35	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.52	$57.52	$0.00	$0.00	$16.15	$0.00	$0.00	$0.00	$0.00	$38.75	$61.38	$62.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0525-200L	SUP	HCPCS C1776		6088-0525-200L  -  STEM FEMORAL 5 LONG 10.9MM 200MM 25MM CEMENT OMNIFIT LEFT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0525-200R	SUP	HCPCS C1776		6088-0525-200R  -  STEM FEMORAL 5 LONG 10.9MM 200MM 25MM CEMENT OMNIFIT RIGHT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0525-250L	SUP	HCPCS C1776		6088-0525-250L  -  STEM FEMORAL 5 LONG 10.9MM 250MM 25MM CEMENT OMNIFIT LEFT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0525-250R	SUP	HCPCS C1776		6088-0525-250R  -  STEM FEMORAL 5 LONG 250MM CEMENTED REVISION OMNIFIT DISTAL	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0525-300L	SUP	HCPCS C1776		6088-0525-300L  -  STEM FEMORAL 5 LONG 10.9MM 300MM 25MM CEMENT OMNIFIT LEFT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0525-300R	SUP	HCPCS C1776		6088-0525-300R  -  STEM FEMORAL 5 LONG 10.9MM 300MM 25MM CEMENT OMNIFIT RIGHT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0525-350L	SUP	HCPCS C1776		6088-0525-350L  -  TRIAL SURG 350MM 10.9MM OMFT LNG LEFT STM CMNT IMPL 25MM	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0525-350R	SUP	HCPCS C1776		6088-0525-350R  -  STEM FEM 350MM 10.9MM CMNT OMFT 5 LNG 25MM RIGHT HIP	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0730-200L	SUP	HCPCS C1776		6088-0730-200L  -  STEM FEMORAL 7 LONG 12.4MM 200MM 30MM CEMENT OMNIFIT LEFT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0730-200R	SUP	HCPCS C1776		6088-0730-200R  -  STEM FEMORAL 7 LONG 12.4MM 200MM 30MM CEMENT OMNIFIT RIGHT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0730-250L	SUP	HCPCS C1776		6088-0730-250L  -  STEM FEMORAL 7 LONG 12.4MM 250MM 30MM CEMENT OMNIFIT LEFT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0730-250R	SUP	HCPCS C1776		6088-0730-250R  -  STEM FEMORAL 7 LONG 12.4MM 250MM 30MM CEMENT OMNIFIT RIGHT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0730-300L	SUP	HCPCS C1776		6088-0730-300L  -  STEM FEMORAL 7 LONG 12.4MM 300MM 30MM CEMENT OMNIFIT LEFT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0730-300R	SUP	HCPCS C1776		6088-0730-300R  -  STEM FEMORAL 7 LONG 12.4MM 300MM 30MM CEMENT OMNIFIT RIGHT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0730-350L	SUP	HCPCS C1776		6088-0730-350L  -  STEM FEM 350MM 12.4MM CMNT OMFT 7 LNG 30MM LEFT HIP	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0730-350R	SUP	HCPCS C1776		6088-0730-350R  -  STEM FEM 350MM 12.4MM CMNT OMFT LNG 30MM HIP	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0935-200L	SUP	HCPCS C1776		6088-0935-200L  -  STEM FEMORAL 9 LONG 14MM 200MM 35MM CEMENT OMNIFIT LEFT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0935-200R	SUP	HCPCS C1776		6088-0935-200R  -  STEM FEM 200MM 14MM REV CMNT NECK TRL OMFT 9 LNG 35MM HIP	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0935-250L	SUP	HCPCS C1776		6088-0935-250L  -  STEM FEMORAL 9 LONG 14MM 250MM 35MM CEMENT OMNIFIT LEFT HIP	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0935-250R	SUP	HCPCS C1776		6088-0935-250R  -  STEM FEMORAL 9 LONG 14MM 250MM 35MM CEMENT OMNIFIT HIP RIGHT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0935-300L	SUP	HCPCS C1776		6088-0935-300L  -  STEM FEMORAL 9 LONG 14MM 300MM 35MM CEMENT OMNIFIT LEFT HIP	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0935-300R	SUP	HCPCS C1776		6088-0935-300R  -  STEM FEMORAL 9 LONG 14MM 300MM 35MM CEMENT OMNIFIT RIGHT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0935-350L	SUP	HCPCS C1776		6088-0935-350L  -  STEM FEM 350MM 14MM CMNT OMFT 9 LNG 35MM LEFT HIP	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-0935-350R	SUP	HCPCS C1776		6088-0935-350R  -  STEM FEM 350MM 14MM CMNT OMFT 9 LNG 35MM RIGHT HIP	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-1140-200L	SUP	HCPCS C1776		6088-1140-200L  -  STEM FEMORAL 11 LONG 15.5MM 200MM 40MM CEMENT OMNIFIT LEFT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-1140-200R	SUP	HCPCS C1776		6088-1140-200R  -  STEM FEMORAL 11 LONG 15.5MM 200MM 40MM CEMENT OMNIFIT RIGHT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-1140-250L	SUP	HCPCS C1776		6088-1140-250L  -  STEM FEMORAL 11 LONG 15.5MM 250MM 40MM CEMENT OMNIFIT LEFT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-1140-250R	SUP	HCPCS C1776		6088-1140-250R  -  STEM FEMORAL 11 LONG 15.5MM 250MM 40MM CEMENT OMNIFIT RIGHT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-1140-300L	SUP	HCPCS C1776		6088-1140-300L  -  STEM FEMORAL 11 LONG 15.5MM 300MM 40MM CEMENT OMNIFIT LEFT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-1140-300R	SUP	HCPCS C1776		6088-1140-300R  -  STEM FEMORAL 11 LONG 15.5MM 300MM 40MM CEMENT OMNIFIT RIGHT	BOTH IP/OP	"$11,872.50 "	"$8,785.65"	$0.00	"$9,498.00"	"$5,342.63"	"$5,342.63"	$0.00	$0.00	$0.00	"$2,474.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,474.23"	$0.00	"$5,853.14"	"$5,853.14"	$0.00	"$5,936.25"	"$9,403.02"	"$9,498.00"	$0.00		$0.00	"$1,858.05"	$0.00	$0.00	"$1,890.10"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-1140-350L	SUP	HCPCS C1776		6088-1140-350L  -  STEM FEM 350MM CMNT OMFT 11 LNG 40MM HIP	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6088-1140-350R	SUP	HCPCS C1776		6088-1140-350R  -  STEM FEM 350MM 15.5MM CMNT OMFT 11 LNG 40MM RIGHT HIP	BOTH IP/OP	"$10,099.38 "	"$7,473.54"	$0.00	"$8,079.50"	"$4,544.72"	"$4,544.72"	$0.00	$0.00	$0.00	"$2,104.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,104.71"	$0.00	"$4,978.99"	"$4,978.99"	$0.00	"$5,049.69"	"$7,998.71"	"$8,079.50"	$0.00		$0.00	"$1,580.55"	$0.00	$0.00	"$1,607.82"	$0.00	$0.00	$0.00	$0.00	$0.00
60-94120	SUP	HCPCS C1713		60-94120  -  COUNTERSINK DRILL BICONCAVE WASHER	BOTH IP/OP	$435.68 	$322.40	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$90.81	$323.36	$323.36	$0.00	$0.00	$90.79	$0.00	$257.70	$257.70	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
6097-0425	SUP	HCPCS C1776		6097-0425  -  STEM FEMORAL 127D 4 33MM OFFST 8.1MM 100MM 25MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6097-0530	SUP	HCPCS C1776		6097-0530  -  STEM FEMORAL 127D 5 39MM OFFST 8.9MM 110MM 30MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6097-0630	SUP	HCPCS C1776		6097-0630  -  STEM FEMORAL 127D 6 40MM OFFST 9.6MM 120MM 30MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6097-0735	SUP	HCPCS C1776		6097-0735  -  STEM FEMORAL 127D 7 45MM OFFST 10.4MM 130MM 35MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6097-0835	SUP	HCPCS C1776		6097-0835  -  STEM FEMORAL 127D 8 46MM OFFST 11.3MM 135MM 35MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6097-0940	SUP	HCPCS C1776		6097-0940  -  STEM FEMORAL 127D 9 51MM OFFST 12.6MM 140MM 40MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6097-1040	SUP	HCPCS C1776		6097-1040  -  STEM FEMORAL 127D 10 52MM OFFST 13.8MM 145MM 40MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6097-1140	SUP	HCPCS C1776		6097-1140  -  STEM FEMORAL 127D 11 53MM OFFST 14.8MM 150MM 40MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6098-0425	SUP	HCPCS C1776		6098-0425  -  STEM FEMORAL 132D 4 29MM OFFST 8.1MM 100MM 25MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6098-0530	SUP	HCPCS C1776		6098-0530  -  STEM FEMORAL 132D 5 35MM OFFST 8.9MM 110MM 30MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6098-0630	SUP	HCPCS C1776		6098-0630  -  STEM FEMORAL 132D 6 36MM OFFST 9.6MM 120MM 30MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6098-0735	SUP	HCPCS C1776		6098-0735  -  STEM FEMORAL 132D 7 41MM OFFST 10.4MM 130MM 35MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6098-0835	SUP	HCPCS C1776		6098-0835  -  STEM FEMORAL 132D 8 42MM OFFST 11.3MM 135MM 35MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6098-0940	SUP	HCPCS C1776		6098-0940  -  STEM FEMORAL 132D 9 46MM OFFST 12.6MM 140MM 40MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6098-1040	SUP	HCPCS C1776		6098-1040  -  STEM FEMORAL 132D 10 47MM OFFST 13.8MM 145MM 40MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
6098-1140	SUP	HCPCS C1776		6098-1140  -  STEM FEMORAL 132D 11 48MM OFFST 14.8MM 150MM 40MM CEMENTED	BOTH IP/OP	"$4,317.50 "	"$3,194.95"	$0.00	"$3,454.00"	"$1,942.88"	"$1,942.88"	$0.00	$0.00	$0.00	$899.87	"$3,204.45"	"$3,204.45"	$0.00	$0.00	$899.77	$0.00	"$2,128.53"	"$2,128.53"	$0.00	"$2,158.75"	"$3,419.46"	"$3,454.00"	$0.00		$0.00	$675.69	$0.00	$0.00	$687.35	$0.00	$0.00	$0.00	$0.00	$0.00
60XLTCD	SUP	Custom 27203010		60XLTCD  -  TUBE TRCH 38MM 49MM 11MM 6MM 95MM STRL LF 8MM SHLY XLT CUF	BOTH IP/OP	$159.65 	$118.14	$0.00	$129.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.49	$118.49	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$81.02	$128.34	$129.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60XLTCP	SUP	HCPCS A7520		60XLTCP  -  TUBE TRCH 38MM 34MM 11MM 6MM 95MM STRL LF 23MM SHLY XLT CUF	BOTH IP/OP	$159.65 	$118.14	$0.00	$129.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.49	$118.49	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$81.02	$128.34	$129.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60XLTUD	SUP	Custom 27203010		60XLTUD  -  TUBE TRCH 38MM 49MM 11MM 6MM 95MM STRL LF 8MM SHLY XLT CUFLS	BOTH IP/OP	$159.65 	$118.14	$0.00	$129.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.49	$118.49	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$81.02	$128.34	$129.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
60XLTUP	SUP	Custom 27203010		60XLTUP  -  TUBE TRCH 38MM 34MM 11MM 6MM 95MM STRL LF 23MM SHLY XLT	BOTH IP/OP	$159.65 	$118.14	$0.00	$129.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.49	$118.49	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$81.02	$128.34	$129.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61.231.017	SUP	HCPCS C1713		61.231.017  -  GRAPHIC CASE FOR 4.5MM VA-LCP INSTRUMENT AND SCREW SET	BOTH IP/OP	"$4,703.45 "	"$3,480.55"	$0.00	"$3,653.16"	"$2,054.90"	"$2,054.90"	$0.00	$0.00	$0.00	$980.32	"$3,490.90"	"$3,490.90"	$0.00	$0.00	$980.20	$0.00	"$2,318.80"	"$2,318.80"	$0.00	"$2,283.23"	"$3,616.63"	"$3,653.16"	$0.00		$0.00	$693.83	$0.00	$0.00	$726.98	$0.00	$0.00	$0.00	$0.00	$0.00
611.105.01S	SUP	Custom 27803010		611.105.01S  -  CABLE ORTHOPEDIC 1.7MM 750MM TITANIUM CRIMP CERCLAGE COCR	BOTH IP/OP	$920.73 	$681.34	$0.00	$715.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$683.36	$683.36	$0.00	$0.00	$191.88	$0.00	$0.00	$0.00	$0.00	$446.95	$707.97	$715.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61114V	SUP	Custom 27203010		61114V  -  CLIP INTNL LG SMTR VESOLOCK	BOTH IP/OP	$62.41 	$46.18	$0.00	$49.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.32	$46.32	$0.00	$0.00	$13.01	$0.00	$0.00	$0.00	$0.00	$31.20	$49.43	$49.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6-1221	SUP	Custom 27803010		6-1221  -  CAGE SPNL 12MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF	BOTH IP/OP	"$8,031.25 "	"$5,943.13"	$0.00	"$6,425.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,673.71"	$0.00	$0.00	$0.00	$0.00	"$4,015.63"	"$6,360.75"	"$6,425.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2244	SUP	Custom 27803010		61-2244  -  CUP ACETAB 44MM 22MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2248	SUP	Custom 27803010		61-2248  -  CUP ACETAB 48MM 22MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2252	SUP	Custom 27803010		61-2252  -  CUP ACETAB 52MM 22MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2256	SUP	Custom 27803010		61-2256  -  CUP ACETAB 56MM 22MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6-1226	SUP	Custom 27803010		6-1226  -  CAGE SPNL 12MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF	BOTH IP/OP	"$8,031.25 "	"$5,943.13"	$0.00	"$6,425.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,673.71"	$0.00	$0.00	$0.00	$0.00	"$4,015.63"	"$6,360.75"	"$6,425.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2261	SUP	Custom 27803010		61-2261  -  CUP ACETAB 61MM 22MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2644	SUP	Custom 27803010		61-2644  -  CUP ACETAB 44MM 26MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2646	SUP	Custom 27803010		61-2646  -  CUP ACETAB 46MM 26MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2648	SUP	Custom 27803010		61-2648  -  CUP ACETAB 48MM 26MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2652	SUP	Custom 27803010		61-2652  -  CUP ACETAB 52MM 26MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2656	SUP	Custom 27803010		61-2656  -  CUP ACETAB 56MM 26MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2658	SUP	Custom 27803010		61-2658  -  CUP ACETAB 58MM 26MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2661	SUP	Custom 27803010		61-2661  -  CUP ACETAB 61MM 26MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2844	SUP	Custom 27803010		61-2844  -  CUP ACETAB 44MM 28MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2846	SUP	Custom 27803010		61-2846  -  CUP ACETAB 46MM 28MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2848	SUP	Custom 27803010		61-2848  -  CUP ACETAB 48MM 28MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2850	SUP	Custom 27803010		61-2850  -  CUP ACETAB 50MM 28MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2852	SUP	Custom 27803010		61-2852  -  CUP ACETAB 52MM 28MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2854	SUP	Custom 27803010		61-2854  -  CUP ACETAB 54MM 28MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2856	SUP	Custom 27803010		61-2856  -  CUP ACETAB 56MM 28MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2858	SUP	Custom 27803010		61-2858  -  CUP ACETAB 58MM 28MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-2861	SUP	Custom 27803010		61-2861  -  CUP ACETAB 61MM 28MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
613.03.01S	SUP	HCPCS C1713		613.03.01S  -  CEMENT BONE NRN CRS FST ST 3ML PTTY STRL	BOTH IP/OP	"$2,151.00 "	"$1,591.74"	$0.00	"$1,720.80"	$967.95	$967.95	$0.00	$0.00	$0.00	$448.32	"$1,596.47"	"$1,596.47"	$0.00	$0.00	$448.27	$0.00	"$1,272.32"	"$1,272.32"	$0.00	"$1,075.50"	"$1,703.59"	"$1,720.80"	$0.00		$0.00	$336.63	$0.00	$0.00	$342.44	$0.00	$0.00	$0.00	$0.00	$0.00
613.05.01S	SUP	HCPCS C1713		613.05.01S  -  CEMENT BONE NRN CRS FST ST 5ML PTTY STRL	BOTH IP/OP	"$3,532.50 "	"$2,614.05"	$0.00	"$2,826.00"	"$1,589.63"	"$1,589.63"	$0.00	$0.00	$0.00	$736.26	"$2,621.82"	"$2,621.82"	$0.00	$0.00	$736.17	$0.00	"$1,741.52"	"$1,741.52"	$0.00	"$1,766.25"	"$2,797.74"	"$2,826.00"	$0.00		$0.00	$552.84	$0.00	$0.00	$562.37	$0.00	$0.00	$0.00	$0.00	$0.00
613.10.01S	SUP	HCPCS C1713		613.10.01S  -  CEMENT BONE NRN CRS FST ST 10ML PTTY STRL	BOTH IP/OP	"$6,945.75 "	"$5,139.86"	$0.00	"$5,556.60"	"$3,125.59"	"$3,125.59"	$0.00	$0.00	$0.00	"$1,447.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,447.49"	$0.00	"$3,424.25"	"$3,424.25"	$0.00	"$3,472.88"	"$5,501.03"	"$5,556.60"	$0.00		$0.00	"$1,087.01"	$0.00	$0.00	"$1,105.76"	$0.00	$0.00	$0.00	$0.00	$0.00
613.15.01S	SUP	HCPCS C1713		613.15.01S  -  CEMENT BONE NRN CRS FST ST 15ML PTTY STRL	BOTH IP/OP	"$10,194.75 "	"$7,544.12"	$0.00	"$8,155.80"	"$4,587.64"	"$4,587.64"	$0.00	$0.00	$0.00	"$2,124.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,124.59"	$0.00	"$5,026.01"	"$5,026.01"	$0.00	"$5,097.38"	"$8,074.24"	"$8,155.80"	$0.00		$0.00	"$1,595.48"	$0.00	$0.00	"$1,623.00"	$0.00	$0.00	$0.00	$0.00	$0.00
61-3248	SUP	Custom 27803010		61-3248  -  CUP ACETAB 48MM 32MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-3252	SUP	Custom 27803010		61-3252  -  CUP ACETAB 52MM 32MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-3254	SUP	Custom 27803010		61-3254  -  CUP ACETAB 54MM 32MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-3256	SUP	Custom 27803010		61-3256  -  CUP ACETAB 56MM 32MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-3258	SUP	Custom 27803010		61-3258  -  CUP ACETAB 58MM 32MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61-3261	SUP	Custom 27803010		61-3261  -  CUP ACETAB 61MM 32MM CEMENTED UHMWPE HIP	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
614.03.01S	SUP	HCPCS C1713		614.03.01S  -  CEMENT BONE NRN CRS 3ML ROTATORY MX STRL	BOTH IP/OP	"$2,151.00 "	"$1,591.74"	$0.00	"$1,720.80"	$967.95	$967.95	$0.00	$0.00	$0.00	$448.32	"$1,596.47"	"$1,596.47"	$0.00	$0.00	$448.27	$0.00	"$1,272.32"	"$1,272.32"	$0.00	"$1,075.50"	"$1,703.59"	"$1,720.80"	$0.00		$0.00	$336.63	$0.00	$0.00	$342.44	$0.00	$0.00	$0.00	$0.00	$0.00
614.05.01S	SUP	HCPCS C1713		614.05.01S  -  CEMENT BONE NRN CRS 5ML ROTATORY MX STRL	BOTH IP/OP	"$3,532.50 "	"$2,614.05"	$0.00	"$2,826.00"	"$1,589.63"	"$1,589.63"	$0.00	$0.00	$0.00	$736.26	"$2,621.82"	"$2,621.82"	$0.00	$0.00	$736.17	$0.00	"$1,741.52"	"$1,741.52"	$0.00	"$1,766.25"	"$2,797.74"	"$2,826.00"	$0.00		$0.00	$552.84	$0.00	$0.00	$562.37	$0.00	$0.00	$0.00	$0.00	$0.00
614.10.01S	SUP	HCPCS C1713		614.10.01S  -  CEMENT BONE NRN CRS 10ML ROTATORY MX STRL	BOTH IP/OP	"$6,945.75 "	"$5,139.86"	$0.00	"$5,556.60"	"$3,125.59"	"$3,125.59"	$0.00	$0.00	$0.00	"$1,447.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,447.49"	$0.00	"$3,424.25"	"$3,424.25"	$0.00	"$3,472.88"	"$5,501.03"	"$5,556.60"	$0.00		$0.00	"$1,087.01"	$0.00	$0.00	"$1,105.76"	$0.00	$0.00	$0.00	$0.00	$0.00
6-1426	SUP	Custom 27803010		6-1426  -  CAGE SPNL 14MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF	BOTH IP/OP	"$8,031.25 "	"$5,943.13"	$0.00	"$6,425.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,673.71"	$0.00	$0.00	$0.00	$0.00	"$4,015.63"	"$6,360.75"	"$6,425.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
615-02	SUP	Custom 27203010		615-02  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$267.75 	$198.14	$0.00	$214.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.72	$198.72	$0.00	$0.00	$55.80	$0.00	$0.00	$0.00	$0.00	$133.88	$212.06	$214.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6154-50-32	SUP	HCPCS C1776		6154-50-32  -  LINER ACETAB TRLG STD 6.3MM 50/52/54MM 32MM TIV	BOTH IP/OP	"$7,425.00 "	"$5,494.50"	$0.00	"$5,940.00"	"$3,341.25"	"$3,341.25"	$0.00	$0.00	$0.00	"$1,547.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,547.37"	$0.00	"$3,660.53"	"$3,660.53"	$0.00	"$3,712.50"	"$5,880.60"	"$5,940.00"	$0.00		$0.00	"$1,162.01"	$0.00	$0.00	"$1,182.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6-1626	SUP	Custom 27803010		6-1626  -  CAGE SPNL 16MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF	BOTH IP/OP	"$8,031.25 "	"$5,943.13"	$0.00	"$6,425.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,673.71"	$0.00	$0.00	$0.00	$0.00	"$4,015.63"	"$6,360.75"	"$6,425.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
617-01	SUP	Custom 25003010		ANTIBODY CLONE OC 125 LAB	BOTH IP/OP	"$1,207.50 "	$893.55	$0.00	$966.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.75	$956.34	$966.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
617-03	SUP	Custom 27203010		617-03  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$274.13 	$202.86	$0.00	$219.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$203.46	$203.46	$0.00	$0.00	$57.13	$0.00	$0.00	$0.00	$0.00	$137.06	$217.11	$219.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
617-12	SUP	Custom 27203010		617-12  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$267.75 	$198.14	$0.00	$214.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.72	$198.72	$0.00	$0.00	$55.80	$0.00	$0.00	$0.00	$0.00	$133.88	$212.06	$214.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6-1821	SUP	Custom 27803010		6-1821  -  CAGE SPNL 18MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF	BOTH IP/OP	"$8,031.25 "	"$5,943.13"	$0.00	"$6,425.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,673.71"	$0.00	$0.00	$0.00	$0.00	"$4,015.63"	"$6,360.75"	"$6,425.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6-1826	SUP	Custom 27803010		6-1826  -  CAGE SPNL 18MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF	BOTH IP/OP	"$8,031.25 "	"$5,943.13"	$0.00	"$6,425.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,673.71"	$0.00	$0.00	$0.00	$0.00	"$4,015.63"	"$6,360.75"	"$6,425.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-2-006	SUP	HCPCS C1762		6183-2-006  -  SPACER ALGRF 6MM ALLOCRAFT C DBM ACDF	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-2-007	SUP	HCPCS C1762		6183-2-007  -  SPACER ALGRF 7MM ALLOCRAFT C DBM ACDF	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-2-008	SUP	Custom 27803010		6183-2-008  -  SPACER ALGRF 8MM ALLOCRAFT C DBM ACDF	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	$0.00	$0.00	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-3-006	SUP	HCPCS C1762		6183-3-006  -  GRAFT BONE ALLOCRAFT CERV 6MM	BOTH IP/OP	"$2,625.68 "	"$1,943.00"	$0.00	"$2,100.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$547.26	"$1,948.78"	"$1,948.78"	$0.00	$0.00	$547.19	$0.00	"$1,294.46"	"$1,294.46"	$0.00	"$1,312.84"	"$2,079.54"	"$2,100.54"	$0.00		$0.00	$410.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-3-007	SUP	HCPCS C1762		6183-3-007  -  GRAFT BONE ALLOCRAFT CERV 7MM	BOTH IP/OP	"$2,625.68 "	"$1,943.00"	$0.00	"$2,100.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$547.26	"$1,948.78"	"$1,948.78"	$0.00	$0.00	$547.19	$0.00	"$1,294.46"	"$1,294.46"	$0.00	"$1,312.84"	"$2,079.54"	"$2,100.54"	$0.00		$0.00	$410.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-3-008	SUP	HCPCS C1762		6183-3-008  -  RNGR SURG 8MM CERV BONE	BOTH IP/OP	"$2,625.68 "	"$1,943.00"	$0.00	"$2,100.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$547.26	"$1,948.78"	"$1,948.78"	$0.00	$0.00	$547.19	$0.00	"$1,294.46"	"$1,294.46"	$0.00	"$1,312.84"	"$2,079.54"	"$2,100.54"	$0.00		$0.00	$410.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-3-010	SUP	HCPCS C1762		6183-3-010  -  GRAFT BONE ALLOCRAFT DBM SPCR ANT CERV INTRBD FS C-RING 10MM	BOTH IP/OP	"$2,625.68 "	"$1,943.00"	$0.00	"$2,100.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$547.26	"$1,948.78"	"$1,948.78"	$0.00	$0.00	$547.19	$0.00	"$1,294.46"	"$1,294.46"	$0.00	"$1,312.84"	"$2,079.54"	"$2,100.54"	$0.00		$0.00	$410.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-4-006	SUP	HCPCS C1762		6183-4-006  -  GRAFT BONE ALLOCRAFT CERV 6MM	BOTH IP/OP	"$3,534.58 "	"$2,615.59"	$0.00	"$2,827.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$736.69	"$2,623.36"	"$2,623.36"	$0.00	$0.00	$736.61	$0.00	"$1,742.55"	"$1,742.55"	$0.00	"$1,767.29"	"$2,799.39"	"$2,827.66"	$0.00		$0.00	$553.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-4-007	SUP	HCPCS C1762		6183-4-007  -  GRAFT BONE ALLOCRAFT CERV 7MM	BOTH IP/OP	"$3,534.58 "	"$2,615.59"	$0.00	"$2,827.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$736.69	"$2,623.36"	"$2,623.36"	$0.00	$0.00	$736.61	$0.00	"$1,742.55"	"$1,742.55"	$0.00	"$1,767.29"	"$2,799.39"	"$2,827.66"	$0.00		$0.00	$553.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-5-005	SUP	HCPCS C1762		6183-5-005  -  GRAFT BONE 5MM LORDOTIC CERV	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-5-006	SUP	HCPCS C1762		6183-5-006  -  SPACER ALLOGRAFT 6MM ANTERIOR CERV INTERBODY FUSION LORDOTIC	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-5-007	SUP	Custom 27803010		6183-5-007  -  SPACER ALLOGRAFT 7MM ANTERIOR CERV INTERBODY FUSION LORDOTIC	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	$0.00	$0.00	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-5-008	SUP	Custom 27803010		6183-5-008  -  SPACER ALGRF 8MM ALLOCRAFT CL DBM ACDF	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	$0.00	$0.00	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-5-009	SUP	HCPCS C1762		6183-5-009  -  SPACER ALLOGRAFT 9MM ANTERIOR CERV INTERBODY FUSION LORDOTIC	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-6-007	SUP	HCPCS C1762		6183-6-007  -  GRAFT BONE 7MM CERV SPN	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-7-005	SUP	HCPCS C1762		6183-7-005  -  GRAFT BONE 14X11X5MM LORDOTIC CANCELLOUS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-7-006	SUP	HCPCS C1762		6183-7-006  -  GRAFT BONE LORDOTIC 14X11X6MM ALLOCRAFT CANCELLOUS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-7-007	SUP	HCPCS C1762		6183-7-007  -  GRAFT BONE LORDOTIC 14X11X7MM ALLOGRAFT ALLOCRAFT CANCELLOUS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-7-008	SUP	HCPCS C1762		6183-7-008  -  GRAFT BONE 14X11X8MM LORDOTIC ALLOGRAFT CANCELLOUS CERV	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-7-009	SUP	HCPCS C1762		6183-7-009  -  GRAFT BONE 14X11X9MM LORDOTIC CANCELLOUS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6183-7-010	SUP	HCPCS C1762		6183-7-010  -  GRAFT BONE 14X11X10MM LORDOTIC CANCELLOUS	BOTH IP/OP	"$6,675.00 "	"$4,939.50"	$0.00	"$5,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,391.07"	$0.00	"$3,290.78"	"$3,290.78"	$0.00	"$3,337.50"	"$5,286.60"	"$5,340.00"	$0.00		$0.00	"$1,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6184-0-025	SUP	HCPCS C1713		6184-0-025  -  CEMENT BONE BNSRC CALCIUM PHOS HYDRXAPT 2.5GM PST	BOTH IP/OP	"$1,078.80 "	$798.31	$0.00	$863.04	$485.46	$485.46	$0.00	$0.00	$0.00	$224.85	$800.69	$800.69	$0.00	$0.00	$224.82	$0.00	$638.11	$638.11	$0.00	$539.40	$854.41	$863.04	$0.00		$0.00	$168.83	$0.00	$0.00	$171.74	$0.00	$0.00	$0.00	$0.00	$0.00
6184-0-050	SUP	HCPCS C1713		6184-0-050  -  CEMENT BONE BNSRC CALCIUM PHOS HYDRXAPT 5GM PST	BOTH IP/OP	"$1,815.83 "	"$1,343.71"	$0.00	"$1,452.66"	$817.12	$817.12	$0.00	$0.00	$0.00	$378.46	"$1,347.71"	"$1,347.71"	$0.00	$0.00	$378.42	$0.00	"$1,074.06"	"$1,074.06"	$0.00	$907.91	"$1,438.14"	"$1,452.66"	$0.00		$0.00	$284.18	$0.00	$0.00	$289.08	$0.00	$0.00	$0.00	$0.00	$0.00
6184-0-100	SUP	HCPCS C1713		6184-0-100  -  CEMENT BONE BNSRC HYDRXAPT 10GM PST FILR STRL	BOTH IP/OP	"$3,554.93 "	"$2,630.65"	$0.00	"$2,843.94"	"$1,599.72"	"$1,599.72"	$0.00	$0.00	$0.00	$740.94	"$2,638.47"	"$2,638.47"	$0.00	$0.00	$740.85	$0.00	"$1,752.58"	"$1,752.58"	$0.00	"$1,777.46"	"$2,815.50"	"$2,843.94"	$0.00		$0.00	$556.35	$0.00	$0.00	$565.94	$0.00	$0.00	$0.00	$0.00	$0.00
6184-0-250	SUP	HCPCS C1713		6184-0-250  -  CEMENT BONE BNSRC HYDRXAPT 25GM PST FILR STRL	BOTH IP/OP	"$7,616.70 "	"$5,636.36"	$0.00	"$6,093.36"	"$3,427.52"	"$3,427.52"	$0.00	$0.00	$0.00	"$1,587.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,587.32"	$0.00	"$3,755.03"	"$3,755.03"	$0.00	"$3,808.35"	"$6,032.43"	"$6,093.36"	$0.00		$0.00	"$1,192.01"	$0.00	$0.00	"$1,212.58"	$0.00	$0.00	$0.00	$0.00	$0.00
6184-0-500	SUP	HCPCS C1713		6184-0-500  -  CEMENT BONE BNSRC 50GM PST STRL	BOTH IP/OP	"$12,682.88 "	"$9,385.33"	$0.00	"$10,146.30"	"$5,707.29"	"$5,707.29"	$0.00	$0.00	$0.00	"$2,643.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,643.11"	$0.00	"$6,252.66"	"$6,252.66"	$0.00	"$6,341.44"	"$10,044.84"	"$10,146.30"	$0.00		$0.00	"$1,984.87"	$0.00	$0.00	"$2,019.11"	$0.00	$0.00	$0.00	$0.00	$0.00
6184-1-003	SUP	HCPCS C1713		6184-1-003  -  CEMENT BONE BCMPT INJ OSTCNDC HYDROSET BONE SUB VOID FILR	BOTH IP/OP	"$2,362.20 "	"$1,748.03"	$0.00	"$1,889.76"	"$1,062.99"	"$1,062.99"	$0.00	$0.00	$0.00	$492.34	"$1,753.22"	"$1,753.22"	$0.00	$0.00	$492.28	$0.00	"$1,397.24"	"$1,397.24"	$0.00	"$1,181.10"	"$1,870.86"	"$1,889.76"	$0.00		$0.00	$369.68	$0.00	$0.00	$376.06	$0.00	$0.00	$0.00	$0.00	$0.00
6184-1-005	SUP	HCPCS C1713		6184-1-005  -  CEMENT BONE HYDROSET SUB VOID FILR CALCIUM PHOS 5ML ORTH	BOTH IP/OP	"$3,785.10 "	"$2,800.97"	$0.00	"$3,028.08"	"$1,703.30"	"$1,703.30"	$0.00	$0.00	$0.00	$788.91	"$2,809.30"	"$2,809.30"	$0.00	$0.00	$788.81	$0.00	"$1,866.05"	"$1,866.05"	$0.00	"$1,892.55"	"$2,997.80"	"$3,028.08"	$0.00		$0.00	$592.37	$0.00	$0.00	$602.59	$0.00	$0.00	$0.00	$0.00	$0.00
6184-1-010	SUP	HCPCS C1713		6184-1-010  -  CEMENT BONE HYDROSET SUB VOID FILR CALCIUM PHOS 10ML INJ	BOTH IP/OP	"$7,286.55 "	"$5,392.05"	$0.00	"$5,829.24"	"$3,278.95"	"$3,278.95"	$0.00	$0.00	$0.00	"$1,518.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,518.52"	$0.00	"$3,592.27"	"$3,592.27"	$0.00	"$3,643.28"	"$5,770.95"	"$5,829.24"	$0.00		$0.00	"$1,140.35"	$0.00	$0.00	"$1,160.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6184-1-015	SUP	HCPCS C1713		6184-1-015  -  CEMENT BONE INJ BCMPT STRL HYDROSET BONE SUB VOID FILR	BOTH IP/OP	"$10,460.18 "	"$7,740.53"	$0.00	"$8,368.14"	"$4,707.08"	"$4,707.08"	$0.00	$0.00	$0.00	"$2,180.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,179.90"	$0.00	"$5,156.87"	"$5,156.87"	$0.00	"$5,230.09"	"$8,284.46"	"$8,368.14"	$0.00		$0.00	"$1,637.02"	$0.00	$0.00	"$1,665.26"	$0.00	$0.00	$0.00	$0.00	$0.00
6184-5-100	SUP	HCPCS C1762		6184-5-100  -  BONE STACK 5MM X 100 PELLETS	BOTH IP/OP	"$1,274.10 "	$942.83	$0.00	"$1,019.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$265.55	$945.64	$945.64	$0.00	$0.00	$265.52	$0.00	$753.63	$753.63	$0.00	$637.05	"$1,009.09"	"$1,019.28"	$0.00		$0.00	$199.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6184-5-300	SUP	HCPCS C1762		6184-5-300  -  BONE STACK 5MM X 300 PELLETS	BOTH IP/OP	"$2,262.23 "	"$1,674.05"	$0.00	"$1,809.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$471.50	"$1,679.02"	"$1,679.02"	$0.00	$0.00	$471.45	$0.00	"$1,338.11"	"$1,338.11"	$0.00	"$1,131.11"	"$1,791.69"	"$1,809.78"	$0.00		$0.00	$354.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6184-9-220	SUP	HCPCS C1713		6184-9-220  -  CEMENT BONE BONESAVE 4-6MM TCP HYDRXAPT 20ML GRNL	BOTH IP/OP	"$3,073.65 "	"$2,274.50"	$0.00	"$2,458.92"	"$1,383.14"	"$1,383.14"	$0.00	$0.00	$0.00	$640.63	"$2,281.26"	"$2,281.26"	$0.00	$0.00	$640.55	$0.00	"$1,515.31"	"$1,515.31"	$0.00	"$1,536.83"	"$2,434.33"	"$2,458.92"	$0.00		$0.00	$481.03	$0.00	$0.00	$489.33	$0.00	$0.00	$0.00	$0.00	$0.00
6188-1-001	SUP	HCPCS C1713		6188-1-001  -  CEMENT BONE RADIOPQ HALF DOSE SIMPLEX P	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$58.50	$58.50	$0.00	$0.00	$0.00	$27.10	$96.49	$96.49	$0.00	$0.00	$27.09	$0.00	$76.90	$76.90	$0.00	$65.00	$102.96	$104.00	$0.00		$0.00	$20.35	$0.00	$0.00	$20.70	$0.00	$0.00	$0.00	$0.00	$0.00
6188-1-010	SUP	HCPCS C1713		6188-1-010  -  CEMENT BONE RADIOPQ HALF DOSE SIMPLEX P STERILE	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$58.50	$58.50	$0.00	$0.00	$0.00	$27.10	$96.49	$96.49	$0.00	$0.00	$27.09	$0.00	$76.90	$76.90	$0.00	$65.00	$102.96	$104.00	$0.00		$0.00	$20.35	$0.00	$0.00	$20.70	$0.00	$0.00	$0.00	$0.00	$0.00
6191-1-001	SUP	HCPCS C1713		6191-1-001  -  CEMENT BONE RADIOPQ FULL DOSE SIMPLEX P	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$76.50	$76.50	$0.00	$0.00	$0.00	$35.43	$126.17	$126.17	$0.00	$0.00	$35.43	$0.00	$100.56	$100.56	$0.00	$85.00	$134.64	$136.00	$0.00		$0.00	$26.61	$0.00	$0.00	$27.06	$0.00	$0.00	$0.00	$0.00	$0.00
6191-1-010	SUP	HCPCS C1713		6191-1-010  -  CEMENT BONE RADIOPQ FULL DOSE SIMPLEX P STERILE	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$76.50	$76.50	$0.00	$0.00	$0.00	$35.43	$126.17	$126.17	$0.00	$0.00	$35.43	$0.00	$100.56	$100.56	$0.00	$85.00	$134.64	$136.00	$0.00		$0.00	$26.61	$0.00	$0.00	$27.06	$0.00	$0.00	$0.00	$0.00	$0.00
6192-1-001	SUP	HCPCS C1713		6192-1-001  -  CEMENT BONE FULL DOSE INDIVIDUAL SIMPLEX P SPEEDSET	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$76.50	$76.50	$0.00	$0.00	$0.00	$35.43	$126.17	$126.17	$0.00	$0.00	$35.43	$0.00	$100.56	$100.56	$0.00	$85.00	$134.64	$136.00	$0.00		$0.00	$26.61	$0.00	$0.00	$27.06	$0.00	$0.00	$0.00	$0.00	$0.00
6192-1-010	SUP	HCPCS C1713		6192-1-010  -  CEMENT BONE SMPX P SPEEDSET FD FST SET STRL	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$76.50	$76.50	$0.00	$0.00	$0.00	$35.43	$126.17	$126.17	$0.00	$0.00	$35.43	$0.00	$100.56	$100.56	$0.00	$85.00	$134.64	$136.00	$0.00		$0.00	$26.61	$0.00	$0.00	$27.06	$0.00	$0.00	$0.00	$0.00	$0.00
6194-1-001	SUP	HCPCS C1713		6194-1-001  -  CEMENT BN SMPX HVISC	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$76.50	$76.50	$0.00	$0.00	$0.00	$35.43	$126.17	$126.17	$0.00	$0.00	$35.43	$0.00	$100.56	$100.56	$0.00	$85.00	$134.64	$136.00	$0.00		$0.00	$26.61	$0.00	$0.00	$27.06	$0.00	$0.00	$0.00	$0.00	$0.00
6194-1-010	SUP	HCPCS C1713		6194-1-010  -  CEMENT BN 20ML STRL SMPX HVISC 40GM	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$76.50	$76.50	$0.00	$0.00	$0.00	$35.43	$126.17	$126.17	$0.00	$0.00	$35.43	$0.00	$100.56	$100.56	$0.00	$85.00	$134.64	$136.00	$0.00		$0.00	$26.61	$0.00	$0.00	$27.06	$0.00	$0.00	$0.00	$0.00	$0.00
6195-1-001	SUP	HCPCS C1713		6195-1-001  -  CEMENT BN SMPX HVISC GNTA 40GM	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$208.13	$208.13	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
6195-1-010	SUP	HCPCS C1713		6195-1-010  -  CEMENT BN 20ML STRL SMPX HVISC GNTA 40GM	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$208.13	$208.13	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
6197-9-001	SUP	HCPCS C1713		6197-9-001  -  CEMENT BONE SMPX P RADIOPQ FD TBR STRL	BOTH IP/OP	$700.00 	$518.00	$0.00	$648.70	$364.89	$364.89	$0.00	$0.00	$0.00	$145.90	$519.54	$519.54	$0.00	$0.00	$145.88	$0.00	$414.05	$414.05	$0.00	$405.44	$642.22	$648.70	$0.00		$0.00	$126.90	$0.00	$0.00	$129.09	$0.00	$0.00	$0.00	$0.00	$0.00
6197-9-010	SUP	HCPCS C1713		6197-9-010  -  CEMENT BONE FULL DOSE RADIOPQ PREBLEND SIMPLEX P TOBRAMYCIN	BOTH IP/OP	$700.00 	$518.00	$0.00	$560.00	$315.00	$315.00	$0.00	$0.00	$0.00	$145.90	$519.54	$519.54	$0.00	$0.00	$145.88	$0.00	$414.05	$414.05	$0.00	$350.00	$554.40	$560.00	$0.00		$0.00	$109.55	$0.00	$0.00	$111.44	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2242	SUP	Custom 27803010		61C-2242  -  CUP ACETAB UHMWPE XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2244	SUP	Custom 27803010		61C-2244  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2246	SUP	Custom 27803010		61C-2246  -  CUP ACETAB UHMWPE XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2248	SUP	Custom 27803010		61C-2248  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2250	SUP	Custom 27803010		61C-2250  -  CUP ACETAB UHMWPE XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2252	SUP	Custom 27803010		61C-2252  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2254	SUP	Custom 27803010		61C-2254  -  CUP ACETAB UHMWPE XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2256	SUP	Custom 27803010		61C-2256  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2258	SUP	Custom 27803010		61C-2258  -  CUP ACETAB UHMWPE XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2261	SUP	Custom 27803010		61C-2261  -  CUP ACETAB UHMWPE XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2642	SUP	Custom 27803010		61C-2642  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2644	SUP	Custom 27803010		61C-2644  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2646	SUP	Custom 27803010		61C-2646  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2648	SUP	Custom 27803010		61C-2648  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2650	SUP	Custom 27803010		61C-2650  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2652	SUP	Custom 27803010		61C-2652  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2654	SUP	Custom 27803010		61C-2654  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2656	SUP	Custom 27803010		61C-2656  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2658	SUP	Custom 27803010		61C-2658  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2661	SUP	Custom 27803010		61C-2661  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2844	SUP	Custom 27803010		61C-2844  -  CUP ACETAB LOW HIP UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2846	SUP	Custom 27803010		61C-2846  -  CUP ACETAB UHMWPE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2848	SUP	Custom 27803010		61C-2848  -  CUP ACETAB ALPLY XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2850	SUP	Custom 27803010		61C-2850  -  CUP ACETAB ALPLY XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2852	SUP	Custom 27803010		61C-2852  -  CUP ACETAB ALPLY XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2854	SUP	Custom 27803010		61C-2854  -  CUP ACETAB ALPLY XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2856	SUP	Custom 27803010		61C-2856  -  CUP ACETAB ALPLY XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2858	SUP	Custom 27803010		61C-2858  -  CUP ACETAB ALPLY XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C-2861	SUP	Custom 27803010		61C-2861  -  CUP ACETAB ALPLY XFIRE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
61C3	SUP	Custom 27203010		CONTROL SPHL RPR IMP RPR 1ML SERO	BOTH IP/OP	$51.20 	$37.89	$0.00	$40.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.60	$40.55	$40.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-00-28D	SUP	Custom 27803010		620-00-28D  -  INSERT ACETAB 28MM 0D D HIP PE TRDNT	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-00-28E	SUP	Custom 27803010		620-00-28E  -  INSERT ACETAB 28MM 0D E HIP PE TRDNT	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-00-28F	SUP	Custom 27803010		620-00-28F  -  INSERT ACETAB 28MM 0D F HIP PE TRDNT	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-00-28G	SUP	Custom 27803010		620-00-28G  -  INSERT ACETAB 28MM 0D G HIP PE TRDNT	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-00-28H	SUP	Custom 27803010		620-00-28H  -  INSERT ACETAB 28MM 0D H HIP PE TRDNT	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-00-28I	SUP	Custom 27803010		620-00-28I  -  INSERT ACETAB 28MM 0D 1 HIP PE TRDNT	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-00-28J	SUP	Custom 27803010		620-00-28J  -  INSERT ACETAB 28MM 0D J HIP PE TRDNT	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-005	SUP	HCPCS C1713		620-005  -  CEMENT BN 5ML STIMULAN RPD CURE KT	BOTH IP/OP	"$2,425.00 "	"$1,794.50"	$0.00	"$1,940.00"	"$1,091.25"	"$1,091.25"	$0.00	$0.00	$0.00	$505.43	"$1,799.84"	"$1,799.84"	$0.00	$0.00	$505.37	$0.00	"$1,434.39"	"$1,434.39"	$0.00	"$1,212.50"	"$1,920.60"	"$1,940.00"	$0.00		$0.00	$379.51	$0.00	$0.00	$386.06	$0.00	$0.00	$0.00	$0.00	$0.00
620-010	SUP	HCPCS C9359		620-010  -  FILLER BN VOID CA SLF	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-00146	SUP	Custom 27100030		62-00146  -  GUIDE DRILL 1.6MM LAG PILOT	BOTH IP/OP	$914.20 	$676.51	$0.00	"$1,458.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$678.52	$678.52	$0.00	$0.00	$190.52	$0.00	$0.00	$0.00	$0.00	$911.25	"$1,443.42"	"$1,458.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-00148	SUP	Custom 27100030		62-00148  -  GUIDE DRILL 2MM LAG OVERDRILL	BOTH IP/OP	$998.50 	$738.89	$0.00	"$1,478.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$741.09	$741.09	$0.00	$0.00	$208.09	$0.00	$0.00	$0.00	$0.00	$923.75	"$1,463.22"	"$1,478.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-020	SUP	HCPCS C1713		620-020  -  CEMENT BONE STIMULAN RPD CURE CALCIUM SLF 20ML KIT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
62-00231	SUP	Custom 27203010		62-00231  -  GUIDE DRILL XS SRR CENTRIC	BOTH IP/OP	$163.63 	$121.09	$0.00	$130.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.44	$121.44	$0.00	$0.00	$34.10	$0.00	$0.00	$0.00	$0.00	$81.81	$129.59	$130.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-00233	SUP	Custom 27203010		62-00233  -  GUIDE DRILL SM SRR CENTRIC LEIBINGER	BOTH IP/OP	$163.63 	$121.09	$0.00	$130.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.44	$121.44	$0.00	$0.00	$34.10	$0.00	$0.00	$0.00	$0.00	$81.81	$129.59	$130.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-00235	SUP	Custom 27203010		62-00235  -  GUIDE MED LG DRILL SRR CENTRIC SURG	BOTH IP/OP	$163.63 	$121.09	$0.00	$130.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.44	$121.44	$0.00	$0.00	$34.10	$0.00	$0.00	$0.00	$0.00	$81.81	$129.59	$130.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-00237	SUP	Custom 27203010		62-00237  -  GUIDE MED DRILL ECNTRC SURG	BOTH IP/OP	$138.88 	$102.77	$0.00	$111.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.07	$103.07	$0.00	$0.00	$28.94	$0.00	$0.00	$0.00	$0.00	$69.44	$109.99	$111.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-00239	SUP	Custom 27203010		62-00239  -  GUIDE LG DRILL ECNTRC SURG	BOTH IP/OP	$138.88 	$102.77	$0.00	$111.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.07	$103.07	$0.00	$0.00	$28.94	$0.00	$0.00	$0.00	$0.00	$69.44	$109.99	$111.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-00241	SUP	Custom 27203010		62-00241  -  GUIDE DRILL 2.7MM ECNTRC	BOTH IP/OP	$82.50 	$61.05	$0.00	$66.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.23	$61.23	$0.00	$0.00	$17.19	$0.00	$0.00	$0.00	$0.00	$41.25	$65.34	$66.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-00249	SUP	Custom 27203010		62-00249  -  GUIDE DRILL 2.7MM SRR CENTRIC	BOTH IP/OP	$204.88 	$151.61	$0.00	$163.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.06	$152.06	$0.00	$0.00	$42.70	$0.00	$0.00	$0.00	$0.00	$102.44	$162.26	$163.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-00254	SUP	Custom 27203010		62-00254  -  GUIDE DRILL HNDL CENTRIC SURG	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-00270	SUP	Custom 27203010		62-00270  -  GUIDE DRILL REDX	BOTH IP/OP	$171.88 	$127.19	$0.00	$137.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.57	$127.57	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$85.94	$136.13	$137.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-00605	SUP	Custom 27803010		62-00605  -  SPACER SPNL HBRD MMF	BOTH IP/OP	$930.00 	$688.20	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$690.25	$690.25	$0.00	$0.00	$193.81	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-10-28D	SUP	Custom 27803010		620-10-28D  -  INSERT ACETAB 28MM 10D D HIP PE TRDNT	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-10-28E	SUP	Custom 27803010		620-10-28E  -  INSERT ACETAB 28MM 10D E HIP PE TRDNT	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-10-28F	SUP	Custom 27803010		620-10-28F  -  INSERT ACETAB 28MM 10D F HIP PE TRDNT	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-10-28G	SUP	Custom 27803010		620-10-28G  -  INSERT ACETAB 10D HIP DUR S12	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-10-28H	SUP	Custom 27803010		620-10-28H  -  INSERT ACETAB 28MM 10D H HIP PE TRDNT	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
620-10-28I	SUP	Custom 27803010		620-10-28I  -  INSERT ACETAB 10D HIP CNSTRN ECNTRC POLY XFIRE OMFT S12	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-01245	SUP	Custom 27203010		62-01245  -  GUIDE DRILL FEM 2.3 MM SCR	BOTH IP/OP	$534.88 	$395.81	$0.00	$427.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$396.98	$396.98	$0.00	$0.00	$111.47	$0.00	$0.00	$0.00	$0.00	$267.44	$423.62	$427.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-01246	SUP	Custom 27203010		62-01246  -  GUIDE DRILL FEM 2.7 MM SCR	BOTH IP/OP	$534.88 	$395.81	$0.00	$427.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$396.98	$396.98	$0.00	$0.00	$111.47	$0.00	$0.00	$0.00	$0.00	$267.44	$423.62	$427.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-01250	SUP	Custom 27203010		62-01250  -  GUIDE CENTRIC DRILL HNDL SURG	BOTH IP/OP	$484.00 	$358.16	$0.00	$387.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.22	$359.22	$0.00	$0.00	$100.87	$0.00	$0.00	$0.00	$0.00	$242.00	$383.33	$387.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6201FAS	SUP	HCPCS C1760		6201FAS  -  TOOL LEAD DELIVERY 15MM 22CM FLEXIBLE FASTAC	BOTH IP/OP	$935.00 	$691.90	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$194.88	$693.96	$693.96	$0.00	$0.00	$194.85	$0.00	$553.05	$553.05	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
6208-3-010	SUP	HCPCS C1713		6208-3-010  -  PLUG BONE CMNT SDL 10MM IM	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$74.25	$74.25	$0.00	$0.00	$0.00	$34.39	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$97.60	$97.60	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
6208-3-016	SUP	HCPCS C1713		6208-3-016  -  PLUG BONE CMNT SDL 16MM IM	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$74.25	$74.25	$0.00	$0.00	$0.00	$34.39	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$97.60	$97.60	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-22A	SUP	Custom 27803010		621-00-22A  -  INSERT ACETAB 0D A 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-22B	SUP	Custom 27803010		621-00-22B  -  INSERT ACETAB 0D B 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-22C	SUP	Custom 27803010		621-00-22C  -  INSERT ACETAB 0D C 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-22D	SUP	Custom 27803010		621-00-22D  -  INSERT ACETAB 0D D 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-22E	SUP	Custom 27803010		621-00-22E  -  INSERT ACETAB 0D E 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-22F	SUP	Custom 27803010		621-00-22F  -  INSERT ACETAB 0D F 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-22G	SUP	Custom 27803010		621-00-22G  -  INSERT ACETAB 0D G 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-22H	SUP	Custom 27803010		621-00-22H  -  INSERT ACETAB 0D H 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-22I	SUP	Custom 27803010		621-00-22I  -  INSERT ACETAB 0D I 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-22J	SUP	Custom 27803010		621-00-22J  -  INSERT ACETAB 0D J 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-26C	SUP	Custom 27803010		621-00-26C  -  INSERT ACETAB 0D C 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-26D	SUP	Custom 27803010		621-00-26D  -  INSERT ACETAB 0D D 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-26E	SUP	Custom 27803010		621-00-26E  -  INSERT ACETAB 0D E 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-26F	SUP	Custom 27803010		621-00-26F  -  INSERT ACETAB 0D F 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-26G	SUP	Custom 27803010		621-00-26G  -  INSERT ACETAB 0D G 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-26H	SUP	Custom 27803010		621-00-26H  -  INSERT ACETAB 0D H 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-26I	SUP	Custom 27803010		621-00-26I  -  INSERT ACETAB 0D I 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-26J	SUP	Custom 27803010		621-00-26J  -  INSERT ACETAB 0D J 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-28C	SUP	Custom 27803010		621-00-28C  -  INSERT ACETAB 0D C 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-28D	SUP	Custom 27803010		621-00-28D  -  INSERT ACETAB 0D D 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-28E	SUP	Custom 27803010		621-00-28E  -  INSERT ACETAB 0D E 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-28F	SUP	Custom 27803010		621-00-28F  -  INSERT ACETAB 0D F 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-28G	SUP	Custom 27803010		621-00-28G  -  INSERT ACETAB 0D G 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-28H	SUP	Custom 27803010		621-00-28H  -  INSERT ACETAB 0D H 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-28I	SUP	Custom 27803010		621-00-28I  -  INSERT ACETAB 0D I 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-28J	SUP	Custom 27803010		621-00-28J  -  INSERT ACETAB 0D J 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-32D	SUP	Custom 27803010		621-00-32D  -  INSERT ACETAB 0D D 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-32E	SUP	Custom 27803010		621-00-32E  -  INSERT ACETAB 0D E 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-32F	SUP	Custom 27803010		621-00-32F  -  INSERT ACETAB 0D F 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-32G	SUP	Custom 27803010		621-00-32G  -  INSERT ACETAB 0D G 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-32H	SUP	Custom 27803010		621-00-32H  -  INSERT ACETAB 0D H 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-32I	SUP	Custom 27803010		621-00-32I  -  INSERT ACETAB 0D I 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-32J	SUP	Custom 27803010		621-00-32J  -  INSERT ACETAB 0D J 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-36E	SUP	Custom 27803010		621-00-36E  -  INSERT ACETAB 0D E 36MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-36F	SUP	Custom 27803010		621-00-36F  -  INSERT ACETAB 0D F 36MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-36G	SUP	Custom 27803010		621-00-36G  -  INSERT ACETAB 0D G 36MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-36H	SUP	Custom 27803010		621-00-36H  -  INSERT ACETAB 0D H 36MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-36I	SUP	Custom 27803010		621-00-36I  -  INSERT ACETAB 0D I 36MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-00-36J	SUP	Custom 27803010		621-00-36J  -  INSERT ACETAB 0D J 36MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6210-0-710	SUP	Custom 27203010		6210-0-710  -  OSTEOTOME SURG 12MM 120MM FLEXIBLE GRAY STERILE	BOTH IP/OP	"$1,422.50 "	"$1,052.65"	$0.00	"$1,138.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,055.78"	"$1,055.78"	$0.00	$0.00	$296.45	$0.00	$0.00	$0.00	$0.00	$711.25	"$1,126.62"	"$1,138.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6210-0-740	SUP	Custom 27203010		6210-0-740  -  OSTEOTOME SURG 12MMX93MM FLEXIBLE GRAY STERILE	BOTH IP/OP	"$1,422.50 "	"$1,052.65"	$0.00	"$1,138.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,055.78"	"$1,055.78"	$0.00	$0.00	$296.45	$0.00	$0.00	$0.00	$0.00	$711.25	"$1,126.62"	"$1,138.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-22A	SUP	Custom 27803010		621-10-22A  -  INSERT ACETAB 10D A 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-22B	SUP	Custom 27803010		621-10-22B  -  INSERT ACETAB 10D B 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-22C	SUP	Custom 27803010		621-10-22C  -  INSERT ACETAB 10D C 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-22D	SUP	Custom 27803010		621-10-22D  -  INSERT ACETAB 10D D 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-22E	SUP	Custom 27803010		621-10-22E  -  INSERT ACETAB 10D E 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-22F	SUP	Custom 27803010		621-10-22F  -  INSERT ACETAB 10D F 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-22G	SUP	Custom 27803010		621-10-22G  -  INSERT ACETAB 10D G 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-22H	SUP	Custom 27803010		621-10-22H  -  INSERT ACETAB 10D H 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-22I	SUP	Custom 27803010		621-10-22I  -  INSERT ACETAB 10D I 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-22J	SUP	Custom 27803010		621-10-22J  -  INSERT ACETAB 10D J 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-26C	SUP	Custom 27803010		621-10-26C  -  INSERT ACETAB 10D C 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-26D	SUP	Custom 27803010		621-10-26D  -  INSERT ACETAB 10D D 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-26E	SUP	Custom 27803010		621-10-26E  -  INSERT ACETAB 10D E 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-26F	SUP	Custom 27803010		621-10-26F  -  INSERT ACETAB 10D F 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-26G	SUP	Custom 27803010		621-10-26G  -  INSERT ACETAB 10D G 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-26H	SUP	Custom 27803010		621-10-26H  -  INSERT ACETAB 10D H 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-26I	SUP	Custom 27803010		621-10-26I  -  INSERT ACETAB 10D I 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-26J	SUP	Custom 27803010		621-10-26J  -  INSERT ACETAB 10D J 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-28C	SUP	Custom 27803010		621-10-28C  -  INSERT ACETAB 10D C 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-28D	SUP	Custom 27803010		621-10-28D  -  INSERT ACETAB 10D D 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-28E	SUP	Custom 27803010		621-10-28E  -  INSERT ACETAB 10D E 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-28F	SUP	Custom 27803010		621-10-28F  -  INSERT ACETAB 10D F 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-28G	SUP	Custom 27803010		621-10-28G  -  INSERT ACETAB 10D G 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-28H	SUP	Custom 27803010		621-10-28H  -  INSERT ACETAB 10D H 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-28I	SUP	Custom 27803010		621-10-28I  -  INSERT ACETAB 10D I 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-28J	SUP	Custom 27803010		621-10-28J  -  INSERT ACETAB 10D J 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-32D	SUP	Custom 27803010		621-10-32D  -  INSERT ACETAB 10D D 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-32E	SUP	Custom 27803010		621-10-32E  -  INSERT ACETAB 10D E 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-32F	SUP	Custom 27803010		621-10-32F  -  INSERT ACETAB 10D F 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-32G	SUP	Custom 27803010		621-10-32G  -  INSERT ACETAB 10D G 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-32H	SUP	HCPCS C1713		621-10-32H  -  INSERT ACETAB 10D H 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$517.50	$517.50	$0.00	$0.00	$0.00	$239.69	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$680.23	$680.23	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$179.98	$0.00	$0.00	$183.08	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-32I	SUP	Custom 27803010		621-10-32I  -  INSERT ACETAB 10D I 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-32J	SUP	Custom 27803010		621-10-32J  -  INSERT ACETAB 10D J 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-36E	SUP	Custom 27803010		621-10-36E  -  INSERT ACETAB 10D E 36MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-36F	SUP	Custom 27803010		621-10-36F  -  INSERT ACETAB 10D F 36MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-36G	SUP	Custom 27803010		621-10-36G  -  INSERT ACETAB 10D G 36MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-36H	SUP	Custom 27803010		621-10-36H  -  INSERT ACETAB 10D H 36MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-36I	SUP	Custom 27803010		621-10-36I  -  INSERT ACETAB 10D I 36MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
621-10-36J	SUP	Custom 27803010		621-10-36J  -  INSERT ACETAB 10D J 36MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-12002	SUP	Custom 27203010		62-12002  -  BLADE XFIT DNTL SHFT END 1.2MM SCRDRVR	BOTH IP/OP	$361.63 	$267.61	$0.00	$289.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.40	$268.40	$0.00	$0.00	$75.36	$0.00	$0.00	$0.00	$0.00	$180.81	$286.41	$289.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-12333	SUP	Custom 27203010		62-12333  -  BLADE 1.2MM XPIN SCRDRVR	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-12335	SUP	Custom 27203010		62-12335  -  BLADE 1.2MM REM SCRDRVR	BOTH IP/OP	$309.70 	$229.18	$0.00	$275.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.86	$229.86	$0.00	$0.00	$64.54	$0.00	$0.00	$0.00	$0.00	$171.88	$272.25	$275.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-12503	SUP	Custom 27803010		62-12503  -  TAP SURG 1.2 MM SCR	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$0.00	$0.00	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6215-5-001	SUP	HCPCS C1713		6215-5-001  -  PLUG BN CMNT SM 18.5MM STRL IM CNL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
6215-5-011	SUP	HCPCS C1713		6215-5-011  -  PLUG BN CMNT MED 25MM STRL IM CNL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
6215-5-021	SUP	HCPCS C1713		6215-5-021  -  PLUG BN CMNT LG 30MM STRL IM CNL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
621573S	SUP	HCPCS C1713		621573S  -  PLATE 81MM TI 3.5MM/4MM SCR 3 HOLE SM FRAG SET SHFT BONE FIB	BOTH IP/OP	$284.00 	$210.16	$0.00	$249.70	$140.46	$140.46	$0.00	$0.00	$0.00	$59.19	$210.78	$210.78	$0.00	$0.00	$59.19	$0.00	$167.99	$167.99	$0.00	$156.06	$247.21	$249.70	$0.00		$0.00	$48.85	$0.00	$0.00	$49.69	$0.00	$0.00	$0.00	$0.00	$0.00
621574S	SUP	HCPCS C1713		621574S  -  PLATE 93MM TI 3.5MM/4MM SCR 4 HOLE SM FRAG SET SHFT BONE FIB	BOTH IP/OP	$284.00 	$210.16	$0.00	$249.70	$140.46	$140.46	$0.00	$0.00	$0.00	$59.19	$210.78	$210.78	$0.00	$0.00	$59.19	$0.00	$167.99	$167.99	$0.00	$156.06	$247.21	$249.70	$0.00		$0.00	$48.85	$0.00	$0.00	$49.69	$0.00	$0.00	$0.00	$0.00	$0.00
621575S	SUP	HCPCS C1713		621575S  -  PLATE 105MM TI 3.5MM/4MM SCR 5 HOLE SM FRAG SET SHFT BONE	BOTH IP/OP	$284.00 	$210.16	$0.00	$249.70	$140.46	$140.46	$0.00	$0.00	$0.00	$59.19	$210.78	$210.78	$0.00	$0.00	$59.19	$0.00	$167.99	$167.99	$0.00	$156.06	$247.21	$249.70	$0.00		$0.00	$48.85	$0.00	$0.00	$49.69	$0.00	$0.00	$0.00	$0.00	$0.00
621576S	SUP	HCPCS C1713		621576S  -  PLATE 117MM TI 3.5MM/4MM SCR 6 HOLE SM FRAG SET SHFT BONE	BOTH IP/OP	$284.00 	$210.16	$0.00	$249.70	$140.46	$140.46	$0.00	$0.00	$0.00	$59.19	$210.78	$210.78	$0.00	$0.00	$59.19	$0.00	$167.99	$167.99	$0.00	$156.06	$247.21	$249.70	$0.00		$0.00	$48.85	$0.00	$0.00	$49.69	$0.00	$0.00	$0.00	$0.00	$0.00
621577S	SUP	HCPCS C1713		621577S  -  PLATE 129MM TI 3.5MM/4MM SCR 7 HOLE SM FRAG SET SHFT BONE	BOTH IP/OP	$284.00 	$210.16	$0.00	$249.70	$140.46	$140.46	$0.00	$0.00	$0.00	$59.19	$210.78	$210.78	$0.00	$0.00	$59.19	$0.00	$167.99	$167.99	$0.00	$156.06	$247.21	$249.70	$0.00		$0.00	$48.85	$0.00	$0.00	$49.69	$0.00	$0.00	$0.00	$0.00	$0.00
621578S	SUP	HCPCS C1713		621578S  -  PLATE 141MM TI 3.5MM/4MM SCR 8 HOLE SM FRAG SET SHFT BONE	BOTH IP/OP	$284.00 	$210.16	$0.00	$249.70	$140.46	$140.46	$0.00	$0.00	$0.00	$59.19	$210.78	$210.78	$0.00	$0.00	$59.19	$0.00	$167.99	$167.99	$0.00	$156.06	$247.21	$249.70	$0.00		$0.00	$48.85	$0.00	$0.00	$49.69	$0.00	$0.00	$0.00	$0.00	$0.00
621579S	SUP	HCPCS C1713		621579S  -  PLATE 153MM TI 3.5MM/4MM SCR 9 HOLE SM FRAG SET SHFT BONE	BOTH IP/OP	$284.00 	$210.16	$0.00	$249.70	$140.46	$140.46	$0.00	$0.00	$0.00	$59.19	$210.78	$210.78	$0.00	$0.00	$59.19	$0.00	$167.99	$167.99	$0.00	$156.06	$247.21	$249.70	$0.00		$0.00	$48.85	$0.00	$0.00	$49.69	$0.00	$0.00	$0.00	$0.00	$0.00
62-17005	SUP	Custom 27203010		62-17005  -  BLADE SCRDRVR 1.7MM XFT	BOTH IP/OP	$361.63 	$267.61	$0.00	$289.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.40	$268.40	$0.00	$0.00	$75.36	$0.00	$0.00	$0.00	$0.00	$180.81	$286.41	$289.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-17333	SUP	Custom 27203010		62-17333  -  BLADE 1.7MM XPIN SCRDRVR	BOTH IP/OP	$240.63 	$178.07	$0.00	$192.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.59	$178.59	$0.00	$0.00	$50.15	$0.00	$0.00	$0.00	$0.00	$120.31	$190.58	$192.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-17335	SUP	Custom 27203010		62-17335  -  BLADE 1.7MM REM SCRDRVR	BOTH IP/OP	$309.70 	$229.18	$0.00	$275.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.86	$229.86	$0.00	$0.00	$64.54	$0.00	$0.00	$0.00	$0.00	$171.88	$272.25	$275.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-17503	SUP	Custom 27803010		62-17503  -  TAP 1.7MM SURG MAXFACL	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$0.00	$0.00	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-20125	SUP	Custom 27203010		62-20125  -  CUTTER SURG PLT	BOTH IP/OP	"$2,457.00 "	"$1,818.18"	$0.00	"$1,936.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,823.59"	"$1,823.59"	$0.00	$0.00	$512.04	$0.00	$0.00	$0.00	$0.00	"$1,210.00"	"$1,916.64"	"$1,936.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-21723	SUP	HCPCS C1713		62-21723  -  IRON BNDRG PLT	BOTH IP/OP	$715.35 	$529.36	$0.00	$583.00	$327.94	$327.94	$0.00	$0.00	$0.00	$149.10	$530.93	$530.93	$0.00	$0.00	$149.08	$0.00	$423.13	$423.13	$0.00	$364.38	$577.17	$583.00	$0.00		$0.00	$114.05	$0.00	$0.00	$116.02	$0.00	$0.00	$0.00	$0.00	$0.00
62-23005	SUP	Custom 27203010		62-23005  -  BLADE 2.3MM XFIT DNTL SHFT END SCRDRVR	BOTH IP/OP	$361.63 	$267.61	$0.00	$289.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.40	$268.40	$0.00	$0.00	$75.36	$0.00	$0.00	$0.00	$0.00	$180.81	$286.41	$289.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-23333	SUP	Custom 27203010		62-23333  -  BLADE 2.3MM XPIN SCRDRVR	BOTH IP/OP	$240.63 	$178.07	$0.00	$192.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.59	$178.59	$0.00	$0.00	$50.15	$0.00	$0.00	$0.00	$0.00	$120.31	$190.58	$192.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-23335	SUP	HCPCS C1713		62-23335  -  SCREW REMOVAL BLADE 2.3 DENTAL	BOTH IP/OP	$309.70 	$229.18	$0.00	$275.00	$154.69	$154.69	$0.00	$0.00	$0.00	$64.55	$229.86	$229.86	$0.00	$0.00	$64.54	$0.00	$183.19	$183.19	$0.00	$171.88	$272.25	$275.00	$0.00		$0.00	$53.80	$0.00	$0.00	$54.73	$0.00	$0.00	$0.00	$0.00	$0.00
62-23503	SUP	Custom 27803010		62-23503  -  TAP SURG 2.3 MM SCR	BOTH IP/OP	$213.13 	$157.72	$0.00	$170.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.18	$158.18	$0.00	$0.00	$44.42	$0.00	$0.00	$0.00	$0.00	$106.56	$168.80	$170.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-27015	SUP	Custom 27203010		62-27015  -  BLADE T7 SCRDRVR 2.3MM 2.7MM SCR	BOTH IP/OP	$501.88 	$371.39	$0.00	$401.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.49	$372.49	$0.00	$0.00	$104.59	$0.00	$0.00	$0.00	$0.00	$250.94	$397.49	$401.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6227DEF04	SUP	Custom 27203010		6227DEF04  -  CATHETER GD 9.9FR 45CM STRL LF ATN PRVL LD DLV SYS DFLC CS	BOTH IP/OP	"$1,242.50 "	$919.45	$0.00	$994.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$922.18	$922.18	$0.00	$0.00	$258.94	$0.00	$0.00	$0.00	$0.00	$621.25	$984.06	$994.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-22A	SUP	Custom 27803010		623-00-22A  -  LINER ACETAB 0D A 22MM 7.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-22B	SUP	Custom 27803010		623-00-22B  -  LINER ACETAB 0D B 22MM 8.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-22C	SUP	Custom 27803010		623-00-22C  -  LINER ACETAB 0D C 22MM 9.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-22D	SUP	Custom 27803010		623-00-22D  -  LINER ACETAB 0D D 22MM 10.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-22E	SUP	Custom 27803010		623-00-22E  -  LINER ACETAB 0D E 22MM 12.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-22F	SUP	Custom 27803010		623-00-22F  -  LINER ACETAB 0D F 22MM 14.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-22G	SUP	Custom 27803010		623-00-22G  -  LINER ACETAB 0D G 22MM 16.3MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-22H	SUP	Custom 27803010		623-00-22H  -  LINER ACETAB 0D H 22MM 18.1MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-22I	SUP	Custom 27803010		623-00-22I  -  LINER ACETAB 0D I 22MM 19.6MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-22J	SUP	Custom 27803010		623-00-22J  -  LINER ACETAB 0D J 22MM 21.6MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-26C	SUP	Custom 27803010		623-00-26C  -  LINER ACETAB 0D C 26MM 7.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-26D	SUP	Custom 27803010		623-00-26D  -  LINER ACETAB 0D D 26MM 8.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-26E	SUP	Custom 27803010		623-00-26E  -  LINER ACETAB 0D E 26MM 10.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-26F	SUP	Custom 27803010		623-00-26F  -  LINER ACETAB 0D F 26MM 12.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-26G	SUP	Custom 27803010		623-00-26G  -  LINER ACETAB 0D G 26MM 14.4MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-26H	SUP	Custom 27803010		623-00-26H  -  LINER ACETAB 0D H 26MM 16.2MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-26I	SUP	Custom 27803010		623-00-26I  -  LINER ACETAB 0D I 26MM 17.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-26J	SUP	Custom 27803010		623-00-26J  -  LINER ACETAB 0D J 26MM 19.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-28A	SUP	Custom 27803010		623-00-28A  -  LINER ACETAB 0D A 28MM 4.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-28B	SUP	Custom 27803010		623-00-28B  -  LINER ACETAB 0D B 28MM 5.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-28C	SUP	Custom 27803010		623-00-28C  -  LINER ACETAB 0D C 28MM 6.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-28D	SUP	Custom 27803010		623-00-28D  -  LINER ACETAB 0D D 28MM 7.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-28E	SUP	Custom 27803010		623-00-28E  -  LINER ACETAB 0D E 28MM 9.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-28F	SUP	Custom 27803010		623-00-28F  -  LINER ACETAB 0D F 28MM 11.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-28G	SUP	Custom 27803010		623-00-28G  -  LINER ACETAB 0D G 28MM 13.4MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-28H	SUP	Custom 27803010		623-00-28H  -  LINER ACETAB 0D H 28MM 15.2MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-28I	SUP	Custom 27803010		623-00-28I  -  LINER ACETAB 0D I 28MM 16.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-28J	SUP	Custom 27803010		623-00-28J  -  LINER ACETAB 0D J 28MM 18.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-32B	SUP	Custom 27803010		623-00-32B  -  LINER ACETAB 0D B 32MM 3.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-32C	SUP	Custom 27803010		623-00-32C  -  LINER ACETAB 0D C 32MM 4.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-32D	SUP	Custom 27803010		623-00-32D  -  LINER ACETAB 0D D 32MM 5.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-32E	SUP	Custom 27803010		623-00-32E  -  LINER ACETAB 0D E 32MM 7.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-32F	SUP	Custom 27803010		623-00-32F  -  LINER ACETAB 0D F 32MM 9.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-32G	SUP	Custom 27803010		623-00-32G  -  LINER ACETAB 0D G 32MM 11.4MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-32H	SUP	Custom 27803010		623-00-32H  -  LINER ACETAB 0D H 32MM 13.2MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-32I	SUP	Custom 27803010		623-00-32I  -  LINER ACETAB 0D I 32MM 14.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-32J	SUP	Custom 27803010		623-00-32J  -  LINER ACETAB 0D J 32MM 16.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-36D	SUP	Custom 27803010		623-00-36D  -  LINER ACETAB 0D D 36MM 3.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-36E	SUP	Custom 27803010		623-00-36E  -  LINER ACETAB 0D E 36MM 5.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-36F	SUP	Custom 27803010		623-00-36F  -  LINER ACETAB 0D F 36MM 7.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-36G	SUP	Custom 27803010		623-00-36G  -  LINER ACETAB 0D G 36MM 9.4MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-36H	SUP	Custom 27803010		623-00-36H  -  LINER ACETAB 0D H 36MM 11.2MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-36I	SUP	Custom 27803010		623-00-36I  -  LINER ACETAB 0D I 36MM 12.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-36J	SUP	Custom 27803010		623-00-36J  -  LINER ACETAB 0D J 36MM 14.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-40E	SUP	Custom 27803010		623-00-40E  -  INSERT ACETAB 0D E 40MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-40F	SUP	Custom 27803010		623-00-40F  -  LINER ACETAB 0D F 40MM 5.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-40G	SUP	Custom 27803010		623-00-40G  -  LINER ACETAB 0D G 40MM 7.4MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-40H	SUP	Custom 27803010		623-00-40H  -  LINER ACETAB 0D H 40MM 9.1MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-40I	SUP	Custom 27803010		623-00-40I  -  LINER ACETAB 0D I 40MM 10.6MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-40J	SUP	Custom 27803010		623-00-40J  -  LINER ACETAB 0D J 40MM 12.6MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-44F	SUP	Custom 27803010		623-00-44F  -  LINER ACETAB 0D B F 44MM 3.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-44G	SUP	Custom 27803010		623-00-44G  -  LINER ACETAB 0D G 44MM 5.4MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-44H	SUP	Custom 27803010		623-00-44H  -  LINER ACETAB 0D H 44MM 7.1MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-44I	SUP	Custom 27803010		623-00-44I  -  LINER ACETAB 0D I 44MM 8.6MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-00-44J	SUP	Custom 27803010		623-00-44J  -  LINER ACETAB 0D J 44MM 10.6MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6230UNI	SUP	Custom 27203010		6230UNI  -  SLITTER CATHETER UNIVERSAL UNIVERSAL II	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$0.00	$0.00	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-22A	SUP	Custom 27803010		623-10-22A  -  LINER ACETAB 10D A 22MM 7.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-22B	SUP	Custom 27803010		623-10-22B  -  LINER ACETAB 10D B 22MM 8.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-22C	SUP	Custom 27803010		623-10-22C  -  LINER ACETAB 10D C 22MM 9.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-22D	SUP	Custom 27803010		623-10-22D  -  LINER ACETAB 10D D 22MM 10.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-22E	SUP	Custom 27803010		623-10-22E  -  LINER ACETAB 10D E 22MM 12.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-22F	SUP	Custom 27803010		623-10-22F  -  LINER ACETAB 10D F 22MM 14.8MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-22G	SUP	Custom 27803010		623-10-22G  -  LINER ACETAB 10D G 22MM 16.3MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-22H	SUP	Custom 27803010		623-10-22H  -  LINER ACETAB 10D H 22MM 18.1MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-22I	SUP	Custom 27803010		623-10-22I  -  LINER ACETAB 10D I 22MM 19.6MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-22J	SUP	Custom 27803010		623-10-22J  -  LINER ACETAB 10D J 22MM 21.6MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-26C	SUP	Custom 27803010		623-10-26C  -  LINER ACETAB 10D C 26MM 7.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-26D	SUP	Custom 27803010		623-10-26D  -  LINER ACETAB 10D D 26MM 8.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-26E	SUP	Custom 27803010		623-10-26E  -  LINER ACETAB 10D E 26MM 10.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-26F	SUP	Custom 27803010		623-10-26F  -  LINER ACETAB 10D F 26MM 12.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-26G	SUP	Custom 27803010		623-10-26G  -  LINER ACETAB 10D G 26MM 14.4MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-26H	SUP	Custom 27803010		623-10-26H  -  LINER ACETAB 10D H 26MM 16.2MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-26I	SUP	Custom 27803010		623-10-26I  -  LINER ACETAB 10D I 26MM 17.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-26J	SUP	Custom 27803010		623-10-26J  -  LINER ACETAB 10D J 26MM 19.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-28C	SUP	Custom 27803010		623-10-28C  -  LINER ACETAB 10D C 28MM 6.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-28D	SUP	Custom 27803010		623-10-28D  -  LINER ACETAB 10D D 28MM 7.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-28E	SUP	Custom 27803010		623-10-28E  -  LINER ACETAB 10D E 28MM 9.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-28F	SUP	Custom 27803010		623-10-28F  -  LINER ACETAB 10D F 28MM 11.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-28G	SUP	Custom 27803010		623-10-28G  -  LINER ACETAB 10D G 28MM 13.4MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-28H	SUP	Custom 27803010		623-10-28H  -  LINER ACETAB 10D H 28MM 15.2MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-28I	SUP	Custom 27803010		623-10-28I  -  LINER ACETAB 10D I 28MM 16.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-28J	SUP	Custom 27803010		623-10-28J  -  LINER ACETAB 10D J 28MM 18.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-32D	SUP	Custom 27803010		623-10-32D  -  LINER ACETAB 10D D 32MM 5.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-32E	SUP	Custom 27803010		623-10-32E  -  INSERT ACETAB 10D E 32MM PRIM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-32F	SUP	Custom 27803010		623-10-32F  -  LINER ACETAB 10D F 32MM 9.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-32G	SUP	Custom 27803010		623-10-32G  -  LINER ACETAB 10D G 32MM 11.4MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-32H	SUP	Custom 27803010		623-10-32H  -  LINER ACETAB 10D H 32MM 13.2MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-32I	SUP	Custom 27803010		623-10-32I  -  LINER ACETAB 10D I 32MM 14.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-32J	SUP	Custom 27803010		623-10-32J  -  LINER ACETAB 10D J 32MM 16.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-36E	SUP	Custom 27803010		623-10-36E  -  INSERT ACETAB 10D E 36MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-36F	SUP	Custom 27803010		623-10-36F  -  LINER ACETAB 10D F 36MM 7.9MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-36G	SUP	Custom 27803010		623-10-36G  -  LINER ACETAB 10D G 36MM 9.4MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-36H	SUP	Custom 27803010		623-10-36H  -  LINER ACETAB 10D H 36MM 11.2MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-36I	SUP	Custom 27803010		623-10-36I  -  LINER ACETAB 10D I 36MM 12.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
623-10-36J	SUP	Custom 27803010		623-10-36J  -  LINER ACETAB 10D J 36MM 14.7MM X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-32440	SUP	Custom 27803010		62-32440  -  POSITIONER IMPL 3.2MM UNV REPOSITION PIN	BOTH IP/OP	"$1,892.50 "	"$1,400.45"	$0.00	"$1,514.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,404.61"	"$1,404.61"	$0.00	$0.00	$394.40	$0.00	$0.00	$0.00	$0.00	$946.25	"$1,498.86"	"$1,514.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6232ADJ	SUP	Custom 27203010		6232ADJ  -  SLITTER CATHETER ADJUSTABLE SHEATH	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$0.00	$0.00	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
624.027S	SUP	Custom 27203010		624.027S  -  KIT SURG PEDICLE ACCES SPN REVERE	BOTH IP/OP	"$2,827.50 "	"$2,092.35"	$0.00	"$2,262.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,098.57"	"$2,098.57"	$0.00	$0.00	$589.25	$0.00	$0.00	$0.00	$0.00	"$1,413.75"	"$2,239.38"	"$2,262.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6248130D02	SUP	Custom 27203010		6248130D02  -  CATHETER GD 130D 7.1FR 65CM STRL LF ATN SLCT II SUREVALVE	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
624890D02	SUP	Custom 27203010		624890D02  -  CATHETER GD 90D 7.1FR 65CM STRL LF ATN SLCT II SUREVALVE	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-50201	SUP	Custom 27203010		62-50201  -  PACK BTRY VARISPEED	BOTH IP/OP	$780.00 	$577.20	$0.00	$624.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$578.92	$578.92	$0.00	$0.00	$162.55	$0.00	$0.00	$0.00	$0.00	$390.00	$617.76	$624.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6250EH02	SUP	Custom 27203010		6250EH02  -  CATHETER GD EH CRV 9FR 50CM STRL LF ATN CMND SUREVALVE 2 BRD	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6250MB202	SUP	Custom 27203010		6250MB202  -  CATHETER GD MB2 CRV 9FR 45CM STRL LF ATN CMND SUREVALVE 2	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
625-0T-28D	SUP	Custom 27803010		625-0T-28D  -  INSERT ACETAB D 28MM TRIDENT ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
625-0T-32E	SUP	Custom 27803010		625-0T-32E  -  INSERT ACETAB E 32MM TRIDENT ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
625-0T-32F	SUP	Custom 27803010		625-0T-32F  -  INSERT ACETAB F 32MM TRIDENT ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
625-0T-36G	SUP	Custom 27803010		625-0T-36G  -  INSERT ACETAB G 36MM TRIDENT ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
625-0T-36H	SUP	Custom 27803010		625-0T-36H  -  INSERT ACETAB H 36MM TRIDENT ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
625-0T-36I	SUP	Custom 27803010		625-0T-36I  -  INSERT ACETAB I 36MM TRIDENT ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-51217	SUP	Custom 27203010		62-51217  -  GUIDE DRILL 1.2MM 1.7MM STD	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-51723	SUP	Custom 27203010		62-51723  -  GUIDE DRILL 1.7MM 2.3MM POLYAX LCK	BOTH IP/OP	$666.88 	$493.49	$0.00	$533.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$494.95	$494.95	$0.00	$0.00	$138.98	$0.00	$0.00	$0.00	$0.00	$333.44	$528.17	$533.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-52323	SUP	Custom 27203010		62-52323  -  GUIDE DRILL 2.3MM CMPR	BOTH IP/OP	$735.63 	$544.37	$0.00	$588.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.98	$545.98	$0.00	$0.00	$153.30	$0.00	$0.00	$0.00	$0.00	$367.81	$582.62	$588.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
62-52325	SUP	Custom 27203010		62-52325  -  GUIDE DRILL 2.3MM 2.5MM STD	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6259-8-080	SUP	Custom 27803010		6259-8-080  -  CNTRLZR STM 8MM RLNC DISTAL FEM	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.69	$124.69	$0.00	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6259-8-090	SUP	Custom 27803010		6259-8-090  -  CNTRLZR STM 9MM RLNC DISTAL FEM	BOTH IP/OP	$168.00 	$124.32	$0.00	$134.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.69	$124.69	$0.00	$0.00	$35.01	$0.00	$0.00	$0.00	$0.00	$84.00	$133.06	$134.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6259-8-100	SUP	Custom 27803010		6259-8-100  -  CENTRALIZER STEM 10MM RELIANCE HIP FEMUR FRAC PRODUCTS F R	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6259-8-110	SUP	HCPCS C1713		6259-8-110  -  CENTRALIZER STEM 11MM PRIM RELIANCE HIP FEMUR	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
6259-8-120	SUP	Custom 27803010		6259-8-120  -  CENTRALIZER STEM 12MM PRIM RELIANCE DISTAL FEMUR HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6259-8-130	SUP	HCPCS C1713		6259-8-130  -  CENTRALIZER STEM 13MM PRIM RELIANCE HIP FEMUR	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
6259-8-140	SUP	HCPCS C1713		6259-8-140  -  CENTRALIZER STEM 14MM RELIANCE HIP FEMUR	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
6259-8-150	SUP	HCPCS C1713		6259-8-150  -  CENTRALIZER STEM 15MM RELIANCE HIP FEMUR	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
6259-8-160	SUP	Custom 27803010		6259-8-160  -  CENTRALIZER STEM 16MM 16MM ACCESSORIES BONE PLUG CENTRALIZER	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6259-8-170	SUP	Custom 27803010		6259-8-170  -  CENTRALIZER STEM 17MM 17MM BONE PLUGS ACCESSORIES HIP FRAC	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6259-8-180	SUP	Custom 27803010		6259-8-180  -  CENTRALIZER STEM 18MM RELIANCE HIP FEMUR DISTAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
626-00-36C	SUP	HCPCS C1776		626-00-36C  -  LINER ACTB C 36MM MDM COCR HIP 22.2MM FEM HD	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	"$1,056.38"	"$1,056.38"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$367.38	$0.00	$0.00	$373.72	$0.00	$0.00	$0.00	$0.00	$0.00
626-00-38D	SUP	HCPCS C1776		626-00-38D  -  LINER ACTB D 38MM MDLR 2 MBL COCR HIP	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	"$1,056.38"	"$1,056.38"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$367.38	$0.00	$0.00	$373.72	$0.00	$0.00	$0.00	$0.00	$0.00
626-00-42E	SUP	HCPCS C1776		626-00-42E  -  LINER ACTB E 42MM MDM 2 MBL MDLR COCR HIP	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	"$1,056.38"	"$1,056.38"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$367.38	$0.00	$0.00	$373.72	$0.00	$0.00	$0.00	$0.00	$0.00
626-00-52H	SUP	HCPCS C1776		626-00-52H  -  LINER ACTB H 52MM MDM COCR HIP 28MM FEM HD	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	"$1,056.38"	"$1,056.38"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$367.38	$0.00	$0.00	$373.72	$0.00	$0.00	$0.00	$0.00	$0.00
626-00-54I	SUP	HCPCS C1776		626-00-54I  -  LINER ACTB I 54MM MDM COCR HIP 28MM FEM HD	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	"$1,056.38"	"$1,056.38"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$367.38	$0.00	$0.00	$373.72	$0.00	$0.00	$0.00	$0.00	$0.00
626-00-58J	SUP	HCPCS C1776		626-00-58J  -  LINER ACTB J 58MM MDM COCR HIP 28MM FEM HD	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	"$1,056.38"	"$1,056.38"	$0.00	$0.00	$0.00	$489.28	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	"$1,388.55"	"$1,388.55"	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$367.38	$0.00	$0.00	$373.72	$0.00	$0.00	$0.00	$0.00	$0.00
6260-1-212	SUP	HCPCS C1776		6260-1-212  -  STEM FEM 237MM PS BW RSTOR TI 2/12 LNG LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-1-313	SUP	HCPCS C1776		6260-1-313  -  STEM FEM 235MM PS BW RSTOR TI 3/13 LNG LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-1-414	SUP	HCPCS C1776		6260-1-414  -  STEM FEM 234MM 14MM PS BW RSTOR TI 4 LNG LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-1-515	SUP	HCPCS C1776		6260-1-515  -  STEM HUM 15MM 5MM MNBLCK RSTOR TI LNG LEFT T1	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-1-616	SUP	HCPCS C1776		6260-1-616  -  STEM HUM 16MM 6MM MNBLCK RSTOR TI LNG LEFT T1	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-1-717	SUP	HCPCS C1776		6260-1-717  -  STEM FEM 241MM 17MM PS BW RSTOR TI 7 LNG LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-1-719	SUP	HCPCS C1776		6260-1-719  -  STEM FEM 251MM 19MM PS BW RSTOR TI 7 LNG LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-1-818	SUP	HCPCS C1776		6260-1-818  -  STEM FEM 240MM 18MM PS BW RSTOR TI 8 LNG LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-1-820	SUP	HCPCS C1776		6260-1-820  -  STEM FEM 251MM 20MM PS BW RSTOR TI 8 LNG LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-1-921	SUP	HCPCS C1776		6260-1-921  -  STEM FEM 250MM 21MM PS BW RSTOR TI 9 LNG LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-2-212	SUP	HCPCS C1776		6260-2-212  -  STEM HUM 12MM 2MM MNBLCK RSTOR TI LNG LEFT T1	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-2-313	SUP	HCPCS C1776		6260-2-313  -  STEM FEM 235MM 13MM PS BW RSTOR TI LNG RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-2-414	SUP	HCPCS C1776		6260-2-414  -  STEM FEM 234MM PS BW RSTOR TI 4/14 LNG RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-2-515	SUP	HCPCS C1776		6260-2-515  -  STEM FEM 233MM 15MM PS BW RSTOR TI 5 LNG RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-2-616	SUP	HCPCS C1776		6260-2-616  -  STEM FEM 242MM 16MM PS BW RSTOR TI 6 LNG RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-2-717	SUP	HCPCS C1776		6260-2-717  -  STEM FEM 241MM PS BW RSTOR TI 7/17 LNG RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-2-719	SUP	HCPCS C1776		6260-2-719  -  STEM FEM 251MM 19MM PS BW RSTOR TI 7 LNG RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-2-818	SUP	HCPCS C1776		6260-2-818  -  STEM FEM 240MM 18MM PS BW RSTOR TI 8 LNG RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-2-820	SUP	HCPCS C1776		6260-2-820  -  STEM FEM 251MM 20MM PS BW RSTOR TI 8 LNG RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-2-921	SUP	HCPCS C1776		6260-2-921  -  STEM HUM 21MM 9MM MNBLCK RSTOR TI LNG RIGHT T1	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-4-122	SUP	Custom 27803010		6260-4-122  -  HEAD FEM +0MM 22.2MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-4-222	SUP	Custom 27803010		6260-4-222  -  HEAD FEM +3MM 22.2MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-4-322	SUP	Custom 27803010		6260-4-322  -  HEAD FEMORAL +8MM TAPER 22.2MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-026	SUP	Custom 27803010		6260-5-026  -  HEAD FEMORAL -3MM TAPER 26MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-028	SUP	Custom 27803010		6260-5-028  -  HEAD FEMORAL -4MM TAPER 28MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-032	SUP	Custom 27803010		6260-5-032  -  HEAD FEMORAL -4MM TAPER 32MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-126	SUP	Custom 27803010		6260-5-126  -  HEAD FEMORAL +0MM TAPER 26MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-128	SUP	Custom 27803010		6260-5-128  -  HEAD FEMORAL +0MM TAPER 28MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-132	SUP	Custom 27803010		6260-5-132  -  HEAD FEMORAL +0MM TAPER 32MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-226	SUP	Custom 27803010		6260-5-226  -  HEAD FEMORAL +4MM TAPER 26MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-228	SUP	Custom 27803010		6260-5-228  -  HEAD FEMORAL +4MM TAPER 28MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-232	SUP	Custom 27803010		6260-5-232  -  HEAD FEMORAL +4MM TAPER 32MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-326	SUP	Custom 27803010		6260-5-326  -  HEAD FEMORAL +8MM TAPER 26MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-328	SUP	Custom 27803010		6260-5-328  -  HEAD FEMORAL +8MM TAPER 28MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-332	SUP	Custom 27803010		6260-5-332  -  HEAD FEMORAL +8MM TAPER 32MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-426	SUP	Custom 27803010		6260-5-426  -  HEAD FEMORAL +1MM TAPER 26MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-428	SUP	Custom 27803010		6260-5-428  -  HEAD FEMORAL +12MM TAPER 28MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-432	SUP	Custom 27803010		6260-5-432  -  HEAD FEMORAL +12MM TAPER 32MM V40 COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-5-628	SUP	Custom 27803010		6260-5-628  -  HEAD FEMORAL +6MM TAPER 28MM V40 COCR HIP	BOTH IP/OP	"$1,302.50 "	$963.85	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$966.72	$966.72	$0.00	$0.00	$271.44	$0.00	$0.00	$0.00	$0.00	$651.25	"$1,031.58"	"$1,042.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-111	SUP	HCPCS C1776		6260-6-111  -  STEM FEMORAL 1 STR 11MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-113	SUP	HCPCS C1776		6260-6-113  -  STEM FEMORAL 1 STR 13MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-212	SUP	HCPCS C1776		6260-6-212  -  STEM FEMORAL 2 STR 12MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-214	SUP	HCPCS C1776		6260-6-214  -  STEM FEMORAL 2 STR 14MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-313	SUP	HCPCS C1776		6260-6-313  -  STEM FEMORAL 3 STR 13MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-315	SUP	HCPCS C1776		6260-6-315  -  STEM FEMORAL 3 STR 15MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-414	SUP	HCPCS C1776		6260-6-414  -  STEM FEMORAL 4 STR 14MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-416	SUP	HCPCS C1776		6260-6-416  -  STEM FEMORAL 4 STR 16MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-515	SUP	HCPCS C1776		6260-6-515  -  STEM FEMORAL 5 STR 15MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-517	SUP	HCPCS C1776		6260-6-517  -  STEM FEMORAL 5 STR 17MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-616	SUP	HCPCS C1776		6260-6-616  -  STEM FEMORAL 6 STR 16MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-618	SUP	HCPCS C1776		6260-6-618  -  STEM FEMORAL 6 STR 18MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-717	SUP	HCPCS C1776		6260-6-717  -  STEM FEMORAL 7 STR 17MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-719	SUP	HCPCS C1776		6260-6-719  -  STEM FEMORAL 7 STR 19MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-818	SUP	HCPCS C1776		6260-6-818  -  STEM FEMORAL 8 STR 18MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-820	SUP	HCPCS C1776		6260-6-820  -  STEM FEMORAL 8 STR 20MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-6-921	SUP	HCPCS C1776		6260-6-921  -  STEM FEMORAL 9 STR 21MM 165MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-036	SUP	Custom 27803010		6260-8-036  -  HEAD FEM -4MM 36MM HIP COCR V40 LFIT	BOTH IP/OP	"$2,035.00 "	"$1,505.90"	$0.00	"$1,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,510.38"	"$1,510.38"	$0.00	$0.00	$424.09	$0.00	$0.00	$0.00	$0.00	"$1,017.50"	"$1,611.72"	"$1,628.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-111	SUP	HCPCS C1776		6260-8-111  -  STEM FEMORAL 1 STR 11MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-113	SUP	HCPCS C1776		6260-8-113  -  STEM FEMORAL 1 STR 13MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-212	SUP	HCPCS C1776		6260-8-212  -  STEM FEMORAL 2 STR 12MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-214	SUP	HCPCS C1776		6260-8-214  -  STEM FEMORAL 2 STR 14MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-236	SUP	Custom 27803010		6260-8-236  -  HEAD FEM +4MM 36MM HIP COCR V40 LFIT	BOTH IP/OP	"$2,035.00 "	"$1,505.90"	$0.00	"$1,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,510.38"	"$1,510.38"	$0.00	$0.00	$424.09	$0.00	$0.00	$0.00	$0.00	"$1,017.50"	"$1,611.72"	"$1,628.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-313	SUP	HCPCS C1776		6260-8-313  -  STEM FEMORAL 3 STR 13MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-315	SUP	HCPCS C1776		6260-8-315  -  STEM FEMORAL 3 STR 15MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-336	SUP	Custom 27803010		6260-8-336  -  HEAD FEM +8MM 36MM HIP COCR V40 LFIT	BOTH IP/OP	"$2,035.00 "	"$1,505.90"	$0.00	"$1,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,510.38"	"$1,510.38"	$0.00	$0.00	$424.09	$0.00	$0.00	$0.00	$0.00	"$1,017.50"	"$1,611.72"	"$1,628.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-414	SUP	HCPCS C1776		6260-8-414  -  STEM FEMORAL 4 STR 14MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-416	SUP	HCPCS C1776		6260-8-416  -  STEM FEMORAL 4 STR 16MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-515	SUP	HCPCS C1776		6260-8-515  -  STEM FEMORAL 5 STR 15MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-517	SUP	HCPCS C1776		6260-8-517  -  STEM FEMORAL 5 STR 17MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-616	SUP	HCPCS C1776		6260-8-616  -  STEM FEMORAL 6 STR 16MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-618	SUP	HCPCS C1776		6260-8-618  -  STEM FEMORAL 6 STR 18MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-717	SUP	HCPCS C1776		6260-8-717  -  STEM FEMORAL 7 STR 17MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-719	SUP	HCPCS C1776		6260-8-719  -  STEM FEMORAL 7 STR 19MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-818	SUP	HCPCS C1776		6260-8-818  -  STEM FEMORAL 8 STR 18MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-820	SUP	HCPCS C1776		6260-8-820  -  STEM FEMORAL 8 STR 20MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-8-921	SUP	HCPCS C1776		6260-8-921  -  STEM FEMORAL 9 STR 21MM 203MM RSTOR TITANIUM PLASMA SPRAY	BOTH IP/OP	"$13,152.50 "	"$9,732.85"	$0.00	"$10,522.00"	"$5,918.63"	"$5,918.63"	$0.00	$0.00	$0.00	"$2,741.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,740.98"	$0.00	"$6,484.18"	"$6,484.18"	$0.00	"$6,576.25"	"$10,416.78"	"$10,522.00"	$0.00		$0.00	"$2,058.37"	$0.00	$0.00	"$2,093.88"	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-026	SUP	Custom 27803010		6260-9-026  -  HEAD FEMORAL -3MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-028	SUP	Custom 27803010		6260-9-028  -  HEAD FEM -4MM OFST TPR 28MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-032	SUP	Custom 27803010		6260-9-032  -  HEAD FEM -4MM OFST 32MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-036	SUP	Custom 27803010		6260-9-036  -  HEAD FEM -5MM OFST TPR 36MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-040	SUP	Custom 27803010		6260-9-040  -  HEAD FEM -4MM OFST TPR 40MM V40 LFIT COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-044	SUP	Custom 27803010		6260-9-044  -  HEAD FEM -4MM OFST TPR 44MM V40 LFIT COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-122	SUP	Custom 27803010		6260-9-122  -  HEAD FEM +0MM OFST TPR 22MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-126	SUP	Custom 27803010		6260-9-126  -  HEAD FEMORAL +0MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-128	SUP	Custom 27803010		6260-9-128  -  HEAD FEM +0MM OFST 28MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-132	SUP	Custom 27803010		6260-9-132  -  HEAD FEMORAL +0MM OFFST TAPER 32MM PRIM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-136	SUP	Custom 27803010		6260-9-136  -  HEAD FEMORAL +0MM OFFST TAPER 36MM PRIM ANATOMIC V40 LFIT	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-140	SUP	Custom 27803010		6260-9-140  -  HEAD FEMORAL +0MM OFFST TAPER 40MM PRIM ANATOMIC V40 LFIT	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-144	SUP	Custom 27803010		6260-9-144  -  HEAD FEM +0MM OFST TPR 44MM V40 LFIT COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-222	SUP	Custom 27803010		6260-9-222  -  HEAD FEM +3MM OFST 22.2MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-226	SUP	Custom 27803010		6260-9-226  -  HEAD FEMORAL +4MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-228	SUP	Custom 27803010		6260-9-228  -  HEAD FEM +4MM OFST 28MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-232	SUP	Custom 27803010		6260-9-232  -  HEAD FEM +4MM OFST TPR 32MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-236	SUP	Custom 27803010		6260-9-236  -  HEAD FEM +5MM OFST TPR 36MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-240	SUP	Custom 27803010		6260-9-240  -  HEAD FEMORAL +4MM OFFST TAPER 40MM PRIM ANATOMIC V40 LFIT	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-244	SUP	Custom 27803010		6260-9-244  -  HEAD FEMORAL +4MM OFFST TAPER 44MM PRIM ANATOMIC V40 LFIT	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-322	SUP	Custom 27803010		6260-9-322  -  HEAD FEM +8MM OFST TPR 22MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-326	SUP	Custom 27803010		6260-9-326  -  HEAD FEMORAL +8MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-328	SUP	Custom 27803010		6260-9-328  -  HEAD FEM +8MM OFST TPR 28MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-332	SUP	Custom 27803010		6260-9-332  -  HEAD FEMORAL +8MM OFFST TAPER 32MM PRIM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-336	SUP	Custom 27803010		6260-9-336  -  HEAD FEM +10MM OFST TPR 36MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-340	SUP	Custom 27803010		6260-9-340  -  HEAD FEM +8MM OFST TPR 40MM V40 LFIT COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-344	SUP	Custom 27803010		6260-9-344  -  HEAD FEMORAL +8MM OFFST TAPER 44MM PRIM ANATOMIC V40 LFIT	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-426	SUP	Custom 27803010		6260-9-426  -  HEAD FEMORAL +12MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-428	SUP	Custom 27803010		6260-9-428  -  HEAD FEM +12MM OFST TPR 28MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-432	SUP	Custom 27803010		6260-9-432  -  HEAD FEM +12MM OFST TPR 32MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-440	SUP	Custom 27803010		6260-9-440  -  HEAD FEM +12MM OFST TPR 40MM V40 LFIT COCR HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-444	SUP	Custom 27803010		6260-9-444  -  HEAD FEMORAL +12MM OFFST TAPER 44MM PRIM ANATOMIC V40 LFIT	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6260-9-628	SUP	Custom 27803010		6260-9-628  -  HEAD FEMORAL +6MM 28MM V40 LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-001	SUP	HCPCS C1776		6261-0-001  -  STEM FEM 9MM CMNTLS MRDN PERIAPT 00 HIP	BOTH IP/OP	"$6,861.00 "	"$5,077.14"	$0.00	"$5,488.80"	"$3,087.45"	"$3,087.45"	$0.00	$0.00	$0.00	"$1,430.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,429.83"	$0.00	"$3,382.47"	"$3,382.47"	$0.00	"$3,430.50"	"$5,433.91"	"$5,488.80"	$0.00		$0.00	"$1,073.75"	$0.00	$0.00	"$1,092.27"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-002	SUP	HCPCS C1776		6261-0-002  -  STEM FEM 10MM CMNTLS MRDN PERIAPT HIP	BOTH IP/OP	"$6,861.00 "	"$5,077.14"	$0.00	"$5,488.80"	"$3,087.45"	"$3,087.45"	$0.00	$0.00	$0.00	"$1,430.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,429.83"	$0.00	"$3,382.47"	"$3,382.47"	$0.00	"$3,430.50"	"$5,433.91"	"$5,488.80"	$0.00		$0.00	"$1,073.75"	$0.00	$0.00	"$1,092.27"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-003	SUP	HCPCS C1776		6261-0-003  -  STEM FEM 11MM CMNTLS MRDN PERIAPT 1 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-004	SUP	HCPCS C1776		6261-0-004  -  STEM FEM 130MM 10MM CMNTLS MRDN PERIAPT 2 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-005	SUP	HCPCS C1776		6261-0-005  -  STEM FEM 12MM CMNTLS MRDN PERIAPT 2 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-006	SUP	HCPCS C1776		6261-0-006  -  STEM FEM 11MM CMNTLS MRDN PERIAPT 3 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-007	SUP	HCPCS C1776		6261-0-007  -  STEM FEM 13MM MRDN PERIAPT 3 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-008	SUP	HCPCS C1776		6261-0-008  -  STEM FEM 12MM CMNTLS MRDN PERIAPT 4 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-009	SUP	HCPCS C1776		6261-0-009  -  STEM FEM 14MM CMNTLS MRDN PERIAPT 4 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-010	SUP	HCPCS C1776		6261-0-010  -  STEM FEM 13MM CMNTLS MRDN PERIAPT 5 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-011	SUP	HCPCS C1776		6261-0-011  -  STEM FEM 15MM CMNTLS MRDN PERIAPT 5 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-012	SUP	HCPCS C1776		6261-0-012  -  STEM FEM 14MM CMNTLS MRDN PERIAPT 6 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-013	SUP	HCPCS C1776		6261-0-013  -  STEM FEM 150MM 16MM MRDN PERIAPT 132D 6 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-014	SUP	HCPCS C1776		6261-0-014  -  STEM FEM 15MM CMNTLS MRDN PERIAPT 7 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-015	SUP	HCPCS C1776		6261-0-015  -  STEM FEM 17MM CMNTLS MRDN PERIAPT 7 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-016	SUP	HCPCS C1776		6261-0-016  -  STEM FEM 16MM CMNTLS MRDN PERIAPT 8 HIP	BOTH IP/OP	"$6,861.00 "	"$5,077.14"	$0.00	"$5,488.80"	"$3,087.45"	"$3,087.45"	$0.00	$0.00	$0.00	"$1,430.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,429.83"	$0.00	"$3,382.47"	"$3,382.47"	$0.00	"$3,430.50"	"$5,433.91"	"$5,488.80"	$0.00		$0.00	"$1,073.75"	$0.00	$0.00	"$1,092.27"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-017	SUP	HCPCS C1776		6261-0-017  -  STEM FEM 18MM CMNTLS MRDN PERIAPT 8 HIP	BOTH IP/OP	"$6,861.00 "	"$5,077.14"	$0.00	"$5,488.80"	"$3,087.45"	"$3,087.45"	$0.00	$0.00	$0.00	"$1,430.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,429.83"	$0.00	"$3,382.47"	"$3,382.47"	$0.00	"$3,430.50"	"$5,433.91"	"$5,488.80"	$0.00		$0.00	"$1,073.75"	$0.00	$0.00	"$1,092.27"	$0.00	$0.00	$0.00	$0.00	$0.00
6261-0-018	SUP	HCPCS C1776		6261-0-018  -  STEM FEM 19MM CMNTLS MRDN PERIAPT 9 HIP	BOTH IP/OP	"$6,861.00 "	"$5,077.14"	$0.00	"$5,488.80"	"$3,087.45"	"$3,087.45"	$0.00	$0.00	$0.00	"$1,430.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,429.83"	$0.00	"$3,382.47"	"$3,382.47"	$0.00	"$3,430.50"	"$5,433.91"	"$5,488.80"	$0.00		$0.00	"$1,073.75"	$0.00	$0.00	"$1,092.27"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-0-010	SUP	HCPCS C1776		6265-0-010  -  STEM FEM 13MM CMNTLS MRDN ST VIT POR 5 HIP	BOTH IP/OP	"$6,538.00 "	"$4,838.12"	$0.00	"$5,230.40"	"$2,942.10"	"$2,942.10"	$0.00	$0.00	$0.00	"$1,362.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,362.52"	$0.00	"$3,223.23"	"$3,223.23"	$0.00	"$3,269.00"	"$5,178.10"	"$5,230.40"	$0.00		$0.00	"$1,023.20"	$0.00	$0.00	"$1,040.85"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-001	SUP	HCPCS C1776		6265-1-001  -  STEM FEM 9MM MRDN TMZF 00 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-002	SUP	HCPCS C1776		6265-1-002  -  STEM FEM 10MM CMNTLS MRDN TMZF 0 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-003	SUP	HCPCS C1776		6265-1-003  -  STEM FEM 11MM MRDN TMZF 1 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-004	SUP	HCPCS C1776		6265-1-004  -  STEM FEM 10MM MRDN TMZF 2 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-005	SUP	HCPCS C1776		6265-1-005  -  STEM FEM 12MM MRDN TMZF 2 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-006	SUP	HCPCS C1776		6265-1-006  -  STEM FEM 3-11MM	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-007	SUP	HCPCS C1776		6265-1-007  -  STEM FEM 13MM MRDN TMZF 3 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-008	SUP	HCPCS C1776		6265-1-008  -  STEM FEM 4-12MM	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-009	SUP	HCPCS C1776		6265-1-009  -  STEM FEM 14MM MRDN TMZF 4 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-010	SUP	HCPCS C1776		6265-1-010  -  STEM FEM 13MM MRDN TMZF 5 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-011	SUP	HCPCS C1776		6265-1-011  -  STEM FEM 15MM CMNTLS MRDN TMZF 5 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-012	SUP	HCPCS C1776		6265-1-012  -  STEM FEM 14MM MRDN TMZF 6 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-013	SUP	HCPCS C1776		6265-1-013  -  STEM FEM 16MM MRDN TMZF 6 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-014	SUP	HCPCS C1776		6265-1-014  -  STEM FEM 15MM CMNTLS MRDN TMZF 7 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-015	SUP	HCPCS C1776		6265-1-015  -  STEM FEM 17MM CMNTLS MRDN TMZF 7 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-016	SUP	HCPCS C1776		6265-1-016  -  STEM FEM 16MM CMNTLS MRDN TMZF 8 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-017	SUP	HCPCS C1776		6265-1-017  -  STEM FEM 18MM CMNTLS MRDN TMZF 8 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-1-018	SUP	HCPCS C1776		6265-1-018  -  STEM FEM 19MM CMNTLS MRDN TMZF 9 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6265-2-000	SUP	Custom 27803010		6265-2-000  -  STEM FEMORAL 132D 0 10MM 115MM 31MM COLLAR PRESS FIT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-2-001	SUP	Custom 27803010		6265-2-001  -  STEM FEMORAL 132D 1 11MM 115MM 31MM COLLAR PRESS FIT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-2-002	SUP	Custom 27803010		6265-2-002  -  STEM FEMORAL 132D 2 12MM 130MM 32MM COLLAR PRESS FIT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-2-003	SUP	Custom 27803010		6265-2-003  -  STEM FEMORAL 132D 3 13MM 130MM 34MM COLLAR PRESS FIT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-2-004	SUP	Custom 27803010		6265-2-004  -  STEM FEMORAL 132D 4 14MM 140MM 35MM COLLAR PRESS FIT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-2-005	SUP	Custom 27803010		6265-2-005  -  STEM FEMORAL 5 15MM CEMENTED COLLARED PRESS FIT RELIANCE PF	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-2-006	SUP	Custom 27803010		6265-2-006  -  STEM FEMORAL 132D 6 16MM 150MM 37MM COLLAR PRESS FIT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-2-007	SUP	Custom 27803010		6265-2-007  -  STEM FEMORAL 132D 7 17MM 150MM 39MM COLLAR PRESS FIT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-099	SUP	Custom 27803010		6265-3-099  -  STEM FEM CMNT DFN PM 0 HIP	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-100	SUP	Custom 27803010		6265-3-100  -  STEM FEM CMNT DFN PM 0 HIP	BOTH IP/OP	"$4,488.00 "	"$3,321.12"	$0.00	"$3,590.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,330.99"	"$3,330.99"	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	"$2,244.00"	"$3,554.50"	"$3,590.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-101	SUP	Custom 27803010		6265-3-101  -  STEM FEM 132D 1 34MM OFST 10MM 115MM 26MM CITN PUREFIX TMZF	BOTH IP/OP	"$4,123.00 "	"$3,051.02"	$0.00	"$3,298.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,060.09"	"$3,060.09"	$0.00	$0.00	$859.23	$0.00	$0.00	$0.00	$0.00	"$2,061.50"	"$3,265.42"	"$3,298.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-102	SUP	Custom 27803010		6265-3-102  -  STEM FEM CMNT DFN PM 2 HIP	BOTH IP/OP	"$4,123.00 "	"$3,051.02"	$0.00	"$3,298.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,060.09"	"$3,060.09"	$0.00	$0.00	$859.23	$0.00	$0.00	$0.00	$0.00	"$2,061.50"	"$3,265.42"	"$3,298.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-103	SUP	Custom 27803010		6265-3-103  -  STEM FEM CMNT DFN PM 3 HIP	BOTH IP/OP	"$4,123.00 "	"$3,051.02"	$0.00	"$3,298.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,060.09"	"$3,060.09"	$0.00	$0.00	$859.23	$0.00	$0.00	$0.00	$0.00	"$2,061.50"	"$3,265.42"	"$3,298.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-104	SUP	Custom 27803010		6265-3-104  -  STEM FEM CMNT DFN PM 4 HIP	BOTH IP/OP	"$4,123.00 "	"$3,051.02"	$0.00	"$3,298.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,060.09"	"$3,060.09"	$0.00	$0.00	$859.23	$0.00	$0.00	$0.00	$0.00	"$2,061.50"	"$3,265.42"	"$3,298.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-105	SUP	Custom 27803010		6265-3-105  -  STEM FEM CMNT DFN PM 5 HIP	BOTH IP/OP	"$4,123.00 "	"$3,051.02"	$0.00	"$3,298.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,060.09"	"$3,060.09"	$0.00	$0.00	$859.23	$0.00	$0.00	$0.00	$0.00	"$2,061.50"	"$3,265.42"	"$3,298.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-106	SUP	Custom 27803010		6265-3-106  -  STEM FEM CMNT DFN PM 6 HIP	BOTH IP/OP	"$4,123.00 "	"$3,051.02"	$0.00	"$3,298.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,060.09"	"$3,060.09"	$0.00	$0.00	$859.23	$0.00	$0.00	$0.00	$0.00	"$2,061.50"	"$3,265.42"	"$3,298.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-107	SUP	Custom 27803010		6265-3-107  -  STEM FEM CMNT DFN PM 7 HIP	BOTH IP/OP	"$4,123.00 "	"$3,051.02"	$0.00	"$3,298.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,060.09"	"$3,060.09"	$0.00	$0.00	$859.23	$0.00	$0.00	$0.00	$0.00	"$2,061.50"	"$3,265.42"	"$3,298.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-111	SUP	Custom 27803010		6265-3-111  -  STEM FEMORAL 132D 1 34MM OFFST 100MM 31MM BASE HEAD CEMENT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-112	SUP	Custom 27803010		6265-3-112  -  STEM FEMORAL 132D 2 36MM OFFST 115MM 32MM BASE HEAD CEMENT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-113	SUP	Custom 27803010		6265-3-113  -  STEM FEMORAL 132D 3 40MM OFFST 115MM 34MM BASE HEAD CEMENT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-114	SUP	Custom 27803010		6265-3-114  -  STEM FEMORAL 132D 4 44MM OFFST 125MM 35MM BASE HEAD CEMENT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-3-115	SUP	Custom 27803010		6265-3-115  -  STEM FEMORAL 132D 5 47MM OFFST 125MM 37MM BASE HEAD CEMENT	BOTH IP/OP	"$2,877.50 "	"$2,129.35"	$0.00	"$2,302.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,135.68"	"$2,135.68"	$0.00	$0.00	$599.67	$0.00	$0.00	$0.00	$0.00	"$1,438.75"	"$2,278.98"	"$2,302.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-010	SUP	Custom 27803010		6265-4-010  -  CNTRLZR STM 10MM DFN DISTAL FEM HIP TYPE AA TPR	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-011	SUP	Custom 27803010		6265-4-011  -  CNTRLZR STM 11MM DFN DISTAL FEM HIP TYPE AA TPR	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-103	SUP	HCPCS C1776		6265-4-103  -  STEM FEM DFN 3 HIP	BOTH IP/OP	"$4,123.00 "	"$3,051.02"	$0.00	"$3,298.40"	"$1,855.35"	"$1,855.35"	$0.00	$0.00	$0.00	$859.34	"$3,060.09"	"$3,060.09"	$0.00	$0.00	$859.23	$0.00	"$2,032.64"	"$2,032.64"	$0.00	"$2,061.50"	"$3,265.42"	"$3,298.40"	$0.00		$0.00	$645.25	$0.00	$0.00	$656.38	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-105	SUP	HCPCS C1776		6265-4-105  -  STEM FEM DFN 5 HIP	BOTH IP/OP	"$4,123.00 "	"$3,051.02"	$0.00	"$3,298.40"	"$1,855.35"	"$1,855.35"	$0.00	$0.00	$0.00	$859.34	"$3,060.09"	"$3,060.09"	$0.00	$0.00	$859.23	$0.00	"$2,032.64"	"$2,032.64"	$0.00	"$2,061.50"	"$3,265.42"	"$3,298.40"	$0.00		$0.00	$645.25	$0.00	$0.00	$656.38	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-411	SUP	Custom 27803010		6265-4-411  -  CNTRLZR STM 11MM DISTAL HIP TYPE A MOD	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-412	SUP	Custom 27803010		6265-4-412  -  CNTRLZR STM 12MM DISTAL HIP TYPE A MOD	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-413	SUP	Custom 27803010		6265-4-413  -  CNTRLZR STM 13MM DISTAL HIP TYPE A MOD	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-414	SUP	Custom 27803010		6265-4-414  -  CNTRLZR STM 14MM DISTAL MOD TYPE A	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-415	SUP	Custom 27803010		6265-4-415  -  CNTRLZR STM 15MM DISTAL HIP TYPE A MOD	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-416	SUP	Custom 27803010		6265-4-416  -  CNTRLZR STM 16MM DFN DISTAL FEM HIP MOD TYPE A	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-417	SUP	Custom 27803010		6265-4-417  -  CNTRLZR STM 17MM DFN DISTAL FEM HIP TYPE A MOD	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-418	SUP	Custom 27803010		6265-4-418  -  CNTRLZR STM 18MM DFN DISTAL FEM HIP MOD TYPE A	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-515	SUP	Custom 27803010		6265-4-515  -  CNTRLZR STM 15MM DFN DISTAL FEM HIP TYPE B MOD	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-516	SUP	Custom 27803010		6265-4-516  -  CNTRLZR STM 16MM MODIFI DISTAL FEM TYPE B	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-517	SUP	Custom 27803010		6265-4-517  -  CNTRLZR STM 17MM DFN DISTAL FEM HIP TYPE A MOD	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-518	SUP	Custom 27803010		6265-4-518  -  CNTRLZR STM 18MM DFN DISTAL FEM HIP TYPE B MOD	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-519	SUP	Custom 27803010		6265-4-519  -  CNTRLZR STM 19MM DFN DISTAL FEM HIP TYPE B MOD	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-520	SUP	Custom 27803010		6265-4-520  -  CONC CNTRF YLW FLTR COLLECT VL 0.5ML	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-521	SUP	Custom 27803010		6265-4-521  -  CNTRLZR STM 21MM DFN DISTAL FEM HIP TYPE B MOD	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-4-522	SUP	Custom 27803010		6265-4-522  -  CNTRLZR STM 22MM DFN DISTAL FEM HIP TYPE B MOD	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$0.00	$0.00	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-100	SUP	HCPCS C1776		6265-5-100  -  STEM FEMORAL 132D 0 34MM OFFST 9MM 110MM 26MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-101	SUP	HCPCS C1776		6265-5-101  -  STEM FEMORAL 132D 1 34MM OFFST 10MM 115MM 26MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-102	SUP	HCPCS C1776		6265-5-102  -  STEM FEMORAL 132D 2 36MM OFFST 11MM 120MM 26MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-103	SUP	HCPCS C1776		6265-5-103  -  STEM FEMORAL 132D 3 40MM OFFST 12MM 125MM 28MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-104	SUP	HCPCS C1776		6265-5-104  -  STEM FEMORAL 132D 4 44MM OFFST 13MM 130MM 30MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-105	SUP	HCPCS C1776		6265-5-105  -  STEM FEMORAL 132D 5 47MM OFFST 14MM 135MM 31MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-106	SUP	HCPCS C1776		6265-5-106  -  STEM FEMORAL 132D 6 50MM OFFST 15MM 140MM 32MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-107	SUP	HCPCS C1776		6265-5-107  -  STEM FEMORAL 132D 7 52MM OFFST 16MM 140MM 34MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-108	SUP	HCPCS C1776		6265-5-108  -  STEM FEMORAL 132D 8 55MM OFFST 17MM 145MM 39MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-109	SUP	HCPCS C1776		6265-5-109  -  STEM FEMORAL 132D 9 55MM OFFST 18MM 150MM 39MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-110	SUP	HCPCS C1776		6265-5-110  -  STEM FEMORAL 132D 0 34MM OFFST 9MM 110MM 26MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-111	SUP	HCPCS C1776		6265-5-111  -  STEM FEMORAL 132D 1 34MM OFFST 10MM 115MM 26MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-112	SUP	HCPCS C1776		6265-5-112  -  STEM FEMORAL 132D 2 36MM OFFST 11MM 120MM 26MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-113	SUP	HCPCS C1776		6265-5-113  -  STEM FEMORAL 132D 3 40MM OFFST 12MM 125MM 28MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-114	SUP	HCPCS C1776		6265-5-114  -  STEM FEMORAL 132D 4 44MM OFFST 13MM 130MM 30MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-115	SUP	HCPCS C1776		6265-5-115  -  STEM FEMORAL 132D 5 47MM OFFST 14MM 135MM 31MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-116	SUP	HCPCS C1776		6265-5-116  -  STEM FEMORAL 132D 6 50MM OFFST 15MM 140MM 32MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-117	SUP	HCPCS C1776		6265-5-117  -  STEM FEMORAL 132D 7 52MM OFFST 16MM 140MM 34MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-118	SUP	HCPCS C1776		6265-5-118  -  STEM FEMORAL 132D 8 55MM OFFST 17MM 145MM 39MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5-119	SUP	HCPCS C1776		6265-5-119  -  STEM FEMORAL 132D 9 55MM OFFST 18MM 150MM 39MM CITATION	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5200	SUP	HCPCS C1776		6265-5200  -  STEM FEMORAL 0 SHORT CITATION TMZF HYDRXAPT LEFT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5201	SUP	HCPCS C1776		6265-5201  -  STEM FEMORAL 1 SHORT CITATION TMZF HYDRXAPT LEFT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5202	SUP	HCPCS C1776		6265-5202  -  STEM FEMORAL 2 SHORT CITATION TMZF HYDRXAPT LEFT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5203	SUP	HCPCS C1776		6265-5203  -  STEM FEMORAL 3 SHORT CITATION TMZF HYDRXAPT LEFT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5204	SUP	HCPCS C1776		6265-5204  -  STEM FEMORAL 4 SHORT CITATION TMZF HYDRXAPT LEFT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5205	SUP	HCPCS C1776		6265-5205  -  STEM FEMORAL 5 SHORT CITATION TMZF HYDRXAPT LEFT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5206	SUP	HCPCS C1776		6265-5206  -  STEM FEMORAL 6 SHORT CITATION TMZF HYDRXAPT LEFT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5207	SUP	HCPCS C1776		6265-5207  -  STEM FEMORAL 7 SHORT CITATION TMZF HYDRXAPT LEFT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5208	SUP	HCPCS C1776		6265-5208  -  STEM FEMORAL 8 SHORT CITATION TMZF HYDRXAPT LEFT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5209	SUP	HCPCS C1776		6265-5209  -  STEM FEMORAL 9 SHORT CITATION TMZF HYDRXAPT LEFT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5210	SUP	HCPCS C1776		6265-5210  -  STEM FEMORAL 0 SHORT CITATION TMZF HYDRXAPT RIGHT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5211	SUP	HCPCS C1776		6265-5211  -  STEM FEMORAL 1 SHORT CITATION TMZF HYDRXAPT RIGHT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5212	SUP	HCPCS C1776		6265-5212  -  STEM FEMORAL 2 SHORT CITATION TMZF HYDRXAPT RIGHT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5213	SUP	HCPCS C1776		6265-5213  -  STEM FEMORAL 3 SHORT CITATION TMZF HYDRXAPT RIGHT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5214	SUP	HCPCS C1776		6265-5214  -  STEM FEMORAL 4 SHORT CITATION TMZF HYDRXAPT RIGHT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5215	SUP	HCPCS C1776		6265-5215  -  STEM FEMORAL 5 SHORT CITATION TMZF HYDRXAPT RIGHT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5216	SUP	HCPCS C1776		6265-5216  -  STEM FEMORAL 6 SHORT CITATION TMZF HYDRXAPT RIGHT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5217	SUP	HCPCS C1776		6265-5217  -  STEM FEMORAL 7 SHORT CITATION TMZF HYDRXAPT RIGHT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5218	SUP	HCPCS C1776		6265-5218  -  STEM FEMORAL 8 SHORT CITATION TMZF HYDRXAPT RIGHT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
6265-5219	SUP	HCPCS C1776		6265-5219  -  STEM FEMORAL 9 SHORT CITATION TMZF HYDRXAPT RIGHT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
626631US	SUP	Custom 27803010		626631US  -  KIT PRESSURE MONITR 14GA BASIC TRANSDUCER TUOHY NEEDLE	BOTH IP/OP	"$2,043.98 "	"$1,512.55"	$0.00	"$1,676.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,517.04"	"$1,517.04"	$0.00	$0.00	$425.96	$0.00	$0.00	$0.00	$0.00	"$1,047.70"	"$1,659.56"	"$1,676.32"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6269-1-212	SUP	HCPCS C1776		6269-1-212  -  STEM FEM 10IN 12MM BW RSTOR TI 2 LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-1-414	SUP	HCPCS C1776		6269-1-414  -  STEM FEM 10IN 14MM BW RSTOR TI 4 LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-1-719	SUP	HCPCS C1776		6269-1-719  -  STEM FEM 10IN 19MM BW RSTOR TI 7 LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-1-818	SUP	HCPCS C1776		6269-1-818  -  STEM FEM 10IN 18MM BW RSTOR TI 8 LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-1-820	SUP	HCPCS C1776		6269-1-820  -  STEM FEM 10IN 20MM BW RSTOR TI 8 LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-1-921	SUP	HCPCS C1776		6269-1-921  -  STEM FEM 10IN 21MM BW RSTOR TI 9 LEFT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-2-212	SUP	HCPCS C1776		6269-2-212  -  STEM FEM 10IN 12MM BW RSTOR TI 2 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-2-313	SUP	HCPCS C1776		6269-2-313  -  STEM FEM 10IN 13MM BW RSTOR TI 3 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-2-414	SUP	HCPCS C1776		6269-2-414  -  STEM FEM 10IN 14MM BW RSTOR TI 4 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-2-515	SUP	HCPCS C1776		6269-2-515  -  STEM FEM 10IN 15MM BW RSTOR TI 5 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-2-616	SUP	HCPCS C1776		6269-2-616  -  STEM FEM 10IN 16MM BW RSTOR TI 6 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-2-717	SUP	HCPCS C1776		6269-2-717  -  STEM FEM 10IN 17MM BW RSTOR TI 7 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-2-719	SUP	HCPCS C1776		6269-2-719  -  STEM FEM 10IN 19MM BW RSTOR TI 7 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-2-818	SUP	HCPCS C1776		6269-2-818  -  STEM FEM 10IN 18MM BW RSTOR TI 8 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-2-820	SUP	HCPCS C1776		6269-2-820  -  STEM FEM 10IN 20MM BW RSTOR TI 8 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-2-921	SUP	HCPCS C1776		6269-2-921  -  STEM FEM 10IN 21MM BW RSTOR TI 9 RIGHT HIP	BOTH IP/OP	"$13,745.88 "	"$10,171.95"	$0.00	"$10,996.70"	"$6,185.64"	"$6,185.64"	$0.00	$0.00	$0.00	"$2,864.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,864.64"	$0.00	"$6,776.72"	"$6,776.72"	$0.00	"$6,872.94"	"$10,886.74"	"$10,996.70"	$0.00		$0.00	"$2,151.23"	$0.00	$0.00	"$2,188.34"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-111	SUP	HCPCS C1776		6269-3-111  -  STEM FEM 8IN 11MM BW RSTOR TI 1 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-113	SUP	HCPCS C1776		6269-3-113  -  STEM FEM 8IN 13MM BW RSTOR TI 1 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-212	SUP	HCPCS C1776		6269-3-212  -  STEM FEM 8IN 12MM BW RSTOR TI 2 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-214	SUP	HCPCS C1776		6269-3-214  -  STEM FEM 8IN 14MM BW RSTOR TI 2 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-313	SUP	HCPCS C1776		6269-3-313  -  STEM FEM 8IN 13MM BW RSTOR TI 3 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-315	SUP	HCPCS C1776		6269-3-315  -  STEM FEM 8IN 15MM BW RSTOR TI 3 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-414	SUP	HCPCS C1776		6269-3-414  -  STEM FEM 8IN 14MM BW RSTOR TI 4 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-416	SUP	HCPCS C1776		6269-3-416  -  STEM FEM 8IN 16MM BW RSTOR TI 4 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-515	SUP	HCPCS C1776		6269-3-515  -  STEM FEM 8IN 15MM BW RSTOR TI 5 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-517	SUP	HCPCS C1776		6269-3-517  -  STEM FEM 8IN 17MM BW RSTOR TI 5 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-616	SUP	HCPCS C1776		6269-3-616  -  STEM FEM 8IN 16MM BW RSTOR TI 6 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-618	SUP	HCPCS C1776		6269-3-618  -  STEM FEM 8IN 18MM BW RSTOR TI 6 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-717	SUP	HCPCS C1776		6269-3-717  -  STEM FEM 8IN 17MM BW RSTOR TI 7 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-818	SUP	HCPCS C1776		6269-3-818  -  STEM FEM 8IN 18MM BW RSTOR TI 8 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-3-820	SUP	HCPCS C1776		6269-3-820  -  STEM FEM 8IN 20MM BW RSTOR TI 8 LEFT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-111	SUP	HCPCS C1776		6269-4-111  -  STEM FEM 8IN 11MM BW RSTOR TI 1 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-113	SUP	HCPCS C1776		6269-4-113  -  STEM FEM 8IN 13MM BW RSTOR TI 1 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-212	SUP	HCPCS C1776		6269-4-212  -  STEM FEM 8IN 12MM BW RSTOR TI 2 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-214	SUP	HCPCS C1776		6269-4-214  -  STEM FEM 8IN 14MM BW RSTOR TI 2 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-313	SUP	HCPCS C1776		6269-4-313  -  STEM FEM 8IN 13MM BW RSTOR TI 3 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-315	SUP	HCPCS C1776		6269-4-315  -  STEM FEM 8IN 15MM BW RSTOR TI 3 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-414	SUP	HCPCS C1776		6269-4-414  -  STEM FEM 8IN 14MM BW PS RSTOR TI 4 RIGHT	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-416	SUP	HCPCS C1776		6269-4-416  -  STEM FEM 8IN 16MM BW RSTOR TI 4 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-515	SUP	HCPCS C1776		6269-4-515  -  STEM FEM 8IN 15MM BW RSTOR TI 5 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-517	SUP	HCPCS C1776		6269-4-517  -  STEM FEM 8IN 17MM BW RSTOR TI 5 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-616	SUP	HCPCS C1776		6269-4-616  -  STEM FEM 8IN 16MM BW RSTOR TI 6 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-618	SUP	HCPCS C1776		6269-4-618  -  STEM FEM 8IN 18MM BW RSTOR TI 6 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-717	SUP	HCPCS C1776		6269-4-717  -  STEM FEM 8IN 17MM BW RSTOR TI 7 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-719	SUP	HCPCS C1776		6269-4-719  -  STEM FEM 8IN 19MM BW RSTOR TI 7 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-818	SUP	HCPCS C1776		6269-4-818  -  STEM FEM 8IN 18MM BW RSTOR TI 8 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-820	SUP	HCPCS C1776		6269-4-820  -  STEM FEM 8IN 20MM BW RSTOR TI 8 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6269-4-921	SUP	HCPCS C1776		6269-4-921  -  STEM FEM 8IN 21MM BW RSTOR TI 9 RIGHT HIP	BOTH IP/OP	"$13,281.13 "	"$9,828.04"	$0.00	"$10,624.90"	"$5,976.51"	"$5,976.51"	$0.00	$0.00	$0.00	"$2,768.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,767.79"	$0.00	"$6,547.59"	"$6,547.59"	$0.00	"$6,640.56"	"$10,518.65"	"$10,624.90"	$0.00		$0.00	"$2,078.50"	$0.00	$0.00	"$2,114.36"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-019	SUP	HCPCS C1776		6276-1-019  -  BODY CONE +0MM STANDARD 19MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-021	SUP	HCPCS C1776		6276-1-021  -  BODY CONE +0MM STANDARD 21MM MODULAR REVISION BOLT RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-023	SUP	HCPCS C1776		6276-1-023  -  BODY CONE +0MM STANDARD 23MM 23MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-025	SUP	HCPCS C1776		6276-1-025  -  BODY CONE +0MM STANDARD 25MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-027	SUP	HCPCS C1776		6276-1-027  -  BODY CONE +0MM STANDARD 27MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-029	SUP	HCPCS C1776		6276-1-029  -  BODY CONE +0MM STANDARD 29MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-031	SUP	HCPCS C1776		6276-1-031  -  BODY CONE +0MM STANDARD 31MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-119	SUP	HCPCS C1776		6276-1-119  -  BODY CONE +10MM 19MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-121	SUP	HCPCS C1776		6276-1-121  -  BODY CONE +10MM 21MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-123	SUP	HCPCS C1776		6276-1-123  -  BODY CONE +10MM 23MM RSTR MDLR REV TI HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-125	SUP	HCPCS C1776		6276-1-125  -  BODY CONE +10MM 25MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-127	SUP	HCPCS C1776		6276-1-127  -  BODY CONE +10MM 27MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-129	SUP	HCPCS C1776		6276-1-129  -  BODY CONE +10MM 29MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-131	SUP	HCPCS C1776		6276-1-131  -  BODY CONE +10MM 31MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-219	SUP	HCPCS C1776		6276-1-219  -  BODY CONE +20MM 19MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-221	SUP	HCPCS C1776		6276-1-221  -  BODY CONE +20MM 21MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-223	SUP	HCPCS C1776		6276-1-223  -  BODY CONE +20MM 23MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-225	SUP	HCPCS C1776		6276-1-225  -  BODY CONE +20MM 25MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-227	SUP	HCPCS C1776		6276-1-227  -  BODY CONE +20MM 27MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-229	SUP	HCPCS C1776		6276-1-229  -  BODY CONE +20MM 29MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-231	SUP	HCPCS C1776		6276-1-231  -  BODY CONE +20MM 31MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-319	SUP	HCPCS C1776		6276-1-319  -  BODY CONE +30MM 19MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-321	SUP	HCPCS C1776		6276-1-321  -  BODY CONE +30MM 21MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-323	SUP	HCPCS C1776		6276-1-323  -  BODY CONE +30MM 23MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-325	SUP	HCPCS C1776		6276-1-325  -  BODY CONE +30MM 25MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-327	SUP	HCPCS C1776		6276-1-327  -  BODY CONE +30MM 27MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-329	SUP	HCPCS C1776		6276-1-329  -  BODY CONE +30MM 29MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-1-331	SUP	HCPCS C1776		6276-1-331  -  BODY CONE +30MM 31MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-019	SUP	HCPCS C1776		6276-2-019  -  BODY MILLED 19MM MODULAR SHALLOW RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-021	SUP	HCPCS C1776		6276-2-021  -  BODY MILLED 21MM MODULAR SHALLOW RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-023	SUP	HCPCS C1776		6276-2-023  -  BODY MILLED 23MM MODULAR SHALLOW RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-025	SUP	HCPCS C1776		6276-2-025  -  BODY MILLED 25MM MODULAR SHALLOW RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-027	SUP	HCPCS C1776		6276-2-027  -  BODY MILLED 27MM MODULAR SHALLOW RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-029	SUP	HCPCS C1776		6276-2-029  -  BODY MILLED 29MM MODULAR SHALLOW RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-031	SUP	HCPCS C1776		6276-2-031  -  BODY MILLED 31MM MODULAR SHALLOW RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-119	SUP	HCPCS C1776		6276-2-119  -  BODY MILLED 19MM MODULAR DEEP RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-121	SUP	HCPCS C1776		6276-2-121  -  BODY MILLED 21MM MODULAR DEEP RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-123	SUP	HCPCS C1776		6276-2-123  -  BODY MILLED 23MM MODULAR DEEP RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-125	SUP	HCPCS C1776		6276-2-125  -  BODY MILLED 25MM MODULAR DEEP RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-127	SUP	HCPCS C1776		6276-2-127  -  BODY MILLED 27MM MODULAR DEEP RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-129	SUP	HCPCS C1776		6276-2-129  -  BODY MILLED 29MM MODULAR DEEP RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-131	SUP	HCPCS C1776		6276-2-131  -  BODY MILLED 31MM MODULAR DEEP RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-227	SUP	HCPCS C1776		6276-2-227  -  BODY MILLED 27MM MODULAR EXTRA DEEP RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-229	SUP	HCPCS C1776		6276-2-229  -  BODY MILLED 29MM MODULAR EXTRA DEEP RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-2-231	SUP	HCPCS C1776		6276-2-231  -  BODY MILLED 31MM MODULAR EXTRA DEEP RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-3-001	SUP	HCPCS C1776		6276-3-001  -  BODY BROACHED 1 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-3-002	SUP	HCPCS C1776		6276-3-002  -  BODY BROACHED 2 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-3-003	SUP	HCPCS C1776		6276-3-003  -  BODY BROACHED 3 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-3-004	SUP	HCPCS C1776		6276-3-004  -  BODY BROACHED 4 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-3-005	SUP	HCPCS C1776		6276-3-005  -  BODY BROACHED 5 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-3-006	SUP	HCPCS C1776		6276-3-006  -  BODY BROACHED 6 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-3-007	SUP	HCPCS C1776		6276-3-007  -  BODY BROACHED 7 REVISION MODULAR RSTOR HIP FEMUR	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-3-008	SUP	HCPCS C1776		6276-3-008  -  BODY BROACHED 8 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL	BOTH IP/OP	"$9,422.50 "	"$6,972.65"	$0.00	"$7,538.00"	"$4,240.13"	"$4,240.13"	$0.00	$0.00	$0.00	"$1,963.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,963.65"	$0.00	"$4,645.29"	"$4,645.29"	$0.00	"$4,711.25"	"$7,462.62"	"$7,538.00"	$0.00		$0.00	"$1,474.62"	$0.00	$0.00	"$1,500.06"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-119	SUP	HCPCS C1776		6276-4-119  -  BODY CALCAR +10MM OFFST 19MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-121	SUP	HCPCS C1776		6276-4-121  -  BODY CALCAR +10MM OFFST 21MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-123	SUP	HCPCS C1776		6276-4-123  -  BODY CALCAR +10MM OFFST 23MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-125	SUP	HCPCS C1776		6276-4-125  -  BODY CALCAR +10MM OFFST 25MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-127	SUP	HCPCS C1776		6276-4-127  -  BODY CALCAR +10MM OFFST 27MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-129	SUP	HCPCS C1776		6276-4-129  -  BODY CALCAR +10MM OFFST 29MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-131	SUP	HCPCS C1776		6276-4-131  -  BODY CALCAR +10MM OFFST 31MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-219	SUP	HCPCS C1776		6276-4-219  -  BODY CALCAR +20MM OFFST 19MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-221	SUP	HCPCS C1776		6276-4-221  -  BODY CALCAR +20MM OFFST 21MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-223	SUP	HCPCS C1776		6276-4-223  -  BODY CALCAR +20MM OFFST 23MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-225	SUP	HCPCS C1776		6276-4-225  -  BODY CALCAR +20MM OFFST 25MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-227	SUP	HCPCS C1776		6276-4-227  -  BODY CALCAR +20MM OFFST 27MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-229	SUP	HCPCS C1776		6276-4-229  -  BODY CALCAR +20MM OFFST 29MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-231	SUP	HCPCS C1776		6276-4-231  -  BODY CALCAR +20MM OFFST 31MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-319	SUP	HCPCS C1776		6276-4-319  -  BODY CALCAR +30MM OFFST 19MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-321	SUP	HCPCS C1776		6276-4-321  -  BODY CALCAR +30MM OFFST 21MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-323	SUP	HCPCS C1776		6276-4-323  -  BODY CALCAR +30MM OFFST 23MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-325	SUP	HCPCS C1776		6276-4-325  -  BODY CALCAR +30MM OFFST 25MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-327	SUP	HCPCS C1776		6276-4-327  -  BODY CALCAR +30MM OFFST 27MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-329	SUP	HCPCS C1776		6276-4-329  -  BODY CALCAR +30MM OFFST 29MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-4-331	SUP	HCPCS C1776		6276-4-331  -  BODY CALCAR +30MM OFFST 31MM MODULAR RSTOR HIP	BOTH IP/OP	"$9,827.50 "	"$7,272.35"	$0.00	"$7,862.00"	"$4,422.38"	"$4,422.38"	$0.00	$0.00	$0.00	"$2,048.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,048.05"	$0.00	"$4,844.96"	"$4,844.96"	$0.00	"$4,913.75"	"$7,783.38"	"$7,862.00"	$0.00		$0.00	"$1,538.00"	$0.00	$0.00	"$1,564.54"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-011	SUP	HCPCS C1776		6276-5-011  -  STEM FEMORAL STR 11MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-012	SUP	HCPCS C1776		6276-5-012  -  STEM FEMORAL STR 12MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-013	SUP	HCPCS C1776		6276-5-013  -  STEM FEMORAL STR 13MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-014	SUP	HCPCS C1776		6276-5-014  -  STEM FEMORAL STR 14MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-015	SUP	HCPCS C1776		6276-5-015  -  STEM FEMORAL STR 15MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-016	SUP	HCPCS C1776		6276-5-016  -  STEM FEMORAL STR 16MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-017	SUP	HCPCS C1776		6276-5-017  -  STEM FEMORAL STR 17MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-018	SUP	HCPCS C1776		6276-5-018  -  STEM FEMORAL STR 18MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-019	SUP	HCPCS C1776		6276-5-019  -  STEM FEMORAL STR 19MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-020	SUP	HCPCS C1776		6276-5-020  -  STEM FEMORAL STR 20MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-021	SUP	HCPCS C1776		6276-5-021  -  STEM FEMORAL STR 21MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-022	SUP	HCPCS C1776		6276-5-022  -  STEM FEMORAL STR 22MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-023	SUP	HCPCS C1776		6276-5-023  -  STEM FEMORAL STR 23MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-024	SUP	HCPCS C1776		6276-5-024  -  STEM FEMORAL STR 24MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-025	SUP	HCPCS C1776		6276-5-025  -  STEM FEMORAL STR 25MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-026	SUP	HCPCS C1776		6276-5-026  -  STEM FEMORAL STR 26MM 127MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-111	SUP	HCPCS C1776		6276-5-111  -  STEM FEMORAL 11MM 167MM MODULAR STR PLASMA RSTOR DISTAL	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-112	SUP	HCPCS C1776		6276-5-112  -  STEM FEMORAL STR 12MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-113	SUP	HCPCS C1776		6276-5-113  -  STEM FEMORAL STR 13MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-114	SUP	HCPCS C1776		6276-5-114  -  STEM FEMORAL STR 14MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-115	SUP	HCPCS C1776		6276-5-115  -  STEM FEMORAL STR 15MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-116	SUP	HCPCS C1776		6276-5-116  -  STEM FEMORAL STR 16MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-117	SUP	HCPCS C1776		6276-5-117  -  STEM FEMORAL STR 17MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-118	SUP	HCPCS C1776		6276-5-118  -  STEM FEMORAL STR 18MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-119	SUP	HCPCS C1776		6276-5-119  -  STEM FEMORAL STR 19MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-120	SUP	HCPCS C1776		6276-5-120  -  STEM FEMORAL STR 20MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-121	SUP	HCPCS C1776		6276-5-121  -  STEM FEMORAL STR 21MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-122	SUP	HCPCS C1776		6276-5-122  -  STEM FEMORAL STR 22MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-123	SUP	HCPCS C1776		6276-5-123  -  STEM FEMORAL STR 23MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-124	SUP	HCPCS C1776		6276-5-124  -  STEM FEMORAL STR 24MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-125	SUP	HCPCS C1776		6276-5-125  -  STEM FEMORAL STR 25MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-126	SUP	HCPCS C1776		6276-5-126  -  STEM FEMORAL STR 26MM 167MM MODULAR RSTOR HA POROUS PLASMA	BOTH IP/OP	"$7,417.50 "	"$5,488.95"	$0.00	"$5,934.00"	"$3,337.88"	"$3,337.88"	$0.00	$0.00	$0.00	"$1,545.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,545.81"	$0.00	"$3,656.83"	"$3,656.83"	$0.00	"$3,708.75"	"$5,874.66"	"$5,934.00"	$0.00		$0.00	"$1,160.84"	$0.00	$0.00	"$1,180.87"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-211	SUP	HCPCS C1776		6276-5-211  -  STEM FEMORAL BOWED 11MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-212	SUP	HCPCS C1776		6276-5-212  -  STEM FEMORAL BOWED 12MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-213	SUP	HCPCS C1776		6276-5-213  -  STEM FEMORAL BOWED 13MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-214	SUP	HCPCS C1776		6276-5-214  -  STEM FEMORAL BOWED 14MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-215	SUP	HCPCS C1776		6276-5-215  -  STEM FEMORAL BOWED 15MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-216	SUP	HCPCS C1776		6276-5-216  -  STEM FEMORAL BOWED 16MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-217	SUP	HCPCS C1776		6276-5-217  -  STEM FEMORAL BOWED 17MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-218	SUP	HCPCS C1776		6276-5-218  -  STEM FEMORAL BOWED 18MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-219	SUP	HCPCS C1776		6276-5-219  -  STEM FEMORAL BOWED 19MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-220	SUP	HCPCS C1776		6276-5-220  -  STEM FEMORAL BOWED 20MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-221	SUP	HCPCS C1776		6276-5-221  -  STEM FEMORAL BOWED 21MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-222	SUP	HCPCS C1776		6276-5-222  -  STEM FEMORAL BOWED 22MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-223	SUP	HCPCS C1776		6276-5-223  -  STEM FEMORAL BOWED 23MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-224	SUP	HCPCS C1776		6276-5-224  -  STEM FEMORAL BOWED 24MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-225	SUP	HCPCS C1776		6276-5-225  -  STEM FEMORAL BOWED 25MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-226	SUP	HCPCS C1776		6276-5-226  -  STEM FEMORAL BOWED 26MM 167MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-411	SUP	HCPCS C1776		6276-5-411  -  STEM FEMORAL BOWED 11MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-412	SUP	HCPCS C1776		6276-5-412  -  STEM FEMORAL BOWED 12MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-413	SUP	HCPCS C1776		6276-5-413  -  STEM FEMORAL BOWED 13MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-414	SUP	HCPCS C1776		6276-5-414  -  STEM FEMORAL BOWED 14MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-415	SUP	HCPCS C1776		6276-5-415  -  STEM FEMORAL BOWED 15MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-416	SUP	HCPCS C1776		6276-5-416  -  STEM FEMORAL BOWED 16MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-417	SUP	HCPCS C1776		6276-5-417  -  STEM FEMORAL BOWED 17MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-418	SUP	HCPCS C1776		6276-5-418  -  STEM FEMORAL BOWED 18MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-419	SUP	HCPCS C1776		6276-5-419  -  STEM FEMORAL BOWED 19MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-420	SUP	HCPCS C1776		6276-5-420  -  STEM FEMORAL BOWED 20MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-421	SUP	HCPCS C1776		6276-5-421  -  STEM FEMORAL BOWED 21MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-422	SUP	HCPCS C1776		6276-5-422  -  STEM FEMORAL BOWED 22MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-423	SUP	HCPCS C1776		6276-5-423  -  STEM FEMORAL BOWED 23MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-424	SUP	HCPCS C1776		6276-5-424  -  STEM FEMORAL BOWED 24MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-425	SUP	HCPCS C1776		6276-5-425  -  STEM FEMORAL BOWED 25MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-426	SUP	HCPCS C1776		6276-5-426  -  STEM FEMORAL BOWED 26MM 217MM MODULAR PLASMA SPRAYED RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-511	SUP	HCPCS C1776		6276-5-511  -  STEM FEMORAL 11MM 267MM BOWED PLASMA REVISION MODULAR RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-512	SUP	HCPCS C1776		6276-5-512  -  STEM FEMORAL 12MM 267MM MODULAR BOWED PLASMA RSTOR DISTAL	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-513	SUP	HCPCS C1776		6276-5-513  -  STEM FEMORAL 13MM 267MM BOWED PLASMA REVISION MODULAR RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-514	SUP	HCPCS C1776		6276-5-514  -  STEM FEMORAL 14MM 267MM BOWED PLASMA REVISION MODULAR RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-515	SUP	HCPCS C1776		6276-5-515  -  STEM FEMORAL 15MM 267MM BOWED PLASMA REVISION MODULAR RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-516	SUP	HCPCS C1776		6276-5-516  -  STEM FEMORAL 16MM 267MM BOWED PLASMA REVISION MODULAR RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-517	SUP	HCPCS C1776		6276-5-517  -  STEM FEMORAL 17MM 267MM BOWED PLASMA REVISION MODULAR RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-518	SUP	HCPCS C1776		6276-5-518  -  STEM FEMORAL 18MM 267MM BOWED PLASMA MODULAR RSTOR DISTAL	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-519	SUP	HCPCS C1776		6276-5-519  -  STEM FEMORAL 19MM 267MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-520	SUP	HCPCS C1776		6276-5-520  -  STEM FEMORAL 20MM 267MM BOWED PLASMA MODULAR RSTOR DISTAL	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-521	SUP	HCPCS C1776		6276-5-521  -  STEM FEMORAL 21MM 267MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-522	SUP	HCPCS C1776		6276-5-522  -  STEM FEMORAL 22MM 267MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-523	SUP	HCPCS C1776		6276-5-523  -  STEM FEMORAL 23MM 267MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-524	SUP	HCPCS C1776		6276-5-524  -  STEM FEMORAL 24MM 267MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-525	SUP	HCPCS C1776		6276-5-525  -  STEM FEMORAL 25MM 267MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-526	SUP	HCPCS C1776		6276-5-526  -  STEM FEMORAL 26MM 267MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-611	SUP	HCPCS C1776		6276-5-611  -  STEM FEMORAL 11MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-612	SUP	HCPCS C1776		6276-5-612  -  STEM FEMORAL 12MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-613	SUP	HCPCS C1776		6276-5-613  -  STEM FEMORAL 13MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-614	SUP	HCPCS C1776		6276-5-614  -  STEM FEMORAL 14MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-615	SUP	HCPCS C1776		6276-5-615  -  STEM FEMORAL 15MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-616	SUP	HCPCS C1776		6276-5-616  -  STEM FEMORAL 16MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-617	SUP	HCPCS C1776		6276-5-617  -  STEM FEMORAL 17MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-618	SUP	HCPCS C1776		6276-5-618  -  STEM FEMORAL 18MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-619	SUP	HCPCS C1776		6276-5-619  -  STEM FEMORAL 19MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-620	SUP	HCPCS C1776		6276-5-620  -  STEM FEMORAL 20MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-621	SUP	HCPCS C1776		6276-5-621  -  STEM FEMORAL 21MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-622	SUP	HCPCS C1776		6276-5-622  -  STEM FEMORAL 22MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-623	SUP	HCPCS C1776		6276-5-623  -  STEM FEMORAL 23MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-624	SUP	HCPCS C1776		6276-5-624  -  STEM FEMORAL 24MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-625	SUP	HCPCS C1776		6276-5-625  -  STEM FEMORAL 25MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-5-626	SUP	HCPCS C1776		6276-5-626  -  STEM FEMORAL 26MM 317MM BOWED PLASMA MODULAR REVISION RSTOR	BOTH IP/OP	"$8,420.00 "	"$6,230.80"	$0.00	"$6,736.00"	"$3,789.00"	"$3,789.00"	$0.00	$0.00	$0.00	"$1,754.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,754.73"	$0.00	"$4,151.06"	"$4,151.06"	$0.00	"$4,210.00"	"$6,668.64"	"$6,736.00"	$0.00		$0.00	"$1,317.73"	$0.00	$0.00	"$1,340.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-011	SUP	HCPCS C1776		6276-6-011  -  STEM FEMORAL STR FLUTE 11MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-012	SUP	HCPCS C1776		6276-6-012  -  STEM FEMORAL STR FLUTE 12MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-013	SUP	HCPCS C1776		6276-6-013  -  STEM FEMORAL STR FLUTE 13MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-014	SUP	HCPCS C1776		6276-6-014  -  STEM FEMORAL STR FLUTE 14MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-015	SUP	HCPCS C1776		6276-6-015  -  STEM FEMORAL STR FLUTE 15MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-016	SUP	HCPCS C1776		6276-6-016  -  STEM FEMORAL STR FLUTE 16MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-017	SUP	HCPCS C1776		6276-6-017  -  STEM FEMORAL STR FLUTE 17MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-018	SUP	HCPCS C1776		6276-6-018  -  STEM FEMORAL STR FLUTE 18MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-019	SUP	HCPCS C1776		6276-6-019  -  STEM FEMORAL STR FLUTE 19MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-020	SUP	HCPCS C1776		6276-6-020  -  STEM FEMORAL STR FLUTE 20MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-021	SUP	HCPCS C1776		6276-6-021  -  STEM FEMORAL STR FLUTE 21MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-022	SUP	HCPCS C1776		6276-6-022  -  STEM FEMORAL STR FLUTE 22MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-023	SUP	HCPCS C1776		6276-6-023  -  STEM FEMORAL STR FLUTE 23MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-024	SUP	HCPCS C1776		6276-6-024  -  STEM FEMORAL STR FLUTE 24MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-025	SUP	HCPCS C1776		6276-6-025  -  STEM FEMORAL STR FLUTE 25MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-026	SUP	HCPCS C1776		6276-6-026  -  STEM FEMORAL STR FLUTE 26MM 127MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-111	SUP	HCPCS C1776		6276-6-111  -  STEM FEMORAL STR FLUTE 11MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-112	SUP	HCPCS C1776		6276-6-112  -  STEM FEMORAL STR FLUTE 12MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-113	SUP	HCPCS C1776		6276-6-113  -  STEM FEMORAL STR FLUTE 13MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-114	SUP	HCPCS C1776		6276-6-114  -  STEM FEMORAL STR FLUTE 14MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-115	SUP	HCPCS C1776		6276-6-115  -  STEM FEMORAL STR FLUTE 15MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-116	SUP	HCPCS C1776		6276-6-116  -  STEM FEMORAL STR FLUTE 16MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-117	SUP	HCPCS C1776		6276-6-117  -  STEM FEMORAL STR FLUTE 17MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-118	SUP	HCPCS C1776		6276-6-118  -  STEM FEMORAL STR FLUTE 18MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-119	SUP	HCPCS C1776		6276-6-119  -  STEM FEMORAL STR FLUTE 19MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-120	SUP	HCPCS C1776		6276-6-120  -  STEM FEMORAL STR FLUTE 20MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-121	SUP	HCPCS C1776		6276-6-121  -  STEM FEMORAL STR FLUTE 21MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-122	SUP	HCPCS C1776		6276-6-122  -  STEM FEMORAL STR FLUTE 22MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-123	SUP	HCPCS C1776		6276-6-123  -  STEM FEMORAL STR FLUTE 23MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-124	SUP	HCPCS C1776		6276-6-124  -  STEM FEMORAL STR FLUTE 24MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-125	SUP	HCPCS C1776		6276-6-125  -  STEM FEMORAL STR FLUTE 25MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-126	SUP	HCPCS C1776		6276-6-126  -  STEM FEMORAL STR FLUTE 26MM 167MM MODULAR RSTOR HIP	BOTH IP/OP	"$5,762.50 "	"$4,264.25"	$0.00	"$4,610.00"	"$2,593.13"	"$2,593.13"	$0.00	$0.00	$0.00	"$1,201.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,200.91"	$0.00	"$2,840.91"	"$2,840.91"	$0.00	"$2,881.25"	"$4,563.90"	"$4,610.00"	$0.00		$0.00	$901.83	$0.00	$0.00	$917.39	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-211	SUP	HCPCS C1776		6276-6-211  -  STEM FEMORAL 11MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-212	SUP	HCPCS C1776		6276-6-212  -  STEM FEMORAL 12MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-213	SUP	HCPCS C1776		6276-6-213  -  STEM FEMORAL 13MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-214	SUP	HCPCS C1776		6276-6-214  -  STEM FEMORAL 14MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-215	SUP	HCPCS C1776		6276-6-215  -  STEM FEMORAL 15MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-216	SUP	HCPCS C1776		6276-6-216  -  STEM FEMORAL 16MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-217	SUP	HCPCS C1776		6276-6-217  -  STEM FEMORAL 17MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-218	SUP	HCPCS C1776		6276-6-218  -  STEM FEMORAL 18MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-219	SUP	HCPCS C1776		6276-6-219  -  STEM FEMORAL 19MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-220	SUP	HCPCS C1776		6276-6-220  -  STEM FEMORAL 20MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-221	SUP	HCPCS C1776		6276-6-221  -  STEM FEMORAL 21MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-222	SUP	HCPCS C1776		6276-6-222  -  STEM FEMORAL 22MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-223	SUP	HCPCS C1776		6276-6-223  -  STEM FEMORAL 23MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-224	SUP	HCPCS C1776		6276-6-224  -  STEM FEMORAL 24MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-225	SUP	HCPCS C1776		6276-6-225  -  STEM FEMORAL 25MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-226	SUP	HCPCS C1776		6276-6-226  -  STEM FEMORAL 26MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-411	SUP	HCPCS C1776		6276-6-411  -  STEM FEMORAL 11MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-412	SUP	HCPCS C1776		6276-6-412  -  STEM FEMORAL 12MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-413	SUP	HCPCS C1776		6276-6-413  -  STEM FEMORAL 13MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-414	SUP	HCPCS C1776		6276-6-414  -  STEM FEMORAL 14MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-415	SUP	HCPCS C1776		6276-6-415  -  STEM FEMORAL 15MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-416	SUP	HCPCS C1776		6276-6-416  -  STEM FEMORAL 16MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-417	SUP	HCPCS C1776		6276-6-417  -  STEM FEMORAL 17MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-418	SUP	HCPCS C1776		6276-6-418  -  STEM FEMORAL 18MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-419	SUP	HCPCS C1776		6276-6-419  -  STEM FEMORAL 19MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-420	SUP	HCPCS C1776		6276-6-420  -  STEM FEMORAL 20MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-421	SUP	HCPCS C1776		6276-6-421  -  STEM FEMORAL 21MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-422	SUP	HCPCS C1776		6276-6-422  -  STEM FEMORAL 22MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-423	SUP	HCPCS C1776		6276-6-423  -  STEM FEMORAL 23MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-424	SUP	HCPCS C1776		6276-6-424  -  STEM FEMORAL 24MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-425	SUP	HCPCS C1776		6276-6-425  -  STEM FEMORAL 25MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-426	SUP	HCPCS C1776		6276-6-426  -  STEM FEMORAL 26MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,760.00 "	"$5,742.40"	$0.00	"$6,208.00"	"$3,492.00"	"$3,492.00"	$0.00	$0.00	$0.00	"$1,617.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,617.18"	$0.00	"$3,825.68"	"$3,825.68"	$0.00	"$3,880.00"	"$6,145.92"	"$6,208.00"	$0.00		$0.00	"$1,214.44"	$0.00	$0.00	"$1,235.39"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-511	SUP	HCPCS C1776		6276-6-511  -  STEM FEMORAL 11MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-512	SUP	HCPCS C1776		6276-6-512  -  STEM FEMORAL 12MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-513	SUP	HCPCS C1776		6276-6-513  -  STEM FEMORAL 13MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-514	SUP	HCPCS C1776		6276-6-514  -  STEM FEMORAL 14MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-515	SUP	HCPCS C1776		6276-6-515  -  STEM FEMORAL 15MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-516	SUP	HCPCS C1776		6276-6-516  -  STEM FEMORAL 16MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-517	SUP	HCPCS C1776		6276-6-517  -  STEM FEMORAL 17MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-518	SUP	HCPCS C1776		6276-6-518  -  STEM FEMORAL 18MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-519	SUP	HCPCS C1776		6276-6-519  -  STEM FEMORAL 19MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-520	SUP	HCPCS C1776		6276-6-520  -  STEM FEMORAL 20MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-521	SUP	HCPCS C1776		6276-6-521  -  STEM FEMORAL 21MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-522	SUP	HCPCS C1776		6276-6-522  -  STEM FEMORAL 22MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-523	SUP	HCPCS C1776		6276-6-523  -  STEM FEMORAL 23MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-524	SUP	HCPCS C1776		6276-6-524  -  STEM FEMORAL 24MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-525	SUP	HCPCS C1776		6276-6-525  -  STEM FEMORAL 25MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-526	SUP	HCPCS C1776		6276-6-526  -  STEM FEMORAL 26MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-611	SUP	HCPCS C1776		6276-6-611  -  STEM FEMORAL 11MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-612	SUP	HCPCS C1776		6276-6-612  -  STEM FEMORAL 12MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-613	SUP	HCPCS C1776		6276-6-613  -  STEM FEMORAL 13MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-614	SUP	HCPCS C1776		6276-6-614  -  STEM FEMORAL 14MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-615	SUP	HCPCS C1776		6276-6-615  -  STEM FEMORAL 15MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-616	SUP	HCPCS C1776		6276-6-616  -  STEM FEMORAL 16MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-617	SUP	HCPCS C1776		6276-6-617  -  STEM FEMORAL 17MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-618	SUP	HCPCS C1776		6276-6-618  -  STEM FEMORAL 18MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-619	SUP	HCPCS C1776		6276-6-619  -  STEM FEMORAL 19MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-620	SUP	HCPCS C1776		6276-6-620  -  STEM FEMORAL 20MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-621	SUP	HCPCS C1776		6276-6-621  -  STEM FEMORAL 21MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-622	SUP	HCPCS C1776		6276-6-622  -  STEM FEMORAL 22MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-623	SUP	HCPCS C1776		6276-6-623  -  STEM FEMORAL 23MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-624	SUP	HCPCS C1776		6276-6-624  -  STEM FEMORAL 24MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-625	SUP	HCPCS C1776		6276-6-625  -  STEM FEMORAL 25MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-6-626	SUP	HCPCS C1776		6276-6-626  -  STEM FEMORAL 26MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-014	SUP	HCPCS C1776		6276-7-014  -  STEM FEMORAL STR CONE 14MM 155MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-015	SUP	HCPCS C1776		6276-7-015  -  STEM FEMORAL CONICAL 15MM 155MM MODULAR DISTAL HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-016	SUP	HCPCS C1776		6276-7-016  -  STEM FEMORAL CONICAL 16MM 155MM MODULAR DISTAL HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-017	SUP	HCPCS C1776		6276-7-017  -  STEM FEMORAL CONICAL 17MM 155MM MODULAR RSTOR HA DISTAL HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-018	SUP	HCPCS C1776		6276-7-018  -  STEM FEMORAL STR CONE 18MM 155MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-019	SUP	HCPCS C1776		6276-7-019  -  STEM FEMORAL CONICAL 19MM 155MM MODULAR RSTOR HA DISTAL HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-020	SUP	HCPCS C1776		6276-7-020  -  STEM FEMORAL STR CONE 20MM 155MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-021	SUP	HCPCS C1776		6276-7-021  -  STEM FEMORAL STR CONE 21MM 155MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-022	SUP	HCPCS C1776		6276-7-022  -  STEM FEMORAL STR CONE 22MM 155MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-023	SUP	HCPCS C1776		6276-7-023  -  STEM FEMORAL STR CONE 23MM 155MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-024	SUP	HCPCS C1776		6276-7-024  -  STEM FEMORAL STR CONE 24MM 155MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-025	SUP	HCPCS C1776		6276-7-025  -  STEM FEMORAL STR CONE 25MM 155MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-026	SUP	HCPCS C1776		6276-7-026  -  STEM FEMORAL STR CONE 26MM 155MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-027	SUP	HCPCS C1776		6276-7-027  -  STEM FEMORAL STR CONE 27MM 155MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-028	SUP	HCPCS C1776		6276-7-028  -  STEM FEMORAL STR CONE 28MM 155MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$6,752.50 "	"$4,996.85"	$0.00	"$5,402.00"	"$3,038.63"	"$3,038.63"	$0.00	$0.00	$0.00	"$1,407.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,407.22"	$0.00	"$3,328.98"	"$3,328.98"	$0.00	"$3,376.25"	"$5,347.98"	"$5,402.00"	$0.00		$0.00	"$1,056.77"	$0.00	$0.00	"$1,075.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-114	SUP	HCPCS C1776		6276-7-114  -  STEM FEMORAL STR CONE 14MM 195MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-115	SUP	HCPCS C1776		6276-7-115  -  STEM FEMORAL STR CONE 15MM 195MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-116	SUP	HCPCS C1776		6276-7-116  -  STEM FEMORAL CONE STR 16MM 195MM MODULAR RSTOR HA HIP DISTAL	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-117	SUP	HCPCS C1776		6276-7-117  -  STEM FEMORAL STR CONE 17MM 195MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-118	SUP	HCPCS C1776		6276-7-118  -  STEM FEMORAL STR CONE 18MM 195MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-119	SUP	HCPCS C1776		6276-7-119  -  STEM FEMORAL STR CONE 19MM 195MM MODULAR RSTOR HA HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-120	SUP	HCPCS C1776		6276-7-120  -  STEM FEMORAL STR CONE 20MM 195MM MODULAR RSTOR HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-121	SUP	HCPCS C1776		6276-7-121  -  STEM FEMORAL STR CONE 21MM 195MM MODULAR RSTOR HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-122	SUP	HCPCS C1776		6276-7-122  -  STEM FEMORAL STR CONE 22MM 195MM MODULAR RSTOR HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-123	SUP	HCPCS C1776		6276-7-123  -  STEM FEMORAL STR CONE 23MM 195MM MODULAR RSTOR HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-124	SUP	HCPCS C1776		6276-7-124  -  STEM FEMORAL STR CONE 24MM 195MM MODULAR RSTOR HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-125	SUP	HCPCS C1776		6276-7-125  -  STEM FEMORAL STR CONE 25MM 195MM MODULAR RSTOR HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-126	SUP	HCPCS C1776		6276-7-126  -  STEM FEMORAL STR CONE 26MM 195MM MODULAR RSTOR HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-127	SUP	HCPCS C1776		6276-7-127  -  STEM FEMORAL STR CONE 27MM 195MM MODULAR RSTOR HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-128	SUP	HCPCS C1776		6276-7-128  -  STEM FEMORAL STR CONE 28MM 195MM MODULAR RSTOR HIP	BOTH IP/OP	"$7,150.00 "	"$5,291.00"	$0.00	"$5,720.00"	"$3,217.50"	"$3,217.50"	$0.00	$0.00	$0.00	"$1,490.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,490.06"	$0.00	"$3,524.95"	"$3,524.95"	$0.00	"$3,575.00"	"$5,662.80"	"$5,720.00"	$0.00		$0.00	"$1,118.98"	$0.00	$0.00	"$1,138.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-214	SUP	HCPCS C1776		6276-7-214  -  STEM FEMORAL CONICAL 14MM 195MM MODULAR RSTOR DISTAL HIP	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-215	SUP	HCPCS C1776		6276-7-215  -  STEM FEMORAL CONICAL 15MM 195MM BOWED MODULAR RSTOR HIP	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-216	SUP	HCPCS C1776		6276-7-216  -  STEM FEMORAL BOW CONE 16MM 195MM MODULAR REVISION RSTOR	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-217	SUP	HCPCS C1776		6276-7-217  -  STEM FEMORAL BOWED CONICAL 17MM 195MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-218	SUP	HCPCS C1776		6276-7-218  -  STEM FEMORAL CONICAL 18MM 195MM BOWED MODULAR RSTOR HA HIP	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-219	SUP	HCPCS C1776		6276-7-219  -  STEM FEMORAL BOWED CONICAL 19MM 195MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-220	SUP	HCPCS C1776		6276-7-220  -  STEM FEMORAL CONICAL 20MM 195MM BOWED MODULAR RSTOR HIP	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-221	SUP	HCPCS C1776		6276-7-221  -  STEM FEMORAL BOWED CONICAL 21MM 195MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-222	SUP	HCPCS C1776		6276-7-222  -  STEM FEMORAL BOWED CONICAL 22MM 195MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-223	SUP	HCPCS C1776		6276-7-223  -  STEM FEMORAL BOWED CONICAL 23MM 195MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-224	SUP	HCPCS C1776		6276-7-224  -  STEM FEMORAL BOWED CONICAL 24MM 195MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-225	SUP	HCPCS C1776		6276-7-225  -  STEM FEMORAL CONE 25MM 195MM MODULAR REVISION RSTOR HIP	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-226	SUP	HCPCS C1776		6276-7-226  -  STEM FEMORAL BOWED CONICAL 26MM 195MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-227	SUP	HCPCS C1776		6276-7-227  -  STEM FEMORAL BOWED CONICAL 27MM 195MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-228	SUP	HCPCS C1776		6276-7-228  -  STEM FEMORAL BOWED CONICAL 28MM 195MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,547.50 "	"$5,585.15"	$0.00	"$6,038.00"	"$3,396.38"	"$3,396.38"	$0.00	$0.00	$0.00	"$1,573.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,572.90"	$0.00	"$3,720.92"	"$3,720.92"	$0.00	"$3,773.75"	"$5,977.62"	"$6,038.00"	$0.00		$0.00	"$1,181.18"	$0.00	$0.00	"$1,201.56"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-314	SUP	HCPCS C1776		6276-7-314  -  STEM FEMORAL BOWED CONICAL 14MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-315	SUP	HCPCS C1776		6276-7-315  -  STEM FEMORAL BOWED CONICAL 15MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-316	SUP	HCPCS C1776		6276-7-316  -  STEM FEMORAL BOWED CONICAL 16MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-317	SUP	HCPCS C1776		6276-7-317  -  STEM FEMORAL BOWED CONICAL 17MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-318	SUP	HCPCS C1776		6276-7-318  -  STEM FEMORAL BOWED CONICAL 18MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-319	SUP	HCPCS C1776		6276-7-319  -  STEM FEMORAL BOWED CONICAL 19MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-320	SUP	HCPCS C1776		6276-7-320  -  STEM FEMORAL BOWED CONICAL 20MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-321	SUP	HCPCS C1776		6276-7-321  -  STEM FEMORAL BOWED CONICAL 21MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-322	SUP	HCPCS C1776		6276-7-322  -  STEM FEMORAL BOWED CONICAL 22MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-323	SUP	HCPCS C1776		6276-7-323  -  STEM FEMORAL BOWED CONICAL 23MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-324	SUP	HCPCS C1776		6276-7-324  -  STEM FEMORAL BOWED CONICAL 24MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-325	SUP	HCPCS C1776		6276-7-325  -  STEM FEMORAL BOWED CONICAL 25MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-326	SUP	HCPCS C1776		6276-7-326  -  STEM FEMORAL BOWED CONICAL 26MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-327	SUP	HCPCS C1776		6276-7-327  -  STEM FEMORAL BOWED CONICAL 27MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-7-328	SUP	HCPCS C1776		6276-7-328  -  STEM FEMORAL BOWED CONICAL 28MM 235MM MODULAR RSTOR DISTAL	BOTH IP/OP	"$7,942.50 "	"$5,877.45"	$0.00	"$6,354.00"	"$3,574.13"	"$3,574.13"	$0.00	$0.00	$0.00	"$1,655.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,655.22"	$0.00	"$3,915.65"	"$3,915.65"	$0.00	"$3,971.25"	"$6,290.46"	"$6,354.00"	$0.00		$0.00	"$1,243.00"	$0.00	$0.00	"$1,264.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-213	SUP	HCPCS C1776		6276-8-213  -  STEM FEMORAL 13MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-214	SUP	HCPCS C1776		6276-8-214  -  STEM FEMORAL 14MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-215	SUP	HCPCS C1776		6276-8-215  -  STEM FEMORAL 15MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-216	SUP	HCPCS C1776		6276-8-216  -  STEM FEMORAL 16MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-217	SUP	HCPCS C1776		6276-8-217  -  STEM FEMORAL 17MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-218	SUP	HCPCS C1776		6276-8-218  -  STEM FEMORAL 18MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-219	SUP	HCPCS C1776		6276-8-219  -  STEM FEMORAL 19MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-220	SUP	HCPCS C1776		6276-8-220  -  STEM FEMORAL 20MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-221	SUP	HCPCS C1776		6276-8-221  -  STEM FEMORAL 21MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-222	SUP	HCPCS C1776		6276-8-222  -  STEM FEMORAL 22MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-223	SUP	HCPCS C1776		6276-8-223  -  STEM FEMORAL 23MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-224	SUP	HCPCS C1776		6276-8-224  -  STEM FEMORAL 24MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-225	SUP	HCPCS C1776		6276-8-225  -  STEM FEMORAL 25MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-226	SUP	HCPCS C1776		6276-8-226  -  STEM FEMORAL 26MM 167MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,260.00 "	"$6,112.40"	$0.00	"$6,608.00"	"$3,717.00"	"$3,717.00"	$0.00	$0.00	$0.00	"$1,721.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,721.38"	$0.00	"$4,072.18"	"$4,072.18"	$0.00	"$4,130.00"	"$6,541.92"	"$6,608.00"	$0.00		$0.00	"$1,292.69"	$0.00	$0.00	"$1,314.99"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-413	SUP	HCPCS C1776		6276-8-413  -  STEM FEMORAL 13MM 217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-414	SUP	HCPCS C1776		6276-8-414  -  STEM FEMORAL 14MM 217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-415	SUP	HCPCS C1776		6276-8-415  -  STEM FEMORAL 15MM 217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-416	SUP	HCPCS C1776		6276-8-416  -  STEM FEMORAL 16MM 1217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-417	SUP	HCPCS C1776		6276-8-417  -  STEM FEMORAL 17MM 217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-418	SUP	HCPCS C1776		6276-8-418  -  STEM FEMORAL 18MM 217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-419	SUP	HCPCS C1776		6276-8-419  -  STEM FEMORAL 19MM 1217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-420	SUP	HCPCS C1776		6276-8-420  -  STEM FEMORAL 20MM 1217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-421	SUP	HCPCS C1776		6276-8-421  -  STEM FEMORAL 21MM 1217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-422	SUP	HCPCS C1776		6276-8-422  -  STEM FEMORAL 22MM 217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-423	SUP	HCPCS C1776		6276-8-423  -  STEM FEMORAL 23MM 217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-424	SUP	HCPCS C1776		6276-8-424  -  STEM FEMORAL 24MM 217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-425	SUP	HCPCS C1776		6276-8-425  -  STEM FEMORAL 25MM 217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-426	SUP	HCPCS C1776		6276-8-426  -  STEM FEMORAL 26MM 217MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$8,640.00 "	"$6,393.60"	$0.00	"$6,912.00"	"$3,888.00"	"$3,888.00"	$0.00	$0.00	$0.00	"$1,800.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,800.58"	$0.00	"$4,259.52"	"$4,259.52"	$0.00	"$4,320.00"	"$6,842.88"	"$6,912.00"	$0.00		$0.00	"$1,352.16"	$0.00	$0.00	"$1,375.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-513	SUP	HCPCS C1776		6276-8-513  -  STEM FEMORAL 13MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-514	SUP	HCPCS C1776		6276-8-514  -  STEM FEMORAL 14MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-515	SUP	HCPCS C1776		6276-8-515  -  STEM FEMORAL 15MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-516	SUP	HCPCS C1776		6276-8-516  -  STEM FEMORAL 16MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-517	SUP	HCPCS C1776		6276-8-517  -  STEM FEMORAL 17MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-518	SUP	HCPCS C1776		6276-8-518  -  STEM FEMORAL 18MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-519	SUP	HCPCS C1776		6276-8-519  -  STEM FEMORAL 19MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-520	SUP	HCPCS C1776		6276-8-520  -  STEM FEMORAL 20MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-521	SUP	HCPCS C1776		6276-8-521  -  STEM FEMORAL 21MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-522	SUP	HCPCS C1776		6276-8-522  -  STEM FEMORAL 22MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-523	SUP	HCPCS C1776		6276-8-523  -  STEM FEMORAL 23MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-524	SUP	HCPCS C1776		6276-8-524  -  STEM FEMORAL 24MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-525	SUP	HCPCS C1776		6276-8-525  -  STEM FEMORAL 25MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-526	SUP	HCPCS C1776		6276-8-526  -  STEM FEMORAL 26MM 267MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,027.50 "	"$6,680.35"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,881.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,881.33"	$0.00	"$4,450.56"	"$4,450.56"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-613	SUP	HCPCS C1776		6276-8-613  -  STEM FEMORAL 13MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-614	SUP	HCPCS C1776		6276-8-614  -  STEM FEMORAL 14MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-615	SUP	HCPCS C1776		6276-8-615  -  STEM FEMORAL 15MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-616	SUP	HCPCS C1776		6276-8-616  -  STEM FEMORAL 16MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-617	SUP	HCPCS C1776		6276-8-617  -  STEM FEMORAL 17MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-618	SUP	HCPCS C1776		6276-8-618  -  STEM FEMORAL 18MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-619	SUP	HCPCS C1776		6276-8-619  -  STEM FEMORAL 19MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-620	SUP	HCPCS C1776		6276-8-620  -  STEM FEMORAL 20MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-621	SUP	HCPCS C1776		6276-8-621  -  STEM FEMORAL 21MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-622	SUP	HCPCS C1776		6276-8-622  -  STEM FEMORAL 22MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-623	SUP	HCPCS C1776		6276-8-623  -  STEM FEMORAL 23MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-624	SUP	HCPCS C1776		6276-8-624  -  STEM FEMORAL 24MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-625	SUP	HCPCS C1776		6276-8-625  -  STEM FEMORAL 25MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6276-8-626	SUP	HCPCS C1776		6276-8-626  -  STEM FEMORAL 26MM 317MM BOWED SLOTTED PLASMA HIP	BOTH IP/OP	"$9,410.00 "	"$6,963.40"	$0.00	"$7,528.00"	"$4,234.50"	"$4,234.50"	$0.00	$0.00	$0.00	"$1,961.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.04"	$0.00	"$4,639.13"	"$4,639.13"	$0.00	"$4,705.00"	"$7,452.72"	"$7,528.00"	$0.00		$0.00	"$1,472.67"	$0.00	$0.00	"$1,498.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-036	SUP	Custom 27803010		6280-0-036  -  HEAD FEM -3MM 36MM PCA OFST	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-126	SUP	Custom 27803010		6280-0-126  -  HEAD FEMORAL STANDARD OFFST 26MM PCA VITALLIUM HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-128	SUP	Custom 27803010		6280-0-128  -  HEAD FEM +0MM OFST 28MM STRL PCA VIT HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-132	SUP	Custom 27803010		6280-0-132  -  HEAD FEM +0MM OFST 32MM STRL PCA VIT HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-136	SUP	Custom 27803010		6280-0-136  -  HEAD FEM 36MM PCA	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-226	SUP	Custom 27803010		6280-0-226  -  HEAD FEMORAL +5MM 26MM PCA VITALLIUM HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-228	SUP	Custom 27803010		6280-0-228  -  HEAD FEM +5MM OFST 28MM STRL PCA VIT HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-232	SUP	Custom 27803010		6280-0-232  -  HEAD FEM +5MM OFST 32MM STRL PCA VIT HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-236	SUP	Custom 27803010		6280-0-236  -  HEAD FEM +5MM OFST 36MM STRL PCA VIT HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-326	SUP	Custom 27803010		6280-0-326  -  HEAD FEMORAL +10MM 26MM PCA VITALLIUM HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-328	SUP	Custom 27803010		6280-0-328  -  HEAD FEM +10MM OFST 28MM PCA HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-332	SUP	Custom 27803010		6280-0-332  -  HEAD FEMORAL +10MM TAPER 32MM PCA VITALLIUM HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-336	SUP	Custom 27803010		6280-0-336  -  HEAD FEM +10MM 36MM HIP OFFST PCA	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-436	SUP	Custom 27803010		6280-0-436  -  HEAD FEM +15MM 36MM OFFST PCA	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-622	SUP	Custom 27803010		6280-0-622  -  HEAD FEM +2MM OFST 22.2MM STRL PCA VIT HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-722	SUP	Custom 27803010		6280-0-722  -  HEAD FEMORAL +5MM 22.2MM PCA VITALLIUM HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-0-822	SUP	Custom 27803010		6280-0-822  -  HEAD FEMORAL +10MM 22MM PCA VITALLIUM HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6280-3-032	SUP	Custom 27803010		6280-3-032  -  HEAD FEMORAL +3MM 32MM PCA VITALLIUM HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6290-7-012	SUP	HCPCS C1713		6290-7-012  -  SCREW BONE 6.2MM 12MM CANC SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6290-7-015	SUP	HCPCS C1713		6290-7-015  -  SCREW BONE 6.2MM 15MM CANC SLFTAP HEX HEAD	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6290-7-020	SUP	HCPCS C1713		6290-7-020  -  SCREW BONE 6.2MM 20MM CANC SLFTAP HEX HEAD	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6290-7-025	SUP	HCPCS C1713		6290-7-025  -  SCREW BONE 6.2MM 25MM CANC SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6290-7-030	SUP	HCPCS C1713		6290-7-030  -  SCREW BONE 6.2MM 30MM CANC SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6290-7-035	SUP	HCPCS C1713		6290-7-035  -  SCREW BONE 6.2MM 35MM CANC SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6290-7-040	SUP	HCPCS C1713		6290-7-040  -  SCREW BONE 6.2MM 40MM CANC SLFTAP HEX HEAD	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6290-7-045	SUP	HCPCS C1713		6290-7-045  -  SCREW BONE 6.2MM 45MM CANC SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6290-7-050	SUP	HCPCS C1713		6290-7-050  -  SCREW BONE 6.2MM 50MM CANC SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6290-7-055	SUP	HCPCS C1713		6290-7-055  -  SCREW BONE 6.2MM 55MM CANC SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6290-7-060	SUP	HCPCS C1713		6290-7-060  -  SCREW BONE 6.2MM 60MM CANC SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6290-7-065	SUP	HCPCS C1713		6290-7-065  -  SCREW BONE 6.2MM 65MM CANC SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6290-8-620	SUP	HCPCS C1713		6290-8-620  -  WASHER 6.2MM SCR ORTH VIT	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$33.75	$33.75	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$0.00	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
629210S	SUP	HCPCS C1713		629210S  -  PLATE 176MM TI 10 SHFT HOLE LCK VARIAX BONE LEFT DISTAL LAT	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$959.06	$959.06	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
629212S	SUP	HCPCS C1713		629212S  -  PLATE 203MM TI 12 SHFT HOLE LCK VARIAX BONE LEFT DISTAL LAT	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,793.00"	"$1,008.56"	"$1,008.56"	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,120.63"	"$1,775.07"	"$1,793.00"	$0.00		$0.00	$350.76	$0.00	$0.00	$356.81	$0.00	$0.00	$0.00	$0.00	$0.00
629230S	SUP	HCPCS C1713		629230S  -  PLATE 176MM TI 10 SHFT HOLE LCK VARIAX BONE RIGHT DISTAL LAT	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$959.06	$959.06	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
629232S	SUP	HCPCS C1713		629232S  -  PLATE 203MM TI 12 SHFT HOLE REDX CLMP SLFTAP BONE RL STRL	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,793.00"	"$1,008.56"	"$1,008.56"	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,120.63"	"$1,775.07"	"$1,793.00"	$0.00		$0.00	$350.76	$0.00	$0.00	$356.81	$0.00	$0.00	$0.00	$0.00	$0.00
629250S	SUP	HCPCS C1713		629250S  -  PLATE BN 173MM STRL VARIAX 10 HL TI HUM LT P/L	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$959.06	$959.06	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
629252S	SUP	HCPCS C1713		629252S  -  PLATE BN 196MM STRL VARIAX 12 HL TI HUM LT P/L	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,793.00"	"$1,008.56"	"$1,008.56"	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,120.63"	"$1,775.07"	"$1,793.00"	$0.00		$0.00	$350.76	$0.00	$0.00	$356.81	$0.00	$0.00	$0.00	$0.00	$0.00
629254S	SUP	HCPCS C1713		629254S  -  DISTAL POSTERIOR LATERAL PLATE  14 HOLE / LEFT	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
629270S	SUP	HCPCS C1713		629270S  -  PLATE BN 173MM STRL VARIAX 10 HL TI HUM RT P/L	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$959.06	$959.06	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
629272S	SUP	HCPCS C1713		629272S  -  PLATE BN 196MM STRL VARIAX 12 HL TI HUM RT P/L	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,793.00"	"$1,008.56"	"$1,008.56"	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,120.63"	"$1,775.07"	"$1,793.00"	$0.00		$0.00	$350.76	$0.00	$0.00	$356.81	$0.00	$0.00	$0.00	$0.00	$0.00
629274S	SUP	HCPCS C1713		629274S  -  PLATE BN 218MM STRL VARIAX 14 HL TI HUM RT P/L	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
629290S	SUP	HCPCS C1713		629290S  -  PLATE 167MM TI 10 SHFT HOLE LCK XTD VARIAX BONE L/R MDL HUM	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$959.06	$959.06	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
629292S	SUP	HCPCS C1713		629292S  -  PLATE 191MM TI 12 HOLE XTD VARIAX BONE MDL ELB STRL	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,793.00"	"$1,008.56"	"$1,008.56"	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,120.63"	"$1,775.07"	"$1,793.00"	$0.00		$0.00	$350.76	$0.00	$0.00	$356.81	$0.00	$0.00	$0.00	$0.00	$0.00
629294S	SUP	HCPCS C1713		629294S  -  PLATE 215MM TI 14 SHFT HOLE LCK XTD VARIAX BONE L/R MDL HUM	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
6293-0-000	SUP	Custom 27803010		6293-0-000  -  HEAD FEM STD 32MM HIP PCA	BOTH IP/OP	"$2,180.00 "	"$1,613.20"	$0.00	"$1,744.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,618.00"	"$1,618.00"	$0.00	$0.00	$454.31	$0.00	$0.00	$0.00	$0.00	"$1,090.00"	"$1,726.56"	"$1,744.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6293-0-005	SUP	Custom 27803010		6293-0-005  -  HEAD FEM +5 32MM HIP PCA	BOTH IP/OP	"$2,180.00 "	"$1,613.20"	$0.00	"$1,744.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,618.00"	"$1,618.00"	$0.00	$0.00	$454.31	$0.00	$0.00	$0.00	$0.00	"$1,090.00"	"$1,726.56"	"$1,744.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
629310S	SUP	HCPCS C1713		629310S  -  PLATE 175MM TI 10 SHFT HOLE BONE LEFT POST MDL STRL	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$959.06	$959.06	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
629312S	SUP	HCPCS C1713		629312S  -  PLATE 199MM TI 12 SHFT HOLE LCK VARIAX BONE LEFT POST MDL	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,793.00"	"$1,008.56"	"$1,008.56"	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,120.63"	"$1,775.07"	"$1,793.00"	$0.00		$0.00	$350.76	$0.00	$0.00	$356.81	$0.00	$0.00	$0.00	$0.00	$0.00
629330S	SUP	HCPCS C1713		629330S  -  PLATE 175MM TI 10 SHFT HOLE LCK VARIAX BONE RIGHT POST MDL	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$959.06	$959.06	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
629332S	SUP	HCPCS C1713		629332S  -  PLATE 199MM TI 12 HOLE LCK VARIAX BONE RIGHT POST MDL ELB	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,793.00"	"$1,008.56"	"$1,008.56"	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,120.63"	"$1,775.07"	"$1,793.00"	$0.00		$0.00	$350.76	$0.00	$0.00	$356.81	$0.00	$0.00	$0.00	$0.00	$0.00
629350S	SUP	HCPCS C1713		629350S  -  PLATE BN 161MM NS VARIAX 10 HL TI OLCRN LT	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$866.25	$866.25	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
629352S	SUP	HCPCS C1713		629352S  -  PLATE 184MM TI 12 SHFT HOLE LCK VARIAX BONE LEFT OLCRN ELB	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$909.56	$909.56	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,010.63"	"$1,600.83"	"$1,617.00"	$0.00		$0.00	$316.33	$0.00	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00
629370S	SUP	HCPCS C1713		629370S  -  PLATE 161MM TI 12 SHFT HOLE LCK VARIAX BONE RIGHT OLCRN ELB	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$866.25	$866.25	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
629372S	SUP	HCPCS C1713		629372S  -  PLATE 184MM TI 12 SHFT HOLE LCK VARIAX BONE RIGHT OLCRN ELB	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$909.56	$909.56	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,010.63"	"$1,600.83"	"$1,617.00"	$0.00		$0.00	$316.33	$0.00	$0.00	$321.78	$0.00	$0.00	$0.00	$0.00	$0.00
629390S	SUP	HCPCS C1713		629390S  -  PLATE 163MM TI 10 HOLE LCK VARIAX BONE MDL ELB STRL	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,769.40"	$959.06	$959.06	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,065.63"	"$1,687.95"	"$1,705.00"	$0.00		$0.00	$333.54	$0.00	$0.00	$339.30	$0.00	$0.00	$0.00	$0.00	$0.00
629392S	SUP	HCPCS C1713		629392S  -  PLATE 187MM TI 12 SHFT HOLE LCK VARIAX BONE L/R DISTAL MDL	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,793.00"	"$1,008.56"	"$1,008.56"	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,120.63"	"$1,775.07"	"$1,793.00"	$0.00		$0.00	$350.76	$0.00	$0.00	$356.81	$0.00	$0.00	$0.00	$0.00	$0.00
629394S	SUP	HCPCS C1713		629394S  -  PLATE 211MM TI 14 SHFT HOLE LCK VARIAX BONE L/R DISTAL MDL	BOTH IP/OP	"$2,384.00 "	"$1,764.16"	$0.00	"$1,925.00"	"$1,082.81"	"$1,082.81"	$0.00	$0.00	$0.00	$496.89	"$1,769.40"	"$1,769.40"	$0.00	$0.00	$496.83	$0.00	"$1,410.14"	"$1,410.14"	$0.00	"$1,203.13"	"$1,905.75"	"$1,925.00"	$0.00		$0.00	$376.58	$0.00	$0.00	$383.08	$0.00	$0.00	$0.00	$0.00	$0.00
6299-2-403	SUP	Custom 27803010		6299-2-403  -  INSERT ACETAB 0D NEUTRAL 40-43MM 26MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-2-469	SUP	Custom 27803010		6299-2-469  -  INSERT ACETAB 0D NEUTRAL 46-49MM 26MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-2-525	SUP	Custom 27803010		6299-2-525  -  INSERT ACETAB 0D NEUTRAL 52-55MM 26MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-2-581	SUP	Custom 27803010		6299-2-581  -  INSERT ACETAB 0D NEUTRAL 58-61MM 26MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-3-469	SUP	Custom 27803010		6299-3-469  -  INSERT ACETAB 0D NEUTRAL 46-49MM 28MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-3-525	SUP	Custom 27803010		6299-3-525  -  INSERT ACETAB 0D NEUTRAL 52-55MM 28MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-3-581	SUP	Custom 27803010		6299-3-581  -  INSERT ACETAB 0D NEUTRAL 58-61MM 28MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-3-647	SUP	Custom 27803010		6299-3-647  -  INSERT ACETAB 0D NEUTRAL 64-67MM 28MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-4-469	SUP	Custom 27803010		6299-4-469  -  INSERT ACETAB 0D NEUTRAL 46-49MM 32MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-4-525	SUP	Custom 27803010		6299-4-525  -  INSERT ACETAB 0D NEUTRAL 52-55MM 32MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-4-581	SUP	Custom 27803010		6299-4-581  -  INSERT ACETAB 0D NEUTRAL 58-61MM 32MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-4-647	SUP	Custom 27803010		6299-4-647  -  INSERT ACETAB 0D NEUTRAL 64-67MM 32MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-5-403	SUP	Custom 27803010		6299-5-403  -  INSERT ACETAB 10D 40-43MM 26MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-5-469	SUP	Custom 27803010		6299-5-469  -  INSERT ACETAB 10D 46-49MM 26MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-5-525	SUP	Custom 27803010		6299-5-525  -  INSERT ACETAB 10D 52-55MM 26MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-5-581	SUP	Custom 27803010		6299-5-581  -  INSERT ACETAB 10D 58-61MM 26MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-6-469	SUP	Custom 27803010		6299-6-469  -  INSERT ACETAB 10D 46-49MM 28MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-6-525	SUP	Custom 27803010		6299-6-525  -  INSERT ACETAB 10D 52-55MM 28MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-6-581	SUP	Custom 27803010		6299-6-581  -  INSERT ACETAB 10D 58-61MM 28MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-6-647	SUP	Custom 27803010		6299-6-647  -  INSERT ACETAB 10D 64-67MM 28MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-7-469	SUP	Custom 27803010		6299-7-469  -  INSERT ACETAB 10D 46-49MM 32MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-7-525	SUP	Custom 27803010		6299-7-525  -  INSERT ACETAB 10D 52-55MM 32MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-7-581	SUP	Custom 27803010		6299-7-581  -  INSERT ACETAB 10D 58-61MM 32MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-7-647	SUP	Custom 27803010		6299-7-647  -  INSERT ACETAB 10D 64-67MM 32MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-8-403	SUP	Custom 27803010		6299-8-403  -  INSERT ACETAB 10D 40-43MM 22MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-8-469	SUP	Custom 27803010		6299-8-469  -  INSERT ACETAB 10D 46-49MM 22MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-8-525	SUP	Custom 27803010		6299-8-525  -  INSERT ACETAB 10D 52-55MM 22MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-8-581	SUP	Custom 27803010		6299-8-581  -  INSERT ACETAB 10D 52-55MM 22MM PCA DUR HIP	BOTH IP/OP	"$2,117.50 "	"$1,566.95"	$0.00	"$1,694.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.61"	"$1,571.61"	$0.00	$0.00	$441.29	$0.00	$0.00	$0.00	$0.00	"$1,058.75"	"$1,677.06"	"$1,694.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-H-332	SUP	Custom 27803010		6299-H-332  -  LINER ACETAB PCA 10D C 32MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6299-N-332	SUP	Custom 27803010		6299-N-332  -  LINER ACETAB PCA NTRL 32MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-012	SUP	HCPCS C1713		6302-3-012  -  SCREW BONE 6.5MM 12MM VTLK VIT PLUG	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-014	SUP	HCPCS C1713		6302-3-014  -  SCREW ACETAB 14MM 6.5MM VTLK VITALIUM PLUG	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-016	SUP	HCPCS C1713		6302-3-016  -  SCREW BONE 6.5MM 16MM VTLK VIT ACETUBULAR PLG VIT	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-018	SUP	HCPCS C1713		6302-3-018  -  SCREW ACETAB 18MM 6.5MM VTLK VIT PLG	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-020	SUP	HCPCS C1713		6302-3-020  -  SCREW BONE 6.5MM 20MM VTLK VIT ACETAB SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-022	SUP	HCPCS C1713		6302-3-022  -  SCREW ACETAB 22MM 6.5MM VTLK VIT PLUG	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-024	SUP	HCPCS C1713		6302-3-024  -  SCREW BONE 6.5MM 24MM VTLK VIT ACETAB SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-026	SUP	HCPCS C1713		6302-3-026  -  SCREW BONE 6.5MM 26MM VTLK VIT SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-028	SUP	HCPCS C1713		6302-3-028  -  SCREW BONE 6.8MM 28MM VTLK VIT PLG	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-030	SUP	HCPCS C1713		6302-3-030  -  SCREW BONE 6.5MM 30MM VTLK VIT ACETAB SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-035	SUP	HCPCS C1713		6302-3-035  -  SCREW BONE 6.5MM 35MM VTLK VIT ACETABULLAR SLFTAP	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-040	SUP	HCPCS C1713		6302-3-040  -  SCREW BONE 6.5MM 40MM VTLK VIT PLUG	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-045	SUP	HCPCS C1713		6302-3-045  -  SCREW ACETAB 45MM 6.5MM VTLK VIT PLUG	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-3-050	SUP	HCPCS C1713		6302-3-050  -  SCREW ACETAB 50MM 6.5MM VTLK VIT PLG	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-4-000	SUP	HCPCS C1713		6302-4-000  -  PLUG DOME HL PRM RECON VIT APCL	BOTH IP/OP	$152.00 	$112.48	$0.00	$121.60	$68.40	$68.40	$0.00	$0.00	$0.00	$31.68	$112.81	$112.81	$0.00	$0.00	$31.68	$0.00	$89.91	$89.91	$0.00	$76.00	$120.38	$121.60	$0.00		$0.00	$23.79	$0.00	$0.00	$24.20	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-000	SUP	Custom 27803010		6302-5-000  -  INSERT ACETAB 22.2MM 0D P0 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-001	SUP	Custom 27803010		6302-5-001  -  INSERT ACETAB 22.2MM P1 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-002	SUP	Custom 27803010		6302-5-002  -  INSERT ACETAB 22.2MM P2 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-003	SUP	Custom 27803010		6302-5-003  -  INSERT ACETAB 22.2MM P3 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-004	SUP	Custom 27803010		6302-5-004  -  INSERT ACETAB 22.2MM P4 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-005	SUP	Custom 27803010		6302-5-005  -  INSERT ACETAB 22.2MM P5 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-006	SUP	Custom 27803010		6302-5-006  -  INSERT ACETAB 22.2MM P6 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-007	SUP	Custom 27803010		6302-5-007  -  INSERT ACETAB 22.2MM P7 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-008	SUP	Custom 27803010		6302-5-008  -  INSERT ACETAB 22.2MM P8 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-009	SUP	Custom 27803010		6302-5-009  -  INSERT ACETAB 22.2MM P9 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-010	SUP	Custom 27803010		6302-5-010  -  INSERT ACETAB 22.2MM 10D P0 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-011	SUP	Custom 27803010		6302-5-011  -  INSERT ACETAB 22.2MM 10D P1 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-012	SUP	Custom 27803010		6302-5-012  -  INSERT ACETAB 22.2MM 10D P2 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-013	SUP	Custom 27803010		6302-5-013  -  INSERT ACETAB 22.2MM 10D P3 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-014	SUP	Custom 27803010		6302-5-014  -  INSERT ACETAB 22.2MM 10D P4 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-015	SUP	Custom 27803010		6302-5-015  -  INSERT ACETAB 22.2MM 10D P5 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-016	SUP	Custom 27803010		6302-5-016  -  INSERT ACETAB 22.2MM 10D P6 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-017	SUP	Custom 27803010		6302-5-017  -  INSERT ACETAB 22.2MM 10D P7 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-018	SUP	Custom 27803010		6302-5-018  -  INSERT ACETAB 22.2MM 10D P8 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-019	SUP	Custom 27803010		6302-5-019  -  INSERT ACETAB 22.2MM 10D P9 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-020	SUP	Custom 27803010		6302-5-020  -  INSERT ACETAB 22.2MM 15D P0 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-021	SUP	Custom 27803010		6302-5-021  -  INSERT ACETAB 22.2MM 15D P1 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-022	SUP	Custom 27803010		6302-5-022  -  INSERT ACETAB 22.2MM 15D P2 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-023	SUP	Custom 27803010		6302-5-023  -  INSERT ACETAB 22.2MM 15D P3 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-024	SUP	Custom 27803010		6302-5-024  -  INSERT ACETAB 22.2MM 15D P4 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-025	SUP	Custom 27803010		6302-5-025  -  INSERT ACETAB 22.2MM 15D P5 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-026	SUP	Custom 27803010		6302-5-026  -  INSERT ACETAB 22.2MM 15D P6 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-027	SUP	Custom 27803010		6302-5-027  -  INSERT ACETAB 22.2MM 15D P7 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-028	SUP	Custom 27803010		6302-5-028  -  INSERT ACETAB 22.2MM 15D P8 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-029	SUP	Custom 27803010		6302-5-029  -  INSERT ACETAB 22.2MM 15D P9 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-030	SUP	Custom 27803010		6302-5-030  -  INSERT ACETAB 26MM P1 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-032	SUP	Custom 27803010		6302-5-032  -  INSERT ACETAB 26MM P2 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-033	SUP	Custom 27803010		6302-5-033  -  INSERT ACETAB 26MM P3 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-034	SUP	Custom 27803010		6302-5-034  -  INSERT ACETAB 26MM P4 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-035	SUP	Custom 27803010		6302-5-035  -  INSERT ACETAB 26MM P5 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-036	SUP	Custom 27803010		6302-5-036  -  INSERT ACETAB 26MM P6 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-037	SUP	Custom 27803010		6302-5-037  -  INSERT ACETAB 26MM P7 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-038	SUP	Custom 27803010		6302-5-038  -  INSERT ACETAB 26MM P8 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-039	SUP	Custom 27803010		6302-5-039  -  INSERT ACETAB 26MM P9 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-040	SUP	Custom 27803010		6302-5-040  -  INSERT ACETAB 26MM 10D P1 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-042	SUP	Custom 27803010		6302-5-042  -  INSERT ACETAB 26MM 10D P2 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-043	SUP	Custom 27803010		6302-5-043  -  INSERT ACETAB 26MM 10D P3 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-044	SUP	Custom 27803010		6302-5-044  -  INSERT ACETAB 26MM 10D P4 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-045	SUP	Custom 27803010		6302-5-045  -  INSERT ACETAB 26MM 10D P5 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-046	SUP	Custom 27803010		6302-5-046  -  INSERT ACETAB 26MM 10D P6 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-047	SUP	Custom 27803010		6302-5-047  -  INSERT ACETAB 26MM 10D P7 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-048	SUP	Custom 27803010		6302-5-048  -  INSERT ACETAB 26MM 10D P8 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-049	SUP	Custom 27803010		6302-5-049  -  INSERT ACETAB 26MM 10D P9 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-050	SUP	Custom 27803010		6302-5-050  -  INSERT ACETAB 26MM 15D P1 HIP DUR PE S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-052	SUP	Custom 27803010		6302-5-052  -  INSERT ACETAB 26MM 15D P2 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-053	SUP	Custom 27803010		6302-5-053  -  INSERT ACETAB 26MM 15D P3 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-054	SUP	Custom 27803010		6302-5-054  -  INSERT ACETAB 26MM 15D P4 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-055	SUP	Custom 27803010		6302-5-055  -  INSERT ACETAB 26MM 15D P5 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-056	SUP	Custom 27803010		6302-5-056  -  INSERT ACETAB 26MM 15D P6 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-057	SUP	Custom 27803010		6302-5-057  -  INSERT ACETAB 26MM 15D P7 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-058	SUP	Custom 27803010		6302-5-058  -  INSERT ACETAB 26MM 15D P8 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-059	SUP	Custom 27803010		6302-5-059  -  INSERT ACETAB 26MM 15D P9 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-062	SUP	Custom 27803010		6302-5-062  -  INSERT ACETAB 28MM P2 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-063	SUP	Custom 27803010		6302-5-063  -  INSERT ACETAB 28MM P3 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-064	SUP	Custom 27803010		6302-5-064  -  INSERT ACETAB 28MM P4 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-065	SUP	Custom 27803010		6302-5-065  -  INSERT ACETAB 28MM P5 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-066	SUP	Custom 27803010		6302-5-066  -  INSERT ACETAB 28MM P6 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-067	SUP	Custom 27803010		6302-5-067  -  INSERT ACETAB 28MM P7 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-068	SUP	Custom 27803010		6302-5-068  -  INSERT ACETAB 28MM P8 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-069	SUP	Custom 27803010		6302-5-069  -  INSERT ACETAB 28MM P9 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-072	SUP	Custom 27803010		6302-5-072  -  INSERT ACETAB 28MM 10D P2 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-073	SUP	Custom 27803010		6302-5-073  -  INSERT ACETAB 28MM 10D P3 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-074	SUP	Custom 27803010		6302-5-074  -  INSERT ACETAB 28MM 10D P4 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-075	SUP	Custom 27803010		6302-5-075  -  INSERT ACETAB 28MM 10D P5 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-076	SUP	Custom 27803010		6302-5-076  -  INSERT ACETAB 28MM 10D P6 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-077	SUP	Custom 27803010		6302-5-077  -  INSERT ACETAB 28MM 10D P7 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-078	SUP	Custom 27803010		6302-5-078  -  INSERT ACETAB 28MM 10D P8 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-079	SUP	Custom 27803010		6302-5-079  -  INSERT ACETAB 28MM 10D P9 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-082	SUP	Custom 27803010		6302-5-082  -  INSERT ACETAB 15D P2 28MM SYSTEM 12 OSTEOLOCK DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-083	SUP	Custom 27803010		6302-5-083  -  INSERT ACETAB 28MM 15D P3 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-084	SUP	Custom 27803010		6302-5-084  -  INSERT ACETAB 28MM 15D P4 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-085	SUP	Custom 27803010		6302-5-085  -  INSERT ACETAB 28MM 15D P5 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-086	SUP	Custom 27803010		6302-5-086  -  INSERT ACETAB 28MM 15D P6 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-087	SUP	Custom 27803010		6302-5-087  -  INSERT ACETAB 28MM 15D P7 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-088	SUP	Custom 27803010		6302-5-088  -  INSERT ACETAB 28MM 15D P8 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-089	SUP	Custom 27803010		6302-5-089  -  INSERT ACETAB 28MM 15D P9 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-093	SUP	Custom 27803010		6302-5-093  -  INSERT ACETAB 15D P3 32MM SYSTEM 12 OSTEOLOCK DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-094	SUP	Custom 27803010		6302-5-094  -  INSERT ACETAB 32MM P4 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-095	SUP	Custom 27803010		6302-5-095  -  INSERT ACETAB 15D P5 32MM SYSTEM 12 OSTEOLOCK DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-096	SUP	Custom 27803010		6302-5-096  -  INSERT ACETAB 15D P6 32MM SYSTEM 12 OSTEOLOCK DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-097	SUP	Custom 27803010		6302-5-097  -  INSERT ACETAB 28MM P7 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-098	SUP	Custom 27803010		6302-5-098  -  INSERT ACETAB 32MM P8 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-099	SUP	Custom 27803010		6302-5-099  -  INSERT ACETAB 32MM P9 NTRL HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-103	SUP	Custom 27803010		6302-5-103  -  INSERT ACETAB 10D P3 32MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-104	SUP	Custom 27803010		6302-5-104  -  INSERT ACETAB 10D P4 32MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-105	SUP	Custom 27803010		6302-5-105  -  INSERT ACETAB 10D P5 32MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-106	SUP	Custom 27803010		6302-5-106  -  INSERT ACETAB 32MM 10D P6 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-107	SUP	Custom 27803010		6302-5-107  -  INSERT ACETAB 10D P7 32MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-108	SUP	Custom 27803010		6302-5-108  -  INSERT ACETAB 10D P8 32MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-109	SUP	Custom 27803010		6302-5-109  -  INSERT ACETAB 10D P9 32MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-113	SUP	Custom 27803010		6302-5-113  -  INSERT ACETAB 10D P3 32MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-114	SUP	Custom 27803010		6302-5-114  -  INSERT ACETAB 15D P4 32MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-115	SUP	Custom 27803010		6302-5-115  -  INSERT ACETAB 15D P5 32MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-116	SUP	Custom 27803010		6302-5-116  -  INSERT ACETAB 15D P6 32MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-117	SUP	Custom 27803010		6302-5-117  -  INSERT ACETAB 32MM 15D P7 HIP DUR S12	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-118	SUP	Custom 27803010		6302-5-118  -  INSERT ACETAB 15D P8 32MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-5-119	SUP	Custom 27803010		6302-5-119  -  INSERT ACETAB 15D P9 32MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$1,942.50 "	"$1,437.45"	$0.00	"$1,554.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.72"	"$1,441.72"	$0.00	$0.00	$404.82	$0.00	$0.00	$0.00	$0.00	$971.25	"$1,538.46"	"$1,554.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-007	SUP	Custom 27803010		6302-6-007  -  INSERT ACETAB 10D P7 26MM SYSTEM 12 DUR HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-008	SUP	Custom 27803010		6302-6-008  -  INSERT ACETAB 10D +4MM P8 26MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-009	SUP	Custom 27803010		6302-6-009  -  INSERT ACETAB 10D +4MM P9 26MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-102	SUP	Custom 27803010		6302-6-102  -  INSERT ACETAB 10D +4MM P2 28MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-103	SUP	Custom 27803010		6302-6-103  -  INSERT ACETAB 10D +4MM P3 28MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-104	SUP	Custom 27803010		6302-6-104  -  INSERT ACETAB 10D +4MM P4 28MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-105	SUP	Custom 27803010		6302-6-105  -  INSERT ACETAB 10D +4MM P5 28MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-106	SUP	Custom 27803010		6302-6-106  -  INSERT ACETAB 10D +4MM P6 28MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-107	SUP	Custom 27803010		6302-6-107  -  INSERT ACETAB 10D +4MM P7 28MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-108	SUP	Custom 27803010		6302-6-108  -  INSERT ACETAB 10D +4MM P8 28MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-109	SUP	Custom 27803010		6302-6-109  -  INSERT ACETAB 10D +4MM P9 28MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-220	SUP	Custom 27803010		6302-6-220  -  INSERT ACETAB 22.2MM 4MM P0 NTRL	BOTH IP/OP	$928.00 	$686.72	$0.00	$742.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$688.76	$688.76	$0.00	$0.00	$193.40	$0.00	$0.00	$0.00	$0.00	$464.00	$734.98	$742.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-303	SUP	Custom 27803010		6302-6-303  -  INSERT ACETAB 10D +4MM P3 32MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-304	SUP	Custom 27803010		6302-6-304  -  INSERT ACETAB 10D +4MM P4 32MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-305	SUP	Custom 27803010		6302-6-305  -  INSERT ACTB 10D P4 32MM S12 LATRILIZING RT	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-306	SUP	Custom 27803010		6302-6-306  -  INSERT ACETAB 10D +4MM P6 32MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-307	SUP	Custom 27803010		6302-6-307  -  INSERT ACETAB 10D +4MM P7 32MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-308	SUP	Custom 27803010		6302-6-308  -  INSERT ACETAB 10D +4MM P8 32MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-6-309	SUP	Custom 27803010		6302-6-309  -  INSERT ACETAB 10D +4MM P9 32MM SYSTEM 12 HIP	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	$0.00	$0.00	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-H-328	SUP	Custom 27803010		6302-H-328  -  LINER ACETAB 10D 28MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-H-428	SUP	Custom 27803010		6302-H-428  -  LINER ACETAB 10D 28MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-H-432	SUP	Custom 27803010		6302-H-432  -  LINER ACETAB 10D 32MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-H-528	SUP	Custom 27803010		6302-H-528  -  LINER ACETAB 10D 28MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-H-532	SUP	Custom 27803010		6302-H-532  -  LINER ACETAB 10D 32MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-H-628	SUP	Custom 27803010		6302-H-628  -  LINER ACETAB 10D 28MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-H-632	SUP	Custom 27803010		6302-H-632  -  LINER ACETAB 10D 32MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-N-222	SUP	Custom 27803010		6302-N-222  -  LINER ACETAB NTRL 22MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-N-328	SUP	Custom 27803010		6302-N-328  -  LINER ACETAB TRDNT NTRL 28MM CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-N-426	SUP	Custom 27803010		6302-N-426  -  LINER ACETAB NTRL 26MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-N-428	SUP	Custom 27803010		6302-N-428  -  LINER ACETAB NTRL 28MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-N-432	SUP	Custom 27803010		6302-N-432  -  LINER ACETAB NTRL 32MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-N-532	SUP	Custom 27803010		6302-N-532  -  LINER ACETAB NTRL 32MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6302-N-632	SUP	Custom 27803010		6302-N-632  -  LINER ACETAB NTRL 32MM HIP CNSTRN	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	$0.00	$0.00	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6309-2-240	SUP	HCPCS C1776		6309-2-240  -  CUP ACTB 40MM 22MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-2-242	SUP	HCPCS C1776		6309-2-242  -  CUP ACTB 42MM 22MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-2-244	SUP	HCPCS C1776		6309-2-244  -  CUP ACTB 44MM 22MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-2-844	SUP	HCPCS C1776		6309-2-844  -  CUP ACTB 44MM 28MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-2-846	SUP	HCPCS C1776		6309-2-846  -  CUP ACTB 46MM 28MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-2-848	SUP	HCPCS C1776		6309-2-848  -  CUP ACTB 48MM 28MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-2-850	SUP	HCPCS C1776		6309-2-850  -  CUP ACTB 50MM 28MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-2-852	SUP	HCPCS C1776		6309-2-852  -  CUP ACTB 52MM 28MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-2-854	SUP	HCPCS C1776		6309-2-854  -  CUP ACTB 54MM 28MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-2-856	SUP	HCPCS C1776		6309-2-856  -  CUP ACTB 56MM 28MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-2-858	SUP	HCPCS C1776		6309-2-858  -  CUP ACTB 58MM 28MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-2-860	SUP	HCPCS C1776		6309-2-860  -  CUP ACTB 60MM 28MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-3-248	SUP	HCPCS C1776		6309-3-248  -  CUP ACTB 48MM 32MM EXTR RIMFIT X3 HIP	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-3-250	SUP	HCPCS C1776		6309-3-250  -  CUP ACTB 50MM 32MM EXTR RIMFIT X3 HIP	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-3-252	SUP	HCPCS C1776		6309-3-252  -  CUP ACTB 52MM 32MM EXTR X3 RIMFIT HIP	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-3-254	SUP	HCPCS C1776		6309-3-254  -  CUP ACTB 54MM 32MM EXTR X3 RIMFIT HIP	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-3-256	SUP	HCPCS C1776		6309-3-256  -  CUP ACTB 56MM 32MM EXTR X3 RIMFIT HIP	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-3-258	SUP	HCPCS C1776		6309-3-258  -  CUP ACTB 58MM 32MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-3-260	SUP	HCPCS C1776		6309-3-260  -  CUP ACTB 60MM 32MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-3-652	SUP	HCPCS C1776		6309-3-652  -  CUP ACTB 52MM 36MM EXTR RIMFIT X3 HIP	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-3-654	SUP	HCPCS C1776		6309-3-654  -  CUP ACTB 54MM 36MM EXTR X3 RIMFIT HIP	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-3-656	SUP	HCPCS C1776		6309-3-656  -  CUP ACTB 56MM 36MM EXTR RIMFIT X3 HIP	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-3-658	SUP	HCPCS C1776		6309-3-658  -  CUP ACTB 58MM 36MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-3-660	SUP	HCPCS C1776		6309-3-660  -  CUP ACTB 60MM 36MM EXTR RIMFIT X3 HIP	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-4-056	SUP	HCPCS C1776		6309-4-056  -  CUP ACTB 56MM 40MM EXTR RIMFIT X3 HIP	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-4-058	SUP	HCPCS C1776		6309-4-058  -  CUP ACTB 58MM 40MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
6309-4-060	SUP	HCPCS C1776		6309-4-060  -  CUP ACTB 58MM 60MM STRL EXTR RIMFIT X3	BOTH IP/OP	"$2,327.50 "	"$1,722.35"	$0.00	"$1,862.00"	"$1,047.38"	"$1,047.38"	$0.00	$0.00	$0.00	$485.11	"$1,727.47"	"$1,727.47"	$0.00	$0.00	$485.05	$0.00	"$1,376.72"	"$1,376.72"	$0.00	"$1,163.75"	"$1,843.38"	"$1,862.00"	$0.00		$0.00	$364.25	$0.00	$0.00	$370.54	$0.00	$0.00	$0.00	$0.00	$0.00
632.414S	SUP	Custom 27803010		632.414S  -  PORT RTRCT BVL 22MM 40MM MRS	BOTH IP/OP	$897.50 	$664.15	$0.00	$718.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$666.12	$666.12	$0.00	$0.00	$187.04	$0.00	$0.00	$0.00	$0.00	$448.75	$710.82	$718.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.415S	SUP	Custom 27803010		632.415S  -  PORT RTRCT BVL 22MM 50MM MRS	BOTH IP/OP	$897.50 	$664.15	$0.00	$718.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$666.12	$666.12	$0.00	$0.00	$187.04	$0.00	$0.00	$0.00	$0.00	$448.75	$710.82	$718.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.416S	SUP	Custom 27803010		"632.416S  -  22MM PORT, BEVELED, 60MM"	BOTH IP/OP	$897.50 	$664.15	$0.00	$718.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$666.12	$666.12	$0.00	$0.00	$187.04	$0.00	$0.00	$0.00	$0.00	$448.75	$710.82	$718.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.417S	SUP	Custom 27803010		632.417S  -  PORT RTRCT BVL 22MM 70MM MRS	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$783.02	$783.02	$0.00	$0.00	$219.86	$0.00	$0.00	$0.00	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.418S	SUP	Custom 27803010		632.418S  -  PORT RTRCT BVL 22MM 80MM MRS	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$783.02	$783.02	$0.00	$0.00	$219.86	$0.00	$0.00	$0.00	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.419S	SUP	Custom 27803010		632.419S  -  PORT RTRCT BVL 22MM 90MM MRS	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$783.02	$783.02	$0.00	$0.00	$219.86	$0.00	$0.00	$0.00	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.420S	SUP	Custom 27803010		632.420S  -  PORT RTRCT BVL 22MM 100MM MRS	BOTH IP/OP	"$1,232.50 "	$912.05	$0.00	$986.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$914.76	$914.76	$0.00	$0.00	$256.85	$0.00	$0.00	$0.00	$0.00	$616.25	$976.14	$986.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.421S	SUP	Custom 27803010		632.421S  -  PORT RTRCT BVL 22MM 110MM MRS	BOTH IP/OP	"$1,232.50 "	$912.05	$0.00	$986.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$914.76	$914.76	$0.00	$0.00	$256.85	$0.00	$0.00	$0.00	$0.00	$616.25	$976.14	$986.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.422S	SUP	Custom 27803010		632.422S  -  PORT RTRCT BVL 22MM 120MM MRS	BOTH IP/OP	"$1,232.50 "	$912.05	$0.00	$986.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$914.76	$914.76	$0.00	$0.00	$256.85	$0.00	$0.00	$0.00	$0.00	$616.25	$976.14	$986.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.424S	SUP	Custom 27803010		632.424S  -  PORT RTRCT STRG 22MM 40MM MRS	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$0.00	$0.00	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.425S	SUP	Custom 27803010		"632.425S  -  22MM PORT, STRAIGHT, 50MM"	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$0.00	$0.00	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.426S	SUP	Custom 27803010		"632.426S  -  22MM PORT, STRAIGHT, 60MM"	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$0.00	$0.00	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.427S	SUP	Custom 27803010		632.427S  -  PORT RTRCT STRG 22MM 70MM	BOTH IP/OP	$975.00 	$721.50	$0.00	$780.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.65	$723.65	$0.00	$0.00	$203.19	$0.00	$0.00	$0.00	$0.00	$487.50	$772.20	$780.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.428S	SUP	Custom 27803010		632.428S  -  PORT RTRCT STRG 22MM 80MM MRS	BOTH IP/OP	$975.00 	$721.50	$0.00	$780.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.65	$723.65	$0.00	$0.00	$203.19	$0.00	$0.00	$0.00	$0.00	$487.50	$772.20	$780.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.429S	SUP	Custom 27803010		632.429S  -  PORT RTRCT STRG 22MM 90MM MRS	BOTH IP/OP	$975.00 	$721.50	$0.00	$780.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.65	$723.65	$0.00	$0.00	$203.19	$0.00	$0.00	$0.00	$0.00	$487.50	$772.20	$780.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.430S	SUP	Custom 27803010		632.430S  -  PORT RTRCT STRG 22MM 100MM MRS	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.431S	SUP	Custom 27803010		632.431S  -  PORT RTRCT STRG 22MM 110MM MRS	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.432S	SUP	Custom 27803010		632.432S  -  PORT RTRCT STRG 22MM 120MM MRS	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.434S	SUP	Custom 27803010		632.434S  -  PORT RTRCT BVL 19MM 40MM MRS	BOTH IP/OP	$897.50 	$664.15	$0.00	$718.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$666.12	$666.12	$0.00	$0.00	$187.04	$0.00	$0.00	$0.00	$0.00	$448.75	$710.82	$718.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.435S	SUP	Custom 27803010		632.435S  -  PORT RTRCT BVL 19MM 50MM MRS	BOTH IP/OP	$897.50 	$664.15	$0.00	$718.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$666.12	$666.12	$0.00	$0.00	$187.04	$0.00	$0.00	$0.00	$0.00	$448.75	$710.82	$718.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.436S	SUP	Custom 27803010		632.436S  -  PORT RTRCT BVL 19MM 60MM MRS	BOTH IP/OP	$897.50 	$664.15	$0.00	$718.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$666.12	$666.12	$0.00	$0.00	$187.04	$0.00	$0.00	$0.00	$0.00	$448.75	$710.82	$718.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.437S	SUP	Custom 27803010		632.437S  -  PORT RTRCT BVL 19MM 70MM MRS	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$783.02	$783.02	$0.00	$0.00	$219.86	$0.00	$0.00	$0.00	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.438S	SUP	Custom 27803010		632.438S  -  PORT RTRCT BVL 19MM 80MM MRS	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$783.02	$783.02	$0.00	$0.00	$219.86	$0.00	$0.00	$0.00	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.439S	SUP	Custom 27803010		"632.439S  -  19MM PORT, BEVELED, 90MM"	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$783.02	$783.02	$0.00	$0.00	$219.86	$0.00	$0.00	$0.00	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.440S	SUP	Custom 27803010		632.440S  -  PORT RTRCT BVL 19MM 100MM MRS	BOTH IP/OP	"$1,232.50 "	$912.05	$0.00	$986.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$914.76	$914.76	$0.00	$0.00	$256.85	$0.00	$0.00	$0.00	$0.00	$616.25	$976.14	$986.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.441S	SUP	Custom 27803010		632.441S  -  PORT RTRCT BVL 19MM 110MM MRS	BOTH IP/OP	"$1,232.50 "	$912.05	$0.00	$986.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$914.76	$914.76	$0.00	$0.00	$256.85	$0.00	$0.00	$0.00	$0.00	$616.25	$976.14	$986.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.442S	SUP	Custom 27803010		632.442S  -  PORT RTRCT BVL 19MM 120MM MRS	BOTH IP/OP	"$1,232.50 "	$912.05	$0.00	$986.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$914.76	$914.76	$0.00	$0.00	$256.85	$0.00	$0.00	$0.00	$0.00	$616.25	$976.14	$986.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.444S	SUP	Custom 27803010		632.444S  -  PORT RTRCT STRG 19MM 40MM MRS	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$0.00	$0.00	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.445S	SUP	Custom 27803010		632.445S  -  PORT RTRCT STRG 19MM 50MM MRS	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$0.00	$0.00	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.446S	SUP	Custom 27803010		632.446S  -  PORT RTRCT STRG 19MM 60MM	BOTH IP/OP	$860.00 	$636.40	$0.00	$688.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$638.29	$638.29	$0.00	$0.00	$179.22	$0.00	$0.00	$0.00	$0.00	$430.00	$681.12	$688.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.447S	SUP	Custom 27803010		632.447S  -  PORT RTRCT STRG 19MM 70MM MRS	BOTH IP/OP	$975.00 	$721.50	$0.00	$780.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.65	$723.65	$0.00	$0.00	$203.19	$0.00	$0.00	$0.00	$0.00	$487.50	$772.20	$780.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.448S	SUP	Custom 27803010		632.448S  -  PORT RTRCT STRG 19MM 80MM MRS	BOTH IP/OP	$975.00 	$721.50	$0.00	$780.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.65	$723.65	$0.00	$0.00	$203.19	$0.00	$0.00	$0.00	$0.00	$487.50	$772.20	$780.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.449S	SUP	Custom 27803010		632.449S  -  PORT RTRCT STRG 19MM 90MM MRS	BOTH IP/OP	$975.00 	$721.50	$0.00	$780.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.65	$723.65	$0.00	$0.00	$203.19	$0.00	$0.00	$0.00	$0.00	$487.50	$772.20	$780.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.450S	SUP	Custom 27803010		632.450S  -  PORT RTRCT STRG 19MM 100MM MRS	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.451S	SUP	Custom 27803010		632.451S  -  PORT RTRCT STRG 19MM 110MM MRS	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.452S	SUP	Custom 27803010		632.452S  -  PORT RTRCT STRG 19MM 120MM MRS	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.454S	SUP	Custom 27803010		632.454S  -  PORT RTRCT BVL 26MM 40MM MRS	BOTH IP/OP	"$1,197.50 "	$886.15	$0.00	$958.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$888.78	$888.78	$0.00	$0.00	$249.56	$0.00	$0.00	$0.00	$0.00	$598.75	$948.42	$958.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.455S	SUP	Custom 27803010		632.455S  -  PORT RTRCT BVL 26MM 50MM MRS	BOTH IP/OP	"$1,197.50 "	$886.15	$0.00	$958.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$888.78	$888.78	$0.00	$0.00	$249.56	$0.00	$0.00	$0.00	$0.00	$598.75	$948.42	$958.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.456S	SUP	Custom 27803010		632.456S  -  PORT RTRCT BVL 26MM 60MM MRS	BOTH IP/OP	"$1,197.50 "	$886.15	$0.00	$958.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$888.78	$888.78	$0.00	$0.00	$249.56	$0.00	$0.00	$0.00	$0.00	$598.75	$948.42	$958.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.457S	SUP	Custom 27803010		632.457S  -  PORT RTRCT BVL 26MM 70MM MRS	BOTH IP/OP	"$1,307.50 "	$967.55	$0.00	"$1,046.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$970.43	$970.43	$0.00	$0.00	$272.48	$0.00	$0.00	$0.00	$0.00	$653.75	"$1,035.54"	"$1,046.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.458S	SUP	Custom 27803010		632.458S  -  PORT RTRCT BVL 26MM 80MM MRS	BOTH IP/OP	"$1,307.50 "	$967.55	$0.00	"$1,046.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$970.43	$970.43	$0.00	$0.00	$272.48	$0.00	$0.00	$0.00	$0.00	$653.75	"$1,035.54"	"$1,046.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.459S	SUP	Custom 27803010		632.459S  -  PORT RTRCT BVL 26MM 90MM MRS	BOTH IP/OP	"$1,307.50 "	$967.55	$0.00	"$1,046.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$970.43	$970.43	$0.00	$0.00	$272.48	$0.00	$0.00	$0.00	$0.00	$653.75	"$1,035.54"	"$1,046.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.460S	SUP	Custom 27803010		632.460S  -  PORT RTRCT BVL 26MM 100MM MRS	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$0.00	$0.00	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.461S	SUP	Custom 27803010		632.461S  -  PORT RTRCT BVL 26MM 110MM MRS	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$0.00	$0.00	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.462S	SUP	Custom 27803010		632.462S  -  PORT RTRCT BVL 26MM 120MM MRS	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$0.00	$0.00	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.464S	SUP	Custom 27803010		632.464S  -  PORT RTRCT STRG 26MM 40MM MRS	BOTH IP/OP	"$1,167.50 "	$863.95	$0.00	$934.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$866.52	$866.52	$0.00	$0.00	$243.31	$0.00	$0.00	$0.00	$0.00	$583.75	$924.66	$934.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.465S	SUP	Custom 27803010		632.465S  -  PORT RTRCT STRG 26MM 50MM MRS	BOTH IP/OP	"$1,167.50 "	$863.95	$0.00	$934.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$866.52	$866.52	$0.00	$0.00	$243.31	$0.00	$0.00	$0.00	$0.00	$583.75	$924.66	$934.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.466S	SUP	Custom 27803010		632.466S  -  PORT RTRCT STRG 26MM 60MM MRS	BOTH IP/OP	"$1,167.50 "	$863.95	$0.00	$934.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$866.52	$866.52	$0.00	$0.00	$243.31	$0.00	$0.00	$0.00	$0.00	$583.75	$924.66	$934.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.467S	SUP	Custom 27803010		632.467S  -  PORT RTRCT STRG 26MM 70MM MRS	BOTH IP/OP	"$1,307.50 "	$967.55	$0.00	"$1,046.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$970.43	$970.43	$0.00	$0.00	$272.48	$0.00	$0.00	$0.00	$0.00	$653.75	"$1,035.54"	"$1,046.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.468S	SUP	Custom 27803010		632.468S  -  PORT RTRCT STRG 26MM 80MM STRL MRS SPNE	BOTH IP/OP	"$1,307.50 "	$967.55	$0.00	"$1,046.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$970.43	$970.43	$0.00	$0.00	$272.48	$0.00	$0.00	$0.00	$0.00	$653.75	"$1,035.54"	"$1,046.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.469S	SUP	Custom 27803010		632.469S  -  PORT RTRCT STRG 26MM 90MM MRS	BOTH IP/OP	"$1,307.50 "	$967.55	$0.00	"$1,046.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$970.43	$970.43	$0.00	$0.00	$272.48	$0.00	$0.00	$0.00	$0.00	$653.75	"$1,035.54"	"$1,046.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.470S	SUP	Custom 27803010		632.470S  -  PORT RTRCT STRG 26MM 100MM MRS	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$0.00	$0.00	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.471S	SUP	Custom 27803010		632.471S  -  PORT RTRCT STRG 26MM 110MM MRS	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$0.00	$0.00	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
632.472S	SUP	Custom 27803010		632.472S  -  PORT RTRCT STRG 26MM 120MM MRS	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$0.00	$0.00	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
633-350	SUP	HCPCS C1884		COIL EMBL 6MM TRFL PSH CMPLX SHP	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-062	SUP	Custom 27803010		6352-5-062  -  INSERT ACETAB 0D P2 46/48MM 28MM LINER CONGRUENT ROBUST LOCK	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-063	SUP	Custom 27803010		6352-5-063  -  INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-064	SUP	Custom 27803010		6352-5-064  -  INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-065	SUP	Custom 27803010		6352-5-065  -  INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-065300	SUP	Custom 27803010		6352-5-065300  -  INSERT ACETAB 28MM 0D XFIRE S12	BOTH IP/OP	"$1,707.00 "	"$1,263.18"	$0.00	"$1,365.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,266.94"	"$1,266.94"	$0.00	$0.00	$355.74	$0.00	$0.00	$0.00	$0.00	$853.50	"$1,351.94"	"$1,365.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-066	SUP	Custom 27803010		6352-5-066  -  INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-066300	SUP	Custom 27803010		6352-5-066300  -  INSERT ACETAB 28MM 0D XFIRE S12	BOTH IP/OP	"$1,707.00 "	"$1,263.18"	$0.00	"$1,365.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,266.94"	"$1,266.94"	$0.00	$0.00	$355.74	$0.00	$0.00	$0.00	$0.00	$853.50	"$1,351.94"	"$1,365.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-072	SUP	Custom 27803010		6352-5-072  -  INSERT ACETAB 0D P2 46/48MM 28MM 5MM LINER CONGRUENT ROBUST	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-073	SUP	HCPCS C1776		6352-5-073  -  INSERT ACTB 10D P3 50/52MM 28MM S12 LINR CNGR RBST LCK XFR	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	"$1,189.13"	"$1,189.13"	$0.00	$0.00	$0.00	$550.76	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	"$1,302.75"	"$1,302.75"	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$413.55	$0.00	$0.00	$420.69	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-073300	SUP	Custom 27803010		6352-5-073300  -  INSERT ACETAB 28MM 10D XFIRE S12	BOTH IP/OP	"$1,707.00 "	"$1,263.18"	$0.00	"$1,365.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,266.94"	"$1,266.94"	$0.00	$0.00	$355.74	$0.00	$0.00	$0.00	$0.00	$853.50	"$1,351.94"	"$1,365.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-074	SUP	HCPCS C1776		6352-5-074  -  INSERT ACTB 10D P4 54/46MM 28MM S12 LINR CNGR RBST LCK XFR	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	"$1,189.13"	"$1,189.13"	$0.00	$0.00	$0.00	$550.76	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	"$1,302.75"	"$1,302.75"	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$413.55	$0.00	$0.00	$420.69	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-074300	SUP	Custom 27803010		6352-5-074300  -  INSERT ACETAB 28MM 10D HIP XFIRE S12	BOTH IP/OP	"$1,707.00 "	"$1,263.18"	$0.00	"$1,365.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,266.94"	"$1,266.94"	$0.00	$0.00	$355.74	$0.00	$0.00	$0.00	$0.00	$853.50	"$1,351.94"	"$1,365.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-075	SUP	Custom 27803010		6352-5-075  -  INSERT ACETAB 10D P5 58/60MM 28MM LINER CONGRUENT ROBUST	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-076	SUP	HCPCS C1776		6352-5-076  -  INSERT ACTB 10D P6 62/64MM 28MM S12 LINR CNGR RBST LCK XFR	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	"$1,189.13"	"$1,189.13"	$0.00	$0.00	$0.00	$550.76	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	"$1,302.75"	"$1,302.75"	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$413.55	$0.00	$0.00	$420.69	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-076300	SUP	Custom 27803010		6352-5-076300  -  INSERT ACETAB 28MM 10D XFIRE S12	BOTH IP/OP	"$1,707.00 "	"$1,263.18"	$0.00	"$1,365.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,266.94"	"$1,266.94"	$0.00	$0.00	$355.74	$0.00	$0.00	$0.00	$0.00	$853.50	"$1,351.94"	"$1,365.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-093	SUP	Custom 27803010		6352-5-093  -  INSERT ACETAB 0D P3 50/52MM 32MM LINER CONGRUENT ROBUST LOCK	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-094	SUP	Custom 27803010		6352-5-094  -  INSERT ACETAB 0D P4 54/46MM 32MM LINER CONGRUENT ROBUST LOCK	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-095	SUP	Custom 27803010		6352-5-095  -  INSERT ACETAB 0D P5 58/60MM 32MM 8MM LINER CONGRUENT ROBUST	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-096	SUP	Custom 27803010		6352-5-096  -  INSERT ACETAB 0D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-097	SUP	HCPCS C1776		6352-5-097  -  INSERT ACTB 0D P7 32MM STRL S12 LINR CNGR RBST LCK XFR HIP	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	"$1,189.13"	"$1,189.13"	$0.00	$0.00	$0.00	$550.76	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	"$1,302.75"	"$1,302.75"	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$413.55	$0.00	$0.00	$420.69	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-097300	SUP	Custom 27803010		6352-5-097300  -  INSERT ACETAB 32MM 0D HIP XFIRE S12	BOTH IP/OP	"$1,707.00 "	"$1,263.18"	$0.00	"$1,365.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,266.94"	"$1,266.94"	$0.00	$0.00	$355.74	$0.00	$0.00	$0.00	$0.00	$853.50	"$1,351.94"	"$1,365.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-098	SUP	HCPCS C1776		6352-5-098  -  INSERT ACTB 0D P8 70/72MM 32MM S12 LINR CNGR XFR HIP	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	"$1,189.13"	"$1,189.13"	$0.00	$0.00	$0.00	$550.76	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	"$1,302.75"	"$1,302.75"	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$413.55	$0.00	$0.00	$420.69	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-098300	SUP	Custom 27803010		6352-5-098300  -  INSERT ACETAB 32MM 0D P8 HIP XFIRE S12	BOTH IP/OP	"$1,707.00 "	"$1,263.18"	$0.00	"$1,365.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,266.94"	"$1,266.94"	$0.00	$0.00	$355.74	$0.00	$0.00	$0.00	$0.00	$853.50	"$1,351.94"	"$1,365.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-103	SUP	Custom 27803010		6352-5-103  -  INSERT ACETAB 10D P3 50/52MM 32MM LINER CONGRUENT ROBUST	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-104	SUP	Custom 27803010		6352-5-104  -  INSERT ACETAB 10D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-105	SUP	Custom 27803010		6352-5-105  -  INSERT ACETAB 10D P5 58/60MM 32MM LINER CONGRUENT ROBUST	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-106	SUP	Custom 27803010		6352-5-106  -  INSERT ACETAB 10D P6 62/64MM 32MM LINER CONGRUENT ROBUST	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-107	SUP	Custom 27803010		6352-5-107  -  INSERT ACETAB 10D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6352-5-108	SUP	Custom 27803010		6352-5-108  -  INSERT ACETAB 10D P8 70/72MM 32MM LINER CONGRUENT ROBUST	BOTH IP/OP	"$2,642.50 "	"$1,955.45"	$0.00	"$2,114.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.26"	"$1,961.26"	$0.00	$0.00	$550.70	$0.00	$0.00	$0.00	$0.00	"$1,321.25"	"$2,092.86"	"$2,114.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-026	SUP	Custom 27803010		6364-2-026  -  HEAD FEMORAL -3MM 26MM NECK V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-028	SUP	Custom 27803010		6364-2-028  -  HEAD FEMORAL -4MM 28MM NECK V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-032	SUP	Custom 27803010		6364-2-032  -  HEAD FEMORAL -4MM 32MM TAPER V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-036	SUP	Custom 27803010		6364-2-036  -  HEAD FEMORAL -5MM 36MM TAPER V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-122	SUP	Custom 27803010		6364-2-122  -  HEAD FEMORAL 0MM 22MM V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-126	SUP	Custom 27803010		6364-2-126  -  HEAD FEMORAL 0MM 26MM TAPER V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-128	SUP	Custom 27803010		6364-2-128  -  HEAD FEMORAL 0MM 28MM TAPER V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-132	SUP	Custom 27803010		6364-2-132  -  HEAD FEMORAL 0MM 32MM TAPER V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-136	SUP	Custom 27803010		6364-2-136  -  HEAD FEMORAL 0MM 36MM V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-226	SUP	Custom 27803010		6364-2-226  -  HEAD FEMORAL +4MM 26MM NECK V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-228	SUP	Custom 27803010		6364-2-228  -  HEAD FEMORAL +4MM 28MM TAPER V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-232	SUP	Custom 27803010		6364-2-232  -  HEAD FEMORAL +4MM TAPER 32MM V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-236	SUP	Custom 27803010		6364-2-236  -  HEAD FEMORAL +5MM 36MM TAPER V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-322	SUP	Custom 27803010		6364-2-322  -  HEAD FEMORAL +8MM 22MM V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-326	SUP	Custom 27803010		6364-2-326  -  HEAD FEMORAL +8MM 26MM NECK V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-328	SUP	Custom 27803010		6364-2-328  -  HEAD FEMORAL +8MM 28MM V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6364-2-332	SUP	Custom 27803010		6364-2-332  -  HEAD FEMORAL +8MM 32MM EXETER V40 ORTHINOX HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6366-9-220	SUP	HCPCS C1776		6366-9-220  -  GUIDE PIN ORTH HMRS AXIS	BOTH IP/OP	"$2,030.00 "	"$1,502.20"	$0.00	"$1,624.00"	$913.50	$913.50	$0.00	$0.00	$0.00	$423.10	"$1,506.67"	"$1,506.67"	$0.00	$0.00	$423.05	$0.00	"$1,200.75"	"$1,200.75"	$0.00	"$1,015.00"	"$1,607.76"	"$1,624.00"	$0.00		$0.00	$317.70	$0.00	$0.00	$323.18	$0.00	$0.00	$0.00	$0.00	$0.00
640301S	SUP	HCPCS C1713		640301S  -  SCREW BONE T2 STD CMPR STRL	BOTH IP/OP	$189.75 	$140.42	$0.00	$151.80	$85.39	$85.39	$0.00	$0.00	$0.00	$39.55	$140.83	$140.83	$0.00	$0.00	$39.54	$0.00	$112.24	$112.24	$0.00	$94.88	$150.28	$151.80	$0.00		$0.00	$29.70	$0.00	$0.00	$30.21	$0.00	$0.00	$0.00	$0.00	$0.00
640302S	SUP	HCPCS C1713		640302S  -  SCREW BONE T2 2 SPNL CMPR STRL	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$89.72	$89.72	$0.00	$0.00	$0.00	$41.55	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$117.93	$117.93	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$31.20	$0.00	$0.00	$31.74	$0.00	$0.00	$0.00	$0.00	$0.00
640303S	SUP	HCPCS C1713		640303S  -  SCREW BONE T2 3 SPNL CMPR STRL	BOTH IP/OP	$170.50 	$126.17	$0.00	$136.40	$76.73	$76.73	$0.00	$0.00	$0.00	$35.54	$126.55	$126.55	$0.00	$0.00	$35.53	$0.00	$100.85	$100.85	$0.00	$85.25	$135.04	$136.40	$0.00		$0.00	$26.68	$0.00	$0.00	$27.14	$0.00	$0.00	$0.00	$0.00	$0.00
640304S	SUP	HCPCS C1713		640304S  -  SCREW BONE T2 4 SPNL CMPR STRL	BOTH IP/OP	$170.50 	$126.17	$0.00	$136.40	$76.73	$76.73	$0.00	$0.00	$0.00	$35.54	$126.55	$126.55	$0.00	$0.00	$35.53	$0.00	$100.85	$100.85	$0.00	$85.25	$135.04	$136.40	$0.00		$0.00	$26.68	$0.00	$0.00	$27.14	$0.00	$0.00	$0.00	$0.00	$0.00
640320S	SUP	HCPCS C1713		640320S  -  WASHER SCR T2 ORTH STRL	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$27.23	$27.23	$0.00	$0.00	$0.00	$12.61	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$35.79	$35.79	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$9.47	$0.00	$0.00	$9.63	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-28C	SUP	Custom 27803010		641-00-28C  -  INSERT ACETAB C 28MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-28D	SUP	Custom 27803010		641-00-28D  -  INSERT ACETAB D 28MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-28E	SUP	Custom 27803010		641-00-28E  -  INSERT ACETAB E 28MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-28F	SUP	Custom 27803010		641-00-28F  -  INSERT ACETAB F 28MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-28G	SUP	Custom 27803010		641-00-28G  -  INSERT ACETAB G 28MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-28H	SUP	Custom 27803010		641-00-28H  -  INSERT ACETAB H 28MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-28I	SUP	Custom 27803010		641-00-28I  -  INSERT ACETAB I 28MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-28J	SUP	Custom 27803010		641-00-28J  -  INSERT ACETAB J 28MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-32E	SUP	Custom 27803010		641-00-32E  -  INSERT ACETAB 0D E 32MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-32F	SUP	Custom 27803010		641-00-32F  -  INSERT ACETAB F 32MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-32G	SUP	Custom 27803010		641-00-32G  -  INSERT ACETAB G 32MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-32H	SUP	Custom 27803010		641-00-32H  -  INSERT ACETAB H 32MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-32I	SUP	Custom 27803010		641-00-32I  -  INSERT ACETAB I 32MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-32J	SUP	Custom 27803010		641-00-32J  -  INSERT ACETAB J 32MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-36E	SUP	Custom 27803010		641-00-36E  -  INSERT ACETAB E 36MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-36F	SUP	Custom 27803010		641-00-36F  -  INSERT ACETAB F 36MM ELEVATED RIM TRIDENT X3 HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-36G	SUP	Custom 27803010		641-00-36G  -  INSERT ACETAB G 36MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-36H	SUP	Custom 27803010		641-00-36H  -  INSERT ACETAB H 36MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-36I	SUP	Custom 27803010		641-00-36I  -  INSERT ACETAB I 36MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
641-00-36J	SUP	Custom 27803010		641-00-36J  -  INSERT ACETAB J 36MM ELEVATED RIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
64122-06	SUP	Custom 27203010		FIXATIVE B5 HISTOLGY	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6430-0-020	SUP	Custom 27803010		6430-0-020  -  COMPONENT PATLR SMALL 20MM AVON KNEE	BOTH IP/OP	"$2,170.00 "	"$1,605.80"	$0.00	"$1,736.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,610.57"	"$1,610.57"	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	"$1,085.00"	"$1,718.64"	"$1,736.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6430-0-030	SUP	Custom 27803010		6430-0-030  -  COMPONENT PATLR MEDIUM 30MM AVON KNEE	BOTH IP/OP	"$2,170.00 "	"$1,605.80"	$0.00	"$1,736.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,610.57"	"$1,610.57"	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	"$1,085.00"	"$1,718.64"	"$1,736.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6430-0-040	SUP	Custom 27803010		6430-0-040  -  COMPONENT PATLR LARGE 40MM AVON KNEE	BOTH IP/OP	"$2,170.00 "	"$1,605.80"	$0.00	"$1,736.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,610.57"	"$1,610.57"	$0.00	$0.00	$452.23	$0.00	$0.00	$0.00	$0.00	"$1,085.00"	"$1,718.64"	"$1,736.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6430-0-050	SUP	HCPCS C1776		6430-0-050  -  COMPONENT FEMORAL XS 50MM AVON KNEE	BOTH IP/OP	"$9,682.50 "	"$7,165.05"	$0.00	"$7,746.00"	"$4,357.13"	"$4,357.13"	$0.00	$0.00	$0.00	"$2,018.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,017.83"	$0.00	"$4,773.47"	"$4,773.47"	$0.00	"$4,841.25"	"$7,668.54"	"$7,746.00"	$0.00		$0.00	"$1,515.31"	$0.00	$0.00	"$1,541.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6430-0-100	SUP	HCPCS C1776		6430-0-100  -  COMPONENT FEMORAL SMALL AVON KNEE	BOTH IP/OP	"$9,682.50 "	"$7,165.05"	$0.00	"$7,746.00"	"$4,357.13"	"$4,357.13"	$0.00	$0.00	$0.00	"$2,018.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,017.83"	$0.00	"$4,773.47"	"$4,773.47"	$0.00	"$4,841.25"	"$7,668.54"	"$7,746.00"	$0.00		$0.00	"$1,515.31"	$0.00	$0.00	"$1,541.45"	$0.00	$0.00	$0.00	$0.00	$0.00
6430-0-200	SUP	HCPCS C1776		6430-0-200  -  COMPONENT FEMORAL MEDIUM AVON KNEE	BOTH IP/OP	"$9,682.50 "	"$7,165.05"	$0.00	"$7,746.00"	"$4,357.13"	"$4,357.13"	$0.00	$0.00	$0.00	"$2,018.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,017.83"	$0.00	"$4,773.47"	"$4,773.47"	$0.00	"$4,841.25"	"$7,668.54"	"$7,746.00"	$0.00		$0.00	"$1,515.31"	$0.00	$0.00	"$1,541.45"	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-28C	SUP	Custom 27803010		643-00-28C  -  INSERT ACETAB C 28MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-28D	SUP	Custom 27803010		643-00-28D  -  INSERT ACETAB D 28MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-28E	SUP	Custom 27803010		643-00-28E  -  INSERT ACETAB E 28MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-28F	SUP	Custom 27803010		643-00-28F  -  INSERT ACETAB F 28MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-28G	SUP	Custom 27803010		643-00-28G  -  INSERT ACETAB G 28MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-28H	SUP	Custom 27803010		643-00-28H  -  INSERT ACETAB H 28MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-28I	SUP	Custom 27803010		643-00-28I  -  INSERT ACETAB I 28MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-28J	SUP	Custom 27803010		643-00-28J  -  INSERT ACETAB J 28MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6430-0-300	SUP	HCPCS C1776		6430-0-300  -  COMPONENT FEMORAL LARGE AVON KNEE	BOTH IP/OP	"$9,682.50 "	"$7,165.05"	$0.00	"$7,746.00"	"$4,357.13"	"$4,357.13"	$0.00	$0.00	$0.00	"$2,018.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,017.83"	$0.00	"$4,773.47"	"$4,773.47"	$0.00	"$4,841.25"	"$7,668.54"	"$7,746.00"	$0.00		$0.00	"$1,515.31"	$0.00	$0.00	"$1,541.45"	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-32E	SUP	Custom 27803010		643-00-32E  -  INSERT ACETAB E 32MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-32F	SUP	Custom 27803010		643-00-32F  -  INSERT ACETAB F 32MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-32G	SUP	Custom 27803010		643-00-32G  -  INSERT ACETAB G 32MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-32H	SUP	Custom 27803010		643-00-32H  -  INSERT ACETAB H 32MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-32I	SUP	Custom 27803010		643-00-32I  -  INSERT ACETAB I 32MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-32J	SUP	Custom 27803010		643-00-32J  -  INSERT ACETAB J 32MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,130.00 "	"$2,316.20"	$0.00	"$2,504.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,323.09"	"$2,323.09"	$0.00	$0.00	$652.29	$0.00	$0.00	$0.00	$0.00	"$1,565.00"	"$2,478.96"	"$2,504.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-36E	SUP	Custom 27803010		643-00-36E  -  INSERT ACETAB E 36MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,345.00 "	"$2,475.30"	$0.00	"$2,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,482.66"	"$2,482.66"	$0.00	$0.00	$697.10	$0.00	$0.00	$0.00	$0.00	"$1,672.50"	"$2,649.24"	"$2,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-36F	SUP	Custom 27803010		643-00-36F  -  INSERT ACETAB F 36MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,345.00 "	"$2,475.30"	$0.00	"$2,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,482.66"	"$2,482.66"	$0.00	$0.00	$697.10	$0.00	$0.00	$0.00	$0.00	"$1,672.50"	"$2,649.24"	"$2,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-36G	SUP	Custom 27803010		643-00-36G  -  INSERT ACETAB G 36MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,345.00 "	"$2,475.30"	$0.00	"$2,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,482.66"	"$2,482.66"	$0.00	$0.00	$697.10	$0.00	$0.00	$0.00	$0.00	"$1,672.50"	"$2,649.24"	"$2,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-36H	SUP	Custom 27803010		643-00-36H  -  INSERT ACETAB H 36MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,345.00 "	"$2,475.30"	$0.00	"$2,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,482.66"	"$2,482.66"	$0.00	$0.00	$697.10	$0.00	$0.00	$0.00	$0.00	"$1,672.50"	"$2,649.24"	"$2,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-36I	SUP	Custom 27803010		643-00-36I  -  INSERT ACETAB I 36MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,345.00 "	"$2,475.30"	$0.00	"$2,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,482.66"	"$2,482.66"	$0.00	$0.00	$697.10	$0.00	$0.00	$0.00	$0.00	"$1,672.50"	"$2,649.24"	"$2,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
643-00-36J	SUP	Custom 27803010		643-00-36J  -  INSERT ACETAB J 36MM ELEVATE RIM TRIDENT X3 HIP	BOTH IP/OP	"$3,345.00 "	"$2,475.30"	$0.00	"$2,676.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,482.66"	"$2,482.66"	$0.00	$0.00	$697.10	$0.00	$0.00	$0.00	$0.00	"$1,672.50"	"$2,649.24"	"$2,676.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-0-808	SUP	Custom 27803010		6471-0-808  -  INSERT TIB XS 8MM CNDYLR MDLR K-2	BOTH IP/OP	"$2,192.13 "	"$1,622.18"	$0.00	"$1,753.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,627.00"	"$1,627.00"	$0.00	$0.00	$456.84	$0.00	$0.00	$0.00	$0.00	"$1,096.06"	"$1,736.17"	"$1,753.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-0-811	SUP	Custom 27803010		6471-0-811  -  INSERT TIB XS 11MM CNDYLR MDLR K-2	BOTH IP/OP	"$2,192.13 "	"$1,622.18"	$0.00	"$1,753.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,627.00"	"$1,627.00"	$0.00	$0.00	$456.84	$0.00	$0.00	$0.00	$0.00	"$1,096.06"	"$1,736.17"	"$1,753.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-0-813	SUP	Custom 27803010		6471-0-813  -  INSERT TIB XS 13MM CNDYLR MDLR K-2	BOTH IP/OP	"$2,192.13 "	"$1,622.18"	$0.00	"$1,753.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,627.00"	"$1,627.00"	$0.00	$0.00	$456.84	$0.00	$0.00	$0.00	$0.00	"$1,096.06"	"$1,736.17"	"$1,753.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-0-816	SUP	Custom 27803010		6471-0-816  -  INSERT TIB XS 16MM CNDYLR MDLR K-2	BOTH IP/OP	"$2,192.13 "	"$1,622.18"	$0.00	"$1,753.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,627.00"	"$1,627.00"	$0.00	$0.00	$456.84	$0.00	$0.00	$0.00	$0.00	"$1,096.06"	"$1,736.17"	"$1,753.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-1-808	SUP	Custom 27803010		6471-1-808  -  INSERT TIB SM 8MM CNDYLR MDLR K-2	BOTH IP/OP	"$1,509.63 "	"$1,117.13"	$0.00	"$1,207.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.44"	"$1,120.44"	$0.00	$0.00	$314.61	$0.00	$0.00	$0.00	$0.00	$754.81	"$1,195.63"	"$1,207.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-1-811	SUP	Custom 27803010		6471-1-811  -  INSERT TIB SM 11MM CNDYLR MDLR K-2	BOTH IP/OP	"$2,283.13 "	"$1,689.52"	$0.00	"$1,826.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,694.54"	"$1,694.54"	$0.00	$0.00	$475.80	$0.00	$0.00	$0.00	$0.00	"$1,141.56"	"$1,808.24"	"$1,826.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-1-813	SUP	Custom 27803010		6471-1-813  -  INSERT TIB SM 13MM CNDYLR MDLR K-2	BOTH IP/OP	"$1,509.63 "	"$1,117.13"	$0.00	"$1,207.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.44"	"$1,120.44"	$0.00	$0.00	$314.61	$0.00	$0.00	$0.00	$0.00	$754.81	"$1,195.63"	"$1,207.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-1-816	SUP	Custom 27803010		6471-1-816  -  INSERT TIB SM 16MM CNDYLR MDLR K-2	BOTH IP/OP	"$1,509.63 "	"$1,117.13"	$0.00	"$1,207.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.44"	"$1,120.44"	$0.00	$0.00	$314.61	$0.00	$0.00	$0.00	$0.00	$754.81	"$1,195.63"	"$1,207.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-3-808	SUP	Custom 27803010		6471-3-808  -  INSERT TIB MED 8MM CNDYLR MDLR K-2	BOTH IP/OP	"$1,509.63 "	"$1,117.13"	$0.00	"$1,207.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.44"	"$1,120.44"	$0.00	$0.00	$314.61	$0.00	$0.00	$0.00	$0.00	$754.81	"$1,195.63"	"$1,207.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-3-811	SUP	Custom 27803010		6471-3-811  -  INSERT TIB MED 11MM CNDYLR MDLR K-2	BOTH IP/OP	"$1,509.63 "	"$1,117.13"	$0.00	"$1,207.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.44"	"$1,120.44"	$0.00	$0.00	$314.61	$0.00	$0.00	$0.00	$0.00	$754.81	"$1,195.63"	"$1,207.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-3-813	SUP	Custom 27803010		6471-3-813  -  INSERT TIB MED 13MM CNDYLR MDLR K-2	BOTH IP/OP	"$1,509.63 "	"$1,117.13"	$0.00	"$1,207.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.44"	"$1,120.44"	$0.00	$0.00	$314.61	$0.00	$0.00	$0.00	$0.00	$754.81	"$1,195.63"	"$1,207.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-3-816	SUP	Custom 27803010		6471-3-816  -  INSERT TIB MED 16MM CNDYLR MDLR K-2	BOTH IP/OP	"$1,509.63 "	"$1,117.13"	$0.00	"$1,207.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.44"	"$1,120.44"	$0.00	$0.00	$314.61	$0.00	$0.00	$0.00	$0.00	$754.81	"$1,195.63"	"$1,207.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-5-808	SUP	Custom 27803010		6471-5-808  -  INSERT TIB LG 8MM CNDYLR MDLR K-2	BOTH IP/OP	"$1,509.63 "	"$1,117.13"	$0.00	"$1,207.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.44"	"$1,120.44"	$0.00	$0.00	$314.61	$0.00	$0.00	$0.00	$0.00	$754.81	"$1,195.63"	"$1,207.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-5-811	SUP	Custom 27803010		6471-5-811  -  INSERT TIB LG 11MM CNDYLR MDLR K-2	BOTH IP/OP	"$2,283.13 "	"$1,689.52"	$0.00	"$1,826.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,694.54"	"$1,694.54"	$0.00	$0.00	$475.80	$0.00	$0.00	$0.00	$0.00	"$1,141.56"	"$1,808.24"	"$1,826.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-5-813	SUP	Custom 27803010		6471-5-813  -  INSERT TIB LG 13MM CNDYLR MDLR K-2	BOTH IP/OP	"$1,509.63 "	"$1,117.13"	$0.00	"$1,207.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.44"	"$1,120.44"	$0.00	$0.00	$314.61	$0.00	$0.00	$0.00	$0.00	$754.81	"$1,195.63"	"$1,207.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-5-816	SUP	Custom 27803010		6471-5-816  -  INSERT TIB LG 16MM CNDYLR MDLR K-2	BOTH IP/OP	"$1,509.63 "	"$1,117.13"	$0.00	"$1,207.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.44"	"$1,120.44"	$0.00	$0.00	$314.61	$0.00	$0.00	$0.00	$0.00	$754.81	"$1,195.63"	"$1,207.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-6-808	SUP	Custom 27803010		6471-6-808  -  INSERT TIB XL 8MM CNDYLR KNEE MDLR K-2	BOTH IP/OP	"$1,349.00 "	$998.26	$0.00	"$1,079.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,001.23"	"$1,001.23"	$0.00	$0.00	$281.13	$0.00	$0.00	$0.00	$0.00	$674.50	"$1,068.41"	"$1,079.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-6-811	SUP	Custom 27803010		6471-6-811  -  INSERT TIB XL 11MM CNDYLR MDLR K-2	BOTH IP/OP	"$2,192.13 "	"$1,622.18"	$0.00	"$1,753.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,627.00"	"$1,627.00"	$0.00	$0.00	$456.84	$0.00	$0.00	$0.00	$0.00	"$1,096.06"	"$1,736.17"	"$1,753.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-6-813	SUP	Custom 27803010		6471-6-813  -  INSERT TIB XL 13MM CNDYLR MDLR K-2	BOTH IP/OP	"$1,349.00 "	$998.26	$0.00	"$1,079.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,001.23"	"$1,001.23"	$0.00	$0.00	$281.13	$0.00	$0.00	$0.00	$0.00	$674.50	"$1,068.41"	"$1,079.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6471-6-816	SUP	Custom 27803010		6471-6-816  -  INSERT TIB XL 16MM CNDYLR MDLR K-2	BOTH IP/OP	"$1,116.00 "	$825.84	$0.00	$892.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$828.30	$828.30	$0.00	$0.00	$232.57	$0.00	$0.00	$0.00	$0.00	$558.00	$883.87	$892.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6472-0-808	SUP	Custom 27803010		6472-0-808  -  INSERT TIB XS 8MM KNEE STAB MDLR	BOTH IP/OP	"$1,398.00 "	"$1,034.52"	$0.00	"$1,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,037.60"	"$1,037.60"	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$699.00	"$1,107.22"	"$1,118.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6472-0-813	SUP	Custom 27803010		6472-0-813  -  INSERT TIB XS 13MM KNEE STAB MDLR	BOTH IP/OP	"$1,398.00 "	"$1,034.52"	$0.00	"$1,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,037.60"	"$1,037.60"	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$699.00	"$1,107.22"	"$1,118.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6472-0-816	SUP	Custom 27803010		6472-0-816  -  INSERT TIB XS 16MM KNEE STAB MDLR	BOTH IP/OP	"$1,398.00 "	"$1,034.52"	$0.00	"$1,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,037.60"	"$1,037.60"	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$699.00	"$1,107.22"	"$1,118.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6472-1-808	SUP	Custom 27803010		6472-1-808  -  INSERT TIB SM 8MM KNEE STAB MDLR	BOTH IP/OP	"$1,398.00 "	"$1,034.52"	$0.00	"$1,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,037.60"	"$1,037.60"	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$699.00	"$1,107.22"	"$1,118.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6472-1-816	SUP	Custom 27803010		6472-1-816  -  INSERT TIB SM 16MM KNEE STAB MDLR	BOTH IP/OP	"$1,398.00 "	"$1,034.52"	$0.00	"$1,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,037.60"	"$1,037.60"	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$699.00	"$1,107.22"	"$1,118.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6472-6-808	SUP	Custom 27803010		6472-6-808  -  INSERT TIB XL 8MM KNEE STAB MDLR	BOTH IP/OP	"$1,456.00 "	"$1,077.44"	$0.00	"$1,164.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,080.64"	"$1,080.64"	$0.00	$0.00	$303.43	$0.00	$0.00	$0.00	$0.00	$728.00	"$1,153.15"	"$1,164.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6472-6-811	SUP	Custom 27803010		6472-6-811  -  INSERT TIB XL 11MM KNEE STAB MDLR	BOTH IP/OP	"$1,456.00 "	"$1,077.44"	$0.00	"$1,164.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,080.64"	"$1,080.64"	$0.00	$0.00	$303.43	$0.00	$0.00	$0.00	$0.00	$728.00	"$1,153.15"	"$1,164.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6472-6-813	SUP	Custom 27803010		6472-6-813  -  INSERT TIB XL 13MM KNEE STAB MDLR	BOTH IP/OP	"$1,456.00 "	"$1,077.44"	$0.00	"$1,164.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,080.64"	"$1,080.64"	$0.00	$0.00	$303.43	$0.00	$0.00	$0.00	$0.00	$728.00	"$1,153.15"	"$1,164.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6472-6-816	SUP	Custom 27803010		6472-6-816  -  INSERT TIB XL 16MM KNEE STAB MDLR	BOTH IP/OP	"$1,398.00 "	"$1,034.52"	$0.00	"$1,118.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,037.60"	"$1,037.60"	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$699.00	"$1,107.22"	"$1,118.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6475-3-933	SUP	HCPCS C1776		6475-3-933  -  BEARING TIBIAL LONG COMPRESSION ROTATE HINGE MRS MRH KNEE	BOTH IP/OP	"$5,895.00 "	"$4,362.30"	$0.00	"$4,716.00"	"$2,652.75"	"$2,652.75"	$0.00	$0.00	$0.00	"$1,228.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,228.52"	$0.00	"$2,906.24"	"$2,906.24"	$0.00	"$2,947.50"	"$4,668.84"	"$4,716.00"	$0.00		$0.00	$922.57	$0.00	$0.00	$938.48	$0.00	$0.00	$0.00	$0.00	$0.00
6475-3-940	SUP	Custom 27803010		6475-3-940  -  AXLE FEMORAL STANDARD ROTATE HINGE MRS KINEMATIC KNEE	BOTH IP/OP	"$2,065.00 "	"$1,528.10"	$0.00	"$1,652.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,532.64"	"$1,532.64"	$0.00	$0.00	$430.35	$0.00	$0.00	$0.00	$0.00	"$1,032.50"	"$1,635.48"	"$1,652.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-0-100	SUP	Custom 27803010		6476-0-100  -  WEDGE TIB 10MM KNMX PLUS XS FULL	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-0-110	SUP	Custom 27203010		6476-0-110  -  TRIAL SURG BLK 10MM KNMX XS LL/RM HALF BLOCK WDG	BOTH IP/OP	$776.00 	$574.24	$0.00	$620.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.95	$575.95	$0.00	$0.00	$161.72	$0.00	$0.00	$0.00	$0.00	$388.00	$614.59	$620.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-0-120	SUP	Custom 27803010		6476-0-120  -  WEDGE TIB 10MM KX+ XS LEFT MDL RIGHT LAT BLOCK	BOTH IP/OP	$808.00 	$597.92	$0.00	$646.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.70	$599.70	$0.00	$0.00	$168.39	$0.00	$0.00	$0.00	$0.00	$404.00	$639.94	$646.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-0-130	SUP	Custom 27803010		6476-0-130  -  WEDGE TIB 5MM KX+ XS LL/RM BLOCK	BOTH IP/OP	$776.00 	$574.24	$0.00	$620.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.95	$575.95	$0.00	$0.00	$161.72	$0.00	$0.00	$0.00	$0.00	$388.00	$614.59	$620.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-0-140	SUP	Custom 27803010		6476-0-140  -  WEDGE TIB 5MM KX+ XS LEFT MDL RIGHT LAT BLOCK	BOTH IP/OP	$776.00 	$574.24	$0.00	$620.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.95	$575.95	$0.00	$0.00	$161.72	$0.00	$0.00	$0.00	$0.00	$388.00	$614.59	$620.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-0-150	SUP	Custom 27803010		6476-0-150  -  WEDGE TIB KX+ XS LL/RM FULL ANG	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-0-160	SUP	Custom 27803010		6476-0-160  -  WEDGE TIB KX+ XS LEFT MDL RIGHT LAT FULL ANG	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-0-310	SUP	Custom 27803010		6476-0-310  -  BSPLT TIB KNMX K2 XS MDLR	BOTH IP/OP	"$2,274.00 "	"$1,682.76"	$0.00	"$1,819.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,687.76"	"$1,687.76"	$0.00	$0.00	$473.90	$0.00	$0.00	$0.00	$0.00	"$1,137.00"	"$1,801.01"	"$1,819.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-0-400	SUP	Custom 27803010		6476-0-400  -  BSPLT TIB KMX+ 4 XS KNEE	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-1-100	SUP	Custom 27803010		6476-1-100  -  WEDGE TIBIAL 10MM FULL BLOCK KINEMAX PLUS SMALL LEFT MEDIAL	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-1-110	SUP	Custom 27803010		6476-1-110  -  WEDGE TIB 10MM KX+ SM LL/RM BLOCK	BOTH IP/OP	$808.00 	$597.92	$0.00	$646.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.70	$599.70	$0.00	$0.00	$168.39	$0.00	$0.00	$0.00	$0.00	$404.00	$639.94	$646.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-1-120	SUP	Custom 27803010		6476-1-120  -  WEDGE TIB 10MM KX+ SM LEFT MDL RIGHT LAT BLOCK	BOTH IP/OP	$808.00 	$597.92	$0.00	$646.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.70	$599.70	$0.00	$0.00	$168.39	$0.00	$0.00	$0.00	$0.00	$404.00	$639.94	$646.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-1-130	SUP	Custom 27803010		6476-1-130  -  WEDGE TIB 5MM KX+ SM LL/RM BLOCK	BOTH IP/OP	$673.00 	$498.02	$0.00	$538.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$499.50	$499.50	$0.00	$0.00	$140.25	$0.00	$0.00	$0.00	$0.00	$336.50	$533.02	$538.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-1-140	SUP	Custom 27803010		6476-1-140  -  WEDGE TIB 5MM KX+ SM LEFT MDL RIGHT LAT BLOCK	BOTH IP/OP	$808.00 	$597.92	$0.00	$646.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.70	$599.70	$0.00	$0.00	$168.39	$0.00	$0.00	$0.00	$0.00	$404.00	$639.94	$646.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-1-150	SUP	Custom 27803010		6476-1-150  -  WEDGE TIB KX+ SM LL/RM FULL ANG	BOTH IP/OP	"$1,248.00 "	$923.52	$0.00	$998.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$926.27	$926.27	$0.00	$0.00	$260.08	$0.00	$0.00	$0.00	$0.00	$624.00	$988.42	$998.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-1-160	SUP	Custom 27803010		6476-1-160  -  WEDGE TIB KX+ SM LEFT MDL RIGHT LAT FULL ANG	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-1-310	SUP	Custom 27803010		6476-1-310  -  BSPLT TIB KNMX SM REG KNEE STM	BOTH IP/OP	"$2,146.00 "	"$1,588.04"	$0.00	"$1,716.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,592.76"	"$1,592.76"	$0.00	$0.00	$447.23	$0.00	$0.00	$0.00	$0.00	"$1,073.00"	"$1,699.63"	"$1,716.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-1-400	SUP	Custom 27803010		6476-1-400  -  BASEPLATE TIBIAL SMALL KINEMAX PLUS KNEE	BOTH IP/OP	"$4,920.00 "	"$3,640.80"	$0.00	"$3,936.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,651.62"	"$3,651.62"	$0.00	$0.00	"$1,025.33"	$0.00	$0.00	$0.00	$0.00	"$2,460.00"	"$3,896.64"	"$3,936.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-3-100	SUP	Custom 27803010		6476-3-100  -  WEDGE TIB 10MM KNMX PLUS MED FULL	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-3-110	SUP	Custom 27803010		6476-3-110  -  WEDGE TIB 10MM KX+ MED LL/RM BLOCK	BOTH IP/OP	$808.00 	$597.92	$0.00	$646.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.70	$599.70	$0.00	$0.00	$168.39	$0.00	$0.00	$0.00	$0.00	$404.00	$639.94	$646.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-3-120	SUP	Custom 27803010		6476-3-120  -  WEDGE TIB 10MM KX+ MED LEFT MDL RIGHT LAT BLOCK	BOTH IP/OP	$808.00 	$597.92	$0.00	$646.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.70	$599.70	$0.00	$0.00	$168.39	$0.00	$0.00	$0.00	$0.00	$404.00	$639.94	$646.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-3-130	SUP	Custom 27803010		6476-3-130  -  WEDGE TIB 5MM KX+ MED LL/RM BLOCK	BOTH IP/OP	$808.00 	$597.92	$0.00	$646.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.70	$599.70	$0.00	$0.00	$168.39	$0.00	$0.00	$0.00	$0.00	$404.00	$639.94	$646.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-3-140	SUP	Custom 27803010		6476-3-140  -  WEDGE TIB 5MM KX+ MED LEFT MDL RIGHT LAT BLOCK	BOTH IP/OP	$808.00 	$597.92	$0.00	$646.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.70	$599.70	$0.00	$0.00	$168.39	$0.00	$0.00	$0.00	$0.00	$404.00	$639.94	$646.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-3-150	SUP	Custom 27803010		6476-3-150  -  WEDGE TIB KX+ MED LL/RM FULL ANG	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-3-160	SUP	Custom 27803010		6476-3-160  -  WEDGE TIBIAL KINEMAX PLUS MEDIUM FULL ANGLE RIGHT MEDIAL	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-3-310	SUP	Custom 27803010		6476-3-310  -  BSPLT TIB KNMX K2 MED KNEE MDLR	BOTH IP/OP	"$2,146.00 "	"$1,588.04"	$0.00	"$1,716.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,592.76"	"$1,592.76"	$0.00	$0.00	$447.23	$0.00	$0.00	$0.00	$0.00	"$1,073.00"	"$1,699.63"	"$1,716.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-3-400	SUP	Custom 27803010		6476-3-400  -  BSPLT TIB KMX+ MED KNEE ASMBLY	BOTH IP/OP	"$2,996.00 "	"$2,217.04"	$0.00	"$2,396.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,223.63"	"$2,223.63"	$0.00	$0.00	$624.37	$0.00	$0.00	$0.00	$0.00	"$1,498.00"	"$2,372.83"	"$2,396.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-5-100	SUP	Custom 27803010		6476-5-100  -  WEDGE TIB 10MM KNMX PLUS LG FULL	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-5-110	SUP	Custom 27803010		6476-5-110  -  WEDGE TIB 10MM KX+ LG LL/RM BLOCK	BOTH IP/OP	$808.00 	$597.92	$0.00	$646.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.70	$599.70	$0.00	$0.00	$168.39	$0.00	$0.00	$0.00	$0.00	$404.00	$639.94	$646.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-5-120	SUP	Custom 27803010		6476-5-120  -  WEDGE TIB 10MM KX+ LG LEFT MDL RIGHT LAT BLOCK	BOTH IP/OP	$673.00 	$498.02	$0.00	$538.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$499.50	$499.50	$0.00	$0.00	$140.25	$0.00	$0.00	$0.00	$0.00	$336.50	$533.02	$538.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-5-130	SUP	Custom 27803010		6476-5-130  -  WEDGE TIB 5MM KX+ LG LL/RM BLOCK	BOTH IP/OP	$808.00 	$597.92	$0.00	$646.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.70	$599.70	$0.00	$0.00	$168.39	$0.00	$0.00	$0.00	$0.00	$404.00	$639.94	$646.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-5-140	SUP	Custom 27803010		6476-5-140  -  WEDGE TIB 5MM KX+ LG LEFT MDL RIGHT LAT BLOCK	BOTH IP/OP	$808.00 	$597.92	$0.00	$646.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.70	$599.70	$0.00	$0.00	$168.39	$0.00	$0.00	$0.00	$0.00	$404.00	$639.94	$646.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-5-150	SUP	Custom 27803010		6476-5-150  -  WEDGE TIB KX+ LG LL/RM FULL ANG	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-5-160	SUP	Custom 27803010		6476-5-160  -  WEDGE TIB KX+ LG LEFT MDL RIGHT LAT FULL ANG	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-5-310	SUP	Custom 27803010		6476-5-310  -  BSPLT TIB KNMX LG KNEE MODULLAR	BOTH IP/OP	"$2,146.00 "	"$1,588.04"	$0.00	"$1,716.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,592.76"	"$1,592.76"	$0.00	$0.00	$447.23	$0.00	$0.00	$0.00	$0.00	"$1,073.00"	"$1,699.63"	"$1,716.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-5-400	SUP	Custom 27803010		6476-5-400  -  BSPLT TIB KMX+ LG KNEE ASMBLY	BOTH IP/OP	"$2,996.00 "	"$2,217.04"	$0.00	"$2,396.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,223.63"	"$2,223.63"	$0.00	$0.00	$624.37	$0.00	$0.00	$0.00	$0.00	"$1,498.00"	"$2,372.83"	"$2,396.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-6-100	SUP	Custom 27803010		6476-6-100  -  WEDGE TIB 10MM KNMX PLUS XL FULL	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-6-110	SUP	Custom 27803010		6476-6-110  -  WEDGE TIB 10MM KX+ XL LL/RM BLOCK	BOTH IP/OP	$776.00 	$574.24	$0.00	$620.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.95	$575.95	$0.00	$0.00	$161.72	$0.00	$0.00	$0.00	$0.00	$388.00	$614.59	$620.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-6-120	SUP	Custom 27803010		6476-6-120  -  WEDGE TIB 10MM KX+ XL LEFT MDL RIGHT LAT BLOCK	BOTH IP/OP	$776.00 	$574.24	$0.00	$620.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.95	$575.95	$0.00	$0.00	$161.72	$0.00	$0.00	$0.00	$0.00	$388.00	$614.59	$620.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-6-130	SUP	Custom 27803010		6476-6-130  -  WEDGE TIB 5MM KX+ XL LL/RM BLOCK	BOTH IP/OP	$776.00 	$574.24	$0.00	$620.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.95	$575.95	$0.00	$0.00	$161.72	$0.00	$0.00	$0.00	$0.00	$388.00	$614.59	$620.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-6-140	SUP	Custom 27803010		6476-6-140  -  WEDGE TIB 5MM KX+ XL LEFT MDL RIGHT LAT BLOCK	BOTH IP/OP	$776.00 	$574.24	$0.00	$620.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.95	$575.95	$0.00	$0.00	$161.72	$0.00	$0.00	$0.00	$0.00	$388.00	$614.59	$620.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-6-150	SUP	Custom 27803010		6476-6-150  -  WEDGE TIB KX+ XL LL/RM FULL ANG	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-6-160	SUP	Custom 27803010		6476-6-160  -  WEDGE TIB KX+ XL LEFT MDL RIGHT LAT FULL ANG	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-6-310	SUP	Custom 27803010		6476-6-310  -  BSPLT TIB KNMX XL KNEE MDLR	BOTH IP/OP	"$2,274.00 "	"$1,682.76"	$0.00	"$1,819.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,687.76"	"$1,687.76"	$0.00	$0.00	$473.90	$0.00	$0.00	$0.00	$0.00	"$1,137.00"	"$1,801.01"	"$1,819.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-6-400	SUP	Custom 27803010		6476-6-400  -  BSPLT TIB KMX+ XL ORTH ASMBLY	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	$0.00	$0.00	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-8-170	SUP	Custom 27803010		6476-8-170  -  WEDGE TIB KMX+ FIX SCR	BOTH IP/OP	$103.00 	$76.22	$0.00	$82.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.45	$76.45	$0.00	$0.00	$21.47	$0.00	$0.00	$0.00	$0.00	$51.50	$81.58	$82.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-8-180	SUP	Custom 27803010		6476-8-180  -  WEDGE TIB 15MM KNMX PLUS FIX PG	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.80	$161.80	$0.00	$0.00	$45.43	$0.00	$0.00	$0.00	$0.00	$109.00	$172.66	$174.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-8-242	SUP	Custom 27803010		6476-8-242  -  STEM FEM 40MM CMNT COCR XS FEM/TIB KNEE	BOTH IP/OP	"$1,839.50 "	"$1,361.23"	$0.00	"$1,471.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,365.28"	"$1,365.28"	$0.00	$0.00	$383.35	$0.00	$0.00	$0.00	$0.00	$919.75	"$1,456.88"	"$1,471.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-8-244	SUP	Custom 27803010		6476-8-244  -  STEM FEM 80MM CMNT COCR XS TIB KNEE	BOTH IP/OP	"$1,839.50 "	"$1,361.23"	$0.00	"$1,471.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,365.28"	"$1,365.28"	$0.00	$0.00	$383.35	$0.00	$0.00	$0.00	$0.00	$919.75	"$1,456.88"	"$1,471.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-8-246	SUP	Custom 27803010		6476-8-246  -  STEM FEM 155MM CMNT COCR XS TIB KNEE	BOTH IP/OP	"$1,860.63 "	"$1,376.87"	$0.00	"$1,488.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,380.96"	"$1,380.96"	$0.00	$0.00	$387.75	$0.00	$0.00	$0.00	$0.00	$930.31	"$1,473.62"	"$1,488.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-8-250	SUP	Custom 27803010		6476-8-250  -  EXTENSION STEM XS 40MM CEMENTED KINEMAX COCR KNEE FEMORAL	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-8-260	SUP	Custom 27803010		6476-8-260  -  STEM FEMORAL 80MM CEMENT KINEMAX COCR KNEE	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-8-270	SUP	Custom 27803010		6476-8-270  -  EXTENSION STEM XS 155MM CEMENTED KINEMAX COCR KNEE FEMORAL	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-8-315	SUP	Custom 27803010		6476-8-315  -  WEDGE TIB KMX+ LG	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6476-8-320	SUP	Custom 27803010		6476-8-320  -  WEDGE TIB KMX+ XL	BOTH IP/OP	$808.00 	$597.92	$0.00	$646.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.70	$599.70	$0.00	$0.00	$168.39	$0.00	$0.00	$0.00	$0.00	$404.00	$639.94	$646.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-020	SUP	Custom 27803010		6478-6-020  -  INSERT TIB 20MM KNEE PEG KMX+	BOTH IP/OP	$446.00 	$330.04	$0.00	$356.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.02	$331.02	$0.00	$0.00	$92.95	$0.00	$0.00	$0.00	$0.00	$223.00	$353.23	$356.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-100	SUP	Custom 27803010		6478-6-100  -  WEDGE TIB KNMX PLUS SM XS SS	BOTH IP/OP	$687.00 	$508.38	$0.00	$549.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$509.89	$509.89	$0.00	$0.00	$143.17	$0.00	$0.00	$0.00	$0.00	$343.50	$544.10	$549.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-110	SUP	Custom 27803010		6478-6-110  -  WEDGE TIB SM KNEE SS MDLR PLUS KX	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-120	SUP	Custom 27803010		6478-6-120  -  WEDGE TIB KNMX L+ MED KNEE SS WDG SUP STAB	BOTH IP/OP	$687.00 	$508.38	$0.00	$549.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$509.89	$509.89	$0.00	$0.00	$143.17	$0.00	$0.00	$0.00	$0.00	$343.50	$544.10	$549.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-395	SUP	Custom 27803010		6478-6-395  -  EXTENSION STEM 10MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-396	SUP	Custom 27803010		6478-6-396  -  EXTENSION STEM 11MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-397	SUP	Custom 27803010		6478-6-397  -  EXTENSION STEM 12MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-398	SUP	Custom 27803010		6478-6-398  -  TRIAL KNEE 13MM 80MM 1 AXIS PRESS FIT CEMENTED STEM EXTN	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-399	SUP	Custom 27803010		6478-6-399  -  EXTENSION STEM 14MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-400	SUP	Custom 27803010		6478-6-400  -  TRIAL KNEE 15MM 80MM 1 AXIS PRESS FIT CEMENTED STEM EXTN	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-405	SUP	Custom 27803010		6478-6-405  -  EXTENSION STEM 16MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-410	SUP	Custom 27803010		6478-6-410  -  EXTENSION STEM 17MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-415	SUP	Custom 27803010		6478-6-415  -  EXTENSION STEM 18MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-420	SUP	Custom 27803010		6478-6-420  -  EXTENSION STEM 19MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-425	SUP	Custom 27803010		6478-6-425  -  EXTENSION STEM 21MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-430	SUP	Custom 27803010		6478-6-430  -  EXTENSION STEM 23MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-435	SUP	Custom 27803010		6478-6-435  -  EXTENSION STEM 10MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-436	SUP	Custom 27803010		6478-6-436  -  EXTENSION STEM 11MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-437	SUP	Custom 27803010		6478-6-437  -  TRIAL KNEE 12MM 155MM 1 AXIS PRESS FIT CEMENTED STEM EXTN	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-438	SUP	Custom 27803010		6478-6-438  -  EXTENSION STEM 13MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-439	SUP	Custom 27803010		6478-6-439  -  EXTENSION STEM 14MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-440	SUP	Custom 27803010		6478-6-440  -  EXTENSION STEM 15MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-445	SUP	Custom 27803010		6478-6-445  -  EXTENSION STEM 16MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-450	SUP	Custom 27803010		6478-6-450  -  EXTENSION STEM 17MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-455	SUP	Custom 27803010		6478-6-455  -  EXTENSION STEM 18MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-460	SUP	Custom 27803010		6478-6-460  -  EXTENSION STEM 19MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-465	SUP	Custom 27803010		6478-6-465  -  EXTENSION STEM 21MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-470	SUP	Custom 27803010		6478-6-470  -  EXTENSION STEM 23MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO	BOTH IP/OP	"$1,915.00 "	"$1,417.10"	$0.00	"$1,532.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.31"	"$1,421.31"	$0.00	$0.00	$399.09	$0.00	$0.00	$0.00	$0.00	$957.50	"$1,516.68"	"$1,532.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-490	SUP	Custom 27803010		6478-6-490  -  ADAPTER STEM 4MM OFFST JAM NUT SCORPIO KNEE	BOTH IP/OP	"$2,220.00 "	"$1,642.80"	$0.00	"$1,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,647.68"	"$1,647.68"	$0.00	$0.00	$462.65	$0.00	$0.00	$0.00	$0.00	"$1,110.00"	"$1,758.24"	"$1,776.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-495	SUP	Custom 27803010		6478-6-495  -  ADAPTER STM 6MM OFST SCRP JAM NUT TIB 1 AXIS KN SYS	BOTH IP/OP	"$2,220.00 "	"$1,642.80"	$0.00	"$1,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,647.68"	"$1,647.68"	$0.00	$0.00	$462.65	$0.00	$0.00	$0.00	$0.00	"$1,110.00"	"$1,758.24"	"$1,776.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-500	SUP	Custom 27803010		6478-6-500  -  ADAPTER STM 8MM OFST SCRP JAM NUT TIB 1 AXIS KN SYS	BOTH IP/OP	"$2,220.00 "	"$1,642.80"	$0.00	"$1,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,647.68"	"$1,647.68"	$0.00	$0.00	$462.65	$0.00	$0.00	$0.00	$0.00	"$1,110.00"	"$1,758.24"	"$1,776.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-585	SUP	Custom 27803010		6478-6-585  -  ADAPTER STM 2MM OFST SCRP JAM NUT FEM 1 AXIS KN SYS	BOTH IP/OP	"$2,220.00 "	"$1,642.80"	$0.00	"$1,776.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,647.68"	"$1,647.68"	$0.00	$0.00	$462.65	$0.00	$0.00	$0.00	$0.00	"$1,110.00"	"$1,758.24"	"$1,776.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-600	SUP	Custom 27803010		6478-6-600  -  STEM TIBIAL FLUTE 10MM 80MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-605	SUP	Custom 27803010		6478-6-605  -  STEM TIBIAL FLUTE 11MM 80MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-610	SUP	Custom 27803010		6478-6-610  -  STEM TIBIAL FLUTE 12MM 80MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-615	SUP	Custom 27803010		6478-6-615  -  STEM TIBIAL FLUTE 13MM 80MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-620	SUP	Custom 27803010		6478-6-620  -  STEM TIBIAL FLUTE 14MM 80MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-625	SUP	Custom 27803010		6478-6-625  -  STEM TIBIAL FLUTE 15MM 80MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-630	SUP	Custom 27803010		6478-6-630  -  STEM TIBIAL FLUTE 16MM 80MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-635	SUP	Custom 27803010		6478-6-635  -  STEM TIBIAL FLUTE 17MM 80MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-640	SUP	Custom 27803010		6478-6-640  -  STEM TIBIAL FLUTE 18MM 80MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-645	SUP	Custom 27803010		6478-6-645  -  STEM TIBIAL FLUTE 19MM 80MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-655	SUP	Custom 27803010		6478-6-655  -  STEM TIBIAL FLUTE 21MM 80MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-665	SUP	Custom 27803010		6478-6-665  -  STEM TIBIAL FLUTE 23MM 80MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-680	SUP	Custom 27803010		6478-6-680  -  STEM TIBIAL FLUTE 10MM 115MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-685	SUP	Custom 27803010		6478-6-685  -  STEM TIBIAL FLUTE 11MM 115MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-690	SUP	Custom 27803010		6478-6-690  -  STEM TIBIAL FLUTE 12MM 115MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-695	SUP	Custom 27803010		6478-6-695  -  STEM TIBIAL FLUTE 13MM 115MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-705	SUP	Custom 27803010		6478-6-705  -  STEM TIBIAL FLUTE 14MM 115MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-710	SUP	Custom 27803010		6478-6-710  -  STEM TIBIAL FLUTE 15MM 115MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-715	SUP	Custom 27803010		6478-6-715  -  STEM TIBIAL FLUTE 16MM 115MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-720	SUP	Custom 27803010		6478-6-720  -  STEM TIBIAL FLUTE 17MM 115MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-725	SUP	Custom 27803010		6478-6-725  -  STEM TIBIAL FLUTE 18MM 115MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-730	SUP	Custom 27803010		6478-6-730  -  STEM TIBIAL FLUTE 19MM 115MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-740	SUP	Custom 27803010		6478-6-740  -  STEM TIBIAL FLUTE 21MM 115MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6478-6-750	SUP	Custom 27803010		6478-6-750  -  STEM TIBIAL FLUTE 23MM 115MM GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$2,342.50 "	"$1,733.45"	$0.00	"$1,874.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,738.60"	"$1,738.60"	$0.00	$0.00	$488.18	$0.00	$0.00	$0.00	$0.00	"$1,171.25"	"$1,855.26"	"$1,874.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-0-050	SUP	HCPCS C1776		6479-0-050  -  CMPNT FEM XS CNDYLR KMX+ NPOR	BOTH IP/OP	"$3,596.00 "	"$2,661.04"	$0.00	"$2,876.80"	"$1,618.20"	"$1,618.20"	$0.00	$0.00	$0.00	$749.50	"$2,668.95"	"$2,668.95"	$0.00	$0.00	$749.41	$0.00	"$1,772.83"	"$1,772.83"	$0.00	"$1,798.00"	"$2,848.03"	"$2,876.80"	$0.00		$0.00	$562.77	$0.00	$0.00	$572.48	$0.00	$0.00	$0.00	$0.00	$0.00
6479-0-100	SUP	HCPCS C1776		6479-0-100  -  CMPNT FEM SM CNDYLR KMX+ NPOR	BOTH IP/OP	"$3,467.00 "	"$2,565.58"	$0.00	"$2,773.60"	"$1,560.15"	"$1,560.15"	$0.00	$0.00	$0.00	$722.61	"$2,573.21"	"$2,573.21"	$0.00	$0.00	$722.52	$0.00	"$1,709.23"	"$1,709.23"	$0.00	"$1,733.50"	"$2,745.86"	"$2,773.60"	$0.00		$0.00	$542.59	$0.00	$0.00	$551.95	$0.00	$0.00	$0.00	$0.00	$0.00
6479-0-150	SUP	HCPCS C1776		6479-0-150  -  CMPNT FEM MED CNDYLR KMX+ NPOR	BOTH IP/OP	"$3,467.00 "	"$2,565.58"	$0.00	"$2,773.60"	"$1,560.15"	"$1,560.15"	$0.00	$0.00	$0.00	$722.61	"$2,573.21"	"$2,573.21"	$0.00	$0.00	$722.52	$0.00	"$1,709.23"	"$1,709.23"	$0.00	"$1,733.50"	"$2,745.86"	"$2,773.60"	$0.00		$0.00	$542.59	$0.00	$0.00	$551.95	$0.00	$0.00	$0.00	$0.00	$0.00
6479-0-200	SUP	HCPCS C1776		6479-0-200  -  CMPNT FEM LG CNDYLR KMX+ NPOR	BOTH IP/OP	"$3,467.00 "	"$2,565.58"	$0.00	"$2,773.60"	"$1,560.15"	"$1,560.15"	$0.00	$0.00	$0.00	$722.61	"$2,573.21"	"$2,573.21"	$0.00	$0.00	$722.52	$0.00	"$1,709.23"	"$1,709.23"	$0.00	"$1,733.50"	"$2,745.86"	"$2,773.60"	$0.00		$0.00	$542.59	$0.00	$0.00	$551.95	$0.00	$0.00	$0.00	$0.00	$0.00
6479-0-250	SUP	HCPCS C1776		6479-0-250  -  CMPNT FEM XL CNDYLR KMX+ NPOR	BOTH IP/OP	"$3,467.00 "	"$2,565.58"	$0.00	"$2,773.60"	"$1,560.15"	"$1,560.15"	$0.00	$0.00	$0.00	$722.61	"$2,573.21"	"$2,573.21"	$0.00	$0.00	$722.52	$0.00	"$1,709.23"	"$1,709.23"	$0.00	"$1,733.50"	"$2,745.86"	"$2,773.60"	$0.00		$0.00	$542.59	$0.00	$0.00	$551.95	$0.00	$0.00	$0.00	$0.00	$0.00
6479-0-300	SUP	HCPCS C1776		6479-0-300  -  CMPNT FEM 2XL CNDYLR KMX+ NPOR	BOTH IP/OP	"$3,596.00 "	"$2,661.04"	$0.00	"$2,876.80"	"$1,618.20"	"$1,618.20"	$0.00	$0.00	$0.00	$749.50	"$2,668.95"	"$2,668.95"	$0.00	$0.00	$749.41	$0.00	"$1,772.83"	"$1,772.83"	$0.00	"$1,798.00"	"$2,848.03"	"$2,876.80"	$0.00		$0.00	$562.77	$0.00	$0.00	$572.48	$0.00	$0.00	$0.00	$0.00	$0.00
6479-4-900	SUP	Custom 27803010		6479-4-900  -  CMPNT PATLR SM KMX+ DUR	BOTH IP/OP	"$1,133.00 "	$838.42	$0.00	$906.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$840.91	$840.91	$0.00	$0.00	$236.12	$0.00	$0.00	$0.00	$0.00	$566.50	$897.34	$906.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-4-911	SUP	Custom 27803010		6479-4-911  -  CMPNT PATLR MED KMX+ DUR	BOTH IP/OP	"$1,133.00 "	$838.42	$0.00	$906.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$840.91	$840.91	$0.00	$0.00	$236.12	$0.00	$0.00	$0.00	$0.00	$566.50	$897.34	$906.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-4-920	SUP	Custom 27803010		6479-4-920  -  INSERT TIB LG PTLR DUR KX+	BOTH IP/OP	"$1,133.00 "	$838.42	$0.00	$906.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$840.91	$840.91	$0.00	$0.00	$236.12	$0.00	$0.00	$0.00	$0.00	$566.50	$897.34	$906.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-008	SUP	Custom 27803010		6479-5-008  -  INSERT TIBIAL XS 65X41X8MM LATERAL STABILIZE CRUCIATE RETAIN	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-010	SUP	Custom 27803010		6479-5-010  -  INSERT TIBIAL XS 65X41X10MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-012	SUP	Custom 27803010		6479-5-012  -  INSERT TIBIAL XS 65X41X12MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-015	SUP	Custom 27803010		6479-5-015  -  INSERT TIBIAL XS 65X41X15MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-018	SUP	Custom 27803010		6479-5-018  -  INSERT TIBIAL XS 65X41X18MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-021	SUP	Custom 27803010		6479-5-021  -  INSERT TIBIAL XS 21MM LATERAL STABILIZED CRUC RET KINEMAX	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-025	SUP	Custom 27803010		6479-5-025  -  INSERT TIBIAL XS 65X41X25MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-108	SUP	Custom 27803010		6479-5-108  -  INSERT TIBIAL SMALL 8MM LATERAL STABILIZED KINEMAX PLUS DUR	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-110	SUP	Custom 27803010		6479-5-110  -  INSERT TIBIAL SMALL 10MM LATERAL STABILIZED KINEMAX PLUS DUR	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-112	SUP	Custom 27803010		6479-5-112  -  INSERT TIBIAL SMALL 12MM LATERAL STABILIZED KINEMAX PLUS DUR	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-115	SUP	Custom 27803010		6479-5-115  -  INSERT TIBIAL SMALL 15MM LATERAL STABILIZED KINEMAX PLUS DUR	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-118	SUP	Custom 27803010		6479-5-118  -  INSERT TIBIAL SMALL 71X44X18MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-121	SUP	Custom 27803010		6479-5-121  -  INSERT TIBIAL SMALL 21MM LATERAL STABILIZED CRUC RET KINEMAX	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-125	SUP	Custom 27803010		6479-5-125  -  INSERT TIBIAL SMALL 71X44X25MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-208	SUP	Custom 27803010		6479-5-208  -  INSERT TIBIAL MEDIUM 8MM LATERAL STABILIZED KINEMAX PLUS DUR	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-210	SUP	Custom 27803010		6479-5-210  -  INSERT TIBIAL MEDIUM 76X48X10MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-212	SUP	Custom 27803010		6479-5-212  -  INSERT TIBIAL MEDIUM 12MM LATERAL STABILIZED KINEMAX PLUS	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-215	SUP	Custom 27803010		6479-5-215  -  INSERT TIBIAL MEDIUM 15MM LATERAL STABILIZED KINEMAX PLUS	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-218	SUP	Custom 27803010		6479-5-218  -  INSERT TIBIAL MEDIUM 18MM LATERAL STABILIZED KINEMAX PLUS	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-221	SUP	Custom 27803010		6479-5-221  -  INSERT TIBIAL MEDIUM 76X48X21MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-225	SUP	Custom 27803010		6479-5-225  -  INSERT TIBIAL MEDIUM 76X48X25MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-308	SUP	Custom 27803010		6479-5-308  -  INSERT TIBIAL LARGE 8MM LATERAL STABILIZED KINEMAX PLUS DUR	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-310	SUP	Custom 27803010		6479-5-310  -  INSERT TIBIAL LARGE 81X51X10MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-312	SUP	Custom 27803010		6479-5-312  -  INSERT TIBIAL LARGE 12MM LATERAL STABILIZED KINEMAX PLUS DUR	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-315	SUP	Custom 27803010		6479-5-315  -  INSERT TIBIAL LARGE 81X51X15MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-318	SUP	Custom 27803010		6479-5-318  -  INSERT TIBIAL LARGE 81X51X18MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-321	SUP	Custom 27803010		6479-5-321  -  INSERT TIBIAL LARGE 81X51X21MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-325	SUP	Custom 27803010		6479-5-325  -  INSERT TIBIAL LARGE 81X51X25MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-408	SUP	Custom 27803010		6479-5-408  -  INSERT TIBIAL XL 86X54X8MM LATERAL STABILIZE CRUCIATE RETAIN	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-410	SUP	Custom 27803010		6479-5-410  -  INSERT TIBIAL XL 86X54X10MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-412	SUP	Custom 27803010		6479-5-412  -  INSERT TIBIAL XL 86X54X12MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-415	SUP	Custom 27803010		6479-5-415  -  INSERT TIBIAL XL 86X54X15MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-418	SUP	Custom 27803010		6479-5-418  -  INSERT TIBIAL XL 86X54X18MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-421	SUP	Custom 27803010		6479-5-421  -  INSERT TIBIAL XL 86X54X21MM LATERAL STABILIZE CRUCIATE	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-425	SUP	Custom 27803010		6479-5-425  -  INSERT TIBIAL XL 25MM LATERAL STABILIZED KINEMAX PLUS DUR	BOTH IP/OP	"$2,265.00 "	"$1,676.10"	$0.00	"$1,812.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.08"	"$1,681.08"	$0.00	$0.00	$472.03	$0.00	$0.00	$0.00	$0.00	"$1,132.50"	"$1,793.88"	"$1,812.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-508	SUP	Custom 27803010		6479-5-508  -  INSERT TIBIAL XS 65X41X8MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-510	SUP	Custom 27803010		6479-5-510  -  INSERT TIBIAL XS 65X41X10MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-512	SUP	Custom 27803010		6479-5-512  -  INSERT TIBIAL XS 65X41X12MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-515	SUP	Custom 27803010		6479-5-515  -  INSERT TIBIAL XS 65X41X15MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-518	SUP	Custom 27803010		6479-5-518  -  INSERT TIBIAL XS 65X41X18MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-521	SUP	Custom 27803010		6479-5-521  -  INSERT TIBIAL XS 65X41X21MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-525	SUP	Custom 27803010		6479-5-525  -  INSERT TIBIAL XS 65X41X25MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-608	SUP	Custom 27803010		6479-5-608  -  INSERT TIBIAL SMALL 70X45X8MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-610	SUP	Custom 27803010		6479-5-610  -  INSERT TIBIAL SMALL 10MM LATERAL STABILIZED KINEMAX PLUS DUR	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-612	SUP	Custom 27803010		6479-5-612  -  INSERT TIBIAL SMALL 12MM LATERAL STABILIZED KINEMAX PLUS DUR	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-615	SUP	Custom 27803010		6479-5-615  -  INSERT TIBIAL SMALL 70X45X15MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-618	SUP	Custom 27803010		6479-5-618  -  INSERT TIBIAL SMALL 70X45X18MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-621	SUP	Custom 27803010		6479-5-621  -  INSERT TIBIAL SMALL 70X45X21MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-625	SUP	Custom 27803010		6479-5-625  -  INSERT TIBIAL SMALL 70X45X25MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-708	SUP	Custom 27803010		6479-5-708  -  INSERT TIBIAL MEDIUM 76X48X8MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-710	SUP	Custom 27803010		6479-5-710  -  INSERT TIBIAL MEDIUM 76X48X10MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-712	SUP	Custom 27803010		6479-5-712  -  INSERT TIBIAL MEDIUM 76X48X12MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-715	SUP	Custom 27803010		6479-5-715  -  INSERT TIBIAL MEDIUM 76X48X15MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-718	SUP	Custom 27803010		6479-5-718  -  INSERT TIBIAL MEDIUM 18MM LATERAL STABILIZED KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-721	SUP	Custom 27803010		6479-5-721  -  INSERT TIBIAL MEDIUM 76X48X21MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-725	SUP	Custom 27803010		6479-5-725  -  INSERT TIBIAL MEDIUM 76X48X25MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-808	SUP	Custom 27803010		6479-5-808  -  INSERT TIBIAL LARGE 81X51X8MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-810	SUP	Custom 27803010		6479-5-810  -  INSERT TIBIAL LARGE 81X51X10MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-812	SUP	Custom 27803010		6479-5-812  -  INSERT TIBIAL LARGE 81X51X12MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-815	SUP	Custom 27803010		6479-5-815  -  INSERT TIBIAL LARGE 81X51X15MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-818	SUP	Custom 27803010		6479-5-818  -  INSERT TIBIAL LARGE 81X51X18MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-821	SUP	Custom 27803010		6479-5-821  -  INSERT TIBIAL LARGE 81X51X21MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-825	SUP	Custom 27803010		6479-5-825  -  INSERT TIBIAL LARGE 81X51X25MM POSTERIOR STABILIZE KINEMAX	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-908	SUP	Custom 27803010		6479-5-908  -  INSERT TIBIAL XL 86X54X8MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-910	SUP	Custom 27803010		6479-5-910  -  INSERT TIBIAL XL 86X54X10MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-912	SUP	Custom 27803010		6479-5-912  -  INSERT TIBIAL XL 86X54X12MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-915	SUP	Custom 27803010		6479-5-915  -  INSERT TIBIAL XL 86X54X15MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-918	SUP	Custom 27803010		6479-5-918  -  INSERT TIBIAL XL 86X54X18MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-921	SUP	Custom 27803010		6479-5-921  -  INSERT TIBIAL XL 86X54X21MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6479-5-925	SUP	Custom 27803010		6479-5-925  -  INSERT TIBIAL XL 86X54X25MM POSTERIOR STABILIZE KINEMAX PLUS	BOTH IP/OP	"$2,347.50 "	"$1,737.15"	$0.00	"$1,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,742.31"	"$1,742.31"	$0.00	$0.00	$489.22	$0.00	$0.00	$0.00	$0.00	"$1,173.75"	"$1,859.22"	"$1,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6480-0-050	SUP	HCPCS C1776		6480-0-050  -  COMPONENT FEMORAL XS STABILIZE KINEMAX PLUS KNEE	BOTH IP/OP	"$5,787.50 "	"$4,282.75"	$0.00	"$4,630.00"	"$2,604.38"	"$2,604.38"	$0.00	$0.00	$0.00	"$1,206.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,206.12"	$0.00	"$2,853.24"	"$2,853.24"	$0.00	"$2,893.75"	"$4,583.70"	"$4,630.00"	$0.00		$0.00	$905.74	$0.00	$0.00	$921.37	$0.00	$0.00	$0.00	$0.00	$0.00
6480-0-100	SUP	HCPCS C1776		6480-0-100  -  COMPONENT FEMORAL SMALL STABILIZE KINEMAX PLUS KNEE	BOTH IP/OP	"$5,787.50 "	"$4,282.75"	$0.00	"$4,630.00"	"$2,604.38"	"$2,604.38"	$0.00	$0.00	$0.00	"$1,206.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,206.12"	$0.00	"$2,853.24"	"$2,853.24"	$0.00	"$2,893.75"	"$4,583.70"	"$4,630.00"	$0.00		$0.00	$905.74	$0.00	$0.00	$921.37	$0.00	$0.00	$0.00	$0.00	$0.00
6480-0-150	SUP	HCPCS C1776		6480-0-150  -  COMPONENT FEMORAL MEDIUM STABILIZE KINEMAX PLUS KNEE	BOTH IP/OP	"$5,787.50 "	"$4,282.75"	$0.00	"$4,630.00"	"$2,604.38"	"$2,604.38"	$0.00	$0.00	$0.00	"$1,206.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,206.12"	$0.00	"$2,853.24"	"$2,853.24"	$0.00	"$2,893.75"	"$4,583.70"	"$4,630.00"	$0.00		$0.00	$905.74	$0.00	$0.00	$921.37	$0.00	$0.00	$0.00	$0.00	$0.00
6480-0-200	SUP	HCPCS C1776		6480-0-200  -  COMPONENT FEMORAL LARGE STABILIZE KINEMAX PLUS KNEE	BOTH IP/OP	"$5,787.50 "	"$4,282.75"	$0.00	"$4,630.00"	"$2,604.38"	"$2,604.38"	$0.00	$0.00	$0.00	"$1,206.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,206.12"	$0.00	"$2,853.24"	"$2,853.24"	$0.00	"$2,893.75"	"$4,583.70"	"$4,630.00"	$0.00		$0.00	$905.74	$0.00	$0.00	$921.37	$0.00	$0.00	$0.00	$0.00	$0.00
6480-0-250	SUP	HCPCS C1776		6480-0-250  -  COMPONENT FEMORAL XL STABILIZE KINEMAX PLUS KNEE	BOTH IP/OP	"$5,787.50 "	"$4,282.75"	$0.00	"$4,630.00"	"$2,604.38"	"$2,604.38"	$0.00	$0.00	$0.00	"$1,206.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,206.12"	$0.00	"$2,853.24"	"$2,853.24"	$0.00	"$2,893.75"	"$4,583.70"	"$4,630.00"	$0.00		$0.00	$905.74	$0.00	$0.00	$921.37	$0.00	$0.00	$0.00	$0.00	$0.00
6480-0-300	SUP	HCPCS C1776		6480-0-300  -  COMPONENT FEMORAL 2XL STABILIZE KINEMAX PLUS KNEE	BOTH IP/OP	"$5,787.50 "	"$4,282.75"	$0.00	"$4,630.00"	"$2,604.38"	"$2,604.38"	$0.00	$0.00	$0.00	"$1,206.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,206.12"	$0.00	"$2,853.24"	"$2,853.24"	$0.00	"$2,893.75"	"$4,583.70"	"$4,630.00"	$0.00		$0.00	$905.74	$0.00	$0.00	$921.37	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-100	SUP	HCPCS C1776		6481-1-100  -  COMPONENT FEMORAL XS 60X54MM MODULAR ROTATE HINGE KNEE LEFT	BOTH IP/OP	"$10,780.00 "	"$7,977.20"	$0.00	"$8,624.00"	"$4,851.00"	"$4,851.00"	$0.00	$0.00	$0.00	"$2,246.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,246.55"	$0.00	"$5,314.54"	"$5,314.54"	$0.00	"$5,390.00"	"$8,537.76"	"$8,624.00"	$0.00		$0.00	"$1,687.07"	$0.00	$0.00	"$1,716.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-101	SUP	HCPCS C1776		6481-1-101  -  COMPONENT FEMORAL XS 60X54MM MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$10,780.00 "	"$7,977.20"	$0.00	"$8,624.00"	"$4,851.00"	"$4,851.00"	$0.00	$0.00	$0.00	"$2,246.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,246.55"	$0.00	"$5,314.54"	"$5,314.54"	$0.00	"$5,390.00"	"$8,537.76"	"$8,624.00"	$0.00		$0.00	"$1,687.07"	$0.00	$0.00	"$1,716.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-110	SUP	HCPCS C1776		6481-1-110  -  COMPONENT FEMORAL SMALL 65X55MM MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$10,780.00 "	"$7,977.20"	$0.00	"$8,624.00"	"$4,851.00"	"$4,851.00"	$0.00	$0.00	$0.00	"$2,246.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,246.55"	$0.00	"$5,314.54"	"$5,314.54"	$0.00	"$5,390.00"	"$8,537.76"	"$8,624.00"	$0.00		$0.00	"$1,687.07"	$0.00	$0.00	"$1,716.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-111	SUP	HCPCS C1776		6481-1-111  -  COMPONENT FEMORAL SMALL 65X55MM MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$10,780.00 "	"$7,977.20"	$0.00	"$8,624.00"	"$4,851.00"	"$4,851.00"	$0.00	$0.00	$0.00	"$2,246.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,246.55"	$0.00	"$5,314.54"	"$5,314.54"	$0.00	"$5,390.00"	"$8,537.76"	"$8,624.00"	$0.00		$0.00	"$1,687.07"	$0.00	$0.00	"$1,716.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-120	SUP	HCPCS C1776		6481-1-120  -  COMPONENT FEMORAL MEDIUM 70X61MM MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$10,780.00 "	"$7,977.20"	$0.00	"$8,624.00"	"$4,851.00"	"$4,851.00"	$0.00	$0.00	$0.00	"$2,246.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,246.55"	$0.00	"$5,314.54"	"$5,314.54"	$0.00	"$5,390.00"	"$8,537.76"	"$8,624.00"	$0.00		$0.00	"$1,687.07"	$0.00	$0.00	"$1,716.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-121	SUP	HCPCS C1776		6481-1-121  -  COMPONENT FEMORAL MEDIUM 70X61MM MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$10,780.00 "	"$7,977.20"	$0.00	"$8,624.00"	"$4,851.00"	"$4,851.00"	$0.00	$0.00	$0.00	"$2,246.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,246.55"	$0.00	"$5,314.54"	"$5,314.54"	$0.00	"$5,390.00"	"$8,537.76"	"$8,624.00"	$0.00		$0.00	"$1,687.07"	$0.00	$0.00	"$1,716.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-130	SUP	HCPCS C1776		6481-1-130  -  COMPONENT FEMORAL LARGE 75X64MM MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$10,780.00 "	"$7,977.20"	$0.00	"$8,624.00"	"$4,851.00"	"$4,851.00"	$0.00	$0.00	$0.00	"$2,246.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,246.55"	$0.00	"$5,314.54"	"$5,314.54"	$0.00	"$5,390.00"	"$8,537.76"	"$8,624.00"	$0.00		$0.00	"$1,687.07"	$0.00	$0.00	"$1,716.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-131	SUP	HCPCS C1776		6481-1-131  -  COMPONENT FEMORAL LARGE 75X64MM MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$10,780.00 "	"$7,977.20"	$0.00	"$8,624.00"	"$4,851.00"	"$4,851.00"	$0.00	$0.00	$0.00	"$2,246.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,246.55"	$0.00	"$5,314.54"	"$5,314.54"	$0.00	"$5,390.00"	"$8,537.76"	"$8,624.00"	$0.00		$0.00	"$1,687.07"	$0.00	$0.00	"$1,716.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-140	SUP	HCPCS C1776		6481-1-140  -  COMPONENT FEMORAL XL 80X66MM MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$10,780.00 "	"$7,977.20"	$0.00	"$8,624.00"	"$4,851.00"	"$4,851.00"	$0.00	$0.00	$0.00	"$2,246.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,246.55"	$0.00	"$5,314.54"	"$5,314.54"	$0.00	"$5,390.00"	"$8,537.76"	"$8,624.00"	$0.00		$0.00	"$1,687.07"	$0.00	$0.00	"$1,716.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-141	SUP	HCPCS C1776		6481-1-141  -  COMPONENT FEMORAL XL 80X66MM MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$10,780.00 "	"$7,977.20"	$0.00	"$8,624.00"	"$4,851.00"	"$4,851.00"	$0.00	$0.00	$0.00	"$2,246.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,246.55"	$0.00	"$5,314.54"	"$5,314.54"	$0.00	"$5,390.00"	"$8,537.76"	"$8,624.00"	$0.00		$0.00	"$1,687.07"	$0.00	$0.00	"$1,716.18"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-200	SUP	Custom 27803010		6481-1-200  -  BLOCK AUGMENTATION XS 10MM GMRS FEMORAL DISTAL	BOTH IP/OP	"$1,455.00 "	"$1,076.70"	$0.00	"$1,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,079.90"	"$1,079.90"	$0.00	$0.00	$303.22	$0.00	$0.00	$0.00	$0.00	$727.50	"$1,152.36"	"$1,164.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-210	SUP	Custom 27803010		6481-1-210  -  BLOCK AUGMENTATION SMALL 10MM GMRS FEMORAL DISTAL	BOTH IP/OP	"$1,455.00 "	"$1,076.70"	$0.00	"$1,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,079.90"	"$1,079.90"	$0.00	$0.00	$303.22	$0.00	$0.00	$0.00	$0.00	$727.50	"$1,152.36"	"$1,164.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-220	SUP	Custom 27803010		6481-1-220  -  BLOCK AUGMENTATION MEDIUM 10MM GMRS FEMORAL DISTAL	BOTH IP/OP	"$1,455.00 "	"$1,076.70"	$0.00	"$1,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,079.90"	"$1,079.90"	$0.00	$0.00	$303.22	$0.00	$0.00	$0.00	$0.00	$727.50	"$1,152.36"	"$1,164.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-230	SUP	Custom 27803010		6481-1-230  -  BLOCK AUGMENTATION LARGE 10MM GMRS FEMORAL DISTAL	BOTH IP/OP	"$1,455.00 "	"$1,076.70"	$0.00	"$1,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,079.90"	"$1,079.90"	$0.00	$0.00	$303.22	$0.00	$0.00	$0.00	$0.00	$727.50	"$1,152.36"	"$1,164.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-1-240	SUP	Custom 27803010		6481-1-240  -  BLOCK AUGMENTATION XL 10MM GMRS FEMORAL DISTAL	BOTH IP/OP	"$1,455.00 "	"$1,076.70"	$0.00	"$1,164.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,079.90"	"$1,079.90"	$0.00	$0.00	$303.22	$0.00	$0.00	$0.00	$0.00	$727.50	"$1,152.36"	"$1,164.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-2-100	SUP	HCPCS C1776		6481-2-100  -  COMPONENT TIB XS-XL MNGR MDLR ROT HNG KN	BOTH IP/OP	"$6,265.00 "	"$4,636.10"	$0.00	"$5,012.00"	"$2,819.25"	"$2,819.25"	$0.00	$0.00	$0.00	"$1,305.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,305.63"	$0.00	"$3,088.65"	"$3,088.65"	$0.00	"$3,132.50"	"$4,961.88"	"$5,012.00"	$0.00		$0.00	$980.47	$0.00	$0.00	$997.39	$0.00	$0.00	$0.00	$0.00	$0.00
6481-2-101	SUP	HCPCS C1776		6481-2-101  -  COMPONENT TIBIAL LARGE XL MOBILE ROTATE HINGE MRS KNEE	BOTH IP/OP	"$6,265.00 "	"$4,636.10"	$0.00	"$5,012.00"	"$2,819.25"	"$2,819.25"	$0.00	$0.00	$0.00	"$1,305.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,305.63"	$0.00	"$3,088.65"	"$3,088.65"	$0.00	"$3,132.50"	"$4,961.88"	"$5,012.00"	$0.00		$0.00	$980.47	$0.00	$0.00	$997.39	$0.00	$0.00	$0.00	$0.00	$0.00
6481-2-103	SUP	HCPCS C1776		6481-2-103  -  COMPONENT TIBIAL XS LONG XL BEARING CROSSOVER MODULAR ROTATE	BOTH IP/OP	"$6,265.00 "	"$4,636.10"	$0.00	"$5,012.00"	"$2,819.25"	"$2,819.25"	$0.00	$0.00	$0.00	"$1,305.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,305.63"	$0.00	"$3,088.65"	"$3,088.65"	$0.00	"$3,132.50"	"$4,961.88"	"$5,012.00"	$0.00		$0.00	$980.47	$0.00	$0.00	$997.39	$0.00	$0.00	$0.00	$0.00	$0.00
6481-2-104	SUP	HCPCS C1776		6481-2-104  -  COMPONENT TIBIAL XS XL SHORT BEARING CROSSOVER MODULAR	BOTH IP/OP	"$6,265.00 "	"$4,636.10"	$0.00	"$5,012.00"	"$2,819.25"	"$2,819.25"	$0.00	$0.00	$0.00	"$1,305.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,305.63"	$0.00	"$3,088.65"	"$3,088.65"	$0.00	"$3,132.50"	"$4,961.88"	"$5,012.00"	$0.00		$0.00	$980.47	$0.00	$0.00	$997.39	$0.00	$0.00	$0.00	$0.00	$0.00
6481-2-107	SUP	HCPCS C1776		6481-2-107  -  COMPONENT TIBIAL BEARING GMRS ALL POLY PEDIATRIC KNEE	BOTH IP/OP	"$5,752.50 "	"$4,256.85"	$0.00	"$4,602.00"	"$2,588.63"	"$2,588.63"	$0.00	$0.00	$0.00	"$1,198.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.82"	$0.00	"$2,835.98"	"$2,835.98"	$0.00	"$2,876.25"	"$4,555.98"	"$4,602.00"	$0.00		$0.00	$900.27	$0.00	$0.00	$915.80	$0.00	$0.00	$0.00	$0.00	$0.00
6481-2-108	SUP	HCPCS C1776		6481-2-108  -  COMPONENT TIBIAL BEARING CROSSOVER MODULAR ROTATE HINGE MRS	BOTH IP/OP	"$6,265.00 "	"$4,636.10"	$0.00	"$5,012.00"	"$2,819.25"	"$2,819.25"	$0.00	$0.00	$0.00	"$1,305.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,305.63"	$0.00	"$3,088.65"	"$3,088.65"	$0.00	"$3,132.50"	"$4,961.88"	"$5,012.00"	$0.00		$0.00	$980.47	$0.00	$0.00	$997.39	$0.00	$0.00	$0.00	$0.00	$0.00
6481-2-110	SUP	Custom 27803010		6481-2-110  -  BUSHING FEMORAL MODULAR ROTATE HINGE KNEE	BOTH IP/OP	$617.50 	$456.95	$0.00	$494.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$458.31	$458.31	$0.00	$0.00	$128.69	$0.00	$0.00	$0.00	$0.00	$308.75	$489.06	$494.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-2-120	SUP	Custom 27803010		6481-2-120  -  AXLE FEMORAL MODULAR ROTATE HINGE KNEE	BOTH IP/OP	"$2,122.50 "	"$1,570.65"	$0.00	"$1,698.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,575.32"	"$1,575.32"	$0.00	$0.00	$442.33	$0.00	$0.00	$0.00	$0.00	"$1,061.25"	"$1,681.02"	"$1,698.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-2-130	SUP	Custom 27803010		6481-2-130  -  INSERT BUMPER NEUTRAL MODULAR ROTATE HINGE GMRS KNEE	BOTH IP/OP	"$1,272.50 "	$941.65	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.45	$944.45	$0.00	$0.00	$265.19	$0.00	$0.00	$0.00	$0.00	$636.25	"$1,007.82"	"$1,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-2-133	SUP	Custom 27803010		6481-2-133  -  INSERT BUMPER 3D MODULAR ROTATE HINGE GMRS KNEE PROXIMAL	BOTH IP/OP	"$1,272.50 "	$941.65	$0.00	"$1,018.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$944.45	$944.45	$0.00	$0.00	$265.19	$0.00	$0.00	$0.00	$0.00	$636.25	"$1,007.82"	"$1,018.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-2-140	SUP	Custom 27203010		6481-2-140  -  SLEEVE TIBIAL MODULAR ROTATE HINGE KNEE	BOTH IP/OP	"$1,065.00 "	$788.10	$0.00	$852.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$790.44	$790.44	$0.00	$0.00	$221.95	$0.00	$0.00	$0.00	$0.00	$532.50	$843.48	$852.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-2-150	SUP	HCPCS C1776		6481-2-150  -  COMPONENT FEMORAL PACK CROSSLINK GMRS POLYETHYLENE KNEE	BOTH IP/OP	"$3,347.50 "	"$2,477.15"	$0.00	"$2,678.00"	"$1,506.38"	"$1,506.38"	$0.00	$0.00	$0.00	$697.70	"$2,484.51"	"$2,484.51"	$0.00	$0.00	$697.62	$0.00	"$1,650.32"	"$1,650.32"	$0.00	"$1,673.75"	"$2,651.22"	"$2,678.00"	$0.00		$0.00	$523.88	$0.00	$0.00	$532.92	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-110	SUP	HCPCS C1776		6481-3-110  -  BASEPLATE TIB 1 SM MDLR ROT HNG KN	BOTH IP/OP	"$6,730.00 "	"$4,980.20"	$0.00	"$5,384.00"	"$3,028.50"	"$3,028.50"	$0.00	$0.00	$0.00	"$1,402.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,402.53"	$0.00	"$3,317.89"	"$3,317.89"	$0.00	"$3,365.00"	"$5,330.16"	"$5,384.00"	$0.00		$0.00	"$1,053.25"	$0.00	$0.00	"$1,071.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-111	SUP	HCPCS C1776		6481-3-111  -  BASEPLATE TIB 2 SM MDLR ROT HNG KN	BOTH IP/OP	"$6,730.00 "	"$4,980.20"	$0.00	"$5,384.00"	"$3,028.50"	"$3,028.50"	$0.00	$0.00	$0.00	"$1,402.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,402.53"	$0.00	"$3,317.89"	"$3,317.89"	$0.00	"$3,365.00"	"$5,330.16"	"$5,384.00"	$0.00		$0.00	"$1,053.25"	$0.00	$0.00	"$1,071.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-112	SUP	HCPCS C1776		6481-3-112  -  BASEPLATE TIB 2 MED MDLR ROT HNG KN	BOTH IP/OP	"$6,730.00 "	"$4,980.20"	$0.00	"$5,384.00"	"$3,028.50"	"$3,028.50"	$0.00	$0.00	$0.00	"$1,402.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,402.53"	$0.00	"$3,317.89"	"$3,317.89"	$0.00	"$3,365.00"	"$5,330.16"	"$5,384.00"	$0.00		$0.00	"$1,053.25"	$0.00	$0.00	"$1,071.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-113	SUP	HCPCS C1776		6481-3-113  -  BASEPLATE TIB 2 LG MDLR ROT HNG KN	BOTH IP/OP	"$6,730.00 "	"$4,980.20"	$0.00	"$5,384.00"	"$3,028.50"	"$3,028.50"	$0.00	$0.00	$0.00	"$1,402.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,402.53"	$0.00	"$3,317.89"	"$3,317.89"	$0.00	"$3,365.00"	"$5,330.16"	"$5,384.00"	$0.00		$0.00	"$1,053.25"	$0.00	$0.00	"$1,071.42"	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-210	SUP	Custom 27803010		6481-3-210  -  INSERT TIBIAL THK10MM S1 S2 MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$2,367.50 "	"$1,751.95"	$0.00	"$1,894.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.16"	"$1,757.16"	$0.00	$0.00	$493.39	$0.00	$0.00	$0.00	$0.00	"$1,183.75"	"$1,875.06"	"$1,894.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-213	SUP	Custom 27803010		6481-3-213  -  INSERT TIBIAL THK13MM S1 S2 MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$2,367.50 "	"$1,751.95"	$0.00	"$1,894.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.16"	"$1,757.16"	$0.00	$0.00	$493.39	$0.00	$0.00	$0.00	$0.00	"$1,183.75"	"$1,875.06"	"$1,894.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-216	SUP	Custom 27803010		6481-3-216  -  INSERT TIBIAL THK16MM S1 S2 MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$2,367.50 "	"$1,751.95"	$0.00	"$1,894.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.16"	"$1,757.16"	$0.00	$0.00	$493.39	$0.00	$0.00	$0.00	$0.00	"$1,183.75"	"$1,875.06"	"$1,894.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-220	SUP	Custom 27803010		6481-3-220  -  INSERT TIBIAL THK20MM S1 S2 MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$2,367.50 "	"$1,751.95"	$0.00	"$1,894.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.16"	"$1,757.16"	$0.00	$0.00	$493.39	$0.00	$0.00	$0.00	$0.00	"$1,183.75"	"$1,875.06"	"$1,894.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-224	SUP	Custom 27803010		6481-3-224  -  INSERT TIBIAL THK24MM S1 S2 MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$2,367.50 "	"$1,751.95"	$0.00	"$1,894.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.16"	"$1,757.16"	$0.00	$0.00	$493.39	$0.00	$0.00	$0.00	$0.00	"$1,183.75"	"$1,875.06"	"$1,894.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-310	SUP	Custom 27803010		6481-3-310  -  INSERT TIBIAL MEDIUM LARGE M2 2 10MM BEARING MODULAR	BOTH IP/OP	"$2,387.50 "	"$1,766.75"	$0.00	"$1,910.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,772.00"	"$1,772.00"	$0.00	$0.00	$497.56	$0.00	$0.00	$0.00	$0.00	"$1,193.75"	"$1,890.90"	"$1,910.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-313	SUP	Custom 27803010		6481-3-313  -  INSERT TIBIAL THK13MM M2 2 BEARING MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$2,387.50 "	"$1,766.75"	$0.00	"$1,910.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,772.00"	"$1,772.00"	$0.00	$0.00	$497.56	$0.00	$0.00	$0.00	$0.00	"$1,193.75"	"$1,890.90"	"$1,910.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-316	SUP	Custom 27803010		6481-3-316  -  INSERT TIBIAL THK16MM M2 2 BEARING MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$2,387.50 "	"$1,766.75"	$0.00	"$1,910.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,772.00"	"$1,772.00"	$0.00	$0.00	$497.56	$0.00	$0.00	$0.00	$0.00	"$1,193.75"	"$1,890.90"	"$1,910.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-320	SUP	Custom 27803010		6481-3-320  -  INSERT TIBIAL THK20MM M2 2 BEARING MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$2,387.50 "	"$1,766.75"	$0.00	"$1,910.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,772.00"	"$1,772.00"	$0.00	$0.00	$497.56	$0.00	$0.00	$0.00	$0.00	"$1,193.75"	"$1,890.90"	"$1,910.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6481-3-324	SUP	Custom 27803010		6481-3-324  -  INSERT TIBIAL THK24MM M2 2 BEARING MODULAR ROTATE HINGE GMRS	BOTH IP/OP	"$2,387.50 "	"$1,766.75"	$0.00	"$1,910.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,772.00"	"$1,772.00"	$0.00	$0.00	$497.56	$0.00	$0.00	$0.00	$0.00	"$1,193.75"	"$1,890.90"	"$1,910.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-020	SUP	HCPCS C1776		6485-0-020  -  CMPNT FEM CNDYLR RIGHT MDLR ROT HNG MRS	BOTH IP/OP	"$14,192.75 "	"$10,502.64"	$0.00	"$11,354.20"	"$6,386.74"	"$6,386.74"	$0.00	$0.00	$0.00	"$2,958.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.77"	$0.00	"$6,997.03"	"$6,997.03"	$0.00	"$7,096.38"	"$11,240.66"	"$11,354.20"	$0.00		$0.00	"$2,221.17"	$0.00	$0.00	"$2,259.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-025	SUP	HCPCS C1776		6485-0-025  -  STEM FEM 75MM CNDYLR MRH MRS SM LEFT PRD	BOTH IP/OP	"$14,192.75 "	"$10,502.64"	$0.00	"$11,354.20"	"$6,386.74"	"$6,386.74"	$0.00	$0.00	$0.00	"$2,958.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.77"	$0.00	"$6,997.03"	"$6,997.03"	$0.00	"$7,096.38"	"$11,240.66"	"$11,354.20"	$0.00		$0.00	"$2,221.17"	$0.00	$0.00	"$2,259.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-045	SUP	HCPCS C1776		6485-0-045  -  CMPNT FEM SM 85MM LEFT CNDYLR MRS	BOTH IP/OP	"$14,192.75 "	"$10,502.64"	$0.00	"$11,354.20"	"$6,386.74"	"$6,386.74"	$0.00	$0.00	$0.00	"$2,958.12"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,957.77"	$0.00	"$6,997.03"	"$6,997.03"	$0.00	"$7,096.38"	"$11,240.66"	"$11,354.20"	$0.00		$0.00	"$2,221.17"	$0.00	$0.00	"$2,259.49"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-050	SUP	HCPCS C1776		6485-0-050  -  CMPNT FEM XS LEFT REV STAB KMX+	BOTH IP/OP	"$5,216.00 "	"$3,859.84"	$0.00	"$4,172.80"	"$2,347.20"	"$2,347.20"	$0.00	$0.00	$0.00	"$1,087.14"	"$3,871.32"	"$3,871.32"	$0.00	$0.00	"$1,087.01"	$0.00	"$2,571.49"	"$2,571.49"	$0.00	"$2,608.00"	"$4,131.07"	"$4,172.80"	$0.00		$0.00	$816.30	$0.00	$0.00	$830.39	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-060	SUP	HCPCS C1776		6485-0-060  -  CMPNT FEM XS RIGHT REV STAB KNMX PLUS	BOTH IP/OP	"$5,189.00 "	"$3,839.86"	$0.00	"$4,151.20"	"$2,335.05"	"$2,335.05"	$0.00	$0.00	$0.00	"$1,081.52"	"$3,851.28"	"$3,851.28"	$0.00	$0.00	"$1,081.39"	$0.00	"$2,558.18"	"$2,558.18"	$0.00	"$2,594.50"	"$4,109.69"	"$4,151.20"	$0.00		$0.00	$812.08	$0.00	$0.00	$826.09	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-075	SUP	HCPCS C1776		6485-0-075  -  CMPNT FEM SM 95MM RIGHT CNDYLR MRS	BOTH IP/OP	"$10,856.63 "	"$8,033.91"	$0.00	"$8,685.30"	"$4,885.48"	"$4,885.48"	$0.00	$0.00	$0.00	"$2,262.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,262.52"	$0.00	"$5,352.32"	"$5,352.32"	$0.00	"$5,428.31"	"$8,598.45"	"$8,685.30"	$0.00		$0.00	"$1,699.06"	$0.00	$0.00	"$1,728.37"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-100	SUP	HCPCS C1776		6485-0-100  -  CMPNT FEM SM LEFT REV STAB KMX+	BOTH IP/OP	"$5,407.00 "	"$4,001.18"	$0.00	"$4,325.60"	"$2,433.15"	"$2,433.15"	$0.00	$0.00	$0.00	"$1,126.95"	"$4,013.08"	"$4,013.08"	$0.00	$0.00	"$1,126.82"	$0.00	"$2,665.65"	"$2,665.65"	$0.00	"$2,703.50"	"$4,282.34"	"$4,325.60"	$0.00		$0.00	$846.20	$0.00	$0.00	$860.79	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-110	SUP	HCPCS C1776		6485-0-110  -  CMPNT FEM SM RIGHT REV STAB KMX+	BOTH IP/OP	"$5,189.00 "	"$3,839.86"	$0.00	"$4,151.20"	"$2,335.05"	"$2,335.05"	$0.00	$0.00	$0.00	"$1,081.52"	"$3,851.28"	"$3,851.28"	$0.00	$0.00	"$1,081.39"	$0.00	"$2,558.18"	"$2,558.18"	$0.00	"$2,594.50"	"$4,109.69"	"$4,151.20"	$0.00		$0.00	$812.08	$0.00	$0.00	$826.09	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-150	SUP	HCPCS C1776		6485-0-150  -  CMPNT FEM MED LEFT REV STAB KMX+	BOTH IP/OP	"$5,407.00 "	"$4,001.18"	$0.00	"$4,325.60"	"$2,433.15"	"$2,433.15"	$0.00	$0.00	$0.00	"$1,126.95"	"$4,013.08"	"$4,013.08"	$0.00	$0.00	"$1,126.82"	$0.00	"$2,665.65"	"$2,665.65"	$0.00	"$2,703.50"	"$4,282.34"	"$4,325.60"	$0.00		$0.00	$846.20	$0.00	$0.00	$860.79	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-160	SUP	HCPCS C1776		6485-0-160  -  CMPNT FEM MED RIGHT REV STAB KMX+	BOTH IP/OP	"$5,407.00 "	"$4,001.18"	$0.00	"$4,325.60"	"$2,433.15"	"$2,433.15"	$0.00	$0.00	$0.00	"$1,126.95"	"$4,013.08"	"$4,013.08"	$0.00	$0.00	"$1,126.82"	$0.00	"$2,665.65"	"$2,665.65"	$0.00	"$2,703.50"	"$4,282.34"	"$4,325.60"	$0.00		$0.00	$846.20	$0.00	$0.00	$860.79	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-200	SUP	HCPCS C1776		6485-0-200  -  CMPNT FEM LG LEFT REV STAB KMX+	BOTH IP/OP	"$5,407.00 "	"$4,001.18"	$0.00	"$4,325.60"	"$2,433.15"	"$2,433.15"	$0.00	$0.00	$0.00	"$1,126.95"	"$4,013.08"	"$4,013.08"	$0.00	$0.00	"$1,126.82"	$0.00	"$2,665.65"	"$2,665.65"	$0.00	"$2,703.50"	"$4,282.34"	"$4,325.60"	$0.00		$0.00	$846.20	$0.00	$0.00	$860.79	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-210	SUP	HCPCS C1776		6485-0-210  -  CMPNT FEM LG RIGHT REV STAB KMX+	BOTH IP/OP	"$5,407.00 "	"$4,001.18"	$0.00	"$4,325.60"	"$2,433.15"	"$2,433.15"	$0.00	$0.00	$0.00	"$1,126.95"	"$4,013.08"	"$4,013.08"	$0.00	$0.00	"$1,126.82"	$0.00	"$2,665.65"	"$2,665.65"	$0.00	"$2,703.50"	"$4,282.34"	"$4,325.60"	$0.00		$0.00	$846.20	$0.00	$0.00	$860.79	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-250	SUP	HCPCS C1776		6485-0-250  -  CMPNT FEM XL LEFT KNEE MDLR STABLILZED ASMBLY KMX+ LATEX	BOTH IP/OP	"$5,407.00 "	"$4,001.18"	$0.00	"$4,325.60"	"$2,433.15"	"$2,433.15"	$0.00	$0.00	$0.00	"$1,126.95"	"$4,013.08"	"$4,013.08"	$0.00	$0.00	"$1,126.82"	$0.00	"$2,665.65"	"$2,665.65"	$0.00	"$2,703.50"	"$4,282.34"	"$4,325.60"	$0.00		$0.00	$846.20	$0.00	$0.00	$860.79	$0.00	$0.00	$0.00	$0.00	$0.00
6485-0-260	SUP	HCPCS C1776		6485-0-260  -  CMPNT FEM XL RIGHT REV STAB KMX+	BOTH IP/OP	"$4,552.00 "	"$3,368.48"	$0.00	"$3,641.60"	"$2,048.40"	"$2,048.40"	$0.00	$0.00	$0.00	$948.75	"$3,378.49"	"$3,378.49"	$0.00	$0.00	$948.64	$0.00	"$2,244.14"	"$2,244.14"	$0.00	"$2,276.00"	"$3,605.18"	"$3,641.60"	$0.00		$0.00	$712.39	$0.00	$0.00	$724.68	$0.00	$0.00	$0.00	$0.00	$0.00
6485-1-915	SUP	Custom 27803010		6485-1-915  -  COMPONENT PATLR SMALL ROTATE HINGE KRH DUR	BOTH IP/OP	"$1,705.00 "	"$1,261.70"	$0.00	"$1,364.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,265.45"	"$1,265.45"	$0.00	$0.00	$355.32	$0.00	$0.00	$0.00	$0.00	$852.50	"$1,350.36"	"$1,364.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-008	SUP	HCPCS C1776		6485-2-008  -  INSERT TIBIAL XS 8MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-011	SUP	HCPCS C1776		6485-2-011  -  INSERT TIBIAL XS 11MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-016	SUP	HCPCS C1776		6485-2-016  -  INSERT TIBIAL XS 16MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-021	SUP	HCPCS C1776		6485-2-021  -  INSERT TIBIAL XS 21MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-108	SUP	HCPCS C1776		6485-2-108  -  INSERT TIBIAL SMALL 8MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-111	SUP	HCPCS C1776		6485-2-111  -  INSERT TIBIAL SMALL 11MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-116	SUP	HCPCS C1776		6485-2-116  -  INSERT TIBIAL SMALL 16MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-121	SUP	HCPCS C1776		6485-2-121  -  INSERT TIBIAL SMALL 21MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-208	SUP	HCPCS C1776		6485-2-208  -  INSERT TIBIAL MEDIUM 8MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-211	SUP	HCPCS C1776		6485-2-211  -  COMPONENT TIBIAL MEDIUM 11MM ROTATING HINGE KRH ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-216	SUP	HCPCS C1776		6485-2-216  -  INSERT TIBIAL MEDIUM 16MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-221	SUP	HCPCS C1776		6485-2-221  -  INSERT TIBIAL MEDIUM 21MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-308	SUP	HCPCS C1776		6485-2-308  -  INSERT TIBIAL LARGE 8MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-311	SUP	HCPCS C1776		6485-2-311  -  INSERT TIBIAL LARGE 11MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-316	SUP	HCPCS C1776		6485-2-316  -  INSERT TIBIAL LARGE 16MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-321	SUP	HCPCS C1776		6485-2-321  -  INSERT TIBIAL LARGE 21MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-408	SUP	HCPCS C1776		6485-2-408  -  INSERT TIBIAL XL 8MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-411	SUP	HCPCS C1776		6485-2-411  -  INSERT TIBIAL XL 11MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-416	SUP	HCPCS C1776		6485-2-416  -  INSERT TIBIAL XL 16MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-421	SUP	HCPCS C1776		6485-2-421  -  INSERT TIBIAL XL 21MM GMRS ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-460	SUP	Custom 27803010		6485-2-460  -  BUSHING FEMORAL STANDARD ROTATE HINGE KINEMATIC DUR	BOTH IP/OP	$632.50 	$468.05	$0.00	$506.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$469.44	$469.44	$0.00	$0.00	$131.81	$0.00	$0.00	$0.00	$0.00	$316.25	$500.94	$506.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-465	SUP	Custom 27803010		6485-2-465  -  BUSHING FEMORAL SMALL ROTATE HINGE KINEMATIC DUR	BOTH IP/OP	$632.50 	$468.05	$0.00	$506.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$469.44	$469.44	$0.00	$0.00	$131.81	$0.00	$0.00	$0.00	$0.00	$316.25	$500.94	$506.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-508	SUP	HCPCS C1776		6485-2-508  -  INSERT TIBIAL 3XS 8MM MRS POLYETHYLENE KNEE	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-511	SUP	HCPCS C1776		6485-2-511  -  COMPONENT TIBIAL 3XS PT1 11MM MRS MRH KRH DUR	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-608	SUP	HCPCS C1776		6485-2-608  -  INSERT TIBIAL 2XS 8MM MRS POLYETHYLENE KNEE	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-2-611	SUP	HCPCS C1776		6485-2-611  -  COMPONENT TIBIAL 2XS PT2 11MM KRH ALL POLY	BOTH IP/OP	"$3,142.50 "	"$2,325.45"	$0.00	"$2,514.00"	"$1,414.13"	"$1,414.13"	$0.00	$0.00	$0.00	$654.98	"$2,332.36"	"$2,332.36"	$0.00	$0.00	$654.90	$0.00	"$1,549.25"	"$1,549.25"	$0.00	"$1,571.25"	"$2,488.86"	"$2,514.00"	$0.00		$0.00	$491.80	$0.00	$0.00	$500.29	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-000	SUP	HCPCS C1776		6485-3-000  -  STEM FEMORAL SMALL 10MM 102MM MRS HIP	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-008	SUP	HCPCS C1776		6485-3-008  -  STEM FEMORAL SMALL 8MM 102MM MRS HIP	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-009	SUP	HCPCS C1776		6485-3-009  -  STEM FEMORAL SMALL 9MM 102MM MRS HIP	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-010	SUP	HCPCS C1776		6485-3-010  -  STEM FEMORAL SMALL 10MM 102MM MRS HIP	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-011	SUP	HCPCS C1776		6485-3-011  -  STEM FEMORAL STANDARD STR 11MM 127MM CEMENTED BODY SECTION	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-013	SUP	HCPCS C1776		6485-3-013  -  STEM FEMORAL STANDARD STR 13MM 127MM CEMENTED BODY SECTION	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-015	SUP	HCPCS C1776		6485-3-015  -  STEM FEMORAL STANDARD 15MM 127MM MODULAR ROTATE HINGE MRS	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-017	SUP	HCPCS C1776		6485-3-017  -  STEM FEMORAL 17MM 127MM CEMENTED BODY SECTION MRS HIP	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-018	SUP	HCPCS C1776		6485-3-018  -  STEM FEMORAL SMALL 8MM 102MM MRS HIP	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-019	SUP	HCPCS C1776		6485-3-019  -  STEM FEMORAL SMALL 9MM 102MM MRS HIP	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-111	SUP	HCPCS C1776		6485-3-111  -  STEM FEMORAL 11MM 127MM MRS KNEE	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-113	SUP	HCPCS C1776		6485-3-113  -  STEM FEMORAL STR 13MM 127MM CEMENTED BODY SECTION GMRS HIP	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-115	SUP	HCPCS C1776		6485-3-115  -  STEM FEMORAL STR 15MM 127MM CEMENTED BODY SECTION MRS KNEE	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-117	SUP	HCPCS C1776		6485-3-117  -  STEM FEMORAL 17MM 127MM MRS KNEE	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-211	SUP	HCPCS C1776		6485-3-211  -  STEM FEMORAL TAPER 11MM 127MM MRS HIP	BOTH IP/OP	"$5,275.00 "	"$3,903.50"	$0.00	"$4,220.00"	"$2,373.75"	"$2,373.75"	$0.00	$0.00	$0.00	"$1,099.44"	"$3,915.11"	"$3,915.11"	$0.00	$0.00	"$1,099.31"	$0.00	"$2,600.58"	"$2,600.58"	$0.00	"$2,637.50"	"$4,177.80"	"$4,220.00"	$0.00		$0.00	$825.54	$0.00	$0.00	$839.78	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-213	SUP	HCPCS C1776		6485-3-213  -  STEM FEMORAL TAPER 13MM 127MM MRS HIP	BOTH IP/OP	"$5,275.00 "	"$3,903.50"	$0.00	"$4,220.00"	"$2,373.75"	"$2,373.75"	$0.00	$0.00	$0.00	"$1,099.44"	"$3,915.11"	"$3,915.11"	$0.00	$0.00	"$1,099.31"	$0.00	"$2,600.58"	"$2,600.58"	$0.00	"$2,637.50"	"$4,177.80"	"$4,220.00"	$0.00		$0.00	$825.54	$0.00	$0.00	$839.78	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-215	SUP	HCPCS C1776		6485-3-215  -  STEM FEMORAL TAPER 15MM 127MM MRS HIP	BOTH IP/OP	"$5,275.00 "	"$3,903.50"	$0.00	"$4,220.00"	"$2,373.75"	"$2,373.75"	$0.00	$0.00	$0.00	"$1,099.44"	"$3,915.11"	"$3,915.11"	$0.00	$0.00	"$1,099.31"	$0.00	"$2,600.58"	"$2,600.58"	$0.00	"$2,637.50"	"$4,177.80"	"$4,220.00"	$0.00		$0.00	$825.54	$0.00	$0.00	$839.78	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-217	SUP	HCPCS C1776		6485-3-217  -  STEM FEMORAL TAPER 17MM 127MM MRS HIP	BOTH IP/OP	"$5,275.00 "	"$3,903.50"	$0.00	"$4,220.00"	"$2,373.75"	"$2,373.75"	$0.00	$0.00	$0.00	"$1,099.44"	"$3,915.11"	"$3,915.11"	$0.00	$0.00	"$1,099.31"	$0.00	"$2,600.58"	"$2,600.58"	$0.00	"$2,637.50"	"$4,177.80"	"$4,220.00"	$0.00		$0.00	$825.54	$0.00	$0.00	$839.78	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-300	SUP	HCPCS C1776		6485-3-300  -  STEM FEMORAL SMALL CURVE 10MM 102MM MRS HIP	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-308	SUP	HCPCS C1776		6485-3-308  -  STEM FEMORAL SMALL CURVE 8MM 102MM MRS HIP	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-309	SUP	HCPCS C1776		6485-3-309  -  STEM FEMORAL SMALL CURVE 9MM 102MM MRS HIP	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-310	SUP	HCPCS C1776		6485-3-310  -  STEM FEMORAL SMALL CURVE 10MM 102MM MRS KNEE	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-311	SUP	HCPCS C1776		6485-3-311  -  STEM FEMORAL 11MM 203MM MRS KNEE	BOTH IP/OP	"$10,430.00 "	"$7,718.20"	$0.00	"$8,344.00"	"$4,693.50"	"$4,693.50"	$0.00	$0.00	$0.00	"$2,173.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,173.61"	$0.00	"$5,141.99"	"$5,141.99"	$0.00	"$5,215.00"	"$8,260.56"	"$8,344.00"	$0.00		$0.00	"$1,632.30"	$0.00	$0.00	"$1,660.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-313	SUP	HCPCS C1776		6485-3-313  -  STEM FEMORAL LONG BOW 13MM 203MM CEMENTED BODY SECTION GMRS	BOTH IP/OP	"$10,430.00 "	"$7,718.20"	$0.00	"$8,344.00"	"$4,693.50"	"$4,693.50"	$0.00	$0.00	$0.00	"$2,173.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,173.61"	$0.00	"$5,141.99"	"$5,141.99"	$0.00	"$5,215.00"	"$8,260.56"	"$8,344.00"	$0.00		$0.00	"$1,632.30"	$0.00	$0.00	"$1,660.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-315	SUP	HCPCS C1776		6485-3-315  -  STEM FEMORAL LONG BOW 15MM 203MM CEMENTED BODY SECTION GMRS	BOTH IP/OP	"$10,430.00 "	"$7,718.20"	$0.00	"$8,344.00"	"$4,693.50"	"$4,693.50"	$0.00	$0.00	$0.00	"$2,173.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,173.61"	$0.00	"$5,141.99"	"$5,141.99"	$0.00	"$5,215.00"	"$8,260.56"	"$8,344.00"	$0.00		$0.00	"$1,632.30"	$0.00	$0.00	"$1,660.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-317	SUP	HCPCS C1776		6485-3-317  -  STEM FEMORAL 17MM 203MM MRS KNEE	BOTH IP/OP	"$10,430.00 "	"$7,718.20"	$0.00	"$8,344.00"	"$4,693.50"	"$4,693.50"	$0.00	$0.00	$0.00	"$2,173.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,173.61"	$0.00	"$5,141.99"	"$5,141.99"	$0.00	"$5,215.00"	"$8,260.56"	"$8,344.00"	$0.00		$0.00	"$1,632.30"	$0.00	$0.00	"$1,660.46"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-318	SUP	HCPCS C1776		6485-3-318  -  STEM FEMORAL SMALL CURVE 8MM 102MM MRS HIP	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-319	SUP	HCPCS C1776		6485-3-319  -  STEM FEMORAL SMALL CURVE 9MM 102MM MRS HIP	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-611	SUP	HCPCS C1776		6485-3-611  -  STEM FEMORAL LONG CURVE 11MM 203MM CEMENTED BODY SECTION	BOTH IP/OP	"$8,115.00 "	"$6,005.10"	$0.00	"$6,492.00"	"$3,651.75"	"$3,651.75"	$0.00	$0.00	$0.00	"$1,691.37"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,691.17"	$0.00	"$4,000.70"	"$4,000.70"	$0.00	"$4,057.50"	"$6,427.08"	"$6,492.00"	$0.00		$0.00	"$1,270.00"	$0.00	$0.00	"$1,291.91"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-613	SUP	HCPCS C1776		6485-3-613  -  STEM FEMORAL LONG CURVE 13MM 203MM CEMENT GMRS HIP DISTAL	BOTH IP/OP	"$8,115.00 "	"$6,005.10"	$0.00	"$6,492.00"	"$3,651.75"	"$3,651.75"	$0.00	$0.00	$0.00	"$1,691.37"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,691.17"	$0.00	"$4,000.70"	"$4,000.70"	$0.00	"$4,057.50"	"$6,427.08"	"$6,492.00"	$0.00		$0.00	"$1,270.00"	$0.00	$0.00	"$1,291.91"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-615	SUP	HCPCS C1776		6485-3-615  -  STEM FEMORAL LONG BOW CURVE 15MM 203MM CEMENTED BODY SECTION	BOTH IP/OP	"$8,115.00 "	"$6,005.10"	$0.00	"$6,492.00"	"$3,651.75"	"$3,651.75"	$0.00	$0.00	$0.00	"$1,691.37"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,691.17"	$0.00	"$4,000.70"	"$4,000.70"	$0.00	"$4,057.50"	"$6,427.08"	"$6,492.00"	$0.00		$0.00	"$1,270.00"	$0.00	$0.00	"$1,291.91"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-617	SUP	HCPCS C1776		6485-3-617  -  STEM FEMORAL LONG BOW 17MM 203MM CEMENTED BODY SECTION GMRS	BOTH IP/OP	"$8,115.00 "	"$6,005.10"	$0.00	"$6,492.00"	"$3,651.75"	"$3,651.75"	$0.00	$0.00	$0.00	"$1,691.37"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,691.17"	$0.00	"$4,000.70"	"$4,000.70"	$0.00	"$4,057.50"	"$6,427.08"	"$6,492.00"	$0.00		$0.00	"$1,270.00"	$0.00	$0.00	"$1,291.91"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-711	SUP	HCPCS C1776		6485-3-711  -  STEM FEMORAL CURVE 11MM 127MM MRS KNEE	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-713	SUP	HCPCS C1776		6485-3-713  -  STEM FEMORAL CURVE 13MM 127MM MRS KNEE	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-715	SUP	HCPCS C1776		6485-3-715  -  STEM FEMORAL CURVE 15MM 127MM MRS KNEE	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-717	SUP	HCPCS C1776		6485-3-717  -  STEM FEMORAL CURVE 17MM 127MM MRS HIP	BOTH IP/OP	"$7,977.50 "	"$5,903.35"	$0.00	"$6,382.00"	"$3,589.88"	"$3,589.88"	$0.00	$0.00	$0.00	"$1,662.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,662.51"	$0.00	"$3,932.91"	"$3,932.91"	$0.00	"$3,988.75"	"$6,318.18"	"$6,382.00"	$0.00		$0.00	"$1,248.48"	$0.00	$0.00	"$1,270.02"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-811	SUP	HCPCS C1776		6485-3-811  -  STEM FEMORAL CURVE 11MM 127MM MRS KNEE	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-813	SUP	HCPCS C1776		6485-3-813  -  STEM FEMORAL CURVE 13MM 127MM MRS KNEE	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-815	SUP	HCPCS C1776		6485-3-815  -  STEM FEMORAL CURVE 15MM 127MM MRS HIP	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-817	SUP	HCPCS C1776		6485-3-817  -  STEM FEMORAL CURVE 17MM 127MM MRS HIP	BOTH IP/OP	"$5,780.00 "	"$4,277.20"	$0.00	"$4,624.00"	"$2,601.00"	"$2,601.00"	$0.00	$0.00	$0.00	"$1,204.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,204.55"	$0.00	"$2,849.54"	"$2,849.54"	$0.00	"$2,890.00"	"$4,577.76"	"$4,624.00"	$0.00		$0.00	$904.57	$0.00	$0.00	$920.18	$0.00	$0.00	$0.00	$0.00	$0.00
6485-3-915	SUP	Custom 27803010		6485-3-915  -  COMPONENT PATLR MEDIUM ROTATE HINGE KRH DUR	BOTH IP/OP	"$1,705.00 "	"$1,261.70"	$0.00	"$1,364.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,265.45"	"$1,265.45"	$0.00	$0.00	$355.32	$0.00	$0.00	$0.00	$0.00	$852.50	"$1,350.36"	"$1,364.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-4-100	SUP	Custom 27803010		6485-4-100  -  COMPONENT FEMORAL STANDARD 10MM ROTATE HINGE BUMPER	BOTH IP/OP	"$1,282.50 "	$949.05	$0.00	"$1,026.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$951.87	$951.87	$0.00	$0.00	$267.27	$0.00	$0.00	$0.00	$0.00	$641.25	"$1,015.74"	"$1,026.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-4-111	SUP	Custom 27803010		6485-4-111  -  INSERT TIBIAL SMALL 11MM MRS DUR METASUL KNEE ENCAPSULATE	BOTH IP/OP	"$3,120.00 "	"$2,308.80"	$0.00	"$2,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,315.66"	"$2,315.66"	$0.00	$0.00	$650.21	$0.00	$0.00	$0.00	$0.00	"$1,560.00"	"$2,471.04"	"$2,496.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-4-113	SUP	Custom 27803010		6485-4-113  -  INSERT TIBIAL SMALL 13MM MRS DUR METASUL KNEE ENCAPSULATE	BOTH IP/OP	"$3,120.00 "	"$2,308.80"	$0.00	"$2,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,315.66"	"$2,315.66"	$0.00	$0.00	$650.21	$0.00	$0.00	$0.00	$0.00	"$1,560.00"	"$2,471.04"	"$2,496.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-4-116	SUP	Custom 27803010		6485-4-116  -  INSERT TIBIAL SMALL 16MM MRS DUR KNEE ENCAP	BOTH IP/OP	"$3,120.00 "	"$2,308.80"	$0.00	"$2,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,315.66"	"$2,315.66"	$0.00	$0.00	$650.21	$0.00	$0.00	$0.00	$0.00	"$1,560.00"	"$2,471.04"	"$2,496.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-4-121	SUP	Custom 27803010		6485-4-121  -  INSERT TIBIAL SMALL 21MM MRS DUR KNEE ENCAP	BOTH IP/OP	"$3,120.00 "	"$2,308.80"	$0.00	"$2,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,315.66"	"$2,315.66"	$0.00	$0.00	$650.21	$0.00	$0.00	$0.00	$0.00	"$1,560.00"	"$2,471.04"	"$2,496.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-4-125	SUP	Custom 27803010		6485-4-125  -  INSERT TIBIAL 12.5MM BUMPER KRH DUR KNEE	BOTH IP/OP	"$1,282.50 "	$949.05	$0.00	"$1,026.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$951.87	$951.87	$0.00	$0.00	$267.27	$0.00	$0.00	$0.00	$0.00	$641.25	"$1,015.74"	"$1,026.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-4-145	SUP	Custom 27803010		6485-4-145  -  INSERT TIBIAL 14.5MM 14.5MM BUMPER MRS MRH KRH DUR	BOTH IP/OP	"$1,282.50 "	$949.05	$0.00	"$1,026.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$951.87	$951.87	$0.00	$0.00	$267.27	$0.00	$0.00	$0.00	$0.00	$641.25	"$1,015.74"	"$1,026.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-4-160	SUP	Custom 27803010		6485-4-160  -  INSERT TIBIAL 16MM BUMPER KRH DUR KNEE	BOTH IP/OP	"$1,282.50 "	$949.05	$0.00	"$1,026.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$951.87	$951.87	$0.00	$0.00	$267.27	$0.00	$0.00	$0.00	$0.00	$641.25	"$1,015.74"	"$1,026.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-4-211	SUP	Custom 27803010		6485-4-211  -  INSERT TIBIAL MEDIUM 11MM MRS DUR KNEE ENCAP	BOTH IP/OP	"$3,120.00 "	"$2,308.80"	$0.00	"$2,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,315.66"	"$2,315.66"	$0.00	$0.00	$650.21	$0.00	$0.00	$0.00	$0.00	"$1,560.00"	"$2,471.04"	"$2,496.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-4-213	SUP	Custom 27803010		6485-4-213  -  INSERT TIBIAL MEDIUM 13MM MRS DUR KNEE ENCAP	BOTH IP/OP	"$3,120.00 "	"$2,308.80"	$0.00	"$2,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,315.66"	"$2,315.66"	$0.00	$0.00	$650.21	$0.00	$0.00	$0.00	$0.00	"$1,560.00"	"$2,471.04"	"$2,496.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-4-216	SUP	Custom 27803010		6485-4-216  -  INSERT TIBIAL MEDIUM 16MM MRS DUR KNEE ENCAP	BOTH IP/OP	"$3,120.00 "	"$2,308.80"	$0.00	"$2,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,315.66"	"$2,315.66"	$0.00	$0.00	$650.21	$0.00	$0.00	$0.00	$0.00	"$1,560.00"	"$2,471.04"	"$2,496.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-4-221	SUP	Custom 27803010		6485-4-221  -  INSERT TIBIAL MEDIUM 21MM MRS DUR KNEE ENCAP	BOTH IP/OP	"$3,120.00 "	"$2,308.80"	$0.00	"$2,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,315.66"	"$2,315.66"	$0.00	$0.00	$650.21	$0.00	$0.00	$0.00	$0.00	"$1,560.00"	"$2,471.04"	"$2,496.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-010	SUP	Custom 27803010		6485-5-010  -  SPACER FEM 10MM KMX+ LCK SCR	BOTH IP/OP	$98.00 	$72.52	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.74	$72.74	$0.00	$0.00	$20.42	$0.00	$0.00	$0.00	$0.00	$49.00	$77.62	$78.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-050	SUP	Custom 27803010		6485-5-050  -  SPACER FEM 5MM KNMX XS LEFT DISTAL MDL	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$0.00	$0.00	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-051	SUP	Custom 27803010		6485-5-051  -  SPACER FEM 10MM KNMX XS LEFT DISTAL MDL	BOTH IP/OP	$687.00 	$508.38	$0.00	$549.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$509.89	$509.89	$0.00	$0.00	$143.17	$0.00	$0.00	$0.00	$0.00	$343.50	$544.10	$549.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-052	SUP	Custom 27803010		6485-5-052  -  SPACER FEM 10MM KMX+ XS RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-053	SUP	Custom 27803010		6485-5-053  -  SPACER FEM 10MM KMX+ XS RIGHT DISTAL MDL	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$0.00	$0.00	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-060	SUP	Custom 27803010		6485-5-060  -  SPACER FEM 5MM KNMX XS RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-061	SUP	Custom 27803010		6485-5-061  -  SPACER FEM 10MM KMX+ XS RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-062	SUP	Custom 27803010		6485-5-062  -  SPACER FEM 10MM KMX+ MED XS DISTAL KNEE	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$0.00	$0.00	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-063	SUP	Custom 27803010		6485-5-063  -  SPACER FEM 10MM KMX+ XS RIGHT DISTAL MDL	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$0.00	$0.00	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-100	SUP	Custom 27803010		6485-5-100  -  SPACER FEM 5MM KNMX SM LEFT DISTAL MDL	BOTH IP/OP	$687.00 	$508.38	$0.00	$549.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$509.89	$509.89	$0.00	$0.00	$143.17	$0.00	$0.00	$0.00	$0.00	$343.50	$544.10	$549.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-101	SUP	Custom 27803010		6485-5-101  -  SPACER FEM 10MM KMX+ SM LEFT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-102	SUP	Custom 27803010		6485-5-102  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-103	SUP	Custom 27803010		6485-5-103  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$0.00	$0.00	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-110	SUP	Custom 27803010		6485-5-110  -  SPACER FEM 5MM KNMX SM RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-111	SUP	Custom 27803010		6485-5-111  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-112	SUP	Custom 27803010		6485-5-112  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL	BOTH IP/OP	$687.00 	$508.38	$0.00	$549.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$509.89	$509.89	$0.00	$0.00	$143.17	$0.00	$0.00	$0.00	$0.00	$343.50	$544.10	$549.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-113	SUP	Custom 27803010		6485-5-113  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-150	SUP	Custom 27803010		6485-5-150  -  SPACER FEM 5MM KMX+ MED LEFT DISTAL MDL	BOTH IP/OP	$816.00 	$603.84	$0.00	$652.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.64	$605.64	$0.00	$0.00	$170.05	$0.00	$0.00	$0.00	$0.00	$408.00	$646.27	$652.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-151	SUP	Custom 27803010		6485-5-151  -  SPACER FEM 10MM KNMX MED LEFT DISTAL MDL	BOTH IP/OP	$816.00 	$603.84	$0.00	$652.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.64	$605.64	$0.00	$0.00	$170.05	$0.00	$0.00	$0.00	$0.00	$408.00	$646.27	$652.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-152	SUP	Custom 27803010		6485-5-152  -  SPACER FEM 10MM KNMX MED RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-153	SUP	Custom 27803010		6485-5-153  -  SPACER FEM 10MM KMX+ MED RIGHT DISTAL MDL	BOTH IP/OP	$816.00 	$603.84	$0.00	$652.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.64	$605.64	$0.00	$0.00	$170.05	$0.00	$0.00	$0.00	$0.00	$408.00	$646.27	$652.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-160	SUP	Custom 27803010		6485-5-160  -  SPACER FEM 5MM KNMX MED RIGHT DISTAL MDL	BOTH IP/OP	$816.00 	$603.84	$0.00	$652.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.64	$605.64	$0.00	$0.00	$170.05	$0.00	$0.00	$0.00	$0.00	$408.00	$646.27	$652.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-161	SUP	Custom 27803010		6485-5-161  -  SPACER FEM 10MM KNMX MED RIGHT DISTAL MDL	BOTH IP/OP	$816.00 	$603.84	$0.00	$652.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.64	$605.64	$0.00	$0.00	$170.05	$0.00	$0.00	$0.00	$0.00	$408.00	$646.27	$652.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-162	SUP	Custom 27803010		6485-5-162  -  SPACER FEM 10MM KNMX MED RIGHT DISTAL MDL	BOTH IP/OP	$816.00 	$603.84	$0.00	$652.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.64	$605.64	$0.00	$0.00	$170.05	$0.00	$0.00	$0.00	$0.00	$408.00	$646.27	$652.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-163	SUP	Custom 27803010		6485-5-163  -  SPACER FEM 10MM KNMX MED RIGHT DISTAL MDL	BOTH IP/OP	$816.00 	$603.84	$0.00	$652.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.64	$605.64	$0.00	$0.00	$170.05	$0.00	$0.00	$0.00	$0.00	$408.00	$646.27	$652.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-200	SUP	Custom 27803010		6485-5-200  -  SPACER FEM 5MM KMX+ LG LEFT DISTAL MDL	BOTH IP/OP	$687.00 	$508.38	$0.00	$549.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$509.89	$509.89	$0.00	$0.00	$143.17	$0.00	$0.00	$0.00	$0.00	$343.50	$544.10	$549.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-201	SUP	Custom 27803010		6485-5-201  -  SPACER FEM 10MM KMX+ LG LEFT DISTAL MDL	BOTH IP/OP	$572.00 	$423.28	$0.00	$457.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.54	$424.54	$0.00	$0.00	$119.20	$0.00	$0.00	$0.00	$0.00	$286.00	$453.02	$457.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-202	SUP	Custom 27803010		6485-5-202  -  SPACER FEM 10MM KMX+ LG RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-203	SUP	Custom 27803010		6485-5-203  -  SPACER FEM 10MM KMX+ MED RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-210	SUP	Custom 27803010		6485-5-210  -  SPACER FEM 5MM KMX+ LG RIGHT DISTAL MDL	BOTH IP/OP	$572.00 	$423.28	$0.00	$457.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.54	$424.54	$0.00	$0.00	$119.20	$0.00	$0.00	$0.00	$0.00	$286.00	$453.02	$457.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-211	SUP	Custom 27803010		6485-5-211  -  SPACER FEM 10MM KMX+ MED RIGHT DISTAL MDL	BOTH IP/OP	$687.00 	$508.38	$0.00	$549.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$509.89	$509.89	$0.00	$0.00	$143.17	$0.00	$0.00	$0.00	$0.00	$343.50	$544.10	$549.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-212	SUP	Custom 27803010		6485-5-212  -  SPACER FEM 10MM KMX+ LG RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-213	SUP	Custom 27803010		6485-5-213  -  SPACER FEM 10MM KMX+ LG RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-250	SUP	Custom 27803010		6485-5-250  -  SPACER FEM 5MM KMX+ XL LEFT DISTAL MDL	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$0.00	$0.00	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-251	SUP	Custom 27803010		6485-5-251  -  SPACER FEM 10MM KMX+ MED XL DISTAL KNEE	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-252	SUP	Custom 27803010		6485-5-252  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-253	SUP	Custom 27803010		6485-5-253  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-260	SUP	Custom 27803010		6485-5-260  -  SPACER FEM 5MM KNMX 2XL RIGHT DISTAL MDL	BOTH IP/OP	$816.00 	$603.84	$0.00	$652.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$605.64	$605.64	$0.00	$0.00	$170.05	$0.00	$0.00	$0.00	$0.00	$408.00	$646.27	$652.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-261	SUP	Custom 27803010		6485-5-261  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$0.00	$0.00	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-262	SUP	Custom 27803010		6485-5-262  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL	BOTH IP/OP	$687.00 	$508.38	$0.00	$549.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$509.89	$509.89	$0.00	$0.00	$143.17	$0.00	$0.00	$0.00	$0.00	$343.50	$544.10	$549.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-263	SUP	Custom 27803010		6485-5-263  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL	BOTH IP/OP	$659.00 	$487.66	$0.00	$527.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.11	$489.11	$0.00	$0.00	$137.34	$0.00	$0.00	$0.00	$0.00	$329.50	$521.93	$527.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-5-915	SUP	Custom 27803010		6485-5-915  -  CMPNT PATLR LG KNMTC	BOTH IP/OP	"$1,639.63 "	"$1,213.33"	$0.00	"$1,311.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,216.93"	"$1,216.93"	$0.00	$0.00	$341.70	$0.00	$0.00	$0.00	$0.00	$819.81	"$1,298.59"	"$1,311.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-6-409	SUP	HCPCS C1776		6485-6-409  -  STEM TIBIAL 9MM MRS KNEE	BOTH IP/OP	"$7,905.00 "	"$5,849.70"	$0.00	"$6,324.00"	"$3,557.25"	"$3,557.25"	$0.00	$0.00	$0.00	"$1,647.60"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,647.40"	$0.00	"$3,897.17"	"$3,897.17"	$0.00	"$3,952.50"	"$6,260.76"	"$6,324.00"	$0.00		$0.00	"$1,237.13"	$0.00	$0.00	"$1,258.48"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-6-411	SUP	HCPCS C1776		6485-6-411  -  STEM TIBIAL 11MM MRS KNEE	BOTH IP/OP	"$7,905.00 "	"$5,849.70"	$0.00	"$6,324.00"	"$3,557.25"	"$3,557.25"	$0.00	$0.00	$0.00	"$1,647.60"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,647.40"	$0.00	"$3,897.17"	"$3,897.17"	$0.00	"$3,952.50"	"$6,260.76"	"$6,324.00"	$0.00		$0.00	"$1,237.13"	$0.00	$0.00	"$1,258.48"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-6-413	SUP	HCPCS C1776		6485-6-413  -  STEM TIBIAL 13MM MRS KNEE	BOTH IP/OP	"$7,905.00 "	"$5,849.70"	$0.00	"$6,324.00"	"$3,557.25"	"$3,557.25"	$0.00	$0.00	$0.00	"$1,647.60"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,647.40"	$0.00	"$3,897.17"	"$3,897.17"	$0.00	"$3,952.50"	"$6,260.76"	"$6,324.00"	$0.00		$0.00	"$1,237.13"	$0.00	$0.00	"$1,258.48"	$0.00	$0.00	$0.00	$0.00	$0.00
6485-6-509	SUP	HCPCS C1776		6485-6-509  -  STEM TIBIAL 9MM 127MM MRS KNEE	BOTH IP/OP	"$5,722.50 "	"$4,234.65"	$0.00	"$4,578.00"	"$2,575.13"	"$2,575.13"	$0.00	$0.00	$0.00	"$1,192.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,192.57"	$0.00	"$2,821.19"	"$2,821.19"	$0.00	"$2,861.25"	"$4,532.22"	"$4,578.00"	$0.00		$0.00	$895.57	$0.00	$0.00	$911.02	$0.00	$0.00	$0.00	$0.00	$0.00
6485-6-511	SUP	HCPCS C1776		6485-6-511  -  STEM TIBIAL 11MM 127MM MRS KNEE	BOTH IP/OP	"$5,722.50 "	"$4,234.65"	$0.00	"$4,578.00"	"$2,575.13"	"$2,575.13"	$0.00	$0.00	$0.00	"$1,192.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,192.57"	$0.00	"$2,821.19"	"$2,821.19"	$0.00	"$2,861.25"	"$4,532.22"	"$4,578.00"	$0.00		$0.00	$895.57	$0.00	$0.00	$911.02	$0.00	$0.00	$0.00	$0.00	$0.00
6485-6-513	SUP	HCPCS C1776		6485-6-513  -  STEM TIBIAL 13MM MRS KNEE	BOTH IP/OP	"$5,722.50 "	"$4,234.65"	$0.00	"$4,578.00"	"$2,575.13"	"$2,575.13"	$0.00	$0.00	$0.00	"$1,192.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,192.57"	$0.00	"$2,821.19"	"$2,821.19"	$0.00	"$2,861.25"	"$4,532.22"	"$4,578.00"	$0.00		$0.00	$895.57	$0.00	$0.00	$911.02	$0.00	$0.00	$0.00	$0.00	$0.00
6485-8-435	SUP	HCPCS C1776		6485-8-435  -  COMPONENT TIBIAL SHORT BEARING MRS KNEE	BOTH IP/OP	"$6,005.00 "	"$4,443.70"	$0.00	"$4,804.00"	"$2,702.25"	"$2,702.25"	$0.00	$0.00	$0.00	"$1,251.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,251.44"	$0.00	"$2,960.47"	"$2,960.47"	$0.00	"$3,002.50"	"$4,755.96"	"$4,804.00"	$0.00		$0.00	$939.78	$0.00	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00
6485-8-450	SUP	HCPCS C1776		6485-8-450  -  COMPONENT TIBIAL 3XS BEARING KRH KNEE	BOTH IP/OP	"$6,122.50 "	"$4,530.65"	$0.00	"$4,898.00"	"$2,755.13"	"$2,755.13"	$0.00	$0.00	$0.00	"$1,276.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,275.93"	$0.00	"$3,018.39"	"$3,018.39"	$0.00	"$3,061.25"	"$4,849.02"	"$4,898.00"	$0.00		$0.00	$958.17	$0.00	$0.00	$974.70	$0.00	$0.00	$0.00	$0.00	$0.00
6485-8-460	SUP	HCPCS C1895		6485-8-460  -  AXLE FEMORAL SMALL ROTATE HINGE MODULE KINEMATIC KNEE	BOTH IP/OP	"$2,182.50 "	"$1,615.05"	$0.00	"$1,746.00"	$982.13	$982.13	$0.00	$0.00	$0.00	$454.89	"$1,619.85"	"$1,619.85"	$0.00	$0.00	$454.83	$0.00	"$1,290.95"	"$1,290.95"	$0.00	"$1,091.25"	"$1,728.54"	"$1,746.00"	$0.00		$0.00	$341.56	$0.00	$0.00	$347.45	$0.00	$0.00	$0.00	$0.00	$0.00
6487-1-040	SUP	HCPCS C1776		6487-1-040  -  BODY HUMERAL TAPER 40MM MALE TO FMALE MRS	BOTH IP/OP	"$5,680.00 "	"$4,203.20"	$0.00	"$4,544.00"	"$2,556.00"	"$2,556.00"	$0.00	$0.00	$0.00	"$1,183.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,183.71"	$0.00	"$2,800.24"	"$2,800.24"	$0.00	"$2,840.00"	"$4,498.56"	"$4,544.00"	$0.00		$0.00	$888.92	$0.00	$0.00	$904.26	$0.00	$0.00	$0.00	$0.00	$0.00
6487-1-060	SUP	HCPCS C1776		6487-1-060  -  BODY HUMERAL TAPER 60MM MALE TO FMALE MRS	BOTH IP/OP	"$5,680.00 "	"$4,203.20"	$0.00	"$4,544.00"	"$2,556.00"	"$2,556.00"	$0.00	$0.00	$0.00	"$1,183.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,183.71"	$0.00	"$2,800.24"	"$2,800.24"	$0.00	"$2,840.00"	"$4,498.56"	"$4,544.00"	$0.00		$0.00	$888.92	$0.00	$0.00	$904.26	$0.00	$0.00	$0.00	$0.00	$0.00
6487-1-080	SUP	HCPCS C1776		6487-1-080  -  BODY HUMERAL 80MM MALE/FMALE TAPERED MRS SHOULDER	BOTH IP/OP	"$5,680.00 "	"$4,203.20"	$0.00	"$4,544.00"	"$2,556.00"	"$2,556.00"	$0.00	$0.00	$0.00	"$1,183.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,183.71"	$0.00	"$2,800.24"	"$2,800.24"	$0.00	"$2,840.00"	"$4,498.56"	"$4,544.00"	$0.00		$0.00	$888.92	$0.00	$0.00	$904.26	$0.00	$0.00	$0.00	$0.00	$0.00
6487-1-100	SUP	HCPCS C1776		6487-1-100  -  BODY HUMERAL TAPER 100MM MALE TO FMALE MRS	BOTH IP/OP	"$5,680.00 "	"$4,203.20"	$0.00	"$4,544.00"	"$2,556.00"	"$2,556.00"	$0.00	$0.00	$0.00	"$1,183.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,183.71"	$0.00	"$2,800.24"	"$2,800.24"	$0.00	"$2,840.00"	"$4,498.56"	"$4,544.00"	$0.00		$0.00	$888.92	$0.00	$0.00	$904.26	$0.00	$0.00	$0.00	$0.00	$0.00
6487-1-120	SUP	HCPCS C1776		6487-1-120  -  BODY HUMERAL TAPER 120MM MALE TO FMALE MRS	BOTH IP/OP	"$5,680.00 "	"$4,203.20"	$0.00	"$4,544.00"	"$2,556.00"	"$2,556.00"	$0.00	$0.00	$0.00	"$1,183.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,183.71"	$0.00	"$2,800.24"	"$2,800.24"	$0.00	"$2,840.00"	"$4,498.56"	"$4,544.00"	$0.00		$0.00	$888.92	$0.00	$0.00	$904.26	$0.00	$0.00	$0.00	$0.00	$0.00
6487-1-140	SUP	HCPCS C1776		6487-1-140  -  BODY HUMERAL TAPER 140MM MALE TO FMALE MRS	BOTH IP/OP	"$5,680.00 "	"$4,203.20"	$0.00	"$4,544.00"	"$2,556.00"	"$2,556.00"	$0.00	$0.00	$0.00	"$1,183.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,183.71"	$0.00	"$2,800.24"	"$2,800.24"	$0.00	"$2,840.00"	"$4,498.56"	"$4,544.00"	$0.00		$0.00	$888.92	$0.00	$0.00	$904.26	$0.00	$0.00	$0.00	$0.00	$0.00
6487-2-075	SUP	HCPCS C1776		6487-2-075  -  STEM HUMERAL 7MM 75MM MRS MRH SHOULDER	BOTH IP/OP	"$7,480.00 "	"$5,535.20"	$0.00	"$5,984.00"	"$3,366.00"	"$3,366.00"	$0.00	$0.00	$0.00	"$1,559.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,558.83"	$0.00	"$3,687.64"	"$3,687.64"	$0.00	"$3,740.00"	"$5,924.16"	"$5,984.00"	$0.00		$0.00	"$1,170.62"	$0.00	$0.00	"$1,190.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6487-2-115	SUP	HCPCS C1776		6487-2-115  -  STEM HUMERAL 7MM 115MM MRS SHOULDER	BOTH IP/OP	"$7,480.00 "	"$5,535.20"	$0.00	"$5,984.00"	"$3,366.00"	"$3,366.00"	$0.00	$0.00	$0.00	"$1,559.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,558.83"	$0.00	"$3,687.64"	"$3,687.64"	$0.00	"$3,740.00"	"$5,924.16"	"$5,984.00"	$0.00		$0.00	"$1,170.62"	$0.00	$0.00	"$1,190.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6487-3-075	SUP	HCPCS C1776		6487-3-075  -  STEM HUMERAL 9MM 75MM MRS SHOULDER	BOTH IP/OP	"$7,480.00 "	"$5,535.20"	$0.00	"$5,984.00"	"$3,366.00"	"$3,366.00"	$0.00	$0.00	$0.00	"$1,559.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,558.83"	$0.00	"$3,687.64"	"$3,687.64"	$0.00	"$3,740.00"	"$5,924.16"	"$5,984.00"	$0.00		$0.00	"$1,170.62"	$0.00	$0.00	"$1,190.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6487-3-115	SUP	HCPCS C1776		6487-3-115  -  STEM HUMERAL 9MM 115MM MRS SHOULDER	BOTH IP/OP	"$7,480.00 "	"$5,535.20"	$0.00	"$5,984.00"	"$3,366.00"	"$3,366.00"	$0.00	$0.00	$0.00	"$1,559.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,558.83"	$0.00	"$3,687.64"	"$3,687.64"	$0.00	"$3,740.00"	"$5,924.16"	"$5,984.00"	$0.00		$0.00	"$1,170.62"	$0.00	$0.00	"$1,190.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6487-4-075	SUP	HCPCS C1776		6487-4-075  -  STEM HUMERAL 11MM 75MM MRS SHOULDER	BOTH IP/OP	"$7,480.00 "	"$5,535.20"	$0.00	"$5,984.00"	"$3,366.00"	"$3,366.00"	$0.00	$0.00	$0.00	"$1,559.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,558.83"	$0.00	"$3,687.64"	"$3,687.64"	$0.00	"$3,740.00"	"$5,924.16"	"$5,984.00"	$0.00		$0.00	"$1,170.62"	$0.00	$0.00	"$1,190.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6487-4-115	SUP	HCPCS C1776		6487-4-115  -  STEM HUMERAL 11MM 115MM MRS SHOULDER	BOTH IP/OP	"$7,480.00 "	"$5,535.20"	$0.00	"$5,984.00"	"$3,366.00"	"$3,366.00"	$0.00	$0.00	$0.00	"$1,559.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,558.83"	$0.00	"$3,687.64"	"$3,687.64"	$0.00	"$3,740.00"	"$5,924.16"	"$5,984.00"	$0.00		$0.00	"$1,170.62"	$0.00	$0.00	"$1,190.82"	$0.00	$0.00	$0.00	$0.00	$0.00
6487-5-010	SUP	HCPCS C1713		6487-5-010  -  SCREW BONE INTERCALARY MRS HUMERUS	BOTH IP/OP	$932.50 	$690.05	$0.00	$746.00	$419.63	$419.63	$0.00	$0.00	$0.00	$194.36	$692.10	$692.10	$0.00	$0.00	$194.33	$0.00	$551.57	$551.57	$0.00	$466.25	$738.54	$746.00	$0.00		$0.00	$145.94	$0.00	$0.00	$148.45	$0.00	$0.00	$0.00	$0.00	$0.00
6487-5-040	SUP	HCPCS C1776		6487-5-040  -  HEAD HUM 40MM STRL MRS SHLDR PROX	BOTH IP/OP	"$7,317.50 "	"$5,414.95"	$0.00	"$5,854.00"	"$3,292.88"	"$3,292.88"	$0.00	$0.00	$0.00	"$1,525.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,524.97"	$0.00	"$3,607.53"	"$3,607.53"	$0.00	"$3,658.75"	"$5,795.46"	"$5,854.00"	$0.00		$0.00	"$1,145.19"	$0.00	$0.00	"$1,164.95"	$0.00	$0.00	$0.00	$0.00	$0.00
6487-5-044	SUP	HCPCS C1776		6487-5-044  -  HEAD HUM 44MM STRL MRS SHLDR PROX	BOTH IP/OP	"$7,317.50 "	"$5,414.95"	$0.00	"$5,854.00"	"$3,292.88"	"$3,292.88"	$0.00	$0.00	$0.00	"$1,525.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,524.97"	$0.00	"$3,607.53"	"$3,607.53"	$0.00	"$3,658.75"	"$5,795.46"	"$5,854.00"	$0.00		$0.00	"$1,145.19"	$0.00	$0.00	"$1,164.95"	$0.00	$0.00	$0.00	$0.00	$0.00
6487-5-051	SUP	HCPCS C1776		6487-5-051  -  STEM HUM 50MM BODY MRS 25MM SHLDR	BOTH IP/OP	"$4,054.38 "	"$3,000.24"	$0.00	"$3,243.50"	"$1,824.47"	"$1,824.47"	$0.00	$0.00	$0.00	$845.03	"$3,009.16"	"$3,009.16"	$0.00	$0.00	$844.93	$0.00	"$1,998.81"	"$1,998.81"	$0.00	"$2,027.19"	"$3,211.07"	"$3,243.50"	$0.00		$0.00	$634.51	$0.00	$0.00	$645.46	$0.00	$0.00	$0.00	$0.00	$0.00
6487-5-075	SUP	HCPCS C1776		6487-5-075  -  STEM HUMERAL 7MM 75MM MRS SHOULDER	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-5-076	SUP	HCPCS C1776		6487-5-076  -  STEM HUMERAL 75MM 25MM BODY MRS MRH SHOULDER	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-5-101	SUP	HCPCS C1776		6487-5-101  -  STEM HUMERAL 100MM 25MM BODY MRS SHOULDER	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-5-115	SUP	HCPCS C1776		6487-5-115  -  STEM HUMERAL 7MM 115MM MRS	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-5-126	SUP	HCPCS C1776		6487-5-126  -  STEM HUM 125MM BODY MRS 25MM SHLDR	BOTH IP/OP	"$4,054.38 "	"$3,000.24"	$0.00	"$3,243.50"	"$1,824.47"	"$1,824.47"	$0.00	$0.00	$0.00	$845.03	"$3,009.16"	"$3,009.16"	$0.00	$0.00	$844.93	$0.00	"$1,998.81"	"$1,998.81"	$0.00	"$2,027.19"	"$3,211.07"	"$3,243.50"	$0.00		$0.00	$634.51	$0.00	$0.00	$645.46	$0.00	$0.00	$0.00	$0.00	$0.00
6487-6-051	SUP	HCPCS C1776		6487-6-051  -  STEM HUM 50MM BODY MRS 50MM SHLDR	BOTH IP/OP	"$4,054.38 "	"$3,000.24"	$0.00	"$3,243.50"	"$1,824.47"	"$1,824.47"	$0.00	$0.00	$0.00	$845.03	"$3,009.16"	"$3,009.16"	$0.00	$0.00	$844.93	$0.00	"$1,998.81"	"$1,998.81"	$0.00	"$2,027.19"	"$3,211.07"	"$3,243.50"	$0.00		$0.00	$634.51	$0.00	$0.00	$645.46	$0.00	$0.00	$0.00	$0.00	$0.00
6487-6-075	SUP	HCPCS C1776		6487-6-075  -  STEM HUMERAL 9MM 75MM MRS	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-6-076	SUP	HCPCS C1776		6487-6-076  -  STEM HUMERAL 50MM 75MM BODY MRS	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-6-101	SUP	HCPCS C1776		6487-6-101  -  STEM HUMERAL 50MM 100MM BODY MRS SHOULDER	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-6-115	SUP	HCPCS C1776		6487-6-115  -  STEM HUMERAL 9MM 115MM MRS SHOULDER	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-6-126	SUP	HCPCS C1776		6487-6-126  -  STEM HUM 125MM BODY MRS 50MM SHLDR	BOTH IP/OP	"$4,054.38 "	"$3,000.24"	$0.00	"$3,243.50"	"$1,824.47"	"$1,824.47"	$0.00	$0.00	$0.00	$845.03	"$3,009.16"	"$3,009.16"	$0.00	$0.00	$844.93	$0.00	"$1,998.81"	"$1,998.81"	$0.00	"$2,027.19"	"$3,211.07"	"$3,243.50"	$0.00		$0.00	$634.51	$0.00	$0.00	$645.46	$0.00	$0.00	$0.00	$0.00	$0.00
6487-7-051	SUP	HCPCS C1776		6487-7-051  -  STEM HUM 50MM BODY MRS 75MM SHLDR	BOTH IP/OP	"$4,054.38 "	"$3,000.24"	$0.00	"$3,243.50"	"$1,824.47"	"$1,824.47"	$0.00	$0.00	$0.00	$845.03	"$3,009.16"	"$3,009.16"	$0.00	$0.00	$844.93	$0.00	"$1,998.81"	"$1,998.81"	$0.00	"$2,027.19"	"$3,211.07"	"$3,243.50"	$0.00		$0.00	$634.51	$0.00	$0.00	$645.46	$0.00	$0.00	$0.00	$0.00	$0.00
6487-7-075	SUP	HCPCS C1776		6487-7-075  -  STEM HUMERAL 11MM 75MM MRS SHOULDER	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-7-076	SUP	HCPCS C1776		6487-7-076  -  STEM HUMERAL 75MM 75MM BODY MRS SHOULDER	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-7-101	SUP	HCPCS C1776		6487-7-101  -  STEM HUMERAL 100MM 75MM BODY MRS MRH SHOULDER	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-7-115	SUP	HCPCS C1776		6487-7-115  -  STEM HUMERAL 11MM 115MM BODY MRS SHOULDER	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-8-051	SUP	HCPCS C1776		6487-8-051  -  STEM HUMERAL 100MM 50MM BODY MRS MRH SHOULDER	BOTH IP/OP	"$5,420.00 "	"$4,010.80"	$0.00	"$4,336.00"	"$2,439.00"	"$2,439.00"	$0.00	$0.00	$0.00	"$1,129.66"	"$4,022.72"	"$4,022.72"	$0.00	$0.00	"$1,129.53"	$0.00	"$2,672.06"	"$2,672.06"	$0.00	"$2,710.00"	"$4,292.64"	"$4,336.00"	$0.00		$0.00	$848.23	$0.00	$0.00	$862.86	$0.00	$0.00	$0.00	$0.00	$0.00
6487-9-051	SUP	HCPCS C1776		6487-9-051  -  CAP END 50MM MRS HUMERAL PROXIMAL	BOTH IP/OP	"$2,635.00 "	"$1,949.90"	$0.00	"$2,108.00"	"$1,185.75"	"$1,185.75"	$0.00	$0.00	$0.00	$549.20	"$1,955.70"	"$1,955.70"	$0.00	$0.00	$549.13	$0.00	"$1,299.06"	"$1,299.06"	$0.00	"$1,317.50"	"$2,086.92"	"$2,108.00"	$0.00		$0.00	$412.38	$0.00	$0.00	$419.49	$0.00	$0.00	$0.00	$0.00	$0.00
6495-1-001	SUP	HCPCS C1776		6495-1-001  -  COMPONENT FEMORAL STANDARD NEUTRAL GMRS COCR HIP	BOTH IP/OP	"$10,355.00 "	"$7,662.70"	$0.00	"$8,284.00"	"$4,659.75"	"$4,659.75"	$0.00	$0.00	$0.00	"$2,158.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,157.98"	$0.00	"$5,105.02"	"$5,105.02"	$0.00	"$5,177.50"	"$8,201.16"	"$8,284.00"	$0.00		$0.00	"$1,620.56"	$0.00	$0.00	"$1,648.52"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-1-002	SUP	HCPCS C1776		6495-1-002  -  COMPONENT FEMORAL NEUTRAL GMRS HIP TROCHANTER	BOTH IP/OP	"$10,355.00 "	"$7,662.70"	$0.00	"$8,284.00"	"$4,659.75"	"$4,659.75"	$0.00	$0.00	$0.00	"$2,158.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,157.98"	$0.00	"$5,105.02"	"$5,105.02"	$0.00	"$5,177.50"	"$8,201.16"	"$8,284.00"	$0.00		$0.00	"$1,620.56"	$0.00	$0.00	"$1,648.52"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-1-101	SUP	HCPCS C1776		6495-1-101  -  COMPONENT FEMORAL 15D ANTEVERT STANDARD GMRS KNEE LEFT	BOTH IP/OP	"$10,355.00 "	"$7,662.70"	$0.00	"$8,284.00"	"$4,659.75"	"$4,659.75"	$0.00	$0.00	$0.00	"$2,158.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,157.98"	$0.00	"$5,105.02"	"$5,105.02"	$0.00	"$5,177.50"	"$8,201.16"	"$8,284.00"	$0.00		$0.00	"$1,620.56"	$0.00	$0.00	"$1,648.52"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-1-102	SUP	HCPCS C1776		6495-1-102  -  COMPONENT FEMORAL 15D ANTEVERT GMRS KNEE LEFT TROCHANTER	BOTH IP/OP	"$10,355.00 "	"$7,662.70"	$0.00	"$8,284.00"	"$4,659.75"	"$4,659.75"	$0.00	$0.00	$0.00	"$2,158.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,157.98"	$0.00	"$5,105.02"	"$5,105.02"	$0.00	"$5,177.50"	"$8,201.16"	"$8,284.00"	$0.00		$0.00	"$1,620.56"	$0.00	$0.00	"$1,648.52"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-1-201	SUP	HCPCS C1776		6495-1-201  -  COMPONENT FEMORAL 15D ANTEVERT STANDARD GMRS KNEE RIGHT	BOTH IP/OP	"$10,355.00 "	"$7,662.70"	$0.00	"$8,284.00"	"$4,659.75"	"$4,659.75"	$0.00	$0.00	$0.00	"$2,158.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,157.98"	$0.00	"$5,105.02"	"$5,105.02"	$0.00	"$5,177.50"	"$8,201.16"	"$8,284.00"	$0.00		$0.00	"$1,620.56"	$0.00	$0.00	"$1,648.52"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-1-202	SUP	HCPCS C1776		6495-1-202  -  COMPONENT FEMORAL 15D ANTEVERT GMRS KNEE RIGHT TROCHANTER	BOTH IP/OP	"$10,355.00 "	"$7,662.70"	$0.00	"$8,284.00"	"$4,659.75"	"$4,659.75"	$0.00	$0.00	$0.00	"$2,158.24"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,157.98"	$0.00	"$5,105.02"	"$5,105.02"	$0.00	"$5,177.50"	"$8,201.16"	"$8,284.00"	$0.00		$0.00	"$1,620.56"	$0.00	$0.00	"$1,648.52"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-2-010	SUP	HCPCS C1776		6495-2-010  -  COMPONENT FEMORAL SMALL 65MM GMRS COCR KNEE LEFT	BOTH IP/OP	"$14,922.50 "	"$11,042.65"	$0.00	"$11,938.00"	"$6,715.13"	"$6,715.13"	$0.00	$0.00	$0.00	"$3,110.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,109.85"	$0.00	"$7,356.79"	"$7,356.79"	$0.00	"$7,461.25"	"$11,818.62"	"$11,938.00"	$0.00		$0.00	"$2,335.37"	$0.00	$0.00	"$2,375.66"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-2-020	SUP	HCPCS C1776		6495-2-020  -  COMPONENT FEMORAL SMALL 65MM GMRS DISTAL RIGHT	BOTH IP/OP	"$14,922.50 "	"$11,042.65"	$0.00	"$11,938.00"	"$6,715.13"	"$6,715.13"	$0.00	$0.00	$0.00	"$3,110.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,109.85"	$0.00	"$7,356.79"	"$7,356.79"	$0.00	"$7,461.25"	"$11,818.62"	"$11,938.00"	$0.00		$0.00	"$2,335.37"	$0.00	$0.00	"$2,375.66"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-2-030	SUP	HCPCS C1776		6495-2-030  -  COMPONENT FEMORAL STANDARD 65MM GMRS COCR KNEE LEFT	BOTH IP/OP	"$14,787.50 "	"$10,942.75"	$0.00	"$11,830.00"	"$6,654.38"	"$6,654.38"	$0.00	$0.00	$0.00	"$3,082.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,081.72"	$0.00	"$7,290.24"	"$7,290.24"	$0.00	"$7,393.75"	"$11,711.70"	"$11,830.00"	$0.00		$0.00	"$2,314.24"	$0.00	$0.00	"$2,354.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-2-040	SUP	HCPCS C1776		6495-2-040  -  COMPONENT FEMORAL STANDARD 65MM GMRS COCR KNEE RIGHT	BOTH IP/OP	"$14,787.50 "	"$10,942.75"	$0.00	"$11,830.00"	"$6,654.38"	"$6,654.38"	$0.00	$0.00	$0.00	"$3,082.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,081.72"	$0.00	"$7,290.24"	"$7,290.24"	$0.00	"$7,393.75"	"$11,711.70"	"$11,830.00"	$0.00		$0.00	"$2,314.24"	$0.00	$0.00	"$2,354.17"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-2-105	SUP	Custom 27803010		6495-2-105  -  BUSHING FEMORAL SMALL GMRS KNEE	BOTH IP/OP	$640.00 	$473.60	$0.00	$512.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$475.01	$475.01	$0.00	$0.00	$133.38	$0.00	$0.00	$0.00	$0.00	$320.00	$506.88	$512.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6495-2-115	SUP	Custom 27803010		6495-2-115  -  AXLE FEMORAL SMALL GMRS KNEE	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6495-3-010	SUP	Custom 27803010		6495-3-010  -  INSERT TIBIAL SMALL 10MM GMRS PROXIMAL	BOTH IP/OP	"$2,367.50 "	"$1,751.95"	$0.00	"$1,894.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.16"	"$1,757.16"	$0.00	$0.00	$493.39	$0.00	$0.00	$0.00	$0.00	"$1,183.75"	"$1,875.06"	"$1,894.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6495-3-013	SUP	Custom 27803010		6495-3-013  -  INSERT TIBIAL SMALL 13MM GMRS PROXIMAL	BOTH IP/OP	"$2,367.50 "	"$1,751.95"	$0.00	"$1,894.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.16"	"$1,757.16"	$0.00	$0.00	$493.39	$0.00	$0.00	$0.00	$0.00	"$1,183.75"	"$1,875.06"	"$1,894.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6495-3-016	SUP	Custom 27803010		6495-3-016  -  INSERT TIBIAL SMALL 16MM GMRS PROXIMAL	BOTH IP/OP	"$2,367.50 "	"$1,751.95"	$0.00	"$1,894.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.16"	"$1,757.16"	$0.00	$0.00	$493.39	$0.00	$0.00	$0.00	$0.00	"$1,183.75"	"$1,875.06"	"$1,894.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6495-3-020	SUP	Custom 27803010		6495-3-020  -  INSERT TIBIAL SMALL 20MM GMRS PROXIMAL	BOTH IP/OP	"$2,367.50 "	"$1,751.95"	$0.00	"$1,894.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.16"	"$1,757.16"	$0.00	$0.00	$493.39	$0.00	$0.00	$0.00	$0.00	"$1,183.75"	"$1,875.06"	"$1,894.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6495-3-024	SUP	Custom 27803010		6495-3-024  -  INSERT TIBIAL SMALL 24MM GMRS PROXIMAL	BOTH IP/OP	"$2,367.50 "	"$1,751.95"	$0.00	"$1,894.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.16"	"$1,757.16"	$0.00	$0.00	$493.39	$0.00	$0.00	$0.00	$0.00	"$1,183.75"	"$1,875.06"	"$1,894.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6495-3-101	SUP	HCPCS C1776		6495-3-101  -  COMPONENT TIBIAL SMALL GMRS PROXIMAL	BOTH IP/OP	"$14,895.00 "	"$11,022.30"	$0.00	"$11,916.00"	"$6,702.75"	"$6,702.75"	$0.00	$0.00	$0.00	"$3,104.49"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,104.12"	$0.00	"$7,343.24"	"$7,343.24"	$0.00	"$7,447.50"	"$11,796.84"	"$11,916.00"	$0.00		$0.00	"$2,331.07"	$0.00	$0.00	"$2,371.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-3-102	SUP	HCPCS C1776		6495-3-102  -  COMPONENT TIBIAL STANDARD GMRS PROXIMAL	BOTH IP/OP	"$14,895.00 "	"$11,022.30"	$0.00	"$11,916.00"	"$6,702.75"	"$6,702.75"	$0.00	$0.00	$0.00	"$3,104.49"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,104.12"	$0.00	"$7,343.24"	"$7,343.24"	$0.00	"$7,447.50"	"$11,796.84"	"$11,916.00"	$0.00		$0.00	"$2,331.07"	$0.00	$0.00	"$2,371.28"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-3-601	SUP	HCPCS C1776		6495-3-601  -  COMPONENT TIBIAL SMALL ROTATE GMRS TITANIUM KNEE PROXIMAL	BOTH IP/OP	"$6,122.50 "	"$4,530.65"	$0.00	"$4,898.00"	"$2,755.13"	"$2,755.13"	$0.00	$0.00	$0.00	"$1,276.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,275.93"	$0.00	"$3,018.39"	"$3,018.39"	$0.00	"$3,061.25"	"$4,849.02"	"$4,898.00"	$0.00		$0.00	$958.17	$0.00	$0.00	$974.70	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-011	SUP	HCPCS C1776		6495-5-011  -  STEM FEMORAL STR FLUTE 11MM 125MM PRESSFIT GMRS COCR HIP	BOTH IP/OP	"$9,450.00 "	"$6,993.00"	$0.00	"$7,560.00"	"$4,252.50"	"$4,252.50"	$0.00	$0.00	$0.00	"$1,969.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,969.38"	$0.00	"$4,658.85"	"$4,658.85"	$0.00	"$4,725.00"	"$7,484.40"	"$7,560.00"	$0.00		$0.00	"$1,478.93"	$0.00	$0.00	"$1,504.44"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-012	SUP	HCPCS C1776		6495-5-012  -  STEM FEMORAL STR FLUTE 12MM 125MM PRESSFIT GMRS COCR HIP	BOTH IP/OP	"$9,450.00 "	"$6,993.00"	$0.00	"$7,560.00"	"$4,252.50"	"$4,252.50"	$0.00	$0.00	$0.00	"$1,969.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,969.38"	$0.00	"$4,658.85"	"$4,658.85"	$0.00	"$4,725.00"	"$7,484.40"	"$7,560.00"	$0.00		$0.00	"$1,478.93"	$0.00	$0.00	"$1,504.44"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-013	SUP	HCPCS C1776		6495-5-013  -  STEM FEMORAL STR FLUTE 13MM 125MM PRESSFIT GMRS COCR HIP	BOTH IP/OP	"$9,450.00 "	"$6,993.00"	$0.00	"$7,560.00"	"$4,252.50"	"$4,252.50"	$0.00	$0.00	$0.00	"$1,969.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,969.38"	$0.00	"$4,658.85"	"$4,658.85"	$0.00	"$4,725.00"	"$7,484.40"	"$7,560.00"	$0.00		$0.00	"$1,478.93"	$0.00	$0.00	"$1,504.44"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-014	SUP	HCPCS C1776		6495-5-014  -  STEM FEMORAL STR FLUTE 14MM 125MM PRESSFIT GMRS COCR HIP	BOTH IP/OP	"$9,450.00 "	"$6,993.00"	$0.00	"$7,560.00"	"$4,252.50"	"$4,252.50"	$0.00	$0.00	$0.00	"$1,969.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,969.38"	$0.00	"$4,658.85"	"$4,658.85"	$0.00	"$4,725.00"	"$7,484.40"	"$7,560.00"	$0.00		$0.00	"$1,478.93"	$0.00	$0.00	"$1,504.44"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-015	SUP	HCPCS C1776		6495-5-015  -  STEM FEMORAL STR FLUTE 15MM 125MM PRESSFIT GMRS COCR HIP	BOTH IP/OP	"$9,450.00 "	"$6,993.00"	$0.00	"$7,560.00"	"$4,252.50"	"$4,252.50"	$0.00	$0.00	$0.00	"$1,969.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,969.38"	$0.00	"$4,658.85"	"$4,658.85"	$0.00	"$4,725.00"	"$7,484.40"	"$7,560.00"	$0.00		$0.00	"$1,478.93"	$0.00	$0.00	"$1,504.44"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-016	SUP	HCPCS C1776		6495-5-016  -  STEM FEMORAL STR FLUTE 16MM 125MM PRESSFIT GMRS COCR HIP	BOTH IP/OP	"$9,450.00 "	"$6,993.00"	$0.00	"$7,560.00"	"$4,252.50"	"$4,252.50"	$0.00	$0.00	$0.00	"$1,969.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,969.38"	$0.00	"$4,658.85"	"$4,658.85"	$0.00	"$4,725.00"	"$7,484.40"	"$7,560.00"	$0.00		$0.00	"$1,478.93"	$0.00	$0.00	"$1,504.44"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-017	SUP	HCPCS C1776		6495-5-017  -  STEM FEMORAL STR FLUTE 17MM 125MM PRESSFIT GMRS COCR HIP	BOTH IP/OP	"$9,450.00 "	"$6,993.00"	$0.00	"$7,560.00"	"$4,252.50"	"$4,252.50"	$0.00	$0.00	$0.00	"$1,969.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,969.38"	$0.00	"$4,658.85"	"$4,658.85"	$0.00	"$4,725.00"	"$7,484.40"	"$7,560.00"	$0.00		$0.00	"$1,478.93"	$0.00	$0.00	"$1,504.44"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-018	SUP	HCPCS C1776		6495-5-018  -  STEM FEMORAL STR FLUTE 18MM 125MM PRESSFIT GMRS COCR HIP	BOTH IP/OP	"$9,450.00 "	"$6,993.00"	$0.00	"$7,560.00"	"$4,252.50"	"$4,252.50"	$0.00	$0.00	$0.00	"$1,969.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,969.38"	$0.00	"$4,658.85"	"$4,658.85"	$0.00	"$4,725.00"	"$7,484.40"	"$7,560.00"	$0.00		$0.00	"$1,478.93"	$0.00	$0.00	"$1,504.44"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-019	SUP	HCPCS C1776		6495-5-019  -  STEM FEMORAL STR FLUTE 19MM 125MM PRESSFIT GMRS COCR HIP	BOTH IP/OP	"$9,450.00 "	"$6,993.00"	$0.00	"$7,560.00"	"$4,252.50"	"$4,252.50"	$0.00	$0.00	$0.00	"$1,969.62"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,969.38"	$0.00	"$4,658.85"	"$4,658.85"	$0.00	"$4,725.00"	"$7,484.40"	"$7,560.00"	$0.00		$0.00	"$1,478.93"	$0.00	$0.00	"$1,504.44"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-111	SUP	HCPCS C1776		6495-5-111  -  STEM FEMORAL LONG BOW 11MM 200MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-112	SUP	HCPCS C1776		6495-5-112  -  STEM FEMORAL LONG BOW 12MM 200MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-113	SUP	HCPCS C1776		6495-5-113  -  STEM FEMORAL LONG BOW 13MM 200MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-114	SUP	HCPCS C1776		6495-5-114  -  STEM FEMORAL LONG BOW 14MM 200MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-115	SUP	HCPCS C1776		6495-5-115  -  STEM FEMORAL LONG BOW 15MM 200MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-116	SUP	HCPCS C1776		6495-5-116  -  STEM FEMORAL LONG BOW 16MM 200MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-117	SUP	HCPCS C1776		6495-5-117  -  STEM FEMORAL LONG BOW 17MM 200MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-118	SUP	HCPCS C1776		6495-5-118  -  STEM FEMORAL LONG BOW 18MM 200MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-119	SUP	HCPCS C1776		6495-5-119  -  STEM FEMORAL LONG BOW 19MM 200MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-211	SUP	HCPCS C1776		6495-5-211  -  STEM FEMORAL BOW 11MM 150MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-212	SUP	HCPCS C1776		6495-5-212  -  STEM FEMORAL BOW 12MM 150MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-213	SUP	HCPCS C1776		6495-5-213  -  STEM FEMORAL BOW 13MM 150MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-214	SUP	HCPCS C1776		6495-5-214  -  STEM FEMORAL BOW 14MM 150MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-215	SUP	HCPCS C1776		6495-5-215  -  STEM FEMORAL BOW 15MM 150MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-216	SUP	HCPCS C1776		6495-5-216  -  STEM FEMORAL BOW 16MM 150MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-217	SUP	HCPCS C1776		6495-5-217  -  STEM FEMORAL BOW 17MM 150MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-218	SUP	HCPCS C1776		6495-5-218  -  STEM FEMORAL BOW 18MM 150MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-5-219	SUP	HCPCS C1776		6495-5-219  -  STEM FEMORAL BOW 19MM 150MM PRESSFIT GMRS HIP	BOTH IP/OP	"$9,962.50 "	"$7,372.25"	$0.00	"$7,970.00"	"$4,483.13"	"$4,483.13"	$0.00	$0.00	$0.00	"$2,076.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.19"	$0.00	"$4,911.51"	"$4,911.51"	$0.00	"$4,981.25"	"$7,890.30"	"$7,970.00"	$0.00		$0.00	"$1,559.13"	$0.00	$0.00	"$1,586.03"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-008	SUP	HCPCS C1776		6495-6-008  -  COMPONENT FEMORAL 80MM CONCTR GMRS KNEE LEFT	BOTH IP/OP	"$9,002.50 "	"$6,661.85"	$0.00	"$7,202.00"	"$4,051.13"	"$4,051.13"	$0.00	$0.00	$0.00	"$1,876.35"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,876.12"	$0.00	"$4,438.23"	"$4,438.23"	$0.00	"$4,501.25"	"$7,129.98"	"$7,202.00"	$0.00		$0.00	"$1,408.89"	$0.00	$0.00	"$1,433.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-009	SUP	HCPCS C1776		6495-6-009  -  COMPONENT FEMORAL 90MM CONNECT PIECE GMRS KNEE LEFT	BOTH IP/OP	"$9,002.50 "	"$6,661.85"	$0.00	"$7,202.00"	"$4,051.13"	"$4,051.13"	$0.00	$0.00	$0.00	"$1,876.35"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,876.12"	$0.00	"$4,438.23"	"$4,438.23"	$0.00	"$4,501.25"	"$7,129.98"	"$7,202.00"	$0.00		$0.00	"$1,408.89"	$0.00	$0.00	"$1,433.20"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-018	SUP	HCPCS C1776		6495-6-018  -  COMPONENT FEMORAL 80MM CONNECT PIECE GMRS TITANIUM HIP RIGHT	BOTH IP/OP	"$9,087.50 "	"$6,724.75"	$0.00	"$7,270.00"	"$4,089.38"	"$4,089.38"	$0.00	$0.00	$0.00	"$1,894.06"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,893.84"	$0.00	"$4,480.14"	"$4,480.14"	$0.00	"$4,543.75"	"$7,197.30"	"$7,270.00"	$0.00		$0.00	"$1,422.19"	$0.00	$0.00	"$1,446.73"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-019	SUP	HCPCS C1776		6495-6-019  -  COMPONENT FEMORAL 90MM CONNECT PIECE GMRS KNEE RIGHT	BOTH IP/OP	"$9,087.50 "	"$6,724.75"	$0.00	"$7,270.00"	"$4,089.38"	"$4,089.38"	$0.00	$0.00	$0.00	"$1,894.06"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,893.84"	$0.00	"$4,480.14"	"$4,480.14"	$0.00	"$4,543.75"	"$7,197.30"	"$7,270.00"	$0.00		$0.00	"$1,422.19"	$0.00	$0.00	"$1,446.73"	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-030	SUP	HCPCS C1776		6495-6-030  -  EXTENSION FEMORAL 30MM GMRS COCR KNEE DISTAL	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-040	SUP	HCPCS C1776		6495-6-040  -  EXTENSION FEMORAL 40MM GMRS COCR KNEE DISTAL	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-050	SUP	HCPCS C1776		6495-6-050  -  EXTENSION FEMORAL 50MM GMRS COCR KNEE DISTAL	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-060	SUP	HCPCS C1776		6495-6-060  -  EXTENSION FEMORAL 60MM GMRS COCR KNEE DISTAL	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-070	SUP	HCPCS C1776		6495-6-070  -  EXTENSION FEMORAL 70MM GMRS COCR KNEE DISTAL	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-080	SUP	HCPCS C1776		6495-6-080  -  EXTENSION FEMORAL 80MM GMRS COCR KNEE DISTAL	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-100	SUP	HCPCS C1776		6495-6-100  -  EXTENSION FEMORAL 100MM GMRS COCR KNEE DISTAL	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-120	SUP	HCPCS C1776		6495-6-120  -  EXTENSION FEMORAL 120MM GMRS COCR KNEE DISTAL	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-140	SUP	HCPCS C1776		6495-6-140  -  EXTENSION FEMORAL 140MM GMRS COCR KNEE DISTAL	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-160	SUP	HCPCS C1776		6495-6-160  -  EXTENSION STEM 160MM GMRS COCR KNEE FEMUR	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-180	SUP	HCPCS C1776		6495-6-180  -  EXTENSION FEMORAL 180MM GMRS COCR KNEE DISTAL	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-200	SUP	HCPCS C1776		6495-6-200  -  EXTENSION FEMORAL 200MM GMRS COCR KNEE DISTAL	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6495-6-220	SUP	HCPCS C1776		6495-6-220  -  EXTENSION FEMORAL 220MM GMRS COCR KNEE DISTAL	BOTH IP/OP	"$6,257.50 "	"$4,630.55"	$0.00	"$5,006.00"	"$2,815.88"	"$2,815.88"	$0.00	$0.00	$0.00	"$1,304.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,304.06"	$0.00	"$3,084.95"	"$3,084.95"	$0.00	"$3,128.75"	"$4,955.94"	"$5,006.00"	$0.00		$0.00	$979.30	$0.00	$0.00	$996.19	$0.00	$0.00	$0.00	$0.00	$0.00
6500-000-009	SUP	Custom 27100030		6500-000-009 -  MODEL ANTM CLRVW ADLT SKL	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	$0.00	$0.00	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65-0003-S	SUP	Custom 27803010		65-0003-S  -  FILLER BN VOID 3ML CALLOS	BOTH IP/OP	"$2,962.50 "	"$2,192.25"	$0.00	"$2,370.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,198.77"	"$2,198.77"	$0.00	$0.00	$617.39	$0.00	$0.00	$0.00	$0.00	"$1,481.25"	"$2,346.30"	"$2,370.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65-0005-S	SUP	Custom 27803010		65-0005-S  -  SYSTEM BN CMNT 5ML CALLOS INJ	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	$0.00	$0.00	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65-0010-S	SUP	Custom 27803010		65-0010-S  -  FILLER BN VOID 10ML CALLOS	BOTH IP/OP	"$7,750.00 "	"$5,735.00"	$0.00	"$6,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,615.10"	$0.00	$0.00	$0.00	$0.00	"$3,875.00"	"$6,138.00"	"$6,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65-0099-S	SUP	Custom 27203010		65-0099-S  -  KIT DLV INJ	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$0.00	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
650-1057	SUP	HCPCS C1776		650-1057  -  HEAD FEM 36MM G7 BLX D OPTN HIP	BOTH IP/OP	"$10,177.50 "	"$7,531.35"	$0.00	"$8,142.00"	"$4,579.88"	"$4,579.88"	$0.00	$0.00	$0.00	"$2,121.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,120.99"	$0.00	"$5,017.51"	"$5,017.51"	$0.00	"$5,088.75"	"$8,060.58"	"$8,142.00"	$0.00		$0.00	"$1,592.78"	$0.00	$0.00	"$1,620.26"	$0.00	$0.00	$0.00	$0.00	$0.00
65-0105-S	SUP	Custom 27803010		65-0105-S  -  FILLER BN VOID 5ML CALLOS	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	$0.00	$0.00	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
650-1066	SUP	HCPCS C1776		650-1066  -  SLEEVE FEMORAL STANDARD TAPER TYPE 1 OPTION BIOLOX DELTA	BOTH IP/OP	"$1,030.00 "	$762.20	$0.00	$824.00	$463.50	$463.50	$0.00	$0.00	$0.00	$214.68	$764.47	$764.47	$0.00	$0.00	$214.65	$0.00	$609.25	$609.25	$0.00	$515.00	$815.76	$824.00	$0.00		$0.00	$161.20	$0.00	$0.00	$163.98	$0.00	$0.00	$0.00	$0.00	$0.00
65-0110-S	SUP	Custom 27803010		65-0110-S  -  FILLER BN VOID 10ML CALLOS	BOTH IP/OP	"$7,750.00 "	"$5,735.00"	$0.00	"$6,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,615.10"	$0.00	$0.00	$0.00	$0.00	"$3,875.00"	"$6,138.00"	"$6,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65-018-E4S	SUP	Custom 27203010		65-018-E4S  -  CATHETER INFS 4 4/3FR 65CM CLARIVEIN	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65-0199-S	SUP	Custom 27203010		65-0199-S  -  SYSTEM BONE CMNT IMPCT KIT CALLOS	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$0.00	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6515-0814L	SUP	HCPCS C1776		6515-0814L  -  STEM FEM 205MM 14MM BW RSTOR HYDRXAPT -5MM LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-0814R	SUP	HCPCS C1776		6515-0814R  -  STEM FEM 205MM 14MM BW RSTOR HYDRXAPT -5MM RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-0915L	SUP	HCPCS C1776		6515-0915L  -  STEM FEM 205MM 15MM BW RSTOR HYDRXAPT -5MM LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-0915R	SUP	HCPCS C1776		6515-0915R  -  STEM FEM 205MM 15MM BW RSTOR HYDRXAPT -5MM RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-1016L	SUP	HCPCS C1776		6515-1016L  -  STEM FEM 205MM 16MM BW RSTOR HYDRXAPT -5MM LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-1016R	SUP	HCPCS C1776		6515-1016R  -  STEM FEM 205MM 16MM BW RSTOR HYDRXAPT -5MM RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-1117L	SUP	HCPCS C1776		6515-1117L  -  STEM FEM 205MM 17MM BW RSTOR HYDRXAPT -5MM LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-1117R	SUP	HCPCS C1776		6515-1117R  -  STEM FEM 205MM 17MM BW RSTOR HYDRXAPT -5MM RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-1218L	SUP	HCPCS C1776		6515-1218L  -  STEM REV 205MM 18MM RSTOR -5MM LEFT HIP HYDRXAPT BW	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-1218R	SUP	HCPCS C1776		6515-1218R  -  STEM FEM 205MM 18MM BW RSTOR HYDRXAPT -5MM RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-1319L	SUP	HCPCS C1776		6515-1319L  -  STEM FEM 205MM 19MM BW RSTOR HYDRXAPT -5MM LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-1319R	SUP	HCPCS C1776		6515-1319R  -  STEM FEM 205MM 19MM BW RSTOR HYDRXAPT -5MM RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-1420L	SUP	HCPCS C1776		6515-1420L  -  STEM FEM 205MM 20MM BW RSTOR HYDRXAPT -5MM LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-1420R	SUP	HCPCS C1776		6515-1420R  -  STEM FEM 205MM 20MM BW RSTOR HYDRXAPT -5MM RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-1422L	SUP	HCPCS C1776		6515-1422L  -  STEM FEM 205MM 22MM BW RSTOR HYDRXAPT -5MM LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6515-1422R	SUP	HCPCS C1776		6515-1422R  -  STEM FEM 205MM 22MM BW RSTOR HYDRXAPT -5MM RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-0814L	SUP	HCPCS C1776		6516-0814L  -  STEM FEM 14MM 14MM RED NECK RSTOR HYDRXAPT -5MM 8 HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-0814R	SUP	HCPCS C1776		6516-0814R  -  STEM FEM 255MM STR RED NECK RSTOR HYDRXAPT -5MM HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-0915L	SUP	HCPCS C1776		6516-0915L  -  NECK FEM 15MM RSTOR LEFT HIP HYDRXAPT RED	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-0915R	SUP	HCPCS C1776		6516-0915R  -  STEM FEM 15MM RED NECK RSTOR HYDRXAPT RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-1016L	SUP	HCPCS C1776		6516-1016L  -  STEM FEM 16MM RED NECK RSTOR HYDRXAPT LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-1016R	SUP	HCPCS C1776		6516-1016R  -  STEM FEM 16MM RED NECK RSTOR HYDRXAPT RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-1117L	SUP	HCPCS C1776		6516-1117L  -  STEM FEM 17MM 17MM NO DISTAL SLOT RED NECK SYS RSTOR	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-1117R	SUP	HCPCS C1776		6516-1117R  -  STEM FEM 17MM RED NECK RSTOR HYDRXAPT RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-1218L	SUP	HCPCS C1776		6516-1218L  -  STEM FEM 18MM RED RSTOR HYDRXAPT LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-1218R	SUP	HCPCS C1776		6516-1218R  -  STEM FEM 18MM 18MM RED NECK NO DISTAL SLOT RSTOR HYDRXAPT -5	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-1319L	SUP	HCPCS C1776		6516-1319L  -  STEM FEM 19MM RED NECK RSTOR HYDRXAPT LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-1319R	SUP	HCPCS C1776		6516-1319R  -  STEM FEM 19MM 19MM RED NECK NO DISTAL SLOT RSTOR HYDRXAPT 13	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-1420L	SUP	HCPCS C1776		6516-1420L  -  STEM FEM 20MM RED NECK RSTOR HYDRXAPT LEFT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-1420R	SUP	HCPCS C1776		6516-1420R  -  STEM FEM 20MM RED NECK NO DISTAL SLOT RSTOR HYDRXAPT RIGHT	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-1422L	SUP	HCPCS C1776		6516-1422L  -  STEM FEM 22MM 22MM NO DISTAL SLOT RED NECK SYS RSTOR	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6516-1422R	SUP	HCPCS C1776		6516-1422R  -  STEM FEM 22MM RED NECK RSTOR HYDRXAPT RIGHT HIP	BOTH IP/OP	"$12,943.13 "	"$9,577.92"	$0.00	"$10,354.50"	"$5,824.41"	"$5,824.41"	$0.00	$0.00	$0.00	"$2,697.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,697.35"	$0.00	"$6,380.96"	"$6,380.96"	$0.00	"$6,471.56"	"$10,250.96"	"$10,354.50"	$0.00		$0.00	"$2,025.60"	$0.00	$0.00	"$2,060.55"	$0.00	$0.00	$0.00	$0.00	$0.00
6519-1-028	SUP	Custom 27803010		6519-1-028  -  HEAD FEM +0MM UNV TPR 28MM STRL BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6519-1-032	SUP	Custom 27803010		6519-1-032  -  HEAD FEM +0MM UNV TPR 32MM STRL BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6519-1-036	SUP	Custom 27803010		6519-1-036  -  HEAD FEM +0MM UNV TPR 36MM STRL BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6519-1-040	SUP	Custom 27803010		6519-1-040  -  HEAD FEM +0MM UNV TPR 40MM STRL BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6519-1-044	SUP	Custom 27803010		6519-1-044  -  HEAD FEM +0MM UNV TPR 44MM STRL BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6519-T-025	SUP	Custom 27803010		6519-T-025  -  SLEEVE ADAPTER -2.5MM OFFST UNIVERSAL TAPER V40 TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6519-T-100	SUP	Custom 27803010		6519-T-100  -  SLEEVE ADAPTER +0MM OFFST UNIVERSAL TAPER V40 TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6519-T-204	SUP	Custom 27803010		6519-T-204  -  SLEEVE ADAPTER +4MM OFFST UNIVERSAL TAPER V40 TITANIUM HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6522-0509	SUP	HCPCS C1776		6522-0509  -  STEM FEM 145MM 9MM CTPR RSTOR TI HYDRXAPT HIP	BOTH IP/OP	"$11,474.13 "	"$8,490.86"	$0.00	"$9,179.30"	"$5,163.36"	"$5,163.36"	$0.00	$0.00	$0.00	"$2,391.49"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,391.21"	$0.00	"$5,656.74"	"$5,656.74"	$0.00	"$5,737.06"	"$9,087.51"	"$9,179.30"	$0.00		$0.00	"$1,795.70"	$0.00	$0.00	"$1,826.68"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-0511	SUP	HCPCS C1776		6522-0511  -  STEM FEM 145MM 11MM CTPR RSTOR TI HYDRXAPT HIP	BOTH IP/OP	"$11,474.13 "	"$8,490.86"	$0.00	"$9,179.30"	"$5,163.36"	"$5,163.36"	$0.00	$0.00	$0.00	"$2,391.49"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,391.21"	$0.00	"$5,656.74"	"$5,656.74"	$0.00	"$5,737.06"	"$9,087.51"	"$9,179.30"	$0.00		$0.00	"$1,795.70"	$0.00	$0.00	"$1,826.68"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-0610	SUP	HCPCS C1776		6522-0610  -  STEM FEM 145MM 10MM CTPR RSTOR TI HYDRXAPT HIP	BOTH IP/OP	"$11,474.13 "	"$8,490.86"	$0.00	"$9,179.30"	"$5,163.36"	"$5,163.36"	$0.00	$0.00	$0.00	"$2,391.49"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,391.21"	$0.00	"$5,656.74"	"$5,656.74"	$0.00	"$5,737.06"	"$9,087.51"	"$9,179.30"	$0.00		$0.00	"$1,795.70"	$0.00	$0.00	"$1,826.68"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-0612	SUP	HCPCS C1776		6522-0612  -  STEM FEM 145MM 12MM CTPR RSTOR TI HYDRXAPT HIP	BOTH IP/OP	"$11,474.13 "	"$8,490.86"	$0.00	"$9,179.30"	"$5,163.36"	"$5,163.36"	$0.00	$0.00	$0.00	"$2,391.49"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,391.21"	$0.00	"$5,656.74"	"$5,656.74"	$0.00	"$5,737.06"	"$9,087.51"	"$9,179.30"	$0.00		$0.00	"$1,795.70"	$0.00	$0.00	"$1,826.68"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-0711	SUP	HCPCS C1776		6522-0711  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$10,684.38 "	"$7,906.44"	$0.00	"$8,547.50"	"$4,807.97"	"$4,807.97"	$0.00	$0.00	$0.00	"$2,226.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,226.62"	$0.00	"$5,267.40"	"$5,267.40"	$0.00	"$5,342.19"	"$8,462.03"	"$8,547.50"	$0.00		$0.00	"$1,672.10"	$0.00	$0.00	"$1,700.95"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-0713	SUP	HCPCS C1776		6522-0713  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$10,684.38 "	"$7,906.44"	$0.00	"$8,547.50"	"$4,807.97"	"$4,807.97"	$0.00	$0.00	$0.00	"$2,226.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,226.62"	$0.00	"$5,267.40"	"$5,267.40"	$0.00	"$5,342.19"	"$8,462.03"	"$8,547.50"	$0.00		$0.00	"$1,672.10"	$0.00	$0.00	"$1,700.95"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-0812	SUP	HCPCS C1776		6522-0812  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$10,684.38 "	"$7,906.44"	$0.00	"$8,547.50"	"$4,807.97"	"$4,807.97"	$0.00	$0.00	$0.00	"$2,226.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,226.62"	$0.00	"$5,267.40"	"$5,267.40"	$0.00	"$5,342.19"	"$8,462.03"	"$8,547.50"	$0.00		$0.00	"$1,672.10"	$0.00	$0.00	"$1,700.95"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-0814	SUP	HCPCS C1776		6522-0814  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$10,684.38 "	"$7,906.44"	$0.00	"$8,547.50"	"$4,807.97"	"$4,807.97"	$0.00	$0.00	$0.00	"$2,226.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,226.62"	$0.00	"$5,267.40"	"$5,267.40"	$0.00	"$5,342.19"	"$8,462.03"	"$8,547.50"	$0.00		$0.00	"$1,672.10"	$0.00	$0.00	"$1,700.95"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-0913	SUP	HCPCS C1776		6522-0913  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$10,684.38 "	"$7,906.44"	$0.00	"$8,547.50"	"$4,807.97"	"$4,807.97"	$0.00	$0.00	$0.00	"$2,226.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,226.62"	$0.00	"$5,267.40"	"$5,267.40"	$0.00	"$5,342.19"	"$8,462.03"	"$8,547.50"	$0.00		$0.00	"$1,672.10"	$0.00	$0.00	"$1,700.95"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-0915	SUP	HCPCS C1776		6522-0915  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$10,684.38 "	"$7,906.44"	$0.00	"$8,547.50"	"$4,807.97"	"$4,807.97"	$0.00	$0.00	$0.00	"$2,226.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,226.62"	$0.00	"$5,267.40"	"$5,267.40"	$0.00	"$5,342.19"	"$8,462.03"	"$8,547.50"	$0.00		$0.00	"$1,672.10"	$0.00	$0.00	"$1,700.95"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-1014	SUP	HCPCS C1776		6522-1014  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$10,684.38 "	"$7,906.44"	$0.00	"$8,547.50"	"$4,807.97"	"$4,807.97"	$0.00	$0.00	$0.00	"$2,226.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,226.62"	$0.00	"$5,267.40"	"$5,267.40"	$0.00	"$5,342.19"	"$8,462.03"	"$8,547.50"	$0.00		$0.00	"$1,672.10"	$0.00	$0.00	"$1,700.95"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-1016	SUP	HCPCS C1776		6522-1016  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$10,684.38 "	"$7,906.44"	$0.00	"$8,547.50"	"$4,807.97"	"$4,807.97"	$0.00	$0.00	$0.00	"$2,226.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,226.62"	$0.00	"$5,267.40"	"$5,267.40"	$0.00	"$5,342.19"	"$8,462.03"	"$8,547.50"	$0.00		$0.00	"$1,672.10"	$0.00	$0.00	"$1,700.95"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-1115	SUP	HCPCS C1776		6522-1115  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$10,684.38 "	"$7,906.44"	$0.00	"$8,547.50"	"$4,807.97"	"$4,807.97"	$0.00	$0.00	$0.00	"$2,226.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,226.62"	$0.00	"$5,267.40"	"$5,267.40"	$0.00	"$5,342.19"	"$8,462.03"	"$8,547.50"	$0.00		$0.00	"$1,672.10"	$0.00	$0.00	"$1,700.95"	$0.00	$0.00	$0.00	$0.00	$0.00
6522-1117	SUP	HCPCS C1776		6522-1117  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$10,684.38 "	"$7,906.44"	$0.00	"$8,547.50"	"$4,807.97"	"$4,807.97"	$0.00	$0.00	$0.00	"$2,226.89"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,226.62"	$0.00	"$5,267.40"	"$5,267.40"	$0.00	"$5,342.19"	"$8,462.03"	"$8,547.50"	$0.00		$0.00	"$1,672.10"	$0.00	$0.00	"$1,700.95"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-0509	SUP	HCPCS C1776		6523-0509  -  STEM FEM 175MM 9MM CTPR RSTOR TI HYDRXAPT HIP	BOTH IP/OP	"$12,150.13 "	"$8,991.10"	$0.00	"$9,720.10"	"$5,467.56"	"$5,467.56"	$0.00	$0.00	$0.00	"$2,532.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,532.09"	$0.00	"$5,990.01"	"$5,990.01"	$0.00	"$6,075.06"	"$9,622.90"	"$9,720.10"	$0.00		$0.00	"$1,901.49"	$0.00	$0.00	"$1,934.30"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-0511	SUP	HCPCS C1776		6523-0511  -  STEM FEM 175MM 11MM CTPR RSTOR TI HYDRXAPT HIP	BOTH IP/OP	"$12,150.13 "	"$8,991.10"	$0.00	"$9,720.10"	"$5,467.56"	"$5,467.56"	$0.00	$0.00	$0.00	"$2,532.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,532.09"	$0.00	"$5,990.01"	"$5,990.01"	$0.00	"$6,075.06"	"$9,622.90"	"$9,720.10"	$0.00		$0.00	"$1,901.49"	$0.00	$0.00	"$1,934.30"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-0610	SUP	HCPCS C1776		6523-0610  -  STEM FEM 175MM 10MM CTPR RSTOR TI HYDRXAPT HIP	BOTH IP/OP	"$12,150.13 "	"$8,991.10"	$0.00	"$9,720.10"	"$5,467.56"	"$5,467.56"	$0.00	$0.00	$0.00	"$2,532.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,532.09"	$0.00	"$5,990.01"	"$5,990.01"	$0.00	"$6,075.06"	"$9,622.90"	"$9,720.10"	$0.00		$0.00	"$1,901.49"	$0.00	$0.00	"$1,934.30"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-0612	SUP	HCPCS C1776		6523-0612  -  STEM FEM 175MM 12MM CTPR RSTOR TI HYDRXAPT HIP	BOTH IP/OP	"$12,150.13 "	"$8,991.10"	$0.00	"$9,720.10"	"$5,467.56"	"$5,467.56"	$0.00	$0.00	$0.00	"$2,532.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,532.09"	$0.00	"$5,990.01"	"$5,990.01"	$0.00	"$6,075.06"	"$9,622.90"	"$9,720.10"	$0.00		$0.00	"$1,901.49"	$0.00	$0.00	"$1,934.30"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-0711	SUP	HCPCS C1776		6523-0711  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$11,313.25 "	"$8,371.81"	$0.00	"$9,050.60"	"$5,090.96"	"$5,090.96"	$0.00	$0.00	$0.00	"$2,357.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,357.68"	$0.00	"$5,577.43"	"$5,577.43"	$0.00	"$5,656.63"	"$8,960.09"	"$9,050.60"	$0.00		$0.00	"$1,770.52"	$0.00	$0.00	"$1,801.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-0713	SUP	HCPCS C1776		6523-0713  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$11,313.25 "	"$8,371.81"	$0.00	"$9,050.60"	"$5,090.96"	"$5,090.96"	$0.00	$0.00	$0.00	"$2,357.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,357.68"	$0.00	"$5,577.43"	"$5,577.43"	$0.00	"$5,656.63"	"$8,960.09"	"$9,050.60"	$0.00		$0.00	"$1,770.52"	$0.00	$0.00	"$1,801.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-0812	SUP	HCPCS C1776		6523-0812  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$11,313.25 "	"$8,371.81"	$0.00	"$9,050.60"	"$5,090.96"	"$5,090.96"	$0.00	$0.00	$0.00	"$2,357.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,357.68"	$0.00	"$5,577.43"	"$5,577.43"	$0.00	"$5,656.63"	"$8,960.09"	"$9,050.60"	$0.00		$0.00	"$1,770.52"	$0.00	$0.00	"$1,801.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-0814	SUP	HCPCS C1776		6523-0814  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$11,313.25 "	"$8,371.81"	$0.00	"$9,050.60"	"$5,090.96"	"$5,090.96"	$0.00	$0.00	$0.00	"$2,357.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,357.68"	$0.00	"$5,577.43"	"$5,577.43"	$0.00	"$5,656.63"	"$8,960.09"	"$9,050.60"	$0.00		$0.00	"$1,770.52"	$0.00	$0.00	"$1,801.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-0913	SUP	HCPCS C1776		6523-0913  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$11,313.25 "	"$8,371.81"	$0.00	"$9,050.60"	"$5,090.96"	"$5,090.96"	$0.00	$0.00	$0.00	"$2,357.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,357.68"	$0.00	"$5,577.43"	"$5,577.43"	$0.00	"$5,656.63"	"$8,960.09"	"$9,050.60"	$0.00		$0.00	"$1,770.52"	$0.00	$0.00	"$1,801.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-0915	SUP	HCPCS C1776		6523-0915  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$11,313.25 "	"$8,371.81"	$0.00	"$9,050.60"	"$5,090.96"	"$5,090.96"	$0.00	$0.00	$0.00	"$2,357.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,357.68"	$0.00	"$5,577.43"	"$5,577.43"	$0.00	"$5,656.63"	"$8,960.09"	"$9,050.60"	$0.00		$0.00	"$1,770.52"	$0.00	$0.00	"$1,801.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-1014	SUP	HCPCS C1776		6523-1014  -  STEM HUM 205MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$11,313.25 "	"$8,371.81"	$0.00	"$9,050.60"	"$5,090.96"	"$5,090.96"	$0.00	$0.00	$0.00	"$2,357.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,357.68"	$0.00	"$5,577.43"	"$5,577.43"	$0.00	"$5,656.63"	"$8,960.09"	"$9,050.60"	$0.00		$0.00	"$1,770.52"	$0.00	$0.00	"$1,801.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-1016	SUP	HCPCS C1776		6523-1016  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$11,313.25 "	"$8,371.81"	$0.00	"$9,050.60"	"$5,090.96"	"$5,090.96"	$0.00	$0.00	$0.00	"$2,357.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,357.68"	$0.00	"$5,577.43"	"$5,577.43"	$0.00	"$5,656.63"	"$8,960.09"	"$9,050.60"	$0.00		$0.00	"$1,770.52"	$0.00	$0.00	"$1,801.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-1115	SUP	HCPCS C1776		6523-1115  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$11,313.25 "	"$8,371.81"	$0.00	"$9,050.60"	"$5,090.96"	"$5,090.96"	$0.00	$0.00	$0.00	"$2,357.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,357.68"	$0.00	"$5,577.43"	"$5,577.43"	$0.00	"$5,656.63"	"$8,960.09"	"$9,050.60"	$0.00		$0.00	"$1,770.52"	$0.00	$0.00	"$1,801.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6523-1117	SUP	HCPCS C1776		6523-1117  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT	BOTH IP/OP	"$11,313.25 "	"$8,371.81"	$0.00	"$9,050.60"	"$5,090.96"	"$5,090.96"	$0.00	$0.00	$0.00	"$2,357.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,357.68"	$0.00	"$5,577.43"	"$5,577.43"	$0.00	"$5,656.63"	"$8,960.09"	"$9,050.60"	$0.00		$0.00	"$1,770.52"	$0.00	$0.00	"$1,801.07"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-0511L	SUP	HCPCS C1776		6524-0511L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-0511R	SUP	HCPCS C1776		6524-0511R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-0612L	SUP	HCPCS C1776		6524-0612L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-0612R	SUP	HCPCS C1776		6524-0612R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-0713L	SUP	HCPCS C1776		6524-0713L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT	BOTH IP/OP	"$12,161.50 "	"$8,999.51"	$0.00	"$9,729.20"	"$5,472.68"	"$5,472.68"	$0.00	$0.00	$0.00	"$2,534.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,534.46"	$0.00	"$5,995.62"	"$5,995.62"	$0.00	"$6,080.75"	"$9,631.91"	"$9,729.20"	$0.00		$0.00	"$1,903.27"	$0.00	$0.00	"$1,936.11"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-0713R	SUP	HCPCS C1776		6524-0713R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-0814L	SUP	HCPCS C1776		6524-0814L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-0814R	SUP	HCPCS C1776		6524-0814R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-0915L	SUP	HCPCS C1776		6524-0915L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-0915R	SUP	HCPCS C1776		6524-0915R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-1016L	SUP	HCPCS C1776		6524-1016L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-1016R	SUP	HCPCS C1776		6524-1016R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-1117L	SUP	HCPCS C1776		6524-1117L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6524-1117R	SUP	HCPCS C1776		6524-1117R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT	BOTH IP/OP	"$11,938.88 "	"$8,834.77"	$0.00	"$9,551.10"	"$5,372.49"	"$5,372.49"	$0.00	$0.00	$0.00	"$2,488.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,488.06"	$0.00	"$5,885.87"	"$5,885.87"	$0.00	"$5,969.44"	"$9,455.59"	"$9,551.10"	$0.00		$0.00	"$1,868.43"	$0.00	$0.00	"$1,900.67"	$0.00	$0.00	$0.00	$0.00	$0.00
6528-0511	SUP	HCPCS C1776		6528-0511  -  STEM FEM 175MM RSTOR HYDRXAPT CLCR 1	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6528-0612	SUP	HCPCS C1776		6528-0612  -  STEM FEM 175MM RSTOR HYDRXAPT CLCR 1	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6528-0713	SUP	HCPCS C1776		6528-0713  -  STEM FEM 175MM RSTOR HYDRXAPT CLCR 1	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6528-0814	SUP	HCPCS C1776		6528-0814  -  STEM FEM 175MM RSTOR HYDRXAPT CLCR 1	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6528-0915	SUP	HCPCS C1776		6528-0915  -  CMPNT FEM 175MM CLCR 2 RSTOR HYDRXAPT	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6528-1016	SUP	HCPCS C1776		6528-1016  -  STEM FEM 145MM 15MM RSTOR HYDRXAPT 10/16 CLCR	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6528-1117	SUP	HCPCS C1776		6528-1117  -  CMPNT FEM 11/17 175MM CLCR 2 RSTOR HYDRXAPT 15MM	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6528-1218	SUP	HCPCS C1776		6528-1218  -  CMPNT FEM 12/18 175MM CLCR RSTOR HYDRXAPT 15MM	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6529-0511	SUP	HCPCS C1776		6529-0511  -  STEM FEM 175MM 30MM RSTOR HYDRXAPT 5/11 CLCR 2	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6529-0612	SUP	HCPCS C1776		6529-0612  -  CMPNT FEM 6/12 175MM CLCR 2 RSTOR HYDRXAPT 30MM	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6529-0713	SUP	HCPCS C1776		6529-0713  -  STEM FEM 175MM 30MM RSTOR HYDRXAPT 7/13 CLCR 2	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6529-0814	SUP	HCPCS C1776		6529-0814  -  STEM FEM 175MM 30MM RSTOR HYDRXAPT 8/14 CLCR	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6529-0915	SUP	HCPCS C1776		6529-0915  -  CMPNT FEM 9/15 175MM CLCR 2 RSTOR HYDRXAPT 30MM	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6529-1016	SUP	HCPCS C1776		6529-1016  -  STEM FEM 175MM 30MM RSTOR HYDRXAPT 10/16 CLCR 2	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6529-1117	SUP	HCPCS C1776		6529-1117  -  CMPNT FEM 11/17 175MM CLCR 2 RSTOR HYDRXAPT 30MM	BOTH IP/OP	"$12,689.63 "	"$9,390.33"	$0.00	"$10,151.70"	"$5,710.33"	"$5,710.33"	$0.00	$0.00	$0.00	"$2,644.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,644.52"	$0.00	"$6,255.99"	"$6,255.99"	$0.00	"$6,344.81"	"$10,050.19"	"$10,151.70"	$0.00		$0.00	"$1,985.93"	$0.00	$0.00	"$2,020.19"	$0.00	$0.00	$0.00	$0.00	$0.00
6565-0-028	SUP	Custom 27803010		6565-0-028  -  HEAD FEMORAL -2.7MM OFFST TAPER 28MM V40 ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6565-0-032	SUP	Custom 27803010		6565-0-032  -  HEAD FEMORAL -4MM OFFST TAPER 32MM V40 ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6565-0-036	SUP	Custom 27803010		6565-0-036  -  HEAD FEMORAL -5MM OFFST TAPER 36MM V40 ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6565-0-128	SUP	Custom 27803010		6565-0-128  -  HEAD FEMORAL +0MM OFFST TAPER 28MM V40 ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6565-0-132	SUP	Custom 27803010		6565-0-132  -  HEAD FEM +0MM OFST TPR 32MM STRL V40 AL CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6565-0-136	SUP	Custom 27803010		6565-0-136  -  HEAD FEMORAL +0MM OFFST TAPER 36MM V40 ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6565-0-228	SUP	Custom 27803010		6565-0-228  -  HEAD FEMORAL +4MM OFFST TAPER 28MM V40 ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6565-0-232	SUP	Custom 27803010		6565-0-232  -  HEAD FEMORAL +4MM OFFST TAPER 32MM V40 ALUM CERAMIC HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6565-0-236	SUP	Custom 27803010		6565-0-236  -  HEAD FEM +5MM OFST TPR 36MM STRL V40 AL CERM HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65652-512	SUP	Custom 27203010		CANISTER SCT 1L CURVE INTNL ON/OFF VLV XTD BKT HLDR REUSE LF	BOTH IP/OP	$64.00 	$47.36	$0.00	$51.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.00	$50.69	$51.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-028	SUP	Custom 27803010		6570-0-028  -  HEAD FEM -4MM OFST TPR 28MM STRL V40 BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-032	SUP	Custom 27803010		6570-0-032  -  HEAD FEM -4MM OFST TPR 32MM STRL V40 BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-036	SUP	Custom 27803010		6570-0-036  -  HEAD FEM -5MM OFST TPR 36MM V40 ANTM BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-128	SUP	Custom 27803010		6570-0-128  -  HEAD FEMORAL 0MM OFFST TAPER 28MM V40 BIOLOX DELTA HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-132	SUP	Custom 27803010		6570-0-132  -  HEAD FEM +0MM OFST TPR 32MM V40 BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-136	SUP	Custom 27803010		6570-0-136  -  HEAD FEM +0MM OFST TPR 36MM V40 ANTM BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-228	SUP	Custom 27803010		6570-0-228  -  HEAD FEM +4MM OFST TPR 28MM STRL V40 BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-232	SUP	Custom 27803010		6570-0-232  -  HEAD FEM +4MM OFST TPR 32MM STRL V40 BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-236	SUP	Custom 27803010		6570-0-236  -  HEAD FEM +5MM OFST TPR 36MM V40 ANTM BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-328	SUP	Custom 27803010		6570-0-328  -  HEAD FEM -2.7MM OFST TPR 28MM STRL V40 BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-436	SUP	Custom 27803010		6570-0-436  -  HEAD FEM -2.5MM OFST TPR 36MM V40 ANTM BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-536	SUP	Custom 27803010		6570-0-536  -  HEAD FEM +2.5MM OFST TPR 36MM V40 ANTM BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6570-0-736	SUP	Custom 27803010		6570-0-736  -  HEAD FEM +7.5MM OFST TPR 36MM STRL V40 BLX D HIP	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	$0.00	$0.00	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2240	SUP	Custom 27803010		65C-2240  -  CUP ACETAB 40MM 22MM 6.4MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2242	SUP	Custom 27803010		65C-2242  -  CUP ACETAB 42MM 22MM 7.4MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2244	SUP	Custom 27803010		65C-2244  -  CUP ACETAB 44MM 22MM 7.9MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2246	SUP	Custom 27803010		65C-2246  -  CUP ACETAB 46MM 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2248	SUP	Custom 27803010		65C-2248  -  CUP ACETAB 48MM 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2250	SUP	Custom 27803010		65C-2250  -  CUP ACETAB 50MM 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2252	SUP	Custom 27803010		65C-2252  -  CUP ACETAB 52MM 22MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2642	SUP	Custom 27803010		65C-2642  -  CUP ACETAB 42MM 26MM 5.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2644	SUP	Custom 27803010		65C-2644  -  CUP ACETAB 44MM 26MM 6.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2646	SUP	Custom 27803010		65C-2646  -  CUP ACETAB 46MM 26MM 7.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2648	SUP	Custom 27803010		65C-2648  -  CUP ACETAB 48MM 26MM 8MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2650	SUP	Custom 27803010		65C-2650  -  CUP ACETAB 50MM 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2652	SUP	Custom 27803010		65C-2652  -  CUP ACETAB 52MM 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2654	SUP	Custom 27803010		65C-2654  -  CUP ACETAB 54MM 26MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2844	SUP	Custom 27803010		65C-2844  -  CUP ACETAB 44MM 28MM 5.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2846	SUP	Custom 27803010		65C-2846  -  CUP ACETAB 46MM 28MM 6.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2848	SUP	Custom 27803010		65C-2848  -  CUP ACETAB 48MM 28MM 7.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2850	SUP	Custom 27803010		65C-2850  -  CUP ACETAB 50MM 28MM 8MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2852	SUP	Custom 27803010		65C-2852  -  CUP ACETAB 52MM 28MM 8.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2854	SUP	Custom 27803010		65C-2854  -  CUP ACETAB 54MM 28MM 9.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2856	SUP	Custom 27803010		65C-2856  -  CUP ACETAB 56MM 28MM 10.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2858	SUP	Custom 27803010		65C-2858  -  CUP ACETAB 58MM 28MM 11.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2860	SUP	Custom 27803010		65C-2860  -  CUP ACETAB 60MM 28MM 12.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2863	SUP	Custom 27803010		65C-2863  -  CUP ACETAB 63MM 28MM 14MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-2866	SUP	Custom 27803010		65C-2866  -  CUP ACETAB 66MM 28MM 15.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-3248	SUP	Custom 27803010		65C-3248  -  CUP ACETAB 48MM 32MM 5.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-3250	SUP	Custom 27803010		65C-3250  -  CUP ACETAB 50MM 32MM 6.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-3252	SUP	Custom 27803010		65C-3252  -  CUP ACETAB 52MM 32MM 7.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-3254	SUP	Custom 27803010		65C-3254  -  CUP ACETAB 54MM 32MM 8MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-3256	SUP	Custom 27803010		65C-3256  -  CUP ACETAB 56MM 32MM 8.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-3258	SUP	Custom 27803010		65C-3258  -  CUP ACETAB 58MM 32MM 9.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-3260	SUP	Custom 27803010		65C-3260  -  CUP ACETAB 60MM 32MM 10.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-3263	SUP	Custom 27803010		65C-3263  -  CUP ACETAB 63MM 32MM 12MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65C-3266	SUP	Custom 27803010		65C-3266  -  CUP ACETAB 66MM 32MM 13.5MM TRIDENT XFIRE HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-28B	SUP	Custom 27803010		661-00-28B  -  INSERT ACETAB 0D B ECCENTRIC 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-28C	SUP	Custom 27803010		661-00-28C  -  INSERT ACETAB 0D C ECCENTRIC 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-28D	SUP	Custom 27803010		661-00-28D  -  INSERT ACETAB 0D D ECCENTRIC 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-28E	SUP	Custom 27803010		661-00-28E  -  INSERT ACETAB 0D E ECCENTRIC 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-28F	SUP	Custom 27803010		661-00-28F  -  INSERT ACETAB 0D F ECCENTRIC 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-28G	SUP	Custom 27803010		661-00-28G  -  INSERT ACETAB 0D G ECCENTRIC 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-28H	SUP	Custom 27803010		661-00-28H  -  INSERT ACETAB 0D H ECCENTRIC 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-28I	SUP	Custom 27803010		661-00-28I  -  INSERT ACETAB 0D I ECCENTRIC 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-28J	SUP	Custom 27803010		661-00-28J  -  INSERT ACETAB 0D J ECCENTRIC 28MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-32D	SUP	Custom 27803010		661-00-32D  -  INSERT ACETAB 0D D ECCENTRIC 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-32E	SUP	Custom 27803010		661-00-32E  -  INSERT ACETAB 0D E ECCENTRIC 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-32F	SUP	Custom 27803010		661-00-32F  -  INSERT ACETAB 0D F ECCENTRIC 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-32G	SUP	Custom 27803010		661-00-32G  -  INSERT ACETAB 0D G ECCENTRIC 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-32H	SUP	Custom 27803010		661-00-32H  -  INSERT ACETAB 0D H ECCENTRIC 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-32I	SUP	Custom 27803010		661-00-32I  -  INSERT ACETAB 0D I ECCENTRIC 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-32J	SUP	Custom 27803010		661-00-32J  -  INSERT ACETAB 0D J ECCENTRIC 32MM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-36E	SUP	Custom 27803010		661-00-36E  -  INSERT ACETAB 0D E 36MM ECCENTRIC TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-36F	SUP	Custom 27803010		661-00-36F  -  INSERT ACETAB 0D F 36MM ECCENTRIC TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-36G	SUP	Custom 27803010		661-00-36G  -  INSERT ACETAB 0D G 36MM ECCENTRIC TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-36H	SUP	Custom 27803010		661-00-36H  -  INSERT ACETAB 0D H 36MM ECCENTRIC TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-36I	SUP	Custom 27803010		661-00-36I  -  INSERT ACETAB 0D I 36MM ECCENTRIC TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-00-36J	SUP	Custom 27803010		661-00-36J  -  INSERT ACETAB 0D J 36MM ECCENTRIC TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-28C	SUP	Custom 27803010		661-10-28C  -  INSERT ACETAB 10D C ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-28D	SUP	Custom 27803010		661-10-28D  -  INSERT ACETAB 10D D ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-28E	SUP	Custom 27803010		661-10-28E  -  INSERT ACETAB 10D E ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-28F	SUP	Custom 27803010		661-10-28F  -  INSERT ACETAB 10D F ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-28G	SUP	Custom 27803010		661-10-28G  -  INSERT ACETAB 10D G ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-28H	SUP	Custom 27803010		661-10-28H  -  INSERT ACETAB 10D H ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-28I	SUP	Custom 27803010		661-10-28I  -  INSERT ACETAB 10D I ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-28J	SUP	Custom 27803010		661-10-28J  -  INSERT ACETAB 10D J ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-32D	SUP	Custom 27803010		661-10-32D  -  INSERT ACETAB 10D D ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-32E	SUP	Custom 27803010		661-10-32E  -  INSERT ACETAB 10D E ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-32F	SUP	Custom 27803010		661-10-32F  -  INSERT ACETAB 10D F ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-32G	SUP	Custom 27803010		661-10-32G  -  INSERT ACETAB 10D G ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-32H	SUP	Custom 27803010		661-10-32H  -  INSERT ACETAB 10D H ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-32I	SUP	Custom 27803010		661-10-32I  -  INSERT ACETAB 10D I ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-32J	SUP	Custom 27803010		661-10-32J  -  INSERT ACETAB 10D J ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-36E	SUP	Custom 27803010		661-10-36E  -  INSERT ACETAB 10D E ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-36F	SUP	Custom 27803010		661-10-36F  -  INSERT ACETAB 10D F ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-36G	SUP	Custom 27803010		661-10-36G  -  INSERT ACETAB 10D G ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-36H	SUP	Custom 27803010		661-10-36H  -  INSERT ACETAB 10D H ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-36I	SUP	Custom 27803010		661-10-36I  -  INSERT ACETAB 10D I ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
661-10-36J	SUP	Custom 27803010		661-10-36J  -  INSERT ACETAB 10D J ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-010	SUP	HCPCS C1776		6630-0-010  -  CMPNT FEM 2XS LEFT KNEE BEADED DRCN	BOTH IP/OP	"$4,464.00 "	"$3,303.36"	$0.00	"$3,571.20"	"$2,008.80"	"$2,008.80"	$0.00	$0.00	$0.00	$930.41	"$3,313.18"	"$3,313.18"	$0.00	$0.00	$930.30	$0.00	"$2,200.75"	"$2,200.75"	$0.00	"$2,232.00"	"$3,535.49"	"$3,571.20"	$0.00		$0.00	$698.62	$0.00	$0.00	$710.67	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-015	SUP	HCPCS C1776		6630-0-015  -  CMPNT FEM 1 2XS LEFT KNEE NBD DRCN	BOTH IP/OP	"$3,525.00 "	"$2,608.50"	$0.00	"$2,820.00"	"$1,586.25"	"$1,586.25"	$0.00	$0.00	$0.00	$734.70	"$2,616.26"	"$2,616.26"	$0.00	$0.00	$734.61	$0.00	"$1,737.83"	"$1,737.83"	$0.00	"$1,762.50"	"$2,791.80"	"$2,820.00"	$0.00		$0.00	$551.66	$0.00	$0.00	$561.18	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-020	SUP	HCPCS C1776		6630-0-020  -  CMPNT FEM 2XS RIGHT BEADED DRCN	BOTH IP/OP	"$4,464.00 "	"$3,303.36"	$0.00	"$3,571.20"	"$2,008.80"	"$2,008.80"	$0.00	$0.00	$0.00	$930.41	"$3,313.18"	"$3,313.18"	$0.00	$0.00	$930.30	$0.00	"$2,200.75"	"$2,200.75"	$0.00	"$2,232.00"	"$3,535.49"	"$3,571.20"	$0.00		$0.00	$698.62	$0.00	$0.00	$710.67	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-025	SUP	HCPCS C1776		6630-0-025  -  CMPNT FEM 1 2XS RIGHT KNEE NBD DRCN	BOTH IP/OP	"$3,525.00 "	"$2,608.50"	$0.00	"$2,820.00"	"$1,586.25"	"$1,586.25"	$0.00	$0.00	$0.00	$734.70	"$2,616.26"	"$2,616.26"	$0.00	$0.00	$734.61	$0.00	"$1,737.83"	"$1,737.83"	$0.00	"$1,762.50"	"$2,791.80"	"$2,820.00"	$0.00		$0.00	$551.66	$0.00	$0.00	$561.18	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-110	SUP	HCPCS C1776		6630-0-110  -  CMPNT FEM XS LEFT BEADED DRCN	BOTH IP/OP	"$4,464.00 "	"$3,303.36"	$0.00	"$3,571.20"	"$2,008.80"	"$2,008.80"	$0.00	$0.00	$0.00	$930.41	"$3,313.18"	"$3,313.18"	$0.00	$0.00	$930.30	$0.00	"$2,200.75"	"$2,200.75"	$0.00	"$2,232.00"	"$3,535.49"	"$3,571.20"	$0.00		$0.00	$698.62	$0.00	$0.00	$710.67	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-115	SUP	HCPCS C1776		6630-0-115  -  CMPNT FEM 2 XS LEFT KNEE NBD DRCN	BOTH IP/OP	"$3,525.00 "	"$2,608.50"	$0.00	"$2,820.00"	"$1,586.25"	"$1,586.25"	$0.00	$0.00	$0.00	$734.70	"$2,616.26"	"$2,616.26"	$0.00	$0.00	$734.61	$0.00	"$1,737.83"	"$1,737.83"	$0.00	"$1,762.50"	"$2,791.80"	"$2,820.00"	$0.00		$0.00	$551.66	$0.00	$0.00	$561.18	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-120	SUP	HCPCS C1776		6630-0-120  -  CMPNT FEM XS RIGHT BEADED DRCN	BOTH IP/OP	"$4,464.00 "	"$3,303.36"	$0.00	"$3,571.20"	"$2,008.80"	"$2,008.80"	$0.00	$0.00	$0.00	$930.41	"$3,313.18"	"$3,313.18"	$0.00	$0.00	$930.30	$0.00	"$2,200.75"	"$2,200.75"	$0.00	"$2,232.00"	"$3,535.49"	"$3,571.20"	$0.00		$0.00	$698.62	$0.00	$0.00	$710.67	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-125	SUP	HCPCS C1776		6630-0-125  -  CMPNT FEM XS STD RIGHT KNEE NBD DRCN	BOTH IP/OP	"$3,525.00 "	"$2,608.50"	$0.00	"$2,820.00"	"$1,586.25"	"$1,586.25"	$0.00	$0.00	$0.00	$734.70	"$2,616.26"	"$2,616.26"	$0.00	$0.00	$734.61	$0.00	"$1,737.83"	"$1,737.83"	$0.00	"$1,762.50"	"$2,791.80"	"$2,820.00"	$0.00		$0.00	$551.66	$0.00	$0.00	$561.18	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-210	SUP	HCPCS C1776		6630-0-210  -  CMPNT FEM SM LEFT BEADED DRCN	BOTH IP/OP	"$4,385.00 "	"$3,244.90"	$0.00	"$3,508.00"	"$1,973.25"	"$1,973.25"	$0.00	$0.00	$0.00	$913.94	"$3,254.55"	"$3,254.55"	$0.00	$0.00	$913.83	$0.00	"$2,161.81"	"$2,161.81"	$0.00	"$2,192.50"	"$3,472.92"	"$3,508.00"	$0.00		$0.00	$686.25	$0.00	$0.00	$698.09	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-215	SUP	HCPCS C1776		6630-0-215  -  CMPNT FEM SM LEFT NBD DRCN	BOTH IP/OP	"$3,464.00 "	"$2,563.36"	$0.00	"$2,771.20"	"$1,558.80"	"$1,558.80"	$0.00	$0.00	$0.00	$721.98	"$2,570.98"	"$2,570.98"	$0.00	$0.00	$721.90	$0.00	"$1,707.75"	"$1,707.75"	$0.00	"$1,732.00"	"$2,743.49"	"$2,771.20"	$0.00		$0.00	$542.12	$0.00	$0.00	$551.47	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-220	SUP	HCPCS C1776		6630-0-220  -  CMPNT FEM SM RIGHT BEADED DRCN	BOTH IP/OP	"$4,385.00 "	"$3,244.90"	$0.00	"$3,508.00"	"$1,973.25"	"$1,973.25"	$0.00	$0.00	$0.00	$913.94	"$3,254.55"	"$3,254.55"	$0.00	$0.00	$913.83	$0.00	"$2,161.81"	"$2,161.81"	$0.00	"$2,192.50"	"$3,472.92"	"$3,508.00"	$0.00		$0.00	$686.25	$0.00	$0.00	$698.09	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-225	SUP	HCPCS C1776		6630-0-225  -  CMPNT FEM SM RIGHT NBD DRCN	BOTH IP/OP	"$3,464.00 "	"$2,563.36"	$0.00	"$2,771.20"	"$1,558.80"	"$1,558.80"	$0.00	$0.00	$0.00	$721.98	"$2,570.98"	"$2,570.98"	$0.00	$0.00	$721.90	$0.00	"$1,707.75"	"$1,707.75"	$0.00	"$1,732.00"	"$2,743.49"	"$2,771.20"	$0.00		$0.00	$542.12	$0.00	$0.00	$551.47	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-28B	SUP	Custom 27803010		663-00-28B  -  INSERT ACETAB 0D B ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-28C	SUP	Custom 27803010		663-00-28C  -  INSERT ACETAB 0D C ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-28D	SUP	Custom 27803010		663-00-28D  -  INSERT ACETAB 0D D ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-28E	SUP	Custom 27803010		663-00-28E  -  INSERT ACETAB 0D E ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-28F	SUP	Custom 27803010		663-00-28F  -  INSERT ACETAB 0D F ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-28G	SUP	Custom 27803010		663-00-28G  -  INSERT ACETAB 0D G ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-28H	SUP	Custom 27803010		663-00-28H  -  INSERT ACETAB 0D H ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-28I	SUP	Custom 27803010		663-00-28I  -  INSERT ACETAB 0D I ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-28J	SUP	Custom 27803010		663-00-28J  -  INSERT ACETAB 0D J ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-310	SUP	HCPCS C1776		6630-0-310  -  CMPNT FEM MED LEFT BEADED DRCN	BOTH IP/OP	"$4,385.00 "	"$3,244.90"	$0.00	"$3,508.00"	"$1,973.25"	"$1,973.25"	$0.00	$0.00	$0.00	$913.94	"$3,254.55"	"$3,254.55"	$0.00	$0.00	$913.83	$0.00	"$2,161.81"	"$2,161.81"	$0.00	"$2,192.50"	"$3,472.92"	"$3,508.00"	$0.00		$0.00	$686.25	$0.00	$0.00	$698.09	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-315	SUP	HCPCS C1776		6630-0-315  -  CMPNT FEM MED LEFT NBD DRCN	BOTH IP/OP	"$3,464.00 "	"$2,563.36"	$0.00	"$2,771.20"	"$1,558.80"	"$1,558.80"	$0.00	$0.00	$0.00	$721.98	"$2,570.98"	"$2,570.98"	$0.00	$0.00	$721.90	$0.00	"$1,707.75"	"$1,707.75"	$0.00	"$1,732.00"	"$2,743.49"	"$2,771.20"	$0.00		$0.00	$542.12	$0.00	$0.00	$551.47	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-320	SUP	HCPCS C1776		6630-0-320  -  CMPNT FEM MED RIGHT BEADED DRCN	BOTH IP/OP	"$4,385.00 "	"$3,244.90"	$0.00	"$3,508.00"	"$1,973.25"	"$1,973.25"	$0.00	$0.00	$0.00	$913.94	"$3,254.55"	"$3,254.55"	$0.00	$0.00	$913.83	$0.00	"$2,161.81"	"$2,161.81"	$0.00	"$2,192.50"	"$3,472.92"	"$3,508.00"	$0.00		$0.00	$686.25	$0.00	$0.00	$698.09	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-325	SUP	HCPCS C1776		6630-0-325  -  CMPNT FEM MED RIGHT NBD DRCN	BOTH IP/OP	"$3,464.00 "	"$2,563.36"	$0.00	"$2,771.20"	"$1,558.80"	"$1,558.80"	$0.00	$0.00	$0.00	$721.98	"$2,570.98"	"$2,570.98"	$0.00	$0.00	$721.90	$0.00	"$1,707.75"	"$1,707.75"	$0.00	"$1,732.00"	"$2,743.49"	"$2,771.20"	$0.00		$0.00	$542.12	$0.00	$0.00	$551.47	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-32D	SUP	Custom 27803010		663-00-32D  -  INSERT ACETAB 0D D ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-32E	SUP	Custom 27803010		663-00-32E  -  INSERT ACETAB 0D E ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-32F	SUP	Custom 27803010		663-00-32F  -  INSERT ACETAB 0D F ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-32G	SUP	Custom 27803010		663-00-32G  -  INSERT ACETAB 0D G ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-32H	SUP	Custom 27803010		663-00-32H  -  INSERT ACETAB 0D H ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-32I	SUP	Custom 27803010		663-00-32I  -  INSERT ACETAB 0D I ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-32J	SUP	Custom 27803010		663-00-32J  -  INSERT ACETAB 0D J ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-36E	SUP	Custom 27803010		663-00-36E  -  INSERT ACETAB 0D E ECCENTRIC 36MM TRIDENT X3 HIP	BOTH IP/OP	"$3,830.00 "	"$2,834.20"	$0.00	"$3,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,842.63"	"$2,842.63"	$0.00	$0.00	$798.17	$0.00	$0.00	$0.00	$0.00	"$1,915.00"	"$3,033.36"	"$3,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-36F	SUP	Custom 27803010		663-00-36F  -  INSERT ACETAB 0D F ECCENTRIC 36MM TRIDENT X3 HIP	BOTH IP/OP	"$3,830.00 "	"$2,834.20"	$0.00	"$3,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,842.63"	"$2,842.63"	$0.00	$0.00	$798.17	$0.00	$0.00	$0.00	$0.00	"$1,915.00"	"$3,033.36"	"$3,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-36G	SUP	Custom 27803010		663-00-36G  -  INSERT ACETAB 0D G ECCENTRIC 36MM TRIDENT X3 HIP	BOTH IP/OP	"$3,830.00 "	"$2,834.20"	$0.00	"$3,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,842.63"	"$2,842.63"	$0.00	$0.00	$798.17	$0.00	$0.00	$0.00	$0.00	"$1,915.00"	"$3,033.36"	"$3,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-36H	SUP	Custom 27803010		663-00-36H  -  INSERT ACETAB 0D H ECCENTRIC 36MM TRIDENT X3 HIP	BOTH IP/OP	"$3,830.00 "	"$2,834.20"	$0.00	"$3,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,842.63"	"$2,842.63"	$0.00	$0.00	$798.17	$0.00	$0.00	$0.00	$0.00	"$1,915.00"	"$3,033.36"	"$3,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-36I	SUP	Custom 27803010		663-00-36I  -  INSERT ACETAB 0D I ECCENTRIC 36MM TRIDENT X3 HIP	BOTH IP/OP	"$3,830.00 "	"$2,834.20"	$0.00	"$3,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,842.63"	"$2,842.63"	$0.00	$0.00	$798.17	$0.00	$0.00	$0.00	$0.00	"$1,915.00"	"$3,033.36"	"$3,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-00-36J	SUP	Custom 27803010		663-00-36J  -  INSERT ACETAB 0D J ECCENTRIC 36MM TRIDENT X3 HIP	BOTH IP/OP	"$3,830.00 "	"$2,834.20"	$0.00	"$3,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,842.63"	"$2,842.63"	$0.00	$0.00	$798.17	$0.00	$0.00	$0.00	$0.00	"$1,915.00"	"$3,033.36"	"$3,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-410	SUP	HCPCS C1776		6630-0-410  -  CMPNT FEM MED LG LEFT BEADED DRCN	BOTH IP/OP	"$4,385.00 "	"$3,244.90"	$0.00	"$3,508.00"	"$1,973.25"	"$1,973.25"	$0.00	$0.00	$0.00	$913.94	"$3,254.55"	"$3,254.55"	$0.00	$0.00	$913.83	$0.00	"$2,161.81"	"$2,161.81"	$0.00	"$2,192.50"	"$3,472.92"	"$3,508.00"	$0.00		$0.00	$686.25	$0.00	$0.00	$698.09	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-415	SUP	HCPCS C1776		6630-0-415  -  CMPNT FEM MED LG LEFT NBD DRCN	BOTH IP/OP	"$3,464.00 "	"$2,563.36"	$0.00	"$2,771.20"	"$1,558.80"	"$1,558.80"	$0.00	$0.00	$0.00	$721.98	"$2,570.98"	"$2,570.98"	$0.00	$0.00	$721.90	$0.00	"$1,707.75"	"$1,707.75"	$0.00	"$1,732.00"	"$2,743.49"	"$2,771.20"	$0.00		$0.00	$542.12	$0.00	$0.00	$551.47	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-420	SUP	HCPCS C1776		6630-0-420  -  CMPNT FEM MED LG RIGHT BEADED DRCN	BOTH IP/OP	"$4,385.00 "	"$3,244.90"	$0.00	"$3,508.00"	"$1,973.25"	"$1,973.25"	$0.00	$0.00	$0.00	$913.94	"$3,254.55"	"$3,254.55"	$0.00	$0.00	$913.83	$0.00	"$2,161.81"	"$2,161.81"	$0.00	"$2,192.50"	"$3,472.92"	"$3,508.00"	$0.00		$0.00	$686.25	$0.00	$0.00	$698.09	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-425	SUP	HCPCS C1776		6630-0-425  -  CMPNT FEM MED LG RIGHT NBD DRCN	BOTH IP/OP	"$3,464.00 "	"$2,563.36"	$0.00	"$2,771.20"	"$1,558.80"	"$1,558.80"	$0.00	$0.00	$0.00	$721.98	"$2,570.98"	"$2,570.98"	$0.00	$0.00	$721.90	$0.00	"$1,707.75"	"$1,707.75"	$0.00	"$1,732.00"	"$2,743.49"	"$2,771.20"	$0.00		$0.00	$542.12	$0.00	$0.00	$551.47	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-510	SUP	HCPCS C1776		6630-0-510  -  CMPNT FEM LG LEFT BEADED DRCN	BOTH IP/OP	"$4,385.00 "	"$3,244.90"	$0.00	"$3,508.00"	"$1,973.25"	"$1,973.25"	$0.00	$0.00	$0.00	$913.94	"$3,254.55"	"$3,254.55"	$0.00	$0.00	$913.83	$0.00	"$2,161.81"	"$2,161.81"	$0.00	"$2,192.50"	"$3,472.92"	"$3,508.00"	$0.00		$0.00	$686.25	$0.00	$0.00	$698.09	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-515	SUP	HCPCS C1776		6630-0-515  -  CMPNT FEM LG LEFT NBD DRCN	BOTH IP/OP	"$3,464.00 "	"$2,563.36"	$0.00	"$2,771.20"	"$1,558.80"	"$1,558.80"	$0.00	$0.00	$0.00	$721.98	"$2,570.98"	"$2,570.98"	$0.00	$0.00	$721.90	$0.00	"$1,707.75"	"$1,707.75"	$0.00	"$1,732.00"	"$2,743.49"	"$2,771.20"	$0.00		$0.00	$542.12	$0.00	$0.00	$551.47	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-520	SUP	HCPCS C1776		6630-0-520  -  CMPNT FEM LG RIGHT BEADED DRCN	BOTH IP/OP	"$4,385.00 "	"$3,244.90"	$0.00	"$3,508.00"	"$1,973.25"	"$1,973.25"	$0.00	$0.00	$0.00	$913.94	"$3,254.55"	"$3,254.55"	$0.00	$0.00	$913.83	$0.00	"$2,161.81"	"$2,161.81"	$0.00	"$2,192.50"	"$3,472.92"	"$3,508.00"	$0.00		$0.00	$686.25	$0.00	$0.00	$698.09	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-525	SUP	HCPCS C1776		6630-0-525  -  CMPNT FEM LG RIGHT NBD DRCN	BOTH IP/OP	"$3,464.00 "	"$2,563.36"	$0.00	"$2,771.20"	"$1,558.80"	"$1,558.80"	$0.00	$0.00	$0.00	$721.98	"$2,570.98"	"$2,570.98"	$0.00	$0.00	$721.90	$0.00	"$1,707.75"	"$1,707.75"	$0.00	"$1,732.00"	"$2,743.49"	"$2,771.20"	$0.00		$0.00	$542.12	$0.00	$0.00	$551.47	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-610	SUP	HCPCS C1776		6630-0-610  -  CMPNT FEM XL LEFT BEADED DRCN	BOTH IP/OP	"$4,464.00 "	"$3,303.36"	$0.00	"$3,571.20"	"$2,008.80"	"$2,008.80"	$0.00	$0.00	$0.00	$930.41	"$3,313.18"	"$3,313.18"	$0.00	$0.00	$930.30	$0.00	"$2,200.75"	"$2,200.75"	$0.00	"$2,232.00"	"$3,535.49"	"$3,571.20"	$0.00		$0.00	$698.62	$0.00	$0.00	$710.67	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-615	SUP	HCPCS C1776		6630-0-615  -  CMPNT FEM 1 XL LEFT NBD DRCN	BOTH IP/OP	"$3,525.00 "	"$2,608.50"	$0.00	"$2,820.00"	"$1,586.25"	"$1,586.25"	$0.00	$0.00	$0.00	$734.70	"$2,616.26"	"$2,616.26"	$0.00	$0.00	$734.61	$0.00	"$1,737.83"	"$1,737.83"	$0.00	"$1,762.50"	"$2,791.80"	"$2,820.00"	$0.00		$0.00	$551.66	$0.00	$0.00	$561.18	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-620	SUP	HCPCS C1776		6630-0-620  -  CMPNT FEM XL RIGHT BEADED DRCN	BOTH IP/OP	"$4,464.00 "	"$3,303.36"	$0.00	"$3,571.20"	"$2,008.80"	"$2,008.80"	$0.00	$0.00	$0.00	$930.41	"$3,313.18"	"$3,313.18"	$0.00	$0.00	$930.30	$0.00	"$2,200.75"	"$2,200.75"	$0.00	"$2,232.00"	"$3,535.49"	"$3,571.20"	$0.00		$0.00	$698.62	$0.00	$0.00	$710.67	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-625	SUP	HCPCS C1776		6630-0-625  -  CMPNT FEM 1 XL RIGHT NBD DRCN	BOTH IP/OP	"$3,525.00 "	"$2,608.50"	$0.00	"$2,820.00"	"$1,586.25"	"$1,586.25"	$0.00	$0.00	$0.00	$734.70	"$2,616.26"	"$2,616.26"	$0.00	$0.00	$734.61	$0.00	"$1,737.83"	"$1,737.83"	$0.00	"$1,762.50"	"$2,791.80"	"$2,820.00"	$0.00		$0.00	$551.66	$0.00	$0.00	$561.18	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-710	SUP	HCPCS C1776		6630-0-710  -  CMPNT FEM 2XL STD LEFT KNEE BEADED DRCN	BOTH IP/OP	"$4,464.00 "	"$3,303.36"	$0.00	"$3,571.20"	"$2,008.80"	"$2,008.80"	$0.00	$0.00	$0.00	$930.41	"$3,313.18"	"$3,313.18"	$0.00	$0.00	$930.30	$0.00	"$2,200.75"	"$2,200.75"	$0.00	"$2,232.00"	"$3,535.49"	"$3,571.20"	$0.00		$0.00	$698.62	$0.00	$0.00	$710.67	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-715	SUP	HCPCS C1776		6630-0-715  -  CMPNT FEM 2XL LEFT NBD DRCN	BOTH IP/OP	"$3,525.00 "	"$2,608.50"	$0.00	"$2,820.00"	"$1,586.25"	"$1,586.25"	$0.00	$0.00	$0.00	$734.70	"$2,616.26"	"$2,616.26"	$0.00	$0.00	$734.61	$0.00	"$1,737.83"	"$1,737.83"	$0.00	"$1,762.50"	"$2,791.80"	"$2,820.00"	$0.00		$0.00	$551.66	$0.00	$0.00	$561.18	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-720	SUP	HCPCS C1776		6630-0-720  -  CMPNT FEM 2XL RIGHT BEADED DRCN	BOTH IP/OP	"$4,464.00 "	"$3,303.36"	$0.00	"$3,571.20"	"$2,008.80"	"$2,008.80"	$0.00	$0.00	$0.00	$930.41	"$3,313.18"	"$3,313.18"	$0.00	$0.00	$930.30	$0.00	"$2,200.75"	"$2,200.75"	$0.00	"$2,232.00"	"$3,535.49"	"$3,571.20"	$0.00		$0.00	$698.62	$0.00	$0.00	$710.67	$0.00	$0.00	$0.00	$0.00	$0.00
6630-0-725	SUP	HCPCS C1776		6630-0-725  -  CMPNT FEM 2XL RIGHT NBD DRCN	BOTH IP/OP	"$3,525.00 "	"$2,608.50"	$0.00	"$2,820.00"	"$1,586.25"	"$1,586.25"	$0.00	$0.00	$0.00	$734.70	"$2,616.26"	"$2,616.26"	$0.00	$0.00	$734.61	$0.00	"$1,737.83"	"$1,737.83"	$0.00	"$1,762.50"	"$2,791.80"	"$2,820.00"	$0.00		$0.00	$551.66	$0.00	$0.00	$561.18	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-105	SUP	Custom 27803010		6630-6-105  -  WEDGE TIBIAL S1 FLAT 5MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-110	SUP	Custom 27803010		6630-6-110  -  WEDGE TIBIAL S1 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-125	SUP	Custom 27803010		6630-6-125  -  WEDGE TIBIAL S1 FLAT 5MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-130	SUP	Custom 27803010		6630-6-130  -  WEDGE TIBIAL S1 FLAT 10MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-150	SUP	Custom 27803010		6630-6-150  -  WEDGE TIBIAL S2 HEMIFLAT 5MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-155	SUP	Custom 27803010		6630-6-155  -  WEDGE TIBIAL S2 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-170	SUP	Custom 27803010		6630-6-170  -  WEDGE TIBIAL S2 HEMIFLAT 5MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-175	SUP	Custom 27803010		6630-6-175  -  WEDGE TIBIAL S2 FLAT 10MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-205	SUP	Custom 27803010		6630-6-205  -  WEDGE TIBIAL M1 FLAT 5MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-210	SUP	Custom 27803010		6630-6-210  -  WEDGE TIBIAL M1 FLAT 10MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-225	SUP	Custom 27803010		6630-6-225  -  WEDGE TIBIAL M1 FLAT 5MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-230	SUP	Custom 27803010		6630-6-230  -  WEDGE TIBIAL M1 FLAT 10MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-250	SUP	Custom 27803010		6630-6-250  -  WEDGE TIBIAL M2 HEMIFLAT 5MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-255	SUP	Custom 27803010		6630-6-255  -  WEDGE TIBIAL M2 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-270	SUP	Custom 27803010		6630-6-270  -  WEDGE TIBIAL M2 HEMIFLAT 5MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-275	SUP	Custom 27803010		6630-6-275  -  WEDGE TIBIAL M2 HEMIFLAT 10MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-305	SUP	Custom 27803010		6630-6-305  -  WEDGE TIBIAL 1 FLAT 5MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-310	SUP	Custom 27803010		6630-6-310  -  WEDGE TIBIAL 1 FLAT 10MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-325	SUP	Custom 27803010		6630-6-325  -  WEDGE TIBIAL 1 FLAT 5MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-330	SUP	Custom 27803010		6630-6-330  -  WEDGE TIBIAL 1 FLAT 10MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-350	SUP	Custom 27803010		6630-6-350  -  WEDGE TIBIAL 2 HEMIFLAT 5MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-355	SUP	Custom 27803010		6630-6-355  -  WEDGE TIBIAL 2 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-370	SUP	Custom 27803010		6630-6-370  -  WEDGE TIBIAL 2 HEMIFLAT 5MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-375	SUP	Custom 27803010		6630-6-375  -  WEDGE TIBIAL 2 HEMIFLAT 10MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-405	SUP	Custom 27803010		6630-6-405  -  WEDGE TIBIAL X1 FLAT 5MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-410	SUP	Custom 27803010		6630-6-410  -  WEDGE TIBIAL X1 FLAT 10MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-425	SUP	Custom 27803010		6630-6-425  -  WEDGE TIBIAL X1 FLAT 5MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-430	SUP	Custom 27803010		6630-6-430  -  WEDGE TIBIAL X1 FLAT 10MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-450	SUP	Custom 27803010		6630-6-450  -  WEDGE TIBIAL X2 FLAT 5MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-455	SUP	Custom 27803010		6630-6-455  -  WEDGE TIBIAL X2 FLAT 10MM REVISION DURACON KNEE RIGHT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-470	SUP	Custom 27803010		6630-6-470  -  WEDGE TIBIAL X2 FLAT 5MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-475	SUP	Custom 27803010		6630-6-475  -  WEDGE TIBIAL X2 FLAT 10MM REVISION DURACON KNEE LEFT	BOTH IP/OP	"$1,885.00 "	"$1,394.90"	$0.00	"$1,508.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.05"	"$1,399.05"	$0.00	$0.00	$392.83	$0.00	$0.00	$0.00	$0.00	$942.50	"$1,492.92"	"$1,508.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-510	SUP	Custom 27803010		6630-6-510  -  WEDGE TIBIAL S1 FULL FLAT 10MM REVISION DURACON KNEE	BOTH IP/OP	"$3,147.50 "	"$2,329.15"	$0.00	"$2,518.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.07"	"$2,336.07"	$0.00	$0.00	$655.94	$0.00	$0.00	$0.00	$0.00	"$1,573.75"	"$2,492.82"	"$2,518.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-515	SUP	Custom 27803010		6630-6-515  -  WEDGE TIBIAL S2 FULL 10MM REVISION DURACON KNEE	BOTH IP/OP	"$3,147.50 "	"$2,329.15"	$0.00	"$2,518.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.07"	"$2,336.07"	$0.00	$0.00	$655.94	$0.00	$0.00	$0.00	$0.00	"$1,573.75"	"$2,492.82"	"$2,518.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-520	SUP	Custom 27803010		6630-6-520  -  WEDGE TIBIAL M1 FULL 10MM REVISION DURACON KNEE	BOTH IP/OP	"$3,147.50 "	"$2,329.15"	$0.00	"$2,518.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.07"	"$2,336.07"	$0.00	$0.00	$655.94	$0.00	$0.00	$0.00	$0.00	"$1,573.75"	"$2,492.82"	"$2,518.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-525	SUP	Custom 27803010		6630-6-525  -  WEDGE TIBIAL M2 FULL FLAT 10MM REVISION DURACON KNEE	BOTH IP/OP	"$3,147.50 "	"$2,329.15"	$0.00	"$2,518.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.07"	"$2,336.07"	$0.00	$0.00	$655.94	$0.00	$0.00	$0.00	$0.00	"$1,573.75"	"$2,492.82"	"$2,518.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-530	SUP	Custom 27803010		6630-6-530  -  WEDGE TIBIAL 1 FULL FLAT 10MM REVISION DURACON KNEE	BOTH IP/OP	"$3,147.50 "	"$2,329.15"	$0.00	"$2,518.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.07"	"$2,336.07"	$0.00	$0.00	$655.94	$0.00	$0.00	$0.00	$0.00	"$1,573.75"	"$2,492.82"	"$2,518.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-535	SUP	Custom 27803010		6630-6-535  -  WEDGE TIBIAL 2 FULL FLAT 10MM REVISION DURACON KNEE	BOTH IP/OP	"$3,147.50 "	"$2,329.15"	$0.00	"$2,518.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.07"	"$2,336.07"	$0.00	$0.00	$655.94	$0.00	$0.00	$0.00	$0.00	"$1,573.75"	"$2,492.82"	"$2,518.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-545	SUP	Custom 27803010		6630-6-545  -  WEDGE TIBIAL X1 FULL 10MM REVISION DURACON KNEE	BOTH IP/OP	"$3,147.50 "	"$2,329.15"	$0.00	"$2,518.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.07"	"$2,336.07"	$0.00	$0.00	$655.94	$0.00	$0.00	$0.00	$0.00	"$1,573.75"	"$2,492.82"	"$2,518.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-6-550	SUP	Custom 27803010		6630-6-550  -  WEDGE TIBIAL X2 FULL 10MM REVISION DURACON KNEE	BOTH IP/OP	"$3,147.50 "	"$2,329.15"	$0.00	"$2,518.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,336.07"	"$2,336.07"	$0.00	$0.00	$655.94	$0.00	$0.00	$0.00	$0.00	"$1,573.75"	"$2,492.82"	"$2,518.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-005	SUP	HCPCS C1776		6630-8-005  -  CMPNT FEM 2XS LEFT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,209.00 "	"$3,854.66"	$0.00	"$4,167.20"	"$2,344.05"	"$2,344.05"	$0.00	$0.00	$0.00	"$1,085.69"	"$3,866.12"	"$3,866.12"	$0.00	$0.00	"$1,085.56"	$0.00	"$2,568.04"	"$2,568.04"	$0.00	"$2,604.50"	"$4,125.53"	"$4,167.20"	$0.00		$0.00	$815.21	$0.00	$0.00	$829.27	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-010	SUP	HCPCS C1776		6630-8-010  -  CMPNT FEM 2XS RIGHT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,209.00 "	"$3,854.66"	$0.00	"$4,167.20"	"$2,344.05"	"$2,344.05"	$0.00	$0.00	$0.00	"$1,085.69"	"$3,866.12"	"$3,866.12"	$0.00	$0.00	"$1,085.56"	$0.00	"$2,568.04"	"$2,568.04"	$0.00	"$2,604.50"	"$4,125.53"	"$4,167.20"	$0.00		$0.00	$815.21	$0.00	$0.00	$829.27	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-015	SUP	HCPCS C1776		6630-8-015  -  CMPNT FEM XS LEFT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,209.00 "	"$3,854.66"	$0.00	"$4,167.20"	"$2,344.05"	"$2,344.05"	$0.00	$0.00	$0.00	"$1,085.69"	"$3,866.12"	"$3,866.12"	$0.00	$0.00	"$1,085.56"	$0.00	"$2,568.04"	"$2,568.04"	$0.00	"$2,604.50"	"$4,125.53"	"$4,167.20"	$0.00		$0.00	$815.21	$0.00	$0.00	$829.27	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-020	SUP	HCPCS C1776		6630-8-020  -  CMPNT FEM XS RIGHT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,209.00 "	"$3,854.66"	$0.00	"$4,167.20"	"$2,344.05"	"$2,344.05"	$0.00	$0.00	$0.00	"$1,085.69"	"$3,866.12"	"$3,866.12"	$0.00	$0.00	"$1,085.56"	$0.00	"$2,568.04"	"$2,568.04"	$0.00	"$2,604.50"	"$4,125.53"	"$4,167.20"	$0.00		$0.00	$815.21	$0.00	$0.00	$829.27	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-025	SUP	HCPCS C1776		6630-8-025  -  CMPNT FEM SM LEFT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,167.00 "	"$3,823.58"	$0.00	"$4,133.60"	"$2,325.15"	"$2,325.15"	$0.00	$0.00	$0.00	"$1,076.93"	"$3,834.95"	"$3,834.95"	$0.00	$0.00	"$1,076.80"	$0.00	"$2,547.33"	"$2,547.33"	$0.00	"$2,583.50"	"$4,092.26"	"$4,133.60"	$0.00		$0.00	$808.64	$0.00	$0.00	$822.59	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-030	SUP	HCPCS C1776		6630-8-030  -  CMPNT FEM SM RIGHT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,167.00 "	"$3,823.58"	$0.00	"$4,133.60"	"$2,325.15"	"$2,325.15"	$0.00	$0.00	$0.00	"$1,076.93"	"$3,834.95"	"$3,834.95"	$0.00	$0.00	"$1,076.80"	$0.00	"$2,547.33"	"$2,547.33"	$0.00	"$2,583.50"	"$4,092.26"	"$4,133.60"	$0.00		$0.00	$808.64	$0.00	$0.00	$822.59	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-035	SUP	HCPCS C1776		6630-8-035  -  CMPNT FEM MED LEFT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,167.00 "	"$3,823.58"	$0.00	"$4,133.60"	"$2,325.15"	"$2,325.15"	$0.00	$0.00	$0.00	"$1,076.93"	"$3,834.95"	"$3,834.95"	$0.00	$0.00	"$1,076.80"	$0.00	"$2,547.33"	"$2,547.33"	$0.00	"$2,583.50"	"$4,092.26"	"$4,133.60"	$0.00		$0.00	$808.64	$0.00	$0.00	$822.59	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-040	SUP	HCPCS C1776		6630-8-040  -  CMPNT FEM MED RIGHT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,167.00 "	"$3,823.58"	$0.00	"$4,133.60"	"$2,325.15"	"$2,325.15"	$0.00	$0.00	$0.00	"$1,076.93"	"$3,834.95"	"$3,834.95"	$0.00	$0.00	"$1,076.80"	$0.00	"$2,547.33"	"$2,547.33"	$0.00	"$2,583.50"	"$4,092.26"	"$4,133.60"	$0.00		$0.00	$808.64	$0.00	$0.00	$822.59	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-045	SUP	HCPCS C1776		6630-8-045  -  CMPNT FEM MED LG LEFT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,167.00 "	"$3,823.58"	$0.00	"$4,133.60"	"$2,325.15"	"$2,325.15"	$0.00	$0.00	$0.00	"$1,076.93"	"$3,834.95"	"$3,834.95"	$0.00	$0.00	"$1,076.80"	$0.00	"$2,547.33"	"$2,547.33"	$0.00	"$2,583.50"	"$4,092.26"	"$4,133.60"	$0.00		$0.00	$808.64	$0.00	$0.00	$822.59	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-050	SUP	HCPCS C1776		6630-8-050  -  CMPNT FEM MED LG RIGHT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,167.00 "	"$3,823.58"	$0.00	"$4,133.60"	"$2,325.15"	"$2,325.15"	$0.00	$0.00	$0.00	"$1,076.93"	"$3,834.95"	"$3,834.95"	$0.00	$0.00	"$1,076.80"	$0.00	"$2,547.33"	"$2,547.33"	$0.00	"$2,583.50"	"$4,092.26"	"$4,133.60"	$0.00		$0.00	$808.64	$0.00	$0.00	$822.59	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-055	SUP	HCPCS C1776		6630-8-055  -  CMPNT FEM LG LEFT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,167.00 "	"$3,823.58"	$0.00	"$4,133.60"	"$2,325.15"	"$2,325.15"	$0.00	$0.00	$0.00	"$1,076.93"	"$3,834.95"	"$3,834.95"	$0.00	$0.00	"$1,076.80"	$0.00	"$2,547.33"	"$2,547.33"	$0.00	"$2,583.50"	"$4,092.26"	"$4,133.60"	$0.00		$0.00	$808.64	$0.00	$0.00	$822.59	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-060	SUP	HCPCS C1776		6630-8-060  -  BSPLT TIB DRCN LG FEM RIGHT BEADED PERIAPT 28MM	BOTH IP/OP	"$5,167.00 "	"$3,823.58"	$0.00	"$4,133.60"	"$2,325.15"	"$2,325.15"	$0.00	$0.00	$0.00	"$1,076.93"	"$3,834.95"	"$3,834.95"	$0.00	$0.00	"$1,076.80"	$0.00	"$2,547.33"	"$2,547.33"	$0.00	"$2,583.50"	"$4,092.26"	"$4,133.60"	$0.00		$0.00	$808.64	$0.00	$0.00	$822.59	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-065	SUP	HCPCS C1776		6630-8-065  -  CMPNT FEM XL LEFT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,209.00 "	"$3,854.66"	$0.00	"$4,167.20"	"$2,344.05"	"$2,344.05"	$0.00	$0.00	$0.00	"$1,085.69"	"$3,866.12"	"$3,866.12"	$0.00	$0.00	"$1,085.56"	$0.00	"$2,568.04"	"$2,568.04"	$0.00	"$2,604.50"	"$4,125.53"	"$4,167.20"	$0.00		$0.00	$815.21	$0.00	$0.00	$829.27	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-070	SUP	HCPCS C1776		6630-8-070  -  CMPNT FEM XL RIGHT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,209.00 "	"$3,854.66"	$0.00	"$4,167.20"	"$2,344.05"	"$2,344.05"	$0.00	$0.00	$0.00	"$1,085.69"	"$3,866.12"	"$3,866.12"	$0.00	$0.00	"$1,085.56"	$0.00	"$2,568.04"	"$2,568.04"	$0.00	"$2,604.50"	"$4,125.53"	"$4,167.20"	$0.00		$0.00	$815.21	$0.00	$0.00	$829.27	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-075	SUP	HCPCS C1776		6630-8-075  -  CMPNT FEM 2XL LEFT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,209.00 "	"$3,854.66"	$0.00	"$4,167.20"	"$2,344.05"	"$2,344.05"	$0.00	$0.00	$0.00	"$1,085.69"	"$3,866.12"	"$3,866.12"	$0.00	$0.00	"$1,085.56"	$0.00	"$2,568.04"	"$2,568.04"	$0.00	"$2,604.50"	"$4,125.53"	"$4,167.20"	$0.00		$0.00	$815.21	$0.00	$0.00	$829.27	$0.00	$0.00	$0.00	$0.00	$0.00
6630-8-080	SUP	HCPCS C1776		6630-8-080  -  CMPNT FEM 2XL RIGHT KNEE BEADED DRCN PERIAPT	BOTH IP/OP	"$5,209.00 "	"$3,854.66"	$0.00	"$4,167.20"	"$2,344.05"	"$2,344.05"	$0.00	$0.00	$0.00	"$1,085.69"	"$3,866.12"	"$3,866.12"	$0.00	$0.00	"$1,085.56"	$0.00	"$2,568.04"	"$2,568.04"	$0.00	"$2,604.50"	"$4,125.53"	"$4,167.20"	$0.00		$0.00	$815.21	$0.00	$0.00	$829.27	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-28C	SUP	Custom 27803010		663-10-28C  -  INSERT ACETAB 10D C ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-28D	SUP	Custom 27803010		663-10-28D  -  INSERT ACETAB 10D D ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-28E	SUP	Custom 27803010		663-10-28E  -  INSERT ACETAB 10D E ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-28F	SUP	Custom 27803010		663-10-28F  -  INSERT ACETAB 10D F ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-28G	SUP	Custom 27803010		663-10-28G  -  INSERT ACETAB 10D G ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-28H	SUP	Custom 27803010		663-10-28H  -  INSERT ACETAB 10D H ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-28I	SUP	Custom 27803010		663-10-28I  -  INSERT ACETAB 10D I ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-28J	SUP	Custom 27803010		663-10-28J  -  INSERT ACETAB 10D J ECCENTRIC 28MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-32D	SUP	Custom 27803010		663-10-32D  -  INSERT ACETAB 10D D ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-32E	SUP	Custom 27803010		663-10-32E  -  INSERT ACETAB 10D E ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-32F	SUP	Custom 27803010		663-10-32F  -  INSERT ACETAB 10D F ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-32G	SUP	Custom 27803010		663-10-32G  -  INSERT ACETAB 10D G ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-32H	SUP	Custom 27803010		663-10-32H  -  INSERT ACETAB 10D H ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-32I	SUP	Custom 27803010		663-10-32I  -  INSERT ACETAB 10D I ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-32J	SUP	Custom 27803010		663-10-32J  -  INSERT ACETAB 10D J ECCENTRIC 32MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-36E	SUP	Custom 27803010		663-10-36E  -  INSERT ACETAB 10D E ECCENTRIC 36MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-36F	SUP	Custom 27803010		663-10-36F  -  INSERT ACETAB 10D F ECCENTRIC 36MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-36G	SUP	Custom 27803010		663-10-36G  -  INSERT ACETAB 10D G ECCENTRIC 36MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-36H	SUP	Custom 27803010		663-10-36H  -  INSERT ACETAB 10D H ECCENTRIC 36MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-36I	SUP	Custom 27803010		663-10-36I  -  INSERT ACETAB 10D I ECCENTRIC 36MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
663-10-36J	SUP	Custom 27803010		663-10-36J  -  INSERT ACETAB 10D J ECCENTRIC 36MM TRIDENT X3 HIP	BOTH IP/OP	"$1,440.00 "	"$1,065.60"	$0.00	"$1,152.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.77"	"$1,068.77"	$0.00	$0.00	$300.10	$0.00	$0.00	$0.00	$0.00	$720.00	"$1,140.48"	"$1,152.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-208	SUP	Custom 27803010		6632-0-208  -  STAB SURG XS DRCN POR CMNT MONO FEM LEFT	BOTH IP/OP	"$5,490.00 "	"$4,062.60"	$0.00	"$4,392.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,074.68"	"$4,074.68"	$0.00	$0.00	"$1,144.12"	$0.00	$0.00	$0.00	$0.00	"$2,745.00"	"$4,348.08"	"$4,392.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-210	SUP	HCPCS C1776		6632-0-210  -  CMPNT FEM SM LEFT KNEE BEADED STAB MDLR DRCN	BOTH IP/OP	"$7,057.38 "	"$5,222.46"	$0.00	"$5,645.90"	"$3,175.82"	"$3,175.82"	$0.00	$0.00	$0.00	"$1,470.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,470.76"	$0.00	"$3,479.29"	"$3,479.29"	$0.00	"$3,528.69"	"$5,589.44"	"$5,645.90"	$0.00		$0.00	"$1,104.48"	$0.00	$0.00	"$1,123.53"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-215	SUP	HCPCS C1776		6632-0-215  -  CMPNT FEM SM LEFT MDLR NBD ASYM DRCN NONSTRL	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-218	SUP	HCPCS C1776		6632-0-218  -  CMPNT FEM XS RIGHT KNEE CMNT MONO STAB DRCN POR	BOTH IP/OP	"$5,490.00 "	"$4,062.60"	$0.00	"$4,392.00"	"$2,470.50"	"$2,470.50"	$0.00	$0.00	$0.00	"$1,144.25"	"$4,074.68"	"$4,074.68"	$0.00	$0.00	"$1,144.12"	$0.00	"$2,706.57"	"$2,706.57"	$0.00	"$2,745.00"	"$4,348.08"	"$4,392.00"	$0.00		$0.00	$859.19	$0.00	$0.00	$874.01	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-220	SUP	HCPCS C1776		6632-0-220  -  CMPNT FEM SM RIGHT KNEE CRUC RET MDLR BEADED ASMBLY DRCN	BOTH IP/OP	"$7,057.38 "	"$5,222.46"	$0.00	"$5,645.90"	"$3,175.82"	"$3,175.82"	$0.00	$0.00	$0.00	"$1,470.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,470.76"	$0.00	"$3,479.29"	"$3,479.29"	$0.00	"$3,528.69"	"$5,589.44"	"$5,645.90"	$0.00		$0.00	"$1,104.48"	$0.00	$0.00	"$1,123.53"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-225	SUP	HCPCS C1776		6632-0-225  -  CMPNT FEM SM RIGHT KNEE CRUC RET MDLR NBD ASMBLY DRCN	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-310	SUP	HCPCS C1776		6632-0-310  -  CMPNT FEM MED LEFT KNEE CRUC RET MDLR BEADED ASMBLY DRCN	BOTH IP/OP	"$7,057.38 "	"$5,222.46"	$0.00	"$5,645.90"	"$3,175.82"	"$3,175.82"	$0.00	$0.00	$0.00	"$1,470.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,470.76"	$0.00	"$3,479.29"	"$3,479.29"	$0.00	"$3,528.69"	"$5,589.44"	"$5,645.90"	$0.00		$0.00	"$1,104.48"	$0.00	$0.00	"$1,123.53"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-315	SUP	HCPCS C1776		6632-0-315  -  CMPNT FEM MED LEFT MDLR NBD ASYM DRCN NONSTRL	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-317	SUP	HCPCS C1776		6632-0-317  -  CMPNT FEM MED NTRL LEFT KNEE CRUC RET NBD MDLR STAB ASMBLY	BOTH IP/OP	"$3,314.00 "	"$2,452.36"	$0.00	"$2,651.20"	"$1,491.30"	"$1,491.30"	$0.00	$0.00	$0.00	$690.72	"$2,459.65"	"$2,459.65"	$0.00	$0.00	$690.64	$0.00	"$1,633.80"	"$1,633.80"	$0.00	"$1,657.00"	"$2,624.69"	"$2,651.20"	$0.00		$0.00	$518.64	$0.00	$0.00	$527.59	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-325	SUP	HCPCS C1776		6632-0-325  -  STEM FEM NBD ASY DRCN MED RIGHT NONSTRL	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-327	SUP	HCPCS C1776		6632-0-327  -  CMPNT FEM MED NTRL RIGHT KNEE CRUC RET NBD MDLR STAB ASMBLY	BOTH IP/OP	"$3,314.00 "	"$2,452.36"	$0.00	"$2,651.20"	"$1,491.30"	"$1,491.30"	$0.00	$0.00	$0.00	$690.72	"$2,459.65"	"$2,459.65"	$0.00	$0.00	$690.64	$0.00	"$1,633.80"	"$1,633.80"	$0.00	"$1,657.00"	"$2,624.69"	"$2,651.20"	$0.00		$0.00	$518.64	$0.00	$0.00	$527.59	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-410	SUP	HCPCS C1776		6632-0-410  -  CMPNT FEM MED LG LEFT KNEE CRUC RET MDLR BEADED ASMBLY DRCN	BOTH IP/OP	"$7,057.38 "	"$5,222.46"	$0.00	"$5,645.90"	"$3,175.82"	"$3,175.82"	$0.00	$0.00	$0.00	"$1,470.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,470.76"	$0.00	"$3,479.29"	"$3,479.29"	$0.00	"$3,528.69"	"$5,589.44"	"$5,645.90"	$0.00		$0.00	"$1,104.48"	$0.00	$0.00	"$1,123.53"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-415	SUP	HCPCS C1776		6632-0-415  -  CMPNT FEM MED LG LEFT KNEE CRUC RET MDLR NBD ASMBLY DRCN	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-425	SUP	HCPCS C1776		6632-0-425  -  CMPNT FEM MED LG RIGHT MDLR NBD ASMBLY DRCN	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-515	SUP	HCPCS C1776		6632-0-515  -  CMPNT FEM LG LEFT KNEE NBD ASMBLY MDLR DRCN NPOR	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-525	SUP	HCPCS C1776		6632-0-525  -  CMPNT FEM LG RIGHT NBD MDLR ASMBLY DRCN	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-610	SUP	HCPCS C1776		6632-0-610  -  CMPNT FEM XL LEFT BEADED MDLR ASMBLY DRCN	BOTH IP/OP	"$7,192.25 "	"$5,322.27"	$0.00	"$5,753.80"	"$3,236.51"	"$3,236.51"	$0.00	$0.00	$0.00	"$1,499.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,498.86"	$0.00	"$3,545.78"	"$3,545.78"	$0.00	"$3,596.13"	"$5,696.26"	"$5,753.80"	$0.00		$0.00	"$1,125.59"	$0.00	$0.00	"$1,145.01"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-615	SUP	HCPCS C1776		6632-0-615  -  CMPNT FEM XL LEFT MDLR NBD ASMBLY DRCN	BOTH IP/OP	"$3,499.00 "	"$2,589.26"	$0.00	"$2,799.20"	"$1,574.55"	"$1,574.55"	$0.00	$0.00	$0.00	$729.28	"$2,596.96"	"$2,596.96"	$0.00	$0.00	$729.19	$0.00	"$1,725.01"	"$1,725.01"	$0.00	"$1,749.50"	"$2,771.21"	"$2,799.20"	$0.00		$0.00	$547.59	$0.00	$0.00	$557.04	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-620	SUP	HCPCS C1776		6632-0-620  -  CMPNT FEM XL RIGHT BEADED MDLR ASMBLY DRCN	BOTH IP/OP	"$7,192.25 "	"$5,322.27"	$0.00	"$5,753.80"	"$3,236.51"	"$3,236.51"	$0.00	$0.00	$0.00	"$1,499.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,498.86"	$0.00	"$3,545.78"	"$3,545.78"	$0.00	"$3,596.13"	"$5,696.26"	"$5,753.80"	$0.00		$0.00	"$1,125.59"	$0.00	$0.00	"$1,145.01"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-625	SUP	HCPCS C1776		6632-0-625  -  CMPNT FEM XL RIGHT KNEE CRUC RET NBD MDLR DRCN	BOTH IP/OP	"$3,499.00 "	"$2,589.26"	$0.00	"$2,799.20"	"$1,574.55"	"$1,574.55"	$0.00	$0.00	$0.00	$729.28	"$2,596.96"	"$2,596.96"	$0.00	$0.00	$729.19	$0.00	"$1,725.01"	"$1,725.01"	$0.00	"$1,749.50"	"$2,771.21"	"$2,799.20"	$0.00		$0.00	$547.59	$0.00	$0.00	$557.04	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-710	SUP	HCPCS C1776		6632-0-710  -  CMPNT FEM 2XL LEFT KNEE CRUC RET BEADED MDLR DRCN	BOTH IP/OP	"$7,192.25 "	"$5,322.27"	$0.00	"$5,753.80"	"$3,236.51"	"$3,236.51"	$0.00	$0.00	$0.00	"$1,499.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,498.86"	$0.00	"$3,545.78"	"$3,545.78"	$0.00	"$3,596.13"	"$5,696.26"	"$5,753.80"	$0.00		$0.00	"$1,125.59"	$0.00	$0.00	"$1,145.01"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-715	SUP	HCPCS C1776		6632-0-715  -  CMPNT FEM 2XL LEFT KNEE NBD ASMBLY MDLR DRCN NPOR	BOTH IP/OP	"$3,499.00 "	"$2,589.26"	$0.00	"$2,799.20"	"$1,574.55"	"$1,574.55"	$0.00	$0.00	$0.00	$729.28	"$2,596.96"	"$2,596.96"	$0.00	$0.00	$729.19	$0.00	"$1,725.01"	"$1,725.01"	$0.00	"$1,749.50"	"$2,771.21"	"$2,799.20"	$0.00		$0.00	$547.59	$0.00	$0.00	$557.04	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-720	SUP	HCPCS C1776		6632-0-720  -  CMPNT FEM 2XL RIGHT BEADED MDLR ASMBLY DRCN	BOTH IP/OP	"$7,192.25 "	"$5,322.27"	$0.00	"$5,753.80"	"$3,236.51"	"$3,236.51"	$0.00	$0.00	$0.00	"$1,499.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,498.86"	$0.00	"$3,545.78"	"$3,545.78"	$0.00	"$3,596.13"	"$5,696.26"	"$5,753.80"	$0.00		$0.00	"$1,125.59"	$0.00	$0.00	"$1,145.01"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-725	SUP	HCPCS C1776		6632-0-725  -  CMPNT FEM 2XL RIGHT KNEE NBD ASMBLY MDLR DRCN NPOR	BOTH IP/OP	"$3,499.00 "	"$2,589.26"	$0.00	"$2,799.20"	"$1,574.55"	"$1,574.55"	$0.00	$0.00	$0.00	$729.28	"$2,596.96"	"$2,596.96"	$0.00	$0.00	$729.19	$0.00	"$1,725.01"	"$1,725.01"	$0.00	"$1,749.50"	"$2,771.21"	"$2,799.20"	$0.00		$0.00	$547.59	$0.00	$0.00	$557.04	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-750	SUP	HCPCS C1713		6632-0-750  -  PEG FIX FEM MDLR REPL	BOTH IP/OP	$524.00 	$387.76	$0.00	$419.20	$235.80	$235.80	$0.00	$0.00	$0.00	$109.21	$388.91	$388.91	$0.00	$0.00	$109.20	$0.00	$309.95	$309.95	$0.00	$262.00	$415.01	$419.20	$0.00		$0.00	$82.01	$0.00	$0.00	$83.42	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-810	SUP	HCPCS C1776		6632-0-810  -  CMPNT FEM SM LEFT MNLTH STAB DRCN	BOTH IP/OP	"$3,869.00 "	"$2,863.06"	$0.00	"$3,095.20"	"$1,741.05"	"$1,741.05"	$0.00	$0.00	$0.00	$806.40	"$2,871.57"	"$2,871.57"	$0.00	$0.00	$806.30	$0.00	"$1,907.42"	"$1,907.42"	$0.00	"$1,934.50"	"$3,064.25"	"$3,095.20"	$0.00		$0.00	$605.50	$0.00	$0.00	$615.94	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-811	SUP	HCPCS C1776		6632-0-811  -  CMPNT FEM SM LEFT KNEE CMNT MNLTH STAB DRCN VIT	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-815	SUP	HCPCS C1776		6632-0-815  -  CMPNT FEM SM RIGHT MNLTH STAB DRCN VIT	BOTH IP/OP	"$3,869.00 "	"$2,863.06"	$0.00	"$3,095.20"	"$1,741.05"	"$1,741.05"	$0.00	$0.00	$0.00	$806.40	"$2,871.57"	"$2,871.57"	$0.00	$0.00	$806.30	$0.00	"$1,907.42"	"$1,907.42"	$0.00	"$1,934.50"	"$3,064.25"	"$3,095.20"	$0.00		$0.00	$605.50	$0.00	$0.00	$615.94	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-820	SUP	HCPCS C1776		6632-0-820  -  CMPNT FEM MED LEFT MONOLITHIX STAB DRCN	BOTH IP/OP	"$3,869.00 "	"$2,863.06"	$0.00	"$3,095.20"	"$1,741.05"	"$1,741.05"	$0.00	$0.00	$0.00	$806.40	"$2,871.57"	"$2,871.57"	$0.00	$0.00	$806.30	$0.00	"$1,907.42"	"$1,907.42"	$0.00	"$1,934.50"	"$3,064.25"	"$3,095.20"	$0.00		$0.00	$605.50	$0.00	$0.00	$615.94	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-821	SUP	HCPCS C1776		6632-0-821  -  CMPNT FEM MED LEFT KNEE CMNT MNLTH STAB DRCN VIT	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-825	SUP	HCPCS C1776		6632-0-825  -  COMPONENT FEM MED DRCN CMNT MNLTH STAB KN RT	BOTH IP/OP	"$3,869.00 "	"$2,863.06"	$0.00	"$3,095.20"	"$1,741.05"	"$1,741.05"	$0.00	$0.00	$0.00	$806.40	"$2,871.57"	"$2,871.57"	$0.00	$0.00	$806.30	$0.00	"$1,907.42"	"$1,907.42"	$0.00	"$1,934.50"	"$3,064.25"	"$3,095.20"	$0.00		$0.00	$605.50	$0.00	$0.00	$615.94	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-826	SUP	HCPCS C1776		6632-0-826  -  COMPONENT FEM MED DRCN CMNT MNLTH STAB KN RT	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-830	SUP	HCPCS C1776		6632-0-830  -  COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN LT	BOTH IP/OP	"$3,869.00 "	"$2,863.06"	$0.00	"$3,095.20"	"$1,741.05"	"$1,741.05"	$0.00	$0.00	$0.00	$806.40	"$2,871.57"	"$2,871.57"	$0.00	$0.00	$806.30	$0.00	"$1,907.42"	"$1,907.42"	$0.00	"$1,934.50"	"$3,064.25"	"$3,095.20"	$0.00		$0.00	$605.50	$0.00	$0.00	$615.94	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-831	SUP	HCPCS C1776		6632-0-831  -  COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN LT	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-835	SUP	HCPCS C1776		6632-0-835  -  COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN RT	BOTH IP/OP	"$3,869.00 "	"$2,863.06"	$0.00	"$3,095.20"	"$1,741.05"	"$1,741.05"	$0.00	$0.00	$0.00	$806.40	"$2,871.57"	"$2,871.57"	$0.00	$0.00	$806.30	$0.00	"$1,907.42"	"$1,907.42"	$0.00	"$1,934.50"	"$3,064.25"	"$3,095.20"	$0.00		$0.00	$605.50	$0.00	$0.00	$615.94	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-836	SUP	HCPCS C1776		6632-0-836  -  COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN RT	BOTH IP/OP	"$3,437.00 "	"$2,543.38"	$0.00	"$2,749.60"	"$1,546.65"	"$1,546.65"	$0.00	$0.00	$0.00	$716.36	"$2,550.94"	"$2,550.94"	$0.00	$0.00	$716.27	$0.00	"$1,694.44"	"$1,694.44"	$0.00	"$1,718.50"	"$2,722.10"	"$2,749.60"	$0.00		$0.00	$537.89	$0.00	$0.00	$547.17	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-840	SUP	HCPCS C1776		6632-0-840  -  CMPNT FEM LG LEFT MNLTH STAB DRCN VIT	BOTH IP/OP	"$3,869.00 "	"$2,863.06"	$0.00	"$3,095.20"	"$1,741.05"	"$1,741.05"	$0.00	$0.00	$0.00	$806.40	"$2,871.57"	"$2,871.57"	$0.00	$0.00	$806.30	$0.00	"$1,907.42"	"$1,907.42"	$0.00	"$1,934.50"	"$3,064.25"	"$3,095.20"	$0.00		$0.00	$605.50	$0.00	$0.00	$615.94	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-845	SUP	HCPCS C1776		6632-0-845  -  CMPNT FEM LG RIGHT MNLTH STAB DRCN	BOTH IP/OP	"$3,869.00 "	"$2,863.06"	$0.00	"$3,095.20"	"$1,741.05"	"$1,741.05"	$0.00	$0.00	$0.00	$806.40	"$2,871.57"	"$2,871.57"	$0.00	$0.00	$806.30	$0.00	"$1,907.42"	"$1,907.42"	$0.00	"$1,934.50"	"$3,064.25"	"$3,095.20"	$0.00		$0.00	$605.50	$0.00	$0.00	$615.94	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-855	SUP	HCPCS C1776		6632-0-855  -  STAB FEM DRCN XL RIGHT MONO	BOTH IP/OP	"$3,941.00 "	"$2,916.34"	$0.00	"$3,152.80"	"$1,773.45"	"$1,773.45"	$0.00	$0.00	$0.00	$821.40	"$2,925.01"	"$2,925.01"	$0.00	$0.00	$821.30	$0.00	"$1,942.91"	"$1,942.91"	$0.00	"$1,970.50"	"$3,121.27"	"$3,152.80"	$0.00		$0.00	$616.77	$0.00	$0.00	$627.41	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-860	SUP	HCPCS C1776		6632-0-860  -  CMPNT FEM 2XL LEFT MNLTH STAB DRCN BLK	BOTH IP/OP	"$3,941.00 "	"$2,916.34"	$0.00	"$3,152.80"	"$1,773.45"	"$1,773.45"	$0.00	$0.00	$0.00	$821.40	"$2,925.01"	"$2,925.01"	$0.00	$0.00	$821.30	$0.00	"$1,942.91"	"$1,942.91"	$0.00	"$1,970.50"	"$3,121.27"	"$3,152.80"	$0.00		$0.00	$616.77	$0.00	$0.00	$627.41	$0.00	$0.00	$0.00	$0.00	$0.00
6632-0-865	SUP	HCPCS C1776		6632-0-865  -  CMPNT FEM 2XL RIGHT MNLTH STAB DRCN	BOTH IP/OP	"$3,941.00 "	"$2,916.34"	$0.00	"$3,152.80"	"$1,773.45"	"$1,773.45"	$0.00	$0.00	$0.00	$821.40	"$2,925.01"	"$2,925.01"	$0.00	$0.00	$821.30	$0.00	"$1,942.91"	"$1,942.91"	$0.00	"$1,970.50"	"$3,121.27"	"$3,152.80"	$0.00		$0.00	$616.77	$0.00	$0.00	$627.41	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-301	SUP	HCPCS C1776		6632-3-301  -  BSPLT TIB DRCN XS1 BEADED CRCIFRM NPOR	BOTH IP/OP	"$2,891.00 "	"$2,139.34"	$0.00	"$2,312.80"	"$1,300.95"	"$1,300.95"	$0.00	$0.00	$0.00	$602.56	"$2,145.70"	"$2,145.70"	$0.00	$0.00	$602.48	$0.00	"$1,425.26"	"$1,425.26"	$0.00	"$1,445.50"	"$2,289.67"	"$2,312.80"	$0.00		$0.00	$452.44	$0.00	$0.00	$460.25	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-303	SUP	HCPCS C1776		6632-3-303  -  BSPLT TIB DRCN 2 XS KNEE CRCIFRM BEADED POR	BOTH IP/OP	"$2,891.00 "	"$2,139.34"	$0.00	"$2,312.80"	"$1,300.95"	"$1,300.95"	$0.00	$0.00	$0.00	$602.56	"$2,145.70"	"$2,145.70"	$0.00	$0.00	$602.48	$0.00	"$1,425.26"	"$1,425.26"	$0.00	"$1,445.50"	"$2,289.67"	"$2,312.80"	$0.00		$0.00	$452.44	$0.00	$0.00	$460.25	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-305	SUP	HCPCS C1776		6632-3-305  -  BSPLT TIB DRCN 1 SM CRCIFRM BSPLT POR	BOTH IP/OP	"$2,838.00 "	"$2,100.12"	$0.00	"$2,270.40"	"$1,277.10"	"$1,277.10"	$0.00	$0.00	$0.00	$591.51	"$2,106.36"	"$2,106.36"	$0.00	$0.00	$591.44	$0.00	"$1,399.13"	"$1,399.13"	$0.00	"$1,419.00"	"$2,247.70"	"$2,270.40"	$0.00		$0.00	$444.15	$0.00	$0.00	$451.81	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-310	SUP	HCPCS C1776		6632-3-310  -  BSPLT TIB DRCN 2 SM KNEE BEADED CRCIFRM POR	BOTH IP/OP	"$2,838.00 "	"$2,100.12"	$0.00	"$2,270.40"	"$1,277.10"	"$1,277.10"	$0.00	$0.00	$0.00	$591.51	"$2,106.36"	"$2,106.36"	$0.00	$0.00	$591.44	$0.00	"$1,399.13"	"$1,399.13"	$0.00	"$1,419.00"	"$2,247.70"	"$2,270.40"	$0.00		$0.00	$444.15	$0.00	$0.00	$451.81	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-315	SUP	HCPCS C1776		6632-3-315  -  BSPLT TIB DRCN 1 MED KNEE BEADED CRCIFRM POR	BOTH IP/OP	"$2,838.00 "	"$2,100.12"	$0.00	"$2,270.40"	"$1,277.10"	"$1,277.10"	$0.00	$0.00	$0.00	$591.51	"$2,106.36"	"$2,106.36"	$0.00	$0.00	$591.44	$0.00	"$1,399.13"	"$1,399.13"	$0.00	"$1,419.00"	"$2,247.70"	"$2,270.40"	$0.00		$0.00	$444.15	$0.00	$0.00	$451.81	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-320	SUP	HCPCS C1776		6632-3-320  -  BSPLT TIB DRCN 2 MED KNEE CRCIFRM POR	BOTH IP/OP	"$2,838.00 "	"$2,100.12"	$0.00	"$2,270.40"	"$1,277.10"	"$1,277.10"	$0.00	$0.00	$0.00	$591.51	"$2,106.36"	"$2,106.36"	$0.00	$0.00	$591.44	$0.00	"$1,399.13"	"$1,399.13"	$0.00	"$1,419.00"	"$2,247.70"	"$2,270.40"	$0.00		$0.00	$444.15	$0.00	$0.00	$451.81	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-325	SUP	HCPCS C1776		6632-3-325  -  BSPLT TIB DRCN 1 LG KNEE BEADED CRCIFRM POR	BOTH IP/OP	"$2,838.00 "	"$2,100.12"	$0.00	"$2,270.40"	"$1,277.10"	"$1,277.10"	$0.00	$0.00	$0.00	$591.51	"$2,106.36"	"$2,106.36"	$0.00	$0.00	$591.44	$0.00	"$1,399.13"	"$1,399.13"	$0.00	"$1,419.00"	"$2,247.70"	"$2,270.40"	$0.00		$0.00	$444.15	$0.00	$0.00	$451.81	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-330	SUP	HCPCS C1776		6632-3-330  -  BSPLT TIB DRCN 2 LG KNEE BEADED CRCIFRM POR	BOTH IP/OP	"$2,838.00 "	"$2,100.12"	$0.00	"$2,270.40"	"$1,277.10"	"$1,277.10"	$0.00	$0.00	$0.00	$591.51	"$2,106.36"	"$2,106.36"	$0.00	$0.00	$591.44	$0.00	"$1,399.13"	"$1,399.13"	$0.00	"$1,419.00"	"$2,247.70"	"$2,270.40"	$0.00		$0.00	$444.15	$0.00	$0.00	$451.81	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-335	SUP	HCPCS C1776		6632-3-335  -  BSPLT TIB DRCN 1 XL KNEE BEADED CRCIFRM POR	BOTH IP/OP	"$2,891.00 "	"$2,139.34"	$0.00	"$2,312.80"	"$1,300.95"	"$1,300.95"	$0.00	$0.00	$0.00	$602.56	"$2,145.70"	"$2,145.70"	$0.00	$0.00	$602.48	$0.00	"$1,425.26"	"$1,425.26"	$0.00	"$1,445.50"	"$2,289.67"	"$2,312.80"	$0.00		$0.00	$452.44	$0.00	$0.00	$460.25	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-340	SUP	HCPCS C1776		6632-3-340  -  BSPLT TIB DRCN 2 XL KNEE BEADED CRCIFRM POR	BOTH IP/OP	"$2,891.00 "	"$2,139.34"	$0.00	"$2,312.80"	"$1,300.95"	"$1,300.95"	$0.00	$0.00	$0.00	$602.56	"$2,145.70"	"$2,145.70"	$0.00	$0.00	$602.48	$0.00	"$1,425.26"	"$1,425.26"	$0.00	"$1,445.50"	"$2,289.67"	"$2,312.80"	$0.00		$0.00	$452.44	$0.00	$0.00	$460.25	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-401	SUP	HCPCS C1776		6632-3-401  -  BSPLT TIB DRCN 1 XS NBD CRCIFRM	BOTH IP/OP	"$1,918.00 "	"$1,419.32"	$0.00	"$1,534.40"	$863.10	$863.10	$0.00	$0.00	$0.00	$399.76	"$1,423.54"	"$1,423.54"	$0.00	$0.00	$399.71	$0.00	"$1,134.50"	"$1,134.50"	$0.00	$959.00	"$1,519.06"	"$1,534.40"	$0.00		$0.00	$300.17	$0.00	$0.00	$305.35	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-403	SUP	HCPCS C1776		6632-3-403  -  BSPLT TIB DRCN 2 XS NBD CRCIFRM	BOTH IP/OP	"$2,149.00 "	"$1,590.26"	$0.00	"$1,719.20"	$967.05	$967.05	$0.00	$0.00	$0.00	$447.91	"$1,594.99"	"$1,594.99"	$0.00	$0.00	$447.85	$0.00	"$1,271.13"	"$1,271.13"	$0.00	"$1,074.50"	"$1,702.01"	"$1,719.20"	$0.00		$0.00	$336.32	$0.00	$0.00	$342.12	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-405	SUP	HCPCS C1776		6632-3-405  -  BSPLT TIB DRCN S1 NBD CRCIFRM NPOR	BOTH IP/OP	"$2,167.00 "	"$1,603.58"	$0.00	"$1,733.60"	$975.15	$975.15	$0.00	$0.00	$0.00	$451.66	"$1,608.35"	"$1,608.35"	$0.00	$0.00	$451.60	$0.00	"$1,281.78"	"$1,281.78"	$0.00	"$1,083.50"	"$1,716.26"	"$1,733.60"	$0.00		$0.00	$339.14	$0.00	$0.00	$344.99	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-410	SUP	HCPCS C1776		6632-3-410  -  BSPLT TIB DRCN S2 NBD CRCIFRM NPOR	BOTH IP/OP	"$2,167.00 "	"$1,603.58"	$0.00	"$1,733.60"	$975.15	$975.15	$0.00	$0.00	$0.00	$451.66	"$1,608.35"	"$1,608.35"	$0.00	$0.00	$451.60	$0.00	"$1,281.78"	"$1,281.78"	$0.00	"$1,083.50"	"$1,716.26"	"$1,733.60"	$0.00		$0.00	$339.14	$0.00	$0.00	$344.99	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-415	SUP	HCPCS C1776		6632-3-415  -  BSPLT TIB DRCN M1 NBD CRCIFRM NPOR	BOTH IP/OP	"$2,131.00 "	"$1,576.94"	$0.00	"$1,704.80"	$958.95	$958.95	$0.00	$0.00	$0.00	$444.15	"$1,581.63"	"$1,581.63"	$0.00	$0.00	$444.10	$0.00	"$1,260.49"	"$1,260.49"	$0.00	"$1,065.50"	"$1,687.75"	"$1,704.80"	$0.00		$0.00	$333.50	$0.00	$0.00	$339.26	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-420	SUP	HCPCS C1776		6632-3-420  -  BSPLT TIB DRCN M2 NBD CRCIFRM NPOR	BOTH IP/OP	"$2,131.00 "	"$1,576.94"	$0.00	"$1,704.80"	$958.95	$958.95	$0.00	$0.00	$0.00	$444.15	"$1,581.63"	"$1,581.63"	$0.00	$0.00	$444.10	$0.00	"$1,260.49"	"$1,260.49"	$0.00	"$1,065.50"	"$1,687.75"	"$1,704.80"	$0.00		$0.00	$333.50	$0.00	$0.00	$339.26	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-425	SUP	HCPCS C1776		6632-3-425  -  BSPLT TIB DRCN 1 NBD CRCIFRM NPOR	BOTH IP/OP	"$2,131.00 "	"$1,576.94"	$0.00	"$1,704.80"	$958.95	$958.95	$0.00	$0.00	$0.00	$444.15	"$1,581.63"	"$1,581.63"	$0.00	$0.00	$444.10	$0.00	"$1,260.49"	"$1,260.49"	$0.00	"$1,065.50"	"$1,687.75"	"$1,704.80"	$0.00		$0.00	$333.50	$0.00	$0.00	$339.26	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-430	SUP	HCPCS C1776		6632-3-430  -  BSPLT TIB DRCN 2 NBD CRCIFRM NPOR	BOTH IP/OP	"$2,131.00 "	"$1,576.94"	$0.00	"$1,704.80"	$958.95	$958.95	$0.00	$0.00	$0.00	$444.15	"$1,581.63"	"$1,581.63"	$0.00	$0.00	$444.10	$0.00	"$1,260.49"	"$1,260.49"	$0.00	"$1,065.50"	"$1,687.75"	"$1,704.80"	$0.00		$0.00	$333.50	$0.00	$0.00	$339.26	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-435	SUP	HCPCS C1776		6632-3-435  -  BSPLT TIB DRCN X1 NBD CRCIFRM NPOR	BOTH IP/OP	"$2,167.00 "	"$1,603.58"	$0.00	"$1,733.60"	$975.15	$975.15	$0.00	$0.00	$0.00	$451.66	"$1,608.35"	"$1,608.35"	$0.00	$0.00	$451.60	$0.00	"$1,281.78"	"$1,281.78"	$0.00	"$1,083.50"	"$1,716.26"	"$1,733.60"	$0.00		$0.00	$339.14	$0.00	$0.00	$344.99	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-440	SUP	HCPCS C1776		6632-3-440  -  BSPLT TIB DRCN 2 XL KNEE NBD CRCIFRM NPOR	BOTH IP/OP	"$2,167.00 "	"$1,603.58"	$0.00	"$1,733.60"	$975.15	$975.15	$0.00	$0.00	$0.00	$451.66	"$1,608.35"	"$1,608.35"	$0.00	$0.00	$451.60	$0.00	"$1,281.78"	"$1,281.78"	$0.00	"$1,083.50"	"$1,716.26"	"$1,733.60"	$0.00		$0.00	$339.14	$0.00	$0.00	$344.99	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-505	SUP	HCPCS C1776		6632-3-505  -  BSPLT TIB DRCN 1 SM KNEE BEADED CRCIFRM PERIAPT	BOTH IP/OP	"$3,355.00 "	"$2,482.70"	$0.00	"$2,684.00"	"$1,509.75"	"$1,509.75"	$0.00	$0.00	$0.00	$699.27	"$2,490.08"	"$2,490.08"	$0.00	$0.00	$699.18	$0.00	"$1,654.02"	"$1,654.02"	$0.00	"$1,677.50"	"$2,657.16"	"$2,684.00"	$0.00		$0.00	$525.06	$0.00	$0.00	$534.12	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-510	SUP	HCPCS C1776		6632-3-510  -  BSPLT TIB DRCN S2 BEADED CRCIFRM PERIAPT	BOTH IP/OP	"$3,355.00 "	"$2,482.70"	$0.00	"$2,684.00"	"$1,509.75"	"$1,509.75"	$0.00	$0.00	$0.00	$699.27	"$2,490.08"	"$2,490.08"	$0.00	$0.00	$699.18	$0.00	"$1,654.02"	"$1,654.02"	$0.00	"$1,677.50"	"$2,657.16"	"$2,684.00"	$0.00		$0.00	$525.06	$0.00	$0.00	$534.12	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-515	SUP	HCPCS C1776		6632-3-515  -  BSPLT TIB DRCN M1 BEADED CRCIFRM PERIAPT	BOTH IP/OP	"$3,339.00 "	"$2,470.86"	$0.00	"$2,671.20"	"$1,502.55"	"$1,502.55"	$0.00	$0.00	$0.00	$695.93	"$2,478.21"	"$2,478.21"	$0.00	$0.00	$695.85	$0.00	"$1,646.13"	"$1,646.13"	$0.00	"$1,669.50"	"$2,644.49"	"$2,671.20"	$0.00		$0.00	$522.55	$0.00	$0.00	$531.57	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-520	SUP	HCPCS C1776		6632-3-520  -  BSPLT TIB DRCN M2 BEADED CRCIFRM PERIAPT	BOTH IP/OP	"$3,339.00 "	"$2,470.86"	$0.00	"$2,671.20"	"$1,502.55"	"$1,502.55"	$0.00	$0.00	$0.00	$695.93	"$2,478.21"	"$2,478.21"	$0.00	$0.00	$695.85	$0.00	"$1,646.13"	"$1,646.13"	$0.00	"$1,669.50"	"$2,644.49"	"$2,671.20"	$0.00		$0.00	$522.55	$0.00	$0.00	$531.57	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-525	SUP	HCPCS C1776		6632-3-525  -  BSPLT TIB DRCN 1 LG KNEE BEADED CRCIFRM PERIAPT	BOTH IP/OP	"$3,339.00 "	"$2,470.86"	$0.00	"$2,671.20"	"$1,502.55"	"$1,502.55"	$0.00	$0.00	$0.00	$695.93	"$2,478.21"	"$2,478.21"	$0.00	$0.00	$695.85	$0.00	"$1,646.13"	"$1,646.13"	$0.00	"$1,669.50"	"$2,644.49"	"$2,671.20"	$0.00		$0.00	$522.55	$0.00	$0.00	$531.57	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-530	SUP	HCPCS C1776		6632-3-530  -  BSPLT TIB DRCN 2 LG KNEE BEADED CRCIFRM PERIAPT	BOTH IP/OP	"$3,339.00 "	"$2,470.86"	$0.00	"$2,671.20"	"$1,502.55"	"$1,502.55"	$0.00	$0.00	$0.00	$695.93	"$2,478.21"	"$2,478.21"	$0.00	$0.00	$695.85	$0.00	"$1,646.13"	"$1,646.13"	$0.00	"$1,669.50"	"$2,644.49"	"$2,671.20"	$0.00		$0.00	$522.55	$0.00	$0.00	$531.57	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-535	SUP	HCPCS C1776		6632-3-535  -  BSPLT TIB DRCN 1 XL KNEE BEADED CRCIFRM PERIAPT	BOTH IP/OP	"$3,355.00 "	"$2,482.70"	$0.00	"$2,684.00"	"$1,509.75"	"$1,509.75"	$0.00	$0.00	$0.00	$699.27	"$2,490.08"	"$2,490.08"	$0.00	$0.00	$699.18	$0.00	"$1,654.02"	"$1,654.02"	$0.00	"$1,677.50"	"$2,657.16"	"$2,684.00"	$0.00		$0.00	$525.06	$0.00	$0.00	$534.12	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-540	SUP	HCPCS C1776		6632-3-540  -  BSPLT TIB DRCN 2 XL KNEE BEADED CRCIFRM PERIAPT	BOTH IP/OP	"$3,355.00 "	"$2,482.70"	$0.00	"$2,684.00"	"$1,509.75"	"$1,509.75"	$0.00	$0.00	$0.00	$699.27	"$2,490.08"	"$2,490.08"	$0.00	$0.00	$699.18	$0.00	"$1,654.02"	"$1,654.02"	$0.00	"$1,677.50"	"$2,657.16"	"$2,684.00"	$0.00		$0.00	$525.06	$0.00	$0.00	$534.12	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-603	SUP	HCPCS C1776		6632-3-603  -  BSPLT TIB DRCN 1 MED UNV KNEE NBD CRCIFRM NPOR	BOTH IP/OP	"$2,169.00 "	"$1,605.06"	$0.00	"$1,735.20"	$976.05	$976.05	$0.00	$0.00	$0.00	$452.07	"$1,609.83"	"$1,609.83"	$0.00	$0.00	$452.02	$0.00	"$1,282.96"	"$1,282.96"	$0.00	"$1,084.50"	"$1,717.85"	"$1,735.20"	$0.00		$0.00	$339.45	$0.00	$0.00	$345.30	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-605	SUP	HCPCS C1776		6632-3-605  -  BSPLT TIB DRCN S1 UNV NBD CRCIFRM NPOR	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$958.50	$958.50	$0.00	$0.00	$0.00	$443.95	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	"$1,259.90"	"$1,259.90"	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$333.35	$0.00	$0.00	$339.10	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-610	SUP	HCPCS C1776		6632-3-610  -  BSPLT TIB DRCN S2 NBD CRCIFRM NPOR	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$958.50	$958.50	$0.00	$0.00	$0.00	$443.95	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	"$1,259.90"	"$1,259.90"	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$333.35	$0.00	$0.00	$339.10	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-615	SUP	HCPCS C1776		6632-3-615  -  BSPLT TIB M1 NPOR HWMDC	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$958.50	$958.50	$0.00	$0.00	$0.00	$443.95	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	"$1,259.90"	"$1,259.90"	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$333.35	$0.00	$0.00	$339.10	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-620	SUP	HCPCS C1776		6632-3-620  -  BSPLT TIB DRCN 2 MED UNV KNEE NBD CRCIFRM NPOR	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$958.50	$958.50	$0.00	$0.00	$0.00	$443.95	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	"$1,259.90"	"$1,259.90"	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$333.35	$0.00	$0.00	$339.10	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-625	SUP	HCPCS C1776		6632-3-625  -  BSPLT TIB DRCN 1 NBD CRCIFRM NPOR	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$958.50	$958.50	$0.00	$0.00	$0.00	$443.95	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	"$1,259.90"	"$1,259.90"	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$333.35	$0.00	$0.00	$339.10	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-630	SUP	HCPCS C1776		6632-3-630  -  BSPLT TIB DRCN 2 LG UNV KNEE NBD CRCIFRM NPOR	BOTH IP/OP	"$2,130.00 "	"$1,576.20"	$0.00	"$1,704.00"	$958.50	$958.50	$0.00	$0.00	$0.00	$443.95	"$1,580.89"	"$1,580.89"	$0.00	$0.00	$443.89	$0.00	"$1,259.90"	"$1,259.90"	$0.00	"$1,065.00"	"$1,686.96"	"$1,704.00"	$0.00		$0.00	$333.35	$0.00	$0.00	$339.10	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-635	SUP	HCPCS C1776		6632-3-635  -  BSPLT TIB DRCN 1 XL UNV KNEE NBD CRCIFRM NPOR	BOTH IP/OP	"$2,169.00 "	"$1,605.06"	$0.00	"$1,735.20"	$976.05	$976.05	$0.00	$0.00	$0.00	$452.07	"$1,609.83"	"$1,609.83"	$0.00	$0.00	$452.02	$0.00	"$1,282.96"	"$1,282.96"	$0.00	"$1,084.50"	"$1,717.85"	"$1,735.20"	$0.00		$0.00	$339.45	$0.00	$0.00	$345.30	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-640	SUP	HCPCS C1776		6632-3-640  -  BSPLT TIB DRCN X2 NBD CRCIFRM NPOR	BOTH IP/OP	"$2,169.00 "	"$1,605.06"	$0.00	"$1,735.20"	$976.05	$976.05	$0.00	$0.00	$0.00	$452.07	"$1,609.83"	"$1,609.83"	$0.00	$0.00	$452.02	$0.00	"$1,282.96"	"$1,282.96"	$0.00	"$1,084.50"	"$1,717.85"	"$1,735.20"	$0.00		$0.00	$339.45	$0.00	$0.00	$345.30	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-701	SUP	HCPCS C1776		6632-3-701  -  BSPLT TIB DRCN XS1 UNV KNEE BEADED POR 62X37MM	BOTH IP/OP	"$2,919.00 "	"$2,160.06"	$0.00	"$2,335.20"	"$1,313.55"	"$1,313.55"	$0.00	$0.00	$0.00	$608.39	"$2,166.48"	"$2,166.48"	$0.00	$0.00	$608.32	$0.00	"$1,439.07"	"$1,439.07"	$0.00	"$1,459.50"	"$2,311.85"	"$2,335.20"	$0.00		$0.00	$456.82	$0.00	$0.00	$464.70	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-703	SUP	HCPCS C1776		6632-3-703  -  BSPLT TIB DRCN XS2 UNV KNEE BEADED POR 64X39MM	BOTH IP/OP	"$2,919.00 "	"$2,160.06"	$0.00	"$2,335.20"	"$1,313.55"	"$1,313.55"	$0.00	$0.00	$0.00	$608.39	"$2,166.48"	"$2,166.48"	$0.00	$0.00	$608.32	$0.00	"$1,439.07"	"$1,439.07"	$0.00	"$1,459.50"	"$2,311.85"	"$2,335.20"	$0.00		$0.00	$456.82	$0.00	$0.00	$464.70	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-705	SUP	HCPCS C1776		6632-3-705  -  BSPLT TIB DRCN S1 UNV KNEE BEADED POR 67X42MM	BOTH IP/OP	"$2,865.00 "	"$2,120.10"	$0.00	"$2,292.00"	"$1,289.25"	"$1,289.25"	$0.00	$0.00	$0.00	$597.14	"$2,126.40"	"$2,126.40"	$0.00	$0.00	$597.07	$0.00	"$1,412.45"	"$1,412.45"	$0.00	"$1,432.50"	"$2,269.08"	"$2,292.00"	$0.00		$0.00	$448.37	$0.00	$0.00	$456.11	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-710	SUP	HCPCS C1776		6632-3-710  -  BSPLT TIB DRCN S2 UNV KNEE BEADED POR 69X45MM	BOTH IP/OP	"$2,865.00 "	"$2,120.10"	$0.00	"$2,292.00"	"$1,289.25"	"$1,289.25"	$0.00	$0.00	$0.00	$597.14	"$2,126.40"	"$2,126.40"	$0.00	$0.00	$597.07	$0.00	"$1,412.45"	"$1,412.45"	$0.00	"$1,432.50"	"$2,269.08"	"$2,292.00"	$0.00		$0.00	$448.37	$0.00	$0.00	$456.11	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-715	SUP	HCPCS C1776		6632-3-715  -  BSPLT TIB DRCN M1 UNV KNEE BEADED POR 72X48MM	BOTH IP/OP	"$2,865.00 "	"$2,120.10"	$0.00	"$2,292.00"	"$1,289.25"	"$1,289.25"	$0.00	$0.00	$0.00	$597.14	"$2,126.40"	"$2,126.40"	$0.00	$0.00	$597.07	$0.00	"$1,412.45"	"$1,412.45"	$0.00	"$1,432.50"	"$2,269.08"	"$2,292.00"	$0.00		$0.00	$448.37	$0.00	$0.00	$456.11	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-720	SUP	HCPCS C1776		6632-3-720  -  BSPLT TIB DRCN M2 BEADED CRCIFRM NPOR	BOTH IP/OP	"$2,865.00 "	"$2,120.10"	$0.00	"$2,292.00"	"$1,289.25"	"$1,289.25"	$0.00	$0.00	$0.00	$597.14	"$2,126.40"	"$2,126.40"	$0.00	$0.00	$597.07	$0.00	"$1,412.45"	"$1,412.45"	$0.00	"$1,432.50"	"$2,269.08"	"$2,292.00"	$0.00		$0.00	$448.37	$0.00	$0.00	$456.11	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-725	SUP	HCPCS C1776		6632-3-725  -  BSPLT TIB DRCN UNV KNEE SCR POR 77X53MM HWMDC X 1	BOTH IP/OP	"$2,865.00 "	"$2,120.10"	$0.00	"$2,292.00"	"$1,289.25"	"$1,289.25"	$0.00	$0.00	$0.00	$597.14	"$2,126.40"	"$2,126.40"	$0.00	$0.00	$597.07	$0.00	"$1,412.45"	"$1,412.45"	$0.00	"$1,432.50"	"$2,269.08"	"$2,292.00"	$0.00		$0.00	$448.37	$0.00	$0.00	$456.11	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-730	SUP	HCPCS C1776		6632-3-730  -  BSPLT TIB DRCN X2 UNV KNEE SCR FIX POR 79X55MM	BOTH IP/OP	"$2,865.00 "	"$2,120.10"	$0.00	"$2,292.00"	"$1,289.25"	"$1,289.25"	$0.00	$0.00	$0.00	$597.14	"$2,126.40"	"$2,126.40"	$0.00	$0.00	$597.07	$0.00	"$1,412.45"	"$1,412.45"	$0.00	"$1,432.50"	"$2,269.08"	"$2,292.00"	$0.00		$0.00	$448.37	$0.00	$0.00	$456.11	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-735	SUP	HCPCS C1776		6632-3-735  -  BSPLT TIB DRCN X1 UNV KNEE BEADED POR 82X58MM	BOTH IP/OP	"$2,919.00 "	"$2,160.06"	$0.00	"$2,335.20"	"$1,313.55"	"$1,313.55"	$0.00	$0.00	$0.00	$608.39	"$2,166.48"	"$2,166.48"	$0.00	$0.00	$608.32	$0.00	"$1,439.07"	"$1,439.07"	$0.00	"$1,459.50"	"$2,311.85"	"$2,335.20"	$0.00		$0.00	$456.82	$0.00	$0.00	$464.70	$0.00	$0.00	$0.00	$0.00	$0.00
6632-3-740	SUP	HCPCS C1776		6632-3-740  -  BSPLT TIB DRCN X2 UNV KNEE SCR FIX POR 85X60MM	BOTH IP/OP	"$2,919.00 "	"$2,160.06"	$0.00	"$2,335.20"	"$1,313.55"	"$1,313.55"	$0.00	$0.00	$0.00	$608.39	"$2,166.48"	"$2,166.48"	$0.00	$0.00	$608.32	$0.00	"$1,439.07"	"$1,439.07"	$0.00	"$1,459.50"	"$2,311.85"	"$2,335.20"	$0.00		$0.00	$456.82	$0.00	$0.00	$464.70	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-080	SUP	Custom 27803010		6632-5-080  -  SPACER FEM 5MM LEFT MDL KNEE	BOTH IP/OP	"$1,794.00 "	"$1,327.56"	$0.00	"$1,435.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,331.51"	"$1,331.51"	$0.00	$0.00	$373.87	$0.00	$0.00	$0.00	$0.00	$897.00	"$1,420.85"	"$1,435.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-085	SUP	Custom 27803010		6632-5-085  -  SPACER FEM 5MM RIGHT MDL KNEE	BOTH IP/OP	"$1,794.00 "	"$1,327.56"	$0.00	"$1,435.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,331.51"	"$1,331.51"	$0.00	$0.00	$373.87	$0.00	$0.00	$0.00	$0.00	$897.00	"$1,420.85"	"$1,435.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-090	SUP	Custom 27803010		6632-5-090  -  SPACER FEM 5MM DRCN XS LEFT DISTAL LAT	BOTH IP/OP	"$1,737.13 "	"$1,285.48"	$0.00	"$1,389.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,289.29"	"$1,289.29"	$0.00	$0.00	$362.02	$0.00	$0.00	$0.00	$0.00	$868.56	"$1,375.81"	"$1,389.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-100	SUP	Custom 27803010		6632-5-100  -  SPACER FEM 5MM DRCN SM LEFT DISTAL MDL VIT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-105	SUP	Custom 27803010		6632-5-105  -  SPACER FEM 5MM DRCN SM RIGHT DISTAL MDL	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-110	SUP	Custom 27803010		6632-5-110  -  SPACER FEM 5MM DRCN SM LEFT DISTAL LAT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-115	SUP	Custom 27803010		6632-5-115  -  SPACER FEM 5MM DRCN SM RIGHT DISTAL LAT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-120	SUP	Custom 27803010		6632-5-120  -  SPACER FEM 5MM DRCN MED LEFT DISTAL MDL	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-125	SUP	Custom 27803010		6632-5-125  -  SPACER FEM 5MM DRCN MED RIGHT DISTAL MDL	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-130	SUP	Custom 27803010		6632-5-130  -  SPACER FEM 5MM DRCN MED LEFT DISTAL LAT VIT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-135	SUP	Custom 27803010		6632-5-135  -  SPACER FEM 5MM DRCN MED RIGHT DISTAL LAT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-140	SUP	Custom 27803010		6632-5-140  -  SPACER FEM 5MM DRCN MED LG LEFT DISTAL MDL VIT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-145	SUP	Custom 27803010		6632-5-145  -  SPACER FEM 5MM DRCN MED LG RIGHT DISTAL MDL VIT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-150	SUP	Custom 27803010		6632-5-150  -  SPACER FEM 5MM DRCN MED LG LEFT DISTAL LAT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-155	SUP	Custom 27803010		6632-5-155  -  SPACER FEM 5MM DRCN MED LG RIGHT DISTAL LAT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-160	SUP	Custom 27803010		6632-5-160  -  SPACER FEM 5MM DRCN LG LEFT DISTAL MDL	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-165	SUP	Custom 27803010		6632-5-165  -  SPACER FEM 5MM DRCN LG RIGHT DISTAL MDL	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-170	SUP	Custom 27803010		6632-5-170  -  SPACER FEM 5MM DRCN LG LEFT DISTAL LAT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-175	SUP	Custom 27803010		6632-5-175  -  SPACER FEM 5MM DRCN LG RIGHT DISTAL LAT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-180	SUP	Custom 27803010		6632-5-180  -  SPACER FEM 5MM DRCN XL LEFT DISTAL MDL VIT	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-185	SUP	Custom 27803010		6632-5-185  -  SPACER FEM 5MM DRCN XL RIGHT DISTAL MDL VIT	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-190	SUP	Custom 27803010		6632-5-190  -  SPACER FEM 5MM DRCN XL LEFT DISTAL LAT	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-195	SUP	Custom 27803010		6632-5-195  -  SPACER FEM 5MM DRCN XL RIGHT DISTAL LAT VIT	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-450	SUP	Custom 27803010		6632-5-450  -  STABILIZER SRG S/MED ML DRCN MDLR KN	BOTH IP/OP	$414.00 	$306.36	$0.00	$331.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.27	$307.27	$0.00	$0.00	$86.28	$0.00	$0.00	$0.00	$0.00	$207.00	$327.89	$331.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-5-600	SUP	HCPCS C1713		6632-5-600  -  SCREW BONE 5MM DRCN VIT DISTAL FEM LCK SMPL	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$54.00	$54.00	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$0.00	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00		$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-100	SUP	Custom 27803010		6632-6-100  -  SPACER FEM SM 10MM DRCN KN LT MDL	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-105	SUP	Custom 27803010		6632-6-105  -  SPACER FEM 10MM DRCN SM RIGHT MDL DP VIT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-110	SUP	Custom 27803010		6632-6-110  -  SPACER FEM 10MM DRCN SM L/L DP	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-115	SUP	Custom 27803010		6632-6-115  -  SPACER FEM 10MM DRCN SM RIGHT LAT DP	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-120	SUP	Custom 27803010		6632-6-120  -  SPACER FEM 10MM DRCN MED LEFT MDL DP	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-125	SUP	Custom 27803010		6632-6-125  -  SPACER FEM 10MM DRCN MED RIGHT MDL DP	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-130	SUP	Custom 27803010		6632-6-130  -  SPACER FEM 10MM DRCN MED L/L DP	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-135	SUP	Custom 27803010		6632-6-135  -  SPACER FEM 10MM DRCN MED RIGHT LAT DP	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-140	SUP	Custom 27803010		6632-6-140  -  SPACER FEM 10MM DRCN MED LG LEFT MDL DP	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-145	SUP	Custom 27803010		6632-6-145  -  SPACER FEM 10MM DRCN MED LG RIGHT MDL DP VIT	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-150	SUP	Custom 27803010		6632-6-150  -  SPACER FEM 10MM DRCN MED LG L/L DP	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-155	SUP	Custom 27803010		6632-6-155  -  SPACER FEM 10MM DRCN MED LG RIGHT LAT DP VIT SPCR STAB	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-160	SUP	Custom 27803010		6632-6-160  -  SPACER FEM 10MM DRCN LG LEFT MDL DP	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-165	SUP	Custom 27803010		6632-6-165  -  SPACER FEM 10MM DRCN LG RIGHT MDL DP	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-170	SUP	Custom 27803010		6632-6-170  -  SPACER FEM 10MM DRCN LG L/L DP	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-175	SUP	Custom 27803010		6632-6-175  -  SPACER FEM 10MM DRCN LG RIGHT LAT DP	BOTH IP/OP	"$1,865.50 "	"$1,380.47"	$0.00	"$1,492.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,384.57"	"$1,384.57"	$0.00	$0.00	$388.77	$0.00	$0.00	$0.00	$0.00	$932.75	"$1,477.48"	"$1,492.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-180	SUP	Custom 27803010		6632-6-180  -  SPACER FEM 10MM DRCN XL LEFT MDL DP	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-185	SUP	Custom 27803010		6632-6-185  -  SPACER FEM 10MM DRCN XL RIGHT MDL DP	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-190	SUP	Custom 27803010		6632-6-190  -  SPACER FEM 10MM DRCN XL L/L DP	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-195	SUP	Custom 27803010		6632-6-195  -  SPACER FEM 10MM DRCN XL RIGHT LAT DP	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-410	SUP	Custom 27803010		6632-6-410  -  SPACER FEM 10MM DRCN SM POST	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-415	SUP	Custom 27803010		6632-6-415  -  SPACER FEM 5MM DRCN SM POST	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-420	SUP	Custom 27803010		6632-6-420  -  SPACER FEM 10MM DRCN MED POST	BOTH IP/OP	"$1,581.13 "	"$1,170.04"	$0.00	"$1,264.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,173.51"	"$1,173.51"	$0.00	$0.00	$329.51	$0.00	$0.00	$0.00	$0.00	$790.56	"$1,252.25"	"$1,264.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-425	SUP	Custom 27803010		6632-6-425  -  SPACER FEM 5MM DRCN MED POST	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-430	SUP	Custom 27803010		6632-6-430  -  SPACER FEM 10MM DRCN MED LG POST	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-435	SUP	Custom 27803010		6632-6-435  -  SPACER FEM 5MM DRCN MED LG POST VIT FULL	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-440	SUP	Custom 27803010		6632-6-440  -  SPACER FEM 10MM DRCN LG POST	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-445	SUP	Custom 27803010		6632-6-445  -  SPACER FEM 5MM DRCN LG POST	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-450	SUP	Custom 27803010		6632-6-450  -  SPACER FEM 10MM DRCN XL POST	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-455	SUP	Custom 27803010		6632-6-455  -  SPACER FEM 5MM DRCN XL POST VIT FULL	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-460	SUP	Custom 27803010		6632-6-460  -  SPACER FEM 10MM DRCN 2XL POST FULL	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-465	SUP	Custom 27803010		6632-6-465  -  SPACER FEM 5MM DRCN 2XL POST FULL	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-600	SUP	HCPCS C1713		6632-6-600  -  SCREW BONE 10MM 10MM DRCN DISTAL FEM LCK	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$54.00	$54.00	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$0.00	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00		$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-705	SUP	Custom 27803010		6632-6-705  -  SPACER FEM 5MM DRCN XS POST HALF	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-710	SUP	Custom 27803010		6632-6-710  -  SPACER FEM 10MM DRCN SM POST HALF	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-715	SUP	Custom 27803010		6632-6-715  -  SPACER FEM 5MM DRCN SM POST HALF	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-720	SUP	Custom 27803010		6632-6-720  -  SPACER FEM 10MM DRCN MED POST HALF	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-725	SUP	Custom 27803010		6632-6-725  -  SPACER FEM 5MM DRCN MED POST HALF	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-730	SUP	Custom 27803010		6632-6-730  -  SPACER FEM 10MM DRCN MED LG POST HALF	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-735	SUP	Custom 27803010		6632-6-735  -  SPACER FEM 5MM DRCN MED LG POST HALF	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-740	SUP	Custom 27803010		6632-6-740  -  SPACER FEM 10MM DRCN LG POST HALF	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-745	SUP	Custom 27803010		6632-6-745  -  SPACER FEM 5MM DRCN LG POST HALF	BOTH IP/OP	"$1,868.75 "	"$1,382.88"	$0.00	"$1,495.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.99"	"$1,386.99"	$0.00	$0.00	$389.45	$0.00	$0.00	$0.00	$0.00	$934.38	"$1,480.05"	"$1,495.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-750	SUP	Custom 27803010		6632-6-750  -  SPACER FEM 10MM DRCN XL POST HALF	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-755	SUP	Custom 27803010		6632-6-755  -  SPACER FEM XL HLF 5MM DRCN KN POST	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-760	SUP	Custom 27803010		6632-6-760  -  SPACER FEM 10MM DRCN 2XL POST KNEE HALF	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-6-765	SUP	Custom 27803010		6632-6-765  -  SPACER FEM 5MM DRCN XL POST HALF	BOTH IP/OP	"$1,961.38 "	"$1,451.42"	$0.00	"$1,569.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,455.73"	"$1,455.73"	$0.00	$0.00	$408.75	$0.00	$0.00	$0.00	$0.00	$980.69	"$1,553.41"	"$1,569.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6632-8-800	SUP	HCPCS C1776		6632-8-800  -  CMPNT FEM XS LEFT TOT STAB	BOTH IP/OP	"$10,811.13 "	"$8,000.24"	$0.00	"$8,648.90"	"$4,865.01"	"$4,865.01"	$0.00	$0.00	$0.00	"$2,253.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,253.04"	$0.00	"$5,329.88"	"$5,329.88"	$0.00	"$5,405.56"	"$8,562.41"	"$8,648.90"	$0.00		$0.00	"$1,691.94"	$0.00	$0.00	"$1,721.13"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-8-805	SUP	HCPCS C1776		6632-8-805  -  CMPNT FEM XS RIGHT KNEE TOT STAB DRCN	BOTH IP/OP	"$10,811.13 "	"$8,000.24"	$0.00	"$8,648.90"	"$4,865.01"	"$4,865.01"	$0.00	$0.00	$0.00	"$2,253.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,253.04"	$0.00	"$5,329.88"	"$5,329.88"	$0.00	"$5,405.56"	"$8,562.41"	"$8,648.90"	$0.00		$0.00	"$1,691.94"	$0.00	$0.00	"$1,721.13"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-8-810	SUP	HCPCS C1776		6632-8-810  -  CMPNT FEM SM LEFT TOT STAB	BOTH IP/OP	"$10,619.38 "	"$7,858.34"	$0.00	"$8,495.50"	"$4,778.72"	"$4,778.72"	$0.00	$0.00	$0.00	"$2,213.34"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,213.08"	$0.00	"$5,235.35"	"$5,235.35"	$0.00	"$5,309.69"	"$8,410.55"	"$8,495.50"	$0.00		$0.00	"$1,661.93"	$0.00	$0.00	"$1,690.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-8-815	SUP	HCPCS C1776		6632-8-815  -  CMPNT FEM SM RIGHT TOT STAB	BOTH IP/OP	"$10,619.38 "	"$7,858.34"	$0.00	"$8,495.50"	"$4,778.72"	"$4,778.72"	$0.00	$0.00	$0.00	"$2,213.34"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,213.08"	$0.00	"$5,235.35"	"$5,235.35"	$0.00	"$5,309.69"	"$8,410.55"	"$8,495.50"	$0.00		$0.00	"$1,661.93"	$0.00	$0.00	"$1,690.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-8-820	SUP	HCPCS C1776		6632-8-820  -  CMPNT FEM MED LEFT TOT STAB	BOTH IP/OP	"$10,619.38 "	"$7,858.34"	$0.00	"$8,495.50"	"$4,778.72"	"$4,778.72"	$0.00	$0.00	$0.00	"$2,213.34"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,213.08"	$0.00	"$5,235.35"	"$5,235.35"	$0.00	"$5,309.69"	"$8,410.55"	"$8,495.50"	$0.00		$0.00	"$1,661.93"	$0.00	$0.00	"$1,690.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-8-825	SUP	HCPCS C1776		6632-8-825  -  CMPNT FEM MED RIGHT TOT STAB	BOTH IP/OP	"$10,619.38 "	"$7,858.34"	$0.00	"$8,495.50"	"$4,778.72"	"$4,778.72"	$0.00	$0.00	$0.00	"$2,213.34"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,213.08"	$0.00	"$5,235.35"	"$5,235.35"	$0.00	"$5,309.69"	"$8,410.55"	"$8,495.50"	$0.00		$0.00	"$1,661.93"	$0.00	$0.00	"$1,690.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-8-830	SUP	HCPCS C1776		6632-8-830  -  CMPNT FEM MED LG LEFT TOT STAB	BOTH IP/OP	"$10,619.38 "	"$7,858.34"	$0.00	"$8,495.50"	"$4,778.72"	"$4,778.72"	$0.00	$0.00	$0.00	"$2,213.34"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,213.08"	$0.00	"$5,235.35"	"$5,235.35"	$0.00	"$5,309.69"	"$8,410.55"	"$8,495.50"	$0.00		$0.00	"$1,661.93"	$0.00	$0.00	"$1,690.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-8-835	SUP	HCPCS C1776		6632-8-835  -  CMPNT FEM MED LG RIGHT TOT STAB	BOTH IP/OP	"$10,619.38 "	"$7,858.34"	$0.00	"$8,495.50"	"$4,778.72"	"$4,778.72"	$0.00	$0.00	$0.00	"$2,213.34"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,213.08"	$0.00	"$5,235.35"	"$5,235.35"	$0.00	"$5,309.69"	"$8,410.55"	"$8,495.50"	$0.00		$0.00	"$1,661.93"	$0.00	$0.00	"$1,690.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-8-840	SUP	HCPCS C1776		6632-8-840  -  CMPNT FEM LG LEFT TOT STAB	BOTH IP/OP	"$10,619.38 "	"$7,858.34"	$0.00	"$8,495.50"	"$4,778.72"	"$4,778.72"	$0.00	$0.00	$0.00	"$2,213.34"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,213.08"	$0.00	"$5,235.35"	"$5,235.35"	$0.00	"$5,309.69"	"$8,410.55"	"$8,495.50"	$0.00		$0.00	"$1,661.93"	$0.00	$0.00	"$1,690.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-8-845	SUP	HCPCS C1776		6632-8-845  -  CMPNT FEM LG RIGHT TOT STAB	BOTH IP/OP	"$10,619.38 "	"$7,858.34"	$0.00	"$8,495.50"	"$4,778.72"	"$4,778.72"	$0.00	$0.00	$0.00	"$2,213.34"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,213.08"	$0.00	"$5,235.35"	"$5,235.35"	$0.00	"$5,309.69"	"$8,410.55"	"$8,495.50"	$0.00		$0.00	"$1,661.93"	$0.00	$0.00	"$1,690.60"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-8-850	SUP	HCPCS C1776		6632-8-850  -  CMPNT FEM XL LEFT TOT STAB	BOTH IP/OP	"$10,811.13 "	"$8,000.24"	$0.00	"$8,648.90"	"$4,865.01"	"$4,865.01"	$0.00	$0.00	$0.00	"$2,253.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,253.04"	$0.00	"$5,329.88"	"$5,329.88"	$0.00	"$5,405.56"	"$8,562.41"	"$8,648.90"	$0.00		$0.00	"$1,691.94"	$0.00	$0.00	"$1,721.13"	$0.00	$0.00	$0.00	$0.00	$0.00
6632-8-855	SUP	HCPCS C1776		6632-8-855  -  CMPNT FEM XL RIGHT TOT STAB	BOTH IP/OP	"$10,811.13 "	"$8,000.24"	$0.00	"$8,648.90"	"$4,865.01"	"$4,865.01"	$0.00	$0.00	$0.00	"$2,253.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,253.04"	$0.00	"$5,329.88"	"$5,329.88"	$0.00	"$5,405.56"	"$8,562.41"	"$8,648.90"	$0.00		$0.00	"$1,691.94"	$0.00	$0.00	"$1,721.13"	$0.00	$0.00	$0.00	$0.00	$0.00
6634-0-330	SUP	Custom 27803010		6634-0-330  -  CMPNT FEM UNV SM LEFT MDL RIGHT LAT DRCN	BOTH IP/OP	"$1,856.00 "	"$1,373.44"	$0.00	"$1,484.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,377.52"	"$1,377.52"	$0.00	$0.00	$386.79	$0.00	$0.00	$0.00	$0.00	$928.00	"$1,469.95"	"$1,484.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-009	SUP	HCPCS C1776		6637-0-009  -  INSERT TIBIAL SMALL 9MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-011	SUP	HCPCS C1776		6637-0-011  -  INSERT TIBIAL SMALL 11MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-013	SUP	HCPCS C1776		6637-0-013  -  INSERT TIBIAL SMALL 13MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-016	SUP	HCPCS C1776		6637-0-016  -  INSERT TIBIAL SMALL 16MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-019	SUP	HCPCS C1776		6637-0-019  -  INSERT TIBIAL SMALL 19MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-022	SUP	HCPCS C1776		6637-0-022  -  INSERT TIBIAL SMALL 22MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-025	SUP	HCPCS C1776		6637-0-025  -  INSERT TIBIAL SMALL 25MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-028	SUP	HCPCS C1776		6637-0-028  -  INSERT TIBIAL SMALL 28MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-031	SUP	HCPCS C1776		6637-0-031  -  INSERT TIBIAL SMALL 31MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-109	SUP	HCPCS C1776		6637-0-109  -  INSERT TIBIAL MEDIUM 9MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-111	SUP	HCPCS C1776		6637-0-111  -  INSERT TIBIAL MEDIUM 11MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-113	SUP	HCPCS C1776		6637-0-113  -  INSERT TIBIAL MEDIUM 13MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-116	SUP	HCPCS C1776		6637-0-116  -  INSERT TIBIAL MEDIUM 16MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-119	SUP	HCPCS C1776		6637-0-119  -  INSERT TIBIAL MEDIUM 19MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-122	SUP	HCPCS C1776		6637-0-122  -  INSERT TIBIAL MEDIUM 22MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-125	SUP	HCPCS C1776		6637-0-125  -  INSERT TIBIAL MEDIUM 25MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-128	SUP	HCPCS C1776		6637-0-128  -  INSERT TIBIAL MEDIUM 28MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-131	SUP	HCPCS C1776		6637-0-131  -  INSERT TIBIAL MEDIUM 31MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-209	SUP	HCPCS C1776		6637-0-209  -  INSERT TIBIAL LARGE 9MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-211	SUP	HCPCS C1776		6637-0-211  -  INSERT TIBIAL LARGE 11MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-213	SUP	HCPCS C1776		6637-0-213  -  INSERT TIBIAL LARGE 13MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-216	SUP	HCPCS C1776		6637-0-216  -  INSERT TIBIAL LARGE 16MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-219	SUP	HCPCS C1776		6637-0-219  -  INSERT TIBIAL LARGE 19MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-222	SUP	HCPCS C1776		6637-0-222  -  INSERT TIBIAL LARGE 22MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-225	SUP	HCPCS C1776		6637-0-225  -  INSERT TIBIAL LARGE 25MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-228	SUP	HCPCS C1776		6637-0-228  -  INSERT TIBIAL LARGE 28MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-231	SUP	HCPCS C1776		6637-0-231  -  INSERT TIBIAL LARGE 31MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-309	SUP	HCPCS C1776		6637-0-309  -  INSERT TIBIAL XL 9MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-311	SUP	HCPCS C1776		6637-0-311  -  INSERT TIBIAL XL 11MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-313	SUP	HCPCS C1776		6637-0-313  -  INSERT TIBIAL XL 13MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-316	SUP	HCPCS C1776		6637-0-316  -  INSERT TIBIAL XL 16MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-319	SUP	HCPCS C1776		6637-0-319  -  INSERT TIBIAL XL 19MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-322	SUP	HCPCS C1776		6637-0-322  -  INSERT TIBIAL XL 22MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-325	SUP	HCPCS C1776		6637-0-325  -  INSERT TIBIAL XL 25MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-328	SUP	HCPCS C1776		6637-0-328  -  INSERT TIBIAL XL 28MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-331	SUP	HCPCS C1776		6637-0-331  -  INSERT TIBIAL XL 31MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-609	SUP	HCPCS C1776		6637-0-609  -  INSERT TIBIAL SMALL 9MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-611	SUP	HCPCS C1776		6637-0-611  -  INSERT TIBIAL SMALL 11MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-613	SUP	HCPCS C1776		6637-0-613  -  INSERT TIBIAL SMALL 13MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-616	SUP	HCPCS C1776		6637-0-616  -  INSERT TIBIAL SMALL 16MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-619	SUP	HCPCS C1776		6637-0-619  -  INSERT TIBIAL SMALL 19MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-622	SUP	HCPCS C1776		6637-0-622  -  INSERT TIBIAL SMALL 22MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-625	SUP	HCPCS C1776		6637-0-625  -  INSERT TIBIAL SMALL 25MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-628	SUP	HCPCS C1776		6637-0-628  -  INSERT TIBIAL SMALL 28MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-631	SUP	HCPCS C1776		6637-0-631  -  INSERT TIBIAL SMALL 31MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-709	SUP	HCPCS C1776		6637-0-709  -  INSERT TIBIAL MEDIUM 9MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-711	SUP	HCPCS C1776		6637-0-711  -  INSERT TIBIAL MEDIUM 11MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-713	SUP	HCPCS C1776		6637-0-713  -  INSERT TIBIAL MEDIUM 13MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-716	SUP	HCPCS C1776		6637-0-716  -  INSERT TIBIAL MEDIUM 16MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-719	SUP	HCPCS C1776		6637-0-719  -  INSERT TIBIAL MEDIUM 19MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-722	SUP	HCPCS C1776		6637-0-722  -  INSERT TIBIAL MEDIUM 22MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-725	SUP	HCPCS C1776		6637-0-725  -  INSERT TIBIAL MEDIUM 25MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-728	SUP	HCPCS C1776		6637-0-728  -  INSERT TIBIAL MEDIUM 28MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-731	SUP	HCPCS C1776		6637-0-731  -  INSERT TIBIAL MEDIUM 31MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-809	SUP	HCPCS C1776		6637-0-809  -  INSERT TIBIAL LARGE 9MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-811	SUP	HCPCS C1776		6637-0-811  -  INSERT TIBIAL LARGE 11MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-813	SUP	HCPCS C1776		6637-0-813  -  INSERT TIBIAL LARGE 13MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-816	SUP	HCPCS C1776		6637-0-816  -  INSERT TIBIAL LARGE 16MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-819	SUP	HCPCS C1776		6637-0-819  -  INSERT TIBIAL LARGE 16MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-822	SUP	HCPCS C1776		6637-0-822  -  INSERT TIBIAL LARGE 22MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-825	SUP	HCPCS C1776		6637-0-825  -  INSERT TIBIAL LARGE 25MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-828	SUP	HCPCS C1776		6637-0-828  -  INSERT TIBIAL LARGE 28MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-831	SUP	HCPCS C1776		6637-0-831  -  INSERT TIBIAL LARGE 31MM REVISION PCA DURACON KNEE LEFT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-909	SUP	HCPCS C1776		6637-0-909  -  INSERT TIBIAL XL 9MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-911	SUP	HCPCS C1776		6637-0-911  -  INSERT TIBIAL XL 11MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-913	SUP	HCPCS C1776		6637-0-913  -  INSERT TIBIAL XL 13MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-916	SUP	HCPCS C1776		6637-0-916  -  INSERT TIBIAL XL 16MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-919	SUP	HCPCS C1776		6637-0-919  -  INSERT TIBIAL XL 19MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-922	SUP	HCPCS C1776		6637-0-922  -  INSERT TIBIAL XL 22MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-925	SUP	HCPCS C1776		6637-0-925  -  INSERT TIBIAL XL 25MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-928	SUP	HCPCS C1776		6637-0-928  -  INSERT TIBIAL XL 28MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-0-931	SUP	HCPCS C1776		6637-0-931  -  INSERT TIBIAL XL 31MM REVISION PCA DURACON KNEE RIGHT	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-009	SUP	HCPCS C1776		6637-4-009  -  INSERT TIBIAL SMALL NEUTRAL 9MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-011	SUP	HCPCS C1776		6637-4-011  -  INSERT TIBIAL SMALL NEUTRAL 11MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-013	SUP	HCPCS C1776		6637-4-013  -  INSERT TIBIAL SMALL NEUTRAL 13MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-016	SUP	HCPCS C1776		6637-4-016  -  INSERT TIBIAL SMALL NEUTRAL 16MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-019	SUP	HCPCS C1776		6637-4-019  -  INSERT TIBIAL SMALL NEUTRAL 19MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-022	SUP	HCPCS C1776		6637-4-022  -  INSERT TIBIAL SMALL NEUTRAL 22MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-025	SUP	HCPCS C1776		6637-4-025  -  INSERT TIBIAL SMALL NEUTRAL 25MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-028	SUP	HCPCS C1776		6637-4-028  -  INSERT TIBIAL SMALL NEUTRAL 28MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-031	SUP	HCPCS C1776		6637-4-031  -  INSERT TIBIAL SMALL NEUTRAL 31MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-109	SUP	HCPCS C1776		6637-4-109  -  INSERT TIBIAL MEDIUM NEUTRAL 9MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-111	SUP	HCPCS C1776		6637-4-111  -  INSERT TIBIAL MEDIUM NEUTRAL 11MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-113	SUP	HCPCS C1776		6637-4-113  -  INSERT TIBIAL MEDIUM NEUTRAL 13MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-116	SUP	HCPCS C1776		6637-4-116  -  INSERT TIBIAL MEDIUM NEUTRAL 16MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-119	SUP	HCPCS C1776		6637-4-119  -  INSERT TIBIAL MEDIUM NEUTRAL 19MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-122	SUP	HCPCS C1776		6637-4-122  -  INSERT TIBIAL MEDIUM NEUTRAL 22MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-125	SUP	HCPCS C1776		6637-4-125  -  INSERT TIBIAL MEDIUM NEUTRAL 25MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-128	SUP	HCPCS C1776		6637-4-128  -  INSERT TIBIAL MEDIUM NEUTRAL 28MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-131	SUP	HCPCS C1776		6637-4-131  -  INSERT TIBIAL MEDIUM NEUTRAL 31MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-209	SUP	HCPCS C1776		6637-4-209  -  INSERT TIBIAL LARGE NEUTRAL 9MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-211	SUP	HCPCS C1776		6637-4-211  -  INSERT TIBIAL LARGE NEUTRAL 11MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-213	SUP	HCPCS C1776		6637-4-213  -  INSERT TIBIAL LARGE NEUTRAL 13MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-216	SUP	HCPCS C1776		6637-4-216  -  INSERT TIBIAL LARGE NEUTRAL 16MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-219	SUP	HCPCS C1776		6637-4-219  -  INSERT TIBIAL LARGE NEUTRAL 19MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-222	SUP	HCPCS C1776		6637-4-222  -  INSERT TIBIAL LARGE NEUTRAL 22MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-225	SUP	HCPCS C1776		6637-4-225  -  INSERT TIBIAL LARGE NEUTRAL 25MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-228	SUP	HCPCS C1776		6637-4-228  -  INSERT TIBIAL LARGE NEUTRAL 28MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-231	SUP	HCPCS C1776		6637-4-231  -  INSERT TIBIAL LARGE NEUTRAL 31MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-309	SUP	HCPCS C1776		6637-4-309  -  INSERT TIBIAL XL NEUTRAL 9MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-311	SUP	HCPCS C1776		6637-4-311  -  INSERT TIBIAL XL NEUTRAL 11MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-313	SUP	HCPCS C1776		6637-4-313  -  INSERT TIBIAL XL NEUTRAL 13MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-316	SUP	HCPCS C1776		6637-4-316  -  INSERT TIBIAL XL NEUTRAL 16MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-319	SUP	HCPCS C1776		6637-4-319  -  INSERT TIBIAL XL NEUTRAL 19MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-322	SUP	HCPCS C1776		6637-4-322  -  INSERT TIBIAL XL NEUTRAL 22MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-325	SUP	HCPCS C1776		6637-4-325  -  INSERT TIBIAL XL NEUTRAL 25MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-328	SUP	HCPCS C1776		6637-4-328  -  INSERT TIBIAL XL NEUTRAL 28MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6637-4-331	SUP	HCPCS C1776		6637-4-331  -  INSERT TIBIAL XL NEUTRAL 31MM REVISION PCA DURACON KNEE	BOTH IP/OP	"$5,517.50 "	"$4,082.95"	$0.00	"$4,414.00"	"$2,482.88"	"$2,482.88"	$0.00	$0.00	$0.00	"$1,149.98"	"$4,095.09"	"$4,095.09"	$0.00	$0.00	"$1,149.85"	$0.00	"$2,720.13"	"$2,720.13"	$0.00	"$2,758.75"	"$4,369.86"	"$4,414.00"	$0.00		$0.00	$863.49	$0.00	$0.00	$878.39	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-009	SUP	Custom 27803010		6642-1-009  -  INSERT TIB XS 9MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,214.00 "	$898.36	$0.00	$971.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.03	$901.03	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$607.00	$961.49	$971.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-011	SUP	Custom 27803010		6642-1-011  -  INSERT TIB XS 11MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,214.00 "	$898.36	$0.00	$971.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.03	$901.03	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$607.00	$961.49	$971.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-013	SUP	Custom 27803010		6642-1-013  -  INSERT TIB XS 13MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,214.00 "	$898.36	$0.00	$971.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.03	$901.03	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$607.00	$961.49	$971.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-016	SUP	Custom 27803010		6642-1-016  -  INSERT TIB XS 16MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,214.00 "	$898.36	$0.00	$971.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.03	$901.03	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$607.00	$961.49	$971.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-109	SUP	Custom 27803010		6642-1-109  -  INSERT TIB SM 9MM CNDYLR DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-111	SUP	Custom 27803010		6642-1-111  -  INSERT TIB SM 11MM CNDYLR DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-113	SUP	Custom 27803010		6642-1-113  -  INSERT TIB SM 13MM CNDYLR DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-116	SUP	Custom 27803010		6642-1-116  -  INSERT TIB SM 16MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-119	SUP	Custom 27803010		6642-1-119  -  INSERT TIB SM 19MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-209	SUP	Custom 27803010		6642-1-209  -  INSERT TIB MED 9MM CNDYLR DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-211	SUP	Custom 27803010		6642-1-211  -  INSERT TIB MED 11MM CNDYLR DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-213	SUP	Custom 27803010		6642-1-213  -  INSERT TIB MED 13MM CNDYLR DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-216	SUP	Custom 27803010		6642-1-216  -  INSERT TIB MED 16MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-219	SUP	Custom 27803010		6642-1-219  -  INSERT TIB MED 19MM CNDYLR KNEE DUR CNDYLR STAB DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-309	SUP	Custom 27803010		6642-1-309  -  INSERT TIB LG 9MM CNDYLR DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-311	SUP	Custom 27803010		6642-1-311  -  INSERT TIB LG 11MM CNDYLR DUR	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-313	SUP	Custom 27803010		6642-1-313  -  INSERT TIB LG 13MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-316	SUP	Custom 27803010		6642-1-316  -  INSERT TIB LG 16MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-319	SUP	Custom 27803010		6642-1-319  -  INSERT TIB LG 19MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,191.00 "	$881.34	$0.00	$952.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.96	$883.96	$0.00	$0.00	$248.20	$0.00	$0.00	$0.00	$0.00	$595.50	$943.27	$952.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-409	SUP	Custom 27803010		6642-1-409  -  INSERT TIB XL 9MM CNDYLR DUR DRCN	BOTH IP/OP	"$1,214.00 "	$898.36	$0.00	$971.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.03	$901.03	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$607.00	$961.49	$971.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-411	SUP	Custom 27803010		6642-1-411  -  INSERT TIB XL 11MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,214.00 "	$898.36	$0.00	$971.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.03	$901.03	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$607.00	$961.49	$971.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-413	SUP	Custom 27803010		6642-1-413  -  INSERT TIB XL 13MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,214.00 "	$898.36	$0.00	$971.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.03	$901.03	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$607.00	$961.49	$971.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-416	SUP	Custom 27803010		6642-1-416  -  INSERT TIB XL 16MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,214.00 "	$898.36	$0.00	$971.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.03	$901.03	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$607.00	$961.49	$971.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-419	SUP	Custom 27803010		6642-1-419  -  INSERT TIB XL 19MM CNDYLR KNEE DUR DRCN	BOTH IP/OP	"$1,214.00 "	$898.36	$0.00	$971.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.03	$901.03	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$607.00	$961.49	$971.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-509	SUP	Custom 27803010		6642-1-509  -  INSERT TIBIAL XS 9MM ANTERIOR/POSTERIOR LIPPED DURACON DUR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-511	SUP	Custom 27803010		6642-1-511  -  INSERT TIBIAL XS 11MM ANTERIOR/POSTERIOR LIPPED DURACON DUR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-513	SUP	Custom 27803010		6642-1-513  -  INSERT TIBIAL XS 13MM ANTERIOR/POSTERIOR LIPPED DURACON DUR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-516	SUP	Custom 27803010		6642-1-516  -  INSERT TIBIAL XS 16MM ANTERIOR/POSTERIOR LIPPED DURACON DUR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-609	SUP	Custom 27803010		6642-1-609  -  INSERT TIBIAL SMALL 9MM DURACON DUR ANTERIOR POSTERIOR KNEE	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-611	SUP	Custom 27803010		6642-1-611  -  INSERT TIBIAL SMALL 11MM LIPPED REVISION RECONSTRUCTION	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-613	SUP	Custom 27803010		6642-1-613  -  INSERT TIBIAL SMALL 13MM DURACON DUR ANTERIOR POSTERIOR KNEE	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-616	SUP	Custom 27803010		6642-1-616  -  INSERT TIBIAL SMALL 16MM DURACON DUR ANTERIOR POSTERIOR KNEE	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-619	SUP	Custom 27803010		6642-1-619  -  INSERT TIBIAL SMALL 19MM DURACON DUR KNEE ANTERIOR POSTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-622	SUP	Custom 27803010		6642-1-622  -  INSERT TIBIAL SMALL 22MM LIP DURACON DUR KNEE	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-625	SUP	Custom 27803010		6642-1-625  -  INSERT TIBIAL SMALL 25MM DURACON DUR KNEE ANTERIOR POSTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-709	SUP	Custom 27803010		6642-1-709  -  INSERT TIBIAL MEDIUM 9MM LIPPED DURACON DUR ANTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-711	SUP	Custom 27803010		6642-1-711  -  INSERT TIBIAL MEDIUM 11MM DURACON DUR ANTERIOR POSTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-713	SUP	Custom 27803010		6642-1-713  -  INSERT TIBIAL MEDIUM 13MM DURACON DUR ANTERIOR POSTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-716	SUP	Custom 27803010		6642-1-716  -  INSERT TIBIAL MEDIUM 16MM LIPPED REVISION RECONSTRUCTION	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-719	SUP	Custom 27803010		6642-1-719  -  INSERT TIBIAL MEDIUM 19MM DURACON DUR ANTERIOR POSTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-722	SUP	Custom 27803010		6642-1-722  -  INSERT TIBIAL MEDIUM 22MM DURACON DUR KNEE ANTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-725	SUP	Custom 27803010		6642-1-725  -  INSERT TIBIAL MEDIUM 25MM DURACON DUR KNEE ANTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-809	SUP	Custom 27803010		6642-1-809  -  INSERT TIBIAL LARGE 9MM DURACON DUR ANTERIOR POSTERIOR KNEE	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-811	SUP	Custom 27803010		6642-1-811  -  INSERT TIBIAL LARGE 11MM DURACON DUR ANTERIOR POSTERIOR KNEE	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-813	SUP	Custom 27803010		6642-1-813  -  INSERT TIBIAL LARGE 13MM LIPPED REVISION RECONSTRUCTION	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-816	SUP	Custom 27803010		6642-1-816  -  INSERT TIBIAL LARGE 16MM LIPPED REVISION RECONSTRUCTION	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-819	SUP	Custom 27803010		6642-1-819  -  INSERT TIBIAL LARGE 19MM DURACON DUR KNEE ANTERIOR POSTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-822	SUP	Custom 27803010		6642-1-822  -  INSERT TIBIAL LARGE 22MM DURACON DUR KNEE ANTERIOR POSTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-825	SUP	Custom 27803010		6642-1-825  -  INSERT TIBIAL LARGE 25MM DURACON DUR KNEE ANTERIOR POSTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-909	SUP	Custom 27803010		6642-1-909  -  INSERT TIBIAL XL 9MM LIPPED REVISION RECONSTRUCTION DURACON	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-911	SUP	Custom 27803010		6642-1-911  -  INSERT TIBIAL XL 11MM DURACON DUR ANTERIOR POSTERIOR KNEE	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-913	SUP	Custom 27803010		6642-1-913  -  INSERT TIBIAL XL 13MM DURACON DUR ANTERIOR POSTERIOR KNEE	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-916	SUP	Custom 27803010		6642-1-916  -  INSERT TIBIAL XL 16MM DURACON DUR ANTERIOR POSTERIOR KNEE	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-919	SUP	Custom 27803010		6642-1-919  -  INSERT TIBIAL XL 19MM DURACON DUR KNEE ANTERIOR POSTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-922	SUP	Custom 27803010		6642-1-922  -  INSERT TIBIAL XL 22MM DURACON DUR KNEE ANTERIOR POSTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-1-925	SUP	Custom 27803010		6642-1-925  -  INSERT TIBIAL XL 25MM DURACON DUR KNEE ANTERIOR POSTERIOR	BOTH IP/OP	"$1,917.50 "	"$1,418.95"	$0.00	"$1,534.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,423.17"	"$1,423.17"	$0.00	$0.00	$399.61	$0.00	$0.00	$0.00	$0.00	$958.75	"$1,518.66"	"$1,534.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-040	SUP	Custom 27803010		6642-2-040  -  COMPONENT PATLR XS 29MM HDPE RESIN KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-050	SUP	Custom 27803010		6642-2-050  -  COMPONENT PATLR SMALL 32MM HDPE RESIN KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-100	SUP	Custom 27803010		6642-2-100  -  COMPONENT PATLR MEDIUM 35MM HDPE RESIN KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-140	SUP	Custom 27803010		6642-2-140  -  CMPNT PATLR 33MM MTLBLK DRCN DUR	BOTH IP/OP	"$1,316.00 "	$973.84	$0.00	"$1,052.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$976.74	$976.74	$0.00	$0.00	$274.25	$0.00	$0.00	$0.00	$0.00	$658.00	"$1,042.27"	"$1,052.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-145	SUP	Custom 27803010		6642-2-145  -  CMPNT PATLR 33MM DRCN	BOTH IP/OP	"$1,571.00 "	"$1,162.54"	$0.00	"$1,256.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,166.00"	"$1,166.00"	$0.00	$0.00	$327.40	$0.00	$0.00	$0.00	$0.00	$785.50	"$1,244.23"	"$1,256.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-150	SUP	Custom 27803010		6642-2-150  -  COMPONENT PATLR LARGE 11MM DURACON DUR ALL POLY KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-200	SUP	Custom 27803010		6642-2-200  -  COMPONENT PATLR XL 11MM DURACON DUR ALL POLY KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-300	SUP	Custom 27803010		6642-2-300  -  CMPNT PATLR SM MTLBLK DRCN DUR	BOTH IP/OP	"$1,316.00 "	$973.84	$0.00	"$1,052.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$976.74	$976.74	$0.00	$0.00	$274.25	$0.00	$0.00	$0.00	$0.00	$658.00	"$1,042.27"	"$1,052.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-350	SUP	Custom 27803010		6642-2-350  -  CMPNT PATLR MED MTLBLK DRCN DUR	BOTH IP/OP	"$1,316.00 "	$973.84	$0.00	"$1,052.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$976.74	$976.74	$0.00	$0.00	$274.25	$0.00	$0.00	$0.00	$0.00	$658.00	"$1,042.27"	"$1,052.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-400	SUP	Custom 27803010		6642-2-400  -  CMPNT PATLR LG ASYM MTLBLK DRCN DUR	BOTH IP/OP	"$1,316.00 "	$973.84	$0.00	"$1,052.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$976.74	$976.74	$0.00	$0.00	$274.25	$0.00	$0.00	$0.00	$0.00	$658.00	"$1,042.27"	"$1,052.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-600	SUP	Custom 27803010		6642-2-600  -  INSERT TIBIAL 8MM 27MM SYMMETRIC DURACON DUR	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-610	SUP	Custom 27803010		6642-2-610  -  INSERT TIBIAL 8MM 29MM SYMMETRIC DURACON DUR	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-620	SUP	Custom 27803010		6642-2-620  -  COMPONENT PATLR 31MM 9MM SYMMETRIC DURACON DUR	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-626	SUP	Custom 27203010		6642-2-626  -  TRIAL SURG 25MM 10MM INSET DURACON DUR PATELLA	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-627	SUP	Custom 27803010		6642-2-627  -  COMPONENT PATLR 27MM 10MM SYMMETRIC DURACON DUR KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-629	SUP	Custom 27803010		6642-2-629  -  COMPONENT PATLR 29MM 10MM INSET DURACON DUR	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-630	SUP	Custom 27803010		6642-2-630  -  INSERT TIBIAL 9MM 33MM SYMMETRIC DURACON DUR KNEE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-631	SUP	Custom 27803010		6642-2-631  -  COMPONENT PATLR 31MM 10MM SYMMETRIC DURACON DUR	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-633	SUP	Custom 27803010		6642-2-633  -  COMPONENT PATLR 33MM 10MM INSET DURACON DUR	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-640	SUP	Custom 27803010		6642-2-640  -  COMPONENT PATLR 36MM 10MM SYMMETRIC DURACON DUR	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-645	SUP	Custom 27803010		6642-2-645  -  INSERT TIBIAL 11MM 39MM SYMMETRIC DURACON DUR	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-700	SUP	Custom 27803010		6642-2-700  -  CMPNT PATLR SM CNVR DRCN DUR	BOTH IP/OP	"$1,634.00 "	"$1,209.16"	$0.00	"$1,307.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,212.75"	"$1,212.75"	$0.00	$0.00	$340.53	$0.00	$0.00	$0.00	$0.00	$817.00	"$1,294.13"	"$1,307.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-705	SUP	Custom 27803010		6642-2-705  -  CMPNT PATLR MED CNVR DRCN DUR	BOTH IP/OP	"$1,634.00 "	"$1,209.16"	$0.00	"$1,307.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,212.75"	"$1,212.75"	$0.00	$0.00	$340.53	$0.00	$0.00	$0.00	$0.00	$817.00	"$1,294.13"	"$1,307.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-710	SUP	Custom 27803010		6642-2-710  -  CMPNT PATLR LG CNVX DRCN DUR	BOTH IP/OP	"$1,634.00 "	"$1,209.16"	$0.00	"$1,307.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,212.75"	"$1,212.75"	$0.00	$0.00	$340.53	$0.00	$0.00	$0.00	$0.00	$817.00	"$1,294.13"	"$1,307.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-715	SUP	Custom 27803010		6642-2-715  -  CMPNT PATLR XL CNVX DRCN DUR UHMWPE	BOTH IP/OP	"$1,634.00 "	"$1,209.16"	$0.00	"$1,307.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,212.75"	"$1,212.75"	$0.00	$0.00	$340.53	$0.00	$0.00	$0.00	$0.00	$817.00	"$1,294.13"	"$1,307.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-720	SUP	Custom 27803010		6642-2-720  -  INSERT TIB SM 20MM KNEE DUR CNVX DRCN 7MM	BOTH IP/OP	$677.00 	$500.98	$0.00	$541.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.47	$502.47	$0.00	$0.00	$141.09	$0.00	$0.00	$0.00	$0.00	$338.50	$536.18	$541.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-725	SUP	Custom 27803010		6642-2-725  -  INSERT TIB MED 25MM KNEE DUR CNVX DRCN 7MM	BOTH IP/OP	$677.00 	$500.98	$0.00	$541.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.47	$502.47	$0.00	$0.00	$141.09	$0.00	$0.00	$0.00	$0.00	$338.50	$536.18	$541.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-730	SUP	Custom 27803010		6642-2-730  -  INSERT TIB LG 30MM KNEE DUR CNVX DRCN 7MM	BOTH IP/OP	$677.00 	$500.98	$0.00	$541.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.47	$502.47	$0.00	$0.00	$141.09	$0.00	$0.00	$0.00	$0.00	$338.50	$536.18	$541.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-735	SUP	Custom 27803010		6642-2-735  -  INSERT TIB XL 35MM KNEE DUR CNVX DRCN 7MM	BOTH IP/OP	$677.00 	$500.98	$0.00	$541.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.47	$502.47	$0.00	$0.00	$141.09	$0.00	$0.00	$0.00	$0.00	$338.50	$536.18	$541.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-740	SUP	Custom 27803010		6642-2-740  -  CMPNT PATLR SM DRCN	BOTH IP/OP	"$1,768.00 "	"$1,308.32"	$0.00	"$1,414.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,312.21"	"$1,312.21"	$0.00	$0.00	$368.45	$0.00	$0.00	$0.00	$0.00	$884.00	"$1,400.26"	"$1,414.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-745	SUP	Custom 27803010		6642-2-745  -  CMPNT PATLR MED DRCN	BOTH IP/OP	"$1,842.00 "	"$1,363.08"	$0.00	"$1,473.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,367.13"	"$1,367.13"	$0.00	$0.00	$383.87	$0.00	$0.00	$0.00	$0.00	$921.00	"$1,458.86"	"$1,473.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-750	SUP	Custom 27803010		6642-2-750  -  CMPNT PATLR ASYM DUR	BOTH IP/OP	"$1,842.00 "	"$1,363.08"	$0.00	"$1,473.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,367.13"	"$1,367.13"	$0.00	$0.00	$383.87	$0.00	$0.00	$0.00	$0.00	$921.00	"$1,458.86"	"$1,473.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-2-755	SUP	Custom 27803010		6642-2-755  -  CMPNT PATLR XL DRCN	BOTH IP/OP	"$1,842.00 "	"$1,363.08"	$0.00	"$1,473.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,367.13"	"$1,367.13"	$0.00	$0.00	$383.87	$0.00	$0.00	$0.00	$0.00	$921.00	"$1,458.86"	"$1,473.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-111	SUP	HCPCS C1776		6642-5-111  -  INSERT TIBIAL SMALL 11MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-113	SUP	HCPCS C1776		6642-5-113  -  INSERT TIBIAL SMALL 13MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-116	SUP	HCPCS C1776		6642-5-116  -  INSERT TIBIAL SMALL 16MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-119	SUP	HCPCS C1776		6642-5-119  -  INSERT TIBIAL SMALL 19MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-122	SUP	HCPCS C1776		6642-5-122  -  INSERT TIBIAL SMALL 22MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-125	SUP	HCPCS C1776		6642-5-125  -  INSERT TIBIAL SMALL 25MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-128	SUP	HCPCS C1776		6642-5-128  -  INSERT TIBIAL SMALL 28MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-131	SUP	HCPCS C1776		6642-5-131  -  INSERT TIBIAL SMALL 31MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-211	SUP	HCPCS C1776		6642-5-211  -  INSERT TIBIAL MEDIUM 11MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-213	SUP	HCPCS C1776		6642-5-213  -  INSERT TIBIAL MEDIUM 13MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-216	SUP	HCPCS C1776		6642-5-216  -  INSERT TIBIAL MEDIUM 16MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-219	SUP	HCPCS C1776		6642-5-219  -  INSERT TIBIAL MEDIUM 19MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-222	SUP	HCPCS C1776		6642-5-222  -  INSERT TIBIAL MEDIUM 22MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-225	SUP	HCPCS C1776		6642-5-225  -  INSERT TIBIAL MEDIUM 25MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-228	SUP	HCPCS C1776		6642-5-228  -  INSERT TIBIAL MEDIUM 28MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-231	SUP	HCPCS C1776		6642-5-231  -  INSERT TIBIAL MEDIUM 31MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-311	SUP	HCPCS C1776		6642-5-311  -  INSERT TIBIAL LARGE 11MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-313	SUP	HCPCS C1776		6642-5-313  -  INSERT TIBIAL LARGE 13MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-316	SUP	HCPCS C1776		6642-5-316  -  INSERT TIBIAL LARGE 16MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-319	SUP	HCPCS C1776		6642-5-319  -  INSERT TIBIAL LARGE 19MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-322	SUP	HCPCS C1776		6642-5-322  -  INSERT TIBIAL LARGE 22MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-325	SUP	HCPCS C1776		6642-5-325  -  INSERT TIBIAL LARGE 25MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-328	SUP	HCPCS C1776		6642-5-328  -  INSERT TIBIAL LARGE 28MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-331	SUP	HCPCS C1776		6642-5-331  -  INSERT TIBIAL LARGE 31MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-411	SUP	HCPCS C1776		6642-5-411  -  INSERT TIBIAL XL 11MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-413	SUP	HCPCS C1776		6642-5-413  -  INSERT TIBIAL XL 13MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-416	SUP	HCPCS C1776		6642-5-416  -  INSERT TIBIAL XL 16MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-419	SUP	HCPCS C1776		6642-5-419  -  INSERT TIBIAL XL 19MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-422	SUP	HCPCS C1776		6642-5-422  -  INSERT TIBIAL XL 22MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-425	SUP	HCPCS C1776		6642-5-425  -  INSERT TIBIAL XL 25MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-428	SUP	HCPCS C1776		6642-5-428  -  INSERT TIBIAL XL 28MM TOT STABILIZED DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-5-431	SUP	HCPCS C1776		6642-5-431  -  INSERT TIBIAL XL 31MM TOT STABILIZE DURACON DUR KNEE	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-009	SUP	Custom 27803010		6642-9-009  -  INSERT TIB XS STD 9MM KNEE DUR DRCN	BOTH IP/OP	"$2,075.13 "	"$1,535.60"	$0.00	"$1,660.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,540.16"	"$1,540.16"	$0.00	$0.00	$432.46	$0.00	$0.00	$0.00	$0.00	"$1,037.56"	"$1,643.50"	"$1,660.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-011	SUP	HCPCS C1776		6642-9-011  -  INSERT TIB XS STD 11MM KNEE DUR DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-013	SUP	HCPCS C1776		6642-9-013  -  INSERT TIB XS STD 13MM KNEE DUR DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-016	SUP	HCPCS C1776		6642-9-016  -  INSERT TIB XS STD 16MM KNEE DUR DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-019	SUP	HCPCS C1776		6642-9-019  -  INSERT TIB XS STD 19MM KNEE DUR DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-109	SUP	HCPCS C1776		6642-9-109  -  INSERT TIB STD SM 9MM KNEE DUR TOT STAB DRCN OTHR	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-111	SUP	HCPCS C1776		6642-9-111  -  INSERT TIB SM STD 11MM KNEE DUR TOT STAB DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-113	SUP	HCPCS C1776		6642-9-113  -  INSERT TIB SM STD 13MM KNEE DUR TOT STAB DRCN OTHR	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-116	SUP	HCPCS C1776		6642-9-116  -  INSERT TIB SM STD 16MM KNEE DUR TOT STAB DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-119	SUP	HCPCS C1776		6642-9-119  -  INSERT TIB STD SM 19MM KNEE DUR TOT STAB DRCN OTHR	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-209	SUP	HCPCS C1776		6642-9-209  -  INSERT TIB STD MED 9MM KNEE DUR DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-211	SUP	HCPCS C1776		6642-9-211  -  INSERT TIB MED 11MM KNEE DUR STD DRCN 11MM	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-213	SUP	HCPCS C1776		6642-9-213  -  INSERT TIB MED 13MM KNEE DUR DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-216	SUP	HCPCS C1776		6642-9-216  -  INSERT TIB STD MED 16MM KNEE DUR OTHR INS DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-219	SUP	HCPCS C1776		6642-9-219  -  INSERT TIB STD 19MM KNEE DUR DRCN 4 016	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-309	SUP	HCPCS C1776		6642-9-309  -  INSERT TIB STD 9MM KNEE DUR DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-311	SUP	HCPCS C1776		6642-9-311  -  INSERT TIB STD 11MM LEG DUR DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-313	SUP	HCPCS C1776		6642-9-313  -  INSERT TIB LG 13MM KNEE COCR CNDYLR STAB LIP DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-316	SUP	HCPCS C1776		6642-9-316  -  INSERT TIB STD LG 16MM KNEE DUR DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-319	SUP	HCPCS C1776		6642-9-319  -  INSERT TIB STD 19MM KNEE DUR DRCN	BOTH IP/OP	"$5,026.13 "	"$3,719.34"	$0.00	"$4,020.90"	"$2,261.76"	"$2,261.76"	$0.00	$0.00	$0.00	"$1,047.57"	"$3,730.39"	"$3,730.39"	$0.00	$0.00	"$1,047.44"	$0.00	"$2,477.88"	"$2,477.88"	$0.00	"$2,513.06"	"$3,980.69"	"$4,020.90"	$0.00		$0.00	$786.59	$0.00	$0.00	$800.16	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-609	SUP	Custom 27803010		6642-9-609  -  INSERT TIBIAL SMALL 9MM CONSTRAIN DURACON DUR KNEE OTHER	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-611	SUP	Custom 27803010		6642-9-611  -  INSERT TIBIAL SMALL 11MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-613	SUP	Custom 27803010		6642-9-613  -  INSERT TIBIAL SMALL 13MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-616	SUP	Custom 27803010		6642-9-616  -  INSERT TIBIAL SMALL 16MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-619	SUP	Custom 27803010		6642-9-619  -  INSERT TIBIAL SMALL 19MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-622	SUP	Custom 27803010		6642-9-622  -  INSERT TIBIAL SMALL 22MM CONSTRAIN DURACON DUR KNEE OTHER	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-625	SUP	Custom 27803010		6642-9-625  -  INSERT TIBIAL SMALL 25MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-709	SUP	Custom 27803010		6642-9-709  -  INSERT TIBIAL MEDIUM 9MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-711	SUP	HCPCS C1776		6642-9-711  -  INSERT TIBIAL MEDIUM 11MM CONSTRAIN DURACON DUR KNEE OTHER	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	"$2,286.00"	"$2,286.00"	$0.00	$0.00	$0.00	"$1,058.80"	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	"$2,504.44"	"$2,504.44"	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$795.02	$0.00	$0.00	$808.74	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-713	SUP	Custom 27803010		6642-9-713  -  INSERT TIBIAL MEDIUM 13MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-716	SUP	Custom 27803010		6642-9-716  -  INSERT TIBIAL MEDIUM 16MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-719	SUP	Custom 27803010		6642-9-719  -  INSERT TIBIAL MEDIUM 19MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-722	SUP	Custom 27803010		6642-9-722  -  INSERT TIBIAL MEDIUM 22MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-725	SUP	Custom 27803010		6642-9-725  -  INSERT TIBIAL MEDIUM 25MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-809	SUP	Custom 27803010		6642-9-809  -  INSERT TIBIAL LARGE 9MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-811	SUP	Custom 27803010		6642-9-811  -  INSERT TIBIAL LARGE 11MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-813	SUP	Custom 27803010		6642-9-813  -  INSERT TIBIAL LARGE 13MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-816	SUP	Custom 27803010		6642-9-816  -  INSERT TIBIAL LARGE 16MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-819	SUP	Custom 27803010		6642-9-819  -  INSERT TIBIAL LARGE 19MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-822	SUP	Custom 27803010		6642-9-822  -  INSERT TIBIAL LARGE 22MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6642-9-825	SUP	Custom 27803010		6642-9-825  -  INSERT TIBIAL LARGE 25MM CONSTRAIN DURACON DUR KNEE	BOTH IP/OP	"$5,080.00 "	"$3,759.20"	$0.00	"$4,064.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,770.38"	"$3,770.38"	$0.00	$0.00	"$1,058.67"	$0.00	$0.00	$0.00	$0.00	"$2,540.00"	"$4,023.36"	"$4,064.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6647-1-018	SUP	HCPCS C1776		6647-1-018  -  CMPNT FEM CMPR WCHT 18MM	BOTH IP/OP	"$7,213.38 "	"$5,337.90"	$0.00	"$5,770.70"	"$3,246.02"	"$3,246.02"	$0.00	$0.00	$0.00	"$1,503.45"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,503.27"	$0.00	"$3,556.19"	"$3,556.19"	$0.00	"$3,606.69"	"$5,713.00"	"$5,770.70"	$0.00		$0.00	"$1,128.89"	$0.00	$0.00	"$1,148.37"	$0.00	$0.00	$0.00	$0.00	$0.00
6647-2-012	SUP	HCPCS C1713		6647-2-012  -  NAIL 12MM HUM TIB WCHT IM	BOTH IP/OP	"$5,000.13 "	"$3,700.10"	$0.00	"$4,000.10"	"$2,250.06"	"$2,250.06"	$0.00	$0.00	$0.00	"$1,042.15"	"$3,711.09"	"$3,711.09"	$0.00	$0.00	"$1,042.03"	$0.00	"$2,465.06"	"$2,465.06"	$0.00	"$2,500.06"	"$3,960.10"	"$4,000.10"	$0.00		$0.00	$782.52	$0.00	$0.00	$796.02	$0.00	$0.00	$0.00	$0.00	$0.00
6647-3-000	SUP	HCPCS C1713		6647-3-000  -  SCREW BONE WCHT FULTHD KNEE CMPR FSN NAIL	BOTH IP/OP	"$3,519.75 "	"$2,604.62"	$0.00	"$2,815.80"	"$1,583.89"	"$1,583.89"	$0.00	$0.00	$0.00	$733.60	"$2,612.36"	"$2,612.36"	$0.00	$0.00	$733.52	$0.00	"$1,735.24"	"$1,735.24"	$0.00	"$1,759.88"	"$2,787.64"	"$2,815.80"	$0.00		$0.00	$550.84	$0.00	$0.00	$560.34	$0.00	$0.00	$0.00	$0.00	$0.00
6647-3-125	SUP	HCPCS C1713		6647-3-125  -  SCREW BONE 6MM 25MM WCHT FULTHD ORTH SLFTAP	BOTH IP/OP	$494.00 	$365.56	$0.00	$395.20	$222.30	$222.30	$0.00	$0.00	$0.00	$102.96	$366.65	$366.65	$0.00	$0.00	$102.95	$0.00	$292.20	$292.20	$0.00	$247.00	$391.25	$395.20	$0.00		$0.00	$77.31	$0.00	$0.00	$78.64	$0.00	$0.00	$0.00	$0.00	$0.00
6647-3-130	SUP	HCPCS C1713		6647-3-130  -  SCREW BONE 6MM 30MM WCHT FULTHD KNEE CMPR FSN NAIL	BOTH IP/OP	$500.50 	$370.37	$0.00	$400.40	$225.23	$225.23	$0.00	$0.00	$0.00	$104.32	$371.47	$371.47	$0.00	$0.00	$104.30	$0.00	$296.05	$296.05	$0.00	$250.25	$396.40	$400.40	$0.00		$0.00	$78.33	$0.00	$0.00	$79.68	$0.00	$0.00	$0.00	$0.00	$0.00
6647-3-135	SUP	HCPCS C1713		6647-3-135  -  SCREW BONE 6MM 35MM WCHT FULTHRD IM NAIL	BOTH IP/OP	$500.50 	$370.37	$0.00	$400.40	$225.23	$225.23	$0.00	$0.00	$0.00	$104.32	$371.47	$371.47	$0.00	$0.00	$104.30	$0.00	$296.05	$296.05	$0.00	$250.25	$396.40	$400.40	$0.00		$0.00	$78.33	$0.00	$0.00	$79.68	$0.00	$0.00	$0.00	$0.00	$0.00
6647-3-140	SUP	HCPCS C1713		6647-3-140  -  SCREW BONE 6MM 40MM WCHT FULTHD KNEE CMPR FSN NAIL	BOTH IP/OP	$500.50 	$370.37	$0.00	$400.40	$225.23	$225.23	$0.00	$0.00	$0.00	$104.32	$371.47	$371.47	$0.00	$0.00	$104.30	$0.00	$296.05	$296.05	$0.00	$250.25	$396.40	$400.40	$0.00		$0.00	$78.33	$0.00	$0.00	$79.68	$0.00	$0.00	$0.00	$0.00	$0.00
6647-3-145	SUP	HCPCS C1713		6647-3-145  -  SCREW BONE 6MM 45MM WCHT FULTHD KNEE CMPR FSN NAIL	BOTH IP/OP	$500.50 	$370.37	$0.00	$400.40	$225.23	$225.23	$0.00	$0.00	$0.00	$104.32	$371.47	$371.47	$0.00	$0.00	$104.30	$0.00	$296.05	$296.05	$0.00	$250.25	$396.40	$400.40	$0.00		$0.00	$78.33	$0.00	$0.00	$79.68	$0.00	$0.00	$0.00	$0.00	$0.00
6647-3-150	SUP	HCPCS C1713		6647-3-150  -  SCREW BONE 6MM 50MM WCHT FULTHD KNEE CMPR FSN NAIL	BOTH IP/OP	$500.50 	$370.37	$0.00	$400.40	$225.23	$225.23	$0.00	$0.00	$0.00	$104.32	$371.47	$371.47	$0.00	$0.00	$104.30	$0.00	$296.05	$296.05	$0.00	$250.25	$396.40	$400.40	$0.00		$0.00	$78.33	$0.00	$0.00	$79.68	$0.00	$0.00	$0.00	$0.00	$0.00
6647-3-155	SUP	HCPCS C1713		6647-3-155  -  SCREW BONE 6MM 55MM WCHT FULTHD KNEE FSN NAIL	BOTH IP/OP	$500.50 	$370.37	$0.00	$400.40	$225.23	$225.23	$0.00	$0.00	$0.00	$104.32	$371.47	$371.47	$0.00	$0.00	$104.30	$0.00	$296.05	$296.05	$0.00	$250.25	$396.40	$400.40	$0.00		$0.00	$78.33	$0.00	$0.00	$79.68	$0.00	$0.00	$0.00	$0.00	$0.00
6647-3-160	SUP	HCPCS C1713		6647-3-160  -  SCREW BONE 6MM 60MM WCHT FULTHD KNEE FSN NAIL	BOTH IP/OP	$500.50 	$370.37	$0.00	$400.40	$225.23	$225.23	$0.00	$0.00	$0.00	$104.32	$371.47	$371.47	$0.00	$0.00	$104.30	$0.00	$296.05	$296.05	$0.00	$250.25	$396.40	$400.40	$0.00		$0.00	$78.33	$0.00	$0.00	$79.68	$0.00	$0.00	$0.00	$0.00	$0.00
670000B	SUP	HCPCS C1713		670000B  -  SCREW BONE 6.5MM 30MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670001B	SUP	HCPCS C1713		670001B  -  SCREW BONE 6.5MM 35MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670002B	SUP	HCPCS C1713		670002B  -  SCREW BONE 6.5MM 40MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670003B	SUP	HCPCS C1713		670003B  -  SCREW BONE 6.5MM 45MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670004B	SUP	HCPCS C1713		670004B  -  SCREW BONE 6.5MM 50MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670005B	SUP	HCPCS C1713		670005B  -  SCREW BONE 7.5MM 35MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670006B	SUP	HCPCS C1713		670006B  -  SCREW BONE 7.5MM 40MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670007B	SUP	HCPCS C1713		670007B  -  SCREW BONE 7.5MM 45MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670008B	SUP	HCPCS C1713		670008B  -  SCREW BONE 7.5MM 50MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670009B	SUP	HCPCS C1713		670009B  -  SCREW BONE 7.5MM 55MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670010B	SUP	HCPCS C1713		670010B  -  SCREW BONE 7.5MM 60MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670015B	SUP	HCPCS C1713		670015B  -  SCREW BONE 6.5MM 55MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670016B	SUP	HCPCS C1713		670016B  -  SCREW BONE 6.5MM 60MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670017B	SUP	HCPCS C1713		670017B  -  SCREW BONE 7.5MM 30MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670-044-00	SUP	HCPCS C1887		CATHETER GUID AL 1ST TIP SHP 6FR .070IN 100CM PTFE VSBR BLUE	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
670061B	SUP	HCPCS C1713		670061B  -  SCREW BONE 5.5MM 30MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670062B	SUP	HCPCS C1713		670062B  -  SCREW BONE 5.5MM 35MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670063B	SUP	HCPCS C1713		670063B  -  SCREW BONE 5.5MM 40MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670070B	SUP	HCPCS C1713		670070B  -  SCREW BONE 6.5MM 30MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670071B	SUP	HCPCS C1713		670071B  -  SCREW BONE 6.5MM 35MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670072B	SUP	HCPCS C1713		670072B  -  SCREW BONE 6.5MM 40MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670073B	SUP	HCPCS C1713		670073B  -  SCREW BONE 6.5MM 45MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670074B	SUP	HCPCS C1713		670074B  -  SCREW BONE 6.5MM 50MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670075B	SUP	HCPCS C1713		670075B  -  SCREW BONE 6.5MM 55MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670076B	SUP	HCPCS C1713		670076B  -  SCREW BONE 6.5MM 60MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670080B	SUP	HCPCS C1713		670080B  -  SCREW BONE 7.5MM 30MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670081B	SUP	HCPCS C1713		670081B  -  SCREW BONE 7.5MM 35MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670082B	SUP	HCPCS C1713		670082B  -  SCREW BONE 7.5MM 40MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670083B	SUP	HCPCS C1713		670083B  -  SCREW BONE 7.5MM 45MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670084B	SUP	HCPCS C1713		670084B  -  SCREW BONE 7.5MM 50MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670086B	SUP	HCPCS C1713		670086B  -  SCREW BONE 7.5MM 55MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670087B	SUP	HCPCS C1713		670087B  -  SCREW BONE 7.5MM 60MM OPUS LNG SPNL HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670-090-00	SUP	HCPCS C1887		CATHETER GUID JR4ST CURVE 6FR .070IN 100CM PTFE VSBR BLUE	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
670110B	SUP	HCPCS C1713		670110B  -  SCREW BONE 9MM 30MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670111B	SUP	HCPCS C1713		670111B  -  SCREW BONE 9MM 35MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670112B	SUP	HCPCS C1713		670112B  -  SCREW BONE 9MM 40MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670113B	SUP	HCPCS C1713		670113B  -  SCREW BONE 9MM 45MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670114B	SUP	HCPCS C1713		670114B  -  SCREW BONE 9MM 50MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670115B	SUP	HCPCS C1713		670115B  -  SCREW BONE 9MM 55MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670116B	SUP	HCPCS C1713		670116B  -  SCREW BONE 9MM 60MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670212B	SUP	HCPCS C1713		670212B  -  SCREW BONE 5.5MM 30MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670213B	SUP	HCPCS C1713		670213B  -  SCREW BONE 5.5MM 35MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670214B	SUP	HCPCS C1713		670214B  -  SCREW BONE 5.5MM 40MM OPUS SPNL CYLND	BOTH IP/OP	"$1,556.83 "	"$1,152.05"	$0.00	"$1,245.46"	$700.57	$700.57	$0.00	$0.00	$0.00	$324.48	"$1,155.48"	"$1,155.48"	$0.00	$0.00	$324.44	$0.00	$920.86	$920.86	$0.00	$778.41	"$1,233.01"	"$1,245.46"	$0.00		$0.00	$243.64	$0.00	$0.00	$247.85	$0.00	$0.00	$0.00	$0.00	$0.00
670215B	SUP	HCPCS C1713		670215B  -  SCREW BONE 5.5MM 45MM OPUS THOR SPN	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670223C	SUP	HCPCS C1713		670223C  -  PLATE SHRT 3 HOLE OPUS BONE SPNL	BOTH IP/OP	"$2,772.18 "	"$2,051.41"	$0.00	"$2,217.74"	"$1,247.48"	"$1,247.48"	$0.00	$0.00	$0.00	$577.79	"$2,057.51"	"$2,057.51"	$0.00	$0.00	$577.72	$0.00	"$1,366.68"	"$1,366.68"	$0.00	"$1,386.09"	"$2,195.57"	"$2,217.74"	$0.00		$0.00	$433.85	$0.00	$0.00	$441.33	$0.00	$0.00	$0.00	$0.00	$0.00
670-26090	SUP	HCPCS C1887		CATHETER GUID STRG ENVOY 6FR .90CM	BOTH IP/OP	$785.00 	$580.90	$0.00	$628.00	$426.26	$426.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$392.50	$621.72	$628.00	$0.00		$0.00	$122.85	$0.00	$0.00	$124.97	$0.00	$0.00	$0.00	$0.00	$0.00
670300B	SUP	HCPCS C1713		670300B  -  SCREW BONE 6.5MM 30MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670301B	SUP	HCPCS C1713		670301B  -  SCREW BONE 6.5MM 35MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670302B	SUP	HCPCS C1713		670302B  -  SCREW BONE 6.5MM 40MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670303B	SUP	HCPCS C1713		670303B  -  SCREW BONE 6.5MM 45MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670304B	SUP	HCPCS C1713		670304B  -  SCREW BONE 6.5MM 50MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670305B	SUP	HCPCS C1713		670305B  -  SCREW BONE 6.5MM 55MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
6703-1-018	SUP	Custom 27203010		6703-1-018  -  WIRE SUT .032IN VIT 6 PER TUBE	BOTH IP/OP	$50.38 	$37.28	$0.00	$40.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.39	$37.39	$0.00	$0.00	$10.50	$0.00	$0.00	$0.00	$0.00	$25.19	$39.90	$40.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
670310B	SUP	HCPCS C1713		670310B  -  SCREW BONE 7.5MM 30MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670311B	SUP	HCPCS C1713		670311B  -  SCREW BONE 7.5MM 35MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670312B	SUP	HCPCS C1713		670312B  -  SCREW BONE 7.5MM 40MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670313B	SUP	HCPCS C1713		670313B  -  SCREW BONE 7.5MM 45MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670314B	SUP	HCPCS C1713		670314B  -  SCREW BONE 7.5MM 50MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670315B	SUP	HCPCS C1713		670315B  -  SCREW BONE 7.5MM 55MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670316B	SUP	HCPCS C1713		670316B  -  SCREW BONE 7.5MM 60MM OPUS SPNL LNG TOP CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
6703-2-120	SUP	Custom 27203010		6703-2-120  -  WIRE SUT .032IN VIT	BOTH IP/OP	$217.75 	$161.14	$0.00	$174.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.61	$161.61	$0.00	$0.00	$45.38	$0.00	$0.00	$0.00	$0.00	$108.88	$172.46	$174.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
670370B	SUP	HCPCS C1713		670370B  -  SCREW BONE 6.5MM 30MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670371B	SUP	HCPCS C1713		670371B  -  SCREW BONE 6.5MM 35MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670372B	SUP	HCPCS C1713		670372B  -  SCREW BONE 6.5MM 40MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670373B	SUP	HCPCS C1713		670373B  -  SCREW BONE 6.5MM 45MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670374B	SUP	HCPCS C1713		670374B  -  SCREW BONE 6.5MM 50MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670375B	SUP	HCPCS C1713		670375B  -  SCREW BONE 6.5MM 55MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670376B	SUP	HCPCS C1713		670376B  -  SCREW BONE 6.5MM 60MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670380B	SUP	HCPCS C1713		670380B  -  SCREW BONE 7.5MM 30MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670381B	SUP	HCPCS C1713		670381B  -  SCREW BONE 7.5MM 35MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670382B	SUP	HCPCS C1713		670382B  -  SCREW BONE 7.5MM 40MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670383B	SUP	HCPCS C1713		670383B  -  SCREW BONE 7.5MM 45MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670384B	SUP	HCPCS C1713		670384B  -  SCREW BONE 7.5MM 50MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670385B	SUP	HCPCS C1713		670385B  -  SCREW BONE 7.5MM 55MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
670386B	SUP	HCPCS C1713		670386B  -  SCREW BONE 7.5MM 60MM OPUS SPNL LNG TOP LNG HEX CYLND	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
6704-0-110	SUP	HCPCS C1713		6704-0-110  -  CABLE ORTHOPEDIC 2 1.6MM HOMOGENOUS GRIP DALL-MILES	BOTH IP/OP	"$2,022.50 "	"$1,496.65"	$0.00	"$1,618.00"	$910.13	$910.13	$0.00	$0.00	$0.00	$421.54	"$1,501.10"	"$1,501.10"	$0.00	$0.00	$421.49	$0.00	"$1,196.31"	"$1,196.31"	$0.00	"$1,011.25"	"$1,601.82"	"$1,618.00"	$0.00		$0.00	$316.52	$0.00	$0.00	$321.98	$0.00	$0.00	$0.00	$0.00	$0.00
6704-0-210	SUP	HCPCS C1713		6704-0-210  -  CABLE ORTHOPEDIC 2 2MM HOMOGENOUS GRIP DALL-MILES VITALLIUM	BOTH IP/OP	"$2,022.50 "	"$1,496.65"	$0.00	"$1,618.00"	$910.13	$910.13	$0.00	$0.00	$0.00	$421.54	"$1,501.10"	"$1,501.10"	$0.00	$0.00	$421.49	$0.00	"$1,196.31"	"$1,196.31"	$0.00	"$1,011.25"	"$1,601.82"	"$1,618.00"	$0.00		$0.00	$316.52	$0.00	$0.00	$321.98	$0.00	$0.00	$0.00	$0.00	$0.00
6704-0-310	SUP	HCPCS C1713		6704-0-310  -  CABLE ORTHOPEDIC 2 LARGE 2MM 22MM GRIP DALL-MILES VITALLIUM	BOTH IP/OP	"$2,022.50 "	"$1,496.65"	$0.00	"$1,618.00"	$910.13	$910.13	$0.00	$0.00	$0.00	$421.54	"$1,501.10"	"$1,501.10"	$0.00	$0.00	$421.49	$0.00	"$1,196.31"	"$1,196.31"	$0.00	"$1,011.25"	"$1,601.82"	"$1,618.00"	$0.00		$0.00	$316.52	$0.00	$0.00	$321.98	$0.00	$0.00	$0.00	$0.00	$0.00
6704-0-410	SUP	HCPCS C1713		6704-0-410  -  CABLE ORTHOPEDIC 1.6MM SET SLEEVE DALL-MILES VITALLIUM HIP	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$310.50	$310.50	$0.00	$0.00	$0.00	$143.81	$512.12	$512.12	$0.00	$0.00	$143.80	$0.00	$408.14	$408.14	$0.00	$345.00	$546.48	$552.00	$0.00		$0.00	$107.99	$0.00	$0.00	$109.85	$0.00	$0.00	$0.00	$0.00	$0.00
6704-0-420	SUP	HCPCS C1713		6704-0-420  -  CABLE ORTHOPEDIC 1.6MM SET SLEEVE BEADED DALL-MILES	BOTH IP/OP	$740.00 	$547.60	$0.00	$592.00	$333.00	$333.00	$0.00	$0.00	$0.00	$154.23	$549.23	$549.23	$0.00	$0.00	$154.22	$0.00	$437.71	$437.71	$0.00	$370.00	$586.08	$592.00	$0.00		$0.00	$115.81	$0.00	$0.00	$117.81	$0.00	$0.00	$0.00	$0.00	$0.00
6704-0-510	SUP	Custom 27803010		6704-0-510  -  CABLE ORTHOPEDIC 2 2MM HOMOGENOUS DALL-MILES VITALLIUM HIP	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$512.12	$512.12	$0.00	$0.00	$143.80	$0.00	$0.00	$0.00	$0.00	$345.00	$546.48	$552.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6704-0-520	SUP	HCPCS C1713		6704-0-520  -  CABLE ORTHOPEDIC 2MM SET SLEEVE BEAD DALL-MILES VITALLIUM	BOTH IP/OP	$740.00 	$547.60	$0.00	$592.00	$333.00	$333.00	$0.00	$0.00	$0.00	$154.23	$549.23	$549.23	$0.00	$0.00	$154.22	$0.00	$437.71	$437.71	$0.00	$370.00	$586.08	$592.00	$0.00		$0.00	$115.81	$0.00	$0.00	$117.81	$0.00	$0.00	$0.00	$0.00	$0.00
6704-1-018	SUP	Custom 27203010		6704-1-018  -  WIRE SUT .04IN 18IN DLMLS VIT 6 PER TUBE	BOTH IP/OP	$48.75 	$36.08	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.18	$36.18	$0.00	$0.00	$10.16	$0.00	$0.00	$0.00	$0.00	$24.38	$38.61	$39.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6704-2-120	SUP	Custom 27203010		6704-2-120  -  WIRE FX .04IN SUT VIT	BOTH IP/OP	$253.50 	$187.59	$0.00	$202.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.15	$188.15	$0.00	$0.00	$52.83	$0.00	$0.00	$0.00	$0.00	$126.75	$200.77	$202.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6704-3-070	SUP	HCPCS C1713		6704-3-070  -  GRIP CBL 2MM SM DLMLS 2 CBL VIT HIP TROCH	BOTH IP/OP	"$2,552.50 "	"$1,888.85"	$0.00	"$2,042.00"	"$1,148.63"	"$1,148.63"	$0.00	$0.00	$0.00	$532.00	"$1,894.47"	"$1,894.47"	$0.00	$0.00	$531.94	$0.00	"$1,258.38"	"$1,258.38"	$0.00	"$1,276.25"	"$2,021.58"	"$2,042.00"	$0.00		$0.00	$399.47	$0.00	$0.00	$406.36	$0.00	$0.00	$0.00	$0.00	$0.00
6704-3-080	SUP	HCPCS C1713		6704-3-080  -  GRIP CABLE 2MM MEDIUM 2MM DALL-MILES VITALLIUM HIP	BOTH IP/OP	"$2,552.50 "	"$1,888.85"	$0.00	"$2,042.00"	"$1,148.63"	"$1,148.63"	$0.00	$0.00	$0.00	$532.00	"$1,894.47"	"$1,894.47"	$0.00	$0.00	$531.94	$0.00	"$1,258.38"	"$1,258.38"	$0.00	"$1,276.25"	"$2,021.58"	"$2,042.00"	$0.00		$0.00	$399.47	$0.00	$0.00	$406.36	$0.00	$0.00	$0.00	$0.00	$0.00
6704-3-081	SUP	HCPCS C1713		6704-3-081  -  PLATE BONE 2MM MEDIUM 100MM 2 CABLE GRIP DALL-MILES	BOTH IP/OP	"$2,552.50 "	"$1,888.85"	$0.00	"$2,042.00"	"$1,148.63"	"$1,148.63"	$0.00	$0.00	$0.00	$532.00	"$1,894.47"	"$1,894.47"	$0.00	$0.00	$531.94	$0.00	"$1,258.38"	"$1,258.38"	$0.00	"$1,276.25"	"$2,021.58"	"$2,042.00"	$0.00		$0.00	$399.47	$0.00	$0.00	$406.36	$0.00	$0.00	$0.00	$0.00	$0.00
6704-3-082	SUP	HCPCS C1713		6704-3-082  -  PLATE BN 2MM MED 150MM DLMLS 2 CBL GRP VIT HIP TROCH	BOTH IP/OP	"$3,325.00 "	"$2,460.50"	$0.00	"$2,660.00"	"$1,496.25"	"$1,496.25"	$0.00	$0.00	$0.00	$693.01	"$2,467.82"	"$2,467.82"	$0.00	$0.00	$692.93	$0.00	"$1,639.23"	"$1,639.23"	$0.00	"$1,662.50"	"$2,633.40"	"$2,660.00"	$0.00		$0.00	$520.36	$0.00	$0.00	$529.34	$0.00	$0.00	$0.00	$0.00	$0.00
6704-3-083	SUP	HCPCS C1713		6704-3-083  -  PLATE BN 2MM MED 200MM DLMLS 2 CBL GRP VIT HIP TROCH	BOTH IP/OP	"$4,115.00 "	"$3,045.10"	$0.00	"$3,292.00"	"$1,851.75"	"$1,851.75"	$0.00	$0.00	$0.00	$857.67	"$3,054.15"	"$3,054.15"	$0.00	$0.00	$857.57	$0.00	"$2,028.70"	"$2,028.70"	$0.00	"$2,057.50"	"$3,259.08"	"$3,292.00"	$0.00		$0.00	$644.00	$0.00	$0.00	$655.11	$0.00	$0.00	$0.00	$0.00	$0.00
6704-3-090	SUP	HCPCS C1713		6704-3-090  -  GRIP CABLE 2MM LARGE DALL-MILES VITALLIUM HIP	BOTH IP/OP	"$2,552.50 "	"$1,888.85"	$0.00	"$2,042.00"	"$1,148.63"	"$1,148.63"	$0.00	$0.00	$0.00	$532.00	"$1,894.47"	"$1,894.47"	$0.00	$0.00	$531.94	$0.00	"$1,258.38"	"$1,258.38"	$0.00	"$1,276.25"	"$2,021.58"	"$2,042.00"	$0.00		$0.00	$399.47	$0.00	$0.00	$406.36	$0.00	$0.00	$0.00	$0.00	$0.00
6704-3-091	SUP	HCPCS C1713		6704-3-091  -  PLATE BN 2MM LG 110MM DLMLS 2 CBL GRP VIT HIP TROCH	BOTH IP/OP	"$2,552.50 "	"$1,888.85"	$0.00	"$2,042.00"	"$1,148.63"	"$1,148.63"	$0.00	$0.00	$0.00	$532.00	"$1,894.47"	"$1,894.47"	$0.00	$0.00	$531.94	$0.00	"$1,258.38"	"$1,258.38"	$0.00	"$1,276.25"	"$2,021.58"	"$2,042.00"	$0.00		$0.00	$399.47	$0.00	$0.00	$406.36	$0.00	$0.00	$0.00	$0.00	$0.00
6704-3-092	SUP	HCPCS C1713		6704-3-092  -  PLATE BONE 2MM LARGE 160MM 2 CABLE GRIP DALL-MILES VITALLIUM	BOTH IP/OP	"$3,325.00 "	"$2,460.50"	$0.00	"$2,660.00"	"$1,496.25"	"$1,496.25"	$0.00	$0.00	$0.00	$693.01	"$2,467.82"	"$2,467.82"	$0.00	$0.00	$692.93	$0.00	"$1,639.23"	"$1,639.23"	$0.00	"$1,662.50"	"$2,633.40"	"$2,660.00"	$0.00		$0.00	$520.36	$0.00	$0.00	$529.34	$0.00	$0.00	$0.00	$0.00	$0.00
6704-3-093	SUP	HCPCS C1713		6704-3-093  -  PLATE BONE 2MM LARGE 210MM 2 CABLE GRIP DALL-MILES VITALLIUM	BOTH IP/OP	"$4,115.00 "	"$3,045.10"	$0.00	"$3,292.00"	"$1,851.75"	"$1,851.75"	$0.00	$0.00	$0.00	$857.67	"$3,054.15"	"$3,054.15"	$0.00	$0.00	$857.57	$0.00	"$2,028.70"	"$2,028.70"	$0.00	"$2,057.50"	"$3,259.08"	"$3,292.00"	$0.00		$0.00	$644.00	$0.00	$0.00	$655.11	$0.00	$0.00	$0.00	$0.00	$0.00
6704-3-120	SUP	HCPCS C1713		6704-3-120  -  WIRE FX .046IN HVY GA VIT	BOTH IP/OP	$253.50 	$187.59	$0.00	$202.80	$114.08	$114.08	$0.00	$0.00	$0.00	$52.84	$188.15	$188.15	$0.00	$0.00	$52.83	$0.00	$149.95	$149.95	$0.00	$126.75	$200.77	$202.80	$0.00		$0.00	$39.67	$0.00	$0.00	$40.36	$0.00	$0.00	$0.00	$0.00	$0.00
6704-4-016	SUP	HCPCS C1713		6704-4-016  -  SLEEVE CABLE SMALL 1.6MM CRIMP DALL-MILES VITALLIUM HIP	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
6704-4-020	SUP	HCPCS C1713		6704-4-020  -  SLEEVE CABLE MEDIUM 2MM GRIP CRIMP DALL-MILES VITALLIUM HIP	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
6704-5-016	SUP	HCPCS C1713		6704-5-016  -  GRIP CABLE SMALL 1.6MM HOLE DALL-MILES VITALLIUM HIP STERILE	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$537.75	$537.75	$0.00	$0.00	$0.00	$249.07	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$706.84	$706.84	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$187.02	$0.00	$0.00	$190.24	$0.00	$0.00	$0.00	$0.00	$0.00
6704-6-020	SUP	HCPCS C1713		6704-6-020  -  GRIP CABLE MEDIUM 2MM HOLE DALL-MILES VITALLIUM HIP STERILE	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$537.75	$537.75	$0.00	$0.00	$0.00	$249.07	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$706.84	$706.84	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$187.02	$0.00	$0.00	$190.24	$0.00	$0.00	$0.00	$0.00	$0.00
6704-6-110	SUP	HCPCS C1713		6704-6-110  -  BUTTON FIX GROOVE LOCK DALL-MILES VITALLIUM HIP	BOTH IP/OP	$647.50 	$479.15	$0.00	$518.00	$291.38	$291.38	$0.00	$0.00	$0.00	$134.96	$480.57	$480.57	$0.00	$0.00	$134.94	$0.00	$383.00	$383.00	$0.00	$323.75	$512.82	$518.00	$0.00		$0.00	$101.33	$0.00	$0.00	$103.08	$0.00	$0.00	$0.00	$0.00	$0.00
6704-7-020	SUP	Custom 27803010		6704-7-020  -  GRIP CABLE LARGE 2MM DALL-MILES VITALLIUM HIP STERILE	BOTH IP/OP	"$1,195.00 "	$884.30	$0.00	$956.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.93	$886.93	$0.00	$0.00	$249.04	$0.00	$0.00	$0.00	$0.00	$597.50	$946.44	$956.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6704-8-030	SUP	HCPCS C1713		6704-8-030  -  CABLE ORTHOPEDIC MINI SLEEVE DALL-MILES VITALLIUM HIP	BOTH IP/OP	$555.00 	$410.70	$0.00	$444.00	$249.75	$249.75	$0.00	$0.00	$0.00	$115.68	$411.92	$411.92	$0.00	$0.00	$115.66	$0.00	$328.28	$328.28	$0.00	$277.50	$439.56	$444.00	$0.00		$0.00	$86.86	$0.00	$0.00	$88.36	$0.00	$0.00	$0.00	$0.00	$0.00
6704-8-236	SUP	HCPCS C1713		6704-8-236  -  CABLE ORTHOPEDIC 1.6MM 750MM GRIP DALL-MILES VITALLIUM HIP	BOTH IP/OP	$622.50 	$460.65	$0.00	$498.00	$280.13	$280.13	$0.00	$0.00	$0.00	$129.74	$462.02	$462.02	$0.00	$0.00	$129.73	$0.00	$368.21	$368.21	$0.00	$311.25	$493.02	$498.00	$0.00		$0.00	$97.42	$0.00	$0.00	$99.10	$0.00	$0.00	$0.00	$0.00	$0.00
6704-8-240	SUP	HCPCS C1713		6704-8-240  -  CABLE ORTHOPEDIC 2MM 750MM GRIP DALL-MILES VITALLIUM HIP	BOTH IP/OP	$622.50 	$460.65	$0.00	$498.00	$280.13	$280.13	$0.00	$0.00	$0.00	$129.74	$462.02	$462.02	$0.00	$0.00	$129.73	$0.00	$368.21	$368.21	$0.00	$311.25	$493.02	$498.00	$0.00		$0.00	$97.42	$0.00	$0.00	$99.10	$0.00	$0.00	$0.00	$0.00	$0.00
6707920P2	SUP	HCPCS C1713		6707920P2  -  IMPLANT SPNL 4D 20X7X9MM LF CRNT LI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6707926P2	SUP	HCPCS C1713		6707926P2  -  IMPLANT SPNL 4D 26X7X9MM LF CRNT LI	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6708520P2	SUP	HCPCS C1713		6708520P2  -  CAGE SPNL 15D LG TPR 20X9X8MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6708820P2	SUP	HCPCS C1713		6708820P2  -  CAGE SPNL 8D LG TPR 20X9X8MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6708920P2	SUP	HCPCS C1713		6708920P2  -  CAGE SPNL 4D LG IMPCT 20X9X8MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6708926P2	SUP	HCPCS C1713		6708926P2  -  CAGE SPNL 4D LG IMPCT 26X9X8MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6708932P2	SUP	HCPCS C1713		6708932P2  -  CAGE SPNL 4D LG IMPCT 32X9X8MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6709920P2	SUP	HCPCS C1713		6709920P2  -  CAGE SPNL 4D LG IMPCT 20X9X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6709926P2	SUP	HCPCS C1713		6709926P2  -  CAGE SPNL 4D LG IMPCT 26X9X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6709932P2	SUP	HCPCS C1713		6709932P2  -  CAGE SPNL 4D LG IMPCT 32X9X9MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6710520P2	SUP	HCPCS C1713		6710520P2  -  CAGE SPNL 15D LG TPR 20X10X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6710820P2	SUP	HCPCS C1713		6710820P2  -  CAGE SPNL 8D LG TPR 20X10X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6710920P2	SUP	HCPCS C1713		6710920P2  -  CAGE SPNL 4D LG IMPCT 20X10X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6710926P2	SUP	HCPCS C1713		6710926P2  -  CAGE SPNL 4D LG IMPCT 26X10X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6710932P2	SUP	HCPCS C1713		6710932P2  -  CAGE SPNL 4D LG IMPCT 32X10X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6711920P2	SUP	HCPCS C1713		6711920P2  -  CAGE SPNL 4D LG IMPCT 20X11X9MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6711926P2	SUP	HCPCS C1713		6711926P2  -  CAGE SPNL 4D LG IMPCT 26X11X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6711932P2	SUP	HCPCS C1713		6711932P2  -  CAGE SPNL 4D LG IMPCT 32X11X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712520P2	SUP	HCPCS C1713		6712520P2  -  CAGE SPNL 15D LG TPR 20X12X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712820P2	SUP	HCPCS C1713		6712820P2  -  CAGE SPNL 8D LG TPR 20X12X9MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712920P2	SUP	HCPCS C1713		6712920P2  -  CAGE SPNL 4D LG IMPCT 20X12X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712926P2	SUP	HCPCS C1713		6712926P2  -  CAGE SPNL 4D LG IMPCT 26X12X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6712932P2	SUP	HCPCS C1713		6712932P2  -  CAGE SPNL 4D LG IMPCT 32X12X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6713920P2	SUP	HCPCS C1713		6713920P2  -  CAGE SPNL 4D LG IMPCT LRDTC 20X13X9MM NS LF CRNT PEEK	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6713926P2	SUP	HCPCS C1713		6713926P2  -  CAGE SPNL 4D LG IMPCT 26X13X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6713932P2	SUP	HCPCS C1713		6713932P2  -  CAGE SPNL 4D LG IMPCT 32X13X9MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6714820P2	SUP	HCPCS C1713		6714820P2  -  CAGE SPNL 8D LG TPR 20X14X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6714920P2	SUP	HCPCS C1713		6714920P2  -  CAGE SPNL 4D LG IMPCT 20X14X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6714926P2	SUP	HCPCS C1713		6714926P2  -  CAGE SPNL 4D LG IMPCT 26X14X9MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6714932P2	SUP	HCPCS C1713		6714932P2  -  CAGE SPNL 4D LG IMPCT 32X14X9MM NS LF CRNT PEEK-OPTM	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6715920P2	SUP	HCPCS C1713		6715920P2  -  CAGE SPNL 4D LG IMPCT 20X9X15MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6715926P2	SUP	HCPCS C1713		6715926P2  -  CAGE SPNL 4D LG IMPCT 26X9X15MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6716920P2	SUP	HCPCS C1713		6716920P2  -  CAGE SPNL 4D LG IMPCT 20X9X16MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6716926P2	SUP	HCPCS C1713		6716926P2  -  CAGE SPNL 4D LG IMPCT 26X9X16MM NS LF CRNT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
6720-0027	SUP	HCPCS C1776		6720-0027  -  STEM FEM 132D 0 28MM STD OFST 93MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6720-0127	SUP	HCPCS C1776		6720-0127  -  STEM FEM 132D 1 29MM STD OFST 96MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6720-0230	SUP	HCPCS C1776		6720-0230  -  STEM FEM 132D 2 33MM STD OFST 99MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6720-0330	SUP	HCPCS C1776		6720-0330  -  STEM FEM 132D 3 35MM STD OFST 102MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6720-0435	SUP	HCPCS C1776		6720-0435  -  STEM FEM 132D 4 38MM STD OFST 105MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6720-0535	SUP	HCPCS C1776		6720-0535  -  STEM FEM 132D 5 40MM STD OFST 108MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6720-0635	SUP	HCPCS C1776		6720-0635  -  STEM FEM 132D 6 41MM STD OFST 111MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6720-0737	SUP	HCPCS C1776		6720-0737  -  STEM FEM 132D 7 46MM STD OFST 114MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6720-0837	SUP	HCPCS C1776		6720-0837  -  STEM FEM 132D 8 47MM STD OFST 117MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6720-0937	SUP	HCPCS C1776		6720-0937  -  STEM FEM 132D 9 49MM STD OFST 120MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6720-1040	SUP	HCPCS C1776		6720-1040  -  STEM FEM 132D 10 51MM STD OFST 123MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6720-1140	SUP	HCPCS C1776		6720-1140  -  STEM FEM 132D 11 53MM STD OFST 126MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6721-0027	SUP	HCPCS C1776		6721-0027  -  STEM FEM 127D 0 32MM HI OFST 93MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6721-0330	SUP	HCPCS C1776		6721-0330  -  STEM FEM ACLD II 3 127D	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6721-0435	SUP	HCPCS C1713		6721-0435  -  STEM FEM ACLD II 4 127D	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6721-0535	SUP	HCPCS C1713		6721-0535  -  STEM FEM ACLD II 5 127D	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6721-0635	SUP	HCPCS C1776		6721-0635  -  STEM FEM 127D 6 TPR 111MM STRL 35MM ACLD MDLR HIP	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6721-0837	SUP	HCPCS C1776		6721-0837  -  STEM FEM 127D 8 TPR 117MM STRL 37MM ACLD II MDLR HIP	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6721-1140	SUP	HCPCS C1776		6721-1140  -  STEM FEM 127D 11 58MM HI OFST 126MM STRL ACLD II V40 PRFT	BOTH IP/OP	"$5,357.50 "	"$3,964.55"	$0.00	"$4,286.00"	"$2,410.88"	"$2,410.88"	$0.00	$0.00	$0.00	"$1,116.64"	"$3,976.34"	"$3,976.34"	$0.00	$0.00	"$1,116.50"	$0.00	"$2,641.25"	"$2,641.25"	$0.00	"$2,678.75"	"$4,243.14"	"$4,286.00"	$0.00		$0.00	$838.45	$0.00	$0.00	$852.91	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-609	SUP	HCPCS C1776		6728-1-609  -  INSERT TIBIAL SMALL 9MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-611	SUP	HCPCS C1776		6728-1-611  -  INSERT TIBIAL SMALL 11MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-613	SUP	HCPCS C1776		6728-1-613  -  INSERT TIBIAL SMALL 13MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-616	SUP	HCPCS C1776		6728-1-616  -  INSERT TIBIAL SMALL 16MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-619	SUP	HCPCS C1776		6728-1-619  -  INSERT TIBIAL SMALL 19MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-622	SUP	HCPCS C1776		6728-1-622  -  INSERT TIBIAL SMALL 22MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-625	SUP	HCPCS C1776		6728-1-625  -  INSERT TIBIAL SMALL 25MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-709	SUP	HCPCS C1776		6728-1-709  -  INSERT TIBIAL SMALL 9MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-711	SUP	HCPCS C1776		6728-1-711  -  INSERT TIBIAL SMALL 11MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-713	SUP	HCPCS C1776		6728-1-713  -  INSERT TIBIAL SMALL 13MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-716	SUP	HCPCS C1776		6728-1-716  -  INSERT TIBIAL SMALL 16MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-719	SUP	HCPCS C1776		6728-1-719  -  INSERT TIBIAL SMALL 19MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-722	SUP	HCPCS C1776		6728-1-722  -  INSERT TIBIAL SMALL 22MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-725	SUP	HCPCS C1776		6728-1-725  -  INSERT TIBIAL SMALL 25MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-1-940	SUP	Custom 27803010		6728-1-940  -  COMPONENT PATLR SMALL PRIM REVISION CUP PCA KNEE	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	$0.00	$0.00	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-609	SUP	HCPCS C1776		6728-2-609  -  INSERT TIBIAL MEDIUM 9MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-611	SUP	HCPCS C1776		6728-2-611  -  INSERT TIBIAL MEDIUM 11MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-613	SUP	HCPCS C1776		6728-2-613  -  INSERT TIBIAL MEDIUM 13MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-616	SUP	HCPCS C1776		6728-2-616  -  INSERT TIBIAL MEDIUM 16MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-619	SUP	HCPCS C1776		6728-2-619  -  INSERT TIBIAL MEDIUM 19MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-622	SUP	HCPCS C1776		6728-2-622  -  INSERT TIBIAL MEDIUM 22MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-625	SUP	HCPCS C1776		6728-2-625  -  INSERT TIBIAL MEDIUM 25MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-709	SUP	HCPCS C1776		6728-2-709  -  INSERT TIBIAL MEDIUM 9MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-711	SUP	HCPCS C1776		6728-2-711  -  INSERT TIBIAL MEDIUM 11MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-713	SUP	HCPCS C1776		6728-2-713  -  INSERT TIBIAL MEDIUM 13MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-716	SUP	HCPCS C1776		6728-2-716  -  INSERT TIBIAL MEDIUM 16MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-719	SUP	HCPCS C1776		6728-2-719  -  INSERT TIBIAL MEDIUM 19MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-722	SUP	HCPCS C1776		6728-2-722  -  INSERT TIBIAL MEDIUM 22MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-725	SUP	HCPCS C1776		6728-2-725  -  INSERT TIBIAL MEDIUM 25MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-2-940	SUP	HCPCS C1776		6728-2-940  -  COMPONENT PATLR MEDIUM PRIM REVISION CUP PCA KNEE	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	"$1,633.50"	"$1,633.50"	$0.00	$0.00	$0.00	$756.58	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	"$1,789.59"	"$1,789.59"	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$568.10	$0.00	$0.00	$577.90	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-609	SUP	HCPCS C1776		6728-4-609  -  INSERT TIBIAL LARGE 9MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-611	SUP	HCPCS C1776		6728-4-611  -  INSERT TIBIAL LARGE 11MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-613	SUP	HCPCS C1776		6728-4-613  -  INSERT TIBIAL LARGE 13MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-616	SUP	HCPCS C1776		6728-4-616  -  INSERT TIBIAL LARGE 16MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-619	SUP	HCPCS C1776		6728-4-619  -  INSERT TIBIAL LARGE 19MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-622	SUP	HCPCS C1776		6728-4-622  -  INSERT TIBIAL LARGE 22MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-625	SUP	HCPCS C1776		6728-4-625  -  INSERT TIBIAL LARGE 25MM REVISION PCA KNEE LEFT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-709	SUP	HCPCS C1776		6728-4-709  -  INSERT TIBIAL LARGE 9MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-711	SUP	HCPCS C1776		6728-4-711  -  INSERT TIBIAL LARGE 11MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-713	SUP	HCPCS C1776		6728-4-713  -  INSERT TIBIAL LARGE 13MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-716	SUP	HCPCS C1776		6728-4-716  -  INSERT TIBIAL LARGE 16MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-719	SUP	HCPCS C1776		6728-4-719  -  INSERT TIBIAL LARGE 19MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-722	SUP	HCPCS C1776		6728-4-722  -  INSERT TIBIAL LARGE 22MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-725	SUP	HCPCS C1776		6728-4-725  -  INSERT TIBIAL LARGE 25MM REVISION PCA KNEE RIGHT	BOTH IP/OP	"$5,410.00 "	"$4,003.40"	$0.00	"$4,328.00"	"$2,434.50"	"$2,434.50"	$0.00	$0.00	$0.00	"$1,127.58"	"$4,015.30"	"$4,015.30"	$0.00	$0.00	"$1,127.44"	$0.00	"$2,667.13"	"$2,667.13"	$0.00	"$2,705.00"	"$4,284.72"	"$4,328.00"	$0.00		$0.00	$846.67	$0.00	$0.00	$861.27	$0.00	$0.00	$0.00	$0.00	$0.00
6728-4-940	SUP	Custom 27803010		6728-4-940  -  COMPONENT PATLR LARGE PRIM REVISION PCA	BOTH IP/OP	"$3,630.00 "	"$2,686.20"	$0.00	"$2,904.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,694.19"	"$2,694.19"	$0.00	$0.00	$756.49	$0.00	$0.00	$0.00	$0.00	"$1,815.00"	"$2,874.96"	"$2,904.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-109	SUP	Custom 27803010		6742-1-109  -  INSERT TIBIAL SMALL 9MM POSTERIOR STABILIZE LIP DURACON DUR	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-111	SUP	Custom 27803010		6742-1-111  -  INSERT TIBIAL SMALL 11MM POSTERIOR STABILIZE LIP DURACON DUR	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-113	SUP	Custom 27803010		6742-1-113  -  INSERT TIBIAL SMALL 13MM POSTERIOR STABILIZE LIP DURACON DUR	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-116	SUP	Custom 27803010		6742-1-116  -  INSERT TIBIAL SMALL 16MM POSTERIOR STABILIZE LIP DURACON DUR	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-119	SUP	Custom 27803010		6742-1-119  -  INSERT TIBIAL SMALL 19MM POSTERIOR STABILIZE LIP DURACON DUR	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-122	SUP	Custom 27803010		6742-1-122  -  INSERT TIBIAL SMALL 22MM POSTERIOR STABILIZE LIP DURACON DUR	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-125	SUP	Custom 27803010		6742-1-125  -  INSERT TIBIAL SMALL 25MM POSTERIOR STABILIZE LIP DURACON DUR	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-209	SUP	Custom 27803010		6742-1-209  -  INSERT TIBIAL MEDIUM 9MM POSTERIOR STABILIZE LIP DURACON DUR	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-211	SUP	Custom 27803010		6742-1-211  -  INSERT TIBIAL MEDIUM 11MM POSTERIOR STABILIZE LIP DURACON	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-213	SUP	Custom 27803010		6742-1-213  -  INSERT TIBIAL MEDIUM 13MM POSTERIOR STABILIZE LIP DURACON	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-216	SUP	Custom 27803010		6742-1-216  -  INSERT TIBIAL MEDIUM 16MM POSTERIOR STABILIZE LIP DURACON	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-219	SUP	Custom 27803010		6742-1-219  -  INSERT TIBIAL MEDIUM 19MM POSTERIOR STABILIZE LIP DURACON	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-222	SUP	Custom 27803010		6742-1-222  -  INSERT TIBIAL MEDIUM 12MM POSTERIOR STABILIZE LIP DURACON	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-225	SUP	Custom 27803010		6742-1-225  -  INSERT TIBIAL MEDIUM 25MM POSTERIOR STABILIZE LIP DURACON	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-309	SUP	Custom 27803010		6742-1-309  -  INSERT TIBIAL LARGE 9MM POSTERIOR STABILIZE LIPPED DURACON	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-311	SUP	Custom 27803010		6742-1-311  -  INSERT TIBIAL LARGE 11MM POSTERIOR STABILIZE LIP DURACON DUR	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-313	SUP	Custom 27803010		6742-1-313  -  INSERT TIBIAL LARGE 13MM POSTERIOR STABILIZE LIP DURACON DUR	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-316	SUP	Custom 27803010		6742-1-316  -  INSERT TIBIAL LARGE 16MM POSTERIOR STABILIZE LIP DURACON DUR	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-319	SUP	Custom 27803010		6742-1-319  -  INSERT TIBIAL LARGE 19MM POSTERIOR STABILIZE LIP DURACON	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-322	SUP	Custom 27803010		6742-1-322  -  INSERT TIBIAL LARGE 22MM POSTERIOR STABILIZE LIP DURACON	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-325	SUP	Custom 27803010		6742-1-325  -  INSERT TIBIAL LARGE 25MM POSTERIOR STABILIZE LIP DURACON	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-409	SUP	Custom 27803010		6742-1-409  -  INSERT TIBIAL XL 9MM POSTERIOR STABILIZE LIP DURACON KNEE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-411	SUP	Custom 27803010		6742-1-411  -  INSERT TIBIAL XL 11MM POSTERIOR STABILIZE LIP DURACON KNEE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-413	SUP	Custom 27803010		6742-1-413  -  INSERT TIBIAL XL 13MM POSTERIOR STABILIZE LIP DURACON KNEE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-416	SUP	Custom 27803010		6742-1-416  -  INSERT TIBIAL XL 16MM POSTERIOR STABILIZE LIP DURACON KNEE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-419	SUP	Custom 27803010		6742-1-419  -  INSERT TIBIAL XL 19MM POSTERIOR STABILIZE LIP DURACON KNEE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-422	SUP	Custom 27803010		6742-1-422  -  INSERT TIBIAL XL 22MM POSTERIOR STABILIZE LIP DURACON KNEE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-1-425	SUP	Custom 27803010		6742-1-425  -  INSERT TIBIAL XL 25MM POSTERIOR STABILIZE LIP DURACON KNEE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-009	SUP	Custom 27803010		6742-4-009  -  INSERT TIBIAL XS 9MM STABILIZE LIP DURACON DUR KNEE CONDYLE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-011	SUP	Custom 27803010		6742-4-011  -  INSERT TIBIAL XS 11MM STABILIZE LIP DURACON DUR KNEE CONDYLE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-013	SUP	Custom 27803010		6742-4-013  -  INSERT TIBIAL XS 13MM STABILIZE LIP DURACON DUR KNEE CONDYLE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-016	SUP	Custom 27803010		6742-4-016  -  INSERT TIBIAL XS 16MM STABILIZE LIP DURACON DUR KNEE CONDYLE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-109	SUP	Custom 27803010		6742-4-109  -  INSERT TIBIAL SMALL 9MM STABILIZE DURACON KNEE CONDYLE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-111	SUP	Custom 27803010		6742-4-111  -  INSERT TIBIAL SMALL 11MM STABILIZE DURACON KNEE CONDYLE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-113	SUP	Custom 27803010		6742-4-113  -  INSERT TIBIAL SMALL 13MM STABILIZE DURACON KNEE CONDYLE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-116	SUP	Custom 27803010		6742-4-116  -  INSERT TIBIAL SMALL 16MM STABILIZE DURACON KNEE CONDYLE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-119	SUP	Custom 27803010		6742-4-119  -  INSERT TIBIAL SMALL 19MM STABILIZE LIP DURACON DUR KNEE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-122	SUP	Custom 27803010		6742-4-122  -  INSERT TIBIAL SMALL 22MM STABILIZE LIP DURACON DUR KNEE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-125	SUP	Custom 27803010		6742-4-125  -  INSERT TIBIAL SMALL 25MM STABILIZE LIP DURACON DUR KNEE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-209	SUP	Custom 27803010		6742-4-209  -  INSERT TIBIAL MEDIUM 9MM STABILIZE DURACON KNEE CONDYLE	BOTH IP/OP	"$2,230.00 "	"$1,650.20"	$0.00	"$1,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,655.11"	"$1,655.11"	$0.00	$0.00	$464.73	$0.00	$0.00	$0.00	$0.00	"$1,115.00"	"$1,766.16"	"$1,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-209X	SUP	Custom 27803010		6742-4-209X  -  INSERT TIBIAL MEDIUM 9MM STABILIZE DURACON X3 KNEE CONDYLE	BOTH IP/OP	"$5,025.00 "	"$3,718.50"	$0.00	"$4,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,729.56"	"$3,729.56"	$0.00	$0.00	"$1,047.21"	$0.00	$0.00	$0.00	$0.00	"$2,512.50"	"$3,979.80"	"$4,020.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-211	SUP	Custom 27803010		6742-4-211  -  INSERT TIBIAL MEDIUM 11MM STABILIZE DURACON KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-211X	SUP	Custom 27803010		6742-4-211X  -  INSERT TIBIAL MEDIUM 11MM STABILIZE DURACON X3 KNEE CONDYLE	BOTH IP/OP	"$5,025.00 "	"$3,718.50"	$0.00	"$4,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,729.56"	"$3,729.56"	$0.00	$0.00	"$1,047.21"	$0.00	$0.00	$0.00	$0.00	"$2,512.50"	"$3,979.80"	"$4,020.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-213	SUP	Custom 27803010		6742-4-213  -  INSERT TIBIAL MEDIUM 13MM STABILIZE DURACON KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-213X	SUP	Custom 27803010		6742-4-213X  -  INSERT TIBIAL MEDIUM 13MM STABILIZE DURACON X3 KNEE CONDYLE	BOTH IP/OP	"$5,025.00 "	"$3,718.50"	$0.00	"$4,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,729.56"	"$3,729.56"	$0.00	$0.00	"$1,047.21"	$0.00	$0.00	$0.00	$0.00	"$2,512.50"	"$3,979.80"	"$4,020.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-216	SUP	Custom 27803010		6742-4-216  -  INSERT TIBIAL MEDIUM 16MM STABILIZE DURACON DUR KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-219	SUP	Custom 27803010		6742-4-219  -  INSERT TIBIAL MEDIUM 19MM STABILIZE DURACON DUR KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-222	SUP	Custom 27803010		6742-4-222  -  INSERT TIBIAL MEDIUM 22MM STABILIZE LIP DURACON DUR KNEE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-225	SUP	Custom 27803010		6742-4-225  -  INSERT TIBIAL MEDIUM 25MM STABILIZE DURACON DUR KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-309	SUP	Custom 27803010		6742-4-309  -  INSERT TIBIAL LARGE 9MM STABILIZE DURACON DUR KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-309X	SUP	Custom 27803010		6742-4-309X  -  INSERT TIBIAL LARGE 9MM STABILIZE DURACON X3 KNEE CONDYLE	BOTH IP/OP	"$5,025.00 "	"$3,718.50"	$0.00	"$4,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,729.56"	"$3,729.56"	$0.00	$0.00	"$1,047.21"	$0.00	$0.00	$0.00	$0.00	"$2,512.50"	"$3,979.80"	"$4,020.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-311	SUP	Custom 27803010		6742-4-311  -  INSERT TIBIAL LARGE 11MM STABILIZE DURACON DUR KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-311X	SUP	Custom 27803010		6742-4-311X  -  INSERT TIBIAL LARGE 11MM STABILIZE DURACON X3 KNEE CONDYLE	BOTH IP/OP	"$5,025.00 "	"$3,718.50"	$0.00	"$4,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,729.56"	"$3,729.56"	$0.00	$0.00	"$1,047.21"	$0.00	$0.00	$0.00	$0.00	"$2,512.50"	"$3,979.80"	"$4,020.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-313	SUP	Custom 27803010		6742-4-313  -  INSERT TIBIAL LARGE 13MM STABILIZE DURACON DUR KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-313X	SUP	Custom 27803010		6742-4-313X  -  INSERT TIBIAL LARGE 13MM STABILIZE DURACON X3 KNEE CONDYLE	BOTH IP/OP	"$5,025.00 "	"$3,718.50"	$0.00	"$4,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,729.56"	"$3,729.56"	$0.00	$0.00	"$1,047.21"	$0.00	$0.00	$0.00	$0.00	"$2,512.50"	"$3,979.80"	"$4,020.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-316	SUP	Custom 27803010		6742-4-316  -  INSERT TIBIAL LARGE 16MM STABILIZE DURACON KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-319	SUP	Custom 27803010		6742-4-319  -  INSERT TIBIAL LARGE 19MM STABILIZE LIP DURACON DUR KNEE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-322	SUP	Custom 27803010		6742-4-322  -  INSERT TIBIAL LARGE 22MM STABILIZE LIP DURACON DUR KNEE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-325	SUP	Custom 27803010		6742-4-325  -  INSERT TIBIAL LARGE 25MM STABILIZE LIP DURACON DUR KNEE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-409	SUP	Custom 27803010		6742-4-409  -  INSERT TIBIAL XL 9MM STABILIZE DURACON KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-409X	SUP	Custom 27803010		6742-4-409X  -  INSERT TIBIAL XL 9MM STABILIZE DURACON X3 KNEE CONDYLE	BOTH IP/OP	"$5,025.00 "	"$3,718.50"	$0.00	"$4,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,729.56"	"$3,729.56"	$0.00	$0.00	"$1,047.21"	$0.00	$0.00	$0.00	$0.00	"$2,512.50"	"$3,979.80"	"$4,020.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-411	SUP	Custom 27803010		6742-4-411  -  INSERT TIBIAL XL 11MM STABILIZE DURACON KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-411X	SUP	Custom 27803010		6742-4-411X  -  INSERT TIBIAL XL 11MM STABILIZE DURACON X3 KNEE CONDYLE	BOTH IP/OP	"$5,025.00 "	"$3,718.50"	$0.00	"$4,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,729.56"	"$3,729.56"	$0.00	$0.00	"$1,047.21"	$0.00	$0.00	$0.00	$0.00	"$2,512.50"	"$3,979.80"	"$4,020.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-413	SUP	Custom 27803010		6742-4-413  -  INSERT TIBIAL XL 13MM STABILIZE DURACON KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-413X	SUP	Custom 27803010		6742-4-413X  -  INSERT TIBIAL XL 13MM STABILIZE DURACON X3 KNEE CONDYLE	BOTH IP/OP	"$5,025.00 "	"$3,718.50"	$0.00	"$4,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,729.56"	"$3,729.56"	$0.00	$0.00	"$1,047.21"	$0.00	$0.00	$0.00	$0.00	"$2,512.50"	"$3,979.80"	"$4,020.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-416	SUP	Custom 27803010		6742-4-416  -  INSERT TIBIAL XL 16MM CNDYLR STABILIZED DURACON RIGHT	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-419	SUP	Custom 27803010		6742-4-419  -  INSERT TIBIAL XL 19MM CNDYLR STABILIZED DURACON RIGHT	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-422	SUP	Custom 27803010		6742-4-422  -  INSERT TIBIAL XL 22MM STABILIZE LIP DURACON DUR KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6742-4-425	SUP	Custom 27803010		6742-4-425  -  INSERT TIBIAL XL 25MM STABILIZE LIP DURACON DUR KNEE CONDYLE	BOTH IP/OP	"$3,055.00 "	"$2,260.70"	$0.00	"$2,444.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,267.42"	"$2,267.42"	$0.00	$0.00	$636.66	$0.00	$0.00	$0.00	$0.00	"$1,527.50"	"$2,419.56"	"$2,444.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-111	SUP	Custom 27803010		6752-5-111  -  INSERT TIB SM 11MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-113	SUP	Custom 27803010		6752-5-113  -  INSERT TIB SM 13MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-116	SUP	Custom 27803010		6752-5-116  -  INSERT TIB SM 16MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-119	SUP	Custom 27803010		6752-5-119  -  INSERT TIB SM 19MM KNEE PS CNSTRN	BOTH IP/OP	"$1,412.00 "	"$1,044.88"	$0.00	"$1,129.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,047.99"	"$1,047.99"	$0.00	$0.00	$294.26	$0.00	$0.00	$0.00	$0.00	$706.00	"$1,118.30"	"$1,129.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-122	SUP	Custom 27803010		6752-5-122  -  INSERT TIB SM 22MM KNEE PS CNSTRN	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-125	SUP	Custom 27803010		6752-5-125  -  INSERT TIB SM 25MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,381.00 "	"$1,021.94"	$0.00	"$1,104.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.98"	"$1,024.98"	$0.00	$0.00	$287.80	$0.00	$0.00	$0.00	$0.00	$690.50	"$1,093.75"	"$1,104.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-128	SUP	Custom 27803010		6752-5-128  -  INSERT TIB SM 28MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-131	SUP	Custom 27803010		6752-5-131  -  INSERT TIB SM 31MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-211	SUP	Custom 27803010		6752-5-211  -  INSERT TIB MED 11MM KNEE PS CNSTRN	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-213	SUP	Custom 27803010		6752-5-213  -  INSERT TIB MED 13MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-216	SUP	Custom 27803010		6752-5-216  -  INSERT TIB MED 16MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-219	SUP	Custom 27803010		6752-5-219  -  INSERT TIB MED 19MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-222	SUP	Custom 27803010		6752-5-222  -  INSERT TIB MED 22MM KNEE PS CNSTRN	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-225	SUP	Custom 27803010		6752-5-225  -  INSERT TIB MED 25MM KNEE PS CNSTRN	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-228	SUP	Custom 27803010		6752-5-228  -  INSERT TIB MED 28MM KNEE PS CNSTRN	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-231	SUP	Custom 27803010		6752-5-231  -  INSERT TIB MED 31MM KNEE PS CNSTRN	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-311	SUP	Custom 27803010		6752-5-311  -  INSERT TIB LG 11MM KNEE PS CNSTRN	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-313	SUP	Custom 27803010		6752-5-313  -  INSERT TIB LG 13MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-316	SUP	Custom 27803010		6752-5-316  -  INSERT TIB LG 16MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-319	SUP	Custom 27803010		6752-5-319  -  INSERT TIB LG 19MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,412.00 "	"$1,044.88"	$0.00	"$1,129.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,047.99"	"$1,047.99"	$0.00	$0.00	$294.26	$0.00	$0.00	$0.00	$0.00	$706.00	"$1,118.30"	"$1,129.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-322	SUP	Custom 27803010		6752-5-322  -  INSERT TIB LG 22MM KNEE PS CNSTRN	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-325	SUP	Custom 27803010		6752-5-325  -  INSERT TIB LG 25MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-328	SUP	Custom 27803010		6752-5-328  -  INSERT TIB LG 28MM KNEE PS CNSTRN	BOTH IP/OP	"$1,381.00 "	"$1,021.94"	$0.00	"$1,104.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.98"	"$1,024.98"	$0.00	$0.00	$287.80	$0.00	$0.00	$0.00	$0.00	$690.50	"$1,093.75"	"$1,104.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-331	SUP	Custom 27803010		6752-5-331  -  INSERT TIB LG 31MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,381.00 "	"$1,021.94"	$0.00	"$1,104.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,024.98"	"$1,024.98"	$0.00	$0.00	$287.80	$0.00	$0.00	$0.00	$0.00	$690.50	"$1,093.75"	"$1,104.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-411	SUP	Custom 27803010		6752-5-411  -  INSERT TIB XL 11MM KNEE PS CNSTRN	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-413	SUP	Custom 27803010		6752-5-413  -  INSERT TIB XL 13MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-416	SUP	Custom 27803010		6752-5-416  -  INSERT TIB XL 16MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-419	SUP	Custom 27803010		6752-5-419  -  INSERT TIB XL 19MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,763.00 "	"$1,304.62"	$0.00	"$1,410.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.50"	"$1,308.50"	$0.00	$0.00	$367.41	$0.00	$0.00	$0.00	$0.00	$881.50	"$1,396.30"	"$1,410.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-422	SUP	Custom 27803010		6752-5-422  -  INSERT TIB XL 22MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6752-5-425	SUP	Custom 27803010		6752-5-425  -  INSERT TIB XL 25MM KNEE PS CNSTRN MRS	BOTH IP/OP	"$1,439.00 "	"$1,064.86"	$0.00	"$1,151.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,068.03"	"$1,068.03"	$0.00	$0.00	$299.89	$0.00	$0.00	$0.00	$0.00	$719.50	"$1,139.69"	"$1,151.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
67525P	SUP	HCPCS C1713		67525P  -  SCREW BN 6.75MM 25MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67525S	SUP	HCPCS C1713		67525S  -  SCREW BN STD 6.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67530P	SUP	HCPCS C1713		67530P  -  SCREW BN 6.75MM 30MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67530S	SUP	HCPCS C1713		67530S  -  SCREW BN STD 6.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67535P	SUP	HCPCS C1713		67535P  -  SCREW BN 6.75MM 35MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67535S	SUP	HCPCS C1713		67535S  -  SCREW BN STD 6.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67540P	SUP	HCPCS C1713		67540P  -  SCREW BN 6.75MM 40MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67540S	SUP	HCPCS C1713		67540S  -  SCREW BN STD 6.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67545P	SUP	HCPCS C1713		67545P  -  SCREW BN 6.75MM 45MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67545S	SUP	HCPCS C1713		67545S  -  SCREW BN STD 6.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67550P	SUP	HCPCS C1713		67550P  -  SCREW BN 6.75MM 50MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67550S	SUP	HCPCS C1713		67550S  -  SCREW BN STD 6.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67555P	SUP	HCPCS C1713		67555P  -  SCREW BN 6.75MM 55MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67555S	SUP	HCPCS C1713		67555S  -  SCREW BN STD 6.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67560P	SUP	HCPCS C1713		67560P  -  SCREW BN 6.75MM 60MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67560S	SUP	HCPCS C1713		67560S  -  SCREW BN STD 6.75MM 60MM SPRL R90D LCK SPNE THORLMBR	BOTH IP/OP	"$2,228.53 "	"$1,649.11"	$0.00	"$1,782.82"	"$1,002.84"	"$1,002.84"	$0.00	$0.00	$0.00	$464.48	"$1,654.01"	"$1,654.01"	$0.00	$0.00	$464.42	$0.00	"$1,318.17"	"$1,318.17"	$0.00	"$1,114.26"	"$1,765.00"	"$1,782.82"	$0.00		$0.00	$348.76	$0.00	$0.00	$354.78	$0.00	$0.00	$0.00	$0.00	$0.00
67565P	SUP	HCPCS C1713		67565P  -  SCREW BN 6.75MM 65MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
67565S	SUP	HCPCS C1713		67565S  -  SCREW BN STD 6.75MM 65MM SPRL R90D LCK SPNE THORLMBR	BOTH IP/OP	"$1,233.33 "	$912.66	$0.00	$986.66	$555.00	$555.00	$0.00	$0.00	$0.00	$257.06	$915.37	$915.37	$0.00	$0.00	$257.02	$0.00	$729.51	$729.51	$0.00	$616.66	$976.80	$986.66	$0.00		$0.00	$193.02	$0.00	$0.00	$196.35	$0.00	$0.00	$0.00	$0.00	$0.00
68-1405	SUP	Custom 27203010		FORCEPS SURG DBKY 5MM ATRM CURVE 330 MD	BOTH IP/OP	"$1,507.50 "	"$1,115.55"	$0.00	"$1,206.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$753.75	"$1,193.94"	"$1,206.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
68-1415	SUP	Custom 27203010		FORCEPS SURG CLN 30MM 10MM JAW 330	BOTH IP/OP	"$1,530.00 "	"$1,132.20"	$0.00	"$1,224.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$765.00	"$1,211.76"	"$1,224.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-00-22D	SUP	Custom 27803010		690-00-22D  -  INSERT ACETAB 0D D 40MM 36MM 22MM 5.6MM CONSTRAIN RING LOCK	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-00-22E	SUP	Custom 27803010		690-00-22E  -  INSERT ACETAB 0D E 44MM 36MM 22MM 7.5MM CONSTRAIN LOCK RING	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-00-28F	SUP	Custom 27803010		690-00-28F  -  INSERT ACETAB 0D F 42MM 28MM CONSTRAIN TRIDENT UHMWPE HIP	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-00-28G	SUP	Custom 27803010		690-00-28G  -  INSERT ACETAB 0D G 51.5MM 42MM 28MM 5.6MM CONSTRAIN LOCK	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-00-32H	SUP	Custom 27803010		690-00-32H  -  INSERT ACETAB 0D H 55MM 46MM 32MM 7.8MM CONSTRAIN LOCK RING	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-00-32I	SUP	Custom 27803010		690-00-32I  -  INSERT ACETAB 0D I 58MM 46MM 32MM CONSTRAIN BIPOL SPLIT RING	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-00-32J	SUP	Custom 27803010		690-00-32J  -  INSERT ACETAB 0D J 62MM 46MM 32MM CONSTRAIN BIPOL SPLIT RING	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6900PTFX	SUP	Custom 27203010		6900PTFX  -  SIZER VLV 29MM CRP-ED PRIMNT PLUS 33MM PRICRD HRT PRICRD	BOTH IP/OP	"$20,695.00 "	"$15,314.30"	$0.00	"$16,556.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,312.84"	$0.00	$0.00	$0.00	$0.00	"$10,347.50"	"$16,390.44"	"$16,556.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6900PTFX 29	SUP	Custom 27803010		6900PTFX 29  -  VALVE MTRL 29MM C-E PRM+ BPRTH THERMAFIX TRICENTRIX HLDR	BOTH IP/OP	"$18,487.50 "	"$13,680.75"	$0.00	"$14,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,852.80"	$0.00	$0.00	$0.00	$0.00	"$9,243.75"	"$14,642.10"	"$14,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-10-22E	SUP	Custom 27803010		690-10-22E  -  INSERT ACETAB 10D E 22MM CONSTRAIN TRIDENT HIP	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-10-22F	SUP	Custom 27803010		690-10-22F  -  INSERT ACETAB 10D H 48.4MM 36MM 22MM 9.9MM CONSTRAIN BIPOL	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-10-28G	SUP	Custom 27803010		690-10-28G  -  INSERT ACETAB 10D G 51.5MM 42MM 28MM 8.4MM CONSTRAIN BIPOL	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-10-28H	SUP	Custom 27803010		690-10-28H  -  INSERT ACETAB 10D H 55MM 42MM 28MM 10.2MM CONSTRAIN BIPOL	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-10-28I	SUP	Custom 27803010		690-10-28I  -  INSERT ACETAB 10D I 58MM 42MM 28MM 11.6MM CONSTRAIN RING	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-10-28J	SUP	Custom 27803010		690-10-28J  -  INSERT ACETAB 10D J 62MM 42MM 28MM 13.7MM CONSTRAIN RING	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
690-10-28K	SUP	Custom 27803010		690-10-28K  -  INSERT ACETAB 10D K 42MM 28MM CONSTRAIN BIPOL SPLIT RING	BOTH IP/OP	"$6,590.00 "	"$4,876.60"	$0.00	"$5,272.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,373.36"	$0.00	$0.00	$0.00	$0.00	"$3,295.00"	"$5,219.28"	"$5,272.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
69-2244	SUP	Custom 27803010		69-2244  -  INSERT ACETAB 0D 44MM 36MM 22MM 7.3MM CONSTRAIN SPLIT RING	BOTH IP/OP	"$6,797.50 "	"$5,030.15"	$0.00	"$5,438.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,416.60"	$0.00	$0.00	$0.00	$0.00	"$3,398.75"	"$5,383.62"	"$5,438.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
69-2246	SUP	Custom 27803010		69-2246  -  INSERT ACETAB 0D 46MM 36MM 22MM 8.3MM CONSTRAIN SPLIT RING	BOTH IP/OP	"$6,797.50 "	"$5,030.15"	$0.00	"$5,438.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,416.60"	$0.00	$0.00	$0.00	$0.00	"$3,398.75"	"$5,383.62"	"$5,438.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
69-2248	SUP	Custom 27803010		69-2248  -  INSERT ACETAB 0D 48MM 36MM 22MM CONSTRAIN BIPOL SPLIT RING	BOTH IP/OP	"$6,797.50 "	"$5,030.15"	$0.00	"$5,438.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,416.60"	$0.00	$0.00	$0.00	$0.00	"$3,398.75"	"$5,383.62"	"$5,438.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
69-2850	SUP	Custom 27803010		69-2850  -  INSERT ACETAB 0D 50MM 42MM 28MM 7.3MM CONSTRAIN SPLIT RING	BOTH IP/OP	"$6,797.50 "	"$5,030.15"	$0.00	"$5,438.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,416.60"	$0.00	$0.00	$0.00	$0.00	"$3,398.75"	"$5,383.62"	"$5,438.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
69-2852	SUP	Custom 27803010		69-2852  -  INSERT ACETAB 0D 52MM 42MM 28MM 8.3MM CONSTRAIN SPLIT RING	BOTH IP/OP	"$6,797.50 "	"$5,030.15"	$0.00	"$5,438.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,416.60"	$0.00	$0.00	$0.00	$0.00	"$3,398.75"	"$5,383.62"	"$5,438.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
69-2854	SUP	Custom 27803010		69-2854  -  INSERT ACETAB 0D 54MM 42MM 28MM 9.3MM CONSTRAIN SPLIT RING	BOTH IP/OP	"$6,797.50 "	"$5,030.15"	$0.00	"$5,438.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,416.60"	$0.00	$0.00	$0.00	$0.00	"$3,398.75"	"$5,383.62"	"$5,438.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
69-3256	SUP	Custom 27803010		69-3256  -  INSERT ACETAB 0D 56MM 46MM 32MM 8.3MM CONSTRAIN SPLIT RING	BOTH IP/OP	"$6,797.50 "	"$5,030.15"	$0.00	"$5,438.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,416.60"	$0.00	$0.00	$0.00	$0.00	"$3,398.75"	"$5,383.62"	"$5,438.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
69-3258	SUP	Custom 27803010		69-3258  -  INSERT ACETAB 0D 58MM 46MM 32MM 9.3MM CONSTRAIN SPLIT RING	BOTH IP/OP	"$6,797.50 "	"$5,030.15"	$0.00	"$5,438.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,416.60"	$0.00	$0.00	$0.00	$0.00	"$3,398.75"	"$5,383.62"	"$5,438.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
69-3260	SUP	Custom 27803010		69-3260  -  INSERT ACETAB 0D 60MM 46MM 32MM CONSTRAIN BIPOL SPLIT RING	BOTH IP/OP	"$6,797.50 "	"$5,030.15"	$0.00	"$5,438.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,416.60"	$0.00	$0.00	$0.00	$0.00	"$3,398.75"	"$5,383.62"	"$5,438.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-380	SUP	Custom 27803010		6936-0-380  -  HEAD FEM 105MM 38MM THMPSN REG HIP ENDOPRSTH FR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-400	SUP	Custom 27803010		6936-0-400  -  HEAD FEM 105MM 40MM THMPSN REG HIP FENST FR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-410	SUP	Custom 27803010		6936-0-410  -  HEAD FEM 41MM HIP ENDOPRSTH UNPLR ZML MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-420	SUP	Custom 27803010		6936-0-420  -  HEAD FEM 42MM THMPSN HIP ENDOPRSTH FR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-430	SUP	Custom 27803010		6936-0-430  -  STEM FEM 105MM 43MM ENDOPRSTH MOORE ODC OMFT RLNC UHR UNPLR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-440	SUP	Custom 27803010		6936-0-440  -  HEAD FEM 44MM THMPSN HIP ENDOPRSTH FR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-450	SUP	Custom 27803010		6936-0-450  -  HEAD FEM 105MM 45MM MOORE ODC OMFT RLNC UHR UNTRX REG HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-460	SUP	Custom 27803010		6936-0-460  -  HEAD FEM 46MM MOORE ODC OMFT RLNC UHR UNTRX HIP ENDOPRSTH FR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-470	SUP	Custom 27803010		6936-0-470  -  HEAD FEM 47MM THMPSN HIP ENDOPRSTH FR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-480	SUP	Custom 27803010		6936-0-480  -  HEAD FEM REG 48MM HIP ENDOPRSTH FRAC PRD FR. THMPSN	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-490	SUP	Custom 27803010		6936-0-490  -  HEAD FEM 105MM 49MM MOORE ODC OMFT RLNC UHR UNTRX REG HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-500	SUP	Custom 27803010		6936-0-500  -  STEM FEM 105MM 50MM ENDOPRSTH MOORE ODC OMFT RLNC UHR UNPLR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-510	SUP	Custom 27803010		6936-0-510  -  STEM FEM 105MM 51MM ENDOPRSTH MOORE ODC OMFT RLNC UHR UNPLR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-520	SUP	Custom 27803010		6936-0-520  -  HEAD FEM 105MM 52MM MOORE ODC OMFT RLNC UHR UNTRX REG HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-530	SUP	Custom 27803010		6936-0-530  -  STEM FEM 105MM 53MM ENDOPRSTH MOORE ODC OMFT RLNC UHR UNPLR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-540	SUP	Custom 27803010		6936-0-540  -  HEAD FEM 105MM 54MM MOORE ODC OMFT RLNC UHR UNTRX REG HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-550	SUP	Custom 27803010		6936-0-550  -  STEM FEM 105MM 55MM FENST MOORE ODC OMFT RLNC UHR UNPLR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6936-0-570	SUP	Custom 27803010		6936-0-570  -  HEAD FEM 57MM THMPSN FEM HIP ENDOPRSTH FR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-380	SUP	Custom 27803010		6939-0-380  -  STEM FEM 130MM 38MM CVD FENST A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-400	SUP	Custom 27803010		6939-0-400  -  STEM FEM 130MM 40MM CVD FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-410	SUP	Custom 27803010		6939-0-410  -  STEM FEM 130MM 41MM CVD FENST ENDOPRSTH A-MVIT HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-420	SUP	Custom 27803010		6939-0-420  -  STEM FEM 130MM 42MM CVD FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-430	SUP	Custom 27803010		6939-0-430  -  STEM FEM 43MM CVD FENST ENDOPRSTH MOORE HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-440	SUP	Custom 27803010		6939-0-440  -  STEM FEM 130MM 44MM CVD FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-450	SUP	Custom 27803010		6939-0-450  -  STEM FEM 140MM 45MM CVD FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-460	SUP	Custom 27803010		6939-0-460  -  STEM FEM 140MM 46MM CVD FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-470	SUP	Custom 27803010		6939-0-470  -  STEM FEM 140MM 47MM CVD FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-480	SUP	Custom 27803010		6939-0-480  -  STEM FEM 140MM 48MM CVD FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-490	SUP	Custom 27803010		6939-0-490  -  STEM FEM 140MM 49MM CVD FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-500	SUP	Custom 27803010		6939-0-500  -  STEM FEM 150MM 50MM CVD FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-510	SUP	Custom 27803010		6939-0-510  -  STEM FEM 150MM 51MM CVD FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-520	SUP	Custom 27803010		6939-0-520  -  STEM FEM 150MM 52MM CVD FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-530	SUP	Custom 27803010		6939-0-530  -  STEM FEM 53MM CVD FENST ENDOPRSTH MOORE HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-540	SUP	Custom 27803010		6939-0-540  -  STEM FEM 150MM 54MM CVD FENST A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-550	SUP	Custom 27803010		6939-0-550  -  HEAD FEM 150MM 55MM A-M FEM HIP FENST CURVE FR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-560	SUP	Custom 27803010		6939-0-560  -  HEAD FEM 56MM HIP FENST CVD MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-570	SUP	Custom 27803010		6939-0-570  -  STEM FEM 150MM 57MM CVD FENST A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-600	SUP	Custom 27803010		6939-0-600  -  STEM FEM 60MM 60MM CVD FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-0-630	SUP	Custom 27803010		6939-0-630  -  STEM FEM 150MM 63MM CVD FENST A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-380	SUP	Custom 27803010		6939-1-380  -  STEM FEM 135MM 38MM CVD FENST NAR A-M NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-400	SUP	Custom 27803010		6939-1-400  -  STEM FEM 40MM 40MM CVD FENST ENDOPRSTH A-M NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-410	SUP	Custom 27803010		6939-1-410  -  STEM FEM 135MM 41MM CVD FENST ENDOPRSTH A-M NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-420	SUP	Custom 27803010		6939-1-420  -  STEM FEM 135MM 42MM CVD FENST NAR A-M NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-430	SUP	Custom 27803010		6939-1-430  -  STEM FEM 135MM 43MM CVD FENST NAR A-M NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-440	SUP	Custom 27803010		6939-1-440  -  STEM FEM 135MM 44MM CVD FENST NAR A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-450	SUP	Custom 27803010		6939-1-450  -  STEM FEM 135MM 45MM CVD FENST A-M NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-460	SUP	Custom 27803010		6939-1-460  -  STEM FEM 135MM 46MM CVD FENST A-M NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-470	SUP	Custom 27803010		6939-1-470  -  STEM FEM 47MM CVD FENST ENDOPRSTH MOORE NAR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-480	SUP	Custom 27803010		6939-1-480  -  STEM FEM 135MM 48MM CVD FENST A-M NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-490	SUP	Custom 27803010		6939-1-490  -  STEM FEM 135MM 49MM CVD FENST A-M NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-500	SUP	Custom 27803010		6939-1-500  -  STEM FEM 135MM 50MM CVD FENST A-M NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-1-510	SUP	Custom 27803010		6939-1-510  -  STEM FEM 135MM 51MM CVD FENST A-M NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-400	SUP	Custom 27803010		6939-5-400  -  STEM FEM 40MM MOORE HIP ENDOPRSTH CVD SLD FRAC	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-410	SUP	Custom 27803010		6939-5-410  -  STEM FEM 41MM ENDOPRSTH CVD SLD FRAC MOORE HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-420	SUP	Custom 27803010		6939-5-420  -  STEM FEM 42MM ENDOPRSTH CVD SLD FRAC MOORE HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-430	SUP	Custom 27803010		6939-5-430  -  STEM FEM 43MM SLD CVD MOORE HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-440	SUP	Custom 27803010		6939-5-440  -  STEM FEM 44MM SLD CVD MOORE HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-450	SUP	Custom 27803010		6939-5-450  -  STEM FEM 45MM SLD CVD MOORE HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-460	SUP	Custom 27803010		6939-5-460  -  STEM FEM 46MM CVD SLD ENDOPRSTH MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-470	SUP	Custom 27803010		6939-5-470  -  STEM FEM 47MM ENDOPRSTH CVD SLD FRAC MOORE HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-480	SUP	Custom 27803010		6939-5-480  -  STEM FEM 48MM CVD SLD ENDOPRSTH MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-490	SUP	Custom 27803010		6939-5-490  -  STEM FEM 49MM ENDOPRSTH CVD SLD FRAC MOORE HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-500	SUP	Custom 27803010		6939-5-500  -  STEM FEM 50MM CVD SLD ENDOPRSTH MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-510	SUP	Custom 27803010		6939-5-510  -  STEM FEM 51MM ENDOPRSTH CVD SLD FRAC MOORE HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-520	SUP	Custom 27803010		6939-5-520  -  STEM FEM 52MM ENDOPRSTH MDLR CVD SLD MOORE HIP FRAC PRD	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-530	SUP	Custom 27803010		6939-5-530  -  STEM FEM 53MM CVD SLD ENDOPRSTH MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-540	SUP	Custom 27803010		6939-5-540  -  STEM FEM 54MM CVD SLD ENDOPRSTH MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-550	SUP	Custom 27803010		6939-5-550  -  STEM FEM 55MM SLD CVD ENDOPRSTH MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6939-5-570	SUP	Custom 27803010		6939-5-570  -  STEM FEM 57MM SLD CVD MOORE HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-380	SUP	Custom 27803010		6940-0-380  -  STEM FEM 165MM 38MM STR FENST A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-400	SUP	Custom 27803010		6940-0-400  -  STEM FEM 165MM 40MM STR FENST A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-410	SUP	Custom 27803010		6940-0-410  -  HEAD UNPLR 165MM 41MM MOORE ODC OMFT RLNC UHR UNTRX FEM HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-420	SUP	Custom 27803010		6940-0-420  -  HEAD FEM 42MM MOORE FEM HIP FENST STR FR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-430	SUP	Custom 27803010		6940-0-430  -  HEAD FEM 43MM A-M FEM HIP STR FENST FR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-440	SUP	Custom 27803010		6940-0-440  -  STEM FEM 165MM 44MM FENST ENDOPRSTH STR MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-450	SUP	Custom 27803010		6940-0-450  -  HEAD FEM 165MM 45MM MOORE ODC OMFT RLNC UHR UNTRX HIP STR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-460	SUP	Custom 27803010		6940-0-460  -  HEAD FEM 165MM 46MM A-M HIP FENST FR STRL	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-470	SUP	Custom 27803010		6940-0-470  -  HEAD FEM 165MM 43MM MOORE ODC OMFT RLNC UHR UNTRX HIP FENST	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-480	SUP	Custom 27803010		6940-0-480  -  HEAD FEM 48MM 48MM MOORE FEM HIP PENESTRATED FR STRL	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-490	SUP	Custom 27803010		6940-0-490  -  HEAD FEM 165MM 49MM A-M FEM HIP STR FENST FR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-500	SUP	Custom 27803010		6940-0-500  -  STEM FEM 190MM 50MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-510	SUP	Custom 27803010		6940-0-510  -  STEM FEM 190MM 51MM STR FENST ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-520	SUP	Custom 27803010		6940-0-520  -  HEAD UNPLR 190MM 52MM MOORE ODC OMFT RLNC UHR UNTRX FEM HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-530	SUP	Custom 27803010		6940-0-530  -  HEAD UNPLR 190MM 53MM MOORE ODC OMFT RLNC UHR UNTRX FEM HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-540	SUP	Custom 27803010		6940-0-540  -  HEAD UNPLR 54MM 54MM MOORE ODC OMFT RLNC UHR UNTRX FEM HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-550	SUP	Custom 27803010		6940-0-550  -  HEAD FEM 190MM 55MM A-M HIP FENST FR STRL	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-570	SUP	Custom 27803010		6940-0-570  -  HEAD FEM 190MM 57MM A-M HIP FENST STR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-600	SUP	Custom 27803010		6940-0-600  -  STEM FEM 190MM 60MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-0-630	SUP	Custom 27803010		6940-0-630  -  STEM FEM 190MM 63MM STR FENST A-M HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-380	SUP	Custom 27803010		6940-1-380  -  STEM FEM 38MM STR FENST ENDOPRSTH MOORE NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-400	SUP	Custom 27803010		6940-1-400  -  STEM FEM 40MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-410	SUP	Custom 27803010		6940-1-410  -  STEM FEM 41MM STR FENST ENDOPRSTH MOORE NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-420	SUP	Custom 27803010		6940-1-420  -  STEM FEM 42MM STR FENST ENDOPRSTH MOORE NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-430	SUP	Custom 27803010		6940-1-430  -  STEM FEM 43MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-440	SUP	Custom 27803010		6940-1-440  -  STEM FEM 44MM STR FENST ENDOPRSTH MOORE NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-450	SUP	Custom 27803010		6940-1-450  -  STEM FEM 45MM STR FENST ENDOPRSTH MOORE NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-460	SUP	Custom 27803010		6940-1-460  -  STEM FEM 46MM STR FENST ENDOPRSTH MOORE NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-470	SUP	Custom 27803010		6940-1-470  -  STEM FEM 47MM STR FENST ENDOPRSTH MOORE NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-480	SUP	Custom 27803010		6940-1-480  -  STEM FEM 48MM STR FENST ENDOPRSTH MOORE NAR HIP	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-490	SUP	Custom 27803010		6940-1-490  -  STEM FEM 49MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-500	SUP	Custom 27803010		6940-1-500  -  STEM FEM 50MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-1-510	SUP	Custom 27803010		6940-1-510  -  STEM FEM 51MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-380	SUP	Custom 27803010		6940-2-380  -  STEM FEM 300MM 38MM ENDOPRSTH STR FENST FRAC MOORE HIP	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-400	SUP	Custom 27803010		6940-2-400  -  STEM FEM 300MM 40MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-410	SUP	Custom 27803010		6940-2-410  -  STEM FEM 300MM 41MM ENDOPRSTH STR FENST FRAC MOORE HIP	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-420	SUP	Custom 27803010		6940-2-420  -  STEM FEM 300MM 42MM STR FENST ENDOPRSTH A-M ODC OMFT RLNC	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-450	SUP	Custom 27803010		6940-2-450  -  STEM FEM 300MM 45MM ENDOPRSTH STR FENST FRAC MOORE HIP	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-460	SUP	Custom 27803010		6940-2-460  -  STEM FEM 300MM 46MM ENDOPRSTH STR FENST FRAC MOORE HIP	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-470	SUP	Custom 27803010		6940-2-470  -  STEM FEM 300MM 47MM ENDOPRSTH STR FENST FRAC MOORE HIP	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-480	SUP	Custom 27803010		6940-2-480  -  STEM FEM 300MM 48MM STR FENST ENDOPRSTH A-M ODC OMFT RLNC	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-490	SUP	Custom 27803010		6940-2-490  -  STEM FEM 300MM 49MM STR FENST ENDOPRSTH MOORE	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-500	SUP	Custom 27803010		6940-2-500  -  STEM FEM 300MM 50MM STR FENST ENDOPRSTH MOORE	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-510	SUP	Custom 27803010		6940-2-510  -  STEM FEM 300MM 51MM STR FENST ENDOPRSTH MOORE HIP	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-520	SUP	Custom 27803010		6940-2-520  -  STEM FEM 300MM 52MM ENDOPRSTH STR FENST FRAC MOORE HIP	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-540	SUP	Custom 27803010		6940-2-540  -  STEM FEM 300MM 54MM ENDOPRSTH STR FENST FRAC MOORE HIP	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-550	SUP	Custom 27803010		6940-2-550  -  STEM FEM 300MM 55MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-600	SUP	Custom 27803010		6940-2-600  -  STEM FEM 300MM 60MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-2-630	SUP	Custom 27803010		6940-2-630  -  STEM FEM 300MM 63MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-400	SUP	Custom 27803010		6940-5-400  -  HEAD FEM 40MM HIP SLD STR MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-410	SUP	Custom 27803010		6940-5-410  -  HEAD FEM 41MM HIP SLD STR MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-420	SUP	Custom 27803010		6940-5-420  -  HEAD FEM 42MM HIP SLD STR MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-430	SUP	Custom 27803010		6940-5-430  -  HEAD FEM 43MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-440	SUP	Custom 27803010		6940-5-440  -  HEAD FEM 44MM HIP SLD STR MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-460	SUP	Custom 27803010		6940-5-460  -  HEAD FEM 46MM HIP SLD STR MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-470	SUP	Custom 27803010		6940-5-470  -  STEM FEM 47MM SLD ENDOPRSTH A-M STRL	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-490	SUP	Custom 27803010		6940-5-490  -  HEAD FEM 49MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-500	SUP	Custom 27803010		6940-5-500  -  HEAD FEM 50MM HIP SLD STR MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-510	SUP	Custom 27803010		6940-5-510  -  HEAD FEM 51MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-520	SUP	Custom 27803010		6940-5-520  -  HEAD FEM 52MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-530	SUP	Custom 27803010		6940-5-530  -  STEM FEM 53MM SLD ENDOPRSTH A-M STRL	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-540	SUP	Custom 27803010		6940-5-540  -  HEAD FEM 54MM HIP SLD STR MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-550	SUP	Custom 27803010		6940-5-550  -  HEAD FEM 55MM HIP SLD STR MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-570	SUP	Custom 27803010		6940-5-570  -  HEAD FEM 57MM HIP SLD STR MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-600	SUP	Custom 27803010		6940-5-600  -  HEAD FEM 60MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-5-630	SUP	Custom 27803010		6940-5-630  -  HEAD FEM 63MM HIP SLD STR MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-6-410	SUP	Custom 27803010		6940-6-410  -  STEM FEM 41MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-6-420	SUP	Custom 27803010		6940-6-420  -  STEM FEM 42MM STR SLD ENDOPRSTH MOORE	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-6-440	SUP	Custom 27803010		6940-6-440  -  STEM FEM 44MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-6-450	SUP	Custom 27803010		6940-6-450  -  STEM FEM 45MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-6-460	SUP	Custom 27803010		6940-6-460  -  STEM FEM 46MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-6-470	SUP	Custom 27803010		6940-6-470  -  STEM FEM 47MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-6-480	SUP	Custom 27803010		6940-6-480  -  STEM FEM 48MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-6-490	SUP	Custom 27803010		6940-6-490  -  STEM FEM 49MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR	BOTH IP/OP	"$1,257.00 "	$930.18	$0.00	"$1,005.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$932.95	$932.95	$0.00	$0.00	$261.96	$0.00	$0.00	$0.00	$0.00	$628.50	$995.54	"$1,005.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-380	SUP	Custom 27803010		6940-8-380  -  STEM FEM 200MM 38MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-400	SUP	Custom 27803010		6940-8-400  -  STEM FEM 200MM 40MM STR FENST ENDOPRSTH MOORE	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-410	SUP	Custom 27803010		6940-8-410  -  STEM FEM 200MM 41MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-420	SUP	Custom 27803010		6940-8-420  -  STEM FEM 200MM 42MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-430	SUP	Custom 27803010		6940-8-430  -  STEM FEM 200MM 43MM ENDOPRSTH A-M HIP	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-440	SUP	Custom 27803010		6940-8-440  -  STEM FEM 200MM 44MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-450	SUP	Custom 27803010		6940-8-450  -  STEM FEM 200MM 45MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-460	SUP	Custom 27803010		6940-8-460  -  STEM FEM 200MM 46MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-470	SUP	Custom 27803010		6940-8-470  -  STEM FEM 200MM 47MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-500	SUP	Custom 27803010		6940-8-500  -  STEM FEM 200MM 50MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-510	SUP	Custom 27803010		6940-8-510  -  STEM FEM 200MM 51MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-530	SUP	Custom 27803010		6940-8-530  -  STEM FEM 200MM 53MM STR FENST A-M HIP	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-540	SUP	Custom 27803010		6940-8-540  -  STEM FEM 200MM 54MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-550	SUP	Custom 27803010		6940-8-550  -  STEM FEM 200MM 55MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-570	SUP	Custom 27803010		6940-8-570  -  STEM FEM 200MM 57MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-600	SUP	Custom 27803010		6940-8-600  -  STEM FEM 200MM 60MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-8-630	SUP	Custom 27803010		6940-8-630  -  STEM FEM 200MM 63MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-9-380	SUP	Custom 27803010		6940-9-380  -  STEM FEM 225MM 38MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-9-410	SUP	Custom 27803010		6940-9-410  -  STEM FEM 225MM 41MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-9-440	SUP	Custom 27803010		6940-9-440  -  STEM FEM 225MM 44MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-9-460	SUP	Custom 27803010		6940-9-460  -  STEM FEM 225MM 46MM STR FENST ASTN-MOORE HIP	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-9-480	SUP	Custom 27803010		6940-9-480  -  STEM FEM 225MM 48MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-9-490	SUP	Custom 27803010		6940-9-490  -  STEM FEM 225MM 49MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-9-510	SUP	Custom 27803010		6940-9-510  -  STEM FEM 225MM 51MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-9-520	SUP	Custom 27803010		6940-9-520  -  STEM FEM 225MM 52MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-9-530	SUP	Custom 27803010		6940-9-530  -  STEM FEM 225MM 53MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-9-550	SUP	Custom 27803010		6940-9-550  -  STEM FEM 225MM 55MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-9-570	SUP	Custom 27803010		6940-9-570  -  STEM FEM 225MM 57MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6940-9-630	SUP	Custom 27803010		6940-9-630  -  STEM FEM 225MM 63MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT	BOTH IP/OP	"$1,544.00 "	"$1,142.56"	$0.00	"$1,235.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.96"	"$1,145.96"	$0.00	$0.00	$321.77	$0.00	$0.00	$0.00	$0.00	$772.00	"$1,222.85"	"$1,235.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-038	SUP	Custom 27803010		6942-5-038  -  HEAD UNPLR 38MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-040	SUP	Custom 27803010		6942-5-040  -  HEAD UNPLR 40MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-041	SUP	Custom 27803010		6942-5-041  -  HEAD UNPLR 41MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-042	SUP	Custom 27803010		6942-5-042  -  HEAD UNPLR 42MM UNTRX FEM HIP MDLR ENDOPRSTH FR STRL	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$853.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$274.00	$434.02	$438.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-043	SUP	Custom 27803010		6942-5-043  -  HEAD UNIPOLAR 43MM MODULAR THOMPSON MOORE ODC OMNIFIT HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-044	SUP	Custom 27803010		6942-5-044  -  HEAD UNPLR 44MM UNTRX HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-045	SUP	Custom 27803010		6942-5-045  -  HEAD UNPLR 45MM UNTRX FEM HIP MDLR ENDOPRSTH FR	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$853.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$274.00	$434.02	$438.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-046	SUP	Custom 27803010		6942-5-046  -  HEAD UNPLR 46MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-047	SUP	Custom 27803010		6942-5-047  -  HEAD UNIPOLAR 47MM MODULAR UNITRAX HIP FEMORAL EXETER V40	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-048	SUP	Custom 27803010		6942-5-048  -  HEAD UNPLR 48MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-049	SUP	Custom 27803010		6942-5-049  -  HEAD UNPLR 49MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$853.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$274.00	$434.02	$438.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-050	SUP	Custom 27803010		6942-5-050  -  HEAD UNPLR 50MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$853.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$274.00	$434.02	$438.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-051	SUP	Custom 27803010		6942-5-051  -  HEAD UNPLR 51MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$853.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$274.00	$434.02	$438.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-052	SUP	Custom 27803010		6942-5-052  -  HEAD UNPLR 52MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-053	SUP	Custom 27803010		6942-5-053  -  HEAD UNPLR 53MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-054	SUP	Custom 27803010		6942-5-054  -  HEAD UNPLR 54MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$853.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$274.00	$434.02	$438.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-055	SUP	Custom 27803010		6942-5-055  -  HEAD UNPLR 55MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-056	SUP	Custom 27803010		6942-5-056  -  HEAD UNPLR 56MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-057	SUP	Custom 27803010		6942-5-057  -  HEAD UNPLR 57MM UNTRX FEM HIP MDLR ENDOPRSTH	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$406.73	$406.73	$0.00	$0.00	$114.20	$0.00	$0.00	$0.00	$0.00	$274.00	$434.02	$438.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-058	SUP	Custom 27803010		6942-5-058  -  HEAD UNPLR 58MM STRL UNTRX MDLR EPRSTH HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-060	SUP	Custom 27803010		6942-5-060  -  HEAD UNPLR 60MM UNTRX FEM HIP MDLR ENDOPRSTH	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$406.73	$406.73	$0.00	$0.00	$114.20	$0.00	$0.00	$0.00	$0.00	$274.00	$434.02	$438.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-061	SUP	Custom 27803010		6942-5-061  -  HEAD UNIPOLAR 61MM MODULAR UNITRAX HIP FEMORAL EXETER V40	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-5-063	SUP	Custom 27803010		6942-5-063  -  HEAD UNPLR 63MM UNTRX FEM HIP MDLR ENDOPRSTH	BOTH IP/OP	$548.00 	$405.52	$0.00	$438.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$406.73	$406.73	$0.00	$0.00	$114.20	$0.00	$0.00	$0.00	$0.00	$274.00	$434.02	$438.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-6-010	SUP	Custom 27803010		6942-6-010  -  SLEEVE CENTERING U PCA +0MM FEM HIP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-6-020	SUP	Custom 27803010		6942-6-020  -  SLEEVE CENTERING +5MM UNITRAX PCA HIP FEMUR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-6-030	SUP	Custom 27803010		6942-6-030  -  SLEEVE CENTERING +10MM UNITRAX PCA HIP FEMUR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-6-050	SUP	Custom 27803010		6942-6-050  -  SLEEVE CENTERING -4MM UNITRAX PCA HIP FEMUR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-6-060	SUP	Custom 27803010		6942-6-060  -  SLEEVE CENTERING -4MM UNIPOLAR UNITRAX V40 HIP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-6-065	SUP	Custom 27803010		6942-6-065  -  SLEEVE CENTERING +0MM TAPER UNIPOLAR UNITRAX V40 EXETER HIP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-6-070	SUP	Custom 27803010		6942-6-070  -  SLEEVE CENTERING +4MM TAPER UNIPOLAR UNITRAX V40 EXETER HIP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-6-075	SUP	Custom 27803010		6942-6-075  -  SLEEVE CENTERING +8MM TAPER UNIPOLAR UNITRAX V40 EXETER HIP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-6-080	SUP	Custom 27803010		6942-6-080  -  SLEEVE CENTERING +12MM UNIPOLAR UNITRAX V40 HIP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-7-060	SUP	Custom 27803010		6942-7-060  -  SLEEVE CENTERING -3MM C TAPER UNITRAX HIP FEMUR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-7-065	SUP	Custom 27803010		6942-7-065  -  SLEEVE CENTERING +0MM C TAPER UNITRAX HIP FEMUR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-7-075	SUP	Custom 27803010		6942-7-075  -  SLEEVE CENTERING UNTRX +5MM HIP CTPR NECK	BOTH IP/OP	$250.00 	$185.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$113.00	$178.99	$180.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-7-080	SUP	Custom 27803010		6942-7-080  -  SLEEVE CENTERING UNTRX 7.5MM CTPR	BOTH IP/OP	$226.00 	$167.24	$0.00	$180.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.74	$167.74	$0.00	$0.00	$47.10	$0.00	$0.00	$0.00	$0.00	$113.00	$178.99	$180.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6942-7-085	SUP	Custom 27203010		6942-7-085  -  SLEEVE ADJ UNTRX +10MM FEM HIP CTPR	BOTH IP/OP	$250.00 	$185.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$113.00	$178.99	$180.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6951-0-036	SUP	Custom 27803010		6951-0-036  -  SHELL ACETAB 44MM 40MM HIP VIT	BOTH IP/OP	"$1,326.00 "	$981.24	$0.00	"$1,060.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.16	$984.16	$0.00	$0.00	$276.34	$0.00	$0.00	$0.00	$0.00	$663.00	"$1,050.19"	"$1,060.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6951-0-040	SUP	Custom 27803010		6951-0-040  -  SHELL ACETAB 48MM 44MM HIP	BOTH IP/OP	"$1,326.00 "	$981.24	$0.00	"$1,060.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.16	$984.16	$0.00	$0.00	$276.34	$0.00	$0.00	$0.00	$0.00	$663.00	"$1,050.19"	"$1,060.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6951-0-045	SUP	Custom 27803010		6951-0-045  -  SHELL ACETAB 53MM 49MM HIP	BOTH IP/OP	"$1,326.00 "	$981.24	$0.00	"$1,060.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.16	$984.16	$0.00	$0.00	$276.34	$0.00	$0.00	$0.00	$0.00	$663.00	"$1,050.19"	"$1,060.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6951-0-050	SUP	Custom 27803010		6951-0-050  -  SHELL ACETAB 58MM 54MM HIP PRTRS	BOTH IP/OP	"$1,326.00 "	$981.24	$0.00	"$1,060.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.16	$984.16	$0.00	$0.00	$276.34	$0.00	$0.00	$0.00	$0.00	$663.00	"$1,050.19"	"$1,060.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6951-0-054	SUP	Custom 27803010		6951-0-054  -  SHELL ACETAB 62MM 58MM HIP VIT	BOTH IP/OP	"$1,326.00 "	$981.24	$0.00	"$1,060.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.16	$984.16	$0.00	$0.00	$276.34	$0.00	$0.00	$0.00	$0.00	$663.00	"$1,050.19"	"$1,060.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6955975L	SUP	HCPCS C1713		6955975L  -  HOOK SPNL 4.5MM NS VRTX MX LT OFST TI LMN RECON SYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
6955975R	SUP	HCPCS C1713		6955975R  -  HOOK SPNL 4.5MM NS VRTX MX RT OFST TI LMN RECON SYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
6955977L	SUP	HCPCS C1713		6955977L  -  HOOK SPNL 6MM NS VRTX MX LT OFST TI LMN RECON SYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
6955977R	SUP	HCPCS C1713		6955977R  -  HOOK SPNL 6MM NS VRTX MX RT OFST TI LMN RECON SYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
6958718PT	SUP	HCPCS C1713		6958718PT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958720PT	SUP	HCPCS C1713		6958720PT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958722PT	SUP	HCPCS C1713		6958722PT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958724PT	SUP	HCPCS C1713		6958724PT  -  SCREW BN P/T 3.5MM 24MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958726PT	SUP	HCPCS C1713		6958726PT  -  SCREW BN P/T 3.5MM 26MM GRN NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958728PT	SUP	HCPCS C1713		6958728PT  -  SCREW BN P/T 3.5MM 28MM GRN NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958730PT	SUP	HCPCS C1713		6958730PT  -  SCREW BN P/T 3.5MM 30MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958732PT	SUP	HCPCS C1713		6958732PT  -  SCREW BN P/T 3.5MM 32MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958734PT	SUP	HCPCS C1713		6958734PT  -  SCREW BN P/T 3.5MM 34MM GRN NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958736PT	SUP	HCPCS C1713		6958736PT  -  SCREW BN P/T 3.5MM 36MM GRN NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958738PT	SUP	HCPCS C1713		6958738PT  -  SCREW BN P/T 3.5MM 38MM GRN NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958740PT	SUP	HCPCS C1713		6958740PT  -  SCREW BN P/T 3.5MM 40MM GRN NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958742PT	SUP	HCPCS C1713		6958742PT  -  SCREW BN P/T 3.5MM 42MM VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958744PT	SUP	HCPCS C1713		6958744PT  -  SCREW BN P/T 3.5MM 44MM VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958746PT	SUP	HCPCS C1713		6958746PT  -  SCREW BN P/T 3.5MM 46MM VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958748PT	SUP	HCPCS C1713		6958748PT  -  SCREW BN P/T 3.5MM 48MM VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958750PT	SUP	HCPCS C1713		6958750PT  -  SCREW BN P/T 3.5MM 50MM VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958752PT	SUP	HCPCS C1713		6958752PT  -  SCREW BN P/T 3.5MM 52MM VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958818PT	SUP	HCPCS C1713		6958818PT  -  SCREW BN P/T 4MM 18MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958820PT	SUP	HCPCS C1713		6958820PT  -  SCREW BN P/T 4MM 20MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958822PT	SUP	HCPCS C1713		6958822PT  -  SCREW BN P/T 4MM 22MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958824PT	SUP	HCPCS C1713		6958824PT  -  SCREW BN P/T 4MM 24MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958826PT	SUP	HCPCS C1713		6958826PT  -  SCREW BN P/T 4MM 26MM AU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958828PT	SUP	HCPCS C1713		6958828PT  -  SCREW BN P/T 4MM 28MM AU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958830PT	SUP	HCPCS C1713		6958830PT  -  SCREW BN P/T 4MM 30MM AU 15MM VRTX MX TI SPNE OCPTL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958832PT	SUP	HCPCS C1713		6958832PT  -  SCREW BN P/T 4MM 32MM AU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958834PT	SUP	HCPCS C1713		6958834PT  -  SCREW BN P/T 4MM 34MM AU NS VRTX MX MA TI SPNE RECON SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958836PT	SUP	HCPCS C1713		6958836PT  -  SCREW BN P/T 4MM 36MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958838PT	SUP	HCPCS C1713		6958838PT  -  SCREW BN P/T 4MM 38MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958840PT	SUP	HCPCS C1713		6958840PT  -  SCREW BN P/T 4MM 40MM AU NS VRTX MX MA TI SPNE THOR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958842PT	SUP	HCPCS C1713		6958842PT  -  SCREW BN P/T 4MM 42MM AU VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958844PT	SUP	HCPCS C1713		6958844PT  -  SCREW BN P/T 4MM 44MM AU VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958846PT	SUP	HCPCS C1713		6958846PT  -  SCREW BN P/T 4MM 46MM AU VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958848PT	SUP	HCPCS C1713		6958848PT  -  SCREW BN P/T 4MM 48MM AU VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958850PT	SUP	HCPCS C1713		6958850PT  -  SCREW BN P/T 4MM 50MM AU VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6958852PT	SUP	HCPCS C1713		6958852PT  -  SCREW BN P/T 4MM 52MM AU VRTX MX MA TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
6959420PT	SUP	HCPCS C1713		6959420PT  -  SCREW BN P/T 4MM 20MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959422PT	SUP	HCPCS C1713		6959422PT  -  SCREW BN P/T 4MM 22MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959424PT	SUP	HCPCS C1713		6959424PT  -  SCREW BN P/T 4MM 24MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959426PT	SUP	HCPCS C1713		6959426PT  -  SCREW BN P/T 4MM 26MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959428PT	SUP	HCPCS C1713		6959428PT  -  SCREW BN P/T 4MM 28MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959430PT	SUP	HCPCS C1713		6959430PT  -  SCREW BN P/T 4MM 30MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959432PT	SUP	HCPCS C1713		6959432PT  -  SCREW BN P/T 4MM 32MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959434PT	SUP	HCPCS C1713		6959434PT  -  SCREW BN P/T 4MM 34MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959436PT	SUP	HCPCS C1713		6959436PT  -  SCREW BN P/T 4MM 36MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959438PT	SUP	HCPCS C1713		6959438PT  -  SCREW BN P/T 4MM 38MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6959440PT	SUP	HCPCS C1713		6959440PT  -  SCREW BN P/T 4MM 40MM MA CNN TI SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
6971250CK	SUP	HCPCS C1713		6971250CK  -  DISC INTVRTB 5MM 12MM SPNE CRV	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971270CK	SUP	HCPCS C1713		6971270CK  -  DISC INTVRTB 7MM 12MM SPNE CRV	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971450CK	SUP	HCPCS C1713		6971450CK  -  DISC INTVRTB 5MM 14MM SPNE CRV	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971470CK	SUP	HCPCS C1713		6971470CK  -  DISC INTVRTB 7MM 14MM SPNE CRV	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971480CK	SUP	HCPCS C1713		6971480CK  -  DISC INTVRTB 8MM 14MM SPNE CRV	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971650CK	SUP	HCPCS C1713		6971650CK  -  DISC INTVRTB 5MM 16MM SPNE CRV	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971670CK	SUP	HCPCS C1713		6971670CK  -  DISC INTVRTB 7MM 16MM SPNE CRV	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971680CK	SUP	HCPCS C1713		6971680CK  -  DISC INTVRTB 8MM 16MM SPNE CRV	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971870CK	SUP	HCPCS C1713		6971870CK  -  DISC INTVRTB 7MM 18MM SPNE CRV	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
6971880CK	SUP	HCPCS C1713		6971880CK  -  DISC INTVRTB 8MM 18MM SPNE CRV	BOTH IP/OP	"$10,200.00 "	"$7,548.00"	$0.00	"$8,160.00"	"$4,590.00"	"$4,590.00"	$0.00	$0.00	$0.00	"$2,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,125.68"	$0.00	"$5,028.60"	"$5,028.60"	$0.00	"$5,100.00"	"$8,078.40"	"$8,160.00"	$0.00		$0.00	"$1,596.30"	$0.00	$0.00	"$1,623.84"	$0.00	$0.00	$0.00	$0.00	$0.00
698.600S	SUP	Custom 27803010		698.600S  -  MARS 3V DISPOSABLE KIT	BOTH IP/OP	"$7,440.00 "	"$5,505.60"	$0.00	"$5,952.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,550.50"	$0.00	$0.00	$0.00	$0.00	"$3,720.00"	"$5,892.48"	"$5,952.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6980-5-030	SUP	Custom 27803010		6980-5-030  -  SRFC ARTC 30MM 1STP DISTAL KNEE	BOTH IP/OP	"$1,817.00 "	"$1,344.58"	$0.00	"$1,453.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,348.58"	"$1,348.58"	$0.00	$0.00	$378.66	$0.00	$0.00	$0.00	$0.00	$908.50	"$1,439.06"	"$1,453.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6980-5-035	SUP	HCPCS C1713		6980-5-035  -  STAPLE BONE DISTAL IMPL 35MM DISTAL KNEE 1STP	BOTH IP/OP	"$1,817.00 "	"$1,344.58"	$0.00	"$1,453.60"	$817.65	$817.65	$0.00	$0.00	$0.00	$378.71	"$1,348.58"	"$1,348.58"	$0.00	$0.00	$378.66	$0.00	"$1,074.76"	"$1,074.76"	$0.00	$908.50	"$1,439.06"	"$1,453.60"	$0.00		$0.00	$284.36	$0.00	$0.00	$289.27	$0.00	$0.00	$0.00	$0.00	$0.00
6980-5-040	SUP	HCPCS C1713		6980-5-040  -  STAPLE BONE 40MM DISTAL TIB 1STP	BOTH IP/OP	"$1,817.00 "	"$1,344.58"	$0.00	"$1,453.60"	$817.65	$817.65	$0.00	$0.00	$0.00	$378.71	"$1,348.58"	"$1,348.58"	$0.00	$0.00	$378.66	$0.00	"$1,074.76"	"$1,074.76"	$0.00	$908.50	"$1,439.06"	"$1,453.60"	$0.00		$0.00	$284.36	$0.00	$0.00	$289.27	$0.00	$0.00	$0.00	$0.00	$0.00
6980-5-045	SUP	Custom 27803010		6980-5-045  -  SRFC ARTC 45MM 1STP DISTAL	BOTH IP/OP	"$1,817.00 "	"$1,344.58"	$0.00	"$1,453.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,348.58"	"$1,348.58"	$0.00	$0.00	$378.66	$0.00	$0.00	$0.00	$0.00	$908.50	"$1,439.06"	"$1,453.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6980-5-050	SUP	HCPCS C1713		6980-5-050  -  STAPLE BONE 50MM DISTAL 1STP	BOTH IP/OP	"$1,817.00 "	"$1,344.58"	$0.00	"$1,453.60"	$817.65	$817.65	$0.00	$0.00	$0.00	$378.71	"$1,348.58"	"$1,348.58"	$0.00	$0.00	$378.66	$0.00	"$1,074.76"	"$1,074.76"	$0.00	$908.50	"$1,439.06"	"$1,453.60"	$0.00		$0.00	$284.36	$0.00	$0.00	$289.27	$0.00	$0.00	$0.00	$0.00	$0.00
6980-5-055	SUP	HCPCS C1713		6980-5-055  -  STAPLE BONE 55MM DISTAL TIB 1STP	BOTH IP/OP	"$1,817.00 "	"$1,344.58"	$0.00	"$1,453.60"	$817.65	$817.65	$0.00	$0.00	$0.00	$378.71	"$1,348.58"	"$1,348.58"	$0.00	$0.00	$378.66	$0.00	"$1,074.76"	"$1,074.76"	$0.00	$908.50	"$1,439.06"	"$1,453.60"	$0.00		$0.00	$284.36	$0.00	$0.00	$289.27	$0.00	$0.00	$0.00	$0.00	$0.00
6980-5-060	SUP	HCPCS C1713		6980-5-060  -  STAPLE BONE 60MM DISTAL FIRSTSTEP	BOTH IP/OP	"$1,817.00 "	"$1,344.58"	$0.00	"$1,453.60"	$817.65	$817.65	$0.00	$0.00	$0.00	$378.71	"$1,348.58"	"$1,348.58"	$0.00	$0.00	$378.66	$0.00	"$1,074.76"	"$1,074.76"	$0.00	$908.50	"$1,439.06"	"$1,453.60"	$0.00		$0.00	$284.36	$0.00	$0.00	$289.27	$0.00	$0.00	$0.00	$0.00	$0.00
6980-5-065	SUP	HCPCS C1713		6980-5-065  -  STAPLE BONE 65MM DISTAL KNEE FIRSTSTEP	BOTH IP/OP	"$1,817.00 "	"$1,344.58"	$0.00	"$1,453.60"	$817.65	$817.65	$0.00	$0.00	$0.00	$378.71	"$1,348.58"	"$1,348.58"	$0.00	$0.00	$378.66	$0.00	"$1,074.76"	"$1,074.76"	$0.00	$908.50	"$1,439.06"	"$1,453.60"	$0.00		$0.00	$284.36	$0.00	$0.00	$289.27	$0.00	$0.00	$0.00	$0.00	$0.00
6981-5-060	SUP	HCPCS C1713		6981-5-060  -  STAPLE BONE 60X15MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-5-065	SUP	HCPCS C1713		6981-5-065  -  STAPLE BONE 65X15MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-5-070	SUP	HCPCS C1713		6981-5-070  -  STAPLE BONE 70X15MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-5-075	SUP	HCPCS C1713		6981-5-075  -  STAPLE BONE 75 MMX 15MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-5-080	SUP	HCPCS C1713		6981-5-080  -  STAPLE BONE 80X15MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-5-085	SUP	HCPCS C1713		6981-5-085  -  STAPLE BONE 85X15MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-5-090	SUP	HCPCS C1713		6981-5-090  -  STAPLE BONE 90X15MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-6-060	SUP	HCPCS C1713		6981-6-060  -  STAPLE BONE 60X10MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-6-065	SUP	HCPCS C1713		6981-6-065  -  STAPLE BONE 65X10MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-6-070	SUP	HCPCS C1713		6981-6-070  -  STAPLE BONE 70X10MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-6-075	SUP	Custom 27803010		6981-6-075  -  SRFC ARTC 75X10MM 1STP PROX	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$0.00	$0.00	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6981-6-080	SUP	HCPCS C1713		6981-6-080  -  STAPLE BONE 80X10MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-6-085	SUP	HCPCS C1713		6981-6-085  -  STAPLE BONE 85X10MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-6-090	SUP	HCPCS C1713		6981-6-090  -  STAPLE BONE 90X10MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-7-060	SUP	HCPCS C1713		6981-7-060  -  STAPLE BONE 60MMX5MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-7-065	SUP	HCPCS C1713		6981-7-065  -  STAPLE BONE 65X5MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-7-070	SUP	HCPCS C1713		6981-7-070  -  STAPLE BONE 70MMX5MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-7-075	SUP	HCPCS C1713		6981-7-075  -  STAPLE BONE 75MMX5MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-7-080	SUP	HCPCS C1713		6981-7-080  -  STAPLE BONE 80MMX5MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-7-085	SUP	HCPCS C1713		6981-7-085  -  STAPLE BONE 85X5MM PROX KNEE 1STP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6981-7-090	SUP	HCPCS C1713		6981-7-090  -  STAPLE BONE 90X5MM PROX FIRSTSTEP	BOTH IP/OP	"$1,137.00 "	$841.38	$0.00	$909.60	$511.65	$511.65	$0.00	$0.00	$0.00	$236.98	$843.88	$843.88	$0.00	$0.00	$236.95	$0.00	$672.54	$672.54	$0.00	$568.50	$900.50	$909.60	$0.00		$0.00	$177.94	$0.00	$0.00	$181.01	$0.00	$0.00	$0.00	$0.00	$0.00
6985M	SUP	Custom 27203010		KIT EXTENDER LEAD	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6A0001	SUP	HCPCS C1725		CATHETER 6FR JR 3.5	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$47.51	$47.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
6A0014	SUP	HCPCS C1725		CATHETER ANGIO JR6 CURVE 6FR 100CM STSR	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
6A0019	SUP	HCPCS C1725		CATHETER ANGIO AR2 CURVE 6FR 100CM STSR	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
6A002	SUP	HCPCS C1725		CATHETER 6FR JR4	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$19.01	$19.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00		$0.00	$5.48	$0.00	$0.00	$5.57	$0.00	$0.00	$0.00	$0.00	$0.00
6A0021	SUP	HCPCS C1725		CATHETER ANGIO AL2 CURVE 6FR 100CM STSR	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
6A0024	SUP	HCPCS C1725		CATHETER ANGIO 6FR 100CM 2 SH STSR	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
6A003	SUP	HCPCS C1725		CATHETER 6FR JR5	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
6A0033	SUP	HCPCS C1725		CATHETER ANGIO IMA CURVE 6FR 100CM STSR	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
6A0034	SUP	HCPCS C1725		CATHETER ANGIO LCB CURVE 6FR 100CM STSR	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
6A0080	SUP	HCPCS C1725		CATHETER ANGIO JL3.5 CURVE 6FR 100CM STSR	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
6A0083	SUP	HCPCS C1725		CATHETER ANGIO JL5 CURVE 6FR 100CM STSR	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
6A0085	SUP	HCPCS C1725		CATHETER ANGIO JL4 CURVE 6FR 100CM STSR	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
6DCFN	SUP	Custom 27203010		6DCFN  -  TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUFLS DISP INR	BOTH IP/OP	$83.74 	$61.97	$0.00	$66.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.15	$62.15	$0.00	$0.00	$17.45	$0.00	$0.00	$0.00	$0.00	$41.87	$66.32	$66.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6DCFS	SUP	Custom 27203010		6DCFS  -  TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUFLS DISP INR	BOTH IP/OP	$104.53 	$77.35	$0.00	$77.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.58	$77.58	$0.00	$0.00	$21.78	$0.00	$0.00	$0.00	$0.00	$44.95	$71.20	$71.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6DCT	SUP	Custom 27203010		6DCT  -  TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUF DISP INR CNN	BOTH IP/OP	$117.10 	$86.65	$0.00	$86.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.91	$86.91	$0.00	$0.00	$24.40	$0.00	$0.00	$0.00	$0.00	$47.54	$75.30	$76.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6DFEN	SUP	Custom 27203010		6DFEN  -  TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUF DISP INR CNN	BOTH IP/OP	$99.43 	$73.58	$0.00	$80.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.79	$73.79	$0.00	$0.00	$20.72	$0.00	$0.00	$0.00	$0.00	$50.46	$79.93	$80.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6E1322	SUP	Custom 25803010		SOLUTION IV 0.9% NA CHLOR 250ML AVIVA LF	BOTH IP/OP	$7.70 	$5.70	$0.00	$6.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.85	$6.10	$6.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6L215	SUP	Custom 27203010		BELT 5 THK7/16IN 101IN B TYPE WRP 21/32IN	BOTH IP/OP	$81.35 	$60.20	$0.00	$65.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.68	$64.43	$65.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6LGT	SUP	Custom 27203010		6LGT  -  TUBE 50MM 11.1MM 6.4MM UNCUF LRNTMY SHLY TRCH 6 STRL LATEX	BOTH IP/OP	$114.73 	$84.90	$0.00	$95.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.15	$85.15	$0.00	$0.00	$23.91	$0.00	$0.00	$0.00	$0.00	$59.99	$92.23	$95.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6LGT	SUP	Custom 27203010		TUBE 6.4MM UNCUF LRNTMY SHLY TRCH 6	BOTH IP/OP	$114.73 	$84.90	$0.00	$95.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.15	$85.15	$0.00	$0.00	$23.91	$0.00	$0.00	$0.00	$0.00	$59.99	$95.02	$95.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6M02A	SUP	Custom 27203010		6M02A  -  SUTURE NONABSORBABLE CV-6 TTC-9 30IN 2 ARM MONOFILAMENT	BOTH IP/OP	$73.33 	$54.26	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.43	$54.43	$0.00	$0.00	$15.28	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
6SCT	SUP	Custom 27203010		6SCT  -  TUBE TRCH 6 8.3MM 6MM 67MM LF SHLY CUF SGL CNN RND TIP OBT	BOTH IP/OP	$71.38 	$52.82	$0.00	$57.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.97	$52.97	$0.00	$0.00	$14.87	$0.00	$0.00	$0.00	$0.00	$36.22	$57.38	$57.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-0007	SUP	HCPCS C1713		70-0007  -  PLATE BN 5 HL 1ST TARSOMETATARSAL	BOTH IP/OP	"$1,022.50 "	$756.65	$0.00	$818.00	$460.13	$460.13	$0.00	$0.00	$0.00	$213.11	$758.90	$758.90	$0.00	$0.00	$213.09	$0.00	$604.81	$604.81	$0.00	$511.25	$809.82	$818.00	$0.00		$0.00	$160.02	$0.00	$0.00	$162.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0008	SUP	HCPCS C1713		70-0008  -  PLATE BN 4 HL 1ST TARSOMETATARSAL	BOTH IP/OP	"$1,022.50 "	$756.65	$0.00	$818.00	$460.13	$460.13	$0.00	$0.00	$0.00	$213.11	$758.90	$758.90	$0.00	$0.00	$213.09	$0.00	$604.81	$604.81	$0.00	$511.25	$809.82	$818.00	$0.00		$0.00	$160.02	$0.00	$0.00	$162.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0009	SUP	HCPCS C1713		70-0009  -  PLATE BN 4 HL 2ND AND 3RD TARSOMETATARSAL	BOTH IP/OP	"$1,022.50 "	$756.65	$0.00	$818.00	$460.13	$460.13	$0.00	$0.00	$0.00	$213.11	$758.90	$758.90	$0.00	$0.00	$213.09	$0.00	$604.81	$604.81	$0.00	$511.25	$809.82	$818.00	$0.00		$0.00	$160.02	$0.00	$0.00	$162.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0010	SUP	HCPCS C1713		70-0010  -  PLATE BN LCK LT PROX MTP	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0011	SUP	HCPCS C1713		70-0011  -  PLATE BN LCK RT PROX MTP	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0012	SUP	HCPCS C1713		70-0012  -  PLATE BN LCK FSN LT DRSL 1ST MTP	BOTH IP/OP	"$1,022.50 "	$756.65	$0.00	$818.00	$460.13	$460.13	$0.00	$0.00	$0.00	$213.11	$758.90	$758.90	$0.00	$0.00	$213.09	$0.00	$604.81	$604.81	$0.00	$511.25	$809.82	$818.00	$0.00		$0.00	$160.02	$0.00	$0.00	$162.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0013	SUP	HCPCS C1713		70-0013  -  PLATE BN LCK FSN RT DRSL 1ST MTP	BOTH IP/OP	"$1,022.50 "	$756.65	$0.00	$818.00	$460.13	$460.13	$0.00	$0.00	$0.00	$213.11	$758.90	$758.90	$0.00	$0.00	$213.09	$0.00	$604.81	$604.81	$0.00	$511.25	$809.82	$818.00	$0.00		$0.00	$160.02	$0.00	$0.00	$162.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0018	SUP	HCPCS C1713		70-0018  -  PLATE BN REV LCK FSN LT 1ST MTP	BOTH IP/OP	"$1,022.50 "	$756.65	$0.00	$818.00	$460.13	$460.13	$0.00	$0.00	$0.00	$213.11	$758.90	$758.90	$0.00	$0.00	$213.09	$0.00	$604.81	$604.81	$0.00	$511.25	$809.82	$818.00	$0.00		$0.00	$160.02	$0.00	$0.00	$162.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0019	SUP	HCPCS C1713		70-0019  -  PLATE BN REV LCK FSN RT 1ST MTP	BOTH IP/OP	"$1,022.50 "	$756.65	$0.00	$818.00	$460.13	$460.13	$0.00	$0.00	$0.00	$213.11	$758.90	$758.90	$0.00	$0.00	$213.09	$0.00	$604.81	$604.81	$0.00	$511.25	$809.82	$818.00	$0.00		$0.00	$160.02	$0.00	$0.00	$162.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0022	SUP	HCPCS C1713		70-0022  -  PLATE SM TI LCK BONE LEFT CALC NONSTRL	BOTH IP/OP	"$3,520.00 "	"$2,604.80"	$0.00	"$2,816.00"	"$1,584.00"	"$1,584.00"	$0.00	$0.00	$0.00	$733.66	"$2,612.54"	"$2,612.54"	$0.00	$0.00	$733.57	$0.00	"$1,735.36"	"$1,735.36"	$0.00	"$1,760.00"	"$2,787.84"	"$2,816.00"	$0.00		$0.00	$550.88	$0.00	$0.00	$560.38	$0.00	$0.00	$0.00	$0.00	$0.00
70-0023	SUP	HCPCS C1713		70-0023  -  PLATE SM LCK BONE RIGHT CALC	BOTH IP/OP	"$3,520.00 "	"$2,604.80"	$0.00	"$2,816.00"	"$1,584.00"	"$1,584.00"	$0.00	$0.00	$0.00	$733.66	"$2,612.54"	"$2,612.54"	$0.00	$0.00	$733.57	$0.00	"$1,735.36"	"$1,735.36"	$0.00	"$1,760.00"	"$2,787.84"	"$2,816.00"	$0.00		$0.00	$550.88	$0.00	$0.00	$560.38	$0.00	$0.00	$0.00	$0.00	$0.00
70-0024	SUP	HCPCS C1713		70-0024  -  PLATE MED BONE LEFT CALC	BOTH IP/OP	"$3,520.00 "	"$2,604.80"	$0.00	"$2,816.00"	"$1,584.00"	"$1,584.00"	$0.00	$0.00	$0.00	$733.66	"$2,612.54"	"$2,612.54"	$0.00	$0.00	$733.57	$0.00	"$1,735.36"	"$1,735.36"	$0.00	"$1,760.00"	"$2,787.84"	"$2,816.00"	$0.00		$0.00	$550.88	$0.00	$0.00	$560.38	$0.00	$0.00	$0.00	$0.00	$0.00
70-0025	SUP	HCPCS C1713		70-0025  -  PLATE BONE RIGHT CALC	BOTH IP/OP	"$3,520.00 "	"$2,604.80"	$0.00	"$2,816.00"	"$1,584.00"	"$1,584.00"	$0.00	$0.00	$0.00	$733.66	"$2,612.54"	"$2,612.54"	$0.00	$0.00	$733.57	$0.00	"$1,735.36"	"$1,735.36"	$0.00	"$1,760.00"	"$2,787.84"	"$2,816.00"	$0.00		$0.00	$550.88	$0.00	$0.00	$560.38	$0.00	$0.00	$0.00	$0.00	$0.00
70-0026	SUP	HCPCS C1713		70-0026  -  PLATE LG LCK BONE LEFT CALC NONSTRL	BOTH IP/OP	"$3,520.00 "	"$2,604.80"	$0.00	"$2,816.00"	"$1,584.00"	"$1,584.00"	$0.00	$0.00	$0.00	$733.66	"$2,612.54"	"$2,612.54"	$0.00	$0.00	$733.57	$0.00	"$1,735.36"	"$1,735.36"	$0.00	"$1,760.00"	"$2,787.84"	"$2,816.00"	$0.00		$0.00	$550.88	$0.00	$0.00	$560.38	$0.00	$0.00	$0.00	$0.00	$0.00
70-0027	SUP	HCPCS C1713		70-0027  -  PLATE LG LCK BONE CALC RIGHT	BOTH IP/OP	"$3,520.00 "	"$2,604.80"	$0.00	"$2,816.00"	"$1,584.00"	"$1,584.00"	$0.00	$0.00	$0.00	$733.66	"$2,612.54"	"$2,612.54"	$0.00	$0.00	$733.57	$0.00	"$1,735.36"	"$1,735.36"	$0.00	"$1,760.00"	"$2,787.84"	"$2,816.00"	$0.00		$0.00	$550.88	$0.00	$0.00	$560.38	$0.00	$0.00	$0.00	$0.00	$0.00
70-0036	SUP	HCPCS C1713		70-0036  -  PLATE BN MPJ 5 HL CMB FSN LCK LT 1ST MTP	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0037	SUP	HCPCS C1713		70-0037  -  PLATE 5 HOLE PRIM BONE RIGHT MTP	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-42A	SUP	HCPCS C1776		700-04-42A  -  SHELL ACTB A 42MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-44B	SUP	HCPCS C1776		700-04-44B  -  SHELL ACTB B 44MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-46C	SUP	HCPCS C1776		700-04-46C  -  SHELL ACTB C 46MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-48D	SUP	HCPCS C1776		700-04-48D  -  SHELL ACTB D 48MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
70-0045	SUP	HCPCS C1713		70-0045  -  PLATE BN STD NS ACLC LOPRFL LCK SHFT FX ANG SCR HL KWR HL TI	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,060.00"	"$1,158.75"	"$1,158.75"	$0.00	$0.00	$0.00	$536.69	"$1,911.17"	"$1,911.17"	$0.00	$0.00	$536.63	$0.00	"$1,269.48"	"$1,269.48"	$0.00	"$1,287.50"	"$2,039.40"	"$2,060.00"	$0.00		$0.00	$402.99	$0.00	$0.00	$409.94	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-50D	SUP	HCPCS C1776		700-04-50D  -  SHELL ACTB D 50MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-52E	SUP	HCPCS C1776		700-04-52E  -  SHELL ACTB E 52MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-54E	SUP	HCPCS C1776		700-04-54E  -  SHELL ACTB E 54MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-56F	SUP	HCPCS C1776		700-04-56F  -  SHELL ACTB F 56MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-58F	SUP	HCPCS C1776		700-04-58F  -  SHELL ACTB F 58MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
70-0046	SUP	HCPCS C1713		70-0046  -  PLATE BN STD RT DIST VOLR ULN	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,060.00"	"$1,158.75"	"$1,158.75"	$0.00	$0.00	$0.00	$536.69	"$1,911.17"	"$1,911.17"	$0.00	$0.00	$536.63	$0.00	"$1,269.48"	"$1,269.48"	$0.00	"$1,287.50"	"$2,039.40"	"$2,060.00"	$0.00		$0.00	$402.99	$0.00	$0.00	$409.94	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-60G	SUP	HCPCS C1776		700-04-60G  -  SHELL ACTB G 60MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-62G	SUP	HCPCS C1776		700-04-62G  -  SHELL ACTB G 62MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-64H	SUP	HCPCS C1776		700-04-64H  -  SHELL ACTB H 64MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
700-04-66H	SUP	HCPCS C1776		700-04-66H  -  SHELL ACTB H 66MM STRL TRDNT II SB TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
70-0047	SUP	HCPCS C1713		70-0047  -  PLATE BN LNG LG DIST ULN	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,060.00"	"$1,158.75"	"$1,158.75"	$0.00	$0.00	$0.00	$536.69	"$1,911.17"	"$1,911.17"	$0.00	$0.00	$536.63	$0.00	"$1,269.48"	"$1,269.48"	$0.00	"$1,287.50"	"$2,039.40"	"$2,060.00"	$0.00		$0.00	$402.99	$0.00	$0.00	$409.94	$0.00	$0.00	$0.00	$0.00	$0.00
70-0048	SUP	HCPCS C1713		70-0048  -  PLATE BN LNG NS ACLC LOPRFL LCK SHFT FX ANG SCR HL KWR HL TI	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,060.00"	"$1,158.75"	"$1,158.75"	$0.00	$0.00	$0.00	$536.69	"$1,911.17"	"$1,911.17"	$0.00	$0.00	$536.63	$0.00	"$1,269.48"	"$1,269.48"	$0.00	"$1,287.50"	"$2,039.40"	"$2,060.00"	$0.00		$0.00	$402.99	$0.00	$0.00	$409.94	$0.00	$0.00	$0.00	$0.00	$0.00
70-0049	SUP	HCPCS C1713		70-0049  -  PLATE 8 HOLE LCK BONE 1ST TARSOMETATARSAL	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-005	SUP	HCPCS C1713		70-005  -  PLATE STD ACLC BONE DORSAL DISTAL RADL	BOTH IP/OP	"$2,362.50 "	"$1,748.25"	$0.00	"$1,890.00"	"$1,063.13"	"$1,063.13"	$0.00	$0.00	$0.00	$492.40	"$1,753.45"	"$1,753.45"	$0.00	$0.00	$492.35	$0.00	"$1,397.42"	"$1,397.42"	$0.00	"$1,181.25"	"$1,871.10"	"$1,890.00"	$0.00		$0.00	$369.73	$0.00	$0.00	$376.11	$0.00	$0.00	$0.00	$0.00	$0.00
70-0050	SUP	HCPCS C1713		70-0050  -  PLATE 7 HOLE LCK BONE 1ST TARSOMETATARSAL	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0051	SUP	HCPCS C1713		70-0051  -  PLATE 7 HOLE LCK BONE SEC 3RD TARSOMETATARSAL	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0052	SUP	HCPCS C1713		70-0052  -  PLATE MPJ LOW PROFILE 4 DEGREE L	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0053	SUP	HCPCS C1713		70-0053  -  PLATE MPJ LOW PROFILE 4 DEGREE R	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0055	SUP	HCPCS C1713		70-0055  -  PLATE STD TI ACLC BONE LEFT DISTAL DORSAL RADL STRL	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,060.00"	"$1,158.75"	"$1,158.75"	$0.00	$0.00	$0.00	$536.69	"$1,911.17"	"$1,911.17"	$0.00	$0.00	$536.63	$0.00	"$1,269.48"	"$1,269.48"	$0.00	"$1,287.50"	"$2,039.40"	"$2,060.00"	$0.00		$0.00	$402.99	$0.00	$0.00	$409.94	$0.00	$0.00	$0.00	$0.00	$0.00
70-0056	SUP	HCPCS C1713		70-0056  -  PLATE BN STD ACLC TI RT DRSL	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,060.00"	"$1,158.75"	"$1,158.75"	$0.00	$0.00	$0.00	$536.69	"$1,911.17"	"$1,911.17"	$0.00	$0.00	$536.63	$0.00	"$1,269.48"	"$1,269.48"	$0.00	"$1,287.50"	"$2,039.40"	"$2,060.00"	$0.00		$0.00	$402.99	$0.00	$0.00	$409.94	$0.00	$0.00	$0.00	$0.00	$0.00
70-0057	SUP	HCPCS C1713		70-0057  -  PLATE BN NAR NS ACLC LOPRFL LCK SHFT FX ANG SCR HL KWR HL TI	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,060.00"	"$1,158.75"	"$1,158.75"	$0.00	$0.00	$0.00	$536.69	"$1,911.17"	"$1,911.17"	$0.00	$0.00	$536.63	$0.00	"$1,269.48"	"$1,269.48"	$0.00	"$1,287.50"	"$2,039.40"	"$2,060.00"	$0.00		$0.00	$402.99	$0.00	$0.00	$409.94	$0.00	$0.00	$0.00	$0.00	$0.00
70-0058	SUP	HCPCS C1713		70-0058  -  PLATE BN NAR ACLC RT DRSL	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,060.00"	"$1,158.75"	"$1,158.75"	$0.00	$0.00	$0.00	$536.69	"$1,911.17"	"$1,911.17"	$0.00	$0.00	$536.63	$0.00	"$1,269.48"	"$1,269.48"	$0.00	"$1,287.50"	"$2,039.40"	"$2,060.00"	$0.00		$0.00	$402.99	$0.00	$0.00	$409.94	$0.00	$0.00	$0.00	$0.00	$0.00
70-0063	SUP	HCPCS C1713		70-0063  -  PLATE BN STD STRL ACLC XTD	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,060.00"	"$1,158.75"	"$1,158.75"	$0.00	$0.00	$0.00	$536.69	"$1,911.17"	"$1,911.17"	$0.00	$0.00	$536.63	$0.00	"$1,269.48"	"$1,269.48"	$0.00	"$1,287.50"	"$2,039.40"	"$2,060.00"	$0.00		$0.00	$402.99	$0.00	$0.00	$409.94	$0.00	$0.00	$0.00	$0.00	$0.00
70-0064	SUP	HCPCS C1713		70-0064  -  PLATE NAR TI ACLC BONE LEFT DISTAL VOLR ULN	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,060.00"	"$1,158.75"	"$1,158.75"	$0.00	$0.00	$0.00	$536.69	"$1,911.17"	"$1,911.17"	$0.00	$0.00	$536.63	$0.00	"$1,269.48"	"$1,269.48"	$0.00	"$1,287.50"	"$2,039.40"	"$2,060.00"	$0.00		$0.00	$402.99	$0.00	$0.00	$409.94	$0.00	$0.00	$0.00	$0.00	$0.00
70-0066	SUP	HCPCS C1713		70-0066  -  PLATE 80MM 6 HOLE MIDSHAFT ACUMED BONE VOLR RADL STRL	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0067	SUP	HCPCS C1713		70-0067  -  PLATE TI 8 HOLE MIDSHAFT BONE VOLR RADL	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0068	SUP	HCPCS C1713		70-0068  -  PLATE 10 HOLE MIDSHAFT ACUMED BONE VOLR RADL STRL	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0069	SUP	HCPCS C1713		70-0069  -  PLATE 160MM 12 HOLE MIDSHAFT BONE VOLR RADL	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0070	SUP	HCPCS C1713		70-0070  -  PLATE BN 80MM NS 6 HL MIDSHAFT LOPRFL ULNA	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0071	SUP	HCPCS C1713		70-0071  -  PLATE BN 100MM NS 8 HL MIDSHAFT LOPRFL ULNA	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0072	SUP	HCPCS C1713		70-0072  -  PLATE TI 10 HOLE BONE ULN	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0073	SUP	HCPCS C1713		70-0073  -  PLATE 12 HOLE MIDSHAFT BONE ULN	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0074	SUP	HCPCS C1713		70-0074  -  PLATE 6 HOLE MIDSHAFT BONE ULN	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0075	SUP	HCPCS C1713		70-0075  -  PLATE BN 100MM NS 8 HL MIDSHAFT LOPRFL RDS DORSOLATERAL	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0076	SUP	HCPCS C1713		70-0076  -  PLATE 10 HOLE BONE DORSOLATERAL RADL	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0077	SUP	HCPCS C1713		70-0077  -  PLATE 12 HOLE BONE DORSOLATERAL RADL	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0078	SUP	HCPCS C1713		70-0078  -  PLATE MPJ PETIETE 4 DEGREE L	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0079	SUP	HCPCS C1713		70-0079  -  PLATE MPJ PETIETE 4 DEGREE R	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0097	SUP	HCPCS C1713		70-0097  -  PLATE BN STD CRVTR 31MM NS 3 HL LCK RADL HD	BOTH IP/OP	"$2,652.50 "	"$1,962.85"	$0.00	"$2,122.00"	"$1,193.63"	"$1,193.63"	$0.00	$0.00	$0.00	$552.85	"$1,968.69"	"$1,968.69"	$0.00	$0.00	$552.78	$0.00	"$1,307.68"	"$1,307.68"	$0.00	"$1,326.25"	"$2,100.78"	"$2,122.00"	$0.00		$0.00	$415.12	$0.00	$0.00	$422.28	$0.00	$0.00	$0.00	$0.00	$0.00
70-0098	SUP	HCPCS C1713		70-0098  -  PLATE BN 5 HLE/HD LCK RDS	BOTH IP/OP	"$2,652.50 "	"$1,962.85"	$0.00	"$2,122.00"	"$1,193.63"	"$1,193.63"	$0.00	$0.00	$0.00	$552.85	"$1,968.69"	"$1,968.69"	$0.00	$0.00	$552.78	$0.00	"$1,307.68"	"$1,307.68"	$0.00	"$1,326.25"	"$2,100.78"	"$2,122.00"	$0.00		$0.00	$415.12	$0.00	$0.00	$422.28	$0.00	$0.00	$0.00	$0.00	$0.00
70-0099	SUP	HCPCS C1713		70-0099  -  PLATE BN SM CRV 3 HL LCK RDS HD	BOTH IP/OP	"$2,652.50 "	"$1,962.85"	$0.00	"$2,122.00"	"$1,193.63"	"$1,193.63"	$0.00	$0.00	$0.00	$552.85	"$1,968.69"	"$1,968.69"	$0.00	$0.00	$552.78	$0.00	"$1,307.68"	"$1,307.68"	$0.00	"$1,326.25"	"$2,100.78"	"$2,122.00"	$0.00		$0.00	$415.12	$0.00	$0.00	$422.28	$0.00	$0.00	$0.00	$0.00	$0.00
7000AC	SUP	Custom 27803010		7000AC  -  CLAMP SPNL SPRL R90D	BOTH IP/OP	"$1,615.25 "	"$1,195.29"	$0.00	"$1,292.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,198.84"	"$1,198.84"	$0.00	$0.00	$336.62	$0.00	$0.00	$0.00	$0.00	$807.63	"$1,279.28"	"$1,292.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7000OC	SUP	Custom 27803010		7000OC  -  CLIP FX SPRL R90D OFST CRNL	BOTH IP/OP	"$2,147.68 "	"$1,589.28"	$0.00	"$1,718.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,594.00"	"$1,594.00"	$0.00	$0.00	$447.58	$0.00	$0.00	$0.00	$0.00	"$1,073.84"	"$1,700.96"	"$1,718.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7000SOL	SUP	HCPCS C1713		7000SOL  -  SCREW BN LG SPRL R90D OFST TI THORLMBR SPNE	BOTH IP/OP	"$1,534.38 "	"$1,135.44"	$0.00	"$1,227.50"	$690.47	$690.47	$0.00	$0.00	$0.00	$319.80	"$1,138.81"	"$1,138.81"	$0.00	$0.00	$319.76	$0.00	$907.58	$907.58	$0.00	$767.19	"$1,215.23"	"$1,227.50"	$0.00		$0.00	$240.13	$0.00	$0.00	$244.27	$0.00	$0.00	$0.00	$0.00	$0.00
7000SOS	SUP	HCPCS C1713		7000SOS  -  SCREW BN SHRT SPRL R90D OFST TI THORLMBR SPNE	BOTH IP/OP	"$1,534.38 "	"$1,135.44"	$0.00	"$1,227.50"	$690.47	$690.47	$0.00	$0.00	$0.00	$319.80	"$1,138.81"	"$1,138.81"	$0.00	$0.00	$319.76	$0.00	$907.58	$907.58	$0.00	$767.19	"$1,215.23"	"$1,227.50"	$0.00		$0.00	$240.13	$0.00	$0.00	$244.27	$0.00	$0.00	$0.00	$0.00	$0.00
70-0100	SUP	HCPCS C1713		70-0100  -  PLATE SM 5 HOLE LCK CRVTR BONE RADL HEAD STRL	BOTH IP/OP	"$2,652.50 "	"$1,962.85"	$0.00	"$2,122.00"	"$1,193.63"	"$1,193.63"	$0.00	$0.00	$0.00	$552.85	"$1,968.69"	"$1,968.69"	$0.00	$0.00	$552.78	$0.00	"$1,307.68"	"$1,307.68"	$0.00	"$1,326.25"	"$2,100.78"	"$2,122.00"	$0.00		$0.00	$415.12	$0.00	$0.00	$422.28	$0.00	$0.00	$0.00	$0.00	$0.00
70-0109	SUP	HCPCS C1713		70-0109  -  PLATE BONE LEFT TIB MTP	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0110	SUP	HCPCS C1713		70-0110  -  PLATE BONE RIGHT TIB MTP	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0111	SUP	HCPCS C1713		70-0111  -  PLATE BN 12 HL LCK LT DIST 3.5 MM SCR	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0112	SUP	HCPCS C1713		70-0112  -  PLATE BN 12 HL LCK LT DIST 3.5 MM SCR	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0116	SUP	HCPCS C1713		70-0116  -  PLATE BN 9 HL LCK LT DIST 3.5 MM SCR	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0117	SUP	HCPCS C1713		70-0117  -  PLATE BN DIST CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0118	SUP	HCPCS C1713		70-0118  -  PLATE BN 8 HL LAT ANT	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0119	SUP	HCPCS C1713		70-0119  -  PLATE BN 8 HL LCK ANT MDL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0120	SUP	HCPCS C1713		70-0120  -  PLATE BN 6 HL LCK ANT MDL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0121	SUP	HCPCS C1713		70-0121  -  PLATE BN 10 HL ANT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0122	SUP	HCPCS C1713		70-0122  -  PLATE BN 6 HL LCK ANT LAT	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0123	SUP	HCPCS C1713		70-0123  -  PLATE BN 16 HL LCK RT DIST 2.3 MM SCR	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0124	SUP	HCPCS C1713		70-0124  -  PLATE BN 101X11MM NS 16 HL LCK LOPRFL TI CLVCL LT DIST 2.3MM	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0125	SUP	HCPCS C1713		70-0125  -  PLATE BN 13 HL LCK RT DIST 2.3 MM SCR	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0126	SUP	HCPCS C1713		70-0126  -  PLATE BN 68X11MM NS 13 HL LCK LOPRFL TI CLVCL LT DIST 2.3MM	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0141	SUP	HCPCS C1713		70-0141  -  PLATE 4D BONE LEFT MTP	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0142	SUP	HCPCS C1713		70-0142  -  PLATE 4D BONE RIGHT MTP	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0143	SUP	HCPCS C1713		70-0143  -  PLATE REV BONE LEFT MTP	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0144	SUP	HCPCS C1713		70-0144  -  PLATE REV BONE RIGHT MTP	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0145	SUP	HCPCS C1713		70-0145  -  PLATE 5 HOLE BONE FIB	BOTH IP/OP	"$3,222.50 "	"$2,384.65"	$0.00	"$2,578.00"	"$1,450.13"	"$1,450.13"	$0.00	$0.00	$0.00	$671.65	"$2,391.74"	"$2,391.74"	$0.00	$0.00	$671.57	$0.00	"$1,588.69"	"$1,588.69"	$0.00	"$1,611.25"	"$2,552.22"	"$2,578.00"	$0.00		$0.00	$504.32	$0.00	$0.00	$513.02	$0.00	$0.00	$0.00	$0.00	$0.00
70-0147	SUP	HCPCS C1713		70-0147  -  PLATE 7 HOLE LCK BONE LAT FIB	BOTH IP/OP	"$3,222.50 "	"$2,384.65"	$0.00	"$2,578.00"	"$1,450.13"	"$1,450.13"	$0.00	$0.00	$0.00	$671.65	"$2,391.74"	"$2,391.74"	$0.00	$0.00	$671.57	$0.00	"$1,588.69"	"$1,588.69"	$0.00	"$1,611.25"	"$2,552.22"	"$2,578.00"	$0.00		$0.00	$504.32	$0.00	$0.00	$513.02	$0.00	$0.00	$0.00	$0.00	$0.00
70-0149	SUP	HCPCS C1713		70-0149  -  PLATE 9 HOLE LP LCK BONE LAT FIB ANKL	BOTH IP/OP	"$3,222.50 "	"$2,384.65"	$0.00	"$2,578.00"	"$1,450.13"	"$1,450.13"	$0.00	$0.00	$0.00	$671.65	"$2,391.74"	"$2,391.74"	$0.00	$0.00	$671.57	$0.00	"$1,588.69"	"$1,588.69"	$0.00	"$1,611.25"	"$2,552.22"	"$2,578.00"	$0.00		$0.00	$504.32	$0.00	$0.00	$513.02	$0.00	$0.00	$0.00	$0.00	$0.00
70-0151	SUP	HCPCS C1713		70-0151  -  PLATE 11 HOLE LCK LP TYPE 2 ANODIZE FNSH BONE LAT FIB ANKL	BOTH IP/OP	"$3,222.50 "	"$2,384.65"	$0.00	"$2,578.00"	"$1,450.13"	"$1,450.13"	$0.00	$0.00	$0.00	$671.65	"$2,391.74"	"$2,391.74"	$0.00	$0.00	$671.57	$0.00	"$1,588.69"	"$1,588.69"	$0.00	"$1,611.25"	"$2,552.22"	"$2,578.00"	$0.00		$0.00	$504.32	$0.00	$0.00	$513.02	$0.00	$0.00	$0.00	$0.00	$0.00
70-0153	SUP	HCPCS C1713		70-0153  -  PLATE 13 HOLE LCK LP BONE LAT FIB ANKL NONSTRL	BOTH IP/OP	"$3,222.50 "	"$2,384.65"	$0.00	"$2,578.00"	"$1,450.13"	"$1,450.13"	$0.00	$0.00	$0.00	$671.65	"$2,391.74"	"$2,391.74"	$0.00	$0.00	$671.57	$0.00	"$1,588.69"	"$1,588.69"	$0.00	"$1,611.25"	"$2,552.22"	"$2,578.00"	$0.00		$0.00	$504.32	$0.00	$0.00	$513.02	$0.00	$0.00	$0.00	$0.00	$0.00
70-0169	SUP	HCPCS C1713		70-0169  -  PLATE BN STD 9 HL LCK LAT FIB	BOTH IP/OP	"$3,222.50 "	"$2,384.65"	$0.00	"$2,578.00"	"$1,450.13"	"$1,450.13"	$0.00	$0.00	$0.00	$671.65	"$2,391.74"	"$2,391.74"	$0.00	$0.00	$671.57	$0.00	"$1,588.69"	"$1,588.69"	$0.00	"$1,611.25"	"$2,552.22"	"$2,578.00"	$0.00		$0.00	$504.32	$0.00	$0.00	$513.02	$0.00	$0.00	$0.00	$0.00	$0.00
70-0171	SUP	HCPCS C1713		70-0171  -  PLATE 11 HOLE LCK BONE LAT FIB ANKL NONSTRL	BOTH IP/OP	"$3,222.50 "	"$2,384.65"	$0.00	"$2,578.00"	"$1,450.13"	"$1,450.13"	$0.00	$0.00	$0.00	$671.65	"$2,391.74"	"$2,391.74"	$0.00	$0.00	$671.57	$0.00	"$1,588.69"	"$1,588.69"	$0.00	"$1,611.25"	"$2,552.22"	"$2,578.00"	$0.00		$0.00	$504.32	$0.00	$0.00	$513.02	$0.00	$0.00	$0.00	$0.00	$0.00
70-0173	SUP	HCPCS C1713		70-0173  -  PLATE 13 HOLE LCK BONE LAT FIB ANKL	BOTH IP/OP	"$3,222.50 "	"$2,384.65"	$0.00	"$2,578.00"	"$1,450.13"	"$1,450.13"	$0.00	$0.00	$0.00	$671.65	"$2,391.74"	"$2,391.74"	$0.00	$0.00	$671.57	$0.00	"$1,588.69"	"$1,588.69"	$0.00	"$1,611.25"	"$2,552.22"	"$2,578.00"	$0.00		$0.00	$504.32	$0.00	$0.00	$513.02	$0.00	$0.00	$0.00	$0.00	$0.00
70-0227	SUP	HCPCS C1713		70-0227  -  PLATE 7 HOLE LCK LP BONE MDL TIB NONSTRL	BOTH IP/OP	"$3,222.50 "	"$2,384.65"	$0.00	"$2,578.00"	"$1,450.13"	"$1,450.13"	$0.00	$0.00	$0.00	$671.65	"$2,391.74"	"$2,391.74"	$0.00	$0.00	$671.57	$0.00	"$1,588.69"	"$1,588.69"	$0.00	"$1,611.25"	"$2,552.22"	"$2,578.00"	$0.00		$0.00	$504.32	$0.00	$0.00	$513.02	$0.00	$0.00	$0.00	$0.00	$0.00
70-0229	SUP	HCPCS C1713		70-0229  -  PLATE 9 HOLE BONE MDL TIB	BOTH IP/OP	"$3,222.50 "	"$2,384.65"	$0.00	"$2,578.00"	"$1,450.13"	"$1,450.13"	$0.00	$0.00	$0.00	$671.65	"$2,391.74"	"$2,391.74"	$0.00	$0.00	$671.57	$0.00	"$1,588.69"	"$1,588.69"	$0.00	"$1,611.25"	"$2,552.22"	"$2,578.00"	$0.00		$0.00	$504.32	$0.00	$0.00	$513.02	$0.00	$0.00	$0.00	$0.00	$0.00
70-0245	SUP	HCPCS C1713		70-0245  -  PLATE 5 HOLE LCK LP BONE ANT TIB NONSTRL	BOTH IP/OP	"$3,222.50 "	"$2,384.65"	$0.00	"$2,578.00"	"$1,450.13"	"$1,450.13"	$0.00	$0.00	$0.00	$671.65	"$2,391.74"	"$2,391.74"	$0.00	$0.00	$671.57	$0.00	"$1,588.69"	"$1,588.69"	$0.00	"$1,611.25"	"$2,552.22"	"$2,578.00"	$0.00		$0.00	$504.32	$0.00	$0.00	$513.02	$0.00	$0.00	$0.00	$0.00	$0.00
70-0247	SUP	HCPCS C1713		70-0247  -  PLATE 7 HOLE LCK LP BONE ANT TIB NONSTRL	BOTH IP/OP	"$3,222.50 "	"$2,384.65"	$0.00	"$2,578.00"	"$1,450.13"	"$1,450.13"	$0.00	$0.00	$0.00	$671.65	"$2,391.74"	"$2,391.74"	$0.00	$0.00	$671.57	$0.00	"$1,588.69"	"$1,588.69"	$0.00	"$1,611.25"	"$2,552.22"	"$2,578.00"	$0.00		$0.00	$504.32	$0.00	$0.00	$513.02	$0.00	$0.00	$0.00	$0.00	$0.00
70-0286	SUP	HCPCS C1713		70-0286  -  PLATE BN 8 HL STRG LOPRFL CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0287	SUP	HCPCS C1713		70-0287  -  PLATE BN 8 HL LOPRFL STRG RT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0288	SUP	HCPCS C1713		70-0288  -  PLATE BN LNG 8 HL LOPRFL LT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0289	SUP	HCPCS C1713		70-0289  -  PLATE BN LNG 8 HL LOPRFL RT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0290	SUP	HCPCS C1713		70-0290  -  PLATE BN 8 HL LT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0291	SUP	HCPCS C1713		70-0291  -  PLATE BN MED 8 HL LOPRFL RT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0292	SUP	HCPCS C1713		70-0292  -  PLATE BN SM 8 HL LOPRFL LT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0293	SUP	HCPCS C1713		70-0293  -  PLATE BN SM 8 HL LOPRFL RT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0294	SUP	HCPCS C1713		70-0294  -  PLATE BN LG 121X11MM NS 10 HL LCK MIDSHAFT LOPRFL TI CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0295	SUP	HCPCS C1713		70-0295  -  PLATE BN 10 HL LOPRFL RT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0296	SUP	HCPCS C1713		70-0296  -  PLATE BN 6 HL LT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0297	SUP	HCPCS C1713		70-0297  -  PLATE BN NAR 6 HL LOPRFL RT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0298	SUP	HCPCS C1713		70-0298  -  PLATE BN 8 HL STRG LT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0299	SUP	HCPCS C1713		70-0299  -  PLATE BN NAR 8 HL LOPRFL STRG RT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0300	SUP	HCPCS C1713		70-0300  -  PLATE BN 8 HL LT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0301	SUP	HCPCS C1713		70-0301  -  PLATE BN NAR 8 HL LOPRFL RT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0302	SUP	HCPCS C1713		70-0302  -  PLATE BN STD 65MM NS 3 HL LOPRFL OLCRN LT	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0303	SUP	HCPCS C1713		70-0303  -  PLATE BN STD 65MM NS 3 HL LOPRFL OLCRN RT	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0304	SUP	HCPCS C1713		70-0304  -  PLATE BN STD 90MM NS 5 HL LOPRFL OLCRN LT	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0305	SUP	HCPCS C1713		70-0305  -  PLATE BN STD 90MM NS 5 HL LOPRFL OLCRN RT	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0306	SUP	HCPCS C1713		70-0306  -  PLATE BN STD 110MM NS 7 HL LOPRFL DIST TPR LMT CNTCT OLCRN	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0307	SUP	HCPCS C1713		70-0307  -  PLATE BN STD 110MM NS 7 HL LOPRFL OLCRN RT	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0308	SUP	HCPCS C1713		70-0308  -  PLATE BN STD 150MM NS 11 HL LOPRFL OLCRN LT	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0309	SUP	HCPCS C1713		70-0309  -  PLATE STD 11 HOLE BONE RIGHT OLCRN	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0310	SUP	HCPCS C1713		70-0310  -  PLATE 15 HOLE BONE CLVCL	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0311	SUP	HCPCS C1713		70-0311  -  PLATE STD 190MM 15 HOLE PRECONTOURED LP TAP-LOC TCH ANTM	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0312	SUP	HCPCS C1713		70-0312  -  PLATE BN 90MM NS 5 HL LOPRFL XTD OLCRN LT	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0313	SUP	HCPCS C1713		70-0313  -  PLATE BN 90MM NS 5 HL LOPRFL XTD OLCRN RT	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0314	SUP	HCPCS C1713		70-0314  -  PLATE 9 HOLE EXTN BONE OLCRN	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0315	SUP	HCPCS C1713		70-0315  -  PLATE 9 HOLE XTD BONE OLCRN	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0316	SUP	HCPCS C1713		70-0316  -  PLATE NAR 85MM 5 HOLE BONE LEFT OLCRN	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0317	SUP	HCPCS C1713		70-0317  -  PLATE NAR 85MM 5 HOLE OPTN DISTAL TPR DSGN LMT CNTCT PR BONE	BOTH IP/OP	"$3,137.50 "	"$2,321.75"	$0.00	"$2,510.00"	"$1,411.88"	"$1,411.88"	$0.00	$0.00	$0.00	$653.93	"$2,328.65"	"$2,328.65"	$0.00	$0.00	$653.86	$0.00	"$1,546.79"	"$1,546.79"	$0.00	"$1,568.75"	"$2,484.90"	"$2,510.00"	$0.00		$0.00	$491.02	$0.00	$0.00	$499.49	$0.00	$0.00	$0.00	$0.00	$0.00
70-0319	SUP	HCPCS C1713		70-0319  -  PLATE BN J LOPRFL LT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0320	SUP	HCPCS C1713		70-0320  -  PLATE BN J LOPRFL RT CLVCL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0323	SUP	HCPCS C1713		70-0323  -  PLATE EXTN OSTMY BONE LEFT	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0324	SUP	HCPCS C1713		70-0324  -  PLATE EXTN OSTMY BONE RIGHT	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0329	SUP	HCPCS C1713		70-0329  -  PLATE BN 4D PET LCK MTP LT	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0330	SUP	HCPCS C1713		70-0330  -  PLATE BN 4D PET MPJ LCK RT MTP	BOTH IP/OP	"$1,280.00 "	$947.20	$0.00	"$1,024.00"	$576.00	$576.00	$0.00	$0.00	$0.00	$266.78	$950.02	$950.02	$0.00	$0.00	$266.75	$0.00	$757.12	$757.12	$0.00	$640.00	"$1,013.76"	"$1,024.00"	$0.00		$0.00	$200.32	$0.00	$0.00	$203.78	$0.00	$0.00	$0.00	$0.00	$0.00
70-0331	SUP	HCPCS C1713		70-0331  -  PLATE BONE RADL STYLOID	BOTH IP/OP	"$2,315.00 "	"$1,713.10"	$0.00	"$1,852.00"	"$1,041.75"	"$1,041.75"	$0.00	$0.00	$0.00	$482.50	"$1,718.19"	"$1,718.19"	$0.00	$0.00	$482.45	$0.00	"$1,369.32"	"$1,369.32"	$0.00	"$1,157.50"	"$1,833.48"	"$1,852.00"	$0.00		$0.00	$362.30	$0.00	$0.00	$368.55	$0.00	$0.00	$0.00	$0.00	$0.00
70-0334	SUP	HCPCS C1713		70-0334  -  PLATE BN NS ACLC 2 SUT RDS LUNATE VOLR DIST	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0335	SUP	HCPCS C1713		70-0335  -  PLATE BN BTRS NS ACLC 2 RIM RDS RT DIST DRSL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0336	SUP	HCPCS C1713		70-0336  -  PLATE FRAC SYS BTRS RIM BONE LEFT DISTAL DORSAL RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0337	SUP	HCPCS C1713		70-0337  -  PLATE FRAC SYS BTRS RIM BONE RIGHT DISTAL DORSAL LUNATE RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0338	SUP	HCPCS C1713		70-0338  -  PLATE BONE LEFT DORSAL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0350	SUP	HCPCS C1713		70-0350  -  PLATE BN STD 49X24MM NS ACLC 2 VA RDS LT VOLR DIST 2.3MM SCR	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0351	SUP	HCPCS C1713		70-0351  -  PLATE BN STD 49X24MM NS ACLC 2 VA RDS RT VOLR DIST 2.3MM SCR	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0352	SUP	HCPCS C1713		70-0352  -  PLATE LNG NAR ACLC 2 BONE PROX DISTAL VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0353	SUP	HCPCS C1713		70-0353  -  PLATE ACLC BONE RIGHT DISTAL VOLR PROX	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0354	SUP	HCPCS C1713		70-0354  -  PLATE BN ACLC 2 W LT PROX	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0355	SUP	HCPCS C1713		70-0355  -  PLATE BN W ACLC 2 RT PROX DIST VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0356	SUP	HCPCS C1713		70-0356  -  PLATE BN STD SLVR NS ACLC 2 LT DIST VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0357	SUP	HCPCS C1713		70-0357  -  PLATE BN STD REG ACLC 2 RT VOLR DIST RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0358	SUP	HCPCS C1713		70-0358  -  PLATE BN NAR STRL ACLC 2 LT DIST VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0359	SUP	HCPCS C1713		70-0359  -  PLATE BN NAR STRL ACLC 2 RT DIST VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0360	SUP	HCPCS C1713		70-0360  -  PLATE BN W STRL ACLC 2 LT DIST VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0361	SUP	HCPCS C1713		70-0361  -  PLATE BN W ACLC 2 RT VOLR DIST RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0364	SUP	HCPCS C1713		70-0364  -  PLATE NTRL ACLC 2 BONE PROX DISTAL VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0365	SUP	HCPCS C1713		70-0365  -  PLATE LNG EXTN ACLC 2 BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0366	SUP	HCPCS C1713		70-0366  -  PLATE LNG EXTN ACLC 2 BONE RIGHT DISTAL VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0368	SUP	HCPCS C1713		70-0368  -  PLATE BN LNG STD ACLC 2 LT DIST VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0369	SUP	HCPCS C1713		70-0369  -  PLATE LNG STD ACLC 2 BONE RIGHT DISTAL RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0370	SUP	HCPCS C1713		70-0370  -  PLATE LNG NAR ACLC 2 BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0371	SUP	HCPCS C1713		70-0371  -  PLATE LNG NAR 65MM OPTM DSGN ACLC 2 BONE RIGHT DISTAL VOLR	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0372	SUP	HCPCS C1713		70-0372  -  PLATE BN LNG STD ACLC 2 LT PROX DIST VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0373	SUP	HCPCS C1713		70-0373  -  PLATE BN LNG STD ACLC 2 RT PROX DIST VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0374	SUP	HCPCS C1713		70-0374  -  PLATE 5 HOLE BONE LEFT DISTAL POSTLAT HUM	BOTH IP/OP	"$3,437.50 "	"$2,543.75"	$0.00	"$2,750.00"	"$1,546.88"	"$1,546.88"	$0.00	$0.00	$0.00	$716.46	"$2,551.31"	"$2,551.31"	$0.00	$0.00	$716.38	$0.00	"$1,694.69"	"$1,694.69"	$0.00	"$1,718.75"	"$2,722.50"	"$2,750.00"	$0.00		$0.00	$537.97	$0.00	$0.00	$547.25	$0.00	$0.00	$0.00	$0.00	$0.00
70-0375	SUP	HCPCS C1713		70-0375  -  PLATE 78MM 5 HOLE BONE RIGHT P/L HUM	BOTH IP/OP	"$3,437.50 "	"$2,543.75"	$0.00	"$2,750.00"	"$1,546.88"	"$1,546.88"	$0.00	$0.00	$0.00	$716.46	"$2,551.31"	"$2,551.31"	$0.00	$0.00	$716.38	$0.00	"$1,694.69"	"$1,694.69"	$0.00	"$1,718.75"	"$2,722.50"	"$2,750.00"	$0.00		$0.00	$537.97	$0.00	$0.00	$547.25	$0.00	$0.00	$0.00	$0.00	$0.00
70-0376	SUP	HCPCS C1713		70-0376  -  PLATE 103MM 7 HOLE BONE LEFT DISTAL POSTLAT HUM NONSTRL	BOTH IP/OP	"$3,437.50 "	"$2,543.75"	$0.00	"$2,750.00"	"$1,546.88"	"$1,546.88"	$0.00	$0.00	$0.00	$716.46	"$2,551.31"	"$2,551.31"	$0.00	$0.00	$716.38	$0.00	"$1,694.69"	"$1,694.69"	$0.00	"$1,718.75"	"$2,722.50"	"$2,750.00"	$0.00		$0.00	$537.97	$0.00	$0.00	$547.25	$0.00	$0.00	$0.00	$0.00	$0.00
70-0377	SUP	HCPCS C1713		70-0377  -  PLATE 7 HOLE BONE RIGHT DISTAL POSTLAT HUM	BOTH IP/OP	"$3,437.50 "	"$2,543.75"	$0.00	"$2,750.00"	"$1,546.88"	"$1,546.88"	$0.00	$0.00	$0.00	$716.46	"$2,551.31"	"$2,551.31"	$0.00	$0.00	$716.38	$0.00	"$1,694.69"	"$1,694.69"	$0.00	"$1,718.75"	"$2,722.50"	"$2,750.00"	$0.00		$0.00	$537.97	$0.00	$0.00	$547.25	$0.00	$0.00	$0.00	$0.00	$0.00
70-0378	SUP	HCPCS C1713		70-0378  -  PLATE 152MM 11 HOLE BONE LEFT DISTAL POSTLAT HUM NONSTRL	BOTH IP/OP	"$3,437.50 "	"$2,543.75"	$0.00	"$2,750.00"	"$1,546.88"	"$1,546.88"	$0.00	$0.00	$0.00	$716.46	"$2,551.31"	"$2,551.31"	$0.00	$0.00	$716.38	$0.00	"$1,694.69"	"$1,694.69"	$0.00	"$1,718.75"	"$2,722.50"	"$2,750.00"	$0.00		$0.00	$537.97	$0.00	$0.00	$547.25	$0.00	$0.00	$0.00	$0.00	$0.00
70-0379	SUP	HCPCS C1713		70-0379  -  PLATE 152MM 11 HOLE BONE RIGHT DISTAL POSTLAT HUM NONSTRL	BOTH IP/OP	"$3,437.50 "	"$2,543.75"	$0.00	"$2,750.00"	"$1,546.88"	"$1,546.88"	$0.00	$0.00	$0.00	$716.46	"$2,551.31"	"$2,551.31"	$0.00	$0.00	$716.38	$0.00	"$1,694.69"	"$1,694.69"	$0.00	"$1,718.75"	"$2,722.50"	"$2,750.00"	$0.00		$0.00	$537.97	$0.00	$0.00	$547.25	$0.00	$0.00	$0.00	$0.00	$0.00
70-0380	SUP	HCPCS C1713		70-0380  -  PLATE 203MM 15 HOLE BONE LEFT DISTAL POSTLAT HUM NONSTRL	BOTH IP/OP	"$3,437.50 "	"$2,543.75"	$0.00	"$2,750.00"	"$1,546.88"	"$1,546.88"	$0.00	$0.00	$0.00	$716.46	"$2,551.31"	"$2,551.31"	$0.00	$0.00	$716.38	$0.00	"$1,694.69"	"$1,694.69"	$0.00	"$1,718.75"	"$2,722.50"	"$2,750.00"	$0.00		$0.00	$537.97	$0.00	$0.00	$547.25	$0.00	$0.00	$0.00	$0.00	$0.00
70-0381	SUP	HCPCS C1713		70-0381  -  PLATE 203MM 15 HOLE BONE RIGHT DISTAL POSTLAT HUM NONSTRL	BOTH IP/OP	"$3,437.50 "	"$2,543.75"	$0.00	"$2,750.00"	"$1,546.88"	"$1,546.88"	$0.00	$0.00	$0.00	$716.46	"$2,551.31"	"$2,551.31"	$0.00	$0.00	$716.38	$0.00	"$1,694.69"	"$1,694.69"	$0.00	"$1,718.75"	"$2,722.50"	"$2,750.00"	$0.00		$0.00	$537.97	$0.00	$0.00	$547.25	$0.00	$0.00	$0.00	$0.00	$0.00
70-0382	SUP	HCPCS C1713		70-0382  -  PLATE NAR LNG ACLC 2 BONE LEFT PROX DISTAL VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0383	SUP	HCPCS C1713		70-0383  -  PLATE LNG NAR ACLC 2 BONE LEFT PROX DISTAL VOLR RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70-0386	SUP	HCPCS C1713		70-0386  -  PLATE MED BONE LEFT ANT CALC	BOTH IP/OP	"$3,052.50 "	"$2,258.85"	$0.00	"$2,442.00"	"$1,373.63"	"$1,373.63"	$0.00	$0.00	$0.00	$636.22	"$2,265.57"	"$2,265.57"	$0.00	$0.00	$636.14	$0.00	"$1,504.88"	"$1,504.88"	$0.00	"$1,526.25"	"$2,417.58"	"$2,442.00"	$0.00		$0.00	$477.72	$0.00	$0.00	$485.96	$0.00	$0.00	$0.00	$0.00	$0.00
70-0387	SUP	HCPCS C1713		70-0387  -  PLATE MED BONE RIGHT ANT CALC	BOTH IP/OP	"$3,052.50 "	"$2,258.85"	$0.00	"$2,442.00"	"$1,373.63"	"$1,373.63"	$0.00	$0.00	$0.00	$636.22	"$2,265.57"	"$2,265.57"	$0.00	$0.00	$636.14	$0.00	"$1,504.88"	"$1,504.88"	$0.00	"$1,526.25"	"$2,417.58"	"$2,442.00"	$0.00		$0.00	$477.72	$0.00	$0.00	$485.96	$0.00	$0.00	$0.00	$0.00	$0.00
70-0388	SUP	HCPCS C1713		70-0388  -  PLATE BONE LEFT ANT CALC	BOTH IP/OP	"$3,052.50 "	"$2,258.85"	$0.00	"$2,442.00"	"$1,373.63"	"$1,373.63"	$0.00	$0.00	$0.00	$636.22	"$2,265.57"	"$2,265.57"	$0.00	$0.00	$636.14	$0.00	"$1,504.88"	"$1,504.88"	$0.00	"$1,526.25"	"$2,417.58"	"$2,442.00"	$0.00		$0.00	$477.72	$0.00	$0.00	$485.96	$0.00	$0.00	$0.00	$0.00	$0.00
70-0389	SUP	HCPCS C1713		70-0389  -  PLATE LG BONE RIGHT ANT CALC	BOTH IP/OP	"$3,052.50 "	"$2,258.85"	$0.00	"$2,442.00"	"$1,373.63"	"$1,373.63"	$0.00	$0.00	$0.00	$636.22	"$2,265.57"	"$2,265.57"	$0.00	$0.00	$636.14	$0.00	"$1,504.88"	"$1,504.88"	$0.00	"$1,526.25"	"$2,417.58"	"$2,442.00"	$0.00		$0.00	$477.72	$0.00	$0.00	$485.96	$0.00	$0.00	$0.00	$0.00	$0.00
70-0394	SUP	HCPCS C1713		70-0394  -  PLATE LG 5 HOLE TUBE BONE POST CALC	BOTH IP/OP	"$3,052.50 "	"$2,258.85"	$0.00	"$2,442.00"	"$1,373.63"	"$1,373.63"	$0.00	$0.00	$0.00	$636.22	"$2,265.57"	"$2,265.57"	$0.00	$0.00	$636.14	$0.00	"$1,504.88"	"$1,504.88"	$0.00	"$1,526.25"	"$2,417.58"	"$2,442.00"	$0.00		$0.00	$477.72	$0.00	$0.00	$485.96	$0.00	$0.00	$0.00	$0.00	$0.00
70-0395	SUP	HCPCS C1713		70-0395  -  PLATE 5 HOLE BONE RIGHT POST CALC	BOTH IP/OP	"$3,052.50 "	"$2,258.85"	$0.00	"$2,442.00"	"$1,373.63"	"$1,373.63"	$0.00	$0.00	$0.00	$636.22	"$2,265.57"	"$2,265.57"	$0.00	$0.00	$636.14	$0.00	"$1,504.88"	"$1,504.88"	$0.00	"$1,526.25"	"$2,417.58"	"$2,442.00"	$0.00		$0.00	$477.72	$0.00	$0.00	$485.96	$0.00	$0.00	$0.00	$0.00	$0.00
70-0396	SUP	HCPCS C1713		70-0396  -  PLATE 6 HOLE BONE LEFT POST CALC	BOTH IP/OP	"$3,052.50 "	"$2,258.85"	$0.00	"$2,442.00"	"$1,373.63"	"$1,373.63"	$0.00	$0.00	$0.00	$636.22	"$2,265.57"	"$2,265.57"	$0.00	$0.00	$636.14	$0.00	"$1,504.88"	"$1,504.88"	$0.00	"$1,526.25"	"$2,417.58"	"$2,442.00"	$0.00		$0.00	$477.72	$0.00	$0.00	$485.96	$0.00	$0.00	$0.00	$0.00	$0.00
70-0397	SUP	HCPCS C1713		70-0397  -  PLATE 6 HOLE BONE RIGHT POST CALC	BOTH IP/OP	"$3,052.50 "	"$2,258.85"	$0.00	"$2,442.00"	"$1,373.63"	"$1,373.63"	$0.00	$0.00	$0.00	$636.22	"$2,265.57"	"$2,265.57"	$0.00	$0.00	$636.14	$0.00	"$1,504.88"	"$1,504.88"	$0.00	"$1,526.25"	"$2,417.58"	"$2,442.00"	$0.00		$0.00	$477.72	$0.00	$0.00	$485.96	$0.00	$0.00	$0.00	$0.00	$0.00
70-0400	SUP	HCPCS C1713		70-0400  -  PLATE 8 HOLE BONE LEFT CALC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
70-0401	SUP	HCPCS C1713		70-0401  -  PLATE MED 8 HOLE COMBO BONE RIGHT CALC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
70-0404	SUP	HCPCS C1713		70-0404  -  PLATE 8 HOLE COMBO BONE LEFT CLVCL	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
70-0405	SUP	HCPCS C1713		70-0405  -  PLATE 8 HOLE BONE RL NONSTRL	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
70-0406	SUP	HCPCS C1713		70-0406  -  PLATE 4 HOLE COMBO BONE LEFT CALC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
70-0407	SUP	HCPCS C1713		70-0407  -  PLATE LG 9 HOLE COMBO BONE RIGHT CALC	BOTH IP/OP	"$3,250.00 "	"$2,405.00"	$0.00	"$2,600.00"	"$1,462.50"	"$1,462.50"	$0.00	$0.00	$0.00	$677.38	"$2,412.15"	"$2,412.15"	$0.00	$0.00	$677.30	$0.00	"$1,602.25"	"$1,602.25"	$0.00	"$1,625.00"	"$2,574.00"	"$2,600.00"	$0.00		$0.00	$508.63	$0.00	$0.00	$517.40	$0.00	$0.00	$0.00	$0.00	$0.00
7005-08003	SUP	HCPCS C1713		7005-08003  -  PLATE BN T .8MM NS LOPRFL TI HND	BOTH IP/OP	"$1,365.00 "	"$1,010.10"	$0.00	"$1,092.00"	$614.25	$614.25	$0.00	$0.00	$0.00	$284.50	"$1,013.10"	"$1,013.10"	$0.00	$0.00	$284.47	$0.00	$807.40	$807.40	$0.00	$682.50	"$1,081.08"	"$1,092.00"	$0.00		$0.00	$213.62	$0.00	$0.00	$217.31	$0.00	$0.00	$0.00	$0.00	$0.00
7005-08006	SUP	HCPCS C1713		7005-08006  -  PLATE BN .8MM NS 6 HL CMPR TI HND	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$533.25	$533.25	$0.00	$0.00	$0.00	$246.98	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$700.93	$700.93	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$185.45	$0.00	$0.00	$188.65	$0.00	$0.00	$0.00	$0.00	$0.00
7005-13005	SUP	HCPCS C1713		7005-13005  -  PLATE BN NS ROT CRRT HND 1.3 MM SCR	BOTH IP/OP	$945.00 	$699.30	$0.00	$756.00	$425.25	$425.25	$0.00	$0.00	$0.00	$196.96	$701.38	$701.38	$0.00	$0.00	$196.94	$0.00	$558.97	$558.97	$0.00	$472.50	$748.44	$756.00	$0.00		$0.00	$147.89	$0.00	$0.00	$150.44	$0.00	$0.00	$0.00	$0.00	$0.00
7005-13006	SUP	HCPCS C1713		7005-13006  -  PLATE BONE 6 HOLE COMPRESSION HAND NONSTRL 1.3 MM SCREW	BOTH IP/OP	"$1,365.00 "	"$1,010.10"	$0.00	"$1,092.00"	$614.25	$614.25	$0.00	$0.00	$0.00	$284.50	"$1,013.10"	"$1,013.10"	$0.00	$0.00	$284.47	$0.00	$807.40	$807.40	$0.00	$682.50	"$1,081.08"	"$1,092.00"	$0.00		$0.00	$213.62	$0.00	$0.00	$217.31	$0.00	$0.00	$0.00	$0.00	$0.00
70-1050	SUP	Custom 27203010		ELECTRODE 3010B SER ANALY	BOTH IP/OP	"$2,600.00 "	"$1,924.00"	$0.00	"$2,080.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,300.00"	"$2,059.20"	"$2,080.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7014-5927	SUP	HCPCS L8613		7014-5927  -  PISTON OSS .6MM 4.25MM SMRT RECON OVR CRMP NTNL FLRPLAS	BOTH IP/OP	$752.40 	$556.78	$0.00	$601.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$558.43	$558.43	$0.00	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$376.20	$595.90	$601.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7014-5928	SUP	HCPCS L8613		7014-5928  -  PISTON OSS .6MM 4.5MM SMRT NTNL FLRPLAS EAR STPS	BOTH IP/OP	$752.40 	$556.78	$0.00	$601.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$558.43	$558.43	$0.00	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$376.20	$595.90	$601.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7016RR	SUP	Custom 27803010		7016RR  -  CONNECTOR ROD 16MM SPRL R90D 2 SD TI THORLMBR SPNE	BOTH IP/OP	"$2,075.80 "	"$1,536.09"	$0.00	"$1,660.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,540.66"	"$1,540.66"	$0.00	$0.00	$432.60	$0.00	$0.00	$0.00	$0.00	"$1,037.90"	"$1,644.03"	"$1,660.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-42A	SUP	HCPCS C1776		702-04-42A  -  SHELL ACTB A 42MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-44B	SUP	HCPCS C1776		702-04-44B  -  SHELL ACTB B 44MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-46C	SUP	HCPCS C1776		702-04-46C  -  SHELL ACTB C 46MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-48D	SUP	HCPCS C1776		702-04-48D  -  SHELL ACTB D 48MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-50D	SUP	HCPCS C1776		702-04-50D  -  SHELL ACTB D 50MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-52E	SUP	HCPCS C1776		702-04-52E  -  SHELL ACTB E 52MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-54E	SUP	HCPCS C1776		702-04-54E  -  SHELL ACTB E 54MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-56F	SUP	HCPCS C1776		702-04-56F  -  SHELL ACTB F 56MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-58F	SUP	HCPCS C1776		702-04-58F  -  SHELL ACTB F 58MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-60G	SUP	HCPCS C1776		702-04-60G  -  SHELL ACTB G 60MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-62G	SUP	HCPCS C1776		702-04-62G  -  SHELL ACTB G 62MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-64H	SUP	HCPCS C1776		702-04-64H  -  SHELL ACTB H 64MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-04-66H	SUP	HCPCS C1776		702-04-66H  -  SHELL ACTB H 66MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-42A	SUP	HCPCS C1776		702-11-42A  -  SHELL ACTB A 42MM TRDNT II CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-44B	SUP	HCPCS C1776		702-11-44B  -  SHELL ACTB B 44MM TRDNT II CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-46C	SUP	HCPCS C1776		702-11-46C  -  SHELL ACTB C 46MM TRDNT II CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-48D	SUP	HCPCS C1776		702-11-48D  -  SHELL ACTB D 48MM TRDNT II CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-50D	SUP	HCPCS C1776		702-11-50D  -  SHELL ACTB D 50MM TRDNT II CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-52E	SUP	HCPCS C1776		702-11-52E  -  SHELL ACTB E 52MM TRDNT II CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-54E	SUP	HCPCS C1776		702-11-54E  -  SHELL ACTB E 54MM TRDNT II CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-56F	SUP	HCPCS C1776		702-11-56F  -  SHELL ACTB F 56MM TRDNT II CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-58F	SUP	HCPCS C1776		702-11-58F  -  SHELL ACTB F 58MM STRL TRDNT II CLSTR 5 HL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-60G	SUP	HCPCS C1776		702-11-60G  -  SHELL ACTB G 60MM STRL TRDNT II CLSTR 5 HL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-62G	SUP	HCPCS C1776		702-11-62G  -  SHELL ACTB G 62MM STRL TRDNT II CLSTR 5 HL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-64H	SUP	HCPCS C1776		702-11-64H  -  SHELL ACTB H 64MM STRL TRDNT II CLSTR 5 HL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702-11-66H	SUP	HCPCS C1776		702-11-66H  -  SHELL ACTB H 66MM STRL TRDNT II CLSTR 5 HL HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
702301-5	SUP	HCPCS C1713		702301-5  -  SCREW BN ALTA CNCT ORTH	BOTH IP/OP	$185.63 	$137.37	$0.00	$148.50	$83.53	$83.53	$0.00	$0.00	$0.00	$38.69	$137.77	$137.77	$0.00	$0.00	$38.68	$0.00	$109.80	$109.80	$0.00	$92.81	$147.02	$148.50	$0.00		$0.00	$29.05	$0.00	$0.00	$29.55	$0.00	$0.00	$0.00	$0.00	$0.00
702336S	SUP	HCPCS C1769		702336S  -  GWIRE ORTH 100MM 3MM SS BALL TIP STRL	BOTH IP/OP	$259.88 	$192.31	$0.00	$207.90	$141.11	$141.11	$0.00	$0.00	$0.00	$54.16	$192.88	$192.88	$0.00	$0.00	$54.16	$0.00	$153.72	$153.72	$0.00	$129.94	$205.82	$207.90	$0.00		$0.00	$40.67	$0.00	$0.00	$41.37	$0.00	$0.00	$0.00	$0.00	$0.00
702341-2	SUP	Custom 27203010		702341-2  -  SLEEVE PRTC REPL	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.21	$408.21	$0.00	$0.00	$114.62	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702460S	SUP	HCPCS C1769		702460S  -  GWIRE ORTH 150MM 2MM ASNS 3 FEM HIP THRD 5MM NONSTRL DISP	BOTH IP/OP	$124.10 	$91.83	$0.00	$130.90	$88.85	$88.85	$0.00	$0.00	$0.00	$25.87	$92.11	$92.11	$0.00	$0.00	$25.86	$0.00	$73.41	$73.41	$0.00	$81.81	$129.59	$130.90	$0.00		$0.00	$25.61	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$0.00
702627S	SUP	HCPCS C1769		702627S  -  GWIRE ORTH 300MM 3.2MM CLBRT FIT STRL	BOTH IP/OP	$281.88 	$208.59	$0.00	$225.50	$153.06	$153.06	$0.00	$0.00	$0.00	$58.75	$209.21	$209.21	$0.00	$0.00	$58.74	$0.00	$166.73	$166.73	$0.00	$140.94	$223.25	$225.50	$0.00		$0.00	$44.11	$0.00	$0.00	$44.87	$0.00	$0.00	$0.00	$0.00	$0.00
702716-2	SUP	HCPCS C1713		702716-2  -  SCREW BONE 4MM AXSOS HUM AIM BLOCK LCK PLT SYS	BOTH IP/OP	$94.88 	$70.21	$0.00	$75.90	$42.69	$42.69	$0.00	$0.00	$0.00	$19.77	$70.42	$70.42	$0.00	$0.00	$19.77	$0.00	$56.12	$56.12	$0.00	$47.44	$75.14	$75.90	$0.00		$0.00	$14.85	$0.00	$0.00	$15.10	$0.00	$0.00	$0.00	$0.00	$0.00
702718-2	SUP	HCPCS C1713		702718-2  -  SCREW BN SET SPR AIM BLCK FEM DIST	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$44.55	$44.55	$0.00	$0.00	$0.00	$20.63	$73.48	$73.48	$0.00	$0.00	$20.63	$0.00	$58.56	$58.56	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$15.49	$0.00	$0.00	$15.76	$0.00	$0.00	$0.00	$0.00	$0.00
702720-2	SUP	HCPCS C1713		702720-2  -  SCREW BONE 4MM AXSOS TIB AIM BLOCK LCK PLT SYS	BOTH IP/OP	$193.88 	$143.47	$0.00	$155.10	$87.24	$87.24	$0.00	$0.00	$0.00	$40.41	$143.89	$143.89	$0.00	$0.00	$40.40	$0.00	$114.68	$114.68	$0.00	$96.94	$153.55	$155.10	$0.00		$0.00	$30.34	$0.00	$0.00	$30.86	$0.00	$0.00	$0.00	$0.00	$0.00
702858-1	SUP	Custom 27803010		702858-1  -  DRIVER SRG 4MM VARIAX RING HD LCK	BOTH IP/OP	$570.63 	$422.27	$0.00	$456.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$423.52	$423.52	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$285.31	$451.94	$456.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
702970-2	SUP	Custom 27803010		702970-2  -  SCREW BONE AXSOS SPR SET HUM AIM BLOCK LCK PALTE SYS	BOTH IP/OP	$199.38 	$147.54	$0.00	$159.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.98	$147.98	$0.00	$0.00	$41.55	$0.00	$0.00	$0.00	$0.00	$99.69	$157.91	$159.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-3003L	SUP	HCPCS C1776		70-3003L  -  CMPNT FEM 3 LEFT KNEE CMNT CRUC RET BASIC SCRP	BOTH IP/OP	"$3,074.00 "	"$2,274.76"	$0.00	"$2,459.20"	"$1,383.30"	"$1,383.30"	$0.00	$0.00	$0.00	$640.70	"$2,281.52"	"$2,281.52"	$0.00	$0.00	$640.62	$0.00	"$1,515.48"	"$1,515.48"	$0.00	"$1,537.00"	"$2,434.61"	"$2,459.20"	$0.00		$0.00	$481.08	$0.00	$0.00	$489.38	$0.00	$0.00	$0.00	$0.00	$0.00
70-3003R	SUP	HCPCS C1776		70-3003R  -  CMPNT FEM 3 RIGHT KNEE CMNT CRUC RET BASIC SCRP	BOTH IP/OP	"$3,074.00 "	"$2,274.76"	$0.00	"$2,459.20"	"$1,383.30"	"$1,383.30"	$0.00	$0.00	$0.00	$640.70	"$2,281.52"	"$2,281.52"	$0.00	$0.00	$640.62	$0.00	"$1,515.48"	"$1,515.48"	$0.00	"$1,537.00"	"$2,434.61"	"$2,459.20"	$0.00		$0.00	$481.08	$0.00	$0.00	$489.38	$0.00	$0.00	$0.00	$0.00	$0.00
70-3004L	SUP	HCPCS C1776		70-3004L  -  CMPNT FEM 4 LEFT KNEE CMNT CRUC RET BASIC SCRP	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	"$1,363.05"	"$1,363.05"	$0.00	$0.00	$0.00	$631.32	"$2,248.12"	"$2,248.12"	$0.00	$0.00	$631.24	$0.00	"$1,493.30"	"$1,493.30"	$0.00	"$1,514.50"	"$2,398.97"	"$2,423.20"	$0.00		$0.00	$474.04	$0.00	$0.00	$482.22	$0.00	$0.00	$0.00	$0.00	$0.00
70-3004R	SUP	HCPCS C1776		70-3004R  -  CMPNT FEM 4 RIGHT KNEE CMNT CRUC RET BASIC SCRP	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	"$1,363.05"	"$1,363.05"	$0.00	$0.00	$0.00	$631.32	"$2,248.12"	"$2,248.12"	$0.00	$0.00	$631.24	$0.00	"$1,493.30"	"$1,493.30"	$0.00	"$1,514.50"	"$2,398.97"	"$2,423.20"	$0.00		$0.00	$474.04	$0.00	$0.00	$482.22	$0.00	$0.00	$0.00	$0.00	$0.00
70-3005L	SUP	HCPCS C1776		70-3005L  -  CMPNT FEM 5 LEFT KNEE CRUC RET BASIC SCRP	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	"$1,363.05"	"$1,363.05"	$0.00	$0.00	$0.00	$631.32	"$2,248.12"	"$2,248.12"	$0.00	$0.00	$631.24	$0.00	"$1,493.30"	"$1,493.30"	$0.00	"$1,514.50"	"$2,398.97"	"$2,423.20"	$0.00		$0.00	$474.04	$0.00	$0.00	$482.22	$0.00	$0.00	$0.00	$0.00	$0.00
70-3005R	SUP	HCPCS C1776		70-3005R  -  CMPNT FEM 5 RIGHT KNEE CRUC RET BASIC SCRP	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	"$1,363.05"	"$1,363.05"	$0.00	$0.00	$0.00	$631.32	"$2,248.12"	"$2,248.12"	$0.00	$0.00	$631.24	$0.00	"$1,493.30"	"$1,493.30"	$0.00	"$1,514.50"	"$2,398.97"	"$2,423.20"	$0.00		$0.00	$474.04	$0.00	$0.00	$482.22	$0.00	$0.00	$0.00	$0.00	$0.00
70-3006L	SUP	HCPCS C1776		70-3006L  -  CMPNT FEM 6 LEFT KNEE CMNT CRUC RET BASIC SCRP	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	"$1,363.05"	"$1,363.05"	$0.00	$0.00	$0.00	$631.32	"$2,248.12"	"$2,248.12"	$0.00	$0.00	$631.24	$0.00	"$1,493.30"	"$1,493.30"	$0.00	"$1,514.50"	"$2,398.97"	"$2,423.20"	$0.00		$0.00	$474.04	$0.00	$0.00	$482.22	$0.00	$0.00	$0.00	$0.00	$0.00
70-3006R	SUP	HCPCS C1776		70-3006R  -  CMPNT FEM 6 RIGHT KNEE CMNT CRUC RET BASIC SCRP	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	"$1,363.05"	"$1,363.05"	$0.00	$0.00	$0.00	$631.32	"$2,248.12"	"$2,248.12"	$0.00	$0.00	$631.24	$0.00	"$1,493.30"	"$1,493.30"	$0.00	"$1,514.50"	"$2,398.97"	"$2,423.20"	$0.00		$0.00	$474.04	$0.00	$0.00	$482.22	$0.00	$0.00	$0.00	$0.00	$0.00
70-3007L	SUP	HCPCS C1776		70-3007L  -  CMPNT FEM 7 LEFT KNEE CRUC RET BASIC SCRP	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	"$1,363.05"	"$1,363.05"	$0.00	$0.00	$0.00	$631.32	"$2,248.12"	"$2,248.12"	$0.00	$0.00	$631.24	$0.00	"$1,493.30"	"$1,493.30"	$0.00	"$1,514.50"	"$2,398.97"	"$2,423.20"	$0.00		$0.00	$474.04	$0.00	$0.00	$482.22	$0.00	$0.00	$0.00	$0.00	$0.00
70-3007R	SUP	HCPCS C1776		70-3007R  -  CMPNT FEM 7 RIGHT KNEE CRUC RET BASIC SCRP	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	"$1,363.05"	"$1,363.05"	$0.00	$0.00	$0.00	$631.32	"$2,248.12"	"$2,248.12"	$0.00	$0.00	$631.24	$0.00	"$1,493.30"	"$1,493.30"	$0.00	"$1,514.50"	"$2,398.97"	"$2,423.20"	$0.00		$0.00	$474.04	$0.00	$0.00	$482.22	$0.00	$0.00	$0.00	$0.00	$0.00
70-3009L	SUP	HCPCS C1776		70-3009L  -  CMPNT FEM 9 LEFT KNEE CRUC RET BASIC SCRP	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	"$1,363.05"	"$1,363.05"	$0.00	$0.00	$0.00	$631.32	"$2,248.12"	"$2,248.12"	$0.00	$0.00	$631.24	$0.00	"$1,493.30"	"$1,493.30"	$0.00	"$1,514.50"	"$2,398.97"	"$2,423.20"	$0.00		$0.00	$474.04	$0.00	$0.00	$482.22	$0.00	$0.00	$0.00	$0.00	$0.00
70-3009R	SUP	HCPCS C1776		70-3009R  -  CMPNT FEM 9 RIGHT KNEE CRUC RET BASIC SCRP	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	"$1,363.05"	"$1,363.05"	$0.00	$0.00	$0.00	$631.32	"$2,248.12"	"$2,248.12"	$0.00	$0.00	$631.24	$0.00	"$1,493.30"	"$1,493.30"	$0.00	"$1,514.50"	"$2,398.97"	"$2,423.20"	$0.00		$0.00	$474.04	$0.00	$0.00	$482.22	$0.00	$0.00	$0.00	$0.00	$0.00
70-3011L	SUP	HCPCS C1776		70-3011L  -  CMPNT FEM 11 LEFT KNEE CRUC RET BASIC SCRP	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	"$1,363.05"	"$1,363.05"	$0.00	$0.00	$0.00	$631.32	"$2,248.12"	"$2,248.12"	$0.00	$0.00	$631.24	$0.00	"$1,493.30"	"$1,493.30"	$0.00	"$1,514.50"	"$2,398.97"	"$2,423.20"	$0.00		$0.00	$474.04	$0.00	$0.00	$482.22	$0.00	$0.00	$0.00	$0.00	$0.00
70-3011R	SUP	HCPCS C1776		70-3011R  -  CMPNT FEM 11 RIGHT KNEE CRUC RET BASIC SCRP	BOTH IP/OP	"$3,029.00 "	"$2,241.46"	$0.00	"$2,423.20"	"$1,363.05"	"$1,363.05"	$0.00	$0.00	$0.00	$631.32	"$2,248.12"	"$2,248.12"	$0.00	$0.00	$631.24	$0.00	"$1,493.30"	"$1,493.30"	$0.00	"$1,514.50"	"$2,398.97"	"$2,423.20"	$0.00		$0.00	$474.04	$0.00	$0.00	$482.22	$0.00	$0.00	$0.00	$0.00	$0.00
70-3013L	SUP	HCPCS C1776		70-3013L  -  CMPNT FEM 13 LEFT KNEE CRUC RET BASIC SCRP	BOTH IP/OP	"$3,074.00 "	"$2,274.76"	$0.00	"$2,459.20"	"$1,383.30"	"$1,383.30"	$0.00	$0.00	$0.00	$640.70	"$2,281.52"	"$2,281.52"	$0.00	$0.00	$640.62	$0.00	"$1,515.48"	"$1,515.48"	$0.00	"$1,537.00"	"$2,434.61"	"$2,459.20"	$0.00		$0.00	$481.08	$0.00	$0.00	$489.38	$0.00	$0.00	$0.00	$0.00	$0.00
70-3013R	SUP	HCPCS C1776		70-3013R  -  CMPNT FEM 13 RIGHT KNEE CRUC RET BASIC SCRP	BOTH IP/OP	"$3,074.00 "	"$2,274.76"	$0.00	"$2,459.20"	"$1,383.30"	"$1,383.30"	$0.00	$0.00	$0.00	$640.70	"$2,281.52"	"$2,281.52"	$0.00	$0.00	$640.62	$0.00	"$1,515.48"	"$1,515.48"	$0.00	"$1,537.00"	"$2,434.61"	"$2,459.20"	$0.00		$0.00	$481.08	$0.00	$0.00	$489.38	$0.00	$0.00	$0.00	$0.00	$0.00
7030-6515	SUP	HCPCS C1713		7030-6515  -  SCREW BN 6.5MM 15MM STRL TRDNT II LOPRFL HEX	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
7030-6520	SUP	HCPCS C1713		7030-6520  -  SCREW BN 6.5MM 20MM STRL TRDNT II LOPRFL HEX	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
7030-6525	SUP	HCPCS C1713		7030-6525  -  SCREW BN 6.5MM 25MM STRL TRDNT II LOPRFL HEX	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
7030-6530	SUP	HCPCS C1713		7030-6530  -  SCREW BN 6.5MM 30MM STRL TRDNT II LOPRFL HEX	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
7030-6535	SUP	HCPCS C1713		7030-6535  -  SCREW BN 6.5MM 35MM STRL TRDNT II LOPRFL HEX	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
7030-6540	SUP	HCPCS C1713		7030-6540  -  SCREW BN 6.5MM 40MM STRL TRDNT II LOPRFL HEX	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
7030-6545	SUP	HCPCS C1713		7030-6545  -  SCREW BN 6.5MM 45MM STRL TRDNT II LOPRFL HEX	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
7030-6550	SUP	HCPCS C1713		7030-6550  -  SCREW BN 6.5MM 50MM STRL TRDNT II LOPRFL HEX	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
7030-6555	SUP	HCPCS C1713		7030-6555  -  SCREW BN 6.5MM 55MM STRL TRDNT II LOPRFL HEX	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
7030-6560	SUP	HCPCS C1713		7030-6560  -  SCREW BN 6.5MM 60MM STRL TRDNT II LOPRFL HEX	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
703165-20	SUP	Custom 27203010		703165-20  -  SLEEVE DRILL ANT FEM RTN	BOTH IP/OP	$559.63 	$414.13	$0.00	$447.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$415.35	$415.35	$0.00	$0.00	$116.63	$0.00	$0.00	$0.00	$0.00	$279.81	$443.23	$447.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-3191	SUP	Custom 27203010		ELECTRODE ANALY SLVR CHLOR REF WIRE 3010B SER	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-3849	SUP	Custom 27203010		CONTROL BLOOD LEAD LVL 1 HMTL	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-3850	SUP	Custom 27203010		CONTROL BLOOD LEAD LVL 2 HMTL	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-3851	SUP	Custom 27203010		CONTROL CHM HI	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
704001-1	SUP	Custom 27203010		704001-1  -  IMPCTR SURG OMEGA HIP HEAD	BOTH IP/OP	$371.25 	$274.73	$0.00	$297.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.54	$275.54	$0.00	$0.00	$77.37	$0.00	$0.00	$0.00	$0.00	$185.63	$294.03	$297.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
704005-10	SUP	Custom 27203010		704005-10  -  REAMER SURG DRILL COMBO	BOTH IP/OP	$701.25 	$518.93	$0.00	$561.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$520.47	$520.47	$0.00	$0.00	$146.14	$0.00	$0.00	$0.00	$0.00	$350.63	$555.39	$561.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
704011S	SUP	HCPCS C1713		704011S  -  PIN SURG GUIDE	BOTH IP/OP	$75.63 	$55.97	$0.00	$60.50	$34.03	$34.03	$0.00	$0.00	$0.00	$15.76	$56.13	$56.13	$0.00	$0.00	$15.76	$0.00	$44.73	$44.73	$0.00	$37.81	$59.90	$60.50	$0.00		$0.00	$11.84	$0.00	$0.00	$12.04	$0.00	$0.00	$0.00	$0.00	$0.00
704012S	SUP	HCPCS C1769		704012S  -  GWIRE ORTH 230MM 2.8MM THRD TIP QC	BOTH IP/OP	$226.88 	$167.89	$0.00	$181.50	$123.19	$123.19	$0.00	$0.00	$0.00	$47.29	$168.39	$168.39	$0.00	$0.00	$47.28	$0.00	$134.20	$134.20	$0.00	$113.44	$179.69	$181.50	$0.00		$0.00	$35.51	$0.00	$0.00	$36.12	$0.00	$0.00	$0.00	$0.00	$0.00
70-4103L	SUP	HCPCS C1776		70-4103L  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4103R	SUP	HCPCS C1776		70-4103R  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4104L	SUP	HCPCS C1776		70-4104L  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4104R	SUP	HCPCS C1776		70-4104R  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4105L	SUP	HCPCS C1776		70-4105L  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4105R	SUP	HCPCS C1776		70-4105R  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4106L	SUP	HCPCS C1776		70-4106L  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4106R	SUP	HCPCS C1776		70-4106R  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4107L	SUP	HCPCS C1776		70-4107L  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4107R	SUP	HCPCS C1776		70-4107R  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4109L	SUP	HCPCS C1776		70-4109L  -  COMPONENT FEMORAL 9 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4109R	SUP	HCPCS C1776		70-4109R  -  COMPONENT FEMORAL 9 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4111L	SUP	HCPCS C1776		70-4111L  -  COMPONENT FEMORAL 11 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4111R	SUP	HCPCS C1776		70-4111R  -  COMPONENT FEMORAL 11 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4113L	SUP	HCPCS C1776		70-4113L  -  COMPONENT FEMORAL 13 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-4113R	SUP	HCPCS C1776		70-4113R  -  COMPONENT FEMORAL 13 CRUCIATE RETAIN CEMENTED WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
70-5003L	SUP	HCPCS C1776		70-5003L  -  CMPNT FEM 3 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,906.00 "	"$3,630.44"	$0.00	"$3,924.80"	"$2,207.70"	"$2,207.70"	$0.00	$0.00	$0.00	"$1,022.53"	"$3,641.23"	"$3,641.23"	$0.00	$0.00	"$1,022.41"	$0.00	"$2,418.66"	"$2,418.66"	$0.00	"$2,453.00"	"$3,885.55"	"$3,924.80"	$0.00		$0.00	$767.79	$0.00	$0.00	$781.04	$0.00	$0.00	$0.00	$0.00	$0.00
70-5003R	SUP	HCPCS C1776		70-5003R  -  CMPNT FEM 3 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,906.00 "	"$3,630.44"	$0.00	"$3,924.80"	"$2,207.70"	"$2,207.70"	$0.00	$0.00	$0.00	"$1,022.53"	"$3,641.23"	"$3,641.23"	$0.00	$0.00	"$1,022.41"	$0.00	"$2,418.66"	"$2,418.66"	$0.00	"$2,453.00"	"$3,885.55"	"$3,924.80"	$0.00		$0.00	$767.79	$0.00	$0.00	$781.04	$0.00	$0.00	$0.00	$0.00	$0.00
70-5004L	SUP	HCPCS C1776		70-5004L  -  CMPNT FEM 4 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,777.00 "	"$3,534.98"	$0.00	"$3,821.60"	"$2,149.65"	"$2,149.65"	$0.00	$0.00	$0.00	$995.65	"$3,545.49"	"$3,545.49"	$0.00	$0.00	$995.53	$0.00	"$2,355.06"	"$2,355.06"	$0.00	"$2,388.50"	"$3,783.38"	"$3,821.60"	$0.00		$0.00	$747.60	$0.00	$0.00	$760.50	$0.00	$0.00	$0.00	$0.00	$0.00
70-5004R	SUP	HCPCS C1776		70-5004R  -  CMPNT FEM 4 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,777.00 "	"$3,534.98"	$0.00	"$3,821.60"	"$2,149.65"	"$2,149.65"	$0.00	$0.00	$0.00	$995.65	"$3,545.49"	"$3,545.49"	$0.00	$0.00	$995.53	$0.00	"$2,355.06"	"$2,355.06"	$0.00	"$2,388.50"	"$3,783.38"	"$3,821.60"	$0.00		$0.00	$747.60	$0.00	$0.00	$760.50	$0.00	$0.00	$0.00	$0.00	$0.00
70-5005L	SUP	HCPCS C1776		70-5005L  -  CMPNT FEM 5 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,777.00 "	"$3,534.98"	$0.00	"$3,821.60"	"$2,149.65"	"$2,149.65"	$0.00	$0.00	$0.00	$995.65	"$3,545.49"	"$3,545.49"	$0.00	$0.00	$995.53	$0.00	"$2,355.06"	"$2,355.06"	$0.00	"$2,388.50"	"$3,783.38"	"$3,821.60"	$0.00		$0.00	$747.60	$0.00	$0.00	$760.50	$0.00	$0.00	$0.00	$0.00	$0.00
70-5005R	SUP	HCPCS C1776		70-5005R  -  CMPNT FEM 5 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,777.00 "	"$3,534.98"	$0.00	"$3,821.60"	"$2,149.65"	"$2,149.65"	$0.00	$0.00	$0.00	$995.65	"$3,545.49"	"$3,545.49"	$0.00	$0.00	$995.53	$0.00	"$2,355.06"	"$2,355.06"	$0.00	"$2,388.50"	"$3,783.38"	"$3,821.60"	$0.00		$0.00	$747.60	$0.00	$0.00	$760.50	$0.00	$0.00	$0.00	$0.00	$0.00
70-5006L	SUP	HCPCS C1776		70-5006L  -  CMPNT FEM 6 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,777.00 "	"$3,534.98"	$0.00	"$3,821.60"	"$2,149.65"	"$2,149.65"	$0.00	$0.00	$0.00	$995.65	"$3,545.49"	"$3,545.49"	$0.00	$0.00	$995.53	$0.00	"$2,355.06"	"$2,355.06"	$0.00	"$2,388.50"	"$3,783.38"	"$3,821.60"	$0.00		$0.00	$747.60	$0.00	$0.00	$760.50	$0.00	$0.00	$0.00	$0.00	$0.00
70-5006R	SUP	HCPCS C1776		70-5006R  -  CMPNT FEM 6 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,777.00 "	"$3,534.98"	$0.00	"$3,821.60"	"$2,149.65"	"$2,149.65"	$0.00	$0.00	$0.00	$995.65	"$3,545.49"	"$3,545.49"	$0.00	$0.00	$995.53	$0.00	"$2,355.06"	"$2,355.06"	$0.00	"$2,388.50"	"$3,783.38"	"$3,821.60"	$0.00		$0.00	$747.60	$0.00	$0.00	$760.50	$0.00	$0.00	$0.00	$0.00	$0.00
70-5007L	SUP	HCPCS C1776		70-5007L  -  CMPNT FEM 7 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,777.00 "	"$3,534.98"	$0.00	"$3,821.60"	"$2,149.65"	"$2,149.65"	$0.00	$0.00	$0.00	$995.65	"$3,545.49"	"$3,545.49"	$0.00	$0.00	$995.53	$0.00	"$2,355.06"	"$2,355.06"	$0.00	"$2,388.50"	"$3,783.38"	"$3,821.60"	$0.00		$0.00	$747.60	$0.00	$0.00	$760.50	$0.00	$0.00	$0.00	$0.00	$0.00
70-5007R	SUP	HCPCS C1776		70-5007R  -  CMPNT FEM 7 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,777.00 "	"$3,534.98"	$0.00	"$3,821.60"	"$2,149.65"	"$2,149.65"	$0.00	$0.00	$0.00	$995.65	"$3,545.49"	"$3,545.49"	$0.00	$0.00	$995.53	$0.00	"$2,355.06"	"$2,355.06"	$0.00	"$2,388.50"	"$3,783.38"	"$3,821.60"	$0.00		$0.00	$747.60	$0.00	$0.00	$760.50	$0.00	$0.00	$0.00	$0.00	$0.00
70-5009L	SUP	HCPCS C1776		70-5009L  -  CMPNT FEM 9 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,777.00 "	"$3,534.98"	$0.00	"$3,821.60"	"$2,149.65"	"$2,149.65"	$0.00	$0.00	$0.00	$995.65	"$3,545.49"	"$3,545.49"	$0.00	$0.00	$995.53	$0.00	"$2,355.06"	"$2,355.06"	$0.00	"$2,388.50"	"$3,783.38"	"$3,821.60"	$0.00		$0.00	$747.60	$0.00	$0.00	$760.50	$0.00	$0.00	$0.00	$0.00	$0.00
70-5009R	SUP	HCPCS C1776		70-5009R  -  CMPNT FEM 9 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,777.00 "	"$3,534.98"	$0.00	"$3,821.60"	"$2,149.65"	"$2,149.65"	$0.00	$0.00	$0.00	$995.65	"$3,545.49"	"$3,545.49"	$0.00	$0.00	$995.53	$0.00	"$2,355.06"	"$2,355.06"	$0.00	"$2,388.50"	"$3,783.38"	"$3,821.60"	$0.00		$0.00	$747.60	$0.00	$0.00	$760.50	$0.00	$0.00	$0.00	$0.00	$0.00
70-5011L	SUP	HCPCS C1776		70-5011L  -  CMPNT FEM 11 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,777.00 "	"$3,534.98"	$0.00	"$3,821.60"	"$2,149.65"	"$2,149.65"	$0.00	$0.00	$0.00	$995.65	"$3,545.49"	"$3,545.49"	$0.00	$0.00	$995.53	$0.00	"$2,355.06"	"$2,355.06"	$0.00	"$2,388.50"	"$3,783.38"	"$3,821.60"	$0.00		$0.00	$747.60	$0.00	$0.00	$760.50	$0.00	$0.00	$0.00	$0.00	$0.00
70-5011R	SUP	HCPCS C1776		70-5011R  -  CMPNT FEM 11 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,777.00 "	"$3,534.98"	$0.00	"$3,821.60"	"$2,149.65"	"$2,149.65"	$0.00	$0.00	$0.00	$995.65	"$3,545.49"	"$3,545.49"	$0.00	$0.00	$995.53	$0.00	"$2,355.06"	"$2,355.06"	$0.00	"$2,388.50"	"$3,783.38"	"$3,821.60"	$0.00		$0.00	$747.60	$0.00	$0.00	$760.50	$0.00	$0.00	$0.00	$0.00	$0.00
70-5013L	SUP	HCPCS C1776		70-5013L  -  CMPNT FEM 13 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP	BOTH IP/OP	"$4,906.00 "	"$3,630.44"	$0.00	"$3,924.80"	"$2,207.70"	"$2,207.70"	$0.00	$0.00	$0.00	"$1,022.53"	"$3,641.23"	"$3,641.23"	$0.00	$0.00	"$1,022.41"	$0.00	"$2,418.66"	"$2,418.66"	$0.00	"$2,453.00"	"$3,885.55"	"$3,924.80"	$0.00		$0.00	$767.79	$0.00	$0.00	$781.04	$0.00	$0.00	$0.00	$0.00	$0.00
70-5013R	SUP	HCPCS C1776		70-5013R  -  CMPNT FEM 13 RIGHT KNEE CRUC RET MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$4,906.00 "	"$3,630.44"	$0.00	"$3,924.80"	"$2,207.70"	"$2,207.70"	$0.00	$0.00	$0.00	"$1,022.53"	"$3,641.23"	"$3,641.23"	$0.00	$0.00	"$1,022.41"	$0.00	"$2,418.66"	"$2,418.66"	$0.00	"$2,453.00"	"$3,885.55"	"$3,924.80"	$0.00		$0.00	$767.79	$0.00	$0.00	$781.04	$0.00	$0.00	$0.00	$0.00	$0.00
70-5103L	SUP	HCPCS C1776		70-5103L  -  CMPNT FEM 3 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,647.00 "	"$3,438.78"	$0.00	"$3,717.60"	"$2,091.15"	"$2,091.15"	$0.00	$0.00	$0.00	$968.55	"$3,449.00"	"$3,449.00"	$0.00	$0.00	$968.43	$0.00	"$2,290.97"	"$2,290.97"	$0.00	"$2,323.50"	"$3,680.42"	"$3,717.60"	$0.00		$0.00	$727.26	$0.00	$0.00	$739.80	$0.00	$0.00	$0.00	$0.00	$0.00
70-5103R	SUP	HCPCS C1776		70-5103R  -  CMPNT FEM 3 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,647.00 "	"$3,438.78"	$0.00	"$3,717.60"	"$2,091.15"	"$2,091.15"	$0.00	$0.00	$0.00	$968.55	"$3,449.00"	"$3,449.00"	$0.00	$0.00	$968.43	$0.00	"$2,290.97"	"$2,290.97"	$0.00	"$2,323.50"	"$3,680.42"	"$3,717.60"	$0.00		$0.00	$727.26	$0.00	$0.00	$739.80	$0.00	$0.00	$0.00	$0.00	$0.00
70-5104L	SUP	HCPCS C1776		70-5104L  -  CMPNT FEM 4 LEFT KNEE CRUC RET MCSTRCT LFIT SCRP	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,652.00"	"$2,054.25"	"$2,054.25"	$0.00	$0.00	$0.00	$951.46	"$3,388.14"	"$3,388.14"	$0.00	$0.00	$951.35	$0.00	"$2,250.55"	"$2,250.55"	$0.00	"$2,282.50"	"$3,615.48"	"$3,652.00"	$0.00		$0.00	$714.42	$0.00	$0.00	$726.75	$0.00	$0.00	$0.00	$0.00	$0.00
70-5104R	SUP	HCPCS C1776		70-5104R  -  CMPNT FEM 4 RIGHT KNEE CRUC RET MCSTRCT LFIT SCRP	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,652.00"	"$2,054.25"	"$2,054.25"	$0.00	$0.00	$0.00	$951.46	"$3,388.14"	"$3,388.14"	$0.00	$0.00	$951.35	$0.00	"$2,250.55"	"$2,250.55"	$0.00	"$2,282.50"	"$3,615.48"	"$3,652.00"	$0.00		$0.00	$714.42	$0.00	$0.00	$726.75	$0.00	$0.00	$0.00	$0.00	$0.00
70-5105L	SUP	HCPCS C1776		70-5105L  -  CMPNT FEM 5 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,652.00"	"$2,054.25"	"$2,054.25"	$0.00	$0.00	$0.00	$951.46	"$3,388.14"	"$3,388.14"	$0.00	$0.00	$951.35	$0.00	"$2,250.55"	"$2,250.55"	$0.00	"$2,282.50"	"$3,615.48"	"$3,652.00"	$0.00		$0.00	$714.42	$0.00	$0.00	$726.75	$0.00	$0.00	$0.00	$0.00	$0.00
70-5105R	SUP	HCPCS C1776		70-5105R  -  CMPNT FEM 5 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,652.00"	"$2,054.25"	"$2,054.25"	$0.00	$0.00	$0.00	$951.46	"$3,388.14"	"$3,388.14"	$0.00	$0.00	$951.35	$0.00	"$2,250.55"	"$2,250.55"	$0.00	"$2,282.50"	"$3,615.48"	"$3,652.00"	$0.00		$0.00	$714.42	$0.00	$0.00	$726.75	$0.00	$0.00	$0.00	$0.00	$0.00
70-5106L	SUP	HCPCS C1776		70-5106L  -  CMPNT FEM 6 LEFT KNEE CRUC RET MCSTRCT LFIT SCRP	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,652.00"	"$2,054.25"	"$2,054.25"	$0.00	$0.00	$0.00	$951.46	"$3,388.14"	"$3,388.14"	$0.00	$0.00	$951.35	$0.00	"$2,250.55"	"$2,250.55"	$0.00	"$2,282.50"	"$3,615.48"	"$3,652.00"	$0.00		$0.00	$714.42	$0.00	$0.00	$726.75	$0.00	$0.00	$0.00	$0.00	$0.00
70-5106R	SUP	HCPCS C1776		70-5106R  -  CMPNT FEM 6 RIGHT KNEE CRUC RET MCSTRCT LFIT SCRP	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,652.00"	"$2,054.25"	"$2,054.25"	$0.00	$0.00	$0.00	$951.46	"$3,388.14"	"$3,388.14"	$0.00	$0.00	$951.35	$0.00	"$2,250.55"	"$2,250.55"	$0.00	"$2,282.50"	"$3,615.48"	"$3,652.00"	$0.00		$0.00	$714.42	$0.00	$0.00	$726.75	$0.00	$0.00	$0.00	$0.00	$0.00
70-5107L	SUP	HCPCS C1776		70-5107L  -  CMPNT FEM 7 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,652.00"	"$2,054.25"	"$2,054.25"	$0.00	$0.00	$0.00	$951.46	"$3,388.14"	"$3,388.14"	$0.00	$0.00	$951.35	$0.00	"$2,250.55"	"$2,250.55"	$0.00	"$2,282.50"	"$3,615.48"	"$3,652.00"	$0.00		$0.00	$714.42	$0.00	$0.00	$726.75	$0.00	$0.00	$0.00	$0.00	$0.00
70-5107R	SUP	HCPCS C1776		70-5107R  -  CMPNT FEM 7 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,652.00"	"$2,054.25"	"$2,054.25"	$0.00	$0.00	$0.00	$951.46	"$3,388.14"	"$3,388.14"	$0.00	$0.00	$951.35	$0.00	"$2,250.55"	"$2,250.55"	$0.00	"$2,282.50"	"$3,615.48"	"$3,652.00"	$0.00		$0.00	$714.42	$0.00	$0.00	$726.75	$0.00	$0.00	$0.00	$0.00	$0.00
70-5109L	SUP	HCPCS C1776		70-5109L  -  CMPNT FEM 9 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,652.00"	"$2,054.25"	"$2,054.25"	$0.00	$0.00	$0.00	$951.46	"$3,388.14"	"$3,388.14"	$0.00	$0.00	$951.35	$0.00	"$2,250.55"	"$2,250.55"	$0.00	"$2,282.50"	"$3,615.48"	"$3,652.00"	$0.00		$0.00	$714.42	$0.00	$0.00	$726.75	$0.00	$0.00	$0.00	$0.00	$0.00
70-5109R	SUP	HCPCS C1776		70-5109R  -  CMPNT FEM 9 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,652.00"	"$2,054.25"	"$2,054.25"	$0.00	$0.00	$0.00	$951.46	"$3,388.14"	"$3,388.14"	$0.00	$0.00	$951.35	$0.00	"$2,250.55"	"$2,250.55"	$0.00	"$2,282.50"	"$3,615.48"	"$3,652.00"	$0.00		$0.00	$714.42	$0.00	$0.00	$726.75	$0.00	$0.00	$0.00	$0.00	$0.00
70-5111L	SUP	HCPCS C1776		70-5111L  -  CMPNT FEM 11 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,652.00"	"$2,054.25"	"$2,054.25"	$0.00	$0.00	$0.00	$951.46	"$3,388.14"	"$3,388.14"	$0.00	$0.00	$951.35	$0.00	"$2,250.55"	"$2,250.55"	$0.00	"$2,282.50"	"$3,615.48"	"$3,652.00"	$0.00		$0.00	$714.42	$0.00	$0.00	$726.75	$0.00	$0.00	$0.00	$0.00	$0.00
70-5111R	SUP	HCPCS C1776		70-5111R  -  CMPNT FEM 11 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,565.00 "	"$3,378.10"	$0.00	"$3,652.00"	"$2,054.25"	"$2,054.25"	$0.00	$0.00	$0.00	$951.46	"$3,388.14"	"$3,388.14"	$0.00	$0.00	$951.35	$0.00	"$2,250.55"	"$2,250.55"	$0.00	"$2,282.50"	"$3,615.48"	"$3,652.00"	$0.00		$0.00	$714.42	$0.00	$0.00	$726.75	$0.00	$0.00	$0.00	$0.00	$0.00
70-5113L	SUP	HCPCS C1776		70-5113L  -  CMPNT FEM 13 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,647.00 "	"$3,438.78"	$0.00	"$3,717.60"	"$2,091.15"	"$2,091.15"	$0.00	$0.00	$0.00	$968.55	"$3,449.00"	"$3,449.00"	$0.00	$0.00	$968.43	$0.00	"$2,290.97"	"$2,290.97"	$0.00	"$2,323.50"	"$3,680.42"	"$3,717.60"	$0.00		$0.00	$727.26	$0.00	$0.00	$739.80	$0.00	$0.00	$0.00	$0.00	$0.00
70-5113R	SUP	HCPCS C1776		70-5113R  -  CMPNT FEM 13 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,647.00 "	"$3,438.78"	$0.00	"$3,717.60"	"$2,091.15"	"$2,091.15"	$0.00	$0.00	$0.00	$968.55	"$3,449.00"	"$3,449.00"	$0.00	$0.00	$968.43	$0.00	"$2,290.97"	"$2,290.97"	$0.00	"$2,323.50"	"$3,680.42"	"$3,717.60"	$0.00		$0.00	$727.26	$0.00	$0.00	$739.80	$0.00	$0.00	$0.00	$0.00	$0.00
70-5203L	SUP	HCPCS C1776		70-5203L  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
70-5203R	SUP	HCPCS C1776		70-5203R  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
70-5205L	SUP	HCPCS C1776		70-5205L  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
70-5205R	SUP	HCPCS C1776		70-5205R  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
70-5207L	SUP	HCPCS C1776		70-5207L  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
70-5207R	SUP	HCPCS C1776		70-5207R  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
70-5209L	SUP	HCPCS C1776		70-5209L  -  COMPONENT FEMORAL 9 CRUCIATE RETAIN MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
70-5209R	SUP	HCPCS C1776		70-5209R  -  COMPONENT FEMORAL 9 CRUCIATE RETAIN MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
70-5211L	SUP	HCPCS C1776		70-5211L  -  COMPONENT FEMORAL 11 CRUCIATE RETAIN MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
70-5211R	SUP	HCPCS C1776		70-5211R  -  COMPONENT FEMORAL 11 CRUCIATE RETAIN MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
70-5213L	SUP	HCPCS C1776		70-5213L  -  COMPONENT FEMORAL 13 CRUCIATE RETAIN MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
70-5213R	SUP	HCPCS C1776		70-5213R  -  COMPONENT FEMORAL 13 CRUCIATE RETAIN MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
7060-0000	SUP	HCPCS C1713		7060-0000  -  PLUG DOME HL HEX STRL LF TRDNT II DISP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
7066-24	SUP	Custom 27203010		SPLINT ORTH UNV 24IN KNEE SUP PRFR FOAM	BOTH IP/OP	$44.23 	$32.73	$0.00	$53.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.82	$32.82	$0.00	$0.00	$9.22	$0.00	$0.00	$0.00	$0.00	$33.43	$52.95	$53.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-42A	SUP	HCPCS C1776		709-04-42A  -  SHELL ACTB A 42MM STRL TRDNT II 8 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-44B	SUP	HCPCS C1776		709-04-44B  -  SHELL ACTB B 44MM STRL TRDNT II 8 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-46C	SUP	HCPCS C1776		709-04-46C  -  SHELL ACTB C 46MM STRL TRDNT II 8 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-48D	SUP	HCPCS C1776		709-04-48D  -  SHELL ACTB D 48MM STRL TRDNT II 9 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-50D	SUP	HCPCS C1776		709-04-50D  -  SHELL ACTB D 50MM STRL TRDNT II 9 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-52E	SUP	HCPCS C1776		709-04-52E  -  SHELL ACTB E 52MM STRL TRDNT II 11 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-54E	SUP	HCPCS C1776		709-04-54E  -  SHELL ACTB E 54MM STRL TRDNT II 11 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-56F	SUP	HCPCS C1776		709-04-56F  -  SHELL ACTB F 56MM STRL TRDNT II 13 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-58F	SUP	HCPCS C1776		709-04-58F  -  SHELL ACTB F 58MM STRL TRDNT II 13 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-60G	SUP	HCPCS C1776		709-04-60G  -  SHELL ACTB G 60MM STRL TRDNT II 13 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-62G	SUP	HCPCS C1776		709-04-62G  -  SHELL ACTB G 62MM STRL TRDNT II 13 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-64H	SUP	HCPCS C1776		709-04-64H  -  SHELL ACTB H 64MM STRL TRDNT II 13 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-66H	SUP	HCPCS C1776		709-04-66H  -  SHELL ACTB H 66MM STRL TRDNT II 13 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-68I	SUP	HCPCS C1776		709-04-68I  -  SHELL ACTB I 68MM STRL TRDNT II 13 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-70I	SUP	HCPCS C1776		709-04-70I  -  SHELL ACTB I 70MM STRL TRDNT II 13 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
709-04-72J	SUP	HCPCS C1776		709-04-72J  -  SHELL ACTB J 72MM STRL TRDNT II 13 HL TRITANIUM HIP	BOTH IP/OP	"$6,782.50 "	"$5,019.05"	$0.00	"$5,426.00"	"$3,052.13"	"$3,052.13"	$0.00	$0.00	$0.00	"$1,413.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,413.47"	$0.00	"$3,343.77"	"$3,343.77"	$0.00	"$3,391.25"	"$5,371.74"	"$5,426.00"	$0.00		$0.00	"$1,061.46"	$0.00	$0.00	"$1,079.77"	$0.00	$0.00	$0.00	$0.00	$0.00
70-DO55	SUP	HCPCS C1713		70-DO55  -  PLATE STD BONE LEFT DISTAL RADL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
70XLTCD	SUP	Custom 27203010		70XLTCD  -  TUBE TRCH 39MM 49MM 12.3MM 7MM 100MM STRL LF 12MM SHLY XLT	BOTH IP/OP	$159.65 	$118.14	$0.00	$129.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.49	$118.49	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$81.02	$128.34	$129.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
70XLTUP	SUP	Custom 27203010		70XLTUP  -  TUBE TRCH 39MM 34MM 12.3MM 7MM 100MM STRL LF 27MM SHLY XLT	BOTH IP/OP	$159.65 	$118.14	$0.00	$129.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.49	$118.49	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$81.02	$128.34	$129.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
710.000.98S	SUP	HCPCS C1763		710.000.98S  -  SUBSTITUTE BNGFT XS VOID FILR GRANULES CHRONOS BTCP .5ML	BOTH IP/OP	$216.25 	$160.03	$0.00	$173.00	$97.31	$97.31	$0.00	$0.00	$0.00	$45.07	$160.50	$160.50	$0.00	$0.00	$45.07	$0.00	$127.91	$127.91	$0.00	$108.13	$171.27	$173.00	$0.00		$0.00	$33.84	$0.00	$0.00	$34.43	$0.00	$0.00	$0.00	$0.00	$0.00
710.001.98S	SUP	HCPCS C1763		710.001.98S  -  SUBSTITUTE BNGFT SMALL .7-1.4MM VOID FILR GRANULES CHRONOS	BOTH IP/OP	$216.25 	$160.03	$0.00	$173.00	$97.31	$97.31	$0.00	$0.00	$0.00	$45.07	$160.50	$160.50	$0.00	$0.00	$45.07	$0.00	$127.91	$127.91	$0.00	$108.13	$171.27	$173.00	$0.00		$0.00	$33.84	$0.00	$0.00	$34.43	$0.00	$0.00	$0.00	$0.00	$0.00
710.002.98S	SUP	HCPCS C1713		710.002.98S  -  CEMENT BONE .7-1.4MM/1CC GRANULES BETA-TRICALCIUM PHOSPHATE	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$180.00	$180.00	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
710.003.98S	SUP	HCPCS C1763		710.003.98S  -  SUBSTITUTE BNGFT SMALL .7-1.4MM VOID FILR GRANULES CHRONOS	BOTH IP/OP	$887.50 	$656.75	$0.00	$710.00	$399.38	$399.38	$0.00	$0.00	$0.00	$184.98	$658.70	$658.70	$0.00	$0.00	$184.96	$0.00	$524.96	$524.96	$0.00	$443.75	$702.90	$710.00	$0.00		$0.00	$138.89	$0.00	$0.00	$141.29	$0.00	$0.00	$0.00	$0.00	$0.00
710.011.98S	SUP	HCPCS C1763		710.011.98S  -  SUBSTITUTE BNGFT MEDIUM 1.4-2.8MM VOID FILR GRANULES CHRONOS	BOTH IP/OP	$887.50 	$656.75	$0.00	$710.00	$399.38	$399.38	$0.00	$0.00	$0.00	$184.98	$658.70	$658.70	$0.00	$0.00	$184.96	$0.00	$524.96	$524.96	$0.00	$443.75	$702.90	$710.00	$0.00		$0.00	$138.89	$0.00	$0.00	$141.29	$0.00	$0.00	$0.00	$0.00	$0.00
710.014.98S	SUP	HCPCS C1763		710.014.98S  -  SUBSTITUTE BNGFT MEDIUM 1.4-2.8MM VOID FILR GRANULES CHRONOS	BOTH IP/OP	"$1,242.50 "	$919.45	$0.00	$994.00	$559.13	$559.13	$0.00	$0.00	$0.00	$258.97	$922.18	$922.18	$0.00	$0.00	$258.94	$0.00	$734.94	$734.94	$0.00	$621.25	$984.06	$994.00	$0.00		$0.00	$194.45	$0.00	$0.00	$197.81	$0.00	$0.00	$0.00	$0.00	$0.00
710.019.97S	SUP	HCPCS C1713		710.019.97S  -  SUBSTITUTE BNGFT 1.4-2.8MM CHRNS MED BTCP VOID	BOTH IP/OP	"$1,849.95 "	"$1,368.96"	$0.00	"$1,436.86"	$808.23	$808.23	$0.00	$0.00	$0.00	$385.58	"$1,373.03"	"$1,373.03"	$0.00	$0.00	$385.53	$0.00	"$1,094.25"	"$1,094.25"	$0.00	$898.04	"$1,422.50"	"$1,436.86"	$0.00		$0.00	$272.90	$0.00	$0.00	$285.94	$0.00	$0.00	$0.00	$0.00	$0.00
710.021.97S	SUP	HCPCS C1713		710.021.97S  -  SUBSTITUTE BNGFT 1.4-2.8MM CHRNS MED BTCP VOID	BOTH IP/OP	"$2,641.65 "	"$1,954.82"	$0.00	"$2,051.76"	"$1,154.12"	"$1,154.12"	$0.00	$0.00	$0.00	$550.59	"$1,960.63"	"$1,960.63"	$0.00	$0.00	$550.52	$0.00	"$1,302.33"	"$1,302.33"	$0.00	"$1,282.35"	"$2,031.24"	"$2,051.76"	$0.00		$0.00	$389.69	$0.00	$0.00	$408.30	$0.00	$0.00	$0.00	$0.00	$0.00
710.042.98S	SUP	HCPCS C1763		710.042.98S  -  SUBSTITUTE BNGFT 10X5X5MM VOID FILR BLOCK CHRONOS BTCP	BOTH IP/OP	$672.50 	$497.65	$0.00	$538.00	$302.63	$302.63	$0.00	$0.00	$0.00	$140.17	$499.13	$499.13	$0.00	$0.00	$140.15	$0.00	$397.78	$397.78	$0.00	$336.25	$532.62	$538.00	$0.00		$0.00	$105.25	$0.00	$0.00	$107.06	$0.00	$0.00	$0.00	$0.00	$0.00
710.045.97S	SUP	HCPCS C1763		710.045.97S  -  SUBSTITUTE BNGFT 12.5X12.5X10MM VOID FILR BLOCK	BOTH IP/OP	$924.98 	$684.49	$0.00	$718.42	$404.11	$404.11	$0.00	$0.00	$0.00	$192.79	$686.52	$686.52	$0.00	$0.00	$192.76	$0.00	$547.12	$547.12	$0.00	$449.01	$711.24	$718.42	$0.00		$0.00	$136.45	$0.00	$0.00	$142.97	$0.00	$0.00	$0.00	$0.00	$0.00
710.047.97S	SUP	HCPCS C1763		710.047.97S  -  SUBSTITUTE BNGFT 20X20X10MM VOID FILR BLOCK OSTEOCONDUCTIVE	BOTH IP/OP	"$1,818.13 "	"$1,345.42"	$0.00	"$1,412.14"	$794.33	$794.33	$0.00	$0.00	$0.00	$378.94	"$1,349.41"	"$1,349.41"	$0.00	$0.00	$378.90	$0.00	"$1,075.42"	"$1,075.42"	$0.00	$882.59	"$1,398.02"	"$1,412.14"	$0.00		$0.00	$268.20	$0.00	$0.00	$281.02	$0.00	$0.00	$0.00	$0.00	$0.00
710.047.98S	SUP	HCPCS C1763		710.047.98S  -  SUBSTITUTE BNGFT 20X20X10MM VOID FILR BLOCK CHRONOS BETA	BOTH IP/OP	"$2,355.00 "	"$1,742.70"	$0.00	"$1,884.00"	"$1,059.75"	"$1,059.75"	$0.00	$0.00	$0.00	$490.84	"$1,747.88"	"$1,747.88"	$0.00	$0.00	$490.78	$0.00	"$1,392.98"	"$1,392.98"	$0.00	"$1,177.50"	"$1,865.16"	"$1,884.00"	$0.00		$0.00	$368.56	$0.00	$0.00	$374.92	$0.00	$0.00	$0.00	$0.00	$0.00
710.050.97S	SUP	HCPCS C1763		710.050.97S  -  SUBSTITUTE BNGFT 10D RECTANGLE 25X20X6.5MM VOID FILR WEDGE	BOTH IP/OP	"$1,838.00 "	"$1,360.12"	$0.00	"$1,427.58"	$803.01	$803.01	$0.00	$0.00	$0.00	$383.09	"$1,364.16"	"$1,364.16"	$0.00	$0.00	$383.04	$0.00	"$1,087.18"	"$1,087.18"	$0.00	$892.24	"$1,413.31"	"$1,427.58"	$0.00		$0.00	$271.14	$0.00	$0.00	$284.09	$0.00	$0.00	$0.00	$0.00	$0.00
710.050.98S	SUP	HCPCS C1713		710.050.98S  -  SUBSTITUTE BNGFT 10D RECTANGLE 25X20MM WEDGE CHRONOS BTCP	BOTH IP/OP	"$2,380.00 "	"$1,761.20"	$0.00	"$1,904.00"	"$1,071.00"	"$1,071.00"	$0.00	$0.00	$0.00	$496.05	"$1,766.44"	"$1,766.44"	$0.00	$0.00	$495.99	$0.00	"$1,407.77"	"$1,407.77"	$0.00	"$1,190.00"	"$1,884.96"	"$1,904.00"	$0.00		$0.00	$372.47	$0.00	$0.00	$378.90	$0.00	$0.00	$0.00	$0.00	$0.00
710.051.97S	SUP	HCPCS C1763		710.051.97S  -  SUBSTITUTE BNGFT 14D RECTANGLE 25X20X8MM VOID FILR WEDGE	BOTH IP/OP	"$1,937.48 "	"$1,433.74"	$0.00	"$1,504.84"	$846.47	$846.47	$0.00	$0.00	$0.00	$403.82	"$1,437.99"	"$1,437.99"	$0.00	$0.00	$403.77	$0.00	"$1,146.02"	"$1,146.02"	$0.00	$940.53	"$1,489.79"	"$1,504.84"	$0.00		$0.00	$285.81	$0.00	$0.00	$299.46	$0.00	$0.00	$0.00	$0.00	$0.00
710.052.97S	SUP	HCPCS C1763		710.052.97S  -  SUBSTITUTE BNGFT 18D RECTANGULAR 25X20X10MM VOID FILR WEDGE	BOTH IP/OP	"$2,058.80 "	"$1,523.51"	$0.00	"$1,599.08"	$899.48	$899.48	$0.00	$0.00	$0.00	$429.11	"$1,528.04"	"$1,528.04"	$0.00	$0.00	$429.05	$0.00	"$1,217.78"	"$1,217.78"	$0.00	$999.43	"$1,583.09"	"$1,599.08"	$0.00		$0.00	$303.71	$0.00	$0.00	$318.22	$0.00	$0.00	$0.00	$0.00	$0.00
710.053.97S	SUP	HCPCS C1763		710.053.97S  -  SUBSTITUTE BNGFT 22D RECTANGLE 25X20X12MM VOID FILR WEDGE	BOTH IP/OP	"$2,170.20 "	"$1,605.95"	$0.00	"$1,685.60"	$948.15	$948.15	$0.00	$0.00	$0.00	$452.32	"$1,610.72"	"$1,610.72"	$0.00	$0.00	$452.27	$0.00	"$1,283.67"	"$1,283.67"	$0.00	"$1,053.50"	"$1,668.74"	"$1,685.60"	$0.00		$0.00	$320.14	$0.00	$0.00	$335.43	$0.00	$0.00	$0.00	$0.00	$0.00
710.057.97S	SUP	HCPCS C1763		710.057.97S  -  SUBSTITUTE BNGFT 7D SEMICIRCLE 35X25X7MM VOID FILR WEDGE	BOTH IP/OP	"$2,170.20 "	"$1,605.95"	$0.00	"$1,685.60"	$948.15	$948.15	$0.00	$0.00	$0.00	$452.32	"$1,610.72"	"$1,610.72"	$0.00	$0.00	$452.27	$0.00	"$1,283.67"	"$1,283.67"	$0.00	"$1,053.50"	"$1,668.74"	"$1,685.60"	$0.00		$0.00	$320.14	$0.00	$0.00	$335.43	$0.00	$0.00	$0.00	$0.00	$0.00
710.057.98S	SUP	HCPCS C1763		710.057.98S  -  SUBSTITUTE BNGFT 7D VOID FILR WEDGE SEMICIRCULAR CHRONOS	BOTH IP/OP	"$2,810.00 "	"$2,079.40"	$0.00	"$2,248.00"	"$1,264.50"	"$1,264.50"	$0.00	$0.00	$0.00	$585.67	"$2,085.58"	"$2,085.58"	$0.00	$0.00	$585.60	$0.00	"$1,385.33"	"$1,385.33"	$0.00	"$1,405.00"	"$2,225.52"	"$2,248.00"	$0.00		$0.00	$439.77	$0.00	$0.00	$447.35	$0.00	$0.00	$0.00	$0.00	$0.00
710.060.97S	SUP	HCPCS C1763		710.060.97S  -  SUBSTITUTE BNGFT 10D VOID FILR WEDGE ANGLED SEMICIRCULAR	BOTH IP/OP	"$2,245.80 "	"$1,661.89"	$0.00	"$1,744.30"	$981.17	$981.17	$0.00	$0.00	$0.00	$468.08	"$1,666.83"	"$1,666.83"	$0.00	$0.00	$468.02	$0.00	"$1,328.39"	"$1,328.39"	$0.00	"$1,090.19"	"$1,726.86"	"$1,744.30"	$0.00		$0.00	$331.29	$0.00	$0.00	$347.12	$0.00	$0.00	$0.00	$0.00	$0.00
710.063.97S	SUP	HCPCS C1763		710.063.97S  -  SUBSTITUTE BNGFT 13D SEMICIRCLE 35X25X13MM WEDGE	BOTH IP/OP	"$2,355.20 "	"$1,742.85"	$0.00	"$1,829.28"	"$1,028.97"	"$1,028.97"	$0.00	$0.00	$0.00	$490.88	"$1,748.03"	"$1,748.03"	$0.00	$0.00	$490.82	$0.00	"$1,393.10"	"$1,393.10"	$0.00	"$1,143.30"	"$1,810.99"	"$1,829.28"	$0.00		$0.00	$347.43	$0.00	$0.00	$364.03	$0.00	$0.00	$0.00	$0.00	$0.00
71063108S	SUP	HCPCS C1713		71063108S  -  PIN HLF 3MM 10MM JTX TI NTRD	BOTH IP/OP	$424.00 	$313.76	$0.00	$339.20	$190.80	$190.80	$0.00	$0.00	$0.00	$88.37	$314.69	$314.69	$0.00	$0.00	$88.36	$0.00	$250.80	$250.80	$0.00	$212.00	$335.81	$339.20	$0.00		$0.00	$66.36	$0.00	$0.00	$67.50	$0.00	$0.00	$0.00	$0.00	$0.00
71063158S	SUP	HCPCS C1713		71063158S  -  PIN HLF 3MM 15MM JTX TI NTRD	BOTH IP/OP	$424.00 	$313.76	$0.00	$339.20	$190.80	$190.80	$0.00	$0.00	$0.00	$88.37	$314.69	$314.69	$0.00	$0.00	$88.36	$0.00	$250.80	$250.80	$0.00	$212.00	$335.81	$339.20	$0.00		$0.00	$66.36	$0.00	$0.00	$67.50	$0.00	$0.00	$0.00	$0.00	$0.00
71063208S	SUP	HCPCS C1713		71063208S  -  PIN HLF 3MM 20MM JTX TI NTRD	BOTH IP/OP	$424.00 	$313.76	$0.00	$339.20	$190.80	$190.80	$0.00	$0.00	$0.00	$88.37	$314.69	$314.69	$0.00	$0.00	$88.36	$0.00	$250.80	$250.80	$0.00	$212.00	$335.81	$339.20	$0.00		$0.00	$66.36	$0.00	$0.00	$67.50	$0.00	$0.00	$0.00	$0.00	$0.00
71063258S	SUP	HCPCS C1713		71063258S  -  PIN HLF 3MM 25MM JTX TI NTRD	BOTH IP/OP	$424.00 	$313.76	$0.00	$339.20	$190.80	$190.80	$0.00	$0.00	$0.00	$88.37	$314.69	$314.69	$0.00	$0.00	$88.36	$0.00	$250.80	$250.80	$0.00	$212.00	$335.81	$339.20	$0.00		$0.00	$66.36	$0.00	$0.00	$67.50	$0.00	$0.00	$0.00	$0.00	$0.00
71064158S	SUP	HCPCS C1713		71064158S  -  PIN HLF 4MM 15MM JTX TI NTRD	BOTH IP/OP	$456.00 	$337.44	$0.00	$364.80	$205.20	$205.20	$0.00	$0.00	$0.00	$95.04	$338.44	$338.44	$0.00	$0.00	$95.03	$0.00	$269.72	$269.72	$0.00	$228.00	$361.15	$364.80	$0.00		$0.00	$71.36	$0.00	$0.00	$72.60	$0.00	$0.00	$0.00	$0.00	$0.00
71064208S	SUP	HCPCS C1713		71064208S  -  PIN HLF 4MM 20MM JTX TI NTRD	BOTH IP/OP	$456.00 	$337.44	$0.00	$364.80	$205.20	$205.20	$0.00	$0.00	$0.00	$95.04	$338.44	$338.44	$0.00	$0.00	$95.03	$0.00	$269.72	$269.72	$0.00	$228.00	$361.15	$364.80	$0.00		$0.00	$71.36	$0.00	$0.00	$72.60	$0.00	$0.00	$0.00	$0.00	$0.00
71064258S	SUP	HCPCS C1713		71064258S  -  PIN HLF 4MM 25MM JTX TI NTRD	BOTH IP/OP	$456.00 	$337.44	$0.00	$364.80	$205.20	$205.20	$0.00	$0.00	$0.00	$95.04	$338.44	$338.44	$0.00	$0.00	$95.03	$0.00	$269.72	$269.72	$0.00	$228.00	$361.15	$364.80	$0.00		$0.00	$71.36	$0.00	$0.00	$72.60	$0.00	$0.00	$0.00	$0.00	$0.00
71064308S	SUP	HCPCS C1713		71064308S  -  PIN HLF 4MM 30MM JTX TI NTRD	BOTH IP/OP	$456.00 	$337.44	$0.00	$364.80	$205.20	$205.20	$0.00	$0.00	$0.00	$95.04	$338.44	$338.44	$0.00	$0.00	$95.03	$0.00	$269.72	$269.72	$0.00	$228.00	$361.15	$364.80	$0.00		$0.00	$71.36	$0.00	$0.00	$72.60	$0.00	$0.00	$0.00	$0.00	$0.00
71064358S	SUP	HCPCS C1713		71064358S  -  PIN HLF 4MM 35MM JTX TI NTRD	BOTH IP/OP	$456.00 	$337.44	$0.00	$364.80	$205.20	$205.20	$0.00	$0.00	$0.00	$95.04	$338.44	$338.44	$0.00	$0.00	$95.03	$0.00	$269.72	$269.72	$0.00	$228.00	$361.15	$364.80	$0.00		$0.00	$71.36	$0.00	$0.00	$72.60	$0.00	$0.00	$0.00	$0.00	$0.00
7106-5300	SUP	HCPCS C1713		7106-5300  -  PIN HLF SHRT 5MM 30MM ORTH	BOTH IP/OP	$608.00 	$449.92	$0.00	$486.40	$273.60	$273.60	$0.00	$0.00	$0.00	$126.72	$451.26	$451.26	$0.00	$0.00	$126.71	$0.00	$359.63	$359.63	$0.00	$304.00	$481.54	$486.40	$0.00		$0.00	$95.15	$0.00	$0.00	$96.79	$0.00	$0.00	$0.00	$0.00	$0.00
71065304S	SUP	HCPCS C1713		71065304S  -  PIN HLF XSH 5MM 30MM STRL JTX TI NTRD	BOTH IP/OP	$584.00 	$432.16	$0.00	$467.20	$262.80	$262.80	$0.00	$0.00	$0.00	$121.72	$433.44	$433.44	$0.00	$0.00	$121.71	$0.00	$345.44	$345.44	$0.00	$292.00	$462.53	$467.20	$0.00		$0.00	$91.40	$0.00	$0.00	$92.97	$0.00	$0.00	$0.00	$0.00	$0.00
71065308S	SUP	HCPCS C1713		71065308S  -  PIN HLF SHRT 5MM 30MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065309S	SUP	HCPCS C1713		71065309S  -  PIN HLF LNG 5MM 30MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065354S	SUP	HCPCS C1713		71065354S  -  PIN HLF XSH 5MM 35MM STRL JTX TI NTRD	BOTH IP/OP	$556.00 	$411.44	$0.00	$444.80	$250.20	$250.20	$0.00	$0.00	$0.00	$115.88	$412.66	$412.66	$0.00	$0.00	$115.87	$0.00	$328.87	$328.87	$0.00	$278.00	$440.35	$444.80	$0.00		$0.00	$87.01	$0.00	$0.00	$88.52	$0.00	$0.00	$0.00	$0.00	$0.00
71065358S	SUP	HCPCS C1713		71065358S  -  PIN HLF SHRT 5MM 35MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065359S	SUP	HCPCS C1713		71065359S  -  PIN HLF LNG 5MM 35MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065404S	SUP	HCPCS C1713		71065404S  -  PIN HLF XSH 5MM 40MM STRL JTX TI NTRD	BOTH IP/OP	$584.00 	$432.16	$0.00	$467.20	$262.80	$262.80	$0.00	$0.00	$0.00	$121.72	$433.44	$433.44	$0.00	$0.00	$121.71	$0.00	$345.44	$345.44	$0.00	$292.00	$462.53	$467.20	$0.00		$0.00	$91.40	$0.00	$0.00	$92.97	$0.00	$0.00	$0.00	$0.00	$0.00
71065407S	SUP	HCPCS C1713		71065407S  -  PIN HLF XSH 1.6MM 40MM STRL JTX CNN TI NTRD	BOTH IP/OP	$790.00 	$584.60	$0.00	$632.00	$355.50	$355.50	$0.00	$0.00	$0.00	$164.66	$586.34	$586.34	$0.00	$0.00	$164.64	$0.00	$467.29	$467.29	$0.00	$395.00	$625.68	$632.00	$0.00		$0.00	$123.64	$0.00	$0.00	$125.77	$0.00	$0.00	$0.00	$0.00	$0.00
71065408S	SUP	HCPCS C1713		71065408S  -  PIN HLF SHRT 5MM 40MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065409S	SUP	HCPCS C1713		71065409S  -  PIN HLF LNG 5MM 40MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065454S	SUP	HCPCS C1713		71065454S  -  PIN HLF XSH 5MM 45MM STRL JTX TI NTRD	BOTH IP/OP	$556.00 	$411.44	$0.00	$444.80	$250.20	$250.20	$0.00	$0.00	$0.00	$115.88	$412.66	$412.66	$0.00	$0.00	$115.87	$0.00	$328.87	$328.87	$0.00	$278.00	$440.35	$444.80	$0.00		$0.00	$87.01	$0.00	$0.00	$88.52	$0.00	$0.00	$0.00	$0.00	$0.00
71065458S	SUP	HCPCS C1713		71065458S  -  PIN HLF SHRT 5MM 45MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065459S	SUP	HCPCS C1713		71065459S  -  PIN HLF LNG 5MM 45MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065507S	SUP	HCPCS C1713		71065507S  -  PIN HLF 5MM 50MM STRL JTX TRC TI NTRD	BOTH IP/OP	"$1,132.00 "	$837.68	$0.00	$905.60	$509.40	$509.40	$0.00	$0.00	$0.00	$235.94	$840.17	$840.17	$0.00	$0.00	$235.91	$0.00	$669.58	$669.58	$0.00	$566.00	$896.54	$905.60	$0.00		$0.00	$177.16	$0.00	$0.00	$180.21	$0.00	$0.00	$0.00	$0.00	$0.00
71065508S	SUP	HCPCS C1713		71065508S  -  PIN HLF SHRT 5MM 50MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065509S	SUP	HCPCS C1713		71065509S  -  PIN HLF LNG 5MM 50MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065558S	SUP	HCPCS C1713		71065558S  -  PIN HLF SHRT 5MM 55MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065559S	SUP	HCPCS C1713		71065559S  -  PIN HLF LNG 5MM 55MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065608S	SUP	HCPCS C1713		71065608S  -  PIN HLF SHRT 5MM 60MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065609S	SUP	HCPCS C1713		71065609S  -  PIN HLF LNG 5MM 60MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065658S	SUP	HCPCS C1713		71065658S  -  PIN HLF SHRT 5MM 65MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065659S	SUP	HCPCS C1713		71065659S  -  PIN HLF LNG 5MM 65MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065708S	SUP	HCPCS C1713		71065708S  -  PIN HLF SHRT 5MM 70MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71065709S	SUP	HCPCS C1713		71065709S  -  PIN HLF LNG 5MM 70MM STRL JTX TI NTRD	BOTH IP/OP	$618.00 	$457.32	$0.00	$494.40	$278.10	$278.10	$0.00	$0.00	$0.00	$128.81	$458.68	$458.68	$0.00	$0.00	$128.79	$0.00	$365.55	$365.55	$0.00	$309.00	$489.46	$494.40	$0.00		$0.00	$96.72	$0.00	$0.00	$98.39	$0.00	$0.00	$0.00	$0.00	$0.00
71066409S	SUP	HCPCS C1713		71066409S  -  PIN HLF LNG 6MM 40MM STRL JTX TI NTRD	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$283.50	$283.50	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$98.60	$0.00	$0.00	$100.30	$0.00	$0.00	$0.00	$0.00	$0.00
71066459S	SUP	HCPCS C1713		71066459S  -  PIN HLF LNG 6MM 45MM STRL JTX TI NTRD	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$283.50	$283.50	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$98.60	$0.00	$0.00	$100.30	$0.00	$0.00	$0.00	$0.00	$0.00
71066509S	SUP	HCPCS C1713		71066509S  -  PIN HLF LNG 6MM 50MM STRL JTX TI NTRD	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$283.50	$283.50	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$98.60	$0.00	$0.00	$100.30	$0.00	$0.00	$0.00	$0.00	$0.00
71066559S	SUP	HCPCS C1713		71066559S  -  PIN HLF LNG 6MM 55MM STRL JTX TI NTRD	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$283.50	$283.50	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$98.60	$0.00	$0.00	$100.30	$0.00	$0.00	$0.00	$0.00	$0.00
71066609S	SUP	HCPCS C1713		71066609S  -  PIN HLF LNG 6MM 60MM JTX TI NTRD	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$143.33	$143.33	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
71070115X	SUP	Custom 27011340		71070115X  -  RING EXFIX 180MM FULL CIR FT TLT SP	BOTH IP/OP	"$3,468.00 "	"$2,566.32"	$0.00	"$2,774.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,573.95"	"$2,573.95"	$0.00	$0.00	$722.73	$0.00	$0.00	$0.00	$0.00	"$1,734.00"	"$2,746.66"	"$2,774.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71071306X	SUP	HCPCS C1713		71071306X  -  RING XTRNFX 2/3 155MM	BOTH IP/OP	"$3,315.00 "	"$2,453.10"	$0.00	"$2,652.00"	"$1,491.75"	"$1,491.75"	$0.00	$0.00	$0.00	$690.93	"$2,460.39"	"$2,460.39"	$0.00	$0.00	$690.85	$0.00	"$1,634.30"	"$1,634.30"	$0.00	"$1,657.50"	"$2,625.48"	"$2,652.00"	$0.00		$0.00	$518.80	$0.00	$0.00	$527.75	$0.00	$0.00	$0.00	$0.00	$0.00
71101545S	SUP	HCPCS C1713		71101545S  -  WASHER ORTH 6MM STRL	BOTH IP/OP	$109.00 	$80.66	$0.00	$87.20	$49.05	$49.05	$0.00	$0.00	$0.00	$22.72	$80.90	$80.90	$0.00	$0.00	$22.72	$0.00	$64.47	$64.47	$0.00	$54.50	$86.33	$87.20	$0.00		$0.00	$17.06	$0.00	$0.00	$17.35	$0.00	$0.00	$0.00	$0.00	$0.00
71101690S	SUP	HCPCS C1713		71101690S  -  WASHER ORTH 12.7MM RND	BOTH IP/OP	$132.30 	$97.90	$0.00	$105.84	$59.54	$59.54	$0.00	$0.00	$0.00	$27.57	$98.19	$98.19	$0.00	$0.00	$27.57	$0.00	$78.26	$78.26	$0.00	$66.15	$104.78	$105.84	$0.00		$0.00	$20.70	$0.00	$0.00	$21.06	$0.00	$0.00	$0.00	$0.00	$0.00
71101693S	SUP	HCPCS C1713		71101693S  -  WASHER ORTH 21.7MM STRL BTRFLY SS LG CNN SCR SYS	BOTH IP/OP	$219.45 	$162.39	$0.00	$175.56	$98.75	$98.75	$0.00	$0.00	$0.00	$45.74	$162.88	$162.88	$0.00	$0.00	$45.73	$0.00	$129.80	$129.80	$0.00	$109.73	$173.80	$175.56	$0.00		$0.00	$34.34	$0.00	$0.00	$34.94	$0.00	$0.00	$0.00	$0.00	$0.00
71103000S	SUP	HCPCS C1713		71103000S  -  WASHER ORTH 12.7MM RND TI	BOTH IP/OP	$77.13 	$57.08	$0.00	$61.70	$34.71	$34.71	$0.00	$0.00	$0.00	$16.07	$57.24	$57.24	$0.00	$0.00	$16.07	$0.00	$45.62	$45.62	$0.00	$38.56	$61.09	$61.70	$0.00		$0.00	$12.07	$0.00	$0.00	$12.28	$0.00	$0.00	$0.00	$0.00	$0.00
71103003S	SUP	HCPCS C1713		71103003S  -  WASHER ORTH 21.7MM BTRFLY TI	BOTH IP/OP	$527.10 	$390.05	$0.00	$421.68	$237.20	$237.20	$0.00	$0.00	$0.00	$109.86	$391.21	$391.21	$0.00	$0.00	$109.85	$0.00	$311.78	$311.78	$0.00	$263.55	$417.46	$421.68	$0.00		$0.00	$82.49	$0.00	$0.00	$83.91	$0.00	$0.00	$0.00	$0.00	$0.00
71106230S	SUP	HCPCS C1713		71106230S  -  SCREW BN FT 6.5MM 30MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106235S	SUP	HCPCS C1713		71106235S  -  SCREW BN FT 6.5MM 35MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106240S	SUP	HCPCS C1713		71106240S  -  SCREW BN FT 6.5MM 40MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106245S	SUP	HCPCS C1713		71106245S  -  SCREW BN FT 6.5MM 45MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106250S	SUP	HCPCS C1713		71106250S  -  SCREW BN FT 6.5MM 50MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106255S	SUP	HCPCS C1713		71106255S  -  SCREW BN FT 6.5MM 55MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106260S	SUP	HCPCS C1713		71106260S  -  SCREW BN FT 6.5MM 60MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106265S	SUP	HCPCS C1713		71106265S  -  SCREW BN FT 6.5MM 65MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106270S	SUP	HCPCS C1713		71106270S  -  SCREW BN FT 6.5MM 70MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106275S	SUP	HCPCS C1713		71106275S  -  SCREW BN FT 6.5MM 75MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106280S	SUP	HCPCS C1713		71106280S  -  SCREW BN FT 6.5MM 80MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106285S	SUP	HCPCS C1713		71106285S  -  SCREW BN 6.5MM 85MM CNN FT SS	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106290S	SUP	HCPCS C1713		71106290S  -  SCREW BN FT 6.5MM 90MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106295S	SUP	HCPCS C1713		71106295S  -  SCREW BN FT 6.5MM 95MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106300S	SUP	HCPCS C1713		71106300S  -  SCREW BN FT 6.5MM 100MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106305S	SUP	HCPCS C1713		71106305S  -  SCREW BN FT 6.5MM 105MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106310S	SUP	HCPCS C1713		71106310S  -  SCREW BN FT 6.5MM 110MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106315S	SUP	HCPCS C1713		71106315S  -  SCREW BN FT 6.5MM 115MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106320S	SUP	HCPCS C1713		71106320S  -  SCREW BN FT 6.5MM 120MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106325S	SUP	HCPCS C1713		71106325S  -  SCREW BN FT 6.5MM 125MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106330S	SUP	HCPCS C1713		71106330S  -  SCREW BN FT 6.5MM 130MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106335S	SUP	HCPCS C1713		71106335S  -  SCREW BN FT 6.5MM 135MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106340S	SUP	HCPCS C1713		71106340S  -  SCREW BN FT 6.5MM 140MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106345S	SUP	HCPCS C1713		71106345S  -  SCREW BN FT 6.5MM 145MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106350S	SUP	HCPCS C1713		71106350S  -  SCREW BN FT 6.5MM 150MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106355S	SUP	HCPCS C1713		71106355S  -  SCREW BN FT 6.5MM 155MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106360S	SUP	HCPCS C1713		71106360S  -  SCREW BN FT 6.5MM 160MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106365S	SUP	HCPCS C1713		71106365S  -  SCREW BN FT 6.5MM 165MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106370S	SUP	HCPCS C1713		71106370S  -  SCREW BN FT 6.5MM 170MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106375S	SUP	HCPCS C1713		71106375S  -  SCREW BN FT 6.5MM 175MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106380S	SUP	HCPCS C1713		71106380S  -  SCREW BN FT 6.5MM 180MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106530S	SUP	HCPCS C1713		71106530S  -  SCREW BN 6.5MM 30MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106535S	SUP	HCPCS C1713		71106535S  -  SCREW BN 6.5MM 35MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106540S	SUP	HCPCS C1713		71106540S  -  SCREW BN 6.5MM 40MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106545S	SUP	HCPCS C1713		71106545S  -  SCREW BN 6.5MM 45MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106550S	SUP	HCPCS C1713		71106550S  -  SCREW BN 6.5MM 50MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106555S	SUP	HCPCS C1713		71106555S  -  SCREW BN 6.5MM 55MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106560S	SUP	HCPCS C1713		71106560S  -  SCREW BN 6.5MM 60MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106565S	SUP	HCPCS C1713		71106565S  -  SCREW BN 6.5MM 65MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106570S	SUP	HCPCS C1713		71106570S  -  SCREW BN 6.5MM 70MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106575S	SUP	HCPCS C1713		71106575S  -  SCREW BN 6.5MM 75MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106580S	SUP	HCPCS C1713		71106580S  -  SCREW BN 6.5MM 80MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106585S	SUP	HCPCS C1713		71106585S  -  SCREW BN 6.5MM 85MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106590S	SUP	HCPCS C1713		71106590S  -  SCREW BN 6.5MM 90MM STRL 22MM CNN SS ORTH	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106595S	SUP	HCPCS C1713		71106595S  -  SCREW BN 6.5MM 95MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106600S	SUP	HCPCS C1713		71106600S  -  SCREW BN 6.5MM 100MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106605S	SUP	HCPCS C1713		71106605S  -  SCREW BN 6.5MM 105MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106610S	SUP	HCPCS C1713		71106610S  -  SCREW BN 6.5MM 110MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106615S	SUP	HCPCS C1713		71106615S  -  SCREW BN 6.5MM 115MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106620S	SUP	HCPCS C1713		71106620S  -  SCREW BN 6.5MM 120MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106625S	SUP	HCPCS C1713		71106625S  -  SCREW BN 6.5MM 125MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106630S	SUP	HCPCS C1713		71106630S  -  SCREW BN 6.5MM 130MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106635S	SUP	HCPCS C1713		71106635S  -  SCREW BN 6.5MM 135MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106640S	SUP	HCPCS C1713		71106640S  -  SCREW BN 6.5MM 140MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106645S	SUP	HCPCS C1713		71106645S  -  SCREW BN 6.5MM 145MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106650S	SUP	HCPCS C1713		71106650S  -  SCREW BN 6.5MM 150MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106655S	SUP	HCPCS C1713		71106655S  -  SCREW BN 6.5MM 155MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106660S	SUP	HCPCS C1713		71106660S  -  SCREW BN 6.5MM 160MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106665S	SUP	HCPCS C1713		71106665S  -  SCREW BN 6.5MM 165MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106670S	SUP	HCPCS C1713		71106670S  -  SCREW BN 6.5MM 170MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106675S	SUP	HCPCS C1713		71106675S  -  SCREW BN 6.5MM 175MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106680S	SUP	HCPCS C1713		71106680S  -  SCREW BN 6.5MM 180MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106755S	SUP	HCPCS C1713		71106755S  -  SCREW BN 6.5MM 55MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106760S	SUP	HCPCS C1713		71106760S  -  SCREW BN 6.5MM 60MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106765S	SUP	HCPCS C1713		71106765S  -  SCREW BN 6.5MM 65MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106770S	SUP	HCPCS C1713		71106770S  -  SCREW BN 6.5MM 70MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106775S	SUP	HCPCS C1713		71106775S  -  SCREW BN 6.5MM 75MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106780S	SUP	HCPCS C1713		71106780S  -  SCREW BN 6.5MM 80MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106785S	SUP	HCPCS C1713		71106785S  -  SCREW BN 6.5MM 85MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106790S	SUP	HCPCS C1713		71106790S  -  SCREW BN 6.5MM 90MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106795S	SUP	HCPCS C1713		71106795S  -  SCREW BN 6.5MM 95MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106800S	SUP	HCPCS C1713		71106800S  -  SCREW BN 6.5MM 100MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106805S	SUP	HCPCS C1713		71106805S  -  SCREW BN 6.5MM 105MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106810S	SUP	HCPCS C1713		71106810S  -  SCREW BN 6.5MM 110MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106815S	SUP	HCPCS C1713		71106815S  -  SCREW BN 6.5MM 115MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106820S	SUP	HCPCS C1713		71106820S  -  SCREW BN 6.5MM 120MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106825S	SUP	HCPCS C1713		71106825S  -  SCREW BN 6.5MM 125MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$435.75 	$322.46	$0.00	$348.60	$196.09	$196.09	$0.00	$0.00	$0.00	$90.82	$323.41	$323.41	$0.00	$0.00	$90.81	$0.00	$257.75	$257.75	$0.00	$217.88	$345.11	$348.60	$0.00		$0.00	$68.19	$0.00	$0.00	$69.37	$0.00	$0.00	$0.00	$0.00	$0.00
71106830S	SUP	HCPCS C1713		71106830S  -  SCREW BN 6.5MM 130MM STRL 40MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106835S	SUP	HCPCS C1713		71106835S  -  SCREW BN 6.5MM 135MM STRL 40MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106840S	SUP	HCPCS C1713		71106840S  -  SCREW BN 6.5MM 140MM STRL 40MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106845S	SUP	HCPCS C1713		71106845S  -  SCREW BN 6.5MM 145MM STRL 40MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106850S	SUP	HCPCS C1713		71106850S  -  SCREW BN 6.5MM 150MM STRL 40MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106855S	SUP	HCPCS C1713		71106855S  -  SCREW BN 6.5MM 155MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106860S	SUP	HCPCS C1713		71106860S  -  SCREW BN 6.5MM 160MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106865S	SUP	HCPCS C1713		71106865S  -  SCREW BN 6.5MM 165MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106870S	SUP	HCPCS C1713		71106870S  -  SCREW BN 6.5MM 170MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106875S	SUP	HCPCS C1713		71106875S  -  SCREW BN 6.5MM 175MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71106880S	SUP	HCPCS C1713		71106880S  -  SCREW BN 6.5MM 180MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$502.95 	$372.18	$0.00	$402.36	$226.33	$226.33	$0.00	$0.00	$0.00	$104.83	$373.29	$373.29	$0.00	$0.00	$104.81	$0.00	$297.49	$297.49	$0.00	$251.48	$398.34	$402.36	$0.00		$0.00	$78.71	$0.00	$0.00	$80.07	$0.00	$0.00	$0.00	$0.00	$0.00
71107230S	SUP	HCPCS C1713		71107230S  -  SCREW BN 6.5MM 30MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107235S	SUP	HCPCS C1713		71107235S  -  SCREW BN 6.5MM 35MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107240S	SUP	HCPCS C1713		71107240S  -  SCREW BN 6.5MM 40MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107245S	SUP	HCPCS C1713		71107245S  -  SCREW BN 6.5MM 45MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107250S	SUP	HCPCS C1713		71107250S  -  SCREW BN 6.5MM 50MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107255S	SUP	HCPCS C1713		71107255S  -  SCREW BN 6.5MM 55MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107260S	SUP	HCPCS C1713		71107260S  -  SCREW BN 6.5MM 60MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107265S	SUP	HCPCS C1713		71107265S  -  SCREW BN 6.5MM 65MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107270S	SUP	HCPCS C1713		71107270S  -  SCREW BN 6.5MM 70MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107275S	SUP	HCPCS C1713		71107275S  -  SCREW BN 6.5MM 75MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107280S	SUP	HCPCS C1713		71107280S  -  SCREW BN 6.5MM 80MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107285S	SUP	HCPCS C1713		71107285S  -  SCREW BN 6.5MM 85MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107290S	SUP	HCPCS C1713		71107290S  -  SCREW BN 6.5MM 90MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107295S	SUP	HCPCS C1713		71107295S  -  SCREW BN 6.5MM 95MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107300S	SUP	HCPCS C1713		71107300S  -  SCREW BN 6.5MM 100MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107305S	SUP	HCPCS C1713		71107305S  -  SCREW BN 6.5MM 105MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107310S	SUP	HCPCS C1713		71107310S  -  SCREW BN 6.5MM 110MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107315S	SUP	HCPCS C1713		71107315S  -  SCREW BN 6.5MM 115MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107320S	SUP	HCPCS C1713		71107320S  -  SCREW BN 6.5MM 120MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107325S	SUP	HCPCS C1713		71107325S  -  SCREW BN FT 6.5MM 125MM CNN SET TI ANKL ASCP ARTHDS	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107330S	SUP	HCPCS C1713		71107330S  -  SCREW BN 6.5MM 130MM CNN FT TI	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107335S	SUP	HCPCS C1713		71107335S  -  SCREW BN 6.5MM 135MM CNN FT TI	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107340S	SUP	HCPCS C1713		71107340S  -  SCREW BN 6.5MM 140MM CNN FT TI	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107345S	SUP	HCPCS C1713		71107345S  -  SCREW BN 6.5MM 145MM CNN FT TI	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107350S	SUP	HCPCS C1713		71107350S  -  SCREW BN 6.5MM 150MM CNN FT TI	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107355S	SUP	HCPCS C1713		71107355S  -  SCREW BN 6.5MM 155MM CNN FT TI	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107360S	SUP	HCPCS C1713		71107360S  -  SCREW BN 6.5MM 160MM CNN FT TI	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107365S	SUP	HCPCS C1713		71107365S  -  SCREW BN 6.5MM 165MM CNN FT TI	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107370S	SUP	HCPCS C1713		71107370S  -  SCREW BN 6.5MM 170MM CNN FT TI	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107375S	SUP	HCPCS C1713		71107375S  -  SCREW BN 6.5MM 175MM CNN FT TI	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107380S	SUP	HCPCS C1713		71107380S  -  SCREW BN 6.5MM 180MM CNN FT TI	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107530S	SUP	HCPCS C1713		71107530S  -  SCREW BN 6.5MM 30MM 20MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107535S	SUP	HCPCS C1713		71107535S  -  SCREW BN 6.5MM 35MM 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107540S	SUP	HCPCS C1713		71107540S  -  SCREW BN 6.5MM 40MM 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107545S	SUP	HCPCS C1713		71107545S  -  SCREW BN 6.5MM 45MM 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107550S	SUP	HCPCS C1713		71107550S  -  SCREW BN 6.5MM 50MM 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107555S	SUP	HCPCS C1713		71107555S  -  SCREW BN 6.5MM 55MM 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107560S	SUP	HCPCS C1713		71107560S  -  SCREW BN 6.5MM 60MM 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107565S	SUP	HCPCS C1713		71107565S  -  SCREW BN 6.5MM 65MM 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107570S	SUP	HCPCS C1713		71107570S  -  SCREW BN 6.5MM 70MM 22MM CNN P/T	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107575S	SUP	HCPCS C1713		71107575S  -  SCREW BN 6.5MM 75MM 22MM CNN P/T	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107580S	SUP	HCPCS C1713		71107580S  -  SCREW BN 6.5MM 80MM 22MM CNN P/T	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107585S	SUP	HCPCS C1713		71107585S  -  SCREW BN 6.5MM 85MM 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107590S	SUP	HCPCS C1713		71107590S  -  SCREW BN 6.5MM 90MM 22MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107595S	SUP	HCPCS C1713		71107595S  -  SCREW BN 6.5MM 95MM 22MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107600S	SUP	HCPCS C1713		71107600S  -  SCREW BN 6.5MM 100MM 22MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107605S	SUP	HCPCS C1713		71107605S  -  SCREW BN 6.5MM 105MM 22MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107610S	SUP	HCPCS C1713		71107610S  -  SCREW BN 6.5MM 110MM 22MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107615S	SUP	HCPCS C1713		71107615S  -  SCREW BN 6.5MM 115MM 22MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107620S	SUP	HCPCS C1713		71107620S  -  SCREW BN 6.5MM 120MM 22MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107625S	SUP	HCPCS C1713		71107625S  -  SCREW BN 6.5MM 125MM 22MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107630S	SUP	HCPCS C1713		71107630S  -  SCREW BN 6.5MM 130MM 22MM CNN P/T	BOTH IP/OP	$564.90 	$418.03	$0.00	$451.92	$254.21	$254.21	$0.00	$0.00	$0.00	$117.74	$419.27	$419.27	$0.00	$0.00	$117.73	$0.00	$334.14	$334.14	$0.00	$282.45	$447.40	$451.92	$0.00		$0.00	$88.41	$0.00	$0.00	$89.93	$0.00	$0.00	$0.00	$0.00	$0.00
71107635S	SUP	HCPCS C1713		71107635S  -  SCREW BN 6.5MM 135MM 22MM CNN P/T	BOTH IP/OP	$564.90 	$418.03	$0.00	$451.92	$254.21	$254.21	$0.00	$0.00	$0.00	$117.74	$419.27	$419.27	$0.00	$0.00	$117.73	$0.00	$334.14	$334.14	$0.00	$282.45	$447.40	$451.92	$0.00		$0.00	$88.41	$0.00	$0.00	$89.93	$0.00	$0.00	$0.00	$0.00	$0.00
71107640S	SUP	HCPCS C1713		71107640S  -  SCREW BN 6.5MM 140MM 22MM CNN P/T	BOTH IP/OP	$564.90 	$418.03	$0.00	$451.92	$254.21	$254.21	$0.00	$0.00	$0.00	$117.74	$419.27	$419.27	$0.00	$0.00	$117.73	$0.00	$334.14	$334.14	$0.00	$282.45	$447.40	$451.92	$0.00		$0.00	$88.41	$0.00	$0.00	$89.93	$0.00	$0.00	$0.00	$0.00	$0.00
71107645S	SUP	HCPCS C1713		71107645S  -  SCREW BN 6.5MM 145MM 22MM CNN P/T	BOTH IP/OP	$564.90 	$418.03	$0.00	$451.92	$254.21	$254.21	$0.00	$0.00	$0.00	$117.74	$419.27	$419.27	$0.00	$0.00	$117.73	$0.00	$334.14	$334.14	$0.00	$282.45	$447.40	$451.92	$0.00		$0.00	$88.41	$0.00	$0.00	$89.93	$0.00	$0.00	$0.00	$0.00	$0.00
71107650S	SUP	HCPCS C1713		71107650S  -  SCREW BN 6.5MM 150MM 22MM CNN P/T	BOTH IP/OP	$564.90 	$418.03	$0.00	$451.92	$254.21	$254.21	$0.00	$0.00	$0.00	$117.74	$419.27	$419.27	$0.00	$0.00	$117.73	$0.00	$334.14	$334.14	$0.00	$282.45	$447.40	$451.92	$0.00		$0.00	$88.41	$0.00	$0.00	$89.93	$0.00	$0.00	$0.00	$0.00	$0.00
71107655S	SUP	HCPCS C1713		71107655S  -  SCREW BN 6.5MM 155MM 22MM CNN P/T	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107660S	SUP	HCPCS C1713		71107660S  -  SCREW BN 6.5MM 160MM 22MM CNN P/T	BOTH IP/OP	$564.90 	$418.03	$0.00	$451.92	$254.21	$254.21	$0.00	$0.00	$0.00	$117.74	$419.27	$419.27	$0.00	$0.00	$117.73	$0.00	$334.14	$334.14	$0.00	$282.45	$447.40	$451.92	$0.00		$0.00	$88.41	$0.00	$0.00	$89.93	$0.00	$0.00	$0.00	$0.00	$0.00
71107665S	SUP	HCPCS C1713		71107665S  -  SCREW BN 6.5MM 165MM 22MM CNN P/T	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107670S	SUP	HCPCS C1713		71107670S  -  SCREW BN 6.5MM 170MM 22MM CNN P/T	BOTH IP/OP	$564.90 	$418.03	$0.00	$451.92	$254.21	$254.21	$0.00	$0.00	$0.00	$117.74	$419.27	$419.27	$0.00	$0.00	$117.73	$0.00	$334.14	$334.14	$0.00	$282.45	$447.40	$451.92	$0.00		$0.00	$88.41	$0.00	$0.00	$89.93	$0.00	$0.00	$0.00	$0.00	$0.00
71107675S	SUP	HCPCS C1713		71107675S  -  SCREW BN 6.5MM 175MM 22MM CNN P/T	BOTH IP/OP	$564.90 	$418.03	$0.00	$451.92	$254.21	$254.21	$0.00	$0.00	$0.00	$117.74	$419.27	$419.27	$0.00	$0.00	$117.73	$0.00	$334.14	$334.14	$0.00	$282.45	$447.40	$451.92	$0.00		$0.00	$88.41	$0.00	$0.00	$89.93	$0.00	$0.00	$0.00	$0.00	$0.00
71107680S	SUP	HCPCS C1713		71107680S  -  SCREW BN 6.5MM 180MM 22MM CNN P/T	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107755S	SUP	HCPCS C1713		71107755S  -  SCREW BN 6.5MM 55MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107760S	SUP	HCPCS C1713		71107760S  -  SCREW BN 6.5MM 60MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107765S	SUP	HCPCS C1713		71107765S  -  SCREW BN 6.5MM 65MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107770S	SUP	HCPCS C1713		71107770S  -  SCREW BN 6.5MM 70MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107775S	SUP	HCPCS C1713		71107775S  -  SCREW BN 6.5MM 75MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107780S	SUP	HCPCS C1713		71107780S  -  SCREW BN 6.5MM 80MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107785S	SUP	HCPCS C1713		71107785S  -  SCREW BN 6.5MM 85MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107790S	SUP	HCPCS C1713		71107790S  -  SCREW BN 6.5MM 90MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107795S	SUP	HCPCS C1713		71107795S  -  SCREW BN 6.5MM 95MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107800S	SUP	HCPCS C1713		71107800S  -  SCREW BN 6.5MM 100MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107805S	SUP	HCPCS C1713		71107805S  -  SCREW BN 6.5MM 105MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107810S	SUP	HCPCS C1713		71107810S  -  SCREW BN 6.5MM 110MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107815S	SUP	HCPCS C1713		71107815S  -  SCREW BN 6.5MM 115MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107820S	SUP	HCPCS C1713		71107820S  -  SCREW BN 6.5MM 120MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107825S	SUP	HCPCS C1713		71107825S  -  SCREW BN 6.5MM 125MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71107830S	SUP	HCPCS C1713		71107830S  -  SCREW BN 6.5MM 130MM 46MM CNN P/T	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107835S	SUP	HCPCS C1713		71107835S  -  SCREW BN 6.5MM 135MM 46MM CNN P/T	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107840S	SUP	HCPCS C1713		71107840S  -  SCREW BN 6.5MM 140MM 46MM CNN P/T	BOTH IP/OP	$564.90 	$418.03	$0.00	$451.92	$254.21	$254.21	$0.00	$0.00	$0.00	$117.74	$419.27	$419.27	$0.00	$0.00	$117.73	$0.00	$334.14	$334.14	$0.00	$282.45	$447.40	$451.92	$0.00		$0.00	$88.41	$0.00	$0.00	$89.93	$0.00	$0.00	$0.00	$0.00	$0.00
71107845S	SUP	HCPCS C1713		71107845S  -  SCREW BN 6.5MM 145MM 46MM CNN P/T	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107850S	SUP	HCPCS C1713		71107850S  -  SCREW BN 6.5MM 150MM 46MM CNN P/T	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107855S	SUP	HCPCS C1713		71107855S  -  SCREW BN 6.5MM 155MM 46MM CNN P/T	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107860S	SUP	HCPCS C1713		71107860S  -  SCREW BN 6.5MM 160MM 46MM CNN P/T	BOTH IP/OP	$564.90 	$418.03	$0.00	$451.92	$254.21	$254.21	$0.00	$0.00	$0.00	$117.74	$419.27	$419.27	$0.00	$0.00	$117.73	$0.00	$334.14	$334.14	$0.00	$282.45	$447.40	$451.92	$0.00		$0.00	$88.41	$0.00	$0.00	$89.93	$0.00	$0.00	$0.00	$0.00	$0.00
71107865S	SUP	HCPCS C1713		71107865S  -  SCREW BN 6.5MM 165MM 46MM CNN P/T	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107870S	SUP	HCPCS C1713		71107870S  -  SCREW BN 6.5MM 170MM 46MM CNN P/T	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107875S	SUP	HCPCS C1713		71107875S  -  SCREW BN 6.5MM 175MM 46MM CNN P/T	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71107880S	SUP	HCPCS C1713		71107880S  -  SCREW BN 6.5MM 180MM 46MM CNN P/T	BOTH IP/OP	$492.45 	$364.41	$0.00	$393.96	$221.60	$221.60	$0.00	$0.00	$0.00	$102.64	$365.50	$365.50	$0.00	$0.00	$102.63	$0.00	$291.28	$291.28	$0.00	$246.23	$390.02	$393.96	$0.00		$0.00	$77.07	$0.00	$0.00	$78.40	$0.00	$0.00	$0.00	$0.00	$0.00
71108240S	SUP	HCPCS C1713		71108240S  -  SCREW BN FT 8MM 40MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108245S	SUP	HCPCS C1713		71108245S  -  SCREW BN FT 8MM 45MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108250S	SUP	HCPCS C1713		71108250S  -  SCREW BN FT 8MM 50MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108255S	SUP	HCPCS C1713		71108255S  -  SCREW BN FT 8MM 55MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108260S	SUP	HCPCS C1713		71108260S  -  SCREW BN FT 8MM 60MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108265S	SUP	HCPCS C1713		71108265S  -  SCREW BN FT 8MM 65MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108270S	SUP	HCPCS C1713		71108270S  -  SCREW BN FT 8MM 70MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108275S	SUP	HCPCS C1713		71108275S  -  SCREW BN FT 8MM 75MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108280S	SUP	HCPCS C1713		71108280S  -  SCREW BN LG FT LOPRFL 8MM 80MM STRL CNN ST SLFDRL REVCT FLUT	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108285S	SUP	HCPCS C1713		71108285S  -  SCREW BN FT 8MM 85MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108290S	SUP	HCPCS C1713		71108290S  -  SCREW BN FT 8MM 90MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108295S	SUP	HCPCS C1713		71108295S  -  SCREW BN FT 8MM 95MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108300S	SUP	HCPCS C1713		71108300S  -  SCREW BN LG FT LOPRFL 8MM 100MM STRL CNN ST SLFDRL REVCT	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108305S	SUP	HCPCS C1713		71108305S  -  SCREW BN FT 8MM 105MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108310S	SUP	HCPCS C1713		71108310S  -  SCREW BN FT 8MM 110MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108315S	SUP	HCPCS C1713		71108315S  -  SCREW BN FT 8MM 115MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108320S	SUP	HCPCS C1713		71108320S  -  SCREW BN FT 8MM 120MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108325S	SUP	HCPCS C1713		71108325S  -  SCREW BN FT 8MM 125MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108330S	SUP	HCPCS C1713		71108330S  -  SCREW BN FT 8MM 130MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108335S	SUP	HCPCS C1713		71108335S  -  SCREW BN FT 8MM 135MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108340S	SUP	HCPCS C1713		71108340S  -  SCREW BN FT 8MM 140MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108345S	SUP	HCPCS C1713		71108345S  -  SCREW BN FT 8MM 145MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108350S	SUP	HCPCS C1713		71108350S  -  SCREW BN FT 8MM 150MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108355S	SUP	HCPCS C1713		71108355S  -  SCREW BN 8MM 155MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108360S	SUP	HCPCS C1713		71108360S  -  SCREW BN 8MM 160MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108365S	SUP	HCPCS C1713		71108365S  -  SCREW BN 8MM 165MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108370S	SUP	HCPCS C1713		71108370S  -  SCREW BN 8MM 170MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108375S	SUP	HCPCS C1713		71108375S  -  SCREW BN 8MM 175MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108380S	SUP	HCPCS C1713		71108380S  -  SCREW BN 8MM 180MM STRL CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108540S	SUP	HCPCS C1713		71108540S  -  SCREW BN 8MM 40MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108545S	SUP	HCPCS C1713		71108545S  -  SCREW BN 8MM 45MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108550S	SUP	HCPCS C1713		71108550S  -  SCREW BN 8MM 50MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108555S	SUP	HCPCS C1713		71108555S  -  SCREW BN 8MM 55MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108560S	SUP	HCPCS C1713		71108560S  -  SCREW BN 8MM 60MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108565S	SUP	HCPCS C1713		71108565S  -  SCREW BN 8MM 65MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108570S	SUP	HCPCS C1713		71108570S  -  SCREW BN 8MM 70MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108575S	SUP	HCPCS C1713		71108575S  -  SCREW BN 8MM 75MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108580S	SUP	HCPCS C1713		71108580S  -  SCREW BN 8MM 80MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108585S	SUP	HCPCS C1713		71108585S  -  SCREW BN 8MM 85MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108590S	SUP	HCPCS C1713		71108590S  -  SCREW BN 8MM 90MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108595S	SUP	HCPCS C1713		71108595S  -  SCREW BN LG P/T LOPRFL 8MM 95MM STRL 22MM CNN ST SLFDRL	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108600S	SUP	HCPCS C1713		71108600S  -  SCREW BN LG P/T LOPRFL 8MM 100MM STRL 22MM CNN ST SLFDRL	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108605S	SUP	HCPCS C1713		71108605S  -  SCREW BN 8MM 105MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108610S	SUP	HCPCS C1713		71108610S  -  SCREW BN 8MM 110MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108615S	SUP	HCPCS C1713		71108615S  -  SCREW BN 8MM 115MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108620S	SUP	HCPCS C1713		71108620S  -  SCREW BN 8MM 120MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108625S	SUP	HCPCS C1713		71108625S  -  SCREW BN 8MM 125MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108630S	SUP	HCPCS C1713		71108630S  -  SCREW BN 8MM 130MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108635S	SUP	HCPCS C1713		71108635S  -  SCREW BN 8MM 135MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108640S	SUP	HCPCS C1713		71108640S  -  SCREW BN 8MM 140MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108645S	SUP	HCPCS C1713		71108645S  -  SCREW BN LG P/T LOPRFL 8MM 145MM STRL 22MM CNN ST SLFDRL	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108650S	SUP	HCPCS C1713		71108650S  -  SCREW BN 8MM 150MM STRL 24MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108655S	SUP	HCPCS C1713		71108655S  -  SCREW BN 8MM 155MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108660S	SUP	HCPCS C1713		71108660S  -  SCREW BN 8MM 160MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108665S	SUP	HCPCS C1713		71108665S  -  SCREW BN 8MM 165MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108670S	SUP	HCPCS C1713		71108670S  -  SCREW BN 8MM 170MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108675S	SUP	HCPCS C1713		71108675S  -  SCREW BN 8MM 175MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108680S	SUP	HCPCS C1713		71108680S  -  SCREW BN 8MM 180MM STRL 22MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108755S	SUP	HCPCS C1713		71108755S  -  SCREW BN LG P/T LOPRFL 8MM 55MM STRL 46MM CNN ST SLFDRL	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108760S	SUP	HCPCS C1713		71108760S  -  SCREW BN LG P/T LOPRFL 8MM 60MM STRL 46MM CNN ST SLFDRL	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108765S	SUP	HCPCS C1713		71108765S  -  SCREW BN 8MM 65MM STRL 40MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108770S	SUP	HCPCS C1713		71108770S  -  SCREW BN 8MM 70MM STRL 40MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108775S	SUP	HCPCS C1713		71108775S  -  SCREW BN LG P/T LOPRFL 8MM 75MM STRL 46MM CNN ST SLFDRL	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108780S	SUP	HCPCS C1713		71108780S  -  SCREW BN 8MM 80MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108785S	SUP	HCPCS C1713		71108785S  -  SCREW BN P/T 8MM 85MM CNN SS FEM TIB	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108790S	SUP	HCPCS C1713		71108790S  -  SCREW BN 8MM 90MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108795S	SUP	HCPCS C1713		71108795S  -  SCREW BN LG P/T LOPRFL 8MM 95MM STRL 46MM CNN ST SLFDRL	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108800S	SUP	HCPCS C1713		71108800S  -  SCREW BN 8MM 100MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108805S	SUP	HCPCS C1713		71108805S  -  SCREW BN LG P/T LOPRFL 8MM 105MM STRL 46MM CNN ST SLFDRL	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108810S	SUP	HCPCS C1713		71108810S  -  SCREW BN 8MM 110MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108815S	SUP	HCPCS C1713		71108815S  -  SCREW BN LG P/T LOPRFL 8MM 115MM STRL 46MM CNN ST SLFDRL	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108820S	SUP	HCPCS C1713		71108820S  -  SCREW BN LG P/T LOPRFL 8MM 120MM STRL 46MM CNN ST SLFDRL	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108825S	SUP	HCPCS C1713		71108825S  -  SCREW BN 8MM 125MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$444.15 	$328.67	$0.00	$355.32	$199.87	$199.87	$0.00	$0.00	$0.00	$92.57	$329.65	$329.65	$0.00	$0.00	$92.56	$0.00	$262.71	$262.71	$0.00	$222.08	$351.77	$355.32	$0.00		$0.00	$69.51	$0.00	$0.00	$70.71	$0.00	$0.00	$0.00	$0.00	$0.00
71108830S	SUP	HCPCS C1713		71108830S  -  SCREW BN 8MM 130MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108835S	SUP	HCPCS C1713		71108835S  -  SCREW BN 8MM 135MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108840S	SUP	HCPCS C1713		71108840S  -  SCREW BN 8MM 140MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108845S	SUP	HCPCS C1713		71108845S  -  SCREW BN 8MM 145MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108850S	SUP	HCPCS C1713		71108850S  -  SCREW BN 8MM 150MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108855S	SUP	HCPCS C1713		71108855S  -  SCREW BN 8MM 155MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108860S	SUP	HCPCS C1713		71108860S  -  SCREW BN 8MM 160MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108865S	SUP	HCPCS C1713		71108865S  -  SCREW BN 8MM 165MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108870S	SUP	HCPCS C1713		71108870S  -  SCREW BN 8MM 170MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108875S	SUP	HCPCS C1713		71108875S  -  SCREW BN 8MM 175MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71108880S	SUP	HCPCS C1713		71108880S  -  SCREW BN 8MM 180MM STRL 46MM CNN SS LNG BN SM BN	BOTH IP/OP	$510.30 	$377.62	$0.00	$408.24	$229.64	$229.64	$0.00	$0.00	$0.00	$106.36	$378.74	$378.74	$0.00	$0.00	$106.35	$0.00	$301.84	$301.84	$0.00	$255.15	$404.16	$408.24	$0.00		$0.00	$79.86	$0.00	$0.00	$81.24	$0.00	$0.00	$0.00	$0.00	$0.00
71109240S	SUP	HCPCS C1713		71109240S  -  SCREW BN 8MM 40MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109245S	SUP	HCPCS C1713		71109245S  -  SCREW BN FT 8MM 45MM CNN SET TI ANKL	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109250S	SUP	HCPCS C1713		71109250S  -  SCREW BN 8MM 50MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109255S	SUP	HCPCS C1713		71109255S  -  SCREW BN 8MM 55MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109260S	SUP	HCPCS C1713		71109260S  -  SCREW BN 8MM 60MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109265S	SUP	HCPCS C1713		71109265S  -  SCREW BN 8MM 65MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109270S	SUP	HCPCS C1713		71109270S  -  SCREW BN 8MM 70MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109275S	SUP	HCPCS C1713		71109275S  -  SCREW BN 8MM 75MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109280S	SUP	HCPCS C1713		71109280S  -  SCREW BN 8MM 80MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109285S	SUP	HCPCS C1713		71109285S  -  SCREW BN 8MM 85MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109290S	SUP	HCPCS C1713		71109290S  -  SCREW BN 8MM 90MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109295S	SUP	HCPCS C1713		71109295S  -  SCREW BN 8MM 95MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109300S	SUP	HCPCS C1713		71109300S  -  SCREW BN 8MM 100MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109305S	SUP	HCPCS C1713		71109305S  -  SCREW BN 8MM 105MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109310S	SUP	HCPCS C1713		71109310S  -  SCREW BN 8MM 110MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109315S	SUP	HCPCS C1713		71109315S  -  SCREW BN 8MM 115MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109320S	SUP	HCPCS C1713		71109320S  -  SCREW BN 8MM 120MM FT CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109325S	SUP	HCPCS C1713		71109325S  -  SCREW BN 8MM 125MM CNN FT TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109330S	SUP	HCPCS C1713		71109330S  -  SCREW BN 8MM 130MM CNN FT TI	BOTH IP/OP	$513.45 	$379.95	$0.00	$410.76	$231.05	$231.05	$0.00	$0.00	$0.00	$107.02	$381.08	$381.08	$0.00	$0.00	$107.00	$0.00	$303.71	$303.71	$0.00	$256.73	$406.65	$410.76	$0.00		$0.00	$80.35	$0.00	$0.00	$81.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109335S	SUP	HCPCS C1713		71109335S  -  SCREW BN 8MM 135MM CNN FT TI	BOTH IP/OP	$513.45 	$379.95	$0.00	$410.76	$231.05	$231.05	$0.00	$0.00	$0.00	$107.02	$381.08	$381.08	$0.00	$0.00	$107.00	$0.00	$303.71	$303.71	$0.00	$256.73	$406.65	$410.76	$0.00		$0.00	$80.35	$0.00	$0.00	$81.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109340S	SUP	HCPCS C1713		71109340S  -  SCREW BN 8MM 140MM CNN FT TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109345S	SUP	HCPCS C1713		71109345S  -  SCREW BN 8MM 145MM CNN FT TI	BOTH IP/OP	$513.45 	$379.95	$0.00	$410.76	$231.05	$231.05	$0.00	$0.00	$0.00	$107.02	$381.08	$381.08	$0.00	$0.00	$107.00	$0.00	$303.71	$303.71	$0.00	$256.73	$406.65	$410.76	$0.00		$0.00	$80.35	$0.00	$0.00	$81.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109350S	SUP	HCPCS C1713		71109350S  -  SCREW BN 8MM 150MM CNN FT TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109355S	SUP	HCPCS C1713		71109355S  -  SCREW BN 8MM 155MM CNN FT TI	BOTH IP/OP	$513.45 	$379.95	$0.00	$410.76	$231.05	$231.05	$0.00	$0.00	$0.00	$107.02	$381.08	$381.08	$0.00	$0.00	$107.00	$0.00	$303.71	$303.71	$0.00	$256.73	$406.65	$410.76	$0.00		$0.00	$80.35	$0.00	$0.00	$81.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109360S	SUP	HCPCS C1713		71109360S  -  SCREW BN 8MM 160MM STRL CNN FT TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109365S	SUP	HCPCS C1713		71109365S  -  SCREW BN 8MM 165MM STRL CNN FT TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109370S	SUP	HCPCS C1713		71109370S  -  SCREW BN 8MM 170MM STRL CNN FT TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109375S	SUP	HCPCS C1713		71109375S  -  SCREW BN 8MM 175MM STRL CNN FT TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109380S	SUP	HCPCS C1713		71109380S  -  SCREW BN 8MM 180MM STRL CNN FT TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109540S	SUP	HCPCS C1713		71109540S  -  SCREW BN 8MM 40MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109545S	SUP	HCPCS C1713		71109545S  -  SCREW BN 8MM 45MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109550S	SUP	HCPCS C1713		71109550S  -  SCREW BN 8MM 50MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109555S	SUP	HCPCS C1713		71109555S  -  SCREW BN 8MM 55MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109560S	SUP	HCPCS C1713		71109560S  -  SCREW BN 8MM 60MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109565S	SUP	HCPCS C1713		71109565S  -  SCREW BN 8MM 65MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109570S	SUP	HCPCS C1713		71109570S  -  SCREW BN 8MM 70MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109575S	SUP	HCPCS C1713		71109575S  -  SCREW BN 8MM 75MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109580S	SUP	HCPCS C1713		71109580S  -  SCREW BN 8MM 80MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109585S	SUP	HCPCS C1713		71109585S  -  SCREW BN 8MM 85MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109590S	SUP	HCPCS C1713		71109590S  -  SCREW BN 8MM 90MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109595S	SUP	HCPCS C1713		71109595S  -  SCREW BN 8MM 95MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109600S	SUP	HCPCS C1713		71109600S  -  SCREW BN 8MM 100MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109605S	SUP	HCPCS C1713		71109605S  -  SCREW BN 8MM 105MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109610S	SUP	HCPCS C1713		71109610S  -  SCREW BN P/T 8MM 110MM 22MM CNN SLFDRL ST SS HND MIDFOOT	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109615S	SUP	HCPCS C1713		71109615S  -  SCREW BN 8MM 115MM 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109620S	SUP	HCPCS C1713		71109620S  -  SCREW BN 8MM 120MM 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109625S	SUP	HCPCS C1713		71109625S  -  SCREW BN 8MM 125MM STRL 22MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109630S	SUP	HCPCS C1713		71109630S  -  SCREW BN 8MM 130MM STRL 22MM CNN P/T TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109635S	SUP	HCPCS C1713		71109635S  -  SCREW BN 8MM 135MM STRL 22MM CNN P/T TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109640S	SUP	HCPCS C1713		71109640S  -  SCREW BN 8MM 140MM 22MM CNN P/T TI	BOTH IP/OP	$513.45 	$379.95	$0.00	$410.76	$231.05	$231.05	$0.00	$0.00	$0.00	$107.02	$381.08	$381.08	$0.00	$0.00	$107.00	$0.00	$303.71	$303.71	$0.00	$256.73	$406.65	$410.76	$0.00		$0.00	$80.35	$0.00	$0.00	$81.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109645S	SUP	HCPCS C1713		71109645S  -  SCREW BN 8MM 145MM STRL 22MM CNN P/T TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109650S	SUP	HCPCS C1713		71109650S  -  SCREW BN 8MM 150MM STRL 22MM P/T CNN TI	BOTH IP/OP	$513.45 	$379.95	$0.00	$410.76	$231.05	$231.05	$0.00	$0.00	$0.00	$107.02	$381.08	$381.08	$0.00	$0.00	$107.00	$0.00	$303.71	$303.71	$0.00	$256.73	$406.65	$410.76	$0.00		$0.00	$80.35	$0.00	$0.00	$81.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109655S	SUP	HCPCS C1713		71109655S  -  SCREW BN P/T 8MM 155MM 22MM CNN TI ANKL	BOTH IP/OP	$513.45 	$379.95	$0.00	$410.76	$231.05	$231.05	$0.00	$0.00	$0.00	$107.02	$381.08	$381.08	$0.00	$0.00	$107.00	$0.00	$303.71	$303.71	$0.00	$256.73	$406.65	$410.76	$0.00		$0.00	$80.35	$0.00	$0.00	$81.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109660S	SUP	HCPCS C1713		71109660S  -  SCREW BN 8MM 160MM 22MM CNN P/T TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109665S	SUP	HCPCS C1713		71109665S  -  SCREW BN 8MM 165MM 22MM CNN P/T TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109670S	SUP	HCPCS C1713		71109670S  -  SCREW BN 8MM 170MM 22MM CNN P/T TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109675S	SUP	HCPCS C1713		71109675S  -  SCREW BN 8MM 175MM 22MM CNN P/T TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109680S	SUP	HCPCS C1713		71109680S  -  SCREW BN 8MM 180MM 22MM CNN P/T TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109755S	SUP	HCPCS C1713		71109755S  -  SCREW BN 8MM 55MM 46MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109760S	SUP	HCPCS C1713		71109760S  -  SCREW BN 8MM 60MM 46MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109765S	SUP	HCPCS C1713		71109765S  -  SCREW BN 8MM 65MM 46MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109770S	SUP	HCPCS C1713		71109770S  -  SCREW BN 8MM 70MM 46MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109775S	SUP	HCPCS C1713		71109775S  -  SCREW BN 8MM 75MM 46MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109780S	SUP	HCPCS C1713		71109780S  -  SCREW BN 6.5MM 80MM CNN	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109785S	SUP	HCPCS C1713		71109785S  -  SCREW BN 8MM 85MM 46MM CNN P/T TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109790S	SUP	HCPCS C1713		71109790S  -  SCREW BN 8MM 90MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109795S	SUP	HCPCS C1713		71109795S  -  SCREW BN 8MM 95MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109800S	SUP	HCPCS C1713		71109800S  -  SCREW BN 8MM 100MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109805S	SUP	HCPCS C1713		71109805S  -  SCREW BN 8MM 105MM 46MM P/T	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109810S	SUP	HCPCS C1713		71109810S  -  SCREW BN 8MM 110MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109815S	SUP	HCPCS C1713		71109815S  -  SCREW BN 8MM 115MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109820S	SUP	HCPCS C1713		71109820S  -  SCREW BN 8MM 120MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109825S	SUP	HCPCS C1713		71109825S  -  SCREW BN 8MM 125MM 46MM P/T CNN TI	BOTH IP/OP	$540.75 	$400.16	$0.00	$432.60	$243.34	$243.34	$0.00	$0.00	$0.00	$112.71	$401.34	$401.34	$0.00	$0.00	$112.69	$0.00	$319.85	$319.85	$0.00	$270.38	$428.27	$432.60	$0.00		$0.00	$84.63	$0.00	$0.00	$86.09	$0.00	$0.00	$0.00	$0.00	$0.00
71109830S	SUP	HCPCS C1713		71109830S  -  SCREW BN 8MM 130MM 46MM P/T CNN TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109835S	SUP	HCPCS C1713		71109835S  -  SCREW BN 8MM 135MM 46MM P/T CNN TI	BOTH IP/OP	$513.45 	$379.95	$0.00	$410.76	$231.05	$231.05	$0.00	$0.00	$0.00	$107.02	$381.08	$381.08	$0.00	$0.00	$107.00	$0.00	$303.71	$303.71	$0.00	$256.73	$406.65	$410.76	$0.00		$0.00	$80.35	$0.00	$0.00	$81.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109840S	SUP	HCPCS C1713		71109840S  -  SCREW BN 8MM 140MM 46MM P/T CNN TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109845S	SUP	HCPCS C1713		71109845S  -  SCREW BN 8MM 145MM 46MM P/T CNN TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109850S	SUP	HCPCS C1713		71109850S  -  SCREW BN 8MM 150MM 46MM P/T CNN TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109855S	SUP	HCPCS C1713		71109855S  -  SCREW BN 8MM 155MM 46MM P/T CNN TI	BOTH IP/OP	$513.45 	$379.95	$0.00	$410.76	$231.05	$231.05	$0.00	$0.00	$0.00	$107.02	$381.08	$381.08	$0.00	$0.00	$107.00	$0.00	$303.71	$303.71	$0.00	$256.73	$406.65	$410.76	$0.00		$0.00	$80.35	$0.00	$0.00	$81.74	$0.00	$0.00	$0.00	$0.00	$0.00
71109860S	SUP	HCPCS C1713		71109860S  -  SCREW BN 8MM 160MM 46MM P/T CNN TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109865S	SUP	HCPCS C1713		71109865S  -  SCREW BN 8MM 165MM 46MM P/T CNN TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109870S	SUP	HCPCS C1713		71109870S  -  SCREW BN 8MM 170MM 46MM P/T CNN TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109875S	SUP	HCPCS C1713		71109875S  -  SCREW BN 8MM 175MM 46MM P/T CNN TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71109880S	SUP	HCPCS C1713		71109880S  -  SCREW BN 8MM 180MM 46MM P/T CNN TI	BOTH IP/OP	$591.15 	$437.45	$0.00	$472.92	$266.02	$266.02	$0.00	$0.00	$0.00	$123.21	$438.75	$438.75	$0.00	$0.00	$123.20	$0.00	$349.67	$349.67	$0.00	$295.58	$468.19	$472.92	$0.00		$0.00	$92.51	$0.00	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00
71114V	SUP	Custom 27203010		71114V  -  CLIP INTNL XLARGE CLIPS (6 CARTRIDGE) ( 14 CARTRIDGES BX)ź	BOTH IP/OP	$67.77 	$50.15	$0.00	$54.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.30	$50.30	$0.00	$0.00	$14.12	$0.00	$0.00	$0.00	$0.00	$33.88	$53.67	$54.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71149308M	SUP	HCPCS C1713		71149308M  -  SCREW BN 2MM 4MM 8MM TC100 ST HEX HD SS CORT MN FRAG SYS	BOTH IP/OP	$106.80 	$79.03	$0.00	$85.44	$48.06	$48.06	$0.00	$0.00	$0.00	$22.26	$79.27	$79.27	$0.00	$0.00	$22.26	$0.00	$63.17	$63.17	$0.00	$53.40	$84.59	$85.44	$0.00		$0.00	$16.71	$0.00	$0.00	$17.00	$0.00	$0.00	$0.00	$0.00	$0.00
71149310M	SUP	HCPCS C1713		71149310M  -  SCREW BN 2MM 4MM 10MM TC100 ST HEX HD SS CORT MN FRAG SYS	BOTH IP/OP	$106.80 	$79.03	$0.00	$85.44	$48.06	$48.06	$0.00	$0.00	$0.00	$22.26	$79.27	$79.27	$0.00	$0.00	$22.26	$0.00	$63.17	$63.17	$0.00	$53.40	$84.59	$85.44	$0.00		$0.00	$16.71	$0.00	$0.00	$17.00	$0.00	$0.00	$0.00	$0.00	$0.00
71149312M	SUP	HCPCS C1713		71149312M  -  SCREW BN 2MM 12MM TC100 ST CORT	BOTH IP/OP	$106.80 	$79.03	$0.00	$85.44	$48.06	$48.06	$0.00	$0.00	$0.00	$22.26	$79.27	$79.27	$0.00	$0.00	$22.26	$0.00	$63.17	$63.17	$0.00	$53.40	$84.59	$85.44	$0.00		$0.00	$16.71	$0.00	$0.00	$17.00	$0.00	$0.00	$0.00	$0.00	$0.00
71149314M	SUP	HCPCS C1713		71149314M  -  SCREW BN 2MM 14MM TC100 ST CORT	BOTH IP/OP	$106.80 	$79.03	$0.00	$85.44	$48.06	$48.06	$0.00	$0.00	$0.00	$22.26	$79.27	$79.27	$0.00	$0.00	$22.26	$0.00	$63.17	$63.17	$0.00	$53.40	$84.59	$85.44	$0.00		$0.00	$16.71	$0.00	$0.00	$17.00	$0.00	$0.00	$0.00	$0.00	$0.00
71149316M	SUP	HCPCS C1713		71149316M  -  SCREW BN 2MM 16MM TC100 ST CORT	BOTH IP/OP	$106.80 	$79.03	$0.00	$85.44	$48.06	$48.06	$0.00	$0.00	$0.00	$22.26	$79.27	$79.27	$0.00	$0.00	$22.26	$0.00	$63.17	$63.17	$0.00	$53.40	$84.59	$85.44	$0.00		$0.00	$16.71	$0.00	$0.00	$17.00	$0.00	$0.00	$0.00	$0.00	$0.00
71149410M	SUP	HCPCS C1713		71149410M  -  SCREW BN 2.7MM 5MM 10MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$93.20 	$68.97	$0.00	$74.56	$41.94	$41.94	$0.00	$0.00	$0.00	$19.43	$69.17	$69.17	$0.00	$0.00	$19.42	$0.00	$55.13	$55.13	$0.00	$46.60	$73.81	$74.56	$0.00		$0.00	$14.59	$0.00	$0.00	$14.84	$0.00	$0.00	$0.00	$0.00	$0.00
71149412M	SUP	HCPCS C1713		71149412M  -  SCREW BN 2.7MM 5MM 12MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$93.20 	$68.97	$0.00	$74.56	$41.94	$41.94	$0.00	$0.00	$0.00	$19.43	$69.17	$69.17	$0.00	$0.00	$19.42	$0.00	$55.13	$55.13	$0.00	$46.60	$73.81	$74.56	$0.00		$0.00	$14.59	$0.00	$0.00	$14.84	$0.00	$0.00	$0.00	$0.00	$0.00
71149414M	SUP	HCPCS C1713		71149414M  -  SCREW BN 2.7MM 5MM 14MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$93.20 	$68.97	$0.00	$74.56	$41.94	$41.94	$0.00	$0.00	$0.00	$19.43	$69.17	$69.17	$0.00	$0.00	$19.42	$0.00	$55.13	$55.13	$0.00	$46.60	$73.81	$74.56	$0.00		$0.00	$14.59	$0.00	$0.00	$14.84	$0.00	$0.00	$0.00	$0.00	$0.00
71149418M	SUP	HCPCS C1713		71149418M  -  SCREW BN 2.7MM 5MM 18MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$93.20 	$68.97	$0.00	$74.56	$41.94	$41.94	$0.00	$0.00	$0.00	$19.43	$69.17	$69.17	$0.00	$0.00	$19.42	$0.00	$55.13	$55.13	$0.00	$46.60	$73.81	$74.56	$0.00		$0.00	$14.59	$0.00	$0.00	$14.84	$0.00	$0.00	$0.00	$0.00	$0.00
71149420M	SUP	HCPCS C1713		71149420M  -  SCREW BN 2.7MM 5MM 20MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$93.20 	$68.97	$0.00	$74.56	$41.94	$41.94	$0.00	$0.00	$0.00	$19.43	$69.17	$69.17	$0.00	$0.00	$19.42	$0.00	$55.13	$55.13	$0.00	$46.60	$73.81	$74.56	$0.00		$0.00	$14.59	$0.00	$0.00	$14.84	$0.00	$0.00	$0.00	$0.00	$0.00
71149422M	SUP	HCPCS C1713		71149422M  -  SCREW BN 2.7MM 5MM 22MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$93.20 	$68.97	$0.00	$74.56	$41.94	$41.94	$0.00	$0.00	$0.00	$19.43	$69.17	$69.17	$0.00	$0.00	$19.42	$0.00	$55.13	$55.13	$0.00	$46.60	$73.81	$74.56	$0.00		$0.00	$14.59	$0.00	$0.00	$14.84	$0.00	$0.00	$0.00	$0.00	$0.00
71149424M	SUP	HCPCS C1713		71149424M  -  SCREW BN 2.7MM 5MM 24MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$93.20 	$68.97	$0.00	$74.56	$41.94	$41.94	$0.00	$0.00	$0.00	$19.43	$69.17	$69.17	$0.00	$0.00	$19.42	$0.00	$55.13	$55.13	$0.00	$46.60	$73.81	$74.56	$0.00		$0.00	$14.59	$0.00	$0.00	$14.84	$0.00	$0.00	$0.00	$0.00	$0.00
71149510A	SUP	HCPCS C1713		71149510A  -  SCREW BN 3.5MM 6MM 10MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149510M	SUP	HCPCS C1713		71149510M  -  SCREW BN 3.5MM 6MM 10MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149512A	SUP	HCPCS C1713		71149512A  -  SCREW BN 3.5MM 6MM 12MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149514A	SUP	HCPCS C1713		71149514A  -  SCREW BN 3.5MM 6MM 14MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149516A	SUP	HCPCS C1713		71149516A  -  SCREW BN 3.5MM 6MM 16MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149518A	SUP	HCPCS C1713		71149518A  -  SCREW BN 3.5MM 6MM 18MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149520A	SUP	HCPCS C1713		71149520A  -  SCREW BN 3.5MM 6MM 20MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149520M	SUP	HCPCS C1713		71149520M  -  SCREW BN 3.5MM 6MM 20MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149522A	SUP	HCPCS C1713		71149522A  -  SCREW BN 3.5MM 6MM 22MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149522M	SUP	HCPCS C1713		71149522M  -  SCREW BN 3.5MM 22MM TC100 ST CORT	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149524A	SUP	HCPCS C1713		71149524A  -  SCREW BN 3.5MM 6MM 24MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149526A	SUP	HCPCS C1713		71149526A  -  SCREW BN 3.5MM 6MM 26MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149526M	SUP	HCPCS C1713		71149526M  -  SCREW BN 3.5MM 6MM 26MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149528A	SUP	HCPCS C1713		71149528A  -  SCREW BN 3.5MM 28MM TC100 ST CORT	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149528M	SUP	HCPCS C1713		71149528M  -  SCREW BN 3.5MM 6MM 28MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149530M	SUP	HCPCS C1713		71149530M  -  SCREW BN 3.5MM 6MM 30MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149532A	SUP	HCPCS C1713		71149532A  -  SCREW BN 3.5MM 6MM 32MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149532M	SUP	HCPCS C1713		71149532M  -  SCREW BN 3.5MM 32MM TC100 ST CORT	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149534A	SUP	HCPCS C1713		71149534A  -  SCREW BN 3.5MM 34MM TC100 ST CORT	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149534M	SUP	HCPCS C1713		71149534M  -  SCREW BN 3.5MM 6MM 34MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149536A	SUP	HCPCS C1713		71149536A  -  SCREW BN 3.5MM 6MM 36MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149536M	SUP	HCPCS C1713		71149536M  -  SCREW BN 3.5MM 36MM TC100 ST CORT	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149538A	SUP	HCPCS C1713		71149538A  -  SCREW BN 3.5MM 6MM 38MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149538M	SUP	HCPCS C1713		71149538M  -  SCREW BN 3.5MM 38MM TC100 ST CORT	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149540A	SUP	HCPCS C1713		71149540A  -  SCREW BN 3.5MM 6MM 40MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149540M	SUP	HCPCS C1713		71149540M  -  SCREW BN 3.5MM 40MM TC100 ST CORT	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149545A	SUP	HCPCS C1713		71149545A  -  SCREW BN 3.5MM 6MM 45MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149545M	SUP	HCPCS C1713		71149545M  -  SCREW BN 3.5MM 6MM 45MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149550A	SUP	HCPCS C1713		71149550A  -  SCREW BN 3.5MM 6MM 50MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$86.40 	$63.94	$0.00	$69.12	$38.88	$38.88	$0.00	$0.00	$0.00	$18.01	$64.13	$64.13	$0.00	$0.00	$18.01	$0.00	$51.11	$51.11	$0.00	$43.20	$68.43	$69.12	$0.00		$0.00	$13.52	$0.00	$0.00	$13.75	$0.00	$0.00	$0.00	$0.00	$0.00
71149550M	SUP	HCPCS C1713		71149550M  -  SCREW BN 3.5MM 6MM 50MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149555M	SUP	HCPCS C1713		71149555M  -  SCREW BN 3.5MM 6MM 55MM TC100 ST HEX SCKT SS CORT SM FRAG	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149714M	SUP	HCPCS C1713		71149714M  -  SCREW BN 4.5MM 14MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149716M	SUP	HCPCS C1713		71149716M  -  SCREW BN 4.5MM 16MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149718M	SUP	HCPCS C1713		71149718M  -  SCREW BN 4.5MM 18MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149720M	SUP	HCPCS C1713		71149720M  -  SCREW BN 4.5MM 20MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149722M	SUP	HCPCS C1713		71149722M  -  SCREW BN 4.5MM 22MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149724M	SUP	HCPCS C1713		71149724M  -  SCREW BN 4.5MM 24MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149726M	SUP	HCPCS C1713		71149726M  -  SCREW BN 4.5MM 26MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149728M	SUP	HCPCS C1713		71149728M  -  SCREW BN 4.5MM 28MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149730M	SUP	HCPCS C1713		71149730M  -  SCREW BN 4.5MM 30MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149732M	SUP	HCPCS C1713		71149732M  -  SCREW BN 4.5MM 32MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149734M	SUP	HCPCS C1713		71149734M  -  SCREW BN 4.5MM 34MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149736M	SUP	HCPCS C1713		71149736M  -  SCREW BN 4.5MM 36MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149738M	SUP	HCPCS C1713		71149738M  -  SCREW BN 4.5MM 38MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149740M	SUP	HCPCS C1713		71149740M  -  SCREW BN 4.5MM 40MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149742M	SUP	HCPCS C1713		71149742M  -  SCREW BN 4.5MM 42MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149744M	SUP	HCPCS C1713		71149744M  -  SCREW BN 4.5MM 44MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149746M	SUP	HCPCS C1713		71149746M  -  SCREW BN 4.5MM 46MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149748M	SUP	HCPCS C1713		71149748M  -  SCREW BN 4.5MM 48MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149750M	SUP	HCPCS C1713		71149750M  -  SCREW BN 4.5MM 50MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149752M	SUP	HCPCS C1713		71149752M  -  SCREW BN 4.5MM 52MM TC100 ST CORT	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149754M	SUP	HCPCS C1713		71149754M  -  SCREW BN 4.5MM 54MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149756M	SUP	HCPCS C1713		71149756M  -  SCREW BN 4.5MM 56MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149758M	SUP	HCPCS C1713		71149758M  -  SCREW BN 4.5MM 58MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149760M	SUP	HCPCS C1713		71149760M  -  SCREW BN 4.5MM 60MM TC100 ST CORT	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149762M	SUP	HCPCS C1713		71149762M  -  SCREW BN 4.5MM 62MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149764M	SUP	HCPCS C1713		71149764M  -  SCREW BN 4.5MM 64MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149766M	SUP	HCPCS C1713		71149766M  -  SCREW BN 4.5MM 66MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149768M	SUP	HCPCS C1713		71149768M  -  SCREW BN 4.5MM 68MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149770M	SUP	HCPCS C1713		71149770M  -  SCREW BN 4.5MM 70MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$101.20 	$74.89	$0.00	$80.96	$45.54	$45.54	$0.00	$0.00	$0.00	$21.09	$75.11	$75.11	$0.00	$0.00	$21.09	$0.00	$59.86	$59.86	$0.00	$50.60	$80.15	$80.96	$0.00		$0.00	$15.84	$0.00	$0.00	$16.11	$0.00	$0.00	$0.00	$0.00	$0.00
71149772M	SUP	HCPCS C1713		71149772M  -  SCREW BN 4.5MM 72MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$167.20 	$123.73	$0.00	$133.76	$75.24	$75.24	$0.00	$0.00	$0.00	$34.85	$124.10	$124.10	$0.00	$0.00	$34.84	$0.00	$98.90	$98.90	$0.00	$83.60	$132.42	$133.76	$0.00		$0.00	$26.17	$0.00	$0.00	$26.62	$0.00	$0.00	$0.00	$0.00	$0.00
71149776M	SUP	HCPCS C1713		71149776M  -  SCREW BN 4.5MM 76MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$167.20 	$123.73	$0.00	$133.76	$75.24	$75.24	$0.00	$0.00	$0.00	$34.85	$124.10	$124.10	$0.00	$0.00	$34.84	$0.00	$98.90	$98.90	$0.00	$83.60	$132.42	$133.76	$0.00		$0.00	$26.17	$0.00	$0.00	$26.62	$0.00	$0.00	$0.00	$0.00	$0.00
71149780M	SUP	HCPCS C1713		71149780M  -  SCREW BN 4.5MM 8MM 80MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$47.25	$47.25	$0.00	$0.00	$0.00	$21.88	$77.93	$77.93	$0.00	$0.00	$21.88	$0.00	$62.11	$62.11	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$16.43	$0.00	$0.00	$16.72	$0.00	$0.00	$0.00	$0.00	$0.00
71149785M	SUP	HCPCS C1713		71149785M  -  SCREW BN 4.5MM 85MM TC100 ST HEX SCKT SS CORT LG FRAG SYS	BOTH IP/OP	$167.20 	$123.73	$0.00	$133.76	$75.24	$75.24	$0.00	$0.00	$0.00	$34.85	$124.10	$124.10	$0.00	$0.00	$34.84	$0.00	$98.90	$98.90	$0.00	$83.60	$132.42	$133.76	$0.00		$0.00	$26.17	$0.00	$0.00	$26.62	$0.00	$0.00	$0.00	$0.00	$0.00
71149790M	SUP	HCPCS C1713		71149790M  -  SCREW BN 4.5MM 8MM 90MM TC100 ST HEX SCKT SS METACARPUS	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$47.25	$47.25	$0.00	$0.00	$0.00	$21.88	$77.93	$77.93	$0.00	$0.00	$21.88	$0.00	$62.11	$62.11	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$16.43	$0.00	$0.00	$16.72	$0.00	$0.00	$0.00	$0.00	$0.00
7115-0003	SUP	HCPCS C1776		7115-0003  -  COMPONENT TIBIAL TRAY 3 STANDARD CEMENT SCORPIO KNEE 7000	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
7115-0004	SUP	HCPCS C1776		7115-0004  -  COMPONENT TIBIAL TRAY STANDARD SERIES 7000	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
7115-0005	SUP	HCPCS C1776		7115-0005  -  COMPONENT TIBIAL TRAY 5 1 AXIS PRIM POSTERIOR STABILIZED	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
7115-0006	SUP	HCPCS C1776		7115-0006  -  COMPONENT TIBIAL TRAY STANDARD 1 AXIS PRIM POSTERIOR	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
7115-0007	SUP	HCPCS C1776		7115-0007  -  COMPONENT TIBIAL TRAY 7 1 AXIS PRIM POSTERIOR STABILIZE	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
7115-0009	SUP	HCPCS C1776		7115-0009  -  COMPONENT TIBIAL TRAY 9 1 AXIS PRIM POSTERIOR STABILIZED	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
7115-0011	SUP	HCPCS C1776		7115-0011  -  COMPONENT TIBIAL TRAY 11 1 AXIS PRIM POSTERIOR STABILIZED	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
7115-0013	SUP	HCPCS C1776		7115-0013  -  COMPONENT TIBIAL TRAY 13 STANDARD 1 AXIS PRIM POSTERIOR	BOTH IP/OP	"$2,330.00 "	"$1,724.20"	$0.00	"$1,864.00"	"$1,048.50"	"$1,048.50"	$0.00	$0.00	$0.00	$485.63	"$1,729.33"	"$1,729.33"	$0.00	$0.00	$485.57	$0.00	"$1,378.20"	"$1,378.20"	$0.00	"$1,165.00"	"$1,845.36"	"$1,864.00"	$0.00		$0.00	$364.65	$0.00	$0.00	$370.94	$0.00	$0.00	$0.00	$0.00	$0.00
7120/60	SUP	HCPCS C1895		7120/60  -  LEAD PCNG 7FR 60CM DURATA TRUE BP ACTFX 2 COIL STRD	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7120/65	SUP	HCPCS C1895		7120/65  -  LEAD PACING 7FR 65CM 2 COIL DF-4 CONCTR TRUE BIPOL	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7120/75	SUP	HCPCS C1895		7120/75  -  DURATA+++PMM#:87533	BOTH IP/OP	"$10,500.00 "	"$7,770.00"	$0.00	"$8,400.00"	"$4,725.00"	"$4,725.00"	$0.00	$0.00	$0.00	"$2,188.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,188.20"	$0.00	"$5,176.50"	"$5,176.50"	$0.00	"$5,250.00"	"$8,316.00"	"$8,400.00"	$0.00		$0.00	"$1,643.25"	$0.00	$0.00	"$1,671.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7120Q/52	SUP	HCPCS C1895		7120Q/52  -  LEAD DEFIBRILLATOR 17CM 7FR 52CM 2 COIL DF-4 CONCTR TRUE	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7120Q/58	SUP	HCPCS C1895		7120Q/58  -  LEAD ICD 7FR 58CM DURATA OPTIM DF4 CNCT 2 COIL BP	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7120Q/65	SUP	HCPCS C1895		7120Q/65  -  LEAD PACING 7FR 65CM 2 COIL DF-4 TRUE BIPOL ACTIVE FIX	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7121/60	SUP	HCPCS C1895		7121/60  -  LEAD DFBR 7FR 60CM 21CM DURATA 2 COIL IS-1 CNCT TRUE BP	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7121/65	SUP	HCPCS C1895		7121/65  -  LEAD PCNG 7FR 65CM DURATA 2 COIL ACTFX IMPL CARDVRT DFBR	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
71-2100	SUP	Custom 27011340		71-2100  -  ADPR SCT MTL DISS	BOTH IP/OP	$144.00 	$106.56	$0.00	$115.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.88	$106.88	$0.00	$0.00	$30.01	$0.00	$0.00	$0.00	$0.00	$72.00	$114.05	$115.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7121Q/52	SUP	HCPCS C1895		7121Q/52  -  LEAD PACING 21CM SPACE 7FR 52CM 2 COIL TRUE BIPOL	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7121Q/58	SUP	HCPCS C1895		7121Q/58  -  LEAD PACING 21CM SPACE 7FR 58CM 2 COIL TRUE BIPOL	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7121Q/65	SUP	HCPCS C1895		7121Q/65  -  LEAD PCNG 7FR 65CM DURATA DF4 CNCT TRUE BP ACTFX IMPL	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7122/60	SUP	HCPCS C1895		7122/60  -  LEAD DFBR 7FR 60CM DURATA 1 COIL DF1 IS-1 CNCT TRUE BP SNS	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7122/65	SUP	HCPCS C1895		7122/65  -  LEAD PACING 7FR 65CM 1 COIL TRUE BIPOL CARDIOVERTER	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
71222010M	SUP	HCPCS C1713		71222010M  -  SCREW BN 3.5MM 6MM 10MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222012M	SUP	HCPCS C1713		71222012M  -  SCREW BN 3.5MM 6MM 12MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222016M	SUP	HCPCS C1713		71222016M  -  SCREW BN 3.5MM 6MM 16MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222018M	SUP	HCPCS C1713		71222018M  -  SCREW BN 3.5MM 6MM 18MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222020M	SUP	HCPCS C1713		71222020M  -  SCREW BN 3.5MM 6MM 20MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222022M	SUP	HCPCS C1713		71222022M  -  SCREW BN 3.5MM 6MM 22MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222024M	SUP	HCPCS C1713		71222024M  -  SCREW BN 3.5MM 6MM 22MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222026M	SUP	HCPCS C1713		71222026M  -  SCREW BN 3.5MM 6MM 26MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222028M	SUP	HCPCS C1713		71222028M  -  SCREW BN 3.5MM 6MM 28MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222030M	SUP	HCPCS C1713		71222030M  -  SCREW BN 3.5MM 6MM 30MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222032M	SUP	HCPCS C1713		71222032M  -  SCREW BN 3.5MM 6MM 32MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222034M	SUP	HCPCS C1713		71222034M  -  SCREW BN 3.5MM 6MM 34MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222036M	SUP	HCPCS C1713		71222036M  -  SCREW BN 3.5MM 6MM 36MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222038M	SUP	HCPCS C1713		71222038M  -  SCREW BN 3.5MM 6MM 38MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222040M	SUP	HCPCS C1713		71222040M  -  SCREW BN 3.5MM 6MM 40MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71222045M	SUP	HCPCS C1713		71222045M  -  SCREW BN 3.5MM 6MM 45MM TC100 SS CORT SM FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71223010M	SUP	HCPCS C1713		71223010M  -  SCREW BN FT 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223012M	SUP	HCPCS C1713		71223012M  -  SCREW BN FT 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223014M	SUP	HCPCS C1713		71223014M  -  SCREW BN FT 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223016M	SUP	HCPCS C1713		71223016M  -  SCREW BN FT 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223018M	SUP	HCPCS C1713		71223018M  -  SCREW BN FT 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223020M	SUP	HCPCS C1713		71223020M  -  SCREW BN FT 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223024M	SUP	HCPCS C1713		71223024M  -  SCREW BN FT 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223026M	SUP	HCPCS C1713		71223026M  -  SCREW BN FT 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223028M	SUP	HCPCS C1713		71223028M  -  SCREW BN FT 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223030M	SUP	HCPCS C1713		71223030M  -  SCREW BN FT 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223032M	SUP	HCPCS C1713		71223032M  -  SCREW BN FT 4MM 6MM 32MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223035M	SUP	HCPCS C1713		71223035M  -  SCREW BN SM FT 4MM 6MM 35MM TC100 SS CANC	BOTH IP/OP	$72.40 	$53.58	$0.00	$57.92	$32.58	$32.58	$0.00	$0.00	$0.00	$15.09	$53.74	$53.74	$0.00	$0.00	$15.09	$0.00	$42.82	$42.82	$0.00	$36.20	$57.34	$57.92	$0.00		$0.00	$11.33	$0.00	$0.00	$11.53	$0.00	$0.00	$0.00	$0.00	$0.00
71223036M	SUP	HCPCS C1713		71223036M  -  SCREW BN FT 4MM 6MM 36MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223040M	SUP	HCPCS C1713		71223040M  -  SCREW BN FT 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223045M	SUP	HCPCS C1713		71223045M  -  SCREW BN FT 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223050M	SUP	HCPCS C1713		71223050M  -  SCREW BN FT 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223055M	SUP	HCPCS C1713		71223055M  -  SCREW BN FT 4MM 6MM 55MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223060M	SUP	HCPCS C1713		71223060M  -  SCREW BN FT 4MM 6MM 60MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$82.80 	$61.27	$0.00	$66.24	$37.26	$37.26	$0.00	$0.00	$0.00	$17.26	$61.45	$61.45	$0.00	$0.00	$17.26	$0.00	$48.98	$48.98	$0.00	$41.40	$65.58	$66.24	$0.00		$0.00	$12.96	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$0.00
71223210M	SUP	HCPCS C1713		71223210M  -  SCREW BN P/T 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223212M	SUP	HCPCS C1713		71223212M  -  SCREW BN P/T 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223214M	SUP	HCPCS C1713		71223214M  -  SCREW BN P/T 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223216M	SUP	HCPCS C1713		71223216M  -  SCREW BN P/T 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223218M	SUP	HCPCS C1713		71223218M  -  SCREW BN P/T 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223220M	SUP	HCPCS C1713		71223220M  -  SCREW BN P/T 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223222M	SUP	HCPCS C1713		71223222M  -  SCREW BN P/T 4MM 6MM 22MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223224M	SUP	HCPCS C1713		71223224M  -  SCREW BN P/T 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223226M	SUP	HCPCS C1713		71223226M  -  SCREW BN P/T 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223228M	SUP	HCPCS C1713		71223228M  -  SCREW BN P/T 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223230M	SUP	HCPCS C1713		71223230M  -  SCREW BN P/T 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223235M	SUP	HCPCS C1713		71223235M  -  SCREW BN P/T 4MM 6MM 35MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223240M	SUP	HCPCS C1713		71223240M  -  SCREW BN P/T 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223245M	SUP	HCPCS C1713		71223245M  -  SCREW BN P/T 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71223250M	SUP	HCPCS C1713		71223250M  -  SCREW BN P/T 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS	BOTH IP/OP	$80.80 	$59.79	$0.00	$64.64	$36.36	$36.36	$0.00	$0.00	$0.00	$16.84	$59.97	$59.97	$0.00	$0.00	$16.84	$0.00	$47.79	$47.79	$0.00	$40.40	$63.99	$64.64	$0.00		$0.00	$12.65	$0.00	$0.00	$12.86	$0.00	$0.00	$0.00	$0.00	$0.00
71225026M	SUP	HCPCS C1713		71225026M  -  SCREW BN 4.5MM 8MM 26MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225028M	SUP	HCPCS C1713		71225028M  -  SCREW BN 4.5MM 8MM 28MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225030M	SUP	HCPCS C1713		71225030M  -  SCREW BN 4.5MM 8MM 30MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225032M	SUP	HCPCS C1713		71225032M  -  SCREW BN 4.5MM 8MM 32MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225034M	SUP	HCPCS C1713		71225034M  -  SCREW BN 4.5MM 8MM 34MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225036M	SUP	HCPCS C1713		71225036M  -  SCREW BN 4.5MM 8MM 36MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225038M	SUP	HCPCS C1713		71225038M  -  SCREW BN 4.5MM 8MM 38MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225040M	SUP	HCPCS C1713		71225040M  -  SCREW BN 4.5MM 8MM 40MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225042M	SUP	HCPCS C1713		71225042M  -  SCREW BN 4.5MM 8MM 42MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225044M	SUP	HCPCS C1713		71225044M  -  SCREW BN 4.5MM 8MM 44MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71225046M	SUP	HCPCS C1713		71225046M  -  SCREW BN 4.5MM 8MM 46MM TC100 SS CORT LG FRAG SYS	BOTH IP/OP	$76.80 	$56.83	$0.00	$61.44	$34.56	$34.56	$0.00	$0.00	$0.00	$16.01	$57.00	$57.00	$0.00	$0.00	$16.01	$0.00	$45.43	$45.43	$0.00	$38.40	$60.83	$61.44	$0.00		$0.00	$12.02	$0.00	$0.00	$12.23	$0.00	$0.00	$0.00	$0.00	$0.00
71226030M	SUP	HCPCS C1713		71226030M  -  SCREW BN P/T 6.5MM 8MM 30MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$164.80 	$121.95	$0.00	$131.84	$74.16	$74.16	$0.00	$0.00	$0.00	$34.35	$122.31	$122.31	$0.00	$0.00	$34.34	$0.00	$97.48	$97.48	$0.00	$82.40	$130.52	$131.84	$0.00		$0.00	$25.79	$0.00	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00
71226035M	SUP	HCPCS C1713		71226035M  -  SCREW BN P/T 6.5MM 8MM 35MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$164.80 	$121.95	$0.00	$131.84	$74.16	$74.16	$0.00	$0.00	$0.00	$34.35	$122.31	$122.31	$0.00	$0.00	$34.34	$0.00	$97.48	$97.48	$0.00	$82.40	$130.52	$131.84	$0.00		$0.00	$25.79	$0.00	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00
71226040M	SUP	HCPCS C1713		71226040M  -  SCREW BN P/T 6.5MM 8MM 40MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$164.80 	$121.95	$0.00	$131.84	$74.16	$74.16	$0.00	$0.00	$0.00	$34.35	$122.31	$122.31	$0.00	$0.00	$34.34	$0.00	$97.48	$97.48	$0.00	$82.40	$130.52	$131.84	$0.00		$0.00	$25.79	$0.00	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00
71226045M	SUP	HCPCS C1713		71226045M  -  SCREW BN P/T 6.5MM 8MM 45MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$164.80 	$121.95	$0.00	$131.84	$74.16	$74.16	$0.00	$0.00	$0.00	$34.35	$122.31	$122.31	$0.00	$0.00	$34.34	$0.00	$97.48	$97.48	$0.00	$82.40	$130.52	$131.84	$0.00		$0.00	$25.79	$0.00	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00
71226055M	SUP	HCPCS C1713		71226055M  -  SCREW BN P/T 6.5MM 8MM 55MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$164.80 	$121.95	$0.00	$131.84	$74.16	$74.16	$0.00	$0.00	$0.00	$34.35	$122.31	$122.31	$0.00	$0.00	$34.34	$0.00	$97.48	$97.48	$0.00	$82.40	$130.52	$131.84	$0.00		$0.00	$25.79	$0.00	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00
71226060M	SUP	HCPCS C1713		71226060M  -  SCREW BN P/T 6.5MM 8MM 60MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$164.80 	$121.95	$0.00	$131.84	$74.16	$74.16	$0.00	$0.00	$0.00	$34.35	$122.31	$122.31	$0.00	$0.00	$34.34	$0.00	$97.48	$97.48	$0.00	$82.40	$130.52	$131.84	$0.00		$0.00	$25.79	$0.00	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00
71226065M	SUP	HCPCS C1713		71226065M  -  SCREW BN P/T 6.5MM 8MM 65MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$164.80 	$121.95	$0.00	$131.84	$74.16	$74.16	$0.00	$0.00	$0.00	$34.35	$122.31	$122.31	$0.00	$0.00	$34.34	$0.00	$97.48	$97.48	$0.00	$82.40	$130.52	$131.84	$0.00		$0.00	$25.79	$0.00	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00
71226070M	SUP	HCPCS C1713		71226070M  -  SCREW BN P/T 6.5MM 8MM 70MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$164.80 	$121.95	$0.00	$131.84	$74.16	$74.16	$0.00	$0.00	$0.00	$34.35	$122.31	$122.31	$0.00	$0.00	$34.34	$0.00	$97.48	$97.48	$0.00	$82.40	$130.52	$131.84	$0.00		$0.00	$25.79	$0.00	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00
71226075M	SUP	HCPCS C1713		71226075M  -  SCREW BN P/T 6.5MM 8MM 75MM 16MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$164.80 	$121.95	$0.00	$131.84	$74.16	$74.16	$0.00	$0.00	$0.00	$34.35	$122.31	$122.31	$0.00	$0.00	$34.34	$0.00	$97.48	$97.48	$0.00	$82.40	$130.52	$131.84	$0.00		$0.00	$25.79	$0.00	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00
71226080M	SUP	HCPCS C1713		71226080M  -  SCREW BN P/T 6.5MM 80MM 16MM TC100 CANC	BOTH IP/OP	$164.80 	$121.95	$0.00	$131.84	$74.16	$74.16	$0.00	$0.00	$0.00	$34.35	$122.31	$122.31	$0.00	$0.00	$34.34	$0.00	$97.48	$97.48	$0.00	$82.40	$130.52	$131.84	$0.00		$0.00	$25.79	$0.00	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00
71229075M	SUP	HCPCS C1713		71229075M  -  SCREW BN FT 6.5MM 8MM 75MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$164.80 	$121.95	$0.00	$131.84	$74.16	$74.16	$0.00	$0.00	$0.00	$34.35	$122.31	$122.31	$0.00	$0.00	$34.34	$0.00	$97.48	$97.48	$0.00	$82.40	$130.52	$131.84	$0.00		$0.00	$25.79	$0.00	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00
71229080M	SUP	HCPCS C1713		71229080M  -  SCREW BN FT 6.5MM 8MM 80MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$180.80 	$133.79	$0.00	$144.64	$81.36	$81.36	$0.00	$0.00	$0.00	$37.68	$134.19	$134.19	$0.00	$0.00	$37.68	$0.00	$106.94	$106.94	$0.00	$90.40	$143.19	$144.64	$0.00		$0.00	$28.30	$0.00	$0.00	$28.78	$0.00	$0.00	$0.00	$0.00	$0.00
71229085M	SUP	HCPCS C1713		71229085M  -  SCREW BN FT 6.5MM 8MM 85MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$180.80 	$133.79	$0.00	$144.64	$81.36	$81.36	$0.00	$0.00	$0.00	$37.68	$134.19	$134.19	$0.00	$0.00	$37.68	$0.00	$106.94	$106.94	$0.00	$90.40	$143.19	$144.64	$0.00		$0.00	$28.30	$0.00	$0.00	$28.78	$0.00	$0.00	$0.00	$0.00	$0.00
71229090M	SUP	HCPCS C1713		71229090M  -  SCREW BN FT 6.5MM 8MM 90MM TC100 SS CANC LG FRAG SYS	BOTH IP/OP	$164.80 	$121.95	$0.00	$131.84	$74.16	$74.16	$0.00	$0.00	$0.00	$34.35	$122.31	$122.31	$0.00	$0.00	$34.34	$0.00	$97.48	$97.48	$0.00	$82.40	$130.52	$131.84	$0.00		$0.00	$25.79	$0.00	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00
7122Q/52	SUP	HCPCS C1777		7122Q/52  -  LEAD PCNG 11MM SPC 6.8FR 58CM DURATA 1 COIL TRUE BP ACTFX	BOTH IP/OP	"$8,775.00 "	"$6,493.50"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,828.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,828.71"	$0.00	"$4,326.08"	"$4,326.08"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7122Q/58	SUP	HCPCS C1777		7122Q/58  -  LEAD PCNG 58CM 6.8FR 11MM SPC ECRDL 1 COIL DFBR ACT FIX TRUE	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
7122Q/65	SUP	HCPCS C1777		7122Q/65  -  LEAD PACING 11MM SPACING 6.8FR 65CM TRUE BIPOL ACTIVE FIX	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7125-0003	SUP	HCPCS C1776		7125-0003  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED SCORPIO KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7125-0004	SUP	HCPCS C1776		7125-0004  -  COMPONENT TIBIAL TRAY STANDARD 4MM MICROSTRUCTURED SERIES	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7125-0005	SUP	HCPCS C1776		7125-0005  -  COMPONENT TIBIAL TRAY 5 STANDARD 66X44MM 30MM STEM WAFFLE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7125-0006	SUP	HCPCS C1776		7125-0006  -  COMPONENT TIBIAL TRAY 6 STANDARD MICROSTRUCTURED CEMENTED	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7125-0007	SUP	HCPCS C1776		7125-0007  -  COMPONENT TIBIAL TRAY STANDARD DELTAFIT MICROSTRUCTURE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7125-0009	SUP	HCPCS C1776		7125-0009  -  COMPONENT TIBIAL TRAY STANDARD DELTAFIT MICROSTRUCTURED	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7125-0011	SUP	HCPCS C1776		7125-0011  -  COMPONENT TIBIAL TRAY STANDARD DELTAFIT MICROSTRUCTURED	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7125-0013	SUP	HCPCS C1776		7125-0013  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED SCORPIO KNEE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7130/60	SUP	HCPCS C1895		7130/60  -  LEAD DFBR 6.8FR 60CM STRL LF 17MM DURATA DISP	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7130/65	SUP	HCPCS C1895		7130/65  -  DURATA+++PMM#:96295	BOTH IP/OP	"$10,500.00 "	"$7,770.00"	$0.00	"$8,400.00"	"$4,725.00"	"$4,725.00"	$0.00	$0.00	$0.00	"$2,188.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,188.20"	$0.00	"$5,176.50"	"$5,176.50"	$0.00	"$5,250.00"	"$8,316.00"	"$8,400.00"	$0.00		$0.00	"$1,643.25"	$0.00	$0.00	"$1,671.60"	$0.00	$0.00	$0.00	$0.00	$0.00
71-3003L	SUP	HCPCS C1776		71-3003L  -  CMPNT FEM 3 LEFT KNEE CMNT PS BASIC SCRP	BOTH IP/OP	"$3,176.00 "	"$2,350.24"	$0.00	"$2,540.80"	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$0.00	$661.96	"$2,357.23"	"$2,357.23"	$0.00	$0.00	$661.88	$0.00	"$1,565.77"	"$1,565.77"	$0.00	"$1,588.00"	"$2,515.39"	"$2,540.80"	$0.00		$0.00	$497.04	$0.00	$0.00	$505.62	$0.00	$0.00	$0.00	$0.00	$0.00
71-3003R	SUP	HCPCS C1776		71-3003R  -  CMPNT FEM 3 RIGHT KNEE CMNT PS BASIC SCRP	BOTH IP/OP	"$3,176.00 "	"$2,350.24"	$0.00	"$2,540.80"	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$0.00	$661.96	"$2,357.23"	"$2,357.23"	$0.00	$0.00	$661.88	$0.00	"$1,565.77"	"$1,565.77"	$0.00	"$1,588.00"	"$2,515.39"	"$2,540.80"	$0.00		$0.00	$497.04	$0.00	$0.00	$505.62	$0.00	$0.00	$0.00	$0.00	$0.00
71-3005L	SUP	HCPCS C1776		71-3005L  -  CMPNT FEM 5 LEFT KNEE CMNT PS BASIC SCRP	BOTH IP/OP	"$3,110.00 "	"$2,301.40"	$0.00	"$2,488.00"	"$1,399.50"	"$1,399.50"	$0.00	$0.00	$0.00	$648.20	"$2,308.24"	"$2,308.24"	$0.00	$0.00	$648.12	$0.00	"$1,533.23"	"$1,533.23"	$0.00	"$1,555.00"	"$2,463.12"	"$2,488.00"	$0.00		$0.00	$486.72	$0.00	$0.00	$495.11	$0.00	$0.00	$0.00	$0.00	$0.00
71-3005R	SUP	HCPCS C1776		71-3005R  -  CMPNT FEM 5 RIGHT KNEE CMNT PS BASIC SCRP	BOTH IP/OP	"$3,110.00 "	"$2,301.40"	$0.00	"$2,488.00"	"$1,399.50"	"$1,399.50"	$0.00	$0.00	$0.00	$648.20	"$2,308.24"	"$2,308.24"	$0.00	$0.00	$648.12	$0.00	"$1,533.23"	"$1,533.23"	$0.00	"$1,555.00"	"$2,463.12"	"$2,488.00"	$0.00		$0.00	$486.72	$0.00	$0.00	$495.11	$0.00	$0.00	$0.00	$0.00	$0.00
71-3007L	SUP	HCPCS C1776		71-3007L  -  CMPNT FEM 7 LEFT KNEE PS CMNT BASIC SCRP NPOR	BOTH IP/OP	"$3,110.00 "	"$2,301.40"	$0.00	"$2,488.00"	"$1,399.50"	"$1,399.50"	$0.00	$0.00	$0.00	$648.20	"$2,308.24"	"$2,308.24"	$0.00	$0.00	$648.12	$0.00	"$1,533.23"	"$1,533.23"	$0.00	"$1,555.00"	"$2,463.12"	"$2,488.00"	$0.00		$0.00	$486.72	$0.00	$0.00	$495.11	$0.00	$0.00	$0.00	$0.00	$0.00
71-3007R	SUP	HCPCS C1776		71-3007R  -  CMPNT FEM 7 RIGHT KNEE PS BASIC SCRP	BOTH IP/OP	"$3,110.00 "	"$2,301.40"	$0.00	"$2,488.00"	"$1,399.50"	"$1,399.50"	$0.00	$0.00	$0.00	$648.20	"$2,308.24"	"$2,308.24"	$0.00	$0.00	$648.12	$0.00	"$1,533.23"	"$1,533.23"	$0.00	"$1,555.00"	"$2,463.12"	"$2,488.00"	$0.00		$0.00	$486.72	$0.00	$0.00	$495.11	$0.00	$0.00	$0.00	$0.00	$0.00
71-3009L	SUP	HCPCS C1776		71-3009L  -  CMPNT FEM 9 LEFT KNEE CMNT PS BASIC SCRP	BOTH IP/OP	"$3,110.00 "	"$2,301.40"	$0.00	"$2,488.00"	"$1,399.50"	"$1,399.50"	$0.00	$0.00	$0.00	$648.20	"$2,308.24"	"$2,308.24"	$0.00	$0.00	$648.12	$0.00	"$1,533.23"	"$1,533.23"	$0.00	"$1,555.00"	"$2,463.12"	"$2,488.00"	$0.00		$0.00	$486.72	$0.00	$0.00	$495.11	$0.00	$0.00	$0.00	$0.00	$0.00
71-3009R	SUP	HCPCS C1776		71-3009R  -  CMPNT FEM 9 RIGHT KNEE CMNT PS BASIC SCRP	BOTH IP/OP	"$3,110.00 "	"$2,301.40"	$0.00	"$2,488.00"	"$1,399.50"	"$1,399.50"	$0.00	$0.00	$0.00	$648.20	"$2,308.24"	"$2,308.24"	$0.00	$0.00	$648.12	$0.00	"$1,533.23"	"$1,533.23"	$0.00	"$1,555.00"	"$2,463.12"	"$2,488.00"	$0.00		$0.00	$486.72	$0.00	$0.00	$495.11	$0.00	$0.00	$0.00	$0.00	$0.00
71-3011L	SUP	HCPCS C1776		71-3011L  -  CMPNT FEM 11 LEFT KNEE CMNT PS BASIC SCRP	BOTH IP/OP	"$3,110.00 "	"$2,301.40"	$0.00	"$2,488.00"	"$1,399.50"	"$1,399.50"	$0.00	$0.00	$0.00	$648.20	"$2,308.24"	"$2,308.24"	$0.00	$0.00	$648.12	$0.00	"$1,533.23"	"$1,533.23"	$0.00	"$1,555.00"	"$2,463.12"	"$2,488.00"	$0.00		$0.00	$486.72	$0.00	$0.00	$495.11	$0.00	$0.00	$0.00	$0.00	$0.00
71-3011R	SUP	HCPCS C1776		71-3011R  -  CMPNT FEM 11 RIGHT KNEE CMNT PS BASIC SCRP	BOTH IP/OP	"$3,110.00 "	"$2,301.40"	$0.00	"$2,488.00"	"$1,399.50"	"$1,399.50"	$0.00	$0.00	$0.00	$648.20	"$2,308.24"	"$2,308.24"	$0.00	$0.00	$648.12	$0.00	"$1,533.23"	"$1,533.23"	$0.00	"$1,555.00"	"$2,463.12"	"$2,488.00"	$0.00		$0.00	$486.72	$0.00	$0.00	$495.11	$0.00	$0.00	$0.00	$0.00	$0.00
71-3013L	SUP	HCPCS C1776		71-3013L  -  CMPNT FEM 13 LEFT KNEE CMNT PS BASIC SCRP	BOTH IP/OP	"$3,176.00 "	"$2,350.24"	$0.00	"$2,540.80"	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$0.00	$661.96	"$2,357.23"	"$2,357.23"	$0.00	$0.00	$661.88	$0.00	"$1,565.77"	"$1,565.77"	$0.00	"$1,588.00"	"$2,515.39"	"$2,540.80"	$0.00		$0.00	$497.04	$0.00	$0.00	$505.62	$0.00	$0.00	$0.00	$0.00	$0.00
71-3013R	SUP	HCPCS C1776		71-3013R  -  CMPNT FEM 13 RIGHT KNEE CMNT PS BASIC SCRP	BOTH IP/OP	"$3,176.00 "	"$2,350.24"	$0.00	"$2,540.80"	"$1,429.20"	"$1,429.20"	$0.00	$0.00	$0.00	$661.96	"$2,357.23"	"$2,357.23"	$0.00	$0.00	$661.88	$0.00	"$1,565.77"	"$1,565.77"	$0.00	"$1,588.00"	"$2,515.39"	"$2,540.80"	$0.00		$0.00	$497.04	$0.00	$0.00	$505.62	$0.00	$0.00	$0.00	$0.00	$0.00
7131/60	SUP	HCPCS C1895		7131/60  -  LEAD DFBR 60CM STRL LF 21CM DURATA DISP	BOTH IP/OP	"$10,500.00 "	"$7,770.00"	$0.00	"$8,400.00"	"$4,725.00"	"$4,725.00"	$0.00	$0.00	$0.00	"$2,188.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,188.20"	$0.00	"$5,176.50"	"$5,176.50"	$0.00	"$5,250.00"	"$8,316.00"	"$8,400.00"	$0.00		$0.00	"$1,643.25"	$0.00	$0.00	"$1,671.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7131/65	SUP	HCPCS C1895		7131/65  -  LEAD PACING 21MM SPACE 6.8FR 65CM 2 COIL INTEGRATE BIPOL	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
71-4103L	SUP	HCPCS C1776		71-4103L  -  CMPNT FEM 3 LEFT KNEE PS WFL POST SCRP LFIT	BOTH IP/OP	"$3,657.00 "	"$2,706.18"	$0.00	"$2,925.60"	"$1,645.65"	"$1,645.65"	$0.00	$0.00	$0.00	$762.21	"$2,714.23"	"$2,714.23"	$0.00	$0.00	$762.12	$0.00	"$1,802.90"	"$1,802.90"	$0.00	"$1,828.50"	"$2,896.34"	"$2,925.60"	$0.00		$0.00	$572.32	$0.00	$0.00	$582.19	$0.00	$0.00	$0.00	$0.00	$0.00
71-4103R	SUP	HCPCS C1776		71-4103R  -  CMPNT FEM 3 RIGHT KNEE PS WFL POST SCRP LFIT	BOTH IP/OP	"$3,657.00 "	"$2,706.18"	$0.00	"$2,925.60"	"$1,645.65"	"$1,645.65"	$0.00	$0.00	$0.00	$762.21	"$2,714.23"	"$2,714.23"	$0.00	$0.00	$762.12	$0.00	"$1,802.90"	"$1,802.90"	$0.00	"$1,828.50"	"$2,896.34"	"$2,925.60"	$0.00		$0.00	$572.32	$0.00	$0.00	$582.19	$0.00	$0.00	$0.00	$0.00	$0.00
71-4104L	SUP	HCPCS C1776		71-4104L  -  CMPNT FEM PS WFL SCRP LFIT	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
71-4104R	SUP	HCPCS C1776		71-4104R  -  CMPNT FEM PS WFL SCRP LFIT	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
71-4105L	SUP	HCPCS C1776		71-4105L  -  CMPNT FEM 5 LEFT PS WFL SCRP LFIT	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
71-4105R	SUP	HCPCS C1776		71-4105R  -  CMPNT FEM 5 RIGHT PS WFL SCRP LFIT	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
71-4106L	SUP	HCPCS C1776		71-4106L  -  CMPNT FEM PS WFL SCRP LFIT	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
71-4106R	SUP	HCPCS C1776		71-4106R  -  CMPNT FEM 6 RIGHT PS WFL SCRP LFIT	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
71-4107L	SUP	HCPCS C1776		71-4107L  -  COMPONENT FEM 7 LFIT SCRP CMNT POST STAB WFL KN LT	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
71-4107R	SUP	HCPCS C1776		71-4107R  -  COMPONENT FEM 7 LFIT SCRP CMNT POST STAB WFL KN RT	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
71-4109L	SUP	HCPCS C1776		71-4109L  -  CMPNT FEM 9 LEFT PS WFL SCRP LFIT	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
71-4109R	SUP	HCPCS C1776		71-4109R  -  CMPNT FEM 9 RIGHT PS WFL SCRP LFIT	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
71-4111L	SUP	HCPCS C1776		71-4111L  -  CMPNT FEM 11 LEFT PS WFL SCRP LFIT	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
71-4111R	SUP	HCPCS C1776		71-4111R  -  CMPNT FEM 11 RIGHT WFL PS SCRP LFIT	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
71-4113L	SUP	HCPCS C1776		71-4113L  -  CMPNT FEM 13 LEFT PS WFL SCRP LFIT	BOTH IP/OP	"$3,657.00 "	"$2,706.18"	$0.00	"$2,925.60"	"$1,645.65"	"$1,645.65"	$0.00	$0.00	$0.00	$762.21	"$2,714.23"	"$2,714.23"	$0.00	$0.00	$762.12	$0.00	"$1,802.90"	"$1,802.90"	$0.00	"$1,828.50"	"$2,896.34"	"$2,925.60"	$0.00		$0.00	$572.32	$0.00	$0.00	$582.19	$0.00	$0.00	$0.00	$0.00	$0.00
71-4113R	SUP	HCPCS C1776		71-4113R  -  CMPNT FEM 13 RIGHT KNEE PS WFL POST SCRP LFIT	BOTH IP/OP	"$3,657.00 "	"$2,706.18"	$0.00	"$2,925.60"	"$1,645.65"	"$1,645.65"	$0.00	$0.00	$0.00	$762.21	"$2,714.23"	"$2,714.23"	$0.00	$0.00	$762.12	$0.00	"$1,802.90"	"$1,802.90"	$0.00	"$1,828.50"	"$2,896.34"	"$2,925.60"	$0.00		$0.00	$572.32	$0.00	$0.00	$582.19	$0.00	$0.00	$0.00	$0.00	$0.00
7145-0003	SUP	HCPCS C1776		7145-0003  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7145-0005	SUP	HCPCS C1776		7145-0005  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7145-0007	SUP	HCPCS C1776		7145-0007  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7145-0009	SUP	HCPCS C1776		7145-0009  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7145-0011	SUP	HCPCS C1776		7145-0011  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
7145-0013	SUP	HCPCS C1776		7145-0013  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4503L	SUP	HCPCS C1776		71-4503L  -  COMPONENT FEMORAL 3 56X35MM 1 AXIS POSTERIOR STABILIZE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4503R	SUP	HCPCS C1776		71-4503R  -  COMPONENT FEMORAL 3 56X35MM 1 AXIS POSTERIOR STABILIZE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4504L	SUP	HCPCS C1776		71-4504L  -  COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4504R	SUP	HCPCS C1776		71-4504R  -  COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4505L	SUP	HCPCS C1776		71-4505L  -  COMPONENT FEMORAL 5 61X39MM 1 AXIS POSTERIOR STABILIZE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4505R	SUP	HCPCS C1776		71-4505R  -  COMPONENT FEMORAL 5 61X39MM 1 AXIS POSTERIOR STABILIZE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4506L	SUP	HCPCS C1776		71-4506L  -  COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4506R	SUP	HCPCS C1776		71-4506R  -  COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE WAFFLE POST	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4507L	SUP	HCPCS C1776		71-4507L  -  COMPONENT FEMORAL 7 66X44MM 1 AXIS POSTERIOR STABILIZE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4507R	SUP	HCPCS C1776		71-4507R  -  COMPONENT FEMORAL 7 66X44MM 1 AXIS POSTERIOR STABILIZE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4509L	SUP	HCPCS C1776		71-4509L  -  COMPONENT FEMORAL 9 71X49MM 1 AXIS POSTERIOR STABILIZE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4509R	SUP	HCPCS C1776		71-4509R  -  COMPONENT FEMORAL 9 71X49MM 1 AXIS POSTERIOR STABILIZE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4511L	SUP	HCPCS C1776		71-4511L  -  COMPONENT FEMORAL 11 76X53MM 1 AXIS POSTERIOR STABILIZE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4511R	SUP	HCPCS C1776		71-4511R  -  COMPONENT FEMORAL 11 76X53MM 1 AXIS POSTERIOR STABILIZE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4513L	SUP	HCPCS C1776		71-4513L  -  COMPONENT FEMORAL 13 81X58MM CEMENTED POSTERIOR STABILIZE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-4513R	SUP	HCPCS C1776		71-4513R  -  COMPONENT FEMORAL 13 81X58MM 1 AXIS POSTERIOR STABILIZE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-5003L	SUP	HCPCS C1776		71-5003L  -  CMPNT FEM 3 LEFT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,199.00 "	"$3,847.26"	$0.00	"$4,159.20"	"$2,339.55"	"$2,339.55"	$0.00	$0.00	$0.00	"$1,083.60"	"$3,858.70"	"$3,858.70"	$0.00	$0.00	"$1,083.47"	$0.00	"$2,563.11"	"$2,563.11"	$0.00	"$2,599.50"	"$4,117.61"	"$4,159.20"	$0.00		$0.00	$813.64	$0.00	$0.00	$827.68	$0.00	$0.00	$0.00	$0.00	$0.00
71-5003R	SUP	HCPCS C1776		71-5003R  -  CMPNT FEM 3 RIGHT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,199.00 "	"$3,847.26"	$0.00	"$4,159.20"	"$2,339.55"	"$2,339.55"	$0.00	$0.00	$0.00	"$1,083.60"	"$3,858.70"	"$3,858.70"	$0.00	$0.00	"$1,083.47"	$0.00	"$2,563.11"	"$2,563.11"	$0.00	"$2,599.50"	"$4,117.61"	"$4,159.20"	$0.00		$0.00	$813.64	$0.00	$0.00	$827.68	$0.00	$0.00	$0.00	$0.00	$0.00
71-5004L	SUP	HCPCS C1776		71-5004L  -  CMPNT FEM 4 LEFT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,096.00 "	"$3,771.04"	$0.00	"$4,076.80"	"$2,293.20"	"$2,293.20"	$0.00	$0.00	$0.00	"$1,062.13"	"$3,782.25"	"$3,782.25"	$0.00	$0.00	"$1,062.01"	$0.00	"$2,512.33"	"$2,512.33"	$0.00	"$2,548.00"	"$4,036.03"	"$4,076.80"	$0.00		$0.00	$797.52	$0.00	$0.00	$811.28	$0.00	$0.00	$0.00	$0.00	$0.00
71-5004R	SUP	HCPCS C1776		71-5004R  -  CMPNT FEM 4 RIGHT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,096.00 "	"$3,771.04"	$0.00	"$4,076.80"	"$2,293.20"	"$2,293.20"	$0.00	$0.00	$0.00	"$1,062.13"	"$3,782.25"	"$3,782.25"	$0.00	$0.00	"$1,062.01"	$0.00	"$2,512.33"	"$2,512.33"	$0.00	"$2,548.00"	"$4,036.03"	"$4,076.80"	$0.00		$0.00	$797.52	$0.00	$0.00	$811.28	$0.00	$0.00	$0.00	$0.00	$0.00
71-5005L	SUP	HCPCS C1776		71-5005L  -  CMPNT FEM 5 LEFT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,096.00 "	"$3,771.04"	$0.00	"$4,076.80"	"$2,293.20"	"$2,293.20"	$0.00	$0.00	$0.00	"$1,062.13"	"$3,782.25"	"$3,782.25"	$0.00	$0.00	"$1,062.01"	$0.00	"$2,512.33"	"$2,512.33"	$0.00	"$2,548.00"	"$4,036.03"	"$4,076.80"	$0.00		$0.00	$797.52	$0.00	$0.00	$811.28	$0.00	$0.00	$0.00	$0.00	$0.00
71-5005R	SUP	HCPCS C1776		71-5005R  -  CMPNT FEM 5 RIGHT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,096.00 "	"$3,771.04"	$0.00	"$4,076.80"	"$2,293.20"	"$2,293.20"	$0.00	$0.00	$0.00	"$1,062.13"	"$3,782.25"	"$3,782.25"	$0.00	$0.00	"$1,062.01"	$0.00	"$2,512.33"	"$2,512.33"	$0.00	"$2,548.00"	"$4,036.03"	"$4,076.80"	$0.00		$0.00	$797.52	$0.00	$0.00	$811.28	$0.00	$0.00	$0.00	$0.00	$0.00
71-5006L	SUP	HCPCS C1776		71-5006L  -  CMPNT FEM 6 LEFT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,096.00 "	"$3,771.04"	$0.00	"$4,076.80"	"$2,293.20"	"$2,293.20"	$0.00	$0.00	$0.00	"$1,062.13"	"$3,782.25"	"$3,782.25"	$0.00	$0.00	"$1,062.01"	$0.00	"$2,512.33"	"$2,512.33"	$0.00	"$2,548.00"	"$4,036.03"	"$4,076.80"	$0.00		$0.00	$797.52	$0.00	$0.00	$811.28	$0.00	$0.00	$0.00	$0.00	$0.00
71-5006R	SUP	HCPCS C1776		71-5006R  -  CMPNT FEM 6 RIGHT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,096.00 "	"$3,771.04"	$0.00	"$4,076.80"	"$2,293.20"	"$2,293.20"	$0.00	$0.00	$0.00	"$1,062.13"	"$3,782.25"	"$3,782.25"	$0.00	$0.00	"$1,062.01"	$0.00	"$2,512.33"	"$2,512.33"	$0.00	"$2,548.00"	"$4,036.03"	"$4,076.80"	$0.00		$0.00	$797.52	$0.00	$0.00	$811.28	$0.00	$0.00	$0.00	$0.00	$0.00
71-5007L	SUP	HCPCS C1776		71-5007L  -  CMPNT FEM 7 LEFT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,096.00 "	"$3,771.04"	$0.00	"$4,076.80"	"$2,293.20"	"$2,293.20"	$0.00	$0.00	$0.00	"$1,062.13"	"$3,782.25"	"$3,782.25"	$0.00	$0.00	"$1,062.01"	$0.00	"$2,512.33"	"$2,512.33"	$0.00	"$2,548.00"	"$4,036.03"	"$4,076.80"	$0.00		$0.00	$797.52	$0.00	$0.00	$811.28	$0.00	$0.00	$0.00	$0.00	$0.00
71-5007R	SUP	HCPCS C1776		71-5007R  -  CMPNT FEM 7 RIGHT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,096.00 "	"$3,771.04"	$0.00	"$4,076.80"	"$2,293.20"	"$2,293.20"	$0.00	$0.00	$0.00	"$1,062.13"	"$3,782.25"	"$3,782.25"	$0.00	$0.00	"$1,062.01"	$0.00	"$2,512.33"	"$2,512.33"	$0.00	"$2,548.00"	"$4,036.03"	"$4,076.80"	$0.00		$0.00	$797.52	$0.00	$0.00	$811.28	$0.00	$0.00	$0.00	$0.00	$0.00
71-5009L	SUP	HCPCS C1776		71-5009L  -  CMPNT FEM 9 LEFT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,096.00 "	"$3,771.04"	$0.00	"$4,076.80"	"$2,293.20"	"$2,293.20"	$0.00	$0.00	$0.00	"$1,062.13"	"$3,782.25"	"$3,782.25"	$0.00	$0.00	"$1,062.01"	$0.00	"$2,512.33"	"$2,512.33"	$0.00	"$2,548.00"	"$4,036.03"	"$4,076.80"	$0.00		$0.00	$797.52	$0.00	$0.00	$811.28	$0.00	$0.00	$0.00	$0.00	$0.00
71-5009R	SUP	HCPCS C1776		71-5009R  -  CMPNT FEM 9 RIGHT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,096.00 "	"$3,771.04"	$0.00	"$4,076.80"	"$2,293.20"	"$2,293.20"	$0.00	$0.00	$0.00	"$1,062.13"	"$3,782.25"	"$3,782.25"	$0.00	$0.00	"$1,062.01"	$0.00	"$2,512.33"	"$2,512.33"	$0.00	"$2,548.00"	"$4,036.03"	"$4,076.80"	$0.00		$0.00	$797.52	$0.00	$0.00	$811.28	$0.00	$0.00	$0.00	$0.00	$0.00
71-5011L	SUP	HCPCS C1776		71-5011L  -  CMPNT FEM 11 LEFT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,096.00 "	"$3,771.04"	$0.00	"$4,076.80"	"$2,293.20"	"$2,293.20"	$0.00	$0.00	$0.00	"$1,062.13"	"$3,782.25"	"$3,782.25"	$0.00	$0.00	"$1,062.01"	$0.00	"$2,512.33"	"$2,512.33"	$0.00	"$2,548.00"	"$4,036.03"	"$4,076.80"	$0.00		$0.00	$797.52	$0.00	$0.00	$811.28	$0.00	$0.00	$0.00	$0.00	$0.00
71-5011R	SUP	HCPCS C1776		71-5011R  -  CMPNT FEM 11 RIGHT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,096.00 "	"$3,771.04"	$0.00	"$4,076.80"	"$2,293.20"	"$2,293.20"	$0.00	$0.00	$0.00	"$1,062.13"	"$3,782.25"	"$3,782.25"	$0.00	$0.00	"$1,062.01"	$0.00	"$2,512.33"	"$2,512.33"	$0.00	"$2,548.00"	"$4,036.03"	"$4,076.80"	$0.00		$0.00	$797.52	$0.00	$0.00	$811.28	$0.00	$0.00	$0.00	$0.00	$0.00
71-5013L	SUP	HCPCS C1776		71-5013L  -  CMPNT FEM 13 LEFT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,199.00 "	"$3,847.26"	$0.00	"$4,159.20"	"$2,339.55"	"$2,339.55"	$0.00	$0.00	$0.00	"$1,083.60"	"$3,858.70"	"$3,858.70"	$0.00	$0.00	"$1,083.47"	$0.00	"$2,563.11"	"$2,563.11"	$0.00	"$2,599.50"	"$4,117.61"	"$4,159.20"	$0.00		$0.00	$813.64	$0.00	$0.00	$827.68	$0.00	$0.00	$0.00	$0.00	$0.00
71-5013R	SUP	HCPCS C1776		71-5013R  -  CMPNT FEM 13 RIGHT KNEE PS MCSTRCT NON LFIT SCRP	BOTH IP/OP	"$5,199.00 "	"$3,847.26"	$0.00	"$4,159.20"	"$2,339.55"	"$2,339.55"	$0.00	$0.00	$0.00	"$1,083.60"	"$3,858.70"	"$3,858.70"	$0.00	$0.00	"$1,083.47"	$0.00	"$2,563.11"	"$2,563.11"	$0.00	"$2,599.50"	"$4,117.61"	"$4,159.20"	$0.00		$0.00	$813.64	$0.00	$0.00	$827.68	$0.00	$0.00	$0.00	$0.00	$0.00
71-5103L	SUP	HCPCS C1776		71-5103L  -  CMPNT FEM 3 LEFT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,839.00 "	"$3,580.86"	$0.00	"$3,871.20"	"$2,177.55"	"$2,177.55"	$0.00	$0.00	$0.00	"$1,008.57"	"$3,591.51"	"$3,591.51"	$0.00	$0.00	"$1,008.45"	$0.00	"$2,385.63"	"$2,385.63"	$0.00	"$2,419.50"	"$3,832.49"	"$3,871.20"	$0.00		$0.00	$757.30	$0.00	$0.00	$770.37	$0.00	$0.00	$0.00	$0.00	$0.00
71-5103R	SUP	HCPCS C1776		71-5103R  -  CMPNT FEM 3 RIGHT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,839.00 "	"$3,580.86"	$0.00	"$3,871.20"	"$2,177.55"	"$2,177.55"	$0.00	$0.00	$0.00	"$1,008.57"	"$3,591.51"	"$3,591.51"	$0.00	$0.00	"$1,008.45"	$0.00	"$2,385.63"	"$2,385.63"	$0.00	"$2,419.50"	"$3,832.49"	"$3,871.20"	$0.00		$0.00	$757.30	$0.00	$0.00	$770.37	$0.00	$0.00	$0.00	$0.00	$0.00
71-5104L	SUP	HCPCS C1776		71-5104L  -  CMPNT FEM LEFT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	"$2,151.00"	"$2,151.00"	$0.00	$0.00	$0.00	$996.27	"$3,547.72"	"$3,547.72"	$0.00	$0.00	$996.15	$0.00	"$2,356.54"	"$2,356.54"	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$748.07	$0.00	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00
71-5104R	SUP	HCPCS C1776		71-5104R  -  CMPNT FEM 4 RIGHT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	"$2,151.00"	"$2,151.00"	$0.00	$0.00	$0.00	$996.27	"$3,547.72"	"$3,547.72"	$0.00	$0.00	$996.15	$0.00	"$2,356.54"	"$2,356.54"	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$748.07	$0.00	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00
71-5105L	SUP	HCPCS C1776		71-5105L  -  CMPNT FEM 5 LEFT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	"$2,151.00"	"$2,151.00"	$0.00	$0.00	$0.00	$996.27	"$3,547.72"	"$3,547.72"	$0.00	$0.00	$996.15	$0.00	"$2,356.54"	"$2,356.54"	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$748.07	$0.00	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00
71-5105R	SUP	HCPCS C1776		71-5105R  -  CMPNT FEM 5 RIGHT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	"$2,151.00"	"$2,151.00"	$0.00	$0.00	$0.00	$996.27	"$3,547.72"	"$3,547.72"	$0.00	$0.00	$996.15	$0.00	"$2,356.54"	"$2,356.54"	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$748.07	$0.00	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00
71-5106L	SUP	HCPCS C1776		71-5106L  -  CMPNT FEM 6 LEFT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	"$2,151.00"	"$2,151.00"	$0.00	$0.00	$0.00	$996.27	"$3,547.72"	"$3,547.72"	$0.00	$0.00	$996.15	$0.00	"$2,356.54"	"$2,356.54"	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$748.07	$0.00	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00
71-5106R	SUP	HCPCS C1776		71-5106R  -  CMPNT FEM 6 RIGHT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	"$2,151.00"	"$2,151.00"	$0.00	$0.00	$0.00	$996.27	"$3,547.72"	"$3,547.72"	$0.00	$0.00	$996.15	$0.00	"$2,356.54"	"$2,356.54"	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$748.07	$0.00	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00
71-5107L	SUP	HCPCS C1776		71-5107L  -  CMPNT FEM 7 LEFT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	"$2,151.00"	"$2,151.00"	$0.00	$0.00	$0.00	$996.27	"$3,547.72"	"$3,547.72"	$0.00	$0.00	$996.15	$0.00	"$2,356.54"	"$2,356.54"	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$748.07	$0.00	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00
71-5107R	SUP	HCPCS C1776		71-5107R  -  CMPNT FEM 7 RIGHT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	"$2,151.00"	"$2,151.00"	$0.00	$0.00	$0.00	$996.27	"$3,547.72"	"$3,547.72"	$0.00	$0.00	$996.15	$0.00	"$2,356.54"	"$2,356.54"	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$748.07	$0.00	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00
71-5109L	SUP	HCPCS C1776		71-5109L  -  CMPNT FEM 9 LEFT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	"$2,151.00"	"$2,151.00"	$0.00	$0.00	$0.00	$996.27	"$3,547.72"	"$3,547.72"	$0.00	$0.00	$996.15	$0.00	"$2,356.54"	"$2,356.54"	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$748.07	$0.00	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00
71-5109R	SUP	HCPCS C1776		71-5109R  -  CMPNT FEM 9 RIGHT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	"$2,151.00"	"$2,151.00"	$0.00	$0.00	$0.00	$996.27	"$3,547.72"	"$3,547.72"	$0.00	$0.00	$996.15	$0.00	"$2,356.54"	"$2,356.54"	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$748.07	$0.00	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00
71-5111L	SUP	HCPCS C1776		71-5111L  -  CMPNT FEM 11 LEFT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	"$2,151.00"	"$2,151.00"	$0.00	$0.00	$0.00	$996.27	"$3,547.72"	"$3,547.72"	$0.00	$0.00	$996.15	$0.00	"$2,356.54"	"$2,356.54"	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$748.07	$0.00	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00
71-5111R	SUP	HCPCS C1776		71-5111R  -  CMPNT FEM 11 RIGHT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	"$2,151.00"	"$2,151.00"	$0.00	$0.00	$0.00	$996.27	"$3,547.72"	"$3,547.72"	$0.00	$0.00	$996.15	$0.00	"$2,356.54"	"$2,356.54"	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$748.07	$0.00	$0.00	$760.98	$0.00	$0.00	$0.00	$0.00	$0.00
71-5113L	SUP	HCPCS C1776		71-5113L  -  CMPNT FEM 13 LEFT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,839.00 "	"$3,580.86"	$0.00	"$3,871.20"	"$2,177.55"	"$2,177.55"	$0.00	$0.00	$0.00	"$1,008.57"	"$3,591.51"	"$3,591.51"	$0.00	$0.00	"$1,008.45"	$0.00	"$2,385.63"	"$2,385.63"	$0.00	"$2,419.50"	"$3,832.49"	"$3,871.20"	$0.00		$0.00	$757.30	$0.00	$0.00	$770.37	$0.00	$0.00	$0.00	$0.00	$0.00
71-5113R	SUP	HCPCS C1776		71-5113R  -  CMPNT FEM 13 RIGHT KNEE PS MCSTRCT SCRP LFIT	BOTH IP/OP	"$4,839.00 "	"$3,580.86"	$0.00	"$3,871.20"	"$2,177.55"	"$2,177.55"	$0.00	$0.00	$0.00	"$1,008.57"	"$3,591.51"	"$3,591.51"	$0.00	$0.00	"$1,008.45"	$0.00	"$2,385.63"	"$2,385.63"	$0.00	"$2,419.50"	"$3,832.49"	"$3,871.20"	$0.00		$0.00	$757.30	$0.00	$0.00	$770.37	$0.00	$0.00	$0.00	$0.00	$0.00
71511V	SUP	Custom 27203010		71511V  -  CLIP INTNL REMOVER MED LARGE - LARGE  STRAIGHT 11INźź	BOTH IP/OP	$412.48 	$305.24	$0.00	$329.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.14	$306.14	$0.00	$0.00	$85.96	$0.00	$0.00	$0.00	$0.00	$206.24	$326.68	$329.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71512V	SUP	Custom 27203010		71512V  -  APPLIER MED LARGE  CURVED 11INźź	BOTH IP/OP	$378.73 	$280.26	$0.00	$302.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.09	$281.09	$0.00	$0.00	$78.93	$0.00	$0.00	$0.00	$0.00	$189.36	$299.95	$302.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71517V	SUP	Custom 27203010		71517V  -  APPLIER MED LARGE  70 DEGREE 11INźź	BOTH IP/OP	$378.73 	$280.26	$0.00	$302.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.09	$281.09	$0.00	$0.00	$78.93	$0.00	$0.00	$0.00	$0.00	$189.36	$299.95	$302.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71-5203L	SUP	HCPCS C1776		71-5203L  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
71-5203R	SUP	HCPCS C1776		71-5203R  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
71-5205L	SUP	HCPCS C1776		71-5205L  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
71-5205R	SUP	HCPCS C1776		71-5205R  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
71-5207L	SUP	HCPCS C1776		71-5207L  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
71-5207R	SUP	HCPCS C1776		71-5207R  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
71-5209L	SUP	HCPCS C1776		71-5209L  -  COMPONENT FEMORAL 9 POSTERIOR STABILIZE MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
71-5209R	SUP	HCPCS C1776		71-5209R  -  COMPONENT FEMORAL 9 POSTERIOR STABILIZE MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
71-5211L	SUP	HCPCS C1776		71-5211L  -  COMPONENT FEMORAL 11 POSTERIOR STABILIZE MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
71-5211R	SUP	HCPCS C1776		71-5211R  -  COMPONENT FEMORAL 11 POSTERIOR STABILIZE MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
71-5213L	SUP	HCPCS C1776		71-5213L  -  COMPONENT FEMORAL 13 POSTERIOR STABILIZE MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
71-5213R	SUP	HCPCS C1776		71-5213R  -  COMPONENT FEMORAL 13 POSTERIOR STABILIZE MICROSTRUCTURE PRIM	BOTH IP/OP	"$4,505.00 "	"$3,333.70"	$0.00	"$3,604.00"	"$2,027.25"	"$2,027.25"	$0.00	$0.00	$0.00	$938.95	"$3,343.61"	"$3,343.61"	$0.00	$0.00	$938.84	$0.00	"$2,220.97"	"$2,220.97"	$0.00	"$2,252.50"	"$3,567.96"	"$3,604.00"	$0.00		$0.00	$705.03	$0.00	$0.00	$717.20	$0.00	$0.00	$0.00	$0.00	$0.00
71582V	SUP	Custom 27203010		71582V  -  APPLIER MED LARGE  CURVED 8INźź	BOTH IP/OP	$378.73 	$280.26	$0.00	$302.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.09	$281.09	$0.00	$0.00	$78.93	$0.00	$0.00	$0.00	$0.00	$189.36	$299.95	$302.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71587V	SUP	Custom 27203010		71587V  -  APPLIER MED LARGE  70 DEGREE 8INźź	BOTH IP/OP	$378.73 	$280.26	$0.00	$302.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.09	$281.09	$0.00	$0.00	$78.93	$0.00	$0.00	$0.00	$0.00	$189.36	$299.95	$302.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7160-20	SUP	Custom 27203010		7160-20  -  KIT PEG 20FR 4X4IN SPONGE FEED TUBE EXTERNAL RETENTION RING	BOTH IP/OP	$225.15 	$166.61	$0.00	$182.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.11	$167.11	$0.00	$0.00	$46.92	$0.00	$0.00	$0.00	$0.00	$114.26	$181.00	$182.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71612V	SUP	Custom 27203010		71612V  -  APPLIER LARGE  CURVED 11INźź	BOTH IP/OP	$378.73 	$280.26	$0.00	$302.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.09	$281.09	$0.00	$0.00	$78.93	$0.00	$0.00	$0.00	$0.00	$189.36	$299.95	$302.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71617V	SUP	Custom 27203010		71617V  -  APPLIER LARGE  70 DEGREE 11INźź	BOTH IP/OP	$378.73 	$280.26	$0.00	$302.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.09	$281.09	$0.00	$0.00	$78.93	$0.00	$0.00	$0.00	$0.00	$189.36	$299.95	$302.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71682510L	SUP	HCPCS C1713		71682510L  -  NAIL IM 125D STD 10MM 19.5CM IMHS CP SS LT HIP	BOTH IP/OP	"$3,329.38 "	"$2,463.74"	$0.00	"$2,663.50"	"$1,498.22"	"$1,498.22"	$0.00	$0.00	$0.00	$693.92	"$2,471.06"	"$2,471.06"	$0.00	$0.00	$693.84	$0.00	"$1,641.38"	"$1,641.38"	$0.00	"$1,664.69"	"$2,636.87"	"$2,663.50"	$0.00		$0.00	$521.05	$0.00	$0.00	$530.04	$0.00	$0.00	$0.00	$0.00	$0.00
71682510R	SUP	HCPCS C1713		71682510R  -  NAIL IM 125D STD 10MM 19.5CM IMHS CP SS HIP RT	BOTH IP/OP	"$3,329.38 "	"$2,463.74"	$0.00	"$2,663.50"	"$1,498.22"	"$1,498.22"	$0.00	$0.00	$0.00	$693.92	"$2,471.06"	"$2,471.06"	$0.00	$0.00	$693.84	$0.00	"$1,641.38"	"$1,641.38"	$0.00	"$1,664.69"	"$2,636.87"	"$2,663.50"	$0.00		$0.00	$521.05	$0.00	$0.00	$530.04	$0.00	$0.00	$0.00	$0.00	$0.00
71682512L	SUP	HCPCS C1713		71682512L  -  NAIL IM 125D STD 12MM 19.5CM IMHS CP SS HIP LT	BOTH IP/OP	"$3,329.38 "	"$2,463.74"	$0.00	"$2,663.50"	"$1,498.22"	"$1,498.22"	$0.00	$0.00	$0.00	$693.92	"$2,471.06"	"$2,471.06"	$0.00	$0.00	$693.84	$0.00	"$1,641.38"	"$1,641.38"	$0.00	"$1,664.69"	"$2,636.87"	"$2,663.50"	$0.00		$0.00	$521.05	$0.00	$0.00	$530.04	$0.00	$0.00	$0.00	$0.00	$0.00
71682512R	SUP	HCPCS C1713		71682512R  -  NAIL IM 125D STD 12MM 19.5CM IMHS CP SS RT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71682514L	SUP	HCPCS C1713		71682514L  -  NAIL IM 125D STD 14MM 19.5CM IMHS CP SS LT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71682514R	SUP	HCPCS C1713		71682514R  -  NAIL IM 125D STD 14MM 19.5CM IMHS CP SS RT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71682516L	SUP	HCPCS C1713		71682516L  -  NAIL IM 125D STD 16MM 19.5CM IMHS CP SS LT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71682516R	SUP	HCPCS C1713		71682516R  -  NAIL IM 125D STD 16MM 19.5CM IMHS CP SS RT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71682532L	SUP	HCPCS C1713		71682532L  -  NAIL IM 125D LNG 10MM 32CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682532R	SUP	HCPCS C1713		71682532R  -  NAIL IM 125D LNG 10MM 32CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682534L	SUP	HCPCS C1713		71682534L  -  NAIL IM 125D LNG 10MM 34CM IMHS CP SS FEM LT	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682534R	SUP	HCPCS C1713		71682534R  -  NAIL IM 125D LNG 10MM 34CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682536L	SUP	HCPCS C1713		71682536L  -  NAIL IM 125D LNG 10MM 36CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682536R	SUP	HCPCS C1713		71682536R  -  NAIL IM 125D LNG 10MM 36CM IMHS CP SS RT	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682538L	SUP	HCPCS C1713		71682538L  -  NAIL IM 125D LNG 10MM 38CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682538R	SUP	HCPCS C1713		71682538R  -  NAIL IM 125D LNG 10MM 38CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682540L	SUP	HCPCS C1713		71682540L  -  NAIL IM 125D LNG 10MM 40CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682540R	SUP	HCPCS C1713		71682540R  -  NAIL IM 125D LNG 10MM 40CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682542L	SUP	HCPCS C1713		71682542L  -  NAIL IM 125D LNG 10MM 42CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682542R	SUP	HCPCS C1713		71682542R  -  NAIL IM 125D LNG 10MM 42CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682544L	SUP	HCPCS C1713		71682544L  -  NAIL IM 125D LNG 10MM 44CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682544R	SUP	HCPCS C1713		71682544R  -  NAIL IM 125D LNG 10MM 44CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682632L	SUP	HCPCS C1713		71682632L  -  NAIL IM 125D LNG 12MM 32CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682632R	SUP	HCPCS C1713		71682632R  -  NAIL IM 125D LNG 12MM 32CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682634L	SUP	HCPCS C1713		71682634L  -  NAIL IM 125D 12MM 34CM IMHS SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682634R	SUP	HCPCS C1713		71682634R  -  NAIL IM 125D LNG 12MM 34CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682636L	SUP	HCPCS C1713		71682636L  -  NAIL IM 125D LNG 12MM 36CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682636R	SUP	HCPCS C1713		71682636R  -  NAIL IM 125D LNG 12MM 36CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682638L	SUP	HCPCS C1713		71682638L  -  NAIL IM 125D LNG 12MM 38CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682638R	SUP	HCPCS C1713		71682638R  -  NAIL IM 125D LNG 12MM 38CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682640L	SUP	HCPCS C1713		71682640L  -  NAIL IM 125D LNG 12MM 40CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682640R	SUP	HCPCS C1713		71682640R  -  NAIL IM 125D LNG 12MM 40CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682642L	SUP	HCPCS C1713		71682642L  -  NAIL IM 125D LNG 12MM 42CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682642R	SUP	HCPCS C1713		71682642R  -  NAIL IM 125D LNG 12MM 42CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682644L	SUP	HCPCS C1713		71682644L  -  NAIL IM 125D LNG 12MM 44CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682644R	SUP	HCPCS C1713		71682644R  -  NAIL IM 125D LNG 12MM 44CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682734R	SUP	HCPCS C1713		71682734R  -  NAIL IM 125D 14MM 34CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,269.38 "	"$4,639.34"	$0.00	"$5,015.50"	"$2,821.22"	"$2,821.22"	$0.00	$0.00	$0.00	"$1,306.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,306.54"	$0.00	"$3,090.80"	"$3,090.80"	$0.00	"$3,134.69"	"$4,965.35"	"$5,015.50"	$0.00		$0.00	$981.16	$0.00	$0.00	$998.08	$0.00	$0.00	$0.00	$0.00	$0.00
71682736L	SUP	HCPCS C1713		71682736L  -  NAIL IM 125D 14MM 36CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71682744L	SUP	HCPCS C1713		71682744L  -  NAIL IM 125D 14MM 44CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,269.38 "	"$4,639.34"	$0.00	"$5,015.50"	"$2,821.22"	"$2,821.22"	$0.00	$0.00	$0.00	"$1,306.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,306.54"	$0.00	"$3,090.80"	"$3,090.80"	$0.00	"$3,134.69"	"$4,965.35"	"$5,015.50"	$0.00		$0.00	$981.16	$0.00	$0.00	$998.08	$0.00	$0.00	$0.00	$0.00	$0.00
71682744R	SUP	HCPCS C1713		71682744R  -  NAIL IM 125D 14MM 44CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,269.38 "	"$4,639.34"	$0.00	"$5,015.50"	"$2,821.22"	"$2,821.22"	$0.00	$0.00	$0.00	"$1,306.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,306.54"	$0.00	"$3,090.80"	"$3,090.80"	$0.00	"$3,134.69"	"$4,965.35"	"$5,015.50"	$0.00		$0.00	$981.16	$0.00	$0.00	$998.08	$0.00	$0.00	$0.00	$0.00	$0.00
71682V	SUP	Custom 27203010		71682V  -  APPLIER LARGE  CURVED 8INźź	BOTH IP/OP	$378.73 	$280.26	$0.00	$302.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.09	$281.09	$0.00	$0.00	$78.93	$0.00	$0.00	$0.00	$0.00	$189.36	$299.95	$302.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71683010L	SUP	HCPCS C1713		71683010L  -  NAIL IM 130D 10MM 19.5CM IMHS CP SS HIP LT	BOTH IP/OP	"$3,329.38 "	"$2,463.74"	$0.00	"$2,663.50"	"$1,498.22"	"$1,498.22"	$0.00	$0.00	$0.00	$693.92	"$2,471.06"	"$2,471.06"	$0.00	$0.00	$693.84	$0.00	"$1,641.38"	"$1,641.38"	$0.00	"$1,664.69"	"$2,636.87"	"$2,663.50"	$0.00		$0.00	$521.05	$0.00	$0.00	$530.04	$0.00	$0.00	$0.00	$0.00	$0.00
71683012L	SUP	HCPCS C1713		71683012L  -  NAIL IM 130D 12MM 19.5CM IMHS SS LT HIP	BOTH IP/OP	"$3,329.38 "	"$2,463.74"	$0.00	"$2,663.50"	"$1,498.22"	"$1,498.22"	$0.00	$0.00	$0.00	$693.92	"$2,471.06"	"$2,471.06"	$0.00	$0.00	$693.84	$0.00	"$1,641.38"	"$1,641.38"	$0.00	"$1,664.69"	"$2,636.87"	"$2,663.50"	$0.00		$0.00	$521.05	$0.00	$0.00	$530.04	$0.00	$0.00	$0.00	$0.00	$0.00
71683012R	SUP	HCPCS C1713		71683012R  -  NAIL IM 130D STD 12MM 19.5CM IMHS SS RT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71683014L	SUP	HCPCS C1713		71683014L  -  NAIL IM 130D 14MM 19.5CM IMHS SS LT HIP	BOTH IP/OP	"$3,329.38 "	"$2,463.74"	$0.00	"$2,663.50"	"$1,498.22"	"$1,498.22"	$0.00	$0.00	$0.00	$693.92	"$2,471.06"	"$2,471.06"	$0.00	$0.00	$693.84	$0.00	"$1,641.38"	"$1,641.38"	$0.00	"$1,664.69"	"$2,636.87"	"$2,663.50"	$0.00		$0.00	$521.05	$0.00	$0.00	$530.04	$0.00	$0.00	$0.00	$0.00	$0.00
71683014R	SUP	HCPCS C1713		71683014R  -  NAIL IM 130D STD 14MM 19.5CM IMHS CP SS RT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71683016L	SUP	HCPCS C1713		71683016L  -  NAIL IM 130D STD 16MM 19.5CM IMHS CP SS HIP LT	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71683016R	SUP	HCPCS C1713		71683016R  -  NAIL IM 130D STD 16MM 19.5CM IMHS CP SS RT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71683032L	SUP	HCPCS C1713		71683032L  -  NAIL IM 130D LNG 10MM 32CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683032R	SUP	HCPCS C1713		71683032R  -  NAIL IM 130D LNG 10MM 32CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683034L	SUP	HCPCS C1713		71683034L  -  NAIL IM 130D LNG 10MM 34CM IMHS CP SS LT	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683034R	SUP	HCPCS C1713		71683034R  -  NAIL IM 130D LNG 10MM 34CM IMHS CP SS RT	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683036L	SUP	HCPCS C1713		71683036L  -  NAIL IM 130D LNG 10MM 36CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683036R	SUP	HCPCS C1713		71683036R  -  NAIL IM 130D LNG 10MM 36CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683038L	SUP	HCPCS C1713		71683038L  -  NAIL IM 130D LNG 10MM 38CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683038R	SUP	HCPCS C1713		71683038R  -  NAIL IM 130D LNG 10MM 38CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683040L	SUP	HCPCS C1713		71683040L  -  NAIL IM 130D LNG 10MM 40CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683040R	SUP	HCPCS C1713		71683040R  -  NAIL IM 130D 10MM 40CM IMHS SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683042L	SUP	HCPCS C1713		71683042L  -  NAIL IM 130D LNG 10MM 42CM IMHS CP SS HIP LT	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683042R	SUP	HCPCS C1713		71683042R  -  NAIL IM 130D LNG 10MM 42CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683044L	SUP	HCPCS C1713		71683044L  -  NAIL IM 130D LNG 10MM 44CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683044R	SUP	HCPCS C1713		71683044R  -  NAIL IM 130D LNG 10MM 44CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683132L	SUP	HCPCS C1713		71683132L  -  NAIL IM 130D LNG 12MM 32CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683132R	SUP	HCPCS C1713		71683132R  -  NAIL IM 130D LNG 12MM 32CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683134L	SUP	HCPCS C1713		71683134L  -  NAIL IM 130D LNG 12MM 34CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683134R	SUP	HCPCS C1713		71683134R  -  NAIL IM 130D 12MM 34CM IMHS CP SS RT	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683136L	SUP	HCPCS C1713		71683136L  -  NAIL IM 130D 12MM 36CM IMHS SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683136R	SUP	HCPCS C1713		71683136R  -  NAIL IM 130D LNG 12MM 36CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683138L	SUP	HCPCS C1713		71683138L  -  NAIL IM 130D LNG 12MM 38CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683138R	SUP	HCPCS C1713		71683138R  -  NAIL IM 130D LNG 12MM 38CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683140L	SUP	HCPCS C1713		71683140L  -  NAIL IM 130D LNG 12MM 40CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683140R	SUP	HCPCS C1713		71683140R  -  NAIL IM 130D LNG 12MM 40CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683142L	SUP	HCPCS C1713		71683142L  -  NAIL IM 130D LNG 12MM 42CM IMHS CP SS HIP LT	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683142R	SUP	HCPCS C1713		71683142R  -  NAIL IM 130D LNG 12MM 42CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683144L	SUP	HCPCS C1713		71683144L  -  NAIL IM 130D LNG 12MM 44CM IMHS CP SS HIP LT	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683144R	SUP	HCPCS C1713		71683144R  -  NAIL IM 130D LNG 12MM 44CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683510L	SUP	HCPCS C1713		71683510L  -  NAIL IM 135D STD 10MM 19.5CM IMHS CP SS LT HIP	BOTH IP/OP	"$3,329.38 "	"$2,463.74"	$0.00	"$2,663.50"	"$1,498.22"	"$1,498.22"	$0.00	$0.00	$0.00	$693.92	"$2,471.06"	"$2,471.06"	$0.00	$0.00	$693.84	$0.00	"$1,641.38"	"$1,641.38"	$0.00	"$1,664.69"	"$2,636.87"	"$2,663.50"	$0.00		$0.00	$521.05	$0.00	$0.00	$530.04	$0.00	$0.00	$0.00	$0.00	$0.00
71683510R	SUP	HCPCS C1713		71683510R  -  NAIL IM 135D STD 10MM 19.5CM IMHS CP SS RT HIP	BOTH IP/OP	"$3,329.38 "	"$2,463.74"	$0.00	"$2,663.50"	"$1,498.22"	"$1,498.22"	$0.00	$0.00	$0.00	$693.92	"$2,471.06"	"$2,471.06"	$0.00	$0.00	$693.84	$0.00	"$1,641.38"	"$1,641.38"	$0.00	"$1,664.69"	"$2,636.87"	"$2,663.50"	$0.00		$0.00	$521.05	$0.00	$0.00	$530.04	$0.00	$0.00	$0.00	$0.00	$0.00
71683512L	SUP	HCPCS C1713		71683512L  -  NAIL IM 135D STD 12MM 19.5CM IMHS CP SS LT HIP	BOTH IP/OP	"$3,329.38 "	"$2,463.74"	$0.00	"$2,663.50"	"$1,498.22"	"$1,498.22"	$0.00	$0.00	$0.00	$693.92	"$2,471.06"	"$2,471.06"	$0.00	$0.00	$693.84	$0.00	"$1,641.38"	"$1,641.38"	$0.00	"$1,664.69"	"$2,636.87"	"$2,663.50"	$0.00		$0.00	$521.05	$0.00	$0.00	$530.04	$0.00	$0.00	$0.00	$0.00	$0.00
71683512R	SUP	HCPCS C1713		71683512R  -  NAIL IM 135D STD 12MM 19.5CM IMHS CP SS RT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71683514L	SUP	HCPCS C1713		71683514L  -  NAIL IM 135D STD 14MM 19.5CM IMHS CP SS LT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71683514R	SUP	HCPCS C1713		71683514R  -  NAIL IM 135D STD 14MM 19.5CM IMHS CP SS RT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71683516L	SUP	HCPCS C1713		71683516L  -  NAIL IM 135D 16MM 19.5CM IMHS CP SS LT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71683516R	SUP	HCPCS C1713		71683516R  -  NAIL IM 135D 16MM 19.5CM IMHS CP SS RT HIP	BOTH IP/OP	"$3,342.50 "	"$2,473.45"	$0.00	"$2,674.00"	"$1,504.13"	"$1,504.13"	$0.00	$0.00	$0.00	$696.66	"$2,480.80"	"$2,480.80"	$0.00	$0.00	$696.58	$0.00	"$1,647.85"	"$1,647.85"	$0.00	"$1,671.25"	"$2,647.26"	"$2,674.00"	$0.00		$0.00	$523.10	$0.00	$0.00	$532.13	$0.00	$0.00	$0.00	$0.00	$0.00
71683532L	SUP	HCPCS C1713		71683532L  -  NAIL IM 135D LNG 10MM 32CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683532R	SUP	HCPCS C1713		71683532R  -  NAIL IM 135D LNG 10MM 32CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683534L	SUP	HCPCS C1713		71683534L  -  NAIL IM 135D LNG 10MM 34CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683534R	SUP	HCPCS C1713		71683534R  -  NAIL IM 135D LNG 10MM 34CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683536L	SUP	HCPCS C1713		71683536L  -  NAIL IM 135D LNG 10MM 36CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683536R	SUP	HCPCS C1713		71683536R  -  NAIL IM 135D LNG 10MM 36CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683538L	SUP	HCPCS C1713		71683538L  -  NAIL IM 135D LNG 10MM 38CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683538R	SUP	HCPCS C1713		71683538R  -  NAIL IM 135D LNG 10MM 38CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683540L	SUP	HCPCS C1713		71683540L  -  NAIL IM 135D LNG 10MM 40CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683540R	SUP	HCPCS C1713		71683540R  -  NAIL IM 135D LNG 10MM 40CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683542L	SUP	HCPCS C1713		71683542L  -  NAIL IM 135D LNG 10MM 42CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683542R	SUP	HCPCS C1713		71683542R  -  NAIL IM 135D LNG 10MM 42CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683544L	SUP	HCPCS C1713		71683544L  -  NAIL IM 135D LNG 10MM 44CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683544R	SUP	HCPCS C1713		71683544R  -  NAIL IM 135D LNG 10MM 44CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683632L	SUP	HCPCS C1713		71683632L  -  NAIL IM 135D LNG 12MM 32CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683632R	SUP	HCPCS C1713		71683632R  -  NAIL IM 135D 12MM 32CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683634L	SUP	HCPCS C1713		71683634L  -  NAIL IM 135D LNG 12MM 34CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683634R	SUP	HCPCS C1713		71683634R  -  NAIL IM 135D LNG 12MM 34CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683636L	SUP	HCPCS C1713		71683636L  -  NAIL IM 135D LNG 12MM 36CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683636R	SUP	HCPCS C1713		71683636R  -  NAIL IM 135D LNG 12MM 36CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683638L	SUP	HCPCS C1713		71683638L  -  NAIL IM 135D LNG 12MM 38CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683638R	SUP	HCPCS C1713		71683638R  -  NAIL IM 135D LNG 12MM 38CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683640L	SUP	HCPCS C1713		71683640L  -  NAIL IM 135D LNG 12MM 40CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683640R	SUP	HCPCS C1713		71683640R  -  NAIL IM 135D LNG 12MM 40CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683642L	SUP	HCPCS C1713		71683642L  -  NAIL IM 135D LNG 12MM 42CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683642R	SUP	HCPCS C1713		71683642R  -  NAIL IM 135D LNG 12MM 42CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683644L	SUP	HCPCS C1713		71683644L  -  NAIL IM 135D LNG 12MM 44CM IMHS CP SS LT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71683644R	SUP	HCPCS C1713		71683644R  -  NAIL IM 135D LNG 12MM 44CM IMHS CP SS RT HIP	BOTH IP/OP	"$6,671.88 "	"$4,937.19"	$0.00	"$5,337.50"	"$3,002.34"	"$3,002.34"	$0.00	$0.00	$0.00	"$1,390.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,390.42"	$0.00	"$3,289.23"	"$3,289.23"	$0.00	"$3,335.94"	"$5,284.13"	"$5,337.50"	$0.00		$0.00	"$1,044.15"	$0.00	$0.00	"$1,062.16"	$0.00	$0.00	$0.00	$0.00	$0.00
71687V	SUP	Custom 27203010		71687V  -  APPLIER LARGE  70 DEGREE 8INźź	BOTH IP/OP	$378.73 	$280.26	$0.00	$302.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.09	$281.09	$0.00	$0.00	$78.93	$0.00	$0.00	$0.00	$0.00	$189.36	$299.95	$302.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71701016L	SUP	HCPCS C1713		71701016L  -  NAIL IM 12-10MM 16CM LIME TRGN FSN RND XSECT DC SLOT TI	BOTH IP/OP	"$5,613.75 "	"$4,154.18"	$0.00	"$4,491.00"	"$2,526.19"	"$2,526.19"	$0.00	$0.00	$0.00	"$1,170.05"	"$4,166.53"	"$4,166.53"	$0.00	$0.00	"$1,169.91"	$0.00	"$2,767.58"	"$2,767.58"	$0.00	"$2,806.88"	"$4,446.09"	"$4,491.00"	$0.00		$0.00	$878.55	$0.00	$0.00	$893.71	$0.00	$0.00	$0.00	$0.00	$0.00
71701016R	SUP	HCPCS C1713		71701016R  -  NAIL IM 10MM 16CM TRGN FSN TI RT HINDFOOT	BOTH IP/OP	"$5,613.75 "	"$4,154.18"	$0.00	"$4,491.00"	"$2,526.19"	"$2,526.19"	$0.00	$0.00	$0.00	"$1,170.05"	"$4,166.53"	"$4,166.53"	$0.00	$0.00	"$1,169.91"	$0.00	"$2,767.58"	"$2,767.58"	$0.00	"$2,806.88"	"$4,446.09"	"$4,491.00"	$0.00		$0.00	$878.55	$0.00	$0.00	$893.71	$0.00	$0.00	$0.00	$0.00	$0.00
71701020L	SUP	HCPCS C1713		71701020L  -  NAIL INTRAMEDULLARY 10MM 20CM FUSION TRIGEN LEFT HINDFOOT	BOTH IP/OP	"$5,613.75 "	"$4,154.18"	$0.00	"$4,491.00"	"$2,526.19"	"$2,526.19"	$0.00	$0.00	$0.00	"$1,170.05"	"$4,166.53"	"$4,166.53"	$0.00	$0.00	"$1,169.91"	$0.00	"$2,767.58"	"$2,767.58"	$0.00	"$2,806.88"	"$4,446.09"	"$4,491.00"	$0.00		$0.00	$878.55	$0.00	$0.00	$893.71	$0.00	$0.00	$0.00	$0.00	$0.00
71701020R	SUP	HCPCS C1713		71701020R  -  NAIL IM 12-10MM 20CM ROSE TRGN FSN RND XSECT DC SLOT TI	BOTH IP/OP	"$5,613.75 "	"$4,154.18"	$0.00	"$4,491.00"	"$2,526.19"	"$2,526.19"	$0.00	$0.00	$0.00	"$1,170.05"	"$4,166.53"	"$4,166.53"	$0.00	$0.00	"$1,169.91"	$0.00	"$2,767.58"	"$2,767.58"	$0.00	"$2,806.88"	"$4,446.09"	"$4,491.00"	$0.00		$0.00	$878.55	$0.00	$0.00	$893.71	$0.00	$0.00	$0.00	$0.00	$0.00
71701025L	SUP	HCPCS C1713		71701025L  -  NAIL IM 10MM 25CM TRGN TI LT HINDFOOT	BOTH IP/OP	"$5,613.75 "	"$4,154.18"	$0.00	"$4,491.00"	"$2,526.19"	"$2,526.19"	$0.00	$0.00	$0.00	"$1,170.05"	"$4,166.53"	"$4,166.53"	$0.00	$0.00	"$1,169.91"	$0.00	"$2,767.58"	"$2,767.58"	$0.00	"$2,806.88"	"$4,446.09"	"$4,491.00"	$0.00		$0.00	$878.55	$0.00	$0.00	$893.71	$0.00	$0.00	$0.00	$0.00	$0.00
71701025R	SUP	HCPCS C1713		71701025R  -  NAIL IM 10MM 25CM TRGN FSN TI RT HINDFOOT	BOTH IP/OP	"$5,613.75 "	"$4,154.18"	$0.00	"$4,491.00"	"$2,526.19"	"$2,526.19"	$0.00	$0.00	$0.00	"$1,170.05"	"$4,166.53"	"$4,166.53"	$0.00	$0.00	"$1,169.91"	$0.00	"$2,767.58"	"$2,767.58"	$0.00	"$2,806.88"	"$4,446.09"	"$4,491.00"	$0.00		$0.00	$878.55	$0.00	$0.00	$893.71	$0.00	$0.00	$0.00	$0.00	$0.00
71701116R	SUP	HCPCS C1713		71701116R  -  NAIL INTRAMEDULLARY 11.5MM 16CM FUSION TRIGEN RIGHT HINDFOOT	BOTH IP/OP	"$5,613.75 "	"$4,154.18"	$0.00	"$4,491.00"	"$2,526.19"	"$2,526.19"	$0.00	$0.00	$0.00	"$1,170.05"	"$4,166.53"	"$4,166.53"	$0.00	$0.00	"$1,169.91"	$0.00	"$2,767.58"	"$2,767.58"	$0.00	"$2,806.88"	"$4,446.09"	"$4,491.00"	$0.00		$0.00	$878.55	$0.00	$0.00	$893.71	$0.00	$0.00	$0.00	$0.00	$0.00
71701120L	SUP	HCPCS C1713		71701120L  -  NAIL INTRAMEDULLARY 11.5MM 20CM FUSION TRIGEN TITANIUM LEFT	BOTH IP/OP	"$5,613.75 "	"$4,154.18"	$0.00	"$4,491.00"	"$2,526.19"	"$2,526.19"	$0.00	$0.00	$0.00	"$1,170.05"	"$4,166.53"	"$4,166.53"	$0.00	$0.00	"$1,169.91"	$0.00	"$2,767.58"	"$2,767.58"	$0.00	"$2,806.88"	"$4,446.09"	"$4,491.00"	$0.00		$0.00	$878.55	$0.00	$0.00	$893.71	$0.00	$0.00	$0.00	$0.00	$0.00
71701120R	SUP	HCPCS C1713		71701120R  -  NAIL INTRAMEDULLARY 11.5MM 20CM FUSION TRIGEN TITANIUM RIGHT	BOTH IP/OP	"$5,613.75 "	"$4,154.18"	$0.00	"$4,491.00"	"$2,526.19"	"$2,526.19"	$0.00	$0.00	$0.00	"$1,170.05"	"$4,166.53"	"$4,166.53"	$0.00	$0.00	"$1,169.91"	$0.00	"$2,767.58"	"$2,767.58"	$0.00	"$2,806.88"	"$4,446.09"	"$4,491.00"	$0.00		$0.00	$878.55	$0.00	$0.00	$893.71	$0.00	$0.00	$0.00	$0.00	$0.00
71701125L	SUP	HCPCS C1713		71701125L  -  NAIL IM 11.5MM 25CM TRGN TI HINDFOOT LT	BOTH IP/OP	"$5,613.75 "	"$4,154.18"	$0.00	"$4,491.00"	"$2,526.19"	"$2,526.19"	$0.00	$0.00	$0.00	"$1,170.05"	"$4,166.53"	"$4,166.53"	$0.00	$0.00	"$1,169.91"	$0.00	"$2,767.58"	"$2,767.58"	$0.00	"$2,806.88"	"$4,446.09"	"$4,491.00"	$0.00		$0.00	$878.55	$0.00	$0.00	$893.71	$0.00	$0.00	$0.00	$0.00	$0.00
71701125R	SUP	HCPCS C1713		71701125R  -  TRIGIN HINDFOOT FUSION NAIL (R) 11.5x25CM	BOTH IP/OP	"$5,613.75 "	"$4,154.18"	$0.00	"$4,491.00"	"$2,526.19"	"$2,526.19"	$0.00	$0.00	$0.00	"$1,170.05"	"$4,166.53"	"$4,166.53"	$0.00	$0.00	"$1,169.91"	$0.00	"$2,767.58"	"$2,767.58"	$0.00	"$2,806.88"	"$4,446.09"	"$4,491.00"	$0.00		$0.00	$878.55	$0.00	$0.00	$893.71	$0.00	$0.00	$0.00	$0.00	$0.00
7170-20	SUP	Custom 27203010		7170-20  -  KIT PG 20FR MIC PUSH	BOTH IP/OP	$229.50 	$169.83	$0.00	$183.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.33	$170.33	$0.00	$0.00	$47.83	$0.00	$0.00	$0.00	$0.00	$114.75	$181.76	$183.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7170-24	SUP	Custom 27203010		7170-24  -  KIT PG 24FR 12ML STRL LF MC SLK PUSH RADOPQ MED PORT SIL	BOTH IP/OP	$229.50 	$169.83	$0.00	$183.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.33	$170.33	$0.00	$0.00	$47.83	$0.00	$0.00	$0.00	$0.00	$114.75	$181.76	$183.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7170Q/52	SUP	HCPCS C1895		7170Q/52  -  DURATA SJ4 - PASSIVE	BOTH IP/OP	"$10,500.00 "	"$7,770.00"	$0.00	"$8,400.00"	"$4,725.00"	"$4,725.00"	$0.00	$0.00	$0.00	"$2,188.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,188.20"	$0.00	"$5,176.50"	"$5,176.50"	$0.00	"$5,250.00"	"$8,316.00"	"$8,400.00"	$0.00		$0.00	"$1,643.25"	$0.00	$0.00	"$1,671.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7170Q/58	SUP	HCPCS C1895		7170Q/58  -  LEAD PACING 7FR 58CM 17CM TRUE BIPOL ACTIVE FIX 2 COIL	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7170Q/65	SUP	HCPCS C1895		7170Q/65  -  LEAD DFBR 17CM 65CM DURATA TINE FX 2 COIL DF4 CNCT TRUE BP	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
71711V	SUP	Custom 27203010		71711V  -  CLIP INTNL REMOVER LARGE - XLARGE  STRAIGHT 11INźź	BOTH IP/OP	$412.48 	$305.24	$0.00	$329.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.14	$306.14	$0.00	$0.00	$85.96	$0.00	$0.00	$0.00	$0.00	$206.24	$326.68	$329.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71712V	SUP	Custom 27203010		71712V  -  APPLIER XLARGE  CURVED 11INźź	BOTH IP/OP	$378.73 	$280.26	$0.00	$302.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.09	$281.09	$0.00	$0.00	$78.93	$0.00	$0.00	$0.00	$0.00	$189.36	$299.95	$302.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71717V	SUP	Custom 27203010		71717V  -  APPLIER XLARGE  70 DEGREE 11INźź	BOTH IP/OP	$378.73 	$280.26	$0.00	$302.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.09	$281.09	$0.00	$0.00	$78.93	$0.00	$0.00	$0.00	$0.00	$189.36	$299.95	$302.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7171Q/52	SUP	HCPCS C1895		7171Q/52  -  DURATA SJ4 - PASSIVE	BOTH IP/OP	"$10,500.00 "	"$7,770.00"	$0.00	"$8,400.00"	"$4,725.00"	"$4,725.00"	$0.00	$0.00	$0.00	"$2,188.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,188.20"	$0.00	"$5,176.50"	"$5,176.50"	$0.00	"$5,250.00"	"$8,316.00"	"$8,400.00"	$0.00		$0.00	"$1,643.25"	$0.00	$0.00	"$1,671.60"	$0.00	$0.00	$0.00	$0.00	$0.00
7171Q/58	SUP	HCPCS C1895		7171Q/58  -  LEAD DFBR 7FR 58CM 21CM DURATA 2 COIL DF4 CNCT TRUE BP ACTFX	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7171Q/65	SUP	HCPCS C1895		7171Q/65  -  LEAD DFBR 65CM DURATA 2 COIL TRUE BP TINE FX DF4 CNCT OPTIM	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
7180025A	SUP	HCPCS C1713		7180025A  -  END CAP SPNL 18MM 20-25MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7180027A	SUP	HCPCS C1713		7180027A  -  END CAP SPNL 18MM 21-27MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7180033A	SUP	HCPCS C1713		7180033A  -  END CAP SPNL 18MM 24-33MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7180041A	SUP	HCPCS C1713		7180041A  -  END CAP SPNL 18MM 28-41MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7180055A	SUP	HCPCS C1713		7180055A  -  END CAP SPNL 18MM 35-55MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7180067A	SUP	HCPCS C1713		7180067A  -  END CAP SPNL 18MM 41-67MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7180079A	SUP	HCPCS C1713		7180079A  -  END CAP SPNL 18MM 47-79MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7180-20	SUP	Custom 27203010		7180-20  -  KIT PG 20FR 4X4IN 12ML STRL LF SECUR-LOK MIC SPNG FDTB XTRN	BOTH IP/OP	$231.75 	$171.50	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.00	$172.00	$0.00	$0.00	$48.30	$0.00	$0.00	$0.00	$0.00	$156.30	$247.58	$250.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7180-24	SUP	Custom 27203010		7180-24  -  KIT PG 24FR 12ML STRL LF MC SLK PUL RADOPQ MED PORT SIL DISP	BOTH IP/OP	$231.75 	$171.50	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.00	$172.00	$0.00	$0.00	$48.30	$0.00	$0.00	$0.00	$0.00	$156.30	$247.58	$250.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71A003	SUP	Custom 27804086		71A003  -  GRAFT BONE SMALL 40-65MM CORTICAL SEGMENT	BOTH IP/OP	"$1,617.50 "	"$1,196.95"	$0.00	"$1,294.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,200.51"	"$1,200.51"	$0.00	$0.00	$337.09	$0.00	$0.00	$0.00	$0.00	$808.75	"$1,281.06"	"$1,294.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71A004	SUP	Custom 27804086		71A004  -  GRAFT BONE LARGE 66-99MM CORTICAL SEGMENT	BOTH IP/OP	"$1,707.50 "	"$1,263.55"	$0.00	"$1,366.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,267.31"	"$1,267.31"	$0.00	$0.00	$355.84	$0.00	$0.00	$0.00	$0.00	$853.75	"$1,352.34"	"$1,366.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
720088-01	SUP	HCPCS C1771		720088-01  -  SLING UROLOGICAL ADVANCE MALE	BOTH IP/OP	"$14,150.00 "	"$10,471.00"	$0.00	"$11,320.00"	"$6,367.50"	"$6,367.50"	$0.00	$0.00	$0.00	"$2,949.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,948.86"	$0.00	"$6,975.95"	"$6,975.95"	$0.00	"$7,075.00"	"$11,206.80"	"$11,320.00"	$0.00		$0.00	"$2,214.48"	$0.00	$0.00	"$2,252.68"	$0.00	$0.00	$0.00	$0.00	$0.00
720185-01	SUP	HCPCS C1813		720185-01  -  PROSTHESIS PENILE PRECONNECT INFLATABLE RESERVOIR AMS 700 MS	BOTH IP/OP	"$4,672.50 "	"$3,457.65"	$0.00	"$3,738.00"	"$2,102.63"	"$2,102.63"	$0.00	$0.00	$0.00	$0.00	"$3,467.93"	"$3,467.93"	$0.00	$0.00	$973.75	$0.00	$0.00	$0.00	$0.00	"$2,336.25"	"$3,700.62"	"$3,738.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$743.86	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0308	SUP	Custom 27803010		72-12-0308  -  INSERT TIBIAL 3 8MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0310	SUP	Custom 27803010		72-12-0310  -  INSERT TIBIAL 3 10MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0312	SUP	Custom 27803010		72-12-0312  -  INSERT TIBIAL 3 12MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0315	SUP	Custom 27803010		72-12-0315  -  INSERT TIBIAL 3 15MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0318	SUP	Custom 27803010		72-12-0318  -  INSERT TIBIAL 3 18MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0321	SUP	Custom 27803010		72-12-0321  -  INSERT TIBIAL 3 21MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0324	SUP	Custom 27803010		72-12-0324  -  INSERT TIBIAL 3 24MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0508	SUP	Custom 27803010		72-12-0508  -  INSERT TIBIAL 5 8MM CRUC RET SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0510	SUP	Custom 27803010		72-12-0510  -  INSERT TIBIAL 5 10MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0512	SUP	Custom 27803010		72-12-0512  -  INSERT TIBIAL 5 12MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0515	SUP	Custom 27803010		72-12-0515  -  INSERT TIBIAL 5 15MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0518	SUP	Custom 27803010		72-12-0518  -  INSERT TIBIAL 5 18MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0521	SUP	Custom 27803010		72-12-0521  -  INSERT TIBIAL 5 21MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0524	SUP	Custom 27803010		72-12-0524  -  INSERT TIBIAL 5 24MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0708	SUP	Custom 27803010		72-12-0708  -  INSERT TIBIAL 7 8MM CRUC RET SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0710	SUP	Custom 27803010		72-12-0710  -  INSERT TIBIAL 7 10MM CRUC RET SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0712	SUP	Custom 27803010		72-12-0712  -  INSERT TIBIAL 7 12MM CRUC RET SCORPIO N2/VAC KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0715	SUP	Custom 27803010		72-12-0715  -  INSERT TIBIAL 7 15MM CRUC RET SCORPIO N2/VAC KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0718	SUP	Custom 27803010		72-12-0718  -  INSERT TIBIAL 7 18MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0721	SUP	Custom 27803010		72-12-0721  -  INSERT TIBIAL 7 21MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0724	SUP	Custom 27803010		72-12-0724  -  INSERT TIBIAL 7 24MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0908	SUP	Custom 27803010		72-12-0908  -  INSERT TIBIAL 9 8MM CRUC RET SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0910	SUP	Custom 27803010		72-12-0910  -  INSERT TIBIAL 9 10MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0912	SUP	Custom 27803010		72-12-0912  -  INSERT TIBIAL 9 12MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0915	SUP	Custom 27803010		72-12-0915  -  INSERT TIBIAL 9 15MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0918	SUP	Custom 27803010		72-12-0918  -  INSERT TIBIAL 9 18MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0921	SUP	Custom 27803010		72-12-0921  -  INSERT TIBIAL 9 21MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-0924	SUP	Custom 27803010		72-12-0924  -  INSERT TIBIAL 9 24MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-1108	SUP	Custom 27803010		72-12-1108  -  INSERT TIBIAL 11 8MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-1110	SUP	Custom 27803010		72-12-1110  -  INSERT TIBIAL 11 10MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-1112	SUP	Custom 27803010		72-12-1112  -  INSERT TIBIAL 11 12MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-1115	SUP	Custom 27803010		72-12-1115  -  INSERT TIBIAL 11 15MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-1118	SUP	Custom 27803010		72-12-1118  -  INSERT TIBIAL 11 18MM CRUC RET SCORPIO POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-1121	SUP	Custom 27803010		72-12-1121  -  INSERT TIBIAL 11 21MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-12-1124	SUP	Custom 27803010		72-12-1124  -  INSERT TIBIAL 11 24MM CRUC RET HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0308	SUP	Custom 27803010		72-13-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZED HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0310	SUP	Custom 27803010		72-13-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0312	SUP	Custom 27803010		72-13-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0315	SUP	Custom 27803010		72-13-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0318	SUP	Custom 27803010		72-13-0318  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0321	SUP	Custom 27803010		72-13-0321  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0324	SUP	Custom 27803010		72-13-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0508	SUP	Custom 27803010		72-13-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZED HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0510	SUP	Custom 27803010		72-13-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0512	SUP	Custom 27803010		72-13-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0515	SUP	Custom 27803010		72-13-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0518	SUP	Custom 27803010		72-13-0518  -  INSERT TIBIAL 5 18MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0521	SUP	Custom 27803010		72-13-0521  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0524	SUP	Custom 27803010		72-13-0524  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0708	SUP	Custom 27803010		72-13-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0710	SUP	Custom 27803010		72-13-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0712	SUP	Custom 27803010		72-13-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZE SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0715	SUP	Custom 27803010		72-13-0715  -  INSERT TIBIAL POSTERIOR STABILIZE SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0718	SUP	Custom 27803010		72-13-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0721	SUP	Custom 27803010		72-13-0721  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0724	SUP	Custom 27803010		72-13-0724  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0908	SUP	Custom 27803010		72-13-0908  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0910	SUP	Custom 27803010		72-13-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0912	SUP	Custom 27803010		72-13-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0915	SUP	Custom 27803010		72-13-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0918	SUP	Custom 27803010		72-13-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0921	SUP	Custom 27803010		72-13-0921  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-0924	SUP	Custom 27803010		72-13-0924  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-1108	SUP	Custom 27803010		72-13-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-1110	SUP	Custom 27803010		72-13-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-1112	SUP	Custom 27803010		72-13-1112  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-1115	SUP	Custom 27803010		72-13-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-1118	SUP	Custom 27803010		72-13-1118  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-1121	SUP	Custom 27803010		72-13-1121  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-13-1124	SUP	Custom 27803010		72-13-1124  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0308	SUP	Custom 27803010		72-15-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0310	SUP	Custom 27803010		72-15-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0312	SUP	Custom 27803010		72-15-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0315	SUP	Custom 27803010		72-15-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0318	SUP	Custom 27803010		72-15-0318  -  INSERT TIBIAL 3 18MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0321	SUP	Custom 27803010		72-15-0321  -  INSERT TIBIAL 3 21MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0324	SUP	Custom 27803010		72-15-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0508	SUP	Custom 27803010		72-15-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0510	SUP	Custom 27803010		72-15-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0512	SUP	Custom 27803010		72-15-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZED HYPREX SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0515	SUP	Custom 27803010		72-15-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0518	SUP	Custom 27803010		72-15-0518  -  INSERT TIBIAL 5 18MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0521	SUP	Custom 27803010		72-15-0521  -  INSERT TIBIAL 5 21MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0524	SUP	Custom 27803010		72-15-0524  -  INSERT TIBIAL 5 24MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0708	SUP	Custom 27803010		72-15-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0710	SUP	Custom 27803010		72-15-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0712	SUP	Custom 27803010		72-15-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0715	SUP	Custom 27803010		72-15-0715  -  INSERT TIBIAL 7 15MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0718	SUP	Custom 27803010		72-15-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0721	SUP	Custom 27803010		72-15-0721  -  INSERT TIBIAL POSTERIOR STABILIZED HYPER EXTN SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0724	SUP	Custom 27803010		72-15-0724  -  INSERT TIBIAL 7 24MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0908	SUP	Custom 27803010		72-15-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0910	SUP	Custom 27803010		72-15-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0912	SUP	Custom 27803010		72-15-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0915	SUP	Custom 27803010		72-15-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0918	SUP	Custom 27803010		72-15-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0921	SUP	Custom 27803010		72-15-0921  -  INSERT TIBIAL 9 21MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-0924	SUP	Custom 27803010		72-15-0924  -  INSERT TIBIAL 9 24MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-1108	SUP	Custom 27803010		72-15-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-1110	SUP	Custom 27803010		72-15-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-1112	SUP	Custom 27803010		72-15-1112  -  INSERT TIBIAL 11 12MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-1115	SUP	Custom 27803010		72-15-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-1118	SUP	Custom 27803010		72-15-1118  -  INSERT TIBIAL 11 18MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-1121	SUP	Custom 27803010		72-15-1121  -  INSERT TIBIAL 11 21MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-15-1124	SUP	Custom 27803010		72-15-1124  -  INSERT TIBIAL 11 24MM POSTERIOR STABILIZED HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0308	SUP	Custom 27803010		72-16-0308  -  INSERT TIBIAL CRUC RET HYPER EXTN SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0310	SUP	Custom 27803010		72-16-0310  -  INSERT TIBIAL CRUC RET HYPER EXTN SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0312	SUP	Custom 27803010		72-16-0312  -  INSERT TIBIAL CRUC RET HYPER EXTN SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0315	SUP	Custom 27803010		72-16-0315  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0318	SUP	Custom 27803010		72-16-0318  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0321	SUP	Custom 27803010		72-16-0321  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0324	SUP	Custom 27803010		72-16-0324  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0508	SUP	Custom 27803010		72-16-0508  -  INSERT TIBIAL 5 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0510	SUP	Custom 27803010		72-16-0510  -  INSERT TIBIAL 5 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0512	SUP	Custom 27803010		72-16-0512  -  INSERT TIBIAL 5 12MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0515	SUP	Custom 27803010		72-16-0515  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0518	SUP	Custom 27803010		72-16-0518  -  INSERT TIBIAL 5 18MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0521	SUP	Custom 27803010		72-16-0521  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0524	SUP	Custom 27803010		72-16-0524  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0708	SUP	Custom 27803010		72-16-0708  -  INSERT TIBIAL 7 8MM CRUC RET SCORPIO KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0710	SUP	Custom 27803010		72-16-0710  -  INSERT TIBIAL 7 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0712	SUP	Custom 27803010		72-16-0712  -  INSERT TIBIAL 7 12MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0715	SUP	Custom 27803010		72-16-0715  -  INSERT TIBIAL 7 15MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0718	SUP	Custom 27803010		72-16-0718  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0721	SUP	Custom 27803010		72-16-0721  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0724	SUP	Custom 27803010		72-16-0724  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0908	SUP	Custom 27803010		72-16-0908  -  INSERT TIBIAL 9 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0910	SUP	Custom 27803010		72-16-0910  -  INSERT TIBIAL 9 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0912	SUP	Custom 27803010		72-16-0912  -  INSERT TIBIAL 9 12MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0915	SUP	Custom 27803010		72-16-0915  -  INSERT TIBIAL 9 15MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0918	SUP	Custom 27803010		72-16-0918  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0921	SUP	Custom 27803010		72-16-0921  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0924	SUP	Custom 27803010		72-16-0924  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-0924300	SUP	Custom 27803010		72-16-0924300  -  INSERT TIB CRUC RET HPR EXTN SCRPFLX	BOTH IP/OP	"$2,013.00 "	"$1,489.62"	$0.00	"$1,610.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,494.05"	"$1,494.05"	$0.00	$0.00	$419.51	$0.00	$0.00	$0.00	$0.00	"$1,006.50"	"$1,594.30"	"$1,610.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-1108	SUP	Custom 27803010		72-16-1108  -  INSERT TIBIAL 11 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-1110	SUP	Custom 27803010		72-16-1110  -  INSERT TIBIAL 11 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-1112	SUP	Custom 27803010		72-16-1112  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-1115	SUP	Custom 27803010		72-16-1115  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-1118	SUP	Custom 27803010		72-16-1118  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-1121	SUP	Custom 27803010		72-16-1121  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-16-1124	SUP	Custom 27803010		72-16-1124  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7220025A	SUP	HCPCS C1713		7220025A  -  END CAP SPNL 22MM 20-25MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7220027A	SUP	HCPCS C1713		7220027A  -  END CAP SPNL 22MM 21-27MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7220033A	SUP	HCPCS C1713		7220033A  -  END CAP SPNL 22MM 24-33MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7220041A	SUP	HCPCS C1713		7220041A  -  END CAP SPNL 22MM 28-41MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7220055A	SUP	HCPCS C1713		7220055A  -  END CAP SPNL 22MM 35-55MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7220067A	SUP	HCPCS C1713		7220067A  -  END CAP SPNL 22MM 41-67MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7220079A	SUP	HCPCS C1713		7220079A  -  END CAP SPNL 22MM 47-79MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
7220121A	SUP	HCPCS C1713		7220121A  -  END CAP SPNL 22MM 68-121MM NS X-COR 2 ATLCK TI	BOTH IP/OP	"$13,962.50 "	"$10,332.25"	$0.00	"$11,170.00"	"$6,283.13"	"$6,283.13"	$0.00	$0.00	$0.00	"$2,910.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,909.79"	$0.00	"$6,883.51"	"$6,883.51"	$0.00	"$6,981.25"	"$11,058.30"	"$11,170.00"	$0.00		$0.00	"$2,185.13"	$0.00	$0.00	"$2,222.83"	$0.00	$0.00	$0.00	$0.00	$0.00
72-2049	SUP	Custom 27203010		72-2049  -  DRILL SURG 1.5MM 5MM STOP HIGH SPEED MANDIB IQ	BOTH IP/OP	$615.00 	$455.10	$0.00	$492.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$456.45	$456.45	$0.00	$0.00	$128.17	$0.00	$0.00	$0.00	$0.00	$307.50	$487.08	$492.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-2055	SUP	Custom 27203010		72-2055  -  DRILL SURG 1.5MM 22MM STOP MANDIB	BOTH IP/OP	$615.00 	$455.10	$0.00	$492.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$456.45	$456.45	$0.00	$0.00	$128.17	$0.00	$0.00	$0.00	$0.00	$307.50	$487.08	$492.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0308	SUP	Custom 27803010		72-25-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0310	SUP	Custom 27803010		72-25-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0312	SUP	HCPCS C1776		72-25-0312  -  INSERT TIB 3 12MM SCRPFLX POST STAB PE KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0315	SUP	HCPCS C1776		72-25-0315  -  INSERT TIB 3 15MM SCRPFLX POST STAB X3 KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0318	SUP	HCPCS C1776		72-25-0318  -  INSERT TIB 3 18MM SCRPFLX POST STAB X3 KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0321	SUP	HCPCS C1776		72-25-0321  -  INSERT TIB 3 21MM SCRPFLX POST STAB X3 KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0324	SUP	HCPCS C1776		72-25-0324  -  INSERT TIB 3 24MM SCRPFLX POST STAB X3 KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0508	SUP	Custom 27803010		72-25-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0510	SUP	Custom 27803010		72-25-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0512	SUP	Custom 27803010		72-25-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0515	SUP	Custom 27803010		72-25-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0518	SUP	HCPCS C1776		72-25-0518  -  INSERT TIB SCRPFLX POST STAB X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0521	SUP	Custom 27803010		72-25-0521  -  INSERT TIB 5 21MM SCRP SFLX POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0524	SUP	Custom 27803010		72-25-0524  -  INSERT TIB 5 24MM SCRPFLX POST STAB X3 ARTC KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0708	SUP	Custom 27803010		72-25-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0710	SUP	Custom 27803010		72-25-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0712	SUP	Custom 27803010		72-25-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0715	SUP	Custom 27803010		72-25-0715  -  INSERT TIBIAL 7 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0718	SUP	Custom 27803010		72-25-0718  -  INSERT TIBIAL POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0721	SUP	Custom 27803010		72-25-0721  -  INSERT TIB 7 21MM SCRP SFLX POST STAB KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0724	SUP	Custom 27803010		72-25-0724  -  INSERT TIB 7 24MM SCRPFLX POST STAB X3 KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0908	SUP	Custom 27803010		72-25-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZE SCRPFLX X3 RIGHT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0910	SUP	Custom 27803010		72-25-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0912	SUP	Custom 27803010		72-25-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0915	SUP	Custom 27803010		72-25-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0918	SUP	Custom 27803010		72-25-0918  -  INSERT TIB 9 18MM SCRPFLX POST STAB X3 ARTC	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0921	SUP	Custom 27803010		72-25-0921  -  INSERT TIB 9 21MM SCRPFLX POST STAB X3 ARTC KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-0924	SUP	Custom 27803010		72-25-0924  -  INSERT TIB 9 24MM STRL SCRPFLX POST STAB X3 KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-1108	SUP	Custom 27803010		72-25-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZE SCORPIO SUPERFLEX	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-1110	SUP	Custom 27803010		72-25-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-1112	SUP	Custom 27803010		72-25-1112  -  INSERT TIBIAL 11 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-1115	SUP	Custom 27803010		72-25-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-1118	SUP	Custom 27803010		72-25-1118  -  INSERT TIBIAL 11 18MM POSTERIOR STABILIZE SCRPFLX	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-1121	SUP	Custom 27803010		72-25-1121  -  INSERT TIBIAL 11 21MM POSTERIOR STABILIZE SCRPFLX X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-25-1124	SUP	Custom 27803010		72-25-1124  -  INSERT TIBIAL 11 24MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0308	SUP	Custom 27803010		72-26-0308  -  INSERT TIBIAL 3 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0310	SUP	Custom 27803010		72-26-0310  -  INSERT TIBIAL 3 10MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0312	SUP	Custom 27803010		72-26-0312  -  INSERT TIBIAL 3 12MM CRUC RET SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0315	SUP	Custom 27803010		72-26-0315  -  INSERT TIBIAL 3 15MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0318	SUP	Custom 27803010		72-26-0318  -  INSERT TIBIAL 3 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0321	SUP	Custom 27803010		72-26-0321  -  INSERT TIBIAL 3 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0324	SUP	Custom 27803010		72-26-0324  -  INSERT TIBIAL 3 24MM CRUC RET SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0508	SUP	Custom 27803010		72-26-0508  -  INSERT TIBIAL 5 8MM CRUC RET POSTERIOR STABILIZED SCRPFLX X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0510	SUP	Custom 27803010		72-26-0510  -  INSERT TIBIAL 5 10MM CRUC RET SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0512	SUP	Custom 27803010		72-26-0512  -  INSERT TIBIAL 5 12MM CRUC RET SCRPFLX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0515	SUP	Custom 27803010		72-26-0515  -  INSERT TIB 5 15MM STRL SCRPFLX CR X3 KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0518	SUP	Custom 27803010		72-26-0518  -  INSERT TIBIAL 5 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0521	SUP	Custom 27803010		72-26-0521  -  INSERT TIBIAL CRUC RET SCORPIO SUPERFLEX	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0524	SUP	Custom 27803010		72-26-0524  -  INSERT TIBIAL CRUC RET SCORPIO SUPERFLEX	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0708	SUP	Custom 27803010		72-26-0708  -  INSERT TIBIAL 7 8MM CRUC RET POSTERIOR STABILIZED SCRPFLX X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0710	SUP	Custom 27803010		72-26-0710  -  INSERT TIBIAL 7 10MM CRUC RET POSTERIOR STABILIZED SCRPFLX	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0712	SUP	Custom 27803010		72-26-0712  -  INSERT TIBIAL 7 12MM CRUC RET POSTERIOR STABILIZED SCRPFLX	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0715	SUP	Custom 27803010		72-26-0715  -  INSERT TIBIAL 7 15MM CRUC RET SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0718	SUP	Custom 27803010		72-26-0718  -  INSERT TIBIAL CRUC RET SCORPIO SUPERFLEX	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0721	SUP	Custom 27803010		72-26-0721  -  INSERT TIBIAL 7 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0724	SUP	Custom 27803010		72-26-0724  -  INSERT TIBIAL 7 24MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0908	SUP	Custom 27803010		72-26-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0910	SUP	Custom 27803010		72-26-0910  -  INSERT TIBIAL 9 10MM CRUC RET SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0912	SUP	Custom 27803010		72-26-0912  -  INSERT TIBIAL 9 12MM CRUC RET SCORPIO SUPERFLEX POLYETHYLENE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0915	SUP	Custom 27803010		72-26-0915  -  INSERT TIBIAL 9 15MM CRUC RET SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0918	SUP	Custom 27803010		72-26-0918  -  INSERT TIBIAL 9 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0921	SUP	Custom 27803010		72-26-0921  -  INSERT TIBIAL 9 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-0924	SUP	Custom 27803010		72-26-0924  -  INSERT TIBIAL 9 24MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-1108	SUP	Custom 27803010		72-26-1108  -  INSERT TIBIAL 11 8MM CRUC RET SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-1110	SUP	Custom 27803010		72-26-1110  -  INSERT TIB 11 10MM SCRP SFLX CRCTE RTN KN	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-1112	SUP	Custom 27803010		72-26-1112  -  INSERT TIBIAL 11 12MM CRUC RET SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-1115	SUP	Custom 27803010		72-26-1115  -  INSERT TIBIAL CRUC RET SCRPFLX	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-1118	SUP	Custom 27803010		72-26-1118  -  INSERT TIBIAL 11 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-1121	SUP	Custom 27803010		72-26-1121  -  INSERT TIBIAL 11 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-26-1124	SUP	Custom 27803010		72-26-1124  -  INSERT TIBIAL 11 24MM CRUC RET SCORPIO SUPERFLEX KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72402408N	SUP	HCPCS C1713		72402408N  -  SCREW BONE 2.4MM 3.8MM 8MM EVOS MINI SS CORT ST T7	BOTH IP/OP	$118.75 	$87.88	$0.00	$95.00	$53.44	$53.44	$0.00	$0.00	$0.00	$24.75	$88.14	$88.14	$0.00	$0.00	$24.75	$0.00	$70.24	$70.24	$0.00	$59.38	$94.05	$95.00	$0.00		$0.00	$18.58	$0.00	$0.00	$18.91	$0.00	$0.00	$0.00	$0.00	$0.00
72402409N	SUP	HCPCS C1713		72402409N  -  SCREW BONE 2.4MM 3.8MM 9MM EVOS MINI SS CORT ST T7	BOTH IP/OP	$118.75 	$87.88	$0.00	$95.00	$53.44	$53.44	$0.00	$0.00	$0.00	$24.75	$88.14	$88.14	$0.00	$0.00	$24.75	$0.00	$70.24	$70.24	$0.00	$59.38	$94.05	$95.00	$0.00		$0.00	$18.58	$0.00	$0.00	$18.91	$0.00	$0.00	$0.00	$0.00	$0.00
72402410N	SUP	HCPCS C1713		72402410N  -  SCREW BONE 2.4MM 3.8MM 10MM EVOS MINI SS CORTEX T7	BOTH IP/OP	$118.75 	$87.88	$0.00	$95.00	$53.44	$53.44	$0.00	$0.00	$0.00	$24.75	$88.14	$88.14	$0.00	$0.00	$24.75	$0.00	$70.24	$70.24	$0.00	$59.38	$94.05	$95.00	$0.00		$0.00	$18.58	$0.00	$0.00	$18.91	$0.00	$0.00	$0.00	$0.00	$0.00
72402420N	SUP	HCPCS C1713		72402420N  -  SCREW BONE 2.4MM 3.8MM 20MM EVOS SS 1.6MM SM BONE	BOTH IP/OP	$118.75 	$87.88	$0.00	$95.00	$53.44	$53.44	$0.00	$0.00	$0.00	$24.75	$88.14	$88.14	$0.00	$0.00	$24.75	$0.00	$70.24	$70.24	$0.00	$59.38	$94.05	$95.00	$0.00		$0.00	$18.58	$0.00	$0.00	$18.91	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0310	SUP	Custom 27203010		72-4-0310  -  TRIAL SURG 3 10MM INSERT TOT STABILITY CONSTRAINED SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	$0.00	$0.00	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0312	SUP	Custom 27203010		72-4-0312  -  TRIAL SURG 3 12MM INSERT TOT STABILITY CONSTRAINED SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	$0.00	$0.00	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0314	SUP	Custom 27203010		72-4-0314  -  TRIAL SURG 3 14MM INSERT TOT STABILITY CONSTRAINED SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	$0.00	$0.00	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0316	SUP	Custom 27203010		72-4-0316  -  TRIAL SURG 3 16MM INSERT TOT STABILITY CONSTRAINED SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	$0.00	$0.00	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0318	SUP	Custom 27203010		72-4-0318  -  INSERT TIBIAL 3 18MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	$0.00	$0.00	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0321	SUP	Custom 27203010		72-4-0321  -  TRIAL SURG 3 21MM INSERT TOT STABILITY CONSTRAINED SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	$0.00	$0.00	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0324	SUP	HCPCS C1776		72-4-0324  -  INSERT TIBIAL 3 24MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0510	SUP	Custom 27203010		72-4-0510  -  TRIAL SURG 5 10MM INSERT TOT STABILITY CONSTRAINED SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	$0.00	$0.00	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0512	SUP	Custom 27203010		72-4-0512  -  INSERT TIBIAL 5 12MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	$0.00	$0.00	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0514	SUP	HCPCS C1776		72-4-0514  -  INSERT TIBIAL 5 14MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0516	SUP	HCPCS C1776		72-4-0516  -  INSERT TIBIAL 5 16MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0518	SUP	HCPCS C1776		72-4-0518  -  INSERT TIBIAL 5 18MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0521	SUP	HCPCS C1776		72-4-0521  -  INSERT TIBIAL 5 21MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0524	SUP	Custom 27203010		72-4-0524  -  TRIAL SURG 5 24MM INSERT TOT STABILITY CONSTRAINED SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	$0.00	$0.00	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0710	SUP	HCPCS C1776		72-4-0710  -  INSERT TIBIAL 7 10MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0712	SUP	HCPCS C1776		72-4-0712  -  INSERT TIBIAL 7 12MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0714	SUP	HCPCS C1776		72-4-0714  -  INSERT TIBIAL 7 14MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0716	SUP	HCPCS C1776		72-4-0716  -  INSERT TIBIAL 7 16MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0718	SUP	HCPCS C1776		72-4-0718  -  INSERT TIBIAL 7 18MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0721	SUP	HCPCS C1776		72-4-0721  -  INSERT TIBIAL 7 21MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0724	SUP	HCPCS C1776		72-4-0724  -  INSERT TIBIAL 7 24MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0910	SUP	Custom 27203010		72-4-0910  -  TRIAL SURG 9 10MM INSERT TOT STABILITY CONSTRAINED SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	$0.00	$0.00	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0912	SUP	HCPCS C1776		72-4-0912  -  INSERT TIBIAL 9 12MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0914	SUP	HCPCS C1776		72-4-0914  -  INSERT TIBIAL 9 14MM CONSTRAINED TOT STABILIZED SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0916	SUP	HCPCS C1776		72-4-0916  -  INSERT TIBIAL 9 16MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0918	SUP	HCPCS C1776		72-4-0918  -  INSERT TIBIAL 9 18MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0921	SUP	HCPCS C1776		72-4-0921  -  INSERT TIBIAL 9 21MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-0924	SUP	Custom 27203010		72-4-0924  -  TRIAL SURG 9 24MM INSERT TOT STABILITY CONSTRAINED SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	$0.00	$0.00	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1110	SUP	HCPCS C1776		72-4-1110  -  INSERT TIBIAL 11 10MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1112	SUP	HCPCS C1776		72-4-1112  -  INSERT TIBIAL 11 12MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1114	SUP	HCPCS C1776		72-4-1114  -  INSERT TIBIAL 11 14MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1116	SUP	HCPCS C1776		72-4-1116  -  INSERT TIBIAL 11 16MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1118	SUP	HCPCS C1776		72-4-1118  -  INSERT TIBIAL 11 18MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1121	SUP	HCPCS C1776		72-4-1121  -  INSERT TIBIAL 11 21MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1124	SUP	HCPCS C1776		72-4-1124  -  INSERT TIBIAL 11 24MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72412410N	SUP	HCPCS C1713		72412410N  -  SCREW BONE 2.4MM 3.8MM 10MM EVOS SS LNG BONE SM	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$172.13	$172.13	$0.00	$0.00	$0.00	$79.72	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$226.25	$226.25	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$59.86	$0.00	$0.00	$60.89	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1910	SUP	HCPCS C1776		72-4-1910  -  INSERT TIBIAL 19 10MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1912	SUP	HCPCS C1776		72-4-1912  -  INSERT TIBIAL 19 12MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1914	SUP	HCPCS C1776		72-4-1914  -  INSERT TIBIAL 19 14MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1916	SUP	HCPCS C1776		72-4-1916  -  INSERT TIBIAL 19 16MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1918	SUP	HCPCS C1776		72-4-1918  -  INSERT TIBIAL 19 18MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1921	SUP	HCPCS C1776		72-4-1921  -  INSERT TIBIAL 19 21MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-1924	SUP	HCPCS C1776		72-4-1924  -  INSERT TIBIAL 19 24MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-5710	SUP	HCPCS C1776		72-4-5710  -  INSERT TIBIAL 7 10MM TOT STABILIZE SCORPIO POLYETHYLENE KNEE	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-5712	SUP	HCPCS C1776		72-4-5712  -  INSERT TIBIAL 7 12MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-5714	SUP	HCPCS C1776		72-4-5714  -  INSERT TIBIAL 7 14MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-5716	SUP	HCPCS C1776		72-4-5716  -  INSERT TIBIAL 7 16MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-5718	SUP	HCPCS C1776		72-4-5718  -  INSERT TIBIAL 7 18MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-5721	SUP	HCPCS C1776		72-4-5721  -  INSERT TIBIAL 7 21MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-5724	SUP	HCPCS C1776		72-4-5724  -  INSERT TIBIAL 7 24MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-7512	SUP	HCPCS C1776		72-4-7512  -  INSERT TIBIAL 7F/5T 12MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-7514	SUP	HCPCS C1776		72-4-7514  -  INSERT TIBIAL 7F/5T 14MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-7516	SUP	HCPCS C1776		72-4-7516  -  INSERT TIBIAL 7F/5T 16MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-7518	SUP	HCPCS C1776		72-4-7518  -  INSERT TIBIAL 7F/5T 18MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-7521	SUP	HCPCS C1776		72-4-7521  -  INSERT TIBIAL 7F/5T 21MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-7524	SUP	HCPCS C1776		72-4-7524  -  INSERT TIBIAL 7F/5T 24MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-9110	SUP	HCPCS C1776		72-4-9110  -  INSERT TIBIAL 9F/11T 10MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-9112	SUP	HCPCS C1776		72-4-9112  -  INSERT TIBIAL 9F/11T 12MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-9114	SUP	HCPCS C1776		72-4-9114  -  INSERT TIBIAL 9F/11T 14MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-9116	SUP	HCPCS C1776		72-4-9116  -  INSERT TIBIAL 9F/11T 16MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-9118	SUP	HCPCS C1776		72-4-9118  -  INSERT TIBIAL 9F/11T 18MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-9121	SUP	HCPCS C1776		72-4-9121  -  INSERT TIBIAL 9F/11T 21MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-4-9124	SUP	HCPCS C1776		72-4-9124  -  INSERT TIBIAL 9F/11T 24MM CONSTRAIN TOT STABILIZE SCORPIO	BOTH IP/OP	"$3,492.50 "	"$2,584.45"	$0.00	"$2,794.00"	"$1,571.63"	"$1,571.63"	$0.00	$0.00	$0.00	$727.92	"$2,592.13"	"$2,592.13"	$0.00	$0.00	$727.84	$0.00	"$1,721.80"	"$1,721.80"	$0.00	"$1,746.25"	"$2,766.06"	"$2,794.00"	$0.00		$0.00	$546.58	$0.00	$0.00	$556.01	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0508	SUP	Custom 27803010		72-5-0508  -  INSERT TIB 5 8MM KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0510	SUP	Custom 27803010		72-5-0510  -  INSERT TIB 5 10MM KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0512	SUP	Custom 27803010		72-5-0512  -  INSERT TIB 5 12MM KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0515	SUP	Custom 27803010		72-5-0515  -  INSERT TIB 5 15MM KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0518	SUP	Custom 27803010		72-5-0518  -  INSERT TIB 5 18MM KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0521	SUP	Custom 27803010		72-5-0521  -  INSERT TIB 5 21MM KNEE PS SCRP SFLX	BOTH IP/OP	"$2,013.00 "	"$1,489.62"	$0.00	"$1,610.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,494.05"	"$1,494.05"	$0.00	$0.00	$419.51	$0.00	$0.00	$0.00	$0.00	"$1,006.50"	"$1,594.30"	"$1,610.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0524	SUP	Custom 27803010		72-5-0524  -  INSERT TIB 5 44X66X24MM SCRPFLX 1 AXIS PS PE KN	BOTH IP/OP	"$2,013.00 "	"$1,489.62"	$0.00	"$1,610.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,494.05"	"$1,494.05"	$0.00	$0.00	$419.51	$0.00	$0.00	$0.00	$0.00	"$1,006.50"	"$1,594.30"	"$1,610.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0708	SUP	Custom 27803010		72-5-0708  -  INSERT TIB 7 8MM KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0710	SUP	Custom 27803010		72-5-0710  -  INSERT TIB KNEE PS SCRPFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0712	SUP	Custom 27803010		72-5-0712  -  INSERT TIB 7 12MM KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0715	SUP	Custom 27803010		72-5-0715  -  INSERT TIB 7 15MM KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0718	SUP	Custom 27803010		72-5-0718  -  INSERT TIB 7 18MM KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0721	SUP	Custom 27803010		72-5-0721  -  INSERT TIB 7 21MM SCRP SFLX POST STAB KN	BOTH IP/OP	"$2,013.00 "	"$1,489.62"	$0.00	"$1,610.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,494.05"	"$1,494.05"	$0.00	$0.00	$419.51	$0.00	$0.00	$0.00	$0.00	"$1,006.50"	"$1,594.30"	"$1,610.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0724	SUP	Custom 27803010		72-5-0724  -  INSERT TIB 7 24MM SCRPFLX POST STAB X3 KN	BOTH IP/OP	"$2,013.00 "	"$1,489.62"	$0.00	"$1,610.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,494.05"	"$1,494.05"	$0.00	$0.00	$419.51	$0.00	$0.00	$0.00	$0.00	"$1,006.50"	"$1,594.30"	"$1,610.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0908	SUP	HCPCS C1776		72-5-0908  -  CMPNT TIB 8MM SCRP 9 KNEE PE PS	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$868.50	$868.50	$0.00	$0.00	$0.00	$402.26	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	"$1,141.60"	"$1,141.60"	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$302.05	$0.00	$0.00	$307.26	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0910	SUP	Custom 27803010		72-5-0910  -  INSERT TIB 9 10MM RIGHT KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0912	SUP	Custom 27803010		72-5-0912  -  INSERT TIB 9 12MM KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0915	SUP	Custom 27803010		72-5-0915  -  INSERT TIB 9 15MM KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0918	SUP	Custom 27803010		72-5-0918  -  INSERT TIB 9 18MM SCRP SFLX POST STAB ARTC KN	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0921	SUP	Custom 27803010		72-5-0921  -  INSERT TIB 9 21MM SCRP SFLX POST STAB ARTC KN	BOTH IP/OP	"$2,013.00 "	"$1,489.62"	$0.00	"$1,610.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,494.05"	"$1,494.05"	$0.00	$0.00	$419.51	$0.00	$0.00	$0.00	$0.00	"$1,006.50"	"$1,594.30"	"$1,610.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-0924	SUP	Custom 27803010		72-5-0924  -  INSERT TIB 9 24MM SCRP SFLX POST STAB KN	BOTH IP/OP	"$2,013.00 "	"$1,489.62"	$0.00	"$1,610.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,494.05"	"$1,494.05"	$0.00	$0.00	$419.51	$0.00	$0.00	$0.00	$0.00	"$1,006.50"	"$1,594.30"	"$1,610.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-5-1110	SUP	Custom 27803010		72-5-1110  -  INSERT TIB 11 10MM KNEE PS SCRP SFLX	BOTH IP/OP	"$1,930.00 "	"$1,428.20"	$0.00	"$1,544.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,432.45"	"$1,432.45"	$0.00	$0.00	$402.21	$0.00	$0.00	$0.00	$0.00	$965.00	"$1,528.56"	"$1,544.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-6-0515	SUP	Custom 27803010		72-6-0515  -  INSERT TIB 5 15MM SCRP SFLX CRCTE RTN KN	BOTH IP/OP	"$1,922.00 "	"$1,422.28"	$0.00	"$1,537.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,426.51"	"$1,426.51"	$0.00	$0.00	$400.54	$0.00	$0.00	$0.00	$0.00	$961.00	"$1,522.22"	"$1,537.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-6-0708	SUP	Custom 27803010		72-6-0708  -  INSERT TIB 7 8MM KNEE CRUC RET SCRP SFLX	BOTH IP/OP	"$1,922.00 "	"$1,422.28"	$0.00	"$1,537.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,426.51"	"$1,426.51"	$0.00	$0.00	$400.54	$0.00	$0.00	$0.00	$0.00	$961.00	"$1,522.22"	"$1,537.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-6-0710	SUP	Custom 27803010		72-6-0710  -  INSERT TIB KNEE CRUC RET SCRP SFLX	BOTH IP/OP	"$1,922.00 "	"$1,422.28"	$0.00	"$1,537.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,426.51"	"$1,426.51"	$0.00	$0.00	$400.54	$0.00	$0.00	$0.00	$0.00	$961.00	"$1,522.22"	"$1,537.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-6-0908	SUP	Custom 27803010		72-6-0908  -  INSERT TIB 9 8MM KNEE CRUC RET SCRP SFLX	BOTH IP/OP	"$1,922.00 "	"$1,422.28"	$0.00	"$1,537.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,426.51"	"$1,426.51"	$0.00	$0.00	$400.54	$0.00	$0.00	$0.00	$0.00	$961.00	"$1,522.22"	"$1,537.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72-6-1110	SUP	Custom 27803010		72-6-1110  -  INSERT TIB 11 10MM SCRP SFLX CRCTE RTN KN	BOTH IP/OP	"$1,922.00 "	"$1,422.28"	$0.00	"$1,537.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,426.51"	"$1,426.51"	$0.00	$0.00	$400.54	$0.00	$0.00	$0.00	$0.00	$961.00	"$1,522.22"	"$1,537.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72821012S	SUP	HCPCS C1713		72821012S  -  PLATE BN 20X11MM STRL VLP LT MDL LAT TALUS 2.5MM SCR	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
72821013S	SUP	HCPCS C1713		72821013S  -  PLATE BN 20X11MM STRL VLP RT MDL LAT TALUS 2.5MM SCR	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
72821014S	SUP	HCPCS C1713		72821014S  -  PLATE BN 22X16MM STRL VLP 3 HL L/L TALUS 2.5MM SCR	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
72821015S	SUP	HCPCS C1713		72821015S  -  PLATE BN 22X16MM STRL VLP 3 HL RL TALUS 2.5MM SCR	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
72821016S	SUP	HCPCS C1713		72821016S  -  PLATE BN 25X16MM STRL VLP 4 HL L/L TALUS 2.5MM SCR	BOTH IP/OP	"$2,275.00 "	"$1,683.50"	$0.00	"$1,820.00"	"$1,023.75"	"$1,023.75"	$0.00	$0.00	$0.00	$474.17	"$1,688.51"	"$1,688.51"	$0.00	$0.00	$474.11	$0.00	"$1,345.66"	"$1,345.66"	$0.00	"$1,137.50"	"$1,801.80"	"$1,820.00"	$0.00		$0.00	$356.04	$0.00	$0.00	$362.18	$0.00	$0.00	$0.00	$0.00	$0.00
72821017S	SUP	HCPCS C1713		72821017S  -  PLATE BN 25X16MM STRL VLP 4 HL RL TALUS FT 2.5MM SCR	BOTH IP/OP	"$2,275.00 "	"$1,683.50"	$0.00	"$1,820.00"	"$1,023.75"	"$1,023.75"	$0.00	$0.00	$0.00	$474.17	"$1,688.51"	"$1,688.51"	$0.00	$0.00	$474.11	$0.00	"$1,345.66"	"$1,345.66"	$0.00	"$1,137.50"	"$1,801.80"	"$1,820.00"	$0.00		$0.00	$356.04	$0.00	$0.00	$362.18	$0.00	$0.00	$0.00	$0.00	$0.00
72821018S	SUP	HCPCS C1713		72821018S  -  PLATE BN SM 55MM STRL VLP LT CALCANEUS FT 2.7MM SCR PERC	BOTH IP/OP	"$2,306.25 "	"$1,706.63"	$0.00	"$1,845.00"	"$1,037.81"	"$1,037.81"	$0.00	$0.00	$0.00	$480.68	"$1,711.70"	"$1,711.70"	$0.00	$0.00	$480.62	$0.00	"$1,364.15"	"$1,364.15"	$0.00	"$1,153.13"	"$1,826.55"	"$1,845.00"	$0.00		$0.00	$360.93	$0.00	$0.00	$367.16	$0.00	$0.00	$0.00	$0.00	$0.00
72821019S	SUP	HCPCS C1713		72821019S  -  PLATE BN SM 55MM STRL VLP RT CALCANEUS 2.7MM SCR PERC	BOTH IP/OP	"$2,306.25 "	"$1,706.63"	$0.00	"$1,845.00"	"$1,037.81"	"$1,037.81"	$0.00	$0.00	$0.00	$480.68	"$1,711.70"	"$1,711.70"	$0.00	$0.00	$480.62	$0.00	"$1,364.15"	"$1,364.15"	$0.00	"$1,153.13"	"$1,826.55"	"$1,845.00"	$0.00		$0.00	$360.93	$0.00	$0.00	$367.16	$0.00	$0.00	$0.00	$0.00	$0.00
72821020S	SUP	HCPCS C1713		72821020S  -  PLATE BN LG 62 STRL VLP LT CALCANEUS FT 2.7MM SCR PERC	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	"$1,130.63"	"$1,130.63"	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$393.21	$0.00	$0.00	$399.99	$0.00	$0.00	$0.00	$0.00	$0.00
72821021S	SUP	HCPCS C1713		72821021S  -  PLATE BN LG 62 STRL VLP RT CALCANEUS FT 2.7MM SCR PERC	BOTH IP/OP	"$2,512.50 "	"$1,859.25"	$0.00	"$2,010.00"	"$1,130.63"	"$1,130.63"	$0.00	$0.00	$0.00	$523.67	"$1,864.78"	"$1,864.78"	$0.00	$0.00	$523.61	$0.00	"$1,238.66"	"$1,238.66"	$0.00	"$1,256.25"	"$1,989.90"	"$2,010.00"	$0.00		$0.00	$393.21	$0.00	$0.00	$399.99	$0.00	$0.00	$0.00	$0.00	$0.00
72821022S	SUP	HCPCS C1713		72821022S  -  PLATE BN 67MM STRL 3 HL FSN PRM RT ANT ANKL 3.5MM SCR	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	"$1,068.75"	"$1,068.75"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
72821023S	SUP	HCPCS C1713		72821023S  -  PLATE BN 67MM STRL 3 HL FSN PRM LT ANT ANKL 3.5MM SCR	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	"$1,068.75"	"$1,068.75"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
72821024S	SUP	HCPCS C1713		72821024S  -  PLATE BN 92MM STRL 5 HL FSN PRM RT ANT ANKL 3.5MM SCR	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
72821025S	SUP	HCPCS C1713		72821025S  -  PLATE BN 92MM STRL 5 HL FSN PRM LT ANT ANKL 3.5MM SCR	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
72821026S	SUP	HCPCS C1713		72821026S  -  PLATE BN 79MM STRL 3 HL FSN UTL RT ANKL HINDFOOT 3.5MM SCR	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,060.00"	"$1,158.75"	"$1,158.75"	$0.00	$0.00	$0.00	$536.69	"$1,911.17"	"$1,911.17"	$0.00	$0.00	$536.63	$0.00	"$1,269.48"	"$1,269.48"	$0.00	"$1,287.50"	"$2,039.40"	"$2,060.00"	$0.00		$0.00	$402.99	$0.00	$0.00	$409.94	$0.00	$0.00	$0.00	$0.00	$0.00
72821027S	SUP	HCPCS C1713		72821027S  -  PLATE BN 79MM STRL 3 HL FSN UTL LT ANKL HINDFOOT 3.5MM SCR	BOTH IP/OP	"$2,575.00 "	"$1,905.50"	$0.00	"$2,060.00"	"$1,158.75"	"$1,158.75"	$0.00	$0.00	$0.00	$536.69	"$1,911.17"	"$1,911.17"	$0.00	$0.00	$536.63	$0.00	"$1,269.48"	"$1,269.48"	$0.00	"$1,287.50"	"$2,039.40"	"$2,060.00"	$0.00		$0.00	$402.99	$0.00	$0.00	$409.94	$0.00	$0.00	$0.00	$0.00	$0.00
72821028S	SUP	HCPCS C1713		72821028S  -  PLATE BN 5 FSN UTL RT ANKL HINDFOOT 3.5MM SCR	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
72821029S	SUP	HCPCS C1713		72821029S  -  PLATE BN 79MM STRL 5 HL FSN UTL LT ANKL HINDFOOT 3.5MM SCR	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
72821030S	SUP	HCPCS C1713		72821030S  -  PLATE BN 120MM STRL PRLC FSN RL TIB TALOCALCANEUS ANKL 4.5MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
72821031S	SUP	HCPCS C1713		72821031S  -  PLATE BN 120MM STRL PRLC FSN L/L TIB TALOCALCANEUS ANKL 4.5	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
72821034S	SUP	HCPCS C1713		72821034S  -  PLATE BN 80MMX3.8-5.3MM STRL PRLC FSN RT POST ANKL 3.5MM SCR	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	"$1,068.75"	"$1,068.75"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
72821035S	SUP	HCPCS C1713		72821035S  -  PLATE BN 80MM STRL PRLC FSN LT POST ANKL 3.5MM SCR SM FRAG	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	"$1,068.75"	"$1,068.75"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
72821036S	SUP	HCPCS C1713		72821036S  -  PLATE BONE MEDIUM 58MM VLP LEFT CALCANEUS FT STERILE 2.7MM	BOTH IP/OP	"$2,400.00 "	"$1,776.00"	$0.00	"$1,920.00"	"$1,080.00"	"$1,080.00"	$0.00	$0.00	$0.00	$500.22	"$1,781.28"	"$1,781.28"	$0.00	$0.00	$500.16	$0.00	"$1,419.60"	"$1,419.60"	$0.00	"$1,200.00"	"$1,900.80"	"$1,920.00"	$0.00		$0.00	$375.60	$0.00	$0.00	$382.08	$0.00	$0.00	$0.00	$0.00	$0.00
72821037S	SUP	HCPCS C1713		72821037S  -  PLATE BN MED 58MM STRL VLP RT CALCANEUS FT 2.7MM SCR PERC	BOTH IP/OP	"$2,400.00 "	"$1,776.00"	$0.00	"$1,920.00"	"$1,080.00"	"$1,080.00"	$0.00	$0.00	$0.00	$500.22	"$1,781.28"	"$1,781.28"	$0.00	$0.00	$500.16	$0.00	"$1,419.60"	"$1,419.60"	$0.00	"$1,200.00"	"$1,900.80"	"$1,920.00"	$0.00		$0.00	$375.60	$0.00	$0.00	$382.08	$0.00	$0.00	$0.00	$0.00	$0.00
72821040S	SUP	HCPCS C1713		72821040S  -  PLATE BN 20X17MM STRL VLP LT MDL LAT TALUS TIB 2.5MM SCR	BOTH IP/OP	"$2,275.00 "	"$1,683.50"	$0.00	"$1,820.00"	"$1,023.75"	"$1,023.75"	$0.00	$0.00	$0.00	$474.17	"$1,688.51"	"$1,688.51"	$0.00	$0.00	$474.11	$0.00	"$1,345.66"	"$1,345.66"	$0.00	"$1,137.50"	"$1,801.80"	"$1,820.00"	$0.00		$0.00	$356.04	$0.00	$0.00	$362.18	$0.00	$0.00	$0.00	$0.00	$0.00
72821041S	SUP	HCPCS C1713		72821041S  -  PLATE BN 20X17MM STRL VLP RT DIST MDL TALUS 2.5MM SCR	BOTH IP/OP	"$2,275.00 "	"$1,683.50"	$0.00	"$1,820.00"	"$1,023.75"	"$1,023.75"	$0.00	$0.00	$0.00	$474.17	"$1,688.51"	"$1,688.51"	$0.00	$0.00	$474.11	$0.00	"$1,345.66"	"$1,345.66"	$0.00	"$1,137.50"	"$1,801.80"	"$1,820.00"	$0.00		$0.00	$356.04	$0.00	$0.00	$362.18	$0.00	$0.00	$0.00	$0.00	$0.00
72821042S	SUP	HCPCS C1713		72821042S  -  PLATE BN 67MM STRL PRLC 3 HL FSN PRM CMPR SLOT ANKL RT ANT	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	"$1,068.75"	"$1,068.75"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
72821043S	SUP	HCPCS C1713		72821043S  -  PLATE BN 67MM STRL PRLC 3 HL FSN PRM CMPR SLOT ANKL LT ANT	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	"$1,068.75"	"$1,068.75"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
72821044S	SUP	HCPCS C1713		72821044S  -  PLATE BN 92MM STRL ANCHORAGE 5 HL PRM FSN CMPR RT ANT	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
72821045S	SUP	HCPCS C1713		72821045S  -  PLATE BN 92MM STRL PRLC 5 HL FSN PRM CMPR SLOT ANKL LT 3.5MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
72821046S	SUP	HCPCS C1713		72821046S  -  PLATE BN 5 FSN UTL CMPR RT ANKL HINDFOOT 3.5MM SCR	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
72821047S	SUP	HCPCS C1713		72821047S  -  PLATE BN 104MM STRL PER-LOC 5 HL FSN UTL CMPR SLOT LT	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
72821048S	SUP	HCPCS C1713		72821048S  -  PLATE BN XL 68X33.5X1.27MM STRL VLP VA FT LT CALCANEUS PERC	BOTH IP/OP	"$2,606.25 "	"$1,928.63"	$0.00	"$2,085.00"	"$1,172.81"	"$1,172.81"	$0.00	$0.00	$0.00	$543.21	"$1,934.36"	"$1,934.36"	$0.00	$0.00	$543.14	$0.00	"$1,284.88"	"$1,284.88"	$0.00	"$1,303.13"	"$2,064.15"	"$2,085.00"	$0.00		$0.00	$407.88	$0.00	$0.00	$414.92	$0.00	$0.00	$0.00	$0.00	$0.00
72821049S	SUP	HCPCS C1713		72821049S  -  PLATE BN XL 68MM VLP RT CALCANEUS FT 2.7MM SCR PERC	BOTH IP/OP	"$2,606.25 "	"$1,928.63"	$0.00	"$2,085.00"	"$1,172.81"	"$1,172.81"	$0.00	$0.00	$0.00	$543.21	"$1,934.36"	"$1,934.36"	$0.00	$0.00	$543.14	$0.00	"$1,284.88"	"$1,284.88"	$0.00	"$1,303.13"	"$2,064.15"	"$2,085.00"	$0.00		$0.00	$407.88	$0.00	$0.00	$414.92	$0.00	$0.00	$0.00	$0.00	$0.00
72822206S	SUP	HCPCS C1713		72822206S  -  SCREW BN 2.5MM 6MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822208S	SUP	HCPCS C1713		72822208S  -  SCREW BN 2.5MM 8MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822210S	SUP	HCPCS C1713		72822210S  -  SCREW BN 2.5MM 10MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822212S	SUP	HCPCS C1713		72822212S  -  SCREW BN 2.5MM 12MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822214S	SUP	HCPCS C1713		72822214S  -  SCREW BN 2.5MM 14MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822216S	SUP	HCPCS C1713		72822216S  -  SCREW BN 2.5MM 16MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822218S	SUP	HCPCS C1713		72822218S  -  SCREW BN 2.5MM 18MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822220S	SUP	HCPCS C1713		72822220S  -  SCREW BN 2.5MM 20MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822222S	SUP	HCPCS C1713		72822222S  -  SCREW BN 2.5MM 22MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822224S	SUP	HCPCS C1713		72822224S  -  SCREW BN 2.5MM 24MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822226S	SUP	HCPCS C1713		72822226S  -  SCREW BN 2.5MM 26MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822228S	SUP	HCPCS C1713		72822228S  -  SCREW BN 2.5MM 28MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822230S	SUP	HCPCS C1713		72822230S  -  SCREW BN 2.5MM 30MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822232S	SUP	HCPCS C1713		72822232S  -  SCREW BN 2.5MM 32MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822234S	SUP	HCPCS C1713		72822234S  -  SCREW BN 2.5MM 34MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822236S	SUP	HCPCS C1713		72822236S  -  SCREW BN 2.5MM 36MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822238S	SUP	HCPCS C1713		72822238S  -  SCREW BN 2.5MM 38MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822240S	SUP	HCPCS C1713		72822240S  -  SCREW BN 2.5MM 40MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822245S	SUP	HCPCS C1713		72822245S  -  SCREW BN 2.5MM 45MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72822250S	SUP	HCPCS C1713		72822250S  -  SCREW BN 2.5MM 50MM STRL VLP ST T7 STRDR RCS FT	BOTH IP/OP	$286.25 	$211.83	$0.00	$229.00	$128.81	$128.81	$0.00	$0.00	$0.00	$59.66	$212.45	$212.45	$0.00	$0.00	$59.65	$0.00	$169.32	$169.32	$0.00	$143.13	$226.71	$229.00	$0.00		$0.00	$44.80	$0.00	$0.00	$45.57	$0.00	$0.00	$0.00	$0.00	$0.00
72823003S	SUP	HCPCS C1713		72823003S  -  PLATE BN STRL PRLC VLP 3 HL 1/3 TBLR 3.5 MM SCR	BOTH IP/OP	$505.00 	$373.70	$0.00	$404.00	$227.25	$227.25	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$252.50	$399.96	$404.00	$0.00		$0.00	$79.03	$0.00	$0.00	$80.40	$0.00	$0.00	$0.00	$0.00	$0.00
72823004S	SUP	HCPCS C1713		72823004S  -  PLATE BN 1/3 TBLR STRL PRLC VLP 4 HL 3.5MM SCR	BOTH IP/OP	$505.00 	$373.70	$0.00	$404.00	$227.25	$227.25	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$252.50	$399.96	$404.00	$0.00		$0.00	$79.03	$0.00	$0.00	$80.40	$0.00	$0.00	$0.00	$0.00	$0.00
72823106S	SUP	HCPCS C1713		72823106S  -  SCREW BN ST 2.7MM 6MM STRL VLP LCK CORT FT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823108S	SUP	HCPCS C1713		72823108S  -  SCREW BN ST 2.7MM 8MM STRL VLP ST LCK FT CORT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823110S	SUP	HCPCS C1713		72823110S  -  SCREW BN 5MM 38MM VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823112S	SUP	HCPCS C1713		72823112S  -  SCREW BN 2.7MM 12MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823114S	SUP	HCPCS C1713		72823114S  -  SCREW BN 2.7MM 14MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823116S	SUP	HCPCS C1713		72823116S  -  SCREW BN 2.7MM 16MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823118S	SUP	HCPCS C1713		72823118S  -  SCREW BN 2.7MM 18MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823120S	SUP	HCPCS C1713		72823120S  -  SCREW BN 2.7MM 20MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823122S	SUP	HCPCS C1713		72823122S  -  SCREW BN 2.7MM 22MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823124S	SUP	HCPCS C1713		72823124S  -  SCREW BN 2.7MM 24MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823126S	SUP	HCPCS C1713		72823126S  -  SCREW BN 2.7MM 26MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823128S	SUP	HCPCS C1713		72823128S  -  SCREW BN 2.7MM 28MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823130S	SUP	HCPCS C1713		72823130S  -  SCREW BN 2.7MM 30MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823132S	SUP	HCPCS C1713		72823132S  -  SCREW BN 2.7MM 32MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823134S	SUP	HCPCS C1713		72823134S  -  SCREW BN 2.7MM 34MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823136S	SUP	HCPCS C1713		72823136S  -  SCREW BN 2.7MM 36MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823138S	SUP	HCPCS C1713		72823138S  -  SCREW BN 2.7MM 38MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823140S	SUP	HCPCS C1713		72823140S  -  SCREW BN 2.7MM 40MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823142S	SUP	HCPCS C1713		72823142S  -  SCREW BN 3 FLUT 2.7MM 4.9MM 42MM STRL VLP ST LCK CORT FT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823144S	SUP	HCPCS C1713		72823144S  -  SCREW BN 3 FLUT LOPRFL 2.7MM 4.9MM 44MM STRL VLP ST LCK CORT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823146S	SUP	HCPCS C1713		72823146S  -  SCREW BN 3 FLUT LOPRFL 2.7MM 4.9MM 46MM STRL VLP ST LCK CORT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823148S	SUP	HCPCS C1713		72823148S  -  SCREW BN 3 FLUT LOPRFL 2.7MM 4.9MM 48MM STRL VLP ST LCK CORT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823150S	SUP	HCPCS C1713		72823150S  -  SCREW BN 2.7MM 4.9MM 50MM STRL VLP 3 FLT ST LCK FT CORT PERC	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$133.88	$133.88	$0.00	$0.00	$0.00	$62.01	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$175.97	$175.97	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$46.56	$0.00	$0.00	$47.36	$0.00	$0.00	$0.00	$0.00	$0.00
72823206S	SUP	HCPCS C1713		72823206S  -  SCREW BN FT 4MM 6MM STRL VLP FT OSTEOPENIA	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
72823208S	SUP	HCPCS C1713		72823208S  -  SCREW BN FT 4MM 8MM STRL VLP FT OSTEOPENIA	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
72823210S	SUP	HCPCS C1713		72823210S  -  SCREW BN 4MM 10MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823212S	SUP	HCPCS C1713		72823212S  -  SCREW BN 4MM 12MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823214S	SUP	HCPCS C1713		72823214S  -  SCREW BN 4MM 14MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823216S	SUP	HCPCS C1713		72823216S  -  SCREW BN 4MM 16MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823218S	SUP	HCPCS C1713		72823218S  -  SCREW BN 4MM 18MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823220S	SUP	HCPCS C1713		72823220S  -  SCREW BN 4MM 20MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823222S	SUP	HCPCS C1713		72823222S  -  SCREW BN 4MM 22MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823224S	SUP	HCPCS C1713		72823224S  -  SCREW BN 4MM 24MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823226S	SUP	HCPCS C1713		72823226S  -  SCREW BN 4MM 26MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823228S	SUP	HCPCS C1713		72823228S  -  SCREW BN 4MM 28MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823230S	SUP	HCPCS C1713		72823230S  -  SCREW BN 4MM 30MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823232S	SUP	HCPCS C1713		72823232S  -  SCREW BN 4MM 32MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823234S	SUP	HCPCS C1713		72823234S  -  SCREW BN 4MM 34MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823236S	SUP	HCPCS C1713		72823236S  -  SCREW BN 4MM 36MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823238S	SUP	HCPCS C1713		72823238S  -  SCREW BN FT 4MM 38MM STRL VLP FT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823240S	SUP	HCPCS C1713		72823240S  -  SCREW BN 4MM 40MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823242S	SUP	HCPCS C1713		72823242S  -  SCREW BN FT 4MM 5MM 42MM STRL VLP FT OSTEOPENIA PERC	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823244S	SUP	HCPCS C1713		72823244S  -  SCREW BN FT 4MM 5MM 44MM STRL VLP FT OSTEOPENIA PERC	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823246S	SUP	HCPCS C1713		72823246S  -  SCREW BN FT LOPRFL 4MM 5MM 46MM STRL VLP FT OSTEOPENIA PERC	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823248S	SUP	HCPCS C1713		72823248S  -  SCREW BN FT LOPRFL 4MM 5MM 48MM STRL VLP FT OSTEOPENIA PERC	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823250S	SUP	HCPCS C1713		72823250S  -  SCREW BN FT LOPRFL 4MM 5MM 50MM STRL VLP FT OSTEOPENIA PERC	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823326S	SUP	HCPCS C1713		72823326S  -  SCREW BN 4MM 26MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823328S	SUP	HCPCS C1713		72823328S  -  SCREW BN 4MM 28MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823330S	SUP	HCPCS C1713		72823330S  -  SCREW BN 4MM 30MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823332S	SUP	HCPCS C1713		72823332S  -  SCREW BN 4MM 32MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823334S	SUP	HCPCS C1713		72823334S  -  SCREW BN 4MM 34MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823336S	SUP	HCPCS C1713		72823336S  -  SCREW BN 4MM 36MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823338S	SUP	HCPCS C1713		72823338S  -  SCREW BN P/T 4MM 5MM 38MMX2.5MM STRL 14MM VLP FOREFOOT	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823340S	SUP	HCPCS C1713		72823340S  -  SCREW BN P/T 4MM 5MM 40MMX2.5MM STRL 14MM VLP FOREFOOT	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823342S	SUP	HCPCS C1713		72823342S  -  SCREW BN P/T LOPRFL 4MM 5MM 42MM STRL VLP FT OSTEOPENIA PERC	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823344S	SUP	HCPCS C1713		72823344S  -  SCREW BN P/T LOPRFL 4MM 5MM 44MM STRL VLP FT OSTEOPENIA PERC	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823346S	SUP	HCPCS C1713		72823346S  -  SCREW BN P/T LOPRFL 4MM 5MM 46MM STRL VLP FT OSTEOPENIA PERC	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823348S	SUP	HCPCS C1713		72823348S  -  SCREW BN P/T LOPRFL 4MM 5MM 48MM STRL VLP FT OSTEOPENIA PERC	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823350S	SUP	HCPCS C1713		72823350S  -  SCREW BN P/T LOPRFL 4MM 5MM 50MM STRL VLP FT OSTEOPENIA PERC	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
72823406S	SUP	HCPCS C1713		72823406S  -  SCREW BN 4MM 6MM STRL VLP LCK FT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823408S	SUP	HCPCS C1713		72823408S  -  SCREW BN 4MM 8MM STRL VLP LCK FT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823410S	SUP	HCPCS C1713		72823410S  -  SCREW BN 4MM 10MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823412S	SUP	HCPCS C1713		72823412S  -  SCREW BN 4MM 12MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823414S	SUP	HCPCS C1713		72823414S  -  SCREW BN 4MM 14MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823416S	SUP	HCPCS C1713		72823416S  -  SCREW BN 4MM 16MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823418S	SUP	HCPCS C1713		72823418S  -  SCREW BN 4MM 18MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823420S	SUP	HCPCS C1713		72823420S  -  SCREW BN 4MM 20MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823422S	SUP	HCPCS C1713		72823422S  -  SCREW BN 4MM 22MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823424S	SUP	HCPCS C1713		72823424S  -  SCREW BN 4MM 24MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823426S	SUP	HCPCS C1713		72823426S  -  SCREW BN 4MM 26MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823428S	SUP	HCPCS C1713		72823428S  -  SCREW BN 4MM 28MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823430S	SUP	HCPCS C1713		72823430S  -  SCREW BN 4MM 30MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823432S	SUP	HCPCS C1713		72823432S  -  SCREW BN 4MM 32MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823434S	SUP	HCPCS C1713		72823434S  -  SCREW BN 4MM 34MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823436S	SUP	HCPCS C1713		72823436S  -  SCREW BN 4MM 36MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823438S	SUP	HCPCS C1713		72823438S  -  SCREW BN 4MM 38MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823440S	SUP	HCPCS C1713		72823440S  -  SCREW BN 4MM 40MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823442S	SUP	HCPCS C1713		72823442S  -  SCREW BN 4MM 4.9MM 42MM STRL VLP LCK FT OSTEOPENIA PERC	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823444S	SUP	HCPCS C1713		72823444S  -  SCREW BN LOPRFL 4MM 4.9MM 44MM STRL VLP LCK FT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823446S	SUP	HCPCS C1713		72823446S  -  SCREW BN LOPRFL 4MM 4.9MM 46MM STRL VLP LCK FT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823448S	SUP	HCPCS C1713		72823448S  -  SCREW BN LOPRFL 4MM 4.9MM 48MM STRL VLP LCK FT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823450S	SUP	HCPCS C1713		72823450S  -  SCREW BN LOPRFL 4MM 4.9MM 50MM STRL VLP LCK FT OSTEOPENIA	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823510S	SUP	HCPCS C1713		72823510S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 10MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823512S	SUP	HCPCS C1713		72823512S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 12MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823514S	SUP	HCPCS C1713		72823514S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 14MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823516S	SUP	HCPCS C1713		72823516S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 16MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823518S	SUP	HCPCS C1713		72823518S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 18MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823520S	SUP	HCPCS C1713		72823520S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 20MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823522S	SUP	HCPCS C1713		72823522S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 22MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823524S	SUP	HCPCS C1713		72823524S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 24MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823526S	SUP	HCPCS C1713		72823526S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 26MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823528S	SUP	HCPCS C1713		72823528S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 28MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823530S	SUP	HCPCS C1713		72823530S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 30MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823532S	SUP	HCPCS C1713		72823532S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 32MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823534S	SUP	HCPCS C1713		72823534S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 34MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823536S	SUP	HCPCS C1713		72823536S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 36MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823538S	SUP	HCPCS C1713		72823538S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 38MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823540S	SUP	HCPCS C1713		72823540S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 40MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823542S	SUP	HCPCS C1713		72823542S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 42MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823544S	SUP	HCPCS C1713		72823544S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 44MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823546S	SUP	HCPCS C1713		72823546S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 46MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823548S	SUP	HCPCS C1713		72823548S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 48MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823550S	SUP	HCPCS C1713		72823550S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 50MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823555S	SUP	HCPCS C1713		72823555S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 55MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72823560S	SUP	HCPCS C1713		72823560S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 60MMX3.3MM STRL VLP LCK LOPRFL	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
72824001S	SUP	HCPCS C1713		72824001S  -  PLATE BN T STRL VLP LCK VA FT 2.7MM SCR	BOTH IP/OP	"$1,262.50 "	$934.25	$0.00	"$1,010.00"	$568.13	$568.13	$0.00	$0.00	$0.00	$263.14	$937.03	$937.03	$0.00	$0.00	$263.11	$0.00	$746.77	$746.77	$0.00	$631.25	$999.90	"$1,010.00"	$0.00		$0.00	$197.58	$0.00	$0.00	$200.99	$0.00	$0.00	$0.00	$0.00	$0.00
72824002S	SUP	HCPCS C1713		72824002S  -  PLATE BN L STRL PRLC VLP SS LT MTP FOREFOOT MIDFOOT 2.7MM	BOTH IP/OP	"$1,021.25 "	$755.73	$0.00	$817.00	$459.56	$459.56	$0.00	$0.00	$0.00	$212.85	$757.97	$757.97	$0.00	$0.00	$212.83	$0.00	$604.07	$604.07	$0.00	$510.63	$808.83	$817.00	$0.00		$0.00	$159.83	$0.00	$0.00	$162.58	$0.00	$0.00	$0.00	$0.00	$0.00
72824003S	SUP	HCPCS C1713		72824003S  -  PLATE BN L STRL PRLC VLP SS RT MTP FOREFOOT MIDFOOT 2.7MM	BOTH IP/OP	"$1,021.25 "	$755.73	$0.00	$817.00	$459.56	$459.56	$0.00	$0.00	$0.00	$212.85	$757.97	$757.97	$0.00	$0.00	$212.83	$0.00	$604.07	$604.07	$0.00	$510.63	$808.83	$817.00	$0.00		$0.00	$159.83	$0.00	$0.00	$162.58	$0.00	$0.00	$0.00	$0.00	$0.00
72824004S	SUP	HCPCS C1713		72824004S  -  PLATE BN H STRL PRLC VLP 5 HL SS FOREFOOT MIDFOOT 2.7MM SCR	BOTH IP/OP	"$1,775.00 "	"$1,313.50"	$0.00	"$1,420.00"	$798.75	$798.75	$0.00	$0.00	$0.00	$369.95	"$1,317.41"	"$1,317.41"	$0.00	$0.00	$369.91	$0.00	"$1,049.91"	"$1,049.91"	$0.00	$887.50	"$1,405.80"	"$1,420.00"	$0.00		$0.00	$277.79	$0.00	$0.00	$282.58	$0.00	$0.00	$0.00	$0.00	$0.00
72824005S	SUP	HCPCS C1713		72824005S  -  PLATE BN STRL PRLC VLP H 8 HL 2.7 MM SCR	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
72824006S	SUP	HCPCS C1713		72824006S  -  PLATE BN .25 TBLR STRL PRLC VLP 3 HL SS FOREFOOT MIDFOOT 2.7	BOTH IP/OP	$968.75 	$716.88	$0.00	$775.00	$435.94	$435.94	$0.00	$0.00	$0.00	$201.91	$719.01	$719.01	$0.00	$0.00	$201.89	$0.00	$573.02	$573.02	$0.00	$484.38	$767.25	$775.00	$0.00		$0.00	$151.61	$0.00	$0.00	$154.23	$0.00	$0.00	$0.00	$0.00	$0.00
72824007S	SUP	HCPCS C1713		72824007S  -  PLATE BN STRL PRLC VLP 4 HL QT TBLR MTP 2.7 MM SCR	BOTH IP/OP	$968.75 	$716.88	$0.00	$775.00	$435.94	$435.94	$0.00	$0.00	$0.00	$201.91	$719.01	$719.01	$0.00	$0.00	$201.89	$0.00	$573.02	$573.02	$0.00	$484.38	$767.25	$775.00	$0.00		$0.00	$151.61	$0.00	$0.00	$154.23	$0.00	$0.00	$0.00	$0.00	$0.00
72824008S	SUP	HCPCS C1713		72824008S  -  PLATE BN .25 TBLR 39.8X8X1.5MM STRL VLP 5 HL FOREFOOT	BOTH IP/OP	$968.75 	$716.88	$0.00	$775.00	$435.94	$435.94	$0.00	$0.00	$0.00	$201.91	$719.01	$719.01	$0.00	$0.00	$201.89	$0.00	$573.02	$573.02	$0.00	$484.38	$767.25	$775.00	$0.00		$0.00	$151.61	$0.00	$0.00	$154.23	$0.00	$0.00	$0.00	$0.00	$0.00
72824009S	SUP	HCPCS C1713		72824009S  -  PLATE BN STRL PRLC VLP 6 HL QT TBLR MTP 2.7 MM SCR	BOTH IP/OP	$968.75 	$716.88	$0.00	$775.00	$435.94	$435.94	$0.00	$0.00	$0.00	$201.91	$719.01	$719.01	$0.00	$0.00	$201.89	$0.00	$573.02	$573.02	$0.00	$484.38	$767.25	$775.00	$0.00		$0.00	$151.61	$0.00	$0.00	$154.23	$0.00	$0.00	$0.00	$0.00	$0.00
72824010S	SUP	HCPCS C1713		72824010S  -  PLATE BN STRL PRLC VLP 7 HL QT TBLR MTP 2.7 MM SCR	BOTH IP/OP	$968.75 	$716.88	$0.00	$775.00	$435.94	$435.94	$0.00	$0.00	$0.00	$201.91	$719.01	$719.01	$0.00	$0.00	$201.89	$0.00	$573.02	$573.02	$0.00	$484.38	$767.25	$775.00	$0.00		$0.00	$151.61	$0.00	$0.00	$154.23	$0.00	$0.00	$0.00	$0.00	$0.00
72824011S	SUP	HCPCS C1713		72824011S  -  PLATE BN .25 TBLR STRL PRLC VLP 8 HL SS FOREFOOT MIDFOOT 2.7	BOTH IP/OP	$968.75 	$716.88	$0.00	$775.00	$435.94	$435.94	$0.00	$0.00	$0.00	$201.91	$719.01	$719.01	$0.00	$0.00	$201.89	$0.00	$573.02	$573.02	$0.00	$484.38	$767.25	$775.00	$0.00		$0.00	$151.61	$0.00	$0.00	$154.23	$0.00	$0.00	$0.00	$0.00	$0.00
72824012S	SUP	HCPCS C1713		72824012S  -  PLATE BN .25 TBLR STRL PRLC VLP 3 HL CMPR SS FOREFOOT	BOTH IP/OP	"$1,518.75 "	"$1,123.88"	$0.00	"$1,215.00"	$683.44	$683.44	$0.00	$0.00	$0.00	$316.55	"$1,127.22"	"$1,127.22"	$0.00	$0.00	$316.51	$0.00	$898.34	$898.34	$0.00	$759.38	"$1,202.85"	"$1,215.00"	$0.00		$0.00	$237.68	$0.00	$0.00	$241.79	$0.00	$0.00	$0.00	$0.00	$0.00
72824013S	SUP	HCPCS C1713		72824013S  -  PLATE BN STRL PRLC VLP 5 HL QT TBLR CMPR 2.7 MM SCR	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$759.38	$759.38	$0.00	$0.00	$0.00	$351.72	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$998.16	$998.16	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$264.09	$0.00	$0.00	$268.65	$0.00	$0.00	$0.00	$0.00	$0.00
72824014S	SUP	HCPCS C1713		72824014S  -  PLATE BN .25 TBLR STRL PRLC VLP 7 HL CMPR SS FOREFOOT	BOTH IP/OP	"$1,775.00 "	"$1,313.50"	$0.00	"$1,420.00"	$798.75	$798.75	$0.00	$0.00	$0.00	$369.95	"$1,317.41"	"$1,317.41"	$0.00	$0.00	$369.91	$0.00	"$1,049.91"	"$1,049.91"	$0.00	$887.50	"$1,405.80"	"$1,420.00"	$0.00		$0.00	$277.79	$0.00	$0.00	$282.58	$0.00	$0.00	$0.00	$0.00	$0.00
72824015S	SUP	HCPCS C1713		72824015S  -  PLATE BN STRL PRLC VLP PRM SS LT MTP FOREFOOT MIDFOOT 2.7 MM	BOTH IP/OP	"$1,775.00 "	"$1,313.50"	$0.00	"$1,420.00"	$798.75	$798.75	$0.00	$0.00	$0.00	$369.95	"$1,317.41"	"$1,317.41"	$0.00	$0.00	$369.91	$0.00	"$1,049.91"	"$1,049.91"	$0.00	$887.50	"$1,405.80"	"$1,420.00"	$0.00		$0.00	$277.79	$0.00	$0.00	$282.58	$0.00	$0.00	$0.00	$0.00	$0.00
72824016S	SUP	HCPCS C1713		72824016S  -  PLATE BN 53.1MMX1.27MM STRL 11MM VLP PRM RT MTP FOREFOOT	BOTH IP/OP	"$1,775.00 "	"$1,313.50"	$0.00	"$1,420.00"	$798.75	$798.75	$0.00	$0.00	$0.00	$369.95	"$1,317.41"	"$1,317.41"	$0.00	$0.00	$369.91	$0.00	"$1,049.91"	"$1,049.91"	$0.00	$887.50	"$1,405.80"	"$1,420.00"	$0.00		$0.00	$277.79	$0.00	$0.00	$282.58	$0.00	$0.00	$0.00	$0.00	$0.00
72824017S	SUP	HCPCS C1713		72824017S  -  PLATE BN STRL PRLC VLP REV LT MTP 2.7 MM SCR	BOTH IP/OP	"$2,262.50 "	"$1,674.25"	$0.00	"$1,810.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$471.56	"$1,679.23"	"$1,679.23"	$0.00	$0.00	$471.51	$0.00	"$1,338.27"	"$1,338.27"	$0.00	"$1,131.25"	"$1,791.90"	"$1,810.00"	$0.00		$0.00	$354.08	$0.00	$0.00	$360.19	$0.00	$0.00	$0.00	$0.00	$0.00
72824018S	SUP	HCPCS C1713		72824018S  -  PLATE BN STRL PRLC VLP REV SS RT MTP FOREFOOT MIDFOOT 2.7 MM	BOTH IP/OP	"$2,262.50 "	"$1,674.25"	$0.00	"$1,810.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$471.56	"$1,679.23"	"$1,679.23"	$0.00	$0.00	$471.51	$0.00	"$1,338.27"	"$1,338.27"	$0.00	"$1,131.25"	"$1,791.90"	"$1,810.00"	$0.00		$0.00	$354.08	$0.00	$0.00	$360.19	$0.00	$0.00	$0.00	$0.00	$0.00
72824019S	SUP	HCPCS C1713		72824019S  -  PLATE BN SHRT STRL VLP FSN LCK VA TARSOMETATARSAL FT 2.7MM	BOTH IP/OP	"$1,775.00 "	"$1,313.50"	$0.00	"$1,420.00"	$798.75	$798.75	$0.00	$0.00	$0.00	$369.95	"$1,317.41"	"$1,317.41"	$0.00	$0.00	$369.91	$0.00	"$1,049.91"	"$1,049.91"	$0.00	$887.50	"$1,405.80"	"$1,420.00"	$0.00		$0.00	$277.79	$0.00	$0.00	$282.58	$0.00	$0.00	$0.00	$0.00	$0.00
72824020S	SUP	HCPCS C1713		72824020S  -  PLATE BN LNG STRL PRLC VLP FSN TARSOMETATARSAL 2.7MM SCR	BOTH IP/OP	"$2,143.75 "	"$1,586.38"	$0.00	"$1,715.00"	$964.69	$964.69	$0.00	$0.00	$0.00	$446.81	"$1,591.09"	"$1,591.09"	$0.00	$0.00	$446.76	$0.00	"$1,268.03"	"$1,268.03"	$0.00	"$1,071.88"	"$1,697.85"	"$1,715.00"	$0.00		$0.00	$335.50	$0.00	$0.00	$341.29	$0.00	$0.00	$0.00	$0.00	$0.00
72824021S	SUP	HCPCS C1713		72824021S  -  PLATE BN 18.1X7.1X1.5MM STRL VLP BRBL FOREFOOT MIDFOOT 2.7MM	BOTH IP/OP	"$1,193.75 "	$883.38	$0.00	$955.00	$537.19	$537.19	$0.00	$0.00	$0.00	$248.81	$886.00	$886.00	$0.00	$0.00	$248.78	$0.00	$706.10	$706.10	$0.00	$596.88	$945.45	$955.00	$0.00		$0.00	$186.82	$0.00	$0.00	$190.05	$0.00	$0.00	$0.00	$0.00	$0.00
72824022S	SUP	HCPCS C1713		72824022S  -  PLATE BN SM 24X18X1.5MM STRL VLP UTL FOREFOOT MIDFOOT 2.7MM	BOTH IP/OP	"$2,012.50 "	"$1,489.25"	$0.00	"$1,610.00"	$905.63	$905.63	$0.00	$0.00	$0.00	$419.46	"$1,493.68"	"$1,493.68"	$0.00	$0.00	$419.41	$0.00	"$1,190.39"	"$1,190.39"	$0.00	"$1,006.25"	"$1,593.90"	"$1,610.00"	$0.00		$0.00	$314.96	$0.00	$0.00	$320.39	$0.00	$0.00	$0.00	$0.00	$0.00
72824023S	SUP	HCPCS C1713		72824023S  -  PLATE BN MED STRL PRLC VLP UTL MTP 2.7MM SCR	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
72824024S	SUP	HCPCS C1713		72824024S  -  PLATE BN LG STRL PRLC VLP UTL SS FOREFOOT MIDFOOT 2.7MM SCR	BOTH IP/OP	"$2,262.50 "	"$1,674.25"	$0.00	"$1,810.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$471.56	"$1,679.23"	"$1,679.23"	$0.00	$0.00	$471.51	$0.00	"$1,338.27"	"$1,338.27"	$0.00	"$1,131.25"	"$1,791.90"	"$1,810.00"	$0.00		$0.00	$354.08	$0.00	$0.00	$360.19	$0.00	$0.00	$0.00	$0.00	$0.00
72824025S	SUP	HCPCS C1713		72824025S  -  PLATE BN STRL PRLC VLP 3 HL 1/3 TBLR CMPR MTP 3.5 MM SCR	BOTH IP/OP	"$1,518.75 "	"$1,123.88"	$0.00	"$1,215.00"	$683.44	$683.44	$0.00	$0.00	$0.00	$316.55	"$1,127.22"	"$1,127.22"	$0.00	$0.00	$316.51	$0.00	$898.34	$898.34	$0.00	$759.38	"$1,202.85"	"$1,215.00"	$0.00		$0.00	$237.68	$0.00	$0.00	$241.79	$0.00	$0.00	$0.00	$0.00	$0.00
72824026S	SUP	HCPCS C1713		72824026S  -  PLATE BN STRL PRLC VLP 5 HL 1/3 TBLR CMPR 3.5 MM SCR	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$759.38	$759.38	$0.00	$0.00	$0.00	$351.72	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$998.16	$998.16	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$264.09	$0.00	$0.00	$268.65	$0.00	$0.00	$0.00	$0.00	$0.00
72824027S	SUP	HCPCS C1713		72824027S  -  PLATE BN STRL PRLC VLP 7 HL 1/3 TBLR CMPR 3.5 MM SCR	BOTH IP/OP	"$1,775.00 "	"$1,313.50"	$0.00	"$1,420.00"	$798.75	$798.75	$0.00	$0.00	$0.00	$369.95	"$1,317.41"	"$1,317.41"	$0.00	$0.00	$369.91	$0.00	"$1,049.91"	"$1,049.91"	$0.00	$887.50	"$1,405.80"	"$1,420.00"	$0.00		$0.00	$277.79	$0.00	$0.00	$282.58	$0.00	$0.00	$0.00	$0.00	$0.00
72824028S	SUP	HCPCS C1713		72824028S  -  PLATE BN SM STRL PRLC VLP LT CALCANEUS 3.5MM SCR	BOTH IP/OP	"$2,018.75 "	"$1,493.88"	$0.00	"$1,615.00"	$908.44	$908.44	$0.00	$0.00	$0.00	$420.76	"$1,498.32"	"$1,498.32"	$0.00	$0.00	$420.71	$0.00	"$1,194.09"	"$1,194.09"	$0.00	"$1,009.38"	"$1,598.85"	"$1,615.00"	$0.00		$0.00	$315.93	$0.00	$0.00	$321.39	$0.00	$0.00	$0.00	$0.00	$0.00
72824029S	SUP	HCPCS C1713		72824029S  -  PLATE BN SM STRL PRLC VLP VA LCK RT CALCANEUS 3.5MM SCR	BOTH IP/OP	"$2,018.75 "	"$1,493.88"	$0.00	"$1,615.00"	$908.44	$908.44	$0.00	$0.00	$0.00	$420.76	"$1,498.32"	"$1,498.32"	$0.00	$0.00	$420.71	$0.00	"$1,194.09"	"$1,194.09"	$0.00	"$1,009.38"	"$1,598.85"	"$1,615.00"	$0.00		$0.00	$315.93	$0.00	$0.00	$321.39	$0.00	$0.00	$0.00	$0.00	$0.00
72824030S	SUP	HCPCS C1713		72824030S  -  PLATE BN LG STRL PRLC VLP LT CALCANEUS MIDFOOT HINDFOOT 3.5	BOTH IP/OP	"$2,087.50 "	"$1,544.75"	$0.00	"$1,670.00"	$939.38	$939.38	$0.00	$0.00	$0.00	$435.09	"$1,549.34"	"$1,549.34"	$0.00	$0.00	$435.04	$0.00	"$1,234.76"	"$1,234.76"	$0.00	"$1,043.75"	"$1,653.30"	"$1,670.00"	$0.00		$0.00	$326.69	$0.00	$0.00	$332.33	$0.00	$0.00	$0.00	$0.00	$0.00
72824031S	SUP	HCPCS C1713		72824031S  -  PLATE BN LG STRL PRLC VLP VA LCK SS RT CALCANEUS 3.5MM SCR	BOTH IP/OP	"$2,087.50 "	"$1,544.75"	$0.00	"$1,670.00"	$939.38	$939.38	$0.00	$0.00	$0.00	$435.09	"$1,549.34"	"$1,549.34"	$0.00	$0.00	$435.04	$0.00	"$1,234.76"	"$1,234.76"	$0.00	"$1,043.75"	"$1,653.30"	"$1,670.00"	$0.00		$0.00	$326.69	$0.00	$0.00	$332.33	$0.00	$0.00	$0.00	$0.00	$0.00
72824032S	SUP	HCPCS C1713		72824032S  -  PLATE BN STRL PRLC VLP FSN MTP 3.5 MM SCR	BOTH IP/OP	"$2,012.50 "	"$1,489.25"	$0.00	"$1,610.00"	$905.63	$905.63	$0.00	$0.00	$0.00	$419.46	"$1,493.68"	"$1,493.68"	$0.00	$0.00	$419.41	$0.00	"$1,190.39"	"$1,190.39"	$0.00	"$1,006.25"	"$1,593.90"	"$1,610.00"	$0.00		$0.00	$314.96	$0.00	$0.00	$320.39	$0.00	$0.00	$0.00	$0.00	$0.00
72824033S	SUP	HCPCS C1713		72824033S  -  PLATE BN LNG STRL PRLC VLP FSN 3.5MM SCR	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
72824034S	SUP	HCPCS C1713		72824034S  -  PLATE BN STRL PRLC VLP CLMN FSN 3.5 MM SCR	BOTH IP/OP	"$2,993.75 "	"$2,215.38"	$0.00	"$2,395.00"	"$1,347.19"	"$1,347.19"	$0.00	$0.00	$0.00	$623.97	"$2,221.96"	"$2,221.96"	$0.00	$0.00	$623.90	$0.00	"$1,475.92"	"$1,475.92"	$0.00	"$1,496.88"	"$2,371.05"	"$2,395.00"	$0.00		$0.00	$468.52	$0.00	$0.00	$476.61	$0.00	$0.00	$0.00	$0.00	$0.00
72824035S	SUP	HCPCS C1713		72824035S  -  PLATE BN STRL VLP 6 HL MLT FRAG MIDFOOT HINDFOOT 3.5 MM SCR	BOTH IP/OP	"$1,775.00 "	"$1,313.50"	$0.00	"$1,420.00"	$798.75	$798.75	$0.00	$0.00	$0.00	$369.95	"$1,317.41"	"$1,317.41"	$0.00	$0.00	$369.91	$0.00	"$1,049.91"	"$1,049.91"	$0.00	$887.50	"$1,405.80"	"$1,420.00"	$0.00		$0.00	$277.79	$0.00	$0.00	$282.58	$0.00	$0.00	$0.00	$0.00	$0.00
72824036S	SUP	HCPCS C1713		72824036S  -  PLATE BN STRL PRLC VLP 10 HL MLT FRAG MTP 3.5 MM SCR	BOTH IP/OP	"$2,443.75 "	"$1,808.38"	$0.00	"$1,955.00"	"$1,099.69"	"$1,099.69"	$0.00	$0.00	$0.00	$509.34	"$1,813.75"	"$1,813.75"	$0.00	$0.00	$509.28	$0.00	"$1,445.48"	"$1,445.48"	$0.00	"$1,221.88"	"$1,935.45"	"$1,955.00"	$0.00		$0.00	$382.45	$0.00	$0.00	$389.05	$0.00	$0.00	$0.00	$0.00	$0.00
72824037S	SUP	HCPCS C1713		72824037S  -  PLATE BN STRL PRLC VLP 14 HL MLT FRAG VARAIBLE ANG MIDFOOT	BOTH IP/OP	"$2,925.00 "	"$2,164.50"	$0.00	"$2,340.00"	"$1,316.25"	"$1,316.25"	$0.00	$0.00	$0.00	$609.64	"$2,170.94"	"$2,170.94"	$0.00	$0.00	$609.57	$0.00	"$1,442.03"	"$1,442.03"	$0.00	"$1,462.50"	"$2,316.60"	"$2,340.00"	$0.00		$0.00	$457.76	$0.00	$0.00	$465.66	$0.00	$0.00	$0.00	$0.00	$0.00
72824038S	SUP	HCPCS C1713		72824038S  -  PLATE BN VLP 4 HL MULTIFRAGMENT MIDFOOT HINDFOOT 3.5 MM SCR	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$759.38	$759.38	$0.00	$0.00	$0.00	$351.72	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$998.16	$998.16	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$264.09	$0.00	$0.00	$268.65	$0.00	$0.00	$0.00	$0.00	$0.00
72824039S	SUP	HCPCS C1713		72824039S  -  PLATE BN MED STRL VLP LT CALCANEUS MIDFOOT HINDFOOT 3.5MM	BOTH IP/OP	"$2,225.00 "	"$1,646.50"	$0.00	"$1,780.00"	"$1,001.25"	"$1,001.25"	$0.00	$0.00	$0.00	$463.75	"$1,651.40"	"$1,651.40"	$0.00	$0.00	$463.69	$0.00	"$1,316.09"	"$1,316.09"	$0.00	"$1,112.50"	"$1,762.20"	"$1,780.00"	$0.00		$0.00	$348.21	$0.00	$0.00	$354.22	$0.00	$0.00	$0.00	$0.00	$0.00
72824040S	SUP	HCPCS C1713		72824040S  -  PLATE BN MED STRL VLP RT CALCANEUS MIDFOOT HINDFOOT 3.5MM	BOTH IP/OP	"$2,225.00 "	"$1,646.50"	$0.00	"$1,780.00"	"$1,001.25"	"$1,001.25"	$0.00	$0.00	$0.00	$463.75	"$1,651.40"	"$1,651.40"	$0.00	$0.00	$463.69	$0.00	"$1,316.09"	"$1,316.09"	$0.00	"$1,112.50"	"$1,762.20"	"$1,780.00"	$0.00		$0.00	$348.21	$0.00	$0.00	$354.22	$0.00	$0.00	$0.00	$0.00	$0.00
72824041S	SUP	HCPCS C1713		72824041S  -  PLATE BN XL STRL VLP LT CALCANEUS MIDFOOT HINDFOOT 3.5MM SCR	BOTH IP/OP	"$2,331.25 "	"$1,725.13"	$0.00	"$1,865.00"	"$1,049.06"	"$1,049.06"	$0.00	$0.00	$0.00	$485.89	"$1,730.25"	"$1,730.25"	$0.00	$0.00	$485.83	$0.00	"$1,378.93"	"$1,378.93"	$0.00	"$1,165.63"	"$1,846.35"	"$1,865.00"	$0.00		$0.00	$364.84	$0.00	$0.00	$371.14	$0.00	$0.00	$0.00	$0.00	$0.00
72824042S	SUP	HCPCS C1713		72824042S  -  PLATE BN XL RT CALC 3.5MM SCR	BOTH IP/OP	"$2,331.25 "	"$1,725.13"	$0.00	"$1,865.00"	"$1,049.06"	"$1,049.06"	$0.00	$0.00	$0.00	$485.89	"$1,730.25"	"$1,730.25"	$0.00	$0.00	$485.83	$0.00	"$1,378.93"	"$1,378.93"	$0.00	"$1,165.63"	"$1,846.35"	"$1,865.00"	$0.00		$0.00	$364.84	$0.00	$0.00	$371.14	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0108	SUP	Custom 27803010		7291-0108  -  INSERT TIB 1 8MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,299.00 "	$961.26	$0.00	"$1,039.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.12	$964.12	$0.00	$0.00	$270.71	$0.00	$0.00	$0.00	$0.00	$649.50	"$1,028.81"	"$1,039.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0110	SUP	Custom 27803010		7291-0110  -  INSERT TIB 1 10MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,298.00 "	$960.52	$0.00	"$1,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.38	$963.38	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$649.00	"$1,028.02"	"$1,038.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0115	SUP	Custom 27803010		7291-0115  -  INSERT TIB 1 15MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,299.00 "	$961.26	$0.00	"$1,039.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.12	$964.12	$0.00	$0.00	$270.71	$0.00	$0.00	$0.00	$0.00	$649.50	"$1,028.81"	"$1,039.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0118	SUP	Custom 27803010		7291-0118  -  INSERT TIB 1 18MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,298.00 "	$960.52	$0.00	"$1,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.38	$963.38	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$649.00	"$1,028.02"	"$1,038.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0121	SUP	Custom 27803010		7291-0121  -  INSERT TIB 1 21MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0124	SUP	Custom 27803010		7291-0124  -  INSERT TIB 1 24MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0308	SUP	Custom 27803010		7291-0308  -  INSERT TIB 3 8MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0310	SUP	Custom 27803010		7291-0310  -  INSERT TIB 3 10MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0312	SUP	Custom 27803010		7291-0312  -  INSERT TIB 3 12MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0315	SUP	Custom 27803010		7291-0315  -  INSERT TIB 3 15MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0318	SUP	Custom 27803010		7291-0318  -  INSERT TIB 3 18MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0321	SUP	Custom 27803010		7291-0321  -  INSERT TIB 3 21MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,298.00 "	$960.52	$0.00	"$1,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.38	$963.38	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$649.00	"$1,028.02"	"$1,038.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0324	SUP	Custom 27803010		7291-0324  -  INSERT TIB 3 24MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0512	SUP	Custom 27803010		7291-0512  -  INSERT TIB 5 12MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0515	SUP	Custom 27803010		7291-0515  -  INSERT TIB 5 15MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,299.00 "	$961.26	$0.00	"$1,039.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.12	$964.12	$0.00	$0.00	$270.71	$0.00	$0.00	$0.00	$0.00	$649.50	"$1,028.81"	"$1,039.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0518	SUP	Custom 27803010		7291-0518  -  INSERT TIB 5 18MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,299.00 "	$961.26	$0.00	"$1,039.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.12	$964.12	$0.00	$0.00	$270.71	$0.00	$0.00	$0.00	$0.00	$649.50	"$1,028.81"	"$1,039.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0521	SUP	Custom 27803010		7291-0521  -  INSERT TIB 5 21MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,298.00 "	$960.52	$0.00	"$1,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.38	$963.38	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$649.00	"$1,028.02"	"$1,038.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0524	SUP	Custom 27803010		7291-0524  -  INSERT TIB 5 24MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0708	SUP	Custom 27803010		7291-0708  -  INSERT TIB 7 8MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,299.00 "	$961.26	$0.00	"$1,039.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.12	$964.12	$0.00	$0.00	$270.71	$0.00	$0.00	$0.00	$0.00	$649.50	"$1,028.81"	"$1,039.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0710	SUP	Custom 27803010		7291-0710  -  INSERT TIB 7 10MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,298.00 "	$960.52	$0.00	"$1,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.38	$963.38	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$649.00	"$1,028.02"	"$1,038.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0712	SUP	Custom 27803010		7291-0712  -  INSERT TIB 7 12MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,298.00 "	$960.52	$0.00	"$1,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.38	$963.38	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$649.00	"$1,028.02"	"$1,038.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0718	SUP	Custom 27803010		7291-0718  -  INSERT TIB 7 18MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,298.00 "	$960.52	$0.00	"$1,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.38	$963.38	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$649.00	"$1,028.02"	"$1,038.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0721	SUP	Custom 27803010		7291-0721  -  INSERT TIB 7 21MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0724	SUP	Custom 27803010		7291-0724  -  INSERT TIB 7 24MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0908	SUP	Custom 27803010		7291-0908  -  INSERT TIB 9 8MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,298.00 "	$960.52	$0.00	"$1,038.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.38	$963.38	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$649.00	"$1,028.02"	"$1,038.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0910	SUP	Custom 27803010		7291-0910  -  INSERT TIB 9 10MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,299.00 "	$961.26	$0.00	"$1,039.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.12	$964.12	$0.00	$0.00	$270.71	$0.00	$0.00	$0.00	$0.00	$649.50	"$1,028.81"	"$1,039.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0915	SUP	Custom 27803010		7291-0915  -  INSERT TIB 9 15MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,299.00 "	$961.26	$0.00	"$1,039.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.12	$964.12	$0.00	$0.00	$270.71	$0.00	$0.00	$0.00	$0.00	$649.50	"$1,028.81"	"$1,039.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0918	SUP	Custom 27803010		7291-0918  -  INSERT TIB 9 18MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0921	SUP	Custom 27803010		7291-0921  -  INSERT TIB 9 21MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,299.00 "	$961.26	$0.00	"$1,039.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.12	$964.12	$0.00	$0.00	$270.71	$0.00	$0.00	$0.00	$0.00	$649.50	"$1,028.81"	"$1,039.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7291-0924	SUP	Custom 27803010		7291-0924  -  INSERT TIB 9 24MM KNEE PS BRNG SER 1	BOTH IP/OP	"$1,246.00 "	$922.04	$0.00	$996.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$924.78	$924.78	$0.00	$0.00	$259.67	$0.00	$0.00	$0.00	$0.00	$623.00	$986.83	$996.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72A002	SUP	Custom 27804086		72A002  -  GRAFT BONE SMALL 100-125MM FREEZE DRIED SHAFT CORTICAL	BOTH IP/OP	"$1,760.00 "	"$1,302.40"	$0.00	"$1,408.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,306.27"	"$1,306.27"	$0.00	$0.00	$366.78	$0.00	$0.00	$0.00	$0.00	$880.00	"$1,393.92"	"$1,408.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
72B006	SUP	HCPCS C1762		72B006  -  GRAFT BONE LARGE 126MM FROZEN SHAFT CORTICAL	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
730032ADP	SUP	Custom 27803010		730032ADP  -  GRAFT CV 42MM 32MM 15CM 32MM GLWV VSLV WVN GELTN AOR ROOT	BOTH IP/OP	"$6,437.50 "	"$4,763.75"	$0.00	"$5,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,218.75"	"$5,098.50"	"$5,150.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7300TFX25MM	SUP	Custom 27803010		7300TFX25MM  -  VALVE MTRL 25MM CRP-ED PRIMNT MAGNA BPRTH EASE HRT	BOTH IP/OP	"$22,275.00 "	"$16,483.50"	$0.00	"$17,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,642.11"	$0.00	$0.00	$0.00	$0.00	"$11,137.50"	"$17,641.80"	"$17,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7300TFX29MM	SUP	Custom 27803010		7300TFX29MM  -  VALVE MTRL 29MM CRP-ED PRIMNT MG HRT PRICRD EASE	BOTH IP/OP	"$22,275.00 "	"$16,483.50"	$0.00	"$17,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,642.11"	$0.00	$0.00	$0.00	$0.00	"$11,137.50"	"$17,641.80"	"$17,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7300TFX31MM	SUP	Custom 27803010		7300TFX31MM  -  VALVE MITRAL 31MM BIOPROSTHESIS EASE CARPENTIER-EDWARDS	BOTH IP/OP	"$22,275.00 "	"$16,483.50"	$0.00	"$17,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,642.11"	$0.00	$0.00	$0.00	$0.00	"$11,137.50"	"$17,641.80"	"$17,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7300TFX33MM	SUP	Custom 27803010		7300TFX33MM  -  VALVE MTRL 33MM CRP-ED PRIMNT MG EASE PRICRD HRT	BOTH IP/OP	"$22,275.00 "	"$16,483.50"	$0.00	"$17,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,642.11"	$0.00	$0.00	$0.00	$0.00	"$11,137.50"	"$17,641.80"	"$17,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-0110	SUP	Custom 27803010		73-0110  -  COMPONENT PATLR 11 10MM MEDIALIZED DOME SCORPIO N2/VAC	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-020S	SUP	HCPCS C1713		73-020S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 20MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-025S	SUP	HCPCS C1713		73-025S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 25MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-030S	SUP	HCPCS C1713		73-030S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 30MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-035S	SUP	HCPCS C1713		73-035S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 35MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-040S	SUP	HCPCS C1713		73-040S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 40MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-045S	SUP	HCPCS C1713		73-045S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 45MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-050S	SUP	HCPCS C1713		73-050S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 50MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-0510	SUP	Custom 27803010		73-0510  -  COMPONENT PATLR 5 1.5MM OFFST 32/35MM 5MM 5MMX10MM MEDIALIZE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-055S	SUP	HCPCS C1713		73-055S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 55MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-060S	SUP	HCPCS C1713		73-060S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 60MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-065S	SUP	HCPCS C1713		73-065S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 65MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-070S	SUP	HCPCS C1713		73-070S  -  SCREW  CANNULATED FULLY THREADED 7.3MM X 70MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-0710	SUP	Custom 27803010		73-0710  -  COMPONENT PATLR 7 1.5MM OFFST 34/38MM 5MM 5MMX10MM MEDIALIZE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-075S	SUP	HCPCS C1713		73-075S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 75MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-080S	SUP	HCPCS C1713		73-080S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 80MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-085S	SUP	HCPCS C1713		73-085S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 85MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-090S	SUP	HCPCS C1713		73-090S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 90MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-0910	SUP	Custom 27803010		73-0910  -  COMPONENT PATLR 7 1.5MM OFFST 36/41MM 5MM 5MMX10MM MEDIALIZE	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-095S	SUP	HCPCS C1713		73-095S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 95MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-100S	SUP	HCPCS C1713		73-100S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 100MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-105S	SUP	HCPCS C1713		73-105S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 105MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-110S	SUP	HCPCS C1713		73-110S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 110MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-115S	SUP	HCPCS C1713		73-115S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 115MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-120S	SUP	HCPCS C1713		73-120S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 120MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-125S	SUP	HCPCS C1713		73-125S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 125MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-130S	SUP	HCPCS C1713		73-130S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 130MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16030S	SUP	HCPCS C1713		73-16030S  -  SCREW 7.3MM X 30MM CANNULATED SCREW 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16035S	SUP	HCPCS C1713		73-16035S  -  SCREW 7.3MM X 35MM CANNULATED SCREW 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16040S	SUP	HCPCS C1713		73-16040S  -  SCREW CANNULATED 7.3MM X 40MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16045S	SUP	HCPCS C1713		73-16045S  -  SCREW CANNULATED 7.3MM X 45MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16050S	SUP	HCPCS C1713		73-16050S  -  SCREW CANNULATED 7.3MM X 50MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16055S	SUP	HCPCS C1713		73-16055S  -  SCREW CANNULATED 7.3MM X 55MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16060S	SUP	HCPCS C1713		73-16060S  -  SCREW CANNULATED 7.3MM X 60MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16065S	SUP	HCPCS C1713		73-16065S  -  SCREW CANNULATED 7.3MM X 65MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16070S	SUP	HCPCS C1713		73-16070S  -  SCREW CANNULATED 7.3MM X 70MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16075S	SUP	HCPCS C1713		73-16075S  -  SCREW CANNULATED 7.3MM X 75MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16080S	SUP	HCPCS C1713		73-16080S  -  SCREW CANNULATED 7.3MM X 80MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16085S	SUP	HCPCS C1713		73-16085S  -  SCREW CANNULATED 7.3MM X 85MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16090S	SUP	HCPCS C1713		73-16090S  -  SCREW CANNULATED 7.3MM X 90MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16095S	SUP	HCPCS C1713		73-16095S  -  SCREW CANNULATED 7.3MM X 95MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16100S	SUP	HCPCS C1713		73-16100S  -  SCREW CANNULATED 7.3MM X 100MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16105S	SUP	HCPCS C1713		73-16105S  -  SCREW CANNULATED 7.3MM X 105MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16110S	SUP	HCPCS C1713		73-16110S  -  SCREW CANNULATED 7.3MM X 110MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16115S	SUP	HCPCS C1713		73-16115S  -  SCREW CANNULATED 7.3MM X 115MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16120S	SUP	HCPCS C1713		73-16120S  -  SCREW CANNULATED 7.3MM X 120MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16125S	SUP	HCPCS C1713		73-16125S  -  SCREW CANNULATED 7.3MM X 125MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16130S	SUP	HCPCS C1713		73-16130S  -  SCREW CANNULATED 7.3MM X 130MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16135S	SUP	HCPCS C1713		73-16135S  -  SCREW CANNULATED 7.3MM X 135MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16140S	SUP	HCPCS C1713		73-16140S  -  SCREW CANNULATED 7.3MM X 140MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16145S	SUP	HCPCS C1713		73-16145S  -  SCREW CANNULATED 7.3MM X 145MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-16150S	SUP	HCPCS C1713		73-16150S  -  SCREW CANNULATED 7.3MM X 150MM 16MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-1952	SUP	HCPCS C1713		73-1952  -  PLATE BN STERNALOCK BLU 8 HL STRG STRNM	BOTH IP/OP	"$2,562.50 "	"$1,896.25"	$0.00	"$2,050.00"	"$1,153.13"	"$1,153.13"	$0.00	$0.00	$0.00	$534.09	"$1,901.89"	"$1,901.89"	$0.00	$0.00	$534.03	$0.00	"$1,263.31"	"$1,263.31"	$0.00	"$1,281.25"	"$2,029.50"	"$2,050.00"	$0.00		$0.00	$401.03	$0.00	$0.00	$407.95	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-0110	SUP	Custom 27803010		73-20-0110  -  COMPONENT PATLR 1 10MM MEDIALIZED DOME SCORPIO X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-0510	SUP	Custom 27803010		73-20-0510  -  COMPONENT PATLR 5 10MM MEDIALIZED DOME SCORPIO X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-0710	SUP	Custom 27803010		73-20-0710  -  COMPONENT PATLR 7 MEDIALIZE DOME SCORPIO X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-0910	SUP	Custom 27803010		73-20-0910  -  COMPONENT PATLR 9 10MM MEDIALIZED DOME SCORPIO X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-2110	SUP	Custom 27803010		73-20-2110  -  COMPONENT PATLR 11 10MM CONCENTRIC DOME SCORPIO X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-2510	SUP	Custom 27803010		73-20-2510  -  COMPONENT PATLR 5 10MM CONCENTRIC DOME SCORPIO X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-2710	SUP	Custom 27803010		73-20-2710  -  COMPONENT PATLR 7 10MM CONCENTRIC DOME SCORPIO X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-2910	SUP	Custom 27803010		73-20-2910  -  COMPONENT PATLR 9 10MM CONCENTRIC DOME SCORPIO X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-3110	SUP	Custom 27803010		73-20-3110  -  COMPONENT PATLR 11 10MM UNIVERSAL DOME SCORPIO X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-3308	SUP	Custom 27803010		73-20-3308  -  COMPONENT PATLR UNIVERSAL DOME SCORPIO X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-3508	SUP	Custom 27803010		73-20-3508  -  COMPONENT PATLR 5 8MM UNIVERSAL DOME SCORPIO X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-3708	SUP	Custom 27803010		73-20-3708  -  COMPONENT PATLR 7 8MM UNIVERSAL DOME SCORPIO X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-3710	SUP	Custom 27803010		73-20-3710  -  COMPONENT PTLR 7 UNV DOME 34MM 10MM STRL SCRP X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-3910	SUP	Custom 27803010		73-20-3910  -  COMPONENT PTLR 9 UNV DOME 36MM 10MM STRL SCRP X3	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-4026	SUP	Custom 27803010		73-20-4026  -  COMPONENT PATLR 26MM RECESSED SCORPIO X3	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-4028	SUP	Custom 27803010		73-20-4028  -  COMPONENT PATLR 28MM SCORPIO X3	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-4030	SUP	Custom 27803010		73-20-4030  -  COMPONENT PATLR 30MM RECESSED SCORPIO X3	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-4032	SUP	Custom 27803010		73-20-4032  -  COMPONENT PATLR 32MM RECESSED SCORPIO X3	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-5030	SUP	Custom 27803010		73-20-5030  -  CMPNT PATLR 30MM SCRP X3	BOTH IP/OP	"$1,205.00 "	$891.70	$0.00	$964.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$894.35	$894.35	$0.00	$0.00	$251.12	$0.00	$0.00	$0.00	$0.00	$602.50	$954.36	$964.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-20-5032	SUP	Custom 27803010		73-20-5032  -  CMPNT PATLR 32MM INSET SCRP X3	BOTH IP/OP	"$1,205.00 "	$891.70	$0.00	$964.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$894.35	$894.35	$0.00	$0.00	$251.12	$0.00	$0.00	$0.00	$0.00	$602.50	$954.36	$964.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-2110	SUP	Custom 27803010		73-2110  -  COMPONENT PATLR 11 10MM CONCENTRIC DOME SCORPIO N2/VAC	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-2408	SUP	HCPCS C1713		73-2408  -  SCREW BN 2.4MM 8MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2410	SUP	HCPCS C1713		73-2410  -  SCREW BN 2.4MM 10MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2412	SUP	HCPCS C1713		73-2412  -  SCREW BN 2.4MM 12MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2414	SUP	HCPCS C1713		73-2414  -  SCREW BN 2.4MM 14MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2416	SUP	HCPCS C1713		73-2416  -  SCREW BN 2.4MM 16MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2418	SUP	HCPCS C1713		73-2418  -  SCREW BN 2.4MM 18MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2420	SUP	HCPCS C1713		73-2420  -  SCREW BN 2.4MM 20MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2510	SUP	Custom 27803010		73-2510  -  COMPONENT PATLR 5 10MM CONCENTRIC DOME SCORPIO N2/VAC	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-2610	SUP	Custom 27803010		73-2610  -  INSERT TIB 6 10MM PATLR N2 VAC INSET SCRP 26MM	BOTH IP/OP	$851.00 	$629.74	$0.00	$680.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$631.61	$631.61	$0.00	$0.00	$177.35	$0.00	$0.00	$0.00	$0.00	$425.50	$673.99	$680.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-2622	SUP	HCPCS C1713		73-2622  -  PLATE BN SQ STERNALOCK BLU 4 HL STRNM	BOTH IP/OP	"$1,537.50 "	"$1,137.75"	$0.00	"$1,230.00"	$691.88	$691.88	$0.00	$0.00	$0.00	$320.45	"$1,141.13"	"$1,141.13"	$0.00	$0.00	$320.42	$0.00	$909.43	$909.43	$0.00	$768.75	"$1,217.70"	"$1,230.00"	$0.00		$0.00	$240.62	$0.00	$0.00	$244.77	$0.00	$0.00	$0.00	$0.00	$0.00
73-2623	SUP	HCPCS C1713		73-2623  -  PLATE BN STERNALOCK BLU 8 HL STRNM	BOTH IP/OP	"$2,077.50 "	"$1,537.35"	$0.00	"$1,662.00"	$934.88	$934.88	$0.00	$0.00	$0.00	$433.00	"$1,541.92"	"$1,541.92"	$0.00	$0.00	$432.95	$0.00	"$1,228.84"	"$1,228.84"	$0.00	"$1,038.75"	"$1,645.38"	"$1,662.00"	$0.00		$0.00	$325.13	$0.00	$0.00	$330.74	$0.00	$0.00	$0.00	$0.00	$0.00
73-2632	SUP	HCPCS C1713		73-2632  -  PLATE BN NAR STERNALOCK BLU 12 HL STRNM 2.4MM SCR	BOTH IP/OP	"$2,175.00 "	"$1,609.50"	$0.00	"$1,740.00"	$978.75	$978.75	$0.00	$0.00	$0.00	$453.32	"$1,614.29"	"$1,614.29"	$0.00	$0.00	$453.27	$0.00	"$1,286.51"	"$1,286.51"	$0.00	"$1,087.50"	"$1,722.60"	"$1,740.00"	$0.00		$0.00	$340.39	$0.00	$0.00	$346.26	$0.00	$0.00	$0.00	$0.00	$0.00
73-2634	SUP	HCPCS C1713		73-2634  -  PLATE BN W STERNALOCK BLU 12 HL STRNM 2.4MM SCR	BOTH IP/OP	"$2,175.00 "	"$1,609.50"	$0.00	"$1,740.00"	$978.75	$978.75	$0.00	$0.00	$0.00	$453.32	"$1,614.29"	"$1,614.29"	$0.00	$0.00	$453.27	$0.00	"$1,286.51"	"$1,286.51"	$0.00	"$1,087.50"	"$1,722.60"	"$1,740.00"	$0.00		$0.00	$340.39	$0.00	$0.00	$346.26	$0.00	$0.00	$0.00	$0.00	$0.00
73-2636	SUP	HCPCS C1713		73-2636  -  PLATE BN STRG STERNALOCK BLU 4 HL STRNM 2.4MM SCR	BOTH IP/OP	"$1,537.50 "	"$1,137.75"	$0.00	"$1,230.00"	$691.88	$691.88	$0.00	$0.00	$0.00	$320.45	"$1,141.13"	"$1,141.13"	$0.00	$0.00	$320.42	$0.00	$909.43	$909.43	$0.00	$768.75	"$1,217.70"	"$1,230.00"	$0.00		$0.00	$240.62	$0.00	$0.00	$244.77	$0.00	$0.00	$0.00	$0.00	$0.00
73-2643	SUP	HCPCS C1713		73-2643  -  PLATE BN 100D L STERNALOCK BLU 4 HL STRNM	BOTH IP/OP	"$1,537.50 "	"$1,137.75"	$0.00	"$1,230.00"	$691.88	$691.88	$0.00	$0.00	$0.00	$320.45	"$1,141.13"	"$1,141.13"	$0.00	$0.00	$320.42	$0.00	$909.43	$909.43	$0.00	$768.75	"$1,217.70"	"$1,230.00"	$0.00		$0.00	$240.62	$0.00	$0.00	$244.77	$0.00	$0.00	$0.00	$0.00	$0.00
73-2645	SUP	HCPCS C1713		73-2645  -  PLATE BN JL STERNALOCK BLU 8 HL STRNM PRM CLSR SYS	BOTH IP/OP	"$1,945.00 "	"$1,439.30"	$0.00	"$1,556.00"	$875.25	$875.25	$0.00	$0.00	$0.00	$405.39	"$1,443.58"	"$1,443.58"	$0.00	$0.00	$405.34	$0.00	"$1,150.47"	"$1,150.47"	$0.00	$972.50	"$1,540.44"	"$1,556.00"	$0.00		$0.00	$304.39	$0.00	$0.00	$309.64	$0.00	$0.00	$0.00	$0.00	$0.00
73-2708	SUP	HCPCS C1713		73-2708  -  SCREW BN 2.7MM 8MM MAG STERNALOCK BLU SLF DRL LCK STRNM CANC	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2710	SUP	HCPCS C1713		73-2710  -  COMPONENT PTLR 7 CONC DOME 34/38MM 10MM SCRP N2/VAC	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2712	SUP	HCPCS C1713		73-2712  -  SCREW BN 2.7MM 12MM MAG STERNALOCK BLU SLF DRL LCK STRNM	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2714	SUP	HCPCS C1713		73-2714  -  SCREW BN 2.7MM 14MM MAG STERNALOCK BLU SLF DRL LCK STRNM	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2716	SUP	HCPCS C1713		73-2716  -  SCREW BN 2.7MM 16MM MAG STERNALOCK BLU SLF DRL LCK STRNM	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2718	SUP	HCPCS C1713		73-2718  -  SCREW BN 2.7MM 18MM MAG STERNALOCK BLU SLF DRL LCK STRNM	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2720	SUP	HCPCS C1713		73-2720  -  SCREW BN 2.7MM 20MM MAG STERNALOCK BLU SLF DRL LCK STRNM	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
73-2810	SUP	Custom 27803010		73-2810  -  CMPNT PATLR 8 10MM 28MM INSET SCRP	BOTH IP/OP	$851.00 	$629.74	$0.00	$680.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$631.61	$631.61	$0.00	$0.00	$177.35	$0.00	$0.00	$0.00	$0.00	$425.50	$673.99	$680.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73281488/8ARM	SUP	HCPCS C1768		73281488/8ARM  -  GRAFT CARDIOVASCULAR PLEXUS 28MM 14X8X8	BOTH IP/OP	"$6,612.50 "	"$4,893.25"	$0.00	"$5,290.00"	"$2,975.63"	"$2,975.63"	$0.00	$0.00	$0.00	"$1,378.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,378.05"	$0.00	"$3,259.96"	"$3,259.96"	$0.00	"$3,306.25"	"$5,237.10"	"$5,290.00"	$0.00		$0.00	"$1,034.86"	$0.00	$0.00	"$1,052.71"	$0.00	$0.00	$0.00	$0.00	$0.00
73-2910	SUP	Custom 27803010		73-2910  -  COMPONENT PATLR 9 CONCENTRIC DOME 10MM SCORPIO N2/VAC	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-3010	SUP	Custom 27803010		73-3010  -  CMPNT PATLR INSET SCRP	BOTH IP/OP	$851.00 	$629.74	$0.00	$680.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$631.61	$631.61	$0.00	$0.00	$177.35	$0.00	$0.00	$0.00	$0.00	$425.50	$673.99	$680.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73301488/8ARM	SUP	HCPCS C1768		73301488/8ARM  -  4 BRANCH TOTAL ARC GRAFT 30MM	BOTH IP/OP	"$6,612.50 "	"$4,893.25"	$0.00	"$5,290.00"	"$2,975.63"	"$2,975.63"	$0.00	$0.00	$0.00	"$1,378.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,378.05"	$0.00	"$3,259.96"	"$3,259.96"	$0.00	"$3,306.25"	"$5,237.10"	"$5,290.00"	$0.00		$0.00	"$1,034.86"	$0.00	$0.00	"$1,052.71"	$0.00	$0.00	$0.00	$0.00	$0.00
73-3110	SUP	Custom 27803010		73-3110  -  COMPONENT PATLR 11MM 10MM UNIVERSAL DOME SCORPIO N2/VAC	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-32045S	SUP	HCPCS C1713		73-32045S  -  SCREW CANNULATED 7.3MM X 45MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32050S	SUP	HCPCS C1713		73-32050S  -  SCREW CANNULATED 7.3MM X 50MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32055S	SUP	HCPCS C1713		73-32055S  -  SCREW CANNULATED 7.3MM X 55MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32060S	SUP	HCPCS C1713		73-32060S  -  SCREW CANNULATED 7.3MM X 60MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32065S	SUP	HCPCS C1713		73-32065S  -  SCREW CANNULATED 7.3MM X 65MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32070S	SUP	HCPCS C1713		73-32070S  -  SCREW CANNULATED 7.3MM X 70MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32075S	SUP	HCPCS C1713		73-32075S  -  SCREW CANNULATED 7.3MM X 75MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32080S	SUP	HCPCS C1713		73-32080S  -  SCREW CANNULATED 7.3MM X 80MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32085S	SUP	HCPCS C1713		73-32085S  -  SCREW CANNULATED 7.3MM X 85MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32090S	SUP	HCPCS C1713		73-32090S  -  SCREW CANNULATED 7.3MM X 90MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32095S	SUP	HCPCS C1713		73-32095S  -  SCREW CANNULATED 7.3MM X 95MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-3210	SUP	Custom 27803010		73-3210  -  CMPNT PATLR 2 10MM 32MM INSET SCRP	BOTH IP/OP	$851.00 	$629.74	$0.00	$680.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$631.61	$631.61	$0.00	$0.00	$177.35	$0.00	$0.00	$0.00	$0.00	$425.50	$673.99	$680.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-32100S	SUP	HCPCS C1713		73-32100S  -  SCREW CANNULATED 7.3MM X 100MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32105S	SUP	HCPCS C1713		73-32105S  -  SCREW CANNULATED 7.3MM X 105MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32110S	SUP	HCPCS C1713		73-32110S  -  SCREW CANNULATED 7.3MM X 110MM 32MM THREAD	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32115S	SUP	HCPCS C1713		73-32115S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 115MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32120S	SUP	HCPCS C1713		73-32120S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 120MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32125S	SUP	HCPCS C1713		73-32125S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 125MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32130S	SUP	HCPCS C1713		73-32130S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 130MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32135S	SUP	HCPCS C1713		73-32135S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 135MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32140S	SUP	HCPCS C1713		73-32140S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 140MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32145S	SUP	HCPCS C1713		73-32145S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 145MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-32150S	SUP	HCPCS C1713		73-32150S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 150MM	BOTH IP/OP	$235.00 	$173.90	$0.00	$188.00	$105.75	$105.75	$0.00	$0.00	$0.00	$48.98	$174.42	$174.42	$0.00	$0.00	$48.97	$0.00	$139.00	$139.00	$0.00	$117.50	$186.12	$188.00	$0.00		$0.00	$36.78	$0.00	$0.00	$37.41	$0.00	$0.00	$0.00	$0.00	$0.00
73-3308	SUP	Custom 27803010		73-3308  -  COMPONENT PATLR 3 8MM UNIVERSAL DOME SCORPIO N2/VAC	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-3508	SUP	Custom 27803010		73-3508  -  COMPONENT PATLR 5 32MM 5MM 8MM 4MM UNIVERSAL DOME PEGGED	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-3708	SUP	Custom 27803010		73-3708  -  COMPONENT PATLR 7 8MM 8MM UNIVERSAL DOME SCORPIO N2/VAC	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-3710	SUP	Custom 27803010		73-3710  -  COMPONENT PTLR 7 UNV DOME 34MM 10MM SCRP PG N2/VAC 1 AXIS KN	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
73-3910	SUP	Custom 27803010		73-3910  -  COMPONENT PTLR 5 UNV DOME 36MM 10MM SCRP PG N2/VAC 1 AXIS KN	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$0.00	$0.00	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
734024/8	SUP	HCPCS C1768		734024/8  -  GRAFT CARDIO 8MM 24MM 8MM 40CM 15CM ANTE-FLO VASCUTEK	BOTH IP/OP	"$3,225.00 "	"$2,386.50"	$0.00	"$2,580.00"	"$1,451.25"	"$1,451.25"	$0.00	$0.00	$0.00	$672.17	"$2,393.60"	"$2,393.60"	$0.00	$0.00	$672.09	$0.00	"$1,589.93"	"$1,589.93"	$0.00	"$1,612.50"	"$2,554.20"	"$2,580.00"	$0.00		$0.00	$504.71	$0.00	$0.00	$513.42	$0.00	$0.00	$0.00	$0.00	$0.00
734026/8	SUP	HCPCS C1768		734026/8  -  GRAFT CARDIO 8MM 26MM 8MM 40CM 15CM PERFUSION SIDE BRANCH	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
734028/8	SUP	HCPCS C1768		734028/8  -  GRAFT CARDIO 40CM 28MM 8MM AORTIC ARCH WVN SIDE BRCH GLWV	BOTH IP/OP	"$3,862.50 "	"$2,858.25"	$0.00	"$2,866.75"	$602.44	$602.44	$0.00	$0.00	$0.00	$0.00	"$2,866.75"	"$2,866.75"	$0.00	$0.00	$804.95	$0.00	$0.00	$0.00	$0.00	$669.38	"$1,060.29"	"$1,071.00"	$0.00		$0.00	$209.51	$0.00	$0.00	$213.13	$0.00	$0.00	$0.00	$0.00	$0.00
734030/8	SUP	HCPCS C1768		734030/8  -  GRAFT CARDIO 30MM 8MM 40CM 15CM ANTEFLO PERFUSION SIDE	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
734032/8	SUP	HCPCS C1768		734032/8  -  GRAFT CARDIO 32MM 8MM 40CM 15CM PERFUSION SIDE BRANCH GRAFT	BOTH IP/OP	"$4,050.00 "	"$2,997.00"	$0.00	"$3,240.00"	"$1,822.50"	"$1,822.50"	$0.00	$0.00	$0.00	$844.12	"$3,005.91"	"$3,005.91"	$0.00	$0.00	$844.02	$0.00	"$1,996.65"	"$1,996.65"	$0.00	"$2,025.00"	"$3,207.60"	"$3,240.00"	$0.00		$0.00	$633.83	$0.00	$0.00	$644.76	$0.00	$0.00	$0.00	$0.00	$0.00
734034/8	SUP	HCPCS C1768		734034/8  -  GRAFT CARDIO 34MM 8MM 40CM 15CM ANTEFLO PERFUSION SIDE	BOTH IP/OP	"$3,387.50 "	"$2,506.75"	$0.00	"$2,710.00"	"$1,524.38"	"$1,524.38"	$0.00	$0.00	$0.00	$706.04	"$2,514.20"	"$2,514.20"	$0.00	$0.00	$705.96	$0.00	"$1,670.04"	"$1,670.04"	$0.00	"$1,693.75"	"$2,682.90"	"$2,710.00"	$0.00		$0.00	$530.14	$0.00	$0.00	$539.29	$0.00	$0.00	$0.00	$0.00	$0.00
74-2-0510	SUP	Custom 27803010		74-2-0510  -  INSERT TIB 5 10MM KNEE ALPLY CRUC RET SCRP	BOTH IP/OP	"$1,431.00 "	"$1,058.94"	$0.00	"$1,144.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,062.09"	"$1,062.09"	$0.00	$0.00	$298.22	$0.00	$0.00	$0.00	$0.00	$715.50	"$1,133.35"	"$1,144.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74-2-0512	SUP	Custom 27803010		74-2-0512  -  INSERT TIB 5 12MM KNEE ALPLY N2 VAC CRUC RET SCRP	BOTH IP/OP	"$1,431.00 "	"$1,058.94"	$0.00	"$1,144.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,062.09"	"$1,062.09"	$0.00	$0.00	$298.22	$0.00	$0.00	$0.00	$0.00	$715.50	"$1,133.35"	"$1,144.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74-2-0515	SUP	HCPCS C1776		74-2-0515  -  CMPNT TIB 15MM SCRP 5 KNEE ALPLY CRUC RET	BOTH IP/OP	"$1,431.00 "	"$1,058.94"	$0.00	"$1,144.80"	$643.95	$643.95	$0.00	$0.00	$0.00	$298.26	"$1,062.09"	"$1,062.09"	$0.00	$0.00	$298.22	$0.00	$846.44	$846.44	$0.00	$715.50	"$1,133.35"	"$1,144.80"	$0.00		$0.00	$223.95	$0.00	$0.00	$227.82	$0.00	$0.00	$0.00	$0.00	$0.00
74-2-0710	SUP	Custom 27803010		74-2-0710  -  INSERT TIB 7 10MM KNEE PE N2 VAC CRUC RET STY SCRP	BOTH IP/OP	"$1,431.00 "	"$1,058.94"	$0.00	"$1,144.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,062.09"	"$1,062.09"	$0.00	$0.00	$298.22	$0.00	$0.00	$0.00	$0.00	$715.50	"$1,133.35"	"$1,144.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74-2-0712	SUP	Custom 27803010		74-2-0712  -  INSERT TIB 7 12MM KNEE ALPLY N2 VAC CRUC RET SCRP	BOTH IP/OP	"$1,431.00 "	"$1,058.94"	$0.00	"$1,144.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,062.09"	"$1,062.09"	$0.00	$0.00	$298.22	$0.00	$0.00	$0.00	$0.00	$715.50	"$1,133.35"	"$1,144.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74-2-0715	SUP	Custom 27803010		74-2-0715  -  INSERT TIB 7 15MM KNEE ALPLY N2 VAC CRUC RET SCRP	BOTH IP/OP	"$1,431.00 "	"$1,058.94"	$0.00	"$1,144.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,062.09"	"$1,062.09"	$0.00	$0.00	$298.22	$0.00	$0.00	$0.00	$0.00	$715.50	"$1,133.35"	"$1,144.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74-2-0910	SUP	HCPCS C1776		74-2-0910  -  CMPNT TIB 10MM SCRP 9 KNEE ALPLY CRUC RET	BOTH IP/OP	"$1,431.00 "	"$1,058.94"	$0.00	"$1,144.80"	$643.95	$643.95	$0.00	$0.00	$0.00	$298.26	"$1,062.09"	"$1,062.09"	$0.00	$0.00	$298.22	$0.00	$846.44	$846.44	$0.00	$715.50	"$1,133.35"	"$1,144.80"	$0.00		$0.00	$223.95	$0.00	$0.00	$227.82	$0.00	$0.00	$0.00	$0.00	$0.00
74-2-0912	SUP	Custom 27803010		74-2-0912  -  INSERT TIB 9 12MM KNEE ALPLY N2 VAC CRUC RET SCRP	BOTH IP/OP	"$1,431.00 "	"$1,058.94"	$0.00	"$1,144.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,062.09"	"$1,062.09"	$0.00	$0.00	$298.22	$0.00	$0.00	$0.00	$0.00	$715.50	"$1,133.35"	"$1,144.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74-2-0915	SUP	Custom 27803010		74-2-0915  -  INSERT TIB 9 15MM KNEE ALPLY N2 VAC CRUC RET SCRP	BOTH IP/OP	"$1,431.00 "	"$1,058.94"	$0.00	"$1,144.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,062.09"	"$1,062.09"	$0.00	$0.00	$298.22	$0.00	$0.00	$0.00	$0.00	$715.50	"$1,133.35"	"$1,144.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74-2-1110	SUP	Custom 27803010		74-2-1110  -  INSERT TIB 11 10MM KNEE ALPLY N2 VAC CRUC RET SCRP	BOTH IP/OP	"$1,431.00 "	"$1,058.94"	$0.00	"$1,144.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,062.09"	"$1,062.09"	$0.00	$0.00	$298.22	$0.00	$0.00	$0.00	$0.00	$715.50	"$1,133.35"	"$1,144.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74-2-1112	SUP	Custom 27803010		74-2-1112  -  INSERT TIB 11 12MM KNEE ALPLY N2 VAC CRUC RET SCRP	BOTH IP/OP	"$1,431.00 "	"$1,058.94"	$0.00	"$1,144.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,062.09"	"$1,062.09"	$0.00	$0.00	$298.22	$0.00	$0.00	$0.00	$0.00	$715.50	"$1,133.35"	"$1,144.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74-2-1115	SUP	Custom 27803010		74-2-1115  -  INSERT TIB 11 15MM KNEE ALPLY N2 VAC CRUC RET SCRP	BOTH IP/OP	"$1,431.00 "	"$1,058.94"	$0.00	"$1,144.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,062.09"	"$1,062.09"	$0.00	$0.00	$298.22	$0.00	$0.00	$0.00	$0.00	$715.50	"$1,133.35"	"$1,144.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-42A	SUP	HCPCS C1776		742-11-42A  -  SHELL ACTB A 42MM STRL TRDNT II PSL 3 HL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-44B	SUP	HCPCS C1776		742-11-44B  -  SHELL ACTB B 44MM STRL TRDNT II PSL 3 HL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-46C	SUP	HCPCS C1776		742-11-46C  -  SHELL ACTB C 46MM STRL TRDNT II PSL 3 HL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-48D	SUP	HCPCS C1776		742-11-48D  -  SHELL ACTB D 48MM STRL TRDNT II PSL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-50D	SUP	HCPCS C1776		742-11-50D  -  SHELL ACTB D 50MM STRL TRDNT II PSL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-52E	SUP	HCPCS C1776		742-11-52E  -  SHELL ACTB E 52MM STRL TRDNT II PSL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-54E	SUP	HCPCS C1776		742-11-54E  -  SHELL ACTB E 54MM STRL TRDNT II PSL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-56F	SUP	HCPCS C1776		742-11-56F  -  SHELL ACTB F 56MM STRL TRDNT II PSL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-58F	SUP	HCPCS C1776		742-11-58F  -  SHELL ACTB F 58MM STRL TRDNT II PSL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-60G	SUP	HCPCS C1776		742-11-60G  -  SHELL ACTB G 60MM STRL TRDNT II PSL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-62G	SUP	HCPCS C1776		742-11-62G  -  SHELL ACTB G 62MM STRL TRDNT II PSL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-64H	SUP	HCPCS C1776		742-11-64H  -  SHELL ACTB H 64MM STRL TRDNT II PSL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
742-11-66H	SUP	HCPCS C1776		742-11-66H  -  SHELL ACTB H 66MM STRL TRDNT II PSL CH HA HIP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
74-3-0510	SUP	HCPCS C1776		74-3-0510  -  CMPNT TIB 10MM 5 KNEE ALPLY PS	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$661.50	$661.50	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
74-3-0512	SUP	HCPCS C1776		74-3-0512  -  CMPNT TIB 12MM 5 KNEE ALPLY PS	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$661.50	$661.50	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
74-3-0515	SUP	HCPCS C1776		74-3-0515  -  CMPNT TIB 15MM 5 KNEE ALPLY PS	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$661.50	$661.50	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
74-3-0710	SUP	HCPCS C1776		74-3-0710  -  CMPNT TIB 10MM 7 KNEE ALPLY PS STY	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$661.50	$661.50	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
74-3-0712	SUP	HCPCS C1776		74-3-0712  -  CMPNT TIB 12MM 7 KNEE ALPLY PS	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$661.50	$661.50	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
74-3-0715	SUP	HCPCS C1776		74-3-0715  -  CMPNT TIB 15MM 7 KNEE ALPLY PS	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$661.50	$661.50	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
74-3-0910	SUP	HCPCS C1776		74-3-0910  -  CMPNT TIB 10MM 9 KNEE ALPLY PS	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$661.50	$661.50	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
74-3-0912	SUP	HCPCS C1776		74-3-0912  -  CMPNT TIB 12MM 9 KNEE ALPLY PS	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$661.50	$661.50	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
74-3-0915	SUP	HCPCS C1776		74-3-0915  -  CMPNT TIB 15MM 9 KNEE ALPLY PS	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$661.50	$661.50	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
74-3-1110	SUP	HCPCS C1776		74-3-1110  -  CMPNT TIB 10MM 11 KNEE ALPLY PS	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$661.50	$661.50	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
74-3-1112	SUP	HCPCS C1776		74-3-1112  -  CMPNT TIB 12MM 11 KNEE ALPLY PS	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$661.50	$661.50	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
74-3-1115	SUP	HCPCS C1776		74-3-1115  -  CMPNT TIB 15MM 11 KNEE ALPLY PS	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$661.50	$661.50	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
74402006N	SUP	HCPCS C1713		74402006N  -  SCREW BN T6 2MM 1.4MM 6MM NS VLP MN-MOD ST TI OSTEOPENIA	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402007N	SUP	HCPCS C1713		74402007N  -  SCREW BN T6 2MM 1.4MM 7MM NS VLP MN-MOD ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402008N	SUP	HCPCS C1713		74402008N  -  SCREW BN T6 2MM 1.4MM 8MM NS VLP MN-MOD ST DRV MECH TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402009N	SUP	HCPCS C1713		74402009N  -  SCREW BN T6 2MM 1.4MM 9MM NS VLP MN-MOD ST TI OSTEOPENIA	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402010N	SUP	HCPCS C1713		74402010N  -  SCREW BN T6 2MM 1.4MM 10MM NS VLP MN-MOD ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402011N	SUP	HCPCS C1713		74402011N  -  SCREW BN T6 2MM 1.4MM 11MM NS VLP MN-MOD ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402012N	SUP	HCPCS C1713		74402012N  -  SCREW BN 2MM 1.4MM 12MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402013N	SUP	HCPCS C1713		74402013N  -  SCREW BN T6 2MM 1.4MM 13MM NS VLP MN-MOD ST TI OSTEOPENIA	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402014N	SUP	HCPCS C1713		74402014N  -  SCREW BN 2MM 1.4MM 14MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402016N	SUP	HCPCS C1713		74402016N  -  SCREW BN 2MM 1.4MM 16MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402018N	SUP	HCPCS C1713		74402018N  -  SCREW BN 2MM 1.4MM 18MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402020N	SUP	HCPCS C1713		74402020N  -  SCREW BN 2MM 1.4MM 20MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402022N	SUP	HCPCS C1713		74402022N  -  SCREW BN T6 2MM 1.4MM 22MM NS VLP MN-MOD ST TI OSTEOPENIA	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402024N	SUP	HCPCS C1713		74402024N  -  SCREW BN T6 2MM 1.4MM 24MM NS VLP MN-MOD ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402026N	SUP	HCPCS C1713		74402026N  -  SCREW BN T6 2MM 1.4MM 26MM NS VLP MN-MOD ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402028N	SUP	HCPCS C1713		74402028N  -  SCREW BN T6 2MM 1.4MM 28MM NS VLP MN-MOD ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402030N	SUP	HCPCS C1713		74402030N  -  SCREW BN T6 2MM 1.4MM 30MM NS VLP MN-MOD ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402032N	SUP	HCPCS C1713		74402032N  -  SCREW BN T6 2MM 1.4MM 32MM NS VLP MN-MOD ST TI OSTEOPENIA	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402034N	SUP	HCPCS C1713		74402034N  -  SCREW BN T6 2MM 1.4MM 34MM NS VLP MN-MOD ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402036N	SUP	HCPCS C1713		74402036N  -  SCREW BN T6 2MM 1.4MM 36MM NS VLP MN-MOD ST TI OSTEOPENIA	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402406N	SUP	HCPCS C1713		74402406N  -  SCREW BN T7 2.4MM 1.7MM 6MM NS VLP MN-MOD ST TI OSTEOPENIA	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402407N	SUP	HCPCS C1713		74402407N  -  SCREW BN T7 2.4MM 1.7MM 7MM NS VLP MN-MOD ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402409N	SUP	HCPCS C1713		74402409N  -  SCREW BN T7 2.4MM 1.7MM 9MM GRN NS VLP ST LO HD PRFL TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402410N	SUP	HCPCS C1713		74402410N  -  SCREW BN T7 2.4MM 1.7MM 10MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402411N	SUP	HCPCS C1713		74402411N  -  SCREW BN T7 2.4MM 1.7MM 11MM NS VLP MN-MOD ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402412N	SUP	HCPCS C1713		74402412N  -  SCREW BN 2.4MM 1.7MM 12MM GRN NS VLP MN-MOD T7 DRVR ST TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402413N	SUP	HCPCS C1713		74402413N  -  SCREW BN T7 2.4MM 1.7MM 13MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402414N	SUP	HCPCS C1713		74402414N  -  SCREW BN 2.4MM 1.7MM 14MM GRN NS VLP MN-MOD T7 DRVR ST TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402415N	SUP	HCPCS C1713		74402415N  -  SCREW BN 2.4MM 1.7MM 15MM GRN NS VLP MN-MOD T7 DRVR ST TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402416N	SUP	HCPCS C1713		74402416N  -  SCREW BN T7 2.4MM 1.7MM 16MM GRN NS VLP ST LOPRFL HD TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402418N	SUP	HCPCS C1713		74402418N  -  SCREW BN T7 2.4MM 1.7MM 18MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402420N	SUP	HCPCS C1713		74402420N  -  SCREW BN T7 2.4MM 1.7MM 20MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402422N	SUP	HCPCS C1713		74402422N  -  SCREW BN T7 2.4MM 1.7MM 22MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402424N	SUP	HCPCS C1713		74402424N  -  SCREW BN T7 2.4MM 1.7MM 24MM GRN NS VLP ST LOPRFL HD TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402426N	SUP	HCPCS C1713		74402426N  -  SCREW BN T7 2.4MM 26MM NS VLP MN-MOD ST TI CORT	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402428N	SUP	HCPCS C1713		74402428N  -  SCREW BN T7 2.4MM 1.7MM 28MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402430N	SUP	HCPCS C1713		74402430N  -  SCREW BN T7 2.4MM 1.7MM 30MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402432N	SUP	HCPCS C1713		74402432N  -  SCREW BN T7 2.4MM 1.7MM 32MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402434N	SUP	HCPCS C1713		74402434N  -  SCREW BN T7 2.4MM 1.7MM 34MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402436N	SUP	HCPCS C1713		74402436N  -  SCREW BN T7 2.4MM 1.7MM 36MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402438N	SUP	HCPCS C1713		74402438N  -  SCREW BN T7 2.4MM 1.7MM 38MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402440N	SUP	HCPCS C1713		74402440N  -  SCREW BN T7 2.4MM 1.7MM 40MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402442N	SUP	HCPCS C1713		74402442N  -  SCREW BN T7 2.4MM 1.7MM 42MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402444N	SUP	HCPCS C1713		74402444N  -  SCREW BN T7 2.4MM 1.7MM 44MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74402446N	SUP	HCPCS C1713		74402446N  -  SCREW BN T7 2.4MM 1.7MM 46MM GRN NS VLP ST LO HD PRFL TI	BOTH IP/OP	$112.48 	$83.24	$0.00	$89.98	$50.61	$50.61	$0.00	$0.00	$0.00	$23.44	$83.48	$83.48	$0.00	$0.00	$23.44	$0.00	$66.53	$66.53	$0.00	$56.24	$89.08	$89.98	$0.00		$0.00	$17.60	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
74412006N	SUP	HCPCS C1713		74412006N  -  SCREW BN T6 2MM 1.4MM 6MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412007N	SUP	HCPCS C1713		74412007N  -  SCREW BN T6 2MM 1.4MM 7MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412008N	SUP	HCPCS C1713		74412008N  -  SCREW BN 2MM 8MM NS VLP LCK ST T6 DRVR TI SM BN	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412009N	SUP	HCPCS C1713		74412009N  -  SCREW BN T6 2MM 1.4MM 9MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412010N	SUP	HCPCS C1713		74412010N  -  SCREW BN 2MM 10MM NS VLP LCK ST T6 DRVR TI SM BN	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412011N	SUP	HCPCS C1713		74412011N  -  SCREW BN 2MM 1.4MM 11MM PUR NS VLP MN-MOD T6 DRVR ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412012N	SUP	HCPCS C1713		74412012N  -  SCREW BN 2MM 1.4MM 12MM PUR NS VLP MN-MOD T6 DRVR ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412013N	SUP	HCPCS C1713		74412013N  -  SCREW BN T6 2MM 1.4MM 13MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412014N	SUP	HCPCS C1713		74412014N  -  SCREW BN 2MM 14MM NS VLP LCK ST T6 DRVR TI SM BN	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412016N	SUP	HCPCS C1713		74412016N  -  SCREW BN T6 2MM 1.4MM 16MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412018N	SUP	HCPCS C1713		74412018N  -  SCREW BN T6 2MM 1.4MM 18MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412020N	SUP	HCPCS C1713		74412020N  -  SCREW BN T6 2MM 1.4MM 20MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412022N	SUP	HCPCS C1713		74412022N  -  SCREW BN T6 2MM 1.4MM 22MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412024N	SUP	HCPCS C1713		74412024N  -  SCREW BN T6 2MM 1.4MM 24MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412026N	SUP	HCPCS C1713		74412026N  -  SCREW BN T6 2MM 1.4MM 26MM PUR NS VLP LCK ST LO HD PRFL TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412028N	SUP	HCPCS C1713		74412028N  -  SCREW BN T6 2MM 1.4MM 28MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412030N	SUP	HCPCS C1713		74412030N  -  SCREW BN T6 2MM 1.4MM 30MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412032N	SUP	HCPCS C1713		74412032N  -  SCREW BN T6 2MM 1.4MM 32MM PUR NS VLP LCK ST LO HD PRFL TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412034N	SUP	HCPCS C1713		74412034N  -  SCREW BN T6 2MM 1.4MM 34MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412036N	SUP	HCPCS C1713		74412036N  -  SCREW BN T6 2MM 1.4MM 36MM PUR NS VLP LCK ST LOPRFL HD TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412406N	SUP	HCPCS C1713		74412406N  -  SCREW BN T7 2.4MM 1.7MM 6MM NS VLP MN-MOD ST LCK TI CORT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412407N	SUP	HCPCS C1713		74412407N  -  SCREW BN T7 2.4MM 1.7MM 7MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412408N	SUP	HCPCS C1713		74412408N  -  SCREW BN T7 2.4MM 8MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412409N	SUP	HCPCS C1713		74412409N  -  SCREW BN T7 2.4MM 1.7MM 9MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412410N	SUP	HCPCS C1713		74412410N  -  SCREW BN T7 2.4MM 10MM NS VLP MN-MOD ST LCK LOPRFL HD TI FT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412411N	SUP	HCPCS C1713		74412411N  -  SCREW BN T7 2.4MM 1.7MM 11MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412412N	SUP	HCPCS C1713		74412412N  -  SCREW BN T7 2.4MM 1.7MM 12MM NS VLP ST LCK TI CORT MN-MOD SM	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412413N	SUP	HCPCS C1713		74412413N  -  SCREW BN T7 2.4MM 1.7MM 13MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412414N	SUP	HCPCS C1713		74412414N  -  SCREW BN T7 2.4MM 1.7MM 14MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412415N	SUP	HCPCS C1713		74412415N  -  SCREW BN T7 2.4MM 1.7MM 15MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412416N	SUP	HCPCS C1713		74412416N  -  SCREW BN 2.4MM 1.7MM 16MM GRN NS VLP MN-MOD T7 DRVR ST LCK	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412418N	SUP	HCPCS C1713		74412418N  -  SCREW BN T7 2.4MM 18MM NS VLP ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412420N	SUP	HCPCS C1713		74412420N  -  SCREW BN T7 2.4MM 1.7MM 20MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412422N	SUP	HCPCS C1713		74412422N  -  SCREW BN T7 2.4MM 22MM GRN NS VLP ST DRVR TI FT SM BN PLT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412424N	SUP	HCPCS C1713		74412424N  -  SCREW BN T7 2.4MM 24MM GRN NS VLP ST DRVR TI FT SM BN PLT	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412426N	SUP	HCPCS C1713		74412426N  -  SCREW BN T7 2.4MM 1.7MM 26MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412428N	SUP	HCPCS C1713		74412428N  -  SCREW BN T7 2.4MM 1.7MM 28MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412430N	SUP	HCPCS C1713		74412430N  -  SCREW BN T7 2.4MM 1.7MM 30MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412432N	SUP	HCPCS C1713		74412432N  -  SCREW BN T7 2.4MM 1.7MM 32MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412434N	SUP	HCPCS C1713		74412434N  -  SCREW BN T7 2.4MM 1.7MM 34MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412436N	SUP	HCPCS C1713		74412436N  -  SCREW BN T7 2.4MM 1.7MM 36MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412438N	SUP	HCPCS C1713		74412438N  -  SCREW BN T7 2.4MM 1.7MM 38MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412440N	SUP	HCPCS C1713		74412440N  -  SCREW BN T7 2.4MM 1.7MM 40MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412442N	SUP	HCPCS C1713		74412442N  -  SCREW BN T7 2.4MM 1.7MM 42MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412444N	SUP	HCPCS C1713		74412444N  -  SCREW BN T7 2.4MM 1.7MM 44MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
74412446N	SUP	HCPCS C1713		74412446N  -  SCREW BN T7 2.4MM 1.7MM 46MM NS VLP MN-MOD ST LCK TI	BOTH IP/OP	$237.88 	$176.03	$0.00	$190.30	$107.04	$107.04	$0.00	$0.00	$0.00	$49.58	$176.55	$176.55	$0.00	$0.00	$49.57	$0.00	$140.70	$140.70	$0.00	$118.94	$188.40	$190.30	$0.00		$0.00	$37.23	$0.00	$0.00	$37.87	$0.00	$0.00	$0.00	$0.00	$0.00
746F8	SUP	HCPCS C1751		746F8  -  CATHETER PA STD 8FR 110CM SG C VIP TD	BOTH IP/OP	"$1,006.70 "	$744.96	$0.00	$805.36	$453.02	$453.02	$0.00	$0.00	$0.00	$209.82	$747.17	$747.17	$0.00	$0.00	$209.80	$0.00	$595.46	$595.46	$0.00	$503.35	$797.31	$805.36	$0.00		$0.00	$157.55	$0.00	$0.00	$160.27	$0.00	$0.00	$0.00	$0.00	$0.00
746HF8	SUP	Custom 27203010		746HF8  -  CATHETER ART LN 8FR 110CM SG C VIP 7 LUM CCO AMC THRMBSH	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$398.93	$398.93	$0.00	$0.00	$112.02	$0.00	$0.00	$0.00	$0.00	$268.75	$425.70	$430.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
74703-02	SUP	Custom 27203010		74703-02  -  TUBING PACK	BOTH IP/OP	$636.25 	$470.83	$0.00	$509.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$472.22	$472.22	$0.00	$0.00	$132.59	$0.00	$0.00	$0.00	$0.00	$318.13	$503.91	$509.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0108	SUP	Custom 27803010		7492-0108  -  BRNG INS PS TIB	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0110	SUP	Custom 27803010		7492-0110  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0112	SUP	Custom 27803010		7492-0112  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0115	SUP	Custom 27803010		7492-0115  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0118	SUP	Custom 27803010		7492-0118  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0121	SUP	Custom 27803010		7492-0121  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0124	SUP	Custom 27803010		7492-0124  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,347.00 "	$996.78	$0.00	"$1,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$999.74	$999.74	$0.00	$0.00	$280.71	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0308	SUP	Custom 27803010		7492-0308  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0310	SUP	Custom 27803010		7492-0310  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0312	SUP	Custom 27803010		7492-0312  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0315	SUP	Custom 27803010		7492-0315  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0318	SUP	Custom 27803010		7492-0318  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0321	SUP	Custom 27803010		7492-0321  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0324	SUP	Custom 27803010		7492-0324  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0508	SUP	Custom 27803010		7492-0508  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0510	SUP	Custom 27803010		7492-0510  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0512	SUP	Custom 27803010		7492-0512  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0515	SUP	Custom 27803010		7492-0515  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,347.00 "	$996.78	$0.00	"$1,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$999.74	$999.74	$0.00	$0.00	$280.71	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0518	SUP	Custom 27803010		7492-0518  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,347.00 "	$996.78	$0.00	"$1,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$999.74	$999.74	$0.00	$0.00	$280.71	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0521	SUP	Custom 27803010		7492-0521  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0524	SUP	Custom 27803010		7492-0524  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0708	SUP	Custom 27803010		7492-0708  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0710	SUP	Custom 27803010		7492-0710  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,347.00 "	$996.78	$0.00	"$1,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$999.74	$999.74	$0.00	$0.00	$280.71	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0712	SUP	Custom 27803010		7492-0712  -  INSERT TIB 7 12MM KNEE BRNG	BOTH IP/OP	"$1,347.00 "	$996.78	$0.00	"$1,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$999.74	$999.74	$0.00	$0.00	$280.71	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0715	SUP	Custom 27803010		7492-0715  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,347.00 "	$996.78	$0.00	"$1,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$999.74	$999.74	$0.00	$0.00	$280.71	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0718	SUP	Custom 27803010		7492-0718  -  INSERT TIB KNEE PS 2 BRNG	BOTH IP/OP	"$1,347.00 "	$996.78	$0.00	"$1,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$999.74	$999.74	$0.00	$0.00	$280.71	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0721	SUP	Custom 27803010		7492-0721  -  INSERT TIB PS 2 BRNG	BOTH IP/OP	"$1,347.00 "	$996.78	$0.00	"$1,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$999.74	$999.74	$0.00	$0.00	$280.71	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0724	SUP	Custom 27803010		7492-0724  -  INSERT TIB PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0908	SUP	Custom 27803010		7492-0908  -  INSERT TIB PS 2 BRNG	BOTH IP/OP	"$1,347.00 "	$996.78	$0.00	"$1,077.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$999.74	$999.74	$0.00	$0.00	$280.71	$0.00	$0.00	$0.00	$0.00	$673.50	"$1,066.82"	"$1,077.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0910	SUP	Custom 27803010		7492-0910  -  INSERT TIB 9 KNEE 10MM	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0912	SUP	Custom 27803010		7492-0912  -  INSERT TIB PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0915	SUP	Custom 27803010		7492-0915  -  INSERT TIB PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0918	SUP	Custom 27803010		7492-0918  -  INSERT TIB PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0921	SUP	Custom 27803010		7492-0921  -  INSERT TIB PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7492-0924	SUP	Custom 27803010		7492-0924  -  INSERT TIB PS 2 BRNG	BOTH IP/OP	"$1,293.00 "	$956.82	$0.00	"$1,034.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.66	$959.66	$0.00	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$646.50	"$1,024.06"	"$1,034.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0108	SUP	Custom 27803010		7493-0108  -  INSERT TIBIAL 1 8MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0110	SUP	Custom 27803010		7493-0110  -  INSERT TIBIAL 1 10MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0112	SUP	Custom 27803010		7493-0112  -  INSERT TIBIAL 1 12MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0115	SUP	Custom 27803010		7493-0115  -  INSERT TIBIAL 1 15MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0118	SUP	Custom 27803010		7493-0118  -  INSERT TIBIAL 1 18MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0121	SUP	Custom 27803010		7493-0121  -  INSERT TIBIAL 1 21MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0124	SUP	Custom 27803010		7493-0124  -  INSERT TIBIAL 1 24MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0308	SUP	Custom 27803010		7493-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0310	SUP	Custom 27803010		7493-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0312	SUP	Custom 27803010		7493-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0315	SUP	Custom 27803010		7493-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0318	SUP	Custom 27803010		7493-0318  -  INSERT TIBIAL 3 18MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0321	SUP	Custom 27803010		7493-0321  -  INSERT TIBIAL 3 21MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0324	SUP	Custom 27803010		7493-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0508	SUP	Custom 27803010		7493-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0510	SUP	Custom 27803010		7493-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0512	SUP	Custom 27803010		7493-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0515	SUP	Custom 27803010		7493-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0518	SUP	Custom 27803010		7493-0518  -  INSERT TIBIAL 5 18MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0521	SUP	Custom 27803010		7493-0521  -  INSERT TIBIAL 5 21MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0524	SUP	Custom 27803010		7493-0524  -  INSERT TIBIAL 5 24MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0708	SUP	Custom 27803010		7493-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0710	SUP	Custom 27803010		7493-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0712	SUP	Custom 27803010		7493-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0715	SUP	Custom 27803010		7493-0715  -  INSERT TIBIAL 7 15MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0718	SUP	Custom 27803010		7493-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0721	SUP	Custom 27803010		7493-0721  -  INSERT TIBIAL 7 21MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0724	SUP	Custom 27803010		7493-0724  -  INSERT TIBIAL 7 24MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0908	SUP	Custom 27803010		7493-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0910	SUP	Custom 27803010		7493-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0912	SUP	Custom 27803010		7493-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0915	SUP	Custom 27803010		7493-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0918	SUP	Custom 27803010		7493-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0921	SUP	Custom 27803010		7493-0921  -  INSERT TIBIAL 9 21MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7493-0924	SUP	Custom 27803010		7493-0924  -  INSERT TIBIAL 9 24MM POSTERIOR STABILIZE BEARING KNEE S7000	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0305	SUP	Custom 27803010		75-1-0305  -  BLOCK AUGMENTATION 3 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0310	SUP	Custom 27803010		75-1-0310  -  BLOCK AUGMENTATION 3 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0315	SUP	Custom 27803010		75-1-0315  -  BLOCK AUGMENTATION 3 15MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0405	SUP	Custom 27803010		75-1-0405  -  BLOCK AUGMENTATION 4 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0410	SUP	Custom 27803010		75-1-0410  -  BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0415	SUP	Custom 27803010		75-1-0415  -  BLOCK AUGMENTATION 4 15MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0505	SUP	Custom 27803010		75-1-0505  -  BLOCK AUGMENTATION 5 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0510	SUP	Custom 27803010		75-1-0510  -  BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0515	SUP	Custom 27803010		75-1-0515  -  BLOCK AUGMENTATION 5 15MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0605	SUP	Custom 27803010		75-1-0605  -  BLOCK AUGMENTATION 6 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0610	SUP	Custom 27803010		75-1-0610  -  BLOCK AUGMENTATION 6 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0615	SUP	Custom 27803010		75-1-0615  -  BLOCK AUGMENTATION 6 15MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0705	SUP	Custom 27803010		75-1-0705  -  BLOCK AUGMENTATION 7 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0710	SUP	Custom 27803010		75-1-0710  -  BLOCK AUGMENTATION 7 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0715	SUP	Custom 27803010		75-1-0715  -  BLOCK AUGMENTATION 7 15MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0905	SUP	Custom 27803010		75-1-0905  -  BLOCK AUGMENTATION 9 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0910	SUP	Custom 27803010		75-1-0910  -  BLOCK AUGMENTATION 9 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-0915	SUP	Custom 27803010		75-1-0915  -  BLOCK AUGMENTATION 9 15MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-1105	SUP	Custom 27803010		75-1-1105  -  BLOCK AUGMENTATION 11 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-1110	SUP	Custom 27803010		75-1-1110  -  BLOCK AUGMENTATION 11 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-1115	SUP	Custom 27803010		75-1-1115  -  BLOCK AUGMENTATION 11 15MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-1305	SUP	Custom 27803010		75-1-1305  -  BLOCK AUGMENTATION 13 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-1310	SUP	Custom 27803010		75-1-1310  -  BLOCK AUGMENTATION 13 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-1-1315	SUP	Custom 27803010		75-1-1315  -  BLOCK AUGMENTATION 13 15MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-0305	SUP	Custom 27803010		75-2-0305  -  BLOCK AUGMENTATION 3 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-0310	SUP	Custom 27803010		75-2-0310  -  BLOCK AUGMENTATION 3 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-0405	SUP	Custom 27803010		75-2-0405  -  BLOCK AUGMENTATION 4 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-0410	SUP	Custom 27803010		75-2-0410  -  BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-0505	SUP	Custom 27803010		75-2-0505  -  BLOCK AUGMENTATION 5 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-0510	SUP	Custom 27803010		75-2-0510  -  BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-0605	SUP	Custom 27803010		75-2-0605  -  BLOCK AUGMENTATION 9 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-0610	SUP	Custom 27803010		75-2-0610  -  BLOCK AUGMENTATION 6 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-0705	SUP	Custom 27803010		75-2-0705  -  BLOCK AUGMENTATION 7 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-0710	SUP	Custom 27803010		75-2-0710  -  BLOCK AUGMENTATION 7 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-0905	SUP	Custom 27803010		75-2-0905  -  BLOCK AUGMENTATION 9 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-0910	SUP	Custom 27803010		75-2-0910  -  BLOCK AUGMENTATION 9 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-1105	SUP	Custom 27803010		75-2-1105  -  BLOCK AUGMENTATION 11 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-1110	SUP	Custom 27803010		75-2-1110  -  BLOCK AUGMENTATION 11 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-1305	SUP	Custom 27803010		75-2-1305  -  BLOCK AUGMENTATION 13 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-2-1310	SUP	Custom 27803010		75-2-1310  -  BLOCK AUGMENTATION 13 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,292.50 "	"$1,696.45"	$0.00	"$1,834.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.49"	"$1,701.49"	$0.00	$0.00	$477.76	$0.00	$0.00	$0.00	$0.00	"$1,146.25"	"$1,815.66"	"$1,834.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-0305	SUP	Custom 27803010		75-3-0305  -  BLOCK AUGMENTATION 3 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-0310	SUP	Custom 27803010		75-3-0310  -  BLOCK AUGMENTATION 3 HALF 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-0405	SUP	Custom 27203010		75-3-0405  -  TRIAL KN 4 5MM SCRP AUG HLF BLCK TIB LT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-0410	SUP	Custom 27203010		75-3-0410  -  TRIAL KN 4 10MM SCRP AUG HLF BLCK TIB LT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-0505	SUP	Custom 27803010		75-3-0505  -  BLOCK AUGMENTATION 5 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-0510	SUP	Custom 27203010		75-3-0510  -  BLOCK AUGMENTATION 5 HALF 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-0605	SUP	Custom 27803010		75-3-0605  -  BLOCK AUGMENTATION 6 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-0610	SUP	Custom 27203010		75-3-0610  -  TRIAL KN 6 10MM SCRP AUG HLF BLCK TIB LT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-0705	SUP	Custom 27803010		75-3-0705  -  BLOCK AUGMENTATION 7 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-0710	SUP	Custom 27203010		75-3-0710  -  BLOCK AUGMENTATION 7 10MM TOT STABILIZED HALF SCORPIO KNEE	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-0905	SUP	Custom 27803010		75-3-0905  -  BLOCK AUGMENTATION 9 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-0910	SUP	Custom 27803010		75-3-0910  -  BLOCK AUGMENTATION 9 HALF 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-1105	SUP	Custom 27803010		75-3-1105  -  BLOCK AUGMENTATION 11 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-1110	SUP	Custom 27203010		75-3-1110  -  BLOCK AUGMENTATION 11 HALF 10MM 1 AXIS CRUC RET POSTERIOR	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-1305	SUP	Custom 27803010		75-3-1305  -  BLOCK AUGMENTATION 13 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-3-1310	SUP	Custom 27803010		75-3-1310  -  BLOCK AUGMENTATION 13 HALF 10MM 1 AXIS CRUC RET POSTERIOR	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	$0.00	$0.00	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-4-0310	SUP	Custom 27803010		75-4-0310  -  BLOCK AUGMENTATION 3 FULL 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-4-0410	SUP	Custom 27803010		75-4-0410  -  BLOCK AUGMENTATION 4 10MM FULL SCORPIO TIBIA	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-4-0510	SUP	Custom 27803010		75-4-0510  -  BLOCK AUGMENTATION 5 FULL 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-4-0610	SUP	Custom 27803010		75-4-0610  -  BLOCK AUGMENTATION 6 10MM FULL SCORPIO TIBIA	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-4-0710	SUP	Custom 27803010		75-4-0710  -  BLOCK AUGMENTATION 7 FULL 10MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-4-0910	SUP	Custom 27803010		75-4-0910  -  BLOCK AUGMENTATION 9 FULL 5MM 1 AXIS CRUC RET POSTERIOR TOT	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-4-1110	SUP	Custom 27803010		75-4-1110  -  BLOCK AUGMENTATION 11 10MM FULL TOT STABILIZED SCORPIO FEMUR	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-4-1310	SUP	Custom 27803010		75-4-1310  -  BLOCK AUGMENTATION 13 10MM FULL TOT STABILIZED SCORPIO FEMUR	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-5-0305	SUP	Custom 27803010		75-5-0305  -  BLOCK AUGMENTATION 5D FULL WEDGE 3MM CRUCIATE RETAIN TOT	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-5-0405	SUP	Custom 27803010		75-5-0405  -  TRIAL SURG 4.5D FULL WEDGE	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-5-0505	SUP	Custom 27803010		75-5-0505  -  WEDGE TIBIAL 5D FULL 5 TOT STABILIZE SCORPIO KNEE	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-5-0605	SUP	Custom 27203010		75-5-0605  -  TRIAL SURG FULL WEDGE 6.5D	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-5-0705	SUP	Custom 27803010		75-5-0705  -  WEDGE TIBIAL 5D FULL 7 10MM TOT STABILIZE SCORPIO KNEE	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-5-0905	SUP	Custom 27803010		75-5-0905  -  BLOCK AUGMENTATION 5D FULL WEDGE 9MM CRUCIATE RETAIN TOT	BOTH IP/OP	"$3,585.00 "	"$2,652.90"	$0.00	"$2,868.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,660.79"	"$2,660.79"	$0.00	$0.00	$747.11	$0.00	$0.00	$0.00	$0.00	"$1,792.50"	"$2,839.32"	"$2,868.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-5-1105	SUP	Custom 27803010		75-5-1105  -  WEDGE TIB 11MM SCRP 5D KNEE TOT STAB FULL	BOTH IP/OP	"$3,445.00 "	"$2,549.30"	$0.00	"$2,756.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,556.88"	"$2,556.88"	$0.00	$0.00	$717.94	$0.00	$0.00	$0.00	$0.00	"$1,722.50"	"$2,728.44"	"$2,756.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75-5-1305	SUP	Custom 27803010		75-5-1305  -  WEDGE TIB 13MM SCRP 5D KNEE TOT STAB FULL	BOTH IP/OP	"$3,615.63 "	"$2,675.57"	$0.00	"$2,892.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,683.52"	"$2,683.52"	$0.00	$0.00	$753.50	$0.00	$0.00	$0.00	$0.00	"$1,807.81"	"$2,863.58"	"$2,892.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75AC50	SUP	Custom 27203010		75AC50  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$303.88 	$224.87	$0.00	$243.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.54	$225.54	$0.00	$0.00	$63.33	$0.00	$0.00	$0.00	$0.00	$151.94	$240.67	$243.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75AC60	SUP	Custom 27203010		75AC60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$303.88 	$224.87	$0.00	$243.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.54	$225.54	$0.00	$0.00	$63.33	$0.00	$0.00	$0.00	$0.00	$151.94	$240.67	$243.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA05	SUP	Custom 27203010		75BA05  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA05L	SUP	Custom 27203010		75BA05L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA06DL	SUP	Custom 27203010		75BA06DL  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA08DL	SUP	Custom 27203010		75BA08DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA10	SUP	Custom 27203010		75BA10  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA10D	SUP	Custom 27203010		75BA10D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA10DC	SUP	Custom 27203010		75BA10DC  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA10DCL	SUP	Custom 27203010		75BA10DCL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA10DL	SUP	Custom 27203010		75BA10DL  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA10DLF	SUP	Custom 27203010		75BA10DLF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA10L	SUP	Custom 27203010		75BA10L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA12DL	SUP	Custom 27203010		75BA12DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA15	SUP	Custom 27203010		75BA15  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA15D	SUP	Custom 27203010		75BA15D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA15DC	SUP	Custom 27203010		75BA15DC  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA15DCL	SUP	Custom 27203010		75BA15DCL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA15DL	SUP	Custom 27203010		75BA15DL  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA15DLF	SUP	Custom 27203010		75BA15DLF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA15L	SUP	Custom 27203010		75BA15L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA20	SUP	Custom 27203010		75BA20  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA20D	SUP	Custom 27203010		75BA20D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA20DC	SUP	Custom 27203010		75BA20DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA20DCL	SUP	Custom 27203010		75BA20DCL  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA20DF	SUP	Custom 27203010		75BA20DF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA20DL	SUP	Custom 27203010		75BA20DL  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA20DLF	SUP	Custom 27203010		75BA20DLF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA20F	SUP	Custom 27203010		75BA20F  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA20L	SUP	Custom 27203010		75BA20L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA20LF	SUP	Custom 27203010		75BA20LF  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA25	SUP	Custom 27203010		75BA25  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA25D	SUP	Custom 27203010		75BA25D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA25DC	SUP	Custom 27203010		75BA25DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA25DCL	SUP	Custom 27203010		75BA25DCL  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA25DL	SUP	Custom 27203010		75BA25DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA25DLF	SUP	Custom 27203010		75BA25DLF  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA25F	SUP	Custom 27203010		75BA25F  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA25L	SUP	Custom 27203010		75BA25L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA25LF	SUP	Custom 27203010		75BA25LF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA30	SUP	Custom 27203010		75BA30  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA30D	SUP	Custom 27203010		75BA30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA30DC	SUP	Custom 27203010		75BA30DC  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA30DCL	SUP	Custom 27203010		75BA30DCL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA30DF	SUP	Custom 27203010		75BA30DF  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA30DL	SUP	Custom 27203010		75BA30DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA30DLF	SUP	Custom 27203010		75BA30DLF  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA30F	SUP	Custom 27203010		75BA30F  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA30L	SUP	Custom 27203010		75BA30L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA30LF	SUP	Custom 27203010		75BA30LF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA35	SUP	Custom 27203010		75BA35  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA35D	SUP	Custom 27203010		75BA35D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA35DCL	SUP	Custom 27203010		75BA35DCL  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA35DL	SUP	Custom 27203010		75BA35DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA35F	SUP	Custom 27203010		75BA35F  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA35L	SUP	Custom 27203010		75BA35L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA35LF	SUP	Custom 27203010		75BA35LF  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA40	SUP	Custom 27203010		75BA40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA40D	SUP	Custom 27203010		75BA40D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA40DC	SUP	Custom 27203010		75BA40DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA40DF	SUP	Custom 27203010		75BA40DF  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA40DL	SUP	Custom 27203010		75BA40DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$320.88 	$237.45	$0.00	$256.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.15	$238.15	$0.00	$0.00	$66.87	$0.00	$0.00	$0.00	$0.00	$160.44	$254.14	$256.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA40DX	SUP	Custom 27203010		75BA40DX  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA40F	SUP	Custom 27203010		75BA40F  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA40L	SUP	Custom 27203010		75BA40L  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA50	SUP	Custom 27203010		75BA50  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA50D	SUP	Custom 27203010		75BA50D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA50DC	SUP	Custom 27203010		75BA50DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA50DF	SUP	Custom 27203010		75BA50DF  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA50DX	SUP	Custom 27203010		75BA50DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA50F	SUP	Custom 27203010		75BA50F  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA60	SUP	Custom 27203010		75BA60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA60D	SUP	Custom 27203010		75BA60D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA60DC	SUP	Custom 27203010		75BA60DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA60DX	SUP	Custom 27203010		75BA60DX  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA60F	SUP	Custom 27203010		75BA60F  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA70	SUP	Custom 27203010		75BA70  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA80	SUP	Custom 27203010		75BA80  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$293.25 	$217.01	$0.00	$234.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.65	$217.65	$0.00	$0.00	$61.11	$0.00	$0.00	$0.00	$0.00	$146.63	$232.25	$234.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA80D	SUP	Custom 27203010		75BA80D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$316.63 	$234.31	$0.00	$253.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.00	$235.00	$0.00	$0.00	$65.98	$0.00	$0.00	$0.00	$0.00	$158.31	$250.77	$253.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75BA80DC	SUP	Custom 27203010		75BA80DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75CY65DX	SUP	Custom 27203010		75CY65DX  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75MH22	SUP	Custom 27203010		75MH22  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$303.88 	$224.87	$0.00	$243.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.54	$225.54	$0.00	$0.00	$63.33	$0.00	$0.00	$0.00	$0.00	$151.94	$240.67	$243.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75MH22D	SUP	Custom 27203010		75MH22D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75MH30	SUP	Custom 27203010		75MH30  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$303.88 	$224.87	$0.00	$243.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.54	$225.54	$0.00	$0.00	$63.33	$0.00	$0.00	$0.00	$0.00	$151.94	$240.67	$243.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75MH30D	SUP	Custom 27203010		75MH30D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
75OV40	SUP	Custom 27203010		75OV40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$303.88 	$224.87	$0.00	$243.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.54	$225.54	$0.00	$0.00	$63.33	$0.00	$0.00	$0.00	$0.00	$151.94	$240.67	$243.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76-0007	SUP	HCPCS C1713		76-0007  -  SCREW BN 2.4MM 10MM RIBFIX BLU LCK TI STRNM	BOTH IP/OP	$615.00 	$455.10	$0.00	$492.00	$276.75	$276.75	$0.00	$0.00	$0.00	$128.18	$456.45	$456.45	$0.00	$0.00	$128.17	$0.00	$363.77	$363.77	$0.00	$307.50	$487.08	$492.00	$0.00		$0.00	$96.25	$0.00	$0.00	$97.91	$0.00	$0.00	$0.00	$0.00	$0.00
76-0010	SUP	HCPCS C1713		76-0010  -  SCREW BN 2.4MM 12MM RIBFIX BLU DRL LCK STRNM SCAPULA	BOTH IP/OP	$605.00 	$447.70	$0.00	$484.00	$272.25	$272.25	$0.00	$0.00	$0.00	$126.10	$449.03	$449.03	$0.00	$0.00	$126.08	$0.00	$357.86	$357.86	$0.00	$302.50	$479.16	$484.00	$0.00		$0.00	$94.68	$0.00	$0.00	$96.32	$0.00	$0.00	$0.00	$0.00	$0.00
7602-20M	SUP	HCPCS C1725		7602-20M  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR .052IN 100CM SIZING	BOTH IP/OP	$226.28 	$167.45	$0.00	$181.02	$122.87	$122.87	$0.00	$0.00	$0.00	$47.16	$167.94	$167.94	$0.00	$0.00	$47.16	$0.00	$133.84	$133.84	$0.00	$113.14	$179.21	$181.02	$0.00		$0.00	$35.41	$0.00	$0.00	$36.02	$0.00	$0.00	$0.00	$0.00	$0.00
7602-2M65	SUP	HCPCS C1725		7602-2M65  -  CATH ANGIO .035IN PGTL CURVE 5FR .052IN 65CM 10 SDPRT 2 BAND	BOTH IP/OP	$69.13 	$51.16	$0.00	$55.30	$37.53	$37.53	$0.00	$0.00	$0.00	$14.41	$51.30	$51.30	$0.00	$0.00	$14.41	$0.00	$40.89	$40.89	$0.00	$34.56	$54.75	$55.30	$0.00		$0.00	$10.82	$0.00	$0.00	$11.00	$0.00	$0.00	$0.00	$0.00	$0.00
7602-51	SUP	HCPCS C1725		7602-51  -  CATHETER ANGIO PGTL CRV 5FR 90CM STRL PRFM 10 SH RADOPQ BRD	BOTH IP/OP	$29.65 	$21.94	$0.00	$23.72	$16.10	$16.10	$0.00	$0.00	$0.00	$6.18	$22.01	$22.01	$0.00	$0.00	$6.18	$0.00	$17.54	$17.54	$0.00	$14.83	$23.48	$23.72	$0.00		$0.00	$4.64	$0.00	$0.00	$4.72	$0.00	$0.00	$0.00	$0.00	$0.00
76-2001	SUP	HCPCS C1713		76-2001  -  SCREW BN 2.4MM 34MM X DRV	BOTH IP/OP	"$1,127.50 "	$834.35	$0.00	$902.00	$507.38	$507.38	$0.00	$0.00	$0.00	$235.00	$836.83	$836.83	$0.00	$0.00	$234.97	$0.00	$666.92	$666.92	$0.00	$563.75	$892.98	$902.00	$0.00		$0.00	$176.45	$0.00	$0.00	$179.50	$0.00	$0.00	$0.00	$0.00	$0.00
76-2408	SUP	HCPCS C1713		76-2408  -  SCREW BN 2.4MM 8MM RIBFIX BLU SLF DRL LCK RB	BOTH IP/OP	$367.50 	$271.95	$0.00	$294.00	$165.38	$165.38	$0.00	$0.00	$0.00	$76.60	$272.76	$272.76	$0.00	$0.00	$76.59	$0.00	$217.38	$217.38	$0.00	$183.75	$291.06	$294.00	$0.00		$0.00	$57.51	$0.00	$0.00	$58.51	$0.00	$0.00	$0.00	$0.00	$0.00
76-2410	SUP	HCPCS C1713		76-2410  -  SCREW BN 2.4MM 10MM RIBFIX BLU ST LCK	BOTH IP/OP	$492.50 	$364.45	$0.00	$365.53	$165.38	$165.38	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$183.75	$291.06	$294.00	$0.00		$0.00	$57.51	$0.00	$0.00	$58.51	$0.00	$0.00	$0.00	$0.00	$0.00
76-2412	SUP	HCPCS C1713		76-2412  -  Screw S/d-lk 2.4x12mm	BOTH IP/OP	$367.50 	$271.95	$0.00	$294.00	$165.38	$165.38	$0.00	$0.00	$0.00	$76.60	$272.76	$272.76	$0.00	$0.00	$76.59	$0.00	$217.38	$217.38	$0.00	$183.75	$291.06	$294.00	$0.00		$0.00	$57.51	$0.00	$0.00	$58.51	$0.00	$0.00	$0.00	$0.00	$0.00
76-2414	SUP	HCPCS C1713		76-2414  -  SCREW BN 2.4MM 14MM RIBFIX BLU ST LCK TI THOR	BOTH IP/OP	$367.50 	$271.95	$0.00	$294.00	$165.38	$165.38	$0.00	$0.00	$0.00	$76.60	$272.76	$272.76	$0.00	$0.00	$76.59	$0.00	$217.38	$217.38	$0.00	$183.75	$291.06	$294.00	$0.00		$0.00	$57.51	$0.00	$0.00	$58.51	$0.00	$0.00	$0.00	$0.00	$0.00
76-2416	SUP	HCPCS C1713		76-2416  -  SCREW BN 2.4MM 16MM RIBFIX BLU SLF DRL LCK RB	BOTH IP/OP	$367.50 	$271.95	$0.00	$294.00	$165.38	$165.38	$0.00	$0.00	$0.00	$76.60	$272.76	$272.76	$0.00	$0.00	$76.59	$0.00	$217.38	$217.38	$0.00	$183.75	$291.06	$294.00	$0.00		$0.00	$57.51	$0.00	$0.00	$58.51	$0.00	$0.00	$0.00	$0.00	$0.00
76-2601	SUP	HCPCS C1713		76-2601  -  PLATE BN STRG NS RIBFIX BLU 8 HL TI RB	BOTH IP/OP	"$2,497.50 "	"$1,848.15"	$0.00	"$1,998.00"	"$1,123.88"	"$1,123.88"	$0.00	$0.00	$0.00	$520.54	"$1,853.64"	"$1,853.64"	$0.00	$0.00	$520.48	$0.00	"$1,477.27"	"$1,477.27"	$0.00	"$1,248.75"	"$1,978.02"	"$1,998.00"	$0.00		$0.00	$390.86	$0.00	$0.00	$397.60	$0.00	$0.00	$0.00	$0.00	$0.00
76-2602	SUP	HCPCS C1713		76-2602  -  SCREW BN PREBNT 2.4MM 14MM SLF DRL LCK TI RB	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
76-2603	SUP	HCPCS C1713		76-2603  -  PLATE BN PREBNT NS RIBFIX BLU 16 HL TI RB	BOTH IP/OP	"$3,747.50 "	"$2,773.15"	$0.00	"$2,998.00"	"$1,686.38"	"$1,686.38"	$0.00	$0.00	$0.00	$781.07	"$2,781.39"	"$2,781.39"	$0.00	$0.00	$780.98	$0.00	"$1,847.52"	"$1,847.52"	$0.00	"$1,873.75"	"$2,968.02"	"$2,998.00"	$0.00		$0.00	$586.48	$0.00	$0.00	$596.60	$0.00	$0.00	$0.00	$0.00	$0.00
76-2708	SUP	HCPCS C1713		76-2708  -  SCREW BN 2.7MM 8MM ER TI RB	BOTH IP/OP	$367.50 	$271.95	$0.00	$294.00	$165.38	$165.38	$0.00	$0.00	$0.00	$76.60	$272.76	$272.76	$0.00	$0.00	$76.59	$0.00	$217.38	$217.38	$0.00	$183.75	$291.06	$294.00	$0.00		$0.00	$57.51	$0.00	$0.00	$58.51	$0.00	$0.00	$0.00	$0.00	$0.00
76-2710	SUP	HCPCS C1713		76-2710  -  SCREW BN 2.7MM 10MM ER TI RB	BOTH IP/OP	$367.50 	$271.95	$0.00	$294.00	$165.38	$165.38	$0.00	$0.00	$0.00	$76.60	$272.76	$272.76	$0.00	$0.00	$76.59	$0.00	$217.38	$217.38	$0.00	$183.75	$291.06	$294.00	$0.00		$0.00	$57.51	$0.00	$0.00	$58.51	$0.00	$0.00	$0.00	$0.00	$0.00
76-2712	SUP	HCPCS C1713		76-2712  -  SCREW BN 2.7MM 12MM ER RB	BOTH IP/OP	$367.50 	$271.95	$0.00	$294.00	$165.38	$165.38	$0.00	$0.00	$0.00	$76.60	$272.76	$272.76	$0.00	$0.00	$76.59	$0.00	$217.38	$217.38	$0.00	$183.75	$291.06	$294.00	$0.00		$0.00	$57.51	$0.00	$0.00	$58.51	$0.00	$0.00	$0.00	$0.00	$0.00
76-2714	SUP	HCPCS C1713		76-2714  -  SCREW BN 2.7MM 14MM ER RB	BOTH IP/OP	$367.50 	$271.95	$0.00	$294.00	$165.38	$165.38	$0.00	$0.00	$0.00	$76.60	$272.76	$272.76	$0.00	$0.00	$76.59	$0.00	$217.38	$217.38	$0.00	$183.75	$291.06	$294.00	$0.00		$0.00	$57.51	$0.00	$0.00	$58.51	$0.00	$0.00	$0.00	$0.00	$0.00
76-4003L	SUP	HCPCS C1776		76-4003L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$10,226.13 "	"$7,567.34"	$0.00	"$8,180.90"	"$4,601.76"	"$4,601.76"	$0.00	$0.00	$0.00	"$2,131.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,131.12"	$0.00	"$5,041.48"	"$5,041.48"	$0.00	"$5,113.06"	"$8,099.09"	"$8,180.90"	$0.00		$0.00	"$1,600.39"	$0.00	$0.00	"$1,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4003R	SUP	HCPCS C1776		76-4003R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$10,226.13 "	"$7,567.34"	$0.00	"$8,180.90"	"$4,601.76"	"$4,601.76"	$0.00	$0.00	$0.00	"$2,131.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,131.12"	$0.00	"$5,041.48"	"$5,041.48"	$0.00	"$5,113.06"	"$8,099.09"	"$8,180.90"	$0.00		$0.00	"$1,600.39"	$0.00	$0.00	"$1,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4004L	SUP	HCPCS C1776		76-4004L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$10,226.13 "	"$7,567.34"	$0.00	"$8,180.90"	"$4,601.76"	"$4,601.76"	$0.00	$0.00	$0.00	"$2,131.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,131.12"	$0.00	"$5,041.48"	"$5,041.48"	$0.00	"$5,113.06"	"$8,099.09"	"$8,180.90"	$0.00		$0.00	"$1,600.39"	$0.00	$0.00	"$1,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4004R	SUP	HCPCS C1776		76-4004R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$10,226.13 "	"$7,567.34"	$0.00	"$8,180.90"	"$4,601.76"	"$4,601.76"	$0.00	$0.00	$0.00	"$2,131.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,131.12"	$0.00	"$5,041.48"	"$5,041.48"	$0.00	"$5,113.06"	"$8,099.09"	"$8,180.90"	$0.00		$0.00	"$1,600.39"	$0.00	$0.00	"$1,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4005L	SUP	HCPCS C1776		76-4005L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$9,995.38 "	"$7,396.58"	$0.00	"$7,996.30"	"$4,497.92"	"$4,497.92"	$0.00	$0.00	$0.00	"$2,083.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,083.04"	$0.00	"$4,927.72"	"$4,927.72"	$0.00	"$4,997.69"	"$7,916.34"	"$7,996.30"	$0.00		$0.00	"$1,564.28"	$0.00	$0.00	"$1,591.26"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4005R	SUP	HCPCS C1776		76-4005R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$9,995.38 "	"$7,396.58"	$0.00	"$7,996.30"	"$4,497.92"	"$4,497.92"	$0.00	$0.00	$0.00	"$2,083.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,083.04"	$0.00	"$4,927.72"	"$4,927.72"	$0.00	"$4,997.69"	"$7,916.34"	"$7,996.30"	$0.00		$0.00	"$1,564.28"	$0.00	$0.00	"$1,591.26"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4006L	SUP	HCPCS C1776		76-4006L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$10,226.13 "	"$7,567.34"	$0.00	"$8,180.90"	"$4,601.76"	"$4,601.76"	$0.00	$0.00	$0.00	"$2,131.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,131.12"	$0.00	"$5,041.48"	"$5,041.48"	$0.00	"$5,113.06"	"$8,099.09"	"$8,180.90"	$0.00		$0.00	"$1,600.39"	$0.00	$0.00	"$1,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4006R	SUP	HCPCS C1776		76-4006R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$10,226.13 "	"$7,567.34"	$0.00	"$8,180.90"	"$4,601.76"	"$4,601.76"	$0.00	$0.00	$0.00	"$2,131.38"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,131.12"	$0.00	"$5,041.48"	"$5,041.48"	$0.00	"$5,113.06"	"$8,099.09"	"$8,180.90"	$0.00		$0.00	"$1,600.39"	$0.00	$0.00	"$1,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4007L	SUP	HCPCS C1776		76-4007L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$9,995.38 "	"$7,396.58"	$0.00	"$7,996.30"	"$4,497.92"	"$4,497.92"	$0.00	$0.00	$0.00	"$2,083.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,083.04"	$0.00	"$4,927.72"	"$4,927.72"	$0.00	"$4,997.69"	"$7,916.34"	"$7,996.30"	$0.00		$0.00	"$1,564.28"	$0.00	$0.00	"$1,591.26"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4007R	SUP	HCPCS C1776		76-4007R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$9,995.38 "	"$7,396.58"	$0.00	"$7,996.30"	"$4,497.92"	"$4,497.92"	$0.00	$0.00	$0.00	"$2,083.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,083.04"	$0.00	"$4,927.72"	"$4,927.72"	$0.00	"$4,997.69"	"$7,916.34"	"$7,996.30"	$0.00		$0.00	"$1,564.28"	$0.00	$0.00	"$1,591.26"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4009L	SUP	HCPCS C1776		76-4009L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$9,995.38 "	"$7,396.58"	$0.00	"$7,996.30"	"$4,497.92"	"$4,497.92"	$0.00	$0.00	$0.00	"$2,083.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,083.04"	$0.00	"$4,927.72"	"$4,927.72"	$0.00	"$4,997.69"	"$7,916.34"	"$7,996.30"	$0.00		$0.00	"$1,564.28"	$0.00	$0.00	"$1,591.26"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4009R	SUP	HCPCS C1776		76-4009R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$9,995.38 "	"$7,396.58"	$0.00	"$7,996.30"	"$4,497.92"	"$4,497.92"	$0.00	$0.00	$0.00	"$2,083.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,083.04"	$0.00	"$4,927.72"	"$4,927.72"	$0.00	"$4,997.69"	"$7,916.34"	"$7,996.30"	$0.00		$0.00	"$1,564.28"	$0.00	$0.00	"$1,591.26"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4011L	SUP	HCPCS C1776		76-4011L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$9,995.38 "	"$7,396.58"	$0.00	"$7,996.30"	"$4,497.92"	"$4,497.92"	$0.00	$0.00	$0.00	"$2,083.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,083.04"	$0.00	"$4,927.72"	"$4,927.72"	$0.00	"$4,997.69"	"$7,916.34"	"$7,996.30"	$0.00		$0.00	"$1,564.28"	$0.00	$0.00	"$1,591.26"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4011R	SUP	HCPCS C1776		76-4011R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$9,995.38 "	"$7,396.58"	$0.00	"$7,996.30"	"$4,497.92"	"$4,497.92"	$0.00	$0.00	$0.00	"$2,083.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,083.04"	$0.00	"$4,927.72"	"$4,927.72"	$0.00	"$4,997.69"	"$7,916.34"	"$7,996.30"	$0.00		$0.00	"$1,564.28"	$0.00	$0.00	"$1,591.26"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4013L	SUP	HCPCS C1776		76-4013L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$8,567.00 "	"$6,339.58"	$0.00	"$6,853.60"	"$3,855.15"	"$3,855.15"	$0.00	$0.00	$0.00	"$1,785.58"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,785.36"	$0.00	"$4,223.53"	"$4,223.53"	$0.00	"$4,283.50"	"$6,785.06"	"$6,853.60"	$0.00		$0.00	"$1,340.74"	$0.00	$0.00	"$1,363.87"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4013R	SUP	HCPCS C1776		76-4013R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP	BOTH IP/OP	"$8,567.00 "	"$6,339.58"	$0.00	"$6,853.60"	"$3,855.15"	"$3,855.15"	$0.00	$0.00	$0.00	"$1,785.58"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,785.36"	$0.00	"$4,223.53"	"$4,223.53"	$0.00	"$4,283.50"	"$6,785.06"	"$6,853.60"	$0.00		$0.00	"$1,340.74"	$0.00	$0.00	"$1,363.87"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4103L	SUP	HCPCS C1776		76-4103L  -  COMPONENT FEMORAL 3 56X35MM MODULAR TOT STABILIZE REVISION	BOTH IP/OP	"$12,130.00 "	"$8,976.20"	$0.00	"$9,704.00"	"$5,458.50"	"$5,458.50"	$0.00	$0.00	$0.00	"$2,528.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,527.89"	$0.00	"$5,980.09"	"$5,980.09"	$0.00	"$6,065.00"	"$9,606.96"	"$9,704.00"	$0.00		$0.00	"$1,898.35"	$0.00	$0.00	"$1,931.10"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4103R	SUP	HCPCS C1776		76-4103R  -  COMPONENT FEMORAL 3 56X35MM MODULAR TOT STABILIZE REVISION	BOTH IP/OP	"$12,130.00 "	"$8,976.20"	$0.00	"$9,704.00"	"$5,458.50"	"$5,458.50"	$0.00	$0.00	$0.00	"$2,528.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,527.89"	$0.00	"$5,980.09"	"$5,980.09"	$0.00	"$6,065.00"	"$9,606.96"	"$9,704.00"	$0.00		$0.00	"$1,898.35"	$0.00	$0.00	"$1,931.10"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4105L	SUP	HCPCS C1776		76-4105L  -  COMPONENT FEMORAL 5 61X39MM MODULAR TOT STABILIZE REVISION	BOTH IP/OP	"$12,130.00 "	"$8,976.20"	$0.00	"$9,704.00"	"$5,458.50"	"$5,458.50"	$0.00	$0.00	$0.00	"$2,528.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,527.89"	$0.00	"$5,980.09"	"$5,980.09"	$0.00	"$6,065.00"	"$9,606.96"	"$9,704.00"	$0.00		$0.00	"$1,898.35"	$0.00	$0.00	"$1,931.10"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4105R	SUP	HCPCS C1776		76-4105R  -  COMPONENT FEMORAL 5 61X39MM MODULAR TOT STABILIZE REVISION	BOTH IP/OP	"$12,130.00 "	"$8,976.20"	$0.00	"$9,704.00"	"$5,458.50"	"$5,458.50"	$0.00	$0.00	$0.00	"$2,528.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,527.89"	$0.00	"$5,980.09"	"$5,980.09"	$0.00	"$6,065.00"	"$9,606.96"	"$9,704.00"	$0.00		$0.00	"$1,898.35"	$0.00	$0.00	"$1,931.10"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4107L	SUP	HCPCS C1776		76-4107L  -  COMPONENT FEMORAL 7 66X44MM MODULAR TOT STABILIZE REVISION	BOTH IP/OP	"$12,130.00 "	"$8,976.20"	$0.00	"$9,704.00"	"$5,458.50"	"$5,458.50"	$0.00	$0.00	$0.00	"$2,528.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,527.89"	$0.00	"$5,980.09"	"$5,980.09"	$0.00	"$6,065.00"	"$9,606.96"	"$9,704.00"	$0.00		$0.00	"$1,898.35"	$0.00	$0.00	"$1,931.10"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4107R	SUP	HCPCS C1776		76-4107R  -  COMPONENT FEMORAL 7 66X44MM MODULAR TOT STABILIZE REVISION	BOTH IP/OP	"$12,130.00 "	"$8,976.20"	$0.00	"$9,704.00"	"$5,458.50"	"$5,458.50"	$0.00	$0.00	$0.00	"$2,528.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,527.89"	$0.00	"$5,980.09"	"$5,980.09"	$0.00	"$6,065.00"	"$9,606.96"	"$9,704.00"	$0.00		$0.00	"$1,898.35"	$0.00	$0.00	"$1,931.10"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4109L	SUP	HCPCS C1776		76-4109L  -  COMPONENT FEMORAL 9 71X49MM MODULAR TOT STABILIZE REVISION	BOTH IP/OP	"$12,130.00 "	"$8,976.20"	$0.00	"$9,704.00"	"$5,458.50"	"$5,458.50"	$0.00	$0.00	$0.00	"$2,528.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,527.89"	$0.00	"$5,980.09"	"$5,980.09"	$0.00	"$6,065.00"	"$9,606.96"	"$9,704.00"	$0.00		$0.00	"$1,898.35"	$0.00	$0.00	"$1,931.10"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4109R	SUP	HCPCS C1776		76-4109R  -  COMPONENT FEMORAL 9 71X49MM MODULAR TOT STABILIZE REVISION	BOTH IP/OP	"$12,130.00 "	"$8,976.20"	$0.00	"$9,704.00"	"$5,458.50"	"$5,458.50"	$0.00	$0.00	$0.00	"$2,528.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,527.89"	$0.00	"$5,980.09"	"$5,980.09"	$0.00	"$6,065.00"	"$9,606.96"	"$9,704.00"	$0.00		$0.00	"$1,898.35"	$0.00	$0.00	"$1,931.10"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4111L	SUP	HCPCS C1776		76-4111L  -  COMPONENT FEMORAL 11 76X53MM MODULAR TOT STABILIZE REVISION	BOTH IP/OP	"$12,130.00 "	"$8,976.20"	$0.00	"$9,704.00"	"$5,458.50"	"$5,458.50"	$0.00	$0.00	$0.00	"$2,528.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,527.89"	$0.00	"$5,980.09"	"$5,980.09"	$0.00	"$6,065.00"	"$9,606.96"	"$9,704.00"	$0.00		$0.00	"$1,898.35"	$0.00	$0.00	"$1,931.10"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4111R	SUP	HCPCS C1776		76-4111R  -  COMPONENT FEMORAL 11 76X53MM MODULAR TOT STABILIZE REVISION	BOTH IP/OP	"$12,130.00 "	"$8,976.20"	$0.00	"$9,704.00"	"$5,458.50"	"$5,458.50"	$0.00	$0.00	$0.00	"$2,528.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,527.89"	$0.00	"$5,980.09"	"$5,980.09"	$0.00	"$6,065.00"	"$9,606.96"	"$9,704.00"	$0.00		$0.00	"$1,898.35"	$0.00	$0.00	"$1,931.10"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4113L	SUP	HCPCS C1776		76-4113L  -  COMPONENT FEMORAL 13 81X58MM MODULAR TOT STABILIZE REVISION	BOTH IP/OP	"$12,130.00 "	"$8,976.20"	$0.00	"$9,704.00"	"$5,458.50"	"$5,458.50"	$0.00	$0.00	$0.00	"$2,528.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,527.89"	$0.00	"$5,980.09"	"$5,980.09"	$0.00	"$6,065.00"	"$9,606.96"	"$9,704.00"	$0.00		$0.00	"$1,898.35"	$0.00	$0.00	"$1,931.10"	$0.00	$0.00	$0.00	$0.00	$0.00
76-4113R	SUP	HCPCS C1776		76-4113R  -  COMPONENT FEMORAL 13 81X58MM MODULAR TOT STABILIZE REVISION	BOTH IP/OP	"$12,130.00 "	"$8,976.20"	$0.00	"$9,704.00"	"$5,458.50"	"$5,458.50"	$0.00	$0.00	$0.00	"$2,528.20"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,527.89"	$0.00	"$5,980.09"	"$5,980.09"	$0.00	"$6,065.00"	"$9,606.96"	"$9,704.00"	$0.00		$0.00	"$1,898.35"	$0.00	$0.00	"$1,931.10"	$0.00	$0.00	$0.00	$0.00	$0.00
7650-2038A	SUP	Custom 27203010		7650-2038A  -  PIN FIX FLUTE SQUARE 1/8IN 3.5IN STAINLESS STEEL KNEE	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76791-MX	SUP	HCPCS C1725		THERMOMETER SYSTEM DIAG INTEGRATED 767	BOTH IP/OP	"$2,070.45 "	"$1,532.13"	$0.00	"$1,656.36"	"$1,124.25"	"$1,124.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,035.23"	"$1,639.80"	"$1,656.36"	$0.00		$0.00	$324.03	$0.00	$0.00	$329.62	$0.00	$0.00	$0.00	$0.00	$0.00
7679922P	SUP	Custom 27203010		7679922P  -  REAMER SRG 3.15MM STRL PCM MRC SPNE	BOTH IP/OP	$960.00 	$710.40	$0.00	$768.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.51	$712.51	$0.00	$0.00	$200.06	$0.00	$0.00	$0.00	$0.00	$480.00	$760.32	$768.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7679925P	SUP	Custom 27203010		7679925P  -  REAMER SRG 3.5MM STRL PCM ANS SPNE	BOTH IP/OP	$960.00 	$710.40	$0.00	$768.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.51	$712.51	$0.00	$0.00	$200.06	$0.00	$0.00	$0.00	$0.00	$480.00	$760.32	$768.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7679926P	SUP	Custom 27203010		7679926P  -  REAMER SRG 3.5MM STRL PCM MRL SPNE	BOTH IP/OP	$960.00 	$710.40	$0.00	$768.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.51	$712.51	$0.00	$0.00	$200.06	$0.00	$0.00	$0.00	$0.00	$480.00	$760.32	$768.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7679927P	SUP	Custom 27203010		7679927P  -  REAMER SRG 3.5MM STRL PCM HXL SPNE	BOTH IP/OP	$960.00 	$710.40	$0.00	$768.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.51	$712.51	$0.00	$0.00	$200.06	$0.00	$0.00	$0.00	$0.00	$480.00	$760.32	$768.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7679930P	SUP	Custom 27203010		7679930P  -  REAMER SRG 3.5MM STRL PCM JC SPNE	BOTH IP/OP	$960.00 	$710.40	$0.00	$768.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.51	$712.51	$0.00	$0.00	$200.06	$0.00	$0.00	$0.00	$0.00	$480.00	$760.32	$768.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7679934P	SUP	Custom 27203010		7679934P  -  REAMER SRG 3.5MM STRL PCM TSPE SPNE	BOTH IP/OP	$960.00 	$710.40	$0.00	$768.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.51	$712.51	$0.00	$0.00	$200.06	$0.00	$0.00	$0.00	$0.00	$480.00	$760.32	$768.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
768G	SUP	Custom 27203010		768G  -  SUTURE NONABSORBABLE 7-0 G-6 18IN 2 ARM BRAID NEEDLE	BOTH IP/OP	$32.63 	$24.15	$0.00	$26.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.22	$24.22	$0.00	$0.00	$6.80	$0.00	$0.00	$0.00	$0.00	$16.56	$26.23	$26.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
76-9102	SUP	HCPCS C1713		76-9102  -  SCREW BN 2.7MM 8MM ER LCK RB	BOTH IP/OP	$185.00 	$136.90	$0.00	$148.00	$83.25	$83.25	$0.00	$0.00	$0.00	$38.56	$137.31	$137.31	$0.00	$0.00	$38.55	$0.00	$109.43	$109.43	$0.00	$92.50	$146.52	$148.00	$0.00		$0.00	$28.95	$0.00	$0.00	$29.45	$0.00	$0.00	$0.00	$0.00	$0.00
76-9103	SUP	HCPCS C1713		76-9103  -  PLATE BN 16 HL TMPLT RB	BOTH IP/OP	$185.00 	$136.90	$0.00	$148.00	$83.25	$83.25	$0.00	$0.00	$0.00	$38.56	$137.31	$137.31	$0.00	$0.00	$38.55	$0.00	$109.43	$109.43	$0.00	$92.50	$146.52	$148.00	$0.00		$0.00	$28.95	$0.00	$0.00	$29.45	$0.00	$0.00	$0.00	$0.00	$0.00
76-9104	SUP	HCPCS C1713		76-9104  -  TEMPLATE SZ 16 HL PLT	BOTH IP/OP	$185.00 	$136.90	$0.00	$148.00	$83.25	$83.25	$0.00	$0.00	$0.00	$38.56	$137.31	$137.31	$0.00	$0.00	$38.55	$0.00	$109.43	$109.43	$0.00	$92.50	$146.52	$148.00	$0.00		$0.00	$28.95	$0.00	$0.00	$29.45	$0.00	$0.00	$0.00	$0.00	$0.00
769G	SUP	Custom 27203010		769G  -  SUTURE NABSB 6-0 G-6 18IN BLK PRMHND MICROPOINT 2 ARM BRD	BOTH IP/OP	$32.39 	$23.97	$0.00	$26.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.04	$24.04	$0.00	$0.00	$6.75	$0.00	$0.00	$0.00	$0.00	$16.44	$26.03	$26.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77-1003	SUP	HCPCS C1776		77-1003  -  CMPNT TIBTRY 3MM KNEE LP SCRP	BOTH IP/OP	"$2,308.00 "	"$1,707.92"	$0.00	"$1,846.40"	"$1,038.60"	"$1,038.60"	$0.00	$0.00	$0.00	$481.04	"$1,713.00"	"$1,713.00"	$0.00	$0.00	$480.99	$0.00	"$1,365.18"	"$1,365.18"	$0.00	"$1,154.00"	"$1,827.94"	"$1,846.40"	$0.00		$0.00	$361.20	$0.00	$0.00	$367.43	$0.00	$0.00	$0.00	$0.00	$0.00
77-1004	SUP	HCPCS C1776		77-1004  -  CMPNT TIBTRY 4MM KNEE LP SCRP	BOTH IP/OP	"$2,308.00 "	"$1,707.92"	$0.00	"$1,846.40"	"$1,038.60"	"$1,038.60"	$0.00	$0.00	$0.00	$481.04	"$1,713.00"	"$1,713.00"	$0.00	$0.00	$480.99	$0.00	"$1,365.18"	"$1,365.18"	$0.00	"$1,154.00"	"$1,827.94"	"$1,846.40"	$0.00		$0.00	$361.20	$0.00	$0.00	$367.43	$0.00	$0.00	$0.00	$0.00	$0.00
77-1006	SUP	HCPCS C1776		77-1006  -  CMPNT TIBTRY 6MM KNEE LP SCRP	BOTH IP/OP	"$2,308.00 "	"$1,707.92"	$0.00	"$1,846.40"	"$1,038.60"	"$1,038.60"	$0.00	$0.00	$0.00	$481.04	"$1,713.00"	"$1,713.00"	$0.00	$0.00	$480.99	$0.00	"$1,365.18"	"$1,365.18"	$0.00	"$1,154.00"	"$1,827.94"	"$1,846.40"	$0.00		$0.00	$361.20	$0.00	$0.00	$367.43	$0.00	$0.00	$0.00	$0.00	$0.00
77-1007	SUP	HCPCS C1776		77-1007  -  CMPNT TIBTRY 7MM KNEE LP SCRP	BOTH IP/OP	"$2,308.00 "	"$1,707.92"	$0.00	"$1,846.40"	"$1,038.60"	"$1,038.60"	$0.00	$0.00	$0.00	$481.04	"$1,713.00"	"$1,713.00"	$0.00	$0.00	$480.99	$0.00	"$1,365.18"	"$1,365.18"	$0.00	"$1,154.00"	"$1,827.94"	"$1,846.40"	$0.00		$0.00	$361.20	$0.00	$0.00	$367.43	$0.00	$0.00	$0.00	$0.00	$0.00
77-1009	SUP	HCPCS C1776		77-1009  -  CMPNT TIB 9MM SCRP KNEE LP	BOTH IP/OP	"$2,308.00 "	"$1,707.92"	$0.00	"$1,846.40"	"$1,038.60"	"$1,038.60"	$0.00	$0.00	$0.00	$481.04	"$1,713.00"	"$1,713.00"	$0.00	$0.00	$480.99	$0.00	"$1,365.18"	"$1,365.18"	$0.00	"$1,154.00"	"$1,827.94"	"$1,846.40"	$0.00		$0.00	$361.20	$0.00	$0.00	$367.43	$0.00	$0.00	$0.00	$0.00	$0.00
7717G	SUP	Custom 27203010		7717G  -  SUTURE NONABSORBABLE 9-0 TG140-8 12IN 2 ARM MONOFILAMENT	BOTH IP/OP	$33.76 	$24.98	$0.00	$27.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.06	$25.06	$0.00	$0.00	$7.04	$0.00	$0.00	$0.00	$0.00	$17.14	$27.14	$27.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7731G	SUP	Custom 27203010		7731G  -  SUTURE NABSB 5-0 S-24 18IN BLK ETH SBLC 2 ARM MFL	BOTH IP/OP	$33.98 	$25.15	$0.00	$27.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.22	$25.22	$0.00	$0.00	$7.08	$0.00	$0.00	$0.00	$0.00	$17.24	$27.32	$27.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
77-4003	SUP	HCPCS C1776		77-4003  -  TRAY TIBIAL 3 40/61MM 35MM 1 AXIS TOT STABILIZE STEM END CAP	BOTH IP/OP	"$5,837.50 "	"$4,319.75"	$0.00	"$4,670.00"	"$2,626.88"	"$2,626.88"	$0.00	$0.00	$0.00	"$1,216.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,216.54"	$0.00	"$2,877.89"	"$2,877.89"	$0.00	"$2,918.75"	"$4,623.30"	"$4,670.00"	$0.00		$0.00	$913.57	$0.00	$0.00	$929.33	$0.00	$0.00	$0.00	$0.00	$0.00
77-4004	SUP	HCPCS C1776		77-4004  -  TRAY TIBIAL 4 TOT STABILIZE MODULAR SCORPIO KNEE	BOTH IP/OP	"$5,837.50 "	"$4,319.75"	$0.00	"$4,670.00"	"$2,626.88"	"$2,626.88"	$0.00	$0.00	$0.00	"$1,216.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,216.54"	$0.00	"$2,877.89"	"$2,877.89"	$0.00	"$2,918.75"	"$4,623.30"	"$4,670.00"	$0.00		$0.00	$913.57	$0.00	$0.00	$929.33	$0.00	$0.00	$0.00	$0.00	$0.00
77-4005	SUP	HCPCS C1776		77-4005  -  TRAY TIBIAL 5 44/66MM 35MM 1 AXIS TOT STABILIZE STEM END CAP	BOTH IP/OP	"$5,837.50 "	"$4,319.75"	$0.00	"$4,670.00"	"$2,626.88"	"$2,626.88"	$0.00	$0.00	$0.00	"$1,216.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,216.54"	$0.00	"$2,877.89"	"$2,877.89"	$0.00	"$2,918.75"	"$4,623.30"	"$4,670.00"	$0.00		$0.00	$913.57	$0.00	$0.00	$929.33	$0.00	$0.00	$0.00	$0.00	$0.00
77-4006	SUP	HCPCS C1776		77-4006  -  TRAY TIBIAL 6 TOT STABILIZE MODULAR SCORPIO KNEE	BOTH IP/OP	"$5,837.50 "	"$4,319.75"	$0.00	"$4,670.00"	"$2,626.88"	"$2,626.88"	$0.00	$0.00	$0.00	"$1,216.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,216.54"	$0.00	"$2,877.89"	"$2,877.89"	$0.00	"$2,918.75"	"$4,623.30"	"$4,670.00"	$0.00		$0.00	$913.57	$0.00	$0.00	$929.33	$0.00	$0.00	$0.00	$0.00	$0.00
77-4007	SUP	HCPCS C1776		77-4007  -  TRAY TIBIAL 7 47/71MM 37MM 1 AXIS TOT STABILIZE STEM END CAP	BOTH IP/OP	"$5,837.50 "	"$4,319.75"	$0.00	"$4,670.00"	"$2,626.88"	"$2,626.88"	$0.00	$0.00	$0.00	"$1,216.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,216.54"	$0.00	"$2,877.89"	"$2,877.89"	$0.00	"$2,918.75"	"$4,623.30"	"$4,670.00"	$0.00		$0.00	$913.57	$0.00	$0.00	$929.33	$0.00	$0.00	$0.00	$0.00	$0.00
77-4009	SUP	HCPCS C1776		77-4009  -  TRAY TIBIAL 9 51/77MM 37MM 1 AXIS TOT STABILIZE STEM END CAP	BOTH IP/OP	"$5,837.50 "	"$4,319.75"	$0.00	"$4,670.00"	"$2,626.88"	"$2,626.88"	$0.00	$0.00	$0.00	"$1,216.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,216.54"	$0.00	"$2,877.89"	"$2,877.89"	$0.00	"$2,918.75"	"$4,623.30"	"$4,670.00"	$0.00		$0.00	$913.57	$0.00	$0.00	$929.33	$0.00	$0.00	$0.00	$0.00	$0.00
77-4011	SUP	HCPCS C1776		77-4011  -  TRAY TIBIAL 11 54/82MM 43MM 1 AXIS TOT STABILIZE STEM END	BOTH IP/OP	"$5,837.50 "	"$4,319.75"	$0.00	"$4,670.00"	"$2,626.88"	"$2,626.88"	$0.00	$0.00	$0.00	"$1,216.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,216.54"	$0.00	"$2,877.89"	"$2,877.89"	$0.00	"$2,918.75"	"$4,623.30"	"$4,670.00"	$0.00		$0.00	$913.57	$0.00	$0.00	$929.33	$0.00	$0.00	$0.00	$0.00	$0.00
77-4013	SUP	HCPCS C1776		77-4013  -  TRAY TIBIAL 13 58/88MM 43MM 1 AXIS TOT STABILIZE STEM END	BOTH IP/OP	"$5,837.50 "	"$4,319.75"	$0.00	"$4,670.00"	"$2,626.88"	"$2,626.88"	$0.00	$0.00	$0.00	"$1,216.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,216.54"	$0.00	"$2,877.89"	"$2,877.89"	$0.00	"$2,918.75"	"$4,623.30"	"$4,670.00"	$0.00		$0.00	$913.57	$0.00	$0.00	$929.33	$0.00	$0.00	$0.00	$0.00	$0.00
7751710EP	SUP	HCPCS C1713		7751710EP  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751712EP	SUP	HCPCS C1713		7751712EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751714EP	SUP	HCPCS C1713		7751714EP  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751716EP	SUP	HCPCS C1713		7751716EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751718EP	SUP	HCPCS C1713		7751718EP  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751720EP	SUP	HCPCS C1713		7751720EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751722EP	SUP	HCPCS C1713		7751722EP  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751724EP	SUP	HCPCS C1713		7751724EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751724PT	SUP	HCPCS C1713		7751724PT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751726PT	SUP	HCPCS C1713		7751726PT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751728PT	SUP	HCPCS C1713		7751728PT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751730PT	SUP	HCPCS C1713		7751730PT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751732PT	SUP	HCPCS C1713		7751732PT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751734PT	SUP	HCPCS C1713		7751734PT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751810EP	SUP	HCPCS C1713		7751810EP  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751812EP	SUP	HCPCS C1713		7751812EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751814EP	SUP	HCPCS C1713		7751814EP  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751816EP	SUP	HCPCS C1713		7751816EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751818EP	SUP	HCPCS C1713		7751818EP  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751820EP	SUP	HCPCS C1713		7751820EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751822EP	SUP	HCPCS C1713		7751822EP  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751824EP	SUP	HCPCS C1713		7751824EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751824PT	SUP	HCPCS C1713		7751824PT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751826EP	SUP	HCPCS C1713		7751826EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751826PT	SUP	HCPCS C1713		7751826PT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751828EP	SUP	HCPCS C1713		7751828EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751828PT	SUP	HCPCS C1713		7751828PT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751830EP	SUP	HCPCS C1713		7751830EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751830PT	SUP	HCPCS C1713		7751830PT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751832EP	SUP	HCPCS C1713		7751832EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751832PT	SUP	HCPCS C1713		7751832PT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751834EP	SUP	HCPCS C1713		7751834EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751834PT	SUP	HCPCS C1713		7751834PT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751924EP	SUP	HCPCS C1713		7751924EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751926EP	SUP	HCPCS C1713		7751926EP  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751928EP	SUP	HCPCS C1713		7751928EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751930EP	SUP	HCPCS C1713		7751930EP  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751932EP	SUP	HCPCS C1713		7751932EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
7751934EP	SUP	HCPCS C1713		7751934EP  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$983.68 	$727.92	$0.00	$786.94	$442.65	$442.65	$0.00	$0.00	$0.00	$205.02	$730.08	$730.08	$0.00	$0.00	$205.00	$0.00	$581.84	$581.84	$0.00	$491.84	$779.07	$786.94	$0.00		$0.00	$153.95	$0.00	$0.00	$156.60	$0.00	$0.00	$0.00	$0.00	$0.00
77525P	SUP	HCPCS C1713		77525P  -  SCREW BN 7.75MM 25MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77525S	SUP	HCPCS C1713		77525S  -  SCREW BN STD 7.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77530P	SUP	HCPCS C1713		77530P  -  SCREW BN 7.75MM 30MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77530S	SUP	HCPCS C1713		77530S  -  SCREW BN STD 7.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77535P	SUP	HCPCS C1713		77535P  -  SCREW BN 7.75MM 35MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77535S	SUP	HCPCS C1713		77535S  -  SCREW BN STD 7.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77540P	SUP	HCPCS C1713		77540P  -  SCREW BN 7.75MM 40MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77540S	SUP	HCPCS C1713		77540S  -  SCREW BN STD 7.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77545P	SUP	HCPCS C1713		77545P  -  SCREW BN 7.75MM 45MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77545S	SUP	HCPCS C1713		77545S  -  SCREW BN STD 7.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77550P	SUP	HCPCS C1713		77550P  -  SCREW BN 7.75MM 50MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77550S	SUP	HCPCS C1713		77550S  -  SCREW BN STD 7.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77555P	SUP	HCPCS C1713		77555P  -  SCREW BN 7.75MM 55MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77555S	SUP	HCPCS C1713		77555S  -  SCREW BN STD 7.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
7756073L	SUP	HCPCS C1713		7756073L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756073R	SUP	HCPCS C1713		7756073R  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756074L	SUP	HCPCS C1713		7756074L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
7756074R	SUP	HCPCS C1713		7756074R  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
77560P	SUP	HCPCS C1713		77560P  -  SCREW BN 7.75MM 60MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77560S	SUP	HCPCS C1713		77560S  -  SCREW BN STD 7.75MM 60MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77565P	SUP	HCPCS C1713		77565P  -  SCREW BN 7.75MM 65MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$1,621.98 "	"$1,200.27"	$0.00	"$1,297.58"	$729.89	$729.89	$0.00	$0.00	$0.00	$338.06	"$1,203.83"	"$1,203.83"	$0.00	$0.00	$338.02	$0.00	$959.40	$959.40	$0.00	$810.99	"$1,284.61"	"$1,297.58"	$0.00		$0.00	$253.84	$0.00	$0.00	$258.22	$0.00	$0.00	$0.00	$0.00	$0.00
77565S	SUP	HCPCS C1713		77565S  -  SCREW BN STD 7.75MM 65MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$1,233.33 "	$912.66	$0.00	$986.66	$555.00	$555.00	$0.00	$0.00	$0.00	$257.06	$915.37	$915.37	$0.00	$0.00	$257.02	$0.00	$729.51	$729.51	$0.00	$616.66	$976.80	$986.66	$0.00		$0.00	$193.02	$0.00	$0.00	$196.35	$0.00	$0.00	$0.00	$0.00	$0.00
77570P	SUP	HCPCS C1713		77570P  -  SCREW BN 7.75MM 70MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77580P	SUP	HCPCS C1713		77580P  -  SCREW BN 7.75MM 80MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
77590P	SUP	HCPCS C1713		77590P  -  SCREW BN 7.75MM 90MM SPRL R90D MULTIANGLE TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
778-014-00	SUP	HCPCS C1887		CATHETER GUID JL4ST CURVE 7FR .078IN 100CM PTFE VSBR BLUE	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
778-081-00	SUP	HCPCS C1887		CATHETER GUID JR3.5 CURVE 7FR .078IN 100CM SH PTFE VSBR BLUE	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
778-181-00	SUP	HCPCS C1887		CATHETER GUID LCB CURVE 7FR .078IN 100CM SH PTFE VSBR BLUE	BOTH IP/OP	$139.93 	$103.55	$0.00	$111.94	$75.98	$75.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.96	$110.82	$111.94	$0.00		$0.00	$21.90	$0.00	$0.00	$22.28	$0.00	$0.00	$0.00	$0.00	$0.00
78-10030	SUP	HCPCS C1713		78-10030  -  IMPLANT CRNL LG KT CSTM	BOTH IP/OP	"$30,104.35 "	"$22,277.22"	$0.00	"$35,102.00"	"$19,744.88"	"$19,744.88"	$0.00	$0.00	$0.00	"$6,274.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,273.75"	$0.00	"$14,841.45"	"$14,841.45"	$0.00	"$21,938.75"	"$34,750.98"	"$35,102.00"	$0.00		$0.00	"$6,866.83"	$0.00	$0.00	"$6,985.30"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-000	SUP	HCPCS C1776		7850-1-000  -  STEM FEM HIPSTAR 135D 0 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-001	SUP	HCPCS C1776		7850-1-001  -  STEM FEM HIPSTAR 135D 1 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-002	SUP	HCPCS C1776		7850-1-002  -  STEM FEM HIPSTAR 135D 2 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-003	SUP	HCPCS C1776		7850-1-003  -  STEM FEM HIPSTAR TMZF 135D 3 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-004	SUP	HCPCS C1776		7850-1-004  -  STEM FEM HIPSTAR HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-005	SUP	HCPCS C1776		7850-1-005  -  STEM FEM HIPSTAR TMZF 135D 5 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-006	SUP	HCPCS C1776		7850-1-006  -  STEM FEM HIPSTAR 135D 6 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-007	SUP	HCPCS C1776		7850-1-007  -  STEM FEM HIPSTAR 135D 7 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-008	SUP	HCPCS C1776		7850-1-008  -  STEM FEM HIPSTAR 135D 8 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-009	SUP	HCPCS C1776		7850-1-009  -  STEM FEM HIPSTAR 135D 9 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-010	SUP	HCPCS C1776		7850-1-010  -  STEM FEM HIPSTAR 135D 10 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-011	SUP	HCPCS C1776		7850-1-011  -  STEM FEM HIPSTAR 135D 11 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-1-012	SUP	HCPCS C1776		7850-1-012  -  STEM FEM HIPSTAR 135D 12 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-000	SUP	HCPCS C1776		7850-5-000  -  STEM FEM HIPSTAR 127D 0 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-001	SUP	HCPCS C1776		7850-5-001  -  STEM FEM HIPSTAR 127D 1 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-002	SUP	HCPCS C1776		7850-5-002  -  STEM FEM HIPSTAR 127D 2 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-003	SUP	HCPCS C1776		7850-5-003  -  STEM FEM HIPSTAR 127D 3 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-004	SUP	HCPCS C1776		7850-5-004  -  STEM FEM HIPSTAR 127D 4 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-005	SUP	HCPCS C1776		7850-5-005  -  STEM FEM HIPSTAR 127D 5 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-006	SUP	HCPCS C1776		7850-5-006  -  STEM FEM HIPSTAR 127D 6 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-007	SUP	HCPCS C1776		7850-5-007  -  STEM FEM HIPSTAR 127D 7 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-008	SUP	HCPCS C1776		7850-5-008  -  STEM FEM HIPSTAR 127D 8 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-009	SUP	HCPCS C1776		7850-5-009  -  STEM FEM HIPSTAR 127D 9 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-010	SUP	HCPCS C1776		7850-5-010  -  STEM FEM HIPSTAR 127D 10 HIP	BOTH IP/OP	"$6,328.00 "	"$4,682.72"	$0.00	"$5,062.40"	"$2,847.60"	"$2,847.60"	$0.00	$0.00	$0.00	"$1,318.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,318.76"	$0.00	"$3,119.70"	"$3,119.70"	$0.00	"$3,164.00"	"$5,011.78"	"$5,062.40"	$0.00		$0.00	$990.33	$0.00	$0.00	"$1,007.42"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-011	SUP	HCPCS C1776		7850-5-011  -  STEM FEM HIPSTAR 127D 11 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
7850-5-012	SUP	HCPCS C1776		7850-5-012  -  STEM FEM HIPSTAR 127D 12 HIP	BOTH IP/OP	"$6,665.00 "	"$4,932.10"	$0.00	"$5,332.00"	"$2,999.25"	"$2,999.25"	$0.00	$0.00	$0.00	"$1,389.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,388.99"	$0.00	"$3,285.85"	"$3,285.85"	$0.00	"$3,332.50"	"$5,278.68"	"$5,332.00"	$0.00		$0.00	"$1,043.07"	$0.00	$0.00	"$1,061.07"	$0.00	$0.00	$0.00	$0.00	$0.00
7925011S	SUP	HCPCS C1713		7925011S  -  CABLE SPINAL 2 LOOP 2 CRIMP TITANIUM STERILE	BOTH IP/OP	"$2,325.00 "	"$1,720.50"	$0.00	"$1,860.00"	"$1,046.25"	"$1,046.25"	$0.00	$0.00	$0.00	$484.59	"$1,725.62"	"$1,725.62"	$0.00	$0.00	$484.53	$0.00	"$1,375.24"	"$1,375.24"	$0.00	"$1,162.50"	"$1,841.40"	"$1,860.00"	$0.00		$0.00	$363.86	$0.00	$0.00	$370.14	$0.00	$0.00	$0.00	$0.00	$0.00
79-43903	SUP	HCPCS C1713		79-43903  -  CEMENT BONE INJECTABLE BIOCOMPATIBLE OSTEOCONDUCTIVE	BOTH IP/OP	"$2,314.78 "	"$1,712.94"	$0.00	"$2,686.00"	"$1,510.88"	"$1,510.88"	$0.00	$0.00	$0.00	$482.46	"$1,718.03"	"$1,718.03"	$0.00	$0.00	$482.40	$0.00	"$1,369.19"	"$1,369.19"	$0.00	"$1,678.75"	"$2,659.14"	"$2,686.00"	$0.00		$0.00	$525.45	$0.00	$0.00	$534.51	$0.00	$0.00	$0.00	$0.00	$0.00
79-43905	SUP	HCPCS C1713		79-43905  -  CEMENT BONE INJECTABLE BIOCOMPATIBLE OSTEOCONDUCTIVE	BOTH IP/OP	"$3,817.23 "	"$2,824.75"	$0.00	"$3,053.79"	"$1,717.75"	"$1,717.75"	$0.00	$0.00	$0.00	$795.61	"$2,833.15"	"$2,833.15"	$0.00	$0.00	$795.51	$0.00	"$1,881.90"	"$1,881.90"	$0.00	"$1,908.62"	"$3,023.25"	"$3,053.79"	$0.00		$0.00	$597.40	$0.00	$0.00	$607.70	$0.00	$0.00	$0.00	$0.00	$0.00
79-43910	SUP	HCPCS C1713		79-43910  -  CEMENT BN 10CC STRL LF HYDROSET INJ OSTCNDC CA PHOS VOID FIL	BOTH IP/OP	"$7,335.12 "	"$5,427.99"	$0.00	"$5,868.10"	"$3,300.80"	"$3,300.80"	$0.00	$0.00	$0.00	"$1,528.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,528.64"	$0.00	"$3,616.21"	"$3,616.21"	$0.00	"$3,667.56"	"$5,809.42"	"$5,868.10"	$0.00		$0.00	"$1,147.95"	$0.00	$0.00	"$1,167.75"	$0.00	$0.00	$0.00	$0.00	$0.00
79-43915	SUP	HCPCS C1713		79-43915  -  CEMENT BONE INJECTABLE OSTEOCONDUCTIVE HYDROSET CALCIUM	BOTH IP/OP	"$10,553.66 "	"$7,809.71"	$0.00	"$8,442.93"	"$4,749.15"	"$4,749.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,276.83"	"$8,358.50"	"$8,442.93"	$0.00		$0.00	"$1,651.65"	$0.00	$0.00	"$1,680.14"	$0.00	$0.00	$0.00	$0.00	$0.00
79-45903	SUP	HCPCS C1713		79-45903  -  DIRECT INJECT 3CC	BOTH IP/OP	"$3,840.00 "	"$2,841.60"	$0.00	"$3,072.00"	"$1,728.00"	"$1,728.00"	$0.00	$0.00	$0.00	$800.35	"$2,850.05"	"$2,850.05"	$0.00	$0.00	$800.26	$0.00	"$1,893.12"	"$1,893.12"	$0.00	"$1,920.00"	"$3,041.28"	"$3,072.00"	$0.00		$0.00	$600.96	$0.00	$0.00	$611.33	$0.00	$0.00	$0.00	$0.00	$0.00
79-45905	SUP	HCPCS C1713		79-45905  -  DIRECT INJECT 5CC	BOTH IP/OP	"$6,010.00 "	"$4,447.40"	$0.00	"$4,808.00"	"$2,704.50"	"$2,704.50"	$0.00	$0.00	$0.00	"$1,252.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,252.48"	$0.00	"$2,962.93"	"$2,962.93"	$0.00	"$3,005.00"	"$4,759.92"	"$4,808.00"	$0.00		$0.00	$940.57	$0.00	$0.00	$956.79	$0.00	$0.00	$0.00	$0.00	$0.00
79-45910	SUP	HCPCS C1713		79-45910  -  DIRECT INJECT 10CC	BOTH IP/OP	"$9,277.75 "	"$6,865.54"	$0.00	"$9,150.00"	"$5,146.88"	"$5,146.88"	$0.00	$0.00	$0.00	"$1,933.72"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,933.48"	$0.00	"$4,573.93"	"$4,573.93"	$0.00	"$5,718.75"	"$9,058.50"	"$9,150.00"	$0.00		$0.00	"$1,789.97"	$0.00	$0.00	"$1,820.85"	$0.00	$0.00	$0.00	$0.00	$0.00
794G	SUP	Custom 27203010		794G  -  SUTURE ABSORBABLE 6-0 G-6 18IN 2 ARM MONOFILAMENT CHROMIC	BOTH IP/OP	$43.50 	$32.19	$0.00	$35.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.28	$32.28	$0.00	$0.00	$9.06	$0.00	$0.00	$0.00	$0.00	$22.08	$34.97	$35.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79-80017	SUP	Custom 27203010		SPLINT ORTH LG 16IN KNEE SUP	BOTH IP/OP	$31.53 	$23.33	$0.00	$25.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.76	$24.97	$25.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79-83203	SUP	HCPCS L0172		79-83203  -  COLLAR CERV SMALL 10-20IN 2IN CHIN REST COMFORT PAD	BOTH IP/OP	$86.65 	$64.12	$0.00	$112.86	$45.85	$45.85	$0.00	$0.00	$0.00	$112.86	$64.31	$64.31	$0.00	$0.00	$18.06	$0.00	$51.25	$51.25	$0.00	$50.94	$80.69	$81.50	$61.13		$61.13	$107.46	$0.00	$0.00	$109.67	$0.00	$0.00	$0.00	$0.00	$0.00
79-83205	SUP	HCPCS L0172		79-83205  -  COLLAR CERV MEDIUM 10-20IN 2.5IN CHIN REST PAD TRACHEAL OPEN	BOTH IP/OP	$101.88 	$75.39	$0.00	$112.86	$45.85	$45.85	$0.00	$0.00	$0.00	$112.86	$75.62	$75.62	$0.00	$0.00	$21.23	$0.00	$60.26	$60.26	$0.00	$50.94	$80.69	$81.50	$61.13		$61.13	$107.46	$0.00	$0.00	$109.67	$0.00	$0.00	$0.00	$0.00	$0.00
79-83207	SUP	HCPCS L0172		79-83207  -  COLLAR CERV LARGE 10-20IN 3IN CHIN REST PAD TRACHEAL OPEN	BOTH IP/OP	$101.88 	$75.39	$0.00	$112.86	$45.85	$45.85	$0.00	$0.00	$0.00	$112.86	$75.62	$75.62	$0.00	$0.00	$21.23	$0.00	$60.26	$60.26	$0.00	$50.94	$80.69	$81.50	$61.13		$61.13	$107.46	$0.00	$0.00	$109.67	$0.00	$0.00	$0.00	$0.00	$0.00
79-83208	SUP	Custom 27203010		COLLAR CERV ADLT STOUT 14-24INX1.75IN MI J CHIN REST TRCH	BOTH IP/OP	$108.68 	$80.42	$0.00	$86.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.34	$86.07	$86.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79-94000	SUP	Custom 27203010		BRACE ORTH SM UNV PS FOAM KNEERANGER	BOTH IP/OP	$139.65 	$103.34	$0.00	$111.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.83	$110.60	$111.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79-94001	SUP	Custom 27203010		BRACE ORTH LG UNV PS FOAM KNEERANGER	BOTH IP/OP	$139.65 	$103.34	$0.00	$111.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.65	$103.65	$0.00	$0.00	$29.10	$0.00	$0.00	$0.00	$0.00	$69.83	$110.60	$111.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79-95413	SUP	Custom 27203010		BRACE WLK SM AIR RCKR SOLE MAXTRAX BLK STD HT	BOTH IP/OP	$93.15 	$68.93	$0.00	$74.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.58	$73.77	$74.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79-96018	SUP	Custom 27203010		IMMOBILIZER ORTH UNV 18IN 36IN KNEE BSC ELAST ML STAY CNTCT	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$0.00	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79-97957	SUP	Custom 27203010		BRACE HUMERAL FX LARGE	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
79-98600	SUP	Custom 27203010		CORD TRC 100YD SPL NYL	BOTH IP/OP	$53.43 	$39.54	$0.00	$42.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.71	$42.32	$42.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7AC60-MN	SUP	Custom 27203010		7AC60-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$0.00	$0.00	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA05	SUP	Custom 27203010		7BA05  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA05L-MN	SUP	Custom 27203010		7BA05L-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA05-MN	SUP	Custom 27203010		7BA05-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA06DL-MN	SUP	Custom 27203010		7BA06DL-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA06D-MN	SUP	Custom 27203010		7BA06D-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA10	SUP	Custom 27203010		7BA10  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA10C-MN	SUP	Custom 27203010		7BA10C-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA10D	SUP	Custom 27203010		7BA10D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA10-MN	SUP	Custom 27203010		7BA10-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA15	SUP	Custom 27203010		7BA15  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA15D	SUP	Custom 27203010		7BA15D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA15DL-MN	SUP	Custom 27203010		7BA15DL-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA15D-MN	SUP	Custom 27203010		7BA15D-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA15-MN	SUP	Custom 27203010		7BA15-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA20	SUP	Custom 27203010		7BA20  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA20C-MN	SUP	Custom 27203010		7BA20C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA20D	SUP	Custom 27203010		7BA20D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA20DC-MN	SUP	Custom 27203010		7BA20DC-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA20DL-MN	SUP	Custom 27203010		7BA20DL-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA20-MN	SUP	Custom 27203010		7BA20-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA25	SUP	Custom 27203010		7BA25  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA25D	SUP	Custom 27203010		7BA25D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA25D-MN	SUP	Custom 27203010		7BA25D-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA25-MN	SUP	Custom 27203010		7BA25-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA30	SUP	Custom 27203010		7BA30  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$299.63 	$221.73	$0.00	$239.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.38	$222.38	$0.00	$0.00	$62.44	$0.00	$0.00	$0.00	$0.00	$149.81	$237.31	$239.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA30C-MN	SUP	Custom 27203010		7BA30C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA30D	SUP	Custom 27203010		7BA30D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA30DC-MN	SUP	Custom 27203010		7BA30DC-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA30DL-MN	SUP	Custom 27203010		7BA30DL-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA30L-MN	SUP	Custom 27203010		7BA30L-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA30-MN	SUP	Custom 27203010		7BA30-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA40C-MN	SUP	Custom 27203010		7BA40C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA40D	SUP	Custom 27203010		7BA40D  -  TOOL DISSECTING BALL 4MM 7CM DIAMOND MIDAS REX LEGEND	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA40DC-MN	SUP	Custom 27203010		7BA40DC-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA40F-MN	SUP	Custom 27203010		7BA40F-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA40-MN	SUP	Custom 27203010		7BA40-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA50C-MN	SUP	Custom 27203010		7BA50C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA50DC-MN	SUP	Custom 27203010		7BA50DC-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA50F-MN	SUP	Custom 27203010		7BA50F-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA50-MN	SUP	Custom 27203010		7BA50-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA60C-MN	SUP	Custom 27203010		7BA60C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA60D	SUP	Custom 27203010		7BA60D  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA60DC-MN	SUP	Custom 27203010		7BA60DC-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$325.13 	$240.60	$0.00	$260.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.31	$241.31	$0.00	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$162.56	$257.50	$260.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA60D-MN	SUP	Custom 27203010		7BA60D-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA60F-MN	SUP	Custom 27203010		7BA60F-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA60-MN	SUP	Custom 27203010		7BA60-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA70C-MN	SUP	Custom 27203010		7BA70C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA70D-MN	SUP	Custom 27203010		7BA70D-MN  -  TOOL DISS MIDAS REX LEGEND MEDNEXT BALL L7 CM OD7 MM STERILE	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA70-MN	SUP	Custom 27203010		7BA70-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$299.63 	$221.73	$0.00	$239.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.38	$222.38	$0.00	$0.00	$62.44	$0.00	$0.00	$0.00	$0.00	$149.81	$237.31	$239.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA80C-MN	SUP	Custom 27203010		7BA80C-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$306.00 	$226.44	$0.00	$244.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.11	$227.11	$0.00	$0.00	$63.77	$0.00	$0.00	$0.00	$0.00	$153.00	$242.35	$244.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA80D-MN	SUP	Custom 27203010		7BA80D-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7BA80-MN	SUP	Custom 27203010		7BA80-MN  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$297.50 	$220.15	$0.00	$238.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.80	$220.80	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$148.75	$235.62	$238.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
7SCT	SUP	Custom 27203010		7SCT  -  TUBE TRACHEOSTOMY 9.6MM 7MM 80MM 1 CANNU CUFF LOW PRESSURE	BOTH IP/OP	$71.38 	$52.82	$0.00	$57.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.97	$52.97	$0.00	$0.00	$14.87	$0.00	$0.00	$0.00	$0.00	$36.22	$57.38	$57.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
800.604.02S	SUP	HCPCS C1713		800.604.02S  -  SCREW BONE 4MM 1.5MM CORT CRNMXF RESORB STRL	BOTH IP/OP	$373.50 	$276.39	$0.00	$298.80	$168.08	$168.08	$0.00	$0.00	$0.00	$77.85	$277.21	$277.21	$0.00	$0.00	$77.84	$0.00	$220.93	$220.93	$0.00	$186.75	$295.81	$298.80	$0.00		$0.00	$58.45	$0.00	$0.00	$59.46	$0.00	$0.00	$0.00	$0.00	$0.00
80-0055	SUP	Custom 27203010		80-0055  -  DRILL SURG CANN	BOTH IP/OP	$730.00 	$540.20	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.81	$541.81	$0.00	$0.00	$152.13	$0.00	$0.00	$0.00	$0.00	$365.00	$578.16	$584.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0056	SUP	Custom 27203010		80-0056  -  BIT DRL 5.5MM ACTRK2	BOTH IP/OP	$730.00 	$540.20	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.81	$541.81	$0.00	$0.00	$152.13	$0.00	$0.00	$0.00	$0.00	$365.00	$578.16	$584.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0100	SUP	Custom 27203010		80-0100  -  DRILL SRG MIC LNG ACTRK2	BOTH IP/OP	$730.00 	$540.20	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.81	$541.81	$0.00	$0.00	$152.13	$0.00	$0.00	$0.00	$0.00	$365.00	$578.16	$584.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
800-1003A	SUP	Custom 27203010		800-1003A  -  KIT CNTRF 30ML GPS III 1 PLTL CONC DISP	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8001021-3	SUP	HCPCS C1781		8001021-3  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,962.25 "	"$2,192.07"	$0.00	"$2,369.80"	"$1,333.01"	"$1,333.01"	$0.00	$0.00	$0.00	$617.41	"$2,198.58"	"$2,198.58"	$0.00	$0.00	$617.33	$0.00	"$1,460.39"	"$1,460.39"	$0.00	"$1,481.13"	"$2,346.10"	"$2,369.80"	$0.00		$0.00	$463.59	$0.00	$0.00	$471.59	$0.00	$0.00	$0.00	$0.00	$0.00
8001021-6	SUP	HCPCS C1781		8001021-6  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,962.25 "	"$2,192.07"	$0.00	"$2,369.80"	"$1,333.01"	"$1,333.01"	$0.00	$0.00	$0.00	$617.41	"$2,198.58"	"$2,198.58"	$0.00	$0.00	$617.33	$0.00	"$1,460.39"	"$1,460.39"	$0.00	"$1,481.13"	"$2,346.10"	"$2,369.80"	$0.00		$0.00	$463.59	$0.00	$0.00	$471.59	$0.00	$0.00	$0.00	$0.00	$0.00
80-0148	SUP	HCPCS C1713		80-0148  -  SCREW BN 3MM 2 TRK TAP DRL CLVCL	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$192.38	$192.38	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$66.90	$0.00	$0.00	$68.06	$0.00	$0.00	$0.00	$0.00	$0.00
80-0149	SUP	Custom 27203010		80-0149  -  SCREW BN 3.8MM 2 TRK TAP DRL CLVCL	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0150	SUP	HCPCS C1769		80-0150  -  GUIDE STD T ACLC SURG LEFT DORSAL	BOTH IP/OP	"$2,960.00 "	"$2,190.40"	$0.00	"$2,368.00"	"$1,607.28"	"$1,607.28"	$0.00	$0.00	$0.00	$616.94	"$2,196.91"	"$2,196.91"	$0.00	$0.00	$616.86	$0.00	"$1,750.84"	"$1,750.84"	$0.00	"$1,480.00"	"$2,344.32"	"$2,368.00"	$0.00		$0.00	$463.24	$0.00	$0.00	$471.23	$0.00	$0.00	$0.00	$0.00	$0.00
8001511-3	SUP	HCPCS C1781		8001511-3  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,188.75 "	"$1,619.68"	$0.00	"$1,751.00"	$984.94	$984.94	$0.00	$0.00	$0.00	$456.19	"$1,624.49"	"$1,624.49"	$0.00	$0.00	$456.14	$0.00	"$1,294.65"	"$1,294.65"	$0.00	"$1,094.38"	"$1,733.49"	"$1,751.00"	$0.00		$0.00	$342.54	$0.00	$0.00	$348.45	$0.00	$0.00	$0.00	$0.00	$0.00
8001511-6	SUP	HCPCS C1781		8001511-6  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,188.75 "	"$1,619.68"	$0.00	"$1,751.00"	$984.94	$984.94	$0.00	$0.00	$0.00	$456.19	"$1,624.49"	"$1,624.49"	$0.00	$0.00	$456.14	$0.00	"$1,294.65"	"$1,294.65"	$0.00	"$1,094.38"	"$1,733.49"	"$1,751.00"	$0.00		$0.00	$342.54	$0.00	$0.00	$348.45	$0.00	$0.00	$0.00	$0.00	$0.00
8001521-3	SUP	HCPCS C1781		8001521-3  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,768.88 "	"$2,048.97"	$0.00	"$2,215.10"	"$1,245.99"	"$1,245.99"	$0.00	$0.00	$0.00	$577.10	"$2,055.06"	"$2,055.06"	$0.00	$0.00	$577.03	$0.00	"$1,365.06"	"$1,365.06"	$0.00	"$1,384.44"	"$2,192.95"	"$2,215.10"	$0.00		$0.00	$433.33	$0.00	$0.00	$440.80	$0.00	$0.00	$0.00	$0.00	$0.00
8001521-6	SUP	HCPCS C1781		8001521-6  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,881.50 "	"$2,132.31"	$0.00	"$2,305.20"	"$1,296.68"	"$1,296.68"	$0.00	$0.00	$0.00	$600.58	"$2,138.65"	"$2,138.65"	$0.00	$0.00	$600.50	$0.00	"$1,420.58"	"$1,420.58"	$0.00	"$1,440.75"	"$2,282.15"	"$2,305.20"	$0.00		$0.00	$450.95	$0.00	$0.00	$458.73	$0.00	$0.00	$0.00	$0.00	$0.00
8001523-6	SUP	HCPCS C1781		8001523-6  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,881.50 "	"$2,132.31"	$0.00	"$2,305.20"	"$1,296.68"	"$1,296.68"	$0.00	$0.00	$0.00	$600.58	"$2,138.65"	"$2,138.65"	$0.00	$0.00	$600.50	$0.00	"$1,420.58"	"$1,420.58"	$0.00	"$1,440.75"	"$2,282.15"	"$2,305.20"	$0.00		$0.00	$450.95	$0.00	$0.00	$458.73	$0.00	$0.00	$0.00	$0.00	$0.00
8001531-6	SUP	HCPCS C1781		8001531-6  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,740.88 "	"$3,508.25"	$0.00	"$3,792.70"	"$2,133.39"	"$2,133.39"	$0.00	$0.00	$0.00	$988.12	"$3,518.68"	"$3,518.68"	$0.00	$0.00	$988.00	$0.00	"$2,337.25"	"$2,337.25"	$0.00	"$2,370.44"	"$3,754.78"	"$3,792.70"	$0.00		$0.00	$741.95	$0.00	$0.00	$754.75	$0.00	$0.00	$0.00	$0.00	$0.00
8001533-6	SUP	HCPCS C1781		8001533-6  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,836.50 "	"$3,579.01"	$0.00	"$3,869.20"	"$2,176.43"	"$2,176.43"	$0.00	$0.00	$0.00	"$1,008.05"	"$3,589.65"	"$3,589.65"	$0.00	$0.00	"$1,007.93"	$0.00	"$2,384.39"	"$2,384.39"	$0.00	"$2,418.25"	"$3,830.51"	"$3,869.20"	$0.00		$0.00	$756.91	$0.00	$0.00	$769.97	$0.00	$0.00	$0.00	$0.00	$0.00
80-018	SUP	Custom 27203010		80-018  -  BIT DRILL 2MM HEAD	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0180	SUP	Custom 27203010		80-0180  -  TIP SCRDRVR 1.5MM SLD HEX AO CONNECT DRVR NONSTRL	BOTH IP/OP	$470.00 	$347.80	$0.00	$376.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.83	$348.83	$0.00	$0.00	$97.95	$0.00	$0.00	$0.00	$0.00	$235.00	$372.24	$376.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0205	SUP	Custom 27203010		80-0205  -  TRPHN ACTRK6/7 SURG	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0206	SUP	Custom 27203010		80-0206  -  TRPHN ACTRK+ SURG	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0207	SUP	Custom 27203010		80-0207  -  TRPHN ACTRK 4/5 SURG	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0208	SUP	Custom 27203010		80-0208  -  TRPHN 20+ MM STD ACTRK SURG	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0209	SUP	Custom 27203010		80-0209  -  TRPHN 0-20MM STD ACTRK SURG	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0210	SUP	Custom 27203010		80-0210  -  TRPHN MINI ACTRK SURG	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0211	SUP	Custom 27203010		80-0211  -  TRPHN STD ACTRK2 SURG	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0212	SUP	Custom 27203010		80-0212  -  TRPHN MINI ACTRK2 SURG	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0213	SUP	Custom 27203010		80-0213  -  TRPHN MIC ACTRK2 SURG	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0214	SUP	Custom 27203010		80-0214  -  TRPHN ACTRK2 SURG 5.5 MM SCR	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0216	SUP	Custom 27203010		80-0216  -  TRPHN ACTRK2 BRKN SURG 3.5 MM CMPR SCR	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0217	SUP	Custom 27203010		80-0217  -  TRPHN ACTRK2 BRKN SURG 2.7 MM CMPR SCR	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8002221-6	SUP	HCPCS C1781		8002221-6  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,828.38 "	"$2,093.00"	$0.00	"$2,262.70"	"$1,272.77"	"$1,272.77"	$0.00	$0.00	$0.00	$589.50	"$2,099.22"	"$2,099.22"	$0.00	$0.00	$589.43	$0.00	"$1,394.39"	"$1,394.39"	$0.00	"$1,414.19"	"$2,240.08"	"$2,262.70"	$0.00		$0.00	$442.64	$0.00	$0.00	$450.28	$0.00	$0.00	$0.00	$0.00	$0.00
8002231-6	SUP	HCPCS C1781		8002231-6  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$4,798.25 "	"$3,550.71"	$0.00	"$3,838.60"	"$2,159.21"	"$2,159.21"	$0.00	$0.00	$0.00	"$1,000.08"	"$3,561.26"	"$3,561.26"	$0.00	$0.00	$999.96	$0.00	"$2,365.54"	"$2,365.54"	$0.00	"$2,399.13"	"$3,800.21"	"$3,838.60"	$0.00		$0.00	$750.93	$0.00	$0.00	$763.88	$0.00	$0.00	$0.00	$0.00	$0.00
8002233-6	SUP	HCPCS C1781		8002233-6  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$4,798.25 "	"$3,550.71"	$0.00	"$3,838.60"	"$2,159.21"	"$2,159.21"	$0.00	$0.00	$0.00	"$1,000.08"	"$3,561.26"	"$3,561.26"	$0.00	$0.00	$999.96	$0.00	"$2,365.54"	"$2,365.54"	$0.00	"$2,399.13"	"$3,800.21"	"$3,838.60"	$0.00		$0.00	$750.93	$0.00	$0.00	$763.88	$0.00	$0.00	$0.00	$0.00	$0.00
80-0248	SUP	HCPCS C1713		80-0248  -  PLATE SM TACK BONE	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$61.88	$61.88	$0.00	$0.00	$0.00	$28.66	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$81.33	$81.33	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$21.52	$0.00	$0.00	$21.89	$0.00	$0.00	$0.00	$0.00	$0.00
80-0297	SUP	Custom 27203010		80-0297  -  BIT DRILL 4.6MM 3.1MM ACTRK DNS	BOTH IP/OP	$805.00 	$595.70	$0.00	$644.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$597.47	$597.47	$0.00	$0.00	$167.76	$0.00	$0.00	$0.00	$0.00	$402.50	$637.56	$644.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0298	SUP	Custom 27203010		80-0298  -  DRILL SURG ACTRK+ CANN DNS QRLSE	BOTH IP/OP	$805.00 	$595.70	$0.00	$644.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$597.47	$597.47	$0.00	$0.00	$167.76	$0.00	$0.00	$0.00	$0.00	$402.50	$637.56	$644.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0302	SUP	Custom 27203010		80-0302  -  BIT DRILL 2.5MM HEX TIP FLXB	BOTH IP/OP	"$1,152.50 "	$852.85	$0.00	$922.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$855.39	$855.39	$0.00	$0.00	$240.18	$0.00	$0.00	$0.00	$0.00	$576.25	$912.78	$922.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0318	SUP	Custom 27203010		80-0318  -  BIT DRL 2MM NS ACLC 2 SURGIBIT QRLSE 2.7MM SCR	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
800-3510	SUP	Custom 27203010		STRIP UA ATNMX 9 PRMTR REAGENT	BOTH IP/OP	$86.13 	$63.74	$0.00	$68.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.06	$68.21	$68.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0362	SUP	Custom 27203010		80-0362  -  TAP BN 2.3MM	BOTH IP/OP	$285.00 	$210.90	$0.00	$228.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.53	$211.53	$0.00	$0.00	$59.39	$0.00	$0.00	$0.00	$0.00	$142.50	$225.72	$228.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0386	SUP	Custom 27203010		80-0386  -  DRILL SURG QRLSE 2MM	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0387	SUP	Custom 27203010		80-0387  -  DRILL SRG 2.8MM QRLSE 3.5MM SCR	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0399	SUP	Custom 27203010		80-0399  -  DRILL SURG 1.5MM ACTRK LEFT HND	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0400	SUP	Custom 27203010		80-0400  -  DRILL SURG 2MM ACTRK LEFT HND SCR REM	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0401	SUP	Custom 27203010		80-0401  -  DRILL SURG 2.5MM ACTRK LEFT HND SCR REM	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0402	SUP	Custom 27203010		80-0402  -  DRILL SURG 3MM ACTRK LEFT HND SCR REM	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0403	SUP	Custom 27203010		80-0403  -  DRILL SURG 3.5MM ACTRK LEFT HND SCR REM	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0404	SUP	Custom 27203010		80-0404  -  DRILL SURG 4MM ACTRK LEFT HND SCR REM	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0411	SUP	Custom 27803010		80-0411  -  PIN TNSNBND SNAPPER	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0413	SUP	HCPCS C1769		80-0413  -  WIRE FX .062IN KRSH	BOTH IP/OP	$37.50 	$27.75	$0.00	$30.00	$20.36	$20.36	$0.00	$0.00	$0.00	$7.82	$27.83	$27.83	$0.00	$0.00	$7.82	$0.00	$22.18	$22.18	$0.00	$18.75	$29.70	$30.00	$0.00		$0.00	$5.87	$0.00	$0.00	$5.97	$0.00	$0.00	$0.00	$0.00	$0.00
80-0465	SUP	Custom 27203010		80-0465  -  DRILL SRG CNN OLCRN	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0477	SUP	Custom 27203010		80-0477  -  DRILL SURG 40-65MM ACTRK6/7 CANN QRLSE DNS	BOTH IP/OP	$805.00 	$595.70	$0.00	$644.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$597.47	$597.47	$0.00	$0.00	$167.76	$0.00	$0.00	$0.00	$0.00	$402.50	$637.56	$644.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0478	SUP	Custom 27203010		80-0478  -  DRILL SURG 70-85MM ACTRK6/7 CANN QRLSE DNS	BOTH IP/OP	$902.50 	$667.85	$0.00	$722.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$669.84	$669.84	$0.00	$0.00	$188.08	$0.00	$0.00	$0.00	$0.00	$451.25	$714.78	$722.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0479	SUP	Custom 27203010		80-0479  -  DRILL SURG 90-120MM ACTRK6/7 CANN QRLSE DNS	BOTH IP/OP	"$1,127.50 "	$834.35	$0.00	$902.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$836.83	$836.83	$0.00	$0.00	$234.97	$0.00	$0.00	$0.00	$0.00	$563.75	$892.98	$902.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0569	SUP	Custom 27203010		80-0569  -  REAMER SURG 16MM CNCV MTP FRFT MIDFT PLT SYS NONSTRL	BOTH IP/OP	"$1,360.00 "	"$1,006.40"	$0.00	"$1,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,009.39"	"$1,009.39"	$0.00	$0.00	$283.42	$0.00	$0.00	$0.00	$0.00	$680.00	"$1,077.12"	"$1,088.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0570	SUP	Custom 27203010		80-0570  -  REAMER SURG 16MM CNVX MTP FRFT MIDFT PLT SYS NONSTRL	BOTH IP/OP	"$1,360.00 "	"$1,006.40"	$0.00	"$1,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,009.39"	"$1,009.39"	$0.00	$0.00	$283.42	$0.00	$0.00	$0.00	$0.00	$680.00	"$1,077.12"	"$1,088.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0571	SUP	Custom 27203010		80-0571  -  REAMER SURG 18MM MALE SET FT	BOTH IP/OP	"$1,360.00 "	"$1,006.40"	$0.00	"$1,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,009.39"	"$1,009.39"	$0.00	$0.00	$283.42	$0.00	$0.00	$0.00	$0.00	$680.00	"$1,077.12"	"$1,088.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0572	SUP	Custom 27203010		80-0572  -  REAMER SURG 18MM FMALE SET FT	BOTH IP/OP	"$1,360.00 "	"$1,006.40"	$0.00	"$1,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,009.39"	"$1,009.39"	$0.00	$0.00	$283.42	$0.00	$0.00	$0.00	$0.00	$680.00	"$1,077.12"	"$1,088.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0573	SUP	Custom 27203010		80-0573  -  REAMER SURG 20MM CNCV MTP FRFT MIDFT PLT SYS NONSTRL	BOTH IP/OP	"$1,360.00 "	"$1,006.40"	$0.00	"$1,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,009.39"	"$1,009.39"	$0.00	$0.00	$283.42	$0.00	$0.00	$0.00	$0.00	$680.00	"$1,077.12"	"$1,088.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0574	SUP	Custom 27203010		80-0574  -  REAMER SURG 74MM STNLS STELL CNCV SM BONE	BOTH IP/OP	"$1,360.00 "	"$1,006.40"	$0.00	"$1,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,009.39"	"$1,009.39"	$0.00	$0.00	$283.42	$0.00	$0.00	$0.00	$0.00	$680.00	"$1,077.12"	"$1,088.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0575	SUP	Custom 27203010		80-0575  -  REAMER SURG 76MM SS CNVX SM BONE	BOTH IP/OP	"$1,360.00 "	"$1,006.40"	$0.00	"$1,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,009.39"	"$1,009.39"	$0.00	$0.00	$283.42	$0.00	$0.00	$0.00	$0.00	$680.00	"$1,077.12"	"$1,088.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0576	SUP	Custom 27203010		80-0576  -  REAMER SURG 75MM SS CNCV SM BONE	BOTH IP/OP	"$1,360.00 "	"$1,006.40"	$0.00	"$1,088.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,009.39"	"$1,009.39"	$0.00	$0.00	$283.42	$0.00	$0.00	$0.00	$0.00	$680.00	"$1,077.12"	"$1,088.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0583	SUP	Custom 27203010		80-0583  -  DRIVER 1.5MM ACTRK QRLSE SLD HEX TIP SURG	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0598	SUP	Custom 27203010		80-0598  -  XTRT SURG EZOUT QRLSE 1.5MM	BOTH IP/OP	$307.50 	$227.55	$0.00	$246.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.23	$228.23	$0.00	$0.00	$64.08	$0.00	$0.00	$0.00	$0.00	$153.75	$243.54	$246.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0599	SUP	Custom 27203010		80-0599  -  XTRT SURG ACTRK QRLSE EZOUT 2MM	BOTH IP/OP	$307.50 	$227.55	$0.00	$246.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.23	$228.23	$0.00	$0.00	$64.08	$0.00	$0.00	$0.00	$0.00	$153.75	$243.54	$246.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0600	SUP	Custom 27203010		80-0600  -  XTRT SURG EZOUT QRLSE 2.5MM	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0601	SUP	Custom 27203010		80-0601  -  TOOL REM 3MM ACTRK SCR EASYOUT	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0602	SUP	Custom 27203010		80-0602  -  TOOL REM 3.5MM ACTRK SCR EASYOUT	BOTH IP/OP	$430.00 	$318.20	$0.00	$344.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$0.00	$0.00	$0.00	$215.00	$340.56	$344.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0603	SUP	Custom 27203010		80-0603  -  TOOL REM 4MM ACTRK SCR EASYOUT	BOTH IP/OP	$490.00 	$362.60	$0.00	$392.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$363.68	$363.68	$0.00	$0.00	$102.12	$0.00	$0.00	$0.00	$0.00	$245.00	$388.08	$392.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0605	SUP	Custom 27203010		80-0605  -  DRIVER ACTRK HEX TIP IMPCT XTRT 3MM SURG	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0606	SUP	Custom 27203010		80-0606  -  DRIVER ACTRK HEX TIP IMPCT SCR XTRT 4MM SURG	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0610	SUP	Custom 27203010		80-0610  -  TIP SCRDRVR ACTRK REM SHFT QRLSE	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$0.00	$0.00	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0611	SUP	Custom 27203010		80-0611  -  WRENCH SURG SCR REM TIP ACTRK	BOTH IP/OP	"$1,837.50 "	"$1,359.75"	$0.00	"$1,470.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,363.79"	"$1,363.79"	$0.00	$0.00	$382.94	$0.00	$0.00	$0.00	$0.00	$918.75	"$1,455.30"	"$1,470.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0612	SUP	Custom 27203010		80-0612  -  TIP SCRDRVR ACTRK MIC REM	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$0.00	$0.00	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0613	SUP	Custom 27203010		80-0613  -  TOOL REM ACTRK MINI TIP	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$0.00	$0.00	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0614	SUP	Custom 27203010		80-0614  -  TOOL REM ACTRK STD TIP	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$0.00	$0.00	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0615	SUP	Custom 27203010		80-0615  -  TOOL REM ACTRK LG TIP	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$0.00	$0.00	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0616	SUP	Custom 27203010		80-0616  -  TOOL REM ACTRK XL TIP	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$0.00	$0.00	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0625	SUP	Custom 27203010		80-0625  -  TAP BONE 2.7MM HEXALOBE SCR	BOTH IP/OP	$307.50 	$227.55	$0.00	$246.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.23	$228.23	$0.00	$0.00	$64.08	$0.00	$0.00	$0.00	$0.00	$153.75	$243.54	$246.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0626	SUP	Custom 27203010		80-0626  -  TAP BN INS CORONOID DISP 3MM NLCKG SCR	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.79	$233.79	$0.00	$0.00	$65.65	$0.00	$0.00	$0.00	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0627	SUP	Custom 27203010		80-0627  -  DRILL SURG QRLSE 2.3MM	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0628	SUP	Custom 27203010		80-0628  -  GUIDE DRILL 2MM 2.3MM NAR	BOTH IP/OP	$730.00 	$540.20	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.81	$541.81	$0.00	$0.00	$152.13	$0.00	$0.00	$0.00	$0.00	$365.00	$578.16	$584.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0632	SUP	Custom 27203010		80-0632  -  DRIVER 2MM QRLSE SLD HEX TIP SURG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0633	SUP	Custom 27203010		80-0633  -  DRIVER 3MM ACTRK QRLSE SLD HEX TIP SURG	BOTH IP/OP	$535.00 	$395.90	$0.00	$428.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$397.08	$397.08	$0.00	$0.00	$111.49	$0.00	$0.00	$0.00	$0.00	$267.50	$423.72	$428.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0634	SUP	Custom 27203010		80-0634  -  DRIVER 3.5MM ACTRK QRLSE SLD HEX TIP SURG	BOTH IP/OP	$597.50 	$442.15	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$443.46	$443.46	$0.00	$0.00	$124.52	$0.00	$0.00	$0.00	$0.00	$298.75	$473.22	$478.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0635	SUP	Custom 27203010		80-0635  -  DRIVER 4MM ACTRK QRLSE SLD HEX TIP SURG	BOTH IP/OP	$657.50 	$486.55	$0.00	$526.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$488.00	$488.00	$0.00	$0.00	$137.02	$0.00	$0.00	$0.00	$0.00	$328.75	$520.74	$526.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0636	SUP	Custom 27203010		80-0636  -  DRIVER ACTRK QRLSE CRCIFRM TIP SURG	BOTH IP/OP	$767.50 	$567.95	$0.00	$614.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$569.64	$569.64	$0.00	$0.00	$159.95	$0.00	$0.00	$0.00	$0.00	$383.75	$607.86	$614.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0642	SUP	Custom 27203010		80-0642  -  ROD XTRNFX 2.8IN DRL FIB	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0659	SUP	Custom 27203010		80-0659  -  TAP SRG DIST ELB 3 MM SCR	BOTH IP/OP	$730.00 	$540.20	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.81	$541.81	$0.00	$0.00	$152.13	$0.00	$0.00	$0.00	$0.00	$365.00	$578.16	$584.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0661	SUP	Custom 27203010		80-0661  -  TAP SRG NS HUM DIST 3.5 MM SCR	BOTH IP/OP	$730.00 	$540.20	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.81	$541.81	$0.00	$0.00	$152.13	$0.00	$0.00	$0.00	$0.00	$365.00	$578.16	$584.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0663	SUP	Custom 27203010		80-0663  -  HANDLE DRVR MED RCHT	BOTH IP/OP	"$2,275.00 "	"$1,683.50"	$0.00	"$1,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,688.51"	"$1,688.51"	$0.00	$0.00	$474.11	$0.00	$0.00	$0.00	$0.00	"$1,137.50"	"$1,801.80"	"$1,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0664	SUP	Custom 27203010		80-0664  -  PROBE SURG 2.3MM DEPTH	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0688	SUP	Custom 27203010		80-0688  -  WIRE FIX .054IN KWIRE GUIDE REUSE	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0724	SUP	Custom 27203010		80-0724  -  BIT DRILL 2.5MM FRAG-LOC SURG	BOTH IP/OP	$535.00 	$395.90	$0.00	$428.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$397.08	$397.08	$0.00	$0.00	$111.49	$0.00	$0.00	$0.00	$0.00	$267.50	$423.72	$428.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0728	SUP	Custom 27203010		80-0728  -  DRIVER 1.5MM HEX TIP LCK GRV 2.3MM SURG	BOTH IP/OP	$535.00 	$395.90	$0.00	$428.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$397.08	$397.08	$0.00	$0.00	$111.49	$0.00	$0.00	$0.00	$0.00	$267.50	$423.72	$428.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0758	SUP	Custom 27203010		80-0758  -  GUIDEWIRE ORTHOPEDIC 24IN THREADED INSTR UCSS	BOTH IP/OP	$805.00 	$595.70	$0.00	$644.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$597.47	$597.47	$0.00	$0.00	$167.76	$0.00	$0.00	$0.00	$0.00	$402.50	$637.56	$644.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0759	SUP	Custom 27203010		80-0759  -  DRIVER SRG T8 MN STICKFIT HEXALOBE QC DRL REUSE	BOTH IP/OP	$707.50 	$523.55	$0.00	$566.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.11	$525.11	$0.00	$0.00	$147.44	$0.00	$0.00	$0.00	$0.00	$353.75	$560.34	$566.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0760	SUP	Custom 27203010		80-0760  -  DRIVER SRG T15 HEXALOBE SCR STK FIR	BOTH IP/OP	$707.50 	$523.55	$0.00	$566.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.11	$525.11	$0.00	$0.00	$147.44	$0.00	$0.00	$0.00	$0.00	$353.75	$560.34	$566.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0772	SUP	HCPCS C1713		80-0772  -  SCREW BN 3MM 2 TRK STP DRL CLVCL	BOTH IP/OP	$547.50 	$405.15	$0.00	$438.00	$246.38	$246.38	$0.00	$0.00	$0.00	$114.11	$406.35	$406.35	$0.00	$0.00	$114.10	$0.00	$323.85	$323.85	$0.00	$273.75	$433.62	$438.00	$0.00		$0.00	$85.68	$0.00	$0.00	$87.16	$0.00	$0.00	$0.00	$0.00	$0.00
80-0773	SUP	Custom 27203010		80-0773  -  SCREW BN 3.8MM 2 TRK STP DRL CLVCL	BOTH IP/OP	$547.50 	$405.15	$0.00	$438.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$406.35	$406.35	$0.00	$0.00	$114.10	$0.00	$0.00	$0.00	$0.00	$273.75	$433.62	$438.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0774	SUP	Custom 27203010		80-0774  -  REAMER SURG 3MM THDL	BOTH IP/OP	"$1,287.50 "	$952.75	$0.00	"$1,030.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.58	$955.58	$0.00	$0.00	$268.32	$0.00	$0.00	$0.00	$0.00	$643.75	"$1,019.70"	"$1,030.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0775	SUP	Custom 27203010		80-0775  -  REAMER SURG 3.8MM THDL DL TRK CLVCL SCR SYS	BOTH IP/OP	"$1,287.50 "	$952.75	$0.00	"$1,030.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.58	$955.58	$0.00	$0.00	$268.32	$0.00	$0.00	$0.00	$0.00	$643.75	"$1,019.70"	"$1,030.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0783	SUP	Custom 27203010		80-0783  -  SCREW BN 3MM 2 TRK TAP CLVCL	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.72	$311.72	$0.00	$0.00	$87.53	$0.00	$0.00	$0.00	$0.00	$210.00	$332.64	$336.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-0838	SUP	HCPCS C1713		80-0838  -  SCREW BONE .75IN 3/32IN BLNK	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$6.75	$6.75	$0.00	$0.00	$0.00	$3.13	$11.13	$11.13	$0.00	$0.00	$3.13	$0.00	$8.87	$8.87	$0.00	$7.50	$11.88	$12.00	$0.00		$0.00	$2.35	$0.00	$0.00	$2.39	$0.00	$0.00	$0.00	$0.00	$0.00
801 325 100	SUP	Custom 27203010		SERACLONE ANTI-A 10X10ML	BOTH IP/OP	$894.38 	$661.84	$0.00	$715.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$447.19	$708.35	$715.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
801 350 100	SUP	Custom 27203010		SERACLONE ANTI-B 10X10ML	BOTH IP/OP	$894.38 	$661.84	$0.00	$715.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$447.19	$708.35	$715.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80129-201	SUP	HCPCS C1874		80129-201  -  STENT ESPH 16FR 18MM 67CM 70MM ALIMAXX-ES FULL CVR PROX SUT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-202	SUP	HCPCS C1874		80129-202  -  STENT ESPH 18MM 22FR 100CM ALIMAXX-E REM COVERED RADOPQ MTL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-203	SUP	HCPCS C1874		80129-203  -  STENT ESPH 22FR 18MM 120CM ALIMAXX-E REM COVERED MTL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-204	SUP	HCPCS C1874		80129-204  -  STENT ESPH 22MM 22FR 70CM ALIMAXX-E REM COVERED RADOPQ MTL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-205	SUP	HCPCS C1874		80129-205  -  STENT ESPH 22FR 100CM ALIMAXX-E SYS MTL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-206	SUP	HCPCS C1874		80129-206  -  STENT ESPH 22FR 120CM ALIMAXX-E SLF XPD MTL DISP	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-207	SUP	HCPCS C1874		80129-207  -  STENT ESPH 12MM 70CM ALIMAXX-ES FLLY COVERED	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-208	SUP	HCPCS C1874		80129-208  -  STENT ESPH 22MM 100CM ALIMAXX-ES PU CVR ANTIMIGRATION STRUT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-209	SUP	HCPCS C1874		80129-209  -  STENT ESPH GMTR 12MM 16FR 120MM NS 62CM ALIMAXX-ES FLLY	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-210	SUP	HCPCS C1874		80129-210  -  STENT ESPH 14MM 70CM ALIMAXX-ES FLLY COVERED	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-211	SUP	HCPCS C1874		80129-211  -  STENT ESPH 14MM 16FR 100MM 64CM ALIMAXX-ES FLLY COVERED SMTH	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-212	SUP	HCPCS C1874		80129-212  -  STENT ESPH 14MM 16FR 62CM 120MM ALIMAXX-ES FLLY COVERED GMTR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-213	SUP	HCPCS C1874		80129-213  -  STENT ESPH GMTR 16MM 70CM ALIMAXX-ES FLLY COVERED PU CVR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-214	SUP	HCPCS C1874		80129-214  -  STENT ESPH 16MM 16FR 100MM 64CM ALIMAXX-ES FLLY COVERED SMTH	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-215	SUP	HCPCS C1874		80129-215  -  STENT ESPH 16MM 62CM 120MM ALIMAXX-ES FLLY COVERED GMTR PU	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
80129-406	SUP	HCPCS C1769		80129-406  -  GUIDEWIRE ENDSCP STR .035IN 260CM SUPER STIFF FLEXIBILITY	BOTH IP/OP	$750.00 	$555.00	$0.00	$556.65	$271.50	$271.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
80-1759	SUP	HCPCS C1713		80-1759  -  TACK FX .04IN PLT	BOTH IP/OP	$322.50 	$238.65	$0.00	$258.00	$145.13	$145.13	$0.00	$0.00	$0.00	$67.22	$239.36	$239.36	$0.00	$0.00	$67.21	$0.00	$190.76	$190.76	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$50.47	$0.00	$0.00	$51.34	$0.00	$0.00	$0.00	$0.00	$0.00
80-1794	SUP	Custom 27203010		80-1794  -  DRILL SRG 1.1MM 3.5IN QRLSE STD AO 1.5MM SCR	BOTH IP/OP	$742.50 	$549.45	$0.00	$594.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$551.08	$551.08	$0.00	$0.00	$154.74	$0.00	$0.00	$0.00	$0.00	$371.25	$588.06	$594.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-1796	SUP	Custom 27203010		80-1796  -  DRILL SURG 2MM 3.5IN QUICK RELEASE STANDARD AO SURGIBIT	BOTH IP/OP	$742.50 	$549.45	$0.00	$594.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$551.08	$551.08	$0.00	$0.00	$154.74	$0.00	$0.00	$0.00	$0.00	$371.25	$588.06	$594.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-1797	SUP	Custom 27203010		80-1797  -  DRILL SURG 3.5IN CUT INSERTION SURGIBIT MINI 2IN REUSABLE	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
802 042 100	SUP	Custom 27203010		SERACLONE ANTI-D 10X10ML	BOTH IP/OP	$928.13 	$686.82	$0.00	$742.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$464.06	$735.08	$742.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
802 336 100	SUP	Custom 27203010		SERACLONE ANTI-E 1X5ML	BOTH IP/OP	$265.50 	$196.47	$0.00	$212.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.75	$210.28	$212.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8023 A	SUP	Custom 27803010		8023 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$213.75 	$158.18	$0.00	$171.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.65	$158.65	$0.00	$0.00	$44.55	$0.00	$0.00	$0.00	$0.00	$106.88	$169.29	$171.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8023 B	SUP	Custom 27803010		8023 B  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$213.75 	$158.18	$0.00	$171.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.65	$158.65	$0.00	$0.00	$44.55	$0.00	$0.00	$0.00	$0.00	$106.88	$169.29	$171.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
803.605.02S	SUP	HCPCS C1713		803.605.02S  -  SCREW BONE 1.5MM 5MM CORT RESORB STRL	BOTH IP/OP	$361.03 	$267.16	$0.00	$288.82	$162.46	$162.46	$0.00	$0.00	$0.00	$75.25	$267.95	$267.95	$0.00	$0.00	$75.24	$0.00	$213.55	$213.55	$0.00	$180.51	$285.94	$288.82	$0.00		$0.00	$56.50	$0.00	$0.00	$57.48	$0.00	$0.00	$0.00	$0.00	$0.00
804 175 100	SUP	Custom 27203010		AHG ANTI-LGG 10 X 10 ML	BOTH IP/OP	$463.50 	$342.99	$0.00	$370.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.75	$367.09	$370.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
804.006.02S	SUP	HCPCS C1713		804.006.02S  -  SCREW BONE 2MM 6MM CORT RESORB MESH STRL	BOTH IP/OP	$361.03 	$267.16	$0.00	$288.82	$162.46	$162.46	$0.00	$0.00	$0.00	$75.25	$267.95	$267.95	$0.00	$0.00	$75.24	$0.00	$213.55	$213.55	$0.00	$180.51	$285.94	$288.82	$0.00		$0.00	$56.50	$0.00	$0.00	$57.48	$0.00	$0.00	$0.00	$0.00	$0.00
80-4403L	SUP	HCPCS C1776		80-4403L  -  COMPONENT FEMORAL 3 57X51MM CRUCIATE RETAIN POST PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4403R	SUP	HCPCS C1776		80-4403R  -  COMPONENT FEMORAL 3 57X51MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4404L	SUP	HCPCS C1776		80-4404L  -  COMPONENT FEMORAL 4 60X53MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4404R	SUP	HCPCS C1776		80-4404R  -  COMPONENT FEMORAL 4 60X53MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4405L	SUP	HCPCS C1776		80-4405L  -  COMPONENT FEMORAL 5 62X55MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4405R	SUP	HCPCS C1776		80-4405R  -  COMPONENT FEMORAL 5 62X55MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4406L	SUP	HCPCS C1776		80-4406L  -  COMPONENT FEMORAL 6 65X57MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4406R	SUP	HCPCS C1776		80-4406R  -  COMPONENT FEMORAL 6 65X57MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4407L	SUP	HCPCS C1776		80-4407L  -  COMPONENT FEMORAL 7 67X60MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4407R	SUP	HCPCS C1776		80-4407R  -  COMPONENT FEMORAL 7 67X60MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4408L	SUP	HCPCS C1776		80-4408L  -  COMPONENT FEMORAL 8 70X62MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4408R	SUP	HCPCS C1776		80-4408R  -  COMPONENT FEMORAL 8 70X62MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4409L	SUP	HCPCS C1776		80-4409L  -  COMPONENT FEMORAL 9 72X64MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4409R	SUP	HCPCS C1776		80-4409R  -  COMPONENT FEMORAL 9 72X64MM CRUCIATE RETAIN PRIM LUG SCORPIO	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4411L	SUP	HCPCS C1776		80-4411L  -  COMPONENT FEMORAL 11 77X69MM CRUCIATE RETAIN PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4411R	SUP	HCPCS C1776		80-4411R  -  COMPONENT FEMORAL 11 77X69MM CRUCIATE RETAIN PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4413L	SUP	HCPCS C1776		80-4413L  -  COMPONENT FEMORAL 13 82X74MM CRUCIATE RETAIN PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
80-4413R	SUP	HCPCS C1776		80-4413R  -  COMPONENT FEMORAL 13 82X74MM CRUCIATE RETAIN PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
805.603.02S	SUP	HCPCS C1713		805.603.02S  -  SCREW BN 1.5MM 3MM STRL CRNMXF CORT 2 PK	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
805.604.02S	SUP	HCPCS C1713		805.604.02S  -  SCREW BONE RPD RESORB 4MM 1.5MM CORT CRNMXF STRL	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
805.605.02S	SUP	HCPCS C1713		805.605.02S  -  SCREW BN 1.5MM 5MM STRL CRNMXF CORT 2 PK	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
805.606.02S	SUP	HCPCS C1713		805.606.02S  -  SCREW BN 1.5MM 6MM STRL CRNMXF CORT 2 PK	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
805.608.02S	SUP	HCPCS C1713		805.608.02S  -  SCREW BONE 8MM 1.5MM CORT CRNMXF RPD RESORB STRL	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
805.614.02S	SUP	HCPCS C1713		805.614.02S  -  TACK FX 1.5MM 4MM STRL RAPIDSORB RSRB CRNMXF	BOTH IP/OP	$373.50 	$276.39	$0.00	$298.80	$168.08	$168.08	$0.00	$0.00	$0.00	$77.85	$277.21	$277.21	$0.00	$0.00	$77.84	$0.00	$220.93	$220.93	$0.00	$186.75	$295.81	$298.80	$0.00		$0.00	$58.45	$0.00	$0.00	$59.46	$0.00	$0.00	$0.00	$0.00	$0.00
806.004.02S	SUP	HCPCS C1713		806.004.02S  -  SCREW BONE 4MM 2MM CORT CRNMXF RPD RESORB STRL	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
806.006.02S	SUP	HCPCS C1713		806.006.02S  -  SCREW BN 2MM 6MM STRL CRNMXF CORT 2 PK	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
806.008.02S	SUP	HCPCS C1713		806.008.02S  -  SCREW BN 2MM 8MM STRL CRNMXF CORT 2 PK	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
806.044.02S	SUP	HCPCS C1713		806.044.02S  -  SCREW BONE 4MM 2.5MM CORT CRNMXF RPD RESORB ER STRL	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
806.046.02S	SUP	HCPCS C1713		806.046.02S  -  SCREW BONE 6MM 2.5MM CORT CRNMXF RPD RESORB ER STRL	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
806.048.02S	SUP	HCPCS C1713		806.048.02S  -  SCREW BONE 8MM 2.5MM CORT CRNMXF RPD RESORB ER STRL	BOTH IP/OP	$393.75 	$291.38	$0.00	$315.00	$177.19	$177.19	$0.00	$0.00	$0.00	$82.07	$292.24	$292.24	$0.00	$0.00	$82.06	$0.00	$232.90	$232.90	$0.00	$196.88	$311.85	$315.00	$0.00		$0.00	$61.62	$0.00	$0.00	$62.69	$0.00	$0.00	$0.00	$0.00	$0.00
808 052 100	SUP	Custom 27203010		SERACLONE ANTI-S 1 X 2 MLL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
808 188 100	SUP	Custom 27203010		SERACLONE ANTI-FYA 1 X 2 ML	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
808 403 100	SUP	Custom 27203010		SERACLONE ANTI-LEA 1X2ML	BOTH IP/OP	$590.63 	$437.07	$0.00	$472.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.31	$467.78	$472.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
808 410 100	SUP	Custom 27203010		SERACLONE ANTI-M 1X 2 ML	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
808 415 100	SUP	Custom 27203010		SERACLONE ANTI-N 1 X 2 ML	BOTH IP/OP	$236.25 	$174.83	$0.00	$189.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.13	$187.11	$189.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
808-002	SUP	HCPCS C1713		808-002  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
808-083	SUP	HCPCS C1713		808-083  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
808-105	SUP	HCPCS C1713		808-105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
808-190	SUP	HCPCS C1713		808-190  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
808-524	SUP	HCPCS C1713		808-524  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,670.00 "	"$1,975.80"	$0.00	"$2,136.00"	"$1,201.50"	"$1,201.50"	$0.00	$0.00	$0.00	$556.49	"$1,981.67"	"$1,981.67"	$0.00	$0.00	$556.43	$0.00	"$1,316.31"	"$1,316.31"	$0.00	"$1,335.00"	"$2,114.64"	"$2,136.00"	$0.00		$0.00	$417.86	$0.00	$0.00	$425.06	$0.00	$0.00	$0.00	$0.00	$0.00
809-DBL	SUP	HCPCS C1713		809-DBL  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$97.05 	$71.82	$0.00	$77.64	$43.67	$43.67	$0.00	$0.00	$0.00	$20.23	$72.03	$72.03	$0.00	$0.00	$20.23	$0.00	$57.41	$57.41	$0.00	$48.53	$76.86	$77.64	$0.00		$0.00	$15.19	$0.00	$0.00	$15.45	$0.00	$0.00	$0.00	$0.00	$0.00
80CR000022	SUP	Custom 27203010		REAGENT TRIS BUFF SAL PH 8 COAG	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80XLTCD	SUP	Custom 27203010		80XLTCD  -  TUBE TRCH 40MM 50MM 13.3MM 8MM 105MM STRL LF 15MM SHLY XLT	BOTH IP/OP	$159.65 	$118.14	$0.00	$129.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.49	$118.49	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$81.02	$128.34	$129.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
80XLTCP	SUP	Custom 27203010		80XLTCP  -  TUBE TRCH 40MM 35MM 13.3MM 8MM 105MM STRL LF 30MM SHLY XLT	BOTH IP/OP	$159.65 	$118.14	$0.00	$129.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.49	$118.49	$0.00	$0.00	$33.27	$0.00	$0.00	$0.00	$0.00	$81.02	$128.34	$129.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
810041B	SUP	HCPCS C1781		810041B  -  MESH TRANSVAGINAL 45X1.1CM TAPE TVT PROLENE BLUE	BOTH IP/OP	"$1,955.10 "	"$1,446.77"	$0.00	"$1,564.08"	$879.80	$879.80	$0.00	$0.00	$0.00	$407.49	"$1,451.08"	"$1,451.08"	$0.00	$0.00	$407.44	$0.00	"$1,156.44"	"$1,156.44"	$0.00	$977.55	"$1,548.44"	"$1,564.08"	$0.00		$0.00	$305.97	$0.00	$0.00	$311.25	$0.00	$0.00	$0.00	$0.00	$0.00
810-200	SUP	HCPCS C1713		810-200  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-201	SUP	HCPCS C1713		810-201  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-202	SUP	HCPCS C1713		810-202  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-203	SUP	HCPCS C1713		810-203  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-205	SUP	HCPCS C1713		810-205  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-206	SUP	HCPCS C1713		810-206  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-207	SUP	HCPCS C1713		810-207  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-208	SUP	HCPCS C1713		810-208  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-221	SUP	HCPCS C1713		810-221  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-222	SUP	HCPCS C1713		810-222  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8103.0201S	SUP	HCPCS C1713		8103.0201S  -  SUBSTITUTE BNGFT PLUS XEMPLIFI DEMINERALIZE BONE MATRIX 1ML	BOTH IP/OP	$570.00 	$421.80	$0.00	$456.00	$256.50	$256.50	$0.00	$0.00	$0.00	$118.80	$423.05	$423.05	$0.00	$0.00	$118.79	$0.00	$337.16	$337.16	$0.00	$285.00	$451.44	$456.00	$0.00		$0.00	$89.21	$0.00	$0.00	$90.74	$0.00	$0.00	$0.00	$0.00	$0.00
8103.0203S	SUP	HCPCS C1713		8103.0203S  -  SUBSTITUTE BNGFT PLUS XEMPLIFI DEMINERALIZE BONE MATRIX 3ML	BOTH IP/OP	"$1,485.00 "	"$1,098.90"	$0.00	"$1,188.00"	$668.25	$668.25	$0.00	$0.00	$0.00	$309.51	"$1,102.17"	"$1,102.17"	$0.00	$0.00	$309.47	$0.00	$878.38	$878.38	$0.00	$742.50	"$1,176.12"	"$1,188.00"	$0.00		$0.00	$232.40	$0.00	$0.00	$236.41	$0.00	$0.00	$0.00	$0.00	$0.00
810-300	SUP	HCPCS C1713		810-300  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-301	SUP	HCPCS C1713		810-301  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-302	SUP	HCPCS C1713		810-302  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-303	SUP	HCPCS C1713		810-303  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-304	SUP	HCPCS C1713		810-304  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-305	SUP	HCPCS C1713		810-305  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-306	SUP	HCPCS C1713		810-306  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-307	SUP	HCPCS C1713		810-307  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-308	SUP	HCPCS C1713		810-308  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-321	SUP	HCPCS C1713		810-321  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-322	SUP	HCPCS C1713		810-322  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-323	SUP	HCPCS C1713		810-323  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-400	SUP	HCPCS C1713		810-400  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-401	SUP	HCPCS C1713		810-401  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-402	SUP	HCPCS C1713		810-402  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-403	SUP	HCPCS C1713		810-403  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-404	SUP	HCPCS C1713		810-404  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-405	SUP	HCPCS C1713		810-405  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-406	SUP	HCPCS C1713		810-406  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-407	SUP	HCPCS C1713		810-407  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-408	SUP	HCPCS C1713		810-408  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-421	SUP	HCPCS C1713		810-421  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-422	SUP	HCPCS C1713		810-422  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-423	SUP	HCPCS C1713		810-423  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-450	SUP	HCPCS C1713		810-450  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
810-451	SUP	HCPCS C1713		810-451  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8104528M	SUP	HCPCS C1713		8104528M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104530M	SUP	HCPCS C1713		8104530M  -  PLATE BN 30-34MM X10 XLNK TI SPNE 4.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104534M	SUP	HCPCS C1713		8104534M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104541M	SUP	HCPCS C1713		8104541M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8104555M	SUP	HCPCS C1713		8104555M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
810-A20-1350	SUP	Custom 27203010		SCISSORS 4.75IN CRB EDG WIRE CTR SURG LTX	BOTH IP/OP	$105.33 	$77.94	$0.00	$84.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.66	$83.42	$84.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
811-300	SUP	HCPCS C1713		811-300  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-301	SUP	HCPCS C1713		811-301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-302	SUP	HCPCS C1713		811-302  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-303	SUP	HCPCS C1713		811-303  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-304	SUP	HCPCS C1713		811-304  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-305	SUP	HCPCS C1713		811-305  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-306	SUP	HCPCS C1713		811-306  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-307	SUP	HCPCS C1713		811-307  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-308	SUP	HCPCS C1713		811-308  -  PLATE BN 1.5IN STRL XLNK CD HZN LOPRFL TI SPNE 5.5MM ROD	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-313	SUP	Custom 27803010		811-313  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
811-321	SUP	HCPCS C1713		811-321  -  PLATE BN 1.55-1.75IN STRL MLSPN XLNK CD HZN LOPRFL TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-322	SUP	HCPCS C1713		811-322  -  PLATE BN 1.75-2.15IN STRL MLSPN XLNK CD HZN LOPRFL TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-323	SUP	HCPCS C1713		811-323  -  PLATE BN 2.15-2.95IN STRL MLSPN XLNK CD HZN LOPRFL TI SPNE	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-324	SUP	HCPCS C1713		811-324  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-400	SUP	HCPCS C1713		811-400  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-401	SUP	HCPCS C1713		811-401  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-402	SUP	HCPCS C1713		811-402  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-403	SUP	HCPCS C1713		811-403  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-404	SUP	HCPCS C1713		811-404  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-405	SUP	HCPCS C1713		811-405  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-406	SUP	HCPCS C1713		811-406  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-407	SUP	HCPCS C1713		811-407  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-408	SUP	HCPCS C1713		811-408  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-421	SUP	HCPCS C1713		811-421  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-422	SUP	HCPCS C1713		811-422  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-423	SUP	HCPCS C1713		811-423  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-450	SUP	HCPCS C1713		811-450  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
811-451	SUP	HCPCS C1713		811-451  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8114528M	SUP	HCPCS C1713		8114528M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114530M	SUP	HCPCS C1713		8114530M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114534M	SUP	HCPCS C1713		8114534M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114541M	SUP	HCPCS C1713		8114541M  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
8114555M	SUP	HCPCS C1713		8114555M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-500	SUP	HCPCS C1713		811-500  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-501	SUP	HCPCS C1713		811-501  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
811-DBL	SUP	HCPCS C1713		811-DBL  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$97.75 	$72.34	$0.00	$78.20	$43.99	$43.99	$0.00	$0.00	$0.00	$20.37	$72.55	$72.55	$0.00	$0.00	$20.37	$0.00	$57.82	$57.82	$0.00	$48.88	$77.42	$78.20	$0.00		$0.00	$15.30	$0.00	$0.00	$15.56	$0.00	$0.00	$0.00	$0.00	$0.00
813-DBL	SUP	HCPCS C1713		813-DBL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$97.75 	$72.34	$0.00	$78.20	$43.99	$43.99	$0.00	$0.00	$0.00	$20.37	$72.55	$72.55	$0.00	$0.00	$20.37	$0.00	$57.82	$57.82	$0.00	$48.88	$77.42	$78.20	$0.00		$0.00	$15.30	$0.00	$0.00	$15.56	$0.00	$0.00	$0.00	$0.00	$0.00
81-4403L	SUP	HCPCS C1776		81-4403L  -  COMPONENT FEMORAL 3 57X51MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4403R	SUP	HCPCS C1776		81-4403R  -  COMPONENT FEMORAL 3 57X51MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4404L	SUP	HCPCS C1776		81-4404L  -  COMPONENT FEMORAL 4 60X54MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4404R	SUP	HCPCS C1776		81-4404R  -  COMPONENT FEMORAL 4 60X54MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4405L	SUP	HCPCS C1776		81-4405L  -  COMPONENT FEMORAL 5 62X56MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4405R	SUP	HCPCS C1776		81-4405R  -  COMPONENT FEMORAL 5 62X56MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4406L	SUP	HCPCS C1776		81-4406L  -  COMPONENT FEMORAL 6 65X58MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4406R	SUP	HCPCS C1776		81-4406R  -  COMPONENT FEMORAL 6 65X58MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4407L	SUP	HCPCS C1776		81-4407L  -  COMPONENT FEMORAL 7 67X61MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4407R	SUP	HCPCS C1776		81-4407R  -  COMPONENT FEMORAL 7 67X61MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4408L	SUP	HCPCS C1776		81-4408L  -  COMPONENT FEMORAL 8 70X63MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4408R	SUP	HCPCS C1776		81-4408R  -  COMPONENT FEMORAL 8 70X63MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4409L	SUP	HCPCS C1776		81-4409L  -  COMPONENT FEMORAL 9 72X65MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4409R	SUP	HCPCS C1776		81-4409R  -  COMPONENT FEMORAL 9 72X65MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4411L	SUP	HCPCS C1776		81-4411L  -  COMPONENT FEMORAL 11 77X70MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4411R	SUP	HCPCS C1776		81-4411R  -  COMPONENT FEMORAL 11 77X70MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4413L	SUP	HCPCS C1776		81-4413L  -  COMPONENT FEMORAL 13 82X75MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81-4413R	SUP	HCPCS C1776		81-4413R  -  COMPONENT FEMORAL 13 82X75MM POSTERIOR STABILIZE PRIM LUG	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
81500V	SUP	Custom 27203010		81500V  -  APPLIER ENDOSCOPIC MED LARGE  STRAIGHT 13INźź	BOTH IP/OP	"$2,373.73 "	"$1,756.56"	$0.00	"$1,898.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,761.78"	"$1,761.78"	$0.00	$0.00	$494.68	$0.00	$0.00	$0.00	$0.00	"$1,186.86"	"$1,879.99"	"$1,898.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
815-013	SUP	HCPCS C1713		815-013  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$475.50 	$351.87	$0.00	$380.40	$213.98	$213.98	$0.00	$0.00	$0.00	$99.11	$352.92	$352.92	$0.00	$0.00	$99.09	$0.00	$281.26	$281.26	$0.00	$237.75	$376.60	$380.40	$0.00		$0.00	$74.42	$0.00	$0.00	$75.70	$0.00	$0.00	$0.00	$0.00	$0.00
815-015	SUP	HCPCS C1713		815-015  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$475.50 	$351.87	$0.00	$380.40	$213.98	$213.98	$0.00	$0.00	$0.00	$99.11	$352.92	$352.92	$0.00	$0.00	$99.09	$0.00	$281.26	$281.26	$0.00	$237.75	$376.60	$380.40	$0.00		$0.00	$74.42	$0.00	$0.00	$75.70	$0.00	$0.00	$0.00	$0.00	$0.00
815-017	SUP	HCPCS C1713		815-017  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$475.50 	$351.87	$0.00	$380.40	$213.98	$213.98	$0.00	$0.00	$0.00	$99.11	$352.92	$352.92	$0.00	$0.00	$99.09	$0.00	$281.26	$281.26	$0.00	$237.75	$376.60	$380.40	$0.00		$0.00	$74.42	$0.00	$0.00	$75.70	$0.00	$0.00	$0.00	$0.00	$0.00
81501V	SUP	Custom 27203010		81501V  -  CLIP INTNL ENDO REMOVER MED LARGE - LARGE  STRAIGHT 13INźź	BOTH IP/OP	"$2,164.98 "	"$1,602.09"	$0.00	"$1,731.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,606.84"	"$1,606.84"	$0.00	$0.00	$451.18	$0.00	$0.00	$0.00	$0.00	"$1,082.49"	"$1,714.66"	"$1,731.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
816-013	SUP	HCPCS C1713		816-013  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$247.05	$247.05	$0.00	$0.00	$0.00	$114.43	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$324.73	$324.73	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$85.92	$0.00	$0.00	$87.40	$0.00	$0.00	$0.00	$0.00	$0.00
816-015	SUP	HCPCS C1713		816-015  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$247.05	$247.05	$0.00	$0.00	$0.00	$114.43	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$324.73	$324.73	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$85.92	$0.00	$0.00	$87.40	$0.00	$0.00	$0.00	$0.00	$0.00
816-017	SUP	HCPCS C1713		816-017  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$549.00 	$406.26	$0.00	$439.20	$247.05	$247.05	$0.00	$0.00	$0.00	$114.43	$407.47	$407.47	$0.00	$0.00	$114.41	$0.00	$324.73	$324.73	$0.00	$274.50	$434.81	$439.20	$0.00		$0.00	$85.92	$0.00	$0.00	$87.40	$0.00	$0.00	$0.00	$0.00	$0.00
81602V	SUP	Custom 27203010		81602V  -  APPLIER ENDOSCOPIC LARGE  CURVED 13INźź	BOTH IP/OP	"$2,373.73 "	"$1,756.56"	$0.00	"$1,898.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,761.78"	"$1,761.78"	$0.00	$0.00	$494.68	$0.00	$0.00	$0.00	$0.00	"$1,186.86"	"$1,879.99"	"$1,898.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8161-35-026	SUP	HCPCS C1713		8161-35-026  -  SCREW 3.5X26MM CORTICAL LOCKING	BOTH IP/OP	$402.50 	$297.85	$0.00	$322.00	$181.13	$181.13	$0.00	$0.00	$0.00	$83.89	$298.74	$298.74	$0.00	$0.00	$83.88	$0.00	$238.08	$238.08	$0.00	$201.25	$318.78	$322.00	$0.00		$0.00	$62.99	$0.00	$0.00	$64.08	$0.00	$0.00	$0.00	$0.00	$0.00
8161-35-044	SUP	HCPCS C1713		8161-35-044  -  SCREW BONE 3.5MM 44MM CORT LCK	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$146.25	$146.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
81701V	SUP	Custom 27203010		81701V  -  CLIP INTNL ENDO REMOVERźLARGE - XLARGE  STRAIGHT 13INźź	BOTH IP/OP	"$2,249.98 "	"$1,664.99"	$0.00	"$1,799.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.93"	"$1,669.93"	$0.00	$0.00	$468.89	$0.00	$0.00	$0.00	$0.00	"$1,124.99"	"$1,781.98"	"$1,799.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81702V	SUP	Custom 27203010		81702V  -  APPLIER ENDOSCOPIC XLARGE  CURVED 13INźź	BOTH IP/OP	"$2,548.73 "	"$1,886.06"	$0.00	"$2,038.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,891.66"	"$1,891.66"	$0.00	$0.00	$531.15	$0.00	$0.00	$0.00	$0.00	"$1,274.36"	"$2,018.59"	"$2,038.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
81B001	SUP	HCPCS C1776		81B001  -  GRAFT SFT TIS FRZDR ANT TIB TNDN	BOTH IP/OP	"$5,032.50 "	"$3,724.05"	$0.00	"$4,026.00"	"$2,264.63"	"$2,264.63"	$0.00	$0.00	$0.00	"$1,048.90"	"$3,735.12"	"$3,735.12"	$0.00	$0.00	"$1,048.77"	$0.00	"$2,481.02"	"$2,481.02"	$0.00	"$2,516.25"	"$3,985.74"	"$4,026.00"	$0.00		$0.00	$787.59	$0.00	$0.00	$801.17	$0.00	$0.00	$0.00	$0.00	$0.00
81B005	SUP	HCPCS C1776		81B005  -  GRAFT BN GRCLS SEMITENDINOSUS	BOTH IP/OP	"$5,045.00 "	"$3,733.30"	$0.00	"$4,036.00"	"$2,270.25"	"$2,270.25"	$0.00	$0.00	$0.00	"$1,051.50"	"$3,744.40"	"$3,744.40"	$0.00	$0.00	"$1,051.38"	$0.00	"$2,487.19"	"$2,487.19"	$0.00	"$2,522.50"	"$3,995.64"	"$4,036.00"	$0.00		$0.00	$789.54	$0.00	$0.00	$803.16	$0.00	$0.00	$0.00	$0.00	$0.00
820-050	SUP	HCPCS C1713		820-050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$553.50 	$409.59	$0.00	$442.80	$249.08	$249.08	$0.00	$0.00	$0.00	$115.36	$410.81	$410.81	$0.00	$0.00	$115.35	$0.00	$327.40	$327.40	$0.00	$276.75	$438.37	$442.80	$0.00		$0.00	$86.62	$0.00	$0.00	$88.12	$0.00	$0.00	$0.00	$0.00	$0.00
82091-01	SUP	HCPCS C1876		82091-01  -  STENT VASCULAR TAPER 8-6MM 30MM SELF EXPANDABLE ERGONOMIC	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	"$1,856.25"	"$1,856.25"	$0.00	$0.00	$0.00	$859.75	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	"$2,033.63"	"$2,033.63"	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$645.56	$0.00	$0.00	$656.70	$0.00	$0.00	$0.00	$0.00	$0.00
82-1750	SUP	HCPCS C1729		82-1750  -  BACTISEAL CLEAR EVD CATHETER ANTIBIOTIC IMPREGNATED CATHETER	BOTH IP/OP	$386.40 	$285.94	$0.00	$309.12	$209.82	$209.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$193.20	$306.03	$309.12	$0.00		$0.00	$60.47	$0.00	$0.00	$61.51	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0308	SUP	Custom 27803010		82-2-0308  -  INSERT TIBIAL 3 8MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0310	SUP	Custom 27803010		82-2-0310  -  INSERT TIBIAL 3 10MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0312	SUP	Custom 27803010		82-2-0312  -  INSERT TIBIAL 3 12MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0315	SUP	Custom 27803010		82-2-0315  -  INSERT TIBIAL 3 15MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0318	SUP	Custom 27803010		82-2-0318  -  INSERT TIBIAL 3 18MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0321	SUP	Custom 27803010		82-2-0321  -  INSERT TIBIAL 3 21MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0324	SUP	Custom 27803010		82-2-0324  -  INSERT TIBIAL 3 24MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0508	SUP	Custom 27803010		82-2-0508  -  INSERT TIBIAL 5 8MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0510	SUP	Custom 27803010		82-2-0510  -  INSERT TIBIAL 5 10MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0512	SUP	Custom 27803010		82-2-0512  -  INSERT TIBIAL 5 12MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0515	SUP	Custom 27803010		82-2-0515  -  INSERT TIBIAL 5 15MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0518	SUP	Custom 27803010		82-2-0518  -  INSERT TIBIAL 5 18MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0521	SUP	Custom 27803010		82-2-0521  -  INSERT TIBIAL 5 21MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0524	SUP	Custom 27803010		82-2-0524  -  INSERT TIBIAL 5 24MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0708	SUP	Custom 27803010		82-2-0708  -  INSERT TIBIAL 7 BEARING NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0710	SUP	Custom 27803010		82-2-0710  -  INSERT TIBIAL 7 10MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0712	SUP	Custom 27803010		82-2-0712  -  INSERT TIBIAL 7 12MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0715	SUP	Custom 27803010		82-2-0715  -  INSERT TIBIAL 7 15MM SCORPIO NRG CR ANKLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0718	SUP	Custom 27803010		82-2-0718  -  INSERT TIBIAL 7 18MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0721	SUP	Custom 27803010		82-2-0721  -  INSERT TIBIAL 7 21MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0724	SUP	Custom 27803010		82-2-0724  -  INSERT TIBIAL 7 24MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0908	SUP	Custom 27803010		82-2-0908  -  INSERT TIBIAL 9 8MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0910	SUP	Custom 27803010		82-2-0910  -  INSERT TIBIAL 9 10MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0912	SUP	Custom 27803010		82-2-0912  -  INSERT TIBIAL 9 12MM SCORPIO NRG CR ANKLE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0915	SUP	Custom 27803010		82-2-0915  -  INSERT TIBIAL 9 15MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0918	SUP	Custom 27803010		82-2-0918  -  INSERT TIBIAL 9 18MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0921	SUP	Custom 27803010		82-2-0921  -  INSERT TIBIAL 9 21MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-0924	SUP	Custom 27803010		82-2-0924  -  INSERT TIBIAL 9 24MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-1108	SUP	Custom 27803010		82-2-1108  -  INSERT TIBIAL 11 8MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-1110	SUP	Custom 27803010		82-2-1110  -  INSERT TIBIAL 11 10MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-1112	SUP	Custom 27803010		82-2-1112  -  INSERT TIBIAL 11 12MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-1115	SUP	Custom 27803010		82-2-1115  -  INSERT TIBIAL 11 15MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-1118	SUP	Custom 27803010		82-2-1118  -  INSERT TIBIAL 11 18MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-1121	SUP	Custom 27803010		82-2-1121  -  INSERT TIBIAL 11 21MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-2-1124	SUP	Custom 27803010		82-2-1124  -  INSERT TIBIAL 11 24MM CRUC RET BEARING SCORPIO NRG KNEE	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
822-230	SUP	HCPCS C1713		822-230  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
822-235	SUP	HCPCS C1713		822-235  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,209.00 "	$894.66	$0.00	$967.20	$544.05	$544.05	$0.00	$0.00	$0.00	$251.99	$897.32	$897.32	$0.00	$0.00	$251.96	$0.00	$715.12	$715.12	$0.00	$604.50	$957.53	$967.20	$0.00		$0.00	$189.21	$0.00	$0.00	$192.47	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0308	SUP	Custom 27803010		82-3-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0310	SUP	Custom 27803010		82-3-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0312	SUP	Custom 27803010		82-3-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0315	SUP	Custom 27803010		82-3-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0318	SUP	Custom 27803010		82-3-0318  -  INSERT TIBIAL 3 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0321	SUP	Custom 27803010		82-3-0321  -  INSERT TIBIAL 3 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0324	SUP	Custom 27803010		82-3-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0508	SUP	Custom 27803010		82-3-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0510	SUP	Custom 27803010		82-3-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0512	SUP	Custom 27803010		82-3-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0515	SUP	Custom 27803010		82-3-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0518	SUP	Custom 27803010		82-3-0518  -  INSERT TIBIAL 5 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0521	SUP	Custom 27803010		82-3-0521  -  INSERT TIBIAL 5 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0524	SUP	Custom 27803010		82-3-0524  -  INSERT TIBIAL 5 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0708	SUP	Custom 27803010		82-3-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0710	SUP	Custom 27803010		82-3-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0712	SUP	Custom 27803010		82-3-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0715	SUP	Custom 27803010		82-3-0715  -  INSERT TIBIAL 7 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0718	SUP	Custom 27803010		82-3-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0721	SUP	Custom 27803010		82-3-0721  -  INSERT TIBIAL 7 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0724	SUP	Custom 27803010		82-3-0724  -  INSERT TIBIAL 7 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0908	SUP	Custom 27803010		82-3-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0910	SUP	Custom 27803010		82-3-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0912	SUP	Custom 27803010		82-3-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0915	SUP	Custom 27803010		82-3-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0918	SUP	Custom 27803010		82-3-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0921	SUP	Custom 27803010		82-3-0921  -  INSERT TIBIAL 9 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-0924	SUP	Custom 27803010		82-3-0924  -  INSERT TIBIAL 9 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-1108	SUP	Custom 27803010		82-3-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-1110	SUP	Custom 27803010		82-3-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZE BEARING SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-1112	SUP	Custom 27803010		82-3-1112  -  INSERT TIBIAL 11 12MM POSTERIOR STABILIZE BEARING SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-1115	SUP	Custom 27803010		82-3-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZE BEARING SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-1118	SUP	Custom 27803010		82-3-1118  -  INSERT TIBIAL 11 18MM POSTERIOR STABILIZE BEARING SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-1121	SUP	Custom 27803010		82-3-1121  -  INSERT TIBIAL 11 21MM POSTERIOR STABILIZE BEARING SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3-1124	SUP	Custom 27803010		82-3-1124  -  INSERT TIBIAL 11 24MM POSTERIOR STABILIZE BEARING SCORPIO	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-3164	SUP	Custom 27803010		82-3164  -  VALVE SHNT REG STRL STRT2 CSF PRGM FLW CNTRL BALL SPRG MECH	BOTH IP/OP	"$9,839.45 "	"$7,281.19"	$0.00	"$7,871.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,919.73"	"$7,792.84"	"$7,871.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
824-005	SUP	HCPCS C1713		824-005  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
824-007	SUP	Custom 27803010		824-007  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
824-027	SUP	HCPCS C1713		824-027  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
824-028	SUP	HCPCS C1713		824-028  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
824-040	SUP	HCPCS C1713		824-040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
824-041	SUP	HCPCS C1713		824-041  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
824-042	SUP	HCPCS C1713		824-042  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
82-50200	SUP	Custom 27203010		ELECTRODE EMG NM RSPN PT SMLTR CBL 15FT 8250200	BOTH IP/OP	"$1,802.50 "	"$1,333.85"	$0.00	"$1,442.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.25	"$1,427.58"	"$1,442.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-50600	SUP	Custom 27203010		ELECTRODE EMG NM RSPN PT SMLTR CBL 15FT 8250600	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-5472	SUP	Custom 27803010		82-5472  -  VALVE SHNT REG STRL DLT CSF 1 LVL	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-5474	SUP	Custom 27803010		82-5474  -  VALVE SHNT REG 40X16.5MM STRL LF 13MM DLT PS MDCL CSF PRFRM	BOTH IP/OP	"$3,617.13 "	"$2,676.68"	$0.00	"$2,893.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,808.56"	"$2,864.77"	"$2,893.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
826-011	SUP	Custom 27203010		826-011  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$828.50 	$613.09	$0.00	$662.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$614.91	$614.91	$0.00	$0.00	$172.66	$0.00	$0.00	$0.00	$0.00	$414.25	$656.17	$662.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
826-012	SUP	Custom 27203010		826-012  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$828.50 	$613.09	$0.00	$662.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$614.91	$614.91	$0.00	$0.00	$172.66	$0.00	$0.00	$0.00	$0.00	$414.25	$656.17	$662.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
826-013	SUP	Custom 27203010		826-013  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$828.50 	$613.09	$0.00	$662.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$614.91	$614.91	$0.00	$0.00	$172.66	$0.00	$0.00	$0.00	$0.00	$414.25	$656.17	$662.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
826-016	SUP	Custom 27803010		826-016  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$388.50 	$287.49	$0.00	$310.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$288.34	$288.34	$0.00	$0.00	$80.96	$0.00	$0.00	$0.00	$0.00	$194.25	$307.69	$310.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0308	SUP	Custom 27803010		82-6-0308  -  INSERT TIBIAL 3 8MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0310	SUP	Custom 27803010		82-6-0310  -  INSERT TIBIAL 3 10MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0312	SUP	Custom 27803010		82-6-0312  -  INSERT TIBIAL 3 12MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0314	SUP	Custom 27803010		82-6-0314  -  INSERT TIBIAL 3 14MM CRUC RET SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0315	SUP	Custom 27803010		82-6-0315  -  INSERT TIBIAL 3 15MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0318	SUP	Custom 27803010		82-6-0318  -  INSERT TIBIAL 3 18MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0321	SUP	Custom 27803010		82-6-0321  -  INSERT TIBIAL 3 21MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0324	SUP	Custom 27803010		82-6-0324  -  INSERT TIBIAL 3 24MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0508	SUP	Custom 27803010		82-6-0508  -  INSERT TIBIAL 5 8MM KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0510	SUP	Custom 27803010		82-6-0510  -  INSERT TIBIAL 5 10MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0512	SUP	Custom 27803010		82-6-0512  -  INSERT TIBIAL 5 12MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0515	SUP	Custom 27803010		82-6-0515  -  INSERT TIBIAL 5 15MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0518	SUP	Custom 27803010		82-6-0518  -  INSERT TIBIAL 5 18MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0521	SUP	Custom 27803010		82-6-0521  -  INSERT TIBIAL 5 21MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0524	SUP	Custom 27803010		82-6-0524  -  INSERT TIBIAL 5 24MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0708	SUP	Custom 27803010		82-6-0708  -  INSERT TIBIAL 7 8MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0710	SUP	Custom 27803010		82-6-0710  -  INSERT TIBIAL 7 10MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0712	SUP	Custom 27803010		82-6-0712  -  INSERT TIBIAL X3 POLYETHYLENE KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0715	SUP	Custom 27803010		82-6-0715  -  INSERT TIBIAL 7 15MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0718	SUP	Custom 27803010		82-6-0718  -  INSERT TIBIAL 7 18MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0721	SUP	Custom 27803010		82-6-0721  -  INSERT TIBIAL 7 21MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0724	SUP	Custom 27803010		82-6-0724  -  INSERT TIBIAL 7 24MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0908	SUP	Custom 27803010		82-6-0908  -  INSERT TIBIAL 9 8MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0910	SUP	Custom 27803010		82-6-0910  -  INSERT TIBIAL 9 10MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0912	SUP	Custom 27803010		82-6-0912  -  INSERT TIBIAL 9 12MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0914	SUP	Custom 27803010		82-6-0914  -  INSERT TIBIAL 9 14MM CRUC RET SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0915	SUP	Custom 27803010		82-6-0915  -  INSERT TIBIAL 9 15MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0916	SUP	Custom 27803010		82-6-0916  -  INSERT TIBIAL 9 16MM CRUC RET SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0918	SUP	Custom 27803010		82-6-0918  -  INSERT TIBIAL 9 18MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0921	SUP	Custom 27803010		82-6-0921  -  INSERT TIBIAL 9 21MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-0924	SUP	Custom 27803010		82-6-0924  -  INSERT TIBIAL 9 24MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-1108	SUP	Custom 27803010		82-6-1108  -  INSERT TIBIAL 11 8MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-1110	SUP	Custom 27803010		82-6-1110  -  INSERT TIBIAL 11 10MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-1112	SUP	Custom 27803010		82-6-1112  -  INSERT TIBIAL 11 12MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-1114	SUP	Custom 27803010		82-6-1114  -  INSERT TIBIAL 11 14MM CRUC RET SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-1115	SUP	Custom 27803010		82-6-1115  -  INSERT TIBIAL 11 15MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-1116	SUP	Custom 27803010		82-6-1116  -  INSERT TIBIAL 11 16MM CRUC RET SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-1118	SUP	Custom 27803010		82-6-1118  -  INSERT TIBIAL CRUC RET SCORPIO X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-1121	SUP	Custom 27803010		82-6-1121  -  INSERT TIBIAL 11 21MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6-1124	SUP	Custom 27803010		82-6-1124  -  INSERT TIBIAL 11 24MM CRUC RET SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
826-212	SUP	Custom 27203010		826-212  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,004.75 "	$743.52	$0.00	$803.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$745.73	$745.73	$0.00	$0.00	$209.39	$0.00	$0.00	$0.00	$0.00	$502.38	$795.76	$803.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
826-213	SUP	Custom 27203010		826-213  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,004.75 "	$743.52	$0.00	$803.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$745.73	$745.73	$0.00	$0.00	$209.39	$0.00	$0.00	$0.00	$0.00	$502.38	$795.76	$803.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
826-216	SUP	Custom 27803010		826-216  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$495.00 	$366.30	$0.00	$396.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$367.39	$367.39	$0.00	$0.00	$103.16	$0.00	$0.00	$0.00	$0.00	$247.50	$392.04	$396.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
826-217	SUP	HCPCS C1713		826-217  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$178.50 	$132.09	$0.00	$142.80	$80.33	$80.33	$0.00	$0.00	$0.00	$37.20	$132.48	$132.48	$0.00	$0.00	$37.20	$0.00	$105.58	$105.58	$0.00	$89.25	$141.37	$142.80	$0.00		$0.00	$27.94	$0.00	$0.00	$28.42	$0.00	$0.00	$0.00	$0.00	$0.00
826-219	SUP	Custom 27203010		826-219  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,004.75 "	$743.52	$0.00	$803.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$745.73	$745.73	$0.00	$0.00	$209.39	$0.00	$0.00	$0.00	$0.00	$502.38	$795.76	$803.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
826-320	SUP	Custom 27203010		826-320  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,004.75 "	$743.52	$0.00	$803.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$745.73	$745.73	$0.00	$0.00	$209.39	$0.00	$0.00	$0.00	$0.00	$502.38	$795.76	$803.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
826614 - USE 19994800	SUP	Custom 27803010		826614 - USE 19994800  -  KIT CRANIOTOMY CRANIAL ACCES CODMAN	BOTH IP/OP	$721.63 	$534.01	$0.00	$577.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$535.59	$535.59	$0.00	$0.00	$150.39	$0.00	$0.00	$0.00	$0.00	$360.81	$571.53	$577.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6638	SUP	Custom 27803010		82-6638  -  KIT PRSS MONITR MCSNSR .7MM SBDRL INPRENCH SKL BOLT	BOTH IP/OP	"$1,947.50 "	"$1,441.15"	$0.00	"$1,558.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,445.43"	"$1,445.43"	$0.00	$0.00	$405.86	$0.00	$0.00	$0.00	$0.00	$973.75	"$1,542.42"	"$1,558.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-6653	SUP	Custom 27803010		82-6653  -  KIT PRESSURE MONITR 38CM TRANSDUCER CATHETER TUNNELING	BOTH IP/OP	"$2,027.50 "	"$1,500.35"	$0.00	"$1,622.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,013.75"	"$1,605.78"	"$1,622.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0308	SUP	Custom 27803010		82-7-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0310	SUP	Custom 27803010		82-7-0310  -  INSERT TIBIAL 3 10MM	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0312	SUP	Custom 27803010		82-7-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0314	SUP	Custom 27803010		82-7-0314  -  INSERT TIBIAL 3 14MM POSTERIOR STABILIZING SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0315	SUP	Custom 27803010		82-7-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0316	SUP	Custom 27803010		82-7-0316  -  INSERT TIBIAL 3 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0318	SUP	Custom 27803010		82-7-0318  -  INSERT TIBIAL 3 18MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0321	SUP	Custom 27803010		82-7-0321  -  INSERT TIBIAL 3 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0324	SUP	Custom 27803010		82-7-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0508	SUP	Custom 27803010		82-7-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0510	SUP	Custom 27803010		82-7-0510  -  INSERT TIBIAL 5 10MM	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0512	SUP	Custom 27803010		82-7-0512  -  INSERT TIBIAL 5 12MM	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0514	SUP	Custom 27803010		82-7-0514  -  INSERT TIBIAL 5 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0515	SUP	Custom 27803010		82-7-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0516	SUP	Custom 27803010		82-7-0516  -  INSERT TIBIAL 5 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0518	SUP	Custom 27803010		82-7-0518  -  INSERT TIBIAL 3 18MM	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0521	SUP	Custom 27803010		82-7-0521  -  INSERT TIBIAL 5 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0524	SUP	Custom 27803010		82-7-0524  -  INSERT TIBIAL 5 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0708	SUP	Custom 27803010		82-7-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0710	SUP	Custom 27803010		82-7-0710  -  INSERT TIBIAL 7 10MM	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0712	SUP	Custom 27803010		82-7-0712  -  INSERT TIBIAL 7 12MM SCORPIO KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0714	SUP	Custom 27803010		82-7-0714  -  INSERT TIBIAL 7 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0715	SUP	Custom 27803010		82-7-0715  -  INSERT TIBIAL 7 15MM SCORPIO KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0716	SUP	Custom 27803010		82-7-0716  -  INSERT TIBIAL 7 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0718	SUP	Custom 27803010		82-7-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0721	SUP	Custom 27803010		82-7-0721  -  INSERT TIBIAL 7 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0724	SUP	Custom 27803010		82-7-0724  -  INSERT TIBIAL 7 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0908	SUP	Custom 27803010		82-7-0908  -  INSERT TIBIAL 9 8MM KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0910	SUP	Custom 27803010		82-7-0910  -  INSERT TIBIAL 10MM KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0912	SUP	Custom 27803010		82-7-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0914	SUP	Custom 27803010		82-7-0914  -  INSERT TIBIAL 9 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0915	SUP	Custom 27803010		82-7-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0916	SUP	Custom 27803010		82-7-0916  -  INSERT TIBIAL 9 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0918	SUP	Custom 27803010		82-7-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0921	SUP	Custom 27803010		82-7-0921  -  INSERT TIBIAL 9 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-0924	SUP	Custom 27803010		82-7-0924  -  INSERT TIBIAL 9 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-1108	SUP	Custom 27803010		82-7-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-1110	SUP	Custom 27803010		82-7-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZE SCORPIO NRG X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-1112	SUP	Custom 27803010		82-7-1112  -  INSERT TIBIAL 11 12MM POSTERIOR STABILIZE SCORPIO NRG X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-1114	SUP	Custom 27803010		82-7-1114  -  INSERT TIBIAL 11 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-1115	SUP	Custom 27803010		82-7-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZE SCORPIO NRG X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-1116	SUP	Custom 27803010		82-7-1116  -  INSERT TIBIAL 11 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-1118	SUP	Custom 27803010		82-7-1118  -  INSERT TIBIAL 11 18MM POSTERIOR STABILIZE SCORPIO NRG X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-1121	SUP	Custom 27803010		82-7-1121  -  INSERT TIBIAL 11 21MM POSTERIOR STABILIZE SCORPIO NRG X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
82-7-1124	SUP	Custom 27803010		82-7-1124  -  INSERT TIBIAL 11 24MM POSTERIOR STABILIZE SCORPIO NRG X3	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
827-160	SUP	HCPCS C1713		827-160  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$129.00 	$95.46	$0.00	$103.20	$58.05	$58.05	$0.00	$0.00	$0.00	$26.89	$95.74	$95.74	$0.00	$0.00	$26.88	$0.00	$76.30	$76.30	$0.00	$64.50	$102.17	$103.20	$0.00		$0.00	$20.19	$0.00	$0.00	$20.54	$0.00	$0.00	$0.00	$0.00	$0.00
828-083	SUP	HCPCS C1713		828-083  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
828-090	SUP	HCPCS C1713		828-090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
828-105	SUP	HCPCS C1713		828-105  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
828-107	SUP	HCPCS C1713		828-107  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
828-135C	SUP	Custom 27803010		828-135C  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,314.30 "	$972.58	$0.00	"$1,051.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$975.47	$975.47	$0.00	$0.00	$273.90	$0.00	$0.00	$0.00	$0.00	$657.15	"$1,040.93"	"$1,051.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
828-136C	SUP	Custom 27803010		828-136C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,314.30 "	$972.58	$0.00	"$1,051.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$975.47	$975.47	$0.00	$0.00	$273.90	$0.00	$0.00	$0.00	$0.00	$657.15	"$1,040.93"	"$1,051.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
828-137C	SUP	Custom 27803010		828-137C  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,314.30 "	$972.58	$0.00	"$1,051.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$975.47	$975.47	$0.00	$0.00	$273.90	$0.00	$0.00	$0.00	$0.00	$657.15	"$1,040.93"	"$1,051.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
828-145	SUP	HCPCS C1713		828-145  -  SCREW BONE TSRH TI SPNL LCK FLSH BRK 6.35 MM ROD	BOTH IP/OP	$482.65 	$357.16	$0.00	$386.12	$217.19	$217.19	$0.00	$0.00	$0.00	$100.60	$358.22	$358.22	$0.00	$0.00	$100.58	$0.00	$285.49	$285.49	$0.00	$241.33	$382.26	$386.12	$0.00		$0.00	$75.53	$0.00	$0.00	$76.84	$0.00	$0.00	$0.00	$0.00	$0.00
828-190	SUP	HCPCS C1713		828-190  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
828-191C	SUP	Custom 27803010		828-191C  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,314.30 "	$972.58	$0.00	"$1,051.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$975.47	$975.47	$0.00	$0.00	$273.90	$0.00	$0.00	$0.00	$0.00	$657.15	"$1,040.93"	"$1,051.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
828-193	SUP	Custom 27803010		828-193  -  BOLT SPNL 6.35MM TSRH SM TI T TOP TGHT VA	BOTH IP/OP	"$2,361.80 "	"$1,747.73"	$0.00	"$1,889.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,752.93"	"$1,752.93"	$0.00	$0.00	$492.20	$0.00	$0.00	$0.00	$0.00	"$1,180.90"	"$1,870.55"	"$1,889.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
828-193C	SUP	HCPCS C1713		828-193C  -  BOLT SPNL 6.35MM TSRH SM TI T TOP TGHT CONNCTR	BOTH IP/OP	"$1,314.30 "	$972.58	$0.00	"$1,051.44"	$591.44	$591.44	$0.00	$0.00	$0.00	$273.93	$975.47	$975.47	$0.00	$0.00	$273.90	$0.00	$777.41	$777.41	$0.00	$657.15	"$1,040.93"	"$1,051.44"	$0.00		$0.00	$205.69	$0.00	$0.00	$209.24	$0.00	$0.00	$0.00	$0.00	$0.00
828-349C	SUP	Custom 27803010		828-349C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,314.30 "	$972.58	$0.00	"$1,051.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$975.47	$975.47	$0.00	$0.00	$273.90	$0.00	$0.00	$0.00	$0.00	$657.15	"$1,040.93"	"$1,051.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
828-780	SUP	HCPCS C1713		828-780  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-785	SUP	HCPCS C1713		828-785  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-790	SUP	HCPCS C1713		828-790  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-795	SUP	HCPCS C1713		828-795  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828800PL	SUP	Custom 27803010		828800PL  -  VALVE SHUNT INLINE CERTAS	BOTH IP/OP	"$11,722.83 "	"$8,674.89"	$0.00	"$9,120.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,443.04"	$0.00	$0.00	$0.00	$0.00	"$5,700.29"	"$9,029.26"	"$9,120.46"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
828-830	SUP	HCPCS C1713		828-830  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-835	SUP	HCPCS C1713		828-835  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-840	SUP	HCPCS C1713		828-840  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-845	SUP	HCPCS C1713		828-845  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-850	SUP	HCPCS C1713		828-850  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-855	SUP	HCPCS C1713		828-855  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-860	SUP	HCPCS C1713		828-860  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-930	SUP	HCPCS C1713		828-930  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-935	SUP	HCPCS C1713		828-935  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-940	SUP	HCPCS C1713		828-940  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-945	SUP	HCPCS C1713		828-945  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
828-950	SUP	HCPCS C1713		828-950  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,194.50 "	"$1,623.93"	$0.00	"$1,755.60"	$987.53	$987.53	$0.00	$0.00	$0.00	$457.39	"$1,628.76"	"$1,628.76"	$0.00	$0.00	$457.33	$0.00	"$1,298.05"	"$1,298.05"	$0.00	"$1,097.25"	"$1,738.04"	"$1,755.60"	$0.00		$0.00	$343.44	$0.00	$0.00	$349.36	$0.00	$0.00	$0.00	$0.00	$0.00
830-031	SUP	HCPCS C1713		830-031  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-033	SUP	HCPCS C1713		830-033  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-035	SUP	HCPCS C1713		830-035  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-037	SUP	HCPCS C1713		830-037  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-039	SUP	HCPCS C1713		830-039  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-041	SUP	HCPCS C1713		830-041  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-043	SUP	HCPCS C1713		830-043  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-045	SUP	HCPCS C1713		830-045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-050	SUP	HCPCS C1713		830-050  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-051	SUP	HCPCS C1713		830-051  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8300KITB19A	SUP	Custom 27803010		8300KITB19A  -  VALVE AOR 19MM STRL LF EDWRD INTUITY ELT	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	$0.00	$0.00	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8300KITB21A	SUP	Custom 27803010		8300KITB21A  -  VALVE AOR 21MM STRL LF EDWRD INTUITY ELT	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	$0.00	$0.00	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8300KITB23A	SUP	Custom 27803010		8300KITB23A  -  VALVE AOR 23MM STRL LF EDWRD INTUITY ELT	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	$0.00	$0.00	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8300KITB25A	SUP	Custom 27803010		8300KITB25A  -  VALVE AOR 25MM STRL LF EDWRD INTUITY ELT	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	$0.00	$0.00	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8300KITB27A	SUP	Custom 27803010		8300KITB27A  -  VALVE AOR 27MM STRL LF EDWRD INTUITY ELT	BOTH IP/OP	"$30,000.00 "	"$22,200.00"	$0.00	"$24,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,252.00"	$0.00	$0.00	$0.00	$0.00	"$15,000.00"	"$23,760.00"	"$24,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8304H	SUP	Custom 27203010		8304H  -  SUTURE NABSB 7-0 BV-1 24IN BLU PR VSBLCK 2 ARM MFL	BOTH IP/OP	$46.76 	$34.60	$0.00	$37.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.71	$34.71	$0.00	$0.00	$9.75	$0.00	$0.00	$0.00	$0.00	$23.73	$37.59	$37.97	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
830-529	SUP	HCPCS C1713		830-529  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-531	SUP	HCPCS C1713		830-531  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-533	SUP	HCPCS C1713		830-533  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-535	SUP	HCPCS C1713		830-535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-537	SUP	HCPCS C1713		830-537  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-539	SUP	HCPCS C1713		830-539  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-541	SUP	HCPCS C1713		830-541  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-550	SUP	HCPCS C1713		830-550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
830-551	SUP	HCPCS C1713		830-551  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
8305H	SUP	Custom 27203010		8305H  -  SUTURE NONABSORBABLE 6-0 BV-1 24IN 2 ARM MONOFILAMENT FIRM	BOTH IP/OP	$46.66 	$34.53	$0.00	$37.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.63	$34.63	$0.00	$0.00	$9.72	$0.00	$0.00	$0.00	$0.00	$23.68	$37.51	$37.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
83545309H	SUP	HCPCS C1713		83545309H  -  SCREW BN OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83545359H	SUP	HCPCS C1713		83545359H  -  SCREW BN OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83545409H	SUP	HCPCS C1713		83545409H  -  SCREW BN 4.5MM 40MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83545459H	SUP	HCPCS C1713		83545459H  -  SCREW BN 4.5MM 45MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83545509H	SUP	HCPCS C1713		83545509H  -  SCREW BN 4.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83545559H	SUP	HCPCS C1713		83545559H  -  SCREW BN 4.5MM 55MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83545609H	SUP	HCPCS C1713		83545609H  -  SCREW BN 4.5MM 60MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83555309H	SUP	HCPCS C1713		83555309H  -  SCREW BN 5.5MM 30MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83555359H	SUP	HCPCS C1713		83555359H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83555409H	SUP	HCPCS C1713		83555409H  -  SCREW BN 5.5MM 40MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83555459H	SUP	HCPCS C1713		83555459H  -  SCREW BN 5.5MM 45MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83555509H	SUP	HCPCS C1713		83555509H  -  SCREW BN 5.5MM 50MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83555559H	SUP	HCPCS C1713		83555559H  -  SCREW BN 5.5MM 55MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83555609H	SUP	HCPCS C1713		83555609H  -  SCREW BN 5.5MM 60MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83565309H	SUP	HCPCS C1713		83565309H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83565359H	SUP	HCPCS C1713		83565359H  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83565409H	SUP	HCPCS C1713		83565409H  -  SCREW BN 5.5MM 40MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83565459H	SUP	HCPCS C1713		83565459H  -  SCREW BN 5.5MM 45MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83565509H	SUP	HCPCS C1713		83565509H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83565559H	SUP	HCPCS C1713		83565559H  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83565609H	SUP	HCPCS C1713		83565609H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83575309H	SUP	HCPCS C1713		83575309H  -  SCREW BN 7.5MM 30MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83575359H	SUP	HCPCS C1713		83575359H  -  SCREW BN 7.5MM 35MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83575409H	SUP	HCPCS C1713		83575409H  -  SCREW BN 7.5MM 40MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83575459H	SUP	HCPCS C1713		83575459H  -  SCREW BN 7.5MM 45MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83575509H	SUP	HCPCS C1713		83575509H  -  SCREW BN 7.5MM 50MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83575559H	SUP	HCPCS C1713		83575559H  -  SCREW BN 7.5MM 55MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83575609H	SUP	HCPCS C1713		83575609H  -  SCREW BN 7.5MM 60MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83585309H	SUP	HCPCS C1713		83585309H  -  SCREW BN 8.5MM 30MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83585359H	SUP	HCPCS C1713		83585359H  -  SCREW BN 8.5MM 35MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83585409H	SUP	HCPCS C1713		83585409H  -  SCREW BN 8.5MM 40MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83585459H	SUP	HCPCS C1713		83585459H  -  SCREW BN 8.5MM 45MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83585509H	SUP	HCPCS C1713		83585509H  -  SCREW BN 8.5MM 50MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83585559H	SUP	HCPCS C1713		83585559H  -  SCREW BN 8.5MM 55MM OSTEOGRIP TSRH HA SPNE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
83585609H	SUP	HCPCS C1713		83585609H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
837-125	SUP	HCPCS C1713		837-125  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
837-135	SUP	HCPCS C1713		837-135  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
837-230	SUP	HCPCS C1713		837-230  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-235	SUP	HCPCS C1713		837-235  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-240	SUP	HCPCS C1713		837-240  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-245	SUP	HCPCS C1713		837-245  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-250	SUP	HCPCS C1713		837-250  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-330	SUP	HCPCS C1713		837-330  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-335	SUP	HCPCS C1713		837-335  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-340	SUP	HCPCS C1713		837-340  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-345	SUP	HCPCS C1713		837-345  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-350	SUP	HCPCS C1713		837-350  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-355	SUP	HCPCS C1713		837-355  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-430	SUP	HCPCS C1713		837-430  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-435	SUP	HCPCS C1713		837-435  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-440	SUP	HCPCS C1713		837-440  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-445	SUP	HCPCS C1713		837-445  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-450	SUP	HCPCS C1713		837-450  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-455	SUP	HCPCS C1713		837-455  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-460	SUP	HCPCS C1713		837-460  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
837-530	SUP	HCPCS C1713		837-530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-535	SUP	HCPCS C1713		837-535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-540	SUP	HCPCS C1713		837-540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-545	SUP	HCPCS C1713		837-545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-550	SUP	HCPCS C1713		837-550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-630	SUP	HCPCS C1713		837-630  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-635	SUP	HCPCS C1713		837-635  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-640	SUP	HCPCS C1713		837-640  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-645	SUP	HCPCS C1713		837-645  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-650	SUP	HCPCS C1713		837-650  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-655	SUP	HCPCS C1713		837-655  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-730	SUP	HCPCS C1713		837-730  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-735	SUP	HCPCS C1713		837-735  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-740	SUP	HCPCS C1713		837-740  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-745	SUP	HCPCS C1713		837-745  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-750	SUP	HCPCS C1713		837-750  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-755	SUP	HCPCS C1713		837-755  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-760	SUP	HCPCS C1713		837-760  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-835	SUP	HCPCS C1713		837-835  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
837-845	SUP	HCPCS C1713		837-845  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$984.00 	$728.16	$0.00	$787.20	$442.80	$442.80	$0.00	$0.00	$0.00	$205.09	$730.32	$730.32	$0.00	$0.00	$205.07	$0.00	$582.04	$582.04	$0.00	$492.00	$779.33	$787.20	$0.00		$0.00	$154.00	$0.00	$0.00	$156.65	$0.00	$0.00	$0.00	$0.00	$0.00
8379120C	SUP	Custom 27803010		8379120C  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8379121C	SUP	Custom 27803010		8379121C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,165.65 "	"$1,602.58"	$0.00	"$1,732.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.35"	"$1,607.35"	$0.00	$0.00	$451.32	$0.00	$0.00	$0.00	$0.00	"$1,082.83"	"$1,715.19"	"$1,732.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
838-012	SUP	HCPCS C1713		838-012  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
838-855	SUP	HCPCS C1713		838-855  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
8400-0611	SUP	HCPCS Q4107		8400-0611  -  TISSUE SYNTH CALCIUM SLF 5ML OSTST RESORB MINI BEAD KIT FST	BOTH IP/OP	"$1,637.50 "	"$1,211.75"	$0.00	"$1,310.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,215.35"	"$1,215.35"	$0.00	$0.00	$109.65	$0.00	$0.00	$0.00	$0.00	$818.75	"$1,296.90"	"$1,310.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84133HT	SUP	HCPCS C1713		84133HT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
84154T	SUP	Custom 27803010		84154T  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,200.50 "	"$1,628.37"	$0.00	"$1,760.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,633.21"	"$1,633.21"	$0.00	$0.00	$458.58	$0.00	$0.00	$0.00	$0.00	"$1,100.25"	"$1,742.80"	"$1,760.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84161HT	SUP	HCPCS C1713		84161HT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
84181H	SUP	Custom 27803010		84181H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,991.25 "	"$1,473.53"	$0.00	"$1,593.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,477.91"	"$1,477.91"	$0.00	$0.00	$414.98	$0.00	$0.00	$0.00	$0.00	$995.63	"$1,577.07"	"$1,593.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84193H	SUP	HCPCS C1713		84193H  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
84193HT	SUP	HCPCS C1713		84193HT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
8450107030D	SUP	Custom 27203010		8450107030D  -  BIT DRILL 3MM 13CM MATCH HEAD DIAMOND	BOTH IP/OP	$466.35 	$345.10	$0.00	$373.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.12	$346.12	$0.00	$0.00	$97.19	$0.00	$0.00	$0.00	$0.00	$233.18	$369.35	$373.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
845-011	SUP	HCPCS C1713		845-011  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
84505H	SUP	Custom 27803010		84505H  -  CONNECTOR ROD 5.5/5.5MM DMN SPNE	BOTH IP/OP	"$1,796.58 "	"$1,329.47"	$0.00	"$1,437.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,333.42"	"$1,333.42"	$0.00	$0.00	$374.41	$0.00	$0.00	$0.00	$0.00	$898.29	"$1,422.89"	"$1,437.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84505HT	SUP	Custom 27803010		84505HT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,831.18 "	"$1,355.07"	$0.00	"$1,464.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,359.10"	"$1,359.10"	$0.00	$0.00	$381.62	$0.00	$0.00	$0.00	$0.00	$915.59	"$1,450.29"	"$1,464.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84505LH	SUP	Custom 27803010		84505LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,796.58 "	"$1,329.47"	$0.00	"$1,437.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,333.42"	"$1,333.42"	$0.00	$0.00	$374.41	$0.00	$0.00	$0.00	$0.00	$898.29	"$1,422.89"	"$1,437.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84505QH	SUP	Custom 27803010		84505QH  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,831.18 "	"$1,355.07"	$0.00	"$1,464.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,359.10"	"$1,359.10"	$0.00	$0.00	$381.62	$0.00	$0.00	$0.00	$0.00	$915.59	"$1,450.29"	"$1,464.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84506H	SUP	Custom 27803010		84506H  -  CONNECTOR ROD 5.5/6.35MM CD HZN DMN SS SPNE	BOTH IP/OP	"$1,796.58 "	"$1,329.47"	$0.00	"$1,437.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,333.42"	"$1,333.42"	$0.00	$0.00	$374.41	$0.00	$0.00	$0.00	$0.00	$898.29	"$1,422.89"	"$1,437.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84506HT	SUP	Custom 27803010		84506HT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,831.18 "	"$1,355.07"	$0.00	"$1,464.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,359.10"	"$1,359.10"	$0.00	$0.00	$381.62	$0.00	$0.00	$0.00	$0.00	$915.59	"$1,450.29"	"$1,464.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84507H	SUP	Custom 27803010		84507H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,052.75 "	"$1,519.04"	$0.00	"$1,642.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,523.55"	"$1,523.55"	$0.00	$0.00	$427.79	$0.00	$0.00	$0.00	$0.00	"$1,026.38"	"$1,625.78"	"$1,642.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84507HT	SUP	Custom 27803010		84507HT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,831.18 "	"$1,355.07"	$0.00	"$1,464.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,359.10"	"$1,359.10"	$0.00	$0.00	$381.62	$0.00	$0.00	$0.00	$0.00	$915.59	"$1,450.29"	"$1,464.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84509H	SUP	Custom 27803010		84509H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84509HT	SUP	Custom 27803010		84509HT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84510H	SUP	Custom 27803010		84510H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84510HT	SUP	Custom 27803010		84510HT  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
84511H	SUP	Custom 27803010		84511H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
848-011	SUP	HCPCS C1713		848-011  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
848-012	SUP	HCPCS C1713		848-012  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
848-520	SUP	HCPCS C1713		848-520  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-523	SUP	HCPCS C1713		848-523  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-525	SUP	HCPCS C1713		848-525  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-528	SUP	HCPCS C1713		848-528  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-530	SUP	HCPCS C1713		848-530  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-533	SUP	HCPCS C1713		848-533  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-535	SUP	HCPCS C1713		848-535  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-538	SUP	HCPCS C1713		848-538  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-540	SUP	HCPCS C1713		848-540  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-543	SUP	HCPCS C1713		848-543  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-545	SUP	HCPCS C1713		848-545  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-548	SUP	HCPCS C1713		848-548  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-550	SUP	HCPCS C1713		848-550  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-553	SUP	HCPCS C1713		848-553  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-555	SUP	HCPCS C1713		848-555  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-625	SUP	HCPCS C1713		848-625  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-630	SUP	HCPCS C1713		848-630  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-635	SUP	HCPCS C1713		848-635  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-640	SUP	HCPCS C1713		848-640  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-645	SUP	HCPCS C1713		848-645  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-725	SUP	HCPCS C1713		848-725  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-730	SUP	HCPCS C1713		848-730  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-735	SUP	HCPCS C1713		848-735  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-740	SUP	HCPCS C1713		848-740  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-745	SUP	HCPCS C1713		848-745  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$2,352.00 "	"$1,740.48"	$0.00	"$1,881.60"	"$1,058.40"	"$1,058.40"	$0.00	$0.00	$0.00	$490.22	"$1,745.65"	"$1,745.65"	$0.00	$0.00	$490.16	$0.00	"$1,391.21"	"$1,391.21"	$0.00	"$1,176.00"	"$1,862.78"	"$1,881.60"	$0.00		$0.00	$368.09	$0.00	$0.00	$374.44	$0.00	$0.00	$0.00	$0.00	$0.00
848-855	SUP	HCPCS C1713		848-855  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
851.002.01S	SUP	HCPCS C1713		851.002.01S  -  PLATE BONE CRNMXF 2 HOLE STR RPD RESORB 1.5 MM SCR STRL	BOTH IP/OP	$315.00 	$233.10	$0.00	$252.00	$141.75	$141.75	$0.00	$0.00	$0.00	$65.65	$233.79	$233.79	$0.00	$0.00	$65.65	$0.00	$186.32	$186.32	$0.00	$157.50	$249.48	$252.00	$0.00		$0.00	$49.30	$0.00	$0.00	$50.15	$0.00	$0.00	$0.00	$0.00	$0.00
851.004.01S	SUP	HCPCS C1713		851.004.01S  -  PLATE BONE CRNMXF 4 HOLE STR RPD RESORB 1.5 MM SCR STRL	BOTH IP/OP	$461.25 	$341.33	$0.00	$369.00	$207.56	$207.56	$0.00	$0.00	$0.00	$96.14	$342.34	$342.34	$0.00	$0.00	$96.12	$0.00	$272.83	$272.83	$0.00	$230.63	$365.31	$369.00	$0.00		$0.00	$72.19	$0.00	$0.00	$73.43	$0.00	$0.00	$0.00	$0.00	$0.00
851.008.01S	SUP	HCPCS C1713		851.008.01S  -  PLATE BONE CRNMXF 8 HOLE ADP RPD RESORB 1.5 MM SCR STRL	BOTH IP/OP	$517.50 	$382.95	$0.00	$414.00	$232.88	$232.88	$0.00	$0.00	$0.00	$107.86	$384.09	$384.09	$0.00	$0.00	$107.85	$0.00	$306.10	$306.10	$0.00	$258.75	$409.86	$414.00	$0.00		$0.00	$80.99	$0.00	$0.00	$82.39	$0.00	$0.00	$0.00	$0.00	$0.00
851.009.01S	SUP	HCPCS C1713		851.009.01S  -  PLATE 1.5 MM SCR 8 HOLE SCLP ADP SCLP RPD RESORB BONE STRL	BOTH IP/OP	$517.50 	$382.95	$0.00	$414.00	$232.88	$232.88	$0.00	$0.00	$0.00	$107.86	$384.09	$384.09	$0.00	$0.00	$107.85	$0.00	$306.10	$306.10	$0.00	$258.75	$409.86	$414.00	$0.00		$0.00	$80.99	$0.00	$0.00	$82.39	$0.00	$0.00	$0.00	$0.00	$0.00
851.020.01S	SUP	HCPCS C1713		851.020.01S  -  PLATE BONE CRNMXF 20 HOLE ADP RPD RESORB 1.5 MM SCR STRL	BOTH IP/OP	$753.75 	$557.78	$0.00	$603.00	$339.19	$339.19	$0.00	$0.00	$0.00	$157.10	$559.43	$559.43	$0.00	$0.00	$157.08	$0.00	$445.84	$445.84	$0.00	$376.88	$596.97	$603.00	$0.00		$0.00	$117.96	$0.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00
851.021.01S	SUP	HCPCS C1713		851.021.01S  -  PLATE 1.5 MM SCR 20 HOLE SCLP ADP SCLP RPD RESORB BONE STRL	BOTH IP/OP	$753.75 	$557.78	$0.00	$603.00	$339.19	$339.19	$0.00	$0.00	$0.00	$157.10	$559.43	$559.43	$0.00	$0.00	$157.08	$0.00	$445.84	$445.84	$0.00	$376.88	$596.97	$603.00	$0.00		$0.00	$117.96	$0.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00
851.110.01S	SUP	HCPCS C1713		851.110.01S  -  PLATE BONE ORBTL RIM 10 HOLE RPD RESORB 1.5 MM SCR STRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$313.88	$313.88	$0.00	$0.00	$0.00	$145.38	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$412.57	$412.57	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$109.16	$0.00	$0.00	$111.04	$0.00	$0.00	$0.00	$0.00	$0.00
851.320.01S	SUP	HCPCS C1713		851.320.01S  -  PLATE BONE CRNMXF 10 HOLE 2 Y RPD RESORB 1.5 MM SCR STRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$313.88	$313.88	$0.00	$0.00	$0.00	$145.38	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$412.57	$412.57	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$109.16	$0.00	$0.00	$111.04	$0.00	$0.00	$0.00	$0.00	$0.00
851.343.01S	SUP	HCPCS C1713		851.343.01S  -  PLATE BONE CRNMXF 4X3X3 HOLE Y RPD RESORB 1.5 MM SCR STRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$313.88	$313.88	$0.00	$0.00	$0.00	$145.38	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$412.57	$412.57	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$109.16	$0.00	$0.00	$111.04	$0.00	$0.00	$0.00	$0.00	$0.00
851.344.01S	SUP	HCPCS C1713		851.344.01S  -  1.5MM RAPID RESORB T-PLATE 2 X 3 HOLES-STERILE	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$313.88	$313.88	$0.00	$0.00	$0.00	$145.38	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$412.57	$412.57	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$109.16	$0.00	$0.00	$111.04	$0.00	$0.00	$0.00	$0.00	$0.00
851.420.01S	SUP	HCPCS C1713		851.420.01S  -  PLATE BONE CRNMXF 2X10 HOLE STRUT RPD RESORB 1.5 MM SCR STRL	BOTH IP/OP	"$1,226.25 "	$907.43	$0.00	$981.00	$551.81	$551.81	$0.00	$0.00	$0.00	$255.58	$910.12	$910.12	$0.00	$0.00	$255.55	$0.00	$725.33	$725.33	$0.00	$613.13	$971.19	$981.00	$0.00		$0.00	$191.91	$0.00	$0.00	$195.22	$0.00	$0.00	$0.00	$0.00	$0.00
851.421.01S	SUP	HCPCS C1713		851.421.01S  -  PLATE BONE CRNMXF 2X18 HOLE STRUT RPD RESORB 1.5 MM SCR STRL	BOTH IP/OP	"$1,518.75 "	"$1,123.88"	$0.00	"$1,215.00"	$683.44	$683.44	$0.00	$0.00	$0.00	$316.55	"$1,127.22"	"$1,127.22"	$0.00	$0.00	$316.51	$0.00	$898.34	$898.34	$0.00	$759.38	"$1,202.85"	"$1,215.00"	$0.00		$0.00	$237.68	$0.00	$0.00	$241.79	$0.00	$0.00	$0.00	$0.00	$0.00
851.424.01S	SUP	HCPCS C1713		851.424.01S  -  PLATE BONE CRNMXF 2X10 HOLE STRUT SCLP RPD RESORB 1.5 MM SCR	BOTH IP/OP	"$1,228.50 "	$909.09	$0.00	$982.80	$552.83	$552.83	$0.00	$0.00	$0.00	$256.05	$911.79	$911.79	$0.00	$0.00	$256.02	$0.00	$726.66	$726.66	$0.00	$614.25	$972.97	$982.80	$0.00		$0.00	$192.26	$0.00	$0.00	$195.58	$0.00	$0.00	$0.00	$0.00	$0.00
851.425.01S	SUP	HCPCS C1713		851.425.01S  -  PLATE BONE CRNMXF 2X18 HOLE STRUT SCLP RPD RESORB 1.5 MM SCR	BOTH IP/OP	"$1,518.75 "	"$1,123.88"	$0.00	"$1,215.00"	$683.44	$683.44	$0.00	$0.00	$0.00	$316.55	"$1,127.22"	"$1,127.22"	$0.00	$0.00	$316.51	$0.00	$898.34	$898.34	$0.00	$759.38	"$1,202.85"	"$1,215.00"	$0.00		$0.00	$237.68	$0.00	$0.00	$241.79	$0.00	$0.00	$0.00	$0.00	$0.00
851.436.01S	SUP	HCPCS C1713		851.436.01S  -  PLATE 1.5 MM SCR 2X36 HOLE STRUT SCLP RPD RESORB BONE STRL	BOTH IP/OP	"$3,026.25 "	"$2,239.43"	$0.00	"$2,421.00"	"$1,361.81"	"$1,361.81"	$0.00	$0.00	$0.00	$630.75	"$2,246.08"	"$2,246.08"	$0.00	$0.00	$630.67	$0.00	"$1,491.94"	"$1,491.94"	$0.00	"$1,513.13"	"$2,396.79"	"$2,421.00"	$0.00		$0.00	$473.61	$0.00	$0.00	$481.78	$0.00	$0.00	$0.00	$0.00	$0.00
851.500.01S	SUP	HCPCS C1713		851.500.01S  -  1.5MM RAPID RESORB BOX PLATE 4 HOLES-STERILE	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$313.88	$313.88	$0.00	$0.00	$0.00	$145.38	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$412.57	$412.57	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$109.16	$0.00	$0.00	$111.04	$0.00	$0.00	$0.00	$0.00	$0.00
851.506.01S	SUP	Custom 27803010		851.506.01S  -  COVER BUR HOLE CRNMXF 8 HOLE RPD RESORB 1.5 MM SCR STRL	BOTH IP/OP	$641.25 	$474.53	$0.00	$513.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$475.94	$475.94	$0.00	$0.00	$133.64	$0.00	$0.00	$0.00	$0.00	$320.63	$507.87	$513.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
851.508.01S	SUP	Custom 27803010		851.508.01S  -  COVER BUR HOLE CRNMXF 10 HOLE RPD RESORB 1.5 MM SCR STRL	BOTH IP/OP	$641.25 	$474.53	$0.00	$513.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$475.94	$475.94	$0.00	$0.00	$133.64	$0.00	$0.00	$0.00	$0.00	$320.63	$507.87	$513.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
851.510.01S	SUP	HCPCS C1713		851.510.01S  -  PLATE BONE 50X50X.5MM CRNMXF MESH RPD RESORB 1.5MM SCR STRL	BOTH IP/OP	"$3,060.00 "	"$2,264.40"	$0.00	"$2,448.00"	"$1,377.00"	"$1,377.00"	$0.00	$0.00	$0.00	$637.78	"$2,271.13"	"$2,271.13"	$0.00	$0.00	$637.70	$0.00	"$1,508.58"	"$1,508.58"	$0.00	"$1,530.00"	"$2,423.52"	"$2,448.00"	$0.00		$0.00	$478.89	$0.00	$0.00	$487.15	$0.00	$0.00	$0.00	$0.00	$0.00
851.512.01S	SUP	HCPCS C1713		851.512.01S  -  PLATE BONE 100X100X.5MM CRNMXF MESH RPD RESORB 1.5MM SCR	BOTH IP/OP	"$6,525.00 "	"$4,828.50"	$0.00	"$5,220.00"	"$2,936.25"	"$2,936.25"	$0.00	$0.00	$0.00	"$1,359.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,359.81"	$0.00	"$3,216.83"	"$3,216.83"	$0.00	"$3,262.50"	"$5,167.80"	"$5,220.00"	$0.00		$0.00	"$1,021.16"	$0.00	$0.00	"$1,038.78"	$0.00	$0.00	$0.00	$0.00	$0.00
851.520.01S	SUP	HCPCS C1713		851.520.01S  -  PLATE BONE 50X50X.8MM CRNMXF MESH RPD RESORB 1.5MM SCR STRL	BOTH IP/OP	"$3,195.00 "	"$2,364.30"	$0.00	"$2,556.00"	"$1,437.75"	"$1,437.75"	$0.00	$0.00	$0.00	$665.92	"$2,371.33"	"$2,371.33"	$0.00	$0.00	$665.84	$0.00	"$1,575.14"	"$1,575.14"	$0.00	"$1,597.50"	"$2,530.44"	"$2,556.00"	$0.00		$0.00	$500.02	$0.00	$0.00	$508.64	$0.00	$0.00	$0.00	$0.00	$0.00
851.521.01S	SUP	HCPCS C1713		851.521.01S  -  PLATE BONE 100X100X.8MM CRNMXF MESH RPD RESORB 1.5MM SCR	BOTH IP/OP	"$7,278.75 "	"$5,386.28"	$0.00	"$5,823.00"	"$3,275.44"	"$3,275.44"	$0.00	$0.00	$0.00	"$1,517.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,516.89"	$0.00	"$3,588.42"	"$3,588.42"	$0.00	"$3,639.38"	"$5,764.77"	"$5,823.00"	$0.00		$0.00	"$1,139.12"	$0.00	$0.00	"$1,158.78"	$0.00	$0.00	$0.00	$0.00	$0.00
851.532.01S	SUP	HCPCS C1713		851.532.01S  -  PLATE BONE 50X50X.5MM CRNMXF SHT RPD RESORB 1.5MM SCR STRL	BOTH IP/OP	"$2,256.75 "	"$1,670.00"	$0.00	"$1,805.40"	"$1,015.54"	"$1,015.54"	$0.00	$0.00	$0.00	$470.36	"$1,674.96"	"$1,674.96"	$0.00	$0.00	$470.31	$0.00	"$1,334.87"	"$1,334.87"	$0.00	"$1,128.38"	"$1,787.35"	"$1,805.40"	$0.00		$0.00	$353.18	$0.00	$0.00	$359.27	$0.00	$0.00	$0.00	$0.00	$0.00
851.534.01S	SUP	HCPCS C1713		851.534.01S  -  PLATE BONE 50X50X.8MM CRNMXF SHT RPD RESORB 1.5MM SCR STRL	BOTH IP/OP	"$2,351.25 "	"$1,739.93"	$0.00	"$1,881.00"	"$1,058.06"	"$1,058.06"	$0.00	$0.00	$0.00	$490.06	"$1,745.10"	"$1,745.10"	$0.00	$0.00	$490.00	$0.00	"$1,390.76"	"$1,390.76"	$0.00	"$1,175.63"	"$1,862.19"	"$1,881.00"	$0.00		$0.00	$367.97	$0.00	$0.00	$374.32	$0.00	$0.00	$0.00	$0.00	$0.00
851.540.01S	SUP	HCPCS C1713		851.540.01S  -  PLATE BONE TRNS 24X24MM THK.5MM ORBTL FLR RPD REABSORBABLE	BOTH IP/OP	"$1,890.00 "	"$1,398.60"	$0.00	"$1,512.00"	$850.50	$850.50	$0.00	$0.00	$0.00	$393.92	"$1,402.76"	"$1,402.76"	$0.00	$0.00	$393.88	$0.00	"$1,117.94"	"$1,117.94"	$0.00	$945.00	"$1,496.88"	"$1,512.00"	$0.00		$0.00	$295.79	$0.00	$0.00	$300.89	$0.00	$0.00	$0.00	$0.00	$0.00
851.541.01S	SUP	HCPCS C1713		851.541.01S  -  PLATE BONE 30MM MED ORBTL FLR RPD RESORB 1.5MM SCR STRL	BOTH IP/OP	"$1,968.75 "	"$1,456.88"	$0.00	"$1,575.00"	$885.94	$885.94	$0.00	$0.00	$0.00	$410.34	"$1,461.21"	"$1,461.21"	$0.00	$0.00	$410.29	$0.00	"$1,164.52"	"$1,164.52"	$0.00	$984.38	"$1,559.25"	"$1,575.00"	$0.00		$0.00	$308.11	$0.00	$0.00	$313.43	$0.00	$0.00	$0.00	$0.00	$0.00
851.542.01S	SUP	HCPCS C1713		851.542.01S  -  PLATE BONE 35MM LG ORBTL FLR RPD RESORB 1.5MM SCR STRL	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
851.604.01S	SUP	HCPCS C1713		851.604.01S  -  PLATE BONE CRNMXF 4 HOLE X RPD RESORB 1.5 MM SCR STRL	BOTH IP/OP	$663.75 	$491.18	$0.00	$531.00	$298.69	$298.69	$0.00	$0.00	$0.00	$138.34	$492.64	$492.64	$0.00	$0.00	$138.33	$0.00	$392.61	$392.61	$0.00	$331.88	$525.69	$531.00	$0.00		$0.00	$103.88	$0.00	$0.00	$105.67	$0.00	$0.00	$0.00	$0.00	$0.00
851.605.01S	SUP	HCPCS C1713		851.605.01S  -  1.5MM RAPID RESORB X-PLATE 8 HOLES-STERILE	BOTH IP/OP	$663.75 	$491.18	$0.00	$531.00	$298.69	$298.69	$0.00	$0.00	$0.00	$138.34	$492.64	$492.64	$0.00	$0.00	$138.33	$0.00	$392.61	$392.61	$0.00	$331.88	$525.69	$531.00	$0.00		$0.00	$103.88	$0.00	$0.00	$105.67	$0.00	$0.00	$0.00	$0.00	$0.00
851.611.01S	SUP	HCPCS C1713		851.611.01S  -  1.5MM RAPID RESORB CONTOURABLE MESH/50X50X0.25MM THK-STERILE	BOTH IP/OP	"$3,352.50 "	"$2,480.85"	$0.00	"$2,682.00"	"$1,508.63"	"$1,508.63"	$0.00	$0.00	$0.00	$698.74	"$2,488.23"	"$2,488.23"	$0.00	$0.00	$698.66	$0.00	"$1,652.78"	"$1,652.78"	$0.00	"$1,676.25"	"$2,655.18"	"$2,682.00"	$0.00		$0.00	$524.67	$0.00	$0.00	$533.72	$0.00	$0.00	$0.00	$0.00	$0.00
851.612.01S	SUP	HCPCS C1713		851.612.01S  -  MESH CRNL 100X100X.25MM STRL RAPIDSORB CNTR RSRB RPD 1.5MM	BOTH IP/OP	"$7,222.50 "	"$5,344.65"	$0.00	"$5,778.00"	"$3,250.13"	"$3,250.13"	$0.00	$0.00	$0.00	"$1,505.35"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,505.17"	$0.00	"$3,560.69"	"$3,560.69"	$0.00	"$3,611.25"	"$5,720.22"	"$5,778.00"	$0.00		$0.00	"$1,130.32"	$0.00	$0.00	"$1,149.82"	$0.00	$0.00	$0.00	$0.00	$0.00
851.621.01S	SUP	HCPCS C1713		851.621.01S  -  1.5MM RAPID RESORB CONTOURABLE MESH/50X50X0.5MM THK-STERILE	BOTH IP/OP	"$3,352.50 "	"$2,480.85"	$0.00	"$2,682.00"	"$1,508.63"	"$1,508.63"	$0.00	$0.00	$0.00	$698.74	"$2,488.23"	"$2,488.23"	$0.00	$0.00	$698.66	$0.00	"$1,652.78"	"$1,652.78"	$0.00	"$1,676.25"	"$2,655.18"	"$2,682.00"	$0.00		$0.00	$524.67	$0.00	$0.00	$533.72	$0.00	$0.00	$0.00	$0.00	$0.00
851.622.01S	SUP	HCPCS C1713		851.622.01S  -  PLATE 100X100X.50MM 1.5MM SCR CONTUR MESH RPD RESORB BONE	BOTH IP/OP	"$7,222.50 "	"$5,344.65"	$0.00	"$5,778.00"	"$3,250.13"	"$3,250.13"	$0.00	$0.00	$0.00	"$1,505.35"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,505.17"	$0.00	"$3,560.69"	"$3,560.69"	$0.00	"$3,611.25"	"$5,720.22"	"$5,778.00"	$0.00		$0.00	"$1,130.32"	$0.00	$0.00	"$1,149.82"	$0.00	$0.00	$0.00	$0.00	$0.00
851.623.01S	SUP	HCPCS C1713		851.623.01S  -  PLATE 150X150X.5MM 1.5MM SCR CONTUR MESH RPD RESORB BONE	BOTH IP/OP	"$12,172.50 "	"$9,007.65"	$0.00	"$9,738.00"	"$5,477.63"	"$5,477.63"	$0.00	$0.00	$0.00	"$2,537.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,536.75"	$0.00	"$6,001.04"	"$6,001.04"	$0.00	"$6,086.25"	"$9,640.62"	"$9,738.00"	$0.00		$0.00	"$1,905.00"	$0.00	$0.00	"$1,937.86"	$0.00	$0.00	$0.00	$0.00	$0.00
851.633.01S	SUP	HCPCS C1713		851.633.01S  -  1.5MM RAPID RESORB CONTOURABLE MESH/150X150X0.8MM THK-STERIL	BOTH IP/OP	"$12,375.00 "	"$9,157.50"	$0.00	"$9,900.00"	"$5,568.75"	"$5,568.75"	$0.00	$0.00	$0.00	"$2,579.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,578.95"	$0.00	"$6,100.88"	"$6,100.88"	$0.00	"$6,187.50"	"$9,801.00"	"$9,900.00"	$0.00		$0.00	"$1,936.69"	$0.00	$0.00	"$1,970.10"	$0.00	$0.00	$0.00	$0.00	$0.00
851.651.01S	SUP	HCPCS C1713		851.651.01S  -  PLATE BONE .5MM CRNMXF CONTUR MESH RPD RESORB 1.5MM SCR STRL	BOTH IP/OP	"$3,352.50 "	"$2,480.85"	$0.00	"$2,682.00"	"$1,508.63"	"$1,508.63"	$0.00	$0.00	$0.00	$698.74	"$2,488.23"	"$2,488.23"	$0.00	$0.00	$698.66	$0.00	"$1,652.78"	"$1,652.78"	$0.00	"$1,676.25"	"$2,655.18"	"$2,682.00"	$0.00		$0.00	$524.67	$0.00	$0.00	$533.72	$0.00	$0.00	$0.00	$0.00	$0.00
851.652.01S	SUP	HCPCS C1713		851.652.01S  -  PLATE BONE .5MM 100MM CRNMXF CONTUR MESH RPD RESORB 1.5MM	BOTH IP/OP	"$7,222.50 "	"$5,344.65"	$0.00	"$5,778.00"	"$3,250.13"	"$3,250.13"	$0.00	$0.00	$0.00	"$1,505.35"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,505.17"	$0.00	"$3,560.69"	"$3,560.69"	$0.00	"$3,611.25"	"$5,720.22"	"$5,778.00"	$0.00		$0.00	"$1,130.32"	$0.00	$0.00	"$1,149.82"	$0.00	$0.00	$0.00	$0.00	$0.00
851.661.01S	SUP	HCPCS C1713		851.661.01S  -  PLATE BONE .8MM 50MM CRNMXF CONTUR MESH RPD RESORB 1.5MM SCR	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
851.662.01S	SUP	HCPCS C1713		851.662.01S  -  PLATE .8MM 1.5MM SCR CONTUR MESH RESORB RGD BONE 100MM	BOTH IP/OP	"$7,605.00 "	"$5,627.70"	$0.00	"$6,084.00"	"$3,422.25"	"$3,422.25"	$0.00	$0.00	$0.00	"$1,585.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,584.88"	$0.00	"$3,749.27"	"$3,749.27"	$0.00	"$3,802.50"	"$6,023.16"	"$6,084.00"	$0.00		$0.00	"$1,190.18"	$0.00	$0.00	"$1,210.72"	$0.00	$0.00	$0.00	$0.00	$0.00
851.680.01S	SUP	HCPCS C1713		851.680.01S  -  1.5MM RAPID RESORB SELLAR FLR PL 7MMX25MM/0.5MM THK-STERILE	BOTH IP/OP	$641.25 	$474.53	$0.00	$513.00	$288.56	$288.56	$0.00	$0.00	$0.00	$133.65	$475.94	$475.94	$0.00	$0.00	$133.64	$0.00	$379.30	$379.30	$0.00	$320.63	$507.87	$513.00	$0.00		$0.00	$100.36	$0.00	$0.00	$102.09	$0.00	$0.00	$0.00	$0.00	$0.00
851.681.01S	SUP	HCPCS C1713		851.681.01S  -  1.5MM RAPID RESORB SELLAR FLR PL 7MMX25MM/0.8MM THK-STERILE	BOTH IP/OP	$641.25 	$474.53	$0.00	$513.00	$288.56	$288.56	$0.00	$0.00	$0.00	$133.65	$475.94	$475.94	$0.00	$0.00	$133.64	$0.00	$379.30	$379.30	$0.00	$320.63	$507.87	$513.00	$0.00		$0.00	$100.36	$0.00	$0.00	$102.09	$0.00	$0.00	$0.00	$0.00	$0.00
851.689.01S	SUP	HCPCS C1713		851.689.01S  -  1.5MM RAPID RESORB ORBTL FL PL W/BENDING TEMPLATE/24MM-STER	BOTH IP/OP	"$1,901.25 "	"$1,406.93"	$0.00	"$1,521.00"	$855.56	$855.56	$0.00	$0.00	$0.00	$396.27	"$1,411.11"	"$1,411.11"	$0.00	$0.00	$396.22	$0.00	"$1,124.59"	"$1,124.59"	$0.00	$950.63	"$1,505.79"	"$1,521.00"	$0.00		$0.00	$297.55	$0.00	$0.00	$302.68	$0.00	$0.00	$0.00	$0.00	$0.00
851.690.01S	SUP	HCPCS C1713		851.690.01S  -  PLATE BONE 30X30MM ORBTL FLR RPD RESORB BNDRG TMPLT 1.5MM	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	$891.00	$891.00	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
851.691.01S	SUP	HCPCS C1713		851.691.01S  -  PLATE 35X35MM 1.5MM SCR BNDRG TMPLT RPD RESORB BONE ORBTL	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
851.711.01S	SUP	HCPCS C1713		851.711.01S  -  PLATE BONE 50X50X.5MM CRNMXF STR ROW MESH RPD RESORB 1.5MM	BOTH IP/OP	"$3,060.00 "	"$2,264.40"	$0.00	"$2,448.00"	"$1,377.00"	"$1,377.00"	$0.00	$0.00	$0.00	$637.78	"$2,271.13"	"$2,271.13"	$0.00	$0.00	$637.70	$0.00	"$1,508.58"	"$1,508.58"	$0.00	"$1,530.00"	"$2,423.52"	"$2,448.00"	$0.00		$0.00	$478.89	$0.00	$0.00	$487.15	$0.00	$0.00	$0.00	$0.00	$0.00
851.711.97S	SUP	HCPCS C1713		851.711.97S  -  PLATE BONE 50X50X.5MM STR ROW MESH RAPID RESORB POLY	BOTH IP/OP	"$2,846.53 "	"$2,106.43"	$0.00	"$2,210.90"	"$1,243.63"	"$1,243.63"	$0.00	$0.00	$0.00	$593.29	"$2,112.69"	"$2,112.69"	$0.00	$0.00	$593.22	$0.00	"$1,403.34"	"$1,403.34"	$0.00	"$1,381.81"	"$2,188.79"	"$2,210.90"	$0.00		$0.00	$419.91	$0.00	$0.00	$439.97	$0.00	$0.00	$0.00	$0.00	$0.00
851.712.01S	SUP	HCPCS C1713		851.712.01S  -  PLATE BONE 100X100X.5MM CRNMXF STR ROW MESH RPD RESORB 1.5MM	BOTH IP/OP	"$6,525.00 "	"$4,828.50"	$0.00	"$5,220.00"	"$2,936.25"	"$2,936.25"	$0.00	$0.00	$0.00	"$1,359.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,359.81"	$0.00	"$3,216.83"	"$3,216.83"	$0.00	"$3,262.50"	"$5,167.80"	"$5,220.00"	$0.00		$0.00	"$1,021.16"	$0.00	$0.00	"$1,038.78"	$0.00	$0.00	$0.00	$0.00	$0.00
851.712.97S	SUP	HCPCS C1713		851.712.97S  -  PLATE BONE 100MM RESORB STR ROW MESH ORTHOPEDIC NONSTRL 1MM	BOTH IP/OP	"$6,071.00 "	"$4,492.54"	$0.00	"$4,715.34"	"$2,652.38"	"$2,652.38"	$0.00	$0.00	$0.00	"$1,265.35"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,265.20"	$0.00	"$2,993.00"	"$2,993.00"	$0.00	"$2,947.09"	"$4,668.19"	"$4,715.34"	$0.00		$0.00	$895.57	$0.00	$0.00	$938.35	$0.00	$0.00	$0.00	$0.00	$0.00
851.721.01S	SUP	HCPCS C1713		851.721.01S  -  PLATE BONE 50X50X.8MM CRNMXF STR ROW MESH RPD RESORB 1.5MM	BOTH IP/OP	"$3,240.00 "	"$2,397.60"	$0.00	"$2,592.00"	"$1,458.00"	"$1,458.00"	$0.00	$0.00	$0.00	$675.30	"$2,404.73"	"$2,404.73"	$0.00	$0.00	$675.22	$0.00	"$1,597.32"	"$1,597.32"	$0.00	"$1,620.00"	"$2,566.08"	"$2,592.00"	$0.00		$0.00	$507.06	$0.00	$0.00	$515.81	$0.00	$0.00	$0.00	$0.00	$0.00
851.722.01S	SUP	HCPCS C1713		851.722.01S  -  PLATE BONE 100X100X.8MM CRNMXF STR ROW MESH RPD RESORB 1.5MM	BOTH IP/OP	"$7,200.00 "	"$5,328.00"	$0.00	"$5,760.00"	"$3,240.00"	"$3,240.00"	$0.00	$0.00	$0.00	"$1,500.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,500.48"	$0.00	"$3,549.60"	"$3,549.60"	$0.00	"$3,600.00"	"$5,702.40"	"$5,760.00"	$0.00		$0.00	"$1,126.80"	$0.00	$0.00	"$1,146.24"	$0.00	$0.00	$0.00	$0.00	$0.00
851.724.01S	SUP	HCPCS C1713		851.724.01S  -  1.5MM RAPID RESORB STRAIGHT ROW MESH/75X75X0.8MM THK-STER	BOTH IP/OP	"$4,657.50 "	"$3,446.55"	$0.00	"$3,726.00"	"$2,095.88"	"$2,095.88"	$0.00	$0.00	$0.00	$970.74	"$3,456.80"	"$3,456.80"	$0.00	$0.00	$970.62	$0.00	"$2,296.15"	"$2,296.15"	$0.00	"$2,328.75"	"$3,688.74"	"$3,726.00"	$0.00		$0.00	$728.90	$0.00	$0.00	$741.47	$0.00	$0.00	$0.00	$0.00	$0.00
851.801.01S	SUP	Custom 27803010		851.801.01S  -  CLAMP TUBE 18MM CRANIAL FLP RPD RESORB STRL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$0.00	$0.00	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
852.002.01S	SUP	HCPCS C1713		852.002.01S  -  PLATE BONE CRNMXF 2 HOLE STR RPD RESORB 2 MM SCR STRL	BOTH IP/OP	$326.25 	$241.43	$0.00	$261.00	$146.81	$146.81	$0.00	$0.00	$0.00	$68.00	$242.14	$242.14	$0.00	$0.00	$67.99	$0.00	$192.98	$192.98	$0.00	$163.13	$258.39	$261.00	$0.00		$0.00	$51.06	$0.00	$0.00	$51.94	$0.00	$0.00	$0.00	$0.00	$0.00
852.004.01S	SUP	HCPCS C1713		852.004.01S  -  PLATE BONE CRNMXF 4 HOLE STR RPD RESORB 2 MM SCR STRL	BOTH IP/OP	$483.75 	$357.98	$0.00	$387.00	$217.69	$217.69	$0.00	$0.00	$0.00	$100.83	$359.04	$359.04	$0.00	$0.00	$100.81	$0.00	$286.14	$286.14	$0.00	$241.88	$383.13	$387.00	$0.00		$0.00	$75.71	$0.00	$0.00	$77.01	$0.00	$0.00	$0.00	$0.00	$0.00
852.008.01S	SUP	HCPCS C1713		852.008.01S  -  PLATE BONE CRNMXF 8 HOLE ADP RPD RESORB 2 MM SCR STRL	BOTH IP/OP	$540.00 	$399.60	$0.00	$432.00	$243.00	$243.00	$0.00	$0.00	$0.00	$112.55	$400.79	$400.79	$0.00	$0.00	$112.54	$0.00	$319.41	$319.41	$0.00	$270.00	$427.68	$432.00	$0.00		$0.00	$84.51	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$0.00
852.020.01S	SUP	HCPCS C1713		852.020.01S  -  PLATE BONE 2MM 20 HOLE ADP RPD RESORB STRL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
852.110.01S	SUP	HCPCS C1713		852.110.01S  -  PLATE BONE ORBTL RIM 10 HOLE RPD RESORB 2 MM SCR STRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$313.88	$313.88	$0.00	$0.00	$0.00	$145.38	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$412.57	$412.57	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$109.16	$0.00	$0.00	$111.04	$0.00	$0.00	$0.00	$0.00	$0.00
852.263.01S	SUP	HCPCS C1713		852.263.01S  -  PLATE BONE CRNMXF 6X4 HOLE L LEFT OBLQ RPD RESORB 2 MM SCR	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$313.88	$313.88	$0.00	$0.00	$0.00	$145.38	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$412.57	$412.57	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$109.16	$0.00	$0.00	$111.04	$0.00	$0.00	$0.00	$0.00	$0.00
852.264.01S	SUP	HCPCS C1713		852.264.01S  -  PLATE BONE CRNMXF 6X4 HOLE L RIGHT OBLQ RPD RESORB 2 MM SCR	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$313.88	$313.88	$0.00	$0.00	$0.00	$145.38	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$412.57	$412.57	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$109.16	$0.00	$0.00	$111.04	$0.00	$0.00	$0.00	$0.00	$0.00
852.343.01S	SUP	HCPCS C1713		852.343.01S  -  PLATE BONE CRNMXF 4X3X3 HOLE RPD RESORB 2 MM SCR STRL	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$313.88	$313.88	$0.00	$0.00	$0.00	$145.38	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$412.57	$412.57	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$109.16	$0.00	$0.00	$111.04	$0.00	$0.00	$0.00	$0.00	$0.00
852.420.01S	SUP	HCPCS C1713		852.420.01S  -  PLATE BONE CRNMXF 2X10 HOLE STRUT RPD RESORB 2 MM SCR STRL	BOTH IP/OP	"$1,293.75 "	$957.38	$0.00	"$1,035.00"	$582.19	$582.19	$0.00	$0.00	$0.00	$269.65	$960.22	$960.22	$0.00	$0.00	$269.62	$0.00	$765.25	$765.25	$0.00	$646.88	"$1,024.65"	"$1,035.00"	$0.00		$0.00	$202.47	$0.00	$0.00	$205.97	$0.00	$0.00	$0.00	$0.00	$0.00
852.421.01S	SUP	HCPCS C1713		852.421.01S  -  PLATE BONE CRNMXF 2X18 HOLE STRUT RPD RESORB 2 MM SCR STRL	BOTH IP/OP	"$1,597.50 "	"$1,182.15"	$0.00	"$1,278.00"	$718.88	$718.88	$0.00	$0.00	$0.00	$332.96	"$1,185.66"	"$1,185.66"	$0.00	$0.00	$332.92	$0.00	$944.92	$944.92	$0.00	$798.75	"$1,265.22"	"$1,278.00"	$0.00		$0.00	$250.01	$0.00	$0.00	$254.32	$0.00	$0.00	$0.00	$0.00	$0.00
852.520.01S	SUP	HCPCS C1713		852.520.01S  -  PLATE BONE 48X48X1.2MM CRNMXF MESH RPD RESORB 2MM SCR STRL	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
852.521.01S	SUP	HCPCS C1713		852.521.01S  -  PLATE BONE 78X78X1.2MM CRNMXF MESH RPD RESORB 2MM SCR STRL	BOTH IP/OP	"$5,445.00 "	"$4,029.30"	$0.00	"$4,356.00"	"$2,450.25"	"$2,450.25"	$0.00	$0.00	$0.00	"$1,134.87"	"$4,041.28"	"$4,041.28"	$0.00	$0.00	"$1,134.74"	$0.00	"$2,684.39"	"$2,684.39"	$0.00	"$2,722.50"	"$4,312.44"	"$4,356.00"	$0.00		$0.00	$852.14	$0.00	$0.00	$866.84	$0.00	$0.00	$0.00	$0.00	$0.00
852.641.01S	SUP	HCPCS C1713		852.641.01S  -  PLATE BONE 1.2MM 50MM CRNMXF CONTUR MESH RPD RESORB 2MM SCR	BOTH IP/OP	"$3,802.50 "	"$2,813.85"	$0.00	"$3,042.00"	"$1,711.13"	"$1,711.13"	$0.00	$0.00	$0.00	$792.54	"$2,822.22"	"$2,822.22"	$0.00	$0.00	$792.44	$0.00	"$1,874.63"	"$1,874.63"	$0.00	"$1,901.25"	"$3,011.58"	"$3,042.00"	$0.00		$0.00	$595.09	$0.00	$0.00	$605.36	$0.00	$0.00	$0.00	$0.00	$0.00
852-000	SUP	Custom 27203010		KIT NOW LGNL URN AG MCBLTST 22 TST	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
853008LH	SUP	HCPCS C1713		853008LH  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853008LW	SUP	HCPCS C1713		853008LW  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853008WM	SUP	HCPCS C1713		853008WM  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853-010	SUP	HCPCS C1713		853-010  -  PLATE 10MM TI MLT HOLE OPN DOOR PCUT INTRINSIC STAB CLR CD	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853010LH	SUP	HCPCS C1713		853010LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853010LW	SUP	HCPCS C1713		853010LW  -  PLATE BN W MTH 10MM CENTERPIECE LAT HL OPN DOOR CLR CD TI	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853010WM	SUP	HCPCS C1713		853010WM  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853-012	SUP	HCPCS C1713		853-012  -  PLATE 12MM TI MLT HOLE OPN DOOR PCUT INTRINSIC STAB CLR CD	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853012LH	SUP	HCPCS C1713		853012LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853012WM	SUP	HCPCS C1713		853012WM  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853-014	SUP	HCPCS C1713		853-014  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853014LH	SUP	HCPCS C1713		853014LH  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853014LW	SUP	HCPCS C1713		853014LW  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853014WM	SUP	HCPCS C1713		853014WM  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853-016	SUP	HCPCS C1713		853-016  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853016LH	SUP	HCPCS C1713		853016LH  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853016LW	SUP	HCPCS C1713		853016LW  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853016WM	SUP	HCPCS C1713		853016WM  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853-018	SUP	HCPCS C1713		853-018  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853018LH	SUP	HCPCS C1713		853018LH  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853018LW	SUP	HCPCS C1713		853018LW  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853018WM	SUP	HCPCS C1713		853018WM  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853-107	SUP	HCPCS C1713		853-107  -  PLATE 7MM TI BONE SPNL	BOTH IP/OP	"$1,657.50 "	"$1,226.55"	$0.00	"$1,326.00"	$745.88	$745.88	$0.00	$0.00	$0.00	$345.46	"$1,230.20"	"$1,230.20"	$0.00	$0.00	$345.42	$0.00	$980.41	$980.41	$0.00	$828.75	"$1,312.74"	"$1,326.00"	$0.00		$0.00	$259.40	$0.00	$0.00	$263.87	$0.00	$0.00	$0.00	$0.00	$0.00
853408LH	SUP	HCPCS C1713		853408LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853-410	SUP	HCPCS C1713		853-410  -  PLATE BN 10MM NS CENTERPIECE GFT SPNE	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853410LH	SUP	HCPCS C1713		853410LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853-412	SUP	HCPCS C1713		853-412  -  PLATE BN 12MM NS CENTERPIECE GFT SPNE	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853412LH	SUP	HCPCS C1713		853412LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853-414	SUP	HCPCS C1713		853-414  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853414LH	SUP	HCPCS C1713		853414LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853-416	SUP	HCPCS C1713		853-416  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853416LH	SUP	HCPCS C1713		853416LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$492.08	$492.08	$0.00	$0.00	$0.00	$227.91	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$646.81	$646.81	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$171.13	$0.00	$0.00	$174.09	$0.00	$0.00	$0.00	$0.00	$0.00
853-418	SUP	Custom 27803010		853-418  -  PLATE 18MM TI BONE SPNL	BOTH IP/OP	"$1,093.50 "	$809.19	$0.00	$874.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$811.60	$811.60	$0.00	$0.00	$227.89	$0.00	$0.00	$0.00	$0.00	$546.75	$866.05	$874.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
853-465	SUP	HCPCS C1713		853-465  -  SCREW BONE 2.6MM 5MM CENTERPIECE TI SPNL SLFTAP CLR CD	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$76.95	$76.95	$0.00	$0.00	$0.00	$35.64	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$101.15	$101.15	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$26.76	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$0.00
853-467	SUP	HCPCS C1713		853-467  -  BONE SCREW 853-467 2.6 X 7MM	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$76.95	$76.95	$0.00	$0.00	$0.00	$35.64	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$101.15	$101.15	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$26.76	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$0.00
853-469	SUP	HCPCS C1713		853-469  -  BONE SCREW 853-469 2.6 X 9MM	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$76.95	$76.95	$0.00	$0.00	$0.00	$35.64	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$101.15	$101.15	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$26.76	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$0.00
853-471	SUP	HCPCS C1713		853-471  -  BONE SCREW 853-471 2.6 X 11MM	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$76.95	$76.95	$0.00	$0.00	$0.00	$35.64	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$101.15	$101.15	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$26.76	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$0.00
853-505	SUP	HCPCS C1713		853-505  -  SCREW BONE 3MM 5MM CENTERPIECE TI SPNL SLFTAP CLR CD	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$76.95	$76.95	$0.00	$0.00	$0.00	$35.64	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$101.15	$101.15	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$26.76	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$0.00
853-507	SUP	HCPCS C1713		853-507  -  BONE SCREW 853-507 3.0 X 7MM	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$76.95	$76.95	$0.00	$0.00	$0.00	$35.64	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$101.15	$101.15	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$26.76	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$0.00
853-509	SUP	HCPCS C1713		853-509  -  BONE SCREW 853-509 3.0 X 9MM	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$76.95	$76.95	$0.00	$0.00	$0.00	$35.64	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$101.15	$101.15	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$26.76	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$0.00
853-511	SUP	HCPCS C1713		853-511  -  BONE SCREW 853-511 3.0 X 11MM	BOTH IP/OP	$171.00 	$126.54	$0.00	$136.80	$76.95	$76.95	$0.00	$0.00	$0.00	$35.64	$126.92	$126.92	$0.00	$0.00	$35.64	$0.00	$101.15	$101.15	$0.00	$85.50	$135.43	$136.80	$0.00		$0.00	$26.76	$0.00	$0.00	$27.22	$0.00	$0.00	$0.00	$0.00	$0.00
853-602	SUP	Custom 27203010		853-602  -  INSTRUMENT 853-602 TRI FLAT DRILL BIT	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8550012L	SUP	HCPCS C1713		8550012L  -  ROD 8550012L 5.5MM TI HEX END LINED ROD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
855-011	SUP	HCPCS C1713		855-011  -  ROD 855-011 5.5 MM HEX-END ROD L20 TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
855011L100	SUP	HCPCS C1713		855011L100  -  ROD 855011L100 TSRH 5.5X100MM TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
855-012	SUP	HCPCS C1713		855-012  -  ROD 855-012 TITANIUM ROD CP GRADE IV	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
85-62010	SUP	Custom 27203010		85-62010  -  STM HNDHLD LCTR VRSTIM3 NRV STD SBDRM	BOTH IP/OP	$113.00 	$83.62	$0.00	$90.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.87	$83.87	$0.00	$0.00	$23.55	$0.00	$0.00	$0.00	$0.00	$56.50	$89.50	$90.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-002	SUP	HCPCS C1713		858-002  -  HOOK 858-002 5.5 SMALL PEDICLE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-010	SUP	HCPCS C1713		858-010  -  HOOK 858-010 5.5 SMALL WIDE BLADE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-020	SUP	HCPCS C1713		858-020  -  HOOK 858-020 5.5 SMALL NARROW BLADE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-024	SUP	HCPCS C1713		858-024  -  HOOK 858-024 5.5 SMALL ANGLED BLADE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-030	SUP	HCPCS C1713		858-030  -  HOOK 858-030 5.5 SMALL EXTENDED BODY	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-052	SUP	HCPCS C1713		858-052  -  HOOK 858-052 5.5 SMALL NARROW BLADE RMPD	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-102	SUP	HCPCS C1713		858-102  -  HOOK 858-102 5.5 PEDICLE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-110	SUP	HCPCS C1713		858-110  -  HOOK 858-110 5.5 WIDE BLADE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-112	SUP	HCPCS C1713		858-112  -  HOOK 858-112 5.5 WIDE BLADE SMALL GRVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-120	SUP	HCPCS C1713		858-120  -  HOOK 858-120 5.5 NARROW BLADE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-122	SUP	HCPCS C1713		858-122  -  HOOK 858-122 NARROW BLADE SMALL GROOVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-124	SUP	HCPCS C1713		858-124  -  HOOK 858-124 5.5 ANGLED BLADE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-130	SUP	HCPCS C1713		858-130  -  HOOK 858-130 5.5 EXTENDED BODY	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-140	SUP	HCPCS C1713		858-140  -  HOOK 858-140 5.5 RIGHT OFFSET	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-142	SUP	HCPCS C1713		858-142  -  HOOK 858-142 5.5 LEFT OFFSET	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-150	SUP	HCPCS C1713		858-150  -  HOOK 858-150 5.5 STANDARD BLADE RAMPED	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-152	SUP	HCPCS C1713		858-152  -  HOOK 858-152 5.5 NARROW BLADE RAMPED	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-160	SUP	HCPCS C1713		858-160  -  HOOK 858-160 5.5 RIGHT ANGLED	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-162	SUP	HCPCS C1713		858-162  -  HOOK 858-162 5.5 LEFT ANGLED	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-202	SUP	HCPCS C1713		858-202  -  HOOK 858-202 5.5 LARGE PEDICLE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-218	SUP	HCPCS C1713		858-218  -  HOOK 858-218 LARGE GROOVE WIDE BLADE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-220	SUP	HCPCS C1713		858-220  -  HOOK 858-220 5.5 LARGE GROOVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-230	SUP	HCPCS C1713		858-230  -  HOOK 858-230 5.5 EXTD BODY LARGE GRVE	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
858-425	SUP	HCPCS C1713		858-425  -  SCREW 858-425 CDH FIXED ANGLE 4.5 X 25	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-430	SUP	HCPCS C1713		858-430  -  SCREW 858-430 CDH FIXED ANGLE 4.5 X 30	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-435	SUP	HCPCS C1713		858-435  -  SCREW 858-435 CDH FIXED ANGLE 4.5 X 35	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-440	SUP	HCPCS C1713		858-440  -  SCREW 858-440 CDH FIXED ANGLE 4.5 X 40	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-525	SUP	HCPCS C1713		858-525  -  SCREW 858-525 CDH FIXED ANGLE 5.5 X 25	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-530	SUP	HCPCS C1713		858-530  -  SCREW 858-530 CDH FIXED ANGLE 5.5 X 30	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-535	SUP	HCPCS C1713		858-535  -  SCREW 858-535 CDH FIXED ANGLE 5.5 X 35	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-540	SUP	HCPCS C1713		858-540  -  SCREW 858-540 CDH FIXED ANGLE 5.5 X 40	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-545	SUP	HCPCS C1713		858-545  -  SCREW 858-545 CDH FIXED ANGLE 5.5 X 45	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-550	SUP	HCPCS C1713		858-550  -  SCREW 858-550 CDH FIXED ANGLE 5.5 X 50	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-555	SUP	HCPCS C1713		858-555  -  SCREW BONE 5.5MM 55MM TI SPNL FIXANG	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-630	SUP	HCPCS C1713		858-630  -  SCREW 858-630 CDH FIXED ANGLE 6.5 X 30	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-635	SUP	HCPCS C1713		858-635  -  SCREW 858-635 CDH FIXED ANGLE 6.5 X 35	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-640	SUP	HCPCS C1713		858-640  -  SCREW 858-640 CDH FIXED ANGLE 6.5 X 40	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-645	SUP	HCPCS C1713		858-645  -  SCREW 858-645 CDH FIXED ANGLE 6.5 X 45	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-650	SUP	HCPCS C1713		858-650  -  SCREW 858-650 CDH FIXED ANGLE 6.5 X 50	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-655	SUP	HCPCS C1713		858-655  -  SCREW 858-655 CDH FIXED ANGLE 6.5 X 55	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-730	SUP	HCPCS C1713		858-730  -  SCREW 858-730 CDH FIXED ANGLE 7.5 X 30	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-735	SUP	HCPCS C1713		858-735  -  SCREW 858-735 CDH FIXED ANGLE 7.5 X 35	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-740	SUP	HCPCS C1713		858-740  -  SCREW 858-740 CDH FIXED ANGLE 7.5 X 40	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-745	SUP	HCPCS C1713		858-745  -  SCREW 858-745 CDH FIXED ANGLE 7.5 X 45	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-750	SUP	HCPCS C1713		858-750  -  SCREW 858-750 CDH FIXED ANGLE 7.5 X 50	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-755	SUP	HCPCS C1713		858-755  -  SCREW 858-755 CDH FIXED ANGLE 7.5 X 55	BOTH IP/OP	"$1,659.00 "	"$1,227.66"	$0.00	"$1,327.20"	$746.55	$746.55	$0.00	$0.00	$0.00	$345.78	"$1,231.31"	"$1,231.31"	$0.00	$0.00	$345.74	$0.00	$981.30	$981.30	$0.00	$829.50	"$1,313.93"	"$1,327.20"	$0.00		$0.00	$259.63	$0.00	$0.00	$264.11	$0.00	$0.00	$0.00	$0.00	$0.00
858-855	SUP	HCPCS C1713		858-855  -  SCREW SET 8.5MM 55MM HZNM8 BRK OFF SS SPNE 5.5MM ROD	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
859-002	SUP	HCPCS C1713		859-002  -  HOOK 859-002 5.5 SMALL PEDICLE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
85900P	SUP	HCPCS C1725		85900P  -  CATHETER ULTRASOUND 20MHZ STANDARD TAPER 5FR 20MM 150CM	BOTH IP/OP	"$1,812.50 "	"$1,341.25"	$0.00	"$1,450.00"	$984.19	$984.19	$0.00	$0.00	$0.00	$377.77	"$1,345.24"	"$1,345.24"	$0.00	$0.00	$377.73	$0.00	"$1,072.09"	"$1,072.09"	$0.00	$906.25	"$1,435.50"	"$1,450.00"	$0.00		$0.00	$283.66	$0.00	$0.00	$288.55	$0.00	$0.00	$0.00	$0.00	$0.00
859-010	SUP	HCPCS C1713		859-010  -  HOOK 859-010 5.5 SMALL WIDE BLADE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-012	SUP	HCPCS C1713		859-012  -  HOOK 859-012 SV WIDE BLADE SM GROOVE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-020	SUP	HCPCS C1713		859-020  -  HOOK 859-020 5.5 SM NARROW BLADE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-024	SUP	HCPCS C1713		859-024  -  HOOK 859-024 5.5 SM ANGLED BLADE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-030	SUP	HCPCS C1713		859-030  -  HOOK 859-030 5.5 SM EXTEND BODY TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-052	SUP	HCPCS C1713		859-052  -  HOOK 859-052 5.5 SM NRW BLD RAMPED TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-102	SUP	HCPCS C1713		859-102  -  HOOK 859-102 5.5 PEDICLE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-110	SUP	HCPCS C1713		859-110  -  HOOK 859-110 5.5 WIDE BLADE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-112	SUP	HCPCS C1713		859-112  -  HOOK 859-112 5.5 WIDE BLADE SM GROOVE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-120	SUP	HCPCS C1713		859-120  -  HOOK 859-120 5.5 NARROW BLADE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-122	SUP	HCPCS C1713		859-122  -  HOOK 859-122 NARROW BLADE SM GROOVE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-124	SUP	HCPCS C1713		859-124  -  HOOK 859-124 5.5 ANGLED BLADE TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-130	SUP	HCPCS C1713		859-130  -  HOOK 859-130 5.5 EXTENDED BOBY TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-140	SUP	HCPCS C1713		859-140  -  HOOK 859-140 5.5 RIGHT OFFSET TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-142	SUP	HCPCS C1713		859-142  -  HOOK 859-142 5.5 LEFT OFFSET TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-150	SUP	HCPCS C1713		859-150  -  HOOK 859-150 5.5 STNDRD BLADE RPD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-152	SUP	HCPCS C1713		859-152  -  HOOK 859-152 5.5 NARROW BLADE RPD TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-160	SUP	HCPCS C1713		859-160  -  HOOK 859-160 5.5 RIGHT ANGLED TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-162	SUP	HCPCS C1713		859-162  -  HOOK 859-162 5.5 LEFT ANGLED TI	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
859-425	SUP	HCPCS C1713		859-425  -  SCREW 859-425 CDH FIXED ANGLE 4.5 X25 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-430	SUP	HCPCS C1713		859-430  -  SCREW 859-430 CDH FIXED ANGLE 4.5 X30 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-435	SUP	HCPCS C1713		859-435  -  SCREW 859-435 CDH FIXED ANGLE 4.5 X35 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-440	SUP	HCPCS C1713		859-440  -  SCREW 859-440 CDH FIXED ANGLE 4.5 X40 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-445	SUP	HCPCS C1713		859-445  -  SCREW 859-445 CDH FIXED ANGLE 4.5 X45 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-450	SUP	HCPCS C1713		859-450  -  SCREW 859-450 CDH FIXED ANGLE 4.5 X50 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-525	SUP	HCPCS C1713		859-525  -  SCREW 859-525  5.5 FIXED ANGLE 5.5X25 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-530	SUP	HCPCS C1713		859-530  -  SCREW 859-530  5.5 FIXED ANGLE 5.5X30 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-535	SUP	HCPCS C1713		859-535  -  SCREW 859-535  5.5 FIXED ANGLE 5.5X35 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-540	SUP	HCPCS C1713		859-540  -  SCREW 859-540  5.5 FIXED ANGLE 5.5X40 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-545	SUP	HCPCS C1713		859-545  -  SCREW 859-545  5.5 FIXED ANGLE 5.5X45 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-550	SUP	HCPCS C1713		859-550  -  SCREW 859-550  5.5 FIXED ANGLE 5.5X50 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-555	SUP	HCPCS C1713		859-555  -  SCREW 859-555  5.5 FIXED ANGLE 5.5X55 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-630	SUP	HCPCS C1713		859-630  -  SCREW 859-630  5.5 FIXED ANGLE 6.5X30 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-635	SUP	HCPCS C1713		859-635  -  SCREW 859-635  5.5 FIXED ANGLE 6.5X35 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-640	SUP	HCPCS C1713		859-640  -  SCREW 859-640  5.5 FIXED ANGLE 6.5X40 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-645	SUP	HCPCS C1713		859-645  -  SCREW 859-645  5.5 FIXED ANGLE 6.5X45 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-650	SUP	HCPCS C1713		859-650  -  SCREW 859-650  5.5 FIXED ANGLE 6.5X50 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-655	SUP	HCPCS C1713		859-655  -  SCREW 859-655  5.5 FIXED ANGLE 6.5X55 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-730	SUP	HCPCS C1713		859-730  -  SCREW 859-730  5.5 FIXED ANGLE 7.5X30 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-735	SUP	HCPCS C1713		859-735  -  SCREW 859-735  5.5 FIXED ANGLE 7.5X35 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-740	SUP	HCPCS C1713		859-740  -  SCREW 859-740  5.5 FIXED ANGLE 7.5X40 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-745	SUP	HCPCS C1713		859-745  -  SCREW 859-745  5.5 FIXED ANGLE 7.5X45 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-750	SUP	HCPCS C1713		859-750  -  SCREW 859-750  5.5 FIXED ANGLE 7.5X50 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-755	SUP	HCPCS C1713		859-755  -  SCREW 859-755  5.5 FIXED ANGLE 7.5X55 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
859-760	SUP	HCPCS C1713		859-760  -  SCREW 859-760  5.5 FIXED ANGLE 7.5X60 TI	BOTH IP/OP	"$1,893.00 "	"$1,400.82"	$0.00	"$1,514.40"	$851.85	$851.85	$0.00	$0.00	$0.00	$394.55	"$1,404.98"	"$1,404.98"	$0.00	$0.00	$394.50	$0.00	"$1,119.71"	"$1,119.71"	$0.00	$946.50	"$1,499.26"	"$1,514.40"	$0.00		$0.00	$296.25	$0.00	$0.00	$301.37	$0.00	$0.00	$0.00	$0.00	$0.00
86-100	SUP	HCPCS C1713		86-100  -  PLATE BN V NS LF TRITIUM STRNL DISP	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
86-200	SUP	HCPCS C1713		86-200  -  PLATE BN TRITIUM 8 HL 1 CBL STRNL	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
86-27-08	SUP	HCPCS C1713		86-27-08  -  SCREW BN 2.7MM 8MM NS TRITIUM STRNL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
86-27-10	SUP	HCPCS C1713		86-27-10  -  SCREW BN 2.7MM 10MM NS TRITIUM STRNL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
86-27-12	SUP	HCPCS C1713		86-27-12  -  SCREW BN 12MM NS LF TRITIUM STRNL CBL PLT SYS	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
86-27-14	SUP	HCPCS C1713		86-27-14  -  SCREW BN 14MM NS LF TRITIUM STRNL CBL PLT SYS	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
86-27-16	SUP	HCPCS C1713		86-27-16  -  SCREW BN 16MM NS TRITIUM STRNL CBL PLT SYS	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
86-300	SUP	HCPCS C1713		86-300  -  PLATE BN NS TRITIUM 2 CBL STRNL	BOTH IP/OP	"$1,845.00 "	"$1,365.30"	$0.00	"$1,476.00"	$830.25	$830.25	$0.00	$0.00	$0.00	$384.54	"$1,369.36"	"$1,369.36"	$0.00	$0.00	$384.50	$0.00	"$1,091.32"	"$1,091.32"	$0.00	$922.50	"$1,461.24"	"$1,476.00"	$0.00		$0.00	$288.74	$0.00	$0.00	$293.72	$0.00	$0.00	$0.00	$0.00	$0.00
86-30-08	SUP	HCPCS C1713		86-30-08  -  SCREW BN NS TRITIUM RSC STRNL CBL PLT SYS	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
86-30-10	SUP	HCPCS C1713		86-30-10  -  SCREW BN 3MM 10MM NS LF RSC TRITIUM STRNL CBL PLT SYS	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
86-30-12	SUP	HCPCS C1713		86-30-12  -  SCREW BN 3MM 12MM NS LF RSC TRITIUM STRNL CBL PLT SYS	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
86-30-14	SUP	HCPCS C1713		86-30-14  -  SCREW BN 3MM 14MM NS LF RSC TRITIUM STRNL CBL PLT SYS	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
86-30-16	SUP	HCPCS C1713		86-30-16  -  SCREW BN NS TRITIUM RSC STRNL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
86-350-S	SUP	HCPCS C1713		86-350-S  -  DEVICE FX STRL LF TRITIUM 4 HL 2 CBL PLT SHRP NDL STRNL	BOTH IP/OP	"$1,882.50 "	"$1,393.05"	$0.00	"$1,506.00"	$847.13	$847.13	$0.00	$0.00	$0.00	$392.36	"$1,397.19"	"$1,397.19"	$0.00	$0.00	$392.31	$0.00	"$1,113.50"	"$1,113.50"	$0.00	$941.25	"$1,490.94"	"$1,506.00"	$0.00		$0.00	$294.61	$0.00	$0.00	$299.69	$0.00	$0.00	$0.00	$0.00	$0.00
86-400	SUP	HCPCS C1713		86-400  -  PLATE BN TRITIUM 5 HL 1 CBL STRNL	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
86-500	SUP	HCPCS C1713		86-500  -  PLATE BN TRITIUM 4 HL 1 CBL STRNL	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
86-600	SUP	HCPCS C1713		86-600  -  PLATE BN NS TRITIUM CBL STRNL RB	BOTH IP/OP	"$1,790.00 "	"$1,324.60"	$0.00	"$1,432.00"	$805.50	$805.50	$0.00	$0.00	$0.00	$373.08	"$1,328.54"	"$1,328.54"	$0.00	$0.00	$373.04	$0.00	"$1,058.79"	"$1,058.79"	$0.00	$895.00	"$1,417.68"	"$1,432.00"	$0.00		$0.00	$280.14	$0.00	$0.00	$284.97	$0.00	$0.00	$0.00	$0.00	$0.00
86-700	SUP	HCPCS C1713		86-700  -  PLATE LADDER TRITIUM SCP 14 HL PRECONTOUR STRNM STRNL CBL	BOTH IP/OP	"$1,797.50 "	"$1,330.15"	$0.00	"$1,438.00"	$808.88	$808.88	$0.00	$0.00	$0.00	$374.64	"$1,334.10"	"$1,334.10"	$0.00	$0.00	$374.60	$0.00	"$1,063.22"	"$1,063.22"	$0.00	$898.75	"$1,423.62"	"$1,438.00"	$0.00		$0.00	$281.31	$0.00	$0.00	$286.16	$0.00	$0.00	$0.00	$0.00	$0.00
868-011	SUP	HCPCS C1713		868-011  -  ROD 868-011 LEG 5.5 DIA HEX END SS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
868-021	SUP	HCPCS C1713		868-021  -  ROD 868-021 LEG 5.5 DIA LINED HEX END SS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
869-011	SUP	HCPCS C1713		869-011  -  ROD 869-011 LEG 5.5 DIA HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
869-012	SUP	HCPCS C1713		869-012  -  ROD 869-012 LEG 5.5 DIA HEX END TI	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
869-013	SUP	HCPCS C1713		869-013  -  ROD SPNL 50MM 5.5MM CD HZN LGC STD TI HEX END IV CP GRAD	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
869-014	SUP	HCPCS C1713		869-014  -  CP 2 ROD - 5.5MM DIA L=500MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
869-021	SUP	HCPCS C1713		869-021  -  SCREW BONE 5.5MM 210MM CD HZN LGC TI PDCL MULTIAX STRL 5.5MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
869-022	SUP	HCPCS C1713		869-022  -  ROD SPNL 50CM 5.5MM CD HZN LGC LNG TI IV HEX END LN CAP	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8696G	SUP	Custom 27203010		8696G  -  SUTURE NABSB 7-0 P1 18IN BLU PRLN MFL	BOTH IP/OP	$16.63 	$12.31	$0.00	$13.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.34	$12.34	$0.00	$0.00	$3.47	$0.00	$0.00	$0.00	$0.00	$8.32	$13.17	$13.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8700-000865-01	SUP	Custom 27203010		8700-000865-01  -  PACK SRG 6FT IVTM COOL LINE SRT UP DISP	BOTH IP/OP	"$6,725.10 "	"$4,976.57"	$0.00	"$5,380.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,401.51"	$0.00	$0.00	$0.00	$0.00	"$3,362.55"	"$5,326.28"	"$5,380.08"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8700-000866-01	SUP	Custom 27203010		8700-000866-01  -  PACK SRG 6FT IVTM ICY SRT UP DISP	BOTH IP/OP	"$9,639.60 "	"$7,133.30"	$0.00	"$7,711.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,008.89"	$0.00	$0.00	$0.00	$0.00	"$4,819.80"	"$7,634.56"	"$7,711.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8700-000867-01	SUP	Custom 27203010		8700-000867-01  -  PACK SRG 6FT IVTM QUATTRO SRT UP DISP	BOTH IP/OP	"$10,579.20 "	"$7,828.61"	$0.00	"$8,463.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,204.71"	$0.00	$0.00	$0.00	$0.00	"$5,289.60"	"$8,378.73"	"$8,463.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8700-0654-01	SUP	HCPCS C1751		8700-0654-01  -  CATH CEN VEN 9.3FR 22CM 58MM ODS	BOTH IP/OP	"$1,226.70 "	$907.76	$0.00	$981.36	$552.02	$552.02	$0.00	$0.00	$0.00	$255.67	$910.46	$910.46	$0.00	$0.00	$255.64	$0.00	$725.59	$725.59	$0.00	$613.35	$971.55	$981.36	$0.00		$0.00	$191.98	$0.00	$0.00	$195.29	$0.00	$0.00	$0.00	$0.00	$0.00
8700-0657-01	SUP	HCPCS C1751		8700-0657-01  -  CATHETER CEN VEN .032IN 9.3FR 38CM 75CM 3 INFUS LUMEN EXTN	BOTH IP/OP	"$1,955.33 "	"$1,446.94"	$0.00	"$1,564.26"	$879.90	$879.90	$0.00	$0.00	$0.00	$407.54	"$1,451.24"	"$1,451.24"	$0.00	$0.00	$407.49	$0.00	"$1,156.57"	"$1,156.57"	$0.00	$977.66	"$1,548.62"	"$1,564.26"	$0.00		$0.00	$306.01	$0.00	$0.00	$311.29	$0.00	$0.00	$0.00	$0.00	$0.00
8700-0660-01	SUP	HCPCS C1752		8700-0660-01  -  KIT 45CM 9.3FR TRIP CATH QT	BOTH IP/OP	"$2,190.23 "	"$1,620.77"	$0.00	"$1,752.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,625.58"	"$1,625.58"	$0.00	$0.00	$456.44	$0.00	$0.00	$0.00	$0.00	"$1,095.11"	"$1,734.66"	"$1,752.18"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8700-0781-01	SUP	Custom 27203010		8700-0781-01  -  CATHETER CV 9.3FR 22CM STRL LF CL LN HEAT EXCH KT	BOTH IP/OP	"$1,287.60 "	$952.82	$0.00	"$1,030.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.66	$955.66	$0.00	$0.00	$268.34	$0.00	$0.00	$0.00	$0.00	$643.80	"$1,019.78"	"$1,030.08"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8700-0782-01	SUP	Custom 27203010		8700-0782-01  -  KIT CATH 9.3FR 38CM ICY CV	BOTH IP/OP	"$2,053.20 "	"$1,519.37"	$0.00	"$1,642.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,523.89"	"$1,523.89"	$0.00	$0.00	$427.89	$0.00	$0.00	$0.00	$0.00	"$1,026.60"	"$1,626.13"	"$1,642.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8700-0783-01	SUP	Custom 27203010		8700-0783-01  -  KIT CATH 9.3FR 45CM QUATTRO HEAT EXCH 3 LUM LL APPLAUSE HEP	BOTH IP/OP	"$2,298.98 "	"$1,701.25"	$0.00	"$1,839.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.30"	"$1,706.30"	$0.00	$0.00	$479.11	$0.00	$0.00	$0.00	$0.00	"$1,149.49"	"$1,820.79"	"$1,839.18"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8700-0784-01	SUP	Custom 27203010		8700-0784-01  -  KIT IV CLGRD 3K SRT	BOTH IP/OP	$454.58 	$336.39	$0.00	$363.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.39	$337.39	$0.00	$0.00	$94.73	$0.00	$0.00	$0.00	$0.00	$227.29	$360.03	$363.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8700-0785-01	SUP	Custom 27203010		8700-0785-01  -  TUBING XTN 9FT	BOTH IP/OP	$511.13 	$378.24	$0.00	$408.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$379.36	$379.36	$0.00	$0.00	$106.52	$0.00	$0.00	$0.00	$0.00	$255.56	$404.81	$408.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8709H	SUP	Custom 27203010		8709H  -  SUTURE NONABSORBABLE 6-0 BV-1 30IN 2 ARM MONOFILAMENT	BOTH IP/OP	$34.09 	$25.23	$0.00	$27.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.30	$25.30	$0.00	$0.00	$7.10	$0.00	$0.00	$0.00	$0.00	$17.04	$27.00	$27.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
873-004	SUP	HCPCS C1769		873-004  -  GWIRE ORTH 24IN UCSS THRD INSTR	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
873-011	SUP	HCPCS C1769		873-011  -  GWIRE ORTH 24IN UCSS NTHRD INSTR DISP	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
873-030	SUP	HCPCS C1713		873-030  -  BONE SCREW 873-030 4.0 CANN CORT L 30MM	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-032	SUP	HCPCS C1713		873-032  -  BONE SCREW 873-032 4.0 CANN CORT L 32MM	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-034	SUP	HCPCS C1713		873-034  -  BONE SCREW 873-034 4.0 CANN CORT L 34MM	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-036	SUP	HCPCS C1713		873-036  -  BONE SCREW 873-036 4.0 CANN CORT L 36MM	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-038	SUP	HCPCS C1713		873-038  -  BONE SCREW 873-038 4.0 CANN CORT L 38MM	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-040	SUP	HCPCS C1713		873-040  -  SCREW BONE 4MM 40MM UCSS TI CORT CANN	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-042	SUP	HCPCS C1713		873-042  -  SCREW BONE 4MM 42MM UCSS TI CORT CANN	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-044	SUP	HCPCS C1713		873-044  -  BONE SCREW 873-044 4.0 CANN CORT L 44MM	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-046	SUP	HCPCS C1713		873-046  -  BONE SCREW 873-046 4.0 CANN CORT L 46MM	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-048	SUP	HCPCS C1713		873-048  -  BONE SCREW 873-048 4.0 CANN CORT L 48MM	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-050	SUP	HCPCS C1713		873-050  -  BONE SCREW 873-050 4.0 CANN CORT L 50MM	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-136	SUP	HCPCS C1713		873-136  -  SCREW BN P/T 4MM 36MM UCSS LG CNN TI SPNE CORT	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-138	SUP	HCPCS C1713		873-138  -  BONE SCREW 873-138 4.0 CAN CORT LAG L 38	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-140	SUP	HCPCS C1713		873-140  -  BONE SCREW 873-140 4.0 CAN CORT LAG L 40	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-142	SUP	HCPCS C1713		873-142  -  BONE SCREW 873-142 4.0 CAN CORT LAG L 42	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-144	SUP	HCPCS C1713		873-144  -  BONE SCREW 873-144 4.0 CAN CORT LAG L 44	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-146	SUP	HCPCS C1713		873-146  -  BONE SCREW 873-146 4.0 CAN CORT LAG L 46	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-148	SUP	HCPCS C1713		873-148  -  BONE SCREW 873-148 4.0 CAN CORT LAG L 48	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
873-150	SUP	HCPCS C1713		873-150  -  BONE SCREW 873-150 4.0 CAN CORT LAG L 50	BOTH IP/OP	"$1,381.50 "	"$1,022.31"	$0.00	"$1,105.20"	$621.68	$621.68	$0.00	$0.00	$0.00	$287.94	"$1,025.35"	"$1,025.35"	$0.00	$0.00	$287.90	$0.00	$817.16	$817.16	$0.00	$690.75	"$1,094.15"	"$1,105.20"	$0.00		$0.00	$216.20	$0.00	$0.00	$219.93	$0.00	$0.00	$0.00	$0.00	$0.00
8747H	SUP	Custom 27203010		8747H  -  SUTURE NONABSORBABLE 7-0 BV175-8 24IN 2 ARM MONOFILAMENT	BOTH IP/OP	$72.38 	$53.56	$0.00	$57.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.72	$53.72	$0.00	$0.00	$15.08	$0.00	$0.00	$0.00	$0.00	$36.19	$57.32	$57.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
87525S	SUP	HCPCS C1713		87525S  -  SCREW BN STD 8.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$1,233.33 "	$912.66	$0.00	$986.66	$555.00	$555.00	$0.00	$0.00	$0.00	$257.06	$915.37	$915.37	$0.00	$0.00	$257.02	$0.00	$729.51	$729.51	$0.00	$616.66	$976.80	$986.66	$0.00		$0.00	$193.02	$0.00	$0.00	$196.35	$0.00	$0.00	$0.00	$0.00	$0.00
87530S	SUP	HCPCS C1713		87530S  -  SCREW BN STD 8.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
87535S	SUP	HCPCS C1713		87535S  -  SCREW BN STD 8.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
87540S	SUP	HCPCS C1713		87540S  -  SCREW BN STD 8.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
87545S	SUP	HCPCS C1713		87545S  -  SCREW BN STD 8.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
87550S	SUP	HCPCS C1713		87550S  -  SCREW BN STD 8.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
87555S	SUP	HCPCS C1713		87555S  -  SCREW BN STD 8.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
876-010	SUP	HCPCS C1713		876-010  -  SCREW 876-010 ATLANTIS CAN FAS 4.0X10MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-011	SUP	HCPCS C1713		876-011  -  SCREW 876-011 ATLANTIS CAN FAS 4.0X11MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-012	SUP	HCPCS C1713		876-012  -  SCREW BN 4MM 12MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-013	SUP	HCPCS C1713		876-013  -  SCREW BN 4MM 13MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-014	SUP	HCPCS C1713		876-014  -  SCREW BN 4MM 14MM GRY STRL ATLNTS FX ANG TI SPNE CANC CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-015	SUP	HCPCS C1713		876-015  -  SCREW BN 4MM 15MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-016	SUP	HCPCS C1713		876-016  -  SCREW BN 4MM 16MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-017	SUP	HCPCS C1713		876-017  -  SCREW BN 4MM 17MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-018	SUP	HCPCS C1713		876-018  -  SCREW BN 4MM 18MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-019	SUP	HCPCS C1713		876-019  -  SCREW 876-019 ATLANTIS CAN FAS 4.0X19MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-020	SUP	HCPCS C1713		876-020  -  SCREW 876-020 ATLANTIS CAN FAS 4.0X20MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-021	SUP	HCPCS C1713		876-021  -  SCREW 876-021 ATLANTIS CAN FAS 4.0X21MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-053	SUP	HCPCS C1713		876-053  -  SCREW BN 4.5MM 13MM BLU STRL ATLNTS FX ANG TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-055	SUP	HCPCS C1713		876-055  -  SCREW BN 4.5MM 15MM BLU STRL ATLNTS FX ANG TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-057	SUP	HCPCS C1713		876-057  -  SCREW BN 4.5MM 17MM BLU STRL ATLNTS FX ANG TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-119	SUP	HCPCS C1713		876-119  -  PLATE 876-119 19MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
876-121	SUP	HCPCS C1713		876-121  -  PLATE 876-121 21MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
876-123	SUP	HCPCS C1713		876-123  -  PLATE 876-123 23MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
876-125	SUP	HCPCS C1713		876-125  -  PLATE 876-125 25MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
876-127	SUP	HCPCS C1713		876-127  -  PLATE 876-127 27.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
876-130	SUP	HCPCS C1713		876-130  -  PLATE 876-130 30MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
876-132	SUP	HCPCS C1713		876-132  -  PLATE 876-132 32.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
876-135	SUP	HCPCS C1713		876-135  -  PLATE 876-135 35MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
876-137	SUP	HCPCS C1713		876-137  -  PLATE 876-137 37.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
876-140	SUP	HCPCS C1713		876-140  -  PLATE 876-140 40MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
876-142	SUP	HCPCS C1713		876-142  -  PLATE BN 42.5MM STRL ATLNTS LCK LOPRFL TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
876-145	SUP	HCPCS C1713		876-145  -  PLATE 876-145 45MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
876-147	SUP	HCPCS C1713		876-147  -  PLATE 876-147 47.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
876-150	SUP	HCPCS C1713		876-150  -  PLATE 876-150 50MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
876-152	SUP	HCPCS C1713		876-152  -  PLATE 876-152 52.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
876-155	SUP	HCPCS C1713		876-155  -  PLATE 876-155 55MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
876-157	SUP	HCPCS C1713		876-157  -  PLATE 876-157 57.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
876-160	SUP	HCPCS C1713		876-160  -  PLATE 876-160 60MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
876-162	SUP	HCPCS C1713		876-162  -  PLATE 876-162 62.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
876-165	SUP	HCPCS C1713		876-165  -  PLATE 876-165 65MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
876-167	SUP	HCPCS C1713		876-167  -  PLATE 876-167 67.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
876-170	SUP	HCPCS C1713		876-170  -  PLATE 876-170 70MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
876-172	SUP	HCPCS C1713		876-172  -  PLATE 876-172 72.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
876-175	SUP	HCPCS C1713		876-175  -  PLATE 876-175 75MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
876-177	SUP	HCPCS C1713		876-177  -  PLATE 876-177 77.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
876-180	SUP	HCPCS C1713		876-180  -  PLATE 876-180 80MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
876-182	SUP	HCPCS C1713		876-182  -  PLATE 876-182 82.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
876-185	SUP	HCPCS C1713		876-185  -  PLATE 876-185 85MM ANTERIOR CERVICAL	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
876-187	SUP	HCPCS C1713		876-187  -  PLATE 876-187 87.5MM ANTERIOR CERVICAL	BOTH IP/OP	"$4,135.50 "	"$3,060.27"	$0.00	"$3,308.40"	"$1,860.98"	"$1,860.98"	$0.00	$0.00	$0.00	$861.94	"$3,069.37"	"$3,069.37"	$0.00	$0.00	$861.84	$0.00	"$2,038.80"	"$2,038.80"	$0.00	"$2,067.75"	"$3,275.32"	"$3,308.40"	$0.00		$0.00	$647.21	$0.00	$0.00	$658.37	$0.00	$0.00	$0.00	$0.00	$0.00
876-190	SUP	HCPCS C1713		876-190  -  PLATE 876-190 90MM ANTERIOR CERVICAL	BOTH IP/OP	"$4,135.50 "	"$3,060.27"	$0.00	"$3,308.40"	"$1,860.98"	"$1,860.98"	$0.00	$0.00	$0.00	$861.94	"$3,069.37"	"$3,069.37"	$0.00	$0.00	$861.84	$0.00	"$2,038.80"	"$2,038.80"	$0.00	"$2,067.75"	"$3,275.32"	"$3,308.40"	$0.00		$0.00	$647.21	$0.00	$0.00	$658.37	$0.00	$0.00	$0.00	$0.00	$0.00
876-195	SUP	HCPCS C1713		876-195  -  PLATE 876-195 95MM ANTERIOR CERVICAL	BOTH IP/OP	"$4,135.50 "	"$3,060.27"	$0.00	"$3,308.40"	"$1,860.98"	"$1,860.98"	$0.00	$0.00	$0.00	$861.94	"$3,069.37"	"$3,069.37"	$0.00	$0.00	$861.84	$0.00	"$2,038.80"	"$2,038.80"	$0.00	"$2,067.75"	"$3,275.32"	"$3,308.40"	$0.00		$0.00	$647.21	$0.00	$0.00	$658.37	$0.00	$0.00	$0.00	$0.00	$0.00
876-200	SUP	HCPCS C1713		876-200  -  PLATE 876-200 100MM ANTERIOR CERVICAL	BOTH IP/OP	"$4,135.50 "	"$3,060.27"	$0.00	"$3,308.40"	"$1,860.98"	"$1,860.98"	$0.00	$0.00	$0.00	$861.94	"$3,069.37"	"$3,069.37"	$0.00	$0.00	$861.84	$0.00	"$2,038.80"	"$2,038.80"	$0.00	"$2,067.75"	"$3,275.32"	"$3,308.40"	$0.00		$0.00	$647.21	$0.00	$0.00	$658.37	$0.00	$0.00	$0.00	$0.00	$0.00
876-205	SUP	HCPCS C1713		876-205  -  PLATE 876-205 105MM ANTERIOR CERVICAL	BOTH IP/OP	"$4,135.50 "	"$3,060.27"	$0.00	"$3,308.40"	"$1,860.98"	"$1,860.98"	$0.00	$0.00	$0.00	$861.94	"$3,069.37"	"$3,069.37"	$0.00	$0.00	$861.84	$0.00	"$2,038.80"	"$2,038.80"	$0.00	"$2,067.75"	"$3,275.32"	"$3,308.40"	$0.00		$0.00	$647.21	$0.00	$0.00	$658.37	$0.00	$0.00	$0.00	$0.00	$0.00
876-210	SUP	HCPCS C1713		876-210  -  PLATE 876-210 110MM ANTERIOR CERVICAL	BOTH IP/OP	"$4,135.50 "	"$3,060.27"	$0.00	"$3,308.40"	"$1,860.98"	"$1,860.98"	$0.00	$0.00	$0.00	$861.94	"$3,069.37"	"$3,069.37"	$0.00	$0.00	$861.84	$0.00	"$2,038.80"	"$2,038.80"	$0.00	"$2,067.75"	"$3,275.32"	"$3,308.40"	$0.00		$0.00	$647.21	$0.00	$0.00	$658.37	$0.00	$0.00	$0.00	$0.00	$0.00
8762H	SUP	Custom 27203010		8762H  -  SUTURE NABSB 3-0 SH-1 30IN BLU PRLN 2 ARM MFL	BOTH IP/OP	$554.42 	$410.27	$0.00	$443.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$411.49	$411.49	$0.00	$0.00	$115.54	$0.00	$0.00	$0.00	$0.00	$277.21	$439.10	$443.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
876-310	SUP	HCPCS C1713		876-310  -  SCREW 876-310 VAS CANCELLOUS 4.0X10MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-311	SUP	HCPCS C1713		876-311  -  SCREW 876-311 VAS CANCELLOUS 4.0X11MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-312	SUP	HCPCS C1713		876-312  -  SCREW BN 4MM 12MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-313	SUP	HCPCS C1713		876-313  -  SCREW BN 4MM 13MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-314	SUP	HCPCS C1713		876-314  -  SCREW BN 4MM 14MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-315	SUP	HCPCS C1713		876-315  -  SCREW BN 4MM 15MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-316	SUP	HCPCS C1713		876-316  -  SCREW BN 4MM 16MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-317	SUP	HCPCS C1713		876-317  -  SCREW BN 4MM 17MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-318	SUP	HCPCS C1713		876-318  -  SCREW BN 4MM 18MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-319	SUP	HCPCS C1713		876-319  -  SCREW 876-319 VAS CANCELLOUS 4.0X19MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-320	SUP	HCPCS C1713		876-320  -  SCREW 876-320 VAS CANCELLOUS 4.0X20MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-321	SUP	HCPCS C1713		876-321  -  SCREW 876-321 VAS CANCELLOUS 4.0X21MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-353	SUP	HCPCS C1713		876-353  -  SCREW BN 4.5MM 13MM MAG STRL ATLNTS VA TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-355	SUP	HCPCS C1713		876-355  -  SCREW BN 4.5MM 15MM MAG STRL ATLNTS VA TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-357	SUP	HCPCS C1713		876-357  -  SCREW BN 4.5MM 17MM MAG STRL ATLNTS VA TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-404	SUP	HCPCS C1713		876-404  -  PIN HLD ATLNTS ANT CERV SPN PLT INSTR TI STRL	BOTH IP/OP	$219.00 	$162.06	$0.00	$175.20	$98.55	$98.55	$0.00	$0.00	$0.00	$45.65	$162.54	$162.54	$0.00	$0.00	$45.64	$0.00	$129.54	$129.54	$0.00	$109.50	$173.45	$175.20	$0.00		$0.00	$34.27	$0.00	$0.00	$34.86	$0.00	$0.00	$0.00	$0.00	$0.00
876-443	SUP	Custom 27203010		876-443  -  BIT DRILL 13MM ATLNTS SPNL 3 FLAT STRL DISP	BOTH IP/OP	$760.00 	$562.40	$0.00	$608.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$564.07	$564.07	$0.00	$0.00	$158.38	$0.00	$0.00	$0.00	$0.00	$380.00	$601.92	$608.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
876-455	SUP	Custom 27203010		876-455  -  BIT DRILL 5MM ATLNTS 3 FLAT ADJ STRL DISP	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$0.00	$0.00	$104.41	$0.00	$0.00	$0.00	$0.00	$250.50	$396.79	$400.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
876-612	SUP	HCPCS C1713		876-612  -  SCREW BN 4MM 12MM STRL ATLNTS VA SLF DRL TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-613	SUP	HCPCS C1713		876-613  -  SCREW BN 4MM 13MM GRN STRL ATLNTS VA SLF DRL TI SPNE CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-614	SUP	HCPCS C1713		876-614  -  SCREW BN 4MM 14MM STRL ATLNTS VA SLF DRL NTNL SPNL CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-615	SUP	HCPCS C1713		876-615  -  SCREW BN 4MM 15MM GRN STRL ATLNTS VA SLF DRL TI SPNE CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-643	SUP	HCPCS C1713		876-643  -  SCREW BN 4.5MM 13MM MAG STRL ATLNTS VA SLF DRL TI SPNE CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-644	SUP	HCPCS C1713		876-644  -  SCREW BN 4.5MM 14MM STRL ATLNTS VA SLF DRL NTNL SPNL CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-645	SUP	HCPCS C1713		876-645  -  SCREW BN 4.5MM 15MM MAG STRL ATLNTS VA SLF DRL TI SPNE CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-710	SUP	HCPCS C1713		876-710  -  SCREW 876-710 FA SELF TAPPING 4.0X10MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-711	SUP	HCPCS C1713		876-711  -  SCREW 876-711 FA SELF TAPPING 4.0X11MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-712	SUP	HCPCS C1713		876-712  -  SCREW BN 4MM 12MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-713	SUP	HCPCS C1713		876-713  -  SCREW BN 4MM 13MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-714	SUP	HCPCS C1713		876-714  -  SCREW BONE 4MM 14MM ATLNTS TI CANC ANT CERV SPN FAVORED ANG	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-715	SUP	HCPCS C1713		876-715  -  SCREW BN 4MM 15MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-716	SUP	HCPCS C1713		876-716  -  SCREW BONE 4MM 16MM ATLNTS TI CANC ANT CERV SPNE SLFTAP FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-717	SUP	HCPCS C1713		876-717  -  SCREW BONE 4MM 17MM ATLNTS TI CANC ANT CERV SPNE SLFTAP FIX	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-718	SUP	HCPCS C1713		876-718  -  SCREW BN 4MM 18MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-753	SUP	HCPCS C1713		876-753  -  SCREW BN 4.5MM 13MM BLU STRL ATLNTS FX ANG ST TI SPNE CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-755	SUP	HCPCS C1713		876-755  -  SCREW BN 4.5MM 15MM BLU STRL ATLNTS FX ANG ST TI SPNE CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-757	SUP	HCPCS C1713		876-757  -  SCREW BONE 4.5MM 17MM ATLNTS TI CANC ANT CERV SPNE SLFTAP	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-810	SUP	HCPCS C1713		876-810  -  SCREW 876-810 VA SELF TAPPING 4.0X10MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-811	SUP	HCPCS C1713		876-811  -  SCREW 876-811 VA SELF TAPPING 4.0X11MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-812	SUP	HCPCS C1713		876-812  -  SCREW BN 4MM 12MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-813	SUP	HCPCS C1713		876-813  -  SCREW BN 4MM 13MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-814	SUP	HCPCS C1713		876-814  -  SCREW BONE 4MM 14MM ATLNTS TI SPNL CANC VAR ANG SLFTAP STRL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-815	SUP	HCPCS C1713		876-815  -  SCREW BN 4MM 15MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-816	SUP	HCPCS C1713		876-816  -  SCREW BONE 4MM 16MM ATLNTS TI SPNL CANC VAR ANG SLFTAP STRL	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-817	SUP	HCPCS C1713		876-817  -  SCREW BONE 4MM 17MM ATLNTS TI CANC ANT CERV SPNE SLFTAP VA	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-818	SUP	HCPCS C1713		876-818  -  SCREW BN 4MM 18MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-853	SUP	HCPCS C1713		876-853  -  SCREW BONE 4.5MM 13MM ATLNTS TI ANT CERV SPN SLFTAP VAR ANG	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-855	SUP	HCPCS C1713		876-855  -  SCREW BN 4.5MM 15MM MAG STRL ATLNTS VA ST TI SPNE CRV CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-857	SUP	HCPCS C1713		876-857  -  SCREW BONE 4.5MM 17MM ATLNTS TI CANC ANT CERV SPNE SLFTAP VA	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
876-943	SUP	Custom 27203010		876-943  -  INSTRUMENT 876-943 ATL NONSTRL 3M DRLBIT	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$0.00	$0.00	$104.41	$0.00	$0.00	$0.00	$0.00	$250.50	$396.79	$400.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
876-955	SUP	Custom 27203010		876-955  -  INSTRUMENT 876-955 ATL NONSTRL ADJ DRLBT	BOTH IP/OP	$501.00 	$370.74	$0.00	$400.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.84	$371.84	$0.00	$0.00	$104.41	$0.00	$0.00	$0.00	$0.00	$250.50	$396.79	$400.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8800500A	SUP	HCPCS C1713		8800500A  -  SCREW BN 10.5MM 100MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800510A	SUP	HCPCS C1713		8800510A  -  SCREW BN 10.5MM 110MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800520A	SUP	HCPCS C1713		8800520A  -  SCREW BN 10.5MM 120MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800525A	SUP	HCPCS C1713		8800525A  -  SCREW BN 10.5MM 25MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800530A	SUP	HCPCS C1713		8800530A  -  SCREW BN 10.5MM 30MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800535A	SUP	HCPCS C1713		8800535A  -  SCREW BN 10.5MM 35MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800540A	SUP	HCPCS C1713		8800540A  -  SCREW BN 10.5MM 40MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800545A	SUP	HCPCS C1713		8800545A  -  SCREW BN 10.5MM 45MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800550A	SUP	HCPCS C1713		8800550A  -  SCREW BN 10.5MM 50MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800555A	SUP	HCPCS C1713		8800555A  -  SCREW BN 10.5MM 55MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800560A	SUP	HCPCS C1713		8800560A  -  SCREW BN 10.5MM 60MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800570A	SUP	HCPCS C1713		8800570A  -  SCREW BN 10.5MM 70MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800580A	SUP	HCPCS C1713		8800580A  -  SCREW BN 10.5MM 80MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8800590A	SUP	HCPCS C1713		8800590A  -  SCREW BN 10.5MM 90MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8804525A	SUP	HCPCS C1713		8804525A  -  SCREW BN 4.5MM 25MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8804530A	SUP	HCPCS C1713		8804530A  -  SCREW BN 4.5MM 30MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8804535A	SUP	HCPCS C1713		8804535A  -  SCREW BN 4.5MM 35MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8804540A	SUP	HCPCS C1713		8804540A  -  SCREW BN 4.5MM 40MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8804545A	SUP	HCPCS C1713		8804545A  -  SCREW BN 4.5MM 45MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8804550A	SUP	HCPCS C1713		8804550A  -  SCREW BN 4.5MM 50MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8804555A	SUP	HCPCS C1713		8804555A  -  SCREW BN 4.5MM 55MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8804560A	SUP	HCPCS C1713		8804560A  -  SCREW BN 4.5MM 60MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805025A	SUP	HCPCS C1713		8805025A  -  SCREW BN 5MM 25MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805030A	SUP	HCPCS C1713		8805030A  -  SCREW BN 5MM 30MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805035A	SUP	HCPCS C1713		8805035A  -  SCREW BN 5MM 35MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805040A	SUP	HCPCS C1713		8805040A  -  SCREW BN 5MM 40MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805045A	SUP	HCPCS C1713		8805045A  -  SCREW BN 5MM 45MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805050A	SUP	HCPCS C1713		8805050A  -  SCREW BN 5MM 50MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805055A	SUP	HCPCS C1713		8805055A  -  SCREW BN 5MM 55MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805060A	SUP	HCPCS C1713		8805060A  -  SCREW BN 5MM 60MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805525A	SUP	HCPCS C1713		8805525A  -  SCREW BN 5.5MM 25MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805530A	SUP	HCPCS C1713		8805530A  -  SCREW BN 5.5MM 30MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805535A	SUP	HCPCS C1713		8805535A  -  SCREW BN 5.5MM 35MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805540A	SUP	HCPCS C1713		8805540A  -  SCREW BONE 40MM POLYAX PRECEPT 5.5MM SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805545A	SUP	HCPCS C1713		8805545A  -  SCREW BONE 45MM POLYAX PRECEPT 5.5MM SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805550A	SUP	HCPCS C1713		8805550A  -  SCREW BONE 50MM POLYAX PRECEPT 5.5MM SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805555A	SUP	HCPCS C1713		8805555A  -  SCREW BN 5.5MM 55MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8805560A	SUP	HCPCS C1713		8805560A  -  SCREW BN 5.5MM 60MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806025A	SUP	HCPCS C1713		8806025A  -  SCREW BN 6MM 25MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806030A	SUP	HCPCS C1713		8806030A  -  SCREW BN 6MM 30MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806035A	SUP	HCPCS C1713		8806035A  -  SCREW BN 6MM 35MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806040A	SUP	HCPCS C1713		8806040A  -  SCREW BN 6MM 40MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806045A	SUP	HCPCS C1713		8806045A  -  SCREW BN 6MM 45MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806050A	SUP	HCPCS C1713		8806050A  -  SCREW BN 6MM 50MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806055A	SUP	HCPCS C1713		8806055A  -  SCREW BN 6MM 55MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806060A	SUP	HCPCS C1713		8806060A  -  SCREW BN 6MM 60MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806500A	SUP	HCPCS C1713		8806500A  -  SCREW BN 6.5MM 100MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806510A	SUP	HCPCS C1713		8806510A  -  SCREW BN 6.5MM 110MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806520A	SUP	HCPCS C1713		8806520A  -  SCREW BN 6.5MM 120MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806525A	SUP	HCPCS C1713		8806525A  -  SCREW BN 6.5MM 25MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806530A	SUP	HCPCS C1713		8806530A  -  SCREW BN 6.5MM 30MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806535A	SUP	HCPCS C1713		8806535A  -  SCREW BN 6.5MM 35MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806540A	SUP	HCPCS C1713		8806540A  -  SCREW BN 6.5MM 40MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806545A	SUP	HCPCS C1713		8806545A  -  SCREW BONE 6.5MM 45MM POLYAX PRECEPT SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806550A	SUP	HCPCS C1713		8806550A  -  SCREW BONE 50MM 6.5MM SPN MAS	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806555A	SUP	HCPCS C1713		8806555A  -  SCREW BN 6.5MM 55MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806560A	SUP	HCPCS C1713		8806560A  -  SCREW BN 6.5MM 60MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806570A	SUP	HCPCS C1713		8806570A  -  SCREW BN 6.5MM 70MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806580A	SUP	HCPCS C1713		8806580A  -  SCREW BN 6.5MM 80MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8806590A	SUP	HCPCS C1713		8806590A  -  SCREW BN 6.5MM 90MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807000A	SUP	HCPCS C1713		8807000A  -  SCREW BN 7MM 100MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807010A	SUP	HCPCS C1713		8807010A  -  SCREW BN 7MM 110MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807020A	SUP	HCPCS C1713		8807020A  -  SCREW BN 7MM 120MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807025A	SUP	HCPCS C1713		8807025A  -  SCREW BN 7MM 25MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807030A	SUP	HCPCS C1713		8807030A  -  SCREW BN 7MM 30MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807035A	SUP	HCPCS C1713		8807035A  -  SCREW BN 7MM 35MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807040A	SUP	HCPCS C1713		8807040A  -  SCREW BN 7MM 40MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807045A	SUP	HCPCS C1713		8807045A  -  SCREW BN 7MM 45MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807050A	SUP	HCPCS C1713		8807050A  -  SCREW BN 7MM 50MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807060A	SUP	HCPCS C1713		8807060A  -  SCREW BN 7MM 60MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807070A	SUP	HCPCS C1713		8807070A  -  SCREW BN 7MM 70MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807080A	SUP	HCPCS C1713		8807080A  -  SCREW BN 7MM 80MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807090A	SUP	HCPCS C1713		8807090A  -  SCREW BN 7MM 90MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807500A	SUP	HCPCS C1713		8807500A  -  SCREW BN 7.5MM 100MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807510A	SUP	HCPCS C1713		8807510A  -  SCREW BN 7.5MM 110MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807520A	SUP	HCPCS C1713		8807520A  -  SCREW BN 7.5MM 120MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807525A	SUP	HCPCS C1713		8807525A  -  SCREW BN 7.5MM 25MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807530A	SUP	HCPCS C1713		8807530A  -  SCREW BN 7.5MM 30MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807535A	SUP	HCPCS C1713		8807535A  -  SCREW BN 7.5MM 35MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807540A	SUP	HCPCS C1713		8807540A  -  SCREW BN 7.5MM 40MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807545A	SUP	HCPCS C1713		8807545A  -  SCREW BN 7.5MM 45MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807550A	SUP	HCPCS C1713		8807550A  -  SCREW BN 7.5MM 50MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807555A	SUP	HCPCS C1713		8807555A  -  SCREW BN 7.5MM 55MM NS PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807560A	SUP	HCPCS C1713		8807560A  -  SCREW BN 7.5MM 60MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807570A	SUP	HCPCS C1713		8807570A  -  SCREW BN 7.5MM 70MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807580A	SUP	HCPCS C1713		8807580A  -  SCREW BN 7.5MM 80MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8807590A	SUP	HCPCS C1713		8807590A  -  SCREW BN 7.5MM 90MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808500A	SUP	HCPCS C1713		8808500A  -  SCREW BN 8.5MM 100MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808510A	SUP	HCPCS C1713		8808510A  -  SCREW BN 8.5MM 110MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808520A	SUP	HCPCS C1713		8808520A  -  SCREW BN 8.5MM 120MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808525A	SUP	HCPCS C1713		8808525A  -  SCREW BN 8.5MM 25MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808530A	SUP	HCPCS C1713		8808530A  -  SCREW BN 8.5MM 30MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808535A	SUP	HCPCS C1713		8808535A  -  SCREW BN 8.5MM 35MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808540A	SUP	HCPCS C1713		8808540A  -  SCREW BN 8.5MM 40MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808545A	SUP	HCPCS C1713		8808545A  -  SCREW BN 8.5MM 45MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808550A	SUP	HCPCS C1713		8808550A  -  SCREW BN 8.5MM 50MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808555A	SUP	HCPCS C1713		8808555A  -  SCREW BN 8.5MM 55MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808560A	SUP	HCPCS C1713		8808560A  -  SCREW BN 8.5MM 60MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808570A	SUP	HCPCS C1713		8808570A  -  SCREW BN 8.5MM 70MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808580A	SUP	HCPCS C1713		8808580A  -  SCREW BN 8.5MM 80MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8808590A	SUP	HCPCS C1713		8808590A  -  SCREW BN 8.5MM 90MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809500A	SUP	HCPCS C1713		8809500A  -  SCREW BN 9.5MM 100MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809510A	SUP	HCPCS C1713		8809510A  -  SCREW BN 9.5MM 110MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809520A	SUP	HCPCS C1713		8809520A  -  SCREW BN 9.5MM 120MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809525A	SUP	HCPCS C1713		8809525A  -  SCREW BN 9.5MM 25MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809530A	SUP	HCPCS C1713		8809530A  -  SCREW BN 9.5MM 30MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809535A	SUP	HCPCS C1713		8809535A  -  SCREW BN 9.5MM 35MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809540A	SUP	HCPCS C1713		8809540A  -  SCREW BN 9.5MM 40MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809545A	SUP	HCPCS C1713		8809545A  -  SCREW BN 9.5MM 45MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809550A	SUP	HCPCS C1713		8809550A  -  SCREW BN 9.5MM 50MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809555A	SUP	HCPCS C1713		8809555A  -  SCREW BN 9.5MM 55MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809560A	SUP	HCPCS C1713		8809560A  -  SCREW BN 9.5MM 60MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809570A	SUP	HCPCS C1713		8809570A  -  SCREW BN 9.5MM 70MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809580A	SUP	HCPCS C1713		8809580A  -  SCREW BN 9.5MM 80MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8809590A	SUP	HCPCS C1713		8809590A  -  SCREW BN 9.5MM 90MM PRCPT PA SPNE	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
8829-01	SUP	Custom 27203010		8829-01  -  PADDING CAST 36X21X.25IN ORTHOPEDIC LATEX FREE WHITE FELT	BOTH IP/OP	$17.45 	$12.91	$0.00	$14.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.95	$12.95	$0.00	$0.00	$3.64	$0.00	$0.00	$0.00	$0.00	$8.86	$14.03	$14.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
88-571042	SUP	HCPCS C1725		88-571042  -  CATH DRAIN 28FR 20IN ARG 6 EYLT RIGHT ANG THRMSNS DEPTH MARK	BOTH IP/OP	$182.39 	$134.97	$0.00	$145.91	$99.04	$99.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.20	$144.45	$145.91	$0.00		$0.00	$28.54	$0.00	$0.00	$29.04	$0.00	$0.00	$0.00	$0.00	$0.00
8872H	SUP	Custom 27203010		8872H  -  SUTURE NONABSORBABLE 3-0 RB-1 30IN MONOFILAMENT PROLENE BLUE	BOTH IP/OP	$337.65 	$249.86	$0.00	$274.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.60	$250.60	$0.00	$0.00	$70.37	$0.00	$0.00	$0.00	$0.00	$171.36	$271.43	$274.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8888146044P	SUP	HCPCS C1750		8888146044P  -  KIT CATHETER 61CM 44CM SYMMETRICAL TIP PALINDROME PRECISION	BOTH IP/OP	$500.00 	$370.00	$0.00	"$1,144.77"	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	"$1,144.77"	$400.00	$0.00		$0.00	$226.21	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
8900-2065	SUP	Custom 27203010		ELECTRODE DFBR PED MULFUNC PAD PDPDZ	BOTH IP/OP	$75.75 	$56.06	$0.00	$60.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.88	$59.99	$60.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8900-4003	SUP	Custom 27203010		8900-4003  -  ELECTRODE DEFIBRILLATOR RECTANGULAR 24IN MULTIFUNCTION CLOSE	BOTH IP/OP	$72.85 	$53.91	$0.00	$58.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.07	$54.07	$0.00	$0.00	$15.18	$0.00	$0.00	$0.00	$0.00	$36.42	$57.70	$58.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-120	SUP	Custom 27803010		890-120  -  CAGE SPNL 20MMX12MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-125	SUP	Custom 27803010		890-125  -  CAGE SPNL 25MMX12MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-140	SUP	Custom 27803010		890-140  -  CAGE SPNL 20MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-143	SUP	Custom 27803010		890-143  -  CAGE SPNL 23MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-146	SUP	Custom 27803010		890-146  -  CAGE SPNL 26MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-149	SUP	Custom 27803010		890-149  -  CAGE SPNL 29MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-160	SUP	Custom 27803010		890-160  -  CAGE SPNL 20MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-163	SUP	Custom 27803010		890-163  -  CAGE SPNL 23MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-166	SUP	Custom 27803010		890-166  -  CAGE SPNL 26MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-169	SUP	Custom 27803010		890-169  -  CAGE SPNL 29MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-180	SUP	Custom 27803010		890-180  -  CAGE SPNL 20MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-183	SUP	Custom 27803010		890-183  -  CAGE SPNL 23MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-186	SUP	Custom 27803010		890-186  -  CAGE SPNL 26MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-189	SUP	Custom 27803010		890-189  -  CAGE SPNL 29MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-200	SUP	Custom 27803010		890-200  -  CAGE SPNL 20MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-203	SUP	Custom 27803010		890-203  -  CAGE SPNL 23MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-206	SUP	Custom 27803010		890-206  -  CAGE SPNL 26MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-209	SUP	Custom 27803010		890-209  -  CAGE SPNL 29MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-220	SUP	Custom 27803010		890-220  -  CAGE SPNL 20MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-223	SUP	Custom 27803010		890-223  -  CAGE SPNL 23MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-226	SUP	Custom 27803010		890-226  -  CAGE SPNL 26MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-229	SUP	Custom 27803010		890-229  -  CAGE SPNL 29MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-240	SUP	Custom 27803010		890-240  -  CAGE SPNL 24MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-243	SUP	Custom 27803010		890-243  -  CAGE SPNL 24MMX23MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-244	SUP	HCPCS C1713		890-244  -  BONE 890-244 PRESS PLUG 12MM	BOTH IP/OP	$541.50 	$400.71	$0.00	$433.20	$243.68	$243.68	$0.00	$0.00	$0.00	$112.86	$401.90	$401.90	$0.00	$0.00	$112.85	$0.00	$320.30	$320.30	$0.00	$270.75	$428.87	$433.20	$0.00		$0.00	$84.74	$0.00	$0.00	$86.21	$0.00	$0.00	$0.00	$0.00	$0.00
890-246	SUP	Custom 27803010		890-246  -  CAGE SPNL 26MMX24MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-249	SUP	Custom 27803010		890-249  -  CAGE SPNL 29MMX24MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
890-444	SUP	HCPCS C1713		890-444  -  BONE 890-444 PRESS PLUG 14MM	BOTH IP/OP	$541.50 	$400.71	$0.00	$433.20	$243.68	$243.68	$0.00	$0.00	$0.00	$112.86	$401.90	$401.90	$0.00	$0.00	$112.85	$0.00	$320.30	$320.30	$0.00	$270.75	$428.87	$433.20	$0.00		$0.00	$84.74	$0.00	$0.00	$86.21	$0.00	$0.00	$0.00	$0.00	$0.00
890-999	SUP	HCPCS C1713		890-999  -  SCREW 890-999 LATERAL EXT. REPLACEMENT	BOTH IP/OP	$42.00 	$31.08	$0.00	$33.60	$18.90	$18.90	$0.00	$0.00	$0.00	$8.75	$31.17	$31.17	$0.00	$0.00	$8.75	$0.00	$24.84	$24.84	$0.00	$21.00	$33.26	$33.60	$0.00		$0.00	$6.57	$0.00	$0.00	$6.69	$0.00	$0.00	$0.00	$0.00	$0.00
89104EH	SUP	HCPCS C1713		89104EH  -  SCREW 89104EH  BREAK OFF SET  T25	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
89104EHT	SUP	HCPCS C1713		89104EHT  -  SET SCR CD HZN M10 BRKOF TI SPNE PDCL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
89-2505	SUP	Custom 27203010		89-2505  -  KIT SRG OB EMS	BOTH IP/OP	$19.18 	$14.19	$0.00	$15.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.23	$14.23	$0.00	$0.00	$4.00	$0.00	$0.00	$0.00	$0.00	$9.59	$15.19	$15.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941420P	SUP	Custom 27803010		8941420P  -  CAGE SPNL 14MM 20X17MM LTCG TI LMBR TPR FSN DEV	BOTH IP/OP	"$7,865.00 "	"$5,820.10"	$0.00	"$6,292.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,639.07"	$0.00	$0.00	$0.00	$0.00	"$3,932.50"	"$6,229.08"	"$6,292.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941423P	SUP	Custom 27803010		8941423P  -  CAGE SPNL 14MM 23X17.5MM LTCG PEEK-OPTM LMBR TPR FSN DEV	BOTH IP/OP	"$7,865.00 "	"$5,820.10"	$0.00	"$6,292.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,639.07"	$0.00	$0.00	$0.00	$0.00	"$3,932.50"	"$6,229.08"	"$6,292.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941620P	SUP	Custom 27803010		8941620P  -  CAGE SPNL 16MM 20X19MM LTCG PEEK-OPTM LMBR TPR FSN DEV	BOTH IP/OP	"$7,865.00 "	"$5,820.10"	$0.00	"$6,292.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,639.07"	$0.00	$0.00	$0.00	$0.00	"$3,932.50"	"$6,229.08"	"$6,292.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941623P	SUP	Custom 27803010		8941623P  -  CAGE SPNL 16MM 23X19MM LTCG TI LMBR TPR FSN DEV	BOTH IP/OP	"$7,865.00 "	"$5,820.10"	$0.00	"$6,292.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,639.07"	$0.00	$0.00	$0.00	$0.00	"$3,932.50"	"$6,229.08"	"$6,292.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941626P	SUP	Custom 27803010		8941626P  -  CAGE SPNL 16MM 26X20MM LTCG PEEK-OPTM LMBR TPR FSN DEV	BOTH IP/OP	"$7,865.00 "	"$5,820.10"	$0.00	"$6,292.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,639.07"	$0.00	$0.00	$0.00	$0.00	"$3,932.50"	"$6,229.08"	"$6,292.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941823P	SUP	Custom 27803010		8941823P  -  CAGE SPNL 18MM 23X21.5MM LTCG PEEK-OPTM LMBR TPR FSN DEV	BOTH IP/OP	"$7,865.00 "	"$5,820.10"	$0.00	"$6,292.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,639.07"	$0.00	$0.00	$0.00	$0.00	"$3,932.50"	"$6,229.08"	"$6,292.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8941826P	SUP	Custom 27803010		8941826P  -  CAGE SPNL 18MM 26X22MM LTCG PEEK-OPTM LMBR TPR FSN DEV	BOTH IP/OP	"$7,865.00 "	"$5,820.10"	$0.00	"$6,292.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,639.07"	$0.00	$0.00	$0.00	$0.00	"$3,932.50"	"$6,229.08"	"$6,292.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
89690E	SUP	Custom 27203010		89690E  -  INSTRUMENT 89690E IMP HLDR CURVD REDUCD	BOTH IP/OP	"$2,295.00 "	"$1,698.30"	$0.00	"$1,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,703.35"	"$1,703.35"	$0.00	$0.00	$478.28	$0.00	$0.00	$0.00	$0.00	"$1,147.50"	"$1,817.64"	"$1,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8AC50	SUP	Custom 27203010		8AC50  -  TOOL LEGEND 8CM 5MM AC	BOTH IP/OP	$320.88 	$237.45	$0.00	$256.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.15	$238.15	$0.00	$0.00	$66.87	$0.00	$0.00	$0.00	$0.00	$160.44	$254.14	$256.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8AC60	SUP	Custom 27203010		8AC60  -  TOOL LEGEND 8CM 6MM AC	BOTH IP/OP	$320.88 	$237.45	$0.00	$256.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.15	$238.15	$0.00	$0.00	$66.87	$0.00	$0.00	$0.00	$0.00	$160.44	$254.14	$256.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8DCFN	SUP	Custom 27203010		8DCFN  -  TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUFLS DISP INR	BOTH IP/OP	$83.74 	$61.97	$0.00	$66.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.15	$62.15	$0.00	$0.00	$17.45	$0.00	$0.00	$0.00	$0.00	$41.87	$66.32	$66.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8DCFS	SUP	Custom 27203010		8DCFS  -  TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUFLS DISP INR	BOTH IP/OP	$88.58 	$65.55	$0.00	$71.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.74	$65.74	$0.00	$0.00	$18.46	$0.00	$0.00	$0.00	$0.00	$44.95	$71.20	$71.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8DCT	SUP	Custom 27203010		8DCT  -  TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUF DISP INR CNN	BOTH IP/OP	$117.10 	$86.65	$0.00	$76.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.53	$69.53	$0.00	$0.00	$19.52	$0.00	$0.00	$0.00	$0.00	$47.54	$75.30	$76.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8DFEN	SUP	Custom 27203010		8DFEN  -  TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUF DISP INR CNN	BOTH IP/OP	$99.43 	$73.58	$0.00	$80.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.79	$73.79	$0.00	$0.00	$20.72	$0.00	$0.00	$0.00	$0.00	$50.46	$79.93	$80.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8LGT	SUP	Custom 27203010		8LGT  -  TUBE TRACHEOSTOMY 8 12.6MM 15MM 7.6MM 50MM CUFFLESS	BOTH IP/OP	$114.73 	$84.90	$0.00	$93.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.15	$85.15	$0.00	$0.00	$23.91	$0.00	$0.00	$0.00	$0.00	$58.22	$92.23	$93.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8LGT	SUP	Custom 27203010		TUBE 50MM 7.6MM UNCUF LRNTMY SHLY TRCH 8 STRL LF DISP	BOTH IP/OP	$114.73 	$84.90	$0.00	$95.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.15	$85.15	$0.00	$0.00	$23.91	$0.00	$0.00	$0.00	$0.00	$58.22	$95.02	$93.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8MH22D	SUP	Custom 27203010		8MH22D  -  TOOL LEGEND 8CM 1.7 MH DIAM	BOTH IP/OP	$295.38 	$218.58	$0.00	$236.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.23	$219.23	$0.00	$0.00	$61.56	$0.00	$0.00	$0.00	$0.00	$147.69	$233.94	$236.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8SCT	SUP	Custom 27203010		8SCT  -  TUBE TRACHEOSTOMY 8 10.9MM 8MM 89MM 1 CANNU CUFF SMOOTH	BOTH IP/OP	$71.38 	$52.82	$0.00	$57.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.97	$52.97	$0.00	$0.00	$14.87	$0.00	$0.00	$0.00	$0.00	$36.22	$57.38	$57.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TA17	SUP	Custom 27203010		8TA17  -  TOOL LEGEND 8CM 1.7MM TA	BOTH IP/OP	$265.63 	$196.57	$0.00	$212.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.15	$197.15	$0.00	$0.00	$55.36	$0.00	$0.00	$0.00	$0.00	$132.81	$210.38	$212.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD084	SUP	Custom 27203010		8TD084  -  TOOL LEGND 8CM 8MM 4MM DEPTH TWST	BOTH IP/OP	$388.88 	$287.77	$0.00	$311.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$288.62	$288.62	$0.00	$0.00	$81.04	$0.00	$0.00	$0.00	$0.00	$194.44	$307.99	$311.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD104	SUP	Custom 27203010		8TD104  -  TOOL LEGEND 8CM 1MM 4MM DEPTH TD	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD114	SUP	Custom 27203010		8TD114  -  TOOL LEGEND 8CM 1.1MM 4MM TD	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD116	SUP	Custom 27203010		8TD116  -  TOOL LEGEND 8CM 1.1MM 6MM DEPTH	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD124	SUP	Custom 27203010		8TD124  -  TOOL LEGEND 8CM 1.2MM 4MM DEPTH	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD126	SUP	Custom 27203010		8TD126  -  TOOL LEGEND 8CM 1.2MM 6MM DEPTH	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD134	SUP	Custom 27203010		8TD134  -  TOOL LEGEND 8CM 1.3MM 4MM DEPTH	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD136	SUP	Custom 27203010		8TD136  -  TOOL LEGEND 8CM 1.3MM 6MM DEPTH	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD154	SUP	Custom 27203010		8TD154  -  TOOL LEGEND 8CM 1.5MM 4MM DEPTH	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD156	SUP	Custom 27203010		8TD156  -  TOOL LEGEND 8CM 1.5MM 6MM DEPTH	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD158	SUP	Custom 27203010		8TD158  -  TOOL LEGEND 8CM 1.5MM 8MM DEPTH	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD174	SUP	Custom 27203010		8TD174  -  TOOL LEGEND 8CM 1.7MM 4MM DEPTH	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD176	SUP	Custom 27203010		8TD176  -  TOOL LEGEND 8CM 1.7MM 6MM DEPTH	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD178	SUP	Custom 27203010		8TD178  -  TOOL LEGEND 8CM 1.7MM 8MM DEPTH	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD204	SUP	Custom 27203010		8TD204  -  TOOL LEGEND 8CM 2MM 4MM DEPTH TD	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD206	SUP	Custom 27203010		8TD206  -  TOOL LEGEND 8CM 2MM 6 MM DEPTH TD	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
8TD208	SUP	Custom 27203010		8TD208  -  TOOL LEGEND 8CM 2MM 8MM DEPTH TD	BOTH IP/OP	$240.13 	$177.70	$0.00	$192.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.22	$178.22	$0.00	$0.00	$50.04	$0.00	$0.00	$0.00	$0.00	$120.06	$190.18	$192.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9001G	SUP	Custom 27203010		9001G  -  SUTURE NONABSORBABLE 10-0 CS160-6 6IN 2 ARM MONOFILAMENT	BOTH IP/OP	$48.64 	$35.99	$0.00	$38.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.10	$36.10	$0.00	$0.00	$10.14	$0.00	$0.00	$0.00	$0.00	$24.32	$38.52	$38.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9001-VC-005	SUP	Custom 27203010		9001-VC-005  -  NEEDLE BAND PRC WRST	BOTH IP/OP	$275.00 	$203.50	$0.00	$204.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9003 B	SUP	Custom 27803010		9003 B  -  KIT 9003 B INTL ONLY SHUNT CONT SM ME	BOTH IP/OP	$859.75 	$636.22	$0.00	$687.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$638.11	$638.11	$0.00	$0.00	$179.17	$0.00	$0.00	$0.00	$0.00	$429.88	$680.92	$687.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900-601	SUP	HCPCS C1769		900-601  -  GWIRE ORTH 150MM 1.6MM DRILL TIP NONSTRL	BOTH IP/OP	$108.65 	$80.40	$0.00	$86.92	$59.00	$59.00	$0.00	$0.00	$0.00	$22.65	$80.64	$80.64	$0.00	$0.00	$22.64	$0.00	$64.27	$64.27	$0.00	$54.33	$86.05	$86.92	$0.00		$0.00	$17.00	$0.00	$0.00	$17.30	$0.00	$0.00	$0.00	$0.00	$0.00
9007 H	SUP	Custom 27803010		9007 H  -  CATH 9007 H C/P STD W/CLOS PRESS-HIGH	BOTH IP/OP	$605.63 	$448.17	$0.00	$484.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.49	$449.49	$0.00	$0.00	$126.21	$0.00	$0.00	$0.00	$0.00	$302.81	$479.66	$484.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9007 L	SUP	Custom 27803010		9007 L  -  CATH 9007 L C/P STD W/CLOS PRESS-LOW	BOTH IP/OP	$605.63 	$448.17	$0.00	$484.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.49	$449.49	$0.00	$0.00	$126.21	$0.00	$0.00	$0.00	$0.00	$302.81	$479.66	$484.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9007 M	SUP	Custom 27803010		9007 M  -  CATH 9007 M C/P STD W/CLOS PRESS-MED	BOTH IP/OP	$605.63 	$448.17	$0.00	$484.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.49	$449.49	$0.00	$0.00	$126.21	$0.00	$0.00	$0.00	$0.00	$302.81	$479.66	$484.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9009 B-H	SUP	Custom 27803010		9009 B-H  -  SHUNT 9009 B-H ASSY SM HI W/PERT OPN-90	BOTH IP/OP	"$2,657.63 "	"$1,966.65"	$0.00	"$2,126.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,972.49"	"$1,972.49"	$0.00	$0.00	$553.85	$0.00	$0.00	$0.00	$0.00	"$1,328.81"	"$2,104.84"	"$2,126.10"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9009 B-L	SUP	Custom 27803010		9009 B-L  -  SHUNT 9009 B-L ASSY SM LO W/PERT OPN-90	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9009 B-M	SUP	Custom 27803010		9009 B-M  -  SHNT 9009 B-M ASSY SM MED W/PERT OPN-90	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
900MR869	SUP	Custom 27203010		PROBE DUAL ARWY THRMTR 90D 60IN MR850 HMDF	BOTH IP/OP	$334.38 	$247.44	$0.00	$267.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.19	$264.83	$267.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
901-118	SUP	Custom 27803010		901-118  -  SHUNT NS INTRO PRTNL	BOTH IP/OP	$127.00 	$93.98	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.26	$94.26	$0.00	$0.00	$26.47	$0.00	$0.00	$0.00	$0.00	$63.50	$100.58	$101.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90129-203	SUP	HCPCS C1874		90129-203  -  STENT TRCHBR LOPRFL 18MM 22FR 56MM NS AERO OTW FULL CVR FLXB	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-204	SUP	HCPCS C1874		90129-204  -  STENT TRCHBR GMTR 16MM 22FR 40MM NS 61CM AERO OTW FLLY CVR	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-206	SUP	HCPCS C1874		90129-206  -  STENT TRCHBR LOPRFL 16MM 22FR 56MM NS AERO OTW FULL CVR FLXB	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-207	SUP	HCPCS C1874		90129-207  -  STENT TRCHBR GMTR 10MM 16FR 20MM NS 63CM AERO OTW FLLY CVR	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-209	SUP	HCPCS C1874		90129-209  -  STENT TRCHBR GMTR 10MM 16FR 40MM NS 61CM AERO OTW FLLY CVR	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-210	SUP	HCPCS C1874		90129-210  -  STENT TRCHBR 12MM 16FR 20MM 63CM AERO FLLY CVR ANTIMIGRATION	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-211	SUP	HCPCS C1874		90129-211  -  STENT TRCHBR GMTR 12MM 16FR 30MM NS 62CM AERO OTW FLLY CVR	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-213	SUP	HCPCS C1874		90129-213  -  STENT TRCHBR GMTR 14MM 16FR 20MM NS 63CM AERO OTW FLLY CVR	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-214	SUP	HCPCS C1874		90129-214  -  STENT TRCHBR GMTR 14MM 16FR 30MM NS 62CM AERO OTW FLLY CVR	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-215	SUP	HCPCS C1874		90129-215  -  STENT TRCHBR GMTR 14MM 16FR 40MM NS 61CM AERO OTW FLLY CVR	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-216	SUP	HCPCS C1874		90129-216  -  STENT TRCHBR GMTR 20MM 22FR 40MM NS 61CM AERO OTW FLLY CVR	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-217	SUP	HCPCS C1874		90129-217  -  STENT TRCHBR 20MM 60MM AERO OTW FLLY COVERED	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-218	SUP	HCPCS C1874		90129-218  -  STENT TRCH 20MM 80MM AERO FLLY COVERED	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
90129-301	SUP	HCPCS C1874		90129-301  -  STENT TRCHBR 18MM 40MM AERO DV FLLY COVERED DRCT VIS SYS	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-302	SUP	HCPCS C1874		90129-302  -  STENT TRCHBR 18MM 60MM AERO DV FLLY COVERED DRCT VIS SYS	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-303	SUP	HCPCS C1874		90129-303  -  STENT TRCHBR 18MM 80MM AERO DV FLLY COVERED DRCT VSN DLV SYS	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-304	SUP	HCPCS C1874		90129-304  -  STENT TRCHBR 16MM 30MM 40MM 39MM AERO OTW DRCT VIS NOVEL	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-305	SUP	HCPCS C1874		90129-305  -  STENT TRCHBR 16MM 60MM AERO FLLY COVERED PURSE STNG DRCT VIS	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-306	SUP	HCPCS C1874		90129-306  -  STENT TRCHBR 16MM 80MM AERO DV FLLY COVERED DRCT VSN DLV SYS	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-310	SUP	HCPCS C1874		90129-310  -  STENT TRCHBR 12MM 20MM AERO DV FLLY COVERED DRCT VSN DLV SYS	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-311	SUP	HCPCS C1874		90129-311  -  STENT TRCHBR GMTR LOPRFL 12MM 28FR 30MM 40CM AERO FULL CVR	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-312	SUP	HCPCS C1874		90129-312  -  STENT TRCHBR GMTR LOPRFL 28FR 12MM 40MM 39CM AERO FULL CVR	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-313	SUP	HCPCS C1874		90129-313  -  STENT TRCHBR 14MM 20MM AERO DV FLLY COVERED DRCT VSN DLV SYS	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-314	SUP	HCPCS C1874		90129-314  -  STENT TRCHBR 14MM 30MM AERO DV FLLY COVERED DRCT VIS SYS	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-315	SUP	HCPCS C1874		90129-315  -  STENT TRCHBR 14MM 40MM AERO FLLY COVERED PURSE STNG DRCT VIS	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-316	SUP	HCPCS C1874		90129-316  -  STENT TRCHBR 20MM 40MM AERO DV FLLY COVERED DRCT VIS SYS	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-317	SUP	HCPCS C1874		90129-317  -  STENT TRCHBR 20MM 60MM AERO DV FLLY COVERED DRCT VIS SYS	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-318	SUP	HCPCS C1874		90129-318  -  STENT TRCHBR 20MM 80MM AERO DV FLLY COVERED DRCT VIS SYS	BOTH IP/OP	"$5,750.00 "	"$4,255.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,198.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,198.30"	$0.00	"$2,834.75"	"$2,834.75"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
90129-501	SUP	HCPCS C1874		90129-501  -  SIZER SRG AEROSIZER STNT MSR DEV	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$168.75	$168.75	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9013 A	SUP	Custom 27803010		9013 A  -  RESERVOIR 9013 A VENT 12MM CONVT IC 50MM	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9013 B	SUP	Custom 27803010		9013 B  -  RESERVOIR 9013 B VENT 12MM CONVT IC 60MM	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9013 F	SUP	Custom 27803010		9013 F  -  RESERVOIR 9013 F VENT 12MM CONVT IC 7CM	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9013 G	SUP	Custom 27803010		9013 G  -  RESERVOIR 9013 G VENT 12MM CONVT IC 8CM	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$0.00	$0.00	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
903016A	SUP	HCPCS C1729		903016A  -  TRAY CATH BDX IC CMP CR 16FR 350ML FOLEY URMTR ANTIINFECTIVE	BOTH IP/OP	$24.95 	$18.46	$0.00	$19.96	$13.55	$13.55	$0.00	$0.00	$0.00	$5.20	$18.52	$18.52	$0.00	$0.00	$5.20	$0.00	$14.76	$14.76	$0.00	$12.48	$19.76	$19.96	$0.00		$0.00	$3.91	$0.00	$0.00	$3.97	$0.00	$0.00	$0.00	$0.00	$0.00
903018A	SUP	HCPCS C1729		TRAY CATH LBRCTH 18FR 350ML FOLEY URMTR	BOTH IP/OP	$41.48 	$30.70	$0.00	$33.18	$22.52	$22.52	$0.00	$0.00	$0.00	$8.64	$30.78	$30.78	$0.00	$0.00	$8.64	$0.00	$24.53	$24.53	$0.00	$20.74	$32.85	$33.18	$0.00		$0.00	$6.49	$0.00	$0.00	$6.60	$0.00	$0.00	$0.00	$0.00	$0.00
9032G	SUP	Custom 27203010		9032G  -  SUTURE NONABSORBABLE 10-0 CS175-8 12IN 2 ARM MONOFILAMENT	BOTH IP/OP	$42.97 	$31.80	$0.00	$34.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.89	$31.89	$0.00	$0.00	$8.95	$0.00	$0.00	$0.00	$0.00	$21.81	$34.54	$34.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9040 R	SUP	Custom 27803010		9040 R  -  KIT 9040 R SHUNT CSF BH MED SML CATHS	BOTH IP/OP	$859.75 	$636.22	$0.00	$687.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$638.11	$638.11	$0.00	$0.00	$179.17	$0.00	$0.00	$0.00	$0.00	$429.88	$680.92	$687.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9042 A	SUP	HCPCS C1894		9042 A  -  VAD 9042 A 12MM CONVT 50MM-INTRODUCER	BOTH IP/OP	"$1,223.13 "	$905.12	$0.00	$978.50	$664.16	$664.16	$0.00	$0.00	$0.00	$254.93	$907.80	$907.80	$0.00	$0.00	$254.90	$0.00	$723.48	$723.48	$0.00	$611.56	$968.72	$978.50	$0.00		$0.00	$191.42	$0.00	$0.00	$194.72	$0.00	$0.00	$0.00	$0.00	$0.00
9042 B	SUP	HCPCS C1894		9042 B  -  VAD 9042 B 12MM CONVT 60MM-INTRODUCER	BOTH IP/OP	"$1,223.13 "	$905.12	$0.00	$978.50	$664.16	$664.16	$0.00	$0.00	$0.00	$254.93	$907.80	$907.80	$0.00	$0.00	$254.90	$0.00	$723.48	$723.48	$0.00	$611.56	$968.72	$978.50	$0.00		$0.00	$191.42	$0.00	$0.00	$194.72	$0.00	$0.00	$0.00	$0.00	$0.00
9042 D	SUP	HCPCS C1894		9042 D  -  VAD 9042 D 12MM CONVT 40MM-INTRODUCER	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$568.72	$568.72	$0.00	$0.00	$0.00	$218.30	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$619.52	$619.52	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$163.91	$0.00	$0.00	$166.74	$0.00	$0.00	$0.00	$0.00	$0.00
9042 G	SUP	HCPCS C1894		9042 G  -  VAD 9042 G 12MM CONVT 35MM-INTRODUCER	BOTH IP/OP	"$1,047.38 "	$775.06	$0.00	$837.90	$568.72	$568.72	$0.00	$0.00	$0.00	$218.30	$777.36	$777.36	$0.00	$0.00	$218.27	$0.00	$619.52	$619.52	$0.00	$523.69	$829.52	$837.90	$0.00		$0.00	$163.91	$0.00	$0.00	$166.74	$0.00	$0.00	$0.00	$0.00	$0.00
9046 B-H	SUP	Custom 27803010		9046 B-H  -  SHUNT 9046 B-H ASSY REG HIGH PERIT 90CM	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9046 B-L	SUP	Custom 27803010		9046 B-L  -  SHUNT 9046 B-L ASSY REG LOW PERIT-90CM	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9046 B-M	SUP	Custom 27803010		9046 B-M  -  SHUNT 9046 B-M ASSY REG MED PERIT-90CM	BOTH IP/OP	"$2,498.50 "	"$1,848.89"	$0.00	"$1,998.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,854.39"	"$1,854.39"	$0.00	$0.00	$520.69	$0.00	$0.00	$0.00	$0.00	"$1,249.25"	"$1,978.81"	"$1,998.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
905-101	SUP	HCPCS C1781		905-101  -  MESH 905-101  PYRM 10MM X 100MM ROUND	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
905-103	SUP	HCPCS C1781		905-103  -  CAGE SPNL RND 10MM 30MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-107	SUP	HCPCS C1781		905-107  -  MESH 905-107  PYRM 10MM X 70MM ROUND	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
905-108	SUP	HCPCS C1781		905-108  -  CAGE SPNL RND 10MM 8MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-110	SUP	HCPCS C1781		905-110  -  CAGE SPNL RND 10MM 10MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-112	SUP	HCPCS C1781		905-112  -  CAGE SPNL RND 10MM 12MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-115	SUP	HCPCS C1781		905-115  -  CAGE SPNL RND 10MM 15MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-133	SUP	HCPCS C1781		905-133  -  CAGE SPNL RND 13MM 30MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-137	SUP	HCPCS C1781		905-137  -  MESH 905-137  PYRM 13MM X 70MM ROUND	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
905-139	SUP	HCPCS C1781		905-139  -  CAGE SPNL RND 13MM 9MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-161	SUP	HCPCS C1781		905-161  -  CAGE SPNL RND 16MM 10MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-163	SUP	HCPCS C1781		905-163  -  CAGE SPNL RND 16MM 30MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-166	SUP	HCPCS C1781		905-166  -  MESH 905-166  PYRM 16MM X 60MM ROUND	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
905-194	SUP	Custom 27803010		905-194  -  CAGE SPNL RND 19MM 40MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	$0.00	$0.00	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
905-199	SUP	HCPCS C1781		905-199  -  CAGE SPNL RND 19MM 90MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
905-251	SUP	HCPCS C1781		905-251  -  MESH 905-251  PYRM 25MM X 100MM ROUND	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
905-255	SUP	HCPCS C1781		905-255  -  MESH 905-255  PYRM 25MM ROUND X 10X15HGT	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-256	SUP	Custom 27803010		905-256  -  CAGE SPNL 60MMX25MM PRMSH TI RND MESH	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	$0.00	$0.00	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
905-299	SUP	HCPCS C1781		905-299  -  MESH 905-299  PYRM 19MM X ROUND END CAP	BOTH IP/OP	$858.00 	$634.92	$0.00	$686.40	$386.10	$386.10	$0.00	$0.00	$0.00	$178.83	$636.81	$636.81	$0.00	$0.00	$178.81	$0.00	$507.51	$507.51	$0.00	$429.00	$679.54	$686.40	$0.00		$0.00	$134.28	$0.00	$0.00	$136.59	$0.00	$0.00	$0.00	$0.00	$0.00
905-308	SUP	HCPCS C1781		905-308  -  CAGE SPNL RND 13MM 8MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-309	SUP	HCPCS C1781		905-309  -  MESH 905-309  PYRM 25MM X 100MM ROUND	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
905-310	SUP	HCPCS C1781		905-310  -  CAGE SPNL RND 13MM 10MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-311	SUP	HCPCS C1781		905-311  -  MESH 905-311  PYRM  13MM X 11MM ROUND	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-312	SUP	HCPCS C1781		905-312  -  MESH 905-312  PYRM  13MM X 12MM ROUND	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-313	SUP	HCPCS C1781		905-313  -  MESH 905-313  PYRM  13MM X 13MM ROUND	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-320	SUP	HCPCS C1781		905-320  -  MESH 905-320  PYRM  13MM X 20MM ROUND	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-399	SUP	HCPCS C1781		905-399  -  MESH 905-399  PYRM 25MM ROUND END CAP	BOTH IP/OP	$858.00 	$634.92	$0.00	$686.40	$386.10	$386.10	$0.00	$0.00	$0.00	$178.83	$636.81	$636.81	$0.00	$0.00	$178.81	$0.00	$507.51	$507.51	$0.00	$429.00	$679.54	$686.40	$0.00		$0.00	$134.28	$0.00	$0.00	$136.59	$0.00	$0.00	$0.00	$0.00	$0.00
905-401	SUP	HCPCS C1781		905-401  -  MESH SRG OVOID 14X10X10MM PRMSH	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-403	SUP	HCPCS C1781		905-403  -  CAGE SPNL OVOID 14X10X30MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-407	SUP	HCPCS C1781		905-407  -  MESH 905-407  PYRM 10X14X70 OVOID	BOTH IP/OP	"$12,604.58 "	"$9,327.39"	$0.00	"$10,083.66"	"$5,672.06"	"$5,672.06"	$0.00	$0.00	$0.00	"$2,627.11"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,626.79"	$0.00	"$6,214.06"	"$6,214.06"	$0.00	"$6,302.29"	"$9,982.83"	"$10,083.66"	$0.00		$0.00	"$1,972.62"	$0.00	$0.00	"$2,006.65"	$0.00	$0.00	$0.00	$0.00	$0.00
905-408	SUP	HCPCS C1781		905-408  -  CAGE SPNL OVOID 14X10X8MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-409	SUP	HCPCS C1781		905-409  -  MESH 905-409  PYRM  10 X 14 OVOID X 9MM	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-411	SUP	HCPCS C1781		905-411  -  MESH 905-411  PYRM  10 X 14 OVOID X 11MM	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-412	SUP	HCPCS C1781		905-412  -  MESH 905-412  PYRM  10 X 14 OVOID X 12MM	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-415	SUP	HCPCS C1781		905-415  -  MESH 905-415  PYRM  10 X 14 OVOID X 15MM	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-501	SUP	HCPCS C1781		905-501  -  MESH 905-501  PYRM 13 X17 X 10 OVOID	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-508	SUP	HCPCS C1781		905-508  -  MESH 905-508  PYRM  13 X 17 OVOID X 8MM	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-509	SUP	HCPCS C1781		905-509  -  MESH 905-509  PYRM  13 X 17 OVOID X 9MM	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-511	SUP	HCPCS C1781		905-511  -  MESH 905-511  PYRM  13 X 17 OVOID X 11MM	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-512	SUP	HCPCS C1781		905-512  -  MESH 905-512  PYRM  13 X 17 OVOID X 12MM	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-515	SUP	HCPCS C1781		905-515  -  MESH 905-515  PYRM  13 X 17 OVOID X 15MM	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-520	SUP	HCPCS C1781		905-520  -  MESH 905-520  PYRM  13 X 17 OVOID X 20MM	BOTH IP/OP	"$7,138.60 "	"$5,282.56"	$0.00	"$5,710.88"	"$3,212.37"	"$3,212.37"	$0.00	$0.00	$0.00	"$1,487.86"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,487.68"	$0.00	"$3,519.33"	"$3,519.33"	$0.00	"$3,569.30"	"$5,653.77"	"$5,710.88"	$0.00		$0.00	"$1,117.19"	$0.00	$0.00	"$1,136.47"	$0.00	$0.00	$0.00	$0.00	$0.00
905-608	SUP	HCPCS C1781		905-608  -  MESH 905-608  PYRM  16MM X 8MM ROUND	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-609	SUP	HCPCS C1781		905-609  -  MESH 905-609  PYRM  16MM X 9MM ROUND	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-611	SUP	HCPCS C1781		905-611  -  MESH 905-611  PYRM  16MM X 11MM ROUND	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-612	SUP	HCPCS C1781		905-612  -  MESH 905-612  PYRM  16MM X 12MM ROUND	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-615	SUP	HCPCS C1781		905-615  -  MESH 905-615  PYRM  16MM X 15MM ROUND	BOTH IP/OP	"$3,513.85 "	"$2,600.25"	$0.00	"$2,811.08"	"$1,581.23"	"$1,581.23"	$0.00	$0.00	$0.00	$732.37	"$2,607.98"	"$2,607.98"	$0.00	$0.00	$732.29	$0.00	"$1,732.33"	"$1,732.33"	$0.00	"$1,756.93"	"$2,782.97"	"$2,811.08"	$0.00		$0.00	$549.92	$0.00	$0.00	$559.40	$0.00	$0.00	$0.00	$0.00	$0.00
905-800	SUP	HCPCS C1781		905-800  -  MESH 905-800  PYRM END RING SET SCRW	BOTH IP/OP	$81.25 	$60.13	$0.00	$65.00	$36.56	$36.56	$0.00	$0.00	$0.00	$16.93	$60.30	$60.30	$0.00	$0.00	$16.93	$0.00	$48.06	$48.06	$0.00	$40.63	$64.35	$65.00	$0.00		$0.00	$12.72	$0.00	$0.00	$12.94	$0.00	$0.00	$0.00	$0.00	$0.00
905-810	SUP	Custom 27203010		905-810  -  INSTRUMENT 905-810 MESH HOLDER STRAIGHT	BOTH IP/OP	"$1,486.50 "	"$1,100.01"	$0.00	"$1,189.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,103.28"	"$1,103.28"	$0.00	$0.00	$309.79	$0.00	$0.00	$0.00	$0.00	$743.25	"$1,177.31"	"$1,189.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
905-815	SUP	Custom 27203010		905-815  -  INSTRUMENT 905-815 MESH HOLDER SMALL	BOTH IP/OP	"$1,486.50 "	"$1,100.01"	$0.00	"$1,189.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,103.28"	"$1,103.28"	$0.00	$0.00	$309.79	$0.00	$0.00	$0.00	$0.00	$743.25	"$1,177.31"	"$1,189.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
905-820	SUP	Custom 27203010		905-820  -  INSTRUMENT 905-820 MESH ACTOR STRAIGHT	BOTH IP/OP	"$1,461.00 "	"$1,081.14"	$0.00	"$1,168.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,084.35"	"$1,084.35"	$0.00	$0.00	$304.47	$0.00	$0.00	$0.00	$0.00	$730.50	"$1,157.11"	"$1,168.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
905-825	SUP	Custom 27203010		905-825  -  INSTRUMENT 905-825 ANGLED MESH IMPACTOR	BOTH IP/OP	"$1,461.00 "	"$1,081.14"	$0.00	"$1,168.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,084.35"	"$1,084.35"	$0.00	$0.00	$304.47	$0.00	$0.00	$0.00	$0.00	$730.50	"$1,157.11"	"$1,168.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
905-830	SUP	Custom 27203010		905-830  -  INSTRUMENT 905-830 MESH TRIMMER	BOTH IP/OP	"$2,518.50 "	"$1,863.69"	$0.00	"$2,014.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,869.23"	"$1,869.23"	$0.00	$0.00	$524.86	$0.00	$0.00	$0.00	$0.00	"$1,259.25"	"$1,994.65"	"$2,014.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
905-880	SUP	Custom 27203010		905-880  -  INSTRUMENT 905-880 END RING DRVR	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$0.00	$0.00	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
905-901	SUP	HCPCS C1781		905-901  -  MESH 905-901  PYRM 13MM X 130MM CURVED	BOTH IP/OP	"$16,827.60 "	"$12,452.42"	$0.00	"$13,462.08"	"$7,572.42"	"$7,572.42"	$0.00	$0.00	$0.00	"$3,507.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,506.87"	$0.00	"$8,296.01"	"$8,296.01"	$0.00	"$8,413.80"	"$13,327.46"	"$13,462.08"	$0.00		$0.00	"$2,633.52"	$0.00	$0.00	"$2,678.95"	$0.00	$0.00	$0.00	$0.00	$0.00
905-902	SUP	HCPCS C1781		905-902  -  MESH 905-902  PYRM 10X14 OVOIDX130MM CRV	BOTH IP/OP	"$16,827.60 "	"$12,452.42"	$0.00	"$13,462.08"	"$7,572.42"	"$7,572.42"	$0.00	$0.00	$0.00	"$3,507.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,506.87"	$0.00	"$8,296.01"	"$8,296.01"	$0.00	"$8,413.80"	"$13,327.46"	"$13,462.08"	$0.00		$0.00	"$2,633.52"	$0.00	$0.00	"$2,678.95"	$0.00	$0.00	$0.00	$0.00	$0.00
905-903	SUP	HCPCS C1781		905-903  -  CAGE SPNL ANG 19MM 150MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$16,827.60 "	"$12,452.42"	$0.00	"$13,462.08"	"$7,572.42"	"$7,572.42"	$0.00	$0.00	$0.00	"$3,507.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,506.87"	$0.00	"$8,296.01"	"$8,296.01"	$0.00	"$8,413.80"	"$13,327.46"	"$13,462.08"	$0.00		$0.00	"$2,633.52"	$0.00	$0.00	"$2,678.95"	$0.00	$0.00	$0.00	$0.00	$0.00
905-904	SUP	HCPCS C1781		905-904  -  CAGE SPNL ANG 25MM 150MM PRMSH MESH TI LMBR INTRBD FS	BOTH IP/OP	"$16,827.60 "	"$12,452.42"	$0.00	"$13,462.08"	"$7,572.42"	"$7,572.42"	$0.00	$0.00	$0.00	"$3,507.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,506.87"	$0.00	"$8,296.01"	"$8,296.01"	$0.00	"$8,413.80"	"$13,327.46"	"$13,462.08"	$0.00		$0.00	"$2,633.52"	$0.00	$0.00	"$2,678.95"	$0.00	$0.00	$0.00	$0.00	$0.00
907-1080011	SUP	Custom 27203010		BRACE ORTH BGE 10.5IN SM RT WRST SPRT 11425-55	BOTH IP/OP	$27.50 	$20.35	$0.00	$22.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.75	$21.78	$22.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
909-145	SUP	Custom 27203010		909-145  -  PIN 14MM DSTRCT	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$0.00	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9091G	SUP	Custom 27203010		9091G  -  SUTURE NABSB 10-0 CTC-6L 4IN BLU PRLN HMSL ULT 2 ARM MFL	BOTH IP/OP	$73.45 	$54.35	$0.00	$59.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.51	$54.51	$0.00	$0.00	$15.31	$0.00	$0.00	$0.00	$0.00	$37.27	$59.04	$59.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91-1504	SUP	HCPCS C1713		91-1504  -  SCREW BONE 1.5MM 4MM SLFTAP HIGH TORQUE CROSS DRIVE GOLD	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
91-1505	SUP	HCPCS C1713		91-1505  -  SCREW BONE 1.5MM 5MM SLFTAP HIGH TORQUE CROSS DRIVE GOLD	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
91-1506	SUP	HCPCS C1713		91-1506  -  SCREW BONE 1.5MM 6MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
91-1507	SUP	HCPCS C1713		91-1507  -  SCREW BONE 1.5MM 7MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
91-1508	SUP	HCPCS C1713		91-1508  -  SCREW TI 8MM 1.5MM MANDIB XDR HTORQ BONE CD	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$63.00	$63.00	$0.00	$0.00	$0.00	$29.18	$103.91	$103.91	$0.00	$0.00	$29.18	$0.00	$82.81	$82.81	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$21.91	$0.00	$0.00	$22.29	$0.00	$0.00	$0.00	$0.00	$0.00
91-1509	SUP	HCPCS C1713		91-1509  -  SCREW BONE 1.5MM 9MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
91-1511	SUP	HCPCS C1713		91-1511  -  SCREW BONE 1.5MM 11MM HIGH TORQUE CROSS DRIVE TITANIUM	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
91-1513	SUP	HCPCS C1713		91-1513  -  SCREW BONE 1.5MM 13MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
91-1515	SUP	HCPCS C1713		91-1515  -  SCREW BONE 1.5MM 15MM HIGH TORQUE CROSS DRIVE TITANIUM	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
91-1805	SUP	HCPCS C1713		91-1805  -  SCREW BONE 1.8MM 5MM EMERGENCY SELF TAP HIGH TORQUE CROSS	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$110.25	$110.25	$0.00	$0.00	$0.00	$51.06	$181.84	$181.84	$0.00	$0.00	$51.06	$0.00	$144.92	$144.92	$0.00	$122.50	$194.04	$196.00	$0.00		$0.00	$38.34	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00
91-1807	SUP	HCPCS C1713		91-1807  -  SCREW BONE 1.8MM 7MM EMERGENCY HIGH TORQUE CROSS DRIVE	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$110.25	$110.25	$0.00	$0.00	$0.00	$51.06	$181.84	$181.84	$0.00	$0.00	$51.06	$0.00	$144.92	$144.92	$0.00	$122.50	$194.04	$196.00	$0.00		$0.00	$38.34	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00
91-1809	SUP	HCPCS C1713		91-1809  -  SCREW TI 9MM 1.8MM MANDIB ER XDR HTORQ BONE CD	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$63.00	$63.00	$0.00	$0.00	$0.00	$29.18	$103.91	$103.91	$0.00	$0.00	$29.18	$0.00	$82.81	$82.81	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$21.91	$0.00	$0.00	$22.29	$0.00	$0.00	$0.00	$0.00	$0.00
91500V	SUP	Custom 27203010		91500V  -  APPLIER ENDOSCOPIC MED LARGE  STRAIGHT 18INźź	BOTH IP/OP	"$2,773.73 "	"$2,052.56"	$0.00	"$2,218.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,058.66"	"$2,058.66"	$0.00	$0.00	$578.04	$0.00	$0.00	$0.00	$0.00	"$1,386.86"	"$2,196.79"	"$2,218.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91501V	SUP	Custom 27203010		91501V  -  CLIP INTNL ENDO REMOVER MED LARGE - LARGE  STRAIGHT 18INźź	BOTH IP/OP	"$2,249.98 "	"$1,664.99"	$0.00	"$1,799.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.93"	"$1,669.93"	$0.00	$0.00	$468.89	$0.00	$0.00	$0.00	$0.00	"$1,124.99"	"$1,781.98"	"$1,799.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
915-3100	SUP	Custom 27803010		915-3100  -  PIN FIX HEAT CONTOURING PEN LACTOSORB STERILE	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91-5607	SUP	HCPCS C1713		91-5607  -  SCREW BONE 2MM 7MM SELF DRILL TRAUMAONE LORENZ BLUE MANDIB	BOTH IP/OP	$435.00 	$321.90	$0.00	$348.00	$195.75	$195.75	$0.00	$0.00	$0.00	$90.66	$322.86	$322.86	$0.00	$0.00	$90.65	$0.00	$257.30	$257.30	$0.00	$217.50	$344.52	$348.00	$0.00		$0.00	$68.08	$0.00	$0.00	$69.25	$0.00	$0.00	$0.00	$0.00	$0.00
91-5609	SUP	HCPCS C1713		91-5609  -  SCREW BONE 2MM 9MM SLFDRILL LORENZ TRAUMAONE BLUE MANDIB	BOTH IP/OP	$435.00 	$321.90	$0.00	$348.00	$195.75	$195.75	$0.00	$0.00	$0.00	$90.66	$322.86	$322.86	$0.00	$0.00	$90.65	$0.00	$257.30	$257.30	$0.00	$217.50	$344.52	$348.00	$0.00		$0.00	$68.08	$0.00	$0.00	$69.25	$0.00	$0.00	$0.00	$0.00	$0.00
91-5611	SUP	HCPCS C1713		91-5611  -  SCREW BONE 2MM 11MM SLFDRILL LORENZ TRAUMAONE BLUE MANDIB	BOTH IP/OP	$435.00 	$321.90	$0.00	$348.00	$195.75	$195.75	$0.00	$0.00	$0.00	$90.66	$322.86	$322.86	$0.00	$0.00	$90.65	$0.00	$257.30	$257.30	$0.00	$217.50	$344.52	$348.00	$0.00		$0.00	$68.08	$0.00	$0.00	$69.25	$0.00	$0.00	$0.00	$0.00	$0.00
91-5707	SUP	HCPCS C1713		91-5707  -  SCREW BONE 2MM 7MM SELF DRILL TEMPORARY ANCHOR CROSS DRIVE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
91602V	SUP	Custom 27203010		91602V  -  APPLIER ENDOSCOPIC LARGE  CURVED 18INźź	BOTH IP/OP	"$2,773.73 "	"$2,052.56"	$0.00	"$2,218.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,058.66"	"$2,058.66"	$0.00	$0.00	$578.04	$0.00	$0.00	$0.00	$0.00	"$1,386.86"	"$2,196.79"	"$2,218.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91-6103	SUP	HCPCS C1713		91-6103  -  SCREW BONE 1.5MM 3.5MM SELF DRILL HIGH TORQUE CROSS DRIVE	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$110.25	$110.25	$0.00	$0.00	$0.00	$51.06	$181.84	$181.84	$0.00	$0.00	$51.06	$0.00	$144.92	$144.92	$0.00	$122.50	$194.04	$196.00	$0.00		$0.00	$38.34	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00
91-6104	SUP	HCPCS C1713		91-6104  -  SCREW BONE 1.5MM 4MM SELF DRILL HIGH TORQUE CROSS DRIVE	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$110.25	$110.25	$0.00	$0.00	$0.00	$51.06	$181.84	$181.84	$0.00	$0.00	$51.06	$0.00	$144.92	$144.92	$0.00	$122.50	$194.04	$196.00	$0.00		$0.00	$38.34	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00
91-6105	SUP	HCPCS C1713		91-6105  -  SCREW BONE 1.5MM 5MM SELF DRILL HIGH TORQUE CROSS DRIVE	BOTH IP/OP	$245.00 	$181.30	$0.00	$196.00	$110.25	$110.25	$0.00	$0.00	$0.00	$51.06	$181.84	$181.84	$0.00	$0.00	$51.06	$0.00	$144.92	$144.92	$0.00	$122.50	$194.04	$196.00	$0.00		$0.00	$38.34	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00
91-6106	SUP	HCPCS C1713		91-6106  -  SCREW BN 1.5MM 6MM GRN SLF DRL XDR TI MDFC LORENZ TRAUMAONE	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
91-6107	SUP	HCPCS C1713		91-6107  -  SCREW BN 1.5MM 7MM GRN SLF DRL XDR TI MDFC LORENZ TRAUMAONE	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$68.63	$68.63	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
91-6703	SUP	HCPCS C1713		91-6703  -  SCREW BONE 1.5MM 3.5MM SELF DRILL CROSS DRIVE THINFLAP	BOTH IP/OP	$260.00 	$192.40	$0.00	$208.00	$117.00	$117.00	$0.00	$0.00	$0.00	$54.19	$192.97	$192.97	$0.00	$0.00	$54.18	$0.00	$153.79	$153.79	$0.00	$130.00	$205.92	$208.00	$0.00		$0.00	$40.69	$0.00	$0.00	$41.39	$0.00	$0.00	$0.00	$0.00	$0.00
91-6704	SUP	HCPCS C1713		91-6704  -  SCREW BONE 1.5MM 4MM SELF DRILL CROSS DRIVE THINFLAP	BOTH IP/OP	$260.00 	$192.40	$0.00	$208.00	$117.00	$117.00	$0.00	$0.00	$0.00	$54.19	$192.97	$192.97	$0.00	$0.00	$54.18	$0.00	$153.79	$153.79	$0.00	$130.00	$205.92	$208.00	$0.00		$0.00	$40.69	$0.00	$0.00	$41.39	$0.00	$0.00	$0.00	$0.00	$0.00
91701V	SUP	Custom 27203010		91701V  -  CLIP INTNL ENDO REMOVER LARGE - XLARGE  STRAIGHT 18INźź	BOTH IP/OP	"$2,364.98 "	"$1,750.09"	$0.00	"$1,891.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,755.28"	"$1,755.28"	$0.00	$0.00	$492.86	$0.00	$0.00	$0.00	$0.00	"$1,182.49"	"$1,873.06"	"$1,891.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
91702V	SUP	Custom 27203010		91702V  -  APPLIER ENDOSCOPIC XLARGE  CURVED 18INźź	BOTH IP/OP	"$2,773.73 "	"$2,052.56"	$0.00	"$2,218.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,058.66"	"$2,058.66"	$0.00	$0.00	$578.04	$0.00	$0.00	$0.00	$0.00	"$1,386.86"	"$2,196.79"	"$2,218.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-00646	SUP	HCPCS C1713		92-00646  -  PLATE BONE 90X90MM MESH PREFORMED TITANIUM	BOTH IP/OP	"$17,716.88 "	"$13,110.49"	$0.00	"$19,800.00"	"$11,137.50"	"$11,137.50"	$0.00	$0.00	$0.00	"$3,692.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,692.20"	$0.00	"$8,734.42"	"$8,734.42"	$0.00	"$12,375.00"	"$19,602.00"	"$19,800.00"	$0.00		$0.00	"$3,873.38"	$0.00	$0.00	"$3,940.20"	$0.00	$0.00	$0.00	$0.00	$0.00
92-00647	SUP	HCPCS C1713		92-00647  -  PLATE BONE 190X140MM MESH PREFORMED TITANIUM	BOTH IP/OP	"$68,617.50 "	"$50,776.95"	$0.00	"$54,894.00"	"$30,877.88"	"$30,877.88"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$14,299.89"	$0.00	"$33,828.43"	"$33,828.43"	$0.00	"$34,308.75"	"$54,345.06"	"$54,894.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
92-03210	SUP	HCPCS C1713		92-03210  -  PLATE BN NS UNV NEURO II 2 HL LOPRFL TAB	BOTH IP/OP	$227.50 	$168.35	$0.00	$432.00	$243.00	$243.00	$0.00	$0.00	$0.00	$47.42	$168.85	$168.85	$0.00	$0.00	$47.41	$0.00	$134.57	$134.57	$0.00	$270.00	$427.68	$432.00	$0.00		$0.00	$84.51	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$0.00
92-03510	SUP	Custom 27803010		92-03510  -  COVER BURR HOLE 10MM LP CRANIUM 3MM SCREW	BOTH IP/OP	$461.25 	$341.33	$0.00	$842.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.34	$342.34	$0.00	$0.00	$96.12	$0.00	$0.00	$0.00	$0.00	$526.25	$833.58	$842.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-03514	SUP	Custom 27803010		92-03514  -  COVER BURR HOLE LP 14MM CRANIUM 3MM SCREW	BOTH IP/OP	$461.25 	$341.33	$0.00	$842.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.34	$342.34	$0.00	$0.00	$96.12	$0.00	$0.00	$0.00	$0.00	$526.25	$833.58	$842.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-03608	SUP	HCPCS C1713		92-03608  -  PLATE BONE 2Y MICRO LP 8MM 6 HOLE BAR CRANIUM	BOTH IP/OP	$639.00 	$472.86	$0.00	$936.00	$526.50	$526.50	$0.00	$0.00	$0.00	$133.18	$474.27	$474.27	$0.00	$0.00	$133.17	$0.00	$377.97	$377.97	$0.00	$585.00	$926.64	$936.00	$0.00		$0.00	$183.11	$0.00	$0.00	$186.26	$0.00	$0.00	$0.00	$0.00	$0.00
92-05228	SUP	HCPCS C1713		92-05228  -  PLATE BONE LARGE LP BOX TITANIUM CRANIOMAXILLOFACIAL	BOTH IP/OP	$498.18 	$368.65	$0.00	$756.00	$425.25	$425.25	$0.00	$0.00	$0.00	$103.83	$369.75	$369.75	$0.00	$0.00	$103.82	$0.00	$294.67	$294.67	$0.00	$472.50	$748.44	$756.00	$0.00		$0.00	$147.89	$0.00	$0.00	$150.44	$0.00	$0.00	$0.00	$0.00	$0.00
92-07211	SUP	Custom 27203010		92-07211  -  SLEEVE LAPSCP TWN FX BLDE	BOTH IP/OP	$525.25 	$388.69	$0.00	$420.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.84	$389.84	$0.00	$0.00	$109.46	$0.00	$0.00	$0.00	$0.00	$262.63	$416.00	$420.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-07230	SUP	Custom 27203010		92-07230  -  BIT DRILL 200MM 3.4MM CANN	BOTH IP/OP	$463.25 	$342.81	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.82	$343.82	$0.00	$0.00	$96.54	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-10504	SUP	HCPCS C1713		92-10504  -  PLATE BN MN 4 HL TI 1.25MM	BOTH IP/OP	"$1,857.50 "	"$1,374.55"	$0.00	"$1,486.00"	$835.88	$835.88	$0.00	$0.00	$0.00	$387.15	"$1,378.64"	"$1,378.64"	$0.00	$0.00	$387.10	$0.00	"$1,098.71"	"$1,098.71"	$0.00	$928.75	"$1,471.14"	"$1,486.00"	$0.00		$0.00	$290.70	$0.00	$0.00	$295.71	$0.00	$0.00	$0.00	$0.00	$0.00
92-10505	SUP	HCPCS C1713		92-10505  -  PLATE BONE MINI 1.5MM 4 HOLE BAR TITANIUM MAXFACL	BOTH IP/OP	"$1,374.23 "	"$1,016.93"	$0.00	"$1,680.00"	$945.00	$945.00	$0.00	$0.00	$0.00	$286.42	"$1,019.95"	"$1,019.95"	$0.00	$0.00	$286.39	$0.00	$812.85	$812.85	$0.00	"$1,050.00"	"$1,663.20"	"$1,680.00"	$0.00		$0.00	$328.65	$0.00	$0.00	$334.32	$0.00	$0.00	$0.00	$0.00	$0.00
92-10506	SUP	HCPCS C1713		92-10506  -  PLATE BONE MINI 6 HOLE CUSTOM MAXFACL	BOTH IP/OP	"$2,555.00 "	"$1,890.70"	$0.00	"$2,044.00"	"$1,149.75"	"$1,149.75"	$0.00	$0.00	$0.00	$532.53	"$1,896.32"	"$1,896.32"	$0.00	$0.00	$532.46	$0.00	"$1,259.62"	"$1,259.62"	$0.00	"$1,277.50"	"$2,023.56"	"$2,044.00"	$0.00		$0.00	$399.86	$0.00	$0.00	$406.76	$0.00	$0.00	$0.00	$0.00	$0.00
92-10507	SUP	HCPCS C1713		92-10507  -  PLATE BONE 2MM 6 HOLE BARMAND LOCK CRANIOMAXILLOFACIAL	BOTH IP/OP	"$1,702.73 "	"$1,260.02"	$0.00	"$2,140.00"	"$1,203.75"	"$1,203.75"	$0.00	$0.00	$0.00	$354.89	"$1,263.76"	"$1,263.76"	$0.00	$0.00	$354.85	$0.00	"$1,007.16"	"$1,007.16"	$0.00	"$1,337.50"	"$2,118.60"	"$2,140.00"	$0.00		$0.00	$418.64	$0.00	$0.00	$425.86	$0.00	$0.00	$0.00	$0.00	$0.00
92-10516	SUP	HCPCS C1713		92-10516  -  PLATE BN 1.5MM MN 16 HL MXLFCL	BOTH IP/OP	"$2,850.00 "	"$2,109.00"	$0.00	"$2,280.00"	"$1,282.50"	"$1,282.50"	$0.00	$0.00	$0.00	$594.01	"$2,115.27"	"$2,115.27"	$0.00	$0.00	$593.94	$0.00	"$1,405.05"	"$1,405.05"	$0.00	"$1,425.00"	"$2,257.20"	"$2,280.00"	$0.00		$0.00	$446.03	$0.00	$0.00	$453.72	$0.00	$0.00	$0.00	$0.00	$0.00
92-10562	SUP	HCPCS C1713		92-10562  -  PLATE BN STRUT TROCH	BOTH IP/OP	"$2,850.00 "	"$2,109.00"	$0.00	"$2,280.00"	"$1,282.50"	"$1,282.50"	$0.00	$0.00	$0.00	$594.01	"$2,115.27"	"$2,115.27"	$0.00	$0.00	$593.94	$0.00	"$1,405.05"	"$1,405.05"	$0.00	"$1,425.00"	"$2,257.20"	"$2,280.00"	$0.00		$0.00	$446.03	$0.00	$0.00	$453.72	$0.00	$0.00	$0.00	$0.00	$0.00
92-15514	SUP	HCPCS C1713		92-15514  -  PLATE BONE 2MM STR FRAC	BOTH IP/OP	"$3,907.50 "	"$2,891.55"	$0.00	"$3,126.00"	"$1,758.38"	"$1,758.38"	$0.00	$0.00	$0.00	$814.42	"$2,900.15"	"$2,900.15"	$0.00	$0.00	$814.32	$0.00	"$1,926.40"	"$1,926.40"	$0.00	"$1,953.75"	"$3,094.74"	"$3,126.00"	$0.00		$0.00	$611.52	$0.00	$0.00	$622.07	$0.00	$0.00	$0.00	$0.00	$0.00
92-15904	SUP	HCPCS C1713		92-15904  -  SCREW BONE 1.5MM 4MM SELF DRILL TITANIUM CRANIOMAXILLOFACIAL	BOTH IP/OP	$100.95 	$74.70	$0.00	$80.76	$45.43	$45.43	$0.00	$0.00	$0.00	$21.04	$74.93	$74.93	$0.00	$0.00	$21.04	$0.00	$59.71	$59.71	$0.00	$50.48	$79.95	$80.76	$0.00		$0.00	$15.80	$0.00	$0.00	$16.07	$0.00	$0.00	$0.00	$0.00	$0.00
92-15905	SUP	HCPCS C1713		92-15905  -  SCREW BONE 5MM 1.5MM MAXFACL TI SLFDRILL XPIN	BOTH IP/OP	$100.95 	$74.70	$0.00	$80.76	$45.43	$45.43	$0.00	$0.00	$0.00	$21.04	$74.93	$74.93	$0.00	$0.00	$21.04	$0.00	$59.71	$59.71	$0.00	$50.48	$79.95	$80.76	$0.00		$0.00	$15.80	$0.00	$0.00	$16.07	$0.00	$0.00	$0.00	$0.00	$0.00
92-15920	SUP	HCPCS C1713		92-15920  -  PLATE BONE 20MM HEMI RECONSTRUCTION TITANIUM MANDIB	BOTH IP/OP	"$10,292.50 "	"$7,616.45"	$0.00	"$8,234.00"	"$4,631.63"	"$4,631.63"	$0.00	$0.00	$0.00	"$2,145.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,144.96"	$0.00	"$5,074.20"	"$5,074.20"	$0.00	"$5,146.25"	"$8,151.66"	"$8,234.00"	$0.00		$0.00	"$1,610.78"	$0.00	$0.00	"$1,638.57"	$0.00	$0.00	$0.00	$0.00	$0.00
92-15922	SUP	HCPCS C1713		92-15922  -  PLATE BONE 22MM HEMI RECONSTRUCTION TITANIUM MANDIB	BOTH IP/OP	"$10,292.50 "	"$7,616.45"	$0.00	"$8,234.00"	"$4,631.63"	"$4,631.63"	$0.00	$0.00	$0.00	"$2,145.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,144.96"	$0.00	"$5,074.20"	"$5,074.20"	$0.00	"$5,146.25"	"$8,151.66"	"$8,234.00"	$0.00		$0.00	"$1,610.78"	$0.00	$0.00	"$1,638.57"	$0.00	$0.00	$0.00	$0.00	$0.00
92-16035	SUP	Custom 27100030		92-16035  -  BIT DRILL 1.6MM 35MM 7MM TWIST STOP	BOTH IP/OP	$468.58 	$346.75	$0.00	$768.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$347.78	$347.78	$0.00	$0.00	$97.65	$0.00	$0.00	$0.00	$0.00	$480.00	$760.32	$768.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-16135	SUP	Custom 27203010		92-16135  -  DRILL SRG 1.6MM 115MM NS LF 35MM CLR CD DISP	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$0.00	$0.00	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-17126	SUP	Custom 27203010		92-17126  -  BIT DRL TWST	BOTH IP/OP	$160.65 	$118.88	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.23	$119.23	$0.00	$0.00	$33.48	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-19035	SUP	Custom 27100030		92-19035  -  BIT DRILL 1.9MM 35MM TWIST	BOTH IP/OP	$736.88 	$545.29	$0.00	$802.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$546.91	$546.91	$0.00	$0.00	$153.56	$0.00	$0.00	$0.00	$0.00	$501.25	$793.98	$802.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-23126	SUP	Custom 27203010		92-23126  -  BIT DRL 23MM	BOTH IP/OP	$160.65 	$118.88	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.23	$119.23	$0.00	$0.00	$33.48	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-25290	SUP	HCPCS C1713		92-25290  -  PLATE STD LNG BONE RIGHT DORSAL RADL	BOTH IP/OP	$893.75 	$661.38	$0.00	$715.00	$402.19	$402.19	$0.00	$0.00	$0.00	$186.28	$663.34	$663.34	$0.00	$0.00	$186.26	$0.00	$528.65	$528.65	$0.00	$446.88	$707.85	$715.00	$0.00		$0.00	$139.87	$0.00	$0.00	$142.29	$0.00	$0.00	$0.00	$0.00	$0.00
92-25291	SUP	HCPCS C1713		92-25291  -  PLATE STD LNG BONE LEFT DORSAL RADL	BOTH IP/OP	$893.75 	$661.38	$0.00	$715.00	$402.19	$402.19	$0.00	$0.00	$0.00	$186.28	$663.34	$663.34	$0.00	$0.00	$186.26	$0.00	$528.65	$528.65	$0.00	$446.88	$707.85	$715.00	$0.00		$0.00	$139.87	$0.00	$0.00	$142.29	$0.00	$0.00	$0.00	$0.00	$0.00
92-25292	SUP	HCPCS C1713		92-25292  -  PLATE LNG W BONE RIGHT DORSAL RADL	BOTH IP/OP	$893.75 	$661.38	$0.00	$715.00	$402.19	$402.19	$0.00	$0.00	$0.00	$186.28	$663.34	$663.34	$0.00	$0.00	$186.26	$0.00	$528.65	$528.65	$0.00	$446.88	$707.85	$715.00	$0.00		$0.00	$139.87	$0.00	$0.00	$142.29	$0.00	$0.00	$0.00	$0.00	$0.00
92-25293	SUP	HCPCS C1713		92-25293  -  PLATE LNG W BONE LEFT DORSAL RADL	BOTH IP/OP	$893.75 	$661.38	$0.00	$715.00	$402.19	$402.19	$0.00	$0.00	$0.00	$186.28	$663.34	$663.34	$0.00	$0.00	$186.26	$0.00	$528.65	$528.65	$0.00	$446.88	$707.85	$715.00	$0.00		$0.00	$139.87	$0.00	$0.00	$142.29	$0.00	$0.00	$0.00	$0.00	$0.00
92-25395	SUP	HCPCS C1713		92-25395  -  PLATE NAR XLNG BONE VOLR RADL	BOTH IP/OP	"$1,216.88 "	$900.49	$0.00	$973.50	$547.59	$547.59	$0.00	$0.00	$0.00	$253.63	$903.16	$903.16	$0.00	$0.00	$253.60	$0.00	$719.78	$719.78	$0.00	$608.44	$963.77	$973.50	$0.00		$0.00	$190.44	$0.00	$0.00	$193.73	$0.00	$0.00	$0.00	$0.00	$0.00
92-25397	SUP	HCPCS C1713		92-25397  -  PLATE STD XLNG BONE VOLR RADL	BOTH IP/OP	"$1,216.88 "	$900.49	$0.00	$973.50	$547.59	$547.59	$0.00	$0.00	$0.00	$253.63	$903.16	$903.16	$0.00	$0.00	$253.60	$0.00	$719.78	$719.78	$0.00	$608.44	$963.77	$973.50	$0.00		$0.00	$190.44	$0.00	$0.00	$193.73	$0.00	$0.00	$0.00	$0.00	$0.00
92-25399	SUP	HCPCS C1713		92-25399  -  PLATE W XLNG BONE VOLR RADL	BOTH IP/OP	"$1,216.88 "	$900.49	$0.00	$973.50	$547.59	$547.59	$0.00	$0.00	$0.00	$253.63	$903.16	$903.16	$0.00	$0.00	$253.60	$0.00	$719.78	$719.78	$0.00	$608.44	$963.77	$973.50	$0.00		$0.00	$190.44	$0.00	$0.00	$193.73	$0.00	$0.00	$0.00	$0.00	$0.00
92-25403	SUP	HCPCS C1713		92-25403  -  PLATE BN SHRT T	BOTH IP/OP	"$1,271.00 "	$940.54	$0.00	$943.34	$506.14	$506.14	$0.00	$0.00	$0.00	$264.91	$943.34	$943.34	$0.00	$0.00	$264.88	$0.00	$751.80	$751.80	$0.00	$562.38	$890.80	$899.80	$0.00		$0.00	$176.02	$0.00	$0.00	$179.06	$0.00	$0.00	$0.00	$0.00	$0.00
92-25405	SUP	HCPCS C1713		92-25405  -  PLATE LNG 7 HOLE T CLMN BONE ULN	BOTH IP/OP	"$1,271.00 "	$940.54	$0.00	$943.34	$506.14	$506.14	$0.00	$0.00	$0.00	$264.91	$943.34	$943.34	$0.00	$0.00	$264.88	$0.00	$751.80	$751.80	$0.00	$562.38	$890.80	$899.80	$0.00		$0.00	$176.02	$0.00	$0.00	$179.06	$0.00	$0.00	$0.00	$0.00	$0.00
92-27007	SUP	Custom 27203010		92-27007  -  HOLDER INSTR SHFT PLT	BOTH IP/OP	$434.50 	$321.53	$0.00	$347.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$322.49	$322.49	$0.00	$0.00	$90.55	$0.00	$0.00	$0.00	$0.00	$217.25	$344.12	$347.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-40281	SUP	HCPCS C1713		92-40281  -  WIRE FX 1.4MM 160MM KRSH STP	BOTH IP/OP	$41.25 	$30.53	$0.00	$33.00	$18.56	$18.56	$0.00	$0.00	$0.00	$8.60	$30.62	$30.62	$0.00	$0.00	$8.60	$0.00	$24.40	$24.40	$0.00	$20.63	$32.67	$33.00	$0.00		$0.00	$6.46	$0.00	$0.00	$6.57	$0.00	$0.00	$0.00	$0.00	$0.00
92-40283	SUP	HCPCS C1713		92-40283  -  WIRE FX .062IN 160MM KRSH	BOTH IP/OP	$48.13 	$35.62	$0.00	$38.50	$21.66	$21.66	$0.00	$0.00	$0.00	$10.03	$35.72	$35.72	$0.00	$0.00	$10.03	$0.00	$28.47	$28.47	$0.00	$24.06	$38.12	$38.50	$0.00		$0.00	$7.53	$0.00	$0.00	$7.66	$0.00	$0.00	$0.00	$0.00	$0.00
92-53514	SUP	Custom 27803010		92-53514  -  COVER BURR HOLE 14MM LP	BOTH IP/OP	$520.05 	$384.84	$0.00	$760.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$385.98	$385.98	$0.00	$0.00	$108.38	$0.00	$0.00	$0.00	$0.00	$475.00	$752.40	$760.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-55005	SUP	HCPCS C1713		92-55005  -  PLATE BONE SHORT 4 HOLE PREBENT CRANIOMAXILLOFACIAL LEFT	BOTH IP/OP	"$1,222.50 "	$904.65	$0.00	$978.00	$550.13	$550.13	$0.00	$0.00	$0.00	$254.80	$907.34	$907.34	$0.00	$0.00	$254.77	$0.00	$723.11	$723.11	$0.00	$611.25	$968.22	$978.00	$0.00		$0.00	$191.32	$0.00	$0.00	$194.62	$0.00	$0.00	$0.00	$0.00	$0.00
92-55007	SUP	HCPCS C1713		92-55007  -  PLATE BONE SHORT 4 HOLE PREBENT CRANIOMAXILLOFACIAL RIGHT	BOTH IP/OP	"$1,222.50 "	$904.65	$0.00	$978.00	$550.13	$550.13	$0.00	$0.00	$0.00	$254.80	$907.34	$907.34	$0.00	$0.00	$254.77	$0.00	$723.11	$723.11	$0.00	$611.25	$968.22	$978.00	$0.00		$0.00	$191.32	$0.00	$0.00	$194.62	$0.00	$0.00	$0.00	$0.00	$0.00
92-55011	SUP	HCPCS C1713		92-55011  -  PLATE BN 2.5MM 11 HL MNDB	BOTH IP/OP	"$7,835.00 "	"$5,797.90"	$0.00	"$6,268.00"	"$3,525.75"	"$3,525.75"	$0.00	$0.00	$0.00	"$1,633.01"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,632.81"	$0.00	"$3,862.66"	"$3,862.66"	$0.00	"$3,917.50"	"$6,205.32"	"$6,268.00"	$0.00		$0.00	"$1,226.18"	$0.00	$0.00	"$1,247.33"	$0.00	$0.00	$0.00	$0.00	$0.00
92-55066	SUP	HCPCS C1713		92-55066  -  PLATE BONE 100D L BAR CRANIOMAXILLOFACIAL RIGHT	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$517.50	$517.50	$0.00	$0.00	$0.00	$239.69	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$680.23	$680.23	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$179.98	$0.00	$0.00	$183.08	$0.00	$0.00	$0.00	$0.00	$0.00
92-55067	SUP	HCPCS C1713		92-55067  -  PLATE BONE 100D L BAR CRANIOMAXILLOFACIAL LEFT	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$517.50	$517.50	$0.00	$0.00	$0.00	$239.69	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$680.23	$680.23	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$179.98	$0.00	$0.00	$183.08	$0.00	$0.00	$0.00	$0.00	$0.00
92-55159	SUP	HCPCS C1713		92-55159  -  PLATE BN 2MM 11 HL CRNMXF	BOTH IP/OP	"$6,960.00 "	"$5,150.40"	$0.00	"$5,568.00"	"$3,132.00"	"$3,132.00"	$0.00	$0.00	$0.00	"$1,450.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,450.46"	$0.00	"$3,431.28"	"$3,431.28"	$0.00	"$3,480.00"	"$5,512.32"	"$5,568.00"	$0.00		$0.00	"$1,089.24"	$0.00	$0.00	"$1,108.03"	$0.00	$0.00	$0.00	$0.00	$0.00
92-55161	SUP	HCPCS C1713		92-55161  -  PLATE BONE 2MM 17 HOLE PRIM RECONSTRUCTION TEMPLATE MANDIB	BOTH IP/OP	"$8,477.50 "	"$6,273.35"	$0.00	"$6,782.00"	"$3,814.88"	"$3,814.88"	$0.00	$0.00	$0.00	"$1,766.92"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,766.71"	$0.00	"$4,179.41"	"$4,179.41"	$0.00	"$4,238.75"	"$6,714.18"	"$6,782.00"	$0.00		$0.00	"$1,326.73"	$0.00	$0.00	"$1,349.62"	$0.00	$0.00	$0.00	$0.00	$0.00
92-55506	SUP	HCPCS C1713		92-55506  -  PLATE BONE 4 HOLE PREBENT TITANIUM LEFT MAXFACL	BOTH IP/OP	"$1,082.50 "	$801.05	$0.00	$866.00	$487.13	$487.13	$0.00	$0.00	$0.00	$225.62	$803.43	$803.43	$0.00	$0.00	$225.59	$0.00	$640.30	$640.30	$0.00	$541.25	$857.34	$866.00	$0.00		$0.00	$169.41	$0.00	$0.00	$172.33	$0.00	$0.00	$0.00	$0.00	$0.00
92-55922	SUP	HCPCS C1713		92-55922  -  PLATE BN 2MM HEMI PRM LT 2	BOTH IP/OP	"$6,475.00 "	"$4,791.50"	$0.00	"$5,180.00"	"$2,913.75"	"$2,913.75"	$0.00	$0.00	$0.00	"$1,349.55"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,349.39"	$0.00	"$3,192.18"	"$3,192.18"	$0.00	"$3,237.50"	"$5,128.20"	"$5,180.00"	$0.00		$0.00	"$1,013.34"	$0.00	$0.00	"$1,030.82"	$0.00	$0.00	$0.00	$0.00	$0.00
92-57262	SUP	HCPCS C1713		92-57262  -  PLATE BN FX 1.7 MM SCR	BOTH IP/OP	$584.38 	$432.44	$0.00	$467.50	$262.97	$262.97	$0.00	$0.00	$0.00	$121.80	$433.72	$433.72	$0.00	$0.00	$121.78	$0.00	$345.66	$345.66	$0.00	$292.19	$462.83	$467.50	$0.00		$0.00	$91.45	$0.00	$0.00	$93.03	$0.00	$0.00	$0.00	$0.00	$0.00
92-60090	SUP	Custom 27203010		92-60090  -  TWIST DRILL DIA.0.9X66MM TWIST LENGTH 22MM AO SHAFT	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-60130	SUP	Custom 27203010		92-60130  -  TWIST DRILL DIA.1.3X66MM TWIST LENGTH 22MM AO SHAFT	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-60165	SUP	Custom 27100030		92-60165  -  BIT DRILL 35MM COLOR CODED	BOTH IP/OP	$406.70 	$300.96	$0.00	$620.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.85	$301.85	$0.00	$0.00	$84.76	$0.00	$0.00	$0.00	$0.00	$387.50	$613.80	$620.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-60170	SUP	Custom 27203010		92-60170  -  DRILL TWST 1.7MM 66MM	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-60190	SUP	Custom 27203010		92-60190  -  TWIST DRILL DIA.1.9X82MM TWIST LENGTH 39MM AO SHAFT	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-60199	SUP	Custom 27100030		92-60199  -  DRILL TWIST 1.9MM STOP 35MM 115MM	BOTH IP/OP	$491.18 	$363.47	$0.00	$702.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$364.55	$364.55	$0.00	$0.00	$102.36	$0.00	$0.00	$0.00	$0.00	$438.75	$694.98	$702.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-60230	SUP	Custom 27203010		92-60230  -  DRILL TWST 2.3MM 82MM	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-62254	SUP	Custom 27203010		92-62254  -  GUIDE DRL 1.2MM 1.7MM FUSED	BOTH IP/OP	"$1,175.63 "	$869.97	$0.00	$940.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$872.55	$872.55	$0.00	$0.00	$245.00	$0.00	$0.00	$0.00	$0.00	$587.81	$931.10	$940.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-62255	SUP	Custom 27203010		92-62255  -  GUIDE DRL 2.3MM LG FUSED CMPR	BOTH IP/OP	"$1,117.88 "	$827.23	$0.00	$894.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$829.69	$829.69	$0.00	$0.00	$232.97	$0.00	$0.00	$0.00	$0.00	$558.94	$885.36	$894.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-62256	SUP	Custom 27203010		92-62256  -  GUIDE DRL 2.3MM 2.5MM FUSED CENTRIC	BOTH IP/OP	"$1,227.88 "	$908.63	$0.00	$982.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$911.33	$911.33	$0.00	$0.00	$255.89	$0.00	$0.00	$0.00	$0.00	$613.94	$972.48	$982.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
92-62270	SUP	Custom 27803010		92-62270  -  TAP FOR 2.7MM SCREW	BOTH IP/OP	$570.63 	$422.27	$0.00	$456.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$423.52	$423.52	$0.00	$0.00	$118.92	$0.00	$0.00	$0.00	$0.00	$285.31	$451.94	$456.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
931HF75	SUP	HCPCS C1887		CATHETER ART 7.5FR 110CM 5 LUM TD SG HEP	BOTH IP/OP	$210.25 	$155.59	$0.00	$168.20	$114.17	$114.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.13	$166.52	$168.20	$0.00		$0.00	$32.90	$0.00	$0.00	$33.47	$0.00	$0.00	$0.00	$0.00	$0.00
93-9268	SUP	HCPCS C1762		93-9268  -  GRAFT SKIN 8X6CM DEHYDRATED GAMA IRRADIATED AXIS TUTOPLAST	BOTH IP/OP	"$3,847.50 "	"$2,847.15"	$0.00	"$3,078.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$801.92	"$2,855.61"	"$2,855.61"	$0.00	$0.00	$801.82	$0.00	"$1,896.82"	"$1,896.82"	$0.00	"$1,923.75"	"$3,047.22"	"$3,078.00"	$0.00		$0.00	$602.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
94107CE	SUP	HCPCS C1713		94107CE  -  CROSSLINK 94107CE DTT4 FOR COMPRESS L60	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
94107DE	SUP	HCPCS C1713		94107DE  -  CROSSLINK 94107DE DTT4 FOR DISTRACT L60	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
94-202	SUP	Custom 27203010		REAGENT LUPOTEK DETECTIN ANALY	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9450002E	SUP	Custom 27203010		9450002E  -  DISPOSABLE 9450002E ELECTRO LOWIMPED22MM	BOTH IP/OP	$669.00 	$495.06	$0.00	$535.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$496.53	$496.53	$0.00	$0.00	$139.42	$0.00	$0.00	$0.00	$0.00	$334.50	$529.85	$535.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DMA1002	SUP	Custom 27203010		945DMA1002  -  ELECTRODE 945DMA1002 AD GOLDFOIL EAR CAN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DMA1004	SUP	Custom 27203010		945DMA1004  -  ELECTRODE 945DMA1004 PED GOLDFOIL EARCAN	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.68	$6.68	$0.00	$0.00	$1.88	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DME1001	SUP	Custom 27203010		945DME1001  -  ELECTRODE 945DME1001 1.2M CORKSCREW	BOTH IP/OP	$82.50 	$61.05	$0.00	$66.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.23	$61.23	$0.00	$0.00	$17.19	$0.00	$0.00	$0.00	$0.00	$41.25	$65.34	$66.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DME1004	SUP	Custom 27203010		945DME1004  -  ELECTRODE 945DME1004 3.5X5CM 2M SING GR	BOTH IP/OP	$25.50 	$18.87	$0.00	$20.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.93	$18.93	$0.00	$0.00	$5.31	$0.00	$0.00	$0.00	$0.00	$12.75	$20.20	$20.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DME2002	SUP	Custom 27203010		945DME2002  -  ELECTRODE 945DME2002 48IN 1.2M CORKSCREW	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSE1115	SUP	Custom 27203010		945DSE1115  -  ELECTRODE 945DSE1115 1.5X2CM 1.5M SINGLE	BOTH IP/OP	$12.00 	$8.88	$0.00	$9.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.91	$8.91	$0.00	$0.00	$2.50	$0.00	$0.00	$0.00	$0.00	$6.00	$9.50	$9.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSE1125	SUP	Custom 27203010		945DSE1125  -  ELECTRODE 945DSE1125 1.5X2CM 2.5M SINGLE	BOTH IP/OP	$18.00 	$13.32	$0.00	$14.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.36	$13.36	$0.00	$0.00	$3.75	$0.00	$0.00	$0.00	$0.00	$9.00	$14.26	$14.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSE2115	SUP	Custom 27203010		945DSE2115  -  ELECTRODE 945DSE2115 2X2.7CM 1.5M SINGLE	BOTH IP/OP	$12.00 	$8.88	$0.00	$9.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.91	$8.91	$0.00	$0.00	$2.50	$0.00	$0.00	$0.00	$0.00	$6.00	$9.50	$9.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSE2125	SUP	Custom 27203010		945DSE2125  -  ELECTRODE 945DSE2125 2X2.7CM 2.5M SINGLE	BOTH IP/OP	$15.00 	$11.10	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.13	$11.13	$0.00	$0.00	$3.13	$0.00	$0.00	$0.00	$0.00	$7.50	$11.88	$12.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSE3115	SUP	Custom 27203010		945DSE3115  -  ELECTRODE 945DSE3115 1.5X2CM 1.5M DUAL	BOTH IP/OP	$43.50 	$32.19	$0.00	$34.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.29	$32.29	$0.00	$0.00	$9.07	$0.00	$0.00	$0.00	$0.00	$21.75	$34.45	$34.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSE3125	SUP	Custom 27203010		945DSE3125  -  ELECTRODE 945DSE3125 1.5X2CM 2.5M DUAL	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.76	$46.76	$0.00	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$31.50	$49.90	$50.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSE4115	SUP	Custom 27203010		945DSE4115  -  ELECTRODE 945DSE4115 2X2.7CM 1.5M DUAL	BOTH IP/OP	$43.50 	$32.19	$0.00	$34.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.29	$32.29	$0.00	$0.00	$9.07	$0.00	$0.00	$0.00	$0.00	$21.75	$34.45	$34.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSE4125	SUP	Custom 27203010		945DSE4125  -  ELECTRODE 945DSE4125 2X2.7CM 2.5M DUAL	BOTH IP/OP	$63.00 	$46.62	$0.00	$50.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.76	$46.76	$0.00	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$31.50	$49.90	$50.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSN1260	SUP	Custom 27203010		945DSN1260  -  ELECTRODE 945DSN1260 13MM 27G 1.5M SING	BOTH IP/OP	$22.50 	$16.65	$0.00	$18.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.70	$16.70	$0.00	$0.00	$4.69	$0.00	$0.00	$0.00	$0.00	$11.25	$17.82	$18.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSN1299	SUP	Custom 27203010		945DSN1299  -  ELECTRODE 945DSN1299 13MM 27G 2.5M SING	BOTH IP/OP	$22.50 	$16.65	$0.00	$18.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.70	$16.70	$0.00	$0.00	$4.69	$0.00	$0.00	$0.00	$0.00	$11.25	$17.82	$18.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSN2260	SUP	Custom 27203010		945DSN2260  -  ELECTRODE 945DSN2260 13MM 27G 1.5M DUAL	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.97	$38.97	$0.00	$0.00	$10.94	$0.00	$0.00	$0.00	$0.00	$26.25	$41.58	$42.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSN2280	SUP	Custom 27203010		945DSN2280  -  ELECTRODE 945DSN2280 13MM 27G 2.0M DUAL	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.97	$38.97	$0.00	$0.00	$10.94	$0.00	$0.00	$0.00	$0.00	$26.25	$41.58	$42.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DSN2299	SUP	Custom 27203010		945DSN2299  -  ELECTRODE 945DSN2299 13MM 27G 2.5M DUAL	BOTH IP/OP	$61.50 	$45.51	$0.00	$49.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.65	$45.65	$0.00	$0.00	$12.82	$0.00	$0.00	$0.00	$0.00	$30.75	$48.71	$49.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DTE0001	SUP	HCPCS C1898		945DTE0001  -  LEAD 945DTE0001 0.6M RED CLIP	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$20.25	$20.25	$0.00	$0.00	$0.00	$9.38	$33.40	$33.40	$0.00	$0.00	$9.38	$0.00	$26.62	$26.62	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$7.04	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00
945DTE0002	SUP	HCPCS C1898		945DTE0002  -  LEAD 945DTE0002 0.6 GREEN CLIP	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$20.25	$20.25	$0.00	$0.00	$0.00	$9.38	$33.40	$33.40	$0.00	$0.00	$9.38	$0.00	$26.62	$26.62	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$7.04	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00
945DTE0003	SUP	HCPCS C1898		945DTE0003  -  LEAD 945DTE0003 0.6M BLACK CLIP	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$20.25	$20.25	$0.00	$0.00	$0.00	$9.38	$33.40	$33.40	$0.00	$0.00	$9.38	$0.00	$26.62	$26.62	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$7.04	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00
945DTE1002	SUP	Custom 27203010		945DTE1002  -  ELECTRODE 945DTE1002 1.27X1.9CMPREGELTAB	BOTH IP/OP	$33.00 	$24.42	$0.00	$26.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.49	$24.49	$0.00	$0.00	$6.88	$0.00	$0.00	$0.00	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945DTE1003	SUP	Custom 27203010		945DTE1003  -  ELECTRODE 945DTE1003 2.54X2.54CMPRETAB	BOTH IP/OP	$33.00 	$24.42	$0.00	$26.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.49	$24.49	$0.00	$0.00	$6.88	$0.00	$0.00	$0.00	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945MEP1001	SUP	Custom 27203010		945MEP1001  -  ELECTRODE 945MEP1001 KEYED CORKSCREW	BOTH IP/OP	$624.00 	$461.76	$0.00	$499.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.13	$463.13	$0.00	$0.00	$130.04	$0.00	$0.00	$0.00	$0.00	$312.00	$494.21	$499.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945NRE1003	SUP	Custom 27203010		945NRE1003  -  ELECTRODE 945NRE1003 SD NEEDLE RECORDING	BOTH IP/OP	$891.00 	$659.34	$0.00	$712.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$661.30	$661.30	$0.00	$0.00	$185.68	$0.00	$0.00	$0.00	$0.00	$445.50	$705.67	$712.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945NRE1004	SUP	Custom 27203010		945NRE1004  -  ELECTRODE 945NRE1004 NEEDLE WITH RING	BOTH IP/OP	"$1,320.00 "	$976.80	$0.00	"$1,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$979.70	$979.70	$0.00	$0.00	$275.09	$0.00	$0.00	$0.00	$0.00	$660.00	"$1,045.44"	"$1,056.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945POC1002	SUP	HCPCS C1713		945POC1002  -  CLIP 945POC1002 SD PULSE OX	BOTH IP/OP	$223.50 	$165.39	$0.00	$178.80	$100.58	$100.58	$0.00	$0.00	$0.00	$46.58	$165.88	$165.88	$0.00	$0.00	$46.58	$0.00	$132.20	$132.20	$0.00	$111.75	$177.01	$178.80	$0.00		$0.00	$34.98	$0.00	$0.00	$35.58	$0.00	$0.00	$0.00	$0.00	$0.00
945PXC2002	SUP	HCPCS C1713		945PXC2002  -  CLIP 945PXC2002 1MLEAD PULSEOX FING/TOE	BOTH IP/OP	$82.50 	$61.05	$0.00	$66.00	$37.13	$37.13	$0.00	$0.00	$0.00	$17.20	$61.23	$61.23	$0.00	$0.00	$17.19	$0.00	$48.80	$48.80	$0.00	$41.25	$65.34	$66.00	$0.00		$0.00	$12.91	$0.00	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$0.00
945RMA1016	SUP	Custom 27203010		945RMA1016  -  TUBE 945RMA1016 REPLACEMENT	BOTH IP/OP	$22.50 	$16.65	$0.00	$18.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.70	$16.70	$0.00	$0.00	$4.69	$0.00	$0.00	$0.00	$0.00	$11.25	$17.82	$18.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945RMA1019	SUP	Custom 27203010		945RMA1019  -  ELECTRODE 945RMA1019 10-7.5MMLARYNGEAL	BOTH IP/OP	$289.50 	$214.23	$0.00	$231.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.87	$214.87	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$144.75	$229.28	$231.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945RMA1019S	SUP	Custom 27203010		945RMA1019S  -  ELECTRODE 945RMA1019S 7-6MM LARYNGEAL	BOTH IP/OP	$289.50 	$214.23	$0.00	$231.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.87	$214.87	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$144.75	$229.28	$231.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945RMA1019SP	SUP	Custom 27203010		945RMA1019SP  -  ELECTRODE 945RMA1019SP 5.5-2MMLARYNGEAL	BOTH IP/OP	$289.50 	$214.23	$0.00	$231.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.87	$214.87	$0.00	$0.00	$60.33	$0.00	$0.00	$0.00	$0.00	$144.75	$229.28	$231.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945RMA2029	SUP	Custom 27203010		945RMA2029  -  ELECTRODE 945RMA2029 LARGE LARYNGEAL	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945RMA2029SP	SUP	Custom 27203010		945RMA2029SP  -  ELECTRODE 945RMA2029SP MEDIUM LARYNGEAL	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$0.00	$0.00	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
945SRE1002	SUP	Custom 27203010		945SRE1002  -  ELECTRODE 945SRE1002 SD SURFACERECORDING	BOTH IP/OP	$891.00 	$659.34	$0.00	$712.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$661.30	$661.30	$0.00	$0.00	$185.68	$0.00	$0.00	$0.00	$0.00	$445.50	$705.67	$712.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9461-217	SUP	Custom 27203010		TUBING BP RECT SCR CONNCTR LF 12FT PED ADLT GRY EGL 3K DASH	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95-1318BIO	SUP	Custom 27203010		BAG 18X13IN BHZR LOGO SPGRD SPEC	BOTH IP/OP	$0.40 	$0.30	$0.00	$0.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.20	$0.32	$0.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95-201	SUP	Custom 27203010		REAGENT LUPOTEK CORRECTIN ANALY	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9529-	SUP	Custom 27203010		9529-  -  SLEEVE CMPR MED KN LGTH 21- IN NS LF KDL SCD EXP ADJ CRCMF	BOTH IP/OP	$34.45 	$25.49	$0.00	$27.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.49	$27.28	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96004-N	SUP	Custom 27203010		PACIFIER NBN SIL STH 1 PC DSGN LF NTR	BOTH IP/OP	$2.58 	$1.91	$0.00	$2.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.29	$2.04	$2.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96505H	SUP	Custom 27803010		96505H  -  CONNECTOR ROD 6.35/6.35MM DMN SPNE	BOTH IP/OP	"$1,796.58 "	"$1,329.47"	$0.00	"$1,437.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,333.42"	"$1,333.42"	$0.00	$0.00	$374.41	$0.00	$0.00	$0.00	$0.00	$898.29	"$1,422.89"	"$1,437.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96505HT	SUP	Custom 27803010		96505HT  -  CONNECTOR 96505HT DOM DIA 6.35-6.35 TI	BOTH IP/OP	"$1,831.18 "	"$1,355.07"	$0.00	"$1,464.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,359.10"	"$1,359.10"	$0.00	$0.00	$381.62	$0.00	$0.00	$0.00	$0.00	$915.59	"$1,450.29"	"$1,464.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96507H	SUP	Custom 27803010		96507H  -  CONNECTOR 96507H CDH DOMINO 6.35-7MM	BOTH IP/OP	"$1,796.58 "	"$1,329.47"	$0.00	"$1,437.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,333.42"	"$1,333.42"	$0.00	$0.00	$374.41	$0.00	$0.00	$0.00	$0.00	$898.29	"$1,422.89"	"$1,437.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96509H	SUP	Custom 27803010		96509H  -  CONNECTOR 96509H AXIAL 6.35- 6.35	BOTH IP/OP	"$2,118.45 "	"$1,567.65"	$0.00	"$1,694.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,572.31"	"$1,572.31"	$0.00	$0.00	$441.48	$0.00	$0.00	$0.00	$0.00	"$1,059.23"	"$1,677.81"	"$1,694.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96509HT	SUP	Custom 27803010		96509HT  -  CONNECTOR 96509HT AXIAL 6.35- 6.35TI	BOTH IP/OP	"$2,346.10 "	"$1,736.11"	$0.00	"$1,876.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,741.28"	"$1,741.28"	$0.00	$0.00	$488.93	$0.00	$0.00	$0.00	$0.00	"$1,173.05"	"$1,858.11"	"$1,876.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
968-021	SUP	HCPCS C1713		968-021  -  ROD 968-021    WITH LINE SS	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
96880-021	SUP	Custom 27803010		96880-021  -  CANNULA PRFSN 60CM 21FR FEM PERC VN ADLT 3/8IN 1	BOTH IP/OP	$986.86 	$730.28	$0.00	$848.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.45	$732.45	$0.00	$0.00	$205.66	$0.00	$0.00	$0.00	$0.00	$530.00	$839.52	$848.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
96880-025	SUP	Custom 27203010		96880-025  -  CANNULA PERFUSION 3/8IN 25FR 60CM 1 PIECE KINK RESISTANT	BOTH IP/OP	$986.86 	$730.28	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.45	$732.45	$0.00	$0.00	$205.66	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
969-012	SUP	HCPCS C1713		969-012  -  ROD 969-012 SEA FOAM GREEN CP	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
969-022	SUP	HCPCS C1713		969-022  -  ROD 969-022 SEA FOAM GREEN CP W/LINE	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
976-119	SUP	HCPCS C1713		976-119  -  PLATE BN 19MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
976-121	SUP	HCPCS C1713		976-121  -  PLATE 21MM TI LCK ATL VS BONE ANT CERV SPNE STRL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
976-123	SUP	HCPCS C1713		976-123  -  PLATE 23MM TI LCK ATL VS BONE ANT CERV SPN STRL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
976-125	SUP	HCPCS C1713		976-125  -  PLATE 25MM TI LCK ATL VS BONE ANT CERV SPN STRL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
976-127	SUP	HCPCS C1713		976-127  -  PLATE 27.5MM TI ATLNTS BONE ANT CERV SPN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
976-130	SUP	HCPCS C1713		976-130  -  PLATE BN 30MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
976-132	SUP	HCPCS C1713		976-132  -  PLATE BN 32.5MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
976-135	SUP	HCPCS C1713		976-135  -  PLATE BN 35MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
976-137	SUP	HCPCS C1713		976-137  -  PLATE BN 37.5MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
976-140	SUP	HCPCS C1713		976-140  -  PLATE BN 40MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
976-142	SUP	HCPCS C1713		976-142  -  PLATE 42.5MM TI ALLOY LCK ATL VS BONE ANT CERV SPN STRL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
976-145	SUP	HCPCS C1713		976-145  -  PLATE 45MM TI ATLNTS BONE ANT CERV SPN	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
976-147	SUP	HCPCS C1713		976-147  -  PLATE BN 47.5MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
976-150	SUP	HCPCS C1713		976-150  -  PLATE BN 50MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
976-152	SUP	HCPCS C1713		976-152  -  PLATE BN 52.5MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
976-155	SUP	HCPCS C1713		976-155  -  PLATE BN 55MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
976-157	SUP	HCPCS C1713		976-157  -  PLATE BN 57.5MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
976-160	SUP	HCPCS C1713		976-160  -  PLATE BN 60MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
976-162	SUP	HCPCS C1713		976-162  -  PLATE BN 62.5MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
976-165	SUP	HCPCS C1713		976-165  -  PLATE BN 65MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
976-167	SUP	HCPCS C1713		976-167  -  PLATE BN 67.5MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
976-170	SUP	HCPCS C1713		976-170  -  PLATE BN 70MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
976-172	SUP	HCPCS C1713		976-172  -  PLATE BN 72.5MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
976-175	SUP	HCPCS C1713		976-175  -  PLATE BN 75MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
976-177	SUP	HCPCS C1713		976-177  -  PLATE BN 77.5MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
976-180	SUP	HCPCS C1713		976-180  -  PLATE BN 80MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
976-182	SUP	HCPCS C1713		976-182  -  PLATE BN 82.5MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
976-185	SUP	HCPCS C1713		976-185  -  PLATE BN 85MM STRL ATL VS LCK TI SPNE CRV ANT	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
976-187	SUP	HCPCS C1713		976-187  -  PLATE 87.5MM TI LCK ATL VS BONE ANT CERV SPN STRL	BOTH IP/OP	"$4,278.00 "	"$3,165.72"	$0.00	"$3,422.40"	"$1,925.10"	"$1,925.10"	$0.00	$0.00	$0.00	$891.64	"$3,175.13"	"$3,175.13"	$0.00	$0.00	$891.54	$0.00	"$2,109.05"	"$2,109.05"	$0.00	"$2,139.00"	"$3,388.18"	"$3,422.40"	$0.00		$0.00	$669.51	$0.00	$0.00	$681.06	$0.00	$0.00	$0.00	$0.00	$0.00
976-190	SUP	HCPCS C1713		976-190  -  PLATE 90MM TI ATL VS BONE ANT CERV SPN	BOTH IP/OP	"$4,278.00 "	"$3,165.72"	$0.00	"$3,422.40"	"$1,925.10"	"$1,925.10"	$0.00	$0.00	$0.00	$891.64	"$3,175.13"	"$3,175.13"	$0.00	$0.00	$891.54	$0.00	"$2,109.05"	"$2,109.05"	$0.00	"$2,139.00"	"$3,388.18"	"$3,422.40"	$0.00		$0.00	$669.51	$0.00	$0.00	$681.06	$0.00	$0.00	$0.00	$0.00	$0.00
976-195	SUP	HCPCS C1713		976-195  -  PLATE 95MM TI LCK ATL VS BONE ANT CERV SPN STRL	BOTH IP/OP	"$4,278.00 "	"$3,165.72"	$0.00	"$3,422.40"	"$1,925.10"	"$1,925.10"	$0.00	$0.00	$0.00	$891.64	"$3,175.13"	"$3,175.13"	$0.00	$0.00	$891.54	$0.00	"$2,109.05"	"$2,109.05"	$0.00	"$2,139.00"	"$3,388.18"	"$3,422.40"	$0.00		$0.00	$669.51	$0.00	$0.00	$681.06	$0.00	$0.00	$0.00	$0.00	$0.00
976-200	SUP	HCPCS C1713		976-200  -  PLATE 100MM TI LCK ATL VS BONE ANT CERV SPN STRL	BOTH IP/OP	"$4,278.00 "	"$3,165.72"	$0.00	"$3,422.40"	"$1,925.10"	"$1,925.10"	$0.00	$0.00	$0.00	$891.64	"$3,175.13"	"$3,175.13"	$0.00	$0.00	$891.54	$0.00	"$2,109.05"	"$2,109.05"	$0.00	"$2,139.00"	"$3,388.18"	"$3,422.40"	$0.00		$0.00	$669.51	$0.00	$0.00	$681.06	$0.00	$0.00	$0.00	$0.00	$0.00
976-205	SUP	HCPCS C1713		976-205  -  PLATE 105MM TI LCK ATL VS BONE ANT CERV SPN STRL	BOTH IP/OP	"$4,278.00 "	"$3,165.72"	$0.00	"$3,422.40"	"$1,925.10"	"$1,925.10"	$0.00	$0.00	$0.00	$891.64	"$3,175.13"	"$3,175.13"	$0.00	$0.00	$891.54	$0.00	"$2,109.05"	"$2,109.05"	$0.00	"$2,139.00"	"$3,388.18"	"$3,422.40"	$0.00		$0.00	$669.51	$0.00	$0.00	$681.06	$0.00	$0.00	$0.00	$0.00	$0.00
976-210	SUP	HCPCS C1713		976-210  -  PLATE 110MM TI LCK ATL VS BONE ANT CERV SPN STRL	BOTH IP/OP	"$4,278.00 "	"$3,165.72"	$0.00	"$3,422.40"	"$1,925.10"	"$1,925.10"	$0.00	$0.00	$0.00	$891.64	"$3,175.13"	"$3,175.13"	$0.00	$0.00	$891.54	$0.00	"$2,109.05"	"$2,109.05"	$0.00	"$2,139.00"	"$3,388.18"	"$3,422.40"	$0.00		$0.00	$669.51	$0.00	$0.00	$681.06	$0.00	$0.00	$0.00	$0.00	$0.00
976-612	SUP	HCPCS C1713		976-612  -  SCREW BN 4MM 12MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
976-613	SUP	HCPCS C1713		976-613  -  SCREW BN 4MM 13MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
976-614	SUP	HCPCS C1713		976-614  -  SCREW BN 4MM 14MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
976-615	SUP	HCPCS C1713		976-615  -  SCREW BN 4MM 15MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
976-643	SUP	HCPCS C1713		976-643  -  SCREW BN 4.5MM 13MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
976-644	SUP	HCPCS C1713		976-644  -  SCREW BN 4.5MM 14MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
976-645	SUP	HCPCS C1713		976-645  -  SCREW BN 4.5MM 15MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
9789-	SUP	Custom 27203010		9789-  -  SLEEVE CMPR LG KN LGTH 26- IN NS LF KDL SCD EXP ADJ CRCMF	BOTH IP/OP	$45.05 	$33.34	$0.00	$35.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.57	$35.68	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
995FR19	SUP	Custom 27803010		995FR19  -  FREESTYLE ROOT VALVE 19 MM	BOTH IP/OP	"$15,330.00 "	"$11,344.20"	$0.00	"$12,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,194.77"	$0.00	$0.00	$0.00	$0.00	"$7,665.00"	"$12,141.36"	"$12,264.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
995FR21	SUP	Custom 27803010		995FR21  -  FREESTYLE ROOT VALVE 21 MM	BOTH IP/OP	"$15,330.00 "	"$11,344.20"	$0.00	"$12,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,194.77"	$0.00	$0.00	$0.00	$0.00	"$7,665.00"	"$12,141.36"	"$12,264.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
995FR23	SUP	Custom 27803010		995FR23  -  FREESTYLE ROOT VALVE 23 MM	BOTH IP/OP	"$15,330.00 "	"$11,344.20"	$0.00	"$12,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,194.77"	$0.00	$0.00	$0.00	$0.00	"$7,665.00"	"$12,141.36"	"$12,264.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
995FR25	SUP	Custom 27803010		995FR25  -  FREESTYLE ROOT VALVE 25 MM	BOTH IP/OP	"$15,330.00 "	"$11,344.20"	$0.00	"$12,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,194.77"	$0.00	$0.00	$0.00	$0.00	"$7,665.00"	"$12,141.36"	"$12,264.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
995FR29	SUP	Custom 27803010		995FR29  -  FREESTYLE ROOT VALVE 29 MM	BOTH IP/OP	"$15,330.00 "	"$11,344.20"	$0.00	"$12,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,194.77"	$0.00	$0.00	$0.00	$0.00	"$7,665.00"	"$12,141.36"	"$12,264.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99-7284	SUP	HCPCS C1713		99-7284  -  SCREW BONE 1.5MM 4MM SELF DRILL CENTRE-DRIVE TITANIUM MANDIB	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$63.00	$63.00	$0.00	$0.00	$0.00	$29.18	$103.91	$103.91	$0.00	$0.00	$29.18	$0.00	$82.81	$82.81	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$21.91	$0.00	$0.00	$22.29	$0.00	$0.00	$0.00	$0.00	$0.00
999-LG	SUP	HCPCS L3702		999-LG  -  SPLINT ORTH LG BCKL VLCR CLSR PVC KODEL POST ELB	BOTH IP/OP	$66.03 	$48.86	$0.00	$208.54	$29.71	$29.71	$0.00	$0.00	$198.92	$208.54	$49.00	$49.00	$0.00	$0.00	$13.76	$0.00	$39.05	$39.05	$0.00	$33.01	$52.30	$52.82	$39.62		$39.62	$198.56	$0.00	$0.00	$202.65	$0.00	$0.00	$0.00	$0.00	$0.00
999-MED	SUP	HCPCS L3702		999-MED  -  SPLINT ORTH MED BCKL VLCR CLSR PVC KODEL POST ELB	BOTH IP/OP	$66.03 	$48.86	$0.00	$208.54	$29.71	$29.71	$0.00	$0.00	$198.92	$208.54	$49.00	$49.00	$0.00	$0.00	$13.76	$0.00	$39.05	$39.05	$0.00	$33.01	$52.30	$52.82	$39.62		$39.62	$198.56	$0.00	$0.00	$202.65	$0.00	$0.00	$0.00	$0.00	$0.00
9AC50	SUP	Custom 27203010		9AC50  -  TOOL LEGEND 9CM 5MM AC	BOTH IP/OP	$320.88 	$237.45	$0.00	$256.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.15	$238.15	$0.00	$0.00	$66.87	$0.00	$0.00	$0.00	$0.00	$160.44	$254.14	$256.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9AC60	SUP	Custom 27203010		9AC60  -  TOOL LEGEND 9CM 6MM AC	BOTH IP/OP	$320.88 	$237.45	$0.00	$256.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.15	$238.15	$0.00	$0.00	$66.87	$0.00	$0.00	$0.00	$0.00	$160.44	$254.14	$256.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9AC75	SUP	Custom 27203010		9AC75  -  TOOL LEGEND 9CM 7.5MM AC	BOTH IP/OP	$320.88 	$237.45	$0.00	$256.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.15	$238.15	$0.00	$0.00	$66.87	$0.00	$0.00	$0.00	$0.00	$160.44	$254.14	$256.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9AC90	SUP	Custom 27203010		9AC90  -  TOOL LEGEND 9CM 9MM AC	BOTH IP/OP	$320.88 	$237.45	$0.00	$256.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.15	$238.15	$0.00	$0.00	$66.87	$0.00	$0.00	$0.00	$0.00	$160.44	$254.14	$256.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA30	SUP	Custom 27203010		9BA30  -  TOOL LEGEND 9CM 3MM BA	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA30D	SUP	Custom 27203010		9BA30D  -  TOOL LEGEND 9CM 3MM BA DIAM	BOTH IP/OP	$380.38 	$281.48	$0.00	$304.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.31	$282.31	$0.00	$0.00	$79.27	$0.00	$0.00	$0.00	$0.00	$190.19	$301.26	$304.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA30DC	SUP	Custom 27203010		9BA30DC  -  TOOL LEGEND 9CM 3MM BA DIAM CRS	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA40	SUP	Custom 27203010		9BA40  -  TOOL LEGEND 9CM 4MM BA FLUTED	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA40D	SUP	Custom 27203010		9BA40D  -  TOOL LEGEND 9CM 4MM BA DIAM	BOTH IP/OP	$380.38 	$281.48	$0.00	$304.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.31	$282.31	$0.00	$0.00	$79.27	$0.00	$0.00	$0.00	$0.00	$190.19	$301.26	$304.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA40DC	SUP	Custom 27203010		9BA40DC  -  TOOL LEGEND 9CM 4MM BA DIAM CRS	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA40DX	SUP	Custom 27203010		9BA40DX  -  TOOL LEGEND 9CM 4MM DIAM X CRS	BOTH IP/OP	$378.25 	$279.91	$0.00	$302.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.74	$280.74	$0.00	$0.00	$78.83	$0.00	$0.00	$0.00	$0.00	$189.13	$299.57	$302.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA50DC	SUP	Custom 27203010		9BA50DC  -  TOOL LEGEND 9CM 5MM BA DIAM CRS	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA50DX	SUP	Custom 27203010		9BA50DX  -  TOOL LEGEND 9CM 5MM DIAM X CRS	BOTH IP/OP	$378.25 	$279.91	$0.00	$302.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.74	$280.74	$0.00	$0.00	$78.83	$0.00	$0.00	$0.00	$0.00	$189.13	$299.57	$302.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA60DC	SUP	Custom 27203010		9BA60DC  -  TOOL LEGEND 9CM 6MM BA DIAM CRS	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$283.89	$283.89	$0.00	$0.00	$79.71	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA60DX	SUP	Custom 27203010		9BA60DX  -  TOOL LEGEND 9CM 6MM DIAM X CRS	BOTH IP/OP	$378.25 	$279.91	$0.00	$302.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.74	$280.74	$0.00	$0.00	$78.83	$0.00	$0.00	$0.00	$0.00	$189.13	$299.57	$302.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA75D	SUP	Custom 27203010		9BA75D  -  TOOL LEGEND 9CM 7.5MM BA DIAM	BOTH IP/OP	$380.38 	$281.48	$0.00	$304.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.31	$282.31	$0.00	$0.00	$79.27	$0.00	$0.00	$0.00	$0.00	$190.19	$301.26	$304.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9BA90	SUP	Custom 27203010		9BA90  -  TOOL LEGEND 9CM 9MM BA	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9CY50	SUP	Custom 27203010		9CY50  -  TOOL LEGEND 9CM 5MM CY	BOTH IP/OP	$308.13 	$228.02	$0.00	$246.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.69	$228.69	$0.00	$0.00	$64.21	$0.00	$0.00	$0.00	$0.00	$154.06	$244.04	$246.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9CY60	SUP	Custom 27203010		9CY60  -  TOOL LEGEND 9CM 6MM CY	BOTH IP/OP	$308.13 	$228.02	$0.00	$246.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.69	$228.69	$0.00	$0.00	$64.21	$0.00	$0.00	$0.00	$0.00	$154.06	$244.04	$246.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9CY75	SUP	Custom 27203010		9CY75  -  TOOL LEGEND 9CM 7.5MM CY	BOTH IP/OP	$308.13 	$228.02	$0.00	$246.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.69	$228.69	$0.00	$0.00	$64.21	$0.00	$0.00	$0.00	$0.00	$154.06	$244.04	$246.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9HM100	SUP	Custom 27203010		9HM100  -  TOOL LEGEND 9CM 10MM HOLE MAKER	BOTH IP/OP	$412.25 	$305.07	$0.00	$329.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.97	$305.97	$0.00	$0.00	$85.91	$0.00	$0.00	$0.00	$0.00	$206.13	$326.50	$329.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9HM126	SUP	Custom 27203010		9HM126  -  TOOL LEGEND 9CM 12.6MM HOLE MAKER	BOTH IP/OP	$412.25 	$305.07	$0.00	$329.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.97	$305.97	$0.00	$0.00	$85.91	$0.00	$0.00	$0.00	$0.00	$206.13	$326.50	$329.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9HM95	SUP	Custom 27203010		9HM95  -  TOOL LEGEND 9CM 9.5MM HOLE MAKER	BOTH IP/OP	$412.25 	$305.07	$0.00	$329.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.97	$305.97	$0.00	$0.00	$85.91	$0.00	$0.00	$0.00	$0.00	$206.13	$326.50	$329.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9HS108	SUP	Custom 27203010		9HS108  -  TOOL LEGEND 9CM 10.8MM ID HS	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.98	$346.98	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$233.75	$370.26	$374.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9HS135	SUP	Custom 27203010		9HS135  -  TOOL LEGEND 9CM 13.5MM ID HS	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.98	$346.98	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$233.75	$370.26	$374.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9MH30DC	SUP	Custom 27203010		9MH30DC  -  TOOL LEGEND 9CM 3MM MH DIAM CRS	BOTH IP/OP	$367.63 	$272.05	$0.00	$294.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.85	$272.85	$0.00	$0.00	$76.61	$0.00	$0.00	$0.00	$0.00	$183.81	$291.16	$294.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9OV55	SUP	Custom 27203010		9OV55  -  TOOL LEGEND 9CM 5.5MM OVAL	BOTH IP/OP	$323.00 	$239.02	$0.00	$258.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.73	$239.73	$0.00	$0.00	$67.31	$0.00	$0.00	$0.00	$0.00	$161.50	$255.82	$258.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9SCT	SUP	Custom 27203010		9SCT  -  TUBE TRACHEOSTOMY 12.1MM 9MM 99MM 1 CANNU CUFF LATEX FREE	BOTH IP/OP	$71.38 	$52.82	$0.00	$57.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.97	$52.97	$0.00	$0.00	$14.87	$0.00	$0.00	$0.00	$0.00	$36.22	$57.38	$57.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
9TA30	SUP	Custom 27203010		9TA30  -  TOOL LEGEND 9CM 3MM TA	BOTH IP/OP	$337.88 	$250.03	$0.00	$270.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.77	$250.77	$0.00	$0.00	$70.41	$0.00	$0.00	$0.00	$0.00	$168.94	$267.60	$270.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A0082	SUP	Custom 25003010		ANTIBODY VWF 8 RBT IGG ANHMN 2ML LAB	BOTH IP/OP	$708.10 	$523.99	$0.00	$566.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.05	$560.82	$566.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A1-0014	SUP	HCPCS C1713		A1-0014  -  SCREW BONE 14MM ACUTWIST	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
A1-0016	SUP	HCPCS C1713		A1-0016  -  SCREW BONE 16MM ACUTWIST	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
A1-0020	SUP	HCPCS C1713		A1-0020  -  SCREW BONE 20MM ACUTWIST	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
A1-0022	SUP	HCPCS C1713		A1-0022  -  SCREW BONE 22MM ACUTWIST	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
A10230592	SUP	Custom 27803010		A10230592  -  VALVE AORTIC 21MM EP SUP THV	BOTH IP/OP	"$23,350.00 "	"$17,279.00"	$0.00	"$18,680.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,866.14"	$0.00	$0.00	$0.00	$0.00	"$11,675.00"	"$18,493.20"	"$18,680.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A10235766	SUP	Custom 27803010		A10235766  -  VALVE MTRL 25MM 23MM EP 3 PIG LEAFLETS STNT LINX AC TCH LP	BOTH IP/OP	"$23,350.00 "	"$17,279.00"	$0.00	"$18,680.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,866.14"	$0.00	$0.00	$0.00	$0.00	"$11,675.00"	"$18,493.20"	"$18,680.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A1072	SUP	Custom 27203010		A1072  -  PIN SKL STRL MYFLD WNG GRV PLS ADLT CRNM DISP	BOTH IP/OP	$27.27 	$20.18	$0.00	$21.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.24	$20.24	$0.00	$0.00	$5.68	$0.00	$0.00	$0.00	$0.00	$13.64	$21.60	$21.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A-1083	SUP	HCPCS C1713		A-1083  -  PIN SKULL 13MM RED O RING SECURE FIT RIGID FIX MAYFIELD	BOTH IP/OP	$102.50 	$75.85	$0.00	$82.00	$46.13	$46.13	$0.00	$0.00	$0.00	$21.36	$76.08	$76.08	$0.00	$0.00	$21.36	$0.00	$60.63	$60.63	$0.00	$51.25	$81.18	$82.00	$0.00		$0.00	$16.04	$0.00	$0.00	$16.32	$0.00	$0.00	$0.00	$0.00	$0.00
A14208	SUP	Custom 27203010		REAGENT FOL ACCES SYN 100 TST ANALY	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A16793	SUP	Custom 27203010		REAGENT ANALY UNCL DSL WSH BUFF 10L 800 SER	BOTH IP/OP	$77.50 	$57.35	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.75	$61.38	$62.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A16953	SUP	Custom 27203010		CALIBRATOR INTC PTH UNICEL IMMUN	BOTH IP/OP	$382.50 	$283.05	$0.00	$306.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.25	$302.94	$306.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A16972	SUP	Custom 27203010		REAGENT INTC PTH ACCES 100 TST ANALY NEO	BOTH IP/OP	$690.00 	$510.60	$0.00	$552.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.00	$546.48	$552.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A16P4	SUP	Custom 27203010		CHEMICAL LAB ACTN POLY BTL 4L HST GRAD	BOTH IP/OP	$196.40 	$145.34	$0.00	$157.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.20	$155.55	$157.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A16S-4	SUP	Custom 27203010		CHEMICAL LAB ACTN SAFETIN 4L HST GRAD	BOTH IP/OP	$264.35 	$195.62	$0.00	$211.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.18	$209.37	$211.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A18/20	SUP	Custom 27203010		NEEDLE BIOP 18GA 20CM ACHV COAX AUTO PRGM SFT TIS DISP	BOTH IP/OP	$123.00 	$91.02	$0.00	$98.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.50	$97.42	$98.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A1815	SUP	Custom 27203010		NEEDLE BIOP 18GA 15CM ACHV COAX AUTO PRGM SFT TIS DISP	BOTH IP/OP	$92.50 	$68.45	$0.00	$86.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.65	$68.65	$0.00	$0.00	$19.28	$0.00	$0.00	$0.00	$0.00	$54.00	$85.54	$86.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A189	SUP	Custom 27203010		NEEDLE BIOP 18GA 9CM ACHV COAX AUTO PRGM SFT TIS DISP	BOTH IP/OP	$106.95 	$79.14	$0.00	$85.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.48	$84.70	$85.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A19611	SUP	Custom 27203010		REAGENT LI SYN INFNT 18ML 130 TST ANALY	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A200S	SUP	Custom 27203010		REAGENT SHTH FLUID A MLTLY BTL ANALY	BOTH IP/OP	$107.53 	$79.57	$0.00	$86.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.76	$85.16	$86.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A2015-020	SUP	HCPCS C1725		A2015-020  -  CATHETER BLNDIL 1.5MM 150CM 20MM ARMADA FLXB MRKR STREAMLINE	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$115.39	$115.39	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
A2020	SUP	Custom 27203010		NEEDLE BIOP 20GA 20CM ACHV COAX AUTO PRGM SFT TIS DISP	BOTH IP/OP	$116.03 	$85.86	$0.00	$92.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.01	$91.90	$92.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A2020-200	SUP	HCPCS C1725		A2020-200  -  CATHETER BLNDIL 2MM 150CM 200MM ARMADA FLXB MRKR STREAMLINE	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$115.39	$115.39	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
A2030-080	SUP	HCPCS C1725		A2030-080  -  CATHETER BLNDIL 3MM 150CM 80MM ARMADA FLXB MRKR STREAMLINE	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$115.39	$115.39	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
A21101	SUP	Custom 27203010		REAGENT ANA 2 A MLTLY ANALY	BOTH IP/OP	"$3,008.98 "	"$2,226.65"	$0.00	"$2,407.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,504.49"	"$2,383.11"	"$2,407.18"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A2552 25	SUP	Custom 27203010		TRAY EPDRL NRV BLCK A2552 25	BOTH IP/OP	$37.33 	$27.62	$0.00	$29.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.66	$29.57	$29.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A-3434	SUP	Custom 27203010		A-3434  -  BIT DRILL 86MM AO SHAFT TWIST STOP 30MM 1.6MM 2MM SCREW	BOTH IP/OP	$290.00 	$214.60	$0.00	$232.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$0.00	$0.00	$0.00	$145.00	$229.68	$232.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A3524	SUP	Custom 25003010		ANTIBODY TDT RBT PLYCLN .5ML LAB	BOTH IP/OP	"$3,400.00 "	"$2,516.00"	$0.00	"$2,720.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,700.00"	"$2,692.80"	"$2,720.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A368LL	SUP	HCPCS L1930		A368LL  -  SPLINT ORTHOPEDIC 9-10.5 LARGE 20.5IN 7.75IN POSTERIOR LEAF	BOTH IP/OP	$74.98 	$55.49	$0.00	$59.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.65	$55.65	$0.00	$0.00	$15.62	$0.00	$0.00	$0.00	$0.00	$37.49	$59.38	$59.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A368LM	SUP	HCPCS L1930		A368LM  -  SPLINT ORTHOPEDIC 7-9 MEDIUM 19.5IN 7IN POSTERIOR LEAF	BOTH IP/OP	$74.98 	$55.49	$0.00	$59.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.65	$55.65	$0.00	$0.00	$15.62	$0.00	$0.00	$0.00	$0.00	$37.49	$59.38	$59.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A368LX	SUP	HCPCS L1930		A368LX  -  SPLINT ORTHOPEDIC 11-12.5 XL 21.5IN 8.5IN POSTERIOR LEAF	BOTH IP/OP	$80.58 	$59.63	$0.00	$64.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.80	$59.80	$0.00	$0.00	$16.79	$0.00	$0.00	$0.00	$0.00	$40.29	$63.82	$64.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A368RL	SUP	HCPCS L1930		A368RL  -  SPLINT ORTHOPEDIC 9-11 LARGE 20.5IN 7.75IN POSTERIOR LEAF	BOTH IP/OP	$74.98 	$55.49	$0.00	$59.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.65	$55.65	$0.00	$0.00	$15.62	$0.00	$0.00	$0.00	$0.00	$37.49	$59.38	$59.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A368RM	SUP	HCPCS L1930		A368RM  -  SPLINT ORTHOPEDIC 7-9 MEDIUM 19.5IN 7IN POSTERIOR LEAF	BOTH IP/OP	$74.98 	$55.49	$0.00	$59.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.65	$55.65	$0.00	$0.00	$15.62	$0.00	$0.00	$0.00	$0.00	$37.49	$59.38	$59.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A368RX	SUP	HCPCS L1930		A368RX  -  SPLINT ORTHOPEDIC 11-12.5 XL 21.5IN 8.5IN POSTERIOR LEAF	BOTH IP/OP	$80.58 	$59.63	$0.00	$64.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.80	$59.80	$0.00	$0.00	$16.79	$0.00	$0.00	$0.00	$0.00	$40.29	$63.82	$64.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A38-212	SUP	Custom 27203010		CHEMICAL GLAC ACETCID 2.5L GLS BTL ACS GRAD LAB	BOTH IP/OP	$267.70 	$198.10	$0.00	$214.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.85	$212.02	$214.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A390014	SUP	HCPCS C1713		A390014  -  WASHER ORTH 8MM 4MM	BOTH IP/OP	$35.70 	$26.42	$0.00	$28.56	$16.07	$16.07	$0.00	$0.00	$0.00	$7.44	$26.50	$26.50	$0.00	$0.00	$7.44	$0.00	$21.12	$21.12	$0.00	$17.85	$28.27	$28.56	$0.00		$0.00	$5.59	$0.00	$0.00	$5.68	$0.00	$0.00	$0.00	$0.00	$0.00
A3SR01	SUP	HCPCS C1786		A3SR01  -  PACEMAKER CRD ADVISA SR MR SURESCAN 1 CHMBR UNPLR	BOTH IP/OP	"$7,595.00 "	"$5,620.30"	$0.00	"$6,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,582.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,582.80"	$0.00	"$3,744.34"	"$3,744.34"	$0.00	"$3,875.00"	"$6,138.00"	"$6,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.01	SUP	HCPCS C1713		A-4300.01  -  PLATE BN STRG 18MMX.6MM APTUS 4 HL FX TI HND 1.2/1.5MM SCR	BOTH IP/OP	$580.13 	$429.30	$0.00	$464.10	$261.06	$261.06	$0.00	$0.00	$0.00	$120.91	$430.57	$430.57	$0.00	$0.00	$120.90	$0.00	$343.14	$343.14	$0.00	$290.06	$459.46	$464.10	$0.00		$0.00	$90.79	$0.00	$0.00	$92.36	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.03	SUP	HCPCS C1713		A-4300.03  -  PLATE 6 HOLE BONE	BOTH IP/OP	$580.13 	$429.30	$0.00	$464.10	$261.06	$261.06	$0.00	$0.00	$0.00	$120.91	$430.57	$430.57	$0.00	$0.00	$120.90	$0.00	$343.14	$343.14	$0.00	$290.06	$459.46	$464.10	$0.00		$0.00	$90.79	$0.00	$0.00	$92.36	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.04	SUP	HCPCS C1713		A-4300.04  -  PLATE 1.5MM 16 HOLE STR BONE 1.2MM	BOTH IP/OP	$784.88 	$580.81	$0.00	$627.90	$353.19	$353.19	$0.00	$0.00	$0.00	$163.59	$582.53	$582.53	$0.00	$0.00	$163.57	$0.00	$464.25	$464.25	$0.00	$392.44	$621.62	$627.90	$0.00		$0.00	$122.83	$0.00	$0.00	$124.95	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.05	SUP	HCPCS C1713		A-4300.05  -  PLATE BN CRV 69MMX.6MM APTUS 16 HL FX TI HND 1.2/1.5MM SCR	BOTH IP/OP	$784.88 	$580.81	$0.00	$627.90	$353.19	$353.19	$0.00	$0.00	$0.00	$163.59	$582.53	$582.53	$0.00	$0.00	$163.57	$0.00	$464.25	$464.25	$0.00	$392.44	$621.62	$627.90	$0.00		$0.00	$122.83	$0.00	$0.00	$124.95	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.06	SUP	HCPCS C1713		A-4300.06  -  PLATE BN OFST 51MMX.6MM APTUS 16 HL FX TI HND 1.2/1.5MM SCR	BOTH IP/OP	$784.88 	$580.81	$0.00	$627.90	$353.19	$353.19	$0.00	$0.00	$0.00	$163.59	$582.53	$582.53	$0.00	$0.00	$163.57	$0.00	$464.25	$464.25	$0.00	$392.44	$621.62	$627.90	$0.00		$0.00	$122.83	$0.00	$0.00	$124.95	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.10	SUP	HCPCS C1713		A-4300.10  -  PLATE BN T 27MMX.6MM APTUS 2X5 HL FX TI HND 1.2/1.5MM SCR	BOTH IP/OP	$690.38 	$510.88	$0.00	$552.30	$310.67	$310.67	$0.00	$0.00	$0.00	$143.89	$512.40	$512.40	$0.00	$0.00	$143.87	$0.00	$408.36	$408.36	$0.00	$345.19	$546.78	$552.30	$0.00		$0.00	$108.04	$0.00	$0.00	$109.91	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.11	SUP	HCPCS C1713		A-4300.11  -  PLATE T 27X10X.6MM TI 1.2-1.5MM SCR 3X5 HOLE FIX APTUS BONE	BOTH IP/OP	$690.38 	$510.88	$0.00	$552.30	$310.67	$310.67	$0.00	$0.00	$0.00	$143.89	$512.40	$512.40	$0.00	$0.00	$143.87	$0.00	$408.36	$408.36	$0.00	$345.19	$546.78	$552.30	$0.00		$0.00	$108.04	$0.00	$0.00	$109.91	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.13	SUP	HCPCS C1713		A-4300.13  -  PLATE BN 1.2MM 1.5MM Y 2.4 HL	BOTH IP/OP	$690.38 	$510.88	$0.00	$552.30	$310.67	$310.67	$0.00	$0.00	$0.00	$143.89	$512.40	$512.40	$0.00	$0.00	$143.87	$0.00	$408.36	$408.36	$0.00	$345.19	$546.78	$552.30	$0.00		$0.00	$108.04	$0.00	$0.00	$109.91	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.20	SUP	HCPCS C1713		A-4300.20  -  PLATE BN 1.2MM 1.5MM L 2-3 HL LT	BOTH IP/OP	$690.38 	$510.88	$0.00	$552.30	$310.67	$310.67	$0.00	$0.00	$0.00	$143.89	$512.40	$512.40	$0.00	$0.00	$143.87	$0.00	$408.36	$408.36	$0.00	$345.19	$546.78	$552.30	$0.00		$0.00	$108.04	$0.00	$0.00	$109.91	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.21	SUP	HCPCS C1713		A-4300.21  -  PLATE BN L RT 18MMX.6MM APTUS 2X3 HL FX TI HND 1.2/1.5MM SCR	BOTH IP/OP	$690.38 	$510.88	$0.00	$552.30	$310.67	$310.67	$0.00	$0.00	$0.00	$143.89	$512.40	$512.40	$0.00	$0.00	$143.87	$0.00	$408.36	$408.36	$0.00	$345.19	$546.78	$552.30	$0.00		$0.00	$108.04	$0.00	$0.00	$109.91	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.50	SUP	HCPCS C1713		A-4300.50  -  PLATE BN RECT 9MMX.6MM APTUS 2X2 HL GRID FX TI HND 1.2/1.5MM	BOTH IP/OP	$711.38 	$526.42	$0.00	$569.10	$320.12	$320.12	$0.00	$0.00	$0.00	$148.27	$527.98	$527.98	$0.00	$0.00	$148.25	$0.00	$420.78	$420.78	$0.00	$355.69	$563.41	$569.10	$0.00		$0.00	$111.33	$0.00	$0.00	$113.25	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.51	SUP	HCPCS C1713		A-4300.51  -  PLATE 1.2 MM 1.5 MM SCR LEAN MESH BONE	BOTH IP/OP	$711.38 	$526.42	$0.00	$569.10	$320.12	$320.12	$0.00	$0.00	$0.00	$148.27	$527.98	$527.98	$0.00	$0.00	$148.25	$0.00	$420.78	$420.78	$0.00	$355.69	$563.41	$569.10	$0.00		$0.00	$111.33	$0.00	$0.00	$113.25	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.54	SUP	HCPCS C1713		A-4300.54  -  PLATE 1.2-1.5 MM SCR MESH TRP 2X2 HOLE BONE	BOTH IP/OP	$711.38 	$526.42	$0.00	$569.10	$320.12	$320.12	$0.00	$0.00	$0.00	$148.27	$527.98	$527.98	$0.00	$0.00	$148.25	$0.00	$420.78	$420.78	$0.00	$355.69	$563.41	$569.10	$0.00		$0.00	$111.33	$0.00	$0.00	$113.25	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.55	SUP	HCPCS C1713		A-4300.55  -  PLATE BN RECT 15MMX.6MM APTUS 3X2 HL GRID FX TI HND 1.2/1.5	BOTH IP/OP	$771.75 	$571.10	$0.00	$617.40	$347.29	$347.29	$0.00	$0.00	$0.00	$160.85	$572.79	$572.79	$0.00	$0.00	$160.83	$0.00	$456.49	$456.49	$0.00	$385.88	$611.23	$617.40	$0.00		$0.00	$120.78	$0.00	$0.00	$122.86	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.56	SUP	HCPCS C1713		A-4300.56  -  PLATE BN TRPZD	BOTH IP/OP	$771.75 	$571.10	$0.00	$617.40	$347.29	$347.29	$0.00	$0.00	$0.00	$160.85	$572.79	$572.79	$0.00	$0.00	$160.83	$0.00	$456.49	$456.49	$0.00	$385.88	$611.23	$617.40	$0.00		$0.00	$120.78	$0.00	$0.00	$122.86	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.58	SUP	HCPCS C1713		A-4300.58  -  PLATE 1.2-1.5 MM SCR MESH TRP 3X2 HOLE BONE LEFT	BOTH IP/OP	$771.75 	$571.10	$0.00	$617.40	$347.29	$347.29	$0.00	$0.00	$0.00	$160.85	$572.79	$572.79	$0.00	$0.00	$160.83	$0.00	$456.49	$456.49	$0.00	$385.88	$611.23	$617.40	$0.00		$0.00	$120.78	$0.00	$0.00	$122.86	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.59	SUP	HCPCS C1713		A-4300.59  -  PLATE BN TRPZD RT 17MMX.6MM APTUS 3X2 HL GRID FX TI HND	BOTH IP/OP	$771.75 	$571.10	$0.00	$617.40	$347.29	$347.29	$0.00	$0.00	$0.00	$160.85	$572.79	$572.79	$0.00	$0.00	$160.83	$0.00	$456.49	$456.49	$0.00	$385.88	$611.23	$617.40	$0.00		$0.00	$120.78	$0.00	$0.00	$122.86	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.60	SUP	HCPCS C1713		A-4300.60  -  PLATE BN ANG LT 17MMX.6MM APTUS 3X3 HL GRID FX TI HND	BOTH IP/OP	$800.63 	$592.47	$0.00	$640.50	$360.28	$360.28	$0.00	$0.00	$0.00	$166.87	$594.22	$594.22	$0.00	$0.00	$166.85	$0.00	$473.57	$473.57	$0.00	$400.31	$634.10	$640.50	$0.00		$0.00	$125.30	$0.00	$0.00	$127.46	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.61	SUP	HCPCS C1713		A-4300.61  -  PLATE BN ANG RT 17MMX.6MM APTUS 3X3 HL GRID FX TI HND	BOTH IP/OP	$800.63 	$592.47	$0.00	$640.50	$360.28	$360.28	$0.00	$0.00	$0.00	$166.87	$594.22	$594.22	$0.00	$0.00	$166.85	$0.00	$473.57	$473.57	$0.00	$400.31	$634.10	$640.50	$0.00		$0.00	$125.30	$0.00	$0.00	$127.46	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.62	SUP	HCPCS C1713		A-4300.62  -  PLATE BN TRPZD 21MMX.6MM APTUS 4X2 HL GRID FX TI HND 1.2/1.5	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$363.83	$363.83	$0.00	$0.00	$0.00	$168.51	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$478.23	$478.23	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$126.53	$0.00	$0.00	$128.71	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.64	SUP	HCPCS C1713		A-4300.64  -  PLATE BN ANG LT 20MMX.6MM APTUS 4X2 HL GRID FX TI HND	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$363.83	$363.83	$0.00	$0.00	$0.00	$168.51	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$478.23	$478.23	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$126.53	$0.00	$0.00	$128.71	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.65	SUP	HCPCS C1713		A-4300.65  -  PLATE BN ANG RT 20MMX.6MM APTUS 4X2 HL GRID FX TI HND	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$363.83	$363.83	$0.00	$0.00	$0.00	$168.51	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$478.23	$478.23	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$126.53	$0.00	$0.00	$128.71	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.66	SUP	HCPCS C1713		A-4300.66  -  PLATE BN ANG LT 27MMX.6MM APTUS 5X2 HL GRID FX TI HND	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$363.83	$363.83	$0.00	$0.00	$0.00	$168.51	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$478.23	$478.23	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$126.53	$0.00	$0.00	$128.71	$0.00	$0.00	$0.00	$0.00	$0.00
A-4300.67	SUP	HCPCS C1713		A-4300.67  -  PLATE BN TRPZD 33MMX.6MM APTUS 6X2 HL GRID FX TI HND 1.2/1.5	BOTH IP/OP	$808.50 	$598.29	$0.00	$646.80	$363.83	$363.83	$0.00	$0.00	$0.00	$168.51	$600.07	$600.07	$0.00	$0.00	$168.49	$0.00	$478.23	$478.23	$0.00	$404.25	$640.33	$646.80	$0.00		$0.00	$126.53	$0.00	$0.00	$128.71	$0.00	$0.00	$0.00	$0.00	$0.00
A43102	SUP	Custom 27804086		A43102  -  FILLER BN VOID 1ML GRFTN ALGRF PTTY JR DBM	BOTH IP/OP	$540.00 	$399.60	$0.00	$432.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$400.79	$400.79	$0.00	$0.00	$112.54	$0.00	$0.00	$0.00	$0.00	$270.00	$427.68	$432.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A43103	SUP	Custom 27804086		A43103  -  GRAFT BN 2.5ML GRFTN PTTY JR DBM	BOTH IP/OP	"$1,190.00 "	$880.60	$0.00	$952.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.22	$883.22	$0.00	$0.00	$248.00	$0.00	$0.00	$0.00	$0.00	$595.00	$942.48	$952.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A433F-1GAL	SUP	Custom 27203010		CHEMICAL METHNL 1GL F STY POLY BTL HST GRAD LAB	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A433P4	SUP	Custom 27203010		CHEMICAL METHNL 4L POLY BTL HST GRAD LAB	BOTH IP/OP	$67.45 	$49.91	$0.00	$53.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.73	$53.42	$53.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A-4340.11	SUP	HCPCS C1713		A-4340.11  -  PLATE BN T OFST 35X10X.6MM APTUS 3X8 HL 2 HK CMPR TI HND	BOTH IP/OP	$879.38 	$650.74	$0.00	$703.50	$395.72	$395.72	$0.00	$0.00	$0.00	$183.28	$652.67	$652.67	$0.00	$0.00	$183.26	$0.00	$520.15	$520.15	$0.00	$439.69	$696.47	$703.50	$0.00		$0.00	$137.62	$0.00	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00
A-4340.12	SUP	HCPCS C1713		A-4340.12  -  PLATE BN T OFST 35X13X.6MM APTUS 4X8 HL CMPR TI HND 1.2/1.5	BOTH IP/OP	$879.38 	$650.74	$0.00	$703.50	$395.72	$395.72	$0.00	$0.00	$0.00	$183.28	$652.67	$652.67	$0.00	$0.00	$183.26	$0.00	$520.15	$520.15	$0.00	$439.69	$696.47	$703.50	$0.00		$0.00	$137.62	$0.00	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00
A-4340.30	SUP	HCPCS C1713		A-4340.30  -  PLATE 30MM 1.5MM SCR 4X8 HOLE GRID ANG CMPR BONE TRPZD	BOTH IP/OP	$950.25 	$703.19	$0.00	$760.20	$427.61	$427.61	$0.00	$0.00	$0.00	$198.06	$705.28	$705.28	$0.00	$0.00	$198.03	$0.00	$562.07	$562.07	$0.00	$475.13	$752.60	$760.20	$0.00		$0.00	$148.71	$0.00	$0.00	$151.28	$0.00	$0.00	$0.00	$0.00	$0.00
A-4340.31	SUP	HCPCS C1713		A-4340.31  -  PLATE 5 HOLE CMPR PIN BONE RIGHT	BOTH IP/OP	$950.25 	$703.19	$0.00	$760.20	$427.61	$427.61	$0.00	$0.00	$0.00	$198.06	$705.28	$705.28	$0.00	$0.00	$198.03	$0.00	$562.07	$562.07	$0.00	$475.13	$752.60	$760.20	$0.00		$0.00	$148.71	$0.00	$0.00	$151.28	$0.00	$0.00	$0.00	$0.00	$0.00
A-4340.32	SUP	HCPCS C1713		A-4340.32  -  PLATE BN .6MM APTUS 1 HL 2 HK CMPR TI HND 1.2/1.5MM SCR	BOTH IP/OP	$879.38 	$650.74	$0.00	$703.50	$395.72	$395.72	$0.00	$0.00	$0.00	$183.28	$652.67	$652.67	$0.00	$0.00	$183.26	$0.00	$520.15	$520.15	$0.00	$439.69	$696.47	$703.50	$0.00		$0.00	$137.62	$0.00	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00
A-4350.01	SUP	HCPCS C1713		A-4350.01  -  PLATE STR 19MMX.8MM TI 1.5MM SCR 4 HOLE APTUS TRLK BONE	BOTH IP/OP	"$1,141.88 "	$844.99	$0.00	$913.50	$513.84	$513.84	$0.00	$0.00	$0.00	$238.00	$847.50	$847.50	$0.00	$0.00	$237.97	$0.00	$675.42	$675.42	$0.00	$570.94	$904.37	$913.50	$0.00		$0.00	$178.70	$0.00	$0.00	$181.79	$0.00	$0.00	$0.00	$0.00	$0.00
A-4350.14	SUP	HCPCS C1713		A-4350.14  -  PLATE T 25X11X.8MM TI 1.5MM SCR 8 HOLE APTUS TRLK BONE	BOTH IP/OP	"$1,218.00 "	$901.32	$0.00	$974.40	$548.10	$548.10	$0.00	$0.00	$0.00	$253.86	$904.00	$904.00	$0.00	$0.00	$253.83	$0.00	$720.45	$720.45	$0.00	$609.00	$964.66	$974.40	$0.00		$0.00	$190.62	$0.00	$0.00	$193.91	$0.00	$0.00	$0.00	$0.00	$0.00
A-4350.23	SUP	HCPCS C1713		A-4350.23  -  PLATE 23X9X.8MM TI 1.5MM SCR 6 HOLE ROT APTUS TRLK BONE	BOTH IP/OP	"$1,241.63 "	$918.81	$0.00	$993.30	$558.73	$558.73	$0.00	$0.00	$0.00	$258.79	$921.53	$921.53	$0.00	$0.00	$258.75	$0.00	$734.42	$734.42	$0.00	$620.81	$983.37	$993.30	$0.00		$0.00	$194.31	$0.00	$0.00	$197.67	$0.00	$0.00	$0.00	$0.00	$0.00
A-4350.41	SUP	HCPCS C1713		A-4350.41  -  PLATE T 24X11X.8MM TI 1.5MM SCR 9 HOLE 2 ROW APTUS TRLK BONE	BOTH IP/OP	"$1,262.63 "	$934.35	$0.00	"$1,010.10"	$568.18	$568.18	$0.00	$0.00	$0.00	$263.16	$937.12	$937.12	$0.00	$0.00	$263.13	$0.00	$746.84	$746.84	$0.00	$631.31	"$1,000.00"	"$1,010.10"	$0.00		$0.00	$197.60	$0.00	$0.00	$201.01	$0.00	$0.00	$0.00	$0.00	$0.00
A-4350.50	SUP	HCPCS C1713		A-4350.50  -  PLATE RECT 9MMX.8MM TI 1.5MM SCR 4 HOLE GRID APTUS TRLK BONE	BOTH IP/OP	"$1,372.88 "	"$1,015.93"	$0.00	"$1,098.30"	$617.79	$617.79	$0.00	$0.00	$0.00	$286.14	"$1,018.95"	"$1,018.95"	$0.00	$0.00	$286.11	$0.00	$812.06	$812.06	$0.00	$686.44	"$1,087.32"	"$1,098.30"	$0.00		$0.00	$214.85	$0.00	$0.00	$218.56	$0.00	$0.00	$0.00	$0.00	$0.00
A-4350.56	SUP	HCPCS C1713		A-4350.56  -  PLATE TRPZD 15MMX.8MM TI 1.5MM SCR 6X2 HOLE GRID APTUS TRLK	BOTH IP/OP	"$1,420.13 "	"$1,050.90"	$0.00	"$1,136.10"	$639.06	$639.06	$0.00	$0.00	$0.00	$295.99	"$1,054.02"	"$1,054.02"	$0.00	$0.00	$295.95	$0.00	$840.00	$840.00	$0.00	$710.06	"$1,124.74"	"$1,136.10"	$0.00		$0.00	$222.25	$0.00	$0.00	$226.08	$0.00	$0.00	$0.00	$0.00	$0.00
A-4350.62	SUP	HCPCS C1713		A-4350.62  -  PLATE TRPZD 21MMX.8MM TI 1.5MM SCR 4X2 HOLE GRID APTUS TRLK	BOTH IP/OP	"$1,496.25 "	"$1,107.23"	$0.00	"$1,197.00"	$673.31	$673.31	$0.00	$0.00	$0.00	$311.86	"$1,110.52"	"$1,110.52"	$0.00	$0.00	$311.82	$0.00	$885.03	$885.03	$0.00	$748.13	"$1,185.03"	"$1,197.00"	$0.00		$0.00	$234.16	$0.00	$0.00	$238.20	$0.00	$0.00	$0.00	$0.00	$0.00
A-4350.66	SUP	HCPCS C1713		A-4350.66  -  PLATE TRPZD 27MMX.8MM TI 1.5MM SCR 5X2 HOLE GRID APTUS TRLK	BOTH IP/OP	"$1,530.38 "	"$1,132.48"	$0.00	"$1,224.30"	$688.67	$688.67	$0.00	$0.00	$0.00	$318.97	"$1,135.84"	"$1,135.84"	$0.00	$0.00	$318.93	$0.00	$905.22	$905.22	$0.00	$765.19	"$1,212.06"	"$1,224.30"	$0.00		$0.00	$239.50	$0.00	$0.00	$243.64	$0.00	$0.00	$0.00	$0.00	$0.00
A-4350.80	SUP	HCPCS C1713		A-4350.80  -  PLATE SCPHD 17MMX.8MM TI 1.5MM SCR 6 HOLE APTUS TRLK BONE	BOTH IP/OP	"$1,496.25 "	"$1,107.23"	$0.00	"$1,197.00"	$673.31	$673.31	$0.00	$0.00	$0.00	$311.86	"$1,110.52"	"$1,110.52"	$0.00	$0.00	$311.82	$0.00	$885.03	$885.03	$0.00	$748.13	"$1,185.03"	"$1,197.00"	$0.00		$0.00	$234.16	$0.00	$0.00	$238.20	$0.00	$0.00	$0.00	$0.00	$0.00
A4502	SUP	Custom 25003010		ANTIBODY CD117 PLYCLN RBT ANHMN .2 1ML LAB	BOTH IP/OP	"$1,399.23 "	"$1,035.43"	$0.00	"$1,119.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$699.61	"$1,108.19"	"$1,119.38"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A45-10020	SUP	HCPCS C1713		A45-10020  -  SCREW BONE 4.5/3.5MM 100MM 20MM DNFX SS CORT TPR	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
A-4645.01	SUP	HCPCS C1713		A-4645.01  -  PLATE BN STRG 29MMX1.3MM APTUS 4 HL CMPR TI MTCRPL 2/2.3MM	BOTH IP/OP	$816.38 	$604.12	$0.00	$653.10	$367.37	$367.37	$0.00	$0.00	$0.00	$170.15	$605.91	$605.91	$0.00	$0.00	$170.13	$0.00	$482.89	$482.89	$0.00	$408.19	$646.57	$653.10	$0.00		$0.00	$127.76	$0.00	$0.00	$129.97	$0.00	$0.00	$0.00	$0.00	$0.00
A-4645.02	SUP	HCPCS C1713		A-4645.02  -  PLATE BN STRG 36MMX1.3MM APTUS 5 HL CMPR TI MTCRPL 2/2.3MM	BOTH IP/OP	$816.38 	$604.12	$0.00	$653.10	$367.37	$367.37	$0.00	$0.00	$0.00	$170.15	$605.91	$605.91	$0.00	$0.00	$170.13	$0.00	$482.89	$482.89	$0.00	$408.19	$646.57	$653.10	$0.00		$0.00	$127.76	$0.00	$0.00	$129.97	$0.00	$0.00	$0.00	$0.00	$0.00
A-4645.03	SUP	HCPCS C1713		A-4645.03  -  PLATE BN STRG 42MMX1.3MM APTUS 6 HL CMPR TI MTCRPL 2/2.3MM	BOTH IP/OP	$816.38 	$604.12	$0.00	$653.10	$367.37	$367.37	$0.00	$0.00	$0.00	$170.15	$605.91	$605.91	$0.00	$0.00	$170.13	$0.00	$482.89	$482.89	$0.00	$408.19	$646.57	$653.10	$0.00		$0.00	$127.76	$0.00	$0.00	$129.97	$0.00	$0.00	$0.00	$0.00	$0.00
A-4645.08	SUP	HCPCS C1713		A-4645.08  -  PLATE STR 2-2.3MM SCR 8 HOLE 4 CRNR FSN CMPR APTUS BONE	BOTH IP/OP	$918.75 	$679.88	$0.00	$735.00	$413.44	$413.44	$0.00	$0.00	$0.00	$191.49	$681.90	$681.90	$0.00	$0.00	$191.47	$0.00	$543.44	$543.44	$0.00	$459.38	$727.65	$735.00	$0.00		$0.00	$143.78	$0.00	$0.00	$146.27	$0.00	$0.00	$0.00	$0.00	$0.00
A-4645.10	SUP	HCPCS C1713		A-4645.10  -  PLATE BN T 35MMX1.3MM APTUS 2X4 HL CMPR TI MTCRPL 2/2.3MM	BOTH IP/OP	$737.63 	$545.85	$0.00	$590.10	$331.93	$331.93	$0.00	$0.00	$0.00	$153.74	$547.47	$547.47	$0.00	$0.00	$153.72	$0.00	$436.31	$436.31	$0.00	$368.81	$584.20	$590.10	$0.00		$0.00	$115.44	$0.00	$0.00	$117.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-4645.16	SUP	HCPCS C1713		A-4645.16  -  PLATE BN T 60MMX1.3MM APTUS 2X8 HL CMPR TI MTCRPL 2/2.3MM	BOTH IP/OP	$997.50 	$738.15	$0.00	$798.00	$448.88	$448.88	$0.00	$0.00	$0.00	$207.90	$740.34	$740.34	$0.00	$0.00	$207.88	$0.00	$590.02	$590.02	$0.00	$498.75	$790.02	$798.00	$0.00		$0.00	$156.11	$0.00	$0.00	$158.80	$0.00	$0.00	$0.00	$0.00	$0.00
A-4645.20	SUP	HCPCS C1713		A-4645.20  -  PLATE BN L LT 37MMX1.3MM APTUS 2X4 HL CMPR TI MTCRPL 2/2.3MM	BOTH IP/OP	$737.63 	$545.85	$0.00	$590.10	$331.93	$331.93	$0.00	$0.00	$0.00	$153.74	$547.47	$547.47	$0.00	$0.00	$153.72	$0.00	$436.31	$436.31	$0.00	$368.81	$584.20	$590.10	$0.00		$0.00	$115.44	$0.00	$0.00	$117.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-4645.21	SUP	HCPCS C1713		A-4645.21  -  PLATE BN L RT 37MMX1.3MM APTUS 2X4 HL CMPR TI MTCRPL 2/2.3MM	BOTH IP/OP	$737.63 	$545.85	$0.00	$590.10	$331.93	$331.93	$0.00	$0.00	$0.00	$153.74	$547.47	$547.47	$0.00	$0.00	$153.72	$0.00	$436.31	$436.31	$0.00	$368.81	$584.20	$590.10	$0.00		$0.00	$115.44	$0.00	$0.00	$117.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-4645.22	SUP	HCPCS C1713		A-4645.22  -  PLATE BN L LT 63MMX1.3MM APTUS 2X8 HL CMPR TI MTCRPL 2/2.3MM	BOTH IP/OP	$997.50 	$738.15	$0.00	$798.00	$448.88	$448.88	$0.00	$0.00	$0.00	$207.90	$740.34	$740.34	$0.00	$0.00	$207.88	$0.00	$590.02	$590.02	$0.00	$498.75	$790.02	$798.00	$0.00		$0.00	$156.11	$0.00	$0.00	$158.80	$0.00	$0.00	$0.00	$0.00	$0.00
A-4645.23	SUP	HCPCS C1713		A-4645.23  -  PLATE RIGHT ANG 63MMX1.3MM 2-2.3MM SCR 2X8 HOLE CMPR BAR	BOTH IP/OP	$997.50 	$738.15	$0.00	$798.00	$448.88	$448.88	$0.00	$0.00	$0.00	$207.90	$740.34	$740.34	$0.00	$0.00	$207.88	$0.00	$590.02	$590.02	$0.00	$498.75	$790.02	$798.00	$0.00		$0.00	$156.11	$0.00	$0.00	$158.80	$0.00	$0.00	$0.00	$0.00	$0.00
A-4650.03	SUP	HCPCS C1713		A-4650.03  -  PLATE BN STRG 33MMX1MM APTUS TRLK 6 HL TI HND 2/2.3MM SCR	BOTH IP/OP	"$1,186.50 "	$878.01	$0.00	$949.20	$533.93	$533.93	$0.00	$0.00	$0.00	$247.30	$880.62	$880.62	$0.00	$0.00	$247.27	$0.00	$701.81	$701.81	$0.00	$593.25	$939.71	$949.20	$0.00		$0.00	$185.69	$0.00	$0.00	$188.89	$0.00	$0.00	$0.00	$0.00	$0.00
A-4650.10	SUP	HCPCS C1713		A-4650.10  -  PLATE BN T 29MMX1MM APTUS TRLK 2X4 HL TI HND 2/2.3MM SCR	BOTH IP/OP	"$1,228.50 "	$909.09	$0.00	$982.80	$552.83	$552.83	$0.00	$0.00	$0.00	$256.05	$911.79	$911.79	$0.00	$0.00	$256.02	$0.00	$726.66	$726.66	$0.00	$614.25	$972.97	$982.80	$0.00		$0.00	$192.26	$0.00	$0.00	$195.58	$0.00	$0.00	$0.00	$0.00	$0.00
A-4650.11	SUP	HCPCS C1713		A-4650.11  -  PLATE BN T 29X13X1MM APTUS TRLK 3X4 HL TI HND 2/2.3MM SCR	BOTH IP/OP	"$1,286.25 "	$951.83	$0.00	"$1,029.00"	$578.81	$578.81	$0.00	$0.00	$0.00	$268.09	$954.65	$954.65	$0.00	$0.00	$268.05	$0.00	$760.82	$760.82	$0.00	$643.13	"$1,018.71"	"$1,029.00"	$0.00		$0.00	$201.30	$0.00	$0.00	$204.77	$0.00	$0.00	$0.00	$0.00	$0.00
A-4650.13	SUP	HCPCS C1713		A-4650.13  -  PLATE BN Y 35MMX1MM APTUS TRLK 2X5 HL TI HND 2/2.3MM SCR	BOTH IP/OP	"$1,265.25 "	$936.29	$0.00	"$1,012.20"	$569.36	$569.36	$0.00	$0.00	$0.00	$263.71	$939.07	$939.07	$0.00	$0.00	$263.68	$0.00	$748.40	$748.40	$0.00	$632.63	"$1,002.08"	"$1,012.20"	$0.00		$0.00	$198.01	$0.00	$0.00	$201.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-4650.20	SUP	HCPCS C1713		A-4650.20  -  PLATE 20MM 2MM SCR 4 HOLE L LCK GRID CMPR BONE TRPZD	BOTH IP/OP	"$1,218.00 "	$901.32	$0.00	$974.40	$548.10	$548.10	$0.00	$0.00	$0.00	$253.86	$904.00	$904.00	$0.00	$0.00	$253.83	$0.00	$720.45	$720.45	$0.00	$609.00	$964.66	$974.40	$0.00		$0.00	$190.62	$0.00	$0.00	$193.91	$0.00	$0.00	$0.00	$0.00	$0.00
A-4650.21	SUP	HCPCS C1713		A-4650.21  -  PLATE BN L RT 32MMX1MM APTUS TRLK 2X4 HL TI HND 2/2.3MM SCR	BOTH IP/OP	"$1,218.00 "	$901.32	$0.00	$974.40	$548.10	$548.10	$0.00	$0.00	$0.00	$253.86	$904.00	$904.00	$0.00	$0.00	$253.83	$0.00	$720.45	$720.45	$0.00	$609.00	$964.66	$974.40	$0.00		$0.00	$190.62	$0.00	$0.00	$193.91	$0.00	$0.00	$0.00	$0.00	$0.00
A-4650.51	SUP	HCPCS C1713		A-4650.51  -  PLATE BN RECT 13MMX1MM APTUS TRLK 2X2 HL GRID TI HND 2/2.3MM	BOTH IP/OP	"$1,428.00 "	"$1,056.72"	$0.00	"$1,142.40"	$642.60	$642.60	$0.00	$0.00	$0.00	$297.63	"$1,059.86"	"$1,059.86"	$0.00	$0.00	$297.60	$0.00	$844.66	$844.66	$0.00	$714.00	"$1,130.98"	"$1,142.40"	$0.00		$0.00	$223.48	$0.00	$0.00	$227.34	$0.00	$0.00	$0.00	$0.00	$0.00
A-4650.56	SUP	HCPCS C1713		A-4650.56  -  PLATE 56MM 2MM SCR 6 HOLE LCK GRID CMPR BONE TRPZD	BOTH IP/OP	"$1,475.25 "	"$1,091.69"	$0.00	"$1,180.20"	$663.86	$663.86	$0.00	$0.00	$0.00	$307.48	"$1,094.93"	"$1,094.93"	$0.00	$0.00	$307.44	$0.00	$872.61	$872.61	$0.00	$737.63	"$1,168.40"	"$1,180.20"	$0.00		$0.00	$230.88	$0.00	$0.00	$234.86	$0.00	$0.00	$0.00	$0.00	$0.00
A-4650.58	SUP	HCPCS C1713		A-4650.58  -  PLATE 2 MM 2.3 MM SCR 3X2 HOLE LCK GRID BONE TRPZD LEFT	BOTH IP/OP	"$1,556.63 "	"$1,151.91"	$0.00	"$1,245.30"	$700.48	$700.48	$0.00	$0.00	$0.00	$324.44	"$1,155.33"	"$1,155.33"	$0.00	$0.00	$324.40	$0.00	$920.74	$920.74	$0.00	$778.31	"$1,232.85"	"$1,245.30"	$0.00		$0.00	$243.61	$0.00	$0.00	$247.81	$0.00	$0.00	$0.00	$0.00	$0.00
A-4650.59	SUP	HCPCS C1713		A-4650.59  -  PLATE BN TRPZD RT 23MMX1MM APTUS TRLK 3X2 HL GRID TI HND	BOTH IP/OP	"$1,556.63 "	"$1,151.91"	$0.00	"$1,245.30"	$700.48	$700.48	$0.00	$0.00	$0.00	$324.44	"$1,155.33"	"$1,155.33"	$0.00	$0.00	$324.40	$0.00	$920.74	$920.74	$0.00	$778.31	"$1,232.85"	"$1,245.30"	$0.00		$0.00	$243.61	$0.00	$0.00	$247.81	$0.00	$0.00	$0.00	$0.00	$0.00
A-4650.62	SUP	HCPCS C1713		A-4650.62  -  PLATE BN TRPZD 29MMX1MM APTUS TRLK 4X2 HL GRID TI HND 2/2.3	BOTH IP/OP	"$1,556.63 "	"$1,151.91"	$0.00	"$1,245.30"	$700.48	$700.48	$0.00	$0.00	$0.00	$324.44	"$1,155.33"	"$1,155.33"	$0.00	$0.00	$324.40	$0.00	$920.74	$920.74	$0.00	$778.31	"$1,232.85"	"$1,245.30"	$0.00		$0.00	$243.61	$0.00	$0.00	$247.81	$0.00	$0.00	$0.00	$0.00	$0.00
A-4650.67	SUP	HCPCS C1713		A-4650.67  -  PLATE BN TRPZD 45MMX1MM APTUS TRLK 6X2 HL GRID TI HND 2/2.3	BOTH IP/OP	"$1,622.25 "	"$1,200.47"	$0.00	"$1,297.80"	$730.01	$730.01	$0.00	$0.00	$0.00	$338.12	"$1,204.03"	"$1,204.03"	$0.00	$0.00	$338.08	$0.00	$959.56	$959.56	$0.00	$811.13	"$1,284.82"	"$1,297.80"	$0.00		$0.00	$253.88	$0.00	$0.00	$258.26	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.01	SUP	HCPCS C1713		A-4655.01  -  PLATE STR 27MMX1.3MM TI 2-2.3MM SCR 4 HOLE LCK GRID APTUS	BOTH IP/OP	"$1,572.50 "	"$1,163.65"	$0.00	"$1,258.00"	$707.63	$707.63	$0.00	$0.00	$0.00	$327.75	"$1,167.11"	"$1,167.11"	$0.00	$0.00	$327.71	$0.00	$930.13	$930.13	$0.00	$786.25	"$1,245.42"	"$1,258.00"	$0.00		$0.00	$246.10	$0.00	$0.00	$250.34	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.02	SUP	HCPCS C1713		A-4655.02  -  PLATE STR 32MMX1.3MM TI 2-2.3MM SCR 5 HOLE LCK GRID APTUS	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.03	SUP	HCPCS C1713		A-4655.03  -  PLATE STR 38MMX1.3MM TI 2-2.3MM SCR 6 HOLE LCK GRID APTUS	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.08	SUP	HCPCS C1713		A-4655.08  -  PLATE 1.3MM 2MM 2.3MM SCR 8 HOLE LCK CVD BONE TRPZD	BOTH IP/OP	"$1,922.50 "	"$1,422.65"	$0.00	"$1,538.00"	$865.13	$865.13	$0.00	$0.00	$0.00	$400.70	"$1,426.88"	"$1,426.88"	$0.00	$0.00	$400.65	$0.00	"$1,137.16"	"$1,137.16"	$0.00	$961.25	"$1,522.62"	"$1,538.00"	$0.00		$0.00	$300.87	$0.00	$0.00	$306.06	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.10	SUP	HCPCS C1713		A-4655.10  -  PLATE 1.3MM 2MM 2.3MM SCR 2-4 HOLE T LCK BONE TRPZD	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.16	SUP	HCPCS C1713		A-4655.16  -  PLATE T 56MMX1.3MM TI 2-2.3MM SCR 2X8 HOLE LCK GRID APTUS	BOTH IP/OP	"$1,922.50 "	"$1,422.65"	$0.00	"$1,538.00"	$865.13	$865.13	$0.00	$0.00	$0.00	$400.70	"$1,426.88"	"$1,426.88"	$0.00	$0.00	$400.65	$0.00	"$1,137.16"	"$1,137.16"	$0.00	$961.25	"$1,522.62"	"$1,538.00"	$0.00		$0.00	$300.87	$0.00	$0.00	$306.06	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.20	SUP	HCPCS C1713		A-4655.20  -  PLATE L LEFT ANG 35MMX1.3MM TI 2-2.3MM SCR 2X6 HOLE LCK GRID	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.21	SUP	HCPCS C1713		A-4655.21  -  PLATE L RIGHT ANG 35MMX1.3MM TI 2-2.3MM SCR 4 HOLE LCK GRID	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.22	SUP	HCPCS C1713		A-4655.22  -  PLATE L LEFT ANG 58MMX1.3MM TI 2-2.3MM SCR 2X8 HOLE LCK GRID	BOTH IP/OP	"$1,922.50 "	"$1,422.65"	$0.00	"$1,538.00"	$865.13	$865.13	$0.00	$0.00	$0.00	$400.70	"$1,426.88"	"$1,426.88"	$0.00	$0.00	$400.65	$0.00	"$1,137.16"	"$1,137.16"	$0.00	$961.25	"$1,522.62"	"$1,538.00"	$0.00		$0.00	$300.87	$0.00	$0.00	$306.06	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.23	SUP	HCPCS C1713		A-4655.23  -  PLATE L RIGHT ANG 58MMX1.3MM TI 2-2.3MM SCR 10 HOLE LCK GRID	BOTH IP/OP	"$1,922.50 "	"$1,422.65"	$0.00	"$1,538.00"	$865.13	$865.13	$0.00	$0.00	$0.00	$400.70	"$1,426.88"	"$1,426.88"	$0.00	$0.00	$400.65	$0.00	"$1,137.16"	"$1,137.16"	$0.00	$961.25	"$1,522.62"	"$1,538.00"	$0.00		$0.00	$300.87	$0.00	$0.00	$306.06	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.51	SUP	HCPCS C1713		A-4655.51  -  PLATE 1.3MM 2MM 2.3MM SCR 2X2 HOLE LCK GRID SQ BONE TRPZD	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.56	SUP	HCPCS C1713		A-4655.56  -  PLATE 3X2 HOLE MESH LCK TRP BONE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.62	SUP	HCPCS C1713		A-4655.62  -  PLATE 1.3MM 2MM 2.3MM SCR 4X2 HOLE T LCK GRID BONE TRPZD	BOTH IP/OP	"$1,970.00 "	"$1,457.80"	$0.00	"$1,576.00"	$886.50	$886.50	$0.00	$0.00	$0.00	$410.60	"$1,462.13"	"$1,462.13"	$0.00	$0.00	$410.55	$0.00	"$1,165.26"	"$1,165.26"	$0.00	$985.00	"$1,560.24"	"$1,576.00"	$0.00		$0.00	$308.31	$0.00	$0.00	$313.62	$0.00	$0.00	$0.00	$0.00	$0.00
A-4655.66	SUP	HCPCS C1713		A-4655.66  -  PLATE TRPZD 42MMX1.3MM TI 2-2.3MM SCR 5X2 HOLE LCK GRID	BOTH IP/OP	"$2,057.50 "	"$1,522.55"	$0.00	"$1,646.00"	$925.88	$925.88	$0.00	$0.00	$0.00	$428.83	"$1,527.08"	"$1,527.08"	$0.00	$0.00	$428.78	$0.00	"$1,217.01"	"$1,217.01"	$0.00	"$1,028.75"	"$1,629.54"	"$1,646.00"	$0.00		$0.00	$322.00	$0.00	$0.00	$327.55	$0.00	$0.00	$0.00	$0.00	$0.00
A-5040.21/1	SUP	Custom 27203010		A-5040.21/1  -  WIRE FX 1.2MM 150MM NS KRSH APTUS TROC TIP SS	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.67	$55.67	$0.00	$0.00	$15.63	$0.00	$0.00	$0.00	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
A-5100.04/1	SUP	HCPCS C1713		A-5100.04/1  -  SCREW 4MM 1.2MM 4MM HEAD CORT BONE	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5100.05/1	SUP	HCPCS C1713		A-5100.05/1  -  SCREW BONE 1.2MM 5MM CORT 4 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5100.06/1	SUP	HCPCS C1713		A-5100.06/1  -  SCREW BONE 1.2MM 6MM CORT 4 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5100.07/1	SUP	HCPCS C1713		A-5100.07/1  -  SCREW BONE 1.2MM 7MM APTUS TI 4MM HEAD CORTEX HAND HEXADRIVE	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5100.08/1	SUP	HCPCS C1713		A-5100.08/1  -  SCREW BONE 1.2MM 08MM CORT HD4 1-PKG	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5100.09/1	SUP	HCPCS C1713		A-5100.09/1  -  SCREW BONE 1.2MM 9MM CORT 4 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5100.10/1	SUP	HCPCS C1713		A-5100.10/1  -  SCREW BONE 10MM 1.2MM 4MM HEAD CORT	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5100.12/1	SUP	HCPCS C1713		A-5100.12/1  -  SCREW BONE 1.2MM 12MM 4MM HEAD CORTEX HAND HEXADRIVE 4	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5100.14/1	SUP	HCPCS C1713		A-5100.14/1  -  SCREW BONE 1.2MM 14MM CORT 4 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5100.16/1	SUP	HCPCS C1713		A-5100.16/1  -  SCREW BONE 1.2MM 16MM CORT 4 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.04/1	SUP	HCPCS C1713		A-5200.04/1  -  SCREW BONE 1.5MM 4MM CORT 4 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.05/1	SUP	HCPCS C1713		A-5200.05/1  -  SCREW BONE 1.5MM 5MM CORT 4 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.06	SUP	HCPCS C1713		A-5200.06  -  SCREW BONE 6MM 1.5MM CORTICAL	BOTH IP/OP	$218.50 	$161.69	$0.00	$174.80	$98.33	$98.33	$0.00	$0.00	$0.00	$45.54	$162.17	$162.17	$0.00	$0.00	$45.54	$0.00	$129.24	$129.24	$0.00	$109.25	$173.05	$174.80	$0.00		$0.00	$34.20	$0.00	$0.00	$34.79	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.06/1	SUP	HCPCS C1713		A-5200.06/1  -  SCREW BONE 1.5MM 6MM APTUS TI HAND CORT HEXADRIVE 4	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.07/1	SUP	HCPCS C1713		A-5200.07/1  -  SCREW BONE 1.5MM 7MM APTUS TI HAND CORT HEXADRIVE 4	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.08	SUP	HCPCS C1713		A-5200.08  -  SCREW BONE 8MM HEXADRIVE 4 APTUS TITANIUM 1.5MM CORTICAL	BOTH IP/OP	$218.50 	$161.69	$0.00	$174.80	$98.33	$98.33	$0.00	$0.00	$0.00	$45.54	$162.17	$162.17	$0.00	$0.00	$45.54	$0.00	$129.24	$129.24	$0.00	$109.25	$173.05	$174.80	$0.00		$0.00	$34.20	$0.00	$0.00	$34.79	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.08/1	SUP	HCPCS C1713		A-5200.08/1  -  SCREW BONE 1.5MM 8MM APTUS TI CORTEX HAND GRN	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.09/1	SUP	HCPCS C1713		A-5200.09/1  -  SCREW BONE 1.5MM 9MM APTUS TI HAND CORT HEXADRIVE 4	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.10	SUP	HCPCS C1713		A-5200.10  -  SCREW BONE 10MM WASHER TWIST DRILL HEXADRIVE 4 APTUS GREEN	BOTH IP/OP	$218.50 	$161.69	$0.00	$174.80	$98.33	$98.33	$0.00	$0.00	$0.00	$45.54	$162.17	$162.17	$0.00	$0.00	$45.54	$0.00	$129.24	$129.24	$0.00	$109.25	$173.05	$174.80	$0.00		$0.00	$34.20	$0.00	$0.00	$34.79	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.10/1	SUP	HCPCS C1713		A-5200.10/1  -  SCREW BONE 1.5MM 10MM APTUS TI HAND CORT HEXADRIVE 4	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.11/1	SUP	HCPCS C1713		A-5200.11/1  -  SCREW BONE 1.5MM 11MM APTUS TI 4MM HEAD CORTEX ELB HAND	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.12/1	SUP	HCPCS C1713		A-5200.12/1  -  SCREW BONE 1.5MM 12MM APTUS TI 4MM HEAD CORTEX HAND 4	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.13/1	SUP	HCPCS C1713		A-5200.13/1  -  SCREW BONE 1.5MM 13MM APTUS TI 4MM HEAD CORTEX ELB HAND	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.14/1	SUP	HCPCS C1713		A-5200.14/1  -  SCREW BONE 1.5MM 14MM APTUS TI HAND CORT HEXADRIVE 4	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.15/1	SUP	HCPCS C1713		A-5200.15/1  -  SCREW BONE 1.5MM 15MM APTUS TI CORTEX HAND HEXADRIVE 4	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.16/1	SUP	HCPCS C1713		A-5200.16/1  -  SCREW BN 1.5MM 16MM 4 HNDL CORT	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.17/1	SUP	HCPCS C1713		A-5200.17/1  -  SCREW BN 1.5MM 17MM 4 HNDL CORT	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.18/1	SUP	HCPCS C1713		A-5200.18/1  -  SCREW BONE 1.5MM 18MM CORT 4 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.19/1	SUP	HCPCS C1713		A-5200.19/1  -  SCREW BONE 1.5MM 19MM APTUS CORT	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.20/1	SUP	HCPCS C1713		A-5200.20/1  -  SCREW BONE 1.5MM 20MM CORT 4 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.21/1	SUP	HCPCS C1713		A-5200.21/1  -  SCREW BONE 1.5MM 21MM CORT 4 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.22/1	SUP	HCPCS C1713		A-5200.22/1  -  SCREW BONE 1.5MM 22MM APTUS CORT	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.23/1	SUP	HCPCS C1713		A-5200.23/1  -  SCREW BN 1.5MM 23MM APTUS CORT	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5200.24/1	SUP	HCPCS C1713		A-5200.24/1  -  SCREW BONE 1.5MM 24MM APTUS TI CORTEX HAND HEXADRIVE 4	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250.04/1	SUP	HCPCS C1713		A-5250.04/1  -  SCREW BONE 1.5MM 4MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250.05/1	SUP	HCPCS C1713		A-5250.05/1  -  SCREW BONE 1.5MM 5MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250.06/1	SUP	HCPCS C1713		A-5250.06/1  -  SCREW BONE 1.5MM 6MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250.07	SUP	HCPCS C1713		A-5250.07  -  SCREW BONE 7MM 2 THREADED HEXADRIVE 4 OPTIMAL SELF RETAINING	BOTH IP/OP	$218.50 	$161.69	$0.00	$174.80	$98.33	$98.33	$0.00	$0.00	$0.00	$45.54	$162.17	$162.17	$0.00	$0.00	$45.54	$0.00	$129.24	$129.24	$0.00	$109.25	$173.05	$174.80	$0.00		$0.00	$34.20	$0.00	$0.00	$34.79	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250.07/1	SUP	HCPCS C1713		A-5250.07/1  -  SCREW BONE 1.5MM 7MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250.08	SUP	HCPCS C1713		A-5250.08  -  SCREW BONE 8MM 2 THREAD HEXADRIVE 4 ATRAUMATIC TIP LOCKING	BOTH IP/OP	$305.00 	$225.70	$0.00	$244.00	$137.25	$137.25	$0.00	$0.00	$0.00	$63.57	$226.37	$226.37	$0.00	$0.00	$63.56	$0.00	$180.41	$180.41	$0.00	$152.50	$241.56	$244.00	$0.00		$0.00	$47.73	$0.00	$0.00	$48.56	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250.08/1	SUP	HCPCS C1713		A-5250.08/1  -  SCREW BONE 1.5MM 8MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250.09/1	SUP	HCPCS C1713		A-5250.09/1  -  SCREW BONE 1.5MM 9MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250.10/1	SUP	HCPCS C1713		A-5250.10/1  -  SCREW BONE 1.5MM 10MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250.11/1	SUP	HCPCS C1713		A-5250.11/1  -  SCREW BONE 1.5MM 11MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250.12/1	SUP	HCPCS C1713		A-5250.12/1  -  SCREW BONE 1.5MM 12MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250.13/1	SUP	HCPCS C1713		A-5250.13/1  -  SCREW BONE 1.5MM 13MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5250-11	SUP	HCPCS C1713		A-5250-11  -  SCREW BONE 11MM LOCK 1.5MM CORTICAL	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
A-5300.06/1	SUP	HCPCS C1713		A-5300.06/1  -  SCREW BONE 1.8MM 6MM CORT 4 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5300.10/1	SUP	HCPCS C1713		A-5300.10/1  -  SCREW BONE 1.8MM 10MM APTUS TI 4MM HEAD CORTEX HAND ER	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.04/1	SUP	HCPCS C1713		A-5400.04/1  -  SCREW BONE 2MM 4MM APTUS TI CORTEX HAND HEXADRIVE 6	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.05	SUP	HCPCS C1713		A-5400.05  -  SCREW BONE 5MM 6MM HEAD 2MM CORTICAL	BOTH IP/OP	$437.00 	$323.38	$0.00	$349.60	$196.65	$196.65	$0.00	$0.00	$0.00	$91.08	$324.34	$324.34	$0.00	$0.00	$91.07	$0.00	$258.49	$258.49	$0.00	$218.50	$346.10	$349.60	$0.00		$0.00	$68.39	$0.00	$0.00	$69.57	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.05/1	SUP	HCPCS C1713		A-5400.05/1  -  SCREW BONE 2MM 5MM APTUS TI CORTEX HAND HEXADRIVE 6	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.06/1	SUP	HCPCS C1713		A-5400.06/1  -  SCREW BONE 2MM 6MM APTUS TI CORTEX HAND HEXADRIVE 6	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.07/1	SUP	HCPCS C1713		A-5400.07/1  -  SCREW BONE 2MM 7MM APTUS TI TPR HAND WRST CORT 2 THRD	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.08	SUP	HCPCS C1713		A-5400.08  -  SCREW BONE 8MM SLFTAP SELF RETAINING ATRAUMATIC TIP	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.08/1	SUP	HCPCS C1713		A-5400.08/1  -  SCREW BONE 2MM 8MM APTUS TI TPR HAND ELB WRST CORT 2 THRD	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.09/1	SUP	HCPCS C1713		A-5400.09/1  -  SCREW BONE 2MM 9MM APTUS TI 6MM HEAD CORTEX HAND LCK BLUE	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.10/1	SUP	HCPCS C1713		A-5400.10/1  -  SCREW BONE 2MM 10MM APTUS TI 6MM HEAD CORTEX WRST ELB HAND	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.11	SUP	HCPCS C1713		A-5400.11  -  SCREW BONE 11MM SLFTAP SELF RETAINING ATRAUMATIC TIP	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.11/1	SUP	HCPCS C1713		A-5400.11/1  -  SCREW BONE 2MM 11MM APTUS TI CORTEX WRST ELB HAND FT 2 THRD	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.12	SUP	HCPCS C1713		A-5400.12  -  SCREW BONE 12MM 6MM HEAD 2MM CORTICAL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.12/1	SUP	HCPCS C1713		A-5400.12/1  -  SCREW BONE 2MM 12MM APTUS TI TPR HAND ELB WRST CORT 2 THRD	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.13	SUP	HCPCS C1713		A-5400.13  -  SCREW BONE 13MM 2MM CORTICAL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.13/1	SUP	HCPCS C1713		A-5400.13/1  -  SCREW BONE 2MM 13MM APTUS TI TPR HAND WRST CORT 2 THRD	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.14	SUP	HCPCS C1713		A-5400.14  -  SCREW BONE 14MM SLFTAP SELF RETAINING ATRAUMATIC TIP	BOTH IP/OP	$218.50 	$161.69	$0.00	$174.80	$98.33	$98.33	$0.00	$0.00	$0.00	$45.54	$162.17	$162.17	$0.00	$0.00	$45.54	$0.00	$129.24	$129.24	$0.00	$109.25	$173.05	$174.80	$0.00		$0.00	$34.20	$0.00	$0.00	$34.79	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.14/1	SUP	HCPCS C1713		A-5400.14/1  -  SCREW BONE 2MM 14MM APTUS TI CORTEX HAND HEXADRIVE 6	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.15/1	SUP	HCPCS C1713		A-5400.15/1  -  SCREW BONE 2MM 15MM APTUS TI CORTEX HAND BLUE	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.16/1	SUP	HCPCS C1713		A-5400.16/1  -  SCREW BONE 2MM 16MM CORT 6 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.17	SUP	HCPCS C1713		A-5400.17  -  SCREW BONE 17MM APTUS BLUE TITANIUM 2MM HAND CORTICAL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.17/1	SUP	HCPCS C1713		A-5400.17/1  -  SCREW BONE 2MM 17MM APTUS TI CORTEX HAND BLUE	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.18/1	SUP	HCPCS C1713		A-5400.18/1  -  SCREW BONE 2MM 18MM CORT 6 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.19/1	SUP	HCPCS C1713		A-5400.19/1  -  SCREW BONE 2MM 19MM CORT 6 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.20	SUP	HCPCS C1713		A-5400.20  -  SCREW BONE 20MM 6MM HEAD 2MM CORTICAL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.20/1	SUP	HCPCS C1713		A-5400.20/1  -  SCREW BONE 2MM 20MM APTUS TRLK TI MIDFT HEXADRIVE 6	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.21/1	SUP	HCPCS C1713		A-5400.21/1  -  SCREW BONE 2MM 21MM APTUS TI CORTEX HEXADRIVE 6	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.22/1	SUP	HCPCS C1713		A-5400.22/1  -  SCREW BONE 2MM 22MM APTUS TI CORTEX HEXADRIVE 6	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.23/1	SUP	HCPCS C1713		A-5400.23/1  -  SCREW BONE 2MM 23MM CORT 6 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5400.24/1	SUP	HCPCS C1713		A-5400.24/1  -  SCREW BONE 2MM 24MM CORT 6 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.06/1	SUP	HCPCS C1713		A-5450.06/1  -  SCREW BONE 2MM 6MM APTUS TRLK TI FT HAND ELB WRST CORT	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.07/1	SUP	HCPCS C1713		A-5450.07/1  -  SCREW BONE 2MM 7MM APTUS TRLK TI FT HAND WRST CORT HEXADRIVE	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.08/1	SUP	HCPCS C1713		A-5450.08/1  -  SCREW BONE 2MM 8MM APTUS TRLK TI FT HAND ELB WRST CORT	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.09	SUP	HCPCS C1713		A-5450.09  -  SCREW BONE 9MM LOCK APTUS BLUE TITANIUM 2MM HAND CORTICAL	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.09/1	SUP	HCPCS C1713		A-5450.09/1  -  SCREW BONE 2MM 9MM APTUS TI 6MM CORTEX WRST 2 THRD TRLK	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.10	SUP	HCPCS C1713		A-5450.10  -  SCREW BONE 10MM TRILOCK LOCKING TECHNOLOGY SLFTAP VAR ANG	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.10/1	SUP	HCPCS C1713		A-5450.10/1  -  SCREW BONE 2MM 10MM APTUS TI 6MM HEAD WRST ELB HAND FT 2	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.11	SUP	HCPCS C1713		A-5450.11  -  SCREW BONE 11MM LOCKING HEXADRIVE 6 APTUS TRILOCK BLUE	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.11/1	SUP	HCPCS C1713		A-5450.11/1  -  SCREW BONE 2MM 11MM APTUS TRLK TI FT HAND WRST CORT	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.12	SUP	HCPCS C1713		A-5450.12  -  SCREW BONE 12MM TRILOCK LOCKING TECHNOLOGY SLFTAP VAR ANG	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.12/1	SUP	HCPCS C1713		A-5450.12/1  -  SCREW BONE 2MM 12MM APTUS TRLK TI CORTEX FRFT MIDFT LCK	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.13/1	SUP	HCPCS C1713		A-5450.13/1  -  SCREW BONE 2MM 13MM APTUS TI 6MM HEAD CORTEX WRST ELB HAND	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.14/1	SUP	HCPCS C1713		A-5450.14/1  -  SCREW BONE 2MM 14MM APTUS TI 6MM HEAD CORTEX HAND LCK BLUE	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.16	SUP	HCPCS C1713		A-5450.16  -  SCREW BONE 16MM LOCKING HEXAGONAL DRIVE 2MM	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.16/1	SUP	HCPCS C1713		A-5450.16/1  -  SCREW BONE 2MM 16MM APTUS TRLK TI MIDFT HEXADRIVE 6	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.18/1	SUP	HCPCS C1713		A-5450.18/1  -  SCREW BONE 2MM 18MM APTUS TRLK TI FT HAND ELB WRST CORT	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5450.20/1	SUP	HCPCS C1713		A-5450.20/1  -  SCREW BONE 2MM 20MM APTUS TI 6MM HEAD WRST ELB HAND FT 2	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$151.88	$151.88	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.05/1	SUP	HCPCS C1713		A-5500.05/1  -  SCREW 5MM 2.3MM 6MM HEAD CORT BONE	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.06/1	SUP	HCPCS C1713		A-5500.06/1  -  SCREW BONE 2.3MM 6MM CORT 6 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.07/1	SUP	HCPCS C1713		A-5500.07/1  -  SCREW BONE 2.3MM 7MM APTUS CORT	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.08/1	SUP	HCPCS C1713		A-5500.08/1  -  SCREW BONE 2.3MM 8MM APTUS TI TPR ATRM CORTEX WRST ELB HAND	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.09/1	SUP	HCPCS C1713		A-5500.09/1  -  SCREW BONE 2.3MM 9MM APTUS TI TPR FT HAND CORT 2 THRD	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.10/1	SUP	HCPCS C1713		A-5500.10/1  -  SCREW BONE 2.3MM 10MM APTUS TI TPR FT HAND ELB WRST CORT 2	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.11/1	SUP	HCPCS C1713		A-5500.11/1  -  SCREW BONE 2.3MM 11MM APTUS TI CORTEX HAND BROWN	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.12/1	SUP	HCPCS C1713		A-5500.12/1  -  SCREW BONE 2.3MM 12MM APTUS TI TPR ATRM CORTEX WRST ELB HAND	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.13/1	SUP	HCPCS C1713		A-5500.13/1  -  SCREW BONE 2.3MM 13MM APTUS TI TPR FT HAND CORT 2 THRD	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.14/1	SUP	HCPCS C1713		A-5500.14/1  -  SCREW BONE 2.3MM 14MM APTUS TI TPR ATRM CORTEX WRST ELB HAND	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.15/1	SUP	HCPCS C1713		A-5500.15/1  -  SCREW BONE 2.3MM 15MM APTUS TI TPR FT HAND CORT 2 THRD	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.16/1	SUP	HCPCS C1713		A-5500.16/1  -  SCREW BONE 2.3MM 16MM APTUS TI TPR FT HAND ELB WRST CORT 2	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.17/1	SUP	HCPCS C1713		A-5500.17/1  -  SCREW BONE 2.3MM 17MM CORT 6 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.18/1	SUP	HCPCS C1713		A-5500.18/1  -  SCREW BONE 2.3MM 18MM APTUS TI TPR FT HAND CORT 2 THRD	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.19/1	SUP	HCPCS C1713		A-5500.19/1  -  SCREW BONE 2.3MM 19MM CORT 6 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.20/1	SUP	HCPCS C1713		A-5500.20/1  -  SCREW BONE 2.3MM 20MM APTUS TI TPR FT HAND CORT 2 THRD	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.21/1	SUP	HCPCS C1713		A-5500.21/1  -  SCREW BONE 2.3MM 21MM CORT 6 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.22/1	SUP	HCPCS C1713		A-5500.22/1  -  SCREW BONE 2.3MM 22MM CORT 6 HNDL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.23/1	SUP	HCPCS C1713		A-5500.23/1  -  SCREW BONE 2.3MM 23MM APTUS TI CORT HAND BROWN	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A-5500.24/1	SUP	HCPCS C1713		A-5500.24/1  -  SCREW BONE 2.3MM 24MM APTUS TI TPR FT HAND CORT 2 THRD	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$94.50	$94.50	$0.00	$0.00	$0.00	$43.77	$155.86	$155.86	$0.00	$0.00	$43.76	$0.00	$124.22	$124.22	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
A60-15030	SUP	HCPCS C1713		A60-15030  -  SCREW BONE 6/5MM 150MM 30MM VSN 6MM SHNK CORT ANKL THRD TPR	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
AAE21	SUP	Custom 27203010		AAE21  -  DST SERIES EEA 21  BX /3	BOTH IP/OP	"$2,445.20 "	"$1,809.45"	$0.00	"$1,956.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,222.60"	"$1,936.60"	"$1,956.16"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-1000	SUP	Custom 27203010		ABS-1000  -  SYSTEM BN CMNT 3ML DLV MX ABS	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$0.00	$0.00	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-1000-L	SUP	Custom 27203010		ABS-1000-L  -  SYSTEM BN CMNT LG MX DLV APL	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$0.00	$0.00	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-1000-S	SUP	Custom 27203010		ABS-1000-S  -  SYSTEM BN CMNT STRL ARTHX DLV MX SM APL	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$0.00	$0.00	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-1001	SUP	Custom 27203010		ABS-1001  -  NEEDLE EPDRL TUO OBT	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.91	$103.91	$0.00	$0.00	$29.18	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-1002	SUP	Custom 27203010		ABS-1002  -  NEEDLE EPDRL STRG TUO OBT	BOTH IP/OP	$140.00 	$103.60	$0.00	$112.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.91	$103.91	$0.00	$0.00	$29.18	$0.00	$0.00	$0.00	$0.00	$70.00	$110.88	$112.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-10020	SUP	Custom 27203010		ABS-10020  -  CENTRIFUGE BNCHTP 110V ACP HETTICH ROTOFIX 32 SWNG OUT RTR	BOTH IP/OP	"$10,750.00 "	"$7,955.00"	$0.00	"$8,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,240.30"	$0.00	$0.00	$0.00	$0.00	"$5,375.00"	"$8,514.00"	"$8,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-10023	SUP	HCPCS C1713		ABS-10023  -  CAP CNTRF ACP HETTICH REPL BCKT ABS-10023	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-1003	SUP	Custom 27203010		ABS-1003  -  SYSTEM BN CMNT FNL	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$0.00	$0.00	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-10050	SUP	Custom 27203010		ABS-10050  -  APPLICATOR SRG XLNG BLNT BVL 10CM VISCOGEL EZ TO FIL HVISC	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-10051	SUP	Custom 27203010		ABS-10051  -  APPLICATOR SRG XLNG BLNT BVL 3CM VSC SPRY EZ TO FIL LVISC MX	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS10055	SUP	Custom 27203010		ABS10055  -  KIT SRG STRL TULIP GEMS CELLFRIENDLY SUPERLUERLOK ADIPOSE	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-1007-BC	SUP	HCPCS C1762		ABS-1007-BC  -  MATRIX TISS .75CC BIOCARTILAGE	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-1010-BC	SUP	HCPCS C1762		ABS-1010-BC  -  FILLER BN VOID 1CC BIOCARTILAGE	BOTH IP/OP	"$2,450.00 "	"$1,813.00"	$0.00	"$1,960.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$510.64	"$1,818.39"	"$1,818.39"	$0.00	$0.00	$510.58	$0.00	"$1,449.18"	"$1,449.18"	$0.00	"$1,225.00"	"$1,940.40"	"$1,960.00"	$0.00		$0.00	$383.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-1102-19	SUP	HCPCS L8699		ABS-1102-19  -  GRAFT BN 19X12MM CARTIFORM	BOTH IP/OP	"$15,625.00 "	"$11,562.50"	$0.00	"$12,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,256.25"	$0.00	$0.00	$0.00	$0.00	"$7,812.50"	"$12,375.00"	"$12,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-1102-25	SUP	HCPCS L8699		ABS-1102-25  -  GRAFT BN 25X20MM CARTIFORM	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	$0.00	$0.00	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-20000	SUP	Custom 27203010		ABS-20000  -  NEEDLE SPNL 17GA 14.63CM 1.27CM 8 HL FENESTRATE HUB	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-2001-01	SUP	HCPCS C1713		ABS-2001-01  -  FILLER BN VOID 1CC STIMUBLAST PTTY	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-2001-02	SUP	HCPCS C1713		ABS-2001-02  -  FILLER BN VOID 2.5CC STIMUBLAST PTTY	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$495.00	$495.00	$0.00	$0.00	$0.00	$229.27	$816.42	$816.42	$0.00	$0.00	$229.24	$0.00	$650.65	$650.65	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$172.15	$0.00	$0.00	$175.12	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-2001-05	SUP	HCPCS C1713		ABS-2001-05  -  FILLER BN VOID 5ML STIMUBLAST PTTY RVRS PHS MED DBM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-2002-05	SUP	HCPCS C1713		ABS-2002-05  -  FILLER BN VOID 5CC NS STIMUBLAST ARTHX GEL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-2002-10	SUP	HCPCS C1713		ABS-2002-10  -  FILLER BN VOID 10ML STIMUBLAST GEL RVRS PHS MED DBM	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-2003-05	SUP	HCPCS C1713		ABS-2003-05  -  FILLER BN VOID 5ML STIMUBLAST PTTY RVRS PHS MED CANC DBM	BOTH IP/OP	"$2,050.00 "	"$1,517.00"	$0.00	"$1,640.00"	$922.50	$922.50	$0.00	$0.00	$0.00	$427.27	"$1,521.51"	"$1,521.51"	$0.00	$0.00	$427.22	$0.00	"$1,212.58"	"$1,212.58"	$0.00	"$1,025.00"	"$1,623.60"	"$1,640.00"	$0.00		$0.00	$320.83	$0.00	$0.00	$326.36	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-2003-10	SUP	HCPCS C1713		ABS-2003-10  -  FILLER BN VOID 10ML STIMUBLAST PTTY RVRS PHS MED CANC DBM	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	"$1,456.88"	"$1,456.88"	$0.00	$0.00	$0.00	$674.78	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	"$1,596.09"	"$1,596.09"	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$506.67	$0.00	$0.00	$515.41	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-2004-01	SUP	HCPCS C1713		ABS-2004-01  -  FILLER BN VOID 1ML STIMUBLAST PTTY RVRS PHS MED CANC DBM	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-2004-03	SUP	HCPCS C1713		ABS-2004-03  -  FILLER BN VOID 3ML STIMUBLAST PST RVRS PHS MED CANC DBM	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-2004-08	SUP	HCPCS C1713		ABS-2004-08  -  FILLER BN VOID 8ML STIMUBLAST PST RVRS PHS MED CANC DBM	BOTH IP/OP	"$2,487.50 "	"$1,840.75"	$0.00	"$1,990.00"	"$1,119.38"	"$1,119.38"	$0.00	$0.00	$0.00	$518.46	"$1,846.22"	"$1,846.22"	$0.00	$0.00	$518.40	$0.00	"$1,471.36"	"$1,471.36"	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$389.29	$0.00	$0.00	$396.01	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-2009-02	SUP	HCPCS L8699		ABS-2009-02  -  GRAFT BN 2.5CC ARTHROCELL	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-2009-05	SUP	HCPCS L8699		ABS-2009-05  -  GRAFT BN 5CC ARTHROCELL	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-21000	SUP	Custom 27203010		ABS-21000  -  NEEDLE EPDRL 17GA 6IN TUO DLV	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-30001S	SUP	HCPCS L8699		ABS-30001S  -  GRAFT SFT TIS THK 5X5CM STRL HDRT RTU REINF DRML XCLR MTRX	BOTH IP/OP	"$4,125.00 "	"$3,052.50"	$0.00	"$3,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,061.58"	"$3,061.58"	$0.00	$0.00	$859.65	$0.00	$0.00	$0.00	$0.00	"$2,062.50"	"$3,267.00"	"$3,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-30002S	SUP	HCPCS L8699		ABS-30002S  -  GRAFT SFT TIS THK 8X6CM STRL HDRT RTU REINF DRML XCLR MTRX	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4003	SUP	Custom 27203010		ABS-4003  -  DRESSING WND 3X3IN JUMPSTART ANMC	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.98	$25.98	$0.00	$0.00	$7.29	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4004	SUP	Custom 27203010		ABS-4004  -  DRESSING WND 4X4IN JUMPSTART ANMC	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4005	SUP	Custom 27203010		ABS-4005  -  DRESSING WND 1.5IN 8IN JUMPSTART ANMC	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$0.00	$0.00	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4008	SUP	Custom 27203010		ABS-4008  -  DRESSING WND 8X8IN JUMPSTART ANMC	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4012	SUP	Custom 27203010		ABS-4012  -  DRESSING WND 12X12IN JUMPSTART 1 LYR DOT MTRX PTRN ANMC LSR	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4025	SUP	Custom 27203010		ABS-4025  -  DRESSING WND 2X5IN JUMPSTART ANMC	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4053	SUP	Custom 27203010		ABS-4053  -  DRESSING WND 4X4IN 2X2IN JUMPSTART COMP ADH BRDR PD ANMC	BOTH IP/OP	$82.50 	$61.05	$0.00	$66.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.23	$61.23	$0.00	$0.00	$17.19	$0.00	$0.00	$0.00	$0.00	$41.25	$65.34	$66.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4054	SUP	Custom 27203010		ABS-4054  -  DRESSING WND 2.5IN 1IN JUMPSTART COMP ADH BRDR PD ANMC	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4056	SUP	Custom 27203010		ABS-4056  -  DRESSING WND 4IN 2IN JUMPSTART COMP ADH BRDR PD ANMC	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.12	$24.12	$0.00	$0.00	$6.77	$0.00	$0.00	$0.00	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4100-022	SUP	HCPCS L8699		ABS-4100-022  -  MATRIX TISS THN 2X2CM ARTHX AMNION	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	$0.00	$0.00	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4100-023	SUP	HCPCS L8699		ABS-4100-023  -  MATRIX TISS THN 3X2CM ARTHX AMNION	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	$0.00	$0.00	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4100-033	SUP	HCPCS L8699		ABS-4100-033  -  MATRIX TISS THN 3X3CM AMNION	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	$0.00	$0.00	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4100-044	SUP	HCPCS L8699		ABS-4100-044  -  MATRIX TISS THN 4X4CM ARTHX AMNION	BOTH IP/OP	"$5,562.50 "	"$4,116.25"	$0.00	"$4,450.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,128.49"	"$4,128.49"	$0.00	$0.00	"$1,159.23"	$0.00	$0.00	$0.00	$0.00	"$2,781.25"	"$4,405.50"	"$4,450.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4100-046	SUP	HCPCS L8699		ABS-4100-046  -  MATRIX TISS THN 6X4CM ALGRF AMNION	BOTH IP/OP	"$7,562.50 "	"$5,596.25"	$0.00	"$6,050.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,576.03"	$0.00	$0.00	$0.00	$0.00	"$3,781.25"	"$5,989.50"	"$6,050.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4100-048	SUP	HCPCS L8699		ABS-4100-048  -  MATRIX TISS THN 8X4CM ARTHX AMNION	BOTH IP/OP	"$9,312.50 "	"$6,891.25"	$0.00	"$7,450.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,940.73"	$0.00	$0.00	$0.00	$0.00	"$4,656.25"	"$7,375.50"	"$7,450.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4100-077	SUP	HCPCS L8699		ABS-4100-077  -  MATRIX TISS THN 7X7CM ARTHX AMNION	BOTH IP/OP	"$12,312.50 "	"$9,111.25"	$0.00	"$9,850.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,565.93"	$0.00	$0.00	$0.00	$0.00	"$6,156.25"	"$9,751.50"	"$9,850.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4100-212	SUP	HCPCS L8699		ABS-4100-212  -  MATRIX TISS THN 12X2CM ARTHX AMNION	BOTH IP/OP	"$7,562.50 "	"$5,596.25"	$0.00	"$6,050.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,576.03"	$0.00	$0.00	$0.00	$0.00	"$3,781.25"	"$5,989.50"	"$6,050.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4200-022	SUP	HCPCS L8699		ABS-4200-022  -  MATRIX TISS THK 2X2CM ALGRF AMNION	BOTH IP/OP	"$2,956.25 "	"$2,187.63"	$0.00	"$2,365.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,194.13"	"$2,194.13"	$0.00	$0.00	$616.08	$0.00	$0.00	$0.00	$0.00	"$1,478.13"	"$2,341.35"	"$2,365.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4200-023	SUP	HCPCS L8699		ABS-4200-023  -  MATRIX TISS THK 8X3CM ARTHX AMNION	BOTH IP/OP	"$4,250.00 "	"$3,145.00"	$0.00	"$3,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,154.35"	"$3,154.35"	$0.00	$0.00	$885.70	$0.00	$0.00	$0.00	$0.00	"$2,125.00"	"$3,366.00"	"$3,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4200-033	SUP	HCPCS L8699		ABS-4200-033  -  MATRIX TISS THK 3X3CM ALGRF AMNION	BOTH IP/OP	"$6,125.00 "	"$4,532.50"	$0.00	"$4,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,276.45"	$0.00	$0.00	$0.00	$0.00	"$3,062.50"	"$4,851.00"	"$4,900.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4200-034	SUP	HCPCS L8699		ABS-4200-034  -  MATRIX TISS THK 4X3CM ARTHX AMNION	BOTH IP/OP	"$7,000.00 "	"$5,180.00"	$0.00	"$5,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,458.80"	$0.00	$0.00	$0.00	$0.00	"$3,500.00"	"$5,544.00"	"$5,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4200-036	SUP	HCPCS L8699		ABS-4200-036  -  MATRIX TISS THK 4X3CM AMNION	BOTH IP/OP	"$9,250.00 "	"$6,845.00"	$0.00	"$7,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,927.70"	$0.00	$0.00	$0.00	$0.00	"$4,625.00"	"$7,326.00"	"$7,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4200-038	SUP	HCPCS L8699		ABS-4200-038  -  MATRIX TISS THK 8X3CM ARTHX AMNION	BOTH IP/OP	"$11,000.00 "	"$8,140.00"	$0.00	"$8,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,292.40"	$0.00	$0.00	$0.00	$0.00	"$5,500.00"	"$8,712.00"	"$8,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4300-050	SUP	HCPCS L8699		ABS-4300-050  -  MATRIX TISS .5CC ARTHX ALGRF FLW AMNION	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4300-100	SUP	HCPCS L8699		ABS-4300-100  -  MATRIX TISS 1CC ARTHX AMNION FLW	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABS-4300-200	SUP	HCPCS L8699		ABS-4300-200  -  MATRIX TISS 2CC ARTHX AMNION FLW	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABSTACK15	SUP	Custom 27203010		ABSTACK15  -  DEVICE FIX 5MM 15 TACK RATCHET HANDLE PISTOL GRIP NO SHARP	BOTH IP/OP	$627.03 	$464.00	$0.00	$501.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$465.38	$465.38	$0.00	$0.00	$130.67	$0.00	$0.00	$0.00	$0.00	$313.51	$496.61	$501.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ABSTACK30	SUP	Custom 27203010		ABSTACK30  -  DEVICE FIX 5MM 30 TACK RATCHET HANDLE PISTOL GRIP NO SHARP	BOTH IP/OP	"$2,104.35 "	"$1,557.22"	$0.00	"$1,561.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,561.85"	"$1,561.85"	$0.00	$0.00	$438.55	$0.00	$0.00	$0.00	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AC003	SUP	Custom 27203010		AC003  -  SET SPNL ADPR BRMR HL MYFLD	BOTH IP/OP	"$2,077.78 "	"$1,537.56"	$0.00	"$1,662.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,542.12"	"$1,542.12"	$0.00	$0.00	$433.01	$0.00	$0.00	$0.00	$0.00	"$1,038.89"	"$1,645.60"	"$1,662.22"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AC018	SUP	HCPCS C1713		AC018  -  PIN BRMR HL SKL STRL	BOTH IP/OP	$116.25 	$86.03	$0.00	$93.00	$52.31	$52.31	$0.00	$0.00	$0.00	$24.23	$86.28	$86.28	$0.00	$0.00	$24.23	$0.00	$68.76	$68.76	$0.00	$58.13	$92.07	$93.00	$0.00		$0.00	$18.19	$0.00	$0.00	$18.51	$0.00	$0.00	$0.00	$0.00	$0.00
AC020	SUP	HCPCS C1713		AC020  -  PIN BRMR HL SKL STRL	BOTH IP/OP	$100.50 	$74.37	$0.00	$80.40	$45.23	$45.23	$0.00	$0.00	$0.00	$20.95	$74.59	$74.59	$0.00	$0.00	$20.94	$0.00	$59.45	$59.45	$0.00	$50.25	$79.60	$80.40	$0.00		$0.00	$15.73	$0.00	$0.00	$16.00	$0.00	$0.00	$0.00	$0.00	$0.00
AC3930A	SUP	Custom 27203010		AC3930A  -  CATHETER ANGEL	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,174.88"	"$4,174.88"	$0.00	$0.00	"$1,172.25"	$0.00	$0.00	$0.00	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ACH140	SUP	HCPCS C1760		ACH140  -  DEVICE CLOSURE STANDARD 40MM EXCLUSION SYSTEM ATRICLIP	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,041.05"	"$1,119.38"	"$1,119.38"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$389.29	$0.00	$0.00	$396.01	$0.00	$0.00	$0.00	$0.00	$0.00
ACTR10	SUP	Custom 27803010		ACTR10  -  RING CPSLR TNSN THK.15MM 10-12.3MM STRL REFORM PMMA	BOTH IP/OP	$492.53 	$364.47	$0.00	$394.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$365.55	$365.55	$0.00	$0.00	$102.64	$0.00	$0.00	$0.00	$0.00	$246.26	$390.08	$394.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ACTR11	SUP	Custom 27803010		ACTR11  -  RING CPSLR FX THK.17MM 11-13MM STRL REFORM PMMA	BOTH IP/OP	$492.53 	$364.47	$0.00	$394.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$365.55	$365.55	$0.00	$0.00	$102.64	$0.00	$0.00	$0.00	$0.00	$246.26	$390.08	$394.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ACTR12	SUP	Custom 27803010		ACTR12  -  RING CPSLR TNSN THK.2MM 12-14.5MM STRL REFORM PMMA	BOTH IP/OP	$492.53 	$364.47	$0.00	$394.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$365.55	$365.55	$0.00	$0.00	$102.64	$0.00	$0.00	$0.00	$0.00	$246.26	$390.08	$394.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ACU0T0.300	SUP	HCPCS V2632		ACU0T0.300  -  LENS IOL +30 DIOP STRL LF ACRSF ULTRASERT 1 PC FLD UV BLU	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
ACX2200	SUP	Custom 27203010		NEUTRALIZER SOL GLUTEX 2 GLUT AND OPA	BOTH IP/OP	$13.03 	$9.64	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.51	$10.32	$10.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AD03	SUP	Custom 27203010		AD03  -  CHUCK DRL 1000 RPM MDSRX LGN JCB PRFR DRVR	BOTH IP/OP	"$7,528.10 "	"$5,570.79"	$0.00	"$6,022.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,568.86"	$0.00	$0.00	$0.00	$0.00	"$3,764.05"	"$5,962.26"	"$6,022.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AD-5230	SUP	HCPCS V2790		AD-5230  -  GRAFT HUM TIS 3X2CM AMBIODRY2 AMNIO MEMBR DHDR STRL DISP	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
ADAPTADRK2	SUP	HCPCS C2619		ADAPTADRK2  -  PACEMAKER CARDIAC THK7.5MM 47.9X44.7MM IMPLTABLE 2 CHAMBER	BOTH IP/OP	"$8,355.00 "	"$6,182.70"	$0.00	"$6,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,741.18"	$0.00	$0.00	$0.00	$0.00	"$4,262.50"	"$6,751.80"	"$6,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ADAPTALGDRK2	SUP	HCPCS C2619		ADAPTALGDRK2  -  KIT PCMKR LG ADAPTA 2 CHMBR 2 LD	BOTH IP/OP	"$8,355.00 "	"$6,182.70"	$0.00	"$6,820.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,741.18"	$0.00	$0.00	$0.00	$0.00	"$4,262.50"	"$6,751.80"	"$6,820.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ADAPTASRK2	SUP	HCPCS C2619		ADAPTASRK2  -  PACEMAKER CARDIAC IMPLTABLE 1 CHAMBER RATE RESPONSIVE	BOTH IP/OP	"$6,382.50 "	"$4,723.05"	$0.00	"$5,210.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,330.11"	$0.00	$0.00	$0.00	$0.00	"$3,256.25"	"$5,157.90"	"$5,210.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ADDR01	SUP	HCPCS C1785		ADDR01  -  PACEMAKER CRD 12.1CC ADAPTA DR 2 CHMBR IS-1 CNCT GNTR 27.1GM	BOTH IP/OP	"$6,370.00 "	"$4,713.80"	$0.00	"$5,200.00"	"$2,925.00"	"$2,925.00"	$0.00	$0.00	$0.00	"$1,327.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,327.51"	$0.00	"$3,140.41"	"$3,140.41"	$0.00	"$3,250.00"	"$5,148.00"	"$5,200.00"	$0.00		$0.00	"$1,017.25"	$0.00	$0.00	"$1,034.80"	$0.00	$0.00	$0.00	$0.00	$0.00
ADDRL1	SUP	HCPCS C2619		ADDRL1  -  PACEMAKER CARDIAC THK7.5MM 45.4X52.3MM 2 CHAMBER UNIPOLAR	BOTH IP/OP	"$6,370.00 "	"$4,713.80"	$0.00	"$5,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,327.51"	$0.00	$0.00	$0.00	$0.00	"$3,250.00"	"$5,148.00"	"$5,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ADDRS1	SUP	Custom 27203010		ADDRS1  -  PACEMAKER CARDIAC THK7.5MM 42.9X44.7MM 2 CHAMBER UNIPOLAR	BOTH IP/OP	"$6,370.00 "	"$4,713.80"	$0.00	"$5,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,327.51"	$0.00	$0.00	$0.00	$0.00	"$3,250.00"	"$5,148.00"	"$5,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ADP215790C	SUP	Custom 27011340		ADP215790C  -  KIT SURG PED	BOTH IP/OP	$29.73 	$22.00	$0.00	$23.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.06	$22.06	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$14.86	$23.55	$23.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ADS201844	SUP	Custom 27203010		ADS201844  -  SEALANT HEMOSTATIC NEEDLE FREE ADAPTER FLOSEAL MATRIX 10ML	BOTH IP/OP	$339.22 	$251.02	$0.00	$766.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$251.77	$251.77	$0.00	$0.00	$70.69	$0.00	$0.00	$0.00	$0.00	$310.31	$766.85	$496.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ADS201845	SUP	Custom 27203010		ADS201845  -  SEALANT HEMOSTATIC NEEDLE FREE ADAPTER FLOSEAL MATRIX 5ML	BOTH IP/OP	$620.62 	$459.26	$0.00	$774.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$460.62	$460.62	$0.00	$0.00	$129.34	$0.00	$0.00	$0.00	$0.00	$484.13	$491.53	$774.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AF02	SUP	Custom 27203010		AF02  -  ATTCH TL FT MDSRX LGN 2.4MM F2	BOTH IP/OP	"$2,133.10 "	"$1,578.49"	$0.00	"$1,706.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,583.19"	"$1,583.19"	$0.00	$0.00	$444.54	$0.00	$0.00	$0.00	$0.00	"$1,066.55"	"$1,689.42"	"$1,706.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AF101	SUP	Custom 27011340		AF101  -  HALTER TRC 28-38IN HALO AIRFLO SHRT HDNK VST SYS EXFIX	BOTH IP/OP	"$2,812.50 "	"$2,081.25"	$0.00	"$2,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,087.44"	"$2,087.44"	$0.00	$0.00	$586.13	$0.00	$0.00	$0.00	$0.00	"$1,406.25"	"$2,227.50"	"$2,250.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AF-101	SUP	Custom 27203010		AF-101  -  HALTER TRC 28-38IN HALO AIRFLO SHRT HDNK VST SYS EXFIX	BOTH IP/OP	"$3,002.13 "	"$2,221.58"	$0.00	"$2,401.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,228.18"	"$2,228.18"	$0.00	$0.00	$625.64	$0.00	$0.00	$0.00	$0.00	"$1,501.06"	"$2,377.69"	"$2,401.70"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AF102	SUP	Custom 27011340		AF102  -  HALTER TRC 30-44IN BREMER AIRFLO LG HDNK VST HALO	BOTH IP/OP	"$2,812.50 "	"$2,081.25"	$0.00	"$2,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,087.44"	"$2,087.44"	$0.00	$0.00	$586.13	$0.00	$0.00	$0.00	$0.00	"$1,406.25"	"$2,227.50"	"$2,250.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AF-1230	SUP	HCPCS V2790		AF-1230  -  GRAFT SFT TIS THN 3X2CM OPQ AMBIODRY5 LTWT AMNIO MEMBR	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$759.38	$759.38	$0.00	$0.00	$0.00	$351.72	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$998.16	$998.16	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$264.09	$0.00	$0.00	$268.65	$0.00	$0.00	$0.00	$0.00	$0.00
AFLEX100	SUP	HCPCS Q4125		AFLEX100  -  GRAFT SFT TIS THK1.5MM 35X35MM STRL ARTHROFLEX FLEXIGRAFT	BOTH IP/OP	"$5,942.50 "	"$4,397.45"	$0.00	"$4,546.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,238.42"	$0.00	$0.00	$0.00	$0.00	"$2,841.25"	"$4,500.54"	"$4,546.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AFLEX101	SUP	HCPCS Q4125		AFLEX101  -  GRAFT SFT TIS THK1.5MM 40X70MM STRL MATRACELL ARTHROFLEX	BOTH IP/OP	"$7,065.00 "	"$5,228.10"	$0.00	"$5,404.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,472.35"	$0.00	$0.00	$0.00	$0.00	"$3,377.50"	"$5,349.96"	"$5,404.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AFLEX103	SUP	HCPCS Q4125		AFLEX103  -  GRAFT SFT TIS THK1.5MM 90X50MM STRL MATRACELL ARTHROFLEX	BOTH IP/OP	"$9,502.50 "	"$7,031.85"	$0.00	"$7,342.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,980.32"	$0.00	$0.00	$0.00	$0.00	"$4,588.75"	"$7,268.58"	"$7,342.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AFLEX150	SUP	HCPCS Q4125		AFLEX150  -  GRAFT SFT TIS THK1.5MM 140X15MM STRL MATRACELL ARTHROFLEX	BOTH IP/OP	"$5,360.00 "	"$3,966.40"	$0.00	"$4,080.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,978.19"	"$3,978.19"	$0.00	$0.00	"$1,117.02"	$0.00	$0.00	$0.00	$0.00	"$2,550.00"	"$4,039.20"	"$4,080.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AFLEX200	SUP	HCPCS Q4125		AFLEX200  -  GRAFT SFT TIS THK2MM 35X35MM STRL MATRACELL ARTHROFLEX	BOTH IP/OP	"$7,932.50 "	"$5,870.05"	$0.00	"$6,130.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,653.13"	$0.00	$0.00	$0.00	$0.00	"$3,831.25"	"$6,068.70"	"$6,130.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AFLEX201	SUP	HCPCS Q4125		AFLEX201  -  GRAFT SFT TIS THK2MM 70X40MM STRL MATRACELL ARTHROFLEX	BOTH IP/OP	"$9,505.00 "	"$7,033.70"	$0.00	"$7,416.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,980.84"	$0.00	$0.00	$0.00	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AFLEX301	SUP	HCPCS Q4125		AFLEX301  -  GRAFT SFT TIS THK3MM 70X40MM DECELLULARIZE DERM	BOTH IP/OP	"$9,965.00 "	"$7,374.10"	$0.00	"$7,778.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,076.71"	$0.00	$0.00	$0.00	$0.00	"$4,861.25"	"$7,700.22"	"$7,778.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AFLEX400	SUP	HCPCS Q4125		AFLEX400  -  GRAFT SFT TIS 40X40X1MM DECELLUARIZE DERM	BOTH IP/OP	"$5,495.00 "	"$4,066.30"	$0.00	"$4,182.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,078.39"	"$4,078.39"	$0.00	$0.00	"$1,145.16"	$0.00	$0.00	$0.00	$0.00	"$2,613.75"	"$4,140.18"	"$4,182.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AFLEX401	SUP	HCPCS Q4125		AFLEX401  -  GRAFT SFT TIS 70X40X1MM DECELLULARIZE DERM	BOTH IP/OP	"$6,700.00 "	"$4,958.00"	$0.00	"$5,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,396.28"	$0.00	$0.00	$0.00	$0.00	"$3,187.50"	"$5,049.00"	"$5,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AFLEX500	SUP	HCPCS Q4125		AFLEX500  -  GRAFT SFT TIS THK.5MM 40X30MM DECELLULARIZE DERM	BOTH IP/OP	"$3,107.50 "	"$2,299.55"	$0.00	"$2,354.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,306.39"	"$2,306.39"	$0.00	$0.00	$647.60	$0.00	$0.00	$0.00	$0.00	"$1,471.25"	"$2,330.46"	"$2,354.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AG0340	SUP	HCPCS C1763		AG0340  -  PROTECTOR NERVE 3.5MM 40MM REINFORCED WRAP AXOGUARD PIG	BOTH IP/OP	"$5,787.50 "	"$4,282.75"	$0.00	"$4,280.00"	"$2,407.50"	"$2,407.50"	$0.00	$0.00	$0.00	"$1,206.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,206.12"	$0.00	"$2,853.24"	"$2,853.24"	$0.00	"$2,675.00"	"$4,237.20"	"$4,280.00"	$0.00		$0.00	$837.28	$0.00	$0.00	$851.72	$0.00	$0.00	$0.00	$0.00	$0.00
AG0740	SUP	HCPCS C1763		AG0740  -  PROTECTOR TISSUE 7MM 40MM AXOGUARD PIG EXTRACELLULAR MATRIX	BOTH IP/OP	"$5,935.00 "	"$4,391.90"	$0.00	"$4,300.00"	"$2,418.75"	"$2,418.75"	$0.00	$0.00	$0.00	"$1,237.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,236.85"	$0.00	"$2,925.96"	"$2,925.96"	$0.00	"$2,687.50"	"$4,257.00"	"$4,300.00"	$0.00		$0.00	$841.19	$0.00	$0.00	$855.70	$0.00	$0.00	$0.00	$0.00	$0.00
AG1040	SUP	HCPCS C1763		AG1040  -  PROTECTOR NERVE 10MM 40MM MULTILAMINAR AXOGUARD	BOTH IP/OP	"$5,935.00 "	"$4,391.90"	$0.00	"$4,390.00"	"$2,469.38"	"$2,469.38"	$0.00	$0.00	$0.00	"$1,237.00"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,236.85"	$0.00	"$2,925.96"	"$2,925.96"	$0.00	"$2,743.75"	"$4,346.10"	"$4,390.00"	$0.00		$0.00	$858.79	$0.00	$0.00	$873.61	$0.00	$0.00	$0.00	$0.00	$0.00
AG-2015	SUP	HCPCS V2790		AG-2015  -  GRAFT SOFT TISSUE B THK50-100UM 2X1.5IN ALLOGRAFT	BOTH IP/OP	"$1,722.50 "	"$1,274.65"	$0.00	"$1,340.00"	$753.75	$753.75	$0.00	$0.00	$0.00	$359.01	"$1,278.44"	"$1,278.44"	$0.00	$0.00	$358.97	$0.00	"$1,018.86"	"$1,018.86"	$0.00	$837.50	"$1,326.60"	"$1,340.00"	$0.00		$0.00	$262.14	$0.00	$0.00	$266.66	$0.00	$0.00	$0.00	$0.00	$0.00
AGX215	SUP	HCPCS C1763		AGX215  -  CONNECTOR NERVE 2MM 15MM COAPTATION AID AXOGUARD PIG	BOTH IP/OP	"$3,730.00 "	"$2,760.20"	$0.00	"$2,768.41"	"$1,552.50"	"$1,552.50"	$0.00	$0.00	$0.00	$777.43	"$2,768.41"	"$2,768.41"	$0.00	$0.00	$777.33	$0.00	"$1,838.89"	"$1,838.89"	$0.00	"$1,725.00"	"$2,732.40"	"$2,760.00"	$0.00		$0.00	$539.93	$0.00	$0.00	$571.13	$0.00	$0.00	$0.00	$0.00	$0.00
AGX310	SUP	HCPCS C1763		AGX310  -  CONNECTOR NERVE 3MM 10MM COAPTATION AID AXOGUARD PIG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AGX415	SUP	HCPCS C1763		AGX415  -  CONNECTOR NERVE 4MM 15MM COAPTATION AID AXOGUARD PIG	BOTH IP/OP	"$3,730.00 "	"$2,760.20"	$0.00	"$2,768.41"	"$1,552.50"	"$1,552.50"	$0.00	$0.00	$0.00	$777.43	"$2,768.41"	"$2,768.41"	$0.00	$0.00	$777.33	$0.00	"$1,838.89"	"$1,838.89"	$0.00	"$1,725.00"	"$2,732.40"	"$2,760.00"	$0.00		$0.00	$539.93	$0.00	$0.00	$571.13	$0.00	$0.00	$0.00	$0.00	$0.00
AGX515	SUP	HCPCS C1763		AGX515  -  CONNECTOR NERVE 5MM 15MM COAPTATION AID AXOGUARD PIG	BOTH IP/OP	"$3,730.00 "	"$2,760.20"	$0.00	"$2,768.41"	"$1,552.50"	"$1,552.50"	$0.00	$0.00	$0.00	$777.43	"$2,768.41"	"$2,768.41"	$0.00	$0.00	$777.33	$0.00	"$1,838.89"	"$1,838.89"	$0.00	"$1,725.00"	"$2,732.40"	"$2,760.00"	$0.00		$0.00	$539.93	$0.00	$0.00	$571.13	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0010-S	SUP	HCPCS C1713		AI-0010-S  -  SCREW BONE 10MM ACUTWIST ACTRK CALC CMPR STRL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0012-S	SUP	HCPCS C1713		AI-0012-S  -  SCREW BONE 12MM ACUTWIST SS CALC CMPR STRL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0014-S	SUP	HCPCS C1713		AI-0014-S  -  SCREW BONE 14MM ACUTWIST SS FT HAND CMPR STRL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0016	SUP	HCPCS C1713		AI-0016  -  SCREW BONE 16MM ACUTWIST TI ORTH CMPR NONSTRL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0016-S	SUP	HCPCS C1713		AI-0016-S  -  SCREW BONE 16MM ACUTWIST ACTRK CMPR STRL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0018-S	SUP	HCPCS C1713		AI-0018-S  -  SCREW BONE 18MM ACUTWIST ACTRK CMPR STRL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0020	SUP	HCPCS C1713		AI-0020  -  SCREW BONE 20MM ACUTWIST	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0020-S	SUP	HCPCS C1713		AI-0020-S  -  SCREW BONE 20MM ACUTWIST SS FT HAND CMPR STRL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0022-S	SUP	HCPCS C1713		AI-0022-S  -  SCREW BONE 22MM ACUTWIST ACTRK TI FULTHD HAND FT CMPR HDLS	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0024	SUP	HCPCS C1713		AI-0024  -  SCREW BONE 24MM ACUTWIST TI ORTH NONSTRL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0024-S	SUP	HCPCS C1713		AI-0024-S  -  SCREW BONE 24MM ACUTWIST ACTRK TI ORTH CMPR STRL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0026	SUP	HCPCS C1713		AI-0026  -  SCREW BONE 26MM ACTRK ACUTWIST CMPR NONSTRL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0026-S	SUP	HCPCS C1713		AI-0026-S  -  SCREW BONE 26MM ACUTWIST ACTRK ORTH CMPR STRL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0028-S	SUP	HCPCS C1713		AI-0028-S  -  SCREW BONE 28MM ACUTWIST ACTRK FT HAND CMPR STRL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-0030-S	SUP	HCPCS C1713		AI-0030-S  -  SCREW BONE 30MM ACUTWIST ACTRK PERIART WRST ANKL HAND FT	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AI-07127	SUP	HCPCS C1725		CATHETER ANGIO 7FR 110CM 2 LUM WDG PRSS PED	BOTH IP/OP	$113.68 	$84.12	$0.00	$90.94	$61.73	$61.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.84	$90.03	$90.94	$0.00		$0.00	$17.79	$0.00	$0.00	$18.10	$0.00	$0.00	$0.00	$0.00	$0.00
AI-EX20	SUP	HCPCS C1713		AI-EX20  -  SCREW BONE ACTRK ACUTWIST CMPNT XTRT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AI-NG30	SUP	HCPCS C1713		AI-NG30  -  SCREW BONE 30MM ACTRK ACUTWIST TI ORTH TAP NONSTRL	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
AK-01000	SUP	Custom 27203010		AK-01000  -  KIT THORACENTESIS 8FR 22GA 7.5IN 1.5IN 3 WAY STOPCOCK	BOTH IP/OP	$140.00 	$103.60	$0.00	$218.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.91	$103.91	$0.00	$0.00	$29.18	$0.00	$0.00	$0.00	$0.00	$66.99	$218.12	$107.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AK-04212	SUP	HCPCS C1751		AK-04212  -  KIT CATHETER .032IN 16GA 18GA 20CM 2.5IN CATHETER GWIRE	BOTH IP/OP	$41.70 	$30.86	$0.00	$33.36	$22.65	$22.65	$0.00	$0.00	$0.00	$8.69	$30.95	$30.95	$0.00	$0.00	$8.69	$0.00	$24.67	$24.67	$0.00	$20.85	$33.03	$33.36	$0.00		$0.00	$6.53	$0.00	$0.00	$6.64	$0.00	$0.00	$0.00	$0.00	$0.00
AK-09000	SUP	HCPCS C1729		AK-09000  -  KIT PERITONEAL LAVAGE .035IN 8FR 18GA 9.25IN 17.75IN	BOTH IP/OP	$58.02 	$42.93	$0.00	$68.13	$46.25	$46.25	$0.00	$0.00	$0.00	$12.09	$43.06	$43.06	$0.00	$0.00	$12.09	$0.00	$34.32	$34.32	$0.00	$42.58	$67.45	$68.13	$0.00		$0.00	$13.33	$0.00	$0.00	$13.56	$0.00	$0.00	$0.00	$0.00	$0.00
AK-09601	SUP	HCPCS C1894		INTRODUCER SHTH 6FR 10CM INTGR HMSTS VLV SDPRT TISS DILAT	BOTH IP/OP	$78.75 	$58.28	$0.00	$63.00	$42.76	$42.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.38	$62.37	$63.00	$0.00		$0.00	$12.32	$0.00	$0.00	$12.54	$0.00	$0.00	$0.00	$0.00	$0.00
AK-15703-ASP	SUP	Custom 27203010		TRAY CATH 7FR 8IN CEN VEN A-H BL FLX 3 LUM RADIOPQ SPRG	BOTH IP/OP	$131.08 	$97.00	$0.00	$104.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.28	$97.28	$0.00	$0.00	$27.32	$0.00	$0.00	$0.00	$0.00	$65.54	$103.82	$104.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AK-16553	SUP	HCPCS C1769		KIT PED 5 1/8IN 5.5FR .018IN 3 LUM RADIOPQ SPRG GUIDEWIRE	BOTH IP/OP	$126.85 	$93.87	$0.00	$101.48	$68.88	$68.88	$0.00	$0.00	$0.00	$26.44	$94.15	$94.15	$0.00	$0.00	$26.44	$0.00	$75.03	$75.03	$0.00	$63.43	$100.47	$101.48	$0.00		$0.00	$19.85	$0.00	$0.00	$20.19	$0.00	$0.00	$0.00	$0.00	$0.00
AK-16702	SUP	HCPCS C1769		KIT 8IN 7FR .032IN 2 LUM RADIOPQ SPRG GUIDEWIRE INTROD NDL	BOTH IP/OP	$95.50 	$70.67	$0.00	$76.40	$51.86	$51.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.75	$75.64	$76.40	$0.00		$0.00	$14.95	$0.00	$0.00	$15.20	$0.00	$0.00	$0.00	$0.00	$0.00
AK-22702	SUP	HCPCS C1729		KIT CATH 6 5/16IN 7FR BLUFLTP ARWG+A BL .025IN CEN VEN PU 2	BOTH IP/OP	$130.25 	$96.39	$0.00	$104.20	$70.73	$70.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.13	$103.16	$104.20	$0.00		$0.00	$20.38	$0.00	$0.00	$20.74	$0.00	$0.00	$0.00	$0.00	$0.00
AK-24703-A	SUP	HCPCS C1729		CATHETER KIT  CENTRAL VENOUS ARROWGUARD 7FR X 12IN MULTI LUM	BOTH IP/OP	$960.00 	$710.40	$0.00	$768.00	$521.28	$521.28	$0.00	$0.00	$0.00	$200.09	$712.51	$712.51	$0.00	$0.00	$200.06	$0.00	$567.84	$567.84	$0.00	$480.00	$760.32	$768.00	$0.00		$0.00	$150.24	$0.00	$0.00	$152.83	$0.00	$0.00	$0.00	$0.00	$0.00
AK-42854-SK	SUP	HCPCS C1769		KIT 6IN 8.5FR .032IN 4 LUM RADIOPQ SPRG GUIDEWIRE INTROD NDL	BOTH IP/OP	$194.61 	$144.01	$0.00	$155.69	$105.67	$105.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.31	$154.13	$155.69	$0.00		$0.00	$30.46	$0.00	$0.00	$30.98	$0.00	$0.00	$0.00	$0.00	$0.00
AM-0025S	SUP	HCPCS C1713		AM-0025S  -  SCREW BONE 4/5MM 25MM ACTRK FIXAT STRL	BOTH IP/OP	$769.78 	$569.64	$0.00	$615.82	$346.40	$346.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$384.89	$609.67	$615.82	$0.00		$0.00	$120.47	$0.00	$0.00	$122.55	$0.00	$0.00	$0.00	$0.00	$0.00
AM-0025-S	SUP	HCPCS C1713		AM-0025-S  -  SCREW BONE 4/5MM 25MM ACTRK TI FULTHD ORTH SLFTAP CANN CMPR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AM-0030S	SUP	HCPCS C1713		AM-0030S  -  SCREW BONE 4/5MM 30MM ACTRK FIXAT STRL	BOTH IP/OP	$769.78 	$569.64	$0.00	$615.82	$346.40	$346.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$384.89	$609.67	$615.82	$0.00		$0.00	$120.47	$0.00	$0.00	$122.55	$0.00	$0.00	$0.00	$0.00	$0.00
AM-0030-S	SUP	HCPCS C1713		AM-0030-S  -  SCREW BONE 4/5MM 30MM ACTRK TI FULTHD HINDFOOT ANKL FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AM-0035S	SUP	HCPCS C1713		AM-0035S  -  SCREW BONE 35MM ACTRK 4/5 ACUMED FIXAT STRL	BOTH IP/OP	$769.78 	$569.64	$0.00	$615.82	$346.40	$346.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$384.89	$609.67	$615.82	$0.00		$0.00	$120.47	$0.00	$0.00	$122.55	$0.00	$0.00	$0.00	$0.00	$0.00
AM-0035-S	SUP	HCPCS C1713		AM-0035-S  -  SCREW BONE 4/5MM 35MM ACTRK TI FULTHD HINDFOOT ANKL SLFTAP	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AM-0040S	SUP	HCPCS C1713		AM-0040S  -  SCREW BONE 40MM ACTRK 4/5 ACUMED FIXAT STRL	BOTH IP/OP	$769.78 	$569.64	$0.00	$615.82	$346.40	$346.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$384.89	$609.67	$615.82	$0.00		$0.00	$120.47	$0.00	$0.00	$122.55	$0.00	$0.00	$0.00	$0.00	$0.00
AM-0040-S	SUP	HCPCS C1713		AM-0040-S  -  SCREW BONE 4MM 5MM 40MM ACTRK TI FULTHD ORTH FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AM-0045S	SUP	HCPCS C1713		AM-0045S  -  SCREW BONE 4/5MM 45MM ACTRK FIXAT STRL	BOTH IP/OP	$769.78 	$569.64	$0.00	$615.82	$346.40	$346.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$384.89	$609.67	$615.82	$0.00		$0.00	$120.47	$0.00	$0.00	$122.55	$0.00	$0.00	$0.00	$0.00	$0.00
AM-0045-S	SUP	HCPCS C1713		AM-0045-S  -  SCREW BN FT 4-5MM 45MM STRL ACTRK ST CNN CMPR HDLS TPR TI	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AM-0050S	SUP	HCPCS C1713		AM-0050S  -  SCREW BONE 4/5MM 50MM ACTRK FIXAT STRL	BOTH IP/OP	$769.78 	$569.64	$0.00	$615.82	$346.40	$346.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$384.89	$609.67	$615.82	$0.00		$0.00	$120.47	$0.00	$0.00	$122.55	$0.00	$0.00	$0.00	$0.00	$0.00
AM-0050-S	SUP	HCPCS C1713		AM-0050-S  -  SCREW BONE 4/5MM 50MM ACTRK TI FULTHD HINDFOOT ANKL FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AM2184	SUP	Custom 27203010		STRIP UA URSTX GLUC PRTN REAGENT	BOTH IP/OP	$48.45 	$35.85	$0.00	$38.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.23	$38.37	$38.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AM2190	SUP	Custom 27203010		STRIP UA HEMASTIX URN BLOOD REAGENT	BOTH IP/OP	$37.98 	$28.11	$0.00	$30.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.99	$30.08	$30.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AM-5010	SUP	Custom 27203010		AM-5010  -  BIT DRILL 4MM 5MM ACTRK STD CANN NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AM-5014	SUP	Custom 27203010		AM-5014  -  DRILL SRG 4/5MM ACTRK DNS CNN BN	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AMP 225 210 152	SUP	HCPCS C1725		AMP 225 210 152  -  CATHETER BLNDIL 2-2.5MM 150CM 210MM AM DP OTW LOPRFL TPR BRD	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$536.21	$536.21	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AM-TA25	SUP	HCPCS C1713		AM-TA25  -  SCREW BONE 25MM ACTRK 4/5 FT ANKL TPR NONSTRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AN04318	SUP	HCPCS C1769		INTRODUCER CATH 18GA 2.5IN SPRG GUIDEWIRE	BOTH IP/OP	$5.38 	$3.98	$0.00	$4.30	$2.92	$2.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.69	$4.26	$4.30	$0.00		$0.00	$0.84	$0.00	$0.00	$0.86	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0035-S	SUP	HCPCS C1713		AP-0035-S  -  SCREW BONE 5/6.5MM 35MM ACTRK+ TI ORTH FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0040-S	SUP	HCPCS C1713		AP-0040-S  -  SCREW BONE 5/6.5MM 40MM ACTRK+ TI HINDFOOT ANKL FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0045-S	SUP	HCPCS C1713		AP-0045-S  -  SCREW BONE 5/6.5MM 45MM ACTRK+ TI ORTH CANN STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0050-S	SUP	HCPCS C1713		AP-0050-S  -  SCREW BONE 5/6.5MM 50MM ACTRK+ TI HINDFOOT ANKL FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0055-S	SUP	HCPCS C1713		AP-0055-S  -  SCREW BONE 5/6.5MM 55MM ACTRK+ TI ORTH FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0060-S	SUP	HCPCS C1713		AP-0060-S  -  SCREW BONE 5/6.5MM 60MM ACTRK+ TI HINDFOOT ANKL FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0065-S	SUP	HCPCS C1713		AP-0065-S  -  SCREW BONE 5/6.5MM 65MM ACTRK+ TI HINDFOOT ANKL FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0070-S	SUP	HCPCS C1713		AP-0070-S  -  SCREW BONE 5/6.5MM 70MM ACMD/TRK PLUS TI ORTH FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0075-S	SUP	HCPCS C1713		AP-0075-S  -  SCREW BONE 5/6.5MM 75MM ACMD/TRK PLUS TI ORTH FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0080-S	SUP	HCPCS C1713		AP-0080-S  -  SCREW BONE 5/6.5MM 80MM ACTRK+ TI HINDFOOT ANKL FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-010	SUP	Custom 27203010		AP-010  -  BIT DRILL CANN	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0100	SUP	Custom 27203010		AP-0100  -  DRILL SURG TAPER CANN ACUTRAK PLUS TITANIUM	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0104	SUP	Custom 27203010		AP-0104  -  DRILL SRG ACTRK+ DNS BN	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AP-0110	SUP	Custom 27203010		AP-0110  -  BIT DRL NS ACTRK+ CNN GRV SPNE	BOTH IP/OP	$785.00 	$580.90	$0.00	$628.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$582.63	$582.63	$0.00	$0.00	$163.59	$0.00	$0.00	$0.00	$0.00	$392.50	$621.72	$628.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AP-67008	SUP	Custom 27203010		AP-67008  -  DEVICE REM 4MM SCR	BOTH IP/OP	$747.50 	$553.15	$0.00	$598.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$554.79	$554.79	$0.00	$0.00	$155.78	$0.00	$0.00	$0.00	$0.00	$373.75	$592.02	$598.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AP-67011	SUP	Custom 27203010		AP-67011  -  DRILL SURG SM 40-120MM CANN ACTRK 6-7MM STRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AP-67012	SUP	Custom 27203010		AP-67012  -  DRILL SURG MED 70-85MM CANN DNS ACTRK 6-7MM STRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AP-67013	SUP	Custom 27203010		AP-67013  -  DRILL SURG LG 90-120MM CANN ACTRK 6-7MM NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AP-67014	SUP	Custom 27203010		AP-67014  -  BIT DRILL 40-65MM 6MM 7MM ACTRK SM CANN DNS STRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AP-67015	SUP	Custom 27203010		AP-67015  -  DRILL HAND RED 70-85MM ACTRK MED CANN DNS 6/7 SCR SYS STRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AP-67016	SUP	Custom 27203010		AP-67016  -  DRILL SURG REG 40-120MM CANN ACTRK 6-7MM STRL YLW ACUTRACK	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AP-67100-S	SUP	HCPCS C1713		AP-67100-S  -  SCREW BONE 6-7MM 100MM ACTRK TI SM BONE NONSTRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-67105-S	SUP	HCPCS C1713		AP-67105-S  -  SCREW BONE 6-7MM 105MM ACTRK FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-67110-S	SUP	HCPCS C1713		AP-67110-S  -  SCREW BONE 6-7MM 110MM ACTRK FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-67115-S	SUP	HCPCS C1713		AP-67115-S  -  SCREW BONE 6/7MM 115MM ACTRK FIX	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-67120-S	SUP	HCPCS C1713		AP-67120-S  -  SCREW BONE 6/7MM 120MM ACTRK FIX	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-6740-S	SUP	HCPCS C1713		AP-6740-S  -  SCREW BONE 6/7MM 40MM ACTRK TI FULTHD ORTH SLFTAP CANN STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-6745-S	SUP	HCPCS C1713		AP-6745-S  -  SCREW BONE 6/7MM 45MM ACTRK TI FULTHD ORTH SLFTAP CANN CMPR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-6750-S	SUP	HCPCS C1713		AP-6750-S  -  SCREW BONE 6/7MM 50MM ACTRK TI UPR XTRMT FRFT FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-6755-S	SUP	HCPCS C1713		AP-6755-S  -  SCREW BONE 6/7MM 55MM ACTRK TI UPR XTRMT FRFT FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-6760-S	SUP	HCPCS C1713		AP-6760-S  -  SCREW BONE 6/7MM 60MM ACTRK TI FULTHD ORTH SLFTAP CANN CMPR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-6765-S	SUP	HCPCS C1713		AP-6765-S  -  SCREW BONE 6/7MM 65MM ACTRK TI ORTH FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-6770-S	SUP	HCPCS C1713		AP-6770-S  -  SCREW BONE 6/7MM 70MM ACTRK TI ORTH FIX STRL 6 7 SCR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-6775-S	SUP	HCPCS C1713		AP-6775-S  -  SCREW BONE 6/7MM 75MM ACTRK TI FULTHD ORTH SLFTAP CANN CMPR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-6780-S	SUP	HCPCS C1713		AP-6780-S  -  SCREW BN .094IN 6/7MM 4MM 80MM STRL ACTRK FX TI	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-6785-S	SUP	HCPCS C1713		AP-6785-S  -  SCREW BONE 6/7MM 85MM ACTRK TI UPR XTRMT FRFT FIX STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-6790-S	SUP	HCPCS C1713		AP-6790-S  -  SCREW BONE 6-7MM 90MM ACTRK TI SM BONE STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AP-6795-S	SUP	HCPCS C1713		AP-6795-S  -  SCREW BONE 6/7MM 95MM ACTRK TI ORTH STRL	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AQL-110	SUP	HCPCS C1713		AQL-110  -  SET TBG AQUILEX FL CNTRL INFL	BOTH IP/OP	$397.50 	$294.15	$0.00	$730.00	$410.63	$410.63	$0.00	$0.00	$0.00	$0.00	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$0.00	$0.00	$0.00	$456.25	$722.70	$730.00	$0.00		$0.00	$142.81	$0.00	$0.00	$145.27	$0.00	$0.00	$0.00	$0.00	$0.00
AQL-111	SUP	Custom 27203010		AQL-111  -  SET TBG AQUILEX FL CNTRL OFLW	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-005-AC00	SUP	Custom 27203010		AR-005-AC00  -  CLAMP XTRNFX IBALANCE ANKL UNCNDL KN ARTHOPLASTY	BOTH IP/OP	"$1,700.00 "	"$1,258.00"	$0.00	"$1,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,261.74"	"$1,261.74"	$0.00	$0.00	$354.28	$0.00	$0.00	$0.00	$0.00	$850.00	"$1,346.40"	"$1,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1000	SUP	Custom 27203010		AR-1000  -  PASSER SUT TRANSOSSEOUS	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$0.00	$0.00	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1006	SUP	HCPCS C1713		AR-1006  -  STAPLE BN SPK 20X6MM STRL COCR ACL PCL	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$88.88	$88.88	$0.00	$0.00	$0.00	$41.16	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$116.82	$116.82	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$30.91	$0.00	$0.00	$31.44	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1006M	SUP	HCPCS C1713		AR-1006M  -  STAPLE BN 20X6MM STRL COCR ACL PCL	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$88.88	$88.88	$0.00	$0.00	$0.00	$41.16	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$116.82	$116.82	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$30.91	$0.00	$0.00	$31.44	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1006MNS	SUP	Custom 27803010		AR-1006MNS  -  STAPLE BN 20X6MM NS COCR ACL PCL	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1006NS	SUP	Custom 27803010		AR-1006NS  -  STAPLE BN SPK 20X6MM NS COCR ACL PCL	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1008	SUP	HCPCS C1713		AR-1008  -  STAPLE BN SPK 20X8MM STRL LOPRFL LGMNT COCR ACL PCL	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$88.88	$88.88	$0.00	$0.00	$0.00	$41.16	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$116.82	$116.82	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$30.91	$0.00	$0.00	$31.44	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1008NS	SUP	Custom 27803010		AR-1008NS  -  STAPLE BN SPK 20X8MM NS COCR ACL PCL	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1011	SUP	HCPCS C1713		AR-1011  -  STAPLE BN SPK 20X11MM STRL COCR ACL PCL	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$88.88	$88.88	$0.00	$0.00	$0.00	$41.16	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$116.82	$116.82	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$30.91	$0.00	$0.00	$31.44	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1011NS	SUP	Custom 27803010		AR-1011NS  -  STAPLE BN SPK LOPRFL 20X11MM NS COCR ACL PCL	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1016	SUP	HCPCS C1713		AR-1016  -  STAPLE BN SPK 20X16MM STRL COCR ACL PCL	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$88.88	$88.88	$0.00	$0.00	$0.00	$41.16	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$116.82	$116.82	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$30.91	$0.00	$0.00	$31.44	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1016NS	SUP	Custom 27803010		AR-1016NS  -  STAPLE BN SPK LOPRFL 20X16MM NS COCR ACL PCL	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1201.7D	SUP	Custom 27203010		AR-1201.7D  -  BIT DRL SM LOPRFL 1.7MM 20X25IN AMERPAK FRM 100 AO CNCT PLT	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1201-7DC	SUP	Custom 27203010		AR-1201-7DC  -  BIT DRL 1.7MM CNN AO CNCT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1202-3D	SUP	Custom 27203010		AR-1202-3D  -  BIT DRL 2.3MM SM FRAG SCR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-12040	SUP	Custom 27203010		AR-12040  -  PUNCH ARTHRO 3.5MM STR SER 1 DSGN WIDEBITER 3.4MM	BOTH IP/OP	"$2,487.50 "	"$1,840.75"	$0.00	"$1,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,846.22"	"$1,846.22"	$0.00	$0.00	$518.40	$0.00	$0.00	$0.00	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-100	SUP	Custom 27203010		AR-1204AF-100  -  CUTTER ASCP 10MM BLU STRL LF FLIPCUTTER II DRL PIN FEM SCKT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-105	SUP	Custom 27203010		AR-1204AF-105  -  CUTTER ARTHRO RTRGRD LP 10.5MM DRILL PIN FEMORAL SOCKET	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-110	SUP	Custom 27203010		AR-1204AF-110  -  CUTTER ARTHRO RTRGRD LP 11MM DRILL PIN FEMORAL SOCKET	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-115	SUP	Custom 27203010		AR-1204AF-115  -  CUTTER ASCP 11.5MM FLIPCUTTER II RETROCONSTRUCTION DRL PIN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-120	SUP	Custom 27203010		AR-1204AF-120  -  CUTTER ASCP 12MM FLIPCUTTER II RETROCONSTRUCTION DRL PIN RMR	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-125	SUP	Custom 27203010		AR-1204AF-125  -  CUTTER ASCP RTRGD LOPRFL 12.5MM BLU STRL LF FLIPCUTTER II	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-130	SUP	Custom 27203010		AR-1204AF-130  -  CUTTER ASCP RTRGD LOPRFL 13MM BLU STRL LF FLIPCUTTER II DRL	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-50	SUP	Custom 27203010		AR-1204AF-50  -  CUTTER ASCP RTRGD LOPRFL 5MM BLU STRL LF FLIPCUTTER II DRL	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-55	SUP	Custom 27203010		AR-1204AF-55  -  CUTTER ASCP 5MM FLIPCUTTER II	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-60	SUP	Custom 27203010		AR-1204AF-60  -  CUTTER ASCP RTRGD LOPRFL 6MM BLU STRL LF FLIPCUTTER II DRL	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-65	SUP	Custom 27203010		AR-1204AF-65  -  CUTTER ASCP RTRGD LOPRFL 6.5MM BLU STRL LF FLIPCUTTER II DRL	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-70	SUP	Custom 27203010		AR-1204AF-70  -  CUTTER ASCP RTRGD LOPRFL 7MM BLU STRL LF FLIPCUTTER II DRL	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-75	SUP	Custom 27203010		AR-1204AF-75  -  CUTTER ASCP RTRGD 7.5MM BLU STRL LF FLIPCUTTER II DRL PIN	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-80	SUP	Custom 27203010		AR-1204AF-80  -  CUTTER ASCP 8MM BLU STRL LF FLIPCUTTER II DRL PIN FEM SCKT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-85	SUP	Custom 27203010		AR-1204AF-85  -  CUTTER ASCP 8.5MM BLU STRL LF FLIPCUTTER II DRL PIN FEM SCKT	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-90	SUP	Custom 27203010		AR-1204AF-90  -  CUTTER ASCP RTRGD 9MM BLU STRL LF FLIPCUTTER II DRL PIN FEM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AF-95	SUP	Custom 27203010		AR-1204AF-95  -  CUTTER ASCP RTRGD LOPRFL 9.5MM BLU STRL LF FLIPCUTTER II DRL	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-105	SUP	Custom 27203010		AR-1204AS-105  -  CUTTER ASCP SHRT 10.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-110	SUP	Custom 27203010		AR-1204AS-110  -  CUTTER ASCP SHRT 11MM FLIPCUTTER II ANTM SCKT KN 3.5MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-120	SUP	Custom 27203010		AR-1204AS-120  -  CUTTER ASCP SHRT 12MM FLIPCUTTER II ANTM SCKT KN 3.5MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-50	SUP	Custom 27203010		AR-1204AS-50  -  CUTTER ASCP SHRT 5MM FLIPCUTTER II ANTM SCKT KN 3.5MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-55	SUP	Custom 27203010		AR-1204AS-55  -  CUTTER ASCP SHRT 5.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-60	SUP	Custom 27203010		AR-1204AS-60  -  CUTTER ASCP SHRT 6MM FLIPCUTTER II ANTM SCKT KN 3.5MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-65	SUP	Custom 27203010		AR-1204AS-65  -  CUTTER ASCP SHRT 6.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-70	SUP	Custom 27203010		AR-1204AS-70  -  CUTTER ASCP SHRT 7MM FLIPCUTTER II ANTM SCKT KN 3.5MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-75	SUP	Custom 27203010		AR-1204AS-75  -  CUTTER ASCP SHRT 7.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-80	SUP	Custom 27203010		AR-1204AS-80  -  CUTTER ASCP SHRT 8MM FLIPCUTTER II ANTM SCKT KN 3.5MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-85	SUP	Custom 27203010		AR-1204AS-85  -  CUTTER ASCP SHRT 8.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-90	SUP	Custom 27203010		AR-1204AS-90  -  CUTTER ARTHRO ANTM SCKT FLIPCUTTER II SHRT KNEE 9	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204AS-95	SUP	Custom 27203010		AR-1204AS-95  -  CUTTER ASCP SHRT 9.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204D	SUP	Custom 27203010		AR-1204D  -  DRILL SURG BIT SCREW BIO-TENODESIS 4MM	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204R-055S	SUP	Custom 27203010		AR-1204R-055S  -  CUTTER ASCP 5.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204R-05S	SUP	Custom 27203010		AR-1204R-05S  -  CUTTER ASCP 5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204R-065S	SUP	Custom 27203010		AR-1204R-065S  -  CUTTER ASCP 6.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204R-06S	SUP	Custom 27203010		AR-1204R-06S  -  CUTTER ASCP 6MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204R-075S	SUP	Custom 27203010		AR-1204R-075S  -  CUTTER ASCP 7.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204R-07S	SUP	Custom 27203010		AR-1204R-07S  -  CUTTER ASCP 7MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204R-08S	SUP	Custom 27203010		AR-1204R-08S  -  CUTTER ASCP 8MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204R-095S	SUP	Custom 27203010		AR-1204R-095S  -  CUTTER ASCP 9.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204R-09S	SUP	Custom 27203010		AR-1204R-09S  -  CUTTER ASCP 9MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204R-105S	SUP	Custom 27203010		AR-1204R-105S  -  CUTTER ASCP 10.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1204R-12S	SUP	Custom 27203010		AR-1204R-12S  -  CUTTER ASCP 12MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-100	SUP	Custom 27203010		AR-1218-100  -  DRILL SURG FULL THICK 10MM CALIBRATE DEPTH MARK CANN ACL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-105	SUP	Custom 27203010		AR-1218-105  -  DRILL SRG 10.5MM STRL CNN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-115	SUP	Custom 27203010		AR-1218-115  -  DRILL SRG 11.5MM STRL CNN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-120	SUP	Custom 27203010		AR-1218-120  -  DRILL SRG 12MM STRL CNN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-150	SUP	Custom 27203010		AR-1218-150  -  DRILL SRG 15MM STRL CNN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-40	SUP	Custom 27203010		AR-1218-40  -  DRILL SRG FULL THK 4MM STRL CLBRT D MRK CNN ACL DISP	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-50	SUP	Custom 27203010		AR-1218-50  -  DRILL SRG FULL THK 5MM STRL CLBRT D MRK CNN ACL DISP	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-55	SUP	Custom 27203010		AR-1218-55  -  DRILL SRG CNN 5.5 MM SCR	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-60	SUP	Custom 27203010		AR-1218-60  -  DRILL SRG FULL THK 6MM STRL CLBRT D MRK CNN ACL HAZ	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-65	SUP	Custom 27203010		AR-1218-65  -  DRILL SRG 6.5MM STRL CNN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-70	SUP	Custom 27203010		AR-1218-70  -  DRILL SRG 7MM STRL CNN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-75	SUP	Custom 27203010		AR-1218-75  -  DRILL SURG 7.5MM CANN STERILE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-80	SUP	Custom 27203010		AR-1218-80  -  DRILL SRG FULL THK 8MM STRL CLBRT D MRK CNN ACL DISP	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-90	SUP	Custom 27203010		AR-1218-90  -  DRILL SURG FULL THICK 9MM CALIBRATE DEPTH MARK CANN ACL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1218-95	SUP	Custom 27203010		AR-1218-95  -  DRILL SURG FULL THK CLBRT DEPTH MARK CANN ACL 9.5	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1220S	SUP	Custom 27203010		AR-1220S  -  REAMER SRG 7MM STRL CNN COLR PIN SET COR DISP	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1222S	SUP	Custom 27203010		AR-1222S  -  REAMER SRG 8MM STRL CNN COLR PIN SET COR DISP	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1223S	SUP	Custom 27203010		AR-1223S  -  REAMER SRG 9MM STRL CNN COLR PIN SET COR DISP	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1224S	SUP	Custom 27203010		AR-1224S  -  REAMER SRG 10MM STRL CNN COLR PIN SET COR DISP	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1226S	SUP	Custom 27203010		AR-1226S  -  REAMER SRG 11MM STRL CNN COLR PIN SET COR DISP	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1227S	SUP	Custom 27203010		AR-1227S  -  REAMER SRG 12MM STRL CNN COLR PIN SET COR DISP	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1229S	SUP	Custom 27203010		AR-1229S  -  REAMER SRG 13MM STRL CNN COLR PIN SET COR DISP	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1231S	SUP	Custom 27203010		AR-1231S  -  REAMER SRG 14MM STRL CNN COLR PIN SET COR DISP	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1246-1	SUP	Custom 27203010		AR-1246-1  -  GUIDE DRL OFST 3MM	BOTH IP/OP	$780.00 	$577.20	$0.00	$624.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$578.92	$578.92	$0.00	$0.00	$162.55	$0.00	$0.00	$0.00	$0.00	$390.00	$617.76	$624.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1250	SUP	Custom 27203010		AR-1250  -  DRILL SRG 25-30MM 2MM 12IN STRL SEMIFIX D MRK NTNL TIB DISP	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1250F	SUP	Custom 27203010		AR-1250F  -  GUIDE PIN ORTH 3.5MM 30CM STRL PREDRILL ACL DISP FLIPCUTTER	BOTH IP/OP	$110.00 	$81.40	$0.00	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.64	$81.64	$0.00	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1250L	SUP	Custom 27203010		AR-1250L  -  GUIDE PIN ORTH 2.4MM 30CM STRL PREDRILL ACL DISP	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1250LT	SUP	Custom 27203010		AR-1250LT  -  DRILL SRG 2.4MM STP 3MM SUT TK	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1250LTC	SUP	Custom 27203010		AR-1250LTC  -  DRILL SRG 3MM STP 3MM SUT TK HRD BN	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1252	SUP	Custom 27203010		AR-1252  -  DRILL SRG THK SPD 3MM SUT TK	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1254	SUP	Custom 27203010		AR-1254  -  GUIDE PIN ORTH 25/30MM 2MM STRL D MRK NTNL 6MM SCR	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.97	$38.97	$0.00	$0.00	$10.94	$0.00	$0.00	$0.00	$0.00	$26.25	$41.58	$42.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1256	SUP	Custom 27203010		AR-1256  -  DRILL SRG SHRT SPD STRL BSUT TK NDL DISP SUT TK	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1257	SUP	Custom 27203010		AR-1257  -  DRILL SRG SPD STRL BSUT TK DISP 3MM SUT TK	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1259	SUP	Custom 27203010		AR-1259  -  PASSER SUT RETROPASSER NTNL ASCP	BOTH IP/OP	$310.00 	$229.40	$0.00	$248.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.08	$230.08	$0.00	$0.00	$64.60	$0.00	$0.00	$0.00	$0.00	$155.00	$245.52	$248.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1267	SUP	HCPCS C1713		AR-1267  -  CAP PCTV POPLITEUM PCL	BOTH IP/OP	$840.00 	$621.60	$0.00	$672.00	$378.00	$378.00	$0.00	$0.00	$0.00	$175.08	$623.45	$623.45	$0.00	$0.00	$175.06	$0.00	$496.86	$496.86	$0.00	$420.00	$665.28	$672.00	$0.00		$0.00	$131.46	$0.00	$0.00	$133.73	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1270	SUP	Custom 27203010		AR-1270  -  GUIDE DRL LNG NS RETROBUTTON D	BOTH IP/OP	$872.50 	$645.65	$0.00	$698.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$647.57	$647.57	$0.00	$0.00	$181.83	$0.00	$0.00	$0.00	$0.00	$436.25	$691.02	$698.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288-100	SUP	HCPCS C1713		AR-1288-100  -  SYSTEM FX SHRT 10MM TGHTRP RT FLIPCUTTER II 2 LD	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288-105	SUP	HCPCS C1713		AR-1288-105  -  SYSTEM FX SHRT 10.5MM TGHTRP RT FLIPCUTTER II 2 LD	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288-110	SUP	HCPCS C1713		AR-1288-110  -  SYSTEM FX 11MM TGHTRP RT SHRT FLIPCUTTER II 2 LD	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288-70	SUP	HCPCS C1713		AR-1288-70  -  SYSTEM FX SHRT 7MM TGHTRP RT FLIPCUTTER II 2 LD	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288-75	SUP	HCPCS C1713		AR-1288-75  -  SYSTEM FX SHRT 7.5MM TGHTRP RT FLIPCUTTER II 2 LD	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288-80	SUP	HCPCS C1713		AR-1288-80  -  SYSTEM FX SHRT 8MM TGHTRP RT FLIPCUTTER II 2 LD	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288-85	SUP	HCPCS C1713		AR-1288-85  -  SYSTEM FX SHRT 8.5MM TGHTRP RT FLIPCUTTER II 2 LD	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288-90	SUP	HCPCS C1713		AR-1288-90  -  SYSTEM FX SHRT 9MM TGHTRP RT FLIPCUTTER II 2 LD	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288-95	SUP	HCPCS C1713		AR-1288-95  -  SYSTEM FX SHRT 9.5MM TGHTRP RT FLIPCUTTER II 2 LD	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288BTB-100	SUP	HCPCS C1713		AR-1288BTB-100  -  KIT FX 10MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288BTB-110	SUP	HCPCS C1713		AR-1288BTB-110  -  KIT FX 11MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288BTB-70	SUP	HCPCS C1713		AR-1288BTB-70  -  KIT FX 7MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288BTB-75	SUP	HCPCS C1713		AR-1288BTB-75  -  KIT FX 7.5MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288BTB-80	SUP	HCPCS C1713		AR-1288BTB-80  -  KIT FX 8MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288BTB-85	SUP	HCPCS C1713		AR-1288BTB-85  -  KIT FX 8.5MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288BTB-90	SUP	HCPCS C1713		AR-1288BTB-90  -  SYSTEM FX 9MM STRL LF ARTHX TGHTRP BTB J DISP FLPCTR IIS	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1288BTB-95	SUP	HCPCS C1713		AR-1288BTB-95  -  SYSTEM FX 9.5MM STRL LF ARTHX TGHTRP BTB J DISP FLPCTR IIS	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	$866.25	$866.25	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1291-4	SUP	Custom 27203010		AR-1291-4  -  NEEDLE SUT STRL GFT PREP DISP	BOTH IP/OP	$925.00 	$684.50	$0.00	$740.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$686.54	$686.54	$0.00	$0.00	$192.77	$0.00	$0.00	$0.00	$0.00	$462.50	$732.60	$740.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1297	SUP	Custom 27203010		AR-1297  -  GUIDE PIN ORTH BALL 1.7MM ACL	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.17	$126.17	$0.00	$0.00	$35.43	$0.00	$0.00	$0.00	$0.00	$85.00	$134.64	$136.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1297L	SUP	Custom 27203010		AR-1297L  -  GUIDE PIN ORTH 2.4MM 50CM STRL SUT EYE ACL DISP PCL REPR	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.17	$126.17	$0.00	$0.00	$35.43	$0.00	$0.00	$0.00	$0.00	$85.00	$134.64	$136.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-12990N	SUP	Custom 27203010		AR-12990N  -  NEEDLE SUT SCRPN KN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100-05.0	SUP	HCPCS C1713		AR-13100-05.0  -  PLATE BN 5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100-07.5	SUP	HCPCS C1713		AR-13100-07.5  -  PLATE BN 7.5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100-09.0	SUP	HCPCS C1713		AR-13100-09.0  -  PLATE BN 9MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100-10.0	SUP	HCPCS C1713		AR-13100-10.0  -  PLATE BN 10MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100-11.0	SUP	HCPCS C1713		AR-13100-11.0  -  PLATE BN 11MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100-12.5	SUP	HCPCS C1713		AR-13100-12.5  -  PLATE BN 12.5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100-15.0	SUP	HCPCS C1713		AR-13100-15.0  -  PLATE BN 15MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100-17.5	SUP	HCPCS C1713		AR-13100-17.5  -  PLATE BN 17.5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100T-05.0	SUP	HCPCS C1713		AR-13100T-05.0  -  PLATE BN 5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100T-07.5	SUP	HCPCS C1713		AR-13100T-07.5  -  PLATE BN 7.5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100T-09.0	SUP	HCPCS C1713		AR-13100T-09.0  -  PLATE BN 9MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100T-10.0	SUP	HCPCS C1713		AR-13100T-10.0  -  PLATE BN 10MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100T-11.0	SUP	HCPCS C1713		AR-13100T-11.0  -  PLATE BN 11MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100T-12.5	SUP	HCPCS C1713		AR-13100T-12.5  -  PLATE BN 12.5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100T-15.0	SUP	HCPCS C1713		AR-13100T-15.0  -  PLATE BN 15MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13100T-17.5	SUP	HCPCS C1713		AR-13100T-17.5  -  PLATE BN 17.5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120G-2	SUP	Custom 27203010		AR-13120G-2  -  GUIDE DRL MN LOPRFL D 2.4MM SCR	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-10	SUP	HCPCS C1713		AR-13120T-10  -  SCREW BN 1.5MM FT HEX 2.3MM 10MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-10C	SUP	HCPCS C1713		AR-13120T-10C  -  SCREW BN 1.5MM P/T HEX 2.3MM 10MM STRL LOPRFL SCR LG CNN ST	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-10S	SUP	HCPCS C1713		AR-13120T-10S  -  SCREW BN 2.3MM 10MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-11	SUP	HCPCS C1713		AR-13120T-11  -  SCREW BN 1.5MM HEX FT 2.3MM 11MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-11S	SUP	HCPCS C1713		AR-13120T-11S  -  SCREW BN 2.3MM 11MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-12	SUP	HCPCS C1713		AR-13120T-12  -  SCREW BN 1.5MM FT HEX 2.3MM 12MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-12C	SUP	HCPCS C1713		AR-13120T-12C  -  SCREW BN 1.5MM P/T HEX 2.3MM 12MM STRL LOPRFL SCR LG CNN ST	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-12S	SUP	HCPCS C1713		AR-13120T-12S  -  SCREW BN 2.3MM 12MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-13	SUP	HCPCS C1713		AR-13120T-13  -  SCREW BN 1.5MM HEX FT 2.3MM 13MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-13S	SUP	HCPCS C1713		AR-13120T-13S  -  SCREW BN 2.3MM 13MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-14	SUP	HCPCS C1713		AR-13120T-14  -  SCREW BN 1.5MM FT HEX 2.3MM 14MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-14C	SUP	HCPCS C1713		AR-13120T-14C  -  SCREW BN 1.5MM P/T HEX 2.3MM 14MM STRL LOPRFL SCR LG CNN ST	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-14S	SUP	HCPCS C1713		AR-13120T-14S  -  SCREW BN 2.3MM 14MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-15	SUP	HCPCS C1713		AR-13120T-15  -  SCREW BN 1.5MM HEX FT 2.3MM 15MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-15S	SUP	HCPCS C1713		AR-13120T-15S  -  SCREW BN 2.3MM 15MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-16	SUP	HCPCS C1713		AR-13120T-16  -  SCREW BN 1.5MM FT HEX 2.3MM 16MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-16C	SUP	HCPCS C1713		AR-13120T-16C  -  SCREW BN 1.5MM P/T HEX 2.3MM 16MM STRL LOPRFL SCR LG CNN ST	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-16S	SUP	HCPCS C1713		AR-13120T-16S  -  SCREW BN 2.3MM 16MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-17	SUP	HCPCS C1713		AR-13120T-17  -  SCREW BN 1.5MM HEX FT 2.3MM 17MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-17S	SUP	HCPCS C1713		AR-13120T-17S  -  SCREW BN 2.3MM 17MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-18	SUP	HCPCS C1713		AR-13120T-18  -  SCREW BN 1.5MM FT HEX 2.3MM 18MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-18C	SUP	HCPCS C1713		AR-13120T-18C  -  SCREW BN 1.5MM P/T HEX 2.3MM 18MM STRL LOPRFL SCR LG CNN ST	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-18S	SUP	HCPCS C1713		AR-13120T-18S  -  SCREW BN 2.3MM 18MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-19	SUP	HCPCS C1713		AR-13120T-19  -  SCREW BN 1.5MM HEX FT 2.3MM 19MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-19S	SUP	HCPCS C1713		AR-13120T-19S  -  SCREW BN 2.3MM 19MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-20	SUP	HCPCS C1713		AR-13120T-20  -  SCREW BN 1.5MM FT HEX 2.3MM 20MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-20C	SUP	HCPCS C1713		AR-13120T-20C  -  SCREW BN 1.5MM P/T HEX 2.3MM 20MM STRL LOPRFL SCR LG CNN ST	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-20S	SUP	HCPCS C1713		AR-13120T-20S  -  SCREW BN 2.3MM 20MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-21	SUP	HCPCS C1713		AR-13120T-21  -  SCREW BN 1.5MM HEX FT 2.3MM 21MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-21S	SUP	HCPCS C1713		AR-13120T-21S  -  SCREW BN 2.3MM 21MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-22	SUP	HCPCS C1713		AR-13120T-22  -  SCREW BN 1.5MM FT HEX 2.3MM 22MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-22C	SUP	HCPCS C1713		AR-13120T-22C  -  SCREW BN 1.5MM P/T HEX 2.3MM 22MM STRL LOPRFL SCR LG CNN ST	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-22S	SUP	HCPCS C1713		AR-13120T-22S  -  SCREW BN 2.3MM 22MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-23	SUP	HCPCS C1713		AR-13120T-23  -  SCREW BN 1.5MM HEX FT 2.3MM 23MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-23S	SUP	HCPCS C1713		AR-13120T-23S  -  SCREW BN 2.3MM 23MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-24	SUP	HCPCS C1713		AR-13120T-24  -  SCREW BN 1.5MM FT HEX 2.3MM 24MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-24C	SUP	HCPCS C1713		AR-13120T-24C  -  SCREW BN 1.5MM P/T HEX 2.3MM 24MM STRL LOPRFL SCR LG CNN ST	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-24S	SUP	HCPCS C1713		AR-13120T-24S  -  SCREW BN 2.3MM 24MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-25	SUP	HCPCS C1713		AR-13120T-25  -  SCREW BN 1.5MM HEX FT 2.3MM 25MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-25S	SUP	HCPCS C1713		AR-13120T-25S  -  SCREW BN 2.3MM 25MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-26	SUP	HCPCS C1713		AR-13120T-26  -  SCREW BN 1.5MM FT HEX 2.3MM 26MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-26C	SUP	HCPCS C1713		AR-13120T-26C  -  SCREW BN 1.5MM P/T HEX 2.3MM 26MM STRL LOPRFL SCR LG CNN ST	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-26S	SUP	HCPCS C1713		AR-13120T-26S  -  SCREW BN 2.3MM 26MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-27	SUP	HCPCS C1713		AR-13120T-27  -  SCREW BN 1.5MM HEX FT 2.3MM 27MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-27S	SUP	HCPCS C1713		AR-13120T-27S  -  SCREW BN 2.3MM 27MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-28	SUP	HCPCS C1713		AR-13120T-28  -  SCREW BN 1.5MM FT HEX 2.3MM 28MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-28C	SUP	HCPCS C1713		AR-13120T-28C  -  SCREW BN 1.5MM P/T HEX 2.3MM 28MM STRL LOPRFL SCR LG CNN ST	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-28S	SUP	HCPCS C1713		AR-13120T-28S  -  SCREW BN 2.3MM 28MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-29	SUP	HCPCS C1713		AR-13120T-29  -  SCREW BN 1.5MM HEX FT 2.3MM 29MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-29S	SUP	HCPCS C1713		AR-13120T-29S  -  SCREW BN 2.3MM 29MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-30	SUP	HCPCS C1713		AR-13120T-30  -  SCREW BN 1.5MM FT HEX 2.3MM 30MM STRL LOPRFL SCR SLF DRL ST	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-30C	SUP	HCPCS C1713		AR-13120T-30C  -  SCREW BN 1.5MM P/T HEX 2.3MM 30MM STRL LOPRFL SCR LG CNN ST	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13120T-30S	SUP	HCPCS C1713		AR-13120T-30S  -  SCREW BN 2.3MM 30MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13123-08	SUP	HCPCS C1713		AR-13123-08  -  SCREW BN 2.3MM 8MM SS CORT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13123-10	SUP	HCPCS C1713		AR-13123-10  -  SCREW BN 2.3MM 10MM STRL LOPRFL SCR SLD SS SM BN CORT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13123-12	SUP	HCPCS C1713		AR-13123-12  -  SCREW BN 2.3MM 12MM STRL LOPRFL SCR SLD SS SM BN CORT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13123-14	SUP	HCPCS C1713		AR-13123-14  -  SCREW BN 2.3MM 14MM STRL LOPRFL SCR SLD SS SM BN CORT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13123-16	SUP	HCPCS C1713		AR-13123-16  -  SCREW BN 2.3MM 16MM STRL LOPRFL SCR SLD SS SM BN CORT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13123-18	SUP	HCPCS C1713		AR-13123-18  -  SCREW BN 2.3MM 18MM STRL LOPRFL SCR SLD SS SM BN CORT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13123-20	SUP	HCPCS C1713		AR-13123-20  -  SCREW BN 2.3MM 20MM STRL LOPRFL SCR SLD SS SM BN CORT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13123-22	SUP	HCPCS C1713		AR-13123-22  -  SCREW BN 2.3MM 22MM STRL LOPRFL SCR SLD SS SM BN CORT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13123-24	SUP	HCPCS C1713		AR-13123-24  -  SCREW BN 2.3MM 24MM SS CORT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1318FT	SUP	HCPCS C1713		AR-1318FT  -  ANCHOR SUTURE 2-0 3/8 CIR MICRO FULTHD TAPER 2.2MM 4MM 17.9	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1318FT-40	SUP	HCPCS C1713		AR-1318FT-40  -  ANCHOR SUTURE 4-0 3/8 CIR MICRO FULTHD TAPER 2.2MM 4MM 12.3	BOTH IP/OP	$712.50 	$527.25	$0.00	$816.00	$459.00	$459.00	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$510.00	$807.84	$816.00	$0.00		$0.00	$159.63	$0.00	$0.00	$162.38	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1319FT	SUP	HCPCS C1713		AR-1319FT  -  ANCHOR SUTURE 2-0 3/8 CIR MINI FULTHD TAPER 2.7MM 7MM 17.9MM	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-03.0	SUP	HCPCS C1713		AR-13200-03.0  -  PLATE BN 3MM STRL SS TIB OPN WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-03.0S	SUP	HCPCS C1713		AR-13200-03.0S  -  PLATE BN 3MM STRL ARTHX TIB OPN WDG OSTM	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$155.25	$155.25	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-05.0	SUP	HCPCS C1713		AR-13200-05.0  -  PLATE BN 5MM STRL SS TIB OPN WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-05.0S	SUP	HCPCS C1713		AR-13200-05.0S  -  PLATE BN 5MM STRL ARTHX TIB OPN WDG OSTM	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$155.25	$155.25	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-06.0	SUP	HCPCS C1713		AR-13200-06.0  -  PLATE BN 6MM STRL SS TIB OPN WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-06.0S	SUP	HCPCS C1713		AR-13200-06.0S  -  PLATE BN 6MM STRL ARTHX TIB OPN WDG OSTM	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$155.25	$155.25	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-07.5	SUP	HCPCS C1713		AR-13200-07.5  -  PLATE BN 7.5MM STRL SS TIB OPN WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-07.5S	SUP	HCPCS C1713		AR-13200-07.5S  -  PLATE BN 7.5MM STRL ARTHX TIB OPN WDG OSTM	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$155.25	$155.25	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-09.0	SUP	HCPCS C1713		AR-13200-09.0  -  PLATE BN 9MM STRL SS TIB OPN WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-09.0S	SUP	HCPCS C1713		AR-13200-09.0S  -  PLATE BN 9MM STRL ARTHX TIB OPN WDG OSTM	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$155.25	$155.25	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-10.0	SUP	HCPCS C1713		AR-13200-10.0  -  PLATE BN 10MM STRL SS TIB OPN WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-10.0S	SUP	HCPCS C1713		AR-13200-10.0S  -  PLATE BN 10MM STRL ARTHX TIB OPN WDG OSTM	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$155.25	$155.25	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-11.0	SUP	HCPCS C1713		AR-13200-11.0  -  PLATE BN 11MM STRL SS TIB OPN WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-11.0S	SUP	HCPCS C1713		AR-13200-11.0S  -  PLATE BN 11MM STRL ARTHX TIB OPN WDG OSTM	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$155.25	$155.25	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-12.5	SUP	HCPCS C1713		AR-13200-12.5  -  PLATE BN 12.5MM STRL SS TIB OPN WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-12.5S	SUP	HCPCS C1713		AR-13200-12.5S  -  PLATE BN 12.5MM STRL ARTHX TIB OPN WDG OSTM	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$155.25	$155.25	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-13.5	SUP	HCPCS C1713		AR-13200-13.5  -  PLATE BN 13.5MM STRL SS TIB OPN WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-13.5S	SUP	HCPCS C1713		AR-13200-13.5S  -  PLATE BN 13.5MM STRL ARTHX TIB OPN WDG OSTM	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$155.25	$155.25	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-15.0	SUP	HCPCS C1713		AR-13200-15.0  -  PLATE BN 15MM STRL SS TIB OPN WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-15.0S	SUP	HCPCS C1713		AR-13200-15.0S  -  PLATE BN 15MM STRL ARTHX TIB OPN WDG OSTM	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$155.25	$155.25	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-16.0	SUP	HCPCS C1713		AR-13200-16.0  -  PLATE BN 16MM STRL SS TIB OPN WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-16.0S	SUP	HCPCS C1713		AR-13200-16.0S  -  PLATE BN 16MM STRL ARTHX TIB OPN WDG OSTM	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$155.25	$155.25	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-17.5	SUP	HCPCS C1713		AR-13200-17.5  -  PLATE BN 17.5MM STRL SS TIB OPN WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200-17.5S	SUP	HCPCS C1713		AR-13200-17.5S  -  PLATE BN 17.5MM STRL ARTHX TIB OPN WDG OSTM	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$155.25	$155.25	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200D-05	SUP	HCPCS C1713		AR-13200D-05  -  PLATE BN LOPRFL 5MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200D-06	SUP	HCPCS C1713		AR-13200D-06  -  PLATE BN LOPRFL 6MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200D-07	SUP	HCPCS C1713		AR-13200D-07  -  PLATE BN LOPRFL 7MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200D-08	SUP	HCPCS C1713		AR-13200D-08  -  PLATE BN LOPRFL 8MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200D-09	SUP	HCPCS C1713		AR-13200D-09  -  PLATE BN LOPRFL 9MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200D-10	SUP	HCPCS C1713		AR-13200D-10  -  PLATE BN LOPRFL 10MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200DC	SUP	HCPCS C1713		AR-13200DC  -  PLATE BN LOPRFL SS TIB DIST 3.5/4MM SCR CLS WDG OSTM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M	SUP	HCPCS C1713		AR-13200M  -  PLATE BN L FLT TI METATARSUS 2.4MM SCR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-025L	SUP	HCPCS C1713		AR-13200M-025L  -  PLATE BN L LOPRFL 2.5MM TI METATARSUS LT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-025R	SUP	HCPCS C1713		AR-13200M-025R  -  PLATE BN L LOPRFL 2.5MM TI METATARSUS RT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-02L	SUP	HCPCS C1713		AR-13200M-02L  -  PLATE BN L LOPRFL 2MM TI METATARSUS LT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-02R	SUP	HCPCS C1713		AR-13200M-02R  -  PLATE BN L LOPRFL 2MM TI METATARSUS RT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-035L	SUP	HCPCS C1713		AR-13200M-035L  -  PLATE BN L LOPRFL 3.5MM TI METATARSUS LT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-035R	SUP	HCPCS C1713		AR-13200M-035R  -  PLATE BN L LOPRFL 3.5MM TI METATARSUS RT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-03L	SUP	HCPCS C1713		AR-13200M-03L  -  PLATE BN L LOPRFL 3MM TI METATARSUS LT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-03R	SUP	HCPCS C1713		AR-13200M-03R  -  PLATE BN L LOPRFL 3MM TI METATARSUS RT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-045L	SUP	HCPCS C1713		AR-13200M-045L  -  PLATE BN L LOPRFL 4.5MM TI METATARSUS LT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-045R	SUP	HCPCS C1713		AR-13200M-045R  -  PLATE BN L LOPRFL 4.5MM TI METATARSUS RT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-04L	SUP	HCPCS C1713		AR-13200M-04L  -  PLATE BN L LOPRFL 4MM TI METATARSUS LT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-04R	SUP	HCPCS C1713		AR-13200M-04R  -  PLATE BN L LOPRFL 4MM TI METATARSUS RT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-055L	SUP	HCPCS C1713		AR-13200M-055L  -  PLATE BN L LOPRFL 5.5MM TI METATARSUS LT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-055R	SUP	HCPCS C1713		AR-13200M-055R  -  PLATE BN L LOPRFL 5.5MM TI METATARSUS RT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-05L	SUP	HCPCS C1713		AR-13200M-05L  -  PLATE BN L LOPRFL 5MM TI METATARSUS LT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-05R	SUP	HCPCS C1713		AR-13200M-05R  -  PLATE BN L LOPRFL 5MM TI METATARSUS RT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-065L	SUP	HCPCS C1713		AR-13200M-065L  -  PLATE BN L LOPRFL 6.5MM TI METATARSUS LT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-065R	SUP	HCPCS C1713		AR-13200M-065R  -  PLATE BN L LOPRFL 6.5MM TI METATARSUS RT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-06L	SUP	HCPCS C1713		AR-13200M-06L  -  PLATE BN L LOPRFL 6MM TI METATARSUS LT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-06R	SUP	HCPCS C1713		AR-13200M-06R  -  PLATE BN L LOPRFL 6MM TI METATARSUS RT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-075L	SUP	HCPCS C1713		AR-13200M-075L  -  PLATE BN 32219095 7.5MM NS ARTHX LOPRFL OPN WDG TI	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-075R	SUP	HCPCS C1713		AR-13200M-075R  -  PLATE BN 7.5MM NS ARTHX LOPRFL OPN WDG TI METATARSUS RT	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-07L	SUP	HCPCS C1713		AR-13200M-07L  -  PLATE BN L LOPRFL 7MM TI METATARSUS LT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200M-07R	SUP	HCPCS C1713		AR-13200M-07R  -  PLATE BN L LOPRFL 7MM TI METATARSUS RT 2.4MM SCR OPN WDG	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200PA-05.0	SUP	HCPCS C1713		AR-13200PA-05.0  -  PLATE BN 5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200PA-06.0	SUP	HCPCS C1713		AR-13200PA-06.0  -  PLATE BN 6MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200PA-07.5	SUP	HCPCS C1713		AR-13200PA-07.5  -  PLATE BN 7.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200PA-09.0	SUP	HCPCS C1713		AR-13200PA-09.0  -  PLATE BN 9MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200PA-10.0	SUP	HCPCS C1713		AR-13200PA-10.0  -  PLATE BN 10MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200PA-11.0	SUP	HCPCS C1713		AR-13200PA-11.0  -  PLATE BN 11MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200PA-12.5	SUP	HCPCS C1713		AR-13200PA-12.5  -  PLATE BN 12.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200PA-13.5	SUP	HCPCS C1713		AR-13200PA-13.5  -  PLATE BN 13.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200PA-15.0	SUP	HCPCS C1713		AR-13200PA-15.0  -  PLATE BN 15MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200PA-16.0	SUP	HCPCS C1713		AR-13200PA-16.0  -  PLATE BN 16MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200PA-17.5	SUP	HCPCS C1713		AR-13200PA-17.5  -  PLATE BN 17.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200ST-05.0	SUP	HCPCS C1713		AR-13200ST-05.0  -  PLATE BN LOPRFL 5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200ST-07.5	SUP	HCPCS C1713		AR-13200ST-07.5  -  PLATE BN LOPRFL 7.5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200ST-09.0	SUP	HCPCS C1713		AR-13200ST-09.0  -  PLATE BN LOPRFL 9MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200ST-10.0	SUP	HCPCS C1713		AR-13200ST-10.0  -  PLATE BN LOPRFL 10MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200ST-11.0	SUP	HCPCS C1713		AR-13200ST-11.0  -  PLATE BN LOPRFL 11MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200ST-12.5	SUP	HCPCS C1713		AR-13200ST-12.5  -  PLATE BN LOPRFL 12.5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200ST-15.0	SUP	HCPCS C1713		AR-13200ST-15.0  -  PLATE BN LOPRFL 15MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200ST-17.5	SUP	HCPCS C1713		AR-13200ST-17.5  -  PLATE BN LOPRFL 17.5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200T-05.0	SUP	HCPCS C1713		AR-13200T-05.0  -  PLATE BN LOPRFL 5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN WDG	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200T-07.5	SUP	HCPCS C1713		AR-13200T-07.5  -  PLATE BN LOPRFL 7.5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200T-09.0	SUP	HCPCS C1713		AR-13200T-09.0  -  PLATE BN LOPRFL 9MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN WDG	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200T-10.0	SUP	HCPCS C1713		AR-13200T-10.0  -  PLATE BN 10MM LOPRFL TI TIB 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200T-11.0	SUP	HCPCS C1713		AR-13200T-11.0  -  PLATE BN LOPRFL 11MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200T-12.5	SUP	HCPCS C1713		AR-13200T-12.5  -  PLATE BN LOPRFL 12.5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200T-15.0	SUP	HCPCS C1713		AR-13200T-15.0  -  PLATE BN LOPRFL 15MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13200T-17.5	SUP	HCPCS C1713		AR-13200T-17.5  -  PLATE BN LOPRFL 17.5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1320BCNF	SUP	HCPCS C1713		AR-1320BCNF  -  ANCHOR SUT MIC NS DISP	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1320BCNF-40	SUP	HCPCS C1713		AR-1320BCNF-40  -  ANCHOR SUT 4-0 MIC 2 TPR 2.4MM 6.5MM NS SUT TK FBRWR BCMPS	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1320DSC	SUP	Custom 27203010		AR-1320DSC  -  KIT INST MIC 1.8MM 2MM STRL SUT TK BIT DRL GD PNCH SHLDR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13215	SUP	HCPCS C1713		AR-13215  -  PLATE BN 30MM STRL 2 HL SPRT KN OSTM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13217	SUP	Custom 27203010		AR-13217  -  KIT INST CUT BLCK PIN DISP T3 AMZ	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$0.00	$0.00	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13220	SUP	Custom 27203010		AR-13220  -  DRILL BIT CNTRSNK 2.3MM AO CNCT	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13220C	SUP	Custom 27203010		AR-13220C  -  DRILL BIT CNTRSNK 2.3MM AO CNCT CNN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13220DG	SUP	Custom 27203010		AR-13220DG  -  GUIDE DRL LOPRFL PLT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1322-752SF	SUP	HCPCS C1713		AR-1322-752SF  -  ANCHOR SUT 2-0 SM 2.4MM 7.5MM STRL FSTK2 FWR BABSR HNDL	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$208.13	$208.13	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1322BCNF	SUP	HCPCS C1713		AR-1322BCNF  -  ANCHOR SUT 2-0 MIC STRG FWD TPR 2.4MM 8.5MM LF BSUT TK FBRWR	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1322D-18	SUP	Custom 27203010		AR-1322D-18  -  DRILL SRG MN 1.8MM SUT TK	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1322D-20	SUP	Custom 27203010		AR-1322D-20  -  DRILL SRG MN 2MM SUT TK	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1322DSC	SUP	Custom 27203010		AR-1322DSC  -  KIT ESCP INST 2-0 MN 2.4MM 8.5MM STRL LF BSUT TK ANCH DRLBT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1322SXF	SUP	HCPCS C1713		AR-1322SXF  -  ANCHOR SUT 2 2.4MM 11.7MM STRL FSTK FWR BRD CNN INSRTR ST TI	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1324B	SUP	HCPCS C1713		AR-1324B  -  ANCHOR SUT 2 3MM 14MM STRL BFSTK TVDK BRD EYLT HNDL INSRTR	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1324BF	SUP	HCPCS C1713		AR-1324BF  -  ANCHOR SUT 2 3MM 14MM STRL BFSTK FWR BRD EYLT HNDL INSRTR	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$275.63	$275.63	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1324BF-2	SUP	HCPCS C1713		AR-1324BF-2  -  ANCHOR SUT 2 3MM 11MM STRL BFSTK FWR BRD EYLT HNDL INSRTR	BOTH IP/OP	$650.00 	$481.00	$0.00	$520.00	$292.50	$292.50	$0.00	$0.00	$0.00	$135.48	$482.43	$482.43	$0.00	$0.00	$135.46	$0.00	$384.48	$384.48	$0.00	$325.00	$514.80	$520.00	$0.00		$0.00	$101.73	$0.00	$0.00	$103.48	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1324D	SUP	Custom 27203010		AR-1324D  -  DRILL SRG SPR 2.8MM FSTK II CNN TI SHLDR	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1324HF	SUP	HCPCS C1713		AR-1324HF  -  ANCHOR SUT 2 2.8MM 11.7MM STRL FSTK2 FWR HNDL TI KN	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$202.50	$202.50	$0.00	$0.00	$0.00	$93.79	$333.99	$333.99	$0.00	$0.00	$93.78	$0.00	$266.18	$266.18	$0.00	$225.00	$356.40	$360.00	$0.00		$0.00	$70.43	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1324SF	SUP	HCPCS C1713		AR-1324SF  -  ANCHOR SUT 2 2.8MM 11.7MM STRL FSTK2 FWR CNN INSRTR TI	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13280-35	SUP	HCPCS C1713		AR-13280-35  -  SCREW BN 6.5MM 35MM TI TIB CANC OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13280-40	SUP	HCPCS C1713		AR-13280-40  -  SCREW BN 6.5MM 40MM TI TIB CANC OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13280-45	SUP	HCPCS C1713		AR-13280-45  -  SCREW BN 6.5MM 45MM TI TIB CANC OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13280-50	SUP	HCPCS C1713		AR-13280-50  -  SCREW BN 6.5MM 50MM TI TIB CANC OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13280-55	SUP	HCPCS C1713		AR-13280-55  -  SCREW BN 6.5MM 55MM TI TIB CANC OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13280-60	SUP	HCPCS C1713		AR-13280-60  -  SCREW BN 6.5MM 60MM TI TIB CANC OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13280-65	SUP	HCPCS C1713		AR-13280-65  -  SCREW BN 6.5MM 65MM TI TIB CANC OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13280-70	SUP	HCPCS C1713		AR-13280-70  -  SCREW BN 6.5MM 70MM TI TIB CANC OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13303-2.4	SUP	Custom 27203010		AR-13303-2.4  -  GUIDE PIN ORTH 2.4MM BRKWY FEM OSTM	BOTH IP/OP	$92.50 	$68.45	$0.00	$74.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.65	$68.65	$0.00	$0.00	$19.28	$0.00	$0.00	$0.00	$0.00	$46.25	$73.26	$74.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13303-3.0	SUP	Custom 27203010		AR-13303-3.0  -  GUIDE PIN ORTH 3MM BRKWY FEM OSTM	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13319	SUP	Custom 27203010		AR-13319  -  DRILL SRG HTO TI SCR	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13320	SUP	Custom 27203010		AR-13320  -  GUIDE DRL OPN WDG OSTM HTO PLT	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13321	SUP	Custom 27203010		AR-13321  -  GUIDE DRL OPN WDG OSTM HTO TI PLT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13370-2	SUP	HCPCS C1713		AR-13370-2  -  FILLER BN VOID 30X10MM STRL OPTM PORE DIA RGD FX DEV TRM WDG	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13370-3	SUP	HCPCS C1713		AR-13370-3  -  FILLER BN VOID 35X12MM STRL OPTM PORE DIA RGD FX DEV TRM WDG	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13370-4	SUP	HCPCS C1713		AR-13370-4  -  FILLER BN VOID 35X15MM STRL OPTM PORE DIA RGD FX DEV TRM WDG	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13372-1	SUP	HCPCS C1713		AR-13372-1  -  FILLER BN VOID 75D THK7MM TRPZD 25X8MM OSFERION	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13372-2	SUP	HCPCS C1713		AR-13372-2  -  FILLER BN VOID 75D THK7MM TRPZD 25X9MM OSFERION	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13372-3	SUP	HCPCS C1713		AR-13372-3  -  FILLER BN VOID 75D THK7MM TRPZD 25X10MM OSFERION	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-26	SUP	HCPCS C1713		AR-13380-26  -  SCREW BN 4.5MM 26MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-28	SUP	HCPCS C1713		AR-13380-28  -  SCREW BN 4.5MM 28MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-30	SUP	HCPCS C1713		AR-13380-30  -  SCREW BN 4.5MM 30MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-32	SUP	HCPCS C1713		AR-13380-32  -  SCREW BN 4.5MM 32MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-34	SUP	HCPCS C1713		AR-13380-34  -  SCREW BN 4.5MM 34MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-36	SUP	HCPCS C1713		AR-13380-36  -  SCREW BN 4.5MM 36MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-38	SUP	HCPCS C1713		AR-13380-38  -  SCREW BN 4.5MM 38MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-40	SUP	HCPCS C1713		AR-13380-40  -  SCREW BN 4.5MM 40MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-42	SUP	HCPCS C1713		AR-13380-42  -  SCREW BN 4.5MM 42MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-44	SUP	HCPCS C1713		AR-13380-44  -  SCREW BN 4.5MM 44MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-46	SUP	HCPCS C1713		AR-13380-46  -  SCREW BN 4.5MM 46MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-48	SUP	HCPCS C1713		AR-13380-48  -  SCREW BN 4.5MM 48MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-50	SUP	HCPCS C1713		AR-13380-50  -  SCREW BN 4.5MM 50MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-52	SUP	HCPCS C1713		AR-13380-52  -  SCREW BN 4.5MM 52MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-54	SUP	HCPCS C1713		AR-13380-54  -  SCREW BN 4.5MM 54MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-56	SUP	HCPCS C1713		AR-13380-56  -  SCREW BN 4.5MM 56MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-58	SUP	HCPCS C1713		AR-13380-58  -  SCREW BN 4.5MM 58MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13380-60	SUP	HCPCS C1713		AR-13380-60  -  SCREW BN 4.5MM 60MM TI TIB CORT OPN WDG OSTM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400L-05	SUP	Custom 27803010		AR-13400L-05  -  WEDGE TIB 5D LG IBALANCE HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400L-06	SUP	Custom 27803010		AR-13400L-06  -  WEDGE TIB 6D 7D LG XL IBALANCE HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400L-07	SUP	Custom 27803010		AR-13400L-07  -  WEDGE TIB 6D 7D LG XL IBALANCE PEEK KN HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400L-08	SUP	Custom 27803010		AR-13400L-08  -  WEDGE TIB 7D 8D LG XL IBALANCE KN HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400L-09	SUP	Custom 27803010		AR-13400L-09  -  WEDGE TIB 8D 9D LG XL IBALANCE PEEK KN HTO PLT	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400L-10	SUP	Custom 27803010		AR-13400L-10  -  WEDGE TIB 9D 10D LG XL IBALANCE PEEK KN HTO PLT	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400L-11	SUP	Custom 27803010		AR-13400L-11  -  WEDGE TIB 10D 11D LG XL IBALANCE PEEK KN HTO PLT	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400L-12	SUP	Custom 27803010		AR-13400L-12  -  WEDGE TIB 11D 12D LG XL IBALANCE PEEK KN HTO PLT	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400L-13	SUP	Custom 27803010		AR-13400L-13  -  WEDGE TIB 12D 13D LG XL IBALANCE HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400L-14	SUP	Custom 27803010		AR-13400L-14  -  WEDGE TIB 13D 14D LG XL IBALANCE PEEK HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400L-15	SUP	Custom 27803010		AR-13400L-15  -  WEDGE TIB 15D LG IBALANCE HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400M-05	SUP	Custom 27803010		AR-13400M-05  -  WEDGE TIB 5D 6D S/MED IBALANCE HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400M-06	SUP	Custom 27803010		AR-13400M-06  -  WEDGE TIB 6D MED IBALANCE HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400M-07	SUP	Custom 27803010		AR-13400M-07  -  WEDGE TIB 7D 8D S/MED IBALANCE PEEK KN HTO PLT	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400M-08	SUP	Custom 27803010		AR-13400M-08  -  WEDGE TIB 8D 9D S/MED IBALANCE PEEK KN HTO PLT	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400M-09	SUP	Custom 27803010		AR-13400M-09  -  WEDGE TIB 9D 10D S/MED IBALANCE PEEK KN HTO PLT	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400M-10	SUP	Custom 27803010		AR-13400M-10  -  WEDGE TIB 10D 11D S/MED IBALANCE PEEK KN HTO PLT	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400M-11	SUP	Custom 27803010		AR-13400M-11  -  WEDGE TIB 13D 11D S/MED IBALANCE HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400M-12	SUP	Custom 27803010		AR-13400M-12  -  WEDGE TIB 12D 14D S/MED IBALANCE PEEK KN HTO PLT	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400M-13	SUP	Custom 27803010		AR-13400M-13  -  WEDGE TIB 15D 13D S/MED IBALANCE KN HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400M-14	SUP	Custom 27803010		AR-13400M-14  -  WEDGE TIB 14D MED IBALANCE HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400M-15	SUP	Custom 27803010		AR-13400M-15  -  WEDGE TIB 15D MED IBALANCE HTO	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13400S-12	SUP	Custom 27803010		AR-13400S-12  -  WEDGE TIB 12D SM IBALANCE PEEK KN HTO PLT	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	$0.00	$0.00	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13401-20	SUP	HCPCS C1713		AR-13401-20  -  ANCHOR SUT 6.5MM 20MM IBALANCE CANC HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13401-22	SUP	HCPCS C1713		AR-13401-22  -  ANCHOR SUT 6.5MM 22MM IBALANCE CANC HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13401-24	SUP	HCPCS C1713		AR-13401-24  -  ANCHOR SUT 6.5MM 24MM IBALANCE CANC HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13401-26	SUP	HCPCS C1713		AR-13401-26  -  ANCHOR SUT 6.5MM 26MM IBALANCE CANC HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13401-28	SUP	HCPCS C1713		AR-13401-28  -  ANCHOR SUT 6.5MM 28MM IBALANCE CANC HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13401-30	SUP	HCPCS C1713		AR-13401-30  -  ANCHOR SUT 6.5MM 30MM IBALANCE CANC HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13401-32	SUP	HCPCS C1713		AR-13401-32  -  ANCHOR SUT 6.5MM 32MM IBALANCE CANC HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-24	SUP	HCPCS C1713		AR-13402-24  -  ANCHOR SUT 4.5MM 24MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-26	SUP	HCPCS C1713		AR-13402-26  -  ANCHOR SUT 4.5MM 26MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-28	SUP	HCPCS C1713		AR-13402-28  -  ANCHOR SUT 4.5MM 28MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-30	SUP	HCPCS C1713		AR-13402-30  -  ANCHOR SUT 4.5MM 30MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-32	SUP	HCPCS C1713		AR-13402-32  -  ANCHOR SUT 4.5MM 32MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-34	SUP	HCPCS C1713		AR-13402-34  -  ANCHOR SUT 4.5MM 34MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-36	SUP	HCPCS C1713		AR-13402-36  -  ANCHOR SUT 4.5MM 36MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-38	SUP	HCPCS C1713		AR-13402-38  -  ANCHOR SUT 4.5MM 38MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-40	SUP	HCPCS C1713		AR-13402-40  -  ANCHOR SUT 4.5MM 40MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-42	SUP	HCPCS C1713		AR-13402-42  -  ANCHOR SUT 4.5MM 42MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-44	SUP	HCPCS C1713		AR-13402-44  -  ANCHOR SUT 4.5MM 44MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-46	SUP	HCPCS C1713		AR-13402-46  -  ANCHOR SUT 4.5MM 46MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-48	SUP	HCPCS C1713		AR-13402-48  -  ANCHOR SUT 4.5MM 48MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-50	SUP	HCPCS C1713		AR-13402-50  -  ANCHOR SUT 4.5MM 50MM IBALANCE CORT HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13402-52	SUP	HCPCS C1713		AR-13402-52  -  ANCHOR SUT 4.5MM 52MM IBALANCE HTO	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13413	SUP	HCPCS C1713		AR-13413  -  WASHER ORTH FSTN LCK	BOTH IP/OP	$177.45 	$131.31	$0.00	$141.96	$79.85	$79.85	$0.00	$0.00	$0.00	$36.99	$131.70	$131.70	$0.00	$0.00	$36.98	$0.00	$104.96	$104.96	$0.00	$88.73	$140.54	$141.96	$0.00		$0.00	$27.77	$0.00	$0.00	$28.25	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13417L	SUP	Custom 27203010		AR-13417L  -  GUIDE DRL LG FREECUT KYHL HTO IBALANCE	BOTH IP/OP	"$2,697.50 "	"$1,996.15"	$0.00	"$2,158.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,002.08"	"$2,002.08"	$0.00	$0.00	$562.16	$0.00	$0.00	$0.00	$0.00	"$1,348.75"	"$2,136.42"	"$2,158.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13417M	SUP	Custom 27203010		AR-13417M  -  GUIDE DRL MED FREECUT KYHL HTO IBALANCE	BOTH IP/OP	"$2,697.50 "	"$1,996.15"	$0.00	"$2,158.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,002.08"	"$2,002.08"	$0.00	$0.00	$562.16	$0.00	$0.00	$0.00	$0.00	"$1,348.75"	"$2,136.42"	"$2,158.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13433	SUP	Custom 27203010		AR-13433  -  GUIDE DRL IBALANCE ANCH HTO	BOTH IP/OP	$632.40 	$467.98	$0.00	$505.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$469.37	$469.37	$0.00	$0.00	$131.79	$0.00	$0.00	$0.00	$0.00	$316.20	$500.86	$505.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1349	SUP	Custom 27803010		AR-1349  -  WASHER 14MM SPK LP ORTH TI CANC SCR STRL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1349L	SUP	Custom 27803010		AR-1349L  -  WASHER ORTH 18MM STRL SPK LOPRFL TI CANC SCR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1349LM	SUP	Custom 27803010		AR-1349LM  -  WASHER ORTH 18MM STRL SUT TI ACL DISP CANC SCR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1349LMNS	SUP	Custom 27803010		AR-1349LMNS  -  WASHER ORTH LOPRFL 18MM NS SUT TI ACL PCL CANC SCR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1349LNS	SUP	Custom 27803010		AR-1349LNS  -  WASHER 18MM ACL PCL SPK LP ORTH TI CANC SCR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1349M	SUP	Custom 27803010		AR-1349M  -  WASHER ORTH 14MM STRL TI CANC SCR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1349MNS	SUP	Custom 27803010		AR-1349MNS  -  WASHER 14MM ACL PCL SUTURE LP ORTH TI CANC SCR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1349NS	SUP	Custom 27803010		AR-1349NS  -  WASHER ORTH SPK LOPRFL 14MM NS TI ACL PCL CANC SCR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1351	SUP	HCPCS C1713		AR-1351  -  PIN FX 3MM 40MM STRL TRNFX SLF CUT ST TI ACL	BOTH IP/OP	$395.00 	$292.30	$0.00	$316.00	$177.75	$177.75	$0.00	$0.00	$0.00	$82.33	$293.17	$293.17	$0.00	$0.00	$82.32	$0.00	$233.64	$233.64	$0.00	$197.50	$312.84	$316.00	$0.00		$0.00	$61.82	$0.00	$0.00	$62.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1351B	SUP	HCPCS C1713		AR-1351B  -  IMPLANT FX 5MM 40MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT	BOTH IP/OP	$722.50 	$534.65	$0.00	$578.00	$325.13	$325.13	$0.00	$0.00	$0.00	$150.59	$536.24	$536.24	$0.00	$0.00	$150.57	$0.00	$427.36	$427.36	$0.00	$361.25	$572.22	$578.00	$0.00		$0.00	$113.07	$0.00	$0.00	$115.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1351BK-CP	SUP	HCPCS C1713		AR-1351BK-CP  -  SET IMPL 40MM BTRNSF PK ACL	BOTH IP/OP	"$1,102.50 "	$815.85	$0.00	$882.00	$496.13	$496.13	$0.00	$0.00	$0.00	$229.79	$818.28	$818.28	$0.00	$0.00	$229.76	$0.00	$652.13	$652.13	$0.00	$551.25	$873.18	$882.00	$0.00		$0.00	$172.54	$0.00	$0.00	$175.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1351BT	SUP	HCPCS C1713		AR-1351BT  -  IMPLANT FX 3MM 40MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT	BOTH IP/OP	$722.50 	$534.65	$0.00	$578.00	$325.13	$325.13	$0.00	$0.00	$0.00	$150.59	$536.24	$536.24	$0.00	$0.00	$150.57	$0.00	$427.36	$427.36	$0.00	$361.25	$572.22	$578.00	$0.00		$0.00	$113.07	$0.00	$0.00	$115.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1351C-01	SUP	HCPCS C1713		AR-1351C-01  -  SCREW INTFR 5MM 40MM STRL TRNFX STRNG BCMPS KN	BOTH IP/OP	$997.50 	$738.15	$0.00	$798.00	$448.88	$448.88	$0.00	$0.00	$0.00	$207.90	$740.34	$740.34	$0.00	$0.00	$207.88	$0.00	$590.02	$590.02	$0.00	$498.75	$790.02	$798.00	$0.00		$0.00	$156.11	$0.00	$0.00	$158.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1351C-02	SUP	HCPCS C1713		AR-1351C-02  -  SCREW INTFR 5MM 50MM STRL TRNFX STRNG BCMPS KN	BOTH IP/OP	$997.50 	$738.15	$0.00	$798.00	$448.88	$448.88	$0.00	$0.00	$0.00	$207.90	$740.34	$740.34	$0.00	$0.00	$207.88	$0.00	$590.02	$590.02	$0.00	$498.75	$790.02	$798.00	$0.00		$0.00	$156.11	$0.00	$0.00	$158.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1351K-CP	SUP	HCPCS C1713		AR-1351K-CP  -  SET IMPL 40MM TRNFX2 PK ACL	BOTH IP/OP	$775.00 	$573.50	$0.00	$620.00	$348.75	$348.75	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$387.50	$613.80	$620.00	$0.00		$0.00	$121.29	$0.00	$0.00	$123.38	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1351L	SUP	HCPCS C1713		AR-1351L  -  IMPLANT FX 3MM 50MM STRL TRNFX SLF CUT ST TI ACL	BOTH IP/OP	$395.00 	$292.30	$0.00	$316.00	$177.75	$177.75	$0.00	$0.00	$0.00	$82.33	$293.17	$293.17	$0.00	$0.00	$82.32	$0.00	$233.64	$233.64	$0.00	$197.50	$312.84	$316.00	$0.00		$0.00	$61.82	$0.00	$0.00	$62.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1351LB	SUP	HCPCS C1713		AR-1351LB  -  IMPLANT FX 5MM 50MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT	BOTH IP/OP	$722.50 	$534.65	$0.00	$578.00	$325.13	$325.13	$0.00	$0.00	$0.00	$150.59	$536.24	$536.24	$0.00	$0.00	$150.57	$0.00	$427.36	$427.36	$0.00	$361.25	$572.22	$578.00	$0.00		$0.00	$113.07	$0.00	$0.00	$115.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1351LBK-CP	SUP	HCPCS C1713		AR-1351LBK-CP  -  SET IMPL 50MM BTRNSF PK ACL	BOTH IP/OP	"$1,102.50 "	$815.85	$0.00	$882.00	$496.13	$496.13	$0.00	$0.00	$0.00	$229.79	$818.28	$818.28	$0.00	$0.00	$229.76	$0.00	$652.13	$652.13	$0.00	$551.25	$873.18	$882.00	$0.00		$0.00	$172.54	$0.00	$0.00	$175.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1351LBT	SUP	HCPCS C1713		AR-1351LBT  -  IMPLANT FX 3MM 50MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT	BOTH IP/OP	$722.50 	$534.65	$0.00	$578.00	$325.13	$325.13	$0.00	$0.00	$0.00	$150.59	$536.24	$536.24	$0.00	$0.00	$150.57	$0.00	$427.36	$427.36	$0.00	$361.25	$572.22	$578.00	$0.00		$0.00	$113.07	$0.00	$0.00	$115.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1351LK-CP	SUP	HCPCS C1713		AR-1351LK-CP  -  SET IMPL 50MM TRNFX PK ACL	BOTH IP/OP	$775.00 	$573.50	$0.00	$620.00	$348.75	$348.75	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$387.50	$613.80	$620.00	$0.00		$0.00	$121.29	$0.00	$0.00	$123.38	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1355	SUP	HCPCS C1713		AR-1355  -  SCREW BONE GROOVE LP 6.5MM 25MM DEPTH MARK STEP DRILL	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1355D	SUP	Custom 27203010		AR-1355D  -  DRILL SRG 25MM LSR D MRK STP KN LOPRFL CANC SCR	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1355NS	SUP	HCPCS C1713		AR-1355NS  -  SCREW BN LOPRFL 6.5MM 25MM NS SMTH SHNK TI ACL PCL CANC	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1356	SUP	HCPCS C1713		AR-1356  -  SCREW BN GRV LOPRFL 6.5MM 30MM STRL D MRK STP DRL TI ACL/PCL	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1356NS	SUP	HCPCS C1713		AR-1356NS  -  SCREW BN LOPRFL 6.5MM 30MM NS SMTH SHNK TI ACL PCL CANC	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1357	SUP	HCPCS C1713		AR-1357  -  SCREW BN GRV LOPRFL 6.5MM 35MM STRL D MRK STP DRL TI ACL/PCL	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1357B	SUP	HCPCS C1713		AR-1357B  -  POST FX 6.25MM 35MM STRL BPST WSHR POLY L LAC ACD ACL DISP	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$303.75	$303.75	$0.00	$0.00	$0.00	$140.69	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$399.26	$399.26	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$105.64	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1357NS	SUP	HCPCS C1713		AR-1357NS  -  SCREW BN LOPRFL 6.5MM 35MM NS SMTH SHNK TI ACL PCL CANC	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1358	SUP	HCPCS C1713		AR-1358  -  SCREW BN GRV LOPRFL 6.5MM 40MM STRL D MRK STP DRL TI ACL/PCL	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1358NS	SUP	HCPCS C1713		AR-1358NS  -  SCREW BN LOPRFL 6.5MM 40MM NS SMTH SHNK TI ACL PCL CANC	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$100.13	$100.13	$0.00	$0.00	$0.00	$46.37	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$131.61	$131.61	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$34.82	$0.00	$0.00	$35.42	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1360B	SUP	HCPCS C1713		AR-1360B  -  SCREW INTFR 6MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1360C	SUP	HCPCS C1713		AR-1360C  -  SCREW INTFR 6MM 23MM STRL CNN RDC HD BCMPS ACL PCL	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1360C-CP	SUP	HCPCS C1713		AR-1360C-CP  -  SET IMPL 4.5MM 6MM CNN DRL GDPN INTFR SCR RMR TMPLT MPFL PK	BOTH IP/OP	"$3,717.50 "	"$2,750.95"	$0.00	"$2,974.00"	"$1,672.88"	"$1,672.88"	$0.00	$0.00	$0.00	$774.82	"$2,759.13"	"$2,759.13"	$0.00	$0.00	$774.73	$0.00	"$1,832.73"	"$1,832.73"	$0.00	"$1,858.75"	"$2,944.26"	"$2,974.00"	$0.00		$0.00	$581.79	$0.00	$0.00	$591.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1360CST-CP	SUP	HCPCS C1713		AR-1360CST-CP  -  SET IMPL 1.1MM 3.5IN CNN CLS EYLT DRL PIN RMR TMPLT MPFL PK	BOTH IP/OP	"$4,217.50 "	"$3,120.95"	$0.00	"$3,374.00"	"$1,897.88"	"$1,897.88"	$0.00	$0.00	$0.00	$879.03	"$3,130.23"	"$3,130.23"	$0.00	$0.00	$878.93	$0.00	"$2,079.23"	"$2,079.23"	$0.00	"$2,108.75"	"$3,340.26"	"$3,374.00"	$0.00		$0.00	$660.04	$0.00	$0.00	$671.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1360E	SUP	HCPCS C1713		AR-1360E  -  SCREW INTFR 6MM 20MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1360P	SUP	HCPCS C1713		AR-1360P  -  SCREW INTFR 6MM 23MM STRL THRD PTRN PEEK-OPTM ACL PCL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1363	SUP	HCPCS C1713		AR-1363  -  SCREW INTFR 3MM 40MM STRL TRNFX SLF CUT ST TI ACL	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1363L	SUP	HCPCS C1713		AR-1363L  -  SCREW INTFR 3MM 50MM STRL TRNFX SLF CUT ST TI ACL	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-25	SUP	HCPCS C1713		AR-1365-25  -  POST FIX LP 4.5MM 25MM SELF TAP THREAD TITANIUM KNEE	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-275	SUP	Custom 27203010		AR-1365-275  -  POST FX LOPRFL 4.5MM 27.5MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-30	SUP	Custom 27203010		AR-1365-30  -  POST FX LOPRFL 4.5MM 30MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-325	SUP	Custom 27203010		AR-1365-325  -  POST FX LOPRFL 4.5MM 32.5MM ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-375	SUP	Custom 27203010		AR-1365-375  -  POST FX LOPRFL 4.5MM 37.5MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-40	SUP	Custom 27203010		AR-1365-40  -  POST FX LOPRFL 4.5MM 40MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-425	SUP	Custom 27203010		AR-1365-425  -  POST FX LOPRFL 4.5MM 42.5MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-45	SUP	Custom 27203010		AR-1365-45  -  POST FX LOPRFL 4.5MM 45MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-475	SUP	Custom 27203010		AR-1365-475  -  POST FX LOPRFL 4.5MM 47.5MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-50	SUP	Custom 27203010		AR-1365-50  -  POST FX LOPRFL 4.5MM 50MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-525	SUP	Custom 27203010		AR-1365-525  -  POST FX LOPRFL 4.5MM 52.5MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-55	SUP	Custom 27203010		AR-1365-55  -  POST FX LOPRFL 4.5MM 55MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-575	SUP	Custom 27203010		AR-1365-575  -  POST FX LOPRFL 4.5MM 57.5MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365-60	SUP	Custom 27203010		AR-1365-60  -  POST FX LOPRFL 4.5MM 60MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-25	SUP	Custom 27203010		AR-1365NS-25  -  POST FX LOPRFL 4.5MM 25MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-275	SUP	Custom 27203010		AR-1365NS-275  -  POST FX LOPRFL 4.5MM 27.5MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-30	SUP	Custom 27203010		AR-1365NS-30  -  POST FX LOPRFL 4.5MM 30MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-325	SUP	Custom 27203010		AR-1365NS-325  -  POST FX LOPRFL 4.5MM 32.5MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-35	SUP	Custom 27203010		AR-1365NS-35  -  POST FX LOPRFL 4.5MM 35MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-375	SUP	Custom 27203010		AR-1365NS-375  -  POST FX LOPRFL 4.5MM 37.5MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-40	SUP	Custom 27203010		AR-1365NS-40  -  POST FX LOPRFL 4.5MM 40MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-425	SUP	Custom 27203010		AR-1365NS-425  -  POST FX LOPRFL 4.5MM 42.5MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-45	SUP	Custom 27203010		AR-1365NS-45  -  POST FX LOPRFL 4.5MM 45MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-475	SUP	Custom 27203010		AR-1365NS-475  -  POST FX LOPRFL 4.5MM 47.5MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-50	SUP	Custom 27203010		AR-1365NS-50  -  POST FX LOPRFL 4.5MM 50MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-525	SUP	Custom 27203010		AR-1365NS-525  -  POST FX LOPRFL 4.5MM 52.5MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-55	SUP	Custom 27203010		AR-1365NS-55  -  POST FX LOPRFL 4.5MM 55MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-575	SUP	Custom 27203010		AR-1365NS-575  -  POST FX LOPRFL 4.5MM 57.5MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1365NS-60	SUP	Custom 27203010		AR-1365NS-60  -  POST FX LOPRFL 4.5MM 60MM NS TI ACL PCL BCORT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366-30	SUP	Custom 27203010		AR-1366-30  -  POST FX LOPRFL 6.5MM 30MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366-32	SUP	Custom 27203010		AR-1366-32  -  POST FX LOPRFL 6.5MM 32MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366-34	SUP	Custom 27203010		AR-1366-34  -  POST FX LOPRFL 6.5MM 34MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366-36	SUP	Custom 27203010		AR-1366-36  -  POST FX LOPRFL 6.5MM 36MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366-38	SUP	Custom 27203010		AR-1366-38  -  POST FX LOPRFL 6.5MM 38MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366-40	SUP	Custom 27203010		AR-1366-40  -  POST FX LOPRFL 6.5MM 40MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366-42	SUP	Custom 27203010		AR-1366-42  -  POST FX LOPRFL 6.5MM 42MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366-44	SUP	Custom 27203010		AR-1366-44  -  POST FX LOPRFL 6.5MM 44MM ST THRD TI KN BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366-46	SUP	Custom 27203010		AR-1366-46  -  POST FX LOPRFL 6.5MM 46MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366-48	SUP	Custom 27203010		AR-1366-48  -  POST FX LOPRFL 6.5MM 48MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366-50	SUP	Custom 27203010		AR-1366-50  -  POST FX LOPRFL 6.5MM 50MM ST THRD TI KN BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366-52	SUP	Custom 27203010		AR-1366-52  -  POST FX LOPRFL 6.5MM 52MM STRL ST THRD TI KN BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366NS-30	SUP	Custom 27203010		AR-1366NS-30  -  POST FX LOPRFL 6.5MM 30MM NS TI ACL PCL BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366NS-32	SUP	Custom 27203010		AR-1366NS-32  -  POST FX LOPRFL 6.5MM 32MM NS TI ACL PCL BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366NS-34	SUP	Custom 27203010		AR-1366NS-34  -  POST FX LOPRFL 6.5MM 34MM NS TI ACL PCL BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366NS-36	SUP	Custom 27203010		AR-1366NS-36  -  POST FX LOPRFL 6.5MM 36MM NS TI ACL PCL BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366NS-38	SUP	Custom 27203010		AR-1366NS-38  -  POST FX LOPRFL 6.5MM 38MM NS TI ACL PCL BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366NS-40	SUP	Custom 27203010		AR-1366NS-40  -  POST FX LOPRFL 6.5MM 40MM NS TI ACL PCL BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366NS-42	SUP	Custom 27203010		AR-1366NS-42  -  POST FX LOPRFL 6.5MM 42MM NS TI ACL PCL BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366NS-44	SUP	Custom 27203010		AR-1366NS-44  -  POST FX LOPRFL 6.5MM 44MM NS TI ACL PCL BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366NS-46	SUP	Custom 27203010		AR-1366NS-46  -  POST FX LOPRFL 6.5MM 46MM NS TI ACL PCL BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366NS-48	SUP	Custom 27203010		AR-1366NS-48  -  POST FX LOPRFL 6.5MM 48MM NS TI ACL PCL BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1366NS-50	SUP	Custom 27203010		AR-1366NS-50  -  POST FX LOPRFL 6.5MM 50MM NS TI ACL PCL BCORT	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1367D	SUP	Custom 27203010		AR-1367D  -  BIT DRL 4.8MM 6.5MM POST	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1370	SUP	HCPCS C1713		"AR-1370  -  SCREW, CANNULATED INTERFERENCE"	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1370B	SUP	HCPCS C1713		AR-1370B  -  SCREW INTFR 7MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1370C	SUP	HCPCS C1713		AR-1370C  -  SCREW INTERFERENCE 7MM 23MM CANN REDUCE HEAD BIOCOMPOSITE	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1370E	SUP	HCPCS C1713		AR-1370E  -  SCREW INTFR 7MM 20MM STRL CNN DISP SHTH TI ACL PCL ACPT 2MM	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1370H-25	SUP	HCPCS C1713		AR-1370H-25  -  SCREW INTFR BLNT RND 7MM 25MM STRL CNN SFT TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1370H-30	SUP	HCPCS C1713		AR-1370H-30  -  SCREW INTFR BLNT RND 7MM 30MM STRL CNN SFT TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1370P	SUP	HCPCS C1713		AR-1370P  -  SCREW INTFR 7MM 23MM STRL PEEK-OPTM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1370T	SUP	HCPCS C1713		AR-1370T  -  SCREW INTFR FT RND 7MM 20MM STRL CNN RECON TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1370TB	SUP	HCPCS C1713		AR-1370TB  -  SCREW INTFR FT 7MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1370TC	SUP	HCPCS C1713		AR-1370TC  -  SCREW INTFR FT STP TPR 7MM 28MM STRL CNN FULL SEAT RDC HD	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1371	SUP	HCPCS C1713		AR-1371  -  SCREW INTFR 7MM 25MM STRL CNN TI ACL PCL	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13710-03.0	SUP	HCPCS C1713		AR-13710-03.0  -  PLATE BN STRG 3MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13710-05.0	SUP	HCPCS C1713		AR-13710-05.0  -  PLATE BN STRG 5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13710-07.5	SUP	HCPCS C1713		AR-13710-07.5  -  PLATE BN STRG 7.5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13710-09.0	SUP	HCPCS C1713		AR-13710-09.0  -  PLATE BN STRG 9MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13710-10.0	SUP	HCPCS C1713		AR-13710-10.0  -  PLATE BN STRG 10MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13710-11.0	SUP	HCPCS C1713		AR-13710-11.0  -  PLATE BN STRG 11MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13710-12.5	SUP	HCPCS C1713		AR-13710-12.5  -  PLATE BN STRG 12.5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13710-15.0	SUP	HCPCS C1713		AR-13710-15.0  -  PLATE BN STRG 15MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13710-17.5	SUP	HCPCS C1713		AR-13710-17.5  -  PLATE BN STRG 17.5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13715-03.0	SUP	HCPCS C1713		AR-13715-03.0  -  PLATE BN STRG 3MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13715-05.0	SUP	HCPCS C1713		AR-13715-05.0  -  PLATE BN STRG 5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13715-07.5	SUP	HCPCS C1713		AR-13715-07.5  -  PLATE BN STRG 7.5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13715-09.0	SUP	HCPCS C1713		AR-13715-09.0  -  PLATE BN STRG 9MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13715-10.0	SUP	HCPCS C1713		AR-13715-10.0  -  PLATE BN STRG 10MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13715-11.0	SUP	HCPCS C1713		AR-13715-11.0  -  PLATE BN STRG 11MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13715-12.5	SUP	HCPCS C1713		AR-13715-12.5  -  PLATE BN STRG 12.5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13715-15.0	SUP	HCPCS C1713		AR-13715-15.0  -  PLATE BN STRG 15MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13715-17.5	SUP	HCPCS C1713		AR-13715-17.5  -  PLATE BN STRG 17.5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1371E	SUP	HCPCS C1713		AR-1371E  -  SCREW INTFR 7MM 25MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1371T	SUP	HCPCS C1713		AR-1371T  -  SCREW INTFR FT RND 7MM 25MM STRL CNN RECON TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1372	SUP	HCPCS C1713		AR-1372  -  SCREW INTFR 7MM 30MM STRL BIOINTF CNN TI ACL PCL	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13720-05.0	SUP	HCPCS C1713		AR-13720-05.0  -  PLATE BN 5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13720-07.5	SUP	HCPCS C1713		AR-13720-07.5  -  PLATE BN 7.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13720-09.0	SUP	HCPCS C1713		AR-13720-09.0  -  PLATE BN 9MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13720-10.0	SUP	HCPCS C1713		AR-13720-10.0  -  PLATE BN 10MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13720-11.0	SUP	HCPCS C1713		AR-13720-11.0  -  PLATE BN 11MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13720-12.5	SUP	HCPCS C1713		AR-13720-12.5  -  PLATE BN 12.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13720-15.0	SUP	HCPCS C1713		AR-13720-15.0  -  PLATE BN 15MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13720-17.5	SUP	HCPCS C1713		AR-13720-17.5  -  PLATE BN 17.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13725-05.0	SUP	HCPCS C1713		AR-13725-05.0  -  PLATE BN 5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13725-07.5	SUP	HCPCS C1713		AR-13725-07.5  -  PLATE BN 7.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13725-09.0	SUP	HCPCS C1713		AR-13725-09.0  -  PLATE BN 9MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13725-10.0	SUP	HCPCS C1713		AR-13725-10.0  -  PLATE BN 10MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13725-11.0	SUP	HCPCS C1713		AR-13725-11.0  -  PLATE BN 11MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13725-12.5	SUP	HCPCS C1713		AR-13725-12.5  -  PLATE BN 12.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13725-15.0	SUP	HCPCS C1713		AR-13725-15.0  -  PLATE BN 15MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13725-17.5	SUP	HCPCS C1713		AR-13725-17.5  -  PLATE BN 17.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1372E	SUP	HCPCS C1713		AR-1372E  -  SCREW INTFR 7MM 30MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1372T	SUP	HCPCS C1713		AR-1372T  -  SCREW INTFR FT RND 7MM 30MM STRL CNN RECON TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13730-01	SUP	HCPCS C1713		AR-13730-01  -  PLATE BN FLT 67MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13730-02	SUP	HCPCS C1713		AR-13730-02  -  PLATE BN FLT 71MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13730-03	SUP	HCPCS C1713		AR-13730-03  -  PLATE BN FLT 84MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13735-01	SUP	HCPCS C1713		AR-13735-01  -  PLATE BN FLT 67MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13735-02	SUP	HCPCS C1713		AR-13735-02  -  PLATE BN FLT 71MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13735-03	SUP	HCPCS C1713		AR-13735-03  -  PLATE BN FLT 84MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1375E	SUP	HCPCS C1713		AR-1375E  -  SCREW INTFR 7MM 15MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1380	SUP	HCPCS C1713		AR-1380  -  SCREW INTFR 8MM 20MM STRL BIOINTF CNN TI ACL PCL	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1380B	SUP	HCPCS C1713		AR-1380B  -  SCREW INTFR 8MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1380E	SUP	HCPCS C1713		AR-1380E  -  SCREW INTERFERENCE 8MM 20MM CANN SHEATH TITANIUM ACL PCL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1380H-25	SUP	HCPCS C1713		AR-1380H-25  -  SCREW INTFR BLNT RND 8MM 25MM STRL CNN SFT TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1380H-30	SUP	HCPCS C1713		AR-1380H-30  -  SCREW INTFR BLNT RND 8MM 30MM STRL CNN SFT TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1380H-35	SUP	HCPCS C1713		AR-1380H-35  -  SCREW INTFR BLNT RND 8MM 35MM STRL CNN SFT TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1380HLU-25	SUP	HCPCS C1713		AR-1380HLU-25  -  SCREW SOFT CANN LFT HAND THD 8X25MM TI	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1380P	SUP	HCPCS C1713		AR-1380P  -  SCREW INTFR 8MM 23MM STRL PEEK-OPTM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1380T	SUP	HCPCS C1713		AR-1380T  -  SCREW INTFR FT RND 8MM 20MM STRL CNN RECON TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1380TB	SUP	HCPCS C1713		AR-1380TB  -  SCREW INTFR FT 8MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1380TC	SUP	HCPCS C1713		AR-1380TC  -  SCREW INTFR BLNT FT STP TPR 8MM 28MM STRL CNN FULL SEAT RDC	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1381	SUP	HCPCS C1713		AR-1381  -  SCREW INTFR 8MM 25MM STRL BIOINTF CNN TI ACL PCL	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1381T	SUP	HCPCS C1713		AR-1381T  -  SCREW INTFR FT RND 8MM 25MM STRL CNN RECON TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1382	SUP	HCPCS C1713		AR-1382  -  SCREW INTFR 8MM 30MM STRL BIOINTF CNN TI ACL PCL	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1382T	SUP	HCPCS C1713		AR-1382T  -  SCREW INTFR FT RND 8MM 30MM STRL CNN RECON TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1390	SUP	HCPCS C1713		AR-1390  -  SCREW INTFR 9MM 20MM STRL BIOINTF CNN TI ACL PCL	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1390B	SUP	HCPCS C1713		AR-1390B  -  SCREW INTFR 9MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1390E	SUP	HCPCS C1713		AR-1390E  -  SCREW INTFR 20MM 9MM KNEE CANN SHTH STRL DISP	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1390H-35	SUP	HCPCS C1713		AR-1390H-35  -  SCREW INTFR BLNT RND 9MM 35MM STRL CNN SFT TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1390P	SUP	HCPCS C1713		AR-1390P  -  SCREW INTFR 9MM 23MM STRL PEEK-OPTM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1390T	SUP	HCPCS C1713		AR-1390T  -  SCREW INTFR FT RND 9MM 20MM STRL CNN RECON TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1390TB	SUP	HCPCS C1713		AR-1390TB  -  SCREW INTFR FT 9MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1390TC	SUP	HCPCS C1713		AR-1390TC  -  SCREW INTERFERENCE BLUNT FULTHD STEP TAPER 9MM 28MM CANN	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1391	SUP	HCPCS C1713		AR-1391  -  SCREW INTFR 9MM 25MM STRL BIOINTF CNN TI ACL PCL	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1391E	SUP	HCPCS C1713		AR-1391E  -  SCREW INTFR 9MM 25MM STRL CNN DISP SHTH TI ACL PCL ACPT 2MM	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1391T	SUP	HCPCS C1713		AR-1391T  -  SCREW INTFR FT RND 9MM 25MM STRL CNN RECON TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1392	SUP	HCPCS C1713		AR-1392  -  SCREW INTFR RND 9MM 30MM STRL CNN TI ACL PCL	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1392E	SUP	HCPCS C1713		AR-1392E  -  SCREW INTFR 9MM 30MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1392T	SUP	HCPCS C1713		AR-1392T  -  SCREW INTFR FT RND 9MM 30MM STRL CNN RECON TI ACL PCL ACPT 2	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13991N	SUP	Custom 27203010		AR-13991N  -  NEEDLE SUTURE SCORPION SUREFIRE ROTATOR CUFF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-13995N	SUP	Custom 27203010		AR-13995N  -  NEEDLE SUT MF SCRPN	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1400	SUP	HCPCS C1713		AR-1400  -  SCREW INTFR 10MM 20MM STRL BIOINTF CNN TI ACL PCL	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14003	SUP	HCPCS C1713		AR-14003  -  PLATE BN STRL SUTUREPLATE 3 HL HUM	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14005	SUP	HCPCS C1713		AR-14005  -  PLATE BN STRL SUTUREPLATE 5 HL HUM	BOTH IP/OP	"$3,987.50 "	"$2,950.75"	$0.00	"$3,190.00"	"$1,794.38"	"$1,794.38"	$0.00	$0.00	$0.00	$831.09	"$2,959.52"	"$2,959.52"	$0.00	$0.00	$831.00	$0.00	"$1,965.84"	"$1,965.84"	$0.00	"$1,993.75"	"$3,158.10"	"$3,190.00"	$0.00		$0.00	$624.04	$0.00	$0.00	$634.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1400B	SUP	HCPCS C1713		AR-1400B  -  SCREW INTFR 10MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1400H-25	SUP	HCPCS C1713		AR-1400H-25  -  SCREW INTFR BLNT RND 10MM 25MM STRL CNN SFT TI ACL PCL ACPT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1400H-30	SUP	HCPCS C1713		AR-1400H-30  -  SCREW INTFR BLNT RND 10MM 30MM STRL CNN SFT TI ACL PCL ACPT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1400H-35	SUP	HCPCS C1713		AR-1400H-35  -  SCREW INTFR BLNT RND 10MM 35MM STRL CNN SFT TI ACL PCL ACPT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1400P	SUP	HCPCS C1713		AR-1400P  -  SCREW INTFR 10MM 23MM STRL PEEK-OPTM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1400T	SUP	HCPCS C1713		AR-1400T  -  SCREW INTFR FT RND 10MM 28MM STRL CNN RECON TI ACL PCL ACPT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1400TB	SUP	HCPCS C1713		AR-1400TB  -  SCREW INTFR FT 10MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1400TC	SUP	HCPCS C1713		AR-1400TC  -  SCREW INTFR BLNT FT STP TPR 10MM 28MM STRL CNN FULL SEAT RDC	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1401	SUP	HCPCS C1713		AR-1401  -  SCREW INTFR 10MM 25MM STRL CNN TI ACL PCL DISP	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14012	SUP	Custom 27203010		AR-14012  -  GUIDE DRL 2.5MM SUTUREPLATE THRD	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$0.00	$0.00	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1401T	SUP	HCPCS C1713		AR-1401T  -  SCREW INTFR FT RND 10MM 25MM STRL CNN RECON TI ACL PCL ACPT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1402	SUP	HCPCS C1713		AR-1402  -  SCREW INTFR 10MM 30MM STRL BIOINTF CNN TI ACL PCL	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14029	SUP	Custom 27203010		AR-14029  -  GUIDE DRL 2.5MM	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$0.00	$0.00	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1402T	SUP	HCPCS C1713		AR-1402T  -  SCREW INTFR FT RND 10MM 30MM STRL CNN RECON TI ACL PCL ACPT	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1403TB	SUP	HCPCS C1713		AR-1403TB  -  SCREW INTFR FT 11MM 28MM STRL BIOINTF CNN BLNT POLY L LAC	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1403TC	SUP	HCPCS C1713		AR-1403TC  -  SCREW INTFR FT STP TPR 11MM 28MM STRL CNN SEAT RDC HD BLNT	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1404TB	SUP	HCPCS C1713		AR-1404TB  -  SCREW INTFR FT 12MM 28MM STRL BIOINTF CNN BLNT POLY L LAC	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1405LP	SUP	Custom 27203010		AR-1405LP  -  REAMER SRG LOPRFL 5MM STRL CNN ACL DISP	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1405LP-50	SUP	Custom 27203010		AR-1405LP-50  -  REAMER SURG LP 5.5MM CANN ACL STERILE DISPOSABLE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1406LP	SUP	Custom 27203010		AR-1406LP  -  REAMER SRG LOPRFL 6MM STRL CNN ACL DISP	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1406LP-50	SUP	Custom 27203010		AR-1406LP-50  -  REAMER SRG LOPRFL 6.5MM STRL CNN ACL DISP	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1407LP	SUP	Custom 27203010		AR-1407LP  -  REAMER SURG LP 7MM CANN ACL STERILE DISPOSABLE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1407LP-50	SUP	Custom 27203010		AR-1407LP-50  -  REAMER SURG LP 7.5MM CANN ACL STERILE DISPOSABLE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1408LP	SUP	Custom 27203010		AR-1408LP  -  REAMER SURG LP 8MM CANN ACL STERILE DISPOSABLE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1408LP-50	SUP	Custom 27203010		AR-1408LP-50  -  REAMER SURG LP 8.5MM CANN ACL STERILE DISPOSABLE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1408LPF	SUP	Custom 27203010		AR-1408LPF  -  REAMER SRG LOPRFL 8MM LOW PROFILE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1408LPF-50	SUP	Custom 27203010		AR-1408LPF-50  -  REAMER SRG LOPRFL 8.5MM LOW PROFILE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1409LP	SUP	Custom 27203010		AR-1409LP  -  REAMER SURG LP 9MM CANN ACL STERILE DISPOSABLE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1409LP-50	SUP	Custom 27203010		AR-1409LP-50  -  REAMER SURG LP 9.5MM CANN ACL STERILE DISPOSABLE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1409LPF	SUP	Custom 27203010		AR-1409LPF  -  REAMER SRG LOPRFL 9MM LOW PROFILE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1409LPF-50	SUP	Custom 27203010		AR-1409LPF-50  -  REAMER SRG LOPRFL 9.5MM LOW PROFILE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1410LP	SUP	Custom 27203010		AR-1410LP  -  REAMER SURG LP 10MM CANN ACL STERILE DISPOSABLE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1410LP-50	SUP	Custom 27203010		AR-1410LP-50  -  REAMER SURG LP 10.5MM CANN ACL STERILE DISPOSABLE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1410LPF	SUP	Custom 27203010		AR-1410LPF  -  REAMER SRG LOPRFL 10MM LOW PROFILE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1410LPF-50	SUP	Custom 27203010		AR-1410LPF-50  -  REAMER SRG LOPRFL 10.5MM LOW PROFILE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14116	SUP	HCPCS C1713		AR-14116  -  SCREW BN LOPRFL 3.5MM 16MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14116NL	SUP	HCPCS C1713		AR-14116NL  -  SCREW BN LOPRFL 3.5MM 16MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14118	SUP	HCPCS C1713		AR-14118  -  SCREW BN LOPRFL 3.5MM 18MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14118NL	SUP	HCPCS C1713		AR-14118NL  -  SCREW BN LOPRFL 3.5MM 18MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1411LP	SUP	Custom 27203010		AR-1411LP  -  REAMER SURG LP 11MM CANN ACL STERILE DISPOSABLE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1411LP-50	SUP	Custom 27203010		AR-1411LP-50  -  REAMER SRG LOPRFL 11.5MM STRL CNN ACL DISP	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1411LPF	SUP	Custom 27203010		AR-1411LPF  -  REAMER SRG LOPRFL 11MM LOW PROFILE	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14120	SUP	HCPCS C1713		AR-14120  -  SCREW BN LOPRFL 3.5MM 20MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14120NL	SUP	HCPCS C1713		AR-14120NL  -  SCREW BN LOPRFL 3.5MM 20MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14122	SUP	HCPCS C1713		AR-14122  -  SCREW BN LOPRFL 3.5MM 22MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14122NL	SUP	HCPCS C1713		AR-14122NL  -  SCREW BN LOPRFL 3.5MM 22MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14124	SUP	HCPCS C1713		AR-14124  -  SCREW BN LOPRFL 3.5MM 24MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14124NL	SUP	HCPCS C1713		AR-14124NL  -  SCREW BN LOPRFL 3.5MM 24MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14126	SUP	HCPCS C1713		AR-14126  -  SCREW BN LOPRFL 3.5MM 26MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14126NL	SUP	HCPCS C1713		AR-14126NL  -  SCREW BN LOPRFL 3.5MM 26MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14128	SUP	HCPCS C1713		AR-14128  -  SCREW BN LOPRFL 3.5MM 28MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14128NL	SUP	HCPCS C1713		AR-14128NL  -  SCREW BN LOPRFL 3.5MM 28MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1412LP	SUP	Custom 27203010		AR-1412LP  -  REAMER SRG LOPRFL 12MM STRL CNN ACL DISP	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1412LP-50	SUP	Custom 27203010		AR-1412LP-50  -  REAMER SRG LOPRFL 12.5MM STRL CNN ACL DISP	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14130	SUP	HCPCS C1713		AR-14130  -  SCREW BN LOPRFL 3.5MM 30MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14130NL	SUP	HCPCS C1713		AR-14130NL  -  SCREW BN LOPRFL 3.5MM 30MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14132	SUP	HCPCS C1713		AR-14132  -  SCREW BN LOPRFL 3.5MM 32MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14132NL	SUP	HCPCS C1713		AR-14132NL  -  SCREW BN LOPRFL 3.5MM 32MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14134	SUP	HCPCS C1713		AR-14134  -  SCREW BN LOPRFL 3.5MM 34MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14134NL	SUP	HCPCS C1713		AR-14134NL  -  SCREW BN LOPRFL 3.5MM 34MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14136	SUP	HCPCS C1713		AR-14136  -  SCREW BN LOPRFL 3.5MM 36MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14136NL	SUP	HCPCS C1713		AR-14136NL  -  SCREW BN LOPRFL 3.5MM 36MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14138	SUP	HCPCS C1713		AR-14138  -  SCREW BN LOPRFL 3.5MM 38MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14138NL	SUP	HCPCS C1713		AR-14138NL  -  SCREW BN LOPRFL 3.5MM 38MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1413LP	SUP	Custom 27203010		AR-1413LP  -  REAMER SRG LOPRFL 13MM STRL CNN ACL DISP	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14140	SUP	HCPCS C1713		AR-14140  -  SCREW BN LOPRFL 3.5MM 40MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14140NL	SUP	HCPCS C1713		AR-14140NL  -  SCREW BN LOPRFL 3.5MM 40MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14145	SUP	HCPCS C1713		AR-14145  -  SCREW BN LOPRFL 3.5MM 45MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14145NL	SUP	HCPCS C1713		AR-14145NL  -  SCREW BN LOPRFL 3.5MM 45MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14150	SUP	HCPCS C1713		AR-14150  -  SCREW BN LOPRFL 3.5MM 50MM SUTUREPLATE LCK TI SHLDR CORT	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14150NL	SUP	HCPCS C1713		AR-14150NL  -  SCREW BN LOPRFL 3.5MM 50MM SUTUREPLATE TI SHLDR CORT ARTHPL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14224	SUP	HCPCS C1713		AR-14224  -  SCREW BN LOPRFL 4MM 24MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14226	SUP	HCPCS C1713		AR-14226  -  SCREW BN LOPRFL 4MM 26MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14228	SUP	HCPCS C1713		AR-14228  -  SCREW BN LOPRFL 4MM 28MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14230	SUP	HCPCS C1713		AR-14230  -  SCREW BN LOPRFL 4MM 30MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14232	SUP	HCPCS C1713		AR-14232  -  SCREW BN LOPRFL 4MM 32MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14234	SUP	HCPCS C1713		AR-14234  -  SCREW BN LOPRFL 4MM 34MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14236	SUP	HCPCS C1713		AR-14236  -  SCREW BN LOPRFL 4MM 36MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14238	SUP	HCPCS C1713		AR-14238  -  SCREW BN LOPRFL 4MM 38MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14240	SUP	HCPCS C1713		AR-14240  -  SCREW BN LOPRFL 4MM 40MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14242	SUP	HCPCS C1713		AR-14242  -  SCREW BN LOPRFL 4MM 42MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14244	SUP	HCPCS C1713		AR-14244  -  SCREW BN LOPRFL 4MM 44MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14246	SUP	HCPCS C1713		AR-14246  -  SCREW BN LOPRFL 4MM 46MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14248	SUP	HCPCS C1713		AR-14248  -  SCREW BN LOPRFL 4MM 48MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14250	SUP	HCPCS C1713		AR-14250  -  SCREW BN 4MM 50MM SUTUREPLATE LCK HUM CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14252	SUP	HCPCS C1713		AR-14252  -  SCREW BN LOPRFL 4MM 52MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14254	SUP	HCPCS C1713		AR-14254  -  SCREW BN LOPRFL 4MM 54MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-14256	SUP	HCPCS C1713		AR-14256  -  SCREW BN LOPRFL 4MM 56MM SUTUREPLATE LCK TI SHLDR CANC	BOTH IP/OP	$280.00 	$207.20	$0.00	$224.00	$126.00	$126.00	$0.00	$0.00	$0.00	$58.36	$207.82	$207.82	$0.00	$0.00	$58.35	$0.00	$165.62	$165.62	$0.00	$140.00	$221.76	$224.00	$0.00		$0.00	$43.82	$0.00	$0.00	$44.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1450	SUP	Custom 27203010		AR-1450  -  REAMER SRG 6MM STRL PILT HD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1451	SUP	Custom 27203010		AR-1451  -  REAMER SURG 6.5MM PILOT HEAD STERILE	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1452	SUP	Custom 27203010		AR-1452  -  REAMER SRG 7MM STRL PILT HD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1453	SUP	Custom 27203010		AR-1453  -  REAMER SRG 7.5MM STRL PILT HD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1454	SUP	Custom 27203010		AR-1454  -  REAMER SRG 8MM STRL PILT HD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1455	SUP	Custom 27203010		AR-1455  -  REAMER SRG 8.5MM STRL PILT HD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1456	SUP	Custom 27203010		AR-1456  -  REAMER SRG 9MM STRL PILT HD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1457	SUP	Custom 27203010		AR-1457  -  REAMER SRG 9.5MM STRL PILT HD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1458	SUP	Custom 27203010		AR-1458  -  REAMER SRG 10MM STRL PILT HD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1502	SUP	Custom 27203010		AR-1502  -  INSERT PSTN CSHN FM LG HLDR	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$0.00	$0.00	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1510FL	SUP	Custom 27203010		AR-1510FL  -  GUIDE DRL RETROCONSTRUCTION SET ADJ C RING FTPRNT SLV FEM LT	BOTH IP/OP	"$1,365.00 "	"$1,010.10"	$0.00	"$1,092.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,013.10"	"$1,013.10"	$0.00	$0.00	$284.47	$0.00	$0.00	$0.00	$0.00	$682.50	"$1,081.08"	"$1,092.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1510FLS	SUP	Custom 27203010		AR-1510FLS  -  GUIDE DRL ANG SM RETROCONSTRUCTION FTPRNT FEM LT ACL	BOTH IP/OP	"$2,433.75 "	"$1,800.98"	$0.00	"$1,947.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,806.33"	"$1,806.33"	$0.00	$0.00	$507.19	$0.00	$0.00	$0.00	$0.00	"$1,216.88"	"$1,927.53"	"$1,947.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1510FPL	SUP	Custom 27203010		AR-1510FPL  -  GUIDE DRL 7MM OFST RETROCONSTRUCTION FTPRNT FEM LT ACL	BOTH IP/OP	"$1,365.00 "	"$1,010.10"	$0.00	"$1,092.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,013.10"	"$1,013.10"	$0.00	$0.00	$284.47	$0.00	$0.00	$0.00	$0.00	$682.50	"$1,081.08"	"$1,092.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1510FPR	SUP	Custom 27203010		AR-1510FPR  -  GUIDE DRL 7MM OFST RETROCONSTRUCTION FTPRNT FEM RT ACL	BOTH IP/OP	"$1,365.00 "	"$1,010.10"	$0.00	"$1,092.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,013.10"	"$1,013.10"	$0.00	$0.00	$284.47	$0.00	$0.00	$0.00	$0.00	$682.50	"$1,081.08"	"$1,092.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1510FR	SUP	Custom 27203010		AR-1510FR  -  GUIDE DRL RETROCONSTRUCTION SET ADJ C RING FTPRNT SLV FEM RT	BOTH IP/OP	"$1,365.00 "	"$1,010.10"	$0.00	"$1,092.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,013.10"	"$1,013.10"	$0.00	$0.00	$284.47	$0.00	$0.00	$0.00	$0.00	$682.50	"$1,081.08"	"$1,092.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1510FRS	SUP	Custom 27203010		AR-1510FRS  -  GUIDE DRL ANG SM RETROCONSTRUCTION FTPRNT FEM RT ACL	BOTH IP/OP	"$2,433.75 "	"$1,800.98"	$0.00	"$1,947.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,806.33"	"$1,806.33"	$0.00	$0.00	$507.19	$0.00	$0.00	$0.00	$0.00	"$1,216.88"	"$1,927.53"	"$1,947.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1530BC	SUP	HCPCS C1713		AR-1530BC  -  SCREW INTFR 3MM 8MM STRL TENODESIS HNDL INSRTR BCMPS SFT TIS	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1530C-25	SUP	Custom 27203010		AR-1530C-25  -  BIT DRL 2.5MM CNN	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1530DS	SUP	Custom 27203010		AR-1530DS  -  KIT INST 2-0 .041IN 2.5MM BTNDS FWR NDL CNN DRL SUT PASS WRE	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1530P-CP	SUP	HCPCS C1713		AR-1530P-CP  -  SYSTEM IMPL STRL INTERNALBRACE PEEK FOREFOOT	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1530PS	SUP	HCPCS C1713		AR-1530PS  -  SCREW INTFR 3MM 8MM STRL TENODESIS HNDL INSRTR VNT PEEK-OPTM	BOTH IP/OP	$912.50 	$675.25	$0.00	$730.00	$410.63	$410.63	$0.00	$0.00	$0.00	$190.19	$677.26	$677.26	$0.00	$0.00	$190.17	$0.00	$539.74	$539.74	$0.00	$456.25	$722.70	$730.00	$0.00		$0.00	$142.81	$0.00	$0.00	$145.27	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1540B	SUP	HCPCS C1713		AR-1540B  -  SCREW INTFR 4MM 10MM STRL BTNDS RECON POLY L LAC ACD ACL PCL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1540BC	SUP	HCPCS C1713		AR-1540BC  -  SCREW INTFR 4MM 10MM STRL TENODESIS BCMPS ACL	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$388.13	$388.13	$0.00	$0.00	$0.00	$179.77	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$510.17	$510.17	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1540CDS	SUP	HCPCS C1713		AR-1540CDS  -  SCREW INTFR 4MM 10MM TENODESIS SCR DISP DRVR PK BCMPS	BOTH IP/OP	"$4,812.50 "	"$3,561.25"	$0.00	"$3,850.00"	"$2,165.63"	"$2,165.63"	$0.00	$0.00	$0.00	"$1,003.05"	"$3,571.84"	"$3,571.84"	$0.00	$0.00	"$1,002.93"	$0.00	"$2,372.56"	"$2,372.56"	$0.00	"$2,406.25"	"$3,811.50"	"$3,850.00"	$0.00		$0.00	$753.16	$0.00	$0.00	$766.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1540PS	SUP	HCPCS C1713		AR-1540PS  -  SCREW INTFR 4MM 10MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1547BC	SUP	HCPCS C1713		AR-1547BC  -  SCREW INTFR 4.75MM 15MM STRL TENODESIS BCMPS ACL	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$388.13	$388.13	$0.00	$0.00	$0.00	$179.77	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$510.17	$510.17	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1547CDS	SUP	HCPCS C1713		AR-1547CDS  -  SCREW INTFR 4.75MM 15MM TENODESIS SCR DISP DRVR PK BCMPS	BOTH IP/OP	"$4,812.50 "	"$3,561.25"	$0.00	"$3,850.00"	"$2,165.63"	"$2,165.63"	$0.00	$0.00	$0.00	"$1,003.05"	"$3,571.84"	"$3,571.84"	$0.00	$0.00	"$1,002.93"	$0.00	"$2,372.56"	"$2,372.56"	$0.00	"$2,406.25"	"$3,811.50"	"$3,850.00"	$0.00		$0.00	$753.16	$0.00	$0.00	$766.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1547PS	SUP	HCPCS C1713		AR-1547PS  -  SCREW INTFR 4.75MM 15MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1555BC	SUP	HCPCS C1713		AR-1555BC  -  SCREW INTFR 5.5MM 15MM STRL TENODESIS BCMPS ACL	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$388.13	$388.13	$0.00	$0.00	$0.00	$179.77	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$510.17	$510.17	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1555CDS-1	SUP	HCPCS C1713		AR-1555CDS-1  -  SCREW BN 5.5MM 15MM STRL ARTHX DISP DRVR BCMPS TENODESIS	BOTH IP/OP	$962.50 	$712.25	$0.00	$770.00	$433.13	$433.13	$0.00	$0.00	$0.00	$200.61	$714.37	$714.37	$0.00	$0.00	$200.59	$0.00	$569.32	$569.32	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$150.63	$0.00	$0.00	$153.23	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1555PS	SUP	HCPCS C1713		AR-1555PS  -  SCREW INTFR 5.5MM 15MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1562BC	SUP	HCPCS C1713		AR-1562BC  -  SCREW INTFR 6.25MM 15MM STRL TENODESIS BCMPS ACL	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$388.13	$388.13	$0.00	$0.00	$0.00	$179.77	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$510.17	$510.17	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1562CDS	SUP	HCPCS C1713		AR-1562CDS  -  SCREW INTFR 6.25MM 15MM TENODESIS SCR DISP DRVR PK BCMPS	BOTH IP/OP	"$4,812.50 "	"$3,561.25"	$0.00	"$3,850.00"	"$2,165.63"	"$2,165.63"	$0.00	$0.00	$0.00	"$1,003.05"	"$3,571.84"	"$3,571.84"	$0.00	$0.00	"$1,002.93"	$0.00	"$2,372.56"	"$2,372.56"	$0.00	"$2,406.25"	"$3,811.50"	"$3,850.00"	$0.00		$0.00	$753.16	$0.00	$0.00	$766.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1562PS	SUP	HCPCS C1713		AR-1562PS  -  SCREW INTFR 6.25MM 15MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1570BC	SUP	HCPCS C1713		AR-1570BC  -  SCREW INTFR 7MM 23MM STRL TENODESIS BCMPS ACL	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$388.13	$388.13	$0.00	$0.00	$0.00	$179.77	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$510.17	$510.17	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1570PS	SUP	HCPCS C1713		AR-1570PS  -  SCREW INTFR 7MM 23MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1580BC	SUP	HCPCS C1713		AR-1580BC  -  SCREW INTFR 8MM 23MM STRL TENODESIS BCMPS ACL	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$388.13	$388.13	$0.00	$0.00	$0.00	$179.77	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$510.17	$510.17	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1580PS	SUP	HCPCS C1713		AR-1580PS  -  SCREW INTFR 8MM 23MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586FR-07	SUP	HCPCS C1713		AR-1586FR-07  -  SCREW INTFR 7MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586FR-08	SUP	HCPCS C1713		AR-1586FR-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586FR-09	SUP	HCPCS C1713		AR-1586FR-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586FR-10	SUP	HCPCS C1713		AR-1586FR-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586FRB-07	SUP	HCPCS C1713		AR-1586FRB-07  -  SCREW INTFR 7MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586FRB-08	SUP	HCPCS C1713		AR-1586FRB-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586FRB-09	SUP	HCPCS C1713		AR-1586FRB-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586FRB-10	SUP	HCPCS C1713		AR-1586FRB-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586LB-08	SUP	HCPCS C1713		AR-1586LB-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586LB-09	SUP	HCPCS C1713		AR-1586LB-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586LB-10	SUP	HCPCS C1713		AR-1586LB-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586R-08	SUP	HCPCS C1713		AR-1586R-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN TI	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586R-09	SUP	HCPCS C1713		AR-1586R-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN TI	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586R-10	SUP	HCPCS C1713		AR-1586R-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586RB-06	SUP	HCPCS C1713		AR-1586RB-06  -  SCREW INTFR 6MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586RB-07	SUP	HCPCS C1713		AR-1586RB-07  -  SCREW INTFR 7MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586RB-08	SUP	HCPCS C1713		AR-1586RB-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD POLY L	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586RB-09	SUP	HCPCS C1713		AR-1586RB-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586RB-10	SUP	HCPCS C1713		AR-1586RB-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586RC-07	SUP	HCPCS C1713		AR-1586RC-07  -  SCREW INTFR 20MM 7MM STRL RETROSCREW RVRS THRD DSGN BCMPS	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586RC-08	SUP	HCPCS C1713		AR-1586RC-08  -  SCREW INTFR 20MM 8MM STRL RETROSCREW RVRS THRD DSGN BCMPS	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586RC-09	SUP	HCPCS C1713		AR-1586RC-09  -  SCREW INTFR 20MM 9MM STRL RETROSCREW RVRS THRD DSGN BCMPS	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1586RC-10	SUP	HCPCS C1713		AR-1586RC-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW ACL RVRS THRD DSGN	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1587S	SUP	Custom 27203010		AR-1587S  -  KIT INST STRL ALL INSD ACL DISP	BOTH IP/OP	"$1,182.50 "	$875.05	$0.00	$946.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$877.65	$877.65	$0.00	$0.00	$246.43	$0.00	$0.00	$0.00	$0.00	$591.25	$936.54	$946.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-15	SUP	HCPCS C1763		AR-1588-15  -  BUTTON FX 12MM STRL 15MM RETROBUTTON LOOP SLF FLP TI UHMWPE	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-25	SUP	HCPCS C1763		AR-1588-25  -  BUTTON FX 12MM STRL 25MM RETROBUTTON LOOP SLF FLP TI UHMWPE	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-25BT	SUP	HCPCS C1763		AR-1588-25BT  -  BUTTON FX 12MM STRL 25MM RETROBUTTON LOOP SLF FLP TI UHMWPE	BOTH IP/OP	$762.50 	$564.25	$0.00	$610.00	$343.13	$343.13	$0.00	$0.00	$0.00	$158.92	$565.93	$565.93	$0.00	$0.00	$158.91	$0.00	$451.02	$451.02	$0.00	$381.25	$603.90	$610.00	$0.00		$0.00	$119.33	$0.00	$0.00	$121.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-30BT	SUP	HCPCS C1763		AR-1588-30BT  -  BUTTON FX 12MM STRL 30MM RETROBUTTON LOOP SLF FLP TI UHMWPE	BOTH IP/OP	$762.50 	$564.25	$0.00	$610.00	$343.13	$343.13	$0.00	$0.00	$0.00	$158.92	$565.93	$565.93	$0.00	$0.00	$158.91	$0.00	$451.02	$451.02	$0.00	$381.25	$603.90	$610.00	$0.00		$0.00	$119.33	$0.00	$0.00	$121.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-35	SUP	HCPCS C1763		AR-1588-35  -  BUTTON FX 12MM STRL 35MM RETROBUTTON LOOP SLF FLP TI UHMWPE	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-35BT	SUP	HCPCS C1763		AR-1588-35BT  -  BUTTON FX 12MM STRL 35MM RETROBUTTON LOOP SLF FLP TI UHMWPE	BOTH IP/OP	$762.50 	$564.25	$0.00	$610.00	$343.13	$343.13	$0.00	$0.00	$0.00	$158.92	$565.93	$565.93	$0.00	$0.00	$158.91	$0.00	$451.02	$451.02	$0.00	$381.25	$603.90	$610.00	$0.00		$0.00	$119.33	$0.00	$0.00	$121.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-40	SUP	HCPCS C1763		AR-1588-40  -  BUTTON FX 12MM STRL 40MM RETROBUTTON LOOP SLF FLP TI UHMWPE	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-45	SUP	HCPCS C1763		AR-1588-45  -  BUTTON FX 12MM STRL 45MM RETROBUTTON LOOP SLF FLP TI UHMWPE	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-50	SUP	HCPCS C1763		AR-1588-50  -  BUTTON FX 12MM STRL 50MM RETROBUTTON LOOP SLF FLP TI UHMWPE	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-55	SUP	HCPCS C1763		AR-1588-55  -  BUTTON FX 12MM STRL 55MM RETROBUTTON LOOP SLF FLP TI UHMWPE	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-55BT	SUP	HCPCS C1763		"AR-1588-55BT  -  BUTTON BTB RETROBUTTON, 12MM X 55MM LOOP"	BOTH IP/OP	$762.50 	$564.25	$0.00	$610.00	$343.13	$343.13	$0.00	$0.00	$0.00	$158.92	$565.93	$565.93	$0.00	$0.00	$158.91	$0.00	$451.02	$451.02	$0.00	$381.25	$603.90	$610.00	$0.00		$0.00	$119.33	$0.00	$0.00	$121.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-60	SUP	HCPCS C1763		AR-1588-60  -  BUTTON FX 12MM STRL 60MM RETROBUTTON LOOP SLF FLP TI UHMWPE	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588-60BT	SUP	HCPCS C1763		"AR-1588-60BT  -  BUTTON BTB 12MM RETROBUTTON, 60MM LOOP"	BOTH IP/OP	$762.50 	$564.25	$0.00	$610.00	$343.13	$343.13	$0.00	$0.00	$0.00	$158.92	$565.93	$565.93	$0.00	$0.00	$158.91	$0.00	$451.02	$451.02	$0.00	$381.25	$603.90	$610.00	$0.00		$0.00	$119.33	$0.00	$0.00	$121.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588BTB	SUP	HCPCS C1713		AR-1588BTB  -  DEVICE FIX SMALL 10MM 4 POINT LOCK ADJUSTABLE LOOP DRILL	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588BTB-J	SUP	HCPCS C1713		AR-1588BTB-J  -  DEVICE FX TGHTRP DEPLOYING SUT	BOTH IP/OP	"$1,112.50 "	$823.25	$0.00	$890.00	$500.63	$500.63	$0.00	$0.00	$0.00	$231.87	$825.70	$825.70	$0.00	$0.00	$231.85	$0.00	$658.04	$658.04	$0.00	$556.25	$881.10	$890.00	$0.00		$0.00	$174.11	$0.00	$0.00	$177.11	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588RT	SUP	HCPCS C1713		AR-1588RT  -  KIT ENDSCP INSTR LATEX FREE TIGHTROPE TITANIUM UHMWPE ACL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588RT-07	SUP	Custom 27203010		AR-1588RT-07  -  KIT ASCP FX 8MM LF TGHTRP FLIPCUTTER II TIB RT ACL	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$0.00	$0.00	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588RT-13	SUP	Custom 27203010		AR-1588RT-13  -  KIT ASCP FX 11MM LF TGHTRP FLIPCUTTER II TIB RT ACL	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$0.00	$0.00	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588RT-18	SUP	Custom 27203010		AR-1588RT-18  -  KIT ASCP FX 9MM LF TGHTRP FLIPCUTTER II TIB RT ACL	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$0.00	$0.00	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588RT-J	SUP	HCPCS C1713		AR-1588RT-J  -  DEVICE FX TGHTRP 2 LD PASS SUT ACL RT	BOTH IP/OP	$925.00 	$684.50	$0.00	$740.00	$416.25	$416.25	$0.00	$0.00	$0.00	$192.79	$686.54	$686.54	$0.00	$0.00	$192.77	$0.00	$547.14	$547.14	$0.00	$462.50	$732.60	$740.00	$0.00		$0.00	$144.76	$0.00	$0.00	$147.26	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588RTS	SUP	HCPCS C1713		AR-1588RTS  -  KIT ARTHRO FIX DELIVERY SYSTEM DRILL PIN TIGHTROPE ACL RIGHT	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588T	SUP	Custom 27203010		AR-1588T  -  KIT ASCP FX STRL TGHTRP REPR ACL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588TB	SUP	HCPCS C1763		AR-1588TB  -  BUTTON FX 12MM 8MM TGHTRP ATCH SLOT ACL	BOTH IP/OP	$357.50 	$264.55	$0.00	$286.00	$160.88	$160.88	$0.00	$0.00	$0.00	$74.51	$265.34	$265.34	$0.00	$0.00	$74.50	$0.00	$211.46	$211.46	$0.00	$178.75	$283.14	$286.00	$0.00		$0.00	$55.95	$0.00	$0.00	$56.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588TB-1	SUP	HCPCS C1763		AR-1588TB-1  -  BUTTON FIXATION TIGHTROPE ROUND OD14 MM ACL ATTACHABLE	BOTH IP/OP	$535.00 	$395.90	$0.00	$428.00	$240.75	$240.75	$0.00	$0.00	$0.00	$111.51	$397.08	$397.08	$0.00	$0.00	$111.49	$0.00	$316.45	$316.45	$0.00	$267.50	$423.72	$428.00	$0.00		$0.00	$83.73	$0.00	$0.00	$85.17	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588TB-2	SUP	HCPCS C1763		AR-1588TB-2  -  BUTTON FX OBLNG 13MMXW 3.4MM TGHTRP ATCH SLOT ACL	BOTH IP/OP	$502.50 	$371.85	$0.00	$402.00	$226.13	$226.13	$0.00	$0.00	$0.00	$104.73	$372.96	$372.96	$0.00	$0.00	$104.72	$0.00	$297.23	$297.23	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$78.64	$0.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588TB-3	SUP	HCPCS C1763		AR-1588TB-3  -  BUTTON FX RND CNCV 11MM TGHTRP ATCH	BOTH IP/OP	$560.00 	$414.40	$0.00	$448.00	$252.00	$252.00	$0.00	$0.00	$0.00	$116.72	$415.63	$415.63	$0.00	$0.00	$116.70	$0.00	$331.24	$331.24	$0.00	$280.00	$443.52	$448.00	$0.00		$0.00	$87.64	$0.00	$0.00	$89.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588TB-4	SUP	HCPCS C1763		AR-1588TB-4  -  BUTTON FX RND CNCV 14MM TGHTRP ATCH	BOTH IP/OP	$560.00 	$414.40	$0.00	$448.00	$252.00	$252.00	$0.00	$0.00	$0.00	$116.72	$415.63	$415.63	$0.00	$0.00	$116.70	$0.00	$331.24	$331.24	$0.00	$280.00	$443.52	$448.00	$0.00		$0.00	$87.64	$0.00	$0.00	$89.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588TB-5	SUP	HCPCS C1763		AR-1588TB-5  -  BUTTON FX RND 20MM 9MM TGHTRP COLR ABS	BOTH IP/OP	$560.00 	$414.40	$0.00	$448.00	$252.00	$252.00	$0.00	$0.00	$0.00	$116.72	$415.63	$415.63	$0.00	$0.00	$116.70	$0.00	$331.24	$331.24	$0.00	$280.00	$443.52	$448.00	$0.00		$0.00	$87.64	$0.00	$0.00	$89.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588TDB-7	SUP	HCPCS C1713		AR-1588TDB-7  -  DEVICE FX 7MM TGHTRP DLV SYS ACL DISP	BOTH IP/OP	"$1,162.50 "	$860.25	$0.00	$930.00	$523.13	$523.13	$0.00	$0.00	$0.00	$242.29	$862.81	$862.81	$0.00	$0.00	$242.27	$0.00	$687.62	$687.62	$0.00	$581.25	$920.70	$930.00	$0.00		$0.00	$181.93	$0.00	$0.00	$185.07	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588TDB-7S	SUP	HCPCS C1713		AR-1588TDB-7S  -  DEVICE FX TGHTRP DLV SYS ACL	BOTH IP/OP	"$1,475.00 "	"$1,091.50"	$0.00	"$1,180.00"	$663.75	$663.75	$0.00	$0.00	$0.00	$307.43	"$1,094.75"	"$1,094.75"	$0.00	$0.00	$307.39	$0.00	$872.46	$872.46	$0.00	$737.50	"$1,168.20"	"$1,180.00"	$0.00		$0.00	$230.84	$0.00	$0.00	$234.82	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588TN	SUP	HCPCS C1713		AR-1588TN  -  DEVICE TGHTRP ACL UHMWPE ATCH	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588TN-1	SUP	HCPCS C1713		AR-1588TN-1  -  DEVICE FX TGHTRP ATCH OPN UHMWPE ACL	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1588TP	SUP	Custom 27203010		AR-1588TP  -  KIT ASCP FX TGHTRP PCL	BOTH IP/OP	$872.50 	$645.65	$0.00	$698.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$647.57	$647.57	$0.00	$0.00	$181.83	$0.00	$0.00	$0.00	$0.00	$436.25	$691.02	$698.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1589-15	SUP	HCPCS C1763		AR-1589-15  -  BUTTON FX LNG 15MM STRL 15MM RETROBUTTON LOOP SLF FLP TI	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1589-20	SUP	HCPCS C1763		AR-1589-20  -  BUTTON FX LNG 15MM STRL 20MM RETROBUTTON LOOP SLF FLP TI	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1589-25	SUP	HCPCS C1763		AR-1589-25  -  BUTTON FX LNG 15MM STRL 25MM RETROBUTTON LOOP SLF FLP TI	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1589-30	SUP	HCPCS C1763		AR-1589-30  -  BUTTON FX LNG 15MM STRL 30MM RETROBUTTON LOOP SLF FLP TI	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1589-35	SUP	HCPCS C1763		AR-1589-35  -  BUTTON FX LNG 15MM STRL 35MM RETROBUTTON LOOP SLF FLP TI	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1589-40	SUP	HCPCS C1763		AR-1589-40  -  BUTTON FX LNG 15MM STRL 40MM RETROBUTTON LOOP SLF FLP TI	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1589RT	SUP	HCPCS C1763		AR-1589RT  -  BUTTON SUT LG 20X5MM TGHTRP XTD FTPRNT	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1590BC	SUP	HCPCS C1713		AR-1590BC  -  SCREW INTFR 9MM 23MM STRL TENODESIS BCMPS ACL	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$388.13	$388.13	$0.00	$0.00	$0.00	$179.77	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$510.17	$510.17	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1590PS	SUP	HCPCS C1713		AR-1590PS  -  SCREW INTFR 9MM 23MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1592	SUP	HCPCS C1763		AR-1592  -  BUTTON FX XL 11MM 20MM STRL RETROBUTTON ASYM LOOP RECON STF	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$298.13	$298.13	$0.00	$0.00	$0.00	$138.08	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$391.87	$391.87	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$103.68	$0.00	$0.00	$105.47	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1593	SUP	Custom 27203010		AR-1593  -  SYSTEM FX ACL	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1595	SUP	HCPCS C1763		AR-1595  -  PIN DRILL RETROBUTTON KNEE ACL STERILE DISPOSABLE	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1595TC	SUP	HCPCS C1763		AR-1595TC  -  PIN DRL 4MM STRL RETROBUTTON TGHTRP CLS EYLT KN ACL DISP	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1605S	SUP	HCPCS C1713		AR-1605S  -  HOOK SCR STOR WLMNT 2 HK 2 BOLT DRL	BOTH IP/OP	$47.50 	$35.15	$0.00	$38.00	$21.38	$21.38	$0.00	$0.00	$0.00	$9.90	$35.25	$35.25	$0.00	$0.00	$9.90	$0.00	$28.10	$28.10	$0.00	$23.75	$37.62	$38.00	$0.00		$0.00	$7.43	$0.00	$0.00	$7.56	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1606	SUP	Custom 27203010		AR-1606  -  DEVICE PSTN STRL CBN STAR SLV LAT TRC ROT STRAP FM FRARM	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1606C	SUP	Custom 27203010		AR-1606C  -  DEVICE PSTN STRL CBN STAR SLV CMPCT LAT TRC ROT STRAP SFT FM	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1606LV	SUP	Custom 27203010		AR-1606LV  -  DEVICE PSTN XLNG STRL STAR SLV VLCR FM ARM DISP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1606SV	SUP	Custom 27203010		AR-1606SV  -  DEVICE PSTN SM STRL STAR SLV VLCR LMB DISP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1606V	SUP	Custom 27203010		AR-1606V  -  DEVICE POSITIONING TRACTION SLING STAR SLEEVE VELCRO FOAM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1627-06	SUP	Custom 27203010		AR-1627-06  -  KIT PSTN UNV HD STRL DISP	BOTH IP/OP	$49.75 	$36.82	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.92	$36.92	$0.00	$0.00	$10.37	$0.00	$0.00	$0.00	$0.00	$24.88	$39.40	$39.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1627-11	SUP	Custom 27203010		AR-1627-11  -  CLAMP OP TBL CLRK RAIL	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$0.00	$0.00	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1644	SUP	Custom 27203010		AR-1644  -  KIT POSITIONING BEACH CHAIR DRAPE HOLDER LIGHTWEIGHT TRIMANO	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1648	SUP	Custom 27203010		AR-1648  -  COVER PSTN STRL TRIMANO DRP	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.40	$33.40	$0.00	$0.00	$9.38	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1650-07	SUP	Custom 27203010		AR-1650-07  -  CLAMP OP TBL CLRK RAIL SHLDR SPNS SYS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1655PS	SUP	HCPCS C1713		AR-1655PS  -  SCREW INTFR 5.5MM 8MM STRL BTNDS RECON PEEK-OPTM ACL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1655PS-10	SUP	HCPCS C1713		AR-1655PS-10  -  SCREW INTFR 5.5MM 10MM STRL BTNDS RECON PEEK-OPTM ACL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1655PS-12	SUP	HCPCS C1713		AR-1655PS-12  -  SCREW INTFR 5.5MM 12MM STRL BTNDS RECON PEEK-OPTM ACL	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1662B	SUP	HCPCS C1713		AR-1662B  -  ANCHOR SUT 6.25MM 19.1MM SWIVELOCK BICEPS TENODESIS SYS	BOTH IP/OP	$950.00 	$703.00	$0.00	$760.00	$427.50	$427.50	$0.00	$0.00	$0.00	$198.00	$705.09	$705.09	$0.00	$0.00	$197.98	$0.00	$561.93	$561.93	$0.00	$475.00	$752.40	$760.00	$0.00		$0.00	$148.68	$0.00	$0.00	$151.24	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1662BC	SUP	HCPCS C1713		AR-1662BC  -  ANCHOR SUT 6.25MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT	BOTH IP/OP	"$1,025.00 "	$758.50	$0.00	$820.00	$461.25	$461.25	$0.00	$0.00	$0.00	$213.64	$760.76	$760.76	$0.00	$0.00	$213.61	$0.00	$606.29	$606.29	$0.00	$512.50	$811.80	$820.00	$0.00		$0.00	$160.41	$0.00	$0.00	$163.18	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1662BC-7	SUP	HCPCS C1713		AR-1662BC-7  -  ANCHOR SUT SWVLK TENO BIO-COMP 7X 19.5MM	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1662BC-8	SUP	HCPCS C1713		AR-1662BC-8  -  ANCHOR SUTURE 8MM 19.5MM FORK EYELET SWIVELOCK TENODESIS	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	"$1,244.00"	$699.75	$699.75	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$777.50	"$1,231.56"	"$1,244.00"	$0.00		$0.00	$243.36	$0.00	$0.00	$247.56	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1662BC-9	SUP	HCPCS C1713		AR-1662BC-9  -  ANCHOR SUT 9MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1662BCC-7	SUP	HCPCS C1713		AR-1662BCC-7  -  ANCHOR SUT 7MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1662BCC-8	SUP	HCPCS C1713		AR-1662BCC-8  -  ANCHOR SUT 8MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1662BCC-9	SUP	HCPCS C1713		AR-1662BCC-9  -  ANCHOR SUT 9MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1662PSL-7	SUP	HCPCS C1713		AR-1662PSL-7  -  ANCHOR SUT 7MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT PEEK	BOTH IP/OP	"$1,012.50 "	$749.25	$0.00	$810.00	$455.63	$455.63	$0.00	$0.00	$0.00	$211.03	$751.48	$751.48	$0.00	$0.00	$211.01	$0.00	$598.89	$598.89	$0.00	$506.25	$801.90	$810.00	$0.00		$0.00	$158.46	$0.00	$0.00	$161.19	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1662PSL-8	SUP	HCPCS C1713		AR-1662PSL-8  -  ANCHOR SUT 8MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT PEEK	BOTH IP/OP	"$1,012.50 "	$749.25	$0.00	"$1,158.00"	$651.38	$651.38	$0.00	$0.00	$0.00	$211.03	$751.48	$751.48	$0.00	$0.00	$211.01	$0.00	$598.89	$598.89	$0.00	$723.75	"$1,146.42"	"$1,158.00"	$0.00		$0.00	$226.53	$0.00	$0.00	$230.44	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1662PSL-9	SUP	HCPCS C1713		AR-1662PSL-9  -  ANCHOR SUT 9MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT PEEK	BOTH IP/OP	"$1,012.50 "	$749.25	$0.00	$810.00	$455.63	$455.63	$0.00	$0.00	$0.00	$211.03	$751.48	$751.48	$0.00	$0.00	$211.01	$0.00	$598.89	$598.89	$0.00	$506.25	$801.90	$810.00	$0.00		$0.00	$158.46	$0.00	$0.00	$161.19	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1670BC	SUP	HCPCS C1713		AR-1670BC  -  SCREW INTFR 7MM 10MM STRL TENODESIS BCMPS ACL	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$388.13	$388.13	$0.00	$0.00	$0.00	$179.77	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$510.17	$510.17	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1670PS	SUP	HCPCS C1713		AR-1670PS  -  SCREW INTFR 7MM 10MM STRL TENODESIS PEEK-OPTM ACL	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1675BC-CP	SUP	HCPCS C1713		AR-1675BC-CP  -  SET IMPL BCMPS SCRDRVR RECON SYS	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1676DS	SUP	Custom 27203010		AR-1676DS  -  KIT INSTR BIOABSORBABLE BIO-TENODESIS STERILE DISPOSABLE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1676-DS	SUP	HCPCS C1713		KIT ARTHRO FIXAT BTNDS BABSR STRL DISP	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1677BC-CP	SUP	HCPCS C1713		AR-1677BC-CP  -  SET IMPL 4MM CNN DRL GDPN RLR SCR TNDN SHTL CMC LGMNT RECON	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1678-01	SUP	Custom 27203010		AR-1678-01  -  GUIDE DRL LF TTH FT	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	$0.00	$0.00	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1678-02	SUP	Custom 27203010		AR-1678-02  -  BIT DRL 3.5MM SWIVELOCK	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1678-05	SUP	Custom 27203010		AR-1678-05  -  BIT DRL 3.5MM SWIVELOCK	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1678-CP	SUP	HCPCS C1713		AR-1678-CP  -  SET IMPL 3.5MM INTERNALBRACE SWIVELOCK FIBERTAPE 2 2 NDL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1680B	SUP	HCPCS C1713		AR-1680B  -  SCREW BABSR 12MM 8MM BTNDS ACL PLLA RECON STRL DISP	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1680PS	SUP	HCPCS C1713		AR-1680PS  -  TENODESIS SCREW 8X12MM	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1688-CP	SUP	Custom 27203010		AR-1688-CP  -  KIT ASCP FX INTERNALBRACE FIBERTAPE CLGN LGMNT AUG REPR	BOTH IP/OP	"$2,687.50 "	"$1,988.75"	$0.00	"$2,150.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,994.66"	"$1,994.66"	$0.00	$0.00	$560.08	$0.00	$0.00	$0.00	$0.00	"$1,343.75"	"$2,128.50"	"$2,150.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-16991N	SUP	Custom 27203010		AR-16991N  -  NEEDLE SUT RND GRV LOPRFL SCRPN FBRWR 1 PRTL SMTH JAW MN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-16992N	SUP	Custom 27203010		AR-16992N  -  NEEDLE SUT SCRPN CAPSULECLOSE	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$0.00	$0.00	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1713-03	SUP	Custom 27203010		AR-1713-03  -  CLAMP BDRL DSTRCT SET STRL ANKL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1801	SUP	Custom 27203010		AR-1801  -  GUIDE DRL OFST 7MM AU FEM ACL TRNTB DISP 7-8MM HL	BOTH IP/OP	"$2,087.50 "	"$1,544.75"	$0.00	"$1,670.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,549.34"	"$1,549.34"	$0.00	$0.00	$435.04	$0.00	$0.00	$0.00	$0.00	"$1,043.75"	"$1,653.30"	"$1,670.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1802D	SUP	Custom 27203010		AR-1802D  -  CANNULA ASCP 9-12MM STRL TNL SIL TIB DISP	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$0.00	$0.00	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1803	SUP	Custom 27203010		AR-1803  -  GUIDE DRL OFST 5MM RD FEM ACL TRNTB DISP 7-8MM HL	BOTH IP/OP	"$2,087.50 "	"$1,544.75"	$0.00	"$1,670.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,549.34"	"$1,549.34"	$0.00	$0.00	$435.04	$0.00	$0.00	$0.00	$0.00	"$1,043.75"	"$1,653.30"	"$1,670.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1804	SUP	Custom 27203010		AR-1804  -  GUIDE DRL OFST 6MM GRN FEM ACL TRNTB DISP 8-9MM HL	BOTH IP/OP	"$2,087.50 "	"$1,544.75"	$0.00	"$1,670.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,549.34"	"$1,549.34"	$0.00	$0.00	$435.04	$0.00	$0.00	$0.00	$0.00	"$1,043.75"	"$1,653.30"	"$1,670.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1805	SUP	Custom 27203010		AR-1805  -  GUIDE DRL OFST 8MM BLU FEM ACL TRNTB DISP 12-13MM HL	BOTH IP/OP	"$2,087.50 "	"$1,544.75"	$0.00	"$1,670.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,549.34"	"$1,549.34"	$0.00	$0.00	$435.04	$0.00	$0.00	$0.00	$0.00	"$1,043.75"	"$1,653.30"	"$1,670.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1806	SUP	Custom 27203010		AR-1806  -  GUIDE DRL OFST 4MM PUR FEM ACL TRNTB DISP 6-7MM HL	BOTH IP/OP	"$2,087.50 "	"$1,544.75"	$0.00	"$1,670.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,549.34"	"$1,549.34"	$0.00	$0.00	$435.04	$0.00	$0.00	$0.00	$0.00	"$1,043.75"	"$1,653.30"	"$1,670.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1822	SUP	Custom 27203010		AR-1822  -  BIT DRL LNG 2MM STRL D STP GFT HRVT	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1861	SUP	Custom 27203010		AR-1861  -  CANNULA ASCP 11MM GFT PASS	BOTH IP/OP	$732.50 	$542.05	$0.00	$586.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$543.66	$543.66	$0.00	$0.00	$152.65	$0.00	$0.00	$0.00	$0.00	$366.25	$580.14	$586.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1875	SUP	Custom 27203010		AR-1875  -  GUIDE DRL ADAPTEUR C RING ACL	BOTH IP/OP	"$3,545.00 "	"$2,623.30"	$0.00	"$2,836.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,631.10"	"$2,631.10"	$0.00	$0.00	$738.78	$0.00	$0.00	$0.00	$0.00	"$1,772.50"	"$2,807.64"	"$2,836.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1897S	SUP	Custom 27203010		AR-1897S  -  KIT INST HALL SW BLDE ACL DISP TRNTB	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-18985	SUP	HCPCS C1713		AR-18985  -  KIT INST ACL TRNTB DISP	BOTH IP/OP	$520.00 	$384.80	$0.00	$416.00	$234.00	$234.00	$0.00	$0.00	$0.00	$108.38	$385.94	$385.94	$0.00	$0.00	$108.37	$0.00	$307.58	$307.58	$0.00	$260.00	$411.84	$416.00	$0.00		$0.00	$81.38	$0.00	$0.00	$82.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1902SF	SUP	HCPCS C1713		AR-1902SF  -  ANCHOR SUT 2 5MM 15.5MM STRL CSCR2 FWR 2 EYLT ST TI ROTR CUF	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$241.88	$241.88	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$0.00	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00		$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1907H-3.5	SUP	Custom 27203010		AR-1907H-3.5  -  GUIDE DRL 3.5MM ANCH CNN TROC SDL HIP	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$0.00	$0.00	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1911	SUP	Custom 27203010		AR-1911  -  DRILL SRG SPD 1 STP 3.5MM PUSHLOCK	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1912	SUP	Custom 27203010		AR-1912  -  DRILL SRG LG 1 STP 3.5MM PUSHLOCK	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1913	SUP	Custom 27203010		AR-1913  -  BIT DRL 3.5MM BCMPS PUSHLOCK	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1915FT-2	SUP	HCPCS C1713		AR-1915FT-2  -  ANCHOR SUT 1 2.3MM .5 CRC 2 DMD PT FT 3.5MM 2.5MM 26.5MM	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1915S	SUP	HCPCS C1713		AR-1915S  -  ANCHOR SUT 2 3.5MM 12MM STRL CRKSCR BABSR ST TI ROTR CUF	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$202.50	$202.50	$0.00	$0.00	$0.00	$93.79	$333.99	$333.99	$0.00	$0.00	$93.78	$0.00	$266.18	$266.18	$0.00	$225.00	$356.40	$360.00	$0.00		$0.00	$70.43	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1915SF	SUP	HCPCS C1713		AR-1915SF  -  ANCHOR SUT 2 3.5MM 12MM STRL CSCR FWR ST SUT EYLT TI ROTR	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1915SNF	SUP	HCPCS C1713		AR-1915SNF  -  ANCHOR SUTURE 2.3MM 0 SHORT .5 CIR 2 DIAMOND POINT 3.5MM	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1920BF	SUP	HCPCS C1713		AR-1920BF  -  BIOCRKSCRW SUTR ANCH 5MM W/2 #2 FW	BOTH IP/OP	$650.00 	$481.00	$0.00	$520.00	$292.50	$292.50	$0.00	$0.00	$0.00	$135.48	$482.43	$482.43	$0.00	$0.00	$135.46	$0.00	$384.48	$384.48	$0.00	$325.00	$514.80	$520.00	$0.00		$0.00	$101.73	$0.00	$0.00	$103.48	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1920BFT	SUP	HCPCS C1713		AR-1920BFT  -  ANCHOR SUT 2 5MM 17.9MM STRL BCSCR TGRL BABSR BRD HNDL	BOTH IP/OP	$700.00 	$518.00	$0.00	$560.00	$315.00	$315.00	$0.00	$0.00	$0.00	$145.90	$519.54	$519.54	$0.00	$0.00	$145.88	$0.00	$414.05	$414.05	$0.00	$350.00	$554.40	$560.00	$0.00		$0.00	$109.55	$0.00	$0.00	$111.44	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1920BNF	SUP	HCPCS C1713		AR-1920BNF  -  ANCHOR SUT 2 3/8 CRC 5MM 26MM STRL 17.9MM BCSCR FWR BABSR	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$303.75	$303.75	$0.00	$0.00	$0.00	$140.69	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$399.26	$399.26	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$105.64	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1920NSF	SUP	HCPCS C1713		AR-1920NSF  -  ANCHOR SUT 2 5MM 15.5MM STRL CSCR FWR BRD NDL ROTR CUF DISP	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$241.88	$241.88	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$0.00	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00		$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1920S	SUP	HCPCS C1713		AR-1920S  -  ANCHOR SUT 2 5MM 15.5MM STRL CRKSCR BRD HNDL INSRTR TI ROTR	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$202.50	$202.50	$0.00	$0.00	$0.00	$93.79	$333.99	$333.99	$0.00	$0.00	$93.78	$0.00	$266.18	$266.18	$0.00	$225.00	$356.40	$360.00	$0.00		$0.00	$70.43	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1920SF	SUP	HCPCS C1713		AR-1920SF  -  ANCHOR SUT 2 5MM 15.5MM STRL CSCR FWR HNDL INSRTR TI ROTR	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1920SNF	SUP	HCPCS C1713		AR-1920SNF  -  ANCHOR SUT 2 5MM 15MM STRL CSCR FWR BABSR HNDL INSRTR NDL	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1922BC	SUP	HCPCS C1713		AR-1922BC  -  ANCHOR SUT 4.5MM 24MM STRL PUSHLOCK BCMPS DISP	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1922BCM	SUP	HCPCS C1713		AR-1922BCM  -  ANCHOR SUT 4.5MM 28MM STRL PUSHLOCK SLF PNCH BCMPS DISP	BOTH IP/OP	"$1,037.50 "	$767.75	$0.00	$830.00	$466.88	$466.88	$0.00	$0.00	$0.00	$216.24	$770.03	$770.03	$0.00	$0.00	$216.22	$0.00	$613.68	$613.68	$0.00	$518.75	$821.70	$830.00	$0.00		$0.00	$162.37	$0.00	$0.00	$165.17	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1922BM	SUP	HCPCS C1713		AR-1922BM  -  ANCHOR SUT 4.5MM 28MM STRL BIO-PUSHLOCK SLF PNCH DISP	BOTH IP/OP	$975.00 	$721.50	$0.00	$780.00	$438.75	$438.75	$0.00	$0.00	$0.00	$203.21	$723.65	$723.65	$0.00	$0.00	$203.19	$0.00	$576.71	$576.71	$0.00	$487.50	$772.20	$780.00	$0.00		$0.00	$152.59	$0.00	$0.00	$155.22	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1922PS	SUP	HCPCS C1713		AR-1922PS  -  ANCHOR SUT 4.5MM 24MM STRL PUSHLOCK PEEK SHLDR DISP	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1922PSM	SUP	HCPCS C1713		AR-1922PSM  -  ANCHOR SUT 4.5MM 28MM STRL PUSHLOCK SLF PNCH PEEK DISP	BOTH IP/OP	$975.00 	$721.50	$0.00	$780.00	$438.75	$438.75	$0.00	$0.00	$0.00	$203.21	$723.65	$723.65	$0.00	$0.00	$203.19	$0.00	$576.71	$576.71	$0.00	$487.50	$772.20	$780.00	$0.00		$0.00	$152.59	$0.00	$0.00	$155.22	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923BC	SUP	HCPCS C1713		AR-1923BC  -  ANCHOR SUTURE 2.9MM 15.5MM PUSHLOCK BIOCOMPOSITE STERILE	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923BCH	SUP	HCPCS C1713		AR-1923BCH  -  ANCHOR SUT PUSHLOCK BCMPS HIP	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923BNF	SUP	HCPCS C1713		AR-1923BNF  -  ANCHOR SUT 3/8 CRC DMD 3.7MM 17.9MM STRL 22.2MM BCSCR FWR	BOTH IP/OP	$650.00 	$481.00	$0.00	$520.00	$292.50	$292.50	$0.00	$0.00	$0.00	$135.48	$482.43	$482.43	$0.00	$0.00	$135.46	$0.00	$384.48	$384.48	$0.00	$325.00	$514.80	$520.00	$0.00		$0.00	$101.73	$0.00	$0.00	$103.48	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923D	SUP	Custom 27203010		AR-1923D  -  DRILL SRG 2.9 MM PUSHLOCK HRD BN	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923DH	SUP	Custom 27203010		AR-1923DH  -  DRILL SRG HIP 2.9 MM PUSHLOCK	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$0.00	$0.00	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923DHS	SUP	Custom 27203010		AR-1923DHS  -  KIT INST 2.9MM DISP 2.9MM PUSHLOCK	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923DHT	SUP	Custom 27203010		AR-1923DHT  -  DRILL SRG HIP HRD BN 2.9 MM PUSHLOCK	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$0.00	$0.00	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923DS	SUP	HCPCS C1713		AR-1923DS  -  KIT INSTR 2.9MM DRILL SPEAR METAL STERILE DISPOSABLE 2.9MM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923D-ST	SUP	Custom 27203010		AR-1923D-ST  -  DRILL SRG STRL 2.9 MM PUSHLOCK	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923DT	SUP	Custom 27203010		AR-1923DT  -  DRILL SRG 2.9 MM SHRT PUSHLOCK HRD BN	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923DT-ST	SUP	Custom 27203010		AR-1923DT-ST  -  DRILL SRG STRL 2.9 MM PUSHLOCK	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923MC	SUP	Custom 27203010		AR-1923MC  -  CANNULA ASCP FT 2.9MM 4.5MM PUSHLOCK CRKSCR MTL REUSE	BOTH IP/OP	$850.00 	$629.00	$0.00	$680.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$630.87	$630.87	$0.00	$0.00	$177.14	$0.00	$0.00	$0.00	$0.00	$425.00	$673.20	$680.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923MCS	SUP	Custom 27203010		AR-1923MCS  -  CANNULA ASCP 2.9MM 4.5MM PUSHLOCK CRKSCR SET MTL REUSE	BOTH IP/OP	"$1,412.50 "	"$1,045.25"	$0.00	"$1,130.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,048.36"	"$1,048.36"	$0.00	$0.00	$294.37	$0.00	$0.00	$0.00	$0.00	$706.25	"$1,118.70"	"$1,130.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923PHS	SUP	HCPCS C1713		AR-1923PHS  -  ANCHOR SUT 2.9MM 15.5MM STRL PUSHLOCK PEEK HIP DISP	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923PK	SUP	Custom 27203010		AR-1923PK  -  KIT ENDSCP INSTR 1.1MM 17GA 2.9MM CANNU DRILL NEEDLE PORTAL	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.21	$408.21	$0.00	$0.00	$114.62	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1923SD	SUP	Custom 27203010		AR-1923SD  -  DRILL SRG SPD STRL 2.9MM PUSHLOCK	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1925BF	SUP	HCPCS C1713		AR-1925BF  -  ANCHOR SUT 2 FT 6.5MM 17.9MM STRL BCSCR 2 BABSR ROTR CUF	BOTH IP/OP	$650.00 	$481.00	$0.00	$520.00	$292.50	$292.50	$0.00	$0.00	$0.00	$135.48	$482.43	$482.43	$0.00	$0.00	$135.46	$0.00	$384.48	$384.48	$0.00	$325.00	$514.80	$520.00	$0.00		$0.00	$101.73	$0.00	$0.00	$103.48	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1925BNF	SUP	HCPCS C1713		AR-1925BNF  -  ANCHOR SUT 2 6.5MM 17.9MM STRL BCSCR FWR 2 BRD BABSR MLD	BOTH IP/OP	$675.00 	$499.50	$0.00	$540.00	$303.75	$303.75	$0.00	$0.00	$0.00	$140.69	$500.99	$500.99	$0.00	$0.00	$140.67	$0.00	$399.26	$399.26	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$105.64	$0.00	$0.00	$107.46	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1925SF	SUP	HCPCS C1713		AR-1925SF  -  ANCHOR SUT 2 6.5MM 15.5MM STRL CSCR FWR 2 BABSR HNDL INSRTR	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1926BC	SUP	HCPCS C1713		AR-1926BC  -  ANCHOR SUT 3.5MM 19.5MM STRL PUSHLOCK BCMPS DISP	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1926BH	SUP	HCPCS C1713		AR-1926BH  -  ANCHOR SUT 3.5MM 19.5MM STRL BIO-PUSHLOCK HIP DISP	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1926DHS	SUP	Custom 27203010		AR-1926DHS  -  KIT INST DISP 3.5MM PUSHLOCK	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1926DS-2	SUP	Custom 27203010		AR-1926DS-2  -  KIT INST OFST DRL GD 3.5MM PUSHLOCK	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$0.00	$0.00	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1926MC	SUP	Custom 27203010		AR-1926MC  -  CANNULA ASCP PUSHLOCK MTL	BOTH IP/OP	$650.00 	$481.00	$0.00	$520.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.43	$482.43	$0.00	$0.00	$135.46	$0.00	$0.00	$0.00	$0.00	$325.00	$514.80	$520.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1926PHS	SUP	HCPCS C1713		AR-1926PHS  -  ANCHOR SUT 3.5MM 19.5MM STRL BIO-PUSHLOCK HIP DISP	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1926PS	SUP	HCPCS C1713		AR-1926PS  -  ANCHOR SUT 3.5MM 19.5MM STRL PUSHLOCK PEEK ROTR CUF DISP	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BCF	SUP	HCPCS C1713		AR-1927BCF  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR TIGERWIRE 2 DRV	BOTH IP/OP	"$4,062.50 "	"$3,006.25"	$0.00	"$3,250.00"	"$1,828.13"	"$1,828.13"	$0.00	$0.00	$0.00	$846.73	"$3,015.19"	"$3,015.19"	$0.00	$0.00	$846.63	$0.00	"$2,002.81"	"$2,002.81"	$0.00	"$2,031.25"	"$3,217.50"	"$3,250.00"	$0.00		$0.00	$635.78	$0.00	$0.00	$646.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BCF-3	SUP	HCPCS C1713		AR-1927BCF-3  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 3 BCMPS DISP	BOTH IP/OP	$850.00 	$629.00	$0.00	$680.00	$382.50	$382.50	$0.00	$0.00	$0.00	$177.16	$630.87	$630.87	$0.00	$0.00	$177.14	$0.00	$502.78	$502.78	$0.00	$425.00	$673.20	$680.00	$0.00		$0.00	$133.03	$0.00	$0.00	$135.32	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BCF-45	SUP	HCPCS C1713		AR-1927BCF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM STRL CSCR FWR 2 BCMPS DISP	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BCF-65	SUP	HCPCS C1713		AR-1927BCF-65  -  ANCHOR SUT 2 FT 6.5MM 14.7MM STRL CSCR FWR 2 VNT BCMPS DISP	BOTH IP/OP	$837.50 	$619.75	$0.00	$670.00	$376.88	$376.88	$0.00	$0.00	$0.00	$174.56	$621.59	$621.59	$0.00	$0.00	$174.54	$0.00	$495.38	$495.38	$0.00	$418.75	$663.30	$670.00	$0.00		$0.00	$131.07	$0.00	$0.00	$133.33	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BCFT	SUP	HCPCS C1713		AR-1927BCFT  -  ANCHOR SUTURE 2 SQUARE FULTHD 5.5MM 14.7MM DRIVE MECHANISM	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$388.13	$388.13	$0.00	$0.00	$0.00	$179.77	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$510.17	$510.17	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BCFT-45	SUP	HCPCS C1713		AR-1927BCFT-45  -  ANCHOR SUT 2 SQ FT 4.5MM 14.7MM STRL CRKSCR TGTL DRV MECH	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$388.13	$388.13	$0.00	$0.00	$0.00	$179.77	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$510.17	$510.17	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BCNF	SUP	HCPCS C1713		AR-1927BCNF  -  ANCHOR SUTURE 2 FULTHD 5.5MM 14.7MM 2 4 NEEDLE CORKSCREW	BOTH IP/OP	$837.50 	$619.75	$0.00	$958.00	$538.88	$538.88	$0.00	$0.00	$0.00	$174.56	$621.59	$621.59	$0.00	$0.00	$174.54	$0.00	$495.38	$495.38	$0.00	$598.75	$948.42	$958.00	$0.00		$0.00	$187.41	$0.00	$0.00	$190.64	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BCNF-45	SUP	HCPCS C1713		AR-1927BCNF-45  -  ANCHOR SUT 4.5MM BCMPS CRKSCR FT NDL	BOTH IP/OP	$837.50 	$619.75	$0.00	$670.00	$376.88	$376.88	$0.00	$0.00	$0.00	$174.56	$621.59	$621.59	$0.00	$0.00	$174.54	$0.00	$495.38	$495.38	$0.00	$418.75	$663.30	$670.00	$0.00		$0.00	$131.07	$0.00	$0.00	$133.33	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BCT	SUP	HCPCS C1713		AR-1927BCT  -  ANCHOR SUT FT 1.3MM 5.5MM 14.7MM BLK BLU WHT CRKSCR	BOTH IP/OP	"$4,437.50 "	"$3,283.75"	$0.00	"$3,550.00"	"$1,996.88"	"$1,996.88"	$0.00	$0.00	$0.00	$924.89	"$3,293.51"	"$3,293.51"	$0.00	$0.00	$924.78	$0.00	"$2,187.69"	"$2,187.69"	$0.00	"$2,218.75"	"$3,514.50"	"$3,550.00"	$0.00		$0.00	$694.47	$0.00	$0.00	$706.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BF	SUP	HCPCS C1713		AR-1927BF  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR FWR 2 POLY L LACTD	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BF-3	SUP	HCPCS C1713		AR-1927BF-3  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR FWR 3 PLAY BABSR VNT	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BF-45	SUP	HCPCS C1713		AR-1927BF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM STRL BCSCR FWR 2 POLY L LACTD CO	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BF-65	SUP	HCPCS C1713		AR-1927BF-65  -  ANCHOR SUT 2 FT 6.5MM 14.7MM STRL BCSCR FWR 2 POLY L LACTD	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BFC	SUP	HCPCS C1713		AR-1927BFC  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR FWR FIBERCHAIN BABSR	BOTH IP/OP	$787.50 	$582.75	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$164.13	$584.48	$584.48	$0.00	$0.00	$164.12	$0.00	$465.81	$465.81	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BFS	SUP	HCPCS C1713		AR-1927BFS  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR SCRPN BABSR NDL DISP	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BFT-45	SUP	HCPCS C1713		AR-1927BFT-45  -  ANCHOR SUT 2 FT 4.5MM 14MM STRL BCSCR TGRL POLY L LACTD CO D	BOTH IP/OP	$762.50 	$564.25	$0.00	$610.00	$343.13	$343.13	$0.00	$0.00	$0.00	$158.92	$565.93	$565.93	$0.00	$0.00	$158.91	$0.00	$451.02	$451.02	$0.00	$381.25	$603.90	$610.00	$0.00		$0.00	$119.33	$0.00	$0.00	$121.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BNF	SUP	HCPCS C1713		AR-1927BNF  -  ANCHOR SUT 2 .5 CRC FT 5.5MM 14.7MM STRL 26MM BCSCR FWR 2 4	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927BNF-45	SUP	HCPCS C1713		AR-1927BNF-45  -  ANCHOR SUT 2 .5 CRC FT 4.5MM 14MM STRL 26MM BCSCR FWR 2 4	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927PBS	SUP	HCPCS C1713		AR-1927PBS  -  PUNCH ARTHRO STERILE DISPOSABLE 5.5 CORKSCREW FULTHD	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927PNF	SUP	HCPCS C1713		AR-1927PNF  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 2 BRD 4 NDL PEEK	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927PNF-45	SUP	HCPCS C1713		AR-1927PNF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM BLU W/B STRL CSCR FWR 2 BRD 4 NDL	BOTH IP/OP	$737.50 	$545.75	$0.00	$547.37	$226.13	$226.13	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$78.64	$0.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927PSF	SUP	HCPCS C1713		AR-1927PSF  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 2 PEEK DISP	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927PSF-3	SUP	HCPCS C1713		AR-1927PSF-3  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 3 PEEK SHLDR DISP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927PSF-45	SUP	HCPCS C1713		AR-1927PSF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM BLK BLU WHT STRL CSCR FWR 2 PEEK	BOTH IP/OP	$712.50 	$527.25	$0.00	$656.00	$369.00	$369.00	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$410.00	$649.44	$656.00	$0.00		$0.00	$128.33	$0.00	$0.00	$130.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1927PSF-65	SUP	HCPCS C1713		AR-1927PSF-65  -  ANCHOR SUT 2 FT 6.5MM STRL CSCR FWR 2 PEEK DISP	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1928SF	SUP	HCPCS C1713		AR-1928SF  -  ANCHOR SUT 2 FT 5.5MM 15MM STRL CSCR2 FWR	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$258.75	$258.75	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$287.50	$455.40	$460.00	$0.00		$0.00	$89.99	$0.00	$0.00	$91.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1928SF-2	SUP	HCPCS C1713		AR-1928SF-2  -  ANCHOR SUT 2 FT 5.5MM 16.3MM STRL CSCR2 FWR TI DISP	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$258.75	$258.75	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$287.50	$455.40	$460.00	$0.00		$0.00	$89.99	$0.00	$0.00	$91.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1928SF-3	SUP	HCPCS C1713		AR-1928SF-3  -  ANCHOR SUT 2 FT 5.5MM 16.3MM STRL CSCR2 FWR 3 TI DISP	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$275.63	$275.63	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1928SF-45	SUP	HCPCS C1713		AR-1928SF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM STRL CSCR2 FWR 2 TI DISP	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$258.75	$258.75	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$287.50	$455.40	$460.00	$0.00		$0.00	$89.99	$0.00	$0.00	$91.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1928SFT-2	SUP	HCPCS C1713		AR-1928SFT-2  -  ANCHOR SUT 2 FT 5.5MM 16.3MM STRL CRKSCR II TGTL TI	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1928SNF	SUP	HCPCS C1713		AR-1928SNF  -  ANCHOR SUT 2 5.5MM 26MM STRL CSCR FWR TI ROTR CUF DISP	BOTH IP/OP	$637.50 	$471.75	$0.00	$510.00	$286.88	$286.88	$0.00	$0.00	$0.00	$132.87	$473.15	$473.15	$0.00	$0.00	$132.86	$0.00	$377.08	$377.08	$0.00	$318.75	$504.90	$510.00	$0.00		$0.00	$99.77	$0.00	$0.00	$101.49	$0.00	$0.00	$0.00	$0.00	$0.00
AR1928SNF-2	SUP	HCPCS C1713		AR1928SNF-2  -  ANCHOR SUT 5.5MM 2 .5 CRC FT DMD CSCR2 FWR ROTR CUF 2 KNT	BOTH IP/OP	$637.50 	$471.75	$0.00	$510.00	$286.88	$286.88	$0.00	$0.00	$0.00	$132.87	$473.15	$473.15	$0.00	$0.00	$132.86	$0.00	$377.08	$377.08	$0.00	$318.75	$504.90	$510.00	$0.00		$0.00	$99.77	$0.00	$0.00	$101.49	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1928SNF-2	SUP	HCPCS C1713		AR-1928SNF-2  -  ANCHOR SUTURE 2 .5 CIR FULTHD DIAMOND 5.5MM 16MM 26MM 2 KNOT	BOTH IP/OP	$637.50 	$471.75	$0.00	$510.00	$286.88	$286.88	$0.00	$0.00	$0.00	$132.87	$473.15	$473.15	$0.00	$0.00	$132.86	$0.00	$377.08	$377.08	$0.00	$318.75	$504.90	$510.00	$0.00		$0.00	$99.77	$0.00	$0.00	$101.49	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1929SF-3	SUP	HCPCS C1713		"AR-1929SF-3  -  SUTURE ANCHOR, CORKSCREW FT III"	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$275.63	$275.63	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1931S	SUP	Custom 27203010		AR-1931S  -  REAMER SRG 14MM STRL CNN COLR PIN SET COR DISP	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934-20DS	SUP	Custom 27203010		AR-1934-20DS  -  KIT INST 2MM SUT TK ANCH DRL SPR TROC DISP	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934-24DS	SUP	Custom 27203010		AR-1934-24DS  -  KIT ESCP INST 2.4MM BSUT TK ANCH SPR STP DRL DISP ASCP	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934BCF	SUP	HCPCS C1713		AR-1934BCF  -  ANCHOR SUT 2 3MM 14.5MM STRL SUT TK FBRWR BCMPS DISP	BOTH IP/OP	$762.50 	$564.25	$0.00	$610.00	$343.13	$343.13	$0.00	$0.00	$0.00	$158.92	$565.93	$565.93	$0.00	$0.00	$158.91	$0.00	$451.02	$451.02	$0.00	$381.25	$603.90	$610.00	$0.00		$0.00	$119.33	$0.00	$0.00	$121.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934BCF-2	SUP	HCPCS C1713		AR-1934BCF-2  -  ANCHOR SUT 2 3MM 14.5MM STRL SUT TK TIGERWIRE FBRWR BCMPS	BOTH IP/OP	$800.00 	$592.00	$0.00	$640.00	$360.00	$360.00	$0.00	$0.00	$0.00	$166.74	$593.76	$593.76	$0.00	$0.00	$166.72	$0.00	$473.20	$473.20	$0.00	$400.00	$633.60	$640.00	$0.00		$0.00	$125.20	$0.00	$0.00	$127.36	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934BCF-20	SUP	HCPCS C1713		AR-1934BCF-20  -  ANCHOR SUT 1 MN 2MM 12MM STRL SUT TK FBRWR BCMPS	BOTH IP/OP	$762.50 	$564.25	$0.00	$610.00	$343.13	$343.13	$0.00	$0.00	$0.00	$158.92	$565.93	$565.93	$0.00	$0.00	$158.91	$0.00	$451.02	$451.02	$0.00	$381.25	$603.90	$610.00	$0.00		$0.00	$119.33	$0.00	$0.00	$121.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934BCF-24	SUP	HCPCS C1713		AR-1934BCF-24  -  ANCHOR SUT 2 2.4MM 12MM STRL SUT TK FBRWR BCMPS DISP	BOTH IP/OP	$762.50 	$564.25	$0.00	$610.00	$343.13	$343.13	$0.00	$0.00	$0.00	$158.92	$565.93	$565.93	$0.00	$0.00	$158.91	$0.00	$451.02	$451.02	$0.00	$381.25	$603.90	$610.00	$0.00		$0.00	$119.33	$0.00	$0.00	$121.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934BCF-24-2	SUP	HCPCS C1713		AR-1934BCF-24-2  -  ANCHOR SUT 2 2.4MM 12MM STRL SUT TK FBRWR BCMPS DISP	BOTH IP/OP	$800.00 	$592.00	$0.00	$640.00	$360.00	$360.00	$0.00	$0.00	$0.00	$166.74	$593.76	$593.76	$0.00	$0.00	$166.72	$0.00	$473.20	$473.20	$0.00	$400.00	$633.60	$640.00	$0.00		$0.00	$125.20	$0.00	$0.00	$127.36	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934BCFT	SUP	HCPCS C1713		AR-1934BCFT  -  ANCHOR SUTURE 2 3MM 14.5MM SUTURETAK TIGERTAIL BIOCOMPOSITE	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934BCFT-2	SUP	HCPCS C1713		AR-1934BCFT-2  -  ANCHOR SUT 2 3MM 14.5MM STRL SUT TK TGTL BCMPS DISP	BOTH IP/OP	$850.00 	$629.00	$0.00	$680.00	$382.50	$382.50	$0.00	$0.00	$0.00	$177.16	$630.87	$630.87	$0.00	$0.00	$177.14	$0.00	$502.78	$502.78	$0.00	$425.00	$673.20	$680.00	$0.00		$0.00	$133.03	$0.00	$0.00	$135.32	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934BF	SUP	HCPCS C1713		AR-1934BF  -  ANCHOR SUT 2 3MM 14.5MM STRL BSUT TK FBRWR BABSR PUSH IN	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$275.63	$275.63	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934BFT	SUP	HCPCS C1713		AR-1934BFT  -  ANCHOR SUTURE 3MM 2 BSUT TK TGTL ROTR CUF BABSR ARTHRO 14MM	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$298.13	$298.13	$0.00	$0.00	$0.00	$138.08	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$391.87	$391.87	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$103.68	$0.00	$0.00	$105.47	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934D-20	SUP	Custom 27203010		AR-1934D-20  -  DRILL SRG 2 MM SUT TK	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934D-20-1	SUP	Custom 27203010		AR-1934D-20-1  -  DRILL SRG 2 MM SUT TK HRD BN	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934D-24	SUP	Custom 27203010		AR-1934D-24  -  DRILL SRG STP DISP 2.4MM SUT TK	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934D-24-1	SUP	Custom 27203010		AR-1934D-24-1  -  DRILL SRG 2.6MM 2.4MM SUT TK	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934D-24-2	SUP	Custom 27203010		AR-1934D-24-2  -  DRILL SRG 2.6MM 2.4MM SUT TK	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934DHS-2	SUP	Custom 27203010		AR-1934DHS-2  -  KIT INST HIP DISP 3MM SUT TK	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934DS-2	SUP	Custom 27203010		AR-1934DS-2  -  KIT INST STRL GD SPR STP DRL TROC DISP 3MM SUT TK	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934PF-20	SUP	HCPCS C1713		AR-1934PF-20  -  ANCHOR SUT 1 2MM 12MM STRL SUT TK FBRWR PEEK	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934PF-24	SUP	HCPCS C1713		AR-1934PF-24  -  ANCHOR SUT 2 2.4MM 12MM STRL SUT TK FBRWR PEEK	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934PI	SUP	Custom 27203010		AR-1934PI  -  KIT INS 1.1MM 17GA 2.4MM BSUT TK DRL NDL PERC INS PRTL DIL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934PI-20	SUP	Custom 27203010		AR-1934PI-20  -  KIT INS 1.1MM 17GA 2MM SUT TK DRL PRTL DIL SPR SPNL NDL WRE	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934PI-30	SUP	Custom 27203010		AR-1934PI-30  -  KIT INSERTION 1.1MM 17GA 3MM STEP DRILL PORTAL DILAT SPEAR	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934PRK	SUP	Custom 27203010		AR-1934PRK  -  KIT ASCP FX 2.4MM 4.5MM SUT TK SWIVELOCK SPR NDL GW DIL	BOTH IP/OP	"$2,962.50 "	"$2,192.25"	$0.00	"$2,370.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,198.77"	"$2,198.77"	$0.00	$0.00	$617.39	$0.00	$0.00	$0.00	$0.00	"$1,481.25"	"$2,346.30"	"$2,370.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934PS	SUP	HCPCS C1713		AR-1934PS  -  ANCHOR SUT 2 3MM 12.4MM BSUT TK FBRWR PEEK	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1934PS-2	SUP	HCPCS C1713		AR-1934PS-2  -  ANCHOR SUT 2 3MM 12.2MM SUT TK FBRWR PEEK ROTR CUF	BOTH IP/OP	$637.50 	$471.75	$0.00	$510.00	$286.88	$286.88	$0.00	$0.00	$0.00	$132.87	$473.15	$473.15	$0.00	$0.00	$132.86	$0.00	$377.08	$377.08	$0.00	$318.75	$504.90	$510.00	$0.00		$0.00	$99.77	$0.00	$0.00	$101.49	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1938BC	SUP	HCPCS C1713		AR-1938BC  -  ANCHOR SUT 2 3MM 12.7MM SUT TK FBRWR KNTLS BCMPS	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1938D	SUP	Custom 27203010		AR-1938D  -  DRILL SRG 2.6MM 3MM SUT TK	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1938PS	SUP	HCPCS C1713		AR-1938PS  -  ANCHOR SUT 2 3MM 12.7MM KNTLS SUT TK FBRWR PEEK	BOTH IP/OP	$962.50 	$712.25	$0.00	$770.00	$433.13	$433.13	$0.00	$0.00	$0.00	$200.61	$714.37	$714.37	$0.00	$0.00	$200.59	$0.00	$569.32	$569.32	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$150.63	$0.00	$0.00	$153.23	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1938PS-PL	SUP	HCPCS C1713		AR-1938PS-PL  -  SUTRE ANCH PEEK S-TAK KNOTLESS 3X12.7M	BOTH IP/OP	$962.50 	$712.25	$0.00	$770.00	$433.13	$433.13	$0.00	$0.00	$0.00	$200.61	$714.37	$714.37	$0.00	$0.00	$200.59	$0.00	$569.32	$569.32	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$150.63	$0.00	$0.00	$153.23	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1949H-2.4	SUP	Custom 27203010		AR-1949H-2.4  -  GUIDE DRL 2.4MM ANCH CNN SDL TROC HIP	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$0.00	$0.00	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1949H-3.0	SUP	Custom 27203010		AR-1949H-3.0  -  GUIDE DRL 3MM ANCH CNN SDL TROC HIP	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$0.00	$0.00	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1965	SUP	Custom 27203010		AR-1965  -  GUIDE DRL ALGTR MNSCL ALGRF	BOTH IP/OP	"$5,120.00 "	"$3,788.80"	$0.00	"$4,096.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,800.06"	"$3,800.06"	$0.00	$0.00	"$1,067.01"	$0.00	$0.00	$0.00	$0.00	"$2,560.00"	"$4,055.04"	"$4,096.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1965G	SUP	Custom 27203010		AR-1965G  -  GUIDE DRL DVTL TIB	BOTH IP/OP	"$7,250.00 "	"$5,365.00"	$0.00	"$5,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,510.90"	$0.00	$0.00	$0.00	$0.00	"$3,625.00"	"$5,742.00"	"$5,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1966DS	SUP	Custom 27203010		AR-1966DS  -  KIT INST ALGRF DISP	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	$0.00	$0.00	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1967A	SUP	Custom 27203010		AR-1967A  -  CLAMP SRG ADJ SFT TIS	BOTH IP/OP	"$1,510.00 "	"$1,117.40"	$0.00	"$1,208.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.72"	"$1,120.72"	$0.00	$0.00	$314.68	$0.00	$0.00	$0.00	$0.00	$755.00	"$1,195.92"	"$1,208.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1967F	SUP	Custom 27203010		AR-1967F  -  CLAMP SRG FX SFT TIS	BOTH IP/OP	"$1,510.00 "	"$1,117.40"	$0.00	"$1,208.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,120.72"	"$1,120.72"	$0.00	$0.00	$314.68	$0.00	$0.00	$0.00	$0.00	$755.00	"$1,195.92"	"$1,208.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1974	SUP	Custom 27203010		AR-1974  -  DRILL SRG 5MM ACL 3MM PIN TRNFX	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1974L	SUP	Custom 27203010		AR-1974L  -  DRILL SRG LNG 5MM STRL 2MM GDPN TRNFX2	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1975	SUP	Custom 27203010		AR-1975  -  GUIDE DRL ACL RECON TIB TRNFX2	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	$0.00	$0.00	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1980-05S	SUP	Custom 27203010		AR-1980-05S  -  SET GFT HRVT 6MM 5MM STRL OATS COLR PIN TUBE ACL DISP	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$0.00	$0.00	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1980-06S	SUP	Custom 27203010		AR-1980-06S  -  SET GFT HRVT 7MM 6MM STRL OATS COLR PIN TUBE ACL DISP	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$0.00	$0.00	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1980-07S	SUP	Custom 27203010		AR-1980-07S  -  SET GFT HRVT 8MM 7MM STRL OATS COLR PIN TUBE ACL DISP	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$0.00	$0.00	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1980-08S	SUP	Custom 27203010		AR-1980-08S  -  SET GFT HRVT 9MM 8MM STRL OATS COLR PIN TUBE ACL DISP	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$0.00	$0.00	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1980-09S	SUP	Custom 27203010		AR-1980-09S  -  SET GFT HRVT 10MM 9MM STRL OATS COLR PIN TUBE ACL DISP	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$0.00	$0.00	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1980-10S	SUP	Custom 27203010		AR-1980-10S  -  SET GFT HRVT 11MM 10MM STRL OATS COLR PIN TUBE ACL DISP	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$0.00	$0.00	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1980-12SU	SUP	Custom 27203010		AR-1980-12SU  -  SET GFT HRVT 12MM 11MM STRL OATS COLR PIN TUBE ACL DISP	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$0.00	$0.00	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1981-04S	SUP	Custom 27203010		AR-1981-04S  -  SET GFT HRVT 4.75MM STRL OATS ALGN ROD COR XTRDR DLV TUBE	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$0.00	$0.00	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1981-06H	SUP	Custom 27203010		AR-1981-06H  -  SET GFT HRVT 6MM STRL OATS ALGN ROD COR XTRDR DLV TUBE TAMP	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1981-06S	SUP	Custom 27203010		AR-1981-06S  -  SET GFT HRVT 7MM 6MM STRL OATS ALGN ROD COR XTRDR DLV TUBE	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$0.00	$0.00	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1981-08H	SUP	Custom 27203010		AR-1981-08H  -  SET GFT HRVT 8MM STRL OATS ALGN ROD COR XTRDR DLV TUBE TAMP	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1981-08S	SUP	Custom 27203010		AR-1981-08S  -  SET GFT HRVT 9MM 8MM STRL OATS ALGN ROD COR XTRDR DLV TUBE	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$0.00	$0.00	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1981-10H	SUP	Custom 27203010		AR-1981-10H  -  SET GFT HRVT 10MM STRL OATS ALGN ROD COR XTRDR DLV TUBE TAMP	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1982-08S	SUP	Custom 27203010		AR-1982-08S  -  SET GFT HRVT RTRGD 8MM STRL OATS DISP	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	$0.00	$0.00	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1982-10S	SUP	Custom 27203010		AR-1982-10S  -  SET GFT HRVT RTRGD 10MM STRL OATS DISP	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	$0.00	$0.00	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1983	SUP	HCPCS C1713		AR-1983  -  CAP PCTV OATS CRTLG ACL	BOTH IP/OP	$775.00 	$573.50	$0.00	$620.00	$348.75	$348.75	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$387.50	$613.80	$620.00	$0.00		$0.00	$121.29	$0.00	$0.00	$123.38	$0.00	$0.00	$0.00	$0.00	$0.00
AR-1991	SUP	HCPCS C1713		AR-1991  -  CALIBRATOR PIN OATS	BOTH IP/OP	$327.50 	$242.35	$0.00	$262.00	$147.38	$147.38	$0.00	$0.00	$0.00	$68.26	$243.07	$243.07	$0.00	$0.00	$68.25	$0.00	$193.72	$193.72	$0.00	$163.75	$259.38	$262.00	$0.00		$0.00	$51.25	$0.00	$0.00	$52.14	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2236B	SUP	HCPCS C1763		AR-2236B  -  BUTTON FX 6.5MM 1MM TISSUEBUTTON HNDL INSRTR PRELD POLY L	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2238B	SUP	HCPCS C1763		AR-2238B  -  BUTTON FX 8MM 1MM STRL TISSUEBUTTON BABSR POLY L LAC ACD SFT	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2240B	SUP	HCPCS C1763		AR-2240B  -  BUTTON FX 5MM 10MM STRL TISSUEBUTTON POLY L LAC ACD ROTR CUF	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2253L	SUP	Custom 27203010		AR-2253L  -  GUIDE DRL ARM LT ACJT ACJT RECON SYS	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2253R	SUP	Custom 27203010		AR-2253R  -  GUIDE DRL ARM RT ACJT ACJT RECON SYS	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2255CG	SUP	Custom 27203010		AR-2255CG  -  GUIDE DRL CNST ACJT	BOTH IP/OP	"$4,912.50 "	"$3,635.25"	$0.00	"$3,930.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,646.06"	"$3,646.06"	$0.00	$0.00	"$1,023.77"	$0.00	$0.00	$0.00	$0.00	"$2,456.25"	"$3,890.70"	"$3,930.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2257-01	SUP	HCPCS C1763		AR-2257-01  -  BUTTON FX CLVCL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2257-02	SUP	HCPCS C1763		AR-2257-02  -  BUTTON FX CORACOID	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2257D-24	SUP	Custom 27203010		AR-2257D-24  -  DRILL SRG 2.4MM CNN ACML REPR	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2257D-30	SUP	Custom 27203010		AR-2257D-30  -  DRILL SRG 3MM CNN AC REPR	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2258-03	SUP	Custom 27803010		AR-2258-03  -  WASHER ORTH CLVCL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2260	SUP	Custom 27203010		AR-2260  -  KIT ASCP FX STRL BTN DRL PIN INSRTR SCR	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2261	SUP	HCPCS C1763		AR-2261  -  BUTTON SUT 12MM STRL BICEPS	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2263	SUP	HCPCS C1763		AR-2263  -  PIN DRL 3.2MM STRL BISCEPSBUTTON DIST DISP	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2264	SUP	HCPCS C1713		AR-2264  -  DEVICE FX STRL TGHTRP TWN TAIL ACJT	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2266	SUP	HCPCS C1763		AR-2266  -  BUTTON FX 2.6MM 10.9MM TI SHLDR PECTORALIS MN OPN REPR	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2267	SUP	HCPCS C1763		AR-2267  -  BUTTON FX LF INSRTR LG EYLT PECTORALIS	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2270	SUP	HCPCS C1763		AR-2270  -  BUTTON FX DOG BN	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2271	SUP	Custom 27203010		AR-2271  -  KIT ASCP FX 2MM 3MM TIGERTAPE SUTLSO 2 DOG BN BTN CNN DRL	BOTH IP/OP	"$2,812.50 "	"$2,081.25"	$0.00	"$2,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,087.44"	"$2,087.44"	$0.00	$0.00	$586.13	$0.00	$0.00	$0.00	$0.00	"$1,406.25"	"$2,227.50"	"$2,250.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2273	SUP	Custom 27203010		AR-2273  -  GUIDE DRL ACJT ACJT RECON SYS	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2274	SUP	Custom 27203010		AR-2274  -  CANNULA ESCP 4.7MM SLOT	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$0.00	$0.00	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2280	SUP	HCPCS C1763		AR-2280  -  BUTTON INSERTER/SUTURE KIT	BOTH IP/OP	"$1,975.00 "	"$1,461.50"	$0.00	"$1,580.00"	$888.75	$888.75	$0.00	$0.00	$0.00	$411.64	"$1,465.85"	"$1,465.85"	$0.00	$0.00	$411.59	$0.00	"$1,168.21"	"$1,168.21"	$0.00	$987.50	"$1,564.20"	"$1,580.00"	$0.00		$0.00	$309.09	$0.00	$0.00	$314.42	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2281	SUP	HCPCS C1763		AR-2281  -  12MM BUTTON/SUTURE CONSTRUCT	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2290	SUP	HCPCS C1713		AR-2290  -  SET IMPLANT PROXIMAL TENODESIS BUTTON FIBERLOOP DRILL PIN	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,350.00"	$759.38	$759.38	$0.00	$0.00	$0.00	$351.72	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$998.16	$998.16	$0.00	$843.75	"$1,336.50"	"$1,350.00"	$0.00		$0.00	$264.09	$0.00	$0.00	$268.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2291	SUP	HCPCS C1763		AR-2291  -  BUTTON FX 0 BICEPS PROX TENODESIS	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2323BCC	SUP	HCPCS C1713		AR-2323BCC  -  ANCHOR SUTURE 5.5MM 19.1MM CLOSE EYELET VENT SWIVELOCK C	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2323BCM	SUP	HCPCS C1713		AR-2323BCM  -  ANCHOR SUT 5.5MM 24.5MM STRL SWIVELOCK SP SLF PNCH VNT BCMPS	BOTH IP/OP	"$1,050.00 "	$777.00	$0.00	$840.00	$472.50	$472.50	$0.00	$0.00	$0.00	$218.85	$779.31	$779.31	$0.00	$0.00	$218.82	$0.00	$621.08	$621.08	$0.00	$525.00	$831.60	$840.00	$0.00		$0.00	$164.33	$0.00	$0.00	$167.16	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2323BCT-2	SUP	HCPCS C1713		AR-2323BCT-2  -  ANCHOR SUT 2 5.5MM 22MM BLK BLU WHT FIBERTAK SWIVELOCK C	BOTH IP/OP	"$5,312.50 "	"$3,931.25"	$0.00	"$4,250.00"	"$2,390.63"	"$2,390.63"	$0.00	$0.00	$0.00	"$1,107.26"	"$3,942.94"	"$3,942.94"	$0.00	$0.00	"$1,107.13"	$0.00	"$2,619.06"	"$2,619.06"	$0.00	"$2,656.25"	"$4,207.50"	"$4,250.00"	$0.00		$0.00	$831.41	$0.00	$0.00	$845.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2323BSL	SUP	HCPCS C1713		AR-2323BSL  -  ANCHOR SUT 5.5MM 20MM STRL BIO-SWIVELOCK SLF PNCH VNT DISP	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2323BSLC	SUP	HCPCS C1713		AR-2323BSLC  -  ANCHOR SUT 5.5MM 19.1MM STRL BIO-SWIVELOCK C CLS EYLT VNT	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2323BSLM	SUP	HCPCS C1713		AR-2323BSLM  -  ANCHOR SUT 5.5MM 24.5MM STRL BIO-SWIVELOCK SLF PNCH VNT DISP	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2323PSL	SUP	HCPCS C1713		AR-2323PSL  -  ANCHOR SUT 5.5MM 20MM SWIVELOCK PEEK	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2323PSLC	SUP	HCPCS C1713		AR-2323PSLC  -  ANCHOR SUTURE 5.5MM 19.1MM CLOSE EYELET SWIVELOCK C	BOTH IP/OP	$937.50 	$693.75	$0.00	"$1,072.00"	$603.00	$603.00	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$670.00	"$1,061.28"	"$1,072.00"	$0.00		$0.00	$209.71	$0.00	$0.00	$213.33	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2323PSLC-2	SUP	HCPCS C1713		AR-2323PSLC-2  -  ANCHOR SUT 5.5MM STRL LF ARTHX SWIVELOCK 2 LD PEEK	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2323PSLM	SUP	HCPCS C1713		AR-2323PSLM  -  ANCHOR SUT 5.5MM 24.5MM STRL BIO-SWIVELOCK SLF PNCH DISP	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2323SLM	SUP	HCPCS C1713		AR-2323SLM  -  ANCHOR SUT 5.5MM 24.5MM STRL SWIVELOCK SLF PNCH DISP	BOTH IP/OP	$800.00 	$592.00	$0.00	$640.00	$360.00	$360.00	$0.00	$0.00	$0.00	$166.74	$593.76	$593.76	$0.00	$0.00	$166.72	$0.00	$473.20	$473.20	$0.00	$400.00	$633.60	$640.00	$0.00		$0.00	$125.20	$0.00	$0.00	$127.36	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324BCC	SUP	HCPCS C1713		AR-2324BCC  -  ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET VENT SWIVELOCK C	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324BCC-2	SUP	HCPCS C1713		AR-2324BCC-2  -  ANCHOR SUT 4.75MM STRL SWIVELOCK TIGERWIRE ARTHX 2 LD 2 TIP	BOTH IP/OP	"$1,042.50 "	$771.45	$0.00	$834.00	$469.13	$469.13	$0.00	$0.00	$0.00	$217.28	$773.74	$773.74	$0.00	$0.00	$217.26	$0.00	$616.64	$616.64	$0.00	$521.25	$825.66	$834.00	$0.00		$0.00	$163.15	$0.00	$0.00	$165.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324BCC-CP	SUP	HCPCS C1713		AR-2324BCC-CP  -  SET IMPL FULL 4.75MM 19.1MM SWIVELOCK C CLS EYLT VNT KN	BOTH IP/OP	"$2,562.50 "	"$1,896.25"	$0.00	"$2,050.00"	"$1,153.13"	"$1,153.13"	$0.00	$0.00	$0.00	$534.09	"$1,901.89"	"$1,901.89"	$0.00	$0.00	$534.03	$0.00	"$1,263.31"	"$1,263.31"	$0.00	"$1,281.25"	"$2,029.50"	"$2,050.00"	$0.00		$0.00	$401.03	$0.00	$0.00	$407.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324BCCS	SUP	HCPCS C1713		AR-2324BCCS  -  SYSTEM ENDSCP FIX 4.75MM NEEDLE MULTIFIRE SCORPION SWIVELOCK	BOTH IP/OP	"$1,600.00 "	"$1,184.00"	$0.00	"$1,280.00"	$720.00	$720.00	$0.00	$0.00	$0.00	$333.48	"$1,187.52"	"$1,187.52"	$0.00	$0.00	$333.44	$0.00	$946.40	$946.40	$0.00	$800.00	"$1,267.20"	"$1,280.00"	$0.00		$0.00	$250.40	$0.00	$0.00	$254.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324BCCT	SUP	HCPCS C1713		AR-2324BCCT  -  ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET TAPE LOOP VENT	BOTH IP/OP	"$1,175.00 "	$869.50	$0.00	"$1,286.00"	$723.38	$723.38	$0.00	$0.00	$0.00	$244.90	$872.09	$872.09	$0.00	$0.00	$244.87	$0.00	$695.01	$695.01	$0.00	$803.75	"$1,273.14"	"$1,286.00"	$0.00		$0.00	$251.57	$0.00	$0.00	$255.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324BCCTT	SUP	HCPCS C1713		AR-2324BCCTT  -  ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET VENT SWIVELOCK C	BOTH IP/OP	"$1,175.00 "	$869.50	$0.00	"$1,080.00"	$607.50	$607.50	$0.00	$0.00	$0.00	$244.90	$872.09	$872.09	$0.00	$0.00	$244.87	$0.00	$695.01	$695.01	$0.00	$675.00	"$1,069.20"	"$1,080.00"	$0.00		$0.00	$211.28	$0.00	$0.00	$214.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324BCM	SUP	HCPCS C1713		AR-2324BCM  -  ANCHOR SUTURE 4.75MM 24.5MM SELF PUNCH VENT SWIVELOCK	BOTH IP/OP	"$1,050.00 "	$777.00	$0.00	"$1,144.00"	$643.50	$643.50	$0.00	$0.00	$0.00	$218.85	$779.31	$779.31	$0.00	$0.00	$218.82	$0.00	$621.08	$621.08	$0.00	$715.00	"$1,132.56"	"$1,144.00"	$0.00		$0.00	$223.80	$0.00	$0.00	$227.66	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324BCT-2	SUP	HCPCS C1713		AR-2324BCT-2  -  ANCHOR SUT 2 4.75MM 22MM BLK BLU WHT SWIVELOCK C FIBERTAK	BOTH IP/OP	"$5,312.50 "	"$3,931.25"	$0.00	"$4,250.00"	"$2,390.63"	"$2,390.63"	$0.00	$0.00	$0.00	"$1,107.26"	"$3,942.94"	"$3,942.94"	$0.00	$0.00	"$1,107.13"	$0.00	"$2,619.06"	"$2,619.06"	$0.00	"$2,656.25"	"$4,207.50"	"$4,250.00"	$0.00		$0.00	$831.41	$0.00	$0.00	$845.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324BSL	SUP	HCPCS C1713		AR-2324BSL  -  ANCHOR SUT 4.75MM 20MM STRL BIO-SWIVELOCK DISP	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324BSLC	SUP	HCPCS C1713		AR-2324BSLC  -  ANCHOR SUT 4.75MM 19.1MM STRL BIO-SWIVELOCK C CLS EYLT VNT	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324PCT	SUP	HCPCS C1713		AR-2324PCT  -  ANCHOR SUT 4.75MM 19.1MM BLU STRL SWIVELOCK C FIBERTAPE CLS	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324PCTT	SUP	HCPCS C1713		AR-2324PCTT  -  ANCHOR SUT 4.75MM 19.1MM B/W STRL SWIVELOCK C TIGERTAPE CLS	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324PSLC	SUP	HCPCS C1713		AR-2324PSLC  -  ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET VENT SWIVELOCK PEEK	BOTH IP/OP	$937.50 	$693.75	$0.00	"$1,072.00"	$603.00	$603.00	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$670.00	"$1,061.28"	"$1,072.00"	$0.00		$0.00	$209.71	$0.00	$0.00	$213.33	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324PSLC-2	SUP	HCPCS C1713		AR-2324PSLC-2  -  ANCHOR SUT 4.75MM STRL LF ARTHX SWIVELOCK 2 LD PEEK	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324PSLM	SUP	HCPCS C1713		AR-2324PSLM  -  ANCHOR SUT 4.75MM 24.5MM STRL SWIVELOCK SLF PNCH VNT PEEK	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2324SLM	SUP	HCPCS C1713		AR-2324SLM  -  ANCHOR SUT 4.75MM 24.5MM STRL SWIVELOCK SLF PNCH VNT TI DISP	BOTH IP/OP	$800.00 	$592.00	$0.00	$640.00	$360.00	$360.00	$0.00	$0.00	$0.00	$166.74	$593.76	$593.76	$0.00	$0.00	$166.72	$0.00	$473.20	$473.20	$0.00	$400.00	$633.60	$640.00	$0.00		$0.00	$125.20	$0.00	$0.00	$127.36	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2325BCC	SUP	HCPCS C1713		AR-2325BCC  -  BIO-COMP SWVLK 3.5X 15.8MM	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2325D	SUP	Custom 27203010		AR-2325D  -  DRILL SRG 3.5 MM SWIVELLOCK	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2325D-ST	SUP	Custom 27203010		AR-2325D-ST  -  DRILL SRG STRL 3.5 MM LABRAL SWIVELOCK	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2325PSLC	SUP	HCPCS C1713		AR-2325PSLC  -  ANCHOR SUT 3.5MM 14.8MM SWIVELOCK VNT PEEK-OPTM	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2374	SUP	Custom 27203010		AR-2374  -  5.1MM CANNULATED REAMER WITH STOP	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2511	SUP	Custom 27203010		AR-2511  -  GUIDE DRL SHLDR PERC REUSE PNG SYS	BOTH IP/OP	"$1,937.50 "	"$1,433.75"	$0.00	"$1,550.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,438.01"	"$1,438.01"	$0.00	$0.00	$403.78	$0.00	$0.00	$0.00	$0.00	$968.75	"$1,534.50"	"$1,550.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2512	SUP	Custom 27203010		AR-2512  -  GUIDE DRL PRLL SHLDR PERC REUSE PNG SYS	BOTH IP/OP	"$2,487.50 "	"$1,840.75"	$0.00	"$1,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,846.22"	"$1,846.22"	$0.00	$0.00	$518.40	$0.00	$0.00	$0.00	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2528	SUP	Custom 27203010		AR-2528  -  DRILL SRG 3.2MM CNN SHLDR PERC DISP PNG SYS	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2600SBS-6	SUP	HCPCS C1713		AR-2600SBS-6  -  SYSTEM FX 4.75MM BLK BLU WHT SPEEDBRIDGE SWIVELOCK FIBERTAPE	BOTH IP/OP	"$4,000.00 "	"$2,960.00"	$0.00	"$3,200.00"	"$1,800.00"	"$1,800.00"	$0.00	$0.00	$0.00	$833.70	"$2,968.80"	"$2,968.80"	$0.00	$0.00	$833.60	$0.00	"$1,972.00"	"$1,972.00"	$0.00	"$2,000.00"	"$3,168.00"	"$3,200.00"	$0.00		$0.00	$626.00	$0.00	$0.00	$636.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2622DL	SUP	HCPCS C1713		AR-2622DL  -  PLATE BN 22MM CLVCL LT DIST	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2622DR	SUP	HCPCS C1713		AR-2622DR  -  PLATE BN 22D STRL ARTHX CLVCL RT DIST	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2650CL	SUP	HCPCS C1713		AR-2650CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2650CR	SUP	HCPCS C1713		AR-2650CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2651CL	SUP	HCPCS C1713		AR-2651CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2651CR	SUP	HCPCS C1713		AR-2651CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2652CL	SUP	HCPCS C1713		AR-2652CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2652CR	SUP	HCPCS C1713		AR-2652CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2653CL	SUP	HCPCS C1713		AR-2653CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2653CR	SUP	HCPCS C1713		AR-2653CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2654CL	SUP	HCPCS C1713		AR-2654CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2654CR	SUP	HCPCS C1713		AR-2654CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2655CL	SUP	HCPCS C1713		AR-2655CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2655CR	SUP	HCPCS C1713		AR-2655CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2656DL	SUP	HCPCS C1713		AR-2656DL  -  PLATE BN SHRT PRECONTOUR STRL CHMFR SUT EYLT CMPR SLOT THRD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2656DR	SUP	HCPCS C1713		AR-2656DR  -  PLATE BN SHRT PRECONTOUR LOPRFL LCK CMPR HL SS CLVCL RT DIST	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2657DL	SUP	HCPCS C1713		AR-2657DL  -  PLATE BN SHRT PRECONTOUR STRL CHMFR SUT EYLT CMPR SLOT THRD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2657DR	SUP	HCPCS C1713		AR-2657DR  -  PLATE BN SHRT PRECONTOUR STRL CHMFR SUT EYLT CMPR SLOT THRD	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2658	SUP	HCPCS C1713		AR-2658  -  BUTTON FX CMPR SLOT PLT SEAT FLSH SS CLVCL DIST	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$393.75	$393.75	$0.00	$0.00	$0.00	$182.37	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$517.56	$517.56	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$136.94	$0.00	$0.00	$139.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2664L	SUP	Custom 27203010		AR-2664L  -  GUIDE DRL PLT SCR CLVCL LT DIST	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2664R	SUP	Custom 27203010		AR-2664R  -  GUIDE DRL PLT SCR CLVCL RT DIST	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2665-10H	SUP	HCPCS C1713		AR-2665-10H  -  SCREW BN HEXALOBE 2.5MM 10MM HRBRT 2 PTCH SS ELB SHLDR SM	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2665-12H	SUP	HCPCS C1713		AR-2665-12H  -  SCREW BN HEXALOBE 2.5MM 12MM HRBRT 2 PTCH SS ELB SHLDR SM	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2665-14H	SUP	HCPCS C1713		AR-2665-14H  -  SCREW BN HEXALOBE 2.5MM 14MM HRBRT 2 PTCH SS ELB SHLDR SM	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2665-16H	SUP	HCPCS C1713		AR-2665-16H  -  SCREW BN HEXALOBE 2.5MM 16MM HRBRT 2 PTCH SS ELB SHLDR SM	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2665-18H	SUP	HCPCS C1713		AR-2665-18H  -  SCREW BN HEXALOBE 2.5MM 18MM HRBRT 2 PTCH SS ELB SHLDR SM	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2665-20H	SUP	HCPCS C1713		AR-2665-20H  -  SCREW BN HEXALOBE 2.5MM 20MM HRBRT 2 PTCH SS ELB SHLDR SM	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2665-22H	SUP	HCPCS C1713		AR-2665-22H  -  SCREW BN HEXALOBE 2.5MM 22MM HRBRT 2 PTCH SS ELB SHLDR SM	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2665-24H	SUP	HCPCS C1713		AR-2665-24H  -  SCREW BN HEXALOBE 2.5MM 24MM HRBRT 2 PTCH SS ELB SHLDR SM	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2668	SUP	Custom 27203010		AR-2668  -  GUIDE DRL LCK SLV 2.7 MM SCR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2669	SUP	Custom 27203010		AR-2669  -  GUIDE DRL LCK DIST 2.7 MM SCR	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2680ST	SUP	HCPCS C1713		AR-2680ST  -  PLATE BN PRECONTOUR FX 7 HL SS CLVCL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2685DR-10	SUP	HCPCS C1713		AR-2685DR-10  -  PLATE BN 10 HL LOPRFL PRECONTOUR CMPR SLOT SS CLVCL RT DIST	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,577.18"	$618.75	$618.75	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2810-20	SUP	Custom 27203010		AR-2810-20  -  PARTIAL ECLIPSE HUMERAL REAMER	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2810-25	SUP	Custom 27203010		AR-2810-25  -  PARTIAL ECLIPSE HUMERAL REAMER	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2810F-18-5	SUP	Custom 27203010		AR-2810F-18-5  -  PARTIAL ECLIPSE GLENOID REAMER	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2810F-20-5	SUP	Custom 27203010		AR-2810F-20-5  -  PARTIAL ECLIPSE GLENOID REAMER	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2810F-22-5	SUP	Custom 27203010		AR-2810F-22-5  -  PARTIAL ECLIPSE GLENOID REAMER	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2810R-20-5	SUP	Custom 27203010		AR-2810R-20-5  -  ALLOGRAFT PARTIAL ECLIPSE HUMERAL REAMER	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2810R-25-5	SUP	Custom 27203010		AR-2810R-25-5  -  ALLOGRAFT PARTIAL ECLIPSE HUMERAL REAMER	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2810R-30-5	SUP	Custom 27203010		AR-2810R-30-5  -  ALLOGRAFT PARTIAL ECLIPSE HUMERAL REAMER	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2820	SUP	Custom 27203010		AR-2820  -  GUIDE DRL PRT ECLPS STEMLESS SHLDR ARTHPL	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2922BC	SUP	HCPCS C1713		AR-2922BC  -  ANCHOR SUT 2.4MM 11.3MM PUSHLOCK BCMPS 1 FBRWR 2 FIBERLINK	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2922D-24-1	SUP	Custom 27203010		AR-2922D-24-1  -  DRILL SRG 2.4 MM PUSHLOCK	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2922PS	SUP	HCPCS C1713		AR-2922PS  -  ANCHOR SUT 2.4MM 14MM STRL PUSHLOCK CNN EYLT HNDL INSRTR	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2923BC	SUP	HCPCS C1713		AR-2923BC  -  ANCHOR SUTURE SHORT 2.9MM 12.5MM CANN EYELET HANDLE INSERTER	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	"$1,144.00"	$643.50	$643.50	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$715.00	"$1,132.56"	"$1,144.00"	$0.00		$0.00	$223.80	$0.00	$0.00	$227.66	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2923BCH	SUP	HCPCS C1713		AR-2923BCH  -  SUTR ANCH HIP BIO-COMP P-LCK 2.9X12.5MM	BOTH IP/OP	"$1,050.00 "	$777.00	$0.00	$840.00	$472.50	$472.50	$0.00	$0.00	$0.00	$218.85	$779.31	$779.31	$0.00	$0.00	$218.82	$0.00	$621.08	$621.08	$0.00	$525.00	$831.60	$840.00	$0.00		$0.00	$164.33	$0.00	$0.00	$167.16	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2923D	SUP	Custom 27203010		AR-2923D  -  DRILL SRG BCMPS 2.9 MM SHRT PUSHLOCK	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2923DHT	SUP	Custom 27203010		AR-2923DHT  -  DRILL SRG HIP SHRT 2.9 MM PUSHLOCK HRD BN	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$0.00	$0.00	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2923D-ST	SUP	Custom 27203010		AR-2923D-ST  -  DRILL SRG STRL ELB SHLDR 2.9 MM SHRT PUSHLOCK	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2923DT	SUP	Custom 27203010		AR-2923DT  -  DRILL SRG 2.9 MM SHRT PUSHLOCK HRD BN	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2923DT-ST	SUP	Custom 27203010		AR-2923DT-ST  -  DRILL SRG STRL 2.9 MM SHRT PUSHLOCK HRD BN	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2923PHS	SUP	HCPCS C1713		AR-2923PHS  -  ANCHOR SUT SHRT 2.9MM 12.5MM PUSHLOCK PEEK HIP	BOTH IP/OP	$950.00 	$703.00	$0.00	$760.00	$427.50	$427.50	$0.00	$0.00	$0.00	$198.00	$705.09	$705.09	$0.00	$0.00	$197.98	$0.00	$561.93	$561.93	$0.00	$475.00	$752.40	$760.00	$0.00		$0.00	$148.68	$0.00	$0.00	$151.24	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2923PS	SUP	HCPCS C1713		AR-2923PS  -  ANCHOR SUT SHRT 2.9MM 12.5MM STRL PUSHLOCK CNN PEEK	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2950SC	SUP	Custom 27203010		AR-2950SC  -  CLAMP SRG GRAFTPRO SFT TIS	BOTH IP/OP	"$1,492.50 "	"$1,104.45"	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,107.73"	"$1,107.73"	$0.00	$0.00	$311.04	$0.00	$0.00	$0.00	$0.00	$746.25	"$1,182.06"	"$1,194.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-2962	SUP	Custom 27203010		AR-2962  -  GUIDE DRL DVTL ALGRF MNSCS	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	$0.00	$0.00	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3400H-4.5	SUP	Custom 27203010		AR-3400H-4.5  -  CANNULA ASCP HIP LGTH TPR 4.5MM BLNT FENESTRATE QCK CNCT LCK	BOTH IP/OP	$869.55 	$643.47	$0.00	$695.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$645.38	$645.38	$0.00	$0.00	$181.21	$0.00	$0.00	$0.00	$0.00	$434.78	$688.68	$695.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3400H-5.0	SUP	Custom 27203010		AR-3400H-5.0  -  CANNULA ASCP HIP LGTH TPR 5MM BLNT FENESTRATE QCK CNCT LCK	BOTH IP/OP	$869.55 	$643.47	$0.00	$695.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$645.38	$645.38	$0.00	$0.00	$181.21	$0.00	$0.00	$0.00	$0.00	$434.78	$688.68	$695.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3400H-5.5	SUP	Custom 27203010		AR-3400H-5.5  -  CANNULA ASCP HIP LGTH TPR 5.5MM BLNT FENESTRATE QCK CNCT LCK	BOTH IP/OP	$869.55 	$643.47	$0.00	$695.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$645.38	$645.38	$0.00	$0.00	$181.21	$0.00	$0.00	$0.00	$0.00	$434.78	$688.68	$695.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3400H-6.5	SUP	Custom 27203010		AR-3400H-6.5  -  CANNULA ASCP HIP LGTH TPR 6.5MM BLNT FENESTRATE QCK CNCT LCK	BOTH IP/OP	$869.55 	$643.47	$0.00	$695.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$645.38	$645.38	$0.00	$0.00	$181.21	$0.00	$0.00	$0.00	$0.00	$434.78	$688.68	$695.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3490HQC	SUP	Custom 27203010		AR-3490HQC  -  CANNULA ASCP STD HIP LGTH HUB QCK CNCT	BOTH IP/OP	$670.73 	$496.34	$0.00	$536.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$497.81	$497.81	$0.00	$0.00	$139.78	$0.00	$0.00	$0.00	$0.00	$335.36	$531.22	$536.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3600-2	SUP	HCPCS C1713		AR-3600-2  -  ANCHOR SUT 2 FIBERTAK FBRWR CLS EYLT	BOTH IP/OP	$850.00 	$629.00	$0.00	$680.00	$382.50	$382.50	$0.00	$0.00	$0.00	$177.16	$630.87	$630.87	$0.00	$0.00	$177.14	$0.00	$502.78	$502.78	$0.00	$425.00	$673.20	$680.00	$0.00		$0.00	$133.03	$0.00	$0.00	$135.32	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3600D-1	SUP	Custom 27203010		AR-3600D-1  -  DRILL SRG 1.6MM FIBERTAK	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3600DS	SUP	HCPCS C1713		AR-3600DS  -  ANCHOR SUT STRL LF ARTHX FIBERTAK DRL SPR OBT DISP	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$585.00	$585.00	$0.00	$0.00	$0.00	$270.95	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$768.95	$768.95	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3600ND-3	SUP	Custom 27203010		AR-3600ND-3  -  DRILL SRG 1.7MM FLXB FIBERTAK	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3601	SUP	HCPCS C1713		"AR-3601  -  KNOTLESS FIBERTAK SUTURE ANCHOR, 1.5MM"	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3602-2	SUP	HCPCS C1713		AR-3602-2  -  ANCHOR SUT 1.3MM BLU WHT FIBERTAK SUTURETAPE 2 LD	BOTH IP/OP	$925.00 	$684.50	$0.00	$740.00	$416.25	$416.25	$0.00	$0.00	$0.00	$192.79	$686.54	$686.54	$0.00	$0.00	$192.77	$0.00	$547.14	$547.14	$0.00	$462.50	$732.60	$740.00	$0.00		$0.00	$144.76	$0.00	$0.00	$147.26	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3603-2	SUP	HCPCS C1713		AR-3603-2  -  ANCHOR SUT 2 FIBERTAK TGTL 2 LD	BOTH IP/OP	$850.00 	$629.00	$0.00	$680.00	$382.50	$382.50	$0.00	$0.00	$0.00	$177.16	$630.87	$630.87	$0.00	$0.00	$177.14	$0.00	$502.78	$502.78	$0.00	$425.00	$673.20	$680.00	$0.00		$0.00	$133.03	$0.00	$0.00	$135.32	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3651T	SUP	HCPCS C1713		AR-3651T  -  ANCHOR SUT 2 BLK GRN/WHT FIBERTAK TGTL LABRALTAPE 2 ROW	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
AR-3651TT	SUP	HCPCS C1713		AR-3651TT  -  ANCHOR SUT 2 BLK BLU WHT FIBERTAK TGTL LABRALTAPE 2 ROW	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4007JS	SUP	Custom 27203010		AR-4007JS  -  SET GFT PREP MNS DRT JSTK	BOTH IP/OP	"$1,300.00 "	$962.00	$0.00	"$1,040.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$964.86	$964.86	$0.00	$0.00	$270.92	$0.00	$0.00	$0.00	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4008	SUP	Custom 27203010		AR-4008  -  PROBE ASCP STRL MNS DRT MSR DISP	BOTH IP/OP	$117.50 	$86.95	$0.00	$94.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.21	$87.21	$0.00	$0.00	$24.49	$0.00	$0.00	$0.00	$0.00	$58.75	$93.06	$94.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4045	SUP	Custom 27203010		AR-4045  -  CANNULA ASCP STRL MNS DRT OBT DISP	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$0.00	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4065-45L	SUP	Custom 27203010		AR-4065-45L  -  PASSER SUT 45D CRV LT STRL CRKSCR SUTLSO DISP ASCP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4065-45R	SUP	Custom 27203010		AR-4065-45R  -  PASSER SUT 45D RT CRV STRL CRKSCR SUTLSO DISP ASCP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4065-90S	SUP	Custom 27203010		AR-4065-90S  -  PASSER SUT 90D 2.3MM STRL SUTLSO NTNL ELB SHLDR DISP ASCP	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4065-90W	SUP	Custom 27203010		AR-4065-90W  -  PASSER SUT 90D 2.3MM STRL SUTLSO WRE LOOP NTNL ELB SHLDR	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4065B	SUP	Custom 27203010		AR-4065B  -  PASSER SUT UNV BNA 2.3MM STRL SUTLSO ROTR CUF NTNL DISP ASCP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4065H	SUP	HCPCS C1713		AR-4065H  -  ANCHOR SUT 45D LASSO HIP	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4065S	SUP	Custom 27203010		AR-4065S  -  PASSER SUT 45D CRV STRL SUTLSO NTNL DISP ASCP	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4065W	SUP	Custom 27203010		AR-4065W  -  PASSER SUT 45D 2.3MM STRL SUTLSO WRE LOOP NTNL DISP ASCP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-05SD	SUP	Custom 27203010		AR-4068-05SD  -  PASSER SUT 1.8MM 3.8MM STRL SUTLSO SD WIRELOOP NTNL ASCP	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$0.00	$0.00	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-25TL	SUP	Custom 27203010		AR-4068-25TL  -  PASSER SUTURE 25D TIGHT LEFT CURVE 1.8MM 3.8MM SUTURELASSO	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-25TLF	SUP	Custom 27203010		AR-4068-25TLF  -  PASSER SUT 25D TIGHT LT CRV 1.8MM 3.8MM STRL SUTLSO SD	BOTH IP/OP	$445.00 	$329.30	$0.00	$356.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$330.28	$330.28	$0.00	$0.00	$92.74	$0.00	$0.00	$0.00	$0.00	$222.50	$352.44	$356.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-25TR	SUP	Custom 27203010		AR-4068-25TR  -  PASSER SUT 25D TIGHT RT CRV 1.8MM 3.8MM STRL SUTLSO SD THB	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-25TRF	SUP	Custom 27203010		AR-4068-25TRF  -  PASSER SUT 25D TIGHT RT CRV 1.8MM 3.8MM STRL SUTLSO SD	BOTH IP/OP	$445.00 	$329.30	$0.00	$356.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$330.28	$330.28	$0.00	$0.00	$92.74	$0.00	$0.00	$0.00	$0.00	$222.50	$352.44	$356.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-30	SUP	Custom 27203010		AR-4068-30  -  PASSER SUT 30D STRG 1.8MM 3.8MM STRL SUTLSO SD THB PD NTNL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-45L	SUP	Custom 27203010		AR-4068-45L  -  PASSER SUTURE 45D LEFT CURVE 1.8MM 3.8MM THUMB PAD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-45LH	SUP	Custom 27203010		AR-4068-45LH  -  PASSER SUT 45D LT CRV STRL SUTLSO DISP HIP ASCP	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-45R	SUP	Custom 27203010		AR-4068-45R  -  PASSER SUTURE 45D RIGHT CURVE 1.8MM 3.8MM THUMB PAD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-45RH	SUP	Custom 27203010		AR-4068-45RH  -  PASSER SUT 45D RT CRV STRL SUTLSO DISP HIP ASCP	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-90	SUP	Custom 27203010		AR-4068-90  -  PASSER SUTURE 90D UP STR 1.8MM 3.8MM THUMB PAD SUTURELASSO	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-90H	SUP	Custom 27203010		AR-4068-90H  -  PASSER SUT 90D STRG STRL SUTLSO DISP HIP ASCP	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-90L	SUP	Custom 27203010		AR-4068-90L  -  PASSER SUTURE 90D LEFT CURVE 1.8MM 3.8MM THUMB PAD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068-90R	SUP	Custom 27203010		AR-4068-90R  -  PASSER SUTURE 90D RIGHT CURVE 1.8MM 3.8MM THUMB PAD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068C	SUP	Custom 27203010		AR-4068C  -  PASSER SUTURE SMALL CRESCENT 1.8MM 3.8MM THUMB PAD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4068CH	SUP	Custom 27203010		AR-4068CH  -  PASSER SUT CRSNT STRL SUTLSO DISP HIP ASCP	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4070-01	SUP	Custom 27203010		AR-4070-01  -  PROBE ASCP 60D 220MM MSR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4070-70S	SUP	Custom 27203010		AR-4070-70S  -  PROBE ASCP 70D STRL MSR MP KN DISP	BOTH IP/OP	$395.00 	$292.30	$0.00	$316.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$293.17	$293.17	$0.00	$0.00	$82.32	$0.00	$0.00	$0.00	$0.00	$197.50	$312.84	$316.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4151B	SUP	HCPCS C1713		AR-4151B  -  PIN DRL 1.5MM 100MM STRL TRMIT DISP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4151DS	SUP	HCPCS C1713		AR-4151DS  -  KIT INST 1.5MM 100MM STRL TRMIT DRL PIN KRSH BN TAMP GD SLV	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4152B	SUP	HCPCS C1713		AR-4152B  -  PIN DRL 2MM 100MM STRL TRMIT DISP	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4152DS	SUP	HCPCS C1713		AR-4152DS  -  KIT INST 2MM 100MM STRL TRMIT DRL PIN KRSH BN TAMP GD SLV	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4152MS	SUP	HCPCS C1713		AR-4152MS  -  PIN DRL 2MM 100MM STRL TRMIT	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4154P-3010	SUP	HCPCS C1713		AR-4154P-3010  -  KIT TRMA FX 10D 2.5MM 30MM STRL PIP DART RDLCNT INSRTR DRL	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4154PS-3000	SUP	HCPCS C1713		AR-4154PS-3000  -  KIT TRMA FX STRG 2.5MM 30MM STRL PIP DART INSRTR DRL GW TROC	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4154PS-3010	SUP	HCPCS C1713		AR-4154PS-3010  -  KIT TRMA FX 10D 2.5MM 30MM STRL PIP DART INSRTR DRL GW BRB	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4155P-3010	SUP	HCPCS C1713		AR-4155P-3010  -  KIT TRMA FX 10D 3MM 30MM STRL PIP DART RDLCNT INSRTR DRL GW	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4155PS-3010	SUP	HCPCS C1713		AR-4155PS-3010  -  KIT TRMA FX 10D 3MM 30MM STRL PIP DART INSRTR DRL GW TROC	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4156DS	SUP	HCPCS C1713		AR-4156DS  -  KIT INST 2MM 100MM STRL TRMIT DRL PIN KRSH BN TAMP GD SLV	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4160-20	SUP	Custom 27203010		AR-4160-20  -  BIT DRL 2MM TRMIT	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4160-24	SUP	Custom 27203010		AR-4160-24  -  BIT DRL 2.4MM TRMIT	BOTH IP/OP	$487.50 	$360.75	$0.00	$361.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4160-25	SUP	Custom 27203010		AR-4160-25  -  BIT DRL 2.5MM TRMIT	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4160-26	SUP	Custom 27203010		AR-4160-26  -  BIT DRL 2.6MM TRMIT	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4160-27	SUP	Custom 27203010		AR-4160-27  -  BIT DRL 2.7MM TRMIT	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4160-34	SUP	Custom 27203010		AR-4160-34  -  BIT DRL 3.4MM TRMIT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4160-35	SUP	Custom 27203010		AR-4160-35  -  BIT DRL 3.5MM TRMIT	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4160-40	SUP	Custom 27203010		AR-4160-40  -  BIT DRL 4MM TRMIT	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4160-45	SUP	Custom 27203010		AR-4160-45  -  BIT DRL 4.5MM TRMIT	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4161	SUP	Custom 27203010		AR-4161  -  DRILL BIT CNTRSNK 2.7MM TRMIT	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$0.00	$0.00	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4161B	SUP	HCPCS C1713		AR-4161B  -  SCREW INTFR HEX 2.7MM 30MM STRL TRMIT CNN POLY L LAC ACD ACL	BOTH IP/OP	$482.50 	$357.05	$0.00	$386.00	$217.13	$217.13	$0.00	$0.00	$0.00	$100.57	$358.11	$358.11	$0.00	$0.00	$100.55	$0.00	$285.40	$285.40	$0.00	$241.25	$382.14	$386.00	$0.00		$0.00	$75.51	$0.00	$0.00	$76.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4161G	SUP	Custom 27203010		AR-4161G  -  GUIDE DRL 2MM 2.7MM TRMIT	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4162B	SUP	HCPCS C1713		AR-4162B  -  SCREW INTFR HEX 3.5MM 40MM STRL TRMIT CNN POLY L LAC ACD ACL	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4163	SUP	Custom 27203010		AR-4163  -  DRILL BIT CNTRSNK 4MM	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$0.00	$0.00	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4163B	SUP	HCPCS C1713		AR-4163B  -  SCREW INTFR HEX 4MM 50MM STRL TRMIT CNN POLY L LAC ACD ACL	BOTH IP/OP	$525.00 	$388.50	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$109.42	$389.66	$389.66	$0.00	$0.00	$109.41	$0.00	$310.54	$310.54	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4163G	SUP	Custom 27203010		AR-4163G  -  GUIDE DRL 2.4MM 4MM TRMIT	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4164	SUP	Custom 27203010		AR-4164  -  DRILL BIT CNTRSNK 4.5MM	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$0.00	$0.00	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4164B	SUP	HCPCS C1713		AR-4164B  -  SCREW INTFR FT HEX 4.5MM 60MM STRL TRMIT CNN POLY L LAC ACD	BOTH IP/OP	$775.00 	$573.50	$0.00	$620.00	$348.75	$348.75	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$387.50	$613.80	$620.00	$0.00		$0.00	$121.29	$0.00	$0.00	$123.38	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4164G	SUP	Custom 27203010		AR-4164G  -  GUIDE DRL 3.4MM 4.5MM TRMIT	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4207-12	SUP	Custom 27203010		AR-4207-12  -  COMPONENT SUBTALAR CNCV 7MM 12MM STRL PROSTOP BABSR TI POLY	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,773.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	$0.00	$0.00	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4208-14	SUP	Custom 27203010		AR-4208-14  -  COMPONENT SUBTALAR CNCV 8MM 14MM STRL PROSTOP BABSR TI POLY	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,773.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	$0.00	$0.00	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4208B-14	SUP	Custom 27203010		AR-4208B-14  -  COMPONENT SUBTALAR CNCV 8MM 14MM STRL PROSTOP + BABSR TI	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	$0.00	$0.00	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4209-14	SUP	Custom 27203010		AR-4209-14  -  COMPONENT SUBTALAR CNCV 9MM 14MM STRL PROSTOP BABSR TI POLY	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,773.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	$0.00	$0.00	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4209B-14	SUP	Custom 27203010		AR-4209B-14  -  COMPONENT SUBTALAR CNCV 9MM 14MM STRL PROSTOP + BABSR TI	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	$0.00	$0.00	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4210-14	SUP	Custom 27203010		AR-4210-14  -  COMPONENT SUBTALAR CNCV 10MM 14MM STRL PROSTOP BABSR TI POLY	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,773.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	$0.00	$0.00	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4210B-14	SUP	Custom 27203010		AR-4210B-14  -  COMPONENT SUBTALAR CNCV 10MM 14MM STRL PROSTOP + BABSR TI	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	$0.00	$0.00	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4211-16	SUP	Custom 27203010		AR-4211-16  -  COMPONENT SUBTALAR CNCV 11MM 16MM STRL PROSTOP BABSR TI POLY	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,773.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	$0.00	$0.00	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4211B-16	SUP	Custom 27203010		AR-4211B-16  -  COMPONENT SUBTALAR CNCV 11MM 16MM STRL PROSTOP + BABSR TI	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	$0.00	$0.00	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4212-16	SUP	Custom 27203010		AR-4212-16  -  COMPONENT SUBTALAR CNCV 12MM 16MM STRL PROSTOP BABSR TI POLY	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,773.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	$0.00	$0.00	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4212B-16	SUP	Custom 27203010		AR-4212B-16  -  COMPONENT SUBTALAR CNCV 12MM 16MM STRL PROSTOP + BABSR TI	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	$0.00	$0.00	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4502	SUP	HCPCS C1713		AR-4502  -  NEEDLE SUT 2-0 CRV SPEEDCINCH FBRWR PEEK	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4515	SUP	Custom 27203010		AR-4515  -  CUTTER SUTURE REMOVAL KNOT PUSHER MENISCAL CINCH STERILE	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-4520	SUP	Custom 27203010		AR-4520  -  CUTTER SUT REM TGHTRP RECON SUT ACL ASCP	BOTH IP/OP	$395.00 	$292.30	$0.00	$316.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$293.17	$293.17	$0.00	$0.00	$82.32	$0.00	$0.00	$0.00	$0.00	$197.50	$312.84	$316.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5010AB	SUP	HCPCS C1713		AR-5010AB  -  SCREW INTFR 50D 10MM 17MM STRL BCRTCL BCK END FLSH POLY L	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5010BB	SUP	HCPCS C1713		AR-5010BB  -  SCREW INTFR 10MM 20MM STRL BCRTCL BCK END FLSH POLY L LAC	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5011AB	SUP	HCPCS C1713		AR-5011AB  -  SCREW INTFR 50D 11MM 17MM STRL BCRTCL BCK END FLSH POLY L	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBA0	SUP	HCPCS C1713		AR-501-TBA0  -  BEARING TIB 1 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBA1	SUP	HCPCS C1713		AR-501-TBA1  -  BEARING TIB 1 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBA2	SUP	HCPCS C1713		AR-501-TBA2  -  BEARING TIB 1 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBA4	SUP	HCPCS C1713		AR-501-TBA4  -  BEARING TIB 1 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBA8	SUP	HCPCS C1713		AR-501-TBA8  -  BEARING TIB 1 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBA9	SUP	HCPCS C1713		AR-501-TBA9  -  BEARING TIB 1 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBB0	SUP	HCPCS C1713		AR-501-TBB0  -  BEARING TIB 2 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBB1	SUP	HCPCS C1713		AR-501-TBB1  -  BEARING TIB 2 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBB2	SUP	HCPCS C1713		AR-501-TBB2  -  BEARING TIB 2 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBB4	SUP	HCPCS C1713		AR-501-TBB4  -  BEARING TIB 2 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBB8	SUP	HCPCS C1713		AR-501-TBB8  -  BEARING TIB 2 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBB9	SUP	HCPCS C1713		AR-501-TBB9  -  BEARING TIB 2 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBC0	SUP	HCPCS C1713		AR-501-TBC0  -  BEARING TIB 3 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBC1	SUP	HCPCS C1713		AR-501-TBC1  -  BEARING TIB 3 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBC2	SUP	HCPCS C1713		AR-501-TBC2  -  BEARING TIB 3 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBC4	SUP	HCPCS C1713		AR-501-TBC4  -  BEARING TIB 3 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBC8	SUP	HCPCS C1713		AR-501-TBC8  -  BEARING TIB 3 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBC9	SUP	HCPCS C1713		AR-501-TBC9  -  BEARING TIB 3 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBD0	SUP	HCPCS C1713		AR-501-TBD0  -  BEARING TIB 4 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBD1	SUP	HCPCS C1713		AR-501-TBD1  -  BEARING TIB 4 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBD2	SUP	HCPCS C1713		AR-501-TBD2  -  BEARING TIB 4 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBD4	SUP	HCPCS C1713		AR-501-TBD4  -  BEARING TIB 4 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBD8	SUP	HCPCS C1713		AR-501-TBD8  -  BEARING TIB 4 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBD9	SUP	HCPCS C1713		AR-501-TBD9  -  BEARING TIB D 9MM UNCMP	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBE0	SUP	HCPCS C1713		AR-501-TBE0  -  BEARING TIB 5 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBE1	SUP	HCPCS C1713		AR-501-TBE1  -  BEARING TIB 5 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBE2	SUP	HCPCS C1713		AR-501-TBE2  -  BEARING TIB 5 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBE4	SUP	HCPCS C1713		AR-501-TBE4  -  BEARING TIB 5 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBE8	SUP	HCPCS C1713		AR-501-TBE8  -  BEARING TIB 5 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBE9	SUP	HCPCS C1713		AR-501-TBE9  -  BEARING TIB 5 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBF0	SUP	HCPCS C1713		AR-501-TBF0  -  BEARING TIB 6 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBF1	SUP	HCPCS C1713		AR-501-TBF1  -  BEARING TIB 6 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBF2	SUP	HCPCS C1713		AR-501-TBF2  -  BEARING TIB 6 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBF4	SUP	HCPCS C1713		AR-501-TBF4  -  BEARING TIB 6 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBF8	SUP	HCPCS C1713		AR-501-TBF8  -  BEARING TIB 6 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TBF9	SUP	HCPCS C1713		AR-501-TBF9  -  BEARING TIB 6 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TTLA	SUP	Custom 27203010		AR-501-TTLA  -  TRAY TIB 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TTLB	SUP	Custom 27203010		AR-501-TTLB  -  TRAY TIB 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TTLC	SUP	Custom 27203010		AR-501-TTLC  -  TRAY TIB 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TTLD	SUP	HCPCS C1776		AR-501-TTLD  -  COMPONENT TIBTRY D UNCMP LT	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$0.00	$937.91	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	"$2,218.50"	"$2,218.50"	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$704.25	$0.00	$0.00	$716.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TTLE	SUP	Custom 27203010		AR-501-TTLE  -  TRAY TIB 5 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TTLF	SUP	Custom 27203010		AR-501-TTLF  -  TRAY TIB 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TTRA	SUP	Custom 27203010		AR-501-TTRA  -  TRAY TIB 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TTRB	SUP	Custom 27203010		AR-501-TTRB  -  TRAY TIB 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TTRC	SUP	Custom 27203010		AR-501-TTRC  -  TRAY TIB 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TTRD	SUP	Custom 27203010		AR-501-TTRD  -  TRAY TIB 4 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TTRE	SUP	Custom 27203010		AR-501-TTRE  -  TRAY TIB 5 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-TTRF	SUP	Custom 27203010		AR-501-TTRF  -  TRAY TIB 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	$0.00	$0.00	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-UFLA	SUP	HCPCS C1776		AR-501-UFLA  -  COMPONENT FEM 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-UFLB	SUP	HCPCS C1776		AR-501-UFLB  -  COMPONENT FEM 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-UFLC	SUP	HCPCS C1776		AR-501-UFLC  -  COMPONENT FEM 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-UFLD	SUP	HCPCS C1776		AR-501-UFLD  -  COMPONENT FEM 4 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-UFLE	SUP	HCPCS C1776		AR-501-UFLE  -  COMPONENT FEM E KN LT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-UFLF	SUP	HCPCS C1776		AR-501-UFLF  -  COMPONENT FEM 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-UFRA	SUP	HCPCS C1776		AR-501-UFRA  -  COMPONENT FEM 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-UFRB	SUP	HCPCS C1776		AR-501-UFRB  -  COMPONENT FEM 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-UFRC	SUP	HCPCS C1776		AR-501-UFRC  -  COMPONENT FEM 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-UFRD	SUP	HCPCS C1776		AR-501-UFRD  -  COMPONENT FEM 4 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-UFRE	SUP	HCPCS C1776		AR-501-UFRE  -  COMPONENT FEM 5 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-501-UFRF	SUP	HCPCS C1776		AR-501-UFRF  -  COMPONENT FEM 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-502-1L	SUP	HCPCS C1776		AR-502-1L  -  COMPONENT FEM 1 IBALANCE PTLFEM LT	BOTH IP/OP	"$11,900.00 "	"$8,806.00"	$0.00	"$9,520.00"	"$5,355.00"	"$5,355.00"	$0.00	$0.00	$0.00	"$2,480.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,479.96"	$0.00	"$5,866.70"	"$5,866.70"	$0.00	"$5,950.00"	"$9,424.80"	"$9,520.00"	$0.00		$0.00	"$1,862.35"	$0.00	$0.00	"$1,894.48"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-502-1R	SUP	HCPCS C1776		AR-502-1R  -  COMPONENT FEM 1 IBALANCE PTLFEM RT	BOTH IP/OP	"$11,900.00 "	"$8,806.00"	$0.00	"$9,520.00"	"$5,355.00"	"$5,355.00"	$0.00	$0.00	$0.00	"$2,480.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,479.96"	$0.00	"$5,866.70"	"$5,866.70"	$0.00	"$5,950.00"	"$9,424.80"	"$9,520.00"	$0.00		$0.00	"$1,862.35"	$0.00	$0.00	"$1,894.48"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-502-2L	SUP	HCPCS C1776		AR-502-2L  -  COMPONENT FEM 2 IBALANCE PTLFEM LT	BOTH IP/OP	"$11,900.00 "	"$8,806.00"	$0.00	"$9,520.00"	"$5,355.00"	"$5,355.00"	$0.00	$0.00	$0.00	"$2,480.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,479.96"	$0.00	"$5,866.70"	"$5,866.70"	$0.00	"$5,950.00"	"$9,424.80"	"$9,520.00"	$0.00		$0.00	"$1,862.35"	$0.00	$0.00	"$1,894.48"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-502-2R	SUP	HCPCS C1776		AR-502-2R  -  COMPONENT FEM 2 IBALANCE PTLFEM RT	BOTH IP/OP	"$11,900.00 "	"$8,806.00"	$0.00	"$9,520.00"	"$5,355.00"	"$5,355.00"	$0.00	$0.00	$0.00	"$2,480.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,479.96"	$0.00	"$5,866.70"	"$5,866.70"	$0.00	"$5,950.00"	"$9,424.80"	"$9,520.00"	$0.00		$0.00	"$1,862.35"	$0.00	$0.00	"$1,894.48"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-502-3L	SUP	HCPCS C1776		AR-502-3L  -  COMPONENT FEM 3 IBALANCE PTLFEM LT	BOTH IP/OP	"$11,900.00 "	"$8,806.00"	$0.00	"$9,520.00"	"$5,355.00"	"$5,355.00"	$0.00	$0.00	$0.00	"$2,480.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,479.96"	$0.00	"$5,866.70"	"$5,866.70"	$0.00	"$5,950.00"	"$9,424.80"	"$9,520.00"	$0.00		$0.00	"$1,862.35"	$0.00	$0.00	"$1,894.48"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-502-3R	SUP	HCPCS C1776		AR-502-3R  -  COMPONENT FEM 3 IBALANCE PTLFEM RT	BOTH IP/OP	"$11,900.00 "	"$8,806.00"	$0.00	"$9,520.00"	"$5,355.00"	"$5,355.00"	$0.00	$0.00	$0.00	"$2,480.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,479.96"	$0.00	"$5,866.70"	"$5,866.70"	$0.00	"$5,950.00"	"$9,424.80"	"$9,520.00"	$0.00		$0.00	"$1,862.35"	$0.00	$0.00	"$1,894.48"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-502-4L	SUP	HCPCS C1776		AR-502-4L  -  COMPONENT FEM 4 IBALANCE PTLFEM LT	BOTH IP/OP	"$11,900.00 "	"$8,806.00"	$0.00	"$9,520.00"	"$5,355.00"	"$5,355.00"	$0.00	$0.00	$0.00	"$2,480.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,479.96"	$0.00	"$5,866.70"	"$5,866.70"	$0.00	"$5,950.00"	"$9,424.80"	"$9,520.00"	$0.00		$0.00	"$1,862.35"	$0.00	$0.00	"$1,894.48"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-502-4R	SUP	HCPCS C1776		AR-502-4R  -  COMPONENT FEM 4 IBALANCE PTLFEM RT	BOTH IP/OP	"$11,900.00 "	"$8,806.00"	$0.00	"$9,520.00"	"$5,355.00"	"$5,355.00"	$0.00	$0.00	$0.00	"$2,480.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,479.96"	$0.00	"$5,866.70"	"$5,866.70"	$0.00	"$5,950.00"	"$9,424.80"	"$9,520.00"	$0.00		$0.00	"$1,862.35"	$0.00	$0.00	"$1,894.48"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5024TDA	SUP	Custom 27203010		AR-5024TDA  -  BIT DRL CMPR SCR TPR ASCP	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5024TDP	SUP	Custom 27203010		AR-5024TDP  -  BIT DRL CMPR SCR TPR PERC	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025B-16	SUP	HCPCS C1713		AR-5025B-16  -  SCREW INTFR TPR 3-3.7MM 16MM STRL BIO-CMPR SCR CNN SLF CMPR	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025B-18	SUP	HCPCS C1713		AR-5025B-18  -  SCREW INTFR TPR 3-3.7MM 18MM STRL BIO-CMPR SCR CNN SLF CMPR	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025B-20	SUP	HCPCS C1713		AR-5025B-20  -  SCREW INTFR TPR 2.7-3.7MM 20MM STRL BIO-CMPR SCR CNN SLF	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025B-22	SUP	HCPCS C1713		AR-5025B-22  -  SCREW INTFR TPR 3-3.7MM 22MM STRL BIO-CMPR SCR CNN SLF CMPR	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025B-24	SUP	HCPCS C1713		AR-5025B-24  -  SCREW INTFR TPR 3-3.7MM 24MM STRL BIO-CMPR SCR CNN SLF CMPR	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025B-26	SUP	HCPCS C1713		AR-5025B-26  -  SCREW INTFR TPR 3-3.7MM 26MM STRL BIO-CMPR SCR CNN SLF CMPR	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025ETDC-26	SUP	Custom 27203010		AR-5025ETDC-26  -  BIT DRL 26MM CNN BIO-CMPR SCR	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$333.99	$333.99	$0.00	$0.00	$93.78	$0.00	$0.00	$0.00	$0.00	$225.00	$356.40	$360.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025TD	SUP	Custom 27203010		AR-5025TD  -  BIT DRL 2.7MM 20MM CNN BIO-CMPR SCR	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025TDC	SUP	Custom 27203010		AR-5025TDC  -  BIT DRL CNN BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025TDC-16	SUP	Custom 27203010		AR-5025TDC-16  -  BIT DRL 16MM CNN BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025TDC-18	SUP	Custom 27203010		AR-5025TDC-18  -  BIT DRL 18MM CNN BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025TDC-22	SUP	Custom 27203010		AR-5025TDC-22  -  BIT DRL 22MM CNN BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025TDC-24	SUP	Custom 27203010		AR-5025TDC-24  -  BIT DRL 24MM CNN BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5025TDC-26	SUP	Custom 27203010		AR-5025TDC-26  -  BIT DRL 26MM CNN BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026B-16	SUP	HCPCS C1713		AR-5026B-16  -  SCREW INTFR TPR 3.5-4.4MM 16MM BIO-CMPR SCR CNN SLF CMPR STP	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026B-18	SUP	HCPCS C1713		AR-5026B-18  -  SCREW INTFR TPR 3.5-4.5MM 18MM BIO-CMPR SCR CNN SLF CMPR STP	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026B-20	SUP	HCPCS C1713		AR-5026B-20  -  SCREW INTFR TPR 3.5-4.6MM 20MM BIO-CMPR SCR CNN SLF CMPR STP	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026B-22	SUP	HCPCS C1713		AR-5026B-22  -  SCREW INTFR TPR 3.5-4.7MM 22MM BIO-CMPR SCR CNN SLF CMPR STP	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026B-24	SUP	HCPCS C1713		AR-5026B-24  -  SCREW INTFR TPR 3.5-4.8MM 24MM BIO-CMPR SCR CNN SLF CMPR STP	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026B-26	SUP	HCPCS C1713		AR-5026B-26  -  SCREW INTFR TPR 3.5-4.9MM 26MM BIO-CMPR SCR CNN SLF CMPR STP	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026B-28	SUP	HCPCS C1713		AR-5026B-28  -  SCREW INTFR TPR 3.5-5-5MM 28MM BIO-CMPR SCR CNN SLF CMPR STP	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026B-30	SUP	HCPCS C1713		AR-5026B-30  -  SCREW INTFR TPR 3.5-5.1MM 30MM BIO-CMPR SCR CNN SLF CMPR STP	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026B-32	SUP	HCPCS C1713		AR-5026B-32  -  SCREW INTFR TPR 3.5-3.5MM 32MM BIO-CMPR SCR CNN SLF CMPR STP	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$444.38	$444.38	$0.00	$0.00	$0.00	$205.82	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$584.11	$584.11	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$154.54	$0.00	$0.00	$157.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026G	SUP	Custom 27203010		AR-5026G  -  GUIDE DRL 20MM C RING DRVR BIO-CMPR SCR	BOTH IP/OP	"$1,900.00 "	"$1,406.00"	$0.00	"$1,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,410.18"	"$1,410.18"	$0.00	$0.00	$395.96	$0.00	$0.00	$0.00	$0.00	$950.00	"$1,504.80"	"$1,520.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026TDC-16	SUP	Custom 27203010		AR-5026TDC-16  -  BIT DRL TPR 3.5MM 16MM BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026TDC-18	SUP	Custom 27203010		AR-5026TDC-18  -  BIT DRL TPR 3.5MM 18MM BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026TDC-20	SUP	Custom 27203010		AR-5026TDC-20  -  BIT DRL TPR 3.5MM 20MM BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026TDC-22	SUP	Custom 27203010		AR-5026TDC-22  -  BIT DRL TPR 3.5MM 22MM BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026TDC-24	SUP	Custom 27203010		AR-5026TDC-24  -  BIT DRL TPR 3.5MM 24MM BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026TDC-26	SUP	Custom 27203010		AR-5026TDC-26  -  BIT DRL TPR 3.5MM 26MM BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026TDC-28	SUP	Custom 27203010		AR-5026TDC-28  -  BIT DRL TPR 3.5MM 28MM BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026TDC-30	SUP	Custom 27203010		AR-5026TDC-30  -  BIT DRL TPR 3.5MM 30MM BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5026TDC-32	SUP	Custom 27203010		AR-5026TDC-32  -  BIT DRL TPR 3.5MM 32MM BIO-CMPR SCR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028B-08	SUP	HCPCS C1713		AR-5028B-08  -  SCREW INTFR DLT TPR 8MM 28MM STRL 6.5MM BIOINTF POLY L LAC	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028B-09	SUP	HCPCS C1713		AR-5028B-09  -  SCREW INTFR DLT TPR 9MM 28MM STRL 7.5MM BIOINTF POLY L LAC	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028B-10	SUP	HCPCS C1713		AR-5028B-10  -  SCREW INTFR DLT TPR 10MM 28MM STRL 8.5MM BIOINTF POLY L LAC	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028B-11	SUP	HCPCS C1713		AR-5028B-11  -  SCREW INTFR DLT TPR 11MM 28MM STRL 9.5MM BIOINTF POLY L LAC	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028C-08	SUP	HCPCS C1713		AR-5028C-08  -  SCREW INTFR DLT TPR 8MM 28MM STRL BCMPS SHLDR	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028C-10	SUP	HCPCS C1713		AR-5028C-10  -  SCREW INTERFERENCE DELTA TAPER 10MM 28MM BIOCOMPOSITE	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028C-11	SUP	HCPCS C1713		AR-5028C-11  -  SCREW INTERFERENCE DELTA TAPER 11MM 28MM BIOCOMPOSITE	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028P-07	SUP	HCPCS C1713		AR-5028P-07  -  SCREW INTFR DLT TPR 7MM 28MM STRL RECON SHTH THRD PTRN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028P-08	SUP	HCPCS C1713		AR-5028P-08  -  ROUND DELTA TAPERED INTERFERENCE SCREW	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028P-09	SUP	HCPCS C1713		AR-5028P-09  -  SCREW INTFR DLT TPR 9MM 28MM STRL RECON SHTH THRD PTRN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028P-10	SUP	HCPCS C1713		AR-5028P-10  -  SCREW INTFR DLT TPR 10MM 28MM STRL RECON SHTH THRD PTRN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028P-11	SUP	HCPCS C1713		AR-5028P-11  -  SCREW INTFR DLT TPR 11MM 28MM STRL RECON SHTH THRD PTRN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5028P-12	SUP	HCPCS C1713		AR-5028P-12  -  SCREW INTFR DLT TPR 12MM 28MM STRL RECON SHTH THRD PTRN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5035P-09	SUP	HCPCS C1713		AR-5035P-09  -  SCREW INTFR DLT TPR 9MM 35MM STRL CNN DRVR RECON PEEK-OPTM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5035P-10	SUP	HCPCS C1713		AR-5035P-10  -  SCREW INTFR DLT TPR 10MM 35MM STRL CNN DRVR RECON PEEK-OPTM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5035P-11	SUP	HCPCS C1713		AR-5035P-11  -  SCREW INTFR DLT TPR 11MM 35MM STRL CNN DRVR RECON PEEK-OPTM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5035P-12	SUP	HCPCS C1713		AR-5035P-12  -  SCREW INTFR DLT TPR 12MM 35MM STRL CNN DRVR RECON PEEK-OPTM	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5035TB-09	SUP	HCPCS C1713		AR-5035TB-09  -  SCREW INTFR DLT TPR 7.5-9MM 35MM STRL BIOINTF CNN POLY L LAC	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5035TB-10	SUP	HCPCS C1713		AR-5035TB-10  -  SCREW INTFR DLT TPR 8.5-10MM 35MM STRL BIOINTF CNN POLY L	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5035TB-11	SUP	HCPCS C1713		AR-5035TB-11  -  SCREW INTFR DLT TPR 9.5-11MM 35MM STRL BIOINTF CNN POLY L	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5035TB-12	SUP	HCPCS C1713		AR-5035TB-12  -  SCREW INTFR DLT TPR 10.5-12MM 35MM STRL BIOINTF CNN POLY L	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5035TC-09	SUP	HCPCS C1713		AR-5035TC-09  -  SCREW INTFR DLT 9MM 35MM STRL CNN BCMPS ACL	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5035TC-10	SUP	HCPCS C1713		AR-5035TC-10  -  SCREW INTFR DLT 10MM 35MM STRL CNN BCMPS ACL	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5035TC-12	SUP	HCPCS C1713		AR-5035TC-12  -  SCREW INTFR BCMPS 35MM 12MM DLT ACL CANN STRL	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A1008	SUP	HCPCS C1776		"AR-503-A1008  -  CR PLUS TIBIAL BEARING, SIZE 10, 8MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A1009	SUP	HCPCS C1776		"AR-503-A1009  -  CR PLUS TIBIAL BEARING, SIZE 10, 9MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A1010	SUP	HCPCS C1776		"AR-503-A1010  -  CR PLUS TIBIAL BEARING, SIZE 10, 10MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A1011	SUP	HCPCS C1776		"AR-503-A1011  -  CR PLUS TIBIAL BEARING, SIZE 10, 11MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A1012	SUP	HCPCS C1776		"AR-503-A1012  -  CR PLUS TIBIAL BEARING, SIZE 10, 12MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A1013	SUP	HCPCS C1776		"AR-503-A1013  -  CR PLUS TIBIAL BEARING, SIZE 10, 13MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A1014	SUP	HCPCS C1776		"AR-503-A1014  -  CR PLUS TIBIAL BEARING, SIZE 10, 14MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A1016	SUP	HCPCS C1776		"AR-503-A1016  -  CR PLUS TIBIAL BEARING, SIZE 10, 16MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A1018	SUP	HCPCS C1776		"AR-503-A1018  -  CR PLUS TIBIAL BEARING, SIZE 10, 18MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A908	SUP	HCPCS C1776		"AR-503-A908  -  CR PLUS TIBIAL BEARING, SIZE 9, 8MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A909	SUP	HCPCS C1776		"AR-503-A909  -  CR PLUS TIBIAL BEARING, SIZE 9, 9MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A910	SUP	HCPCS C1776		"AR-503-A910  -  CR PLUS TIBIAL BEARING, SIZE 9, 10MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A911	SUP	HCPCS C1776		"AR-503-A911  -  CR PLUS TIBIAL BEARING, SIZE 9, 11MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A912	SUP	HCPCS C1776		"AR-503-A912  -  CR PLUS TIBIAL BEARING, SIZE 9, 12MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A913	SUP	HCPCS C1776		"AR-503-A913  -  CR PLUS TIBIAL BEARING, SIZE 9, 13MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A914	SUP	HCPCS C1776		"AR-503-A914  -  CR PLUS TIBIAL BEARING, SIZE 9, 14MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A916	SUP	HCPCS C1776		"AR-503-A916  -  CR PLUS TIBIAL BEARING, SIZE 9, 16MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-A918	SUP	HCPCS C1776		"AR-503-A918  -  CR PLUS TIBIAL BEARING, SIZE 9, 18MM"	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-503-PSRA	SUP	HCPCS C1776		AR-503-PSRA  -  COMPONENT FEM IBALANCE CMNT POST STAB KN RT	BOTH IP/OP	"$7,750.00 "	"$5,735.00"	$0.00	"$6,200.00"	"$3,487.50"	"$3,487.50"	$0.00	$0.00	$0.00	"$1,615.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,615.10"	$0.00	"$3,820.75"	"$3,820.75"	$0.00	"$3,875.00"	"$6,138.00"	"$6,200.00"	$0.00		$0.00	"$1,212.88"	$0.00	$0.00	"$1,233.80"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-504-PSA8	SUP	HCPCS C1776		AR-504-PSA8  -  COMPONENT PTLR DOME 27MM 8MM IBALANCE	BOTH IP/OP	"$2,187.50 "	"$1,618.75"	$0.00	"$1,750.00"	$984.38	$984.38	$0.00	$0.00	$0.00	$455.93	"$1,623.56"	"$1,623.56"	$0.00	$0.00	$455.88	$0.00	"$1,293.91"	"$1,293.91"	$0.00	"$1,093.75"	"$1,732.50"	"$1,750.00"	$0.00		$0.00	$342.34	$0.00	$0.00	$348.25	$0.00	$0.00	$0.00	$0.00	$0.00
AR-504-PSB8	SUP	HCPCS C1776		AR-504-PSB8  -  COMPONENT PTLR DOME 30MM 8MM IBALANCE	BOTH IP/OP	"$2,187.50 "	"$1,618.75"	$0.00	"$1,750.00"	$984.38	$984.38	$0.00	$0.00	$0.00	$455.93	"$1,623.56"	"$1,623.56"	$0.00	$0.00	$455.88	$0.00	"$1,293.91"	"$1,293.91"	$0.00	"$1,093.75"	"$1,732.50"	"$1,750.00"	$0.00		$0.00	$342.34	$0.00	$0.00	$348.25	$0.00	$0.00	$0.00	$0.00	$0.00
AR-504-PSE0	SUP	HCPCS C1776		AR-504-PSE0  -  COMPONENT PTLR THK10MM 3 DOME 40MM IBALANCE 3 PG	BOTH IP/OP	"$2,187.50 "	"$1,618.75"	$0.00	"$1,750.00"	$984.38	$984.38	$0.00	$0.00	$0.00	$455.93	"$1,623.56"	"$1,623.56"	$0.00	$0.00	$455.88	$0.00	"$1,293.91"	"$1,293.91"	$0.00	"$1,093.75"	"$1,732.50"	"$1,750.00"	$0.00		$0.00	$342.34	$0.00	$0.00	$348.25	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5050-05	SUP	Custom 27203010		AR-5050-05  -  CLAMP SRG 2X SM WEBER LNG THROW PTLR FX SYS	BOTH IP/OP	$442.50 	$327.45	$0.00	$354.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.42	$328.42	$0.00	$0.00	$92.22	$0.00	$0.00	$0.00	$0.00	$221.25	$350.46	$354.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5050-07	SUP	Custom 27203010		AR-5050-07  -  GUIDE DRL 2MM 1.6MM	BOTH IP/OP	"$1,117.50 "	$826.95	$0.00	$894.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$829.41	$829.41	$0.00	$0.00	$232.89	$0.00	$0.00	$0.00	$0.00	$558.75	$885.06	$894.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5050-11	SUP	Custom 27203010		AR-5050-11  -  GUIDE DRL PRLL PTLR FX	BOTH IP/OP	"$1,402.50 "	"$1,037.85"	$0.00	"$1,122.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,040.94"	"$1,040.94"	$0.00	$0.00	$292.28	$0.00	$0.00	$0.00	$0.00	$701.25	"$1,110.78"	"$1,122.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5050K-2	SUP	Custom 27203010		AR-5050K-2  -  CANNULA ASCP 7MM 7CM STRL OBT THRD SHLDR DISP	BOTH IP/OP	$97.50 	$72.15	$0.00	$78.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.36	$72.36	$0.00	$0.00	$20.32	$0.00	$0.00	$0.00	$0.00	$48.75	$77.22	$78.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-24	SUP	HCPCS C1713		AR-5051-24  -  SCREW BN 4MM 24MM CNN BLNT TIP LOPRFL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-26	SUP	HCPCS C1713		AR-5051-26  -  SCREW BN 4MM 26MM CNN BLNT TIP LOPRFL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-28	SUP	HCPCS C1713		AR-5051-28  -  SCREW BN 4MM 28MM CNN BLNT TIP LOPRFL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-30	SUP	HCPCS C1713		AR-5051-30  -  SCREW BN 4MM 30MM CNN BLNT TIP LOPRFL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-32	SUP	HCPCS C1713		AR-5051-32  -  SCREW BN 4MM 32MM BLNT TIP CNN LG	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-34	SUP	HCPCS C1713		AR-5051-34  -  SCREW BN 4MM 34MM BLNT TIP CNN LG	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-36	SUP	HCPCS C1713		AR-5051-36  -  SCREW BN 4MM 36MM CNN BLNT TIP LOPRFL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-38	SUP	HCPCS C1713		AR-5051-38  -  SCREW BN 4MM 38MM CNN BLNT TIP LOPRFL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-40	SUP	HCPCS C1713		AR-5051-40  -  SCREW BN 4MM 40MM BLNT TIP CNN LG	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-42	SUP	HCPCS C1713		AR-5051-42  -  SCREW BN 4MM 42MM BLNT TIP CNN LG	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-44	SUP	HCPCS C1713		AR-5051-44  -  SCREW BN 4MM 44MM CNN BLNT LOPRFL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-46	SUP	HCPCS C1713		AR-5051-46  -  SCREW BN 4MM 46MM CNN BLNT LOPRFL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-48	SUP	HCPCS C1713		AR-5051-48  -  SCREW BN 4MM 48MM CNN BLNT TIP LOPRFL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-50	SUP	HCPCS C1713		AR-5051-50  -  SCREW BN 4MM 50MM CNN LOPRFL BLNT TIP	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-55	SUP	HCPCS C1713		AR-5051-55  -  SCREW BN 4MM 55MM CNN BLNT LOPRFL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5051-60	SUP	HCPCS C1713		AR-5051-60  -  SCREW BN 4MM 60MM CNN BLNT LOPRFL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5068-25TL	SUP	Custom 27203010		AR-5068-25TL  -  PASSER SUT 25D SUTLSO SD CRV LT SHFT TIGHT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5068-25TR	SUP	Custom 27203010		AR-5068-25TR  -  PASSER SUT 25D SUTLSO SD CRV RT SHFT TIGHT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5068-30	SUP	Custom 27203010		AR-5068-30  -  PASSER SUT 30D SUTLSO SD STRG SHFT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5068-45L	SUP	Custom 27203010		AR-5068-45L  -  PASSER SUT 45D SUTLSO SD CRV LT SHFT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5068-45R	SUP	Custom 27203010		AR-5068-45R  -  PASSER SUT 45D SUTLSO SD CRV RT SHFT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5068-90	SUP	Custom 27203010		AR-5068-90  -  PASSER SUT 90D SUTLSO SD STRG SHFT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5068-90L	SUP	Custom 27203010		AR-5068-90L  -  PASSER SUT 90D SUTLSO SD CRV LT SHFT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5068-90R	SUP	Custom 27203010		AR-5068-90R  -  PASSER SUT 90D SUTLSO SD CRV RT SHFT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5068-90T	SUP	Custom 27203010		AR-5068-90T  -  PASSER SUT 90D 2 SUTLSO SD SHFT STRG RT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5068C	SUP	Custom 27203010		AR-5068C  -  PASSER SUT SUTLSO SD CRSNT SHFT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5068H	SUP	Custom 27203010		AR-5068H  -  PASSER SUT SUTLSO HNDL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5080AB	SUP	HCPCS C1713		AR-5080AB  -  SCREW INTFR 50D 8MM 17MM STRL BCRTCL BCK END FLSH POLY L LAC	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5080BB	SUP	HCPCS C1713		AR-5080BB  -  SCREW INTFR 8MM 20MM STRL BCRTCL BCK END FLSH POLY L LAC ACD	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5090AB	SUP	HCPCS C1713		AR-5090AB  -  SCREW INTFR 50D 9MM 17MM STRL BCRTCL BCK END FLSH POLY L LAC	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5090BB	SUP	HCPCS C1713		AR-5090BB  -  SCREW INTFR 9MM 20MM STRL BCRTCL BCK END FLSH POLY L LAC ACD	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-10100	SUP	HCPCS C1776		AR-513-10100  -  EXTENSION STM 10MM 100MM IBALANCE SCR TIB	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-1050	SUP	HCPCS C1776		AR-513-1050  -  STEM XTN 10MM 50MM IBALANCE TKA SCR TIB	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-12100	SUP	HCPCS C1776		AR-513-12100  -  EXTENSION STM 12MM 100MM IBALANCE SCR TIB	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-1250	SUP	HCPCS C1776		AR-513-1250  -  COMPONENT FEM 12MM 50MM STRL IBALANCE ARTHX STM XTN CMNT T/K	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-14100	SUP	HCPCS C1776		AR-513-14100  -  EXTENSION STM 14MM 100MM IBALANCE SCR TIB	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-1450	SUP	HCPCS C1776		AR-513-1450  -  COMPONENT FEM 14MM 50MM STRL IBALANCE ARTHX STM XTN CMNT T/K	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL1010	SUP	HCPCS C1713		AR-513-RL1010  -  AUGMENT TIB 10 10MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL105	SUP	HCPCS C1713		AR-513-RL105  -  AUGMENT TIB 10 5MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL110	SUP	HCPCS C1713		AR-513-RL110  -  AUGMENT TIB 1 10MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL15	SUP	HCPCS C1713		AR-513-RL15  -  AUGMENT TIB 1 5MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL210	SUP	HCPCS C1713		AR-513-RL210  -  AUGMENT TIB 2 10MM IBALANCE SCR LT MDL RL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL25	SUP	HCPCS C1713		AR-513-RL25  -  AUGMENT TIB 2 5MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL310	SUP	HCPCS C1713		AR-513-RL310  -  AUGMENT TIB 3 10MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL35	SUP	HCPCS C1713		AR-513-RL35  -  AUGMENT TIB 3 5MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL410	SUP	HCPCS C1713		AR-513-RL410  -  AUGMENT TIB 4 10MM IBALANCE SCR LT MDL RL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL45	SUP	HCPCS C1713		AR-513-RL45  -  AUGMENT TIB 4 5MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL510	SUP	HCPCS C1713		AR-513-RL510  -  AUGMENT TIB 5 10MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL55	SUP	HCPCS C1713		AR-513-RL55  -  AUGMENT TIB 5 5MM IBALANCE SCR LT MDL RL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL610	SUP	HCPCS C1713		AR-513-RL610  -  AUGMENT TIB 6 10MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL65	SUP	HCPCS C1713		AR-513-RL65  -  AUGMENT TIB 5 5MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL710	SUP	HCPCS C1713		AR-513-RL710  -  AUGMENT TIB 7 10MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL75	SUP	HCPCS C1713		AR-513-RL75  -  AUGMENT TIB 7 5MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL810	SUP	HCPCS C1713		AR-513-RL810  -  AUGMENT TIB 8 10MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL85	SUP	HCPCS C1713		AR-513-RL85  -  AUGMENT TIB 8 5MM IBALANCE SCR LT MDL RL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL910	SUP	HCPCS C1713		AR-513-RL910  -  AUGMENT TIB 9 10MM IBALANCE SCR LT MDL RL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RL95	SUP	HCPCS C1713		AR-513-RL95  -  AUGMENT TIB 9 5MM IBALANCE SCR RL/LM TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM1010	SUP	HCPCS C1713		AR-513-RM1010  -  AUGMENT TIB 10 10MM IBALANCE SCR LT MDL RL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM105	SUP	HCPCS C1713		AR-513-RM105  -  AUGMENT TIB 10 5MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM110	SUP	HCPCS C1713		AR-513-RM110  -  AUGMENT TIB 1 10MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM15	SUP	HCPCS C1713		AR-513-RM15  -  AUGMENT TIB 1 5MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM210	SUP	HCPCS C1713		AR-513-RM210  -  AUGMENT TIB 2 10MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM25	SUP	HCPCS C1713		AR-513-RM25  -  AUGMENT TIB 2 5MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM310	SUP	HCPCS C1713		AR-513-RM310  -  AUGMENT TIB 3 10MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM35	SUP	HCPCS C1713		AR-513-RM35  -  AUGMENT TIB 3 5MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM410	SUP	HCPCS C1713		AR-513-RM410  -  AUGMENT TIB 4 10MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM45	SUP	HCPCS C1713		AR-513-RM45  -  AUGMENT TIB 4 5MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM510	SUP	HCPCS C1713		AR-513-RM510  -  AUGMENT TIB 5 10MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM55	SUP	HCPCS C1713		AR-513-RM55  -  AUGMENT TIB 5 5MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM610	SUP	HCPCS C1713		AR-513-RM610  -  AUGMENT TIB 6 10MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM65	SUP	HCPCS C1713		AR-513-RM65  -  AUGMENT TIB 6 5MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM710	SUP	HCPCS C1713		AR-513-RM710  -  AUGMENT TIB 7 10MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM75	SUP	HCPCS C1713		AR-513-RM75  -  AUGMENT TIB 7 5MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM810	SUP	HCPCS C1713		AR-513-RM810  -  AUGMENT TIB 8 10MM IBALANCE SCR LT MDL RL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM85	SUP	HCPCS C1713		AR-513-RM85  -  AUGMENT TIB 8 5MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM910	SUP	HCPCS C1713		AR-513-RM910  -  AUGMENT TIB 9 10MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-RM95	SUP	HCPCS C1713		AR-513-RM95  -  AUGMENT TIB 9 5MM IBALANCE SCR RMLL TKA	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-T1	SUP	HCPCS C1713		AR-513-T1  -  COMPONENT TIBTRY 1 STRL IBALANCE ARTHX MDLR T/K ARTHPL	BOTH IP/OP	"$6,175.00 "	"$4,569.50"	$0.00	"$4,940.00"	"$2,778.75"	"$2,778.75"	$0.00	$0.00	$0.00	"$1,287.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,286.87"	$0.00	"$3,044.28"	"$3,044.28"	$0.00	"$3,087.50"	"$4,890.60"	"$4,940.00"	$0.00		$0.00	$966.39	$0.00	$0.00	$983.06	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-T2	SUP	HCPCS C1713		AR-513-T2  -  COMPONENT TIBTRY 2 STRL IBALANCE ARTHX MDLR T/K ARTHPL	BOTH IP/OP	"$6,175.00 "	"$4,569.50"	$0.00	"$4,940.00"	"$2,778.75"	"$2,778.75"	$0.00	$0.00	$0.00	"$1,287.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,286.87"	$0.00	"$3,044.28"	"$3,044.28"	$0.00	"$3,087.50"	"$4,890.60"	"$4,940.00"	$0.00		$0.00	$966.39	$0.00	$0.00	$983.06	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-T5	SUP	HCPCS C1713		AR-513-T5  -  COMPONENT TIBTRY 5 STRL IBALANCE ARTHX MDLR T/K ARTHPL	BOTH IP/OP	"$6,175.00 "	"$4,569.50"	$0.00	"$4,940.00"	"$2,778.75"	"$2,778.75"	$0.00	$0.00	$0.00	"$1,287.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,286.87"	$0.00	"$3,044.28"	"$3,044.28"	$0.00	"$3,087.50"	"$4,890.60"	"$4,940.00"	$0.00		$0.00	$966.39	$0.00	$0.00	$983.06	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-T7	SUP	HCPCS C1713		AR-513-T7  -  COMPONENT TIBTRY 7 STRL IBALANCE ARTHX MDLR T/K ARTHPL	BOTH IP/OP	"$6,175.00 "	"$4,569.50"	$0.00	"$4,940.00"	"$2,778.75"	"$2,778.75"	$0.00	$0.00	$0.00	"$1,287.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,286.87"	$0.00	"$3,044.28"	"$3,044.28"	$0.00	"$3,087.50"	"$4,890.60"	"$4,940.00"	$0.00		$0.00	$966.39	$0.00	$0.00	$983.06	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-T8	SUP	HCPCS C1713		AR-513-T8  -  COMPONENT TIBTRY 8 STRL IBALANCE ARTHX MDLR T/K ARTHPL	BOTH IP/OP	"$6,175.00 "	"$4,569.50"	$0.00	"$4,940.00"	"$2,778.75"	"$2,778.75"	$0.00	$0.00	$0.00	"$1,287.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,286.87"	$0.00	"$3,044.28"	"$3,044.28"	$0.00	"$3,087.50"	"$4,890.60"	"$4,940.00"	$0.00		$0.00	$966.39	$0.00	$0.00	$983.06	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-T9	SUP	HCPCS C1713		AR-513-T9  -  COMPONENT TIBTRY 9 STRL IBALANCE ARTHX MDLR T/K ARTHPL	BOTH IP/OP	"$6,175.00 "	"$4,569.50"	$0.00	"$4,940.00"	"$2,778.75"	"$2,778.75"	$0.00	$0.00	$0.00	"$1,287.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,286.87"	$0.00	"$3,044.28"	"$3,044.28"	$0.00	"$3,087.50"	"$4,890.60"	"$4,940.00"	$0.00		$0.00	$966.39	$0.00	$0.00	$983.06	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-TL10	SUP	HCPCS C1713		AR-513-TL10  -  AUGMENT TIB 10MM LCK SCR	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-513-TL5	SUP	HCPCS C1713		AR-513-TL5  -  AUGMENT TIB 5MM LCK SCR KN	BOTH IP/OP	$167.50 	$123.95	$0.00	$134.00	$75.38	$75.38	$0.00	$0.00	$0.00	$34.91	$124.32	$124.32	$0.00	$0.00	$34.91	$0.00	$99.08	$99.08	$0.00	$83.75	$132.66	$134.00	$0.00		$0.00	$26.21	$0.00	$0.00	$26.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-516-5R	SUP	HCPCS C1776		AR-516-5R  -  COMPONENT FEM 5 IBALANCE CMNT POST STAB KN RT T/K ARTHPL	BOTH IP/OP	"$7,750.00 "	"$5,735.00"	$0.00	"$6,200.00"	"$3,487.50"	"$3,487.50"	$0.00	$0.00	$0.00	"$1,615.29"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,615.10"	$0.00	"$3,820.75"	"$3,820.75"	$0.00	"$3,875.00"	"$6,138.00"	"$6,200.00"	$0.00		$0.00	"$1,212.88"	$0.00	$0.00	"$1,233.80"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B1008	SUP	HCPCS C1776		"AR-523-B1008  -  PS TIBIAL BEARING, SIZE 10, 8MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B1009	SUP	HCPCS C1776		"AR-523-B1009  -  PS TIBIAL BEARING, SIZE 10, 9MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B1010	SUP	HCPCS C1776		"AR-523-B1010  -  PS TIBIAL BEARING, SIZE 10, 10MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B1011	SUP	HCPCS C1776		"AR-523-B1011  -  PS TIBIAL BEARING, SIZE 10, 11MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B1012	SUP	HCPCS C1776		"AR-523-B1012  -  PS TIBIAL BEARING, SIZE 10, 12MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B1013	SUP	HCPCS C1776		"AR-523-B1013  -  PS TIBIAL BEARING, SIZE 10, 13MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B1014	SUP	HCPCS C1776		"AR-523-B1014  -  PS TIBIAL BEARING, SIZE 10, 14MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B1016	SUP	HCPCS C1776		"AR-523-B1016  -  PS TIBIAL BEARING, SIZE 10, 16MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B1018	SUP	HCPCS C1776		"AR-523-B1018  -  PS TIBIAL BEARING, SIZE 10, 18MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B1020	SUP	HCPCS C1776		"AR-523-B1020  -  PS TIBIAL BEARING, SIZE 10, 20MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B108	SUP	HCPCS C1776		"AR-523-B108  -  PS TIBIAL BEARING, SIZE 1, 8MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B109	SUP	HCPCS C1776		"AR-523-B109  -  PS TIBIAL BEARING, SIZE 1, 9MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B110	SUP	HCPCS C1776		"AR-523-B110  -  PS TIBIAL BEARING, SIZE 1, 10MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B111	SUP	HCPCS C1776		"AR-523-B111  -  PS TIBIAL BEARING, SIZE 1, 11MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B112	SUP	HCPCS C1776		"AR-523-B112  -  PS TIBIAL BEARING, SIZE 1, 12MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B113	SUP	HCPCS C1776		"AR-523-B113  -  PS TIBIAL BEARING, SIZE 1, 13MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B114	SUP	HCPCS C1776		"AR-523-B114  -  PS TIBIAL BEARING, SIZE 1, 14MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B116	SUP	HCPCS C1776		"AR-523-B116  -  PS TIBIAL BEARING, SIZE 1, 16MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B118	SUP	HCPCS C1776		"AR-523-B118  -  PS TIBIAL BEARING, SIZE 1, 18MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B120	SUP	HCPCS C1776		"AR-523-B120  -  PS TIBIAL BEARING, SIZE 1, 20MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B208	SUP	HCPCS C1776		"AR-523-B208  -  PS TIBIAL BEARING, SIZE 2, 8MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B209	SUP	HCPCS C1776		"AR-523-B209  -  PS TIBIAL BEARING, SIZE 2, 9MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B210	SUP	HCPCS C1776		"AR-523-B210  -  PS TIBIAL BEARING, SIZE 2, 10MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B211	SUP	HCPCS C1776		"AR-523-B211  -  PS TIBIAL BEARING, SIZE 2, 11MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B212	SUP	HCPCS C1776		"AR-523-B212  -  PS TIBIAL BEARING, SIZE 2, 12MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B213	SUP	HCPCS C1776		"AR-523-B213  -  PS TIBIAL BEARING, SIZE 2, 13MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B214	SUP	HCPCS C1776		"AR-523-B214  -  PS TIBIAL BEARING, SIZE 2, 14MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B216	SUP	HCPCS C1776		"AR-523-B216  -  PS TIBIAL BEARING, SIZE 2, 16MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B218	SUP	HCPCS C1776		"AR-523-B218  -  PS TIBIAL BEARING, SIZE 2, 18MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B220	SUP	HCPCS C1776		"AR-523-B220  -  PS TIBIAL BEARING, SIZE 2, 20MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B308	SUP	HCPCS C1776		"AR-523-B308  -  PS TIBIAL BEARING, SIZE 3, 8MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B309	SUP	HCPCS C1776		"AR-523-B309  -  PS TIBIAL BEARING, SIZE 3, 9MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B310	SUP	HCPCS C1776		"AR-523-B310  -  PS TIBIAL BEARING, SIZE 3, 10MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B311	SUP	HCPCS C1776		"AR-523-B311  -  PS TIBIAL BEARING, SIZE 3, 11MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B312	SUP	HCPCS C1776		"AR-523-B312  -  PS TIBIAL BEARING, SIZE 3, 12MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B313	SUP	HCPCS C1776		"AR-523-B313  -  PS TIBIAL BEARING, SIZE 3, 13MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B314	SUP	HCPCS C1776		"AR-523-B314  -  PS TIBIAL BEARING, SIZE 3, 14MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B316	SUP	HCPCS C1776		"AR-523-B316  -  PS TIBIAL BEARING, SIZE 3, 16MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B318	SUP	HCPCS C1776		"AR-523-B318  -  PS TIBIAL BEARING, SIZE 3, 18MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B320	SUP	HCPCS C1776		"AR-523-B320  -  PS TIBIAL BEARING, SIZE 3, 20MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B408	SUP	HCPCS C1776		"AR-523-B408  -  PS TIBIAL BEARING, SIZE 4, 8MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B409	SUP	HCPCS C1776		"AR-523-B409  -  PS TIBIAL BEARING, SIZE 4, 9MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B410	SUP	HCPCS C1776		"AR-523-B410  -  PS TIBIAL BEARING, SIZE 4, 10MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B411	SUP	HCPCS C1776		"AR-523-B411  -  PS TIBIAL BEARING, SIZE 4, 11MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B412	SUP	HCPCS C1776		"AR-523-B412  -  PS TIBIAL BEARING, SIZE 4, 12MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B413	SUP	HCPCS C1776		"AR-523-B413  -  PS TIBIAL BEARING, SIZE 4, 13MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B414	SUP	HCPCS C1776		"AR-523-B414  -  PS TIBIAL BEARING, SIZE 4, 14MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B416	SUP	HCPCS C1776		"AR-523-B416  -  PS TIBIAL BEARING, SIZE 4, 16MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B418	SUP	HCPCS C1776		"AR-523-B418  -  PS TIBIAL BEARING, SIZE 4, 18MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B420	SUP	HCPCS C1776		"AR-523-B420  -  PS TIBIAL BEARING, SIZE 4, 20MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B508	SUP	HCPCS C1776		"AR-523-B508  -  PS TIBIAL BEARING, SIZE 5, 8MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B509	SUP	HCPCS C1776		"AR-523-B509  -  PS TIBIAL BEARING, SIZE 5, 9MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B510	SUP	HCPCS C1776		"AR-523-B510  -  PS TIBIAL BEARING, SIZE 5, 10MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B511	SUP	HCPCS C1776		"AR-523-B511  -  PS TIBIAL BEARING, SIZE 5, 11MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B512	SUP	HCPCS C1776		"AR-523-B512  -  PS TIBIAL BEARING, SIZE 5, 12MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B513	SUP	HCPCS C1776		"AR-523-B513  -  PS TIBIAL BEARING, SIZE 5, 13MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B514	SUP	HCPCS C1776		"AR-523-B514  -  PS TIBIAL BEARING, SIZE 5, 14MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B516	SUP	HCPCS C1776		"AR-523-B516  -  PS TIBIAL BEARING, SIZE 5, 16MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B518	SUP	HCPCS C1776		"AR-523-B518  -  PS TIBIAL BEARING, SIZE 5, 18MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B520	SUP	HCPCS C1776		"AR-523-B520  -  PS TIBIAL BEARING, SIZE 5, 20MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B608	SUP	HCPCS C1776		"AR-523-B608  -  PS TIBIAL BEARING, SIZE 6, 8MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B609	SUP	HCPCS C1776		"AR-523-B609  -  PS TIBIAL BEARING, SIZE 6, 9MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B610	SUP	HCPCS C1776		"AR-523-B610  -  PS TIBIAL BEARING, SIZE 6, 10MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B611	SUP	HCPCS C1776		"AR-523-B611  -  PS TIBIAL BEARING, SIZE 6, 11MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B612	SUP	HCPCS C1776		"AR-523-B612  -  PS TIBIAL BEARING, SIZE 6, 12MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B613	SUP	HCPCS C1776		"AR-523-B613  -  PS TIBIAL BEARING, SIZE 6, 13MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B614	SUP	HCPCS C1776		"AR-523-B614  -  PS TIBIAL BEARING, SIZE 6, 14MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B616	SUP	HCPCS C1776		"AR-523-B616  -  PS TIBIAL BEARING, SIZE 6, 16MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B618	SUP	HCPCS C1776		"AR-523-B618  -  PS TIBIAL BEARING, SIZE 6, 18MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B620	SUP	HCPCS C1776		"AR-523-B620  -  PS TIBIAL BEARING, SIZE 6, 20MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B708	SUP	HCPCS C1776		"AR-523-B708  -  PS TIBIAL BEARING, SIZE 7, 8MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B709	SUP	HCPCS C1776		"AR-523-B709  -  PS TIBIAL BEARING, SIZE 7, 9MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B710	SUP	HCPCS C1776		"AR-523-B710  -  PS TIBIAL BEARING, SIZE 7, 10MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B711	SUP	HCPCS C1776		"AR-523-B711  -  PS TIBIAL BEARING, SIZE 7, 11MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B712	SUP	HCPCS C1776		"AR-523-B712  -  PS TIBIAL BEARING, SIZE 7, 12MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B713	SUP	HCPCS C1776		"AR-523-B713  -  PS TIBIAL BEARING, SIZE 7, 13MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B714	SUP	HCPCS C1776		"AR-523-B714  -  PS TIBIAL BEARING, SIZE 7, 14MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B716	SUP	HCPCS C1776		"AR-523-B716  -  PS TIBIAL BEARING, SIZE 7, 16MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B718	SUP	HCPCS C1776		"AR-523-B718  -  PS TIBIAL BEARING, SIZE 7, 18MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B720	SUP	HCPCS C1776		"AR-523-B720  -  PS TIBIAL BEARING, SIZE 7, 20MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B808	SUP	HCPCS C1776		"AR-523-B808  -  PS TIBIAL BEARING, SIZE 8, 8MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B809	SUP	HCPCS C1776		"AR-523-B809  -  PS TIBIAL BEARING, SIZE 8, 9MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B810	SUP	HCPCS C1776		"AR-523-B810  -  PS TIBIAL BEARING, SIZE 8, 10MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B811	SUP	HCPCS C1776		"AR-523-B811  -  PS TIBIAL BEARING, SIZE 8, 11MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B812	SUP	HCPCS C1776		"AR-523-B812  -  PS TIBIAL BEARING, SIZE 8, 12MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B813	SUP	HCPCS C1776		"AR-523-B813  -  PS TIBIAL BEARING, SIZE 8, 13MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B814	SUP	HCPCS C1776		"AR-523-B814  -  PS TIBIAL BEARING, SIZE 8, 14MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B816	SUP	HCPCS C1776		"AR-523-B816  -  PS TIBIAL BEARING, SIZE 8, 16MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B818	SUP	HCPCS C1776		"AR-523-B818  -  PS TIBIAL BEARING, SIZE 8, 18MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B820	SUP	HCPCS C1776		"AR-523-B820  -  PS TIBIAL BEARING, SIZE 8, 20MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B908	SUP	HCPCS C1776		"AR-523-B908  -  PS TIBIAL BEARING, SIZE 9, 8MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B909	SUP	HCPCS C1776		"AR-523-B909  -  PS TIBIAL BEARING, SIZE 9, 9MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B910	SUP	HCPCS C1776		"AR-523-B910  -  PS TIBIAL BEARING, SIZE 9, 10MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B911	SUP	HCPCS C1776		"AR-523-B911  -  PS TIBIAL BEARING, SIZE 9, 11MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B912	SUP	HCPCS C1776		"AR-523-B912  -  PS TIBIAL BEARING, SIZE 9, 12MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B913	SUP	HCPCS C1776		"AR-523-B913  -  PS TIBIAL BEARING, SIZE 9, 13MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B914	SUP	HCPCS C1776		"AR-523-B914  -  PS TIBIAL BEARING, SIZE 9, 14MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B916	SUP	HCPCS C1776		"AR-523-B916  -  PS TIBIAL BEARING, SIZE 9, 16MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B918	SUP	HCPCS C1776		"AR-523-B918  -  PS TIBIAL BEARING, SIZE 9, 18MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-523-B920	SUP	HCPCS C1776		"AR-523-B920  -  PS TIBIAL BEARING, SIZE 9, 20MM, VIT E"	BOTH IP/OP	"$5,085.00 "	"$3,762.90"	$0.00	"$4,068.00"	"$2,288.25"	"$2,288.25"	$0.00	$0.00	$0.00	"$1,059.84"	"$3,774.09"	"$3,774.09"	$0.00	$0.00	"$1,059.71"	$0.00	"$2,506.91"	"$2,506.91"	$0.00	"$2,542.50"	"$4,027.32"	"$4,068.00"	$0.00		$0.00	$795.80	$0.00	$0.00	$809.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-524-PS328	SUP	HCPCS C1713		AR-524-PS328  -  DOME PTLR 32MM 8MM STRL LF ARTHX VIT E KN	BOTH IP/OP	"$2,967.50 "	"$2,195.95"	$0.00	"$2,374.00"	"$1,335.38"	"$1,335.38"	$0.00	$0.00	$0.00	$618.50	"$2,202.48"	"$2,202.48"	$0.00	$0.00	$618.43	$0.00	"$1,462.98"	"$1,462.98"	$0.00	"$1,483.75"	"$2,350.26"	"$2,374.00"	$0.00		$0.00	$464.41	$0.00	$0.00	$472.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-524-PSA8	SUP	HCPCS C1713		AR-524-PSA8  -  DOME PTLR 27MM 8MM STRL LF ARTHX VIT E KN	BOTH IP/OP	"$2,967.50 "	"$2,195.95"	$0.00	"$2,374.00"	"$1,335.38"	"$1,335.38"	$0.00	$0.00	$0.00	$618.50	"$2,202.48"	"$2,202.48"	$0.00	$0.00	$618.43	$0.00	"$1,462.98"	"$1,462.98"	$0.00	"$1,483.75"	"$2,350.26"	"$2,374.00"	$0.00		$0.00	$464.41	$0.00	$0.00	$472.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-524-PSB8	SUP	HCPCS C1713		AR-524-PSB8  -  DOME PTLR 30MM 8MM STRL LF ARTHX VIT E KN	BOTH IP/OP	"$2,967.50 "	"$2,195.95"	$0.00	"$2,374.00"	"$1,335.38"	"$1,335.38"	$0.00	$0.00	$0.00	$618.50	"$2,202.48"	"$2,202.48"	$0.00	$0.00	$618.43	$0.00	"$1,462.98"	"$1,462.98"	$0.00	"$1,483.75"	"$2,350.26"	"$2,374.00"	$0.00		$0.00	$464.41	$0.00	$0.00	$472.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-524-PSC9	SUP	HCPCS C1713		AR-524-PSC9  -  DOME PTLR 34MM 9MM STRL LF ARTHX VIT E	BOTH IP/OP	"$2,967.50 "	"$2,195.95"	$0.00	"$2,374.00"	"$1,335.38"	"$1,335.38"	$0.00	$0.00	$0.00	$618.50	"$2,202.48"	"$2,202.48"	$0.00	$0.00	$618.43	$0.00	"$1,462.98"	"$1,462.98"	$0.00	"$1,483.75"	"$2,350.26"	"$2,374.00"	$0.00		$0.00	$464.41	$0.00	$0.00	$472.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-524-PSD0	SUP	HCPCS C1713		AR-524-PSD0  -  DOME PTLR 37MM 10MM STRL LF ARTHX VIT E	BOTH IP/OP	"$2,967.50 "	"$2,195.95"	$0.00	"$2,374.00"	"$1,335.38"	"$1,335.38"	$0.00	$0.00	$0.00	$618.50	"$2,202.48"	"$2,202.48"	$0.00	$0.00	$618.43	$0.00	"$1,462.98"	"$1,462.98"	$0.00	"$1,483.75"	"$2,350.26"	"$2,374.00"	$0.00		$0.00	$464.41	$0.00	$0.00	$472.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-524-PSE0	SUP	HCPCS C1713		AR-524-PSE0  -  DOME PTLR 40MM 10MM STRL LF ARTHX VIT E KN	BOTH IP/OP	"$2,967.50 "	"$2,195.95"	$0.00	"$2,374.00"	"$1,335.38"	"$1,335.38"	$0.00	$0.00	$0.00	$618.50	"$2,202.48"	"$2,202.48"	$0.00	$0.00	$618.43	$0.00	"$1,462.98"	"$1,462.98"	$0.00	"$1,483.75"	"$2,350.26"	"$2,374.00"	$0.00		$0.00	$464.41	$0.00	$0.00	$472.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5503	SUP	Custom 27203010		AR-5503  -  GUIDE DRL PIN PRLL	BOTH IP/OP	"$1,390.30 "	"$1,028.82"	$0.00	"$1,112.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,031.88"	"$1,031.88"	$0.00	$0.00	$289.74	$0.00	$0.00	$0.00	$0.00	$695.15	"$1,101.12"	"$1,112.24"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5511-CP	SUP	HCPCS C1713		AR-5511-CP  -  KIT ARTHRO FIX INTERNALBRACE FIBERTAPE SWIVELOCK	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5600-01	SUP	Custom 27203010		AR-5600-01  -  GUIDE DRL OFST CRDL FISH MTH 4MM CHONDROGUARD NOVEL TIP XTN	BOTH IP/OP	"$1,497.50 "	"$1,108.15"	$0.00	"$1,198.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,111.44"	"$1,111.44"	$0.00	$0.00	$312.08	$0.00	$0.00	$0.00	$0.00	$748.75	"$1,186.02"	"$1,198.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-5600-02	SUP	Custom 27203010		AR-5600-02  -  GUIDE DRL OFST CRDL FISH MTH 6MM CHONDROGUARD NOVEL TIP XTN	BOTH IP/OP	"$1,497.50 "	"$1,108.15"	$0.00	"$1,198.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,111.44"	"$1,111.44"	$0.00	$0.00	$312.08	$0.00	$0.00	$0.00	$0.00	$748.75	"$1,186.02"	"$1,198.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-601-BBS0	SUP	Custom 27203010		AR-601-BBS0  -  BIT DRL 2.7MM TRMIT CNN SLF CMPR THRD PTCH	BOTH IP/OP	$850.00 	$629.00	$0.00	$680.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$630.87	$630.87	$0.00	$0.00	$177.14	$0.00	$0.00	$0.00	$0.00	$425.00	$673.20	$680.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-601-SB06	SUP	Custom 27203010		AR-601-SB06  -  INSERT TIB 6MM IBALANCE SPCR BLCK KN UNCNDL	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$0.00	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-601-SB07	SUP	Custom 27203010		AR-601-SB07  -  INSERT TIB 7MM IBALANCE SPCR BLCK KN UNCNDL	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$0.00	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-601-SB08	SUP	Custom 27203010		AR-601-SB08  -  INSERT TIB 8MM IBALANCE SPCR BLCK KN UNCNDL	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$0.00	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-601-SB09	SUP	Custom 27203010		AR-601-SB09  -  INSERT TIB 9MM IBALANCE SPCR BLCK KN UNCNDL	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$0.00	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-601-SB10	SUP	Custom 27203010		AR-601-SB10  -  INSERT TIB 10MM IBALANCE SPCR BLCK KN UNCNDL	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$0.00	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-602-44	SUP	Custom 27203010		AR-602-44  -  GUIDE DRL 27MM IBALANCE PTLR	BOTH IP/OP	$617.50 	$456.95	$0.00	$494.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$458.31	$458.31	$0.00	$0.00	$128.69	$0.00	$0.00	$0.00	$0.00	$308.75	$489.06	$494.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-602-45	SUP	Custom 27203010		AR-602-45  -  GUIDE DRL 30MM IBALANCE PTLR	BOTH IP/OP	$617.50 	$456.95	$0.00	$494.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$458.31	$458.31	$0.00	$0.00	$128.69	$0.00	$0.00	$0.00	$0.00	$308.75	$489.06	$494.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-602-46	SUP	Custom 27203010		AR-602-46  -  GUIDE DRL 34MM IBALANCE PTLR	BOTH IP/OP	$617.50 	$456.95	$0.00	$494.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$458.31	$458.31	$0.00	$0.00	$128.69	$0.00	$0.00	$0.00	$0.00	$308.75	$489.06	$494.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-602-47	SUP	Custom 27203010		AR-602-47  -  GUIDE DRL 37MM IBALANCE PTLR	BOTH IP/OP	$617.50 	$456.95	$0.00	$494.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$458.31	$458.31	$0.00	$0.00	$128.69	$0.00	$0.00	$0.00	$0.00	$308.75	$489.06	$494.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-602-49	SUP	Custom 27203010		AR-602-49  -  GUIDE DRL IBALANCE CMBN PTLR	BOTH IP/OP	$915.00 	$677.10	$0.00	$732.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$679.11	$679.11	$0.00	$0.00	$190.69	$0.00	$0.00	$0.00	$0.00	$457.50	$724.68	$732.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-603-85	SUP	Custom 27203010		AR-603-85  -  CLAMP SRG IBALANCE CMNT TMPLT PTLR	BOTH IP/OP	"$3,712.50 "	"$2,747.25"	$0.00	"$2,970.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,755.42"	"$2,755.42"	$0.00	$0.00	$773.69	$0.00	$0.00	$0.00	$0.00	"$1,856.25"	"$2,940.30"	"$2,970.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6068-25TL	SUP	Custom 27203010		AR-6068-25TL  -  PASSER SUTURE 25D SMALL TIGHT LEFT CURVE 8.25MM CANNU	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6068-25TR	SUP	Custom 27203010		AR-6068-25TR  -  PASSER SUT 25D SM TIGHT RT CRV 8.25MM STRL QUICKPASS SUTLSO	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6068-30	SUP	Custom 27203010		AR-6068-30  -  PASSER SUT 30D SM STRG 7MM STRL QUICKPASS SUTLSO CNN ERG	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6068-45L	SUP	Custom 27203010		AR-6068-45L  -  PASSER SUT 45D SM LT CRV 7MM STRL QUICKPASS SUTLSO CNN ERG	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6068-45R	SUP	Custom 27203010		AR-6068-45R  -  PASSER SUT 45D CRV QUICKPASS SUTLSO RT	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6068-90	SUP	Custom 27203010		AR-6068-90  -  PASSER SUTURE 90D SMALL STR 7MM CANNU ERGONOMIC HANDLE	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6068-90L	SUP	Custom 27203010		AR-6068-90L  -  PASSER SUT 90D SM LT CRV 8.25MM STRL QUICKPASS SUTLSO CNN	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6068-90R	SUP	Custom 27203010		AR-6068-90R  -  PASSER SUT 90D SM RT CRV 8.25MM STRL QUICKPASS SUTLSO CNN	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6068-90T	SUP	Custom 27203010		AR-6068-90T  -  PASSER SUT 90D SM TC 7MM STRL QUICKPASS SUTLSO CNN ERG HNDL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6069-45L	SUP	Custom 27203010		AR-6069-45L  -  PASSER SUT 45D 1 LT CRV 1.5MM 10YD BLU SUTLSO ERG HNDL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6069-45R	SUP	Custom 27203010		AR-6069-45R  -  PASSER SUT 45D 1 RT CRV 1.5MM 10YD BLU SUTLSO ERG HNDL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6069-90	SUP	Custom 27203010		AR-6069-90  -  PASSER SUT 90D STRG CRV SUTLSO REELPASS	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6506	SUP	Custom 27203010		AR-6506  -  CANNULA ASCP OPN	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$0.00	$0.00	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6507	SUP	Custom 27203010		AR-6507  -  CANNULA ASCP BLNT OPN	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$0.00	$0.00	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6507-01	SUP	Custom 27203010		AR-6507-01  -  CANNULA ASCP TPR OPN SHRP PLYCRB	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6507-02	SUP	Custom 27203010		AR-6507-02  -  CANNULA ASCP BLNT OPN SHRP PLYCRB	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6507-03	SUP	Custom 27203010		AR-6507-03  -  CANNULA ASCP TPR DTCH HNDL OPN MTL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6507-04	SUP	Custom 27203010		AR-6507-04  -  CANNULA ASCP BLNT DTCH HNDL OPN MTL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6520-15	SUP	Custom 27203010		AR-6520-15  -  STICK SWH LNG ACR CNN DTCH HNDL HIP	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$0.00	$0.00	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6520-16	SUP	Custom 27203010		AR-6520-16  -  STICK SWH LNG 3.5MM 15IN CNN	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$0.00	$0.00	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6521	SUP	Custom 27203010		AR-6521  -  NEEDLE ESCP STRL PIN REPL DISP PRTL DILATION SET ASCP	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$0.00	$0.00	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6523	SUP	Custom 27203010		AR-6523  -  NEEDLE ESCP BLNT STRL DISP PRTL DILATION SET ASCP	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$0.00	$0.00	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6526S	SUP	Custom 27203010		AR-6526S  -  KIT ENDSCP INSTR MSTR 1.5MM 14GA GWIRE KNF BLADE	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6527S	SUP	Custom 27203010		AR-6527S  -  KIT ESCP INST CRV BNA 14GA 1.5MM 35ML BLDE KNF PIN SYR NTNL	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$0.00	$0.00	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6528-07	SUP	Custom 27203010		AR-6528-07  -  PROBE ASCP 220MM NAV-X RND ABLT MNPLR STRBL COAG HIP	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6529-07	SUP	Custom 27203010		AR-6529-07  -  POST OP TBL PERI HDS	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6530	SUP	Custom 27203010		AR-6530  -  CANNU ARTHRO 7CM THRD TWST IN STRL DISP 8.25MM	BOTH IP/OP	$62.50 	$46.25	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6530N	SUP	Custom 27203010		AR-6530N  -  CANNU ARTHRO 7CM NTCH TWST IN STRL DISP 8.25MM	BOTH IP/OP	$62.50 	$46.25	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6532	SUP	Custom 27203010		AR-6532  -  CANNULA ASCP 5.5MM 9CM STRL OBT THRD SHLDR DISP	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6535	SUP	Custom 27203010		AR-6535  -  CANNULA ARTHRO 6MM 7CM OBTURATOR THREAD TWIST-IN TRANSLUCENT	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6535TD	SUP	Custom 27203010		AR-6535TD  -  CANNULA ASCP 6MM 7CM TWST-IN 3 DAM SDPRT LL CNCT VLV SWH	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6545	SUP	Custom 27203010		AR-6545  -  CANNULA ASCP 6MM 9CM TRNLU STRL TWST-IN OBT THRD SHLDR DISP	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6548	SUP	Custom 27203010		AR-6548  -  CANNULA ARTHRO LP OBTURATOR THREAD PUSHLOCK SHOULDER STERILE	BOTH IP/OP	$62.50 	$46.25	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6550TD	SUP	Custom 27203010		AR-6550TD  -  CANNULA ASCP 7MM 7CM TWST-IN 3 DAM SDPRT LL CNCT VLV SWH	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6551L	SUP	Custom 27203010		AR-6551L  -  CANNULA ASCP SM 6MM 7.75CM	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6560	SUP	Custom 27203010		AR-6560  -  CANNULA ASCP BRL 5.75MM 7CM TRNLU STRL CRYS DIST RING RTNT	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6560F	SUP	Custom 27203010		AR-6560F  -  CANNULA ASCP BRL 5.75MM 7CM TRNLU STRL CRYS DIST RING FLXB	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$0.00	$0.00	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6562	SUP	Custom 27203010		AR-6562  -  CANNULA ASCP BRL 5.75MM 7CM TRNLU STRL CRYS RTNT BWL SMTH	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6564	SUP	Custom 27203010		AR-6564  -  CANNULA ASCP P/T BRL 5.75MM 7CM TRNLU STRL CRYS RTNT BWL	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6565	SUP	Custom 27203010		AR-6565  -  CANNULA ASCP 6MM 9CM STRL SHOHN LNGTDNL SLOT OBT SHLDR DISP	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6566	SUP	Custom 27203010		AR-6566  -  CANNULA ASCP P/T 8.25MM 7CM TRNLU STRL FLXB OBT THRD ROTR	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6568	SUP	Custom 27203010		AR-6568  -  CANNULA ASCP SHRT P/T 5.75MM 5CM TRNLU CRYS	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6570	SUP	Custom 27203010		AR-6570  -  CANNULA ARTHRO 7MM 7CM OBTURATOR TWIST-IN TRANSLUCENT	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6570F	SUP	Custom 27203010		AR-6570F  -  CANNULA ASCP 7MM 7CM TRNLU STRL TWST-IN FLXB OBT SHLDR DISP	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$0.00	$0.00	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6570TD	SUP	Custom 27203010		AR-6570TD  -  CANNULA ASCP 7MM 7CM TWST-IN 3 DAM SDPRT LL CNCT VLV SWH	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6570TDNV	SUP	Custom 27203010		AR-6570TDNV  -  CANNULA ASCP 6MM 7CM TWST-IN 3 DAM SDPRT LL CNCT NO VLV	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6572	SUP	Custom 27203010		AR-6572  -  CANNULA ARTHRO LP 8.25MM 9CM SELF RETAINING SYSTEM GEMINI SR	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6575-09	SUP	Custom 27203010		AR-6575-09  -  CANNULA ASCP P/T 8.25MM 9CM TRNLU STRL OBT DISP	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6575-11	SUP	Custom 27203010		AR-6575-11  -  CANNULA ASCP P/T 8.25MM 11CM TRNLU STRL OBT DISP	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6576S-C	SUP	Custom 27203010		AR-6576S-C  -  SYSTEM ESCP XL ASCP C MNT HIP	BOTH IP/OP	"$69,755.00 "	"$51,618.70"	$0.00	"$54,824.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$14,536.94"	$0.00	$0.00	$0.00	$0.00	"$34,265.00"	"$54,275.76"	"$54,824.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6576S-E	SUP	Custom 27203010		AR-6576S-E  -  SYSTEM ESCP XL ASCP EYE PC HIP	BOTH IP/OP	"$62,280.00 "	"$46,087.20"	$0.00	"$48,844.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$12,979.15"	$0.00	$0.00	$0.00	$0.00	"$30,527.50"	"$48,355.56"	"$48,844.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6577-09	SUP	Custom 27203010		AR-6577-09  -  CANNULA ARTHRO PTHRD 7MM 9CM HIP STERILE	BOTH IP/OP	$62.50 	$46.25	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6577-11	SUP	Custom 27203010		AR-6577-11  -  CANNULA ASCP P/T 7MM 11CM STRL HIP	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6580	SUP	Custom 27203010		AR-6580  -  CANNULA ASCP 3.75MM 3 DAM	BOTH IP/OP	$343.75 	$254.38	$0.00	$275.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$255.13	$255.13	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$171.88	$272.25	$275.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6590	SUP	Custom 27203010		AR-6590  -  CANNULA ASCP TRMIT CSTM HIP	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$0.00	$0.00	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6590DT	SUP	Custom 27203010		AR-6590DT  -  CANNULA ASCP TRMIT DTCH OBT	BOTH IP/OP	$650.00 	$481.00	$0.00	$520.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.43	$482.43	$0.00	$0.00	$135.46	$0.00	$0.00	$0.00	$0.00	$325.00	$514.80	$520.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6590ST	SUP	Custom 27203010		AR-6590ST  -  STICK SWH 4MM TRMIT CNN CNN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592	SUP	Custom 27203010		AR-6592  -  CANNULA BTN CRV LOPRFL STRL LF PSPRT 1 PC MLD 2 DAM DSGN 2	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$0.00	$0.00	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-06-20	SUP	Custom 27203010		AR-6592-06-20  -  CANNULA BTN CRV LOPRFL 6MM 2CM STRL LF PSPRT 1 PC MLD 2 DAM	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-06-30	SUP	Custom 27203010		AR-6592-06-30  -  CANNULA BTN CRV LOPRFL 6MM 3CM STRL LF PSPRT 1 PC MLD 2 DAM	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-06-40	SUP	Custom 27203010		AR-6592-06-40  -  CANNULA BTN CRV LOPRFL 6MM 4CM STRL LF PSPRT 1 PC MLD 2 DAM	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-06-50	SUP	Custom 27203010		AR-6592-06-50  -  CANNULA BTN CRV LOPRFL 6MM 5CM STRL LF PSPRT 1 PC MLD 2 DAM	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-08-20	SUP	Custom 27203010		AR-6592-08-20  -  CANNULA BTN CRV LOPRFL 8MM 2CM STRL LF PSPRT 1 PC MLD 2 DAM	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-08-40	SUP	Custom 27203010		AR-6592-08-40  -  CANNULA BTN CRV LOPRFL 8MM 4CM STRL LF PSPRT 1 PC MLD 2 DAM	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-08-50	SUP	Custom 27203010		AR-6592-08-50  -  CANNULA BTN CRV LOPRFL 8MM 5CM STRL LF PSPRT 1 PC MLD 2 DAM	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-08-60	SUP	Custom 27203010		AR-6592-08-60  -  CANNULA BTN CRV LOPRFL 8MM 6CM STRL LF PSPRT 1 PC MLD 2 DAM	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-08-90	SUP	Custom 27203010		AR-6592-08-90  -  CANNULA BTN CRV LOPRFL 9MM 9CM STRL LF PSPRT 1 PC MLD 2 DAM	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-10-20	SUP	Custom 27203010		AR-6592-10-20  -  CANNULA BTN CRV LOPRFL 10MM 2CM STRL LF PSPRT 1 PC MLD 2 DAM	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-10-30	SUP	Custom 27203010		AR-6592-10-30  -  CANNU 3CM 10MM CANNU BTN PSPRT DISP STRL	BOTH IP/OP	$80.00 	$59.20	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$57.50	$91.08	$92.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-10-40	SUP	Custom 27203010		AR-6592-10-40  -  CANNULA BUTTON CURVE LP 10MM 4CM 1 PIECE MOLD 2 DAM DESIGN 2	BOTH IP/OP	$80.00 	$59.20	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$57.50	$91.08	$92.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6592-10-50	SUP	Custom 27203010		AR-6592-10-50  -  CANNULA BUTTON CURVE LP 10MM 5CM 1 PIECE MOLD 2 DAM DESIGN 2	BOTH IP/OP	$80.00 	$59.20	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$57.50	$91.08	$92.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-6955	SUP	HCPCS C1713		AR-6955  -  SET IMPL 2.7MM TRMIT TNL INSTRUMENTATION SET	BOTH IP/OP	"$4,917.50 "	"$3,638.95"	$0.00	"$3,934.00"	"$2,212.88"	"$2,212.88"	$0.00	$0.00	$0.00	"$1,024.93"	"$3,649.77"	"$3,649.77"	$0.00	$0.00	"$1,024.81"	$0.00	"$2,424.33"	"$2,424.33"	$0.00	"$2,458.75"	"$3,894.66"	"$3,934.00"	$0.00		$0.00	$769.59	$0.00	$0.00	$782.87	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-03	SUP	Custom 27203010		AR-7000-03  -  GUIDE DRL 4MM PRLL	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-04	SUP	Custom 27203010		AR-7000-04  -  GUIDE DRL 6MM PRLL	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-05	SUP	Custom 27203010		AR-7000-05  -  GUIDE DRL 8MM PRLL	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-07	SUP	Custom 27203010		AR-7000-07  -  GUIDE DRL CORACOID	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-14	SUP	Custom 27203010		AR-7000-14  -  DRILL SURG MINI .066IN 2.75MM CANN OPEN REPAIR	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-15	SUP	Custom 27803010		AR-7000-15  -  WASHER ORTHOPEDIC CANN SELF COMPRESS THREAD PITCH TITANIUM	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-16	SUP	Custom 27203010		AR-7000-16  -  GUIDE DRL PRLL	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$0.00	$0.00	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-17	SUP	Custom 27203010		AR-7000-17  -  GUIDE DRL SHLW CORACOID	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-18T	SUP	Custom 27803010		AR-7000-18T  -  WASHER ESCP 2 CRV FBRWR NDL SUT TI ASCP	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-26	SUP	HCPCS C1713		AR-7000-26  -  SCREW BN P/T 3.75MM 26MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-26FT	SUP	HCPCS C1713		AR-7000-26FT  -  SCREW BN FT 3.75MM 26MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-28	SUP	HCPCS C1713		AR-7000-28  -  SCREW BN P/T 3.75MM 28MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-28FT	SUP	HCPCS C1713		AR-7000-28FT  -  SCREW BN FT 3.75MM 28MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-30	SUP	HCPCS C1713		AR-7000-30  -  SCREW BN P/T 3.75MM 30MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-30FT	SUP	HCPCS C1713		AR-7000-30FT  -  SCREW BN FT 3.75MM 30MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-32	SUP	HCPCS C1713		AR-7000-32  -  SCREW BONE PTHRD 3.75MM 32MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-32FT	SUP	HCPCS C1713		AR-7000-32FT  -  SCREW BN FT 3.75MM 32MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-34	SUP	HCPCS C1713		AR-7000-34  -  SCREW BN P/T 3.75MM 34MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-34FT	SUP	HCPCS C1713		AR-7000-34FT  -  SCREW BONE 3.75MM 34MM TI FULTHD SHLDR GLND SLF	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-36	SUP	HCPCS C1713		AR-7000-36  -  SCREW BONE PTHRD 3.75MM 36MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-36FT	SUP	HCPCS C1713		AR-7000-36FT  -  SCREW BN FT 3.75MM 36MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-38	SUP	HCPCS C1713		AR-7000-38  -  SCREW BN P/T 3.75MM 38MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-38FT	SUP	HCPCS C1713		AR-7000-38FT  -  SCREW BN FT 3.75MM 38MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-40	SUP	HCPCS C1713		AR-7000-40  -  SCREW BONE PTHRD 3.75MM 40MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-40FT	SUP	HCPCS C1713		AR-7000-40FT  -  SCREW BN FT 3.75MM 40MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-42	SUP	HCPCS C1713		AR-7000-42  -  SCREW BONE PTHRD 3.75MM 42MM SELF DRILL SELF TAP CANN	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7000-42FT	SUP	HCPCS C1713		AR-7000-42FT  -  SCREW BN FT 3.75MM 42MM SLF DRL ST CNN TI SHLDR GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7199	SUP	Custom 27203010		AR-7199  -  DEVICE PSTN BLU WHT FINGERSHIELD LT OPN TIP MRKR PCTV RADOPQ	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$0.00	$0.00	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7200	SUP	Custom 27803010		AR-7200  -  SUTURE NABSB 2 T-5 38IN BLU FBRWR MS LWR KNT PRFL	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7200B	SUP	Custom 27803010		AR-7200B  -  SUTURE NABSB 2 TPR 38IN FBRWR BRD TIE MS LWR KNT PRFL NDL	BOTH IP/OP	$97.50 	$72.15	$0.00	$78.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.36	$72.36	$0.00	$0.00	$20.32	$0.00	$0.00	$0.00	$0.00	$48.75	$77.22	$78.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7201	SUP	Custom 27803010		AR-7201  -  SUTURE NABSB 2 .5 CRC STRG DMD PT RVRS CUT 38IN BLK BLU WHT	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$0.00	$0.00	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7202	SUP	Custom 27803010		AR-7202  -  SUTURE NABSB 2 C-13 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7203	SUP	Custom 27203010		AR-7203  -  SUTURE NABSB 2 38IN B/W TIGERWIRE BRD	BOTH IP/OP	$57.50 	$42.55	$0.00	$46.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.68	$42.68	$0.00	$0.00	$11.98	$0.00	$0.00	$0.00	$0.00	$28.75	$45.54	$46.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7204	SUP	Custom 27803010		AR-7204  -  SUTURE NABSB 2 STRG 26IN GRN 10MM FBRWR BRD MS CLS LOOP LWR	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7205	SUP	Custom 27803010		AR-7205  -  SUTURE NABSB 2 T-5 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7205T	SUP	Custom 27203010		AR-7205T  -  SUTURE NABSB 2 T-5 38IN B/W FVR TGRWR 2 ARM BRD TIE MS LWR	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7206	SUP	Custom 27803010		AR-7206  -  SUTURE NABSB 2 T-8 38IN BLU FBRWR 2 ARM BRD MS LWR KNT PRFL	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7207	SUP	Custom 27803010		AR-7207  -  SUTURE NABSB 2 38IN BLU 10MM FBRWR BRD TIE MS LWR KNT PRFL	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.22	$74.22	$0.00	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7208	SUP	Custom 27803010		AR-7208  -  SUTURE NABSB 2 T-5 38IN BLK BLU WHT FBRWR BRD TIE MS LWR KNT	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.06	$89.06	$0.00	$0.00	$25.01	$0.00	$0.00	$0.00	$0.00	$60.00	$95.04	$96.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7209	SUP	Custom 27803010		AR-7209  -  SUTURE NABSB 2 50IN 12IN FBSTK FBRWR 1 END STIFFEN	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7209T	SUP	HCPCS C1713		AR-7209T  -  SUTURE NONABSORBABLE 2 50IN 12IN 1 END STIFFEN MONOFILAMENT	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7210	SUP	Custom 27803010		AR-7210  -  SUTURE NABSB 5 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7211	SUP	Custom 27203010		AR-7211  -  SUTURE NABSB 5 CCS-1 38IN BLU FBRWR MS LWR KNT PRFL	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.22	$74.22	$0.00	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7212	SUP	Custom 27803010		AR-7212  -  SUTURE NABSB 5 .5 CRC 38IN BLK BLU WHT 48MM FBRWR CNV CUT	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7213	SUP	Custom 27803010		AR-7213  -  SUTURE NONABSORBABLE 5 T-5 CCS-1 38IN 48MM BRAID TIES	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.22	$74.22	$0.00	$0.00	$20.84	$0.00	$0.00	$0.00	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7216	SUP	Custom 27803010		AR-7216  -  SUTURE NABSB 1 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.97	$38.97	$0.00	$0.00	$10.94	$0.00	$0.00	$0.00	$0.00	$26.25	$41.58	$42.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7217	SUP	Custom 27803010		AR-7217  -  SUTURE NABSB 2 .5 CRC RVRS CUT 38IN BLK BLU WHT 36.6MM FBRWR	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.06	$89.06	$0.00	$0.00	$25.01	$0.00	$0.00	$0.00	$0.00	$60.00	$95.04	$96.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7220	SUP	Custom 27203010		AR-7220  -  SUTURE NABSB 2-0 T-13 18IN BLU FBRWR MS LWR KNT PRFL	BOTH IP/OP	$55.00 	$40.70	$0.00	$40.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$24.38	$38.61	$39.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7221	SUP	Custom 27803010		"AR-7221  -  FIBERWIRE, BRAIDED PB 2-0 SUTURE, BLUE"	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.97	$38.97	$0.00	$0.00	$10.94	$0.00	$0.00	$0.00	$0.00	$26.25	$41.58	$42.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7222	SUP	Custom 27803010		AR-7222  -  SUTURE NABSB 2-0 50IN BLU 12IN FBRWR FBSTK 1 END STIFFEN BRD	BOTH IP/OP	$105.00 	$77.70	$0.00	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.93	$77.93	$0.00	$0.00	$21.88	$0.00	$0.00	$0.00	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7223SM	SUP	Custom 27803010		AR-7223SM  -  SUTURE NABSB 2-0 SM STRL FBRWR BRD SWEDGE LO KNT PRFL MNSCS	BOTH IP/OP	$180.00 	$133.20	$0.00	$165.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$103.13	$163.35	$165.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7227-01	SUP	Custom 27803010		AR-7227-01  -  SUTURE NABSB 3-0 T-43 18IN BLU FBRWR BRD TIE MS LWR KNT PRFL	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7227-02	SUP	Custom 27803010		AR-7227-02  -  SUTURE NABSB 3-0 C-22 18IN BLU FBRWR BRD TIE MS LWR KNT PRFL	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7228	SUP	Custom 27803010		AR-7228  -  SUTURE NABSB 4-0 DE-10 18IN BLU FBRWR BRD TIE MS LWR KNT	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7229-12	SUP	Custom 27203010		AR-7229-12  -  SUTURE NABSB 4-0 T-13 12IN BLU FIBERLOOP MS	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7229-20	SUP	Custom 27203010		AR-7229-20  -  SUTURE NABSB 4-0 3/8 CRC 10IN BLU 17.9MM FIBERLOOP TPR NDL	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7230-01	SUP	Custom 27803010		AR-7230-01  -  SUTURE NABSB 4-0 T-12 18IN BLU FBRWR MS LWR KNT PRFL	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7230-02	SUP	Custom 27803010		AR-7230-02  -  SUTURE NABSB 4-0 C-17 18IN BLU FBRWR BRD TIE MS LWR KNT PRFL	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7232-01	SUP	Custom 27203010		AR-7232-01  -  SUTURE NABSB 2-0 D-17 60IN BLU FIBERLOOP 2 ARM MS	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7232-02	SUP	Custom 27203010		AR-7232-02  -  SUTURE NABSB 2-0 D-14 24IN BLU FIBERLOOP 2 ARM MS	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7232-03	SUP	Custom 27203010		AR-7232-03  -  SUTURE NABSB 2-0 SD-2 13IN BLU FIBERLOOP 2 ARM MS	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7232-05	SUP	Custom 27203010		AR-7232-05  -  SUTURE NABSB 2-0 3/8 CRC TPR PNT 14IN 17.9MM FIBERLOOP LOOP	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7233	SUP	Custom 27803010		AR-7233  -  SUTURE NABSB 2 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.97	$38.97	$0.00	$0.00	$10.94	$0.00	$0.00	$0.00	$0.00	$26.25	$41.58	$42.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7234	SUP	Custom 27203010		AR-7234  -  SUTURE NONABSORBABLE 2 7MM STR 20IN 76MM BRAID MULTISTRAND	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7234-01	SUP	Custom 27203010		AR-7234-01  -  SUTURE NABSB 2 7MM STRG 20IN WHT 76MM FIBERLOOP BRD MS NDL	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7234B	SUP	Custom 27203010		AR-7234B  -  SUTURE NABSB 2 STRG 20IN BLU 76MM FIBERLOOP BRD MS NDL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7234C	SUP	Custom 27203010		AR-7234C  -  SUTURE NONABSORBABLE 2 .5 CIR CURVE 20IN BRAID MULTISTRAND	BOTH IP/OP	$125.00 	$92.50	$0.00	$129.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$80.63	$127.71	$129.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7234T	SUP	Custom 27203010		AR-7234T  -  SUTURE NONABSORBABLE 2 STR 20IN 3IN BRAID MULTISTRAND NEEDLE	BOTH IP/OP	$125.00 	$92.50	$0.00	$129.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$80.63	$127.71	$129.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7235	SUP	Custom 27203010		AR-7235  -  SUTURE NONABSORBABLE 2 26IN 1.5IN BRAID TIES MULTISTRAND	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7235T	SUP	Custom 27203010		AR-7235T  -  SUTURE NABSB 2 26IN B/W TIGERLINK FBRWR CLS LOOP	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.05	$102.05	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7237	SUP	Custom 27803010		AR-7237  -  SUTURE NABSB 2 TPR 54IN BLU 36INX2MM FIBERTAPE FBRWR BRD	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$0.00	$0.00	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7237-17LN	SUP	Custom 27803010		AR-7237-17LN  -  SUTURE NABSB 2MM STRG 17IN BLU FIBERTAPE BRD	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7237-17N	SUP	Custom 27803010		AR-7237-17N  -  SUTURE NABSB 2 .5 CRC TPR 17IN BLU 26.5MM FIBERTAPE FBRWR	BOTH IP/OP	$190.00 	$140.60	$0.00	$152.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.02	$141.02	$0.00	$0.00	$39.60	$0.00	$0.00	$0.00	$0.00	$95.00	$150.48	$152.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7237-7	SUP	Custom 27803010		AR-7237-7  -  SUTURE NONABSORBABLE 2 TAPER 7INX2MM BRAID FIBERTAPE	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7237-7T	SUP	Custom 27203010		AR-7237-7T  -  SUTURE NABSB 2 TPR 7INX2MM B/W TIGERTAPE TIGERWIRE BRD	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7240	SUP	Custom 27803010		AR-7240  -  SUTURE NONABSORBABLE 2 38IN BRAID 2 STRAND LOWER KNOT	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$0.00	$0.00	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7242	SUP	Custom 27203010		AR-7242  -  SUTURE NABSB 2-0 T-5 18IN BLU TIGERTAPE FBRWR BRD TIE MS	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7246	SUP	Custom 27803010		AR-7246  -  SUTURE NABSB 2 STRG DMD 38IN BLU 26.5MM FBRWR 1 END NDL	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7246-02	SUP	Custom 27803010		AR-7246-02  -  SUTURE NABSB 2 STRG DMD 38IN BLU 64MM FBRWR 1 END 2 NDL	BOTH IP/OP	$110.00 	$81.40	$0.00	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.64	$81.64	$0.00	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7248	SUP	Custom 27803010		AR-7248  -  SUTURE NABSB 4-0 T-22 18IN WHT FBRWR BRD TIE MS LWR KNT PRFL	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7249-12	SUP	Custom 27203010		AR-7249-12  -  SUTURE NABSB 4-0 T-22 6IN WHT FIBERLOOP MS	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7249-20	SUP	Custom 27203010		AR-7249-20  -  SUTURE NABSB 4-0 T-22 10IN WHT FIBERLOOP MS	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7250	SUP	Custom 27803010		AR-7250  -  SUTURE NABSB 0 T-4 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7251	SUP	Custom 27803010		AR-7251  -  SUTURE NABSB 0 D-10 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7253	SUP	Custom 27203010		AR-7253  -  SUTURE NABSB 0 7MM STRG 13IN BLU 76MM FIBERLOOP BRD MS	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7253T	SUP	Custom 27203010		AR-7253T  -  SUTURE NABSB 0 7MM STRG 13IN B/W 76MM FIBERLOOP TIGERLOOP	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7254	SUP	Custom 27803010		AR-7254  -  SUTURE NABSB 0 FBRWR	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.97	$38.97	$0.00	$0.00	$10.94	$0.00	$0.00	$0.00	$0.00	$26.25	$41.58	$42.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7255	SUP	Custom 27803010		AR-7255  -  SUTURE NABSB 0 38IN WHT FBRWR LWR KNT PRFL SMTH TIE ABL SUP	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$0.00	$0.00	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7258	SUP	Custom 27203010		AR-7258  -  SUTURE NABSB 0 36IN BLU 1.5IN FIBERLINK LOOP	BOTH IP/OP	"$1,950.00 "	"$1,443.00"	$0.00	"$1,560.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,447.29"	"$1,447.29"	$0.00	$0.00	$406.38	$0.00	$0.00	$0.00	$0.00	$975.00	"$1,544.40"	"$1,560.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7258T	SUP	Custom 27203010		AR-7258T  -  SUTURE NABSB 0 36IN 1.5IN TIGERLINK LOOP	BOTH IP/OP	"$1,950.00 "	"$1,443.00"	$0.00	"$1,560.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,447.29"	"$1,447.29"	$0.00	$0.00	$406.38	$0.00	$0.00	$0.00	$0.00	$975.00	"$1,544.40"	"$1,560.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7264	SUP	Custom 27803010		AR-7264  -  SUTURE NABSB 2 FIBERTAG SPEEDWHIP FIBERLOOP	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7270	SUP	Custom 27803010		AR-7270  -  SUTURE NABSB 2 10 LNG LOOP 7MM FBRWR FIBERCHAIN BRD	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7272	SUP	Custom 27803010		AR-7272  -  FIBERWIRE CL WHITE BLUE 38IN	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.97	$38.97	$0.00	$0.00	$10.94	$0.00	$0.00	$0.00	$0.00	$26.25	$41.58	$42.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7272T	SUP	Custom 27203010		AR-7272T  -  TIGERWIRE CL WHITE BLACK 38IN W  NDL	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$0.00	$0.00	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7275	SUP	Custom 27803010		AR-7275  -  SUTURE NONABSORBABLE 2 2MM 8IN 24IN FIBERTAPE FIBERWIRE BLUE	BOTH IP/OP	$175.00 	$129.50	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7275T	SUP	Custom 27203010		AR-7275T  -  SUTURE NONABSORBABLE 2 2MM 8IN 24IN TIGERTAPE TIGERWIRE BLUE	BOTH IP/OP	$175.00 	$129.50	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7276	SUP	Custom 27203010		AR-7276  -  SUTURE NABSB 1.5MM 36IN WHT LABRALTAPE	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7276T	SUP	Custom 27203010		AR-7276T  -  SUTURE NONABSORBABLE 1.5MM 36IN LABRALTAPE BLACK WHITE	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7280	SUP	Custom 27203010		AR-7280  -  NEEDLE SUT C-13 .5 CRC RVRS CUT 36.6MM LOOP NTNL	BOTH IP/OP	$47.50 	$35.15	$0.00	$38.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.25	$35.25	$0.00	$0.00	$9.90	$0.00	$0.00	$0.00	$0.00	$23.75	$37.62	$38.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7281	SUP	Custom 27203010		AR-7281  -  NEEDLE SUT T-5 .5 CRC TPR 26.5MM BTNDS LOOP NTNL DISP	BOTH IP/OP	$47.50 	$35.15	$0.00	$38.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.25	$35.25	$0.00	$0.00	$9.90	$0.00	$0.00	$0.00	$0.00	$23.75	$37.62	$38.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7282	SUP	Custom 27203010		AR-7282  -  PASSER SUT 1 FBRWR LOOP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7284	SUP	Custom 27203010		AR-7284  -  SUTURE NABSB 2 FIBERLOOP SWAGE STRG NDL	BOTH IP/OP	"$1,950.00 "	"$1,443.00"	$0.00	"$1,560.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,447.29"	"$1,447.29"	$0.00	$0.00	$406.38	$0.00	$0.00	$0.00	$0.00	$975.00	"$1,544.40"	"$1,560.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7300DS	SUP	Custom 27203010		AR-7300DS  -  BLADE SHVR 3MM 7CM STRL COOLCUT ASCP DSCT S JNT DISP	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7300OBT	SUP	Custom 27203010		AR-7300OBT  -  BURR SHVR 10 FLUT OVL3MM S JNT	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7324PSL	SUP	HCPCS C1713		AR-7324PSL  -  ANCHOR SUT SWIVELOCK TENODESIS PEEK	BOTH IP/OP	"$1,087.50 "	$804.75	$0.00	$870.00	$489.38	$489.38	$0.00	$0.00	$0.00	$226.66	$807.14	$807.14	$0.00	$0.00	$226.64	$0.00	$643.26	$643.26	$0.00	$543.75	$861.30	$870.00	$0.00		$0.00	$170.19	$0.00	$0.00	$173.13	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7400TD	SUP	Custom 27203010		AR-7400TD  -  BLADE SHVR 4MM 7CM TORPEDO COOLCUT OVIOD OUTR WDW SMTH CUT	BOTH IP/OP	$252.50 	$186.85	$0.00	$202.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.41	$187.41	$0.00	$0.00	$52.62	$0.00	$0.00	$0.00	$0.00	$126.25	$199.98	$202.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7500	SUP	Custom 27203010		AR-7500  -  SUTURE NABSB 1.3MM 36IN WHT BLU STRL SUTURETAPE .5 CRC TPR	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$0.00	$0.00	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7710	SUP	Custom 27203010		AR-7710  -  BIT DRL 5MM 15MM SCKT HUM TNL ULN COLLATERAL LGMNT	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$0.00	$0.00	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7710-4.5	SUP	Custom 27203010		AR-7710-4.5  -  BIT DRL 4.5MM HUM TNL ULN COLLATERAL LGMNT	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$0.00	$0.00	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7710-5.0	SUP	Custom 27203010		AR-7710-5.0  -  BIT DRL 5MM HUM TNL ULN COLLATERAL LGMNT	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$0.00	$0.00	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7711	SUP	Custom 27203010		AR-7711  -  BIT DRL 4.5MM 15MM SCKT HUM TNL ULN COLLATERAL LGMNT	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$0.00	$0.00	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7715-4.5	SUP	Custom 27203010		AR-7715-4.5  -  KIT INST 2 MIC CRV 6IN STRL TIGERLOOP FIBERLOOP SUTLSO NDL	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	$0.00	$0.00	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7720-2.0	SUP	Custom 27203010		AR-7720-2.0  -  DRILL SRG 2MM RECON ELB HUM ULN COLLATERAL LGMNT	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$0.00	$0.00	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7720-2.7	SUP	Custom 27203010		AR-7720-2.7  -  DRILL SRG 2.7MM HUM	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$0.00	$0.00	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7720-3.2	SUP	Custom 27203010		AR-7720-3.2  -  DRILL SRG 3.2MM HUM	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$0.00	$0.00	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7720-3.5	SUP	Custom 27203010		AR-7720-3.5  -  DRILL SRG 3.5MM RECON ELB HUM ULN COLLATERAL LGMNT	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$0.00	$0.00	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7720-4.0	SUP	Custom 27203010		AR-7720-4.0  -  DRILL SRG 4MM RECON ELB HUM ULN COLLATERAL LGMNT	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$0.00	$0.00	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7750-3.5	SUP	Custom 27203010		AR-7750-3.5  -  GUIDE DRL V 3.5MM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7750-55	SUP	Custom 27203010		AR-7750-55  -  GUIDE DRL 55D V ULNA	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7750-55M	SUP	Custom 27203010		AR-7750-55M  -  GUIDE DRL 55D V PRT ULNA	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7752	SUP	Custom 27203010		AR-7752  -  GUIDE DRL 3.5MM	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$0.00	$0.00	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-7755	SUP	Custom 27203010		AR-7755  -  GUIDE DRL OFST 7MM ULNA	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8003-10	SUP	HCPCS C1713		AR-8003-10  -  STAPLE BN 10X10MM CMPR SS	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8003-15	SUP	HCPCS C1713		AR-8003-15  -  STAPLE BN 15X10MM CMPR SS	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8004-10	SUP	HCPCS C1713		AR-8004-10  -  STAPLE BN 10X15MM CMPR SS	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8004-15	SUP	HCPCS C1713		AR-8004-15  -  STAPLE BN 15X15MM CMPR SS DISP	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8005-20	SUP	HCPCS C1713		AR-8005-20  -  STAPLE BN 20X20MM CMPR SS DISP	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8005D-20	SUP	Custom 27203010		AR-8005D-20  -  BIT DRL 2MM 120MM CNN	BOTH IP/OP	$347.50 	$257.15	$0.00	$278.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.91	$257.91	$0.00	$0.00	$72.42	$0.00	$0.00	$0.00	$0.00	$173.75	$275.22	$278.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8005D-30	SUP	Custom 27203010		AR-8005D-30  -  BIT DRL 3MM 120MM CNN	BOTH IP/OP	$347.50 	$257.15	$0.00	$278.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.91	$257.91	$0.00	$0.00	$72.42	$0.00	$0.00	$0.00	$0.00	$173.75	$275.22	$278.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8006-20	SUP	HCPCS C1713		AR-8006-20  -  PLATE BN 20MM 2 CMPR 2 HL SS FT/ANKL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8006-25	SUP	HCPCS C1713		AR-8006-25  -  PLATE BN 25MM 2 CMPR 2 HL SS FT/ANKL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8006-30	SUP	HCPCS C1713		AR-8006-30  -  PLATE BN 30MM 2 CMPR 2 HL SS FT/ANKL	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8006C	SUP	Custom 27203010		AR-8006C  -  BIT DRL 2.4MM TRMIT CNN SLF CMPR THRD PTCH	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	$0.00	$0.00	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8006S	SUP	Custom 27203010		AR-8006S  -  BIT DRL 2.5MM LAPIDUS CNN SLF CMPR THRD PTCH MIDFOOT	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	$0.00	$0.00	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8006T	SUP	HCPCS C1713		AR-8006T  -  PLATE BN TRL 2 HL 2 CMPR	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8007-20	SUP	HCPCS C1713		AR-8007-20  -  PLATE BN 20MM 2 CMPR 3 HL SS FT/ANKL	BOTH IP/OP	"$2,487.50 "	"$1,840.75"	$0.00	"$1,990.00"	"$1,119.38"	"$1,119.38"	$0.00	$0.00	$0.00	$518.46	"$1,846.22"	"$1,846.22"	$0.00	$0.00	$518.40	$0.00	"$1,471.36"	"$1,471.36"	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$389.29	$0.00	$0.00	$396.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8007-25	SUP	HCPCS C1713		AR-8007-25  -  PLATE BN 25MM 2 CMPR 3 HL SS FT/ANKL	BOTH IP/OP	"$2,487.50 "	"$1,840.75"	$0.00	"$1,990.00"	"$1,119.38"	"$1,119.38"	$0.00	$0.00	$0.00	$518.46	"$1,846.22"	"$1,846.22"	$0.00	$0.00	$518.40	$0.00	"$1,471.36"	"$1,471.36"	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$389.29	$0.00	$0.00	$396.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8007-30	SUP	HCPCS C1713		AR-8007-30  -  PLATE BN 30MM 2 CMPR 3 HL SS FT/ANKL	BOTH IP/OP	"$2,487.50 "	"$1,840.75"	$0.00	"$1,990.00"	"$1,119.38"	"$1,119.38"	$0.00	$0.00	$0.00	$518.46	"$1,846.22"	"$1,846.22"	$0.00	$0.00	$518.40	$0.00	"$1,471.36"	"$1,471.36"	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$389.29	$0.00	$0.00	$396.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8007C-1	SUP	HCPCS C1713		AR-8007C-1  -  CASE INST 2 CMPR	BOTH IP/OP	"$4,737.50 "	"$3,505.75"	$0.00	"$3,790.00"	"$2,131.88"	"$2,131.88"	$0.00	$0.00	$0.00	$987.41	"$3,516.17"	"$3,516.17"	$0.00	$0.00	$987.30	$0.00	"$2,335.59"	"$2,335.59"	$0.00	"$2,368.75"	"$3,752.10"	"$3,790.00"	$0.00		$0.00	$741.42	$0.00	$0.00	$754.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8007T	SUP	HCPCS C1713		AR-8007T  -  TRIAL TRMA 3 HL 2 CMPR PLT	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8008-20	SUP	HCPCS C1713		AR-8008-20  -  PLATE BN STRG 20MM 2 CMPR 4 HL SS FT/ANKL	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8008-25	SUP	HCPCS C1713		AR-8008-25  -  PLATE BN STRG 25MM 2 CMPR 4 HL SS FT/ANKL	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8008-30	SUP	HCPCS C1713		AR-8008-30  -  PLATE BN STRG 30MM 2 CMPR 4 HL SS FT/ANKL	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8009-20	SUP	HCPCS C1713		AR-8009-20  -  PLATE BN SQ 20MM 2 CMPR 4 HL SS FT/ANKL	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8009-25	SUP	HCPCS C1713		AR-8009-25  -  PLATE BN SQ 25MM 2 CMPR 4 HL SS FT/ANKL	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8009-30	SUP	HCPCS C1713		AR-8009-30  -  PLATE BN SQ 30MM 2 CMPR 4 HL SS FT/ANKL	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8400CSS	SUP	Custom 27203010		AR-8400CSS  -  BURR SHVR 6 FLUT 4MM 13CM STRL CLRCT COOLCUT SLAP	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8400EX	SUP	Custom 27203010		AR-8400EX  -  BLADE SHVR 4MM 13CM STRL EXCLBR COOLCUT DISP	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8400OBE	SUP	Custom 27203010		AR-8400OBE  -  BURR SHVR 8 FLUT OVL 4MM 13CM STRL COOLCUT DISP	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8500BC	SUP	Custom 27203010		AR-8500BC  -  CUTTER BN CUT 5MM 13CM STRL COOLCUT DISP	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8500EX	SUP	Custom 27203010		AR-8500EX  -  BLADE SHVR 5MM 13CM STRL EXCLBR COOLCUT DISP	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8500OBE	SUP	Custom 27203010		AR-8500OBE  -  BURR SHVR 8 FLUT OVL 5MM 13CM STRL COOLCUT DISP	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-16	SUP	HCPCS C1713		AR-8545-16  -  SCREW BN LOPRFL 4.5MM 16MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-18	SUP	HCPCS C1713		AR-8545-18  -  SCREW BN LOPRFL 4.5MM 18MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-20	SUP	HCPCS C1713		AR-8545-20  -  SCREW BN LOPRFL 4.5MM 20MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-22	SUP	HCPCS C1713		AR-8545-22  -  SCREW BN LOPRFL 4.5MM 22MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-24	SUP	HCPCS C1713		AR-8545-24  -  SCREW BN LOPRFL 4.5MM 24MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-26	SUP	HCPCS C1713		AR-8545-26  -  SCREW BN LOPRFL 4.5MM 26MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-28	SUP	HCPCS C1713		AR-8545-28  -  SCREW BN LOPRFL 4.5MM 28MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-30	SUP	HCPCS C1713		AR-8545-30  -  SCREW BN LOPRFL 4.5MM 30MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-32	SUP	HCPCS C1713		AR-8545-32  -  SCREW BN LOPRFL 4.5MM 32MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-34	SUP	HCPCS C1713		AR-8545-34  -  SCREW BN LOPRFL 4.5MM 34MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-36	SUP	HCPCS C1713		AR-8545-36  -  SCREW BN LOPRFL 4.5MM 36MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-38	SUP	HCPCS C1713		AR-8545-38  -  SCREW BN LOPRFL 4.5MM 38MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-40	SUP	HCPCS C1713		AR-8545-40  -  SCREW BN LOPRFL 4.5MM 40MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-42	SUP	HCPCS C1713		AR-8545-42  -  SCREW BN 4.5MM 42MM NS ARTHX LOPRFL TI	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-45	SUP	HCPCS C1713		AR-8545-45  -  SCREW BN LOPRFL 4.5MM 45MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-48	SUP	HCPCS C1713		AR-8545-48  -  SCREW BN 4.5MM 48MM LOPRFL TI	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-50	SUP	HCPCS C1713		AR-8545-50  -  SCREW BN LOPRFL 4.5MM 50MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-55	SUP	HCPCS C1713		AR-8545-55  -  SCREW BN LOPRFL 4.5MM 55MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-60	SUP	HCPCS C1713		AR-8545-60  -  SCREW BN LOPRFL 4.5MM 60MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545-65	SUP	HCPCS C1713		AR-8545-65  -  SCREW BN LOPRFL 4.5MM 65MM ANKL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-16	SUP	HCPCS C1713		AR-8545L-16  -  SCREW BN LOPRFL 4.5MM 16MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-18	SUP	HCPCS C1713		AR-8545L-18  -  SCREW BN LOPRFL 4.5MM 18MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-20	SUP	HCPCS C1713		AR-8545L-20  -  SCREW BN LOPRFL 4.5MM 20MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-22	SUP	HCPCS C1713		AR-8545L-22  -  SCREW BN LOPRFL 4.5MM 22MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-24	SUP	HCPCS C1713		AR-8545L-24  -  SCREW BN LOPRFL 4.5MM 24MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-26	SUP	HCPCS C1713		AR-8545L-26  -  SCREW BN LOPRFL 4.5MM 26MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-28	SUP	HCPCS C1713		AR-8545L-28  -  SCREW BN LOPRFL 4.5MM 28MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-30	SUP	HCPCS C1713		AR-8545L-30  -  SCREW BN LOPRFL 4.5MM 30MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-32	SUP	HCPCS C1713		AR-8545L-32  -  SCREW BN LOPRFL 4.5MM 32MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-34	SUP	HCPCS C1713		AR-8545L-34  -  SCREW BN LOPRFL 4.5MM 34MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-36	SUP	HCPCS C1713		AR-8545L-36  -  SCREW BN LOPRFL 4.5MM 36MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-38	SUP	HCPCS C1713		AR-8545L-38  -  SCREW BN LOPRFL 4.5MM 38MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-40	SUP	HCPCS C1713		AR-8545L-40  -  SCREW BN LOPRFL 4.5MM 40MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-44	SUP	HCPCS C1713		AR-8545L-44  -  SCREW BN 4.5MM 44MM NS ARTHX LCK LOPRFL TI	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-50	SUP	HCPCS C1713		AR-8545L-50  -  SCREW BN LOPRFL 4.5MM 50MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-50S	SUP	HCPCS C1713		AR-8545L-50S  -  SCREW BN 4.5MM 50MM STRL ARTHX LOPRFL LCK	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-52	SUP	HCPCS C1713		AR-8545L-52  -  SCREW BN 4.5MM 52MM LOPRFL LCK	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-54	SUP	HCPCS C1713		AR-8545L-54  -  SCREW BN 4.5MM 54MM LOPRFL LCK	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-55	SUP	HCPCS C1713		AR-8545L-55  -  SCREW BN LOPRFL 4.5MM 55MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-56	SUP	HCPCS C1713		AR-8545L-56  -  SCREW BN 4.5MM 56MM LOPRFL LCK	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-58	SUP	HCPCS C1713		AR-8545L-58  -  SCREW BN 4.5MM 58MM LOPRFL LCK	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-60	SUP	HCPCS C1713		AR-8545L-60  -  SCREW BN LOPRFL 4.5MM 60MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8545L-65	SUP	HCPCS C1713		AR-8545L-65  -  SCREW BN LOPRFL 4.5MM 65MM LCK ANKL	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8555-20	SUP	HCPCS C1713		AR-8555-20  -  SCREW BN LOPRFL 5.5MM 20MM ANKL CANC	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8555-25	SUP	HCPCS C1713		AR-8555-25  -  SCREW BN LOPRFL 5.5MM 25MM ANKL CANC	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8555-30	SUP	HCPCS C1713		AR-8555-30  -  SCREW BN LOPRFL 5.5MM 30MM ANKL CANC	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8555-35	SUP	HCPCS C1713		AR-8555-35  -  SCREW BN LOPRFL 5.5MM 35MM ANKL CANC	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8555-40	SUP	HCPCS C1713		AR-8555-40  -  SCREW BN LOPRFL 5.5MM 40MM ANKL CANC	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8555-45	SUP	HCPCS C1713		AR-8555-45  -  SCREW BN LOPRFL 5.5MM 45MM ANKL CANC	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8555-50	SUP	HCPCS C1713		AR-8555-50  -  SCREW BN LOPRFL 5.5MM 50MM ANKL CANC	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8555-55	SUP	HCPCS C1713		AR-8555-55  -  SCREW BN LOPRFL 5.5MM 55MM ANKL CANC	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8555-60	SUP	HCPCS C1713		AR-8555-60  -  SCREW BN LOPRFL 5.5MM 60MM ANKL CANC	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8555-65	SUP	HCPCS C1713		AR-8555-65  -  SCREW BN LOPRFL 5.5MM 65MM ANKL CANC	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8555-70	SUP	HCPCS C1713		AR-8555-70  -  SCREW BN LOPRFL 5.5MM 70MM ANKL CANC	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8555-75	SUP	HCPCS C1713		AR-8555-75  -  SCREW BN LOPRFL 5.5MM 75MM ANKL CANC	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8610DB-25	SUP	Custom 27203010		"AR-8610DB-25  -  DRILL BIT, CANNULATED, 1.7MM"	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8610DB-25C	SUP	Custom 27203010		AR-8610DB-25C  -  BIT DRL 1.7MM CNN	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8610DB-30	SUP	Custom 27203010		"AR-8610DB-30  -  DRILL BIT, CANNULATED, 2.0MM"	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8610DB-30C	SUP	Custom 27203010		AR-8610DB-30C  -  BIT DRL 2MM CNN VTRN	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8610DB-43	SUP	Custom 27203010		"AR-8610DB-43  -  DRILL BIT, CANNULATED, 3.0MM"	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8610DB-43C	SUP	Custom 27203010		AR-8610DB-43C  -  BIT DRL 3MM CNN DISP 4.3MM HDLS CMPR SCR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8610DB-65	SUP	Custom 27203010		"AR-8610DB-65  -  DRILL BIT, CANNULATED, 4.3MM"	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8610DB-65C	SUP	Custom 27203010		AR-8610DB-65C  -  BIT DRL 4.3MM CNN DISP 6.5MM HDLS CMPR P/T SCR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8610S-01	SUP	HCPCS C1713		AR-8610S-01  -  HEADLESS COMPRESSION SCREW SYSTEM2.5/3.0	BOTH IP/OP	"$34,412.50 "	"$25,465.25"	$0.00	"$27,530.00"	"$15,485.63"	"$15,485.63"	$0.00	$0.00	$0.00	"$7,172.43"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,171.57"	$0.00	"$16,965.36"	"$16,965.36"	$0.00	"$17,206.25"	"$27,254.70"	"$27,530.00"	$0.00		$0.00	"$5,385.56"	$0.00	$0.00	"$5,478.47"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8610S-02	SUP	HCPCS C1713		AR-8610S-02  -  HEADLESS COMPRESSION SCREW SYSTEM4.3/6.5	BOTH IP/OP	"$29,750.00 "	"$22,015.00"	$0.00	"$23,800.00"	"$13,387.50"	"$13,387.50"	$0.00	$0.00	$0.00	"$6,200.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,199.90"	$0.00	"$14,666.75"	"$14,666.75"	$0.00	"$14,875.00"	"$23,562.00"	"$23,800.00"	$0.00		$0.00	"$4,655.88"	$0.00	$0.00	"$4,736.20"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-08	SUP	HCPCS C1713		AR-8625-08  -  HEADLESS COMPR SCRW 2.5X 8 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-10	SUP	HCPCS C1713		AR-8625-10  -  HEADLESS COMPR SCRW 2.5X 10 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-12	SUP	HCPCS C1713		AR-8625-12  -  HEADLESS COMPR SCRW 2.5X 12 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-14	SUP	HCPCS C1713		AR-8625-14  -  HEADLESS COMPR SCRW 2.5X 14 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-16	SUP	HCPCS C1713		AR-8625-16  -  HEADLESS COMPR SCRW 2.5X 16 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-18	SUP	HCPCS C1713		AR-8625-18  -  HEADLESS COMPR SCRW 2.5X 18 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-20	SUP	HCPCS C1713		AR-8625-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-22	SUP	HCPCS C1713		AR-8625-22  -  HEADLESS COMPR SCRW 2.5X 22 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-24	SUP	HCPCS C1713		AR-8625-24  -  HEADLESS COMPR SCRW 2.5X 24 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-26	SUP	HCPCS C1713		AR-8625-26  -  HEADLESS COMPR SCRW 2.5X 26 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-28	SUP	HCPCS C1713		AR-8625-28  -  HEADLESS COMPR SCRW 2.5X 28 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-30	SUP	HCPCS C1713		AR-8625-30  -  HEADLESS COMPR SCRW 2.5X 30 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-32	SUP	HCPCS C1713		AR-8625-32  -  HEADLESS COMPR SCRW 2.5X 32 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8625-34	SUP	HCPCS C1713		AR-8625-34  -  HEADLESS COMPR SCRW 2.5X 34 MMCANN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-10	SUP	HCPCS C1713		"AR-8630-10  -  HEDLESS COMPR SCRW,3.0X 10 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-12	SUP	HCPCS C1713		"AR-8630-12  -  HEDLESS COMPR SCRW,3.0X 12 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-14	SUP	HCPCS C1713		"AR-8630-14  -  HEDLESS COMPR SCRW,3.0X 14 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-16	SUP	HCPCS C1713		"AR-8630-16  -  HEDLESS COMPR SCRW,3.0X 16 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-18	SUP	HCPCS C1713		"AR-8630-18  -  HEDLESS COMPR SCRW,3.0X 18 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-20	SUP	HCPCS C1713		"AR-8630-20  -  HEDLESS COMPR SCRW,3.0X 20 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-22	SUP	HCPCS C1713		"AR-8630-22  -  HEDLESS COMPR SCRW,3.0X 22 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-24	SUP	HCPCS C1713		AR-8630-24  -  SCREW BN 3MM 24MM NS ARTHX CMPR CNN HDLS	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-26	SUP	HCPCS C1713		"AR-8630-26  -  HEDLESS COMPR SCRW,3.0X 26 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-28	SUP	HCPCS C1713		"AR-8630-28  -  HEDLESS COMPR SCRW,3.0X 28 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-30	SUP	HCPCS C1713		"AR-8630-30  -  HEDLESS COMPR SCRW,3.0X 30 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-32	SUP	HCPCS C1713		"AR-8630-32  -  HEDLESS COMPR SCRW,3.0X 32 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-34	SUP	HCPCS C1713		"AR-8630-34  -  HEDLESS COMPR SCRW,3.0X 34 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8630-36	SUP	HCPCS C1713		"AR-8630-36  -  HEDLESS COMPR SCRW,3.0X 36 MMCANN"	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-14	SUP	HCPCS C1713		"AR-8643-14  -  HEDLESS COMPR SCRW,4.3X 14 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-16	SUP	HCPCS C1713		"AR-8643-16  -  HEDLESS COMPR SCRW,4.3X 16 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-18	SUP	HCPCS C1713		"AR-8643-18  -  HEDLESS COMPR SCRW,4.3X 18 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-20	SUP	HCPCS C1713		"AR-8643-20  -  HEDLESS COMPR SCRW,4.3X 20 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-22	SUP	HCPCS C1713		"AR-8643-22  -  HEDLESS COMPR SCRW,4.3X 22 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-24	SUP	HCPCS C1713		"AR-8643-24  -  HEDLESS COMPR SCRW,4.3X 24 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-26	SUP	HCPCS C1713		"AR-8643-26  -  HEDLESS COMPR SCRW,4.3X 26 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-28	SUP	HCPCS C1713		"AR-8643-28  -  HEDLESS COMPR SCRW,4.3X 28 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-30	SUP	HCPCS C1713		"AR-8643-30  -  HEDLESS COMPR SCRW,4.3X 30 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-32	SUP	HCPCS C1713		"AR-8643-32  -  HEDLESS COMPR SCRW,4.3X 32 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-34	SUP	HCPCS C1713		"AR-8643-34  -  HEDLESS COMPR SCRW,4.3X 34 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-36	SUP	HCPCS C1713		"AR-8643-36  -  HEDLESS COMPR SCRW,4.3X 36 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-38	SUP	HCPCS C1713		"AR-8643-38  -  HEDLESS COMPR SCRW,4.3X 38 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-40	SUP	HCPCS C1713		"AR-8643-40  -  HEDLESS COMPR SCRW,4.3X 40 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-42	SUP	HCPCS C1713		"AR-8643-42  -  HEDLESS COMPR SCRW,4.3X 42 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-44	SUP	HCPCS C1713		"AR-8643-44  -  HEDLESS COMPR SCRW,4.3X 44 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-46	SUP	HCPCS C1713		"AR-8643-46  -  HEDLESS COMPR SCRW,4.3X 46 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-48	SUP	HCPCS C1713		"AR-8643-48  -  HEDLESS COMPR SCRW,4.3X 48 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-50	SUP	HCPCS C1713		"AR-8643-50  -  HEDLESS COMPR SCRW,4.3X 50 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-55	SUP	HCPCS C1713		"AR-8643-55  -  HEDLESS COMPR SCRW,4.3X 55 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-60	SUP	HCPCS C1713		"AR-8643-60  -  HEDLESS COMPR SCRW,4.3X 60 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-65	SUP	HCPCS C1713		"AR-8643-65  -  HEDLESS COMPR SCRW,4.3X 65 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-70	SUP	HCPCS C1713		"AR-8643-70  -  HEDLESS COMPR SCRW,4.3X 70 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-75	SUP	HCPCS C1713		"AR-8643-75  -  HEDLESS COMPR SCRW,4.3X 75 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8643-80	SUP	HCPCS C1713		"AR-8643-80  -  HEDLESS COMPR SCRW,4.3X 80 MMCANN"	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8655-13	SUP	Custom 27203010		AR-8655-13  -  GUIDE DRL ANKL	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8656G	SUP	Custom 27203010		AR-8656G  -  GUIDE DRL GPS TRGT	BOTH IP/OP	"$4,987.50 "	"$3,690.75"	$0.00	"$3,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,701.72"	"$3,701.72"	$0.00	$0.00	"$1,039.40"	$0.00	$0.00	$0.00	$0.00	"$2,493.75"	"$3,950.10"	"$3,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8656G-04	SUP	Custom 27203010		AR-8656G-04  -  CANNULA ASCP GPS 1.1/1.6/2.4 MM	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-100	SUP	HCPCS C1713		AR-8665-100  -  HEDLESS COMPR SCRW 6.5X 100 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-105	SUP	HCPCS C1713		AR-8665-105  -  HEDLESS COMPR SCRW 6.5X 105 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-110	SUP	HCPCS C1713		AR-8665-110  -  HEDLESS COMPR SCRW 6.5X 110MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-115	SUP	HCPCS C1713		AR-8665-115  -  HEDLESS COMPR SCRW 6.5X 115 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-120	SUP	HCPCS C1713		AR-8665-120  -  HEDLESS COMPR SCRW 6.5X 120 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-18100	SUP	HCPCS C1713		AR-8665-18100  -  SCREW BN ST 6.5MM 100MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-18105	SUP	HCPCS C1713		AR-8665-18105  -  SCREW BN ST 6.5MM 105MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-18110	SUP	HCPCS C1713		AR-8665-18110  -  SCREW BN ST 6.5MM 110MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-18115	SUP	HCPCS C1713		AR-8665-18115  -  SCREW BN ST 6.5MM 115MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-18120	SUP	HCPCS C1713		AR-8665-18120  -  SCREW BN ST 6.5MM 120MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-1830	SUP	HCPCS C1713		AR-8665-1830  -  SCREW BN ST 6.5MM 30MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-1835	SUP	HCPCS C1713		AR-8665-1835  -  SCREW BN ST 6.5MM 35MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-1850	SUP	HCPCS C1713		AR-8665-1850  -  SCREW BN P/T 6.5MM 50MM CMPR HDLS	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-1855	SUP	HCPCS C1713		AR-8665-1855  -  SCREW BN ST 6.5MM 55MM CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-1860	SUP	HCPCS C1713		AR-8665-1860  -  SCREW BN ST 6.5MM 60MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-1865	SUP	HCPCS C1713		AR-8665-1865  -  SCREW BN ST 6.5MM 65MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-1880	SUP	HCPCS C1713		AR-8665-1880  -  SCREW BN P/T 6.5MM 80MM CMPR HDLS	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-1885	SUP	HCPCS C1713		AR-8665-1885  -  SCREW BN P/T 6.5MM 85MM CMPR HDLS	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-1890	SUP	HCPCS C1713		AR-8665-1890  -  SCREW BN ST 6.5MM 90MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-1895	SUP	HCPCS C1713		AR-8665-1895  -  SCREW BN ST 6.5MM 95MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-28100	SUP	HCPCS C1713		AR-8665-28100  -  SCREW BN L/T 6.5MM 100MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-28105	SUP	HCPCS C1713		AR-8665-28105  -  SCREW BN L/T 6.5MM 105MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-28110	SUP	HCPCS C1713		AR-8665-28110  -  SCREW BN L/T 6.5MM 110MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-28115	SUP	HCPCS C1713		AR-8665-28115  -  SCREW BN L/T 6.5MM 115MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-28120	SUP	HCPCS C1713		AR-8665-28120  -  SCREW BN L/T 6.5MM 120MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-2860	SUP	HCPCS C1713		AR-8665-2860  -  SCREW BN L/T 6.5MM 60MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-2865	SUP	HCPCS C1713		AR-8665-2865  -  SCREW BN L/T 6.5MM 65MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-2870	SUP	HCPCS C1713		AR-8665-2870  -  SCREW BN L/T 6.5MM 70MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-2875	SUP	HCPCS C1713		AR-8665-2875  -  SCREW BN L/T 6.5MM 75MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-2880	SUP	HCPCS C1713		AR-8665-2880  -  SCREW BN L/T 6.5MM 80MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-2885	SUP	HCPCS C1713		AR-8665-2885  -  SCREW BN L/T 6.5MM 85MM NS ARTHX CMPR HDLS	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-2890	SUP	HCPCS C1713		AR-8665-2890  -  SCREW BN L/T 6.5MM 90MM CMPR CNN HDLS VTRN	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-2895	SUP	HCPCS C1713		AR-8665-2895  -  SCREW BN L/T 6.5MM 95MM NS ARTHX CMPR HDLS	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$646.88	$646.88	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-30	SUP	HCPCS C1713		AR-8665-30  -  HEDLESS COMPR SCRW 6.5X 30 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-35	SUP	HCPCS C1713		AR-8665-35  -  HEDLESS COMPR SCRW 6.5X 35 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-40	SUP	HCPCS C1713		AR-8665-40  -  HEDLESS COMPR SCRW 6.5X 40 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-45	SUP	HCPCS C1713		AR-8665-45  -  HEDLESS COMPR SCRW 6.5X 45 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-50	SUP	HCPCS C1713		AR-8665-50  -  HEDLESS COMPR SCRW 6.5X 50 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-55	SUP	HCPCS C1713		AR-8665-55  -  HEDLESS COMPR SCRW 6.5X 55 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-60	SUP	HCPCS C1713		AR-8665-60  -  HEDLESS COMPR SCRW 6.5X 60 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-65	SUP	HCPCS C1713		AR-8665-65  -  HEDLESS COMPR SCRW 6.5X 65 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-70	SUP	HCPCS C1713		AR-8665-70  -  HEDLESS COMPR SCRW 6.5X 70 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-75	SUP	HCPCS C1713		AR-8665-75  -  HEDLESS COMPR SCRW 6.5X 75 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-80	SUP	HCPCS C1713		AR-8665-80  -  SCREW BN 6.5MM 80MM NS ARTHX CMPR CNN HDLS	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-85	SUP	HCPCS C1713		AR-8665-85  -  HEDLESS COMPR SCRW 6.5X 85 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-90	SUP	HCPCS C1713		AR-8665-90  -  SCREW BN 6.5MM 90MM NS ARTHX CMPR CNN HDLS	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8665-95	SUP	HCPCS C1713		AR-8665-95  -  HEDLESS COMPR SCRW 6.5X 95 MMCANN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8690DS	SUP	HCPCS C1713		AR-8690DS  -  SYSTEM FX CPR MN SCRPN DX	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,031.77"	"$1,068.75"	"$1,068.75"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8692DS	SUP	Custom 27203010		AR-8692DS  -  SYSTEM FX CPR VPR	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,031.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	$0.00	$0.00	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8701	SUP	Custom 27203010		AR-8701  -  PASSER SUTURE MICRO SMALL CURVE BENT 1.25MM 6IN BRAID EASIER	BOTH IP/OP	$350.00 	$259.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8703	SUP	Custom 27203010		AR-8703  -  PASSER SUTLSO MIC STR SUTURE STRL DISP	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8704	SUP	Custom 27203010		AR-8704  -  PASSER SUT 70D MIC SHRT BNT 3ANG STRL SUTLSO FIBROCARTILAGE	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8708	SUP	HCPCS C1713		AR-8708  -  STAPLE BN SM 8MM SUT SS	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8708S	SUP	HCPCS C1713		AR-8708S  -  STAPLE BN SM QFIX	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	"$2,531.25"	"$2,531.25"	$0.00	$0.00	$0.00	"$1,172.39"	"$4,174.88"	"$4,174.88"	$0.00	$0.00	"$1,172.25"	$0.00	"$2,773.13"	"$2,773.13"	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00		$0.00	$880.31	$0.00	$0.00	$895.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8710	SUP	HCPCS C1713		AR-8710  -  STAPLE BN SM 10MM QFIX SS	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8714	SUP	HCPCS C1713		AR-8714  -  PLATE BN LOPRFL 12MM PLAPLE SS DIAPHYSIS	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$788.59	$433.13	$433.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$150.63	$0.00	$0.00	$153.23	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8715	SUP	HCPCS C1713		AR-8715  -  PLATE BN LOPRFL 15MM PLAPLE SS SM BN 2.3MM CORT SCR	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$788.59	$433.13	$433.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$150.63	$0.00	$0.00	$153.23	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8716	SUP	HCPCS C1713		AR-8716  -  PLATE BN LOPRFL 20MM PLAPLE SS SM BN 2.3MM CORT SCR	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$788.59	$433.13	$433.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$481.25	$762.30	$770.00	$0.00		$0.00	$150.63	$0.00	$0.00	$153.23	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8720-08PT	SUP	HCPCS C1713		AR-8720-08PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 8MM QFIX SLF DRL ST CNN	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8720-10PT	SUP	HCPCS C1713		AR-8720-10PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 10MM QFIX SLF DRL ST CNN	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8720-12PT	SUP	HCPCS C1713		AR-8720-12PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 12MM QFIX SLF DRL ST CNN	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8720-14PT	SUP	HCPCS C1713		AR-8720-14PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 14MM QFIX SLF DRL ST CNN	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8720-16PT	SUP	HCPCS C1713		AR-8720-16PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 16MM QFIX SLF DRL ST CNN	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8720-18PT	SUP	HCPCS C1713		AR-8720-18PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 18MM QFIX SLF DRL ST CNN	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8720-20PT	SUP	HCPCS C1713		AR-8720-20PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 20MM QFIX SLF DRL ST CNN	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8720-22PT	SUP	HCPCS C1713		AR-8720-22PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 22MM QFIX SLF DRL ST CNN	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8720-24PT	SUP	HCPCS C1713		AR-8720-24PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 24MM QFIX SLF DRL ST CNN	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8720-26PT	SUP	HCPCS C1713		AR-8720-26PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 26MM QFIX SLF DRL ST CNN	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8720-28PT	SUP	HCPCS C1713		AR-8720-28PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 28MM QFIX SLF DRL ST CNN	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8720-30PT	SUP	HCPCS C1713		AR-8720-30PT  -  SCREW BN P/T 2MM 30MM QFIX CNN TI	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-08	SUP	HCPCS C1713		AR-8724-08  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 8MM QFIX SLF DRL ST	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-08PT	SUP	HCPCS C1713		AR-8724-08PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 8MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-10	SUP	HCPCS C1713		AR-8724-10  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 10MM QFIX SLF DRL ST	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-10PT	SUP	HCPCS C1713		AR-8724-10PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 10MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-12	SUP	HCPCS C1713		AR-8724-12  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 12MM QFIX SLF DRL ST	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-12PT	SUP	HCPCS C1713		AR-8724-12PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 12MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-14	SUP	HCPCS C1713		AR-8724-14  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 14MM QFIX SLF DRL ST	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-14PT	SUP	HCPCS C1713		AR-8724-14PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 14MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-16	SUP	HCPCS C1713		AR-8724-16  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 16MM QFIX SLF DRL ST	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-16PT	SUP	HCPCS C1713		AR-8724-16PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 16MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-18PT	SUP	HCPCS C1713		AR-8724-18PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 18MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-20	SUP	HCPCS C1713		AR-8724-20  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 20MM QFIX SLF DRL ST	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-20PT	SUP	HCPCS C1713		AR-8724-20PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 20MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-22	SUP	HCPCS C1713		AR-8724-22  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 22MM QFIX SLF DRL ST	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-22PT	SUP	HCPCS C1713		AR-8724-22PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 22MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-24PT	SUP	HCPCS C1713		AR-8724-24PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 24MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-26PT	SUP	HCPCS C1713		AR-8724-26PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 26MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-28	SUP	HCPCS C1713		AR-8724-28  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 28MM QFIX SLF DRL ST	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-28PT	SUP	HCPCS C1713		AR-8724-28PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 28MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-30	SUP	HCPCS C1713		AR-8724-30  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 30MM QFIX SLF DRL ST	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-30PT	SUP	HCPCS C1713		AR-8724-30PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 30MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-32	SUP	HCPCS C1713		AR-8724-32  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 32MM QFIX SLF DRL ST	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-32PT	SUP	HCPCS C1713		AR-8724-32PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 32MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-34	SUP	HCPCS C1713		AR-8724-34  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 34MM QFIX SLF DRL ST	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-34PT	SUP	HCPCS C1713		AR-8724-34PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 34MM QFIX SLF DRL ST	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-36	SUP	HCPCS C1713		AR-8724-36  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 36MM QFIX SLF DRL ST	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-36PT	SUP	HCPCS C1713		AR-8724-36PT  -  SCREW BN P/T 2.4MM 36MM QFIX CNN TI	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$163.13	$163.13	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-38	SUP	HCPCS C1713		AR-8724-38  -  SCREW BN 2.4MM 38MM LOPRFL TI FT/ANKL CORT	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724-40	SUP	HCPCS C1713		AR-8724-40  -  SCREW BN 2.4MM 40MM LOPRFL TI FT/ANKL CORT	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724GV	SUP	Custom 27203010		AR-8724GV  -  GUIDE DRL 2.4MM VA	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$881.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$0.00	$0.00	$0.00	$518.75	$821.70	$830.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-08	SUP	HCPCS C1713		AR-8724L-08  -  SCREW BN 2.4MM 8MM LCK LOPRFL	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-10	SUP	HCPCS C1713		AR-8724L-10  -  SCREW BN T8 FT HEXALOBE 2.4MM 10MM SLF DRL SLD LCK TI SM BN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-12	SUP	HCPCS C1713		AR-8724L-12  -  SCREW BN T8 FT HEXALOBE 2.4MM 12MM SLF DRL SLD LCK TI SM BN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-14	SUP	HCPCS C1713		AR-8724L-14  -  SCREW BN T8 FT HEXALOBE 2.4MM 14MM SLF DRL SLD LCK TI SM BN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-16	SUP	HCPCS C1713		AR-8724L-16  -  SCREW BN T8 FT HEXALOBE 2.4MM 16MM SLF DRL SLD LCK TI SM BN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-18	SUP	HCPCS C1713		AR-8724L-18  -  SCREW BN T8 FT HEXALOBE 2.4MM 18MM SLF DRL SLD LCK TI SM BN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-20	SUP	HCPCS C1713		AR-8724L-20  -  SCREW BN T8 FT HEXALOBE 2.4MM 20MM SLF DRL SLD LCK TI SM BN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-22	SUP	HCPCS C1713		AR-8724L-22  -  SCREW BN LOPRFL 2.4MM 22MM LCK ST SLD TI FT	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-24	SUP	HCPCS C1713		AR-8724L-24  -  SCREW BN LOPRFL 2.4MM 24MM LCK ST SLD TI FT	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-26	SUP	HCPCS C1713		AR-8724L-26  -  SCREW BN 2.4MM 26MM LCK LOPRFL TI FT/ANKL	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-28	SUP	HCPCS C1713		AR-8724L-28  -  SCREW BN 2.4MM 28MM LOPRFL LCK TI	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-30	SUP	HCPCS C1713		AR-8724L-30  -  SCREW BN 2.4MM 30MM LCK LOPRFL TI FT/ANKL	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-32	SUP	HCPCS C1713		AR-8724L-32  -  SCREW BN 2.4MM 32MM LCK LOPRFL TI FT/ANKL	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-34	SUP	HCPCS C1713		AR-8724L-34  -  SCREW BN T8 FT HEXALOBE 2.4MM 34MM LCK SLF DRL SLD TI SM BN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-36	SUP	HCPCS C1713		AR-8724L-36  -  SCREW BN T8 FT HEXALOBE 2.4MM 36MM LCK SLF DRL SLD TI SM BN	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-38	SUP	HCPCS C1713		AR-8724L-38  -  SCREW BN 2.4MM 38MM LCK LOPRFL TI FT/ANKL	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724L-40	SUP	HCPCS C1713		AR-8724L-40  -  SCREW BN 2.4MM 40MM LCK LOPRFL TI FT/ANKL	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-08	SUP	HCPCS C1713		AR-8724V-08  -  SCREW BN LOPRFL 2.4MM 8MM VA ST SLD LCK TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-10	SUP	HCPCS C1713		AR-8724V-10  -  SCREW BN LOPRFL 2.4MM 10MM VA ST SLD LCK TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-12	SUP	HCPCS C1713		AR-8724V-12  -  SCREW BN LOPRFL 2.4MM 12MM VA ST SLD LCK TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-14	SUP	HCPCS C1713		AR-8724V-14  -  SCREW BN LOPRFL 2.4MM 14MM VA ST SLD LCK TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-16	SUP	HCPCS C1713		AR-8724V-16  -  SCREW BN LOPRFL 2.4MM 16MM VA ST SLD LCK TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-18	SUP	HCPCS C1713		AR-8724V-18  -  SCREW BN LOPRFL 2.4MM 18MM VA ST SLD LCK TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-20	SUP	HCPCS C1713		AR-8724V-20  -  SCREW BN LOPRFL 2.4MM 20MM VA ST SLD LCK TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-22	SUP	HCPCS C1713		AR-8724V-22  -  SCREW BN LOPRFL 2.4MM 22MM VA ST SLD LCK TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-24	SUP	HCPCS C1713		AR-8724V-24  -  SCREW BN LOPRFL 2.4MM 24MM VA ST SLD LCK TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-26	SUP	HCPCS C1713		AR-8724V-26  -  SCREW BN LOPRFL 2.4MM 26MM VA ST SLD LCK TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-28	SUP	HCPCS C1713		AR-8724V-28  -  SCREW BN LOPRFL 2.4MM 28MM VA ST SLD LCK TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-30	SUP	HCPCS C1713		AR-8724V-30  -  SCREW BN LOPRFL 2.4MM 30MM VA ST SLD LCK TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-32	SUP	HCPCS C1713		AR-8724V-32  -  SCREW BN LOPRFL 2.4MM 32MM LCK ST SLD VA TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-34	SUP	HCPCS C1713		AR-8724V-34  -  SCREW BN LOPRFL 2.4MM 34MM LCK ST SLD VA TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-36	SUP	HCPCS C1713		AR-8724V-36  -  SCREW BN LOPRFL 2.4MM 32MM LCK ST SLD VA TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-38	SUP	HCPCS C1713		AR-8724V-38  -  SCREW BN LOPRFL 2.4MM 38MM LCK ST SLD VA TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724V-40	SUP	HCPCS C1713		AR-8724V-40  -  SCREW BN LOPRFL 2.4MM 40MM LCK ST SLD VA TI FT HND ANKL WRST	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8724W	SUP	HCPCS C1713		AR-8724W  -  WASHER ORTH 6MM TI 2/2.4MM QFIX SCR	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-08H	SUP	HCPCS C1713		AR-8725-08H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 8MM QFIX SLF DRL ST CNN CMPR	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-09H	SUP	HCPCS C1713		AR-8725-09H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 9MM QFIX SLF DRL ST CNN CMPR	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-10H	SUP	HCPCS C1713		AR-8725-10H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 10MM QFIX SLF DRL ST CNN	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-11H	SUP	HCPCS C1713		AR-8725-11H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 11MM QFIX SLF DRL ST CNN	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-12H	SUP	HCPCS C1713		AR-8725-12H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 12MM QFIX SLF DRL ST CNN	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-13H	SUP	HCPCS C1713		AR-8725-13H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 13MM QFIX SLF DRL ST CNN	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-14H	SUP	HCPCS C1713		AR-8725-14H  -  SCREW BN 1.5MM MIC FT 2.5MM 14MM QFIX SLF DRL ST CNN CMPR TI	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-16H	SUP	HCPCS C1713		AR-8725-16H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 16MM QFIX SLF DRL ST CNN	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-18H	SUP	HCPCS C1713		AR-8725-18H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 18MM QFIX SLF DRL ST CNN	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-20H	SUP	HCPCS C1713		AR-8725-20H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 20MM QFIX SLF DRL ST CNN	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-22H	SUP	HCPCS C1713		AR-8725-22H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 22MM QFIX SLF DRL ST CNN	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-24H	SUP	HCPCS C1713		AR-8725-24H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 24MM QFIX SLF DRL ST CNN	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-26H	SUP	HCPCS C1713		AR-8725-26H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 26MM QFIX SLF DRL ST CNN	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-28H	SUP	HCPCS C1713		AR-8725-28H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 28MM QFIX SLF DRL ST CNN	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8725-30H	SUP	HCPCS C1713		AR-8725-30H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 30MM QFIX SLF DRL ST CNN	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-10PT	SUP	HCPCS C1713		AR-8730-10PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 10MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-12H	SUP	HCPCS C1713		AR-8730-12H  -  SCREW BN MN FT 3.6MM 12MM QFIX CNN CMPR TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-12PT	SUP	HCPCS C1713		AR-8730-12PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 12MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-14H	SUP	HCPCS C1713		AR-8730-14H  -  SCREW BN MN FT 3.6MM 14MM QFIX CNN CMPR TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-14PT	SUP	HCPCS C1713		AR-8730-14PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 14MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-16H	SUP	HCPCS C1713		AR-8730-16H  -  SCREW BN MN FT 3.6MM 16MM QFIX CNN CMPR TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-16PT	SUP	HCPCS C1713		AR-8730-16PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 16MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-18H	SUP	HCPCS C1713		AR-8730-18H  -  SCREW BN MN FT 3.6MM 18MM QFIX CNN CMPR TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-18PT	SUP	HCPCS C1713		AR-8730-18PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 18MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-20H	SUP	HCPCS C1713		AR-8730-20H  -  SCREW BN MN FT 3.6MM 20MM QFIX CNN CMPR TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-20PT	SUP	HCPCS C1713		AR-8730-20PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 20MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-22H	SUP	HCPCS C1713		AR-8730-22H  -  SCREW BN MN FT 3.5MM 22MM QFIX CMPR TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-22PT	SUP	HCPCS C1713		AR-8730-22PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 22MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-24H	SUP	HCPCS C1713		AR-8730-24H  -  SCREW BN MN FT 3.6MM 24MM QFIX CNN CMPR TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-24PT	SUP	HCPCS C1713		AR-8730-24PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 24MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-26H	SUP	HCPCS C1713		AR-8730-26H  -  SCREW BN MN FT 3.6MM 26MM QFIX CNN CMPR TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-26PT	SUP	HCPCS C1713		AR-8730-26PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 26MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-28H	SUP	HCPCS C1713		AR-8730-28H  -  SCREW BN MN FT 3.6MM 28MM QFIX CNN CMPR TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-28PT	SUP	HCPCS C1713		AR-8730-28PT  -  SCREW BN P/T 3MM 28MM QFIX TI CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-30H	SUP	HCPCS C1713		AR-8730-30H  -  SCREW BN MN FT 3.6MM 30MM QFIX CNN CMPR TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-30PT	SUP	HCPCS C1713		AR-8730-30PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 30MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-32H	SUP	HCPCS C1713		AR-8730-32H  -  SCREW BN MN FT 3.6MM 32MM QFIX CNN CMPR TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-32PT	SUP	HCPCS C1713		AR-8730-32PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 32MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-34H	SUP	HCPCS C1713		AR-8730-34H  -  SCREW BN MN FT 3.6MM 34MM QFIX CNN CMPR TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-34PT	SUP	HCPCS C1713		AR-8730-34PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 34MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-36PT	SUP	HCPCS C1713		AR-8730-36PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 36MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-38PT	SUP	HCPCS C1713		AR-8730-38PT  -  SCREW BN P/T 3MM 38MM QFIX TI CANC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-40PT	SUP	HCPCS C1713		AR-8730-40PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 40MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-42PT	SUP	HCPCS C1713		AR-8730-42PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 42MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-44PT	SUP	HCPCS C1713		AR-8730-44PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 44MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-46PT	SUP	HCPCS C1713		AR-8730-46PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 46MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-48PT	SUP	HCPCS C1713		AR-8730-48PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 48MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730-50PT	SUP	HCPCS C1713		AR-8730-50PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 50MM QFIX SLF DRL ST	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8730W	SUP	HCPCS C1713		AR-8730W  -  WASHER ORTH 6.5MM TI 3MM QFIX SCR	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-03	SUP	Custom 27203010		AR-8737-03  -  GUIDE DRL .86MM 1.7MM	BOTH IP/OP	$850.00 	$629.00	$0.00	$680.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$630.87	$630.87	$0.00	$0.00	$177.14	$0.00	$0.00	$0.00	$0.00	$425.00	$673.20	$680.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-06	SUP	Custom 27203010		AR-8737-06  -  GUIDE DRL 3MM 4MM	BOTH IP/OP	$850.00 	$629.00	$0.00	$680.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$630.87	$630.87	$0.00	$0.00	$177.14	$0.00	$0.00	$0.00	$0.00	$425.00	$673.20	$680.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-09	SUP	Custom 27203010		AR-8737-09  -  BIT DRL 2.5MM QFIX CNN	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-11	SUP	Custom 27203010		AR-8737-11  -  BIT DRL 4MM QFIX CNN	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-17	SUP	Custom 27203010		AR-8737-17  -  BIT DRL 1.7MM QFIX CNN	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-23	SUP	Custom 27203010		AR-8737-23  -  DRILL BIT CNTRSNK 2-2.4MM QFIX CNN	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-24	SUP	Custom 27203010		AR-8737-24  -  DRILL BIT CNTRSNK 3MM QFIX CNN	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-34	SUP	Custom 27203010		AR-8737-34  -  BIT DRL STRG 2MM CNN DISP MIC CMPR FT SCR	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-35	SUP	Custom 27203010		AR-8737-35  -  BIT DRL STRG 2.7MM CNN 3.5MM MN CMPR FT SCR	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-43	SUP	Custom 27203010		AR-8737-43  -  GUIDE DRL PERC CMPR FT SCR SYS SET	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	$0.00	$0.00	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-48	SUP	Custom 27203010		AR-8737-48  -  GUIDE DRL PRLL MIC CMPR FT SCR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-49	SUP	Custom 27203010		AR-8737-49  -  GUIDE DRL PRLL MN CMPR FT SCR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-50	SUP	Custom 27203010		AR-8737-50  -  BIT DRL STRG 2.7MM CLBRT CNN STD CMPR FT 4MM SCR	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-55	SUP	Custom 27203010		AR-8737-55  -  GUIDE DRL PRLL 4 MM STD CMPR FT SCR	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$0.00	$0.00	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-57	SUP	Custom 27203010		AR-8737-57  -  CLAMP XTRNFX PIN PERC CMPR FT SCR SYS SET	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737-58	SUP	Custom 27203010		AR-8737-58  -  BIT DRL STRG 2.2MM CNN 2.5MM CMPR FT SCR	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737C-SC-01	SUP	HCPCS C1713		AR-8737C-SC-01  -  PLATE STRL QFIX CADDY TOP CNN SCR SYS	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8737H-2	SUP	HCPCS C1713		AR-8737H-2  -  SET TRMA FX UPGRD CMPR FT SCR	BOTH IP/OP	"$15,587.50 "	"$11,534.75"	$0.00	"$12,470.00"	"$7,014.38"	"$7,014.38"	$0.00	$0.00	$0.00	"$3,248.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,248.44"	$0.00	"$7,684.64"	"$7,684.64"	$0.00	"$7,793.75"	"$12,345.30"	"$12,470.00"	$0.00		$0.00	"$2,439.44"	$0.00	$0.00	"$2,481.53"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-14PTS	SUP	HCPCS C1713		AR-8740-14PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 14MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-16H	SUP	HCPCS C1713		AR-8740-16H  -  SCREW BN STD FT 4.6MM 16MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-16PTS	SUP	HCPCS C1713		AR-8740-16PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 16MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-18H	SUP	HCPCS C1713		AR-8740-18H  -  SCREW BN STD FT 4.6MM 18MM QFIX CNN CMPR TI ANKL/FT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-18PTS	SUP	HCPCS C1713		AR-8740-18PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 18MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-20H	SUP	HCPCS C1713		AR-8740-20H  -  SCREW BN STD FT 4.6MM 20MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-20PTS	SUP	HCPCS C1713		AR-8740-20PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 20MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-22H	SUP	HCPCS C1713		AR-8740-22H  -  SCREW BN STD FT 4MM 22MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-22PTS	SUP	HCPCS C1713		AR-8740-22PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 22MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-24H	SUP	HCPCS C1713		AR-8740-24H  -  SCREW BN STD FT 4.6MM 24MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-24PTS	SUP	HCPCS C1713		AR-8740-24PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 24MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-26H	SUP	HCPCS C1713		AR-8740-26H  -  SCREW BN STD FT 4.6MM 26MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-26PTS	SUP	HCPCS C1713		AR-8740-26PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 26MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-28H	SUP	HCPCS C1713		AR-8740-28H  -  SCREW BN STD FT 4.6MM 28MM QFIX CNN CMPR TI ANKL/FT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-28PTS	SUP	HCPCS C1713		AR-8740-28PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 28MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-30H	SUP	HCPCS C1713		AR-8740-30H  -  SCREW BN STD FT 4MM 30MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-30PTL	SUP	HCPCS C1713		AR-8740-30PTL  -  SCREW BN LNG P/T LOPRFL 4MM 30MM SLF DRL ST CNN TI SHLDR	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-30PTS	SUP	HCPCS C1713		AR-8740-30PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 30MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-32H	SUP	HCPCS C1713		AR-8740-32H  -  SCREW BN STD FT 4.6MM 32MM QFIX CNN CMPR TI ANKL/FT	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-32PTL	SUP	HCPCS C1713		AR-8740-32PTL  -  SCREW BN LNG P/T LOPRFL 4MM 32MM SLF DRL ST CNN TI SHLDR	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-32PTS	SUP	HCPCS C1713		AR-8740-32PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 32MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-34H	SUP	HCPCS C1713		AR-8740-34H  -  SCREW BN STD FT 4MM 34MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-34PTL	SUP	HCPCS C1713		AR-8740-34PTL  -  SCREW BN LNG P/T LOPRFL 4MM 34MM SLF DRL ST CNN TI SHLDR	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-34PTS	SUP	HCPCS C1713		AR-8740-34PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 34MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-36H	SUP	HCPCS C1713		AR-8740-36H  -  SCREW BN STD FT 4MM 36MM CNN CMPR VAR STP PTCH TI FT/ANKL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-36PTL	SUP	HCPCS C1713		AR-8740-36PTL  -  SCREW BN LNG P/T LOPRFL 4MM 36MM SLF DRL ST CNN TI SHLDR	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-36PTS	SUP	HCPCS C1713		AR-8740-36PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 36MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-38H	SUP	HCPCS C1713		AR-8740-38H  -  SCREW BN STD FT 4MM 38MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-38PTL	SUP	HCPCS C1713		AR-8740-38PTL  -  SCREW BN LNG P/T LOPRFL 4MM 38MM SLF DRL ST CNN TI SHLDR	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-38PTS	SUP	HCPCS C1713		AR-8740-38PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 38MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-40H	SUP	HCPCS C1713		AR-8740-40H  -  SCREW BN STD FT 4MM 40MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-40PTS	SUP	HCPCS C1713		AR-8740-40PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 40MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-42H	SUP	HCPCS C1713		AR-8740-42H  -  SCREW BN STD FT 4.6MM 42MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-42PTS	SUP	HCPCS C1713		AR-8740-42PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 42MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-44H	SUP	HCPCS C1713		AR-8740-44H  -  SCREW BN STD FT 4.6MM 44MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-44PTS	SUP	HCPCS C1713		AR-8740-44PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 44MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-46H	SUP	HCPCS C1713		AR-8740-46H  -  SCREW BN STD FT 4.6MM 46MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-46PTS	SUP	HCPCS C1713		AR-8740-46PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 46MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-48H	SUP	HCPCS C1713		AR-8740-48H  -  SCREW BN STD FT 4.6MM 48MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-48PTS	SUP	HCPCS C1713		AR-8740-48PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 48MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-50H	SUP	HCPCS C1713		AR-8740-50H  -  SCREW BN STD FT 4.6MM 50MM CNN CMPR VAR STP PTCH TI FT HND	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-50PTS	SUP	HCPCS C1713		AR-8740-50PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 50MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-52PTLS	SUP	HCPCS C1713		AR-8740-52PTLS  -  SCREW BN P/T 4MM 52MM STRL ARTHX LOPRFL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-52PTS	SUP	HCPCS C1713		AR-8740-52PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 52MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-54PTS	SUP	HCPCS C1713		AR-8740-54PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 54MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-56PTS	SUP	HCPCS C1713		AR-8740-56PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 56MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-58PTS	SUP	HCPCS C1713		AR-8740-58PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 58MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740-60PTS	SUP	HCPCS C1713		AR-8740-60PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 60MM QFIX BCMPT	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8740W	SUP	HCPCS C1713		AR-8740W  -  WASHER ORTH 7MM TI 4MM QFIX SCR	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8801	SUP	Custom 27203010		AR-8801  -  SHEATH ASCP GD SLOT	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8825B	SUP	HCPCS C1713		AR-8825B  -  ANCHOR SUT MN 2.5MM 8MM STRL BIO-PUSHLOCK	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8825CP	SUP	Custom 27203010		AR-8825CP  -  KIT INST 3ANG FIBROCARTILAGE CMPLX DISP	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8825P	SUP	HCPCS C1713		AR-8825P  -  ANCHOR SUT MN 2.5MM 8MM STRL PUSHLOCK PEEK	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8826G	SUP	Custom 27203010		AR-8826G  -  GUIDE DRL C RING GFT ANCH	BOTH IP/OP	"$7,187.50 "	"$5,318.75"	$0.00	"$5,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,497.88"	$0.00	$0.00	$0.00	$0.00	"$3,593.75"	"$5,692.50"	"$5,750.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-10	SUP	HCPCS C1713		AR-8827-10  -  SCREW BN 2.7MM 10MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-12	SUP	HCPCS C1713		AR-8827-12  -  SCREW BN 2.7MM 12MM LOPRFL SCR NONLOCK SS CORT ANKL FX MGMT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-14	SUP	HCPCS C1713		AR-8827-14  -  SCREW BN 2.7MM 14MM LOPRFL SCR NONLOCK SS CORT ANKL FX MGMT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-16	SUP	HCPCS C1713		AR-8827-16  -  SCREW BN 2.7MM 16MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-18	SUP	HCPCS C1713		AR-8827-18  -  SCREW BN 2.7MM 18MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-20	SUP	HCPCS C1713		AR-8827-20  -  SCREW BN 2.7MM 20MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-22	SUP	HCPCS C1713		AR-8827-22  -  SCREW BN 2.7MM 22MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-24	SUP	HCPCS C1713		AR-8827-24  -  SCREW BN 2.7MM 24MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-26	SUP	HCPCS C1713		AR-8827-26  -  SCREW BN 2.7MM 26MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-28	SUP	HCPCS C1713		AR-8827-28  -  SCREW BN 2.7MM 28MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-30	SUP	HCPCS C1713		AR-8827-30  -  SCREW BN 2.7MM 30MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-32	SUP	HCPCS C1713		AR-8827-32  -  SCREW BN 2.7MM 32MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-34	SUP	HCPCS C1713		AR-8827-34  -  SCREW BN 2.7MM 34MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-36	SUP	HCPCS C1713		AR-8827-36  -  SCREW BN 2.7MM 36MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-38	SUP	HCPCS C1713		AR-8827-38  -  SCREW BN 2.7MM 38MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-40	SUP	HCPCS C1713		AR-8827-40  -  SCREW BN 2.7MM 40MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-42	SUP	HCPCS C1713		AR-8827-42  -  SCREW BN 2.7MM 42MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-44	SUP	HCPCS C1713		AR-8827-44  -  SCREW BN 2.7MM 44MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-46	SUP	HCPCS C1713		AR-8827-46  -  SCREW BN 2.7MM 46MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-48	SUP	HCPCS C1713		AR-8827-48  -  SCREW BN 2.7MM 48MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-50	SUP	HCPCS C1713		AR-8827-50  -  SCREW BN 2.7MM 50MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-52	SUP	HCPCS C1713		AR-8827-52  -  SCREW BN 2.7MM 52MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-54	SUP	HCPCS C1713		AR-8827-54  -  SCREW BN 2.7MM 54MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-56	SUP	HCPCS C1713		AR-8827-56  -  SCREW BN 2.7MM 56MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-58	SUP	HCPCS C1713		AR-8827-58  -  SCREW BN 2.7MM 56MM NONLOCK LOPRFL ANKL CORT FX MGMT SYS	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827-60	SUP	HCPCS C1713		AR-8827-60  -  SCREW BN 2.7MM 60MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827D-01	SUP	Custom 27203010		AR-8827D-01  -  BIT DRL 2.7MM 2.7/3MM SCR ANKL FX MGMT SYS	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827D-02	SUP	Custom 27203010		AR-8827D-02  -  GUIDE DRL 2.7MM 2MM	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-08	SUP	HCPCS C1713		AR-8827L-08  -  SCREW BN T10 HEXALOBE FT 2.7MM 8MM LOPRFL SCR LCK MDLR SLF	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-10	SUP	HCPCS C1713		AR-8827L-10  -  SCREW BN FT T10 HEXALOBE 2.7MM 10MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-12	SUP	HCPCS C1713		AR-8827L-12  -  SCREW BN FT T10 HEXALOBE 2.7MM 12MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-14	SUP	HCPCS C1713		AR-8827L-14  -  SCREW BN FT T10 HEXALOBE 2.7MM 14MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-16	SUP	HCPCS C1713		AR-8827L-16  -  SCREW BN FT T10 HEXALOBE 2.7MM 16MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-18	SUP	HCPCS C1713		AR-8827L-18  -  SCREW BN FT T10 HEXALOBE 2.7MM 18MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-20	SUP	HCPCS C1713		AR-8827L-20  -  SCREW BN FT T10 HEXALOBE 2.7MM 20MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-22	SUP	HCPCS C1713		AR-8827L-22  -  SCREW BN FT T10 HEXALOBE 2.7MM 22MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-24	SUP	HCPCS C1713		AR-8827L-24  -  SCREW BN FT T10 HEXALOBE 2.7MM 24MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-26	SUP	HCPCS C1713		AR-8827L-26  -  SCREW BN FT T10 HEXALOBE 2.7MM 26MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-28	SUP	HCPCS C1713		AR-8827L-28  -  SCREW BN T10 HEXALOBE FT 2.7MM 28MM LOPRFL SCR LCK MDLR SLF	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-30	SUP	HCPCS C1713		AR-8827L-30  -  SCREW BN 2.7MM 30MM LOPRFL LCK ANKL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-34	SUP	HCPCS C1713		AR-8827L-34  -  SCREW BN 2.7MM 34MM NS LF LPR ARTHX LCK SS	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-36	SUP	HCPCS C1713		AR-8827L-36  -  SCREW BN 2.7MM 36MM NS LF LPR ARTHX LCK SS	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-38	SUP	HCPCS C1713		AR-8827L-38  -  SCREW BN 2.7MM 38MM NS LF LPR ARTHX LCK SS	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-40	SUP	HCPCS C1713		AR-8827L-40  -  SCREW BN 2.7MM 40MM NS LF LPR ARTHX LCK SS	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-42	SUP	HCPCS C1713		AR-8827L-42  -  SCREW BN 2.7MM 42MM STRL LOPRFL SCR LCK ANKL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-44	SUP	HCPCS C1713		AR-8827L-44  -  SCREW BN 2.7MM 44MM LOPRFL SCR LCK	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-46	SUP	HCPCS C1713		AR-8827L-46  -  SCREW BN 2.7MM 46MM STRL LOPRFL SCR LCK ANKL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-48	SUP	HCPCS C1713		AR-8827L-48  -  SCREW BN 2.7MM 48MM STRL LOPRFL SCR LCK	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-50	SUP	HCPCS C1713		AR-8827L-50  -  SCREW BN 2.7MM 50MM LOPRFL SCR LCK ANKL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-52	SUP	HCPCS C1713		AR-8827L-52  -  SCREW BN 2.7MM 52MM LOPRFL SCR LCK ANKL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-54	SUP	HCPCS C1713		AR-8827L-54  -  SCREW BN 2.7MM 54MM ARTHX LOPRFL SCR LCK	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-56	SUP	HCPCS C1713		AR-8827L-56  -  SCREW BN 2.7MM 56MM LOPRFL SCR LCK ANKL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-58	SUP	HCPCS C1713		AR-8827L-58  -  SCREW BN 2.7MM 58MM ARTHX LOPRFL SCR LCK	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8827L-60	SUP	HCPCS C1713		AR-8827L-60  -  SCREW BN 2.7MM 60MM LOPRFL SCR LCK ANKL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8830-10	SUP	HCPCS C1713		AR-8830-10  -  SCREW BN FT T10 HEXALOBE 3MM 10MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8830-12	SUP	HCPCS C1713		AR-8830-12  -  SCREW BN FT T10 HEXALOBE 3MM 12MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8830-14	SUP	HCPCS C1713		AR-8830-14  -  SCREW BN FT T10 HEXALOBE 3MM 14MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8830-16	SUP	HCPCS C1713		AR-8830-16  -  SCREW BN FT T10 HEXALOBE 3MM 16MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8830-18	SUP	HCPCS C1713		AR-8830-18  -  SCREW BN FT T10 HEXALOBE 3MM 18MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8830-20	SUP	HCPCS C1713		AR-8830-20  -  SCREW BN FT T10 HEXALOBE 3MM 20MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8830-22	SUP	HCPCS C1713		AR-8830-22  -  SCREW BN FT T10 HEXALOBE 3MM 22MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8830-24	SUP	HCPCS C1713		AR-8830-24  -  SCREW BN FT T10 HEXALOBE 3MM 24MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8830-26	SUP	HCPCS C1713		AR-8830-26  -  SCREW BN FT T10 HEXALOBE 3MM 26MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8830-28	SUP	HCPCS C1713		AR-8830-28  -  SCREW BN FT T10 HEXALOBE 3MM 28MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8830-30	SUP	HCPCS C1713		AR-8830-30  -  SCREW BN FT T10 HEXALOBE 3MM 30MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-08	SUP	HCPCS C1713		AR-8835-08  -  SCREW BN T15 HEXALOBE FT 3.5MM 8MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-08S	SUP	HCPCS C1713		AR-8835-08S  -  SCREW BN 3.5MM 8MM STRL ARTHX LOPRFL CORT	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-10	SUP	HCPCS C1713		AR-8835-10  -  SCREW BN T15 FT HEXALOBE 3.5MM 10MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-12	SUP	HCPCS C1713		AR-8835-12  -  SCREW BN T15 FT HEXALOBE 3.5MM 12MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-14	SUP	HCPCS C1713		AR-8835-14  -  SCREW BN T15 FT HEXALOBE 3.5MM 14MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-16	SUP	HCPCS C1713		AR-8835-16  -  SCREW BN T15 FT HEXALOBE 3.5MM 16MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-18	SUP	HCPCS C1713		AR-8835-18  -  SCREW BN T15 FT HEXALOBE 3.5MM 18MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-20	SUP	HCPCS C1713		AR-8835-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-22	SUP	HCPCS C1713		AR-8835-22  -  SCREW BN T15 FT HEXALOBE 3.5MM 22MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-24	SUP	HCPCS C1713		AR-8835-24  -  SCREW BN T15 FT HEXALOBE 3.5MM 24MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-26	SUP	HCPCS C1713		AR-8835-26  -  SCREW BN T15 FT HEXALOBE 3.5MM 26MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-28	SUP	HCPCS C1713		AR-8835-28  -  SCREW BN T15 FT HEXALOBE 3.5MM 28MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-30	SUP	HCPCS C1713		AR-8835-30  -  SCREW BN T15 HEXALOBE FT 3.5MM 30MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-32	SUP	HCPCS C1713		AR-8835-32  -  SCREW BN T15 HEXALOBE FT 3.5MM 32MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-34	SUP	HCPCS C1713		AR-8835-34  -  SCREW BN T15 HEXALOBE FT 3.5MM 34MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-35	SUP	HCPCS C1713		AR-8835-35  -  SCREW BN T15 FT HEXALOBE 3.5MM 35MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-36	SUP	HCPCS C1713		AR-8835-36  -  SCREW BN T15 HEXALOBE FT 3.5MM 36MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-38	SUP	HCPCS C1713		AR-8835-38  -  SCREW BN T15 HEXALOBE FT 3.5MM 38MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-40	SUP	HCPCS C1713		AR-8835-40  -  SCREW BN T15 FT HEXALOBE 3.5MM 40MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-42	SUP	HCPCS C1713		AR-8835-42  -  SCREW BN T15 HEXALOBE FT 3.5MM 42MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-44	SUP	HCPCS C1713		AR-8835-44  -  SCREW BN T15 FT HEXALOBE 3.5MM 44MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-45	SUP	HCPCS C1713		AR-8835-45  -  SCREW BN T15 FT HEXALOBE 3.5MM 45MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-46	SUP	HCPCS C1713		AR-8835-46  -  SCREW BN T15 HEXALOBE FT 3.5MM 46MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-48	SUP	HCPCS C1713		AR-8835-48  -  SCREW BN T15 HEXALOBE FT 3.5MM 48MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-50	SUP	HCPCS C1713		AR-8835-50  -  SCREW BN T15 FT HEXALOBE 3.5MM 50MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-55	SUP	HCPCS C1713		AR-8835-55  -  SCREW BN T15 FT HEXALOBE 3.5MM 55MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-60	SUP	HCPCS C1713		AR-8835-60  -  SCREW BN T15 FT HEXALOBE 3.5MM 60MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-65	SUP	HCPCS C1713		AR-8835-65  -  SCREW BN HEXALOBE FT 3.5MM 65MM LOPRFL SCR T15 SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-70	SUP	HCPCS C1713		AR-8835-70  -  SCREW BN HEXALOBE FT 3.5MM 70MM LOPRFL SCR T15 SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-75	SUP	HCPCS C1713		AR-8835-75  -  SCREW BN HEXALOBE FT 3.5MM 75MM LOPRFL SCR T15 SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835-80	SUP	HCPCS C1713		AR-8835-80  -  SCREW BN 3.5MM 80MM ARTHX LOPRFL SCR CORT	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-08	SUP	HCPCS C1713		AR-8835L-08  -  SCREW BN T15 HEXALOBE FT 3.5MM 8MM LOPRFL SCR LCK MDLR SLF	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-10	SUP	HCPCS C1713		AR-8835L-10  -  SCREW BN T15 FT HEXALOBE 3.5MM 10MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-12	SUP	HCPCS C1713		AR-8835L-12  -  SCREW BN T15 FT HEXALOBE 3.5MM 12MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-14	SUP	HCPCS C1713		AR-8835L-14  -  SCREW BN T15 FT HEXALOBE 3.5MM 14MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-16	SUP	HCPCS C1713		AR-8835L-16  -  SCREW BN T15 FT HEXALOBE 3.5MM 16MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-18	SUP	HCPCS C1713		AR-8835L-18  -  SCREW BN T15 FT HEXALOBE 3.5MM 18MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-20	SUP	HCPCS C1713		AR-8835L-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-22	SUP	HCPCS C1713		AR-8835L-22  -  SCREW BN T15 FT HEXALOBE 3.5MM 22MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-24	SUP	HCPCS C1713		AR-8835L-24  -  SCREW BN T15 HEXALOBE FT 3.5MM 24MM LOPRFL SCR LCK MDLR SLF	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-26	SUP	HCPCS C1713		AR-8835L-26  -  SCREW BN T15 HEXALOBE FT 3.5MM 26MM LOPRFL SCR LCK MDLR SLF	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-28	SUP	HCPCS C1713		AR-8835L-28  -  SCREW BN T15 HEXALOBE FT 3.5MM 28MM LOPRFL SCR LCK MDLR SLF	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-30	SUP	HCPCS C1713		AR-8835L-30  -  SCREW BN T15 FT HEXALOBE 3.5MM 30MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-32	SUP	HCPCS C1713		AR-8835L-32  -  SCREW BN T15 HEXALOBE FT 3.5MM 32MM LOPRFL SCR LCK MDLR SLF	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-34	SUP	HCPCS C1713		AR-8835L-34  -  SCREW BN T15 HEXALOBE FT 3.5MM 34MM LOPRFL SCR LCK MDLR SLF	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-36	SUP	HCPCS C1713		AR-8835L-36  -  SCREW BN T15 HEXALOBE FT 3.5MM 36MM LOPRFL SCR LCK MDLR SLF	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-38	SUP	HCPCS C1713		AR-8835L-38  -  SCREW BN T15 HEXALOBE FT 3.5MM 38MM LOPRFL SCR LCK MDLR SLF	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-40	SUP	HCPCS C1713		AR-8835L-40  -  SCREW BN T15 FT HEXALOBE 3.5MM 40MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-42	SUP	HCPCS C1713		AR-8835L-42  -  SCREW BN T15 FT HEXALOBE 3.5MM 42MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-44	SUP	HCPCS C1713		AR-8835L-44  -  SCREW BN T15 FT HEXALOBE 3.5MM 44MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-45	SUP	HCPCS C1713		AR-8835L-45  -  SCREW BN T15 FT HEXALOBE 3.5MM 45MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-46	SUP	HCPCS C1713		AR-8835L-46  -  SCREW BN T15 FT HEXALOBE 3.5MM 46MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-48	SUP	HCPCS C1713		AR-8835L-48  -  SCREW BN T15 FT HEXALOBE 3.5MM 48MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8835L-50	SUP	HCPCS C1713		AR-8835L-50  -  SCREW BN T15 HEXALOBE FT 3.5MM 50MM LOPRFL SCR LCK MDLR SLF	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-10	SUP	HCPCS C1713		AR-8840-10  -  SCREW BN T15 FT HEXALOBE 4MM 10MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-10S	SUP	HCPCS C1713		AR-8840-10S  -  SCREW BN 4MM 10MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-12	SUP	HCPCS C1713		AR-8840-12  -  SCREW BN T15 FT HEXALOBE 4MM 12MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-12S	SUP	HCPCS C1713		AR-8840-12S  -  SCREW BN 4MM 12MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-14	SUP	HCPCS C1713		AR-8840-14  -  SCREW BN T15 FT HEXALOBE 4MM 14MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-16	SUP	HCPCS C1713		AR-8840-16  -  SCREW BN T15 FT HEXALOBE 4MM 16MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-16S	SUP	HCPCS C1713		AR-8840-16S  -  SCREW BN 4MM 16MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-18	SUP	HCPCS C1713		AR-8840-18  -  SCREW BN T15 FT HEXALOBE 4MM 18MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-18S	SUP	HCPCS C1713		AR-8840-18S  -  SCREW BN 4MM 18MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-20	SUP	HCPCS C1713		AR-8840-20  -  SCREW BN T15 FT HEXALOBE 4MM 20MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-20S	SUP	HCPCS C1713		AR-8840-20S  -  SCREW BN 4MM 20MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-22	SUP	HCPCS C1713		AR-8840-22  -  SCREW BN T15 FT HEXALOBE 4MM 22MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-22S	SUP	HCPCS C1713		AR-8840-22S  -  SCREW BN 4MM 22MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-24	SUP	HCPCS C1713		AR-8840-24  -  SCREW BN T15 FT HEXALOBE 4MM 24MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-26	SUP	HCPCS C1713		AR-8840-26  -  SCREW BN T15 FT HEXALOBE 4MM 26MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-26S	SUP	HCPCS C1713		AR-8840-26S  -  SCREW BN 4MM 26MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-28	SUP	HCPCS C1713		AR-8840-28  -  SCREW BN T15 FT HEXALOBE 4MM 28MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-28S	SUP	HCPCS C1713		AR-8840-28S  -  SCREW BN 4MM 28MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-30	SUP	HCPCS C1713		AR-8840-30  -  SCREW BN T15 FT HEXALOBE 4MM 30MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-32	SUP	HCPCS C1713		AR-8840-32  -  SCREW BN T15 FT HEXALOBE 4MM 32MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-32S	SUP	HCPCS C1713		AR-8840-32S  -  SCREW BN 4MM 32MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-34	SUP	HCPCS C1713		AR-8840-34  -  SCREW BN T15 FT HEXALOBE 4MM 34MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-34S	SUP	HCPCS C1713		AR-8840-34S  -  SCREW BN 4MM 34MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-36	SUP	HCPCS C1713		AR-8840-36  -  SCREW BN T15 HEXALOBE FT 4MM 36MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-36S	SUP	HCPCS C1713		AR-8840-36S  -  SCREW BN 4MM 36MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-38	SUP	HCPCS C1713		AR-8840-38  -  SCREW BN T15 FT HEXALOBE 4MM 38MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-38S	SUP	HCPCS C1713		AR-8840-38S  -  SCREW BN 4MM 38MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-40	SUP	HCPCS C1713		AR-8840-40  -  SCREW BN T15 FT HEXALOBE 4MM 40MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-40S	SUP	HCPCS C1713		AR-8840-40S  -  SCREW BN 4MM 40MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-42	SUP	HCPCS C1713		AR-8840-42  -  SCREW BN T15 FT HEXALOBE 4MM 42MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-44	SUP	HCPCS C1713		AR-8840-44  -  SCREW BN T15 HEXALOBE FT 4MM 44MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-45	SUP	HCPCS C1713		AR-8840-45  -  SCREW BN T15 FT HEXALOBE 4MM 45MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-46	SUP	HCPCS C1713		AR-8840-46  -  SCREW BN T15 HEXALOBE FT 4MM 46MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-48	SUP	HCPCS C1713		AR-8840-48  -  SCREW BN T15 HEXALOBE FT 4MM 48MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-50	SUP	HCPCS C1713		AR-8840-50  -  SCREW BN T15 HEXALOBE FT 4MM 50MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-50S	SUP	HCPCS C1713		AR-8840-50S  -  SCREW BN 4MM 50MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-55	SUP	HCPCS C1713		AR-8840-55  -  SCREW BN T15 FT HEXALOBE 4MM 55MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-55S	SUP	HCPCS C1713		AR-8840-55S  -  SCREW BN 4MM 55MM STRL ARTHX LOPRFL CANC	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840-60	SUP	HCPCS C1713		AR-8840-60  -  SCREW BN T15 HEXALOBE FT 4MM 60MM LOPRFL SCR MDLR SLF DRL	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-30	SUP	HCPCS C1713		AR-8840C-30  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 30MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-32	SUP	HCPCS C1713		AR-8840C-32  -  SCREW BN ST 4MM 32MM LOPRFL SCR CNN SS ANKL FX MGMT SYS	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-34	SUP	HCPCS C1713		AR-8840C-34  -  SCREW BN ST 4MM 34MM LOPRFL SCR CNN SS ANKL FX MGMT SYS	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-35	SUP	HCPCS C1713		AR-8840C-35  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 35MM LOPRFL SCR MDLR	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-36	SUP	HCPCS C1713		AR-8840C-36  -  SCREW BN ST 4MM 36MM LOPRFL SCR CNN SS ANKL FX MGMT SYS	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-38	SUP	HCPCS C1713		AR-8840C-38  -  SCREW BN ST 4MM 38MM LOPRFL SCR CNN SS ANKL FX MGMT SYS	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-40	SUP	HCPCS C1713		AR-8840C-40  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 40MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-42	SUP	HCPCS C1713		AR-8840C-42  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 42MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-44	SUP	HCPCS C1713		AR-8840C-44  -  SCREW BN ST 4MM 44MM LOPRFL SCR CNN SS ANKL FX MGMT SYS	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-45	SUP	HCPCS C1713		AR-8840C-45  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 45MM LOPRFL SCR MDLR	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-46	SUP	HCPCS C1713		AR-8840C-46  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 46MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-48	SUP	HCPCS C1713		AR-8840C-48  -  SCREW BN ST 4MM 48MM LOPRFL SCR CNN SS ANKL FX MGMT SYS	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-50	SUP	HCPCS C1713		AR-8840C-50  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 50MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-55	SUP	HCPCS C1713		AR-8840C-55  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 55MM LOPRFL SCR MDLR	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840C-60	SUP	HCPCS C1713		AR-8840C-60  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 60MM LOPRFL SCR MDLR	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-30	SUP	HCPCS C1713		AR-8840CL-30  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 30MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-32	SUP	HCPCS C1713		AR-8840CL-32  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 32MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-34	SUP	HCPCS C1713		AR-8840CL-34  -  SCREW BN L/T 4MM 34MM LOPRFL SCR CNN SS ANKL FX MGMT SYS	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-35	SUP	HCPCS C1713		AR-8840CL-35  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 35MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-36	SUP	HCPCS C1713		AR-8840CL-36  -  SCREW BN L/T 4MM 36MM LOPRFL SCR CNN SS ANKL FX MGMT SYS	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-38	SUP	HCPCS C1713		AR-8840CL-38  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 38MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-40	SUP	HCPCS C1713		AR-8840CL-40  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 40MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-42	SUP	HCPCS C1713		AR-8840CL-42  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 42MM LOPRFL SCR MDLR	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-44	SUP	HCPCS C1713		AR-8840CL-44  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 44MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-45	SUP	HCPCS C1713		AR-8840CL-45  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 45MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-46	SUP	HCPCS C1713		AR-8840CL-46  -  SCREW BN L/T 4MM 46MM LOPRFL SCR CNN SS ANKL FX MGMT SYS	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-48	SUP	HCPCS C1713		AR-8840CL-48  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 48MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-50	SUP	HCPCS C1713		AR-8840CL-50  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 50MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-55	SUP	HCPCS C1713		AR-8840CL-55  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 55MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840CL-60	SUP	HCPCS C1713		AR-8840CL-60  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 60MM LOPRFL SCR SLF	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-30	SUP	HCPCS C1713		AR-8840P-30  -  SCREW BN ST 4MM 30MM LOPRFL SCR SS ANKL FX MGMT SYS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-32	SUP	HCPCS C1713		AR-8840P-32  -  SCREW BN ST 4MM 32MM LOPRFL SCR SS ANKL FX MGMT SYS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-34	SUP	HCPCS C1713		AR-8840P-34  -  SCREW BN ST 4MM 34MM LOPRFL SCR SS ANKL FX MGMT SYS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-36	SUP	HCPCS C1713		AR-8840P-36  -  SCREW BN ST 4MM 36MM LOPRFL SCR SS ANKL FX MGMT SYS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-38	SUP	HCPCS C1713		AR-8840P-38  -  SCREW BN ST 4MM 38MM LOPRFL SCR SS ANKL FX MGMT SYS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-40	SUP	HCPCS C1713		AR-8840P-40  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 40MM LOPRFL SCR SLF	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-42	SUP	HCPCS C1713		AR-8840P-42  -  SCREW BN ST 4MM 42MM LOPRFL SCR SS ANKL FX MGMT SYS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-44	SUP	HCPCS C1713		AR-8840P-44  -  SCREW BN ST 4MM 44MM LOPRFL SCR SS ANKL FX MGMT SYS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-46	SUP	HCPCS C1713		AR-8840P-46  -  SCREW BN ST 4MM 46MM LOPRFL SS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-48	SUP	HCPCS C1713		AR-8840P-48  -  SCREW BN ST 4MM 48MM LOPRFL SCR SS ANKL FX MGMT SYS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-50	SUP	HCPCS C1713		AR-8840P-50  -  SCREW BN ST 4MM 50MM LOPRFL SS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-55	SUP	HCPCS C1713		AR-8840P-55  -  SCREW BN ST 4MM 55MM LOPRFL SCR SS ANKL FX MGMT SYS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840P-60	SUP	HCPCS C1713		AR-8840P-60  -  SCREW BN ST 4MM 60MM LOPRFL SS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-30	SUP	HCPCS C1713		AR-8840PL-30  -  SCREW BN L/T 4MM 30MM LOPRFL SS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-32	SUP	HCPCS C1713		AR-8840PL-32  -  SCREW BN L/T 4MM 32MM LOPRFL SS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-34	SUP	HCPCS C1713		AR-8840PL-34  -  SCREW BN L/T 4MM 34MM LOPRFL SS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-36	SUP	HCPCS C1713		AR-8840PL-36  -  SCREW BN L/T 4MM 36MM LOPRFL SS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-38	SUP	HCPCS C1713		AR-8840PL-38  -  SCREW BN LNG 1/3 LGTH T15 HEXALOBE 4MM 38MM LOPRFL SCR MDLR	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-40	SUP	HCPCS C1713		AR-8840PL-40  -  SCREW BN L/T 4MM 40MM LOPRFL SS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-42	SUP	HCPCS C1713		AR-8840PL-42  -  SCREW BN L/T 4MM 42MM LOPRFL SS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-44	SUP	HCPCS C1713		AR-8840PL-44  -  SCREW BN L/T 4MM 44MM LOPRFL SS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-46	SUP	HCPCS C1713		AR-8840PL-46  -  SCREW BN LNG 1/3 LGTH T15 HEXALOBE 4MM 46MM LOPRFL SCR MDLR	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-48	SUP	HCPCS C1713		AR-8840PL-48  -  SCREW BN LNG 1/3 LGTH T15 HEXALOBE 4MM 48MM LOPRFL SCR MDLR	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-50	SUP	HCPCS C1713		AR-8840PL-50  -  SCREW BN L/T 4MM 50MM LOPRFL SS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-55	SUP	HCPCS C1713		AR-8840PL-55  -  SCREW BN L/T 4MM 55MM LOPRFL SCR SS ANKL FX MGMT SYS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8840PL-60	SUP	HCPCS C1713		AR-8840PL-60  -  SCREW BN L/T 4MM 60MM LOPRFL SCR SS ANKL FX MGMT SYS	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8870W	SUP	HCPCS C1713		AR-8870W  -  WASHER ORTH 7MM	BOTH IP/OP	$80.25 	$59.39	$0.00	$64.20	$36.11	$36.11	$0.00	$0.00	$0.00	$16.73	$59.56	$59.56	$0.00	$0.00	$16.72	$0.00	$47.47	$47.47	$0.00	$40.13	$63.56	$64.20	$0.00		$0.00	$12.56	$0.00	$0.00	$12.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8911DC	SUP	Custom 27203010		AR-8911DC  -  BIT DRL CNN MN TGHTRP	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8911DS	SUP	HCPCS C1713		AR-8911DS  -  KIT ESCP INST .45IN MN RND 2.7MM 1.6MM STRL TGHTRP BTN CNN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8911G-05	SUP	Custom 27203010		AR-8911G-05  -  GUIDE DRL KRSH WRE MN TGHTRP	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8912DS	SUP	HCPCS C1713		AR-8912DS  -  KIT ESCP INST MN FT STRL TGHTRP BCSCR CNN DRLBT CUP BTN DRVR	BOTH IP/OP	"$1,700.00 "	"$1,258.00"	$0.00	"$1,360.00"	$765.00	$765.00	$0.00	$0.00	$0.00	$354.32	"$1,261.74"	"$1,261.74"	$0.00	$0.00	$354.28	$0.00	"$1,005.55"	"$1,005.55"	$0.00	$850.00	"$1,346.40"	"$1,360.00"	$0.00		$0.00	$266.05	$0.00	$0.00	$270.64	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8913DS	SUP	HCPCS C1713		AR-8913DS  -  BUTTON FX MN TGHTRP INSRTR	BOTH IP/OP	"$1,512.50 "	"$1,119.25"	$0.00	"$1,210.00"	$680.63	$680.63	$0.00	$0.00	$0.00	$315.24	"$1,122.58"	"$1,122.58"	$0.00	$0.00	$315.21	$0.00	$894.64	$894.64	$0.00	$756.25	"$1,197.90"	"$1,210.00"	$0.00		$0.00	$236.71	$0.00	$0.00	$240.79	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8914P	SUP	HCPCS C1713		AR-8914P  -  PLATE BN MN TGHTRP BTRS	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916-05	SUP	Custom 27203010		AR-8916-05  -  GUIDE DRL 1.7MM 2.5MM	BOTH IP/OP	$937.50 	$693.75	$0.00	$695.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916-06	SUP	Custom 27203010		AR-8916-06  -  BIT DRL 2.5MM CLBRT GRAD 3.5MM LCK CORT SCR	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.17	$126.17	$0.00	$0.00	$35.43	$0.00	$0.00	$0.00	$0.00	$85.00	$134.64	$136.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916-07	SUP	Custom 27203010		AR-8916-07  -  GUIDE DRL 3.5MM 30MM THRD WRST PLT SYS	BOTH IP/OP	$720.00 	$532.80	$0.00	$576.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$534.38	$534.38	$0.00	$0.00	$150.05	$0.00	$0.00	$0.00	$0.00	$360.00	$570.24	$576.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916-09	SUP	Custom 27203010		AR-8916-09  -  GUIDE DRL 2.4MM AIM WRST PLT SYS	BOTH IP/OP	$790.00 	$584.60	$0.00	$632.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$586.34	$586.34	$0.00	$0.00	$164.64	$0.00	$0.00	$0.00	$0.00	$395.00	$625.68	$632.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916-16	SUP	HCPCS C1713		AR-8916-16  -  SCREW BN ATCH RDS RT DIST VOLR	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916-17	SUP	HCPCS C1713		AR-8916-17  -  SCREW BN ATCH RDS LT DIST VOLR	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916-21	SUP	Custom 27203010		AR-8916-21  -  GUIDE DRL 2.4MM VAL DRP WRST PLT SYS	BOTH IP/OP	$610.00 	$451.40	$0.00	$488.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$452.74	$452.74	$0.00	$0.00	$127.12	$0.00	$0.00	$0.00	$0.00	$305.00	$483.12	$488.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916-23	SUP	Custom 27203010		AR-8916-23  -  GUIDE DRL 2.5MM 1.7MM	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	$828.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.18	$768.18	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	$517.50	$819.72	$828.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916-26	SUP	Custom 27203010		AR-8916-26  -  GUIDE DRL PRLL Y 1.7MM PLT PERIPROSTHETIC	BOTH IP/OP	$950.00 	$703.00	$0.00	$760.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$705.09	$705.09	$0.00	$0.00	$197.98	$0.00	$0.00	$0.00	$0.00	$475.00	$752.40	$760.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916-28	SUP	Custom 27203010		AR-8916-28  -  BIT DRL SHRT 1.7MM GRAD 2.4MM VA LCK CORT SCR	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916CX24-18	SUP	HCPCS C1713		AR-8916CX24-18  -  SCREW BN 2.4MM CORT	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916DNL-04	SUP	HCPCS C1713		AR-8916DNL-04  -  PLATE BN NAR 4 HL RDS LT DIST DRSL	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	"$1,456.88"	"$1,456.88"	$0.00	$0.00	$0.00	$674.78	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	"$1,596.09"	"$1,596.09"	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$506.67	$0.00	$0.00	$515.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916DNR-04	SUP	HCPCS C1713		AR-8916DNR-04  -  PLATE BN NAR 4 HL RDS RT DIST DRSL	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	"$1,456.88"	"$1,456.88"	$0.00	$0.00	$0.00	$674.78	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	"$1,596.09"	"$1,596.09"	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$506.67	$0.00	$0.00	$515.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916DSL-04	SUP	HCPCS C1713		AR-8916DSL-04  -  PLATE BN 4 HL RDS LT DIST DRSL	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	"$1,456.88"	"$1,456.88"	$0.00	$0.00	$0.00	$674.78	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	"$1,596.09"	"$1,596.09"	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$506.67	$0.00	$0.00	$515.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916DSR-04	SUP	HCPCS C1713		AR-8916DSR-04  -  PLATE BN STD 4 HL RDS RT DRSL DIST	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	"$1,456.88"	"$1,456.88"	$0.00	$0.00	$0.00	$674.78	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	"$1,596.09"	"$1,596.09"	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$506.67	$0.00	$0.00	$515.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916FS	SUP	HCPCS C1713		AR-8916FS  -  MODULE INST FRAG SPC SYS	BOTH IP/OP	"$5,662.50 "	"$4,190.25"	$0.00	"$4,530.00"	"$2,548.13"	"$2,548.13"	$0.00	$0.00	$0.00	"$1,180.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,180.07"	$0.00	"$2,791.61"	"$2,791.61"	$0.00	"$2,831.25"	"$4,484.70"	"$4,530.00"	$0.00		$0.00	$886.18	$0.00	$0.00	$901.47	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916RSTY-05	SUP	HCPCS C1713		AR-8916RSTY-05  -  PLATE BN 5 HL WRST RDS 2.4 MM SCR STYLOID	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916SPN	SUP	HCPCS C1713		AR-8916SPN  -  PLATE BN 9 HL SPAN TI WRST	BOTH IP/OP	"$4,487.50 "	"$3,320.75"	$0.00	"$3,590.00"	"$2,019.38"	"$2,019.38"	$0.00	$0.00	$0.00	$935.31	"$3,330.62"	"$3,330.62"	$0.00	$0.00	$935.20	$0.00	"$2,212.34"	"$2,212.34"	$0.00	"$2,243.75"	"$3,554.10"	"$3,590.00"	$0.00		$0.00	$702.29	$0.00	$0.00	$714.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VH-04	SUP	HCPCS C1713		AR-8916VH-04  -  PLATE BN 4 HL HK RDS VOLR	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VH-06	SUP	HCPCS C1713		AR-8916VH-06  -  PLATE BN 6 HL HK TI WRST VOLR	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-08	SUP	HCPCS C1713		AR-8916VNC-08  -  SCREW BN P/T LOPRFL 2.4MM 8MM AU LCK SMTH VA TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-10	SUP	HCPCS C1713		AR-8916VNC-10  -  SCREW BN P/T LOPRFL 2.4MM 10MM AU LCK SMTH VA TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-12	SUP	HCPCS C1713		AR-8916VNC-12  -  SCREW BN P/T LOPRFL 2.4MM 12MM AU LCK SMTH VA TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-14	SUP	HCPCS C1713		AR-8916VNC-14  -  SCREW BN P/T LOPRFL 2.4MM 14MM AU VA LCK SMTH TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-16	SUP	HCPCS C1713		AR-8916VNC-16  -  SCREW BN P/T LOPRFL 2.4MM 16MM AU VA LCK SMTH TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-18	SUP	HCPCS C1713		AR-8916VNC-18  -  SCREW BN P/T LOPRFL 2.4MM 18MM AU VA LCK SMTH TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-20	SUP	HCPCS C1713		AR-8916VNC-20  -  SCREW BN P/T LOPRFL 2.4MM 20MM AU VA LCK SMTH TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-22	SUP	HCPCS C1713		AR-8916VNC-22  -  SCREW BN P/T LOPRFL 2.4MM 22MM AU VA LCK SMTH TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-24	SUP	HCPCS C1713		AR-8916VNC-24  -  SCREW BN P/T LOPRFL 2.4MM 24MM AU VA LCK SMTH TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-26	SUP	HCPCS C1713		AR-8916VNC-26  -  SCREW BN P/T LOPRFL 2.4MM 26MM AU LCK SMTH VA TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-28	SUP	HCPCS C1713		AR-8916VNC-28  -  SCREW BN P/T LOPRFL 2.4MM 28MM AU LCK SMTH VA TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-30	SUP	HCPCS C1713		AR-8916VNC-30  -  SCREW BN P/T LOPRFL 2.4MM 30MM AU LCK SMTH VA TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-32	SUP	HCPCS C1713		AR-8916VNC-32  -  SCREW BN P/T LOPRFL 2.4MM 32MM AU LCK SMTH VA TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNC-34	SUP	HCPCS C1713		AR-8916VNC-34  -  SCREW BN P/T LOPRFL 2.4MM 34MM AU LCK SMTH VA TI RDS CORT	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNL-03	SUP	HCPCS C1713		AR-8916VNL-03  -  PLATE BN NAR CNTR 3 HL ANTM GFT WDW TI RDS LT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNL-05	SUP	HCPCS C1713		AR-8916VNL-05  -  PLATE BN NAR CNTR 5 HL ANTM GFT WDW TI RDS LT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNL-07	SUP	HCPCS C1713		AR-8916VNL-07  -  PLATE BN NAR CNTR 7 HL ANTM GFT WDW TI RDS LT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNR-03	SUP	HCPCS C1713		AR-8916VNR-03  -  PLATE BN NAR CNTR 3 HL ANTM GFT WDW TI RDS RT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNR-05	SUP	HCPCS C1713		AR-8916VNR-05  -  PLATE BN NAR CNTR 5 HL ANTM GFT WDW TI RDS RT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VNR-07	SUP	HCPCS C1713		AR-8916VNR-07  -  PLATE BN NAR CNTR 7 HL ANTM GFT WDW TI RDS RT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VSL-03	SUP	HCPCS C1713		AR-8916VSL-03  -  PLATE BN STD CNTR 3 HL ANTM GFT WDW TI RDS LT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VSL-05	SUP	HCPCS C1713		AR-8916VSL-05  -  PLATE BN STD CNTR 5 HL ANTM GFT WDW TI RDS LT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VSL-07	SUP	HCPCS C1713		AR-8916VSL-07  -  PLATE BN STD CNTR 7 HL ANTM GFT WDW TI RDS LT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VSL-09	SUP	HCPCS C1713		AR-8916VSL-09  -  PLATE BN STD CNTR 9 HL ANTM GFT WDW TI RDS LT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VSR-03	SUP	HCPCS C1713		AR-8916VSR-03  -  PLATE BN STD CNTR 3 HL ANTM GFT WDW TI RDS RT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VSR-05	SUP	HCPCS C1713		AR-8916VSR-05  -  PLATE BN STD CNTR 5 HL ANTM GFT WDW TI RDS RT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VSR-07	SUP	HCPCS C1713		AR-8916VSR-07  -  PLATE BN STD CNTR 7 HL ANTM GFT WDW TI RDS RT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VSR-09	SUP	HCPCS C1713		AR-8916VSR-09  -  PLATE BN STD CNTR 9 HL ANTM GFT WDW TI RDS RT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VWL-03	SUP	HCPCS C1713		AR-8916VWL-03  -  PLATE BN W CNTR 3 HL ANTM GFT WDW TI RDS LT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VWL-05	SUP	HCPCS C1713		AR-8916VWL-05  -  PLATE BN W CNTR 5 HL ANTM GFT WDW TI RDS LT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VWL-07	SUP	HCPCS C1713		AR-8916VWL-07  -  PLATE BN W CNTR 7 HL ANTM GFT WDW TI RDS LT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VWL-09	SUP	HCPCS C1713		AR-8916VWL-09  -  PLATE BN W CNTR 9 HL ANTM GFT WDW TI RDS LT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VWR-03	SUP	HCPCS C1713		AR-8916VWR-03  -  PLATE BN W CNTR 3 HL ANTM GFT WDW TI RDS RT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VWR-05	SUP	HCPCS C1713		AR-8916VWR-05  -  PLATE BN W CNTR 5 HL ANTM GFT WDW TI RDS RT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VWR-07	SUP	HCPCS C1713		AR-8916VWR-07  -  PLATE BN W CNTR 7 HL ANTM GFT WDW TI RDS RT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8916VWR-09	SUP	HCPCS C1713		AR-8916VWR-09  -  PLATE BN W CNTR 9 HL ANTM GFT WDW TI RDS RT WRST VOLR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8917DS	SUP	HCPCS C1713		AR-8917DS  -  KIT ESCP INST MN FT 3.5MM STRL TGHTRP DRL GW HNDL INSRTR	BOTH IP/OP	"$1,575.00 "	"$1,165.50"	$0.00	"$1,260.00"	$708.75	$708.75	$0.00	$0.00	$0.00	$328.27	"$1,168.97"	"$1,168.97"	$0.00	$0.00	$328.23	$0.00	$931.61	$931.61	$0.00	$787.50	"$1,247.40"	"$1,260.00"	$0.00		$0.00	$246.49	$0.00	$0.00	$250.74	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8919DS	SUP	Custom 27203010		AR-8919DS  -  KIT ASCP FX MN 1.1MM TGHTRP KRSH BTN ANCH SUT CMC	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8920	SUP	HCPCS C1763		AR-8920  -  BUTTON SUT 3.5MM STRL	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8920CDS	SUP	Custom 27203010		AR-8920CDS  -  KIT ESCP INST STRL TGHTRP CNN FLXB TI DISP SYNDESMOSIS REPR	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$0.00	$0.00	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8920DC	SUP	Custom 27203010		AR-8920DC  -  BIT DRL 3.5MM CNN	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8921CDS	SUP	HCPCS C1769		AR-8921CDS  -  TIGHTROPE AR-8921CDS	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$712.69	$712.69	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8922	SUP	HCPCS C1763		AR-8922  -  BUTTON SUT 12MM STRL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8923BC	SUP	HCPCS C1713		AR-8923BC  -  ANCHOR SUT SHRT MED 2.9MM 2.3MM 12.5MM STRL PUSHLOCK BCMPS	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8923DSC	SUP	Custom 27203010		AR-8923DSC  -  KIT INST SHRT DRLBT DRL GD DISP 2.9/12.5MM BCMPS PUSHLOCK	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8926SS	SUP	Custom 27203010		AR-8926SS  -  KIT ESCP INST STRL TGHTRP CNN SS SYNDESMOSIS REPR ASCP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8926T	SUP	Custom 27203010		AR-8926T  -  KIT ESCP INST STRL TGHTRP SUT TI DESMOSIS REPR ASCP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	$0.00	$0.00	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8927BC	SUP	HCPCS C1713		AR-8927BC  -  ANCHOR SUT 1 LG FT TPR 3.4MM 15MM CSCR FWR TIGERWIRE BRD NDL	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$365.63	$365.63	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$127.16	$0.00	$0.00	$129.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8927BCNF-CP	SUP	HCPCS C1713		AR-8927BCNF-CP  -  SET IMPL STRL LF ARTHX SUTUREBRIDGE BCMPS DISP AHLS PK	BOTH IP/OP	"$3,987.50 "	"$2,950.75"	$0.00	"$3,190.00"	"$1,794.38"	"$1,794.38"	$0.00	$0.00	$0.00	$831.09	"$2,959.52"	"$2,959.52"	$0.00	$0.00	$831.00	$0.00	"$1,965.84"	"$1,965.84"	$0.00	"$1,993.75"	"$3,158.10"	"$3,190.00"	$0.00		$0.00	$624.04	$0.00	$0.00	$634.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8927BNF	SUP	HCPCS C1713		AR-8927BNF  -  ANCHOR SUT 1 LG FT TPR 5.5MM 15MM BCSCR FWR BRD NDL POLY L	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8927BNF-CP	SUP	HCPCS C1713		AR-8927BNF-CP  -  SET IMPL LG TPR SUTUREBRIDGE ANCH DRL GD NDL PNCH TAP AHLS	BOTH IP/OP	"$3,100.00 "	"$2,294.00"	$0.00	"$2,480.00"	"$1,395.00"	"$1,395.00"	$0.00	$0.00	$0.00	$646.12	"$2,300.82"	"$2,300.82"	$0.00	$0.00	$646.04	$0.00	"$1,528.30"	"$1,528.30"	$0.00	"$1,550.00"	"$2,455.20"	"$2,480.00"	$0.00		$0.00	$485.15	$0.00	$0.00	$493.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8927DSC	SUP	Custom 27203010		AR-8927DSC  -  KIT INST DISP 4.5/14MM BCMPS CRKSCR	BOTH IP/OP	$437.50 	$323.75	$0.00	$402.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8927P-CP	SUP	HCPCS C1713		AR-8927P-CP  -  SET IMPL SUTUREBRIDGE DRL GD PNCH PUSHLOCK TAP PEEK AHLS PK	BOTH IP/OP	"$3,100.00 "	"$2,294.00"	$0.00	"$2,480.00"	"$1,395.00"	"$1,395.00"	$0.00	$0.00	$0.00	$646.12	"$2,300.82"	"$2,300.82"	$0.00	$0.00	$646.04	$0.00	"$1,528.30"	"$1,528.30"	$0.00	"$1,550.00"	"$2,455.20"	"$2,480.00"	$0.00		$0.00	$485.15	$0.00	$0.00	$493.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8928BC-CP	SUP	HCPCS C1713		AR-8928BC-CP  -  SET IMPL SUTUREBRIDGE ANCH DRILL GUIDE PNCH TAP	BOTH IP/OP	"$4,350.00 "	"$3,219.00"	$0.00	"$3,480.00"	"$1,957.50"	"$1,957.50"	$0.00	$0.00	$0.00	$906.65	"$3,228.57"	"$3,228.57"	$0.00	$0.00	$906.54	$0.00	"$2,144.55"	"$2,144.55"	$0.00	"$2,175.00"	"$3,445.20"	"$3,480.00"	$0.00		$0.00	$680.78	$0.00	$0.00	$692.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8928BCJ-CP	SUP	HCPCS C1713		AR-8928BCJ-CP  -  SYSTEM FX STRL SPEEDBRIDGE JUMPSTART BCMPS AHLS	BOTH IP/OP	"$4,987.50 "	"$3,690.75"	$0.00	"$3,990.00"	"$2,244.38"	"$2,244.38"	$0.00	$0.00	$0.00	"$1,039.52"	"$3,701.72"	"$3,701.72"	$0.00	$0.00	"$1,039.40"	$0.00	"$2,458.84"	"$2,458.84"	$0.00	"$2,493.75"	"$3,950.10"	"$3,990.00"	$0.00		$0.00	$780.54	$0.00	$0.00	$794.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8928P-CP	SUP	HCPCS C1713		AR-8928P-CP  -  SET IMPL SUTUREBRIDGE ANCH DRL GD PNCH TAP PEEK AHLS PK	BOTH IP/OP	"$4,350.00 "	"$3,219.00"	$0.00	"$3,480.00"	"$1,957.50"	"$1,957.50"	$0.00	$0.00	$0.00	$906.65	"$3,228.57"	"$3,228.57"	$0.00	$0.00	$906.54	$0.00	"$2,144.55"	"$2,144.55"	$0.00	"$2,175.00"	"$3,445.20"	"$3,480.00"	$0.00		$0.00	$680.78	$0.00	$0.00	$692.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8928PJ-CP	SUP	HCPCS C1713		AR-8928PJ-CP  -  SYSTEM IMPL STRL ARTHX SPEEDBRIDGE JUMPSTART AHLS	BOTH IP/OP	"$4,987.50 "	"$3,690.75"	$0.00	"$3,990.00"	"$2,244.38"	"$2,244.38"	$0.00	$0.00	$0.00	"$1,039.52"	"$3,701.72"	"$3,701.72"	$0.00	$0.00	"$1,039.40"	$0.00	"$2,458.84"	"$2,458.84"	$0.00	"$2,493.75"	"$3,950.10"	"$3,990.00"	$0.00		$0.00	$780.54	$0.00	$0.00	$794.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8930-10	SUP	HCPCS C1713		AR-8930-10  -  SCREW BN FT 2MM 10MM SLVR QFIX 3 PR SLF DRL ST SNPOF SLD TI	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8930-11	SUP	HCPCS C1713		AR-8930-11  -  SCREW BN FT 2MM 11MM MAG QFIX 3 PR SLF DRL ST SNPOF SLD TI	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8930-12	SUP	HCPCS C1713		AR-8930-12  -  SCREW BN FT 2MM 12MM BLU QFIX 3 PR SLF DRL ST SNPOF SLD TI	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8930-13	SUP	HCPCS C1713		AR-8930-13  -  SCREW BN FT 2MM 13MM GRN QFIX 3 PR SLF DRL ST SNPOF SLD TI	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8930-14	SUP	HCPCS C1713		AR-8930-14  -  SCREW BN FT 2MM 14MM PUR QFIX 3 PR SLF DRL ST SNPOF SLD TI	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8930D-13	SUP	Custom 27203010		AR-8930D-13  -  BIT DRL 1.3MM 2MM QFIX SCR	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8930MC	SUP	Custom 27203010		AR-8930MC  -  CLAMP SRG QFIX WEIL OSTM	BOTH IP/OP	"$3,987.50 "	"$2,950.75"	$0.00	"$2,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.52"	"$2,959.52"	$0.00	$0.00	$831.00	$0.00	$0.00	$0.00	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8930MCS	SUP	Custom 27203010		AR-8930MCS  -  CLAMP SRG QFIX INST SET	BOTH IP/OP	"$4,737.50 "	"$3,505.75"	$0.00	"$3,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,516.17"	"$3,516.17"	$0.00	$0.00	$987.30	$0.00	$0.00	$0.00	$0.00	"$2,368.75"	"$3,752.10"	"$3,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8931-13	SUP	HCPCS C1713		AR-8931-13  -  SCREW BN FT 3MM 13MM YLW QFIX 3 PR SLF DRL SNPOF TI FT HND	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8931-15	SUP	HCPCS C1713		AR-8931-15  -  SCREW BN FT 3MM 15MM LGHT BLU QFIX 3 PR SLF DRL SNPOF TI FT	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8931-17	SUP	HCPCS C1713		AR-8931-17  -  SCREW BN FT 3MM 17MM AQ QFIX 3 PR SLF DRL SNPOF TI FT HND	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8931-17S	SUP	HCPCS C1713		AR-8931-17S  -  SCREW BN 3MM 17MM STRL ARTHX QFIX	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8931-19	SUP	HCPCS C1713		AR-8931-19  -  SCREW BN FT 3MM 19MM BRNZ QFIX 3 PR SLF DRL SNPOF TI FT HND	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-10	SUP	HCPCS C1713		AR-8933-10  -  SCREW BN FT T10 HEXALOBE 3MM 10MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-10PT	SUP	HCPCS C1713		AR-8933-10PT  -  SCREW BN 2.5MM HEX P/T 3MM 10MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-12	SUP	HCPCS C1713		AR-8933-12  -  SCREW BN FT T10 HEXALOBE 3MM 12MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-12PT	SUP	HCPCS C1713		AR-8933-12PT  -  SCREW BN 2.5MM P/T HEX 3MM 12MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-14	SUP	HCPCS C1713		AR-8933-14  -  SCREW BN FT T10 HEXALOBE 3MM 14MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-14PT	SUP	HCPCS C1713		AR-8933-14PT  -  SCREW BN 2.5MM P/T HEX 3MM 14MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-16	SUP	HCPCS C1713		AR-8933-16  -  SCREW BN FT T10 HEXALOBE 3MM 16MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-16PT	SUP	HCPCS C1713		AR-8933-16PT  -  SCREW BN 2.5MM P/T HEX 3MM 16MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-18	SUP	HCPCS C1713		AR-8933-18  -  SCREW BN T10 HEXALOBE FT 3MM 18MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-18PT	SUP	HCPCS C1713		AR-8933-18PT  -  SCREW BN 2.5MM P/T HEX 3MM 18MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-18PTS	SUP	HCPCS C1713		AR-8933-18PTS  -  SCREW BN P/T 3MM 18MM STRL ARTHX LOPRFL SCR CNN TI	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-20	SUP	HCPCS C1713		AR-8933-20  -  SCREW BN FT T10 HEXALOBE 3MM 20MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-20C	SUP	Custom 27203010		AR-8933-20C  -  BIT DRL 2MM CNN AO	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-20PT	SUP	HCPCS C1713		AR-8933-20PT  -  SCREW BN 2.5MM P/T HEX 3MM 20MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-20PTS	SUP	HCPCS C1713		AR-8933-20PTS  -  SCREW BN P/T 3MM 20MM STRL ARTHX LOPRFL SCR CNN TI	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-22	SUP	HCPCS C1713		AR-8933-22  -  SCREW BN FT T10 HEXALOBE 3MM 22MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-22PT	SUP	HCPCS C1713		AR-8933-22PT  -  SCREW BN 2.5MM P/T HEX 3MM 22MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-24	SUP	HCPCS C1713		AR-8933-24  -  SCREW BN FT T10 HEXALOBE 3MM 24MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-24PT	SUP	HCPCS C1713		AR-8933-24PT  -  SCREW BN 2.5MM P/T HEX 3MM 24MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-26	SUP	HCPCS C1713		AR-8933-26  -  SCREW BN T10 HEXALOBE FT 3MM 26MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-26PT	SUP	HCPCS C1713		AR-8933-26PT  -  SCREW BN 2.5MM P/T HEX 3MM 26MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-28	SUP	HCPCS C1713		AR-8933-28  -  SCREW BN FT T10 HEXALOBE 3MM 28MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-28PT	SUP	HCPCS C1713		AR-8933-28PT  -  SCREW BN 2.5MM P/T HEX 3MM 28MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-30	SUP	HCPCS C1713		AR-8933-30  -  SCREW BN T10 HEXALOBE FT 3MM 30MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-30C	SUP	Custom 27203010		AR-8933-30C  -  BIT DRL 3MM CNN	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-30PT	SUP	HCPCS C1713		AR-8933-30PT  -  SCREW BN 2.5MM P/T HEX 3MM 30MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-30PTS	SUP	HCPCS C1713		AR-8933-30PTS  -  SCREW BN P/T 3MM 30MM STRL ARTHX LOPRFL SCR CNN TI	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$39.38	$39.38	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-32PT	SUP	HCPCS C1713		AR-8933-32PT  -  SCREW BN 2.5MM P/T HEX 3MM 32MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-34	SUP	HCPCS C1713		AR-8933-34  -  SCREW BN T10 HEXALOBE FT 3MM 34MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-34PT	SUP	HCPCS C1713		AR-8933-34PT  -  SCREW BN 2.5MM HEX P/T 3MM 34MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-36	SUP	HCPCS C1713		AR-8933-36  -  SCREW BN T10 HEXALOBE FT 3MM 36MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-36PT	SUP	HCPCS C1713		AR-8933-36PT  -  SCREW BN 2.5MM P/T HEX 3MM 36MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-38	SUP	HCPCS C1713		AR-8933-38  -  SCREW BN T10 HEXALOBE FT 3MM 38MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-38PT	SUP	HCPCS C1713		AR-8933-38PT  -  SCREW BN 2.5MM P/T HEX 3MM 38MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-40	SUP	HCPCS C1713		AR-8933-40  -  SCREW BN T10 HEXALOBE FT 3MM 40MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$123.75	$123.75	$0.00	$0.00	$0.00	$57.32	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$162.66	$162.66	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933-40PT	SUP	HCPCS C1713		AR-8933-40PT  -  SCREW BN 2.5MM P/T HEX 3MM 40MM LOPRFL SCR SLF DRL ST CNN TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933G	SUP	Custom 27203010		AR-8933G  -  GUIDE DRL LOPRFL 1.1-2MM	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$0.00	$0.00	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933GV	SUP	Custom 27203010		AR-8933GV  -  GUIDE DRL 3MM VA	BOTH IP/OP	"$1,037.50 "	$767.75	$0.00	$830.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$770.03	$770.03	$0.00	$0.00	$216.22	$0.00	$0.00	$0.00	$0.00	$518.75	$821.70	$830.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-10	SUP	HCPCS C1713		AR-8933L-10  -  SCREW BN FT T10 HEXALOBE 3MM 10MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-12	SUP	HCPCS C1713		AR-8933L-12  -  SCREW BN FT T10 HEXALOBE 3MM 12MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-14	SUP	HCPCS C1713		AR-8933L-14  -  SCREW BN FT T10 HEXALOBE 3MM 14MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-16	SUP	HCPCS C1713		AR-8933L-16  -  SCREW BN FT T10 HEXALOBE 3MM 16MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-18	SUP	HCPCS C1713		AR-8933L-18  -  SCREW BN T10 HEXALOBE FT 3MM 18MM SLF DRL SLD LCK LOPRFL TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-20	SUP	HCPCS C1713		AR-8933L-20  -  SCREW BN FT T10 3MM 20MM SLF DRL SLD LCK LOPRFL TI FOREFOOT	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-22	SUP	HCPCS C1713		AR-8933L-22  -  SCREW BN FT T10 HEXALOBE 3MM 22MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-24	SUP	HCPCS C1713		AR-8933L-24  -  SCREW BN FT T10 HEXALOBE 3MM 24MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-26	SUP	HCPCS C1713		AR-8933L-26  -  SCREW BN T10 HEXALOBE FT 3MM 26MM LCK SLF DRL SLD TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-28	SUP	HCPCS C1713		AR-8933L-28  -  SCREW BN 3MM 28MM LCK LOPRFL TI FT HND ANKL WRST	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-30	SUP	HCPCS C1713		AR-8933L-30  -  SCREW BN 3MM 30MM LCK LOPRFL TI FT HND ANKL WRST	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-32	SUP	HCPCS C1713		AR-8933L-32  -  SCREW BN 3MM 32MM LCK TI FT/ANKL	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-36	SUP	HCPCS C1713		AR-8933L-36  -  SCREW BN 3MM 36MM LOPRFL LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-38	SUP	HCPCS C1713		AR-8933L-38  -  SCREW BN 3MM 38MM LCK TI FT/ANKL	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933L-40	SUP	HCPCS C1713		AR-8933L-40  -  SCREW BN 3MM 40MM LCK TI FT/ANKL	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$123.75	$123.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-10	SUP	HCPCS C1713		AR-8933V-10  -  SCREW BN 3MM 10MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-12	SUP	HCPCS C1713		AR-8933V-12  -  SCREW BN 3MM 12MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-14	SUP	HCPCS C1713		AR-8933V-14  -  SCREW BN 3MM 14MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-16	SUP	HCPCS C1713		AR-8933V-16  -  SCREW BN 3MM 16MM VA LCK TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-18	SUP	HCPCS C1713		AR-8933V-18  -  SCREW BN 3MM 18MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-20	SUP	HCPCS C1713		AR-8933V-20  -  SCREW BN 3MM 20MM VA LCK TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-22	SUP	HCPCS C1713		AR-8933V-22  -  SCREW BN 3MM 22MM VA LCK TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-24	SUP	HCPCS C1713		AR-8933V-24  -  SCREW BN 3MM 24MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-26	SUP	HCPCS C1713		AR-8933V-26  -  SCREW BN 3MM 26MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-28	SUP	HCPCS C1713		AR-8933V-28  -  SCREW BN 3MM 28MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-30	SUP	HCPCS C1713		AR-8933V-30  -  SCREW BN 3MM 30MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-32	SUP	HCPCS C1713		AR-8933V-32  -  SCREW BN 3MM 32MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-34	SUP	HCPCS C1713		AR-8933V-34  -  SCREW BN 3MM 34MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-36	SUP	HCPCS C1713		AR-8933V-36  -  SCREW BN 3MM 36MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-38	SUP	HCPCS C1713		AR-8933V-38  -  SCREW BN 3MM 38MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8933V-40	SUP	HCPCS C1713		AR-8933V-40  -  SCREW BN 3MM 40MM LCK VA TI FT	BOTH IP/OP	$437.50 	$323.75	$0.00	$324.71	$157.50	$157.50	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8934BCNF	SUP	HCPCS C1713		AR-8934BCNF  -  ANCHOR SUTURE 1 .5 CIR 2 DIAMOND 26.2MM NEEDLE SUTURETAK	BOTH IP/OP	$812.50 	$601.25	$0.00	$930.00	$523.13	$523.13	$0.00	$0.00	$0.00	$169.35	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$480.59	$480.59	$0.00	$581.25	$920.70	$930.00	$0.00		$0.00	$181.93	$0.00	$0.00	$185.07	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8934BCNF-00	SUP	HCPCS C1713		AR-8934BCNF-00  -  ANCHOR SUT 0 .5 CRC 4 DMD 22.2MM SUT TK FBRWR NDL BCMPS S	BOTH IP/OP	"$4,062.50 "	"$3,006.25"	$0.00	"$3,250.00"	"$1,828.13"	"$1,828.13"	$0.00	$0.00	$0.00	$846.73	"$3,015.19"	"$3,015.19"	$0.00	$0.00	$846.63	$0.00	"$2,002.81"	"$2,002.81"	$0.00	"$2,031.25"	"$3,217.50"	"$3,250.00"	$0.00		$0.00	$635.78	$0.00	$0.00	$646.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8934DSC	SUP	Custom 27203010		AR-8934DSC  -  KIT INSTR 2.4MM DRILL GUIDE STEP DRILL DISPOSABLE SMALL	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$0.00	$0.00	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-10	SUP	HCPCS C1713		AR-8935-10  -  SCREW BN T15 HEXALOBE FT 3.5MM 10MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-11	SUP	HCPCS C1713		AR-8935-11  -  SCREW BN T15 HEXALOBE FT 3.5MM 11MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-12	SUP	HCPCS C1713		AR-8935-12  -  SCREW BN T15 FT HEXALOBE 3.5MM 12MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-13	SUP	HCPCS C1713		AR-8935-13  -  SCREW BN T15 FT HEXALOBE 3.5MM 13MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-14	SUP	HCPCS C1713		AR-8935-14  -  SCREW BN T15 FT HEXALOBE 3.5MM 14MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-16	SUP	HCPCS C1713		AR-8935-16  -  SCREW BN T15 FT HEXALOBE 3.5MM 16MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-18	SUP	HCPCS C1713		AR-8935-18  -  SCREW BN T15 FT HEXALOBE 3.5MM 18MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-20	SUP	HCPCS C1713		AR-8935-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-22	SUP	HCPCS C1713		AR-8935-22  -  SCREW BN T15 FT HEXALOBE 3.5MM 22MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-28	SUP	HCPCS C1713		AR-8935-28  -  SCREW BN T15 FT HEXALOBE 3.5MM 28MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-30	SUP	HCPCS C1713		AR-8935-30  -  SCREW BN T15 FT HEXALOBE 3.5MM 30MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-34	SUP	HCPCS C1713		AR-8935-34  -  SCREW BN T15 FT HEXALOBE 3.5MM 34MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-36	SUP	HCPCS C1713		AR-8935-36  -  SCREW BN T15 FT HEXALOBE 3.5MM 36MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-38	SUP	HCPCS C1713		AR-8935-38  -  SCREW BN T15 FT HEXALOBE 3.5MM 38MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-40	SUP	HCPCS C1713		AR-8935-40  -  SCREW BN T15 FT HEXALOBE 3.5MM 40MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-42	SUP	HCPCS C1713		AR-8935-42  -  SCREW BN T15 FT HEXALOBE 3.5MM 42MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-44	SUP	HCPCS C1713		AR-8935-44  -  SCREW BN T15 FT HEXALOBE 3.5MM 44MM LOPRFL SCR SLF DRL SLD	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-46	SUP	HCPCS C1713		AR-8935-46  -  SCREW BN 3.5MM 46MM LOPRFL TI FT/ANKL CORT	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-48	SUP	HCPCS C1713		AR-8935-48  -  SCREW BN 3.5MM 48MM LOPRFL TI CORT	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-50	SUP	HCPCS C1713		AR-8935-50  -  SCREW BN 3.5MM 50MM LOPRFL TI FT/ANKL CORT	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-52	SUP	HCPCS C1713		AR-8935-52  -  SCREW BN 3.5MM 52MM LOPRFL TI CORT	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-54	SUP	HCPCS C1713		AR-8935-54  -  SCREW BN 3.5MM 54MM LOPRFL TI FT/ANKL CORT	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-56	SUP	HCPCS C1713		AR-8935-56  -  SCREW BN 3.5MM 56MM LOPRFL TI FT/ANKL CORT	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-58	SUP	HCPCS C1713		AR-8935-58  -  SCREW BN 3.5MM 58MM LOPRFL TI FT/ANKL CORT	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935-60	SUP	HCPCS C1713		AR-8935-60  -  SCREW BN 3.5MM 60MM LOPRFL TI FT/ANKL CORT	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935G	SUP	Custom 27203010		AR-8935G  -  GUIDE DRL 3.5MM 4MM	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935GV	SUP	Custom 27203010		AR-8935GV  -  GUIDE DRL 3.5MM VA	BOTH IP/OP	"$1,037.50 "	$767.75	$0.00	$830.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$770.03	$770.03	$0.00	$0.00	$216.22	$0.00	$0.00	$0.00	$0.00	$518.75	$821.70	$830.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935GVN	SUP	Custom 27203010		AR-8935GVN  -  GUIDE DRL 3.5MM LCK VA	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$0.00	$0.00	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-10	SUP	HCPCS C1713		AR-8935L-10  -  SCREW BN 3.5MM 10MM LOPRFL LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-12	SUP	HCPCS C1713		AR-8935L-12  -  SCREW BN 3.5MM 12MM LCK LOPRFL TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-14	SUP	HCPCS C1713		AR-8935L-14  -  SCREW BN T15 FT HEXALOBE 3.5MM 14MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-16	SUP	HCPCS C1713		AR-8935L-16  -  SCREW BN 3.5MM 16MM LCK TI MIDFOOT CORT	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-20	SUP	HCPCS C1713		AR-8935L-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-22	SUP	HCPCS C1713		AR-8935L-22  -  SCREW BN T15 FT HEXALOBE 3.5MM 22MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-24	SUP	HCPCS C1713		AR-8935L-24  -  SCREW BN T15 FT HEXALOBE 3.5MM 24MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-26	SUP	HCPCS C1713		AR-8935L-26  -  SCREW BN T15 FT HEXALOBE 3.5MM 26MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-28	SUP	HCPCS C1713		AR-8935L-28  -  SCREW BN T15 FT HEXALOBE 3.5MM 28MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-30	SUP	HCPCS C1713		AR-8935L-30  -  SCREW BN T15 FT HEXALOBE 3.5MM 30MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-32	SUP	HCPCS C1713		AR-8935L-32  -  SCREW BN T15 FT HEXALOBE 3.5MM 32MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-34	SUP	HCPCS C1713		AR-8935L-34  -  SCREW BN T15 FT HEXALOBE 3.5MM 34MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-36	SUP	HCPCS C1713		AR-8935L-36  -  SCREW BN T15 FT HEXALOBE 3.5MM 36MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-38	SUP	HCPCS C1713		AR-8935L-38  -  SCREW BN T15 FT HEXALOBE 3.5MM 38MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-40	SUP	HCPCS C1713		AR-8935L-40  -  SCREW BN T15 FT HEXALOBE 3.5MM 40MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-42	SUP	HCPCS C1713		AR-8935L-42  -  SCREW BN T15 FT HEXALOBE 3.5MM 42MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-44	SUP	HCPCS C1713		AR-8935L-44  -  SCREW BN T15 FT HEXALOBE 3.5MM 44MM SLF DRL SLD LCK TI	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-46	SUP	HCPCS C1713		AR-8935L-46  -  SCREW BN 3.5MM 46MM LCK LOPRFL TI HND ANKL LNG BN	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-48	SUP	HCPCS C1713		AR-8935L-48  -  SCREW BN 3.5MM 48MM LCK LOPRFL TI FT/ANKL	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-50	SUP	HCPCS C1713		AR-8935L-50  -  SCREW BN 3.5MM 50MM LCK LOPRFL TI FT/ANKL	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-52	SUP	HCPCS C1713		AR-8935L-52  -  SCREW BN 3.5MM 52MM LCK LOPRFL TI FT/ANKL	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-54	SUP	HCPCS C1713		AR-8935L-54  -  SCREW BN 3.5MM 54MM LCK LOPRFL TI FT/ANKL	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-56	SUP	HCPCS C1713		AR-8935L-56  -  SCREW BN 3.5MM 56MM LCK LOPRFL TI FT/ANKL	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-58	SUP	HCPCS C1713		AR-8935L-58  -  SCREW BN 3.5MM 58MM LCK LOPRFL TI FT/ANKL	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8935L-60	SUP	HCPCS C1713		AR-8935L-60  -  SCREW BN 3.5MM 60MM LCK LOPRFL TI FT/ANKL	BOTH IP/OP	$375.00 	$277.50	$0.00	$278.33	$95.63	$95.63	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8936BC-CP	SUP	HCPCS C1713		AR-8936BC-CP  -  KIT ESCP INST CNN STP DRL DRL GD OBT BROSTROM ASCP	BOTH IP/OP	"$3,625.00 "	"$2,682.50"	$0.00	"$2,900.00"	"$1,631.25"	"$1,631.25"	$0.00	$0.00	$0.00	$755.54	"$2,690.48"	"$2,690.48"	$0.00	$0.00	$755.45	$0.00	"$1,787.13"	"$1,787.13"	$0.00	"$1,812.50"	"$2,871.00"	"$2,900.00"	$0.00		$0.00	$567.31	$0.00	$0.00	$577.10	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8938P	SUP	HCPCS C1713		AR-8938P  -  KIT INST RD YLW 2 EYLT CNVR LCK DRVR SMPL SNP SUT LDR PEEK	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$219.38	$219.38	$0.00	$0.00	$0.00	$101.61	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$288.36	$288.36	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-14	SUP	HCPCS C1713		AR-8940-14  -  SCREW BN T15 FT HEXALOBE 4MM 14MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-16	SUP	HCPCS C1713		AR-8940-16  -  SCREW BN T15 FT HEXALOBE 4MM 16MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-16S	SUP	HCPCS C1713		AR-8940-16S  -  SCREW BN 4MM 16MM STRL ARTHX LOPRFL SCR TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-18	SUP	HCPCS C1713		AR-8940-18  -  SCREW BN T15 FT HEXALOBE 4MM 18MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-18S	SUP	HCPCS C1713		AR-8940-18S  -  SCREW BN 4MM 18MM STRL ARTHX LOPRFL SCR TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-20	SUP	HCPCS C1713		AR-8940-20  -  SCREW BN T15 FT HEXALOBE 4MM 20MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-20S	SUP	HCPCS C1713		AR-8940-20S  -  SCREW BN 4MM 20MM STRL ARTHX LOPRFL SCR TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-22	SUP	HCPCS C1713		AR-8940-22  -  SCREW BN T15 FT HEXALOBE 4MM 22MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-22S	SUP	HCPCS C1713		AR-8940-22S  -  SCREW BN 4MM 22MM STRL ARTHX LOPRFL SCR TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-24	SUP	HCPCS C1713		AR-8940-24  -  SCREW BN T15 FT HEXALOBE 4MM 24MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-26	SUP	HCPCS C1713		AR-8940-26  -  SCREW BN T15 FT HEXALOBE 4MM 26MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-28	SUP	HCPCS C1713		AR-8940-28  -  SCREW BN T15 FT HEXALOBE 4MM 28MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-28S	SUP	HCPCS C1713		AR-8940-28S  -  SCREW BN 4MM 28MM STRL ARTHX LOPRFL SCR TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-30	SUP	HCPCS C1713		AR-8940-30  -  SCREW BN T15 FT HEXALOBE 4MM 30MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-30S	SUP	HCPCS C1713		AR-8940-30S  -  SCREW BN 4MM 30MM STRL ARTHX LOPRFL SCR TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-32	SUP	HCPCS C1713		AR-8940-32  -  SCREW BN T15 FT HEXALOBE 4MM 32MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-32S	SUP	HCPCS C1713		AR-8940-32S  -  SCREW BN 4MM 32MM STRL ARTHX LOPRFL SCR TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-34	SUP	HCPCS C1713		AR-8940-34  -  SCREW BN T15 FT HEXALOBE 4MM 34MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-36	SUP	HCPCS C1713		AR-8940-36  -  SCREW BN T15 FT HEXALOBE 4MM 36MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-38	SUP	HCPCS C1713		AR-8940-38  -  SCREW BN T15 FT HEXALOBE 4MM 38MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-40	SUP	HCPCS C1713		AR-8940-40  -  SCREW BN T15 FT HEXALOBE 4MM 40MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-40S	SUP	HCPCS C1713		AR-8940-40S  -  SCREW BN 4MM 40MM STRL ARTHX LOPRFL SCR TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-42	SUP	HCPCS C1713		AR-8940-42  -  SCREW BN T15 FT HEXALOBE 4MM 42MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-42S	SUP	HCPCS C1713		AR-8940-42S  -  SCREW BN 4MM 42MM STRL ARTHX LOPRFL SCR TI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-44	SUP	HCPCS C1713		AR-8940-44  -  SCREW BN T15 FT HEXALOBE 4MM 44MM LOPRFL SCR SLF DRL SLD TI	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-46	SUP	HCPCS C1713		AR-8940-46  -  SCREW BN 4MM 46MM LOPRFL TI FT/ANKL CANC	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-48	SUP	HCPCS C1713		AR-8940-48  -  SCREW BN 4MM 48MM LOPRFL TI FT/ANKL CANC	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-50	SUP	HCPCS C1713		AR-8940-50  -  SCREW BN 4MM 50MM LOPRFL TI HND ANKL LNG BN	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-52	SUP	HCPCS C1713		AR-8940-52  -  SCREW BN 4MM 52MM LOPRFL TI FT/ANKL CANC	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-54	SUP	HCPCS C1713		AR-8940-54  -  SCREW BN 4MM 54MM LOPRFL TI FT/ANKL CANC	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-56	SUP	HCPCS C1713		AR-8940-56  -  SCREW BN 4MM 56MM LOPRFL TI FT/ANKL CANC	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-58	SUP	HCPCS C1713		AR-8940-58  -  SCREW BN 4MM 58MM LOPRFL TI FT/ANKL CANC	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8940-60	SUP	HCPCS C1713		AR-8940-60  -  SCREW BN 4MM 60MM LOPRFL TI FT/ANKL CANC	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8941-6	SUP	HCPCS C1769		AR-8941-6  -  WIRE FIX .062IN .062IN 6IN KWIRE	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$54.30	$54.30	$0.00	$0.00	$0.00	$20.84	$74.22	$74.22	$0.00	$0.00	$20.84	$0.00	$59.15	$59.15	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$15.65	$0.00	$0.00	$15.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8941-7	SUP	HCPCS C1769		AR-8941-7  -  WIRE FIX .062IN .062IN 7IN KWIRE	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$54.30	$54.30	$0.00	$0.00	$0.00	$20.84	$74.22	$74.22	$0.00	$0.00	$20.84	$0.00	$59.15	$59.15	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$15.65	$0.00	$0.00	$15.92	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8941G	SUP	Custom 27203010		AR-8941G  -  GUIDE DRL 3.5/4 MM MTL SCR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8941GL	SUP	Custom 27203010		AR-8941GL  -  GUIDE DRL D LCK	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8941L	SUP	HCPCS C1713		AR-8941L  -  PLATE BN LNG LOPRFL FT/ANKL LAPIDUS LISFRANC	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$731.25	$731.25	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8941PLS	SUP	HCPCS C1713		AR-8941PLS  -  PLATE BN SHRT LOPRFL PRECONTOUR TI PLNTR LT LAPIDUS	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8941PR	SUP	HCPCS C1713		AR-8941PR  -  PLATE BN PLNTR RT LAPIDUS	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8941PRS	SUP	HCPCS C1713		AR-8941PRS  -  PLATE BN SHRT PLNTR RT LAPIDUS	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942-02	SUP	Custom 27203010		AR-8942-02  -  BIT DRL WDG 1.7MM EVANS DISP	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942-03	SUP	Custom 27203010		AR-8942-03  -  GUIDE DRL 1.7MM EVANS WDG	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942L-06	SUP	HCPCS C1713		AR-8942L-06  -  PLATE BN H WDG LOPRFL 34X16X6MM TI MIDFOOT LT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$731.25	$731.25	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942L-08	SUP	HCPCS C1713		AR-8942L-08  -  PLATE BN H WDG LOPRFL 36X16X8MM TI MIDFOOT LT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$731.25	$731.25	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942L-10	SUP	HCPCS C1713		AR-8942L-10  -  PLATE BN H WDG LOPRFL 36X16X10MM TI MIDFOOT LT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$731.25	$731.25	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942L-L	SUP	HCPCS C1713		AR-8942L-L  -  PLATE BN LG H FLT LOPRFL 38X16MM TI MIDFOOT LT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$675.00	$675.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942L-M	SUP	HCPCS C1713		AR-8942L-M  -  PLATE BN MED H FLT LOPRFL 34X16MM TI MIDFOOT LT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$675.00	$675.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942L-S	SUP	HCPCS C1713		AR-8942L-S  -  PLATE BN SM H FLT LOPRFL 28X16MM TI MIDFOOT LT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$675.00	$675.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942R-06	SUP	HCPCS C1713		AR-8942R-06  -  PLATE BN H WDG LOPRFL 34X16X6MM TI MIDFOOT RT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$731.25	$731.25	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942R-08	SUP	HCPCS C1713		AR-8942R-08  -  PLATE BN H WDG LOPRFL 34X16X8MM TI MIDFOOT RT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$731.25	$731.25	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942R-10	SUP	HCPCS C1713		AR-8942R-10  -  PLATE BN H WDG LOPRFL 36X16X10MM TI MIDFOOT RT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$731.25	$731.25	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942R-L	SUP	HCPCS C1713		AR-8942R-L  -  PLATE BN LG H FLT LOPRFL 38X16MM TI MIDFOOT RT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$675.00	$675.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942R-M	SUP	HCPCS C1713		AR-8942R-M  -  PLATE BN MED H FLT LOPRFL 34X16MM TI MIDFOOT RT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$675.00	$675.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8942R-S	SUP	HCPCS C1713		AR-8942R-S  -  PLATE BN SM H FLT LOPRFL 28X16MM TI MIDFOOT RT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$675.00	$675.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-02	SUP	Custom 27203010		AR-8943-02  -  BIT DRL 2.6MM 160MM CNN 4MM LPS P/T SCR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-03	SUP	Custom 27203010		AR-8943-03  -  GUIDE DRL 1.35-2.6MM 4MM LPS P/T SCR	BOTH IP/OP	$937.50 	$693.75	$0.00	$695.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-05	SUP	Custom 27203010		AR-8943-05  -  DRILL BIT CNTRSNK 4MM QFIX CNN 4MM LPS P/T SCR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-13	SUP	Custom 27203010		AR-8943-13  -  BIT DRL 2.5MM CLBRT GRAD	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-14	SUP	Custom 27203010		AR-8943-14  -  GUIDE DRL 3.5MM 2.5MM 3.5MM CORT 4MM CANC SCR LCK	BOTH IP/OP	"$1,687.50 "	"$1,248.75"	$0.00	"$1,252.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,252.46"	"$1,252.46"	$0.00	$0.00	$351.68	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-16	SUP	Custom 27203010		AR-8943-16  -  BIT DRL 2MM CLBRT GRAD 2.7/3MM SCR	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-17	SUP	Custom 27203010		AR-8943-17  -  GUIDE DRL LOPRFL 2.7MM THRD 2.7/3MM SCR	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-24	SUP	Custom 27203010		AR-8943-24  -  CLAMP SRG WEBER	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-26	SUP	Custom 27203010		AR-8943-26  -  GUIDE DRL LOPRFL 3.5MM THRD	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-30	SUP	Custom 27203010		AR-8943-30  -  BIT DRL 2.5MM 110MM ANKL 3.5MM CORT 4MM CANC SCR LCK	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-31	SUP	Custom 27203010		AR-8943-31  -  GUIDE DRL 3MM 2MM ANKL 2.7/3MM SCR	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$788.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$0.00	$0.00	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-36	SUP	Custom 27203010		AR-8943-36  -  BIT DRL 3MM ANKL 2.7/3MM SCR	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-37	SUP	HCPCS C1713		AR-8943-37  -  SCREW BN REPL ATCH ANKL FX MGMT	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-40	SUP	Custom 27203010		AR-8943-40  -  BIT DRL 2MM CNN	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-41	SUP	Custom 27203010		AR-8943-41  -  GUIDE DRL 2.6MM 1.35MM PRLL 4MM LPS P/T SCR	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-43	SUP	Custom 27203010		AR-8943-43  -  GUIDE DRL 3.5MM BIT FX LCK VA FT/ANKL 3.5MM CORT 4MM CANC	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943-44	SUP	Custom 27203010		AR-8943-44  -  CLAMP SRG SYNDESMOSIS	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BL-04	SUP	HCPCS C1713		AR-8943BL-04  -  PLATE BN LOPRFL 4 HL LCK MDLR SS FIB LT DIST	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BL-05	SUP	HCPCS C1713		AR-8943BL-05  -  PLATE BN LOPRFL 5 HL LCK MDLR SS FIB LT DIST	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$731.25	$731.25	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BL-06	SUP	HCPCS C1713		AR-8943BL-06  -  PLATE BN LOPRFL 6 HL LCK MDLR SS FIB LT DIST	BOTH IP/OP	"$1,812.50 "	"$1,341.25"	$0.00	"$1,450.00"	$815.63	$815.63	$0.00	$0.00	$0.00	$377.77	"$1,345.24"	"$1,345.24"	$0.00	$0.00	$377.73	$0.00	"$1,072.09"	"$1,072.09"	$0.00	$906.25	"$1,435.50"	"$1,450.00"	$0.00		$0.00	$283.66	$0.00	$0.00	$288.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BL-08	SUP	HCPCS C1713		AR-8943BL-08  -  PLATE BN LOPRFL 8 HL LCK MDLR SS FIB LT DIST	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BLS-10	SUP	HCPCS C1713		AR-8943BLS-10  -  PLATE BN STRL 10 HL LCK FIB LT DIST	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BLS-12	SUP	HCPCS C1713		AR-8943BLS-12  -  PLATE BN STRL 12 HL LCK FIB LT DIST	BOTH IP/OP	"$2,150.00 "	"$1,591.00"	$0.00	"$1,720.00"	$967.50	$967.50	$0.00	$0.00	$0.00	$448.11	"$1,595.73"	"$1,595.73"	$0.00	$0.00	$448.06	$0.00	"$1,271.73"	"$1,271.73"	$0.00	"$1,075.00"	"$1,702.80"	"$1,720.00"	$0.00		$0.00	$336.48	$0.00	$0.00	$342.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BLS-14	SUP	HCPCS C1713		AR-8943BLS-14  -  PLATE BN STRL 14 HL LCK FIB LT DIST	BOTH IP/OP	"$2,175.00 "	"$1,609.50"	$0.00	"$1,740.00"	$978.75	$978.75	$0.00	$0.00	$0.00	$453.32	"$1,614.29"	"$1,614.29"	$0.00	$0.00	$453.27	$0.00	"$1,286.51"	"$1,286.51"	$0.00	"$1,087.50"	"$1,722.60"	"$1,740.00"	$0.00		$0.00	$340.39	$0.00	$0.00	$346.26	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BR-04	SUP	HCPCS C1713		AR-8943BR-04  -  PLATE BN LOPRFL 4 HL LCK MDLR SS ANKL RT FIB	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BR-05	SUP	HCPCS C1713		AR-8943BR-05  -  PLATE BN LOPRFL 5 HL LCK MDLR SS ANKL RT FIB	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$731.25	$731.25	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BR-06	SUP	HCPCS C1713		AR-8943BR-06  -  PLATE BN LOPRFL 6 HL LCK MDLR SS ANKL RT FIB	BOTH IP/OP	"$1,812.50 "	"$1,341.25"	$0.00	"$1,450.00"	$815.63	$815.63	$0.00	$0.00	$0.00	$377.77	"$1,345.24"	"$1,345.24"	$0.00	$0.00	$377.73	$0.00	"$1,072.09"	"$1,072.09"	$0.00	$906.25	"$1,435.50"	"$1,450.00"	$0.00		$0.00	$283.66	$0.00	$0.00	$288.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BR-08	SUP	HCPCS C1713		AR-8943BR-08  -  PLATE BN LOPRFL 8 HL LCK MDLR SS ANKL RT FIB	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BRS-10	SUP	HCPCS C1713		AR-8943BRS-10  -  PLATE BN STRL 10 HL LCK FIB RT DIST	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BRS-12	SUP	HCPCS C1713		AR-8943BRS-12  -  PLATE BN STRL 12 HL LCK FIB RT DIST	BOTH IP/OP	"$2,150.00 "	"$1,591.00"	$0.00	"$1,720.00"	$967.50	$967.50	$0.00	$0.00	$0.00	$448.11	"$1,595.73"	"$1,595.73"	$0.00	$0.00	$448.06	$0.00	"$1,271.73"	"$1,271.73"	$0.00	"$1,075.00"	"$1,702.80"	"$1,720.00"	$0.00		$0.00	$336.48	$0.00	$0.00	$342.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943BRS-14	SUP	HCPCS C1713		AR-8943BRS-14  -  PLATE BN STRL 12 HL LCK FIB RT DIST	BOTH IP/OP	"$2,175.00 "	"$1,609.50"	$0.00	"$1,740.00"	$978.75	$978.75	$0.00	$0.00	$0.00	$453.32	"$1,614.29"	"$1,614.29"	$0.00	$0.00	$453.27	$0.00	"$1,286.51"	"$1,286.51"	$0.00	"$1,087.50"	"$1,722.60"	"$1,740.00"	$0.00		$0.00	$340.39	$0.00	$0.00	$346.26	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943C-04	SUP	HCPCS C1713		AR-8943C-04  -  PLATE BN STRG 55MM 4 HL LCK SS ANKL	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943C-06	SUP	HCPCS C1713		AR-8943C-06  -  PLATE BN STRG 80MM 6 HL LCK SS ANKL	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$534.38	$534.38	$0.00	$0.00	$0.00	$247.50	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$702.41	$702.41	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$185.84	$0.00	$0.00	$189.05	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943C-07	SUP	HCPCS C1713		AR-8943C-07  -  PLATE BN STRG 93MM 7 HL LCK SS ANKL	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943C-08	SUP	HCPCS C1713		AR-8943C-08  -  PLATE BN STRG 106MM 8 HL LCK SS ANKL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943C-10	SUP	HCPCS C1713		AR-8943C-10  -  PLATE BN STRG 131MM 10 HL LCK SS ANKL	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943C-12	SUP	HCPCS C1713		AR-8943C-12  -  PLATE BN STRG 156MM 12 HL LCK SS ANKL	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943H-03	SUP	HCPCS C1713		AR-8943H-03  -  PLATE BN 61MM 3 HL HK LCK SS ANKL MLLE MDL	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943H-05	SUP	HCPCS C1713		AR-8943H-05  -  PLATE BN 79MM 5 HL HK LCK SS FT/ANKL MDL	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943H-07	SUP	HCPCS C1713		AR-8943H-07  -  PLATE BN 97MM 7 HL HK LCK SS FT/ANKL MDL	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943I	SUP	HCPCS C1713		AR-8943I  -  SET IMPL ANKL FX SYS	BOTH IP/OP	"$112,500.00 "	"$83,250.00"	$0.00	"$90,000.00"	"$50,625.00"	"$50,625.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$23,445.00"	$0.00	"$55,462.50"	"$55,462.50"	$0.00	"$56,250.00"	"$89,100.00"	"$90,000.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943T-04	SUP	HCPCS C1713		AR-8943T-04  -  PLATE BN 1/3 TUBE 47MM 4 HL LCK SS ANKL	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943T-05	SUP	HCPCS C1713		AR-8943T-05  -  PLATE BN 1/3 TUBE 59MM 5 HL LCK SS ANKL	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943T-06	SUP	HCPCS C1713		AR-8943T-06  -  PLATE BN 1/3 TUBE 72MM 6 HL LCK SS ANKL	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943T-07	SUP	HCPCS C1713		AR-8943T-07  -  PLATE BN 1/3 TUBE 85MM 7 HL LCK SS ANKL	BOTH IP/OP	$637.50 	$471.75	$0.00	$510.00	$286.88	$286.88	$0.00	$0.00	$0.00	$132.87	$473.15	$473.15	$0.00	$0.00	$132.86	$0.00	$377.08	$377.08	$0.00	$318.75	$504.90	$510.00	$0.00		$0.00	$99.77	$0.00	$0.00	$101.49	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943T-08	SUP	HCPCS C1713		AR-8943T-08  -  PLATE BN 1/3 TUBE 98MM 8 HL LCK SS ANKL	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$298.13	$298.13	$0.00	$0.00	$0.00	$138.08	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$391.87	$391.87	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$103.68	$0.00	$0.00	$105.47	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943T-10	SUP	HCPCS C1713		AR-8943T-10  -  PLATE BN 1/3 TUBE 123MM 10 HL LCK SS ANKL	BOTH IP/OP	$700.00 	$518.00	$0.00	$560.00	$315.00	$315.00	$0.00	$0.00	$0.00	$145.90	$519.54	$519.54	$0.00	$0.00	$145.88	$0.00	$414.05	$414.05	$0.00	$350.00	$554.40	$560.00	$0.00		$0.00	$109.55	$0.00	$0.00	$111.44	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943T-12	SUP	HCPCS C1713		AR-8943T-12  -  PLATE BN 1/3 TUBE 148MM 12 HL LCK SS ANKL	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943TH-03	SUP	HCPCS C1713		AR-8943TH-03  -  PLATE BN 72MM 3 HL AVULSION HK LCK SS ANKL LAT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943TH-05	SUP	HCPCS C1713		AR-8943TH-05  -  PLATE BN 98MM 5 HL AVULSION HK LCK SS ANKL LAT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8943TH-07	SUP	HCPCS C1713		AR-8943TH-07  -  PLATE BN 123MM 7 HL AVULSION HK LCK SS ANKL LAT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8944-10S	SUP	HCPCS C1713		AR-8944-10S  -  PLATE BN 10D STD LOPRFL MTP VLGS	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8944-22	SUP	Custom 27203010		AR-8944-22  -  BIT DRL 2MM AO CNCT LCK 3MM SCR	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8944C-10S	SUP	HCPCS C1713		AR-8944C-10S  -  PLATE BN 10D STD DFLXN MTP VLGS	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8944CL-L	SUP	HCPCS C1713		AR-8944CL-L  -  PLATE BN LNG CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT LT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$900.00	$900.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8944CL-P	SUP	HCPCS C1713		AR-8944CL-P  -  PLATE BN SHRT CNTR FSN MOD TI FOREFOOT 1ST MTP LT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$900.00	$900.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8944CL-S	SUP	HCPCS C1713		AR-8944CL-S  -  PLATE BN STD CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT LT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$900.00	$900.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8944CR-L	SUP	HCPCS C1713		AR-8944CR-L  -  PLATE BN LNG CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT RT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$900.00	$900.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8944CR-P	SUP	HCPCS C1713		AR-8944CR-P  -  PLATE BN SHRT CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT RT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$900.00	$900.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8944CR-S	SUP	HCPCS C1713		AR-8944CR-S  -  PLATE BN STD CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT RT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$900.00	$900.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8944-L	SUP	HCPCS C1713		AR-8944-L  -  PLATE BN LNG STRG LOPRFL MTP PLT FSN MOD TI FOREFOOT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$900.00	$900.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8944-P	SUP	HCPCS C1713		AR-8944-P  -  PLATE BN SHRT STRG LOPRFL MTP PLT FSN MOD TI FOREFOOT	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,660.67"	$900.00	$900.00	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-20FT	SUP	HCPCS C1713		AR-8945-20FT  -  SCREW BN .062IN 3.5MM FT HEX LOPRFL 4.5MM 20MM SLF DRL ST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-20PT	SUP	HCPCS C1713		AR-8945-20PT  -  SCREW BN .062IN 3.5MM 1/3 FT HEX LOPRFL 4.5MM 20MM SLF DRL	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-22FT	SUP	HCPCS C1713		AR-8945-22FT  -  SCREW BN FT HEX 4.5MM 22MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-22PT	SUP	HCPCS C1713		AR-8945-22PT  -  SCREW BN P/T LOPRFL 4.5MM 22MM CNN TI MLR CORT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-24FT	SUP	HCPCS C1713		AR-8945-24FT  -  SCREW BN FT HEX 4.5MM 24MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-24PT	SUP	HCPCS C1713		AR-8945-24PT  -  SCREW BN P/T HEX 4.5MM 24MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-26FT	SUP	HCPCS C1713		AR-8945-26FT  -  SCREW BN FT HEX 4.5MM 26MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-26PT	SUP	HCPCS C1713		AR-8945-26PT  -  SCREW BN P/T LOPRFL 4.5MM 26MM CNN TI MLR CORT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-28FT	SUP	HCPCS C1713		AR-8945-28FT  -  SCREW BN FT HEX 4.5MM 28MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-28PT	SUP	HCPCS C1713		AR-8945-28PT  -  SCREW BN P/T HEX 4.5MM 28MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-30C	SUP	Custom 27203010		AR-8945-30C  -  BIT DRL MN 3MM 120MM CNN 4.5MM SCR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-30FT	SUP	HCPCS C1713		AR-8945-30FT  -  SCREW BN FT HEX 4.5MM 30MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-30PT	SUP	HCPCS C1713		AR-8945-30PT  -  SCREW BN P/T HEX 4.5MM 30MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-32FT	SUP	HCPCS C1713		AR-8945-32FT  -  SCREW BN FT HEX 4.5MM 32MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-32PT	SUP	HCPCS C1713		AR-8945-32PT  -  SCREW BN P/T HEX 4.5MM 32MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-34FT	SUP	HCPCS C1713		AR-8945-34FT  -  SCREW BN FT HEX 4.5MM 34MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-34PT	SUP	HCPCS C1713		AR-8945-34PT  -  SCREW BN P/T HEX 4.5MM 34MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-35FT	SUP	HCPCS C1713		AR-8945-35FT  -  SCREW BN FT HEX 4.5MM 35MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-35PT	SUP	HCPCS C1713		AR-8945-35PT  -  SCREW BN P/T HEX 4.5MM 35MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-36FT	SUP	HCPCS C1713		AR-8945-36FT  -  SCREW BN FT HEX 4.5MM 36MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-36PT	SUP	HCPCS C1713		AR-8945-36PT  -  SCREW BN P/T HEX 4.5MM 36MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-38FT	SUP	HCPCS C1713		AR-8945-38FT  -  SCREW BN FT HEX 4.5MM 38MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-38PT	SUP	HCPCS C1713		AR-8945-38PT  -  SCREW BN P/T HEX 4.5MM 38MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-40FT	SUP	HCPCS C1713		AR-8945-40FT  -  SCREW BN FT HEX 4.5MM 40MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-40PT	SUP	HCPCS C1713		AR-8945-40PT  -  SCREW BN P/T HEX 4.5MM 40MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-45C	SUP	Custom 27203010		AR-8945-45C  -  BIT DRL 4.5MM HDSN CNN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-45FT	SUP	HCPCS C1713		AR-8945-45FT  -  SCREW BN FT HEX 4.5MM 45MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-45PT	SUP	HCPCS C1713		AR-8945-45PT  -  SCREW BN P/T HEX 4.5MM 45MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-50FT	SUP	HCPCS C1713		AR-8945-50FT  -  SCREW BN FT HEX 4.5MM 50MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-50PT	SUP	HCPCS C1713		AR-8945-50PT  -  SCREW BN P/T HEX 4.5MM 50MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-55FT	SUP	HCPCS C1713		AR-8945-55FT  -  SCREW BN FT HEX 4.5MM 55MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-55PT	SUP	HCPCS C1713		AR-8945-55PT  -  SCREW BN P/T HEX 4.5MM 55MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-60FT	SUP	HCPCS C1713		AR-8945-60FT  -  SCREW BN FT HEX 4.5MM 60MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-60PT	SUP	HCPCS C1713		AR-8945-60PT  -  SCREW BN P/T HEX 4.5MM 60MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-65FT	SUP	HCPCS C1713		AR-8945-65FT  -  SCREW BN FT HEX 4.5MM 65MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-65PT	SUP	HCPCS C1713		AR-8945-65PT  -  SCREW BN P/T HEX 4.5MM 65MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-70FT	SUP	HCPCS C1713		AR-8945-70FT  -  SCREW BN FT HEX 4.5MM 70MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-70PT	SUP	HCPCS C1713		AR-8945-70PT  -  SCREW BN P/T HEX 4.5MM 70MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-75FT	SUP	HCPCS C1713		AR-8945-75FT  -  SCREW BN FT HEX 4.5MM 75MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-75PT	SUP	HCPCS C1713		AR-8945-75PT  -  SCREW BN P/T HEX 4.5MM 75MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-80FT	SUP	HCPCS C1713		AR-8945-80FT  -  SCREW BN FT HEX 4.5MM 80MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945-80PT	SUP	HCPCS C1713		AR-8945-80PT  -  SCREW BN P/T HEX 4.5MM 80MM LOPRFL SCR SLF DRL ST CNN LG TI	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945CS	SUP	Custom 27203010		AR-8945CS  -  DRILL BIT CNTRSNK CNN FX HNDL 4.5/6 MM	BOTH IP/OP	$550.00 	$407.00	$0.00	$440.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.21	$408.21	$0.00	$0.00	$114.62	$0.00	$0.00	$0.00	$0.00	$275.00	$435.60	$440.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945CSF	SUP	Custom 27203010		AR-8945CSF  -  COUNTERSINK DRL CNN 4.5 MM SCR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8945W	SUP	HCPCS C1713		AR-8945W  -  WASHER ORTH 10MM CNN TI	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$90.00	$90.00	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8947DS	SUP	HCPCS C1713		AR-8947DS  -  PLATE BN BTRS TGHTRP IMPL DLV ANKL SYNDESMOSIS	BOTH IP/OP	"$2,562.50 "	"$1,896.25"	$0.00	"$2,050.00"	"$1,153.13"	"$1,153.13"	$0.00	$0.00	$0.00	$534.09	"$1,901.89"	"$1,901.89"	$0.00	$0.00	$534.03	$0.00	"$1,263.31"	"$1,263.31"	$0.00	"$1,281.25"	"$2,029.50"	"$2,050.00"	$0.00		$0.00	$401.03	$0.00	$0.00	$407.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8948-00	SUP	HCPCS C1713		AR-8948-00  -  PLATE BN FLT LOPRFL TI CTTN FT/ANKL 2.4MM SCR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8948-02	SUP	HCPCS C1713		AR-8948-02  -  PLATE BN LOPRFL 2MM TI CTTN FT/ANKL 2.4MM SCR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8948-06	SUP	HCPCS C1713		AR-8948-06  -  PLATE BN LOPRFL 6MM TI CTTN FT/ANKL 2.4MM SCR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8948-08	SUP	HCPCS C1713		AR-8948-08  -  PLATE BN LOPRFL 8MM TI CTTN FT/ANKL 2.4MM SCR	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8949-050	SUP	HCPCS C1713		AR-8949-050  -  PLATE BN 5MM STP CALCANEUS	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,031.77"	"$1,102.50"	"$1,102.50"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,225.00"	"$1,940.40"	"$1,960.00"	$0.00		$0.00	$383.43	$0.00	$0.00	$390.04	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8949-075	SUP	HCPCS C1713		AR-8949-075  -  PLATE BN 7.5MM STP CALCANEUS	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,031.77"	"$1,102.50"	"$1,102.50"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,225.00"	"$1,940.40"	"$1,960.00"	$0.00		$0.00	$383.43	$0.00	$0.00	$390.04	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8949-100	SUP	HCPCS C1713		AR-8949-100  -  PLATE BN 10MM STP CALCANEUS	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,031.77"	"$1,102.50"	"$1,102.50"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,225.00"	"$1,940.40"	"$1,960.00"	$0.00		$0.00	$383.43	$0.00	$0.00	$390.04	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8949DG	SUP	Custom 27203010		AR-8949DG  -  GUIDE DRL CMPR HL	BOTH IP/OP	"$1,200.00 "	$888.00	$0.00	$960.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$890.64	$890.64	$0.00	$0.00	$250.08	$0.00	$0.00	$0.00	$0.00	$600.00	$950.40	$960.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8949S	SUP	HCPCS C1713		AR-8949S  -  PLATE BN 5MM 7.5MM 10MM STP CALCANEUS	BOTH IP/OP	"$5,625.00 "	"$4,162.50"	$0.00	"$4,500.00"	"$2,531.25"	"$2,531.25"	$0.00	$0.00	$0.00	"$1,172.39"	"$4,174.88"	"$4,174.88"	$0.00	$0.00	"$1,172.25"	$0.00	"$2,773.13"	"$2,773.13"	$0.00	"$2,812.50"	"$4,455.00"	"$4,500.00"	$0.00		$0.00	$880.31	$0.00	$0.00	$895.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8950-01	SUP	Custom 27203010		AR-8950-01  -  COUNTERSINK DRL 2.4MM	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8950-02	SUP	Custom 27203010		AR-8950-02  -  COUNTERSINK DRL 3MM	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8950-03	SUP	Custom 27203010		AR-8950-03  -  COUNTERSINK DRL 3.5 4 MM SCR	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8950-05	SUP	Custom 27203010		AR-8950-05  -  BIT DRL 3MM	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8950-08	SUP	Custom 27203010		AR-8950-08  -  GUIDE DRL BNT 2.4MM LCK	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8950-09	SUP	Custom 27203010		AR-8950-09  -  GUIDE DRL BNT 3MM LCK	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8950C-14	SUP	Custom 27203010		AR-8950C-14  -  INSERT TRY CMPRH FT SYS	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	$0.00	$0.00	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8950JD-1	SUP	HCPCS C1713		AR-8950JD-1  -  DISTRACTOR SRG MN 16MM TRC SCR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8950JD-2	SUP	HCPCS C1713		AR-8950JD-2  -  SCREW DSTRCT 20MM MN JNT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8950S-V1	SUP	HCPCS C1713		AR-8950S-V1  -  SET SCR VA CMPRH FT SYS	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8951LL	SUP	HCPCS C1713		AR-8951LL  -  PLATE BN LG CNTR LOPRFL 1.4MM TI LISFRANC LT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8951LR	SUP	HCPCS C1713		AR-8951LR  -  PLATE BN LG CNTR LOPRFL 1.4MM TI LISFRANC RT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8951ML	SUP	HCPCS C1713		AR-8951ML  -  PLATE BN MED CNTR LOPRFL 1.4MM TI LISFRANC LT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8951MR	SUP	HCPCS C1713		AR-8951MR  -  PLATE BN MED CNTR LOPRFL 1.4MM TI LISFRANC RT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8951SL	SUP	HCPCS C1713		AR-8951SL  -  PLATE BN SM CNTR LOPRFL 1.4MM TI LISFRANC LT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8951SR	SUP	HCPCS C1713		AR-8951SR  -  PLATE BN SM CNTR LOPRFL 1.4MM TI LISFRANC RT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MC-LL	SUP	HCPCS C1713		AR-8952MC-LL  -  PLATE BN LG LOPRFL CLMN FT LT MDL 3.5MM SCR	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MC-LR	SUP	HCPCS C1713		AR-8952MC-LR  -  PLATE BN LG LOPRFL CLMN FT RT MDL 3.5MM SCR	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MC-ML	SUP	HCPCS C1713		AR-8952MC-ML  -  PLATE BN MED LOPRFL CLMN FT LT MDL 3.5MM SCR	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MC-MR	SUP	HCPCS C1713		AR-8952MC-MR  -  PLATE BN MED LOPRFL CLMN FT RT MDL 3.5MM SCR	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MC-SL	SUP	HCPCS C1713		AR-8952MC-SL  -  PLATE BN SM LOPRFL CLMN FT LT MDL 3.5MM SCR	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MC-SR	SUP	HCPCS C1713		AR-8952MC-SR  -  PLATE BN SM LOPRFL CLMN FT RT MDL 3.5MM SCR	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952ML-05L	SUP	HCPCS C1713		AR-8952ML-05L  -  PLATE BN 5 HL TI WRST LT 2.4 MM SCR	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952ML-05R	SUP	HCPCS C1713		AR-8952ML-05R  -  PLATE BN L 2 HLE/HD 5 HL SHFT TI RT 2.4MM SCR	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MS-04	SUP	HCPCS C1713		AR-8952MS-04  -  PLATE BN STRG LOPRFL 2.4MM 4 HL FT	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MS-05	SUP	HCPCS C1713		AR-8952MS-05  -  PLATE BN STRG LOPRFL 2.4MM 5 HL FT	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MS-06	SUP	HCPCS C1713		AR-8952MS-06  -  PLATE BN STRG LOPRFL 2.4MM 6 HL FT	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MS-07	SUP	HCPCS C1713		AR-8952MS-07  -  PLATE BN STRG LOPRFL 2.4MM 7 HL FT	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MS-08	SUP	HCPCS C1713		AR-8952MS-08  -  PLATE BN STRG 8 HL LOPRFL 2.4MM SCR	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MT-03	SUP	HCPCS C1713		AR-8952MT-03  -  PLATE BN T 3 HL LOPRFL 2.4MM SCR	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MT-04	SUP	HCPCS C1713		AR-8952MT-04  -  PLATE BN T LOPRFL 4 HL FT 2.4MM SCR	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MT-05	SUP	HCPCS C1713		AR-8952MT-05  -  PLATE BN T LOPRFL 2.4MM 5 HL FT	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MT-06	SUP	HCPCS C1713		AR-8952MT-06  -  PLATE BN T LOPRFL 2.4MM 6 HL FT	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MT-07	SUP	HCPCS C1713		AR-8952MT-07  -  PLATE BN T 2.4MM 7 HL LOPRFL	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MT-08	SUP	HCPCS C1713		AR-8952MT-08  -  PLATE BN T 8 HL LOPRFL 2.4MM SCR	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952MT-09	SUP	HCPCS C1713		AR-8952MT-09  -  PLATE BN T LOPRFL 9 HL 2.4MM SCR	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952TS-02	SUP	HCPCS C1713		AR-8952TS-02  -  PLATE BN STRG LOPRFL 2 HL TI FT 3MM SCR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952TS-04	SUP	HCPCS C1713		AR-8952TS-04  -  PLATE BN STRG 3MM LOPRFL 4 HL TI	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952TS-05	SUP	HCPCS C1713		AR-8952TS-05  -  PLATE BN STRG 5 HL LOPRFL TI 3MM SCR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952TT-03	SUP	HCPCS C1713		AR-8952TT-03  -  PLATE BN T LOPRFL 3MM 3 HL TI FT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952TT-04	SUP	HCPCS C1713		AR-8952TT-04  -  PLATE BN T 4 HL LOPRFL TI 3MM SCR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952XL	SUP	HCPCS C1713		AR-8952XL  -  PLATE BN LG X 2 HL TI FT 3MM SCR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952XM	SUP	HCPCS C1713		AR-8952XM  -  PLATE BN MED X TI 3MM SCR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8952XP	SUP	HCPCS C1713		AR-8952XP  -  PLATE BN SM X TI 2.4MM SCR	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8953-00	SUP	HCPCS C1713		AR-8953-00  -  PLATE BN FLT LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG OSTM	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8953-02	SUP	HCPCS C1713		AR-8953-02  -  PLATE BN LOPRFL 2MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8953-025	SUP	HCPCS C1713		AR-8953-025  -  PLATE BN LOPRFL 2.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8953-03	SUP	HCPCS C1713		AR-8953-03  -  PLATE BN LOPRFL 3MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8953-035	SUP	HCPCS C1713		AR-8953-035  -  PLATE BN LOPRFL 3.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8953-04	SUP	HCPCS C1713		AR-8953-04  -  PLATE BN 4MM LCK POW LOPRFL TI FT/ANKL PROX 3MM SCR OPN WDG	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8953-045	SUP	HCPCS C1713		AR-8953-045  -  PLATE BN LOPRFL 4.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8953-05	SUP	HCPCS C1713		AR-8953-05  -  PLATE BN LOPRFL 5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8953-055	SUP	HCPCS C1713		AR-8953-055  -  PLATE BN LOPRFL 5.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8953-06	SUP	HCPCS C1713		AR-8953-06  -  PLATE BN LOPRFL 6MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8953-065	SUP	HCPCS C1713		AR-8953-065  -  PLATE BN LOPRFL 6.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8953-07	SUP	HCPCS C1713		AR-8953-07  -  PLATE BN LOPRFL 7MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954-07	SUP	Custom 27203010		AR-8954-07  -  GUIDE DRL BNT 3.5MM LCK	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954ML-L	SUP	HCPCS C1713		AR-8954ML-L  -  PLATE BN LNG LOPRFL TPR LCK CALCANEUS LT ANT ATCH GD PERC	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954ML-S	SUP	HCPCS C1713		AR-8954ML-S  -  PLATE BN STD LOPRFL TPR LCK CALCANEUS LT ANT ATCH GD PERC	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954MR-L	SUP	HCPCS C1713		AR-8954MR-L  -  PLATE BN LNG LOPRFL TPR LCK CALCANEUS RT ANT ATCH GD PERC	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954MR-S	SUP	HCPCS C1713		AR-8954MR-S  -  PLATE BN STD LOPRFL TPR LCK CALCANEUS RT ANT ATCH GD PERC	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954MT	SUP	HCPCS C1713		AR-8954MT  -  PLATE BN T LOPRFL 4 HL FT 3.5MM SCR	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954PL-L	SUP	HCPCS C1713		AR-8954PL-L  -  PLATE BN LG PRIMTR CALC FX LT	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954PL-M	SUP	HCPCS C1713		AR-8954PL-M  -  PLATE BN MED LOPRFL LCK PRIMTR TI CALCANEUS LT 3.5/4MM SCR	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954PL-S	SUP	HCPCS C1713		AR-8954PL-S  -  PLATE BN SM LOPRFL LCK PRIMTR TI CALCANEUS LT 3.5/4MM SCR	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954PL-XS	SUP	HCPCS C1713		AR-8954PL-XS  -  PLATE BN XS LOPRFL LCK PRIMTR TI CALCANEUS LT 3.5/4MM SCR	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954PR-L	SUP	HCPCS C1713		AR-8954PR-L  -  PLATE BN LG LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954PR-M	SUP	HCPCS C1713		AR-8954PR-M  -  PLATE BN MED LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954PR-S	SUP	HCPCS C1713		AR-8954PR-S  -  PLATE BN SM LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954PR-XS	SUP	HCPCS C1713		AR-8954PR-XS  -  PLATE BN XS LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954YL-L	SUP	HCPCS C1713		AR-8954YL-L  -  PLATE BN LNG LOPRFL TPR LCK CALCANEUS LT ANT POST ATCH GD	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954YL-S	SUP	HCPCS C1713		AR-8954YL-S  -  PLATE BN STD LOPRFL TPR LCK CALCANEUS LT ANT POST ATCH GD	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954YR-L	SUP	HCPCS C1713		AR-8954YR-L  -  PLATE BN LNG LOPRFL TPR LCK CALCANEUS RT ANT POST ATCH GD	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8954YR-S	SUP	HCPCS C1713		AR-8954YR-S  -  PLATE BN STD LOPRFL TPR LCK CALCANEUS RT ANT POST ATCH GD	BOTH IP/OP	"$2,737.50 "	"$2,025.75"	$0.00	"$2,190.00"	"$1,231.88"	"$1,231.88"	$0.00	$0.00	$0.00	$570.56	"$2,031.77"	"$2,031.77"	$0.00	$0.00	$570.50	$0.00	"$1,349.59"	"$1,349.59"	$0.00	"$1,368.75"	"$2,168.10"	"$2,190.00"	$0.00		$0.00	$428.42	$0.00	$0.00	$435.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8955-60PT	SUP	HCPCS C1713		AR-8955-60PT  -  SCREW BN 3.5MM P/T HEX 5.5MM 60MM LOPRFL SCR SLF DRL SLD LG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8955-65PT	SUP	HCPCS C1713		AR-8955-65PT  -  SCREW BN 3.5MM P/T HEX 5.5MM 65MM LOPRFL SCR SLF DRL SLD LG	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8955G	SUP	Custom 27203010		AR-8955G  -  GUIDE DRL LOPRFL 4MM 1.6MM 4.5MM SCR	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8955T	SUP	HCPCS C1713		AR-8955T  -  SCREW BN LOPRFL 5.5MM TAP JNS FX	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8956-01	SUP	HCPCS C1713		AR-8956-01  -  PLATE BN UNV HK METATARSUS FIFTH MTRSL FX SYS	BOTH IP/OP	"$2,312.50 "	"$1,711.25"	$0.00	"$1,850.00"	"$1,040.63"	"$1,040.63"	$0.00	$0.00	$0.00	$481.98	"$1,716.34"	"$1,716.34"	$0.00	$0.00	$481.93	$0.00	"$1,367.84"	"$1,367.84"	$0.00	"$1,156.25"	"$1,831.50"	"$1,850.00"	$0.00		$0.00	$361.91	$0.00	$0.00	$368.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8956-08	SUP	HCPCS C1713		AR-8956-08  -  PLATE BN HK TAMP METATARSUS FIFTH MTRSL FX SYS	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8956L-02	SUP	HCPCS C1713		AR-8956L-02  -  PLATE BN LNG HK METATARSUS LT FIFTH MTRSL FX SYS	BOTH IP/OP	"$3,187.50 "	"$2,358.75"	$0.00	"$2,550.00"	"$1,434.38"	"$1,434.38"	$0.00	$0.00	$0.00	$664.35	"$2,365.76"	"$2,365.76"	$0.00	$0.00	$664.28	$0.00	"$1,571.44"	"$1,571.44"	$0.00	"$1,593.75"	"$2,524.50"	"$2,550.00"	$0.00		$0.00	$498.84	$0.00	$0.00	$507.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8956R-03	SUP	HCPCS C1713		AR-8956R-03  -  PLATE BN LNG 7 HL HK LOPRFL 5TH MTRSL RT 2.4MM SCR	BOTH IP/OP	"$3,187.50 "	"$2,358.75"	$0.00	"$2,550.00"	"$1,434.38"	"$1,434.38"	$0.00	$0.00	$0.00	$664.35	"$2,365.76"	"$2,365.76"	$0.00	$0.00	$664.28	$0.00	"$1,571.44"	"$1,571.44"	$0.00	"$1,593.75"	"$2,524.50"	"$2,550.00"	$0.00		$0.00	$498.84	$0.00	$0.00	$507.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8958-01	SUP	HCPCS C1713		AR-8958-01  -  PLATE BN TGHTRP 2 HL SS SYNDESMOSIS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8958-01S	SUP	HCPCS C1713		AR-8958-01S  -  PLATE BN STRL TGHTRP 2 HL SS SYNDESMOSIS	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8958-02	SUP	HCPCS C1713		AR-8958-02  -  PLATE BN TGHTRP 2 HL TI SYNDESMOSIS	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8958-02S	SUP	HCPCS C1713		AR-8958-02S  -  PLATE BN STRL TGHTRP 2 HL TI SYNDESMOSIS	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8958TDS	SUP	HCPCS C1713		AR-8958TDS  -  SYSTEM FX TGHTRP BB-TAK 2	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963-05	SUP	Custom 27203010		AR-8963-05  -  BIT DRL LNG 2MM CLBRT TIB DIST	BOTH IP/OP	$275.00 	$203.50	$0.00	$204.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963-08	SUP	Custom 27203010		AR-8963-08  -  GUIDE DRL 2.7MM 10-60MM THRD	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963A-03	SUP	HCPCS C1713		AR-8963A-03  -  PLATE BN 62MM 3 HL 2 ROW CONSTRUCT TPR TIP TIB DIST ANT 2.7	BOTH IP/OP	"$2,312.50 "	"$1,711.25"	$0.00	"$1,850.00"	"$1,040.63"	"$1,040.63"	$0.00	$0.00	$0.00	$481.98	"$1,716.34"	"$1,716.34"	$0.00	$0.00	$481.93	$0.00	"$1,367.84"	"$1,367.84"	$0.00	"$1,156.25"	"$1,831.50"	"$1,850.00"	$0.00		$0.00	$361.91	$0.00	$0.00	$368.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963A-05	SUP	HCPCS C1713		AR-8963A-05  -  PLATE BN 84MM 5 HL TIB DIST ANT	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	"$1,068.75"	"$1,068.75"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963A-07	SUP	HCPCS C1713		AR-8963A-07  -  PLATE BN 107MM 7 HL 2 ROW CONSTRUCT TPR TIP TIB DIST ANT 2.7	BOTH IP/OP	"$2,450.00 "	"$1,813.00"	$0.00	"$1,960.00"	"$1,102.50"	"$1,102.50"	$0.00	$0.00	$0.00	$510.64	"$1,818.39"	"$1,818.39"	$0.00	$0.00	$510.58	$0.00	"$1,449.18"	"$1,449.18"	$0.00	"$1,225.00"	"$1,940.40"	"$1,960.00"	$0.00		$0.00	$383.43	$0.00	$0.00	$390.04	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963A-09	SUP	HCPCS C1713		AR-8963A-09  -  PLATE BN 130MM 9 HL 2 ROW CONSTRUCT TPR TIP TIB DIST ANT 2.7	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AL-04	SUP	HCPCS C1713		AR-8963AL-04  -  PLATE BN CNTR 66MM 4 HL TPR TIP LOPRFL TIB LT DIST ALAT 2.7	BOTH IP/OP	"$4,550.00 "	"$3,367.00"	$0.00	"$3,640.00"	"$2,047.50"	"$2,047.50"	$0.00	$0.00	$0.00	$948.33	"$3,377.01"	"$3,377.01"	$0.00	$0.00	$948.22	$0.00	"$2,243.15"	"$2,243.15"	$0.00	"$2,275.00"	"$3,603.60"	"$3,640.00"	$0.00		$0.00	$712.08	$0.00	$0.00	$724.36	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AL-06	SUP	HCPCS C1713		AR-8963AL-06  -  PLATE BN OBLNG 91MM 6 HL TPR TIP LOPRFL TIB LT DIST ALAT	BOTH IP/OP	"$4,600.00 "	"$3,404.00"	$0.00	"$3,680.00"	"$2,070.00"	"$2,070.00"	$0.00	$0.00	$0.00	$958.76	"$3,414.12"	"$3,414.12"	$0.00	$0.00	$958.64	$0.00	"$2,267.80"	"$2,267.80"	$0.00	"$2,300.00"	"$3,643.20"	"$3,680.00"	$0.00		$0.00	$719.90	$0.00	$0.00	$732.32	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AL-08	SUP	HCPCS C1713		AR-8963AL-08  -  PLATE BN 117MM 8 HL TIB LT DIST ALAT	BOTH IP/OP	"$4,650.00 "	"$3,441.00"	$0.00	"$3,720.00"	"$2,092.50"	"$2,092.50"	$0.00	$0.00	$0.00	$969.18	"$3,451.23"	"$3,451.23"	$0.00	$0.00	$969.06	$0.00	"$2,292.45"	"$2,292.45"	$0.00	"$2,325.00"	"$3,682.80"	"$3,720.00"	$0.00		$0.00	$727.73	$0.00	$0.00	$740.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AL-10	SUP	HCPCS C1713		AR-8963AL-10  -  PLATE BN 142MM 10 HL TIB LT DIST ALAT	BOTH IP/OP	"$4,700.00 "	"$3,478.00"	$0.00	"$3,760.00"	"$2,115.00"	"$2,115.00"	$0.00	$0.00	$0.00	$979.60	"$3,488.34"	"$3,488.34"	$0.00	$0.00	$979.48	$0.00	"$2,317.10"	"$2,317.10"	$0.00	"$2,350.00"	"$3,722.40"	"$3,760.00"	$0.00		$0.00	$735.55	$0.00	$0.00	$748.24	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AL-12	SUP	HCPCS C1713		AR-8963AL-12  -  PLATE BN 168MM 12 HL TIB LT DIST ALAT	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AL-14	SUP	HCPCS C1713		AR-8963AL-14  -  PLATE BN 193MM 14 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST	BOTH IP/OP	"$4,800.00 "	"$3,552.00"	$0.00	"$3,840.00"	"$2,160.00"	"$2,160.00"	$0.00	$0.00	$0.00	"$1,000.44"	"$3,562.56"	"$3,562.56"	$0.00	$0.00	"$1,000.32"	$0.00	"$2,366.40"	"$2,366.40"	$0.00	"$2,400.00"	"$3,801.60"	"$3,840.00"	$0.00		$0.00	$751.20	$0.00	$0.00	$764.16	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AL-16	SUP	HCPCS C1713		AR-8963AL-16  -  PLATE BN 218MM 16 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST	BOTH IP/OP	"$4,850.00 "	"$3,589.00"	$0.00	"$3,880.00"	"$2,182.50"	"$2,182.50"	$0.00	$0.00	$0.00	"$1,010.86"	"$3,599.67"	"$3,599.67"	$0.00	$0.00	"$1,010.74"	$0.00	"$2,391.05"	"$2,391.05"	$0.00	"$2,425.00"	"$3,841.20"	"$3,880.00"	$0.00		$0.00	$759.03	$0.00	$0.00	$772.12	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AL-18	SUP	HCPCS C1713		AR-8963AL-18  -  PLATE BN BTRS 244MM 18 HL OBLNG HL TPR TIP LOPRFL TIB LT	BOTH IP/OP	"$4,900.00 "	"$3,626.00"	$0.00	"$3,920.00"	"$2,205.00"	"$2,205.00"	$0.00	$0.00	$0.00	"$1,021.28"	"$3,636.78"	"$3,636.78"	$0.00	$0.00	"$1,021.16"	$0.00	"$2,415.70"	"$2,415.70"	$0.00	"$2,450.00"	"$3,880.80"	"$3,920.00"	$0.00		$0.00	$766.85	$0.00	$0.00	$780.08	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963APLL-04	SUP	HCPCS C1713		AR-8963APLL-04  -  PLATE BN 75MM 4 HL TPR TIP LOPRFL FIB LT DIST P/L 2.7MM LCK	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963APLL-06	SUP	HCPCS C1713		AR-8963APLL-06  -  PLATE BN 126MM ANTM 6 HL SS FIB LT DIST P/L	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963APLL-08	SUP	HCPCS C1713		AR-8963APLL-08  -  PLATE BN 151MM 8 HL ANTM TPR TIP CUT OUT FIB LT DIST P/L	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963APLL-10	SUP	HCPCS C1713		AR-8963APLL-10  -  PLATE BN 10 HL ANTM TPR TIP CUT OUT FIB LT DIST P/L	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963APLR-04	SUP	HCPCS C1713		AR-8963APLR-04  -  PLATE BN 75MM JUMPSTART 4 HL FIB RT DIST P/L	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963APLR-06	SUP	HCPCS C1713		AR-8963APLR-06  -  PLATE BN LOPRFL SS FIB RT P/L DIST	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$599.22	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	"$1,417.38"	"$1,417.38"	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963APLR-08	SUP	HCPCS C1713		AR-8963APLR-08  -  PLATE BN 151MM 8 HL FIB RT DIST P/L	BOTH IP/OP	"$3,000.00 "	"$2,220.00"	$0.00	"$2,400.00"	"$1,350.00"	"$1,350.00"	$0.00	$0.00	$0.00	$625.28	"$2,226.60"	"$2,226.60"	$0.00	$0.00	$625.20	$0.00	"$1,479.00"	"$1,479.00"	$0.00	"$1,500.00"	"$2,376.00"	"$2,400.00"	$0.00		$0.00	$469.50	$0.00	$0.00	$477.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963APLR-10	SUP	HCPCS C1713		AR-8963APLR-10  -  PLATE BN 10 HL FIB RT DIST P/L	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AR-04	SUP	HCPCS C1713		AR-8963AR-04  -  PLATE BN BTRS 66MM 4 HL OBLNG HL TPR TIP LOPRFL TIB RT DIST	BOTH IP/OP	"$4,550.00 "	"$3,367.00"	$0.00	"$3,640.00"	"$2,047.50"	"$2,047.50"	$0.00	$0.00	$0.00	$948.33	"$3,377.01"	"$3,377.01"	$0.00	$0.00	$948.22	$0.00	"$2,243.15"	"$2,243.15"	$0.00	"$2,275.00"	"$3,603.60"	"$3,640.00"	$0.00		$0.00	$712.08	$0.00	$0.00	$724.36	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AR-06	SUP	HCPCS C1713		AR-8963AR-06  -  PLATE BN BTRS 91MM 6 HL OBLNG HL TPR TIP LOPRFL TIB RT DIST	BOTH IP/OP	"$4,600.00 "	"$3,404.00"	$0.00	"$3,680.00"	"$2,070.00"	"$2,070.00"	$0.00	$0.00	$0.00	$958.76	"$3,414.12"	"$3,414.12"	$0.00	$0.00	$958.64	$0.00	"$2,267.80"	"$2,267.80"	$0.00	"$2,300.00"	"$3,643.20"	"$3,680.00"	$0.00		$0.00	$719.90	$0.00	$0.00	$732.32	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AR-08	SUP	HCPCS C1713		AR-8963AR-08  -  PLATE BN 117MM 8 HL TIB RT DIST ALAT	BOTH IP/OP	"$4,650.00 "	"$3,441.00"	$0.00	"$3,720.00"	"$2,092.50"	"$2,092.50"	$0.00	$0.00	$0.00	$969.18	"$3,451.23"	"$3,451.23"	$0.00	$0.00	$969.06	$0.00	"$2,292.45"	"$2,292.45"	$0.00	"$2,325.00"	"$3,682.80"	"$3,720.00"	$0.00		$0.00	$727.73	$0.00	$0.00	$740.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AR-10	SUP	HCPCS C1713		AR-8963AR-10  -  PLATE BN 142MM 10 HL TIB RT DIST ALAT	BOTH IP/OP	"$4,700.00 "	"$3,478.00"	$0.00	"$3,760.00"	"$2,115.00"	"$2,115.00"	$0.00	$0.00	$0.00	$979.60	"$3,488.34"	"$3,488.34"	$0.00	$0.00	$979.48	$0.00	"$2,317.10"	"$2,317.10"	$0.00	"$2,350.00"	"$3,722.40"	"$3,760.00"	$0.00		$0.00	$735.55	$0.00	$0.00	$748.24	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AR-14	SUP	HCPCS C1713		AR-8963AR-14  -  PLATE BN 193MM 14 HL TIB RT DIST ALAT	BOTH IP/OP	"$4,800.00 "	"$3,552.00"	$0.00	"$3,840.00"	"$2,160.00"	"$2,160.00"	$0.00	$0.00	$0.00	"$1,000.44"	"$3,562.56"	"$3,562.56"	$0.00	$0.00	"$1,000.32"	$0.00	"$2,366.40"	"$2,366.40"	$0.00	"$2,400.00"	"$3,801.60"	"$3,840.00"	$0.00		$0.00	$751.20	$0.00	$0.00	$764.16	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AR-16	SUP	HCPCS C1713		AR-8963AR-16  -  PLATE BN 218MM 16 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST	BOTH IP/OP	"$4,850.00 "	"$3,589.00"	$0.00	"$3,880.00"	"$2,182.50"	"$2,182.50"	$0.00	$0.00	$0.00	"$1,010.86"	"$3,599.67"	"$3,599.67"	$0.00	$0.00	"$1,010.74"	$0.00	"$2,391.05"	"$2,391.05"	$0.00	"$2,425.00"	"$3,841.20"	"$3,880.00"	$0.00		$0.00	$759.03	$0.00	$0.00	$772.12	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963AR-18	SUP	HCPCS C1713		AR-8963AR-18  -  PLATE BN BTRS 244MM 18 HL OBLNG HL TPR TIP LOPRFL TIB RT	BOTH IP/OP	"$4,900.00 "	"$3,626.00"	$0.00	"$3,920.00"	"$2,205.00"	"$2,205.00"	$0.00	$0.00	$0.00	"$1,021.28"	"$3,636.78"	"$3,636.78"	$0.00	$0.00	"$1,021.16"	$0.00	"$2,415.70"	"$2,415.70"	$0.00	"$2,450.00"	"$3,880.80"	"$3,920.00"	$0.00		$0.00	$766.85	$0.00	$0.00	$780.08	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963ML-04	SUP	HCPCS C1713		AR-8963ML-04  -  PLATE BN 103MM 4 HL TIB LT DIST MDL	BOTH IP/OP	"$4,300.00 "	"$3,182.00"	$0.00	"$3,440.00"	"$1,935.00"	"$1,935.00"	$0.00	$0.00	$0.00	$896.23	"$3,191.46"	"$3,191.46"	$0.00	$0.00	$896.12	$0.00	"$2,119.90"	"$2,119.90"	$0.00	"$2,150.00"	"$3,405.60"	"$3,440.00"	$0.00		$0.00	$672.95	$0.00	$0.00	$684.56	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963ML-06	SUP	HCPCS C1713		AR-8963ML-06  -  PLATE BN 128MM 6 HL TIB LT DIST MDL	BOTH IP/OP	"$4,350.00 "	"$3,219.00"	$0.00	"$3,480.00"	"$1,957.50"	"$1,957.50"	$0.00	$0.00	$0.00	$906.65	"$3,228.57"	"$3,228.57"	$0.00	$0.00	$906.54	$0.00	"$2,144.55"	"$2,144.55"	$0.00	"$2,175.00"	"$3,445.20"	"$3,480.00"	$0.00		$0.00	$680.78	$0.00	$0.00	$692.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963ML-10	SUP	HCPCS C1713		AR-8963ML-10  -  PLATE BN 179MM 10 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST MDL	BOTH IP/OP	"$4,450.00 "	"$3,293.00"	$0.00	"$3,560.00"	"$2,002.50"	"$2,002.50"	$0.00	$0.00	$0.00	$927.49	"$3,302.79"	"$3,302.79"	$0.00	$0.00	$927.38	$0.00	"$2,193.85"	"$2,193.85"	$0.00	"$2,225.00"	"$3,524.40"	"$3,560.00"	$0.00		$0.00	$696.43	$0.00	$0.00	$708.44	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963ML-14	SUP	HCPCS C1713		AR-8963ML-14  -  PLATE BN 230MM 14 HL TIB LT DIST MDL	BOTH IP/OP	"$4,550.00 "	"$3,367.00"	$0.00	"$3,640.00"	"$2,047.50"	"$2,047.50"	$0.00	$0.00	$0.00	$948.33	"$3,377.01"	"$3,377.01"	$0.00	$0.00	$948.22	$0.00	"$2,243.15"	"$2,243.15"	$0.00	"$2,275.00"	"$3,603.60"	"$3,640.00"	$0.00		$0.00	$712.08	$0.00	$0.00	$724.36	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963ML-16	SUP	HCPCS C1713		AR-8963ML-16  -  PLATE BN 278MM 16 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST MDL	BOTH IP/OP	"$4,600.00 "	"$3,404.00"	$0.00	"$3,680.00"	"$2,070.00"	"$2,070.00"	$0.00	$0.00	$0.00	$958.76	"$3,414.12"	"$3,414.12"	$0.00	$0.00	$958.64	$0.00	"$2,267.80"	"$2,267.80"	$0.00	"$2,300.00"	"$3,643.20"	"$3,680.00"	$0.00		$0.00	$719.90	$0.00	$0.00	$732.32	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963MR-04	SUP	HCPCS C1713		AR-8963MR-04  -  PLATE BN 4 HL LOPRFL SS TIB RT DIST MDL 2.7 MM SCR	BOTH IP/OP	"$4,300.00 "	"$3,182.00"	$0.00	"$3,440.00"	"$1,935.00"	"$1,935.00"	$0.00	$0.00	$0.00	$896.23	"$3,191.46"	"$3,191.46"	$0.00	$0.00	$896.12	$0.00	"$2,119.90"	"$2,119.90"	$0.00	"$2,150.00"	"$3,405.60"	"$3,440.00"	$0.00		$0.00	$672.95	$0.00	$0.00	$684.56	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963MR-06	SUP	HCPCS C1713		AR-8963MR-06  -  PLATE BN CNTR 128MM 6 HL TPR TIP LOPRFL TIB RT DIST MDL 2.7	BOTH IP/OP	"$4,350.00 "	"$3,219.00"	$0.00	"$3,480.00"	"$1,957.50"	"$1,957.50"	$0.00	$0.00	$0.00	$906.65	"$3,228.57"	"$3,228.57"	$0.00	$0.00	$906.54	$0.00	"$2,144.55"	"$2,144.55"	$0.00	"$2,175.00"	"$3,445.20"	"$3,480.00"	$0.00		$0.00	$680.78	$0.00	$0.00	$692.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963MR-08	SUP	HCPCS C1713		AR-8963MR-08  -  PLATE BN 154MM 8 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL	BOTH IP/OP	"$4,400.00 "	"$3,256.00"	$0.00	"$3,520.00"	"$1,980.00"	"$1,980.00"	$0.00	$0.00	$0.00	$917.07	"$3,265.68"	"$3,265.68"	$0.00	$0.00	$916.96	$0.00	"$2,169.20"	"$2,169.20"	$0.00	"$2,200.00"	"$3,484.80"	"$3,520.00"	$0.00		$0.00	$688.60	$0.00	$0.00	$700.48	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963MR-10	SUP	HCPCS C1713		AR-8963MR-10  -  PLATE BN CNTR 179MM 10 HL LOPRFL TPR TIP TIB RT DIST MDL	BOTH IP/OP	"$4,450.00 "	"$3,293.00"	$0.00	"$3,560.00"	"$2,002.50"	"$2,002.50"	$0.00	$0.00	$0.00	$927.49	"$3,302.79"	"$3,302.79"	$0.00	$0.00	$927.38	$0.00	"$2,193.85"	"$2,193.85"	$0.00	"$2,225.00"	"$3,524.40"	"$3,560.00"	$0.00		$0.00	$696.43	$0.00	$0.00	$708.44	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963MR-12	SUP	HCPCS C1713		AR-8963MR-12  -  PLATE BN 204MM 12 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$0.00	$937.91	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	"$2,218.50"	"$2,218.50"	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$704.25	$0.00	$0.00	$716.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963MR-14	SUP	HCPCS C1713		AR-8963MR-14  -  PLATE BN 230MM 14 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL	BOTH IP/OP	"$4,550.00 "	"$3,367.00"	$0.00	"$3,640.00"	"$2,047.50"	"$2,047.50"	$0.00	$0.00	$0.00	$948.33	"$3,377.01"	"$3,377.01"	$0.00	$0.00	$948.22	$0.00	"$2,243.15"	"$2,243.15"	$0.00	"$2,275.00"	"$3,603.60"	"$3,640.00"	$0.00		$0.00	$712.08	$0.00	$0.00	$724.36	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963MR-16	SUP	HCPCS C1713		AR-8963MR-16  -  PLATE BN 278MM 16 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL	BOTH IP/OP	"$4,600.00 "	"$3,404.00"	$0.00	"$3,680.00"	"$2,070.00"	"$2,070.00"	$0.00	$0.00	$0.00	$958.76	"$3,414.12"	"$3,414.12"	$0.00	$0.00	$958.64	$0.00	"$2,267.80"	"$2,267.80"	$0.00	"$2,300.00"	"$3,643.20"	"$3,680.00"	$0.00		$0.00	$719.90	$0.00	$0.00	$732.32	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963P-03	SUP	HCPCS C1713		AR-8963P-03  -  PLATE BN 57MM ARTHX 3 HL TIB DP	BOTH IP/OP	"$2,487.50 "	"$1,840.75"	$0.00	"$1,990.00"	"$1,119.38"	"$1,119.38"	$0.00	$0.00	$0.00	$518.46	"$1,846.22"	"$1,846.22"	$0.00	$0.00	$518.40	$0.00	"$1,471.36"	"$1,471.36"	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$389.29	$0.00	$0.00	$396.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963P-05	SUP	HCPCS C1713		AR-8963P-05  -  PLATE BN 77MM 5 HL TIB DP	BOTH IP/OP	"$2,487.50 "	"$1,840.75"	$0.00	"$1,990.00"	"$1,119.38"	"$1,119.38"	$0.00	$0.00	$0.00	$518.46	"$1,846.22"	"$1,846.22"	$0.00	$0.00	$518.40	$0.00	"$1,471.36"	"$1,471.36"	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$389.29	$0.00	$0.00	$396.01	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963P-07	SUP	HCPCS C1713		AR-8963P-07  -  PLATE BN 7 HL TIB DP	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,041.05"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963P-09	SUP	HCPCS C1713		AR-8963P-09  -  PLATE BN 118MM 9 HL TIB DP	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963PLL-04	SUP	HCPCS C1713		AR-8963PLL-04  -  PLATE BN 75MM 4 HL FIB DIST P/L	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963PLL-05	SUP	HCPCS C1713		AR-8963PLL-05  -  PLATE BN STD 88MM 5 HL TPR TIP FIB DIST P/L 2.7MM LCK	BOTH IP/OP	"$2,050.00 "	"$1,517.00"	$0.00	"$1,640.00"	$922.50	$922.50	$0.00	$0.00	$0.00	$427.27	"$1,521.51"	"$1,521.51"	$0.00	$0.00	$427.22	$0.00	"$1,212.58"	"$1,212.58"	$0.00	"$1,025.00"	"$1,623.60"	"$1,640.00"	$0.00		$0.00	$320.83	$0.00	$0.00	$326.36	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963PLL-06	SUP	HCPCS C1713		AR-8963PLL-06  -  PLATE BN 100MM 6 HL TPR TIP CUT OUT SCLP FIB DIST P/L	BOTH IP/OP	"$2,100.00 "	"$1,554.00"	$0.00	"$1,680.00"	$945.00	$945.00	$0.00	$0.00	$0.00	$437.69	"$1,558.62"	"$1,558.62"	$0.00	$0.00	$437.64	$0.00	"$1,242.15"	"$1,242.15"	$0.00	"$1,050.00"	"$1,663.20"	"$1,680.00"	$0.00		$0.00	$328.65	$0.00	$0.00	$334.32	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963PLL-08	SUP	HCPCS C1713		AR-8963PLL-08  -  PLATE BN STD 126MM 8 HL TPR TIP FIB DIST P/L 2.7MM LCK	BOTH IP/OP	"$2,150.00 "	"$1,591.00"	$0.00	"$1,720.00"	$967.50	$967.50	$0.00	$0.00	$0.00	$448.11	"$1,595.73"	"$1,595.73"	$0.00	$0.00	$448.06	$0.00	"$1,271.73"	"$1,271.73"	$0.00	"$1,075.00"	"$1,702.80"	"$1,720.00"	$0.00		$0.00	$336.48	$0.00	$0.00	$342.28	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963RM-02	SUP	HCPCS C1713		AR-8963RM-02  -  PLATE BN STRG 16MM 2 HL OBLNG HL TPR TIP LOPRFL 2.7MM SCR	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963RM-03	SUP	HCPCS C1713		AR-8963RM-03  -  PLATE BN STRG 16MM 3 HL OBLNG HL TPR TIP LOPRFL 2.7MM SCR	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963RM-04	SUP	HCPCS C1713		AR-8963RM-04  -  PLATE BN STRG 16MM 4 HL OBLNG HL TPR TIP LOPRFL 2.7MM SCR	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$320.63	$320.63	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8963RM-05	SUP	HCPCS C1713		AR-8963RM-05  -  PLATE BN STRG 40MM 5 HL 2.7MM SCR	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964-01	SUP	HCPCS C1713		AR-8964-01  -  SCREW BN 4MM 125MM SCHNZ	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964-02	SUP	HCPCS C1713		AR-8964-02  -  SCREW BN 4MM 125MM SCHNZ	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964-03	SUP	HCPCS C1713		AR-8964-03  -  SCREW BN 5MM 175MM SCHNZ	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964-04	SUP	HCPCS C1713		AR-8964-04  -  SCREW BN 5MM 200MM SCHNZ	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964-05	SUP	HCPCS C1713		AR-8964-05  -  PIN FX 6MM 225MM TRNFX	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964-06	SUP	HCPCS C1713		AR-8964-06  -  PIN FX 6MM 300MM TRNFX	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964-07	SUP	Custom 27203010		AR-8964-07  -  CLAMP XTRNFX LG CMBN	BOTH IP/OP	"$1,240.00 "	$917.60	$0.00	$992.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$920.33	$920.33	$0.00	$0.00	$258.42	$0.00	$0.00	$0.00	$0.00	$620.00	$982.08	$992.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964-08	SUP	Custom 27203010		AR-8964-08  -  CLAMP XTRNFX LG MLPN	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964-09	SUP	Custom 27203010		AR-8964-09  -  CLAMP XTRNFX LG MLPN ROD ATCH	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$0.00	$0.00	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964-10	SUP	Custom 27203010		AR-8964-10  -  BIT DRL 3.5MM 195MM	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964-22	SUP	HCPCS C1713		AR-8964-22  -  CAP END NS LF ARTHX SCR	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$562.50	$562.50	$0.00	$0.00	$0.00	$260.53	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$739.38	$739.38	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964-24	SUP	HCPCS C1713		AR-8964-24  -  SCREW BN 5MM 250MM SCHNZ	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$140.63	$140.63	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964R-100	SUP	HCPCS C1713		AR-8964R-100  -  ROD XTRNFX 11MM 100MM ARTHROFX RDLCNT LTWT CFBR	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964R-150	SUP	HCPCS C1713		AR-8964R-150  -  ROD XTRNFX 11MM 150MM CFBR	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964R-200	SUP	HCPCS C1713		AR-8964R-200  -  ROD XTRNFX 11MM 200MM ARTHROFX CFBR	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964R-250	SUP	HCPCS C1713		AR-8964R-250  -  ROD XTRNFX 11MM 250MM CFBR	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$190.13	$190.13	$0.00	$0.00	$0.00	$88.06	$313.58	$313.58	$0.00	$0.00	$88.05	$0.00	$249.91	$249.91	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964R-300	SUP	HCPCS C1713		AR-8964R-300  -  ROD XTRNFX 11MM 300MM CFBR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964R-350	SUP	HCPCS C1713		AR-8964R-350  -  ROD XTRNFX 11MM 350MM CFBR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964R-400	SUP	HCPCS C1713		AR-8964R-400  -  ROD XTRNFX 11MM 400MM CFBR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964R-450	SUP	HCPCS C1713		AR-8964R-450  -  ROD XTRNFX 11MM 450MM CFBR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964R-500	SUP	HCPCS C1713		AR-8964R-500  -  ROD XTRNFX 11MM 500MM ARTHROFX RDLCNT LTWT CFBR	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8964S	SUP	Custom 27203010		AR-8964S  -  SYSTEM XTRNFX ARTHROFX	BOTH IP/OP	"$35,000.00 "	"$25,900.00"	$0.00	"$28,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,294.00"	$0.00	$0.00	$0.00	$0.00	"$17,500.00"	"$27,720.00"	"$28,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-100FT	SUP	HCPCS C1713		AR-8967-100FT  -  SCREW BN FT 6.7MM 100MM LOPRFL SCR SLF DRL ST CNN MTL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-105FT	SUP	HCPCS C1713		AR-8967-105FT  -  SCREW BN FT 6.7MM 105MM LOPRFL SCR SLF DRL ST CNN MTL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-110FT	SUP	HCPCS C1713		AR-8967-110FT  -  SCREW BN FT 6.7MM 110MM LOPRFL SCR SLF DRL ST CNN MTL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-115FT	SUP	HCPCS C1713		AR-8967-115FT  -  SCREW BN FT 6.7MM 115MM LOPRFL SCR SLF DRL ST CNN MTL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-120FT	SUP	HCPCS C1713		AR-8967-120FT  -  SCREW BN FT 6.7MM 120MM LOPRFL SCR SLF DRL ST CNN MTL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-18100	SUP	HCPCS C1713		AR-8967-18100  -  SCREW BN LOPRFL 6.7MM 100MM 18MM CNN TI FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-18105	SUP	HCPCS C1713		AR-8967-18105  -  SCREW BN LOPRFL 6.7MM 105MM 18MM CNN TI FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-18110	SUP	HCPCS C1713		AR-8967-18110  -  SCREW BN LOPRFL 6.7MM 110MM 18MM CNN TI FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-18115	SUP	HCPCS C1713		AR-8967-18115  -  SCREW BN LOPRFL 6.7MM 115MM 18MM CNN TI FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-18120	SUP	HCPCS C1713		AR-8967-18120  -  SCREW BN LOPRFL 6.7MM 120MM 18MM CNN TI FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1840	SUP	HCPCS C1713		AR-8967-1840  -  SCREW BN 3.5MM HEX 6.7MM 40MM 18MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1845	SUP	HCPCS C1713		AR-8967-1845  -  SCREW BN 3.5MM HEX 6.7MM 45MM 18MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1850	SUP	HCPCS C1713		AR-8967-1850  -  SCREW BN 3.5MM HEX 6.7MM 50MM 18MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1855	SUP	HCPCS C1713		AR-8967-1855  -  SCREW BN 3.5MM HEX 6.7MM 55MM 18MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1860	SUP	HCPCS C1713		AR-8967-1860  -  SCREW BN 3.5MM HEX 6.7MM 60MM 18MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1865	SUP	HCPCS C1713		AR-8967-1865  -  SCREW BN 3.5MM HEX 6.7MM 65MM 18MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1865S	SUP	HCPCS C1713		AR-8967-1865S  -  SCREW BN P/T 6.7MM 65MM STRL ARTHX LOPRFL SCR CNN TI	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1870	SUP	HCPCS C1713		AR-8967-1870  -  SCREW BN 3.5MM HEX 6.7MM 70MM 18MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1875	SUP	HCPCS C1713		AR-8967-1875  -  SCREW BN 3.5MM HEX 6.7MM 75MM 18MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1880	SUP	HCPCS C1713		AR-8967-1880  -  SCREW BN 3.5MM HEX 6.7MM 80MM 18MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1880S	SUP	HCPCS C1713		AR-8967-1880S  -  SCREW BN P/T 6.7MM 80MM STRL ARTHX LOPRFL SCR CNN TI	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1885	SUP	HCPCS C1713		AR-8967-1885  -  SCREW BN 3.5MM HEX 6.7MM 85MM 18MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1890	SUP	HCPCS C1713		AR-8967-1890  -  SCREW BN 3.5MM HEX 6.7MM 90MM 18MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1890S	SUP	HCPCS C1713		AR-8967-1890S  -  SCREW BN P/T 6.7MM 90MM STRL ARTHX LOPRFL SCR CNN TI	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-1895	SUP	HCPCS C1713		AR-8967-1895  -  SCREW BN 3.5MM HEX 6.7MM 95MM 18MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-28100	SUP	HCPCS C1713		AR-8967-28100  -  SCREW BN 3.5MM HEX 6.7MM 100MM 18MM LOPRFL SCR SLF DRL ST	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-28105	SUP	HCPCS C1713		AR-8967-28105  -  SCREW BN 3.5MM HEX 6.7MM 105MM 18MM LOPRFL SCR SLF DRL ST	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-28110	SUP	HCPCS C1713		AR-8967-28110  -  SCREW BN 3.5MM HEX 6.7MM 110MM 18MM LOPRFL SCR SLF DRL ST	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-28115	SUP	HCPCS C1713		AR-8967-28115  -  SCREW BN 3.5MM HEX 6.7MM 115MM 18MM LOPRFL SCR SLF DRL ST	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-28120	SUP	HCPCS C1713		AR-8967-28120  -  SCREW BN 3.5MM HEX 6.7MM 120MM 18MM LOPRFL SCR SLF DRL ST	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-2840	SUP	HCPCS C1713		AR-8967-2840  -  SCREW BN 3.5MM HEX 6.7MM 40MM 28MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-2845	SUP	HCPCS C1713		AR-8967-2845  -  SCREW BN 3.5MM HEX 6.7MM 45MM 28MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-2850	SUP	HCPCS C1713		AR-8967-2850  -  SCREW BN 3.5MM HEX 6.7MM 50MM 28MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-2855	SUP	HCPCS C1713		AR-8967-2855  -  SCREW BN 3.5MM HEX 6.7MM 55MM 28MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-2860	SUP	HCPCS C1713		AR-8967-2860  -  SCREW BN 3.5MM HEX 6.7MM 60MM 28MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-2865	SUP	HCPCS C1713		AR-8967-2865  -  SCREW BN 3.5MM HEX 6.7MM 65MM 28MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-2870	SUP	HCPCS C1713		AR-8967-2870  -  SCREW BN 3.5MM HEX 6.7MM 70MM 28MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-2875	SUP	HCPCS C1713		AR-8967-2875  -  SCREW BN 3.5MM HEX 6.7MM 75MM 28MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-2880	SUP	HCPCS C1713		AR-8967-2880  -  SCREW BN 3.5MM HEX 6.7MM 80MM 28MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-2885	SUP	HCPCS C1713		AR-8967-2885  -  SCREW BN 3.5MM HEX 6.7MM 85MM 28MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-2890	SUP	HCPCS C1713		AR-8967-2890  -  SCREW BN 3.5MM HEX 6.7MM 90MM 28MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-2895	SUP	HCPCS C1713		AR-8967-2895  -  SCREW BN 3.5MM HEX 6.7MM 95MM 28MM LOPRFL SCR SLF DRL ST CNN	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-40C	SUP	Custom 27203010		AR-8967-40C  -  BIT DRL 4MM 120MM CNN 6.7MM SCR	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-40FT	SUP	HCPCS C1713		AR-8967-40FT  -  SCREW BN FT 6.7MM 40MM LOPRFL SCR CNN MTL FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-45FT	SUP	HCPCS C1713		AR-8967-45FT  -  SCREW BN FT 6.7MM 45MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-50FT	SUP	HCPCS C1713		AR-8967-50FT  -  SCREW BN FT 6.7MM 50MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-55FT	SUP	HCPCS C1713		AR-8967-55FT  -  SCREW BN FT 6.7MM 55MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-60FT	SUP	HCPCS C1713		AR-8967-60FT  -  SCREW BN FT 6.7MM 60MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-65FT	SUP	HCPCS C1713		AR-8967-65FT  -  SCREW BN FT 6.7MM 65MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-67C	SUP	Custom 27203010		AR-8967-67C  -  BIT DRL MN 6.7MM HDSN CNN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-70FT	SUP	HCPCS C1713		AR-8967-70FT  -  SCREW BN FT 6.7MM 70MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-75FT	SUP	HCPCS C1713		AR-8967-75FT  -  SCREW BN FT 6.7MM 75MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-80FT	SUP	HCPCS C1713		AR-8967-80FT  -  SCREW BN FT 6.7MM 80MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-85FT	SUP	HCPCS C1713		AR-8967-85FT  -  SCREW BN FT 6.7MM 85MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-90FT	SUP	HCPCS C1713		AR-8967-90FT  -  SCREW BN FT 6.7MM 90MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967-95FT	SUP	HCPCS C1713		AR-8967-95FT  -  SCREW BN FT 6.7MM 95MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967C	SUP	HCPCS C1713		AR-8967C  -  SCREW BN LOPRFL 7MM PLT INS SM BN	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967CSF	SUP	Custom 27203010		AR-8967CSF  -  COUNTERSINK DRL CNN 6.7 MM SCR	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967G	SUP	Custom 27203010		AR-8967G  -  GUIDE DRL 6.7MM 4MM CNN	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967S	SUP	HCPCS C1713		AR-8967S  -  MODULE INST 6.7 MM TENODESIS LOPRFL SCR	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8967W	SUP	HCPCS C1713		AR-8967W  -  WASHER ORTH 13MM TI	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$90.00	$90.00	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970-01	SUP	Custom 27203010		AR-8970-01  -  GUIDE DRL 4.5 MM LCK SCR	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970-02	SUP	Custom 27203010		AR-8970-02  -  GUIDE DRL 3 4.5 MM SCR	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$0.00	$0.00	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970-30	SUP	Custom 27203010		AR-8970-30  -  BIT DRL 3MM CLBRT	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970-30C	SUP	Custom 27203010		AR-8970-30C  -  BIT DRL 3MM CNN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970-40C	SUP	Custom 27203010		AR-8970-40C  -  BIT DRL 4MM CNN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970-45	SUP	Custom 27203010		AR-8970-45  -  BIT DRL 4.5MM	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970-55	SUP	Custom 27203010		AR-8970-55  -  BIT DRL 5.5MM	BOTH IP/OP	$197.50 	$146.15	$0.00	$158.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.58	$146.58	$0.00	$0.00	$41.16	$0.00	$0.00	$0.00	$0.00	$98.75	$156.42	$158.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970AL	SUP	HCPCS C1713		AR-8970AL  -  PLATE BN ANKL LT ANT	BOTH IP/OP	"$5,187.50 "	"$3,838.75"	$0.00	"$4,150.00"	"$2,334.38"	"$2,334.38"	$0.00	$0.00	$0.00	"$1,081.20"	"$3,850.16"	"$3,850.16"	$0.00	$0.00	"$1,081.08"	$0.00	"$2,557.44"	"$2,557.44"	$0.00	"$2,593.75"	"$4,108.50"	"$4,150.00"	$0.00		$0.00	$811.84	$0.00	$0.00	$825.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970AR	SUP	HCPCS C1713		AR-8970AR  -  PLATE BN ANKL RT ANT	BOTH IP/OP	"$5,187.50 "	"$3,838.75"	$0.00	"$4,150.00"	"$2,334.38"	"$2,334.38"	$0.00	$0.00	$0.00	"$1,081.20"	"$3,850.16"	"$3,850.16"	$0.00	$0.00	"$1,081.08"	$0.00	"$2,557.44"	"$2,557.44"	$0.00	"$2,593.75"	"$4,108.50"	"$4,150.00"	$0.00		$0.00	$811.84	$0.00	$0.00	$825.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970PL	SUP	HCPCS C1713		AR-8970PL  -  PLATE BN ANKL LT TIBIOTALOCALCANEAL POST	BOTH IP/OP	"$5,687.50 "	"$4,208.75"	$0.00	"$4,550.00"	"$2,559.38"	"$2,559.38"	$0.00	$0.00	$0.00	"$1,185.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,185.28"	$0.00	"$2,803.94"	"$2,803.94"	$0.00	"$2,843.75"	"$4,504.50"	"$4,550.00"	$0.00		$0.00	$890.09	$0.00	$0.00	$905.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970PR	SUP	HCPCS C1713		AR-8970PR  -  PLATE BN ANKL RT POST TIBIOTALOCALCANEAL	BOTH IP/OP	"$5,687.50 "	"$4,208.75"	$0.00	"$4,550.00"	"$2,559.38"	"$2,559.38"	$0.00	$0.00	$0.00	"$1,185.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,185.28"	$0.00	"$2,803.94"	"$2,803.94"	$0.00	"$2,843.75"	"$4,504.50"	"$4,550.00"	$0.00		$0.00	$890.09	$0.00	$0.00	$905.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970S	SUP	HCPCS C1713		AR-8970S  -  SCREW BN ANKL FSN PLT SYS	BOTH IP/OP	"$36,250.00 "	"$26,825.00"	$0.00	"$29,000.00"	"$16,312.50"	"$16,312.50"	$0.00	$0.00	$0.00	"$7,555.41"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,554.50"	$0.00	"$17,871.25"	"$17,871.25"	$0.00	"$18,125.00"	"$28,710.00"	"$29,000.00"	$0.00		$0.00	"$5,673.13"	$0.00	$0.00	"$5,771.00"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970TT	SUP	HCPCS C1713		AR-8970TT  -  PLATE BN FSN ANKL TIBIOTALAR LAT	BOTH IP/OP	"$5,187.50 "	"$3,838.75"	$0.00	"$4,150.00"	"$2,334.38"	"$2,334.38"	$0.00	$0.00	$0.00	"$1,081.20"	"$3,850.16"	"$3,850.16"	$0.00	$0.00	"$1,081.08"	$0.00	"$2,557.44"	"$2,557.44"	$0.00	"$2,593.75"	"$4,108.50"	"$4,150.00"	$0.00		$0.00	$811.84	$0.00	$0.00	$825.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8970TTC	SUP	HCPCS C1713		AR-8970TTC  -  PLATE BN FSN ANKL LAT TIBIOTALOCALCANEAL	BOTH IP/OP	"$5,437.50 "	"$4,023.75"	$0.00	"$4,350.00"	"$2,446.88"	"$2,446.88"	$0.00	$0.00	$0.00	"$1,133.31"	"$4,035.71"	"$4,035.71"	$0.00	$0.00	"$1,133.18"	$0.00	"$2,680.69"	"$2,680.69"	$0.00	"$2,718.75"	"$4,306.50"	"$4,350.00"	$0.00		$0.00	$850.97	$0.00	$0.00	$865.65	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8978DS	SUP	Custom 27203010		AR-8978DS  -  KIT ASCP FX 3.5MM 8.5MM STRL ARTHX DX SWIVELOCK SL	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8978P	SUP	HCPCS C1713		AR-8978P  -  ANCHOR SUT 3.5MM STRL DX SWIVELOCK SL8.5MM FRK EYLT	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8981-06S	SUP	Custom 27203010		AR-8981-06S  -  SET GFT HRVT 6MM STRL OATS DISP S JNT	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8981-08S	SUP	Custom 27203010		AR-8981-08S  -  SET GFT HRVT 8MM STRL OATS DISP S JNT	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8981-10S	SUP	Custom 27203010		AR-8981-10S  -  SET GFT HRVT 10MM STRL OATS DISP S JNT	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-8999N	SUP	Custom 27203010		AR-8999N  -  NEEDLE SUT MN SCRPN DX	BOTH IP/OP	"$4,937.50 "	"$3,653.75"	$0.00	"$3,950.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,664.61"	"$3,664.61"	$0.00	$0.00	"$1,028.98"	$0.00	$0.00	$0.00	$0.00	"$2,468.75"	"$3,910.50"	"$3,950.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9045-40PT	SUP	HCPCS C1713		AR-9045-40PT  -  SCREW BN P/T LOPRFL 4.5MM 40MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9045-45PT	SUP	HCPCS C1713		AR-9045-45PT  -  SCREW BN P/T 4.5MM 45MM LOPRFL HD ST TI METATARSUS	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9045-50PT	SUP	HCPCS C1713		AR-9045-50PT  -  SCREW BN P/T LOPRFL 4.5MM 50MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9045-55PT	SUP	HCPCS C1713		AR-9045-55PT  -  SCREW BN P/T LOPRFL 4.5MM 55MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9045-60PT	SUP	HCPCS C1713		AR-9045-60PT  -  SCREW BN P/T LOPRFL 4.5MM 60MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9045-65PT	SUP	HCPCS C1713		AR-9045-65PT  -  SCREW BN P/T LOPRFL 4.5MM 65MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9055-40PT	SUP	HCPCS C1713		AR-9055-40PT  -  SCREW BN P/T LOPRFL 5.5MM 40MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9055-45PT	SUP	HCPCS C1713		AR-9055-45PT  -  SCREW BN P/T 5.5MM 45MM SOLINULLD LOPRFL ST TI METATARSUS	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9055-50PT	SUP	HCPCS C1713		AR-9055-50PT  -  SCREW BN P/T LOPRFL 5.5MM 50MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9055-55PT	SUP	HCPCS C1713		AR-9055-55PT  -  SCREW BN P/T 5.5MM 55MM LOPRFL HD ST TI METATARSUS	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9055-60PT	SUP	HCPCS C1713		AR-9055-60PT  -  SCREW BN P/T LOPRFL 5.5MM 60MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9055-65PT	SUP	HCPCS C1713		AR-9055-65PT  -  SCREW BN P/T LOPRFL 5.5MM 65MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9060-40PT	SUP	HCPCS C1713		AR-9060-40PT  -  SCREW BN P/T LOPRFL 6MM 40MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9060-45PT	SUP	HCPCS C1713		AR-9060-45PT  -  SCREW BN P/T LOPRFL 6MM 45MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9060-50PT	SUP	HCPCS C1713		AR-9060-50PT  -  SCREW BN P/T LOPRFL 6MM 50MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9060-55PT	SUP	HCPCS C1713		AR-9060-55PT  -  SCREW BN P/T LOPRFL 6MM 55MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9060-60PT	SUP	HCPCS C1713		AR-9060-60PT  -  SCREW BN P/T LOPRFL 6MM 60MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9060-65PT	SUP	HCPCS C1713		AR-9060-65PT  -  SCREW BN P/T LOPRFL 6MM 65MM SLD TI METATARSUS JNS FX	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-05P	SUP	HCPCS C1776		AR-9100-05P  -  STEM HUM 5MM 105MM STRL	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-05S	SUP	HCPCS C1776		AR-9100-05S  -  STEM HUM 132.5D 5MM 60MM UNIVERS APX	BOTH IP/OP	"$10,437.50 "	"$7,723.75"	$0.00	"$8,350.00"	"$4,696.88"	"$4,696.88"	$0.00	$0.00	$0.00	"$2,175.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,175.18"	$0.00	"$5,145.69"	"$5,145.69"	$0.00	"$5,218.75"	"$8,266.50"	"$8,350.00"	$0.00		$0.00	"$1,633.47"	$0.00	$0.00	"$1,661.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-06P	SUP	HCPCS C1776		AR-9100-06P  -  STEM HUM 6MM 115MM STRL UNIVERS II SHLDR	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-06S	SUP	HCPCS C1776		AR-9100-06S  -  STEM HUM RECT 6MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL	BOTH IP/OP	"$10,437.50 "	"$7,723.75"	$0.00	"$8,350.00"	"$4,696.88"	"$4,696.88"	$0.00	$0.00	$0.00	"$2,175.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,175.18"	$0.00	"$5,145.69"	"$5,145.69"	$0.00	"$5,218.75"	"$8,266.50"	"$8,350.00"	$0.00		$0.00	"$1,633.47"	$0.00	$0.00	"$1,661.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-07	SUP	HCPCS C1776		AR-9100-07  -  STEM HUM 7MM UNIVERS SHLDR	BOTH IP/OP	"$5,987.50 "	"$4,430.75"	$0.00	"$4,790.00"	"$2,694.38"	"$2,694.38"	$0.00	$0.00	$0.00	"$1,247.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,247.80"	$0.00	"$2,951.84"	"$2,951.84"	$0.00	"$2,993.75"	"$4,742.10"	"$4,790.00"	$0.00		$0.00	$937.04	$0.00	$0.00	$953.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-07P	SUP	HCPCS C1776		AR-9100-07P  -  STEM HUM 7MM 140MM STRL UNIVERS II SHLDR	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-07S	SUP	HCPCS C1776		AR-9100-07S  -  STEM HUM RECT 7MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL	BOTH IP/OP	"$10,437.50 "	"$7,723.75"	$0.00	"$8,350.00"	"$4,696.88"	"$4,696.88"	$0.00	$0.00	$0.00	"$2,175.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,175.18"	$0.00	"$5,145.69"	"$5,145.69"	$0.00	"$5,218.75"	"$8,266.50"	"$8,350.00"	$0.00		$0.00	"$1,633.47"	$0.00	$0.00	"$1,661.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-08	SUP	HCPCS C1776		AR-9100-08  -  STEM HUM 8MM UNIVERS SHLDR	BOTH IP/OP	"$5,987.50 "	"$4,430.75"	$0.00	"$4,790.00"	"$2,694.38"	"$2,694.38"	$0.00	$0.00	$0.00	"$1,247.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,247.80"	$0.00	"$2,951.84"	"$2,951.84"	$0.00	"$2,993.75"	"$4,742.10"	"$4,790.00"	$0.00		$0.00	$937.04	$0.00	$0.00	$953.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-08F	SUP	HCPCS C1776		AR-9100-08F  -  STEM HUM 8MM 158MM STRL UNIVERS ADJ HT SHLDR	BOTH IP/OP	"$6,812.50 "	"$5,041.25"	$0.00	"$5,450.00"	"$3,065.63"	"$3,065.63"	$0.00	$0.00	$0.00	"$1,419.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,419.73"	$0.00	"$3,358.56"	"$3,358.56"	$0.00	"$3,406.25"	"$5,395.50"	"$5,450.00"	$0.00		$0.00	"$1,066.16"	$0.00	$0.00	"$1,084.55"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-08P	SUP	HCPCS C1776		AR-9100-08P  -  STEM HUM 8MM 143MM STRL UNIVERS II SHLDR	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-08S	SUP	HCPCS C1776		AR-9100-08S  -  STEM HUM RECT 8MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL	BOTH IP/OP	"$10,437.50 "	"$7,723.75"	$0.00	"$8,350.00"	"$4,696.88"	"$4,696.88"	$0.00	$0.00	$0.00	"$2,175.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,175.18"	$0.00	"$5,145.69"	"$5,145.69"	$0.00	"$5,218.75"	"$8,266.50"	"$8,350.00"	$0.00		$0.00	"$1,633.47"	$0.00	$0.00	"$1,661.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-09	SUP	HCPCS C1776		AR-9100-09  -  STEM HUM 9MM UNIVERS SHLDR	BOTH IP/OP	"$5,987.50 "	"$4,430.75"	$0.00	"$4,790.00"	"$2,694.38"	"$2,694.38"	$0.00	$0.00	$0.00	"$1,247.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,247.80"	$0.00	"$2,951.84"	"$2,951.84"	$0.00	"$2,993.75"	"$4,742.10"	"$4,790.00"	$0.00		$0.00	$937.04	$0.00	$0.00	$953.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-09F	SUP	HCPCS C1776		AR-9100-09F  -  STEM HUM 9MM 173MM STRL UNIVERS ADJ HT SHLDR	BOTH IP/OP	"$6,812.50 "	"$5,041.25"	$0.00	"$5,450.00"	"$3,065.63"	"$3,065.63"	$0.00	$0.00	$0.00	"$1,419.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,419.73"	$0.00	"$3,358.56"	"$3,358.56"	$0.00	"$3,406.25"	"$5,395.50"	"$5,450.00"	$0.00		$0.00	"$1,066.16"	$0.00	$0.00	"$1,084.55"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-09P	SUP	HCPCS C1776		AR-9100-09P  -  STEM HUM 9MM 146MM STRL UNIVERS II SHLDR	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-09S	SUP	HCPCS C1776		AR-9100-09S  -  STEM HUM RECT 9MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL	BOTH IP/OP	"$10,437.50 "	"$7,723.75"	$0.00	"$8,350.00"	"$4,696.88"	"$4,696.88"	$0.00	$0.00	$0.00	"$2,175.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,175.18"	$0.00	"$5,145.69"	"$5,145.69"	$0.00	"$5,218.75"	"$8,266.50"	"$8,350.00"	$0.00		$0.00	"$1,633.47"	$0.00	$0.00	"$1,661.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-10F	SUP	HCPCS C1776		AR-9100-10F  -  STEM HUM 10MM 180MM STRL UNIVERS ADJ HT FX SHLDR	BOTH IP/OP	"$6,812.50 "	"$5,041.25"	$0.00	"$5,450.00"	"$3,065.63"	"$3,065.63"	$0.00	$0.00	$0.00	"$1,419.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,419.73"	$0.00	"$3,358.56"	"$3,358.56"	$0.00	"$3,406.25"	"$5,395.50"	"$5,450.00"	$0.00		$0.00	"$1,066.16"	$0.00	$0.00	"$1,084.55"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-10P	SUP	HCPCS C1776		AR-9100-10P  -  STEM HUM 10MM 148MM STRL UNIVERS II SHLDR	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-10S	SUP	HCPCS C1776		AR-9100-10S  -  STEM HUM RECT 10MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL	BOTH IP/OP	"$10,437.50 "	"$7,723.75"	$0.00	"$8,350.00"	"$4,696.88"	"$4,696.88"	$0.00	$0.00	$0.00	"$2,175.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,175.18"	$0.00	"$5,145.69"	"$5,145.69"	$0.00	"$5,218.75"	"$8,266.50"	"$8,350.00"	$0.00		$0.00	"$1,633.47"	$0.00	$0.00	"$1,661.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-11	SUP	HCPCS C1776		AR-9100-11  -  STEM HUM 11MM UNIVERS SHLDR	BOTH IP/OP	"$5,987.50 "	"$4,430.75"	$0.00	"$4,790.00"	"$2,694.38"	"$2,694.38"	$0.00	$0.00	$0.00	"$1,247.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,247.80"	$0.00	"$2,951.84"	"$2,951.84"	$0.00	"$2,993.75"	"$4,742.10"	"$4,790.00"	$0.00		$0.00	$937.04	$0.00	$0.00	$953.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-11F	SUP	HCPCS C1776		AR-9100-11F  -  STEM HUM 11MM 187MM STRL UNIVERS ADJ HT SHLDR	BOTH IP/OP	"$6,812.50 "	"$5,041.25"	$0.00	"$5,450.00"	"$3,065.63"	"$3,065.63"	$0.00	$0.00	$0.00	"$1,419.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,419.73"	$0.00	"$3,358.56"	"$3,358.56"	$0.00	"$3,406.25"	"$5,395.50"	"$5,450.00"	$0.00		$0.00	"$1,066.16"	$0.00	$0.00	"$1,084.55"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-11P	SUP	HCPCS C1776		AR-9100-11P  -  STEM HUM 11MM 151MM STRL UNIVERS II SHLDR	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-11S	SUP	HCPCS C1776		AR-9100-11S  -  STEM HUM RECT 11MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL	BOTH IP/OP	"$10,437.50 "	"$7,723.75"	$0.00	"$8,350.00"	"$4,696.88"	"$4,696.88"	$0.00	$0.00	$0.00	"$2,175.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,175.18"	$0.00	"$5,145.69"	"$5,145.69"	$0.00	"$5,218.75"	"$8,266.50"	"$8,350.00"	$0.00		$0.00	"$1,633.47"	$0.00	$0.00	"$1,661.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-12	SUP	HCPCS C1776		AR-9100-12  -  STEM HUM 12MM UNIVERS SHLDR	BOTH IP/OP	"$5,987.50 "	"$4,430.75"	$0.00	"$4,790.00"	"$2,694.38"	"$2,694.38"	$0.00	$0.00	$0.00	"$1,247.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,247.80"	$0.00	"$2,951.84"	"$2,951.84"	$0.00	"$2,993.75"	"$4,742.10"	"$4,790.00"	$0.00		$0.00	$937.04	$0.00	$0.00	$953.21	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-12F	SUP	HCPCS C1776		AR-9100-12F  -  STEM HUM 12MM 195MM STRL UNIVERS ADJ HT SHLDR	BOTH IP/OP	"$6,812.50 "	"$5,041.25"	$0.00	"$5,450.00"	"$3,065.63"	"$3,065.63"	$0.00	$0.00	$0.00	"$1,419.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,419.73"	$0.00	"$3,358.56"	"$3,358.56"	$0.00	"$3,406.25"	"$5,395.50"	"$5,450.00"	$0.00		$0.00	"$1,066.16"	$0.00	$0.00	"$1,084.55"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-12P	SUP	HCPCS C1776		AR-9100-12P  -  STEM HUM 12MM 151MM STRL UNIVERS II SHLDR	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-12S	SUP	HCPCS C1776		AR-9100-12S  -  STEM HUM RECT 12MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL	BOTH IP/OP	"$10,437.50 "	"$7,723.75"	$0.00	"$8,350.00"	"$4,696.88"	"$4,696.88"	$0.00	$0.00	$0.00	"$2,175.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,175.18"	$0.00	"$5,145.69"	"$5,145.69"	$0.00	"$5,218.75"	"$8,266.50"	"$8,350.00"	$0.00		$0.00	"$1,633.47"	$0.00	$0.00	"$1,661.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-13F	SUP	HCPCS C1776		AR-9100-13F  -  STEM HUM 13MM 204MM STRL UNIVERS ADJ HT SHLDR FX	BOTH IP/OP	"$6,812.50 "	"$5,041.25"	$0.00	"$5,450.00"	"$3,065.63"	"$3,065.63"	$0.00	$0.00	$0.00	"$1,419.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,419.73"	$0.00	"$3,358.56"	"$3,358.56"	$0.00	"$3,406.25"	"$5,395.50"	"$5,450.00"	$0.00		$0.00	"$1,066.16"	$0.00	$0.00	"$1,084.55"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-13P	SUP	HCPCS C1776		AR-9100-13P  -  STEM HUM 13MM UNIVERS SHLDR	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-13S	SUP	HCPCS C1776		AR-9100-13S  -  STEM HUM RECT 13MM 65MM UNIVERS APX PRFT REM TRUNION SUT HL	BOTH IP/OP	"$10,437.50 "	"$7,723.75"	$0.00	"$8,350.00"	"$4,696.88"	"$4,696.88"	$0.00	$0.00	$0.00	"$2,175.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,175.18"	$0.00	"$5,145.69"	"$5,145.69"	$0.00	"$5,218.75"	"$8,266.50"	"$8,350.00"	$0.00		$0.00	"$1,633.47"	$0.00	$0.00	"$1,661.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-14P	SUP	HCPCS C1776		AR-9100-14P  -  STEM HUM 14MM 151MM STRL UNIVERS II SHLDR	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-14S	SUP	HCPCS C1776		AR-9100-14S  -  STEM HUM RECT 14MM 65MM UNIVERS APX PRFT REM TRUNION SUT HL	BOTH IP/OP	"$10,437.50 "	"$7,723.75"	$0.00	"$8,350.00"	"$4,696.88"	"$4,696.88"	$0.00	$0.00	$0.00	"$2,175.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,175.18"	$0.00	"$5,145.69"	"$5,145.69"	$0.00	"$5,218.75"	"$8,266.50"	"$8,350.00"	$0.00		$0.00	"$1,633.47"	$0.00	$0.00	"$1,661.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-15P	SUP	HCPCS C1776		AR-9100-15P  -  STEM HUM 15MM 151MM STRL UNIVERS II SHLDR	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-15S	SUP	HCPCS C1776		AR-9100-15S  -  STEM HUM RECT 15MM 65MM UNIVERS APX PRFT REM TRUNION SUT HL	BOTH IP/OP	"$10,437.50 "	"$7,723.75"	$0.00	"$8,350.00"	"$4,696.88"	"$4,696.88"	$0.00	$0.00	$0.00	"$2,175.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,175.18"	$0.00	"$5,145.69"	"$5,145.69"	$0.00	"$5,218.75"	"$8,266.50"	"$8,350.00"	$0.00		$0.00	"$1,633.47"	$0.00	$0.00	"$1,661.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-21	SUP	Custom 27203010		AR-9100-21  -  KIT ASCP FX UNV TRUNNION	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-22	SUP	HCPCS C1776		AR-9100-22  -  COMPONENT GLND 3 USP UNIVERS REPL TRUNION KT	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9100-24	SUP	HCPCS C1776		AR-9100-24  -  COMPONENT GLND 5 USP UNIVERS REPL TRUNION KT	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9104-01	SUP	HCPCS C1776		AR-9104-01  -  COMPONENT GLND SM STRL UNIVERS II CMNT KEEL PE SHLDR	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9104-02	SUP	HCPCS C1776		AR-9104-02  -  COMPONENT GLND MED STRL UNIVERS II CMNT KEEL PE SHLDR	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9104-03	SUP	HCPCS C1776		AR-9104-03  -  COMPONENT GLND LG STRL UNIVERS II CMNT KEEL PE SHLDR	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9104-04	SUP	HCPCS C1776		AR-9104-04  -  COMPONENT GLND XL STRL UNIVERS II CMNT KEEL PE SHLDR	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9105-01	SUP	HCPCS C1776		AR-9105-01  -  COMPONENT GLND SM STRL UNIVERS II CMNT PG PE SHLDR	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9105-02	SUP	HCPCS C1776		AR-9105-02  -  COMPONENT GLND MED STRL UNIVERS II CMNT PG PE SHLDR	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9105-03	SUP	HCPCS C1776		AR-9105-03  -  COMPONENT GLND LG STRL UNIVERS II CMNT PG PE SHLDR	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9105-04	SUP	HCPCS C1776		AR-9105-04  -  COMPONENT GLND XL STRL UNIVERS II CMNT PG PE SHLDR	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9106-01	SUP	HCPCS C1713		AR-9106-01  -  COMPONENT GLND SM STRL LF UNIVERS VAULTLOCK DISP	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9106-02	SUP	HCPCS C1776		AR-9106-02  -  COMPONENT GLND MED STRL ARTHX UNIVERS VAULTLOCK	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9106-04	SUP	HCPCS C1776		AR-9106-04  -  COMPONENT GLND XL STRL ARTHX UNIVERS VAULTLOCK	BOTH IP/OP	"$3,937.50 "	"$2,913.75"	$0.00	"$3,150.00"	"$1,771.88"	"$1,771.88"	$0.00	$0.00	$0.00	$820.67	"$2,922.41"	"$2,922.41"	$0.00	$0.00	$820.58	$0.00	"$1,941.19"	"$1,941.19"	$0.00	"$1,968.75"	"$3,118.50"	"$3,150.00"	$0.00		$0.00	$616.22	$0.00	$0.00	$626.85	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9120-01	SUP	HCPCS C1713		AR-9120-01  -  BASEPLATE GLND SM UNV SHLDR	BOTH IP/OP	"$4,287.50 "	"$3,172.75"	$0.00	"$3,430.00"	"$1,929.38"	"$1,929.38"	$0.00	$0.00	$0.00	$893.62	"$3,182.18"	"$3,182.18"	$0.00	$0.00	$893.52	$0.00	"$2,113.74"	"$2,113.74"	$0.00	"$2,143.75"	"$3,395.70"	"$3,430.00"	$0.00		$0.00	$670.99	$0.00	$0.00	$682.57	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9125-1	SUP	Custom 27203010		AR-9125-1  -  GUIDE DRL -10D 5D SM GLND	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9125-10	SUP	Custom 27203010		AR-9125-10  -  GUIDE DRL -20D 15D 0D SM GLND	BOTH IP/OP	"$1,787.50 "	"$1,322.75"	$0.00	"$1,430.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,326.68"	"$1,326.68"	$0.00	$0.00	$372.52	$0.00	$0.00	$0.00	$0.00	$893.75	"$1,415.70"	"$1,430.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9125-2	SUP	Custom 27203010		AR-9125-2  -  GUIDE DRL -10D 5D MED GLND	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9125-20	SUP	Custom 27203010		AR-9125-20  -  GUIDE DRL -20D 15D 0D MED GLND	BOTH IP/OP	"$1,787.50 "	"$1,322.75"	$0.00	"$1,430.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,326.68"	"$1,326.68"	$0.00	$0.00	$372.52	$0.00	$0.00	$0.00	$0.00	$893.75	"$1,415.70"	"$1,430.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9125-3	SUP	Custom 27203010		AR-9125-3  -  GUIDE DRL -10D 5D LG GLND	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	$0.00	$0.00	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9125-30	SUP	Custom 27203010		AR-9125-30  -  GUIDE DRL -20D 15D 0D LG GLND	BOTH IP/OP	"$1,787.50 "	"$1,322.75"	$0.00	"$1,430.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,326.68"	"$1,326.68"	$0.00	$0.00	$372.52	$0.00	$0.00	$0.00	$0.00	$893.75	"$1,415.70"	"$1,430.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9140-14	SUP	HCPCS C1776		AR-9140-14  -  HEAD HUM 40MM 14MM UNIVERS 3D MTL SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9140-17P	SUP	HCPCS C1776		AR-9140-17P  -  HEAD HUM 40MM 17MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9142-17CA	SUP	HCPCS C1776		"AR-9142-17CA  -  UNIVERS CA HUMERAL HEAD,  42/17"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9142-17P	SUP	HCPCS C1776		AR-9142-17P  -  HEAD HUM 42MM 17MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9143-15	SUP	HCPCS C1776		AR-9143-15  -  HEAD HUM 43MM 15MM SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9143-15F	SUP	HCPCS C1776		AR-9143-15F  -  HEAD HUM 43MM 15MM SHLDR	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9144-17CA	SUP	HCPCS C1776		"AR-9144-17CA  -  UNIVERS CA HUMERAL HEAD, 44/17"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9144-17P	SUP	HCPCS C1776		AR-9144-17P  -  HEAD HUM 44MM 17MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9144-19CA	SUP	HCPCS C1776		"AR-9144-19CA  -  UNIVERS CA HUMERAL HEAD, 44/19"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9144-19P	SUP	HCPCS C1776		AR-9144-19P  -  HEAD HUM 44MM 19MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9145-15	SUP	HCPCS C1776		AR-9145-15  -  HEAD HUM 45MM 15MM MTL SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9145-24	SUP	HCPCS C1713		AR-9145-24  -  SCREW BN 18D 4.5MM 24MM UNIVERS REVERS LCK VA SHLDR GLND	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9145-24NL	SUP	HCPCS C1713		AR-9145-24NL  -  SCREW BN 4.5MM 24MM UNIVERS REVERS NONLOCK PERI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9145-30	SUP	HCPCS C1713		AR-9145-30  -  SCREW BONE 4.5MM 30MM UNIVERS REVERS 18D SHLDR	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9145-30NL	SUP	HCPCS C1713		"AR-9145-30NL  -  PERIPHERAL SCREW,  NL, UNI REV, 4.5X30MM"	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9145-36	SUP	HCPCS C1713		AR-9145-36  -  SCREW BONE 4.5MM 36MM UNIVERS REVERS 18D SHLDR	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9145-36NL	SUP	HCPCS C1713		AR-9145-36NL  -  SCREW BN 4.5MM 36MM UNIVERS REVERS NONLOCK PERI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9145-42	SUP	HCPCS C1713		AR-9145-42  -  SCREW BN 18D 4.5MM 42MM UNIVERS REVERS LCK VA SHLDR GLND	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9145-42NL	SUP	HCPCS C1713		AR-9145-42NL  -  SCREW BN 4.5MM 42MM UNIVERS REVERS NONLOCK PERI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9145-48	SUP	HCPCS C1713		AR-9145-48  -  SCREW BN 18D 4.5MM 48MM UNIVERS REVERS LCK VA SHLDR GLND	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9145-48NL	SUP	HCPCS C1713		AR-9145-48NL  -  SCREW BN 4.5MM 48MM UNIVERS REVERS NONLOCK PERI	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$135.00	$135.00	$0.00	$0.00	$0.00	$62.53	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$177.45	$177.45	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$46.95	$0.00	$0.00	$47.76	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9145DG	SUP	Custom 27203010		AR-9145DG  -  GUIDE DRL 45MM UNIVERS REVERS GLND	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	$0.00	$0.00	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9146-17	SUP	HCPCS C1776		AR-9146-17  -  HEAD HUM 46MM 17MM STRL UNIVERS ADJ HT ANTM REFIXATION	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9146-17F	SUP	HCPCS C1776		AR-9146-17F  -  HEAD HUM 46MM 17MM STRL UNIVERS ADJ HT ANTM REFIXATION	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9146-18CA	SUP	HCPCS C1776		"AR-9146-18CA  -  UNIVERS CA HUMERAL HEAD, 46/18"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9146-18P	SUP	HCPCS C1776		AR-9146-18P  -  HEAD HUM 46MM 18MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9146-20CA	SUP	HCPCS C1776		"AR-9146-20CA  -  UNIVERS CA HUMERAL HEAD, 46/20"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9146-20P	SUP	HCPCS C1776		AR-9146-20P  -  HEAD HUM 46MM 20MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9148-17	SUP	HCPCS C1776		AR-9148-17  -  HEAD HUM 48MM 17MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9148-17F	SUP	HCPCS C1776		AR-9148-17F  -  HEAD HUM 48MM 17MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9148-18	SUP	HCPCS C1776		AR-9148-18  -  HEAD HUM 3D	BOTH IP/OP	"$2,987.50 "	"$2,210.75"	$0.00	"$2,390.00"	"$1,344.38"	"$1,344.38"	$0.00	$0.00	$0.00	$622.67	"$2,217.32"	"$2,217.32"	$0.00	$0.00	$622.60	$0.00	"$1,472.84"	"$1,472.84"	$0.00	"$1,493.75"	"$2,366.10"	"$2,390.00"	$0.00		$0.00	$467.54	$0.00	$0.00	$475.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9148-19CA	SUP	HCPCS C1776		"AR-9148-19CA  -  UNIVERS CA HUMERAL HEAD, 48/19"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9148-19P	SUP	HCPCS C1776		AR-9148-19P  -  HEAD HUM 48MM 19MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9148-21CA	SUP	HCPCS C1776		"AR-9148-21CA  -  UNIVERS CA HUMERAL HEAD, 48/21"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9148-21P	SUP	HCPCS C1776		AR-9148-21P  -  HEAD HUM 48MM 21MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9150-19	SUP	HCPCS C1776		AR-9150-19  -  HEAD HUM 50MM 19MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9150-19CA	SUP	HCPCS C1776		"AR-9150-19CA  -  UNIVERS CA HUMERAL HEAD, 50/19"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9150-19F	SUP	HCPCS C1776		AR-9150-19F  -  HEAD HUM 50MM 19MM STRL UNIVERS ADJ HT ANTM REFIXATION	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9150-19P	SUP	HCPCS C1776		AR-9150-19P  -  HEAD HUM 50MM 19MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9150-21CA	SUP	HCPCS C1776		"AR-9150-21CA  -  UNIVERS CA HUMERAL HEAD, 50/21"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9150-21P	SUP	HCPCS C1776		AR-9150-21P  -  HEAD HUM 50MM 21MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9151-22	SUP	HCPCS C1776		AR-9151-22  -  HEAD HUM 51MM 22MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9151-22F	SUP	HCPCS C1776		AR-9151-22F  -  HEAD HUM 51MM 22MM STRL UNIVERS ADJ HT ANTM REFIXATION	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9152-20CA	SUP	HCPCS C1776		"AR-9152-20CA  -  UNIVERS CA HUMERAL HEAD, 52/20"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9152-20P	SUP	HCPCS C1776		AR-9152-20P  -  HEAD HUM 52MM 20MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9152-22CA	SUP	HCPCS C1776		"AR-9152-22CA  -  UNIVERS CA HUMERAL HEAD, 52/22"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9152-22P	SUP	HCPCS C1776		AR-9152-22P  -  HEAD HUM 52MM 22MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9153-19	SUP	HCPCS C1776		AR-9153-19  -  HEAD HUM 53MM 19MM UNIVERS 3D SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9153-19F	SUP	HCPCS C1776		AR-9153-19F  -  HEAD HUM 53MM 19MM STRL UNIVERS ADJ HT ANTM REFIXATION	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9153-23	SUP	HCPCS C1776		AR-9153-23  -  HEAD HUM 53MM 23MM UNIVERS 3D SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9154-21CA	SUP	HCPCS C1776		"AR-9154-21CA  -  UNIVERS CA HUMERAL HEAD, 54/21"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9154-21P	SUP	HCPCS C1776		AR-9154-21P  -  HEAD HUM 54MM 21MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9154-23CA	SUP	HCPCS C1776		"AR-9154-23CA  -  UNIVERS CA HUMERAL HEAD, 54/23"	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9154-23P	SUP	HCPCS C1776		AR-9154-23P  -  HEAD HUM 54MM 23MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9156-22CA	SUP	HCPCS C1776		AR-9156-22CA  -  HEAD HUM 56MM 22MM UNIVERS CA	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9156-22P	SUP	HCPCS C1776		AR-9156-22P  -  HEAD HUM 56MM 22MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9156-24CA	SUP	HCPCS C1776		AR-9156-24CA  -  HEAD HUM 56MM 24MM UNIVERS CA	BOTH IP/OP	"$5,875.00 "	"$4,347.50"	$0.00	"$4,700.00"	"$2,643.75"	"$2,643.75"	$0.00	$0.00	$0.00	"$1,224.50"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,224.35"	$0.00	"$2,896.38"	"$2,896.38"	$0.00	"$2,937.50"	"$4,653.00"	"$4,700.00"	$0.00		$0.00	$919.44	$0.00	$0.00	$935.30	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9156-24P	SUP	HCPCS C1776		AR-9156-24P  -  HEAD HUM 56MM 24MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9165-15	SUP	HCPCS C1713		AR-9165-15  -  SCREW BN 6.5MM 15MM UNIVERS REVERS VA SHLDR GLND CNTR	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9165-15NL	SUP	HCPCS C1713		AR-9165-15NL  -  SCREW BN 6.5MM 15MM UNIVERS REVERS VA SHLDR GLND CNTR NONLOC	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9165-20	SUP	HCPCS C1713		AR-9165-20  -  SCREW BN 6.5MM 20MM UNIVERS REVERS VA SHLDR GLND CNTR	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9165-20NL	SUP	HCPCS C1713		AR-9165-20NL  -  SCREW BONE 6.5MM 20MM UNIVERS REVERS	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9165-25	SUP	HCPCS C1713		AR-9165-25  -  SCREW BN 6.5MM 25MM UNIVERS REVERS VA SHLDR GLND CNTR	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9165-25NL	SUP	HCPCS C1713		AR-9165-25NL  -  SCREW BN 6.5MM 25MM UNIVERS REVERS CNTR NONLOCK	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9165-30NL	SUP	HCPCS C1713		AR-9165-30NL  -  SCREW BN 6.5MM 30MM UNIVERS REVERS CNTR NONLOCK	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9165-35NL	SUP	HCPCS C1713		AR-9165-35NL  -  SCREW BN 6.5MM 35MM UNIVERS REVERS CNTR NONLOCK	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$191.25	$191.25	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9165DDG	SUP	HCPCS C1713		AR-9165DDG  -  SCREW BN UNIVERS REVERS CNTR UNV BSPLT IMPCTR	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9202-16	SUP	HCPCS C1776		AR-9202-16  -  CONNECTOR XTRNFX UNIVERS 3D TRL HD	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$258.75	$258.75	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$287.50	$455.40	$460.00	$0.00		$0.00	$89.99	$0.00	$0.00	$91.54	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9204-02	SUP	HCPCS C1776		AR-9204-02  -  STEM HUM UNIVERS XTRT SHLDR SHLDR FX	BOTH IP/OP	"$2,100.00 "	"$1,554.00"	$0.00	"$1,680.00"	$945.00	$945.00	$0.00	$0.00	$0.00	$437.69	"$1,558.62"	"$1,558.62"	$0.00	$0.00	$437.64	$0.00	"$1,242.15"	"$1,242.15"	$0.00	"$1,050.00"	"$1,663.20"	"$1,680.00"	$0.00		$0.00	$328.65	$0.00	$0.00	$334.32	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9207S	SUP	HCPCS C1776		AR-9207S  -  SET SPNL UNIVERS II STRL	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9215-1-01	SUP	Custom 27203010		AR-9215-1-01  -  GUIDE DRL 6.5IN HNDL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9215-1-02	SUP	Custom 27203010		AR-9215-1-02  -  GUIDE DRL LNG UNIVERS II HNDL GLND	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9215-2	SUP	Custom 27203010		AR-9215-2  -  GUIDE DRL 1 SM GLND	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9215-3	SUP	Custom 27203010		AR-9215-3  -  GUIDE DRL 2 SM KEEL GLND	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9215-4	SUP	Custom 27203010		AR-9215-4  -  GUIDE DRL 1 MED KEEL GLND	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9215-5	SUP	Custom 27203010		AR-9215-5  -  GUIDE DRL 2 MED KEEL GLND	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9215-6	SUP	Custom 27203010		AR-9215-6  -  GUIDE DRL 1 LG KEEL GLND	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9215-7	SUP	Custom 27203010		AR-9215-7  -  GUIDE DRL 2 LG KEEL GLND	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9215-8	SUP	Custom 27203010		AR-9215-8  -  GUIDE DRL 1 XL GLND	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9215-9	SUP	Custom 27203010		AR-9215-9  -  GUIDE DRL 2 XL KEEL GLND	BOTH IP/OP	$875.00 	$647.50	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.43	$649.43	$0.00	$0.00	$182.35	$0.00	$0.00	$0.00	$0.00	$437.50	$693.00	$700.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9216-1	SUP	Custom 27203010		AR-9216-1  -  GUIDE DRL 6MM UNIVERS II GLND	BOTH IP/OP	$812.50 	$601.25	$0.00	$650.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$406.25	$643.50	$650.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9216-2	SUP	Custom 27203010		AR-9216-2  -  GUIDE DRL UNIVERS II GLV PRTC GLND	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9216-4	SUP	Custom 27203010		AR-9216-4  -  GUIDE DRL UNIVERS II GLV PRTC GLND	BOTH IP/OP	$420.00 	$310.80	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.72	$311.72	$0.00	$0.00	$87.53	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9231-01	SUP	Custom 27203010		AR-9231-01  -  GUIDE DRL 2 SM UNIVERS II PG GLND	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9231-01PP	SUP	Custom 27203010		AR-9231-01PP  -  GUIDE DRL SM UNIVERS VAULTLOCK GLND	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9231-02	SUP	Custom 27203010		AR-9231-02  -  GUIDE DRL 2 MED UNIVERS II PG GLND	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9231-02PP	SUP	Custom 27203010		AR-9231-02PP  -  GUIDE DRL MED UNIVERS VAULTLOCK GLND	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9231-03	SUP	Custom 27203010		AR-9231-03  -  GUIDE DRL 2 LG UNIVERS II PG GLND	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9231-03PP	SUP	Custom 27203010		AR-9231-03PP  -  GUIDE DRL LG UNIVERS VAULTLOCK GLND	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9231-04	SUP	Custom 27203010		AR-9231-04  -  GUIDE DRL 2 XL UNIVERS II PG GLND	BOTH IP/OP	"$1,250.00 "	$925.00	$0.00	"$1,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.75	$927.75	$0.00	$0.00	$260.50	$0.00	$0.00	$0.00	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9231-04PP	SUP	Custom 27203010		AR-9231-04PP  -  GUIDE DRL XL UNIVERS VAULTLOCK GLND	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9500-170	SUP	HCPCS C1776		AR-9500-170  -  JOINT TOE 17MM STRL ANATOEMIC PILT PNCH COCR PHALANX	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9500-185	SUP	HCPCS C1776		AR-9500-185  -  JOINT TOE 18.5MM STRL ANATOEMIC PILT PNCH COCR PHALANX	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9500-200	SUP	HCPCS C1776		AR-9500-200  -  JOINT TOE 20MM STRL ANATOEMIC PILT PNCH COCR PHALANX	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9500-215	SUP	HCPCS C1776		AR-9500-215  -  JOINT TOE 21.5MM STRL ANATOEMIC PILT PNCH COCR PHALANX	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9500-230	SUP	HCPCS C1776		AR-9500-230  -  JOINT TOE 23MM STRL ANATOEMIC PILT PNCH COCR PHALANX	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9500T-170	SUP	HCPCS C1776		AR-9500T-170  -  TRIAL ANKL 17MM ANATOEMIC PHALANX	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9500T-185	SUP	HCPCS C1776		AR-9500T-185  -  TRIAL ANKL 18.5MM ANATOEMIC PHALANX	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9500T-200	SUP	HCPCS C1776		AR-9500T-200  -  TRIAL ANKL 20MM ANATOEMIC PHALANX	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9500T-215	SUP	HCPCS C1776		AR-9500T-215  -  TRIAL ANKL 21.5MM ANATOEMIC PHALANX	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9500T-230	SUP	HCPCS C1776		AR-9500T-230  -  TRIAL ANKL 23MM ANATOEMIC PHALANX	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-05-135CPC	SUP	HCPCS C1776		AR-9501-05-135CPC  -  STEM HUM 135D 5 95MM STRL UNIVERS REVERS SET SPL MNBLCK PROX	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-05-155CPC	SUP	HCPCS C1776		AR-9501-05-155CPC  -  STEM HUM 155D 5 95MM STRL UNIVERS REVERS SET SPL MNBLCK PROX	BOTH IP/OP	"$9,187.50 "	"$6,798.75"	$0.00	"$7,350.00"	"$4,134.38"	"$4,134.38"	$0.00	$0.00	$0.00	"$1,914.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,914.68"	$0.00	"$4,529.44"	"$4,529.44"	$0.00	"$4,593.75"	"$7,276.50"	"$7,350.00"	$0.00		$0.00	"$1,437.84"	$0.00	$0.00	"$1,462.65"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-06CPC	SUP	HCPCS C1776		AR-9501-06CPC  -  STEM HUM 6 111MM STRL UNIVERS REVERS COR SET PROX FIL CA	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-06RCPC	SUP	HCPCS C1776		AR-9501-06RCPC  -  STEM HUM 6 LNG 150MM STRL UNIVERS REVERS PROX FIL REV CA	BOTH IP/OP	"$7,437.50 "	"$5,503.75"	$0.00	"$5,950.00"	"$3,346.88"	"$3,346.88"	$0.00	$0.00	$0.00	"$1,550.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,549.98"	$0.00	"$3,666.69"	"$3,666.69"	$0.00	"$3,718.75"	"$5,890.50"	"$5,950.00"	$0.00		$0.00	"$1,163.97"	$0.00	$0.00	"$1,184.05"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-07CPC	SUP	HCPCS C1776		AR-9501-07CPC  -  STEM HUM 115MM CORE SET PROX FIL UNIVERS REVERS	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-08CPC	SUP	HCPCS C1776		AR-9501-08CPC  -  STEM HUM 8 119MM STRL UNIVERS REVERS COR SET PROX FIL CA	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-09CPC	SUP	HCPCS C1776		AR-9501-09CPC  -  STEM HUM 9 123MM STRL UNIVERS REVERS COR SET PROX FIL CA	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-09RCPC	SUP	HCPCS C1776		AR-9501-09RCPC  -  STEM HUM 9 LNG 180MM STRL UNIVERS REVERS PROX FIL REV CA	BOTH IP/OP	"$7,437.50 "	"$5,503.75"	$0.00	"$5,950.00"	"$3,346.88"	"$3,346.88"	$0.00	$0.00	$0.00	"$1,550.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,549.98"	$0.00	"$3,666.69"	"$3,666.69"	$0.00	"$3,718.75"	"$5,890.50"	"$5,950.00"	$0.00		$0.00	"$1,163.97"	$0.00	$0.00	"$1,184.05"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-10CPC	SUP	HCPCS C1776		AR-9501-10CPC  -  STEM HUM 10 127MM STRL UNIVERS REVERS COR SET PROX FIL CA	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-11CPC	SUP	HCPCS C1776		AR-9501-11CPC  -  STEM HUM 11 131MM STRL UNIVERS REVERS COR SET PROX FIL CA	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-12CPC	SUP	HCPCS C1776		AR-9501-12CPC  -  STEM HUM 12 135MM STRL UNIVERS REVERS COR SET PROX FIL CA	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-12RCPC	SUP	HCPCS C1776		AR-9501-12RCPC  -  STEM HUM 12 LNG 180MM STRL UNIVERS REVERS PROX FIL REV CA	BOTH IP/OP	"$7,437.50 "	"$5,503.75"	$0.00	"$5,950.00"	"$3,346.88"	"$3,346.88"	$0.00	$0.00	$0.00	"$1,550.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,549.98"	$0.00	"$3,666.69"	"$3,666.69"	$0.00	"$3,718.75"	"$5,890.50"	"$5,950.00"	$0.00		$0.00	"$1,163.97"	$0.00	$0.00	"$1,184.05"	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-13CPC	SUP	HCPCS C1776		AR-9501-13CPC  -  STEM HUM 13 139MM STRL UNIVERS REVERS SET SPL PROX FIL CA	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-14CPC	SUP	HCPCS C1776		AR-9501-14CPC  -  STEM HUM 14 143MM STRL UNIVERS REVERS SET SPL PROX FIL CA	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9501-15CPC	SUP	HCPCS C1776		AR-9501-15CPC  -  STEM HUM 15 146MM STRL UNIVERS REVERS SET SPL PROX FIL CA	BOTH IP/OP	"$6,212.50 "	"$4,597.25"	$0.00	"$4,970.00"	"$2,795.63"	"$2,795.63"	$0.00	$0.00	$0.00	"$1,294.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.69"	$0.00	"$3,062.76"	"$3,062.76"	$0.00	"$3,106.25"	"$4,920.30"	"$4,970.00"	$0.00		$0.00	$972.26	$0.00	$0.00	$989.03	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502-36ARCA	SUP	HCPCS C1776		AR-9502-36ARCA  -  ADAPTER HD 36MM STRL ARTHX RVRS CUF ARTHROPATHY	BOTH IP/OP	"$5,375.00 "	"$3,977.50"	$0.00	"$4,300.00"	"$2,418.75"	"$2,418.75"	$0.00	$0.00	$0.00	"$1,120.28"	"$3,989.33"	"$3,989.33"	$0.00	$0.00	"$1,120.15"	$0.00	"$2,649.88"	"$2,649.88"	$0.00	"$2,687.50"	"$4,257.00"	"$4,300.00"	$0.00		$0.00	$841.19	$0.00	$0.00	$855.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502-36CPC	SUP	Custom 27803010		AR-9502-36CPC  -  CUP HUM NTRL 36MM STRL UNIVERS REVERS CA PHOS SHLDR ARTHPL	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502-36LCPC	SUP	Custom 27803010		AR-9502-36LCPC  -  CUP HUM +2MM OFST 36MM STRL UNIVERS REVERS CA PHOS SHLDR LT	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502-36RCPC	SUP	Custom 27803010		AR-9502-36RCPC  -  CUP HUM +2MM OFST 36MM STRL UNIVERS REVERS CA PHOS SHLDR RT	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502-39ARCA	SUP	HCPCS C1776		AR-9502-39ARCA  -  ADAPTER HD 39MM STRL ARTHX RVRS	BOTH IP/OP	"$5,375.00 "	"$3,977.50"	$0.00	"$4,300.00"	"$2,418.75"	"$2,418.75"	$0.00	$0.00	$0.00	"$1,120.28"	"$3,989.33"	"$3,989.33"	$0.00	$0.00	"$1,120.15"	$0.00	"$2,649.88"	"$2,649.88"	$0.00	"$2,687.50"	"$4,257.00"	"$4,300.00"	$0.00		$0.00	$841.19	$0.00	$0.00	$855.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502-39CPC	SUP	Custom 27803010		AR-9502-39CPC  -  CUP HUM NTRL 39MM STRL UNIVERS REVERS CA PHOS SHLDR ARTHPL	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502-39LCPC	SUP	Custom 27803010		AR-9502-39LCPC  -  CUP HUM +2MM OFST 39MM STRL UNIVERS REVERS CA PHOS SHLDR LT	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502-39RCPC	SUP	Custom 27803010		AR-9502-39RCPC  -  CUP HUM +2MM OFST 39MM STRL UNIVERS REVERS CA PHOS SHLDR RT	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502-42ARCA	SUP	HCPCS C1776		AR-9502-42ARCA  -  ADAPTER HD 42MM STRL ARTHX RVRS	BOTH IP/OP	"$5,375.00 "	"$3,977.50"	$0.00	"$4,300.00"	"$2,418.75"	"$2,418.75"	$0.00	$0.00	$0.00	"$1,120.28"	"$3,989.33"	"$3,989.33"	$0.00	$0.00	"$1,120.15"	$0.00	"$2,649.88"	"$2,649.88"	$0.00	"$2,687.50"	"$4,257.00"	"$4,300.00"	$0.00		$0.00	$841.19	$0.00	$0.00	$855.70	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502-42CPC	SUP	Custom 27803010		AR-9502-42CPC  -  CUP HUM NTRL 42MM STRL UNIVERS REVERS CA PHOS SHLDR ARTHPL	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502-42LCPC	SUP	Custom 27803010		AR-9502-42LCPC  -  CUP HUM +2MM OFST 42MM STRL UNIVERS REVERS CA PHOS SHLDR LT	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502-42RCPC	SUP	Custom 27803010		AR-9502-42RCPC  -  CUP HUM +2MM OFST 42MM STRL UNIVERS REVERS CA PHOS SHLDR RT	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502F-36CPC	SUP	HCPCS C1776		AR-9502F-36CPC  -  CUP HUM 36MM STRL LF ARTHX UNIVERS REVERS SUT	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	"$2,008.13"	"$2,008.13"	$0.00	$0.00	$0.00	$930.10	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	"$2,200.01"	"$2,200.01"	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$698.38	$0.00	$0.00	$710.43	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502F-36LCPC	SUP	Custom 27803010		AR-9502F-36LCPC  -  CUP HUM +2 36MM UNIVERS REVERS SUT SHLDR LT	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502F-36RCPC	SUP	Custom 27803010		AR-9502F-36RCPC  -  CUP HUM +2 36MM UNIVERS REVERS SUT SHLDR RT	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502F-39LCPC	SUP	Custom 27803010		AR-9502F-39LCPC  -  CUP HUM +2 39MM UNIVERS REVERS SUT SHLDR LT	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502F-39RCPC	SUP	Custom 27803010		AR-9502F-39RCPC  -  CUP HUM +2 39MM UNIVERS REVERS SUT SHLDR RT	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9502F-42RCPC	SUP	Custom 27803010		AR-9502F-42RCPC  -  CUP HUM +2 42MM UNIVERS REVERS SUT SHLDR RT	BOTH IP/OP	"$4,462.50 "	"$3,302.25"	$0.00	"$3,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,312.07"	"$3,312.07"	$0.00	$0.00	$929.99	$0.00	$0.00	$0.00	$0.00	"$2,231.25"	"$3,534.30"	"$3,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9503L-03	SUP	HCPCS C1776		AR-9503L-03  -  INSERT HUM +3MM LG 42MM STRL UNIVERS REVERS SHLDR ARTHPL	BOTH IP/OP	"$2,537.50 "	"$1,877.75"	$0.00	"$2,030.00"	"$1,141.88"	"$1,141.88"	$0.00	$0.00	$0.00	$528.88	"$1,883.33"	"$1,883.33"	$0.00	$0.00	$528.82	$0.00	"$1,250.99"	"$1,250.99"	$0.00	"$1,268.75"	"$2,009.70"	"$2,030.00"	$0.00		$0.00	$397.12	$0.00	$0.00	$403.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9503L-03C	SUP	HCPCS C1776		AR-9503L-03C  -  INSERT HUM +3MM LG 42MM STRL UNIVERS REVERS CNSTRN SHLDR	BOTH IP/OP	"$2,537.50 "	"$1,877.75"	$0.00	"$2,030.00"	"$1,141.88"	"$1,141.88"	$0.00	$0.00	$0.00	$528.88	"$1,883.33"	"$1,883.33"	$0.00	$0.00	$528.82	$0.00	"$1,250.99"	"$1,250.99"	$0.00	"$1,268.75"	"$2,009.70"	"$2,030.00"	$0.00		$0.00	$397.12	$0.00	$0.00	$403.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9503L-06	SUP	HCPCS C1776		AR-9503L-06  -  INSERT HUM +6MM LG 42MM STRL UNIVERS REVERS SHLDR ARTHPL	BOTH IP/OP	"$2,537.50 "	"$1,877.75"	$0.00	"$2,030.00"	"$1,141.88"	"$1,141.88"	$0.00	$0.00	$0.00	$528.88	"$1,883.33"	"$1,883.33"	$0.00	$0.00	$528.82	$0.00	"$1,250.99"	"$1,250.99"	$0.00	"$1,268.75"	"$2,009.70"	"$2,030.00"	$0.00		$0.00	$397.12	$0.00	$0.00	$403.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9503L-06C	SUP	HCPCS C1776		AR-9503L-06C  -  INSERT HUM +6MM LG 42MM STRL UNIVERS REVERS CNSTRN SHLDR	BOTH IP/OP	"$2,537.50 "	"$1,877.75"	$0.00	"$2,030.00"	"$1,141.88"	"$1,141.88"	$0.00	$0.00	$0.00	$528.88	"$1,883.33"	"$1,883.33"	$0.00	$0.00	$528.82	$0.00	"$1,250.99"	"$1,250.99"	$0.00	"$1,268.75"	"$2,009.70"	"$2,030.00"	$0.00		$0.00	$397.12	$0.00	$0.00	$403.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9503M-03	SUP	HCPCS C1776		AR-9503M-03  -  INSERT HUM +3MM MED 39MM STRL UNIVERS REVERS SHLDR ARTHPL	BOTH IP/OP	"$2,537.50 "	"$1,877.75"	$0.00	"$2,030.00"	"$1,141.88"	"$1,141.88"	$0.00	$0.00	$0.00	$528.88	"$1,883.33"	"$1,883.33"	$0.00	$0.00	$528.82	$0.00	"$1,250.99"	"$1,250.99"	$0.00	"$1,268.75"	"$2,009.70"	"$2,030.00"	$0.00		$0.00	$397.12	$0.00	$0.00	$403.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9503M-03C	SUP	HCPCS C1776		AR-9503M-03C  -  INSERT HUM +3MM MED 39MM STRL UNIVERS REVERS CNSTRN SHLDR	BOTH IP/OP	"$2,537.50 "	"$1,877.75"	$0.00	"$2,030.00"	"$1,141.88"	"$1,141.88"	$0.00	$0.00	$0.00	$528.88	"$1,883.33"	"$1,883.33"	$0.00	$0.00	$528.82	$0.00	"$1,250.99"	"$1,250.99"	$0.00	"$1,268.75"	"$2,009.70"	"$2,030.00"	$0.00		$0.00	$397.12	$0.00	$0.00	$403.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9503M-06	SUP	HCPCS C1776		AR-9503M-06  -  INSERT HUM +6MM MED 39MM STRL UNIVERS REVERS SHLDR ARTHPL	BOTH IP/OP	"$2,537.50 "	"$1,877.75"	$0.00	"$2,030.00"	"$1,141.88"	"$1,141.88"	$0.00	$0.00	$0.00	$528.88	"$1,883.33"	"$1,883.33"	$0.00	$0.00	$528.82	$0.00	"$1,250.99"	"$1,250.99"	$0.00	"$1,268.75"	"$2,009.70"	"$2,030.00"	$0.00		$0.00	$397.12	$0.00	$0.00	$403.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9503M-06C	SUP	HCPCS C1776		AR-9503M-06C  -  INSERT HUM +6MM MED 39MM STRL UNIVERS REVERS CNSTRN SHLDR	BOTH IP/OP	"$2,537.50 "	"$1,877.75"	$0.00	"$2,030.00"	"$1,141.88"	"$1,141.88"	$0.00	$0.00	$0.00	$528.88	"$1,883.33"	"$1,883.33"	$0.00	$0.00	$528.82	$0.00	"$1,250.99"	"$1,250.99"	$0.00	"$1,268.75"	"$2,009.70"	"$2,030.00"	$0.00		$0.00	$397.12	$0.00	$0.00	$403.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9503S-03	SUP	HCPCS C1776		AR-9503S-03  -  INSERT HUM 36MM UNIVERS REVERS +3MM SM SHLDR	BOTH IP/OP	"$2,537.50 "	"$1,877.75"	$0.00	"$2,030.00"	"$1,141.88"	"$1,141.88"	$0.00	$0.00	$0.00	$528.88	"$1,883.33"	"$1,883.33"	$0.00	$0.00	$528.82	$0.00	"$1,250.99"	"$1,250.99"	$0.00	"$1,268.75"	"$2,009.70"	"$2,030.00"	$0.00		$0.00	$397.12	$0.00	$0.00	$403.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9503S-03C	SUP	HCPCS C1776		AR-9503S-03C  -  INSERT HUM +3MM SM 36MM STRL UNIVERS REVERS CNSTRN SHLDR	BOTH IP/OP	"$2,537.50 "	"$1,877.75"	$0.00	"$2,030.00"	"$1,141.88"	"$1,141.88"	$0.00	$0.00	$0.00	$528.88	"$1,883.33"	"$1,883.33"	$0.00	$0.00	$528.82	$0.00	"$1,250.99"	"$1,250.99"	$0.00	"$1,268.75"	"$2,009.70"	"$2,030.00"	$0.00		$0.00	$397.12	$0.00	$0.00	$403.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9503S-06	SUP	HCPCS C1776		AR-9503S-06  -  INSERT HUM +6MM SM 36MM STRL UNIVERS REVERS SHLDR ARTHPL	BOTH IP/OP	"$2,537.50 "	"$1,877.75"	$0.00	"$2,030.00"	"$1,141.88"	"$1,141.88"	$0.00	$0.00	$0.00	$528.88	"$1,883.33"	"$1,883.33"	$0.00	$0.00	$528.82	$0.00	"$1,250.99"	"$1,250.99"	$0.00	"$1,268.75"	"$2,009.70"	"$2,030.00"	$0.00		$0.00	$397.12	$0.00	$0.00	$403.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9503S-06C	SUP	HCPCS C1776		AR-9503S-06C  -  INSERT HUM +6MM SM 36MM STRL UNIVERS REVERS CNSTRN SHLDR	BOTH IP/OP	"$2,537.50 "	"$1,877.75"	$0.00	"$2,030.00"	"$1,141.88"	"$1,141.88"	$0.00	$0.00	$0.00	$528.88	"$1,883.33"	"$1,883.33"	$0.00	$0.00	$528.82	$0.00	"$1,250.99"	"$1,250.99"	$0.00	"$1,268.75"	"$2,009.70"	"$2,030.00"	$0.00		$0.00	$397.12	$0.00	$0.00	$403.97	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9504L	SUP	HCPCS C1776		AR-9504L  -  HEAD GLND LG UNV 42MM STRL UNIVERS REVERS GLENOSPHERE VA CA	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9504L-04	SUP	HCPCS C1776		AR-9504L-04  -  HEAD GLND +4MM LG UNV LAT OFST 42MM STRL UNIVERS REVERS	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9504M	SUP	HCPCS C1776		AR-9504M  -  HEAD GLND MED UNV 39MM STRL UNIVERS REVERS GLENOSPHERE VA CA	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9504M-02	SUP	HCPCS C1776		AR-9504M-02  -  HEAD GLND +2.5MM MED UNV INFR OFST 42MM STRL UNIVERS REVERS	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9504M-04	SUP	HCPCS C1776		AR-9504M-04  -  HEAD GLND +4MM MED UNV LAT OFST 39MM STRL UNIVERS REVERS	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9504S	SUP	HCPCS C1776		AR-9504S  -  HEAD GLND SM UNV 36MM STRL UNIVERS REVERS GLENOSPHERE VA CA	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9504S-02	SUP	HCPCS C1776		AR-9504S-02  -  HEAD GLND +2.5MM SM UNV INFR OFST 36MM STRL UNIVERS REVERS	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9504S-04	SUP	HCPCS C1776		AR-9504S-04  -  HEAD GLND 36MM UNIVERS REVERS +4MM SM UNV LAT	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9504S-INF	SUP	HCPCS C1776		AR-9504S-INF  -  HEAD GLND +2.5MM INFR OFST 36MM STRL UNIVERS REVERS	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9505-06	SUP	HCPCS C1776		AR-9505-06  -  SPACER HUM +6MM 39MM STRL UNIVERS REVERS TI SHLDR ARTHPL	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$551.25	$551.25	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9505-09	SUP	HCPCS C1776		AR-9505-09  -  SPACER HUM +9MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$551.25	$551.25	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9505-12	SUP	HCPCS C1776		AR-9505-12  -  SPACER HUM +12MM 39MM STRL UNIVERS REVERS TI SHLDR ARTHPL	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$551.25	$551.25	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9505-15	SUP	HCPCS C1776		AR-9505-15  -  SPACER HUM +15MM 39MM STRL UNIVERS REVERS TI SHLDR ARTHPL	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$551.25	$551.25	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9510-06	SUP	HCPCS C1776		AR-9510-06  -  RASP SRG 6 UNIVERS REVERS STM TRL SHLDR ARTHPL	BOTH IP/OP	"$3,262.50 "	"$2,414.25"	$0.00	"$2,610.00"	"$1,468.13"	"$1,468.13"	$0.00	$0.00	$0.00	$679.99	"$2,421.43"	"$2,421.43"	$0.00	$0.00	$679.91	$0.00	"$1,608.41"	"$1,608.41"	$0.00	"$1,631.25"	"$2,583.90"	"$2,610.00"	$0.00		$0.00	$510.58	$0.00	$0.00	$519.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9510-07	SUP	HCPCS C1776		AR-9510-07  -  RASP SRG 7 UNIVERS REVERS STM TRL SHLDR ARTHPL	BOTH IP/OP	"$3,262.50 "	"$2,414.25"	$0.00	"$2,610.00"	"$1,468.13"	"$1,468.13"	$0.00	$0.00	$0.00	$679.99	"$2,421.43"	"$2,421.43"	$0.00	$0.00	$679.91	$0.00	"$1,608.41"	"$1,608.41"	$0.00	"$1,631.25"	"$2,583.90"	"$2,610.00"	$0.00		$0.00	$510.58	$0.00	$0.00	$519.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9510-08	SUP	HCPCS C1776		AR-9510-08  -  RASP SRG 8 UNIVERS REVERS STM TRL SHLDR ARTHPL	BOTH IP/OP	"$3,262.50 "	"$2,414.25"	$0.00	"$2,610.00"	"$1,468.13"	"$1,468.13"	$0.00	$0.00	$0.00	$679.99	"$2,421.43"	"$2,421.43"	$0.00	$0.00	$679.91	$0.00	"$1,608.41"	"$1,608.41"	$0.00	"$1,631.25"	"$2,583.90"	"$2,610.00"	$0.00		$0.00	$510.58	$0.00	$0.00	$519.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9510-09	SUP	HCPCS C1776		AR-9510-09  -  RASP SRG 9 UNIVERS REVERS STM TRL SHLDR ARTHPL	BOTH IP/OP	"$3,262.50 "	"$2,414.25"	$0.00	"$2,610.00"	"$1,468.13"	"$1,468.13"	$0.00	$0.00	$0.00	$679.99	"$2,421.43"	"$2,421.43"	$0.00	$0.00	$679.91	$0.00	"$1,608.41"	"$1,608.41"	$0.00	"$1,631.25"	"$2,583.90"	"$2,610.00"	$0.00		$0.00	$510.58	$0.00	$0.00	$519.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9510-09R	SUP	HCPCS C1776		AR-9510-09R  -  RASP SRG 9 LNG 180MM UNIVERS REVERS REV STM TRL SHLDR ARTHPL	BOTH IP/OP	"$3,612.50 "	"$2,673.25"	$0.00	"$2,890.00"	"$1,625.63"	"$1,625.63"	$0.00	$0.00	$0.00	$752.94	"$2,681.20"	"$2,681.20"	$0.00	$0.00	$752.85	$0.00	"$1,780.96"	"$1,780.96"	$0.00	"$1,806.25"	"$2,861.10"	"$2,890.00"	$0.00		$0.00	$565.36	$0.00	$0.00	$575.11	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9510-10	SUP	HCPCS C1776		AR-9510-10  -  RASP SRG 10 UNIVERS REVERS STM TRL SHLDR ARTHPL	BOTH IP/OP	"$3,262.50 "	"$2,414.25"	$0.00	"$2,610.00"	"$1,468.13"	"$1,468.13"	$0.00	$0.00	$0.00	$679.99	"$2,421.43"	"$2,421.43"	$0.00	$0.00	$679.91	$0.00	"$1,608.41"	"$1,608.41"	$0.00	"$1,631.25"	"$2,583.90"	"$2,610.00"	$0.00		$0.00	$510.58	$0.00	$0.00	$519.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9510-11	SUP	HCPCS C1776		AR-9510-11  -  RASP SRG 11 UNIVERS REVERS STM TRL SHLDR ARTHPL	BOTH IP/OP	"$3,262.50 "	"$2,414.25"	$0.00	"$2,610.00"	"$1,468.13"	"$1,468.13"	$0.00	$0.00	$0.00	$679.99	"$2,421.43"	"$2,421.43"	$0.00	$0.00	$679.91	$0.00	"$1,608.41"	"$1,608.41"	$0.00	"$1,631.25"	"$2,583.90"	"$2,610.00"	$0.00		$0.00	$510.58	$0.00	$0.00	$519.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9510-12	SUP	HCPCS C1776		AR-9510-12  -  RASP SRG 12 UNIVERS REVERS STM TRL SHLDR ARTHPL	BOTH IP/OP	"$3,262.50 "	"$2,414.25"	$0.00	"$2,610.00"	"$1,468.13"	"$1,468.13"	$0.00	$0.00	$0.00	$679.99	"$2,421.43"	"$2,421.43"	$0.00	$0.00	$679.91	$0.00	"$1,608.41"	"$1,608.41"	$0.00	"$1,631.25"	"$2,583.90"	"$2,610.00"	$0.00		$0.00	$510.58	$0.00	$0.00	$519.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9510-12R	SUP	HCPCS C1776		AR-9510-12R  -  RASP SRG 12 LNG 180MM UNIVERS REVERS REV STM TRL SHLDR	BOTH IP/OP	"$3,612.50 "	"$2,673.25"	$0.00	"$2,890.00"	"$1,625.63"	"$1,625.63"	$0.00	$0.00	$0.00	$752.94	"$2,681.20"	"$2,681.20"	$0.00	$0.00	$752.85	$0.00	"$1,780.96"	"$1,780.96"	$0.00	"$1,806.25"	"$2,861.10"	"$2,890.00"	$0.00		$0.00	$565.36	$0.00	$0.00	$575.11	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9510-13	SUP	HCPCS C1776		AR-9510-13  -  RASP SRG 13 UNIVERS REVERS STM TRL SHLDR ARTHPL	BOTH IP/OP	"$3,262.50 "	"$2,414.25"	$0.00	"$2,610.00"	"$1,468.13"	"$1,468.13"	$0.00	$0.00	$0.00	$679.99	"$2,421.43"	"$2,421.43"	$0.00	$0.00	$679.91	$0.00	"$1,608.41"	"$1,608.41"	$0.00	"$1,631.25"	"$2,583.90"	"$2,610.00"	$0.00		$0.00	$510.58	$0.00	$0.00	$519.39	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9510-14	SUP	HCPCS C1776		AR-9510-14  -  RASP SRG 14 UNIVERS REVERS STM TRL SHLDR ARTHPL	BOTH IP/OP	"$3,412.50 "	"$2,525.25"	$0.00	"$2,730.00"	"$1,535.63"	"$1,535.63"	$0.00	$0.00	$0.00	$711.25	"$2,532.76"	"$2,532.76"	$0.00	$0.00	$711.17	$0.00	"$1,682.36"	"$1,682.36"	$0.00	"$1,706.25"	"$2,702.70"	"$2,730.00"	$0.00		$0.00	$534.06	$0.00	$0.00	$543.27	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9510-15	SUP	HCPCS C1776		AR-9510-15  -  RASP SRG 15 UNIVERS REVERS STM TRL SHLDR ARTHPL	BOTH IP/OP	"$3,412.50 "	"$2,525.25"	$0.00	"$2,730.00"	"$1,535.63"	"$1,535.63"	$0.00	$0.00	$0.00	$711.25	"$2,532.76"	"$2,532.76"	$0.00	$0.00	$711.17	$0.00	"$1,682.36"	"$1,682.36"	$0.00	"$1,706.25"	"$2,702.70"	"$2,730.00"	$0.00		$0.00	$534.06	$0.00	$0.00	$543.27	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9550-06	SUP	HCPCS C1776		AR-9550-06  -  SPACER HUM +6MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$551.25	$551.25	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9550-09	SUP	HCPCS C1776		AR-9550-09  -  SPACER HUM +9MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$551.25	$551.25	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9550-12	SUP	HCPCS C1776		AR-9550-12  -  SPACER HUM +12MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$551.25	$551.25	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9550-15	SUP	HCPCS C1776		AR-9550-15  -  SPACER HUM +15MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$551.25	$551.25	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9555-06	SUP	HCPCS C1776		AR-9555-06  -  SPACER HUM 36MM UNIVERS REVERS +6MM SHLDR TI	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$551.25	$551.25	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9555-09	SUP	HCPCS C1776		AR-9555-09  -  SPACER HUM +9MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$551.25	$551.25	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9555-12	SUP	HCPCS C1776		AR-9555-12  -  SPACER HUM +12MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$551.25	$551.25	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9555-15	SUP	HCPCS C1776		AR-9555-15  -  SPACER HUM +15MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$551.25	$551.25	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9703A-90	SUP	Custom 27203010		AR-9703A-90  -  PROBE ESURG 90D LOPRFL 3MM STRL OPES ASPIRATE ABLT DISP	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9704A-90	SUP	Custom 27203010		AR-9704A-90  -  PROBE ESURG 90D LOPRFL 4MM STRL OPES ASPIRATE ABLT DISP	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9705-90	SUP	Custom 27203010		AR-9705-90  -  PROBE ESURG 90D LOPRFL STRL OPES ABLT TTHBRSH DISP	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$0.00	$0.00	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9705A-90	SUP	Custom 27203010		AR-9705A-90  -  PROBE ESURG 90D LOPRFL STRL OPES ASPIRATE ABLT TTHBRSH DISP	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$0.00	$0.00	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9802M-45	SUP	Custom 27203010		AR-9802M-45  -  ELECTRODE ESURG 45D STRL COOLCUT ABLATOR MNSCTM	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9802M-90	SUP	Custom 27203010		AR-9802M-90  -  ELECTRODE ESURG 90D COOLCUT ABLATOR MNSCTM	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9803-30	SUP	Custom 27203010		AR-9803-30  -  PROBE ESURG 30D 3MM STRL COOLCUT ABLT RF WND	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9803-50	SUP	Custom 27203010		AR-9803-50  -  ELECTRODE ESURG 50D 3MM COOLCUT 50 ABLATOR 50NA	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9803-90	SUP	Custom 27203010		AR-9803-90  -  PROBE ESURG 90D 3MM STRL COOLCUT ABLT RF WND	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9803A-30	SUP	Custom 27203010		AR-9803A-30  -  PROBE ESURG 30D 3MM STRL COOLCUT ASPIRATE ABLT RF WND	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9803A-50	SUP	Custom 27203010		AR-9803A-50  -  PROBE ESURG 50D 3MM STRL COOLCUT ASPIRATE ABLT RF WND	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9803A-90	SUP	Custom 27203010		AR-9803A-90  -  PROBE ESURG 3MM COOLCUT 90D ASPIRATE ABLT RF WND	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9808	SUP	Custom 27203010		AR-9808  -  ELECTRODE ESURG BALL STRL COOLCUT ABLT RF WND S JNT	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9808-45	SUP	Custom 27203010		AR-9808-45  -  ELECTRODE ESURG 45D COOLCUT BALL ASCP	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9808SJ	SUP	Custom 27203010		AR-9808SJ  -  ELECTRODE ESURG BALL STRL COOLCUT ABLT RF WND S JNT	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9808SJ-45	SUP	Custom 27203010		AR-9808SJ-45  -  ELECTRODE ESURG 45D BALL STRL COOLCUT ABLT RF WND S JNT	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9809SJ-45	SUP	Custom 27203010		AR-9809SJ-45  -  ELECTRODE ESURG 45D BALL STRL COOLCUT ABLT RF WND S JNT	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9809SJ-90	SUP	Custom 27203010		AR-9809SJ-90  -  ELECTRODE ESURG 90D BALL STRL COOLCUT ABLT RF WND S JNT	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9811	SUP	Custom 27203010		AR-9811  -  PROBE ESURG 90D APLO RF ML PRT	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$0.00	$0.00	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-992	SUP	Custom 27203010		AR-992  -  KIT ARTHRO FIX TRNFX2 SCR CANN DILAT ROTR CUF STRL DISP	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BL-04	SUP	HCPCS C1713		AR-9943BL-04  -  PLATE BN 4 HL LCK TI FIB LT DIST	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BL-05	SUP	HCPCS C1713		AR-9943BL-05  -  PLATE BN 5 HL LCK TI FIB LT DIST	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BL-06	SUP	HCPCS C1713		AR-9943BL-06  -  PLATE BN 6 HL LCK TI FIB LT DIST	BOTH IP/OP	"$1,937.50 "	"$1,433.75"	$0.00	"$1,550.00"	$871.88	$871.88	$0.00	$0.00	$0.00	$403.82	"$1,438.01"	"$1,438.01"	$0.00	$0.00	$403.78	$0.00	"$1,146.03"	"$1,146.03"	$0.00	$968.75	"$1,534.50"	"$1,550.00"	$0.00		$0.00	$303.22	$0.00	$0.00	$308.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BL-08	SUP	HCPCS C1713		AR-9943BL-08  -  PLATE BN ARTHX 8 HL LCK TI FIB LT DIST	BOTH IP/OP	"$2,112.50 "	"$1,563.25"	$0.00	"$1,690.00"	$950.63	$950.63	$0.00	$0.00	$0.00	$440.30	"$1,567.90"	"$1,567.90"	$0.00	$0.00	$440.25	$0.00	"$1,249.54"	"$1,249.54"	$0.00	"$1,056.25"	"$1,673.10"	"$1,690.00"	$0.00		$0.00	$330.61	$0.00	$0.00	$336.31	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BL-10	SUP	HCPCS C1713		AR-9943BL-10  -  PLATE BN ARTHX 10 HL LCK TI FIB LT DIST	BOTH IP/OP	"$2,325.00 "	"$1,720.50"	$0.00	"$1,860.00"	"$1,046.25"	"$1,046.25"	$0.00	$0.00	$0.00	$484.59	"$1,725.62"	"$1,725.62"	$0.00	$0.00	$484.53	$0.00	"$1,375.24"	"$1,375.24"	$0.00	"$1,162.50"	"$1,841.40"	"$1,860.00"	$0.00		$0.00	$363.86	$0.00	$0.00	$370.14	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BL-12	SUP	HCPCS C1713		AR-9943BL-12  -  PLATE BN ARTHX 12 HL LCK TI FIB LT DIST	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	"$1,057.50"	"$1,057.50"	$0.00	$0.00	$0.00	$489.80	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	"$1,390.03"	"$1,390.03"	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$367.78	$0.00	$0.00	$374.12	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BL-14	SUP	HCPCS C1713		AR-9943BL-14  -  PLATE BN ARTHX 14 HL LCK TI FIB LT DIST	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	"$1,068.75"	"$1,068.75"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BR-04	SUP	HCPCS C1713		AR-9943BR-04  -  PLATE BN 4 HL LCK TI FIB DIST	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BR-06	SUP	HCPCS C1713		AR-9943BR-06  -  PLATE BN 6 HL LCK TI FIB RT DIST	BOTH IP/OP	"$1,937.50 "	"$1,433.75"	$0.00	"$1,550.00"	$871.88	$871.88	$0.00	$0.00	$0.00	$403.82	"$1,438.01"	"$1,438.01"	$0.00	$0.00	$403.78	$0.00	"$1,146.03"	"$1,146.03"	$0.00	$968.75	"$1,534.50"	"$1,550.00"	$0.00		$0.00	$303.22	$0.00	$0.00	$308.45	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BR-08	SUP	HCPCS C1713		AR-9943BR-08  -  PLATE BN ARTHX 8 HL LCK TI FIB RT DIST	BOTH IP/OP	"$2,112.50 "	"$1,563.25"	$0.00	"$1,690.00"	$950.63	$950.63	$0.00	$0.00	$0.00	$440.30	"$1,567.90"	"$1,567.90"	$0.00	$0.00	$440.25	$0.00	"$1,249.54"	"$1,249.54"	$0.00	"$1,056.25"	"$1,673.10"	"$1,690.00"	$0.00		$0.00	$330.61	$0.00	$0.00	$336.31	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BR-10	SUP	HCPCS C1713		AR-9943BR-10  -  PLATE BN ARTHX 10 HL LCK TI FIB RT DIST	BOTH IP/OP	"$2,325.00 "	"$1,720.50"	$0.00	"$1,860.00"	"$1,046.25"	"$1,046.25"	$0.00	$0.00	$0.00	$484.59	"$1,725.62"	"$1,725.62"	$0.00	$0.00	$484.53	$0.00	"$1,375.24"	"$1,375.24"	$0.00	"$1,162.50"	"$1,841.40"	"$1,860.00"	$0.00		$0.00	$363.86	$0.00	$0.00	$370.14	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BR-12	SUP	HCPCS C1713		AR-9943BR-12  -  PLATE BN NS ARTHX 12 HL LCK TI FIB RT DIST	BOTH IP/OP	"$2,350.00 "	"$1,739.00"	$0.00	"$1,880.00"	"$1,057.50"	"$1,057.50"	$0.00	$0.00	$0.00	$489.80	"$1,744.17"	"$1,744.17"	$0.00	$0.00	$489.74	$0.00	"$1,390.03"	"$1,390.03"	$0.00	"$1,175.00"	"$1,861.20"	"$1,880.00"	$0.00		$0.00	$367.78	$0.00	$0.00	$374.12	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943BR-14	SUP	HCPCS C1713		AR-9943BR-14  -  PLATE BN ARTHX 14 HL LCK TI FIB RT DIST	BOTH IP/OP	"$2,375.00 "	"$1,757.50"	$0.00	"$1,900.00"	"$1,068.75"	"$1,068.75"	$0.00	$0.00	$0.00	$495.01	"$1,762.73"	"$1,762.73"	$0.00	$0.00	$494.95	$0.00	"$1,404.81"	"$1,404.81"	$0.00	"$1,187.50"	"$1,881.00"	"$1,900.00"	$0.00		$0.00	$371.69	$0.00	$0.00	$378.10	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943C-04	SUP	HCPCS C1713		AR-9943C-04  -  PLATE BN STRG 4 HL LCK TI	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943C-06	SUP	HCPCS C1713		AR-9943C-06  -  PLATE BN STRG 6 HL LCK TI	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$534.38	$534.38	$0.00	$0.00	$0.00	$247.50	$881.36	$881.36	$0.00	$0.00	$247.48	$0.00	$702.41	$702.41	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$185.84	$0.00	$0.00	$189.05	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943C-07	SUP	HCPCS C1713		AR-9943C-07  -  PLATE BN STRG 7 HL LCK TI	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$273.56	$974.14	$974.14	$0.00	$0.00	$273.53	$0.00	$776.34	$776.34	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943C-08	SUP	HCPCS C1713		AR-9943C-08  -  PLATE BN STRG 8 HL LCK TI ANKL	BOTH IP/OP	"$1,375.00 "	"$1,017.50"	$0.00	"$1,100.00"	$618.75	$618.75	$0.00	$0.00	$0.00	$286.58	"$1,020.53"	"$1,020.53"	$0.00	$0.00	$286.55	$0.00	$813.31	$813.31	$0.00	$687.50	"$1,089.00"	"$1,100.00"	$0.00		$0.00	$215.19	$0.00	$0.00	$218.90	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943C-10	SUP	HCPCS C1713		AR-9943C-10  -  PLATE BN STRG 10 HL LCK TI	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943C-12	SUP	HCPCS C1713		AR-9943C-12  -  PLATE BN STRG 12 HL LCK TI	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$362.14	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	"$1,027.73"	"$1,027.73"	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943T-04	SUP	HCPCS C1713		AR-9943T-04  -  PLATE BN 1/3 TBLR 4 HL LCK TI	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943T-05	SUP	HCPCS C1713		AR-9943T-05  -  PLATE BN 1/3 TBLR 5 HL LCK TI	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943T-06	SUP	HCPCS C1713		AR-9943T-06  -  PLATE BN 1/3 TUBE 6 HL LCK TI	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$270.00	$270.00	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943T-07	SUP	HCPCS C1713		AR-9943T-07  -  PLATE BN 3 TBLR 7 HL LCK TI	BOTH IP/OP	$637.50 	$471.75	$0.00	$510.00	$286.88	$286.88	$0.00	$0.00	$0.00	$132.87	$473.15	$473.15	$0.00	$0.00	$132.86	$0.00	$377.08	$377.08	$0.00	$318.75	$504.90	$510.00	$0.00		$0.00	$99.77	$0.00	$0.00	$101.49	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943T-08	SUP	HCPCS C1713		AR-9943T-08  -  PLATE BN 1/3 TBLR 8 HL LCK TI	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$298.13	$298.13	$0.00	$0.00	$0.00	$138.08	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$391.87	$391.87	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$103.68	$0.00	$0.00	$105.47	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943T-10	SUP	HCPCS C1713		AR-9943T-10  -  PLATE BN 1/3 TBLR 10 HL LCK TI ANKL	BOTH IP/OP	$700.00 	$518.00	$0.00	$560.00	$315.00	$315.00	$0.00	$0.00	$0.00	$145.90	$519.54	$519.54	$0.00	$0.00	$145.88	$0.00	$414.05	$414.05	$0.00	$350.00	$554.40	$560.00	$0.00		$0.00	$109.55	$0.00	$0.00	$111.44	$0.00	$0.00	$0.00	$0.00	$0.00
AR-9943T-12	SUP	HCPCS C1713		AR-9943T-12  -  PLATE BN 1/3 TBLR 12 HL LCK TI	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
AS09	SUP	Custom 27203010		AS09  -  ATTACHMENT TL STRG 3.2MM 9CM MDSRX LGN LG BORE	BOTH IP/OP	"$2,133.10 "	"$1,578.49"	$0.00	"$1,706.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,583.19"	"$1,583.19"	$0.00	$0.00	$444.54	$0.00	$0.00	$0.00	$0.00	"$1,066.55"	"$1,689.42"	"$1,706.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AS10	SUP	Custom 27203010		AS10  -  ATTCH TL 10CM STR SM BORE MDSRX LGN 2.4MM	BOTH IP/OP	"$1,823.93 "	"$1,349.71"	$0.00	"$1,459.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,353.72"	"$1,353.72"	$0.00	$0.00	$380.11	$0.00	$0.00	$0.00	$0.00	$911.96	"$1,444.55"	"$1,459.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AS74180-06	SUP	Custom 27203010		AS74180-06  -  PACK VITRECTOMY 23GA	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AT-0225-S	SUP	HCPCS C1713		AT-0225-S  -  SCREW BONE 22.5MM ACTRK STD	BOTH IP/OP	$775.00 	$573.50	$0.00	$620.00	$348.75	$348.75	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$387.50	$613.80	$620.00	$0.00		$0.00	$121.29	$0.00	$0.00	$123.38	$0.00	$0.00	$0.00	$0.00	$0.00
AT-1032	SUP	Custom 27203010		AT-1032  -  BIT DRILL ACTRK CANN	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AT-1125-S	SUP	HCPCS C1713		AT-1125-S  -  SCREW BONE 3.3-4.6MM 12.5MM ACTRK TI STD FULTHD ORTH SLFTAP	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AT-1150-S	SUP	HCPCS C1713		AT-1150-S  -  SCREW BN STD 15MM	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AT-1175-S	SUP	HCPCS C1713		AT-1175-S  -  SCREW BN STD 3.3-4.6MM 17.5MM STRL ACTRK SLF CUT CNN VAR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AT-1200-S	SUP	HCPCS C1713		AT-1200-S  -  SCREW BN STD 3.3-4.6MM 20MM STRL ACTRK SLF CUT CNN VAR PTCH	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AT-1225-S	SUP	HCPCS C1713		AT-1225-S  -  SCREW BN STD 3.3-4.6MM 22.5MM STRL ACTRK SLF CUT CNN VAR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AT-1250-S	SUP	HCPCS C1713		AT-1250-S  -  SCREW BN STD 3.3-4.6MM 25MM STRL ACTRK SLF CUT CNN VAR PTCH	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AT-1275-S	SUP	HCPCS C1713		AT-1275-S  -  SCREW BN STD 3.3-4.6MM 27.5MM STRL ACTRK SLF CUT CNN VAR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AT-1300-S	SUP	HCPCS C1713		AT-1300-S  -  SCREW BN STD 3.3-4.6MM 30MM STRL ACTRK SLF CUT CNN VAR PTCH	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-1509	SUP	Custom 27203010		AT2-1509  -  BIT DRL 2 MIC ACUTRAL	BOTH IP/OP	$567.50 	$419.95	$0.00	$454.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.20	$421.20	$0.00	$0.00	$118.27	$0.00	$0.00	$0.00	$0.00	$283.75	$449.46	$454.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-2515	SUP	Custom 27203010		AT2-2515  -  BIT DRL STD ACTRK2	BOTH IP/OP	$567.50 	$419.95	$0.00	$454.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.20	$421.20	$0.00	$0.00	$118.27	$0.00	$0.00	$0.00	$0.00	$283.75	$449.46	$454.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-3500	SUP	HCPCS C1769		AT2-3500  -  GUIDEWIRE ORTH .035IN PRLL	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$325.80	$325.80	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-4500	SUP	HCPCS C1769		AT2-4500  -  GWIRE ORTH .045IN PRLL	BOTH IP/OP	$560.00 	$414.40	$0.00	$448.00	$304.08	$304.08	$0.00	$0.00	$0.00	$116.72	$415.63	$415.63	$0.00	$0.00	$116.70	$0.00	$331.24	$331.24	$0.00	$280.00	$443.52	$448.00	$0.00		$0.00	$87.64	$0.00	$0.00	$89.15	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-520-S	SUP	HCPCS C1713		AT2-520-S  -  SCREW BONE 20MM ACTRK2 STD STRL	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$221.45	$788.59	$788.59	$0.00	$0.00	$221.43	$0.00	$628.47	$628.47	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-5400	SUP	HCPCS C1769		AT2-5400  -  GWIRE ORTH .054IN PRLL	BOTH IP/OP	$560.00 	$414.40	$0.00	$448.00	$304.08	$304.08	$0.00	$0.00	$0.00	$116.72	$415.63	$415.63	$0.00	$0.00	$116.70	$0.00	$331.24	$331.24	$0.00	$280.00	$443.52	$448.00	$0.00		$0.00	$87.64	$0.00	$0.00	$89.15	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-C08-S	SUP	HCPCS C1713		AT2-C08-S  -  SCREW BN MIC 8MM FUSHIA	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-C09-S	SUP	HCPCS C1713		AT2-C09-S  -  SCREW BN MIC 9MM FUSHIA	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-C10-S	SUP	HCPCS C1713		AT2-C10-S  -  SCREW BN MIC 10MM FUSHIA	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-C11-S	SUP	HCPCS C1713		AT2-C11-S  -  SCREW BONE 2MM 11MM ACTRK TI MIC FULTHD ORTH SLFTAP CANN	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-C12-S	SUP	HCPCS C1713		AT2-C12-S  -  SCREW BN MIC 12MM FUSHIA	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-C13-S	SUP	HCPCS C1713		AT2-C13-S  -  SCREW BONE 2MM 13MM ACTRK2 TI MIC FULTHD ORTH SLFTAP CANN	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-C14-S	SUP	HCPCS C1713		AT2-C14-S  -  SCREW BN MIC 14MM FUSHIA	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-C16-S	SUP	HCPCS C1713		AT2-C16-S  -  SCREW BN MIC 16MM FUSHIA	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-C18-S	SUP	HCPCS C1713		AT2-C18-S  -  SCREW BN MIC 18MM FUSHIA	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-C20-S	SUP	HCPCS C1713		AT2-C20-S  -  SCREW BN MIC FT 2.5-2.8MM 20MM STRL ACTRK2 SLF CUT CNN VAR	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2L1813	SUP	Custom 27203010		AT2L1813  -  BIT DRILL ACTRK2 MINI	BOTH IP/OP	$567.50 	$419.95	$0.00	$454.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.20	$421.20	$0.00	$0.00	$118.27	$0.00	$0.00	$0.00	$0.00	$283.75	$449.46	$454.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-L2515	SUP	HCPCS C1713		AT2-L2515  -  BIT DRL LNG ACTRK2	BOTH IP/OP	$567.50 	$419.95	$0.00	$454.00	$255.38	$255.38	$0.00	$0.00	$0.00	$118.28	$421.20	$421.20	$0.00	$0.00	$118.27	$0.00	$335.68	$335.68	$0.00	$283.75	$449.46	$454.00	$0.00		$0.00	$88.81	$0.00	$0.00	$90.35	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-M16-S	SUP	HCPCS C1713		AT2-M16-S  -  SCREW BN MN FT 3.5-3.6MM 16MM STRL ACTRK2 SLF CUT CNN VAR	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2M-1813	SUP	Custom 27203010		AT2M-1813  -  BIT DRILL 2MM ACTRK2 MINI PRFL 3.5-4MM SCR NONSTRL	BOTH IP/OP	$567.50 	$419.95	$0.00	$454.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.20	$421.20	$0.00	$0.00	$118.27	$0.00	$0.00	$0.00	$0.00	$283.75	$449.46	$454.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-M18-S	SUP	HCPCS C1713		AT2-M18-S  -  SCREW BN MN 18MM STRL ACTRK2 TI ORTH	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-M20-S	SUP	HCPCS C1713		AT2-M20-S  -  SCREW BN MN 20MM STRL ACTRK2 TI ORTH	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-M22-S	SUP	HCPCS C1713		AT2-M22-S  -  SCREW BN MN FT 3.5-3.6MM 22MM STRL ACTRK2 SLF CUT CNN VAR	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-M24-S	SUP	HCPCS C1713		AT2-M24-S  -  SCREW BN MN 24MM STRL ACTRK2 TI ORTH	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2M-26S	SUP	HCPCS C1713		AT2M-26S  -  SCREW BONE 26MM ACTRK2 MINI STRL	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-M26-S	SUP	HCPCS C1713		AT2-M26-S  -  SCREW BN MN FT 3.5-3.6MM 26MM STRL ACTRK2 SLF CUT CNN VAR	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2M-28S	SUP	HCPCS C1713		AT2M-28S  -  SCREW BONE 28MM ACTRK2 MINI STRL	BOTH IP/OP	"$1,062.50 "	$786.25	$0.00	$850.00	$478.13	$478.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$531.25	$841.50	$850.00	$0.00		$0.00	$166.28	$0.00	$0.00	$169.15	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-M28-S	SUP	HCPCS C1713		AT2-M28-S  -  SCREW BN MN FT 3.5-3.6MM 28MM STRL ACTRK2 SLF CUT CNN VAR	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-M30-S	SUP	HCPCS C1713		AT2-M30-S  -  SCREW 30.0MM MINI ACUTRAK 2 BONE	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2M-L1813	SUP	Custom 27203010		AT2M-L1813  -  BIT DRL MN	BOTH IP/OP	$567.50 	$419.95	$0.00	$454.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.20	$421.20	$0.00	$0.00	$118.27	$0.00	$0.00	$0.00	$0.00	$283.75	$449.46	$454.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-ML1813	SUP	Custom 27203010		BIT DRILL ACTRK2 MINI LNG INSTR	BOTH IP/OP	$467.50 	$345.95	$0.00	$374.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.75	$370.26	$374.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AT2ML1816	SUP	Custom 27203010		AT2ML1816  -  BIT DRILL	BOTH IP/OP	$567.50 	$419.95	$0.00	$454.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.20	$421.20	$0.00	$0.00	$118.27	$0.00	$0.00	$0.00	$0.00	$283.75	$449.46	$454.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-S16-S	SUP	HCPCS C1713		AT2-S16-S  -  SCREW BN STD 2MM 16MM ACTRK2	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-S18-S	SUP	HCPCS C1713		AT2-S18-S  -  SCREW BN STD FT 4-4.1MM 18MM STRL ACTRK2 SLF CUT CNN VAR	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-S20-S	SUP	HCPCS C1713		AT2-S20-S  -  SCREW BN STD FT 4-4.1MM 20MM STRL ACTRK2 SLF CUT CNN VAR	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-S22-S	SUP	HCPCS C1713		AT2-S22-S  -  SCREW BN STD FT 4-4.1MM 22MM STRL ACTRK2 SLF CUT CNN VAR	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-S24-S	SUP	HCPCS C1713		AT2-S24-S  -  SCREW BN 24MM STRL	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-S26-S	SUP	HCPCS C1713		AT2-S26-S  -  SCREW BN STD FT 4-4.1MM 26MM STRL ACTRK2 SLFCT CNN CMPR HEX	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-S28-S	SUP	HCPCS C1713		AT2-S28-S  -  SCREW BN STD 2MM 28MM ACTRK2	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-S30-S	SUP	HCPCS C1713		AT2-S30-S  -  SCREW BONE 2MM 30MM ACTRK2 TI STD HINDFOOT ANKL SLFTAP CANN	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-S32-S	SUP	HCPCS C1713		AT2-S32-S  -  SCREW BONE 2MM 32MM ACTRK2 TI STD FT HAND SLFTAP CANN CMPR	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT2-S34-S	SUP	HCPCS C1713		AT2-S34-S  -  SCREW BONE 2MM 34MM ACTRK2 TI STD FT HAND SLFTAP CANN CMPR	BOTH IP/OP	"$1,160.00 "	$858.40	$0.00	$928.00	$522.00	$522.00	$0.00	$0.00	$0.00	$241.77	$860.95	$860.95	$0.00	$0.00	$241.74	$0.00	$686.14	$686.14	$0.00	$580.00	$918.72	$928.00	$0.00		$0.00	$181.54	$0.00	$0.00	$184.67	$0.00	$0.00	$0.00	$0.00	$0.00
AT-7032	SUP	Custom 27203010		AT-7032  -  BIT DRL STD TPR 2.5MM 4.7MM STRL ACTRK CNN TI	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AT-7044	SUP	Custom 27203010		AT-7044  -  BIT DRILL ACTRK STD BONE CANN DNS STRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ATF-024	SUP	Custom 27203010		ATF-024  -  DRILL SRG 24MM ACTRK FSN	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ATF-032	SUP	Custom 27203010		ATF-032  -  BIT DRILL 32MM ACTRK FSN STRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ATF-037	SUP	Custom 27203010		ATF-037  -  BIT DRILL 37MM ACTRK FSN STRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ATF-140-S	SUP	HCPCS C1713		ATF-140-S  -  SCREW BN 14MM ACTRK FSN	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$364.50	$364.50	$0.00	$0.00	$0.00	$168.82	$601.18	$601.18	$0.00	$0.00	$168.80	$0.00	$479.12	$479.12	$0.00	$405.00	$641.52	$648.00	$0.00		$0.00	$126.77	$0.00	$0.00	$128.95	$0.00	$0.00	$0.00	$0.00	$0.00
ATF-160-S	SUP	HCPCS C1713		ATF-160-S  -  SCREW BN 16MM ACTRK FSN	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$364.50	$364.50	$0.00	$0.00	$0.00	$168.82	$601.18	$601.18	$0.00	$0.00	$168.80	$0.00	$479.12	$479.12	$0.00	$405.00	$641.52	$648.00	$0.00		$0.00	$126.77	$0.00	$0.00	$128.95	$0.00	$0.00	$0.00	$0.00	$0.00
ATF-180-S	SUP	HCPCS C1713		ATF-180-S  -  SCREW BN 18MM ACTRK FSN	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$364.50	$364.50	$0.00	$0.00	$0.00	$168.82	$601.18	$601.18	$0.00	$0.00	$168.80	$0.00	$479.12	$479.12	$0.00	$405.00	$641.52	$648.00	$0.00		$0.00	$126.77	$0.00	$0.00	$128.95	$0.00	$0.00	$0.00	$0.00	$0.00
ATF-200-S	SUP	HCPCS C1713		ATF-200-S  -  SCREW BN 20MM ACTRK FSN	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$364.50	$364.50	$0.00	$0.00	$0.00	$168.82	$601.18	$601.18	$0.00	$0.00	$168.80	$0.00	$479.12	$479.12	$0.00	$405.00	$641.52	$648.00	$0.00		$0.00	$126.77	$0.00	$0.00	$128.95	$0.00	$0.00	$0.00	$0.00	$0.00
ATF-220-S	SUP	HCPCS C1713		ATF-220-S  -  SCREW BN 22MM ACTRK FSN	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$364.50	$364.50	$0.00	$0.00	$0.00	$168.82	$601.18	$601.18	$0.00	$0.00	$168.80	$0.00	$479.12	$479.12	$0.00	$405.00	$641.52	$648.00	$0.00		$0.00	$126.77	$0.00	$0.00	$128.95	$0.00	$0.00	$0.00	$0.00	$0.00
ATF-240-S	SUP	HCPCS C1713		ATF-240-S  -  SCREW BN FT 2-2.5MM 24MM STRL ACTRK SLF CUT CNN FSN HDLS TI	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$364.50	$364.50	$0.00	$0.00	$0.00	$168.82	$601.18	$601.18	$0.00	$0.00	$168.80	$0.00	$479.12	$479.12	$0.00	$405.00	$641.52	$648.00	$0.00		$0.00	$126.77	$0.00	$0.00	$128.95	$0.00	$0.00	$0.00	$0.00	$0.00
ATF-270-S	SUP	HCPCS C1713		ATF-270-S  -  SCREW BN FT 2.8-3.5MM 27MM STRL ACTRK SLF CUT CNN FSN HDLS	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$364.50	$364.50	$0.00	$0.00	$0.00	$168.82	$601.18	$601.18	$0.00	$0.00	$168.80	$0.00	$479.12	$479.12	$0.00	$405.00	$641.52	$648.00	$0.00		$0.00	$126.77	$0.00	$0.00	$128.95	$0.00	$0.00	$0.00	$0.00	$0.00
ATF-320-S	SUP	HCPCS C1713		ATF-320-S  -  SCREW BONE 32MM ACTRK TI HAND FT STRL	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$364.50	$364.50	$0.00	$0.00	$0.00	$168.82	$601.18	$601.18	$0.00	$0.00	$168.80	$0.00	$479.12	$479.12	$0.00	$405.00	$641.52	$648.00	$0.00		$0.00	$126.77	$0.00	$0.00	$128.95	$0.00	$0.00	$0.00	$0.00	$0.00
ATF-370-S	SUP	Custom 27803010		ATF-370-S  -  FUSION DEVICE 37.0MM ACUTRAK	BOTH IP/OP	$810.00 	$599.40	$0.00	$648.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$601.18	$601.18	$0.00	$0.00	$168.80	$0.00	$0.00	$0.00	$0.00	$405.00	$641.52	$648.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ATM-008-S	SUP	HCPCS C1713		ATM-008-S  -  SCREW BN 8MM ACTRK	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
ATM-078	SUP	Custom 27203010		ATM-078  -  BIT DRILL MN ACTRK SHRT CANN STRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ATM-099	SUP	Custom 27203010		ATM-099  -  BIT DRILL ACTRK LNG CANN TIP TPR STRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ATM-100-S	SUP	HCPCS C1713		ATM-100-S  -  SCREW BN MN 10MM ACTRK FX	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
ATM-120-S	SUP	HCPCS C1713		ATM-120-S  -  SCREW BN MN FT 2.8-3.6MM 12MM STRL ACTRK SLF CUT CNN VAR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
ATM-140-S	SUP	HCPCS C1713		ATM-140-S  -  SCREW BN MN FT 2.8-3.6MM 14MM STRL ACTRK SLF CUT CNN VAR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
ATM-160-S	SUP	HCPCS C1713		ATM-160-S  -  SCREW BN MN FT 2.8-3.6MM 16MM STRL ACTRK SLF CUT CNN VAR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
ATM-180-S	SUP	HCPCS C1713		ATM-180-S  -  SCREW BN MN FT 2.8-3.6MM 18MM STRL ACTRK SLF CUT CNN VAR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
ATM-200-S	SUP	HCPCS C1713		ATM-200-S  -  SCREW BN MN FT 2.8-3.6MM 20MM STRL ACTRK SLF CUT CNN VAR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
ATM-220-S	SUP	HCPCS C1713		ATM-220-S  -  SCREW BN MN FT 2.8-3.6MM 22MM STRL ACTRK SLF CUT CNN VAR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
ATM-240-S	SUP	HCPCS C1713		ATM-240-S  -  SCREW BN MN 24MM ACTRK FX	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
ATM-260-S	SUP	HCPCS C1713		ATM-260-S  -  SCREW BN MN FT 2.8-3.6MM 26MM STRL ACTRK SLF CUT CNN VAR	BOTH IP/OP	$940.00 	$695.60	$0.00	$752.00	$423.00	$423.00	$0.00	$0.00	$0.00	$195.92	$697.67	$697.67	$0.00	$0.00	$195.90	$0.00	$556.01	$556.01	$0.00	$470.00	$744.48	$752.00	$0.00		$0.00	$147.11	$0.00	$0.00	$149.65	$0.00	$0.00	$0.00	$0.00	$0.00
AU00T0	SUP	HCPCS V2632		AU00T0  -  LENS IOL 0D PLANAR 6MM 30MM ACRSF IQ STABLEFORCE ULTRASERT	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$241.88	$241.88	$0.00	$0.00	$0.00	$112.03	$398.93	$398.93	$0.00	$0.00	$112.02	$0.00	$317.93	$317.93	$0.00	$268.75	$425.70	$430.00	$0.00		$0.00	$84.12	$0.00	$0.00	$85.57	$0.00	$0.00	$0.00	$0.00	$0.00
AVM851	SUP	Custom 27803010		AVM851  -  CLIP INTNL SM STRL LF FLSH SFLN UPR JAW SIL TI FLLPN TUBE	BOTH IP/OP	$223.95 	$165.72	$0.00	$179.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.22	$166.22	$0.00	$0.00	$46.67	$0.00	$0.00	$0.00	$0.00	$111.98	$177.37	$179.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AVSM10060	SUP	HCPCS C2625		AVSM10060  -  STENT VASCULAR COVERA COVERED 10MM X 60MM 80CM DELIVERY STR	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
AW-04018	SUP	HCPCS C1769		GUIDEWIRE VASC .018IN 25CM STRG SFTP SPRG	BOTH IP/OP	$15.50 	$11.47	$0.00	$12.40	$8.42	$8.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.75	$12.28	$12.40	$0.00		$0.00	$2.43	$0.00	$0.00	$2.47	$0.00	$0.00	$0.00	$0.00	$0.00
AW04432	SUP	HCPCS C1769		GUIDEWIRE VASC .032IN 60CM JTP STRG SFTP DUAL END SPRG ARW	BOTH IP/OP	$23.50 	$17.39	$0.00	$18.80	$12.76	$12.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.75	$18.61	$18.80	$0.00		$0.00	$3.68	$0.00	$0.00	$3.74	$0.00	$0.00	$0.00	$0.00	$0.00
AW-04432	SUP	HCPCS C1769		GUIDEWIRE VASC .032IN 60CM JTP STRG SFTP DUAL END SPRG ARW	BOTH IP/OP	$58.75 	$43.48	$0.00	$47.00	$31.90	$31.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.38	$46.53	$47.00	$0.00		$0.00	$9.19	$0.00	$0.00	$9.35	$0.00	$0.00	$0.00	$0.00	$0.00
AW-14735	SUP	HCPCS C1769		GUIDEWIRE VASC .35IN 65CM SPRG JTP 2 END STRG ARW ADV SS	BOTH IP/OP	$40.15 	$29.71	$0.00	$37.71	$12.81	$12.81	$0.00	$0.00	$0.00	$8.37	$29.80	$29.80	$0.00	$0.00	$8.37	$0.00	$37.71	$37.71	$0.00	$11.80	$18.69	$18.88	$0.00		$0.00	$3.69	$0.00	$0.00	$3.76	$0.00	$0.00	$0.00	$0.00	$0.00
AX100	SUP	Custom 27203010		CALIBRATOR A MLTLY 5ML IMMUN	BOTH IP/OP	"$1,452.78 "	"$1,075.06"	$0.00	"$1,162.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$726.39	"$1,150.60"	"$1,162.22"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
AX9001	SUP	Custom 27203010		REAGENT A MLTLY DLY MNTN ANALY	BOTH IP/OP	$460.95 	$341.10	$0.00	$368.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.48	$365.07	$368.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B000-0185	SUP	HCPCS C1713		B000-0185  -  RESTRICTOR CEMENT SMALL UNIVERSAL 18.5MM REVISION PLUG HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B000-0200	SUP	HCPCS C1713		B000-0200  -  PLUG BONE CMNT MED UNV 20MM	BOTH IP/OP	$188.00 	$139.12	$0.00	$150.40	$84.60	$84.60	$0.00	$0.00	$0.00	$39.18	$139.53	$139.53	$0.00	$0.00	$39.18	$0.00	$111.20	$111.20	$0.00	$94.00	$148.90	$150.40	$0.00		$0.00	$29.42	$0.00	$0.00	$29.93	$0.00	$0.00	$0.00	$0.00	$0.00
B000-0240	SUP	HCPCS C1713		B000-0240  -  RSTRC CMNT MED UNV 24MM HIP REV	BOTH IP/OP	$112.50 	$83.25	$0.00	$146.40	$82.35	$82.35	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$91.50	$144.94	$146.40	$0.00		$0.00	$28.64	$0.00	$0.00	$29.13	$0.00	$0.00	$0.00	$0.00	$0.00
B000-0300	SUP	HCPCS C1713		B000-0300  -  RESTRICTOR CEMENT XL UNIVERSAL 30MM REVISION HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B000-1185	SUP	HCPCS C1713		B000-1185  -  RESTRICTOR CEMENT SMALL UNIVERSAL DISPOSABLE INSERTER DISTAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B000-1240	SUP	HCPCS C1713		B000-1240  -  RESTRICTOR CEMENT MEDIUM UNIVERSAL DISPOSABLE INSERTER	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B000-1300	SUP	HCPCS C1713		B000-1300  -  RESTRICTOR CEMENT UNIVERSAL DISPOSABLE INSERTER	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B001-0110	SUP	HCPCS C1713		B001-0110  -  PLUG BONE CEMENT 1 11MM UHMWPE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B002-0125	SUP	HCPCS C1713		B002-0125  -  PLUG BONE CEMENT 2 12.5MM UHMWPE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B003-0140	SUP	HCPCS C1713		B003-0140  -  PLUG BONE CEMENT 3 17.5MM UHMWPE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B004-0155	SUP	HCPCS C1713		B004-0155  -  PLUG BONE CEMENT 4 23MM UHMWPE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B005-0170	SUP	HCPCS C1713		B005-0170  -  PLUG BONE CEMENT 5 17MM UHMWPE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B006-0185	SUP	HCPCS C1713		B006-0185  -  PLUG BONE CEMENT 6 18MM UHMWPE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B007-0200	SUP	HCPCS C1713		B007-0200  -  PLUG BONE CEMENT 7 20MM UHMWPE HIP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B008-0215	SUP	HCPCS C1713		B008-0215  -  PLUG BONE CEMENT 8 21.5MM  UHMWPE	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$50.63	$50.63	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
B1000729BL	SUP	Custom 27203010		CASSETTE TISS BLUE SHDN EMBD DISP	BOTH IP/OP	$288.18 	$213.25	$0.00	$230.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$144.09	$228.24	$230.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B1000729DRD	SUP	Custom 27203010		CASSETTE TISS ANTM PTH 2	BOTH IP/OP	$328.35 	$242.98	$0.00	$262.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.18	$260.05	$262.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B1000729OR	SUP	Custom 27203010		CASSETTE TISS ORNG SHDN EMBD 2 DISP	BOTH IP/OP	$262.25 	$194.07	$0.00	$209.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.13	$207.70	$209.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B1000729PK	SUP	Custom 27203010		CASSETTE TISS PNK SHDN EMBD DISP	BOTH IP/OP	$326.50 	$241.61	$0.00	$261.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.25	$258.59	$261.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B1000729WH	SUP	Custom 27203010		CASSETTE TISS/BIOP WHT EMBD SM SLOT ACTL PLMR	BOTH IP/OP	$262.25 	$194.07	$0.00	$209.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.13	$207.70	$209.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B10-27A-00	SUP	Custom 27803010		B10-27A-00  -  VALVE AORTIC 17MM 27MM BIOCOR PIG STNT LP FLEXFIT STENT	BOTH IP/OP	"$19,200.00 "	"$14,208.00"	$0.00	"$15,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,001.28"	$0.00	$0.00	$0.00	$0.00	"$9,600.00"	"$15,206.40"	"$15,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B1036-1	SUP	Custom 27203010		KIT PR RTCLN RVIR EIA DIR AG DTCT MICROTITRATION VIR TST 48	BOTH IP/OP	$789.23 	$584.03	$0.00	$631.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$394.61	$625.07	$631.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B1046-23	SUP	Custom 27203010		KIT IMMUN TST GNGN 2 N GC 24 TST	BOTH IP/OP	$181.90 	$134.61	$0.00	$145.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.95	$144.06	$145.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B1055-16A	SUP	Custom 27203010		REAGENT MYCL CALCOFLUOR WHT DRPR .5ML	BOTH IP/OP	$135.93 	$100.59	$0.00	$108.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.96	$107.66	$108.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B1055-4	SUP	Custom 27203010		REAGENT MCBL INDOPHENOL OXDS DRPR CRUSHABLE AMPULE BBL .5ML	BOTH IP/OP	$1.28 	$0.95	$0.00	$1.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.64	$1.01	$1.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B1076-1B	SUP	Custom 25003010		DISK NITROCEFIN B LCTMS DTCT BBL ID	BOTH IP/OP	$125.60 	$92.94	$0.00	$100.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.80	$99.48	$100.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B12LT	SUP	Custom 27203010		B12LT  -  TROCAR LAPSCOP 12MM 100MM STABILITY SLEEVE OPTICAL TIP	BOTH IP/OP	$475.45 	$351.83	$0.00	$380.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.88	$352.88	$0.00	$0.00	$99.08	$0.00	$0.00	$0.00	$0.00	$237.73	$376.56	$380.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B12XT	SUP	Custom 27203010		B12XT  -  TROCAR LAPSCOP 12MM 150MM STABILITY SLEEVE OPTICAL OBTURATOR	BOTH IP/OP	$536.91 	$397.31	$0.00	$429.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$398.49	$398.49	$0.00	$0.00	$111.89	$0.00	$0.00	$0.00	$0.00	$268.45	$425.23	$429.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B2996-60	SUP	HCPCS C1760		CLOSURE TUBE UNV NTR WHT XTRN SL CLR CD VRSSCLSR 10-16MM	BOTH IP/OP	$0.10 	$0.07	$0.00	$0.08	$0.05	$0.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.05	$0.08	$0.08	$0.00		$0.00	$0.02	$0.00	$0.00	$0.02	$0.00	$0.00	$0.00	$0.00	$0.00
B40826	SUP	Custom 27203010		REAGENT MCBL COAG PLSM EDTA RBT LYPH BBL 15ML	BOTH IP/OP	$581.23 	$430.11	$0.00	$464.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.61	$460.33	$464.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B4340863	SUP	Custom 27203010		KIT MYCTST MYCOPREP NAOH NA CHLOR PHOS BUFF DCNT DGST 150ML	BOTH IP/OP	$447.88 	$331.43	$0.00	$358.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$223.94	$354.72	$358.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5016	SUP	HCPCS C1713		B500-5016  -  SCREW BONE 5MM 16MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5020	SUP	HCPCS C1713		B500-5020  -  SCREW BONE 5MM 20MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5024	SUP	HCPCS C1713		B500-5024  -  SCREW BONE 5MM 24MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5028	SUP	HCPCS C1713		B500-5028  -  SCREW BONE 5MM 28MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5032	SUP	HCPCS C1713		B500-5032  -  SCREW BONE 5MM 32MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5034	SUP	HCPCS C1713		B500-5034  -  SCREW BONE 5MM 34MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5036	SUP	HCPCS C1713		B500-5036  -  SCREW BONE 5MM 36MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5038	SUP	HCPCS C1713		B500-5038  -  SCREW BONE 5MM 38MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5040	SUP	HCPCS C1713		B500-5040  -  SCREW BONE 5MM 40MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5042	SUP	HCPCS C1713		B500-5042  -  SCREW BONE 5MM 42MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5044	SUP	HCPCS C1713		B500-5044  -  SCREW BONE 5MM 44MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5046	SUP	HCPCS C1713		B500-5046  -  SCREW BONE 5MM 46MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5048	SUP	HCPCS C1713		B500-5048  -  SCREW BONE 5MM 48MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5050	SUP	HCPCS C1713		B500-5050  -  SCREW BONE 5MM 50MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5052	SUP	HCPCS C1713		B500-5052  -  SCREW BONE 5MM 52MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5054	SUP	HCPCS C1713		B500-5054  -  SCREW BONE 5MM 54MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B500-5056	SUP	HCPCS C1713		B500-5056  -  SCREW BONE 5MM 56MM CORT	BOTH IP/OP	$89.38 	$66.14	$0.00	$71.50	$40.22	$40.22	$0.00	$0.00	$0.00	$18.63	$66.33	$66.33	$0.00	$0.00	$18.63	$0.00	$52.87	$52.87	$0.00	$44.69	$70.79	$71.50	$0.00		$0.00	$13.99	$0.00	$0.00	$14.23	$0.00	$0.00	$0.00	$0.00	$0.00
B56030	SUP	Custom 27203010		KIT DRCGN EZ RSV CNTRL REAGENT TUBE TIP VIR TST 30 TST	BOTH IP/OP	$355.50 	$263.07	$0.00	$284.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.75	$281.56	$284.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B5LT	SUP	Custom 27203010		B5LT  -  TROCAR LAPSCOP 5MM 100MM STABILITY SLEEVE CANNU XCEL	BOTH IP/OP	$349.76 	$258.82	$0.00	$279.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.59	$259.59	$0.00	$0.00	$72.89	$0.00	$0.00	$0.00	$0.00	$174.88	$277.01	$279.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B5STF	SUP	Custom 27203010		B5STF  -  TROCAR LAPSCP STD 5MM STRL LF VERSAONE FX CNN BLDE DISP	BOTH IP/OP	$72.88 	$53.93	$0.00	$59.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.09	$54.09	$0.00	$0.00	$15.19	$0.00	$0.00	$0.00	$0.00	$36.98	$58.58	$59.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B5XT	SUP	Custom 27203010		B5XT  -  TROCAR LAPSCOP 5MM 100MM STABILITY SLEEVE XCEL ENDOPATH	BOTH IP/OP	$405.73 	$300.24	$0.00	$324.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.13	$301.13	$0.00	$0.00	$84.55	$0.00	$0.00	$0.00	$0.00	$202.86	$321.34	$324.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B6940-20	SUP	Custom 27203010		CONTROL RPR BBL MACV CRD 1.5ML IMMUN	BOTH IP/OP	$46.10 	$34.11	$0.00	$36.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.05	$36.51	$36.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B6940-21	SUP	Custom 27203010		DEVICE DISPENSTIRS RPR CRD IMMUN TST	BOTH IP/OP	$79.23 	$58.63	$0.00	$63.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.61	$62.75	$63.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B6940-4	SUP	Custom 27203010		KIT MACV RPR QUAL SPOT CRD SERTST 10 TST	BOTH IP/OP	$243.75 	$180.38	$0.00	$195.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.88	$193.05	$195.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B6944-19	SUP	Custom 27203010		KIT DRCGN RSV LAT FLW CLIA WVD VIR TST 30 TST	BOTH IP/OP	$994.50 	$735.93	$0.00	$795.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$497.25	$787.64	$795.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
B9990800	SUP	Custom 27203010		REAGENT CYTO RD CYRCH COLLECT FLUID ALC BS 3.8L	BOTH IP/OP	$278.58 	$206.15	$0.00	$222.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.29	$220.64	$222.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BA22-40/I13-40	SUP	Custom 27803010		BA22-40/I13-40  -  GRAFT STNT 2 BRCH 22MM 13MM 40MM STRL LF 40MM AFX STRATA	BOTH IP/OP	"$28,950.00 "	"$21,423.00"	$0.00	"$23,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,033.18"	$0.00	$0.00	$0.00	$0.00	"$14,475.00"	"$22,928.40"	"$23,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BA22-60/I13-40	SUP	Custom 27803010		BA22-60/I13-40  -  GRAFT STNT BFUR 22-13MM 17FR 60MM 40MM AFX ACTIVESEAL STRATA	BOTH IP/OP	"$28,025.00 "	"$20,738.50"	$0.00	"$22,420.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,840.41"	$0.00	$0.00	$0.00	$0.00	"$14,012.50"	"$22,195.80"	"$22,420.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BA22-70/I16-30	SUP	Custom 27803010		BA22-70/I16-30  -  GRAFT STNT 2 BRCH 22MM 16MM 70MM STRL 30MM AFX LMB XTN PTFE	BOTH IP/OP	"$28,950.00 "	"$21,423.00"	$0.00	"$23,160.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,033.18"	$0.00	$0.00	$0.00	$0.00	"$14,475.00"	"$22,928.40"	"$23,160.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BA25-70/I16-30	SUP	Custom 27803010		BA25-70/I16-30  -  GRAFT STENT 70MM SELF EXPANDABLE MAIN BODY POLYPRO SUTURE	BOTH IP/OP	"$28,025.00 "	"$20,738.50"	$0.00	"$22,420.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,840.41"	$0.00	$0.00	$0.00	$0.00	"$14,012.50"	"$22,195.80"	"$22,420.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BA25-80/I16-40	SUP	Custom 27803010		BA25-80/I16-40  -  GRAFT STENT 80MM SELF EXPAND MAIN BODY AFX ACTIVESEAL STRATA	BOTH IP/OP	"$28,025.00 "	"$20,738.50"	$0.00	"$22,420.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,840.41"	$0.00	$0.00	$0.00	$0.00	"$14,012.50"	"$22,195.80"	"$22,420.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BA28-70/I16-30	SUP	Custom 27803010		BA28-70/I16-30  -  GRAFT STNT BFUR 28-16MM 17FR 70MM 30MM AFX ACTIVESEAL STRATA	BOTH IP/OP	"$28,237.50 "	"$20,895.75"	$0.00	"$22,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,884.70"	$0.00	$0.00	$0.00	$0.00	"$14,118.75"	"$22,364.10"	"$22,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BC585049	SUP	Custom 27203010		BC585049  -  CYSTOTOME IRR 50MM 45D ANG TIP	BOTH IP/OP	$95.65 	$70.78	$0.00	$76.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.83	$75.75	$76.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BCK9015	SUP	Custom 27804086		BCK9015  -  SYSTEM BONE CMNT 15CM DLV NDL HNDL KT 11GA STRL AVTX	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.75	$425.70	$430.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BE1234	SUP	HCPCS C1713		"BE1234  -  ROD, PEEK, 200MM"	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
BE6055	SUP	HCPCS L8613		BE6055  -  SET ET 14GA 26IN STRL 24IN BLM-SNG INTRO NDL SHTH CATH PNCT	BOTH IP/OP	$589.50 	$436.23	$0.00	$471.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$437.53	$437.53	$0.00	$0.00	$122.85	$0.00	$0.00	$0.00	$0.00	$294.75	$466.88	$471.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BEA22-70/I16-30	SUP	Custom 27803010		BEA22-70/I16-30  -  GRAFT STNT 2 BRCH 22MM 16MM 70MM STRL LF 30MM AFX2 MAIN BD	BOTH IP/OP	"$34,997.50 "	"$25,898.15"	$0.00	"$27,998.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$17,498.75"	"$27,718.02"	"$27,998.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BG101-350	SUP	HCPCS C1783		BG101-350  -  DRAIN GLAUCOMA IMNPLANT BAERVELDT SILICONE ANTER CHAM	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$312.64	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$887.25	$887.25	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
BG3510-5-US	SUP	HCPCS A4364		BG3510-5-US  -  ADH SURG BIOGL SFT TIS BSA GLUT PREFL SYR 10ML STRL LATEX	BOTH IP/OP	"$1,725.00 "	"$1,276.50"	$0.00	"$1,380.00"	$936.68	$936.68	$0.00	$0.00	$0.00	$359.53	"$1,280.30"	"$1,280.30"	$0.00	$0.00	$359.49	$0.00	"$1,020.34"	"$1,020.34"	$0.00	$862.50	"$1,366.20"	"$1,380.00"	$0.00		$0.00	$269.96	$0.00	$0.00	$274.62	$0.00	$0.00	$0.00	$0.00	$0.00
BG-8006-S	SUP	Custom 27203010		BG-8006-S  -  BIT DRILL 6MM BNGFT BNGFT SYS STRL	BOTH IP/OP	$965.00 	$714.10	$0.00	$772.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$716.22	$716.22	$0.00	$0.00	$201.11	$0.00	$0.00	$0.00	$0.00	$482.50	$764.28	$772.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BG-8010-S	SUP	Custom 27203010		BG-8010-S  -  BIT DRILL 8MM BNGFT BNGFT SYS STRL	BOTH IP/OP	$965.00 	$714.10	$0.00	$772.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$716.22	$716.22	$0.00	$0.00	$201.11	$0.00	$0.00	$0.00	$0.00	$482.50	$764.28	$772.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BG-8020-S	SUP	Custom 27203010		BG-8020-S  -  BIT DRILL 10MM BNGFT BNGFT SYS STRL	BOTH IP/OP	$965.00 	$714.10	$0.00	$772.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$716.22	$716.22	$0.00	$0.00	$201.11	$0.00	$0.00	$0.00	$0.00	$482.50	$764.28	$772.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BG-8030-S	SUP	Custom 27203010		BG-8030-S  -  BIT DRILL 12MM BNGFT BNGFT SYS STRL	BOTH IP/OP	$965.00 	$714.10	$0.00	$772.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$716.22	$716.22	$0.00	$0.00	$201.11	$0.00	$0.00	$0.00	$0.00	$482.50	$764.28	$772.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BG-8040	SUP	Custom 27203010		BG-8040  -  ADPR TBG HDSN FIT	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$0.00	$0.00	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BG-8043	SUP	Custom 27203010		BG-8043  -  HANDLE RCHT T BNGFT	BOTH IP/OP	"$2,287.50 "	"$1,692.75"	$0.00	"$1,830.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,697.78"	"$1,697.78"	$0.00	$0.00	$476.72	$0.00	$0.00	$0.00	$0.00	"$1,143.75"	"$1,811.70"	"$1,830.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BG-8044	SUP	Custom 27203010		BG-8044  -  ADPR CHK JCB	BOTH IP/OP	$572.50 	$423.65	$0.00	$458.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.91	$424.91	$0.00	$0.00	$119.31	$0.00	$0.00	$0.00	$0.00	$286.25	$453.42	$458.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BG-8060	SUP	Custom 27203010		BG-8060  -  EXTRACTOR SRG G S GFT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$0.00	$0.00	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BG-8064	SUP	Custom 27203010		BG-8064  -  EXTRACTOR SRG 6MM G S	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$0.00	$0.00	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BG-8080	SUP	Custom 27203010		BG-8080  -  PUNCH SRG GFT TROC	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BI-2030	SUP	Custom 27203010		BI-2030  -  CIRCUIT BREATHING 9X8X3IN TRANSPORT TEST CAP PORTABLE	BOTH IP/OP	$73.61 	$54.47	$0.00	$58.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.63	$54.63	$0.00	$0.00	$15.34	$0.00	$0.00	$0.00	$0.00	$36.80	$58.30	$58.89	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BK406	SUP	Custom 27203010		BK406  -  PROTECTOR STUMP ROOKE BKA	BOTH IP/OP	$622.50 	$460.65	$0.00	$498.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$462.02	$462.02	$0.00	$0.00	$129.73	$0.00	$0.00	$0.00	$0.00	$311.25	$493.02	$498.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BL5115-2	SUP	Custom 27203010		BL5115-2  -  PACK SRG STD NS LF ADP FLUIDICS DISP	BOTH IP/OP	$160.00 	$118.40	$0.00	$128.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.75	$118.75	$0.00	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$80.00	$126.72	$128.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BM200	SUP	Custom 27203010		BM200  -  BONE MILL BM200 LEGEND PNEU DISPOSABLE	BOTH IP/OP	$627.75 	$464.54	$0.00	$502.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$465.92	$465.92	$0.00	$0.00	$130.82	$0.00	$0.00	$0.00	$0.00	$313.88	$497.18	$502.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BMW2021	SUP	HCPCS Q4108		BMW2021  -  DRESSING BIO 2X2IN STRL LF INTGR BL MX BVN CLGN GAG	BOTH IP/OP	"$5,171.98 "	"$3,827.27"	$0.00	"$4,701.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,838.64"	"$3,838.64"	$0.00	$0.00	$41.87	$0.00	$0.00	$0.00	$0.00	"$2,938.63"	"$4,654.78"	"$4,701.80"	$0.00		$0.00	$39.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BMW8101	SUP	HCPCS Q4104		BMW8101  -  DRESSING BIOLOGICAL 10X8IN ADHERENT BILAYER MATRIX FLEXIBLE	BOTH IP/OP	"$23,893.18 "	"$17,680.95"	$0.00	"$21,721.06"	"$12,218.10"	"$12,218.10"	$0.00	$0.00	$0.00	"$4,979.93"	"$17,733.51"	"$17,733.51"	$0.00	$0.00	$38.02	$0.00	"$11,779.34"	"$11,779.34"	$0.00	"$13,575.66"	"$21,503.85"	"$21,721.06"	$0.00		$0.00	$0.00	$0.00	$0.00	"$4,322.49"	$0.00	$0.00	$0.00	$0.00	$0.00
BP10405	SUP	Custom 27803010		BP10405  -  BP SUTURABLE GRAFT 4CM X 5CM	BOTH IP/OP	$850.28 	$629.21	$0.00	$782.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$631.07	$631.07	$0.00	$0.00	$177.20	$0.00	$0.00	$0.00	$0.00	$489.13	$774.77	$782.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BP10608	SUP	Custom 27803010		BP10608  -  BP SUTURABLE GRAFT 6CM X 8CM	BOTH IP/OP	"$1,097.98 "	$812.51	$0.00	"$1,011.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$814.92	$814.92	$0.00	$0.00	$228.82	$0.00	$0.00	$0.00	$0.00	$632.45	"$1,001.80"	"$1,011.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BP10812	SUP	Custom 27803010		BP10812  -  BP SUTURABLE GRAFT 8CM X 12CM	BOTH IP/OP	"$1,811.00 "	"$1,340.14"	$0.00	"$1,667.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,344.12"	"$1,344.12"	$0.00	$0.00	$377.41	$0.00	$0.00	$0.00	$0.00	"$1,041.95"	"$1,650.45"	"$1,667.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BP11216	SUP	Custom 27803010		BP11216  -  GRAFT SFT TIS 12X16CM STRL TTPLST RSRB SUTURABLE	BOTH IP/OP	"$3,613.63 "	"$2,674.09"	$0.00	"$3,107.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,682.03"	"$2,682.03"	$0.00	$0.00	$753.08	$0.00	$0.00	$0.00	$0.00	"$1,942.40"	"$3,076.76"	"$3,107.84"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BRC000410-00	SUP	HCPCS C1725		BRC000410-00  -  CATHETER BLNOCC 4MM 10MM ASCNT CMPT SYS MCIOL NRVSC ANRSM	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,582.85"	"$1,582.85"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,724.22"	"$1,724.22"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
BRC000415-00	SUP	HCPCS C1725		BRC000415-00  -  CATHETER BLNOCC 4MM 15MM ASCNT REMODEL	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,582.85"	"$1,582.85"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,724.22"	"$1,724.22"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
BRS000609-00	SUP	HCPCS C1725		BRS000609-00  -  CATHETER BLNOCC 6MM 9MM ASCNT REMODEL	BOTH IP/OP	"$2,915.00 "	"$2,157.10"	$0.00	"$2,332.00"	"$1,582.85"	"$1,582.85"	$0.00	$0.00	$0.00	$607.56	"$2,163.51"	"$2,163.51"	$0.00	$0.00	$607.49	$0.00	"$1,724.22"	"$1,724.22"	$0.00	"$1,457.50"	"$2,308.68"	"$2,332.00"	$0.00		$0.00	$456.20	$0.00	$0.00	$464.07	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX351304100	SUP	Custom 27203010		BSCLX351304100  -  CATHETER BLNDIL 4MM 130CM LF 100MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX351304120	SUP	Custom 27203010		BSCLX351304120  -  CATHETER BLNDIL 4MM 130CM LF 120MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX351304150	SUP	Custom 27203010		BSCLX351304150  -  CATHETER BLNDIL 4MM 130CM LF 150MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX35130440	SUP	Custom 27203010		BSCLX35130440  -  CATHETER BLNDIL 4MM 130CM LF 40MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX35130460	SUP	Custom 27203010		BSCLX35130460  -  CATHETER BLNDIL 4MM 130CM LF 60MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX35130480	SUP	Custom 27203010		BSCLX35130480  -  CATHETER BLNDIL 4MM 130CM LF 80MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX351305100	SUP	Custom 27203010		BSCLX351305100  -  CATHETER BLNDIL 5MM 130CM LF 100MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX351305120	SUP	Custom 27203010		BSCLX351305120  -  CATHETER BLNDIL 5MM 130CM LF 120MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX351305150	SUP	Custom 27203010		BSCLX351305150  -  CATHETER BLNDIL 5MM 130CM LF 150MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX35130540	SUP	Custom 27203010		BSCLX35130540  -  CATHETER BLNDIL 5MM 130CM LF 40MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX35130560	SUP	Custom 27203010		BSCLX35130560  -  CATHETER BLNDIL 5MM 130CM LF 60MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX35130580	SUP	Custom 27203010		BSCLX35130580  -  CATHETER BLNDIL 5MM 130CM LF 80MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX351306100	SUP	Custom 27203010		BSCLX351306100  -  CATHETER BLNDIL 6MM 130CM LF 100MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX351306120	SUP	Custom 27203010		BSCLX351306120  -  CATHETER BALDILAT 6FR 6MM 130CM 120MM PCLTXL	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX351306150	SUP	Custom 27203010		BSCLX351306150  -  CATHETER BLNDIL 6MM 130CM LF 150MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX35130640	SUP	Custom 27203010		BSCLX35130640  -  CATHETER BLNDIL 6MM 130CM LF 40MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX35130660	SUP	Custom 27203010		BSCLX35130660  -  CATHETER BLNDIL 6MM 130CM LF 60MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BSCLX35130680	SUP	Custom 27203010		BSCLX35130680  -  CATHETER BLNDIL 6MM 130CM LF 80MM LUTONIX 035 PCLTXL ACPT	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	$0.00	$0.00	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BTC-100	SUP	HCPCS C1758		CATHETER URET BT-CATH TEMPONADE	BOTH IP/OP	$290.00 	$214.60	$0.00	$215.24	$144.85	$144.85	$0.00	$0.00	$0.00	$0.00	$215.24	$215.24	$0.00	$0.00	$60.44	$0.00	$157.78	$157.78	$0.00	$133.38	$211.27	$213.40	$0.00		$0.00	$41.75	$0.00	$0.00	$42.47	$0.00	$0.00	$0.00	$0.00	$0.00
BTE1000	SUP	Custom 27803010		BTE1000  -  EXPANDER TISSUE P8-10.2CM RECTANGLE 17X8CM REMOTE PORT	BOTH IP/OP	"$1,337.50 "	$989.75	$0.00	"$1,070.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$992.69	$992.69	$0.00	$0.00	$278.74	$0.00	$0.00	$0.00	$0.00	$668.75	"$1,059.30"	"$1,070.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BTE750	SUP	Custom 27803010		BTE750  -  EXPANDER TISSUE P7-9CM RECTANGLE 15X7.5CM REMOTE PORT SMOOTH	BOTH IP/OP	"$1,337.50 "	$989.75	$0.00	"$1,070.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$992.69	$992.69	$0.00	$0.00	$278.74	$0.00	$0.00	$0.00	$0.00	$668.75	"$1,059.30"	"$1,070.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BW012	SUP	Custom 27803010		BW012  -  WAX BN STRL LF OSTENE HMST AGNT ALK OXD 2.5GM DISP	BOTH IP/OP	$192.05 	$142.12	$0.00	$153.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.54	$142.54	$0.00	$0.00	$40.02	$0.00	$0.00	$0.00	$0.00	$96.03	$152.10	$153.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BW-012	SUP	Custom 27203010		OSTENE-A WATER-SOLUBLE BONE HEMOSTASIS MATERIALS	BOTH IP/OP	$165.63 	$122.57	$0.00	$132.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.81	$131.18	$132.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BX00711052	SUP	Custom 27203010		BX00711052  -  NET SPEC RTRVL 230CM 2.5MM RTHNT STD STRNG REINF NT X SCR	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$0.00	$0.00	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BX-1000	SUP	Custom 27203010		BX-1000  -  KIT ASCP ARTHROBOX	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$0.00	$0.00	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
BXA073901A	SUP	HCPCS C1874		BXA073901A  -  STENT EPRSTH .035IN 7MM 11MM 7FR 39MM 80CM GORE VBHN BLN	BOTH IP/OP	"$8,935.00 "	"$6,611.90"	$0.00	"$7,008.00"	"$3,942.00"	"$3,942.00"	$0.00	$0.00	$0.00	"$1,862.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,862.05"	$0.00	"$4,404.96"	"$4,404.96"	$0.00	"$4,380.00"	"$6,937.92"	"$7,008.00"	$0.00		$0.00	"$1,370.94"	$0.00	$0.00	"$1,394.59"	$0.00	$0.00	$0.00	$0.00	$0.00
BXA075901A	SUP	HCPCS C1874		BXA075901A  -  STENT EPRSTH .035IN 7MM 11MM 7FR 59MM 80CM GORE VBHN BLN	BOTH IP/OP	"$8,935.00 "	"$6,611.90"	$0.00	"$7,008.00"	"$3,942.00"	"$3,942.00"	$0.00	$0.00	$0.00	"$1,862.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,862.05"	$0.00	"$4,404.96"	"$4,404.96"	$0.00	"$4,380.00"	"$6,937.92"	"$7,008.00"	$0.00		$0.00	"$1,370.94"	$0.00	$0.00	"$1,394.59"	$0.00	$0.00	$0.00	$0.00	$0.00
BXA082901A	SUP	HCPCS C1874		BXA082901A  -  STENT EPRSTH .035IN 8MM 11MM 7FR 29MM 80CM GORE VBHN BLN	BOTH IP/OP	"$8,935.00 "	"$6,611.90"	$0.00	"$7,008.00"	"$3,942.00"	"$3,942.00"	$0.00	$0.00	$0.00	"$1,862.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,862.05"	$0.00	"$4,404.96"	"$4,404.96"	$0.00	"$4,380.00"	"$6,937.92"	"$7,008.00"	$0.00		$0.00	"$1,370.94"	$0.00	$0.00	"$1,394.59"	$0.00	$0.00	$0.00	$0.00	$0.00
BXA083901A	SUP	HCPCS C1874		BXA083901A  -  STENT EPRSTH .035IN 8MM 11MM 7FR 39MM 80CM GORE VBHN BLN	BOTH IP/OP	"$8,935.00 "	"$6,611.90"	$0.00	"$7,008.00"	"$3,942.00"	"$3,942.00"	$0.00	$0.00	$0.00	"$1,862.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,862.05"	$0.00	"$4,404.96"	"$4,404.96"	$0.00	"$4,380.00"	"$6,937.92"	"$7,008.00"	$0.00		$0.00	"$1,370.94"	$0.00	$0.00	"$1,394.59"	$0.00	$0.00	$0.00	$0.00	$0.00
BXA085901A	SUP	HCPCS C1874		BXA085901A  -  STENT EPRSTH .035IN 8MM 11MM 7FR 59MM 80CM GORE VBHN BLN	BOTH IP/OP	"$8,935.00 "	"$6,611.90"	$0.00	"$7,008.00"	"$3,942.00"	"$3,942.00"	$0.00	$0.00	$0.00	"$1,862.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,862.05"	$0.00	"$4,404.96"	"$4,404.96"	$0.00	"$4,380.00"	"$6,937.92"	"$7,008.00"	$0.00		$0.00	"$1,370.94"	$0.00	$0.00	"$1,394.59"	$0.00	$0.00	$0.00	$0.00	$0.00
C021D	SUP	Custom 27203010		C021D  -  SUTURE NONABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8	BOTH IP/OP	$285.50 	$211.27	$0.00	$231.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.90	$211.90	$0.00	$0.00	$59.50	$0.00	$0.00	$0.00	$0.00	$144.89	$229.51	$231.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C-028	SUP	HCPCS C1713		C-028  -  GUARD PIN YLW .028IN PINCAP .028IN POST SURG KWR STNM PIN	BOTH IP/OP	$4.58 	$3.39	$0.00	$3.67	$2.06	$2.06	$0.00	$0.00	$0.00	$0.96	$3.40	$3.40	$0.00	$0.00	$0.96	$0.00	$2.71	$2.71	$0.00	$2.29	$3.63	$3.67	$0.00		$0.00	$0.72	$0.00	$0.00	$0.73	$0.00	$0.00	$0.00	$0.00	$0.00
C-045	SUP	HCPCS C1713		C-045  -  CAP PCTV PINCAP STRL WHT .045IN 1.1MM .045IN	BOTH IP/OP	$4.58 	$3.39	$0.00	$3.67	$2.06	$2.06	$0.00	$0.00	$0.00	$0.96	$3.40	$3.40	$0.00	$0.00	$0.96	$0.00	$2.71	$2.71	$0.00	$2.29	$3.63	$3.67	$0.00		$0.00	$0.72	$0.00	$0.00	$0.73	$0.00	$0.00	$0.00	$0.00	$0.00
C-062	SUP	HCPCS C1713		C-062  -  CAP PCTV .062IN KWR PINCAP STRL POST SURG KWR STNM PIN GRN	BOTH IP/OP	$2.75 	$2.04	$0.00	$2.20	$1.24	$1.24	$0.00	$0.00	$0.00	$0.57	$2.04	$2.04	$0.00	$0.00	$0.57	$0.00	$1.63	$1.63	$0.00	$1.38	$2.18	$2.20	$0.00		$0.00	$0.43	$0.00	$0.00	$0.44	$0.00	$0.00	$0.00	$0.00	$0.00
C-078	SUP	HCPCS C1713		C-078  -  GUARD PIN PNK .078IN .035IN KWR STNM STRL	BOTH IP/OP	$5.00 	$3.70	$0.00	$4.00	$2.25	$2.25	$0.00	$0.00	$0.00	$1.04	$3.71	$3.71	$0.00	$0.00	$1.04	$0.00	$2.96	$2.96	$0.00	$2.50	$3.96	$4.00	$0.00		$0.00	$0.78	$0.00	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00
C0L-3140	SUP	HCPCS C1713		C0L-3140  -  SCREW BONE 3.5MM 14MM ACUMED ACLC CORT ORTH LCK STRL	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
C0L-3160	SUP	HCPCS C1713		C0L-3160  -  SCREW BONE 3.5MM 16MM TI DISTAL RADL CORT CLVCL WR HND LCK	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
C141	SUP	HCPCS C1713		C141  -  COVER PIN .141IN KWR	BOTH IP/OP	$5.00 	$3.70	$0.00	$4.00	$2.25	$2.25	$0.00	$0.00	$0.00	$1.04	$3.71	$3.71	$0.00	$0.00	$1.04	$0.00	$2.96	$2.96	$0.00	$2.50	$3.96	$4.00	$0.00		$0.00	$0.78	$0.00	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00
C156	SUP	HCPCS C1713		C156  -  COVER PIN .156IN KWR	BOTH IP/OP	$5.00 	$3.70	$0.00	$4.00	$2.25	$2.25	$0.00	$0.00	$0.00	$1.04	$3.71	$3.71	$0.00	$0.00	$1.04	$0.00	$2.96	$2.96	$0.00	$2.50	$3.96	$4.00	$0.00		$0.00	$0.78	$0.00	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00
C1712	SUP	HCPCS C1713		C1712  -  SCREW BONE 1.7MM 12MM CANN LBLU	BOTH IP/OP	$825.00 	$610.50	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$0.00	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
C1713	SUP	HCPCS C1713		C1713  -  SCREW BONE 13MM CANN LIGHT BLUE 1.7MM	BOTH IP/OP	$825.00 	$610.50	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$0.00	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
C1714	SUP	HCPCS C1713		C1714  -  SCREW BONE 9MM CANN COMPRESSION LIGHT BLUE 1.7MM ORTHOPEDIC	BOTH IP/OP	$825.00 	$610.50	$0.00	$630.00	$354.38	$354.38	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$0.00	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$123.24	$0.00	$0.00	$125.37	$0.00	$0.00	$0.00	$0.00	$0.00
C2314	SUP	HCPCS C1713		C2314  -  SCREW BONE L14 MM OD2.3 MM ORTHOPEDIC LOCK BLUE	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C2316	SUP	HCPCS C1713		C2316  -  SCREW BN 2.3MM 16MM BLU CNN CMPR	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C2318	SUP	HCPCS C1713		"C2318  -  CANNULATED SCREW 2.3MM, 18MM"	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C2320	SUP	HCPCS C1713		C2320  -  SCREW BONE 20MM LOCK BLUE 2.3MM ORTHOPEDIC	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C2322	SUP	HCPCS C1713		C2322  -  SCREW BONE 22MM CANN COMPRESSION BLUE 2.3MM	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C2324	SUP	HCPCS C1713		C2324  -  SCREW BN 2.3MM 24MM BLU CNN CMPR	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C2326	SUP	HCPCS C1713		C2326  -  SCREW BONE 26MM CANN COMPRESSION BLUE 2.3MM	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C2328	SUP	HCPCS C1713		C2328  -  SCREW BONE 28MM CANN COMPRESSION BLUE 2.3MM	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C2TR01	SUP	HCPCS C2621		C2TR01  -  PACEMAKER CARDIAC THK6MM 57X59MM 2 CHAMBER RATE RESPONSIVE	BOTH IP/OP	"$14,700.00 "	"$10,878.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,063.48"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C3.5-20	SUP	HCPCS C1713		C3.5-20  -  SCREW BONE 20MM CANN ORANGE 3.5MM ORTHOPEDIC	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C3018	SUP	HCPCS C1713		C3018  -  SCREW BONE 18MM CANN COMPRESSION YELLOW 3MM	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C3020	SUP	HCPCS C1713		C3020  -  SCREW BONE 20MM CANN COMPRESSION YELLOW 3MM	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C3022	SUP	HCPCS C1713		C3022  -  SCREW BONE 22MM CANN YELLOW 3MM	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C3024	SUP	HCPCS C1713		C3024  -  SCREW BONE 24MM COMPRESSION 3MM	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C3026	SUP	HCPCS C1713		C3026  -  SCREW BONE 26MM CANN COMPRESSION YELLOW 3MM	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C3524	SUP	HCPCS C1713		C3524  -  SCREW BONE 24MM CANN COMPRESSION ORANGE 3.5MM ORTHOPEDIC	BOTH IP/OP	$775.00 	$573.50	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$161.53	$575.21	$575.21	$0.00	$0.00	$161.51	$0.00	$458.41	$458.41	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
C3RL01-B:US	SUP	HCPCS Q4100		C3RL01-B:US  -  DEVICE CELL HRVT RECELL ATLGS	BOTH IP/OP	"$16,687.50 "	"$12,348.75"	$0.00	"$13,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,477.68"	$0.00	$0.00	$0.00	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C4120	SUP	Custom 27203010		C4120  -  CARTRIDGE GRSPR 5MM 38CM STRL 20MM D DR ATRM DISP	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C4319-5B	SUP	Custom 27203010		C4319-5B  -  ADPR SCT 15MM 15MM BLUE SWVL TRCHCR CLOSE SCT SYS TRCHCR	BOTH IP/OP	$86.68 	$64.14	$0.00	$69.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.34	$68.65	$69.35	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C4330	SUP	Custom 27203010		CHEMICAL LAB XYLN CLR AGNT POLY BTL 1GL HST GRAD	BOTH IP/OP	$35.93 	$26.59	$0.00	$28.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.96	$28.46	$28.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C46145	SUP	Custom 27203010		C46145  -  CUSA CURVED EXTENDED STD TIPS 8/BX	BOTH IP/OP	"$1,219.38 "	$902.34	$0.00	$975.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$905.02	$905.02	$0.00	$0.00	$254.12	$0.00	$0.00	$0.00	$0.00	$609.69	$965.75	$975.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C514D	SUP	Custom 27203010		C514D  -  SUTURE NONABSORBABLE 4-0 SH 18IN CONTROL RELEASE BRAID 8	BOTH IP/OP	$30.13 	$22.30	$0.00	$24.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.36	$22.36	$0.00	$0.00	$6.28	$0.00	$0.00	$0.00	$0.00	$15.07	$23.86	$24.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C554D	SUP	Custom 27203010		C554D  -  SUTURE NRLN 4-0 RB1 18IN BRAID CR MPK BLK NABSB	BOTH IP/OP	$35.34 	$26.15	$0.00	$28.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.23	$26.23	$0.00	$0.00	$7.36	$0.00	$0.00	$0.00	$0.00	$17.67	$27.99	$28.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C584D	SUP	Custom 27203010		C584D  -  SUTURE NABSB 4-0 TF 18IN BLK NRLN CR BRD 8 STRN NYL 6 6	BOTH IP/OP	$39.86 	$29.50	$0.00	$32.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.58	$29.58	$0.00	$0.00	$8.31	$0.00	$0.00	$0.00	$0.00	$20.23	$32.04	$32.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C8402	SUP	Custom 27203010		C8402  -  RETRACTOR SURG MEDIUM RING ATRAUMATIC SELF RETAIN WOUND	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C8403	SUP	Custom 27203010		C8403  -  RETRACTOR SURG LARGE RIGID RETRACTION RING ALEXIS O 9-14CM	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C8404	SUP	Custom 27203010		C8404  -  RETRACTOR SURG XL 11-17CM WOUND LATEX FREE ALEXIS 11-17CM	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C8584	SUP	Custom 27203010		C8584  -  BIT DRILL 9IN TAPERED HEAD TUNNEL DEPTH ECCENTRIC MONOFLUTED	BOTH IP/OP	"$1,751.00 "	"$1,295.74"	$0.00	"$1,400.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,299.59"	"$1,299.59"	$0.00	$0.00	$364.91	$0.00	$0.00	$0.00	$0.00	$875.50	"$1,386.79"	"$1,400.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C8XX2	SUP	Custom 27203010		C8XX2  -  PORT HND ACC 120MM LF ALEXIS GLPRT WND RTRCTR LAPSCP MRK PEN	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C8XX2NONCE	SUP	Custom 27203010		PORT HND ACCES GLPRT ALEXIS O RTRCTR LAPSCOP	BOTH IP/OP	"$1,264.65 "	$935.84	$0.00	"$1,011.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.33	"$1,001.60"	"$1,011.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C8XXX2N	SUP	Custom 27203010		C8XXX2N  -  GELPORT	BOTH IP/OP	"$1,264.65 "	$935.84	$0.00	"$1,011.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.33	"$1,001.60"	"$1,011.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C-99999-13	SUP	Custom 27203010		CAP TUBE BLK PHNL SCR ON RBR LINR DISP	BOTH IP/OP	$0.25 	$0.19	$0.00	$0.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.13	$0.20	$0.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CA0304	SUP	Custom 27803010		CA0304  -  GRAFT SFT TISSUE AVIVE HUMAN UMBILICAL CORD MEMBRANE 3CMX4CM	BOTH IP/OP	"$6,000.00 "	"$4,440.00"	$0.00	"$4,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,250.40"	$0.00	$0.00	$0.00	$0.00	"$3,000.00"	"$4,752.00"	"$4,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CA2011	SUP	HCPCS C1894		DEVICE BIOP 11CM 20GA ACHV SFT TIS COAX AUTO INTROD THNWL	BOTH IP/OP	$149.10 	$110.33	$0.00	$119.28	$80.96	$80.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.55	$118.09	$119.28	$0.00		$0.00	$23.33	$0.00	$0.00	$23.74	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4120	SUP	HCPCS C1713		CA-4120  -  SCREW BN 4MM 12MM NS HEX TI CANC	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4140	SUP	HCPCS C1713		CA-4140  -  SCREW BN 4MM 14MM NS HEX TI CANC	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4160	SUP	HCPCS C1713		CA-4160  -  SCREW BN 4MM 16MM NS HEX TI CANC	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4180	SUP	HCPCS C1713		CA-4180  -  SCREW BN 4MM 18MM NS HEX TI CANC	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4200	SUP	HCPCS C1713		CA-4200  -  SCREW BN 4MM 20MM NS HEX TI CANC	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4220	SUP	HCPCS C1713		CA-4220  -  SCREW BN 4MM 22MM NS HEX TI CANC	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4225	SUP	HCPCS C1713		CA-4225  -  SCREW BONE 4MM 22.5MM TI CANC NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4240	SUP	HCPCS C1713		CA-4240  -  SCREW BN 4MM 24MM NS HEX TI CANC	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4250	SUP	HCPCS C1713		CA-4250  -  SCREW BONE 4MM 25MM TI CANC NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4260	SUP	HCPCS C1713		CA-4260  -  SCREW BN 4MM 26MM NS HEX TI CANC	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4275	SUP	HCPCS C1713		CA-4275  -  SCREW BONE 4MM 27.5MM CANC NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4280	SUP	HCPCS C1713		CA-4280  -  SCREW BN 4MM 28MM CNN	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4300	SUP	HCPCS C1713		CA-4300  -  SCREW BN 4MM 30MM NS HEX TI CANC	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4340	SUP	HCPCS C1713		CA-4340  -  SCREW BONE 4MM 34MM TI CANC NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4350	SUP	HCPCS C1713		CA-4350  -  SCREW BONE 4MM 35MM TI CANC NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4400	SUP	HCPCS C1713		CA-4400  -  SCREW BONE 4MM 40MM TI CANC NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4450	SUP	HCPCS C1713		CA-4450  -  SCREW BONE 4MM 45MM TI CANC NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4500	SUP	HCPCS C1713		CA-4500  -  SCREW BONE 4MM 50MM TI CANC NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4550	SUP	HCPCS C1713		CA-4550  -  SCREW BN 4MM 55MM CNN	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CA-4600	SUP	HCPCS C1713		CA-4600  -  SCREW BN 4MM 60MM NS HEX TI CANC	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CAB3.8-12	SUP	HCPCS C1713		CAB3.8-12  -  SCREW BONE 3.8MM 12MM CANCELLOUS	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
CAB3.8-16	SUP	HCPCS C1713		CAB3.8-16  -  SCREW BONE 3.8MM 16MM CANCELLOUS	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
CAB3.8-20	SUP	HCPCS C1713		CAB3.8-20  -  SCREW BONE 3.8MM 20MM CANCELLOUS ANKLE FIX SYSTEM	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
CAB3.8-24	SUP	HCPCS C1713		CAB3.8-24  -  SCREW BN 3.8MM 24MM CANC ANKL FX SYS	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
CAB3.8-26	SUP	HCPCS C1713		CAB3.8-26  -  SCREW BONE 3.8MM 26MM CANCELLOUS ANKLE FIX SYSTEM	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
CA-PHB25	SUP	HCPCS C1713		CA-PHB25  -  SCREW BONE 4.5MM 25MM TI ORTH LCK BTRS NONSTRL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$180.00	$180.00	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
CA-PHB275	SUP	HCPCS C1713		CA-PHB275  -  SCREW BONE 27.5MM CANC PROX HUM BTRS	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$180.00	$180.00	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
CA-PHB30	SUP	HCPCS C1713		CA-PHB30  -  SCREW BONE 4.5MM 30MM TI ORTH LCK BTRS NONSTRL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$180.00	$180.00	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
CA-PHB325	SUP	HCPCS C1713		CA-PHB325  -  SCREW BONE 4.5MM 32.5MM TI ORTH LCK BTRS NONSTRL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$180.00	$180.00	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
CA-PHB35	SUP	HCPCS C1713		CA-PHB35  -  SCREW BONE 4.5MM 35MM TI ORTH LCK BTRS NONSTRL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$180.00	$180.00	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
CA-PHB375	SUP	HCPCS C1713		CA-PHB375  -  SCREW BONE 4.5MM 37.5MM TI CANC LCK BTRS NONSTRL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$180.00	$180.00	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
CA-PHB40	SUP	HCPCS C1713		CA-PHB40  -  SCREW BN 4.5MM 40MM NS CORT	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$180.00	$180.00	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
CA-PHB45	SUP	HCPCS C1713		CA-PHB45  -  SCREW BN 4.5MM 45MM LCK	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$180.00	$180.00	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
CA-PHB50	SUP	HCPCS C1713		CA-PHB50  -  SCREW BONE 4.5MM 50MM TI PROX HUM BTRS NONSTRL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$180.00	$180.00	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
CA-PHB55	SUP	HCPCS C1713		CA-PHB55  -  SCREW BONE 4.5MM 55MM TI PROX HUM PLT BTRS NONSTRL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$180.00	$180.00	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
CAR500	SUP	Custom 27203010		CARTRIDGE HMDIAL DISP CAR-500	BOTH IP/OP	"$3,225.00 "	"$2,386.50"	$0.00	"$2,580.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,612.50"	"$2,554.20"	"$2,580.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CAT00241	SUP	Custom 27203010		CAT00241  -  KIT ARTHRO 17GA HIP NTNL PRTL ENTRY 2 SPNL NDL SYR	BOTH IP/OP	$822.50 	$608.65	$0.00	$658.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.46	$610.46	$0.00	$0.00	$171.41	$0.00	$0.00	$0.00	$0.00	$411.25	$651.42	$658.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB09BA10	SUP	Custom 27203010		CB09BA10  -  CURVEDBUR CB09BA10 09CMX1MM BALL	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB09BA10D	SUP	Custom 27203010		CB09BA10D  -  CURVEDBUR CB09BA10D 09CMX1MM BALL DIAMND	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB09BA20	SUP	Custom 27203010		CB09BA20  -  CURVEDBUR CB09BA20 09CMX2MM BALL	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB09BA20D	SUP	Custom 27203010		CB09BA20D  -  CURVEDBUR CB09BA20D 09CMX2MM BALL DIAMND	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB09BA30	SUP	Custom 27203010		CB09BA30  -  CURVEDBUR CB09BA30 09CMX3MM BALL	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB09BA30D	SUP	Custom 27203010		CB09BA30D  -  CURVEDBUR CB09BA30D 09CMX1MM BALL DIAMND	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB09BA40	SUP	Custom 27203010		CB09BA40  -  CURVEDBUR CB09BA40 09CMX4MM BALL	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB09BA40D	SUP	Custom 27203010		CB09BA40D  -  CURVEDBUR CB09BA40D 09CMX4MM BALL DIAMND	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB11BA10	SUP	Custom 27203010		CB11BA10  -  CURVEDBUR CB11BA10 11CMX1MM BALL	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB11BA10D	SUP	Custom 27203010		CB11BA10D  -  CURVEDBUR CB11BA10D 11CMX1MM BALL DIAMND	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB11BA20	SUP	Custom 27203010		CB11BA20  -  CURVEDBUR CB11BA20 11CMX2MM BALL	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB11BA20D	SUP	Custom 27203010		CB11BA20D  -  CURVEDBUR CB11BA20D 11CMX2MM BALL DIAMND	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB11BA30	SUP	Custom 27203010		CB11BA30  -  CURVEDBUR CB11BA30 11CMX3MM BALL	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB11BA30D	SUP	Custom 27203010		CB11BA30D  -  CURVEDBUR CB11BA30D 11CMX1MM BALL DIAMND	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB11BA40	SUP	Custom 27203010		CB11BA40  -  CURVEDBUR CB11BA40 11CMX4MM BALL	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CB11BA40D	SUP	Custom 27203010		CB11BA40D  -  CURVEDBUR CB11BA40D 11CMX4MM BALL DIAMND	BOTH IP/OP	$711.00 	$526.14	$0.00	$568.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.70	$527.70	$0.00	$0.00	$148.17	$0.00	$0.00	$0.00	$0.00	$355.50	$563.11	$568.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CBO33010	SUP	HCPCS C1726		CBO33010  -  CATHETER BLNDIL 3MM 10MM ANGPLSTY	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$373.31	$373.31	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
CC-2300	SUP	Custom 27203010		CC-2300  -  CONNECTOR DIALYSIS TITANIUM 2 PART FLEX-NECK CATHETER STERIL	BOTH IP/OP	$377.50 	$279.35	$0.00	$302.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.18	$280.18	$0.00	$0.00	$78.67	$0.00	$0.00	$0.00	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C-CAE-14.0-100-DLT-EF	SUP	HCPCS C1729		CATHETER ARWYEX 14FR 100CM 2 LUM ENDOTRAC TUBE XFRM RPFT	BOTH IP/OP	$114.05 	$84.40	$0.00	$91.24	$61.93	$61.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.03	$90.33	$91.24	$0.00		$0.00	$17.85	$0.00	$0.00	$18.16	$0.00	$0.00	$0.00	$0.00	$0.00
CCH1910	SUP	Custom 27203010		COAXIAL INTRODUCER NEEDLE 19GA 10CM	BOTH IP/OP	$33.75 	$24.98	$0.00	$27.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.88	$26.73	$27.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CD1231-40	SUP	HCPCS C1722		CD1231-40  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X73MM 1 CHAMBER IS-1	BOTH IP/OP	"$32,250.00 "	"$23,865.00"	$0.00	"$25,800.00"	"$14,512.50"	"$14,512.50"	$0.00	$0.00	$0.00	"$6,721.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,720.90"	$0.00	"$15,899.25"	"$15,899.25"	$0.00	"$16,125.00"	"$25,542.00"	"$25,800.00"	$0.00		$0.00	"$5,047.13"	$0.00	$0.00	"$5,134.20"	$0.00	$0.00	$0.00	$0.00	$0.00
CD1231-40Q	SUP	HCPCS C1722		CD1231-40Q  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X71MM 1 CHAMBER DF-4 RF	BOTH IP/OP	"$32,250.00 "	"$23,865.00"	$0.00	"$25,800.00"	"$14,512.50"	"$14,512.50"	$0.00	$0.00	$0.00	"$6,721.71"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,720.90"	$0.00	"$15,899.25"	"$15,899.25"	$0.00	"$16,125.00"	"$25,542.00"	"$25,800.00"	$0.00		$0.00	"$5,047.13"	$0.00	$0.00	"$5,134.20"	$0.00	$0.00	$0.00	$0.00	$0.00
CD2231-40	SUP	HCPCS C1721		CD2231-40  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X74MM 2 CHAMBER 2DF-1	BOTH IP/OP	"$33,075.00 "	"$24,475.50"	$0.00	"$26,460.00"	"$14,883.75"	"$14,883.75"	$0.00	$0.00	$0.00	"$6,893.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,892.83"	$0.00	"$16,305.98"	"$16,305.98"	$0.00	"$16,537.50"	"$26,195.40"	"$26,460.00"	$0.00		$0.00	"$5,176.24"	$0.00	$0.00	"$5,265.54"	$0.00	$0.00	$0.00	$0.00	$0.00
CD2231-40Q	SUP	HCPCS C1721		CD2231-40Q  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X71MM 2 CHAMBER 2DF-4	BOTH IP/OP	"$33,075.00 "	"$24,475.50"	$0.00	"$26,460.00"	"$14,883.75"	"$14,883.75"	$0.00	$0.00	$0.00	"$6,893.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,892.83"	$0.00	"$16,305.98"	"$16,305.98"	$0.00	"$16,537.50"	"$26,195.40"	"$26,460.00"	$0.00		$0.00	"$5,176.24"	$0.00	$0.00	"$5,265.54"	$0.00	$0.00	$0.00	$0.00	$0.00
CD2257-40	SUP	HCPCS C1721		CD2257-40  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X74MM 2 CHAMBER 2DF-1	BOTH IP/OP	"$33,075.00 "	"$24,475.50"	$0.00	"$26,460.00"	"$14,883.75"	"$14,883.75"	$0.00	$0.00	$0.00	"$6,893.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,892.83"	$0.00	"$16,305.98"	"$16,305.98"	$0.00	"$16,537.50"	"$26,195.40"	"$26,460.00"	$0.00		$0.00	"$5,176.24"	$0.00	$0.00	"$5,265.54"	$0.00	$0.00	$0.00	$0.00	$0.00
CD2257-40Q	SUP	HCPCS C1721		CD2257-40Q  -  DEFIBRILLATOR CRD THK14MM 40J 40X71MM 35CC STRL LF FORTIFY	BOTH IP/OP	"$33,075.00 "	"$24,475.50"	$0.00	"$26,460.00"	"$14,883.75"	"$14,883.75"	$0.00	$0.00	$0.00	"$6,893.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,892.83"	$0.00	"$16,305.98"	"$16,305.98"	$0.00	"$16,537.50"	"$26,195.40"	"$26,460.00"	$0.00		$0.00	"$5,176.24"	$0.00	$0.00	"$5,265.54"	$0.00	$0.00	$0.00	$0.00	$0.00
CD2311-36	SUP	HCPCS C1721		CD2311-36  -  DEFIBRILLATOR CARDIAC THK12MM 36J 51X69MM 1 CHAMBER 1IS-1 1	BOTH IP/OP	"$33,075.00 "	"$24,475.50"	$0.00	"$26,460.00"	"$14,883.75"	"$14,883.75"	$0.00	$0.00	$0.00	"$6,893.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,892.83"	$0.00	"$16,305.98"	"$16,305.98"	$0.00	"$16,537.50"	"$26,195.40"	"$26,460.00"	$0.00		$0.00	"$5,176.24"	$0.00	$0.00	"$5,265.54"	$0.00	$0.00	$0.00	$0.00	$0.00
CD2311-36Q	SUP	HCPCS C1721		CD2311-36Q  -  DEFIBRILLATOR CRD THK12MM 36J 51X70MM 31ML ELLIPSE 2 CHMBR 1	BOTH IP/OP	"$33,075.00 "	"$24,475.50"	$0.00	"$26,460.00"	"$14,883.75"	"$14,883.75"	$0.00	$0.00	$0.00	"$6,893.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,892.83"	$0.00	"$16,305.98"	"$16,305.98"	$0.00	"$16,537.50"	"$26,195.40"	"$26,460.00"	$0.00		$0.00	"$5,176.24"	$0.00	$0.00	"$5,265.54"	$0.00	$0.00	$0.00	$0.00	$0.00
CD3231-40	SUP	HCPCS C1721		CD3231-40  -  DEFIBRILLATOR CRD THK14MM 2.5V 40X79MM 36ML UNIFY CRT-D QHR	BOTH IP/OP	"$45,500.00 "	"$33,670.00"	$0.00	"$36,400.00"	"$20,475.00"	"$20,475.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,482.20"	$0.00	"$22,431.50"	"$22,431.50"	$0.00	"$22,750.00"	"$36,036.00"	"$36,400.00"	$0.00		$0.00	"$7,120.75"	$0.00	$0.00	"$7,243.60"	$0.00	$0.00	$0.00	$0.00	$0.00
CD3231-40Q	SUP	HCPCS C1721		CD3231-40Q  -  DEFIBRILLATOR CARDIAC THK14MM 2.5V 500OHM 60 PPM 40X73MM 2	BOTH IP/OP	"$39,825.00 "	"$29,470.50"	$0.00	"$31,860.00"	"$17,921.25"	"$17,921.25"	$0.00	$0.00	$0.00	"$8,300.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,299.53"	$0.00	"$19,633.73"	"$19,633.73"	$0.00	"$19,912.50"	"$31,541.40"	"$31,860.00"	$0.00		$0.00	"$6,232.61"	$0.00	$0.00	"$6,340.14"	$0.00	$0.00	$0.00	$0.00	$0.00
CD3257-40	SUP	HCPCS C1882		CD3257-40  -  DEFIBRILLATOR CRD THK14MM 40J 40X79MM 36CC UNIFY ASR CRT-D 2	BOTH IP/OP	"$39,825.00 "	"$29,470.50"	$0.00	"$31,860.00"	"$17,921.25"	"$17,921.25"	$0.00	$0.00	$0.00	"$8,300.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,299.53"	$0.00	"$19,633.73"	"$19,633.73"	$0.00	"$19,912.50"	"$31,541.40"	"$31,860.00"	$0.00		$0.00	"$6,232.61"	$0.00	$0.00	"$6,340.14"	$0.00	$0.00	$0.00	$0.00	$0.00
CD3257-40Q	SUP	HCPCS C1882		CD3257-40Q  -  DEFIBRILLATOR CRD THK14MM 40J 40X73MM 36CC UNIFY ASR	BOTH IP/OP	"$39,825.00 "	"$29,470.50"	$0.00	"$31,860.00"	"$17,921.25"	"$17,921.25"	$0.00	$0.00	$0.00	"$8,300.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,299.53"	$0.00	"$19,633.73"	"$19,633.73"	$0.00	"$19,912.50"	"$31,541.40"	"$31,860.00"	$0.00		$0.00	"$6,232.61"	$0.00	$0.00	"$6,340.14"	$0.00	$0.00	$0.00	$0.00	$0.00
CD3265-40	SUP	HCPCS C1882		CD3265-40  -  DEFIBRILLATOR CARDIAC THK14MM 40J 41X83MM 2 CHAMBER 1IS-1 1	BOTH IP/OP	"$42,750.00 "	"$31,635.00"	$0.00	"$34,200.00"	"$19,237.50"	"$19,237.50"	$0.00	$0.00	$0.00	"$8,910.17"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,909.10"	$0.00	"$21,075.75"	"$21,075.75"	$0.00	"$21,375.00"	"$33,858.00"	"$34,200.00"	$0.00		$0.00	"$6,690.38"	$0.00	$0.00	"$6,805.80"	$0.00	$0.00	$0.00	$0.00	$0.00
CD3265-40Q	SUP	HCPCS C1882		CD3265-40Q  -  DEFIBRILLATOR CRD THK14MM 40J 41X76MM 38CC QD ASR	BOTH IP/OP	"$42,750.00 "	"$31,635.00"	$0.00	"$34,200.00"	"$19,237.50"	"$19,237.50"	$0.00	$0.00	$0.00	"$8,910.17"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,909.10"	$0.00	"$21,075.75"	"$21,075.75"	$0.00	"$21,375.00"	"$33,858.00"	"$34,200.00"	$0.00		$0.00	"$6,690.38"	$0.00	$0.00	"$6,805.80"	$0.00	$0.00	$0.00	$0.00	$0.00
CDSLM57	SUP	Custom 27803010		CDSLM57  -  PATCH DURAL 7X5IN LATEX FREE DURAMATRIX-ONLAY	BOTH IP/OP	"$4,337.03 "	"$3,209.40"	$0.00	"$4,852.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,218.94"	"$3,218.94"	$0.00	$0.00	$903.84	$0.00	$0.00	$0.00	$0.00	"$3,032.50"	"$4,803.48"	"$4,852.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CDSM33	SUP	Custom 27803010		CDSM33  -  PATCH DURA 3X3IN DRMTRX IMPL FLXB STRNG CLGN MTRX	BOTH IP/OP	"$1,731.00 "	"$1,280.94"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.75"	"$1,284.75"	$0.00	$0.00	$360.74	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CF7-3-60	SUP	HCPCS C1888		CF7-3-60  -  CATHETER INTERVENTIONAL .025IN 7FR 60CM 3CM RADIOFREQUENCY	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	$0.00	$0.00	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CFF03	SUP	Custom 27203010		CFF03  -  TROCAR LAPSCP 5MM 100MM LF KII FIOS ADV FX SLV RPD INSFL 1ST	BOTH IP/OP	$225.00 	$166.50	$0.00	"$1,080.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$0.00	$0.00	$0.00	$675.00	"$1,069.20"	"$1,080.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CFF71	SUP	Custom 27203010		CFF71  -  TROCAR LAPSCP 12MM 150MM LF KII FIOS 1ST ENTRY ADV FX SLV	BOTH IP/OP	$250.00 	$185.00	$0.00	$185.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CG409	SUP	HCPCS C1725		CG409  -  CATHETER ANGIO CBR 2 CRV 4FR .041IN 65CM 15CM GLDCATH GLD	BOTH IP/OP	$132.95 	$98.38	$0.00	$98.68	$65.91	$65.91	$0.00	$0.00	$0.00	$27.71	$98.68	$98.68	$0.00	$0.00	$27.71	$0.00	$78.64	$78.64	$0.00	$60.69	$96.13	$97.10	$0.00		$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
CG415	SUP	HCPCS C1725		CG415  -  CATHETER ANGIOGRAPHIC ANGLE 4FR .041IN 65CM 15CM 2 BRAID	BOTH IP/OP	$132.95 	$98.38	$0.00	$98.68	$65.91	$65.91	$0.00	$0.00	$0.00	$27.71	$98.68	$98.68	$0.00	$0.00	$27.71	$0.00	$78.64	$78.64	$0.00	$60.69	$96.13	$97.10	$0.00		$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
CG416	SUP	HCPCS C1887		CG416  -  CATHETER ANGIOGRAPHIC ANGLE 4FR .041IN 100CM 15CM 2 BRAID	BOTH IP/OP	$132.95 	$98.38	$0.00	$98.68	$65.91	$65.91	$0.00	$0.00	$0.00	$27.71	$98.68	$98.68	$0.00	$0.00	$27.71	$0.00	$78.64	$78.64	$0.00	$60.69	$96.13	$97.10	$0.00		$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
CG502	SUP	HCPCS C1725		CG502  -  CATHETER ANGIO CBR 2 CRV 5FR .047IN 65CM 25CM GLDCATH GLD	BOTH IP/OP	$132.95 	$98.38	$0.00	$98.68	$65.91	$65.91	$0.00	$0.00	$0.00	$27.71	$98.68	$98.68	$0.00	$0.00	$27.71	$0.00	$78.64	$78.64	$0.00	$60.69	$96.13	$97.10	$0.00		$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
CG506	SUP	HCPCS C1725		CG506  -  CATHETER ANGIO STRG TPR 5FR .047IN 100CM GLDCATH GLD TCH BRD	BOTH IP/OP	$132.95 	$98.38	$0.00	$98.68	$65.91	$65.91	$0.00	$0.00	$0.00	$27.71	$98.68	$98.68	$0.00	$0.00	$27.71	$0.00	$78.64	$78.64	$0.00	$60.69	$96.13	$97.10	$0.00		$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
CG507	SUP	HCPCS C1725		CG507  -  CATHETER ANGIOGRAPHIC ANGLE 5FR .047IN 65CM 25CM 1 BRAID	BOTH IP/OP	$132.95 	$98.38	$0.00	$98.68	$65.91	$65.91	$0.00	$0.00	$0.00	$27.71	$98.68	$98.68	$0.00	$0.00	$27.71	$0.00	$78.64	$78.64	$0.00	$60.69	$96.13	$97.10	$0.00		$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
CG508	SUP	HCPCS C1725		CG508  -  CATHETER ANGIOGRAPHIC ANGLE 5FR .047IN 100CM 25CM 1 BRAID	BOTH IP/OP	$132.95 	$98.38	$0.00	$98.68	$65.91	$65.91	$0.00	$0.00	$0.00	$27.71	$98.68	$98.68	$0.00	$0.00	$27.71	$0.00	$78.64	$78.64	$0.00	$60.69	$96.13	$97.10	$0.00		$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
CG511	SUP	HCPCS C1725		CG511  -  CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 5FR .047IN 100CM 1	BOTH IP/OP	$132.95 	$98.38	$0.00	$98.68	$65.91	$65.91	$0.00	$0.00	$0.00	$27.71	$98.68	$98.68	$0.00	$0.00	$27.71	$0.00	$78.64	$78.64	$0.00	$60.69	$96.13	$97.10	$0.00		$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
CG513	SUP	HCPCS C1725		CG513  -  CATHETER ANGIO HDHNTR 1 CRV 5FR .047IN 100CM 25CM GLDCATH	BOTH IP/OP	$132.95 	$98.38	$0.00	$98.68	$65.91	$65.91	$0.00	$0.00	$0.00	$27.71	$98.68	$98.68	$0.00	$0.00	$27.71	$0.00	$78.64	$78.64	$0.00	$60.69	$96.13	$97.10	$0.00		$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
CG514	SUP	HCPCS C1725		CG514  -  CATHETER ANGIO BNTSN 1 CRV 5FR .047IN 100CM 25CM GLDCATH GLD	BOTH IP/OP	$132.95 	$98.38	$0.00	$98.68	$65.91	$65.91	$0.00	$0.00	$0.00	$27.71	$98.68	$98.68	$0.00	$0.00	$27.71	$0.00	$78.64	$78.64	$0.00	$60.69	$96.13	$97.10	$0.00		$0.00	$19.00	$0.00	$0.00	$19.32	$0.00	$0.00	$0.00	$0.00	$0.00
CL-07735	SUP	HCPCS C1894		INTRODUCER SHTH 7FR 8FR 13.75IN INTGR HMSTS VLV SDPRT	BOTH IP/OP	$149.00 	$110.26	$0.00	$119.20	$80.91	$80.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.50	$118.01	$119.20	$0.00		$0.00	$23.32	$0.00	$0.00	$23.72	$0.00	$0.00	$0.00	$0.00	$0.00
CL-07765	SUP	HCPCS C1894		INTRODUCER SHTH 7FR 65CM INTGR HMSTS VLV SDPRT TISS DILAT 3W	BOTH IP/OP	$233.45 	$172.75	$0.00	$186.76	$126.76	$126.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.73	$184.89	$186.76	$0.00		$0.00	$36.53	$0.00	$0.00	$37.17	$0.00	$0.00	$0.00	$0.00	$0.00
CM105C	SUP	Custom 25003010		ANTIBODY CK 5 CK 6 CLONE CK5/6.007 MS IGG1 1ML LAB	BOTH IP/OP	"$1,257.50 "	$930.55	$0.00	"$1,006.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$628.75	$995.94	"$1,006.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CM1520	SUP	HCPCS Q4116		CM1520  -  MATRIX TISS THK.4-1.6MM MED CNTR 19.3X9.6CM ALDRM SLCT ALGRF	BOTH IP/OP	"$9,007.50 "	"$6,665.55"	$0.00	"$11,178.00"	"$6,287.63"	"$6,287.63"	$0.00	$0.00	$0.00	"$1,877.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,877.16"	$0.00	"$4,440.70"	"$4,440.70"	$0.00	"$6,986.25"	"$11,066.22"	"$11,178.00"	$0.00		$0.00	"$2,186.70"	$0.00	$0.00	"$2,224.42"	$0.00	$0.00	$0.00	$0.00	$0.00
CM630147S	SUP	HCPCS C1713		CM630147S  -  NAIL 11MM 32CM HIP RIGHT GAMMA3 IM 130D LNG STRL	BOTH IP/OP	"$1,947.00 "	"$1,440.78"	$0.00	"$1,557.60"	$876.15	$876.15	$0.00	$0.00	$0.00	$405.80	"$1,445.06"	"$1,445.06"	$0.00	$0.00	$405.75	$0.00	"$1,151.65"	"$1,151.65"	$0.00	$973.50	"$1,542.02"	"$1,557.60"	$0.00		$0.00	$304.71	$0.00	$0.00	$309.96	$0.00	$0.00	$0.00	$0.00	$0.00
CM640047S	SUP	HCPCS C1713		CM640047S  -  NAIL 11MM 32CM LEFT HIP GAMA IM 130D LNG STRL	BOTH IP/OP	"$1,947.00 "	"$1,440.78"	$0.00	"$1,557.60"	$876.15	$876.15	$0.00	$0.00	$0.00	$405.80	"$1,445.06"	"$1,445.06"	$0.00	$0.00	$405.75	$0.00	"$1,151.65"	"$1,151.65"	$0.00	$973.50	"$1,542.02"	"$1,557.60"	$0.00		$0.00	$304.71	$0.00	$0.00	$309.96	$0.00	$0.00	$0.00	$0.00	$0.00
CM640048S	SUP	HCPCS C1713		CM640048S  -  NAIL 11MM 28CM LEFT HIP GAMA IM 130D LNG	BOTH IP/OP	"$1,947.00 "	"$1,440.78"	$0.00	"$1,557.60"	$876.15	$876.15	$0.00	$0.00	$0.00	$405.80	"$1,445.06"	"$1,445.06"	$0.00	$0.00	$405.75	$0.00	"$1,151.65"	"$1,151.65"	$0.00	$973.50	"$1,542.02"	"$1,557.60"	$0.00		$0.00	$304.71	$0.00	$0.00	$309.96	$0.00	$0.00	$0.00	$0.00	$0.00
CM640060S	SUP	HCPCS C1713		CM640060S  -  NAIL 11MM 300MM HIP LEFT GAMMA3 IM 135D LNG	BOTH IP/OP	"$1,947.00 "	"$1,440.78"	$0.00	"$1,557.60"	$876.15	$876.15	$0.00	$0.00	$0.00	$405.80	"$1,445.06"	"$1,445.06"	$0.00	$0.00	$405.75	$0.00	"$1,151.65"	"$1,151.65"	$0.00	$973.50	"$1,542.02"	"$1,557.60"	$0.00		$0.00	$304.71	$0.00	$0.00	$309.96	$0.00	$0.00	$0.00	$0.00	$0.00
CM640106S	SUP	HCPCS C1713		CM640106S  -  NAIL 11MM 32CM LEFT ORTH GAMA IM 135D LNG STRL	BOTH IP/OP	"$1,947.00 "	"$1,440.78"	$0.00	"$1,557.60"	$876.15	$876.15	$0.00	$0.00	$0.00	$405.80	"$1,445.06"	"$1,445.06"	$0.00	$0.00	$405.75	$0.00	"$1,151.65"	"$1,151.65"	$0.00	$973.50	"$1,542.02"	"$1,557.60"	$0.00		$0.00	$304.71	$0.00	$0.00	$309.96	$0.00	$0.00	$0.00	$0.00	$0.00
CM640113S	SUP	HCPCS C1713		CM640113S  -  NAIL 11MM 30CM HIP LEFT FEM GAMMA3 IM 130D LNG TI STRL	BOTH IP/OP	"$1,947.00 "	"$1,440.78"	$0.00	"$1,557.60"	$876.15	$876.15	$0.00	$0.00	$0.00	$405.80	"$1,445.06"	"$1,445.06"	$0.00	$0.00	$405.75	$0.00	"$1,151.65"	"$1,151.65"	$0.00	$973.50	"$1,542.02"	"$1,557.60"	$0.00		$0.00	$304.71	$0.00	$0.00	$309.96	$0.00	$0.00	$0.00	$0.00	$0.00
CM644004S	SUP	HCPCS C1713		CM644004S  -  NAIL 11MM 28CM LEFT HIP GAMA IM 135D LNG	BOTH IP/OP	"$1,947.00 "	"$1,440.78"	$0.00	"$1,557.60"	$876.15	$876.15	$0.00	$0.00	$0.00	$405.80	"$1,445.06"	"$1,445.06"	$0.00	$0.00	$405.75	$0.00	"$1,151.65"	"$1,151.65"	$0.00	$973.50	"$1,542.02"	"$1,557.60"	$0.00		$0.00	$304.71	$0.00	$0.00	$309.96	$0.00	$0.00	$0.00	$0.00	$0.00
CM645050S	SUP	HCPCS C1713		CM645050S  -  NAIL RIGHT GAMA IM LNG	BOTH IP/OP	"$1,947.00 "	"$1,440.78"	$0.00	"$1,557.60"	$876.15	$876.15	$0.00	$0.00	$0.00	$405.80	"$1,445.06"	"$1,445.06"	$0.00	$0.00	$405.75	$0.00	"$1,151.65"	"$1,151.65"	$0.00	$973.50	"$1,542.02"	"$1,557.60"	$0.00		$0.00	$304.71	$0.00	$0.00	$309.96	$0.00	$0.00	$0.00	$0.00	$0.00
CM645051S	SUP	HCPCS C1713		CM645051S  -  NAIL 11MM 280MM HIP RIGHT GAMMA3 IM 135D LNG	BOTH IP/OP	"$1,947.00 "	"$1,440.78"	$0.00	"$1,557.60"	$876.15	$876.15	$0.00	$0.00	$0.00	$405.80	"$1,445.06"	"$1,445.06"	$0.00	$0.00	$405.75	$0.00	"$1,151.65"	"$1,151.65"	$0.00	$973.50	"$1,542.02"	"$1,557.60"	$0.00		$0.00	$304.71	$0.00	$0.00	$309.96	$0.00	$0.00	$0.00	$0.00	$0.00
CM645059S	SUP	HCPCS C1713		CM645059S  -  NAIL 11MM 30CM RIGHT ORTH GAMA IM 135D LNG STRL	BOTH IP/OP	"$1,947.00 "	"$1,440.78"	$0.00	"$1,557.60"	$876.15	$876.15	$0.00	$0.00	$0.00	$405.80	"$1,445.06"	"$1,445.06"	$0.00	$0.00	$405.75	$0.00	"$1,151.65"	"$1,151.65"	$0.00	$973.50	"$1,542.02"	"$1,557.60"	$0.00		$0.00	$304.71	$0.00	$0.00	$309.96	$0.00	$0.00	$0.00	$0.00	$0.00
CM645092S	SUP	HCPCS C1713		CM645092S  -  NAIL RIGHT GAMA IM LNG	BOTH IP/OP	"$1,947.00 "	"$1,440.78"	$0.00	"$1,557.60"	$876.15	$876.15	$0.00	$0.00	$0.00	$405.80	"$1,445.06"	"$1,445.06"	$0.00	$0.00	$405.75	$0.00	"$1,151.65"	"$1,151.65"	$0.00	$973.50	"$1,542.02"	"$1,557.60"	$0.00		$0.00	$304.71	$0.00	$0.00	$309.96	$0.00	$0.00	$0.00	$0.00	$0.00
CM645107S	SUP	HCPCS C1713		CM645107S  -  NAIL 11MM 30CM HIP RIGHT FEM GAMMA3 IM 130D LNG TI STRL	BOTH IP/OP	"$1,947.00 "	"$1,440.78"	$0.00	"$1,557.60"	$876.15	$876.15	$0.00	$0.00	$0.00	$405.80	"$1,445.06"	"$1,445.06"	$0.00	$0.00	$405.75	$0.00	"$1,151.65"	"$1,151.65"	$0.00	$973.50	"$1,542.02"	"$1,557.60"	$0.00		$0.00	$304.71	$0.00	$0.00	$309.96	$0.00	$0.00	$0.00	$0.00	$0.00
CMRM6122	SUP	Custom 27503206		CMRM6122  -  ENVELOPE DFBR MED 2.5X2.75IN AIGISRX PCMKR ANBCTRL KNTD DISP	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,289.57"	"$1,289.57"	$0.00	$0.00	$362.10	$0.00	$0.00	$0.00	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CMRM6133	SUP	Custom 27503206		CMRM6133  -  ENVELOPE DFBR 3.35X3IN AIGISRX RSRB MINOCYCLINE RFMPN PP	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	$0.00	$0.00	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CMW-18-190	SUP	HCPCS C1769		CMW-18-190  -  GUIDEWIRE VASCULAR MICRO .018IN 190CM SHAPEABLE TIP APPROACH	BOTH IP/OP	$167.03 	$123.60	$0.00	$133.62	$90.69	$90.69	$0.00	$0.00	$0.00	$34.81	$123.97	$123.97	$0.00	$0.00	$34.81	$0.00	$98.80	$98.80	$0.00	$83.51	$132.29	$133.62	$0.00		$0.00	$26.14	$0.00	$0.00	$26.59	$0.00	$0.00	$0.00	$0.00	$0.00
CO201037	SUP	HCPCS C1760		CO201037  -  CLIP SURG HEMOSTATIC TEMPORARY NEUROLOGICAL RANEY PLST SCALP	BOTH IP/OP	$42.14 	$31.18	$0.00	$33.72	$18.96	$18.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.07	$33.37	$33.72	$0.00		$0.00	$6.60	$0.00	$0.00	$6.71	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2324	SUP	HCPCS C1713		CO-2324  -  SCREW BONE 2.3MM 24MM TI CORT NONSTRL	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$74.25	$74.25	$0.00	$0.00	$0.00	$34.39	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$97.60	$97.60	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2326	SUP	HCPCS C1713		CO-2326  -  SCREW BONE 2.3MM 26MM TI CORT NONSTRL	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$74.25	$74.25	$0.00	$0.00	$0.00	$34.39	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$97.60	$97.60	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
CO261230	SUP	Custom 27203010		CO261230  -  KIT CRANIOTOMY	BOTH IP/OP	"$1,025.00 "	$758.50	$0.00	$820.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$760.76	$760.76	$0.00	$0.00	$213.61	$0.00	$0.00	$0.00	$0.00	$512.50	$811.80	$820.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2706	SUP	HCPCS C1713		CO-2706  -  SCREW BONE 2MM 7MM 6MM CORT DORSAL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2708	SUP	HCPCS C1713		CO-2708  -  SCREW BN 2.7MM 8MM CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2710	SUP	HCPCS C1713		CO-2710  -  SCREW BN 2.7MM 10MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2712	SUP	HCPCS C1713		CO-2712  -  SCREW BN 2.7MM 12MM NS CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2714	SUP	HCPCS C1713		CO-2714  -  SCREW BN 2.7MM 14MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2716	SUP	HCPCS C1713		CO-2716  -  SCREW BN 2.7MM 16MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2718	SUP	HCPCS C1713		CO-2718  -  SCREW BN 2.7MM 18MM NS CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2720	SUP	HCPCS C1713		CO-2720  -  SCREW BN 2.7MM 20MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2722	SUP	HCPCS C1713		CO-2722  -  SCREW BN 2.7MM 22MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-27225	SUP	HCPCS C1713		CO-27225  -  SCREW BONE 2.7MM 22.5MM TI CORT ELB NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2724	SUP	HCPCS C1713		CO-2724  -  SCREW BN 2.7MM 24MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2725	SUP	HCPCS C1713		CO-2725  -  SCREW BN 2.7MM 25MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2726	SUP	HCPCS C1713		CO-2726  -  SCREW BN 2.7MM 26MM CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-27275	SUP	HCPCS C1713		CO-27275  -  SCREW BONE 2.7MM 27.5MM TI CORT ELB NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2728	SUP	HCPCS C1713		CO-2728  -  SCREW BN 2.7MM 28MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2730	SUP	HCPCS C1713		CO-2730  -  SCREW BN 2.7MM 30MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2732	SUP	HCPCS C1713		CO-2732  -  SCREW BN 2.7MM 32MM CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2734	SUP	HCPCS C1713		CO-2734  -  SCREW BN 2.7MM 34MM CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2735	SUP	HCPCS C1713		CO-2735  -  SCREW BONE 2.7MM 35MM TI CORT ELB NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2736	SUP	HCPCS C1713		CO-2736  -  SCREW BN 2.7MM 36MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-27375	SUP	HCPCS C1713		CO-27375  -  SCREW BONE 2.7MM 37.5MM CORT NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2738	SUP	HCPCS C1713		CO-2738  -  SCREW BN 2.7MM 38MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2740	SUP	HCPCS C1713		CO-2740  -  SCREW BN 2.7MM 40MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2745	SUP	HCPCS C1713		CO-2745  -  SCREW BONE 2.7MM 45MM TI CORT NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2750	SUP	HCPCS C1713		CO-2750  -  SCREW BN 2.7MM 50MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2755	SUP	HCPCS C1713		CO-2755  -  SCREW BN 2.7MM 55MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2760	SUP	HCPCS C1713		CO-2760  -  SCREW BN 2.7MM 60MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-2765	SUP	HCPCS C1713		CO-2765  -  SCREW BONE 2.7MM 65MM TI CORT ORTH LCK NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3060	SUP	HCPCS C1713		CO-3060  -  SCREW BONE 3.5MM 6MM CORT NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3080	SUP	HCPCS C1713		CO-3080  -  SCREW BN 3.5MM 8MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3100	SUP	HCPCS C1713		CO-3100  -  SCREW BN 3.5MM 10MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3110	SUP	HCPCS C1713		CO-3110  -  SCREW BN 3.5MM 10MM NS NLCKG CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3120	SUP	HCPCS C1713		CO-3120  -  SCREW BN 3.5MM 12MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3140	SUP	HCPCS C1713		CO-3140  -  SCREW BN 3.5MM 14MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3150-S	SUP	HCPCS C1713		CO-3150-S  -  SCREW BONE 3.5MM 15MM ACUMED TI CORT WR HND STRL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3160	SUP	HCPCS C1713		CO-3160  -  SCREW BN 3.5MM 16MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3175-S	SUP	HCPCS C1713		CO-3175-S  -  SCREW BONE 3.5MM 17.5MM ACUMED TI CORT WR HND STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3180	SUP	HCPCS C1713		CO-3180  -  SCREW BN 3.5MM 18MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3200	SUP	HCPCS C1713		CO-3200  -  SCREW BN 3.5MM 20MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3200-S	SUP	HCPCS C1713		CO-3200-S  -  SCREW BONE 3.5MM 20MM CORT STRL	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3220	SUP	HCPCS C1713		CO-3220  -  SCREW BN 3.5MM 22MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3225	SUP	HCPCS C1713		CO-3225  -  SCREW BN 3.5MM 22.5MM CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3240	SUP	HCPCS C1713		CO-3240  -  SCREW BN 3.5MM 24MM CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3250	SUP	HCPCS C1713		CO-3250  -  SCREW BONE 3.5MM 25MM TI CORT NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3250-S	SUP	HCPCS C1713		CO-3250-S  -  SCREW BONE L25 MM OD3.5 MM CORTICAL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3260	SUP	HCPCS C1713		CO-3260  -  SCREW BN 3.5MM 26MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3275	SUP	HCPCS C1713		CO-3275  -  SCREW BONE 3.5MM 27.5MM TI CORT ELB NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3280	SUP	HCPCS C1713		CO-3280  -  SCREW BN 3.5MM 28MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO3300	SUP	HCPCS C1713		CO3300  -  SCREW BONE 3.5MM 30MM TI CORT ORTH STRL	BOTH IP/OP	$135.85 	$100.53	$0.00	$108.68	$61.13	$61.13	$0.00	$0.00	$0.00	$28.31	$100.83	$100.83	$0.00	$0.00	$28.31	$0.00	$80.36	$80.36	$0.00	$67.93	$107.59	$108.68	$0.00		$0.00	$21.26	$0.00	$0.00	$21.63	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3300	SUP	HCPCS C1713		CO-3300  -  SCREW BN 3.5MM 30MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3300-S	SUP	HCPCS C1713		CO-3300-S  -  SCREW BONE 3.5MM 30MM ACUMED TI CORT WR HND STRL	BOTH IP/OP	$165.00 	$122.10	$0.00	$132.00	$74.25	$74.25	$0.00	$0.00	$0.00	$34.39	$122.46	$122.46	$0.00	$0.00	$34.39	$0.00	$97.60	$97.60	$0.00	$82.50	$130.68	$132.00	$0.00		$0.00	$25.82	$0.00	$0.00	$26.27	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3320	SUP	HCPCS C1713		CO-3320  -  SCREW BN 3.5MM 32MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3325	SUP	HCPCS C1713		CO-3325  -  SCREW BN 3.5MM 32.5MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3340	SUP	HCPCS C1713		CO-3340  -  SCREW BONE 3.5MM 34MM TI CORT CLVCL SHLDR ANKL FT LCK	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3350	SUP	HCPCS C1713		CO-3350  -  SCREW BONE 3.5MM 35MM TI CORT ELB NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3360	SUP	HCPCS C1713		CO-3360  -  SCREW BN 3.5MM 36MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3375	SUP	HCPCS C1713		CO-3375  -  SCREW BONE 3.5MM 37.5MM TI CORT NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3380	SUP	HCPCS C1713		CO-3380  -  SCREW BN 3.5MM 38MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3400	SUP	HCPCS C1713		CO-3400  -  SCREW BN 3.5MM 40MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3450	SUP	HCPCS C1713		CO-3450  -  SCREW BN 3.5MM 45MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3500	SUP	HCPCS C1713		CO-3500  -  SCREW BONE 3.5MM 50MM TI CORT FIB NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3550	SUP	HCPCS C1713		CO-3550  -  SCREW BN 3.5MM 55MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3600	SUP	HCPCS C1713		CO-3600  -  SCREW BN 3.5MM 60MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-3650	SUP	HCPCS C1713		CO-3650  -  SCREW BN 3.5MM 65MM NS TI CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO431022	SUP	HCPCS C1713		CO431022  -  PLATE BONE 150X150MM MESH TITANIUM CRANFCL	BOTH IP/OP	"$2,950.00 "	"$2,183.00"	$0.00	"$2,360.00"	"$1,327.50"	"$1,327.50"	$0.00	$0.00	$0.00	$614.85	"$2,189.49"	"$2,189.49"	$0.00	$0.00	$614.78	$0.00	"$1,454.35"	"$1,454.35"	$0.00	"$1,475.00"	"$2,336.40"	"$2,360.00"	$0.00		$0.00	$461.68	$0.00	$0.00	$469.64	$0.00	$0.00	$0.00	$0.00	$0.00
CO431050	SUP	HCPCS C1713		KIT CRANIOPLASTY 2 BAG POWDER 2 VIAL LIQUID 2 MATRIX BAG	BOTH IP/OP	"$2,879.26 "	"$2,130.65"	$0.00	"$2,303.41"	"$1,295.67"	"$1,295.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,439.63"	"$2,280.37"	"$2,303.41"	$0.00		$0.00	$450.60	$0.00	$0.00	$458.38	$0.00	$0.00	$0.00	$0.00	$0.00
CODA-2-10.0-35-120-32	SUP	HCPCS C2628		CODA-2-10.0-35-120-32  -  CATH BALDILAT .035IN 10FR OD 32MM 120CM BALLON VASC PROS	BOTH IP/OP	"$1,042.50 "	$771.45	$0.00	$834.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$521.25	$825.66	$834.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CODA-2-10.0-35-120-40	SUP	HCPCS C2628		CODA-2-10.0-35-120-40  -  CATH BALDILAT .035IN 10FR 40MM 120CM CODA 40ML	BOTH IP/OP	"$1,042.50 "	$771.45	$0.00	$834.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.28	$773.74	$773.74	$0.00	$0.00	$217.26	$0.00	$616.64	$616.64	$0.00	$521.25	$825.66	$834.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2106	SUP	HCPCS C1713		CO-F2106  -  SCREW BONE 2.1MM 6MM TI CORT WR HND CRCIFRM RECESS NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2108	SUP	HCPCS C1713		CO-F2108  -  SCREW BN 2.1MM 8MM NLCKG TI	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2110	SUP	HCPCS C1713		CO-F2110  -  SCREW BN 2.1MM 10MM NLCKG TI	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2112	SUP	HCPCS C1713		CO-F2112  -  SCREW BN 2.1MM 12MM NLCKG TI	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2114	SUP	HCPCS C1713		CO-F2114  -  SCREW BONE 2.1MM 14MM TI WR HND CRCIFRM NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2116	SUP	HCPCS C1713		CO-F2116  -  SCREW BN 2.1MM 16MM NLCKG TI	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2118	SUP	HCPCS C1713		CO-F2118  -  SCREW BONE 2.1MM 18MM TI CORT LCK NONSTRL MDLR HAND SYS	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2120	SUP	HCPCS C1713		CO-F2120  -  SCREW BONE 2.1MM 20MM CORT NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2122	SUP	HCPCS C1713		CO-F2122  -  SCREW BONE 2.1MM 22MM TI ORTH NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2124	SUP	HCPCS C1713		CO-F2124  -  SCREW BONE 2.1MM 24MM TI CORT CRCIFRM RECESS NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2126	SUP	HCPCS C1713		CO-F2126  -  SCREW BONE 2.1MM 26MM TI CORT CRCIFRM RECESS NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2128	SUP	HCPCS C1713		CO-F2128  -  SCREW BONE 2.1MM 28MM TI CORT CRCIFRM RECESS NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2706	SUP	HCPCS C1713		CO-F2706  -  SCREW BN 2.7MM 6MM NS CRFRM TI CORT MDLR HND SYS	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2708	SUP	HCPCS C1713		CO-F2708  -  SCREW BN 2.7MM 8MM NS CRFRM TI CORT MDLR HND SYS	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2710	SUP	HCPCS C1713		CO-F2710  -  SCREW BN 2.7MM 10MM NS CRFRM TI CORT MDLR HND SYS	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2712	SUP	HCPCS C1713		CO-F2712  -  SCREW BN 2.7MM 12MM NS CRFRM TI CORT MDLR HND SYS	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2714	SUP	HCPCS C1713		CO-F2714  -  SCREW BN 2.7MM 14MM CRFRM CORT	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2716	SUP	HCPCS C1713		CO-F2716  -  SCREW BONE 2.7MM 16MM TI ORTH CRCIFRM NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2718	SUP	HCPCS C1713		CO-F2718  -  SCREW BONE 2.7MM 18MM TI CORT LCK NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2720	SUP	HCPCS C1713		CO-F2720  -  SCREW BONE 2.7MM 20MM TI CORT LCK NSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2722	SUP	HCPCS C1713		CO-F2722  -  SCREW BONE 2.7MM 22MM TI CORT LCK NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2724	SUP	HCPCS C1713		CO-F2724  -  SCREW BONE 2.7MM 24MM TI CORT LCK NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2726	SUP	HCPCS C1713		CO-F2726  -  SCREW BONE 2.7MM 26MM ACUMED TI RADL ELB CRCIFRM STRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-F2728	SUP	HCPCS C1713		CO-F2728  -  SCREW BONE 2.7MM 28MM TI CORT CRCIFRM NONSTRL	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$81.00	$81.00	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
CO-FA2736	SUP	HCPCS C1713		CO-FA2736  -  SCREW BONE 2.7MM 36MM TAP-LOC ACUMED CORT ELB STRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
CO-FA3545	SUP	HCPCS C1713		CO-FA3545  -  SCREW BONE 3.5MM 45MM TAP-LOC ACUMED ELB STRL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
CO-FA3555	SUP	HCPCS C1713		CO-FA3555  -  SCREW BONE 3.5MM 55MM TAP-LOC ACUMED ELB STRL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2080	SUP	HCPCS C1713		COL-2080  -  SCREW BN 2.7MM 8MM LCK CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2100	SUP	HCPCS C1713		COL-2100  -  SCREW BONE 2.7MM 10MM TI CORT ELB LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2120	SUP	HCPCS C1713		COL-2120  -  SCREW BN 2.7MM 12MM LCK CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2140	SUP	HCPCS C1713		COL-2140  -  SCREW BN 2.7MM 14MM NS LCK HEX TI CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2160	SUP	HCPCS C1713		COL-2160  -  SCREW BN 2.7MM 16MM NS LCK HEX TI CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2180	SUP	HCPCS C1713		COL-2180  -  SCREW BN 2.7MM 18MM NS LCK HEX TI CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2200	SUP	HCPCS C1713		COL-2200  -  SCREW BN 2.7MM 20MM LCK CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2220	SUP	HCPCS C1713		COL-2220  -  SCREW BN 2.7MM 22MM NS LCK HEX TI CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2240	SUP	HCPCS C1713		COL-2240  -  SCREW BONE 2.7MM 24MM TI CORT ELB LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2250	SUP	HCPCS C1713		COL-2250  -  SCREW BONE 2.7MM 25MM CORT SCAPULAR LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2260	SUP	HCPCS C1713		COL-2260  -  SCREW BONE 2.7MM 26MM TI CORT ELB LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2280	SUP	HCPCS C1713		COL-2280  -  SCREW BONE 2.7MM 28MM TI CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2300	SUP	HCPCS C1713		COL-2300  -  SCREW BONE 2.7MM 30MM CORT LCK	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2320	SUP	HCPCS C1713		COL-2320  -  SCREW BONE 2.7MM 32MM CORT LCK	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2340	SUP	HCPCS C1713		COL-2340  -  SCREW BONE 2.7MM 34MM TI CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2360	SUP	HCPCS C1713		COL-2360  -  SCREW BONE 2.7MM 36MM CORT LCK	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2380	SUP	HCPCS C1713		COL-2380  -  SCREW BONE 2.7MM 38MM TI FULTHD CORT LCK	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2400	SUP	HCPCS C1713		COL-2400  -  SCREW BONE 2.7MM 40MM TI CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2450	SUP	HCPCS C1713		COL-2450  -  SCREW BONE 2.7MM 45MM CORT SCAPULAR LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2500	SUP	HCPCS C1713		COL-2500  -  SCREW BONE 2.7MM 50MM CORT SCAPULAR LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2550	SUP	HCPCS C1713		COL-2550  -  SCREW BONE 2.7MM 55MM CORT SCAPULAR LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2600	SUP	HCPCS C1713		COL-2600  -  SCREW BN 2.7MM 60MM NS LCK HEX TI CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2650	SUP	HCPCS C1713		COL-2650  -  SCREW BONE 2.7MM 65MM CORT SCAPULAR LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2718	SUP	HCPCS C1713		COL-2718  -  SCREW BONE 2.7MM 18MM CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2720	SUP	HCPCS C1713		COL-2720  -  SCREW BONE 2.7MM 20MM CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-2722	SUP	HCPCS C1713		COL-2722  -  SCREW BONE 2.7MM 22MM TI CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3060	SUP	HCPCS C1713		COL-3060  -  SCREW BONE 3.5MM 6MM CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3080	SUP	HCPCS C1713		COL-3080  -  SCREW BONE 3.5MM 8MM TI DISTAL RADL CORT CLVCL WR HND LCK	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3100	SUP	HCPCS C1713		COL-3100  -  SCREW BONE 3.5MM 10MM TI DISTAL RADL CORT CLVCL WR HND LCK	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3120	SUP	HCPCS C1713		COL-3120  -  SCREW BONE 3.5MM 12MM TI CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
CO-L3120	SUP	HCPCS C1713		CO-L3120  -  SCREW BONE 3.5MM 12MM CORT LCK NSTRL	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3140	SUP	HCPCS C1713		COL-3140  -  SCREW BONE 3.5MM 14MM TI DISTAL RADL CORT CLVCL WR HND LCK	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
CO-L3140	SUP	HCPCS C1713		CO-L3140  -  SCREW BONE 3.5MM 14MM ACUMED ACLC CORT ORTH LCK STRL	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3160	SUP	HCPCS C1713		COL-3160  -  SCREW BONE 3.5MM 16MM TI DISTAL RADL CORT CLVCL WR HND LCK	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3180	SUP	HCPCS C1713		COL-3180  -  SCREW BONE 3.5MM 18MM TI CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
CO-L3180	SUP	HCPCS C1713		CO-L3180  -  SCREW BONE 3.5MM 18MM ACLC ACUMED CORT ORTH LCK STRL	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3200	SUP	HCPCS C1713		COL-3200  -  SCREW BONE 3.5MM 20MM TI DISTAL RADL CORT CLVCL WR HND LCK	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3220	SUP	HCPCS C1713		COL-3220  -  SCREW BONE 3.5MM 22MM TI DISTAL RADL CORT CLVCL WR HND LCK	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3225	SUP	HCPCS C1713		COL-3225  -  SCREW BONE 3.5MM 22.5MM CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3240	SUP	HCPCS C1713		COL-3240  -  SCREW BONE 3.5MM 24MM ACUMED TI CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3250	SUP	HCPCS C1713		COL-3250  -  SCREW BONE 3.5MM 25MM TI CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3260	SUP	HCPCS C1713		COL-3260  -  SCREW BONE 3.5MM 26MM ACUMED TI DISTAL RADL CORT CLVCL WR	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3275	SUP	HCPCS C1713		COL-3275  -  SCREW BONE 3.5MM 27.5MM TI CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3280	SUP	HCPCS C1713		COL-3280  -  SCREW BONE 3.5MM 28MM TI DISTAL RADL CORT CLVCL WR HND LCK	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3300	SUP	HCPCS C1713		COL-3300  -  SCREW BN 3.5MM 30MM NS TI CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3320	SUP	HCPCS C1713		COL-3320  -  SCREW BN 3.5MM 32MM NS LCK TI CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3340	SUP	HCPCS C1713		COL-3340  -  SCREW BONE 3.5MM 34MM TI CORT LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3360	SUP	HCPCS C1713		COL-3360  -  SCREW BN 3.5MM 36MM NS LCK TI CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3380	SUP	HCPCS C1713		COL-3380  -  SCREW BN 3.5MM 38MM LCK CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3400	SUP	HCPCS C1713		COL-3400  -  SCREW BN 3.5MM 40MM NS LCK TI CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3450	SUP	HCPCS C1713		COL-3450  -  SCREW BN 3.5MM 45MM NS LCK TI CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3500	SUP	HCPCS C1713		COL-3500  -  SCREW BN 3.5MM 50MM NS LCK TI CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3550	SUP	HCPCS C1713		COL-3550  -  SCREW BN 3.5MM 55MM LCK CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3600	SUP	HCPCS C1713		COL-3600  -  SCREW BN 3.5MM 60MM LCK CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COL-3650	SUP	HCPCS C1713		COL-3650  -  SCREW BN 3.5MM 65MM LCK CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
COLS-35080-TS	SUP	HCPCS C1713		COLS-35080-TS  -  SCREW BN 3.5MM 8MM LCK TI RDS CORT DIST	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
COLS-35090-TS	SUP	HCPCS C1713		COLS-35090-TS  -  SCREW BN 3.5MM 9MM LCK TI RDS CORT DIST	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
COLS-35100-TS	SUP	HCPCS C1713		COLS-35100-TS  -  SCREW BN 3.5MM 10MM NS GEMINUS LCK TI DIST CORT VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
COLS-35110-TS	SUP	HCPCS C1713		COLS-35110-TS  -  SCREW BN 3.5MM 11MM BRNZ NS GEMINUS LCK TI CORT VOLR DIST	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
COLS-35120-TS	SUP	HCPCS C1713		COLS-35120-TS  -  SCREW BN 3.5MM 12MM NS GEMINUS LCK TI DIST CORT VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
COLS-35130-TS	SUP	HCPCS C1713		COLS-35130-TS  -  SCREW BN 3.5MM 13MM NS GEMINUS LCK TI DIST CORT VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
COLS-35140-TS	SUP	HCPCS C1713		COLS-35140-TS  -  SCREW BN 3.5MM 14MM NS GEMINUS LCK TI DIST CORT VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
COLS-35150-TS	SUP	HCPCS C1713		COLS-35150-TS  -  SCREW BN 3.5MM 15MM NS GEMINUS LCK TI DIST CORT VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
COLS-35160-TS	SUP	HCPCS C1713		COLS-35160-TS  -  SCREW BN 3.5MM 16MM NS GEMINUS LCK TI DIST CORT VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
COLS-35180-TS	SUP	HCPCS C1713		COLS-35180-TS  -  SCREW BN 3.5MM 18MM NS GEMINUS LCK TI DIST CORT VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2308	SUP	HCPCS C1713		CO-N2308  -  SCREW BN 2.3MM 8MM NONTOGGLING	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2310	SUP	HCPCS C1713		CO-N2310  -  SCREW BN 2.3MM 10MM NONTOGGLING CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2312	SUP	HCPCS C1713		CO-N2312  -  SCREW BN 2.3MM 12MM NLCKG	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2314	SUP	HCPCS C1713		CO-N2314  -  SCREW BN 2.3MM 14MM SLVR NS NONTOGGLE HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2316	SUP	HCPCS C1713		CO-N2316  -  SCREW BN 2.3MM 16MM SLVR NS NONTOGGLE HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2318	SUP	HCPCS C1713		CO-N2318  -  SCREW BN 2.3MM 18MM SLVR NS NONTOGGLE HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2320	SUP	HCPCS C1713		CO-N2320  -  SCREW BN 2.3MM 20MM SLVR NS NONTOGGLE HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2322	SUP	HCPCS C1713		CO-N2322  -  SCREW BN 2.3MM 22MM SLVR NS NONTOGGLE HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2324	SUP	HCPCS C1713		CO-N2324  -  SCREW BONE 2.3MM 24MM ACLC ACUMED TI DISTAL RADL WR HND	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CON-2326	SUP	HCPCS C1713		CON-2326  -  SCREW BONE 2.3MM 26MM ACLC ACUMED DISTAL RADL WR HND	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2326	SUP	HCPCS C1713		CO-N2326  -  SCREW BONE 2.3MM 26MM ACLC ACUMED TI THRD DISTAL RADL WR HND	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2328	SUP	HCPCS C1713		CO-N2328  -  SCREW 2.3MM X 28MM NON-TOGGLING CORTICAL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2330	SUP	HCPCS C1713		CO-N2330  -  SCREW BONE 2.3MM 30MM ACLC ACUMED TI THRD DISTAL RADL WR HND	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2332	SUP	HCPCS C1713		CO-N2332  -  SCREW BN 2.3MM 32MM STRL NONTOGGLING CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2334	SUP	HCPCS C1713		CO-N2334  -  SCREW BONE 2.3MM 34MM ACLC 2 DISTAL VOLR CORT RADL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2336	SUP	HCPCS C1713		CO-N2336  -  SCREW BONE 2.3MM 36MM ACLC 2 DISTAL VOLR CORT RADL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2338	SUP	HCPCS C1713		CO-N2338  -  SCREW BONE 2.3MM 38MM ACLC 2 DISTAL VOLR CORT RADL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2340	SUP	HCPCS C1713		CO-N2340  -  SCREW BONE 2.3MM 40MM ACLC 2 DISTAL VOLR CORT RADL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2342	SUP	HCPCS C1713		CO-N2342  -  SCREW BONE 2.3MM 42MM ACLC 2 DISTAL VOLR CORT RADL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2344	SUP	HCPCS C1713		CO-N2344  -  SCREW BONE 2.3MM 44MM ACLC 2 DISTAL VOLR CORT RADL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-N2346	SUP	HCPCS C1713		CO-N2346  -  SCREW BONE 2.3MM 46MM ACLC 2 DISTAL VOLR CORT RADL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CONSULTAMMAM	SUP	HCPCS C2621		CONSULTAMMAM  -  CONSULTA CRT-D ADVANCED SYSTEM	BOTH IP/OP	"$60,500.00 "	"$44,770.00"	$0.00	"$48,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$12,608.20"	$0.00	$0.00	$0.00	$0.00	"$30,250.00"	"$47,916.00"	"$48,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2112	SUP	HCPCS C1713		CO-S2112  -  SCREW BONE 2.1MM 12MM CORT LP STRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2114	SUP	HCPCS C1713		CO-S2114  -  SCREW BONE 2.1MM 14MM CORT LP STRL	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2308	SUP	Custom 27803010		CO-S2308  -  PEG FIX 2.3MM 8MM CORT LCK ACUMED STRL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2310	SUP	HCPCS C1713		CO-S2310  -  PEG FX 2.3MM 10MM LCK SMTH	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2312	SUP	Custom 27203010		CO-S2312  -  PEG FIX 2.3MM 12MM CORT LCK STRL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2314	SUP	Custom 27803010		CO-S2314  -  PEG 2.3MM 14MM CORT LCK TI NONSTRL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2316	SUP	Custom 27803010		CO-S2316  -  PEG FX 2.3MM 16MM SMTH LCK CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2318	SUP	Custom 27803010		CO-S2318  -  PEG 2.3MM 18MM DISTAL RADL WR HND LCK SMTH TI NONSTRL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2320	SUP	Custom 27803010		CO-S2320  -  PEG BONE 20MM 2.3MM CORT SMTH LCK STRL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2322	SUP	Custom 27803010		CO-S2322  -  PEG BONE 22MM 2.3MM ACLC CORT SMTH LCK	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2324	SUP	Custom 27803010		CO-S2324  -  PEG 2.3MM 24MM DISTAL RADL WR HND LCK SMTH TI ACUMED STRL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2326	SUP	Custom 27803010		CO-S2326  -  PEG 2.3MM 26MM WR HND LCK SMTH TI ACUMED STRL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2328	SUP	HCPCS C1713		CO-S2328  -  PEG FX 2.3MM 28MM SMTH LCK CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-S2714	SUP	HCPCS C1713		CO-S2714  -  SCREW BONE 2.7MM 14MM CORT LP STRL	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$65.25	$65.25	$0.00	$0.00	$0.00	$30.22	$107.62	$107.62	$0.00	$0.00	$30.22	$0.00	$85.77	$85.77	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$22.69	$0.00	$0.00	$23.08	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2308	SUP	HCPCS C1713		CO-T2308  -  SCREW BN FT 2.3MM 8MM AU NS LCK HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2310	SUP	HCPCS C1713		CO-T2310  -  SCREW BN FT 2.3MM 10MM AU NS LCK HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2312	SUP	HCPCS C1713		CO-T2312  -  SCREW BN FT 2.3MM 12MM AU NS LCK HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
COT-2314	SUP	HCPCS C1713		COT-2314  -  SCREW BONE 2.3MM 14MM CORT LCK NSTRL	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2314	SUP	HCPCS C1713		CO-T2314  -  SCREW BN FT 2.3MM 14MM AU NS LCK HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2316	SUP	HCPCS C1713		CO-T2316  -  SCREW BN FT 2.3MM 16MM AU NS LCK HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2318	SUP	HCPCS C1713		CO-T2318  -  SCREW BN FT 2.3MM 18MM AU NS LCK HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2320	SUP	HCPCS C1713		CO-T2320  -  SCREW BN FT 2.3MM 20MM AU NS LCK HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2322	SUP	HCPCS C1713		CO-T2322  -  SCREW BN FT 2.3MM 22MM AU NS LCK HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2324	SUP	HCPCS C1713		CO-T2324  -  SCREW BN FT 2.3MM 24MM AU NS LCK HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2326	SUP	HCPCS C1713		CO-T2326  -  SCREW BN FT 2.3MM 26MM AU NS LCK HEX TI CORT	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2328	SUP	HCPCS C1713		CO-T2328  -  SCREW BONE 2.3MM 28MM ACUMED TI THRD DISTAL RADL CORT WR HND	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2330	SUP	HCPCS C1713		CO-T2330  -  SCREW CORTICAL LOCK 2.3MM X 30MM	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2332	SUP	HCPCS C1713		CO-T2332  -  SCREW BONE 2.3MM 32MM ACLC 2 FULTHD DISTAL VOLR CORT RADL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2334	SUP	HCPCS C1713		CO-T2334  -  SCREW BONE 2.3MM 34MM CORT LCK	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2336	SUP	HCPCS C1713		CO-T2336  -  SCREW BONE 2.3MM 36MM CORT LCK	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2338	SUP	HCPCS C1713		CO-T2338  -  SCREW BONE 2.3MM 38MM ACLC 2 FULTHD DISTAL VOLR CORT RADL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2340	SUP	HCPCS C1713		CO-T2340  -  SCREW BONE 2.3MM 24MM TI CORT ELB LCK NONSTRL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2342	SUP	HCPCS C1713		CO-T2342  -  SCREW BONE 2.3MM 42MM ACLC 2 FULTHD DISTAL VOLR CORT RADL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2344	SUP	HCPCS C1713		CO-T2344  -  SCREW BONE 2.3MM 44MM ACLC 2 FULTHD DISTAL VOLR CORT RADL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CO-T2346	SUP	HCPCS C1713		CO-T2346  -  SCREW BONE 2.3MM 46MM ACLC 2 FULTHD DISTAL VOLR CORT RADL	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$99.00	$99.00	$0.00	$0.00	$0.00	$45.85	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$130.13	$130.13	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$34.43	$0.00	$0.00	$35.02	$0.00	$0.00	$0.00	$0.00	$0.00
CP320340	SUP	HCPCS C1713		CP320340  -  CUSTOM KNEE ARTHRODESIS NAIL 11.5X880MM	BOTH IP/OP	"$16,225.00 "	"$12,006.50"	$0.00	"$12,980.00"	"$7,301.25"	"$7,301.25"	$0.00	$0.00	$0.00	"$3,381.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,381.29"	$0.00	"$7,998.93"	"$7,998.93"	$0.00	"$8,112.50"	"$12,850.20"	"$12,980.00"	$0.00		$0.00	"$2,539.21"	$0.00	$0.00	"$2,583.02"	$0.00	$0.00	$0.00	$0.00	$0.00
CP326963	SUP	HCPCS C1713		CP326963  -  ASNIS SCREW 8.0 X 160MM	BOTH IP/OP	"$1,097.25 "	$811.97	$0.00	$877.80	$493.76	$493.76	$0.00	$0.00	$0.00	$228.69	$814.38	$814.38	$0.00	$0.00	$228.67	$0.00	$649.02	$649.02	$0.00	$548.63	$869.02	$877.80	$0.00		$0.00	$171.72	$0.00	$0.00	$174.68	$0.00	$0.00	$0.00	$0.00	$0.00
CP326981	SUP	HCPCS C1713		CP326981  -  ASNIS SCREW 8.0 X 180MM	BOTH IP/OP	"$1,097.25 "	$811.97	$0.00	$877.80	$493.76	$493.76	$0.00	$0.00	$0.00	$228.69	$814.38	$814.38	$0.00	$0.00	$228.67	$0.00	$649.02	$649.02	$0.00	$548.63	$869.02	$877.80	$0.00		$0.00	$171.72	$0.00	$0.00	$174.68	$0.00	$0.00	$0.00	$0.00	$0.00
CP390009	SUP	HCPCS C1713		CP390009  -  WASHER 26MM	BOTH IP/OP	$140.25 	$103.79	$0.00	$112.20	$63.11	$63.11	$0.00	$0.00	$0.00	$29.23	$104.09	$104.09	$0.00	$0.00	$29.23	$0.00	$82.96	$82.96	$0.00	$70.13	$111.08	$112.20	$0.00		$0.00	$21.95	$0.00	$0.00	$22.33	$0.00	$0.00	$0.00	$0.00	$0.00
CP425737	SUP	HCPCS C1713		CP425737  -  CUSTOM CLAVICLE PLATE	BOTH IP/OP	"$4,400.00 "	"$3,256.00"	$0.00	"$3,520.00"	"$1,980.00"	"$1,980.00"	$0.00	$0.00	$0.00	$917.07	"$3,265.68"	"$3,265.68"	$0.00	$0.00	$916.96	$0.00	"$2,169.20"	"$2,169.20"	$0.00	"$2,200.00"	"$3,484.80"	"$3,520.00"	$0.00		$0.00	$688.60	$0.00	$0.00	$700.48	$0.00	$0.00	$0.00	$0.00	$0.00
CP427181	SUP	HCPCS C1713		CP427181  -  AXSOS CUSTOM-MADE DEVICE_ HUMERUS PLATE 8-HOLES	BOTH IP/OP	"$4,812.50 "	"$3,561.25"	$0.00	"$3,850.00"	"$2,165.63"	"$2,165.63"	$0.00	$0.00	$0.00	"$1,003.05"	"$3,571.84"	"$3,571.84"	$0.00	$0.00	"$1,002.93"	$0.00	"$2,372.56"	"$2,372.56"	$0.00	"$2,406.25"	"$3,811.50"	"$3,850.00"	$0.00		$0.00	$753.16	$0.00	$0.00	$766.15	$0.00	$0.00	$0.00	$0.00	$0.00
CP427182	SUP	HCPCS C1713		CP427182  -  AXSOS CUSTOM-MADE DEVICE - HUMERUS PLATE 6 HOLES	BOTH IP/OP	"$9,625.00 "	"$7,122.50"	$0.00	"$7,700.00"	"$4,331.25"	"$4,331.25"	$0.00	$0.00	$0.00	"$2,006.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,005.85"	$0.00	"$4,745.13"	"$4,745.13"	$0.00	"$4,812.50"	"$7,623.00"	"$7,700.00"	$0.00		$0.00	"$1,506.31"	$0.00	$0.00	"$1,532.30"	$0.00	$0.00	$0.00	$0.00	$0.00
CP461006	SUP	Custom 27803010		CP461006  -  TRIAL SURG 4CM OSS DPHSL IMPL	BOTH IP/OP	"$2,500,000.00 "	"$1,850,000.00"	$0.00	"$2,000,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$521,000.00"	$0.00	$0.00	$0.00	$0.00	"$1,250,000.00"	"$1,980,000.00"	"$2,000,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CP5080-2-112	SUP	Custom 27203010		CP5080-2-112  -  APEX PIN DIA 2MM_ LENGTH 100MM_ THREAD LENGTH 12MM	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CP5080-2-120	SUP	Custom 27203010		CP5080-2-120  -  APEX PIN DIA 2MM_ LENGTH 100MM_ THREAD LENGTH 20MM	BOTH IP/OP	$220.00 	$162.80	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.28	$163.28	$0.00	$0.00	$45.85	$0.00	$0.00	$0.00	$0.00	$110.00	$174.24	$176.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CP5080-2-212	SUP	Custom 27203010		CP5080-2-212  -  CUSTOM-MADE DEVICE APEX DIA 2MM 100 X 12MM	BOTH IP/OP	$364.38 	$269.64	$0.00	$291.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.44	$270.44	$0.00	$0.00	$75.94	$0.00	$0.00	$0.00	$0.00	$182.19	$288.59	$291.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CP5080-2-220	SUP	Custom 27203010		CP5080-2-220  -  CUSTOM-MADE DEVICE APEX DIA 2MM 100 X 20MM	BOTH IP/OP	$364.38 	$269.64	$0.00	$291.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.44	$270.44	$0.00	$0.00	$75.94	$0.00	$0.00	$0.00	$0.00	$182.19	$288.59	$291.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CP5150-2-864	SUP	Custom 27803010		CP5150-2-864  -  MONOTUBE TRIAX DIA 20 X 640MM	BOTH IP/OP	"$3,118.50 "	"$2,307.69"	$0.00	"$2,494.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,314.55"	"$2,314.55"	$0.00	$0.00	$649.90	$0.00	$0.00	$0.00	$0.00	"$1,559.25"	"$2,469.85"	"$2,494.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CP606155	SUP	Custom 27803010		CP606155  -  ASNIS III DIA 6.5 X 155MM - CUSTOM MADE DEVICE	BOTH IP/OP	"$1,080.75 "	$799.76	$0.00	$864.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$802.13	$802.13	$0.00	$0.00	$225.23	$0.00	$0.00	$0.00	$0.00	$540.38	$855.95	$864.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CP606160	SUP	Custom 27803010		CP606160  -  ASNIS III DIA 6.5 X 160MM - CUSTOM MADE DEVICE	BOTH IP/OP	"$1,080.75 "	$799.76	$0.00	$864.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$802.13	$802.13	$0.00	$0.00	$225.23	$0.00	$0.00	$0.00	$0.00	$540.38	$855.95	$864.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CP910	SUP	HCPCS L8614		CP910  -  PROCESSOR SOUND EARHOOK INDICATOR LIGHT RECHARGABLE BATTERY	BOTH IP/OP	"$23,250.00 "	"$17,205.00"	$0.00	"$18,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,845.30"	$0.00	$0.00	$0.00	$0.00	"$11,625.00"	"$18,414.00"	"$18,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CPO-6	SUP	Custom 27011340		CPO-6  -  CATHETER SURG 6FR PNEUMO COLPOTOMY LATEX FREE COLPO-PNEUMO	BOTH IP/OP	$109.68 	$81.16	$0.00	$87.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.40	$81.40	$0.00	$0.00	$22.86	$0.00	$0.00	$0.00	$0.00	$54.84	$86.87	$87.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C-PTISY-100-HC-PERC8	SUP	HCPCS C1769		C-PTISY-100-HC-PERC8  -  INTROD TUBE 24-28FR CGL BRHN 8 PERC HYDPHI INTROD SHLY DILAT	BOTH IP/OP	$905.05 	$669.74	$0.00	$724.04	$491.44	$491.44	$0.00	$0.00	$0.00	$188.64	$671.73	$671.73	$0.00	$0.00	$188.61	$0.00	$535.34	$535.34	$0.00	$452.53	$716.80	$724.04	$0.00		$0.00	$141.64	$0.00	$0.00	$144.08	$0.00	$0.00	$0.00	$0.00	$0.00
CQ75102	SUP	HCPCS C1725		CQ75102  -  CATHETER BLNDIL 10MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$359.74	$359.74	$0.00	$0.00	$0.00	$138.08	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$391.87	$391.87	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$103.68	$0.00	$0.00	$105.47	$0.00	$0.00	$0.00	$0.00	$0.00
CQ75104	SUP	HCPCS C1725		CQ75104  -  CATHETER BLNDIL 10MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
CQ75122	SUP	HCPCS C1725		CQ75122  -  CATHETER BLNDIL 12MM 75CM LF 2CM CONQ RPD INFL SHTHLS ENTRY	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
CQ75124	SUP	HCPCS C1725		CQ75124  -  CATHETER BLNDIL 12MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
CQ7552	SUP	HCPCS C1725		CQ7552  -  CATHETER BLNDIL 5MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
CQ7554	SUP	HCPCS C1725		CQ7554  -  CATHETER BLNDIL 5MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
CQ7562	SUP	HCPCS C1725		CQ7562  -  CATHETER BLNDIL 6MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$359.74	$359.74	$0.00	$0.00	$0.00	$138.08	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$391.87	$391.87	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$103.68	$0.00	$0.00	$105.47	$0.00	$0.00	$0.00	$0.00	$0.00
CQ7564	SUP	HCPCS C1725		CQ7564  -  CATHETER BLNDIL 6MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
CQ7572	SUP	HCPCS C1725		CQ7572  -  CATHETER BLNDIL 7MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$359.74	$359.74	$0.00	$0.00	$0.00	$138.08	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$391.87	$391.87	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$103.68	$0.00	$0.00	$105.47	$0.00	$0.00	$0.00	$0.00	$0.00
CQ7574	SUP	HCPCS C1725		CQ7574  -  CATHETER BLNDIL 7MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS	BOTH IP/OP	$662.50 	$490.25	$0.00	$530.00	$359.74	$359.74	$0.00	$0.00	$0.00	$138.08	$491.71	$491.71	$0.00	$0.00	$138.07	$0.00	$391.87	$391.87	$0.00	$331.25	$524.70	$530.00	$0.00		$0.00	$103.68	$0.00	$0.00	$105.47	$0.00	$0.00	$0.00	$0.00	$0.00
CQ7582	SUP	HCPCS C1725		CQ7582  -  CATHETER BLNDIL 8MM 75CM LF 2CM CONQ RPD INFL SHTHLS ENTRY	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
CQ7584	SUP	HCPCS C1725		CQ7584  -  CATHETER BLNDIL 8MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$251.14	$251.14	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.100	SUP	HCPCS V2632		CR5BU0.100  -  LENS IOL +10 DIOP 13.5MM 7MM PSTCHBR BICNVX 1 PC PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.105	SUP	HCPCS V2632		CR5BU0.105  -  LENS IOL +10.5 DIOP 13.5MM 7MM PSTCHBR BICNVX 1 PC PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.110	SUP	HCPCS V2632		CR5BU0.110  -  LENS INTRAOCULAR PMMA 11.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.115	SUP	HCPCS V2632		CR5BU0.115  -  LENS INTRAOCULAR PMMA 11.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.120	SUP	HCPCS V2632		CR5BU0.120  -  LENS INTRAOCULAR PMMA 12.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.125	SUP	HCPCS V2632		CR5BU0.125  -  LENS INTRAOCULAR PMMA 12.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.130	SUP	HCPCS V2632		CR5BU0.130  -  LENS INTRAOCULAR PMMA 13.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.135	SUP	HCPCS V2632		CR5BU0.135  -  LENS INTRAOCULAR PMMA 13.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.140	SUP	HCPCS V2632		CR5BU0.140  -  LENS INTRAOCULAR PMMA 14.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.145	SUP	HCPCS V2632		CR5BU0.145  -  LENS INTRAOCULAR PMMA 14.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.150	SUP	HCPCS V2632		CR5BU0.150  -  LENS INTRAOCULAR PMMA 15.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.155	SUP	HCPCS V2632		CR5BU0.155  -  LENS INTRAOCULAR PMMA 15.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.160	SUP	HCPCS V2632		CR5BU0.160  -  LENS INTRAOCULAR PMMA 16.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.165	SUP	HCPCS V2632		CR5BU0.165  -  LENS INTRAOCULAR PMMA 16.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.170	SUP	HCPCS V2632		CR5BU0.170  -  LENS INTRAOCULAR PMMA 17.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.175	SUP	HCPCS V2632		CR5BU0.175  -  LENS INTRAOCULAR PMMA 17.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.180	SUP	HCPCS V2632		CR5BU0.180  -  LENS INTRAOCULAR PMMA 18.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.185	SUP	HCPCS V2632		CR5BU0.185  -  LENS INTRAOCULAR PMMA 18.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.190	SUP	HCPCS V2632		CR5BU0.190  -  LENS INTRAOCULAR PMMA 19.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.195	SUP	HCPCS V2632		CR5BU0.195  -  LENS INTRAOCULAR PMMA 19.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.200	SUP	HCPCS V2632		CR5BU0.200  -  LENS INTRAOCULAR PMMA 20.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.205	SUP	HCPCS V2632		CR5BU0.205  -  LENS INTRAOCULAR PMMA 20.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.210	SUP	HCPCS V2632		CR5BU0.210  -  LENS INTRAOCULAR PMMA 21.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.215	SUP	HCPCS V2632		CR5BU0.215  -  LENS INTRAOCULAR PMMA 21.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.220	SUP	HCPCS V2632		CR5BU0.220  -  LENS INTRAOCULAR PMMA 22.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.225	SUP	HCPCS V2632		CR5BU0.225  -  LENS INTRAOCULAR PMMA 22.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.230	SUP	HCPCS V2632		CR5BU0.230  -  LENS INTRAOCULAR PMMA 23.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.235	SUP	HCPCS V2632		CR5BU0.235  -  LENS INTRAOCULAR PMMA 23.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.240	SUP	HCPCS V2632		CR5BU0.240  -  LENS INTRAOCULAR PMMA 24.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.245	SUP	HCPCS V2632		CR5BU0.245  -  LENS INTRAOCULAR PMMA 24.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.250	SUP	HCPCS V2632		CR5BU0.250  -  LENS INTRAOCULAR PMMA 25.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.255	SUP	HCPCS V2632		CR5BU0.255  -  LENS INTRAOCULAR PMMA 25.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.260	SUP	HCPCS V2632		CR5BU0.260  -  LENS INTRAOCULAR PMMA 26.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.265	SUP	HCPCS V2632		CR5BU0.265  -  LENS INTRAOCULAR PMMA 26.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.270	SUP	HCPCS V2632		CR5BU0.270  -  LENS INTRAOCULAR PMMA 27.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.275	SUP	HCPCS V2632		CR5BU0.275  -  LENS INTRAOCULAR PMMA 27.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.280	SUP	HCPCS V2632		CR5BU0.280  -  LENS INTRAOCULAR PMMA 28.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.285	SUP	HCPCS V2632		CR5BU0.285  -  LENS INTRAOCULAR PMMA 28.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.290	SUP	HCPCS V2632		CR5BU0.290  -  LENS INTRAOCULAR PMMA 29.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.295	SUP	HCPCS V2632		CR5BU0.295  -  LENS INTRAOCULAR PMMA 29.5 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR5BU0.300	SUP	HCPCS V2632		CR5BU0.300  -  LENS INTRAOCULAR PMMA 30.0 DIOPTER L13.5 MM OD7 MM	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.040	SUP	HCPCS V2632		CR70BU.040  -  LENS IOL 10 D +4 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.045	SUP	HCPCS V2632		CR70BU.045  -  LENS IOL 10 D +4.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.050	SUP	HCPCS V2632		CR70BU.050  -  LENS IOL 10 D +5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.055	SUP	HCPCS V2632		CR70BU.055  -  LENS IOL 10 D +5.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.060	SUP	HCPCS V2632		CR70BU.060  -  LENS IOL 10 D +6 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.065	SUP	HCPCS V2632		CR70BU.065  -  LENS IOL 10 D +6.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.070	SUP	HCPCS V2632		CR70BU.070  -  LENS IOL 10 D +7 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.075	SUP	HCPCS V2632		CR70BU.075  -  LENS IOL 10 D +7.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.080	SUP	HCPCS V2632		CR70BU.080  -  LENS IOL 10 D +8 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.085	SUP	HCPCS V2632		CR70BU.085  -  LENS IOL 10 D +8.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.090	SUP	HCPCS V2632		CR70BU.090  -  LENS IOL 10 D +9 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.095	SUP	HCPCS V2632		CR70BU.095  -  LENS IOL 10 D +9.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.100	SUP	HCPCS V2632		CR70BU.100  -  LENS IOL 10 D +10 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.105	SUP	HCPCS V2632		CR70BU.105  -  LENS IOL 10 D +10.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.110	SUP	HCPCS V2632		CR70BU.110  -  LENS IOL 10 D +11 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.115	SUP	HCPCS V2632		CR70BU.115  -  LENS IOL 10 D +11.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.120	SUP	HCPCS V2632		CR70BU.120  -  LENS IOL 10 D +12 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.125	SUP	HCPCS V2632		CR70BU.125  -  LENS IOL 10 D +12.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.130	SUP	HCPCS V2632		CR70BU.130  -  LENS IOL 10 D +13 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.135	SUP	HCPCS V2632		CR70BU.135  -  LENS IOL 10 D +13.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.140	SUP	HCPCS V2632		CR70BU.140  -  LENS IOL 10 D +14 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.145	SUP	HCPCS V2632		CR70BU.145  -  LENS IOL 10 D +14.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.150	SUP	HCPCS V2632		CR70BU.150  -  LENS IOL 10 D +15 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.155	SUP	HCPCS V2632		CR70BU.155  -  LENS IOL 10 D +15.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.160	SUP	HCPCS V2632		CR70BU.160  -  LENS IOL 10 D +16 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.165	SUP	HCPCS V2632		CR70BU.165  -  LENS IOL 10 D +16.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.170	SUP	HCPCS V2632		CR70BU.170  -  LENS IOL 10 D +17 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.175	SUP	HCPCS V2632		CR70BU.175  -  LENS IOL 10 D +17.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.180	SUP	HCPCS V2632		CR70BU.180  -  LENS IOL 10 D +18 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.185	SUP	HCPCS V2632		CR70BU.185  -  LENS IOL 10 D +18.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.190	SUP	HCPCS V2632		CR70BU.190  -  LENS IOL 10 D +19 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.195	SUP	HCPCS V2632		CR70BU.195  -  LENS IOL 10 D +19.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.200	SUP	HCPCS V2632		CR70BU.200  -  LENS IOL 10 D +20 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.205	SUP	HCPCS V2632		CR70BU.205  -  LENS IOL 10 D +20.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.210	SUP	HCPCS V2632		CR70BU.210  -  LENS IOL 10 D +21 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.215	SUP	HCPCS V2632		CR70BU.215  -  LENS IOL 10 D +21.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.220	SUP	HCPCS V2632		CR70BU.220  -  LENS IOL 10 D +22 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.225	SUP	HCPCS V2632		CR70BU.225  -  LENS IOL 10 D +22.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.230	SUP	HCPCS V2632		CR70BU.230  -  LENS IOL 10 D +23 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.235	SUP	HCPCS V2632		CR70BU.235  -  LENS IOL 10 D +23.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.240	SUP	HCPCS V2632		CR70BU.240  -  LENS IOL 10 D +24 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.245	SUP	HCPCS V2632		CR70BU.245  -  LENS IOL 10 D +24.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.250	SUP	HCPCS V2632		CR70BU.250  -  LENS IOL 10 D +25 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.255	SUP	HCPCS V2632		CR70BU.255  -  LENS IOL 10 D +25.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.260	SUP	HCPCS V2632		CR70BU.260  -  LENS IOL 10 D +26 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.265	SUP	HCPCS V2632		CR70BU.265  -  LENS IOL 10 D +26.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.270	SUP	HCPCS V2632		CR70BU.270  -  LENS IOL 10 D +27 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.275	SUP	HCPCS V2632		CR70BU.275  -  LENS IOL 10 D +27.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.280	SUP	HCPCS V2632		CR70BU.280  -  LENS IOL 10 D +28 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.285	SUP	HCPCS V2632		CR70BU.285  -  LENS IOL 10 D +28.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.290	SUP	HCPCS V2632		CR70BU.290  -  LENS IOL 10 D +29 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.295	SUP	HCPCS V2632		CR70BU.295  -  LENS IOL 10 D +29.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CR70BU.300	SUP	HCPCS V2632		CR70BU.300  -  LENS IOL 10 D +30 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CS-01701	SUP	HCPCS C1726		CS-01701  -  KIT CHLGM 4FR 10FR 60CM 1.25ML 21.4CM 2 LUM 3W STPCK CATH	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
CS-12	SUP	HCPCS C1713		CS-12  -  SCREW BONE 3.5MM 12MM DVR TI DISTAL RADL VOLR CORT	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
CS-16	SUP	HCPCS C1713		CS-16  -  SCREW BONE 3.5MM 16MM DVR TI DISTAL RADL VOLR CORT	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
CS-18	SUP	HCPCS C1713		CS-18  -  SCREW BONE 3.5MM 18MM DVR TI DISTAL RADL VOLR CORT	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
CS220-ICC	SUP	Custom 27203010		DRESSING NADH VAC GFM FOAM ABD	BOTH IP/OP	$801.14 	$592.84	$0.00	$640.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$594.61	$594.61	$0.00	$0.00	$166.96	$0.00	$0.00	$0.00	$0.00	$400.57	$634.50	$640.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CS-362	SUP	Custom 27203010		CS-362  -  CATHETER DIALYSIS FLEX-NECK ADULT SMALL L62 CM W6-14 CM OD5.	BOTH IP/OP	$222.50 	$164.65	$0.00	$178.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.14	$165.14	$0.00	$0.00	$46.37	$0.00	$0.00	$0.00	$0.00	$111.25	$176.22	$178.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CS40G	SUP	Custom 27203010		CS40G  -  STAPLER INTERNAL CURVE 40MMX4.7MM 2MM 6 FIRING 4 ROW LINEAR	BOTH IP/OP	"$1,625.51 "	"$1,202.88"	$0.00	"$1,300.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,206.45"	"$1,206.45"	$0.00	$0.00	$338.76	$0.00	$0.00	$0.00	$0.00	$812.75	"$1,287.40"	"$1,300.41"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CSOFT6	SUP	Custom 27203010		CSOFT6  -  CLIP SURG FGRTY SFJW 6MM SPRG ATRM OCL STRL	BOTH IP/OP	$33.23 	$24.59	$0.00	$258.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.66	$24.66	$0.00	$0.00	$6.92	$0.00	$0.00	$0.00	$0.00	$161.25	$255.42	$258.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CSP243	SUP	Custom 27203010		PACK HAEMONETICS BASIC HI	BOTH IP/OP	$170.00 	$125.80	$0.00	$136.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.00	$134.64	$136.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CTI-512N	SUP	Custom 27203010		CTI-512N  -  DEVICE CLOSURE 5MM 10/12MM SUTURE PASSER CARTER-THOMASON	BOTH IP/OP	$278.10 	$205.79	$0.00	$222.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.41	$206.41	$0.00	$0.00	$57.96	$0.00	$0.00	$0.00	$0.00	$139.05	$220.26	$222.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C-TP-1507	SUP	Custom 27803010		C-TP-1507  -  DEVICE CLSR ANG TIGERPAW SYS II 7 CNCT UNQ FSTNR ZERO BLD	BOTH IP/OP	"$3,375.00 "	"$2,497.50"	$0.00	"$2,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,504.93"	"$2,504.93"	$0.00	$0.00	$703.35	$0.00	$0.00	$0.00	$0.00	"$1,687.50"	"$2,673.00"	"$2,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
C-TP-1509	SUP	Custom 27803010		C-TP-1509  -  DEVICE CLSR ANG TIGERPAW SYS II 9 CNCT UNQ FSTNR ZERO BLD	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CTP200-FLS	SUP	Custom 27203010		SYRINGE INJEC 60IN VSTRN CT LP TBG QKFL TUBE FRN LD 200ML	BOTH IP/OP	$865.00 	$640.10	$0.00	$692.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$432.50	$685.08	$692.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CTR11R	SUP	Custom 27803010		CTR11R  -  RING TENSION FORTIFEYE PMMA 13 MM 11 MM CAPSULAR RIGHT PRELO	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CUSTOM IMPLANT	SUP	HCPCS C1763		CUSTOM IMPLANT  -  TISSUE SYNTH PE POR MEDPOR IMPL CSTM CRANIAL	BOTH IP/OP	"$12,000.00 "	"$8,880.00"	$0.00	"$9,600.00"	"$5,400.00"	"$5,400.00"	$0.00	$0.00	$0.00	"$2,501.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,500.80"	$0.00	"$5,916.00"	"$5,916.00"	$0.00	"$6,000.00"	"$9,504.00"	"$9,600.00"	$0.00		$0.00	"$1,878.00"	$0.00	$0.00	"$1,910.40"	$0.00	$0.00	$0.00	$0.00	$0.00
CX30D	SUP	Custom 27203010		CX30D  -  SUTURE NABSB 1 CTX 18IN GRN EBND CR BRD 8 STRN	BOTH IP/OP	$355.28 	$262.91	$0.00	$288.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.69	$263.69	$0.00	$0.00	$74.04	$0.00	$0.00	$0.00	$0.00	$180.30	$285.60	$288.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CX41D	SUP	Custom 27203010		CX41D  -  SUTURE NONABSORBABLE 0 MO-7 18IN CONTROL RELEASE BRAID 8	BOTH IP/OP	$35.29 	$26.11	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.19	$26.19	$0.00	$0.00	$7.35	$0.00	$0.00	$0.00	$0.00	$17.91	$28.37	$28.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
CXI-4.0-35-150-P-NS-0	SUP	HCPCS C1887		CXI-4.0-35-150-P-NS-0  -  CATH GUID .035IN 4FR 150CM SPRT STR TIP LP RADIOPQ BRAID SS	BOTH IP/OP	$422.50 	$312.65	$0.00	$338.00	$229.42	$229.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.25	$334.62	$338.00	$0.00		$0.00	$66.12	$0.00	$0.00	$67.26	$0.00	$0.00	$0.00	$0.00	$0.00
CXS08300	SUP	HCPCS C1874		CXS08300  -  STENT CORON 3MM 8MM 137CM .014IN OTW SLF XPD RAPEX RAPTORAIL	BOTH IP/OP	"$6,500.00 "	"$4,810.00"	$0.00	"$5,200.00"	"$2,925.00"	"$2,925.00"	$0.00	$0.00	$0.00	"$1,354.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,354.60"	$0.00	"$3,204.50"	"$3,204.50"	$0.00	"$3,250.00"	"$5,148.00"	"$5,200.00"	$0.00		$0.00	"$1,017.25"	$0.00	$0.00	"$1,034.80"	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.100	SUP	HCPCS V2632		CZ70BD.100  -  LENS IOL +10 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.105	SUP	HCPCS V2632		CZ70BD.105  -  LENS IOL +10.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.110	SUP	HCPCS V2632		CZ70BD.110  -  LENS IOL +11 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.115	SUP	HCPCS V2632		CZ70BD.115  -  LENS IOL +11.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.120	SUP	HCPCS V2632		CZ70BD.120  -  LENS IOL +12 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.125	SUP	HCPCS V2632		CZ70BD.125  -  LENS IOL +12.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.130	SUP	HCPCS V2632		CZ70BD.130  -  LENS IOL +13 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.135	SUP	HCPCS V2632		CZ70BD.135  -  LENS IOL +13.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.140	SUP	HCPCS V2632		CZ70BD.140  -  LENS IOL +14 DIOP 12.5MM 7MM PSTCHBR BICNVX EYLT 1 PC PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.145	SUP	HCPCS V2632		CZ70BD.145  -  LENS IOL +14.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.150	SUP	HCPCS V2632		CZ70BD.150  -  LENS IOL +15 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.155	SUP	HCPCS V2632		CZ70BD.155  -  LENS IOL +15.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.160	SUP	HCPCS V2632		CZ70BD.160  -  LENS IOL +16 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.165	SUP	HCPCS V2632		CZ70BD.165  -  LENS IOL +16.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.170	SUP	HCPCS V2632		CZ70BD.170  -  LENS IOL +17 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.175	SUP	HCPCS V2632		CZ70BD.175  -  LENS IOL +17.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.180	SUP	HCPCS V2632		CZ70BD.180  -  LENS IOL 5 D +18 DIOP 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.185	SUP	HCPCS V2632		CZ70BD.185  -  LENS IOL +18.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.190	SUP	HCPCS V2632		CZ70BD.190  -  LENS IOL +19 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.195	SUP	HCPCS V2632		CZ70BD.195  -  LENS IOL +19.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.200	SUP	HCPCS V2632		CZ70BD.200  -  LENS IOL 5 D +20 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$56.25	$56.25	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.205	SUP	HCPCS V2632		CZ70BD.205  -  LENS IOL +20.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.210	SUP	HCPCS V2632		CZ70BD.210  -  LENS IOL +21 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.215	SUP	HCPCS V2632		CZ70BD.215  -  LENS IOL +21.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.220	SUP	HCPCS V2632		CZ70BD.220  -  LENS IOL 5 D +22 DIOP 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.225	SUP	HCPCS V2632		CZ70BD.225  -  LENS IOL +22.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.230	SUP	HCPCS V2632		CZ70BD.230  -  LEN INTRAOCULAR CZ70BD 23.0D	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.235	SUP	HCPCS V2632		CZ70BD.235  -  LENS IOL 5 D +23.5 DIOP 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.240	SUP	HCPCS V2632		CZ70BD.240  -  LENS IOL +24 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.245	SUP	HCPCS V2632		CZ70BD.245  -  LENS IOL +24.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.250	SUP	HCPCS V2632		CZ70BD.250  -  LENS IOL 5 D +25 DIOP 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.255	SUP	HCPCS V2632		CZ70BD.255  -  LENS IOL +25.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.260	SUP	HCPCS V2632		CZ70BD.260  -  LENS IOL +26 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.265	SUP	HCPCS V2632		CZ70BD.265  -  LENS IOL +26.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.270	SUP	HCPCS V2632		CZ70BD.270  -  LENS IOL +27 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.275	SUP	HCPCS V2632		CZ70BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.280	SUP	HCPCS V2632		CZ70BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.285	SUP	HCPCS V2632		CZ70BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.290	SUP	HCPCS V2632		CZ70BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.295	SUP	HCPCS V2632		CZ70BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
CZ70BD.300	SUP	HCPCS V2632		CZ70BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
D204DRM	SUP	HCPCS C1721		D204DRM  -  ICD D204DRM SECURA DR DF4 US	BOTH IP/OP	"$38,750.00 "	"$28,675.00"	$0.00	"$31,000.00"	"$17,437.50"	"$17,437.50"	$0.00	$0.00	$0.00	"$8,076.47"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,075.50"	$0.00	"$19,103.75"	"$19,103.75"	$0.00	"$19,375.00"	"$30,690.00"	"$31,000.00"	$0.00		$0.00	"$6,064.38"	$0.00	$0.00	"$6,169.00"	$0.00	$0.00	$0.00	$0.00	$0.00
D204TRM	SUP	HCPCS C2621		D204TRM  -  DEFIBRILLATOR CARDIAC THK15MM 51X66MM 2 CHAMBER 2IS-1 1DF-4	BOTH IP/OP	"$69,920.00 "	"$51,740.80"	$0.00	"$55,936.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$14,571.33"	$0.00	$0.00	$0.00	$0.00	"$34,960.00"	"$55,376.64"	"$55,936.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
D204VRM	SUP	HCPCS C1721		D204VRM  -  ICD D204VRM SECURA VR DF4 US	BOTH IP/OP	"$33,750.00 "	"$24,975.00"	$0.00	"$27,000.00"	"$15,187.50"	"$15,187.50"	$0.00	$0.00	$0.00	"$7,034.34"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,033.50"	$0.00	"$16,638.75"	"$16,638.75"	$0.00	"$16,875.00"	"$26,730.00"	"$27,000.00"	$0.00		$0.00	"$5,281.88"	$0.00	$0.00	"$5,373.00"	$0.00	$0.00	$0.00	$0.00	$0.00
D224DRG	SUP	HCPCS C1721		D224DRG  -  ICD D224DRG SECURA DR	BOTH IP/OP	"$38,750.00 "	"$28,675.00"	$0.00	"$31,000.00"	"$17,437.50"	"$17,437.50"	$0.00	$0.00	$0.00	"$8,076.47"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,075.50"	$0.00	"$19,103.75"	"$19,103.75"	$0.00	"$19,375.00"	"$30,690.00"	"$31,000.00"	$0.00		$0.00	"$6,064.38"	$0.00	$0.00	"$6,169.00"	$0.00	$0.00	$0.00	$0.00	$0.00
D224TRK	SUP	HCPCS C1882		D224TRK  -  DEFIBRILLATOR CARDIAC THK.59IN 2.01X2.72IN IMPLTABLE	BOTH IP/OP	"$69,920.00 "	"$51,740.80"	$0.00	"$55,936.00"	"$31,464.00"	"$31,464.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$14,571.33"	$0.00	"$34,470.56"	"$34,470.56"	$0.00	"$34,960.00"	"$55,376.64"	"$55,936.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
D25L	SUP	Custom 27203010		SENSOR ADLT NC OXSNSR 2 36IN OXM PLS ADH STRAP CBL DISP	BOTH IP/OP	$38.43 	$28.44	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.21	$30.44	$30.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
D284DRG	SUP	HCPCS C1721		D284DRG  -  DEFIBRILLATOR CARD MXMO 2 IMPLTABLE 2 CHMBR DR MODL	BOTH IP/OP	"$38,750.00 "	"$28,675.00"	$0.00	"$31,000.00"	"$17,437.50"	"$17,437.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$19,375.00"	"$30,690.00"	"$31,000.00"	$0.00		$0.00	"$6,064.38"	$0.00	$0.00	"$6,169.00"	$0.00	$0.00	$0.00	$0.00	$0.00
D284VRC	SUP	HCPCS C1721		D284VRC  -  DEFIBRILLATOR CARD MXMO 2 IMPLTABLE 1 CHMBR VR MODL	BOTH IP/OP	"$32,500.00 "	"$24,050.00"	$0.00	"$26,000.00"	"$14,625.00"	"$14,625.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$16,250.00"	"$25,740.00"	"$26,000.00"	$0.00		$0.00	"$5,086.25"	$0.00	$0.00	"$5,174.00"	$0.00	$0.00	$0.00	$0.00	$0.00
D-2871-600	SUP	Custom 27203010		FILTER INCBTR OHMD	BOTH IP/OP	$27.68 	$20.48	$0.00	$22.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.84	$21.92	$22.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
D300	SUP	Custom 27203010		SYSTEM BLOOD WRM ADM SET NRMTH LVL 1 DISP 1000ML/MIN STRL LF	BOTH IP/OP	$269.20 	$199.21	$0.00	$215.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.60	$213.21	$215.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
D334DRG	SUP	HCPCS C1721		D334DRG  -  ICD D334DRG PROTECTA DR IS-1/DF-1 US	BOTH IP/OP	"$38,750.00 "	"$28,675.00"	$0.00	"$31,000.00"	"$17,437.50"	"$17,437.50"	$0.00	$0.00	$0.00	"$8,076.47"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,075.50"	$0.00	"$19,103.75"	"$19,103.75"	$0.00	"$19,375.00"	"$30,690.00"	"$31,000.00"	$0.00		$0.00	"$6,064.38"	$0.00	$0.00	"$6,169.00"	$0.00	$0.00	$0.00	$0.00	$0.00
D334DRM	SUP	HCPCS C1721		D334DRM  -  ICD D334DRM PROTECTA DR DF4 US	BOTH IP/OP	"$38,750.00 "	"$28,675.00"	$0.00	"$31,000.00"	"$17,437.50"	"$17,437.50"	$0.00	$0.00	$0.00	"$8,076.47"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,075.50"	$0.00	"$19,103.75"	"$19,103.75"	$0.00	"$19,375.00"	"$30,690.00"	"$31,000.00"	$0.00		$0.00	"$6,064.38"	$0.00	$0.00	"$6,169.00"	$0.00	$0.00	$0.00	$0.00	$0.00
D334TRG	SUP	HCPCS C1721		D334TRG  -  CRT-D D334TRG PROTECTA IS-1/DF-1 US	BOTH IP/OP	"$45,500.00 "	"$33,670.00"	$0.00	"$36,400.00"	"$20,475.00"	"$20,475.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,482.20"	$0.00	"$22,431.50"	"$22,431.50"	$0.00	"$22,750.00"	"$36,036.00"	"$36,400.00"	$0.00		$0.00	"$7,120.75"	$0.00	$0.00	"$7,243.60"	$0.00	$0.00	$0.00	$0.00	$0.00
D334TRM	SUP	HCPCS C1721		D334TRM  -  CRT-D D334TRM PROTECTA DF4 US	BOTH IP/OP	"$45,500.00 "	"$33,670.00"	$0.00	"$36,400.00"	"$20,475.00"	"$20,475.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,482.20"	$0.00	"$22,431.50"	"$22,431.50"	$0.00	"$22,750.00"	"$36,036.00"	"$36,400.00"	$0.00		$0.00	"$7,120.75"	$0.00	$0.00	"$7,243.60"	$0.00	$0.00	$0.00	$0.00	$0.00
D4295	SUP	Custom 27203010		D4295  -  SUTURE PRLN 4-0 TF 36IN MFL CSTM BLUE NABSB	BOTH IP/OP	$120.03 	$88.82	$0.00	$96.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.08	$89.08	$0.00	$0.00	$25.01	$0.00	$0.00	$0.00	$0.00	$60.01	$95.06	$96.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
D5961	SUP	Custom 27203010		D5961  -  SUTURE ABSORBABLE 2 BP-1 27IN BRAID COATED CUSTOM VICRYL	BOTH IP/OP	$375.79 	$278.08	$0.00	$286.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.91	$278.91	$0.00	$0.00	$78.32	$0.00	$0.00	$0.00	$0.00	$178.80	$283.22	$286.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
D7933	SUP	Custom 27203010		D7933  -  SUTURE ABS 4-0 SH 36IN VIOL PDS2 2 ARM MFL	BOTH IP/OP	$97.96 	$72.49	$0.00	$78.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.71	$72.71	$0.00	$0.00	$20.42	$0.00	$0.00	$0.00	$0.00	$48.98	$77.58	$78.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
D900VP8HS	SUP	Custom 27203010		PROBE DPLR 2.9X5.5IN MN DPL 8 MHZ MINI	BOTH IP/OP	"$1,846.28 "	"$1,366.25"	$0.00	"$1,370.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,370.31"	"$1,370.31"	$0.00	$0.00	$384.76	$0.00	$0.00	$0.00	$0.00	$640.41	"$1,014.42"	"$1,024.66"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
D9311	SUP	Custom 27203010		D9311  -  KIT SUTURE 3-0 EBND EXC CSTM D SPCL	BOTH IP/OP	$179.13 	$132.56	$0.00	$132.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.95	$132.95	$0.00	$0.00	$37.33	$0.00	$0.00	$0.00	$0.00	$47.29	$74.91	$75.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
D98100H	SUP	Custom 27203010		D98100H  -  PROBE PCNG 135CM 2.4FR CHND TRNLMN 5 PCNG PCPRT CATH	BOTH IP/OP	$481.83 	$356.55	$0.00	$385.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.91	$381.61	$385.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DB2.5	SUP	Custom 27203010		BIT DRILL 2.5MM FAST STRL DISP	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DB-2.5	SUP	Custom 27203010		DB-2.5  -  BIT DRILL 2.5MM STRL DISP	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DCE-110	SUP	Custom 27203010		ELECTRODE ESURG 23MM 15MM CLTZ LG CNZTN DISP	BOTH IP/OP	$52.25 	$38.67	$0.00	$41.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DCE-115	SUP	Custom 27203010		ELECTRODE ESURG 18X11MM CLTZ MED CNZTN CNTOUR	BOTH IP/OP	$52.25 	$38.67	$0.00	$41.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.13	$41.38	$41.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DFS100210-20	SUP	Custom 27803010		DFS100210-20  -  COIL EMBL 2MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH	BOTH IP/OP	"$2,294.25 "	"$1,697.75"	$0.00	"$1,835.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,702.79"	"$1,702.79"	$0.00	$0.00	$478.12	$0.00	$0.00	$0.00	$0.00	"$1,147.13"	"$1,817.05"	"$1,835.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DFS100250-20	SUP	Custom 27803010		DFS100250-20  -  COIL EMBL 2.5MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS	BOTH IP/OP	"$2,294.25 "	"$1,697.75"	$0.00	"$1,835.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,702.79"	"$1,702.79"	$0.00	$0.00	$478.12	$0.00	$0.00	$0.00	$0.00	"$1,147.13"	"$1,817.05"	"$1,835.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DFS100310-20	SUP	Custom 27803010		DFS100310-20  -  MICROCOIL PLATINUM DELTAPAQ 3MMX10CM	BOTH IP/OP	"$2,294.25 "	"$1,697.75"	$0.00	"$1,835.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,702.79"	"$1,702.79"	$0.00	$0.00	$478.12	$0.00	$0.00	$0.00	$0.00	"$1,147.13"	"$1,817.05"	"$1,835.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DFS100406-20	SUP	Custom 27803010		DFS100406-20  -  COIL EMBL 4MM 6CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH	BOTH IP/OP	"$2,294.25 "	"$1,697.75"	$0.00	"$1,835.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,702.79"	"$1,702.79"	$0.00	$0.00	$478.12	$0.00	$0.00	$0.00	$0.00	"$1,147.13"	"$1,817.05"	"$1,835.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DFS100408-20	SUP	Custom 27803010		DFS100408-20  -  COIL EMBL 4MM 8CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH	BOTH IP/OP	"$2,294.25 "	"$1,697.75"	$0.00	"$1,835.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,702.79"	"$1,702.79"	$0.00	$0.00	$478.12	$0.00	$0.00	$0.00	$0.00	"$1,147.13"	"$1,817.05"	"$1,835.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DFS100410-20	SUP	Custom 27803010		DFS100410-20  -  COIL EMBL 4MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH	BOTH IP/OP	"$2,294.25 "	"$1,697.75"	$0.00	"$1,835.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,702.79"	"$1,702.79"	$0.00	$0.00	$478.12	$0.00	$0.00	$0.00	$0.00	"$1,147.13"	"$1,817.05"	"$1,835.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DFS100510-20	SUP	Custom 27803010		DFS100510-20  -  COIL EMBL 5MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH	BOTH IP/OP	"$2,294.25 "	"$1,697.75"	$0.00	"$1,835.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,702.79"	"$1,702.79"	$0.00	$0.00	$478.12	$0.00	$0.00	$0.00	$0.00	"$1,147.13"	"$1,817.05"	"$1,835.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DFS100515-20	SUP	Custom 27803010		DFS100515-20  -  COIL EMBL 5MM 15CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH	BOTH IP/OP	"$2,294.25 "	"$1,697.75"	$0.00	"$1,835.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,702.79"	"$1,702.79"	$0.00	$0.00	$478.12	$0.00	$0.00	$0.00	$0.00	"$1,147.13"	"$1,817.05"	"$1,835.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DIN1515X	SUP	Custom 27203010		NEEDLE IO 3/8-1 7/8IN 15GA BN MRW LNCT PNT ADJ FLNG STY	BOTH IP/OP	$31.73 	$23.48	$0.00	$25.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.86	$25.13	$25.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DJ4008X	SUP	Custom 27203010		DJ4008X  -  NEEDLE BIOP STANDARD TAPER 8GA 4IN LIGHTWEIGHT HANDLE DISTAL	BOTH IP/OP	$55.13 	$40.80	$0.00	$44.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.92	$40.92	$0.00	$0.00	$11.49	$0.00	$0.00	$0.00	$0.00	$27.98	$34.71	$44.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DJ4011X	SUP	Custom 27203010		NEEDLE BIOP 11GA 4IN JMSHD STD HNDL TPR DISTAL TIP BN MRW	BOTH IP/OP	$51.00 	$37.74	$0.00	$43.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.85	$37.85	$0.00	$0.00	$10.63	$0.00	$0.00	$0.00	$0.00	$26.93	$42.65	$43.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DJ6011X	SUP	Custom 27203010		DJ6011X  -  NEEDLE BIOP 11GA 6IN TAPER DISTAL SHARP BEVEL TIP ADAPTER	BOTH IP/OP	$39.36 	$29.13	$0.00	$31.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.21	$29.21	$0.00	$0.00	$8.20	$0.00	$0.00	$0.00	$0.00	$19.68	$31.17	$31.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DL900F	SUP	HCPCS C1880		DL900F  -  FILTER EMBOLIZATION DELIVERY KIT DENALI NITINOL FEMORAL VENA	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	"$1,687.50"	"$1,687.50"	$0.00	$0.00	$0.00	$781.59	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	"$1,848.75"	"$1,848.75"	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$586.88	$0.00	$0.00	$597.00	$0.00	$0.00	$0.00	$0.00	$0.00
DLP-B11	SUP	Custom 27203010		ELECTRODE ESURG TN 11CM LETZ SF-T-GA UTAHLOOP RND LOOP SHAFT	BOTH IP/OP	$35.63 	$26.37	$0.00	$28.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.81	$28.22	$28.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DLS-7083-01S	SUP	Custom 27203010		DLS-7083-01S  -  NEEDLE BN CMNT 8GA 10CM STRL DLV	BOTH IP/OP	$151.18 	$111.87	$0.00	$117.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.20	$112.20	$0.00	$0.00	$31.50	$0.00	$0.00	$0.00	$0.00	$73.39	$116.25	$117.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DLS-7083-05S	SUP	Custom 27203010		DLS-7083-05S  -  NEEDLE BONE CEMENT 8GA 10CM DELIVERY NORIAN SRS STERILE	BOTH IP/OP	$114.38 	$84.64	$0.00	$91.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.89	$84.89	$0.00	$0.00	$23.84	$0.00	$0.00	$0.00	$0.00	$57.19	$90.59	$91.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DLS-7103-01S	SUP	Custom 27804086		DLS-7103-01S  -  SYSTEM BONE CEMENT 10GA 10CM DELIVERY NEEDLE NORIAN SRS	BOTH IP/OP	$151.18 	$111.87	$0.00	$117.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.20	$112.20	$0.00	$0.00	$31.50	$0.00	$0.00	$0.00	$0.00	$73.39	$116.25	$117.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DLS-7103-05S	SUP	Custom 27203010		DLS-7103-05S  -  NEEDLE BONE CEMENT 10GA 10CM NORIAN SRS STERILE DISPOSABLE	BOTH IP/OP	$606.70 	$448.96	$0.00	$471.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$450.29	$450.29	$0.00	$0.00	$126.44	$0.00	$0.00	$0.00	$0.00	$294.51	$466.51	$471.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DNX12	SUP	HCPCS A4364		DNX12  -  ADH SKNCLS 2 OCTYL CYNCRLT DRMBND ADV EZ TO USE APL TOP .7ML	BOTH IP/OP	$49.98 	$36.99	$0.00	$39.98	$27.14	$27.14	$0.00	$0.00	$0.00	$10.42	$37.09	$37.09	$0.00	$0.00	$10.41	$0.00	$29.56	$29.56	$0.00	$24.99	$39.58	$39.98	$0.00		$0.00	$7.82	$0.00	$0.00	$7.96	$0.00	$0.00	$0.00	$0.00	$0.00
DPL 100151-20	SUP	Custom 27803010		DPL 100151-20  -  COIL EMBL 1MM 1.5CM DELTAPLUSH PLTN	BOTH IP/OP	"$2,544.60 "	"$1,883.00"	$0.00	"$2,035.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.60"	"$1,888.60"	$0.00	$0.00	$530.29	$0.00	$0.00	$0.00	$0.00	"$1,272.30"	"$2,015.32"	"$2,035.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DPL 100152-20	SUP	Custom 27803010		DPL 100152-20  -  COIL EMBL 1.5MM 2CM DELTAPLUSH PLTN	BOTH IP/OP	"$2,544.60 "	"$1,883.00"	$0.00	"$2,035.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.60"	"$1,888.60"	$0.00	$0.00	$530.29	$0.00	$0.00	$0.00	$0.00	"$1,272.30"	"$2,015.32"	"$2,035.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DPL 100153-20	SUP	Custom 27803010		DPL 100153-20  -  COIL EMBL MIC 1.5MM 3CM DELTAPLUSH	BOTH IP/OP	"$2,544.60 "	"$1,883.00"	$0.00	"$2,035.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.60"	"$1,888.60"	$0.00	$0.00	$530.29	$0.00	$0.00	$0.00	$0.00	"$1,272.30"	"$2,015.32"	"$2,035.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DPL 100202-20	SUP	Custom 27803010		DPL 100202-20  -  COIL EMBL 2MM 2CM DELTAPLUSH PLTN	BOTH IP/OP	"$2,544.60 "	"$1,883.00"	$0.00	"$2,035.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.60"	"$1,888.60"	$0.00	$0.00	$530.29	$0.00	$0.00	$0.00	$0.00	"$1,272.30"	"$2,015.32"	"$2,035.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DPL 100203-20	SUP	Custom 27803010		DPL 100203-20  -  COIL EMBL 2MM 3CM DELTAPLUSH PLTN	BOTH IP/OP	"$2,544.60 "	"$1,883.00"	$0.00	"$2,035.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.60"	"$1,888.60"	$0.00	$0.00	$530.29	$0.00	$0.00	$0.00	$0.00	"$1,272.30"	"$2,015.32"	"$2,035.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DPL 100204-20	SUP	Custom 27803010		DPL 100204-20  -  COIL EMBL 2MM 4CM DELTAPLUSH PLTN	BOTH IP/OP	"$2,544.60 "	"$1,883.00"	$0.00	"$2,035.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.60"	"$1,888.60"	$0.00	$0.00	$530.29	$0.00	$0.00	$0.00	$0.00	"$1,272.30"	"$2,015.32"	"$2,035.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DPL 100206-20	SUP	Custom 27803010		DPL 100206-20  -  COIL EMBL 2MM 6CM DELTAPLUSH PLTN	BOTH IP/OP	"$2,544.60 "	"$1,883.00"	$0.00	"$2,035.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.60"	"$1,888.60"	$0.00	$0.00	$530.29	$0.00	$0.00	$0.00	$0.00	"$1,272.30"	"$2,015.32"	"$2,035.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DPL10020120	SUP	Custom 27803010		DPL10020120  -  COIL EMBL 2MM 1CM DELTAPLUSH PLTN	BOTH IP/OP	"$2,544.60 "	"$1,883.00"	$0.00	"$2,035.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,888.60"	"$1,888.60"	$0.00	$0.00	$530.29	$0.00	$0.00	$0.00	$0.00	"$1,272.30"	"$2,015.32"	"$2,035.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRB1015	SUP	Custom 27203010		DRB1015  -  BIT DRILL 10MM BUD NONSTRL	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$0.00	$0.00	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRB1115	SUP	Custom 27203010		DRB1115  -  DRILL SURG 11MM IMPL FIX BUD STRL	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$0.00	$0.00	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL BIT	SUP	HCPCS C1713		DRILL BIT  -  DRILL BIT 2.4MM QUICK COUPLING W/65MM STOP	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$208.13	$208.13	$0.00	$0.00	$0.00	$96.40	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$273.57	$273.57	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$72.38	$0.00	$0.00	$73.63	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-1.6CL	SUP	Custom 27203010		DRILL-1.6CL  -  BIT DRILL TWISTED 1.6MM	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$0.00	$0.00	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-1.75L	SUP	Custom 27203010		DRILL-1.75L  -  BIT DRL 1.75IN TWST	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-2.00	SUP	Custom 27203010		DRILL-2.00  -  DRILL TWIST REGULAR 2MM	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-2.00CL	SUP	Custom 27203010		DRILL-2.00CL  -  BIT DRILL CANN TWIST LONG 3.2MM 2MM	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$0.00	$0.00	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-2.00L	SUP	Custom 27203010		DRILL-2.00L  -  DRILL TWIST LONG 2MM	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-2.1/110C	SUP	Custom 27203010		DRILL-2.1/110C  -  DRILL SRG 2.1MM 110MM CNN TI	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-2.1CL	SUP	Custom 27203010		DRILL-2.1CL  -  BIT DRILL SMALL HEADLESS SCREWS 2.1MM	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$0.00	$0.00	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-2.3	SUP	Custom 27203010		DRILL-2.3  -  BIT DRL 2.3MM STRL	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-2.3/080	SUP	Custom 27203010		DRILL-2.3/080  -  DRILL SRG 2.3MM 80MM NS LF REUSE	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-2.30	SUP	Custom 27203010		DRILL-2.30  -  BIT DRILL TWIST 2.3MM	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-2.30L	SUP	Custom 27203010		DRILL-2.30L  -  BIT DRILL LONG TWIST 2.3MM	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-2.4CL	SUP	Custom 27203010		DRILL-2.4CL  -  BIT DRILL 2.4MM GS	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$0.00	$0.00	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRILL-3.20L	SUP	Custom 27203010		DRILL-3.20L  -  DRILL TWIST NONCANNULATED 3.2MM	BOTH IP/OP	$300.00 	$222.00	$0.00	$240.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.66	$222.66	$0.00	$0.00	$62.52	$0.00	$0.00	$0.00	$0.00	$150.00	$237.60	$240.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRLL-PLS-20	SUP	HCPCS C1713		DRLL-PLS-20  -  DRILL SRG 2MM 40MM GEMINUS CNN PA LCK SCR	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
DRLL-SSC-20040	SUP	Custom 27203010		DRLL-SSC-20040  -  DRILL SURG 2MM 40MM SOLID SIDE CUT GEMINUS NONSTRL	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRLL-SSC-23040	SUP	Custom 27203010		"DRLL-SSC-23040  -  DRILL, 2.3MM X 40MM"	BOTH IP/OP	"$2,755.00 "	"$2,038.70"	$0.00	"$2,204.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,044.76"	"$2,044.76"	$0.00	$0.00	$574.14	$0.00	$0.00	$0.00	$0.00	"$1,377.50"	"$2,181.96"	"$2,204.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRLL-SSC-25040	SUP	Custom 27203010		DRLL-SSC-25040  -  DRILL SURG 2.5MM 40MM SOLID SIDE CUT GEMINUS NONSTRL	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRM600	SUP	Custom 27203010		HEMOCYTOMETER SPERM CNT 2 CHMBR SLD COVERLIP GRID ETCH CLVU	BOTH IP/OP	$399.20 	$295.41	$0.00	$319.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.60	$316.17	$319.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRV22508UX	SUP	HCPCS C1874		STENT CORON 2.25MM 8MM RAPEX MDRVR DRV22508UX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV22512UX	SUP	HCPCS C1874		STENT CORON 2.25MM 12MM RAPEX MDRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV22514UX	SUP	HCPCS C1874		STENT CORON 2.25MM 14MM RAPEX MDRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV22518UX	SUP	HCPCS C1874		STENT CORON 2.25MM 18MM RAPEX MDRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV22524UX	SUP	HCPCS C1874		STENT CORON 2.25MM 24MM RAPEX MDRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV25008UX	SUP	HCPCS C1874		STENT CORON 2.5MM 8MM RAPEX MDRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV25012UX	SUP	HCPCS C1874		STENT CORON 2.25MM 8MM RAPEX MDRVR DRV25012UX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV25014UX	SUP	HCPCS C1874		STENT CORON 2.5MM 14MM RAPEX MDRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV25018UX	SUP	HCPCS C1874		STENT CORON 2.5MM 18MM RAPEX MDRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV25024UX	SUP	HCPCS C1874		STENT CORON 2.5MM 24MM RAPEX MDRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV27508UX	SUP	HCPCS C1874		STENT CORON 2.75MM 8MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV27512UX	SUP	HCPCS C1874		STENT CORON 2.75MM 12MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV27514UX	SUP	HCPCS C1874		STENT CORON 2.75MM 14MM RAPEX MDRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV27518UX	SUP	HCPCS C1874		STENT CORON 2.75MM 18MM RAPEX MDRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV27524UX	SUP	HCPCS C1874		STENT CORON 2.75MM 24MM RAPEX MDRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV30012UX	SUP	HCPCS C1874		STENT CORON 3MM 12MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV30015UX	SUP	HCPCS C1874		STENT CORON 3MM 15MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV30018UX	SUP	HCPCS C1874		STENT CORON 3MM 18MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV30024UX	SUP	HCPCS C1874		STENT CORON 3MM 24MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV30030UX	SUP	HCPCS C1874		STENT CORON 3MM 30MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV35009UX	SUP	HCPCS C1874		STENT CORON 3.5MM 9MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV35012UX	SUP	HCPCS C1874		STENT CORON 3.5MM 12MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV35015UX	SUP	HCPCS C1874		STENT CORON 3.5MM 15MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV35018UX	SUP	HCPCS C1874		STENT CORON 3.5MM 18MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV35024UX	SUP	HCPCS C1874		STENT CORON 3.5MM 24MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV35030UX	SUP	HCPCS C1874		STENT CORON 3.5MM 30MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV40009UX	SUP	HCPCS C1874		STENT CORON 4MM 9MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV40012UX	SUP	HCPCS C1874		STENT CORON 4MM 12MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV40015UX	SUP	HCPCS C1874		STENT CORON 4MM 15MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV40018UX	SUP	HCPCS C1874		STENT CORON 4MM 18MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV40024UX	SUP	HCPCS C1874		STENT CORON 4MM 24MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRV40030UX	SUP	HCPCS C1874		STENT CORON 4MM 30MM RAPEX DRVR	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
DRVR-AOS-PLS	SUP	Custom 27203010		DRVR-AOS-PLS  -  DRIVER SRG GEMINUS PA LCK SCR AO CNCT DISP	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$0.00	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRVR-AOS-S20	SUP	Custom 27203010		DRVR-AOS-S20  -  DRIVER SRG 2MM NS GEMINUS SQ TIP AO CNCT DISP	BOTH IP/OP	$207.50 	$153.55	$0.00	$166.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.01	$154.01	$0.00	$0.00	$43.24	$0.00	$0.00	$0.00	$0.00	$103.75	$164.34	$166.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DRVR-UQC-T10	SUP	Custom 27203010		DRVR-UQC-T10  -  DRIVER SRG 2MM NS GEMINUS T10 UNV QCK CNCT DISP	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DS100A-1	SUP	Custom 27203010		SENSOR ADLT DRSNSR 24IN FNGR OXM CLIP DGT MEM CHP NSTRL	BOTH IP/OP	$210.63 	$155.87	$0.00	$168.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.31	$166.82	$168.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DS2A003	SUP	Custom 27203010		DS2A003  -  SLITTER CATH UNV CPS ERG DSGN ACPT 4-6FR LD	BOTH IP/OP	$80.00 	$59.20	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$59.38	$0.00	$0.00	$16.67	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DS2C002	SUP	HCPCS C1893		DS2C002  -  CATHETER GD 115D 9FR 47CM CPS DRCT SL II DRCT-TO-TRGT BRD	BOTH IP/OP	$450.00 	$333.00	$0.00	"$1,000.00"	$678.75	$678.75	$0.00	$0.00	$0.00	$93.79	$333.99	$333.99	$0.00	$0.00	$93.78	$0.00	$266.18	$266.18	$0.00	$625.00	$990.00	"$1,000.00"	$0.00		$0.00	$195.63	$0.00	$0.00	$199.00	$0.00	$0.00	$0.00	$0.00	$0.00
DS2N021/59	SUP	HCPCS C1893		DS2N021/59  -  CATHETER GD ACUTE CRV 7FR 59CM CPS AIM SL DRCT-TO-TRGT	BOTH IP/OP	$427.50 	$316.35	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
DS2N021/65	SUP	HCPCS C1887		DS2N021/65  -  CATHETER GD ACUTE CRV 7FR 65CM CPS AIM SL DRCT-TO-TRGT	BOTH IP/OP	$427.50 	$316.35	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
DS2N022/59	SUP	HCPCS C1887		DS2N022/59  -  CPS AIM SL	BOTH IP/OP	$427.50 	$316.35	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
DS2N022/65	SUP	HCPCS C1887		DS2N022/65  -  CATHETER GD 90D 7FR 65CM CPS AIM SL DRCT-TO-TRGT SLITTABLE	BOTH IP/OP	$427.50 	$316.35	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
DS2N023/59	SUP	HCPCS C1887		DS2N023/59  -  CATHETER GD OBTUSE CRV 7FR 59CM CPS AIM SL DRCT-TO-TRGT	BOTH IP/OP	$427.50 	$316.35	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
DS2N023/65	SUP	HCPCS C1887		DS2N023/65  -  CPS AIM SL	BOTH IP/OP	$427.50 	$316.35	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
DS2N024/65	SUP	HCPCS C1887		DS2N024/65  -  CATHETER GD CSL CRV 7FR 65CM CPS AIM SL DRCT-TO-TRGT	BOTH IP/OP	$427.50 	$316.35	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
DS2N025/65	SUP	HCPCS C1887		DS2N025/65  -  CATHETER GD ASII CRV 7FR 65CM CPS AIM SL DRCT-TO-TRGT	BOTH IP/OP	$427.50 	$316.35	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$89.10	$317.29	$317.29	$0.00	$0.00	$89.09	$0.00	$252.87	$252.87	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
DSF1833	SUP	HCPCS C1894		DSF1833  -  SHEATH INTRO 18FR 6.7MM 6MM 33CM GORE DRYSEAL FLX HDRPH	BOTH IP/OP	"$1,657.50 "	"$1,226.55"	$0.00	"$1,230.20"	$819.93	$819.93	$0.00	$0.00	$0.00	$345.46	"$1,230.20"	"$1,230.20"	$0.00	$0.00	$345.42	$0.00	$980.41	$980.41	$0.00	$755.00	"$1,195.92"	"$1,208.00"	$0.00		$0.00	$236.32	$0.00	$0.00	$240.39	$0.00	$0.00	$0.00	$0.00	$0.00
DSL1228	SUP	HCPCS C1894		DSL1228  -  SHEATH INTRO 12FR 5MM 4.1MM 28CM DRYSEAL DIL VLV INFL SYR	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$373.31	$373.31	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
DSL1628	SUP	HCPCS C1894		DSL1628  -  SHEATH INTRO 16FR 6.2MM 5.3MM 28CM DRYSEAL DIL VLV INFL SYR	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$373.31	$373.31	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
DSL2628	SUP	HCPCS C1894		DSL2628  -  SHEATH INTROD 28CM DRYSEAL DILAT VALVE INFLAT SYRINGE	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$468.34	$468.34	$0.00	$0.00	$0.00	$179.77	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$510.17	$510.17	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$134.98	$0.00	$0.00	$137.31	$0.00	$0.00	$0.00	$0.00	$0.00
DUET4535A	SUP	Custom 27203010		DUET4535A  -  RELOAD STPLR 45MMX3.5MM STRL LF 1.5MM DUET TRS ARTC TISS	BOTH IP/OP	"$1,718.23 "	"$1,271.49"	$0.00	"$1,374.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,275.27"	"$1,275.27"	$0.00	$0.00	$358.08	$0.00	$0.00	$0.00	$0.00	$859.11	"$1,360.84"	"$1,374.58"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DUET4548A	SUP	Custom 27203010		DUET4548A  -  RELOAD STPLR 45MMX4.8MM STRL LF 2MM DUET TRS ARTC TISS DISP	BOTH IP/OP	"$1,909.14 "	"$1,412.76"	$0.00	"$1,527.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,416.97"	"$1,416.97"	$0.00	$0.00	$397.87	$0.00	$0.00	$0.00	$0.00	$954.57	"$1,512.04"	"$1,527.31"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DUET6035A	SUP	Custom 27203010		DUET6035A  -  RELOAD STPLR 60MMX3.5MM STRL LF 1.5MM DUET TRS ARTC TISS	BOTH IP/OP	"$1,867.59 "	"$1,382.02"	$0.00	"$1,494.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,386.13"	"$1,386.13"	$0.00	$0.00	$389.21	$0.00	$0.00	$0.00	$0.00	$933.80	"$1,479.13"	"$1,494.07"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DUET6048A	SUP	Custom 27203010		DUET6048A  -  RELOAD STPLR 60MMX4.8MM STRL LF 2MM DUET TRS ARTC TISS DISP	BOTH IP/OP	"$11,205.54 "	"$8,292.10"	$0.00	"$8,964.43"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,335.23"	$0.00	$0.00	$0.00	$0.00	"$5,602.77"	"$8,874.79"	"$8,964.43"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DUR1000D	SUP	Custom 27011340		DUR1000D  -  LASER FIBER_ 1000 MICRON	BOTH IP/OP	"$2,794.28 "	"$2,067.77"	$0.00	"$2,235.43"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,073.92"	"$2,073.92"	$0.00	$0.00	$582.33	$0.00	$0.00	$0.00	$0.00	"$1,397.14"	"$2,213.07"	"$2,235.43"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DUR270D	SUP	Custom 27011340		DUR270D  -  LASER FIBER_ 270 MICRON	BOTH IP/OP	"$1,266.67 "	$937.34	$0.00	"$1,013.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$940.12	$940.12	$0.00	$0.00	$263.97	$0.00	$0.00	$0.00	$0.00	$633.33	"$1,003.20"	"$1,013.33"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DUR400D	SUP	Custom 27011340		DUR400D  -  LASER FIBER_ 400 MICRON	BOTH IP/OP	"$1,266.67 "	$937.34	$0.00	"$1,013.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$940.12	$940.12	$0.00	$0.00	$263.97	$0.00	$0.00	$0.00	$0.00	$633.33	"$1,003.20"	"$1,013.33"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DUR400DBX	SUP	Custom 27011340		DUR400DBX  -  FIBER LSR 400UM STRL DUR HO DISP LTHTRP	BOTH IP/OP	"$1,074.28 "	$794.97	$0.00	$859.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$797.33	$797.33	$0.00	$0.00	$223.88	$0.00	$0.00	$0.00	$0.00	$537.14	$850.83	$859.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DUR600D	SUP	Custom 27011340		DUR600D  -  LASER FIBER_ 600 MICRON	BOTH IP/OP	"$1,475.00 "	"$1,091.50"	$0.00	"$1,180.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,094.75"	"$1,094.75"	$0.00	$0.00	$307.39	$0.00	$0.00	$0.00	$0.00	$737.50	"$1,168.20"	"$1,180.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DUR600DBX	SUP	Custom 27011340		DUR600DBX  -  FIBER LSR 600UM STRL DUR HO DISP LTHTRP	BOTH IP/OP	"$1,254.17 "	$928.09	$0.00	"$1,003.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$930.84	$930.84	$0.00	$0.00	$261.37	$0.00	$0.00	$0.00	$0.00	$627.08	$993.30	"$1,003.33"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DVR-AXXL	SUP	HCPCS C1713		DVR-AXXL  -  PLATE X XTD DVR BONE LEFT DISTAL VOLR RADL STRL	BOTH IP/OP	"$3,865.00 "	"$2,860.10"	$0.00	"$3,092.00"	"$1,739.25"	"$1,739.25"	$0.00	$0.00	$0.00	$805.56	"$2,868.60"	"$2,868.60"	$0.00	$0.00	$805.47	$0.00	"$1,905.45"	"$1,905.45"	$0.00	"$1,932.50"	"$3,061.08"	"$3,092.00"	$0.00		$0.00	$604.87	$0.00	$0.00	$615.31	$0.00	$0.00	$0.00	$0.00	$0.00
DWB172	SUP	HCPCS C1776		DWB172  -  STEM HUM 130MM 9MM BONE GRW AQLS CMNT 25IN NECK FRAC	BOTH IP/OP	"$10,685.00 "	"$7,906.90"	$0.00	"$8,548.00"	"$4,808.25"	"$4,808.25"	$0.00	$0.00	$0.00	"$2,227.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,226.75"	$0.00	"$5,267.71"	"$5,267.71"	$0.00	"$5,342.50"	"$8,462.52"	"$8,548.00"	$0.00		$0.00	"$1,672.20"	$0.00	$0.00	"$1,701.05"	$0.00	$0.00	$0.00	$0.00	$0.00
DWB173	SUP	HCPCS C1776		DWB173  -  HEAD HUM 130MM 12MM SHLDR FRAC AQLS COCR 130D	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
DWB243	SUP	HCPCS C1776		DWB243  -  HEAD HUM CALOTTE HUMERALE	BOTH IP/OP	"$4,215.00 "	"$3,119.10"	$0.00	"$3,372.00"	"$1,896.75"	"$1,896.75"	$0.00	$0.00	$0.00	$878.51	"$3,128.37"	"$3,128.37"	$0.00	$0.00	$878.41	$0.00	"$2,078.00"	"$2,078.00"	$0.00	"$2,107.50"	"$3,338.28"	"$3,372.00"	$0.00		$0.00	$659.65	$0.00	$0.00	$671.03	$0.00	$0.00	$0.00	$0.00	$0.00
DWB252	SUP	HCPCS C1776		DWB252  -  HEAD HUM 52MM 19MM AQLS CMNT PVRS TI SHLDR	BOTH IP/OP	"$17,125.00 "	"$12,672.50"	$0.00	"$13,700.00"	"$7,706.25"	"$7,706.25"	$0.00	$0.00	$0.00	"$3,569.28"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,568.85"	$0.00	"$8,442.63"	"$8,442.63"	$0.00	"$8,562.50"	"$13,563.00"	"$13,700.00"	$0.00		$0.00	"$2,680.06"	$0.00	$0.00	"$2,726.30"	$0.00	$0.00	$0.00	$0.00	$0.00
DWB253	SUP	HCPCS C1776		DWB253  -  HEAD HUM 23MM 52MM SHLDR CMNT PVRS AQLS TI	BOTH IP/OP	"$10,685.00 "	"$7,906.90"	$0.00	"$8,548.00"	"$4,808.25"	"$4,808.25"	$0.00	$0.00	$0.00	"$2,227.02"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,226.75"	$0.00	"$5,267.71"	"$5,267.71"	$0.00	"$5,342.50"	"$8,462.52"	"$8,548.00"	$0.00		$0.00	"$1,672.20"	$0.00	$0.00	"$1,701.05"	$0.00	$0.00	$0.00	$0.00	$0.00
DWD020	SUP	HCPCS C1713		DWD020  -  SCREW BSPLT 20MM 4.5MM AQLS GLND TI LOCK MLDIR ST	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
DWD023	SUP	HCPCS C1713		DWD023  -  SCREW BSPLT 23MM 4.5MM AQLS GLND TI LOCK MLDIR ST	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
DWD029	SUP	HCPCS C1713		DWD029  -  SCREW BSPLT 29MM 4.5MM AQLS GLND TI LOCK MLDIR ST	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
DWD055	SUP	Custom 27203010		DWD055  -  BIT DRL 3MM STRL DISP	BOTH IP/OP	$342.50 	$253.45	$0.00	$274.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.20	$254.20	$0.00	$0.00	$71.38	$0.00	$0.00	$0.00	$0.00	$171.25	$271.26	$274.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DWD180	SUP	HCPCS C1776		DWD180  -  SPHERE GLND 36MM AQLS CRCO RVRS CNTR 25MM BSPLT	BOTH IP/OP	"$8,312.50 "	"$6,151.25"	$0.00	"$6,650.00"	"$3,740.63"	"$3,740.63"	$0.00	$0.00	$0.00	"$1,732.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,732.33"	$0.00	"$4,098.06"	"$4,098.06"	$0.00	"$4,156.25"	"$6,583.50"	"$6,650.00"	$0.00		$0.00	"$1,300.91"	$0.00	$0.00	"$1,323.35"	$0.00	$0.00	$0.00	$0.00	$0.00
DWD860	SUP	HCPCS C1776		DWD860  -  INSERT HUM 36MM AQLS 6MM SHLDR LAT PVRS ADPR FRAC	BOTH IP/OP	"$4,507.50 "	"$3,335.55"	$0.00	"$3,606.00"	"$2,028.38"	"$2,028.38"	$0.00	$0.00	$0.00	$939.48	"$3,345.47"	"$3,345.47"	$0.00	$0.00	$939.36	$0.00	"$2,222.20"	"$2,222.20"	$0.00	"$2,253.75"	"$3,569.94"	"$3,606.00"	$0.00		$0.00	$705.42	$0.00	$0.00	$717.59	$0.00	$0.00	$0.00	$0.00	$0.00
DWD861	SUP	HCPCS C1776		DWD861  -  INSERT HUM 36MM AQLS +9MM LAT RVRS ADPR FRAC PRIM	BOTH IP/OP	"$4,507.50 "	"$3,335.55"	$0.00	"$3,606.00"	"$2,028.38"	"$2,028.38"	$0.00	$0.00	$0.00	$939.48	"$3,345.47"	"$3,345.47"	$0.00	$0.00	$939.36	$0.00	"$2,222.20"	"$2,222.20"	$0.00	"$2,253.75"	"$3,569.94"	"$3,606.00"	$0.00		$0.00	$705.42	$0.00	$0.00	$717.59	$0.00	$0.00	$0.00	$0.00	$0.00
DWD901	SUP	HCPCS C1776		DWD901  -  STEM HUM 130MM 7MM PVRS FRAC AQLS SHLDR	BOTH IP/OP	"$13,975.00 "	"$10,341.50"	$0.00	"$11,180.00"	"$6,288.75"	"$6,288.75"	$0.00	$0.00	$0.00	"$2,912.74"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,912.39"	$0.00	"$6,889.68"	"$6,889.68"	$0.00	"$6,987.50"	"$11,068.20"	"$11,180.00"	$0.00		$0.00	"$2,187.09"	$0.00	$0.00	"$2,224.82"	$0.00	$0.00	$0.00	$0.00	$0.00
DX-22-100	SUP	Custom 27203010		DX-22-100  -  SYSTEM SPNL FX DTRAX	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	$0.00	$0.00	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
DYND13522	SUP	HCPCS A4351		DYND13522  -  CATHETER URTH RBNSN 22FR 16IN SMTH TIP 2 OVL EYE RADIOPQ FNL	BOTH IP/OP	$1.65 	$1.22	$0.00	$1.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.34	$1.22	$1.22	$0.00	$0.00	$0.34	$0.00	$0.98	$0.98	$0.00	$1.03	$1.64	$1.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E05021	SUP	Custom 27203010		E05021  -  ADAPTER ESURG UNV STRL VLAB MNPLR FTSWTCH DISP ACPT 3.2- MM	BOTH IP/OP	$97.83 	$72.39	$0.00	$78.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.61	$72.61	$0.00	$0.00	$20.39	$0.00	$0.00	$0.00	$0.00	$48.91	$77.48	$78.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E0570	SUP	Custom 27203010		RETRACTOR STRG NRV ROOT SURG	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E100-21A-00	SUP	Custom 27803010		E100-21A-00  -  VALVE AORTIC 21MM EP	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E100-23A-00	SUP	Custom 27803010		E100-23A-00  -  VALVE AOR 23MM 21MM 15MM EP LINX BPRTH STNT SW CUF PLSTR SUP	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E100-25A-00	SUP	Custom 27803010		E100-25A-00  -  VALVE AORTIC 25MM EP	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E100-25M-00	SUP	Custom 27803010		E100-25M-00  -  VALVE MTRL 25MM 23MM 16MM EP FLEXFIT BPRTH STNT HLDR LOPRFL	BOTH IP/OP	"$23,350.00 "	"$17,279.00"	$0.00	"$18,680.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,866.14"	$0.00	$0.00	$0.00	$0.00	"$11,675.00"	"$18,493.20"	"$18,680.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E100-27A-00	SUP	Custom 27803010		E100-27A-00  -  VALVE AOR 27MM 25MM 17MM EP LINX BPRTH STNT SW CUF PLSTR SUP	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E100-27M-00	SUP	Custom 27803010		E100-27M-00  -  VALVE MTRL LOPRFL 25MM 23MM 16MM EP FLEXFIT BPRTH STNT HLDR	BOTH IP/OP	"$15,500.00 "	"$11,470.00"	$0.00	"$12,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,230.20"	$0.00	$0.00	$0.00	$0.00	"$7,750.00"	"$12,276.00"	"$12,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E100-29A-00	SUP	Custom 27803010		E100-29A-00  -  VALVE AORTIC 29MM EP THV	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E100-29M-00	SUP	Custom 27803010		E100-29M-00  -  VALVE MTRL 29MM 27MM 19MM LF 10MM EP LINX BIOCOR FLEXFIT	BOTH IP/OP	"$15,500.00 "	"$11,470.00"	$0.00	"$12,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,230.20"	$0.00	$0.00	$0.00	$0.00	"$7,750.00"	"$12,276.00"	"$12,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E100-31M-00	SUP	Custom 27803010		E100-31M-00  -  VALVE MTRL 31MM 29MM 20MM STRL LF EP FLEXFIT BPRTH STNT HLDR	BOTH IP/OP	"$15,500.00 "	"$11,470.00"	$0.00	"$12,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,230.20"	$0.00	$0.00	$0.00	$0.00	"$7,750.00"	"$12,276.00"	"$12,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E100-33M-00	SUP	Custom 27803010		E100-33M-00  -  VALVE MTRL 33MM 41MM 31MM 20MM STRL EP FLEXFIT BPRTH STNT	BOTH IP/OP	"$15,500.00 "	"$11,470.00"	$0.00	"$12,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,230.20"	$0.00	$0.00	$0.00	$0.00	"$7,750.00"	"$12,276.00"	"$12,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E1457	SUP	Custom 27203010		E1457  -  ELECTRODE ELECTROSURGICAL 45D 178MM NEEDLE SLEEVE	BOTH IP/OP	$282.50 	$209.05	$0.00	$226.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$209.67	$209.67	$0.00	$0.00	$58.87	$0.00	$0.00	$0.00	$0.00	$141.25	$223.74	$226.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E2505-10FR	SUP	Custom 27203010		E2505-10FR  -  COAG SCT 6IN 10FR LECTROVAC FTSWTCH ACT SHFT STRL DISP	BOTH IP/OP	$19.33 	$14.30	$0.00	$15.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.66	$15.31	$15.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E2530-6	SUP	Custom 27203010		E2530-6  -  ELECTRODE ELECTROSURGICAL 6IN HANDSET COAGULATION FLEXIBLE	BOTH IP/OP	$649.00 	$480.26	$0.00	$519.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$481.69	$481.69	$0.00	$0.00	$135.25	$0.00	$0.00	$0.00	$0.00	$324.50	$514.01	$519.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E-3F	SUP	Custom 27203010		PROBE LTHTRP 120CM 3FR ELHDR STRL AEH2 3	BOTH IP/OP	$446.68 	$330.54	$0.00	$357.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$223.34	$353.77	$357.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E5211-6K	SUP	Custom 27203010		E5211-6K  -  BIT DRILL 7.4MM 150MM	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$0.00	$0.00	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E5211-6L	SUP	Custom 27203010		E5211-6L  -  BIT DRILL 7.4MM 200MM	BOTH IP/OP	$291.50 	$215.71	$0.00	$233.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.35	$216.35	$0.00	$0.00	$60.75	$0.00	$0.00	$0.00	$0.00	$145.75	$230.87	$233.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
E-70-0045	SUP	HCPCS C1713		E-70-0045  -  PLATE ACUMED BONE LEFT DISTAL ULN	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
EA100	SUP	Custom 27203010		EA100  -  INSTRUMENT TRAY EA100 LEGEND EHS STYLUS	BOTH IP/OP	"$1,258.00 "	$930.92	$0.00	"$1,006.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$933.69	$933.69	$0.00	$0.00	$262.17	$0.00	$0.00	$0.00	$0.00	$629.00	$996.34	"$1,006.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EAW2827	SUP	Custom 27203010		REGULATOR FLOW 1 DISS OXYGEN CYLINDER	BOTH IP/OP	$240.00 	$177.60	$0.00	$192.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.00	$190.08	$192.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EB0101	SUP	Custom 27203010		EB0101  -  RSTRC CMNT LTD 8-15MM ELB	BOTH IP/OP	$420.00 	$310.80	$0.00	$336.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.72	$311.72	$0.00	$0.00	$87.53	$0.00	$0.00	$0.00	$0.00	$210.00	$332.64	$336.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EB2S103	SUP	HCPCS C1884		EB2S103  -  PARTICLES EMBL 100-300UM 2ML YLW BDBL MCSPH CMPR PVA	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
EB2S305	SUP	Custom 27803010		EB2S305  -  PARTICLES EMBL 300-500UM 2ML BLU BDBL CMPR MCSPH PVA	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$0.00	$0.00	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EB2S507	SUP	HCPCS C1884		EB2S507  -  PARTICLES EMBL 500-700UM 2ML RD BDBL CMPR PRECISELY CLBRT	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
EB2S709	SUP	HCPCS C1884		EB2S709  -  PARTICLES EMBL 700-900UM 2ML GRN BDBL CMPR PRECISELY CLBRT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
EB2S912	SUP	HCPCS C1884		EB2S912  -  PARTICLES EMBL 900-1200UM 2ML PUR BDBL CMPR PRECISELY CLBRT	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
ECATCH15	SUP	Custom 27203010		ECATCH15  -  POUCH SPEC RTRVL 15MM 34.5CM LF 29.5CM E-CTCH II FLXB ERG	BOTH IP/OP	$283.90 	$210.09	$0.00	$227.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.71	$210.71	$0.00	$0.00	$59.16	$0.00	$0.00	$0.00	$0.00	$141.95	$224.85	$227.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ECH060040A	SUP	HCPCS C1768		ECH060040A  -  GRAFT VASCULAR 6CM 40CM 3 LAYER ACUSEAL PTFE	BOTH IP/OP	"$3,225.00 "	"$2,386.50"	$0.00	"$2,580.00"	"$1,451.25"	"$1,451.25"	$0.00	$0.00	$0.00	$672.17	"$2,393.60"	"$2,393.60"	$0.00	$0.00	$672.09	$0.00	"$1,589.93"	"$1,589.93"	$0.00	"$1,612.50"	"$2,554.20"	"$2,580.00"	$0.00		$0.00	$504.71	$0.00	$0.00	$513.42	$0.00	$0.00	$0.00	$0.00	$0.00
ECH470045A	SUP	HCPCS C1768		ECH470045A  -  GRAFT VASCULAR 4-7MM 45CM TAPER GORE ACUSEAL STERILE	BOTH IP/OP	"$3,700.00 "	"$2,738.00"	$0.00	"$2,960.00"	"$1,665.00"	"$1,665.00"	$0.00	$0.00	$0.00	$771.17	"$2,746.14"	"$2,746.14"	$0.00	$0.00	$771.08	$0.00	"$1,824.10"	"$1,824.10"	$0.00	"$1,850.00"	"$2,930.40"	"$2,960.00"	$0.00		$0.00	$579.05	$0.00	$0.00	$589.04	$0.00	$0.00	$0.00	$0.00	$0.00
ECHO-1-22	SUP	Custom 27203102		SHEATH BLUE 22G (STIFFER)	BOTH IP/OP	$669.30 	$495.28	$0.00	$535.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$334.65	$530.09	$535.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ECHO--19	SUP	Custom 27203105		NEEDLE 19G	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ECHO-19-CB	SUP	Custom 27203106		CYTOLOGY BRUSH (ECHO-19)	BOTH IP/OP	$20.13 	$14.90	$0.00	$16.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.06	$15.94	$16.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ECHO-20-CPN	SUP	Custom 27203104		CELIAC PLEXUS NEUROLYSIS NEEDLE 20G	BOTH IP/OP	$272.58 	$201.71	$0.00	$218.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.29	$215.88	$218.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ECHO-25	SUP	Custom 27203590		NEEDLE BX 25G	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ECHO-3-22	SUP	Custom 27203103		GREEN SPRING COIL SHEATH 22G	BOTH IP/OP	$669.30 	$495.28	$0.00	$535.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$334.65	$530.09	$535.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EDI-3180	SUP	Custom 27203010		PAD DFBR PADPRO RDTRNS ADLT 2516 LF	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EDI-3183	SUP	Custom 27203010		PAD DFBR PADPRO RDTRNS INF 2603 LF	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EEA2835	SUP	Custom 27203010		EEA2835  -  STAPLER INTERNAL 3.5MM CIRCULAR 28MM 22CM SHAFT LARGE	BOTH IP/OP	$746.73 	$552.58	$0.00	$597.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$554.22	$554.22	$0.00	$0.00	$155.62	$0.00	$0.00	$0.00	$0.00	$373.36	$591.41	$597.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EGIA60CTAMT	SUP	Custom 27203010		EGIA60CTAMT  -  RELOAD STPLR 60MM PUR STRL LF ARTC CRV TIP INTRO MED THKTIS	BOTH IP/OP	"$4,321.80 "	"$3,198.13"	$0.00	"$3,457.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,207.64"	"$3,207.64"	$0.00	$0.00	$900.66	$0.00	$0.00	$0.00	$0.00	"$2,160.90"	"$3,422.87"	"$3,457.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EGIARADXT	SUP	Custom 27203010		EGIARADXT  -  RELOAD STPLR 15MM BLK STRL LF EGIA RADL TI X THKTIS DISP	BOTH IP/OP	"$6,411.75 "	"$4,744.70"	$0.00	"$5,129.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,336.21"	$0.00	$0.00	$0.00	$0.00	"$3,205.88"	"$5,078.11"	"$5,129.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EL21L	SUP	Custom 27203010		EL21L  -  SUTURE ABSORBABLE 0 3.9MM 21IN BRAID COATED LIGATE LOOP	BOTH IP/OP	$54.25 	$40.15	$0.00	$44.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.26	$40.26	$0.00	$0.00	$11.31	$0.00	$0.00	$0.00	$0.00	$27.53	$43.61	$44.05	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ELAFIXP2P744	SUP	HCPCS C1893		ELAFIXP2P744  -  LEAD PCNG ELAPASS PSV FX ART VNTRC	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$610.88	$610.88	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
ELAFIXP2P752	SUP	HCPCS C1893		ELAFIXP2P752  -  LEAD PCNG 52CM SCR IN BP ATRERY	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$610.88	$610.88	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
ELAFIXP2P758	SUP	HCPCS C1893		ELAFIXP2P758  -  LEAD SRG 10MM 7FR 58CM SCR IN IS 1	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$610.88	$610.88	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
ELAFIXS2J748	SUP	HCPCS C1898		ELAFIXS2J748  -  LEAD PCNG JTP ATR	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
ELAFIXS2J752	SUP	HCPCS C1898		ELAFIXS2J752  -  LEAD PCNG JTP ATR	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
ELAPASSP752	SUP	HCPCS C1898		ELAPASSP752  -  LEAD PCNG ELAPASS TN VNTRC	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
ELAPASSP758	SUP	HCPCS C1898		ELAPASSP758  -  LEAD PCNG 58CM BP STRG VNTRC	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
ELAPASSPJ744	SUP	HCPCS C1898		ELAPASSPJ744  -  LEAD PCNG 7FR 44CM ELAPASS P BP ATR	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
ELAPASSPJ752	SUP	HCPCS C1898		ELAPASSPJ752  -  LEAD PACING J 52CM BIPOL PREFORMED TINED LOW VOLTAGE ELAPASS	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$234.48	$834.98	$834.98	$0.00	$0.00	$234.45	$0.00	$665.44	$665.44	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
EMP-FBX1000HS	SUP	Custom 27203010		EMP-FBX1000HS  -  LASER SURGICAL 1000 MH FIBER SINGLE USE	BOTH IP/OP	"$1,937.50 "	"$1,433.75"	$0.00	"$1,620.91"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,438.01"	"$1,438.01"	$0.00	$0.00	$403.78	$0.00	$0.00	$0.00	$0.00	"$1,013.07"	"$1,604.70"	"$1,620.91"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EMP-FBX272HS-C	SUP	Custom 27203010		"EMP-FBX272HS-C  -  LASER SURGICAL 272 MH FIBER SINGLE USE, COMPATIBLE"	BOTH IP/OP	$725.95 	$537.20	$0.00	$538.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$538.80	$538.80	$0.00	$0.00	$151.29	$0.00	$0.00	$0.00	$0.00	$320.31	$507.37	$512.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EMP-FBX365HS	SUP	Custom 27203010		EMP-FBX365HS  -  LASER SURGICAL 365 MH FIBER SINGLE USE	BOTH IP/OP	$874.75 	$647.32	$0.00	$649.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.24	$649.24	$0.00	$0.00	$182.30	$0.00	$0.00	$0.00	$0.00	$320.31	$507.37	$512.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EMP-FBX550HS	SUP	Custom 27203010		EMP-FBX550HS  -  LASER SURGICAL 550 MH FIBER SINGLE USE	BOTH IP/OP	"$1,070.50 "	$792.17	$0.00	$867.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$794.53	$794.53	$0.00	$0.00	$223.09	$0.00	$0.00	$0.00	$0.00	$542.34	$859.07	$867.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EN2006015-C	SUP	HCPCS C1757		EN2006015-C  -  SNARE VASC STD 9-15MM 6FR 120CM 100CM ENSNR 3 PREFRM LOOP	BOTH IP/OP	$827.50 	$612.35	$0.00	$662.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.47	$614.17	$614.17	$0.00	$0.00	$172.45	$0.00	$489.47	$489.47	$0.00	$413.75	$655.38	$662.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EN2007030	SUP	Custom 27203010		EN2007030  -  SNARE VASC STD 18-30MM 7FR 120CM 100CM ENSNR 3 INTERLACE	BOTH IP/OP	$827.50 	$612.35	$0.00	$662.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.75	$655.38	$662.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EN2007045	SUP	Custom 27203010		EN2007045  -  SNARE VASCULAR 120CM 3 PREFORM LOOP WIRE KINK RESISTANT	BOTH IP/OP	"$1,100.00 "	$814.00	$0.00	$880.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$816.42	$816.42	$0.00	$0.00	$229.24	$0.00	$0.00	$0.00	$0.00	$550.00	$871.20	$880.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ENBD-7	SUP	HCPCS C1725		CATHETER DRAIN 7FR 250CM 5 SDPRT LCK PGTL ENDSCP BIL NSL	BOTH IP/OP	$286.15 	$211.75	$0.00	$228.92	$155.38	$155.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.08	$226.63	$228.92	$0.00		$0.00	$44.78	$0.00	$0.00	$45.56	$0.00	$0.00	$0.00	$0.00	$0.00
ENDO-014	SUP	HCPCS C1769		ENDO-014  -  GUIDEWIRE ENDOVASCULAR L260 CM OD.014 IN ANCILLARY	BOTH IP/OP	$450.00 	$333.00	$0.00	$360.00	$244.35	$244.35	$0.00	$0.00	$0.00	$93.79	$333.99	$333.99	$0.00	$0.00	$93.78	$0.00	$266.18	$266.18	$0.00	$225.00	$356.40	$360.00	$0.00		$0.00	$70.43	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$0.00
ENF402300	SUP	HCPCS C1874		ENF402300  -  STENT VASCULAR 4.5MM 22MM W/O DISTAL TIP ENTERPRISE NITINOL	BOTH IP/OP	"$14,899.20 "	"$11,025.41"	$0.00	"$11,919.36"	"$6,704.64"	"$6,704.64"	$0.00	$0.00	$0.00	"$3,105.37"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,104.99"	$0.00	"$7,345.31"	"$7,345.31"	$0.00	"$7,449.60"	"$11,800.17"	"$11,919.36"	$0.00		$0.00	"$2,331.72"	$0.00	$0.00	"$2,371.95"	$0.00	$0.00	$0.00	$0.00	$0.00
ENF402312	SUP	HCPCS C1874		ENF402312  -  STENT VASC 4.5MM 22MM ENTRP RECON DEV SLF EXPANDABLE DLV SYS	BOTH IP/OP	"$14,899.20 "	"$11,025.41"	$0.00	"$11,919.36"	"$6,704.64"	"$6,704.64"	$0.00	$0.00	$0.00	"$3,105.37"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,104.99"	$0.00	"$7,345.31"	"$7,345.31"	$0.00	"$7,449.60"	"$11,800.17"	"$11,919.36"	$0.00		$0.00	"$2,331.72"	$0.00	$0.00	"$2,371.95"	$0.00	$0.00	$0.00	$0.00	$0.00
ENF403000	SUP	HCPCS C1874		ENF403000  -  STENT VASCULAR 4.5MM 28MM W/O DISTAL TIP ENTERPRISE NITINOL	BOTH IP/OP	"$14,899.20 "	"$11,025.41"	$0.00	"$11,919.36"	"$6,704.64"	"$6,704.64"	$0.00	$0.00	$0.00	"$3,105.37"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,104.99"	$0.00	"$7,345.31"	"$7,345.31"	$0.00	"$7,449.60"	"$11,800.17"	"$11,919.36"	$0.00		$0.00	"$2,331.72"	$0.00	$0.00	"$2,371.95"	$0.00	$0.00	$0.00	$0.00	$0.00
ENF403012	SUP	HCPCS C1874		ENF403012  -  STENT VASC 4.5MM 28MM ENTRP RECON DEV SLF EXPANDABLE DLV SYS	BOTH IP/OP	"$14,899.20 "	"$11,025.41"	$0.00	"$11,919.36"	"$6,704.64"	"$6,704.64"	$0.00	$0.00	$0.00	"$3,105.37"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,104.99"	$0.00	"$7,345.31"	"$7,345.31"	$0.00	"$7,449.60"	"$11,800.17"	"$11,919.36"	$0.00		$0.00	"$2,331.72"	$0.00	$0.00	"$2,371.95"	$0.00	$0.00	$0.00	$0.00	$0.00
ENF403900	SUP	HCPCS C1874		ENF403900  -  STENT VASCULAR 4.5MM 37MM W/O DISTAL TIP ENTERPRISE NITINOL	BOTH IP/OP	"$14,899.20 "	"$11,025.41"	$0.00	"$11,919.36"	"$6,704.64"	"$6,704.64"	$0.00	$0.00	$0.00	"$3,105.37"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,104.99"	$0.00	"$7,345.31"	"$7,345.31"	$0.00	"$7,449.60"	"$11,800.17"	"$11,919.36"	$0.00		$0.00	"$2,331.72"	$0.00	$0.00	"$2,371.95"	$0.00	$0.00	$0.00	$0.00	$0.00
ENF403912	SUP	HCPCS C1874		ENF403912  -  STENT VASC 4.5MM 37MM ENTRP RECON DEV SLF EXPANDABLE DLV SYS	BOTH IP/OP	"$14,899.20 "	"$11,025.41"	$0.00	"$11,919.36"	"$6,704.64"	"$6,704.64"	$0.00	$0.00	$0.00	"$3,105.37"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,104.99"	$0.00	"$7,345.31"	"$7,345.31"	$0.00	"$7,449.60"	"$11,800.17"	"$11,919.36"	$0.00		$0.00	"$2,331.72"	$0.00	$0.00	"$2,371.95"	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP25008UX	SUP	HCPCS C1874		STENT CORON 8MM 25MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP25012UX	SUP	HCPCS C1874		STENT CORON 2.5MM 12MM DRUG ELUDING ENDVR SPRNT	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP25014UX	SUP	HCPCS C1874		STENT CORON 2.5MM 14MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP25018UX	SUP	HCPCS C1874		STENT CORON 2.5MM 18MM DRUG ELUDING ENDVR SPRNT	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP25024UX	SUP	HCPCS C1874		STENT CORON 2.5MM 24MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP25030UX	SUP	HCPCS C1874		STENT CORON 2.5MM 30MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP30009UX	SUP	HCPCS C1874		STENT CORON 3MM 9MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP30012UX	SUP	HCPCS C1874		STENT CORON 3MM 12MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP30015UX	SUP	HCPCS C1874		STENT CORON 3MM 15MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP30018UX	SUP	HCPCS C1874		STENT CORON 3MM 18MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP30024UX	SUP	HCPCS C1874		STENT CORON 3MM 24MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP30030UX	SUP	HCPCS C1874		STENT CORON 3MM 30MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP35009UX	SUP	HCPCS C1874		STENT CORON 3.5MM 9MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP35012UX	SUP	HCPCS C1874		STENT CORON 3.5MM 12MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP35015UX	SUP	HCPCS C1874		STENT CORON 3.5MM 15MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP35018UX	SUP	HCPCS C1874		STENT CORON 3.5MM 18MM DRUG ELUDING ENDVR SPRNT	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP35024UX	SUP	HCPCS C1874		STENT CORON 3.5MM 24MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ENSP35030UX	SUP	HCPCS C1874		STENT CORON 3.5MM 30MM DRUG ELUDING ENDVR	BOTH IP/OP	"$4,312.50 "	"$3,191.25"	$0.00	"$3,450.00"	"$1,940.63"	"$1,940.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,156.25"	"$3,415.50"	"$3,450.00"	$0.00		$0.00	$674.91	$0.00	$0.00	$686.55	$0.00	$0.00	$0.00	$0.00	$0.00
ER7232A	SUP	HCPCS C2628		ER7232A  -  ER-REBOA CATHETER	BOTH IP/OP	"$5,437.50 "	"$4,023.75"	$0.00	"$4,350.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,133.31"	"$4,035.71"	"$4,035.71"	$0.00	$0.00	"$1,133.18"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,718.75"	"$4,306.50"	"$4,350.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ES3352	SUP	HCPCS C1729		CATHETER INTRAVENOUS PROTECTIV ACUVANCE 16G X 2IN SAFETY STR	BOTH IP/OP	$4.10 	$3.03	$0.00	$3.28	$2.23	$2.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.05	$3.25	$3.28	$0.00		$0.00	$0.64	$0.00	$0.00	$0.65	$0.00	$0.00	$0.00	$0.00	$0.00
ESCDH33	SUP	Custom 27203010		ESCDH33  -  STAPLER INTNL CRV CRC 33MM 5.5MM STRL LF 1-2.5MM PRX LNR CTR	BOTH IP/OP	"$3,588.47 "	"$2,655.47"	$0.00	"$2,870.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,663.36"	"$2,663.36"	$0.00	$0.00	$747.84	$0.00	$0.00	$0.00	$0.00	"$1,794.24"	"$2,842.07"	"$2,870.78"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ESEJ10G	SUP	Custom 27203010		ESEJ10G  -  SUTURE ABSORBABLE 0 18IN BRAID TIES COATED VICRYL ENDOLOOP	BOTH IP/OP	$376.17 	$278.37	$0.00	$300.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.19	$279.19	$0.00	$0.00	$78.39	$0.00	$0.00	$0.00	$0.00	$188.09	$297.93	$300.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ESP100-21-00	SUP	Custom 27803010		ESP100-21-00  -  VALVE AORTIC 21MM EP SUP THV	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ESP100-23-00	SUP	Custom 27803010		ESP100-23-00  -  VALVE AOR 23MM 16MM EP FLEXFIT BPRTH STNT SCLP INFL EDG HLDR	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ESP100-25-00	SUP	Custom 27803010		ESP100-25-00  -  VALVE AORTIC 25MM EP SUP THV	BOTH IP/OP	"$19,700.00 "	"$14,578.00"	$0.00	"$15,760.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,105.48"	$0.00	$0.00	$0.00	$0.00	"$9,850.00"	"$15,602.40"	"$15,760.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ESP100-27-00	SUP	Custom 27803010		ESP100-27-00  -  VALVE AORTIC 27MM EP SUP THV	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ESP1955	SUP	Custom 27011340		ESP1955  -  SPLINTS YELLOW JACKET	BOTH IP/OP	$65.63 	$48.57	$0.00	$52.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.71	$48.71	$0.00	$0.00	$13.68	$0.00	$0.00	$0.00	$0.00	$32.81	$51.98	$52.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ESP3075	SUP	Custom 27203010		ESP3075  -  KIT SPLINT NEOPRENE DURABLE NONABSORBENT EASY FRACTURE MANAG	BOTH IP/OP	$437.38 	$323.66	$0.00	$349.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.62	$324.62	$0.00	$0.00	$91.15	$0.00	$0.00	$0.00	$0.00	$218.69	$346.40	$349.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ESP-3100	SUP	Custom 27203010		SPLINT TRACTION 4 LEG ADULT	BOTH IP/OP	$412.38 	$305.16	$0.00	$329.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.19	$326.60	$329.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ESP3101	SUP	Custom 27203010		SPLINT TRACTION 3 LEG PEDIATRIC	BOTH IP/OP	$412.38 	$305.16	$0.00	$329.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.19	$326.60	$329.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ESP-3119	SUP	Custom 27203010		SPLINT TRACTION SINGLE SAGER FORM III	BOTH IP/OP	$686.25 	$507.83	$0.00	$549.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.13	$543.51	$549.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ESU-501	SUP	Custom 27203010		FILTER SMKEVC PK FINESSE	BOTH IP/OP	$83.13 	$61.52	$0.00	$66.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.56	$65.84	$66.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ETBF3216C166E	SUP	Custom 27803010		ETBF3216C166E  -  GRAFT STNT 2 BRCH 32-16MM 20FR 166MM ENDURANT II DLV SYS C	BOTH IP/OP	"$24,937.50 "	"$18,453.75"	$0.00	"$19,950.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,196.98"	$0.00	$0.00	$0.00	$0.00	"$12,468.75"	"$19,750.50"	"$19,950.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ETDPP6	SUP	Custom 27203010		ETDPP6  -  ADHESIVE SKNCLS 2 OCTYL CYNCRLT DRMBND VL TOP LQ HVISC PRPN	BOTH IP/OP	$64.42 	$47.67	$0.00	$51.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.81	$47.81	$0.00	$0.00	$13.43	$0.00	$0.00	$0.00	$0.00	$32.21	$51.02	$51.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ETLW1616C82E	SUP	Custom 27803010		ETLW1616C82E  -  GRAFT STNT 16-16MM 14FR 82MM ENDURANT II DLV SYS C DIST	BOTH IP/OP	"$11,187.50 "	"$8,278.75"	$0.00	"$8,950.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,331.48"	$0.00	$0.00	$0.00	$0.00	"$5,593.75"	"$8,860.50"	"$8,950.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ETLW1620C156E	SUP	Custom 27803010		ETLW1620C156E  -  GRAFT STNT 16-20MM 16FR 156MM ENDURANT II DLV SYS C DIST	BOTH IP/OP	"$16,000.00 "	"$11,840.00"	$0.00	"$12,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,334.40"	$0.00	$0.00	$0.00	$0.00	"$8,000.00"	"$12,672.00"	"$12,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ETLW1628C93E	SUP	HCPCS C2625		ETLW1628C93E  -  GRAFT STNT 16-28MM 16FR 93MM ENDURANT II DLV SYS C DIST	BOTH IP/OP	"$12,312.50 "	"$9,111.25"	$0.00	"$9,850.00"	"$5,540.63"	"$5,540.63"	$0.00	$0.00	$0.00	"$2,566.23"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,565.93"	$0.00	"$6,070.06"	"$6,070.06"	$0.00	"$6,156.25"	"$9,751.50"	"$9,850.00"	$0.00		$0.00	"$1,926.91"	$0.00	$0.00	"$1,960.15"	$0.00	$0.00	$0.00	$0.00	$0.00
ETVKMM	SUP	HCPCS C1781		ETVKMM  -  MESH SURG 6X6IN ABS KNTD WVN VCL PLGC 910	BOTH IP/OP	$791.30 	$585.56	$0.00	$633.04	$356.09	$356.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$395.65	$626.71	$633.04	$0.00		$0.00	$123.84	$0.00	$0.00	$125.97	$0.00	$0.00	$0.00	$0.00	$0.00
EUSCFS-070026-14-13	SUP	HCPCS C1768		EUSCFS-070026-14-13  -  SET STENT 26CM 7-14FR CFLX URET EURTM RELS SLV PSTNR 13CM	BOTH IP/OP	$297.06 	$219.82	$0.00	$237.65	$133.68	$133.68	$0.00	$0.00	$0.00	$61.92	$220.48	$220.48	$0.00	$0.00	$61.91	$0.00	$175.71	$175.71	$0.00	$148.53	$235.27	$237.65	$0.00		$0.00	$46.49	$0.00	$0.00	$47.29	$0.00	$0.00	$0.00	$0.00	$0.00
EUSN-19-QC	SUP	Custom 27203105		NEEDLE BX 19G	BOTH IP/OP	$359.88 	$266.31	$0.00	$287.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.94	$285.02	$287.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EX70410	SUP	HCPCS A4364		EX70410  -  ADHESIVE SKNCLS 1ML EXOFIN	BOTH IP/OP	$25.00 	$18.50	$0.00	$18.56	$1.36	$1.36	$0.00	$0.00	$0.00	$5.21	$18.56	$18.56	$0.00	$0.00	$5.21	$0.00	$14.79	$14.79	$0.00	$1.25	$1.98	$2.00	$0.00		$0.00	$0.39	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
EXPORTAP	SUP	HCPCS C1757		EXPORTAP  -  CATHETER THROMBECTOMY FULL WALL 6FR .07IN 140CM BRAID	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$297.01	"$1,057.64"	"$1,057.64"	$0.00	$0.00	$296.97	$0.00	$842.89	$842.89	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EZ15-15-15	SUP	HCPCS C1713		EZ15-15-15  -  STAPLE BONE 2MM 15X15X1.8-1.3MM MONOCORTICAL SUPERELASTIC LP	BOTH IP/OP	"$3,208.50 "	"$2,374.29"	$0.00	"$2,474.16"	"$1,391.72"	"$1,391.72"	$0.00	$0.00	$0.00	$668.73	"$2,381.35"	"$2,381.35"	$0.00	$0.00	$668.65	$0.00	"$1,581.79"	"$1,581.79"	$0.00	"$1,546.35"	"$2,449.42"	"$2,474.16"	$0.00		$0.00	$484.01	$0.00	$0.00	$492.36	$0.00	$0.00	$0.00	$0.00	$0.00
EZF21TA	SUP	Custom 27203010		EZF21TA  -  CANNULA PERFUSION 3/8IN 21FR 14.8IN CURVE TIP SUTURE FLANGE	BOTH IP/OP	$110.68 	$81.90	$0.00	$88.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.14	$82.14	$0.00	$0.00	$23.06	$0.00	$0.00	$0.00	$0.00	$55.34	$87.66	$88.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
EZS24TA	SUP	Custom 27203010		EZS24TA  -  CANNULA PERFUSION 3/8IN STR 24FR 14IN AUTO DILATE TIP SUTURE	BOTH IP/OP	$93.30 	$69.04	$0.00	$74.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.25	$69.25	$0.00	$0.00	$19.44	$0.00	$0.00	$0.00	$0.00	$46.65	$73.89	$74.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
F1/8TA15S	SUP	Custom 27203010		F1/8TA15S  -  TOOL LEGEND 8 CM 1.5MM SPIRAL	BOTH IP/OP	$269.88 	$199.71	$0.00	$215.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.30	$200.30	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$134.94	$213.74	$215.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
F1006	SUP	HCPCS C1768		F1006  -  GRAFT VASC 10CM 6MM IMPR CBFL PTFE PERI BYPS FLX	BOTH IP/OP	$891.48 	$659.70	$0.00	$713.18	$401.16	$401.16	$0.00	$0.00	$0.00	$185.81	$661.65	$661.65	$0.00	$0.00	$185.78	$0.00	$527.31	$527.31	$0.00	$445.74	$706.05	$713.18	$0.00		$0.00	$139.52	$0.00	$0.00	$141.92	$0.00	$0.00	$0.00	$0.00	$0.00
F1010	SUP	HCPCS C1768		F1010  -  GRAFT VASC 10CM 10MM IMPR CBFL PTFE PERI BYPS FLX	BOTH IP/OP	$891.48 	$659.70	$0.00	$713.18	$401.16	$401.16	$0.00	$0.00	$0.00	$185.81	$661.65	$661.65	$0.00	$0.00	$185.78	$0.00	$527.31	$527.31	$0.00	$445.74	$706.05	$713.18	$0.00		$0.00	$139.52	$0.00	$0.00	$141.92	$0.00	$0.00	$0.00	$0.00	$0.00
F2/8TA23S	SUP	Custom 27203010		F2/8TA23S  -  TOOL LEGEND 8CM 2.3MM SPIRAL	BOTH IP/OP	$269.88 	$199.71	$0.00	$215.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.30	$200.30	$0.00	$0.00	$56.24	$0.00	$0.00	$0.00	$0.00	$134.94	$213.74	$215.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
F-30	SUP	Custom 27203010		FILTER TRNSF GAS VNT REPL LKCYT RBC 40UM	BOTH IP/OP	$51.75 	$38.30	$0.00	$41.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.88	$40.99	$41.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
F6008	SUP	HCPCS C1768		F6008  -  GRAFT VASC 60CM 8MM IMPR CBFL PTFE PERI BYPS FLX	BOTH IP/OP	"$2,160.88 "	"$1,599.05"	$0.00	"$1,728.70"	$972.39	$972.39	$0.00	$0.00	$0.00	$450.38	"$1,603.80"	"$1,603.80"	$0.00	$0.00	$450.33	$0.00	"$1,278.16"	"$1,278.16"	$0.00	"$1,080.44"	"$1,711.42"	"$1,728.70"	$0.00		$0.00	$338.18	$0.00	$0.00	$344.01	$0.00	$0.00	$0.00	$0.00	$0.00
F7006	SUP	HCPCS C1768		F7006  -  GRAFT VASC 70CM 6MM IMPR CBFL PTFE PERI BYPS FLX	BOTH IP/OP	"$2,570.28 "	"$1,902.01"	$0.00	"$2,056.22"	"$1,156.62"	"$1,156.62"	$0.00	$0.00	$0.00	$535.71	"$1,907.66"	"$1,907.66"	$0.00	$0.00	$535.65	$0.00	"$1,267.15"	"$1,267.15"	$0.00	"$1,285.14"	"$2,035.66"	"$2,056.22"	$0.00		$0.00	$402.25	$0.00	$0.00	$409.19	$0.00	$0.00	$0.00	$0.00	$0.00
F7008	SUP	HCPCS C1768		F7008  -  GRAFT VASC STRG 8MM 70CM IMPRA FLX SM BEAD EPTFE	BOTH IP/OP	"$2,570.28 "	"$1,902.01"	$0.00	"$2,056.22"	"$1,156.62"	"$1,156.62"	$0.00	$0.00	$0.00	$535.71	"$1,907.66"	"$1,907.66"	$0.00	$0.00	$535.65	$0.00	"$1,267.15"	"$1,267.15"	$0.00	"$1,285.14"	"$2,035.66"	"$2,056.22"	$0.00		$0.00	$402.25	$0.00	$0.00	$409.19	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0140	SUP	HCPCS C1713		FA-0140  -  SCREW BN 3.5MM 14MM CNN XTRMT	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$253.13	$253.13	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0160	SUP	HCPCS C1713		FA-0160  -  SCREW BN 3.5MM 16MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0180	SUP	HCPCS C1713		FA-0180  -  SCREW BN 3.5MM 18MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0200	SUP	HCPCS C1713		FA-0200  -  SCREW BN 3.5MM 20MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0220	SUP	HCPCS C1713		FA-0220  -  SCREW BN 3.5MM 22MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0240	SUP	HCPCS C1713		FA-0240  -  SCREW BN 3.5MM 24MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0260	SUP	HCPCS C1713		FA-0260  -  SCREW BN 3.5MM 26MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0280	SUP	HCPCS C1713		FA-0280  -  SCREW BN 3.5MM 28MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0300	SUP	HCPCS C1713		FA-0300  -  SCREW BN 3.5MM 30MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0320	SUP	HCPCS C1713		FA-0320  -  SCREW BN 3.5MM 32MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0340	SUP	HCPCS C1713		FA-0340  -  SCREW BN 3.5MM 34MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0360	SUP	HCPCS C1713		FA-0360  -  SCREW BN 3.5MM 36MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0380	SUP	HCPCS C1713		FA-0380  -  SCREW BN 3.5MM 38MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0400	SUP	HCPCS C1713		FA-0400  -  SCREW BN 3.5MM 40MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-04020	SUP	Custom 27203010		FA-04020  -  KIT ARTERIAL LINE .018IN 20GA 22GA 1.75IN CATHETER RADIOPQ	BOTH IP/OP	$34.40 	$25.46	$0.00	$45.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.53	$25.53	$0.00	$0.00	$7.17	$0.00	$0.00	$0.00	$0.00	$28.52	$45.18	$45.63	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FA-0420	SUP	HCPCS C1713		FA-0420  -  SCREW BN 3.5MM 42MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4014	SUP	HCPCS C1713		FA-4014  -  SCREW BN 4MM 14MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4016	SUP	HCPCS C1713		FA-4016  -  SCREW BN 4MM 16MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4018	SUP	HCPCS C1713		FA-4018  -  SCREW BN 4MM 18MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4020	SUP	HCPCS C1713		FA-4020  -  SCREW BN 4MM 20MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4022	SUP	HCPCS C1713		FA-4022  -  SCREW BN 4MM 22MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4024	SUP	HCPCS C1713		FA-4024  -  SCREW BN 4MM 24MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4026	SUP	HCPCS C1713		FA-4026  -  SCREW BN 4MM 26MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4028	SUP	HCPCS C1713		FA-4028  -  SCREW BN 4MM 28MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4030	SUP	HCPCS C1713		FA-4030  -  SCREW BN 4MM 30MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4032	SUP	HCPCS C1713		FA-4032  -  SCREW BN 4MM 32MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4034	SUP	HCPCS C1713		FA-4034  -  SCREW BN 4MM 34MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4036	SUP	HCPCS C1713		FA-4036  -  SCREW BN 4MM 36MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4038	SUP	HCPCS C1713		FA-4038  -  SCREW BN 4MM 38MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4040	SUP	HCPCS C1713		FA-4040  -  SCREW BN 4MM 40MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-4042	SUP	HCPCS C1713		FA-4042  -  SCREW BN 4MM 42MM CNN XTRMT	BOTH IP/OP	$492.50 	$364.45	$0.00	$394.00	$221.63	$221.63	$0.00	$0.00	$0.00	$102.65	$365.53	$365.53	$0.00	$0.00	$102.64	$0.00	$291.31	$291.31	$0.00	$246.25	$390.06	$394.00	$0.00		$0.00	$77.08	$0.00	$0.00	$78.41	$0.00	$0.00	$0.00	$0.00	$0.00
FA-55150-1030	SUP	HCPCS C2628		FA-55150-1030  -  CATH INFUS MIC 2.8FR 3.2FR .027IN 150CM 10CM MARKSMAN	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$2,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FA-88810-20	SUP	Custom 27203010		FA-88810-20  -  DEVICE RTRVL 2MM ALGTR NRVSC FB ATRM DSGN SF RELS	BOTH IP/OP	"$6,562.50 "	"$4,856.25"	$0.00	"$5,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,367.63"	$0.00	$0.00	$0.00	$0.00	"$3,281.25"	"$5,197.50"	"$5,250.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FA-88810-30	SUP	Custom 27203010		FA-88810-30  -  ALLIGATOR RETRIEVAL-30	BOTH IP/OP	"$6,562.50 "	"$4,856.25"	$0.00	"$5,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,367.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,367.63"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,281.25"	"$5,197.50"	"$5,250.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FA-88810-40	SUP	Custom 27203010		FA-88810-40  -  DEVICE RTRVL ALGTR 4MM FB ATRM DSGN SF RELS	BOTH IP/OP	"$6,562.50 "	"$4,856.25"	$0.00	"$5,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,367.63"	$0.00	$0.00	$0.00	$0.00	"$3,281.25"	"$5,197.50"	"$5,250.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FA-88810-50	SUP	HCPCS C1773		FA-88810-50  -  DEVICE SPEC RTRVL ALGTR 5MM NRVSC 4 INTLCK PLTN JAW	BOTH IP/OP	"$6,562.50 "	"$4,856.25"	$0.00	"$5,250.00"	"$3,563.44"	"$3,563.44"	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,367.63"	$0.00	$0.00	$0.00	$0.00	"$3,281.25"	"$5,197.50"	"$5,250.00"	$0.00		$0.00	"$1,027.03"	$0.00	$0.00	"$1,044.75"	$0.00	$0.00	$0.00	$0.00	$0.00
FA-9020	SUP	HCPCS C1713		FA-9020  -  DRILL SRG XTRMT 3.5 MM SCR	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$159.75	$159.75	$0.00	$0.00	$0.00	$73.99	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$209.98	$209.98	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$55.56	$0.00	$0.00	$56.52	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO2736	SUP	HCPCS C1713		FA-CO2736  -  SCREW BONE 2.7MM 36MM TAP-LOC ACUMED TI ELB TAP STRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO2738	SUP	HCPCS C1713		FA-CO2738  -  SCREW BONE 2.7MM 38MM TI CORT TAP NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO2740	SUP	HCPCS C1713		FA-CO2740  -  SCREW BONE 2.7MM 40MM ACUMED TI CORT TAP NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO2745	SUP	HCPCS C1713		FA-CO2745  -  SCREW BONE 2.7MM 45MM TI ELB LCK TAP STRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO2750	SUP	HCPCS C1713		FA-CO2750  -  SCREW BONE 2.7MM 50MM TAP-LOC TI CORT ELB LCK NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO2755	SUP	HCPCS C1713		FA-CO2755  -  SCREW BONE 2.7MM 55MM TAP-LOC ACUMED TI ELB TAP STRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO2760	SUP	HCPCS C1713		FA-CO2760  -  SCREW BONE 2.7MM 60MM TAP-LOC ACUMED TI ELB TPR STRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO3536	SUP	HCPCS C1713		FA-CO3536  -  SCREW BONE 3.5MM 36MM TAP-LOC TI CORT LCK TAP NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO3538	SUP	HCPCS C1713		FA-CO3538  -  SCREW BN 3.5MM 38MM TAP LCK	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO3540	SUP	HCPCS C1713		FA-CO3540  -  SCREW BONE 3.5MM 40MM TAP-LOC TI ELB LCK TAP NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO3545	SUP	HCPCS C1713		FA-CO3545  -  SCREW BONE 3.5MM 45MM TI CORT LCK TAP NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO3550	SUP	HCPCS C1713		FA-CO3550  -  SCREW BN 3.5MM 50MM NS TPRLK CORT	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO3555	SUP	HCPCS C1713		FA-CO3555  -  SCREW BN 3.5MM 55MM NS LCK TAP TI ELB PLT SYS	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FA-CO3560	SUP	HCPCS C1713		FA-CO3560  -  SCREW BN 3.5MM 60MM NS LCK TAP TI ELB PLT SYS	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$104.63	$104.63	$0.00	$0.00	$0.00	$48.46	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$137.52	$137.52	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$36.39	$0.00	$0.00	$37.01	$0.00	$0.00	$0.00	$0.00	$0.00
FBRC	SUP	HCPCS C1884		FBRC  -  SYSTEM REM .035IN 10FR 75CM RCVR CN WRE BSKT RADOPQ PEBAX	BOTH IP/OP	"$1,593.45 "	"$1,179.15"	$0.00	"$1,274.76"	$717.05	$717.05	$0.00	$0.00	$0.00	$332.11	"$1,182.66"	"$1,182.66"	$0.00	$0.00	$332.07	$0.00	$942.52	$942.52	$0.00	$796.72	"$1,262.01"	"$1,274.76"	$0.00		$0.00	$249.37	$0.00	$0.00	$253.68	$0.00	$0.00	$0.00	$0.00	$0.00
FCROF2005	SUP	Custom 27203010		FILTER 20.5UM	BOTH IP/OP	$31.58 	$23.37	$0.00	$25.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.79	$25.01	$25.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FD-410LR	SUP	Custom 27203010		FD-410LR  -  FORCEPS MNPLR 2.75MM 2.8MM 165X5MM STRL COAGRASPER HMSTS	BOTH IP/OP	$463.53 	$343.01	$0.00	$370.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$344.03	$344.03	$0.00	$0.00	$96.60	$0.00	$0.00	$0.00	$0.00	$231.76	$367.12	$370.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FD-411UR	SUP	Custom 27203010		FD-411UR  -  FORCEPS MNPLR 2.75MM 3.2MM 230X4MM STRL COAGRASPER HMSTS	BOTH IP/OP	$588.85 	$435.75	$0.00	$471.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$437.04	$437.04	$0.00	$0.00	$122.72	$0.00	$0.00	$0.00	$0.00	$294.43	$466.37	$471.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FD-412LR	SUP	Custom 27203010		FD-412LR  -  FORCEPS ESCP 2.8MM 2.75MM 165CM COAGRASPER HMST GRSPR MNPLR	BOTH IP/OP	$463.53 	$343.01	$0.00	$370.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$344.03	$344.03	$0.00	$0.00	$96.60	$0.00	$0.00	$0.00	$0.00	$231.76	$367.12	$370.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FDB2.0	SUP	Custom 27203010		BIT DRILL 2MM STRL DISP DB20	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FE660K	SUP	Custom 27803010		FE660K  -  CLIP ANEURYSM STANDARD 10.3MM OPENING 5MM 12MM STR FENST	BOTH IP/OP	"$1,013.59 "	$750.06	$0.00	$752.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$752.28	$752.28	$0.00	$0.00	$211.23	$0.00	$0.00	$0.00	$0.00	$460.48	$729.39	$736.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FE664K	SUP	Custom 27803010		FE664K  -  CLIP ANEURYSM 5.5MM OPEN STANDARD 5MM 10/6.4MM PERMANENT	BOTH IP/OP	"$1,013.59 "	$750.06	$0.00	$752.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$752.28	$752.28	$0.00	$0.00	$211.23	$0.00	$0.00	$0.00	$0.00	$460.48	$729.39	$736.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FE776K	SUP	Custom 27803010		FE776K  -  CLIP ANEURYSM STANDARD 5MM OPENING 5MM 10MM CVD DOWN FENST	BOTH IP/OP	"$1,013.59 "	$750.06	$0.00	$752.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$752.28	$752.28	$0.00	$0.00	$211.23	$0.00	$0.00	$0.00	$0.00	$460.48	$729.39	$736.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FE779K	SUP	Custom 27803010		FE779K  -  CLIP ANEURYSM STANDARD 5MM OPENING 5MM 10MM CVD UP FENST	BOTH IP/OP	"$1,013.59 "	$750.06	$0.00	$752.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$752.28	$752.28	$0.00	$0.00	$211.23	$0.00	$0.00	$0.00	$0.00	$460.48	$729.39	$736.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FEM08040	SUP	HCPCS C1876		FEM08040  -  GRAFT STNT 8MM 9FR 40MM 80CM FLN + 2 LYR KINK RST INR CATH	BOTH IP/OP	"$7,857.50 "	"$5,814.55"	$0.00	"$6,286.00"	"$3,535.88"	"$3,535.88"	$0.00	$0.00	$0.00	"$1,637.70"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,637.50"	$0.00	"$3,873.75"	"$3,873.75"	$0.00	"$3,928.75"	"$6,223.14"	"$6,286.00"	$0.00		$0.00	"$1,229.70"	$0.00	$0.00	"$1,250.91"	$0.00	$0.00	$0.00	$0.00	$0.00
FEMII016AS	SUP	Custom 27203010		FEMII016AS  -  FEM-FLEX II CANNULA 16 FR	BOTH IP/OP	$592.30 	$438.30	$0.00	$473.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$439.61	$439.61	$0.00	$0.00	$123.44	$0.00	$0.00	$0.00	$0.00	$296.15	$469.10	$473.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FEMII018AS	SUP	Custom 27203010		FEMII018AS  -  FEM-FLEX II CANNULA 18 FR	BOTH IP/OP	$592.30 	$438.30	$0.00	$473.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$439.61	$439.61	$0.00	$0.00	$123.44	$0.00	$0.00	$0.00	$0.00	$296.15	$469.10	$473.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FEMII020AS	SUP	Custom 27203010		FEMII020AS  -  FEM-FLEX II CANNULA 20 FR	BOTH IP/OP	$592.30 	$438.30	$0.00	$473.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$439.61	$439.61	$0.00	$0.00	$123.44	$0.00	$0.00	$0.00	$0.00	$296.15	$469.10	$473.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FG-0201	SUP	Custom 27203010		FG-0201  -  DEVICE TISS REM 3.6MM SYMPHION RESCT	BOTH IP/OP	"$4,120.00 "	"$3,048.80"	$0.00	"$3,296.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,057.86"	"$3,057.86"	$0.00	$0.00	$858.61	$0.00	$0.00	$0.00	$0.00	"$2,060.00"	"$3,263.04"	"$3,296.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FG-0202	SUP	Custom 27203010		FG-0202  -  TISSUE REMOVAL SYSTEM FLUID MANAGEMENT ACCESSORIES	BOTH IP/OP	"$1,284.93 "	$950.85	$0.00	"$1,027.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$953.67	$953.67	$0.00	$0.00	$267.78	$0.00	$0.00	$0.00	$0.00	$642.46	"$1,017.66"	"$1,027.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FG-44NR-1	SUP	Custom 27203010		FG-44NR-1  -  FORCEP SPEC RTRVL 180CM 2.8MM BRNCHL FB ROT ALGTR JAW RAT	BOTH IP/OP	"$1,163.58 "	$861.05	$0.00	$930.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$863.61	$863.61	$0.00	$0.00	$242.49	$0.00	$0.00	$0.00	$0.00	$581.79	$921.56	$930.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FGL07560	SUP	HCPCS L8699		FGL07560  -  GRAFT SFT TIS 7.5MM 60MM FLEXIGRAFT GRAFTLINK ALGRF FRZN	BOTH IP/OP	"$6,160.00 "	"$4,558.40"	$0.00	"$4,832.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,283.74"	$0.00	$0.00	$0.00	$0.00	"$3,020.00"	"$4,783.68"	"$4,832.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FLT08040	SUP	HCPCS C1768		STENT TRACHEOBRONCHIAL FLUENCY 8MM X 40MM SELF EXPANDING COV	BOTH IP/OP	"$5,737.50 "	"$4,245.75"	$0.00	"$4,590.00"	"$2,581.88"	"$2,581.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,868.75"	"$4,544.10"	"$4,590.00"	$0.00		$0.00	$897.92	$0.00	$0.00	$913.41	$0.00	$0.00	$0.00	$0.00	$0.00
FP-07.24.0	SUP	HCPCS C1713		FP-07.24.0  -  CAGE SPNL 24MMX7MM FUSE 0D PLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
FP-08.24.0	SUP	HCPCS C1713		FP-08.24.0  -  CAGE SPNL 24MMX8MM FUSE 0D PLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
FP-09.24.4	SUP	HCPCS C1713		FP-09.24.4  -  CAGE SPNL 24MMX9MM FUSE 4D PLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
FP-09.24.8	SUP	HCPCS C1713		FP-09.24.8  -  CAGE SPNL 24MMX9MM FUSE 8D PLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
FP-10.24.4	SUP	HCPCS C1713		FP-10.24.4  -  CAGE SPNL 24MMX10MM FUSE 4D PLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
FP-10.24.8	SUP	HCPCS C1713		FP-10.24.8  -  CAGE SPNL 24MMX10MM FUSE 8D PLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
FP-11.24.4	SUP	HCPCS C1713		FP-11.24.4  -  CAGE SPNL 24MMX11MM FUSE 4D PLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
FP-11.24.8	SUP	HCPCS C1713		FP-11.24.8  -  CAGE SPNL 24MMX11MM FUSE 8D PLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
FP-12.24.4	SUP	HCPCS C1713		FP-12.24.4  -  CAGE SPNL 24MMX12MM FUSE 4D PLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
FP-12.24.8	SUP	HCPCS C1713		FP-12.24.8  -  CAGE SPNL 24MMX12MM FUSE 8D PLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
FP-13.24.4	SUP	HCPCS C1713		FP-13.24.4  -  CAGE SPNL 24MMX13MM FUSE 4D PLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
FP-13.24.8	SUP	HCPCS C1713		FP-13.24.8  -  CAGE SPNL 24MMX13MM FUSE 8D PLIF	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	"$3,375.00"	"$3,375.00"	$0.00	$0.00	$0.00	"$1,563.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	"$3,697.50"	"$3,697.50"	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	"$1,173.75"	$0.00	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00
FP-14	SUP	HCPCS C1713		FP-14  -  PEG FIX 2.5MM 14MM FULTHD	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
FP-16	SUP	HCPCS C1713		FP-16  -  PEG FIX 2.5MM 16MM FULTHD	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
FP-20	SUP	HCPCS C1713		FP-20  -  PEG FIX 2.5MM 20MM FULTHD	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
FP-26	SUP	HCPCS C1713		FP-26  -  PEG FIX 2.5MM 26MM FULTHD	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
FP-7	SUP	HCPCS C1783		FP-7  -  DRAIN GLAUCOMA THK.9MM BLUNT TAPER .635MM .305MM 16X13MM 25	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
FR995-27	SUP	Custom 27803010		FR995-27  -  VALVE AOR 27MM 34MM STRL 3MM FRSTL BPRTH PRCN ROOT	BOTH IP/OP	"$23,125.00 "	"$17,112.50"	$0.00	"$18,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,819.25"	$0.00	$0.00	$0.00	$0.00	"$11,562.50"	"$18,315.00"	"$18,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FR995-29	SUP	Custom 27803010		FR995-29  -  FREESTYLE ROOT VALVE 29 MM	BOTH IP/OP	"$15,330.00 "	"$11,344.20"	$0.00	"$12,264.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,665.00"	"$12,141.36"	"$12,264.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FS0808	SUP	HCPCS C1781		FS0808  -  GRAFT SNTH TISS 8X8CM BIO-A BABSR REINF SCFLD TISS	BOTH IP/OP	"$1,022.50 "	$756.65	$0.00	$818.00	$460.13	$460.13	$0.00	$0.00	$0.00	$213.11	$758.90	$758.90	$0.00	$0.00	$213.09	$0.00	$604.81	$604.81	$0.00	$511.25	$809.82	$818.00	$0.00		$0.00	$160.02	$0.00	$0.00	$162.78	$0.00	$0.00	$0.00	$0.00	$0.00
FS0915	SUP	HCPCS C1781		FS0915  -  GRAFT SNTH TISS 15X9CM GORE BIO-A BABSR SCFLD	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$821.25	$821.25	$0.00	$0.00	$0.00	$380.38	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	"$1,079.49"	"$1,079.49"	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$285.61	$0.00	$0.00	$290.54	$0.00	$0.00	$0.00	$0.00	$0.00
FS1030	SUP	HCPCS C1781		FS1030  -  MESH SRG 30X10CM BIO-ASNTH BABSR REINF SCFLD TRM TISS	BOTH IP/OP	"$5,027.50 "	"$3,720.35"	$0.00	"$4,022.00"	"$2,262.38"	"$2,262.38"	$0.00	$0.00	$0.00	"$1,047.86"	"$3,731.41"	"$3,731.41"	$0.00	$0.00	"$1,047.73"	$0.00	"$2,478.56"	"$2,478.56"	$0.00	"$2,513.75"	"$3,981.78"	"$4,022.00"	$0.00		$0.00	$786.80	$0.00	$0.00	$800.38	$0.00	$0.00	$0.00	$0.00	$0.00
FS2020	SUP	HCPCS C1781		FS2020  -  GRAFT SNTH TISS 20X20CM BIO-A BABSR REINF SCFLD TISS	BOTH IP/OP	"$6,712.50 "	"$4,967.25"	$0.00	"$5,370.00"	"$3,020.63"	"$3,020.63"	$0.00	$0.00	$0.00	"$1,399.05"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,398.89"	$0.00	"$3,309.26"	"$3,309.26"	$0.00	"$3,356.25"	"$5,316.30"	"$5,370.00"	$0.00		$0.00	"$1,050.51"	$0.00	$0.00	"$1,068.63"	$0.00	$0.00	$0.00	$0.00	$0.00
FS2030	SUP	HCPCS C1781		FS2030  -  MESH SRG 30X20CM BIO-A BABSR REINF SCFLD TISS	BOTH IP/OP	"$10,080.00 "	"$7,459.20"	$0.00	"$8,064.00"	"$4,536.00"	"$4,536.00"	$0.00	$0.00	$0.00	"$2,100.92"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,100.67"	$0.00	"$4,969.44"	"$4,969.44"	$0.00	"$5,040.00"	"$7,983.36"	"$8,064.00"	$0.00		$0.00	"$1,577.52"	$0.00	$0.00	"$1,604.74"	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100201-20	SUP	Custom 27803010		FSR100201-20  -  COIL EMBL HLCL 2MM 1CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH	BOTH IP/OP	"$2,165.95 "	"$1,602.80"	$0.00	"$1,732.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,607.57"	"$1,607.57"	$0.00	$0.00	$451.38	$0.00	$0.00	$0.00	$0.00	"$1,082.98"	"$1,715.43"	"$1,732.76"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100202-20	SUP	Custom 27803010		FSR100202-20  -  COIL EMBL HLCL 2MM 2CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH	BOTH IP/OP	"$2,195.23 "	"$1,624.47"	$0.00	"$1,756.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,629.30"	"$1,629.30"	$0.00	$0.00	$457.48	$0.00	$0.00	$0.00	$0.00	"$1,097.61"	"$1,738.62"	"$1,756.18"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100203-20	SUP	Custom 27803010		FSR100203-20  -  COIL EMBL HLCL 2MM 3CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH	BOTH IP/OP	"$2,224.50 "	"$1,646.13"	$0.00	"$1,779.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,651.02"	"$1,651.02"	$0.00	$0.00	$463.59	$0.00	$0.00	$0.00	$0.00	"$1,112.25"	"$1,761.80"	"$1,779.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100204-20	SUP	Custom 27803010		FSR100204-20  -  COIL EMBL HLCL 2MM 4CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH	BOTH IP/OP	"$2,224.50 "	"$1,646.13"	$0.00	"$1,779.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,651.02"	"$1,651.02"	$0.00	$0.00	$463.59	$0.00	$0.00	$0.00	$0.00	"$1,112.25"	"$1,761.80"	"$1,779.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100206-20	SUP	Custom 27803010		FSR100206-20  -  COIL EMBL HLCL 2MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH	BOTH IP/OP	"$2,253.78 "	"$1,667.80"	$0.00	"$1,803.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,672.75"	"$1,672.75"	$0.00	$0.00	$469.69	$0.00	$0.00	$0.00	$0.00	"$1,126.89"	"$1,784.99"	"$1,803.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100208-20	SUP	Custom 27803010		FSR100208-20  -  COIL EMBL HLX 2MM 8CM ULTIPAQ 10 MCIOL STRCH RS HLCL LOOP	BOTH IP/OP	"$2,283.05 "	"$1,689.46"	$0.00	"$1,826.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,694.48"	"$1,694.48"	$0.00	$0.00	$475.79	$0.00	$0.00	$0.00	$0.00	"$1,141.53"	"$1,808.18"	"$1,826.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100252-20	SUP	Custom 27803010		FSR100252-20  -  COIL EMBL HLX 2.5MM 2CM ULTIPAQ 10 MCIOL STRCH RS HLCL LOOP	BOTH IP/OP	"$2,195.23 "	"$1,624.47"	$0.00	"$1,756.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,629.30"	"$1,629.30"	$0.00	$0.00	$457.48	$0.00	$0.00	$0.00	$0.00	"$1,097.61"	"$1,738.62"	"$1,756.18"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100254-20	SUP	Custom 27803010		FSR100254-20  -  COIL EMBL HLCL 2.5MM 4CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH	BOTH IP/OP	"$2,224.50 "	"$1,646.13"	$0.00	"$1,779.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,651.02"	"$1,651.02"	$0.00	$0.00	$463.59	$0.00	$0.00	$0.00	$0.00	"$1,112.25"	"$1,761.80"	"$1,779.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100256-20	SUP	Custom 27803010		FSR100256-20  -  COIL EMBL HLCL 2.5MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH	BOTH IP/OP	"$2,253.78 "	"$1,667.80"	$0.00	"$1,803.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,672.75"	"$1,672.75"	$0.00	$0.00	$469.69	$0.00	$0.00	$0.00	$0.00	"$1,126.89"	"$1,784.99"	"$1,803.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100258-20	SUP	Custom 27803010		FSR100258-20  -  COIL EMBL 2.5MM 8CM ULTIPAQ 10 MCIOL STRCH RS HLCL LOOP DTCH	BOTH IP/OP	"$2,283.05 "	"$1,689.46"	$0.00	"$1,826.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,694.48"	"$1,694.48"	$0.00	$0.00	$475.79	$0.00	$0.00	$0.00	$0.00	"$1,141.53"	"$1,808.18"	"$1,826.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100306-20	SUP	Custom 27803010		FSR100306-20  -  COIL EMBL HLCL 3MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH	BOTH IP/OP	"$2,253.78 "	"$1,667.80"	$0.00	"$1,803.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,672.75"	"$1,672.75"	$0.00	$0.00	$469.69	$0.00	$0.00	$0.00	$0.00	"$1,126.89"	"$1,784.99"	"$1,803.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100308-20	SUP	Custom 27803010		FSR100308-20  -  COIL EMBL 3MM 8CM ULTIPAQ 10 MCIOL HLCL LOOP DTCH SFT STRCH	BOTH IP/OP	"$2,283.05 "	"$1,689.46"	$0.00	"$1,826.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,694.48"	"$1,694.48"	$0.00	$0.00	$475.79	$0.00	$0.00	$0.00	$0.00	"$1,141.53"	"$1,808.18"	"$1,826.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100406-20	SUP	Custom 27803010		FSR100406-20  -  COIL EMBL HLCL 4MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH	BOTH IP/OP	"$2,253.78 "	"$1,667.80"	$0.00	"$1,803.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,672.75"	"$1,672.75"	$0.00	$0.00	$469.69	$0.00	$0.00	$0.00	$0.00	"$1,126.89"	"$1,784.99"	"$1,803.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FSR100408-20	SUP	Custom 27803010		FSR100408-20  -  COIL EMBL HLCL 4MM 8CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH	BOTH IP/OP	"$2,283.05 "	"$1,689.46"	$0.00	"$1,826.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,694.48"	"$1,694.48"	$0.00	$0.00	$475.79	$0.00	$0.00	$0.00	$0.00	"$1,141.53"	"$1,808.18"	"$1,826.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT-1100	SUP	Custom 27203010		FT-1100  -  TROCAR SURGICAL FALLER DIALYSIS CATHETER	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT-12100	SUP	Custom 27803010		FT-12100  -  CORONARY SHUNT 1.00 MM	BOTH IP/OP	$174.00 	$128.76	$0.00	$139.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.14	$129.14	$0.00	$0.00	$36.26	$0.00	$0.00	$0.00	$0.00	$87.00	$137.81	$139.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT12125	SUP	Custom 27803010		FT12125  -  SHUNT CARDIO BULB TAPER 1.25MM 18MM RADIOPQ FLEXIBLE	BOTH IP/OP	$174.00 	$128.76	$0.00	$139.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.00	$137.81	$139.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT-12125	SUP	Custom 27803010		FT-12125  -  CORONARY SHUNT 1.25 MM	BOTH IP/OP	$174.00 	$128.76	$0.00	$139.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.14	$129.14	$0.00	$0.00	$36.26	$0.00	$0.00	$0.00	$0.00	$87.00	$137.81	$139.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT-12150	SUP	Custom 27803010		FT-12150  -  CORONARY SHUNT 1.50 MM	BOTH IP/OP	$174.00 	$128.76	$0.00	$139.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.14	$129.14	$0.00	$0.00	$36.26	$0.00	$0.00	$0.00	$0.00	$87.00	$137.81	$139.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT-12175	SUP	Custom 27803010		FT-12175  -  CORONARY SHUNT 1.75 MM	BOTH IP/OP	$174.00 	$128.76	$0.00	$139.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.14	$129.14	$0.00	$0.00	$36.26	$0.00	$0.00	$0.00	$0.00	$87.00	$137.81	$139.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT-12200	SUP	Custom 27803010		FT-12200  -  CORONARY SHUNT 2.00 MM	BOTH IP/OP	$184.60 	$136.60	$0.00	$147.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.01	$137.01	$0.00	$0.00	$38.47	$0.00	$0.00	$0.00	$0.00	$92.30	$146.20	$147.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT-12225	SUP	Custom 27803010		FT-12225  -  CORONARY SHUNT 2.25 MM	BOTH IP/OP	$174.00 	$128.76	$0.00	$139.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.14	$129.14	$0.00	$0.00	$36.26	$0.00	$0.00	$0.00	$0.00	$87.00	$137.81	$139.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT12250	SUP	Custom 27803010		FT12250  -  SHUNT CARDIO 2.5MM 18MM FLO-THRU INTRALUMINAL	BOTH IP/OP	$174.00 	$128.76	$0.00	$139.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.14	$129.14	$0.00	$0.00	$36.26	$0.00	$0.00	$0.00	$0.00	$87.00	$137.81	$139.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT-12250	SUP	Custom 27803010		FT-12250  -  CORONARY SHUNT 2.20 MM	BOTH IP/OP	$174.00 	$128.76	$0.00	$139.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.00	$137.81	$139.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT180T	SUP	Custom 27803010		FT180T  -  CLIP ANEURYSM MINI 3.3MM OPENING 3MM STR TEMPORARY NARROW	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT190T	SUP	Custom 27803010		FT190T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM STR NARROW TEMPORARY	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT220T	SUP	Custom 27803010		FT220T  -  CLIP ANEURYSM MINI 4.6MM OPENING 7MM STR TEMPORARY LATEX	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT222T	SUP	Custom 27803010		FT222T  -  CLIP ANEURYSM MINI 4.4MM OPENING 6.6MM CVD SLIGHTLY	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT224T	SUP	Custom 27803010		FT224T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM CVD TEMPORARY LATEX FREE	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT250T	SUP	Custom 27803010		FT250T  -  CLIP ANEURYSM 7MM OPEN STANDARD 9MM TEMPORARY SPRING	BOTH IP/OP	$975.25 	$721.69	$0.00	$780.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.83	$723.83	$0.00	$0.00	$203.24	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT252T	SUP	Custom 27803010		FT252T  -  CLIP ANEURYSM STANDARD 6.8MM OPENING 8.3MM CVD SLIGHTLY	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT254T	SUP	Custom 27803010		FT254T  -  CLIP ANEURYSM STANDARD 6.1MM OPENING 6.4MM CVD TEMPORARY	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT280T	SUP	Custom 27803010		FT280T  -  CLIP ANEURYSM 9.2MM OPENING STANDARD 15MM TEMPORARY MRI	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT290T	SUP	Custom 27803010		FT290T  -  CLIP ANEURYSM STANDARD 11.4MM OPENING 20MM STR TEMPORARY	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT620T	SUP	Custom 27803010		FT620T  -  CLIP ANEURYSM STANDARD 9.6MM OPENING 3.5MM 12MM STR FENST	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT623T	SUP	Custom 27803010		FT623T  -  CLIP ANEURYSM 7.8MM OPENING STANDARD 10.6MM PERMANENT MRI	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT640T	SUP	Custom 27803010		FT640T  -  CLIP ANEURYSM STANDARD 7.9MM OPENING 5MM 6MM STR FENST	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT680T	SUP	Custom 27803010		FT680T  -  CLIP ANEURYSM MINI 3.3MM OPENING 3MM STR NARROW PERMANENT	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT690T	SUP	Custom 27803010		FT690T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM STR NARROW PERMANENT	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT700T	SUP	Custom 27803010		FT700T  -  CLIP ANEURYSM MINI 3.5MM OPENING 3MM SLIGHTLY CVD PERMANENT	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT710T	SUP	Custom 27803010		FT710T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM STR PERMANENT LATEX FREE	BOTH IP/OP	$975.25 	$721.69	$0.00	$780.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.83	$723.83	$0.00	$0.00	$203.24	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT712T	SUP	Custom 27803010		FT712T  -  CLIP ANEURYSM MINI 3.8MM OPENING 4.7MM CVD SLIGHTLY	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT714T	SUP	Custom 27803010		FT714T  -  CLIP ANEURYSM MINI 3.5MM OPENING 3.9MM SLIGHTLY CVD	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT720T	SUP	Custom 27803010		FT720T  -  CLIP ANEURYSM MINI 4.6MM OPENING 7MM STR PERMANENT LATEX	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT722T	SUP	Custom 27803010		FT722T  -  CLIP ANEURYSM MINI 4.4MM OPENING 6.6MM CVD SLIGHTLY	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT724T	SUP	Custom 27803010		FT724T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM CVD PERMANENT LATEX FREE	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT726T	SUP	Custom 27803010		FT726T  -  CLIP ANEURYSM MINI 4MM OPENING 5.2MM SLIGHTLY CVD PERMANENT	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT727T	SUP	Custom 27803010		FT727T  -  CLIP ANEURYSM MINI 7MM OPENING 4MM BAYONET PERMANENT LATEX	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT728D	SUP	Custom 27803010		FT728D  -  CLIP ANEURYSM MINI 5.7MM OPENING 7MM BAYONET PERMANENT LATEX	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT740T	SUP	Custom 27803010		FT740T  -  CLIP ANEURYSM 6.2MM OPENING STANDARD 7MM PERMANENT MRI	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT742T	SUP	Custom 27803010		FT742T  -  CLIP ANEURYSM STANDARD 6MM OPENING 6.5MM SLIGHTLY CVD	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT744T	SUP	Custom 27803010		FT744T  -  CLIP ANEURYSM STANDARD 5.5MM OPENING 5.4MM CVD PERMANENT	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT746T	SUP	Custom 27803010		FT746T  -  CLIP ANEURYSM STANDARD 5.7MM OPENING 7MM LATERAL ANGLED	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT747T	SUP	Custom 27803010		FT747T  -  CLIP ANEURYSM 7MM OPENING STANDARD 8.6MM PERMANENT MRI	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT750T	SUP	Custom 27803010		FT750T  -  CLIP ANEURYSM STANDARD 7MM OPENING 9MM STR PERMANENT LATEX	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT752T	SUP	Custom 27803010		FT752T  -  CLIP ANEURYSM STANDARD 6.8MM OPENING 8.3MM SLIGHTLY CVD	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT754T	SUP	Custom 27803010		FT754T  -  CLIP ANEURYSM STANDARD 6.1MM OPENING 6.4MM CVD PERMANENT	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT760T	SUP	Custom 27803010		FT760T  -  CLIP ANEURYSM STANDARD 7.8MM OPENING 11MM STR PERMANENT	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT762T	SUP	Custom 27803010		FT762T  -  CLIP ANEURYSM 7.5MM OPENING STANDARD 10.2MM PERMANENT MRI	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT780D	SUP	Custom 27803010		FT780D  -  CLIP ANEURYSM 9.2MM OPENING STANDARD 15MM PERMANENT MRI	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT782T	SUP	Custom 27803010		FT782T  -  CLIP ANEURYSM STANDARD 8.7MM OPENING 13.7MM PERMANENT CVD	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT786T	SUP	Custom 27803010		FT786T  -  CLIP ANEURYSM STANDARD 9.8MM OPENING 15.3MM CVD SLIGHTLY	BOTH IP/OP	$975.25 	$721.69	$0.00	$780.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.83	$723.83	$0.00	$0.00	$203.24	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT790D	SUP	Custom 27803010		FT790D  -  CLIP ANEURYSM STANDARD 11.4MM OPENING 20MM STR PERMANENT	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT806T	SUP	Custom 27803010		FT806T  -  CLIP ANEURYSM MINI 4.5MM OPENING 7MM ANGLED FORWARD	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT810T	SUP	Custom 27803010		FT810T  -  CLIP ANEURYSM STANDARD 6.5MM OPENING 9MM ANGLED FORWARD	BOTH IP/OP	"$1,084.23 "	$802.33	$0.00	$804.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.71	$804.71	$0.00	$0.00	$225.95	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FT820T	SUP	Custom 27803010		FT820T  -  CLIP ANEURYSM STANDARD 4.5MM OPENING 7MM ANGLED RIGHT	BOTH IP/OP	$975.25 	$721.69	$0.00	$780.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$723.83	$723.83	$0.00	$0.00	$203.24	$0.00	$0.00	$0.00	$0.00	$487.63	$772.40	$780.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FTL10040	SUP	HCPCS C1876		FTL10040  -  STENT TRCHBR 10MM 9FR 40MM STRL 117CM FLN + PUZZLE GFT	BOTH IP/OP	"$7,482.50 "	"$5,537.05"	$0.00	"$5,986.00"	"$3,367.13"	"$3,367.13"	$0.00	$0.00	$0.00	"$1,559.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,559.35"	$0.00	"$3,688.87"	"$3,688.87"	$0.00	"$3,741.25"	"$5,926.14"	"$5,986.00"	$0.00		$0.00	"$1,171.01"	$0.00	$0.00	"$1,191.21"	$0.00	$0.00	$0.00	$0.00	$0.00
FTM06040	SUP	HCPCS C1876		FTM06040  -  STENT TRCHBR 6MM 40MM 80CM .035IN SLF XPD DLV SYS FLN PLUS	BOTH IP/OP	"$7,482.50 "	"$5,537.05"	$0.00	"$5,986.00"	"$3,367.13"	"$3,367.13"	$0.00	$0.00	$0.00	"$1,559.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,559.35"	$0.00	"$3,688.87"	"$3,688.87"	$0.00	"$3,741.25"	"$5,926.14"	"$5,986.00"	$0.00		$0.00	"$1,171.01"	$0.00	$0.00	"$1,191.21"	$0.00	$0.00	$0.00	$0.00	$0.00
FX-4001-S	SUP	Custom 27203010		FX-4001-S  -  KIT XTRNFX STRL STABLELOC LTWT RDLCNT WRST	BOTH IP/OP	"$3,462.50 "	"$2,562.25"	$0.00	"$2,770.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,569.87"	"$2,569.87"	$0.00	$0.00	$721.59	$0.00	$0.00	$0.00	$0.00	"$1,731.25"	"$2,742.30"	"$2,770.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FX-4004-S	SUP	Custom 27203010		FX-4004-S  -  PIN FIX 3.2MM SLFDRILL 30MM ORTH STABLELOC STRL	BOTH IP/OP	$707.50 	$523.55	$0.00	$566.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.11	$525.11	$0.00	$0.00	$147.44	$0.00	$0.00	$0.00	$0.00	$353.75	$560.34	$566.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
FX-4054-S	SUP	Custom 27203010		FX-4054-S  -  PIN FIX 2.7MM SLFDRILL 25MM	BOTH IP/OP	$707.50 	$523.55	$0.00	$566.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.11	$525.11	$0.00	$0.00	$147.44	$0.00	$0.00	$0.00	$0.00	$353.75	$560.34	$566.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G00130	SUP	HCPCS C1725		G00130  -  CATH ANGIO .035IN 5FR 65CM STR FLXB PE	BOTH IP/OP	$65.00 	$48.10	$0.00	$48.24	$17.65	$17.65	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$5.09	$0.00	$0.00	$5.17	$0.00	$0.00	$0.00	$0.00	$0.00
G00164	SUP	Custom 27203010		G00164  -  STOPCOCK IV .95IN CLR STRL 1 WY F TO M LL ROT ADPR LP PLS	BOTH IP/OP	$14.38 	$10.64	$0.00	$11.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.67	$10.67	$0.00	$0.00	$3.00	$0.00	$0.00	$0.00	$0.00	$7.19	$11.39	$11.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G00165	SUP	HCPCS C1770		G00165  -  COIL EMBL 5CM 5MM 3.2 LOOP FBR OCL SPRG .035IN SS A/V STRL	BOTH IP/OP	$65.89 	$48.76	$0.00	$52.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.90	$48.90	$0.00	$0.00	$13.73	$0.00	$0.00	$0.00	$0.00	$32.94	$52.18	$52.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G00314	SUP	HCPCS C1769		G00314  -  GUIDEWIRE VASC 3MM .038IN 100CM STRL SFTJ JTP HVYDTY CRV	BOTH IP/OP	$25.50 	$18.87	$0.00	$20.40	$13.85	$13.85	$0.00	$0.00	$0.00	$5.31	$18.93	$18.93	$0.00	$0.00	$5.31	$0.00	$15.08	$15.08	$0.00	$12.75	$20.20	$20.40	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
G00321	SUP	HCPCS C1769		G00321  -  GUIDEWIRE VASC STRG .038IN 145CM LNDRQS RING TRQ SS PTFE	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G00331	SUP	HCPCS C1769		G00331  -  SET STNT .035IN 2 PGTL CRV 4.7FR 28CM STRL PSTNR GW SFLX	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G00511	SUP	HCPCS C1769		G00511  -  GUIDEWIRE VASCULAR CURVE TAPER .035IN 145CM 3CM FLEXIBLE TIP	BOTH IP/OP	$36.87 	$27.28	$0.00	$28.50	$19.34	$19.34	$0.00	$0.00	$0.00	$7.69	$27.37	$27.37	$0.00	$0.00	$7.68	$0.00	$21.81	$21.81	$0.00	$17.81	$28.22	$28.50	$0.00		$0.00	$5.58	$0.00	$0.00	$5.67	$0.00	$0.00	$0.00	$0.00	$0.00
G00529	SUP	HCPCS C1769		G00529  -  GUIDEWIRE VASCULAR CURVE TAPER .035IN 80CM 3CM FLEXIBLE TIP	BOTH IP/OP	$33.10 	$24.49	$0.00	$25.58	$17.36	$17.36	$0.00	$0.00	$0.00	$6.90	$24.56	$24.56	$0.00	$0.00	$6.90	$0.00	$19.58	$19.58	$0.00	$15.99	$25.33	$25.58	$0.00		$0.00	$5.00	$0.00	$0.00	$5.09	$0.00	$0.00	$0.00	$0.00	$0.00
G00593	SUP	HCPCS C1769		G00593  -  GUIDEWIRE VASCULAR STR TAPER .018IN 50CM FLEXIBLE TIP FIX	BOTH IP/OP	$32.03 	$23.70	$0.00	$24.76	$16.81	$16.81	$0.00	$0.00	$0.00	$6.68	$23.77	$23.77	$0.00	$0.00	$6.68	$0.00	$18.95	$18.95	$0.00	$15.48	$24.51	$24.76	$0.00		$0.00	$4.84	$0.00	$0.00	$4.93	$0.00	$0.00	$0.00	$0.00	$0.00
G00631	SUP	HCPCS C1769		G00631  -  GUIDEWIRE VASC STRG .038IN 145CM FX COR SS	BOTH IP/OP	$45.70 	$33.82	$0.00	$36.56	$24.82	$24.82	$0.00	$0.00	$0.00	$9.53	$33.92	$33.92	$0.00	$0.00	$9.52	$0.00	$27.03	$27.03	$0.00	$22.85	$36.19	$36.56	$0.00		$0.00	$7.15	$0.00	$0.00	$7.28	$0.00	$0.00	$0.00	$0.00	$0.00
G00666	SUP	HCPCS C1769		G00666  -  GUIDEWIRE VASC .035IN 145CM 8CM AMPTZ 2 FLX TP XSTIF SS	BOTH IP/OP	$52.55 	$38.89	$0.00	$42.04	$28.53	$28.53	$0.00	$0.00	$0.00	$10.95	$39.00	$39.00	$0.00	$0.00	$10.95	$0.00	$31.08	$31.08	$0.00	$26.28	$41.62	$42.04	$0.00		$0.00	$8.22	$0.00	$0.00	$8.37	$0.00	$0.00	$0.00	$0.00	$0.00
G00683	SUP	HCPCS C1769		G00683  -  GUIDEWIRE VASC STRG TPR .028IN 145CM STRL FX COR SS PTFE	BOTH IP/OP	$43.38 	$32.10	$0.00	$34.70	$23.55	$23.55	$0.00	$0.00	$0.00	$9.04	$32.19	$32.19	$0.00	$0.00	$9.04	$0.00	$25.66	$25.66	$0.00	$21.69	$34.36	$34.70	$0.00		$0.00	$6.79	$0.00	$0.00	$6.91	$0.00	$0.00	$0.00	$0.00	$0.00
G00691	SUP	HCPCS C1769		G00691  -  GWIRE VASC .035IN 145CM 20CM STR FLEXIBILE TIP FLPY BNTSN LG	BOTH IP/OP	$49.97 	$36.98	$0.00	$39.00	$26.47	$26.47	$0.00	$0.00	$0.00	$10.41	$37.09	$37.09	$0.00	$0.00	$10.41	$0.00	$29.56	$29.56	$0.00	$24.38	$38.61	$39.00	$0.00		$0.00	$7.63	$0.00	$0.00	$7.76	$0.00	$0.00	$0.00	$0.00	$0.00
G00693	SUP	HCPCS C1769		G00693  -  GUIDEWIRE VASCULAR STR BENTSON CURVE .038IN 145CM 20CM	BOTH IP/OP	$61.88 	$45.79	$0.00	$49.50	$33.60	$33.60	$0.00	$0.00	$0.00	$12.90	$45.92	$45.92	$0.00	$0.00	$12.89	$0.00	$36.60	$36.60	$0.00	$30.94	$49.01	$49.50	$0.00		$0.00	$9.68	$0.00	$0.00	$9.85	$0.00	$0.00	$0.00	$0.00	$0.00
G00785	SUP	HCPCS C1769		G00785  -  GUIDEWIRE VASC .045IN 145CM STRL STRG TPR FXCR SS PTFE DISP	BOTH IP/OP	$44.10 	$32.63	$0.00	$35.28	$23.95	$23.95	$0.00	$0.00	$0.00	$9.19	$32.73	$32.73	$0.00	$0.00	$9.19	$0.00	$26.09	$26.09	$0.00	$22.05	$34.93	$35.28	$0.00		$0.00	$6.90	$0.00	$0.00	$7.02	$0.00	$0.00	$0.00	$0.00	$0.00
G00852	SUP	Custom 27203010		G00852  -  NEEDLE BIOP 22GA 10CM CHIBA STERILE DISPOSABLE ASPIRAT	BOTH IP/OP	$26.58 	$19.67	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.72	$19.72	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$13.29	$21.05	$21.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G01035	SUP	Custom 27203010		COIL 38-2-3 EMBOLIZATION  MWCE	BOTH IP/OP	$145.00 	$107.30	$0.00	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.50	$114.84	$116.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G01095	SUP	HCPCS C1769		G01095  -  GWIRE VASC 6CM .035IN 200CM 20CM BNTSN STR ATRM TIP LG DIA	BOTH IP/OP	$52.53 	$38.87	$0.00	$41.00	$27.83	$27.83	$0.00	$0.00	$0.00	$10.95	$38.99	$38.99	$0.00	$0.00	$10.95	$0.00	$31.07	$31.07	$0.00	$25.63	$40.59	$41.00	$0.00		$0.00	$8.02	$0.00	$0.00	$8.16	$0.00	$0.00	$0.00	$0.00	$0.00
G01184	SUP	HCPCS C1770		G01184  -  COIL EMBL 4CM 3MM 4.3 LOOP .038IN SS VASC STRL DISP	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G01185	SUP	HCPCS C1770		G01185  -  COIL EMBL .038IN 5MM 5CM STRL 3.2 LOOP SS VASC	BOTH IP/OP	$65.89 	$48.76	$0.00	$52.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.90	$48.90	$0.00	$0.00	$13.73	$0.00	$0.00	$0.00	$0.00	$32.94	$52.18	$52.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G011LF	SUP	Custom 27203010		GUIDE PRB 11GA MAMTM BRST BIOP LORAD FSCHR STRL DISP	BOTH IP/OP	$18.38 	$13.60	$0.00	$14.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.19	$14.56	$14.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G01212	SUP	HCPCS C1892		G01212  -  DILATOR SURG STANDARD 16FR 20CM RADIOPQ VESSEL STERILE	BOTH IP/OP	$19.91 	$14.73	$0.00	$14.78	$9.96	$9.96	$0.00	$0.00	$0.00	$4.15	$14.78	$14.78	$0.00	$0.00	$4.15	$0.00	$11.78	$11.78	$0.00	$9.18	$14.53	$14.68	$0.00		$0.00	$2.87	$0.00	$0.00	$2.92	$0.00	$0.00	$0.00	$0.00	$0.00
G01232	SUP	HCPCS C1770		G01232  -  COIL EMBOLIZATION 15MM 8CM 1.7 LOOP LOAD CARTRIDGE STAINLESS	BOTH IP/OP	$65.89 	$48.76	$0.00	$52.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.90	$48.90	$0.00	$0.00	$13.73	$0.00	$0.00	$0.00	$0.00	$32.94	$52.18	$52.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G01261	SUP	HCPCS C1769		G01261  -  GUIDEWIRE VASCULAR J ROSEN CURVE .035IN 145CM 1.5CM HEAVY	BOTH IP/OP	$36.93 	$27.33	$0.00	$28.00	$19.01	$19.01	$0.00	$0.00	$0.00	$7.70	$27.41	$27.41	$0.00	$0.00	$7.70	$0.00	$21.84	$21.84	$0.00	$17.50	$27.72	$28.00	$0.00		$0.00	$5.48	$0.00	$0.00	$5.57	$0.00	$0.00	$0.00	$0.00	$0.00
G01292	SUP	HCPCS C1770		G01292  -  COIL EMBL .038IN 10MM 5CM STRL 1.6 LOOP SS VASC	BOTH IP/OP	$65.89 	$48.76	$0.00	$52.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.90	$48.90	$0.00	$0.00	$13.73	$0.00	$0.00	$0.00	$0.00	$32.94	$52.18	$52.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G01371	SUP	HCPCS C1769		G01371  -  GUIDEWIRE VASC .038IN 145CM AMPTZ MOV COR TPR STRG PTFE	BOTH IP/OP	$45.70 	$33.82	$0.00	$36.56	$24.82	$24.82	$0.00	$0.00	$0.00	$9.53	$33.92	$33.92	$0.00	$0.00	$9.52	$0.00	$27.03	$27.03	$0.00	$22.85	$36.19	$36.56	$0.00		$0.00	$7.15	$0.00	$0.00	$7.28	$0.00	$0.00	$0.00	$0.00	$0.00
G01384	SUP	HCPCS C1725		G01384  -  CATHETER BLNDIL 80CM 4.5CM V ANDL TPR TIP ILC FEM POPLT ART	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$32.58	$32.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00		$0.00	$9.39	$0.00	$0.00	$9.55	$0.00	$0.00	$0.00	$0.00	$0.00
G01471	SUP	Custom 27203010		G01471  -  DILATOR VASCULAR STANDARD 20FR 20CM RADIOPQ STERILE	BOTH IP/OP	$36.95 	$27.34	$0.00	$27.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.42	$27.42	$0.00	$0.00	$7.70	$0.00	$0.00	$0.00	$0.00	$17.03	$26.97	$27.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G01472	SUP	Custom 27203010		G01472  -  DILATOR VASCULAR .038IN 22FR 20CM RADIOPQ GWIRE STERILE	BOTH IP/OP	$36.95 	$27.34	$0.00	$27.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.42	$27.42	$0.00	$0.00	$7.70	$0.00	$0.00	$0.00	$0.00	$17.03	$26.97	$27.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G01616	SUP	HCPCS C1769		G01616  -  GUIDEWIRE VASC .038IN 260CM BNTSN STRG FXCR SS PTFE CRBRL	BOTH IP/OP	$121.25 	$89.73	$0.00	$97.00	$65.84	$65.84	$0.00	$0.00	$0.00	$25.27	$89.99	$89.99	$0.00	$0.00	$25.27	$0.00	$71.72	$71.72	$0.00	$60.63	$96.03	$97.00	$0.00		$0.00	$18.98	$0.00	$0.00	$19.30	$0.00	$0.00	$0.00	$0.00	$0.00
G01618	SUP	Custom 27203010		G01618  -  NEEDLE PROCEDURE 21GA 7CM 1 PART ENTRY THIN WALL	BOTH IP/OP	$8.23 	$6.09	$0.00	$6.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.11	$6.52	$6.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G01729	SUP	HCPCS C1769		G01729  -  GUIDEWIRE VASC STD STRG .035IN 145CM 3CM 2 FLXB SS PTFE	BOTH IP/OP	$39.33 	$29.10	$0.00	$31.46	$21.35	$21.35	$0.00	$0.00	$0.00	$8.20	$29.19	$29.19	$0.00	$0.00	$8.20	$0.00	$23.26	$23.26	$0.00	$19.66	$31.15	$31.46	$0.00		$0.00	$6.15	$0.00	$0.00	$6.26	$0.00	$0.00	$0.00	$0.00	$0.00
G01884	SUP	Custom 27203010		G01884  -  DILATOR VASCULAR .038IN STANDARD 24FR 20CM STANDARD RADIOPQ	BOTH IP/OP	$36.95 	$27.34	$0.00	$27.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.42	$27.42	$0.00	$0.00	$7.70	$0.00	$0.00	$0.00	$0.00	$17.03	$26.97	$27.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G02295	SUP	HCPCS C1769		G02295  -  CATHETER URET UNV 4FR 70CM RTNR WDG	BOTH IP/OP	$4.30 	$3.18	$0.00	$3.44	$2.34	$2.34	$0.00	$0.00	$0.00	$0.90	$3.19	$3.19	$0.00	$0.00	$0.90	$0.00	$2.54	$2.54	$0.00	$2.15	$3.41	$3.44	$0.00		$0.00	$0.67	$0.00	$0.00	$0.68	$0.00	$0.00	$0.00	$0.00	$0.00
G02760	SUP	HCPCS C1770		G02760  -  COIL EMBL 4CM 3MM 4.3 LOOP .035IN SS STRL DISP	BOTH IP/OP	$65.89 	$48.76	$0.00	$52.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.90	$48.90	$0.00	$0.00	$13.73	$0.00	$0.00	$0.00	$0.00	$32.94	$52.18	$52.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G03031	SUP	HCPCS C1769		G03031  -  GUIDEWIRE VASCULAR STR FLOPPY TAPER .038IN 145CM FLEXIBLE	BOTH IP/OP	$64.58 	$47.79	$0.00	$51.66	$35.06	$35.06	$0.00	$0.00	$0.00	$13.46	$47.93	$47.93	$0.00	$0.00	$13.46	$0.00	$38.20	$38.20	$0.00	$32.29	$51.15	$51.66	$0.00		$0.00	$10.11	$0.00	$0.00	$10.28	$0.00	$0.00	$0.00	$0.00	$0.00
G03037	SUP	HCPCS C1769		G03037  -  GUIDEWIRE VASC .038IN 100CM STRL STRG TPR FXCR SS PTFE DISP	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$29.87	$29.87	$0.00	$0.00	$0.00	$11.46	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$32.53	$32.53	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$8.61	$0.00	$0.00	$8.76	$0.00	$0.00	$0.00	$0.00	$0.00
G03095	SUP	HCPCS C1769		G03095  -  GUIDEWIRE VASCULAR 3CM STR TAPER .035IN 145CM 7CM FLEXIBLE	BOTH IP/OP	$67.16 	$49.70	$0.00	$51.66	$35.06	$35.06	$0.00	$0.00	$0.00	$14.00	$49.84	$49.84	$0.00	$0.00	$14.00	$0.00	$39.72	$39.72	$0.00	$32.29	$51.15	$51.66	$0.00		$0.00	$10.11	$0.00	$0.00	$10.28	$0.00	$0.00	$0.00	$0.00	$0.00
G03211	SUP	HCPCS C1769		G03211  -  GUIDEWIRE VASC .038IN 145CM STRL STRG MOV COR SS PTFE DISP	BOTH IP/OP	$51.93 	$38.43	$0.00	$41.54	$28.20	$28.20	$0.00	$0.00	$0.00	$10.82	$38.54	$38.54	$0.00	$0.00	$10.82	$0.00	$30.71	$30.71	$0.00	$25.96	$41.13	$41.54	$0.00		$0.00	$8.13	$0.00	$0.00	$8.27	$0.00	$0.00	$0.00	$0.00	$0.00
G03301	SUP	HCPCS C1729		G03301  -  SET DRAIN 29CM 9FR PTFE THOR 20 SDPRT 1 WY STPCK CATH NDL	BOTH IP/OP	$458.70 	$339.44	$0.00	$340.45	$208.32	$208.32	$0.00	$0.00	$0.00	$95.60	$340.45	$340.45	$0.00	$0.00	$95.59	$0.00	$271.32	$271.32	$0.00	$191.83	$303.85	$306.92	$0.00		$0.00	$60.04	$0.00	$0.00	$61.08	$0.00	$0.00	$0.00	$0.00	$0.00
G03445	SUP	HCPCS C1769		G03445  -  GUIDEWIRE URO STD STRG .038IN 145CM STRL 3CM 2 FLX TP FXCR	BOTH IP/OP	$55.00 	$40.70	$0.00	$44.00	$29.87	$29.87	$0.00	$0.00	$0.00	$11.46	$40.82	$40.82	$0.00	$0.00	$11.46	$0.00	$32.53	$32.53	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$8.61	$0.00	$0.00	$8.76	$0.00	$0.00	$0.00	$0.00	$0.00
G03522	SUP	HCPCS C1769		G03522  -  GUIDEWIRE VASC STRG TPR .035IN 145CM STRL AMPTZ MOV COR SS	BOTH IP/OP	$50.10 	$37.07	$0.00	$40.08	$27.20	$27.20	$0.00	$0.00	$0.00	$10.44	$37.18	$37.18	$0.00	$0.00	$10.44	$0.00	$29.63	$29.63	$0.00	$25.05	$39.68	$40.08	$0.00		$0.00	$7.84	$0.00	$0.00	$7.98	$0.00	$0.00	$0.00	$0.00	$0.00
G03562	SUP	HCPCS C1769		G03562  -  GUIDEWIRE VASCULAR STR .035IN 260CM EXTRA STIFF SHAFT COIL	BOTH IP/OP	$70.20 	$51.95	$0.00	$54.00	$36.65	$36.65	$0.00	$0.00	$0.00	$14.63	$52.10	$52.10	$0.00	$0.00	$14.63	$0.00	$41.52	$41.52	$0.00	$33.75	$53.46	$54.00	$0.00		$0.00	$10.56	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
G03579	SUP	HCPCS C1769		G03579  -  GUIDEWIRE VASCULAR STR .038IN 300CM EXTRA STIFF SHAFT	BOTH IP/OP	$67.50 	$49.95	$0.00	$54.00	$36.65	$36.65	$0.00	$0.00	$0.00	$14.07	$50.10	$50.10	$0.00	$0.00	$14.07	$0.00	$39.93	$39.93	$0.00	$33.75	$53.46	$54.00	$0.00		$0.00	$10.56	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
G03831	SUP	HCPCS C2628		G03831  -  CATHETER BLNDIL 32MM 120CM CODA PU ACPT .035IN GW 12FR INTRO	BOTH IP/OP	"$1,042.50 "	$771.45	$0.00	$834.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.28	$773.74	$773.74	$0.00	$0.00	$217.26	$0.00	$616.64	$616.64	$0.00	$521.25	$825.66	$834.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G04001	SUP	HCPCS C1769		G04001  -  GUIDEWIRE VASCULAR STR .035IN 300CM FLEXIBLE TIP EXTRA STIFF	BOTH IP/OP	$105.30 	$77.92	$0.00	$81.00	$54.98	$54.98	$0.00	$0.00	$0.00	$21.95	$78.15	$78.15	$0.00	$0.00	$21.94	$0.00	$62.28	$62.28	$0.00	$50.63	$80.19	$81.00	$0.00		$0.00	$15.85	$0.00	$0.00	$16.12	$0.00	$0.00	$0.00	$0.00	$0.00
G04044	SUP	HCPCS C1770		G04044  -  COIL EMBL 2CM 3MM 2.1 LOOP .035IN SS STRL DISP	BOTH IP/OP	$65.89 	$48.76	$0.00	$52.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.90	$48.90	$0.00	$0.00	$13.73	$0.00	$0.00	$0.00	$0.00	$32.94	$52.18	$52.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G04096	SUP	HCPCS C1892		G04096  -  INTRODUCER SHEATH LARGE 22FR 13CM 20CM GWIRE DILAT PEEL-AWAY	BOTH IP/OP	$114.85 	$84.99	$0.00	$90.52	$61.44	$61.44	$0.00	$0.00	$0.00	$23.94	$85.24	$85.24	$0.00	$0.00	$23.93	$0.00	$67.93	$67.93	$0.00	$56.58	$89.61	$90.52	$0.00		$0.00	$17.71	$0.00	$0.00	$18.01	$0.00	$0.00	$0.00	$0.00	$0.00
G04267	SUP	HCPCS C1894		G04267  -  SET ACC NEFF PERC	BOTH IP/OP	$208.90 	$154.59	$0.00	$163.84	$111.21	$111.21	$0.00	$0.00	$0.00	$43.54	$155.04	$155.04	$0.00	$0.00	$43.53	$0.00	$123.56	$123.56	$0.00	$102.40	$162.20	$163.84	$0.00		$0.00	$32.05	$0.00	$0.00	$32.60	$0.00	$0.00	$0.00	$0.00	$0.00
G04636	SUP	HCPCS C1894		G04636  -  INTROD SHTH 4FR 10CM 40CM COAX CATH MPNCH SS .018IN	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$37.47	$37.47	$0.00	$0.00	$0.00	$14.38	$51.21	$51.21	$0.00	$0.00	$14.38	$0.00	$40.81	$40.81	$0.00	$34.50	$54.65	$55.20	$0.00		$0.00	$10.80	$0.00	$0.00	$10.98	$0.00	$0.00	$0.00	$0.00	$0.00
G05021	SUP	Custom 27203010		G05021  -  COIL EMBOLIZATION .035IN X 10MM X 5CM SPRING METAL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G05060	SUP	HCPCS C1725		G05060  -  CATH ANGIO .035IN STD PGTL CURVE 4FR 70CM 10 SDPRT HFLO NYL	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$17.65	$17.65	$0.00	$0.00	$0.00	$6.77	$24.12	$24.12	$0.00	$0.00	$6.77	$0.00	$19.22	$19.22	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$5.09	$0.00	$0.00	$5.17	$0.00	$0.00	$0.00	$0.00	$0.00
G05183	SUP	HCPCS C1769		G05183  -  GUIDEWIRE VASCULAR ANGLED .018IN 60CM 7CM SOFT COPE MANDRIL	BOTH IP/OP	$97.83 	$72.39	$0.00	$75.62	$51.33	$51.33	$0.00	$0.00	$0.00	$20.39	$72.61	$72.61	$0.00	$0.00	$20.39	$0.00	$57.87	$57.87	$0.00	$47.26	$74.87	$75.62	$0.00		$0.00	$14.79	$0.00	$0.00	$15.05	$0.00	$0.00	$0.00	$0.00	$0.00
G05189	SUP	HCPCS C1725		G05189  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 70CM SIZING 10	BOTH IP/OP	$57.75 	$42.74	$0.00	$44.00	$29.87	$29.87	$0.00	$0.00	$0.00	$12.04	$42.86	$42.86	$0.00	$0.00	$12.04	$0.00	$34.16	$34.16	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$8.61	$0.00	$0.00	$8.76	$0.00	$0.00	$0.00	$0.00	$0.00
G05641	SUP	Custom 27203010		G05641  -  ADAPTER TUBING MALE LUER LOCK LOCK TO TUOHY BORST STOPCOCK	BOTH IP/OP	$25.20 	$18.65	$0.00	$20.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.70	$18.70	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$12.60	$19.96	$20.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G05839	SUP	Custom 27203010		G05839  -  SET JJNSTM 80CM 16.5FR 24FR CR-ALZT-CNS 2 LUM 2 CATH SDPRT	BOTH IP/OP	$825.80 	$611.09	$0.00	$660.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$612.91	$612.91	$0.00	$0.00	$172.10	$0.00	$0.00	$0.00	$0.00	$412.90	$654.03	$660.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G06299	SUP	Custom 27203010		G06299  -  ADAPTER CATHETER 9FR LARGE BORE SIDE ARM ROTATING MALE INFUS	BOTH IP/OP	$53.00 	$39.22	$0.00	$40.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.34	$39.34	$0.00	$0.00	$11.05	$0.00	$0.00	$0.00	$0.00	$25.00	$39.60	$40.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G06444	SUP	HCPCS C1892		G06444  -  SET INTROD 18FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE	BOTH IP/OP	$114.85 	$84.99	$0.00	$90.52	$61.44	$61.44	$0.00	$0.00	$0.00	$23.94	$85.24	$85.24	$0.00	$0.00	$23.93	$0.00	$67.93	$67.93	$0.00	$56.58	$89.61	$90.52	$0.00		$0.00	$17.71	$0.00	$0.00	$18.01	$0.00	$0.00	$0.00	$0.00	$0.00
G06445	SUP	HCPCS C1892		G06445  -  INTRODUCER SHEATH LARGE 20FR 13CM 20CM PEEL-AWAY	BOTH IP/OP	$114.85 	$84.99	$0.00	$90.52	$61.44	$61.44	$0.00	$0.00	$0.00	$23.94	$85.24	$85.24	$0.00	$0.00	$23.93	$0.00	$67.93	$67.93	$0.00	$56.58	$89.61	$90.52	$0.00		$0.00	$17.71	$0.00	$0.00	$18.01	$0.00	$0.00	$0.00	$0.00	$0.00
G06446	SUP	HCPCS C1892		G06446  -  INTRODUCER SHEATH .038IN LARGE 24FR 13CM 20CM PEEL-AWAY	BOTH IP/OP	$114.85 	$84.99	$0.00	$90.52	$61.44	$61.44	$0.00	$0.00	$0.00	$23.94	$85.24	$85.24	$0.00	$0.00	$23.93	$0.00	$67.93	$67.93	$0.00	$56.58	$89.61	$90.52	$0.00		$0.00	$17.71	$0.00	$0.00	$18.01	$0.00	$0.00	$0.00	$0.00	$0.00
G06447	SUP	HCPCS C1892		G06447  -  INTRODUCER SHEATH .038IN LARGE 26FR 13CM 20CM W/O GWIRE	BOTH IP/OP	$114.85 	$84.99	$0.00	$90.52	$61.44	$61.44	$0.00	$0.00	$0.00	$23.94	$85.24	$85.24	$0.00	$0.00	$23.93	$0.00	$67.93	$67.93	$0.00	$56.58	$89.61	$90.52	$0.00		$0.00	$17.71	$0.00	$0.00	$18.01	$0.00	$0.00	$0.00	$0.00	$0.00
G06451	SUP	HCPCS C1880		G06451  -  SYSTEM EMBOLIZATION .038IN 11FR 12FR 40CM EMERGENCY CHRONIC	BOTH IP/OP	"$4,010.63 "	"$2,967.87"	$0.00	"$2,976.69"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$835.91	"$2,976.69"	"$2,976.69"	$0.00	$0.00	$835.81	$0.00	"$1,977.24"	"$1,977.24"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
G06452	SUP	HCPCS C1880		G06452  -  FILTER EMBOLIZATION .038IN 40MM 11FR 75CM CATHETER GWIRE	BOTH IP/OP	"$4,010.63 "	"$2,967.87"	$0.00	"$2,976.69"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$835.91	"$2,976.69"	"$2,976.69"	$0.00	$0.00	$835.81	$0.00	"$1,977.24"	"$1,977.24"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
G06491	SUP	HCPCS C1892		G06491  -  SET INTROD .038IN 11FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE	BOTH IP/OP	$114.85 	$84.99	$0.00	$90.52	$61.44	$61.44	$0.00	$0.00	$0.00	$23.94	$85.24	$85.24	$0.00	$0.00	$23.93	$0.00	$67.93	$67.93	$0.00	$56.58	$89.61	$90.52	$0.00		$0.00	$17.71	$0.00	$0.00	$18.01	$0.00	$0.00	$0.00	$0.00	$0.00
G06492	SUP	HCPCS C1892		G06492  -  SET INTROD .038IN 12FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE	BOTH IP/OP	$114.85 	$84.99	$0.00	$90.52	$61.44	$61.44	$0.00	$0.00	$0.00	$23.94	$85.24	$85.24	$0.00	$0.00	$23.93	$0.00	$67.93	$67.93	$0.00	$56.58	$89.61	$90.52	$0.00		$0.00	$17.71	$0.00	$0.00	$18.01	$0.00	$0.00	$0.00	$0.00	$0.00
G06541	SUP	HCPCS C1894		G06541  -  SET INTERVENTIONAL 9FR 16GA 38.5CM 50.5CM INTROD SHEATH	BOTH IP/OP	"$1,215.25 "	$899.29	$0.00	$972.20	$659.88	$659.88	$0.00	$0.00	$0.00	$253.29	$901.96	$901.96	$0.00	$0.00	$253.26	$0.00	$718.82	$718.82	$0.00	$607.63	$962.48	$972.20	$0.00		$0.00	$190.19	$0.00	$0.00	$193.47	$0.00	$0.00	$0.00	$0.00	$0.00
G06929	SUP	Custom 27203010		G06929  -  SET INTERVENTIONAL .038IN 10FR 40CM 62.5CM CATHETER CANNU	BOTH IP/OP	"$1,101.30 "	$814.96	$0.00	$881.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$817.38	$817.38	$0.00	$0.00	$229.51	$0.00	$0.00	$0.00	$0.00	$550.65	$872.23	$881.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G07090	SUP	HCPCS C1729		G07090  -  TRAY DRAIN 14FR 41CM 4 SIDEPORT RADIOPQ ENTRY NEEDLE SCALPEL	BOTH IP/OP	$424.90 	$314.43	$0.00	$315.36	$205.24	$205.24	$0.00	$0.00	$0.00	$88.56	$315.36	$315.36	$0.00	$0.00	$88.55	$0.00	$251.33	$251.33	$0.00	$188.99	$299.36	$302.38	$0.00		$0.00	$59.15	$0.00	$0.00	$60.17	$0.00	$0.00	$0.00	$0.00	$0.00
G07429	SUP	HCPCS C1894		G07429  -  SET INTROD 6FR 13CM 20CM SIDEARM FITTING SIDE CONNECT LINE	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$27.15	$27.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.00	$39.60	$40.00	$0.00		$0.00	$7.83	$0.00	$0.00	$7.96	$0.00	$0.00	$0.00	$0.00	$0.00
G07465	SUP	HCPCS C1894		G07465  -  INTRODUCER SHEATH 9FR 30CM SMALL VALVE ASMBLY RADIOPQ BAND	BOTH IP/OP	$177.63 	$131.45	$0.00	$140.00	$95.03	$95.03	$0.00	$0.00	$0.00	$37.02	$131.83	$131.83	$0.00	$0.00	$37.02	$0.00	$105.07	$105.07	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
G07914	SUP	HCPCS C1769		G07914  -  GUIDEWIRE VASCULAR TAPER .035IN 145CM RADIOPQ FLOPPY TIP	BOTH IP/OP	$97.50 	$72.15	$0.00	$75.00	$50.91	$50.91	$0.00	$0.00	$0.00	$20.32	$72.36	$72.36	$0.00	$0.00	$20.32	$0.00	$57.67	$57.67	$0.00	$46.88	$74.25	$75.00	$0.00		$0.00	$14.67	$0.00	$0.00	$14.93	$0.00	$0.00	$0.00	$0.00	$0.00
G07937	SUP	HCPCS C1769		G07937  -  GUIDEWIRE VASCULAR ANGLE TAPER .035IN 180CM 9CM RADIOPQ	BOTH IP/OP	$97.50 	$72.15	$0.00	$75.00	$50.91	$50.91	$0.00	$0.00	$0.00	$20.32	$72.36	$72.36	$0.00	$0.00	$20.32	$0.00	$57.67	$57.67	$0.00	$46.88	$74.25	$75.00	$0.00		$0.00	$14.67	$0.00	$0.00	$14.93	$0.00	$0.00	$0.00	$0.00	$0.00
G08113	SUP	Custom 27203010		G08113  -  CATHETER ANGIOGRAPHIC SLIP-CATH BEACON TIP HYDROPHILIC OD18	BOTH IP/OP	$313.20 	$231.77	$0.00	$250.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.46	$232.46	$0.00	$0.00	$65.27	$0.00	$0.00	$0.00	$0.00	$156.60	$248.05	$250.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G08259	SUP	Custom 27203010		G08259  -  COIL EMBOLIZATION .018IN 6-2MM 7CM SOFT MICROCOIL TORNADO	BOTH IP/OP	$275.33 	$203.74	$0.00	$220.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.35	$204.35	$0.00	$0.00	$57.38	$0.00	$0.00	$0.00	$0.00	$137.66	$218.06	$220.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G08261	SUP	HCPCS C1770		G08261  -  COIL EMBL 2CM 3-2MM TRND MCIOL MLFRM SFT .018IN PLTN	BOTH IP/OP	$275.33 	$203.74	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.35	$204.35	$0.00	$0.00	$57.38	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G08283	SUP	Custom 27203010		G08283  -  SET BIOP 60CM 18GA 7FR Q COR CHK FLO VLV ADPR HVDTY FRNG	BOTH IP/OP	"$1,075.00 "	$795.50	$0.00	$860.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$797.87	$797.87	$0.00	$0.00	$224.03	$0.00	$0.00	$0.00	$0.00	$537.50	$851.40	$860.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G08417	SUP	HCPCS C1729		G08417  -  SET GSTRM 14FR 1 LUM 6 SDPRT CATH GWIRE NDL LOOP W-O 30CM	BOTH IP/OP	$301.63 	$223.21	$0.00	$241.30	$163.78	$163.78	$0.00	$0.00	$0.00	$62.87	$223.87	$223.87	$0.00	$0.00	$62.86	$0.00	$178.41	$178.41	$0.00	$150.81	$238.89	$241.30	$0.00		$0.00	$47.20	$0.00	$0.00	$48.02	$0.00	$0.00	$0.00	$0.00	$0.00
G08421	SUP	HCPCS C1725		G08421  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 5FR 100CM TORCON NB	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.00	$33.94	$33.94	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
G08422	SUP	HCPCS C1725		G08422  -  CATHETER ANGIOGRAPHIC ANGLE SIMMONS 2 CURVE 5FR 100CM	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.00	$33.94	$33.94	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
G08427	SUP	HCPCS C1769		G08427  -  GUIDEWIRE VASCULAR ANGLE TAPER .018IN 60CM SOFT TIP COPE	BOTH IP/OP	$119.34 	$88.31	$0.00	$92.24	$62.61	$62.61	$0.00	$0.00	$0.00	$24.87	$88.57	$88.57	$0.00	$0.00	$24.87	$0.00	$70.59	$70.59	$0.00	$57.65	$91.32	$92.24	$0.00		$0.00	$18.04	$0.00	$0.00	$18.36	$0.00	$0.00	$0.00	$0.00	$0.00
G08441	SUP	HCPCS C1725		G08441  -  CATHETER ANGIOGRAPHIC C1 CURVE ANGLE 5FR 65CM MULTPUR TORCON	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.00	$33.94	$33.94	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
G08442	SUP	HCPCS C1725		G08442  -  CATH ANGIO .035IN C2 CURVE 5FR 65CM VSCR ANG MULTPUR NYL SS	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$17.65	$17.65	$0.00	$0.00	$0.00	$6.77	$24.12	$24.12	$0.00	$0.00	$6.77	$0.00	$19.22	$19.22	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$5.09	$0.00	$0.00	$5.17	$0.00	$0.00	$0.00	$0.00	$0.00
G08471	SUP	HCPCS C1725		G08471  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 100CM TORCON NB	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.00	$33.94	$33.94	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
G08515	SUP	HCPCS C1725		G08515  -  CATH ANGIO .035IN NEFF CURVE 5FR 80CM 8 SDPRT NYL SS TRNB AD	BOTH IP/OP	$40.55 	$30.01	$0.00	$32.44	$22.02	$22.02	$0.00	$0.00	$0.00	$8.45	$30.10	$30.10	$0.00	$0.00	$8.45	$0.00	$23.99	$23.99	$0.00	$20.28	$32.12	$32.44	$0.00		$0.00	$6.35	$0.00	$0.00	$6.46	$0.00	$0.00	$0.00	$0.00	$0.00
G08581	SUP	HCPCS C1884		G08581  -  CATHETER ANGIOGRAPHIC DAV CURVE ANGLE 5FR 100CM MULTPUR	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.00	$28.13	$28.13	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
G08597	SUP	HCPCS C1725		G08597  -  CATHETER ANGIOGRAPHIC SIMMONS 3 CURVE 5FR 100CM TORCON NB	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.00	$33.94	$33.94	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
G08686	SUP	HCPCS C1894		G08686  -  SET INTRO 10FR 3.3MM 30CM STRL 41CM CKFL DISP ACPT .038IN GW	BOTH IP/OP	$111.80 	$82.73	$0.00	$86.00	$58.37	$58.37	$0.00	$0.00	$0.00	$23.30	$82.98	$82.98	$0.00	$0.00	$23.30	$0.00	$66.13	$66.13	$0.00	$53.75	$85.14	$86.00	$0.00		$0.00	$16.82	$0.00	$0.00	$17.11	$0.00	$0.00	$0.00	$0.00	$0.00
G08699	SUP	Custom 27203010		G08699  -  CATHETER ANGIOGRAPHIC DAV CURVE ANGLE 5FR 100CM MULTPUR	BOTH IP/OP	$325.00 	$240.50	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G08777	SUP	HCPCS C1769		G08777  -  GUIDEWIRE VASCULAR ANGLE SPRING COIL .014IN 180CM HEAVY DUTY	BOTH IP/OP	$282.30 	$208.90	$0.00	$222.50	$151.02	$151.02	$0.00	$0.00	$0.00	$58.84	$209.52	$209.52	$0.00	$0.00	$58.83	$0.00	$166.98	$166.98	$0.00	$139.06	$220.28	$222.50	$0.00		$0.00	$43.53	$0.00	$0.00	$44.28	$0.00	$0.00	$0.00	$0.00	$0.00
G08801	SUP	HCPCS C1769		G08801  -  GUIDEWIRE VASCULAR TAPER FLOPPY ANGLE SPRING COIL .014IN 300	BOTH IP/OP	$310.85 	$230.03	$0.00	$245.00	$166.29	$166.29	$0.00	$0.00	$0.00	$64.79	$230.71	$230.71	$0.00	$0.00	$64.78	$0.00	$183.86	$183.86	$0.00	$153.13	$242.55	$245.00	$0.00		$0.00	$47.93	$0.00	$0.00	$48.76	$0.00	$0.00	$0.00	$0.00	$0.00
G08943	SUP	HCPCS C1725		G08943  -  CATH ANGIO .038IN 7FR 100CM PULM 4 SDPRT MONT1 TIP GW FLXB	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$17.65	$17.65	$0.00	$0.00	$0.00	$6.77	$24.12	$24.12	$0.00	$0.00	$6.77	$0.00	$19.22	$19.22	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$5.09	$0.00	$0.00	$5.17	$0.00	$0.00	$0.00	$0.00	$0.00
G08957	SUP	HCPCS C1894		G08957  -  SET INTROD .038IN 14FR 30CM 41CM RADIOPQ DILAT SIDEARM FIT	BOTH IP/OP	$330.20 	$244.35	$0.00	$254.00	$172.40	$172.40	$0.00	$0.00	$0.00	$68.82	$245.07	$245.07	$0.00	$0.00	$68.81	$0.00	$195.31	$195.31	$0.00	$158.75	$251.46	$254.00	$0.00		$0.00	$49.69	$0.00	$0.00	$50.55	$0.00	$0.00	$0.00	$0.00	$0.00
G09215	SUP	HCPCS C1770		G09215  -  COIL EMBOLIZATION .018IN 8-4MM 9.5CM MICROCOIL SOFT SPACED	BOTH IP/OP	$275.33 	$203.74	$0.00	$220.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.35	$204.35	$0.00	$0.00	$57.38	$0.00	$0.00	$0.00	$0.00	$137.66	$218.06	$220.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G09409	SUP	HCPCS C1725		G09409  -  CATH ANGIO .035IN 4FR 70CM 10 SDPRT STR HFLO ATRM TIP DSGN	BOTH IP/OP	$46.88 	$34.69	$0.00	$37.50	$25.45	$25.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.44	$37.13	$37.50	$0.00		$0.00	$7.34	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00
G09411	SUP	HCPCS C1725		G09411  -  CATH ANGIO .035IN 5FR 70CM 10 SDPRT STR HFLO ATRM TIP DSGN	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$17.65	$17.65	$0.00	$0.00	$0.00	$6.77	$24.12	$24.12	$0.00	$0.00	$6.77	$0.00	$19.22	$19.22	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$5.09	$0.00	$0.00	$5.17	$0.00	$0.00	$0.00	$0.00	$0.00
G09469	SUP	HCPCS C1725		G09469  -  CATHETER ANGIOGRAPHIC ANGLE KMP CURVE TAPER 5FR 65CM LP	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.00	$33.94	$33.94	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
G09479	SUP	HCPCS C1894		G09479  -  INTRODUCER CATHETER .038IN 7FR 40CM BALKIN UP AND OVER	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
G09497	SUP	HCPCS C1729		G09497  -  CATHETER DRAIN 8.5FR 40CM 32 SIDEPORT RADIOPQ BAND MAC-LOC	BOTH IP/OP	$253.65 	$187.70	$0.00	$199.92	$135.70	$135.70	$0.00	$0.00	$0.00	$52.87	$188.26	$188.26	$0.00	$0.00	$52.86	$0.00	$150.03	$150.03	$0.00	$124.95	$197.92	$199.92	$0.00		$0.00	$39.11	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00
G09498	SUP	HCPCS C1729		G09498  -  CATHETER DRAIN 10.2FR 40CM 32 SIDEPORT RADIOPQ BAND MAC-LOC	BOTH IP/OP	$253.65 	$187.70	$0.00	$199.92	$135.70	$135.70	$0.00	$0.00	$0.00	$52.87	$188.26	$188.26	$0.00	$0.00	$52.86	$0.00	$150.03	$150.03	$0.00	$124.95	$197.92	$199.92	$0.00		$0.00	$39.11	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00
G09499	SUP	HCPCS C1729		G09499  -  CATHETER DRAIN 12FR 40CM 32 SIDEPORT RADIOPQ BAND MAC-LOC	BOTH IP/OP	$253.65 	$187.70	$0.00	$199.92	$135.70	$135.70	$0.00	$0.00	$0.00	$52.87	$188.26	$188.26	$0.00	$0.00	$52.86	$0.00	$150.03	$150.03	$0.00	$124.95	$197.92	$199.92	$0.00		$0.00	$39.11	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00
G09500	SUP	HCPCS C1729		G09500  -  CATHETER DRAIN 14FR 40CM 8CM 32 SIDEPORT LOCK MECHANISM	BOTH IP/OP	$253.65 	$187.70	$0.00	$199.92	$135.70	$135.70	$0.00	$0.00	$0.00	$52.87	$188.26	$188.26	$0.00	$0.00	$52.86	$0.00	$150.03	$150.03	$0.00	$124.95	$197.92	$199.92	$0.00		$0.00	$39.11	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00
G09501	SUP	HCPCS C1729		G09501  -  CATHETER DRAIN 8.5FR 25CM 6 SIDEPORT TROCAR MULTPUR RADIOPQ	BOTH IP/OP	$254.90 	$188.63	$0.00	$199.92	$135.70	$135.70	$0.00	$0.00	$0.00	$53.13	$189.18	$189.18	$0.00	$0.00	$53.12	$0.00	$150.77	$150.77	$0.00	$124.95	$197.92	$199.92	$0.00		$0.00	$39.11	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00
G09502	SUP	HCPCS C1729		G09502  -  CATHETER DRAIN 10.2FR 25CM 6 SIDEPORT LOCK LOOP RADIOPQ BAND	BOTH IP/OP	$254.90 	$188.63	$0.00	$199.92	$135.70	$135.70	$0.00	$0.00	$0.00	$53.13	$189.18	$189.18	$0.00	$0.00	$53.12	$0.00	$150.77	$150.77	$0.00	$124.95	$197.92	$199.92	$0.00		$0.00	$39.11	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00
G09503	SUP	HCPCS C1729		G09503  -  CATHETER DRAIN .038IN 12FR 25CM 6 SIDEPORT MAC LOC LOCKING	BOTH IP/OP	$254.90 	$188.63	$0.00	$199.92	$135.70	$135.70	$0.00	$0.00	$0.00	$53.13	$189.18	$189.18	$0.00	$0.00	$53.12	$0.00	$150.77	$150.77	$0.00	$124.95	$197.92	$199.92	$0.00		$0.00	$39.11	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00
G09504	SUP	HCPCS C1729		G09504  -  CATHETER DRAIN .038IN 14FR 25CM 6 SIDEPORT MAC-LOC LOCKING	BOTH IP/OP	$254.90 	$188.63	$0.00	$199.92	$135.70	$135.70	$0.00	$0.00	$0.00	$53.13	$189.18	$189.18	$0.00	$0.00	$53.12	$0.00	$150.77	$150.77	$0.00	$124.95	$197.92	$199.92	$0.00		$0.00	$39.11	$0.00	$0.00	$39.78	$0.00	$0.00	$0.00	$0.00	$0.00
G09607	SUP	HCPCS C1769		G09607  -  GUIDEWIRE VASCULAR .035IN 145CM ANGLE SHORT TAPER FLEXIBLE	BOTH IP/OP	$97.50 	$72.15	$0.00	$75.00	$50.91	$50.91	$0.00	$0.00	$0.00	$20.32	$72.36	$72.36	$0.00	$0.00	$20.32	$0.00	$57.67	$57.67	$0.00	$46.88	$74.25	$75.00	$0.00		$0.00	$14.67	$0.00	$0.00	$14.93	$0.00	$0.00	$0.00	$0.00	$0.00
G09691	SUP	HCPCS C1892		G09691  -  INTRODUCER SHEATH .038IN LARGE 16FR 30CM 42CM RADIOPQ BAND	BOTH IP/OP	$328.61 	$243.17	$0.00	$254.00	$172.40	$172.40	$0.00	$0.00	$0.00	$68.49	$243.90	$243.90	$0.00	$0.00	$68.48	$0.00	$194.37	$194.37	$0.00	$158.75	$251.46	$254.00	$0.00		$0.00	$49.69	$0.00	$0.00	$50.55	$0.00	$0.00	$0.00	$0.00	$0.00
G09751	SUP	HCPCS C1725		G09751  -  CATHETER ANGIOGRAPHIC KMP CURVE 5FR 40CM TORCON NB ADVANTAGE	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.00	$33.94	$33.94	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
G09954	SUP	HCPCS C1769		G09954  -  GUIDEWIRE VASCULAR STR .035IN 145CM FLEXIBLE TIP ULTRA-STIFF	BOTH IP/OP	$67.16 	$49.70	$0.00	$51.66	$35.06	$35.06	$0.00	$0.00	$0.00	$14.00	$49.84	$49.84	$0.00	$0.00	$14.00	$0.00	$39.72	$39.72	$0.00	$32.29	$51.15	$51.66	$0.00		$0.00	$10.11	$0.00	$0.00	$10.28	$0.00	$0.00	$0.00	$0.00	$0.00
G09956	SUP	HCPCS C1769		G09956  -  GUIDEWIRE VASCULAR STR .035IN 180CM FLEXIBLE TIP ULTRA-STIFF	BOTH IP/OP	$89.70 	$66.38	$0.00	$69.00	$46.83	$46.83	$0.00	$0.00	$0.00	$18.70	$66.58	$66.58	$0.00	$0.00	$18.69	$0.00	$53.06	$53.06	$0.00	$43.13	$68.31	$69.00	$0.00		$0.00	$13.50	$0.00	$0.00	$13.73	$0.00	$0.00	$0.00	$0.00	$0.00
G10205	SUP	Custom 27203010		G10205  -  DILATOR VASCULAR .025IN 4FR 20CM DECREASED FRICTION RADIOPQ	BOTH IP/OP	$26.75 	$19.80	$0.00	$21.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.38	$21.19	$21.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G10210	SUP	Custom 27203010		G10210  -  TRAY PERICARDIOCENTESIS PIGTAIL CURVE 8.3FR 18GA 40CM 15CM 6	BOTH IP/OP	$473.75 	$350.58	$0.00	$379.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$351.62	$351.62	$0.00	$0.00	$98.73	$0.00	$0.00	$0.00	$0.00	$236.88	$375.21	$379.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G10292	SUP	HCPCS C1758		G10292  -  DILATOR VASCULAR 12FR 20CM RADIOPQ HYDPHI STERILE DISPOSABLE	BOTH IP/OP	$29.03 	$21.48	$0.00	$21.54	$14.53	$14.53	$0.00	$0.00	$0.00	$6.05	$21.54	$21.54	$0.00	$0.00	$6.05	$0.00	$17.17	$17.17	$0.00	$13.38	$21.19	$21.40	$0.00		$0.00	$4.19	$0.00	$0.00	$4.26	$0.00	$0.00	$0.00	$0.00	$0.00
G10383	SUP	HCPCS C1894		G10383  -  INTRODUCER SHEATH 6FR 40CM OVER CONTRALATERAL RADIOPQ BAND	BOTH IP/OP	$194.06 	$143.60	$0.00	$150.00	$101.81	$101.81	$0.00	$0.00	$0.00	$40.45	$144.03	$144.03	$0.00	$0.00	$40.44	$0.00	$114.79	$114.79	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G10405	SUP	HCPCS C1894		G10405  -  INTROD SHTH 7FR 40CM BLK U-O CNTRLT DSGN RADIOPQ BAND W/O	BOTH IP/OP	$154.70 	$114.48	$0.00	$123.76	$84.00	$84.00	$0.00	$0.00	$0.00	$32.24	$114.82	$114.82	$0.00	$0.00	$32.24	$0.00	$91.51	$91.51	$0.00	$77.35	$122.52	$123.76	$0.00		$0.00	$24.21	$0.00	$0.00	$24.63	$0.00	$0.00	$0.00	$0.00	$0.00
G10414	SUP	HCPCS C1770		G10414  -  COIL EMBOLIZATION .035IN STANDARD SMALL 4-3MM 2.6CM TORNADO	BOTH IP/OP	$275.33 	$203.74	$0.00	$220.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.35	$204.35	$0.00	$0.00	$57.38	$0.00	$0.00	$0.00	$0.00	$137.66	$218.06	$220.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G10415	SUP	HCPCS C1770		G10415  -  COIL EMBOLIZATION .035IN STANDARD SMALL 5-3MM 4.1CM SOFT	BOTH IP/OP	$275.33 	$203.74	$0.00	$220.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.35	$204.35	$0.00	$0.00	$57.38	$0.00	$0.00	$0.00	$0.00	$137.66	$218.06	$220.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G10417	SUP	HCPCS C1770		G10417  -  COIL EMBOLIZATION 7-3MM 8CM TORNADO PLATINUM ARTERIOVENOUS	BOTH IP/OP	$275.33 	$203.74	$0.00	$220.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.35	$204.35	$0.00	$0.00	$57.38	$0.00	$0.00	$0.00	$0.00	$137.66	$218.06	$220.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G10455	SUP	HCPCS C1725		G10455  -  CATHETER ANGIOGRAPHIC MPA CURVE 5FR 65CM TORCON NB ADVANTAGE	BOTH IP/OP	$60.00 	$44.40	$0.00	$44.53	$29.87	$29.87	$0.00	$0.00	$0.00	$12.51	$44.53	$44.53	$0.00	$0.00	$12.50	$0.00	$35.49	$35.49	$0.00	$27.50	$43.56	$44.00	$0.00		$0.00	$8.61	$0.00	$0.00	$8.76	$0.00	$0.00	$0.00	$0.00	$0.00
G10460	SUP	HCPCS C1894		G10460  -  SET ACCES 15CM 6FR 22GA 4FR NEFF .018IN PERC HYDPHI CHBA NDL	BOTH IP/OP	$249.38 	$184.54	$0.00	$199.50	$135.41	$135.41	$0.00	$0.00	$0.00	$51.98	$185.09	$185.09	$0.00	$0.00	$51.97	$0.00	$147.51	$147.51	$0.00	$124.69	$197.51	$199.50	$0.00		$0.00	$39.03	$0.00	$0.00	$39.70	$0.00	$0.00	$0.00	$0.00	$0.00
G10554	SUP	Custom 27203010		G10554  -  SET INTUBATION .038IN 3MM 14FR 70CM 110CM RTRGRD RADIOPQ	BOTH IP/OP	$383.33 	$283.66	$0.00	$284.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$284.50	$284.50	$0.00	$0.00	$79.88	$0.00	$0.00	$0.00	$0.00	$158.13	$250.47	$253.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G10722	SUP	Custom 27203010		G10722  -  NEEDLE INTRAOSSEOUS 15.5GA 3CM 2 OPPOSE SIDEPORT INFUS	BOTH IP/OP	$111.25 	$82.33	$0.00	$89.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.57	$82.57	$0.00	$0.00	$23.18	$0.00	$0.00	$0.00	$0.00	$55.63	$88.11	$89.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G10992	SUP	Custom 27203010		G10992  -  CATH IU DISP HSG	BOTH IP/OP	$299.49 	$221.62	$0.00	$239.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.74	$237.20	$239.59	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G11017	SUP	HCPCS C1894		G11017  -  INTROD CATH 40CM 8FR .038IN CHK-FLO PRFRMR BLK U-O CNTRLT	BOTH IP/OP	$337.50 	$249.75	$0.00	$270.00	$183.26	$183.26	$0.00	$0.00	$0.00	$70.34	$250.49	$250.49	$0.00	$0.00	$70.34	$0.00	$199.63	$199.63	$0.00	$168.75	$267.30	$270.00	$0.00		$0.00	$52.82	$0.00	$0.00	$53.73	$0.00	$0.00	$0.00	$0.00	$0.00
G11189	SUP	HCPCS C1892		G11189 - CATHETER ANGIOGRAPHIC VISCERAL 1 CURVE 5FR 80CM TORCON NB	BOTH IP/OP	$65.00 	$48.10	$0.00	$48.24	$25.45	$25.45	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$23.44	$37.13	$37.50	$0.00		$0.00	$7.34	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00
G11240	SUP	HCPCS C1894		G11240  -  SET INTROD .038IN 11FR 70CM RADIOPQ BAND CHK-FLO PERFORMER	BOTH IP/OP	$247.00 	$182.78	$0.00	$190.00	$128.96	$128.96	$0.00	$0.00	$0.00	$51.48	$183.32	$183.32	$0.00	$0.00	$51.47	$0.00	$146.10	$146.10	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
G11667	SUP	HCPCS C1769		G11667  -  GUIDEWIRE VASC CRV .035IN 260CM STRL 2MM RDRR PC THE FIRM	BOTH IP/OP	$122.50 	$90.65	$0.00	$90.92	$50.91	$50.91	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$46.88	$74.25	$75.00	$0.00		$0.00	$14.67	$0.00	$0.00	$14.93	$0.00	$0.00	$0.00	$0.00	$0.00
G11672	SUP	HCPCS C1894		G11672  -  INTRODUCER SHEATH .038IN LARGE 18FR 30CM 42CM RADIOPQ BAND	BOTH IP/OP	$328.61 	$243.17	$0.00	$254.00	$172.40	$172.40	$0.00	$0.00	$0.00	$68.49	$243.90	$243.90	$0.00	$0.00	$68.48	$0.00	$194.37	$194.37	$0.00	$158.75	$251.46	$254.00	$0.00		$0.00	$49.69	$0.00	$0.00	$50.55	$0.00	$0.00	$0.00	$0.00	$0.00
G11916	SUP	HCPCS C1884		G11916  -  CATHETER ANGIO PGTL CRV 5FR 100CM AUROUS 10 SDPRT RADOPQ SZ	BOTH IP/OP	$343.13 	$253.92	$0.00	$274.50	$154.41	$154.41	$0.00	$0.00	$0.00	$71.52	$254.67	$254.67	$0.00	$0.00	$71.51	$0.00	$202.96	$202.96	$0.00	$171.56	$271.76	$274.50	$0.00		$0.00	$53.70	$0.00	$0.00	$54.63	$0.00	$0.00	$0.00	$0.00	$0.00
G12016	SUP	HCPCS C1769		G12016  -  GUIDEWIRE VASC .018IN 8FR 6.5FR 20CM STRL 15CM JEFFREY SET	BOTH IP/OP	$324.31 	$239.99	$0.00	$254.36	$172.65	$172.65	$0.00	$0.00	$0.00	$67.59	$240.70	$240.70	$0.00	$0.00	$67.59	$0.00	$191.83	$191.83	$0.00	$158.98	$251.82	$254.36	$0.00		$0.00	$49.76	$0.00	$0.00	$50.62	$0.00	$0.00	$0.00	$0.00	$0.00
G12082	SUP	HCPCS C1884		G12082  -  CATHETER ANGIO VTK CRBRL CRV 5FR 125CM SCTH BTP BRD RADOPQ	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
G12168	SUP	HCPCS C1884		G12168  -  CATH ANGIO .038IN VERT CURVE 5FR 125CM RADIOPQ LUB SRFC	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$55.13	$55.13	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
G12170	SUP	HCPCS C1725		G12170  -  CATHETER ANGIOGRAPHIC .038IN VERT CURVE 5FR 125CM LP RADIOPQ	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.00	$33.94	$33.94	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
G12179	SUP	Custom 27203010		G12179  -  CATH ANGIO .038IN TEGT CURVE 5FR 65CM HYDPHI SCTH BTP	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$0.00	$0.00	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G12266	SUP	HCPCS C1894		G12266  -  SHEATH GUID 6FR 2.2MM 90CM CHK-FLO VALVE SOFT TIP RADIOPQ	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$101.81	$101.81	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G12423	SUP	HCPCS C1894		G12423  -  SET INTROD .018IN 6FR 20CM 13CM ACCES NEEDLE PLATINUM TIP	BOTH IP/OP	$104.50 	$77.33	$0.00	$77.56	$51.59	$51.59	$0.00	$0.00	$0.00	$21.78	$77.56	$77.56	$0.00	$0.00	$21.78	$0.00	$61.81	$61.81	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$14.87	$0.00	$0.00	$15.12	$0.00	$0.00	$0.00	$0.00	$0.00
G12513	SUP	Custom 27203010		G12513  -  TRAY TRCH 24-28FR CGL BRHN STD HYDPHI SHLY PERC TUBE DILAT	BOTH IP/OP	$800.00 	$592.00	$0.00	$670.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$593.76	$593.76	$0.00	$0.00	$166.72	$0.00	$0.00	$0.00	$0.00	$419.21	$664.04	$670.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G12560	SUP	HCPCS C1894		G12560  -  SET INTROD 10CM 4FR MPNCH PSH+ .018IN GWIRE PLTN TIP CATH 40	BOTH IP/OP	$122.93 	$90.97	$0.00	$98.34	$66.75	$66.75	$0.00	$0.00	$0.00	$25.62	$91.23	$91.23	$0.00	$0.00	$25.62	$0.00	$72.71	$72.71	$0.00	$61.46	$97.36	$98.34	$0.00		$0.00	$19.24	$0.00	$0.00	$19.57	$0.00	$0.00	$0.00	$0.00	$0.00
G12565	SUP	HCPCS C1894		G12565  -  TRAY TRCH 8FR STRL SHLY CGL BLU RHINO JTP NDL GD CATH RADOPQ	BOTH IP/OP	"$1,096.10 "	$811.11	$0.00	"$1,305.12"	$885.85	$885.85	$0.00	$0.00	$0.00	$228.45	$813.53	$813.53	$0.00	$0.00	$228.43	$0.00	$648.34	$648.34	$0.00	$815.70	"$1,292.07"	"$1,305.12"	$0.00		$0.00	$255.31	$0.00	$0.00	$259.72	$0.00	$0.00	$0.00	$0.00	$0.00
G12580	SUP	HCPCS C1763		G12580  -  GRAFT SFT TIS 10X7CM 4 SHT FRZDR SIS ES PIG ACLR CLGN MTRX	BOTH IP/OP	"$2,262.50 "	"$1,674.25"	$0.00	"$1,810.00"	"$1,018.13"	"$1,018.13"	$0.00	$0.00	$0.00	$471.56	"$1,679.23"	"$1,679.23"	$0.00	$0.00	$471.51	$0.00	"$1,338.27"	"$1,338.27"	$0.00	"$1,131.25"	"$1,791.90"	"$1,810.00"	$0.00		$0.00	$354.08	$0.00	$0.00	$360.19	$0.00	$0.00	$0.00	$0.00	$0.00
G12831	SUP	HCPCS C1894		G12831  -  INTRODUCER SHEATH 25CM DILAT NONTAPER CLOSE CHK-FLO XL AQ 41	BOTH IP/OP	$847.50 	$627.15	$0.00	$678.00	$460.19	$460.19	$0.00	$0.00	$0.00	$176.64	$629.01	$629.01	$0.00	$0.00	$176.62	$0.00	$501.30	$501.30	$0.00	$423.75	$671.22	$678.00	$0.00		$0.00	$132.63	$0.00	$0.00	$134.92	$0.00	$0.00	$0.00	$0.00	$0.00
G12835	SUP	HCPCS C1894		G12835  -  INTRODUCER CATHETER 7FR 2.5MM 90CM TUOHY BORST SIDEARM DILAT	BOTH IP/OP	$390.71 	$289.13	$0.00	$302.00	$204.98	$204.98	$0.00	$0.00	$0.00	$81.43	$289.99	$289.99	$0.00	$0.00	$81.42	$0.00	$231.11	$231.11	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$59.08	$0.00	$0.00	$60.10	$0.00	$0.00	$0.00	$0.00	$0.00
G12847	SUP	HCPCS C1763		G12847  -  GUIDEWIRE ESCP STRG .038IN 145CM 2 FLX TP	BOTH IP/OP	$872.83 	$645.89	$0.00	$698.26	$392.77	$392.77	$0.00	$0.00	$0.00	$181.92	$647.81	$647.81	$0.00	$0.00	$181.90	$0.00	$516.28	$516.28	$0.00	$436.41	$691.28	$698.26	$0.00		$0.00	$136.60	$0.00	$0.00	$138.95	$0.00	$0.00	$0.00	$0.00	$0.00
G12848	SUP	HCPCS C1763		G12848  -  GRAFT SFT TIS 10X7CM SURGISIS 1 LYR SHT PEEL OPN DRY PRCN	BOTH IP/OP	"$2,391.50 "	"$1,769.71"	$0.00	"$1,913.20"	"$1,076.18"	"$1,076.18"	$0.00	$0.00	$0.00	$498.45	"$1,774.97"	"$1,774.97"	$0.00	$0.00	$498.39	$0.00	"$1,414.57"	"$1,414.57"	$0.00	"$1,195.75"	"$1,894.07"	"$1,913.20"	$0.00		$0.00	$374.27	$0.00	$0.00	$380.73	$0.00	$0.00	$0.00	$0.00	$0.00
G13032	SUP	HCPCS C1894		G13032  -  INTRODUCER CATHETER .038IN 10IN 30CM LARGE VALVE ASMBLY	BOTH IP/OP	$192.85 	$142.71	$0.00	$152.00	$103.17	$103.17	$0.00	$0.00	$0.00	$40.19	$143.13	$143.13	$0.00	$0.00	$40.19	$0.00	$114.07	$114.07	$0.00	$95.00	$150.48	$152.00	$0.00		$0.00	$29.74	$0.00	$0.00	$30.25	$0.00	$0.00	$0.00	$0.00	$0.00
G13033	SUP	HCPCS C1894		G13033  -  INTRODUCER SHEATH .038IN 10FR 80CM LARGE VALVE ASMBLY	BOTH IP/OP	$268.98 	$199.05	$0.00	$212.00	$143.90	$143.90	$0.00	$0.00	$0.00	$56.06	$199.63	$199.63	$0.00	$0.00	$56.05	$0.00	$159.10	$159.10	$0.00	$132.50	$209.88	$212.00	$0.00		$0.00	$41.47	$0.00	$0.00	$42.19	$0.00	$0.00	$0.00	$0.00	$0.00
G13081	SUP	HCPCS C1894		G13081  -  INTRODUCER CATHETER .035IN 10FR 38.5CM CHK FLO VALVE RADIOPQ	BOTH IP/OP	$214.23 	$158.53	$0.00	$171.38	$116.32	$116.32	$0.00	$0.00	$0.00	$44.65	$159.00	$159.00	$0.00	$0.00	$44.64	$0.00	$126.71	$126.71	$0.00	$107.11	$169.67	$171.38	$0.00		$0.00	$33.53	$0.00	$0.00	$34.10	$0.00	$0.00	$0.00	$0.00	$0.00
G13116	SUP	HCPCS C1763		G13116  -  GRAFT SFT TIS 20X7CM SURGISIS BIODESIGN 4 PLY SHT PRCN ACLR	BOTH IP/OP	"$1,309.23 "	$968.83	$0.00	"$1,047.38"	$589.15	$589.15	$0.00	$0.00	$0.00	$272.88	$971.71	$971.71	$0.00	$0.00	$272.84	$0.00	$774.41	$774.41	$0.00	$654.61	"$1,036.91"	"$1,047.38"	$0.00		$0.00	$204.89	$0.00	$0.00	$208.43	$0.00	$0.00	$0.00	$0.00	$0.00
G13166	SUP	HCPCS C1769		G13166  -  TRAY TRCH STRL SHLY CGL BLU RHINO PERC DISP	BOTH IP/OP	"$1,096.10 "	$811.11	$0.00	"$1,406.18"	$954.44	$954.44	$0.00	$0.00	$0.00	$228.45	$813.53	$813.53	$0.00	$0.00	$228.43	$0.00	$648.34	$648.34	$0.00	$878.86	"$1,392.11"	"$1,406.18"	$0.00		$0.00	$275.08	$0.00	$0.00	$279.83	$0.00	$0.00	$0.00	$0.00	$0.00
G13287	SUP	HCPCS C1773		G13287  -  SET RETRIEVAL 6.3FR 11FR 80CM 60CM LOOP CATHETER GUNTHER	BOTH IP/OP	$879.37 	$650.73	$0.00	$652.67	$339.38	$339.38	$0.00	$0.00	$0.00	$183.28	$652.67	$652.67	$0.00	$0.00	$183.26	$0.00	$520.15	$520.15	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
G13338	SUP	HCPCS C1894		G13338  -  INTRODUCER SHEATH 7FR .1IN 80CM TUOHY BORST SIDEARM RADIOPQ	BOTH IP/OP	$390.71 	$289.13	$0.00	$302.00	$204.98	$204.98	$0.00	$0.00	$0.00	$81.43	$289.99	$289.99	$0.00	$0.00	$81.42	$0.00	$231.11	$231.11	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$59.08	$0.00	$0.00	$60.10	$0.00	$0.00	$0.00	$0.00	$0.00
G13389	SUP	HCPCS C1876		G13389  -  STENT VASC 6MM 40MM 80CM .035IN SLF XPD DLV SYS ZL NTNL	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
G13398	SUP	HCPCS C1876		G13398  -  STENT VASC 8MM 30MM 80CM SLF XPD DLV SYS ZL	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
G13399	SUP	HCPCS C1876		G13399  -  STENT BIL 9MM 7FR 40MM 80CM .035IN SLF XPD PRELD DLV SYS ZL	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
G13400	SUP	HCPCS C1876		G13400  -  STENT BIL 8MM 6CM 80CM .035IN SLF XPD PRELD DLV SYS ZL NTNL	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
G13404	SUP	HCPCS C1876		G13404  -  STENT VASC 9MM 40MM 80CM SLF XPD DLV SYS ZL	BOTH IP/OP	$2.50 	$1.85	$0.00	$2.00	$1.13	$1.13	$0.00	$0.00	$0.00	$0.52	$1.86	$1.86	$0.00	$0.00	$0.52	$0.00	$1.48	$1.48	$0.00	$1.25	$1.98	$2.00	$0.00		$0.00	$0.39	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
G13539	SUP	HCPCS C1894		G13539  -  INTRODUCER SHEATH .038IN 6FR .087IN 80CM GWIRE FLEXOR	BOTH IP/OP	$390.71 	$289.13	$0.00	$302.00	$204.98	$204.98	$0.00	$0.00	$0.00	$81.43	$289.99	$289.99	$0.00	$0.00	$81.42	$0.00	$231.11	$231.11	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$59.08	$0.00	$0.00	$60.10	$0.00	$0.00	$0.00	$0.00	$0.00
G13559	SUP	HCPCS C1725		G13559  -  CATH ANGIO .038IN CHG-A CURVE 5FR 80CM VSCR NYL SS TRNB AD	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$47.51	$47.51	$0.00	$0.00	$0.00	$18.24	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$51.76	$51.76	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
G13561	SUP	HCPCS C1725		G13561  -  CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 80CM TORCON NB	BOTH IP/OP	$65.00 	$48.10	$0.00	$50.00	$33.94	$33.94	$0.00	$0.00	$0.00	$13.55	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$38.45	$38.45	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
G13793	SUP	Custom 27203010		G13793  -  CATHETER ANGIOGRAPHIC 65CM MULTPUR TORCON NB ADVANTAGE	BOTH IP/OP	$65.00 	$48.10	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.24	$48.24	$0.00	$0.00	$13.55	$0.00	$0.00	$0.00	$0.00	$32.50	$51.48	$52.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G13806	SUP	HCPCS C1763		G13806  -  GRAFT SFT TIS 7X4CM SURGISIS BIODESIGN 4 PLY PRCN ACLR CLGN	BOTH IP/OP	"$1,870.33 "	"$1,384.04"	$0.00	"$1,496.26"	$841.65	$841.65	$0.00	$0.00	$0.00	$389.82	"$1,388.16"	"$1,388.16"	$0.00	$0.00	$389.78	$0.00	"$1,106.30"	"$1,106.30"	$0.00	$935.16	"$1,481.30"	"$1,496.26"	$0.00		$0.00	$292.71	$0.00	$0.00	$297.76	$0.00	$0.00	$0.00	$0.00	$0.00
G13807	SUP	HCPCS C1763		G13807  -  GRAFT SFT TIS 10X7CM SURGISIS BIODESIGN 4 PLY PRCN ACLR CLGN	BOTH IP/OP	$897.75 	$664.34	$0.00	$718.20	$403.99	$403.99	$0.00	$0.00	$0.00	$187.11	$666.31	$666.31	$0.00	$0.00	$187.09	$0.00	$531.02	$531.02	$0.00	$448.88	$711.02	$718.20	$0.00		$0.00	$140.50	$0.00	$0.00	$142.92	$0.00	$0.00	$0.00	$0.00	$0.00
G13808	SUP	HCPCS C1763		G13808  -  GRAFT SFT TIS 3.5X5CM SURGISIS BIODESIGN 4 PLY PRCN ACLR	BOTH IP/OP	$993.60 	$735.26	$0.00	$794.88	$447.12	$447.12	$0.00	$0.00	$0.00	$207.09	$737.45	$737.45	$0.00	$0.00	$207.07	$0.00	$587.71	$587.71	$0.00	$496.80	$786.93	$794.88	$0.00		$0.00	$155.50	$0.00	$0.00	$158.18	$0.00	$0.00	$0.00	$0.00	$0.00
G13816	SUP	HCPCS C1769		G13816  -  GUIDEWIRE ENDSCP STR STANDARD .035IN 480CM PURPLE STERILE	BOTH IP/OP	$192.50 	$142.45	$0.00	$154.00	$104.53	$104.53	$0.00	$0.00	$0.00	$40.12	$142.87	$142.87	$0.00	$0.00	$40.12	$0.00	$113.86	$113.86	$0.00	$96.25	$152.46	$154.00	$0.00		$0.00	$30.13	$0.00	$0.00	$30.65	$0.00	$0.00	$0.00	$0.00	$0.00
G14014	SUP	HCPCS C1758		G14014  -  GRAFT SFT TIS 2X3CM SURGISIS BIODESIGN FRZDR PRCN ACLR CLGN	BOTH IP/OP	$276.25 	$204.43	$0.00	$221.00	$150.00	$150.00	$0.00	$0.00	$0.00	$57.58	$205.03	$205.03	$0.00	$0.00	$57.57	$0.00	$163.40	$163.40	$0.00	$138.13	$218.79	$221.00	$0.00		$0.00	$43.23	$0.00	$0.00	$43.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14015	SUP	HCPCS C1758		G14015  -  CATHETER URET 3FR 70CM FLXTP CLS END RT	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G14016	SUP	HCPCS C1758		G14016  -  CATHETER URET 4FR 70CM LF FLXTP CLS END FLX TP RT	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G14017	SUP	HCPCS C1758		G14017  -  CATHETER URET 5FR 70CM LF FLXTP CLS END RT	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G14018	SUP	HCPCS C1758		G14018  -  CATHETER URET 6FR 70CM LF FLXTP CLS END FLX TP RT	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G14019	SUP	HCPCS C1758		G14019  -  CATHETER URET 7FR 70CM FLXTP CLS END RT	BOTH IP/OP	$31.77 	$23.51	$0.00	$25.42	$17.25	$17.25	$0.00	$0.00	$0.00	$6.62	$23.58	$23.58	$0.00	$0.00	$6.62	$0.00	$18.79	$18.79	$0.00	$15.89	$25.16	$25.42	$0.00		$0.00	$4.97	$0.00	$0.00	$5.06	$0.00	$0.00	$0.00	$0.00	$0.00
G14022	SUP	HCPCS C1758		G14022  -  CATHETER URET 8FR 70CM LF FLXTP CLS END FLX TP RT	BOTH IP/OP	$31.77 	$23.51	$0.00	$25.42	$17.25	$17.25	$0.00	$0.00	$0.00	$6.62	$23.58	$23.58	$0.00	$0.00	$6.62	$0.00	$18.79	$18.79	$0.00	$15.89	$25.16	$25.42	$0.00		$0.00	$4.97	$0.00	$0.00	$5.06	$0.00	$0.00	$0.00	$0.00	$0.00
G14023	SUP	HCPCS C1758		G14023  -  CATHETER URET 3FR 70CM FLXTP CLS END FLX TP LT	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G14024	SUP	HCPCS C1758		G14024  -  CATHETER URET 4FR 70CM FLXTP CLS END FLX TP LT	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G14025	SUP	HCPCS C1758		G14025  -  CATHETER URET 5FR 70CM LF FLXTP CLS END FLX TP LT	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G14026	SUP	HCPCS C1758		G14026  -  CATHETER URET 6FR 70CM FLXTP CLS END LT	BOTH IP/OP	$31.77 	$23.51	$0.00	$25.42	$17.25	$17.25	$0.00	$0.00	$0.00	$6.62	$23.58	$23.58	$0.00	$0.00	$6.62	$0.00	$18.79	$18.79	$0.00	$15.89	$25.16	$25.42	$0.00		$0.00	$4.97	$0.00	$0.00	$5.06	$0.00	$0.00	$0.00	$0.00	$0.00
G14027	SUP	HCPCS C1758		G14027  -  CATHETER URET 7FR 70CM FLXTP CLS END LT	BOTH IP/OP	$31.77 	$23.51	$0.00	$25.42	$17.25	$17.25	$0.00	$0.00	$0.00	$6.62	$23.58	$23.58	$0.00	$0.00	$6.62	$0.00	$18.79	$18.79	$0.00	$15.89	$25.16	$25.42	$0.00		$0.00	$4.97	$0.00	$0.00	$5.06	$0.00	$0.00	$0.00	$0.00	$0.00
G14034	SUP	HCPCS C1758		G14034  -  CATHETER URET 8FR 70CM WHSTLTP RT	BOTH IP/OP	$2.78 	$2.06	$0.00	$2.23	$1.51	$1.51	$0.00	$0.00	$0.00	$0.58	$2.07	$2.07	$0.00	$0.00	$0.58	$0.00	$1.65	$1.65	$0.00	$1.39	$2.20	$2.23	$0.00		$0.00	$0.44	$0.00	$0.00	$0.44	$0.00	$0.00	$0.00	$0.00	$0.00
G14035	SUP	HCPCS C1758		G14035  -  CATHETER URET 9FR 70CM WHSTLTP RT	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14040	SUP	HCPCS C1758		G14040  -  CATHETER URET 6FR 70CM WHSTLTP LT	BOTH IP/OP	$26.88 	$19.89	$0.00	$21.51	$14.60	$14.60	$0.00	$0.00	$0.00	$5.60	$19.95	$19.95	$0.00	$0.00	$5.60	$0.00	$15.90	$15.90	$0.00	$13.44	$21.29	$21.51	$0.00		$0.00	$4.21	$0.00	$0.00	$4.28	$0.00	$0.00	$0.00	$0.00	$0.00
G14041	SUP	HCPCS C1758		G14041  -  CATHETER URET WHSTL 7FR 70CM LT	BOTH IP/OP	$26.88 	$19.89	$0.00	$21.51	$14.60	$14.60	$0.00	$0.00	$0.00	$5.60	$19.95	$19.95	$0.00	$0.00	$5.60	$0.00	$15.90	$15.90	$0.00	$13.44	$21.29	$21.51	$0.00		$0.00	$4.21	$0.00	$0.00	$4.28	$0.00	$0.00	$0.00	$0.00	$0.00
G14046	SUP	HCPCS C1758		G14046  -  CATHETER URET 6FR 70CM RND TIP LT	BOTH IP/OP	$26.88 	$19.89	$0.00	$21.51	$14.60	$14.60	$0.00	$0.00	$0.00	$5.60	$19.95	$19.95	$0.00	$0.00	$5.60	$0.00	$15.90	$15.90	$0.00	$13.44	$21.29	$21.51	$0.00		$0.00	$4.21	$0.00	$0.00	$4.28	$0.00	$0.00	$0.00	$0.00	$0.00
G14047	SUP	HCPCS C1758		G14047  -  CATHETER URET 7FR 70CM RND TIP LT	BOTH IP/OP	$26.88 	$19.89	$0.00	$21.51	$14.60	$14.60	$0.00	$0.00	$0.00	$5.60	$19.95	$19.95	$0.00	$0.00	$5.60	$0.00	$15.90	$15.90	$0.00	$13.44	$21.29	$21.51	$0.00		$0.00	$4.21	$0.00	$0.00	$4.28	$0.00	$0.00	$0.00	$0.00	$0.00
G14048	SUP	HCPCS C1758		G14048  -  CATHETER URET 8FR 70CM RND TIP LT	BOTH IP/OP	$2.78 	$2.06	$0.00	$2.23	$1.51	$1.51	$0.00	$0.00	$0.00	$0.58	$2.07	$2.07	$0.00	$0.00	$0.58	$0.00	$1.65	$1.65	$0.00	$1.39	$2.20	$2.23	$0.00		$0.00	$0.44	$0.00	$0.00	$0.44	$0.00	$0.00	$0.00	$0.00	$0.00
G14049	SUP	HCPCS C1758		G14049  -  CATHETER URET 9FR 70CM RND TIP LT	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14050	SUP	HCPCS C1758		G14050  -  CATHETER URET 10FR 70CM RND TIP LT	BOTH IP/OP	$26.88 	$19.89	$0.00	$21.51	$14.60	$14.60	$0.00	$0.00	$0.00	$5.60	$19.95	$19.95	$0.00	$0.00	$5.60	$0.00	$15.90	$15.90	$0.00	$13.44	$21.29	$21.51	$0.00		$0.00	$4.21	$0.00	$0.00	$4.28	$0.00	$0.00	$0.00	$0.00	$0.00
G14053	SUP	HCPCS C1758		G14053  -  CATHETER URET RND 5FR 70CM STY NTCH PORT LT	BOTH IP/OP	$26.88 	$19.89	$0.00	$21.51	$14.60	$14.60	$0.00	$0.00	$0.00	$5.60	$19.95	$19.95	$0.00	$0.00	$5.60	$0.00	$15.90	$15.90	$0.00	$13.44	$21.29	$21.51	$0.00		$0.00	$4.21	$0.00	$0.00	$4.28	$0.00	$0.00	$0.00	$0.00	$0.00
G14054	SUP	HCPCS C1758		G14054  -  CATHETER URET RND 6FR 70CM STY NTCH PORT LT	BOTH IP/OP	$2.78 	$2.06	$0.00	$2.23	$1.51	$1.51	$0.00	$0.00	$0.00	$0.58	$2.07	$2.07	$0.00	$0.00	$0.58	$0.00	$1.65	$1.65	$0.00	$1.39	$2.20	$2.23	$0.00		$0.00	$0.44	$0.00	$0.00	$0.44	$0.00	$0.00	$0.00	$0.00	$0.00
G14055	SUP	HCPCS C1758		G14055  -  CATHETER URET 7FR 70CM RND TIP RT	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14056	SUP	HCPCS C1758		G14056  -  CATHETER URET PGTL CRV 4.7FR 45CM DRETLER MTLNTH	BOTH IP/OP	$276.25 	$204.43	$0.00	$221.00	$150.00	$150.00	$0.00	$0.00	$0.00	$57.58	$205.03	$205.03	$0.00	$0.00	$57.57	$0.00	$163.40	$163.40	$0.00	$138.13	$218.79	$221.00	$0.00		$0.00	$43.23	$0.00	$0.00	$43.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14057	SUP	HCPCS C1758		G14057  -  CATHETER URET RND 8FR 70CM STY NTCH PORT RT	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G14099	SUP	HCPCS C2627		G14099  -  CATH SPBC STAMEY 14FR 25CM OBT CONNCTNG TUBE STPCK PERC STRL	BOTH IP/OP	$95.63 	$70.77	$0.00	$76.50	$51.92	$51.92	$0.00	$0.00	$0.00	$0.00	$70.97	$70.97	$0.00	$0.00	$19.93	$0.00	$0.00	$0.00	$0.00	$47.81	$75.74	$76.50	$0.00		$0.00	$14.97	$0.00	$0.00	$15.22	$0.00	$0.00	$0.00	$0.00	$0.00
G14120	SUP	HCPCS C1729		G14120  -  TUBE CONNCTNG STANDARD 14FR 50CM MALE LUER LOCK LOCK LOCK	BOTH IP/OP	$40.70 	$30.12	$0.00	$32.56	$22.10	$22.10	$0.00	$0.00	$0.00	$8.48	$30.21	$30.21	$0.00	$0.00	$8.48	$0.00	$24.07	$24.07	$0.00	$20.35	$32.23	$32.56	$0.00		$0.00	$6.37	$0.00	$0.00	$6.48	$0.00	$0.00	$0.00	$0.00	$0.00
G14121	SUP	HCPCS C1729		G14121  -  TUBE CNCT 14FR 30CM T-B 2 F LL Y 1 DRN BG CNCT ADPR	BOTH IP/OP	$40.70 	$30.12	$0.00	$32.56	$22.10	$22.10	$0.00	$0.00	$0.00	$8.48	$30.21	$30.21	$0.00	$0.00	$8.48	$0.00	$24.07	$24.07	$0.00	$20.35	$32.23	$32.56	$0.00		$0.00	$6.37	$0.00	$0.00	$6.48	$0.00	$0.00	$0.00	$0.00	$0.00
G14127	SUP	HCPCS C1773		G14127  -  STOPCOCK IV 3W 2 F TO 1 M LL PLS PERC	BOTH IP/OP	$398.45 	$294.85	$0.00	$318.76	$216.36	$216.36	$0.00	$0.00	$0.00	$83.05	$295.73	$295.73	$0.00	$0.00	$83.04	$0.00	$235.68	$235.68	$0.00	$199.23	$315.57	$318.76	$0.00		$0.00	$62.36	$0.00	$0.00	$63.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14133	SUP	HCPCS C2627		G14133  -  DISK RTNT 14FR PERC	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14134	SUP	HCPCS C2627		G14134  -  DILATOR URTH 6FR 20CM PE FSCA	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14135	SUP	HCPCS C2627		G14135  -  DILATOR URTH 7FR 20CM STRL PE FSCA	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14136	SUP	HCPCS C2627		G14136  -  DILATOR URTH 7FR 20CM STRL PE FSCA	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14137	SUP	HCPCS C2627		G14137  -  DILATOR URTH 9FR 20CM PE FSCA	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14138	SUP	HCPCS C2627		G14138  -  DILATOR URTH 10FR 20CM PE FSCA	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14139	SUP	HCPCS C2627		G14139  -  DILATOR URTH 12FR 20CM PE FSCA	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14140	SUP	HCPCS C2627		G14140  -  DILATOR URTH 14FR 20CM PE FSCA	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14141	SUP	HCPCS C2627		G14141  -  DILATOR URTH 16FR 20CM PE FSCA	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14143	SUP	HCPCS C1758		G14143  -  DILATOR URTH 18FR 20CM STRL PE FSCA	BOTH IP/OP	$123.83 	$91.63	$0.00	$99.06	$67.24	$67.24	$0.00	$0.00	$0.00	$25.81	$91.90	$91.90	$0.00	$0.00	$25.81	$0.00	$73.24	$73.24	$0.00	$61.91	$98.07	$99.06	$0.00		$0.00	$19.38	$0.00	$0.00	$19.71	$0.00	$0.00	$0.00	$0.00	$0.00
G14144	SUP	HCPCS C1758		G14144  -  SET CATH .025IN PGTL CRV 4FR 70CM STRL 145CM SDPRT GW PU RT	BOTH IP/OP	$108.45 	$80.25	$0.00	$86.76	$58.89	$58.89	$0.00	$0.00	$0.00	$22.60	$80.49	$80.49	$0.00	$0.00	$22.60	$0.00	$64.15	$64.15	$0.00	$54.23	$85.89	$86.76	$0.00		$0.00	$16.97	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00
G14145	SUP	HCPCS C1758		G14145  -  SET CATH PGTL CRV 5FR .38IN 70CM STRL 145CM SDPRT GW RT	BOTH IP/OP	$108.45 	$80.25	$0.00	$86.76	$58.89	$58.89	$0.00	$0.00	$0.00	$22.60	$80.49	$80.49	$0.00	$0.00	$22.60	$0.00	$64.15	$64.15	$0.00	$54.23	$85.89	$86.76	$0.00		$0.00	$16.97	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00
G14146	SUP	HCPCS C1758		G14146  -  SET CATH .038IN PGTL CRV 5FR 70CM 145CM SDPRT GW LFRIC SRFC	BOTH IP/OP	$108.45 	$80.25	$0.00	$86.76	$58.89	$58.89	$0.00	$0.00	$0.00	$22.60	$80.49	$80.49	$0.00	$0.00	$22.60	$0.00	$64.15	$64.15	$0.00	$54.23	$85.89	$86.76	$0.00		$0.00	$16.97	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00
G14147	SUP	HCPCS C1758		G14147  -  SET CATH PGTL CRV 7FR .045IN 70CM STRL 145CM SDPRT GW RT	BOTH IP/OP	$123.83 	$91.63	$0.00	$99.06	$67.24	$67.24	$0.00	$0.00	$0.00	$25.81	$91.90	$91.90	$0.00	$0.00	$25.81	$0.00	$73.24	$73.24	$0.00	$61.91	$98.07	$99.06	$0.00		$0.00	$19.38	$0.00	$0.00	$19.71	$0.00	$0.00	$0.00	$0.00	$0.00
G14148	SUP	HCPCS C1758		G14148  -  SET CATH .025IN PGTL CRV 4FR 70CM 145CM SDPRT GW LFRIC SRFC	BOTH IP/OP	$108.45 	$80.25	$0.00	$86.76	$58.89	$58.89	$0.00	$0.00	$0.00	$22.60	$80.49	$80.49	$0.00	$0.00	$22.60	$0.00	$64.15	$64.15	$0.00	$54.23	$85.89	$86.76	$0.00		$0.00	$16.97	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00
G14149	SUP	HCPCS C1758		G14149  -  SET CATH .038IN PGTL CRV 5FR 70CM 145CM SDPRT GW LFRIC SRFC	BOTH IP/OP	$108.45 	$80.25	$0.00	$86.76	$58.89	$58.89	$0.00	$0.00	$0.00	$22.60	$80.49	$80.49	$0.00	$0.00	$22.60	$0.00	$64.15	$64.15	$0.00	$54.23	$85.89	$86.76	$0.00		$0.00	$16.97	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00
G14150	SUP	HCPCS C1758		G14150  -  SET CATH .038IN PGTL CRV 6FR 70CM 145CM SDPRT GW LFRIC SRFC	BOTH IP/OP	$108.45 	$80.25	$0.00	$86.76	$58.89	$58.89	$0.00	$0.00	$0.00	$22.60	$80.49	$80.49	$0.00	$0.00	$22.60	$0.00	$64.15	$64.15	$0.00	$54.23	$85.89	$86.76	$0.00		$0.00	$16.97	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00
G14151	SUP	HCPCS C1758		G14151  -  SET CATH .045IN PGTL CRV 7FR 70CM 145CM SDPRT GW LFRIC SRFC	BOTH IP/OP	$123.83 	$91.63	$0.00	$99.06	$67.24	$67.24	$0.00	$0.00	$0.00	$25.81	$91.90	$91.90	$0.00	$0.00	$25.81	$0.00	$73.24	$73.24	$0.00	$61.91	$98.07	$99.06	$0.00		$0.00	$19.38	$0.00	$0.00	$19.71	$0.00	$0.00	$0.00	$0.00	$0.00
G14152	SUP	HCPCS C1758		G14152  -  SET CATH .025IN PGTL CRV 4FR 70CM STRL 145CM SDPRT GW ALONG	BOTH IP/OP	$108.45 	$80.25	$0.00	$86.76	$58.89	$58.89	$0.00	$0.00	$0.00	$22.60	$80.49	$80.49	$0.00	$0.00	$22.60	$0.00	$64.15	$64.15	$0.00	$54.23	$85.89	$86.76	$0.00		$0.00	$16.97	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00
G14153	SUP	HCPCS C1758		G14153  -  SET CATH .038IN PGTL CRV 6FR 70CM STRL 145CM SDPRT GW ALONG	BOTH IP/OP	$123.83 	$91.63	$0.00	$99.06	$67.24	$67.24	$0.00	$0.00	$0.00	$25.81	$91.90	$91.90	$0.00	$0.00	$25.81	$0.00	$73.24	$73.24	$0.00	$61.91	$98.07	$99.06	$0.00		$0.00	$19.38	$0.00	$0.00	$19.71	$0.00	$0.00	$0.00	$0.00	$0.00
G14155	SUP	HCPCS C1758		G14155  -  SET CATH .045IN PGTL CRV 7FR 70CM 145CM SDPRT GW ALONG SHFT	BOTH IP/OP	$123.83 	$91.63	$0.00	$99.06	$67.24	$67.24	$0.00	$0.00	$0.00	$25.81	$91.90	$91.90	$0.00	$0.00	$25.81	$0.00	$73.24	$73.24	$0.00	$61.91	$98.07	$99.06	$0.00		$0.00	$19.38	$0.00	$0.00	$19.71	$0.00	$0.00	$0.00	$0.00	$0.00
G14156	SUP	HCPCS C1758		G14156  -  SET CATH .038IN PGTL CRV 5FR 70CM STRL 145CM SDPRT GW ALONG	BOTH IP/OP	$108.45 	$80.25	$0.00	$86.76	$58.89	$58.89	$0.00	$0.00	$0.00	$22.60	$80.49	$80.49	$0.00	$0.00	$22.60	$0.00	$64.15	$64.15	$0.00	$54.23	$85.89	$86.76	$0.00		$0.00	$16.97	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00
G14157	SUP	HCPCS C1758		G14157  -  SET CATH .038IN PGTL CRV 6FR 70CM 145CM SDPRT GW ALONG SHFT	BOTH IP/OP	$123.83 	$91.63	$0.00	$99.06	$67.24	$67.24	$0.00	$0.00	$0.00	$25.81	$91.90	$91.90	$0.00	$0.00	$25.81	$0.00	$73.24	$73.24	$0.00	$61.91	$98.07	$99.06	$0.00		$0.00	$19.38	$0.00	$0.00	$19.71	$0.00	$0.00	$0.00	$0.00	$0.00
G14158	SUP	HCPCS C1758		G14158  -  SET CATH .045IN PGTL CRV 7FR 70CM 145CM SDPRT GW ALONG SHFT	BOTH IP/OP	$108.45 	$80.25	$0.00	$86.76	$58.89	$58.89	$0.00	$0.00	$0.00	$22.60	$80.49	$80.49	$0.00	$0.00	$22.60	$0.00	$64.15	$64.15	$0.00	$54.23	$85.89	$86.76	$0.00		$0.00	$16.97	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00
G14173	SUP	HCPCS C2627		G14173  -  SET CATH .038IN PGTL CRV 5FR 70CM 145CM SDPRT GW ALONG SHFT	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14174	SUP	HCPCS C2627		G14174  -  DILATOR URTH 24FR 20CM PE FSCA	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14175	SUP	HCPCS C2627		G14175  -  DILATOR URTH 20FR 20CM STRL PE FSCA DISP	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14177	SUP	HCPCS C2627		G14177  -  DILATOR URTH 22FR 20CM STRL PE FSCA DISP	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$0.00	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G14178	SUP	Custom 27203010		G14178  -  DILATOR URTH 5FR 20CM STRL PE FSCA DISP	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14185	SUP	HCPCS C1769		G14185  -  SHEATH ACC 12FR 13CM LF FLXR PRLL RPD RELS WKG CHNL LFRIC	BOTH IP/OP	$510.95 	$378.10	$0.00	$408.76	$277.45	$277.45	$0.00	$0.00	$0.00	$106.49	$379.23	$379.23	$0.00	$0.00	$106.48	$0.00	$302.23	$302.23	$0.00	$255.48	$404.67	$408.76	$0.00		$0.00	$79.96	$0.00	$0.00	$81.34	$0.00	$0.00	$0.00	$0.00	$0.00
G14186	SUP	HCPCS C2627		G14186  -  STYLET NPHSTM 14FR FLXB	BOTH IP/OP	$63.25 	$46.81	$0.00	$50.60	$34.34	$34.34	$0.00	$0.00	$0.00	$0.00	$46.94	$46.94	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$31.63	$50.09	$50.60	$0.00		$0.00	$9.90	$0.00	$0.00	$10.07	$0.00	$0.00	$0.00	$0.00	$0.00
G14187	SUP	HCPCS C2627		G14187  -  DILATOR URTH 8FR 37CM STRL PE FSCA DISP	BOTH IP/OP	$63.25 	$46.81	$0.00	$50.60	$34.34	$34.34	$0.00	$0.00	$0.00	$0.00	$46.94	$46.94	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$31.63	$50.09	$50.60	$0.00		$0.00	$9.90	$0.00	$0.00	$10.07	$0.00	$0.00	$0.00	$0.00	$0.00
G14188	SUP	HCPCS C2627		G14188  -  DILATOR URTH 10FR 37CM STRL PE FSCA DISP	BOTH IP/OP	$63.25 	$46.81	$0.00	$50.60	$34.34	$34.34	$0.00	$0.00	$0.00	$0.00	$46.94	$46.94	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$31.63	$50.09	$50.60	$0.00		$0.00	$9.90	$0.00	$0.00	$10.07	$0.00	$0.00	$0.00	$0.00	$0.00
G14189	SUP	HCPCS C2627		G14189  -  DILATOR URTH 12FR 37CM STRL PE FSCA DISP	BOTH IP/OP	$63.25 	$46.81	$0.00	$50.60	$34.34	$34.34	$0.00	$0.00	$0.00	$0.00	$46.94	$46.94	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$31.63	$50.09	$50.60	$0.00		$0.00	$9.90	$0.00	$0.00	$10.07	$0.00	$0.00	$0.00	$0.00	$0.00
G14190	SUP	HCPCS C2627		G14190  -  DILATOR URTH 14FR 37CM STRL PE FSCA DISP	BOTH IP/OP	$63.25 	$46.81	$0.00	$50.60	$34.34	$34.34	$0.00	$0.00	$0.00	$0.00	$46.94	$46.94	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$31.63	$50.09	$50.60	$0.00		$0.00	$9.90	$0.00	$0.00	$10.07	$0.00	$0.00	$0.00	$0.00	$0.00
G14191	SUP	HCPCS C2627		G14191  -  DILATOR URTH 16FR 37CM PE FSCA	BOTH IP/OP	$63.25 	$46.81	$0.00	$50.60	$34.34	$34.34	$0.00	$0.00	$0.00	$0.00	$46.94	$46.94	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$31.63	$50.09	$50.60	$0.00		$0.00	$9.90	$0.00	$0.00	$10.07	$0.00	$0.00	$0.00	$0.00	$0.00
G14192	SUP	HCPCS C2627		G14192  -  DILATOR URTH 20FR 37CM PE FSCA	BOTH IP/OP	$63.25 	$46.81	$0.00	$50.60	$34.34	$34.34	$0.00	$0.00	$0.00	$0.00	$46.94	$46.94	$0.00	$0.00	$13.18	$0.00	$0.00	$0.00	$0.00	$31.63	$50.09	$50.60	$0.00		$0.00	$9.90	$0.00	$0.00	$10.07	$0.00	$0.00	$0.00	$0.00	$0.00
G14193	SUP	HCPCS C2627		G14193  -  DILATOR URTH 22FR 37CM STRL DISP	BOTH IP/OP	$72.73 	$53.82	$0.00	$58.18	$39.49	$39.49	$0.00	$0.00	$0.00	$0.00	$53.98	$53.98	$0.00	$0.00	$15.16	$0.00	$0.00	$0.00	$0.00	$36.36	$57.60	$58.18	$0.00		$0.00	$11.38	$0.00	$0.00	$11.58	$0.00	$0.00	$0.00	$0.00	$0.00
G14194	SUP	HCPCS C2627		G14194  -  DILATOR URTH 24FR 37CM STRL DISP	BOTH IP/OP	$75.28 	$55.71	$0.00	$60.22	$40.87	$40.87	$0.00	$0.00	$0.00	$0.00	$55.87	$55.87	$0.00	$0.00	$15.69	$0.00	$0.00	$0.00	$0.00	$37.64	$59.62	$60.22	$0.00		$0.00	$11.78	$0.00	$0.00	$11.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14195	SUP	HCPCS C2627		G14195  -  DILATOR URTH 8FR 37CM SDPRT PE FSCA	BOTH IP/OP	$65.45 	$48.43	$0.00	$52.36	$35.54	$35.54	$0.00	$0.00	$0.00	$0.00	$48.58	$48.58	$0.00	$0.00	$13.64	$0.00	$0.00	$0.00	$0.00	$32.73	$51.84	$52.36	$0.00		$0.00	$10.24	$0.00	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$0.00
G14196	SUP	HCPCS C2627		G14196  -  DILATOR URTH 10FR 37CM STRL SDPRT DISP	BOTH IP/OP	$65.45 	$48.43	$0.00	$52.36	$35.54	$35.54	$0.00	$0.00	$0.00	$0.00	$48.58	$48.58	$0.00	$0.00	$13.64	$0.00	$0.00	$0.00	$0.00	$32.73	$51.84	$52.36	$0.00		$0.00	$10.24	$0.00	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$0.00
G14197	SUP	HCPCS C2627		G14197  -  DILATOR URTH 12FR 37CM SDPRT PE FSCA	BOTH IP/OP	$65.45 	$48.43	$0.00	$52.36	$35.54	$35.54	$0.00	$0.00	$0.00	$0.00	$48.58	$48.58	$0.00	$0.00	$13.64	$0.00	$0.00	$0.00	$0.00	$32.73	$51.84	$52.36	$0.00		$0.00	$10.24	$0.00	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$0.00
G14198	SUP	HCPCS C2627		G14198  -  DILATOR URTH 14FR 37CM STRL SDPRT DISP	BOTH IP/OP	$65.45 	$48.43	$0.00	$52.36	$35.54	$35.54	$0.00	$0.00	$0.00	$0.00	$48.58	$48.58	$0.00	$0.00	$13.64	$0.00	$0.00	$0.00	$0.00	$32.73	$51.84	$52.36	$0.00		$0.00	$10.24	$0.00	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$0.00
G14199	SUP	HCPCS C2627		G14199  -  DILATOR URTH 16FR 37CM SDPRT PE FSCA	BOTH IP/OP	$65.45 	$48.43	$0.00	$52.36	$35.54	$35.54	$0.00	$0.00	$0.00	$0.00	$48.58	$48.58	$0.00	$0.00	$13.64	$0.00	$0.00	$0.00	$0.00	$32.73	$51.84	$52.36	$0.00		$0.00	$10.24	$0.00	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$0.00
G14200	SUP	HCPCS C2627		G14200  -  DILATOR URTH 18FR 37CM STRL SDPRT DISP	BOTH IP/OP	$65.45 	$48.43	$0.00	$52.36	$35.54	$35.54	$0.00	$0.00	$0.00	$0.00	$48.58	$48.58	$0.00	$0.00	$13.64	$0.00	$0.00	$0.00	$0.00	$32.73	$51.84	$52.36	$0.00		$0.00	$10.24	$0.00	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$0.00
G14201	SUP	HCPCS C2627		G14201  -  DILATOR URTH 20FR 37CM STRL SDPRT DISP	BOTH IP/OP	$65.45 	$48.43	$0.00	$52.36	$35.54	$35.54	$0.00	$0.00	$0.00	$0.00	$48.58	$48.58	$0.00	$0.00	$13.64	$0.00	$0.00	$0.00	$0.00	$32.73	$51.84	$52.36	$0.00		$0.00	$10.24	$0.00	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$0.00
G14202	SUP	HCPCS C2627		G14202  -  DILATOR URTH 22FR 37CM STRL SDPRT DISP	BOTH IP/OP	$65.45 	$48.43	$0.00	$52.36	$35.54	$35.54	$0.00	$0.00	$0.00	$0.00	$48.58	$48.58	$0.00	$0.00	$13.64	$0.00	$0.00	$0.00	$0.00	$32.73	$51.84	$52.36	$0.00		$0.00	$10.24	$0.00	$0.00	$10.42	$0.00	$0.00	$0.00	$0.00	$0.00
G14211	SUP	HCPCS C1773		G14211  -  DILATOR URTH 24FR 37CM STRL SDPRT DISP	BOTH IP/OP	$398.45 	$294.85	$0.00	$318.76	$216.36	$216.36	$0.00	$0.00	$0.00	$83.05	$295.73	$295.73	$0.00	$0.00	$83.04	$0.00	$235.68	$235.68	$0.00	$199.23	$315.57	$318.76	$0.00		$0.00	$62.36	$0.00	$0.00	$63.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14214	SUP	HCPCS C2627		G14214  -  FORCEPS GRSP 5FR 20MM 60CM 3 PR	BOTH IP/OP	$510.95 	$378.10	$0.00	$408.76	$277.45	$277.45	$0.00	$0.00	$0.00	$0.00	$379.23	$379.23	$0.00	$0.00	$106.48	$0.00	$0.00	$0.00	$0.00	$255.48	$404.67	$408.76	$0.00		$0.00	$79.96	$0.00	$0.00	$81.34	$0.00	$0.00	$0.00	$0.00	$0.00
G14220	SUP	Custom 27203010		G14220  -  NEEDLE ENDSCP 35CM 23GA 8MM URTH CSCP INJEC PRC WMS	BOTH IP/OP	$47.30 	$35.00	$0.00	$37.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.65	$37.46	$37.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14231	SUP	HCPCS C1769		G14231  -  TUBE DRN STD 14FR 30CM STRL LF 1 WY STPCK CNCT DISP	BOTH IP/OP	$33.80 	$25.01	$0.00	$27.04	$18.35	$18.35	$0.00	$0.00	$0.00	$7.04	$25.09	$25.09	$0.00	$0.00	$7.04	$0.00	$19.99	$19.99	$0.00	$16.90	$26.77	$27.04	$0.00		$0.00	$5.29	$0.00	$0.00	$5.38	$0.00	$0.00	$0.00	$0.00	$0.00
G14254	SUP	Custom 27203010		G14254  -  PUNCH SRG 14FR 3MM NS FL CATH TIP REUSE CUT .118IN RND HL	BOTH IP/OP	$33.00 	$24.42	$0.00	$26.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.49	$24.49	$0.00	$0.00	$6.88	$0.00	$0.00	$0.00	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14255	SUP	Custom 27203010		G14255  -  NEEDLE PRC 22GA 20CM SKNY CHBA TIP PERC NPHSTM	BOTH IP/OP	$35.75 	$26.46	$0.00	$28.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.53	$26.53	$0.00	$0.00	$7.45	$0.00	$0.00	$0.00	$0.00	$17.88	$28.31	$28.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14256	SUP	Custom 27203010		G14256  -  NEEDLE PRC STD 18GA 20CM ECHTP 2 PRT TROC DISP NPHSTM	BOTH IP/OP	$35.75 	$26.46	$0.00	$28.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.53	$26.53	$0.00	$0.00	$7.45	$0.00	$0.00	$0.00	$0.00	$17.88	$28.31	$28.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14257	SUP	Custom 27203010		G14257  -  NEEDLE PRC 18GA 11CM MTPLK PERC	BOTH IP/OP	$74.65 	$55.24	$0.00	$59.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.41	$55.41	$0.00	$0.00	$15.56	$0.00	$0.00	$0.00	$0.00	$37.33	$59.12	$59.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14259	SUP	Custom 27203010		G14259  -  NEEDLE PRC STD 18GA 25CM 2 PRT TROC DISP	BOTH IP/OP	$95.70 	$70.82	$0.00	$76.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.03	$71.03	$0.00	$0.00	$19.94	$0.00	$0.00	$0.00	$0.00	$47.85	$75.79	$76.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14260	SUP	HCPCS C1769		G14260  -  NEEDLE BX STD 18GA 25CM TFE SHTH TROC STY RNL	BOTH IP/OP	$91.25 	$67.53	$0.00	$73.00	$49.55	$49.55	$0.00	$0.00	$0.00	$19.02	$67.73	$67.73	$0.00	$0.00	$19.02	$0.00	$53.97	$53.97	$0.00	$45.63	$72.27	$73.00	$0.00		$0.00	$14.28	$0.00	$0.00	$14.53	$0.00	$0.00	$0.00	$0.00	$0.00
G14261	SUP	HCPCS C1726		G14261  -  GUIDEWIRE URO STD .038IN 80CM STRL LF 3MM SFTJ FX COR STRG	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$179.19	$179.19	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
G14263	SUP	Custom 27203010		G14263  -  DILATOR URTH 18FR 37CM STRL DISP	BOTH IP/OP	$525.20 	$388.65	$0.00	$420.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.80	$389.80	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$262.60	$415.96	$420.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14270	SUP	HCPCS C1894		G14270  -  SET NDL 18-22GA 14-22CM MTPLK COAX PERC	BOTH IP/OP	$128.70 	$95.24	$0.00	$102.96	$69.88	$69.88	$0.00	$0.00	$0.00	$26.82	$95.52	$95.52	$0.00	$0.00	$26.82	$0.00	$76.13	$76.13	$0.00	$64.35	$101.93	$102.96	$0.00		$0.00	$20.14	$0.00	$0.00	$20.49	$0.00	$0.00	$0.00	$0.00	$0.00
G14275	SUP	HCPCS C2627		G14275  -  TUBE CNCT STD 14FR 135CM M LL DRN BG	BOTH IP/OP	$578.13 	$427.82	$0.00	$462.50	$313.92	$313.92	$0.00	$0.00	$0.00	$0.00	$429.08	$429.08	$0.00	$0.00	$120.48	$0.00	$0.00	$0.00	$0.00	$289.06	$457.88	$462.50	$0.00		$0.00	$90.48	$0.00	$0.00	$92.04	$0.00	$0.00	$0.00	$0.00	$0.00
G14276	SUP	Custom 27203010		G14276  -  SET DIL 26-36FR 37CM STRL PE FSCA DISP	BOTH IP/OP	$103.73 	$76.76	$0.00	$82.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.98	$76.98	$0.00	$0.00	$21.62	$0.00	$0.00	$0.00	$0.00	$51.86	$82.15	$82.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14277	SUP	Custom 27203010		G14277  -  DILATOR URTH 26FR 37CM PE FSCA	BOTH IP/OP	$90.20 	$66.75	$0.00	$72.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.95	$66.95	$0.00	$0.00	$18.80	$0.00	$0.00	$0.00	$0.00	$45.10	$71.44	$72.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14278	SUP	Custom 27203010		G14278  -  DILATOR URTH 28FR 37CM STRL PE FSCA DISP	BOTH IP/OP	$103.73 	$76.76	$0.00	$82.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.98	$76.98	$0.00	$0.00	$21.62	$0.00	$0.00	$0.00	$0.00	$51.86	$82.15	$82.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14279	SUP	Custom 27203010		G14279  -  DILATOR URTH 30FR 37CM STRL DISP	BOTH IP/OP	$103.73 	$76.76	$0.00	$82.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.98	$76.98	$0.00	$0.00	$21.62	$0.00	$0.00	$0.00	$0.00	$51.86	$82.15	$82.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14280	SUP	Custom 27203010		G14280  -  DILATOR URTH 32FR 37CM PE FSCA	BOTH IP/OP	$103.73 	$76.76	$0.00	$82.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.98	$76.98	$0.00	$0.00	$21.62	$0.00	$0.00	$0.00	$0.00	$51.86	$82.15	$82.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14281	SUP	Custom 27203010		G14281  -  DILATOR URTH 34FR 37CM PE FSCA	BOTH IP/OP	$103.73 	$76.76	$0.00	$82.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.98	$76.98	$0.00	$0.00	$21.62	$0.00	$0.00	$0.00	$0.00	$51.86	$82.15	$82.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14282	SUP	HCPCS C1729		G14282  -  DILATOR URTH 36FR 37CM PE FSCA	BOTH IP/OP	$404.80 	$299.55	$0.00	$323.84	$219.81	$219.81	$0.00	$0.00	$0.00	$84.37	$300.44	$300.44	$0.00	$0.00	$84.36	$0.00	$239.44	$239.44	$0.00	$202.40	$320.60	$323.84	$0.00		$0.00	$63.35	$0.00	$0.00	$64.44	$0.00	$0.00	$0.00	$0.00	$0.00
G14283	SUP	HCPCS C1729		G14283  -  SET NPHSTM STD 10FR 19.5CM LTX COPE LOOP NDL GW CATH CNN DIL	BOTH IP/OP	$188.10 	$139.19	$0.00	$150.48	$102.14	$102.14	$0.00	$0.00	$0.00	$39.20	$139.61	$139.61	$0.00	$0.00	$39.20	$0.00	$111.26	$111.26	$0.00	$94.05	$148.98	$150.48	$0.00		$0.00	$29.44	$0.00	$0.00	$29.95	$0.00	$0.00	$0.00	$0.00	$0.00
G14284	SUP	HCPCS C1894		G14284  -  SET NPHSTM 10FR 18GA 19.5CM STRL LTX 35CM CK RADOPQ CATH CNN	BOTH IP/OP	$216.70 	$160.36	$0.00	$173.36	$117.67	$117.67	$0.00	$0.00	$0.00	$45.17	$160.83	$160.83	$0.00	$0.00	$45.16	$0.00	$128.18	$128.18	$0.00	$108.35	$171.63	$173.36	$0.00		$0.00	$33.91	$0.00	$0.00	$34.50	$0.00	$0.00	$0.00	$0.00	$0.00
G14285	SUP	HCPCS C1769		G14285  -  SET NPHSTM 6-16FR 20CM COPE LOOP NDL GW CATH CNN DIL PERC	BOTH IP/OP	$33.80 	$25.01	$0.00	$27.04	$18.35	$18.35	$0.00	$0.00	$0.00	$7.04	$25.09	$25.09	$0.00	$0.00	$7.04	$0.00	$19.99	$19.99	$0.00	$16.90	$26.77	$27.04	$0.00		$0.00	$5.29	$0.00	$0.00	$5.38	$0.00	$0.00	$0.00	$0.00	$0.00
G14287	SUP	Custom 27203010		G14287  -  GUIDEWIRE VASC 39CM STD STRG .038IN 80CM STRL 1CM FXCR FLX	BOTH IP/OP	$50.60 	$37.44	$0.00	$40.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.56	$37.56	$0.00	$0.00	$10.55	$0.00	$0.00	$0.00	$0.00	$25.30	$40.08	$40.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14297	SUP	HCPCS C1769		G14297  -  ADAPTER INST 3-6FR 1 WY STPCK SDARM Y FIT M LL	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$179.19	$179.19	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
G14298	SUP	HCPCS C2627		G14298  -  SET DIL 6-18FR 60CM PE URETER	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$22.70	$22.70	$0.00	$0.00	$0.00	$0.00	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
G14299	SUP	HCPCS C2627		G14299  -  DILATOR URET 8FR 60CM STRL PE DISP	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$22.70	$22.70	$0.00	$0.00	$0.00	$0.00	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
G14300	SUP	HCPCS C2627		G14300  -  DILATOR URET 9FR 60CM STRL PE DISP	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$22.70	$22.70	$0.00	$0.00	$0.00	$0.00	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
G14301	SUP	HCPCS C2627		G14301  -  DILATOR URET 10FR 60CM STRL PE	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$22.70	$22.70	$0.00	$0.00	$0.00	$0.00	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
G14302	SUP	HCPCS C2627		G14302  -  DILATOR URET 12FR 60CM STRL PE	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$22.70	$22.70	$0.00	$0.00	$0.00	$0.00	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
G14303	SUP	HCPCS C2627		G14303  -  DILATOR URET 14FR 60CM STRL PE	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$22.70	$22.70	$0.00	$0.00	$0.00	$0.00	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
G14304	SUP	HCPCS C2627		G14304  -  DILATOR URET 16FR 60CM STRL PE	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$22.70	$22.70	$0.00	$0.00	$0.00	$0.00	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
G14305	SUP	HCPCS C1726		G14305  -  DILATOR URET 16FR 60CM PE FSCA	BOTH IP/OP	$51.15 	$37.85	$0.00	$40.92	$27.77	$27.77	$0.00	$0.00	$0.00	$10.66	$37.96	$37.96	$0.00	$0.00	$10.66	$0.00	$30.26	$30.26	$0.00	$25.58	$40.51	$40.92	$0.00		$0.00	$8.00	$0.00	$0.00	$8.14	$0.00	$0.00	$0.00	$0.00	$0.00
G14306	SUP	HCPCS C1894		G14306  -  CATHETER BLNDIL 8FR 84CM STRL AMPTZ GD RNL	BOTH IP/OP	$86.90 	$64.31	$0.00	$69.52	$47.19	$47.19	$0.00	$0.00	$0.00	$18.11	$64.50	$64.50	$0.00	$0.00	$18.11	$0.00	$51.40	$51.40	$0.00	$43.45	$68.82	$69.52	$0.00		$0.00	$13.60	$0.00	$0.00	$13.83	$0.00	$0.00	$0.00	$0.00	$0.00
G14307	SUP	HCPCS C1769		G14307  -  SET INTRO .038IN 50CM 12FR 5FR 100CM STRL 22CM GW RADOPQ	BOTH IP/OP	$38.88 	$28.77	$0.00	$31.10	$21.11	$21.11	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$22.99	$22.99	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$6.08	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
G14309	SUP	HCPCS C1769		G14309  -  GUIDEWIRE ESCP STD CDE .038IN 145CM FXCR	BOTH IP/OP	$33.80 	$25.01	$0.00	$27.04	$18.35	$18.35	$0.00	$0.00	$0.00	$7.04	$25.09	$25.09	$0.00	$0.00	$7.04	$0.00	$19.99	$19.99	$0.00	$16.90	$26.77	$27.04	$0.00		$0.00	$5.29	$0.00	$0.00	$5.38	$0.00	$0.00	$0.00	$0.00	$0.00
G14311	SUP	HCPCS C1892		G14311  -  GUIDEWIRE VASC STD STRG .038IN 145CM STRL 3CM FLX TP FXCR SS	BOTH IP/OP	$143.00 	$105.82	$0.00	$114.40	$77.65	$77.65	$0.00	$0.00	$0.00	$29.80	$106.13	$106.13	$0.00	$0.00	$29.80	$0.00	$84.58	$84.58	$0.00	$71.50	$113.26	$114.40	$0.00		$0.00	$22.38	$0.00	$0.00	$22.77	$0.00	$0.00	$0.00	$0.00	$0.00
G14320	SUP	HCPCS C1758		G14320  -  SET INTRO STD 9FR 65CM 60CM PLWY SHTH GW URET	BOTH IP/OP	$352.00 	$260.48	$0.00	$281.60	$191.14	$191.14	$0.00	$0.00	$0.00	$73.37	$261.25	$261.25	$0.00	$0.00	$73.36	$0.00	$208.21	$208.21	$0.00	$176.00	$278.78	$281.60	$0.00		$0.00	$55.09	$0.00	$0.00	$56.04	$0.00	$0.00	$0.00	$0.00	$0.00
G14323	SUP	HCPCS C1769		G14323  -  DILATOR URET 7FR 6MM 65CM 4CM BLN CATH	BOTH IP/OP	$37.40 	$27.68	$0.00	$29.92	$20.31	$20.31	$0.00	$0.00	$0.00	$7.80	$27.76	$27.76	$0.00	$0.00	$7.79	$0.00	$22.12	$22.12	$0.00	$18.70	$29.62	$29.92	$0.00		$0.00	$5.85	$0.00	$0.00	$5.95	$0.00	$0.00	$0.00	$0.00	$0.00
G14326	SUP	HCPCS C1769		G14326  -  GUIDEWIRE URO .038IN 145CM 3CM FX COR STRG FLX TP HVDTY SS	BOTH IP/OP	$38.88 	$28.77	$0.00	$31.10	$21.11	$21.11	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$22.99	$22.99	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$6.08	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
G14328	SUP	Custom 27203010		G14328  -  GUIDEWIRE VASC STD .038IN 100CM FXCR SS	BOTH IP/OP	$572.00 	$423.28	$0.00	$457.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.54	$424.54	$0.00	$0.00	$119.20	$0.00	$0.00	$0.00	$0.00	$286.00	$453.02	$457.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14335	SUP	HCPCS C1773		G14335  -  SET NPHSTM 7FR 82CM STRL LAWSON RTRGD GW PNCT PERC DISP	BOTH IP/OP	$398.45 	$294.85	$0.00	$318.76	$216.36	$216.36	$0.00	$0.00	$0.00	$83.05	$295.73	$295.73	$0.00	$0.00	$83.04	$0.00	$235.68	$235.68	$0.00	$199.23	$315.57	$318.76	$0.00		$0.00	$62.36	$0.00	$0.00	$63.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14337	SUP	HCPCS C2628		G14337  -  FORCEPS GRSP 4.5FR 65CM 15MM 3WR COAX SHTH	BOTH IP/OP	$319.00 	$236.06	$0.00	$255.20	$0.00	$0.00	$0.00	$0.00	$0.00	$66.49	$236.76	$236.76	$0.00	$0.00	$66.48	$0.00	$188.69	$188.69	$0.00	$159.50	$252.65	$255.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14343	SUP	HCPCS C1729		G14343  -  CATHETER BLNOCC 6FR 75CM STRL REM ADPR RADOPQ SIL UPJ DISP	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$197.11	$197.11	$0.00	$0.00	$0.00	$75.66	$269.42	$269.42	$0.00	$0.00	$75.65	$0.00	$214.71	$214.71	$0.00	$181.50	$287.50	$290.40	$0.00		$0.00	$56.81	$0.00	$0.00	$57.79	$0.00	$0.00	$0.00	$0.00	$0.00
G14344	SUP	HCPCS C1758		G14344  -  CATHETER NPHSTM 17FR 12MM 25CM 15CM KAYE TMPND BLN RADOPQ	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$179.19	$179.19	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
G14363	SUP	HCPCS C2617		G14363  -  DILATOR SRG 7FR 6MM 65CM STRL 10CM BLN CATH RADOPQ PINVISE	BOTH IP/OP	$300.60 	$222.44	$0.00	$240.48	$135.27	$135.27	$0.00	$0.00	$0.00	$62.65	$223.11	$223.11	$0.00	$0.00	$62.65	$0.00	$177.80	$177.80	$0.00	$150.30	$238.08	$240.48	$0.00		$0.00	$47.04	$0.00	$0.00	$47.86	$0.00	$0.00	$0.00	$0.00	$0.00
G14364	SUP	HCPCS C2617		G14364  -  SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 8CM GRN STRL 70	BOTH IP/OP	$300.60 	$222.44	$0.00	$240.48	$135.27	$135.27	$0.00	$0.00	$0.00	$62.65	$223.11	$223.11	$0.00	$0.00	$62.65	$0.00	$177.80	$177.80	$0.00	$150.30	$238.08	$240.48	$0.00		$0.00	$47.04	$0.00	$0.00	$47.86	$0.00	$0.00	$0.00	$0.00	$0.00
G14365	SUP	HCPCS C2617		G14365  -  SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 10CM GRN STRL 70	BOTH IP/OP	$300.60 	$222.44	$0.00	$240.48	$135.27	$135.27	$0.00	$0.00	$0.00	$62.65	$223.11	$223.11	$0.00	$0.00	$62.65	$0.00	$177.80	$177.80	$0.00	$150.30	$238.08	$240.48	$0.00		$0.00	$47.04	$0.00	$0.00	$47.86	$0.00	$0.00	$0.00	$0.00	$0.00
G14366	SUP	HCPCS C2617		G14366  -  SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 12CM GRN STRL 70	BOTH IP/OP	$300.60 	$222.44	$0.00	$240.48	$135.27	$135.27	$0.00	$0.00	$0.00	$62.65	$223.11	$223.11	$0.00	$0.00	$62.65	$0.00	$177.80	$177.80	$0.00	$150.30	$238.08	$240.48	$0.00		$0.00	$47.04	$0.00	$0.00	$47.86	$0.00	$0.00	$0.00	$0.00	$0.00
G14367	SUP	HCPCS C2617		G14367  -  SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 14CM GRN STRL 70	BOTH IP/OP	$300.60 	$222.44	$0.00	$240.48	$135.27	$135.27	$0.00	$0.00	$0.00	$62.65	$223.11	$223.11	$0.00	$0.00	$62.65	$0.00	$177.80	$177.80	$0.00	$150.30	$238.08	$240.48	$0.00		$0.00	$47.04	$0.00	$0.00	$47.86	$0.00	$0.00	$0.00	$0.00	$0.00
G14405	SUP	HCPCS C1892		G14405  -  SET STNT .035IN 50CM SM 2 PGTL CRV 5FR 16CM GRN STRL 70CM	BOTH IP/OP	$143.00 	$105.82	$0.00	$114.40	$77.65	$77.65	$0.00	$0.00	$0.00	$29.80	$106.13	$106.13	$0.00	$0.00	$29.80	$0.00	$84.58	$84.58	$0.00	$71.50	$113.26	$114.40	$0.00		$0.00	$22.38	$0.00	$0.00	$22.77	$0.00	$0.00	$0.00	$0.00	$0.00
G14408	SUP	HCPCS C1758		G14408  -  SET INTRO 14FR 60CM 65CM PLWY CATH 2 KNOB GW SHTH URET	BOTH IP/OP	$60.38 	$44.68	$0.00	$48.30	$32.78	$32.78	$0.00	$0.00	$0.00	$12.58	$44.81	$44.81	$0.00	$0.00	$12.58	$0.00	$35.71	$35.71	$0.00	$30.19	$47.82	$48.30	$0.00		$0.00	$9.45	$0.00	$0.00	$9.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14420	SUP	HCPCS C2627		G14420  -  TUBE CNCT LG 24FR 30CM LF M LL TO BG DRN	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$22.70	$22.70	$0.00	$0.00	$0.00	$0.00	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
G14421	SUP	HCPCS C2627		G14421  -  DILATOR URET 6FR 60CM STRL LFRIC SRFC PE DISP	BOTH IP/OP	$165.73 	$122.64	$0.00	$132.58	$89.99	$89.99	$0.00	$0.00	$0.00	$0.00	$123.00	$123.00	$0.00	$0.00	$34.54	$0.00	$0.00	$0.00	$0.00	$82.86	$131.26	$132.58	$0.00		$0.00	$25.94	$0.00	$0.00	$26.38	$0.00	$0.00	$0.00	$0.00	$0.00
G14422	SUP	HCPCS C1758		G14422  -  SET NPHSTM 5FR 75CM 15CM KAYE TMPND BLN CATH STY STNT PERC	BOTH IP/OP	$352.00 	$260.48	$0.00	$281.60	$191.14	$191.14	$0.00	$0.00	$0.00	$73.37	$261.25	$261.25	$0.00	$0.00	$73.36	$0.00	$208.21	$208.21	$0.00	$176.00	$278.78	$281.60	$0.00		$0.00	$55.09	$0.00	$0.00	$56.04	$0.00	$0.00	$0.00	$0.00	$0.00
G14423	SUP	HCPCS C1729		G14423  -  DILATOR URET .038IN 5FR 5MM 65CM STRL 4CM INFL BLN RADOPQ	BOTH IP/OP	$466.40 	$345.14	$0.00	$373.12	$253.26	$253.26	$0.00	$0.00	$0.00	$97.21	$346.16	$346.16	$0.00	$0.00	$97.20	$0.00	$275.88	$275.88	$0.00	$233.20	$369.39	$373.12	$0.00		$0.00	$72.99	$0.00	$0.00	$74.25	$0.00	$0.00	$0.00	$0.00	$0.00
G14426	SUP	HCPCS C1892		G14426  -  SET NPHSTM 17FR 12MM 25CM 10ML STRL LF 15CM KAYE TMPND BLN	BOTH IP/OP	$143.00 	$105.82	$0.00	$114.40	$77.65	$77.65	$0.00	$0.00	$0.00	$29.80	$106.13	$106.13	$0.00	$0.00	$29.80	$0.00	$84.58	$84.58	$0.00	$71.50	$113.26	$114.40	$0.00		$0.00	$22.38	$0.00	$0.00	$22.77	$0.00	$0.00	$0.00	$0.00	$0.00
G14427	SUP	HCPCS C1892		G14427  -  SET INTRO STD 12FR 65CM 60CM PLWY GW 2 KNOB URET	BOTH IP/OP	$143.00 	$105.82	$0.00	$114.40	$77.65	$77.65	$0.00	$0.00	$0.00	$29.80	$106.13	$106.13	$0.00	$0.00	$29.80	$0.00	$84.58	$84.58	$0.00	$71.50	$113.26	$114.40	$0.00		$0.00	$22.38	$0.00	$0.00	$22.77	$0.00	$0.00	$0.00	$0.00	$0.00
G14428	SUP	HCPCS C1892		G14428  -  SET INTRO STD 11FR 65CM 60CM PLWY GW 2 KNOB URET	BOTH IP/OP	$143.00 	$105.82	$0.00	$114.40	$77.65	$77.65	$0.00	$0.00	$0.00	$29.80	$106.13	$106.13	$0.00	$0.00	$29.80	$0.00	$84.58	$84.58	$0.00	$71.50	$113.26	$114.40	$0.00		$0.00	$22.38	$0.00	$0.00	$22.77	$0.00	$0.00	$0.00	$0.00	$0.00
G14431	SUP	HCPCS C1729		G14431  -  CATHETER URET .025IN 4FR 70CM STRL OP-EN PVC DISP	BOTH IP/OP	$18.59 	$13.76	$0.00	$14.87	$10.09	$10.09	$0.00	$0.00	$0.00	$3.87	$13.80	$13.80	$0.00	$0.00	$3.87	$0.00	$11.00	$11.00	$0.00	$9.30	$14.72	$14.87	$0.00		$0.00	$2.91	$0.00	$0.00	$2.96	$0.00	$0.00	$0.00	$0.00	$0.00
G14432	SUP	HCPCS C1892		G14432  -  SET NPHSTM 7-18FR 20-30CM STRL MLCT CATH STNT STY RTNT DISK	BOTH IP/OP	$164.45 	$121.69	$0.00	$131.56	$89.30	$89.30	$0.00	$0.00	$0.00	$34.28	$122.05	$122.05	$0.00	$0.00	$34.27	$0.00	$97.27	$97.27	$0.00	$82.23	$130.24	$131.56	$0.00		$0.00	$25.74	$0.00	$0.00	$26.18	$0.00	$0.00	$0.00	$0.00	$0.00
G14433	SUP	HCPCS C1892		G14433  -  SET INTRO .038IN STD STRG 16FR 65CM 60CM PLWY 2 KNOB GW SHTH	BOTH IP/OP	$164.45 	$121.69	$0.00	$131.56	$89.30	$89.30	$0.00	$0.00	$0.00	$34.28	$122.05	$122.05	$0.00	$0.00	$34.27	$0.00	$97.27	$97.27	$0.00	$82.23	$130.24	$131.56	$0.00		$0.00	$25.74	$0.00	$0.00	$26.18	$0.00	$0.00	$0.00	$0.00	$0.00
G14434	SUP	HCPCS C2627		G14434  -  SET INTRO STD 18FR 65CM 60CM PLWY GW SHTH 2 KNOB URET	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$22.70	$22.70	$0.00	$0.00	$0.00	$0.00	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
G14437	SUP	HCPCS C1729		G14437  -  DILATOR URET 11FR 60CM SET PE	BOTH IP/OP	$185.90 	$137.57	$0.00	$148.72	$100.94	$100.94	$0.00	$0.00	$0.00	$38.75	$137.97	$137.97	$0.00	$0.00	$38.74	$0.00	$109.96	$109.96	$0.00	$92.95	$147.23	$148.72	$0.00		$0.00	$29.09	$0.00	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00
G14440	SUP	HCPCS C1892		G14440  -  SET NPHSTM 22FR 35CM MLCT CATH STY RTNT DISK CNCT TUBE PU	BOTH IP/OP	$118.80 	$87.91	$0.00	$95.04	$64.51	$64.51	$0.00	$0.00	$0.00	$24.76	$88.17	$88.17	$0.00	$0.00	$24.76	$0.00	$70.27	$70.27	$0.00	$59.40	$94.09	$95.04	$0.00		$0.00	$18.59	$0.00	$0.00	$18.91	$0.00	$0.00	$0.00	$0.00	$0.00
G14441	SUP	HCPCS C1892		G14441  -  SET INTRO STD 9FR 37CM 32CM PLWY 2 KNOB SHTH GW	BOTH IP/OP	$118.80 	$87.91	$0.00	$95.04	$64.51	$64.51	$0.00	$0.00	$0.00	$24.76	$88.17	$88.17	$0.00	$0.00	$24.76	$0.00	$70.27	$70.27	$0.00	$59.40	$94.09	$95.04	$0.00		$0.00	$18.59	$0.00	$0.00	$18.91	$0.00	$0.00	$0.00	$0.00	$0.00
G14442	SUP	HCPCS C1892		G14442  -  SET INTRO STD 10FR 37CM 32CM PLWY GW 2 KNOB SHTH URET	BOTH IP/OP	$118.80 	$87.91	$0.00	$95.04	$64.51	$64.51	$0.00	$0.00	$0.00	$24.76	$88.17	$88.17	$0.00	$0.00	$24.76	$0.00	$70.27	$70.27	$0.00	$59.40	$94.09	$95.04	$0.00		$0.00	$18.59	$0.00	$0.00	$18.91	$0.00	$0.00	$0.00	$0.00	$0.00
G14443	SUP	HCPCS C1892		G14443  -  SET INTRO STD 12FR 37CM 32CM PLWY 2 KNOB SHTH GW URETER	BOTH IP/OP	$118.80 	$87.91	$0.00	$95.04	$64.51	$64.51	$0.00	$0.00	$0.00	$24.76	$88.17	$88.17	$0.00	$0.00	$24.76	$0.00	$70.27	$70.27	$0.00	$59.40	$94.09	$95.04	$0.00		$0.00	$18.59	$0.00	$0.00	$18.91	$0.00	$0.00	$0.00	$0.00	$0.00
G14444	SUP	HCPCS C1892		G14444  -  SET INTRO STD 14FR 37CM 32CM PLWY 2 KNOB SHTH GW	BOTH IP/OP	$118.80 	$87.91	$0.00	$95.04	$64.51	$64.51	$0.00	$0.00	$0.00	$24.76	$88.17	$88.17	$0.00	$0.00	$24.76	$0.00	$70.27	$70.27	$0.00	$59.40	$94.09	$95.04	$0.00		$0.00	$18.59	$0.00	$0.00	$18.91	$0.00	$0.00	$0.00	$0.00	$0.00
G14445	SUP	HCPCS C1892		G14445  -  SET INTRO STD 16FR 37CM 32CM PLWY GW 2 KNOB SHTH URET	BOTH IP/OP	$118.80 	$87.91	$0.00	$95.04	$64.51	$64.51	$0.00	$0.00	$0.00	$24.76	$88.17	$88.17	$0.00	$0.00	$24.76	$0.00	$70.27	$70.27	$0.00	$59.40	$94.09	$95.04	$0.00		$0.00	$18.59	$0.00	$0.00	$18.91	$0.00	$0.00	$0.00	$0.00	$0.00
G14454	SUP	HCPCS C1729		G14454  -  LINE INJ 7FR 30CM CNRST STD FIT	BOTH IP/OP	$185.90 	$137.57	$0.00	$148.72	$100.94	$100.94	$0.00	$0.00	$0.00	$38.75	$137.97	$137.97	$0.00	$0.00	$38.74	$0.00	$109.96	$109.96	$0.00	$92.95	$147.23	$148.72	$0.00		$0.00	$29.09	$0.00	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00
G14457	SUP	Custom 27203010		G14457  -  CATHETER URET .038IN 8FR 70CM STRL OP-EN DISP	BOTH IP/OP	$11.01 	$8.15	$0.00	$8.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.17	$8.17	$0.00	$0.00	$2.29	$0.00	$0.00	$0.00	$0.00	$5.50	$8.72	$8.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14461	SUP	Custom 27203010		G14461  -  NEEDLE PRC STD 18GA 15CM ECHTP TROC STY SHTH PTFE RNL	BOTH IP/OP	$35.75 	$26.46	$0.00	$28.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.53	$26.53	$0.00	$0.00	$7.45	$0.00	$0.00	$0.00	$0.00	$17.88	$28.31	$28.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14463	SUP	HCPCS C1758		G14463  -  NEEDLE PRC 18GA 15CM STRL ECHTP 2 PRT TROC DISP NPHSTM	BOTH IP/OP	$404.80 	$299.55	$0.00	$323.84	$219.81	$219.81	$0.00	$0.00	$0.00	$84.37	$300.44	$300.44	$0.00	$0.00	$84.36	$0.00	$239.44	$239.44	$0.00	$202.40	$320.60	$323.84	$0.00		$0.00	$63.35	$0.00	$0.00	$64.44	$0.00	$0.00	$0.00	$0.00	$0.00
G14485	SUP	HCPCS C1726		G14485  -  ADAPTER CATH F LL TO LG FIT	BOTH IP/OP	$510.95 	$378.10	$0.00	$408.76	$277.45	$277.45	$0.00	$0.00	$0.00	$106.49	$379.23	$379.23	$0.00	$0.00	$106.48	$0.00	$302.23	$302.23	$0.00	$255.48	$404.67	$408.76	$0.00		$0.00	$79.96	$0.00	$0.00	$81.34	$0.00	$0.00	$0.00	$0.00	$0.00
G14500	SUP	Custom 27203010		G14500  -  STYLET NPHSTM 8.5FR FLXB MLCT CATH REM	BOTH IP/OP	$147.40 	$109.08	$0.00	$117.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.40	$109.40	$0.00	$0.00	$30.72	$0.00	$0.00	$0.00	$0.00	$73.70	$116.74	$117.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14501	SUP	HCPCS C1729		G14501  -  APPROXIMATOR SRG WILLSCHER SET VASC	BOTH IP/OP	$185.90 	$137.57	$0.00	$148.72	$100.94	$100.94	$0.00	$0.00	$0.00	$38.75	$137.97	$137.97	$0.00	$0.00	$38.74	$0.00	$109.96	$109.96	$0.00	$92.95	$147.23	$148.72	$0.00		$0.00	$29.09	$0.00	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00
G14504	SUP	HCPCS C1726		G14504  -  SET NPHSTM 5FR 20CM MLCT CATH LL STY RTNT DISK CNCT TUBE PU	BOTH IP/OP	$587.60 	$434.82	$0.00	$470.08	$319.07	$319.07	$0.00	$0.00	$0.00	$122.47	$436.12	$436.12	$0.00	$0.00	$122.46	$0.00	$347.57	$347.57	$0.00	$293.80	$465.38	$470.08	$0.00		$0.00	$91.96	$0.00	$0.00	$93.55	$0.00	$0.00	$0.00	$0.00	$0.00
G14508	SUP	HCPCS C1729		G14508  -  SET DIL 6-30FR 30CM 19CM AMPTZ MOD RADOPQ SHTH RNL	BOTH IP/OP	$363.00 	$268.62	$0.00	$290.40	$197.11	$197.11	$0.00	$0.00	$0.00	$75.66	$269.42	$269.42	$0.00	$0.00	$75.65	$0.00	$214.71	$214.71	$0.00	$181.50	$287.50	$290.40	$0.00		$0.00	$56.81	$0.00	$0.00	$57.79	$0.00	$0.00	$0.00	$0.00	$0.00
G14510	SUP	HCPCS C1729		G14510  -  SET NPHSTM PGTL CRV 6FR 7CM STRL 3 DIL 2 NDL CATH CNCT TUBE	BOTH IP/OP	$185.90 	$137.57	$0.00	$148.72	$100.94	$100.94	$0.00	$0.00	$0.00	$38.75	$137.97	$137.97	$0.00	$0.00	$38.74	$0.00	$109.96	$109.96	$0.00	$92.95	$147.23	$148.72	$0.00		$0.00	$29.09	$0.00	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00
G14511	SUP	HCPCS C1758		G14511  -  SET NPHSTM 7FR 20CM MLCT CATH STNT LL RTNT DISK PU	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14513	SUP	HCPCS C2625		G14513  -  CATHETER URET 10FR 70CM OP-EN ACPT .038IN GW	BOTH IP/OP	$123.00 	$91.02	$0.00	$98.40	$55.35	$55.35	$0.00	$0.00	$0.00	$25.64	$91.29	$91.29	$0.00	$0.00	$25.63	$0.00	$72.75	$72.75	$0.00	$61.50	$97.42	$98.40	$0.00		$0.00	$19.25	$0.00	$0.00	$19.58	$0.00	$0.00	$0.00	$0.00	$0.00
G14514	SUP	HCPCS C2625		G14514  -  SET STNT .025IN PGTL CRV STRG 3.7FR 125CM BLU STRL 145CM	BOTH IP/OP	$141.45 	$104.67	$0.00	$113.16	$63.65	$63.65	$0.00	$0.00	$0.00	$29.48	$104.98	$104.98	$0.00	$0.00	$29.48	$0.00	$83.67	$83.67	$0.00	$70.73	$112.03	$113.16	$0.00		$0.00	$22.14	$0.00	$0.00	$22.52	$0.00	$0.00	$0.00	$0.00	$0.00
G14515	SUP	HCPCS C2628		G14515  -  SET STNT .035IN PGTL CRV STRG 4.7FR 125CM BLU STRL 145CM	BOTH IP/OP	$319.00 	$236.06	$0.00	$255.20	$0.00	$0.00	$0.00	$0.00	$0.00	$66.49	$236.76	$236.76	$0.00	$0.00	$66.48	$0.00	$188.69	$188.69	$0.00	$159.50	$252.65	$255.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14519	SUP	Custom 27203010		G14519  -  PROBE LTHTRP 1MM 605MM LMA STONEBREAKER PNEUM KT DISP	BOTH IP/OP	$15.62 	$11.56	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.59	$11.59	$0.00	$0.00	$3.26	$0.00	$0.00	$0.00	$0.00	$7.81	$12.37	$12.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14521	SUP	HCPCS C1758		G14521  -  SET DRN 300ML NS PCH 1 CNCT	BOTH IP/OP	$276.25 	$204.43	$0.00	$221.00	$150.00	$150.00	$0.00	$0.00	$0.00	$57.58	$205.03	$205.03	$0.00	$0.00	$57.57	$0.00	$163.40	$163.40	$0.00	$138.13	$218.79	$221.00	$0.00		$0.00	$43.23	$0.00	$0.00	$43.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14526	SUP	HCPCS C1729		G14526  -  STYLET NPHSTM 5FR FLXB 10FR MLCT CATH REM	BOTH IP/OP	$185.90 	$137.57	$0.00	$148.72	$100.94	$100.94	$0.00	$0.00	$0.00	$38.75	$137.97	$137.97	$0.00	$0.00	$38.74	$0.00	$109.96	$109.96	$0.00	$92.95	$147.23	$148.72	$0.00		$0.00	$29.09	$0.00	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00
G14544	SUP	HCPCS C1769		G14544  -  DEVICE SPEC RTRVL 5FR 5MM 65CM 4CM RTNR 4WR OCL STON BLN	BOTH IP/OP	$33.80 	$25.01	$0.00	$27.04	$18.35	$18.35	$0.00	$0.00	$0.00	$7.04	$25.09	$25.09	$0.00	$0.00	$7.04	$0.00	$19.99	$19.99	$0.00	$16.90	$26.77	$27.04	$0.00		$0.00	$5.29	$0.00	$0.00	$5.38	$0.00	$0.00	$0.00	$0.00	$0.00
G14547	SUP	Custom 27203010		G14547  -  GUIDEWIRE URO STD STRG .035IN 145CM STRL 3CM FLX TP FX COR	BOTH IP/OP	$604.00 	$446.96	$0.00	$483.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$448.29	$448.29	$0.00	$0.00	$125.87	$0.00	$0.00	$0.00	$0.00	$302.00	$478.37	$483.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14551	SUP	HCPCS C1769		G14551  -  EXTRACTOR STON 5FR 6MM 65CM 4CM RTNR 4WR HLCL BLNDIL FLFRM	BOTH IP/OP	$38.88 	$28.77	$0.00	$31.10	$21.11	$21.11	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$22.99	$22.99	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$6.08	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
G14554	SUP	HCPCS C1769		G14554  -  GUIDEWIRE ESCP STD .028IN 145CM LD EXTR RDRR PC FXCR DFLC	BOTH IP/OP	$33.80 	$25.01	$0.00	$27.04	$18.35	$18.35	$0.00	$0.00	$0.00	$7.04	$25.09	$25.09	$0.00	$0.00	$7.04	$0.00	$19.99	$19.99	$0.00	$16.90	$26.77	$27.04	$0.00		$0.00	$5.29	$0.00	$0.00	$5.38	$0.00	$0.00	$0.00	$0.00	$0.00
G14565	SUP	HCPCS C2627		G14565  -  GUIDEWIRE ESCP STD STRG .038IN 145CM STRL 1CM FXCR FLX TP SS	BOTH IP/OP	$103.73 	$76.76	$0.00	$82.98	$56.32	$56.32	$0.00	$0.00	$0.00	$0.00	$76.98	$76.98	$0.00	$0.00	$21.62	$0.00	$0.00	$0.00	$0.00	$51.86	$82.15	$82.98	$0.00		$0.00	$16.23	$0.00	$0.00	$16.51	$0.00	$0.00	$0.00	$0.00	$0.00
G14566	SUP	HCPCS C2627		G14566  -  DILATOR URTH 6FR 37CM SET PTFE FSCA	BOTH IP/OP	$90.20 	$66.75	$0.00	$72.16	$48.98	$48.98	$0.00	$0.00	$0.00	$0.00	$66.95	$66.95	$0.00	$0.00	$18.80	$0.00	$0.00	$0.00	$0.00	$45.10	$71.44	$72.16	$0.00		$0.00	$14.12	$0.00	$0.00	$14.36	$0.00	$0.00	$0.00	$0.00	$0.00
G14567	SUP	HCPCS C2627		G14567  -  DILATOR URTH 8FR 37CM SET PTFE FSCA	BOTH IP/OP	$90.20 	$66.75	$0.00	$72.16	$48.98	$48.98	$0.00	$0.00	$0.00	$0.00	$66.95	$66.95	$0.00	$0.00	$18.80	$0.00	$0.00	$0.00	$0.00	$45.10	$71.44	$72.16	$0.00		$0.00	$14.12	$0.00	$0.00	$14.36	$0.00	$0.00	$0.00	$0.00	$0.00
G14568	SUP	HCPCS C2627		G14568  -  DILATOR URTH 10FR 37CM SET TFE FSCA	BOTH IP/OP	$90.20 	$66.75	$0.00	$72.16	$48.98	$48.98	$0.00	$0.00	$0.00	$0.00	$66.95	$66.95	$0.00	$0.00	$18.80	$0.00	$0.00	$0.00	$0.00	$45.10	$71.44	$72.16	$0.00		$0.00	$14.12	$0.00	$0.00	$14.36	$0.00	$0.00	$0.00	$0.00	$0.00
G14569	SUP	HCPCS C2627		G14569  -  DILATOR URTH 12FR 37CM PTFE FSCA	BOTH IP/OP	$103.73 	$76.76	$0.00	$82.98	$56.32	$56.32	$0.00	$0.00	$0.00	$0.00	$76.98	$76.98	$0.00	$0.00	$21.62	$0.00	$0.00	$0.00	$0.00	$51.86	$82.15	$82.98	$0.00		$0.00	$16.23	$0.00	$0.00	$16.51	$0.00	$0.00	$0.00	$0.00	$0.00
G14570	SUP	HCPCS C2627		G14570  -  DILATOR URTH 14FR 37CM SET TFE FSCA	BOTH IP/OP	$103.73 	$76.76	$0.00	$82.98	$56.32	$56.32	$0.00	$0.00	$0.00	$0.00	$76.98	$76.98	$0.00	$0.00	$21.62	$0.00	$0.00	$0.00	$0.00	$51.86	$82.15	$82.98	$0.00		$0.00	$16.23	$0.00	$0.00	$16.51	$0.00	$0.00	$0.00	$0.00	$0.00
G14571	SUP	HCPCS C2627		G14571  -  DILATOR URTH 16FR 37CM SET PTFE FSCA	BOTH IP/OP	$103.73 	$76.76	$0.00	$82.98	$56.32	$56.32	$0.00	$0.00	$0.00	$0.00	$76.98	$76.98	$0.00	$0.00	$21.62	$0.00	$0.00	$0.00	$0.00	$51.86	$82.15	$82.98	$0.00		$0.00	$16.23	$0.00	$0.00	$16.51	$0.00	$0.00	$0.00	$0.00	$0.00
G14572	SUP	HCPCS C2627		G14572  -  DILATOR URTH 18FR 37CM SET PTFE FSCA	BOTH IP/OP	$721.05 	$533.58	$0.00	$576.84	$391.53	$391.53	$0.00	$0.00	$0.00	$0.00	$535.16	$535.16	$0.00	$0.00	$150.27	$0.00	$0.00	$0.00	$0.00	$360.53	$571.07	$576.84	$0.00		$0.00	$112.84	$0.00	$0.00	$114.79	$0.00	$0.00	$0.00	$0.00	$0.00
G14574	SUP	HCPCS C1769		G14574  -  DILATOR URET 6-18FR 37CM SET PTFE FSCA	BOTH IP/OP	$638.00 	$472.12	$0.00	$510.40	$346.43	$346.43	$0.00	$0.00	$0.00	$132.98	$473.52	$473.52	$0.00	$0.00	$132.96	$0.00	$377.38	$377.38	$0.00	$319.00	$505.30	$510.40	$0.00		$0.00	$99.85	$0.00	$0.00	$101.57	$0.00	$0.00	$0.00	$0.00	$0.00
G14575	SUP	HCPCS C2627		G14575  -  DILATOR URET 6-18FR 60CM SET GW LFRIC SRFC PTFE FSCA	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$53.76	$53.76	$0.00	$0.00	$0.00	$0.00	$73.48	$73.48	$0.00	$0.00	$20.63	$0.00	$0.00	$0.00	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$15.49	$0.00	$0.00	$15.76	$0.00	$0.00	$0.00	$0.00	$0.00
G14576	SUP	HCPCS C2627		G14576  -  DILATOR URET 6FR 60CM SET PTFE DISP	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$53.76	$53.76	$0.00	$0.00	$0.00	$0.00	$73.48	$73.48	$0.00	$0.00	$20.63	$0.00	$0.00	$0.00	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$15.49	$0.00	$0.00	$15.76	$0.00	$0.00	$0.00	$0.00	$0.00
G14577	SUP	HCPCS C2627		G14577  -  DILATOR URET 8FR 60CM SET PTFE FSCA	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$53.76	$53.76	$0.00	$0.00	$0.00	$0.00	$73.48	$73.48	$0.00	$0.00	$20.63	$0.00	$0.00	$0.00	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$15.49	$0.00	$0.00	$15.76	$0.00	$0.00	$0.00	$0.00	$0.00
G14578	SUP	HCPCS C2627		G14578  -  DILATOR URET 10FR 60CM SET PTFE DISP	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$53.76	$53.76	$0.00	$0.00	$0.00	$0.00	$73.48	$73.48	$0.00	$0.00	$20.63	$0.00	$0.00	$0.00	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$15.49	$0.00	$0.00	$15.76	$0.00	$0.00	$0.00	$0.00	$0.00
G14579	SUP	HCPCS C2627		G14579  -  DILATOR URET 12FR 60CM SET PTFE DISP	BOTH IP/OP	$113.85 	$84.25	$0.00	$91.08	$61.82	$61.82	$0.00	$0.00	$0.00	$0.00	$84.50	$84.50	$0.00	$0.00	$23.73	$0.00	$0.00	$0.00	$0.00	$56.93	$90.17	$91.08	$0.00		$0.00	$17.82	$0.00	$0.00	$18.12	$0.00	$0.00	$0.00	$0.00	$0.00
G14580	SUP	HCPCS C2627		G14580  -  DILATOR URET 14FR 60CM SET PTFE FSCA	BOTH IP/OP	$113.85 	$84.25	$0.00	$91.08	$61.82	$61.82	$0.00	$0.00	$0.00	$0.00	$84.50	$84.50	$0.00	$0.00	$23.73	$0.00	$0.00	$0.00	$0.00	$56.93	$90.17	$91.08	$0.00		$0.00	$17.82	$0.00	$0.00	$18.12	$0.00	$0.00	$0.00	$0.00	$0.00
G14581	SUP	HCPCS C2627		G14581  -  DILATOR URET 16FR 60CM SET TFE FSCA	BOTH IP/OP	$113.85 	$84.25	$0.00	$91.08	$61.82	$61.82	$0.00	$0.00	$0.00	$0.00	$84.50	$84.50	$0.00	$0.00	$23.73	$0.00	$0.00	$0.00	$0.00	$56.93	$90.17	$91.08	$0.00		$0.00	$17.82	$0.00	$0.00	$18.12	$0.00	$0.00	$0.00	$0.00	$0.00
G14587	SUP	HCPCS C1758		G14587  -  DILATOR URET 18FR 60CM SET PTFE FSCA	BOTH IP/OP	$72.60 	$53.72	$0.00	$58.08	$39.42	$39.42	$0.00	$0.00	$0.00	$15.13	$53.88	$53.88	$0.00	$0.00	$15.13	$0.00	$42.94	$42.94	$0.00	$36.30	$57.50	$58.08	$0.00		$0.00	$11.36	$0.00	$0.00	$11.56	$0.00	$0.00	$0.00	$0.00	$0.00
G14589	SUP	HCPCS C1769		G14589  -  CATHETER URET 20D .035IN TPR STRG 6FR 70CM 145CM GW	BOTH IP/OP	$52.08 	$38.54	$0.00	$41.66	$28.28	$28.28	$0.00	$0.00	$0.00	$10.85	$38.65	$38.65	$0.00	$0.00	$10.85	$0.00	$30.80	$30.80	$0.00	$26.04	$41.25	$41.66	$0.00		$0.00	$8.15	$0.00	$0.00	$8.29	$0.00	$0.00	$0.00	$0.00	$0.00
G14590	SUP	HCPCS C1769		G14590  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 15CM BNTSN FLX TP FX	BOTH IP/OP	$52.08 	$38.54	$0.00	$41.66	$28.28	$28.28	$0.00	$0.00	$0.00	$10.85	$38.65	$38.65	$0.00	$0.00	$10.85	$0.00	$30.80	$30.80	$0.00	$26.04	$41.25	$41.66	$0.00		$0.00	$8.15	$0.00	$0.00	$8.29	$0.00	$0.00	$0.00	$0.00	$0.00
G14592	SUP	HCPCS C1758		G14592  -  GUIDEWIRE VASC .035IN 145CM STRL 15CM BNTSN BNTSN FLX TP	BOTH IP/OP	$27.50 	$20.35	$0.00	$22.00	$14.93	$14.93	$0.00	$0.00	$0.00	$5.73	$20.41	$20.41	$0.00	$0.00	$5.73	$0.00	$16.27	$16.27	$0.00	$13.75	$21.78	$22.00	$0.00		$0.00	$4.30	$0.00	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$0.00
G14593	SUP	HCPCS C1758		G14593  -  CATHETER URET 4FR 70CM RND TIP STY LT	BOTH IP/OP	$27.50 	$20.35	$0.00	$22.00	$14.93	$14.93	$0.00	$0.00	$0.00	$5.73	$20.41	$20.41	$0.00	$0.00	$5.73	$0.00	$16.27	$16.27	$0.00	$13.75	$21.78	$22.00	$0.00		$0.00	$4.30	$0.00	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$0.00
G14595	SUP	HCPCS C1773		G14595  -  CATHETER URET 5FR 70CM RND TIP STY LT	BOTH IP/OP	$398.45 	$294.85	$0.00	$318.76	$216.36	$216.36	$0.00	$0.00	$0.00	$83.05	$295.73	$295.73	$0.00	$0.00	$83.04	$0.00	$235.68	$235.68	$0.00	$199.23	$315.57	$318.76	$0.00		$0.00	$62.36	$0.00	$0.00	$63.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14596	SUP	HCPCS C1773		G14596  -  FORCEPS SPEC RTRVL 3.2FR 10MM 65CM STRL 3WR GRSP COAX SHTH	BOTH IP/OP	$398.45 	$294.85	$0.00	$318.76	$216.36	$216.36	$0.00	$0.00	$0.00	$83.05	$295.73	$295.73	$0.00	$0.00	$83.04	$0.00	$235.68	$235.68	$0.00	$199.23	$315.57	$318.76	$0.00		$0.00	$62.36	$0.00	$0.00	$63.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14597	SUP	HCPCS C1758		G14597  -  FORCEPS ESCP 14MM 3.5FR 65CM STRL GRSP	BOTH IP/OP	$83.50 	$61.79	$0.00	$66.80	$45.34	$45.34	$0.00	$0.00	$0.00	$17.40	$61.97	$61.97	$0.00	$0.00	$17.40	$0.00	$49.39	$49.39	$0.00	$41.75	$66.13	$66.80	$0.00		$0.00	$13.07	$0.00	$0.00	$13.29	$0.00	$0.00	$0.00	$0.00	$0.00
G14598	SUP	HCPCS C1758		G14598  -  CATHETER URET 20D .028IN TPR STRG 4FR 70CM 145CM GW	BOTH IP/OP	$72.60 	$53.72	$0.00	$58.08	$39.42	$39.42	$0.00	$0.00	$0.00	$15.13	$53.88	$53.88	$0.00	$0.00	$15.13	$0.00	$42.94	$42.94	$0.00	$36.30	$57.50	$58.08	$0.00		$0.00	$11.36	$0.00	$0.00	$11.56	$0.00	$0.00	$0.00	$0.00	$0.00
G14599	SUP	HCPCS C1758		G14599  -  CATHETER URET 20D .035IN 5FR 70CM FLXB ANG TIP TPR END GW	BOTH IP/OP	$83.50 	$61.79	$0.00	$66.80	$45.34	$45.34	$0.00	$0.00	$0.00	$17.40	$61.97	$61.97	$0.00	$0.00	$17.40	$0.00	$49.39	$49.39	$0.00	$41.75	$66.13	$66.80	$0.00		$0.00	$13.07	$0.00	$0.00	$13.29	$0.00	$0.00	$0.00	$0.00	$0.00
G14600	SUP	HCPCS C1758		G14600  -  CATHETER URET 20D .028IN BVL STRG 4FR 70CM 145CM GW	BOTH IP/OP	$72.60 	$53.72	$0.00	$58.08	$39.42	$39.42	$0.00	$0.00	$0.00	$15.13	$53.88	$53.88	$0.00	$0.00	$15.13	$0.00	$42.94	$42.94	$0.00	$36.30	$57.50	$58.08	$0.00		$0.00	$11.36	$0.00	$0.00	$11.56	$0.00	$0.00	$0.00	$0.00	$0.00
G14606	SUP	HCPCS C2617		G14606  -  CATHETER URET 20D .035IN 5FR 70CM 145CM ANG TIP BVL END GW	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14608	SUP	HCPCS C1758		G14608  -  SET STNT .025IN 50CM SM 2 PGTL CRV STRG 3.7FR 26CM GRN STRL	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$179.19	$179.19	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
G14619	SUP	HCPCS C1769		G14619  -  TROCAR SRG STD 18GA 11CM DISP	BOTH IP/OP	$52.08 	$38.54	$0.00	$41.66	$28.28	$28.28	$0.00	$0.00	$0.00	$10.85	$38.65	$38.65	$0.00	$0.00	$10.85	$0.00	$30.80	$30.80	$0.00	$26.04	$41.25	$41.66	$0.00		$0.00	$8.15	$0.00	$0.00	$8.29	$0.00	$0.00	$0.00	$0.00	$0.00
G14631	SUP	HCPCS C1769		G14631  -  GUIDEWIRE ESCP .038IN 145CM STRL CNS BNTSN MOV COR SS PTFE	BOTH IP/OP	$71.38 	$52.82	$0.00	$57.10	$38.76	$38.76	$0.00	$0.00	$0.00	$14.88	$52.97	$52.97	$0.00	$0.00	$14.87	$0.00	$42.22	$42.22	$0.00	$35.69	$56.53	$57.10	$0.00		$0.00	$11.17	$0.00	$0.00	$11.36	$0.00	$0.00	$0.00	$0.00	$0.00
G14639	SUP	HCPCS C2617		G14639  -  GUIDEWIRE VASC STRG .038IN 145CM AMPTZ FLXB FXCR	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14650	SUP	HCPCS C2627		G14650  -  SET NPHSTM .038IN 22GA 18GA 80CM 20CM SFTJ 2 NDL ENTRY GW	BOTH IP/OP	$306.13 	$226.54	$0.00	$244.90	$166.23	$166.23	$0.00	$0.00	$0.00	$0.00	$227.21	$227.21	$0.00	$0.00	$63.80	$0.00	$0.00	$0.00	$0.00	$153.06	$242.45	$244.90	$0.00		$0.00	$47.91	$0.00	$0.00	$48.74	$0.00	$0.00	$0.00	$0.00	$0.00
G14658	SUP	HCPCS C1769		G14658  -  SET NPHSTM 300ML STRL 2 CNCT DRN PCH SFT ELC BELT REED VLV	BOTH IP/OP	$465.53 	$344.49	$0.00	$372.42	$252.78	$252.78	$0.00	$0.00	$0.00	$97.03	$345.51	$345.51	$0.00	$0.00	$97.02	$0.00	$275.36	$275.36	$0.00	$232.76	$368.70	$372.42	$0.00		$0.00	$72.85	$0.00	$0.00	$74.11	$0.00	$0.00	$0.00	$0.00	$0.00
G14659	SUP	HCPCS C1758		G14659  -  SET NPHSTM 8.2FR 19.5CM LTX COPE LOOP CATH NDL GW STPCK	BOTH IP/OP	$32.90 	$24.35	$0.00	$26.32	$17.86	$17.86	$0.00	$0.00	$0.00	$6.86	$24.42	$24.42	$0.00	$0.00	$6.86	$0.00	$19.46	$19.46	$0.00	$16.45	$26.06	$26.32	$0.00		$0.00	$5.15	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$0.00
G14663	SUP	HCPCS C1758		G14663  -  CATHETER URETERAL 4.8FR 8FR 70CM CONE TIP	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G14665	SUP	HCPCS C1758		G14665  -  CATHETER URET .038IN 5FR 70CM FLXTP OP-EN GW MOD	BOTH IP/OP	$27.63 	$20.45	$0.00	$221.00	$150.00	$150.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$138.13	$218.79	$221.00	$0.00		$0.00	$43.23	$0.00	$0.00	$43.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14667	SUP	HCPCS C1758		G14667  -  CATHETER URETERAL CONE 7FR 12FR 70CM	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G14669	SUP	HCPCS C1758		G14669  -  CATHETER URET 6FR 10FR 70CM CONE TIP	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G14671	SUP	HCPCS C1758		G14671  -  CATHETER URET 8FR 14FR 70CM CONE TIP	BOTH IP/OP	$3.29 	$2.43	$0.00	$2.63	$1.79	$1.79	$0.00	$0.00	$0.00	$0.69	$2.44	$2.44	$0.00	$0.00	$0.69	$0.00	$1.95	$1.95	$0.00	$1.65	$2.61	$2.63	$0.00		$0.00	$0.51	$0.00	$0.00	$0.52	$0.00	$0.00	$0.00	$0.00	$0.00
G14674	SUP	HCPCS C1773		G14674  -  CATHETER URET 5FR 70CM ANG TIP TPR END MOD	BOTH IP/OP	$313.45 	$231.95	$0.00	$250.76	$170.20	$170.20	$0.00	$0.00	$0.00	$65.33	$232.64	$232.64	$0.00	$0.00	$65.32	$0.00	$185.41	$185.41	$0.00	$156.73	$248.25	$250.76	$0.00		$0.00	$49.05	$0.00	$0.00	$49.90	$0.00	$0.00	$0.00	$0.00	$0.00
G14676	SUP	Custom 27203010		G14676  -  FORCEPS GRASPING 10MM 3.2FR 115MM COAXIAL SHEATH HANDLE	BOTH IP/OP	$398.45 	$294.85	$0.00	$318.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.73	$295.73	$0.00	$0.00	$83.04	$0.00	$0.00	$0.00	$0.00	$199.23	$315.57	$318.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14677	SUP	HCPCS C1773		G14677  -  RETRIEVER SRG 3FR 115CM STRL FLTWR LOOP URET	BOTH IP/OP	$398.45 	$294.85	$0.00	$318.76	$216.36	$216.36	$0.00	$0.00	$0.00	$83.05	$295.73	$295.73	$0.00	$0.00	$83.04	$0.00	$235.68	$235.68	$0.00	$199.23	$315.57	$318.76	$0.00		$0.00	$62.36	$0.00	$0.00	$63.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14681	SUP	Custom 27203010		G14681  -  SYRINGE ASP 5ML VAC	BOTH IP/OP	$604.00 	$446.96	$0.00	$483.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$448.29	$448.29	$0.00	$0.00	$125.87	$0.00	$0.00	$0.00	$0.00	$302.00	$478.37	$483.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14685	SUP	HCPCS C1769		G14685  -  DEVICE SPEC RTRVL 5CM 5MM 5FR 4CM 65CM RTNR 3WR STON HLCL	BOTH IP/OP	$52.08 	$38.54	$0.00	$41.66	$28.28	$28.28	$0.00	$0.00	$0.00	$10.85	$38.65	$38.65	$0.00	$0.00	$10.85	$0.00	$30.80	$30.80	$0.00	$26.04	$41.25	$41.66	$0.00		$0.00	$8.15	$0.00	$0.00	$8.29	$0.00	$0.00	$0.00	$0.00	$0.00
G14686	SUP	HCPCS C1758		G14686  -  GUIDEWIRE VASC .035IN 145CM CNS BNTSN MOV COR DSGN FLXB	BOTH IP/OP	$27.50 	$20.35	$0.00	$22.00	$14.93	$14.93	$0.00	$0.00	$0.00	$5.73	$20.41	$20.41	$0.00	$0.00	$5.73	$0.00	$16.27	$16.27	$0.00	$13.75	$21.78	$22.00	$0.00		$0.00	$4.30	$0.00	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$0.00
G14687	SUP	HCPCS C1758		G14687  -  CATHETER URET 4FR 70CM RND TIP STY RT	BOTH IP/OP	$27.50 	$20.35	$0.00	$22.00	$14.93	$14.93	$0.00	$0.00	$0.00	$5.73	$20.41	$20.41	$0.00	$0.00	$5.73	$0.00	$16.27	$16.27	$0.00	$13.75	$21.78	$22.00	$0.00		$0.00	$4.30	$0.00	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$0.00
G14688	SUP	HCPCS C1894		G14688  -  CATHETER URET 5FR 70CM RND TIP STY LT	BOTH IP/OP	$86.90 	$64.31	$0.00	$69.52	$47.19	$47.19	$0.00	$0.00	$0.00	$18.11	$64.50	$64.50	$0.00	$0.00	$18.11	$0.00	$51.40	$51.40	$0.00	$43.45	$68.82	$69.52	$0.00		$0.00	$13.60	$0.00	$0.00	$13.83	$0.00	$0.00	$0.00	$0.00	$0.00
G14693	SUP	HCPCS C1769		G14693  -  STRAINER SPEC NS STON DISP	BOTH IP/OP	$1.40 	$1.04	$0.00	$1.12	$0.76	$0.76	$0.00	$0.00	$0.00	$0.29	$1.04	$1.04	$0.00	$0.00	$0.29	$0.00	$0.83	$0.83	$0.00	$0.70	$1.11	$1.12	$0.00		$0.00	$0.22	$0.00	$0.00	$0.22	$0.00	$0.00	$0.00	$0.00	$0.00
G14694	SUP	HCPCS C1729		G14694  -  GUIDEWIRE VASC .035IN 145CM 8CM AMPTZ FLX TP XSTIF SS	BOTH IP/OP	$188.10 	$139.19	$0.00	$150.48	$102.14	$102.14	$0.00	$0.00	$0.00	$39.20	$139.61	$139.61	$0.00	$0.00	$39.20	$0.00	$111.26	$111.26	$0.00	$94.05	$148.98	$150.48	$0.00		$0.00	$29.44	$0.00	$0.00	$29.95	$0.00	$0.00	$0.00	$0.00	$0.00
G14700	SUP	HCPCS C2617		G14700  -  CATHETER NPHSTM 8.2FR 19.5CM STRL LTX COPE LOOP CNN PERC	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14705	SUP	HCPCS C1729		G14705  -  SET STNT .025IN SM 2 PGTL CRV STRG 3.7FR 14CM GRN STRL 70CM	BOTH IP/OP	$188.10 	$139.19	$0.00	$150.48	$102.14	$102.14	$0.00	$0.00	$0.00	$39.20	$139.61	$139.61	$0.00	$0.00	$39.20	$0.00	$111.26	$111.26	$0.00	$94.05	$148.98	$150.48	$0.00		$0.00	$29.44	$0.00	$0.00	$29.95	$0.00	$0.00	$0.00	$0.00	$0.00
G14706	SUP	HCPCS C1758		G14706  -  SET NPHSTM 12FR 19.5CM CK CNN GW COPE TY LOOP	BOTH IP/OP	$32.90 	$24.35	$0.00	$26.32	$17.86	$17.86	$0.00	$0.00	$0.00	$6.86	$24.42	$24.42	$0.00	$0.00	$6.86	$0.00	$19.46	$19.46	$0.00	$16.45	$26.06	$26.32	$0.00		$0.00	$5.15	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$0.00
G14714	SUP	HCPCS C1729		G14714  -  CATHETER URET 6FR 70CM ANG TIP TPR END	BOTH IP/OP	$404.80 	$299.55	$0.00	$323.84	$219.81	$219.81	$0.00	$0.00	$0.00	$84.37	$300.44	$300.44	$0.00	$0.00	$84.36	$0.00	$239.44	$239.44	$0.00	$202.40	$320.60	$323.84	$0.00		$0.00	$63.35	$0.00	$0.00	$64.44	$0.00	$0.00	$0.00	$0.00	$0.00
G14717	SUP	HCPCS C1758		G14717  -  SET NPHSTM THNWL 12FR 21GA 19.5CM STRL 15CM COPE LOOP 1 WY	BOTH IP/OP	$28.60 	$21.16	$0.00	$22.88	$15.53	$15.53	$0.00	$0.00	$0.00	$5.96	$21.23	$21.23	$0.00	$0.00	$5.96	$0.00	$16.92	$16.92	$0.00	$14.30	$22.65	$22.88	$0.00		$0.00	$4.48	$0.00	$0.00	$4.55	$0.00	$0.00	$0.00	$0.00	$0.00
G14731	SUP	HCPCS C1769		G14731  -  CATHETER URET 4.8FR 8FR 70CM CONE TIP OP-EN	BOTH IP/OP	$3.38 	$2.50	$0.00	$2.70	$1.84	$1.84	$0.00	$0.00	$0.00	$0.70	$2.51	$2.51	$0.00	$0.00	$0.70	$0.00	$2.00	$2.00	$0.00	$1.69	$2.68	$2.70	$0.00		$0.00	$0.53	$0.00	$0.00	$0.54	$0.00	$0.00	$0.00	$0.00	$0.00
G14732	SUP	Custom 27203010		G14732  -  GUIDEWIRE URO STD STRG .038IN 145CM STRL LF 3CM FX COR FLX	BOTH IP/OP	$61.25 	$45.33	$0.00	$49.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.46	$45.46	$0.00	$0.00	$12.76	$0.00	$0.00	$0.00	$0.00	$30.63	$48.51	$49.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14738	SUP	HCPCS C1758		G14738  -  ADAPTER CATH Y 3-6FR M LL SDARM T-B	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14742	SUP	HCPCS C2617		G14742  -  FILIFORM URTH 7FR 10IN MLBL TIP THRD	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14744	SUP	Custom 27203010		G14744  -  SET STNT .035IN 70CM SM 2 PGTL CRV STRG 3.7FR 24CM GRN STRL	BOTH IP/OP	$366.85 	$271.47	$0.00	$293.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.28	$272.28	$0.00	$0.00	$76.45	$0.00	$0.00	$0.00	$0.00	$183.43	$290.55	$293.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14748	SUP	Custom 27203010		G14748  -  ADAPTER CATHETER 3-6FR FOLEY SIDEARM TUOHY-BORST STERILE	BOTH IP/OP	$50.60 	$37.44	$0.00	$40.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.56	$37.56	$0.00	$0.00	$10.55	$0.00	$0.00	$0.00	$0.00	$25.30	$40.08	$40.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14772	SUP	HCPCS C1729		G14772  -  DISK RTNT 12FR STAB INDWL PERC CATH TIE	BOTH IP/OP	$185.90 	$137.57	$0.00	$148.72	$100.94	$100.94	$0.00	$0.00	$0.00	$38.75	$137.97	$137.97	$0.00	$0.00	$38.74	$0.00	$109.96	$109.96	$0.00	$92.95	$147.23	$148.72	$0.00		$0.00	$29.09	$0.00	$0.00	$29.60	$0.00	$0.00	$0.00	$0.00	$0.00
G14779	SUP	HCPCS C2625		G14779  -  SET NPHSTM 7-12FR 30CM 20CM MLCT CATH STNT LL CNCT TUBE STY	BOTH IP/OP	$139.40 	$103.16	$0.00	$111.52	$62.73	$62.73	$0.00	$0.00	$0.00	$29.05	$103.46	$103.46	$0.00	$0.00	$29.05	$0.00	$82.46	$82.46	$0.00	$69.70	$110.40	$111.52	$0.00		$0.00	$21.82	$0.00	$0.00	$22.19	$0.00	$0.00	$0.00	$0.00	$0.00
G14780	SUP	HCPCS C2617		G14780  -  SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100CM BNDR CATH	BOTH IP/OP	$139.40 	$103.16	$0.00	$111.52	$62.73	$62.73	$0.00	$0.00	$0.00	$29.05	$103.46	$103.46	$0.00	$0.00	$29.05	$0.00	$82.46	$82.46	$0.00	$69.70	$110.40	$111.52	$0.00		$0.00	$21.82	$0.00	$0.00	$22.19	$0.00	$0.00	$0.00	$0.00	$0.00
G14782	SUP	HCPCS C1769		G14782  -  SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100CM BNDR CATH	BOTH IP/OP	$404.80 	$299.55	$0.00	$323.84	$219.81	$219.81	$0.00	$0.00	$0.00	$84.37	$300.44	$300.44	$0.00	$0.00	$84.36	$0.00	$239.44	$239.44	$0.00	$202.40	$320.60	$323.84	$0.00		$0.00	$63.35	$0.00	$0.00	$64.44	$0.00	$0.00	$0.00	$0.00	$0.00
G14787	SUP	HCPCS C2617		G14787  -  DILATOR URET 7FR 6MM 65CM 4CM SET BLN RADOPQ GW	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14788	SUP	HCPCS C2617		G14788  -  SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 16CM STRL 145CM	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14789	SUP	HCPCS C2617		G14789  -  SET STNT .038IN 40CM J 2 PGTL CRV STRG 10FR 10FR 26CM STRL	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14790	SUP	HCPCS C2617		G14790  -  SET STNT .038IN 40CM J 2 PGTL CRV STRG 10FR 10FR 24CM STRL	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14791	SUP	HCPCS C2628		G14791  -  CATHETER BLNOCC 5.3FR 75CM STRL REM ADPR RADOPQ SIL UPJ DISP	BOTH IP/OP	$319.00 	$236.06	$0.00	$255.20	$0.00	$0.00	$0.00	$0.00	$0.00	$66.49	$236.76	$236.76	$0.00	$0.00	$66.48	$0.00	$188.69	$188.69	$0.00	$159.50	$252.65	$255.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14794	SUP	HCPCS C2617		G14794  -  SET STNT .038IN 40CM J 2 PGTL CRV STRG 10FR 10FR 22CM STRL	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14796	SUP	HCPCS C2627		G14796  -  SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 8CM STRL 145CM	BOTH IP/OP	$36.70 	$27.16	$0.00	$29.36	$19.93	$19.93	$0.00	$0.00	$0.00	$0.00	$27.24	$27.24	$0.00	$0.00	$7.65	$0.00	$0.00	$0.00	$0.00	$18.35	$29.07	$29.36	$0.00		$0.00	$5.74	$0.00	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$0.00
G14798	SUP	HCPCS C1758		G14798  -  DILATOR URTH 11FR 20CM PE FSCA	BOTH IP/OP	$28.60 	$21.16	$0.00	$22.88	$15.53	$15.53	$0.00	$0.00	$0.00	$5.96	$21.23	$21.23	$0.00	$0.00	$5.96	$0.00	$16.92	$16.92	$0.00	$14.30	$22.65	$22.88	$0.00		$0.00	$4.48	$0.00	$0.00	$4.55	$0.00	$0.00	$0.00	$0.00	$0.00
G14799	SUP	HCPCS C2617		G14799  -  CATHETER URET 5FR 110CM FLXTP CLS END RT	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14803	SUP	HCPCS C1758		G14803  -  SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 18CM STRL 145CM	BOTH IP/OP	$123.83 	$91.63	$0.00	$99.06	$67.24	$67.24	$0.00	$0.00	$0.00	$25.81	$91.90	$91.90	$0.00	$0.00	$25.81	$0.00	$73.24	$73.24	$0.00	$61.91	$98.07	$99.06	$0.00		$0.00	$19.38	$0.00	$0.00	$19.71	$0.00	$0.00	$0.00	$0.00	$0.00
G14804	SUP	HCPCS C1758		G14804  -  CATHETER URET .045IN PGTL CRV 8FR 70CM SDPRT GW RT	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14808	SUP	HCPCS C1758		G14808  -  CATHETER URET .038IN 5FR 115CM OP-EN GW MOD	BOTH IP/OP	$276.25 	$204.43	$0.00	$221.00	$150.00	$150.00	$0.00	$0.00	$0.00	$57.58	$205.03	$205.03	$0.00	$0.00	$57.57	$0.00	$163.40	$163.40	$0.00	$138.13	$218.79	$221.00	$0.00		$0.00	$43.23	$0.00	$0.00	$43.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14809	SUP	HCPCS C1758		G14809  -  CATHETER URET STD 6FR 70CM FLXTP OP-EN FLX TP ACPT .038IN GW	BOTH IP/OP	$27.63 	$20.45	$0.00	$22.10	$15.00	$15.00	$0.00	$0.00	$0.00	$5.76	$20.50	$20.50	$0.00	$0.00	$5.76	$0.00	$16.34	$16.34	$0.00	$13.81	$21.88	$22.10	$0.00		$0.00	$4.32	$0.00	$0.00	$4.40	$0.00	$0.00	$0.00	$0.00	$0.00
G14822	SUP	HCPCS C2625		G14822  -  CATHETER URET 3FR 70CM OP-EN ACPT .018IN GW	BOTH IP/OP	$139.40 	$103.16	$0.00	$111.52	$62.73	$62.73	$0.00	$0.00	$0.00	$29.05	$103.46	$103.46	$0.00	$0.00	$29.05	$0.00	$82.46	$82.46	$0.00	$69.70	$110.40	$111.52	$0.00		$0.00	$21.82	$0.00	$0.00	$22.19	$0.00	$0.00	$0.00	$0.00	$0.00
G14823	SUP	HCPCS C2625		G14823  -  SET STNT .038IN 5MM PGTL CRV 7FR 70CM WHT STRL 145CM BNDR	BOTH IP/OP	$139.40 	$103.16	$0.00	$111.52	$62.73	$62.73	$0.00	$0.00	$0.00	$29.05	$103.46	$103.46	$0.00	$0.00	$29.05	$0.00	$82.46	$82.46	$0.00	$69.70	$110.40	$111.52	$0.00		$0.00	$21.82	$0.00	$0.00	$22.19	$0.00	$0.00	$0.00	$0.00	$0.00
G14832	SUP	HCPCS C2617		G14832  -  SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 4FR 12CM STRL CP	BOTH IP/OP	$253.25 	$187.41	$0.00	$202.60	$113.96	$113.96	$0.00	$0.00	$0.00	$52.78	$187.96	$187.96	$0.00	$0.00	$52.78	$0.00	$149.80	$149.80	$0.00	$126.63	$200.57	$202.60	$0.00		$0.00	$39.63	$0.00	$0.00	$40.32	$0.00	$0.00	$0.00	$0.00	$0.00
G14834	SUP	HCPCS C2617		G14834  -  SET STNT .038IN 5MM PGTL CRV 7FR 70CM WHT STRL 145CM BNDR	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14836	SUP	HCPCS C2625		G14836  -  SET STNT SM 2 PGTL CRV 3.7FR AST LGTH STRL CATH RADOPQ PSTNR	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14837	SUP	HCPCS C2625		G14837  -  SET STNT .038IN 3CM 40CM 70CM 6FR 22-32CM STRL 145CM KWART	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14840	SUP	HCPCS C2617		G14840  -  SET STNT .038IN 3CM 40CM 70CM .038IN 7FR 22-32CM STRL 145CM	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14843	SUP	HCPCS C2617		G14843  -  SET STNT .018IN SM 2 PGTL CRV 4.7FR 4FR 16CM STRL CP MDRL	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14844	SUP	HCPCS C2625		G14844  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 12FR 12FR 26CM STRL 145	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14854	SUP	HCPCS C2617		G14854  -  SET STNT .038IN 8.2FR 22-32CM STRL KWART RETRO-INJ STNT	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14857	SUP	HCPCS C1758		G14857  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 12FR 12FR 24CM STRL 145	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14859	SUP	HCPCS C2627		G14859  -  CATHETER URET .038IN 5FR 95CM OP-EN GW MOD	BOTH IP/OP	$66.43 	$49.16	$0.00	$53.14	$36.07	$36.07	$0.00	$0.00	$0.00	$0.00	$49.30	$49.30	$0.00	$0.00	$13.84	$0.00	$0.00	$0.00	$0.00	$33.21	$52.61	$53.14	$0.00		$0.00	$10.40	$0.00	$0.00	$10.57	$0.00	$0.00	$0.00	$0.00	$0.00
G14861	SUP	HCPCS C2627		G14861  -  DILATOR URTH 26FR 20CM PE FSCA	BOTH IP/OP	$66.43 	$49.16	$0.00	$53.14	$36.07	$36.07	$0.00	$0.00	$0.00	$0.00	$49.30	$49.30	$0.00	$0.00	$13.84	$0.00	$0.00	$0.00	$0.00	$33.21	$52.61	$53.14	$0.00		$0.00	$10.40	$0.00	$0.00	$10.57	$0.00	$0.00	$0.00	$0.00	$0.00
G14865	SUP	HCPCS C2617		G14865  -  DILATOR URTH 30FR 20CM PE FSCA	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14866	SUP	HCPCS C2617		G14866  -  SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 16CM STRL CP MDRL	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14867	SUP	HCPCS C2617		G14867  -  SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 14CM STRL CP MDRL	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14870	SUP	HCPCS C1758		G14870  -  SET STNT .018IN SM 2 PGTL CRV 6FR 4FR 12CM STRL CP MDRL	BOTH IP/OP	$36.70 	$27.16	$0.00	$29.36	$19.93	$19.93	$0.00	$0.00	$0.00	$7.65	$27.24	$27.24	$0.00	$0.00	$7.65	$0.00	$21.71	$21.71	$0.00	$18.35	$29.07	$29.36	$0.00		$0.00	$5.74	$0.00	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$0.00
G14873	SUP	HCPCS C1758		G14873  -  CATHETER URET 3.8FR 70CM LSR	BOTH IP/OP	$276.25 	$204.43	$0.00	$221.00	$150.00	$150.00	$0.00	$0.00	$0.00	$57.58	$205.03	$205.03	$0.00	$0.00	$57.57	$0.00	$163.40	$163.40	$0.00	$138.13	$218.79	$221.00	$0.00		$0.00	$43.23	$0.00	$0.00	$43.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14885	SUP	HCPCS C2625		G14885  -  SET STNT 3CM 6FR 22CM STRL 145CM KWART RETRO-INJ RADOPQ	BOTH IP/OP	$300.60 	$222.44	$0.00	$240.48	$135.27	$135.27	$0.00	$0.00	$0.00	$62.65	$223.11	$223.11	$0.00	$0.00	$62.65	$0.00	$177.80	$177.80	$0.00	$150.30	$238.08	$240.48	$0.00		$0.00	$47.04	$0.00	$0.00	$47.86	$0.00	$0.00	$0.00	$0.00	$0.00
G14886	SUP	HCPCS C2625		G14886  -  CATHETER URET 5FR 70CM SPRL TIP SDPRT ACC ACPT .038IN GW	BOTH IP/OP	$26.14 	$19.34	$0.00	$20.91	$11.76	$11.76	$0.00	$0.00	$0.00	$5.45	$19.40	$19.40	$0.00	$0.00	$5.45	$0.00	$15.46	$15.46	$0.00	$13.07	$20.70	$20.91	$0.00		$0.00	$4.09	$0.00	$0.00	$4.16	$0.00	$0.00	$0.00	$0.00	$0.00
G14887	SUP	HCPCS C2625		G14887  -  SET STNT .038IN 2 PGTL CRV 6FR 26CM STRL KWART RETRO-INJ	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14890	SUP	HCPCS C1758		G14890  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 6FR 24CM STRL 145	BOTH IP/OP	$36.70 	$27.16	$0.00	$29.36	$19.93	$19.93	$0.00	$0.00	$0.00	$7.65	$27.24	$27.24	$0.00	$0.00	$7.65	$0.00	$21.71	$21.71	$0.00	$18.35	$29.07	$29.36	$0.00		$0.00	$5.74	$0.00	$0.00	$5.84	$0.00	$0.00	$0.00	$0.00	$0.00
G14891	SUP	HCPCS C2627		G14891  -  SET CATH 16FR 25CM SET SPBC STM MLCT	BOTH IP/OP	$95.63 	$70.77	$0.00	$76.50	$51.92	$51.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.81	$75.74	$76.50	$0.00		$0.00	$14.97	$0.00	$0.00	$15.22	$0.00	$0.00	$0.00	$0.00	$0.00
G14893	SUP	HCPCS C1894		G14893  -  CATHETER URET 3FR 70CM LSR ACPT .010IN GW	BOTH IP/OP	$451.00 	$333.74	$0.00	$360.80	$244.89	$244.89	$0.00	$0.00	$0.00	$94.00	$334.73	$334.73	$0.00	$0.00	$93.99	$0.00	$266.77	$266.77	$0.00	$225.50	$357.19	$360.80	$0.00		$0.00	$70.58	$0.00	$0.00	$71.80	$0.00	$0.00	$0.00	$0.00	$0.00
G14897	SUP	HCPCS C2617		G14897  -  DILATOR URTH RING 8-26FR 50CM LTX RADOPQ PTFE TRQ GW RADOPQ	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14898	SUP	HCPCS C2617		G14898  -  SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 22CM STRL 145CM	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14900	SUP	Custom 27203010		G14900  -  SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 4FR 14CM STRL CP	BOTH IP/OP	$26.58 	$19.67	$0.00	$21.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.72	$19.72	$0.00	$0.00	$5.54	$0.00	$0.00	$0.00	$0.00	$13.29	$21.05	$21.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14905	SUP	HCPCS C2625		G14905  -  DEVICE SCR 16FR STRL RTNT DISK SIL DISP ACPT 16FR	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14906	SUP	HCPCS C2617		G14906  -  SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 10CM STRL RADOPQ	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14910	SUP	HCPCS C2625		G14910  -  SET STNT .038IN 2 PGTL CRV 6FR 28CM STRL KWART RETRO-INJ	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14911	SUP	HCPCS C2625		G14911  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 7FR 26CM STRL 145	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14912	SUP	HCPCS C2625		G14912  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV 7FR 24CM STRL 145CM	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14916	SUP	HCPCS C2625		G14916  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 7FR 28CM STRL 145	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14917	SUP	HCPCS C1729		G14917  -  SET STNT .038IN 3CM 40CM 70CM STRG 4.7FR 22-32CM STRL 145CM	BOTH IP/OP	$404.80 	$299.55	$0.00	$323.84	$219.81	$219.81	$0.00	$0.00	$0.00	$84.37	$300.44	$300.44	$0.00	$0.00	$84.36	$0.00	$239.44	$239.44	$0.00	$202.40	$320.60	$323.84	$0.00		$0.00	$63.35	$0.00	$0.00	$64.44	$0.00	$0.00	$0.00	$0.00	$0.00
G14919	SUP	Custom 27203010		G14919  -  SET NPHSTM .038IN THNWL CRV 14FR 19.5CM STRL 30CM COPE LOOP	BOTH IP/OP	$185.60 	$137.34	$0.00	$148.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.75	$137.75	$0.00	$0.00	$38.68	$0.00	$0.00	$0.00	$0.00	$92.80	$147.00	$148.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G14920	SUP	HCPCS C2627		G14920  -  BRUSH CYTO 3.2FR 115CM BX SET STRG TIP OCL URET	BOTH IP/OP	$144.10 	$106.63	$0.00	$115.28	$78.25	$78.25	$0.00	$0.00	$0.00	$0.00	$106.95	$106.95	$0.00	$0.00	$30.03	$0.00	$0.00	$0.00	$0.00	$72.05	$114.13	$115.28	$0.00		$0.00	$22.55	$0.00	$0.00	$22.94	$0.00	$0.00	$0.00	$0.00	$0.00
G14921	SUP	HCPCS C1773		G14921  -  GUIDEWIRE ESCP .035IN 145CM 3CM FLX TP STD BD SS URET	BOTH IP/OP	$664.55 	$491.77	$0.00	$531.64	$360.85	$360.85	$0.00	$0.00	$0.00	$138.51	$493.23	$493.23	$0.00	$0.00	$138.49	$0.00	$393.08	$393.08	$0.00	$332.28	$526.32	$531.64	$0.00		$0.00	$104.00	$0.00	$0.00	$105.80	$0.00	$0.00	$0.00	$0.00	$0.00
G14922	SUP	HCPCS C1773		G14922  -  SET CATH 16FR 14FR 22CM 3CC LTX 30CM RTNR BLN NDL OBT CNCT	BOTH IP/OP	$664.55 	$491.77	$0.00	$531.64	$360.85	$360.85	$0.00	$0.00	$0.00	$138.51	$493.23	$493.23	$0.00	$0.00	$138.49	$0.00	$393.08	$393.08	$0.00	$332.28	$526.32	$531.64	$0.00		$0.00	$104.00	$0.00	$0.00	$105.80	$0.00	$0.00	$0.00	$0.00	$0.00
G14925	SUP	HCPCS C1758		G14925  -  FORCEPS SPEC RTRVL 3.3FR 115CM STRL 1 JAW STON FLXB SHFT	BOTH IP/OP	$32.90 	$24.35	$0.00	$26.32	$17.86	$17.86	$0.00	$0.00	$0.00	$6.86	$24.42	$24.42	$0.00	$0.00	$6.86	$0.00	$19.46	$19.46	$0.00	$16.45	$26.06	$26.32	$0.00		$0.00	$5.15	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$0.00
G14935	SUP	HCPCS C1773		G14935  -  CATHETER URET STD 8FR 70CM PLLK OP-EN FLX TP ACPT .038IN GW	BOTH IP/OP	$664.55 	$491.77	$0.00	$531.64	$360.85	$360.85	$0.00	$0.00	$0.00	$138.51	$493.23	$493.23	$0.00	$0.00	$138.49	$0.00	$393.08	$393.08	$0.00	$332.28	$526.32	$531.64	$0.00		$0.00	$104.00	$0.00	$0.00	$105.80	$0.00	$0.00	$0.00	$0.00	$0.00
G14936	SUP	HCPCS C1773		G14936  -  FORCEPS SPEC RTRVL 3.3FR 65CM STRL LF ALGTR TTH FLXB SHFT	BOTH IP/OP	$764.25 	$565.55	$0.00	$611.40	$414.99	$414.99	$0.00	$0.00	$0.00	$159.29	$567.23	$567.23	$0.00	$0.00	$159.27	$0.00	$452.05	$452.05	$0.00	$382.13	$605.29	$611.40	$0.00		$0.00	$119.61	$0.00	$0.00	$121.67	$0.00	$0.00	$0.00	$0.00	$0.00
G14938	SUP	HCPCS C1758		G14938  -  FORCEPS SPEC RTRVL 3.3FR 65CM 1 JAW RAT TTH URO	BOTH IP/OP	$28.60 	$21.16	$0.00	$22.88	$15.53	$15.53	$0.00	$0.00	$0.00	$5.96	$21.23	$21.23	$0.00	$0.00	$5.96	$0.00	$16.92	$16.92	$0.00	$14.30	$22.65	$22.88	$0.00		$0.00	$4.48	$0.00	$0.00	$4.55	$0.00	$0.00	$0.00	$0.00	$0.00
G14941	SUP	HCPCS C1758		G14941  -  CATHETER URET .038IN 5FR 70CM PLLK OP-EN GW MOD FLX TP	BOTH IP/OP	$28.60 	$21.16	$0.00	$22.88	$15.53	$15.53	$0.00	$0.00	$0.00	$5.96	$21.23	$21.23	$0.00	$0.00	$5.96	$0.00	$16.92	$16.92	$0.00	$14.30	$22.65	$22.88	$0.00		$0.00	$4.48	$0.00	$0.00	$4.55	$0.00	$0.00	$0.00	$0.00	$0.00
G14943	SUP	HCPCS C2617		G14943  -  CATHETER URET SPRL 6FR 70CM LG SDPRT ACPT .038IN GW	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14951	SUP	HCPCS C2617		G14951  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 12FR 22CM STRL 145CM	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14952	SUP	HCPCS C1758		G14952  -  SET STNT .018IN SM 2 PGTL CRV CDE 7FR 4FR 12CM STRL CP MDRL	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14955	SUP	HCPCS C2625		G14955  -  CATHETER URET 5FR 70CM WHSTLTP MOD	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G14975	SUP	HCPCS C1769		G14975  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 4.7FR 24CM STRL	BOTH IP/OP	$69.98 	$51.79	$0.00	$55.98	$38.00	$38.00	$0.00	$0.00	$0.00	$14.58	$51.94	$51.94	$0.00	$0.00	$14.58	$0.00	$41.39	$41.39	$0.00	$34.99	$55.42	$55.98	$0.00		$0.00	$10.95	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
G14980	SUP	HCPCS C1758		G14980  -  GUIDEWIRE URO .035IN 145CM 8CM AMPTZ STRG FLX TP SS	BOTH IP/OP	$109.48 	$81.02	$0.00	$87.58	$59.44	$59.44	$0.00	$0.00	$0.00	$22.82	$81.25	$81.25	$0.00	$0.00	$22.81	$0.00	$64.75	$64.75	$0.00	$54.74	$86.71	$87.58	$0.00		$0.00	$17.13	$0.00	$0.00	$17.43	$0.00	$0.00	$0.00	$0.00	$0.00
G14991	SUP	HCPCS C2617		G14991  -  SET CATH .038IN PGTL CRV 7FR 90CM STRL 145CM PSTNR SDPRT GW	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G14992	SUP	HCPCS C2617		G14992  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 10FR 28CM STRL 145CM	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15000	SUP	HCPCS C2617		G15000  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 10FR 20CM STRL 145CM	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15003	SUP	HCPCS C2617		G15003  -  SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 8CM STRL CP MDRL	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15015	SUP	HCPCS C2625		G15015  -  SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 10CM STRL CP MDRL	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G15016	SUP	HCPCS C2625		G15016  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 8.2FR 24CM STRL	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G15020	SUP	HCPCS C1758		G15020  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 4.7FR 26CM STRL	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$6.65	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$18.87	$18.87	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G15030	SUP	Custom 27203010		G15030  -  CATHETER URET 3FR 115CM LSR FBR HNDL	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$0.00	$0.00	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15034	SUP	HCPCS C1729		G15034  -  ADAPTER CATH 14FR 15CM GOLDBERG FL DRN BG URET	BOTH IP/OP	$155.60 	$115.14	$0.00	$124.48	$84.49	$84.49	$0.00	$0.00	$0.00	$32.43	$115.49	$115.49	$0.00	$0.00	$32.43	$0.00	$92.04	$92.04	$0.00	$77.80	$123.24	$124.48	$0.00		$0.00	$24.35	$0.00	$0.00	$24.77	$0.00	$0.00	$0.00	$0.00	$0.00
G15035	SUP	HCPCS C1729		G15035  -  SET NPHSTM PGTL CRV 8.2FR 15CM 5CM MOD CATH STNT CNCT TUBE	BOTH IP/OP	$155.60 	$115.14	$0.00	$124.48	$84.49	$84.49	$0.00	$0.00	$0.00	$32.43	$115.49	$115.49	$0.00	$0.00	$32.43	$0.00	$92.04	$92.04	$0.00	$77.80	$123.24	$124.48	$0.00		$0.00	$24.35	$0.00	$0.00	$24.77	$0.00	$0.00	$0.00	$0.00	$0.00
G15037	SUP	HCPCS C1758		G15037  -  SET NPHSTM PGTL CRV 8.2FR 15CM 7CM MOD CATH STNT CNCT TUBE	BOTH IP/OP	$32.90 	$24.35	$0.00	$26.32	$17.86	$17.86	$0.00	$0.00	$0.00	$6.86	$24.42	$24.42	$0.00	$0.00	$6.86	$0.00	$19.46	$19.46	$0.00	$16.45	$26.06	$26.32	$0.00		$0.00	$5.15	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$0.00
G15038	SUP	HCPCS C2617		G15038  -  CATHETER URET .038IN 5FR 115CM PLLK OP-EN GW MOD FLX TP	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15040	SUP	HCPCS C1758		G15040  -  SET STNT .038IN 2 PGTL CRV CDE 7FR 10CM STRL RADOPQ GW SFLX	BOTH IP/OP	$276.25 	$204.43	$0.00	$221.00	$150.00	$150.00	$0.00	$0.00	$0.00	$57.58	$205.03	$205.03	$0.00	$0.00	$57.57	$0.00	$163.40	$163.40	$0.00	$138.13	$218.79	$221.00	$0.00		$0.00	$43.23	$0.00	$0.00	$43.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15042	SUP	HCPCS C2617		G15042  -  CATHETER URET STD 4FR 70CM LF FLXTP PLCK OP-EN ACPT .028IN	BOTH IP/OP	$6.66 	$4.93	$0.00	$5.33	$3.00	$3.00	$0.00	$0.00	$0.00	$1.39	$4.94	$4.94	$0.00	$0.00	$1.39	$0.00	$3.94	$3.94	$0.00	$3.33	$5.27	$5.33	$0.00		$0.00	$1.04	$0.00	$0.00	$1.06	$0.00	$0.00	$0.00	$0.00	$0.00
G15045	SUP	Custom 27203010		G15045  -  STENT URTH 10FR 30CM STRL FRLT KLG SUT BLB SIL DISP	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15047	SUP	HCPCS C2617		G15047  -  SET BX 3.2FR 115CM BRSH DFLC RADOPQ URET	BOTH IP/OP	$66.63 	$49.31	$0.00	$53.30	$29.98	$29.98	$0.00	$0.00	$0.00	$13.89	$49.45	$49.45	$0.00	$0.00	$13.88	$0.00	$39.41	$39.41	$0.00	$33.31	$52.77	$53.30	$0.00		$0.00	$10.43	$0.00	$0.00	$10.61	$0.00	$0.00	$0.00	$0.00	$0.00
G15049	SUP	HCPCS C2617		G15049  -  STENT URTH 8FR 30CM STRL FRLT KLG SIL DISP HYPOSPADIAS	BOTH IP/OP	$66.63 	$49.31	$0.00	$53.30	$29.98	$29.98	$0.00	$0.00	$0.00	$13.89	$49.45	$49.45	$0.00	$0.00	$13.88	$0.00	$39.41	$39.41	$0.00	$33.31	$52.77	$53.30	$0.00		$0.00	$10.43	$0.00	$0.00	$10.61	$0.00	$0.00	$0.00	$0.00	$0.00
G15050	SUP	HCPCS C2617		G15050  -  STENT URTH 8FR 12CM STRL ZAONTZ DISP HYPOSPADIAS EPISPADIAS	BOTH IP/OP	$66.63 	$49.31	$0.00	$53.30	$29.98	$29.98	$0.00	$0.00	$0.00	$13.89	$49.45	$49.45	$0.00	$0.00	$13.88	$0.00	$39.41	$39.41	$0.00	$33.31	$52.77	$53.30	$0.00		$0.00	$10.43	$0.00	$0.00	$10.61	$0.00	$0.00	$0.00	$0.00	$0.00
G15054	SUP	Custom 27203010		G15054  -  FORCEPS ENDSCP 3.3FR 115CM FLEXIBLE OVAL BIOP CUP TISSUE	BOTH IP/OP	$781.00 	$577.94	$0.00	$624.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$579.66	$579.66	$0.00	$0.00	$162.76	$0.00	$0.00	$0.00	$0.00	$390.50	$618.55	$624.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15056	SUP	Custom 27203010		G15056  -  STENT URTH 10FR 12CM STRL ZAONTZ DISP HYPOSPADIAS OR	BOTH IP/OP	$45.55 	$33.71	$0.00	$36.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.81	$33.81	$0.00	$0.00	$9.49	$0.00	$0.00	$0.00	$0.00	$22.78	$36.08	$36.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15061	SUP	HCPCS C1726		G15061  -  CARRIER SUT 30D 16CM PEREYRA RAZ LGT REUSE	BOTH IP/OP	$385.00 	$284.90	$0.00	$308.00	$209.06	$209.06	$0.00	$0.00	$0.00	$80.24	$285.75	$285.75	$0.00	$0.00	$80.23	$0.00	$227.73	$227.73	$0.00	$192.50	$304.92	$308.00	$0.00		$0.00	$60.25	$0.00	$0.00	$61.29	$0.00	$0.00	$0.00	$0.00	$0.00
G15062	SUP	HCPCS C1726		G15062  -  CATHETER URTH 7FR 30CM STRL M DISP	BOTH IP/OP	$442.75 	$327.64	$0.00	$354.20	$240.41	$240.41	$0.00	$0.00	$0.00	$92.28	$328.61	$328.61	$0.00	$0.00	$92.27	$0.00	$261.89	$261.89	$0.00	$221.38	$350.66	$354.20	$0.00		$0.00	$69.29	$0.00	$0.00	$70.49	$0.00	$0.00	$0.00	$0.00	$0.00
G15067	SUP	HCPCS C1769		G15067  -  CATHETER BLNDIL SET F URET	BOTH IP/OP	$37.40 	$27.68	$0.00	$29.92	$20.31	$20.31	$0.00	$0.00	$0.00	$7.80	$27.76	$27.76	$0.00	$0.00	$7.79	$0.00	$22.12	$22.12	$0.00	$18.70	$29.62	$29.92	$0.00		$0.00	$5.85	$0.00	$0.00	$5.95	$0.00	$0.00	$0.00	$0.00	$0.00
G15070	SUP	HCPCS C2627		G15070  -  GUIDEWIRE ESCP STRG STD .038IN 80CM STRL 3CM FLX TP FXCR SS	BOTH IP/OP	$144.10 	$106.63	$0.00	$115.28	$78.25	$78.25	$0.00	$0.00	$0.00	$0.00	$106.95	$106.95	$0.00	$0.00	$30.03	$0.00	$0.00	$0.00	$0.00	$72.05	$114.13	$115.28	$0.00		$0.00	$22.55	$0.00	$0.00	$22.94	$0.00	$0.00	$0.00	$0.00	$0.00
G15076	SUP	HCPCS C2617		G15076  -  SET CATH 10FR 22CM 3ML STRL LTX 30CM RTNR BLN SS NDL OBT	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15077	SUP	HCPCS C2617		G15077  -  SET DRN 8FR 6-10FR 30CM 20CM CATH DIL LOOP	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15079	SUP	HCPCS C1892		G15079  -  SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 8CM STRL RADOPQ	BOTH IP/OP	$103.53 	$76.61	$0.00	$82.82	$56.21	$56.21	$0.00	$0.00	$0.00	$21.58	$76.84	$76.84	$0.00	$0.00	$21.57	$0.00	$61.24	$61.24	$0.00	$51.76	$82.00	$82.82	$0.00		$0.00	$16.20	$0.00	$0.00	$16.48	$0.00	$0.00	$0.00	$0.00	$0.00
G15088	SUP	HCPCS C2627		G15088  -  CATHETER URO 8FR 8.5FR 88CM 30CM CK SET GW 810 STNT PLC	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$22.70	$22.70	$0.00	$0.00	$0.00	$0.00	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$6.54	$0.00	$0.00	$6.65	$0.00	$0.00	$0.00	$0.00	$0.00
G15089	SUP	HCPCS C2627		G15089  -  DILATOR URET 7FR 60CM SET PE	BOTH IP/OP	$187.00 	$138.38	$0.00	$149.60	$101.54	$101.54	$0.00	$0.00	$0.00	$0.00	$138.79	$138.79	$0.00	$0.00	$38.97	$0.00	$0.00	$0.00	$0.00	$93.50	$148.10	$149.60	$0.00		$0.00	$29.27	$0.00	$0.00	$29.77	$0.00	$0.00	$0.00	$0.00	$0.00
G15093	SUP	HCPCS C2617		G15093  -  CATHETER SPBC 16FR 12CM OB PLWY ACC INTRO SET GW TROC NDL	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15108	SUP	Custom 27203010		G15108  -  SET STNT .018IN 2 PGTL CRV CDE 7FR 16CM STRL RADOPQ PSTNR GW	BOTH IP/OP	$75.90 	$56.17	$0.00	$60.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.33	$56.33	$0.00	$0.00	$15.82	$0.00	$0.00	$0.00	$0.00	$37.95	$60.11	$60.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15109	SUP	Custom 27203010		G15109  -  DILATOR URTH 8FR 35.5CM DIST TIP	BOTH IP/OP	$75.90 	$56.17	$0.00	$60.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.33	$56.33	$0.00	$0.00	$15.82	$0.00	$0.00	$0.00	$0.00	$37.95	$60.11	$60.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15116	SUP	HCPCS C1758		G15116  -  CATHETER URET 4FR 70CM WHSTLTP MOD	BOTH IP/OP	$32.90 	$24.35	$0.00	$26.32	$17.86	$17.86	$0.00	$0.00	$0.00	$6.86	$24.42	$24.42	$0.00	$0.00	$6.86	$0.00	$19.46	$19.46	$0.00	$16.45	$26.06	$26.32	$0.00		$0.00	$5.15	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$0.00
G15120	SUP	HCPCS C2617		G15120  -  CATHETER URET 4FR 115CM FLXTP CLS END RT	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15121	SUP	HCPCS C1758		G15121  -  SET STNT .038IN 2 PGTL CRV 7FR 24CM BLK STRL 145CM RADOPQ	BOTH IP/OP	$83.50 	$61.79	$0.00	$66.80	$45.34	$45.34	$0.00	$0.00	$0.00	$17.40	$61.97	$61.97	$0.00	$0.00	$17.40	$0.00	$49.39	$49.39	$0.00	$41.75	$66.13	$66.80	$0.00		$0.00	$13.07	$0.00	$0.00	$13.29	$0.00	$0.00	$0.00	$0.00	$0.00
G15123	SUP	HCPCS C2617		G15123  -  CATHETER URET 20D .035IN 7FR 70CM 145CM ANG TIP TPR END GW	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15124	SUP	HCPCS C2617		G15124  -  SET STNT .038IN 2 PGTL CRV FLFRM 7FR 22CM BLK STRL 145CM	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15125	SUP	HCPCS C2617		G15125  -  SET STNT .038IN 2 PGTL CRV 7FR 26CM BLK STRL 145CM RADOPQ	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15126	SUP	HCPCS C2617		G15126  -  SET STNT .038IN 2 PGTL CRV 7FR 28CM BLK STRL 145CM RADOPQ	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15127	SUP	HCPCS C2617		G15127  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 7FR 30CM BLK STRL 145	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15128	SUP	HCPCS C2617		G15128  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 8.5FR 22CM BLK STRL	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15129	SUP	HCPCS C2617		G15129  -  SET STNT .038IN 2 PGTL CRV 8.5FR 24CM BLK STRL 145CM RADOPQ	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15130	SUP	HCPCS C2617		G15130  -  SET STNT .038IN 2 PGTL CRV 8.5FR 28CM BLK STRL 145CM RADOPQ	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15133	SUP	Custom 27203010		G15133  -  SET NPHSTM 500ML STRL 1 CNCT DRN PCH SFT ELC BELT REED VLV	BOTH IP/OP	$71.25 	$52.73	$0.00	$57.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.88	$52.88	$0.00	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$35.63	$56.43	$57.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15134	SUP	Custom 27203010		G15134  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 8.5FR 26CM BLK STRL	BOTH IP/OP	$71.25 	$52.73	$0.00	$57.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.88	$52.88	$0.00	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$35.63	$56.43	$57.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15136	SUP	Custom 27203010		G15136  -  SET NPHSTM 500ML STRL DRN PCH SFT ELC BELT REED VLV MECH	BOTH IP/OP	$71.25 	$52.73	$0.00	$57.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.88	$52.88	$0.00	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$35.63	$56.43	$57.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15137	SUP	Custom 27203010		G15137  -  SET NPHSTM 500ML NS CK 1 CNCT DRN PCH SFT ELC BELT DISP	BOTH IP/OP	$71.25 	$52.73	$0.00	$57.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.88	$52.88	$0.00	$0.00	$14.85	$0.00	$0.00	$0.00	$0.00	$35.63	$56.43	$57.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15138	SUP	HCPCS C2617		G15138  -  SET NPHSTM 500ML NS 2 CNCT DRN PCH SFT ELC BELT REED VLV	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15144	SUP	HCPCS C2617		G15144  -  SET STNT .018IN SM 2 PGTL CRV 7FR 14CM STRL RADOPQ PSTNR GW	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15145	SUP	HCPCS C2617		G15145  -  SET STNT .038IN 2 PGTL CRV FLFRM 6FR 22CM BLK STRL 145CM	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15146	SUP	HCPCS C2617		G15146  -  SET STNT .038IN 2 PGTL CRV FLFRM 6FR 24CM BLK STRL 145CM	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15147	SUP	HCPCS C2617		G15147  -  SET STNT .038IN 2 PGTL CRV FLFRM 6FR 26CM BLK STRL 145CM	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15148	SUP	HCPCS C2617		G15148  -  SET STNT .038IN 2 PGTL CRV 6FR 28CM BLK STRL 145CM RADOPQ	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15149	SUP	HCPCS C2627		G15149  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 6FR 30CM BLK STRL 145	BOTH IP/OP	$137.90 	$102.05	$0.00	$110.32	$74.88	$74.88	$0.00	$0.00	$0.00	$0.00	$102.35	$102.35	$0.00	$0.00	$28.74	$0.00	$0.00	$0.00	$0.00	$68.95	$109.22	$110.32	$0.00		$0.00	$21.58	$0.00	$0.00	$21.95	$0.00	$0.00	$0.00	$0.00	$0.00
G15150	SUP	HCPCS C2617		G15150  -  SET CATH LOOP 14FR 23CM BLU SFLX 1 WY STPCK NDL OBT CNCT	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15167	SUP	Custom 27203010		G15167  -  DILATOR URTH 6-10FR MEATUS	BOTH IP/OP	$35.43 	$26.22	$0.00	$28.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.29	$26.29	$0.00	$0.00	$7.38	$0.00	$0.00	$0.00	$0.00	$17.71	$28.06	$28.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15168	SUP	HCPCS C2625		G15168  -  CATHETER URO 8-14FR SPRT SFT LOPRFL NKNK CRV PERC	BOTH IP/OP	$141.45 	$104.67	$0.00	$113.16	$63.65	$63.65	$0.00	$0.00	$0.00	$29.48	$104.98	$104.98	$0.00	$0.00	$29.48	$0.00	$83.67	$83.67	$0.00	$70.73	$112.03	$113.16	$0.00		$0.00	$22.14	$0.00	$0.00	$22.52	$0.00	$0.00	$0.00	$0.00	$0.00
G15170	SUP	Custom 27203010		G15170  -  SET NPHSTM PGTL CRV 8.2FR 125CM DRETLER STNT GW	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$0.00	$0.00	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15172	SUP	HCPCS C1758		G15172  -  CATHETER URTH 22-24FR RTNR FL TRC TEMP TRC	BOTH IP/OP	$31.63 	$23.41	$0.00	$25.30	$17.17	$17.17	$0.00	$0.00	$0.00	$6.59	$23.47	$23.47	$0.00	$0.00	$6.59	$0.00	$18.71	$18.71	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
G15193	SUP	HCPCS C2617		G15193  -  CATHETER URET 3FR 70CM RND TIP STY RT	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15195	SUP	HCPCS C1758		G15195  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 6FR 20CM BLK STRL 145	BOTH IP/OP	$31.90 	$23.61	$0.00	$25.52	$17.32	$17.32	$0.00	$0.00	$0.00	$6.65	$23.68	$23.68	$0.00	$0.00	$6.65	$0.00	$18.87	$18.87	$0.00	$15.95	$25.26	$25.52	$0.00		$0.00	$4.99	$0.00	$0.00	$5.08	$0.00	$0.00	$0.00	$0.00	$0.00
G15196	SUP	HCPCS C2627		G15196  -  CATHETER URET 2FR 115CM LSR ADPR	BOTH IP/OP	$256.80 	$190.03	$0.00	$205.44	$139.44	$139.44	$0.00	$0.00	$0.00	$0.00	$190.60	$190.60	$0.00	$0.00	$53.52	$0.00	$0.00	$0.00	$0.00	$128.40	$203.39	$205.44	$0.00		$0.00	$40.19	$0.00	$0.00	$40.88	$0.00	$0.00	$0.00	$0.00	$0.00
G15211	SUP	HCPCS C1773		G15211  -  FOLLOWER URTH 10FR 35.5CM PHLPS DIL DIST TIP THRD WO SDPRT	BOTH IP/OP	$664.55 	$491.77	$0.00	$531.64	$360.85	$360.85	$0.00	$0.00	$0.00	$138.51	$493.23	$493.23	$0.00	$0.00	$138.49	$0.00	$393.08	$393.08	$0.00	$332.28	$526.32	$531.64	$0.00		$0.00	$104.00	$0.00	$0.00	$105.80	$0.00	$0.00	$0.00	$0.00	$0.00
G15214	SUP	HCPCS C1729		G15214  -  FORCEPS SPEC RTRVL 3.3FR 115CM MS TTH FLXB SHFT	BOTH IP/OP	$188.10 	$139.19	$0.00	$150.48	$102.14	$102.14	$0.00	$0.00	$0.00	$39.20	$139.61	$139.61	$0.00	$0.00	$39.20	$0.00	$111.26	$111.26	$0.00	$94.05	$148.98	$150.48	$0.00		$0.00	$29.44	$0.00	$0.00	$29.95	$0.00	$0.00	$0.00	$0.00	$0.00
G15216	SUP	HCPCS C1758		G15216  -  SET NPHSTM 14FR 19.5CM STRL LTX CK CATH CNN COPE LOOP NTR	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G15219	SUP	Custom 27203010		G15219  -  CATHETER URET .038IN 5FR 70CM OP-EN MOD	BOTH IP/OP	$25.30 	$18.72	$0.00	$20.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.78	$18.78	$0.00	$0.00	$5.27	$0.00	$0.00	$0.00	$0.00	$12.65	$20.04	$20.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15221	SUP	HCPCS C1892		G15221  -  ADAPTER CATH 7-10FR T-B M LL LD TM	BOTH IP/OP	$136.63 	$101.11	$0.00	$109.30	$74.19	$74.19	$0.00	$0.00	$0.00	$28.48	$101.40	$101.40	$0.00	$0.00	$28.47	$0.00	$80.81	$80.81	$0.00	$68.31	$108.21	$109.30	$0.00		$0.00	$21.38	$0.00	$0.00	$21.75	$0.00	$0.00	$0.00	$0.00	$0.00
G15223	SUP	HCPCS C2625		G15223  -  SET INTRO STD 20FR 37CM 32CM PLWY 2 KNOB SHTH GW	BOTH IP/OP	$160.30 	$118.62	$0.00	$128.24	$72.14	$72.14	$0.00	$0.00	$0.00	$33.41	$118.97	$118.97	$0.00	$0.00	$33.41	$0.00	$94.82	$94.82	$0.00	$80.15	$126.96	$128.24	$0.00		$0.00	$25.09	$0.00	$0.00	$25.52	$0.00	$0.00	$0.00	$0.00	$0.00
G15224	SUP	HCPCS C2625		G15224  -  SET STNT .038IN 5MM PGTL CRV 6FR 75CM BLK STRL 100CM BNDR	BOTH IP/OP	$160.30 	$118.62	$0.00	$128.24	$72.14	$72.14	$0.00	$0.00	$0.00	$33.41	$118.97	$118.97	$0.00	$0.00	$33.41	$0.00	$94.82	$94.82	$0.00	$80.15	$126.96	$128.24	$0.00		$0.00	$25.09	$0.00	$0.00	$25.52	$0.00	$0.00	$0.00	$0.00	$0.00
G15225	SUP	HCPCS C1769		G15225  -  SET STNT .038IN 5MM PGTL CRV 6FR 75CM BLK STRL 100CM BNDR	BOTH IP/OP	$38.88 	$28.77	$0.00	$31.10	$21.11	$21.11	$0.00	$0.00	$0.00	$8.10	$28.85	$28.85	$0.00	$0.00	$8.10	$0.00	$22.99	$22.99	$0.00	$19.44	$30.79	$31.10	$0.00		$0.00	$6.08	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$0.00
G15227	SUP	HCPCS C2625		G15227  -  SET STNT 3CM 2 PGTL CRV 7FR 22CM STRL 145CM KWART RETRO-INJ	BOTH IP/OP	$300.60 	$222.44	$0.00	$240.48	$135.27	$135.27	$0.00	$0.00	$0.00	$62.65	$223.11	$223.11	$0.00	$0.00	$62.65	$0.00	$177.80	$177.80	$0.00	$150.30	$238.08	$240.48	$0.00		$0.00	$47.04	$0.00	$0.00	$47.86	$0.00	$0.00	$0.00	$0.00	$0.00
G15230	SUP	Custom 27203010		G15230  -  FORCEP SPEC RTRVL 65CM 5.2FR 1 JAW ALGTR TOOTH FLXB SHFT	BOTH IP/OP	$646.00 	$478.04	$0.00	$516.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$323.00	$511.63	$516.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15233	SUP	HCPCS C2617		G15233  -  GUIDEWIRE ESCP STD .035IN 145CM FXCR SS	BOTH IP/OP	$66.63 	$49.31	$0.00	$53.30	$29.98	$29.98	$0.00	$0.00	$0.00	$13.89	$49.45	$49.45	$0.00	$0.00	$13.88	$0.00	$39.41	$39.41	$0.00	$33.31	$52.77	$53.30	$0.00		$0.00	$10.43	$0.00	$0.00	$10.61	$0.00	$0.00	$0.00	$0.00	$0.00
G15240	SUP	HCPCS C1729		G15240  -  TUBE CNCT 10FR 30CM M LL DRN BG	BOTH IP/OP	$150.55 	$111.41	$0.00	$120.44	$81.75	$81.75	$0.00	$0.00	$0.00	$31.38	$111.74	$111.74	$0.00	$0.00	$31.37	$0.00	$89.05	$89.05	$0.00	$75.28	$119.24	$120.44	$0.00		$0.00	$23.56	$0.00	$0.00	$23.97	$0.00	$0.00	$0.00	$0.00	$0.00
G15248	SUP	HCPCS C1769		G15248  -  SET NPHSTM 10FR 19.5CM COPE LOOP CATH CNN GW	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$27.69	$27.69	$0.00	$0.00	$0.00	$10.63	$37.85	$37.85	$0.00	$0.00	$10.63	$0.00	$30.17	$30.17	$0.00	$25.50	$40.39	$40.80	$0.00		$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
G15252	SUP	HCPCS C1769		G15252  -  GUIDEWIRE VASC STD STRG .028IN 145CM STRL 3CM FXCR FLX TP SS	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$27.69	$27.69	$0.00	$0.00	$0.00	$10.63	$37.85	$37.85	$0.00	$0.00	$10.63	$0.00	$30.17	$30.17	$0.00	$25.50	$40.39	$40.80	$0.00		$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
G15256	SUP	HCPCS C1769		G15256  -  GUIDEWIRE VASC STD STRG .035IN 145CM STRL 3CM FX COR FLX TP	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$27.69	$27.69	$0.00	$0.00	$0.00	$10.63	$37.85	$37.85	$0.00	$0.00	$10.63	$0.00	$30.17	$30.17	$0.00	$25.50	$40.39	$40.80	$0.00		$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
G15261	SUP	HCPCS C2627		G15261  -  CUFF CONTINENCE 10ML NS TEMP INTOP CAP SYR SIL M REUSE	BOTH IP/OP	$144.10 	$106.63	$0.00	$115.28	$78.25	$78.25	$0.00	$0.00	$0.00	$0.00	$106.95	$106.95	$0.00	$0.00	$30.03	$0.00	$0.00	$0.00	$0.00	$72.05	$114.13	$115.28	$0.00		$0.00	$22.55	$0.00	$0.00	$22.94	$0.00	$0.00	$0.00	$0.00	$0.00
G15262	SUP	Custom 27203010		G15262  -  GUIDEWIRE URO STD STRG .038IN 145CM STRL 3CM FLX TP FXCR SS	BOTH IP/OP	$177.10 	$131.05	$0.00	$141.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.44	$131.44	$0.00	$0.00	$36.91	$0.00	$0.00	$0.00	$0.00	$88.55	$140.26	$141.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15276	SUP	Custom 27203010		G15276  -  ADAPTER CATH 2 M LL	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$0.00	$0.00	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15279	SUP	Custom 27203010		G15279  -  NEEDLE ESCP 25GA 5FR 35CM 8MM WMS CSCP	BOTH IP/OP	$46.83 	$34.65	$0.00	$37.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.75	$34.75	$0.00	$0.00	$9.76	$0.00	$0.00	$0.00	$0.00	$23.41	$37.09	$37.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15280	SUP	HCPCS C1769		G15280  -  NEEDLE ESCP 14FR 20CM HATTER ASP CSCP FLXB	BOTH IP/OP	$51.00 	$37.74	$0.00	$40.80	$27.69	$27.69	$0.00	$0.00	$0.00	$10.63	$37.85	$37.85	$0.00	$0.00	$10.63	$0.00	$30.17	$30.17	$0.00	$25.50	$40.39	$40.80	$0.00		$0.00	$7.98	$0.00	$0.00	$8.12	$0.00	$0.00	$0.00	$0.00	$0.00
G15284	SUP	HCPCS C1758		G15284  -  GUIDEWIRE VASC STD .035IN 145CM STRL MOV COR SS SLIP-COAT	BOTH IP/OP	$40.70 	$30.12	$0.00	$32.56	$22.10	$22.10	$0.00	$0.00	$0.00	$8.48	$30.21	$30.21	$0.00	$0.00	$8.48	$0.00	$24.07	$24.07	$0.00	$20.35	$32.23	$32.56	$0.00		$0.00	$6.37	$0.00	$0.00	$6.48	$0.00	$0.00	$0.00	$0.00	$0.00
G15290	SUP	Custom 27203010		G15290  -  CATHETER ESCP 2FR 3CM SILBER ASP	BOTH IP/OP	$37.40 	$27.68	$0.00	$29.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.76	$27.76	$0.00	$0.00	$7.79	$0.00	$0.00	$0.00	$0.00	$18.70	$29.62	$29.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15291	SUP	Custom 27203010		G15291  -  NEEDLE PRC 22GA 20CM STRL SKNY ECHTP CHBA TIP PERC US IMG	BOTH IP/OP	$41.80 	$30.93	$0.00	$33.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.02	$31.02	$0.00	$0.00	$8.71	$0.00	$0.00	$0.00	$0.00	$20.90	$33.11	$33.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15292	SUP	Custom 27203010		G15292  -  NEEDLE PRC TROC 18GA 20CM STRL ECHTP 2 PRT DISP US IMG	BOTH IP/OP	$93.50 	$69.19	$0.00	$74.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.40	$69.40	$0.00	$0.00	$19.49	$0.00	$0.00	$0.00	$0.00	$46.75	$74.05	$74.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15293	SUP	Custom 27203010		G15293  -  NEEDLE PRC 18GA 22GA 14-22CM MTPLK ECHTP COAX PERC	BOTH IP/OP	$79.70 	$58.98	$0.00	$63.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.15	$59.15	$0.00	$0.00	$16.61	$0.00	$0.00	$0.00	$0.00	$39.85	$63.12	$63.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15296	SUP	Custom 27203010		G15296  -  NEEDLE TROC STD 18GA 25CM ECHTP 2 PRT DISP	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$0.00	$0.00	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15299	SUP	HCPCS C1758		G15299  -  NEEDLE ESCP 23GA 3.7FR 35CM WMS CSCP	BOTH IP/OP	$29.70 	$21.98	$0.00	$23.76	$16.13	$16.13	$0.00	$0.00	$0.00	$6.19	$22.04	$22.04	$0.00	$0.00	$6.19	$0.00	$17.57	$17.57	$0.00	$14.85	$23.52	$23.76	$0.00		$0.00	$4.65	$0.00	$0.00	$4.73	$0.00	$0.00	$0.00	$0.00	$0.00
G15300	SUP	HCPCS C1758		G15300  -  ADAPTER ESCP ANG STRL LF SCHOBORG LSR FBR CATH URET DISP	BOTH IP/OP	$83.50 	$61.79	$0.00	$66.80	$45.34	$45.34	$0.00	$0.00	$0.00	$17.40	$61.97	$61.97	$0.00	$0.00	$17.40	$0.00	$49.39	$49.39	$0.00	$41.75	$66.13	$66.80	$0.00		$0.00	$13.07	$0.00	$0.00	$13.29	$0.00	$0.00	$0.00	$0.00	$0.00
G15301	SUP	HCPCS C1758		G15301  -  CATHETER URET 40D .035IN TPR STRG 5FR 70CM 145CM SF GW NYL	BOTH IP/OP	$72.60 	$53.72	$0.00	$58.08	$39.42	$39.42	$0.00	$0.00	$0.00	$15.13	$53.88	$53.88	$0.00	$0.00	$15.13	$0.00	$42.94	$42.94	$0.00	$36.30	$57.50	$58.08	$0.00		$0.00	$11.36	$0.00	$0.00	$11.56	$0.00	$0.00	$0.00	$0.00	$0.00
G15302	SUP	HCPCS C1758		G15302  -  CATHETER URET 40D .035IN TPR 6FR 70CM 145CM GW	BOTH IP/OP	$72.60 	$53.72	$0.00	$58.08	$39.42	$39.42	$0.00	$0.00	$0.00	$15.13	$53.88	$53.88	$0.00	$0.00	$15.13	$0.00	$42.94	$42.94	$0.00	$36.30	$57.50	$58.08	$0.00		$0.00	$11.36	$0.00	$0.00	$11.56	$0.00	$0.00	$0.00	$0.00	$0.00
G15397	SUP	HCPCS C2617		G15397  -  CATHETER URET 40D .035IN 5FR 70CM 145CM FLXB ANG TIP BVL END	BOTH IP/OP	$215.55 	$159.51	$0.00	$172.44	$97.00	$97.00	$0.00	$0.00	$0.00	$44.93	$159.98	$159.98	$0.00	$0.00	$44.92	$0.00	$127.50	$127.50	$0.00	$107.78	$170.72	$172.44	$0.00		$0.00	$33.73	$0.00	$0.00	$34.32	$0.00	$0.00	$0.00	$0.00	$0.00
G15422	SUP	Custom 27203010		G15422  -  FORCEP SPEC RTRVL 65CM 5.2FR 2 JAW ALGTR TOOTH	BOTH IP/OP	$675.28 	$499.71	$0.00	$524.80	$0.00	$0.00	$0.00	$0.00	$0.00	$140.74	$501.19	$501.19	$0.00	$0.00	$140.73	$0.00	$399.43	$399.43	$0.00	$328.00	$519.55	$524.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15424	SUP	HCPCS C1758		G15424  -  STENT URET 2 PGTL CRV 4.7FR 8CM STRL SFLX PED DISP ACPT .035	BOTH IP/OP	$31.63 	$23.41	$0.00	$25.30	$17.17	$17.17	$0.00	$0.00	$0.00	$6.59	$23.47	$23.47	$0.00	$0.00	$6.59	$0.00	$18.71	$18.71	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
G15425	SUP	HCPCS C1758		G15425  -  CATHETER URET .018IN 3FR 70CM OP-EN GW MOD	BOTH IP/OP	$31.63 	$23.41	$0.00	$25.30	$17.17	$17.17	$0.00	$0.00	$0.00	$6.59	$23.47	$23.47	$0.00	$0.00	$6.59	$0.00	$18.71	$18.71	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
G15429	SUP	HCPCS C1726		G15429  -  CATHETER URET .025IN 4FR 70CM OP-EN GW MOD	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$24.44	$24.44	$0.00	$0.00	$0.00	$9.38	$33.40	$33.40	$0.00	$0.00	$9.38	$0.00	$26.62	$26.62	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$7.04	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00
G15434	SUP	HCPCS C1726		G15434  -  DEVICE SUT 10D 17CM PEREYRA LGT CR REUSE	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$24.44	$24.44	$0.00	$0.00	$0.00	$9.38	$33.40	$33.40	$0.00	$0.00	$9.38	$0.00	$26.62	$26.62	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$7.04	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00
G15435	SUP	HCPCS C1726		G15435  -  CATHETER URDY 7FR 38CM STRL 2 LUM URETER DISP	BOTH IP/OP	$54.23 	$40.13	$0.00	$43.38	$29.44	$29.44	$0.00	$0.00	$0.00	$11.30	$40.25	$40.25	$0.00	$0.00	$11.30	$0.00	$32.07	$32.07	$0.00	$27.11	$42.95	$43.38	$0.00		$0.00	$8.49	$0.00	$0.00	$8.63	$0.00	$0.00	$0.00	$0.00	$0.00
G15443	SUP	HCPCS C2617		G15443  -  CATHETER URDY 7.4FR 30CM 3 LUM	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15444	SUP	HCPCS C2617		G15444  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 8.5FR 20CM BLK STRL	BOTH IP/OP	$287.00 	$212.38	$0.00	$229.60	$129.15	$129.15	$0.00	$0.00	$0.00	$59.82	$213.01	$213.01	$0.00	$0.00	$59.81	$0.00	$169.76	$169.76	$0.00	$143.50	$227.30	$229.60	$0.00		$0.00	$44.92	$0.00	$0.00	$45.69	$0.00	$0.00	$0.00	$0.00	$0.00
G15469	SUP	HCPCS C1769		G15469  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 7FR 20CM BLK STRL 145	BOTH IP/OP	$207.90 	$153.85	$0.00	$166.32	$112.89	$112.89	$0.00	$0.00	$0.00	$43.33	$154.30	$154.30	$0.00	$0.00	$43.33	$0.00	$122.97	$122.97	$0.00	$103.95	$164.66	$166.32	$0.00		$0.00	$32.54	$0.00	$0.00	$33.10	$0.00	$0.00	$0.00	$0.00	$0.00
G15473	SUP	HCPCS C2625		G15473  -  SET INTRO .035IN STRG 8-14FR 18GA 14CM STRL 10CM SP TUBE NDL	BOTH IP/OP	$160.30 	$118.62	$0.00	$128.24	$72.14	$72.14	$0.00	$0.00	$0.00	$33.41	$118.97	$118.97	$0.00	$0.00	$33.41	$0.00	$94.82	$94.82	$0.00	$80.15	$126.96	$128.24	$0.00		$0.00	$25.09	$0.00	$0.00	$25.52	$0.00	$0.00	$0.00	$0.00	$0.00
G15475	SUP	Custom 27203010		G15475  -  SET STNT .038IN 5MM PGTL CRV 8.2FR 75CM STRL 100CM BNDR CATH	BOTH IP/OP	$29.70 	$21.98	$0.00	$23.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.04	$22.04	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$14.85	$23.52	$23.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15476	SUP	Custom 27203010		G15476  -  ADAPTER CATH 9FR STRL CKFL SDARM STPCK F LL PEEL OPN DISP	BOTH IP/OP	$27.50 	$20.35	$0.00	$22.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.41	$20.41	$0.00	$0.00	$5.73	$0.00	$0.00	$0.00	$0.00	$13.75	$21.78	$22.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15495	SUP	HCPCS C2625		G15495  -  SET STNT 3CM 145CM STRL KWART RETRO-INJ INSRTR TETH RELS SLV	BOTH IP/OP	$300.60 	$222.44	$0.00	$240.48	$135.27	$135.27	$0.00	$0.00	$0.00	$62.65	$223.11	$223.11	$0.00	$0.00	$62.65	$0.00	$177.80	$177.80	$0.00	$150.30	$238.08	$240.48	$0.00		$0.00	$47.04	$0.00	$0.00	$47.86	$0.00	$0.00	$0.00	$0.00	$0.00
G15500	SUP	HCPCS C1758		G15500  -  ADAPTER CATH 9FR STRL CKFL SLF SL F LL DISP	BOTH IP/OP	$32.90 	$24.35	$0.00	$26.32	$17.86	$17.86	$0.00	$0.00	$0.00	$6.86	$24.42	$24.42	$0.00	$0.00	$6.86	$0.00	$19.46	$19.46	$0.00	$16.45	$26.06	$26.32	$0.00		$0.00	$5.15	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$0.00
G15513	SUP	Custom 27203010		G15513  -  CATHETER URET 4FR 70CM SPRL TIP ACC LG SDPRT ACPT .028IN GW	BOTH IP/OP	$115.13 	$85.20	$0.00	$92.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.45	$85.45	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$57.56	$91.18	$92.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15514	SUP	HCPCS C2617		G15514  -  NEEDLE PRC 18GA 25CM ECHTP TROC STY SHTH TFE RNL	BOTH IP/OP	$215.55 	$159.51	$0.00	$172.44	$97.00	$97.00	$0.00	$0.00	$0.00	$44.93	$159.98	$159.98	$0.00	$0.00	$44.92	$0.00	$127.50	$127.50	$0.00	$107.78	$170.72	$172.44	$0.00		$0.00	$33.73	$0.00	$0.00	$34.32	$0.00	$0.00	$0.00	$0.00	$0.00
G15530	SUP	HCPCS C1769		G15530  -  STENT URET 2 PGTL CRV 7FR 20CM STRL SFLX DISP ACPT .038IN GW	BOTH IP/OP	$58.65 	$43.40	$0.00	$46.92	$31.85	$31.85	$0.00	$0.00	$0.00	$12.22	$43.53	$43.53	$0.00	$0.00	$12.22	$0.00	$34.69	$34.69	$0.00	$29.33	$46.45	$46.92	$0.00		$0.00	$9.18	$0.00	$0.00	$9.34	$0.00	$0.00	$0.00	$0.00	$0.00
G15532	SUP	HCPCS C2617		G15532  -  GUIDEWIRE ESCP STD .028IN 145CM FXCR HDRPH	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G15540	SUP	HCPCS C1726		G15540  -  SET STNT .025IN 3.7FR 21-32CM STRL CATH RADOPQ MTLNTH PSTNR	BOTH IP/OP	$97.18 	$71.91	$0.00	$77.74	$52.77	$52.77	$0.00	$0.00	$0.00	$20.25	$72.12	$72.12	$0.00	$0.00	$20.25	$0.00	$57.48	$57.48	$0.00	$48.59	$76.97	$77.74	$0.00		$0.00	$15.21	$0.00	$0.00	$15.47	$0.00	$0.00	$0.00	$0.00	$0.00
G15579	SUP	HCPCS C1758		G15579  -  CATHETER URDY 7.4FR 30CM 3 LUM BLN	BOTH IP/OP	$32.90 	$24.35	$0.00	$26.32	$17.86	$17.86	$0.00	$0.00	$0.00	$6.86	$24.42	$24.42	$0.00	$0.00	$6.86	$0.00	$19.46	$19.46	$0.00	$16.45	$26.06	$26.32	$0.00		$0.00	$5.15	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$0.00
G15600	SUP	HCPCS C1769		G15600  -  CATHETER URET .028IN 4FR 115CM FLXTP OP-EN GW MOD FLX TP	BOTH IP/OP	$58.65 	$43.40	$0.00	$46.92	$31.85	$31.85	$0.00	$0.00	$0.00	$12.22	$43.53	$43.53	$0.00	$0.00	$12.22	$0.00	$34.69	$34.69	$0.00	$29.33	$46.45	$46.92	$0.00		$0.00	$9.18	$0.00	$0.00	$9.34	$0.00	$0.00	$0.00	$0.00	$0.00
G15602	SUP	HCPCS C1769		G15602  -  GUIDEWIRE ESCP STD .035IN 145CM FXCR HDRPH	BOTH IP/OP	$58.65 	$43.40	$0.00	$46.92	$31.85	$31.85	$0.00	$0.00	$0.00	$12.22	$43.53	$43.53	$0.00	$0.00	$12.22	$0.00	$34.69	$34.69	$0.00	$29.33	$46.45	$46.92	$0.00		$0.00	$9.18	$0.00	$0.00	$9.34	$0.00	$0.00	$0.00	$0.00	$0.00
G15603	SUP	HCPCS C1726		G15603  -  GUIDEWIRE URO BNTSN CRV STRG .035IN 145CM STRL 15CM FXCR FLX	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$24.44	$24.44	$0.00	$0.00	$0.00	$9.38	$33.40	$33.40	$0.00	$0.00	$9.38	$0.00	$26.62	$26.62	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$7.04	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00
G15606	SUP	HCPCS C2617		G15606  -  CATHETER URDY 10FR 39CM 2 LUM	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15607	SUP	HCPCS C2617		G15607  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 8CM GRY STRL CATH	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15608	SUP	HCPCS C2617		G15608  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 10CM GRY STRL CATH	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15610	SUP	HCPCS C2617		G15610  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 12CM GRY STRL CATH	BOTH IP/OP	$215.55 	$159.51	$0.00	$172.44	$97.00	$97.00	$0.00	$0.00	$0.00	$44.93	$159.98	$159.98	$0.00	$0.00	$44.92	$0.00	$127.50	$127.50	$0.00	$107.78	$170.72	$172.44	$0.00		$0.00	$33.73	$0.00	$0.00	$34.32	$0.00	$0.00	$0.00	$0.00	$0.00
G15621	SUP	Custom 27203010		G15621  -  STENT URET 2 PGTL CRV 4.7FR 10CM STRL SFLX PED DISP ACPT	BOTH IP/OP	$48.08 	$35.58	$0.00	$38.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.68	$35.68	$0.00	$0.00	$10.02	$0.00	$0.00	$0.00	$0.00	$24.04	$38.08	$38.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15624	SUP	HCPCS C2617		G15624  -  NEEDLE PRC STD 18GA 11CM ECHTP 2 PRT TROC DISP	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15632	SUP	HCPCS C2627		G15632  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 7FR 6CM STRL RADOPQ GW	BOTH IP/OP	$258.05 	$190.96	$0.00	$206.44	$140.12	$140.12	$0.00	$0.00	$0.00	$0.00	$191.52	$191.52	$0.00	$0.00	$53.78	$0.00	$0.00	$0.00	$0.00	$129.03	$204.38	$206.44	$0.00		$0.00	$40.38	$0.00	$0.00	$41.08	$0.00	$0.00	$0.00	$0.00	$0.00
G15636	SUP	HCPCS C1758		G15636  -  SET DIL 6-12FR 60CM WO GW PE HDRPH URET	BOTH IP/OP	$47.30 	$35.00	$0.00	$37.84	$25.68	$25.68	$0.00	$0.00	$0.00	$9.86	$35.11	$35.11	$0.00	$0.00	$9.86	$0.00	$27.98	$27.98	$0.00	$23.65	$37.46	$37.84	$0.00		$0.00	$7.40	$0.00	$0.00	$7.53	$0.00	$0.00	$0.00	$0.00	$0.00
G15637	SUP	HCPCS C1758		G15637  -  CATHETER URET 5FR 70CM ECHTP OP-EN ACPT .038IN GW	BOTH IP/OP	$54.40 	$40.26	$0.00	$43.52	$29.54	$29.54	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$27.20	$43.08	$43.52	$0.00		$0.00	$8.51	$0.00	$0.00	$8.66	$0.00	$0.00	$0.00	$0.00	$0.00
G15638	SUP	HCPCS C1758		G15638  -  CATHETER URET .038IN 6FR 70CM ECHTP OP-EN GW	BOTH IP/OP	$54.40 	$40.26	$0.00	$43.52	$29.54	$29.54	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$27.20	$43.08	$43.52	$0.00		$0.00	$8.51	$0.00	$0.00	$8.66	$0.00	$0.00	$0.00	$0.00	$0.00
G15639	SUP	HCPCS C1758		G15639  -  CATHETER URET .038IN 7FR 70CM ECHTP OP-EN GW	BOTH IP/OP	$54.40 	$40.26	$0.00	$43.52	$29.54	$29.54	$0.00	$0.00	$0.00	$11.34	$40.38	$40.38	$0.00	$0.00	$11.34	$0.00	$32.18	$32.18	$0.00	$27.20	$43.08	$43.52	$0.00		$0.00	$8.51	$0.00	$0.00	$8.66	$0.00	$0.00	$0.00	$0.00	$0.00
G15650	SUP	Custom 27203010		G15650  -  CATHETER URET .038IN 8FR 70CM ECHTP OP-EN GW	BOTH IP/OP	$29.70 	$21.98	$0.00	$23.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.04	$22.04	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$14.85	$23.52	$23.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15670	SUP	HCPCS C1758		G15670  -  ADAPTER CATH UNV 9FR STRL CKFL F LL DISP	BOTH IP/OP	$150.68 	$111.50	$0.00	$120.54	$81.82	$81.82	$0.00	$0.00	$0.00	$31.40	$111.83	$111.83	$0.00	$0.00	$31.40	$0.00	$89.12	$89.12	$0.00	$75.34	$119.34	$120.54	$0.00		$0.00	$23.58	$0.00	$0.00	$23.99	$0.00	$0.00	$0.00	$0.00	$0.00
G15731	SUP	HCPCS C1769		G15731  -  GUIDEWIRE VASC .032IN 145CM AMPTZ MOV COR STRG TPR	BOTH IP/OP	$69.98 	$51.79	$0.00	$55.98	$38.00	$38.00	$0.00	$0.00	$0.00	$14.58	$51.94	$51.94	$0.00	$0.00	$14.58	$0.00	$41.39	$41.39	$0.00	$34.99	$55.42	$55.98	$0.00		$0.00	$10.95	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
G15732	SUP	HCPCS C1769		G15732  -  CATHETER URET .045IN PGTL CRV 8FR 70CM 145CM SDPRT SHFT GW	BOTH IP/OP	$69.98 	$51.79	$0.00	$55.98	$38.00	$38.00	$0.00	$0.00	$0.00	$14.58	$51.94	$51.94	$0.00	$0.00	$14.58	$0.00	$41.39	$41.39	$0.00	$34.99	$55.42	$55.98	$0.00		$0.00	$10.95	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
G15733	SUP	HCPCS C1892		G15733  -  GUIDEWIRE VASC .038IN 145CM LF 3CM AMPTZ 2 FLXB STF SS	BOTH IP/OP	$136.63 	$101.11	$0.00	$109.30	$74.19	$74.19	$0.00	$0.00	$0.00	$28.48	$101.40	$101.40	$0.00	$0.00	$28.47	$0.00	$80.81	$80.81	$0.00	$68.31	$108.21	$109.30	$0.00		$0.00	$21.38	$0.00	$0.00	$21.75	$0.00	$0.00	$0.00	$0.00	$0.00
G15739	SUP	HCPCS C1726		G15739  -  POUCH SPEC RTRVL 5X2IN YLW LAPSAC SRG REM MORCELLATION INTGR	BOTH IP/OP	$54.23 	$40.13	$0.00	$43.38	$29.44	$29.44	$0.00	$0.00	$0.00	$11.30	$40.25	$40.25	$0.00	$0.00	$11.30	$0.00	$32.07	$32.07	$0.00	$27.11	$42.95	$43.38	$0.00		$0.00	$8.49	$0.00	$0.00	$8.63	$0.00	$0.00	$0.00	$0.00	$0.00
G15753	SUP	HCPCS C2627		G15753  -  TUBE CNCT 14FR 11CM M LL DRN BG T-B ADPR	BOTH IP/OP	$72.73 	$53.82	$0.00	$58.18	$39.49	$39.49	$0.00	$0.00	$0.00	$0.00	$53.98	$53.98	$0.00	$0.00	$15.16	$0.00	$0.00	$0.00	$0.00	$36.36	$57.60	$58.18	$0.00		$0.00	$11.38	$0.00	$0.00	$11.58	$0.00	$0.00	$0.00	$0.00	$0.00
G15764	SUP	HCPCS C2627		G15764  -  DILATOR URTH 6FR 37CM PE FSCA	BOTH IP/OP	$29.70 	$21.98	$0.00	$23.76	$16.13	$16.13	$0.00	$0.00	$0.00	$0.00	$22.04	$22.04	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$14.85	$23.52	$23.76	$0.00		$0.00	$4.65	$0.00	$0.00	$4.73	$0.00	$0.00	$0.00	$0.00	$0.00
G15766	SUP	Custom 27203010		G15766  -  CATHETER URDY 4FR 60CM PRSS BLDR	BOTH IP/OP	$70.40 	$52.10	$0.00	$56.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.25	$52.25	$0.00	$0.00	$14.67	$0.00	$0.00	$0.00	$0.00	$35.20	$55.76	$56.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15771	SUP	Custom 27203010		G15771  -  CATHETER URDY 12FR 36CM STRL LTX 5CM PRSS BLN SIL RCTL DISP	BOTH IP/OP	$626.88 	$463.89	$0.00	$501.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$465.27	$465.27	$0.00	$0.00	$130.64	$0.00	$0.00	$0.00	$0.00	$313.44	$496.49	$501.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15789	SUP	HCPCS C1729		G15789  -  INTRODUCER ESCP 25.5CM 5X8IN LAPSAC LGR ACC PORT HNDL SS AL	BOTH IP/OP	$465.53 	$344.49	$0.00	$372.42	$252.78	$252.78	$0.00	$0.00	$0.00	$97.03	$345.51	$345.51	$0.00	$0.00	$97.02	$0.00	$275.36	$275.36	$0.00	$232.76	$368.70	$372.42	$0.00		$0.00	$72.85	$0.00	$0.00	$74.11	$0.00	$0.00	$0.00	$0.00	$0.00
G15792	SUP	HCPCS C1758		G15792  -  SET NPHSTM 12FR 30CM STRL LTX 20CM COPE LOOP NDL GW DIL CNCT	BOTH IP/OP	$32.90 	$24.35	$0.00	$26.32	$17.86	$17.86	$0.00	$0.00	$0.00	$6.86	$24.42	$24.42	$0.00	$0.00	$6.86	$0.00	$19.46	$19.46	$0.00	$16.45	$26.06	$26.32	$0.00		$0.00	$5.15	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$0.00
G15803	SUP	HCPCS C1758		G15803  -  CATHETER URET .038IN 5FR 120CM FLXTP OP-EN GW MOD	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G15821	SUP	HCPCS C1758		G15821  -  CATHETER URET 9FR 15CM WHSTLTP MOD LT	BOTH IP/OP	$31.63 	$23.41	$0.00	$25.30	$17.17	$17.17	$0.00	$0.00	$0.00	$6.59	$23.47	$23.47	$0.00	$0.00	$6.59	$0.00	$18.71	$18.71	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
G15859	SUP	HCPCS C1758		G15859  -  CATHETER URET 3FR 125CM RND TIP STY LT	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G15864	SUP	Custom 27203010		G15864  -  CATHETER URET 4FR 90CM WHSTLTP MOD RT	BOTH IP/OP	$69.58 	$51.49	$0.00	$55.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.64	$51.64	$0.00	$0.00	$14.50	$0.00	$0.00	$0.00	$0.00	$34.79	$55.11	$55.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G15871	SUP	HCPCS C1758		G15871  -  NEEDLE INJ 20GA 5FR 35CM 7MM WMS CSCP	BOTH IP/OP	$100.25 	$74.19	$0.00	$80.20	$54.44	$54.44	$0.00	$0.00	$0.00	$20.89	$74.41	$74.41	$0.00	$0.00	$20.89	$0.00	$59.30	$59.30	$0.00	$50.13	$79.40	$80.20	$0.00		$0.00	$15.69	$0.00	$0.00	$15.96	$0.00	$0.00	$0.00	$0.00	$0.00
G15873	SUP	HCPCS C1726		G15873  -  CATHETER URET PGTL CRV 8.2FR 56CM SFLX	BOTH IP/OP	$49.10 	$36.33	$0.00	$39.28	$26.66	$26.66	$0.00	$0.00	$0.00	$10.23	$36.44	$36.44	$0.00	$0.00	$10.23	$0.00	$29.04	$29.04	$0.00	$24.55	$38.89	$39.28	$0.00		$0.00	$7.68	$0.00	$0.00	$7.82	$0.00	$0.00	$0.00	$0.00	$0.00
G15875	SUP	HCPCS C2625		G15875  -  CATHETER URDY 7.4FR 30CM 3 LUM	BOTH IP/OP	$259.33 	$191.90	$0.00	$207.46	$116.70	$116.70	$0.00	$0.00	$0.00	$54.05	$192.47	$192.47	$0.00	$0.00	$54.04	$0.00	$153.39	$153.39	$0.00	$129.66	$205.39	$207.46	$0.00		$0.00	$40.58	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
G15876	SUP	HCPCS C2625		G15876  -  SET STNT .038IN 5MM PGTL CRV 8.4FR 90CM STRL 125CM BNDR CATH	BOTH IP/OP	$225.50 	$166.87	$0.00	$180.40	$101.48	$101.48	$0.00	$0.00	$0.00	$47.00	$167.37	$167.37	$0.00	$0.00	$46.99	$0.00	$133.38	$133.38	$0.00	$112.75	$178.60	$180.40	$0.00		$0.00	$35.29	$0.00	$0.00	$35.90	$0.00	$0.00	$0.00	$0.00	$0.00
G15877	SUP	HCPCS C2625		G15877  -  SET STNT .038IN 5MM PGTL CRV 7.2FR 90CM STRL 125CM BNDR CATH	BOTH IP/OP	$259.33 	$191.90	$0.00	$207.46	$116.70	$116.70	$0.00	$0.00	$0.00	$54.05	$192.47	$192.47	$0.00	$0.00	$54.04	$0.00	$153.39	$153.39	$0.00	$129.66	$205.39	$207.46	$0.00		$0.00	$40.58	$0.00	$0.00	$41.28	$0.00	$0.00	$0.00	$0.00	$0.00
G15878	SUP	HCPCS C2625		G15878  -  SET STNT .038IN 5MM PGTL CRV 8.4FR 90CM STRL 125CM BNDR CATH	BOTH IP/OP	$225.50 	$166.87	$0.00	$180.40	$101.48	$101.48	$0.00	$0.00	$0.00	$47.00	$167.37	$167.37	$0.00	$0.00	$46.99	$0.00	$133.38	$133.38	$0.00	$112.75	$178.60	$180.40	$0.00		$0.00	$35.29	$0.00	$0.00	$35.90	$0.00	$0.00	$0.00	$0.00	$0.00
G15885	SUP	HCPCS C1758		G15885  -  SET STNT .038IN 5MM PGTL CRV 7.2FR 90CM STRL 125CM BNDR CATH	BOTH IP/OP	$36.30 	$26.86	$0.00	$29.04	$19.71	$19.71	$0.00	$0.00	$0.00	$7.57	$26.94	$26.94	$0.00	$0.00	$7.56	$0.00	$21.47	$21.47	$0.00	$18.15	$28.75	$29.04	$0.00		$0.00	$5.68	$0.00	$0.00	$5.78	$0.00	$0.00	$0.00	$0.00	$0.00
G15889	SUP	HCPCS C1758		G15889  -  CATHETER URET 3FR 70CM STF STY PED	BOTH IP/OP	$39.95 	$29.56	$0.00	$31.96	$21.69	$21.69	$0.00	$0.00	$0.00	$8.33	$29.65	$29.65	$0.00	$0.00	$8.33	$0.00	$23.63	$23.63	$0.00	$19.98	$31.64	$31.96	$0.00		$0.00	$6.25	$0.00	$0.00	$6.36	$0.00	$0.00	$0.00	$0.00	$0.00
G15899	SUP	HCPCS C1726		G15899  -  CATHETER URET .038IN 5FR 70CM FLXTP OP-EN GW MOD	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$24.44	$24.44	$0.00	$0.00	$0.00	$9.38	$33.40	$33.40	$0.00	$0.00	$9.38	$0.00	$26.62	$26.62	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$7.04	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00
G15924	SUP	HCPCS C2617		G15924  -  POUCH DRN 300ML STRL SFT ELC BELT REED VLV MECH REUSE	BOTH IP/OP	$76.63 	$56.71	$0.00	$61.30	$34.48	$34.48	$0.00	$0.00	$0.00	$15.97	$56.87	$56.87	$0.00	$0.00	$15.97	$0.00	$45.32	$45.32	$0.00	$38.31	$60.69	$61.30	$0.00		$0.00	$11.99	$0.00	$0.00	$12.20	$0.00	$0.00	$0.00	$0.00	$0.00
G15925	SUP	HCPCS C1729		G15925  -  STENT URTH 8FR 40CM STRL FRLT KLG CNTR BLB SIL DISP	BOTH IP/OP	$404.80 	$299.55	$0.00	$323.84	$219.81	$219.81	$0.00	$0.00	$0.00	$84.37	$300.44	$300.44	$0.00	$0.00	$84.36	$0.00	$239.44	$239.44	$0.00	$202.40	$320.60	$323.84	$0.00		$0.00	$63.35	$0.00	$0.00	$64.44	$0.00	$0.00	$0.00	$0.00	$0.00
G15929	SUP	HCPCS C2617		G15929  -  SET NPHSTM 10FR 19.5CM LTX COPE LOOP MOD CATH GW RTNT DISK	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G15934	SUP	HCPCS C1769		G15934  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 14CM STRL CP MDRL	BOTH IP/OP	$58.65 	$43.40	$0.00	$46.92	$31.85	$31.85	$0.00	$0.00	$0.00	$12.22	$43.53	$43.53	$0.00	$0.00	$12.22	$0.00	$34.69	$34.69	$0.00	$29.33	$46.45	$46.92	$0.00		$0.00	$9.18	$0.00	$0.00	$9.34	$0.00	$0.00	$0.00	$0.00	$0.00
G15935	SUP	HCPCS C1769		G15935  -  GUIDEWIRE ESCP STD STRG .025IN 145CM 3CM FLX TP FXCR SS	BOTH IP/OP	$52.08 	$38.54	$0.00	$41.66	$28.28	$28.28	$0.00	$0.00	$0.00	$10.85	$38.65	$38.65	$0.00	$0.00	$10.85	$0.00	$30.80	$30.80	$0.00	$26.04	$41.25	$41.66	$0.00		$0.00	$8.15	$0.00	$0.00	$8.29	$0.00	$0.00	$0.00	$0.00	$0.00
G16019	SUP	HCPCS C2617		G16019  -  TUBE CNCT 14FR 30CM STRL 2 DRN PCH	BOTH IP/OP	$253.45 	$187.55	$0.00	$202.76	$114.05	$114.05	$0.00	$0.00	$0.00	$52.83	$188.11	$188.11	$0.00	$0.00	$52.82	$0.00	$149.92	$149.92	$0.00	$126.73	$200.73	$202.76	$0.00		$0.00	$39.66	$0.00	$0.00	$40.35	$0.00	$0.00	$0.00	$0.00	$0.00
G16020	SUP	HCPCS C2617		G16020  -  SET STNT .035IN SM 2 PGTL CRV 4.7FR 4FR 10CM STRL CATH	BOTH IP/OP	$253.45 	$187.55	$0.00	$202.76	$114.05	$114.05	$0.00	$0.00	$0.00	$52.83	$188.11	$188.11	$0.00	$0.00	$52.82	$0.00	$149.92	$149.92	$0.00	$126.73	$200.73	$202.76	$0.00		$0.00	$39.66	$0.00	$0.00	$40.35	$0.00	$0.00	$0.00	$0.00	$0.00
G16021	SUP	HCPCS C2617		G16021  -  SET STNT .035IN SM 2 PGTL CRV 4.7FR 4FR 14CM STRL CATH	BOTH IP/OP	$253.45 	$187.55	$0.00	$202.76	$114.05	$114.05	$0.00	$0.00	$0.00	$52.83	$188.11	$188.11	$0.00	$0.00	$52.82	$0.00	$149.92	$149.92	$0.00	$126.73	$200.73	$202.76	$0.00		$0.00	$39.66	$0.00	$0.00	$40.35	$0.00	$0.00	$0.00	$0.00	$0.00
G16035	SUP	HCPCS C2617		G16035  -  SET STNT .035IN SM 2 PGTL CRV 4.7FR 4FR 16CM STRL CATH	BOTH IP/OP	$253.45 	$187.55	$0.00	$202.76	$114.05	$114.05	$0.00	$0.00	$0.00	$52.83	$188.11	$188.11	$0.00	$0.00	$52.82	$0.00	$149.92	$149.92	$0.00	$126.73	$200.73	$202.76	$0.00		$0.00	$39.66	$0.00	$0.00	$40.35	$0.00	$0.00	$0.00	$0.00	$0.00
G16040	SUP	HCPCS C2617		G16040  -  SET STNT .038IN SM 2 PGTL CRV 7FR 4FR 12CM STRL CATH RADOPQ	BOTH IP/OP	$253.45 	$187.55	$0.00	$202.76	$114.05	$114.05	$0.00	$0.00	$0.00	$52.83	$188.11	$188.11	$0.00	$0.00	$52.82	$0.00	$149.92	$149.92	$0.00	$126.73	$200.73	$202.76	$0.00		$0.00	$39.66	$0.00	$0.00	$40.35	$0.00	$0.00	$0.00	$0.00	$0.00
G16112	SUP	Custom 27203010		G16112  -  SET STNT .038IN SM 2 PGTL CRV 6FR 4FR 14CM STRL CATH RADOPQ	BOTH IP/OP	$69.58 	$51.49	$0.00	$55.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.64	$51.64	$0.00	$0.00	$14.50	$0.00	$0.00	$0.00	$0.00	$34.79	$55.11	$55.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G16116	SUP	HCPCS C1726		G16116  -  NEEDLE INJ 23GA 5FR 45CM 8MM WMS CSCP	BOTH IP/OP	$587.60 	$434.82	$0.00	$470.08	$319.07	$319.07	$0.00	$0.00	$0.00	$122.47	$436.12	$436.12	$0.00	$0.00	$122.46	$0.00	$347.57	$347.57	$0.00	$293.80	$465.38	$470.08	$0.00		$0.00	$91.96	$0.00	$0.00	$93.55	$0.00	$0.00	$0.00	$0.00	$0.00
G16120	SUP	HCPCS C2627		G16120  -  SET DIL 6-30FR 30CM 16CM AMPTZ MOD RADOPQ SHTH RNL	BOTH IP/OP	$215.05 	$159.14	$0.00	$172.04	$116.77	$116.77	$0.00	$0.00	$0.00	$0.00	$159.61	$159.61	$0.00	$0.00	$44.82	$0.00	$0.00	$0.00	$0.00	$107.53	$170.32	$172.04	$0.00		$0.00	$33.66	$0.00	$0.00	$34.24	$0.00	$0.00	$0.00	$0.00	$0.00
G16121	SUP	HCPCS C1769		G16121  -  INTRODUCER NPHSTM 18FR 12CM OB PLWY ACC SET GW TROC NDL SPBC	BOTH IP/OP	$215.05 	$159.14	$0.00	$172.04	$116.77	$116.77	$0.00	$0.00	$0.00	$44.82	$159.61	$159.61	$0.00	$0.00	$44.82	$0.00	$127.20	$127.20	$0.00	$107.53	$170.32	$172.04	$0.00		$0.00	$33.66	$0.00	$0.00	$34.24	$0.00	$0.00	$0.00	$0.00	$0.00
G16122	SUP	HCPCS C1769		G16122  -  SET CATH TROC 20FR 12CM OB PLWY INTRO NDL GW SPBC	BOTH IP/OP	$215.05 	$159.14	$0.00	$172.04	$116.77	$116.77	$0.00	$0.00	$0.00	$44.82	$159.61	$159.61	$0.00	$0.00	$44.82	$0.00	$127.20	$127.20	$0.00	$107.53	$170.32	$172.04	$0.00		$0.00	$33.66	$0.00	$0.00	$34.24	$0.00	$0.00	$0.00	$0.00	$0.00
G16123	SUP	HCPCS C1769		G16123  -  INTRODUCER NPHSTM 22FR 12CM PLWY ACC SET GW TROC NDL	BOTH IP/OP	$215.05 	$159.14	$0.00	$172.04	$116.77	$116.77	$0.00	$0.00	$0.00	$44.82	$159.61	$159.61	$0.00	$0.00	$44.82	$0.00	$127.20	$127.20	$0.00	$107.53	$170.32	$172.04	$0.00		$0.00	$33.66	$0.00	$0.00	$34.24	$0.00	$0.00	$0.00	$0.00	$0.00
G16187	SUP	HCPCS C2625		G16187  -  POUCH DRN STRL BELT PLS ADJ REUSE	BOTH IP/OP	$160.30 	$118.62	$0.00	$128.24	$72.14	$72.14	$0.00	$0.00	$0.00	$33.41	$118.97	$118.97	$0.00	$0.00	$33.41	$0.00	$94.82	$94.82	$0.00	$80.15	$126.96	$128.24	$0.00		$0.00	$25.09	$0.00	$0.00	$25.52	$0.00	$0.00	$0.00	$0.00	$0.00
G16198	SUP	HCPCS C2627		G16198  -  CATHETER URET .038IN 5FR 120CM OP-EN GW MOD	BOTH IP/OP	$165.73 	$122.64	$0.00	$132.58	$89.99	$89.99	$0.00	$0.00	$0.00	$0.00	$123.00	$123.00	$0.00	$0.00	$34.54	$0.00	$0.00	$0.00	$0.00	$82.86	$131.26	$132.58	$0.00		$0.00	$25.94	$0.00	$0.00	$26.38	$0.00	$0.00	$0.00	$0.00	$0.00
G16226	SUP	HCPCS C2617		G16226  -  SET CATH 10FR 22CM RTNR BLN SPBC	BOTH IP/OP	$317.75 	$235.14	$0.00	$254.20	$142.99	$142.99	$0.00	$0.00	$0.00	$66.23	$235.83	$235.83	$0.00	$0.00	$66.22	$0.00	$187.95	$187.95	$0.00	$158.88	$251.66	$254.20	$0.00		$0.00	$49.73	$0.00	$0.00	$50.59	$0.00	$0.00	$0.00	$0.00	$0.00
G16227	SUP	HCPCS C2617		G16227  -  SET STNT 5FR 8-20CM GRN GW CATH PSTNR RNL TRNSPLNT	BOTH IP/OP	$317.75 	$235.14	$0.00	$254.20	$142.99	$142.99	$0.00	$0.00	$0.00	$66.23	$235.83	$235.83	$0.00	$0.00	$66.22	$0.00	$187.95	$187.95	$0.00	$158.88	$251.66	$254.20	$0.00		$0.00	$49.73	$0.00	$0.00	$50.59	$0.00	$0.00	$0.00	$0.00	$0.00
G16228	SUP	HCPCS C2617		G16228  -  SET STNT .028IN 6FR 8-20CM GRN STRL 145CM GRN CATH MTLNTH	BOTH IP/OP	$365.43 	$270.42	$0.00	$292.34	$164.44	$164.44	$0.00	$0.00	$0.00	$76.16	$271.22	$271.22	$0.00	$0.00	$76.15	$0.00	$216.15	$216.15	$0.00	$182.71	$289.42	$292.34	$0.00		$0.00	$57.19	$0.00	$0.00	$58.18	$0.00	$0.00	$0.00	$0.00	$0.00
G16229	SUP	HCPCS C2617		G16229  -  SET STNT 6FR 22-32CM GRN GW CATH PSTNR RNL TRNSPLNT	BOTH IP/OP	$317.75 	$235.14	$0.00	$254.20	$142.99	$142.99	$0.00	$0.00	$0.00	$66.23	$235.83	$235.83	$0.00	$0.00	$66.22	$0.00	$187.95	$187.95	$0.00	$158.88	$251.66	$254.20	$0.00		$0.00	$49.73	$0.00	$0.00	$50.59	$0.00	$0.00	$0.00	$0.00	$0.00
G16230	SUP	HCPCS C2617		G16230  -  SET STNT 7FR 8-20CM GRN GW CATH PSTNR RNL TRNSPLNT	BOTH IP/OP	$317.75 	$235.14	$0.00	$254.20	$142.99	$142.99	$0.00	$0.00	$0.00	$66.23	$235.83	$235.83	$0.00	$0.00	$66.22	$0.00	$187.95	$187.95	$0.00	$158.88	$251.66	$254.20	$0.00		$0.00	$49.73	$0.00	$0.00	$50.59	$0.00	$0.00	$0.00	$0.00	$0.00
G16658	SUP	HCPCS C1769		G16658  -  SET STNT 8.5FR 8-20CM GRN GW CATH PSTNR RNL TRNSPLNT	BOTH IP/OP	$465.53 	$344.49	$0.00	$372.42	$252.78	$252.78	$0.00	$0.00	$0.00	$97.03	$345.51	$345.51	$0.00	$0.00	$97.02	$0.00	$275.36	$275.36	$0.00	$232.76	$368.70	$372.42	$0.00		$0.00	$72.85	$0.00	$0.00	$74.11	$0.00	$0.00	$0.00	$0.00	$0.00
G16672	SUP	Custom 27203010		G16672  -  SET NPHSTM 12FR 19.5CM LTX COPE LOOP MOD CATH GW RTNT DISK	BOTH IP/OP	$482.33 	$356.92	$0.00	$385.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$357.98	$357.98	$0.00	$0.00	$100.52	$0.00	$0.00	$0.00	$0.00	$241.16	$382.01	$385.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G16684	SUP	Custom 27203010		G16684  -  EXTRACTOR STON FLT 3FR 115CM 4WR BSKT LSR PLMD	BOTH IP/OP	$60.50 	$44.77	$0.00	$48.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.90	$44.90	$0.00	$0.00	$12.61	$0.00	$0.00	$0.00	$0.00	$30.25	$47.92	$48.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G16695	SUP	Custom 27203010		G16695  -  NEEDLE INJ 23GA 3.7FR 35CM 8MM WMS CSCP	BOTH IP/OP	$73.15 	$54.13	$0.00	$58.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.29	$54.29	$0.00	$0.00	$15.24	$0.00	$0.00	$0.00	$0.00	$36.58	$57.93	$58.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G16696	SUP	HCPCS C2627		G16696  -  CATHETER PRSS 12FR 36CM 2CM BLN SIL RCTL	BOTH IP/OP	$166.10 	$122.91	$0.00	$132.88	$90.19	$90.19	$0.00	$0.00	$0.00	$0.00	$123.28	$123.28	$0.00	$0.00	$34.62	$0.00	$0.00	$0.00	$0.00	$83.05	$131.55	$132.88	$0.00		$0.00	$25.99	$0.00	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$0.00
G16699	SUP	HCPCS C2627		G16699  -  SET CATH TROC 8FR 54CM STRL DRN ADPR SPBC CYSTOSTOMY	BOTH IP/OP	$166.10 	$122.91	$0.00	$132.88	$90.19	$90.19	$0.00	$0.00	$0.00	$0.00	$123.28	$123.28	$0.00	$0.00	$34.62	$0.00	$0.00	$0.00	$0.00	$83.05	$131.55	$132.88	$0.00		$0.00	$25.99	$0.00	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$0.00
G16702	SUP	HCPCS C1773		G16702  -  SET CATH LOPRFL STD 10FR 54CM STRL TROC STY PLS DRN ADPR	BOTH IP/OP	$397.80 	$294.37	$0.00	$318.24	$216.01	$216.01	$0.00	$0.00	$0.00	$82.91	$295.25	$295.25	$0.00	$0.00	$82.90	$0.00	$235.30	$235.30	$0.00	$198.90	$315.06	$318.24	$0.00		$0.00	$62.26	$0.00	$0.00	$63.33	$0.00	$0.00	$0.00	$0.00	$0.00
G16705	SUP	HCPCS C1726		G16705  -  FORCEPS SPEC RTRVL 2.5FR 10MM 115CM COAX SHTH GRSP	BOTH IP/OP	$98.20 	$72.67	$0.00	$78.56	$53.32	$53.32	$0.00	$0.00	$0.00	$20.47	$72.88	$72.88	$0.00	$0.00	$20.46	$0.00	$58.09	$58.09	$0.00	$49.10	$77.77	$78.56	$0.00		$0.00	$15.37	$0.00	$0.00	$15.63	$0.00	$0.00	$0.00	$0.00	$0.00
G16708	SUP	HCPCS C1758		G16708  -  CATHETER URDY 7FR 43CM STRL 2 LUM LOOP URETHRA DISP	BOTH IP/OP	$28.60 	$21.16	$0.00	$22.88	$15.53	$15.53	$0.00	$0.00	$0.00	$5.96	$21.23	$21.23	$0.00	$0.00	$5.96	$0.00	$16.92	$16.92	$0.00	$14.30	$22.65	$22.88	$0.00		$0.00	$4.48	$0.00	$0.00	$4.55	$0.00	$0.00	$0.00	$0.00	$0.00
G16731	SUP	HCPCS C2617		G16731  -  CATHETER URET .038IN 6FR 10CM FLXTP OP-EN GW MOD	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G16740	SUP	HCPCS C2627		G16740  -  SET CATH 12FR 16GA 30CM UNIVERSA MLCT 1 WY STPCK CNCT TUBE	BOTH IP/OP	$166.10 	$122.91	$0.00	$132.88	$90.19	$90.19	$0.00	$0.00	$0.00	$0.00	$123.28	$123.28	$0.00	$0.00	$34.62	$0.00	$0.00	$0.00	$0.00	$83.05	$131.55	$132.88	$0.00		$0.00	$25.99	$0.00	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$0.00
G16758	SUP	HCPCS C2617		G16758  -  SET STNT .038IN CDE 3FR 4FR 8-12CM STRL CATH RADOPQ MTLNTH	BOTH IP/OP	$66.63 	$49.31	$0.00	$53.30	$29.98	$29.98	$0.00	$0.00	$0.00	$13.89	$49.45	$49.45	$0.00	$0.00	$13.88	$0.00	$39.41	$39.41	$0.00	$33.31	$52.77	$53.30	$0.00		$0.00	$10.43	$0.00	$0.00	$10.61	$0.00	$0.00	$0.00	$0.00	$0.00
G16775	SUP	Custom 27203010		G16775  -  STENT URTH 6FR 12CM STRL ZAONTZ PS DRN DISP HYPOSPADIAS	BOTH IP/OP	$78.10 	$57.79	$0.00	$62.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.97	$57.97	$0.00	$0.00	$16.28	$0.00	$0.00	$0.00	$0.00	$39.05	$61.86	$62.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G16780	SUP	HCPCS C1726		G16780  -  NEEDLE ESCP 4.5MM 18GA 10CM INCISING RNL FSCA	BOTH IP/OP	$49.10 	$36.33	$0.00	$39.28	$26.66	$26.66	$0.00	$0.00	$0.00	$10.23	$36.44	$36.44	$0.00	$0.00	$10.23	$0.00	$29.04	$29.04	$0.00	$24.55	$38.89	$39.28	$0.00		$0.00	$7.68	$0.00	$0.00	$7.82	$0.00	$0.00	$0.00	$0.00	$0.00
G16783	SUP	HCPCS C1758		G16783  -  CATHETER URDY 7FR 30CM 2 LUM	BOTH IP/OP	$31.63 	$23.41	$0.00	$25.30	$17.17	$17.17	$0.00	$0.00	$0.00	$6.59	$23.47	$23.47	$0.00	$0.00	$6.59	$0.00	$18.71	$18.71	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
G16784	SUP	HCPCS C1758		G16784  -  CATHETER URET 4FR 110CM RND TIP RT	BOTH IP/OP	$31.63 	$23.41	$0.00	$25.30	$17.17	$17.17	$0.00	$0.00	$0.00	$6.59	$23.47	$23.47	$0.00	$0.00	$6.59	$0.00	$18.71	$18.71	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
G16791	SUP	HCPCS C2627		G16791  -  CATHETER URET 3FR 70CM RND TIP STY PORT LT	BOTH IP/OP	$50.60 	$37.44	$0.00	$40.48	$27.48	$27.48	$0.00	$0.00	$0.00	$0.00	$37.56	$37.56	$0.00	$0.00	$10.55	$0.00	$0.00	$0.00	$0.00	$25.30	$40.08	$40.48	$0.00		$0.00	$7.92	$0.00	$0.00	$8.06	$0.00	$0.00	$0.00	$0.00	$0.00
G16792	SUP	HCPCS C1758		G16792  -  CATHETER SPBC 8FR 54CM CYSTOSTOMY SFT LOPRFL	BOTH IP/OP	$35.43 	$26.22	$0.00	$28.34	$19.24	$19.24	$0.00	$0.00	$0.00	$7.38	$26.29	$26.29	$0.00	$0.00	$7.38	$0.00	$20.95	$20.95	$0.00	$17.71	$28.06	$28.34	$0.00		$0.00	$5.54	$0.00	$0.00	$5.64	$0.00	$0.00	$0.00	$0.00	$0.00
G16816	SUP	HCPCS C1729		G16816  -  CATHETER URET .038IN 5FR 70CM FLXTP OP-EN GW MOD	BOTH IP/OP	$216.33 	$160.08	$0.00	$173.06	$117.46	$117.46	$0.00	$0.00	$0.00	$45.09	$160.56	$160.56	$0.00	$0.00	$45.08	$0.00	$127.96	$127.96	$0.00	$108.16	$171.33	$173.06	$0.00		$0.00	$33.85	$0.00	$0.00	$34.44	$0.00	$0.00	$0.00	$0.00	$0.00
G16817	SUP	HCPCS C2625		G16817  -  SET NPHSTM 12FR 40CM COPE LOOP MOD NDL GW CNN DIL	BOTH IP/OP	$139.40 	$103.16	$0.00	$111.52	$62.73	$62.73	$0.00	$0.00	$0.00	$29.05	$103.46	$103.46	$0.00	$0.00	$29.05	$0.00	$82.46	$82.46	$0.00	$69.70	$110.40	$111.52	$0.00		$0.00	$21.82	$0.00	$0.00	$22.19	$0.00	$0.00	$0.00	$0.00	$0.00
G16818	SUP	HCPCS C2625		G16818  -  SET STNT .038IN 5MM 6FR 75CM STRL 100CM BNDR CATH RADOPQ	BOTH IP/OP	$139.40 	$103.16	$0.00	$111.52	$62.73	$62.73	$0.00	$0.00	$0.00	$29.05	$103.46	$103.46	$0.00	$0.00	$29.05	$0.00	$82.46	$82.46	$0.00	$69.70	$110.40	$111.52	$0.00		$0.00	$21.82	$0.00	$0.00	$22.19	$0.00	$0.00	$0.00	$0.00	$0.00
G16820	SUP	HCPCS C2617		G16820  -  SET STNT .038IN 5MM 6FR 75CM STRL 100CM BNDR CATH RADOPQ	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G16821	SUP	HCPCS C2617		G16821  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 16CM STRL CP MDRL CATH	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G16876	SUP	HCPCS C1769		G16876  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 20CM STRL CP MDRL CATH	BOTH IP/OP	$39.33 	$29.10	$0.00	$31.46	$21.35	$21.35	$0.00	$0.00	$0.00	$8.20	$29.19	$29.19	$0.00	$0.00	$8.20	$0.00	$23.26	$23.26	$0.00	$19.66	$31.15	$31.46	$0.00		$0.00	$6.15	$0.00	$0.00	$6.26	$0.00	$0.00	$0.00	$0.00	$0.00
G16880	SUP	HCPCS C2617		G16880  -  GUIDEWIRE ESCP 70CM STD STRG .038IN 145CM STRL 3CM FXCR FLX	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G16881	SUP	HCPCS C2617		G16881  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 22CM STRL CP MDRL CATH	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G16890	SUP	HCPCS C1758		G16890  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 24CM STRL CP MDRL CATH	BOTH IP/OP	$182.45 	$135.01	$0.00	$145.96	$99.07	$99.07	$0.00	$0.00	$0.00	$38.03	$135.41	$135.41	$0.00	$0.00	$38.02	$0.00	$107.92	$107.92	$0.00	$91.23	$144.50	$145.96	$0.00		$0.00	$28.55	$0.00	$0.00	$29.05	$0.00	$0.00	$0.00	$0.00	$0.00
G16893	SUP	HCPCS C1726		G16893  -  SET CATH 7.5FR 25CM DEWAN URDY NDL SF WRE PLWY SHTH DIL SPBC	BOTH IP/OP	$510.95 	$378.10	$0.00	$408.76	$277.45	$277.45	$0.00	$0.00	$0.00	$106.49	$379.23	$379.23	$0.00	$0.00	$106.48	$0.00	$302.23	$302.23	$0.00	$255.48	$404.67	$408.76	$0.00		$0.00	$79.96	$0.00	$0.00	$81.34	$0.00	$0.00	$0.00	$0.00	$0.00
G16919	SUP	HCPCS C2627		G16919  -  SYSTEM IRR URTSCP	BOTH IP/OP	$205.38 	$151.98	$0.00	$164.30	$111.52	$111.52	$0.00	$0.00	$0.00	$0.00	$152.43	$152.43	$0.00	$0.00	$42.80	$0.00	$0.00	$0.00	$0.00	$102.69	$162.66	$164.30	$0.00		$0.00	$32.14	$0.00	$0.00	$32.70	$0.00	$0.00	$0.00	$0.00	$0.00
G16920	SUP	HCPCS C2627		G16920  -  CATHETER SPBC 8FR 20CM STRL MLCT SIL DISP	BOTH IP/OP	$205.38 	$151.98	$0.00	$164.30	$111.52	$111.52	$0.00	$0.00	$0.00	$0.00	$152.43	$152.43	$0.00	$0.00	$42.80	$0.00	$0.00	$0.00	$0.00	$102.69	$162.66	$164.30	$0.00		$0.00	$32.14	$0.00	$0.00	$32.70	$0.00	$0.00	$0.00	$0.00	$0.00
G16921	SUP	HCPCS C2627		G16921  -  CATHETER SPBC 10FR 20CM MLCT WNG SFT SIL	BOTH IP/OP	$205.38 	$151.98	$0.00	$164.30	$111.52	$111.52	$0.00	$0.00	$0.00	$0.00	$152.43	$152.43	$0.00	$0.00	$42.80	$0.00	$0.00	$0.00	$0.00	$102.69	$162.66	$164.30	$0.00		$0.00	$32.14	$0.00	$0.00	$32.70	$0.00	$0.00	$0.00	$0.00	$0.00
G16922	SUP	HCPCS C2627		G16922  -  CATHETER SPBC 12FR 20CM STRL MLCT SIL DISP	BOTH IP/OP	$205.38 	$151.98	$0.00	$164.30	$111.52	$111.52	$0.00	$0.00	$0.00	$0.00	$152.43	$152.43	$0.00	$0.00	$42.80	$0.00	$0.00	$0.00	$0.00	$102.69	$162.66	$164.30	$0.00		$0.00	$32.14	$0.00	$0.00	$32.70	$0.00	$0.00	$0.00	$0.00	$0.00
G16923	SUP	HCPCS C2627		G16923  -  CATHETER SPBC 14FR 25CM STRL MLCT WNG SIL DISP	BOTH IP/OP	$205.38 	$151.98	$0.00	$164.30	$111.52	$111.52	$0.00	$0.00	$0.00	$0.00	$152.43	$152.43	$0.00	$0.00	$42.80	$0.00	$0.00	$0.00	$0.00	$102.69	$162.66	$164.30	$0.00		$0.00	$32.14	$0.00	$0.00	$32.70	$0.00	$0.00	$0.00	$0.00	$0.00
G16924	SUP	HCPCS C2627		G16924  -  CATHETER SPBC 16FR 25CM STRL MLCT WNG SIL DISP	BOTH IP/OP	$205.38 	$151.98	$0.00	$164.30	$111.52	$111.52	$0.00	$0.00	$0.00	$0.00	$152.43	$152.43	$0.00	$0.00	$42.80	$0.00	$0.00	$0.00	$0.00	$102.69	$162.66	$164.30	$0.00		$0.00	$32.14	$0.00	$0.00	$32.70	$0.00	$0.00	$0.00	$0.00	$0.00
G16925	SUP	HCPCS C2627		G16925  -  CATHETER SPBC 18FR 25CM MLCT WNG SFT SIL	BOTH IP/OP	$205.38 	$151.98	$0.00	$164.30	$111.52	$111.52	$0.00	$0.00	$0.00	$0.00	$152.43	$152.43	$0.00	$0.00	$42.80	$0.00	$0.00	$0.00	$0.00	$102.69	$162.66	$164.30	$0.00		$0.00	$32.14	$0.00	$0.00	$32.70	$0.00	$0.00	$0.00	$0.00	$0.00
G16926	SUP	HCPCS C2627		G16926  -  CATHETER SPBC 20FR 25CM STRL MLCT WNG SIL DISP	BOTH IP/OP	$205.38 	$151.98	$0.00	$164.30	$111.52	$111.52	$0.00	$0.00	$0.00	$0.00	$152.43	$152.43	$0.00	$0.00	$42.80	$0.00	$0.00	$0.00	$0.00	$102.69	$162.66	$164.30	$0.00		$0.00	$32.14	$0.00	$0.00	$32.70	$0.00	$0.00	$0.00	$0.00	$0.00
G16927	SUP	HCPCS C2627		G16927  -  CATHETER SPBC 22FR 25CM STRL MLCT WNG SIL DISP	BOTH IP/OP	$205.38 	$151.98	$0.00	$164.30	$111.52	$111.52	$0.00	$0.00	$0.00	$0.00	$152.43	$152.43	$0.00	$0.00	$42.80	$0.00	$0.00	$0.00	$0.00	$102.69	$162.66	$164.30	$0.00		$0.00	$32.14	$0.00	$0.00	$32.70	$0.00	$0.00	$0.00	$0.00	$0.00
G16938	SUP	HCPCS C2625		G16938  -  CATHETER SPBC 24FR 25CM STRL MLCT WNG SFT SIL	BOTH IP/OP	$160.30 	$118.62	$0.00	$128.24	$72.14	$72.14	$0.00	$0.00	$0.00	$33.41	$118.97	$118.97	$0.00	$0.00	$33.41	$0.00	$94.82	$94.82	$0.00	$80.15	$126.96	$128.24	$0.00		$0.00	$25.09	$0.00	$0.00	$25.52	$0.00	$0.00	$0.00	$0.00	$0.00
G16939	SUP	Custom 27203010		G16939  -  SET STNT .038IN 5MM PGTL CRV TPR 7FR 75CM STRL 100CM BNDR	BOTH IP/OP	$266.20 	$196.99	$0.00	$212.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.57	$197.57	$0.00	$0.00	$55.48	$0.00	$0.00	$0.00	$0.00	$133.10	$210.83	$212.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G16940	SUP	Custom 27203010		G16940  -  SET NPHSTM 16.8CM NDL GW PERC	BOTH IP/OP	$306.13 	$226.54	$0.00	$244.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.21	$227.21	$0.00	$0.00	$63.80	$0.00	$0.00	$0.00	$0.00	$153.06	$242.45	$244.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G16987	SUP	HCPCS C1726		G16987  -  SET NPHSTM NDL SHTH PERC	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$60.27	$60.27	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00		$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
G16989	SUP	HCPCS C1758		G16989  -  CATHETER URDY 7.4FR 30CM 3 LUM CDE OVL PORT BLN	BOTH IP/OP	$31.63 	$23.41	$0.00	$25.30	$17.17	$17.17	$0.00	$0.00	$0.00	$6.59	$23.47	$23.47	$0.00	$0.00	$6.59	$0.00	$18.71	$18.71	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
G16992	SUP	HCPCS C2625		G16992  -  CATHETER URET .038IN 5FR 70CM OP-EN GW	BOTH IP/OP	$235.75 	$174.46	$0.00	$188.60	$106.09	$106.09	$0.00	$0.00	$0.00	$49.14	$174.97	$174.97	$0.00	$0.00	$49.13	$0.00	$139.45	$139.45	$0.00	$117.88	$186.71	$188.60	$0.00		$0.00	$36.89	$0.00	$0.00	$37.53	$0.00	$0.00	$0.00	$0.00	$0.00
G16993	SUP	HCPCS C2625		G16993  -  SET STNT .038IN 5MM PGTL CRV 4.7FR 75CM STRL 100CM BNDR CATH	BOTH IP/OP	$379.25 	$280.65	$0.00	$303.40	$170.66	$170.66	$0.00	$0.00	$0.00	$79.05	$281.48	$281.48	$0.00	$0.00	$79.04	$0.00	$224.33	$224.33	$0.00	$189.63	$300.37	$303.40	$0.00		$0.00	$59.35	$0.00	$0.00	$60.38	$0.00	$0.00	$0.00	$0.00	$0.00
G16994	SUP	HCPCS C2625		G16994  -  SET STNT .038IN 5MM PGTL CRV 8.4FR 90CM STRL 125CM BNDR CATH	BOTH IP/OP	$379.25 	$280.65	$0.00	$303.40	$170.66	$170.66	$0.00	$0.00	$0.00	$79.05	$281.48	$281.48	$0.00	$0.00	$79.04	$0.00	$224.33	$224.33	$0.00	$189.63	$300.37	$303.40	$0.00		$0.00	$59.35	$0.00	$0.00	$60.38	$0.00	$0.00	$0.00	$0.00	$0.00
G16995	SUP	HCPCS C2625		G16995  -  SET STENT .038IN 5MM PIGTAIL CURVE 8.2FR 75CM 100CM CATHETER	BOTH IP/OP	$235.75 	$174.46	$0.00	$188.60	$106.09	$106.09	$0.00	$0.00	$0.00	$49.14	$174.97	$174.97	$0.00	$0.00	$49.13	$0.00	$139.45	$139.45	$0.00	$117.88	$186.71	$188.60	$0.00		$0.00	$36.89	$0.00	$0.00	$37.53	$0.00	$0.00	$0.00	$0.00	$0.00
G16996	SUP	HCPCS C2625		G16996  -  SET STNT .038IN 5MM PGTL CRV 7.2FR 90CM STRL 125CM BNDR CATH	BOTH IP/OP	$235.75 	$174.46	$0.00	$188.60	$106.09	$106.09	$0.00	$0.00	$0.00	$49.14	$174.97	$174.97	$0.00	$0.00	$49.13	$0.00	$139.45	$139.45	$0.00	$117.88	$186.71	$188.60	$0.00		$0.00	$36.89	$0.00	$0.00	$37.53	$0.00	$0.00	$0.00	$0.00	$0.00
G16997	SUP	HCPCS C2625		G16997  -  SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100CM BNDR CATH	BOTH IP/OP	$235.75 	$174.46	$0.00	$188.60	$106.09	$106.09	$0.00	$0.00	$0.00	$49.14	$174.97	$174.97	$0.00	$0.00	$49.13	$0.00	$139.45	$139.45	$0.00	$117.88	$186.71	$188.60	$0.00		$0.00	$36.89	$0.00	$0.00	$37.53	$0.00	$0.00	$0.00	$0.00	$0.00
G17013	SUP	HCPCS C1758		G17013  -  CATHETER URET .05IN 10FR 50CM STRL LF 2 INJ LUM TPR TIP	BOTH IP/OP	$79.20 	$58.61	$0.00	$63.36	$43.01	$43.01	$0.00	$0.00	$0.00	$16.51	$58.78	$58.78	$0.00	$0.00	$16.51	$0.00	$46.85	$46.85	$0.00	$39.60	$62.73	$63.36	$0.00		$0.00	$12.39	$0.00	$0.00	$12.61	$0.00	$0.00	$0.00	$0.00	$0.00
G17018	SUP	Custom 27203010		G17018  -  SET STNT .038IN 5MM PGTL CRV 6FR 75CM STRL 100CM BNDR CATH	BOTH IP/OP	$89.10 	$65.93	$0.00	$71.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.13	$66.13	$0.00	$0.00	$18.57	$0.00	$0.00	$0.00	$0.00	$44.55	$70.57	$71.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G17043	SUP	HCPCS C1726		G17043  -  TUBE CNCT 5FR 10CM M TO F LL MOD	BOTH IP/OP	$73.60 	$54.46	$0.00	$58.88	$39.96	$39.96	$0.00	$0.00	$0.00	$15.34	$54.63	$54.63	$0.00	$0.00	$15.34	$0.00	$43.53	$43.53	$0.00	$36.80	$58.29	$58.88	$0.00		$0.00	$11.52	$0.00	$0.00	$11.72	$0.00	$0.00	$0.00	$0.00	$0.00
G17051	SUP	HCPCS C1758		G17051  -  CATHETER URDY 7FR 38CM CLR JSPH 2 LUM NRDOP	BOTH IP/OP	$28.60 	$21.16	$0.00	$22.88	$15.53	$15.53	$0.00	$0.00	$0.00	$5.96	$21.23	$21.23	$0.00	$0.00	$5.96	$0.00	$16.92	$16.92	$0.00	$14.30	$22.65	$22.88	$0.00		$0.00	$4.48	$0.00	$0.00	$4.55	$0.00	$0.00	$0.00	$0.00	$0.00
G17083	SUP	HCPCS C1758		G17083  -  ADAPTER CATH STD TLR LL SYR	BOTH IP/OP	$56.10 	$41.51	$0.00	$44.88	$30.46	$30.46	$0.00	$0.00	$0.00	$11.69	$41.64	$41.64	$0.00	$0.00	$11.69	$0.00	$33.18	$33.18	$0.00	$28.05	$44.43	$44.88	$0.00		$0.00	$8.78	$0.00	$0.00	$8.93	$0.00	$0.00	$0.00	$0.00	$0.00
G17104	SUP	Custom 27203010		G17104  -  CATHETER URET .028IN 4FR 70CM FLXTP OP-EN GW MOD	BOTH IP/OP	$306.13 	$226.54	$0.00	$244.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.21	$227.21	$0.00	$0.00	$63.80	$0.00	$0.00	$0.00	$0.00	$153.06	$242.45	$244.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G17111	SUP	Custom 27203010		G17111  -  CATH URTH 6FR 25CM 2W FOLEY CLOSE END RND SIL 1.5ML	BOTH IP/OP	$48.76 	$36.08	$0.00	$39.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.38	$38.62	$39.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G17128	SUP	HCPCS C1769		G17128  -  SET NPHSTM 6-12FR NDL GW DIL PERC	BOTH IP/OP	$248.30 	$183.74	$0.00	$198.64	$134.83	$134.83	$0.00	$0.00	$0.00	$51.75	$184.29	$184.29	$0.00	$0.00	$51.75	$0.00	$146.87	$146.87	$0.00	$124.15	$196.65	$198.64	$0.00		$0.00	$38.86	$0.00	$0.00	$39.53	$0.00	$0.00	$0.00	$0.00	$0.00
G17130	SUP	HCPCS C2617		G17130  -  SET STNT .038IN 2 PGTL CRV 6FR 10CM STRL CATH RADOPQ PSTNR	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$140.57	$140.57	$0.00	$0.00	$0.00	$65.11	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$184.77	$184.77	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$48.89	$0.00	$0.00	$49.73	$0.00	$0.00	$0.00	$0.00	$0.00
G17131	SUP	HCPCS C2617		G17131  -  SET STNT 2 PGTL CRV 7-14FR 30CM 13CM RELS SLV PSTNR ULTHNE	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$140.57	$140.57	$0.00	$0.00	$0.00	$65.11	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$184.77	$184.77	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$48.89	$0.00	$0.00	$49.73	$0.00	$0.00	$0.00	$0.00	$0.00
G17132	SUP	HCPCS C2617		G17132  -  SET STNT .038IN 2 PGTL CRV 7-14FR 13CM STRL 28CM RADOPQ	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$140.57	$140.57	$0.00	$0.00	$0.00	$65.11	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$184.77	$184.77	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$48.89	$0.00	$0.00	$49.73	$0.00	$0.00	$0.00	$0.00	$0.00
G17133	SUP	HCPCS C2617		G17133  -  SET STNT BCNTP 7-14FR 26CM STRL 13CM RELS SLV PSTNR ULTHNE	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$140.57	$140.57	$0.00	$0.00	$0.00	$65.11	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$184.77	$184.77	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$48.89	$0.00	$0.00	$49.73	$0.00	$0.00	$0.00	$0.00	$0.00
G17135	SUP	HCPCS C2617		G17135  -  SET STNT 2 PGTL CRV 7-14FR 24CM 13CM RELS SLV PSTNR ULTHNE	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$140.57	$140.57	$0.00	$0.00	$0.00	$65.11	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$184.77	$184.77	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$48.89	$0.00	$0.00	$49.73	$0.00	$0.00	$0.00	$0.00	$0.00
G17136	SUP	HCPCS C2617		G17136  -  SET STNT 2 PGTL CRV 7-14FR 22CM 13CM RELS SLV PSTNR ULTHNE	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$140.57	$140.57	$0.00	$0.00	$0.00	$65.11	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$184.77	$184.77	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$48.89	$0.00	$0.00	$49.73	$0.00	$0.00	$0.00	$0.00	$0.00
G17138	SUP	HCPCS C2617		G17138  -  SET STNT .038IN 2 PGTL CRV 7-14FR 13CM STRL 20CM RADOPQ	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$140.57	$140.57	$0.00	$0.00	$0.00	$65.11	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$184.77	$184.77	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$48.89	$0.00	$0.00	$49.73	$0.00	$0.00	$0.00	$0.00	$0.00
G17139	SUP	HCPCS C2617		G17139  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 30CM RADOPQ	BOTH IP/OP	$271.63 	$201.01	$0.00	$217.30	$122.23	$122.23	$0.00	$0.00	$0.00	$56.61	$201.60	$201.60	$0.00	$0.00	$56.61	$0.00	$160.67	$160.67	$0.00	$135.81	$215.13	$217.30	$0.00		$0.00	$42.51	$0.00	$0.00	$43.24	$0.00	$0.00	$0.00	$0.00	$0.00
G17140	SUP	HCPCS C2617		G17140  -  STENT URET THNWL PGTL CRV 7-14FR 26CM STRL LF RTRMX+ PSTNR	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$140.57	$140.57	$0.00	$0.00	$0.00	$65.11	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$184.77	$184.77	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$48.89	$0.00	$0.00	$49.73	$0.00	$0.00	$0.00	$0.00	$0.00
G17141	SUP	HCPCS C2617		G17141  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 28CM RADOPQ	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$140.57	$140.57	$0.00	$0.00	$0.00	$65.11	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$184.77	$184.77	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$48.89	$0.00	$0.00	$49.73	$0.00	$0.00	$0.00	$0.00	$0.00
G17142	SUP	HCPCS C2617		G17142  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 24CM RADOPQ	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$140.57	$140.57	$0.00	$0.00	$0.00	$65.11	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$184.77	$184.77	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$48.89	$0.00	$0.00	$49.73	$0.00	$0.00	$0.00	$0.00	$0.00
G17143	SUP	HCPCS C2617		G17143  -  SET STNT 2 PGTL CRV 6-9.5FR 22CM 13CM RELS SLV PSTNR ULTHNE	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$140.57	$140.57	$0.00	$0.00	$0.00	$65.11	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$184.77	$184.77	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$48.89	$0.00	$0.00	$49.73	$0.00	$0.00	$0.00	$0.00	$0.00
G17144	SUP	HCPCS C2617		G17144  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 20CM RADOPQ	BOTH IP/OP	$312.38 	$231.16	$0.00	$249.90	$140.57	$140.57	$0.00	$0.00	$0.00	$65.11	$231.84	$231.84	$0.00	$0.00	$65.10	$0.00	$184.77	$184.77	$0.00	$156.19	$247.40	$249.90	$0.00		$0.00	$48.89	$0.00	$0.00	$49.73	$0.00	$0.00	$0.00	$0.00	$0.00
G17145	SUP	HCPCS C1758		G17145  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 18CM RADOPQ	BOTH IP/OP	$85.80 	$63.49	$0.00	$68.64	$46.59	$46.59	$0.00	$0.00	$0.00	$17.88	$63.68	$63.68	$0.00	$0.00	$17.88	$0.00	$50.75	$50.75	$0.00	$42.90	$67.95	$68.64	$0.00		$0.00	$13.43	$0.00	$0.00	$13.66	$0.00	$0.00	$0.00	$0.00	$0.00
G17150	SUP	HCPCS C2625		G17150  -  CATHETER URET .04IN 6/10FR 50CM LF FLXTP 2 LUM GW AQ	BOTH IP/OP	$292.13 	$216.18	$0.00	$233.70	$131.46	$131.46	$0.00	$0.00	$0.00	$60.89	$216.82	$216.82	$0.00	$0.00	$60.88	$0.00	$172.79	$172.79	$0.00	$146.06	$231.37	$233.70	$0.00		$0.00	$45.72	$0.00	$0.00	$46.51	$0.00	$0.00	$0.00	$0.00	$0.00
G17151	SUP	HCPCS C2625		G17151  -  SET STNT .038IN 3CM STRG 4.7FR 22-32CM STRL 145CM KWART	BOTH IP/OP	$292.13 	$216.18	$0.00	$233.70	$131.46	$131.46	$0.00	$0.00	$0.00	$60.89	$216.82	$216.82	$0.00	$0.00	$60.88	$0.00	$172.79	$172.79	$0.00	$146.06	$231.37	$233.70	$0.00		$0.00	$45.72	$0.00	$0.00	$46.51	$0.00	$0.00	$0.00	$0.00	$0.00
G17152	SUP	HCPCS C2625		G17152  -  SET STNT .038IN 3CM STRG 6FR 22-32CM STRL 145CM KWART	BOTH IP/OP	$292.13 	$216.18	$0.00	$233.70	$131.46	$131.46	$0.00	$0.00	$0.00	$60.89	$216.82	$216.82	$0.00	$0.00	$60.88	$0.00	$172.79	$172.79	$0.00	$146.06	$231.37	$233.70	$0.00		$0.00	$45.72	$0.00	$0.00	$46.51	$0.00	$0.00	$0.00	$0.00	$0.00
G17153	SUP	HCPCS C2625		G17153  -  SET STNT 7FR 22-32CM KWART RETRO-INJ SFLX MTLNTH RELS SLV GW	BOTH IP/OP	$292.13 	$216.18	$0.00	$233.70	$131.46	$131.46	$0.00	$0.00	$0.00	$60.89	$216.82	$216.82	$0.00	$0.00	$60.88	$0.00	$172.79	$172.79	$0.00	$146.06	$231.37	$233.70	$0.00		$0.00	$45.72	$0.00	$0.00	$46.51	$0.00	$0.00	$0.00	$0.00	$0.00
G17155	SUP	HCPCS C2627		G17155  -  SET STNT .038IN 3CM STRG 8.2FR 22-32CM STRL 145CM KWART	BOTH IP/OP	$444.40 	$328.86	$0.00	$355.52	$241.31	$241.31	$0.00	$0.00	$0.00	$0.00	$329.83	$329.83	$0.00	$0.00	$92.61	$0.00	$0.00	$0.00	$0.00	$222.20	$351.96	$355.52	$0.00		$0.00	$69.55	$0.00	$0.00	$70.75	$0.00	$0.00	$0.00	$0.00	$0.00
G17156	SUP	HCPCS C1769		G17156  -  SET NPHSTM 8.5FR 25CM STRL 2 GW CNN DIL MCLC CATH ULTHNE	BOTH IP/OP	$444.40 	$328.86	$0.00	$355.52	$241.31	$241.31	$0.00	$0.00	$0.00	$92.62	$329.83	$329.83	$0.00	$0.00	$92.61	$0.00	$262.86	$262.86	$0.00	$222.20	$351.96	$355.52	$0.00		$0.00	$69.55	$0.00	$0.00	$70.75	$0.00	$0.00	$0.00	$0.00	$0.00
G17157	SUP	HCPCS C2627		G17157  -  SET NPHSTM 10.2FR 25CM STRL MCLC 2 GW CNN DIL CNCT TUBE	BOTH IP/OP	$511.05 	$378.18	$0.00	$408.84	$277.50	$277.50	$0.00	$0.00	$0.00	$0.00	$379.30	$379.30	$0.00	$0.00	$106.50	$0.00	$0.00	$0.00	$0.00	$255.53	$404.75	$408.84	$0.00		$0.00	$79.98	$0.00	$0.00	$81.36	$0.00	$0.00	$0.00	$0.00	$0.00
G17158	SUP	HCPCS C2627		G17158  -  SET NPHSTM 12FR 25CM 2 GW CNN DIL CNCT TUBE MC LC LCK LOOP	BOTH IP/OP	$511.05 	$378.18	$0.00	$408.84	$277.50	$277.50	$0.00	$0.00	$0.00	$0.00	$379.30	$379.30	$0.00	$0.00	$106.50	$0.00	$0.00	$0.00	$0.00	$255.53	$404.75	$408.84	$0.00		$0.00	$79.98	$0.00	$0.00	$81.36	$0.00	$0.00	$0.00	$0.00	$0.00
G17160	SUP	HCPCS C1758		G17160  -  SET NPHSTM 14FR 25CM 2 GW CNN DIL CNCT TUBE MC LC LCK LOOP	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G17185	SUP	HCPCS C2625		G17185  -  DRAIN INCS .25IN 12IN STRL LF PNRS SIL DISP OPN WND	BOTH IP/OP	$235.75 	$174.46	$0.00	$188.60	$106.09	$106.09	$0.00	$0.00	$0.00	$49.14	$174.97	$174.97	$0.00	$0.00	$49.13	$0.00	$139.45	$139.45	$0.00	$117.88	$186.71	$188.60	$0.00		$0.00	$36.89	$0.00	$0.00	$37.53	$0.00	$0.00	$0.00	$0.00	$0.00
G17186	SUP	HCPCS C2625		G17186  -  SET STNT 8.2FR 75CM BNDR SFLX OP-EN DVRSN URETER	BOTH IP/OP	$235.75 	$174.46	$0.00	$188.60	$106.09	$106.09	$0.00	$0.00	$0.00	$49.14	$174.97	$174.97	$0.00	$0.00	$49.13	$0.00	$139.45	$139.45	$0.00	$117.88	$186.71	$188.60	$0.00		$0.00	$36.89	$0.00	$0.00	$37.53	$0.00	$0.00	$0.00	$0.00	$0.00
G17214	SUP	HCPCS C1769		G17214  -  CATHETER URTH 18FR 34CM 5ML UNIVERSA 2W FL CLS END RND TIP	BOTH IP/OP	$8.59 	$6.36	$0.00	$6.88	$4.67	$4.67	$0.00	$0.00	$0.00	$1.79	$6.38	$6.38	$0.00	$0.00	$1.79	$0.00	$5.08	$5.08	$0.00	$4.30	$6.80	$6.88	$0.00		$0.00	$1.34	$0.00	$0.00	$1.37	$0.00	$0.00	$0.00	$0.00	$0.00
G17230	SUP	HCPCS C1726		G17230  -  SET CATH .021IN 6FR 25CM 1ML UNIVERSA 2W FL OP-EN GW SIL PED	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$24.44	$24.44	$0.00	$0.00	$0.00	$9.38	$33.40	$33.40	$0.00	$0.00	$9.38	$0.00	$26.62	$26.62	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$7.04	$0.00	$0.00	$7.16	$0.00	$0.00	$0.00	$0.00	$0.00
G17237	SUP	HCPCS C1758		G17237  -  CATHETER URDY 7FR 38CM 2 LUM CDE	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G17239	SUP	HCPCS C1729		G17239  -  CATHETER URET 5FR 110CM RND TIP RT	BOTH IP/OP	$311.20 	$230.29	$0.00	$248.96	$168.98	$168.98	$0.00	$0.00	$0.00	$64.86	$230.97	$230.97	$0.00	$0.00	$64.85	$0.00	$184.07	$184.07	$0.00	$155.60	$246.47	$248.96	$0.00		$0.00	$48.70	$0.00	$0.00	$49.54	$0.00	$0.00	$0.00	$0.00	$0.00
G17252	SUP	HCPCS C1726		G17252  -  CATHETER XTRN 1.3IN NS NADH CNDM SIL M REUSE	BOTH IP/OP	$51.15 	$37.85	$0.00	$40.92	$27.77	$27.77	$0.00	$0.00	$0.00	$10.66	$37.96	$37.96	$0.00	$0.00	$10.66	$0.00	$30.26	$30.26	$0.00	$25.58	$40.51	$40.92	$0.00		$0.00	$8.00	$0.00	$0.00	$8.14	$0.00	$0.00	$0.00	$0.00	$0.00
G17262	SUP	HCPCS C1758		G17262  -  TUBING URDY INF ST VNT	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G17306	SUP	HCPCS C2617		G17306  -  ADAPTER CATH TLR LL SYR PED	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G17310	SUP	HCPCS C1769		G17310  -  SET STNT .025IN 3.7FR 8-30CM STRL CATH RADOPQ MTLNTH PSTNR	BOTH IP/OP	$396.00 	$293.04	$0.00	$316.80	$215.03	$215.03	$0.00	$0.00	$0.00	$82.54	$293.91	$293.91	$0.00	$0.00	$82.53	$0.00	$234.23	$234.23	$0.00	$198.00	$313.63	$316.80	$0.00		$0.00	$61.97	$0.00	$0.00	$63.04	$0.00	$0.00	$0.00	$0.00	$0.00
G17318	SUP	HCPCS C1726		G17318  -  SET DIL 6-18FR 60CM AQ PE URET	BOTH IP/OP	$48.08 	$35.58	$0.00	$38.46	$26.10	$26.10	$0.00	$0.00	$0.00	$10.02	$35.68	$35.68	$0.00	$0.00	$10.02	$0.00	$28.44	$28.44	$0.00	$24.04	$38.08	$38.46	$0.00		$0.00	$7.52	$0.00	$0.00	$7.65	$0.00	$0.00	$0.00	$0.00	$0.00
G17320	SUP	HCPCS C1726		G17320  -  CATHETER SUPRAPUBIC 14FR 22CM 30CM SET NEEDLE OBTURATOR	BOTH IP/OP	$144.10 	$106.63	$0.00	$115.28	$78.25	$78.25	$0.00	$0.00	$0.00	$30.03	$106.95	$106.95	$0.00	$0.00	$30.03	$0.00	$85.24	$85.24	$0.00	$72.05	$114.13	$115.28	$0.00		$0.00	$22.55	$0.00	$0.00	$22.94	$0.00	$0.00	$0.00	$0.00	$0.00
G17322	SUP	HCPCS C1726		G17322  -  CATHETER URDY 5FR 30CM 2 LUM	BOTH IP/OP	$657.80 	$486.77	$0.00	$526.24	$357.19	$357.19	$0.00	$0.00	$0.00	$137.10	$488.22	$488.22	$0.00	$0.00	$137.09	$0.00	$389.09	$389.09	$0.00	$328.90	$520.98	$526.24	$0.00		$0.00	$102.95	$0.00	$0.00	$104.72	$0.00	$0.00	$0.00	$0.00	$0.00
G17323	SUP	HCPCS C1758		G17323  -  SET DIL 6-30FR 30CM 16CM AMPTZ RADOPQ SHTH HDRPH RNL	BOTH IP/OP	$97.18 	$71.91	$0.00	$77.74	$52.77	$52.77	$0.00	$0.00	$0.00	$20.25	$72.12	$72.12	$0.00	$0.00	$20.25	$0.00	$57.48	$57.48	$0.00	$48.59	$76.97	$77.74	$0.00		$0.00	$15.21	$0.00	$0.00	$15.47	$0.00	$0.00	$0.00	$0.00	$0.00
G17330	SUP	HCPCS C1758		G17330  -  CATHETER URET .05IN 6/10FR .04IN 50CM STRL LF FLXTP 2 LUM AQ	BOTH IP/OP	$103.33 	$76.46	$0.00	$82.66	$56.11	$56.11	$0.00	$0.00	$0.00	$21.54	$76.69	$76.69	$0.00	$0.00	$21.53	$0.00	$61.12	$61.12	$0.00	$51.66	$81.84	$82.66	$0.00		$0.00	$16.17	$0.00	$0.00	$16.45	$0.00	$0.00	$0.00	$0.00	$0.00
G17354	SUP	HCPCS C2627		G17354  -  CATHETER URTH 16FR 34CM 5ML UNIVERSA 2W FL OP-EN SIL	BOTH IP/OP	$4.85 	$3.59	$0.00	$3.88	$2.63	$2.63	$0.00	$0.00	$0.00	$0.00	$3.60	$3.60	$0.00	$0.00	$1.01	$0.00	$0.00	$0.00	$0.00	$2.43	$3.84	$3.88	$0.00		$0.00	$0.76	$0.00	$0.00	$0.77	$0.00	$0.00	$0.00	$0.00	$0.00
G17355	SUP	HCPCS C2627		G17355  -  DILATOR URET 8FR 60CM PE HDRPH	BOTH IP/OP	$58.20 	$43.07	$0.00	$46.56	$31.60	$31.60	$0.00	$0.00	$0.00	$0.00	$43.20	$43.20	$0.00	$0.00	$12.13	$0.00	$0.00	$0.00	$0.00	$29.10	$46.09	$46.56	$0.00		$0.00	$9.11	$0.00	$0.00	$9.27	$0.00	$0.00	$0.00	$0.00	$0.00
G17477	SUP	HCPCS C2627		G17477  -  STOPCOCK CSCP SAN ANTONIO MOD FIT	BOTH IP/OP	$58.20 	$43.07	$0.00	$46.56	$31.60	$31.60	$0.00	$0.00	$0.00	$0.00	$43.20	$43.20	$0.00	$0.00	$12.13	$0.00	$0.00	$0.00	$0.00	$29.10	$46.09	$46.56	$0.00		$0.00	$9.11	$0.00	$0.00	$9.27	$0.00	$0.00	$0.00	$0.00	$0.00
G17515	SUP	HCPCS C2627		G17515  -  CATHETER URTH 18FR 34CM 5ML UNIVERSA 2W OP-EN BLN FL SIL DOD	BOTH IP/OP	$15.92 	$11.78	$0.00	$12.74	$8.64	$8.64	$0.00	$0.00	$0.00	$0.00	$11.81	$11.81	$0.00	$0.00	$3.32	$0.00	$0.00	$0.00	$0.00	$7.96	$12.61	$12.74	$0.00		$0.00	$2.49	$0.00	$0.00	$2.53	$0.00	$0.00	$0.00	$0.00	$0.00
G17520	SUP	Custom 27203010		G17520  -  CATHETER SPBC 8FR 54CM CYSTOSTOMY MOD TROC STY DRN ADPR PUL	BOTH IP/OP	$302.83 	$224.09	$0.00	$242.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.76	$224.76	$0.00	$0.00	$63.11	$0.00	$0.00	$0.00	$0.00	$151.41	$239.84	$242.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G17521	SUP	HCPCS C1758		G17521  -  EXTRACTOR STON 4.5FR 2CM 65CM STRL NCRCL TPLS UNDX HNDL WRE	BOTH IP/OP	$100.25 	$74.19	$0.00	$80.20	$54.44	$54.44	$0.00	$0.00	$0.00	$20.89	$74.41	$74.41	$0.00	$0.00	$20.89	$0.00	$59.30	$59.30	$0.00	$50.13	$79.40	$80.20	$0.00		$0.00	$15.69	$0.00	$0.00	$15.96	$0.00	$0.00	$0.00	$0.00	$0.00
G17539	SUP	HCPCS C1769		G17539  -  CATHETER URET .038IN PGTL CRV 6FR 70CM SDPRT GW	BOTH IP/OP	$94.58 	$69.99	$0.00	$75.66	$51.35	$51.35	$0.00	$0.00	$0.00	$19.71	$70.19	$70.19	$0.00	$0.00	$19.71	$0.00	$55.94	$55.94	$0.00	$47.29	$74.91	$75.66	$0.00		$0.00	$14.80	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$0.00
G17540	SUP	HCPCS C1769		G17540  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 3CM RDRR PC STD BD	BOTH IP/OP	$94.58 	$69.99	$0.00	$75.66	$51.35	$51.35	$0.00	$0.00	$0.00	$19.71	$70.19	$70.19	$0.00	$0.00	$19.71	$0.00	$55.94	$55.94	$0.00	$47.29	$74.91	$75.66	$0.00		$0.00	$14.80	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$0.00
G17541	SUP	HCPCS C1769		G17541  -  GUIDEWIRE VASC ANG STD .035IN 145CM 3CM RDRR PC TRQ CNTRL	BOTH IP/OP	$94.58 	$69.99	$0.00	$75.66	$51.35	$51.35	$0.00	$0.00	$0.00	$19.71	$70.19	$70.19	$0.00	$0.00	$19.71	$0.00	$55.94	$55.94	$0.00	$47.29	$74.91	$75.66	$0.00		$0.00	$14.80	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$0.00
G17542	SUP	HCPCS C1769		G17542  -  GUIDEWIRE VASC ANG .038IN 145CM STRL 3CM RDRR PC STD BD NTNL	BOTH IP/OP	$94.58 	$69.99	$0.00	$75.66	$51.35	$51.35	$0.00	$0.00	$0.00	$19.71	$70.19	$70.19	$0.00	$0.00	$19.71	$0.00	$55.94	$55.94	$0.00	$47.29	$74.91	$75.66	$0.00		$0.00	$14.80	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$0.00
G17558	SUP	Custom 27203010		G17558  -  CATH IU NOVY 5FR 40CM SET CVD CANNULATION 55CM DISP	BOTH IP/OP	$243.48 	$180.18	$0.00	$196.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.71	$180.71	$0.00	$0.00	$50.74	$0.00	$0.00	$0.00	$0.00	$123.01	$194.85	$196.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G17560	SUP	HCPCS C1758		G17560  -  POSITIONER STNT 6FR 50CM RADOPQ URET	BOTH IP/OP	$111.00 	$82.14	$0.00	$88.80	$60.27	$60.27	$0.00	$0.00	$0.00	$23.14	$82.38	$82.38	$0.00	$0.00	$23.13	$0.00	$65.66	$65.66	$0.00	$55.50	$87.91	$88.80	$0.00		$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
G17571	SUP	HCPCS C2625		G17571  -  CATHETER URET .03IN 4FR 70CM SFLX OP-EN GW	BOTH IP/OP	$141.45 	$104.67	$0.00	$113.16	$63.65	$63.65	$0.00	$0.00	$0.00	$29.48	$104.98	$104.98	$0.00	$0.00	$29.48	$0.00	$83.67	$83.67	$0.00	$70.73	$112.03	$113.16	$0.00		$0.00	$22.14	$0.00	$0.00	$22.52	$0.00	$0.00	$0.00	$0.00	$0.00
G17578	SUP	HCPCS C2627		G17578  -  CATHETER URET .05IN 5/10FR .04IN 50CM FLXTP 2 LUM AQ	BOTH IP/OP	$58.20 	$43.07	$0.00	$46.56	$31.60	$31.60	$0.00	$0.00	$0.00	$0.00	$43.20	$43.20	$0.00	$0.00	$12.13	$0.00	$0.00	$0.00	$0.00	$29.10	$46.09	$46.56	$0.00		$0.00	$9.11	$0.00	$0.00	$9.27	$0.00	$0.00	$0.00	$0.00	$0.00
G17601	SUP	HCPCS C1892		G17601  -  DILATOR URET 14FR 60CM PE HDRPH	BOTH IP/OP	$164.45 	$121.69	$0.00	$131.56	$89.30	$89.30	$0.00	$0.00	$0.00	$34.28	$122.05	$122.05	$0.00	$0.00	$34.27	$0.00	$97.27	$97.27	$0.00	$82.23	$130.24	$131.56	$0.00		$0.00	$25.74	$0.00	$0.00	$26.18	$0.00	$0.00	$0.00	$0.00	$0.00
G17618	SUP	Custom 27203010		G17618  -  INTRODUCER NPHSTM 14FR 65CM 60CM PLWY PERC	BOTH IP/OP	$390.50 	$288.97	$0.00	$312.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.83	$289.83	$0.00	$0.00	$81.38	$0.00	$0.00	$0.00	$0.00	$195.25	$309.28	$312.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G17627	SUP	Custom 27203010		G17627  -  NEEDLE BRCHTX 18GA 20CM ECHTP SET	BOTH IP/OP	$462.20 	$342.03	$0.00	$369.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.04	$343.04	$0.00	$0.00	$96.32	$0.00	$0.00	$0.00	$0.00	$231.10	$366.06	$369.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G17639	SUP	HCPCS C2625		G17639  -  DILATOR URET LNG TPR 6-12FR 60CM STRL LFRIC SRFC AQ	BOTH IP/OP	$141.45 	$104.67	$0.00	$113.16	$63.65	$63.65	$0.00	$0.00	$0.00	$29.48	$104.98	$104.98	$0.00	$0.00	$29.48	$0.00	$83.67	$83.67	$0.00	$70.73	$112.03	$113.16	$0.00		$0.00	$22.14	$0.00	$0.00	$22.52	$0.00	$0.00	$0.00	$0.00	$0.00
G17648	SUP	HCPCS C2617		G17648  -  POSITIONER STNT 4FR 25CM	BOTH IP/OP	$76.63 	$56.71	$0.00	$61.30	$34.48	$34.48	$0.00	$0.00	$0.00	$15.97	$56.87	$56.87	$0.00	$0.00	$15.97	$0.00	$45.32	$45.32	$0.00	$38.31	$60.69	$61.30	$0.00		$0.00	$11.99	$0.00	$0.00	$12.20	$0.00	$0.00	$0.00	$0.00	$0.00
G17666	SUP	HCPCS C2617		G17666  -  STENT URTH 8FR 24FR 30CM STRL FRLT KLG SDPRT SUT BLB DISP	BOTH IP/OP	$117.88 	$87.23	$0.00	$94.30	$53.04	$53.04	$0.00	$0.00	$0.00	$24.57	$87.49	$87.49	$0.00	$0.00	$24.57	$0.00	$69.72	$69.72	$0.00	$58.94	$93.36	$94.30	$0.00		$0.00	$18.45	$0.00	$0.00	$18.77	$0.00	$0.00	$0.00	$0.00	$0.00
G17667	SUP	HCPCS C2617		G17667  -  SET STNT 6FR 50CM STRL KL DPR URETHRA DISP	BOTH IP/OP	$92.25 	$68.27	$0.00	$73.80	$41.51	$41.51	$0.00	$0.00	$0.00	$19.23	$68.47	$68.47	$0.00	$0.00	$19.22	$0.00	$54.57	$54.57	$0.00	$46.13	$73.06	$73.80	$0.00		$0.00	$14.44	$0.00	$0.00	$14.69	$0.00	$0.00	$0.00	$0.00	$0.00
G17668	SUP	HCPCS C2617		G17668  -  STENT URTH 6FR 50CM KL DPR	BOTH IP/OP	$102.50 	$75.85	$0.00	$82.00	$46.13	$46.13	$0.00	$0.00	$0.00	$21.36	$76.08	$76.08	$0.00	$0.00	$21.36	$0.00	$60.63	$60.63	$0.00	$51.25	$81.18	$82.00	$0.00		$0.00	$16.04	$0.00	$0.00	$16.32	$0.00	$0.00	$0.00	$0.00	$0.00
G17669	SUP	HCPCS C2617		G17669  -  SET STNT 8FR 50CM STRL KL DPR URETHRA DISP	BOTH IP/OP	$92.25 	$68.27	$0.00	$73.80	$41.51	$41.51	$0.00	$0.00	$0.00	$19.23	$68.47	$68.47	$0.00	$0.00	$19.22	$0.00	$54.57	$54.57	$0.00	$46.13	$73.06	$73.80	$0.00		$0.00	$14.44	$0.00	$0.00	$14.69	$0.00	$0.00	$0.00	$0.00	$0.00
G17671	SUP	HCPCS C2617		G17671  -  STENT URTH 8FR 50CM STRL KL DPR DISP	BOTH IP/OP	$300.60 	$222.44	$0.00	$240.48	$135.27	$135.27	$0.00	$0.00	$0.00	$62.65	$223.11	$223.11	$0.00	$0.00	$62.65	$0.00	$177.80	$177.80	$0.00	$150.30	$238.08	$240.48	$0.00		$0.00	$47.04	$0.00	$0.00	$47.86	$0.00	$0.00	$0.00	$0.00	$0.00
G17676	SUP	HCPCS C2617		G17676  -  SET STNT .025IN SM 2 PGTL CRV STRG 3.7FR 6CM STRL RADOPQ	BOTH IP/OP	$253.45 	$187.55	$0.00	$202.76	$114.05	$114.05	$0.00	$0.00	$0.00	$52.83	$188.11	$188.11	$0.00	$0.00	$52.82	$0.00	$149.92	$149.92	$0.00	$126.73	$200.73	$202.76	$0.00		$0.00	$39.66	$0.00	$0.00	$40.35	$0.00	$0.00	$0.00	$0.00	$0.00
G17793	SUP	HCPCS C2617		G17793  -  POSITIONER STNT 5FR 50CM	BOTH IP/OP	$288.80 	$213.71	$0.00	$231.04	$129.96	$129.96	$0.00	$0.00	$0.00	$60.19	$214.35	$214.35	$0.00	$0.00	$60.19	$0.00	$170.83	$170.83	$0.00	$144.40	$228.73	$231.04	$0.00		$0.00	$45.20	$0.00	$0.00	$45.98	$0.00	$0.00	$0.00	$0.00	$0.00
G17794	SUP	HCPCS C2627		G17794  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 4CM STRL CP MDRL CATH	BOTH IP/OP	$72.60 	$53.72	$0.00	$58.08	$39.42	$39.42	$0.00	$0.00	$0.00	$0.00	$53.88	$53.88	$0.00	$0.00	$15.13	$0.00	$0.00	$0.00	$0.00	$36.30	$57.50	$58.08	$0.00		$0.00	$11.36	$0.00	$0.00	$11.56	$0.00	$0.00	$0.00	$0.00	$0.00
G17795	SUP	HCPCS C1726		G17795  -  DILATOR URTH 6-12FR 30CM LNG TPR FSCA	BOTH IP/OP	$72.60 	$53.72	$0.00	$58.08	$39.42	$39.42	$0.00	$0.00	$0.00	$15.13	$53.88	$53.88	$0.00	$0.00	$15.13	$0.00	$42.94	$42.94	$0.00	$36.30	$57.50	$58.08	$0.00		$0.00	$11.36	$0.00	$0.00	$11.56	$0.00	$0.00	$0.00	$0.00	$0.00
G17797	SUP	HCPCS C1758		G17797  -  DILATOR URTH LNG TPR 18FR 30CM AQ	BOTH IP/OP	$42.90 	$31.75	$0.00	$34.32	$23.29	$23.29	$0.00	$0.00	$0.00	$8.94	$31.84	$31.84	$0.00	$0.00	$8.94	$0.00	$25.38	$25.38	$0.00	$21.45	$33.98	$34.32	$0.00		$0.00	$6.71	$0.00	$0.00	$6.83	$0.00	$0.00	$0.00	$0.00	$0.00
G17819	SUP	HCPCS C1758		G17819  -  DEVICE TRQ STRL OLCOTT DISP ACPT .014-.045IN GW RDRR	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G17842	SUP	HCPCS C1726		G17842  -  CATHETER URET .040IN 7FR 70CM SFLX OP-EN GW	BOTH IP/OP	$264.00 	$195.36	$0.00	$211.20	$143.35	$143.35	$0.00	$0.00	$0.00	$55.02	$195.94	$195.94	$0.00	$0.00	$55.02	$0.00	$156.16	$156.16	$0.00	$132.00	$209.09	$211.20	$0.00		$0.00	$41.32	$0.00	$0.00	$42.03	$0.00	$0.00	$0.00	$0.00	$0.00
G17843	SUP	HCPCS C1726		G17843  -  CATHETER URTH 9FR 8.7MM 29CM 18CM CDE BLN	BOTH IP/OP	$264.00 	$195.36	$0.00	$211.20	$143.35	$143.35	$0.00	$0.00	$0.00	$55.02	$195.94	$195.94	$0.00	$0.00	$55.02	$0.00	$156.16	$156.16	$0.00	$132.00	$209.09	$211.20	$0.00		$0.00	$41.32	$0.00	$0.00	$42.03	$0.00	$0.00	$0.00	$0.00	$0.00
G17844	SUP	HCPCS C1726		G17844  -  CATHETER URTH FLFRM 9FR 8.7MM 29CM 18CM BLN	BOTH IP/OP	$264.00 	$195.36	$0.00	$211.20	$143.35	$143.35	$0.00	$0.00	$0.00	$55.02	$195.94	$195.94	$0.00	$0.00	$55.02	$0.00	$156.16	$156.16	$0.00	$132.00	$209.09	$211.20	$0.00		$0.00	$41.32	$0.00	$0.00	$42.03	$0.00	$0.00	$0.00	$0.00	$0.00
G17852	SUP	HCPCS C2617		G17852  -  CATHETER URTH 7FR 8.7MM 29CM 18CM OPN TIP BLN	BOTH IP/OP	$251.13 	$185.84	$0.00	$200.90	$113.01	$113.01	$0.00	$0.00	$0.00	$52.34	$186.38	$186.38	$0.00	$0.00	$52.33	$0.00	$148.54	$148.54	$0.00	$125.56	$198.89	$200.90	$0.00		$0.00	$39.30	$0.00	$0.00	$39.98	$0.00	$0.00	$0.00	$0.00	$0.00
G17866	SUP	HCPCS C1769		G17866  -  SET STNT .035IN 4.7FR 21-32CM STRL CATH RADOPQ MTLNTH PSTNR	BOTH IP/OP	$107.85 	$79.81	$0.00	$86.28	$58.56	$58.56	$0.00	$0.00	$0.00	$22.48	$80.05	$80.05	$0.00	$0.00	$22.48	$0.00	$63.79	$63.79	$0.00	$53.93	$85.42	$86.28	$0.00		$0.00	$16.88	$0.00	$0.00	$17.17	$0.00	$0.00	$0.00	$0.00	$0.00
G17898	SUP	HCPCS C1769		G17898  -  KIT PRC 11FR MNPRC ENTRY PED PERC	BOTH IP/OP	$108.75 	$80.48	$0.00	$87.00	$59.05	$59.05	$0.00	$0.00	$0.00	$22.67	$80.71	$80.71	$0.00	$0.00	$22.66	$0.00	$64.33	$64.33	$0.00	$54.38	$86.13	$87.00	$0.00		$0.00	$17.02	$0.00	$0.00	$17.31	$0.00	$0.00	$0.00	$0.00	$0.00
G17913	SUP	HCPCS C1758		G17913  -  FILIFORM URTH 18FR 12.5IN INTGR	BOTH IP/OP	$27.50 	$20.35	$0.00	$22.00	$14.93	$14.93	$0.00	$0.00	$0.00	$5.73	$20.41	$20.41	$0.00	$0.00	$5.73	$0.00	$16.27	$16.27	$0.00	$13.75	$21.78	$22.00	$0.00		$0.00	$4.30	$0.00	$0.00	$4.38	$0.00	$0.00	$0.00	$0.00	$0.00
G17915	SUP	HCPCS C1758		G17915  -  CATHETER URET .038IN 7FR 15CM FLXTP OP-EN GW MOD	BOTH IP/OP	$32.90 	$24.35	$0.00	$26.32	$17.86	$17.86	$0.00	$0.00	$0.00	$6.86	$24.42	$24.42	$0.00	$0.00	$6.86	$0.00	$19.46	$19.46	$0.00	$16.45	$26.06	$26.32	$0.00		$0.00	$5.15	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$0.00
G17940	SUP	Custom 27203010		G17940  -  SET DRN 200ML NS BG PED DISP	BOTH IP/OP	$478.13 	$353.82	$0.00	$382.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.86	$354.86	$0.00	$0.00	$99.64	$0.00	$0.00	$0.00	$0.00	$239.06	$378.68	$382.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G17941	SUP	Custom 27203010		G17941  -  EXTRACTOR STON 3.2FR 115CM 5CM NFORCE DWR 3WR BSKT HLCL OCL	BOTH IP/OP	$478.13 	$353.82	$0.00	$382.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.86	$354.86	$0.00	$0.00	$99.64	$0.00	$0.00	$0.00	$0.00	$239.06	$378.68	$382.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G17948	SUP	HCPCS C1726		G17948  -  EXTRACTOR SRG 3.2FR 115CM 7CM NFORCE HLCL STON SET NTNL URO	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$32.25	$32.25	$0.00	$0.00	$0.00	$12.38	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$35.14	$35.14	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$9.30	$0.00	$0.00	$9.46	$0.00	$0.00	$0.00	$0.00	$0.00
G17949	SUP	HCPCS C1726		G17949  -  DILATOR URTH 12FR 30CM AMPTZ RNL	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$32.25	$32.25	$0.00	$0.00	$0.00	$12.38	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$35.14	$35.14	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$9.30	$0.00	$0.00	$9.46	$0.00	$0.00	$0.00	$0.00	$0.00
G17950	SUP	HCPCS C1726		G17950  -  DILATOR URTH 14FR 30CM AMPTZ RNL	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$32.25	$32.25	$0.00	$0.00	$0.00	$12.38	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$35.14	$35.14	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$9.30	$0.00	$0.00	$9.46	$0.00	$0.00	$0.00	$0.00	$0.00
G17951	SUP	HCPCS C1892		G17951  -  DILATOR URET 16FR 30CM AMPTZ RNL	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$32.25	$32.25	$0.00	$0.00	$0.00	$12.38	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$35.14	$35.14	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$9.30	$0.00	$0.00	$9.46	$0.00	$0.00	$0.00	$0.00	$0.00
G17952	SUP	HCPCS C1892		G17952  -  DILATOR URTH 18FR 30CM AMPTZ RNL	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$32.25	$32.25	$0.00	$0.00	$0.00	$12.38	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$35.14	$35.14	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$9.30	$0.00	$0.00	$9.46	$0.00	$0.00	$0.00	$0.00	$0.00
G17953	SUP	HCPCS C1726		G17953  -  DILATOR URET 20FR 30CM AMPTZ RNL	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$32.25	$32.25	$0.00	$0.00	$0.00	$12.38	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$35.14	$35.14	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$9.30	$0.00	$0.00	$9.46	$0.00	$0.00	$0.00	$0.00	$0.00
G17954	SUP	HCPCS C1726		G17954  -  DILATOR URET 22FR 30CM AMPTZ RNL	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$32.25	$32.25	$0.00	$0.00	$0.00	$12.38	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$35.14	$35.14	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$9.30	$0.00	$0.00	$9.46	$0.00	$0.00	$0.00	$0.00	$0.00
G17955	SUP	HCPCS C1726		G17955  -  DILATOR SRG 24FR 30CM AMPTZ NPHSTM TRACT DILATION	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$32.25	$32.25	$0.00	$0.00	$0.00	$12.38	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$35.14	$35.14	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$9.30	$0.00	$0.00	$9.46	$0.00	$0.00	$0.00	$0.00	$0.00
G17956	SUP	HCPCS C1726		G17956  -  DILATOR URET 26FR 30CM AMPTZ RNL	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$32.25	$32.25	$0.00	$0.00	$0.00	$12.38	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$35.14	$35.14	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$9.30	$0.00	$0.00	$9.46	$0.00	$0.00	$0.00	$0.00	$0.00
G17957	SUP	HCPCS C1726		G17957  -  DILATOR URET 28FR 30CM AMPTZ RNL	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$32.25	$32.25	$0.00	$0.00	$0.00	$12.38	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$35.14	$35.14	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$9.30	$0.00	$0.00	$9.46	$0.00	$0.00	$0.00	$0.00	$0.00
G17963	SUP	HCPCS C1894		G17963  -  DILATOR URTH 30FR 30CM AMPTZ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17964	SUP	HCPCS C1892		G17964  -  SHEATH DIL 22FR 16CM AMPTZ OPQ RNL	BOTH IP/OP	$61.60 	$45.58	$0.00	$49.28	$33.45	$33.45	$0.00	$0.00	$0.00	$12.84	$45.72	$45.72	$0.00	$0.00	$12.84	$0.00	$36.44	$36.44	$0.00	$30.80	$48.79	$49.28	$0.00		$0.00	$9.64	$0.00	$0.00	$9.81	$0.00	$0.00	$0.00	$0.00	$0.00
G17965	SUP	HCPCS C1894		G17965  -  SHEATH ACC 24FR 16CM AMPTZ OPQ RNL	BOTH IP/OP	$61.60 	$45.58	$0.00	$49.28	$33.45	$33.45	$0.00	$0.00	$0.00	$12.84	$45.72	$45.72	$0.00	$0.00	$12.84	$0.00	$36.44	$36.44	$0.00	$30.80	$48.79	$49.28	$0.00		$0.00	$9.64	$0.00	$0.00	$9.81	$0.00	$0.00	$0.00	$0.00	$0.00
G17966	SUP	HCPCS C1894		G17966  -  SHEATH DIL 26FR 16CM AMPTZ OPQ RNL	BOTH IP/OP	$61.60 	$45.58	$0.00	$49.28	$33.45	$33.45	$0.00	$0.00	$0.00	$12.84	$45.72	$45.72	$0.00	$0.00	$12.84	$0.00	$36.44	$36.44	$0.00	$30.80	$48.79	$49.28	$0.00		$0.00	$9.64	$0.00	$0.00	$9.81	$0.00	$0.00	$0.00	$0.00	$0.00
G17967	SUP	HCPCS C1894		G17967  -  SHEATH DIL 28FR 16CM AMPTZ OPQ RNL	BOTH IP/OP	$61.60 	$45.58	$0.00	$49.28	$33.45	$33.45	$0.00	$0.00	$0.00	$12.84	$45.72	$45.72	$0.00	$0.00	$12.84	$0.00	$36.44	$36.44	$0.00	$30.80	$48.79	$49.28	$0.00		$0.00	$9.64	$0.00	$0.00	$9.81	$0.00	$0.00	$0.00	$0.00	$0.00
G17968	SUP	HCPCS C1894		G17968  -  SHEATH DIL 30FR 16CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17969	SUP	HCPCS C1894		G17969  -  SHEATH DIL 24FR 20CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17970	SUP	HCPCS C1894		G17970  -  SHEATH DIL 26FR 20CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17971	SUP	HCPCS C1894		G17971  -  SHEATH DIL 28FR 20CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17973	SUP	HCPCS C1894		G17973  -  SHEATH DIL 30FR 20CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17975	SUP	HCPCS C1894		G17975  -  SHEATH DIL 30FR 19CM AMPTZ OPQ RNL	BOTH IP/OP	$61.60 	$45.58	$0.00	$49.28	$33.45	$33.45	$0.00	$0.00	$0.00	$12.84	$45.72	$45.72	$0.00	$0.00	$12.84	$0.00	$36.44	$36.44	$0.00	$30.80	$48.79	$49.28	$0.00		$0.00	$9.64	$0.00	$0.00	$9.81	$0.00	$0.00	$0.00	$0.00	$0.00
G17976	SUP	HCPCS C1894		G17976  -  SHEATH DIL 28FR 30CM OPQ AMPTZ RNL	BOTH IP/OP	$61.60 	$45.58	$0.00	$49.28	$33.45	$33.45	$0.00	$0.00	$0.00	$12.84	$45.72	$45.72	$0.00	$0.00	$12.84	$0.00	$36.44	$36.44	$0.00	$30.80	$48.79	$49.28	$0.00		$0.00	$9.64	$0.00	$0.00	$9.81	$0.00	$0.00	$0.00	$0.00	$0.00
G17980	SUP	HCPCS C1894		G17980  -  SHEATH DIL 30FR 30CM AMPTZ OPQ	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17981	SUP	HCPCS C1894		G17981  -  SHEATH DIL 30FR 24CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17982	SUP	HCPCS C1894		G17982  -  SHEATH DIL 12FR 16CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17983	SUP	HCPCS C1894		G17983  -  SHEATH DIL 14FR 16CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17984	SUP	HCPCS C1894		G17984  -  SHEATH DIL 16FR 16CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17985	SUP	HCPCS C1894		G17985  -  SHEATH DIL 18FR 16CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17986	SUP	HCPCS C1894		G17986  -  SHEATH DIL 20FR 16CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17997	SUP	HCPCS C1894		G17997  -  SHEATH DIL 30FR 25CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17998	SUP	HCPCS C1894		G17998  -  SHEATH DIL 30FR 22CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G17999	SUP	HCPCS C1894		G17999  -  SHEATH DIL 32FR 16CM AMPTZ OPQ RNL	BOTH IP/OP	$70.85 	$52.43	$0.00	$56.68	$38.47	$38.47	$0.00	$0.00	$0.00	$14.77	$52.58	$52.58	$0.00	$0.00	$14.77	$0.00	$41.91	$41.91	$0.00	$35.43	$56.11	$56.68	$0.00		$0.00	$11.09	$0.00	$0.00	$11.28	$0.00	$0.00	$0.00	$0.00	$0.00
G18001	SUP	HCPCS C1892		G18001  -  SHEATH DIL 34FR 16CM AMPTZ OPQ RNL	BOTH IP/OP	$80.85 	$59.83	$0.00	$64.68	$43.90	$43.90	$0.00	$0.00	$0.00	$16.85	$60.01	$60.01	$0.00	$0.00	$16.85	$0.00	$47.82	$47.82	$0.00	$40.43	$64.03	$64.68	$0.00		$0.00	$12.65	$0.00	$0.00	$12.87	$0.00	$0.00	$0.00	$0.00	$0.00
G18002	SUP	HCPCS C1894		G18002  -  INTRODUCER NPHSTM 24FR 16CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$80.85 	$59.83	$0.00	$64.68	$43.90	$43.90	$0.00	$0.00	$0.00	$16.85	$60.01	$60.01	$0.00	$0.00	$16.85	$0.00	$47.82	$47.82	$0.00	$40.43	$64.03	$64.68	$0.00		$0.00	$12.65	$0.00	$0.00	$12.87	$0.00	$0.00	$0.00	$0.00	$0.00
G18003	SUP	HCPCS C1892		G18003  -  INTRODUCER NPHSTM 26FR 16CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$80.85 	$59.83	$0.00	$64.68	$43.90	$43.90	$0.00	$0.00	$0.00	$16.85	$60.01	$60.01	$0.00	$0.00	$16.85	$0.00	$47.82	$47.82	$0.00	$40.43	$64.03	$64.68	$0.00		$0.00	$12.65	$0.00	$0.00	$12.87	$0.00	$0.00	$0.00	$0.00	$0.00
G18004	SUP	HCPCS C1894		G18004  -  INTRODUCER NPHSTM 28FR 16CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$80.85 	$59.83	$0.00	$64.68	$43.90	$43.90	$0.00	$0.00	$0.00	$16.85	$60.01	$60.01	$0.00	$0.00	$16.85	$0.00	$47.82	$47.82	$0.00	$40.43	$64.03	$64.68	$0.00		$0.00	$12.65	$0.00	$0.00	$12.87	$0.00	$0.00	$0.00	$0.00	$0.00
G18005	SUP	HCPCS C1892		G18005  -  INTRODUCER NPHSTM 30FR 16CM 30CM AMPTZ DIL SHTH RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18006	SUP	HCPCS C1892		G18006  -  INTRODUCER NPHSTM 28FR 20CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18007	SUP	HCPCS C1892		G18007  -  INTRODUCER NPHSTM 30FR 20CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18008	SUP	HCPCS C1892		G18008  -  INTRODUCER NPHSTM 22FR 16CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18009	SUP	HCPCS C1892		G18009  -  INTRODUCER NPHSTM 24FR 24CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18010	SUP	HCPCS C1892		G18010  -  INTRODUCER NPHSTM 26FR 24CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18011	SUP	HCPCS C1892		G18011  -  INTRODUCER NPHSTM 28FR 24CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18012	SUP	HCPCS C1892		G18012  -  INTRODUCER NPHSTM 30FR 24CM 30CM AMPTZ DIL SHTH RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18013	SUP	HCPCS C1892		G18013  -  INTRODUCER NPHSTM 16FR 16CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18014	SUP	HCPCS C1892		G18014  -  INTRODUCER NPHSTM 18FR 16CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18015	SUP	HCPCS C1892		G18015  -  INTRODUCER NPHSTM 20FR 16CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18016	SUP	HCPCS C1892		G18016  -  INTRODUCER NPHSTM 28FR 30CM 40CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18017	SUP	HCPCS C1892		G18017  -  INTRODUCER NPHSTM 30FR 25CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18018	SUP	HCPCS C1892		G18018  -  INTRODUCER NPHSTM 30FR 28CM 32CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18019	SUP	HCPCS C1892		G18019  -  INTRODUCER NPHSTM 30FR 30CM 40CM AMPTZ DIL RNL	BOTH IP/OP	$80.85 	$59.83	$0.00	$64.68	$43.90	$43.90	$0.00	$0.00	$0.00	$16.85	$60.01	$60.01	$0.00	$0.00	$16.85	$0.00	$47.82	$47.82	$0.00	$40.43	$64.03	$64.68	$0.00		$0.00	$12.65	$0.00	$0.00	$12.87	$0.00	$0.00	$0.00	$0.00	$0.00
G18020	SUP	HCPCS C1892		G18020  -  INTRODUCER NPHSTM 32FR 16CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$80.85 	$59.83	$0.00	$64.68	$43.90	$43.90	$0.00	$0.00	$0.00	$16.85	$60.01	$60.01	$0.00	$0.00	$16.85	$0.00	$47.82	$47.82	$0.00	$40.43	$64.03	$64.68	$0.00		$0.00	$12.65	$0.00	$0.00	$12.87	$0.00	$0.00	$0.00	$0.00	$0.00
G18021	SUP	HCPCS C1892		G18021  -  INTRODUCER NPHSTM 34FR 16CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18063	SUP	HCPCS C1892		G18063  -  INTRODUCER NPHSTM 36FR 16CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$103.53 	$76.61	$0.00	$82.82	$56.21	$56.21	$0.00	$0.00	$0.00	$21.58	$76.84	$76.84	$0.00	$0.00	$21.57	$0.00	$61.24	$61.24	$0.00	$51.76	$82.00	$82.82	$0.00		$0.00	$16.20	$0.00	$0.00	$16.48	$0.00	$0.00	$0.00	$0.00	$0.00
G18067	SUP	HCPCS C1726		G18067  -  SET INTRO 8FR 10FR 70CM 30CM DSLT HFMN SHTH CATH RADOPQ BAND	BOTH IP/OP	$58.83 	$43.53	$0.00	$47.06	$31.94	$31.94	$0.00	$0.00	$0.00	$12.26	$43.66	$43.66	$0.00	$0.00	$12.26	$0.00	$34.79	$34.79	$0.00	$29.41	$46.59	$47.06	$0.00		$0.00	$9.21	$0.00	$0.00	$9.36	$0.00	$0.00	$0.00	$0.00	$0.00
G18070	SUP	HCPCS C2625		G18070  -  CATHETER GD .038IN 5FR 100CM AMPTZ RADOPQ TFE SHTH RNL	BOTH IP/OP	$235.75 	$174.46	$0.00	$188.60	$106.09	$106.09	$0.00	$0.00	$0.00	$49.14	$174.97	$174.97	$0.00	$0.00	$49.13	$0.00	$139.45	$139.45	$0.00	$117.88	$186.71	$188.60	$0.00		$0.00	$36.89	$0.00	$0.00	$37.53	$0.00	$0.00	$0.00	$0.00	$0.00
G18127	SUP	HCPCS C2617		G18127  -  SET STENT 26CM 7-14FR CFLX URET EURTM RELS SLV PSTNR 13CM	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G18131	SUP	HCPCS C2617		G18131  -  SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100MM BNDR 2 CATH	BOTH IP/OP	$235.75 	$174.46	$0.00	$188.60	$106.09	$106.09	$0.00	$0.00	$0.00	$49.14	$174.97	$174.97	$0.00	$0.00	$49.13	$0.00	$139.45	$139.45	$0.00	$117.88	$186.71	$188.60	$0.00		$0.00	$36.89	$0.00	$0.00	$37.53	$0.00	$0.00	$0.00	$0.00	$0.00
G18140	SUP	HCPCS C2617		G18140  -  SET STNT .038IN 2 PGTL CRV 6-10FR 13CM STRL 26CM RADOPQ	BOTH IP/OP	$155.40 	$115.00	$0.00	$124.32	$69.93	$69.93	$0.00	$0.00	$0.00	$32.39	$115.34	$115.34	$0.00	$0.00	$32.39	$0.00	$91.92	$91.92	$0.00	$77.70	$123.08	$124.32	$0.00		$0.00	$24.32	$0.00	$0.00	$24.74	$0.00	$0.00	$0.00	$0.00	$0.00
G18142	SUP	HCPCS C1769		G18142  -  SET CATH .038IN PGTL CRV 6FR 70CM 145CM SDPRT SHFT GW MOD	BOTH IP/OP	$94.58 	$69.99	$0.00	$75.66	$51.35	$51.35	$0.00	$0.00	$0.00	$19.71	$70.19	$70.19	$0.00	$0.00	$19.71	$0.00	$55.94	$55.94	$0.00	$47.29	$74.91	$75.66	$0.00		$0.00	$14.80	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$0.00
G18143	SUP	HCPCS C1769		G18143  -  GUIDEWIRE VASC STRG .035IN 145CM STRL 7CM RDRR PC STD BD	BOTH IP/OP	$94.58 	$69.99	$0.00	$75.66	$51.35	$51.35	$0.00	$0.00	$0.00	$19.71	$70.19	$70.19	$0.00	$0.00	$19.71	$0.00	$55.94	$55.94	$0.00	$47.29	$74.91	$75.66	$0.00		$0.00	$14.80	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$0.00
G18144	SUP	HCPCS C1769		G18144  -  GUIDEWIRE VASC ANG STD .035IN 145CM STRL 7CM RDRR PC STF BD	BOTH IP/OP	$94.58 	$69.99	$0.00	$75.66	$51.35	$51.35	$0.00	$0.00	$0.00	$19.71	$70.19	$70.19	$0.00	$0.00	$19.71	$0.00	$55.94	$55.94	$0.00	$47.29	$74.91	$75.66	$0.00		$0.00	$14.80	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$0.00
G18145	SUP	HCPCS C1769		G18145  -  GUIDEWIRE VASC STRG STD .038IN 145CM STRL 7CM RDRR PC STF BD	BOTH IP/OP	$94.58 	$69.99	$0.00	$75.66	$51.35	$51.35	$0.00	$0.00	$0.00	$19.71	$70.19	$70.19	$0.00	$0.00	$19.71	$0.00	$55.94	$55.94	$0.00	$47.29	$74.91	$75.66	$0.00		$0.00	$14.80	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$0.00
G18153	SUP	HCPCS C1769		G18153  -  GUIDEWIRE VASC STD ANG .038IN 145CM STRL 7CM RDRR PC NTNL	BOTH IP/OP	$94.58 	$69.99	$0.00	$75.66	$51.35	$51.35	$0.00	$0.00	$0.00	$19.71	$70.19	$70.19	$0.00	$0.00	$19.71	$0.00	$55.94	$55.94	$0.00	$47.29	$74.91	$75.66	$0.00		$0.00	$14.80	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$0.00
G18154	SUP	HCPCS C1769		G18154  -  GUIDEWIRE VASC STRG .035IN 145CM 8CM RDRR PC STF BD LFRIC	BOTH IP/OP	$94.58 	$69.99	$0.00	$75.66	$51.35	$51.35	$0.00	$0.00	$0.00	$19.71	$70.19	$70.19	$0.00	$0.00	$19.71	$0.00	$55.94	$55.94	$0.00	$47.29	$74.91	$75.66	$0.00		$0.00	$14.80	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$0.00
G18155	SUP	HCPCS C1769		G18155  -  GUIDEWIRE VASC .035IN 145CM STRL 8CM RDRR PC STF BD ANG TIP	BOTH IP/OP	$94.58 	$69.99	$0.00	$75.66	$51.35	$51.35	$0.00	$0.00	$0.00	$19.71	$70.19	$70.19	$0.00	$0.00	$19.71	$0.00	$55.94	$55.94	$0.00	$47.29	$74.91	$75.66	$0.00		$0.00	$14.80	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$0.00
G18156	SUP	HCPCS C1769		G18156  -  GUIDEWIRE VASC STRG .038IN 145CM 8CM RDRR PC 1 TO 1 TRQ	BOTH IP/OP	$94.58 	$69.99	$0.00	$75.66	$51.35	$51.35	$0.00	$0.00	$0.00	$19.71	$70.19	$70.19	$0.00	$0.00	$19.71	$0.00	$55.94	$55.94	$0.00	$47.29	$74.91	$75.66	$0.00		$0.00	$14.80	$0.00	$0.00	$15.06	$0.00	$0.00	$0.00	$0.00	$0.00
G18162	SUP	HCPCS C2617		G18162  -  GUIDEWIRE URO STRG .038IN 145CM STRL 5CM AMPTZ FLX TP FX COR	BOTH IP/OP	$32.90 	$24.35	$0.00	$26.32	$14.81	$14.81	$0.00	$0.00	$0.00	$6.86	$24.42	$24.42	$0.00	$0.00	$6.86	$0.00	$19.46	$19.46	$0.00	$16.45	$26.06	$26.32	$0.00		$0.00	$5.15	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$0.00
G18189	SUP	HCPCS C2627		G18189  -  SET STNT 4FR 12-18CM STRL SALLE CATH MTLNTH PSTNR CNCT GW	BOTH IP/OP	$198.63 	$146.99	$0.00	$158.90	$107.85	$107.85	$0.00	$0.00	$0.00	$0.00	$147.42	$147.42	$0.00	$0.00	$41.39	$0.00	$0.00	$0.00	$0.00	$99.31	$157.31	$158.90	$0.00		$0.00	$31.08	$0.00	$0.00	$31.62	$0.00	$0.00	$0.00	$0.00	$0.00
G18191	SUP	Custom 27203010		G18191  -  SET CATH 8FR 54CM CYSTOSTOMY MOD TROC STY DRN ADPR SPBC	BOTH IP/OP	$462.20 	$342.03	$0.00	$369.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.04	$343.04	$0.00	$0.00	$96.32	$0.00	$0.00	$0.00	$0.00	$231.10	$366.06	$369.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G18193	SUP	Custom 27203010		G18193  -  EXTRACTOR STON HLX 3FR 1CM 115CM NCRCL FLXB SHTH NTNL MEM	BOTH IP/OP	$302.83 	$224.09	$0.00	$242.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.76	$224.76	$0.00	$0.00	$63.11	$0.00	$0.00	$0.00	$0.00	$151.41	$239.84	$242.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G18201	SUP	HCPCS C1892		G18201  -  CATHETER XTRN 1.53IN NS NADH CNDM SIL M DISP	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18622	SUP	HCPCS C2617		G18622  -  INTRODUCER NPHSTM 30FR 22CM 30CM AMPTZ DIL RNL	BOTH IP/OP	$285.83 	$211.51	$0.00	$228.66	$128.62	$128.62	$0.00	$0.00	$0.00	$59.57	$212.14	$212.14	$0.00	$0.00	$59.57	$0.00	$169.07	$169.07	$0.00	$142.91	$226.38	$228.66	$0.00		$0.00	$44.73	$0.00	$0.00	$45.50	$0.00	$0.00	$0.00	$0.00	$0.00
G18624	SUP	HCPCS C2625		G18624  -  SET STNT .038IN 2 PGTL CRV 7FR 20CM BLU STRL CATH RADOPQ	BOTH IP/OP	$271.13 	$200.64	$0.00	$216.90	$122.01	$122.01	$0.00	$0.00	$0.00	$56.51	$201.23	$201.23	$0.00	$0.00	$56.50	$0.00	$160.37	$160.37	$0.00	$135.56	$214.73	$216.90	$0.00		$0.00	$42.43	$0.00	$0.00	$43.16	$0.00	$0.00	$0.00	$0.00	$0.00
G18629	SUP	HCPCS C1769		G18629  -  SET STNT .038IN 5MM PGTL CRV 4.7FR 75CM STRL 100MM BNDR 2	BOTH IP/OP	$107.85 	$79.81	$0.00	$86.28	$58.56	$58.56	$0.00	$0.00	$0.00	$22.48	$80.05	$80.05	$0.00	$0.00	$22.48	$0.00	$63.79	$63.79	$0.00	$53.93	$85.42	$86.28	$0.00		$0.00	$16.88	$0.00	$0.00	$17.17	$0.00	$0.00	$0.00	$0.00	$0.00
G18639	SUP	HCPCS C2617		G18639  -  GUIDEWIRE ESCP STRG .035IN 145CM STRL 3CM RDRR PC 1-1 TRQ	BOTH IP/OP	$285.83 	$211.51	$0.00	$228.66	$128.62	$128.62	$0.00	$0.00	$0.00	$59.57	$212.14	$212.14	$0.00	$0.00	$59.57	$0.00	$169.07	$169.07	$0.00	$142.91	$226.38	$228.66	$0.00		$0.00	$44.73	$0.00	$0.00	$45.50	$0.00	$0.00	$0.00	$0.00	$0.00
G18671	SUP	Custom 27203010		G18671  -  SET STNT .038IN 2 PGTL CRV 7FR 24CM BLU STRL CATH RADOPQ	BOTH IP/OP	$84.70 	$62.68	$0.00	$67.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.86	$62.86	$0.00	$0.00	$17.65	$0.00	$0.00	$0.00	$0.00	$42.35	$67.08	$67.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G18702	SUP	Custom 27203010		G18702  -  NEEDLE BRCHTX 18GA 20CM ECHTP LOC	BOTH IP/OP	$94.60 	$70.00	$0.00	$75.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.21	$70.21	$0.00	$0.00	$19.71	$0.00	$0.00	$0.00	$0.00	$47.30	$74.92	$75.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G18705	SUP	Custom 27203010		G18705  -  NEEDLE BX 14GA 15CM STRL Q COR 1 HNDCNTL LTWT SFT TIS DISP	BOTH IP/OP	$94.60 	$70.00	$0.00	$75.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.21	$70.21	$0.00	$0.00	$19.71	$0.00	$0.00	$0.00	$0.00	$47.30	$74.92	$75.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G18707	SUP	Custom 27203010		G18707  -  NEEDLE BX 18GA 15CM STRL Q COR 1 HND CNTRL LTWT SFT TIS DISP	BOTH IP/OP	$94.60 	$70.00	$0.00	$75.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.21	$70.21	$0.00	$0.00	$19.71	$0.00	$0.00	$0.00	$0.00	$47.30	$74.92	$75.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G18725	SUP	HCPCS C1892		G18725  -  NEEDLE BX 18GA 20CM STRL Q COR 1 HND CNTRL LTWT SFT TIS DISP	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$50.49	$50.49	$0.00	$0.00	$0.00	$19.38	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$54.99	$54.99	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$14.55	$0.00	$0.00	$14.80	$0.00	$0.00	$0.00	$0.00	$0.00
G18758	SUP	HCPCS C1758		G18758  -  INTRODUCER NPHSTM 26FR 20CM 32CM AMPTZ DIL RNL	BOTH IP/OP	$39.95 	$29.56	$0.00	$31.96	$21.69	$21.69	$0.00	$0.00	$0.00	$8.33	$29.65	$29.65	$0.00	$0.00	$8.33	$0.00	$23.63	$23.63	$0.00	$19.98	$31.64	$31.96	$0.00		$0.00	$6.25	$0.00	$0.00	$6.36	$0.00	$0.00	$0.00	$0.00	$0.00
G18777	SUP	Custom 27203010		G18777  -  CATHETER URET .038IN 5FR 85CM FLXTP OP-EN GW MOD	BOTH IP/OP	$462.20 	$342.03	$0.00	$369.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.04	$343.04	$0.00	$0.00	$96.32	$0.00	$0.00	$0.00	$0.00	$231.10	$366.06	$369.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G18778	SUP	Custom 27203010		G18778  -  EXTRACTOR STON 2.2FR 2CM 115CM NCRCL TPLS MOD BSKT NTNL	BOTH IP/OP	$462.20 	$342.03	$0.00	$369.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.04	$343.04	$0.00	$0.00	$96.32	$0.00	$0.00	$0.00	$0.00	$231.10	$366.06	$369.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G18790	SUP	HCPCS C1758		G18790  -  EXTRACTOR STON 2.2FR 1CM 115CM STRL NCRCL NTNL URO DISP	BOTH IP/OP	$32.90 	$24.35	$0.00	$26.32	$17.86	$17.86	$0.00	$0.00	$0.00	$6.86	$24.42	$24.42	$0.00	$0.00	$6.86	$0.00	$19.46	$19.46	$0.00	$16.45	$26.06	$26.32	$0.00		$0.00	$5.15	$0.00	$0.00	$5.24	$0.00	$0.00	$0.00	$0.00	$0.00
G18792	SUP	HCPCS C1769		G18792  -  CATHETER URET .038IN 5FR 110CM FLXTP OP-EN GW MOD	BOTH IP/OP	$108.38 	$80.20	$0.00	$86.70	$58.85	$58.85	$0.00	$0.00	$0.00	$22.59	$80.44	$80.44	$0.00	$0.00	$22.59	$0.00	$64.10	$64.10	$0.00	$54.19	$85.84	$86.70	$0.00		$0.00	$16.96	$0.00	$0.00	$17.25	$0.00	$0.00	$0.00	$0.00	$0.00
G18803	SUP	HCPCS C1892		G18803  -  GUIDEWIRE URO .035IN 145CM STRL RDRR PC 2 FLX TP AQ DISP	BOTH IP/OP	$164.45 	$121.69	$0.00	$131.56	$89.30	$89.30	$0.00	$0.00	$0.00	$34.28	$122.05	$122.05	$0.00	$0.00	$34.27	$0.00	$97.27	$97.27	$0.00	$82.23	$130.24	$131.56	$0.00		$0.00	$25.74	$0.00	$0.00	$26.18	$0.00	$0.00	$0.00	$0.00	$0.00
G18813	SUP	Custom 27203010		G18813  -  INTRODUCER NPHSTM 12FR 65CM 60CM PLWY 2 KNOB	BOTH IP/OP	$59.40 	$43.96	$0.00	$47.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.09	$44.09	$0.00	$0.00	$12.38	$0.00	$0.00	$0.00	$0.00	$29.70	$47.04	$47.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G18827	SUP	HCPCS C2627		G18827  -  ADAPTER CATH 6FR STRL T-B SDARM URET DISP	BOTH IP/OP	$102.50 	$75.85	$0.00	$82.00	$55.66	$55.66	$0.00	$0.00	$0.00	$0.00	$76.08	$76.08	$0.00	$0.00	$21.36	$0.00	$0.00	$0.00	$0.00	$51.25	$81.18	$82.00	$0.00		$0.00	$16.04	$0.00	$0.00	$16.32	$0.00	$0.00	$0.00	$0.00	$0.00
G18845	SUP	HCPCS C1758		G18845  -  STENT URTH 6FR 50CM STRL 26CM KL DPR INK MRK DISP	BOTH IP/OP	$85.80 	$63.49	$0.00	$68.64	$46.59	$46.59	$0.00	$0.00	$0.00	$17.88	$63.68	$63.68	$0.00	$0.00	$17.88	$0.00	$50.75	$50.75	$0.00	$42.90	$67.95	$68.64	$0.00		$0.00	$13.43	$0.00	$0.00	$13.66	$0.00	$0.00	$0.00	$0.00	$0.00
G18876	SUP	HCPCS C1758		G18876  -  CATHETER URET STD 6/10FR 24CM FLXTP 2 LUM ACC HDRPH	BOTH IP/OP	$27.83 	$20.59	$0.00	$22.26	$15.11	$15.11	$0.00	$0.00	$0.00	$5.80	$20.65	$20.65	$0.00	$0.00	$5.80	$0.00	$16.46	$16.46	$0.00	$13.91	$22.04	$22.26	$0.00		$0.00	$4.35	$0.00	$0.00	$4.43	$0.00	$0.00	$0.00	$0.00	$0.00
G18882	SUP	Custom 27203010		G18882  -  GRASPER ENDSCP 3.2FR 10MM 115CM 3 PRONG DELTA WIRE STAINLESS	BOTH IP/OP	$472.83 	$349.89	$0.00	$378.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$350.93	$350.93	$0.00	$0.00	$98.54	$0.00	$0.00	$0.00	$0.00	$236.41	$374.48	$378.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G18883	SUP	HCPCS C1758		G18883  -  CATHETER URET 5FR 100CM RND TIP LT	BOTH IP/OP	$49.35 	$36.52	$0.00	$39.48	$26.80	$26.80	$0.00	$0.00	$0.00	$10.29	$36.63	$36.63	$0.00	$0.00	$10.28	$0.00	$29.19	$29.19	$0.00	$24.68	$39.09	$39.48	$0.00		$0.00	$7.72	$0.00	$0.00	$7.86	$0.00	$0.00	$0.00	$0.00	$0.00
G18884	SUP	HCPCS C1758		G18884  -  CATHETER URET .05IN 7.1FR 40CM SFLX NTPR TIP LSR	BOTH IP/OP	$104.35 	$77.22	$0.00	$83.48	$56.66	$56.66	$0.00	$0.00	$0.00	$21.75	$77.45	$77.45	$0.00	$0.00	$21.75	$0.00	$61.72	$61.72	$0.00	$52.18	$82.65	$83.48	$0.00		$0.00	$16.33	$0.00	$0.00	$16.61	$0.00	$0.00	$0.00	$0.00	$0.00
G18909	SUP	HCPCS C1758		G18909  -  CATHETER URET PGTL CRV 8.2FR 56CM SFLX HDRPH	BOTH IP/OP	$31.63 	$23.41	$0.00	$25.30	$17.17	$17.17	$0.00	$0.00	$0.00	$6.59	$23.47	$23.47	$0.00	$0.00	$6.59	$0.00	$18.71	$18.71	$0.00	$15.81	$25.05	$25.30	$0.00		$0.00	$4.95	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00
G18996	SUP	HCPCS C1758		G18996  -  CATHETER URET 3FR 100CM RND TIP STY LT	BOTH IP/OP	$104.35 	$77.22	$0.00	$83.48	$56.66	$56.66	$0.00	$0.00	$0.00	$21.75	$77.45	$77.45	$0.00	$0.00	$21.75	$0.00	$61.72	$61.72	$0.00	$52.18	$82.65	$83.48	$0.00		$0.00	$16.33	$0.00	$0.00	$16.61	$0.00	$0.00	$0.00	$0.00	$0.00
G18997	SUP	HCPCS C1758		G18997  -  CATHETER URET PGTL CRV 10FR 56CM SFLX HDRPH	BOTH IP/OP	$119.20 	$88.21	$0.00	$95.36	$64.73	$64.73	$0.00	$0.00	$0.00	$24.84	$88.47	$88.47	$0.00	$0.00	$24.84	$0.00	$70.51	$70.51	$0.00	$59.60	$94.41	$95.36	$0.00		$0.00	$18.65	$0.00	$0.00	$18.98	$0.00	$0.00	$0.00	$0.00	$0.00
G19002	SUP	HCPCS C1758		G19002  -  CATHETER URET PGTL CRV 7FR 56CM SFLX HDRPH	BOTH IP/OP	$53.13 	$39.32	$0.00	$42.50	$28.85	$28.85	$0.00	$0.00	$0.00	$11.07	$39.43	$39.43	$0.00	$0.00	$11.07	$0.00	$31.42	$31.42	$0.00	$26.56	$42.08	$42.50	$0.00		$0.00	$8.31	$0.00	$0.00	$8.46	$0.00	$0.00	$0.00	$0.00	$0.00
G19030	SUP	Custom 27203010		G19030  -  CATHETER URET .038IN 7FR 70CM OP-EN GW MOD	BOTH IP/OP	$43.00 	$31.82	$0.00	$34.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.91	$31.91	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$21.50	$34.06	$34.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G19032	SUP	Custom 27203010		G19032  -  NEEDLE ESCP 18GA 20CM SKNY ECHTP CHBA TIP	BOTH IP/OP	$29.70 	$21.98	$0.00	$23.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.04	$22.04	$0.00	$0.00	$6.19	$0.00	$0.00	$0.00	$0.00	$14.85	$23.52	$23.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G19055	SUP	HCPCS C1758		G19055  -  ADAPTER CATH 9FR CKFL 3W STPCK SDARM SLF SL	BOTH IP/OP	$53.13 	$39.32	$0.00	$42.50	$28.85	$28.85	$0.00	$0.00	$0.00	$11.07	$39.43	$39.43	$0.00	$0.00	$11.07	$0.00	$31.42	$31.42	$0.00	$26.56	$42.08	$42.50	$0.00		$0.00	$8.31	$0.00	$0.00	$8.46	$0.00	$0.00	$0.00	$0.00	$0.00
G19069	SUP	HCPCS C2617		G19069  -  CATHETER URET .038IN 7FR 70CM OP-EN GW MOD	BOTH IP/OP	$261.38 	$193.42	$0.00	$209.10	$117.62	$117.62	$0.00	$0.00	$0.00	$54.48	$193.99	$193.99	$0.00	$0.00	$54.47	$0.00	$154.60	$154.60	$0.00	$130.69	$207.01	$209.10	$0.00		$0.00	$40.91	$0.00	$0.00	$41.61	$0.00	$0.00	$0.00	$0.00	$0.00
G19072	SUP	Custom 27203010		G19072  -  SET STNT 5FR 8-20CM STRL GRN CATH RADOPQ MTLNTH PSTNR	BOTH IP/OP	$478.13 	$353.82	$0.00	$382.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.86	$354.86	$0.00	$0.00	$99.64	$0.00	$0.00	$0.00	$0.00	$239.06	$378.68	$382.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G19073	SUP	Custom 27203010		G19073  -  EXTRACTOR STON 2.2FR 115CM 5CM NFORCE 3WR HLCL OCL NTNL	BOTH IP/OP	$549.85 	$406.89	$0.00	$439.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.10	$408.10	$0.00	$0.00	$114.59	$0.00	$0.00	$0.00	$0.00	$274.93	$435.48	$439.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G19089	SUP	HCPCS C1729		G19089  -  SET NPHSTM ECHTP NDL GW DIL PERC	BOTH IP/OP	$417.45 	$308.91	$0.00	$333.96	$226.68	$226.68	$0.00	$0.00	$0.00	$87.01	$309.83	$309.83	$0.00	$0.00	$87.00	$0.00	$246.92	$246.92	$0.00	$208.73	$330.62	$333.96	$0.00		$0.00	$65.33	$0.00	$0.00	$66.46	$0.00	$0.00	$0.00	$0.00	$0.00
G19097	SUP	HCPCS C1894		G19097  -  SET NPHSTM PGTL CRV 6FR 7CM ECHTP NDL GW CATH DIL CNCT TUBE	BOTH IP/OP	$254.28 	$188.17	$0.00	$203.42	$138.07	$138.07	$0.00	$0.00	$0.00	$53.00	$188.72	$188.72	$0.00	$0.00	$52.99	$0.00	$150.40	$150.40	$0.00	$127.14	$201.39	$203.42	$0.00		$0.00	$39.79	$0.00	$0.00	$40.48	$0.00	$0.00	$0.00	$0.00	$0.00
G19098	SUP	HCPCS C1769		G19098  -  SET NPHSTM COPE LOOP ECHTP NDL GW CATH CNN PERC	BOTH IP/OP	$465.53 	$344.49	$0.00	$372.42	$252.78	$252.78	$0.00	$0.00	$0.00	$97.03	$345.51	$345.51	$0.00	$0.00	$97.02	$0.00	$275.36	$275.36	$0.00	$232.76	$368.70	$372.42	$0.00		$0.00	$72.85	$0.00	$0.00	$74.11	$0.00	$0.00	$0.00	$0.00	$0.00
G19110	SUP	Custom 27203010		G19110  -  SET NPHSTM 10FR 19.5CM LTX COPE LOOP ECHTP NDL STPCK CNN	BOTH IP/OP	$515.33 	$381.34	$0.00	$412.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.47	$382.47	$0.00	$0.00	$107.39	$0.00	$0.00	$0.00	$0.00	$257.66	$408.14	$412.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G19111	SUP	Custom 27203010		G19111  -  EXTRACTOR STON 3ANG 2.4FR 1CM 115CM STRL NCR DWR TPLS BSKT	BOTH IP/OP	$515.33 	$381.34	$0.00	$412.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.47	$382.47	$0.00	$0.00	$107.39	$0.00	$0.00	$0.00	$0.00	$257.66	$408.14	$412.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G19119	SUP	HCPCS C1758		G19119  -  EXTRACTOR STON 2.4FR 2CM 115CM NCR DWR TPLS MOD BSKT NTNL	BOTH IP/OP	$225.50 	$166.87	$0.00	$180.40	$122.45	$122.45	$0.00	$0.00	$0.00	$47.00	$167.37	$167.37	$0.00	$0.00	$46.99	$0.00	$133.38	$133.38	$0.00	$112.75	$178.60	$180.40	$0.00		$0.00	$35.29	$0.00	$0.00	$35.90	$0.00	$0.00	$0.00	$0.00	$0.00
G19168	SUP	HCPCS C1894		G19168  -  SHEATH ACCES 12FR 35CM DILATION CONTIN WORKING CHANNEL	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G19169	SUP	HCPCS C1894		G19169  -  SET STNT ANTGRD 2 PGTL CRV 6FR 50CM GRN STRL 32CM SEIDMON	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G19172	SUP	HCPCS C1894		G19172  -  SHEATH ACCES 12FR DILATION CONTIN WKG CHNL FLXR	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G19173	SUP	HCPCS C1894		G19173  -  SHEATH ACC 12FR 55CM STRL LTX FLXR DILATION CNT WRK CHNL	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G19174	SUP	HCPCS C1894		G19174  -  SHEATH ACCES 9.5FR TPR DILAT CONTIN WRK CHNL LOCK	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G19175	SUP	HCPCS C1894		G19175  -  SHEATH ACC 12FR 20CM STRL LTX FLXR DILATION CNT WRK CHNL	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G19176	SUP	HCPCS C1894		G19176  -  SHEATH ACCES 9.5FR TPR DILAT CONTIN WRK CHNL LOCK	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G19177	SUP	HCPCS C1894		G19177  -  SHEATH ACC FNL 9.5FR 55CM STRL FLXR WKG CHNL LFRIC SRFC DIL	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G19191	SUP	Custom 27203010		G19191  -  NEEDLE ENDSCP 22GA 25CM SKINNY NEEDLE CHIBA ECHOTIP	BOTH IP/OP	$28.60 	$21.16	$0.00	$22.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.23	$21.23	$0.00	$0.00	$5.96	$0.00	$0.00	$0.00	$0.00	$14.30	$22.65	$22.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G21363	SUP	Custom 27203010		G21363  -  PROBE DPLR IMPLTABLE FLW 20MHZ STRL CKSWTZ	BOTH IP/OP	"$1,240.00 "	$917.60	$0.00	$920.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$920.33	$920.33	$0.00	$0.00	$258.42	$0.00	$0.00	$0.00	$0.00	$503.19	$797.05	$805.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G21421	SUP	HCPCS C1729		G21421  -  CATHETER ENDSCP 7FR 250CM 5 SIDEPORT LATEX FREE BILIARY	BOTH IP/OP	$207.50 	$153.55	$0.00	$166.00	$112.67	$112.67	$0.00	$0.00	$0.00	$43.25	$154.01	$154.01	$0.00	$0.00	$43.24	$0.00	$122.74	$122.74	$0.00	$103.75	$164.34	$166.00	$0.00		$0.00	$32.47	$0.00	$0.00	$33.03	$0.00	$0.00	$0.00	$0.00	$0.00
G21509	SUP	HCPCS C2617		G21509  -  STENT PANCREATIC 7FR 15CM DRAIN OBSTRUCTED POSITIONING	BOTH IP/OP	$177.50 	$131.35	$0.00	$142.00	$79.88	$79.88	$0.00	$0.00	$0.00	$37.00	$131.74	$131.74	$0.00	$0.00	$36.99	$0.00	$104.99	$104.99	$0.00	$88.75	$140.58	$142.00	$0.00		$0.00	$27.78	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$0.00
G21586	SUP	HCPCS C1729		G21586  -  SET DRAIN PUR 250CM 7FR .035IN PGTL CURVE NSBIL 5 SDPRT CATH	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$190.05	$190.05	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
G21962	SUP	HCPCS C1769		G21962  -  GUIDEWIRE ENDSCP 250CM PROGRESSIVELY FLEXIBLE TIP	BOTH IP/OP	$415.00 	$307.10	$0.00	$332.00	$225.35	$225.35	$0.00	$0.00	$0.00	$86.50	$308.01	$308.01	$0.00	$0.00	$86.49	$0.00	$245.47	$245.47	$0.00	$207.50	$328.68	$332.00	$0.00		$0.00	$64.95	$0.00	$0.00	$66.07	$0.00	$0.00	$0.00	$0.00	$0.00
G21978	SUP	HCPCS C1769		G21978  -  GUIDEWIRE ENDSCP 360CM SAVARY-GILLIARD NONSTRL REUSABLE	BOTH IP/OP	$480.00 	$355.20	$0.00	$384.00	$260.64	$260.64	$0.00	$0.00	$0.00	$100.04	$356.26	$356.26	$0.00	$0.00	$100.03	$0.00	$283.92	$283.92	$0.00	$240.00	$380.16	$384.00	$0.00		$0.00	$75.12	$0.00	$0.00	$76.42	$0.00	$0.00	$0.00	$0.00	$0.00
G22102	SUP	HCPCS C2617		G22102  -  STENT PANCREATIC 5FR 153CM DRAIN OBSTRUCTED POSITIONING	BOTH IP/OP	$177.50 	$131.35	$0.00	$142.00	$79.88	$79.88	$0.00	$0.00	$0.00	$37.00	$131.74	$131.74	$0.00	$0.00	$36.99	$0.00	$104.99	$104.99	$0.00	$88.75	$140.58	$142.00	$0.00		$0.00	$27.78	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$0.00
G22139	SUP	HCPCS C1769		G22139  -  GUIDEWIRE ENDSCP 200CM FLEXIBLE TIP SAVARY-GILLIARD	BOTH IP/OP	$345.00 	$255.30	$0.00	$276.00	$187.34	$187.34	$0.00	$0.00	$0.00	$71.91	$256.06	$256.06	$0.00	$0.00	$71.90	$0.00	$204.07	$204.07	$0.00	$172.50	$273.24	$276.00	$0.00		$0.00	$53.99	$0.00	$0.00	$54.92	$0.00	$0.00	$0.00	$0.00	$0.00
G22409	SUP	Custom 27203010		G22409  -  BRUSH CYTOLOGY 5FR 2MM 180CM GASTROSCOPE GREEN	BOTH IP/OP	$46.25 	$34.23	$0.00	$37.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.33	$34.33	$0.00	$0.00	$9.64	$0.00	$0.00	$0.00	$0.00	$23.13	$36.63	$37.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G23239	SUP	HCPCS C2617		G23239  -  LASER SRG 115V 20AMP RHPSD H-30	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23240	SUP	HCPCS C2617		G23240  -  SET STNT .038IN 3CM PGTL CRV 7FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$137.05 	$101.42	$0.00	$109.64	$61.67	$61.67	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$68.53	$108.54	$109.64	$0.00		$0.00	$21.45	$0.00	$0.00	$21.82	$0.00	$0.00	$0.00	$0.00	$0.00
G23241	SUP	HCPCS C2617		G23241  -  STENT URET 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23242	SUP	HCPCS C2617		G23242  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM	BOTH IP/OP	$137.05 	$101.42	$0.00	$109.64	$61.67	$61.67	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$68.53	$108.54	$109.64	$0.00		$0.00	$21.45	$0.00	$0.00	$21.82	$0.00	$0.00	$0.00	$0.00	$0.00
G23243	SUP	HCPCS C2617		G23243  -  STENT URET 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23244	SUP	HCPCS C2617		G23244  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23312	SUP	HCPCS C2617		G23312  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM	BOTH IP/OP	$137.05 	$101.42	$0.00	$109.64	$61.67	$61.67	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$68.53	$108.54	$109.64	$0.00		$0.00	$21.45	$0.00	$0.00	$21.82	$0.00	$0.00	$0.00	$0.00	$0.00
G23313	SUP	HCPCS C2617		G23313  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23314	SUP	HCPCS C2617		G23314  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23315	SUP	HCPCS C2617		G23315  -  SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23316	SUP	HCPCS C2617		G23316  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23317	SUP	HCPCS C2617		G23317  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23318	SUP	HCPCS C2617		G23318  -  SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23319	SUP	HCPCS C2617		G23319  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23320	SUP	HCPCS C2617		G23320  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23326	SUP	HCPCS C2617		G23326  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23327	SUP	HCPCS C2617		G23327  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23328	SUP	HCPCS C2617		G23328  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23329	SUP	HCPCS C2617		G23329  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23330	SUP	HCPCS C2617		G23330  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23331	SUP	HCPCS C2617		G23331  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23332	SUP	HCPCS C2617		G23332  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23333	SUP	HCPCS C2617		G23333  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM	BOTH IP/OP	$137.05 	$101.42	$0.00	$109.64	$61.67	$61.67	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$68.53	$108.54	$109.64	$0.00		$0.00	$21.45	$0.00	$0.00	$21.82	$0.00	$0.00	$0.00	$0.00	$0.00
G23334	SUP	HCPCS C2617		G23334  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23335	SUP	HCPCS C2617		G23335  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23336	SUP	HCPCS C2617		G23336  -  SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23337	SUP	HCPCS C2617		G23337  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23338	SUP	HCPCS C2617		G23338  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23339	SUP	HCPCS C2617		G23339  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23340	SUP	HCPCS C2617		G23340  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23341	SUP	HCPCS C2617		G23341  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23342	SUP	HCPCS C2617		G23342  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23343	SUP	HCPCS C2617		G23343  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23344	SUP	HCPCS C2617		G23344  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23345	SUP	HCPCS C2617		G23345  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23346	SUP	HCPCS C2617		G23346  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23347	SUP	HCPCS C2617		G23347  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23348	SUP	HCPCS C2617		G23348  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23349	SUP	HCPCS C2617		G23349  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23350	SUP	HCPCS C2617		G23350  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23351	SUP	HCPCS C2617		G23351  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23352	SUP	HCPCS C2617		G23352  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23353	SUP	HCPCS C2617		G23353  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23354	SUP	HCPCS C2617		G23354  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23355	SUP	HCPCS C2617		G23355  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23356	SUP	HCPCS C2617		G23356  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23357	SUP	HCPCS C2617		G23357  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23358	SUP	HCPCS C2617		G23358  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23359	SUP	HCPCS C2617		G23359  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23360	SUP	HCPCS C2617		G23360  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23361	SUP	HCPCS C2617		G23361  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23362	SUP	HCPCS C2617		G23362  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23363	SUP	HCPCS C2617		G23363  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23365	SUP	HCPCS C2617		G23365  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$137.05 	$101.42	$0.00	$109.64	$61.67	$61.67	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$68.53	$108.54	$109.64	$0.00		$0.00	$21.45	$0.00	$0.00	$21.82	$0.00	$0.00	$0.00	$0.00	$0.00
G23366	SUP	HCPCS C2617		G23366  -  SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23367	SUP	HCPCS C2617		G23367  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23368	SUP	HCPCS C2617		G23368  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23369	SUP	HCPCS C2617		G23369  -  SET STNT 2 PGTL CRV 5FR 26CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23370	SUP	HCPCS C2617		G23370  -  SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23371	SUP	HCPCS C2617		G23371  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23372	SUP	HCPCS C2617		G23372  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23373	SUP	HCPCS C2617		G23373  -  SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23374	SUP	HCPCS C2617		G23374  -  SET STNT 2 PGTL CRV 6FR 22CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23376	SUP	HCPCS C2617		G23376  -  SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23377	SUP	HCPCS C2617		G23377  -  SET STNT 2 PGTL CRV 6FR 26CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23378	SUP	HCPCS C2617		G23378  -  SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23379	SUP	HCPCS C2617		G23379  -  SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23380	SUP	HCPCS C2617		G23380  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23381	SUP	HCPCS C2617		G23381  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23382	SUP	HCPCS C2617		G23382  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ GRAD PSTNR	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23383	SUP	HCPCS C2617		G23383  -  STENT URET 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23384	SUP	HCPCS C2617		G23384  -  STENT URET 2 PGTL CRV 7FR 26CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23385	SUP	HCPCS C2617		G23385  -  SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ GRAD PSTNR	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23386	SUP	HCPCS C2617		G23386  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23387	SUP	HCPCS C2617		G23387  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23388	SUP	HCPCS C2617		G23388  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23389	SUP	HCPCS C2617		G23389  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23390	SUP	HCPCS C2617		G23390  -  SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23391	SUP	HCPCS C2617		G23391  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23392	SUP	HCPCS C2617		G23392  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23395	SUP	HCPCS C2617		G23395  -  SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23396	SUP	HCPCS C2617		G23396  -  STENT URET 5FR 20CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23397	SUP	HCPCS C2617		G23397  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23398	SUP	HCPCS C2617		G23398  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23399	SUP	HCPCS C2617		G23399  -  STENT URET 5FR 26CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23400	SUP	HCPCS C2617		G23400  -  STENT URET 5FR 28CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23401	SUP	HCPCS C2617		G23401  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23402	SUP	HCPCS C2617		G23402  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23404	SUP	HCPCS C2617		G23404  -  SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23405	SUP	HCPCS C2617		G23405  -  STENT URET 6FR 22CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23406	SUP	HCPCS C2617		G23406  -  SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23407	SUP	HCPCS C2617		G23407  -  STENT URET 6FR 26CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23408	SUP	HCPCS C2617		G23408  -  STENT URET 6FR 28CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23411	SUP	HCPCS C2617		G23411  -  STENT URET 6FR 30CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23412	SUP	HCPCS C2617		G23412  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23413	SUP	HCPCS C2617		G23413  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23415	SUP	HCPCS C2617		G23415  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23416	SUP	HCPCS C2617		G23416  -  STENT URET 7FR 24CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23417	SUP	HCPCS C2617		G23417  -  STENT URET 7FR 26CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23418	SUP	HCPCS C2617		G23418  -  STENT URET 7FR 28CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23419	SUP	HCPCS C2617		G23419  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23420	SUP	HCPCS C2617		G23420  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23421	SUP	HCPCS C2617		G23421  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23422	SUP	HCPCS C2617		G23422  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23423	SUP	HCPCS C2617		G23423  -  STENT URET 8FR 24CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23424	SUP	HCPCS C2617		G23424  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23425	SUP	HCPCS C2617		G23425  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23428	SUP	HCPCS C2617		G23428  -  SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23429	SUP	HCPCS C2617		G23429  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23430	SUP	HCPCS C2617		G23430  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23431	SUP	HCPCS C2617		G23431  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23432	SUP	HCPCS C2617		G23432  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23433	SUP	HCPCS C2617		G23433  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23434	SUP	HCPCS C2617		G23434  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23435	SUP	HCPCS C2617		G23435  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23436	SUP	HCPCS C2617		G23436  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23437	SUP	HCPCS C2617		G23437  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23438	SUP	HCPCS C2617		G23438  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23439	SUP	HCPCS C2617		G23439  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23440	SUP	HCPCS C2617		G23440  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23441	SUP	HCPCS C2617		G23441  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23442	SUP	HCPCS C2617		G23442  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23443	SUP	HCPCS C2617		G23443  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23444	SUP	HCPCS C2617		G23444  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23445	SUP	HCPCS C2617		G23445  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23446	SUP	HCPCS C2617		G23446  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23447	SUP	HCPCS C2617		G23447  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23448	SUP	HCPCS C2617		G23448  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23449	SUP	HCPCS C2617		G23449  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23450	SUP	HCPCS C2617		G23450  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23451	SUP	HCPCS C2617		G23451  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23452	SUP	HCPCS C2617		G23452  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23453	SUP	HCPCS C2617		G23453  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23454	SUP	HCPCS C2617		G23454  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23455	SUP	HCPCS C2617		G23455  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$137.05 	$101.42	$0.00	$109.64	$61.67	$61.67	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$68.53	$108.54	$109.64	$0.00		$0.00	$21.45	$0.00	$0.00	$21.82	$0.00	$0.00	$0.00	$0.00	$0.00
G23456	SUP	HCPCS C2617		G23456  -  SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23457	SUP	HCPCS C2617		G23457  -  SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23458	SUP	HCPCS C2617		G23458  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23459	SUP	HCPCS C2617		G23459  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23460	SUP	HCPCS C2617		G23460  -  SET STNT 2 PGTL CRV 5FR 26CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23461	SUP	HCPCS C2617		G23461  -  SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23462	SUP	HCPCS C2617		G23462  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23463	SUP	HCPCS C2617		G23463  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23464	SUP	HCPCS C2617		G23464  -  SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23465	SUP	HCPCS C2617		G23465  -  SET STNT 2 PGTL CRV 6FR 22CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23466	SUP	HCPCS C2617		G23466  -  SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23467	SUP	HCPCS C2617		G23467  -  SET STNT 2 PGTL CRV 6FR 26CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23468	SUP	HCPCS C2617		G23468  -  SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23469	SUP	HCPCS C2617		G23469  -  SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23470	SUP	HCPCS C2617		G23470  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23471	SUP	HCPCS C2617		G23471  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23472	SUP	HCPCS C2617		G23472  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23473	SUP	HCPCS C2617		G23473  -  SET STNT 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23474	SUP	HCPCS C2617		G23474  -  SET STNT 2 PGTL CRV 7FR 26CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23475	SUP	HCPCS C2617		G23475  -  SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23476	SUP	HCPCS C2617		G23476  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23477	SUP	HCPCS C2617		G23477  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23478	SUP	HCPCS C2617		G23478  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23479	SUP	HCPCS C2617		G23479  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23480	SUP	HCPCS C2617		G23480  -  SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23481	SUP	HCPCS C2617		G23481  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23482	SUP	HCPCS C2617		G23482  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$148.75 	$110.08	$0.00	$119.00	$66.94	$66.94	$0.00	$0.00	$0.00	$31.00	$110.40	$110.40	$0.00	$0.00	$31.00	$0.00	$87.99	$87.99	$0.00	$74.38	$117.81	$119.00	$0.00		$0.00	$23.28	$0.00	$0.00	$23.68	$0.00	$0.00	$0.00	$0.00	$0.00
G23483	SUP	HCPCS C2617		G23483  -  SET STNT .038IN 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23484	SUP	HCPCS C2617		G23484  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23485	SUP	HCPCS C2617		G23485  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23486	SUP	HCPCS C2617		G23486  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23487	SUP	HCPCS C2617		G23487  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23488	SUP	HCPCS C2617		G23488  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23489	SUP	HCPCS C2617		G23489  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23490	SUP	HCPCS C2617		G23490  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23491	SUP	HCPCS C2617		G23491  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23492	SUP	HCPCS C2617		G23492  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23493	SUP	HCPCS C2617		G23493  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23494	SUP	HCPCS C2617		G23494  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23495	SUP	HCPCS C2617		G23495  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23496	SUP	HCPCS C2617		G23496  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23497	SUP	HCPCS C2617		G23497  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23498	SUP	HCPCS C2617		G23498  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23499	SUP	HCPCS C2617		G23499  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23500	SUP	HCPCS C2617		G23500  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23501	SUP	HCPCS C2617		G23501  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23502	SUP	HCPCS C2617		G23502  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23503	SUP	HCPCS C2617		G23503  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23504	SUP	HCPCS C2617		G23504  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23505	SUP	HCPCS C2617		G23505  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23506	SUP	HCPCS C2617		G23506  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23507	SUP	HCPCS C2617		G23507  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23508	SUP	HCPCS C2617		G23508  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23509	SUP	HCPCS C2617		G23509  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23510	SUP	HCPCS C2617		G23510  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23511	SUP	HCPCS C2617		G23511  -  SET STNT .038IN 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$137.05 	$101.42	$0.00	$109.64	$61.67	$61.67	$0.00	$0.00	$0.00	$28.56	$101.72	$101.72	$0.00	$0.00	$28.56	$0.00	$81.07	$81.07	$0.00	$68.53	$108.54	$109.64	$0.00		$0.00	$21.45	$0.00	$0.00	$21.82	$0.00	$0.00	$0.00	$0.00	$0.00
G23512	SUP	HCPCS C2617		G23512  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA RADOPQ	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G23523	SUP	Custom 27803010		G23523  -  COIL EMBOLIZATION 3MM 7CM 7.4 LOOP NESTER PLATINUM SYNTH	BOTH IP/OP	$264.20 	$195.51	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.09	$196.09	$0.00	$0.00	$55.06	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G23552	SUP	Custom 27203010		G23552  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G23553	SUP	Custom 27203010		G23553  -  FIBER LSR 20W 365UM RD STRL SMARTSYNC CNCT HO DISP RHPSD	BOTH IP/OP	"$2,367.30 "	"$1,751.80"	$0.00	"$1,893.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.01"	"$1,757.01"	$0.00	$0.00	$493.35	$0.00	$0.00	$0.00	$0.00	"$1,183.65"	"$1,874.90"	"$1,893.84"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G23665	SUP	Custom 27203010		G23665  -  LASER SRG 230V 10AMP RHPSD H-30 HL-30B	BOTH IP/OP	"$2,231.25 "	"$1,651.13"	$0.00	"$1,785.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,656.03"	"$1,656.03"	$0.00	$0.00	$464.99	$0.00	$0.00	$0.00	$0.00	"$1,115.63"	"$1,767.15"	"$1,785.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G23666	SUP	Custom 27203010		G23666  -  FIBER LSR 940UM CK HO	BOTH IP/OP	"$1,168.75 "	$864.88	$0.00	$935.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$867.45	$867.45	$0.00	$0.00	$243.57	$0.00	$0.00	$0.00	$0.00	$584.38	$925.65	$935.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G23667	SUP	Custom 27203010		G23667  -  FIBER LSR 550UM CK HO	BOTH IP/OP	"$1,009.38 "	$746.94	$0.00	$807.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$749.16	$749.16	$0.00	$0.00	$210.35	$0.00	$0.00	$0.00	$0.00	$504.69	$799.43	$807.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G23668	SUP	Custom 27203010		G23668  -  FIBER LSR 365UM CK HO	BOTH IP/OP	"$1,593.75 "	"$1,179.38"	$0.00	"$1,275.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,182.88"	"$1,182.88"	$0.00	$0.00	$332.14	$0.00	$0.00	$0.00	$0.00	$796.88	"$1,262.25"	"$1,275.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G23731	SUP	Custom 27203010		G23731  -  FIBER LSR 273UM CK HO	BOTH IP/OP	"$2,921.25 "	"$2,161.73"	$0.00	"$2,337.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,168.15"	"$2,168.15"	$0.00	$0.00	$608.79	$0.00	$0.00	$0.00	$0.00	"$1,460.63"	"$2,313.63"	"$2,337.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G23733	SUP	Custom 27203010		G23733  -  FIBER LSR 150UM CK HO	BOTH IP/OP	$849.10 	$628.33	$0.00	$679.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$630.20	$630.20	$0.00	$0.00	$176.95	$0.00	$0.00	$0.00	$0.00	$424.55	$672.49	$679.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G23734	SUP	Custom 27203010		G23734  -  FIBER LSR 200UM RD STRL SMARTSYNC CNCT HO DISP RHPSD H-30	BOTH IP/OP	$953.25 	$705.41	$0.00	$762.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$707.50	$707.50	$0.00	$0.00	$198.66	$0.00	$0.00	$0.00	$0.00	$476.63	$754.97	$762.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G23735	SUP	Custom 27203010		G23735  -  FIBER LSR 550UM RD STRL SMARTSYNC CNCT HO DISP RHPSD H-30	BOTH IP/OP	"$1,578.50 "	"$1,168.09"	$0.00	"$1,262.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,171.56"	"$1,171.56"	$0.00	$0.00	$328.96	$0.00	$0.00	$0.00	$0.00	$789.25	"$1,250.17"	"$1,262.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G24129	SUP	HCPCS C1769		G24129  -  SET INTRO .018IN .087IN 5.5CM GW SUBMANDIBULAR SLVA DCT	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$210.41	$210.41	$0.00	$0.00	$0.00	$80.76	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$229.21	$229.21	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$60.64	$0.00	$0.00	$61.69	$0.00	$0.00	$0.00	$0.00	$0.00
G24132	SUP	HCPCS C1769		G24132  -  SET INTRO .018IN .074IN 5.5CM GW SUBMANDIBULAR SLVA DCT	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$210.41	$210.41	$0.00	$0.00	$0.00	$80.76	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$229.21	$229.21	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$60.64	$0.00	$0.00	$61.69	$0.00	$0.00	$0.00	$0.00	$0.00
G24889	SUP	HCPCS C1874		G24889  -  STENT VASCULAR 60MM DRUG ELUTING OTW DELIVERY SYSTEM ZILVER	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
G24890	SUP	HCPCS C1874		G24890  -  STENT VASCULAR 80MM DRUG ELUTING SELF EXPANDING GWIRE ZILVER	BOTH IP/OP	"$4,487.50 "	"$3,320.75"	$0.00	"$3,590.00"	"$2,019.38"	"$2,019.38"	$0.00	$0.00	$0.00	$935.31	"$3,330.62"	"$3,330.62"	$0.00	$0.00	$935.20	$0.00	"$2,212.34"	"$2,212.34"	$0.00	"$2,243.75"	"$3,554.10"	"$3,590.00"	$0.00		$0.00	$702.29	$0.00	$0.00	$714.41	$0.00	$0.00	$0.00	$0.00	$0.00
G24894	SUP	HCPCS C1874		G24894  -  STENT VASCULAR 60MM DRUG ELUTING OTW DELIVERY SYSTEM ZILVER	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
G24895	SUP	HCPCS C1874		G24895  -  STENT VASC .035IN 7MM 6FR 80MM 125CM ZL PTX DRG ELUT SLF XPD	BOTH IP/OP	"$4,487.50 "	"$3,320.75"	$0.00	"$3,590.00"	"$2,019.38"	"$2,019.38"	$0.00	$0.00	$0.00	$935.31	"$3,330.62"	"$3,330.62"	$0.00	$0.00	$935.20	$0.00	"$2,212.34"	"$2,212.34"	$0.00	"$2,243.75"	"$3,554.10"	"$3,590.00"	$0.00		$0.00	$702.29	$0.00	$0.00	$714.41	$0.00	$0.00	$0.00	$0.00	$0.00
G24935	SUP	HCPCS C1874		G24935  -  STENT VASCULAR 100MM DRUG ELUTING OTW SELF EXPAND ZILVER PTX	BOTH IP/OP	"$4,487.50 "	"$3,320.75"	$0.00	"$3,590.00"	"$2,019.38"	"$2,019.38"	$0.00	$0.00	$0.00	$935.31	"$3,330.62"	"$3,330.62"	$0.00	$0.00	$935.20	$0.00	"$2,212.34"	"$2,212.34"	$0.00	"$2,243.75"	"$3,554.10"	"$3,590.00"	$0.00		$0.00	$702.29	$0.00	$0.00	$714.41	$0.00	$0.00	$0.00	$0.00	$0.00
G24937	SUP	HCPCS C1874		G24937  -  STENT VASCULAR 100MM DRUG ELUTING OTW DELIVERY SYSTEM ZILVER	BOTH IP/OP	"$4,487.50 "	"$3,320.75"	$0.00	"$3,590.00"	"$2,019.38"	"$2,019.38"	$0.00	$0.00	$0.00	$935.31	"$3,330.62"	"$3,330.62"	$0.00	$0.00	$935.20	$0.00	"$2,212.34"	"$2,212.34"	$0.00	"$2,243.75"	"$3,554.10"	"$3,590.00"	$0.00		$0.00	$702.29	$0.00	$0.00	$714.41	$0.00	$0.00	$0.00	$0.00	$0.00
G25292	SUP	Custom 27203010		G25292  -  SYSTEM LTHTRP UNV 11.6FR 5FR 38CM STRL LITHASSIST TUO 2 LUM	BOTH IP/OP	"$2,666.15 "	"$1,972.95"	$0.00	"$2,132.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,978.82"	"$1,978.82"	$0.00	$0.00	$555.63	$0.00	$0.00	$0.00	$0.00	"$1,333.08"	"$2,111.59"	"$2,132.92"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G25293	SUP	Custom 27203010		G25293  -  FIBER LSR CK HO DISP	BOTH IP/OP	$802.58 	$593.91	$0.00	$642.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$595.67	$595.67	$0.00	$0.00	$167.26	$0.00	$0.00	$0.00	$0.00	$401.29	$635.64	$642.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G25294	SUP	Custom 27203010		G25294  -  FIBER LSR 200UM CK HO DISP	BOTH IP/OP	$659.25 	$487.85	$0.00	$527.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.30	$489.30	$0.00	$0.00	$137.39	$0.00	$0.00	$0.00	$0.00	$329.63	$522.13	$527.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G25295	SUP	Custom 27203010		G25295  -  FIBER LSR HO HO DISP	BOTH IP/OP	$659.25 	$487.85	$0.00	$527.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.30	$489.30	$0.00	$0.00	$137.39	$0.00	$0.00	$0.00	$0.00	$329.63	$522.13	$527.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G25296	SUP	Custom 27203010		G25296  -  FIBER LSR 365UM RD SMARTSYNC HO DISP STD SMA CNCT	BOTH IP/OP	$857.93 	$634.87	$0.00	$686.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$636.75	$636.75	$0.00	$0.00	$178.79	$0.00	$0.00	$0.00	$0.00	$428.96	$679.48	$686.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G25297	SUP	Custom 27203010		G25297  -  FIBER LSR 550UM CK HO DISP	BOTH IP/OP	"$1,420.65 "	"$1,051.28"	$0.00	"$1,136.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,054.41"	"$1,054.41"	$0.00	$0.00	$296.06	$0.00	$0.00	$0.00	$0.00	$710.33	"$1,125.15"	"$1,136.52"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G25298	SUP	Custom 27203010		G25298  -  FIBER LSR 940UM RD SMARTSYNC HO DISP STD SMA CNCT	BOTH IP/OP	$531.25 	$393.13	$0.00	$425.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$394.29	$394.29	$0.00	$0.00	$110.71	$0.00	$0.00	$0.00	$0.00	$265.63	$420.75	$425.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G25299	SUP	Custom 27203010		G25299  -  FIBER LSR 273UM CK MU HO	BOTH IP/OP	"$1,009.38 "	$746.94	$0.00	$807.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$749.16	$749.16	$0.00	$0.00	$210.35	$0.00	$0.00	$0.00	$0.00	$504.69	$799.43	$807.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G25300	SUP	Custom 27203010		G25300  -  FIBER LSR 365UM CK MU HO	BOTH IP/OP	"$1,168.75 "	$864.88	$0.00	$935.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$867.45	$867.45	$0.00	$0.00	$243.57	$0.00	$0.00	$0.00	$0.00	$584.38	$925.65	$935.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G25301	SUP	Custom 27203010		G25301  -  FIBER LSR 550UM CK MU HO	BOTH IP/OP	"$2,231.25 "	"$1,651.13"	$0.00	"$1,785.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,656.03"	"$1,656.03"	$0.00	$0.00	$464.99	$0.00	$0.00	$0.00	$0.00	"$1,115.63"	"$1,767.15"	"$1,785.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G25507	SUP	Custom 27203010		G25507  -  NEEDLE ENDSCP 0-8CM 19GA 5.2FR 138-140CM SFT TIS US SHTH Q	BOTH IP/OP	$650.00 	$481.00	$0.00	$520.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.43	$482.43	$0.00	$0.00	$135.46	$0.00	$0.00	$0.00	$0.00	$325.00	$514.80	$520.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G25668	SUP	Custom 27203010		G25668  -  LGTR 15MM SHORTSHOT SA HMRHD 4 BAND NONSTRL DISP ENDSCP	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G25981	SUP	HCPCS C1894		G25981  -  BUNDLE FO 150CM VUEOPTIC	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$95.57	$95.57	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
G26124	SUP	Custom 27203010		G26124  -  INTRODUCER SPBC 10FR 14FR 17CM 20CM 1STP DRN CATH DIL TROC	BOTH IP/OP	$536.58 	$397.07	$0.00	$429.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$398.25	$398.25	$0.00	$0.00	$111.82	$0.00	$0.00	$0.00	$0.00	$268.29	$424.97	$429.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G26574	SUP	HCPCS C1726		G26574  -  SET SPINAL MICROCOMPRESSION BROWN 4FR TRIGEMINAL GANGLION	BOTH IP/OP	"$1,027.00 "	$759.98	$0.00	$821.60	$557.66	$557.66	$0.00	$0.00	$0.00	$214.05	$762.24	$762.24	$0.00	$0.00	$214.03	$0.00	$607.47	$607.47	$0.00	$513.50	$813.38	$821.60	$0.00		$0.00	$160.73	$0.00	$0.00	$163.50	$0.00	$0.00	$0.00	$0.00	$0.00
G26642	SUP	HCPCS C1894		G26642  -  EXTRACTOR STON 5CM 7FR 6MM 65CM 4CM RTNR 3WR HLCL BLN	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$95.57	$95.57	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
G26648	SUP	HCPCS C1894		G26648  -  INTRODUCER SPBC 10FR 16FR 17CM 20CM 1STP DRN CATH DIL TROC	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$95.57	$95.57	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
G26655	SUP	HCPCS C1894		G26655  -  INTRODUCER SPBC 12FR 18FR 17CM 20CM 1STP DRN CATH DIL TROC	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$95.57	$95.57	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
G26666	SUP	HCPCS C1894		G26666  -  INTRODUCER SPBC 16FR 20- FR 17CM 20CM PLWY 1 STP DIL TROC	BOTH IP/OP	$176.00 	$130.24	$0.00	$140.80	$95.57	$95.57	$0.00	$0.00	$0.00	$36.68	$130.63	$130.63	$0.00	$0.00	$36.68	$0.00	$104.10	$104.10	$0.00	$88.00	$139.39	$140.80	$0.00		$0.00	$27.54	$0.00	$0.00	$28.02	$0.00	$0.00	$0.00	$0.00	$0.00
G26891	SUP	HCPCS C1725		G26891  -  CATHETER BLNDIL 4MM 80CM STRL 2CM ATB ADV 2 LUM XPD RADOPQ	BOTH IP/OP	$277.75 	$205.54	$0.00	$220.00	$149.33	$149.33	$0.00	$0.00	$0.00	$57.89	$206.15	$206.15	$0.00	$0.00	$57.88	$0.00	$164.29	$164.29	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$43.04	$0.00	$0.00	$43.78	$0.00	$0.00	$0.00	$0.00	$0.00
G26908	SUP	HCPCS C1726		G26908  -  SET ENDSCP INSTR BILE DUCT ADPR CATH STON XTRT XPLR STRL	BOTH IP/OP	"$1,980.00 "	"$1,465.20"	$0.00	"$1,584.00"	"$1,075.14"	"$1,075.14"	$0.00	$0.00	$0.00	$412.68	"$1,469.56"	"$1,469.56"	$0.00	$0.00	$412.63	$0.00	"$1,171.17"	"$1,171.17"	$0.00	$990.00	"$1,568.16"	"$1,584.00"	$0.00		$0.00	$309.87	$0.00	$0.00	$315.22	$0.00	$0.00	$0.00	$0.00	$0.00
G26957	SUP	HCPCS C1769		G26957  -  GUIDEWIRE VASCULAR 10MM RAD .035IN 110CM REUTER TIP	BOTH IP/OP	$215.63 	$159.57	$0.00	$160.04	$101.81	$101.81	$0.00	$0.00	$0.00	$44.94	$160.04	$160.04	$0.00	$0.00	$44.94	$0.00	$127.54	$127.54	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G26973	SUP	HCPCS C1725		G26973  -  CATH ANGIO 5FR .35IN 90CM VSCR SUP VIS GRADUAL TRNS OF	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$17.65	$17.65	$0.00	$0.00	$0.00	$6.77	$24.12	$24.12	$0.00	$0.00	$6.77	$0.00	$19.22	$19.22	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$5.09	$0.00	$0.00	$5.17	$0.00	$0.00	$0.00	$0.00	$0.00
G26986	SUP	HCPCS C1770		G26986  -  COIL EMBOLIZATION .018IN 10MM 14CM 4.5 LOOP SOFT RADIOPACITY	BOTH IP/OP	$264.20 	$195.51	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.09	$196.09	$0.00	$0.00	$55.06	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G26989	SUP	HCPCS C1770		G26989  -  COIL EMBOLIZATION .018IN 6MM 14CM 7.4 LOOP SOFT RADIOPACITY	BOTH IP/OP	$264.20 	$195.51	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.09	$196.09	$0.00	$0.00	$55.06	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G26990	SUP	HCPCS C1770		G26990  -  COIL EMBOLIZATION .018IN 8MM 14CM 5.6 LOOP SOFT RADIOPACITY	BOTH IP/OP	$264.20 	$195.51	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.09	$196.09	$0.00	$0.00	$55.06	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G26991	SUP	Custom 27203010		G26991  -  COIL EMBOLIZATION .035IN 10MM 14CM 4.5 LOOP SOFT NESTER	BOTH IP/OP	$264.20 	$195.51	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.09	$196.09	$0.00	$0.00	$55.06	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G26994	SUP	Custom 27803010		G26994  -  COIL EMBOLIZATION .035IN 7.4 LOOP 6MM 14CM SOFT CATHETER	BOTH IP/OP	$264.20 	$195.51	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.09	$196.09	$0.00	$0.00	$55.06	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G26995	SUP	HCPCS C1770		G26995  -  COIL EMBOLIZATION .035IN 5.6 LOOPS 8MM 14CM SOFT CATHETER	BOTH IP/OP	$264.20 	$195.51	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.09	$196.09	$0.00	$0.00	$55.06	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G27035	SUP	HCPCS C1769		G27035  -  GUIDEWIRE VASCULAR STR .035IN 260CM FLEXIBLE TIP STIFF SHAFT	BOTH IP/OP	$89.70 	$66.38	$0.00	$69.00	$46.83	$46.83	$0.00	$0.00	$0.00	$18.70	$66.58	$66.58	$0.00	$0.00	$18.69	$0.00	$53.06	$53.06	$0.00	$43.13	$68.31	$69.00	$0.00		$0.00	$13.50	$0.00	$0.00	$13.73	$0.00	$0.00	$0.00	$0.00	$0.00
G27047	SUP	Custom 27203010		G27047  -  CATH JJNSTM 80CM 16.5FR CR-ALZT-CNS 2 LUM REPL STRL DISP	BOTH IP/OP	$180.35 	$133.46	$0.00	$144.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.86	$133.86	$0.00	$0.00	$37.58	$0.00	$0.00	$0.00	$0.00	$90.18	$142.84	$144.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G27059	SUP	HCPCS C2617		G27059  -  INTRODUCER SPBC 18FR 22FR 17CM 20CM 1STP DRN CATH DIL TROC	BOTH IP/OP	$253.45 	$187.55	$0.00	$202.76	$114.05	$114.05	$0.00	$0.00	$0.00	$52.83	$188.11	$188.11	$0.00	$0.00	$52.82	$0.00	$149.92	$149.92	$0.00	$126.73	$200.73	$202.76	$0.00		$0.00	$39.66	$0.00	$0.00	$40.35	$0.00	$0.00	$0.00	$0.00	$0.00
G27061	SUP	HCPCS C1729		G27061  -  SET STNT 2 PGTL CRV 8.2FR 40CM RADOPQ PSTNR SFLX URETER	BOTH IP/OP	$150.55 	$111.41	$0.00	$120.44	$81.75	$81.75	$0.00	$0.00	$0.00	$31.38	$111.74	$111.74	$0.00	$0.00	$31.37	$0.00	$89.05	$89.05	$0.00	$75.28	$119.24	$120.44	$0.00		$0.00	$23.56	$0.00	$0.00	$23.97	$0.00	$0.00	$0.00	$0.00	$0.00
G27063	SUP	HCPCS C2617		G27063  -  SET NPHSTM 12FR 30CM COPE LOOP MOD NDL GW CNN DIL	BOTH IP/OP	$365.43 	$270.42	$0.00	$292.34	$164.44	$164.44	$0.00	$0.00	$0.00	$76.16	$271.22	$271.22	$0.00	$0.00	$76.15	$0.00	$216.15	$216.15	$0.00	$182.71	$289.42	$292.34	$0.00		$0.00	$57.19	$0.00	$0.00	$58.18	$0.00	$0.00	$0.00	$0.00	$0.00
G27161	SUP	HCPCS C2617		G27161  -  STENT PANCREATIC 5FR 14CM DRAIN OBSTRUCTED POSITIONING	BOTH IP/OP	$177.50 	$131.35	$0.00	$142.00	$79.88	$79.88	$0.00	$0.00	$0.00	$37.00	$131.74	$131.74	$0.00	$0.00	$36.99	$0.00	$104.99	$104.99	$0.00	$88.75	$140.58	$142.00	$0.00		$0.00	$27.78	$0.00	$0.00	$28.26	$0.00	$0.00	$0.00	$0.00	$0.00
G27234	SUP	Custom 27203010		G27234  -  DEVICE STNT RTRVL 4.5FR 65CM NSNARE FLXB NTNL WRE CNSTRCT	BOTH IP/OP	$289.10 	$213.93	$0.00	$231.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.57	$214.57	$0.00	$0.00	$60.25	$0.00	$0.00	$0.00	$0.00	$144.55	$228.97	$231.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G27887	SUP	HCPCS C1769		G27887  -  GUIDEWIRE VASC STRG .028IN 145CM FX COR SS	BOTH IP/OP	$64.83 	$47.97	$0.00	$51.86	$35.20	$35.20	$0.00	$0.00	$0.00	$13.51	$48.11	$48.11	$0.00	$0.00	$13.51	$0.00	$38.34	$38.34	$0.00	$32.41	$51.35	$51.86	$0.00		$0.00	$10.15	$0.00	$0.00	$10.32	$0.00	$0.00	$0.00	$0.00	$0.00
G28999	SUP	HCPCS C1894		G28999  -  INTRODUCER CATHETER 25CM SET CHK-FLO 20FR	BOTH IP/OP	$847.50 	$627.15	$0.00	$678.00	$460.19	$460.19	$0.00	$0.00	$0.00	$176.64	$629.01	$629.01	$0.00	$0.00	$176.62	$0.00	$501.30	$501.30	$0.00	$423.75	$671.22	$678.00	$0.00		$0.00	$132.63	$0.00	$0.00	$134.92	$0.00	$0.00	$0.00	$0.00	$0.00
G29965	SUP	HCPCS C1769		GUIDE WIRE .035IN X 80CM X 10CM REFLECTOR REUTER TIP DEFLECT	BOTH IP/OP	$161.00 	$119.14	$0.00	$128.80	$87.42	$87.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.50	$127.51	$128.80	$0.00		$0.00	$25.20	$0.00	$0.00	$25.63	$0.00	$0.00	$0.00	$0.00	$0.00
G29982	SUP	HCPCS C1894		G29982  -  SHEATH GUID .018/.038IN ANL1 CURVE 6FR .087IN 45CM RADIOPQ	BOTH IP/OP	$202.50 	$149.85	$0.00	$150.30	$101.81	$101.81	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G29983	SUP	HCPCS C1894		G29983  -  SHEATH GUID .018/.038IN ANL2 CURVE 6FR .087IN 45CM RADIOPQ	BOTH IP/OP	$202.50 	$149.85	$0.00	$150.30	$101.81	$101.81	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G29985	SUP	HCPCS C1894		G29985  -  SHEATH GUID ANL1 CURVE 7FR .100IN 45CM UNIQUELY FABRICATED	BOTH IP/OP	$202.50 	$149.85	$0.00	$150.30	$101.81	$101.81	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G29986	SUP	HCPCS C1894		G29986  -  SHEATH GUID .018/.038IN ANL2 CURVE 7FR .1IN 45CM RADIOPQ	BOTH IP/OP	$202.50 	$149.85	$0.00	$150.30	$101.81	$101.81	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G29989	SUP	HCPCS C1894		G29989  -  SHEATH GUID .018-.038IN ANL2 CURVE 6FR .087IN 90CM RADIOPQ	BOTH IP/OP	$392.60 	$290.52	$0.00	$302.00	$204.98	$204.98	$0.00	$0.00	$0.00	$81.83	$291.39	$291.39	$0.00	$0.00	$81.82	$0.00	$232.22	$232.22	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$59.08	$0.00	$0.00	$60.10	$0.00	$0.00	$0.00	$0.00	$0.00
G30117	SUP	HCPCS C1894		G30117  -  INTRODUCER SHEATH .018 .038IN ANL2 CURVE 5FR .074IN 45CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$150.30	$101.81	$101.81	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G30357	SUP	HCPCS C1726		G30357  -  POUCH DRN 300ML NS ELC BELT ADJ 1 CNCT 2 TUBE REED VLV MECH	BOTH IP/OP	$618.80 	$457.91	$0.00	$495.04	$336.01	$336.01	$0.00	$0.00	$0.00	$128.97	$459.27	$459.27	$0.00	$0.00	$128.96	$0.00	$366.02	$366.02	$0.00	$309.40	$490.09	$495.04	$0.00		$0.00	$96.84	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
G30358	SUP	HCPCS C1726		G30358  -  EXTRACTOR SRG 12FR 38CM STRL PRC NC STON TPLS ATRM NTNL DISP	BOTH IP/OP	$519.35 	$384.32	$0.00	$415.48	$282.01	$282.01	$0.00	$0.00	$0.00	$108.25	$385.46	$385.46	$0.00	$0.00	$108.23	$0.00	$307.20	$307.20	$0.00	$259.68	$411.33	$415.48	$0.00		$0.00	$81.28	$0.00	$0.00	$82.68	$0.00	$0.00	$0.00	$0.00	$0.00
G30360	SUP	HCPCS C1773		G30360  -  CATHETER NPHSTM 10MM 15CM CLR ULTRX TRNS TPR BLN RADOPQ STRP	BOTH IP/OP	$419.70 	$310.58	$0.00	$335.76	$227.90	$227.90	$0.00	$0.00	$0.00	$87.48	$311.50	$311.50	$0.00	$0.00	$87.47	$0.00	$248.25	$248.25	$0.00	$209.85	$332.40	$335.76	$0.00		$0.00	$65.68	$0.00	$0.00	$66.82	$0.00	$0.00	$0.00	$0.00	$0.00
G30361	SUP	HCPCS C1773		G30361  -  FORCEPS SPEC RTRVL 15MM 3.2FR 115CM STRL CPTR 3 PR STON FB	BOTH IP/OP	$419.70 	$310.58	$0.00	$335.76	$227.90	$227.90	$0.00	$0.00	$0.00	$87.48	$311.50	$311.50	$0.00	$0.00	$87.47	$0.00	$248.25	$248.25	$0.00	$209.85	$332.40	$335.76	$0.00		$0.00	$65.68	$0.00	$0.00	$66.82	$0.00	$0.00	$0.00	$0.00	$0.00
G30362	SUP	HCPCS C1773		G30362  -  GRASPER ESCP 2.8FR 15MM 115CM CPTR 3 PR OPN WD MICROTHROW	BOTH IP/OP	$419.70 	$310.58	$0.00	$335.76	$227.90	$227.90	$0.00	$0.00	$0.00	$87.48	$311.50	$311.50	$0.00	$0.00	$87.47	$0.00	$248.25	$248.25	$0.00	$209.85	$332.40	$335.76	$0.00		$0.00	$65.68	$0.00	$0.00	$66.82	$0.00	$0.00	$0.00	$0.00	$0.00
G30364	SUP	HCPCS C1726		G30364  -  CATHETER NEPHROSTOMY 20 ATM 10MM 15CM INFLATE BALLOON SHEATH	BOTH IP/OP	$519.35 	$384.32	$0.00	$415.48	$282.01	$282.01	$0.00	$0.00	$0.00	$108.25	$385.46	$385.46	$0.00	$0.00	$108.23	$0.00	$307.20	$307.20	$0.00	$259.68	$411.33	$415.48	$0.00		$0.00	$81.28	$0.00	$0.00	$82.68	$0.00	$0.00	$0.00	$0.00	$0.00
G30365	SUP	HCPCS C1726		G30365  -  SET NEPHROSTOMY 10MM 15CM CATHETER RADIOPQ BALLOON SHEATH	BOTH IP/OP	$618.80 	$457.91	$0.00	$495.04	$336.01	$336.01	$0.00	$0.00	$0.00	$128.97	$459.27	$459.27	$0.00	$0.00	$128.96	$0.00	$366.02	$366.02	$0.00	$309.40	$490.09	$495.04	$0.00		$0.00	$96.84	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
G30375	SUP	HCPCS C1773		G30375  -  FORCEPS SPEC RTRVL 15MM 3.2FR 90CM STRL CPTR 3 PR STON FB	BOTH IP/OP	$482.65 	$357.16	$0.00	$386.12	$262.08	$262.08	$0.00	$0.00	$0.00	$100.60	$358.22	$358.22	$0.00	$0.00	$100.58	$0.00	$285.49	$285.49	$0.00	$241.33	$382.26	$386.12	$0.00		$0.00	$75.53	$0.00	$0.00	$76.84	$0.00	$0.00	$0.00	$0.00	$0.00
G30389	SUP	HCPCS C1894		G30389  -  SHEATH ACCES 14FR 35CM DILATION CONTIN WORKING CHANNEL	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G30390	SUP	HCPCS C1894		G30390  -  FORCEPS SPEC RTRVL 15MM 2.8FR 115CM STRL CPTR 3 PR STON FB	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G30391	SUP	HCPCS C1894		G30391  -  SHEATH ACC 14FR 55CM STRL FLXR DILATION CNT WRK CHNL AQ URET	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G30393	SUP	HCPCS C1894		G30393  -  SHEATH ACC 14FR 20CM FLXR DILATION CNT WKG CHNL URET	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G30403	SUP	HCPCS C2627		G30403  -  SHEATH ACC 14FR 28CM FLXR DILATION CNT WKG CHNL LFRIC SM	BOTH IP/OP	$166.10 	$122.91	$0.00	$132.88	$90.19	$90.19	$0.00	$0.00	$0.00	$0.00	$123.28	$123.28	$0.00	$0.00	$34.62	$0.00	$0.00	$0.00	$0.00	$83.05	$131.55	$132.88	$0.00		$0.00	$25.99	$0.00	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$0.00
G30404	SUP	HCPCS C2627		G30404  -  SET CATH 8.5FR 25CM MCLC NDL OBT CNN CNCT TUBE ULTHNE SPBC	BOTH IP/OP	$166.10 	$122.91	$0.00	$132.88	$90.19	$90.19	$0.00	$0.00	$0.00	$0.00	$123.28	$123.28	$0.00	$0.00	$34.62	$0.00	$0.00	$0.00	$0.00	$83.05	$131.55	$132.88	$0.00		$0.00	$25.99	$0.00	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$0.00
G30405	SUP	HCPCS C2627		G30405  -  SET CATH 12FR 25CM MCLC NDL OBT CNN CNCT TUBE ULTHNE SPBC	BOTH IP/OP	$166.10 	$122.91	$0.00	$132.88	$90.19	$90.19	$0.00	$0.00	$0.00	$0.00	$123.28	$123.28	$0.00	$0.00	$34.62	$0.00	$0.00	$0.00	$0.00	$83.05	$131.55	$132.88	$0.00		$0.00	$25.99	$0.00	$0.00	$26.44	$0.00	$0.00	$0.00	$0.00	$0.00
G30470	SUP	HCPCS C1769		G30470  -  SET CATH 14FR 25CM MCLC NDL OBT CNN CNCT TUBE LCK LOOP	BOTH IP/OP	$595.83 	$440.91	$0.00	$476.66	$323.53	$323.53	$0.00	$0.00	$0.00	$124.18	$442.22	$442.22	$0.00	$0.00	$124.17	$0.00	$352.43	$352.43	$0.00	$297.91	$471.90	$476.66	$0.00		$0.00	$93.25	$0.00	$0.00	$94.86	$0.00	$0.00	$0.00	$0.00	$0.00
G30471	SUP	HCPCS C1769		G30471  -  GUIDEWIRE VASCULAR .038IN 150CM 3CM STIFF ANGLED TIP CORE	BOTH IP/OP	$119.17 	$88.19	$0.00	$95.33	$64.71	$64.71	$0.00	$0.00	$0.00	$24.84	$88.44	$88.44	$0.00	$0.00	$24.83	$0.00	$70.49	$70.49	$0.00	$59.58	$94.38	$95.33	$0.00		$0.00	$18.65	$0.00	$0.00	$18.97	$0.00	$0.00	$0.00	$0.00	$0.00
G30472	SUP	HCPCS C1769		G30472  -  GUIDEWIRE VASC STRG TPR .038IN 150CM STRL 3CM HIWIRE 1-1 TRQ	BOTH IP/OP	$75.84 	$56.12	$0.00	$60.67	$41.18	$41.18	$0.00	$0.00	$0.00	$15.81	$56.28	$56.28	$0.00	$0.00	$15.80	$0.00	$44.86	$44.86	$0.00	$37.92	$60.07	$60.67	$0.00		$0.00	$11.87	$0.00	$0.00	$12.07	$0.00	$0.00	$0.00	$0.00	$0.00
G30473	SUP	HCPCS C1769		G30473  -  GUIDEWIRE VASCULAR STANDARD STR TAPER .038IN 150CM 3CM ONE	BOTH IP/OP	$74.80 	$55.35	$0.00	$59.84	$40.61	$40.61	$0.00	$0.00	$0.00	$15.59	$55.51	$55.51	$0.00	$0.00	$15.59	$0.00	$44.24	$44.24	$0.00	$37.40	$59.24	$59.84	$0.00		$0.00	$11.71	$0.00	$0.00	$11.91	$0.00	$0.00	$0.00	$0.00	$0.00
G30474	SUP	HCPCS C1769		G30474  -  GUIDEWIRE VASC STRG TPR .038IN 150CM STRL 3CM HIWIRE 1-1 TRQ	BOTH IP/OP	$119.17 	$88.19	$0.00	$95.33	$64.71	$64.71	$0.00	$0.00	$0.00	$24.84	$88.44	$88.44	$0.00	$0.00	$24.83	$0.00	$70.49	$70.49	$0.00	$59.58	$94.38	$95.33	$0.00		$0.00	$18.65	$0.00	$0.00	$18.97	$0.00	$0.00	$0.00	$0.00	$0.00
G30475	SUP	HCPCS C1769		G30475  -  GUIDEWIRE VASCULAR ANGLE TAPER .035IN 150CM 3CM 1TO 1 TORQUE	BOTH IP/OP	$119.17 	$88.19	$0.00	$95.33	$64.71	$64.71	$0.00	$0.00	$0.00	$24.84	$88.44	$88.44	$0.00	$0.00	$24.83	$0.00	$70.49	$70.49	$0.00	$59.58	$94.38	$95.33	$0.00		$0.00	$18.65	$0.00	$0.00	$18.97	$0.00	$0.00	$0.00	$0.00	$0.00
G30476	SUP	HCPCS C1769		G30476  -  GUIDEWIRE VASCULAR STANDARD STR TAPER .035IN 150CM 3CM 1TO 1	BOTH IP/OP	$74.80 	$55.35	$0.00	$59.84	$40.61	$40.61	$0.00	$0.00	$0.00	$15.59	$55.51	$55.51	$0.00	$0.00	$15.59	$0.00	$44.24	$44.24	$0.00	$37.40	$59.24	$59.84	$0.00		$0.00	$11.71	$0.00	$0.00	$11.91	$0.00	$0.00	$0.00	$0.00	$0.00
G30477	SUP	HCPCS C1769		G30477  -  GUIDEWIRE VASC STRG TPR .035IN 150CM 3CM HIWIRE STF BD 1 TO	BOTH IP/OP	$119.17 	$88.19	$0.00	$95.33	$64.71	$64.71	$0.00	$0.00	$0.00	$24.84	$88.44	$88.44	$0.00	$0.00	$24.83	$0.00	$70.49	$70.49	$0.00	$59.58	$94.38	$95.33	$0.00		$0.00	$18.65	$0.00	$0.00	$18.97	$0.00	$0.00	$0.00	$0.00	$0.00
G30478	SUP	HCPCS C1769		G30478  -  GUIDEWIRE VASC TPR .025IN 150CM STRL 3MM HIWIRE STF BD STRG	BOTH IP/OP	$119.17 	$88.19	$0.00	$95.33	$64.71	$64.71	$0.00	$0.00	$0.00	$24.84	$88.44	$88.44	$0.00	$0.00	$24.83	$0.00	$70.49	$70.49	$0.00	$59.58	$94.38	$95.33	$0.00		$0.00	$18.65	$0.00	$0.00	$18.97	$0.00	$0.00	$0.00	$0.00	$0.00
G30479	SUP	HCPCS C1769		G30479  -  GUIDEWIRE VASC TPR .025IN 150CM STRL 3MM HIWIRE STF BD ANG	BOTH IP/OP	$75.84 	$56.12	$0.00	$60.67	$41.18	$41.18	$0.00	$0.00	$0.00	$15.81	$56.28	$56.28	$0.00	$0.00	$15.80	$0.00	$44.86	$44.86	$0.00	$37.92	$60.07	$60.67	$0.00		$0.00	$11.87	$0.00	$0.00	$12.07	$0.00	$0.00	$0.00	$0.00	$0.00
G30480	SUP	HCPCS C1769		G30480  -  GUIDEWIRE VASC ANG TPR .025IN 150CM STRL 3CM HIWIRE STD BD	BOTH IP/OP	$75.84 	$56.12	$0.00	$60.67	$41.18	$41.18	$0.00	$0.00	$0.00	$15.81	$56.28	$56.28	$0.00	$0.00	$15.80	$0.00	$44.86	$44.86	$0.00	$37.92	$60.07	$60.67	$0.00		$0.00	$11.87	$0.00	$0.00	$12.07	$0.00	$0.00	$0.00	$0.00	$0.00
G30481	SUP	HCPCS C1769		G30481  -  GUIDEWIRE VASCULAR STANDARD ANGLE TAPER .035IN 150CM 3CM 1TO	BOTH IP/OP	$379.18 	$280.59	$0.00	$303.34	$205.89	$205.89	$0.00	$0.00	$0.00	$79.03	$281.42	$281.42	$0.00	$0.00	$79.02	$0.00	$224.28	$224.28	$0.00	$189.59	$300.31	$303.34	$0.00		$0.00	$59.34	$0.00	$0.00	$60.36	$0.00	$0.00	$0.00	$0.00	$0.00
G31027	SUP	Custom 27203010		G31027  -  DEVICE SPHR 20ML EZTRD ERGONOMICAL QRLSE LOCK LVR INFLAT 30	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G31138	SUP	HCPCS C1894		G31138  -  INTRODUCER SHEATH .038IN 6FR .087IN 90CM TUOHY BORST SIDEARM	BOTH IP/OP	$401.06 	$296.78	$0.00	$310.00	$210.41	$210.41	$0.00	$0.00	$0.00	$83.59	$297.67	$297.67	$0.00	$0.00	$83.58	$0.00	$237.23	$237.23	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$60.64	$0.00	$0.00	$61.69	$0.00	$0.00	$0.00	$0.00	$0.00
G31215	SUP	Custom 27203010		G31215  -  CATH ANGIO .035IN PGTL 5FR 70CM SZ 10 SDPRT RADIOPQ MRKR NYL	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$0.00	$0.00	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G31216	SUP	HCPCS C1884		G31216  -  CATH ANGIO .035IN PGTL 5FR 100CM SZ 10 SDPRT RADIOPQ MRKR	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
G31221	SUP	HCPCS C1884		G31221  -  CATH ANGIO .035IN VCF CURVE 5FR 100CM 10 SDPRT RADIOPQ MRKR	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
G31518	SUP	Custom 27203010		G31518  -  NEEDLE ENDSCP 22GA 5.2FR 8- CM ULTRASOUND BALL TIP ADJUST	BOTH IP/OP	$730.00 	$540.20	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.81	$541.81	$0.00	$0.00	$152.13	$0.00	$0.00	$0.00	$0.00	$365.00	$578.16	$584.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G31519	SUP	Custom 27203010		G31519  -  NEEDLE ENDSCP 25GA 5.2FR 0-8CM ULTRASOUND CNTOUR HANDLE	BOTH IP/OP	$730.00 	$540.20	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.81	$541.81	$0.00	$0.00	$152.13	$0.00	$0.00	$0.00	$0.00	$365.00	$578.16	$584.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G31520	SUP	Custom 27203010		G31520  -  NEEDLE ENDSCP 19GA 5.2-4.2FR 0-8CM ULTRASOUND CNTOUR HANDLE	BOTH IP/OP	$730.00 	$540.20	$0.00	$584.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$541.81	$541.81	$0.00	$0.00	$152.13	$0.00	$0.00	$0.00	$0.00	$365.00	$578.16	$584.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G31550	SUP	HCPCS C1894		G31550  -  CATHETER PSH .035IN 5FR STRL LF FSN GW BIL DCT DISP ESCP	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$97.74	$97.74	$0.00	$0.00	$0.00	$37.52	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$106.47	$106.47	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$28.17	$0.00	$0.00	$28.66	$0.00	$0.00	$0.00	$0.00	$0.00
G31551	SUP	Custom 27203010		G31551  -  CATHETER ENDSCP 7FR 3.2MM 170CM DOME TIP FUSION PURPLE	BOTH IP/OP	$180.00 	$133.20	$0.00	$144.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.60	$133.60	$0.00	$0.00	$37.51	$0.00	$0.00	$0.00	$0.00	$90.00	$142.56	$144.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32011	SUP	HCPCS C1876		G32011  -  STENT BIL 6MM 6FR 30MM 80CM SLF XPD FLXB FLXR INTROD GOLD	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
G32233	SUP	HCPCS C1894		G32233  -  INTRODUCER SHEATH .038IN LONG 10FR 40CM LARGE VALVE ASMBLY	BOTH IP/OP	$192.85 	$142.71	$0.00	$152.00	$103.17	$103.17	$0.00	$0.00	$0.00	$40.19	$143.13	$143.13	$0.00	$0.00	$40.19	$0.00	$114.07	$114.07	$0.00	$95.00	$150.48	$152.00	$0.00		$0.00	$29.74	$0.00	$0.00	$30.25	$0.00	$0.00	$0.00	$0.00	$0.00
G32500	SUP	HCPCS C1874		G32500  -  GRAFT EVAS 2 BRCH 12MM 106MM STRL 28MM H&L-B 1-SHOT ZNTH	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32501	SUP	HCPCS C1874		G32501  -  GRAFT EVAS 2 BRCH 12MM 7.7MM 20FR 121MM 28MM ZNTH H&L-B	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32502	SUP	HCPCS C1874		G32502  -  GRAFT EVAS 24MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32503	SUP	HCPCS C1874		G32503  -  GRAFT EVAS 26MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32504	SUP	HCPCS C1874		G32504  -  GRAFT EVAS 28MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32505	SUP	HCPCS C1874		G32505  -  GRAFT EVAS 30MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32506	SUP	HCPCS C1874		G32506  -  GRAFT EVAS 32MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32507	SUP	HCPCS C1874		G32507  -  GRAFT EVAS 24MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32508	SUP	HCPCS C1874		G32508  -  GRAFT EVAS 26MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32509	SUP	HCPCS C1874		G32509  -  GRAFT EVAS 28MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32510	SUP	HCPCS C1874		G32510  -  GRAFT EVAS 30MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32511	SUP	HCPCS C1874		G32511  -  GRAFT EVAS 32MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32512	SUP	HCPCS C1874		G32512  -  GRAFT EVAS 24MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32513	SUP	HCPCS C1874		G32513  -  GRAFT EVAS 26MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32514	SUP	HCPCS C1874		G32514  -  GRAFT EVAS 28MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32515	SUP	HCPCS C1874		G32515  -  GRAFT EVAS 30MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32516	SUP	HCPCS C1874		G32516  -  GRAFT EVAS 32MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32517	SUP	HCPCS C1874		G32517  -  GRAFT EVAS 24MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32518	SUP	HCPCS C1874		G32518  -  GRAFT EVAS 26MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32519	SUP	HCPCS C1874		G32519  -  GRAFT EVAS 28MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32520	SUP	HCPCS C1874		G32520  -  GRAFT EVAS 30MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32521	SUP	HCPCS C1874		G32521  -  GRAFT EVAS 32MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32522	SUP	HCPCS C1874		G32522  -  GRAFT EVAS 34MM 7.7MM 20FR 84MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32523	SUP	HCPCS C1874		G32523  -  GRAFT EVAS 36MM 8.5MM 20FR 84MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32524	SUP	HCPCS C1874		G32524  -  GRAFT EVAS 34MM 7.7MM 20FR 99MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32525	SUP	HCPCS C1874		G32525  -  GRAFT EVAS 36MM 8.5MM 20FR 99MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32526	SUP	HCPCS C1874		G32526  -  GRAFT EVAS 34MM 7.7MM 20FR 114MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32527	SUP	HCPCS C1874		G32527  -  GRAFT EVAS 36MM 8.5MM 20FR 114MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32528	SUP	HCPCS C1874		G32528  -  GRAFT EVAS 34MM 7.7MM 20FR 129MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32529	SUP	HCPCS C1874		G32529  -  GRAFT EVAS 36MM 8.5MM 20FR 129MM ZNTH H&L-B 1-SHOT 1 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32530	SUP	HCPCS C1874		G32530  -  GRAFT EVAS 24MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32531	SUP	HCPCS C1874		G32531  -  GRAFT EVAS 26MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32532	SUP	HCPCS C1874		G32532  -  GRAFT EVAS 20FR 94MM 28MM ZNTH VSCR FEN PROX BFUR BD AAA	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32533	SUP	HCPCS C1874		G32533  -  GRAFT EVAS 30MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32534	SUP	HCPCS C1874		G32534  -  GRAFT EVAS 32MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32535	SUP	HCPCS C1874		G32535  -  GRAFT EVAS 24MM 7.7MM 20FR 109MM ZNTH H&L-B 1-SHOT 2 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32536	SUP	HCPCS C1874		G32536  -  GRAFT EVAS 26MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32537	SUP	HCPCS C1874		G32537  -  GRAFT EVAS 28MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32538	SUP	HCPCS C1874		G32538  -  GRAFT EVAS 30MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32539	SUP	HCPCS C1874		G32539  -  GRAFT EVAS 32MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32540	SUP	HCPCS C1874		G32540  -  GRAFT EVAS 24MM 7.7MM 20FR 124MM ZNTH H&L-B 1-SHOT 2 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32541	SUP	HCPCS C1874		G32541  -  GRAFT EVAS 12FR 124MM 91MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32542	SUP	HCPCS C1874		G32542  -  GRAFT EVAS 2FR 124MM 28MM ZNTH FEN PROX BD AAA	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32543	SUP	HCPCS C1874		G32543  -  GRAFT EVAS 30MM 124MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32544	SUP	HCPCS C1874		G32544  -  GRAFT EVAS 32MM 124MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32545	SUP	HCPCS C1874		G32545  -  GRAFT EVAS 34MM 107MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32546	SUP	HCPCS C1874		G32546  -  GRAFT EVAS 36MM 107MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32547	SUP	HCPCS C1874		G32547  -  GRAFT EVAS 34MM 20FR 122MM STRL H L-B 1-SHOT ZNTH 2 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32548	SUP	HCPCS C1874		G32548  -  GRAFT EVAS 36MM 8.5MM 22FR 122MM ZNTH H&L-B 1-SHOT 2 PROX	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32549	SUP	HCPCS C1874		G32549  -  GRAFT EVAS 34MM 137MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32550	SUP	HCPCS C1874		G32550  -  GRAFT EVAS 36MM 137MM STRL ZNTH H&L-B 1-SHOT 2 PROX INTNL	BOTH IP/OP	"$27,500.00 "	"$20,350.00"	$0.00	"$22,000.00"	"$12,375.00"	"$12,375.00"	$0.00	$0.00	$0.00	"$5,731.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,731.00"	$0.00	"$13,557.50"	"$13,557.50"	$0.00	"$13,750.00"	"$21,780.00"	"$22,000.00"	$0.00		$0.00	"$4,303.75"	$0.00	$0.00	"$4,378.00"	$0.00	$0.00	$0.00	$0.00	$0.00
G32551	SUP	HCPCS C1874		G32551  -  GRAFT EVAS 12FR 76MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32552	SUP	HCPCS C1874		G32552  -  GRAFT EVAS 16FR 76MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32553	SUP	HCPCS C1874		G32553  -  GRAFT EVAS 20FR 76MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32554	SUP	HCPCS C1874		G32554  -  GRAFT EVAS 12FR 91MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32555	SUP	HCPCS C1874		G32555  -  GRAFT EVAS 16FR 91MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32556	SUP	HCPCS C1874		G32556  -  GRAFT EVAS 20FR 91MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32557	SUP	HCPCS C1874		G32557  -  GRAFT EVAS 16FR 106MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32558	SUP	HCPCS C1874		G32558  -  GRAFT EVAS 20FR 106MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32559	SUP	HCPCS C1874		G32559  -  GRAFT EVAS 16FR 121MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32560	SUP	HCPCS C1874		G32560  -  GRAFT EVAS 20FR 121MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32561	SUP	HCPCS C1874		G32561  -  GRAFT EVAS 12FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32562	SUP	HCPCS C1874		G32562  -  GRAFT EVAS 16FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32563	SUP	HCPCS C1874		G32563  -  GRAFT EVAS 20FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32564	SUP	HCPCS C1874		G32564  -  GRAFT EVAS 24FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32565	SUP	HCPCS C1874		G32565  -  GRAFT EVAS 12FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32566	SUP	HCPCS C1874		G32566  -  GRAFT EVAS 16FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32567	SUP	HCPCS C1874		G32567  -  GRAFT EVAS 20FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32568	SUP	HCPCS C1874		G32568  -  GRAFT EVAS 24FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32569	SUP	HCPCS C1874		G32569  -  GRAFT EVAS 12FR 106MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32570	SUP	HCPCS C1874		G32570  -  GRAFT EVAS 16FR 106MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32571	SUP	HCPCS C1874		G32571  -  GRAFT EVAS 2 BRCH 20FR 106MM 45MM ZNTH H&L-B 1-SHOT VSCR FEN	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32572	SUP	HCPCS C1874		G32572  -  GRAFT EVAS 24FR 106MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32573	SUP	HCPCS C1874		G32573  -  GRAFT EVAS 12FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32574	SUP	HCPCS C1874		G32574  -  GRAFT EVAS 16FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32575	SUP	HCPCS C1874		G32575  -  GRAFT EVAS 20FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32576	SUP	HCPCS C1874		G32576  -  GRAFT EVAS 24FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32577	SUP	HCPCS C1874		G32577  -  GRAFT EVAS 12FR 76MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32578	SUP	HCPCS C1874		G32578  -  GRAFT EVAS 2 BRCH 20MM 8.1MM 20FR 76MM STRL 62MM ZNTH DIST	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32579	SUP	HCPCS C1874		G32579  -  GRAFT EVAS 24FR 76MM 62MM ZNTH 1-SHOT 2 BRCH VSCR FENESTRATE	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32580	SUP	HCPCS C1874		G32580  -  GRAFT EVAS 12FR 91MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32581	SUP	HCPCS C1874		G32581  -  GRAFT EVAS 16FR 91MM 62MM ZNTH FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32582	SUP	HCPCS C1874		G32582  -  GRAFT EVAS 20FR 91MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32583	SUP	HCPCS C1874		G32583  -  GRAFT EVAS 24FR 91MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32584	SUP	HCPCS C1874		G32584  -  GRAFT EVAS 12FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32585	SUP	HCPCS C1874		G32585  -  GRAFT EVAS 16FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32586	SUP	HCPCS C1874		G32586  -  GRAFT EVAS 20FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32587	SUP	HCPCS C1874		G32587  -  GRAFT EVAS 24FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32588	SUP	HCPCS C1874		G32588  -  GRAFT EVAS 12FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32589	SUP	HCPCS C1874		G32589  -  GRAFT EVAS 16FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32590	SUP	HCPCS C1874		G32590  -  GRAFT EVAS 20FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32591	SUP	HCPCS C1874		G32591  -  GRAFT EVAS 24FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32592	SUP	HCPCS C1874		G32592  -  GRAFT EVAS 16FR 76MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	"$4,171.50"	"$4,171.50"	$0.00	$0.00	$0.00	"$1,932.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	"$4,570.11"	"$4,570.11"	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	"$1,450.76"	$0.00	$0.00	"$1,475.78"	$0.00	$0.00	$0.00	$0.00	$0.00
G32701	SUP	Custom 27203010		G32701  -  GUIDEWIRE VASC TPR STRG .025IN 150CM 3CM HIWIRE 1 TO 1 TRQ	BOTH IP/OP	$103.07 	$76.27	$0.00	$82.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.49	$76.49	$0.00	$0.00	$21.48	$0.00	$0.00	$0.00	$0.00	$51.53	$81.63	$82.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32702	SUP	Custom 27203010		G32702  -  EXTRACTOR STON 2.4FR 1CM 115CM STRL NCOMPASS NCRCL 16 4WR	BOTH IP/OP	$515.33 	$381.34	$0.00	$412.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.47	$382.47	$0.00	$0.00	$107.39	$0.00	$0.00	$0.00	$0.00	$257.66	$408.14	$412.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32724	SUP	Custom 27203010		G32724  -  EXTRACTOR STON 7MM 2.8FR 145MM NTRAP UMRL DSGN ENTRAPMENT	BOTH IP/OP	$515.33 	$381.34	$0.00	$412.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.47	$382.47	$0.00	$0.00	$107.39	$0.00	$0.00	$0.00	$0.00	$257.66	$408.14	$412.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32727	SUP	Custom 27203010		G32727  -  CATHETER URTH 26FR 34CM UNIVERSA 2W FL CLS END RND TIP SIL	BOTH IP/OP	$33.94 	$25.12	$0.00	$27.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.19	$25.19	$0.00	$0.00	$7.07	$0.00	$0.00	$0.00	$0.00	$16.97	$26.88	$27.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32730	SUP	Custom 27203010		G32730  -  EXTRACTOR STON HLX 3FR 3.2FR 115CM STRL CPTR 4WR OCL BSKT	BOTH IP/OP	$473.25 	$350.21	$0.00	$378.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$351.25	$351.25	$0.00	$0.00	$98.63	$0.00	$0.00	$0.00	$0.00	$236.63	$374.81	$378.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32733	SUP	Custom 27203010		G32733  -  EXTRACTOR STONE 3FR 3.2FR 115CM 3 WIRE HELICAL OCCLUSIVE	BOTH IP/OP	$407.30 	$301.40	$0.00	$325.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.30	$302.30	$0.00	$0.00	$84.88	$0.00	$0.00	$0.00	$0.00	$203.65	$322.58	$325.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32734	SUP	Custom 27203010		G32734  -  EXTRACTOR STON 3FR 3.2FR 115CM 5CM ATLS WR 4WR FLFRM BSKT	BOTH IP/OP	$407.30 	$301.40	$0.00	$325.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.30	$302.30	$0.00	$0.00	$84.88	$0.00	$0.00	$0.00	$0.00	$203.65	$322.58	$325.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32739	SUP	Custom 27203010		G32739  -  EXTRACTOR STON 1.1FR 1.7FR 115CM STRL ATLS WR 4WR OCL BSKT	BOTH IP/OP	$281.55 	$208.35	$0.00	$225.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.97	$208.97	$0.00	$0.00	$58.68	$0.00	$0.00	$0.00	$0.00	$140.78	$222.99	$225.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32740	SUP	Custom 27203010		G32740  -  EXTRACTOR STON 4.5FR 65CM CPTR 4WR OCL BSKT SHTH SS	BOTH IP/OP	$281.55 	$208.35	$0.00	$225.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.97	$208.97	$0.00	$0.00	$58.68	$0.00	$0.00	$0.00	$0.00	$140.78	$222.99	$225.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32742	SUP	Custom 27203010		G32742  -  EXTRACTOR STON 4.5FR 65CM 5CM CPTR 4WR HLCL FLFRM BSKT SHTH	BOTH IP/OP	$281.55 	$208.35	$0.00	$225.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.97	$208.97	$0.00	$0.00	$58.68	$0.00	$0.00	$0.00	$0.00	$140.78	$222.99	$225.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32746	SUP	Custom 27203010		G32746  -  EXTRACTOR STON 4.5FR 65CM 5CM CPTR 5WR HLCL FLFRM BSKT SHTH	BOTH IP/OP	$281.55 	$208.35	$0.00	$225.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.97	$208.97	$0.00	$0.00	$58.68	$0.00	$0.00	$0.00	$0.00	$140.78	$222.99	$225.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32749	SUP	Custom 27203010		G32749  -  EXTRACTOR STON HLX 4.5FR 65CM CPTR 4WR HLCL OCL BSKT SHTH SS	BOTH IP/OP	$407.30 	$301.40	$0.00	$325.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.30	$302.30	$0.00	$0.00	$84.88	$0.00	$0.00	$0.00	$0.00	$203.65	$322.58	$325.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32750	SUP	Custom 27203010		G32750  -  EXTRACTOR STON HLCL 3FR 3.2FR 115CM STRL CPTR 5WR OCL SHTH	BOTH IP/OP	$407.30 	$301.40	$0.00	$325.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.30	$302.30	$0.00	$0.00	$84.88	$0.00	$0.00	$0.00	$0.00	$203.65	$322.58	$325.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32756	SUP	Custom 27203010		G32756  -  EXTRACTOR STON 3FR 3.2FR 115CM 5CM CPTR 4WR HLCL FLFRM BSKT	BOTH IP/OP	$407.30 	$301.40	$0.00	$325.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.30	$302.30	$0.00	$0.00	$84.88	$0.00	$0.00	$0.00	$0.00	$203.65	$322.58	$325.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32757	SUP	Custom 27203010		G32757  -  EXTRACTOR STON 2.5FR 115CM CPTR 4WR HLCL OCL URO SS	BOTH IP/OP	$407.30 	$301.40	$0.00	$325.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.30	$302.30	$0.00	$0.00	$84.88	$0.00	$0.00	$0.00	$0.00	$203.65	$322.58	$325.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32773	SUP	HCPCS C2625		G32773  -  CATHETER URTH 26FR 34CM UNIVERSA 2W FL OP-EN OPN TIP SIL	BOTH IP/OP	$17.08 	$12.64	$0.00	$13.67	$7.69	$7.69	$0.00	$0.00	$0.00	$3.56	$12.68	$12.68	$0.00	$0.00	$3.56	$0.00	$10.10	$10.10	$0.00	$8.54	$13.53	$13.67	$0.00		$0.00	$2.67	$0.00	$0.00	$2.72	$0.00	$0.00	$0.00	$0.00	$0.00
G32774	SUP	HCPCS C2625		G32774  -  SET NPHSTM 4FR .025IN 12-18CM 145CM SALLE SFLX GW STY SS PU	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$92.25	$92.25	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
G32779	SUP	Custom 27203010		G32779  -  EXTRACTOR STONE 1.7FR 115CM 3 WIRE HELICAL OCCLUSIVE BASKET	BOTH IP/OP	$407.30 	$301.40	$0.00	$325.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.30	$302.30	$0.00	$0.00	$84.88	$0.00	$0.00	$0.00	$0.00	$203.65	$322.58	$325.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32781	SUP	Custom 27203010		G32781  -  SET STNT .038IN 4.7FR 12-18CM STRL 145CM SALLE INTOP GW STY	BOTH IP/OP	$281.55 	$208.35	$0.00	$225.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.97	$208.97	$0.00	$0.00	$58.68	$0.00	$0.00	$0.00	$0.00	$140.78	$222.99	$225.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32784	SUP	Custom 27203010		G32784  -  EXTRACTOR STON 4.5FR 65CM 5CM CPTR 6WR HLCL OCL BSKT SHTH SS	BOTH IP/OP	$407.30 	$301.40	$0.00	$325.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.30	$302.30	$0.00	$0.00	$84.88	$0.00	$0.00	$0.00	$0.00	$203.65	$322.58	$325.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32786	SUP	Custom 27203010		G32786  -  EXTRACTOR STON 5CM 3.2FR 3FR 115CM CPTR 3WR HLCL FLFRM SS	BOTH IP/OP	$281.55 	$208.35	$0.00	$225.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.97	$208.97	$0.00	$0.00	$58.68	$0.00	$0.00	$0.00	$0.00	$140.78	$222.99	$225.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32788	SUP	Custom 27203010		G32788  -  EXTRACTOR STON HLX 4.5FR 65CM 5CM CPTR 4WR HLCL FLFRM BSKT	BOTH IP/OP	$407.30 	$301.40	$0.00	$325.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.30	$302.30	$0.00	$0.00	$84.88	$0.00	$0.00	$0.00	$0.00	$203.65	$322.58	$325.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32789	SUP	HCPCS C1726		G32789  -  SET DILAT 8-20FR 37CM SIDEPORT LOW FRICTION SLIPPERY SURFACE	BOTH IP/OP	$451.00 	$333.74	$0.00	$360.80	$244.89	$244.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.50	$357.19	$360.80	$0.00		$0.00	$70.58	$0.00	$0.00	$71.80	$0.00	$0.00	$0.00	$0.00	$0.00
G32824	SUP	Custom 27203010		G32824  -  EXTRACTOR STONE 3.2FR 3FR 115CM 4 WIRE SHEATH TIP OCCLUSIVE	BOTH IP/OP	$407.30 	$301.40	$0.00	$325.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.30	$302.30	$0.00	$0.00	$84.88	$0.00	$0.00	$0.00	$0.00	$203.65	$322.58	$325.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32831	SUP	HCPCS C1758		G32831  -  CATH URET .038IN 5FR 6MM 4CM TPR TIP PLTN BAND GWIRE	BOTH IP/OP	$433.88 	$321.07	$0.00	$347.10	$235.59	$235.59	$0.00	$0.00	$0.00	$90.43	$322.02	$322.02	$0.00	$0.00	$90.42	$0.00	$256.64	$256.64	$0.00	$216.94	$343.63	$347.10	$0.00		$0.00	$67.90	$0.00	$0.00	$69.07	$0.00	$0.00	$0.00	$0.00	$0.00
G32833	SUP	HCPCS C1758		G32833  -  CATH URET .038IN 5FR 6MM 10CM TPR TIP PLTN BAND GWIRE	BOTH IP/OP	$433.88 	$321.07	$0.00	$347.10	$235.59	$235.59	$0.00	$0.00	$0.00	$90.43	$322.02	$322.02	$0.00	$0.00	$90.42	$0.00	$256.64	$256.64	$0.00	$216.94	$343.63	$347.10	$0.00		$0.00	$67.90	$0.00	$0.00	$69.07	$0.00	$0.00	$0.00	$0.00	$0.00
G32840	SUP	HCPCS C1758		G32840  -  SET CATH ASCND BALDILAT INFLAT DEV TPR TIP PLTN BAND GWIRE 5	BOTH IP/OP	$511.88 	$378.79	$0.00	$409.50	$277.95	$277.95	$0.00	$0.00	$0.00	$106.69	$379.91	$379.91	$0.00	$0.00	$106.67	$0.00	$302.77	$302.77	$0.00	$255.94	$405.41	$409.50	$0.00		$0.00	$80.11	$0.00	$0.00	$81.49	$0.00	$0.00	$0.00	$0.00	$0.00
G32842	SUP	HCPCS C1758		G32842  -  SET CATH ASCND BALDILAT INFLAT DEV TPR TIP PLTN BAND GWIRE 5	BOTH IP/OP	$511.88 	$378.79	$0.00	$409.50	$277.95	$277.95	$0.00	$0.00	$0.00	$106.69	$379.91	$379.91	$0.00	$0.00	$106.67	$0.00	$302.77	$302.77	$0.00	$255.94	$405.41	$409.50	$0.00		$0.00	$80.11	$0.00	$0.00	$81.49	$0.00	$0.00	$0.00	$0.00	$0.00
G32852	SUP	HCPCS C1894		G32852  -  EXTRACTOR STON 2.5FR 2.8FR 115CM CPTR 4WR OCL BSKT SHTH SS	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G32853	SUP	HCPCS C1894		G32853  -  SHEATH ACC 12FR 13CM FLXR DILATION CNT WRK CHNL PRTC PED	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G32855	SUP	HCPCS C2627		G32855  -  SHEATH ACC 9.5FR 13CM FLXR DILATION CNT WKG CHNL PRTC PED	BOTH IP/OP	$223.98 	$165.75	$0.00	$179.18	$121.62	$121.62	$0.00	$0.00	$0.00	$0.00	$166.23	$166.23	$0.00	$0.00	$46.68	$0.00	$0.00	$0.00	$0.00	$111.99	$177.39	$179.18	$0.00		$0.00	$35.05	$0.00	$0.00	$35.66	$0.00	$0.00	$0.00	$0.00	$0.00
G32862	SUP	Custom 27203010		G32862  -  STENT URET 8.5FR 65CM WHT STRL PATERSON-FORRESTER DISP URN	BOTH IP/OP	$289.10 	$213.93	$0.00	$231.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$214.57	$214.57	$0.00	$0.00	$60.25	$0.00	$0.00	$0.00	$0.00	$144.55	$228.97	$231.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G32863	SUP	Custom 27203010		G32863  -  EXTRACTOR STON 10FR 2CM 38CM PRC NC BSKT RPD ATRM TPLS NTNL	BOTH IP/OP	$515.33 	$381.34	$0.00	$412.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.47	$382.47	$0.00	$0.00	$107.39	$0.00	$0.00	$0.00	$0.00	$257.66	$408.14	$412.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G33016	SUP	HCPCS C1880		G33016  -  SYSTEM EMBOLIC PROTECTION 30MM 8.5FR 50MM 65CM DILAT COAXIAL	BOTH IP/OP	"$3,050.00 "	"$2,257.00"	$0.00	"$2,440.00"	"$1,372.50"	"$1,372.50"	$0.00	$0.00	$0.00	$635.70	"$2,263.71"	"$2,263.71"	$0.00	$0.00	$635.62	$0.00	"$1,503.65"	"$1,503.65"	$0.00	"$1,525.00"	"$2,415.60"	"$2,440.00"	$0.00		$0.00	$477.33	$0.00	$0.00	$485.56	$0.00	$0.00	$0.00	$0.00	$0.00
G33017	SUP	HCPCS C1880		G33017  -  FILTER EMBOLIZATION 30MM 8.5FR 50MM 65CM 3 WAY STOPCOCK	BOTH IP/OP	"$3,050.00 "	"$2,257.00"	$0.00	"$2,440.00"	"$1,372.50"	"$1,372.50"	$0.00	$0.00	$0.00	$635.70	"$2,263.71"	"$2,263.71"	$0.00	$0.00	$635.62	$0.00	"$1,503.65"	"$1,503.65"	$0.00	"$1,525.00"	"$2,415.60"	"$2,440.00"	$0.00		$0.00	$477.33	$0.00	$0.00	$485.56	$0.00	$0.00	$0.00	$0.00	$0.00
G34038	SUP	Custom 27203010		G34038  -  BRUSH CYTO 1MM 5MM SHFT US CYSTIC ECHOBRUSH ECHTP STRL DISP	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$0.00	$0.00	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G34176	SUP	HCPCS C2625		G34176  -  EXTRACTOR STON 1.5CM 2.4FR 115CM 1.5CM NCOMPASS 4/16 WRE MOD	BOTH IP/OP	"$2,245.75 "	"$1,661.86"	$0.00	"$1,796.60"	"$1,010.59"	"$1,010.59"	$0.00	$0.00	$0.00	$468.07	"$1,666.80"	"$1,666.80"	$0.00	$0.00	$468.01	$0.00	"$1,328.36"	"$1,328.36"	$0.00	"$1,122.88"	"$1,778.63"	"$1,796.60"	$0.00		$0.00	$351.46	$0.00	$0.00	$357.52	$0.00	$0.00	$0.00	$0.00	$0.00
G34309	SUP	HCPCS C1880		G34309  -  FILTER EMBL 65CM 30MM 7FR 49MM STRL 71CM CELECT NAVALIGN	BOTH IP/OP	"$3,522.38 "	"$2,606.56"	$0.00	"$2,614.31"	"$1,040.63"	"$1,040.63"	$0.00	$0.00	$0.00	$734.15	"$2,614.31"	"$2,614.31"	$0.00	$0.00	$734.06	$0.00	"$1,736.53"	"$1,736.53"	$0.00	"$1,156.25"	"$1,831.50"	"$1,850.00"	$0.00		$0.00	$361.91	$0.00	$0.00	$368.15	$0.00	$0.00	$0.00	$0.00	$0.00
G34311	SUP	Custom 27203010		G34311  -  STENT URET 6FR 30CM RSNCE PSTN MTL ADLT URETER	BOTH IP/OP	$45.00 	$33.30	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.40	$33.40	$0.00	$0.00	$9.38	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G34502	SUP	HCPCS C1880		G34502  -  FILTER EMBOLIZATION 65CM 30MM 7FR 49MM 79CM RADIOPQ PRELOAD	BOTH IP/OP	"$3,522.38 "	"$2,606.56"	$0.00	"$2,614.31"	"$1,040.63"	"$1,040.63"	$0.00	$0.00	$0.00	$734.15	"$2,614.31"	"$2,614.31"	$0.00	$0.00	$734.06	$0.00	"$1,736.53"	"$1,736.53"	$0.00	"$1,156.25"	"$1,831.50"	"$1,850.00"	$0.00		$0.00	$361.91	$0.00	$0.00	$368.15	$0.00	$0.00	$0.00	$0.00	$0.00
G34870	SUP	HCPCS C1894		G34870  -  ADAPTER L/S NS VUELITE ACMI SCP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G34871	SUP	HCPCS C1894		G34871  -  SHEATH ACC 10.7FR 13CM RPD RELS PRLL FLXR CNT CHNL URETER	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G34872	SUP	HCPCS C1894		G34872  -  SHEATH ACC 10.7FR 20CM RPD RELS PRLL FLXR CNT CHNL URETER	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G34873	SUP	HCPCS C1894		G34873  -  SHEATH ACC 10.7FR 28CM RPD RELS PRLL FLXR CNT CHNL URETER	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G34874	SUP	HCPCS C1894		G34874  -  SHEATH ACC 10.7FR 35CM RPD RELS PRLL FLXR CNT CHNL URETER	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G34875	SUP	HCPCS C1894		G34875  -  SHEATH ACC 10.7FR 45CM RPD RELS PRLL FLXR CNT CHNL URETER	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G34876	SUP	HCPCS C1894		G34876  -  SHEATH ACC 10.7FR 55CM RPD RELS PRLL FLXR CNT CHNL URETER	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G34877	SUP	HCPCS C1894		G34877  -  SHEATH ACC 10.7FR 13CM FLXR DILATION CNT WRK CHNL URETER	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G34878	SUP	HCPCS C1894		G34878  -  SHEATH ACCES SM TPR FNL 10.7FR DILAT LOCK HUB FLXB	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G34879	SUP	HCPCS C1894		G34879  -  SHEATH ACCES 10.7FR DILATION CONTIN WRK CHNL FLXR	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G34880	SUP	HCPCS C1894		G34880  -  SHEATH ACCES 10.7FR DILATION CONTIN WRK CHNL FLXR	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G34881	SUP	HCPCS C1894		G34881  -  SHEATH ACC 10.7FR 20CM FLXR DILATION CNT WRK CHNL URETER	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G34931	SUP	Custom 27203010		G34931  -  SHEATH ACC 10.7FR 55CM FLXR DILATION CNT WRK CHNL URETER	BOTH IP/OP	$462.50 	$342.25	$0.00	$370.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.27	$343.27	$0.00	$0.00	$96.39	$0.00	$0.00	$0.00	$0.00	$231.25	$366.30	$370.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G35129	SUP	Custom 27203010		G35129  -  LIGATOR ENDSCP MINI HEXAGON 9.5-13MM 5FR 2.8MM 6 BAND SNARE	BOTH IP/OP	$795.00 	$588.30	$0.00	$636.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$590.05	$590.05	$0.00	$0.00	$165.68	$0.00	$0.00	$0.00	$0.00	$397.50	$629.64	$636.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G36022	SUP	HCPCS C1876		G36022  -  STENT BILIARY .035IN 5MM 6FR 80MM 125CM SELF EXPANDING	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
G36226	SUP	HCPCS C1763		G36226  -  GRAFT SFT TIS 9.5X.6CM ANAL FSTL PLUS SIS AFP PIG STRL DISP	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
G36229	SUP	HCPCS C1876		G36229  -  STENT BIL 12MM 6FR 40MM 80CM .035IN SLF XPD FLXB FLXR INTROD	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G36231	SUP	HCPCS C1876		G36231  -  STENT BIL 12MM 6FR 80MM 80CM .035IN SLF XPD FLXB FLXR INTROD	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G36239	SUP	HCPCS C1876		G36239  -  STENT BIL 12MM 40MM STRL 125CM ZL 635 FLXR SLF XPD RADOPQ	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G36240	SUP	HCPCS C1876		G36240  -  STENT BIL .035IN 12MM 6FR 60MM STRL 125CM ZL 635 SLF XPD	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G36245	SUP	HCPCS C1876		G36245  -  STENT BIL 14MM 6FR 60MM 125CM .035IN SLF XPD FLXB FLXR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G36321	SUP	Custom 27803010		G36321  -  CATH ANGIO SLIP-CATH HYDROPHILIC .038 IN 160 D TIGHT CURVE	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$0.00	$0.00	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G36333	SUP	HCPCS C1894		G36333  -  SET INTROD .018IN 5FR 21GA 10CM 40CM COAXIAL CATHETER GWIRE	BOTH IP/OP	$101.50 	$75.11	$0.00	$80.00	$54.30	$54.30	$0.00	$0.00	$0.00	$21.16	$75.33	$75.33	$0.00	$0.00	$21.15	$0.00	$60.04	$60.04	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$15.65	$0.00	$0.00	$15.92	$0.00	$0.00	$0.00	$0.00	$0.00
G36359	SUP	HCPCS C1725		G36359  -  CATH ANGIO .035IN VTK CURVE 5.5FR 125CM SHTH GWIRE RADIOPQ	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$105.89	$105.89	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
G36360	SUP	HCPCS C1725		G36360  -  CATH ANGIO .035IN SIM2 CURVE 5.5FR 125CM SHTH GWIRE RADIOPQ	BOTH IP/OP	$195.00 	$144.30	$0.00	$156.00	$105.89	$105.89	$0.00	$0.00	$0.00	$40.64	$144.73	$144.73	$0.00	$0.00	$40.64	$0.00	$115.34	$115.34	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
G36405	SUP	HCPCS C1770		G36405  -  COIL EMBOLIZATION .035IN 5MM 5CM 3.1 LOOP MREYE PLATINUM	BOTH IP/OP	$264.07 	$195.41	$0.00	$200.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.99	$195.99	$0.00	$0.00	$55.03	$0.00	$0.00	$0.00	$0.00	$125.15	$198.24	$200.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G38463	SUP	HCPCS C1874		G38463  -  STENT VASCULAR 6MM 40MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM	BOTH IP/OP	"$2,937.50 "	"$2,173.75"	$0.00	"$2,350.00"	"$1,321.88"	"$1,321.88"	$0.00	$0.00	$0.00	$612.25	"$2,180.21"	"$2,180.21"	$0.00	$0.00	$612.18	$0.00	"$1,448.19"	"$1,448.19"	$0.00	"$1,468.75"	"$2,326.50"	"$2,350.00"	$0.00		$0.00	$459.72	$0.00	$0.00	$467.65	$0.00	$0.00	$0.00	$0.00	$0.00
G38479	SUP	HCPCS C1874		G38479  -  STENT VASCULAR 6MM 60MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
G38480	SUP	HCPCS C1874		G38480  -  STENT VASCULAR 6MM 80MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM	BOTH IP/OP	"$4,487.50 "	"$3,320.75"	$0.00	"$3,590.00"	"$2,019.38"	"$2,019.38"	$0.00	$0.00	$0.00	$935.31	"$3,330.62"	"$3,330.62"	$0.00	$0.00	$935.20	$0.00	"$2,212.34"	"$2,212.34"	$0.00	"$2,243.75"	"$3,554.10"	"$3,590.00"	$0.00		$0.00	$702.29	$0.00	$0.00	$714.41	$0.00	$0.00	$0.00	$0.00	$0.00
G38481	SUP	HCPCS C1874		G38481  -  STENT VASCULAR 125CM 6FR 80MM 100MM OTW ZILVER PTX	BOTH IP/OP	"$4,487.50 "	"$3,320.75"	$0.00	"$3,590.00"	"$2,019.38"	"$2,019.38"	$0.00	$0.00	$0.00	$935.31	"$3,330.62"	"$3,330.62"	$0.00	$0.00	$935.20	$0.00	"$2,212.34"	"$2,212.34"	$0.00	"$2,243.75"	"$3,554.10"	"$3,590.00"	$0.00		$0.00	$702.29	$0.00	$0.00	$714.41	$0.00	$0.00	$0.00	$0.00	$0.00
G38482	SUP	HCPCS C1874		G38482  -  STENT VASCULAR 6MM 120MM 125CM DRUG ELUTE OTW DELIVERY	BOTH IP/OP	"$4,987.50 "	"$3,690.75"	$0.00	"$3,990.00"	"$2,244.38"	"$2,244.38"	$0.00	$0.00	$0.00	"$1,039.52"	"$3,701.72"	"$3,701.72"	$0.00	$0.00	"$1,039.40"	$0.00	"$2,458.84"	"$2,458.84"	$0.00	"$2,493.75"	"$3,950.10"	"$3,990.00"	$0.00		$0.00	$780.54	$0.00	$0.00	$794.01	$0.00	$0.00	$0.00	$0.00	$0.00
G38486	SUP	HCPCS C1874		G38486  -  STENT VASCULAR 7MM 40MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM	BOTH IP/OP	"$2,937.50 "	"$2,173.75"	$0.00	"$2,350.00"	"$1,321.88"	"$1,321.88"	$0.00	$0.00	$0.00	$612.25	"$2,180.21"	"$2,180.21"	$0.00	$0.00	$612.18	$0.00	"$1,448.19"	"$1,448.19"	$0.00	"$1,468.75"	"$2,326.50"	"$2,350.00"	$0.00		$0.00	$459.72	$0.00	$0.00	$467.65	$0.00	$0.00	$0.00	$0.00	$0.00
G38487	SUP	HCPCS C1874		G38487  -  STENT VASCULAR 7MM 60MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM	BOTH IP/OP	"$3,737.50 "	"$2,765.75"	$0.00	"$2,990.00"	"$1,681.88"	"$1,681.88"	$0.00	$0.00	$0.00	$778.99	"$2,773.97"	"$2,773.97"	$0.00	$0.00	$778.90	$0.00	"$1,842.59"	"$1,842.59"	$0.00	"$1,868.75"	"$2,960.10"	"$2,990.00"	$0.00		$0.00	$584.92	$0.00	$0.00	$595.01	$0.00	$0.00	$0.00	$0.00	$0.00
G38488	SUP	HCPCS C1874		G38488  -  STENT VASCULAR 7MM 80MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM	BOTH IP/OP	"$4,487.50 "	"$3,320.75"	$0.00	"$3,590.00"	"$2,019.38"	"$2,019.38"	$0.00	$0.00	$0.00	$935.31	"$3,330.62"	"$3,330.62"	$0.00	$0.00	$935.20	$0.00	"$2,212.34"	"$2,212.34"	$0.00	"$2,243.75"	"$3,554.10"	"$3,590.00"	$0.00		$0.00	$702.29	$0.00	$0.00	$714.41	$0.00	$0.00	$0.00	$0.00	$0.00
G38489	SUP	HCPCS C1874		G38489  -  STENT VASCULAR 7MM 100MM 125CM DRUG ELUTE OTW DELIVERY	BOTH IP/OP	"$4,487.50 "	"$3,320.75"	$0.00	"$3,590.00"	"$2,019.38"	"$2,019.38"	$0.00	$0.00	$0.00	$935.31	"$3,330.62"	"$3,330.62"	$0.00	$0.00	$935.20	$0.00	"$2,212.34"	"$2,212.34"	$0.00	"$2,243.75"	"$3,554.10"	"$3,590.00"	$0.00		$0.00	$702.29	$0.00	$0.00	$714.41	$0.00	$0.00	$0.00	$0.00	$0.00
G38490	SUP	HCPCS C1874		G38490  -  STENT VASCULAR 7MM 120MM 125CM DRUG ELUTE OTW DELIVERY	BOTH IP/OP	"$4,987.50 "	"$3,690.75"	$0.00	"$3,990.00"	"$2,244.38"	"$2,244.38"	$0.00	$0.00	$0.00	"$1,039.52"	"$3,701.72"	"$3,701.72"	$0.00	$0.00	"$1,039.40"	$0.00	"$2,458.84"	"$2,458.84"	$0.00	"$2,493.75"	"$3,950.10"	"$3,990.00"	$0.00		$0.00	$780.54	$0.00	$0.00	$794.01	$0.00	$0.00	$0.00	$0.00	$0.00
G38532	SUP	HCPCS C1874		G38532  -  STENT VASCULAR 8MM 120MM 125CM OTW DRUG ELUTE DELIVERY	BOTH IP/OP	"$4,987.50 "	"$3,690.75"	$0.00	"$3,990.00"	"$2,244.38"	"$2,244.38"	$0.00	$0.00	$0.00	"$1,039.52"	"$3,701.72"	"$3,701.72"	$0.00	$0.00	"$1,039.40"	$0.00	"$2,458.84"	"$2,458.84"	$0.00	"$2,493.75"	"$3,950.10"	"$3,990.00"	$0.00		$0.00	$780.54	$0.00	$0.00	$794.01	$0.00	$0.00	$0.00	$0.00	$0.00
G38589	SUP	Custom 27803010		G38589  -  GRAFT EVAS 2 BRCH 20MM 7.7MM 20FR 109MM 45MM ZNTH FENESTRATE	BOTH IP/OP	"$9,270.00 "	"$6,859.80"	$0.00	"$7,416.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,931.87"	$0.00	$0.00	$0.00	$0.00	"$4,635.00"	"$7,341.84"	"$7,416.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G42409	SUP	Custom 27803010		G42409  -  COIL EMBOLIZATION .035IN 4MM 3CM 2.4 LOOP MREYE PLATINUM	BOTH IP/OP	$264.07 	$195.41	$0.00	$200.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.99	$195.99	$0.00	$0.00	$55.03	$0.00	$0.00	$0.00	$0.00	$125.15	$198.24	$200.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G42410	SUP	HCPCS C1770		G42410  -  COIL EMBOLIZATION 5MM 3CM 1.9 LOOP STAINLESS STEEL SYNTH	BOTH IP/OP	$264.07 	$195.41	$0.00	$200.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.99	$195.99	$0.00	$0.00	$55.03	$0.00	$0.00	$0.00	$0.00	$125.15	$198.24	$200.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G42419	SUP	HCPCS C1770		G42419  -  COIL EMBOLIZATION .035IN 3MM 5CM 5.3 LOOP STAINLESS STEEL	BOTH IP/OP	$264.07 	$195.41	$0.00	$200.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.99	$195.99	$0.00	$0.00	$55.03	$0.00	$0.00	$0.00	$0.00	$125.15	$198.24	$200.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G42423	SUP	HCPCS C1770		G42423  -  COIL EMBOLIZATION .035IN 8MM 5CM 2 LOOP MREYE PLATINUM	BOTH IP/OP	$264.07 	$195.41	$0.00	$200.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.99	$195.99	$0.00	$0.00	$55.03	$0.00	$0.00	$0.00	$0.00	$125.15	$198.24	$200.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G43821	SUP	HCPCS C1876		G43821  -  STENT VASCULAR .035IN 6MM 6FR 40MM 125CM SELF EXPANDING	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
G43823	SUP	HCPCS C1876		G43823  -  STENT VASCULAR 6MM 6FR 80MM 125CM SELF EXPAND INTROD OTW	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
G43831	SUP	HCPCS C1876		G43831  -  STENT VASC 8MM 6FR 40MM 125CM .035IN SLF EXPANDABLE DLV SYS	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G43833	SUP	HCPCS C1876		G43833  -  STENT VASC 8MM 6FR 80MM 125CM .035IN SLF XPD FLXB FLXR	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G43845	SUP	HCPCS C1877		G43845  -  STENT VASC 6MM 6FR 30MM 80CM .035IN SLF XPD FLXB FLXR INTROD	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G43846	SUP	HCPCS C1876		G43846  -  STENT VASCULAR 6MM 40MM 80CM SELF EXPAND OTW INTROD RADIOPQ	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
G43850	SUP	HCPCS C1876		G43850  -  STENT VASC 7MM 6FR 30MM 80CM .035IN SLF XPD FLXB FLXR INTROD	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G43851	SUP	HCPCS C1876		G43851  -  STENT VASCULAR 7MM 6FR 40MM 80CM SELF EXPAND FLEXIBLE SLOT	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
G43855	SUP	HCPCS C1876		G43855  -  STENT VASCULAR .035IN 8MM 6FR 30MM 80CM SELF EXPANDING	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
G43856	SUP	HCPCS C1876		G43856  -  STENT VASCULAR .035IN 8MM 6FR 40MM 80CM SELF EXPANDING	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
G43857	SUP	HCPCS C1876		G43857  -  STENT VASCULAR .035IN 8MM 6FR 60MM 80CM SELF EXPANDING	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
G43861	SUP	HCPCS C1876		G43861  -  STENT VASCULAR 9MM 6FR 40MM 80CM SELF EXPAND INTROD OTW	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
G43863	SUP	HCPCS C1876		G43863  -  STENT VASC 9MM 6FR 80MM 80CM .035IN SLF XPD FLXB FLXR INTROD	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G43865	SUP	HCPCS C1876		G43865  -  STENT VASCULAR .035IN 10MM 6FR 30MM 80CM SELF EXPANDING	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
G43866	SUP	HCPCS C1876		G43866  -  STENT VASCULAR .035IN 10MM 6FR 40MM 80CM SELF EXPANDING	BOTH IP/OP	"$2,283.75 "	"$1,689.98"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$475.99	"$1,695.00"	"$1,695.00"	$0.00	$0.00	$475.93	$0.00	"$1,350.84"	"$1,350.84"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
G43868	SUP	HCPCS C1876		G43868  -  STENT VASC 10MM 6FR 80MM 80CM .035IN SLF EXPANDABLE DLV SYS	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G43870	SUP	HCPCS C1894		G43870  -  SET INTROD 40CM 5FR MPNCH .018IN NTNL GWIRE 10CM VLNK STRL	BOTH IP/OP	$69.00 	$51.06	$0.00	$55.20	$37.47	$37.47	$0.00	$0.00	$0.00	$14.38	$51.21	$51.21	$0.00	$0.00	$14.38	$0.00	$40.81	$40.81	$0.00	$34.50	$54.65	$55.20	$0.00		$0.00	$10.80	$0.00	$0.00	$10.98	$0.00	$0.00	$0.00	$0.00	$0.00
G44153	SUP	HCPCS C1894		G44153  -  SHEATH GUID .018-.038IN ANL0 CURVE 5FR .074IN 45CM INTROD	BOTH IP/OP	$202.50 	$149.85	$0.00	$150.30	$101.81	$101.81	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G44154	SUP	HCPCS C1894		G44154  -  SHEATH GUID .018-.038IN ANL0 CURVE 6FR .087IN 45CM INTROD	BOTH IP/OP	$202.50 	$149.85	$0.00	$150.30	$101.81	$101.81	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G44155	SUP	HCPCS C1894		G44155  -  SHEATH GUID .018/.038IN ANL0 CURVE 7FR .1IN 45CM INTROD	BOTH IP/OP	$202.50 	$149.85	$0.00	$150.30	$101.81	$101.81	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G44846	SUP	HCPCS C1769		G44846  -  GUIDEWIRE URO STRG .035IN 150CM 3CM MTN HBRD FLXB	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$0.00	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00		$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
G44848	SUP	HCPCS C1769		G44848  -  GUIDEWIRE URO .035IN 150CM 3CM MTN HBRD FLXB STRG TIP	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$0.00	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00		$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
G44849	SUP	HCPCS C1769		G44849  -  GUIDEWIRE URO .038IN 150CM 3CM MTN HBRD FLXB STRG TIP	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$0.00	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00		$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
G44855	SUP	HCPCS C1769		G44855  -  GUIDEWIRE URO .038IN 150CM 3CM MTN HBRD FLXB ANG TIP	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$0.00	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00		$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
G45208	SUP	HCPCS C1769		G45208  -  GUIDEWIRE VASCULAR CURVE .035IN 260CM 2 END FLEXIBLE TIP	BOTH IP/OP	"$1,432.50 "	"$1,060.05"	$0.00	"$1,146.00"	$777.85	$777.85	$0.00	$0.00	$0.00	$298.57	"$1,063.20"	"$1,063.20"	$0.00	$0.00	$298.53	$0.00	$847.32	$847.32	$0.00	$716.25	"$1,134.54"	"$1,146.00"	$0.00		$0.00	$224.19	$0.00	$0.00	$228.05	$0.00	$0.00	$0.00	$0.00	$0.00
G45352	SUP	HCPCS C1769		G45352  -  GUIDEWIRE VASC STRG .035IN 300CM 4CM LNDRQS XSTF FLX TP PTFE	BOTH IP/OP	"$1,169.05 "	$865.10	$0.00	$935.24	$634.79	$634.79	$0.00	$0.00	$0.00	$243.66	$867.67	$867.67	$0.00	$0.00	$243.63	$0.00	$691.49	$691.49	$0.00	$584.53	$925.89	$935.24	$0.00		$0.00	$182.96	$0.00	$0.00	$186.11	$0.00	$0.00	$0.00	$0.00	$0.00
G46023	SUP	HCPCS C1726		G46023  -  GUIDEWIRE URO .035IN 150CM 3CM MTN HBRD FLXB ANG TIP	BOTH IP/OP	$103.87 	$76.86	$0.00	$83.10	$56.40	$56.40	$0.00	$0.00	$0.00	$21.65	$77.09	$77.09	$0.00	$0.00	$21.65	$0.00	$61.44	$61.44	$0.00	$51.94	$82.27	$83.10	$0.00		$0.00	$16.26	$0.00	$0.00	$16.54	$0.00	$0.00	$0.00	$0.00	$0.00
G46024	SUP	HCPCS C1726		G46024  -  CATHETER NPHSTM 6MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR	BOTH IP/OP	$618.80 	$457.91	$0.00	$495.04	$336.01	$336.01	$0.00	$0.00	$0.00	$128.97	$459.27	$459.27	$0.00	$0.00	$128.96	$0.00	$366.02	$366.02	$0.00	$309.40	$490.09	$495.04	$0.00		$0.00	$96.84	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
G46027	SUP	Custom 27203010		G46027  -  SET NPHSTM 8MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR RADOPQ	BOTH IP/OP	$515.33 	$381.34	$0.00	$412.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.47	$382.47	$0.00	$0.00	$107.39	$0.00	$0.00	$0.00	$0.00	$257.66	$408.14	$412.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46028	SUP	HCPCS C1894		G46028  -  EXTRACTOR STON 1.7FR 1CM 115CM NCOMPASS 4/16 WRE BSKT MOD	BOTH IP/OP	$407.00 	$301.18	$0.00	$325.60	$221.00	$221.00	$0.00	$0.00	$0.00	$84.83	$302.08	$302.08	$0.00	$0.00	$84.82	$0.00	$240.74	$240.74	$0.00	$203.50	$322.34	$325.60	$0.00		$0.00	$63.70	$0.00	$0.00	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00
G46029	SUP	HCPCS C1894		G46029  -  SHEATH ACC 3FR 9.5FR 55CM FLXR 2 CNT WRK CHNL 2 LUM DILATION	BOTH IP/OP	$407.00 	$301.18	$0.00	$325.60	$221.00	$221.00	$0.00	$0.00	$0.00	$84.83	$302.08	$302.08	$0.00	$0.00	$84.82	$0.00	$240.74	$240.74	$0.00	$203.50	$322.34	$325.60	$0.00		$0.00	$63.70	$0.00	$0.00	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00
G46030	SUP	HCPCS C2627		G46030  -  SHEATH ACC 3FR 12FR 13CM FLXR 2 CNT WRK CHNL 2 LUM DILATION	BOTH IP/OP	$117.15 	$86.69	$0.00	$93.72	$63.61	$63.61	$0.00	$0.00	$0.00	$0.00	$86.95	$86.95	$0.00	$0.00	$24.41	$0.00	$0.00	$0.00	$0.00	$58.58	$92.78	$93.72	$0.00		$0.00	$18.33	$0.00	$0.00	$18.65	$0.00	$0.00	$0.00	$0.00	$0.00
G46031	SUP	HCPCS C2627		G46031  -  SHEATH ACC 18FR 17CM CLR AMPTZ RADOPQ STRP RNL	BOTH IP/OP	$117.15 	$86.69	$0.00	$93.72	$63.61	$63.61	$0.00	$0.00	$0.00	$0.00	$86.95	$86.95	$0.00	$0.00	$24.41	$0.00	$0.00	$0.00	$0.00	$58.58	$92.78	$93.72	$0.00		$0.00	$18.33	$0.00	$0.00	$18.65	$0.00	$0.00	$0.00	$0.00	$0.00
G46032	SUP	HCPCS C2627		G46032  -  SHEATH ACC 24FR 17CM CLR AMPTZ RADOPQ STRP RNL	BOTH IP/OP	$117.15 	$86.69	$0.00	$93.72	$63.61	$63.61	$0.00	$0.00	$0.00	$0.00	$86.95	$86.95	$0.00	$0.00	$24.41	$0.00	$0.00	$0.00	$0.00	$58.58	$92.78	$93.72	$0.00		$0.00	$18.33	$0.00	$0.00	$18.65	$0.00	$0.00	$0.00	$0.00	$0.00
G46033	SUP	HCPCS C1726		G46033  -  SHEATH ACC 30FR 17CM CLR AMPTZ RADOPQ STRP RNL	BOTH IP/OP	$519.35 	$384.32	$0.00	$415.48	$282.01	$282.01	$0.00	$0.00	$0.00	$108.25	$385.46	$385.46	$0.00	$0.00	$108.23	$0.00	$307.20	$307.20	$0.00	$259.68	$411.33	$415.48	$0.00		$0.00	$81.28	$0.00	$0.00	$82.68	$0.00	$0.00	$0.00	$0.00	$0.00
G46034	SUP	HCPCS C1726		G46034  -  CATHETER NPHSTM 6MM 15CM ULTRX INFL BLN SHRT TRNS TPR RADOPQ	BOTH IP/OP	$519.35 	$384.32	$0.00	$415.48	$282.01	$282.01	$0.00	$0.00	$0.00	$108.25	$385.46	$385.46	$0.00	$0.00	$108.23	$0.00	$307.20	$307.20	$0.00	$259.68	$411.33	$415.48	$0.00		$0.00	$81.28	$0.00	$0.00	$82.68	$0.00	$0.00	$0.00	$0.00	$0.00
G46035	SUP	HCPCS C1726		G46035  -  CATHETER NPHSTM 8MM 15CM ULTRX INFL BLN SHRT TRNS TPR RADOPQ	BOTH IP/OP	$519.35 	$384.32	$0.00	$415.48	$282.01	$282.01	$0.00	$0.00	$0.00	$108.25	$385.46	$385.46	$0.00	$0.00	$108.23	$0.00	$307.20	$307.20	$0.00	$259.68	$411.33	$415.48	$0.00		$0.00	$81.28	$0.00	$0.00	$82.68	$0.00	$0.00	$0.00	$0.00	$0.00
G46036	SUP	HCPCS C1726		G46036  -  CATHETER NPHSTM 8MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR	BOTH IP/OP	$618.80 	$457.91	$0.00	$495.04	$336.01	$336.01	$0.00	$0.00	$0.00	$128.97	$459.27	$459.27	$0.00	$0.00	$128.96	$0.00	$366.02	$366.02	$0.00	$309.40	$490.09	$495.04	$0.00		$0.00	$96.84	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
G46037	SUP	HCPCS C1726		G46037  -  SET NPHSTM 6MM 15CM ULTRX INFL BLN SHRT TRNS TPR RADOPQ STRP	BOTH IP/OP	$618.80 	$457.91	$0.00	$495.04	$336.01	$336.01	$0.00	$0.00	$0.00	$128.97	$459.27	$459.27	$0.00	$0.00	$128.96	$0.00	$366.02	$366.02	$0.00	$309.40	$490.09	$495.04	$0.00		$0.00	$96.84	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
G46038	SUP	HCPCS C1726		G46038  -  SET NPHSTM 6MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR RADOPQ	BOTH IP/OP	$618.80 	$457.91	$0.00	$495.04	$336.01	$336.01	$0.00	$0.00	$0.00	$128.97	$459.27	$459.27	$0.00	$0.00	$128.96	$0.00	$366.02	$366.02	$0.00	$309.40	$490.09	$495.04	$0.00		$0.00	$96.84	$0.00	$0.00	$98.51	$0.00	$0.00	$0.00	$0.00	$0.00
G46041	SUP	HCPCS C1726		G46041  -  CATHETER NPHSTM 10MM 15CM ULTRX	BOTH IP/OP	$519.35 	$384.32	$0.00	$415.48	$282.01	$282.01	$0.00	$0.00	$0.00	$108.25	$385.46	$385.46	$0.00	$0.00	$108.23	$0.00	$307.20	$307.20	$0.00	$259.68	$411.33	$415.48	$0.00		$0.00	$81.28	$0.00	$0.00	$82.68	$0.00	$0.00	$0.00	$0.00	$0.00
G46042	SUP	HCPCS C1726		G46042  -  CATHETER NPHSTM 6MM 15CM ULTRX	BOTH IP/OP	$519.35 	$384.32	$0.00	$415.48	$282.01	$282.01	$0.00	$0.00	$0.00	$108.25	$385.46	$385.46	$0.00	$0.00	$108.23	$0.00	$307.20	$307.20	$0.00	$259.68	$411.33	$415.48	$0.00		$0.00	$81.28	$0.00	$0.00	$82.68	$0.00	$0.00	$0.00	$0.00	$0.00
G46043	SUP	HCPCS C1726		G46043  -  EXTRACTOR STON 2.2FR 11MM 115CM STRL NGAGE NTNL URETER	BOTH IP/OP	$519.35 	$384.32	$0.00	$415.48	$282.01	$282.01	$0.00	$0.00	$0.00	$108.25	$385.46	$385.46	$0.00	$0.00	$108.23	$0.00	$307.20	$307.20	$0.00	$259.68	$411.33	$415.48	$0.00		$0.00	$81.28	$0.00	$0.00	$82.68	$0.00	$0.00	$0.00	$0.00	$0.00
G46044	SUP	Custom 27203010		G46044  -  SET NPHSTM 8MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR RADOPQ	BOTH IP/OP	$814.00 	$602.36	$0.00	$651.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$604.15	$604.15	$0.00	$0.00	$169.64	$0.00	$0.00	$0.00	$0.00	$407.00	$644.69	$651.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46071	SUP	Custom 27203010		G46071  -  DEVICE BX BX KNDY REUSE	BOTH IP/OP	$814.00 	$602.36	$0.00	$651.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$604.15	$604.15	$0.00	$0.00	$169.64	$0.00	$0.00	$0.00	$0.00	$407.00	$644.69	$651.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46072	SUP	HCPCS C1894		G46072  -  NEEDLE BX 18GA 25CM STRL HUB ECHGN TIP SMPL NTCH DISP	BOTH IP/OP	$20.35 	$15.06	$0.00	$16.28	$11.05	$11.05	$0.00	$0.00	$0.00	$4.24	$15.10	$15.10	$0.00	$0.00	$4.24	$0.00	$12.04	$12.04	$0.00	$10.18	$16.12	$16.28	$0.00		$0.00	$3.18	$0.00	$0.00	$3.24	$0.00	$0.00	$0.00	$0.00	$0.00
G46073	SUP	HCPCS C1894		G46073  -  SHEATH ACC 3FR 9.5FR 13CM FLXR DL 2 CNT WRK CHNL 2 LUM	BOTH IP/OP	$407.00 	$301.18	$0.00	$325.60	$221.00	$221.00	$0.00	$0.00	$0.00	$84.83	$302.08	$302.08	$0.00	$0.00	$84.82	$0.00	$240.74	$240.74	$0.00	$203.50	$322.34	$325.60	$0.00		$0.00	$63.70	$0.00	$0.00	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00
G46074	SUP	HCPCS C1894		G46074  -  SHEATH ACC 3FR 9.5FR 20CM FLXR DL 2 CNT WRK CHNL 2 LUM	BOTH IP/OP	$407.00 	$301.18	$0.00	$325.60	$221.00	$221.00	$0.00	$0.00	$0.00	$84.83	$302.08	$302.08	$0.00	$0.00	$84.82	$0.00	$240.74	$240.74	$0.00	$203.50	$322.34	$325.60	$0.00		$0.00	$63.70	$0.00	$0.00	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00
G46075	SUP	HCPCS C1894		G46075  -  SHEATH ACC 3FR 9.5FR 28CM FLXR DL 2 CNT WRK CHNL 2 LUM	BOTH IP/OP	$407.00 	$301.18	$0.00	$325.60	$221.00	$221.00	$0.00	$0.00	$0.00	$84.83	$302.08	$302.08	$0.00	$0.00	$84.82	$0.00	$240.74	$240.74	$0.00	$203.50	$322.34	$325.60	$0.00		$0.00	$63.70	$0.00	$0.00	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00
G46076	SUP	HCPCS C1894		G46076  -  SHEATH ACC 3FR 9.5FR 35CM FLXR DL 2 CNT WRK CHNL 2 LUM	BOTH IP/OP	$407.00 	$301.18	$0.00	$325.60	$221.00	$221.00	$0.00	$0.00	$0.00	$84.83	$302.08	$302.08	$0.00	$0.00	$84.82	$0.00	$240.74	$240.74	$0.00	$203.50	$322.34	$325.60	$0.00		$0.00	$63.70	$0.00	$0.00	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00
G46077	SUP	HCPCS C1894		G46077  -  SHEATH ACC 3FR 9.5FR 45CM FLXR DL 2 CNT WRK CHNL 2 LUM	BOTH IP/OP	$407.00 	$301.18	$0.00	$325.60	$221.00	$221.00	$0.00	$0.00	$0.00	$84.83	$302.08	$302.08	$0.00	$0.00	$84.82	$0.00	$240.74	$240.74	$0.00	$203.50	$322.34	$325.60	$0.00		$0.00	$63.70	$0.00	$0.00	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00
G46078	SUP	HCPCS C1894		G46078  -  SHEATH ACC 3FR 12FR 20CM FLXR 2 CNT WRK CHNL 2 LUM DILATION	BOTH IP/OP	$407.00 	$301.18	$0.00	$325.60	$221.00	$221.00	$0.00	$0.00	$0.00	$84.83	$302.08	$302.08	$0.00	$0.00	$84.82	$0.00	$240.74	$240.74	$0.00	$203.50	$322.34	$325.60	$0.00		$0.00	$63.70	$0.00	$0.00	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00
G46079	SUP	HCPCS C1894		G46079  -  SHEATH ACC 3FR 12FR 28CM FLXR 2 CNT WRK CHNL 2 LUM DILATION	BOTH IP/OP	$407.00 	$301.18	$0.00	$325.60	$221.00	$221.00	$0.00	$0.00	$0.00	$84.83	$302.08	$302.08	$0.00	$0.00	$84.82	$0.00	$240.74	$240.74	$0.00	$203.50	$322.34	$325.60	$0.00		$0.00	$63.70	$0.00	$0.00	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00
G46080	SUP	HCPCS C1894		G46080  -  SHEATH ACC 3FR 12FR 35CM FLXR DL 2 CNT WRK CHNL 2 LUM	BOTH IP/OP	$407.00 	$301.18	$0.00	$325.60	$221.00	$221.00	$0.00	$0.00	$0.00	$84.83	$302.08	$302.08	$0.00	$0.00	$84.82	$0.00	$240.74	$240.74	$0.00	$203.50	$322.34	$325.60	$0.00		$0.00	$63.70	$0.00	$0.00	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00
G46081	SUP	HCPCS C1894		G46081  -  SHEATH ACC 3FR 12FR 45CM FLXR DL 2 CNT WRK CHNL 2 LUM	BOTH IP/OP	$407.00 	$301.18	$0.00	$325.60	$221.00	$221.00	$0.00	$0.00	$0.00	$84.83	$302.08	$302.08	$0.00	$0.00	$84.82	$0.00	$240.74	$240.74	$0.00	$203.50	$322.34	$325.60	$0.00		$0.00	$63.70	$0.00	$0.00	$64.79	$0.00	$0.00	$0.00	$0.00	$0.00
G46137	SUP	HCPCS C1769		G46137  -  SHEATH ACC 3FR 12FR 55CM FLXR 2 CNT WRK CHNL 2 LUM DILATION	BOTH IP/OP	$669.38 	$495.34	$0.00	$535.50	$363.47	$363.47	$0.00	$0.00	$0.00	$139.51	$496.81	$496.81	$0.00	$0.00	$139.50	$0.00	$395.94	$395.94	$0.00	$334.69	$530.15	$535.50	$0.00		$0.00	$104.76	$0.00	$0.00	$106.56	$0.00	$0.00	$0.00	$0.00	$0.00
G46138	SUP	HCPCS C1769		G46138  -  GUIDEWIRE ESCP ANG STRG TPR .038IN 150CM STRL 3CM BIWIRE 1-1	BOTH IP/OP	$133.88 	$99.07	$0.00	$107.10	$72.69	$72.69	$0.00	$0.00	$0.00	$27.90	$99.36	$99.36	$0.00	$0.00	$27.90	$0.00	$79.19	$79.19	$0.00	$66.94	$106.03	$107.10	$0.00		$0.00	$20.95	$0.00	$0.00	$21.31	$0.00	$0.00	$0.00	$0.00	$0.00
G46139	SUP	HCPCS C1769		G46139  -  GUIDEWIRE ESCP ANG .035IN 150CM STRL 3CM BIWIRE 1TO 1 TRQ	BOTH IP/OP	$133.88 	$99.07	$0.00	$107.10	$72.69	$72.69	$0.00	$0.00	$0.00	$27.90	$99.36	$99.36	$0.00	$0.00	$27.90	$0.00	$79.19	$79.19	$0.00	$66.94	$106.03	$107.10	$0.00		$0.00	$20.95	$0.00	$0.00	$21.31	$0.00	$0.00	$0.00	$0.00	$0.00
G46140	SUP	HCPCS C1769		G46140  -  GUIDEWIRE VASC STRG ANG TPR .025IN 150CM 3CM BIWIRE 1TO 1	BOTH IP/OP	$111.38 	$82.42	$0.00	$89.10	$60.48	$60.48	$0.00	$0.00	$0.00	$23.21	$82.66	$82.66	$0.00	$0.00	$23.21	$0.00	$65.88	$65.88	$0.00	$55.69	$88.21	$89.10	$0.00		$0.00	$17.43	$0.00	$0.00	$17.73	$0.00	$0.00	$0.00	$0.00	$0.00
G46141	SUP	HCPCS C1769		G46141  -  GUIDEWIRE URO ANG STRG TPR .038IN 150CM STRL 3CM BIWIRE 1-1	BOTH IP/OP	$111.38 	$82.42	$0.00	$89.10	$60.48	$60.48	$0.00	$0.00	$0.00	$23.21	$82.66	$82.66	$0.00	$0.00	$23.21	$0.00	$65.88	$65.88	$0.00	$55.69	$88.21	$89.10	$0.00		$0.00	$17.43	$0.00	$0.00	$17.73	$0.00	$0.00	$0.00	$0.00	$0.00
G46142	SUP	HCPCS C1769		G46142  -  GUIDEWIRE VASC STD STRG .035IN 150CM 3CM BIWIRE 1TO 1 TRQ	BOTH IP/OP	$111.38 	$82.42	$0.00	$89.10	$60.48	$60.48	$0.00	$0.00	$0.00	$23.21	$82.66	$82.66	$0.00	$0.00	$23.21	$0.00	$65.88	$65.88	$0.00	$55.69	$88.21	$89.10	$0.00		$0.00	$17.43	$0.00	$0.00	$17.73	$0.00	$0.00	$0.00	$0.00	$0.00
G46167	SUP	HCPCS C1894		G46167  -  SHEATH ACCES 9.5FR CONTIN WKG CHNL FLXB SCP	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G46168	SUP	HCPCS C1894		G46168  -  SHEATH ACCES 12FR CONTIN WOR CHNL TPR DILAT LOCK	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G46169	SUP	HCPCS C1894		G46169  -  GUIDEWIRE URO ANG STRG TPR .025IN 150CM 3CM BIWIRE STD BD	BOTH IP/OP	$308.00 	$227.92	$0.00	$246.40	$167.24	$167.24	$0.00	$0.00	$0.00	$64.19	$228.60	$228.60	$0.00	$0.00	$64.19	$0.00	$182.18	$182.18	$0.00	$154.00	$243.94	$246.40	$0.00		$0.00	$48.20	$0.00	$0.00	$49.03	$0.00	$0.00	$0.00	$0.00	$0.00
G46199	SUP	Custom 27203010		G46199  -  RETRIEVER STNT 2.4FR 115CM NSNARE FLXB NTNL	BOTH IP/OP	$796.88 	$589.69	$0.00	$637.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$591.44	$591.44	$0.00	$0.00	$166.07	$0.00	$0.00	$0.00	$0.00	$398.44	$631.13	$637.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46200	SUP	Custom 27203010		G46200  -  ELECTRODE ESURG .014IN 27FR CUT LOOP FIT 27FR STRZ 1 STM	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46202	SUP	Custom 27203010		G46202  -  KNIFE ESCP STRL COLLINGS DISP FIT 24/27FR 1 STM RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46203	SUP	Custom 27203010		G46203  -  ELECTRODE ESURG 3MM RLLR BRL FIT 24/26/28FR ACMI USA/ELT	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46204	SUP	Custom 27203010		G46204  -  ELECTRODE ESURG .014IN CUT LOOP GW FIT 24FR STRZ 2 STM RSSCP	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46205	SUP	Custom 27203010		G46205  -  ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR ACMI USA/ELT RSSCP	BOTH IP/OP	$308.13 	$228.02	$0.00	$246.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.69	$228.69	$0.00	$0.00	$64.21	$0.00	$0.00	$0.00	$0.00	$154.06	$244.04	$246.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46206	SUP	Custom 27203010		G46206  -  EXTRACTOR STONE 1.5FR 1CM 115CM 4 WIRE TIPLESS BASKET	BOTH IP/OP	$515.33 	$381.34	$0.00	$412.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.47	$382.47	$0.00	$0.00	$107.39	$0.00	$0.00	$0.00	$0.00	$257.66	$408.14	$412.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46209	SUP	Custom 27203010		G46209  -  KNIFE ESCP COLLINGS FIT 24/26/28 FR ACMI USA/ELT RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46210	SUP	Custom 27203010		G46210  -  ELECTRODE ESURG .012IN CUT LOOP GW FIT 24FR ACMI USA/ELT	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46211	SUP	Custom 27203010		G46211  -  ELECTRODE ESURG .015IN CUT LOOP GW FIT 24FR ACMI USA/ELT	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46212	SUP	Custom 27203010		G46212  -  ELECTRODE ESURG .012IN CUT LOOP GW FIT 26FR ACMI USA/ELT	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46213	SUP	Custom 27203010		G46213  -  ELECTRODE ESURG .015IN CUT LOOP GW FIT 26FR ACMI USA/ELT	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46214	SUP	Custom 27203010		G46214  -  ELECTRODE ESURG .012IN CUT LOOP GW FIT 28FR ACMI USA/ELT	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46215	SUP	Custom 27203010		G46215  -  ELECTRODE ESURG .015IN LOOP GW URO FIT 28FR ACMI USA/ELT	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46216	SUP	Custom 27203010		G46216  -  ELECTRODE ESURG PRFR RESCT COAG FIT 28 FR ACMI USA/ELT RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46217	SUP	Custom 27203010		G46217  -  ELECTRODE ESURG 3MM RLLR BALL FIT 24/26/28FR ACMI USA/ELT	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46218	SUP	Custom 27203010		G46218  -  ELECTRODE ESURG 5MM RLLR BALL FIT 24/26/28FR ACMI USA/ELT	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46219	SUP	Custom 27203010		G46219  -  ELECTRODE ESURG .012IN CUT LOOP GW FIT 24FR STRZ 1 STM RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46220	SUP	Custom 27203010		G46220  -  ELECTRODE MNPLR .014IN CUT LOOP GW FIT 24FR STRZ 1 STM RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46221	SUP	Custom 27203010		G46221  -  ELECTRODE ESURG .012IN LOOP GW URO FIT 27FR STRZ SGL STM	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46222	SUP	Custom 27203010		G46222  -  ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR STRZ 1 STM RSSCP	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46223	SUP	Custom 27203010		G46223  -  ELECTRODE ESURG PRFR RESCT COAG FIT 27 FR STRZ 1 STM RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46224	SUP	Custom 27203010		G46224  -  ELECTRODE MNPLR 3MM CK RLLR BALL DISP FIT 24/27FR STRZ 1 STM	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46225	SUP	Custom 27203010		G46225  -  ELECTRODE ESURG 5MM RLLR BALL FIT 24/27FR STRZ 1 STM RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46226	SUP	Custom 27203010		G46226  -  ELECTRODE ESURG 3MM RLLR BRL FIT 24/27FR STRZ 1 STM RSSCP	BOTH IP/OP	$308.13 	$228.02	$0.00	$246.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.69	$228.69	$0.00	$0.00	$64.21	$0.00	$0.00	$0.00	$0.00	$154.06	$244.04	$246.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46228	SUP	Custom 27203010		G46228  -  KNIFE ESCP COLLINGS 24/26/28 FR RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46229	SUP	Custom 27203010		G46229  -  ELECTRODE ESURG 12D .012IN CUT LOOP GW FIT 24FR OL OES RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46230	SUP	Custom 27203010		G46230  -  ELECTRODE ESURG 30D 24FR .012IN CUT LOOP WRE OL OES RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46231	SUP	Custom 27203010		G46231  -  ELECTRODE ESURG 12D .012IN CUT LOOP GW FIT 26FR OL OES RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46232	SUP	Custom 27203010		G46232  -  ELECTRODE ESURG 30D .012IN 26FR LOOP CUT WRE FIT 26FR OL OES	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46233	SUP	Custom 27203010		G46233  -  ELECTRODE ESURG 12D .012IN CUT LOOP GW FIT 28FR OL OES RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46234	SUP	Custom 27203010		G46234  -  ELECTRODE ESURG 30D .012IN CUT LOOP GW FIT 28FR OL OES RSSCP	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46235	SUP	Custom 27203010		G46235  -  ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR OL OES RSSCP	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46236	SUP	Custom 27203010		G46236  -  ELECTRODE ESURG PRFR RESCT COAG FIT 26 FR OL OES RSSCP	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46237	SUP	Custom 27203010		G46237  -  ELECTRODE ESURG PRFR RESCT COAG FIT 28 FR OL OES RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46238	SUP	Custom 27203010		G46238  -  ELECTRODE ESURG 5MM RLLR BALL FIT 24/26/28FR OL OES RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46239	SUP	Custom 27203010		G46239  -  ELECTRODE ESURG 3MM RLLR BALL FIT 24/26/28FR OL OES RSSCP	BOTH IP/OP	$308.13 	$228.02	$0.00	$246.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.69	$228.69	$0.00	$0.00	$64.21	$0.00	$0.00	$0.00	$0.00	$154.06	$244.04	$246.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46240	SUP	Custom 27203010		G46240  -  ELECTRODE ESURG 3MM DIMPLED TIP VPR RLLR BALL FIT 24/26/28FR	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46241	SUP	Custom 27203010		G46241  -  ELECTRODE ESURG .014IN CUT LOOP GW FIT 27FR STRZ 2 STM	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46242	SUP	Custom 27203010		G46242  -  ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR STRZ 2 STM RSSCP	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46243	SUP	Custom 27203010		G46243  -  ELECTRODE ESURG PRFR RESCT COAG FIT 27 FR STRZ 2 STM RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46244	SUP	Custom 27203010		G46244  -  ELECTRODE ESURG 3MM RLLR BALL FIT 24/27FR STRZ 2 STM RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46245	SUP	Custom 27203010		G46245  -  ELECTRODE ESURG 5MM RLLR BALL FIT 24/27FR STRZ 2 STM RSSCP	BOTH IP/OP	$159.38 	$117.94	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.29	$118.29	$0.00	$0.00	$33.21	$0.00	$0.00	$0.00	$0.00	$79.69	$126.23	$127.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46246	SUP	Custom 27203010		G46246  -  ELECTRODE ESURG 3MM RLLR BALL FIT 24/27FR STRZ 2 STM RSSCP	BOTH IP/OP	$308.13 	$228.02	$0.00	$246.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.69	$228.69	$0.00	$0.00	$64.21	$0.00	$0.00	$0.00	$0.00	$154.06	$244.04	$246.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46247	SUP	Custom 27203010		G46247  -  ELECTRODE ESURG 3MM DIMPLED TIP VPR RLLR BALL FIT 24/27FR	BOTH IP/OP	$350.63 	$259.47	$0.00	$280.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$260.23	$260.23	$0.00	$0.00	$73.07	$0.00	$0.00	$0.00	$0.00	$175.31	$277.70	$280.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G46612	SUP	HCPCS C1763		G46612  -  GRAFT SFT TIS 13X8CM PLVC FLR INS SIS ES PIG ACLR CLGN MTRX	BOTH IP/OP	"$2,487.50 "	"$1,840.75"	$0.00	"$1,990.00"	"$1,119.38"	"$1,119.38"	$0.00	$0.00	$0.00	$518.46	"$1,846.22"	"$1,846.22"	$0.00	$0.00	$518.40	$0.00	"$1,471.36"	"$1,471.36"	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$389.29	$0.00	$0.00	$396.01	$0.00	$0.00	$0.00	$0.00	$0.00
G47325	SUP	HCPCS C1770		G47325  -  COIL EMBL 10MM 14CM NST MCIOL PLTN .018IN CATH	BOTH IP/OP	$264.20 	$195.51	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.09	$196.09	$0.00	$0.00	$55.06	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47329	SUP	HCPCS C1770		G47329  -  COIL EMBL 6MM 14CM NST MCIOL PLTN .018IN CATH	BOTH IP/OP	$278.73 	$206.26	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.87	$206.87	$0.00	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47330	SUP	HCPCS C1770		G47330  -  COIL EMBL 8MM 14CM NST MCIOL PLTN .018IN CATH	BOTH IP/OP	$278.73 	$206.26	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.87	$206.87	$0.00	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47338	SUP	HCPCS Q4107		G47338  -  COIL EMBL 3MM 7CM NST MCIOL PLTN .018IN CATH	BOTH IP/OP	$278.73 	$206.26	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.87	$206.87	$0.00	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47339	SUP	Custom 27805113		G47339  -  COIL EMBL 4MM 7CM NST MCIOL PLTN .018IN CATH	BOTH IP/OP	$278.73 	$206.26	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.87	$206.87	$0.00	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47345	SUP	HCPCS C1770		G47345  -  COIL EMBL 10MM 14CM NST MCIOL PLTN .035IN CATH	BOTH IP/OP	$278.73 	$206.26	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.87	$206.87	$0.00	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47354	SUP	Custom 27803010		G47354  -  COIL EMBL 6MM 14CM NST MCIOL PLTN .035IN CATH	BOTH IP/OP	$278.73 	$206.26	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.87	$206.87	$0.00	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47355	SUP	HCPCS C1770		G47355  -  COIL EMBL 8MM 14CM NST MCIOL PLTN .035IN CATH	BOTH IP/OP	$278.73 	$206.26	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.87	$206.87	$0.00	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47365	SUP	Custom 27803010		G47365  -  COIL EMBL 10MM 7CM NST MCIOL PLTN .035IN CATH	BOTH IP/OP	$278.73 	$206.26	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.87	$206.87	$0.00	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47371	SUP	Custom 27803010		G47371  -  COIL EMBL 3MM 7IN NST PLTN ACPT .035IN CATH	BOTH IP/OP	$278.73 	$206.26	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.87	$206.87	$0.00	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47372	SUP	Custom 27803010		G47372  -  COIL EMBL 4MM 7CM NST MCIOL PLTN .035IN CATH	BOTH IP/OP	$278.73 	$206.26	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.87	$206.87	$0.00	$0.00	$58.09	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47416	SUP	HCPCS C1770		G47416  -  COIL EMBL 3-2MM TRND MCIOL PLTN .018IN CATH	BOTH IP/OP	$275.33 	$203.74	$0.00	$220.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.66	$218.06	$220.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47419	SUP	HCPCS C1770		G47419  -  COIL EMBL 6-2MM TRND MCIOL PLTN .018IN CATH	BOTH IP/OP	$290.47 	$214.95	$0.00	$220.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.58	$215.58	$0.00	$0.00	$60.53	$0.00	$0.00	$0.00	$0.00	$137.66	$218.06	$220.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47421	SUP	HCPCS C1770		G47421  -  COIL EMBL 8-4MM 9.5CM TRND MCL PRELD CRTDG PLTN SNTH FBR	BOTH IP/OP	$290.47 	$214.95	$0.00	$220.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.58	$215.58	$0.00	$0.00	$60.53	$0.00	$0.00	$0.00	$0.00	$137.66	$218.06	$220.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47519	SUP	HCPCS C1770		G47519  -  COIL EMBL 4-3MM TRND PLTN .035IN CATH	BOTH IP/OP	$290.47 	$214.95	$0.00	$220.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.58	$215.58	$0.00	$0.00	$60.53	$0.00	$0.00	$0.00	$0.00	$137.66	$218.06	$220.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47520	SUP	HCPCS C1770		G47520  -  COIL EMBL 5-3MM TRND PLTN .035IN CATH	BOTH IP/OP	$290.47 	$214.95	$0.00	$220.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.58	$215.58	$0.00	$0.00	$60.53	$0.00	$0.00	$0.00	$0.00	$137.66	$218.06	$220.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47522	SUP	HCPCS C1770		G47522  -  COIL EMBL 7-3MM TRND PLTN .035IN CATH	BOTH IP/OP	$290.47 	$214.95	$0.00	$220.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.58	$215.58	$0.00	$0.00	$60.53	$0.00	$0.00	$0.00	$0.00	$137.66	$218.06	$220.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47654	SUP	HCPCS C1763		G47654  -  DILATOR URTH 26FR 37CM S-CRV SDPRT HDRPH	BOTH IP/OP	$985.03 	$728.92	$0.00	$788.02	$443.26	$443.26	$0.00	$0.00	$0.00	$205.30	$731.09	$731.09	$0.00	$0.00	$205.28	$0.00	$582.64	$582.64	$0.00	$492.51	$780.14	$788.02	$0.00		$0.00	$154.16	$0.00	$0.00	$156.82	$0.00	$0.00	$0.00	$0.00	$0.00
G47655	SUP	HCPCS C1763		G47655  -  GRAFT SFT TIS STD SURGISIS BIODESIGN STRTH FLXB RST TO INFCT	BOTH IP/OP	"$1,457.50 "	"$1,078.55"	$0.00	"$1,166.00"	$655.88	$655.88	$0.00	$0.00	$0.00	$303.78	"$1,081.76"	"$1,081.76"	$0.00	$0.00	$303.74	$0.00	$862.11	$862.11	$0.00	$728.75	"$1,154.34"	"$1,166.00"	$0.00		$0.00	$228.10	$0.00	$0.00	$232.03	$0.00	$0.00	$0.00	$0.00	$0.00
G47700	SUP	HCPCS C1892		G47700  -  INTRODUCER SHEATH .035IN ANL1 CURVE 11.4FR 10FR 45CM HIGH	BOTH IP/OP	$212.00 	$156.88	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$44.19	$157.35	$157.35	$0.00	$0.00	$44.18	$0.00	$125.40	$125.40	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
G47701	SUP	HCPCS C1892		G47701  -  INTRODUCER SHEATH .035IN ANL1 CURVE 13.4FR 12FR 45CM HIGH	BOTH IP/OP	$212.00 	$156.88	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$44.19	$157.35	$157.35	$0.00	$0.00	$44.18	$0.00	$125.40	$125.40	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
G47732	SUP	HCPCS C1769		G47732  -  GUIDEWIRE VASCULAR .014IN 135CM SHAPEABLE TIP KINK	BOTH IP/OP	$167.03 	$123.60	$0.00	$133.62	$90.69	$90.69	$0.00	$0.00	$0.00	$34.81	$123.97	$123.97	$0.00	$0.00	$34.81	$0.00	$98.80	$98.80	$0.00	$83.51	$132.29	$133.62	$0.00		$0.00	$26.14	$0.00	$0.00	$26.59	$0.00	$0.00	$0.00	$0.00	$0.00
G47733	SUP	HCPCS C1769		G47733  -  GUIDEWIRE VASC .014IN 190CM APRCH SHP TIP KINK RST MNVBL LNR	BOTH IP/OP	$204.00 	$150.96	$0.00	$163.20	$110.77	$110.77	$0.00	$0.00	$0.00	$42.52	$151.41	$151.41	$0.00	$0.00	$42.51	$0.00	$120.67	$120.67	$0.00	$102.00	$161.57	$163.20	$0.00		$0.00	$31.93	$0.00	$0.00	$32.48	$0.00	$0.00	$0.00	$0.00	$0.00
G47734	SUP	HCPCS C1769		G47734  -  GUIDEWIRE VASC .014IN 300CM APRCH SHP TIP KINK RST MNVBL LNR	BOTH IP/OP	$204.00 	$150.96	$0.00	$163.20	$110.77	$110.77	$0.00	$0.00	$0.00	$42.52	$151.41	$151.41	$0.00	$0.00	$42.51	$0.00	$120.67	$120.67	$0.00	$102.00	$161.57	$163.20	$0.00		$0.00	$31.93	$0.00	$0.00	$32.48	$0.00	$0.00	$0.00	$0.00	$0.00
G47804	SUP	HCPCS C1729		G47804  -  GRAFT SFT TIS LG SURGISIS BIODESIGN STRTH FLXB RST TO INFCT	BOTH IP/OP	$244.20 	$180.71	$0.00	$195.36	$132.60	$132.60	$0.00	$0.00	$0.00	$50.90	$181.25	$181.25	$0.00	$0.00	$50.89	$0.00	$144.44	$144.44	$0.00	$122.10	$193.41	$195.36	$0.00		$0.00	$38.22	$0.00	$0.00	$38.88	$0.00	$0.00	$0.00	$0.00	$0.00
G47805	SUP	HCPCS C1729		G47805  -  SET CATH CRC NPHSTM SPBC	BOTH IP/OP	$244.20 	$180.71	$0.00	$195.36	$132.60	$132.60	$0.00	$0.00	$0.00	$50.90	$181.25	$181.25	$0.00	$0.00	$50.89	$0.00	$144.44	$144.44	$0.00	$122.10	$193.41	$195.36	$0.00		$0.00	$38.22	$0.00	$0.00	$38.88	$0.00	$0.00	$0.00	$0.00	$0.00
G47806	SUP	HCPCS C1729		G47806  -  SET CATH CRC NPHSTM SPBC	BOTH IP/OP	$244.20 	$180.71	$0.00	$195.36	$132.60	$132.60	$0.00	$0.00	$0.00	$50.90	$181.25	$181.25	$0.00	$0.00	$50.89	$0.00	$144.44	$144.44	$0.00	$122.10	$193.41	$195.36	$0.00		$0.00	$38.22	$0.00	$0.00	$38.88	$0.00	$0.00	$0.00	$0.00	$0.00
G47833	SUP	HCPCS C1769		G47833  -  TRAY CENTRAL LINE INSERTION WITH BIOPATCH	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$378.74	$378.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$109.16	$0.00	$0.00	$111.04	$0.00	$0.00	$0.00	$0.00	$0.00
G47858	SUP	Custom 27203010		G47858  -  SET CATH CRC NPHSTM SPBC	BOTH IP/OP	"$1,034.00 "	$765.16	$0.00	$827.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$767.43	$767.43	$0.00	$0.00	$215.49	$0.00	$0.00	$0.00	$0.00	$517.00	$818.93	$827.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47859	SUP	Custom 27203010		G47859  -  NEEDLE BX 18GA 20CM PAT HUB ECHGN TIP SMPL NTCH PRCS PSTN	BOTH IP/OP	$51.70 	$38.26	$0.00	$41.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.37	$38.37	$0.00	$0.00	$10.77	$0.00	$0.00	$0.00	$0.00	$25.85	$40.95	$41.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47868	SUP	HCPCS C1770		G47868  -  COIL EMBL MREYE STRT KIT VRSTL MCIOL PLTN STRL DISP	BOTH IP/OP	"$8,750.00 "	"$6,475.00"	$0.00	"$7,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,823.50"	$0.00	$0.00	$0.00	$0.00	"$4,375.00"	"$6,930.00"	"$7,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G47942	SUP	HCPCS C1894		G47942  -  SET INTROD .018IN 4FR 21GA 40CM 10CM SILHOUETTE	BOTH IP/OP	$106.58 	$78.87	$0.00	$84.00	$57.02	$57.02	$0.00	$0.00	$0.00	$22.21	$79.10	$79.10	$0.00	$0.00	$22.21	$0.00	$63.04	$63.04	$0.00	$52.50	$83.16	$84.00	$0.00		$0.00	$16.43	$0.00	$0.00	$16.72	$0.00	$0.00	$0.00	$0.00	$0.00
G48003	SUP	HCPCS C1894		G48003  -  SET INTROD .018IN 4FR 40CM 10CM TRANSITIONLESS STIFFENED	BOTH IP/OP	$172.55 	$127.69	$0.00	$136.00	$92.31	$92.31	$0.00	$0.00	$0.00	$35.96	$128.07	$128.07	$0.00	$0.00	$35.96	$0.00	$102.06	$102.06	$0.00	$85.00	$134.64	$136.00	$0.00		$0.00	$26.61	$0.00	$0.00	$27.06	$0.00	$0.00	$0.00	$0.00	$0.00
G48007	SUP	HCPCS C1894		G48007  -  INTRODUCER SHTH 5FR 10CM 40CM TRNSTLS STF MPNCH NTNL .018IN	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$47.51	$47.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$13.69	$0.00	$0.00	$13.93	$0.00	$0.00	$0.00	$0.00	$0.00
G48008	SUP	HCPCS C1894		G48008  -  SET INTROD .018IN 5FR 21GA 40CM 10CM COAXIAL CATHETER GWIRE	BOTH IP/OP	$175.09 	$129.57	$0.00	$138.00	$93.67	$93.67	$0.00	$0.00	$0.00	$36.49	$129.95	$129.95	$0.00	$0.00	$36.49	$0.00	$103.56	$103.56	$0.00	$86.25	$136.62	$138.00	$0.00		$0.00	$27.00	$0.00	$0.00	$27.46	$0.00	$0.00	$0.00	$0.00	$0.00
G48031	SUP	HCPCS C1876		G48031  -  STENT ESOPHAGEAL 20MM 25MM 10CM 8MM PARTIALLY COVERED	BOTH IP/OP	"$4,705.00 "	"$3,481.70"	$0.00	"$3,764.00"	"$2,117.25"	"$2,117.25"	$0.00	$0.00	$0.00	$980.64	"$3,492.05"	"$3,492.05"	$0.00	$0.00	$980.52	$0.00	"$2,319.57"	"$2,319.57"	$0.00	"$2,352.50"	"$3,726.36"	"$3,764.00"	$0.00		$0.00	$736.33	$0.00	$0.00	$749.04	$0.00	$0.00	$0.00	$0.00	$0.00
G48186	SUP	HCPCS C1894		G48186  -  SHEATH GUID .018-.035IN ANL0 CURVE 4FR 1.5IN 45CM RADIOPQ	BOTH IP/OP	$202.50 	$149.85	$0.00	$156.00	$105.89	$105.89	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$97.50	$154.44	$156.00	$0.00		$0.00	$30.52	$0.00	$0.00	$31.04	$0.00	$0.00	$0.00	$0.00	$0.00
G48188	SUP	HCPCS C1894		G48188  -  SHEATH GUID .018/.035IN ANL0 CURVE 4FR .059IN 90CM RADIOPQ	BOTH IP/OP	$392.60 	$290.52	$0.00	$302.00	$204.98	$204.98	$0.00	$0.00	$0.00	$81.83	$291.39	$291.39	$0.00	$0.00	$81.82	$0.00	$232.22	$232.22	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$59.08	$0.00	$0.00	$60.10	$0.00	$0.00	$0.00	$0.00	$0.00
G48189	SUP	HCPCS C1894		G48189  -  SHEATH GUID ANL0 CURVE STR 5FR .074IN 90CM CHK-FLO VALVE	BOTH IP/OP	$392.60 	$290.52	$0.00	$302.00	$204.98	$204.98	$0.00	$0.00	$0.00	$81.83	$291.39	$291.39	$0.00	$0.00	$81.82	$0.00	$232.22	$232.22	$0.00	$188.75	$298.98	$302.00	$0.00		$0.00	$59.08	$0.00	$0.00	$60.10	$0.00	$0.00	$0.00	$0.00	$0.00
G48240	SUP	Custom 27203010		G48240  -  FORCEPS BIOP 2.4FR 115CM 1 BITE COLLECT BACKLOAD BIGOPSY	BOTH IP/OP	$880.00 	$651.20	$0.00	$704.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$653.14	$653.14	$0.00	$0.00	$183.39	$0.00	$0.00	$0.00	$0.00	$440.00	$696.96	$704.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48294	SUP	Custom 27203010		G48294  -  EXTRACTOR STONE 1.7FR 8MM 115CM PATENTED NGAGE NITINOL	BOTH IP/OP	$515.33 	$381.34	$0.00	$412.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.47	$382.47	$0.00	$0.00	$107.39	$0.00	$0.00	$0.00	$0.00	$257.66	$408.14	$412.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48295	SUP	Custom 27203010		G48295  -  NEEDLE BX 20GA 20CM PAT HUB ECHGN TIP SMPL NTCH PRCS PSTN	BOTH IP/OP	$25.77 	$19.07	$0.00	$20.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.12	$19.12	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$12.88	$20.41	$20.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48296	SUP	Custom 27203010		G48296  -  SET NPHSTM 10MM 30FR 15CM CLR 17CM ULTRX RADOPQ STRP BLN	BOTH IP/OP	$515.33 	$381.34	$0.00	$412.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.47	$382.47	$0.00	$0.00	$107.39	$0.00	$0.00	$0.00	$0.00	$257.66	$408.14	$412.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48297	SUP	Custom 27203010		G48297  -  EXTRACTOR STONE 2.2FR 8MM 115CM NGAGE NITINOL KIDNEY URETER	BOTH IP/OP	$515.33 	$381.34	$0.00	$412.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.47	$382.47	$0.00	$0.00	$107.39	$0.00	$0.00	$0.00	$0.00	$257.66	$408.14	$412.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48373	SUP	HCPCS C1880		G48373  -  FILTER EMBOLIZATION 30MM 8.5FR 48MM 65CM 3 WAY STOPCOCK	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$573.17	"$2,041.05"	"$2,041.05"	$0.00	$0.00	$573.10	$0.00	"$1,355.75"	"$1,355.75"	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
G48402	SUP	HCPCS C1874		G48402  -  GRAFT EVAS 2 BRCH 22MM 18FR 82MM STRL Z-TRK ZNTH FLX SLF	BOTH IP/OP	"$21,145.00 "	"$15,647.30"	$0.00	"$16,916.00"	"$9,515.25"	"$9,515.25"	$0.00	$0.00	$0.00	"$4,407.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,406.62"	$0.00	"$10,424.49"	"$10,424.49"	$0.00	"$10,572.50"	"$16,746.84"	"$16,916.00"	$0.00		$0.00	"$3,309.19"	$0.00	$0.00	"$3,366.28"	$0.00	$0.00	$0.00	$0.00	$0.00
G48422	SUP	HCPCS C1874		G48422  -  GRAFT EVAS BFUR 30MM 7.7MM 20FR 82MM ZNTH FLX Z-TRK SLF XPD	BOTH IP/OP	"$21,145.00 "	"$15,647.30"	$0.00	"$16,916.00"	"$9,515.25"	"$9,515.25"	$0.00	$0.00	$0.00	"$4,407.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,406.62"	$0.00	"$10,424.49"	"$10,424.49"	$0.00	"$10,572.50"	"$16,746.84"	"$16,916.00"	$0.00		$0.00	"$3,309.19"	$0.00	$0.00	"$3,366.28"	$0.00	$0.00	$0.00	$0.00	$0.00
G48424	SUP	Custom 27803010		G48424  -  GRAFT EVAS 2 BRCH 30MM 20FR 111MM ZNTH FLX Z-TRK SLF	BOTH IP/OP	"$21,145.00 "	"$15,647.30"	$0.00	"$16,916.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,406.62"	$0.00	$0.00	$0.00	$0.00	"$10,572.50"	"$16,746.84"	"$16,916.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48429	SUP	HCPCS C1874		G48429  -  GRAFT EVAS 2 BRCH 32MM 20FR 111MM ZNTH FLX Z-TRK SLF	BOTH IP/OP	"$21,145.00 "	"$15,647.30"	$0.00	"$16,916.00"	"$9,515.25"	"$9,515.25"	$0.00	$0.00	$0.00	"$4,407.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,406.62"	$0.00	"$10,424.49"	"$10,424.49"	$0.00	"$10,572.50"	"$16,746.84"	"$16,916.00"	$0.00		$0.00	"$3,309.19"	$0.00	$0.00	"$3,366.28"	$0.00	$0.00	$0.00	$0.00	$0.00
G48431	SUP	HCPCS C1874		G48431  -  GRAFT EVAS BFUR 32MM 20FR 140MM ZNTH FLX Z-TRK SLF XPD WVN	BOTH IP/OP	"$21,145.00 "	"$15,647.30"	$0.00	"$16,916.00"	"$9,515.25"	"$9,515.25"	$0.00	$0.00	$0.00	"$4,407.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,406.62"	$0.00	"$10,424.49"	"$10,424.49"	$0.00	"$10,572.50"	"$16,746.84"	"$16,916.00"	$0.00		$0.00	"$3,309.19"	$0.00	$0.00	"$3,366.28"	$0.00	$0.00	$0.00	$0.00	$0.00
G48522	SUP	Custom 27203010		G48522  -  EXTRACTOR STON 1.7FR 11MM 115CM NGAGE NTNL KNDY URETER	BOTH IP/OP	"$1,615.00 "	"$1,195.10"	$0.00	"$1,292.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,198.65"	"$1,198.65"	$0.00	$0.00	$336.57	$0.00	$0.00	$0.00	$0.00	$807.50	"$1,279.08"	"$1,292.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48526	SUP	Custom 27203010		G48526  -  FIBER LSR 273UM GRN OPTILITE FLT TIP CNCT HO REUSE STD SMA	BOTH IP/OP	"$2,329.80 "	"$1,724.05"	$0.00	"$1,863.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,729.18"	"$1,729.18"	$0.00	$0.00	$485.53	$0.00	$0.00	$0.00	$0.00	"$1,164.90"	"$1,845.20"	"$1,863.84"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48611	SUP	Custom 27203010		G48611  -  FIBER LSR 273UM FLT BLK OPTILITE CNCT HO DISP STD SMA CNCT	BOTH IP/OP	$538.33 	$398.36	$0.00	$430.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$399.55	$399.55	$0.00	$0.00	$112.19	$0.00	$0.00	$0.00	$0.00	$269.17	$426.36	$430.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48612	SUP	Custom 27203010		G48612  -  FIBER LSR 273UM GRN OPTILITE FLT TIP CNCT HO REUSE CNVGNT	BOTH IP/OP	"$4,735.50 "	"$3,504.27"	$0.00	"$3,788.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,514.69"	"$3,514.69"	$0.00	$0.00	$986.88	$0.00	$0.00	$0.00	$0.00	"$2,367.75"	"$3,750.52"	"$3,788.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48613	SUP	Custom 27203010		G48613  -  FIBER LSR 940UM BLK OPTILITE FLT TIP CNCT HO DISP STD SMA	BOTH IP/OP	$336.46 	$248.98	$0.00	$269.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.72	$249.72	$0.00	$0.00	$70.12	$0.00	$0.00	$0.00	$0.00	$168.23	$266.48	$269.17	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48614	SUP	Custom 27203010		G48614  -  FIBER LSR 365UM BLU OPTILITE FLT TIP CNCT HO REUSE CNVGNT	BOTH IP/OP	"$2,367.30 "	"$1,751.80"	$0.00	"$1,893.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.01"	"$1,757.01"	$0.00	$0.00	$493.35	$0.00	$0.00	$0.00	$0.00	"$1,183.65"	"$1,874.90"	"$1,893.84"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48615	SUP	Custom 27203010		G48615  -  FIBER LSR 273UM RD OPTILITE FLT TIP CNCT HO DISP CNVGNT LSR	BOTH IP/OP	$389.58 	$288.29	$0.00	$311.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.15	$289.15	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$194.79	$308.55	$311.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48616	SUP	Custom 27203010		G48616  -  FIBER LSR 550UM VIOL OPTILITE FLT TIP CNCT HO REUSE CNVGNT	BOTH IP/OP	"$2,152.50 "	"$1,592.85"	$0.00	"$1,722.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,597.59"	"$1,597.59"	$0.00	$0.00	$448.58	$0.00	$0.00	$0.00	$0.00	"$1,076.25"	"$1,704.78"	"$1,722.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48617	SUP	Custom 27203010		G48617  -  FIBER LSR 365UM FLT RD OPTILITE CNCT HO DISP CNVGNT LSR SYS	BOTH IP/OP	$743.75 	$550.38	$0.00	$595.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$552.01	$552.01	$0.00	$0.00	$155.00	$0.00	$0.00	$0.00	$0.00	$371.88	$589.05	$595.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48618	SUP	Custom 27203010		G48618  -  FIBER LSR 940UM ORNG OPTILITE FLT TIP CNCT HO REUSE CNVGNT	BOTH IP/OP	"$1,009.38 "	$746.94	$0.00	$807.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$749.16	$749.16	$0.00	$0.00	$210.35	$0.00	$0.00	$0.00	$0.00	$504.69	$799.43	$807.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48619	SUP	Custom 27203010		G48619  -  FIBER LSR 365UM FLT BLU OPTILITE FLXB CNCT HO REUSE STD SMA	BOTH IP/OP	"$1,168.75 "	$864.88	$0.00	$935.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$867.45	$867.45	$0.00	$0.00	$243.57	$0.00	$0.00	$0.00	$0.00	$584.38	$925.65	$935.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48620	SUP	Custom 27203010		G48620  -  FIBER LSR 550UM RD OPTILITE FLT TIP CNCT HO REUSE STD SMA	BOTH IP/OP	"$2,859.75 "	"$2,116.22"	$0.00	"$2,287.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,122.51"	"$2,122.51"	$0.00	$0.00	$595.97	$0.00	$0.00	$0.00	$0.00	"$1,429.88"	"$2,264.92"	"$2,287.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48621	SUP	Custom 27203010		G48621  -  FIBER LSR 550UM FLT RD OPTILITE CNCT HO DISP CNVGNT LSR SYS	BOTH IP/OP	$743.75 	$550.38	$0.00	$595.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$552.01	$552.01	$0.00	$0.00	$155.00	$0.00	$0.00	$0.00	$0.00	$371.88	$589.05	$595.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48622	SUP	Custom 27203010		G48622  -  FIBER LSR 940UM ORNG OPTILITE FLT TIP CNCT HO REUSE STD SMA	BOTH IP/OP	"$4,735.50 "	"$3,504.27"	$0.00	"$3,788.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,514.69"	"$3,514.69"	$0.00	$0.00	$986.88	$0.00	$0.00	$0.00	$0.00	"$2,367.75"	"$3,750.52"	"$3,788.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48623	SUP	Custom 27203010		G48623  -  FIBER LSR 940UM FLT 940UM RD OPTILITE RD CNCT HO DISP CNVGNT	BOTH IP/OP	$891.75 	$659.90	$0.00	$713.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$661.86	$661.86	$0.00	$0.00	$185.84	$0.00	$0.00	$0.00	$0.00	$445.88	$706.27	$713.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48624	SUP	Custom 27203010		G48624  -  FIBER LSR 273UM BLK OPTILITE FLT TIP CNCT HO DISP TRMDN LSR	BOTH IP/OP	$973.75 	$720.58	$0.00	$779.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$722.72	$722.72	$0.00	$0.00	$202.93	$0.00	$0.00	$0.00	$0.00	$486.88	$771.21	$779.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48625	SUP	Custom 27203010		G48625  -  FIBER LSR 150UM BLK OPTILITE FLT TIP CNCT HO DISP STD SMA	BOTH IP/OP	$891.75 	$659.90	$0.00	$713.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$661.86	$661.86	$0.00	$0.00	$185.84	$0.00	$0.00	$0.00	$0.00	$445.88	$706.27	$713.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48626	SUP	Custom 27203010		G48626  -  FIBER LSR 200UM BLK OPTILITE FLT TIP CNCT HO DISP STD SMA	BOTH IP/OP	$717.50 	$530.95	$0.00	$574.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$532.53	$532.53	$0.00	$0.00	$149.53	$0.00	$0.00	$0.00	$0.00	$358.75	$568.26	$574.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G48627	SUP	Custom 27203010		G48627  -  FIBER LSR FLT 365UM BLK OPTILITE CNCT EXTREMELY FLXB HO DISP	BOTH IP/OP	$953.25 	$705.41	$0.00	$762.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$707.50	$707.50	$0.00	$0.00	$198.66	$0.00	$0.00	$0.00	$0.00	$476.63	$754.97	$762.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G49044	SUP	HCPCS C1894		G49044  -  INTRODUCER SHEATH .035IN ANL1 CURVE 8.8FR 7FR 110CM GUIDE	BOTH IP/OP	$502.50 	$371.85	$0.00	$402.00	$272.86	$272.86	$0.00	$0.00	$0.00	$104.73	$372.96	$372.96	$0.00	$0.00	$104.72	$0.00	$297.23	$297.23	$0.00	$251.25	$397.98	$402.00	$0.00		$0.00	$78.64	$0.00	$0.00	$80.00	$0.00	$0.00	$0.00	$0.00	$0.00
G49099	SUP	HCPCS C1894		G49099  -  SHEATH GUID .018/.038IN ANL0 CURVE 8FR .113IN 45CM RADIOPQ	BOTH IP/OP	$202.50 	$149.85	$0.00	$150.30	$101.81	$101.81	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49100	SUP	HCPCS C1894		G49100  -  INTRODUCER CATHETER .018/.038IN ANL1 CURVE 8FR .113IN 45CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$150.30	$101.81	$101.81	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49257	SUP	Custom 27203010		G49257  -  NEEDLE ESCP 20GA 6FR 8- CM STRL ECHTP ULT US CONE TIP SH CLC	BOTH IP/OP	$697.50 	$516.15	$0.00	$558.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$517.68	$517.68	$0.00	$0.00	$145.36	$0.00	$0.00	$0.00	$0.00	$348.75	$552.42	$558.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G49333	SUP	HCPCS C1877		G49333  -  STENT VASC 10MM 5FR 80MM 125CM .018IN SLF XPD FLXB FLXR	BOTH IP/OP	"$3,062.50 "	"$2,266.25"	$0.00	"$2,450.00"	"$1,378.13"	"$1,378.13"	$0.00	$0.00	$0.00	$638.30	"$2,272.99"	"$2,272.99"	$0.00	$0.00	$638.23	$0.00	"$1,509.81"	"$1,509.81"	$0.00	"$1,531.25"	"$2,425.50"	"$2,450.00"	$0.00		$0.00	$479.28	$0.00	$0.00	$487.55	$0.00	$0.00	$0.00	$0.00	$0.00
G49472	SUP	HCPCS C1892		G49472  -  SET INTROD .018IN LONG 5FR 70CM 30CM COAXIAL CATHETER PEEL	BOTH IP/OP	$151.93 	$112.43	$0.00	$118.00	$80.09	$80.09	$0.00	$0.00	$0.00	$31.66	$112.76	$112.76	$0.00	$0.00	$31.66	$0.00	$89.86	$89.86	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$23.08	$0.00	$0.00	$23.48	$0.00	$0.00	$0.00	$0.00	$0.00
G49473	SUP	HCPCS C1894		G49473  -  SET INTROD .018IN LONG 5FR 21GA 100CM 45CM NEEDLE WIRE GUIDE	BOTH IP/OP	$151.93 	$112.43	$0.00	$118.00	$80.09	$80.09	$0.00	$0.00	$0.00	$31.66	$112.76	$112.76	$0.00	$0.00	$31.66	$0.00	$89.86	$89.86	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$23.08	$0.00	$0.00	$23.48	$0.00	$0.00	$0.00	$0.00	$0.00
G49620	SUP	Custom 27203010		G49620  -  FIBER LSR 550UM FLT BLK OPTILITE CNCT HO DISP STD SMA CNCT	BOTH IP/OP	$154.07 	$114.01	$0.00	$123.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.35	$114.35	$0.00	$0.00	$32.11	$0.00	$0.00	$0.00	$0.00	$77.03	$122.02	$123.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G49762	SUP	HCPCS C2617		G49762  -  MICROSCOPE SRG NS INSP FO SAFE EFCT CMPLT	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49862	SUP	HCPCS C2617		G49862  -  SET STNT .038IN 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49863	SUP	HCPCS C2617		G49863  -  SET STNT .038IN 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49864	SUP	HCPCS C2617		G49864  -  SET STNT .038IN 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49865	SUP	HCPCS C2617		G49865  -  SET STNT .038IN 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49866	SUP	HCPCS C2617		G49866  -  SET STNT .038IN 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49867	SUP	HCPCS C2617		G49867  -  SET STNT .038IN 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49868	SUP	HCPCS C2617		G49868  -  SET STNT .038IN 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49869	SUP	HCPCS C2617		G49869  -  SET STNT .038IN 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49870	SUP	HCPCS C2617		G49870  -  SET STNT .038IN 2 PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49871	SUP	HCPCS C2617		G49871  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49872	SUP	HCPCS C2617		G49872  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49873	SUP	HCPCS C2617		G49873  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49874	SUP	HCPCS C2617		G49874  -  SET STENT .038IN 3CM 2 PIGTAIL CURVE 6FR 26CM 145CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49875	SUP	HCPCS C2617		G49875  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49876	SUP	HCPCS C2617		G49876  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49877	SUP	HCPCS C2617		G49877  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49878	SUP	HCPCS C2617		G49878  -  SET STNT 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49879	SUP	HCPCS C2617		G49879  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49880	SUP	HCPCS C2617		G49880  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49881	SUP	HCPCS C2617		G49881  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49882	SUP	HCPCS C2617		G49882  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49883	SUP	HCPCS C2617		G49883  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49884	SUP	HCPCS C2617		G49884  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49885	SUP	HCPCS C2617		G49885  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49886	SUP	HCPCS C2617		G49886  -  SET STNT 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49887	SUP	HCPCS C2617		G49887  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49888	SUP	HCPCS C2617		G49888  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49889	SUP	HCPCS C2617		G49889  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49890	SUP	HCPCS C2617		G49890  -  SET STNT 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA FIRM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49891	SUP	HCPCS C2617		G49891  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49892	SUP	HCPCS C2617		G49892  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49893	SUP	HCPCS C2617		G49893  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49894	SUP	HCPCS C2617		G49894  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49895	SUP	HCPCS C2625		G49895  -  SET STENT 2 PIGTAIL CURVE 5FR 20CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49896	SUP	HCPCS C2625		G49896  -  SET STENT 2 PIGTAIL CURVE 5FR 22CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49897	SUP	HCPCS C2625		G49897  -  SET STENT 2 PIGTAIL CURVE 5FR 24CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49898	SUP	HCPCS C2625		G49898  -  SET STENT 2 PIGTAIL CURVE 5FR 26CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49899	SUP	HCPCS C2625		G49899  -  SET STENT 2 PIGTAIL CURVE 5FR 28CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49900	SUP	HCPCS C2617		G49900  -  SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49901	SUP	HCPCS C2617		G49901  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49902	SUP	HCPCS C2617		G49902  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49903	SUP	HCPCS C2625		G49903  -  SET STENT 2 PIGTAIL CURVE 6FR 20CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49904	SUP	HCPCS C2625		G49904  -  SET STENT 2 PIGTAIL CURVE 6FR 22CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49906	SUP	HCPCS C2625		G49906  -  STENT URETERAL 6FR 26CM POSITIONER BRAID TETHER STRAIGHTENER	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49907	SUP	HCPCS C2625		G49907  -  STENT URETERAL 6FR 28CM POSITIONER SET BRAID TETHER RADIOPQ	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49908	SUP	HCPCS C2617		G49908  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49909	SUP	HCPCS C2617		G49909  -  SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49910	SUP	HCPCS C2617		G49910  -  STENT URET 6FR 22-32CM UNIVERSA PSTNR SET BRD TETH RADOPQ	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49911	SUP	HCPCS C2617		G49911  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49912	SUP	HCPCS C2625		G49912  -  SET STENT 2 PIGTAIL CURVE 7FR 22CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49913	SUP	HCPCS C2625		G49913  -  SET STENT PIGTAIL 7FR 24CM RADIOPQ TIP STRAIGHTENER	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49914	SUP	HCPCS C2625		G49914  -  SET STENT PIGTAIL 7FR 26CM RADIOPQ TIP STRAIGHTENER	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49915	SUP	HCPCS C2625		G49915  -  SET STENT 2 PIGTAIL CURVE 7FR 28CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49916	SUP	HCPCS C2617		G49916  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49917	SUP	HCPCS C2617		G49917  -  STENT URET 2 PGTL CRV 7FR 30CM UNIVERSA FIRM GRAD MRK RADOPQ	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49918	SUP	HCPCS C2617		G49918  -  SET STNT PGTL 7FR 22-32CM STRL UNIVERSA RADOPQ TIP	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49919	SUP	HCPCS C2617		G49919  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49920	SUP	HCPCS C2625		G49920  -  SET STENT 2 PIGTAIL CURVE 8FR 22CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49921	SUP	HCPCS C2625		G49921  -  SET STENT 2 PIGTAIL CURVE 8FR 24CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49922	SUP	HCPCS C2625		G49922  -  SET STENT 2 PIGTAIL CURVE 8FR 26CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49923	SUP	HCPCS C2625		G49923  -  SET STENT 2 PIGTAIL CURVE 8FR 28CM RADIOPQ GRADUATE MARK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49924	SUP	HCPCS C2617		G49924  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49925	SUP	HCPCS C2617		G49925  -  SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49931	SUP	HCPCS C2617		G49931  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49932	SUP	HCPCS C2617		G49932  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49933	SUP	HCPCS C2617		G49933  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49934	SUP	HCPCS C2617		G49934  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49935	SUP	HCPCS C2617		G49935  -  SET STNT .038IN 2 PGTL CRV 3CM 5FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49936	SUP	HCPCS C2617		G49936  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49937	SUP	HCPCS C2617		G49937  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49938	SUP	HCPCS C2617		G49938  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49939	SUP	HCPCS C2617		G49939  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49940	SUP	HCPCS C2617		G49940  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49941	SUP	HCPCS C2617		G49941  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49942	SUP	HCPCS C2617		G49942  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49943	SUP	HCPCS C2617		G49943  -  SET STNT .038IN 3CM PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49944	SUP	HCPCS C2617		G49944  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49945	SUP	HCPCS C2617		G49945  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49946	SUP	HCPCS C2617		G49946  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49947	SUP	HCPCS C2617		G49947  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49948	SUP	HCPCS C2617		G49948  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49949	SUP	HCPCS C2617		G49949  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49950	SUP	HCPCS C2617		G49950  -  SET STNT 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA SFT	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49951	SUP	HCPCS C2617		G49951  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49952	SUP	HCPCS C2617		G49952  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49953	SUP	HCPCS C2617		G49953  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49954	SUP	HCPCS C2617		G49954  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49955	SUP	HCPCS C2617		G49955  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49956	SUP	HCPCS C2617		G49956  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49957	SUP	HCPCS C2617		G49957  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49958	SUP	HCPCS C2617		G49958  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49959	SUP	HCPCS C2617		G49959  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49960	SUP	HCPCS C2617		G49960  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49961	SUP	HCPCS C2617		G49961  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G49962	SUP	HCPCS C2617		G49962  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49963	SUP	HCPCS C2617		G49963  -  SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49964	SUP	HCPCS C2617		G49964  -  SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49965	SUP	HCPCS C2617		G49965  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49966	SUP	HCPCS C2617		G49966  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49967	SUP	HCPCS C2617		G49967  -  SET STNT 2 PGTL CRV 5FR 26CM UNIVERSA SFT GRAD MRK RADOPQ	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49968	SUP	HCPCS C2617		G49968  -  SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49969	SUP	HCPCS C2617		G49969  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49970	SUP	HCPCS C2617		G49970  -  STENT URET 2 PGTL CRV 5FR 30CM UNIVERSA SFT GRAD MRK RADOPQ	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49971	SUP	HCPCS C2617		G49971  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49972	SUP	HCPCS C2617		G49972  -  SET STNT PGTL 6FR 20CM STRL UNIVERSA RADOPQ TIP PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49973	SUP	HCPCS C2617		G49973  -  SET STNT PGTL 6FR 22CM STRL UNIVERSA RADOPQ TIP PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49974	SUP	HCPCS C2617		G49974  -  SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49975	SUP	HCPCS C2617		G49975  -  SET STNT 2 PGTL CRV 6FR 26CM STRL UNIVERSA RADOPQ PSTNR BRD	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49976	SUP	HCPCS C2617		G49976  -  SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49977	SUP	HCPCS C2617		G49977  -  STENT URET 2 PGTL CRV 6FR 30CM UNIVERSA SFT GRAD MRK RADOPQ	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49978	SUP	HCPCS C2617		G49978  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49979	SUP	HCPCS C2617		G49979  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49980	SUP	HCPCS C2617		G49980  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49981	SUP	HCPCS C2617		G49981  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49982	SUP	HCPCS C2617		G49982  -  SET STNT 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49983	SUP	HCPCS C2617		G49983  -  SET STNT 2 PGTL CRV 7FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49984	SUP	HCPCS C2617		G49984  -  SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49985	SUP	HCPCS C2617		G49985  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49986	SUP	HCPCS C2617		G49986  -  SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49987	SUP	HCPCS C2617		G49987  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49988	SUP	HCPCS C2617		G49988  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49989	SUP	HCPCS C2617		G49989  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49990	SUP	HCPCS C2617		G49990  -  SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49991	SUP	HCPCS C2617		G49991  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49992	SUP	HCPCS C2617		G49992  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G49993	SUP	HCPCS C2617		G49993  -  SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G50001	SUP	HCPCS C1887		G50001  -  CATHETER GUID .018IN 2.6FR 150CM DEPTH MARKER RADIOPQ	BOTH IP/OP	$545.56 	$403.71	$0.00	$404.92	$264.71	$264.71	$0.00	$0.00	$0.00	$113.71	$404.92	$404.92	$0.00	$0.00	$113.70	$0.00	$322.70	$322.70	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
G50003	SUP	HCPCS C1887		G50003  -  CATHETER GUID 2.6FR 150CM BRAID KINK RESISTANT RADIOPQ	BOTH IP/OP	$545.56 	$403.71	$0.00	$404.92	$264.71	$264.71	$0.00	$0.00	$0.00	$113.71	$404.92	$404.92	$0.00	$0.00	$113.70	$0.00	$322.70	$322.70	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
G50010	SUP	Custom 27203010		G50010  -  FIBER LSR 550UM NS STRP TL	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.11	$204.11	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G50122	SUP	HCPCS C1876		G50122  -  STENT BIL 6MM 6FR 140MM 80CM .035IN SLF EXPANDABLE DLV SYS	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	"$1,456.88"	"$1,456.88"	$0.00	$0.00	$0.00	$674.78	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	"$1,596.09"	"$1,596.09"	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$506.67	$0.00	$0.00	$515.41	$0.00	$0.00	$0.00	$0.00	$0.00
G50131	SUP	HCPCS C1876		G50131  -  STENT BIL 7MM 6FR 140MM 80CM .035IN SLF EXPANDABLE DLV SYS	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	"$1,456.88"	"$1,456.88"	$0.00	$0.00	$0.00	$674.78	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	"$1,596.09"	"$1,596.09"	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$506.67	$0.00	$0.00	$515.41	$0.00	$0.00	$0.00	$0.00	$0.00
G50168	SUP	HCPCS C1876		G50168  -  STENT BIL 7MM 6FR 100MM 125CM .035IN SLF EXPANDABLE DLV SYS	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	"$1,456.88"	"$1,456.88"	$0.00	$0.00	$0.00	$674.78	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	"$1,596.09"	"$1,596.09"	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$506.67	$0.00	$0.00	$515.41	$0.00	$0.00	$0.00	$0.00	$0.00
G50171	SUP	HCPCS C1876		G50171  -  STENT BIL 8MM 6FR 100MM 125CM .035IN SLF EXPANDABLE DLV SYS	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	"$1,456.88"	"$1,456.88"	$0.00	$0.00	$0.00	$674.78	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	"$1,596.09"	"$1,596.09"	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$506.67	$0.00	$0.00	$515.41	$0.00	$0.00	$0.00	$0.00	$0.00
G50214	SUP	Custom 27203010		G50214  -  GLASSES SF NS HO LSR	BOTH IP/OP	$95.70 	$70.82	$0.00	$76.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.03	$71.03	$0.00	$0.00	$19.94	$0.00	$0.00	$0.00	$0.00	$47.85	$75.79	$76.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G50319	SUP	HCPCS C1725		G50319  -  CATHETER BLNDIL 2MM 170CM STRL LF 20CM ADV LOPRFL KINK RST	BOTH IP/OP	"$1,351.50 "	"$1,000.11"	$0.00	"$1,081.20"	$733.86	$733.86	$0.00	$0.00	$0.00	$281.69	"$1,003.08"	"$1,003.08"	$0.00	$0.00	$281.65	$0.00	$799.41	$799.41	$0.00	$675.75	"$1,070.39"	"$1,081.20"	$0.00		$0.00	$211.51	$0.00	$0.00	$215.16	$0.00	$0.00	$0.00	$0.00	$0.00
G50333	SUP	HCPCS C1725		G50333  -  CATHETER BLNDIL 3MM 170CM STRL LF 20CM ADV LOPRFL KINK RST	BOTH IP/OP	"$1,351.50 "	"$1,000.11"	$0.00	"$1,081.20"	$733.86	$733.86	$0.00	$0.00	$0.00	$281.69	"$1,003.08"	"$1,003.08"	$0.00	$0.00	$281.65	$0.00	$799.41	$799.41	$0.00	$675.75	"$1,070.39"	"$1,081.20"	$0.00		$0.00	$211.51	$0.00	$0.00	$215.16	$0.00	$0.00	$0.00	$0.00	$0.00
G50337	SUP	HCPCS C1725		G50337  -  CATHETER BLNDIL 4MM 170CM STRL LF 8CM ADV LOPRFL KINK RST	BOTH IP/OP	"$1,351.50 "	"$1,000.11"	$0.00	"$1,081.20"	$733.86	$733.86	$0.00	$0.00	$0.00	$281.69	"$1,003.08"	"$1,003.08"	$0.00	$0.00	$281.65	$0.00	$799.41	$799.41	$0.00	$675.75	"$1,070.39"	"$1,081.20"	$0.00		$0.00	$211.51	$0.00	$0.00	$215.16	$0.00	$0.00	$0.00	$0.00	$0.00
G50686	SUP	HCPCS C1880		G50686  -  SYSTEM EMBOLIC PROTECTION .038IN 12FR 40MM 11FR 75CM GWIRE	BOTH IP/OP	"$3,953.13 "	"$2,925.32"	$0.00	"$2,934.01"	"$1,546.88"	"$1,546.88"	$0.00	$0.00	$0.00	$823.93	"$2,934.01"	"$2,934.01"	$0.00	$0.00	$823.83	$0.00	"$1,948.89"	"$1,948.89"	$0.00	"$1,718.75"	"$2,722.50"	"$2,750.00"	$0.00		$0.00	$537.97	$0.00	$0.00	$547.25	$0.00	$0.00	$0.00	$0.00	$0.00
G50687	SUP	HCPCS C1880		G50687  -  SYSTEM EMBOLIC PROTECTION .038IN 12FR 40MM 11FR 45CM GWIRE	BOTH IP/OP	"$3,953.13 "	"$2,925.32"	$0.00	"$2,934.01"	"$1,546.88"	"$1,546.88"	$0.00	$0.00	$0.00	$823.93	"$2,934.01"	"$2,934.01"	$0.00	$0.00	$823.83	$0.00	"$1,948.89"	"$1,948.89"	$0.00	"$1,718.75"	"$2,722.50"	"$2,750.00"	$0.00		$0.00	$537.97	$0.00	$0.00	$547.25	$0.00	$0.00	$0.00	$0.00	$0.00
G50784	SUP	HCPCS C1769		G50784  -  GUIDEWIRE VASCULAR TAPER .014IN 135CM APPROACH STAINLESS	BOTH IP/OP	$416.88 	$308.49	$0.00	$333.50	$226.36	$226.36	$0.00	$0.00	$0.00	$86.89	$309.40	$309.40	$0.00	$0.00	$86.88	$0.00	$246.58	$246.58	$0.00	$208.44	$330.17	$333.50	$0.00		$0.00	$65.24	$0.00	$0.00	$66.37	$0.00	$0.00	$0.00	$0.00	$0.00
G50785	SUP	HCPCS C1769		G50785  -  GUIDEWIRE VASCULAR TAPER .014IN 135CM APPROACH STAINLESS	BOTH IP/OP	$416.88 	$308.49	$0.00	$333.50	$226.36	$226.36	$0.00	$0.00	$0.00	$86.89	$309.40	$309.40	$0.00	$0.00	$86.88	$0.00	$246.58	$246.58	$0.00	$208.44	$330.17	$333.50	$0.00		$0.00	$65.24	$0.00	$0.00	$66.37	$0.00	$0.00	$0.00	$0.00	$0.00
G50788	SUP	HCPCS C1769		G50788  -  GUIDEWIRE VASCULAR TAPER .014IN 190CM APPROACH STAINLESS	BOTH IP/OP	$423.13 	$313.12	$0.00	$333.50	$226.36	$226.36	$0.00	$0.00	$0.00	$88.19	$314.05	$314.05	$0.00	$0.00	$88.18	$0.00	$250.28	$250.28	$0.00	$208.44	$330.17	$333.50	$0.00		$0.00	$65.24	$0.00	$0.00	$66.37	$0.00	$0.00	$0.00	$0.00	$0.00
G50789	SUP	HCPCS C1769		G50789  -  GUIDEWIRE VASCULAR TAPER .014IN 190CM APPROACH STAINLESS	BOTH IP/OP	$423.13 	$313.12	$0.00	$333.50	$226.36	$226.36	$0.00	$0.00	$0.00	$88.19	$314.05	$314.05	$0.00	$0.00	$88.18	$0.00	$250.28	$250.28	$0.00	$208.44	$330.17	$333.50	$0.00		$0.00	$65.24	$0.00	$0.00	$66.37	$0.00	$0.00	$0.00	$0.00	$0.00
G50791	SUP	HCPCS C1769		G50791  -  GUIDEWIRE VASCULAR TAPER .014IN 300CM 12GM TIP LOAD APPROACH	BOTH IP/OP	$423.13 	$313.12	$0.00	$333.50	$226.36	$226.36	$0.00	$0.00	$0.00	$88.19	$314.05	$314.05	$0.00	$0.00	$88.18	$0.00	$250.28	$250.28	$0.00	$208.44	$330.17	$333.50	$0.00		$0.00	$65.24	$0.00	$0.00	$66.37	$0.00	$0.00	$0.00	$0.00	$0.00
G50792	SUP	HCPCS C1769		G50792  -  GUIDEWIRE VASCULAR TAPER .014IN 300CM 18GM TIP LOAD APPROACH	BOTH IP/OP	$423.13 	$313.12	$0.00	$333.50	$226.36	$226.36	$0.00	$0.00	$0.00	$88.19	$314.05	$314.05	$0.00	$0.00	$88.18	$0.00	$250.28	$250.28	$0.00	$208.44	$330.17	$333.50	$0.00		$0.00	$65.24	$0.00	$0.00	$66.37	$0.00	$0.00	$0.00	$0.00	$0.00
G50793	SUP	HCPCS C1769		G50793  -  GUIDEWIRE VASCULAR TAPER .014IN 300CM 25GM TIP LOAD APPROACH	BOTH IP/OP	$423.13 	$313.12	$0.00	$333.50	$226.36	$226.36	$0.00	$0.00	$0.00	$88.19	$314.05	$314.05	$0.00	$0.00	$88.18	$0.00	$250.28	$250.28	$0.00	$208.44	$330.17	$333.50	$0.00		$0.00	$65.24	$0.00	$0.00	$66.37	$0.00	$0.00	$0.00	$0.00	$0.00
G50972	SUP	HCPCS C1894		G50972  -  NEEDLE PRC SHTH TFE	BOTH IP/OP	"$5,118.75 "	"$3,787.88"	$0.00	"$4,095.00"	"$2,779.48"	"$2,779.48"	$0.00	$0.00	$0.00	"$1,066.88"	"$3,799.14"	"$3,799.14"	$0.00	$0.00	"$1,066.75"	$0.00	"$3,027.74"	"$3,027.74"	$0.00	"$2,559.38"	"$4,054.05"	"$4,095.00"	$0.00		$0.00	$801.08	$0.00	$0.00	$814.91	$0.00	$0.00	$0.00	$0.00	$0.00
G50973	SUP	HCPCS C1894		G50973  -  SHEATH ACC FLXR DFLC VSN URETER	BOTH IP/OP	"$1,023.75 "	$757.58	$0.00	$819.00	$555.90	$555.90	$0.00	$0.00	$0.00	$213.38	$759.83	$759.83	$0.00	$0.00	$213.35	$0.00	$605.55	$605.55	$0.00	$511.88	$810.81	$819.00	$0.00		$0.00	$160.22	$0.00	$0.00	$162.98	$0.00	$0.00	$0.00	$0.00	$0.00
G50974	SUP	HCPCS C1894		G50974  -  SHEATH ACC 180D FLXR DFLC VSN URETER	BOTH IP/OP	"$1,023.75 "	$757.58	$0.00	$819.00	$555.90	$555.90	$0.00	$0.00	$0.00	$213.38	$759.83	$759.83	$0.00	$0.00	$213.35	$0.00	$605.55	$605.55	$0.00	$511.88	$810.81	$819.00	$0.00		$0.00	$160.22	$0.00	$0.00	$162.98	$0.00	$0.00	$0.00	$0.00	$0.00
G51183	SUP	HCPCS C1874		G51183  -  STENT ESOPHAGEAL 23MM 18MM 12CM 2 LASSO LOOP CONTROL RELEASE	BOTH IP/OP	"$4,705.00 "	"$3,481.70"	$0.00	"$3,764.00"	"$2,117.25"	"$2,117.25"	$0.00	$0.00	$0.00	$980.64	"$3,492.05"	"$3,492.05"	$0.00	$0.00	$980.52	$0.00	"$2,319.57"	"$2,319.57"	$0.00	"$2,352.50"	"$3,726.36"	"$3,764.00"	$0.00		$0.00	$736.33	$0.00	$0.00	$749.04	$0.00	$0.00	$0.00	$0.00	$0.00
G51574	SUP	HCPCS C1887		G51574  -  CATHETER GUID .014IN 3-1.9FR 150CM SUPPORT CORSSCATH	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$196.84	$196.84	$0.00	$0.00	$0.00	$75.55	$269.05	$269.05	$0.00	$0.00	$75.55	$0.00	$214.42	$214.42	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$56.73	$0.00	$0.00	$57.71	$0.00	$0.00	$0.00	$0.00	$0.00
G51954	SUP	HCPCS C1769		G51954  -  GUIDEWIRE VASCULAR MICRO .018IN 190CM SHAPEABLE TIP APPROACH	BOTH IP/OP	$167.03 	$123.60	$0.00	$133.62	$90.69	$90.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.51	$132.29	$133.62	$0.00		$0.00	$26.14	$0.00	$0.00	$26.59	$0.00	$0.00	$0.00	$0.00	$0.00
G51956	SUP	HCPCS C1769		G51956  -  GUIDEWIRE VASCULAR MICRO .018IN 300CM SHAPEABLE TIP APPROACH	BOTH IP/OP	$218.68 	$161.82	$0.00	$174.94	$118.74	$118.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.34	$173.19	$174.94	$0.00		$0.00	$34.22	$0.00	$0.00	$34.81	$0.00	$0.00	$0.00	$0.00	$0.00
G52226	SUP	HCPCS C1874		G52226  -  STENT ESOPHAGEAL 25MM 20MM 12CM CONTROLLED RELEASE FULLY	BOTH IP/OP	"$4,705.00 "	"$3,481.70"	$0.00	"$3,764.00"	"$2,117.25"	"$2,117.25"	$0.00	$0.00	$0.00	$980.64	"$3,492.05"	"$3,492.05"	$0.00	$0.00	$980.52	$0.00	"$2,319.57"	"$2,319.57"	$0.00	"$2,352.50"	"$3,726.36"	"$3,764.00"	$0.00		$0.00	$736.33	$0.00	$0.00	$749.04	$0.00	$0.00	$0.00	$0.00	$0.00
G52247	SUP	HCPCS C1725		G52247  -  CATHETER BLNDIL 3MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL	BOTH IP/OP	$612.00 	$452.88	$0.00	$489.60	$332.32	$332.32	$0.00	$0.00	$0.00	$127.56	$454.23	$454.23	$0.00	$0.00	$127.54	$0.00	$362.00	$362.00	$0.00	$306.00	$484.70	$489.60	$0.00		$0.00	$95.78	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$0.00
G52249	SUP	HCPCS C1725		G52249  -  CATHETER BLNDIL 3MM 135CM STRL LF 12CM ADV 2 LUM LOPRFL	BOTH IP/OP	$612.00 	$452.88	$0.00	$489.60	$332.32	$332.32	$0.00	$0.00	$0.00	$127.56	$454.23	$454.23	$0.00	$0.00	$127.54	$0.00	$362.00	$362.00	$0.00	$306.00	$484.70	$489.60	$0.00		$0.00	$95.78	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$0.00
G52253	SUP	HCPCS C1725		G52253  -  CATHETER BLNDIL 4MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL	BOTH IP/OP	$612.00 	$452.88	$0.00	$489.60	$332.32	$332.32	$0.00	$0.00	$0.00	$127.56	$454.23	$454.23	$0.00	$0.00	$127.54	$0.00	$362.00	$362.00	$0.00	$306.00	$484.70	$489.60	$0.00		$0.00	$95.78	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$0.00
G52260	SUP	HCPCS C1725		G52260  -  CATHETER BLNDIL 5MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL	BOTH IP/OP	$612.00 	$452.88	$0.00	$489.60	$332.32	$332.32	$0.00	$0.00	$0.00	$127.56	$454.23	$454.23	$0.00	$0.00	$127.54	$0.00	$362.00	$362.00	$0.00	$306.00	$484.70	$489.60	$0.00		$0.00	$95.78	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$0.00
G52263	SUP	HCPCS C1725		G52263  -  CATHETER BLNDIL 5MM 135CM STRL LF 14CM ADV 2 LUM LOPRFL	BOTH IP/OP	$612.00 	$452.88	$0.00	$489.60	$332.32	$332.32	$0.00	$0.00	$0.00	$127.56	$454.23	$454.23	$0.00	$0.00	$127.54	$0.00	$362.00	$362.00	$0.00	$306.00	$484.70	$489.60	$0.00		$0.00	$95.78	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$0.00
G52267	SUP	HCPCS C1725		G52267  -  CATHETER BLNDIL 6MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL	BOTH IP/OP	$612.00 	$452.88	$0.00	$489.60	$332.32	$332.32	$0.00	$0.00	$0.00	$127.56	$454.23	$454.23	$0.00	$0.00	$127.54	$0.00	$362.00	$362.00	$0.00	$306.00	$484.70	$489.60	$0.00		$0.00	$95.78	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$0.00
G52270	SUP	HCPCS C1725		G52270  -  CATHETER BLNDIL 6MM 135CM STRL LF 14CM ADV 2 LUM LOPRFL	BOTH IP/OP	$612.00 	$452.88	$0.00	$489.60	$332.32	$332.32	$0.00	$0.00	$0.00	$127.56	$454.23	$454.23	$0.00	$0.00	$127.54	$0.00	$362.00	$362.00	$0.00	$306.00	$484.70	$489.60	$0.00		$0.00	$95.78	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$0.00
G52274	SUP	HCPCS C1725		G52274  -  CATHETER BLNDIL 7MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL	BOTH IP/OP	$612.00 	$452.88	$0.00	$489.60	$332.32	$332.32	$0.00	$0.00	$0.00	$127.56	$454.23	$454.23	$0.00	$0.00	$127.54	$0.00	$362.00	$362.00	$0.00	$306.00	$484.70	$489.60	$0.00		$0.00	$95.78	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$0.00
G52277	SUP	HCPCS C1725		G52277  -  CATHETER BLNDIL 7MM 135CM STRL LF 14CM ADV 2 LUM LOPRFL	BOTH IP/OP	$600.00 	$444.00	$0.00	$480.00	$325.80	$325.80	$0.00	$0.00	$0.00	$125.06	$445.32	$445.32	$0.00	$0.00	$125.04	$0.00	$354.90	$354.90	$0.00	$300.00	$475.20	$480.00	$0.00		$0.00	$93.90	$0.00	$0.00	$95.52	$0.00	$0.00	$0.00	$0.00	$0.00
G52349	SUP	HCPCS C1725		G52349  -  CATHETER BLNDIL 6MM 80CM STRL LF 12CM ADV 2 LUM LOPRFL	BOTH IP/OP	$612.00 	$452.88	$0.00	$489.60	$332.32	$332.32	$0.00	$0.00	$0.00	$127.56	$454.23	$454.23	$0.00	$0.00	$127.54	$0.00	$362.00	$362.00	$0.00	$306.00	$484.70	$489.60	$0.00		$0.00	$95.78	$0.00	$0.00	$97.43	$0.00	$0.00	$0.00	$0.00	$0.00
G52542	SUP	HCPCS C1887		G52542  -  CATHETER GUID .035IN 4FR 135CM SUPPORT STR TIP LP RADIOPQ	BOTH IP/OP	$494.81 	$366.16	$0.00	$390.00	$264.71	$264.71	$0.00	$0.00	$0.00	$103.13	$367.25	$367.25	$0.00	$0.00	$103.12	$0.00	$292.68	$292.68	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
G52543	SUP	HCPCS C1887		G52543  -  CATHETER SPRT DAV CRV 4FR 135CM STRL CXI RADOPQ BRD LOPRFL	BOTH IP/OP	$494.81 	$366.16	$0.00	$390.00	$264.71	$264.71	$0.00	$0.00	$0.00	$103.13	$367.25	$367.25	$0.00	$0.00	$103.12	$0.00	$292.68	$292.68	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
G52545	SUP	HCPCS C1887		G52545  -  CATHETER GUID .035IN 4FR 150CM SUPPORT ANGLED TIP LP RADIOPQ	BOTH IP/OP	$494.81 	$366.16	$0.00	$390.00	$264.71	$264.71	$0.00	$0.00	$0.00	$103.13	$367.25	$367.25	$0.00	$0.00	$103.12	$0.00	$292.68	$292.68	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$76.29	$0.00	$0.00	$77.61	$0.00	$0.00	$0.00	$0.00	$0.00
G52599	SUP	Custom 27203010		G52599  -  SHEATH ACC VUE FLXR DFLC UT ESCP SYS	BOTH IP/OP	$64.13 	$47.46	$0.00	$51.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.59	$47.59	$0.00	$0.00	$13.36	$0.00	$0.00	$0.00	$0.00	$32.06	$50.79	$51.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52603	SUP	Custom 27203010		G52603  -  CARTRIDGE CO2 LITHOTRIPTER PNEUMATIC KIT LMA STONEBREAKER	BOTH IP/OP	$35.63 	$26.37	$0.00	$28.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.44	$26.44	$0.00	$0.00	$7.42	$0.00	$0.00	$0.00	$0.00	$17.81	$28.22	$28.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52605	SUP	Custom 27203010		G52605  -  CATHETER URTH 10FR 25CM 3ML UNIVERSA 2W OP-EN BLN FL SIL DOD	BOTH IP/OP	$192.19 	$142.22	$0.00	$153.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.64	$142.64	$0.00	$0.00	$40.05	$0.00	$0.00	$0.00	$0.00	$96.09	$152.21	$153.75	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52606	SUP	Custom 27203010		G52606  -  PROBE LITHOTRIPTER 1.6MM 500MM PNEUMATIC KIT LMA	BOTH IP/OP	$461.25 	$341.33	$0.00	$369.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.34	$342.34	$0.00	$0.00	$96.12	$0.00	$0.00	$0.00	$0.00	$230.63	$365.31	$369.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52607	SUP	Custom 27203010		G52607  -  PROBE LITHOTRIPTER 1MM 500MM PNEUMATIC KIT LMA STONEBREAKER	BOTH IP/OP	$461.25 	$341.33	$0.00	$369.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.34	$342.34	$0.00	$0.00	$96.12	$0.00	$0.00	$0.00	$0.00	$230.63	$365.31	$369.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52608	SUP	Custom 27203010		G52608  -  PROBE LITHOTRIPTER 2MM 425MM PNEUMATIC KIT STONEBREAKER	BOTH IP/OP	$461.25 	$341.33	$0.00	$369.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.34	$342.34	$0.00	$0.00	$96.12	$0.00	$0.00	$0.00	$0.00	$230.63	$365.31	$369.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52609	SUP	Custom 27203010		G52609  -  LITHOTRIPTER SRG LMA STONEBREAKER XHST LN STRL PRB CAP PORT	BOTH IP/OP	"$2,306.25 "	"$1,706.63"	$0.00	"$1,845.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,711.70"	"$1,711.70"	$0.00	$0.00	$480.62	$0.00	$0.00	$0.00	$0.00	"$1,153.13"	"$1,826.55"	"$1,845.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52736	SUP	HCPCS Q4107		G52736  -  COIL EMBOLIZATION 7CM 3MM NESTER 7.4 LOOP SOFT ENHANCED RADI	BOTH IP/OP	$249.30 	$184.48	$0.00	$199.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.03	$185.03	$0.00	$0.00	$51.95	$0.00	$0.00	$0.00	$0.00	$124.65	$197.45	$199.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52737	SUP	Custom 27805113		G52737  -  COIL EMBOLIZATION .018IN 4MM 7CM 5.6 LOOP SOFT ENHANCED	BOTH IP/OP	$264.20 	$195.51	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.09	$196.09	$0.00	$0.00	$55.06	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52742	SUP	Custom 27803010		G52742  -  COIL EMBOLIZATION .035IN 4MM 7CM 5.6 LOOP SOFT ENHANCED	BOTH IP/OP	$264.20 	$195.51	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.09	$196.09	$0.00	$0.00	$55.06	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52745	SUP	Custom 27803010		G52745  -  COIL EMBOLIZATION .035IN 10MM 7CM 2.2 LOOP SOFT ENHANCED	BOTH IP/OP	$264.20 	$195.51	$0.00	$211.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.09	$196.09	$0.00	$0.00	$55.06	$0.00	$0.00	$0.00	$0.00	$132.10	$209.25	$211.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52753	SUP	Custom 27803010		G52753  -  COIL EMBOLIZATION .035IN 18MM 14CM 2.5 LOOP SOFT ENHANCED	BOTH IP/OP	$303.83 	$224.83	$0.00	$243.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.50	$225.50	$0.00	$0.00	$63.32	$0.00	$0.00	$0.00	$0.00	$151.91	$240.63	$243.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52754	SUP	Custom 27803010		G52754  -  COIL EMBOLIZATION .035IN 20MM 14CM 2.2 LOOP SOFT ENHANCED	BOTH IP/OP	$303.83 	$224.83	$0.00	$243.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.50	$225.50	$0.00	$0.00	$63.32	$0.00	$0.00	$0.00	$0.00	$151.91	$240.63	$243.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52756	SUP	Custom 27803010		G52756  -  COIL EMBOLIZATION .035IN 20MM 20CM 3.2 LOOP SOFT ENHANCED	BOTH IP/OP	$325.28 	$240.71	$0.00	$260.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.42	$241.42	$0.00	$0.00	$67.79	$0.00	$0.00	$0.00	$0.00	$162.64	$257.62	$260.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G52909	SUP	HCPCS C1880		G52909  -  FILTER EMBOLIZATION 30MM 7FR 48MM 65CM NAVALIGN DELIVERY	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
G52914	SUP	HCPCS C1880		G52914  -  SYSTEM EMBL PRTC 30MM 7FR 48MM 65CM CELECT NAVALIGN DLV	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,569.38"	"$1,569.38"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$1,719.34"	"$1,719.34"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
G53030	SUP	HCPCS C1758		G53030  -  PROBE LTHTRP 1.6MM 605MM LMA STONEBREAKER PNEUM KT DISP	BOTH IP/OP	$63.75 	$47.18	$0.00	$51.00	$34.62	$34.62	$0.00	$0.00	$0.00	$13.29	$47.32	$47.32	$0.00	$0.00	$13.29	$0.00	$37.71	$37.71	$0.00	$31.88	$50.49	$51.00	$0.00		$0.00	$9.98	$0.00	$0.00	$10.15	$0.00	$0.00	$0.00	$0.00	$0.00
G53145	SUP	HCPCS C2617		G53145  -  CATHETER URTH 16FR 34CM 30ML UNIVERSA 3W FL RND BLDR SIL	BOTH IP/OP	$20.25 	$14.99	$0.00	$16.20	$9.11	$9.11	$0.00	$0.00	$0.00	$4.22	$15.03	$15.03	$0.00	$0.00	$4.22	$0.00	$11.98	$11.98	$0.00	$10.13	$16.04	$16.20	$0.00		$0.00	$3.17	$0.00	$0.00	$3.22	$0.00	$0.00	$0.00	$0.00	$0.00
G53146	SUP	HCPCS C2617		G53146  -  SET STNT .038IN 3CM PGTL CRV 5FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53179	SUP	HCPCS C1769		G53179  -  TRAY TRACHEOSTOMY 2 CANNU TUBE SHILEY CUFFED PLIANT TIP	BOTH IP/OP	"$1,142.50 "	$845.45	$0.00	$975.16	$661.89	$661.89	$0.00	$0.00	$0.00	$238.13	$847.96	$847.96	$0.00	$0.00	$238.10	$0.00	$675.79	$675.79	$0.00	$609.48	$965.41	$975.16	$0.00		$0.00	$190.77	$0.00	$0.00	$194.06	$0.00	$0.00	$0.00	$0.00	$0.00
G53211	SUP	HCPCS C1769		G53211  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ SFT	BOTH IP/OP	$67.58 	$50.01	$0.00	$54.06	$36.69	$36.69	$0.00	$0.00	$0.00	$14.08	$50.15	$50.15	$0.00	$0.00	$14.08	$0.00	$39.97	$39.97	$0.00	$33.79	$53.52	$54.06	$0.00		$0.00	$10.58	$0.00	$0.00	$10.76	$0.00	$0.00	$0.00	$0.00	$0.00
G53235	SUP	HCPCS C1758		G53235  -  CATHETER URTH 26FR 34CM 30ML UNIVERSA 2W FL RND TIP CLS END	BOTH IP/OP	$26.56 	$19.65	$0.00	$21.25	$14.42	$14.42	$0.00	$0.00	$0.00	$5.54	$19.71	$19.71	$0.00	$0.00	$5.54	$0.00	$15.71	$15.71	$0.00	$13.28	$21.04	$21.25	$0.00		$0.00	$4.16	$0.00	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$0.00
G53236	SUP	HCPCS C1758		G53236  -  CATHETER URTH 18FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END	BOTH IP/OP	$31.88 	$23.59	$0.00	$25.50	$17.31	$17.31	$0.00	$0.00	$0.00	$6.64	$23.66	$23.66	$0.00	$0.00	$6.64	$0.00	$18.85	$18.85	$0.00	$15.94	$25.25	$25.50	$0.00		$0.00	$4.99	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$0.00
G53237	SUP	HCPCS C1758		G53237  -  CATHETER URTH 20FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END	BOTH IP/OP	$31.88 	$23.59	$0.00	$25.50	$17.31	$17.31	$0.00	$0.00	$0.00	$6.64	$23.66	$23.66	$0.00	$0.00	$6.64	$0.00	$18.85	$18.85	$0.00	$15.94	$25.25	$25.50	$0.00		$0.00	$4.99	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$0.00
G53238	SUP	HCPCS C1758		G53238  -  CATHETER URTH 22FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END	BOTH IP/OP	$31.88 	$23.59	$0.00	$25.50	$17.31	$17.31	$0.00	$0.00	$0.00	$6.64	$23.66	$23.66	$0.00	$0.00	$6.64	$0.00	$18.85	$18.85	$0.00	$15.94	$25.25	$25.50	$0.00		$0.00	$4.99	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$0.00
G53240	SUP	HCPCS C1758		G53240  -  CATHETER URTH 24FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END	BOTH IP/OP	$31.88 	$23.59	$0.00	$25.50	$17.31	$17.31	$0.00	$0.00	$0.00	$6.64	$23.66	$23.66	$0.00	$0.00	$6.64	$0.00	$18.85	$18.85	$0.00	$15.94	$25.25	$25.50	$0.00		$0.00	$4.99	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$0.00
G53241	SUP	HCPCS C1758		G53241  -  CATHETER URTH 26FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END	BOTH IP/OP	$31.88 	$23.59	$0.00	$25.50	$17.31	$17.31	$0.00	$0.00	$0.00	$6.64	$23.66	$23.66	$0.00	$0.00	$6.64	$0.00	$18.85	$18.85	$0.00	$15.94	$25.25	$25.50	$0.00		$0.00	$4.99	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$0.00
G53242	SUP	HCPCS C1758		G53242  -  CATHETER URTH 16FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL	BOTH IP/OP	$31.88 	$23.59	$0.00	$25.50	$17.31	$17.31	$0.00	$0.00	$0.00	$6.64	$23.66	$23.66	$0.00	$0.00	$6.64	$0.00	$18.85	$18.85	$0.00	$15.94	$25.25	$25.50	$0.00		$0.00	$4.99	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$0.00
G53243	SUP	HCPCS C1758		G53243  -  CATHETER URTH 18FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL	BOTH IP/OP	$31.88 	$23.59	$0.00	$25.50	$17.31	$17.31	$0.00	$0.00	$0.00	$6.64	$23.66	$23.66	$0.00	$0.00	$6.64	$0.00	$18.85	$18.85	$0.00	$15.94	$25.25	$25.50	$0.00		$0.00	$4.99	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$0.00
G53244	SUP	HCPCS C1758		G53244  -  CATHETER URTH 20FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL	BOTH IP/OP	$31.88 	$23.59	$0.00	$25.50	$17.31	$17.31	$0.00	$0.00	$0.00	$6.64	$23.66	$23.66	$0.00	$0.00	$6.64	$0.00	$18.85	$18.85	$0.00	$15.94	$25.25	$25.50	$0.00		$0.00	$4.99	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$0.00
G53245	SUP	HCPCS C1758		G53245  -  CATHETER URTH 22FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL	BOTH IP/OP	$31.88 	$23.59	$0.00	$25.50	$17.31	$17.31	$0.00	$0.00	$0.00	$6.64	$23.66	$23.66	$0.00	$0.00	$6.64	$0.00	$18.85	$18.85	$0.00	$15.94	$25.25	$25.50	$0.00		$0.00	$4.99	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$0.00
G53246	SUP	HCPCS C1758		G53246  -  CATHETER URTH 24FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL	BOTH IP/OP	$31.88 	$23.59	$0.00	$25.50	$17.31	$17.31	$0.00	$0.00	$0.00	$6.64	$23.66	$23.66	$0.00	$0.00	$6.64	$0.00	$18.85	$18.85	$0.00	$15.94	$25.25	$25.50	$0.00		$0.00	$4.99	$0.00	$0.00	$5.07	$0.00	$0.00	$0.00	$0.00	$0.00
G53421	SUP	HCPCS C1874		G53421  -  GRAFT EVAS BFUR 30MM 20FR 120MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	"$13,605.75"	"$13,605.75"	$0.00	$0.00	$0.00	"$6,301.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	"$14,905.86"	"$14,905.86"	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	"$4,731.78"	$0.00	$0.00	"$4,813.41"	$0.00	$0.00	$0.00	$0.00	$0.00
G53422	SUP	Custom 27803010		G53422  -  GRAFT EVAS BFUR 30MM 20FR 140MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53423	SUP	Custom 27803010		G53423  -  GRAFT EVAS 30MM 20FR 200MM ZNTH TX2 DIST CMPNT PRFRM Z TRK +	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53424	SUP	Custom 27803010		G53424  -  GRAFT EVAS BFUR 32MM 20FR 120MM ZNTH TX2 PRFRM Z-TRK + PROX	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53426	SUP	HCPCS C1874		G53426  -  GRAFT EVAS 2 BRCH 32MM 20FR 200MM ZNTH TX2 PROX PRFRM Z-TRK	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	"$13,605.75"	"$13,605.75"	$0.00	$0.00	$0.00	"$6,301.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	"$14,905.86"	"$14,905.86"	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	"$4,731.78"	$0.00	$0.00	"$4,813.41"	$0.00	$0.00	$0.00	$0.00	$0.00
G53427	SUP	HCPCS C1874		G53427  -  GRAFT EVAS 2 BRCH CYL 34MM 20FR 127MM STRL PRFRM Z-TRK +	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	"$13,605.75"	"$13,605.75"	$0.00	$0.00	$0.00	"$6,301.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	"$14,905.86"	"$14,905.86"	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	"$4,731.78"	$0.00	$0.00	"$4,813.41"	$0.00	$0.00	$0.00	$0.00	$0.00
G53428	SUP	Custom 27803010		G53428  -  GRAFT EVAS BFUR 34MM 20FR 152MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53429	SUP	Custom 27803010		G53429  -  GRAFT EVAS BFUR 34MM 20FR 202MM ZNTH TX2 PRFRM Z-TRK + PROX	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53430	SUP	Custom 27803010		G53430  -  GRAFT EVAS BFUR 36MM 22FR 127MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53433	SUP	HCPCS C1874		G53433  -  GRAFT EVAS 2 BRCH 38MM 22FR 127MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	"$13,605.75"	"$13,605.75"	$0.00	$0.00	$0.00	"$6,301.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	"$14,905.86"	"$14,905.86"	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	"$4,731.78"	$0.00	$0.00	"$4,813.41"	$0.00	$0.00	$0.00	$0.00	$0.00
G53434	SUP	Custom 27803010		G53434  -  GRAFT EVAS BFUR 38MM 22FR 152MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53435	SUP	Custom 27803010		G53435  -  GRAFT EVAS BFUR 38MM 22FR 202MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53436	SUP	Custom 27803010		G53436  -  GRAFT EVAS BFUR 40MM 22FR 135MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53440	SUP	Custom 27803010		G53440  -  GRAFT EVAS BFUR 42MM 22FR 162MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53441	SUP	Custom 27803010		G53441  -  GRAFT EVAS BFUR 42MM 22FR 216MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53442	SUP	Custom 27803010		G53442  -  GRAFT EVAS BFUR 32MM 20FR 160MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53446	SUP	Custom 27803010		G53446  -  GRAFT EVAS BFUR 36MM 22FR 157MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53449	SUP	HCPCS C1874		G53449  -  GRAFT EVAS CYL TPR 38-34MM 8.5MM 22FR 202MM STRL PRFRM Z-TRK	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	"$13,605.75"	"$13,605.75"	$0.00	$0.00	$0.00	"$6,301.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	"$14,905.86"	"$14,905.86"	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	"$4,731.78"	$0.00	$0.00	"$4,813.41"	$0.00	$0.00	$0.00	$0.00	$0.00
G53450	SUP	Custom 27803010		G53450  -  GRAFT EVAS 40MM 22FR 158MM ZNTH TX2 PROX TPR CMPNT PRFRM	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	$0.00	$0.00	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53454	SUP	Custom 27803010		G53454  -  GRAFT EVAS 28MM 20FR 80MM ZNTH TX2 TBE CMPNT PROX XTN PRFRM	BOTH IP/OP	"$12,996.03 "	"$9,617.06"	$0.00	"$10,396.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,708.37"	$0.00	$0.00	$0.00	$0.00	"$6,498.01"	"$10,292.86"	"$10,396.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53455	SUP	Custom 27803010		G53455  -  GRAFT EVAS BFUR 30MM 20FR 80MM ZNTH TX2 PRFRM Z-TRK + PROX	BOTH IP/OP	"$12,995.00 "	"$9,616.30"	$0.00	"$10,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,708.16"	$0.00	$0.00	$0.00	$0.00	"$6,497.50"	"$10,292.04"	"$10,396.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53456	SUP	Custom 27803010		G53456  -  GRAFT EVAS BFUR 32MM 20FR 80MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$12,995.00 "	"$9,616.30"	$0.00	"$10,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,708.16"	$0.00	$0.00	$0.00	$0.00	"$6,497.50"	"$10,292.04"	"$10,396.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53457	SUP	Custom 27803010		G53457  -  GRAFT EVAS 34MM 20FR 77MM ZNTH TX2 DIST XTN TBE CMPNT PRFRM	BOTH IP/OP	"$12,995.00 "	"$9,616.30"	$0.00	"$10,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,708.16"	$0.00	$0.00	$0.00	$0.00	"$6,497.50"	"$10,292.04"	"$10,396.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53458	SUP	Custom 27803010		G53458  -  GRAFT EVAS 36MM 22FR 77MM ZNTH TX2 PROX XTN Z-TRK + TAA	BOTH IP/OP	"$12,995.00 "	"$9,616.30"	$0.00	"$10,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,708.16"	$0.00	$0.00	$0.00	$0.00	"$6,497.50"	"$10,292.04"	"$10,396.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53459	SUP	Custom 27803010		G53459  -  GRAFT EVAS 38MM 22FR 77MM ZNTH TX2 PROX XTN PRFRM Z TRK +	BOTH IP/OP	"$12,995.00 "	"$9,616.30"	$0.00	"$10,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,708.16"	$0.00	$0.00	$0.00	$0.00	"$6,497.50"	"$10,292.04"	"$10,396.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53460	SUP	Custom 27803010		G53460  -  GRAFT EVAS BFUR 40MM 22FR 81MM ZNTH TX2 PRFRM Z-TRK + SLF	BOTH IP/OP	"$12,995.00 "	"$9,616.30"	$0.00	"$10,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,708.16"	$0.00	$0.00	$0.00	$0.00	"$6,497.50"	"$10,292.04"	"$10,396.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53461	SUP	Custom 27803010		G53461  -  GRAFT EVAS 42MM 22FR 81MM ZNTH TX2 PROX XTN PRFRM Z-TRK +	BOTH IP/OP	"$12,995.00 "	"$9,616.30"	$0.00	"$10,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,708.16"	$0.00	$0.00	$0.00	$0.00	"$6,497.50"	"$10,292.04"	"$10,396.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53463	SUP	HCPCS C1874		G53463  -  GRAFT EVAS 30MM 7.7MM 20FR 80MM STRL ZNTH TX2 PRFRM ESBE	BOTH IP/OP	"$12,995.00 "	"$9,616.30"	$0.00	"$10,396.00"	"$5,847.75"	"$5,847.75"	$0.00	$0.00	$0.00	"$2,708.48"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,708.16"	$0.00	"$6,406.54"	"$6,406.54"	$0.00	"$6,497.50"	"$10,292.04"	"$10,396.00"	$0.00		$0.00	"$2,033.72"	$0.00	$0.00	"$2,068.80"	$0.00	$0.00	$0.00	$0.00	$0.00
G53486	SUP	Custom 27803010		G53486  -  GRAFT EVAS 42MM 22FR 144MM ZNTH TX2 PRFRM Z TRK + INTRO SYS	BOTH IP/OP	"$16,442.50 "	"$12,167.45"	$0.00	"$13,154.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,426.62"	$0.00	$0.00	$0.00	$0.00	"$8,221.25"	"$13,022.46"	"$13,154.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G53556	SUP	HCPCS C1769		G53556  -  CATHETER URTH 26FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL	BOTH IP/OP	$6.76 	$5.00	$0.00	$5.41	$3.67	$3.67	$0.00	$0.00	$0.00	$1.41	$5.02	$5.02	$0.00	$0.00	$1.41	$0.00	$4.00	$4.00	$0.00	$3.38	$5.35	$5.41	$0.00		$0.00	$1.06	$0.00	$0.00	$1.08	$0.00	$0.00	$0.00	$0.00	$0.00
G53557	SUP	HCPCS C1769		G53557  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ FLXB STF	BOTH IP/OP	$67.58 	$50.01	$0.00	$54.06	$36.69	$36.69	$0.00	$0.00	$0.00	$14.08	$50.15	$50.15	$0.00	$0.00	$14.08	$0.00	$39.97	$39.97	$0.00	$33.79	$53.52	$54.06	$0.00		$0.00	$10.58	$0.00	$0.00	$10.76	$0.00	$0.00	$0.00	$0.00	$0.00
G53558	SUP	HCPCS C1769		G53558  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ 2 FLXB STF	BOTH IP/OP	$67.58 	$50.01	$0.00	$54.06	$36.69	$36.69	$0.00	$0.00	$0.00	$14.08	$50.15	$50.15	$0.00	$0.00	$14.08	$0.00	$39.97	$39.97	$0.00	$33.79	$53.52	$54.06	$0.00		$0.00	$10.58	$0.00	$0.00	$10.76	$0.00	$0.00	$0.00	$0.00	$0.00
G53559	SUP	HCPCS C1769		G53559  -  GUIDEWIRE ESCP STRG .025IN 145CM STRL 5CM AMPTZ XSTF FXCR	BOTH IP/OP	$67.58 	$50.01	$0.00	$54.06	$36.69	$36.69	$0.00	$0.00	$0.00	$14.08	$50.15	$50.15	$0.00	$0.00	$14.08	$0.00	$39.97	$39.97	$0.00	$33.79	$53.52	$54.06	$0.00		$0.00	$10.58	$0.00	$0.00	$10.76	$0.00	$0.00	$0.00	$0.00	$0.00
G53560	SUP	HCPCS C1769		G53560  -  CATHETER NPHSTM 8MM 15CM ULTRX	BOTH IP/OP	$67.58 	$50.01	$0.00	$54.06	$36.69	$36.69	$0.00	$0.00	$0.00	$14.08	$50.15	$50.15	$0.00	$0.00	$14.08	$0.00	$39.97	$39.97	$0.00	$33.79	$53.52	$54.06	$0.00		$0.00	$10.58	$0.00	$0.00	$10.76	$0.00	$0.00	$0.00	$0.00	$0.00
G53561	SUP	HCPCS C1769		G53561  -  GUIDEWIRE ESCP .035IN STRG 145CM 5CM AMPTZ FLX TP FXCR XSTF	BOTH IP/OP	$88.13 	$65.22	$0.00	$70.50	$47.85	$47.85	$0.00	$0.00	$0.00	$18.37	$65.41	$65.41	$0.00	$0.00	$18.37	$0.00	$52.13	$52.13	$0.00	$44.06	$69.80	$70.50	$0.00		$0.00	$13.79	$0.00	$0.00	$14.03	$0.00	$0.00	$0.00	$0.00	$0.00
G53562	SUP	HCPCS C1769		G53562  -  GUIDEWIRE ESCP STRG .035IN 260CM STRL 5CM AMPTZ XSTF FXCR	BOTH IP/OP	$88.13 	$65.22	$0.00	$70.50	$47.85	$47.85	$0.00	$0.00	$0.00	$18.37	$65.41	$65.41	$0.00	$0.00	$18.37	$0.00	$52.13	$52.13	$0.00	$44.06	$69.80	$70.50	$0.00		$0.00	$13.79	$0.00	$0.00	$14.03	$0.00	$0.00	$0.00	$0.00	$0.00
G53563	SUP	HCPCS C1769		G53563  -  GUIDEWIRE ESCP STRG .038IN 260CM STRL 5CM AMPTZ XSTF FXCR	BOTH IP/OP	$67.58 	$50.01	$0.00	$54.06	$36.69	$36.69	$0.00	$0.00	$0.00	$14.08	$50.15	$50.15	$0.00	$0.00	$14.08	$0.00	$39.97	$39.97	$0.00	$33.79	$53.52	$54.06	$0.00		$0.00	$10.58	$0.00	$0.00	$10.76	$0.00	$0.00	$0.00	$0.00	$0.00
G53564	SUP	HCPCS C1769		G53564  -  GUIDEWIRE VASC STRG .035IN 145CM STRL 5CM AMPTZ 2 FLX TP	BOTH IP/OP	$67.58 	$50.01	$0.00	$54.06	$36.69	$36.69	$0.00	$0.00	$0.00	$14.08	$50.15	$50.15	$0.00	$0.00	$14.08	$0.00	$39.97	$39.97	$0.00	$33.79	$53.52	$54.06	$0.00		$0.00	$10.58	$0.00	$0.00	$10.76	$0.00	$0.00	$0.00	$0.00	$0.00
G53566	SUP	HCPCS C1769		G53566  -  GUIDEWIRE URO STRG .038IN 145CM 5CM AMPTZ 2 FLX TP FX COR	BOTH IP/OP	$67.58 	$50.01	$0.00	$54.06	$36.69	$36.69	$0.00	$0.00	$0.00	$14.08	$50.15	$50.15	$0.00	$0.00	$14.08	$0.00	$39.97	$39.97	$0.00	$33.79	$53.52	$54.06	$0.00		$0.00	$10.58	$0.00	$0.00	$10.76	$0.00	$0.00	$0.00	$0.00	$0.00
G53567	SUP	HCPCS C1769		G53567  -  GUIDEWIRE VASC STRG .035IN 145CM 5CM AMPTZ 2 FLX TP FXCR ULT	BOTH IP/OP	$67.58 	$50.01	$0.00	$54.06	$36.69	$36.69	$0.00	$0.00	$0.00	$14.08	$50.15	$50.15	$0.00	$0.00	$14.08	$0.00	$39.97	$39.97	$0.00	$33.79	$53.52	$54.06	$0.00		$0.00	$10.58	$0.00	$0.00	$10.76	$0.00	$0.00	$0.00	$0.00	$0.00
G53568	SUP	HCPCS C1769		G53568  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ FLXB ULT STF	BOTH IP/OP	$67.58 	$50.01	$0.00	$54.06	$36.69	$36.69	$0.00	$0.00	$0.00	$14.08	$50.15	$50.15	$0.00	$0.00	$14.08	$0.00	$39.97	$39.97	$0.00	$33.79	$53.52	$54.06	$0.00		$0.00	$10.58	$0.00	$0.00	$10.76	$0.00	$0.00	$0.00	$0.00	$0.00
G53569	SUP	HCPCS C1769		G53569  -  GUIDEWIRE VASC STRG .035IN 145CM STRL 5CM AMPTZ 2 FLXB ULT	BOTH IP/OP	$67.58 	$50.01	$0.00	$54.06	$36.69	$36.69	$0.00	$0.00	$0.00	$14.08	$50.15	$50.15	$0.00	$0.00	$14.08	$0.00	$39.97	$39.97	$0.00	$33.79	$53.52	$54.06	$0.00		$0.00	$10.58	$0.00	$0.00	$10.76	$0.00	$0.00	$0.00	$0.00	$0.00
G53672	SUP	HCPCS C2617		G53672  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ 2 FLXB ULT	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53674	SUP	HCPCS C2617		G53674  -  SET STNT .038IN 3CM PGTL CRV 5FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53675	SUP	HCPCS C2617		G53675  -  SET STNT .038IN 3CM PGTL CRV 5FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53676	SUP	HCPCS C2617		G53676  -  SET STNT 3CM PGTL CRV 5FR 22CM STRL 145CM UNIVERSA RADOPQ	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53677	SUP	HCPCS C2617		G53677  -  SET STNT .038IN 3CM PGTL CRV 5FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53678	SUP	HCPCS C2617		G53678  -  SET STNT .038IN 3CM PGTL CRV 5FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53680	SUP	HCPCS C2617		G53680  -  SET STNT .038IN 3CM PGTL CRV 5FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53681	SUP	HCPCS C2617		G53681  -  SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53682	SUP	HCPCS C2617		G53682  -  SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53683	SUP	HCPCS C2617		G53683  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53684	SUP	HCPCS C2617		G53684  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53685	SUP	HCPCS C2617		G53685  -  SET STNT 2 PGTL CRV 5FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53686	SUP	HCPCS C2617		G53686  -  SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53687	SUP	HCPCS C2617		G53687  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53688	SUP	HCPCS C2617		G53688  -  SET STNT .038IN 3CM PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53689	SUP	HCPCS C2617		G53689  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA PSTNR	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53690	SUP	HCPCS C2617		G53690  -  SET STNT 2 PGTL CRV 6FR 18CM UNIVERSA SFT GRAD MRK	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53691	SUP	HCPCS C2617		G53691  -  SET STNT PGTL CRV 6FR 20CM UNIVERSA SFT GRAD MRK	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53692	SUP	HCPCS C2617		G53692  -  SET STNT 2 PGTL CRV 6FR 22CM UNIVERSA SFT GRAD MRK	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53693	SUP	HCPCS C2617		G53693  -  SET STNT .038IN 3CM PGTL CRV 6FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53694	SUP	HCPCS C2617		G53694  -  SET STNT .038IN 3CM PGTL CRV 6FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53695	SUP	HCPCS C2617		G53695  -  SET STNT PGTL CRV 6FR 28CM UNIVERSA GW SFT GRAD MRK	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53696	SUP	HCPCS C2617		G53696  -  SET STNT .038IN 3CM PGTL CRV 6FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53697	SUP	HCPCS C2617		G53697  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53698	SUP	HCPCS C2617		G53698  -  SET STNT 6FR 22CM STRL LF UNIVERSA PSTNR GW BRD TETH RADOPQ	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53699	SUP	HCPCS C2617		G53699  -  SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53700	SUP	HCPCS C2617		G53700  -  SET STNT 6FR 26CM STRL LF UNIVERSA PSTNR GW BRD TETH RADOPQ	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53701	SUP	HCPCS C2617		G53701  -  SET STNT 6FR 24CM STRL LF UNIVERSA PSTNR GW BRD TETH RADOPQ	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53702	SUP	HCPCS C2617		G53702  -  SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53703	SUP	HCPCS C2617		G53703  -  SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53704	SUP	HCPCS C2617		G53704  -  SET STNT .038IN 3CM PGTL CRV 6FR 22-32CM STRL 145CM UNIVERSA	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53706	SUP	HCPCS C2617		G53706  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53707	SUP	HCPCS C2617		G53707  -  SET STNT 3CM PGTL CRV 7FR 22-32CM STRL LF 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53708	SUP	HCPCS C2617		G53708  -  SET STNT .038IN 3CM PGTL CRV 7FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53709	SUP	HCPCS C2617		G53709  -  SET STNT .038IN 3CM PGTL CRV 7FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53710	SUP	HCPCS C2617		G53710  -  SET STNT .038IN 3CM PGTL CRV 7FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53711	SUP	HCPCS C2617		G53711  -  SET STNT .038IN 3CM PGTL CRV 7FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53712	SUP	HCPCS C2617		G53712  -  SET STNT .038IN 3CM PGTL CRV 7FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53713	SUP	HCPCS C2617		G53713  -  SET STNT .038IN 3CM PGTL CRV 7FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53714	SUP	HCPCS C2617		G53714  -  SET STNT .038IN 3CM PGTL CRV 7FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53715	SUP	HCPCS C2617		G53715  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53716	SUP	HCPCS C2617		G53716  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53717	SUP	HCPCS C2617		G53717  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53718	SUP	HCPCS C2617		G53718  -  SET STNT 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53719	SUP	HCPCS C2617		G53719  -  SET STNT 2 PGTL CRV 7FR 26CM STRL LF UNIVERSA RADOPQ SFT	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53720	SUP	HCPCS C2617		G53720  -  SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53721	SUP	HCPCS C2617		G53721  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53722	SUP	HCPCS C2617		G53722  -  SET STNT .038IN 3CM PGTL CRV 8FR 22-32CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53723	SUP	HCPCS C2617		G53723  -  SET STNT .038IN 3CM PGTL CRV 8FR 18CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53724	SUP	HCPCS C2617		G53724  -  SET STNT .038IN 3CM PGTL CRV 8FR 20CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53725	SUP	HCPCS C2617		G53725  -  SET STNT .038IN 3CM PGTL CRV 8FR 22CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53726	SUP	HCPCS C2617		G53726  -  SET STNT .038IN 3CM PGTL CRV 8FR 24CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53727	SUP	HCPCS C2617		G53727  -  SET STNT .038IN 3CM PGTL CRV 8FR 26CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53728	SUP	HCPCS C2617		G53728  -  SET STNT .038IN 3CM PGTL CRV 8FR 28CM STRL 145CM UNIVERSA	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$91.13	$91.13	$0.00	$0.00	$0.00	$42.21	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$119.78	$119.78	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$31.69	$0.00	$0.00	$32.24	$0.00	$0.00	$0.00	$0.00	$0.00
G53729	SUP	HCPCS C2617		G53729  -  SET STNT .038IN 3CM PGTL CRV 8FR 30CM STRL 145CM UNIVERSA	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53731	SUP	HCPCS C2617		G53731  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53732	SUP	HCPCS C2617		G53732  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53734	SUP	HCPCS C2617		G53734  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53735	SUP	HCPCS C2617		G53735  -  SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53736	SUP	HCPCS C2617		G53736  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G53737	SUP	HCPCS C2617		G53737  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G54613	SUP	HCPCS C1763		G54613  -  GRAFT SOFT TISSUE .4CM SET PLUG BUTTON BIODESIGN SURGISIS	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G54614	SUP	HCPCS C1763		G54614  -  GRAFT ENDOVASCULAR .7CM SET PLUG BUTTON BIODESIGN SURGISIS	BOTH IP/OP	"$2,612.50 "	"$1,933.25"	$0.00	"$2,090.00"	"$1,175.63"	"$1,175.63"	$0.00	$0.00	$0.00	$544.51	"$1,939.00"	"$1,939.00"	$0.00	$0.00	$544.45	$0.00	"$1,287.96"	"$1,287.96"	$0.00	"$1,306.25"	"$2,069.10"	"$2,090.00"	$0.00		$0.00	$408.86	$0.00	$0.00	$415.91	$0.00	$0.00	$0.00	$0.00	$0.00
G55230	SUP	HCPCS C1874		G55230  -  GRAFT EVAS 2 BRCH 13MM 5.4MM 14FR 39MM STRL ZNTH SPRLZ Z-TRK	BOTH IP/OP	"$7,712.50 "	"$5,707.25"	$0.00	"$6,170.00"	"$3,470.63"	"$3,470.63"	$0.00	$0.00	$0.00	"$1,607.48"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,607.29"	$0.00	"$3,802.26"	"$3,802.26"	$0.00	"$3,856.25"	"$6,108.30"	"$6,170.00"	$0.00		$0.00	"$1,207.01"	$0.00	$0.00	"$1,227.83"	$0.00	$0.00	$0.00	$0.00	$0.00
G55231	SUP	HCPCS C1874		G55231  -  GRAFT EVAS 2 BRCH 13MM 5.4MM 14FR 56MM STRL ZNTH SPRLZ Z-TRK	BOTH IP/OP	"$7,712.50 "	"$5,707.25"	$0.00	"$6,170.00"	"$3,470.63"	"$3,470.63"	$0.00	$0.00	$0.00	"$1,607.48"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,607.29"	$0.00	"$3,802.26"	"$3,802.26"	$0.00	"$3,856.25"	"$6,108.30"	"$6,170.00"	$0.00		$0.00	"$1,207.01"	$0.00	$0.00	"$1,227.83"	$0.00	$0.00	$0.00	$0.00	$0.00
G55236	SUP	HCPCS C1874		G55236  -  GRAFT EVAS 2 BRCH 16MM 14FR 39MM SPRLZ ZNTH Z-TRK SLF XPD LG	BOTH IP/OP	"$7,712.50 "	"$5,707.25"	$0.00	"$6,170.00"	"$3,470.63"	"$3,470.63"	$0.00	$0.00	$0.00	"$1,607.48"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,607.29"	$0.00	"$3,802.26"	"$3,802.26"	$0.00	"$3,856.25"	"$6,108.30"	"$6,170.00"	$0.00		$0.00	"$1,207.01"	$0.00	$0.00	"$1,227.83"	$0.00	$0.00	$0.00	$0.00	$0.00
G55237	SUP	HCPCS C1874		G55237  -  GRAFT EVAS BFUR 16MM 5.4MM 14FR 56MM ZNTH SPRLZ ANCLRY	BOTH IP/OP	"$7,712.50 "	"$5,707.25"	$0.00	"$6,170.00"	"$3,470.63"	"$3,470.63"	$0.00	$0.00	$0.00	"$1,607.48"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,607.29"	$0.00	"$3,802.26"	"$3,802.26"	$0.00	"$3,856.25"	"$6,108.30"	"$6,170.00"	$0.00		$0.00	"$1,207.01"	$0.00	$0.00	"$1,227.83"	$0.00	$0.00	$0.00	$0.00	$0.00
G55242	SUP	HCPCS C1874		G55242  -  GRAFT EVAS 2 BRCH 20MM 6MM 16FR 74MM ZNTH SPRLZ ILC LG	BOTH IP/OP	"$7,712.50 "	"$5,707.25"	$0.00	"$6,170.00"	"$3,470.63"	"$3,470.63"	$0.00	$0.00	$0.00	"$1,607.48"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,607.29"	$0.00	"$3,802.26"	"$3,802.26"	$0.00	"$3,856.25"	"$6,108.30"	"$6,170.00"	$0.00		$0.00	"$1,207.01"	$0.00	$0.00	"$1,227.83"	$0.00	$0.00	$0.00	$0.00	$0.00
G55243	SUP	Custom 27803010		G55243  -  GRAFT EVAS 2 BRCH 20MM 16FR 90MM SPRLZ ZNTH Z-TRK SLF XPD LG	BOTH IP/OP	"$7,712.50 "	"$5,707.25"	$0.00	"$6,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,607.29"	$0.00	$0.00	$0.00	$0.00	"$3,856.25"	"$6,108.30"	"$6,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G55245	SUP	Custom 27803010		G55245  -  GRAFT EVAS 24MM 6MM 5.3MM 56MM 71CM ZNTH SPRLZ ILC LG CAPTOR	BOTH IP/OP	"$9,412.50 "	"$6,965.25"	$0.00	"$7,530.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,961.57"	$0.00	$0.00	$0.00	$0.00	"$4,706.25"	"$7,454.70"	"$7,530.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G55246	SUP	Custom 27803010		G55246  -  GRAFT EVAS BFUR 24MM 16FR 74MM ZNTH SPRLZ Z-TRK SLF XPD WVN	BOTH IP/OP	"$7,712.50 "	"$5,707.25"	$0.00	"$6,170.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,607.29"	$0.00	$0.00	$0.00	$0.00	"$3,856.25"	"$6,108.30"	"$6,170.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G55247	SUP	HCPCS C1874		G55247  -  GRAFT EVAS 24MM 6MM 16FR 90MM ZNTH SPRLZ ANCLRY CNTRLT/IPSL	BOTH IP/OP	$385.63 	$285.37	$0.00	$308.50	$173.53	$173.53	$0.00	$0.00	$0.00	$80.37	$286.21	$286.21	$0.00	$0.00	$80.36	$0.00	$228.10	$228.10	$0.00	$192.81	$305.42	$308.50	$0.00		$0.00	$60.35	$0.00	$0.00	$61.39	$0.00	$0.00	$0.00	$0.00	$0.00
G55800	SUP	HCPCS C1729		G55800  -  SET DRN 14FR 6-16FR 30CM 20CM UNIVERSA ECHTP SFTJ LOOP CATH	BOTH IP/OP	$350.68 	$259.50	$0.00	$280.54	$190.42	$190.42	$0.00	$0.00	$0.00	$73.09	$260.27	$260.27	$0.00	$0.00	$73.08	$0.00	$207.42	$207.42	$0.00	$175.34	$277.74	$280.54	$0.00		$0.00	$54.88	$0.00	$0.00	$55.83	$0.00	$0.00	$0.00	$0.00	$0.00
G55801	SUP	HCPCS C1729		G55801  -  SET DRN 6FR 5-8FR 15CM 20CM CATH DIL LOOP	BOTH IP/OP	$350.68 	$259.50	$0.00	$280.54	$190.42	$190.42	$0.00	$0.00	$0.00	$73.09	$260.27	$260.27	$0.00	$0.00	$73.08	$0.00	$207.42	$207.42	$0.00	$175.34	$277.74	$280.54	$0.00		$0.00	$54.88	$0.00	$0.00	$55.83	$0.00	$0.00	$0.00	$0.00	$0.00
G55802	SUP	HCPCS C1729		G55802  -  SHIELD SPLSH ELLIPSE 9X12IN LTX BRR RBR	BOTH IP/OP	$350.68 	$259.50	$0.00	$280.54	$190.42	$190.42	$0.00	$0.00	$0.00	$73.09	$260.27	$260.27	$0.00	$0.00	$73.08	$0.00	$207.42	$207.42	$0.00	$175.34	$277.74	$280.54	$0.00		$0.00	$54.88	$0.00	$0.00	$55.83	$0.00	$0.00	$0.00	$0.00	$0.00
G55803	SUP	HCPCS C1729		G55803  -  SET DRN 12FR 6-14FR 30CM 20CM UNIVERSA DIL LOOP CATH INTRO	BOTH IP/OP	$350.68 	$259.50	$0.00	$280.54	$190.42	$190.42	$0.00	$0.00	$0.00	$73.09	$260.27	$260.27	$0.00	$0.00	$73.08	$0.00	$207.42	$207.42	$0.00	$175.34	$277.74	$280.54	$0.00		$0.00	$54.88	$0.00	$0.00	$55.83	$0.00	$0.00	$0.00	$0.00	$0.00
G55804	SUP	HCPCS C1729		G55804  -  SET DRN 10FR 6-12FR 30CM 20CM CATH DIL LOOP	BOTH IP/OP	$350.68 	$259.50	$0.00	$280.54	$190.42	$190.42	$0.00	$0.00	$0.00	$73.09	$260.27	$260.27	$0.00	$0.00	$73.08	$0.00	$207.42	$207.42	$0.00	$175.34	$277.74	$280.54	$0.00		$0.00	$54.88	$0.00	$0.00	$55.83	$0.00	$0.00	$0.00	$0.00	$0.00
G55821	SUP	HCPCS C2627		G55821  -  SET CATH 14FR 15GA 30CM UNIVERSA MLCT 1 WY STPCK CNCT TUBE	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$53.76	$53.76	$0.00	$0.00	$0.00	$0.00	$73.48	$73.48	$0.00	$0.00	$20.63	$0.00	$0.00	$0.00	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$15.49	$0.00	$0.00	$15.76	$0.00	$0.00	$0.00	$0.00	$0.00
G55822	SUP	HCPCS C2627		G55822  -  CATHETER SPBC 12FR 14FR 22CM 3CC STRL LTX 30CM RTNR SET NDL	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$53.76	$53.76	$0.00	$0.00	$0.00	$0.00	$73.48	$73.48	$0.00	$0.00	$20.63	$0.00	$0.00	$0.00	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$15.49	$0.00	$0.00	$15.76	$0.00	$0.00	$0.00	$0.00	$0.00
G55823	SUP	HCPCS C2627		G55823  -  SET CATH 10FR 18GA 30CM UNIVERSA MLCT DRN SPBC	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$53.76	$53.76	$0.00	$0.00	$0.00	$0.00	$73.48	$73.48	$0.00	$0.00	$20.63	$0.00	$0.00	$0.00	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$15.49	$0.00	$0.00	$15.76	$0.00	$0.00	$0.00	$0.00	$0.00
G55824	SUP	HCPCS C2627		G55824  -  SET CATH 12FR 54CM TROC STY DRN ADPR SPBC CYSTOSTOMY	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$53.76	$53.76	$0.00	$0.00	$0.00	$0.00	$73.48	$73.48	$0.00	$0.00	$20.63	$0.00	$0.00	$0.00	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$15.49	$0.00	$0.00	$15.76	$0.00	$0.00	$0.00	$0.00	$0.00
G55825	SUP	HCPCS C1729		G55825  -  INSERTER SRG 1.91IN STRL DISP ACPT 3.1FR	BOTH IP/OP	$3.96 	$2.93	$0.00	$3.17	$2.15	$2.15	$0.00	$0.00	$0.00	$0.83	$2.94	$2.94	$0.00	$0.00	$0.83	$0.00	$2.34	$2.34	$0.00	$1.98	$3.14	$3.17	$0.00		$0.00	$0.62	$0.00	$0.00	$0.63	$0.00	$0.00	$0.00	$0.00	$0.00
G56219	SUP	HCPCS C1894		G56219  -  INTRODUCER SHEATH .035IN 4FR .059IN 70CM ANL0 CURVE STR TIP	BOTH IP/OP	$238.50 	$176.49	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$49.71	$177.01	$177.01	$0.00	$0.00	$49.70	$0.00	$141.07	$141.07	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
G56220	SUP	HCPCS C1894		G56220  -  INTRODUCER SHEATH .035IN 5FR .074IN 70CM ANL0 CURVE STR TIP	BOTH IP/OP	$238.50 	$176.49	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$49.71	$177.01	$177.01	$0.00	$0.00	$49.70	$0.00	$141.07	$141.07	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
G56221	SUP	HCPCS C1894		G56221  -  INTRODUCER SHEATH .035IN 6FR .087IN 70CM ANL0 CURVE STR TIP	BOTH IP/OP	$238.50 	$176.49	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$49.71	$177.01	$177.01	$0.00	$0.00	$49.70	$0.00	$141.07	$141.07	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
G56222	SUP	HCPCS C1894		G56222  -  INTRODUCER SHEATH .035IN 7FR .1IN 70CM ANL0 CURVE STR TIP	BOTH IP/OP	$238.50 	$176.49	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$49.71	$177.01	$177.01	$0.00	$0.00	$49.70	$0.00	$141.07	$141.07	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
G56224	SUP	HCPCS C1894		G56224  -  INTRODUCER SHEATH .035IN 4FR .059IN 70CM ANL1 CURVE MULTPUR	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
G56225	SUP	HCPCS C1894		G56225  -  INTRODUCER SHEATH .035IN 5FR .074IN 70CM ANL1 CURVE MULTPUR	BOTH IP/OP	$238.50 	$176.49	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$49.71	$177.01	$177.01	$0.00	$0.00	$49.70	$0.00	$141.07	$141.07	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
G56226	SUP	HCPCS C1894		G56226  -  INTRODUCER SHEATH .035IN 6FR .087IN 70CM ANL1 CURVE MULTPUR	BOTH IP/OP	$238.50 	$176.49	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$49.71	$177.01	$177.01	$0.00	$0.00	$49.70	$0.00	$141.07	$141.07	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
G56227	SUP	HCPCS C1894		G56227  -  INTRODUCER SHEATH .035IN 7FR .1IN 70CM ANL1 CURVE MULTPUR	BOTH IP/OP	$238.50 	$176.49	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$49.71	$177.01	$177.01	$0.00	$0.00	$49.70	$0.00	$141.07	$141.07	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
G56228	SUP	HCPCS C1894		G56228  -  INTRODUCER SHEATH .035IN 8FR .113IN 70CM ANL1 CURVE MULTPUR	BOTH IP/OP	$238.50 	$176.49	$0.00	$180.00	$122.18	$122.18	$0.00	$0.00	$0.00	$49.71	$177.01	$177.01	$0.00	$0.00	$49.70	$0.00	$141.07	$141.07	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
G56277	SUP	HCPCS C1751		G56277  -  TRAY CATHETER CEN VEN STERILE	BOTH IP/OP	$463.00 	$342.62	$0.00	$370.39	$251.40	$251.40	$0.00	$0.00	$0.00	$96.50	$343.64	$343.64	$0.00	$0.00	$96.49	$0.00	$273.86	$273.86	$0.00	$231.50	$366.69	$370.39	$0.00		$0.00	$72.46	$0.00	$0.00	$73.71	$0.00	$0.00	$0.00	$0.00	$0.00
G56278	SUP	HCPCS C1892		G56278  -  INTRODUCER SHEATH .035IN 10FR .134IN 45CM ANL0 CURVE STR TIP	BOTH IP/OP	$212.00 	$156.88	$0.00	$157.35	$101.81	$101.81	$0.00	$0.00	$0.00	$44.19	$157.35	$157.35	$0.00	$0.00	$44.18	$0.00	$125.40	$125.40	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
G56279	SUP	HCPCS C1892		G56279  -  INTRODUCER SHEATH .035IN 12FR .162IN 45CM ANL0 CURVE STR TIP	BOTH IP/OP	$212.00 	$156.88	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$44.19	$157.35	$157.35	$0.00	$0.00	$44.18	$0.00	$125.40	$125.40	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
G56334	SUP	HCPCS C1729		G56334  -  CATHETER DRN 16FR 15GA 30CM UNIVERSA MLCT NDL	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$53.76	$53.76	$0.00	$0.00	$0.00	$20.63	$73.48	$73.48	$0.00	$0.00	$20.63	$0.00	$58.56	$58.56	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$15.49	$0.00	$0.00	$15.76	$0.00	$0.00	$0.00	$0.00	$0.00
G56335	SUP	HCPCS C1729		G56335  -  CATHETER DRN 8FR 19GA 15CM UNIVERSA MLCT NDL	BOTH IP/OP	$99.00 	$73.26	$0.00	$79.20	$53.76	$53.76	$0.00	$0.00	$0.00	$20.63	$73.48	$73.48	$0.00	$0.00	$20.63	$0.00	$58.56	$58.56	$0.00	$49.50	$78.41	$79.20	$0.00		$0.00	$15.49	$0.00	$0.00	$15.76	$0.00	$0.00	$0.00	$0.00	$0.00
G56401	SUP	Custom 27203010		G56401  -  CATHETER DRN 10FR 18GA 15CM UNIVERSA MLCT NDL	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
G56428	SUP	HCPCS C1894		G56428  -  EXTRACTOR STON STD 10FR 1.5CM 38CM PERC NGAGE BSKT NTNL SS	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56429	SUP	HCPCS C1894		G56429  -  SHEATH ESCP 9.5FR 20CM STRL PRLL FLXR DIL HDRPH URETER DISP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56430	SUP	HCPCS C1894		G56430  -  SHEATH ESCP 9.5FR 28CM STRL PRLL FLXR DIL HDRPH URETER DISP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56431	SUP	HCPCS C1894		G56431  -  SHEATH ESCP 9.5FR 35CM STRL PRLL FLXR DIL HDRPH URETER DISP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56432	SUP	HCPCS C1894		G56432  -  SHEATH ESCP 9.5FR 45CM STRL PRLL FLXR DIL HDRPH URETER DISP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56433	SUP	HCPCS C1894		G56433  -  SHEATH ESCP 9.5FR 55CM STRL PRLL FLXR DIL HDRPH URETER DISP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56434	SUP	HCPCS C1894		G56434  -  SHEATH ESCP 12FR 20CM STRL PRLL FLXR DIL HDRPH URETER DISP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56435	SUP	HCPCS C1894		G56435  -  SHEATH ACC 12FR 28CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56436	SUP	HCPCS C1894		G56436  -  SHEATH ACC 12FR 35CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56438	SUP	HCPCS C1894		G56438  -  SHEATH ESCP 12FR 45CM STRL PRLL FLXR DIL HDRPH URETER DISP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56439	SUP	HCPCS C1894		G56439  -  SHEATH ESCP 12FR 55CM STRL PRLL FLXR DIL HDRPH URETER DISP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56440	SUP	HCPCS C1894		G56440  -  SHEATH ESCP 14FR 20CM STRL PRLL FLXR DIL HDRPH URETER DISP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56441	SUP	HCPCS C1894		G56441  -  SHEATH ACC 14FR 28CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56442	SUP	HCPCS C1894		G56442  -  SHEATH ACC 14FR 35CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56443	SUP	HCPCS C1894		G56443  -  SHEATH ESCP 14FR 45CM STRL PRLL FLXR DIL HDRPH URETER DISP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56445	SUP	HCPCS C1894		G56445  -  SHEATH ESCP 14FR 55CM STRL PRLL FLXR DIL HDRPH URETER DISP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56446	SUP	HCPCS C1894		G56446  -  SHEATH ESCP 9.5FR 13CM STRL PRLL FLXR DIL HDRPH URETER DISP	BOTH IP/OP	$325.00 	$240.50	$0.00	$260.00	$176.48	$176.48	$0.00	$0.00	$0.00	$67.74	$241.22	$241.22	$0.00	$0.00	$67.73	$0.00	$192.24	$192.24	$0.00	$162.50	$257.40	$260.00	$0.00		$0.00	$50.86	$0.00	$0.00	$51.74	$0.00	$0.00	$0.00	$0.00	$0.00
G56537	SUP	Custom 27203010		G56537  -  TRAY SURG 14FR 18GA 29CM 5CM 19 SIDEPORT CATHETER ECHOGENIC	BOTH IP/OP	$450.38 	$333.28	$0.00	$663.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$334.27	$334.27	$0.00	$0.00	$93.86	$0.00	$0.00	$0.00	$0.00	$414.99	$657.34	$663.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GA3501	SUP	HCPCS C1769		GA3501  -  GUIDEWIRE VASC ANG .035IN 180CM 25CM GLDWR ADV PTFE NTNL	BOTH IP/OP	$400.00 	$296.00	$0.00	$320.00	$217.20	$217.20	$0.00	$0.00	$0.00	$83.37	$296.88	$296.88	$0.00	$0.00	$83.36	$0.00	$236.60	$236.60	$0.00	$200.00	$316.80	$320.00	$0.00		$0.00	$62.60	$0.00	$0.00	$63.68	$0.00	$0.00	$0.00	$0.00	$0.00
GA3502	SUP	HCPCS C1769		GA3502  -  GUIDEWIRE VASCULAR ANGLED .035IN 260CM 25CM GLIDEWIRE	BOTH IP/OP	$575.00 	$425.50	$0.00	$426.77	$244.35	$244.35	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$225.00	$356.40	$360.00	$0.00		$0.00	$70.43	$0.00	$0.00	$71.64	$0.00	$0.00	$0.00	$0.00	$0.00
GD-1115-100	SUP	Custom 27203010		GD-1115-100  -  CANNULA ASCP 10CM OSTEOPRECISION VNT	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	$0.00	$0.00	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GEM1521	SUP	Custom 27203010		GEM1521  -  CLIP HEMOSTATIC 30 CARTRIDGE SUPERFINE GEM BLUE TITANIUM	BOTH IP/OP	$29.17 	$21.59	$0.00	$23.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.65	$21.65	$0.00	$0.00	$6.08	$0.00	$0.00	$0.00	$0.00	$14.58	$23.10	$23.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GEM2431	SUP	Custom 27203010		GEM2431  -  CLIP INTNL MIC GM CRTDG TI HMST	BOTH IP/OP	$25.83 	$19.11	$0.00	$20.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.17	$19.17	$0.00	$0.00	$5.38	$0.00	$0.00	$0.00	$0.00	$12.92	$20.46	$20.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GEM2751	SUP	Custom 27803010		GEM2751  -  COUPLER ANSTM 1.5MM STRL GM MCVSC ANSTM DISP	BOTH IP/OP	$645.83 	$477.91	$0.00	$516.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$479.34	$479.34	$0.00	$0.00	$134.59	$0.00	$0.00	$0.00	$0.00	$322.92	$511.50	$516.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GEM2752	SUP	Custom 27803010		GEM2752  -  COUPLER ANSTM 20MHZ 2MM STRL LF GM RING PIN US DPLR SS DISP	BOTH IP/OP	$770.83 	$570.41	$0.00	$598.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$572.11	$572.11	$0.00	$0.00	$160.64	$0.00	$0.00	$0.00	$0.00	$373.96	$592.35	$598.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GEM2753	SUP	Custom 27803010		GEM2753  -  COUPLER ANSTM 20MHZ 2.5MM STRL LF GM RING PIN US DPLR SS	BOTH IP/OP	$770.83 	$570.41	$0.00	$598.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$572.11	$572.11	$0.00	$0.00	$160.64	$0.00	$0.00	$0.00	$0.00	$373.96	$592.35	$598.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GEM2754	SUP	Custom 27803010		GEM2754  -  COUPLER ANSTM 3MM STRL GM MCVSC DISP	BOTH IP/OP	$770.83 	$570.41	$0.00	$598.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$572.11	$572.11	$0.00	$0.00	$160.64	$0.00	$0.00	$0.00	$0.00	$373.96	$592.35	$598.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GEM2756	SUP	Custom 27803010		GEM2756  -  COUPLER ANSTM 4MM STRL GM MCVSC ANSTM DISP	BOTH IP/OP	$770.83 	$570.41	$0.00	$598.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$572.11	$572.11	$0.00	$0.00	$160.64	$0.00	$0.00	$0.00	$0.00	$373.96	$592.35	$598.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GEZ6200US7B	SUP	HCPCS C1757		GEZ6200US7B  -  CATHETER THROMBECTOMY 7FR .08IN 145CM ASPIRAT FULL-WALL	BOTH IP/OP	"$1,425.00 "	"$1,054.50"	$0.00	"$1,140.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$297.01	"$1,057.64"	"$1,057.64"	$0.00	$0.00	$296.97	$0.00	$842.89	$842.89	$0.00	$712.50	"$1,128.60"	"$1,140.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GFS-10A	SUP	Custom 27203010		GFS-10A  -  PASSER SUT STRL LF GAB/FRAT GD ORG VLV IMPL	BOTH IP/OP	$950.18 	$703.13	$0.00	$760.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$705.22	$705.22	$0.00	$0.00	$198.02	$0.00	$0.00	$0.00	$0.00	$475.09	$752.54	$760.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GFS-1A	SUP	Custom 27203010		GFS-1A  -  PASSER SUTURE GUIDE ORGANIZER LATEX FREE GABBAY-FRATER VALVE	BOTH IP/OP	$403.53 	$298.61	$0.00	$322.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$299.50	$299.50	$0.00	$0.00	$84.09	$0.00	$0.00	$0.00	$0.00	$201.76	$319.60	$322.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GH-05501	SUP	HCPCS C1729		KIT EPDRL 9.84CM 17GA CATH	BOTH IP/OP	$90.80 	$67.19	$0.00	$72.64	$49.30	$49.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.40	$71.91	$72.64	$0.00		$0.00	$14.21	$0.00	$0.00	$14.46	$0.00	$0.00	$0.00	$0.00	$0.00
GIA10038L	SUP	Custom 27203010		GIA10038L  -  RELOAD STPLR 100MMX3.8MM BLU STRL LF 1.5MM DST GIA 4 ROW LNR	BOTH IP/OP	$268.10 	$198.39	$0.00	$217.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.98	$198.98	$0.00	$0.00	$55.87	$0.00	$0.00	$0.00	$0.00	$136.06	$215.52	$217.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GIA10038S	SUP	Custom 27203010		GIA10038S  -  STAPLER INTERNAL 100MMX3.8MM 1.5MM 2 STAGGER ROW STAPLE LOAD	BOTH IP/OP	$514.53 	$380.75	$0.00	$417.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$381.88	$381.88	$0.00	$0.00	$107.23	$0.00	$0.00	$0.00	$0.00	$261.12	$413.61	$417.79	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GIA10048L	SUP	Custom 27203010		GIA10048L  -  RELOAD STPLR 100MMX4.8MM GRN STRL LF 2MM DST GIA 4 ROW LNR	BOTH IP/OP	$268.10 	$198.39	$0.00	$220.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.98	$198.98	$0.00	$0.00	$55.87	$0.00	$0.00	$0.00	$0.00	$137.52	$217.83	$220.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GIA10048S	SUP	Custom 27203010		GIA10048S  -  STAPLER INTERNAL 104MMX4.8MM 2MM 2 STAGGER ROW STAPLE LOAD	BOTH IP/OP	$564.67 	$417.86	$0.00	$451.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$419.10	$419.10	$0.00	$0.00	$117.68	$0.00	$0.00	$0.00	$0.00	$282.34	$447.22	$451.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GIA6025L	SUP	Custom 27203010		GIA6025L  -  RELOAD STPLR 60MMX2.5MM WHT STRL LF 1MM DST GIA 4 ROW LNR	BOTH IP/OP	$128.02 	$94.73	$0.00	$102.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.01	$95.01	$0.00	$0.00	$26.68	$0.00	$0.00	$0.00	$0.00	$64.01	$101.39	$102.41	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GIA6038L	SUP	Custom 27203010		GIA6038L  -  RELOAD STPLR 60MMX3.8MM BLU STRL LF 1.5MM DST GIA 4 ROW LNR	BOTH IP/OP	$117.10 	$86.65	$0.00	$95.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.91	$86.91	$0.00	$0.00	$24.40	$0.00	$0.00	$0.00	$0.00	$59.43	$94.14	$95.09	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GIA6038S	SUP	Custom 27203010		GIA6038S  -  STAPLER INTERNAL TEARDROP 60MMX3.8MM 1.5MM 4 ROW 2 STAGGER	BOTH IP/OP	$222.80 	$164.87	$0.00	$180.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.36	$165.36	$0.00	$0.00	$46.43	$0.00	$0.00	$0.00	$0.00	$113.07	$179.10	$180.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GIA6048L	SUP	Custom 27203010		GIA6048L  -  RELOAD STPLR 60MMX4.8MM GRN STRL LF 2MM DST GIA 4 ROW LNR	BOTH IP/OP	$115.40 	$85.40	$0.00	$93.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.65	$85.65	$0.00	$0.00	$24.05	$0.00	$0.00	$0.00	$0.00	$58.57	$92.77	$93.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GIA6048S	SUP	Custom 27203010		GIA6048S  -  STAPLER INTERNAL TEARDROP 60MMX4.8MM 2MM 4 ROW 2 STAGGER	BOTH IP/OP	$228.58 	$169.15	$0.00	$182.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.65	$169.65	$0.00	$0.00	$47.64	$0.00	$0.00	$0.00	$0.00	$114.29	$181.04	$182.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GIA8038L	SUP	Custom 27203010		GIA8038L  -  RELOAD STPLR 80MMX3.8MM BLU STRL LF 1.5MM DST GIA 4 ROW LNR	BOTH IP/OP	$171.20 	$126.69	$0.00	$139.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.06	$127.06	$0.00	$0.00	$35.68	$0.00	$0.00	$0.00	$0.00	$86.88	$137.63	$139.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GIA8038S	SUP	Custom 27203010		GIA8038S  -  STAPLER INTERNAL TEARDROP 80MMX3.8MM 1.5MM 4 ROW 2 STAGGER	BOTH IP/OP	$328.33 	$242.96	$0.00	$266.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$243.68	$243.68	$0.00	$0.00	$68.42	$0.00	$0.00	$0.00	$0.00	$166.63	$263.93	$266.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GIA8048L	SUP	Custom 27203010		GIA8048L  -  RELOAD STPLR 80MMX4.8MM GRN STRL LF 2MM DST GIA 4 ROW LNR	BOTH IP/OP	$171.20 	$126.69	$0.00	$139.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.06	$127.06	$0.00	$0.00	$35.68	$0.00	$0.00	$0.00	$0.00	$86.88	$137.63	$139.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GIA8048S	SUP	Custom 27203010		GIA8048S  -  STAPLER INTERNAL TEARDROP 80MMX4.8MM 2MM 4 ROW 2 STAGGER	BOTH IP/OP	$336.83 	$249.25	$0.00	$269.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.99	$249.99	$0.00	$0.00	$70.19	$0.00	$0.00	$0.00	$0.00	$168.41	$266.77	$269.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GJ44	SUP	HCPCS Q4107		GJ44  -  GRAFT SKIN 4CMX4CMX.38-1.02MM GRAFTJACKET THK.4-.8MM REGENER	BOTH IP/OP	"$4,302.50 "	"$3,183.85"	$0.00	"$3,442.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,193.32"	"$3,193.32"	$0.00	$0.00	$109.65	$0.00	$0.00	$0.00	$0.00	"$2,151.25"	"$3,407.58"	"$3,442.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GJ48	SUP	HCPCS Q4107		GJ48  -  GRAFT SKIN 8CMX4CMX.38-1.02MM GRAFTJACKET THK.4-.8MM REGENER	BOTH IP/OP	"$7,570.20 "	"$5,601.95"	$0.00	"$6,056.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,618.60"	"$5,618.60"	$0.00	$0.00	$109.65	$0.00	$0.00	$0.00	$0.00	"$3,785.10"	"$5,995.60"	"$6,056.16"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GJX	SUP	HCPCS Q4113		GJX  -  GRAFT SKN 2ML GTJKT XPRESS SFT TIS SCFLD FLW ACLR DRML MTRX	BOTH IP/OP	"$4,840.00 "	"$3,581.60"	$0.00	"$3,872.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,592.25"	"$3,592.25"	$0.00	$0.00	"$1,008.66"	$0.00	$0.00	$0.00	$0.00	"$2,420.00"	"$3,833.28"	"$3,872.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GLU-50122	SUP	HCPCS A6196		GLU-50122  -  DRESSING WND 12X5IN STRL LF GLUCAN II B GLUCAN CLGN DISP	BOTH IP/OP	$170.71 	$126.33	$0.00	$136.57	$92.69	$92.69	$0.00	$0.00	$0.00	$0.00	$126.70	$126.70	$0.00	$0.00	$35.58	$0.00	$0.00	$0.00	$0.00	$85.35	$135.20	$136.57	$0.00		$0.00	$26.72	$0.00	$0.00	$27.18	$0.00	$0.00	$0.00	$0.00	$0.00
GM1253-1720	SUP	Custom 27203010		GM1253-1720  -  SET 3 NEEDLES W/MARKER 1.2X5MM	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GM1601	SUP	HCPCS C1769		GM1601  -  GWIRE VASC 45D .016IN 180CM 2MM ANG FLX TP TRQ DEV GLDWR GL	BOTH IP/OP	$725.00 	$536.50	$0.00	$580.00	$393.68	$393.68	$0.00	$0.00	$0.00	$151.11	$538.10	$538.10	$0.00	$0.00	$151.09	$0.00	$428.84	$428.84	$0.00	$362.50	$574.20	$580.00	$0.00		$0.00	$113.46	$0.00	$0.00	$115.42	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-DSP-160	SUP	HCPCS C1713		"GMN-DSP-160  -  PLATE DORSAL SPANNING, SHORT"	BOTH IP/OP	"$2,990.00 "	"$2,212.60"	$0.00	"$2,392.00"	"$1,345.50"	"$1,345.50"	$0.00	$0.00	$0.00	$623.19	"$2,219.18"	"$2,219.18"	$0.00	$0.00	$623.12	$0.00	"$1,474.07"	"$1,474.07"	$0.00	"$1,495.00"	"$2,368.08"	"$2,392.00"	$0.00		$0.00	$467.94	$0.00	$0.00	$476.01	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-DSP-210	SUP	HCPCS C1713		GMN-DSP-210  -  PLATE DORSAL SPANNING	BOTH IP/OP	"$2,990.00 "	"$2,212.60"	$0.00	"$2,392.00"	"$1,345.50"	"$1,345.50"	$0.00	$0.00	$0.00	$623.19	"$2,219.18"	"$2,219.18"	$0.00	$0.00	$623.12	$0.00	"$1,474.07"	"$1,474.07"	$0.00	"$1,495.00"	"$2,368.08"	"$2,392.00"	$0.00		$0.00	$467.94	$0.00	$0.00	$476.01	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-HP	SUP	HCPCS C1713		GMN-HP  -  PLATE BN GEMINUS HK VOLR	BOTH IP/OP	$990.00 	$732.60	$0.00	$792.00	$445.50	$445.50	$0.00	$0.00	$0.00	$206.34	$734.78	$734.78	$0.00	$0.00	$206.32	$0.00	$585.59	$585.59	$0.00	$495.00	$784.08	$792.00	$0.00		$0.00	$154.94	$0.00	$0.00	$157.61	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-HP-SCRW	SUP	HCPCS C1713		GMN-HP-SCRW  -  PLATE BN GEMINUS HK SCR VOLR	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-LTN-3HL	SUP	HCPCS C1713		GMN-LTN-3HL  -  PLATE BN NAR NS GEMINUS 3 HL TI LT DIST VOLR RDS FOSSA	BOTH IP/OP	"$1,990.00 "	"$1,472.60"	$0.00	"$1,592.00"	$895.50	$895.50	$0.00	$0.00	$0.00	$414.77	"$1,476.98"	"$1,476.98"	$0.00	$0.00	$414.72	$0.00	"$1,177.09"	"$1,177.09"	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$311.44	$0.00	$0.00	$316.81	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-LTN-4HL	SUP	HCPCS C1713		GMN-LTN-4HL  -  PLATE BN NAR NS GEMINUS 4 HL TI LT DIST VOLR RDS FOSSA	BOTH IP/OP	"$1,990.00 "	"$1,472.60"	$0.00	"$1,592.00"	$895.50	$895.50	$0.00	$0.00	$0.00	$414.77	"$1,476.98"	"$1,476.98"	$0.00	$0.00	$414.72	$0.00	"$1,177.09"	"$1,177.09"	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$311.44	$0.00	$0.00	$316.81	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-LTS-3HL	SUP	HCPCS C1713		GMN-LTS-3HL  -  PLATE BN STD NS GEMINUS 3 HL TI RDS LT VOLR DIST	BOTH IP/OP	"$2,237.50 "	"$1,655.75"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$466.35	"$1,660.67"	"$1,660.67"	$0.00	$0.00	$466.30	$0.00	"$1,323.48"	"$1,323.48"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-LTS-4HL	SUP	HCPCS C1713		GMN-LTS-4HL  -  PLATE BN STD NS GEMINUS 4 HL TI LT DIST VOLR RDS FOSSA	BOTH IP/OP	"$1,990.00 "	"$1,472.60"	$0.00	"$1,592.00"	$895.50	$895.50	$0.00	$0.00	$0.00	$414.77	"$1,476.98"	"$1,476.98"	$0.00	$0.00	$414.72	$0.00	"$1,177.09"	"$1,177.09"	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$311.44	$0.00	$0.00	$316.81	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-LTS-7HL	SUP	HCPCS C1713		GMN-LTS-7HL  -  PLATE BN STD NS GEMINUS 7 HL TI LT DIST VOLR RDS FOSSA	BOTH IP/OP	"$2,190.00 "	"$1,620.60"	$0.00	"$1,752.00"	$985.50	$985.50	$0.00	$0.00	$0.00	$456.45	"$1,625.42"	"$1,625.42"	$0.00	$0.00	$456.40	$0.00	"$1,295.39"	"$1,295.39"	$0.00	"$1,095.00"	"$1,734.48"	"$1,752.00"	$0.00		$0.00	$342.74	$0.00	$0.00	$348.65	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-LTW-4HL	SUP	HCPCS C1713		GMN-LTW-4HL  -  PLATE BN W NS GEMINUS 4 HL TI LT DIST VOLR RDS FOSSA	BOTH IP/OP	"$1,990.00 "	"$1,472.60"	$0.00	"$1,592.00"	$895.50	$895.50	$0.00	$0.00	$0.00	$414.77	"$1,476.98"	"$1,476.98"	$0.00	$0.00	$414.72	$0.00	"$1,177.09"	"$1,177.09"	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$311.44	$0.00	$0.00	$316.81	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-RTN-3HL	SUP	HCPCS C1713		GMN-RTN-3HL  -  PLATE BN NAR NS GEMINUS 3 HL TI RT DIST VOLR RDS FOSSA	BOTH IP/OP	"$1,990.00 "	"$1,472.60"	$0.00	"$1,592.00"	$895.50	$895.50	$0.00	$0.00	$0.00	$414.77	"$1,476.98"	"$1,476.98"	$0.00	$0.00	$414.72	$0.00	"$1,177.09"	"$1,177.09"	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$311.44	$0.00	$0.00	$316.81	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-RTN-4HL	SUP	HCPCS C1713		GMN-RTN-4HL  -  PLATE BN NAR NS GEMINUS 4 HL TI RT DIST VOLR RDS FOSSA	BOTH IP/OP	"$1,990.00 "	"$1,472.60"	$0.00	"$1,592.00"	$895.50	$895.50	$0.00	$0.00	$0.00	$414.77	"$1,476.98"	"$1,476.98"	$0.00	$0.00	$414.72	$0.00	"$1,177.09"	"$1,177.09"	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$311.44	$0.00	$0.00	$316.81	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-RTS-3HL	SUP	HCPCS C1713		GMN-RTS-3HL  -  PLATE BN STD NS GEMINUS 3 HL TI RT DIST VOLR RDS	BOTH IP/OP	"$1,990.00 "	"$1,472.60"	$0.00	"$1,592.00"	$895.50	$895.50	$0.00	$0.00	$0.00	$414.77	"$1,476.98"	"$1,476.98"	$0.00	$0.00	$414.72	$0.00	"$1,177.09"	"$1,177.09"	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$311.44	$0.00	$0.00	$316.81	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-RTS-4HL	SUP	HCPCS C1713		GMN-RTS-4HL  -  PLATE BN STD NS GEMINUS 4 HL TI RT DIST VOLR RDS FOSSA	BOTH IP/OP	"$1,990.00 "	"$1,472.60"	$0.00	"$1,592.00"	$895.50	$895.50	$0.00	$0.00	$0.00	$414.77	"$1,476.98"	"$1,476.98"	$0.00	$0.00	$414.72	$0.00	"$1,177.09"	"$1,177.09"	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$311.44	$0.00	$0.00	$316.81	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-RTS-7HL	SUP	HCPCS C1713		GMN-RTS-7HL  -  PLATE BN STD NS GEMINUS 7 HL TI RDS RT FOSSA DIST	BOTH IP/OP	"$2,190.00 "	"$1,620.60"	$0.00	"$1,752.00"	$985.50	$985.50	$0.00	$0.00	$0.00	$456.45	"$1,625.42"	"$1,625.42"	$0.00	$0.00	$456.40	$0.00	"$1,295.39"	"$1,295.39"	$0.00	"$1,095.00"	"$1,734.48"	"$1,752.00"	$0.00		$0.00	$342.74	$0.00	$0.00	$348.65	$0.00	$0.00	$0.00	$0.00	$0.00
GMN-RTW-4HL	SUP	HCPCS C1713		GMN-RTW-4HL  -  PLATE BN W NS GEMINUS 4 HL TI RDS RT DIST FOSSA	BOTH IP/OP	"$1,990.00 "	"$1,472.60"	$0.00	"$1,592.00"	$895.50	$895.50	$0.00	$0.00	$0.00	$414.77	"$1,476.98"	"$1,476.98"	$0.00	$0.00	$414.72	$0.00	"$1,177.09"	"$1,177.09"	$0.00	$995.00	"$1,576.08"	"$1,592.00"	$0.00		$0.00	$311.44	$0.00	$0.00	$316.81	$0.00	$0.00	$0.00	$0.00	$0.00
GN1000	SUP	Custom 27803010		GN1000  -  KIT SNR 10MM 4FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$612.32	$612.32	$0.00	$0.00	$171.93	$0.00	$0.00	$0.00	$0.00	$412.50	$653.40	$660.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GN1500	SUP	Custom 27203010		GN1500  -  KIT VASC 120CM 15MM 6FR AGN NTNL GOLD TUNG LOOP CATH NTNL	BOTH IP/OP	$800.00 	$592.00	$0.00	$593.76	$0.00	$0.00	$0.00	$0.00	$0.00	$166.74	$593.76	$593.76	$0.00	$0.00	$166.72	$0.00	$473.20	$473.20	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GN2500	SUP	Custom 27803010		GN2500  -  KIT SNR 25MM 6FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ	BOTH IP/OP	$800.00 	$592.00	$0.00	$640.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$593.76	$593.76	$0.00	$0.00	$166.72	$0.00	$0.00	$0.00	$0.00	$400.00	$633.60	$640.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GN500	SUP	Custom 27803010		GN500  -  KIT SNR 5MM 4FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ	BOTH IP/OP	$747.25 	$552.97	$0.00	$554.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$554.61	$554.61	$0.00	$0.00	$155.73	$0.00	$0.00	$0.00	$0.00	$337.50	$534.60	$540.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GOLD-18	SUP	HCPCS L8610		GOLD-18  -  WEIGHT EYELID 3 SUTURE HOLE SUTUREGROOVE GOLD 1.8GM STERILE	BOTH IP/OP	$800.00 	$592.00	$0.00	$640.00	$360.00	$360.00	$0.00	$0.00	$0.00	$166.74	$593.76	$593.76	$0.00	$0.00	$166.72	$0.00	$473.20	$473.20	$0.00	$400.00	$633.60	$640.00	$0.00		$0.00	$125.20	$0.00	$0.00	$127.36	$0.00	$0.00	$0.00	$0.00	$0.00
GPSL	SUP	HCPCS C1781		GPSL  -  MESH SURG GYNMSH 6X4IN PLVC NABSB SFT KNTD LTWT STRL POLYPRO	BOTH IP/OP	$847.00 	$626.78	$0.00	$677.60	$381.15	$381.15	$0.00	$0.00	$0.00	$176.54	$628.64	$628.64	$0.00	$0.00	$176.51	$0.00	$501.00	$501.00	$0.00	$423.50	$670.82	$677.60	$0.00		$0.00	$132.56	$0.00	$0.00	$134.84	$0.00	$0.00	$0.00	$0.00	$0.00
GPSXL3	SUP	HCPCS C1781		GPSXL3  -  MESH SURG 25X25CM SOFT KNIT NONABSORBABLE GYNECARE GYNEMESH	BOTH IP/OP	"$4,367.00 "	"$3,231.58"	$0.00	"$3,493.60"	"$1,965.15"	"$1,965.15"	$0.00	$0.00	$0.00	$910.19	"$3,241.19"	"$3,241.19"	$0.00	$0.00	$910.08	$0.00	"$2,152.93"	"$2,152.93"	$0.00	"$2,183.50"	"$3,458.66"	"$3,493.60"	$0.00		$0.00	$683.44	$0.00	$0.00	$695.23	$0.00	$0.00	$0.00	$0.00	$0.00
GR1807	SUP	HCPCS C1769		GR1807  -  GUIDEWIRE VASCULAR ANGLE .018IN 260CM 3CM GLIDEWIRE HYDPHI	BOTH IP/OP	"$1,010.63 "	$747.87	$0.00	$780.00	$529.43	$529.43	$0.00	$0.00	$0.00	$210.64	$750.09	$750.09	$0.00	$0.00	$210.61	$0.00	$597.78	$597.78	$0.00	$487.50	$772.20	$780.00	$0.00		$0.00	$152.59	$0.00	$0.00	$155.22	$0.00	$0.00	$0.00	$0.00	$0.00
GR3501	SUP	HCPCS C1769		GR3501  -  GUIDEWIRE VASC STRG .035IN 150CM 3CM GLDWR STF SHFT HDRPH	BOTH IP/OP	$80.45 	$59.53	$0.00	$59.71	$39.37	$39.37	$0.00	$0.00	$0.00	$16.77	$59.71	$59.71	$0.00	$0.00	$16.77	$0.00	$47.59	$47.59	$0.00	$36.25	$57.42	$58.00	$0.00		$0.00	$11.35	$0.00	$0.00	$11.54	$0.00	$0.00	$0.00	$0.00	$0.00
GR3503	SUP	HCPCS C1769		GR3503  -  GUIDEWIRE VASCULAR STANDARD STR .035IN 180CM 3CM JACKET CORE	BOTH IP/OP	$108.00 	$79.92	$0.00	$80.16	$53.89	$53.89	$0.00	$0.00	$0.00	$22.51	$80.16	$80.16	$0.00	$0.00	$22.51	$0.00	$63.88	$63.88	$0.00	$49.63	$78.61	$79.40	$0.00		$0.00	$15.53	$0.00	$0.00	$15.80	$0.00	$0.00	$0.00	$0.00	$0.00
GR3504	SUP	HCPCS C1769		GR3504  -  GUIDEWIRE VASCULAR STANDARD STR .035IN 260CM 3CM JACKET CORE	BOTH IP/OP	$120.75 	$89.36	$0.00	$89.62	$60.27	$60.27	$0.00	$0.00	$0.00	$25.17	$89.62	$89.62	$0.00	$0.00	$25.16	$0.00	$71.42	$71.42	$0.00	$55.50	$87.91	$88.80	$0.00		$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
GR3508	SUP	HCPCS C1769		GR3508  -  GUIDEWIRE VASCULAR ANGLE STANDARD .035IN 180CM 3CM JACKET	BOTH IP/OP	$108.00 	$79.92	$0.00	$80.16	$53.89	$53.89	$0.00	$0.00	$0.00	$22.51	$80.16	$80.16	$0.00	$0.00	$22.51	$0.00	$63.88	$63.88	$0.00	$49.63	$78.61	$79.40	$0.00		$0.00	$15.53	$0.00	$0.00	$15.80	$0.00	$0.00	$0.00	$0.00	$0.00
GR3509	SUP	HCPCS C1769		GUIDEWIRE VASC .035IN 260CM 3CM ANG FLX TP STD GLDWR GR3509	BOTH IP/OP	$120.75 	$89.36	$0.00	$94.88	$64.40	$64.40	$0.00	$0.00	$0.00	$25.17	$89.62	$89.62	$0.00	$0.00	$25.16	$0.00	$71.42	$71.42	$0.00	$59.30	$93.93	$94.88	$0.00		$0.00	$18.56	$0.00	$0.00	$18.88	$0.00	$0.00	$0.00	$0.00	$0.00
GR3807	SUP	HCPCS C1769		GR3807  -  GUIDEWIRE VASCULAR ANGLED .038IN 150CM 8CM GLIDEWIRE HYDPHI	BOTH IP/OP	$89.00 	$65.86	$0.00	$66.06	$44.39	$44.39	$0.00	$0.00	$0.00	$18.55	$66.06	$66.06	$0.00	$0.00	$18.55	$0.00	$52.64	$52.64	$0.00	$40.88	$64.75	$65.40	$0.00		$0.00	$12.79	$0.00	$0.00	$13.01	$0.00	$0.00	$0.00	$0.00	$0.00
GR3808	SUP	HCPCS C1769		GR3808  -  GUIDEWIRE VASCULAR ANGLED .038IN 180CM 3CM GLIDEWIRE HYDPHI	BOTH IP/OP	$108.00 	$79.92	$0.00	$80.16	$53.89	$53.89	$0.00	$0.00	$0.00	$22.51	$80.16	$80.16	$0.00	$0.00	$22.51	$0.00	$63.88	$63.88	$0.00	$49.63	$78.61	$79.40	$0.00		$0.00	$15.53	$0.00	$0.00	$15.80	$0.00	$0.00	$0.00	$0.00	$0.00
GR3809	SUP	HCPCS C1769		GR3809  -  GUIDEWIRE VASCULAR ANGLED .038IN 260CM 3CM GLIDEWIRE HYDPHI	BOTH IP/OP	$120.75 	$89.36	$0.00	$89.62	$60.27	$60.27	$0.00	$0.00	$0.00	$25.17	$89.62	$89.62	$0.00	$0.00	$25.16	$0.00	$71.42	$71.42	$0.00	$55.50	$87.91	$88.80	$0.00		$0.00	$17.37	$0.00	$0.00	$17.67	$0.00	$0.00	$0.00	$0.00	$0.00
GR74089-02	SUP	Custom 27203010		GR74089-02  -  BAG TISS CLSR 7.5CM DRAIN WL DFCT 7.5CM SILO STRL DISP SIL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GRAD0026-06	SUP	HCPCS C1751		GRAD0026-06  -  TRAY SRG STRL PICC CTH LB RAD	BOTH IP/OP	$88.91 	$65.79	$0.00	$71.13	$48.28	$48.28	$0.00	$0.00	$0.00	$18.53	$65.99	$65.99	$0.00	$0.00	$18.53	$0.00	$52.59	$52.59	$0.00	$44.46	$70.42	$71.13	$0.00		$0.00	$13.92	$0.00	$0.00	$14.16	$0.00	$0.00	$0.00	$0.00	$0.00
GRAD0027-05	SUP	Custom 27203010		GRAD0027-05  -  TRAY SRG STRL VNS ACC CTH LB RAD	BOTH IP/OP	$117.73 	$87.12	$0.00	$94.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.38	$87.38	$0.00	$0.00	$24.54	$0.00	$0.00	$0.00	$0.00	$58.87	$93.24	$94.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GRAD0058-03	SUP	Custom 27203010		GRAD0058-03  -  TRAY NEURO ANGIO	BOTH IP/OP	$131.43 	$97.26	$0.00	$105.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.54	$97.54	$0.00	$0.00	$27.39	$0.00	$0.00	$0.00	$0.00	$65.71	$104.09	$105.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GRAD0059-03	SUP	Custom 27203010		GRAD0059-03  -  TRAY BX STRL LF AVID TRUCUSTOM DISP	BOTH IP/OP	$52.27 	$38.68	$0.00	$41.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.80	$38.80	$0.00	$0.00	$10.89	$0.00	$0.00	$0.00	$0.00	$26.14	$41.40	$41.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GS3503	SUP	HCPCS C1769		GS3503  -  GUIDEWIRE VASCULAR STR .035IN 180CM 3CM STIFF SHAFT	BOTH IP/OP	$116.75 	$86.40	$0.00	$93.40	$63.40	$63.40	$0.00	$0.00	$0.00	$24.33	$86.65	$86.65	$0.00	$0.00	$24.33	$0.00	$69.06	$69.06	$0.00	$58.38	$92.47	$93.40	$0.00		$0.00	$18.27	$0.00	$0.00	$18.59	$0.00	$0.00	$0.00	$0.00	$0.00
GS3504	SUP	HCPCS C1769		GS3504  -  GUIDEWIRE VASCULAR STR .035IN 260CM 3CM STIFF SHAFT FLEXIBLE	BOTH IP/OP	$135.58 	$100.33	$0.00	$100.62	$67.67	$67.67	$0.00	$0.00	$0.00	$28.26	$100.62	$100.62	$0.00	$0.00	$28.25	$0.00	$80.19	$80.19	$0.00	$62.31	$98.71	$99.70	$0.00		$0.00	$19.50	$0.00	$0.00	$19.84	$0.00	$0.00	$0.00	$0.00	$0.00
GS3506	SUP	HCPCS C1769		GS3506  -  GUIDEWIRE VASCULAR ANGLE .035IN 150CM 3CM FLEXIBLE TIP STIFF	BOTH IP/OP	$122.85 	$90.91	$0.00	$91.18	$61.29	$61.29	$0.00	$0.00	$0.00	$25.61	$91.18	$91.18	$0.00	$0.00	$25.60	$0.00	$72.67	$72.67	$0.00	$56.44	$89.40	$90.30	$0.00		$0.00	$17.66	$0.00	$0.00	$17.97	$0.00	$0.00	$0.00	$0.00	$0.00
GS3508	SUP	HCPCS C1769		GS3508  -  GUIDEWIRE VASCULAR ANGLE .035IN 180CM 3CM STIFF SHAFT	BOTH IP/OP	$127.18 	$94.11	$0.00	$94.39	$63.40	$63.40	$0.00	$0.00	$0.00	$26.51	$94.39	$94.39	$0.00	$0.00	$26.50	$0.00	$75.22	$75.22	$0.00	$58.38	$92.47	$93.40	$0.00		$0.00	$18.27	$0.00	$0.00	$18.59	$0.00	$0.00	$0.00	$0.00	$0.00
GS3509	SUP	HCPCS C1769		GS3509  -  GUIDEWIRE VASCULAR ANGLE .035IN 260CM 3CM STIFF SHAFT	BOTH IP/OP	$135.58 	$100.33	$0.00	$100.62	$67.67	$67.67	$0.00	$0.00	$0.00	$28.26	$100.62	$100.62	$0.00	$0.00	$28.25	$0.00	$80.19	$80.19	$0.00	$62.31	$98.71	$99.70	$0.00		$0.00	$19.50	$0.00	$0.00	$19.84	$0.00	$0.00	$0.00	$0.00	$0.00
GS3807	SUP	HCPCS C1769		GS3807  -  GUIDEWIRE VASCULAR ANGLE .038IN 180CM 3CM STIFF SHAFT	BOTH IP/OP	$127.18 	$94.11	$0.00	$94.39	$63.40	$63.40	$0.00	$0.00	$0.00	$26.51	$94.39	$94.39	$0.00	$0.00	$26.50	$0.00	$75.22	$75.22	$0.00	$58.38	$92.47	$93.40	$0.00		$0.00	$18.27	$0.00	$0.00	$18.59	$0.00	$0.00	$0.00	$0.00	$0.00
GSLM-14	SUP	HCPCS L8610		GSLM-14  -  WEIGHT EYELID SLIM SUTUREGROOVE THK.75MM GOLD 1.4GM STERILE	BOTH IP/OP	$700.00 	$518.00	$0.00	$560.00	$315.00	$315.00	$0.00	$0.00	$0.00	$145.90	$519.54	$519.54	$0.00	$0.00	$145.88	$0.00	$414.05	$414.05	$0.00	$350.00	$554.40	$560.00	$0.00		$0.00	$109.55	$0.00	$0.00	$111.44	$0.00	$0.00	$0.00	$0.00	$0.00
GSLM-16	SUP	HCPCS L8610		GSLM-16  -  WEIGHT EYELID SLIM SUTUREGROOVE THK.75MM GOLD 1.6GM STERILE	BOTH IP/OP	$750.00 	$555.00	$0.00	$600.00	$337.50	$337.50	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$117.38	$0.00	$0.00	$119.40	$0.00	$0.00	$0.00	$0.00	$0.00
GST45B	SUP	Custom 27203010		GST45B  -  RELOAD STPLR 45MMX3.6MM BLU STRL LF 1.5MM ECHLN EPTH ECHLN	BOTH IP/OP	$877.84 	$649.60	$0.00	$712.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$651.53	$651.53	$0.00	$0.00	$182.94	$0.00	$0.00	$0.00	$0.00	$445.50	$705.67	$712.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GST45G	SUP	Custom 27203010		GST45G  -  RELOAD STPLR 45MMX4.1MM GRN STRL LF 2MM ECHLN EPTH ECHLN FLX	BOTH IP/OP	$877.84 	$649.60	$0.00	"$8,427.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$651.53	$651.53	$0.00	$0.00	$182.94	$0.00	$0.00	$0.00	$0.00	"$5,267.01"	"$8,342.95"	"$8,427.22"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GST45W	SUP	Custom 27203010		GST45W  -  RELOAD STPLR 45MMX2.6MM WHT STRL LF 1MM ECHLN EPTH ECHLN FLX	BOTH IP/OP	$877.84 	$649.60	$0.00	$702.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$651.53	$651.53	$0.00	$0.00	$182.94	$0.00	$0.00	$0.00	$0.00	$438.92	$695.25	$702.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GST60G	SUP	Custom 27203010		GST60G  -  RELOAD STPLR 60MMX4.1MM GRN STRL LF 2MM ECHLN EPTH ECHLN FLX	BOTH IP/OP	$949.21 	$702.42	$0.00	$759.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$704.50	$704.50	$0.00	$0.00	$197.82	$0.00	$0.00	$0.00	$0.00	$474.60	$751.77	$759.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GST60W	SUP	Custom 27203010		GST60W  -  RELOAD STPLR 60MMX2.6MM WHT STRL LF 1MM ECHLN EPTH ECHLN FLX	BOTH IP/OP	$949.21 	$702.42	$0.00	$759.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$704.50	$704.50	$0.00	$0.00	$197.82	$0.00	$0.00	$0.00	$0.00	$474.60	$751.77	$759.37	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GTK14	SUP	Custom 27203010		GTK14  -  SYSTEM XTRT 14CM ALEXIS KII SPEC CNTN BG BLN BLNT TPGRD	BOTH IP/OP	$812.50 	$601.25	$0.00	$603.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GTK17	SUP	Custom 27203010		GTK17  -  SYSTEM XTRT 12X100MM 6500ML ALEXIS BLN BLNT TIP CNTN	BOTH IP/OP	$812.50 	$601.25	$0.00	$603.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.04	$603.04	$0.00	$0.00	$169.33	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GYN-0480	SUP	Custom 27203010		KIT SRPTH PK LAB CYTO 480 TST	BOTH IP/OP	"$7,380.00 "	"$5,461.20"	$0.00	"$5,904.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,690.00"	"$5,844.96"	"$5,904.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
GYN-0500-B	SUP	Custom 27203010		BRUSH CYTO BLUE BRM HNDL	BOTH IP/OP	$10.90 	$8.07	$0.00	$8.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.45	$8.63	$8.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H1058	SUP	Custom 27203010		MASK O2 PED NREB	BOTH IP/OP	$8.00 	$5.92	$0.00	$6.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.00	$6.34	$6.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H312-4	SUP	Custom 27203010		CHEMICAL LAB 3% H2O2 AMBR GLS BTL 4L	BOTH IP/OP	$460.25 	$340.59	$0.00	$368.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.13	$364.52	$368.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H470045A	SUP	HCPCS C1768		H470045A  -  GRAFT VASCULAR STANDARD WALL TAPER 4-7MM 45CM STRETCH COATED	BOTH IP/OP	"$3,147.50 "	"$2,329.15"	$0.00	"$2,518.00"	"$1,416.38"	"$1,416.38"	$0.00	$0.00	$0.00	$656.02	"$2,336.07"	"$2,336.07"	$0.00	$0.00	$655.94	$0.00	"$1,551.72"	"$1,551.72"	$0.00	"$1,573.75"	"$2,492.82"	"$2,518.00"	$0.00		$0.00	$492.58	$0.00	$0.00	$501.08	$0.00	$0.00	$0.00	$0.00	$0.00
H74912100012	SUP	HCPCS C1769		H74912100012  -  GUIDEWIRE VASCULAR STR FLOPPY SPRING COIL .014IN 300CM	BOTH IP/OP	$159.25 	$117.85	$0.00	$127.40	$86.47	$86.47	$0.00	$0.00	$0.00	$33.19	$118.20	$118.20	$0.00	$0.00	$33.19	$0.00	$94.20	$94.20	$0.00	$79.63	$126.13	$127.40	$0.00		$0.00	$24.92	$0.00	$0.00	$25.35	$0.00	$0.00	$0.00	$0.00	$0.00
H74912118012	SUP	HCPCS C1769		H74912118012  -  GUIDEWIRE VASCULAR STR SPRING COIL .014IN 300CM 3CM MODERATE	BOTH IP/OP	$796.25 	$589.23	$0.00	$637.00	$432.36	$432.36	$0.00	$0.00	$0.00	$165.96	$590.98	$590.98	$0.00	$0.00	$165.94	$0.00	$470.98	$470.98	$0.00	$398.13	$630.63	$637.00	$0.00		$0.00	$124.61	$0.00	$0.00	$126.76	$0.00	$0.00	$0.00	$0.00	$0.00
H74912119012	SUP	HCPCS C1769		H74912119012  -  GUIDEWIRE VASCULAR STR SPRING COIL .014IN 300CM EXTRA	BOTH IP/OP	$159.25 	$117.85	$0.00	$127.40	$86.47	$86.47	$0.00	$0.00	$0.00	$33.19	$118.20	$118.20	$0.00	$0.00	$33.19	$0.00	$94.20	$94.20	$0.00	$79.63	$126.13	$127.40	$0.00		$0.00	$24.92	$0.00	$0.00	$25.35	$0.00	$0.00	$0.00	$0.00	$0.00
H74912154012	SUP	HCPCS C1769		H74912154012  -  GUIDEWIRE VASCULAR STR FLOPPY INTERMEDIATE .014IN 300CM 35CM	BOTH IP/OP	$159.25 	$117.85	$0.00	$127.40	$86.47	$86.47	$0.00	$0.00	$0.00	$33.19	$118.20	$118.20	$0.00	$0.00	$33.19	$0.00	$94.20	$94.20	$0.00	$79.63	$126.13	$127.40	$0.00		$0.00	$24.92	$0.00	$0.00	$25.35	$0.00	$0.00	$0.00	$0.00	$0.00
H74912155012	SUP	HCPCS C1769		H74912155012  -  GUIDEWIRE VASCULAR STR .014IN 300CM EXTRA SUPPORT	BOTH IP/OP	$159.25 	$117.85	$0.00	$127.40	$86.47	$86.47	$0.00	$0.00	$0.00	$33.19	$118.20	$118.20	$0.00	$0.00	$33.19	$0.00	$94.20	$94.20	$0.00	$79.63	$126.13	$127.40	$0.00		$0.00	$24.92	$0.00	$0.00	$25.35	$0.00	$0.00	$0.00	$0.00	$0.00
H74914090100	SUP	HCPCS C1876		H74914090100  -  STENT EPRSTH 14MM 90MM 100MM VICI VNS STNT CATH NTNL ACPT	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
H74916060100	SUP	HCPCS C1876		H74916060100  -  STENT EPRSTH 16MM 60MM 100MM VICI VNS STNT CATH NTNL ACPT	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	"$2,250.00"	"$2,250.00"	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$782.50	$0.00	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74916090100	SUP	HCPCS C1876		H74916090100  -  STENT EPRSTH 16MM 90MM 100MM VICI VNS STNT CATH NTNL ACPT	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
H74917521	SUP	HCPCS C1769		H74917521  -  GUIDEWIRE VASCULAR STR SPRING COIL .014IN 300CM 5CM SUPER	BOTH IP/OP	$477.75 	$353.54	$0.00	$382.20	$259.42	$259.42	$0.00	$0.00	$0.00	$99.58	$354.59	$354.59	$0.00	$0.00	$99.56	$0.00	$282.59	$282.59	$0.00	$238.88	$378.38	$382.20	$0.00		$0.00	$74.77	$0.00	$0.00	$76.06	$0.00	$0.00	$0.00	$0.00	$0.00
H749201001900	SUP	HCPCS C1884		H749201001900  -  SYSTEM EMBOLIC PROTECTION .014IN 110UM 3.2FR 6FR 3.5-5.5MM	BOTH IP/OP	"$3,001.25 "	"$2,220.93"	$0.00	"$2,401.00"	"$1,350.56"	"$1,350.56"	$0.00	$0.00	$0.00	$625.54	"$2,227.53"	"$2,227.53"	$0.00	$0.00	$625.46	$0.00	"$1,479.62"	"$1,479.62"	$0.00	"$1,500.63"	"$2,376.99"	"$2,401.00"	$0.00		$0.00	$469.70	$0.00	$0.00	$477.80	$0.00	$0.00	$0.00	$0.00	$0.00
H749201003000	SUP	HCPCS C1884		H749201003000  -  SYSTEM EMBOLIC PROTECTION .014IN 110UM 3.2FR 6FR 3.5-5.5MM	BOTH IP/OP	"$3,001.25 "	"$2,220.93"	$0.00	"$2,401.00"	"$1,350.56"	"$1,350.56"	$0.00	$0.00	$0.00	$625.54	"$2,227.53"	"$2,227.53"	$0.00	$0.00	$625.46	$0.00	"$1,479.62"	"$1,479.62"	$0.00	"$1,500.63"	"$2,376.99"	"$2,401.00"	$0.00		$0.00	$469.70	$0.00	$0.00	$477.80	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062009150	SUP	HCPCS C1726		H7492062009150  -  CATH BALDILAT .014IN 3.2-2.3FR 1.5MM 135CM 9MM PTCA OTW TRK	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062009200	SUP	HCPCS C1726		H7492062009200  -  CATH BALDILAT .014IN 3.2-2.3FR 2MM 135CM 9MM PTCA OTW TRK	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062009250	SUP	HCPCS C1726		H7492062009250  -  CATH BALDILAT .014IN 3.2-2.4FR 2.5MM 135CM 9MM PTCA OTW TRK	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062009300	SUP	HCPCS C1726		H7492062009300  -  CATH BALDILAT .014IN 3.2-2.4FR 3MM 135CM 9MM PTCA OTW TRK	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062009350	SUP	HCPCS C1726		H7492062009350  -  CATH BALDILAT .014IN 3.5MM 135CM 9MM CORON OTW TRK TIP MAV	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062015150	SUP	HCPCS C1726		H7492062015150  -  CATH BALDILAT .014IN 3.2-2.3FR 1.5MM 135CM 15MM PTCA OTW TRK	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062015200	SUP	HCPCS C1726		H7492062015200  -  CATH BALDILAT .014IN 3.2-2.3FR 2MM 135CM 15MM PTCA OTW TRK	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062015250	SUP	HCPCS C1726		H7492062015250  -  CATH BALDILAT .014IN 3.2-2.4FR 2.5MM 135CM 15MM PTCA OTW TRK	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062015270	SUP	HCPCS C1726		H7492062015270  -  CATH BALDILAT .014IN 2.75MM 135CM 15MM CORON OTW TRK TIP MAV	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062015300	SUP	HCPCS C1726		H7492062015300  -  CATH BALDILAT .014IN 3.2-2.4FR 3MM 135CM 15MM PTCA OTW TRK	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062015350	SUP	HCPCS C1726		H7492062015350  -  CATH BALDILAT .014IN 3.2-2.7FR 3.5MM 135CM 15MM PTCA OTW TRK	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062020150	SUP	HCPCS C1726		H7492062020150  -  CATH BALDILAT .014IN 3.2-2.3FR 1.5MM 135CM 20MM PTCA OTW TRK	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062020200	SUP	HCPCS C1726		H7492062020200  -  CATH BALDILAT .014IN 3.2-2.3FR 2MM 135CM 20MM PTCA OTW TRK	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062020250	SUP	HCPCS C1726		H7492062020250  -  CATH BALDILAT .014IN 3.2-2.4FR 2.5MM 135CM 20MM PTCA OTW TRK	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7492062020300	SUP	HCPCS C1726		H7492062020300  -  CATH BALDILAT .014IN 3MM 135CM 20MM CORON OTW TRK TIP MAV	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H749364560	SUP	HCPCS C1753		H749364560  -  CATHETER ULTRASOUND 95CM OTW ATLANTIS PV 15MHZ 8FR	BOTH IP/OP	"$1,925.00 "	"$1,424.50"	$0.00	"$1,540.00"	"$1,045.28"	"$1,045.28"	$0.00	$0.00	$0.00	$401.22	"$1,428.74"	"$1,428.74"	$0.00	$0.00	$401.17	$0.00	"$1,138.64"	"$1,138.64"	$0.00	$962.50	"$1,524.60"	"$1,540.00"	$0.00		$0.00	$301.26	$0.00	$0.00	$306.46	$0.00	$0.00	$0.00	$0.00	$0.00
H74937911415150	SUP	HCPCS C1877		H74937911415150  -  STENT BILIARY 4MM 15MM 150CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937911415900	SUP	HCPCS C1877		H74937911415900  -  STENT BILIARY 4MM 15MM 90CM PREMOUNT BALLOON EXPAND CATHETER	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937911515150	SUP	HCPCS C1877		H74937911515150  -  STENT BILIARY 5MM 15MM 150CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937911515900	SUP	HCPCS C2617		H74937911515900  -  STENT BILIARY SMALL 5MM 15MM 90CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937911614150	SUP	HCPCS C1877		H74937911614150  -  STENT BILIARY 6MM 14MM 150CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937911614900	SUP	HCPCS C2617		H74937911614900  -  STENT BILIARY SMALL 6MM 16MM 90CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937911715150	SUP	HCPCS C1877		H74937911715150  -  STENT BILIARY 7MM 15MM 150CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937911715900	SUP	HCPCS C1877		H74937911715900  -  STENT BILIARY SMALL 7MM 15MM 90CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937912419150	SUP	HCPCS C1877		H74937912419150  -  STENT BILIARY 4MM 19MM 150CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937912419900	SUP	HCPCS C1877		H74937912419900  -  STENT BILIARY 4MM 19MM 90CM PREMOUNTED BALLOON EXPANDING	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937912519150	SUP	HCPCS C1877		H74937912519150  -  STENT BILIARY 5MM 19MM 150CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937912519900	SUP	HCPCS C2617		H74937912519900  -  STENT BILIARY SMALL 5MM 19MM 90CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937912618150	SUP	HCPCS C1877		H74937912618150  -  STENT BILIARY 6MM 18MM 150CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937912618900	SUP	HCPCS C2617		H74937912618900  -  STENT BILIARY SMALL 6MM 18MM 90CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937912719150	SUP	HCPCS C1877		H74937912719150  -  STENT BILIARY 7MM 19MM 150CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74937912719900	SUP	HCPCS C1877		H74937912719900  -  STENT BILIARY SMALL 7MM 19MM 90CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H7493791540200	SUP	HCPCS C1725		H7493791540200  -  CATHETER BALDILAT 4MM 90CM 2CM SV RAPEX ULSF SV ANGIOPLST	BOTH IP/OP	"$1,162.50 "	$860.25	$0.00	$930.00	$631.24	$631.24	$0.00	$0.00	$0.00	$242.29	$862.81	$862.81	$0.00	$0.00	$242.27	$0.00	$687.62	$687.62	$0.00	$581.25	$920.70	$930.00	$0.00		$0.00	$181.93	$0.00	$0.00	$185.07	$0.00	$0.00	$0.00	$0.00	$0.00
H7493791550200	SUP	HCPCS C1726		H7493791550200  -  CATHETER BLNDIL 3.1FR 5MM 90CM 2CM ULSF SV PTA RX NONLASER	BOTH IP/OP	"$1,055.00 "	$780.70	$0.00	$844.00	$572.87	$572.87	$0.00	$0.00	$0.00	$219.89	$783.02	$783.02	$0.00	$0.00	$219.86	$0.00	$624.03	$624.03	$0.00	$527.50	$835.56	$844.00	$0.00		$0.00	$165.11	$0.00	$0.00	$167.96	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046102070	SUP	HCPCS C1877		H74938046102070  -  STENT BILIARY 30MM 10MM 25MM 75CM OTW PREMOUNT BALLOON	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046104070	SUP	HCPCS C1877		H74938046104070  -  STENT BILIARY 40MM 10MM 37MM 75CM OTW PREMOUNT CATHETER	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046106070	SUP	HCPCS C1877		H74938046106070  -  STENT BILIARY 60MM 10MM 57MM 75CM OTW PREMOUNT CATHETER	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046520750	SUP	HCPCS C1877		H74938046520750  -  STENT BILIARY 5MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046530750	SUP	HCPCS C1877		H74938046530750  -  STENT BILIARY 30MM 5MM 27MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046540750	SUP	HCPCS C1877		H74938046540750  -  STENT BILIARY 5MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046560750	SUP	HCPCS C1877		H74938046560750  -  STENT BILIARY 5MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046620750	SUP	HCPCS C1877		H74938046620750  -  STENT BILIARY 6MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046630750	SUP	HCPCS C1877		H74938046630750  -  STENT BILIARY 6MM 30MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046640750	SUP	HCPCS C1877		H74938046640750  -  STENT BILIARY 40MM 6MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046660750	SUP	HCPCS C1877		H74938046660750  -  STENT BILIARY 60MM 6MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046720750	SUP	HCPCS C1877		H74938046720750  -  STENT BILIARY 7MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046730750	SUP	HCPCS C1877		H74938046730750  -  STENT BILIARY 30MM 7MM 27MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046740750	SUP	HCPCS C1877		H74938046740750  -  STENT BILIARY 40MM 7MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046760750	SUP	HCPCS C1877		H74938046760750  -  STENT BILIARY 60MM 7MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046820750	SUP	HCPCS C1877		H74938046820750  -  STENT BILIARY 8MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046830750	SUP	HCPCS C1877		H74938046830750  -  STENT BILIARY 8MM 27MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046840750	SUP	HCPCS C1877		H74938046840750  -  STENT BILIARY 40MM 8MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046860750	SUP	HCPCS C1877		H74938046860750  -  STENT BILIARY 60MM 8MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046920750	SUP	HCPCS C1877		H74938046920750  -  STENT BILIARY 30MM 9MM 25MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046940750	SUP	HCPCS C1877		H74938046940750  -  STENT BILIARY 40MM 9MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938046960750	SUP	HCPCS C1877		H74938046960750  -  STENT BILIARY 60MM 9MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047120130	SUP	HCPCS C1877		H74938047120130  -  STENT BILIARY 30MM 10MM 25MM 135CM OTW PREMOUNT BALLOON	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047140130	SUP	HCPCS C1877		H74938047140130  -  STENT BILIARY 10MM 7FR 37MM 135CM BALLOON EXPANDABLE	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$67.50	$67.50	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047160130	SUP	HCPCS C1877		H74938047160130  -  STENT BILIARY 10MM 7FR 57MM 135CM BALLOON EXPANDABLE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047520130	SUP	HCPCS C1877		H74938047520130  -  STENT BILIARY .035IN 5MM 17MM 75CM CATHETER BALLOON INFLAT	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047530130	SUP	HCPCS C1877		H74938047530130  -  STENT BILIARY 5MM 27MM 135CM OTW BALLOON EXPAND PREMOUNT	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047540130	SUP	HCPCS C1877		H74938047540130  -  STENT BILIARY 5MM 40MM 135CM OTW BALLOON EXPAND PREMOUNT	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047560130	SUP	HCPCS C1877		H74938047560130  -  STENT BILIARY 5MM 6FR 60MM 135CM BALLOON EXPANDING	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047620130	SUP	HCPCS C1877		H74938047620130  -  STENT BILIARY 6MM 6FR 17MM 135CM PREMOUNTED BALLOON EXPRESS	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047630130	SUP	HCPCS C1877		H74938047630130  -  STENT BILIARY 30MM 6MM 27MM 135CM OTW PREMOUNT BALLOON	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047640130	SUP	HCPCS C1877		H74938047640130  -  STENT BILIARY 40MM 6MM 37MM 135CM OTW PREMOUNT BALLOON	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047660130	SUP	HCPCS C1877		H74938047660130  -  STENT BILIARY 9MM 6MM 57MM 135CM PREMOUNT BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047720130	SUP	HCPCS C1877		H74938047720130  -  STENT BILIARY 20MM 7MM 17MM 135CM OTW BALLOON EXPAND	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047730130	SUP	HCPCS C1877		H74938047730130  -  STENT BILIARY 30MM 7MM 27MM 135CM OTW PREMOUNT BALLOON	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047740130	SUP	HCPCS C1877		H74938047740130  -  STENT BILIARY 9MM 7MM 6FR 37MM 135CM BALLOON EXPANDABLE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047760130	SUP	HCPCS C1877		H74938047760130  -  STENT BILIARY 9MM 7MM 6FR 57MM 135CM BALLOON EXPANDABLE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047820130	SUP	HCPCS C1877		H74938047820130  -  STENT BILIARY 8MM 6FR 17MM 135CM BALLOON EXPANDABLE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047830130	SUP	HCPCS C1877		H74938047830130  -  STENT BILIARY 30MM 8MM 27MM 135CM OTW PREMOUNT BALLOON	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047840130	SUP	HCPCS C1877		H74938047840130  -  STENT BILIARY 8MM 37MM 135CM BALLOON EXPAND PREMOUNT EXPRESS	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047860130	SUP	HCPCS C1877		H74938047860130  -  STENT BILIARY 8MM 7IN 57MM 135CM OTW PREMOUNT BALLOON	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047920130	SUP	HCPCS C1877		H74938047920130  -  STENT BILIARY 30MM 9MM 25MM 135CM OTW PREMOUNT BALLOON	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047940130	SUP	HCPCS C1877		H74938047940130  -  STENT BILIARY 9MM 7FR 37MM 135CM BALLOON EXPANDABLE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74938047960130	SUP	HCPCS C1877		H74938047960130  -  STENT BILIARY 11MM 9MM 7FR 57MM 135CM PREMOUNT BALLOON	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808012200	SUP	HCPCS C1726		H7493808012200  -  CATH BALDILAT .014IN 2MM 12MM PCTA RAPEX LP TPR TIP Q M	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808012250	SUP	HCPCS C1726		H7493808012250  -  CATH BALDILAT 1.8-2.7FR 2.5MM 135CM 12MM PTCA RAPEX LP TPR	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808012300	SUP	HCPCS C1726		H7493808012300  -  CATH BALDILAT 3MM 135CM 12MM PCTA RAPEX LP TPR TIP Q M	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808012350	SUP	HCPCS C1726		H7493808012350  -  CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 12MM PTCA RAPEX	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808012400	SUP	HCPCS C1726		H7493808012400  -  CATH BALDILAT .014IN 1.8-2.7FR 4MM 135CM 12MM PTCA RAPEX LP	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808012450	SUP	HCPCS C1726		H7493808012450  -  CATH BALDILAT .014IN 2-2.7FR 4.5MM 135CM 12MM PTCA RAPEX LP	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H749380801250	SUP	HCPCS C1726		H749380801250  -  CATH BALDILAT .014IN 2-2.7FR 5MM 135CM 12MM PTCA RAPEX LP	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808015250	SUP	HCPCS C1726		H7493808015250  -  CATH BALDILAT .014IN 2.5MM 15MM PTCA RAPEX Q M	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808015300	SUP	HCPCS C1726		H7493808015300  -  CATH BALDILAT 3MM 135CM 15MM CORON PCTA RAPEX LP TPR TIP Q M	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808015350	SUP	HCPCS C1726		H7493808015350  -  CATH BALDILAT .014IN 3.5MM 15MM PTCA RAPEX Q M	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808015400	SUP	HCPCS C1726		H7493808015400  -  CATH BALDILAT .014IN 1.8-2.7FR 4MM 135CM 15MM PTCA RAPEX LP	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808015450	SUP	HCPCS C1726		H7493808015450  -  CATH BALDILAT .014IN 2-2.7FR 4.5MM 135CM 15MM PTCA RAPEX LP	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808015500	SUP	HCPCS C1726		H7493808015500  -  CATH BALDILAT .014IN 2-2.7FR 5MM 135CM 15MM PTCA RAPEX LP	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808020250	SUP	HCPCS C1726		H7493808020250  -  CATH BALDILAT .014IN 1.8-2.7FR 2.5MM 135CM 20MM PTCA RAPEX	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808020300	SUP	HCPCS C1726		H7493808020300  -  CATH BALDILAT .014IN 1.8-2.7FR 3MM 135CM 20MM PTCA RAPEX LP	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808020350	SUP	HCPCS C1726		H7493808020350  -  CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 20MM PTCA RAPEX	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493808020400	SUP	HCPCS C1726		H7493808020400  -  CATH BALDILAT .014IN 2-2.7FR 4MM 135CM 20MM PTCA RAPEX LP	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493892809200	SUP	HCPCS C1726		H7493892809200  -  CATHETER BLNDIL 2MM 142CM 9MM MAVERICK2 MNRL TRAKTIP TPR	BOTH IP/OP	$269.50 	$199.43	$0.00	$215.60	$146.34	$146.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.75	$213.44	$215.60	$0.00		$0.00	$42.18	$0.00	$0.00	$42.90	$0.00	$0.00	$0.00	$0.00	$0.00
H7493892809250	SUP	HCPCS C1725		H7493892809250  -  CATHETER BLNDIL 2.5MM 142CM 9MM MAVERICK2 MNRL TRAKTIP TPR	BOTH IP/OP	$269.50 	$199.43	$0.00	$215.60	$146.34	$146.34	$0.00	$0.00	$0.00	$56.17	$200.02	$200.02	$0.00	$0.00	$56.16	$0.00	$159.41	$159.41	$0.00	$134.75	$213.44	$215.60	$0.00		$0.00	$42.18	$0.00	$0.00	$42.90	$0.00	$0.00	$0.00	$0.00	$0.00
H7493892809300	SUP	HCPCS C1725		H7493892809300  -  CATHETER BLNDIL 3MM 142CM 9MM MAVERICK2 MNRL TRAKTIP TPR	BOTH IP/OP	$269.50 	$199.43	$0.00	$215.60	$146.34	$146.34	$0.00	$0.00	$0.00	$56.17	$200.02	$200.02	$0.00	$0.00	$56.16	$0.00	$159.41	$159.41	$0.00	$134.75	$213.44	$215.60	$0.00		$0.00	$42.18	$0.00	$0.00	$42.90	$0.00	$0.00	$0.00	$0.00	$0.00
H7493892809350	SUP	HCPCS C1726		H7493892809350  -  CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 9MM PTCA RAPEX LP	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493892815150	SUP	HCPCS C1726		H7493892815150  -  CATH BALDILAT .014IN 1.8-2.6-2.3FR 1.5MM 135CM 15MM PTCA	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493892815200	SUP	HCPCS C1726		H7493892815200  -  CATHETER BLNDIL 2MM 142CM 15MM MAVERICK2 MNRL TRAKTIP TPR	BOTH IP/OP	$269.50 	$199.43	$0.00	$215.60	$146.34	$146.34	$0.00	$0.00	$0.00	$56.17	$200.02	$200.02	$0.00	$0.00	$56.16	$0.00	$159.41	$159.41	$0.00	$134.75	$213.44	$215.60	$0.00		$0.00	$42.18	$0.00	$0.00	$42.90	$0.00	$0.00	$0.00	$0.00	$0.00
H7493892815250	SUP	HCPCS C1726		H7493892815250  -  CATH BALDILAT .014IN 1.8-2.6-2.4FR 2.5MM 135CM 15MM PTCA	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493892815300	SUP	HCPCS C1726		H7493892815300  -  CATH BALDILAT .014IN 1.8-2.6-2.4FR 3MM 135CM 15MM PTCA RAPEX	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493892815350	SUP	HCPCS C1726		H7493892815350  -  CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 15MM PTCA RAPEX	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493892820200	SUP	HCPCS C1726		H7493892820200  -  CATH BALDILAT .014IN 1.8-2.6-2.3FR 2MM 135CM 20MM PTCA RAPEX	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493892820250	SUP	HCPCS C1726		H7493892820250  -  CATH BALDILAT .014IN 1.8-2.6-2.4FR 2.5MM 135CM 20MM PTCA	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493892820300	SUP	HCPCS C1726		H7493892820300  -  CATH BALDILAT .014IN 1.8-2.6-2.4FR 3MM 135CM 20MM PTCA RAPEX	BOTH IP/OP	$612.50 	$453.25	$0.00	$490.00	$332.59	$332.59	$0.00	$0.00	$0.00	$127.66	$454.60	$454.60	$0.00	$0.00	$127.65	$0.00	$362.29	$362.29	$0.00	$306.25	$485.10	$490.00	$0.00		$0.00	$95.86	$0.00	$0.00	$97.51	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894812010	SUP	HCPCS C1876		H7493894812010  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 135CM 10	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894812070	SUP	HCPCS C1876		H7493894812070  -  STENT BILIARY 21MM SELF EXPANDING NONCOATED NONCOVERED	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894814010	SUP	HCPCS C1876		H7493894814010  -  STENT BILIARY 40MM SELF EXPANDING SENTINOL NITINOL 135CM 10	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894814070	SUP	HCPCS C1876		H7493894814070  -  STENT BILIARY 41MM SELF EXPANDING SHEATH CATHETER SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894816010	SUP	HCPCS C1876		H7493894816010  -  STENT BILIARY 59MM SELF EXPANDABLE SENTINOL NITINOL 135CM 10	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894818010	SUP	HCPCS C1876		H7493894818010  -  STENT BILIARY 80MM SELF EXPANDING SENTINOL NITINOL 135CM 10	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894852010	SUP	HCPCS C1876		H7493894852010  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 135CM 5MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894852070	SUP	HCPCS C1876		H7493894852070  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 75CM 5MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894854010	SUP	HCPCS C1876		H7493894854010  -  STENT BILIARY 40MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894854070	SUP	HCPCS C1876		H7493894854070  -  STENT BILIARY 40MM SELF EXPANDING NONCOATED NONCOVERED	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894856010	SUP	HCPCS C1876		H7493894856010  -  STENT BILIARY 60MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894856070	SUP	HCPCS C1876		H7493894856070  -  STENT BILIARY 60MM SELF EXPANDING NONCOATED NONCOVERED	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894862010	SUP	HCPCS C1876		H7493894862010  -  STENT BILIARY 20MM SELF EXPANDING SENTINOL NITINOL 135CM 6MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894862070	SUP	HCPCS C1876		H7493894862070  -  STENT BILIARY 20MM SELF EXPANDING SENTINOL NITINOL 75CM 6MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894864010	SUP	HCPCS C1876		H7493894864010  -  STENT BILIARY 40MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894864070	SUP	HCPCS C1876		H7493894864070  -  STENT BILIARY 40MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894866010	SUP	HCPCS C1876		H7493894866010  -  STENT BILIARY 59MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894866070	SUP	HCPCS C1876		H7493894866070  -  STENT BILIARY 59MM SELF EXPANDING SENTINOL NITINOL 75CM 6MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894868010	SUP	HCPCS C1876		H7493894868010  -  STENT BILIARY 79MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894868070	SUP	HCPCS C1876		H7493894868070  -  STENT BILIARY 79MM SELF EXPANDING SENTINOL NITINOL 75CM 6MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894872010	SUP	HCPCS C1876		H7493894872010  -  STENT BILIARY 1350MM SELF EXPANDING CATHETER DELIVERY SYSTEM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894872070	SUP	HCPCS C1876		H7493894872070  -  STENT BILIARY 20MM SELF EXPANDING SENTINOL NITINOL 75CM 7MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894874010	SUP	HCPCS C1876		H7493894874010  -  STENT BILIARY 39MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894874070	SUP	HCPCS C1876		H7493894874070  -  STENT BILIARY 39MM SELF EXPANDABLE SENTINOL NITINOL 75CM 7MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894876010	SUP	HCPCS C1876		H7493894876010  -  STENT BILIARY 59MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894876070	SUP	HCPCS C1876		H7493894876070  -  STENT BILIARY 59MM SELF EXPANDING SENTINOL NITINOL 75CM 7MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894878010	SUP	HCPCS C1876		H7493894878010  -  STENT BILIARY 78MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894878070	SUP	HCPCS C1876		H7493894878070  -  STENT BILIARY 78MM SELF EXPANDING SENTINOL NITINOL 75CM 7MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894882010	SUP	HCPCS C1876		H7493894882010  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 135CM 8MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894882070	SUP	HCPCS C1876		H7493894882070  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 75CM 8MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894884010	SUP	HCPCS C1876		H7493894884010  -  STENT BILIARY 42MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894884070	SUP	HCPCS C1876		H7493894884070  -  STENT BILIARY 42MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894886010	SUP	HCPCS C1876		H7493894886010  -  STENT BILIARY 60MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894886070	SUP	HCPCS C1876		H7493894886070  -  STENT BILIARY 60MM SELF EXPAND DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894888010	SUP	HCPCS C1876		H7493894888010  -  STENT BILIARY 81MM SELF EXPANDING DELIVERY SYSTEM SENTINOL	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894892010	SUP	HCPCS C1876		H7493894892010  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 135CM 9MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894892070	SUP	HCPCS C1876		H7493894892070  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 75CM 9MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894894010	SUP	HCPCS C1876		H7493894894010  -  STENT BILIARY 42MM SELF EXPANDING SENTINOL NITINOL 135CM 9MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894894070	SUP	HCPCS C1876		H7493894894070  -  STENT BILIARY 750MM SELF EXPANDING CATHETER DELIVERY SYSTEM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894896010	SUP	HCPCS C1876		H7493894896010  -  STENT BILIARY 60MM SELF EXPANDING SENTINOL NITINOL 135CM 9MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894896070	SUP	HCPCS C1876		H7493894896070  -  STENT BILIARY 60MM SELF EXPANDING SENTINOL NITINOL 75CM 9MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894898010	SUP	HCPCS C1876		H7493894898010  -  STENT BILIARY 80MM SELF EXPANDING SENTINOL NITINOL 135CM 9MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493894898070	SUP	HCPCS C1876		H7493894898070  -  STENT BILIARY 80MM SELF EXPANDING SENTINOL NITINOL 75CM 9MM	BOTH IP/OP	"$2,437.50 "	"$1,803.75"	$0.00	"$1,950.00"	"$1,096.88"	"$1,096.88"	$0.00	$0.00	$0.00	$508.04	"$1,809.11"	"$1,809.11"	$0.00	$0.00	$507.98	$0.00	"$1,441.78"	"$1,441.78"	$0.00	"$1,218.75"	"$1,930.50"	"$1,950.00"	$0.00		$0.00	$381.47	$0.00	$0.00	$388.05	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897008250	SUP	HCPCS C2617		H7493897008250  -  STENT CORON 2.5MM 8MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8%	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897008300	SUP	HCPCS C2617		H7493897008300  -  STENT CORON 3MM 8MM RAPEX BLN EXPANDABLE TAXUS XPR2 MNRL	BOTH IP/OP	"$6,500.00 "	"$4,810.00"	$0.00	"$5,200.00"	"$2,925.00"	"$2,925.00"	$0.00	$0.00	$0.00	"$1,354.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,354.60"	$0.00	"$3,204.50"	"$3,204.50"	$0.00	"$3,250.00"	"$5,148.00"	"$5,200.00"	$0.00		$0.00	"$1,017.25"	$0.00	$0.00	"$1,034.80"	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897008350	SUP	HCPCS C2617		H7493897008350  -  STENT CORON 3.5MM 8MM RAPEX BLN XPD TAXUS XPR2 MNRL PCLTXL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897012250	SUP	HCPCS C2617		H7493897012250  -  STENT CORON 2.50MM 12MM XPR TAXUS XPR2 MNRL PCLTXL ELUT RX	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897012300	SUP	HCPCS C2617		H7493897012300  -  STENT CORON 3MM 12MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8%	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897012350	SUP	HCPCS C2617		H7493897012350  -  STENT CORON 3.5MM 12MM RAPEX BLN XPD TAXUS XPR2 MNRL PCLTXL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897016250	SUP	HCPCS C2617		H7493897016250  -  STENT CORON 2.5MM 16MM SYS ART TAXUS XPR2 MNRL 8.8% PCLTXL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897016300	SUP	HCPCS C2617		H7493897016300  -  STENT CORONARY ARTERY EXPRESS 2 TAXUS 3 X 16MM 8.8% PACLITAX	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897016350	SUP	HCPCS C2617		H7493897016350  -  STENT CORON 3.5MM 16MM RAPEX BLN EXPANDABLE TAXUS XPR2 MNRL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897020250	SUP	HCPCS C2617		H7493897020250  -  STENT CORON 2.5MM 20MM TAXUS XPR2 MNRL 8.8% PCLTXL ELUT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897020300	SUP	HCPCS C2617		H7493897020300  -  STENT CORON 3MM 20MM RAPEX BLN EXPANDABLE TAXUS XPR2 MNRL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897020350	SUP	HCPCS C2617		H7493897020350  -  STENT CORON 3.5MM 20MM RAPEX BLN XPD XPR RX PCLTXL ELUT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897028300	SUP	HCPCS C2617		H7493897028300  -  STENT CORON 3MM 28MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8%	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897028350	SUP	HCPCS C2617		H7493897028350  -  STENT CORON 3.5MM 28MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8%	BOTH IP/OP	"$6,500.00 "	"$4,810.00"	$0.00	"$5,200.00"	"$2,925.00"	"$2,925.00"	$0.00	$0.00	$0.00	"$1,354.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,354.60"	$0.00	"$3,204.50"	"$3,204.50"	$0.00	"$3,250.00"	"$5,148.00"	"$5,200.00"	$0.00		$0.00	"$1,017.25"	$0.00	$0.00	"$1,034.80"	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897032300	SUP	HCPCS C2617		H7493897032300  -  STENT CORON 3MM 32MM RAPEX BLN XPD TAXUS XPR2 MNRL PCLTXL	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7493897032350	SUP	HCPCS C2617		H7493897032350  -  STENT CORON 3.5MM 32MM RAPEX BLN XPD XPR RX PCLTXL ELUT	BOTH IP/OP	"$6,250.00 "	"$4,625.00"	$0.00	"$5,000.00"	"$2,812.50"	"$2,812.50"	$0.00	$0.00	$0.00	"$1,302.66"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,302.50"	$0.00	"$3,081.25"	"$3,081.25"	$0.00	"$3,125.00"	"$4,950.00"	"$5,000.00"	$0.00		$0.00	$978.13	$0.00	$0.00	$995.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031302010	SUP	HCPCS C1725		H74939031302010  -  CATHETER BLNDIL 3MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031303010	SUP	HCPCS C1725		H74939031303010  -  CATHETER BLNDIL 3MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031304010	SUP	HCPCS C1725		H74939031304010  -  CATHETER BLNDIL 3MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031306010	SUP	HCPCS C1725		H74939031306010  -  CATHETER BLNDIL 3MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031352010	SUP	HCPCS C1725		H74939031352010  -  CATHETER BLNDIL 3.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031353010	SUP	HCPCS C1725		H74939031353010  -  CATHETER BLNDIL 3.5MM 135CM 30MM STRLG MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031354010	SUP	HCPCS C1725		H74939031354010  -  CATHETER BLNDIL 3.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031401080	SUP	HCPCS C1725		H74939031401080  -  CATHETER BLNDIL 4MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031401580	SUP	HCPCS C1725		H74939031401580  -  CATHETER BLNDIL 4MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031402010	SUP	HCPCS C1725		H74939031402010  -  CATHETER BLNDIL 4MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031402080	SUP	HCPCS C1725		H74939031402080  -  CATHETER BLNDIL 4MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031403010	SUP	HCPCS C1725		H74939031403010  -  CATHETER BLNDIL 4MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031403080	SUP	HCPCS C1725		H74939031403080  -  CATHETER BLNDIL 4MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031404010	SUP	HCPCS C1725		H74939031404010  -  CATHETER BLNDIL 4MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031404080	SUP	HCPCS C1725		H74939031404080  -  CATHETER BLNDIL 4MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031406010	SUP	HCPCS C1725		H74939031406010  -  CATHETER BLNDIL 4MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031451580	SUP	HCPCS C1725		H74939031451580  -  CATHETER BLNDIL 4.5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031452010	SUP	HCPCS C1725		H74939031452010  -  CATHETER BLNDIL 4.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031452080	SUP	HCPCS C1725		H74939031452080  -  CATHETER BLNDIL 4.5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031453010	SUP	HCPCS C1725		H74939031453010  -  CATHETER BLNDIL 4.5MM 135CM 30MM STRLG MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031453080	SUP	HCPCS C1725		H74939031453080  -  CATHETER BLNDIL 4.5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031454010	SUP	HCPCS C1725		H74939031454010  -  CATHETER BLNDIL 4.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031454080	SUP	HCPCS C1725		H74939031454080  -  CATHETER BLNDIL 4.5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031501080	SUP	HCPCS C1725		H74939031501080  -  CATHETER BLNDIL 5MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031501580	SUP	HCPCS C1725		H74939031501580  -  CATHETER BLNDIL 5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031502010	SUP	HCPCS C1725		H74939031502010  -  CATHETER BLNDIL 5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031502080	SUP	HCPCS C1725		H74939031502080  -  CATHETER BLNDIL 5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031503010	SUP	HCPCS C1725		H74939031503010  -  CATHETER BLNDIL 5MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031503080	SUP	HCPCS C1725		H74939031503080  -  CATHETER BLNDIL 5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031504010	SUP	HCPCS C1725		H74939031504010  -  CATHETER BLNDIL 5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031504080	SUP	HCPCS C1725		H74939031504080  -  CATHETER BLNDIL 5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031506010	SUP	HCPCS C1725		H74939031506010  -  CATHETER BLNDIL 5MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031551580	SUP	HCPCS C1725		H74939031551580  -  CATHETER BLNDIL 5.5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031552010	SUP	HCPCS C1725		H74939031552010  -  CATHETER BLNDIL 5.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031552080	SUP	HCPCS C1725		H74939031552080  -  CATHETER BLNDIL 5.5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031553010	SUP	HCPCS C1725		H74939031553010  -  CATHETER BLNDIL 5.5MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031553080	SUP	HCPCS C1725		H74939031553080  -  CATHETER BLNDIL 5.5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031554010	SUP	HCPCS C1725		H74939031554010  -  CATHETER BLNDIL 5.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031554080	SUP	HCPCS C1725		H74939031554080  -  CATHETER BLNDIL 5.5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031601080	SUP	HCPCS C1725		H74939031601080  -  CATHETER BLNDIL 6MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031601580	SUP	HCPCS C1725		H74939031601580  -  CATHETER BLNDIL 6MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031602010	SUP	HCPCS C1725		H74939031602010  -  CATHETER BLNDIL 6MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031602080	SUP	HCPCS C1725		H74939031602080  -  CATHETER BLNDIL 6MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031603010	SUP	HCPCS C1725		H74939031603010  -  CATHETER BLNDIL 6MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031603080	SUP	HCPCS C1725		H74939031603080  -  CATHETER BLNDIL 6MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031604010	SUP	HCPCS C1725		H74939031604010  -  CATHETER BLNDIL 6MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031604080	SUP	HCPCS C1725		H74939031604080  -  CATHETER BLNDIL 6MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031606010	SUP	HCPCS C1725		H74939031606010  -  CATHETER BLNDIL 6MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031651580	SUP	HCPCS C1725		H74939031651580  -  CATHETER BLNDIL 6.5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031652010	SUP	HCPCS C1725		H74939031652010  -  CATHETER BLNDIL 6.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031652080	SUP	HCPCS C1725		H74939031652080  -  CATHETER BLNDIL 6.5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031653010	SUP	HCPCS C1725		H74939031653010  -  CATHETER BLNDIL 6.5MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031653080	SUP	HCPCS C1725		H74939031653080  -  CATHETER BLNDIL 6.5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031654010	SUP	HCPCS C1725		H74939031654010  -  CATHETER BLNDIL 6.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031654080	SUP	HCPCS C1725		H74939031654080  -  CATHETER BLNDIL 6.5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031701080	SUP	HCPCS C1725		H74939031701080  -  CATHETER BLNDIL 7MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031701580	SUP	HCPCS C1725		H74939031701580  -  CATHETER BLNDIL 7MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031702010	SUP	HCPCS C1725		H74939031702010  -  CATHETER BLNDIL 7MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031702080	SUP	HCPCS C1725		H74939031702080  -  CATHETER BLNDIL 7MM 80CM 20MM STRLG MNRL RX INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031703010	SUP	HCPCS C1725		H74939031703010  -  CATHETER BLNDIL 7MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031703080	SUP	HCPCS C1725		H74939031703080  -  CATHETER BLNDIL 7MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031704010	SUP	HCPCS C1725		H74939031704010  -  CATHETER BLNDIL 7MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031704080	SUP	HCPCS C1725		H74939031704080  -  CATHETER BLNDIL 7MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031706010	SUP	HCPCS C1725		H74939031706010  -  CATHETER BLNDIL 7MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031801080	SUP	HCPCS C1725		H74939031801080  -  CATHETER BLNDIL 8MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031801580	SUP	HCPCS C1725		H74939031801580  -  CATHETER BLNDIL 8MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031802010	SUP	HCPCS C1725		H74939031802010  -  CATHETER BLNDIL 8MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031802080	SUP	HCPCS C1725		H74939031802080  -  CATHETER BLNDIL 8MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031803010	SUP	HCPCS C1725		H74939031803010  -  CATHETER BLNDIL 8MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031803080	SUP	HCPCS C1725		H74939031803080  -  CATHETER BLNDIL 8MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031804010	SUP	HCPCS C1725		H74939031804010  -  CATHETER BLNDIL 8MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031804080	SUP	HCPCS C1725		H74939031804080  -  CATHETER BLNDIL 8MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939031806010	SUP	HCPCS C1725		H74939031806010  -  CATHETER BLNDIL 8MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032102010	SUP	HCPCS C1753		H74939032102010  -  CATHETER BLNDIL 10MM 135CM 20MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032102080	SUP	HCPCS C1753		H74939032102080  -  CATHETER BLNDIL 10MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032103010	SUP	HCPCS C1753		H74939032103010  -  CATHETER BLNDIL 10MM 135CM 30MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032103080	SUP	HCPCS C1753		H74939032103080  -  CATHETER BLNDIL 10MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032104010	SUP	HCPCS C1753		H74939032104010  -  CATHETER BLNDIL 10MM 135CM 40MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032104080	SUP	HCPCS C1753		H74939032104080  -  CATHETER BLNDIL 10MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032106010	SUP	HCPCS C1753		H74939032106010  -  CATHETER BLNDIL 10MM 135CM 60MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032106080	SUP	HCPCS C1753		H74939032106080  -  CATHETER BLNDIL 10MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032108010	SUP	HCPCS C1753		H74939032108010  -  CATHETER BLNDIL 10MM 135CM 80MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032108080	SUP	HCPCS C1753		H74939032108080  -  CATHETER BLNDIL 10MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032401010	SUP	HCPCS C1753		H74939032401010  -  CATHETER BLNDIL 4MM 135CM 100MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032401080	SUP	HCPCS C1753		H74939032401080  -  CATHETER BLNDIL 4MM 80CM 100MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032402010	SUP	HCPCS C1726		H74939032402010  -  CATHETER BLNDIL 4MM 135CM 20MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032402040	SUP	HCPCS C1753		H74939032402040  -  CATHETER BLNDIL 4MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032402080	SUP	HCPCS C1753		H74939032402080  -  CATHETER BLNDIL 4MM 80CM 20MM STRLG OTW INFL PORT LOPRFL TPR	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032403010	SUP	HCPCS C1753		H74939032403010  -  CATHETER BLNDIL 4MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032403080	SUP	HCPCS C1753		H74939032403080  -  CATHETER BLNDIL 4MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032404010	SUP	HCPCS C1726		H74939032404010  -  CATHETER BLNDIL 4MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032404040	SUP	HCPCS C1753		H74939032404040  -  CATHETER BLNDIL 4MM 40CM 40MM STRLG OTW INFL PORT LOPRFL TPR	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032404080	SUP	HCPCS C1753		H74939032404080  -  CATHETER BLNDIL 4MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032406010	SUP	HCPCS C1753		H74939032406010  -  CATHETER BLNDIL 4MM 135CM 60MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032406080	SUP	HCPCS C1753		H74939032406080  -  CATHETER BLNDIL 4MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032408010	SUP	HCPCS C1753		H74939032408010  -  CATHETER BLNDIL 4MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032408080	SUP	HCPCS C1753		H74939032408080  -  CATHETER BLNDIL 4MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032501010	SUP	HCPCS C1753		H74939032501010  -  CATHETER BLNDIL 5MM 135CM 100MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032501080	SUP	HCPCS C1726		H74939032501080  -  CATHETER BLNDIL 5MM 80CM 100MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032501510	SUP	HCPCS C1725		H74939032501510  -  CATHETER BLNDIL 5MM 150CM 150MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032502010	SUP	HCPCS C1753		H74939032502010  -  CATHETER BLNDIL 5MM 135CM 20MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032502040	SUP	HCPCS C1753		H74939032502040  -  CATHETER BLNDIL 5MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032502080	SUP	HCPCS C1726		H74939032502080  -  CATHETER BLNDIL 5MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032502110	SUP	HCPCS C1725		H74939032502110  -  CATHETER BLNDIL 5MM 150CM 200MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032503010	SUP	HCPCS C1753		H74939032503010  -  CATHETER BLNDIL 5MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032503080	SUP	HCPCS C1753		H74939032503080  -  CATHETER BLNDIL 5MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032504010	SUP	HCPCS C1726		H74939032504010  -  CATHETER BLNDIL 5MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032504040	SUP	HCPCS C1753		H74939032504040  -  CATHETER BLNDIL 5MM 40CM 40MM STRLG OTW INFL PORT LOPRFL TPR	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032504080	SUP	HCPCS C1726		H74939032504080  -  CATHETER BLNDIL 5MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032506010	SUP	HCPCS C1753		H74939032506010  -  CATHETER BLNDIL 5MM 135CM 60MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032506080	SUP	HCPCS C1726		H74939032506080  -  CATHETER BLNDIL 5MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032508010	SUP	HCPCS C1753		H74939032508010  -  CATHETER BLNDIL 5MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032508080	SUP	HCPCS C1726		H74939032508080  -  CATHETER BLNDIL 5MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032601010	SUP	HCPCS C1753		H74939032601010  -  CATHETER BLNDIL 6MM 135CM 100MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032601080	SUP	HCPCS C1753		H74939032601080  -  CATHETER BLNDIL 6MM 80CM 100MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032601510	SUP	HCPCS C1725		H74939032601510  -  CATHETER BLNDIL 6MM 150CM 150MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032602010	SUP	HCPCS C1726		H74939032602010  -  CATHETER BLNDIL 6MM 135CM 20MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032602040	SUP	HCPCS C1753		H74939032602040  -  CATHETER BLNDIL 6MM 40CM 20MM STRLG OTW INFL PORT LOPRFL TPR	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032602080	SUP	HCPCS C1726		H74939032602080  -  CATHETER BLNDIL 6MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032602210	SUP	HCPCS C1725		H74939032602210  -  CATHETER BLNDIL 6MM 150CM 220MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032603010	SUP	HCPCS C1753		H74939032603010  -  CATHETER BLNDIL 6MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032603080	SUP	HCPCS C1753		H74939032603080  -  CATHETER BLNDIL 6MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032604010	SUP	HCPCS C1726		H74939032604010  -  CATHETER BLNDIL 6MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032604040	SUP	HCPCS C1753		H74939032604040  -  CATHETER BLNDIL 6MM 40CM 40MM STRLG OTW INFL PORT LOPRFL TPR	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032604080	SUP	HCPCS C1726		H74939032604080  -  CATHETER BLNDIL 6MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032606010	SUP	HCPCS C1726		H74939032606010  -  CATHETER BLNDIL 6MM 135CM 60MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032606080	SUP	HCPCS C1726		H74939032606080  -  CATHETER BLNDIL 6MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032608010	SUP	HCPCS C1726		H74939032608010  -  CATHETER BLNDIL 6MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032608080	SUP	HCPCS C1753		H74939032608080  -  CATHETER BLNDIL 6MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032701010	SUP	HCPCS C1753		H74939032701010  -  CATHETER BLNDIL 7MM 135CM 100MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032701080	SUP	HCPCS C1753		H74939032701080  -  CATHETER BLNDIL 7MM 80CM 100MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032701210	SUP	HCPCS C1725		H74939032701210  -  CATHETER BLNDIL 7MM 150CM 120MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032701510	SUP	HCPCS C1725		H74939032701510  -  CATHETER BLNDIL 7MM 150CM 150MM STRLG OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032702010	SUP	HCPCS C1726		H74939032702010  -  CATHETER BLNDIL 7MM 135CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032702040	SUP	HCPCS C1753		H74939032702040  -  CATHETER BLNDIL 7MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032702080	SUP	HCPCS C1726		H74939032702080  -  CATHETER BLNDIL 7MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032702110	SUP	HCPCS C1725		H74939032702110  -  CATHETER BLNDIL 7MM 150CM 200MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032702210	SUP	HCPCS C1725		H74939032702210  -  CATHETER BLNDIL 7MM 150CM 220MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032703010	SUP	HCPCS C1753		H74939032703010  -  CATHETER BLNDIL 7MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032703080	SUP	HCPCS C1753		H74939032703080  -  CATHETER BLNDIL 7MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032704010	SUP	HCPCS C1726		H74939032704010  -  CATHETER BLNDIL 7MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032704040	SUP	HCPCS C1753		H74939032704040  -  CATHETER BLNDIL 7MM 40CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032704080	SUP	HCPCS C1726		H74939032704080  -  CATHETER BLNDIL 7MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032706010	SUP	HCPCS C1726		H74939032706010  -  CATHETER BLNDIL 7MM 135CM 60MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032706080	SUP	HCPCS C1726		H74939032706080  -  CATHETER BLNDIL 7MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032708010	SUP	HCPCS C1753		H74939032708010  -  CATHETER BLNDIL 7MM 135CM 80MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032708080	SUP	HCPCS C1726		H74939032708080  -  CATHETER BLNDIL 7MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032802010	SUP	HCPCS C1726		H74939032802010  -  CATHETER BLNDIL 8MM 135CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032802040	SUP	HCPCS C1753		H74939032802040  -  CATHETER BLNDIL 8MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032802080	SUP	HCPCS C1726		H74939032802080  -  CATHETER BLNDIL 8MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032803010	SUP	HCPCS C1753		H74939032803010  -  CATHETER BLNDIL 8MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032803080	SUP	HCPCS C1753		H74939032803080  -  CATHETER BLNDIL 8MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032804010	SUP	HCPCS C1726		H74939032804010  -  CATHETER BLNDIL 8MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032804040	SUP	HCPCS C1753		H74939032804040  -  CATHETER BLNDIL 8MM 40CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032804080	SUP	HCPCS C1726		H74939032804080  -  CATHETER BLNDIL 8MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032806010	SUP	HCPCS C1726		H74939032806010  -  CATHETER BLNDIL 8MM 135CM 40MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032806080	SUP	HCPCS C1726		H74939032806080  -  CATHETER BLNDIL 8MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$81.45	$81.45	$0.00	$0.00	$0.00	$31.26	$111.33	$111.33	$0.00	$0.00	$31.26	$0.00	$88.73	$88.73	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$23.48	$0.00	$0.00	$23.88	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032808010	SUP	HCPCS C1726		H74939032808010  -  CATHETER BLNDIL 8MM 135CM 80MM STRLG OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032808080	SUP	HCPCS C1753		H74939032808080  -  CATHETER BLNDIL 8MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032902010	SUP	HCPCS C1753		H74939032902010  -  CATHETER BLNDIL 9MM 135CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032902080	SUP	HCPCS C1753		H74939032902080  -  CATHETER BLNDIL 9MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032903010	SUP	HCPCS C1753		H74939032903010  -  CATHETER BLNDIL 9MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032903080	SUP	HCPCS C1753		H74939032903080  -  CATHETER BLNDIL 9MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032904010	SUP	HCPCS C1726		H74939032904010  -  CATHETER BLNDIL 9MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032904080	SUP	HCPCS C1726		H74939032904080  -  CATHETER BLNDIL 9MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032906010	SUP	HCPCS C1753		H74939032906010  -  CATHETER BLNDIL 9MM 135CM 60MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032906080	SUP	HCPCS C1753		H74939032906080  -  CATHETER BLNDIL 9MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032908010	SUP	HCPCS C1753		H74939032908010  -  CATHETER BLNDIL 9MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939032908080	SUP	HCPCS C1753		H74939032908080  -  CATHETER BLNDIL 9MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134152010	SUP	HCPCS C1726		H74939134152010  -  CATHETER BLNDIL 1.5MM 142CM 20MM CYTE ES OTW ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134202010	SUP	HCPCS C1726		H74939134202010  -  CATHETER BLNDIL 2MM 142CM 20MM CYTE ES OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134203010	SUP	HCPCS C1753		H74939134203010  -  CATHETER BLNDIL 2MM 143CM 30MM CYTE ES OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134204010	SUP	HCPCS C1726		H74939134204010  -  CATHETER BLNDIL 2MM 144CM 40MM CYTE ES OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134252010	SUP	HCPCS C1753		H74939134252010  -  CATHETER BLNDIL 2.5MM 143CM 20MM CYTE ES OTW ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134253010	SUP	HCPCS C1753		H74939134253010  -  CATHETER BLNDIL 2.5MM 144CM 30MM CYTE ES OTW ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134254010	SUP	HCPCS C1726		H74939134254010  -  CATHETER BLNDIL 2.5MM 145CM 40MM CYTE ES OTW ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134302010	SUP	HCPCS C1726		H74939134302010  -  CATHETER BLNDIL 3MM 143CM 20MM CYTE ES OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134303010	SUP	HCPCS C1753		H74939134303010  -  CATHETER BLNDIL 3MM 144CM 30MM CYTE ES OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134304010	SUP	HCPCS C1726		H74939134304010  -  CATHETER BLNDIL 3MM 145CM 40MM CYTE ES OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134352010	SUP	HCPCS C1753		H74939134352010  -  CATHETER BLNDIL 3.5MM 143CM 20MM CYTE ES OTW ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134353010	SUP	HCPCS C1753		H74939134353010  -  CATHETER BLNDIL 3.5MM 144CM 30MM CYTE ES OTW ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134354010	SUP	HCPCS C1753		H74939134354010  -  CATHETER BLNDIL 3.5MM 145CM 40MM CYTE ES OTW ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134402010	SUP	HCPCS C1726		H74939134402010  -  CATHETER BLNDIL 4MM 143CM 20MM CYTE ES OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134403010	SUP	HCPCS C1753		H74939134403010  -  CATHETER BLNDIL 4MM 144CM 30MM CYTE ES OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939134404010	SUP	HCPCS C1726		H74939134404010  -  CATHETER BLNDIL 4MM 145CM 40MM CYTE ES OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135152010	SUP	HCPCS C1753		H74939135152010  -  CATHETER BLNDIL 1.5MM 143CM 20MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135202010	SUP	HCPCS C1753		H74939135202010  -  CATHETER BLNDIL 2MM 143CM 20MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135203010	SUP	HCPCS C1753		H74939135203010  -  CATHETER BLNDIL 2MM 144CM 30MM CYTE ES MNRL ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135204010	SUP	HCPCS C1753		H74939135204010  -  CATHETER BLNDIL 2MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135252010	SUP	HCPCS C1753		H74939135252010  -  CATHETER BLNDIL 2.5MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135253010	SUP	HCPCS C1753		H74939135253010  -  CATHETER BLNDIL 2.5MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135254010	SUP	HCPCS C1753		H74939135254010  -  CATHETER BLNDIL 2.5MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135302010	SUP	HCPCS C1753		H74939135302010  -  CATHETER BLNDIL 3MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135303010	SUP	HCPCS C1753		H74939135303010  -  CATHETER BLNDIL 3MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135304010	SUP	HCPCS C1753		H74939135304010  -  CATHETER BLNDIL 3MM 146CM 40MM CYTE ES MNRL ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135352010	SUP	HCPCS C1753		H74939135352010  -  CATHETER BLNDIL 3.5MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135353010	SUP	HCPCS C1753		H74939135353010  -  CATHETER BLNDIL 3.5MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135354010	SUP	HCPCS C1753		H74939135354010  -  CATHETER BLNDIL 3.5MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135402010	SUP	HCPCS C1753		H74939135402010  -  CATHETER BLNDIL 4MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135403010	SUP	HCPCS C1753		H74939135403010  -  CATHETER BLNDIL 4MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939135404010	SUP	HCPCS C1753		H74939135404010  -  CATHETER BLNDIL 4MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147201010	SUP	HCPCS C1725		H74939147201010  -  CATHETER BLNDIL 2MM 150CM 100MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147201090	SUP	HCPCS C1725		H74939147201090  -  CATHETER BLNDIL 2MM 90CM 100MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147201210	SUP	HCPCS C1725		H74939147201210  -  CATHETER BLNDIL 2MM 150CM 120MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147201290	SUP	HCPCS C1725		H74939147201290  -  CATHETER BLNDIL 2MM 90CM 120MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147201510	SUP	HCPCS C1725		H74939147201510  -  CATHETER BLNDIL 2MM 150CM 150MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147201590	SUP	HCPCS C1725		H74939147201590  -  CATHETER BLNDIL 2MM 90CM 150MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147208010	SUP	HCPCS C1725		H74939147208010  -  CATHETER BLNDIL 2MM 150CM 80MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147208090	SUP	HCPCS C1725		H74939147208090  -  CATHETER BLNDIL 2MM 90CM 80MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147251010	SUP	HCPCS C1725		H74939147251010  -  CATHETER BLNDIL 2.5MM 150CM 100MM STRLG SL OTW TPR TIP	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147251090	SUP	HCPCS C1725		H74939147251090  -  CATHETER BLNDIL 2.5MM 90CM 100MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147251210	SUP	HCPCS C1725		H74939147251210  -  CATHETER BLNDIL 2.5MM 150CM 120MM STRLG SL MNRL TPR TIP	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147251290	SUP	HCPCS C1725		H74939147251290  -  CATHETER BLNDIL 2.5MM 90CM 120MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147251510	SUP	HCPCS C1725		H74939147251510  -  CATHETER BLNDIL 2.5MM 150CM 150MM STRLG SL MNRL TPR TIP	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147251590	SUP	HCPCS C1725		H74939147251590  -  CATHETER BLNDIL 2.5MM 90CM 150MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147258010	SUP	HCPCS C1725		H74939147258010  -  CATHETER BLNDIL 2.5MM 150CM 80MM STRLG SL MNRL TPR TIP	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147258090	SUP	HCPCS C1725		H74939147258090  -  CATHETER BLNDIL 2.5MM 90CM 80MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147301010	SUP	HCPCS C1725		H74939147301010  -  CATHETER BLNDIL 3MM 150CM 100MM STRLG SL MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147301090	SUP	HCPCS C1725		H74939147301090  -  CATHETER BLNDIL 3MM 90CM 100MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147301210	SUP	HCPCS C1725		H74939147301210  -  CATHETER BLNDIL 3MM 150CM 120MM STRLG SL MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147301290	SUP	HCPCS C1725		H74939147301290  -  CATHETER BLNDIL 3MM 90CM 120MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147301510	SUP	HCPCS C1725		H74939147301510  -  CATHETER BLNDIL 3MM 150CM 150MM STRLG SL MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147301590	SUP	HCPCS C1725		H74939147301590  -  CATHETER BLNDIL 3MM 90CM 150MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147308010	SUP	HCPCS C1725		H74939147308010  -  CATHETER BLNDIL 3MM 150CM 80MM STRLG SL MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147308090	SUP	HCPCS C1725		H74939147308090  -  CATHETER BLNDIL 3MM 90CM 80MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147351010	SUP	HCPCS C1725		H74939147351010  -  CATHETER BLNDIL 3.5MM 150CM 100MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147351090	SUP	HCPCS C1725		H74939147351090  -  CATHETER BLNDIL 3.5MM 90CM 100MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147351210	SUP	HCPCS C1725		H74939147351210  -  CATHETER BLNDIL 3.5MM 150CM 120MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147351290	SUP	HCPCS C1725		H74939147351290  -  CATHETER BLNDIL 3.5MM 90CM 120MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147351510	SUP	HCPCS C1725		H74939147351510  -  CATHETER BLNDIL 3.5MM 150CM 150MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147351590	SUP	HCPCS C1725		H74939147351590  -  CATHETER BLNDIL 3.5MM 90CM 150MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147358010	SUP	HCPCS C1725		H74939147358010  -  CATHETER BLNDIL 3.5MM 150CM 80MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147358090	SUP	HCPCS C1725		H74939147358090  -  CATHETER BLNDIL 3.5MM 90CM 80MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147401010	SUP	HCPCS C1725		H74939147401010  -  CATHETER BLNDIL 4MM 150CM 100MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147401090	SUP	HCPCS C1725		H74939147401090  -  CATHETER BLNDIL 4MM 90CM 100MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147401210	SUP	HCPCS C1725		H74939147401210  -  CATHETER BLNDIL 4MM 150CM 120MM STRLG SL MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147401290	SUP	HCPCS C1725		H74939147401290  -  CATHETER BLNDIL 4MM 90CM 120MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147401510	SUP	HCPCS C1725		H74939147401510  -  CATHETER BLNDIL 4MM 150CM 150MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147401590	SUP	HCPCS C1725		H74939147401590  -  CATHETER BLNDIL 4MM 90CM 150MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147408010	SUP	HCPCS C1725		H74939147408010  -  CATHETER BLNDIL 4MM 150CM 80MM STRLG SL MNRL TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939147408090	SUP	HCPCS C1725		H74939147408090  -  CATHETER BLNDIL 4MM 90CM 80MM STRLG SL MNRL RX INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148201010	SUP	HCPCS C1726		H74939148201010  -  CATHETER BLNDIL 2MM 150CM 100MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148201090	SUP	HCPCS C1753		H74939148201090  -  CATHETER BLNDIL 2MM 100CM 90MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148201210	SUP	HCPCS C1726		H74939148201210  -  CATHETER BLNDIL 2MM 150CM 120MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148201290	SUP	HCPCS C1725		H74939148201290  -  CATHETER BLNDIL 2MM 90CM 120MM STRLG SL OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148201510	SUP	HCPCS C1726		H74939148201510  -  CATHETER BLNDIL 2MM 150CM 150MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148201590	SUP	HCPCS C1725		H74939148201590  -  CATHETER BLNDIL 2MM 90CM 150MM STRLG SL OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148208010	SUP	HCPCS C1726		H74939148208010  -  CATHETER BLNDIL 2MM 150CM 80MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148208090	SUP	HCPCS C1753		H74939148208090  -  CATHETER BLNDIL 2MM 90CM 80MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148251010	SUP	HCPCS C1753		H74939148251010  -  CATHETER BLNDIL 2.5MM 150CM 100MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148251090	SUP	HCPCS C1753		H74939148251090  -  CATHETER BLNDIL 2.5MM 90CM 100MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148251210	SUP	HCPCS C1725		H74939148251210  -  CATHETER BLNDIL 2.5MM 150CM 120MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148251290	SUP	HCPCS C1725		H74939148251290  -  CATHETER BLNDIL 2.5MM 90CM 120MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148251510	SUP	HCPCS C1725		H74939148251510  -  CATHETER BLNDIL 2.5MM 150CM 150MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148251590	SUP	HCPCS C1725		H74939148251590  -  CATHETER BLNDIL 2.5MM 90CM 150MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148258010	SUP	HCPCS C1753		H74939148258010  -  CATHETER BLNDIL 2.5MM 150CM 80MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148258090	SUP	HCPCS C1753		H74939148258090  -  CATHETER BLNDIL 2.5MM 90CM 80MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148301010	SUP	HCPCS C1726		H74939148301010  -  CATHETER BLNDIL 3MM 150CM 100MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148301090	SUP	HCPCS C1753		H74939148301090  -  CATHETER BLNDIL 3MM 90CM 100MM STRLG SL OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148301210	SUP	HCPCS C1726		H74939148301210  -  CATHETER BLNDIL 3MM 150CM 120MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148301290	SUP	HCPCS C1725		H74939148301290  -  CATHETER BLNDIL 3MM 90CM 120MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148301510	SUP	HCPCS C1726		H74939148301510  -  CATHETER BLNDIL 3MM 150CM 150MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148301590	SUP	HCPCS C1725		H74939148301590  -  CATHETER BLNDIL 3MM 90CM 150MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148308010	SUP	HCPCS C1726		H74939148308010  -  CATHETER BLNDIL 3MM 150CM 80MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148308090	SUP	HCPCS C1753		H74939148308090  -  CATHETER BLNDIL 3MM 90CM 80MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148351010	SUP	HCPCS C1753		H74939148351010  -  CATHETER BLNDIL 3.5MM 150CM 100MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148351090	SUP	HCPCS C1753		H74939148351090  -  CATHETER BLNDIL 3.5MM 90CM 100MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148351210	SUP	HCPCS C1725		H74939148351210  -  CATHETER BLNDIL 3.5MM 150CM 120MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148351290	SUP	HCPCS C1725		H74939148351290  -  CATHETER BLNDIL 3.5MM 90CM 120MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148351510	SUP	HCPCS C1725		H74939148351510  -  CATHETER BLNDIL 3.5MM 150CM 150MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148351590	SUP	HCPCS C1725		H74939148351590  -  CATHETER BLNDIL 3.5MM 90CM 150MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148358010	SUP	HCPCS C1753		H74939148358010  -  CATHETER BLNDIL 3.5MM 150CM 80MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148358090	SUP	HCPCS C1753		H74939148358090  -  CATHETER BLNDIL 3.5MM 90CM 80MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148401010	SUP	HCPCS C1753		H74939148401010  -  CATHETER BLNDIL 4MM 150CM 100MM STRLG SL OTW INFL PORT	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148401210	SUP	HCPCS C1725		H74939148401210  -  CATHETER BLNDIL 4MM 150CM 120MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148401290	SUP	HCPCS C1725		H74939148401290  -  CATHETER BLNDIL 4MM 90CM 120MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148401510	SUP	HCPCS C1726		H74939148401510  -  CATHETER BLNDIL 4MM 150CM 150MM STRLG SL OTW TPR TIP LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148401590	SUP	HCPCS C1725		H74939148401590  -  CATHETER BLNDIL 4MM 90CM 150MM STRLG SL OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939148408010	SUP	HCPCS C1726		H74939148408010  -  CATHETER BLNDIL 4MM 150CM 80MM STRLG SL OTW INFL PORT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030210	SUP	HCPCS C1753		H74939171030210  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 20MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030240	SUP	HCPCS C1753		H74939171030240  -  CATHETER BLNDIL 3MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030270	SUP	HCPCS C1753		H74939171030270  -  CATHETER BALDILAT LP 5.3FR 3MM 75CM 20MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030310	SUP	HCPCS C1753		H74939171030310  -  CATHETER BALDILAT .035IN 5FR 3MM 135CM 30MM PTA LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030340	SUP	HCPCS C1753		H74939171030340  -  CATHETER BLNDIL 3MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030370	SUP	HCPCS C1753		H74939171030370  -  CATHETER BLNDIL 3MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030410	SUP	HCPCS C1753		H74939171030410  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 40MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030440	SUP	HCPCS C1753		H74939171030440  -  CATHETER BLNDIL 3MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030470	SUP	HCPCS C1753		H74939171030470  -  CATHETER BALDILAT LP 5.3FR 3MM 75CM 40MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030610	SUP	HCPCS C1753		H74939171030610  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 60MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030640	SUP	HCPCS C1753		H74939171030640  -  CATHETER BLNDIL 3MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030670	SUP	HCPCS C1753		H74939171030670  -  CATHETER BALDILAT LP 5.3FR 3MM 75CM 60MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030810	SUP	HCPCS C1753		H74939171030810  -  CATHETER BLNDIL 3MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030840	SUP	HCPCS C1753		H74939171030840  -  CATHETER BLNDIL 3MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171030870	SUP	HCPCS C1753		H74939171030870  -  CATHETER BLNDIL 3MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171031010	SUP	HCPCS C1753		H74939171031010  -  CATHETER BALDILAT .035IN 3MM 135CM 100MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171031040	SUP	HCPCS C1753		H74939171031040  -  CATHETER BLNDIL 3MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171031070	SUP	HCPCS C1753		H74939171031070  -  CATHETER BLNDIL 3MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171031210	SUP	HCPCS C1753		H74939171031210  -  CATHETER BLNDIL 3MM 135CM 120MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171031270	SUP	HCPCS C1753		H74939171031270  -  CATHETER BLNDIL 3MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171031510	SUP	HCPCS C1753		H74939171031510  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 150MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171031570	SUP	HCPCS C1753		H74939171031570  -  CATHETER BLNDIL 3MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171031810	SUP	HCPCS C1753		H74939171031810  -  CATHETER BALDILAT .035IN 5FR 3MM 135CM 180MM PTA LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171031870	SUP	HCPCS C1753		H74939171031870  -  CATHETER BLNDIL 3MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171032010	SUP	HCPCS C1753		H74939171032010  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 200MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171032070	SUP	HCPCS C1753		H74939171032070  -  CATHETER BLNDIL 3MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040210	SUP	HCPCS C1725		H74939171040210  -  CATHETER BALDILAT .035IN 4MM 135CM 20MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040240	SUP	HCPCS C1753		H74939171040240  -  CATHETER BLNDIL 4MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040270	SUP	HCPCS C1726		H74939171040270  -  CATHETER BALDILAT LP 5.3FR 4MM 75CM 20MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040310	SUP	HCPCS C1753		H74939171040310  -  CATHETER BALDILAT 4MM 135CM 30MM HIGH PRESSURE LP INFLAT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040340	SUP	HCPCS C1753		H74939171040340  -  CATHETER BLNDIL 4MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040370	SUP	HCPCS C1753		H74939171040370  -  CATHETER BLNDIL 4MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040410	SUP	HCPCS C1726		H74939171040410  -  CATHETER BALDILAT LP 5.3FR 4MM 135CM 40MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040440	SUP	HCPCS C1753		H74939171040440  -  CATHETER BLNDIL 4MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040470	SUP	HCPCS C1726		H74939171040470  -  CATHETER BALDILAT LP 5.3FR 4MM 75CM 40MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040610	SUP	HCPCS C1753		H74939171040610  -  CATHETER BALDILAT LP 5.3FR 4MM 135CM 60MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040640	SUP	HCPCS C1753		H74939171040640  -  CATHETER BLNDIL 4MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040670	SUP	HCPCS C1753		H74939171040670  -  CATHETER BALDILAT LP 5.3FR 4MM 75CM 60MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040810	SUP	HCPCS C1753		H74939171040810  -  CATHETER BALDILAT LP 5.3FR 4MM 135CM 80MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040840	SUP	HCPCS C1753		H74939171040840  -  CATHETER BLNDIL 4MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171040870	SUP	HCPCS C1753		H74939171040870  -  CATHETER BLNDIL 4MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171041010	SUP	HCPCS C1753		H74939171041010  -  CATHETER BALDILAT .035IN 4MM 135CM 100MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171041040	SUP	HCPCS C1753		H74939171041040  -  CATHETER BLNDIL 4MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171041070	SUP	HCPCS C1753		H74939171041070  -  CATHETER BLNDIL 4MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171041210	SUP	HCPCS C1726		H74939171041210  -  CATHETER BLNDIL 4MM 135CM 120MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171041270	SUP	HCPCS C1753		H74939171041270  -  CATHETER BLNDIL 4MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171041510	SUP	HCPCS C1753		H74939171041510  -  CATHETER BALDILAT LP 5.3FR 4MM 135CM 150MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171041570	SUP	HCPCS C1753		H74939171041570  -  CATHETER BLNDIL 4MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171041810	SUP	HCPCS C1753		H74939171041810  -  CATHETER BLNDIL 4MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171041870	SUP	HCPCS C1753		H74939171041870  -  CATHETER BLNDIL 4MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171042010	SUP	HCPCS C1725		H74939171042010  -  CATHETER BALDILAT .035IN 4MM 135CM 200MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171042070	SUP	HCPCS C1753		H74939171042070  -  CATHETER BLNDIL 4MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050210	SUP	HCPCS C1726		H74939171050210  -  CATHETER BALDILAT .035IN 5MM 135CM 20MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050240	SUP	HCPCS C1753		H74939171050240  -  CATHETER BLNDIL 5MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050270	SUP	HCPCS C1725		H74939171050270  -  CATHETER BALDILAT LP 5.3FR 5MM 75CM 20MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050310	SUP	HCPCS C1753		H74939171050310  -  CATHETER BALDILAT LP 5FR 5MM 135CM 30MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050340	SUP	HCPCS C1753		H74939171050340  -  CATHETER BLNDIL 5MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050370	SUP	HCPCS C1753		H74939171050370  -  CATHETER BLNDIL 5MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050410	SUP	HCPCS C1726		H74939171050410  -  CATHETER BALDILAT 5FR 5MM 135CM 40MM HIGH PRESSURE LP INFLAT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050440	SUP	HCPCS C1726		H74939171050440  -  CATHETER BLNDIL 5MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050470	SUP	HCPCS C1726		H74939171050470  -  CATHETER BALDILAT .035IN 5MM 75CM 40MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050610	SUP	HCPCS C1753		H74939171050610  -  CATHETER BALDILAT .035IN 5MM 135CM 60MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050640	SUP	HCPCS C1753		H74939171050640  -  CATHETER BLNDIL 5MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050670	SUP	HCPCS C1753		H74939171050670  -  CATHETER BALDILAT .035IN 5MM 75CM 60MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050810	SUP	HCPCS C1753		H74939171050810  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 80MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050840	SUP	HCPCS C1753		H74939171050840  -  CATHETER BLNDIL 5MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171050870	SUP	HCPCS C1753		H74939171050870  -  CATHETER BLNDIL 5MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171051010	SUP	HCPCS C1725		H74939171051010  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 100MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171051040	SUP	HCPCS C1753		H74939171051040  -  CATHETER BLNDIL 5MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171051070	SUP	HCPCS C1753		H74939171051070  -  CATHETER BLNDIL 5MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171051210	SUP	HCPCS C1753		H74939171051210  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 120MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171051240	SUP	HCPCS C1753		H74939171051240  -  CATHETER BLNDIL 5MM 40CM 120MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171051270	SUP	HCPCS C1753		H74939171051270  -  CATHETER BLNDIL 5MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171051510	SUP	HCPCS C1726		H74939171051510  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 150MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171051570	SUP	HCPCS C1753		H74939171051570  -  CATHETER BLNDIL 5MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171051810	SUP	HCPCS C1753		H74939171051810  -  CATHETER BLNDIL 5MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171051870	SUP	HCPCS C1753		H74939171051870  -  CATHETER BLNDIL 5MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171052010	SUP	HCPCS C1726		H74939171052010  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 200MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171052070	SUP	HCPCS C1753		H74939171052070  -  CATHETER BLNDIL 5MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060210	SUP	HCPCS C1726		H74939171060210  -  CATHETER BALDILAT .035IN 6MM 135CM 20MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060240	SUP	HCPCS C1753		H74939171060240  -  CATHETER BLNDIL 6MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060270	SUP	HCPCS C1726		H74939171060270  -  CATHETER BALDILAT .035IN 6MM 75CM 20MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060310	SUP	HCPCS C1753		H74939171060310  -  CATHETER BLNDIL 6MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060340	SUP	HCPCS C1753		H74939171060340  -  CATHETER BLNDIL 6MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060370	SUP	HCPCS C1753		H74939171060370  -  CATHETER BLNDIL 6MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060410	SUP	HCPCS C1726		H74939171060410  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 40MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060440	SUP	HCPCS C1726		H74939171060440  -  CATHETER BLNDIL 6MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060470	SUP	HCPCS C1726		H74939171060470  -  CATHETER BALDILAT 6MM 75CM 40MM HIGH PRESSURE LP INFLAT PORT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060610	SUP	HCPCS C1753		H74939171060610  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 60MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060640	SUP	HCPCS C1753		H74939171060640  -  CATHETER BLNDIL 6MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060670	SUP	HCPCS C1753		H74939171060670  -  CATHETER BALDILAT .035IN 6MM 75CM 60MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060810	SUP	HCPCS C1753		H74939171060810  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 80MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060840	SUP	HCPCS C1753		H74939171060840  -  CATHETER BLNDIL 6MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171060870	SUP	HCPCS C1753		H74939171060870  -  CATHETER BALDILAT .035IN 6MM 75CM 80MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171061010	SUP	HCPCS C1726		H74939171061010  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 100MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171061040	SUP	HCPCS C1753		H74939171061040  -  CATHETER BLNDIL 6MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171061070	SUP	HCPCS C1726		H74939171061070  -  CATHETER BALDILAT LP 5.3FR 6MM 75CM 100MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171061210	SUP	HCPCS C1753		H74939171061210  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 120MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171061240	SUP	HCPCS C1753		H74939171061240  -  CATHETER BLNDIL 6MM 40CM 120MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171061270	SUP	HCPCS C1753		H74939171061270  -  CATHETER BLNDIL 6MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171061510	SUP	HCPCS C1726		H74939171061510  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 150MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171061570	SUP	HCPCS C1753		H74939171061570  -  CATHETER BLNDIL 6MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171061810	SUP	HCPCS C1753		H74939171061810  -  CATHETER BLNDIL 6MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171061870	SUP	HCPCS C1753		H74939171061870  -  CATHETER BLNDIL 6MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171062010	SUP	HCPCS C1726		H74939171062010  -  CATHETER BALDILAT 6MM 135CM 200MM HIGH PRESSURE LP INFLAT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171062070	SUP	HCPCS C1753		H74939171062070  -  CATHETER BLNDIL 6MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070210	SUP	HCPCS C1753		H74939171070210  -  CATHETER BALDILAT .035IN 7MM 135CM 20MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070240	SUP	HCPCS C1753		H74939171070240  -  CATHETER BLNDIL 7MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070270	SUP	HCPCS C1726		H74939171070270  -  CATHETER BALDILAT LP 5.3FR 7MM 75CM 20MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070310	SUP	HCPCS C1753		H74939171070310  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 30MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070340	SUP	HCPCS C1753		H74939171070340  -  CATHETER BLNDIL 7MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070370	SUP	HCPCS C1753		H74939171070370  -  CATHETER BLNDIL 7MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070410	SUP	HCPCS C1726		H74939171070410  -  CATHETER BALDILAT .035IN 7MM 135CM 40MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070440	SUP	HCPCS C1726		H74939171070440  -  CATHETER BLNDIL 7MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070470	SUP	HCPCS C1726		H74939171070470  -  CATHETER BALDILAT .035IN 7MM 75CM 40MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070610	SUP	HCPCS C1753		H74939171070610  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 60MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070640	SUP	HCPCS C1753		H74939171070640  -  CATHETER BLNDIL 7MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070670	SUP	HCPCS C1753		H74939171070670  -  CATHETER BALDILAT .035IN 7MM 75CM 60MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070810	SUP	HCPCS C1753		H74939171070810  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 80MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070840	SUP	HCPCS C1753		H74939171070840  -  CATHETER BLNDIL 7MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171070870	SUP	HCPCS C1753		H74939171070870  -  CATHETER BLNDIL 7MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171071010	SUP	HCPCS C1725		H74939171071010  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 100MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171071040	SUP	HCPCS C1753		H74939171071040  -  CATHETER BLNDIL 7MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171071070	SUP	HCPCS C1753		H74939171071070  -  CATHETER BLNDIL 7MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171071210	SUP	HCPCS C1753		H74939171071210  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 120MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171071270	SUP	HCPCS C1753		H74939171071270  -  CATHETER BLNDIL 7MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171071510	SUP	HCPCS C1753		H74939171071510  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 150MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171071570	SUP	HCPCS C1753		H74939171071570  -  CATHETER BLNDIL 7MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171071810	SUP	HCPCS C1753		H74939171071810  -  CATHETER BLNDIL 7MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171071870	SUP	HCPCS C1753		H74939171071870  -  CATHETER BLNDIL 7MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171072010	SUP	HCPCS C1753		H74939171072010  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 200MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171072070	SUP	HCPCS C1753		H74939171072070  -  CATHETER BLNDIL 7MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080210	SUP	HCPCS C1753		H74939171080210  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 20MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080240	SUP	HCPCS C1753		H74939171080240  -  CATHETER BLNDIL 8MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080270	SUP	HCPCS C1725		H74939171080270  -  CATHETER BALDILAT LP 5.3FR 8MM 75CM 20MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080310	SUP	HCPCS C1753		H74939171080310  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 30MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080340	SUP	HCPCS C1753		H74939171080340  -  CATHETER BLNDIL 8MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080370	SUP	HCPCS C1753		H74939171080370  -  CATHETER BALDILAT LP 5.3FR 8MM 75CM 30MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080410	SUP	HCPCS C1726		H74939171080410  -  CATHETER BALDILAT 8MM 135CM 40MM HIGH PRESSURE LP INFLAT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080440	SUP	HCPCS C1726		H74939171080440  -  CATHETER BLNDIL 8MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080470	SUP	HCPCS C1726		H74939171080470  -  CATHETER BALDILAT .035IN 8MM 75CM 40MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080610	SUP	HCPCS C1753		H74939171080610  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 60MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080640	SUP	HCPCS C1753		H74939171080640  -  CATHETER BLNDIL 8MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080670	SUP	HCPCS C1753		H74939171080670  -  CATHETER BALDILAT .035IN 8MM 75CM 60MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080810	SUP	HCPCS C1753		H74939171080810  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 80MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080840	SUP	HCPCS C1753		H74939171080840  -  CATHETER BLNDIL 8MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171080870	SUP	HCPCS C1725		H74939171080870  -  CATHETER BALDILAT .035IN 8MM 75CM 80MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171081010	SUP	HCPCS C1726		H74939171081010  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 100MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171081040	SUP	HCPCS C1753		H74939171081040  -  CATHETER BLNDIL 8MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171081070	SUP	HCPCS C1726		H74939171081070  -  CATHETER BLNDIL 8MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171081210	SUP	HCPCS C1753		H74939171081210  -  CATHETER BLNDIL 8MM 135CM 120MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171081270	SUP	HCPCS C1753		H74939171081270  -  CATHETER BLNDIL 8MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171081510	SUP	HCPCS C1753		H74939171081510  -  CATHETER BLNDIL 8MM 135CM 150MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171081570	SUP	HCPCS C1753		H74939171081570  -  CATHETER BLNDIL 8MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171081810	SUP	HCPCS C1753		H74939171081810  -  CATHETER BALDILAT .035IN 5FR 8MM 135CM 180MM PTA LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171081870	SUP	HCPCS C1753		H74939171081870  -  CATHETER BLNDIL 8MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171082010	SUP	HCPCS C1753		H74939171082010  -  CATHETER BALDILAT .035IN 5FR 8MM 135CM 200MM PTA LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171082070	SUP	HCPCS C1753		H74939171082070  -  CATHETER BALDILAT LP 5.3FR 8MM 75CM 200MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171086070	SUP	HCPCS C1725		"H74939171086070  -  MUSTANG 8X 60, 75"	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090210	SUP	HCPCS C1753		H74939171090210  -  CATHETER BALDILAT 18 ATM LP TAPER 5.8FR 9MM 135CM 20MM 2	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090240	SUP	HCPCS C1753		H74939171090240  -  CATHETER BLNDIL 9MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090270	SUP	HCPCS C1753		H74939171090270  -  CATHETER BALDILAT LP 5.3FR 9MM 75CM 20MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090310	SUP	HCPCS C1753		H74939171090310  -  CATHETER BLNDIL 9MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090340	SUP	HCPCS C1753		H74939171090340  -  CATHETER BLNDIL 9MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090370	SUP	HCPCS C1753		H74939171090370  -  CATHETER BLNDIL 9MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090410	SUP	HCPCS C1753		H74939171090410  -  CATHETER BALDILAT LP 5.8FR 9MM 135CM 40MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090440	SUP	HCPCS C1753		H74939171090440  -  CATHETER BLNDIL 9MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090470	SUP	HCPCS C1725		H74939171090470  -  CATHETER BALDILAT .035IN 9MM 75CM 40MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090610	SUP	HCPCS C1753		H74939171090610  -  CATHETER BLNDIL 9MM 135CM 60MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090640	SUP	HCPCS C1753		H74939171090640  -  CATHETER BLNDIL 9MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090670	SUP	HCPCS C1726		H74939171090670  -  CATHETER BLNDIL 9MM 75CM 60MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090810	SUP	HCPCS C1753		H74939171090810  -  CATHETER BLNDIL 9MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090840	SUP	HCPCS C1753		H74939171090840  -  CATHETER BLNDIL 9MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171090870	SUP	HCPCS C1753		H74939171090870  -  CATHETER BLNDIL 9MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100210	SUP	HCPCS C1753		H74939171100210  -  CATHETER BALDILAT LP 5.8FR 10MM 135CM 20MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100240	SUP	HCPCS C1753		H74939171100240  -  CATHETER BLNDIL 10MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100270	SUP	HCPCS C1726		H74939171100270  -  CATHETER BALDILAT 10MM 75CM 20MM HIGH PRESSURE LP INFLAT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100310	SUP	HCPCS C1753		H74939171100310  -  CATHETER BLNDIL 10MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100340	SUP	HCPCS C1753		H74939171100340  -  CATHETER BLNDIL 10MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100370	SUP	HCPCS C1753		H74939171100370  -  CATHETER BALDILAT LP 5.8FR 10MM 75CM 30MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100410	SUP	HCPCS C1753		H74939171100410  -  CATHETER BALDILAT LP 5.8FR 10MM 135CM 40MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100440	SUP	HCPCS C1753		H74939171100440  -  CATHETER BLNDIL 10MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100470	SUP	HCPCS C1726		H74939171100470  -  CATHETER BALDILAT 10MM 75CM 40MM HIGH PRESSURE LP MUSTANG	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100610	SUP	HCPCS C1753		H74939171100610  -  CATHETER BLNDIL 10MM 135CM 60MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100640	SUP	HCPCS C1753		H74939171100640  -  CATHETER BLNDIL 10MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100670	SUP	HCPCS C1725		H74939171100670  -  CATHETER BALDILAT 5.8FR 10MM 75CM 60MM HIGH PRESSURE LP	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100810	SUP	HCPCS C1753		H74939171100810  -  CATHETER BLNDIL 10MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100840	SUP	HCPCS C1753		H74939171100840  -  CATHETER BLNDIL 10MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171100870	SUP	HCPCS C1753		H74939171100870  -  CATHETER BALDILAT LP 5.8FR 10MM 75CM 80MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120210	SUP	HCPCS C1753		H74939171120210  -  CATHETER BALDILAT LP 5.8FR 12MM 135CM 20MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120240	SUP	HCPCS C1753		H74939171120240  -  CATHETER BLNDIL 12MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120270	SUP	HCPCS C1753		H74939171120270  -  CATHETER BALDILAT LP 5.8FR 12MM 75CM 20MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120310	SUP	HCPCS C1753		H74939171120310  -  CATHETER BLNDIL 12MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120340	SUP	HCPCS C1753		H74939171120340  -  CATHETER BLNDIL 12MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120370	SUP	HCPCS C1753		H74939171120370  -  CATHETER BALDILAT LP 5.8FR 12MM 75CM 30MM HIGH PRESSURE	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120410	SUP	HCPCS C1753		H74939171120410  -  CATHETER BLNDIL 12MM 135CM 40MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120440	SUP	HCPCS C1753		H74939171120440  -  CATHETER BLNDIL 12MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120470	SUP	HCPCS C1726		H74939171120470  -  CATHETER BALDILAT 12MM 75CM 40MM HIGH PRESSURE LP MUSTANG	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120610	SUP	HCPCS C1753		H74939171120610  -  CATHETER BLNDIL 12MM 135CM 60MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120640	SUP	HCPCS C1753		H74939171120640  -  CATHETER BLNDIL 12MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120670	SUP	HCPCS C1753		H74939171120670  -  CATHETER BLNDIL 12MM 75CM 60MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120810	SUP	HCPCS C1753		H74939171120810  -  CATHETER BLNDIL 12MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120840	SUP	HCPCS C1753		H74939171120840  -  CATHETER BLNDIL 12MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939171120870	SUP	HCPCS C1753		H74939171120870  -  CATHETER BLNDIL 12MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT	BOTH IP/OP	$430.00 	$318.20	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$89.62	$319.15	$319.15	$0.00	$0.00	$89.61	$0.00	$254.35	$254.35	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185150410	SUP	HCPCS C1725		H74939185150410  -  CATHETER BLNDIL 1.5MM 150CM 40MM CYTE MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185201210	SUP	HCPCS C1725		H74939185201210  -  CATHETER BLNDIL 2MM 150CM 120MM CYTE MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185201290	SUP	HCPCS C1725		H74939185201290  -  CATHETER BLNDIL 2MM 90CM 120MM CYTE MNRL RX ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185201510	SUP	HCPCS C1725		H74939185201510  -  CATHETER BLNDIL 2MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185201590	SUP	HCPCS C1725		H74939185201590  -  CATHETER BLNDIL 2MM 90CM 150MM CYTE MNRL RX ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185251210	SUP	HCPCS C1725		H74939185251210  -  CATHETER BLNDIL 2.5MM 150CM 120MM CYTE MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185251290	SUP	HCPCS C1725		H74939185251290  -  CATHETER BLNDIL 2.5MM 90CM 120MM CYTE MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185251510	SUP	HCPCS C1725		H74939185251510  -  CATHETER BLNDIL 2.5MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185251590	SUP	HCPCS C1725		H74939185251590  -  CATHETER BLNDIL 2.5MM 90CM 150MM CYTE MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185301210	SUP	HCPCS C1725		H74939185301210  -  CATHETER BLNDIL 3MM 150CM 120MM CYTE MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185301290	SUP	HCPCS C1725		H74939185301290  -  CATHETER BLNDIL 3MM 90CM 120MM CYTE MNRL RX ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185301510	SUP	HCPCS C1725		H74939185301510  -  CATHETER BLNDIL 3MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185301590	SUP	HCPCS C1725		H74939185301590  -  CATHETER BLNDIL 3MM 90CM 150MM CYTE MNRL RX ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185351210	SUP	HCPCS C1725		H74939185351210  -  CATHETER BLNDIL 3.5MM 150CM 120MM CYTE MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185351290	SUP	HCPCS C1725		H74939185351290  -  CATHETER BLNDIL 3.5MM 90CM 120MM CYTE MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185351510	SUP	HCPCS C1725		H74939185351510  -  CATHETER BLNDIL 3.5MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185351590	SUP	HCPCS C1725		H74939185351590  -  CATHETER BLNDIL 3.5MM 90CM 150MM CYTE MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185401210	SUP	HCPCS C1725		H74939185401210  -  CATHETER BLNDIL 4MM 150CM 120MM CYTE MNRL RX ULT LOPRFL	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185401290	SUP	HCPCS C1725		H74939185401290  -  CATHETER BLNDIL 4MM 90CM 120MM CYTE MNRL RX ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185401510	SUP	HCPCS C1725		H74939185401510  -  CATHETER BLNDIL 4MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939185401590	SUP	HCPCS C1725		H74939185401590  -  CATHETER BLNDIL 4MM 90CM 150MM CYTE MNRL RX ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186150410	SUP	HCPCS C1726		H74939186150410  -  CATHETER BLNDIL 1.5MM 150CM 40MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186150490	SUP	HCPCS C1753		H74939186150490  -  CATHETER BLNDIL 1.5MM 90CM 40MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186200610	SUP	HCPCS C1753		H74939186200610  -  CATHETER BLNDIL 2MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186200690	SUP	HCPCS C1753		H74939186200690  -  CATHETER BLNDIL 2MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BSLD	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186200810	SUP	HCPCS C1753		H74939186200810  -  CATHETER BLNDIL 2MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186200890	SUP	HCPCS C1753		H74939186200890  -  CATHETER BLNDIL 2MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX BSLD	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186201010	SUP	HCPCS C1726		H74939186201010  -  CATHETER BLNDIL 2MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186201090	SUP	HCPCS C1753		H74939186201090  -  CATHETER BLNDIL 2MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186201210	SUP	HCPCS C1726		H74939186201210  -  CATHETER BLNDIL 2MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186201290	SUP	HCPCS C1753		H74939186201290  -  CATHETER BLNDIL 2MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186201510	SUP	HCPCS C1726		H74939186201510  -  CATHETER BLNDIL 2MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186201590	SUP	HCPCS C1753		H74939186201590  -  CATHETER BLNDIL 2MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186202210	SUP	HCPCS C1726		H74939186202210  -  CATHETER BLNDIL 2MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186202290	SUP	HCPCS C1753		H74939186202290  -  CATHETER BLNDIL 2MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186250610	SUP	HCPCS C1725		H74939186250610  -  CATHETER BLNDIL 2.5MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186250690	SUP	HCPCS C1753		H74939186250690  -  CATHETER BLNDIL 2.5MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186250810	SUP	HCPCS C1753		H74939186250810  -  CATHETER BLNDIL 2.5MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186250890	SUP	HCPCS C1753		H74939186250890  -  CATHETER BLNDIL 2.5MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186251010	SUP	HCPCS C1753		H74939186251010  -  CATHETER BLNDIL 2.5MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186251090	SUP	HCPCS C1753		H74939186251090  -  CATHETER BLNDIL 2.5MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186251210	SUP	HCPCS C1726		H74939186251210  -  CATHETER BLNDIL 2.5MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186251290	SUP	HCPCS C1753		H74939186251290  -  CATHETER BLNDIL 2.5MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186251510	SUP	HCPCS C1753		H74939186251510  -  CATHETER BLNDIL 2.5MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186251590	SUP	HCPCS C1753		H74939186251590  -  CATHETER BLNDIL 2.5MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186252210	SUP	HCPCS C1726		H74939186252210  -  CATHETER BLNDIL 2.5MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186252290	SUP	HCPCS C1753		H74939186252290  -  CATHETER BLNDIL 2.5MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186300610	SUP	HCPCS C1753		H74939186300610  -  CATHETER BLNDIL 3MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186300690	SUP	HCPCS C1753		H74939186300690  -  CATHETER BLNDIL 3MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BSLD	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186300810	SUP	HCPCS C1753		H74939186300810  -  CATHETER BLNDIL 3MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186300890	SUP	HCPCS C1753		H74939186300890  -  CATHETER BLNDIL 3MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX BSLD	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186301010	SUP	HCPCS C1726		H74939186301010  -  CATHETER BLNDIL 3MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186301090	SUP	HCPCS C1753		H74939186301090  -  CATHETER BLNDIL 3MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186301210	SUP	HCPCS C1726		H74939186301210  -  CATHETER BLNDIL 3MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186301290	SUP	HCPCS C1753		H74939186301290  -  CATHETER BLNDIL 3MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186301510	SUP	HCPCS C1726		H74939186301510  -  CATHETER BLNDIL 3MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186301590	SUP	HCPCS C1753		H74939186301590  -  CATHETER BLNDIL 3MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186302210	SUP	HCPCS C1726		H74939186302210  -  CATHETER BLNDIL 3MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186302290	SUP	HCPCS C1753		H74939186302290  -  CATHETER BLNDIL 3MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186350610	SUP	HCPCS C1753		H74939186350610  -  CATHETER BLNDIL 3.5MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186350690	SUP	HCPCS C1753		H74939186350690  -  CATHETER BLNDIL 3.5MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186350810	SUP	HCPCS C1753		H74939186350810  -  CATHETER BLNDIL 3.5MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186350890	SUP	HCPCS C1753		H74939186350890  -  CATHETER BLNDIL 3.5MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186351010	SUP	HCPCS C1753		H74939186351010  -  CATHETER BLNDIL 3.5MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186351090	SUP	HCPCS C1753		H74939186351090  -  CATHETER BLNDIL 3.5MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186351210	SUP	HCPCS C1753		H74939186351210  -  CATHETER BLNDIL 3.5MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186351290	SUP	HCPCS C1753		H74939186351290  -  CATHETER BLNDIL 3.5MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186351510	SUP	HCPCS C1753		H74939186351510  -  CATHETER BLNDIL 3.5MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186351590	SUP	HCPCS C1753		H74939186351590  -  CATHETER BLNDIL 3.5MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186352210	SUP	HCPCS C1753		H74939186352210  -  CATHETER BLNDIL 3.5MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186352290	SUP	HCPCS C1753		H74939186352290  -  CATHETER BLNDIL 3.5MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186400610	SUP	HCPCS C1753		H74939186400610  -  CATHETER BLNDIL 4MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186400690	SUP	HCPCS C1753		H74939186400690  -  CATHETER BLNDIL 4MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BSLD	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186400810	SUP	HCPCS C1753		H74939186400810  -  CATHETER BLNDIL 4MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186400890	SUP	HCPCS C1753		H74939186400890  -  CATHETER BLNDIL 4MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX BSLD	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186401010	SUP	HCPCS C1726		H74939186401010  -  CATHETER BLNDIL 4MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186401090	SUP	HCPCS C1753		H74939186401090  -  CATHETER BLNDIL 4MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186401210	SUP	HCPCS C1726		H74939186401210  -  CATHETER BLNDIL 4MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186401290	SUP	HCPCS C1753		H74939186401290  -  CATHETER BLNDIL 4MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186401510	SUP	HCPCS C1753		H74939186401510  -  CATHETER BLNDIL 4MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186401590	SUP	HCPCS C1753		H74939186401590  -  CATHETER BLNDIL 4MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186402210	SUP	HCPCS C1726		H74939186402210  -  CATHETER BLNDIL 4MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939186402290	SUP	HCPCS C1753		H74939186402290  -  CATHETER BLNDIL 4MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX	BOTH IP/OP	$417.50 	$308.95	$0.00	$334.00	$226.70	$226.70	$0.00	$0.00	$0.00	$87.02	$309.87	$309.87	$0.00	$0.00	$87.01	$0.00	$246.95	$246.95	$0.00	$208.75	$330.66	$334.00	$0.00		$0.00	$65.34	$0.00	$0.00	$66.47	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200061020	SUP	HCPCS C1876		H74939200061020  -  STENT VASCULAR .035IN 6MM 100MM 120CM SELF EXPAND OTW GWIRE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200061070	SUP	HCPCS C1876		H74939200061070  -  STENT VASCULAR 6MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200061220	SUP	HCPCS C1876		H74939200061220  -  STENT VASCULAR 6MM 120MM 120CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200061270	SUP	HCPCS C1876		H74939200061270  -  STENT VASCULAR .035IN 6MM 120MM 75CM SELF EXPAND OTW GWIRE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200062020	SUP	HCPCS C1876		H74939200062020  -  STENT VASCULAR 6MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200062070	SUP	HCPCS C1876		H74939200062070  -  STENT VASCULAR 6MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200063020	SUP	HCPCS C1876		H74939200063020  -  STENT VASCULAR 6MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200063070	SUP	HCPCS C1876		H74939200063070  -  STENT VASCULAR 6MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200064020	SUP	HCPCS C1876		H74939200064020  -  STENT VASCULAR 6MM 40MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200064070	SUP	HCPCS C1876		H74939200064070  -  STENT VASCULAR .035IN 6MM 40MM 75CM SELF EXPAND OTW GWIRE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200065020	SUP	HCPCS C1876		H74939200065020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 6MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200065070	SUP	HCPCS C1876		H74939200065070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 6MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200066020	SUP	HCPCS C1876		H74939200066020  -  STENT VASCULAR .035IN 6MM 60MM 120CM SELF EXPAND OTW GWIRE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200066070	SUP	HCPCS C1876		H74939200066070  -  STENT VASCULAR 6MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200067020	SUP	HCPCS C1876		H74939200067020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 6MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200067070	SUP	HCPCS C1876		H74939200067070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 6MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200068020	SUP	HCPCS C1876		H74939200068020  -  STENT VASCULAR 6MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200068070	SUP	HCPCS C1876		H74939200068070  -  STENT VASCULAR 6MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200071020	SUP	HCPCS C1876		H74939200071020  -  STENT VASCULAR .035IN 7MM 100MM 120CM SELF EXPAND OTW GWIRE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200071070	SUP	HCPCS C1876		H74939200071070  -  STENT VASCULAR 7MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200071220	SUP	HCPCS C1876		H74939200071220  -  STENT VASCULAR 7MM 120MM 120CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200071270	SUP	HCPCS C1876		H74939200071270  -  STENT VASCULAR 7MM 120MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200072020	SUP	HCPCS C1876		H74939200072020  -  STENT VASCULAR 7MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200072070	SUP	HCPCS C1876		H74939200072070  -  STENT VASCULAR 7MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200073020	SUP	HCPCS C1876		H74939200073020  -  STENT VASCULAR 7MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200073070	SUP	HCPCS C1876		H74939200073070  -  STENT VASCULAR .035IN 7MM 30MM 75CM SELF EXPAND OTW GWIRE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200074020	SUP	HCPCS C1876		H74939200074020  -  STENT VASCULAR .035IN 7MM 40MM 120CM SELF EXPAND OTW GWIRE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200074070	SUP	HCPCS C1876		H74939200074070  -  STENT VASCULAR .035IN 7MM 40MM 75CM SELF EXPAND OTW GWIRE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200075020	SUP	HCPCS C1876		H74939200075020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 7MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200075070	SUP	HCPCS C1876		H74939200075070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 7MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200076020	SUP	HCPCS C1876		H74939200076020  -  STENT VASCULAR 7MM 60MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200076070	SUP	HCPCS C1876		H74939200076070  -  STENT VASCULAR 7MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200077020	SUP	HCPCS C1876		H74939200077020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 7MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200077070	SUP	HCPCS C1876		H74939200077070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 7MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200078020	SUP	HCPCS C1876		H74939200078020  -  STENT VASCULAR 7MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200078070	SUP	HCPCS C1876		H74939200078070  -  STENT VASCULAR 7MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIUM	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200081020	SUP	HCPCS C1876		H74939200081020  -  STENT VASCULAR 8MM 100MM 120CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200081070	SUP	HCPCS C1876		H74939200081070  -  STENT VASCULAR 8MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200081220	SUP	HCPCS C1876		H74939200081220  -  STENT VASCULAR .035IN 8MM 120MM 120CM SELF EXPAND OTW GWIRE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200081270	SUP	HCPCS C1876		H74939200081270  -  STENT VASCULAR 8MM 120MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200082020	SUP	HCPCS C1876		H74939200082020  -  STENT VASCULAR 8MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200082070	SUP	HCPCS C1876		H74939200082070  -  STENT VASCULAR 8MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIUM	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200083020	SUP	HCPCS C1876		H74939200083020  -  STENT VASCULAR 8MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200083070	SUP	HCPCS C1876		H74939200083070  -  STENT VASCULAR .035IN 8MM 30MM 75CM SELF EXPAND OTW GWIRE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200084020	SUP	HCPCS C1876		H74939200084020  -  STENT VASCULAR 8MM 40MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200085020	SUP	HCPCS C1876		H74939200085020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 8MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200085070	SUP	HCPCS C1876		H74939200085070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 8MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200086020	SUP	HCPCS C1876		H74939200086020  -  STENT VASCULAR 8MM 60MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200086070	SUP	HCPCS C1876		H74939200086070  -  STENT VASCULAR 8MM 6FR 60MM 75CM SELF EXPAND SHEATH EPIC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200087020	SUP	HCPCS C1876		H74939200087020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 8MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200087070	SUP	HCPCS C1876		H74939200087070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 8MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200088020	SUP	HCPCS C1876		H74939200088020  -  STENT VASCULAR 8MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200088070	SUP	HCPCS C1876		H74939200088070  -  STENT VASCULAR 8MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200091020	SUP	HCPCS C1876		H74939200091020  -  STENT VASCULAR .035IN 8MM 100MM 120CM SELF EXPAND OTW GWIRE	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200091070	SUP	HCPCS C1876		H74939200091070  -  STENT VASCULAR 9MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200092020	SUP	HCPCS C1876		H74939200092020  -  STENT VASCULAR 9MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200092070	SUP	HCPCS C1876		H74939200092070  -  STENT VASCULAR 9MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200093020	SUP	HCPCS C1876		H74939200093020  -  STENT VASCULAR 9MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200093070	SUP	HCPCS C1876		H74939200093070  -  STENT VASCULAR 9MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200094020	SUP	HCPCS C1876		H74939200094020  -  STENT VASCULAR 9MM 40MM 120CM SELF EXPAND EPIC METAL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200094070	SUP	HCPCS C1876		H74939200094070  -  STENT VASCULAR 9MM 40MM 75CM SELF EXPAND EPIC NITINOL ILIUM	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200095020	SUP	HCPCS C1876		H74939200095020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 9MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200095070	SUP	HCPCS C1876		H74939200095070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 9MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200096020	SUP	HCPCS C1876		H74939200096020  -  STENT VASCULAR 9MM 60MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200096070	SUP	HCPCS C1876		H74939200096070  -  STENT VASCULAR 9MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIUM	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200097020	SUP	HCPCS C1876		H74939200097020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 9MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200097070	SUP	HCPCS C1876		H74939200097070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 9MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200098020	SUP	HCPCS C1876		H74939200098020  -  STENT VASCULAR 9MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200098070	SUP	HCPCS C1876		H74939200098070  -  STENT VASCULAR 9MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIUM	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200101020	SUP	HCPCS C1876		H74939200101020  -  STENT VASCULAR 9MM 100MM 120CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200101070	SUP	HCPCS C1876		H74939200101070  -  STENT VASCULAR 10MM 100MM 75CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200102020	SUP	HCPCS C1876		H74939200102020  -  STENT VASCULAR 10MM 20MM 120CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200102070	SUP	HCPCS C1876		H74939200102070  -  STENT VASCULAR 10MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200103020	SUP	HCPCS C1876		H74939200103020  -  STENT VASCULAR 10MM 30MM 120CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200103070	SUP	HCPCS C1876		H74939200103070  -  STENT VASCULAR 10MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200104020	SUP	HCPCS C1876		H74939200104020  -  STENT VASCULAR 10MM 40MM 120CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200104070	SUP	HCPCS C1876		H74939200104070  -  STENT VASCULAR 10MM 40MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200105020	SUP	HCPCS C1876		H74939200105020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 10MM	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200105070	SUP	HCPCS C1876		H74939200105070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 10MM ILIAC	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200106020	SUP	HCPCS C1876		H74939200106020  -  STENT VASCULAR 10MM 60MM 120CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200106070	SUP	HCPCS C1876		H74939200106070  -  STENT VASCULAR 10MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200107020	SUP	HCPCS C1876		H74939200107020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 10MM	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200107070	SUP	HCPCS C1876		H74939200107070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 10MM ILIUM	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200108020	SUP	HCPCS C1876		H74939200108020  -  STENT VASCULAR 10MM 80MM 120CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200108070	SUP	HCPCS C1876		H74939200108070  -  STENT VASCULAR 10MM 80MM 75CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200123020	SUP	HCPCS C1876		H74939200123020  -  STENT VASCULAR 12MM 30MM 120CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200123070	SUP	HCPCS C1876		H74939200123070  -  STENT VASCULAR 12MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200124020	SUP	HCPCS C1876		H74939200124020  -  STENT VASCULAR 12MM 40MM 120CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200124070	SUP	HCPCS C1876		H74939200124070  -  STENT VASCULAR 12MM 40MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200125020	SUP	HCPCS C1876		H74939200125020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 12MM	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200125070	SUP	HCPCS C1876		H74939200125070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 12MM ILIUM	BOTH IP/OP	"$2,500.00 "	"$1,850.00"	$0.00	"$2,000.00"	"$1,125.00"	"$1,125.00"	$0.00	$0.00	$0.00	$521.06	"$1,855.50"	"$1,855.50"	$0.00	$0.00	$521.00	$0.00	"$1,478.75"	"$1,478.75"	$0.00	"$1,250.00"	"$1,980.00"	"$2,000.00"	$0.00		$0.00	$391.25	$0.00	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200126020	SUP	HCPCS C1876		H74939200126020  -  STENT VASCULAR 12MM 60MM 120CM SELF EXPAND EPIC NITINOL	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939200126070	SUP	HCPCS C1876		H74939200126070  -  STENT VASCULAR 12MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC	BOTH IP/OP	"$1,462.50 "	"$1,082.25"	$0.00	"$1,170.00"	$658.13	$658.13	$0.00	$0.00	$0.00	$304.82	"$1,085.47"	"$1,085.47"	$0.00	$0.00	$304.79	$0.00	$865.07	$865.07	$0.00	$731.25	"$1,158.30"	"$1,170.00"	$0.00		$0.00	$228.88	$0.00	$0.00	$232.83	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206030210	SUP	HCPCS C1753		H74939206030210  -  CATHETER BLNDIL 3MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206030270	SUP	HCPCS C1753		H74939206030270  -  CATHETER BLNDIL 3MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206030370	SUP	HCPCS C1753		H74939206030370  -  CATHETER BLNDIL 3MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206030410	SUP	HCPCS C1753		H74939206030410  -  CATHETER BLNDIL 3MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206030470	SUP	HCPCS C1753		H74939206030470  -  CATHETER BLNDIL 3MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206030670	SUP	HCPCS C1753		H74939206030670  -  CATHETER BLNDIL 3MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206030810	SUP	HCPCS C1753		H74939206030810  -  CATHETER BLNDIL 3MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206031010	SUP	HCPCS C1753		H74939206031010  -  CATHETER BLNDIL 3MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206031210	SUP	HCPCS C1753		H74939206031210  -  CATHETER BLNDIL 3MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206031510	SUP	HCPCS C1753		H74939206031510  -  CATHETER BLNDIL 3MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206031810	SUP	HCPCS C1753		H74939206031810  -  CATHETER BLNDIL 3MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206032010	SUP	HCPCS C1753		H74939206032010  -  CATHETER BLNDIL 3MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206040210	SUP	HCPCS C1753		H74939206040210  -  CATHETER BLNDIL 4MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206040270	SUP	HCPCS C1753		H74939206040270  -  CATHETER BLNDIL 4MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206040370	SUP	HCPCS C1753		H74939206040370  -  CATHETER BLNDIL 4MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206040410	SUP	HCPCS C1753		H74939206040410  -  CATHETER BLNDIL 4MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206040470	SUP	HCPCS C1753		H74939206040470  -  CATHETER BLNDIL 4MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206040610	SUP	HCPCS C1753		H74939206040610  -  CATHETER BLNDIL 4MM 135CM 60MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206040670	SUP	HCPCS C1753		H74939206040670  -  CATHETER BLNDIL 4MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206040810	SUP	HCPCS C1753		H74939206040810  -  CATHETER BLNDIL 4MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206040870	SUP	HCPCS C1753		H74939206040870  -  CATHETER BLNDIL 4MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206041010	SUP	HCPCS C1753		H74939206041010  -  CATHETER BLNDIL 4MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206041070	SUP	HCPCS C1753		H74939206041070  -  CATHETER BLNDIL 4MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206041210	SUP	HCPCS C1753		H74939206041210  -  CATHETER BLNDIL 4MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206041510	SUP	HCPCS C1753		H74939206041510  -  CATHETER BLNDIL 4MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206041810	SUP	HCPCS C1753		H74939206041810  -  CATHETER BLNDIL 4MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206042010	SUP	HCPCS C1753		H74939206042010  -  CATHETER BLNDIL 4MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206050210	SUP	HCPCS C1753		H74939206050210  -  CATHETER BLNDIL 5MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206050270	SUP	HCPCS C1753		H74939206050270  -  CATHETER BLNDIL 5MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206050370	SUP	HCPCS C1753		H74939206050370  -  CATHETER BLNDIL 5MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206050410	SUP	HCPCS C1753		H74939206050410  -  CATHETER BLNDIL 5MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206050470	SUP	HCPCS C1753		H74939206050470  -  CATHETER BLNDIL 5MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206050610	SUP	HCPCS C1753		H74939206050610  -  CATHETER BLNDIL 5MM 135CM 60MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206050670	SUP	HCPCS C1753		H74939206050670  -  CATHETER BLNDIL 5MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206050810	SUP	HCPCS C1753		H74939206050810  -  CATHETER BLNDIL 5MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206050870	SUP	HCPCS C1753		H74939206050870  -  CATHETER BLNDIL 5MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206051010	SUP	HCPCS C1753		H74939206051010  -  CATHETER BLNDIL 5MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206051070	SUP	HCPCS C1753		H74939206051070  -  CATHETER BLNDIL 5MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206051210	SUP	HCPCS C1753		H74939206051210  -  CATHETER BLNDIL 5MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206051510	SUP	HCPCS C1753		H74939206051510  -  CATHETER BLNDIL 5MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206051810	SUP	HCPCS C1753		H74939206051810  -  CATHETER BLNDIL 5MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206052010	SUP	HCPCS C1753		H74939206052010  -  CATHETER BLNDIL 5MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206060210	SUP	HCPCS C1753		H74939206060210  -  CATHETER BLNDIL 6MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206060270	SUP	HCPCS C1753		H74939206060270  -  CATHETER BLNDIL 6MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206060370	SUP	HCPCS C1753		H74939206060370  -  CATHETER BLNDIL 6MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206060410	SUP	HCPCS C1753		H74939206060410  -  CATHETER BLNDIL 6MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206060470	SUP	HCPCS C1753		H74939206060470  -  CATHETER BLNDIL 6MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206060610	SUP	HCPCS C1753		H74939206060610  -  CATHETER BLNDIL 6MM 135CM 60MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206060670	SUP	HCPCS C1753		H74939206060670  -  CATHETER BLNDIL 6MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206060810	SUP	HCPCS C1753		H74939206060810  -  CATHETER BLNDIL 6MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206060870	SUP	HCPCS C1753		H74939206060870  -  CATHETER BLNDIL 6MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206061010	SUP	HCPCS C1753		H74939206061010  -  CATHETER BLNDIL 6MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206061070	SUP	HCPCS C1753		H74939206061070  -  CATHETER BLNDIL 6MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206061210	SUP	HCPCS C1753		H74939206061210  -  CATHETER BLNDIL 6MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206061510	SUP	HCPCS C1753		H74939206061510  -  CATHETER BLNDIL 6MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206061810	SUP	HCPCS C1753		H74939206061810  -  CATHETER BLNDIL 6MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206062010	SUP	HCPCS C1753		H74939206062010  -  CATHETER BLNDIL 6MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206070210	SUP	HCPCS C1753		H74939206070210  -  CATHETER BLNDIL 7MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206070270	SUP	HCPCS C1753		H74939206070270  -  CATHETER BLNDIL 7MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206070370	SUP	HCPCS C1753		H74939206070370  -  CATHETER BLNDIL 7MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206070410	SUP	HCPCS C1753		H74939206070410  -  CATHETER BLNDIL 7MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206070470	SUP	HCPCS C1753		H74939206070470  -  CATHETER BLNDIL 7MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206070610	SUP	HCPCS C1753		"H74939206070610  -  BALLOON CATHETER CHARGER 7.0 x60, 135cm"	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206070670	SUP	HCPCS C1753		H74939206070670  -  CATHETER BLNDIL 7MM 75CM 60MM CHRGR OTW 2 LUM TPR TIP LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206070810	SUP	HCPCS C1753		H74939206070810  -  CATHETER BLNDIL 7MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206070870	SUP	HCPCS C1753		H74939206070870  -  CATHETER BLNDIL 7MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206071010	SUP	HCPCS C1753		H74939206071010  -  CATHETER BLNDIL 7MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206071070	SUP	HCPCS C1753		H74939206071070  -  CATHETER BLNDIL 7MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206071210	SUP	HCPCS C1753		H74939206071210  -  CATHETER BLNDIL 7MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206071510	SUP	HCPCS C1753		H74939206071510  -  CATHETER BLNDIL 7MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206071810	SUP	HCPCS C1753		H74939206071810  -  CATHETER BLNDIL 7MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206072010	SUP	HCPCS C1753		H74939206072010  -  CATHETER BLNDIL 7MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206080210	SUP	HCPCS C1753		H74939206080210  -  CATHETER BLNDIL 8MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206080270	SUP	HCPCS C1753		H74939206080270  -  CATHETER BLNDIL 8MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206080370	SUP	HCPCS C1753		H74939206080370  -  CATHETER BLNDIL 8MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206080410	SUP	HCPCS C1753		H74939206080410  -  CATHETER BLNDIL 8MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206080470	SUP	HCPCS C1753		H74939206080470  -  CATHETER BLNDIL 8MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206080670	SUP	HCPCS C1753		H74939206080670  -  CATHETER BLNDIL 8MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206080810	SUP	HCPCS C1753		H74939206080810  -  CATHETER BLNDIL 8MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206080870	SUP	HCPCS C1753		H74939206080870  -  CATHETER BLNDIL 8MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206081010	SUP	HCPCS C1753		H74939206081010  -  CATHETER BLNDIL 8MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206081070	SUP	HCPCS C1753		H74939206081070  -  CATHETER BLNDIL 8MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206081210	SUP	HCPCS C1753		H74939206081210  -  CATHETER BLNDIL 8MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206081510	SUP	HCPCS C1753		H74939206081510  -  CATHETER BLNDIL 8MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206081810	SUP	HCPCS C1753		H74939206081810  -  CATHETER BLNDIL 8MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206082010	SUP	HCPCS C1753		H74939206082010  -  CATHETER BLNDIL 8MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206090210	SUP	HCPCS C1753		H74939206090210  -  CATHETER BLNDIL 9MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206090270	SUP	HCPCS C1753		H74939206090270  -  CATHETER BLNDIL 9MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206090370	SUP	HCPCS C1753		H74939206090370  -  CATHETER BLNDIL 9MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206090410	SUP	HCPCS C1753		H74939206090410  -  CATHETER BLNDIL 9MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206090470	SUP	HCPCS C1753		H74939206090470  -  CATHETER BLNDIL 9MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206090670	SUP	HCPCS C1753		H74939206090670  -  CATHETER BLNDIL 9MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206090870	SUP	HCPCS C1753		H74939206090870  -  CATHETER BLNDIL 9MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206100210	SUP	HCPCS C1753		H74939206100210  -  CATHETER BLNDIL 10MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206100270	SUP	HCPCS C1753		H74939206100270  -  CATHETER BLNDIL 10MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206100370	SUP	HCPCS C1753		H74939206100370  -  CATHETER BLNDIL 10MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206100410	SUP	HCPCS C1753		H74939206100410  -  CATHETER BLNDIL 10MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206100470	SUP	HCPCS C1753		H74939206100470  -  CATHETER BLNDIL 10MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206100670	SUP	HCPCS C1753		H74939206100670  -  CATHETER BLNDIL 10MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206100870	SUP	HCPCS C1753		H74939206100870  -  CATHETER BLNDIL 10MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206120210	SUP	HCPCS C1753		H74939206120210  -  CATHETER BLNDIL 12MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206120270	SUP	HCPCS C1753		H74939206120270  -  CATHETER BLNDIL 12MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206120370	SUP	HCPCS C1753		H74939206120370  -  CATHETER BLNDIL 12MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206120410	SUP	HCPCS C1753		H74939206120410  -  CATHETER BLNDIL 12MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206120470	SUP	HCPCS C1753		H74939206120470  -  CATHETER BLNDIL 12MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206120670	SUP	HCPCS C1753		H74939206120670  -  CATHETER BLNDIL 12MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939206120870	SUP	HCPCS C1753		H74939206120870  -  CATHETER BLNDIL 12MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$108.60	$108.60	$0.00	$0.00	$0.00	$41.69	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$118.30	$118.30	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$31.30	$0.00	$0.00	$31.84	$0.00	$0.00	$0.00	$0.00	$0.00
H74939208001601	SUP	HCPCS C1769		H74939208001601  -  WIRE CATHETER .017IN .018IN 165CM 300CM SHAPABLE DISTAL TIP	BOTH IP/OP	$205.80 	$152.29	$0.00	$164.64	$111.75	$111.75	$0.00	$0.00	$0.00	$42.89	$152.74	$152.74	$0.00	$0.00	$42.89	$0.00	$121.73	$121.73	$0.00	$102.90	$162.99	$164.64	$0.00		$0.00	$32.21	$0.00	$0.00	$32.76	$0.00	$0.00	$0.00	$0.00	$0.00
H74939208181650	SUP	HCPCS C2628		H74939208181650  -  CATHETER ATHERECTOMY .017IN .018IN 165CM SHAPABLE DISTAL TIP	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$2,318.68"	"$2,318.68"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H74939212014131	SUP	HCPCS C1887		H74939212014131  -  CATHETER SPRT 15MM SPC 3.4FR 135CM CLR PUR RUBICON 14 RADOPQ	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$798.21	$798.21	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
H74939212014151	SUP	HCPCS C1887		H74939212014151  -  CATHETER GUID .018IN 150CM RADIOPQ ULTRA LP ROBUST BALLOON	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$798.21	$798.21	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
H74939216718210	SUP	HCPCS C1769		H74939216718210  -  GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 182CM 8CM ROBUST	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$172.95	$172.95	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
H74939216718220	SUP	HCPCS C1769		H74939216718220  -  GUIDEWIRE VASCULAR ANGLE SHORT TAPER .014IN 182CM 8CM ROBUST	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$172.95	$172.95	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
H74939216730010	SUP	HCPCS C1769		H74939216730010  -  GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 300CM 8CM ROBUST	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$172.95	$172.95	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
H74939216730020	SUP	HCPCS C1769		H74939216730020  -  GUIDEWIRE VASCULAR ANGLE SHORT TAPER .014IN 300CM 8CM ROBUST	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$172.95	$172.95	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
H74939216918210	SUP	HCPCS C1769		H74939216918210  -  GUIDEWIRE VASCULAR STR LONG TAPER .014IN 182CM 11CM ROBUST	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$172.95	$172.95	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
H74939216918220	SUP	HCPCS C1769		H74939216918220  -  GUIDEWIRE VASCULAR ANGLE LONG TAPER .014IN 182CM 11CM ROBUST	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$172.95	$172.95	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
H74939216930010	SUP	HCPCS C1769		H74939216930010  -  GUIDEWIRE VASCULAR STR LONG TAPER .014IN 300CM 11CM ROBUST	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$172.95	$172.95	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
H74939216930020	SUP	HCPCS C1769		H74939216930020  -  GUIDEWIRE VASCULAR ANGLE LONG TAPER .014IN 300CM 11CM ROBUST	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$172.95	$172.95	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
H74939239018091	SUP	HCPCS C1887		H74939239018091  -  CATHETER SPRT 15MM SPC 4FR 90CM CLR PUR RUBICON 18 RADOPQ	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$798.21	$798.21	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
H74939239018131	SUP	HCPCS C1887		H74939239018131  -  CATHETER SPRT 15MM SPC 4FR 135CM CLR PUR RUBICON 18 RADOPQ	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$798.21	$798.21	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
H74939239018151	SUP	HCPCS C1887		H74939239018151  -  CATHETER SPRT 15MM SPC 4FR 150CM CLR PUR RUBICON 18 RADOPQ	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$798.21	$798.21	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
H74939240035061	SUP	HCPCS C1887		H74939240035061  -  CATHETER SPRT 50MM SPC 5.1FR 65CM CLR PUR RUBICON 35 RADOPQ	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$798.21	$798.21	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
H74939240035091	SUP	HCPCS C1887		H74939240035091  -  CATHETER SPRT 50MM SPC 5.1FR 90CM CLR PUR RUBICON 35 RADOPQ	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$798.21	$798.21	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
H74939240035131	SUP	HCPCS C1887		H74939240035131  -  CATHETER SPRT 50MM SPC 5.1FR 135CM CLR PUR RUBICON 35 RADOPQ	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$798.21	$798.21	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
H74939240035151	SUP	HCPCS C1887		H74939240035151  -  CATHETER SPRT 50MM SPC 5.1FR 150CM CLR PUR RUBICON 35 RADOPQ	BOTH IP/OP	"$1,470.00 "	"$1,087.80"	$0.00	"$1,176.00"	$798.21	$798.21	$0.00	$0.00	$0.00	$306.38	"$1,091.03"	"$1,091.03"	$0.00	$0.00	$306.35	$0.00	$869.51	$869.51	$0.00	$735.00	"$1,164.24"	"$1,176.00"	$0.00		$0.00	$230.06	$0.00	$0.00	$234.02	$0.00	$0.00	$0.00	$0.00	$0.00
H749501001500	SUP	Custom 27203010		H749501001500  -  SHEATH RTRVL 150CM 4FR F EZ .014IN BNTP	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H749CBO3200100	SUP	HCPCS C1726		H749CBO3200100  -  CATHETER BLNDIL 2MM 137CM 10MM F CBLN OTW INFL PORT GW PORT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	"$1,086.00"	"$1,086.00"	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
H749CBO3200150	SUP	HCPCS C1726		H749CBO3200150  -  CATHETER BLNDIL 2MM 137CM 15MM F CBLN OTW INFL PORT GW PORT	BOTH IP/OP	"$1,715.00 "	"$1,269.10"	$0.00	"$1,372.00"	$931.25	$931.25	$0.00	$0.00	$0.00	$357.45	"$1,272.87"	"$1,272.87"	$0.00	$0.00	$357.41	$0.00	"$1,014.42"	"$1,014.42"	$0.00	$857.50	"$1,358.28"	"$1,372.00"	$0.00		$0.00	$268.40	$0.00	$0.00	$273.03	$0.00	$0.00	$0.00	$0.00	$0.00
H749CBO3250100	SUP	HCPCS C1726		H749CBO3250100  -  CATHETER BLNDIL 2.5MM 137CM 10MM F CBLN OTW INFL PORT GW	BOTH IP/OP	"$1,715.00 "	"$1,269.10"	$0.00	"$1,372.00"	$931.25	$931.25	$0.00	$0.00	$0.00	$357.45	"$1,272.87"	"$1,272.87"	$0.00	$0.00	$357.41	$0.00	"$1,014.42"	"$1,014.42"	$0.00	$857.50	"$1,358.28"	"$1,372.00"	$0.00		$0.00	$268.40	$0.00	$0.00	$273.03	$0.00	$0.00	$0.00	$0.00	$0.00
H749CBO3250150	SUP	HCPCS C1726		H749CBO3250150  -  CATHETER BLNDIL 2.5MM 137CM 15MM F CBLN OTW INFL PORT GW	BOTH IP/OP	"$1,715.00 "	"$1,269.10"	$0.00	"$1,372.00"	$931.25	$931.25	$0.00	$0.00	$0.00	$357.45	"$1,272.87"	"$1,272.87"	$0.00	$0.00	$357.41	$0.00	"$1,014.42"	"$1,014.42"	$0.00	$857.50	"$1,358.28"	"$1,372.00"	$0.00		$0.00	$268.40	$0.00	$0.00	$273.03	$0.00	$0.00	$0.00	$0.00	$0.00
H7587-58	SUP	Custom 27203010		REAGENT B-OHB R1 R2 50ML ANALY	BOTH IP/OP	$854.13 	$632.06	$0.00	$683.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.06	$676.47	$683.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H7587-CTL	SUP	Custom 27203010		CONTROL CHM 5ML SET B-OHB	BOTH IP/OP	$723.00 	$535.02	$0.00	$578.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.50	$572.62	$578.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H787107140145	SUP	HCPCS C1713		H787107140145  -  CATHETER ANGIO ANG KMP CRV 4FR 65CM SFVU RADOPQ SLCT HTORQ	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$15.75	$15.75	$0.00	$0.00	$0.00	$7.29	$25.98	$25.98	$0.00	$0.00	$7.29	$0.00	$20.70	$20.70	$0.00	$17.50	$27.72	$28.00	$0.00		$0.00	$5.48	$0.00	$0.00	$5.57	$0.00	$0.00	$0.00	$0.00	$0.00
H787107322055	SUP	HCPCS C1887		H787107322055  -  CATHETER ANGIO OM CRV 5FR 100CM SFVU RADOPQ FLSH HTORQ SHFT	BOTH IP/OP	$35.00 	$25.90	$0.00	$28.00	$19.01	$19.01	$0.00	$0.00	$0.00	$7.29	$25.98	$25.98	$0.00	$0.00	$7.29	$0.00	$20.70	$20.70	$0.00	$17.50	$27.72	$28.00	$0.00		$0.00	$5.48	$0.00	$0.00	$5.57	$0.00	$0.00	$0.00	$0.00	$0.00
H965100510	SUP	HCPCS C1887		H965100510  -  CATHETER GD STRG 7FR 90CM STRL GDR SFTP XF 2X2 RND BRD X	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
H965251850	SUP	Custom 27203010		H965251850  -  CANNULA PRFSN ANGIOVAC DIL FNL TIP RADOPQ COIL REINF DISP	BOTH IP/OP	"$28,750.00 "	"$21,275.00"	$0.00	"$23,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,991.50"	$0.00	$0.00	$0.00	$0.00	"$14,375.00"	"$22,770.00"	"$23,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H965251860	SUP	Custom 27203010		H965251860  -  CANNULA PRFSN 20D ANGIOVAC DIL FNL TIP RADOPQ COIL REINF	BOTH IP/OP	"$28,750.00 "	"$21,275.00"	$0.00	"$23,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,991.50"	$0.00	$0.00	$0.00	$0.00	"$14,375.00"	"$22,770.00"	"$23,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H965251870	SUP	Custom 27203010		H965251870  -  SYSTEM PRFSN ANGIOVAC CRCT PMP HD BBL TRP	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H965251880	SUP	Custom 27203010		H965251880  -  SYSTEM PRFSN ANGIOVAC CRCT BBL TRP	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H965251900	SUP	Custom 27203010		H965251900  -  CANNULA PRFSN ANGIOVAC STRG DIL CRCT BBL TRP COIL REINF DISP	BOTH IP/OP	"$32,500.00 "	"$24,050.00"	$0.00	"$26,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,773.00"	$0.00	$0.00	$0.00	$0.00	"$16,250.00"	"$25,740.00"	"$26,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H965251910	SUP	Custom 27203010		H965251910  -  CANNULA PRFSN 20D ANGIOVAC DIL CRCT PMP HD BBL TRP DISP	BOTH IP/OP	"$32,500.00 "	"$24,050.00"	$0.00	"$26,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,773.00"	$0.00	$0.00	$0.00	$0.00	"$16,250.00"	"$25,740.00"	"$26,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H965251990	SUP	Custom 27203010		H965251990  -  SYSTEM PRFSN ANGIOVAC CRCT	BOTH IP/OP	"$3,750.00 "	"$2,775.00"	$0.00	"$3,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,783.25"	"$2,783.25"	$0.00	$0.00	$781.50	$0.00	$0.00	$0.00	$0.00	"$1,875.00"	"$2,970.00"	"$3,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H965402100	SUP	HCPCS C1877		H965402100  -  STENT ENDOPRSTH 100CM 12MM 20MM 75CM UNCONSTRAIN FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965402110	SUP	HCPCS C1877		H965402110  -  STENT ENDOPRSTH 12MM 8FR 40MM 100CM FLEXIBLE RECONSTRAINABLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965402120	SUP	HCPCS C2617		H965402120  -  STENT ENDOPRSTH 100CM 12MM 8FR 60MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965402130	SUP	HCPCS C2617		H965402130  -  STENT ENDOPRSTH 100CM 12MM 8FR 90MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965403100	SUP	HCPCS C1877		H965403100  -  STENT ENDOPRSTH 100CM 14MM 20MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965403110	SUP	HCPCS C1877		H965403110  -  STENT ENDOPRSTH 100CM 14MM 40MM 75CM UNCONSTRAIN FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965403120	SUP	HCPCS C1877		H965403120  -  STENT ENDOPRSTH 100CM 14MM 9FR 60MM 75CM CATHETER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965403130	SUP	HCPCS C1877		H965403130  -  STENT ENDOPRSTH 100CM 14MM 9FR 90MM 75CM CATHETER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965403300	SUP	HCPCS C1877		H965403300  -  STENT ENDOPRSTH 160CM 16MM 9FR 20MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965403310	SUP	HCPCS C1877		H965403310  -  STENT ENDOPRSTH 100CM 16MM 9FR 40MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965403320	SUP	HCPCS C1877		H965403320  -  STENT ENDOPRSTH 100CM 16MM 9FR 60MM 75CM CATHETER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965403330	SUP	HCPCS C2617		H965403330  -  STENT ENDOPRSTH 100CM 16MM 9FR 90MM 75CM CATHETER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965404110	SUP	HCPCS C1877		H965404110  -  STENT ENDOPRSTH 100CM 18MM 10FR 40MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965404120	SUP	HCPCS C1877		H965404120  -  STENT ENDOPRSTH 100CM 18MM 10FR 60MM 75CM CATHETER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965404130	SUP	HCPCS C1877		H965404130  -  STENT ENDOPRSTH 100CM 18MM 10FR 90MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965404300	SUP	HCPCS C1877		H965404300  -  STENT ENDOPRSTH 100CM 20MM 10FR 40MM 75CM CATHETER	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965404310	SUP	HCPCS C1877		H965404310  -  STENT ENDOPRSTH 100CM 20MM 10FR 55MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965404320	SUP	HCPCS C1877		H965404320  -  STENT ENDOPRSTH 100CM 20MM 10FR 80MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965404500	SUP	HCPCS C1877		H965404500  -  STENT ENDOPRSTH 100CM 22MM 10FR 35MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965404510	SUP	HCPCS C1877		H965404510  -  STENT ENDOPRSTH 100CM 22MM 10FR 45MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965404520	SUP	HCPCS C1877		H965404520  -  STENT ENDOPRSTH 100CM 22MM 10FR 70MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965405100	SUP	HCPCS C1877		H965405100  -  STENT ENDOPRSTH 100CM 24MM 11FR 35MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965405110	SUP	HCPCS C1877		H965405110  -  STENT ENDOPRSTH 100CM 24MM 12FR 45MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965405120	SUP	HCPCS C1877		H965405120  -  STENT ENDOPRSTH 100CM 24MM 11FR 70MM 75CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965412000	SUP	HCPCS C1877		H965412000  -  STENT ENDOPRSTH 160CM 12MM 9FR 20MM 135CM FLEXIBLE DELIVERY	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965412010	SUP	HCPCS C1877		H965412010  -  STENT ENDOPRSTH 160CM 12MM 8FR 40MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965412020	SUP	HCPCS C1877		H965412020  -  STENT ENDOPRSTH 160CM 12MM 8FR 60MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965412030	SUP	HCPCS C1877		H965412030  -  STENT ENDOPRSTH 160CM 12MM 8FR 90MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
H965700150021	SUP	Custom 27203010		H965700150021  -  STOPCOCK ANGIO 200 PSI NAMIC 3W ROT M COLR RT PORT PRTC	BOTH IP/OP	$2.32 	$1.72	$0.00	$1.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.72	$1.72	$0.00	$0.00	$0.48	$0.00	$0.00	$0.00	$0.00	$1.16	$1.84	$1.85	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H965700150151	SUP	Custom 27203010		H965700150151  -  STOPCOCK ANGIO 200 PSI NAMIC 1 WY ROT M COLR PORT PRTC	BOTH IP/OP	$2.16 	$1.60	$0.00	$1.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.60	$1.60	$0.00	$0.00	$0.45	$0.00	$0.00	$0.00	$0.00	$1.08	$1.58	$1.73	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H965914000211	SUP	Custom 27203010		H965914000211  -  ADAPTER ANGIO 200 PSI 5/16IN 28 THRD ORG Y .1IN STRL NAMIC	BOTH IP/OP	$16.05 	$11.88	$0.00	$12.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.91	$11.91	$0.00	$0.00	$3.34	$0.00	$0.00	$0.00	$0.00	$8.03	$12.71	$12.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
H965SCH306011	SUP	HCPCS C1769		H965SCH306011  -  GUIDEWIRE VASCULAR C .035IN 300CM 10CM FLEXIBLE MEIER WIRE	BOTH IP/OP	$391.15 	$289.45	$0.00	$312.92	$212.39	$212.39	$0.00	$0.00	$0.00	$81.53	$290.31	$290.31	$0.00	$0.00	$81.52	$0.00	$231.37	$231.37	$0.00	$195.58	$309.79	$312.92	$0.00		$0.00	$61.21	$0.00	$0.00	$62.27	$0.00	$0.00	$0.00	$0.00	$0.00
HARH36	SUP	Custom 27203010		HARH36  -  SHEARS ESURG CRV 5MM 36CM STRL LF HRMN A +7 ADV HMSTS 3	BOTH IP/OP	$756.33 	$559.68	$0.00	"$7,368.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,605.60"	"$7,295.27"	"$7,368.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HC0002	SUP	Custom 27203010		HEMOSTASE MPH 5G 5-PACK	BOTH IP/OP	$669.50 	$495.43	$0.00	$535.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$334.75	$530.24	$535.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HC7001GAL	SUP	Custom 27203010		REAGENT XYLN HSTPRP 1GL SLVT HISTOLGY	BOTH IP/OP	$58.70 	$43.44	$0.00	$46.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.35	$46.49	$46.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-5125	SUP	HCPCS C1713		HCA-5125  -  SCREW BONE 5MM 25MM TI CANC LCK NONSTRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-5127	SUP	HCPCS C1713		HCA-5127  -  SCREW BONE 5MM 27.5MM CANC	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-5130	SUP	HCPCS C1713		HCA-5130  -  SCREW BONE 5MM 30MM TI CANC NONSTRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-5132	SUP	HCPCS C1713		HCA-5132  -  SCREW BONE 5MM 32.5MM TI CANC NONSTRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-5135	SUP	HCPCS C1713		HCA-5135  -  SCREW BN 5MM 35MM NLCKG ORTH	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-5137	SUP	HCPCS C1713		HCA-5137  -  SCREW BONE 5MM 37.5MM PLRS TI CANC HUM LCK NONSTRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-5140	SUP	HCPCS C1713		HCA-5140  -  SCREW BN 5MM 40MM CANC	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-5145	SUP	HCPCS C1713		HCA-5145  -  SCREW BONE 5MM 45MM CANC	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-5150	SUP	HCPCS C1713		HCA-5150  -  SCREW BONE 5MM 50MM TI CANC NONSTRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-5155	SUP	HCPCS C1713		HCA-5155  -  SCREW BN 5MM 55MM CANC	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA5200-S	SUP	HCPCS C1713		HCA5200-S  -  SCREW BONE 5MM 20MM PLRS TI CANC HUM STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA5250-S	SUP	HCPCS C1713		HCA5250-S  -  SCREW BONE 5MM 25MM PLRS TI CANC STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA5275-S	SUP	HCPCS C1713		HCA5275-S  -  SCREW BONE 5MM 27.5MM PLRS RADL ULN HUM FIB CANC STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA5300-S	SUP	HCPCS C1713		HCA5300-S  -  SCREW BONE 5MM 30MM PLRS TI CANC HUM STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA5325-S	SUP	HCPCS C1713		HCA5325-S  -  SCREW BONE 5MM 32.5MM CANC STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA5350-S	SUP	HCPCS C1713		HCA5350-S  -  SCREW BONE 5MM 35MM PLRS TI CANC HUM LCK STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA5375-S	SUP	HCPCS C1713		HCA5375-S  -  SCREW BONE 5MM 37.5MM PLRS RADL ULN HUM FIB CANC STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA5400-S	SUP	HCPCS C1713		HCA5400-S  -  SCREW BONE 5MM 40MM PLRS TI CANC STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA5425-S	SUP	HCPCS C1713		HCA5425-S  -  SCREW BONE 5MM 42.5MM PLRS RADL ULN HUM FIB CANC STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA5450-S	SUP	HCPCS C1713		HCA5450-S  -  SCREW BONE 5MM 45MM PLRS TI CANC STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA5500-S	SUP	HCPCS C1713		HCA5500-S  -  SCREW BONE 5MM 50MM PLRS TI CANC STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA5550-S	SUP	HCPCS C1713		HCA5550-S  -  SCREW BONE 5MM 50MM PLRS TI CANC HUM LCK STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-L5325-S	SUP	HCPCS C1713		HCA-L5325-S  -  SCREW BN 5.3MM 25MM STRL PLRS LCK TI CANC HUM	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-L5330-S	SUP	HCPCS C1713		HCA-L5330-S  -  SCREW BONE 5.3MM 30MM PLRS TI ORTH LCK STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-L5335-S	SUP	HCPCS C1713		HCA-L5335-S  -  SCREW BONE 5.3MM 35MM TI CANC LCK STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-L5340-S	SUP	HCPCS C1713		HCA-L5340-S  -  SCREW BONE 5.3MM 40MM PLRS TI ORTH LCK STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCA-L5345-S	SUP	HCPCS C1713		HCA-L5345-S  -  SCREW BN 5.3MM 45MM STRL LCK TI CANC	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27100-TS	SUP	HCPCS C1713		HCLP-27100-TS  -  PEG FX 2.7MM 10MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27120-TS	SUP	HCPCS C1713		HCLP-27120-TS  -  PEG FX 2.7MM 12MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27140-TS	SUP	HCPCS C1713		HCLP-27140-TS  -  PEG FX 2.7MM 14MM NS GEMINUS HI CMPR LCK TI RDS DIST VOLR	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27160-TS	SUP	HCPCS C1713		HCLP-27160-TS  -  PEG FIX 2.7MM 16MM HIGH COMPRESSION LOCKING GEMINUS TITANIUM	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27180-TS	SUP	HCPCS C1713		HCLP-27180-TS  -  PEG FX 2.7MM 18MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27190-TS	SUP	HCPCS C1713		HCLP-27190-TS  -  PEG FX 2.7MM 19MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27200-TS	SUP	HCPCS C1713		HCLP-27200-TS  -  PEG FIX 2.7MM 20MM HIGH COMPRESSION LOCKING GEMINUS TITANIUM	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27210-TS	SUP	HCPCS C1713		HCLP-27210-TS  -  PEG FX 2.7MM 21MM NS GEMINUS HI CMPR LCK TI RDS DIST VOLR	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27220-TS	SUP	HCPCS C1713		HCLP-27220-TS  -  PEG FX 2.7MM 22MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27230-TS	SUP	HCPCS C1713		HCLP-27230-TS  -  PEG FX 2.7MM 23MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27240-TS	SUP	HCPCS C1713		HCLP-27240-TS  -  PEG FX 2.7MM 24MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27260-TS	SUP	HCPCS C1713		HCLP-27260-TS  -  PEG FX 2.7MM 26MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27280-TS	SUP	HCPCS C1713		HCLP-27280-TS  -  PEG FX 2.7MM 28MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27300-TS	SUP	HCPCS C1713		HCLP-27300-TS  -  PEG FX 2.7MM 30MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCLP-27320-TS	SUP	HCPCS C1713		HCLP-27320-TS  -  PEG FX 2.7MM 32MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
HCO-3150-S	SUP	HCPCS C1713		HCO-3150-S  -  SCREW BONE 3.5MM 15MM CORT	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3175-S	SUP	HCPCS C1713		HCO3175-S  -  SCREW BONE 3.5MM 17.5MM PLRS TI CORT SHLDR STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3200-S	SUP	HCPCS C1713		HCO3200-S  -  SCREW BONE 3.5MM 20MM PLRS TI CORT HUM INTLCK STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3225-S	SUP	HCPCS C1713		HCO3225-S  -  SCREW BN 3.5MM 22.5MM STRL CORT	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3250-S	SUP	HCPCS C1713		HCO3250-S  -  SCREW BONE 3.5MM 25MM PLRS TI CORT HUM SHLDR STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3275-S	SUP	HCPCS C1713		HCO3275-S  -  SCREW BONE 3.5MM 27.5MM PLRS CORT HUM SHLDR STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3300-S	SUP	HCPCS C1713		HCO3300-S  -  SCREW BONE 3.5MM 30MM PLRS TI CORT HUM INTLCK STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3325-S	SUP	HCPCS C1713		HCO3325-S  -  SCREW BONE 3.5MM 32.5MM PLRS TI CORT HUM STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3350-S	SUP	HCPCS C1713		HCO3350-S  -  SCREW BONE 3.5MM 35MM ACUMED TI CORT SHLDR STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3375-S	SUP	HCPCS C1713		HCO3375-S  -  SCREW BONE 3.5MM 37.5MM TI CORT STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3400-S	SUP	HCPCS C1713		HCO3400-S  -  SCREW BONE 3.5MM 40MM PLRS TI CORT HUM STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3450-S	SUP	HCPCS C1713		HCO3450-S  -  SCREW BONE 3.5MM 45MM PLRS TI CORT STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3500-S	SUP	HCPCS C1713		HCO3500-S  -  SCREW BONE 3.5MM 50MM PLRS TI CORT HUM SHLDR STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3550-S	SUP	HCPCS C1713		HCO3550-S  -  SCREW BONE 3.5MM 55MM PLRS TI CORT HUM STRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HCO35WA	SUP	Custom 27803010		HCO35WA  -  WASHER ORTH 3.5MM NS PLRS TI CORT SCR	BOTH IP/OP	$92.50 	$68.45	$0.00	$74.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.65	$68.65	$0.00	$0.00	$19.28	$0.00	$0.00	$0.00	$0.00	$46.25	$73.26	$74.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HCO3600-S	SUP	HCPCS C1713		HCO3600-S  -  SCREW BONE 3.5MM 60MM PLRS TI CORT NONSTRL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HD-1500	SUP	Custom 27203010		HD-1500  -  DRIVER HEX SLD 1.5MM SURG	BOTH IP/OP	$301.88 	$223.39	$0.00	$241.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.05	$224.05	$0.00	$0.00	$62.91	$0.00	$0.00	$0.00	$0.00	$150.94	$239.09	$241.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HD-1509	SUP	Custom 27203010		HD-1509  -  DRIVER CANN HEX ASMBLY 1.5MM SURG	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HD-2000	SUP	Custom 27203010		HD-2000  -  DRIVER 2MM SLD SURG	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HD-2011	SUP	Custom 27203010		HD-2011  -  DRIVER SRG 2MM HEX CNN	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HD-2500	SUP	Custom 27203010		HD-2500  -  DRIVER SURG 2.5MM HEX SLD ASMBLY 2.5MM	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HD-2515	SUP	Custom 27203010		HD-2515  -  SCRDRVR 2.5MM CANN HEX 2.5MM SURG	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HD-2516	SUP	Custom 27203010		HD-2516  -  DRIVER CANN HEX ASMBLY 2.5MM SURG	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HD-3016	SUP	Custom 27203010		HD-3016  -  DRIVER CANN ASMBLY 3MM SURG	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HD-3500	SUP	Custom 27203010		HD-3500  -  SCRDRVR SLD ASMBLY 3.5MM SURG	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HD-3725	SUP	Custom 27203010		HD-3725  -  DRIVER PLRS CANN HDSN FIT 3MM SURG NONSTRL	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HDF-1500	SUP	Custom 27203010		HDF-1500  -  DRIVER 1.5MM ACTRK FSN SLD 1.5MM SURG MINI SCR	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HDL-2000	SUP	Custom 27203010		HDL-2000  -  SCREWDRIVER SRG 2MM SLD	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HDL-2500	SUP	Custom 27203010		HDL-2500  -  SCRDRVR 2.5MM HEX SLD SURG	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HDM-1500	SUP	Custom 27203010		HDM-1500  -  DRIVER 1.5MM SLD SURG	BOTH IP/OP	$682.50 	$505.05	$0.00	$546.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.55	$506.55	$0.00	$0.00	$142.23	$0.00	$0.00	$0.00	$0.00	$341.25	$540.54	$546.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HEL180620-20	SUP	Custom 27803010		HEL180620-20  -  COIL EMBL HLCL 6MM 20CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS	BOTH IP/OP	"$1,268.93 "	$939.01	$0.00	"$1,015.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$941.80	$941.80	$0.00	$0.00	$264.44	$0.00	$0.00	$0.00	$0.00	$634.46	"$1,004.99"	"$1,015.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HEL180730-20	SUP	Custom 27803010		HEL180730-20  -  COIL EMBL HLCL 7MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS	BOTH IP/OP	"$1,358.30 "	"$1,005.14"	$0.00	"$1,086.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,008.13"	"$1,008.13"	$0.00	$0.00	$283.07	$0.00	$0.00	$0.00	$0.00	$679.15	"$1,075.77"	"$1,086.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HEL180830-20	SUP	Custom 27803010		HEL180830-20  -  COIL EMBL HLCL 8MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS	BOTH IP/OP	"$1,358.30 "	"$1,005.14"	$0.00	"$1,086.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,008.13"	"$1,008.13"	$0.00	$0.00	$283.07	$0.00	$0.00	$0.00	$0.00	$679.15	"$1,075.77"	"$1,086.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HEL18093020	SUP	Custom 27803010		HEL18093020  -  COIL EMBL HLCL 9MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS	BOTH IP/OP	"$1,358.30 "	"$1,005.14"	$0.00	"$1,086.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,008.13"	"$1,008.13"	$0.00	$0.00	$283.07	$0.00	$0.00	$0.00	$0.00	$679.15	"$1,075.77"	"$1,086.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HEL181030-20	SUP	Custom 27803010		HEL181030-20  -  COIL EMBL HLCL 10MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS	BOTH IP/OP	"$1,358.30 "	"$1,005.14"	$0.00	"$1,086.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,008.13"	"$1,008.13"	$0.00	$0.00	$283.07	$0.00	$0.00	$0.00	$0.00	$679.15	"$1,075.77"	"$1,086.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HEL181230-20	SUP	Custom 27803010		HEL181230-20  -  COIL EMBL 12MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS	BOTH IP/OP	"$1,429.78 "	"$1,058.04"	$0.00	"$1,143.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,061.18"	"$1,061.18"	$0.00	$0.00	$297.97	$0.00	$0.00	$0.00	$0.00	$714.89	"$1,132.39"	"$1,143.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HEL181430-20	SUP	Custom 27803010		HEL181430-20  -  COIL EMBL 14MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS	BOTH IP/OP	"$1,429.78 "	"$1,058.04"	$0.00	"$1,143.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,061.18"	"$1,061.18"	$0.00	$0.00	$297.97	$0.00	$0.00	$0.00	$0.00	$714.89	"$1,132.39"	"$1,143.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HEL181630-20	SUP	Custom 27803010		HEL181630-20  -  COIL EMBL 16MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS	BOTH IP/OP	"$1,268.93 "	$939.01	$0.00	"$1,015.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$941.80	$941.80	$0.00	$0.00	$264.44	$0.00	$0.00	$0.00	$0.00	$634.46	"$1,004.99"	"$1,015.14"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HEL181830-20	SUP	Custom 27803010		HEL181830-20  -  COIL EMBL 18MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS	BOTH IP/OP	"$1,501.28 "	"$1,110.95"	$0.00	"$1,201.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,114.25"	"$1,114.25"	$0.00	$0.00	$312.87	$0.00	$0.00	$0.00	$0.00	$750.64	"$1,189.01"	"$1,201.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HEL182030-20	SUP	Custom 27803010		HEL182030-20  -  COIL EMBL 20MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS	BOTH IP/OP	"$1,501.28 "	"$1,110.95"	$0.00	"$1,201.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,114.25"	"$1,114.25"	$0.00	$0.00	$312.87	$0.00	$0.00	$0.00	$0.00	$750.64	"$1,189.01"	"$1,201.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HERO 1003	SUP	Custom 27203010		HERO 1003  -  KIT HEMODIALYSIS 16FR Y 10FR 12FR DELIVERY STYLET DILAT	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$0.00	$0.00	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HEX2.7-12	SUP	HCPCS C1713		HEX2.7-12  -  SCREW BN 2.7MM 12MM SS CORT TRIMED CLVCL FX SYS	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX2.7-14	SUP	HCPCS C1713		HEX2.7-14  -  SCREW BN 2.7MM 14MM SS CORT TRIMED CLVCL FX SYS	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-08	SUP	HCPCS C1713		HEX3.2-08  -  SCREW BONE 3.2MM 8MM HEXAGONAL HEAD CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-10	SUP	HCPCS C1713		HEX3.2-10  -  SCREW BN 3.2MM 10MM HEX CORT ANKL FX SYS	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-11	SUP	HCPCS C1713		HEX3.2-11  -  SCREW BONE 3.2MM 11MM HEXAGONAL HEAD CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-12	SUP	HCPCS C1713		HEX3.2-12  -  SCREW BN 3.2MM 12MM HEX CORT ANKL FX SYS	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-13	SUP	HCPCS C1713		HEX3.2-13  -  SCREW BN 3.2MM 13MM HEX CORT ANKL FX SYS	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-14	SUP	HCPCS C1713		HEX3.2-14  -  SCREW BN 3.2MM 14MM HEX CORT ANKL FX SYS	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-15	SUP	HCPCS C1713		HEX3.2-15  -  SCREW BONE 3.2MM 15MM HEXAGONAL HEAD CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-16	SUP	HCPCS C1713		HEX3.2-16  -  SCREW BN 3.2MM 16MM HEX CORT ANKL FX SYS	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-18	SUP	HCPCS C1713		HEX3.2-18  -  SCREW BN 3.2MM 18MM HEX CORT ANKL FX SYS	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-20	SUP	HCPCS C1713		HEX3.2-20  -  SCREW BONE 3.2MM 20MM HEXAGONAL HEAD CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-22	SUP	HCPCS C1713		HEX3.2-22  -  SCREW BONE 3.2MM 22MM HEXAGONAL HEAD CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-24	SUP	HCPCS C1713		HEX3.2-24  -  SCREW BONE 3.2MM 24MM HEXAGONAL HEAD CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-26	SUP	HCPCS C1713		HEX3.2-26  -  SCREW BONE 3.2MM 26MM HEXAGONAL HEAD CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-28	SUP	HCPCS C1713		HEX3.2-28  -  SCREW BONE 3.2MM 28MM HEXAGON CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HEX3.2-30	SUP	HCPCS C1713		HEX3.2-30  -  SCREW BN 3.2MM 30MM HEX CORT	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
HF0200DSSM	SUP	Custom 27011340		HF0200DSSM  -  FIBER LSR 270UM HO 1 WL STRL DISP	BOTH IP/OP	"$1,074.28 "	$794.97	$0.00	$859.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$797.33	$797.33	$0.00	$0.00	$223.88	$0.00	$0.00	$0.00	$0.00	$537.14	$850.83	$859.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HH0710	SUP	HCPCS C1781		HH0710  -  MESH SRG 10X7CM GORE BIO-ASNTH REINF TISS HIATAL HRN REPR	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
HIC135	SUP	HCPCS C1729		EMBOCATHETER INFUSION SEGWAY	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$339.38	$339.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
HLFDBX0270C	SUP	Custom 27203010		HLFDBX0270C  -  LASER SRG 270MH DISP	BOTH IP/OP	$710.67 	$525.90	$0.00	$568.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.46	$527.46	$0.00	$0.00	$148.10	$0.00	$0.00	$0.00	$0.00	$355.33	$562.85	$568.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HLFDBX0400C	SUP	Custom 27203010		HLFDBX0400C  -  LASER SRG 400MH DISP	BOTH IP/OP	$848.67 	$628.02	$0.00	$678.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$629.88	$629.88	$0.00	$0.00	$176.86	$0.00	$0.00	$0.00	$0.00	$424.33	$672.15	$678.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HLFDBX0600C	SUP	Custom 27011340		HLFDBX0600C  -  FIBER LSR 600UM STRL DUR HO DISP LTHTRP	BOTH IP/OP	$848.67 	$628.02	$0.00	$678.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.33	$672.15	$678.93	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HLFDBX1000C	SUP	Custom 27203010		HLFDBX1000C  -  LASER SURGICAL 1000 MH DISPOSABLE	BOTH IP/OP	"$2,193.09 "	"$1,622.89"	$0.00	"$1,627.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,627.71"	"$1,627.71"	$0.00	$0.00	$457.04	$0.00	$0.00	$0.00	$0.00	$955.80	"$1,513.99"	"$1,529.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HLS1007M	SUP	HCPCS C1894		HLS1007M  -  INTRODUCER SHTH 7FR 13CM 20CM SFSHTH HMSTS VLV TRAW SDPRT	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$70.59	$70.59	$0.00	$0.00	$0.00	$27.10	$96.49	$96.49	$0.00	$0.00	$27.09	$0.00	$76.90	$76.90	$0.00	$65.00	$102.96	$104.00	$0.00		$0.00	$20.35	$0.00	$0.00	$20.70	$0.00	$0.00	$0.00	$0.00	$0.00
HLS10095M	SUP	HCPCS C1894		HLS10095M  -  INTRODUCER SHEATH 9.5FR 13CM 20CM HEMOSTASIS VALVE TEAR AWAY	BOTH IP/OP	$146.25 	$108.23	$0.00	$117.00	$79.41	$79.41	$0.00	$0.00	$0.00	$30.48	$108.55	$108.55	$0.00	$0.00	$30.48	$0.00	$86.51	$86.51	$0.00	$73.13	$115.83	$117.00	$0.00		$0.00	$22.89	$0.00	$0.00	$23.28	$0.00	$0.00	$0.00	$0.00	$0.00
HLS1009M	SUP	HCPCS C1894		HLS1009M  -  INTRODUCER LEAD 13CM 9FR SFSHTH HMSTS VLV TRAW SDPRT 20CM	BOTH IP/OP	$650.00 	$481.00	$0.00	$520.00	$352.95	$352.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$325.00	$514.80	$520.00	$0.00		$0.00	$101.73	$0.00	$0.00	$103.48	$0.00	$0.00	$0.00	$0.00	$0.00
HLS10105M	SUP	HCPCS C1894		HLS10105M  -  INTRODUCER SHEATH 10.5FR 13CM 20CM HEMOSTASIS VALVE TEAR	BOTH IP/OP	$130.00 	$96.20	$0.00	$104.00	$70.59	$70.59	$0.00	$0.00	$0.00	$27.10	$96.49	$96.49	$0.00	$0.00	$27.09	$0.00	$76.90	$76.90	$0.00	$65.00	$102.96	$104.00	$0.00		$0.00	$20.35	$0.00	$0.00	$20.70	$0.00	$0.00	$0.00	$0.00	$0.00
HLS2509M	SUP	HCPCS C1894		HLS2509M  -  INTRODUCER LEAD LONG 9FR 25CM 31.5CM HEMOSTASIS VALVE TEAR	BOTH IP/OP	$146.00 	$108.04	$0.00	$116.80	$79.28	$79.28	$0.00	$0.00	$0.00	$30.43	$108.36	$108.36	$0.00	$0.00	$30.43	$0.00	$86.36	$86.36	$0.00	$73.00	$115.63	$116.80	$0.00		$0.00	$22.85	$0.00	$0.00	$23.24	$0.00	$0.00	$0.00	$0.00	$0.00
HN1200	SUP	HCPCS C1776		HN1200  -  SLEEVE CENTERING 38.1IN 9MM 12.7IN IMHS CP SET SCR IM HIP	BOTH IP/OP	$831.25 	$615.13	$0.00	$665.00	$374.06	$374.06	$0.00	$0.00	$0.00	$173.25	$616.95	$616.95	$0.00	$0.00	$173.23	$0.00	$491.68	$491.68	$0.00	$415.63	$658.35	$665.00	$0.00		$0.00	$130.09	$0.00	$0.00	$132.34	$0.00	$0.00	$0.00	$0.00	$0.00
HN1202	SUP	HCPCS C1713		HN1202  -  SCREW SET IMHS CENTERING SLV HIP	BOTH IP/OP	$533.75 	$394.98	$0.00	$427.00	$240.19	$240.19	$0.00	$0.00	$0.00	$111.25	$396.15	$396.15	$0.00	$0.00	$111.23	$0.00	$315.71	$315.71	$0.00	$266.88	$422.73	$427.00	$0.00		$0.00	$83.53	$0.00	$0.00	$84.97	$0.00	$0.00	$0.00	$0.00	$0.00
HNR4.0-35-70-P-10S-0	SUP	HCPCS C1725		HNR4.0-35-70-P-10S-0  -  CATH ANGIO .035IN 4FR 70CM 10 SDPRT STR HFLO ATRM TIP DSGN	BOTH IP/OP	$46.88 	$34.69	$0.00	$37.50	$25.45	$25.45	$0.00	$0.00	$0.00	$9.77	$34.79	$34.79	$0.00	$0.00	$9.77	$0.00	$27.73	$27.73	$0.00	$23.44	$37.13	$37.50	$0.00		$0.00	$7.34	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00
HOOK-L4	SUP	HCPCS C1713		HOOK-L4  -  PLATE BONE 4 HOLE HOOK LEFT ELBOW	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
HOOK-R6	SUP	HCPCS C1713		HOOK-R6  -  PLATE BONE 6 HOLE HOOK ORTHOPEDIC	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$416.85	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	"$1,183.00"	"$1,183.00"	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
HP01	SUP	HCPCS C1781		HP01  -  PLUG SURG BIOABSORBABLE BIO-A HERN REPAIR	BOTH IP/OP	"$1,260.00 "	$932.40	$0.00	"$1,008.00"	$567.00	$567.00	$0.00	$0.00	$0.00	$262.62	$935.17	$935.17	$0.00	$0.00	$262.58	$0.00	$745.29	$745.29	$0.00	$630.00	$997.92	"$1,008.00"	$0.00		$0.00	$197.19	$0.00	$0.00	$200.59	$0.00	$0.00	$0.00	$0.00	$0.00
HP-2515	SUP	Custom 27203010		HP-2515  -  DRIVER 2.5MM PWR TIP CANN SURG	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$0.00	$0.00	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HP3000	SUP	Custom 27203010		HP3000  -  POSITIONER SRG STRFSH EVO MULTIAPPENDAGE SIL SCT CUP LOPRFL	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	$0.00	$0.00	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HP-3016	SUP	Custom 27203010		HP-3016  -  DRIVER CANN PWR TIP 3MM SURG OPTN INST	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$0.00	$0.00	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HPC-0015	SUP	Custom 27203010		HPC-0015  -  DRIVER 1.5MM SM HEX TIP SHFT 1.5MM SURG STRL DISP	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HPC-0025	SUP	Custom 27203010		HPC-0025  -  DRIVER 2.5MM QRLSE 2.5MM SURG	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HPC-0035	SUP	Custom 27203010		HPC-0035  -  DRIVER HEX QRLSE 3.5MM SURG	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HR-0001-S	SUP	HCPCS C1713		HR-0001-S  -  CAP END ORTH SCR ASMBLY IM NAIL STRL PLRS	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$171.00	$171.00	$0.00	$0.00	$0.00	$79.20	$282.04	$282.04	$0.00	$0.00	$79.19	$0.00	$224.77	$224.77	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$59.47	$0.00	$0.00	$60.50	$0.00	$0.00	$0.00	$0.00	$0.00
HR-0024-S	SUP	HCPCS C1713		HR-0024-S  -  CAP END 4MM STRL PLRS SCR ASMB	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$340.88	$340.88	$0.00	$0.00	$0.00	$157.88	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$448.06	$448.06	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$118.55	$0.00	$0.00	$120.59	$0.00	$0.00	$0.00	$0.00	$0.00
HR-0028-S	SUP	HCPCS C1713		HR-0028-S  -  CAP END 8MM STRL PLRS SCR ASMB	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$340.88	$340.88	$0.00	$0.00	$0.00	$157.88	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$448.06	$448.06	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$118.55	$0.00	$0.00	$120.59	$0.00	$0.00	$0.00	$0.00	$0.00
HR-0050-S	SUP	HCPCS C1713		HR-0050-S  -  CAP END PLRS SCR ASMB INS DEV	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$340.88	$340.88	$0.00	$0.00	$0.00	$157.88	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$448.06	$448.06	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$118.55	$0.00	$0.00	$120.59	$0.00	$0.00	$0.00	$0.00	$0.00
HR-0054-S	SUP	HCPCS C1713		HR-0054-S  -  CAP END 4MM STRL PLRS SCR ASMB	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$340.88	$340.88	$0.00	$0.00	$0.00	$157.88	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$448.06	$448.06	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$118.55	$0.00	$0.00	$120.59	$0.00	$0.00	$0.00	$0.00	$0.00
HR-0058-S	SUP	HCPCS C1713		HR-0058-S  -  CAP END 8MM STRL PLRS SCR ASMB	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$340.88	$340.88	$0.00	$0.00	$0.00	$157.88	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$448.06	$448.06	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$118.55	$0.00	$0.00	$120.59	$0.00	$0.00	$0.00	$0.00	$0.00
HR-0105	SUP	Custom 27203010		HR-0105  -  BIT DRILL 2.7MM PLRS TAP	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.67	$55.67	$0.00	$0.00	$15.63	$0.00	$0.00	$0.00	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HR-0820-S	SUP	HCPCS C1713		HR-0820-S  -  ROD ORTH 200MM 8MM PLRS PLUS HUM SHLDR TI HUM IM IMPL STRL	BOTH IP/OP	"$4,107.50 "	"$3,039.55"	$0.00	"$3,286.00"	"$1,848.38"	"$1,848.38"	$0.00	$0.00	$0.00	$856.11	"$3,048.59"	"$3,048.59"	$0.00	$0.00	$856.00	$0.00	"$2,025.00"	"$2,025.00"	$0.00	"$2,053.75"	"$3,253.14"	"$3,286.00"	$0.00		$0.00	$642.82	$0.00	$0.00	$653.91	$0.00	$0.00	$0.00	$0.00	$0.00
HR-0822-S	SUP	HCPCS C1713		HR-0822-S  -  ROD ORTH 220MM 8MM PLRS PLUS HUM SHLDR TI HUM IM IMPL STRL	BOTH IP/OP	"$4,107.50 "	"$3,039.55"	$0.00	"$3,286.00"	"$1,848.38"	"$1,848.38"	$0.00	$0.00	$0.00	$856.11	"$3,048.59"	"$3,048.59"	$0.00	$0.00	$856.00	$0.00	"$2,025.00"	"$2,025.00"	$0.00	"$2,053.75"	"$3,253.14"	"$3,286.00"	$0.00		$0.00	$642.82	$0.00	$0.00	$653.91	$0.00	$0.00	$0.00	$0.00	$0.00
HR-0824-S	SUP	HCPCS C1713		HR-0824-S  -  ROD ORTH 240MM 8MM PLRS PLUS HUM TI IM IMPL STRL	BOTH IP/OP	"$4,107.50 "	"$3,039.55"	$0.00	"$3,286.00"	"$1,848.38"	"$1,848.38"	$0.00	$0.00	$0.00	$856.11	"$3,048.59"	"$3,048.59"	$0.00	$0.00	$856.00	$0.00	"$2,025.00"	"$2,025.00"	$0.00	"$2,053.75"	"$3,253.14"	"$3,286.00"	$0.00		$0.00	$642.82	$0.00	$0.00	$653.91	$0.00	$0.00	$0.00	$0.00	$0.00
HR-0826-S	SUP	HCPCS C1713		HR-0826-S  -  ROD ORTH 260MM 8MM PLRS PLUS HUM SHLDR TI HUM IM IMPL STRL	BOTH IP/OP	"$4,107.50 "	"$3,039.55"	$0.00	"$3,286.00"	"$1,848.38"	"$1,848.38"	$0.00	$0.00	$0.00	$856.11	"$3,048.59"	"$3,048.59"	$0.00	$0.00	$856.00	$0.00	"$2,025.00"	"$2,025.00"	$0.00	"$2,053.75"	"$3,253.14"	"$3,286.00"	$0.00		$0.00	$642.82	$0.00	$0.00	$653.91	$0.00	$0.00	$0.00	$0.00	$0.00
HR-0828-S	SUP	HCPCS C1713		HR-0828-S  -  ROD ORTH 280MM 8MM PLRS PLUS HUM SHLDR TI HUM IM IMPL STRL	BOTH IP/OP	"$4,107.50 "	"$3,039.55"	$0.00	"$3,286.00"	"$1,848.38"	"$1,848.38"	$0.00	$0.00	$0.00	$856.11	"$3,048.59"	"$3,048.59"	$0.00	$0.00	$856.00	$0.00	"$2,025.00"	"$2,025.00"	$0.00	"$2,053.75"	"$3,253.14"	"$3,286.00"	$0.00		$0.00	$642.82	$0.00	$0.00	$653.91	$0.00	$0.00	$0.00	$0.00	$0.00
HR-3106	SUP	Custom 27203010		HR-3106  -  DRILL SRG WITNESS HL CLRNC	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HR-3107	SUP	Custom 27203010		HR-3107  -  TAP SRG 3.5 MM SCR	BOTH IP/OP	$930.00 	$688.20	$0.00	$744.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$690.25	$690.25	$0.00	$0.00	$193.81	$0.00	$0.00	$0.00	$0.00	$465.00	$736.56	$744.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HR-4D1055-S	SUP	HCPCS C1713		HR-4D1055-S  -  ROD XTRNFX 2-4D 5.5MM 150MM STRL 10MM ANT POST	BOTH IP/OP	"$3,817.50 "	"$2,824.95"	$0.00	"$3,054.00"	"$1,717.88"	"$1,717.88"	$0.00	$0.00	$0.00	$795.66	"$2,833.35"	"$2,833.35"	$0.00	$0.00	$795.57	$0.00	"$1,882.03"	"$1,882.03"	$0.00	"$1,908.75"	"$3,023.46"	"$3,054.00"	$0.00		$0.00	$597.44	$0.00	$0.00	$607.75	$0.00	$0.00	$0.00	$0.00	$0.00
HRA-1055-S	SUP	HCPCS C1713		HRA-1055-S  -  ROD XTRNFX 2-4D STD 5.5MM 150MM STRL 10MM	BOTH IP/OP	"$5,422.50 "	"$4,012.65"	$0.00	"$4,338.00"	"$2,440.13"	"$2,440.13"	$0.00	$0.00	$0.00	"$1,130.18"	"$4,024.58"	"$4,024.58"	$0.00	$0.00	"$1,130.05"	$0.00	"$2,673.29"	"$2,673.29"	$0.00	"$2,711.25"	"$4,294.62"	"$4,338.00"	$0.00		$0.00	$848.62	$0.00	$0.00	$863.26	$0.00	$0.00	$0.00	$0.00	$0.00
HR-D105	SUP	Custom 27203010		HR-D105  -  BIT DRILL 35MM .109MM PLRS LNG TAP STRL	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HRH-0820-S	SUP	HCPCS C1713		HRH-0820-S  -  ROD XTRNFX 8MM 200MM STRL PLRS + SPCL	BOTH IP/OP	"$4,107.50 "	"$3,039.55"	$0.00	"$3,286.00"	"$1,848.38"	"$1,848.38"	$0.00	$0.00	$0.00	$856.11	"$3,048.59"	"$3,048.59"	$0.00	$0.00	$856.00	$0.00	"$2,025.00"	"$2,025.00"	$0.00	"$2,053.75"	"$3,253.14"	"$3,286.00"	$0.00		$0.00	$642.82	$0.00	$0.00	$653.91	$0.00	$0.00	$0.00	$0.00	$0.00
HRH-0822-S	SUP	HCPCS C1713		HRH-0822-S  -  ROD XTRNFX 8MM 220MM PLRS + HUM PROX	BOTH IP/OP	"$4,107.50 "	"$3,039.55"	$0.00	"$3,286.00"	"$1,848.38"	"$1,848.38"	$0.00	$0.00	$0.00	$856.11	"$3,048.59"	"$3,048.59"	$0.00	$0.00	$856.00	$0.00	"$2,025.00"	"$2,025.00"	$0.00	"$2,053.75"	"$3,253.14"	"$3,286.00"	$0.00		$0.00	$642.82	$0.00	$0.00	$653.91	$0.00	$0.00	$0.00	$0.00	$0.00
HRH-0824-S	SUP	HCPCS C1713		HRH-0824-S  -  ROD XTRNFX 8MM 240MM PLRS + SPCL	BOTH IP/OP	"$4,107.50 "	"$3,039.55"	$0.00	"$3,286.00"	"$1,848.38"	"$1,848.38"	$0.00	$0.00	$0.00	$856.11	"$3,048.59"	"$3,048.59"	$0.00	$0.00	$856.00	$0.00	"$2,025.00"	"$2,025.00"	$0.00	"$2,053.75"	"$3,253.14"	"$3,286.00"	$0.00		$0.00	$642.82	$0.00	$0.00	$653.91	$0.00	$0.00	$0.00	$0.00	$0.00
HRH-0826-S	SUP	HCPCS C1713		HRH-0826-S  -  ROD XTRNFX 8MM 260MM STRL PLRS + SPCL	BOTH IP/OP	"$4,107.50 "	"$3,039.55"	$0.00	"$3,286.00"	"$1,848.38"	"$1,848.38"	$0.00	$0.00	$0.00	$856.11	"$3,048.59"	"$3,048.59"	$0.00	$0.00	$856.00	$0.00	"$2,025.00"	"$2,025.00"	$0.00	"$2,053.75"	"$3,253.14"	"$3,286.00"	$0.00		$0.00	$642.82	$0.00	$0.00	$653.91	$0.00	$0.00	$0.00	$0.00	$0.00
HRH-0828-S	SUP	HCPCS C1713		HRH-0828-S  -  ROD XTRNFX 8MM 280MM NS PLRS + SPCL	BOTH IP/OP	"$4,107.50 "	"$3,039.55"	$0.00	"$3,286.00"	"$1,848.38"	"$1,848.38"	$0.00	$0.00	$0.00	$856.11	"$3,048.59"	"$3,048.59"	$0.00	$0.00	$856.00	$0.00	"$2,025.00"	"$2,025.00"	$0.00	"$2,053.75"	"$3,253.14"	"$3,286.00"	$0.00		$0.00	$642.82	$0.00	$0.00	$653.91	$0.00	$0.00	$0.00	$0.00	$0.00
HR-L1115-S	SUP	HCPCS C1713		HR-L1115-S  -  NAIL 11MM 15CM HUM PLRS IM LCK TI STRL	BOTH IP/OP	"$4,107.50 "	"$3,039.55"	$0.00	"$3,286.00"	"$1,848.38"	"$1,848.38"	$0.00	$0.00	$0.00	$856.11	"$3,048.59"	"$3,048.59"	$0.00	$0.00	$856.00	$0.00	"$2,025.00"	"$2,025.00"	$0.00	"$2,053.75"	"$3,253.14"	"$3,286.00"	$0.00		$0.00	$642.82	$0.00	$0.00	$653.91	$0.00	$0.00	$0.00	$0.00	$0.00
HRSD105	SUP	Custom 27203010		HRSD105  -  BIT DRILL 2.8MM PLRS SHRT TAP STRL	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.51	$70.51	$0.00	$0.00	$19.80	$0.00	$0.00	$0.00	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HR-WC50-S	SUP	Custom 27203010		HR-WC50-S  -  WASHER XTRNFX 5MM STRL CIRC CLEATED FIB	BOTH IP/OP	$132.50 	$98.05	$0.00	$106.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.34	$98.34	$0.00	$0.00	$27.61	$0.00	$0.00	$0.00	$0.00	$66.25	$104.94	$106.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HS007	SUP	Custom 27011340		HS007  -  SPRT ORTH HALO SSTRC TLSO 14	BOTH IP/OP	"$1,860.55 "	"$1,376.81"	$0.00	"$1,488.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,380.90"	"$1,380.90"	$0.00	$0.00	$387.74	$0.00	$0.00	$0.00	$0.00	$930.28	"$1,473.56"	"$1,488.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HS765-010	SUP	HCPCS C1713		SPACER MDI OPTHLR HLD CHMBR HNDHLD	BOTH IP/OP	$13.30 	$9.84	$0.00	$10.64	$5.99	$5.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.65	$10.53	$10.64	$0.00		$0.00	$2.08	$0.00	$0.00	$2.12	$0.00	$0.00	$0.00	$0.00	$0.00
HS80010-010	SUP	HCPCS C1713		SPACER MDI OPTCH ADV VLV HLD CHMBR HNDHLD RPD BRTHG ALRM WO	BOTH IP/OP	$8.55 	$6.33	$0.00	$6.84	$3.85	$3.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.28	$6.77	$6.84	$0.00		$0.00	$1.34	$0.00	$0.00	$1.36	$0.00	$0.00	$0.00	$0.00	$0.00
HSK-3038	SUP	Custom 27203010		HSK-3038  -  SYSTEM PROX SL 3.8MM HRTSTR III DLV DEV LDR AOR CTR	BOTH IP/OP	"$1,650.00 "	"$1,221.00"	$0.00	"$1,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$825.00	"$1,306.80"	"$1,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HT036	SUP	Custom 27011340		HT036  -  HALTER TRC LG HLCRWN VST XTRNFXTR ADLT HDNK	BOTH IP/OP	"$1,492.50 "	"$1,104.45"	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,107.73"	"$1,107.73"	$0.00	$0.00	$311.04	$0.00	$0.00	$0.00	$0.00	$746.25	"$1,182.06"	"$1,194.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HT036HI	SUP	Custom 27011340		HT036HI  -  SET HLCRWN PIN LG SKL TRC	BOTH IP/OP	"$1,492.50 "	"$1,104.45"	$0.00	"$1,194.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,107.73"	"$1,107.73"	$0.00	$0.00	$311.04	$0.00	$0.00	$0.00	$0.00	$746.25	"$1,182.06"	"$1,194.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HT064050A	SUP	HCPCS C1768		HT064050A  -  GRAFT VASCULAR THIN WALL 6MM 50CM 40CM REMOVABLE RING	BOTH IP/OP	"$4,527.50 "	"$3,350.35"	$0.00	"$3,622.00"	"$2,037.38"	"$2,037.38"	$0.00	$0.00	$0.00	$943.64	"$3,360.31"	"$3,360.31"	$0.00	$0.00	$943.53	$0.00	"$2,232.06"	"$2,232.06"	$0.00	"$2,263.75"	"$3,585.78"	"$3,622.00"	$0.00		$0.00	$708.55	$0.00	$0.00	$720.78	$0.00	$0.00	$0.00	$0.00	$0.00
HT067090A	SUP	HCPCS C1768		HT067090A  -  GRAFT VASCULAR THIN WALL 6MM 90CM 70CM REMOVABLE RING	BOTH IP/OP	"$7,437.50 "	"$5,503.75"	$0.00	"$5,950.00"	"$3,346.88"	"$3,346.88"	$0.00	$0.00	$0.00	"$1,550.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,549.98"	$0.00	"$3,666.69"	"$3,666.69"	$0.00	"$3,718.75"	"$5,890.50"	"$5,950.00"	$0.00		$0.00	"$1,163.97"	$0.00	$0.00	"$1,184.05"	$0.00	$0.00	$0.00	$0.00	$0.00
HT084050A	SUP	HCPCS C1768		HT084050A  -  GRAFT VASCULAR THIN WALL 8MM 50CM 40CM REMOVABLE RING	BOTH IP/OP	"$4,527.50 "	"$3,350.35"	$0.00	"$3,622.00"	"$2,037.38"	"$2,037.38"	$0.00	$0.00	$0.00	$943.64	"$3,360.31"	"$3,360.31"	$0.00	$0.00	$943.53	$0.00	"$2,232.06"	"$2,232.06"	$0.00	"$2,263.75"	"$3,585.78"	"$3,622.00"	$0.00		$0.00	$708.55	$0.00	$0.00	$720.78	$0.00	$0.00	$0.00	$0.00	$0.00
HT087090A	SUP	HCPCS C1768		HT087090A  -  GRAFT VASCULAR THINWALL 8MM 90CM 70CM REMOVABLE RING STRETCH	BOTH IP/OP	"$7,437.50 "	"$5,503.75"	$0.00	"$5,950.00"	"$3,346.88"	"$3,346.88"	$0.00	$0.00	$0.00	"$1,550.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,549.98"	$0.00	"$3,666.69"	"$3,666.69"	$0.00	"$3,718.75"	"$5,890.50"	"$5,950.00"	$0.00		$0.00	"$1,163.97"	$0.00	$0.00	"$1,184.05"	$0.00	$0.00	$0.00	$0.00	$0.00
HT-0915	SUP	Custom 27203010		HT-0915  -  DRIVER SRG 1.5MM HEX	BOTH IP/OP	$470.00 	$347.80	$0.00	$376.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.83	$348.83	$0.00	$0.00	$97.95	$0.00	$0.00	$0.00	$0.00	$235.00	$372.24	$376.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HT-1120	SUP	Custom 27203010		HT-1120  -  DRIVER SRG 2MM HEX	BOTH IP/OP	$470.00 	$347.80	$0.00	$376.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.83	$348.83	$0.00	$0.00	$97.95	$0.00	$0.00	$0.00	$0.00	$235.00	$372.24	$376.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HT-1725	SUP	Custom 27203010		HT-1725  -  DRIVER SRG 2.5MM HEX	BOTH IP/OP	$470.00 	$347.80	$0.00	$376.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.83	$348.83	$0.00	$0.00	$97.95	$0.00	$0.00	$0.00	$0.00	$235.00	$372.24	$376.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HT-2502	SUP	Custom 27203010		HT-2502  -  TIP SCRDRVR 6IN 2.5MM QRLSE SLD	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$0.00	$0.00	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HT-3010	SUP	HCPCS C1713		HT-3010  -  SCREW BN ACUTRAC DRVR CNN TIP	BOTH IP/OP	$470.00 	$347.80	$0.00	$376.00	$211.50	$211.50	$0.00	$0.00	$0.00	$97.96	$348.83	$348.83	$0.00	$0.00	$97.95	$0.00	$278.01	$278.01	$0.00	$235.00	$372.24	$376.00	$0.00		$0.00	$73.56	$0.00	$0.00	$74.82	$0.00	$0.00	$0.00	$0.00	$0.00
HT-3012	SUP	Custom 27203010		HT-3012  -  TIP SCRDRVR 3MM QRLSE SLD HEX	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$0.00	$0.00	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HT-4000	SUP	Custom 27203010		HT-4000  -  DRIVER SRG 4MM CNN	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.82	$361.82	$0.00	$0.00	$101.60	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HT-4001	SUP	Custom 27203010		HT-4001  -  TIP SCRDRVR 4MM SLD HEX	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$0.00	$0.00	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
HW-0034	SUP	HCPCS C1713		HW-0034  -  SCREW BN .25IN 8-32IN DRL HNDL SET	BOTH IP/OP	$2.50 	$1.85	$0.00	$2.00	$1.13	$1.13	$0.00	$0.00	$0.00	$0.52	$1.86	$1.86	$0.00	$0.00	$0.52	$0.00	$1.48	$1.48	$0.00	$1.25	$1.98	$2.00	$0.00		$0.00	$0.39	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
I20	SUP	Custom 27203010		SENSOR INF OXSNR 2 OXM ADH	BOTH IP/OP	$30.80 	$22.79	$0.00	$24.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.40	$24.39	$24.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
I20-13/C70F	SUP	Custom 27803010		I20-13/C70F  -  GRAFT STNT STRG 20-13MM 17FR 70MM AFX ACTIVESEAL STRATA SLF	BOTH IP/OP	"$8,237.50 "	"$6,095.75"	$0.00	"$6,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,716.70"	$0.00	$0.00	$0.00	$0.00	"$4,118.75"	"$6,524.10"	"$6,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
I20-13/C88F	SUP	Custom 27803010		I20-13/C88F  -  GRAFT STNT STRG 20-13MM 17FR 88MM AFX ACTIVESEAL STRATA SLF	BOTH IP/OP	"$8,187.50 "	"$6,058.75"	$0.00	"$6,550.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,706.28"	$0.00	$0.00	$0.00	$0.00	"$4,093.75"	"$6,484.50"	"$6,550.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
I20-13/C88F SA	SUP	Custom 27803010		I20-13/C88F SA  -  GRAFT STNT 20-13MM 88MM STRL LF AFX STRATA ILC LMB AAA	BOTH IP/OP	"$8,187.50 "	"$6,058.75"	$0.00	"$6,550.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,706.28"	$0.00	$0.00	$0.00	$0.00	"$4,093.75"	"$6,484.50"	"$6,550.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
I20-20/C55F	SUP	Custom 27803010		I20-20/C55F  -  GRAFT STNT STRG 20MM 17FR 55MM AFX ACTIVESEAL STRATA SLF	BOTH IP/OP	"$6,700.00 "	"$4,958.00"	$0.00	"$5,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,396.28"	$0.00	$0.00	$0.00	$0.00	"$3,350.00"	"$5,306.40"	"$5,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IAB05830-LWS	SUP	HCPCS C1714		IAB05830-LWS  -  CATH IAB .025IN 8FR 25.3IN 6IN GWIRE NYL PU CARDIOTHANE 2	BOTH IP/OP	"$3,451.70 "	"$2,554.26"	$0.00	"$2,761.36"	"$1,874.27"	"$1,874.27"	$0.00	$0.00	$0.00	$0.00	"$2,561.85"	"$2,561.85"	$0.00	$0.00	$719.33	$0.00	$0.00	$0.00	$0.00	"$1,725.85"	"$2,733.75"	"$2,761.36"	$0.00		$0.00	$540.19	$0.00	$0.00	$549.51	$0.00	$0.00	$0.00	$0.00	$0.00
IAB-05830-LWS	SUP	Custom 27203010		CATHETER IAB 8FR FIBEROPTIX 30ML LF	BOTH IP/OP	"$2,560.00 "	"$1,894.40"	$0.00	"$2,048.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,280.00"	"$2,027.52"	"$2,048.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IAB-05840-LWS	SUP	HCPCS C1714		IAB-05840-LWS  -  CATH IAB .025IN 8FR 27.3IN 6IN GWIRE NYL PU CARDIOTHANE 2	BOTH IP/OP	"$3,451.70 "	"$2,554.26"	$0.00	"$2,761.36"	"$1,874.27"	"$1,874.27"	$0.00	$0.00	$0.00	$0.00	"$2,561.85"	"$2,561.85"	$0.00	$0.00	$719.33	$0.00	$0.00	$0.00	$0.00	"$1,725.85"	"$2,733.75"	"$2,761.36"	$0.00		$0.00	$540.19	$0.00	$0.00	$549.51	$0.00	$0.00	$0.00	$0.00	$0.00
IAB-06830-LWS	SUP	HCPCS C1725		CATHETER IAB 7.5FR FIBEROPTIX FLXB 30ML LF	BOTH IP/OP	"$2,087.50 "	"$1,544.75"	$0.00	"$1,670.00"	"$1,133.51"	"$1,133.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,043.75"	"$1,653.30"	"$1,670.00"	$0.00		$0.00	$326.69	$0.00	$0.00	$332.33	$0.00	$0.00	$0.00	$0.00	$0.00
IAS5-120LP	SUP	Custom 27203010		IAS5-120LP  -  PORT ACC 5MM 120MM AIRSEAL 2 WL CNN LOPRFL OBT BLDLS OPTC	BOTH IP/OP	$291.67 	$215.84	$0.00	$233.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.48	$216.48	$0.00	$0.00	$60.78	$0.00	$0.00	$0.00	$0.00	$145.83	$231.00	$233.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IBI-85641	SUP	Custom 27203010		IBI-85641  -  CABLE CATH 8FT STRL LF REUSE	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IBI-85931	SUP	Custom 27203010		IBI-85931  -  CABLE CATH 150CM INQ 24 PIN CNCT DX	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IBI-87008	SUP	HCPCS C1731		IBI-87008  -  CATHETER EP 4MM SPC 7FR 20MM 110CM INQ AFOCUS II 20 ELTRD MP	BOTH IP/OP	"$3,800.00 "	"$2,812.00"	$0.00	"$3,040.00"	"$2,063.40"	"$2,063.40"	$0.00	$0.00	$0.00	$792.02	"$2,820.36"	"$2,820.36"	$0.00	$0.00	$791.92	$0.00	"$2,247.70"	"$2,247.70"	$0.00	"$1,900.00"	"$3,009.60"	"$3,040.00"	$0.00		$0.00	$594.70	$0.00	$0.00	$604.96	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1102	SUP	HCPCS C1785		ICV1102  -  PACEMAKER CRD REPLY 2 CHMBR	BOTH IP/OP	"$10,500.00 "	"$7,770.00"	$0.00	"$8,400.00"	"$4,725.00"	"$4,725.00"	$0.00	$0.00	$0.00	"$2,188.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,188.20"	$0.00	"$5,176.50"	"$5,176.50"	$0.00	"$5,250.00"	"$8,316.00"	"$8,400.00"	$0.00		$0.00	"$1,643.25"	$0.00	$0.00	"$1,671.60"	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1102 SYSTEM	SUP	HCPCS C1785		ICV1102 SYSTEM  -  REPLY DR V2  SYSTEM	BOTH IP/OP	"$12,500.00 "	"$9,250.00"	$0.00	"$10,000.00"	"$5,625.00"	"$5,625.00"	$0.00	$0.00	$0.00	"$2,605.31"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,605.00"	$0.00	"$6,162.50"	"$6,162.50"	$0.00	"$6,250.00"	"$9,900.00"	"$10,000.00"	$0.00		$0.00	"$1,956.25"	$0.00	$0.00	"$1,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1116	SUP	HCPCS C1786		ICV1116  -  PACEMAKER CRD ESPRT DR	BOTH IP/OP	"$9,125.00 "	"$6,752.50"	$0.00	"$7,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,901.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,901.65"	$0.00	"$4,498.63"	"$4,498.63"	$0.00	"$4,562.50"	"$7,227.00"	"$7,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1116 SYSTEM	SUP	HCPCS C1785		ICV1116 SYSTEM  -  ESPRIT DR SYSTEM	BOTH IP/OP	"$11,610.00 "	"$8,591.40"	$0.00	"$9,288.00"	"$5,224.50"	"$5,224.50"	$0.00	$0.00	$0.00	"$2,419.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,419.52"	$0.00	"$5,723.73"	"$5,723.73"	$0.00	"$5,805.00"	"$9,195.12"	"$9,288.00"	$0.00		$0.00	"$1,816.97"	$0.00	$0.00	"$1,848.31"	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1122	SUP	HCPCS C1786		ICV1122  -  PACEMAKER CRD REPLY 1 CHMBR	BOTH IP/OP	"$8,250.00 "	"$6,105.00"	$0.00	"$6,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,719.51"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,719.30"	$0.00	"$4,067.25"	"$4,067.25"	$0.00	"$4,125.00"	"$6,534.00"	"$6,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1122 SYSTEM	SUP	HCPCS C1786		ICV1122 SYSTEM  -  REPLY SR V2 SYSTEM	BOTH IP/OP	"$9,500.00 "	"$7,030.00"	$0.00	"$7,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,980.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,979.80"	$0.00	"$4,683.50"	"$4,683.50"	$0.00	"$4,750.00"	"$7,524.00"	"$7,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1127	SUP	HCPCS C1786		ICV1127  -  PACEMAKER CRD ESPRT SR	BOTH IP/OP	"$6,962.50 "	"$5,152.25"	$0.00	"$5,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,451.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,450.99"	$0.00	"$3,432.51"	"$3,432.51"	$0.00	"$3,481.25"	"$5,514.30"	"$5,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1127 SYSTEM	SUP	HCPCS C1786		ICV1127 SYSTEM  -  ESPRIT SR SYSTEM	BOTH IP/OP	"$8,205.00 "	"$6,071.70"	$0.00	"$6,564.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,710.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,709.92"	$0.00	"$4,045.07"	"$4,045.07"	$0.00	"$4,102.50"	"$6,498.36"	"$6,564.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1179	SUP	HCPCS C1882		ICV1179  -  DEFIBRILLATOR CRD PARADYM CRT ICD	BOTH IP/OP	"$44,412.50 "	"$32,865.25"	$0.00	"$35,530.00"	"$19,985.63"	"$19,985.63"	$0.00	$0.00	$0.00	"$9,256.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,255.57"	$0.00	"$21,895.36"	"$21,895.36"	$0.00	"$22,206.25"	"$35,174.70"	"$35,530.00"	$0.00		$0.00	"$6,950.56"	$0.00	$0.00	"$7,070.47"	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1179 SYSTEM	SUP	HCPCS C1882		ICV1179 SYSTEM  -  PARADYM CRT-D 8750 SYSTEM	BOTH IP/OP	"$58,187.50 "	"$43,058.75"	$0.00	"$46,550.00"	"$26,184.38"	"$26,184.38"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$12,126.28"	$0.00	"$28,686.44"	"$28,686.44"	$0.00	"$29,093.75"	"$46,084.50"	"$46,550.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1199	SUP	HCPCS C1722		ICV1199  -  DEFIBRILLATOR CRD PARADYM VR ICD	BOTH IP/OP	"$36,575.00 "	"$27,065.50"	$0.00	"$29,260.00"	"$16,458.75"	"$16,458.75"	$0.00	$0.00	$0.00	"$7,623.14"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,622.23"	$0.00	"$18,031.48"	"$18,031.48"	$0.00	"$18,287.50"	"$28,967.40"	"$29,260.00"	$0.00		$0.00	"$5,723.99"	$0.00	$0.00	"$5,822.74"	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1200	SUP	HCPCS C1721		ICV1200  -  DEFIBRILLATOR CRD PARADYM DR ICD	BOTH IP/OP	"$42,512.50 "	"$31,459.25"	$0.00	"$34,010.00"	"$19,130.63"	"$19,130.63"	$0.00	$0.00	$0.00	"$8,860.67"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,859.61"	$0.00	"$20,958.66"	"$20,958.66"	$0.00	"$21,256.25"	"$33,669.90"	"$34,010.00"	$0.00		$0.00	"$6,653.21"	$0.00	$0.00	"$6,767.99"	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1258	SUP	HCPCS C1785		ICV1258  -  REPLY DR	BOTH IP/OP	"$9,125.00 "	"$6,752.50"	$0.00	"$7,300.00"	"$4,106.25"	"$4,106.25"	$0.00	$0.00	$0.00	"$1,901.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,901.65"	$0.00	"$4,498.63"	"$4,498.63"	$0.00	"$4,562.50"	"$7,227.00"	"$7,300.00"	$0.00		$0.00	"$1,428.06"	$0.00	$0.00	"$1,452.70"	$0.00	$0.00	$0.00	$0.00	$0.00
ICV1258 SYSTEM	SUP	HCPCS C1785		ICV1258 SYSTEM  -  REPLY DR SYSTEM	BOTH IP/OP	"$11,610.00 "	"$8,591.40"	$0.00	"$9,288.00"	"$5,224.50"	"$5,224.50"	$0.00	$0.00	$0.00	"$2,419.81"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,419.52"	$0.00	"$5,723.73"	"$5,723.73"	$0.00	"$5,805.00"	"$9,195.12"	"$9,288.00"	$0.00		$0.00	"$1,816.97"	$0.00	$0.00	"$1,848.31"	$0.00	$0.00	$0.00	$0.00	$0.00
ID-1-5	SUP	Custom 27203010		ID-1-5  -  ACTU PNEUM LRS AXIUM 3D DTCH HLCL	BOTH IP/OP	$57.75 	$42.74	$0.00	$107.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.86	$42.86	$0.00	$0.00	$12.04	$0.00	$0.00	$0.00	$0.00	$67.25	$106.52	$107.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ID3305	SUP	Custom 27803010		ID3305  -  GRAFT SOFT TISSUE 3X3IN PATCH RESORB SUTURABLE DURAGEN	BOTH IP/OP	"$2,068.76 "	"$1,530.88"	$0.00	"$1,804.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,535.43"	"$1,535.43"	$0.00	$0.00	$431.13	$0.00	$0.00	$0.00	$0.00	"$1,127.85"	"$1,786.51"	"$1,804.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IJ27U	SUP	HCPCS C1898		IJ27U  -  LEAD PACING 58CM ACTIVE FIX ISOLINE	BOTH IP/OP	"$10,000.00 "	"$7,400.00"	$0.00	"$8,000.00"	"$4,500.00"	"$4,500.00"	$0.00	$0.00	$0.00	"$2,084.25"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,084.00"	$0.00	"$4,930.00"	"$4,930.00"	$0.00	"$5,000.00"	"$7,920.00"	"$8,000.00"	$0.00		$0.00	"$1,565.00"	$0.00	$0.00	"$1,592.00"	$0.00	$0.00	$0.00	$0.00	$0.00
IM3ST	SUP	Custom 27803010		IM3ST  -  BRAIN TISSUE MONITERING KIT	BOTH IP/OP	"$3,115.00 "	"$2,305.10"	$0.00	"$2,492.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,311.95"	"$2,311.95"	$0.00	$0.00	$649.17	$0.00	$0.00	$0.00	$0.00	"$1,557.50"	"$2,467.08"	"$2,492.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
INS5010	SUP	HCPCS C1729		INS5010  -  CATHETER DRN 1.5MM .7MM 80CM STRL LF HRMTC TUO CLS TIP LL	BOTH IP/OP	$635.93 	$470.59	$0.00	$471.98	$308.45	$308.45	$0.00	$0.00	$0.00	$132.54	$471.98	$471.98	$0.00	$0.00	$132.53	$0.00	$376.15	$376.15	$0.00	$284.03	$449.90	$454.44	$0.00		$0.00	$88.90	$0.00	$0.00	$90.43	$0.00	$0.00	$0.00	$0.00	$0.00
INS8401	SUP	Custom 27803010		INS8401  -  SYSTEM DRN 35CM 700ML BLU STRL LF BE2 MNTR TRNDCR ATCH VNTRC	BOTH IP/OP	$763.85 	$565.25	$0.00	$784.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$566.93	$566.93	$0.00	$0.00	$159.19	$0.00	$0.00	$0.00	$0.00	$490.00	$776.16	$784.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
INS-8420	SUP	Custom 27803010		INS-8420  -  KIT XTRN DRN 1.9MM VNTRC	BOTH IP/OP	$361.25 	$267.33	$0.00	$289.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.63	$286.11	$289.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
INS8700	SUP	Custom 27011340		INS8700  -  BAG XTRN DRN 700ML EDS 3 CSF CLT	BOTH IP/OP	$824.38 	$610.04	$0.00	$630.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$611.85	$611.85	$0.00	$0.00	$171.80	$0.00	$0.00	$0.00	$0.00	$393.75	$623.70	$630.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
INSHITHRZN	SUP	Custom 27803010		INSHITHRZN  -  KIT CRNTMY 25GA 5/8IN STRL RZR NDL DRP	BOTH IP/OP	$700.60 	$518.44	$0.00	$560.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$350.30	$554.88	$560.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
INT-105-19	SUP	HCPCS C1894		INT-105-19  -  INTRODUCER SHTH 16FR 15CM PTFE	BOTH IP/OP	$52.50 	$38.85	$0.00	$42.00	$28.51	$28.51	$0.00	$0.00	$0.00	$10.94	$38.97	$38.97	$0.00	$0.00	$10.94	$0.00	$31.05	$31.05	$0.00	$26.25	$41.58	$42.00	$0.00		$0.00	$8.22	$0.00	$0.00	$8.36	$0.00	$0.00	$0.00	$0.00	$0.00
INT-105-45	SUP	HCPCS C1894		INT-105-45  -  INTRODUCER TEAR AWAY 120F X 30CM	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$26.05	$92.78	$92.78	$0.00	$0.00	$26.05	$0.00	$73.94	$73.94	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
INT22508UX	SUP	HCPCS C1876		STENT METAL BARE INT22508UX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
INT22512UX	SUP	HCPCS C1876		INT22512UX  -  SYSTEM COR STNT 2.25MM 12MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT22514UX	SUP	HCPCS C1876		STENT METAL BARE INT22514UX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
INT22518UX	SUP	HCPCS C1876		STENT METAL BARE INT22518UX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
INT22522UX	SUP	HCPCS C1874		INT22522UX  -  SYSTEM COR STNT 2.25MM 22MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT22526UX	SUP	HCPCS C1874		INT22526UX  -  SYSTEM COR STNT 2.25MM 26MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$731.25	$731.25	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
INT25008UX	SUP	HCPCS C1877		INT25008UX  -  SYSTEM COR STNT 2.5MM 8MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT25012UX	SUP	HCPCS C1874		INT25012UX  -  SYSTEM COR STNT 2.5MM 12MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT25014UX	SUP	HCPCS C1874		INT25014UX  -  SYSTEM COR STNT 2.5MM 14MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT25018UX	SUP	HCPCS C1876		STENT METAL BARE INT25018UX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
INT25022UX	SUP	HCPCS C1874		INT25022UX  -  SYSTEM COR STNT 2.5MM 22MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$731.25	$731.25	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
INT25026UX	SUP	HCPCS C1874		INT25026UX  -  SYSTEM COR STNT 2.5MM 26MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT27508UX	SUP	HCPCS C1874		INT27508UX  -  SYSTEM COR STNT 2.75MM 8MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT27512UX	SUP	HCPCS C1874		INT27512UX  -  SYSTEM COR STNT 2.75MM 12MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT27514UX	SUP	HCPCS C1874		INT27514UX  -  SYSTEM COR STNT 2.75MM 14MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT27518UX	SUP	HCPCS C1874		INT27518UX  -  SYSTEM COR STNT 2.75MM 18MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$731.25	$731.25	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
INT27526UX	SUP	HCPCS C1876		INT27526UX  -  STENT CORON 2.75MM 26MM 1 STRN RAPEX SINUSOID OPTM	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
INT30009UX	SUP	HCPCS C1876		INT30009UX  -  SYSTEM COR STNT 3MM 9MM INTGR MICROTRAC RX 1 STRN INTGR TIP	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT30012UX	SUP	HCPCS C1874		INT30012UX  -  SYSTEM COR STNT 3MM 12MM INTGR MICROTRAC RX 1 STRN INTGR TIP	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT30018UX	SUP	HCPCS C1874		INT30018UX  -  SYSTEM COR STNT 3MM 18MM INTGR MICROTRAC RX 1 STRN INTGR TIP	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT30022UX	SUP	HCPCS C1874		INT30022UX  -  SYSTEM COR STNT 3MM 22MM INTGR MICROTRAC RX 1 STRN INTGR TIP	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT30026UX	SUP	HCPCS C1874		INT30026UX  -  SYSTEM COR STNT 3MM 26MM INTGR MICROTRAC RX 1 STRN INTGR TIP	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$731.25	$731.25	$0.00	$0.00	$0.00	$338.69	"$1,206.08"	"$1,206.08"	$0.00	$0.00	$338.65	$0.00	$961.19	$961.19	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
INT30030UX	SUP	HCPCS C1876		STENT METAL BARE INT30030UX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
INT35009UX	SUP	HCPCS C1876		STENT METAL BARE INT35009UX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
INT35012UX	SUP	HCPCS C1876		STENT METAL BARE INT35012UX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
INT35015UX	SUP	HCPCS C1876		STENT METAL BARE INT35015UX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
INT35018UX	SUP	HCPCS C1876		STENT METAL BARE INT35018UX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
INT35022UX	SUP	HCPCS C1876		STENT METAL BARE INT35022UX	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$900.00	$900.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$313.00	$0.00	$0.00	$318.40	$0.00	$0.00	$0.00	$0.00	$0.00
INT35026UX	SUP	HCPCS C1874		INT35026UX  -  SYSTEM COR STNT 3.5MM 26MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT35030UX	SUP	HCPCS C1874		INT35030UX  -  SYSTEM COR STNT 3.5MM 30MM INTGR MICROTRAC RX 1 STRN INTGR	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT40009UX	SUP	HCPCS C1874		INT40009UX  -  SYSTEM COR STNT 4MM 9MM INTGR MICROTRAC RX 1 STRN INTGR TIP	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT40012UX	SUP	HCPCS C1876		INT40012UX  -  SYSTEM COR STNT 4MM 12MM INTGR MICROTRAC RX 1 STRN INTGR TIP	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT40015UX	SUP	HCPCS C1874		INT40015UX  -  SYSTEM COR STNT 4MM 15MM INTGR MICROTRAC RX 1 STRN INTGR TIP	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT40018UX	SUP	HCPCS C1874		INT40018UX  -  SYSTEM COR STNT 4MM 18MM INTGR MICROTRAC RX 1 STRN INTGR TIP	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT40022UX	SUP	HCPCS C1874		INT40022UX  -  SYSTEM COR STNT 4MM 22MM INTGR MICROTRAC RX 1 STRN INTGR TIP	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT40026UX	SUP	HCPCS C1874		INT40026UX  -  SYSTEM COR STNT 4MM 26MM INTGR MICROTRAC RX 1 STRN INTGR TIP	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
INT40030UX	SUP	HCPCS C1874		INT40030UX  -  SYSTEM COR STNT 4MM 30MM INTGR MICROTRAC RX 1 STRN INTGR TIP	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$787.50	$787.50	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
IPC-5000E	SUP	Custom 27203010		IPC-5000E  -  CATHETER PRESSURE 3.5MM 5MM 82CM 2CM SENSOR TIP EXTERNAL	BOTH IP/OP	$56.88 	$42.09	$0.00	$46.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.21	$42.21	$0.00	$0.00	$11.85	$0.00	$0.00	$0.00	$0.00	$28.86	$45.72	$46.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IRC115	SUP	Custom 27203010		IRC115  -  CONSOLE LEGEND EHS IRRIGATION	BOTH IP/OP	"$4,710.00 "	"$3,485.40"	$0.00	"$3,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,495.76"	"$3,495.76"	$0.00	$0.00	$981.56	$0.00	$0.00	$0.00	$0.00	"$2,355.00"	"$3,730.32"	"$3,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IRC230	SUP	Custom 27203010		IRC230  -  CONSOLE LEGEND IRRIGATION EHS EU	BOTH IP/OP	"$4,710.00 "	"$3,485.40"	$0.00	"$3,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,495.76"	"$3,495.76"	$0.00	$0.00	$981.56	$0.00	$0.00	$0.00	$0.00	"$2,355.00"	"$3,730.32"	"$3,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IRC400	SUP	Custom 27203010		IRC400  -  CABLE SIGNAL IRRIGATION SYSTEM	BOTH IP/OP	$254.00 	$187.96	$0.00	$203.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.52	$188.52	$0.00	$0.00	$52.93	$0.00	$0.00	$0.00	$0.00	$127.00	$201.17	$203.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IRC500	SUP	Custom 27203010		IRC500  -  IV POLE IRC500  EHS IRRIGATION SYSTEM	BOTH IP/OP	$218.00 	$161.32	$0.00	$174.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.80	$161.80	$0.00	$0.00	$45.43	$0.00	$0.00	$0.00	$0.00	$109.00	$172.66	$174.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IRD200	SUP	Custom 27203010		IRD200  -  DISPOSABLE IRD200 IRRIGATION CONTROL	BOTH IP/OP	$162.00 	$119.88	$0.00	$129.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.24	$120.24	$0.00	$0.00	$33.76	$0.00	$0.00	$0.00	$0.00	$81.00	$128.30	$129.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IRD250	SUP	Custom 27203010		IRD250  -  DISPOSABLE IRD250 IRRIGATION TUBING SET	BOTH IP/OP	$200.00 	$148.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.44	$148.44	$0.00	$0.00	$41.68	$0.00	$0.00	$0.00	$0.00	$100.00	$158.40	$160.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IRD300	SUP	Custom 27203010		IRD300  -  TUBING IRRIGATION MIDAS REX LEGEND EHS DISPOSABLE	BOTH IP/OP	$196.40 	$145.34	$0.00	$157.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.77	$145.77	$0.00	$0.00	$40.93	$0.00	$0.00	$0.00	$0.00	$98.20	$155.55	$157.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IRD350	SUP	Custom 27203010		IRD350  -  TUBING IRRIGATION BURR TRANSNASAL	BOTH IP/OP	$322.00 	$238.28	$0.00	$257.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.99	$238.99	$0.00	$0.00	$67.10	$0.00	$0.00	$0.00	$0.00	$161.00	$255.02	$257.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
IST2	SUP	Custom 27203010		"IST2  -  INDIGO SYSTEM, ASPIRATION TUBING"	BOTH IP/OP	$912.50 	$675.25	$0.00	$730.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$677.26	$677.26	$0.00	$0.00	$190.17	$0.00	$0.00	$0.00	$0.00	$456.25	$722.70	$730.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J3053-20	SUP	Custom 27203010		INDICATOR ANAER GSPK DISP	BOTH IP/OP	$90.98 	$67.33	$0.00	$72.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.49	$72.06	$72.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J3053-21	SUP	Custom 27203010		INDICATOR ANAER DRY STRP GSPK	BOTH IP/OP	$107.10 	$79.25	$0.00	$85.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.55	$84.82	$85.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J408G	SUP	Custom 27203010		J408G  -  SUTURE VCL 8-0 5-130-4 9IN BRAID COAT VIOL ABS	BOTH IP/OP	$48.93 	$36.21	$0.00	$39.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.32	$36.32	$0.00	$0.00	$10.20	$0.00	$0.00	$0.00	$0.00	$24.47	$38.75	$39.15	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J494H	SUP	Custom 27203010		J494H  -  SUTURE ABSORBABLE 4-0 P-3 18IN BRAID COATED VICRYL MULTIPASS	BOTH IP/OP	$411.38 	$304.42	$0.00	$334.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.32	$305.32	$0.00	$0.00	$85.73	$0.00	$0.00	$0.00	$0.00	$208.77	$330.70	$334.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J546G	SUP	Custom 27203010		J546G  -  SUTURE ABS 7-0 TG140-8 18IN VIOL VC MCRPT 2 ARM BRD COAT	BOTH IP/OP	$35.56 	$26.31	$0.00	$28.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.39	$26.39	$0.00	$0.00	$7.41	$0.00	$0.00	$0.00	$0.00	$18.05	$28.58	$28.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J548G	SUP	Custom 27203010		J548G  -  SUTURE ABSORBABLE 8-0 TG140-8 12IN 2 ARM BRAID COATED VICRYL	BOTH IP/OP	$36.05 	$26.68	$0.00	$29.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.76	$26.76	$0.00	$0.00	$7.51	$0.00	$0.00	$0.00	$0.00	$18.30	$28.98	$29.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J555G	SUP	Custom 27203010		J555G  -  SUTURE ABS 6-0 S-29 18IN VIOL VC SBRLC 2 ARM BRD COAT	BOTH IP/OP	$37.20 	$27.53	$0.00	$30.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.61	$27.61	$0.00	$0.00	$7.75	$0.00	$0.00	$0.00	$0.00	$18.88	$29.91	$30.21	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J570G	SUP	Custom 27203010		J570G  -  SUTURE ABSORBABLE 6-0 S-14 18IN 2 ARM BRAID COATED VICRYL	BOTH IP/OP	$37.29 	$27.59	$0.00	$30.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.68	$27.68	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$18.92	$29.98	$30.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J6054-0610	SUP	HCPCS C1776		J6054-0610  -  SYSTEM THR SCRFT+ 6-10	BOTH IP/OP	"$7,204.00 "	"$5,330.96"	$0.00	"$5,763.20"	"$3,241.80"	"$3,241.80"	$0.00	$0.00	$0.00	"$1,501.49"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,501.31"	$0.00	"$3,551.57"	"$3,551.57"	$0.00	"$3,602.00"	"$5,705.57"	"$5,763.20"	$0.00		$0.00	"$1,127.43"	$0.00	$0.00	"$1,146.88"	$0.00	$0.00	$0.00	$0.00	$0.00
J6054-0711	SUP	HCPCS C1776		J6054-0711  -  STEM FEM 130MM 11MM PRIM SECFIT PLUS HYDRXAPT 7 HIP	BOTH IP/OP	"$6,865.00 "	"$5,080.10"	$0.00	"$5,492.00"	"$3,089.25"	"$3,089.25"	$0.00	$0.00	$0.00	"$1,430.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,430.67"	$0.00	"$3,384.45"	"$3,384.45"	$0.00	"$3,432.50"	"$5,437.08"	"$5,492.00"	$0.00		$0.00	"$1,074.37"	$0.00	$0.00	"$1,092.91"	$0.00	$0.00	$0.00	$0.00	$0.00
J6054-0713	SUP	HCPCS C1776		J6054-0713  -  STEM FEM 130MM 13MM PRIM SECFIT PLUS HYDRXAPT 7 HIP	BOTH IP/OP	"$6,865.00 "	"$5,080.10"	$0.00	"$5,492.00"	"$3,089.25"	"$3,089.25"	$0.00	$0.00	$0.00	"$1,430.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,430.67"	$0.00	"$3,384.45"	"$3,384.45"	$0.00	"$3,432.50"	"$5,437.08"	"$5,492.00"	$0.00		$0.00	"$1,074.37"	$0.00	$0.00	"$1,092.91"	$0.00	$0.00	$0.00	$0.00	$0.00
J6054-0812	SUP	HCPCS C1776		J6054-0812  -  STEM FEM 130MM 12MM PRIM SECFIT PLUS HYDRXAPT 8 HIP	BOTH IP/OP	"$6,865.00 "	"$5,080.10"	$0.00	"$5,492.00"	"$3,089.25"	"$3,089.25"	$0.00	$0.00	$0.00	"$1,430.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,430.67"	$0.00	"$3,384.45"	"$3,384.45"	$0.00	"$3,432.50"	"$5,437.08"	"$5,492.00"	$0.00		$0.00	"$1,074.37"	$0.00	$0.00	"$1,092.91"	$0.00	$0.00	$0.00	$0.00	$0.00
J6054-0814	SUP	HCPCS C1776		J6054-0814  -  STEM FEM 130MM 14MM PRIM SECFIT PLUS HYDRXAPT 8 HIP	BOTH IP/OP	"$6,865.00 "	"$5,080.10"	$0.00	"$5,492.00"	"$3,089.25"	"$3,089.25"	$0.00	$0.00	$0.00	"$1,430.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,430.67"	$0.00	"$3,384.45"	"$3,384.45"	$0.00	"$3,432.50"	"$5,437.08"	"$5,492.00"	$0.00		$0.00	"$1,074.37"	$0.00	$0.00	"$1,092.91"	$0.00	$0.00	$0.00	$0.00	$0.00
J6054-0913	SUP	HCPCS C1776		J6054-0913  -  STEM FEM 130MM 13MM PRIM SECFIT PLUS HYDRXAPT 9 HIP	BOTH IP/OP	"$6,865.00 "	"$5,080.10"	$0.00	"$5,492.00"	"$3,089.25"	"$3,089.25"	$0.00	$0.00	$0.00	"$1,430.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,430.67"	$0.00	"$3,384.45"	"$3,384.45"	$0.00	"$3,432.50"	"$5,437.08"	"$5,492.00"	$0.00		$0.00	"$1,074.37"	$0.00	$0.00	"$1,092.91"	$0.00	$0.00	$0.00	$0.00	$0.00
J6054-0915	SUP	HCPCS C1776		J6054-0915  -  STEM FEM 130MM 15MM PRIM SECFIT PLUS HYDRXAPT 9 HIP	BOTH IP/OP	"$6,865.00 "	"$5,080.10"	$0.00	"$5,492.00"	"$3,089.25"	"$3,089.25"	$0.00	$0.00	$0.00	"$1,430.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,430.67"	$0.00	"$3,384.45"	"$3,384.45"	$0.00	"$3,432.50"	"$5,437.08"	"$5,492.00"	$0.00		$0.00	"$1,074.37"	$0.00	$0.00	"$1,092.91"	$0.00	$0.00	$0.00	$0.00	$0.00
J6054-1014	SUP	HCPCS C1776		J6054-1014  -  STEM FEM 130MM 14MM PRIM SECFIT PLUS HYDRXAPT 10 HIP	BOTH IP/OP	"$6,865.00 "	"$5,080.10"	$0.00	"$5,492.00"	"$3,089.25"	"$3,089.25"	$0.00	$0.00	$0.00	"$1,430.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,430.67"	$0.00	"$3,384.45"	"$3,384.45"	$0.00	"$3,432.50"	"$5,437.08"	"$5,492.00"	$0.00		$0.00	"$1,074.37"	$0.00	$0.00	"$1,092.91"	$0.00	$0.00	$0.00	$0.00	$0.00
J6054-1016	SUP	HCPCS C1776		J6054-1016  -  STEM FEM 130MM 16MM PRIM SECFIT PLUS HYDRXAPT 10 HIP	BOTH IP/OP	"$6,865.00 "	"$5,080.10"	$0.00	"$5,492.00"	"$3,089.25"	"$3,089.25"	$0.00	$0.00	$0.00	"$1,430.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,430.67"	$0.00	"$3,384.45"	"$3,384.45"	$0.00	"$3,432.50"	"$5,437.08"	"$5,492.00"	$0.00		$0.00	"$1,074.37"	$0.00	$0.00	"$1,092.91"	$0.00	$0.00	$0.00	$0.00	$0.00
J6054-1115	SUP	HCPCS C1776		J6054-1115  -  STEM FEM 170MM 15MM PRIM SECFIT PLUS HYDRXAPT 11 HIP	BOTH IP/OP	"$6,865.00 "	"$5,080.10"	$0.00	"$5,492.00"	"$3,089.25"	"$3,089.25"	$0.00	$0.00	$0.00	"$1,430.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,430.67"	$0.00	"$3,384.45"	"$3,384.45"	$0.00	"$3,432.50"	"$5,437.08"	"$5,492.00"	$0.00		$0.00	"$1,074.37"	$0.00	$0.00	"$1,092.91"	$0.00	$0.00	$0.00	$0.00	$0.00
J6054-1117	SUP	HCPCS C1776		J6054-1117  -  STEM FEM 170MM 17MM PRIM SECFIT PLUS HYDRXAPT 11 HIP	BOTH IP/OP	"$6,865.00 "	"$5,080.10"	$0.00	"$5,492.00"	"$3,089.25"	"$3,089.25"	$0.00	$0.00	$0.00	"$1,430.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,430.67"	$0.00	"$3,384.45"	"$3,384.45"	$0.00	"$3,432.50"	"$5,437.08"	"$5,492.00"	$0.00		$0.00	"$1,074.37"	$0.00	$0.00	"$1,092.91"	$0.00	$0.00	$0.00	$0.00	$0.00
J6054-1216	SUP	HCPCS C1776		J6054-1216  -  STEM FEM 170MM 16MM PRIM SECFIT PLUS HYDRXAPT 12 HIP	BOTH IP/OP	"$6,865.00 "	"$5,080.10"	$0.00	"$5,492.00"	"$3,089.25"	"$3,089.25"	$0.00	$0.00	$0.00	"$1,430.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,430.67"	$0.00	"$3,384.45"	"$3,384.45"	$0.00	"$3,432.50"	"$5,437.08"	"$5,492.00"	$0.00		$0.00	"$1,074.37"	$0.00	$0.00	"$1,092.91"	$0.00	$0.00	$0.00	$0.00	$0.00
J634H	SUP	Custom 27203010		J634H  -  SUTURE ABS VIOL 18IN VCL 3-0 TIE BRAID COAT	BOTH IP/OP	$5.29 	$3.91	$0.00	$4.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.93	$3.93	$0.00	$0.00	$1.10	$0.00	$0.00	$0.00	$0.00	$2.65	$4.19	$4.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J671G	SUP	Custom 27203010		J671G  -  SUTURE ABSORBABLE 5-0 S-14 18IN 2 ARM BRAID COATED VICRYL	BOTH IP/OP	$31.41 	$23.24	$0.00	$25.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.31	$23.31	$0.00	$0.00	$6.55	$0.00	$0.00	$0.00	$0.00	$15.71	$24.88	$25.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J726D	SUP	Custom 27203010		J726D  -  SUTURE VCL 2-0 CT2 8-18IN CR BRAID COAT VIOL ABS	BOTH IP/OP	$47.20 	$34.93	$0.00	$37.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.03	$35.03	$0.00	$0.00	$9.84	$0.00	$0.00	$0.00	$0.00	$23.60	$37.38	$37.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J727D	SUP	Custom 27203010		J727D  -  SUTURE ABSORBABLE 0 CT-2 8-18IN TAPER POINT BRAID 8 STRAND	BOTH IP/OP	$29.89 	$22.12	$0.00	$24.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.19	$22.19	$0.00	$0.00	$6.23	$0.00	$0.00	$0.00	$0.00	$15.17	$24.03	$24.27	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J739D	SUP	Custom 27203010		J739D  -  SUTURE ABSORBABLE 2-0 CT-1 18IN CONTROL RELEASE BRAIDED 8	BOTH IP/OP	$29.86 	$22.10	$0.00	$24.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.16	$22.16	$0.00	$0.00	$6.22	$0.00	$0.00	$0.00	$0.00	$15.15	$24.00	$24.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J740D	SUP	Custom 27203010		J740D  -  SUTURE ABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND	BOTH IP/OP	$29.96 	$22.17	$0.00	$24.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.24	$22.24	$0.00	$0.00	$6.24	$0.00	$0.00	$0.00	$0.00	$15.20	$24.08	$24.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J741D	SUP	Custom 27203010		J741D  -  SUTURE ABSORBABLE 1 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND	BOTH IP/OP	$361.24 	$267.32	$0.00	$288.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.11	$268.11	$0.00	$0.00	$75.28	$0.00	$0.00	$0.00	$0.00	$180.62	$286.10	$288.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J754T CR	SUP	Custom 27203010		J754T CR  -  NEEDLE 0 VICRYL 18 OS-6	BOTH IP/OP	$465.23 	$344.27	$0.00	$372.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.29	$345.29	$0.00	$0.00	$96.95	$0.00	$0.00	$0.00	$0.00	$232.61	$368.46	$372.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J761D	SUP	Custom 27203010		J761D  -  SUTURE ABSORBABLE 3-0 CP-2 18IN CONTROL RELEASE BRAID 8	BOTH IP/OP	$37.30 	$27.60	$0.00	$30.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.69	$27.69	$0.00	$0.00	$7.77	$0.00	$0.00	$0.00	$0.00	$18.93	$29.99	$30.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J762D	SUP	Custom 27203010		J762D  -  SUTURE ABSORBABLE 2-0 CP-2 18IN CONTROL RELEASE BRAID 8	BOTH IP/OP	$37.49 	$27.74	$0.00	$29.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.04	$27.04	$0.00	$0.00	$7.59	$0.00	$0.00	$0.00	$0.00	$18.49	$29.29	$29.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J764D	SUP	Custom 27203010		J764D  -  SUTURE ABSORBABLE 0 CTX 18IN CONTROL RELEASE BRAID 8 STRAND	BOTH IP/OP	$29.82 	$22.07	$0.00	$24.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.13	$22.13	$0.00	$0.00	$6.22	$0.00	$0.00	$0.00	$0.00	$15.14	$23.97	$24.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J765D	SUP	Custom 27203010		J765D  -  SUTURE ABSORBABLE 1 CTX 18IN CONTROL RELEASE BRAID 8 STRAND	BOTH IP/OP	$29.82 	$22.07	$0.00	$24.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.13	$22.13	$0.00	$0.00	$6.22	$0.00	$0.00	$0.00	$0.00	$15.14	$23.97	$24.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J774D	SUP	Custom 27203010		J774D  -  SUTURE ABS 3-0 SH 18IN VIOL VCL CR BRD 8 STRN COAT	BOTH IP/OP	$29.45 	$21.79	$0.00	$23.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.86	$21.86	$0.00	$0.00	$6.14	$0.00	$0.00	$0.00	$0.00	$14.94	$23.67	$23.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J775D	SUP	Custom 27203010		J775D  -  SUTURE ABS 2-0 SH 18IN VIOL VCL CR BRD 8 STRN COAT	BOTH IP/OP	$28.82 	$21.33	$0.00	$23.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.39	$21.39	$0.00	$0.00	$6.01	$0.00	$0.00	$0.00	$0.00	$14.63	$23.17	$23.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J790D	SUP	Custom 27203010		J790D  -  SUTURE ABSORBABLE 3-0 X-1 18IN CONTROL RELEASE BRAID 8	BOTH IP/OP	$43.68 	$32.32	$0.00	$35.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.42	$32.42	$0.00	$0.00	$9.10	$0.00	$0.00	$0.00	$0.00	$22.17	$35.12	$35.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J840D	SUP	Custom 27203010		J840D  -  SUTURE ABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND	BOTH IP/OP	$30.02 	$22.21	$0.00	$24.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$0.00	$0.00	$0.00	$15.24	$24.13	$24.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J841D	SUP	Custom 27203010		J841D  -  SUTURE ABSORBABLE 1 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND	BOTH IP/OP	$29.80 	$22.05	$0.00	$24.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.11	$22.11	$0.00	$0.00	$6.21	$0.00	$0.00	$0.00	$0.00	$15.12	$23.95	$24.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J841D CR	SUP	Custom 27203010		J841D CR  -  NEEDLE 1VICRYL 18 CT1	BOTH IP/OP	$355.23 	$262.87	$0.00	$284.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.65	$263.65	$0.00	$0.00	$74.03	$0.00	$0.00	$0.00	$0.00	$177.61	$281.34	$284.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
J864D	SUP	Custom 27203010		J864D  -  SUTURE ABS 3-0 SH 18IN UD VCL CR BRD 8 STRN COAT	BOTH IP/OP	$361.08 	$267.20	$0.00	$293.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$267.99	$267.99	$0.00	$0.00	$75.25	$0.00	$0.00	$0.00	$0.00	$183.25	$290.26	$293.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JA-DLVT35L	SUP	Custom 27203010		JA-DLVT35L  -  TUBE VIVASIGHT DL DOUBLE LUMEN ENDOTRACHEAL 35 FR LEFT SIDED	BOTH IP/OP	$442.50 	$327.45	$0.00	$354.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.42	$328.42	$0.00	$0.00	$92.22	$0.00	$0.00	$0.00	$0.00	$221.25	$350.46	$354.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JA-DLVT37L	SUP	Custom 27203010		JA-DLVT37L  -  TUBE VIVASIGHT DL DOUBLE LUMEN ENDOTRACHEAL 37 FR LEFT SIDED	BOTH IP/OP	$442.50 	$327.45	$0.00	$354.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.42	$328.42	$0.00	$0.00	$92.22	$0.00	$0.00	$0.00	$0.00	$221.25	$350.46	$354.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JA-DLVT39L	SUP	Custom 27203010		JA-DLVT39L  -  TUBE VIVASIGHT DL DOUBLE LUMEN ENDOTRACHEAL 39 FR LEFT SIDED	BOTH IP/OP	$442.50 	$327.45	$0.00	$354.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.42	$328.42	$0.00	$0.00	$92.22	$0.00	$0.00	$0.00	$0.00	$221.25	$350.46	$354.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JA-DLVT41L	SUP	Custom 27203010		JA-DLVT41L  -  TUBE VIVASIGHT DL DOUBLE LUMEN ENDOTRACHEAL 41 FR LEFT SIDED	BOTH IP/OP	$442.50 	$327.45	$0.00	$354.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.42	$328.42	$0.00	$0.00	$92.22	$0.00	$0.00	$0.00	$0.00	$221.25	$350.46	$354.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JA-TVT70100	SUP	Custom 27203010		JA-TVT70100  -  TUBE ENDOTRACHEAL VIVASIGHT SL SINGLE LUMEN 7.0MM	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JA-TVT75105	SUP	Custom 27203010		JA-TVT75105  -  TUBE ENDOTRACHEAL VIVASIGHT SL SINGLE LUMEN 7.5MM	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JA-TVT80110	SUP	Custom 27203010		JA-TVT80110  -  TUBE ENDOTRACHEAL VIVASIGHT SL SINGLE LUMEN 8.0MM	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.52	$224.52	$0.00	$0.00	$63.04	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JB840	SUP	Custom 27203010		JB840  -  SUTURE ABS 0 CTB-1 18IN UD VCL ETHGRD CR BRD 8 STRN COAT	BOTH IP/OP	$37.53 	$27.77	$0.00	$30.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.85	$27.85	$0.00	$0.00	$7.82	$0.00	$0.00	$0.00	$0.00	$19.04	$30.17	$30.47	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JCDS-1618-EDS-HC	SUP	Custom 27203010		SET DILATOR 16 AND 18 FR	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JCDS-2022-EDS-HC	SUP	Custom 27203010		SET DILATOR 20 AND 22 FR	BOTH IP/OP	$427.50 	$316.35	$0.00	$342.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.75	$338.58	$342.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JEM 330	SUP	HCPCS A7521		JEM 330  -  TUBE ENDOTRAC 3MM CHGR SMTH RND TIP PE LATEX FREE DISP 3MM	BOTH IP/OP	$23.75 	$17.58	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.63	$17.63	$0.00	$0.00	$4.95	$0.00	$0.00	$0.00	$0.00	$11.88	$18.81	$19.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JEM 365	SUP	HCPCS A7520		JEM 365  -  CATHETER AIRWAY EXCHANGE SMOOTH ROUNDED TIP LATEX FREE JEM	BOTH IP/OP	$26.15 	$19.35	$0.00	$20.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.41	$19.41	$0.00	$0.00	$5.45	$0.00	$0.00	$0.00	$0.00	$13.08	$20.71	$20.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JEM 400	SUP	Custom 27203010		JEM 400  -  CATHETER AIRWAY EXCHANGE SMOOTH ROUNDED TIP LATEX FREE JEM	BOTH IP/OP	$27.50 	$20.35	$0.00	$20.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.41	$20.41	$0.00	$0.00	$5.73	$0.00	$0.00	$0.00	$0.00	$13.08	$20.71	$20.92	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JEM370	SUP	Custom 27203010		JEM370  -  CATHETER ARWYEX SMPL RPD TCHQ PE DISP 7MM	BOTH IP/OP	$22.55 	$16.69	$0.00	$18.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.74	$16.74	$0.00	$0.00	$4.70	$0.00	$0.00	$0.00	$0.00	$11.28	$17.86	$18.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JJ1952	SUP	Custom 27203010		JJ1952  -  HEMOSTAT ABSORBABLE 8X4IN ORIGINAL FLEXIBLE SHEER WEAVE	BOTH IP/OP	$147.91 	$109.45	$0.00	$118.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.78	$109.78	$0.00	$0.00	$30.82	$0.00	$0.00	$0.00	$0.00	$73.95	$117.14	$118.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JJ4055	SUP	HCPCS C1729		CATHETER IV 18GA 1.25IN RADIOPQ GRN JELCO TFLN STRL LF	BOTH IP/OP	$327.60 	$242.42	$0.00	$262.08	$177.89	$177.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.80	$259.46	$262.08	$0.00		$0.00	$51.27	$0.00	$0.00	$52.15	$0.00	$0.00	$0.00	$0.00	$0.00
J-NCS-504070	SUP	HCPCS C1887		J-NCS-504070  -  CATH IU NOVY 5FR 40CM SET CVD CANNULATION 55CM DISP	BOTH IP/OP	$246.25 	$182.23	$0.00	$197.00	$133.71	$133.71	$0.00	$0.00	$0.00	$51.32	$182.77	$182.77	$0.00	$0.00	$51.32	$0.00	$145.66	$145.66	$0.00	$123.13	$195.03	$197.00	$0.00		$0.00	$38.54	$0.00	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00
JP-2230	SUP	Custom 27203010		JP-2230  -  DRAIN INCS 19FR JP SIL RND HBLS CHNL STRL LATEX	BOTH IP/OP	$40.63 	$30.07	$0.00	$34.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.15	$30.15	$0.00	$0.00	$8.47	$0.00	$0.00	$0.00	$0.00	$20.31	$34.10	$32.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JP-HUF071	SUP	Custom 27203010		JP-HUF071  -  DRAIN INCISION 20CMX7MM 10FR FULL DUCT TROCAR LATEX FREE	BOTH IP/OP	$55.14 	$40.80	$0.00	$44.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.92	$40.92	$0.00	$0.00	$11.49	$0.00	$0.00	$0.00	$0.00	$27.57	$43.67	$44.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
JW31U	SUP	HCPCS C1898		JW31U  -  LEAD PCNG OTW LT VNTRC SIN	BOTH IP/OP	"$4,750.00 "	"$3,515.00"	$0.00	"$3,800.00"	"$2,137.50"	"$2,137.50"	$0.00	$0.00	$0.00	$990.02	"$3,525.45"	"$3,525.45"	$0.00	$0.00	$989.90	$0.00	"$2,341.75"	"$2,341.75"	$0.00	"$2,375.00"	"$3,762.00"	"$3,800.00"	$0.00		$0.00	$743.38	$0.00	$0.00	$756.20	$0.00	$0.00	$0.00	$0.00	$0.00
K0675	SUP	Custom 27203010		REAGENT RBT MS AB LSAB 2 110ML UNV SYS HRP CNJG IMMUN	BOTH IP/OP	"$1,382.93 "	"$1,023.37"	$0.00	"$1,106.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$691.46	"$1,095.28"	"$1,106.34"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
K20-2154	SUP	Custom 27203010		K20-2154  -  BLADE OPTH 7MM CRNL SS TRPHN HNDL STRL DISP	BOTH IP/OP	$92.50 	$68.45	$0.00	$74.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.65	$68.65	$0.00	$0.00	$19.28	$0.00	$0.00	$0.00	$0.00	$46.25	$73.26	$74.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
K3468	SUP	Custom 27203010		REAGENT DAB PLUS 110ML LQ CHRMGN 1100 TST IMMUN	BOTH IP/OP	$366.93 	$271.53	$0.00	$293.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.46	$290.61	$293.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
K4061	SUP	Custom 27203010		REAGENT HRP ENVSN PLUS 11ML RBT MS DUAL LNK 1100 TST IMMUN	BOTH IP/OP	"$4,024.85 "	"$2,978.39"	$0.00	"$3,219.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,012.43"	"$3,187.68"	"$3,219.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
K5204	SUP	Custom 27203010		KIT IMMUN TST HERCEPTEST SLD REAGENT HER 2 35 TST	BOTH IP/OP	"$3,781.18 "	"$2,798.07"	$0.00	"$3,024.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,890.59"	"$2,994.69"	"$3,024.94"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
K581H	SUP	Custom 27203010		K581H  -  SUTURE NONABSORBABLE 4-0 BB 24IN 2 ARM BRAID PERMA-HAND	BOTH IP/OP	$391.58 	$289.77	$0.00	$317.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.63	$290.63	$0.00	$0.00	$81.60	$0.00	$0.00	$0.00	$0.00	$198.72	$314.78	$317.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
K8-6180	SUP	Custom 27203010		K8-6180  -  SPHERE EYE 18MM PLST SLD CLR	BOTH IP/OP	$62.78 	$46.46	$0.00	$46.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.59	$46.59	$0.00	$0.00	$13.08	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
K8-6200	SUP	HCPCS L8610		K8-6200  -  SPHERE EYE 20MM PLST SLD CLR	BOTH IP/OP	$62.78 	$46.46	$0.00	$50.22	$28.25	$28.25	$0.00	$0.00	$0.00	$13.08	$46.59	$46.59	$0.00	$0.00	$13.08	$0.00	$37.13	$37.13	$0.00	$31.39	$49.72	$50.22	$0.00		$0.00	$9.82	$0.00	$0.00	$9.99	$0.00	$0.00	$0.00	$0.00	$0.00
K8-6220	SUP	HCPCS L8610		K8-6220  -  SPHERE EYE 22MM PLST SLD CLR	BOTH IP/OP	$62.78 	$46.46	$0.00	$54.00	$30.38	$30.38	$0.00	$0.00	$0.00	$13.08	$46.59	$46.59	$0.00	$0.00	$13.08	$0.00	$37.13	$37.13	$0.00	$33.75	$53.46	$54.00	$0.00		$0.00	$10.56	$0.00	$0.00	$10.75	$0.00	$0.00	$0.00	$0.00	$0.00
K8-6330	SUP	HCPCS L8610		K8-6330  -  CNFRMR OPTH LG UNV PLST CLR	BOTH IP/OP	$62.78 	$46.46	$0.00	$46.59	$15.75	$15.75	$0.00	$0.00	$0.00	$0.00	$46.59	$46.59	$0.00	$0.00	$13.08	$0.00	$0.00	$0.00	$0.00	$17.50	$27.72	$28.00	$0.00		$0.00	$5.48	$0.00	$0.00	$5.57	$0.00	$0.00	$0.00	$0.00	$0.00
KC9529	SUP	Custom 27203010		KC9529  -  SLEEVES KNEE MEDIUM LENGTH	BOTH IP/OP	$73.60 	$54.46	$0.00	$58.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.63	$54.63	$0.00	$0.00	$15.34	$0.00	$0.00	$0.00	$0.00	$36.80	$58.29	$58.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
KCFW-6.0-35-70-RB-HFANL1-HC	SUP	HCPCS C1894		KCFW-6.0-35-70-RB-HFANL1-HC  -  INTROD SHTH 6FR .087IN 70CM ANL1 CURVE MULTPUR TIP ANSEL	BOTH IP/OP	$210.00 	$155.40	$0.00	$168.00	$114.03	$114.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.00	$166.32	$168.00	$0.00		$0.00	$32.87	$0.00	$0.00	$33.43	$0.00	$0.00	$0.00	$0.00	$0.00
KC-RUMI-35	SUP	HCPCS C1713		KC-RUMI-35  -  MANIPULATOR ESCP 3.5CM STRL LF KOH-EFCT RUMI II K CP EZ LD	BOTH IP/OP	$223.26 	$165.21	$0.00	$178.61	$100.47	$100.47	$0.00	$0.00	$0.00	$46.53	$165.70	$165.70	$0.00	$0.00	$46.53	$0.00	$132.06	$132.06	$0.00	$111.63	$176.82	$178.61	$0.00		$0.00	$34.94	$0.00	$0.00	$35.54	$0.00	$0.00	$0.00	$0.00	$0.00
KLIPPEN	SUP	HCPCS C1879		KLIPPEN  -  MARKER	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$0.00	$0.00	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
KLTSD403	SUP	Custom 27203010		AIRWAY ESPH 3 KLT-D SCT MGMT PORT	BOTH IP/OP	$80.58 	$59.63	$0.00	$64.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.29	$63.82	$64.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
KLTSD424	SUP	Custom 27203010		KLTSD424 - AIRWAY ESPH 4 KLT-D SCT MGMT PORT	BOTH IP/OP	$90.67 	$67.10	$0.00	$67.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.30	$67.30	$0.00	$0.00	$18.90	$0.00	$0.00	$0.00	$0.00	$40.29	$63.82	$64.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
KLTSD425	SUP	Custom 27203010		KLTSD425 - AIRWAY ESPH 5 KLT-D SCT MGMT PORT	BOTH IP/OP	$85.44 	$63.23	$0.00	$63.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.41	$63.41	$0.00	$0.00	$17.81	$0.00	$0.00	$0.00	$0.00	$38.93	$61.66	$62.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
KM172-14-54	SUP	Custom 27203010		KM172-14-54  -  WIRE .054IN 4IN KWIRE SS SMTH TROCAR PNT 1 END ORTH NONSTRL	BOTH IP/OP	$5.70 	$4.22	$0.00	$4.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.23	$4.23	$0.00	$0.00	$1.19	$0.00	$0.00	$0.00	$0.00	$2.85	$4.51	$4.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
KT1835C	SUP	HCPCS C1753		KT1835C  -  KIT CATH ER-REBOA	BOTH IP/OP	$467.50 	$345.95	$0.00	$346.98	$203.63	$203.63	$0.00	$0.00	$0.00	$97.44	$346.98	$346.98	$0.00	$0.00	$97.43	$0.00	$276.53	$276.53	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
KW-062	SUP	HCPCS C1769		KW-062  -  WIRE FIX .062IN KWIRE SS	BOTH IP/OP	$181.25 	$134.13	$0.00	$145.00	$98.42	$98.42	$0.00	$0.00	$0.00	$37.78	$134.52	$134.52	$0.00	$0.00	$37.77	$0.00	$107.21	$107.21	$0.00	$90.63	$143.55	$145.00	$0.00		$0.00	$28.37	$0.00	$0.00	$28.86	$0.00	$0.00	$0.00	$0.00	$0.00
KW062SS	SUP	HCPCS C1769		KW062SS  -  WIRE FIX 1.6MM KWIRE SS	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$33.94	$33.94	$0.00	$0.00	$0.00	$13.03	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$36.97	$36.97	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
KWIR-STD-09152	SUP	Custom 27203010		KWIR-STD-09152  -  WIRE FX STD .9MM 152MM KRSH TIP SS	BOTH IP/OP	$60.00 	$44.40	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.53	$44.53	$0.00	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$30.00	$47.52	$48.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
KWIR-STD-15127	SUP	HCPCS C1713		KWIR-STD-15127  -  WIRE FX 1.5MM 127MM KRSH STD TIP SS	BOTH IP/OP	$70.00 	$51.80	$0.00	$56.00	$31.50	$31.50	$0.00	$0.00	$0.00	$14.59	$51.95	$51.95	$0.00	$0.00	$14.59	$0.00	$41.41	$41.41	$0.00	$35.00	$55.44	$56.00	$0.00		$0.00	$10.96	$0.00	$0.00	$11.14	$0.00	$0.00	$0.00	$0.00	$0.00
L270309B	SUP	Custom 27203010		KIT BBL RPR CRD SERTST 3ML	BOTH IP/OP	$131.50 	$97.31	$0.00	$105.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.75	$104.15	$105.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
L3030	SUP	HCPCS C1713		L3030  -  PIN SKL STRL MYFLD WNG GRV PLS ADLT CRNM DISP	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$405.00	$405.00	$0.00	$0.00	$0.00	$187.58	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$532.35	$532.35	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$140.85	$0.00	$0.00	$143.28	$0.00	$0.00	$0.00	$0.00	$0.00
L-70	SUP	Custom 27203010		SYSTEM BLOOD WRM ADM SET INJEC PORT LVL 1 HTLN DISP STRL LF	BOTH IP/OP	$31.10 	$23.01	$0.00	$24.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.55	$24.63	$24.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LA6EBU30	SUP	HCPCS C1887		CATHETER GUID EBU3 CURVE 6FR 100CM CORON LNCHR	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
LA6EBU40	SUP	HCPCS C1887		CATHETER GUID EBU4 CURVE 6FR 100CM LNCHR	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
LAG3.2-24	SUP	HCPCS C1713		LAG3.2-24  -  SCREW BN 3.2MM 24MM LG CORT	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
LAG3.2-26	SUP	HCPCS C1713		LAG3.2-26  -  SCREW BN 3.2MM 26MM LG CORT	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-4300	SUP	HCPCS C1713		LAG-4300  -  SCREW BONE 30MM MLR LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-4350	SUP	HCPCS C1713		LAG-4350  -  SCREW BONE 35MM MLR LAG NONSTRL	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-4400	SUP	HCPCS C1713		LAG-4400  -  SCREW BONE 40MM MLR LAG STRL	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-4450	SUP	HCPCS C1713		LAG-4450  -  SCREW BONE 45MM MLR LAG NONSTRL	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-4500	SUP	HCPCS C1713		LAG-4500  -  SCREW BONE 4MM 50MM TI MLR LAG NONSTRL	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5036	SUP	HCPCS C1713		LAG-5036  -  SCREW BONE 36MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5038	SUP	HCPCS C1713		LAG-5038  -  SCREW BONE 38MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5040	SUP	HCPCS C1713		LAG-5040  -  SCREW BONE 40MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5042	SUP	HCPCS C1713		LAG-5042  -  SCREW BONE 42MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5044	SUP	HCPCS C1713		LAG-5044  -  SCREW BONE 44MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5046	SUP	HCPCS C1713		LAG-5046  -  SCREW BONE 46MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5048	SUP	HCPCS C1713		LAG-5048  -  SCREW BONE 48MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5050	SUP	HCPCS C1713		LAG-5050  -  SCREW BONE 50MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5052	SUP	HCPCS C1713		LAG-5052  -  SCREW BONE 52MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5054	SUP	HCPCS C1713		LAG-5054  -  SCREW BONE 54MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5056	SUP	HCPCS C1713		LAG-5056  -  SCREW BONE 56MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5058	SUP	HCPCS C1713		LAG-5058  -  SCREW BONE 58MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5060	SUP	HCPCS C1713		LAG-5060  -  SCREW BONE 60MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5062	SUP	HCPCS C1713		LAG-5062  -  SCREW BONE 62MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5064	SUP	HCPCS C1713		LAG-5064  -  SCREW BONE 64MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5066	SUP	HCPCS C1713		LAG-5066  -  SCREW BONE 66MM ANKL SYNDESMOSIS LAG NONSTRL	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5068	SUP	HCPCS C1713		LAG-5068  -  SCREW BONE 68MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5070	SUP	HCPCS C1713		LAG-5070  -  SCREW BONE 70MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5072	SUP	HCPCS C1713		LAG-5072  -  SCREW BONE 72MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LAG-5074	SUP	HCPCS C1713		LAG-5074  -  SCREW BONE 74MM UPR/LWR XTRMT SYNDESMOSIS LAG	BOTH IP/OP	$460.00 	$340.40	$0.00	$368.00	$207.00	$207.00	$0.00	$0.00	$0.00	$95.88	$341.41	$341.41	$0.00	$0.00	$95.86	$0.00	$272.09	$272.09	$0.00	$230.00	$364.32	$368.00	$0.00		$0.00	$71.99	$0.00	$0.00	$73.23	$0.00	$0.00	$0.00	$0.00	$0.00
LC3006	SUP	Custom 27203010		LC3006  -  KIT SRG STRL LF SPY PAQ DISP	BOTH IP/OP	"$1,374.25 "	"$1,016.95"	$0.00	"$1,099.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,019.97"	"$1,019.97"	$0.00	$0.00	$286.39	$0.00	$0.00	$0.00	$0.00	$687.13	"$1,088.41"	"$1,099.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LCB002	SUP	Custom 27203010		KIT INDCTR VRF MONITR STRP MEDIA VL LF	BOTH IP/OP	$6.83 	$5.05	$0.00	$5.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.41	$5.41	$5.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LCBS2.7-10	SUP	HCPCS C1713		LCBS2.7-10  -  SCREW BN 2.7MM 10MM LCK SS CORT TRIMED CLVCL FX SYS	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
LCBS2.7-16	SUP	HCPCS C1713		LCBS2.7-16  -  SCREW BN 2.7MM 16MM LCK SS CORT TRIMED CLVCL FX SYS	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
LCBS3.2-08	SUP	HCPCS C1713		LCBS3.2-08  -  SCREW BONE 3.2MM 8MM FRARM ELB CORT LOCK	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
LCBS3.2-12	SUP	HCPCS C1713		LCBS3.2-12  -  SCREW BONE 3.2MM 12MM LOCK FOREARM ELBOW CORTICAL	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
LCBS3.2-14	SUP	HCPCS C1713		LCBS3.2-14  -  SCREW BONE 3.2MM 14MM LOCK OLECRANON HOOK PLATE FOREARM	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
LCBS3.2-16	SUP	HCPCS C1713		LCBS3.2-16  -  SCREW BONE 3.2MM 16MM LOCK FOREARM ELBOW CORTICAL	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
LCBS3.2-18	SUP	HCPCS C1713		LCBS3.2-18  -  SCREW BONE 3.2MM 18MM LOCK FOREARM ELBOW CORTICAL	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
LCBS3.2-22	SUP	HCPCS C1713		LCBS3.2-22  -  SCREW BONE 3.2MM 22MM LOCK FOREARM ELBOW CORTICAL	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
LCBS32-24	SUP	HCPCS C1713		LCBS32-24  -  SCREW BONE 24MM LOCK 3.2MM FOREARM ELBOW CORTICAL	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
LCC008	SUP	Custom 27203010		STRIP INDCTR CHM MONITR VRF S1 PRC	BOTH IP/OP	$4.40 	$3.26	$0.00	$3.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.20	$3.48	$3.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LF1737	SUP	Custom 27203010		LF1737  -  SEALER/DIVIDER LAPSCP 350D 5MM 37CM LGSR MD 1 STP SL MLFNC	BOTH IP/OP	"$1,318.35 "	$975.58	$0.00	"$1,054.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$978.48	$978.48	$0.00	$0.00	$274.74	$0.00	$0.00	$0.00	$0.00	$659.18	"$1,044.13"	"$1,054.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LF4318	SUP	Custom 27203010		LF4318  -  SEALER/DIVIDER BP 180D 34MM LG 13.5MM 7.1IN STRL LF 36MM	BOTH IP/OP	"$8,795.55 "	"$6,508.71"	$0.00	"$7,036.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,832.99"	$0.00	$0.00	$0.00	$0.00	"$4,397.78"	"$6,966.08"	"$7,036.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LF4418	SUP	Custom 27203010		LF4418  -  SEALER/DIVIDER BP 14D 180D 34MM 13.5MM 18CM STRL LF 36MM	BOTH IP/OP	"$1,465.93 "	"$1,084.79"	$0.00	"$1,172.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,088.01"	"$1,088.01"	$0.00	$0.00	$305.50	$0.00	$0.00	$0.00	$0.00	$732.96	"$1,161.02"	"$1,172.74"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LFC002	SUP	Custom 27203010		LFC002  -  TIP APL LIQUIBAND ADH TISS FLW CNTRL	BOTH IP/OP	$92.98 	$68.81	$0.00	$74.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.01	$69.01	$0.00	$0.00	$19.38	$0.00	$0.00	$0.00	$0.00	$46.49	$73.64	$74.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LHEX3.2-12	SUP	HCPCS C1713		LHEX3.2-12  -  SCREW BN 3.2MM 12MM LCK SS CORT TRIMED CLVCL FX SYS	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
LIG101	SUP	Custom 27203010		LIQUIMMUNE IMMUNOASSAY LV 1 6X5ML	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LIG-101	SUP	Custom 27203010		CONTROL IMAS MAS LIQUIMMUNE LVL 1 LQ 5ML IMMUN	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LIG202	SUP	Custom 27203010		LIQUIMMUNE IMMUNOASSAY LV 2 6X5ML	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LIG-202	SUP	Custom 27203010		CONTROL MLANLT 3-PNT LIQUIMMUNE LVL 2 ASY 5ML IMMUN	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LIG303	SUP	Custom 27203010		LIQUIMMUNE IMMUNOASSAY LV 3 6X5ML	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LIG-303	SUP	Custom 27203010		CONTROL IMAS MAS LIQUIMMUNE LVL 3 LQ 5ML IMMUN	BOTH IP/OP	$150.00 	$111.00	$0.00	$120.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$118.80	$120.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LL0004	SUP	Custom 27203010		LL0004  -  SET TBG 250 MILLIBAR STRL LTX 1 LUM INFL 2 OFLW DISP	BOTH IP/OP	$362.50 	$268.25	$0.00	$290.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.25	$287.10	$290.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LN205	SUP	Custom 27203010		LN205  -  RESERVOIR CARDIOTOMY 3L UNFILTERED	BOTH IP/OP	$77.00 	$56.98	$0.00	$61.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.15	$57.15	$0.00	$0.00	$16.05	$0.00	$0.00	$0.00	$0.00	$38.50	$60.98	$61.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LPG1510	SUP	HCPCS C1781		LPG1510  -  MESH SURG 15X10CM SELF FIXATE FLAT SHEET LATEX FREE PROGRIP	BOTH IP/OP	$886.40 	$655.94	$0.00	$838.60	$471.71	$471.71	$0.00	$0.00	$0.00	$184.75	$657.89	$657.89	$0.00	$0.00	$184.73	$0.00	$524.31	$524.31	$0.00	$524.13	$830.21	$838.60	$0.00		$0.00	$164.05	$0.00	$0.00	$166.88	$0.00	$0.00	$0.00	$0.00	$0.00
LPP11	SUP	Custom 27803010		LPP11  -  EXPANDER TISSUE P5CM 11X9CM TEXTURED LP PLUS LATERAL EXTN	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	$0.00	$0.00	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LPP12	SUP	HCPCS C1789		LPP12  -  EXPANDER TISSUE P5.2CM 9.8X12CM TEXTURED LOW POLE PLUS	BOTH IP/OP	"$3,025.00 "	"$2,238.50"	$0.00	"$2,420.00"	"$1,361.25"	"$1,361.25"	$0.00	$0.00	$0.00	$630.49	"$2,245.16"	"$2,245.16"	$0.00	$0.00	$630.41	$0.00	"$1,491.33"	"$1,491.33"	$0.00	"$1,512.50"	"$2,395.80"	"$2,420.00"	$0.00		$0.00	$473.41	$0.00	$0.00	$481.58	$0.00	$0.00	$0.00	$0.00	$0.00
LPP13	SUP	HCPCS C1789		LPP13  -  XPD TISS 380-450ML TXTR LP PLUS LAT EXTN MID HT DERMASPAN	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
LPP14	SUP	HCPCS C1789		LPP14  -  EXPANDER TISSUE P6CM 14X11.2CM TEXTURED LP PLUS LATERAL EXTN	BOTH IP/OP	"$3,025.00 "	"$2,238.50"	$0.00	"$2,420.00"	"$1,361.25"	"$1,361.25"	$0.00	$0.00	$0.00	$630.49	"$2,245.16"	"$2,245.16"	$0.00	$0.00	$630.41	$0.00	"$1,491.33"	"$1,491.33"	$0.00	"$1,512.50"	"$2,395.80"	"$2,420.00"	$0.00		$0.00	$473.41	$0.00	$0.00	$481.58	$0.00	$0.00	$0.00	$0.00	$0.00
LPP15	SUP	HCPCS C1789		LPP15  -  EXPANDER TISS P6.4-7.9CM MID HT 15X11.5CM 500-600CC	BOTH IP/OP	"$3,025.00 "	"$2,238.50"	$0.00	"$2,420.00"	"$1,361.25"	"$1,361.25"	$0.00	$0.00	$0.00	$630.49	"$2,245.16"	"$2,245.16"	$0.00	$0.00	$630.41	$0.00	"$1,491.33"	"$1,491.33"	$0.00	"$1,512.50"	"$2,395.80"	"$2,420.00"	$0.00		$0.00	$473.41	$0.00	$0.00	$481.58	$0.00	$0.00	$0.00	$0.00	$0.00
LPP16	SUP	HCPCS C1789		LPP16  -  EXPANDER TISS P6.6-8.2CM MID HT 16X12CM 580-690CC DERMASPAN	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
LQB001	SUP	Custom 27203010		LQB001  -  LIQUIBAND SKIN ADHESIVE DOME TIP	BOTH IP/OP	$127.22 	$94.14	$0.00	$101.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.43	$94.43	$0.00	$0.00	$26.51	$0.00	$0.00	$0.00	$0.00	$63.61	$100.76	$101.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LS1500	SUP	Custom 27203010		LS1500  -  SEALER/DIVIDER LAPSCP 179D 12MM 5MM 37CM STRL 18X2.6MM LGSR	BOTH IP/OP	"$1,215.66 "	$899.59	$0.00	$972.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$902.26	$902.26	$0.00	$0.00	$253.34	$0.00	$0.00	$0.00	$0.00	$607.83	$962.80	$972.53	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LS3111	SUP	Custom 27203010		ELECTRODE ESURG LG XTD SNP IN RDG GR SRFC CORD	BOTH IP/OP	$102.05 	$75.52	$0.00	$81.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.03	$80.82	$81.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LT200	SUP	HCPCS C1760		LT200  -  CLIP MED 3.2MM INTNL LGCLP EX TI ENDSCP LIGAT STRL DISP LF	BOTH IP/OP	$30.60 	$22.64	$0.00	$24.48	$13.77	$13.77	$0.00	$0.00	$0.00	$6.38	$22.71	$22.71	$0.00	$0.00	$6.38	$0.00	$18.10	$18.10	$0.00	$15.30	$24.24	$24.48	$0.00		$0.00	$4.79	$0.00	$0.00	$4.87	$0.00	$0.00	$0.00	$0.00	$0.00
LT400	SUP	HCPCS C1760		LT400  -  CLIP LG 6.2MM INTNL LGCLP EX TI ENDSCP LIGAT STRL DISP LF	BOTH IP/OP	$56.10 	$41.51	$0.00	$44.88	$25.25	$25.25	$0.00	$0.00	$0.00	$11.69	$41.64	$41.64	$0.00	$0.00	$11.69	$0.00	$33.18	$33.18	$0.00	$28.05	$44.43	$44.88	$0.00		$0.00	$8.78	$0.00	$0.00	$8.93	$0.00	$0.00	$0.00	$0.00	$0.00
LUB07030	SUP	HCPCS C2625		LUB07030  -  STENT BIL 7MM 6FR 30MM 80CM .035IN CATH GWIRE E-LMNX	BOTH IP/OP	"$3,883.20 "	"$2,873.57"	$0.00	"$3,106.56"	"$1,747.44"	"$1,747.44"	$0.00	$0.00	$0.00	$809.36	"$2,882.11"	"$2,882.11"	$0.00	$0.00	$809.26	$0.00	"$1,914.42"	"$1,914.42"	$0.00	"$1,941.60"	"$3,075.49"	"$3,106.56"	$0.00		$0.00	$607.72	$0.00	$0.00	$618.21	$0.00	$0.00	$0.00	$0.00	$0.00
LUB07040	SUP	HCPCS C2625		LUB07040  -  STENT BIL .035IN 7MM 6FR 40MM 80CM LMNX SLF XPD DLV SYS NTNL	BOTH IP/OP	"$3,883.19 "	"$2,873.56"	$0.00	"$3,106.55"	"$1,747.44"	"$1,747.44"	$0.00	$0.00	$0.00	$809.35	"$2,882.10"	"$2,882.10"	$0.00	$0.00	$809.26	$0.00	"$1,914.41"	"$1,914.41"	$0.00	"$1,941.60"	"$3,075.49"	"$3,106.55"	$0.00		$0.00	$607.72	$0.00	$0.00	$618.20	$0.00	$0.00	$0.00	$0.00	$0.00
LUB08030	SUP	HCPCS C2625		LUB08030  -  STENT BIL .035IN 8MM 6FR 30MM 80CM LMNX SLF XPD DLV SYS NTNL	BOTH IP/OP	"$3,883.19 "	"$2,873.56"	$0.00	"$3,106.55"	"$1,747.44"	"$1,747.44"	$0.00	$0.00	$0.00	$809.35	"$2,882.10"	"$2,882.10"	$0.00	$0.00	$809.26	$0.00	"$1,914.41"	"$1,914.41"	$0.00	"$1,941.60"	"$3,075.49"	"$3,106.55"	$0.00		$0.00	$607.72	$0.00	$0.00	$618.20	$0.00	$0.00	$0.00	$0.00	$0.00
LUB08060	SUP	HCPCS C2625		LUB08060  -  STENT BIL .035IN 8MM 6FR 60MM 80CM LMNX SLF XPD DLV SYS NTNL	BOTH IP/OP	"$3,883.19 "	"$2,873.56"	$0.00	"$3,106.55"	"$1,747.44"	"$1,747.44"	$0.00	$0.00	$0.00	$809.35	"$2,882.10"	"$2,882.10"	$0.00	$0.00	$809.26	$0.00	"$1,914.41"	"$1,914.41"	$0.00	"$1,941.60"	"$3,075.49"	"$3,106.55"	$0.00		$0.00	$607.72	$0.00	$0.00	$618.20	$0.00	$0.00	$0.00	$0.00	$0.00
LUB10040	SUP	HCPCS C2625		LUB10040  -  STENT VASC .035IN 10MM 6FR 40MM 80CM E-LMNX SAFE PERFORMAXX	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	"$1,012.50"	"$1,012.50"	$0.00	$0.00	$0.00	$468.96	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	"$1,330.88"	"$1,330.88"	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$352.13	$0.00	$0.00	$358.20	$0.00	$0.00	$0.00	$0.00	$0.00
LUB10060	SUP	HCPCS C2625		LUB10060  -  STENT BIL 10MM 60MM 80CM PERFORMAXX GRP E-LMNX	BOTH IP/OP	"$3,883.20 "	"$2,873.57"	$0.00	"$3,106.56"	"$1,747.44"	"$1,747.44"	$0.00	$0.00	$0.00	$809.36	"$2,882.11"	"$2,882.11"	$0.00	$0.00	$809.26	$0.00	"$1,914.42"	"$1,914.42"	$0.00	"$1,941.60"	"$3,075.49"	"$3,106.56"	$0.00		$0.00	$607.72	$0.00	$0.00	$618.21	$0.00	$0.00	$0.00	$0.00	$0.00
LUB12080	SUP	HCPCS C2625		LUB12080  -  STENT BIL 12MM 6FR 80MM 80CM .035IN SLF XPD DLV SYS LMNX	BOTH IP/OP	"$4,686.61 "	"$3,468.09"	$0.00	"$3,749.29"	"$2,108.97"	"$2,108.97"	$0.00	$0.00	$0.00	$976.81	"$3,478.40"	"$3,478.40"	$0.00	$0.00	$976.69	$0.00	"$2,310.50"	"$2,310.50"	$0.00	"$2,343.30"	"$3,711.80"	"$3,749.29"	$0.00		$0.00	$733.45	$0.00	$0.00	$746.11	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.100	SUP	HCPCS V2632		LX10BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.105	SUP	HCPCS V2632		LX10BD.105  -  LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.110	SUP	HCPCS V2632		LX10BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.115	SUP	HCPCS V2632		LX10BD.115  -  LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.120	SUP	HCPCS V2632		LX10BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.125	SUP	HCPCS V2632		LX10BD.125  -  LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.130	SUP	HCPCS V2632		LX10BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.135	SUP	HCPCS V2632		LX10BD.135  -  LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.140	SUP	HCPCS V2632		LX10BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.145	SUP	HCPCS V2632		LX10BD.145  -  LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.150	SUP	HCPCS V2632		LX10BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.155	SUP	HCPCS V2632		LX10BD.155  -  LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.160	SUP	HCPCS V2632		LX10BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.165	SUP	HCPCS V2632		LX10BD.165  -  LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.170	SUP	HCPCS V2632		LX10BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.175	SUP	HCPCS V2632		LX10BD.175  -  LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.180	SUP	HCPCS V2632		LX10BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.185	SUP	HCPCS V2632		LX10BD.185  -  LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.190	SUP	HCPCS V2632		LX10BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.195	SUP	HCPCS V2632		LX10BD.195  -  LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.200	SUP	HCPCS V2632		LX10BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.205	SUP	HCPCS V2632		LX10BD.205  -  LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.210	SUP	HCPCS V2632		LX10BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.215	SUP	HCPCS V2632		LX10BD.215  -  LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.220	SUP	HCPCS V2632		LX10BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.225	SUP	HCPCS V2632		LX10BD.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.230	SUP	HCPCS V2632		LX10BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.235	SUP	HCPCS V2632		LX10BD.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.240	SUP	HCPCS V2632		LX10BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.245	SUP	HCPCS V2632		LX10BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.250	SUP	HCPCS V2632		LX10BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.255	SUP	HCPCS V2632		LX10BD.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.260	SUP	HCPCS V2632		LX10BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.265	SUP	HCPCS V2632		LX10BD.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.270	SUP	HCPCS V2632		LX10BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.275	SUP	HCPCS V2632		LX10BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.280	SUP	HCPCS V2632		LX10BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.285	SUP	HCPCS V2632		LX10BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.290	SUP	HCPCS V2632		LX10BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.295	SUP	HCPCS V2632		LX10BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX10BD.300	SUP	HCPCS V2632		LX10BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.100	SUP	HCPCS V2632		LX90BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.105	SUP	HCPCS V2632		LX90BD.105  -  LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.110	SUP	HCPCS V2632		LX90BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.115	SUP	HCPCS V2632		LX90BD.115  -  LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.120	SUP	HCPCS V2632		LX90BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.125	SUP	HCPCS V2632		LX90BD.125  -  LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.130	SUP	HCPCS V2632		LX90BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.135	SUP	HCPCS V2632		LX90BD.135  -  LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.140	SUP	HCPCS V2632		LX90BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.145	SUP	HCPCS V2632		LX90BD.145  -  LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.150	SUP	HCPCS V2632		LX90BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.155	SUP	HCPCS V2632		LX90BD.155  -  LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.160	SUP	HCPCS V2632		LX90BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.165	SUP	HCPCS V2632		LX90BD.165  -  LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.170	SUP	HCPCS V2632		LX90BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.175	SUP	HCPCS V2632		LX90BD.175  -  LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.180	SUP	HCPCS V2632		LX90BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.185	SUP	HCPCS V2632		LX90BD.185  -  LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.190	SUP	HCPCS V2632		LX90BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.195	SUP	HCPCS V2632		LX90BD.195  -  LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.200	SUP	HCPCS V2632		LX90BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.205	SUP	HCPCS V2632		LX90BD.205  -  LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.210	SUP	HCPCS V2632		LX90BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.215	SUP	HCPCS V2632		LX90BD.215  -  LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.220	SUP	HCPCS V2632		LX90BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.225	SUP	HCPCS V2632		LX90BD.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.230	SUP	HCPCS V2632		LX90BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.235	SUP	HCPCS V2632		LX90BD.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.240	SUP	HCPCS V2632		LX90BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.245	SUP	HCPCS V2632		LX90BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.250	SUP	HCPCS V2632		LX90BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.255	SUP	HCPCS V2632		LX90BD.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.260	SUP	HCPCS V2632		LX90BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.265	SUP	HCPCS V2632		LX90BD.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.270	SUP	HCPCS V2632		LX90BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.275	SUP	HCPCS V2632		LX90BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.280	SUP	HCPCS V2632		LX90BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.285	SUP	HCPCS V2632		LX90BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.290	SUP	HCPCS V2632		LX90BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.295	SUP	HCPCS V2632		LX90BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LX90BD.300	SUP	HCPCS V2632		LX90BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
LXA19	SUP	Custom 27803010		LXA19  -  VALVE AORTIC 19MM MITROFLOW BVN PRICRD	BOTH IP/OP	"$12,500.00 "	"$9,250.00"	$0.00	"$10,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,605.00"	$0.00	$0.00	$0.00	$0.00	"$6,250.00"	"$9,900.00"	"$10,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
LXA21	SUP	Custom 27803010		LXA21  -  VALVE AORTIC 21MM MITROFLOW BVN PRICRD	BOTH IP/OP	"$12,500.00 "	"$9,250.00"	$0.00	"$10,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,605.00"	$0.00	$0.00	$0.00	$0.00	"$6,250.00"	"$9,900.00"	"$10,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001102200	SUP	HCPCS C1726		M001102200  -  CATHETER BLNDIL 9FR 15MM 100CM 3CM LV ANGPLSTY	BOTH IP/OP	$998.00 	$738.52	$0.00	$798.40	$541.91	$541.91	$0.00	$0.00	$0.00	$208.01	$740.72	$740.72	$0.00	$0.00	$207.98	$0.00	$590.32	$590.32	$0.00	$499.00	$790.42	$798.40	$0.00		$0.00	$156.19	$0.00	$0.00	$158.88	$0.00	$0.00	$0.00	$0.00	$0.00
M001102240	SUP	HCPCS C1726		M001102240  -  CATHETER BLNDIL 9FR 20MM 100CM 3CM BLU MAX 20 OTW NC HI-PRS	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$373.31	$373.31	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
M0011031020	SUP	HCPCS C1751		M0011031020  -  CATHETER INFS .014-.016IN 3-2.7FR .021-.022IN 150CM 12CM	BOTH IP/OP	"$1,225.00 "	$906.50	$0.00	$980.00	$665.18	$665.18	$0.00	$0.00	$0.00	$255.32	$909.20	$909.20	$0.00	$0.00	$255.29	$0.00	$724.59	$724.59	$0.00	$612.50	$970.20	$980.00	$0.00		$0.00	$191.71	$0.00	$0.00	$195.02	$0.00	$0.00	$0.00	$0.00	$0.00
M001125000	SUP	HCPCS C1753		M001125000  -  CATHETER BLNDIL 4MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125010	SUP	HCPCS C1753		M001125010  -  CATHETER BLNDIL 4MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125020	SUP	HCPCS C1753		M001125020  -  CATHETER BLNDIL 4MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125030	SUP	HCPCS C1753		M001125030  -  CATHETER BLNDIL 4MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125040	SUP	HCPCS C1753		M001125040  -  CATHETER BLNDIL 4MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125050	SUP	HCPCS C1753		M001125050  -  CATHETER BLNDIL 4MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125060	SUP	HCPCS C1753		M001125060  -  CATHETER BLNDIL 4MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125070	SUP	HCPCS C1753		M001125070  -  CATHETER BLNDIL 4MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125080	SUP	HCPCS C1753		M001125080  -  CATHETER BLNDIL 4MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125090	SUP	HCPCS C1753		M001125090  -  CATHETER BLNDIL 4MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125100	SUP	HCPCS C1753		M001125100  -  CATHETER BLNDIL 4MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125110	SUP	HCPCS C1753		M001125110  -  CATHETER BLNDIL 4MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$447.98	$447.98	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$0.00	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$412.50	$653.40	$660.00	$0.00		$0.00	$129.11	$0.00	$0.00	$131.34	$0.00	$0.00	$0.00	$0.00	$0.00
M001125120	SUP	HCPCS C1753		M001125120  -  CATHETER BLNDIL 5MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125130	SUP	HCPCS C1753		M001125130  -  CATHETER BLNDIL 5MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125140	SUP	HCPCS C1753		M001125140  -  CATHETER BLNDIL 5MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125150	SUP	HCPCS C1753		M001125150  -  CATHETER BLNDIL 5MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125160	SUP	HCPCS C1753		M001125160  -  CATHETER BLNDIL 5MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125170	SUP	HCPCS C1753		M001125170  -  CATHETER BLNDIL 5MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125180	SUP	HCPCS C1753		M001125180  -  CATHETER BLNDIL 5MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125190	SUP	HCPCS C1753		M001125190  -  CATHETER BLNDIL 5MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125200	SUP	HCPCS C1753		M001125200  -  CATHETER BLNDIL 5MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125210	SUP	HCPCS C1753		M001125210  -  CATHETER BLNDIL 5MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125220	SUP	HCPCS C1753		M001125220  -  CATHETER BLNDIL 5MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125230	SUP	HCPCS C1753		M001125230  -  CATHETER BLNDIL 5MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125240	SUP	HCPCS C1753		M001125240  -  CATHETER BLNDIL 6MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125250	SUP	HCPCS C1753		M001125250  -  CATHETER BLNDIL 6MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125260	SUP	HCPCS C1753		M001125260  -  CATHETER BLNDIL 6MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125270	SUP	HCPCS C1753		M001125270  -  CATHETER BLNDIL 6MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125280	SUP	HCPCS C1753		M001125280  -  CATHETER BLNDIL 6MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125290	SUP	HCPCS C1753		M001125290  -  CATHETER BLNDIL 6MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125300	SUP	HCPCS C1753		M001125300  -  CATHETER BLNDIL 6MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125310	SUP	HCPCS C1753		M001125310  -  CATHETER BLNDIL 6MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125320	SUP	HCPCS C1753		M001125320  -  CATHETER BLNDIL 6MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125330	SUP	HCPCS C1753		M001125330  -  CATHETER BLNDIL 6MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125340	SUP	HCPCS C1753		M001125340  -  CATHETER BLNDIL 6MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125350	SUP	HCPCS C1753		M001125350  -  CATHETER BLNDIL 6MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125360	SUP	HCPCS C1753		M001125360  -  CATHETER BLNDIL 7MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125370	SUP	HCPCS C1753		M001125370  -  CATHETER BLNDIL 7MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125380	SUP	HCPCS C1753		M001125380  -  CATHETER BLNDIL 7MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125390	SUP	HCPCS C1753		M001125390  -  CATHETER BLNDIL 7MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125400	SUP	HCPCS C1753		M001125400  -  CATHETER BLNDIL 7MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125410	SUP	HCPCS C1753		M001125410  -  CATHETER BLNDIL 7MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125420	SUP	HCPCS C1753		M001125420  -  CATHETER BLNDIL 7MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125430	SUP	HCPCS C1753		M001125430  -  CATHETER BLNDIL 7MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125440	SUP	HCPCS C1753		M001125440  -  CATHETER BLNDIL 7MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125450	SUP	HCPCS C1753		M001125450  -  CATHETER BLNDIL 7MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125460	SUP	HCPCS C1753		M001125460  -  CATHETER BLNDIL 7MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125470	SUP	HCPCS C1753		M001125470  -  CATHETER BLNDIL 7MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$447.98	$447.98	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$0.00	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$412.50	$653.40	$660.00	$0.00		$0.00	$129.11	$0.00	$0.00	$131.34	$0.00	$0.00	$0.00	$0.00	$0.00
M001125480	SUP	HCPCS C1753		M001125480  -  CATHETER BLNDIL 8MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125490	SUP	HCPCS C1726		M001125490  -  CATHETER BLNDIL 8MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125500	SUP	HCPCS C1753		M001125500  -  CATHETER BLNDIL 8MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125510	SUP	HCPCS C1753		M001125510  -  CATHETER BLNDIL 8MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125520	SUP	HCPCS C1753		M001125520  -  CATHETER BLNDIL 8MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125530	SUP	HCPCS C1753		M001125530  -  CATHETER BLNDIL 8MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125540	SUP	HCPCS C1753		M001125540  -  CATHETER BLNDIL 8MM 40CM 80MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125550	SUP	HCPCS C1753		M001125550  -  CATHETER BLNDIL 8MM 75CM 80MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125560	SUP	HCPCS C1753		M001125560  -  CATHETER BLNDIL 8MM 120CM 80MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125580	SUP	HCPCS C1753		M001125580  -  CATHETER BLNDIL 9MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125590	SUP	HCPCS C1753		M001125590  -  CATHETER BLNDIL 9MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125600	SUP	HCPCS C1753		M001125600  -  CATHETER BLNDIL 9MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125610	SUP	HCPCS C1753		M001125610  -  CATHETER BLNDIL 9MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125620	SUP	HCPCS C1753		M001125620  -  CATHETER BLNDIL 9MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125630	SUP	HCPCS C1753		M001125630  -  CATHETER BLNDIL 9MM 40CM 80MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125640	SUP	HCPCS C1753		M001125640  -  CATHETER BLNDIL 9MM 75CM 80MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125650	SUP	HCPCS C1753		M001125650  -  CATHETER BLNDIL 9MM 120CM 80MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125660	SUP	HCPCS C1753		M001125660  -  CATHETER BLNDIL 10MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125670	SUP	HCPCS C1753		M001125670  -  CATHETER BLNDIL 10MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125680	SUP	HCPCS C1753		M001125680  -  CATHETER BLNDIL 10MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125690	SUP	HCPCS C1753		M001125690  -  CATHETER BLNDIL 10MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125700	SUP	HCPCS C1726		M001125700  -  CATHETER BLNDIL 10MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125710	SUP	HCPCS C1753		M001125710  -  CATHETER BLNDIL 10MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125720	SUP	HCPCS C1753		M001125720  -  CATHETER BLNDIL 10MM 40CM 80MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125730	SUP	HCPCS C1753		M001125730  -  CATHETER BLNDIL 10MM 75CM 80MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M001125740	SUP	HCPCS C1753		M001125740  -  CATHETER BLNDIL 10MM 120CM 80MM BLU MAX 20 OTW HI-PRS PERI	BOTH IP/OP	$463.05 	$342.66	$0.00	$370.44	$251.44	$251.44	$0.00	$0.00	$0.00	$96.51	$343.68	$343.68	$0.00	$0.00	$96.50	$0.00	$273.89	$273.89	$0.00	$231.53	$366.74	$370.44	$0.00		$0.00	$72.47	$0.00	$0.00	$73.72	$0.00	$0.00	$0.00	$0.00	$0.00
M0011341080	SUP	HCPCS C1751		M0011341080  -  CATH INFUS .014-.016IN 3-2.5FR .022-.021IN 150CM 20CM MCTH 1	BOTH IP/OP	"$1,437.50 "	"$1,063.75"	$0.00	"$1,150.00"	$780.56	$780.56	$0.00	$0.00	$0.00	$299.61	"$1,066.91"	"$1,066.91"	$0.00	$0.00	$299.58	$0.00	$850.28	$850.28	$0.00	$718.75	"$1,138.50"	"$1,150.00"	$0.00		$0.00	$224.97	$0.00	$0.00	$228.85	$0.00	$0.00	$0.00	$0.00	$0.00
M001145080	SUP	HCPCS C1753		M001145080  -  CATHETER BLNDIL 12MM 75CM 20MM XXL QD-FOLD SCRCH RST HI	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145090	SUP	HCPCS C1753		M001145090  -  CATHETER BLNDIL 12MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145100	SUP	HCPCS C1726		M001145100  -  CATHETER BLNDIL 12MM 75CM 40MM XXL SCRCH RST HI STRTH SHFT	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145110	SUP	HCPCS C1726		M001145110  -  CATHETER BLNDIL 12MM 120CM 40MM XXL QD-FOLD SCRCH RST HI	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145120	SUP	HCPCS C1753		M001145120  -  CATHETER BLNDIL 14MM 75CM 20MM XXL QD-FOLD SCRCH RST HI	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145130	SUP	HCPCS C1753		M001145130  -  CATHETER BLNDIL 14MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145140	SUP	HCPCS C1753		M001145140  -  CATHETER BLNDIL 14MM 75CM 40MM XXL SCRCH RST HI STRTH SHFT	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145150	SUP	HCPCS C1726		M001145150  -  CATHETER BLNDIL 14MM 120CM 40MM XXL QD-FOLD SCRCH RST HI	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145300	SUP	HCPCS C1753		M001145300  -  CATHETER BLNDIL 12MM 75CM 60MM XXL QD-FOLD SCRCH RST HI	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145320	SUP	HCPCS C1753		M001145320  -  CATHETER BLNDIL 14MM 75CM 60MM XXL QD-FOLD SCRCH RST HI	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145500	SUP	HCPCS C1753		M001145500  -  CATHETER BLNDIL 16MM 75CM 20MM XXL QD-FOLD SCRCH RST HI	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145510	SUP	HCPCS C1753		M001145510  -  CATHETER BLNDIL 16MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145520	SUP	HCPCS C1753		M001145520  -  CATHETER BLNDIL 16MM 75CM 40MM XXL QD-FOLD SCRCH RST HI	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145530	SUP	HCPCS C1726		M001145530  -  CATHETER BLNDIL 16MM 120CM 40MM XXL SCRCH RST HI STRTH SHFT	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145540	SUP	HCPCS C1753		M001145540  -  CATHETER BLNDIL 16MM 75CM 60MM XXL QD-FOLD SCRCH RST HI	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145550	SUP	HCPCS C1753		M001145550  -  CATHETER BLNDIL 18MM 75CM 20MM XXL QD-FOLD SCRCH RST HI	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145560	SUP	HCPCS C1753		M001145560  -  CATHETER BLNDIL 18MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145570	SUP	HCPCS C1753		M001145570  -  CATHETER BLNDIL 18MM 75CM 40MM XXL QD-FOLD SCRCH RST HI	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145580	SUP	HCPCS C1726		M001145580  -  CATHETER BLNDIL 18MM 120CM 40MM XXL SCRCH RST HI STRTH SHFT	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001145590	SUP	HCPCS C1753		M001145590  -  CATHETER BLNDIL 18MM 75CM 60MM XXL QD-FOLD SCRCH RST HI	BOTH IP/OP	$505.00 	$373.70	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$105.25	$374.81	$374.81	$0.00	$0.00	$105.24	$0.00	$298.71	$298.71	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001163980	SUP	HCPCS C1753		M001163980  -  CATHETER BLNDIL 3MM 120CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164000	SUP	HCPCS C1753		M001164000  -  CATHETER BLNDIL 3MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164010	SUP	HCPCS C1753		M001164010  -  CATHETER BLNDIL 3MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164020	SUP	HCPCS C1753		M001164020  -  CATHETER BLNDIL 3MM 120CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164030	SUP	HCPCS C1753		M001164030  -  CATHETER BLNDIL 3MM 150CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164040	SUP	HCPCS C1753		M001164040  -  CATHETER BLNDIL 3MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164050	SUP	HCPCS C1753		M001164050  -  CATHETER BLNDIL 3MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164060	SUP	HCPCS C1753		M001164060  -  CATHETER BLNDIL 3MM 120CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164070	SUP	HCPCS C1753		M001164070  -  CATHETER BLNDIL 3MM 150CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164080	SUP	HCPCS C1753		M001164080  -  CATHETER BLNDIL 3MM 40CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164090	SUP	HCPCS C1753		M001164090  -  CATHETER BLNDIL 3MM 75CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164100	SUP	HCPCS C1753		M001164100  -  CATHETER BLNDIL 3MM 120CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164110	SUP	HCPCS C1753		M001164110  -  CATHETER BLNDIL 3MM 150CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164120	SUP	HCPCS C1753		M001164120  -  CATHETER BLNDIL 4MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164130	SUP	HCPCS C1753		M001164130  -  CATHETER BLNDIL 4MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164140	SUP	HCPCS C1753		M001164140  -  CATHETER BLNDIL 4MM 120CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164150	SUP	HCPCS C1753		M001164150  -  CATHETER BLNDIL 4MM 150CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164160	SUP	HCPCS C1753		M001164160  -  CATHETER BLNDIL 4MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164170	SUP	HCPCS C1726		M001164170  -  CATHETER BLNDIL 4MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164180	SUP	HCPCS C1726		M001164180  -  CATHETER BLNDIL 4MM 120CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164190	SUP	HCPCS C1753		M001164190  -  CATHETER BLNDIL 4MM 150CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164200	SUP	HCPCS C1753		M001164200  -  CATHETER BLNDIL 4MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164210	SUP	HCPCS C1753		M001164210  -  CATHETER BLNDIL 4MM 120CM 30MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164220	SUP	HCPCS C1753		M001164220  -  CATHETER BLNDIL 4MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164230	SUP	HCPCS C1726		M001164230  -  CATHETER BLNDIL 4MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164240	SUP	HCPCS C1726		M001164240  -  CATHETER BLNDIL 4MM 120CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164250	SUP	HCPCS C1753		M001164250  -  CATHETER BLNDIL 4MM 150CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164280	SUP	HCPCS C1753		M001164280  -  CATHETER BLNDIL 4MM 40CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164290	SUP	HCPCS C1726		M001164290  -  CATHETER BLNDIL 4MM 75CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164300	SUP	HCPCS C1726		M001164300  -  CATH BALDILAT 5FR 4MM 120CM 10CM PERI PTA OTW TPR SHFT LP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164310	SUP	HCPCS C1753		M001164310  -  CATHETER BLNDIL 4MM 150CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164320	SUP	HCPCS C1753		M001164320  -  CATHETER BLNDIL 5MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164330	SUP	HCPCS C1753		M001164330  -  CATHETER BLNDIL 5MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164340	SUP	HCPCS C1753		M001164340  -  CATHETER BLNDIL 5MM 120CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164350	SUP	HCPCS C1753		M001164350  -  CATHETER BLNDIL 5MM 150CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164360	SUP	HCPCS C1753		M001164360  -  CATHETER BLNDIL 5MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164370	SUP	HCPCS C1753		M001164370  -  CATHETER BLNDIL 5MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164380	SUP	HCPCS C1753		M001164380  -  CATHETER BLNDIL 5MM 120CM 50MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164390	SUP	HCPCS C1753		M001164390  -  CATHETER BLNDIL 5MM 150CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164400	SUP	HCPCS C1753		M001164400  -  CATHETER BLNDIL 5MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164410	SUP	HCPCS C1753		M001164410  -  CATHETER BLNDIL 5MM 120CM 30MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164420	SUP	HCPCS C1753		M001164420  -  CATHETER BLNDIL 5MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164430	SUP	HCPCS C1753		M001164430  -  CATHETER BLNDIL 5MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164440	SUP	HCPCS C1753		M001164440  -  CATHETER BLNDIL 5MM 120CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164450	SUP	HCPCS C1753		M001164450  -  CATHETER BLNDIL 5MM 150CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164480	SUP	HCPCS C1753		M001164480  -  CATHETER BLNDIL 5MM 40CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164490	SUP	HCPCS C1726		M001164490  -  CATHETER BLNDIL 5MM 75CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164500	SUP	HCPCS C1726		M001164500  -  CATH BALDILAT 5FR 5MM 120CM 10CM PERI PTA OTW TPR SHFT LP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164510	SUP	HCPCS C1753		M001164510  -  CATHETER BLNDIL 5MM 150CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164520	SUP	HCPCS C1753		M001164520  -  CATHETER BLNDIL 6MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164530	SUP	HCPCS C1753		M001164530  -  CATHETER BLNDIL 6MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164540	SUP	HCPCS C1753		M001164540  -  CATHETER BLNDIL 6MM 120CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164550	SUP	HCPCS C1753		M001164550  -  CATHETER BLNDIL 6MM 150CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164560	SUP	HCPCS C1753		M001164560  -  CATHETER BLNDIL 6MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164570	SUP	HCPCS C1753		M001164570  -  CATHETER BLNDIL 6MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164580	SUP	HCPCS C1753		M001164580  -  CATHETER BLNDIL 6MM 120CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164590	SUP	HCPCS C1753		M001164590  -  CATHETER BLNDIL 6MM 150CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164600	SUP	HCPCS C1753		M001164600  -  CATHETER BLNDIL 6MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164610	SUP	HCPCS C1753		M001164610  -  CATHETER BLNDIL 6MM 120CM 30MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164620	SUP	HCPCS C1753		M001164620  -  CATHETER BLNDIL TPR 6MM 40CM 40MM U-T D OTW NC HDRPH PERI	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164630	SUP	HCPCS C1753		M001164630  -  CATHETER BLNDIL 6MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164640	SUP	HCPCS C1753		M001164640  -  CATHETER BLNDIL 6MM 120CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164650	SUP	HCPCS C1753		M001164650  -  CATHETER BLNDIL 6MM 150CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164680	SUP	HCPCS C1753		M001164680  -  CATHETER BLNDIL 6MM 40CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164690	SUP	HCPCS C1726		M001164690  -  CATHETER BLNDIL TPR 6MM 75CM 100MM U-T D OTW NC HDRPH PERI	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164700	SUP	HCPCS C1726		M001164700  -  CATHETER BLNDIL 6MM 120CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164710	SUP	HCPCS C1753		M001164710  -  CATHETER BLNDIL 6MM 150CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164720	SUP	HCPCS C1753		M001164720  -  CATHETER BLNDIL 7MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$509.93 	$377.35	$0.00	$407.94	$276.89	$276.89	$0.00	$0.00	$0.00	$106.28	$378.47	$378.47	$0.00	$0.00	$106.27	$0.00	$301.62	$301.62	$0.00	$254.96	$403.86	$407.94	$0.00		$0.00	$79.80	$0.00	$0.00	$81.18	$0.00	$0.00	$0.00	$0.00	$0.00
M001164730	SUP	HCPCS C1753		M001164730  -  CATHETER BLNDIL 7MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164740	SUP	HCPCS C1753		M001164740  -  CATHETER BLNDIL 7MM 120CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164750	SUP	HCPCS C1753		M001164750  -  CATHETER BLNDIL 7MM 150CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164760	SUP	HCPCS C1753		M001164760  -  CATHETER BLNDIL 7MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164770	SUP	HCPCS C1753		M001164770  -  CATHETER BLNDIL 7MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164780	SUP	HCPCS C1753		M001164780  -  CATHETER BLNDIL 7MM 120CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164790	SUP	HCPCS C1753		M001164790  -  CATHETER BLNDIL 7MM 150CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164800	SUP	HCPCS C1753		M001164800  -  CATHETER BLNDIL 7MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164810	SUP	HCPCS C1753		M001164810  -  CATHETER BLNDIL 7MM 120CM 30MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164820	SUP	HCPCS C1753		M001164820  -  CATHETER BLNDIL TPR 7MM 40CM 40MM U-T D OTW NC HDRPH PERI	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164830	SUP	HCPCS C1753		M001164830  -  CATHETER BLNDIL 7MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164840	SUP	HCPCS C1753		M001164840  -  CATHETER BLNDIL 7MM 120CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164850	SUP	HCPCS C1753		M001164850  -  CATHETER BLNDIL 7MM 150CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164880	SUP	HCPCS C1753		M001164880  -  CATHETER BLNDIL 7MM 40CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164890	SUP	HCPCS C1753		M001164890  -  CATHETER BLNDIL TPR 7MM 75CM 100MM U-T D OTW NC HDRPH PERI	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164900	SUP	HCPCS C1753		M001164900  -  CATHETER BLNDIL 7MM 120CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164910	SUP	HCPCS C1753		M001164910  -  CATHETER BLNDIL 7MM 150CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164920	SUP	HCPCS C1753		M001164920  -  CATHETER BLNDIL 8MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164930	SUP	HCPCS C1753		M001164930  -  CATHETER BLNDIL 8MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164940	SUP	HCPCS C1753		M001164940  -  CATHETER BLNDIL 8MM 120CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164950	SUP	HCPCS C1753		M001164950  -  CATHETER BLNDIL 8MM 150CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164960	SUP	HCPCS C1753		M001164960  -  CATHETER BLNDIL 8MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164970	SUP	HCPCS C1753		M001164970  -  CATHETER BLNDIL 8MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164980	SUP	HCPCS C1753		M001164980  -  CATHETER BLNDIL 8MM 120CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001164990	SUP	HCPCS C1753		M001164990  -  CATHETER BLNDIL 8MM 150CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165000	SUP	HCPCS C1753		M001165000  -  CATHETER BLNDIL 8MM 40CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165010	SUP	HCPCS C1726		M001165010  -  CATHETER BLNDIL 8MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165020	SUP	HCPCS C1753		M001165020  -  CATHETER BLNDIL 8MM 120CM 30MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165030	SUP	HCPCS C1753		M001165030  -  CATHETER BLNDIL 8MM 150CM 30MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165040	SUP	HCPCS C1753		M001165040  -  CATHETER BLNDIL TPR 8MM 40CM 40MM U-T D OTW NC HDRPH PERI	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165050	SUP	HCPCS C1753		M001165050  -  CATHETER BLNDIL 8MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165060	SUP	HCPCS C1753		M001165060  -  CATHETER BLNDIL 8MM 120CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165070	SUP	HCPCS C1753		M001165070  -  CATHETER BLNDIL 8MM 150CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165080	SUP	HCPCS C1753		M001165080  -  CATHETER BLNDIL 8MM 40CM 80MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165090	SUP	HCPCS C1753		M001165090  -  CATHETER BLNDIL 8MM 75CM 80MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165100	SUP	HCPCS C1753		M001165100  -  CATHETER BLNDIL 8MM 120CM 80MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165110	SUP	HCPCS C1753		M001165110  -  CATHETER BLNDIL 8MM 150CM 80MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165120	SUP	HCPCS C1753		M001165120  -  CATHETER BLNDIL 9MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165130	SUP	HCPCS C1753		M001165130  -  CATHETER BLNDIL 9MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165140	SUP	HCPCS C1753		M001165140  -  CATHETER BLNDIL 9MM 120CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165150	SUP	HCPCS C1753		M001165150  -  CATHETER BLNDIL 9MM 150CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165160	SUP	HCPCS C1753		M001165160  -  CATHETER BLNDIL 9MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165170	SUP	HCPCS C1753		M001165170  -  CATHETER BLNDIL 9MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165180	SUP	HCPCS C1753		M001165180  -  CATHETER BLNDIL 9MM 120CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165190	SUP	HCPCS C1753		M001165190  -  CATHETER BLNDIL 9MM 150CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165200	SUP	HCPCS C1753		M001165200  -  CATHETER BLNDIL 10MM 40CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165210	SUP	HCPCS C1753		M001165210  -  CATHETER BLNDIL 10MM 75CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165220	SUP	HCPCS C1753		M001165220  -  CATHETER BLNDIL 10MM 120CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165230	SUP	HCPCS C1753		M001165230  -  CATHETER BLNDIL 10MM 150CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165240	SUP	HCPCS C1753		M001165240  -  CATHETER BLNDIL TPR 10MM 40CM 40MM U-T D OTW NC HDRPH PERI	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165250	SUP	HCPCS C1753		M001165250  -  CATHETER BLNDIL 10MM 75CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165260	SUP	HCPCS C1753		M001165260  -  CATHETER BLNDIL 10MM 120CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165270	SUP	HCPCS C1753		M001165270  -  CATHETER BLNDIL 10MM 150CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165290	SUP	HCPCS C1726		M001165290  -  CATHETER BLNDIL 12MM 75CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165300	SUP	HCPCS C1753		M001165300  -  CATHETER BLNDIL 12MM 120CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165330	SUP	HCPCS C1753		M001165330  -  CATHETER BLNDIL 12MM 75CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165340	SUP	HCPCS C1753		M001165340  -  CATHETER BLNDIL 12MM 120CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165550	SUP	HCPCS C1753		M001165550  -  CATHETER BLNDIL 4MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165560	SUP	HCPCS C1753		M001165560  -  CATHETER BLNDIL 4MM 120CM 60MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165590	SUP	HCPCS C1753		M001165590  -  CATHETER BLNDIL 5MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165600	SUP	HCPCS C1753		M001165600  -  CATHETER BLNDIL 5MM 120CM 60MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165630	SUP	HCPCS C1753		M001165630  -  CATHETER BLNDIL 6MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165640	SUP	HCPCS C1753		M001165640  -  CATHETER BLNDIL 6MM 120CM 60MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165670	SUP	HCPCS C1753		M001165670  -  CATHETER BLNDIL 7MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001165680	SUP	HCPCS C1753		M001165680  -  CATHETER BLNDIL 7MM 120CM 60MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169410	SUP	HCPCS C1753		M001169410  -  CATHETER BLNDIL 3MM 135CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169420	SUP	HCPCS C1753		M001169420  -  CATHETER BLNDIL 3MM 135CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169430	SUP	HCPCS C1753		M001169430  -  CATHETER BLNDIL 3MM 135CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169440	SUP	HCPCS C1753		M001169440  -  CATHETER BLNDIL 4MM 135CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169450	SUP	HCPCS C1753		M001169450  -  CATHETER BLNDIL 4MM 135CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169460	SUP	HCPCS C1753		M001169460  -  CATHETER BLNDIL 4MM 135CM 30MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169470	SUP	HCPCS C1753		M001169470  -  CATHETER BLNDIL 4MM 135CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169480	SUP	HCPCS C1753		M001169480  -  CATHETER BLNDIL 4MM 135CM 60MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169490	SUP	HCPCS C1753		M001169490  -  CATHETER BLNDIL 4MM 135CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169510	SUP	HCPCS C1753		M001169510  -  CATHETER BLNDIL 5MM 135CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169520	SUP	HCPCS C1753		M001169520  -  CATHETER BLNDIL 5MM 135CM 30MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169530	SUP	HCPCS C1753		M001169530  -  CATHETER BLNDIL 5MM 135CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169540	SUP	HCPCS C1753		M001169540  -  CATHETER BLNDIL 5MM 135CM 60MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169550	SUP	HCPCS C1753		M001169550  -  CATHETER BLNDIL 5MM 135CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169570	SUP	HCPCS C1753		M001169570  -  CATHETER BLNDIL 6MM 135CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169580	SUP	HCPCS C1753		M001169580  -  CATHETER BLNDIL 6MM 135CM 30MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169590	SUP	HCPCS C1753		M001169590  -  CATHETER BLNDIL 6MM 135CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169600	SUP	HCPCS C1753		M001169600  -  CATHETER BLNDIL 6MM 135CM 60MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169610	SUP	HCPCS C1753		M001169610  -  CATHETER BLNDIL 6MM 135CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169620	SUP	HCPCS C1753		M001169620  -  CATHETER BLNDIL 7MM 135CM 15MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169630	SUP	HCPCS C1753		M001169630  -  CATHETER BLNDIL 7MM 135CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169640	SUP	HCPCS C1753		M001169640  -  CATHETER BLNDIL 7MM 135CM 30MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169650	SUP	HCPCS C1753		M001169650  -  CATHETER BLNDIL 7MM 135CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169660	SUP	HCPCS C1753		M001169660  -  CATHETER BLNDIL 7MM 135CM 60MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169670	SUP	HCPCS C1753		M001169670  -  CATHETER BLNDIL 7MM 135CM 100MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169690	SUP	HCPCS C1753		M001169690  -  CATHETER BLNDIL 8MM 135CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169700	SUP	HCPCS C1753		M001169700  -  CATHETER BLNDIL 8MM 135CM 30MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169710	SUP	HCPCS C1753		M001169710  -  CATHETER BLNDIL 8MM 135CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169720	SUP	HCPCS C1753		M001169720  -  CATHETER BLNDIL 8MM 135CM 60MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169730	SUP	HCPCS C1753		M001169730  -  CATHETER BLNDIL 8MM 135CM 80MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169740	SUP	HCPCS C1753		M001169740  -  CATHETER BLNDIL 9MM 135CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169750	SUP	HCPCS C1753		M001169750  -  CATHETER BLNDIL 9MM 135CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169760	SUP	HCPCS C1753		M001169760  -  CATHETER BLNDIL 10MM 135CM 20MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001169770	SUP	HCPCS C1753		M001169770  -  CATHETER BLNDIL 10MM 135CM 40MM U-T D OTW 2 LUM TPR TIP	BOTH IP/OP	$415.25 	$307.29	$0.00	$332.20	$225.48	$225.48	$0.00	$0.00	$0.00	$86.55	$308.20	$308.20	$0.00	$0.00	$86.54	$0.00	$245.62	$245.62	$0.00	$207.63	$328.88	$332.20	$0.00		$0.00	$64.99	$0.00	$0.00	$66.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001171020	SUP	Custom 27203010		M001171020  -  CATHETER BALLOON OCCLUSION STANDARD 7FR 110.5MM 65CM 2 LUMEN	BOTH IP/OP	$471.45 	$348.87	$0.00	$377.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$349.91	$349.91	$0.00	$0.00	$98.25	$0.00	$0.00	$0.00	$0.00	$235.73	$373.39	$377.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001171030	SUP	HCPCS C2628		M001171030  -  CATHETER BALLOON OCCLUSION STANDARD 7FR 110.5MM 100CM 2	BOTH IP/OP	$471.45 	$348.87	$0.00	$377.16	$0.00	$0.00	$0.00	$0.00	$0.00	$98.26	$349.91	$349.91	$0.00	$0.00	$98.25	$0.00	$278.86	$278.86	$0.00	$235.73	$373.39	$377.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001171050	SUP	HCPCS C1726		M001171050  -  CATHETER BALLOON OCCLUSION 14FR 20MM 65CM 2 LUMEN RADIOPQ	BOTH IP/OP	$605.65 	$448.18	$0.00	$484.52	$328.87	$328.87	$0.00	$0.00	$0.00	$126.23	$449.51	$449.51	$0.00	$0.00	$126.22	$0.00	$358.24	$358.24	$0.00	$302.83	$479.67	$484.52	$0.00		$0.00	$94.78	$0.00	$0.00	$96.42	$0.00	$0.00	$0.00	$0.00	$0.00
M001171060	SUP	HCPCS C1726		M001171060  -  CATHETER BALLOON OCCLUSION 14FR 20MM 100CM 2 LUMEN GWIRE	BOTH IP/OP	$605.65 	$448.18	$0.00	$484.52	$328.87	$328.87	$0.00	$0.00	$0.00	$126.23	$449.51	$449.51	$0.00	$0.00	$126.22	$0.00	$358.24	$358.24	$0.00	$302.83	$479.67	$484.52	$0.00		$0.00	$94.78	$0.00	$0.00	$96.42	$0.00	$0.00	$0.00	$0.00	$0.00
M001171070	SUP	HCPCS C1726		M001171070  -  CATHETER BALLOON OCCLUSION 7FR 27MM 65CM 2 LUMEN RADIOPQ	BOTH IP/OP	$605.65 	$448.18	$0.00	$484.52	$328.87	$328.87	$0.00	$0.00	$0.00	$126.23	$449.51	$449.51	$0.00	$0.00	$126.22	$0.00	$358.24	$358.24	$0.00	$302.83	$479.67	$484.52	$0.00		$0.00	$94.78	$0.00	$0.00	$96.42	$0.00	$0.00	$0.00	$0.00	$0.00
M001171080	SUP	HCPCS C1726		M001171080  -  CATH BLNOCC .038IN 7FR 27MM 100CM 2 LUM EQLZR 10ML	BOTH IP/OP	$575.93 	$426.19	$0.00	$460.74	$312.73	$312.73	$0.00	$0.00	$0.00	$120.04	$427.45	$427.45	$0.00	$0.00	$120.02	$0.00	$340.66	$340.66	$0.00	$287.96	$456.14	$460.74	$0.00		$0.00	$90.13	$0.00	$0.00	$91.69	$0.00	$0.00	$0.00	$0.00	$0.00
M001171090	SUP	HCPCS C1726		M001171090  -  CATHETER BALLOON OCCLUSION 7FR 33MM 65CM 2 LUMEN RADIOPQ	BOTH IP/OP	$605.65 	$448.18	$0.00	$484.52	$328.87	$328.87	$0.00	$0.00	$0.00	$126.23	$449.51	$449.51	$0.00	$0.00	$126.22	$0.00	$358.24	$358.24	$0.00	$302.83	$479.67	$484.52	$0.00		$0.00	$94.78	$0.00	$0.00	$96.42	$0.00	$0.00	$0.00	$0.00	$0.00
M001171100	SUP	HCPCS C1726		M001171100  -  CATHETER BALLOON OCCLUSION 16FR 33MM 100CM 2 LUMEN RADIOPQ	BOTH IP/OP	$605.65 	$448.18	$0.00	$484.52	$328.87	$328.87	$0.00	$0.00	$0.00	$126.23	$449.51	$449.51	$0.00	$0.00	$126.22	$0.00	$358.24	$358.24	$0.00	$302.83	$479.67	$484.52	$0.00		$0.00	$94.78	$0.00	$0.00	$96.42	$0.00	$0.00	$0.00	$0.00	$0.00
M001171110	SUP	HCPCS C1726		M001171110  -  CATHETER BALLOON OCCLUSION 7FR 40MM 65CM 2 LUMEN RADIOPQ	BOTH IP/OP	$605.65 	$448.18	$0.00	$484.52	$328.87	$328.87	$0.00	$0.00	$0.00	$126.23	$449.51	$449.51	$0.00	$0.00	$126.22	$0.00	$358.24	$358.24	$0.00	$302.83	$479.67	$484.52	$0.00		$0.00	$94.78	$0.00	$0.00	$96.42	$0.00	$0.00	$0.00	$0.00	$0.00
M001171120	SUP	HCPCS C1726		M001171120  -  CATHETER BALLOON OCCLUSION 7FR 40MM 100CM 2 LUMEN RADIOPQ	BOTH IP/OP	$605.65 	$448.18	$0.00	$484.52	$328.87	$328.87	$0.00	$0.00	$0.00	$126.23	$449.51	$449.51	$0.00	$0.00	$126.22	$0.00	$358.24	$358.24	$0.00	$302.83	$479.67	$484.52	$0.00		$0.00	$94.78	$0.00	$0.00	$96.42	$0.00	$0.00	$0.00	$0.00	$0.00
M001173010	SUP	HCPCS C2628		M001173010  -  CATHETER BALLOON OCCLUSION 6FR 11.5MM 80CM 2 LUMEN RADIOPQ	BOTH IP/OP	$471.45 	$348.87	$0.00	$377.16	$0.00	$0.00	$0.00	$0.00	$0.00	$98.26	$349.91	$349.91	$0.00	$0.00	$98.25	$0.00	$278.86	$278.86	$0.00	$235.73	$373.39	$377.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001175000	SUP	Custom 27203010		M001175000  -  CATHETER BLNOCC .035IN 5FR 8.5MM 65CM EQLZR 2 LUM	BOTH IP/OP	$551.13 	$407.84	$0.00	$440.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$409.04	$409.04	$0.00	$0.00	$114.85	$0.00	$0.00	$0.00	$0.00	$275.56	$436.49	$440.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001181250	SUP	HCPCS C1887		M001181250  -  MICROCATHETER INFS STRG 3-2.4FR 105CM RNGD STC 18 RADOPQ	BOTH IP/OP	"$1,008.00 "	$745.92	$0.00	$806.40	$547.34	$547.34	$0.00	$0.00	$0.00	$210.09	$748.14	$748.14	$0.00	$0.00	$210.07	$0.00	$596.23	$596.23	$0.00	$504.00	$798.34	$806.40	$0.00		$0.00	$157.75	$0.00	$0.00	$160.47	$0.00	$0.00	$0.00	$0.00	$0.00
M001181260	SUP	HCPCS C1887		M001181260  -  MICROCATHETER INFS STRG 3-2.4FR 105CM RNGD STC 18 RADOPQ	BOTH IP/OP	"$1,008.00 "	$745.92	$0.00	$806.40	$547.34	$547.34	$0.00	$0.00	$0.00	$210.09	$748.14	$748.14	$0.00	$0.00	$210.07	$0.00	$596.23	$596.23	$0.00	$504.00	$798.34	$806.40	$0.00		$0.00	$157.75	$0.00	$0.00	$160.47	$0.00	$0.00	$0.00	$0.00	$0.00
M001181270	SUP	HCPCS C1887		M001181270  -  MICROCATHETER INFS 90D 3-2.4FR 105CM RNGD STC 18 RADOPQ	BOTH IP/OP	"$1,055.25 "	$780.89	$0.00	$844.20	$573.00	$573.00	$0.00	$0.00	$0.00	$219.94	$783.21	$783.21	$0.00	$0.00	$219.91	$0.00	$624.18	$624.18	$0.00	$527.63	$835.76	$844.20	$0.00		$0.00	$165.15	$0.00	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001181280	SUP	HCPCS C1887		M001181280  -  MICROCATHETER INFS 90D 3-2.4FR 105CM RNGD STC 18 RADOPQ	BOTH IP/OP	"$1,055.25 "	$780.89	$0.00	$844.20	$573.00	$573.00	$0.00	$0.00	$0.00	$219.94	$783.21	$783.21	$0.00	$0.00	$219.91	$0.00	$624.18	$624.18	$0.00	$527.63	$835.76	$844.20	$0.00		$0.00	$165.15	$0.00	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001181310	SUP	HCPCS C1887		M001181310  -  MICROCATHETER INFS STRG 3-2.4FR 130CM RNGD STC 18 RADOPQ	BOTH IP/OP	"$1,008.00 "	$745.92	$0.00	$806.40	$547.34	$547.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$504.00	$798.34	$806.40	$0.00		$0.00	$157.75	$0.00	$0.00	$160.47	$0.00	$0.00	$0.00	$0.00	$0.00
M001181320	SUP	HCPCS C1887		M001181320  -  MICROCATHETER INFS STRG 3-2.4FR 130CM RNGD STC 18 RADOPQ	BOTH IP/OP	"$1,008.00 "	$745.92	$0.00	$806.40	$547.34	$547.34	$0.00	$0.00	$0.00	$210.09	$748.14	$748.14	$0.00	$0.00	$210.07	$0.00	$596.23	$596.23	$0.00	$504.00	$798.34	$806.40	$0.00		$0.00	$157.75	$0.00	$0.00	$160.47	$0.00	$0.00	$0.00	$0.00	$0.00
M001181330	SUP	HCPCS C1887		M001181330  -  MICROCATHETER INFS 90D 3-2.4FR 130CM RNGD STC 18 RADOPQ	BOTH IP/OP	"$1,055.25 "	$780.89	$0.00	$844.20	$573.00	$573.00	$0.00	$0.00	$0.00	$219.94	$783.21	$783.21	$0.00	$0.00	$219.91	$0.00	$624.18	$624.18	$0.00	$527.63	$835.76	$844.20	$0.00		$0.00	$165.15	$0.00	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001181340	SUP	HCPCS C1887		M001181340  -  MICROCATHETER INFS 90D 3-2.4FR 130CM RNGD STC 18 RADOPQ	BOTH IP/OP	"$1,055.25 "	$780.89	$0.00	$844.20	$573.00	$573.00	$0.00	$0.00	$0.00	$219.94	$783.21	$783.21	$0.00	$0.00	$219.91	$0.00	$624.18	$624.18	$0.00	$527.63	$835.76	$844.20	$0.00		$0.00	$165.15	$0.00	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001181370	SUP	HCPCS C1887		M001181370  -  MICROCATHETER INFS STRG 3-2.4FR 150CM RNGD STC 18 RADOPQ	BOTH IP/OP	"$1,008.00 "	$745.92	$0.00	$806.40	$547.34	$547.34	$0.00	$0.00	$0.00	$210.09	$748.14	$748.14	$0.00	$0.00	$210.07	$0.00	$596.23	$596.23	$0.00	$504.00	$798.34	$806.40	$0.00		$0.00	$157.75	$0.00	$0.00	$160.47	$0.00	$0.00	$0.00	$0.00	$0.00
M001181380	SUP	HCPCS C1887		M001181380  -  MICROCATHETER INFS STRG 3-2.4FR 150CM RNGD STC 18 RADOPQ	BOTH IP/OP	"$1,008.00 "	$745.92	$0.00	$806.40	$547.34	$547.34	$0.00	$0.00	$0.00	$210.09	$748.14	$748.14	$0.00	$0.00	$210.07	$0.00	$596.23	$596.23	$0.00	$504.00	$798.34	$806.40	$0.00		$0.00	$157.75	$0.00	$0.00	$160.47	$0.00	$0.00	$0.00	$0.00	$0.00
M001181390	SUP	HCPCS C1887		M001181390  -  MICROCATHETER INFS 90D 3-2.4FR 150CM RNGD STC 18 RADOPQ	BOTH IP/OP	"$1,055.25 "	$780.89	$0.00	$844.20	$573.00	$573.00	$0.00	$0.00	$0.00	$219.94	$783.21	$783.21	$0.00	$0.00	$219.91	$0.00	$624.18	$624.18	$0.00	$527.63	$835.76	$844.20	$0.00		$0.00	$165.15	$0.00	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001181400	SUP	HCPCS C1887		M001181400  -  MICROCATHETER INFS 90D 3-2.4FR 150CM RNGD STC 18 RADOPQ	BOTH IP/OP	"$1,055.25 "	$780.89	$0.00	$844.20	$573.00	$573.00	$0.00	$0.00	$0.00	$219.94	$783.21	$783.21	$0.00	$0.00	$219.91	$0.00	$624.18	$624.18	$0.00	$527.63	$835.76	$844.20	$0.00		$0.00	$165.15	$0.00	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001182590	SUP	HCPCS C1887		M001182590  -  MICROCATHETER INFS 3-2.5FR 150CM RNGD RADOPQ BRD DIST TIP	BOTH IP/OP	"$1,959.90 "	"$1,450.33"	$0.00	"$1,454.64"	$902.74	$902.74	$0.00	$0.00	$0.00	$408.49	"$1,454.64"	"$1,454.64"	$0.00	$0.00	$408.44	$0.00	"$1,159.28"	"$1,159.28"	$0.00	$831.25	"$1,316.70"	"$1,330.00"	$0.00		$0.00	$260.18	$0.00	$0.00	$264.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001182830	SUP	HCPCS C1751		M001182830  -  CATHETER INFUS MICRO 3-2.8FR .027IN 80CM 20CM KIT RADIOPQ	BOTH IP/OP	$899.60 	$665.70	$0.00	$719.68	$488.48	$488.48	$0.00	$0.00	$0.00	$187.50	$667.68	$667.68	$0.00	$0.00	$187.48	$0.00	$532.11	$532.11	$0.00	$449.80	$712.48	$719.68	$0.00		$0.00	$140.79	$0.00	$0.00	$143.22	$0.00	$0.00	$0.00	$0.00	$0.00
M001182840	SUP	HCPCS C1751		M001182840  -  CATHETER INFUS STR 20.8-30FR .027IN 105CM 10CM RENEGADE	BOTH IP/OP	$899.60 	$665.70	$0.00	$719.68	$488.48	$488.48	$0.00	$0.00	$0.00	$187.50	$667.68	$667.68	$0.00	$0.00	$187.48	$0.00	$532.11	$532.11	$0.00	$449.80	$712.48	$719.68	$0.00		$0.00	$140.79	$0.00	$0.00	$143.22	$0.00	$0.00	$0.00	$0.00	$0.00
M001182850	SUP	HCPCS C1751		M001182850  -  CATHETER INFUS MICRO 3-2.8FR .027IN 105CM 20CM KIT RADIOPQ	BOTH IP/OP	$899.60 	$665.70	$0.00	$719.68	$488.48	$488.48	$0.00	$0.00	$0.00	$187.50	$667.68	$667.68	$0.00	$0.00	$187.48	$0.00	$532.11	$532.11	$0.00	$449.80	$712.48	$719.68	$0.00		$0.00	$140.79	$0.00	$0.00	$143.22	$0.00	$0.00	$0.00	$0.00	$0.00
M001182860	SUP	HCPCS C1751		M001182860  -  CATHETER INFUS MICRO 3-2.8FR .027IN 115CM 10CM KIT RADIOPQ	BOTH IP/OP	$899.60 	$665.70	$0.00	$719.68	$488.48	$488.48	$0.00	$0.00	$0.00	$187.50	$667.68	$667.68	$0.00	$0.00	$187.48	$0.00	$532.11	$532.11	$0.00	$449.80	$712.48	$719.68	$0.00		$0.00	$140.79	$0.00	$0.00	$143.22	$0.00	$0.00	$0.00	$0.00	$0.00
M001182870	SUP	HCPCS C1751		M001182870  -  CATHETER INFUS MICRO 3-2.8FR .027IN 115CM 20CM KIT RADIOPQ	BOTH IP/OP	$899.60 	$665.70	$0.00	$719.68	$488.48	$488.48	$0.00	$0.00	$0.00	$187.50	$667.68	$667.68	$0.00	$0.00	$187.48	$0.00	$532.11	$532.11	$0.00	$449.80	$712.48	$719.68	$0.00		$0.00	$140.79	$0.00	$0.00	$143.22	$0.00	$0.00	$0.00	$0.00	$0.00
M001182880	SUP	HCPCS C1751		M001182880  -  CATHETER INFUS MICRO 3-2.8FR .027IN 135CM 10CM KIT RADIOPQ	BOTH IP/OP	$899.60 	$665.70	$0.00	$719.68	$488.48	$488.48	$0.00	$0.00	$0.00	$187.50	$667.68	$667.68	$0.00	$0.00	$187.48	$0.00	$532.11	$532.11	$0.00	$449.80	$712.48	$719.68	$0.00		$0.00	$140.79	$0.00	$0.00	$143.22	$0.00	$0.00	$0.00	$0.00	$0.00
M001182890	SUP	HCPCS C1751		M001182890  -  CATHETER INFUS MICRO 3-2.8FR .027IN 135CM 20CM KIT RADIOPQ	BOTH IP/OP	$899.60 	$665.70	$0.00	$719.68	$488.48	$488.48	$0.00	$0.00	$0.00	$187.50	$667.68	$667.68	$0.00	$0.00	$187.48	$0.00	$532.11	$532.11	$0.00	$449.80	$712.48	$719.68	$0.00		$0.00	$140.79	$0.00	$0.00	$143.22	$0.00	$0.00	$0.00	$0.00	$0.00
M001182900	SUP	HCPCS C1751		M001182900  -  CATHETER INFUS MICRO 3-2.8FR .027IN 150CM 10CM KIT RADIOPQ	BOTH IP/OP	$899.60 	$665.70	$0.00	$719.68	$488.48	$488.48	$0.00	$0.00	$0.00	$187.50	$667.68	$667.68	$0.00	$0.00	$187.48	$0.00	$532.11	$532.11	$0.00	$449.80	$712.48	$719.68	$0.00		$0.00	$140.79	$0.00	$0.00	$143.22	$0.00	$0.00	$0.00	$0.00	$0.00
M001182910	SUP	HCPCS C1751		M001182910  -  CATHETER INFUS MICRO 3-2.8FR .027IN 150CM 20CM KIT RADIOPQ	BOTH IP/OP	$899.60 	$665.70	$0.00	$719.68	$488.48	$488.48	$0.00	$0.00	$0.00	$187.50	$667.68	$667.68	$0.00	$0.00	$187.48	$0.00	$532.11	$532.11	$0.00	$449.80	$712.48	$719.68	$0.00		$0.00	$140.79	$0.00	$0.00	$143.22	$0.00	$0.00	$0.00	$0.00	$0.00
M001182920	SUP	HCPCS C1887		M001182920  -  CATHETER INFUS 105CM KIT MICROCATHETER RADIOPQ MARKER	BOTH IP/OP	"$1,193.53 "	$883.21	$0.00	$954.82	$648.08	$648.08	$0.00	$0.00	$0.00	$248.76	$885.83	$885.83	$0.00	$0.00	$248.73	$0.00	$705.97	$705.97	$0.00	$596.76	$945.28	$954.82	$0.00		$0.00	$186.79	$0.00	$0.00	$190.01	$0.00	$0.00	$0.00	$0.00	$0.00
M001182930	SUP	HCPCS C1887		M001182930  -  CATHETER INFUS 105CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO	BOTH IP/OP	"$1,193.53 "	$883.21	$0.00	$954.82	$648.08	$648.08	$0.00	$0.00	$0.00	$248.76	$885.83	$885.83	$0.00	$0.00	$248.73	$0.00	$705.97	$705.97	$0.00	$596.76	$945.28	$954.82	$0.00		$0.00	$186.79	$0.00	$0.00	$190.01	$0.00	$0.00	$0.00	$0.00	$0.00
M001182940	SUP	HCPCS C1887		M001182940  -  CATHETER INFUS 115CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO	BOTH IP/OP	"$1,193.53 "	$883.21	$0.00	$954.82	$648.08	$648.08	$0.00	$0.00	$0.00	$248.76	$885.83	$885.83	$0.00	$0.00	$248.73	$0.00	$705.97	$705.97	$0.00	$596.76	$945.28	$954.82	$0.00		$0.00	$186.79	$0.00	$0.00	$190.01	$0.00	$0.00	$0.00	$0.00	$0.00
M001182950	SUP	HCPCS C1887		M001182950  -  CATHETER INFUS 115CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO	BOTH IP/OP	"$1,193.53 "	$883.21	$0.00	$954.82	$648.08	$648.08	$0.00	$0.00	$0.00	$248.76	$885.83	$885.83	$0.00	$0.00	$248.73	$0.00	$705.97	$705.97	$0.00	$596.76	$945.28	$954.82	$0.00		$0.00	$186.79	$0.00	$0.00	$190.01	$0.00	$0.00	$0.00	$0.00	$0.00
M001182960	SUP	HCPCS C1887		M001182960  -  CATHETER INFUS 135CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO	BOTH IP/OP	"$1,193.53 "	$883.21	$0.00	$954.82	$648.08	$648.08	$0.00	$0.00	$0.00	$248.76	$885.83	$885.83	$0.00	$0.00	$248.73	$0.00	$705.97	$705.97	$0.00	$596.76	$945.28	$954.82	$0.00		$0.00	$186.79	$0.00	$0.00	$190.01	$0.00	$0.00	$0.00	$0.00	$0.00
M001182970	SUP	HCPCS C1887		M001182970  -  CATHETER INFUS 135CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO	BOTH IP/OP	"$1,193.53 "	$883.21	$0.00	$954.82	$648.08	$648.08	$0.00	$0.00	$0.00	$248.76	$885.83	$885.83	$0.00	$0.00	$248.73	$0.00	$705.97	$705.97	$0.00	$596.76	$945.28	$954.82	$0.00		$0.00	$186.79	$0.00	$0.00	$190.01	$0.00	$0.00	$0.00	$0.00	$0.00
M001184500	SUP	HCPCS C1887		M001184500  -  GUIDEWIRE VASCULAR .016IN 105CM 10CM PRELOAD HI-FLO RENEGADE	BOTH IP/OP	"$1,540.00 "	"$1,139.60"	$0.00	"$1,232.00"	$836.22	$836.22	$0.00	$0.00	$0.00	$320.97	"$1,142.99"	"$1,142.99"	$0.00	$0.00	$320.94	$0.00	$910.91	$910.91	$0.00	$770.00	"$1,219.68"	"$1,232.00"	$0.00		$0.00	$241.01	$0.00	$0.00	$245.17	$0.00	$0.00	$0.00	$0.00	$0.00
M001184510	SUP	HCPCS C1887		M001184510  -  GUIDEWIRE VASCULAR .016IN 105CM 20CM PRELOAD HI-FLO RENEGADE	BOTH IP/OP	"$1,540.00 "	"$1,139.60"	$0.00	"$1,232.00"	$836.22	$836.22	$0.00	$0.00	$0.00	$320.97	"$1,142.99"	"$1,142.99"	$0.00	$0.00	$320.94	$0.00	$910.91	$910.91	$0.00	$770.00	"$1,219.68"	"$1,232.00"	$0.00		$0.00	$241.01	$0.00	$0.00	$245.17	$0.00	$0.00	$0.00	$0.00	$0.00
M001184520	SUP	HCPCS C1887		M001184520  -  GUIDEWIRE VASCULAR .016IN 115CM 10CM PRELOAD HI-FLO RENEGADE	BOTH IP/OP	"$1,540.00 "	"$1,139.60"	$0.00	"$1,232.00"	$836.22	$836.22	$0.00	$0.00	$0.00	$320.97	"$1,142.99"	"$1,142.99"	$0.00	$0.00	$320.94	$0.00	$910.91	$910.91	$0.00	$770.00	"$1,219.68"	"$1,232.00"	$0.00		$0.00	$241.01	$0.00	$0.00	$245.17	$0.00	$0.00	$0.00	$0.00	$0.00
M001184530	SUP	HCPCS C1887		M001184530  -  GUIDEWIRE VASCULAR .016IN 115CM 20CM PRELOAD HI-FLO RENEGADE	BOTH IP/OP	"$1,540.00 "	"$1,139.60"	$0.00	"$1,232.00"	$836.22	$836.22	$0.00	$0.00	$0.00	$320.97	"$1,142.99"	"$1,142.99"	$0.00	$0.00	$320.94	$0.00	$910.91	$910.91	$0.00	$770.00	"$1,219.68"	"$1,232.00"	$0.00		$0.00	$241.01	$0.00	$0.00	$245.17	$0.00	$0.00	$0.00	$0.00	$0.00
M001184540	SUP	HCPCS C1887		M001184540  -  CATHETER GUID 10CM MICRO 2.8-3FR 180CM 135CM KIT STEERABLE	BOTH IP/OP	"$1,540.00 "	"$1,139.60"	$0.00	"$1,232.00"	$836.22	$836.22	$0.00	$0.00	$0.00	$320.97	"$1,142.99"	"$1,142.99"	$0.00	$0.00	$320.94	$0.00	$910.91	$910.91	$0.00	$770.00	"$1,219.68"	"$1,232.00"	$0.00		$0.00	$241.01	$0.00	$0.00	$245.17	$0.00	$0.00	$0.00	$0.00	$0.00
M001184550	SUP	HCPCS C1887		M001184550  -  MICROCATHETER INFS .016IN 3-2.8FR 180CM RNGD HFL FATHOM	BOTH IP/OP	"$1,540.00 "	"$1,139.60"	$0.00	"$1,232.00"	$836.22	$836.22	$0.00	$0.00	$0.00	$320.97	"$1,142.99"	"$1,142.99"	$0.00	$0.00	$320.94	$0.00	$910.91	$910.91	$0.00	$770.00	"$1,219.68"	"$1,232.00"	$0.00		$0.00	$241.01	$0.00	$0.00	$245.17	$0.00	$0.00	$0.00	$0.00	$0.00
M001184560	SUP	HCPCS C1887		M001184560  -  MICROCATHETER INFS .016IN 3-2.8FR 180CM RNGD HFL FATHOM	BOTH IP/OP	"$1,540.00 "	"$1,139.60"	$0.00	"$1,232.00"	$836.22	$836.22	$0.00	$0.00	$0.00	$320.97	"$1,142.99"	"$1,142.99"	$0.00	$0.00	$320.94	$0.00	$910.91	$910.91	$0.00	$770.00	"$1,219.68"	"$1,232.00"	$0.00		$0.00	$241.01	$0.00	$0.00	$245.17	$0.00	$0.00	$0.00	$0.00	$0.00
M001184570	SUP	HCPCS C1887		M001184570  -  MICROCATHETER INFS .016IN 3-2.8FR 180CM RNGD HFL FATHOM	BOTH IP/OP	"$1,540.00 "	"$1,139.60"	$0.00	"$1,232.00"	$836.22	$836.22	$0.00	$0.00	$0.00	$320.97	"$1,142.99"	"$1,142.99"	$0.00	$0.00	$320.94	$0.00	$910.91	$910.91	$0.00	$770.00	"$1,219.68"	"$1,232.00"	$0.00		$0.00	$241.01	$0.00	$0.00	$245.17	$0.00	$0.00	$0.00	$0.00	$0.00
M001196000	SUP	HCPCS C1887		M001196000  -  CATHETER GD HS CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196040	SUP	HCPCS C1887		M001196040  -  CATHETER GD RE S 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196080	SUP	HCPCS C1887		M001196080  -  CATHETER GD RE SS CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196120	SUP	HCPCS C1887		M001196120  -  CATHETER GD RE1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196160	SUP	HCPCS C1887		M001196160  -  CATHETER GD C1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196200	SUP	HCPCS C1887		M001196200  -  CATHETER GD C2 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196230	SUP	HCPCS C1887		M001196230  -  CATHETER GD MP CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196260	SUP	HCPCS C1887		M001196260  -  CATHETER GD MP CRV 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196300	SUP	HCPCS C1887		M001196300  -  CATHETER GD MP2 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196330	SUP	HCPCS C1887		M001196330  -  CATHETER GD MP2 CRV 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196380	SUP	HCPCS C1887		M001196380  -  CATHETER GD 40D 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 RND	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196450	SUP	HCPCS C1887		M001196450  -  CATHETER GD ST CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196480	SUP	HCPCS C1887		M001196480  -  CATHETER GD ST CRV 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196530	SUP	HCPCS C1887		M001196530  -  CATHETER GD XVR 1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196560	SUP	HCPCS C1887		M001196560  -  CATHETER GD XVR 2 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196620	SUP	HCPCS C1887		M001196620  -  CATHETER GD LIMA CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196660	SUP	HCPCS C1887		M001196660  -  CATHETER GD RDC CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196700	SUP	HCPCS C1887		M001196700  -  CATHETER GD BATES 1 CRV 6FR 55CM STRL LF MACH1 LG LUM SH	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196800	SUP	HCPCS C1887		M001196800  -  CATHETER GD BATES 2 CRV 6FR 55CM STRL LF MACH1 LG LUM SH	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001196960	SUP	HCPCS C1887		M001196960  -  CATHETER GD RDC1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197000	SUP	HCPCS C1887		M001197000  -  CATHETER GD HS CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197040	SUP	HCPCS C1887		M001197040  -  CATHETER GD RE S 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197080	SUP	HCPCS C1887		M001197080  -  CATHETER GD RE SS CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197120	SUP	HCPCS C1887		M001197120  -  CATHETER GD RE L CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197160	SUP	HCPCS C1887		M001197160  -  CATHETER GD C1 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197200	SUP	HCPCS C1887		M001197200  -  CATHETER GD C2 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197230	SUP	HCPCS C1887		M001197230  -  CATHETER GD MP CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197260	SUP	HCPCS C1887		M001197260  -  CATHETER GD MP CRV 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197300	SUP	HCPCS C1887		M001197300  -  CATHETER GD MP2 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197330	SUP	HCPCS C1887		M001197330  -  CATHETER GD MP2 CRV 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197380	SUP	HCPCS C1887		M001197380  -  CATHETER GD 40D 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 RND	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197450	SUP	HCPCS C1887		M001197450  -  CATHETER GD ST CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197480	SUP	HCPCS C1887		M001197480  -  CATHETER GD ST CRV 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197530	SUP	HCPCS C1887		M001197530  -  CATHETER GD XVR 1 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197560	SUP	HCPCS C1887		M001197560  -  CATHETER GD XVR 2 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197620	SUP	HCPCS C1887		M001197620  -  CATHETER GD LIMA CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197660	SUP	HCPCS C1887		M001197660  -  CATHETER GD RDC CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197700	SUP	HCPCS C1887		M001197700  -  CATHETER GD BATES 1 CRV 7FR 55CM STRL LF MACH1 LG LUM SH	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197800	SUP	HCPCS C1887		M001197800  -  CATHETER GD BATES 2 CRV 7FR 55CM STRL LF MACH1 LG LUM SH	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001197960	SUP	HCPCS C1887		M001197960  -  CATHETER GD RDC1 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198000	SUP	HCPCS C1887		M001198000  -  CATHETER GD HS CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198040	SUP	HCPCS C1887		M001198040  -  CATHETER GD RE S 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198080	SUP	HCPCS C1887		M001198080  -  CATHETER GD RE SS CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198120	SUP	HCPCS C1887		M001198120  -  CATHETER GD RE L CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198160	SUP	HCPCS C1887		M001198160  -  CATHETER GD C1 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198200	SUP	HCPCS C1887		M001198200  -  CATHETER GD C2 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198230	SUP	HCPCS C1887		M001198230  -  CATHETER GD MP CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198260	SUP	HCPCS C1887		M001198260  -  CATHETER GD MP CRV 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198300	SUP	HCPCS C1887		M001198300  -  CATHETER GD MP2 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198330	SUP	HCPCS C1887		M001198330  -  CATHETER GD MP2 CRV 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198380	SUP	HCPCS C1887		M001198380  -  CATHETER GD 40D 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 RND	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198450	SUP	HCPCS C1887		M001198450  -  CATHETER GD ST CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198480	SUP	HCPCS C1887		M001198480  -  CATHETER GD ST CRV 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198530	SUP	HCPCS C1887		M001198530  -  CATHETER GD XVR 1 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198560	SUP	HCPCS C1887		M001198560  -  CATHETER GD XVR 2 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198620	SUP	HCPCS C1887		M001198620  -  CATHETER GD LIMA CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198660	SUP	HCPCS C1887		M001198660  -  CATHETER GD RDC CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198700	SUP	HCPCS C1887		M001198700  -  CATHETER GD BATES 1 CRV 8FR 55CM STRL LF MACH1 LG LUM SH	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198800	SUP	HCPCS C1887		M001198800  -  CATHETER GD BATES 2 CRV 8FR 55CM STRL LF MACH1 LG LUM SH	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001198960	SUP	HCPCS C1887		M001198960  -  CATHETER GD RDC1 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2	BOTH IP/OP	$214.50 	$158.73	$0.00	$171.60	$116.47	$116.47	$0.00	$0.00	$0.00	$44.71	$159.20	$159.20	$0.00	$0.00	$44.70	$0.00	$126.88	$126.88	$0.00	$107.25	$169.88	$171.60	$0.00		$0.00	$33.57	$0.00	$0.00	$34.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001206130	SUP	HCPCS C1892		M001206130  -  INTRODUCER SHTH 11FR 30CM BNA PL PLWY COAX LCK TPR PE	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$73.31	$73.31	$0.00	$0.00	$0.00	$28.14	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$79.85	$79.85	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$21.13	$0.00	$0.00	$21.49	$0.00	$0.00	$0.00	$0.00	$0.00
M001207020	SUP	HCPCS C1894		M001207020  -  INTROD SHTH 6FR 4FR 20CM COAX DILAT JTP HVDTY FLPY XSTIF	BOTH IP/OP	$63.13 	$46.72	$0.00	$186.50	$126.59	$126.59	$0.00	$0.00	$0.00	$13.16	$46.85	$46.85	$0.00	$0.00	$13.16	$0.00	$37.34	$37.34	$0.00	$116.56	$184.64	$186.50	$0.00		$0.00	$36.48	$0.00	$0.00	$37.11	$0.00	$0.00	$0.00	$0.00	$0.00
M001207030	SUP	HCPCS C1894		M001207030  -  SYSTEM INTROD .018IN .038IN FLOPPY STR 6FR 4FR 60CM 145CM 2	BOTH IP/OP	$189.38 	$140.14	$0.00	$151.50	$102.83	$102.83	$0.00	$0.00	$0.00	$39.47	$140.55	$140.55	$0.00	$0.00	$39.47	$0.00	$112.02	$112.02	$0.00	$94.69	$149.99	$151.50	$0.00		$0.00	$29.64	$0.00	$0.00	$30.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001207040	SUP	HCPCS C1892		M001207040  -  SYSTEM INTROD .038IN FLOPPY 6FR 4FR 60CM 20CM DILAT RADIOPQ	BOTH IP/OP	$151.88 	$112.39	$0.00	$121.50	$82.47	$82.47	$0.00	$0.00	$0.00	$31.65	$112.72	$112.72	$0.00	$0.00	$31.65	$0.00	$89.83	$89.83	$0.00	$75.94	$120.29	$121.50	$0.00		$0.00	$23.77	$0.00	$0.00	$24.18	$0.00	$0.00	$0.00	$0.00	$0.00
M001207050	SUP	HCPCS C1894		M001207050  -  SYSTEM INTROD 6FR ACCUSTICK II STERILE DISPOSABLE	BOTH IP/OP	$120.00 	$88.80	$0.00	$96.00	$65.16	$65.16	$0.00	$0.00	$0.00	$25.01	$89.06	$89.06	$0.00	$0.00	$25.01	$0.00	$70.98	$70.98	$0.00	$60.00	$95.04	$96.00	$0.00		$0.00	$18.78	$0.00	$0.00	$19.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001207111	SUP	HCPCS C1729		M001207111  -  INTRODUCER SHEATH .018IN FLOPPY 60CM 6CM RADIOPQ GWIRE	BOTH IP/OP	$451.88 	$334.39	$0.00	$361.50	$245.37	$245.37	$0.00	$0.00	$0.00	$94.18	$335.38	$335.38	$0.00	$0.00	$94.17	$0.00	$267.28	$267.28	$0.00	$225.94	$357.89	$361.50	$0.00		$0.00	$70.72	$0.00	$0.00	$71.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001208500	SUP	Custom 27203010		M001208500  -  SET GSTRM 18GA BVL NDL AFFIXATION DEV BR-MLR TFSTNR SET	BOTH IP/OP	$131.25 	$97.13	$0.00	$105.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.41	$97.41	$0.00	$0.00	$27.35	$0.00	$0.00	$0.00	$0.00	$65.63	$103.95	$105.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001221000	SUP	HCPCS C1729		M001221000  -  CATHETER DRAIN 8FR 30CM LOCK STIFFEN CANNU AMPLATZ ANCHOR	BOTH IP/OP	$189.38 	$140.14	$0.00	$151.50	$102.83	$102.83	$0.00	$0.00	$0.00	$39.47	$140.55	$140.55	$0.00	$0.00	$39.47	$0.00	$112.02	$112.02	$0.00	$94.69	$149.99	$151.50	$0.00		$0.00	$29.64	$0.00	$0.00	$30.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001221010	SUP	HCPCS C1729		M001221010  -  CATHETER DRAIN 10FR 30CM LOCK STIFFEN CANNU AMPLATZ ANCHOR	BOTH IP/OP	$189.38 	$140.14	$0.00	$151.50	$102.83	$102.83	$0.00	$0.00	$0.00	$39.47	$140.55	$140.55	$0.00	$0.00	$39.47	$0.00	$112.02	$112.02	$0.00	$94.69	$149.99	$151.50	$0.00		$0.00	$29.64	$0.00	$0.00	$30.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001221020	SUP	HCPCS C2617		M001221020  -  CATHETER DRAIN 12FR 30CM LOCK STIFFEN CANNU LATEX FREE	BOTH IP/OP	$189.38 	$140.14	$0.00	$151.50	$85.22	$85.22	$0.00	$0.00	$0.00	$39.47	$140.55	$140.55	$0.00	$0.00	$39.47	$0.00	$112.02	$112.02	$0.00	$94.69	$149.99	$151.50	$0.00		$0.00	$29.64	$0.00	$0.00	$30.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001221360	SUP	HCPCS C2617		M001221360  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 2.66MM	BOTH IP/OP	$245.63 	$181.77	$0.00	$196.50	$110.53	$110.53	$0.00	$0.00	$0.00	$51.19	$182.30	$182.30	$0.00	$0.00	$51.19	$0.00	$145.29	$145.29	$0.00	$122.81	$194.54	$196.50	$0.00		$0.00	$38.44	$0.00	$0.00	$39.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001221370	SUP	HCPCS C2617		M001221370  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 2.66MM	BOTH IP/OP	$245.63 	$181.77	$0.00	$196.50	$110.53	$110.53	$0.00	$0.00	$0.00	$51.19	$182.30	$182.30	$0.00	$0.00	$51.19	$0.00	$145.29	$145.29	$0.00	$122.81	$194.54	$196.50	$0.00		$0.00	$38.44	$0.00	$0.00	$39.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001221380	SUP	HCPCS C2617		M001221380  -  STENT NEPHROURETERAL 2.66MM 26CM STIFFENING CANNU INTERNAL	BOTH IP/OP	$245.63 	$181.77	$0.00	$196.50	$110.53	$110.53	$0.00	$0.00	$0.00	$51.19	$182.30	$182.30	$0.00	$0.00	$51.19	$0.00	$145.29	$145.29	$0.00	$122.81	$194.54	$196.50	$0.00		$0.00	$38.44	$0.00	$0.00	$39.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001221390	SUP	HCPCS C2617		M001221390  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 2.66MM	BOTH IP/OP	$245.63 	$181.77	$0.00	$196.50	$110.53	$110.53	$0.00	$0.00	$0.00	$51.19	$182.30	$182.30	$0.00	$0.00	$51.19	$0.00	$145.29	$145.29	$0.00	$122.81	$194.54	$196.50	$0.00		$0.00	$38.44	$0.00	$0.00	$39.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001221400	SUP	HCPCS C2617		M001221400  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM	BOTH IP/OP	$245.63 	$181.77	$0.00	$196.50	$110.53	$110.53	$0.00	$0.00	$0.00	$51.19	$182.30	$182.30	$0.00	$0.00	$51.19	$0.00	$145.29	$145.29	$0.00	$122.81	$194.54	$196.50	$0.00		$0.00	$38.44	$0.00	$0.00	$39.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001221410	SUP	HCPCS C2617		M001221410  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM	BOTH IP/OP	$245.63 	$181.77	$0.00	$196.50	$110.53	$110.53	$0.00	$0.00	$0.00	$51.19	$182.30	$182.30	$0.00	$0.00	$51.19	$0.00	$145.29	$145.29	$0.00	$122.81	$194.54	$196.50	$0.00		$0.00	$38.44	$0.00	$0.00	$39.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001221420	SUP	HCPCS C2617		M001221420  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM	BOTH IP/OP	$245.63 	$181.77	$0.00	$196.50	$110.53	$110.53	$0.00	$0.00	$0.00	$51.19	$182.30	$182.30	$0.00	$0.00	$51.19	$0.00	$145.29	$145.29	$0.00	$122.81	$194.54	$196.50	$0.00		$0.00	$38.44	$0.00	$0.00	$39.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001221430	SUP	HCPCS C2617		M001221430  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM	BOTH IP/OP	$245.63 	$181.77	$0.00	$196.50	$110.53	$110.53	$0.00	$0.00	$0.00	$51.19	$182.30	$182.30	$0.00	$0.00	$51.19	$0.00	$145.29	$145.29	$0.00	$122.81	$194.54	$196.50	$0.00		$0.00	$38.44	$0.00	$0.00	$39.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001225140	SUP	HCPCS C1729		M001225140  -  SET NEPHROSTOMY PIGTAIL CURVE 8FR FIRM DUROMETER LOCK VTC	BOTH IP/OP	$176.25 	$130.43	$0.00	$141.00	$95.70	$95.70	$0.00	$0.00	$0.00	$36.73	$130.81	$130.81	$0.00	$0.00	$36.73	$0.00	$104.25	$104.25	$0.00	$88.13	$139.59	$141.00	$0.00		$0.00	$27.58	$0.00	$0.00	$28.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001225510	SUP	HCPCS C2617		M001225510  -  STENT URET .038IN LG REG PGTL CRV 8FR 24CM DRMTR RADOPQ DRN	BOTH IP/OP	$313.50 	$231.99	$0.00	$250.80	$141.08	$141.08	$0.00	$0.00	$0.00	$65.34	$232.68	$232.68	$0.00	$0.00	$65.33	$0.00	$185.44	$185.44	$0.00	$156.75	$248.29	$250.80	$0.00		$0.00	$49.06	$0.00	$0.00	$49.91	$0.00	$0.00	$0.00	$0.00	$0.00
M001225520	SUP	HCPCS C1768		STENT URET 8FR 26CM REG DRMTR LG DRAIN HOLE PROX PGTL LCK	BOTH IP/OP	$303.28 	$224.43	$0.00	$242.62	$136.47	$136.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.64	$240.20	$242.62	$0.00		$0.00	$47.46	$0.00	$0.00	$48.28	$0.00	$0.00	$0.00	$0.00	$0.00
M001262160	SUP	Custom 27203010		M001262160  -  NEEDLE ELECTROSURGICAL STANDARD UMBRELLA 5CM 15CM ARRAY TIP	BOTH IP/OP	"$5,362.50 "	"$3,968.25"	$0.00	"$4,290.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,980.05"	"$3,980.05"	$0.00	$0.00	"$1,117.55"	$0.00	$0.00	$0.00	$0.00	"$2,681.25"	"$4,247.10"	"$4,290.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001271460	SUP	HCPCS C1729		M001271460  -  CATHETER DRAIN LOOP 8FR 25CM QUICKSTICK FLEXIMA HYDPHI	BOTH IP/OP	$170.18 	$125.93	$0.00	$136.14	$92.41	$92.41	$0.00	$0.00	$0.00	$35.47	$126.30	$126.30	$0.00	$0.00	$35.46	$0.00	$100.66	$100.66	$0.00	$85.09	$134.78	$136.14	$0.00		$0.00	$26.63	$0.00	$0.00	$27.09	$0.00	$0.00	$0.00	$0.00	$0.00
M001271470	SUP	HCPCS C1729		M001271470  -  CATHETER DRAIN LOOP 10FR 25CM QUICKSTICK FLEXIMA HYDPHI	BOTH IP/OP	$170.18 	$125.93	$0.00	$136.14	$92.41	$92.41	$0.00	$0.00	$0.00	$35.47	$126.30	$126.30	$0.00	$0.00	$35.46	$0.00	$100.66	$100.66	$0.00	$85.09	$134.78	$136.14	$0.00		$0.00	$26.63	$0.00	$0.00	$27.09	$0.00	$0.00	$0.00	$0.00	$0.00
M001271540	SUP	HCPCS C1729		M001271540  -  CATHETER DRAIN PIGTAIL CURVE 8FR 35CM FLEXIBLE STIFF CANNU	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271550	SUP	HCPCS C1729		M001271550  -  CATHETER DRAIN 10FR 35CM METAL AND FLEXIBLE STIFFENING CANNU	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271560	SUP	HCPCS C1729		M001271560  -  CATHETER DRAIN PIGTAIL CURVE 8FR 35CM FLEXIBLE STIFF CANNU	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271570	SUP	HCPCS C1729		M001271570  -  CATHETER DRAIN PIGTAIL CURVE 10FR 35CM FLEXIBLE STIFF CANNU	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271580	SUP	HCPCS C1729		M001271580  -  CATHETER DRAIN PIGTAIL CURVE 12FR 35CM FLEXIBLE STIFF CANNU	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271590	SUP	HCPCS C1729		M001271590  -  CATHETER DRAIN PIGTAIL CURVE 14FR 35CM FLEXIBLE STIFF CANNU	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271600	SUP	HCPCS C1729		M001271600  -  CATHETER DRAIN PIGTAIL CURVE 10FR 35CM FLEXIBLE STIFF CANNU	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271610	SUP	HCPCS C1729		M001271610  -  CATHETER DRN PGTL CRV 12FR 35CM FLXB STF CNN LCK DRMTR SFT	BOTH IP/OP	$235.25 	$174.09	$0.00	$188.20	$127.74	$127.74	$0.00	$0.00	$0.00	$49.03	$174.60	$174.60	$0.00	$0.00	$49.03	$0.00	$139.15	$139.15	$0.00	$117.63	$186.32	$188.20	$0.00		$0.00	$36.82	$0.00	$0.00	$37.45	$0.00	$0.00	$0.00	$0.00	$0.00
M001271620	SUP	HCPCS C1729		M001271620  -  CATHETER DRAIN PIGTAIL CURVE 14FR 35CM FLEXIBLE STIFF CANNU	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271630	SUP	HCPCS C1729		M001271630  -  KIT DRAIN 8FR 35CM FIRM DUROMETER LARGE HOLE FLEXIMA	BOTH IP/OP	$344.00 	$254.56	$0.00	$275.20	$186.79	$186.79	$0.00	$0.00	$0.00	$71.70	$255.32	$255.32	$0.00	$0.00	$71.69	$0.00	$203.48	$203.48	$0.00	$172.00	$272.45	$275.20	$0.00		$0.00	$53.84	$0.00	$0.00	$54.76	$0.00	$0.00	$0.00	$0.00	$0.00
M001271640	SUP	HCPCS C1729		M001271640  -  KIT DRAIN 10FR 35CM FIRM DUROMETER LARGE HOLE FLEXIMA	BOTH IP/OP	$344.00 	$254.56	$0.00	$275.20	$186.79	$186.79	$0.00	$0.00	$0.00	$71.70	$255.32	$255.32	$0.00	$0.00	$71.69	$0.00	$203.48	$203.48	$0.00	$172.00	$272.45	$275.20	$0.00		$0.00	$53.84	$0.00	$0.00	$54.76	$0.00	$0.00	$0.00	$0.00	$0.00
M001271650	SUP	HCPCS C1729		M001271650  -  CATHETER DRAIN REGULAR PIGTAIL CURVE 8FR 35CM KIT LOCK	BOTH IP/OP	$344.00 	$254.56	$0.00	$275.20	$186.79	$186.79	$0.00	$0.00	$0.00	$71.70	$255.32	$255.32	$0.00	$0.00	$71.69	$0.00	$203.48	$203.48	$0.00	$172.00	$272.45	$275.20	$0.00		$0.00	$53.84	$0.00	$0.00	$54.76	$0.00	$0.00	$0.00	$0.00	$0.00
M001271660	SUP	HCPCS C1729		M001271660  -  KIT DRAIN REGULAR 10FR 35CM DUROMETER LARGE HOLE FLEXIMA	BOTH IP/OP	$344.00 	$254.56	$0.00	$275.20	$186.79	$186.79	$0.00	$0.00	$0.00	$71.70	$255.32	$255.32	$0.00	$0.00	$71.69	$0.00	$203.48	$203.48	$0.00	$172.00	$272.45	$275.20	$0.00		$0.00	$53.84	$0.00	$0.00	$54.76	$0.00	$0.00	$0.00	$0.00	$0.00
M001271770	SUP	HCPCS C1729		M001271770  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 8FR 25CM LOCK DUROMETER	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271780	SUP	HCPCS C1729		M001271780  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK DUROMETER	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271790	SUP	HCPCS C1729		M001271790  -  CATHETER NEPHROSTOMY REGULAR PIGTAIL CURVE 8FR 25CM LOCK	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271800	SUP	HCPCS C1729		M001271800  -  CATHETER NEPHROSTOMY REGULAR PIGTAIL CURVE 10FR 25CM LOCK	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271810	SUP	HCPCS C1729		M001271810  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 12FR 25CM LOCK DUROMETER	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271820	SUP	Custom 27203010		M001271820  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 14FR 25CM LOCK DUROMETER	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$0.00	$0.00	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001271830	SUP	HCPCS C1726		M001271830  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK DUROMETER	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271840	SUP	HCPCS C1729		M001271840  -  CATHETER DRAIN 12FR 25CM RADIOPQ SOFT DUROMETER TEMP TIP	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271850	SUP	HCPCS C1729		M001271850  -  CATHETER NPHSTM PGTL CRV 14FR 25CM LCK SFT DRMTR FLXM PU	BOTH IP/OP	$190.30 	$140.82	$0.00	$152.24	$103.33	$103.33	$0.00	$0.00	$0.00	$39.66	$141.24	$141.24	$0.00	$0.00	$39.66	$0.00	$112.56	$112.56	$0.00	$95.15	$150.72	$152.24	$0.00		$0.00	$29.78	$0.00	$0.00	$30.30	$0.00	$0.00	$0.00	$0.00	$0.00
M001271860	SUP	Custom 27203010		M001271860  -  SET NEPHROSTOMY PIGTAIL CURVE 8FR 25CM LOCK REGULAR	BOTH IP/OP	$344.00 	$254.56	$0.00	$275.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$255.32	$255.32	$0.00	$0.00	$71.69	$0.00	$0.00	$0.00	$0.00	$172.00	$272.45	$275.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001271870	SUP	Custom 27203010		M001271870  -  KIT NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK REGULAR	BOTH IP/OP	$344.00 	$254.56	$0.00	$275.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$255.32	$255.32	$0.00	$0.00	$71.69	$0.00	$0.00	$0.00	$0.00	$172.00	$272.45	$275.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001271880	SUP	Custom 27203010		M001271880  -  KIT NEPHROSTOMY PIGTAIL CURVE 12FR 25CM LOCK REGULAR	BOTH IP/OP	$344.00 	$254.56	$0.00	$275.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$255.32	$255.32	$0.00	$0.00	$71.69	$0.00	$0.00	$0.00	$0.00	$172.00	$272.45	$275.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001271900	SUP	Custom 27203010		M001271900  -  KIT NEPHROSTOMY J PIGTAIL CURVE 18FR 21GA 25CM DUROMETER	BOTH IP/OP	$344.00 	$254.56	$0.00	$275.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$255.32	$255.32	$0.00	$0.00	$71.69	$0.00	$0.00	$0.00	$0.00	$172.00	$272.45	$275.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001272600	SUP	HCPCS C1729		M001272600  -  CATH DRAIN 8FR 35CM LCK PGTL REG DRMTR RADIOPQ BIL PU HYDPHI	BOTH IP/OP	$200.63 	$148.47	$0.00	$160.50	$108.94	$108.94	$0.00	$0.00	$0.00	$41.82	$148.90	$148.90	$0.00	$0.00	$41.81	$0.00	$118.67	$118.67	$0.00	$100.31	$158.90	$160.50	$0.00		$0.00	$31.40	$0.00	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001272610	SUP	HCPCS C1729		M001272610  -  CATH DRAIN 10FR 35CM LCK REG DRMTR RADIOPQ BIL PU HYDPHI	BOTH IP/OP	$200.63 	$148.47	$0.00	$160.50	$108.94	$108.94	$0.00	$0.00	$0.00	$41.82	$148.90	$148.90	$0.00	$0.00	$41.81	$0.00	$118.67	$118.67	$0.00	$100.31	$158.90	$160.50	$0.00		$0.00	$31.40	$0.00	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001272620	SUP	HCPCS C1729		M001272620  -  CATH DRAIN 12FR 35CM LCK REG DRMTR RADIOPQ BIL PU HYDPHI	BOTH IP/OP	$200.63 	$148.47	$0.00	$160.50	$108.94	$108.94	$0.00	$0.00	$0.00	$41.82	$148.90	$148.90	$0.00	$0.00	$41.81	$0.00	$118.67	$118.67	$0.00	$100.31	$158.90	$160.50	$0.00		$0.00	$31.40	$0.00	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001272630	SUP	HCPCS C1729		M001272630  -  CATH DRAIN 14FR 35CM LCK PGTL REG DRMTR RADIOPQ BIL PU FLXM	BOTH IP/OP	$200.63 	$148.47	$0.00	$160.50	$108.94	$108.94	$0.00	$0.00	$0.00	$41.82	$148.90	$148.90	$0.00	$0.00	$41.81	$0.00	$118.67	$118.67	$0.00	$100.31	$158.90	$160.50	$0.00		$0.00	$31.40	$0.00	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001272640	SUP	HCPCS C1729		M001272640  -  CATH DRAIN 8FR 35CM LCK FIRM DRMTR RADIOPQ BIL PU HYDPHI	BOTH IP/OP	$200.63 	$148.47	$0.00	$160.50	$108.94	$108.94	$0.00	$0.00	$0.00	$41.82	$148.90	$148.90	$0.00	$0.00	$41.81	$0.00	$118.67	$118.67	$0.00	$100.31	$158.90	$160.50	$0.00		$0.00	$31.40	$0.00	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001272650	SUP	HCPCS C1729		M001272650  -  CATH DRAIN 10FR 35CM LCK REG DRMTR RADIOPQ BIL PU HYDPHI	BOTH IP/OP	$200.63 	$148.47	$0.00	$160.50	$108.94	$108.94	$0.00	$0.00	$0.00	$41.82	$148.90	$148.90	$0.00	$0.00	$41.81	$0.00	$118.67	$118.67	$0.00	$100.31	$158.90	$160.50	$0.00		$0.00	$31.40	$0.00	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001272660	SUP	HCPCS C1729		M001272660  -  CATH DRAIN 10FR 35CM LCK SFT DRMTR RADIOPQ BIL PU HYDPHI	BOTH IP/OP	$200.63 	$148.47	$0.00	$160.50	$108.94	$108.94	$0.00	$0.00	$0.00	$41.82	$148.90	$148.90	$0.00	$0.00	$41.81	$0.00	$118.67	$118.67	$0.00	$100.31	$158.90	$160.50	$0.00		$0.00	$31.40	$0.00	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001272670	SUP	HCPCS C1729		M001272670  -  CATH DRAIN 12FR 35CM LCK SFT DRMTR RADIOPQ BIL PU HYDPHI	BOTH IP/OP	$200.63 	$148.47	$0.00	$160.50	$108.94	$108.94	$0.00	$0.00	$0.00	$41.82	$148.90	$148.90	$0.00	$0.00	$41.81	$0.00	$118.67	$118.67	$0.00	$100.31	$158.90	$160.50	$0.00		$0.00	$31.40	$0.00	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001273130	SUP	HCPCS C1729		M001273130  -  CATHETER DRAIN 30CM 2 LUMEN REGULAR DUROMETER VANSONNENBERG	BOTH IP/OP	$364.25 	$269.55	$0.00	$291.40	$197.79	$197.79	$0.00	$0.00	$0.00	$75.92	$270.35	$270.35	$0.00	$0.00	$75.91	$0.00	$215.45	$215.45	$0.00	$182.13	$288.49	$291.40	$0.00		$0.00	$57.01	$0.00	$0.00	$57.99	$0.00	$0.00	$0.00	$0.00	$0.00
M001274000	SUP	HCPCS C2617		M001274000  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 20CM	BOTH IP/OP	$266.25 	$197.03	$0.00	$213.00	$119.81	$119.81	$0.00	$0.00	$0.00	$55.49	$197.61	$197.61	$0.00	$0.00	$55.49	$0.00	$157.49	$157.49	$0.00	$133.13	$210.87	$213.00	$0.00		$0.00	$41.67	$0.00	$0.00	$42.39	$0.00	$0.00	$0.00	$0.00	$0.00
M001274010	SUP	HCPCS C2617		M001274010  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 22CM	BOTH IP/OP	$266.25 	$197.03	$0.00	$213.00	$119.81	$119.81	$0.00	$0.00	$0.00	$55.49	$197.61	$197.61	$0.00	$0.00	$55.49	$0.00	$157.49	$157.49	$0.00	$133.13	$210.87	$213.00	$0.00		$0.00	$41.67	$0.00	$0.00	$42.39	$0.00	$0.00	$0.00	$0.00	$0.00
M001274020	SUP	HCPCS C2617		M001274020  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 24CM	BOTH IP/OP	$266.25 	$197.03	$0.00	$213.00	$119.81	$119.81	$0.00	$0.00	$0.00	$55.49	$197.61	$197.61	$0.00	$0.00	$55.49	$0.00	$157.49	$157.49	$0.00	$133.13	$210.87	$213.00	$0.00		$0.00	$41.67	$0.00	$0.00	$42.39	$0.00	$0.00	$0.00	$0.00	$0.00
M001274030	SUP	HCPCS C2617		M001274030  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 26CM	BOTH IP/OP	$266.25 	$197.03	$0.00	$213.00	$119.81	$119.81	$0.00	$0.00	$0.00	$55.49	$197.61	$197.61	$0.00	$0.00	$55.49	$0.00	$157.49	$157.49	$0.00	$133.13	$210.87	$213.00	$0.00		$0.00	$41.67	$0.00	$0.00	$42.39	$0.00	$0.00	$0.00	$0.00	$0.00
M001274040	SUP	HCPCS C2617		M001274040  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 28CM	BOTH IP/OP	$266.25 	$197.03	$0.00	$213.00	$119.81	$119.81	$0.00	$0.00	$0.00	$55.49	$197.61	$197.61	$0.00	$0.00	$55.49	$0.00	$157.49	$157.49	$0.00	$133.13	$210.87	$213.00	$0.00		$0.00	$41.67	$0.00	$0.00	$42.39	$0.00	$0.00	$0.00	$0.00	$0.00
M001274050	SUP	HCPCS C2617		M001274050  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 20CM	BOTH IP/OP	$266.25 	$197.03	$0.00	$213.00	$119.81	$119.81	$0.00	$0.00	$0.00	$55.49	$197.61	$197.61	$0.00	$0.00	$55.49	$0.00	$157.49	$157.49	$0.00	$133.13	$210.87	$213.00	$0.00		$0.00	$41.67	$0.00	$0.00	$42.39	$0.00	$0.00	$0.00	$0.00	$0.00
M001274060	SUP	HCPCS C2617		M001274060  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 22CM	BOTH IP/OP	$266.25 	$197.03	$0.00	$213.00	$119.81	$119.81	$0.00	$0.00	$0.00	$55.49	$197.61	$197.61	$0.00	$0.00	$55.49	$0.00	$157.49	$157.49	$0.00	$133.13	$210.87	$213.00	$0.00		$0.00	$41.67	$0.00	$0.00	$42.39	$0.00	$0.00	$0.00	$0.00	$0.00
M001274070	SUP	HCPCS C2617		M001274070  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 24CM	BOTH IP/OP	$266.25 	$197.03	$0.00	$213.00	$119.81	$119.81	$0.00	$0.00	$0.00	$55.49	$197.61	$197.61	$0.00	$0.00	$55.49	$0.00	$157.49	$157.49	$0.00	$133.13	$210.87	$213.00	$0.00		$0.00	$41.67	$0.00	$0.00	$42.39	$0.00	$0.00	$0.00	$0.00	$0.00
M001274080	SUP	HCPCS C2617		M001274080  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 26CM	BOTH IP/OP	$266.25 	$197.03	$0.00	$213.00	$119.81	$119.81	$0.00	$0.00	$0.00	$55.49	$197.61	$197.61	$0.00	$0.00	$55.49	$0.00	$157.49	$157.49	$0.00	$133.13	$210.87	$213.00	$0.00		$0.00	$41.67	$0.00	$0.00	$42.39	$0.00	$0.00	$0.00	$0.00	$0.00
M001274090	SUP	HCPCS C2617		M001274090  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 28CM	BOTH IP/OP	$266.25 	$197.03	$0.00	$213.00	$119.81	$119.81	$0.00	$0.00	$0.00	$55.49	$197.61	$197.61	$0.00	$0.00	$55.49	$0.00	$157.49	$157.49	$0.00	$133.13	$210.87	$213.00	$0.00		$0.00	$41.67	$0.00	$0.00	$42.39	$0.00	$0.00	$0.00	$0.00	$0.00
M001274110	SUP	HCPCS C2617		M001274110  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 22CM DRAIN	BOTH IP/OP	$423.75 	$313.58	$0.00	$339.00	$190.69	$190.69	$0.00	$0.00	$0.00	$88.32	$314.51	$314.51	$0.00	$0.00	$88.31	$0.00	$250.65	$250.65	$0.00	$211.88	$335.61	$339.00	$0.00		$0.00	$66.32	$0.00	$0.00	$67.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001274120	SUP	HCPCS C2617		M001274120  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 24CM DRAIN	BOTH IP/OP	$423.75 	$313.58	$0.00	$339.00	$190.69	$190.69	$0.00	$0.00	$0.00	$88.32	$314.51	$314.51	$0.00	$0.00	$88.31	$0.00	$250.65	$250.65	$0.00	$211.88	$335.61	$339.00	$0.00		$0.00	$66.32	$0.00	$0.00	$67.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001274130	SUP	HCPCS C2617		M001274130  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 26CM DRAIN	BOTH IP/OP	$423.75 	$313.58	$0.00	$339.00	$190.69	$190.69	$0.00	$0.00	$0.00	$88.32	$314.51	$314.51	$0.00	$0.00	$88.31	$0.00	$250.65	$250.65	$0.00	$211.88	$335.61	$339.00	$0.00		$0.00	$66.32	$0.00	$0.00	$67.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001274140	SUP	HCPCS C2617		M001274140  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 28CM DRAIN	BOTH IP/OP	$423.75 	$313.58	$0.00	$339.00	$190.69	$190.69	$0.00	$0.00	$0.00	$88.32	$314.51	$314.51	$0.00	$0.00	$88.31	$0.00	$250.65	$250.65	$0.00	$211.88	$335.61	$339.00	$0.00		$0.00	$66.32	$0.00	$0.00	$67.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001274150	SUP	HCPCS C2617		M001274150  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 20CM DRAIN	BOTH IP/OP	$423.75 	$313.58	$0.00	$339.00	$190.69	$190.69	$0.00	$0.00	$0.00	$88.32	$314.51	$314.51	$0.00	$0.00	$88.31	$0.00	$250.65	$250.65	$0.00	$211.88	$335.61	$339.00	$0.00		$0.00	$66.32	$0.00	$0.00	$67.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001274160	SUP	HCPCS C2617		M001274160  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 22CM DRAIN	BOTH IP/OP	$423.75 	$313.58	$0.00	$339.00	$190.69	$190.69	$0.00	$0.00	$0.00	$88.32	$314.51	$314.51	$0.00	$0.00	$88.31	$0.00	$250.65	$250.65	$0.00	$211.88	$335.61	$339.00	$0.00		$0.00	$66.32	$0.00	$0.00	$67.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001274170	SUP	HCPCS C2617		M001274170  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 24CM DRAIN	BOTH IP/OP	$423.75 	$313.58	$0.00	$339.00	$190.69	$190.69	$0.00	$0.00	$0.00	$88.32	$314.51	$314.51	$0.00	$0.00	$88.31	$0.00	$250.65	$250.65	$0.00	$211.88	$335.61	$339.00	$0.00		$0.00	$66.32	$0.00	$0.00	$67.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001274180	SUP	HCPCS C2617		M001274180  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 26CM DRAIN	BOTH IP/OP	$423.75 	$313.58	$0.00	$339.00	$190.69	$190.69	$0.00	$0.00	$0.00	$88.32	$314.51	$314.51	$0.00	$0.00	$88.31	$0.00	$250.65	$250.65	$0.00	$211.88	$335.61	$339.00	$0.00		$0.00	$66.32	$0.00	$0.00	$67.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001274190	SUP	HCPCS C2617		M001274190  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 28CM DRAIN	BOTH IP/OP	$423.75 	$313.58	$0.00	$339.00	$190.69	$190.69	$0.00	$0.00	$0.00	$88.32	$314.51	$314.51	$0.00	$0.00	$88.31	$0.00	$250.65	$250.65	$0.00	$211.88	$335.61	$339.00	$0.00		$0.00	$66.32	$0.00	$0.00	$67.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001281560	SUP	HCPCS C1729		M001281560  -  CATHETER DRAIN 8FR 35CM 1 LUMEN REGULAR DUROMETER FLEXIBLE	BOTH IP/OP	$197.63 	$146.25	$0.00	$158.10	$107.31	$107.31	$0.00	$0.00	$0.00	$41.19	$146.68	$146.68	$0.00	$0.00	$41.19	$0.00	$116.90	$116.90	$0.00	$98.81	$156.52	$158.10	$0.00		$0.00	$30.93	$0.00	$0.00	$31.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001281570	SUP	HCPCS C1729		M001281570  -  CATHETER DRAIN 10FR 35CM REGULAR DUROMETER DISSOLVABLE TIP	BOTH IP/OP	$197.63 	$146.25	$0.00	$158.10	$107.31	$107.31	$0.00	$0.00	$0.00	$41.19	$146.68	$146.68	$0.00	$0.00	$41.19	$0.00	$116.90	$116.90	$0.00	$98.81	$156.52	$158.10	$0.00		$0.00	$30.93	$0.00	$0.00	$31.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001281580	SUP	HCPCS C1729		M001281580  -  CATHETER DRAIN REGULAR 12FR 35CM TEMP TIP FLEXIMA HYDPHI	BOTH IP/OP	$197.63 	$146.25	$0.00	$158.10	$107.31	$107.31	$0.00	$0.00	$0.00	$41.19	$146.68	$146.68	$0.00	$0.00	$41.19	$0.00	$116.90	$116.90	$0.00	$98.81	$156.52	$158.10	$0.00		$0.00	$30.93	$0.00	$0.00	$31.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001281590	SUP	HCPCS C1729		M001281590  -  CATHETER DRAIN 14FR 35CM REGULAR DUROMETER DISSOLVABLE TIP	BOTH IP/OP	$197.63 	$146.25	$0.00	$158.10	$107.31	$107.31	$0.00	$0.00	$0.00	$41.19	$146.68	$146.68	$0.00	$0.00	$41.19	$0.00	$116.90	$116.90	$0.00	$98.81	$156.52	$158.10	$0.00		$0.00	$30.93	$0.00	$0.00	$31.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001281660	SUP	Custom 27203010		M001281660  -  KIT NEPHROSTOMY .018IN PIGTAIL CURVE FLOPPY 10FR 21GA 25CM	BOTH IP/OP	$364.13 	$269.46	$0.00	$291.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.25	$270.25	$0.00	$0.00	$75.88	$0.00	$0.00	$0.00	$0.00	$182.06	$288.39	$291.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001281790	SUP	HCPCS C1726		M001281790  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 8FR 25CM LOCK REGULAR	BOTH IP/OP	$197.63 	$146.25	$0.00	$158.10	$107.31	$107.31	$0.00	$0.00	$0.00	$41.19	$146.68	$146.68	$0.00	$0.00	$41.19	$0.00	$116.90	$116.90	$0.00	$98.81	$156.52	$158.10	$0.00		$0.00	$30.93	$0.00	$0.00	$31.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001281800	SUP	HCPCS C1729		M001281800  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK SOFT	BOTH IP/OP	$197.63 	$146.25	$0.00	$158.10	$107.31	$107.31	$0.00	$0.00	$0.00	$41.19	$146.68	$146.68	$0.00	$0.00	$41.19	$0.00	$116.90	$116.90	$0.00	$98.81	$156.52	$158.10	$0.00		$0.00	$30.93	$0.00	$0.00	$31.46	$0.00	$0.00	$0.00	$0.00	$0.00
M001281810	SUP	Custom 27203010		M001281810  -  CATHETER NEPHROSTOMY 12FR 25CM REGULAR DUROMETER DRAIN HOLE	BOTH IP/OP	$197.63 	$146.25	$0.00	$158.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.68	$146.68	$0.00	$0.00	$41.19	$0.00	$0.00	$0.00	$0.00	$98.81	$156.52	$158.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001281820	SUP	Custom 27203010		M001281820  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 14FR 25CM LOCK REGULAR	BOTH IP/OP	$197.63 	$146.25	$0.00	$158.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.68	$146.68	$0.00	$0.00	$41.19	$0.00	$0.00	$0.00	$0.00	$98.81	$156.52	$158.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001282600	SUP	HCPCS C1729		M001282600  -  CATH DRAIN 8FR 35CM LCK REG DRMTR TMPTP RADIOPQ BIL PU	BOTH IP/OP	$200.63 	$148.47	$0.00	$160.50	$108.94	$108.94	$0.00	$0.00	$0.00	$41.82	$148.90	$148.90	$0.00	$0.00	$41.81	$0.00	$118.67	$118.67	$0.00	$100.31	$158.90	$160.50	$0.00		$0.00	$31.40	$0.00	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001282610	SUP	HCPCS C1729		M001282610  -  CATH DRAIN 10FR 35CM LCK TEMP TIP RADIOPQ BIL PU HYDPHI FLXM	BOTH IP/OP	$200.63 	$148.47	$0.00	$160.50	$108.94	$108.94	$0.00	$0.00	$0.00	$41.82	$148.90	$148.90	$0.00	$0.00	$41.81	$0.00	$118.67	$118.67	$0.00	$100.31	$158.90	$160.50	$0.00		$0.00	$31.40	$0.00	$0.00	$31.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001291650	SUP	HCPCS C1729		M001291650  -  KIT DRAIN 35CM 8FR PU HYDPHI FLXM BIL REG DRMTR STRL DISP	BOTH IP/OP	$402.85 	$298.11	$0.00	$322.28	$218.75	$218.75	$0.00	$0.00	$0.00	$83.96	$299.00	$299.00	$0.00	$0.00	$83.95	$0.00	$238.29	$238.29	$0.00	$201.43	$319.06	$322.28	$0.00		$0.00	$63.05	$0.00	$0.00	$64.13	$0.00	$0.00	$0.00	$0.00	$0.00
M0013120021	SUP	Custom 27803010		M0013120021  -  COIL EMBOLIZATION .018IN HELIX STR 2MM PLATINUM FIBER	BOTH IP/OP	$136.50 	$101.01	$0.00	$109.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.31	$101.31	$0.00	$0.00	$28.45	$0.00	$0.00	$0.00	$0.00	$68.25	$108.11	$109.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0013120051	SUP	Custom 27803010		M0013120051  -  COIL EMBOLIZATION STR 2MM 50MM 5MM 18 COIL PLATINUM FIBER	BOTH IP/OP	$136.50 	$101.01	$0.00	$109.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.31	$101.31	$0.00	$0.00	$28.45	$0.00	$0.00	$0.00	$0.00	$68.25	$108.11	$109.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0013120211	SUP	Custom 27803010		M0013120211  -  COIL EMBOLIZATION 2MM 5MM 10MM 8-18 COIL FIBERED PLATINUM	BOTH IP/OP	$198.83 	$147.13	$0.00	$159.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.57	$147.57	$0.00	$0.00	$41.44	$0.00	$0.00	$0.00	$0.00	$99.42	$157.47	$159.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0013120221	SUP	Custom 27803010		M0013120221  -  COIL EMBOLIZATION .018IN HELIX 4MM 4MM COMPLEX PLATINUM	BOTH IP/OP	$994.15 	$735.67	$0.00	$795.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$737.86	$737.86	$0.00	$0.00	$207.18	$0.00	$0.00	$0.00	$0.00	$497.08	$787.37	$795.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0013120331	SUP	Custom 27803010		M0013120331  -  COIL EMBOLIZATION .018IN HELIX 6MM 6MM COMPLEX PLATINUM	BOTH IP/OP	$198.83 	$147.13	$0.00	$159.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.57	$147.57	$0.00	$0.00	$41.44	$0.00	$0.00	$0.00	$0.00	$99.42	$157.47	$159.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0013120431	SUP	Custom 27803010		M0013120431  -  COIL EMBOLIZATION .018IN HELIX 4MM 30MM COMPLEX PLATINUM	BOTH IP/OP	"$1,025.05 "	$758.54	$0.00	$820.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$760.79	$760.79	$0.00	$0.00	$213.62	$0.00	$0.00	$0.00	$0.00	$512.53	$811.84	$820.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0013120441	SUP	Custom 27803010		M0013120441  -  COIL EMBOLIZATION .018IN HELIX 7MM 10MM COMPLEX PLATINUM	BOTH IP/OP	$205.01 	$151.71	$0.00	$164.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.16	$152.16	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$0.00	$102.51	$162.37	$164.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0013120551	SUP	Custom 27803010		M0013120551  -  COIL EMBOLIZATION .018IN HELICAL 8MM 12MM FIBERED COMPLEX	BOTH IP/OP	"$1,025.05 "	$758.54	$0.00	$820.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$760.79	$760.79	$0.00	$0.00	$213.62	$0.00	$0.00	$0.00	$0.00	$512.53	$811.84	$820.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0013120661	SUP	Custom 27803010		M0013120661  -  COIL EMBOLIZATION .018IN HELICAL COMPLEX 10MM 14MM 60MM	BOTH IP/OP	$205.01 	$151.71	$0.00	$164.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.16	$152.16	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$0.00	$102.51	$162.37	$164.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0013120771	SUP	Custom 27803010		M0013120771  -  COIL EMBOLIZATION .018IN HELIX 11MM 17MM COMPLEX PLATINUM	BOTH IP/OP	$205.01 	$151.71	$0.00	$164.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.16	$152.16	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$0.00	$102.51	$162.37	$164.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001314001	SUP	HCPCS C1725		M001314001  -  CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314011	SUP	HCPCS C1725		M001314011  -  CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 5FR 100CM	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314021	SUP	HCPCS C1725		M001314021  -  CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314031	SUP	HCPCS C1725		M001314031  -  CATHETER ANGIOGRAPHIC STR 5FR 100CM BRAID TORQUE SELECTIVE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314041	SUP	HCPCS C1725		M001314041  -  CATHETER ANGIOGRAPHIC BERN CURVE FLUTE TAPER 5FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314051	SUP	HCPCS C1725		M001314051  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314061	SUP	HCPCS C1725		M001314061  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314071	SUP	HCPCS C1725		M001314071  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 40CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314081	SUP	HCPCS C1887		M001314081  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 40CM BRAID TORQUE	BOTH IP/OP	$127.40 	$94.28	$0.00	$101.92	$69.18	$69.18	$0.00	$0.00	$0.00	$26.55	$94.56	$94.56	$0.00	$0.00	$26.55	$0.00	$75.36	$75.36	$0.00	$63.70	$100.90	$101.92	$0.00		$0.00	$19.94	$0.00	$0.00	$20.28	$0.00	$0.00	$0.00	$0.00	$0.00
M001314101	SUP	HCPCS C1725		M001314101  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314111	SUP	HCPCS C1725		M001314111  -  CATHETER ANGIOGRAPHIC WEIN CURVE FLUTE TAPER 5FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314121	SUP	HCPCS C1725		M001314121  -  CATHETER ANGIOGRAPHIC WEIN CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314131	SUP	HCPCS C1725		M001314131  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314141	SUP	HCPCS C1725		M001314141  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 5FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314151	SUP	HCPCS C1725		M001314151  -  CATHETER ANGIO HDHNTR 1 CRV 5FR 100CM IMGR2 BRD TRQ SLCT	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314161	SUP	HCPCS C1725		M001314161  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 CURVE 5FR 100CM TAPER TIP	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314171	SUP	HCPCS C1725		M001314171  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 CURVE 5FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314181	SUP	HCPCS C1725		M001314181  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 HEADHUNTER CURVE 5FR 100	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314191	SUP	HCPCS C1725		M001314191  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 HEADHUNTER CURVE 5FR 100	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314201	SUP	HCPCS C1725		M001314201  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 HEADHUNTER CURVE 5FR 100	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314211	SUP	HCPCS C1725		M001314211  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314221	SUP	HCPCS C1725		M001314221  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314231	SUP	HCPCS C1725		M001314231  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314241	SUP	HCPCS C1725		M001314241  -  CATHETER ANGIOGRAPHIC BENTSON 2 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314251	SUP	HCPCS C1725		M001314251  -  CATHETER ANGIOGRAPHIC BENTSON 2 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314261	SUP	HCPCS C1725		M001314261  -  CATHETER ANGIOGRAPHIC BENTSON 3 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314271	SUP	HCPCS C1725		M001314271  -  CATHETER ANGIOGRAPHIC BENTSON 3 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314281	SUP	HCPCS C1725		M001314281  -  CATHETER ANGIOGRAPHIC MANN CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314291	SUP	HCPCS C1725		M001314291  -  CATHETER ANGIOGRAPHIC MANN CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314301	SUP	HCPCS C1725		M001314301  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314311	SUP	HCPCS C1725		M001314311  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314321	SUP	HCPCS C1725		M001314321  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314331	SUP	HCPCS C1725		M001314331  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314341	SUP	HCPCS C1725		M001314341  -  CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314351	SUP	HCPCS C1725		M001314351  -  CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314361	SUP	HCPCS C1725		M001314361  -  CATHETER ANGIOGRAPHIC SIMMONS 3 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314371	SUP	HCPCS C1725		M001314371  -  CATHETER ANGIOGRAPHIC SIMMONS 3 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314381	SUP	HCPCS C1725		M001314381  -  CATHETER ANGIOGRAPHIC SIMMONS 4 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314391	SUP	HCPCS C1725		M001314391  -  CATHETER ANGIOGRAPHIC NEWTON 1 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314401	SUP	HCPCS C1725		M001314401  -  CATHETER ANGIOGRAPHIC NEWTON 1 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314411	SUP	HCPCS C1725		M001314411  -  CATHETER ANGIOGRAPHIC NEWTON 2 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314421	SUP	HCPCS C1725		M001314421  -  CATHETER ANGIOGRAPHIC NEWTON 2 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314431	SUP	HCPCS C1725		M001314431  -  CATHETER ANGIOGRAPHIC NEWTON 3 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314441	SUP	HCPCS C1725		M001314441  -  CATHETER ANGIOGRAPHIC NEWTON 3 CURVE 5FR 100CM TAPER TIP	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314451	SUP	HCPCS C1725		M001314451  -  CATHETER ANGIOGRAPHIC NEWTON 4 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314461	SUP	HCPCS C1725		M001314461  -  CATHETER ANGIOGRAPHIC NEWTON 4 CURVE 5FR 100CM TAPER TIP	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314471	SUP	HCPCS C1725		M001314471  -  CATHETER ANGIOGRAPHIC NEWTON 5 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314481	SUP	HCPCS C1725		M001314481  -  CATHETER ANGIOGRAPHIC NEWTON 5 CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314491	SUP	HCPCS C1725		M001314491  -  CATHETER ANGIOGRAPHIC CK CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314501	SUP	HCPCS C1725		M001314501  -  CATHETER ANGIOGRAPHIC MULTPUR GEN CURVE 5FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314511	SUP	HCPCS C1725		M001314511  -  CATHETER ANGIOGRAPHIC MULTPUR GEN CURVE 5FR 100CM BRAID	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314521	SUP	HCPCS C1725		M001314521  -  CATHETER ANGIOGRAPHIC CHUANG B CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314531	SUP	HCPCS C1725		M001314531  -  CATHETER ANGIOGRAPHIC CHUANG B CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314541	SUP	HCPCS C1725		M001314541  -  CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314551	SUP	HCPCS C1725		M001314551  -  CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 65CM TAPER TIP	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314561	SUP	HCPCS C1725		M001314561  -  CATHETER ANGIOGRAPHIC CHUANG 2.5 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314571	SUP	HCPCS C1725		M001314571  -  CATHETER ANGIOGRAPHIC CHUANG 2.5 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314581	SUP	HCPCS C1725		M001314581  -  CATHETER ANGIOGRAPHIC CONTRALATERAL 2 CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314591	SUP	HCPCS C1726		M001314591  -  CATHETER ANGIOGRAPHIC CONTRALATERAL 2 CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314601	SUP	HCPCS C1725		M001314601  -  CATHETER ANGIOGRAPHIC DUCK CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314611	SUP	HCPCS C1725		M001314611  -  CATHETER ANGIOGRAPHIC DUCK CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314621	SUP	HCPCS C1725		M001314621  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314631	SUP	HCPCS C1725		M001314631  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314641	SUP	HCPCS C1725		M001314641  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314651	SUP	HCPCS C1725		M001314651  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314661	SUP	HCPCS C1725		M001314661  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314671	SUP	HCPCS C1725		M001314671  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314681	SUP	HCPCS C1725		M001314681  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314691	SUP	HCPCS C1725		M001314691  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314701	SUP	HCPCS C1725		M001314701  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314711	SUP	HCPCS C1725		M001314711  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314721	SUP	HCPCS C1725		M001314721  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314731	SUP	HCPCS C1725		M001314731  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314741	SUP	HCPCS C1725		M001314741  -  CATHETER ANGIOGRAPHIC VAN ANDEL 2 CURVE 5FR 65CM BRAID	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314751	SUP	HCPCS C1725		M001314751  -  CATHETER ANGIOGRAPHIC TRAIN CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314761	SUP	HCPCS C1725		M001314761  -  CATHETER ANGIOGRAPHIC MIKELSON CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314771	SUP	HCPCS C1725		M001314771  -  CATHETER ANGIOGRAPHIC MIKELSON CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314781	SUP	HCPCS C1725		M001314781  -  CATHETER ANGIOGRAPHIC HK 1 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314791	SUP	HCPCS C1725		M001314791  -  CATHETER ANGIOGRAPHIC HK 1 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314801	SUP	HCPCS C1725		M001314801  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK .8 CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314811	SUP	HCPCS C1725		M001314811  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK .8 CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314821	SUP	HCPCS C1725		M001314821  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK 1 CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314831	SUP	HCPCS C1725		M001314831  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK 1 CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314841	SUP	HCPCS C1725		M001314841  -  CATHETER ANGIOGRAPHIC ROSCH 1 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314851	SUP	HCPCS C1725		M001314851  -  CATHETER ANGIOGRAPHIC ROSCH 1 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314861	SUP	HCPCS C1725		M001314861  -  CATHETER ANGIOGRAPHIC ROSCH 2 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314871	SUP	HCPCS C1725		M001314871  -  CATHETER ANGIOGRAPHIC ROSCH 2 CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314881	SUP	HCPCS C1725		M001314881  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314891	SUP	HCPCS C1725		M001314891  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001314901	SUP	HCPCS C1725		M001314901  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001314911	SUP	HCPCS C1725		M001314911  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001315001	SUP	HCPCS C1725		M001315001  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 4FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315011	SUP	HCPCS C1725		M001315011  -  CATHETER ANGIOGRAPHIC .035IN TENNIS RACQUET CURVE 4FR 90CM	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315021	SUP	HCPCS C1725		M001315021  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 4FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315031	SUP	HCPCS C1725		M001315031  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315041	SUP	HCPCS C1725		M001315041  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 90CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315051	SUP	HCPCS C1725		M001315051  -  CATHETER ANGIOGRAPHIC .035IN TENNIS RACQUET CURVE 5FR 100CM	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315061	SUP	HCPCS C1725		M001315061  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315071	SUP	HCPCS C1725		M001315071  -  CATHETER ANGIOGRAPHIC .038IN TENNIS RACQUET CURVE 5FR 90CM	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315081	SUP	HCPCS C1725		M001315081  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315091	SUP	HCPCS C1725		M001315091  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315101	SUP	HCPCS C1725		M001315101  -  CATHETER ANGIOGRAPHIC STR FLUSH CURVE 4FR 65CM HIGH FLOW	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315111	SUP	HCPCS C1725		M001315111  -  CATHETER ANGIOGRAPHIC .035IN 4FR 90CM PIGTAIL IMAGER II	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315121	SUP	HCPCS C1725		M001315121  -  CATHETER ANGIOGRAPHIC STR 4FR 90CM BRAID TORQUE SELECTIVE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315131	SUP	HCPCS C1726		M001315131  -  CATHETER ANGIOGRAPHIC PIGTAIL FLUSH CURVE 5FR 65CM HIGH FLOW	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315141	SUP	HCPCS C1725		M001315141  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 90CM TAPER TIP FLUTE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315151	SUP	HCPCS C1725		M001315151  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 100CM TAPER TIP	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315161	SUP	HCPCS C1725		M001315161  -  CATHETER ANGIOGRAPHIC STR FLUSH CURVE 5FR 65CM HIGH FLOW	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315171	SUP	HCPCS C1725		M001315171  -  CATHETER ANGIOGRAPHIC STR FLUSH CURVE 5FR 90CM HIGH FLOW	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315181	SUP	HCPCS C1725		M001315181  -  CATHETER ANGIOGRAPHIC STR 5FR 100CM BRAID TORQUE SELECTIVE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315191	SUP	HCPCS C1725		M001315191  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M00131520	SUP	HCPCS C1725		M00131520  -  CATHETER ANGIOGRAPHIC STR 5FR 65CM BRAID TORQUE SELECTIVE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315201	SUP	HCPCS C1725		M001315201  -  CATHETER ANGIOGRAPHIC STR 5FR 65CM BRAID TORQUE SELECTIVE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315211	SUP	HCPCS C1725		M001315211  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 90CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315221	SUP	HCPCS C1725		M001315221  -  CATHETER ANGIOGRAPHIC STR 5FR 90CM TAPER TIP FLUTE HUB BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315231	SUP	HCPCS C1725		M001315231  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315241	SUP	HCPCS C1725		M001315241  -  CATHETER ANGIOGRAPHIC STR 5FR 100CM BRAID TORQUE SELECTIVE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315251	SUP	HCPCS C1725		M001315251  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315261	SUP	HCPCS C1725		M001315261  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 90CM IMAGER II	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315271	SUP	HCPCS C1725		M001315271  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315281	SUP	HCPCS C1726		M001315281  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315291	SUP	HCPCS C1725		M001315291  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 90CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315301	SUP	HCPCS C1725		M001315301  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315311	SUP	HCPCS C1725		M001315311  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 65CM TAPER TIP	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315321	SUP	HCPCS C1725		M001315321  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 90CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001315331	SUP	HCPCS C1725		M001315331  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316021	SUP	HCPCS C1725		M001316021  -  CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 4FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316031	SUP	HCPCS C1725		M001316031  -  CATHETER ANGIOGRAPHIC SHORT TIP CURVE 4FR 100CM TAPER TIP	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316041	SUP	HCPCS C1725		M001316041  -  CATHETER ANGIOGRAPHIC BARNH CURVE 4FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316061	SUP	HCPCS C1725		M001316061  -  CATHETER ANGIOGRAPHIC .035IN BERN CURVE 4FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316071	SUP	HCPCS C1725		M001316071  -  CATHETER ANGIOGRAPHIC BERNSTEIN CURVE 4FR 40CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316091	SUP	HCPCS C1725		M001316091  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316121	SUP	HCPCS C1725		M001316121  -  CATHETER ANGIOGRAPHIC WEINBERG CEREBRAL CURVE 4FR 100CM	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316131	SUP	HCPCS C1725		M001316131  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 4FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316151	SUP	HCPCS C1725		M001316151  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 4FR 100CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316171	SUP	HCPCS C1725		M001316171  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 CURVE 4FR 100CM BRAID	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316191	SUP	HCPCS C1725		M001316191  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 HEADHUNTER CURVE 4FR 100	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316201	SUP	HCPCS C1725		M001316201  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 HEADHUNTER CURVE 4FR 100	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316211	SUP	HCPCS C1725		M001316211  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316231	SUP	HCPCS C1725		M001316231  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 4FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316251	SUP	HCPCS C1725		M001316251  -  CATHETER ANGIOGRAPHIC BENTSON 2 CURVE 4FR 100CM TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316271	SUP	HCPCS C1725		M001316271  -  CATHETER ANGIOGRAPHIC BENTSON 3 CURVE 4FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316291	SUP	HCPCS C1725		M001316291  -  CATHETER ANGIOGRAPHIC MANI CURVE 4FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316311	SUP	HCPCS C1725		M001316311  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316331	SUP	HCPCS C1725		M001316331  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 4FR 100CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316351	SUP	HCPCS C1725		M001316351  -  CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 4FR 100CM TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316371	SUP	HCPCS C1725		M001316371  -  CATHETER ANGIOGRAPHIC SIM3 CURVE 4FR 100CM BRAID IMAGER II	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316381	SUP	HCPCS C1725		M001316381  -  CATHETER ANGIOGRAPHIC SIMMONS 4 CURVE 4FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316401	SUP	HCPCS C1725		M001316401  -  CATHETER ANGIOGRAPHIC NEWTON 1 CURVE 4FR 100CM TORQUE SELECT	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316421	SUP	HCPCS C1725		M001316421  -  CATHETER ANGIOGRAPHIC NEWTON 2 CURVE 4FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316441	SUP	HCPCS C1725		M001316441  -  CATHETER ANGIOGRAPHIC NEWTON 3 CURVE 4FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316461	SUP	HCPCS C1725		M001316461  -  CATHETER ANGIOGRAPHIC NEWTON 4 CURVE 4FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316481	SUP	HCPCS C1725		M001316481  -  CATHETER ANGIOGRAPHIC NEWTON 5 CURVE 4FR 100CM BRAID IMAGER	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316491	SUP	HCPCS C1725		M001316491  -  CATHETER ANGIOGRAPHIC CK CURVE 4FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316511	SUP	HCPCS C1725		M001316511  -  CATHETER ANGIOGRAPHIC GEN CURVE 4FR 100CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316531	SUP	HCPCS C1725		M001316531  -  CATHETER ANGIOGRAPHIC CHUANG B CURVE 4FR 65CM TORQUE SELECT	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316551	SUP	HCPCS C1725		M001316551  -  CATHETER ANGIOGRAPHIC CHUANG C CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316571	SUP	HCPCS C1725		M001316571  -  CATHETER ANGIOGRAPHIC CHUANG 2 CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316581	SUP	HCPCS C1725		M001316581  -  CATHETER ANGIOGRAPHIC CONTRALATERAL 2 CURVE 4FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316611	SUP	HCPCS C1725		M001316611  -  CATHETER ANGIOGRAPHIC DUCK CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316631	SUP	HCPCS C1725		M001316631  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316651	SUP	HCPCS C1725		M001316651  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316671	SUP	HCPCS C1725		M001316671  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316691	SUP	HCPCS C1725		M001316691  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 4FR 65CM TAPER TIP FLUTE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316711	SUP	HCPCS C1725		M001316711  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316731	SUP	HCPCS C1725		M001316731  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316741	SUP	HCPCS C1725		M001316741  -  CATHETER ANGIOGRAPHIC VAN CURVE 4FR 65CM BRAID TORQUE	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001316751	SUP	HCPCS C1725		M001316751  -  CATHETER ANGIOGRAPHIC TRAIN CURVE FLUTE TAPER 4FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316771	SUP	HCPCS C1725		M001316771  -  CATHETER ANGIOGRAPHIC MIKELSON CURVE FLUTE TAPER 4FR 65CM	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316791	SUP	HCPCS C1725		M001316791  -  CATHETER ANGIOGRAPHIC HK 1 CURVE FLUTE TAPER 4FR 65CM BRAID	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316811	SUP	HCPCS C1725		M001316811  -  CATHETER ANGIOGRAPHIC SHK .8 CURVE FLUTE TAPER 4FR 65CM	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316831	SUP	HCPCS C1725		M001316831  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK 1 CURVE 4FR 65CM TAPER	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316851	SUP	HCPCS C1725		M001316851  -  CATHETER ANGIOGRAPHIC RIGHT CORON 1 CURVE 4FR 65CM TAPER TIP	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316871	SUP	HCPCS C1725		M001316871  -  CATHETER ANGIOGRAPHIC RIGHT CORON SHEPHERDS CROOK 2 CURVE	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316891	SUP	HCPCS C1725		M001316891  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE FLUTE TAPER 4FR 65	BOTH IP/OP	$25.48 	$18.86	$0.00	$20.38	$13.84	$13.84	$0.00	$0.00	$0.00	$5.31	$18.91	$18.91	$0.00	$0.00	$5.31	$0.00	$15.07	$15.07	$0.00	$12.74	$20.18	$20.38	$0.00		$0.00	$3.99	$0.00	$0.00	$4.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001316911	SUP	HCPCS C1725		M001316911  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE FLUTE TAPER 4FR 65	BOTH IP/OP	$30.00 	$22.20	$0.00	$24.00	$16.29	$16.29	$0.00	$0.00	$0.00	$6.25	$22.27	$22.27	$0.00	$0.00	$6.25	$0.00	$17.75	$17.75	$0.00	$15.00	$23.76	$24.00	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M001321751	SUP	HCPCS C1887		M001321751  -  CATHETER ANGIO .038IN C2 4FR 65CM GLDCATH TIP HDRPH	BOTH IP/OP	$139.50 	$103.23	$0.00	$111.60	$75.75	$75.75	$0.00	$0.00	$0.00	$29.08	$103.54	$103.54	$0.00	$0.00	$29.07	$0.00	$82.51	$82.51	$0.00	$69.75	$110.48	$111.60	$0.00		$0.00	$21.83	$0.00	$0.00	$22.21	$0.00	$0.00	$0.00	$0.00	$0.00
M001361480	SUP	HCPCS C1895		M001361480  -  COIL EMBOLIZATION .018IN STANDARD LENGTH 2D 2MM 4CM	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
M001361490	SUP	HCPCS C1895		M001361490  -  COIL EMBOLIZATION .018IN STANDARD LENGTH 2D 2MM 6CM	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
M001361500	SUP	Custom 27803010		M001361500  -  COIL EMBOLIZATION 2D HELIX 3MM 6CM 18 COIL OCCLUSION SYSTEM	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361510	SUP	Custom 27803010		M001361510  -  COIL EMBOLIZATION 2D HELIX 3MM 12CM 18 COIL OCCLUSION SYSTEM	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361520	SUP	Custom 27803010		M001361520  -  COIL EMBOLIZATION 2D HELIX 4MM 8CM 18 COIL OCCLUSION SYSTEM	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361530	SUP	Custom 27803010		M001361530  -  COIL EMBOLIZATION 2D HELIX 4MM 15CM 8 COIL OCCLUSION SYSTEM	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361540	SUP	Custom 27203010		M001361540  -  COIL EMBL 8CM 5MM INTLK 2D HLCL FBR OCL DTCH	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$758.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$471.44	$746.76	$754.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361550	SUP	Custom 27803010		M001361550  -  COIL EMBOLIZATION 2D HELIX 5MM 15CM 8 COIL OCCLUSION SYSTEM	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361560	SUP	Custom 27803010		M001361560  -  COIL EMBOLIZATION 2D HELIX 6MM 10CM 18 COIL OCCLUSION SYSTEM	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361570	SUP	Custom 27803010		M001361570  -  COIL EMBOLIZATION 2D HELIX 6MM 20CM 18 COIL OCCLUSION SYSTEM	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361580	SUP	Custom 27803010		M001361580  -  COIL EMBOLIZATION 2D HELIX 8MM 20CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361590	SUP	Custom 27803010		M001361590  -  COIL EMBOLIZATION 2D HELIX 10MM 20CM DETACHABLE OCCLUSION	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361600	SUP	Custom 27803010		M001361600  -  COIL EMBOLIZATION .018IN 2D HELIX BUCK 10MM 30CM OCCLUSION	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361610	SUP	Custom 27803010		M001361610  -  COIL EMBOLIZATION 2D HELIX 12MM 20CM OCCLUSION INTERLOCK	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361620	SUP	Custom 27803010		M001361620  -  COIL EMBOLIZATION .018IN 2D HELIX TAPER 12MM 30CM 18 COIL	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361630	SUP	Custom 27803010		M001361630  -  COIL EMBOLIZATION .018IN 2D HELIX TAPER 14MM 20CM 18 COIL	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361640	SUP	Custom 27803010		M001361640  -  COIL EMBOLIZATION .018IN 2D HELIX 14MM 30CM INTERLOCK IDC	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361740	SUP	Custom 27803010		M001361740  -  COIL EMBOLIZATION DIAMOND 2/3MM 2.3CM 18 COIL RETRACTABLE	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361750	SUP	Custom 27803010		M001361750  -  COIL EMBOLIZATION DIAMOND 2/4MM 4.1CM 18 COIL RETRACTABLE	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361760	SUP	Custom 27803010		M001361760  -  COIL EMBOLIZATION DIAMOND 2/5MM 5.8CM 18 COIL RETRACTABLE	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361770	SUP	Custom 27803010		M001361770  -  COIL EMBOLIZATION DIAMOND 2/6MM 8CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,022.48 "	$756.64	$0.00	$817.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$758.88	$758.88	$0.00	$0.00	$213.08	$0.00	$0.00	$0.00	$0.00	$511.24	$809.80	$817.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001361920	SUP	HCPCS C1895		M001361920  -  COIL EMBOLIZATION 2D LONG LENGTH 10MM 50CM 18 COIL	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
M001361930	SUP	HCPCS C1895		M001361930  -  COIL EMBOLIZATION .018IN 2D LONG 14CM 50CM 18 COIL	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
M001361940	SUP	HCPCS C1895		M001361940  -  COIL EMBOLIZATION .018IN LONG LENGTH 2D HELIX 18CM 50CM	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
M001361950	SUP	HCPCS C1895		M001361950  -  COIL EMBOLIZATION .018IN LONG LENGTH 2D HELIX 20MM 50CM	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
M001361960	SUP	HCPCS C1895		M001361960  -  COIL EMBOLIZATION .018IN LONG LENGTH 2D HELIX 20MM 50CM	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
M001363500	SUP	Custom 27803010		M001363500  -  COIL EMBOLIZATION .035IN 2D 3MM 4CM OCCLUSION INTERLOCK IDC	BOTH IP/OP	"$1,177.13 "	$871.08	$0.00	$941.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$873.66	$873.66	$0.00	$0.00	$245.31	$0.00	$0.00	$0.00	$0.00	$588.56	$932.29	$941.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363520	SUP	Custom 27803010		M001363520  -  COIL EMBOLIZATION .035IN 2D HELICAL 4MM 10CM 35 COIL	BOTH IP/OP	"$1,177.13 "	$871.08	$0.00	$941.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$873.66	$873.66	$0.00	$0.00	$245.31	$0.00	$0.00	$0.00	$0.00	$588.56	$932.29	$941.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363530	SUP	Custom 27803010		M001363530  -  COIL EMBL 20CM 4MM INTLK .035IN	BOTH IP/OP	"$1,755.00 "	"$1,298.70"	$0.00	"$1,404.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,302.56"	"$1,302.56"	$0.00	$0.00	$365.74	$0.00	$0.00	$0.00	$0.00	$877.50	"$1,389.96"	"$1,404.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363540	SUP	Custom 27803010		M001363540  -  COIL EMBOLIZATION .035IN 2D 6MM 10CM OCCLUSION DETACHABLE	BOTH IP/OP	"$1,177.13 "	$871.08	$0.00	$941.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$873.66	$873.66	$0.00	$0.00	$245.31	$0.00	$0.00	$0.00	$0.00	$588.56	$932.29	$941.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363550	SUP	Custom 27803010		M001363550  -  COIL EMBOLIZATION .035IN 2D 6MM 20CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,761.40 "	"$1,303.44"	$0.00	"$1,409.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,307.31"	"$1,307.31"	$0.00	$0.00	$367.08	$0.00	$0.00	$0.00	$0.00	$880.70	"$1,395.03"	"$1,409.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363560	SUP	Custom 27803010		M001363560  -  COIL EMBL 40CM 6MM INTLK .035IN	BOTH IP/OP	"$2,340.00 "	"$1,731.60"	$0.00	"$1,872.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,736.75"	"$1,736.75"	$0.00	$0.00	$487.66	$0.00	$0.00	$0.00	$0.00	"$1,170.00"	"$1,853.28"	"$1,872.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363570	SUP	HCPCS C1895		M001363570  -  COIL EMBOLIZATION .018IN 2D HELIX 8MM 10CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,177.13 "	$871.08	$0.00	$941.70	$529.71	$529.71	$0.00	$0.00	$0.00	$245.34	$873.66	$873.66	$0.00	$0.00	$245.31	$0.00	$696.27	$696.27	$0.00	$588.56	$932.29	$941.70	$0.00		$0.00	$184.22	$0.00	$0.00	$187.40	$0.00	$0.00	$0.00	$0.00	$0.00
M001363580	SUP	Custom 27803010		M001363580  -  COIL EMBOLIZATION .035IN 2D 8MM 20CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,761.40 "	"$1,303.44"	$0.00	"$1,409.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,307.31"	"$1,307.31"	$0.00	$0.00	$367.08	$0.00	$0.00	$0.00	$0.00	$880.70	"$1,395.03"	"$1,409.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363590	SUP	Custom 27803010		M001363590  -  COIL EMBOLIZATION .035IN 2D 8MM 40CM OCCLUSION SYSTEM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363600	SUP	Custom 27803010		M001363600  -  COIL EMBOLIZATION .035IN 2D 10MM 20CM OCCLUSION INTERLOCK	BOTH IP/OP	"$1,761.40 "	"$1,303.44"	$0.00	"$1,409.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,307.31"	"$1,307.31"	$0.00	$0.00	$367.08	$0.00	$0.00	$0.00	$0.00	$880.70	"$1,395.03"	"$1,409.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363610	SUP	Custom 27803010		M001363610  -  COIL EMBOLIZATION .035IN 2D 10MM 40CM OCCLUSION SYSTEM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363620	SUP	Custom 27803010		M001363620  -  COIL EMBOLIZATION .035IN 2D 12MM 20CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,761.40 "	"$1,303.44"	$0.00	"$1,409.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,307.31"	"$1,307.31"	$0.00	$0.00	$367.08	$0.00	$0.00	$0.00	$0.00	$880.70	"$1,395.03"	"$1,409.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363630	SUP	Custom 27803010		M001363630  -  COIL EMBOLIZATION .035IN 2D 12MM 40CM FIBER OCCLUSION SYSTEM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363640	SUP	Custom 27803010		M001363640  -  COIL EMBOLIZATION .035IN 2D 15MM 20CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,761.40 "	"$1,303.44"	$0.00	"$1,409.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,307.31"	"$1,307.31"	$0.00	$0.00	$367.08	$0.00	$0.00	$0.00	$0.00	$880.70	"$1,395.03"	"$1,409.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363650	SUP	Custom 27803010		M001363650  -  COIL EMBOLIZATION .035IN 2D 15MM 40CM OCCLUSION SYSTEM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363660	SUP	HCPCS C1895		M001363660  -  COIL EMBOLIZATION .018IN 2D 18MM 20CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,761.40 "	"$1,303.44"	$0.00	"$1,409.12"	$792.63	$792.63	$0.00	$0.00	$0.00	$367.12	"$1,307.31"	"$1,307.31"	$0.00	$0.00	$367.08	$0.00	"$1,041.87"	"$1,041.87"	$0.00	$880.70	"$1,395.03"	"$1,409.12"	$0.00		$0.00	$275.66	$0.00	$0.00	$280.41	$0.00	$0.00	$0.00	$0.00	$0.00
M001363670	SUP	Custom 27803010		M001363670  -  COIL EMBOLIZATION .035IN 2D 18MM 40CM OCCLUSION SYSTEM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363700	SUP	Custom 27803010		M001363700  -  COIL EMBOLIZATION .035IN CUBE 4MM 6CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,177.13 "	$871.08	$0.00	$941.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$873.66	$873.66	$0.00	$0.00	$245.31	$0.00	$0.00	$0.00	$0.00	$588.56	$932.29	$941.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363710	SUP	Custom 27803010		M001363710  -  COIL EMBL 17CM 4MM INTLK 360D	BOTH IP/OP	"$1,755.00 "	"$1,298.70"	$0.00	"$1,404.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,302.56"	"$1,302.56"	$0.00	$0.00	$365.74	$0.00	$0.00	$0.00	$0.00	$877.50	"$1,389.96"	"$1,404.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363720	SUP	Custom 27803010		M001363720  -  COIL EMBOLIZATION .035IN CUBE 6MM 10CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,177.13 "	$871.08	$0.00	$941.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$873.66	$873.66	$0.00	$0.00	$245.31	$0.00	$0.00	$0.00	$0.00	$588.56	$932.29	$941.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363730	SUP	Custom 27803010		M001363730  -  COIL EMBOLIZATION .035IN CUBE 6MM 20CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,761.40 "	"$1,303.44"	$0.00	"$1,409.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,307.31"	"$1,307.31"	$0.00	$0.00	$367.08	$0.00	$0.00	$0.00	$0.00	$880.70	"$1,395.03"	"$1,409.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363760	SUP	Custom 27803010		M001363760  -  COIL EMBOLIZATION .035IN CUBE 8MM 20CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,761.40 "	"$1,303.44"	$0.00	"$1,409.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,307.31"	"$1,307.31"	$0.00	$0.00	$367.08	$0.00	$0.00	$0.00	$0.00	$880.70	"$1,395.03"	"$1,409.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363770	SUP	Custom 27803010		M001363770  -  COIL EMBL 40CM 8MM INTLK 360D	BOTH IP/OP	"$2,340.00 "	"$1,731.60"	$0.00	"$1,872.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,736.75"	"$1,736.75"	$0.00	$0.00	$487.66	$0.00	$0.00	$0.00	$0.00	"$1,170.00"	"$1,853.28"	"$1,872.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363790	SUP	Custom 27803010		M001363790  -  COIL EMBOLIZATION .035IN CUBE 10MM 25CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,761.40 "	"$1,303.44"	$0.00	"$1,409.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,307.31"	"$1,307.31"	$0.00	$0.00	$367.08	$0.00	$0.00	$0.00	$0.00	$880.70	"$1,395.03"	"$1,409.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363800	SUP	Custom 27803010		M001363800  -  COIL EMBOLIZATION .035IN CUBE 10MM 40CM OCCLUSION SYSTEM	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363810	SUP	Custom 27803010		M001363810  -  COIL EMBOLIZATION .035IN CUBE 15MM 25CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,761.40 "	"$1,303.44"	$0.00	"$1,409.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,307.31"	"$1,307.31"	$0.00	$0.00	$367.08	$0.00	$0.00	$0.00	$0.00	$880.70	"$1,395.03"	"$1,409.12"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363820	SUP	Custom 27803010		M001363820  -  COIL EMBOLIZATION .035IN CUBE 15MM 40CM FIBER OCCLUSION	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363830	SUP	Custom 27803010		M001363830  -  COIL EMBOLIZATION .035IN CUBE 20MM 40CM FIBER OCCLUSION	BOTH IP/OP	"$2,250.00 "	"$1,665.00"	$0.00	"$1,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,669.95"	"$1,669.95"	$0.00	$0.00	$468.90	$0.00	$0.00	$0.00	$0.00	"$1,125.00"	"$1,782.00"	"$1,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363910	SUP	Custom 27803010		M001363910  -  COIL EMBOLIZATION .035IN DIAMOND 4MM 4.5CM OCCLUSION SYSTEM	BOTH IP/OP	"$1,177.13 "	$871.08	$0.00	$941.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$873.66	$873.66	$0.00	$0.00	$245.31	$0.00	$0.00	$0.00	$0.00	$588.56	$932.29	$941.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363920	SUP	Custom 27803010		M001363920  -  COIL EMBOLIZATION .035IN DIAMOND 6MM 9CM OCCLUSION INTERLOCK	BOTH IP/OP	"$1,177.13 "	$871.08	$0.00	$941.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$873.66	$873.66	$0.00	$0.00	$245.31	$0.00	$0.00	$0.00	$0.00	$588.56	$932.29	$941.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363930	SUP	Custom 27803010		M001363930  -  COIL EMBOLIZATION .035IN DIAMOND 8MM 14CM OCCLUSION	BOTH IP/OP	"$1,177.13 "	$871.08	$0.00	$941.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$873.66	$873.66	$0.00	$0.00	$245.31	$0.00	$0.00	$0.00	$0.00	$588.56	$932.29	$941.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363940	SUP	Custom 27803010		M001363940  -  COIL EMBL 10MM INTLK .035IN	BOTH IP/OP	"$1,755.00 "	"$1,298.70"	$0.00	"$1,404.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,302.56"	"$1,302.56"	$0.00	$0.00	$365.74	$0.00	$0.00	$0.00	$0.00	$877.50	"$1,389.96"	"$1,404.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001363950	SUP	Custom 27803010		M001363950  -  COIL EMBL 12MM INTLK .035IN	BOTH IP/OP	"$1,755.00 "	"$1,298.70"	$0.00	"$1,404.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,302.56"	"$1,302.56"	$0.00	$0.00	$365.74	$0.00	$0.00	$0.00	$0.00	$877.50	"$1,389.96"	"$1,404.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001391260	SUP	HCPCS C1769		M001391260  -  GUIDEWIRE VASCULAR STR .014IN 185CM JOURNEY NITINOL HYDPHI	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$172.95	$172.95	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
M001391270	SUP	HCPCS C1769		M001391270  -  GUIDEWIRE VASCULAR .014IN 185CM 7CM NAVIGATE RADIOPQ ANGLE	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$172.95	$172.95	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
M001391280	SUP	HCPCS C1769		M001391280  -  GUIDEWIRE VASCULAR .014IN 300CM 2CM FLEXIBLE CONVENTION STR	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$172.95	$172.95	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
M001391290	SUP	HCPCS C1769		M001391290  -  GUIDEWIRE VASCULAR .014IN 300CM 7CM NAVIGATE RADIOPQ ANGLE	BOTH IP/OP	$318.50 	$235.69	$0.00	$254.80	$172.95	$172.95	$0.00	$0.00	$0.00	$66.38	$236.39	$236.39	$0.00	$0.00	$66.38	$0.00	$188.39	$188.39	$0.00	$159.25	$252.25	$254.80	$0.00		$0.00	$49.85	$0.00	$0.00	$50.71	$0.00	$0.00	$0.00	$0.00	$0.00
M0014012160	SUP	Custom 27803010		M0014012160  -  PUSHER SURG .016FR .018IN 177CM EMBOLIZATION COIL	BOTH IP/OP	$419.80 	$310.65	$0.00	$335.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.58	$311.58	$0.00	$0.00	$87.49	$0.00	$0.00	$0.00	$0.00	$209.90	$332.48	$335.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001442001	SUP	Custom 27203010		M001442001  -  DEVICE FLOW CONTROL 1050 PSI 1 WAY HIGH PRESSURE FLOSWITCH	BOTH IP/OP	$11.43 	$8.46	$0.00	$9.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.48	$8.48	$0.00	$0.00	$2.38	$0.00	$0.00	$0.00	$0.00	$5.71	$9.05	$9.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001461541	SUP	HCPCS C1769		M001461541  -  GUIDEWIRE VASC .035IN 260CM 3CM GLDWR ANG TIP FLXB COR STD	BOTH IP/OP	$712.50 	$527.25	$0.00	$570.00	$386.89	$386.89	$0.00	$0.00	$0.00	$148.50	$528.82	$528.82	$0.00	$0.00	$148.49	$0.00	$421.44	$421.44	$0.00	$356.25	$564.30	$570.00	$0.00		$0.00	$111.51	$0.00	$0.00	$113.43	$0.00	$0.00	$0.00	$0.00	$0.00
M001461940	SUP	HCPCS C1769		M001461940  -  GWIRE VASC .035IN 145CM 9CM INFUS KTZN PERI	BOTH IP/OP	$473.28 	$350.23	$0.00	$378.62	$256.99	$256.99	$0.00	$0.00	$0.00	$98.64	$351.26	$351.26	$0.00	$0.00	$98.63	$0.00	$279.94	$279.94	$0.00	$236.64	$374.84	$378.62	$0.00		$0.00	$74.07	$0.00	$0.00	$75.35	$0.00	$0.00	$0.00	$0.00	$0.00
M001461960	SUP	HCPCS C1769		M001461960  -  GWIRE VASC .035IN 145CM 12CM INFUS KTZN	BOTH IP/OP	$473.28 	$350.23	$0.00	$378.62	$256.99	$256.99	$0.00	$0.00	$0.00	$98.64	$351.26	$351.26	$0.00	$0.00	$98.63	$0.00	$279.94	$279.94	$0.00	$236.64	$374.84	$378.62	$0.00		$0.00	$74.07	$0.00	$0.00	$75.35	$0.00	$0.00	$0.00	$0.00	$0.00
M001465001	SUP	HCPCS C1769		M001465001  -  GUIDEWIRE VASCULAR 6CM J .035IN 145CM 3MM FLEXIBLE TIP	BOTH IP/OP	$75.95 	$56.20	$0.00	$60.76	$41.24	$41.24	$0.00	$0.00	$0.00	$15.83	$56.37	$56.37	$0.00	$0.00	$15.83	$0.00	$44.92	$44.92	$0.00	$37.98	$60.15	$60.76	$0.00		$0.00	$11.89	$0.00	$0.00	$12.09	$0.00	$0.00	$0.00	$0.00	$0.00
M001465011	SUP	HCPCS C1769		M001465011  -  GUIDEWIRE VASCULAR SHORT LARGE J FLAT SPRING COIL .035IN 180	BOTH IP/OP	$103.81 	$76.82	$0.00	$83.04	$56.37	$56.37	$0.00	$0.00	$0.00	$21.64	$77.04	$77.04	$0.00	$0.00	$21.63	$0.00	$61.40	$61.40	$0.00	$51.90	$82.22	$83.04	$0.00		$0.00	$16.25	$0.00	$0.00	$16.53	$0.00	$0.00	$0.00	$0.00	$0.00
M001465021	SUP	HCPCS C1769		M001465021  -  GUIDEWIRE VASCULAR J .035IN 260CM 3MM FLEXIBLE TIP AMPLATZ	BOTH IP/OP	$108.46 	$80.26	$0.00	$86.77	$58.89	$58.89	$0.00	$0.00	$0.00	$22.61	$80.50	$80.50	$0.00	$0.00	$22.60	$0.00	$64.15	$64.15	$0.00	$54.23	$85.90	$86.77	$0.00		$0.00	$16.97	$0.00	$0.00	$17.27	$0.00	$0.00	$0.00	$0.00	$0.00
M001465031	SUP	HCPCS C1769		M001465031  -  GUIDEWIRE VASCULAR J .035IN 145CM 3MM FLEXIBLE TIP AMPLATZ	BOTH IP/OP	$75.95 	$56.20	$0.00	$60.76	$41.24	$41.24	$0.00	$0.00	$0.00	$15.83	$56.37	$56.37	$0.00	$0.00	$15.83	$0.00	$44.92	$44.92	$0.00	$37.98	$60.15	$60.76	$0.00		$0.00	$11.89	$0.00	$0.00	$12.09	$0.00	$0.00	$0.00	$0.00	$0.00
M001465041	SUP	HCPCS C1769		M001465041  -  GUIDEWIRE VASCULAR 6CM LARGE J .035IN 180CM 3MM FLEXIBLE TIP	BOTH IP/OP	$103.81 	$76.82	$0.00	$83.04	$56.37	$56.37	$0.00	$0.00	$0.00	$21.64	$77.04	$77.04	$0.00	$0.00	$21.63	$0.00	$61.40	$61.40	$0.00	$51.90	$82.22	$83.04	$0.00		$0.00	$16.25	$0.00	$0.00	$16.53	$0.00	$0.00	$0.00	$0.00	$0.00
M001465091	SUP	HCPCS C1769		M001465091  -  GUIDEWIRE VASCULAR SHORT STR .035IN 260CM FLEXIBLE TIP	BOTH IP/OP	$110.79 	$81.98	$0.00	$88.63	$60.16	$60.16	$0.00	$0.00	$0.00	$23.09	$82.23	$82.23	$0.00	$0.00	$23.09	$0.00	$65.53	$65.53	$0.00	$55.40	$87.75	$88.63	$0.00		$0.00	$17.34	$0.00	$0.00	$17.64	$0.00	$0.00	$0.00	$0.00	$0.00
M001465101	SUP	HCPCS C1769		M001465101  -  GUIDEWIRE VASCULAR .038IN 260CM 1CM FLEXIBLE TIP AMPLATZ	BOTH IP/OP	$110.79 	$81.98	$0.00	$88.63	$60.16	$60.16	$0.00	$0.00	$0.00	$23.09	$82.23	$82.23	$0.00	$0.00	$23.09	$0.00	$65.53	$65.53	$0.00	$55.40	$87.75	$88.63	$0.00		$0.00	$17.34	$0.00	$0.00	$17.64	$0.00	$0.00	$0.00	$0.00	$0.00
M001465171	SUP	HCPCS C1769		M001465171  -  GUIDEWIRE VASCULAR TAPER .038IN 145CM 6CM STR TIP AMPLATZ	BOTH IP/OP	$66.57 	$49.26	$0.00	$53.25	$36.14	$36.14	$0.00	$0.00	$0.00	$13.87	$49.40	$49.40	$0.00	$0.00	$13.87	$0.00	$39.37	$39.37	$0.00	$33.28	$52.72	$53.25	$0.00		$0.00	$10.42	$0.00	$0.00	$10.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001465181	SUP	HCPCS C1769		M001465181  -  GUIDEWIRE VASCULAR SHORT J .038IN 145CM 4CM FLEXIBLE TIP	BOTH IP/OP	$69.58 	$51.49	$0.00	$55.66	$37.78	$37.78	$0.00	$0.00	$0.00	$14.50	$51.64	$51.64	$0.00	$0.00	$14.50	$0.00	$41.16	$41.16	$0.00	$34.79	$55.11	$55.66	$0.00		$0.00	$10.89	$0.00	$0.00	$11.08	$0.00	$0.00	$0.00	$0.00	$0.00
M001465191	SUP	HCPCS C1769		M001465191  -  GUIDEWIRE VASCULAR STR .038IN 180CM 6CM FLEXIBLE TIP AMPLATZ	BOTH IP/OP	$101.48 	$75.10	$0.00	$81.18	$55.10	$55.10	$0.00	$0.00	$0.00	$21.15	$75.32	$75.32	$0.00	$0.00	$21.15	$0.00	$60.03	$60.03	$0.00	$50.74	$80.37	$81.18	$0.00		$0.00	$15.88	$0.00	$0.00	$16.16	$0.00	$0.00	$0.00	$0.00	$0.00
M001465201	SUP	HCPCS C1769		M001465201  -  GUIDEWIRE VASCULAR STR .038IN 260CM 6CM FLEXIBLE TIP AMPLATZ	BOTH IP/OP	$106.14 	$78.54	$0.00	$84.91	$57.63	$57.63	$0.00	$0.00	$0.00	$22.12	$78.77	$78.77	$0.00	$0.00	$22.12	$0.00	$62.78	$62.78	$0.00	$53.07	$84.06	$84.91	$0.00		$0.00	$16.61	$0.00	$0.00	$16.90	$0.00	$0.00	$0.00	$0.00	$0.00
M001465231	SUP	HCPCS C1769		M001465231  -  GUIDEWIRE VASCULAR STR .035IN 145CM 7CM FLEXIBLE TIP AMPLATZ	BOTH IP/OP	$66.15 	$48.95	$0.00	$52.92	$35.92	$35.92	$0.00	$0.00	$0.00	$13.79	$49.10	$49.10	$0.00	$0.00	$13.79	$0.00	$39.13	$39.13	$0.00	$33.08	$52.39	$52.92	$0.00		$0.00	$10.35	$0.00	$0.00	$10.53	$0.00	$0.00	$0.00	$0.00	$0.00
M001465241	SUP	HCPCS C1769		M001465241  -  GUIDEWIRE VASCULAR STR .035IN 145CM 3.5CM SUPER STIFF SHAFT	BOTH IP/OP	$66.15 	$48.95	$0.00	$52.92	$35.92	$35.92	$0.00	$0.00	$0.00	$13.79	$49.10	$49.10	$0.00	$0.00	$13.79	$0.00	$39.13	$39.13	$0.00	$33.08	$52.39	$52.92	$0.00		$0.00	$10.35	$0.00	$0.00	$10.53	$0.00	$0.00	$0.00	$0.00	$0.00
M001465251	SUP	HCPCS C1769		M001465251  -  GUIDEWIRE VASCULAR TAPER .035IN 180CM 7CM STR TIP AMPLATZ	BOTH IP/OP	$101.48 	$75.10	$0.00	$81.18	$55.10	$55.10	$0.00	$0.00	$0.00	$21.15	$75.32	$75.32	$0.00	$0.00	$21.15	$0.00	$60.03	$60.03	$0.00	$50.74	$80.37	$81.18	$0.00		$0.00	$15.88	$0.00	$0.00	$16.16	$0.00	$0.00	$0.00	$0.00	$0.00
M001465261	SUP	HCPCS C1769		M001465261  -  GUIDEWIRE VASCULAR STR .035IN 260CM 7CM FLEXIBLE TIP AMPLATZ	BOTH IP/OP	$106.14 	$78.54	$0.00	$84.91	$57.63	$57.63	$0.00	$0.00	$0.00	$22.12	$78.77	$78.77	$0.00	$0.00	$22.12	$0.00	$62.78	$62.78	$0.00	$53.07	$84.06	$84.91	$0.00		$0.00	$16.61	$0.00	$0.00	$16.90	$0.00	$0.00	$0.00	$0.00	$0.00
M001465501	SUP	Custom 27203010		M001465501  -  VISE TORQUE ACCEPTS .025-.038 IN GWIRE	BOTH IP/OP	$155.95 	$115.40	$0.00	$124.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$115.75	$115.75	$0.00	$0.00	$32.50	$0.00	$0.00	$0.00	$0.00	$77.98	$123.51	$124.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001465631	SUP	HCPCS C1769		M001465631  -  GUIDEWIRE VASCULAR .035IN 75CM 7CM DISTAL STR TIP ATRAUMATIC	BOTH IP/OP	$66.15 	$48.95	$0.00	$52.92	$35.92	$35.92	$0.00	$0.00	$0.00	$13.79	$49.10	$49.10	$0.00	$0.00	$13.79	$0.00	$39.13	$39.13	$0.00	$33.08	$52.39	$52.92	$0.00		$0.00	$10.35	$0.00	$0.00	$10.53	$0.00	$0.00	$0.00	$0.00	$0.00
M001465641	SUP	HCPCS C1769		M001465641  -  GUIDEWIRE VASCULAR STR .038IN 75CM 6CM FLOPPY TIP AMPLATZ	BOTH IP/OP	$66.15 	$48.95	$0.00	$52.92	$35.92	$35.92	$0.00	$0.00	$0.00	$13.79	$49.10	$49.10	$0.00	$0.00	$13.79	$0.00	$39.13	$39.13	$0.00	$33.08	$52.39	$52.92	$0.00		$0.00	$10.35	$0.00	$0.00	$10.53	$0.00	$0.00	$0.00	$0.00	$0.00
M001465911	SUP	HCPCS C1769		M001465911  -  GUIDEWIRE VASCULAR SHAPEABLE CURVE .035IN 180CM 5CM STR TIP	BOTH IP/OP	$126.58 	$93.67	$0.00	$101.27	$68.73	$68.73	$0.00	$0.00	$0.00	$26.38	$93.95	$93.95	$0.00	$0.00	$26.38	$0.00	$74.87	$74.87	$0.00	$63.29	$100.25	$101.27	$0.00		$0.00	$19.81	$0.00	$0.00	$20.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001465921	SUP	HCPCS C1769		M001465921  -  GUIDEWIRE VASCULAR SHAPEABLE CURVE .035IN 260CM 5CM STR TIP	BOTH IP/OP	$126.58 	$93.67	$0.00	$101.27	$68.73	$68.73	$0.00	$0.00	$0.00	$26.38	$93.95	$93.95	$0.00	$0.00	$26.38	$0.00	$74.87	$74.87	$0.00	$63.29	$100.25	$101.27	$0.00		$0.00	$19.81	$0.00	$0.00	$20.15	$0.00	$0.00	$0.00	$0.00	$0.00
M001466000	SUP	HCPCS C1769		M001466000  -  GUIDEWIRE VASCULAR LONG .018IN 145CM 10CM RADIOPQ PLATINUM	BOTH IP/OP	$194.35 	$143.82	$0.00	$155.48	$105.53	$105.53	$0.00	$0.00	$0.00	$40.51	$144.25	$144.25	$0.00	$0.00	$40.50	$0.00	$114.96	$114.96	$0.00	$97.18	$153.93	$155.48	$0.00		$0.00	$30.42	$0.00	$0.00	$30.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001466010	SUP	HCPCS C1769		M001466010  -  GUIDEWIRE VASCULAR LONG .018IN 180CM 10CM RADIOPQ PLATINUM	BOTH IP/OP	$194.35 	$143.82	$0.00	$155.48	$105.53	$105.53	$0.00	$0.00	$0.00	$40.51	$144.25	$144.25	$0.00	$0.00	$40.50	$0.00	$114.96	$114.96	$0.00	$97.18	$153.93	$155.48	$0.00		$0.00	$30.42	$0.00	$0.00	$30.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001466020	SUP	HCPCS C1769		M001466020  -  GUIDEWIRE VASCULAR LONG .018IN 260CM 8CM RADIOPQ PLATINUM	BOTH IP/OP	$203.35 	$150.48	$0.00	$162.68	$110.42	$110.42	$0.00	$0.00	$0.00	$42.38	$150.93	$150.93	$0.00	$0.00	$42.38	$0.00	$120.28	$120.28	$0.00	$101.68	$161.05	$162.68	$0.00		$0.00	$31.82	$0.00	$0.00	$32.37	$0.00	$0.00	$0.00	$0.00	$0.00
M001466040	SUP	HCPCS C1769		M001466040  -  GUIDEWIRE VASCULAR SHORT .018IN 180CM 3CM RADIOPQ PLATINUM	BOTH IP/OP	$194.35 	$143.82	$0.00	$155.48	$105.53	$105.53	$0.00	$0.00	$0.00	$40.51	$144.25	$144.25	$0.00	$0.00	$40.50	$0.00	$114.96	$114.96	$0.00	$97.18	$153.93	$155.48	$0.00		$0.00	$30.42	$0.00	$0.00	$30.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001466050	SUP	HCPCS C1769		M001466050  -  GUIDEWIRE VASC .018IN 260CM 3CM PLTN + SHRT TPR TIP RADOPQ	BOTH IP/OP	$203.35 	$150.48	$0.00	$162.68	$110.42	$110.42	$0.00	$0.00	$0.00	$42.38	$150.93	$150.93	$0.00	$0.00	$42.38	$0.00	$120.28	$120.28	$0.00	$101.68	$161.05	$162.68	$0.00		$0.00	$31.82	$0.00	$0.00	$32.37	$0.00	$0.00	$0.00	$0.00	$0.00
M001466100	SUP	HCPCS C1769		M001466100  -  GUIDEWIRE VASCULAR SHORT .025IN 180CM 3CM RADIOPQ PLATINUM	BOTH IP/OP	$194.35 	$143.82	$0.00	$155.48	$105.53	$105.53	$0.00	$0.00	$0.00	$40.51	$144.25	$144.25	$0.00	$0.00	$40.50	$0.00	$114.96	$114.96	$0.00	$97.18	$153.93	$155.48	$0.00		$0.00	$30.42	$0.00	$0.00	$30.94	$0.00	$0.00	$0.00	$0.00	$0.00
M001466110	SUP	HCPCS C1769		M001466110  -  GUIDEWIRE VASCULAR SHORT .025IN 260CM 3CM RADIOPQ PLATINUM	BOTH IP/OP	$202.33 	$149.72	$0.00	$161.86	$109.86	$109.86	$0.00	$0.00	$0.00	$42.17	$150.17	$150.17	$0.00	$0.00	$42.16	$0.00	$119.68	$119.68	$0.00	$101.16	$160.25	$161.86	$0.00		$0.00	$31.66	$0.00	$0.00	$32.21	$0.00	$0.00	$0.00	$0.00	$0.00
M001467120	SUP	HCPCS C1769		M001467120  -  GUIDEWIRE VASCULAR .014IN 300CM 7CM SHORT TAPER STR TIP	BOTH IP/OP	$203.35 	$150.48	$0.00	$162.68	$110.42	$110.42	$0.00	$0.00	$0.00	$42.38	$150.93	$150.93	$0.00	$0.00	$42.38	$0.00	$120.28	$120.28	$0.00	$101.68	$161.05	$162.68	$0.00		$0.00	$31.82	$0.00	$0.00	$32.37	$0.00	$0.00	$0.00	$0.00	$0.00
M001467300	SUP	HCPCS C1769		M001467300  -  GUIDEWIRE VASCULAR STR .018IN 60CM 3CM RADIOPQ PLATINUM PLUS	BOTH IP/OP	$203.35 	$150.48	$0.00	$162.68	$110.42	$110.42	$0.00	$0.00	$0.00	$42.38	$150.93	$150.93	$0.00	$0.00	$42.38	$0.00	$120.28	$120.28	$0.00	$101.68	$161.05	$162.68	$0.00		$0.00	$31.82	$0.00	$0.00	$32.37	$0.00	$0.00	$0.00	$0.00	$0.00
M001467310	SUP	HCPCS C1769		M001467310  -  GUIDEWIRE VASCULAR STR .018IN 180CM 3CM RADIOPQ PLATINUM	BOTH IP/OP	$203.35 	$150.48	$0.00	$162.68	$110.42	$110.42	$0.00	$0.00	$0.00	$42.38	$150.93	$150.93	$0.00	$0.00	$42.38	$0.00	$120.28	$120.28	$0.00	$101.68	$161.05	$162.68	$0.00		$0.00	$31.82	$0.00	$0.00	$32.37	$0.00	$0.00	$0.00	$0.00	$0.00
M001467320	SUP	HCPCS C1769		M001467320  -  GUIDEWIRE VASCULAR STR .018IN 260CM 3CM RADIOPQ PLATINUM	BOTH IP/OP	$203.35 	$150.48	$0.00	$162.68	$110.42	$110.42	$0.00	$0.00	$0.00	$42.38	$150.93	$150.93	$0.00	$0.00	$42.38	$0.00	$120.28	$120.28	$0.00	$101.68	$161.05	$162.68	$0.00		$0.00	$31.82	$0.00	$0.00	$32.37	$0.00	$0.00	$0.00	$0.00	$0.00
M001467400	SUP	HCPCS C1769		M001467400  -  GUIDEWIRE VASCULAR .014IN 180CM 3CM RADIOPQ PLATINUM PLUS	BOTH IP/OP	$203.35 	$150.48	$0.00	$162.68	$110.42	$110.42	$0.00	$0.00	$0.00	$42.38	$150.93	$150.93	$0.00	$0.00	$42.38	$0.00	$120.28	$120.28	$0.00	$101.68	$161.05	$162.68	$0.00		$0.00	$31.82	$0.00	$0.00	$32.37	$0.00	$0.00	$0.00	$0.00	$0.00
M001468010	SUP	HCPCS C1769		M001468010  -  GUIDEWIRE VASCULAR STR .014IN 190CM 2CM STEERABLE TRANSEND	BOTH IP/OP	$546.00 	$404.04	$0.00	$436.80	$296.48	$296.48	$0.00	$0.00	$0.00	$113.80	$405.24	$405.24	$0.00	$0.00	$113.79	$0.00	$322.96	$322.96	$0.00	$273.00	$432.43	$436.80	$0.00		$0.00	$85.45	$0.00	$0.00	$86.92	$0.00	$0.00	$0.00	$0.00	$0.00
M001468050	SUP	HCPCS C1769		M001468050  -  GUIDEWIRE VASC .014IN 182CM 2CM TRNSD EX RADOPQ HDRPH PLTN	BOTH IP/OP	"$1,116.25 "	$826.03	$0.00	$893.00	$606.12	$606.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$558.13	$884.07	$893.00	$0.00		$0.00	$174.69	$0.00	$0.00	$177.71	$0.00	$0.00	$0.00	$0.00	$0.00
M001468070	SUP	HCPCS C1769		M001468070  -  GUIDEWIRE VASC .014IN 205CM 2CM TRNSD EX SHP FLPY	BOTH IP/OP	"$1,116.25 "	$826.03	$0.00	$893.00	$606.12	$606.12	$0.00	$0.00	$0.00	$232.65	$828.48	$828.48	$0.00	$0.00	$232.63	$0.00	$660.26	$660.26	$0.00	$558.13	$884.07	$893.00	$0.00		$0.00	$174.69	$0.00	$0.00	$177.71	$0.00	$0.00	$0.00	$0.00	$0.00
M001468100	SUP	HCPCS C1769		M001468100  -  GUIDEWIRE VASCULAR STR .014IN 135CM 2CM STEERABLE TRANSEND	BOTH IP/OP	$546.00 	$404.04	$0.00	$436.80	$296.48	$296.48	$0.00	$0.00	$0.00	$113.80	$405.24	$405.24	$0.00	$0.00	$113.79	$0.00	$322.96	$322.96	$0.00	$273.00	$432.43	$436.80	$0.00		$0.00	$85.45	$0.00	$0.00	$86.92	$0.00	$0.00	$0.00	$0.00	$0.00
M001468110	SUP	HCPCS C1769		M001468110  -  GUIDEWIRE VASCULAR STR .014IN 165CM 2CM STEERABLE TRANSEND	BOTH IP/OP	$546.00 	$404.04	$0.00	$436.80	$296.48	$296.48	$0.00	$0.00	$0.00	$113.80	$405.24	$405.24	$0.00	$0.00	$113.79	$0.00	$322.96	$322.96	$0.00	$273.00	$432.43	$436.80	$0.00		$0.00	$85.45	$0.00	$0.00	$86.92	$0.00	$0.00	$0.00	$0.00	$0.00
M001468120	SUP	HCPCS C1769		M001468120  -  GUIDEWIRE VASCULAR STR .018IN 135CM 2CM STEERABLE TRANSEND	BOTH IP/OP	$546.00 	$404.04	$0.00	$436.80	$296.48	$296.48	$0.00	$0.00	$0.00	$113.80	$405.24	$405.24	$0.00	$0.00	$113.79	$0.00	$322.96	$322.96	$0.00	$273.00	$432.43	$436.80	$0.00		$0.00	$85.45	$0.00	$0.00	$86.92	$0.00	$0.00	$0.00	$0.00	$0.00
M001468130	SUP	HCPCS C1769		M001468130  -  GUIDEWIRE VASCULAR STR .018IN 165CM 2CM STEERABLE TRANSEND	BOTH IP/OP	$546.00 	$404.04	$0.00	$436.80	$296.48	$296.48	$0.00	$0.00	$0.00	$113.80	$405.24	$405.24	$0.00	$0.00	$113.79	$0.00	$322.96	$322.96	$0.00	$273.00	$432.43	$436.80	$0.00		$0.00	$85.45	$0.00	$0.00	$86.92	$0.00	$0.00	$0.00	$0.00	$0.00
M001468480	SUP	HCPCS C1769		M001468480  -  GUIDEWIRE VASCULAR STR .018IN 110CM 8CM RADIOPQ V-18	BOTH IP/OP	$211.00 	$156.14	$0.00	$168.80	$114.57	$114.57	$0.00	$0.00	$0.00	$43.98	$156.60	$156.60	$0.00	$0.00	$43.97	$0.00	$124.81	$124.81	$0.00	$105.50	$167.11	$168.80	$0.00		$0.00	$33.02	$0.00	$0.00	$33.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001468500	SUP	HCPCS C1769		M001468500  -  GUIDEWIRE VASCULAR STR .018IN 150CM 8CM RADIOPQ V-18	BOTH IP/OP	$178.95 	$132.42	$0.00	$143.16	$97.17	$97.17	$0.00	$0.00	$0.00	$37.30	$132.82	$132.82	$0.00	$0.00	$37.29	$0.00	$105.85	$105.85	$0.00	$89.48	$141.73	$143.16	$0.00		$0.00	$28.01	$0.00	$0.00	$28.49	$0.00	$0.00	$0.00	$0.00	$0.00
M001468520	SUP	HCPCS C1769		M001468520  -  GUIDEWIRE VASCULAR TAPER .018IN 200CM 8CM RADIOPQ STR TIP	BOTH IP/OP	$188.53 	$139.51	$0.00	$150.82	$102.37	$102.37	$0.00	$0.00	$0.00	$39.29	$139.92	$139.92	$0.00	$0.00	$39.29	$0.00	$111.51	$111.51	$0.00	$94.26	$149.32	$150.82	$0.00		$0.00	$29.50	$0.00	$0.00	$30.01	$0.00	$0.00	$0.00	$0.00	$0.00
M001468540	SUP	HCPCS C1769		M001468540  -  GUIDEWIRE VASCULAR TAPER .018IN 300CM 8CM RADIOPQ STR TIP	BOTH IP/OP	$197.25 	$145.97	$0.00	$157.80	$107.11	$107.11	$0.00	$0.00	$0.00	$41.11	$146.40	$146.40	$0.00	$0.00	$41.11	$0.00	$116.67	$116.67	$0.00	$98.63	$156.22	$157.80	$0.00		$0.00	$30.87	$0.00	$0.00	$31.40	$0.00	$0.00	$0.00	$0.00	$0.00
M001468560	SUP	HCPCS C1769		M001468560  -  GUIDEWIRE VASCULAR STR .018IN 150CM 12CM RADIOPQ V-18	BOTH IP/OP	$213.15 	$157.73	$0.00	$170.52	$115.74	$115.74	$0.00	$0.00	$0.00	$44.43	$158.20	$158.20	$0.00	$0.00	$44.42	$0.00	$126.08	$126.08	$0.00	$106.58	$168.81	$170.52	$0.00		$0.00	$33.36	$0.00	$0.00	$33.93	$0.00	$0.00	$0.00	$0.00	$0.00
M001468580	SUP	HCPCS C1769		M001468580  -  GUIDEWIRE VASCULAR STR .018IN 200CM 12CM RADIOPQ V-18	BOTH IP/OP	$213.15 	$157.73	$0.00	$170.52	$115.74	$115.74	$0.00	$0.00	$0.00	$44.43	$158.20	$158.20	$0.00	$0.00	$44.42	$0.00	$126.08	$126.08	$0.00	$106.58	$168.81	$170.52	$0.00		$0.00	$33.36	$0.00	$0.00	$33.93	$0.00	$0.00	$0.00	$0.00	$0.00
M001468600	SUP	HCPCS C1769		M001468600  -  GUIDEWIRE VASCULAR STR .018IN 300CM 12CM RADIOPQ V-18	BOTH IP/OP	$213.15 	$157.73	$0.00	$170.52	$115.74	$115.74	$0.00	$0.00	$0.00	$44.43	$158.20	$158.20	$0.00	$0.00	$44.42	$0.00	$126.08	$126.08	$0.00	$106.58	$168.81	$170.52	$0.00		$0.00	$33.36	$0.00	$0.00	$33.93	$0.00	$0.00	$0.00	$0.00	$0.00
M001491001	SUP	HCPCS C1769		M001491001  -  GUIDEWIRE VASCULAR STANDARD TAPER .025IN 150CM 3CM FIX CORE	BOTH IP/OP	$15.28 	$11.31	$0.00	$12.22	$8.29	$8.29	$0.00	$0.00	$0.00	$3.18	$11.34	$11.34	$0.00	$0.00	$3.18	$0.00	$9.04	$9.04	$0.00	$7.64	$12.10	$12.22	$0.00		$0.00	$2.39	$0.00	$0.00	$2.43	$0.00	$0.00	$0.00	$0.00	$0.00
M001491011	SUP	HCPCS C1769		M001491011  -  GUIDEWIRE STAR SFC .035 150CM PTFE	BOTH IP/OP	$15.28 	$11.31	$0.00	$15.60	$10.59	$10.59	$0.00	$0.00	$0.00	$3.18	$11.34	$11.34	$0.00	$0.00	$3.18	$0.00	$9.04	$9.04	$0.00	$9.75	$15.44	$15.60	$0.00		$0.00	$3.05	$0.00	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001491021	SUP	HCPCS C1769		M001491021  -  GUIDEWIRE VASCULAR STANDARD STR SPRING COIL .038IN 150CM 3CM	BOTH IP/OP	$15.28 	$11.31	$0.00	$12.22	$8.29	$8.29	$0.00	$0.00	$0.00	$3.18	$11.34	$11.34	$0.00	$0.00	$3.18	$0.00	$9.04	$9.04	$0.00	$7.64	$12.10	$12.22	$0.00		$0.00	$2.39	$0.00	$0.00	$2.43	$0.00	$0.00	$0.00	$0.00	$0.00
M001491031	SUP	HCPCS C1769		M001491031  -  GUIDEWIRE VASCULAR STR .035IN 260CM 3CM FIX CORE FLEXIBLE	BOTH IP/OP	$34.94 	$25.86	$0.00	$27.95	$18.97	$18.97	$0.00	$0.00	$0.00	$7.28	$25.93	$25.93	$0.00	$0.00	$7.28	$0.00	$20.66	$20.66	$0.00	$17.47	$27.67	$27.95	$0.00		$0.00	$5.47	$0.00	$0.00	$5.56	$0.00	$0.00	$0.00	$0.00	$0.00
M001491451	SUP	HCPCS C1769		M001491451  -  GUIDEWIRE VASCULAR STR SPRING COIL .035IN 150CM 15CM STARTER	BOTH IP/OP	$24.71 	$18.29	$0.00	$19.76	$13.41	$13.41	$0.00	$0.00	$0.00	$5.15	$18.34	$18.34	$0.00	$0.00	$5.15	$0.00	$14.61	$14.61	$0.00	$12.35	$19.57	$19.76	$0.00		$0.00	$3.87	$0.00	$0.00	$3.93	$0.00	$0.00	$0.00	$0.00	$0.00
M001491471	SUP	HCPCS C1769		M001491471  -  GUIDEWIRE VASCULAR STANDARD TAPER .035IN 180CM 15CM STR TIP	BOTH IP/OP	$195.50 	$144.67	$0.00	$156.40	$106.16	$106.16	$0.00	$0.00	$0.00	$40.75	$145.10	$145.10	$0.00	$0.00	$40.74	$0.00	$115.64	$115.64	$0.00	$97.75	$154.84	$156.40	$0.00		$0.00	$30.60	$0.00	$0.00	$31.12	$0.00	$0.00	$0.00	$0.00	$0.00
M001491481	SUP	HCPCS C1769		M001491481  -  GUIDEWIRE VASCULAR STANDARD TAPER .035IN 260CM 15CM STR TIP	BOTH IP/OP	$251.38 	$186.02	$0.00	$201.10	$136.50	$136.50	$0.00	$0.00	$0.00	$52.39	$186.57	$186.57	$0.00	$0.00	$52.39	$0.00	$148.69	$148.69	$0.00	$125.69	$199.09	$201.10	$0.00		$0.00	$39.34	$0.00	$0.00	$40.02	$0.00	$0.00	$0.00	$0.00	$0.00
M001491561	SUP	HCPCS C1769		M001491561  -  GUIDEWIRE VASCULAR 1.5MM STANDARD ROSEN CURVE TAPER .035IN	BOTH IP/OP	$129.88 	$96.11	$0.00	$103.90	$70.52	$70.52	$0.00	$0.00	$0.00	$27.07	$96.39	$96.39	$0.00	$0.00	$27.07	$0.00	$76.82	$76.82	$0.00	$64.94	$102.86	$103.90	$0.00		$0.00	$20.33	$0.00	$0.00	$20.68	$0.00	$0.00	$0.00	$0.00	$0.00
M001491571	SUP	HCPCS C1769		M001491571  -  GUIDEWIRE VASCULAR 1.5MM STANDARD ROSEN CURVE TAPER .035IN	BOTH IP/OP	$208.95 	$154.62	$0.00	$167.16	$113.46	$113.46	$0.00	$0.00	$0.00	$43.55	$155.08	$155.08	$0.00	$0.00	$43.55	$0.00	$123.59	$123.59	$0.00	$104.48	$165.49	$167.16	$0.00		$0.00	$32.70	$0.00	$0.00	$33.26	$0.00	$0.00	$0.00	$0.00	$0.00
M001491601	SUP	HCPCS C1769		M001491601  -  GUIDEWIRE VASCULAR STANDARD STR .035IN 150CM 3CM FIX CORE	BOTH IP/OP	$18.62 	$13.78	$0.00	$14.90	$10.11	$10.11	$0.00	$0.00	$0.00	$3.88	$13.82	$13.82	$0.00	$0.00	$3.88	$0.00	$11.01	$11.01	$0.00	$9.31	$14.75	$14.90	$0.00		$0.00	$2.91	$0.00	$0.00	$2.96	$0.00	$0.00	$0.00	$0.00	$0.00
M001491611	SUP	HCPCS C1769		M001491611  -  GUIDEWIRE VASCULAR STANDARD STR .035IN 260CM 3CM FIX CORE	BOTH IP/OP	$37.24 	$27.56	$0.00	$29.79	$20.22	$20.22	$0.00	$0.00	$0.00	$7.76	$27.64	$27.64	$0.00	$0.00	$7.76	$0.00	$22.03	$22.03	$0.00	$18.62	$29.49	$29.79	$0.00		$0.00	$5.83	$0.00	$0.00	$5.93	$0.00	$0.00	$0.00	$0.00	$0.00
M001491771	SUP	HCPCS C1769		M001491771  -  GUIDEWIRE VASCULAR BENTSON STANDARD .035IN 180CM 15CM SPRING	BOTH IP/OP	$216.00 	$159.84	$0.00	$172.80	$117.29	$117.29	$0.00	$0.00	$0.00	$45.02	$160.32	$160.32	$0.00	$0.00	$45.01	$0.00	$127.76	$127.76	$0.00	$108.00	$171.07	$172.80	$0.00		$0.00	$33.80	$0.00	$0.00	$34.39	$0.00	$0.00	$0.00	$0.00	$0.00
M001491851	SUP	HCPCS C1769		M001491851  -  GUIDEWIRE VASCULAR J ROSEN CURVE SPRING COIL .035IN 180CM	BOTH IP/OP	$180.63 	$133.67	$0.00	$144.50	$98.08	$98.08	$0.00	$0.00	$0.00	$37.65	$134.06	$134.06	$0.00	$0.00	$37.64	$0.00	$106.84	$106.84	$0.00	$90.31	$143.06	$144.50	$0.00		$0.00	$28.27	$0.00	$0.00	$28.76	$0.00	$0.00	$0.00	$0.00	$0.00
M001492031	SUP	HCPCS C1769		M001492031  -  GWIRE VASC 125CM .025IN STR FIX CORE 3CM TIP 10MM STRT PTFE	BOTH IP/OP	$19.50 	$14.43	$0.00	$15.60	$10.59	$10.59	$0.00	$0.00	$0.00	$4.06	$14.47	$14.47	$0.00	$0.00	$4.06	$0.00	$11.53	$11.53	$0.00	$9.75	$15.44	$15.60	$0.00		$0.00	$3.05	$0.00	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001492061	SUP	HCPCS C1769		M001492061  -  GWIRE VASC 150CM .028IN STR FIX CORE 3CM TIP 10MM STRT PTFE	BOTH IP/OP	$19.50 	$14.43	$0.00	$15.60	$10.59	$10.59	$0.00	$0.00	$0.00	$4.06	$14.47	$14.47	$0.00	$0.00	$4.06	$0.00	$11.53	$11.53	$0.00	$9.75	$15.44	$15.60	$0.00		$0.00	$3.05	$0.00	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001492081	SUP	HCPCS C1769		M001492081  -  GWIRE VASC 150CM .032IN STR FIX CORE 3CM TIP 10MM STRT PTFE	BOTH IP/OP	$28.75 	$21.28	$0.00	$23.00	$15.61	$15.61	$0.00	$0.00	$0.00	$5.99	$21.34	$21.34	$0.00	$0.00	$5.99	$0.00	$17.01	$17.01	$0.00	$14.38	$22.77	$23.00	$0.00		$0.00	$4.50	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
M001492111	SUP	HCPCS C1769		M001492111  -  GWIRE VASC 125CM .035IN STR FIX CORE 3CM TIP 10MM STRT PTFE	BOTH IP/OP	$19.50 	$14.43	$0.00	$15.60	$10.59	$10.59	$0.00	$0.00	$0.00	$4.06	$14.47	$14.47	$0.00	$0.00	$4.06	$0.00	$11.53	$11.53	$0.00	$9.75	$15.44	$15.60	$0.00		$0.00	$3.05	$0.00	$0.00	$3.10	$0.00	$0.00	$0.00	$0.00	$0.00
M001492121	SUP	HCPCS C1769		M001492121  -  GUIDEWIRE VASCULAR STR .035IN 180CM 3CM FIX CORE STARTER	BOTH IP/OP	$38.45 	$28.45	$0.00	$30.76	$20.88	$20.88	$0.00	$0.00	$0.00	$8.01	$28.54	$28.54	$0.00	$0.00	$8.01	$0.00	$22.74	$22.74	$0.00	$19.23	$30.45	$30.76	$0.00		$0.00	$6.02	$0.00	$0.00	$6.12	$0.00	$0.00	$0.00	$0.00	$0.00
M001492311	SUP	HCPCS C1769		M001492311  -  GUIDEWIRE VASCULAR STR .035IN 80CM 3MM FIX CORE STARTER PTFE	BOTH IP/OP	$15.28 	$11.31	$0.00	$12.22	$8.29	$8.29	$0.00	$0.00	$0.00	$3.18	$11.34	$11.34	$0.00	$0.00	$3.18	$0.00	$9.04	$9.04	$0.00	$7.64	$12.10	$12.22	$0.00		$0.00	$2.39	$0.00	$0.00	$2.43	$0.00	$0.00	$0.00	$0.00	$0.00
M001492751	SUP	HCPCS C1769		M001492751  -  GUIDEWIRE VASCULAR .018IN 130CM 3CM SHORT TAPER STR TIP	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$106.43	$106.43	$0.00	$0.00	$0.00	$40.85	$145.47	$145.47	$0.00	$0.00	$40.85	$0.00	$115.93	$115.93	$0.00	$98.00	$155.23	$156.80	$0.00		$0.00	$30.67	$0.00	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00
M001492761	SUP	HCPCS C1769		M001492761  -  GUIDEWIRE VASCULAR J SHORT TAPER .018IN 130CM 3CM THRUWAY	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$106.43	$106.43	$0.00	$0.00	$0.00	$40.85	$145.47	$145.47	$0.00	$0.00	$40.85	$0.00	$115.93	$115.93	$0.00	$98.00	$155.23	$156.80	$0.00		$0.00	$30.67	$0.00	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00
M001492771	SUP	HCPCS C1769		M001492771  -  GUIDEWIRE VASCULAR STR LONG TAPER .018IN 130CM 3CM SHAPEABLE	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$106.43	$106.43	$0.00	$0.00	$0.00	$40.85	$145.47	$145.47	$0.00	$0.00	$40.85	$0.00	$115.93	$115.93	$0.00	$98.00	$155.23	$156.80	$0.00		$0.00	$30.67	$0.00	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00
M001492781	SUP	HCPCS C1769		M001492781  -  GUIDEWIRE VASCULAR J LONG TAPER .018IN 130CM 3CM THRUWAY	BOTH IP/OP	$210.10 	$155.47	$0.00	$168.08	$114.08	$114.08	$0.00	$0.00	$0.00	$43.79	$155.94	$155.94	$0.00	$0.00	$43.78	$0.00	$124.27	$124.27	$0.00	$105.05	$166.40	$168.08	$0.00		$0.00	$32.88	$0.00	$0.00	$33.45	$0.00	$0.00	$0.00	$0.00	$0.00
M001492791	SUP	HCPCS C1769		M001492791  -  GUIDEWIRE VASCULAR STR SHORT TAPER .018IN 190CM 3CM	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$106.43	$106.43	$0.00	$0.00	$0.00	$40.85	$145.47	$145.47	$0.00	$0.00	$40.85	$0.00	$115.93	$115.93	$0.00	$98.00	$155.23	$156.80	$0.00		$0.00	$30.67	$0.00	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00
M001492801	SUP	HCPCS C1769		M001492801  -  GUIDEWIRE VASCULAR .018IN 190CM 3CM SHORT TAPER J TIP DISTAL	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$106.43	$106.43	$0.00	$0.00	$0.00	$40.85	$145.47	$145.47	$0.00	$0.00	$40.85	$0.00	$115.93	$115.93	$0.00	$98.00	$155.23	$156.80	$0.00		$0.00	$30.67	$0.00	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00
M001492811	SUP	HCPCS C1769		M001492811  -  GUIDEWIRE VASCULAR STR LONG TAPER .018IN 190CM 3CM SHAPEABLE	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$106.43	$106.43	$0.00	$0.00	$0.00	$40.85	$145.47	$145.47	$0.00	$0.00	$40.85	$0.00	$115.93	$115.93	$0.00	$98.00	$155.23	$156.80	$0.00		$0.00	$30.67	$0.00	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00
M001492821	SUP	HCPCS C1769		M001492821  -  GUIDEWIRE VASCULAR J LONG TAPER .018IN 190CM 3CM THRUWAY	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$106.43	$106.43	$0.00	$0.00	$0.00	$40.85	$145.47	$145.47	$0.00	$0.00	$40.85	$0.00	$115.93	$115.93	$0.00	$98.00	$155.23	$156.80	$0.00		$0.00	$30.67	$0.00	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00
M001492831	SUP	HCPCS C1769		M001492831  -  GUIDEWIRE VASCULAR STR SHORT TAPER .018IN 300CM 3CM	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$106.43	$106.43	$0.00	$0.00	$0.00	$40.85	$145.47	$145.47	$0.00	$0.00	$40.85	$0.00	$115.93	$115.93	$0.00	$98.00	$155.23	$156.80	$0.00		$0.00	$30.67	$0.00	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00
M001492841	SUP	HCPCS C1769		M001492841  -  GUIDEWIRE VASCULAR J SHORT TAPER .018IN 300CM 3CM THRUWAY	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$106.43	$106.43	$0.00	$0.00	$0.00	$40.85	$145.47	$145.47	$0.00	$0.00	$40.85	$0.00	$115.93	$115.93	$0.00	$98.00	$155.23	$156.80	$0.00		$0.00	$30.67	$0.00	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00
M001492851	SUP	HCPCS C1769		M001492851  -  GUIDEWIRE VASCULAR STR LONG TAPER .018IN 300CM 3CM SHAPEABLE	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$106.43	$106.43	$0.00	$0.00	$0.00	$40.85	$145.47	$145.47	$0.00	$0.00	$40.85	$0.00	$115.93	$115.93	$0.00	$98.00	$155.23	$156.80	$0.00		$0.00	$30.67	$0.00	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00
M001492861	SUP	HCPCS C1769		M001492861  -  GUIDEWIRE VASCULAR J LONG TAPER .018IN 300CM 3CM THRUWAY	BOTH IP/OP	$196.00 	$145.04	$0.00	$156.80	$106.43	$106.43	$0.00	$0.00	$0.00	$40.85	$145.47	$145.47	$0.00	$0.00	$40.85	$0.00	$115.93	$115.93	$0.00	$98.00	$155.23	$156.80	$0.00		$0.00	$30.67	$0.00	$0.00	$31.20	$0.00	$0.00	$0.00	$0.00	$0.00
M001503000	SUP	HCPCS C1884		M001503000  -  SYSTEM EMBL PRTC 47MM VC JUG INTROD 12FR TI 38MM GRNFLD	BOTH IP/OP	"$2,497.25 "	"$1,847.97"	$0.00	"$1,997.80"	"$1,123.76"	"$1,123.76"	$0.00	$0.00	$0.00	$520.49	"$1,853.46"	"$1,853.46"	$0.00	$0.00	$520.43	$0.00	"$1,477.12"	"$1,477.12"	$0.00	"$1,248.63"	"$1,977.82"	"$1,997.80"	$0.00		$0.00	$390.82	$0.00	$0.00	$397.56	$0.00	$0.00	$0.00	$0.00	$0.00
M001503010	SUP	HCPCS C1884		M001503010  -  SYSTEM EMBL PRTC 47MM VC FEM INTROD 15FR TI 38MM GRNFLD	BOTH IP/OP	"$2,497.25 "	"$1,847.97"	$0.00	"$1,997.80"	"$1,123.76"	"$1,123.76"	$0.00	$0.00	$0.00	$520.49	"$1,853.46"	"$1,853.46"	$0.00	$0.00	$520.43	$0.00	"$1,477.12"	"$1,477.12"	$0.00	"$1,248.63"	"$1,977.82"	"$1,997.80"	$0.00		$0.00	$390.82	$0.00	$0.00	$397.56	$0.00	$0.00	$0.00	$0.00	$0.00
M001503350	SUP	Custom 27803010		M001503350  -  DILATOR VASC 12FR INTRO 6-14FR GRNFLD RADOPQ TI VC	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$0.00	$0.00	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001503500	SUP	HCPCS C1884		M001503500  -  SYSTEM EMBL PRTC 47MM VC NDL SYR ACC INTROD 12FR TI 38MM	BOTH IP/OP	$332.50 	$246.05	$0.00	$266.00	$149.63	$149.63	$0.00	$0.00	$0.00	$69.30	$246.78	$246.78	$0.00	$0.00	$69.29	$0.00	$196.67	$196.67	$0.00	$166.25	$263.34	$266.00	$0.00		$0.00	$52.04	$0.00	$0.00	$52.93	$0.00	$0.00	$0.00	$0.00	$0.00
M001504000	SUP	Custom 27803010		M001504000  -  FILTER VASCULAR .035IN 12FR 46MM 32MM OTW REINFORCE SHEATH	BOTH IP/OP	"$2,363.53 "	"$1,749.01"	$0.00	"$1,890.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,754.21"	"$1,754.21"	$0.00	$0.00	$492.56	$0.00	$0.00	$0.00	$0.00	"$1,181.76"	"$1,871.92"	"$1,890.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001505010	SUP	Custom 27803010		M001505010  -  FILTER VASCULAR 12FR OTW CAPSULE GREENFIELD FEMORAL SYSTEM	BOTH IP/OP	"$2,363.53 "	"$1,749.01"	$0.00	"$1,890.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,754.21"	"$1,754.21"	$0.00	$0.00	$492.56	$0.00	$0.00	$0.00	$0.00	"$1,181.76"	"$1,871.92"	"$1,890.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001509000	SUP	HCPCS C1769		M001509000  -  GUIDEWIRE VASCULAR STR .016IN 140CM 25CM STEERABLE FATHOM	BOTH IP/OP	$744.33 	$550.80	$0.00	$595.46	$404.17	$404.17	$0.00	$0.00	$0.00	$155.14	$552.44	$552.44	$0.00	$0.00	$155.12	$0.00	$440.27	$440.27	$0.00	$372.16	$589.51	$595.46	$0.00		$0.00	$116.49	$0.00	$0.00	$118.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001509010	SUP	HCPCS C1769		M001509010  -  GUIDEWIRE VASCULAR STR .016IN 140CM 35CM STEERABLE FATHOM	BOTH IP/OP	$744.33 	$550.80	$0.00	$595.46	$404.17	$404.17	$0.00	$0.00	$0.00	$155.14	$552.44	$552.44	$0.00	$0.00	$155.12	$0.00	$440.27	$440.27	$0.00	$372.16	$589.51	$595.46	$0.00		$0.00	$116.49	$0.00	$0.00	$118.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001509100	SUP	HCPCS C1769		M001509100  -  GUIDEWIRE VASCULAR .016IN 180CM 25CM STEERABLE STR TIP	BOTH IP/OP	$744.33 	$550.80	$0.00	$595.46	$404.17	$404.17	$0.00	$0.00	$0.00	$155.14	$552.44	$552.44	$0.00	$0.00	$155.12	$0.00	$440.27	$440.27	$0.00	$372.16	$589.51	$595.46	$0.00		$0.00	$116.49	$0.00	$0.00	$118.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001509110	SUP	HCPCS C1769		M001509110  -  GUIDEWIRE VASCULAR .016IN 180CM 35CM STEERABLE STR TIP	BOTH IP/OP	$744.33 	$550.80	$0.00	$595.46	$404.17	$404.17	$0.00	$0.00	$0.00	$155.14	$552.44	$552.44	$0.00	$0.00	$155.12	$0.00	$440.27	$440.27	$0.00	$372.16	$589.51	$595.46	$0.00		$0.00	$116.49	$0.00	$0.00	$118.50	$0.00	$0.00	$0.00	$0.00	$0.00
M0015501010	SUP	HCPCS C1887		M0015501010  -  CATHETER INFUS .014IN MICRO TAPER 14 FLEX 3-2.8FR .024IN 105	BOTH IP/OP	"$1,157.13 "	$856.28	$0.00	$925.70	$628.32	$628.32	$0.00	$0.00	$0.00	$241.17	$858.82	$858.82	$0.00	$0.00	$241.14	$0.00	$684.44	$684.44	$0.00	$578.56	$916.45	$925.70	$0.00		$0.00	$181.09	$0.00	$0.00	$184.21	$0.00	$0.00	$0.00	$0.00	$0.00
M0015501030	SUP	HCPCS C1887		M0015501030  -  CATHETER INFUS .038IN MICRO TAPER-14 FLEX 3-2.8FR .024IN 125	BOTH IP/OP	"$1,157.13 "	$856.28	$0.00	$925.70	$628.32	$628.32	$0.00	$0.00	$0.00	$241.17	$858.82	$858.82	$0.00	$0.00	$241.14	$0.00	$684.44	$684.44	$0.00	$578.56	$916.45	$925.70	$0.00		$0.00	$181.09	$0.00	$0.00	$184.21	$0.00	$0.00	$0.00	$0.00	$0.00
M0015501040	SUP	HCPCS C1887		M0015501040  -  CATHETER INFUS .014IN MICRO TAPER-14 FLEX 3-2.8FR .024IN 135	BOTH IP/OP	"$1,157.13 "	$856.28	$0.00	$925.70	$628.32	$628.32	$0.00	$0.00	$0.00	$241.17	$858.82	$858.82	$0.00	$0.00	$241.14	$0.00	$684.44	$684.44	$0.00	$578.56	$916.45	$925.70	$0.00		$0.00	$181.09	$0.00	$0.00	$184.21	$0.00	$0.00	$0.00	$0.00	$0.00
M0015502030	SUP	HCPCS C1887		M0015502030  -  CATHETER INFUS .016IN MICRO TAPER 14 FLEX 3-2.8FR .024IN 125	BOTH IP/OP	"$1,157.13 "	$856.28	$0.00	$925.70	$628.32	$628.32	$0.00	$0.00	$0.00	$241.17	$858.82	$858.82	$0.00	$0.00	$241.14	$0.00	$684.44	$684.44	$0.00	$578.56	$916.45	$925.70	$0.00		$0.00	$181.09	$0.00	$0.00	$184.21	$0.00	$0.00	$0.00	$0.00	$0.00
M0015502040	SUP	HCPCS C1887		M0015502040  -  CATHETER INFUS .038IN MICRO TAPER 14 FLEX 3-2.8FR .024IN 135	BOTH IP/OP	"$1,157.13 "	$856.28	$0.00	$925.70	$628.32	$628.32	$0.00	$0.00	$0.00	$241.17	$858.82	$858.82	$0.00	$0.00	$241.14	$0.00	$684.44	$684.44	$0.00	$578.56	$916.45	$925.70	$0.00		$0.00	$181.09	$0.00	$0.00	$184.21	$0.00	$0.00	$0.00	$0.00	$0.00
M001705020	SUP	HCPCS C1874		M001705020  -  STENT ENDOPRSTH 116CM 10MM 10FR 20MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705030	SUP	HCPCS C2628		M001705030  -  STENT ENDOPRSTH 116CM 10MM 10FR 30MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$2,318.68"	"$2,318.68"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001705050	SUP	HCPCS C1874		M001705050  -  STENT ENDOPRSTH 116CM 10MM 10FR 50MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705070	SUP	HCPCS C1874		M001705070  -  STENT ENDOPRSTH 116CM 10MM 10FR 70MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705230	SUP	HCPCS C2628		M001705230  -  STENT ENDOPRSTH 116CM 12MM 11FR 30MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$2,318.68"	"$2,318.68"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001705250	SUP	HCPCS C2628		M001705250  -  STENT ENDOPRSTH 116CM 12MM 11FR 50MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$2,318.68"	"$2,318.68"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001705270	SUP	HCPCS C1874		M001705270  -  STENT ENDOPRSTH 116CM 12MM 11FR 70MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705450	SUP	HCPCS C1874		M001705450  -  STENT ENDOPRSTH 116CM 14MM 12FR 50MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705470	SUP	HCPCS C1874		M001705470  -  STENT ENDOPRSTH 116CM 14MM 12FR 70MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705620	SUP	HCPCS C1874		M001705620  -  STENT ENDOPRSTH 116CM 6MM 20MM 90CM DELIVERY SYSTEM	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705630	SUP	HCPCS C1874		M001705630  -  STENT ENDOPRSTH 116CM 6MM 9FR 30MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705650	SUP	HCPCS C2617		M001705650  -  STENT ENDOPRSTH 116CM 6MM 9FR 50MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705670	SUP	HCPCS C1874		M001705670  -  STENT ENDOPRSTH 116CM 6MM 9FR 70MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705720	SUP	HCPCS C1874		M001705720  -  STENT ENDOPRSTH 116CM 7MM 9FR 20MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705730	SUP	HCPCS C1874		M001705730  -  STENT ENDOPRSTH 116CM 7MM 9FR 30MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705750	SUP	HCPCS C1874		M001705750  -  STENT ENDOPRSTH 116CM 7MM 9FR 50MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705770	SUP	HCPCS C1874		M001705770  -  STENT ENDOPRSTH 116CM 7MM 9FR 90MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705820	SUP	HCPCS C1874		M001705820  -  STENT ENDOPRSTH 116CM 8MM 9FR 20MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705830	SUP	HCPCS C1874		M001705830  -  STENT ENDOPRSTH 116CM 8MM 9FR 30MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705850	SUP	HCPCS C1874		M001705850  -  STENT ENDOPRSTH 116CM 8MM 9FR 50MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705870	SUP	HCPCS C1874		M001705870  -  STENT ENDOPRSTH 116CM 8MM 9FR 70MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705920	SUP	HCPCS C1874		M001705920  -  STENT ENDOPRSTH 116CM 9MM 10FR 20MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705930	SUP	HCPCS C1874		M001705930  -  STENT ENDOPRSTH 116CM 9MM 10FR 30MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705950	SUP	HCPCS C1874		M001705950  -  STENT ENDOPRSTH 116CM 9MM 10FR 50MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001705970	SUP	HCPCS C1874		M001705970  -  STENT ENDOPRSTH 116CM 9MM 10FR 70MM 90CM COVER COATED	BOTH IP/OP	"$3,920.00 "	"$2,900.80"	$0.00	"$3,136.00"	"$1,764.00"	"$1,764.00"	$0.00	$0.00	$0.00	$817.03	"$2,909.42"	"$2,909.42"	$0.00	$0.00	$816.93	$0.00	"$1,932.56"	"$1,932.56"	$0.00	"$1,960.00"	"$3,104.64"	"$3,136.00"	$0.00		$0.00	$613.48	$0.00	$0.00	$624.06	$0.00	$0.00	$0.00	$0.00	$0.00
M001711000	SUP	HCPCS C1877		M001711000  -  STENT ENDOPRSTH 100CM 5MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711010	SUP	HCPCS C1877		M001711010  -  STENT ENDOPRSTH 5MM 6FR 20MM 135CM FLEXIBLE RECONSTRAINABLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711020	SUP	HCPCS C1877		M001711020  -  STENT ENDOPRSTH 100CM 5MM 40MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711030	SUP	HCPCS C1877		M001711030  -  STENT ENDOPRSTH 160CM 5MM 40MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711040	SUP	HCPCS C1877		M001711040  -  STENT ENDOPRSTH 100CM 5MM 55MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711050	SUP	HCPCS C1877		M001711050  -  STENT ENDOPRSTH 160CM 5MM 55MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711060	SUP	HCPCS C1877		M001711060  -  STENT ENDOPRSTH 100CM 5MM 80MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711070	SUP	HCPCS C1877		M001711070  -  STENT ENDOPRSTH 160CM 5MM 80MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711080	SUP	HCPCS C1877		M001711080  -  STENT ENDOPRSTH 100CM 6MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711090	SUP	HCPCS C1877		M001711090  -  STENT ENDOPRSTH 5MM 6FR 20MM 160CM FLEXIBLE RECONSTRAINABLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711100	SUP	HCPCS C1877		M001711100  -  STENT ENDOPRSTH 100CM 6MM 45MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711110	SUP	HCPCS C1877		M001711110  -  STENT ENDOPRSTH 160CM 6MM 45MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711120	SUP	HCPCS C1877		M001711120  -  STENT ENDOPRSTH 100CM 6MM 60MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711130	SUP	HCPCS C1877		M001711130  -  STENT ENDOPRSTH 160CM 6MM 60MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711140	SUP	HCPCS C1877		M001711140  -  STENT ENDOPRSTH 100CM 6MM 90MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711150	SUP	HCPCS C1877		M001711150  -  STENT ENDOPRSTH 160CM 6MM 90MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711160	SUP	HCPCS C1877		M001711160  -  STENT ENDOPRSTH 100CM 7MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711170	SUP	HCPCS C1877		M001711170  -  STENT ENDOPRSTH 7MM 6FR 20MM 160CM FLEXIBLE RECONSTRAINABLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711180	SUP	HCPCS C1877		M001711180  -  STENT ENDOPRSTH 100CM 7MM 40MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711190	SUP	HCPCS C1877		M001711190  -  STENT ENDOPRSTH 160CM 7MM 40MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711200	SUP	HCPCS C1877		M001711200  -  STENT ENDOPRSTH STENT 100CM 7MM 6FR 60MM 75CM SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711210	SUP	HCPCS C1877		M001711210  -  STENT ENDOPRSTH 160CM 7MM 60MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711220	SUP	HCPCS C1877		M001711220  -  STENT ENDOPRSTH 100CM 7MM 90MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711230	SUP	HCPCS C1877		M001711230  -  STENT ENDOPRSTH 160CM 7MM 90MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711240	SUP	HCPCS C1877		M001711240  -  STENT ENDOPRSTH 8MM 6FR 20MM 100CM FLEXIBLE RECONSTRAINABLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711250	SUP	HCPCS C1877		M001711250  -  STENT ENDOPRSTH 160CM 8MM 20MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711260	SUP	HCPCS C2617		M001711260  -  STENT ENDOPRSTH 8MM 6FR 40MM 100CM FLEXIBLE RECONSTRAINABLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711270	SUP	HCPCS C1877		M001711270  -  STENT TRACHEOBRONCHIAL 8MM 6FR 40MM 135CM ENDOPRSTH UNISTEP	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711280	SUP	HCPCS C2617		M001711280  -  STENT ENDOPRSTH 8MM 6FR 60MM 100CM FLEXIBLE RECONSTRAINABLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711290	SUP	HCPCS C2617		M001711290  -  STENT ENDOPRSTH 160CM 8MM 60MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711300	SUP	HCPCS C2617		M001711300  -  STENT ENDOPRSTH 100CM 8MM 80MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711310	SUP	HCPCS C2617		M001711310  -  STENT ENDOPRSTH 160CM 8MM 80MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711320	SUP	HCPCS C1877		M001711320  -  STENT ENDOPRSTH 10MM 6FR 20MM 100CM FLEXIBLE RECONSTRAINABLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711330	SUP	HCPCS C1877		M001711330  -  STENT ENDOPRSTH 160CM 10MM 20MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711340	SUP	HCPCS C1877		M001711340  -  STENT ENDOPRSTH 10MM 7FR 42MM 75CM ENDOPRSTH UNCOVERED	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711350	SUP	HCPCS C1877		M001711350  -  STENT ENDOPRSTH 160CM 10MM 42MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711360	SUP	HCPCS C1877		M001711360  -  STENT ENDOPRSTH 10MM 68MM 100CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711370	SUP	HCPCS C1877		M001711370  -  STENT ENDOPRSTH 160CM 10MM 68MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711380	SUP	HCPCS C2617		M001711380  -  STENT ENDOPRSTH 100CM 10MM 94MM 75CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001711390	SUP	HCPCS C1877		M001711390  -  STENT ENDOPRSTH 160CM 10MM 94MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712000	SUP	HCPCS C1877		M001712000  -  STENT ENDOPRSTH 100CM 6MM 24MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712010	SUP	HCPCS C1877		M001712010  -  STENT ENDOPRSTH 160CM 6MM 24MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712020	SUP	HCPCS C1877		M001712020  -  STENT ENDOPRSTH 100CM 6MM 6FR 36MM 75CM SYSTEM NONCOVERED	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712030	SUP	HCPCS C1877		M001712030  -  STENT ENDOPRSTH 160CM 6MM 36MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712040	SUP	HCPCS C1877		M001712040  -  STENT ENDOPRSTH 100CM 6MM 46MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712050	SUP	HCPCS C1877		M001712050  -  STENT ENDOPRSTH 160CM 6MM 46MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712060	SUP	HCPCS C1877		M001712060  -  STENT ENDOPRSTH 100CM 6MM 59MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712070	SUP	HCPCS C1877		M001712070  -  STENT ENDOPRSTH 160CM 6MM 59MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712080	SUP	HCPCS C1877		M001712080  -  STENT ENDOPRSTH 100CM 7MM 23MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712090	SUP	HCPCS C1877		M001712090  -  STENT ENDOPRSTH 160CM 7MM 6FR 23MM 135CM SYSTEM NONCOVERED	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712100	SUP	HCPCS C1877		M001712100  -  STENT ENDOPRSTH 100CM 7MM 34MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712110	SUP	HCPCS C1877		M001712110  -  STENT ENDOPRSTH 160CM 7MM 34MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712120	SUP	HCPCS C1877		M001712120  -  STENT ENDOPRSTH 100CM 7MM 6FR 55MM 75CM SYSTEM NONCOVERED	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712130	SUP	HCPCS C1877		M001712130  -  STENT ENDOPRSTH 160CM 7MM 55MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712140	SUP	HCPCS C1877		M001712140  -  STENT ENDOPRSTH 100CM 7MM 67MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712150	SUP	HCPCS C1877		M001712150  -  STENT ENDOPRSTH 160CM 7MM 67MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712160	SUP	HCPCS C1877		M001712160  -  STENT ENDOPRSTH 100CM 8MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712170	SUP	HCPCS C1877		M001712170  -  STENT ENDOPRSTH 160CM 8MM 20MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712180	SUP	HCPCS C1877		M001712180  -  STENT ENDOPRSTH 100CM 8MM 38MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712190	SUP	HCPCS C1877		M001712190  -  STENT ENDOPRSTH 160CM 8MM 38MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712200	SUP	HCPCS C1877		M001712200  -  STENT ENDOPRSTH 100CM 8MM 47MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712210	SUP	HCPCS C1877		M001712210  -  STENT ENDOPRSTH 160CM 8MM 47MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712220	SUP	HCPCS C1877		M001712220  -  STENT ENDOPRSTH 100CM 8MM 6FR 66MM 75CM SYSTEM NONCOVERED	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712230	SUP	HCPCS C1877		M001712230  -  STENT ENDOPRSTH 160CM 8MM 66MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712240	SUP	HCPCS C1877		M001712240  -  STENT ENDOPRSTH 100CM 9MM 6FR 18MM 75CM SYSTEM NONCOVERED	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712250	SUP	HCPCS C1877		M001712250  -  STENT ENDOPRSTH 160CM 9MM 6FR 18MM 135CM SYSTEM NONCOVERED	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712260	SUP	HCPCS C1877		M001712260  -  STENT ENDOPRSTH 100CM 9MM 35MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712270	SUP	HCPCS C1877		M001712270  -  STENT ENDOPRSTH 9MM 35MM 160CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712280	SUP	HCPCS C1877		M001712280  -  STENT ENDOPRSTH 100CM 9MM 52MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712290	SUP	HCPCS C1877		M001712290  -  STENT ENDOPRSTH 9MM 52MM 160CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712300	SUP	HCPCS C1877		M001712300  -  STENT ENDOPRSTH 100CM 9MM 61MM 75CM DELIVERY SYSTEM FLEXIBLE	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712310	SUP	HCPCS C1877		M001712310  -  STENT ENDOPRSTH 160CM 9MM 61MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712320	SUP	HCPCS C1877		M001712320  -  STENT ENDOPRSTH 100CM 10MM 20MM 75CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712330	SUP	HCPCS C1877		M001712330  -  STENT ENDOPRSTH 160CM 10MM 20MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712340	SUP	HCPCS C1877		M001712340  -  STENT ENDOPRSTH 100CM 10MM 39MM 75CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712350	SUP	HCPCS C1877		M001712350  -  STENT ENDOPRSTH 160CM 10MM 39MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712360	SUP	HCPCS C2617		M001712360  -  STENT ENDOPRSTH 10MM 6FR 49MM 75CM UNCOVERED UNISTEP PLUS	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712370	SUP	HCPCS C1877		M001712370  -  STENT ENDOPRSTH 160CM 10MM 49MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712380	SUP	HCPCS C2617		M001712380  -  STENT ENDOPRSTH 100CM 10MM 69MM 75CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001712390	SUP	HCPCS C1877		M001712390  -  STENT ENDOPRSTH 160CM 10MM 69MM 135CM DELIVERY SYSTEM	BOTH IP/OP	"$2,200.00 "	"$1,628.00"	$0.00	"$1,760.00"	$990.00	$990.00	$0.00	$0.00	$0.00	$458.54	"$1,632.84"	"$1,632.84"	$0.00	$0.00	$458.48	$0.00	"$1,301.30"	"$1,301.30"	$0.00	"$1,100.00"	"$1,742.40"	"$1,760.00"	$0.00		$0.00	$344.30	$0.00	$0.00	$350.24	$0.00	$0.00	$0.00	$0.00	$0.00
M001719000	SUP	HCPCS C1876		M001719000  -  STENT ENDOPRSTH 6MM 22MM CLOSE CELL DESIGN HIGH DELIVERABLE	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$0.00	$937.91	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	"$2,218.50"	"$2,218.50"	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$704.25	$0.00	$0.00	$716.40	$0.00	$0.00	$0.00	$0.00	$0.00
M001719010	SUP	HCPCS C1876		M001719010  -  STENT ENDOPRSTH 8MM 21MM CLOSE CELL DESIGN HIGH DELIVERABLE	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$0.00	$937.91	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	"$2,218.50"	"$2,218.50"	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$704.25	$0.00	$0.00	$716.40	$0.00	$0.00	$0.00	$0.00	$0.00
M001719020	SUP	HCPCS C1876		M001719020  -  STENT ENDOPRSTH 8MM 29MM CLOSE CELL DESIGN HIGH DELIVERABLE	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$0.00	$937.91	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	"$2,218.50"	"$2,218.50"	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$704.25	$0.00	$0.00	$716.40	$0.00	$0.00	$0.00	$0.00	$0.00
M001719030	SUP	HCPCS C1876		M001719030  -  STENT ENDOPRSTH 8MM 22MM CLOSE CELL DESIGN HIGH DELIVERABLE	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$0.00	$937.91	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	"$2,218.50"	"$2,218.50"	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$704.25	$0.00	$0.00	$716.40	$0.00	$0.00	$0.00	$0.00	$0.00
M001719040	SUP	HCPCS C1876		M001719040  -  STENT ENDOPRSTH 10MM 24MM CLOSE CELL DESIGN HIGH DELIVERABLE	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$0.00	$937.91	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	"$2,218.50"	"$2,218.50"	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$704.25	$0.00	$0.00	$716.40	$0.00	$0.00	$0.00	$0.00	$0.00
M001719050	SUP	HCPCS C1876		M001719050  -  STENT ENDOPRSTH 10MM 31MM CLOSE CELL DESIGN HIGH DELIVERABLE	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$0.00	$937.91	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	"$2,218.50"	"$2,218.50"	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$704.25	$0.00	$0.00	$716.40	$0.00	$0.00	$0.00	$0.00	$0.00
M001719060	SUP	HCPCS C1876		M001719060  -  STENT ENDOPRSTH 10MM 37MM CLOSE CELL DESIGN HIGH DELIVERABLE	BOTH IP/OP	"$4,500.00 "	"$3,330.00"	$0.00	"$3,600.00"	"$2,025.00"	"$2,025.00"	$0.00	$0.00	$0.00	$937.91	"$3,339.90"	"$3,339.90"	$0.00	$0.00	$937.80	$0.00	"$2,218.50"	"$2,218.50"	$0.00	"$2,250.00"	"$3,564.00"	"$3,600.00"	$0.00		$0.00	$704.25	$0.00	$0.00	$716.40	$0.00	$0.00	$0.00	$0.00	$0.00
M0017600121	SUP	HCPCS C1884		M0017600121  -  PARTICLES EMBOLIZATION 45-150UM 2 VIAL CNTOUR-PVA PVA	BOTH IP/OP	$367.01 	$271.59	$0.00	$293.61	$165.16	$165.16	$0.00	$0.00	$0.00	$76.49	$272.40	$272.40	$0.00	$0.00	$76.49	$0.00	$217.09	$217.09	$0.00	$183.51	$290.67	$293.61	$0.00		$0.00	$57.44	$0.00	$0.00	$58.43	$0.00	$0.00	$0.00	$0.00	$0.00
M0017600151	SUP	HCPCS C1884		M0017600151  -  PARTICLES EMBOLIZATION 45-150UM 5 VIAL CNTOUR PVA	BOTH IP/OP	$358.51 	$265.30	$0.00	$286.81	$161.33	$161.33	$0.00	$0.00	$0.00	$74.72	$266.09	$266.09	$0.00	$0.00	$74.71	$0.00	$212.06	$212.06	$0.00	$179.26	$283.94	$286.81	$0.00		$0.00	$56.11	$0.00	$0.00	$57.07	$0.00	$0.00	$0.00	$0.00	$0.00
M0017600221	SUP	HCPCS C1884		M0017600221  -  PARTICLES EMBOLIZATION 150-250UM 2 VIAL CNTOUR PVA	BOTH IP/OP	$367.01 	$271.59	$0.00	$293.61	$165.16	$165.16	$0.00	$0.00	$0.00	$76.49	$272.40	$272.40	$0.00	$0.00	$76.49	$0.00	$217.09	$217.09	$0.00	$183.51	$290.67	$293.61	$0.00		$0.00	$57.44	$0.00	$0.00	$58.43	$0.00	$0.00	$0.00	$0.00	$0.00
M0017600251	SUP	HCPCS C1884		M0017600251  -  PARTICLES EMBOLIZATION 150-250UM 5 VIAL CNTOUR PVA	BOTH IP/OP	$358.51 	$265.30	$0.00	$286.81	$161.33	$161.33	$0.00	$0.00	$0.00	$74.72	$266.09	$266.09	$0.00	$0.00	$74.71	$0.00	$212.06	$212.06	$0.00	$179.26	$283.94	$286.81	$0.00		$0.00	$56.11	$0.00	$0.00	$57.07	$0.00	$0.00	$0.00	$0.00	$0.00
M0017600321	SUP	HCPCS C1884		M0017600321  -  PARTICLES EMBOLIZATION 250-355UM 2 VIAL CNTOUR PVA	BOTH IP/OP	$367.01 	$271.59	$0.00	$293.61	$165.16	$165.16	$0.00	$0.00	$0.00	$76.49	$272.40	$272.40	$0.00	$0.00	$76.49	$0.00	$217.09	$217.09	$0.00	$183.51	$290.67	$293.61	$0.00		$0.00	$57.44	$0.00	$0.00	$58.43	$0.00	$0.00	$0.00	$0.00	$0.00
M0017600351	SUP	HCPCS C1884		M0017600351  -  PARTICLES EMBOLIZATION 250-355UM 5 VIAL CNTOUR PVA	BOTH IP/OP	$358.51 	$265.30	$0.00	$286.81	$161.33	$161.33	$0.00	$0.00	$0.00	$74.72	$266.09	$266.09	$0.00	$0.00	$74.71	$0.00	$212.06	$212.06	$0.00	$179.26	$283.94	$286.81	$0.00		$0.00	$56.11	$0.00	$0.00	$57.07	$0.00	$0.00	$0.00	$0.00	$0.00
M0017600421	SUP	HCPCS C1884		M0017600421  -  PARTICLES EMBOLIZATION 355-500UM 2 VIAL CNTOUR PVA	BOTH IP/OP	$367.01 	$271.59	$0.00	$293.61	$165.16	$165.16	$0.00	$0.00	$0.00	$76.49	$272.40	$272.40	$0.00	$0.00	$76.49	$0.00	$217.09	$217.09	$0.00	$183.51	$290.67	$293.61	$0.00		$0.00	$57.44	$0.00	$0.00	$58.43	$0.00	$0.00	$0.00	$0.00	$0.00
M0017600451	SUP	Custom 27203010		M0017600451  -  PARTICLES EMBL 355-500UM 5 VL CNTOUR PVA	BOTH IP/OP	$348.00 	$257.52	$0.00	$278.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$174.00	$275.62	$278.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0017600621	SUP	Custom 27203010		PARTICLES EMBL 500-710UM 2 VL CNTOUR-PVA	BOTH IP/OP	$356.25 	$263.63	$0.00	$285.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.13	$282.15	$285.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0017600651	SUP	HCPCS C1884		M0017600651  -  PARTICLES EMBOLIZATION 500-710UM 5 VIAL CNTOUR PVA	BOTH IP/OP	$358.51 	$265.30	$0.00	$286.81	$161.33	$161.33	$0.00	$0.00	$0.00	$74.72	$266.09	$266.09	$0.00	$0.00	$74.71	$0.00	$212.06	$212.06	$0.00	$179.26	$283.94	$286.81	$0.00		$0.00	$56.11	$0.00	$0.00	$57.07	$0.00	$0.00	$0.00	$0.00	$0.00
M0017600821	SUP	Custom 27203010		PARTICLES EMBL 710-1000UM 2 VL CNTOUR-PVA	BOTH IP/OP	$367.01 	$271.59	$0.00	$399.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.49	$272.40	$272.40	$0.00	$0.00	$76.49	$0.00	$217.09	$217.09	$0.00	$249.38	$395.01	$399.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0017600851	SUP	HCPCS C1884		M0017600851  -  PARTICLES EMBOLIZATION 710-1000UM 5 VIAL CNTOUR PVA	BOTH IP/OP	$358.51 	$265.30	$0.00	$286.81	$161.33	$161.33	$0.00	$0.00	$0.00	$74.72	$266.09	$266.09	$0.00	$0.00	$74.71	$0.00	$212.06	$212.06	$0.00	$179.26	$283.94	$286.81	$0.00		$0.00	$56.11	$0.00	$0.00	$57.07	$0.00	$0.00	$0.00	$0.00	$0.00
M0017601151	SUP	HCPCS C1884		M0017601151  -  PARTICLES EMBOLIZATION 1000-1180UM 5 VIAL CNTOUR PVA	BOTH IP/OP	$358.51 	$265.30	$0.00	$286.81	$161.33	$161.33	$0.00	$0.00	$0.00	$74.72	$266.09	$266.09	$0.00	$0.00	$74.71	$0.00	$212.06	$212.06	$0.00	$179.26	$283.94	$286.81	$0.00		$0.00	$56.11	$0.00	$0.00	$57.07	$0.00	$0.00	$0.00	$0.00	$0.00
M001BATR111000	SUP	HCPCS C1753		M001BATR111000  -  MODULE CATH POLARCATH PWR SYS PERI CRYOPLASTY	BOTH IP/OP	"$1,415.95 "	"$1,047.80"	$0.00	"$1,132.76"	$768.86	$768.86	$0.00	$0.00	$0.00	$295.12	"$1,050.92"	"$1,050.92"	$0.00	$0.00	$295.08	$0.00	$837.53	$837.53	$0.00	$707.98	"$1,121.43"	"$1,132.76"	$0.00		$0.00	$221.60	$0.00	$0.00	$225.42	$0.00	$0.00	$0.00	$0.00	$0.00
M001NC20000001	SUP	Custom 27203010		M001NC20000001  -  CARTRIDGE CATH POLARCATH N2O PERI	BOTH IP/OP	"$1,354.38 "	"$1,002.24"	$0.00	"$1,083.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,005.22"	"$1,005.22"	$0.00	$0.00	$282.25	$0.00	$0.00	$0.00	$0.00	$677.19	"$1,072.67"	"$1,083.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001P4100080010	SUP	HCPCS C1753		M001P4100080010  -  CATHETER BLNDIL 4MM 80CM 100MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P4100120010	SUP	HCPCS C1753		M001P4100120010  -  CATHETER BLNDIL 4MM 120CM 100MM POLARCATH PERI ACPT .035IN	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P420080010	SUP	HCPCS C1753		M001P420080010  -  CATHETER BLNDIL 4MM 80CM 20MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P420120010	SUP	HCPCS C1753		M001P420120010  -  CATHETER BLNDIL 4MM 120CM 20MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P440080010	SUP	HCPCS C1753		M001P440080010  -  CATHETER BLNDIL 4MM 80CM 40MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P440120010	SUP	HCPCS C1753		M001P440120010  -  CATHETER BLNDIL 4MM 120CM 40MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P460080010	SUP	HCPCS C1753		M001P460080010  -  CATHETER BLNDIL 4MM 80CM 60MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P460120010	SUP	HCPCS C1726		M001P460120010  -  CATHETER BLNDIL 4MM 120CM 60MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P480080010	SUP	HCPCS C1753		M001P480080010  -  CATHETER BLNDIL 4MM 80CM 80MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P480120010	SUP	HCPCS C1726		M001P480120010  -  CATHETER BLNDIL 4MM 120CM 80MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P5100080010	SUP	HCPCS C1753		M001P5100080010  -  CATHETER BLNDIL 5MM 80CM 100MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P5100120010	SUP	HCPCS C1753		M001P5100120010  -  CATHETER BLNDIL 5MM 120CM 100MM POLARCATH PERI ACPT .035IN	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P5120120010	SUP	HCPCS C1725		M001P5120120010  -  CATHETER BLNDIL 5MM 120CM 120MM POLARCATH PERI ACPT .035IN	BOTH IP/OP	"$2,228.58 "	"$1,649.15"	$0.00	"$1,782.86"	"$1,210.12"	"$1,210.12"	$0.00	$0.00	$0.00	$464.49	"$1,654.05"	"$1,654.05"	$0.00	$0.00	$464.44	$0.00	"$1,318.20"	"$1,318.20"	$0.00	"$1,114.29"	"$1,765.04"	"$1,782.86"	$0.00		$0.00	$348.77	$0.00	$0.00	$354.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001P5150120010	SUP	HCPCS C1725		M001P5150120010  -  CATHETER BLNDIL 5MM 150CM 120MM POLARCATH PERI ACPT .035IN	BOTH IP/OP	"$2,487.13 "	"$1,840.48"	$0.00	"$1,989.70"	"$1,350.51"	"$1,350.51"	$0.00	$0.00	$0.00	$518.38	"$1,845.94"	"$1,845.94"	$0.00	$0.00	$518.32	$0.00	"$1,471.13"	"$1,471.13"	$0.00	"$1,243.56"	"$1,969.81"	"$1,989.70"	$0.00		$0.00	$389.24	$0.00	$0.00	$395.95	$0.00	$0.00	$0.00	$0.00	$0.00
M001P520080010	SUP	HCPCS C1753		M001P520080010  -  CATHETER BLNDIL 5MM 80CM 20MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P520120010	SUP	HCPCS C1753		M001P520120010  -  CATHETER BLNDIL 5MM 120CM 20MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P540080010	SUP	HCPCS C1753		M001P540080010  -  CATHETER BLNDIL 5MM 80CM 40MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P540120010	SUP	HCPCS C1726		M001P540120010  -  CATHETER BLNDIL 5MM 120CM 40MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P560080010	SUP	HCPCS C1753		M001P560080010  -  CATHETER BLNDIL 5MM 80CM 60MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P560120010	SUP	HCPCS C1726		M001P560120010  -  CATHETER BLNDIL 5MM 120CM 60MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P580080010	SUP	HCPCS C1753		M001P580080010  -  CATHETER BLNDIL 5MM 80CM 80MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P580120010	SUP	HCPCS C1726		M001P580120010  -  CATHETER BLNDIL 5MM 120CM 80MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P6100080010	SUP	HCPCS C1753		M001P6100080010  -  CATHETER BLNDIL 6MM 80CM 100MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P6100120010	SUP	HCPCS C1753		M001P6100120010  -  CATHETER BLNDIL 6MM 120CM 100MM POLARCATH PERI ACPT .035IN	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P6120120010	SUP	HCPCS C1725		M001P6120120010  -  CATHETER BLNDIL 6MM 120CM 120MM POLARCATH PERI ACPT .035IN	BOTH IP/OP	"$2,228.58 "	"$1,649.15"	$0.00	"$1,782.86"	"$1,210.12"	"$1,210.12"	$0.00	$0.00	$0.00	$464.49	"$1,654.05"	"$1,654.05"	$0.00	$0.00	$464.44	$0.00	"$1,318.20"	"$1,318.20"	$0.00	"$1,114.29"	"$1,765.04"	"$1,782.86"	$0.00		$0.00	$348.77	$0.00	$0.00	$354.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001P6150120010	SUP	HCPCS C1725		M001P6150120010  -  CATHETER BLNDIL 6MM 120CM 150MM POLARCATH PERI ACPT .035IN	BOTH IP/OP	"$2,487.13 "	"$1,840.48"	$0.00	"$1,989.70"	"$1,350.51"	"$1,350.51"	$0.00	$0.00	$0.00	$518.38	"$1,845.94"	"$1,845.94"	$0.00	$0.00	$518.32	$0.00	"$1,471.13"	"$1,471.13"	$0.00	"$1,243.56"	"$1,969.81"	"$1,989.70"	$0.00		$0.00	$389.24	$0.00	$0.00	$395.95	$0.00	$0.00	$0.00	$0.00	$0.00
M001P620080010	SUP	HCPCS C1753		M001P620080010  -  CATHETER BLNDIL 6MM 80CM 20MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P620120010	SUP	HCPCS C1753		M001P620120010  -  CATHETER BLNDIL 6MM 120CM 20MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P640080010	SUP	HCPCS C1726		M001P640080010  -  CATHETER BLNDIL 6MM 80CM 40MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P640120010	SUP	HCPCS C1726		M001P640120010  -  CATHETER BLNDIL 6MM 120CM 40MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P660080010	SUP	HCPCS C1753		M001P660080010  -  CATHETER BLNDIL 6MM 80CM 60MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P660120010	SUP	HCPCS C1726		M001P660120010  -  CATHETER BLNDIL 6MM 120CM 60MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P680080010	SUP	HCPCS C1753		M001P680080010  -  CATHETER BLNDIL 6MM 80CM 80MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P680120010	SUP	HCPCS C1753		M001P680120010  -  CATHETER BLNDIL 6MM 120CM 80MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P720080010	SUP	HCPCS C1753		M001P720080010  -  CATHETER BLNDIL 7MM 80CM 20MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P720120010	SUP	HCPCS C1726		M001P720120010  -  CATHETER BLNDIL 7MM 120CM 20MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P740080010	SUP	HCPCS C1753		M001P740080010  -  CATHETER BLNDIL 7MM 80CM 40MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P740120010	SUP	HCPCS C1726		M001P740120010  -  CATHETER BLNDIL 7MM 120CM 40MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P760080010	SUP	HCPCS C2618		M001P760080010  -  CATHETER BLNDIL 7MM 80CM 60MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	$0.00	$0.00	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001P760120010	SUP	HCPCS C1753		M001P760120010  -  CATHETER BLNDIL 7MM 120CM 60MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P780080010	SUP	HCPCS C1753		M001P780080010  -  CATHETER BLNDIL 7MM 80CM 80MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P780120010	SUP	HCPCS C1726		M001P780120010  -  CATHETER BLNDIL 7MM 120CM 80MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,982.33 "	"$1,466.92"	$0.00	"$1,585.86"	"$1,076.40"	"$1,076.40"	$0.00	$0.00	$0.00	$413.17	"$1,471.28"	"$1,471.28"	$0.00	$0.00	$413.12	$0.00	"$1,172.55"	"$1,172.55"	$0.00	$991.16	"$1,570.01"	"$1,585.86"	$0.00		$0.00	$310.23	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00
M001P820080010	SUP	HCPCS C1725		M001P820080010  -  CATHETER BLNDIL 8MM 80CM 20MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P840080010	SUP	HCPCS C1725		M001P840080010  -  CATHETER BLNDIL 8MM 80CM 40MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001P840120010	SUP	HCPCS C1726		M001P840120010  -  CATHETER BLNDIL 8MM 120CM 40MM POLARCATH PERI ACPT .035IN GW	BOTH IP/OP	"$1,699.13 "	"$1,257.36"	$0.00	"$1,359.30"	$922.62	$922.62	$0.00	$0.00	$0.00	$354.14	"$1,261.09"	"$1,261.09"	$0.00	$0.00	$354.10	$0.00	"$1,005.03"	"$1,005.03"	$0.00	$849.56	"$1,345.71"	"$1,359.30"	$0.00		$0.00	$265.91	$0.00	$0.00	$270.50	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCB50201350	SUP	HCPCS C1726		M001PCB50201350  -  CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCB5020500	SUP	HCPCS C1753		M001PCB5020500  -  CATHETER BALDILAT 5MM 50CM 2CM OTW PERIPHERAL CUTTING	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCB5020900	SUP	HCPCS C1726		M001PCB5020900  -  CATHETER BALDILAT 5MM 90CM 20MM OTW PLAQUE MODIFICATION	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCB60201350	SUP	HCPCS C1726		M001PCB60201350  -  CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCB6020500	SUP	HCPCS C1753		M001PCB6020500  -  CATHETER BLNDIL 6MM 50CM 20MM PR CTBLN OTW TPR TIP INFL PORT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCB6020900	SUP	HCPCS C1726		M001PCB6020900  -  CATHETER BLNDIL 6MM 90CM 20MM PR CTBLN OTW INFL PORT TPR TIP	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCB70201350	SUP	HCPCS C1753		M001PCB70201350  -  CATHETER BLNDIL 7MM 135CM 20MM PR CTBLN OTW TPR TIP INFL	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCB7020500	SUP	HCPCS C1753		M001PCB7020500  -  CATHETER BLNDIL 7MM 50CM 20MM PR CTBLN OTW TPR TIP INFL PORT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCB7020900	SUP	HCPCS C1753		M001PCB7020900  -  CATHETER BLNDIL 7MM 90CM 20MM PR CTBLN OTW TPR TIP INFL PORT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCB80201350	SUP	HCPCS C1753		M001PCB80201350  -  CATHETER BALDILAT 8MM 135CM 2CM OTW PLAQUE MODIFICATION	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCB8020500	SUP	HCPCS C1753		M001PCB8020500  -  CATHETER BLNDIL 8MM 50CM 20MM PR CTBLN OTW INFL PORT TPR TIP	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCB8020900	SUP	HCPCS C1753		M001PCB8020900  -  CATHETER BLNDIL 8MM 90CM 20MM PR CTBLN OTW TPR TIP INFL PORT	BOTH IP/OP	"$1,750.00 "	"$1,295.00"	$0.00	"$1,400.00"	$950.25	$950.25	$0.00	$0.00	$0.00	$364.74	"$1,298.85"	"$1,298.85"	$0.00	$0.00	$364.70	$0.00	"$1,035.13"	"$1,035.13"	$0.00	$875.00	"$1,386.00"	"$1,400.00"	$0.00		$0.00	$273.88	$0.00	$0.00	$278.60	$0.00	$0.00	$0.00	$0.00	$0.00
M001PCIU400000	SUP	HCPCS C2618		M001PCIU400000  -  UNIT CATH POLARCATH PERI CRYOPLASTY	BOTH IP/OP	"$2,561.00 "	"$1,895.14"	$0.00	"$2,048.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,900.77"	"$1,900.77"	$0.00	$0.00	$533.71	$0.00	$0.00	$0.00	$0.00	"$1,280.50"	"$2,028.31"	"$2,048.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M001T20100135010	SUP	HCPCS C1725		M001T20100135010  -  CATHETER BLNDIL 2MM 135CM 100MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,536.38 "	"$1,876.92"	$0.00	"$2,029.10"	"$1,377.25"	"$1,377.25"	$0.00	$0.00	$0.00	$528.64	"$1,882.50"	"$1,882.50"	$0.00	$0.00	$528.58	$0.00	"$1,500.27"	"$1,500.27"	$0.00	"$1,268.19"	"$2,008.81"	"$2,029.10"	$0.00		$0.00	$396.94	$0.00	$0.00	$403.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001T20100150010	SUP	HCPCS C1725		M001T20100150010  -  CATHETER BLNDIL 2MM 150CM 100MM POLARCATH COAX RADOPQ PERI	BOTH IP/OP	"$2,536.38 "	"$1,876.92"	$0.00	"$2,029.10"	"$1,377.25"	"$1,377.25"	$0.00	$0.00	$0.00	$528.64	"$1,882.50"	"$1,882.50"	$0.00	$0.00	$528.58	$0.00	"$1,500.27"	"$1,500.27"	$0.00	"$1,268.19"	"$2,008.81"	"$2,029.10"	$0.00		$0.00	$396.94	$0.00	$0.00	$403.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001T20120150010	SUP	HCPCS C1725		M001T20120150010  -  CATHETER BLNDIL 2MM 150CM 120MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,794.95 "	"$2,068.26"	$0.00	"$2,235.96"	"$1,517.66"	"$1,517.66"	$0.00	$0.00	$0.00	$582.54	"$2,074.41"	"$2,074.41"	$0.00	$0.00	$582.47	$0.00	"$1,653.21"	"$1,653.21"	$0.00	"$1,397.48"	"$2,213.60"	"$2,235.96"	$0.00		$0.00	$437.41	$0.00	$0.00	$444.96	$0.00	$0.00	$0.00	$0.00	$0.00
M001T20150150010	SUP	HCPCS C1725		M001T20150150010  -  CATHETER BLNDIL 2MM 150CM 150MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$3,041.20 "	"$2,250.49"	$0.00	"$2,432.96"	"$1,651.37"	"$1,651.37"	$0.00	$0.00	$0.00	$633.86	"$2,257.18"	"$2,257.18"	$0.00	$0.00	$633.79	$0.00	"$1,798.87"	"$1,798.87"	$0.00	"$1,520.60"	"$2,408.63"	"$2,432.96"	$0.00		$0.00	$475.95	$0.00	$0.00	$484.16	$0.00	$0.00	$0.00	$0.00	$0.00
M001T2020135010	SUP	HCPCS C1725		M001T2020135010  -  CATHETER BLNDIL 2MM 135CM 20MM POLARCATH COAX RADOPQ PERI	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T2020150010	SUP	HCPCS C1725		M001T2020150010  -  CATHETER BLNDIL 2MM 150CM 20MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T2040135010	SUP	HCPCS C1725		M001T2040135010  -  CATHETER BLNDIL 2MM 135CM 40MM POLARCATH COAX RADOPQ PERI	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T2040150010	SUP	HCPCS C1725		M001T2040150010  -  CATHETER BLNDIL 2MM 150CM 40MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T2060135010	SUP	HCPCS C1725		M001T2060135010  -  CATHETER BLNDIL 2MM 135CM 60MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T2060150010	SUP	HCPCS C1725		M001T2060150010  -  CATHETER BLNDIL 2MM 150CM 60MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T25100135010	SUP	HCPCS C1725		M001T25100135010  -  CATHETER BLNDIL 2.5MM 135CM 100MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,536.38 "	"$1,876.92"	$0.00	"$2,029.10"	"$1,377.25"	"$1,377.25"	$0.00	$0.00	$0.00	$528.64	"$1,882.50"	"$1,882.50"	$0.00	$0.00	$528.58	$0.00	"$1,500.27"	"$1,500.27"	$0.00	"$1,268.19"	"$2,008.81"	"$2,029.10"	$0.00		$0.00	$396.94	$0.00	$0.00	$403.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001T25100150010	SUP	HCPCS C1725		M001T25100150010  -  CATHETER BLNDIL 2.5MM 150CM 100MM POLARCATH COAX RADOPQ PERI	BOTH IP/OP	"$2,536.38 "	"$1,876.92"	$0.00	"$2,029.10"	"$1,377.25"	"$1,377.25"	$0.00	$0.00	$0.00	$528.64	"$1,882.50"	"$1,882.50"	$0.00	$0.00	$528.58	$0.00	"$1,500.27"	"$1,500.27"	$0.00	"$1,268.19"	"$2,008.81"	"$2,029.10"	$0.00		$0.00	$396.94	$0.00	$0.00	$403.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001T25120150010	SUP	HCPCS C1725		M001T25120150010  -  CATHETER BLNDIL 2.5MM 150CM 120MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,794.95 "	"$2,068.26"	$0.00	"$2,235.96"	"$1,517.66"	"$1,517.66"	$0.00	$0.00	$0.00	$582.54	"$2,074.41"	"$2,074.41"	$0.00	$0.00	$582.47	$0.00	"$1,653.21"	"$1,653.21"	$0.00	"$1,397.48"	"$2,213.60"	"$2,235.96"	$0.00		$0.00	$437.41	$0.00	$0.00	$444.96	$0.00	$0.00	$0.00	$0.00	$0.00
M001T25150150010	SUP	HCPCS C1725		M001T25150150010  -  CATHETER BLNDIL 2.5MM 150CM 150MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$3,041.20 "	"$2,250.49"	$0.00	"$2,432.96"	"$1,651.37"	"$1,651.37"	$0.00	$0.00	$0.00	$633.86	"$2,257.18"	"$2,257.18"	$0.00	$0.00	$633.79	$0.00	"$1,798.87"	"$1,798.87"	$0.00	"$1,520.60"	"$2,408.63"	"$2,432.96"	$0.00		$0.00	$475.95	$0.00	$0.00	$484.16	$0.00	$0.00	$0.00	$0.00	$0.00
M001T2520135010	SUP	HCPCS C1725		M001T2520135010  -  CATHETER BLNDIL 2.5MM 135CM 20MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T2520150010	SUP	HCPCS C1725		M001T2520150010  -  CATHETER BLNDIL 2.5MM 150CM 20MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T2540135010	SUP	HCPCS C1725		M001T2540135010  -  CATHETER BLNDIL 2.5MM 135CM 40MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T2540150010	SUP	HCPCS C1725		M001T2540150010  -  CATHETER BLNDIL 2.5MM 150CM 40MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T2560135010	SUP	HCPCS C1725		M001T2560135010  -  CATHETER BLNDIL 2.5MM 135CM 60MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T2560150010	SUP	HCPCS C1725		M001T2560150010  -  CATHETER BLNDIL 2.5MM 150CM 60MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T30100135010	SUP	HCPCS C1725		M001T30100135010  -  CATHETER BLNDIL 3MM 135CM 100MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,536.38 "	"$1,876.92"	$0.00	"$2,029.10"	"$1,377.25"	"$1,377.25"	$0.00	$0.00	$0.00	$528.64	"$1,882.50"	"$1,882.50"	$0.00	$0.00	$528.58	$0.00	"$1,500.27"	"$1,500.27"	$0.00	"$1,268.19"	"$2,008.81"	"$2,029.10"	$0.00		$0.00	$396.94	$0.00	$0.00	$403.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001T30100150010	SUP	HCPCS C1725		M001T30100150010  -  CATHETER BLNDIL 3MM 150CM 100MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,536.38 "	"$1,876.92"	$0.00	"$2,029.10"	"$1,377.25"	"$1,377.25"	$0.00	$0.00	$0.00	$528.64	"$1,882.50"	"$1,882.50"	$0.00	$0.00	$528.58	$0.00	"$1,500.27"	"$1,500.27"	$0.00	"$1,268.19"	"$2,008.81"	"$2,029.10"	$0.00		$0.00	$396.94	$0.00	$0.00	$403.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001T30120150010	SUP	HCPCS C1725		M001T30120150010  -  CATHETER BLNDIL 3MM 150CM 120MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,794.95 "	"$2,068.26"	$0.00	"$2,235.96"	"$1,517.66"	"$1,517.66"	$0.00	$0.00	$0.00	$582.54	"$2,074.41"	"$2,074.41"	$0.00	$0.00	$582.47	$0.00	"$1,653.21"	"$1,653.21"	$0.00	"$1,397.48"	"$2,213.60"	"$2,235.96"	$0.00		$0.00	$437.41	$0.00	$0.00	$444.96	$0.00	$0.00	$0.00	$0.00	$0.00
M001T30150150010	SUP	HCPCS C1725		M001T30150150010  -  CATHETER BLNDIL 3MM 150CM 150MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$3,041.20 "	"$2,250.49"	$0.00	"$2,432.96"	"$1,651.37"	"$1,651.37"	$0.00	$0.00	$0.00	$633.86	"$2,257.18"	"$2,257.18"	$0.00	$0.00	$633.79	$0.00	"$1,798.87"	"$1,798.87"	$0.00	"$1,520.60"	"$2,408.63"	"$2,432.96"	$0.00		$0.00	$475.95	$0.00	$0.00	$484.16	$0.00	$0.00	$0.00	$0.00	$0.00
M001T3020135010	SUP	HCPCS C1725		M001T3020135010  -  CATHETER BLNDIL 3MM 135CM 20MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T3020150010	SUP	HCPCS C1725		M001T3020150010  -  CATHETER BLNDIL 3MM 150CM 20MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T3040135010	SUP	HCPCS C1725		M001T3040135010  -  CATHETER BLNDIL 3MM 135CM 40MM POLARCATH COAX RADOPQ PERI	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T3040150010	SUP	HCPCS C1725		M001T3040150010  -  CATHETER BLNDIL 3MM 150CM 40MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T3060135010	SUP	HCPCS C1725		M001T3060135010  -  CATHETER BLNDIL 3MM 135CM 60MM POLARCATH COAX RADOPQ MRKNG	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T3060150010	SUP	HCPCS C1725		M001T3060150010  -  CATHETER BLNDIL 3MM 150CM 60MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T35100135010	SUP	HCPCS C1725		M001T35100135010  -  CATHETER BLNDIL 3.5MM 135CM 100MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,536.38 "	"$1,876.92"	$0.00	"$2,029.10"	"$1,377.25"	"$1,377.25"	$0.00	$0.00	$0.00	$528.64	"$1,882.50"	"$1,882.50"	$0.00	$0.00	$528.58	$0.00	"$1,500.27"	"$1,500.27"	$0.00	"$1,268.19"	"$2,008.81"	"$2,029.10"	$0.00		$0.00	$396.94	$0.00	$0.00	$403.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001T35100150010	SUP	HCPCS C1725		M001T35100150010  -  CATHETER BLNDIL 3.5MM 150CM 100MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,536.38 "	"$1,876.92"	$0.00	"$2,029.10"	"$1,377.25"	"$1,377.25"	$0.00	$0.00	$0.00	$528.64	"$1,882.50"	"$1,882.50"	$0.00	$0.00	$528.58	$0.00	"$1,500.27"	"$1,500.27"	$0.00	"$1,268.19"	"$2,008.81"	"$2,029.10"	$0.00		$0.00	$396.94	$0.00	$0.00	$403.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001T35120150010	SUP	HCPCS C1725		M001T35120150010  -  CATHETER BLNDIL 3.5MM 150CM 120MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,794.95 "	"$2,068.26"	$0.00	"$2,235.96"	"$1,517.66"	"$1,517.66"	$0.00	$0.00	$0.00	$582.54	"$2,074.41"	"$2,074.41"	$0.00	$0.00	$582.47	$0.00	"$1,653.21"	"$1,653.21"	$0.00	"$1,397.48"	"$2,213.60"	"$2,235.96"	$0.00		$0.00	$437.41	$0.00	$0.00	$444.96	$0.00	$0.00	$0.00	$0.00	$0.00
M001T35150150010	SUP	HCPCS C1725		M001T35150150010  -  CATHETER BLNDIL 3.5MM 150CM 150MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$3,041.20 "	"$2,250.49"	$0.00	"$2,432.96"	"$1,651.37"	"$1,651.37"	$0.00	$0.00	$0.00	$633.86	"$2,257.18"	"$2,257.18"	$0.00	$0.00	$633.79	$0.00	"$1,798.87"	"$1,798.87"	$0.00	"$1,520.60"	"$2,408.63"	"$2,432.96"	$0.00		$0.00	$475.95	$0.00	$0.00	$484.16	$0.00	$0.00	$0.00	$0.00	$0.00
M001T3520135010	SUP	HCPCS C1725		M001T3520135010  -  CATHETER BLNDIL 3.5MM 135CM 20MM POLARCATH COAX RADOPQ PERI	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T3520150010	SUP	HCPCS C1725		M001T3520150010  -  CATHETER BLNDIL 3.5MM 150CM 20MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T3540135010	SUP	HCPCS C1725		M001T3540135010  -  CATHETER BLNDIL 3.5MM 135CM 40MM POLARCATH COAX RADOPQ MRKNG	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T3540150010	SUP	HCPCS C1725		M001T3540150010  -  CATHETER BLNDIL 3.5MM 150CM 40MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T3560135010	SUP	HCPCS C1725		M001T3560135010  -  CATHETER BLNDIL 3.5MM 135CM 60MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T3560150010	SUP	HCPCS C1725		M001T3560150010  -  CATHETER BLNDIL 3.5MM 150CM 60MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T40100135010	SUP	HCPCS C1725		M001T40100135010  -  CATHETER BLNDIL 4MM 135CM 100MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,536.38 "	"$1,876.92"	$0.00	"$2,029.10"	"$1,377.25"	"$1,377.25"	$0.00	$0.00	$0.00	$528.64	"$1,882.50"	"$1,882.50"	$0.00	$0.00	$528.58	$0.00	"$1,500.27"	"$1,500.27"	$0.00	"$1,268.19"	"$2,008.81"	"$2,029.10"	$0.00		$0.00	$396.94	$0.00	$0.00	$403.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001T40100150010	SUP	HCPCS C1725		M001T40100150010  -  CATHETER BLNDIL 4MM 150CM 100MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,536.38 "	"$1,876.92"	$0.00	"$2,029.10"	"$1,377.25"	"$1,377.25"	$0.00	$0.00	$0.00	$528.64	"$1,882.50"	"$1,882.50"	$0.00	$0.00	$528.58	$0.00	"$1,500.27"	"$1,500.27"	$0.00	"$1,268.19"	"$2,008.81"	"$2,029.10"	$0.00		$0.00	$396.94	$0.00	$0.00	$403.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001T40120150010	SUP	HCPCS C1725		M001T40120150010  -  CATHETER BLNDIL 4MM 150CM 120MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,794.95 "	"$2,068.26"	$0.00	"$2,235.96"	"$1,517.66"	"$1,517.66"	$0.00	$0.00	$0.00	$582.54	"$2,074.41"	"$2,074.41"	$0.00	$0.00	$582.47	$0.00	"$1,653.21"	"$1,653.21"	$0.00	"$1,397.48"	"$2,213.60"	"$2,235.96"	$0.00		$0.00	$437.41	$0.00	$0.00	$444.96	$0.00	$0.00	$0.00	$0.00	$0.00
M001T40150150010	SUP	HCPCS C1725		M001T40150150010  -  CATHETER BLNDIL 4MM 150CM 150MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$3,041.20 "	"$2,250.49"	$0.00	"$2,432.96"	"$1,651.37"	"$1,651.37"	$0.00	$0.00	$0.00	$633.86	"$2,257.18"	"$2,257.18"	$0.00	$0.00	$633.79	$0.00	"$1,798.87"	"$1,798.87"	$0.00	"$1,520.60"	"$2,408.63"	"$2,432.96"	$0.00		$0.00	$475.95	$0.00	$0.00	$484.16	$0.00	$0.00	$0.00	$0.00	$0.00
M001T4020135010	SUP	HCPCS C1725		M001T4020135010  -  CATHETER BLNDIL 5FR 4MM 135CM 20MM POLARCATH SHTH PERI ACPT	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T4020150010	SUP	HCPCS C1725		M001T4020150010  -  CATHETER BLNDIL 4MM 150CM 20MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T4040135010	SUP	HCPCS C1725		M001T4040135010  -  CATHETER BLNDIL 4MM 135CM 40MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T4040150010	SUP	HCPCS C1725		M001T4040150010  -  CATHETER BLNDIL 4MM 150CM 40MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T4060135010	SUP	HCPCS C1725		M001T4060135010  -  CATHETER BLNDIL 4MM 135CM 60MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T4060150010	SUP	HCPCS C1725		M001T4060150010  -  CATHETER BLNDIL 4MM 150CM 60MM POLARCATH COAX RADOPQ PERI	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T50100135010	SUP	HCPCS C1725		M001T50100135010  -  CATHETER BLNDIL 5MM 135CM 100MM POLARCATH COAX RADOPQ PERI	BOTH IP/OP	"$2,536.38 "	"$1,876.92"	$0.00	"$2,029.10"	"$1,377.25"	"$1,377.25"	$0.00	$0.00	$0.00	$528.64	"$1,882.50"	"$1,882.50"	$0.00	$0.00	$528.58	$0.00	"$1,500.27"	"$1,500.27"	$0.00	"$1,268.19"	"$2,008.81"	"$2,029.10"	$0.00		$0.00	$396.94	$0.00	$0.00	$403.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001T50120135010	SUP	HCPCS C1725		M001T50120135010  -  CATHETER BLNDIL 5MM 135CM 120MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$2,794.95 "	"$2,068.26"	$0.00	"$2,235.96"	"$1,517.66"	"$1,517.66"	$0.00	$0.00	$0.00	$582.54	"$2,074.41"	"$2,074.41"	$0.00	$0.00	$582.47	$0.00	"$1,653.21"	"$1,653.21"	$0.00	"$1,397.48"	"$2,213.60"	"$2,235.96"	$0.00		$0.00	$437.41	$0.00	$0.00	$444.96	$0.00	$0.00	$0.00	$0.00	$0.00
M001T50150135010	SUP	HCPCS C1725		M001T50150135010  -  CATHETER BLNDIL 5MM 135CM 150MM POLARCATH COAX RADOPQ PERI	BOTH IP/OP	"$3,041.20 "	"$2,250.49"	$0.00	"$2,432.96"	"$1,651.37"	"$1,651.37"	$0.00	$0.00	$0.00	$633.86	"$2,257.18"	"$2,257.18"	$0.00	$0.00	$633.79	$0.00	"$1,798.87"	"$1,798.87"	$0.00	"$1,520.60"	"$2,408.63"	"$2,432.96"	$0.00		$0.00	$475.95	$0.00	$0.00	$484.16	$0.00	$0.00	$0.00	$0.00	$0.00
M001T5020135010	SUP	HCPCS C1725		M001T5020135010  -  CATHETER BLNDIL 5MM 135CM 20MM POLARCATH COAX RADOPQ PERI	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T5040135010	SUP	HCPCS C1725		M001T5040135010  -  CATHETER BLNDIL 5MM 135CM 40MM POLARCATH COAX RADOPQ PERI	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T5060135010	SUP	HCPCS C1725		M001T5060135010  -  CATHETER BLNDIL 5MM 135CM 60MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T60100135010	SUP	HCPCS C1725		M001T60100135010  -  CATHETER BLNDIL 6MM 135CM 100MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,536.38 "	"$1,876.92"	$0.00	"$2,029.10"	"$1,377.25"	"$1,377.25"	$0.00	$0.00	$0.00	$528.64	"$1,882.50"	"$1,882.50"	$0.00	$0.00	$528.58	$0.00	"$1,500.27"	"$1,500.27"	$0.00	"$1,268.19"	"$2,008.81"	"$2,029.10"	$0.00		$0.00	$396.94	$0.00	$0.00	$403.79	$0.00	$0.00	$0.00	$0.00	$0.00
M001T60120135010	SUP	HCPCS C1725		M001T60120135010  -  CATHETER BLNDIL 6MM 135CM 120MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$2,794.95 "	"$2,068.26"	$0.00	"$2,235.96"	"$1,517.66"	"$1,517.66"	$0.00	$0.00	$0.00	$582.54	"$2,074.41"	"$2,074.41"	$0.00	$0.00	$582.47	$0.00	"$1,653.21"	"$1,653.21"	$0.00	"$1,397.48"	"$2,213.60"	"$2,235.96"	$0.00		$0.00	$437.41	$0.00	$0.00	$444.96	$0.00	$0.00	$0.00	$0.00	$0.00
M001T60150135010	SUP	HCPCS C1725		M001T60150135010  -  CATHETER BLNDIL 6MM 135CM 150MM POLARCATH PERI ACPT .014IN	BOTH IP/OP	"$3,041.20 "	"$2,250.49"	$0.00	"$2,432.96"	"$1,651.37"	"$1,651.37"	$0.00	$0.00	$0.00	$633.86	"$2,257.18"	"$2,257.18"	$0.00	$0.00	$633.79	$0.00	"$1,798.87"	"$1,798.87"	$0.00	"$1,520.60"	"$2,408.63"	"$2,432.96"	$0.00		$0.00	$475.95	$0.00	$0.00	$484.16	$0.00	$0.00	$0.00	$0.00	$0.00
M001T6020135010	SUP	HCPCS C1725		M001T6020135010  -  CATHETER BLNDIL 6MM 135CM 20MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T6040135010	SUP	HCPCS C1725		M001T6040135010  -  CATHETER BLNDIL 6MM 135CM 40MM POLARCATH RADOPQ PERI ACPT	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M001T6060135010	SUP	HCPCS C1725		M001T6060135010  -  CATHETER BLNDIL 6MM 135CM 60MM POLARCATH PERI ACPT .014IN GW	BOTH IP/OP	"$2,265.50 "	"$1,676.47"	$0.00	"$1,812.40"	"$1,230.17"	"$1,230.17"	$0.00	$0.00	$0.00	$472.19	"$1,681.45"	"$1,681.45"	$0.00	$0.00	$472.13	$0.00	"$1,340.04"	"$1,340.04"	$0.00	"$1,132.75"	"$1,794.28"	"$1,812.40"	$0.00		$0.00	$354.55	$0.00	$0.00	$360.67	$0.00	$0.00	$0.00	$0.00	$0.00
M002002231680	SUP	HCPCS C1768		M002002231680  -  GRAFT CARDIO 40CM 16X8MM WVN BFUR NONSEALED CLY VRSFT EPTFE	BOTH IP/OP	"$1,337.50 "	$989.75	$0.00	"$1,070.00"	$601.88	$601.88	$0.00	$0.00	$0.00	$278.77	$992.69	$992.69	$0.00	$0.00	$278.74	$0.00	$791.13	$791.13	$0.00	$668.75	"$1,059.30"	"$1,070.00"	$0.00		$0.00	$209.32	$0.00	$0.00	$212.93	$0.00	$0.00	$0.00	$0.00	$0.00
M002020195300	SUP	HCPCS C1768		M002020195300  -  PATCH CARDIO THK.36MM 3X1IN KNTD ULTHN HMSH FNS	BOTH IP/OP	$278.93 	$206.41	$0.00	$223.14	$125.52	$125.52	$0.00	$0.00	$0.00	$58.13	$207.02	$207.02	$0.00	$0.00	$58.13	$0.00	$164.98	$164.98	$0.00	$139.46	$220.91	$223.14	$0.00		$0.00	$43.65	$0.00	$0.00	$44.40	$0.00	$0.00	$0.00	$0.00	$0.00
M00202019530P0	SUP	HCPCS C1768		M00202019530P0  -  PATCH CV THK.36MM ULTHN TPR 3X1IN HMSH PL FNS KNIT PRETRIM	BOTH IP/OP	$321.70 	$238.06	$0.00	$248.28	$139.66	$139.66	$0.00	$0.00	$0.00	$67.05	$238.77	$238.77	$0.00	$0.00	$67.04	$0.00	$190.29	$190.29	$0.00	$155.18	$245.80	$248.28	$0.00		$0.00	$48.57	$0.00	$0.00	$49.41	$0.00	$0.00	$0.00	$0.00	$0.00
M002020851470	SUP	HCPCS C1768		M002020851470  -  GRAFT CV 2 BRCH THN 14MM 7MM 40CM STRL HMSH G2 VLR MCVL SFT	BOTH IP/OP	"$1,772.45 "	"$1,311.61"	$0.00	"$1,467.64"	$825.55	$825.55	$0.00	$0.00	$0.00	$369.42	"$1,315.51"	"$1,315.51"	$0.00	$0.00	$369.38	$0.00	"$1,048.40"	"$1,048.40"	$0.00	$917.28	"$1,452.96"	"$1,467.64"	$0.00		$0.00	$287.11	$0.00	$0.00	$292.06	$0.00	$0.00	$0.00	$0.00	$0.00
M002020851680	SUP	HCPCS C1768		M002020851680  -  GRAFT VASC 2 BRCH 16MM 8MM 40CM STRL HMSH GMCVL 2 VLR CLGN	BOTH IP/OP	"$1,834.55 "	"$1,357.57"	$0.00	"$1,467.64"	$825.55	$825.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$917.28	"$1,452.96"	"$1,467.64"	$0.00		$0.00	$287.11	$0.00	$0.00	$292.06	$0.00	$0.00	$0.00	$0.00	$0.00
M002020952080	SUP	HCPCS C1768		M002020952080  -  GRAFT CV 8MM 60CM STRL HMSH GMCVL 2 VLR STRG TUBE KNIT SFT	BOTH IP/OP	"$1,308.00 "	$967.92	$0.00	$996.58	$560.58	$560.58	$0.00	$0.00	$0.00	$272.62	$970.80	$970.80	$0.00	$0.00	$272.59	$0.00	$773.68	$773.68	$0.00	$622.86	$986.62	$996.58	$0.00		$0.00	$194.96	$0.00	$0.00	$198.32	$0.00	$0.00	$0.00	$0.00	$0.00
M002020952160	SUP	HCPCS C1768		M002020952160  -  GRAFT VASC 16MM 30CM STRL HMSH GMCVL PLSTR 2 VLR STRG TUBE	BOTH IP/OP	"$1,239.88 "	$917.51	$0.00	"$1,026.64"	$577.49	$577.49	$0.00	$0.00	$0.00	$258.42	$920.24	$920.24	$0.00	$0.00	$258.39	$0.00	$733.39	$733.39	$0.00	$641.65	"$1,016.37"	"$1,026.64"	$0.00		$0.00	$200.84	$0.00	$0.00	$204.30	$0.00	$0.00	$0.00	$0.00	$0.00
M00202175416P0	SUP	HCPCS C1768		M00202175416P0  -  GRAFT CARDIO 30CM 16MM 2 VLR WVN STR TUBE HMSH PL PLSTR STRL	BOTH IP/OP	"$1,384.73 "	"$1,024.70"	$0.00	"$1,043.02"	$586.70	$586.70	$0.00	$0.00	$0.00	$288.61	"$1,027.74"	"$1,027.74"	$0.00	$0.00	$288.58	$0.00	$819.06	$819.06	$0.00	$651.89	"$1,032.59"	"$1,043.02"	$0.00		$0.00	$204.04	$0.00	$0.00	$207.56	$0.00	$0.00	$0.00	$0.00	$0.00
M002021754180	SUP	HCPCS C1768		M002021754180  -  GRAFT VASC 30CM 18MM HMSHLD MCVL WVN STR	BOTH IP/OP	"$1,235.50 "	$914.27	$0.00	$988.40	$555.98	$555.98	$0.00	$0.00	$0.00	$257.51	$916.99	$916.99	$0.00	$0.00	$257.48	$0.00	$730.80	$730.80	$0.00	$617.75	$978.52	$988.40	$0.00		$0.00	$193.36	$0.00	$0.00	$196.69	$0.00	$0.00	$0.00	$0.00	$0.00
M00202175420P0	SUP	HCPCS C1768		M00202175420P0  -  GRAFT VASC 30CM 20MM HMSH PL EPTFE 2 VLR WVN STR TUBE SFT	BOTH IP/OP	"$1,384.73 "	"$1,024.70"	$0.00	"$1,055.02"	$593.45	$593.45	$0.00	$0.00	$0.00	$288.61	"$1,027.74"	"$1,027.74"	$0.00	$0.00	$288.58	$0.00	$819.06	$819.06	$0.00	$659.39	"$1,044.47"	"$1,055.02"	$0.00		$0.00	$206.39	$0.00	$0.00	$209.95	$0.00	$0.00	$0.00	$0.00	$0.00
M00202175426P0	SUP	HCPCS C1768		M00202175426P0  -  GRAFT CARDIO 30CM 36MM 2 VLR SL TXTL STR TUBE WVN HMSH PL	BOTH IP/OP	"$1,371.55 "	"$1,014.95"	$0.00	"$1,097.24"	$617.20	$617.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$685.78	"$1,086.27"	"$1,097.24"	$0.00		$0.00	$214.65	$0.00	$0.00	$218.35	$0.00	$0.00	$0.00	$0.00	$0.00
M00202175428P0	SUP	HCPCS C1768		M00202175428P0  -  GRAFT CV STRG TUBE 28MM 30CM HMSH PL WVN SMTH NDL PSG SUT	BOTH IP/OP	"$1,440.13 "	"$1,065.70"	$0.00	"$1,564.50"	$880.03	$880.03	$0.00	$0.00	$0.00	$300.16	"$1,068.86"	"$1,068.86"	$0.00	$0.00	$300.12	$0.00	$851.83	$851.83	$0.00	$977.81	"$1,548.86"	"$1,564.50"	$0.00		$0.00	$306.06	$0.00	$0.00	$311.34	$0.00	$0.00	$0.00	$0.00	$0.00
M00202175430P0	SUP	HCPCS C1768		M00202175430P0  -  GRAFT CARDIO 30CM 30MM 2 VLR WVN STR TUBE HMSH PL PLSTR STRL	BOTH IP/OP	"$1,440.13 "	"$1,065.70"	$0.00	"$1,097.24"	$617.20	$617.20	$0.00	$0.00	$0.00	$300.16	"$1,068.86"	"$1,068.86"	$0.00	$0.00	$300.12	$0.00	$851.83	$851.83	$0.00	$685.78	"$1,086.27"	"$1,097.24"	$0.00		$0.00	$214.65	$0.00	$0.00	$218.35	$0.00	$0.00	$0.00	$0.00	$0.00
M00202175434P0	SUP	HCPCS C1768		M00202175434P0  -  GRAFT VASC 30CM 34MM HMSH PL WVN STR	BOTH IP/OP	"$1,440.13 "	"$1,065.70"	$0.00	"$1,097.24"	$617.20	$617.20	$0.00	$0.00	$0.00	$300.16	"$1,068.86"	"$1,068.86"	$0.00	$0.00	$300.12	$0.00	$851.83	$851.83	$0.00	$685.78	"$1,086.27"	"$1,097.24"	$0.00		$0.00	$214.65	$0.00	$0.00	$218.35	$0.00	$0.00	$0.00	$0.00	$0.00
M002363200201	SUP	HCPCS C1768		M002363200201  -  GRAFT SIZER 5-24MM	BOTH IP/OP	$26.00 	$19.24	$0.00	$19.86	$11.17	$11.17	$0.00	$0.00	$0.00	$5.42	$19.30	$19.30	$0.00	$0.00	$5.42	$0.00	$15.38	$15.38	$0.00	$12.41	$19.67	$19.86	$0.00		$0.00	$3.89	$0.00	$0.00	$3.95	$0.00	$0.00	$0.00	$0.00	$0.00
M002363200211	SUP	HCPCS C1768		M002363200211  -  TMPLT SZ 24-38MM VASC GFT	BOTH IP/OP	$26.00 	$19.24	$0.00	$19.86	$11.17	$11.17	$0.00	$0.00	$0.00	$5.42	$19.30	$19.30	$0.00	$0.00	$5.42	$0.00	$15.38	$15.38	$0.00	$12.41	$19.67	$19.86	$0.00		$0.00	$3.89	$0.00	$0.00	$3.95	$0.00	$0.00	$0.00	$0.00	$0.00
M0031351020	SUP	HCPCS C1757		M0031351020  -  CATHETER INFS MIC 155CM 15CM FRCKR10	BOTH IP/OP	"$2,303.00 "	"$1,704.22"	$0.00	"$1,842.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$480.00	"$1,709.29"	"$1,709.29"	$0.00	$0.00	$479.95	$0.00	"$1,362.22"	"$1,362.22"	$0.00	"$1,151.50"	"$1,823.98"	"$1,842.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0031441890	SUP	HCPCS C1751		M0031441890  -  MICROCATHETER CRBRVASC .014-.016IN STRG 2.6-2FR .019IN 150CM	BOTH IP/OP	"$2,138.50 "	"$1,582.49"	$0.00	"$1,710.80"	"$1,161.21"	"$1,161.21"	$0.00	$0.00	$0.00	$445.72	"$1,587.19"	"$1,587.19"	$0.00	$0.00	$445.66	$0.00	"$1,264.92"	"$1,264.92"	$0.00	"$1,069.25"	"$1,693.69"	"$1,710.80"	$0.00		$0.00	$334.68	$0.00	$0.00	$340.45	$0.00	$0.00	$0.00	$0.00	$0.00
M0031681890	SUP	HCPCS C1751		M0031681890  -  CATHETER INFS .038IN 2.4-1.7FR .014IN 150CM 6CM EXCLS SL-10	BOTH IP/OP	"$2,162.00 "	"$1,599.88"	$0.00	"$1,729.60"	"$1,173.97"	"$1,173.97"	$0.00	$0.00	$0.00	$450.61	"$1,604.64"	"$1,604.64"	$0.00	$0.00	$450.56	$0.00	"$1,278.82"	"$1,278.82"	$0.00	"$1,081.00"	"$1,712.30"	"$1,729.60"	$0.00		$0.00	$338.35	$0.00	$0.00	$344.19	$0.00	$0.00	$0.00	$0.00	$0.00
M0031681900	SUP	HCPCS C1751		M0031681900  -  MICROCATHETER CRBRVASC 45D .014IN PSHP 2.4-1.7FR .0165IN 150	BOTH IP/OP	"$2,326.50 "	"$1,721.61"	$0.00	"$1,861.20"	"$1,263.29"	"$1,263.29"	$0.00	$0.00	$0.00	$484.90	"$1,726.73"	"$1,726.73"	$0.00	$0.00	$484.84	$0.00	"$1,376.12"	"$1,376.12"	$0.00	"$1,163.25"	"$1,842.59"	"$1,861.20"	$0.00		$0.00	$364.10	$0.00	$0.00	$370.38	$0.00	$0.00	$0.00	$0.00	$0.00
M003182880US0	SUP	HCPCS C1887		M003182880US0  -  MICROCATHETER INFS 135CM RNGD HFL RADOPQ DIST TIP VORTEC +	BOTH IP/OP	"$1,774.25 "	"$1,312.95"	$0.00	"$1,419.40"	$963.42	$963.42	$0.00	$0.00	$0.00	$369.80	"$1,316.85"	"$1,316.85"	$0.00	$0.00	$369.75	$0.00	"$1,049.47"	"$1,049.47"	$0.00	$887.13	"$1,405.21"	"$1,419.40"	$0.00		$0.00	$277.67	$0.00	$0.00	$282.46	$0.00	$0.00	$0.00	$0.00	$0.00
M003182900US0	SUP	HCPCS C1751		M003182900US0  -  CATHETER INFS 150CM 10CM RNGD HF KT MCTH RADOPQ BRAID HDRPH	BOTH IP/OP	"$1,774.25 "	"$1,312.95"	$0.00	"$1,419.40"	$963.42	$963.42	$0.00	$0.00	$0.00	$369.80	"$1,316.85"	"$1,316.85"	$0.00	$0.00	$369.75	$0.00	"$1,049.47"	"$1,049.47"	$0.00	$887.13	"$1,405.21"	"$1,419.40"	$0.00		$0.00	$277.67	$0.00	$0.00	$282.46	$0.00	$0.00	$0.00	$0.00	$0.00
M0032072209150	SUP	HCPCS C1726		M0032072209150  -  CATHETER BLNDIL 1.5MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT	BOTH IP/OP	"$2,643.75 "	"$1,956.38"	$0.00	"$2,115.00"	"$1,435.56"	"$1,435.56"	$0.00	$0.00	$0.00	$551.02	"$1,962.19"	"$1,962.19"	$0.00	$0.00	$550.96	$0.00	"$1,563.78"	"$1,563.78"	$0.00	"$1,321.88"	"$2,093.85"	"$2,115.00"	$0.00		$0.00	$413.75	$0.00	$0.00	$420.89	$0.00	$0.00	$0.00	$0.00	$0.00
M0032072209200	SUP	HCPCS C1726		M0032072209200  -  CATHETER BLNDIL 2MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT	BOTH IP/OP	"$2,643.75 "	"$1,956.38"	$0.00	"$2,115.00"	"$1,435.56"	"$1,435.56"	$0.00	$0.00	$0.00	$551.02	"$1,962.19"	"$1,962.19"	$0.00	$0.00	$550.96	$0.00	"$1,563.78"	"$1,563.78"	$0.00	"$1,321.88"	"$2,093.85"	"$2,115.00"	$0.00		$0.00	$413.75	$0.00	$0.00	$420.89	$0.00	$0.00	$0.00	$0.00	$0.00
M0032072209250	SUP	HCPCS C1726		M0032072209250  -  CATHETER BLNDIL 2.5MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT	BOTH IP/OP	"$2,643.75 "	"$1,956.38"	$0.00	"$2,115.00"	"$1,435.56"	"$1,435.56"	$0.00	$0.00	$0.00	$551.02	"$1,962.19"	"$1,962.19"	$0.00	$0.00	$550.96	$0.00	"$1,563.78"	"$1,563.78"	$0.00	"$1,321.88"	"$2,093.85"	"$2,115.00"	$0.00		$0.00	$413.75	$0.00	$0.00	$420.89	$0.00	$0.00	$0.00	$0.00	$0.00
M0032072209300	SUP	HCPCS C1726		M0032072209300  -  CATHETER BLNDIL 3MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT	BOTH IP/OP	"$2,643.75 "	"$1,956.38"	$0.00	"$2,115.00"	"$1,435.56"	"$1,435.56"	$0.00	$0.00	$0.00	$551.02	"$1,962.19"	"$1,962.19"	$0.00	$0.00	$550.96	$0.00	"$1,563.78"	"$1,563.78"	$0.00	"$1,321.88"	"$2,093.85"	"$2,115.00"	$0.00		$0.00	$413.75	$0.00	$0.00	$420.89	$0.00	$0.00	$0.00	$0.00	$0.00
M0032072209350	SUP	HCPCS C1726		M0032072209350  -  CATHETER BLNDIL 3.5MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT	BOTH IP/OP	"$2,643.75 "	"$1,956.38"	$0.00	"$2,115.00"	"$1,435.56"	"$1,435.56"	$0.00	$0.00	$0.00	$551.02	"$1,962.19"	"$1,962.19"	$0.00	$0.00	$550.96	$0.00	"$1,563.78"	"$1,563.78"	$0.00	"$1,321.88"	"$2,093.85"	"$2,115.00"	$0.00		$0.00	$413.75	$0.00	$0.00	$420.89	$0.00	$0.00	$0.00	$0.00	$0.00
M0032072215250	SUP	HCPCS C1726		M0032072215250  -  CATHETER BLNDIL 2.5MM 135CM LF 15MM GTWY OTW 2 LUM HDRPH	BOTH IP/OP	"$2,643.75 "	"$1,956.38"	$0.00	"$2,115.00"	"$1,435.56"	"$1,435.56"	$0.00	$0.00	$0.00	$551.02	"$1,962.19"	"$1,962.19"	$0.00	$0.00	$550.96	$0.00	"$1,563.78"	"$1,563.78"	$0.00	"$1,321.88"	"$2,093.85"	"$2,115.00"	$0.00		$0.00	$413.75	$0.00	$0.00	$420.89	$0.00	$0.00	$0.00	$0.00	$0.00
M0032072215300	SUP	HCPCS C1726		M0032072215300  -  CATHETER BLNDIL 3MM 135CM LF 15MM GTWY OTW 2 LUM HDRPH ACPT	BOTH IP/OP	"$2,643.75 "	"$1,956.38"	$0.00	"$2,115.00"	"$1,435.56"	"$1,435.56"	$0.00	$0.00	$0.00	$551.02	"$1,962.19"	"$1,962.19"	$0.00	$0.00	$550.96	$0.00	"$1,563.78"	"$1,563.78"	$0.00	"$1,321.88"	"$2,093.85"	"$2,115.00"	$0.00		$0.00	$413.75	$0.00	$0.00	$420.89	$0.00	$0.00	$0.00	$0.00	$0.00
M0032072215350	SUP	HCPCS C1726		M0032072215350  -  CATHETER BLNDIL 3.5MM 135CM LF 15MM GTWY OTW 2 LUM HDRPH	BOTH IP/OP	"$2,643.75 "	"$1,956.38"	$0.00	"$2,115.00"	"$1,435.56"	"$1,435.56"	$0.00	$0.00	$0.00	$551.02	"$1,962.19"	"$1,962.19"	$0.00	$0.00	$550.96	$0.00	"$1,563.78"	"$1,563.78"	$0.00	"$1,321.88"	"$2,093.85"	"$2,115.00"	$0.00		$0.00	$413.75	$0.00	$0.00	$420.89	$0.00	$0.00	$0.00	$0.00	$0.00
M00326110	SUP	HCPCS C1769		M00326110  -  GUIDEWIRE VASCULAR .014IN 200CM 35CM SOFT TIP ATRAUMATIC	BOTH IP/OP	"$1,386.50 "	"$1,026.01"	$0.00	"$1,109.20"	$752.87	$752.87	$0.00	$0.00	$0.00	$288.98	"$1,029.06"	"$1,029.06"	$0.00	$0.00	$288.95	$0.00	$820.11	$820.11	$0.00	$693.25	"$1,098.11"	"$1,109.20"	$0.00		$0.00	$216.99	$0.00	$0.00	$220.73	$0.00	$0.00	$0.00	$0.00	$0.00
M00326410	SUP	HCPCS C1769		M00326410  -  GUIDEWIRE VASC .014IN 200CM 35CM SYNCHRO2 STD ATRM RBN TIP	BOTH IP/OP	"$1,316.00 "	$973.84	$0.00	"$1,052.80"	$714.59	$714.59	$0.00	$0.00	$0.00	$274.29	$976.74	$976.74	$0.00	$0.00	$274.25	$0.00	$778.41	$778.41	$0.00	$658.00	"$1,042.27"	"$1,052.80"	$0.00		$0.00	$205.95	$0.00	$0.00	$209.51	$0.00	$0.00	$0.00	$0.00	$0.00
M00326420	SUP	HCPCS C1769		M00326420  -  GUIDEWIRE VASCULAR STANDARD .014IN 200CM 35CM PRESHAPED	BOTH IP/OP	"$1,386.50 "	"$1,026.01"	$0.00	"$1,109.20"	$752.87	$752.87	$0.00	$0.00	$0.00	$288.98	"$1,029.06"	"$1,029.06"	$0.00	$0.00	$288.95	$0.00	$820.11	$820.11	$0.00	$693.25	"$1,098.11"	"$1,109.20"	$0.00		$0.00	$216.99	$0.00	$0.00	$220.73	$0.00	$0.00	$0.00	$0.00	$0.00
M00326520	SUP	HCPCS C1769		M00326520  -  GUIDEWIRE VASC .014IN 300CM 35CM SYNCHRO2 STD ATRM RBN TIP	BOTH IP/OP	"$1,715.50 "	"$1,269.47"	$0.00	"$1,372.40"	$931.52	$931.52	$0.00	$0.00	$0.00	$357.55	"$1,273.24"	"$1,273.24"	$0.00	$0.00	$357.51	$0.00	"$1,014.72"	"$1,014.72"	$0.00	$857.75	"$1,358.68"	"$1,372.40"	$0.00		$0.00	$268.48	$0.00	$0.00	$273.11	$0.00	$0.00	$0.00	$0.00	$0.00
M003468140	SUP	HCPCS C1769		M003468140  -  GUIDEWIRE VASC .014IN 300CM STRL LF 2CM TRNSD X SPRT ICE	BOTH IP/OP	"$1,351.25 "	$999.93	$0.00	"$1,081.00"	$733.73	$733.73	$0.00	$0.00	$0.00	$281.63	"$1,002.90"	"$1,002.90"	$0.00	$0.00	$281.60	$0.00	$799.26	$799.26	$0.00	$675.63	"$1,070.19"	"$1,081.00"	$0.00		$0.00	$211.47	$0.00	$0.00	$215.12	$0.00	$0.00	$0.00	$0.00	$0.00
M0035503010	SUP	HCPCS C1887		M0035503010  -  CATHETER INFUS .038IN MICRO 3FR .024IN 105CM 12CM KIT GWIRE	BOTH IP/OP	"$1,157.13 "	$856.28	$0.00	$925.70	$628.32	$628.32	$0.00	$0.00	$0.00	$241.17	$858.82	$858.82	$0.00	$0.00	$241.14	$0.00	$684.44	$684.44	$0.00	$578.56	$916.45	$925.70	$0.00		$0.00	$181.09	$0.00	$0.00	$184.21	$0.00	$0.00	$0.00	$0.00	$0.00
M0035503040	SUP	HCPCS C1887		M0035503040  -  CATHETER INFUS .018IN MICRO 3-2.8FR .024-.018IN 135CM 12CM	BOTH IP/OP	"$1,157.13 "	$856.28	$0.00	$925.70	$628.32	$628.32	$0.00	$0.00	$0.00	$241.17	$858.82	$858.82	$0.00	$0.00	$241.14	$0.00	$684.44	$684.44	$0.00	$578.56	$916.45	$925.70	$0.00		$0.00	$181.09	$0.00	$0.00	$184.21	$0.00	$0.00	$0.00	$0.00	$0.00
M003N3EZ25200	SUP	HCPCS C2617		M003N3EZ25200  -  STENT INTRCRAN 2.5MM 20MM NRFRM EZ 3	BOTH IP/OP	"$15,745.00 "	"$11,651.30"	$0.00	"$12,596.00"	"$7,085.25"	"$7,085.25"	$0.00	$0.00	$0.00	"$3,281.65"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,281.26"	$0.00	"$7,762.29"	"$7,762.29"	$0.00	"$7,872.50"	"$12,470.04"	"$12,596.00"	$0.00		$0.00	"$2,464.09"	$0.00	$0.00	"$2,506.60"	$0.00	$0.00	$0.00	$0.00	$0.00
M003N3EZ30200	SUP	HCPCS C2617		M003N3EZ30200  -  STENT INTRCRAN 3MM 20MM NRFRM EZ NRFRM3	BOTH IP/OP	"$15,745.00 "	"$11,651.30"	$0.00	"$12,596.00"	"$7,085.25"	"$7,085.25"	$0.00	$0.00	$0.00	"$3,281.65"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,281.26"	$0.00	"$7,762.29"	"$7,762.29"	$0.00	"$7,872.50"	"$12,470.04"	"$12,596.00"	$0.00		$0.00	"$2,464.09"	$0.00	$0.00	"$2,506.60"	$0.00	$0.00	$0.00	$0.00	$0.00
M003N3EZ35200	SUP	HCPCS C2617		M003N3EZ35200  -  STENT INTRCRAN 3.5MM 20MM NRFRM EZ NRFRM3	BOTH IP/OP	"$15,745.00 "	"$11,651.30"	$0.00	"$12,596.00"	"$7,085.25"	"$7,085.25"	$0.00	$0.00	$0.00	"$3,281.65"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,281.26"	$0.00	"$7,762.29"	"$7,762.29"	$0.00	"$7,872.50"	"$12,470.04"	"$12,596.00"	$0.00		$0.00	"$2,464.09"	$0.00	$0.00	"$2,506.60"	$0.00	$0.00	$0.00	$0.00	$0.00
M003N3EZ40200	SUP	HCPCS C2617		M003N3EZ40200  -  STENT INTRCRAN 4MM 20MM NRFRM EZ 3	BOTH IP/OP	"$15,745.00 "	"$11,651.30"	$0.00	"$12,596.00"	"$7,085.25"	"$7,085.25"	$0.00	$0.00	$0.00	"$3,281.65"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,281.26"	$0.00	"$7,762.29"	"$7,762.29"	$0.00	"$7,872.50"	"$12,470.04"	"$12,596.00"	$0.00		$0.00	"$2,464.09"	$0.00	$0.00	"$2,506.60"	$0.00	$0.00	$0.00	$0.00	$0.00
M003N3EZ45200	SUP	HCPCS C2617		M003N3EZ45200  -  STENT INTRCRAN 4.5MM 20MM NRFRM EZ PRELD SLF XPD RADOPQ NTNL	BOTH IP/OP	"$15,745.00 "	"$11,651.30"	$0.00	"$12,596.00"	"$7,085.25"	"$7,085.25"	$0.00	$0.00	$0.00	"$3,281.65"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,281.26"	$0.00	"$7,762.29"	"$7,762.29"	$0.00	"$7,872.50"	"$12,470.04"	"$12,596.00"	$0.00		$0.00	"$2,464.09"	$0.00	$0.00	"$2,506.60"	$0.00	$0.00	$0.00	$0.00	$0.00
M003N3EZ45300	SUP	Custom 27803010		M003N3EZ45300  -  STENT INTRCRAN 4.5MM 30MM NRFRM EZ PRELD SLF XPD RADOPQ NTNL	BOTH IP/OP	"$15,745.00 "	"$11,651.30"	$0.00	"$12,596.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,281.26"	$0.00	$0.00	$0.00	$0.00	"$7,872.50"	"$12,470.04"	"$12,596.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M003SNF3STA0	SUP	Custom 27203010		M003SNF3STA0  -  STENT INTRCRAN 2FR NRFRM3 STAB CATH	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,133.83"	"$2,133.83"	$0.00	$0.00	$599.15	$0.00	$0.00	$0.00	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M003UZAS30150	SUP	Custom 27803010		M003UZAS30150  -  STENT 3.0MM 15MM 3.5MM NEUROFORM ATLAS	BOTH IP/OP	"$18,125.00 "	"$13,412.50"	$0.00	"$14,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,777.25"	$0.00	$0.00	$0.00	$0.00	"$9,062.50"	"$14,355.00"	"$14,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M003UZAS30210	SUP	Custom 27803010		M003UZAS30210  -  STENT 3.0MM 21MM 3.5MM NEUROFORM ATLAS	BOTH IP/OP	"$18,125.00 "	"$13,412.50"	$0.00	"$14,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,777.25"	$0.00	$0.00	$0.00	$0.00	"$9,062.50"	"$14,355.00"	"$14,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M003UZAS30240	SUP	Custom 27803010		M003UZAS30240  -  STENT 3.0MM 24MM 3.5MM NEUROFORM ATLAS	BOTH IP/OP	"$18,125.00 "	"$13,412.50"	$0.00	"$14,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,777.25"	$0.00	$0.00	$0.00	$0.00	"$9,062.50"	"$14,355.00"	"$14,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M003UZAS40210	SUP	Custom 27803010		M003UZAS40210  -  STENT 4.0MM 21MM 4.5MM NEUROFORM ATLAS	BOTH IP/OP	"$18,125.00 "	"$13,412.50"	$0.00	"$14,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,777.25"	$0.00	$0.00	$0.00	$0.00	"$9,062.50"	"$14,355.00"	"$14,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M003UZAS40240	SUP	Custom 27803010		M003UZAS40240  -  STENT 4.0MM 24MM 4.5MM NEUROFORM ATLAS	BOTH IP/OP	"$18,125.00 "	"$13,412.50"	$0.00	"$14,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,777.25"	$0.00	$0.00	$0.00	$0.00	"$9,062.50"	"$14,355.00"	"$14,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M003UZAS45210	SUP	Custom 27803010		M003UZAS45210  -  STENT 4.5MM 21MM 5.0MM NEUROFORM ATLAS	BOTH IP/OP	"$18,125.00 "	"$13,412.50"	$0.00	"$14,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,777.25"	$0.00	$0.00	$0.00	$0.00	"$9,062.50"	"$14,355.00"	"$14,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M003UZAS45300	SUP	Custom 27803010		M003UZAS45300  -  STENT 4.5MM 30MM 5.0MM NEUROFORM ATLAS	BOTH IP/OP	"$18,125.00 "	"$13,412.50"	$0.00	"$14,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,777.25"	$0.00	$0.00	$0.00	$0.00	"$9,062.50"	"$14,355.00"	"$14,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M003WS0250090	SUP	HCPCS C2617		M003WS0250090  -  STENT INTRCRAN 2.5MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD	BOTH IP/OP	"$15,980.00 "	"$11,825.20"	$0.00	"$12,784.00"	"$7,191.00"	"$7,191.00"	$0.00	$0.00	$0.00	"$3,330.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,330.23"	$0.00	"$7,878.14"	"$7,878.14"	$0.00	"$7,990.00"	"$12,656.16"	"$12,784.00"	$0.00		$0.00	"$2,500.87"	$0.00	$0.00	"$2,544.02"	$0.00	$0.00	$0.00	$0.00	$0.00
M003WS0250150	SUP	HCPCS C2617		M003WS0250150  -  STENT INTRACRANIAL .014IN 2.5MM 15MM OTW FLEXIBLE TRACKABLE	BOTH IP/OP	"$15,980.00 "	"$11,825.20"	$0.00	"$12,784.00"	"$7,191.00"	"$7,191.00"	$0.00	$0.00	$0.00	"$3,330.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,330.23"	$0.00	"$7,878.14"	"$7,878.14"	$0.00	"$7,990.00"	"$12,656.16"	"$12,784.00"	$0.00		$0.00	"$2,500.87"	$0.00	$0.00	"$2,544.02"	$0.00	$0.00	$0.00	$0.00	$0.00
M003WS0300090	SUP	HCPCS C2617		M003WS0300090  -  STENT INTRCRAN 3MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD OTW	BOTH IP/OP	"$15,980.00 "	"$11,825.20"	$0.00	"$12,784.00"	"$7,191.00"	"$7,191.00"	$0.00	$0.00	$0.00	"$3,330.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,330.23"	$0.00	"$7,878.14"	"$7,878.14"	$0.00	"$7,990.00"	"$12,656.16"	"$12,784.00"	$0.00		$0.00	"$2,500.87"	$0.00	$0.00	"$2,544.02"	$0.00	$0.00	$0.00	$0.00	$0.00
M003WS0300150	SUP	Custom 27803010		M003WS0300150  -  STENT INTRCRAN 3MM 3.5FR 15MM STRL WINGSPAN GTWY SLF XPD OTW	BOTH IP/OP	"$15,980.00 "	"$11,825.20"	$0.00	"$12,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,330.23"	$0.00	$0.00	$0.00	$0.00	"$7,990.00"	"$12,656.16"	"$12,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M003WS0350090	SUP	HCPCS C2617		M003WS0350090  -  STENT INTRCRAN 3.5MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD	BOTH IP/OP	"$15,980.00 "	"$11,825.20"	$0.00	"$12,784.00"	"$7,191.00"	"$7,191.00"	$0.00	$0.00	$0.00	"$3,330.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,330.23"	$0.00	"$7,878.14"	"$7,878.14"	$0.00	"$7,990.00"	"$12,656.16"	"$12,784.00"	$0.00		$0.00	"$2,500.87"	$0.00	$0.00	"$2,544.02"	$0.00	$0.00	$0.00	$0.00	$0.00
M003WS0350150	SUP	Custom 27803010		M003WS0350150  -  STENT INTRCRAN 3.5MM 3.5FR 15MM STRL WINGSPAN GTWY SLF XPD	BOTH IP/OP	"$15,980.00 "	"$11,825.20"	$0.00	"$12,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,330.23"	$0.00	$0.00	$0.00	$0.00	"$7,990.00"	"$12,656.16"	"$12,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M003WS0400090	SUP	HCPCS C2617		M003WS0400090  -  STENT INTRCRAN 4MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD OTW	BOTH IP/OP	"$15,980.00 "	"$11,825.20"	$0.00	"$12,784.00"	"$7,191.00"	"$7,191.00"	$0.00	$0.00	$0.00	"$3,330.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,330.23"	$0.00	"$7,878.14"	"$7,878.14"	$0.00	"$7,990.00"	"$12,656.16"	"$12,784.00"	$0.00		$0.00	"$2,500.87"	$0.00	$0.00	"$2,544.02"	$0.00	$0.00	$0.00	$0.00	$0.00
M003WS0400150	SUP	Custom 27803010		M003WS0400150  -  STENT INTRCRAN 4MM 3.5FR 15MM STRL WINGSPAN GTWY SLF XPD OTW	BOTH IP/OP	"$15,980.00 "	"$11,825.20"	$0.00	"$12,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,330.23"	$0.00	$0.00	$0.00	$0.00	"$7,990.00"	"$12,656.16"	"$12,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00510860	SUP	Custom 27203010		M00510860  -  BASKET SPEC RTRVL 1.5CM 3.2MM STRL 3CM TRPZD RX LTHTRP DIST	BOTH IP/OP	$645.18 	$477.43	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.85	$478.85	$0.00	$0.00	$134.45	$0.00	$0.00	$0.00	$0.00	$355.00	$529.02	$568.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00510860	SUP	Custom 27203592		RX LITHOTRIPTER COMPATABLE BASKET 3	BOTH IP/OP	$645.18 	$477.43	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.85	$478.85	$0.00	$0.00	$134.45	$0.00	$0.00	$0.00	$0.00	$355.00	$562.32	$568.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00510870	SUP	Custom 27203010		M00510870  -  BASKET SPEC RTRVL 2MM 3.2MM STRL 4CM TRPZD RX LTHTRP DIST	BOTH IP/OP	$645.18 	$477.43	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.85	$478.85	$0.00	$0.00	$134.45	$0.00	$0.00	$0.00	$0.00	$355.00	$529.02	$568.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00510870	SUP	Custom 27203593		RX LITHOTRIPTER COMPATABLE BASKET 4	BOTH IP/OP	$645.18 	$477.43	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.85	$478.85	$0.00	$0.00	$134.45	$0.00	$0.00	$0.00	$0.00	$355.00	$562.32	$568.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00510880	SUP	Custom 27203010		M00510880  -  BASKET SPEC RTRVL 2.5CM 3.2MM STRL 5CM TRPZD RX LTHTRP DIST	BOTH IP/OP	$645.18 	$477.43	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.85	$478.85	$0.00	$0.00	$134.45	$0.00	$0.00	$0.00	$0.00	$355.00	$529.02	$568.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00510880	SUP	Custom 27203594		RX LITHOTRIPTER COMPATABLE BASKET 5	BOTH IP/OP	$645.18 	$477.43	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.85	$478.85	$0.00	$0.00	$134.45	$0.00	$0.00	$0.00	$0.00	$355.00	$562.32	$568.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00510890	SUP	Custom 27203010		M00510890  -  BASKET SPEC RTRVL 3CM 3.2MM STRL 3CM TRPZD RX LTHTRP DIST	BOTH IP/OP	$645.18 	$477.43	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.85	$478.85	$0.00	$0.00	$134.45	$0.00	$0.00	$0.00	$0.00	$355.00	$529.02	$568.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00510890	SUP	Custom 27203595		RX LITHOTRIPTER COMPATABLE BASKET 6	BOTH IP/OP	$645.18 	$477.43	$0.00	$568.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.85	$478.85	$0.00	$0.00	$134.45	$0.00	$0.00	$0.00	$0.00	$355.00	$562.32	$568.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00513210	SUP	Custom 27203010		M00513210  -  BASKET SPECIMEN RETRIEVAL 16MM 1MM 120CM AIRWAY ZERO TIP	BOTH IP/OP	$622.40 	$460.58	$0.00	$501.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$461.95	$461.95	$0.00	$0.00	$129.71	$0.00	$0.00	$0.00	$0.00	$313.26	$496.21	$501.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00513740	SUP	HCPCS C1874		M00513740  -  STENT ESOPHAGEAL 18-23MM 12CM 9CM COVER DISTAL RELEASE NEXT	BOTH IP/OP	"$4,137.50 "	"$3,061.75"	$0.00	"$3,314.14"	"$1,864.20"	"$1,864.20"	$0.00	$0.00	$0.00	$862.36	"$3,070.85"	"$3,070.85"	$0.00	$0.00	$862.26	$0.00	"$2,039.79"	"$2,039.79"	$0.00	"$2,071.34"	"$3,281.00"	"$3,314.14"	$0.00		$0.00	$648.33	$0.00	$0.00	$659.51	$0.00	$0.00	$0.00	$0.00	$0.00
M00516720	SUP	HCPCS C1874		M00516720  -  STENT ESOPHAGEAL FLARE LP 18MM 18.5FR 15CM 120CM SELF EXPAND	BOTH IP/OP	"$5,892.90 "	"$4,360.75"	$0.00	"$4,778.42"	"$2,687.86"	"$2,687.86"	$0.00	$0.00	$0.00	"$1,228.23"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,228.08"	$0.00	"$2,905.20"	"$2,905.20"	$0.00	"$2,986.51"	"$4,730.64"	"$4,778.42"	$0.00		$0.00	$934.78	$0.00	$0.00	$950.91	$0.00	$0.00	$0.00	$0.00	$0.00
M00516900	SUP	HCPCS C1874		M00516900  -  STENT ESOPHAGEAL LP 18MM 18.5FR 10CM 7CM PRTL COVER COAXIAL	BOTH IP/OP	"$5,772.58 "	"$4,271.71"	$0.00	"$4,729.78"	"$2,660.50"	"$2,660.50"	$0.00	$0.00	$0.00	"$1,203.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,203.00"	$0.00	"$2,845.88"	"$2,845.88"	$0.00	"$2,956.11"	"$4,682.49"	"$4,729.78"	$0.00		$0.00	$925.26	$0.00	$0.00	$941.23	$0.00	$0.00	$0.00	$0.00	$0.00
M00516910	SUP	HCPCS C1874		M00516910  -  STENT ESOPHAGEAL LP 18MM 18.5FR 12CM 9CM PRTL COVER COAXIAL	BOTH IP/OP	"$5,772.58 "	"$4,271.71"	$0.00	"$4,729.78"	"$2,660.50"	"$2,660.50"	$0.00	$0.00	$0.00	"$1,203.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,203.00"	$0.00	"$2,845.88"	"$2,845.88"	$0.00	"$2,956.11"	"$4,682.49"	"$4,729.78"	$0.00		$0.00	$925.26	$0.00	$0.00	$941.23	$0.00	$0.00	$0.00	$0.00	$0.00
M00516920	SUP	HCPCS C1874		M00516920  -  STENT ESOPHAGEAL LP 23MM 18MM 153MM 12CM PRTL COVER COAXIAL	BOTH IP/OP	"$5,772.58 "	"$4,271.71"	$0.00	"$4,729.78"	"$2,660.50"	"$2,660.50"	$0.00	$0.00	$0.00	"$1,203.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,203.00"	$0.00	"$2,845.88"	"$2,845.88"	$0.00	"$2,956.11"	"$4,682.49"	"$4,729.78"	$0.00		$0.00	$925.26	$0.00	$0.00	$941.23	$0.00	$0.00	$0.00	$0.00	$0.00
M00516930	SUP	HCPCS C1874		M00516930  -  STENT ESOPHAGEAL LP 23MM 18.5MM 10CM 7CM BRAID DELIVERY	BOTH IP/OP	"$5,772.58 "	"$4,271.71"	$0.00	"$4,729.78"	"$2,660.50"	"$2,660.50"	$0.00	$0.00	$0.00	"$1,203.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,203.00"	$0.00	"$2,845.88"	"$2,845.88"	$0.00	"$2,956.11"	"$4,682.49"	"$4,729.78"	$0.00		$0.00	$925.26	$0.00	$0.00	$941.23	$0.00	$0.00	$0.00	$0.00	$0.00
M00516950	SUP	HCPCS C1874		M00516950  -  STENT ESOPHAGEAL LP 23MM 18.5FR 15CM 12CM BRAID DELIVERY	BOTH IP/OP	"$5,772.58 "	"$4,271.71"	$0.00	"$4,729.78"	"$2,660.50"	"$2,660.50"	$0.00	$0.00	$0.00	"$1,203.15"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,203.00"	$0.00	"$2,845.88"	"$2,845.88"	$0.00	"$2,956.11"	"$4,682.49"	"$4,729.78"	$0.00		$0.00	$925.26	$0.00	$0.00	$941.23	$0.00	$0.00	$0.00	$0.00	$0.00
M00522611	SUP	Custom 27203591		RESOLUTION 235CM	BOTH IP/OP	$392.29 	$290.29	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$291.16	$291.16	$0.00	$0.00	$81.75	$0.00	$0.00	$0.00	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00522611	SUP	Custom 27803010		M00522611  -  CLIP INTERNAL 11MM 235CM 2.8MM SECURE LOCK RADIOPQ USER	BOTH IP/OP	$392.29 	$290.29	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$291.16	$291.16	$0.00	$0.00	$81.75	$0.00	$0.00	$0.00	$0.00	$212.50	$314.53	$340.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00522612	SUP	Custom 27803010		M00522612  -  CLIP INTERNAL 11MM OPEN 235CM 2.8MM HEMOSTASIS RESOLUTION	BOTH IP/OP	$380.74 	$281.75	$0.00	$307.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.59	$282.59	$0.00	$0.00	$79.35	$0.00	$0.00	$0.00	$0.00	$192.38	$304.73	$307.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00530850	SUP	HCPCS C1769		M00530850  -  CANNULA ERCP STANDARD 5FR 210CM GWIRE CNTOUR BILIARY STERILE	BOTH IP/OP	$112.50 	$83.25	$0.00	$91.50	$62.11	$62.11	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$57.19	$90.59	$91.50	$0.00		$0.00	$17.90	$0.00	$0.00	$18.21	$0.00	$0.00	$0.00	$0.00	$0.00
M00530860	SUP	HCPCS C1769		M00530860  -  CANNULA ERCP TAPER 5FR 210CM CNTOUR BILIARY DISPOSABLE	BOTH IP/OP	$112.50 	$83.25	$0.00	$91.50	$62.11	$62.11	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$57.19	$90.59	$91.50	$0.00		$0.00	$17.90	$0.00	$0.00	$18.21	$0.00	$0.00	$0.00	$0.00	$0.00
M00530960	SUP	HCPCS C1769		M00530960  -  CANNU ERCP .025IN STD TIP GWIRE FLRTP 210CM 5FR BIL STRL	BOTH IP/OP	$81.93 	$60.63	$0.00	$65.54	$44.49	$44.49	$0.00	$0.00	$0.00	$17.08	$60.81	$60.81	$0.00	$0.00	$17.07	$0.00	$48.46	$48.46	$0.00	$40.96	$64.89	$65.54	$0.00		$0.00	$12.82	$0.00	$0.00	$13.04	$0.00	$0.00	$0.00	$0.00	$0.00
M00530970	SUP	HCPCS C1769		M00530970  -  CANNU ERCP .035IN TPR TIP GWIRE FLRTP 210CM 5FR BIL STRL	BOTH IP/OP	$81.93 	$60.63	$0.00	$65.54	$44.49	$44.49	$0.00	$0.00	$0.00	$17.08	$60.81	$60.81	$0.00	$0.00	$17.07	$0.00	$48.46	$48.46	$0.00	$40.96	$64.89	$65.54	$0.00		$0.00	$12.82	$0.00	$0.00	$13.04	$0.00	$0.00	$0.00	$0.00	$0.00
M00530980	SUP	HCPCS C1769		M00530980  -  CANNU ERCP .025IN TPR TIP FLRTP 210CM 5FR BIL STRL DISP	BOTH IP/OP	$81.93 	$60.63	$0.00	$65.54	$44.49	$44.49	$0.00	$0.00	$0.00	$17.08	$60.81	$60.81	$0.00	$0.00	$17.07	$0.00	$48.46	$48.46	$0.00	$40.96	$64.89	$65.54	$0.00		$0.00	$12.82	$0.00	$0.00	$13.04	$0.00	$0.00	$0.00	$0.00	$0.00
M00532240	SUP	HCPCS C2617		M00532240  -  STENT BILIARY 2 PIGTAIL CURVE 10FR 3CM RAPEX TEMPORARY	BOTH IP/OP	$133.55 	$98.83	$0.00	$108.70	$61.14	$61.14	$0.00	$0.00	$0.00	$27.84	$99.12	$99.12	$0.00	$0.00	$27.83	$0.00	$78.99	$78.99	$0.00	$67.94	$107.62	$108.70	$0.00		$0.00	$21.26	$0.00	$0.00	$21.63	$0.00	$0.00	$0.00	$0.00	$0.00
M00532260	SUP	HCPCS C2617		M00532260  -  STENT BILIARY 2 PIGTAIL CURVE 3.3MM 5CM TEMPORARY RAPEX	BOTH IP/OP	$133.55 	$98.83	$0.00	$108.70	$61.14	$61.14	$0.00	$0.00	$0.00	$27.84	$99.12	$99.12	$0.00	$0.00	$27.83	$0.00	$78.99	$78.99	$0.00	$67.94	$107.62	$108.70	$0.00		$0.00	$21.26	$0.00	$0.00	$21.63	$0.00	$0.00	$0.00	$0.00	$0.00
M00532270	SUP	HCPCS C2617		M00532270  -  STENT BILIARY 2 PIGTAIL CURVE 10FR 7CM RAPEX TEMPORARY	BOTH IP/OP	$133.55 	$98.83	$0.00	$108.70	$61.14	$61.14	$0.00	$0.00	$0.00	$27.84	$99.12	$99.12	$0.00	$0.00	$27.83	$0.00	$78.99	$78.99	$0.00	$67.94	$107.62	$108.70	$0.00		$0.00	$21.26	$0.00	$0.00	$21.63	$0.00	$0.00	$0.00	$0.00	$0.00
M00533580	SUP	HCPCS C2617		M00533580  -  STENT BILIARY 10FR 202.5CM DELIVERY SYSTEM RAPEX ADVANIX	BOTH IP/OP	$198.93 	$147.21	$0.00	$161.16	$90.65	$90.65	$0.00	$0.00	$0.00	$41.46	$147.64	$147.64	$0.00	$0.00	$41.46	$0.00	$117.66	$117.66	$0.00	$100.73	$159.55	$161.16	$0.00		$0.00	$31.53	$0.00	$0.00	$32.07	$0.00	$0.00	$0.00	$0.00	$0.00
M00534200	SUP	HCPCS C2617		M00534200  -  STENT BILIARY DUODENAL BEND 7FR 5CM RAPEX PRELOAD DELIVERY	BOTH IP/OP	$324.83 	$240.37	$0.00	$264.58	$148.83	$148.83	$0.00	$0.00	$0.00	$67.70	$241.09	$241.09	$0.00	$0.00	$67.69	$0.00	$192.13	$192.13	$0.00	$165.36	$261.94	$264.58	$0.00		$0.00	$51.76	$0.00	$0.00	$52.65	$0.00	$0.00	$0.00	$0.00	$0.00
M00534210	SUP	HCPCS C2617		M00534210  -  STENT BILIARY DUODENAL BEND 7FR 7CM PRELOAD TEMPORARY RAPEX	BOTH IP/OP	$324.83 	$240.37	$0.00	$264.58	$148.83	$148.83	$0.00	$0.00	$0.00	$67.70	$241.09	$241.09	$0.00	$0.00	$67.69	$0.00	$192.13	$192.13	$0.00	$165.36	$261.94	$264.58	$0.00		$0.00	$51.76	$0.00	$0.00	$52.65	$0.00	$0.00	$0.00	$0.00	$0.00
M00534220	SUP	HCPCS C2617		M00534220  -  STENT BILIARY DUODENAL BEND 7FR 9CM RAPEX PRELOAD ADVANIX	BOTH IP/OP	$324.83 	$240.37	$0.00	$264.58	$148.83	$148.83	$0.00	$0.00	$0.00	$67.70	$241.09	$241.09	$0.00	$0.00	$67.69	$0.00	$192.13	$192.13	$0.00	$165.36	$261.94	$264.58	$0.00		$0.00	$51.76	$0.00	$0.00	$52.65	$0.00	$0.00	$0.00	$0.00	$0.00
M00534230	SUP	HCPCS C2617		M00534230  -  STENT BILIARY DUODENAL BEND 7FR 12CM RAPEX PRELOAD ADVANIX	BOTH IP/OP	$324.83 	$240.37	$0.00	$264.58	$148.83	$148.83	$0.00	$0.00	$0.00	$67.70	$241.09	$241.09	$0.00	$0.00	$67.69	$0.00	$192.13	$192.13	$0.00	$165.36	$261.94	$264.58	$0.00		$0.00	$51.76	$0.00	$0.00	$52.65	$0.00	$0.00	$0.00	$0.00	$0.00
M00534260	SUP	HCPCS C2617		M00534260  -  STENT BILIARY DUODENAL BEND 2.83MM 5CM PRELOAD RAPEX	BOTH IP/OP	$324.83 	$240.37	$0.00	$264.58	$148.83	$148.83	$0.00	$0.00	$0.00	$67.70	$241.09	$241.09	$0.00	$0.00	$67.69	$0.00	$192.13	$192.13	$0.00	$165.36	$261.94	$264.58	$0.00		$0.00	$51.76	$0.00	$0.00	$52.65	$0.00	$0.00	$0.00	$0.00	$0.00
M00534270	SUP	HCPCS C2617		M00534270  -  STENT BILIARY DUODENAL BEND 2.83MM 7CM PRELOAD RAPEX	BOTH IP/OP	$324.83 	$240.37	$0.00	$264.58	$148.83	$148.83	$0.00	$0.00	$0.00	$67.70	$241.09	$241.09	$0.00	$0.00	$67.69	$0.00	$192.13	$192.13	$0.00	$165.36	$261.94	$264.58	$0.00		$0.00	$51.76	$0.00	$0.00	$52.65	$0.00	$0.00	$0.00	$0.00	$0.00
M00534320	SUP	HCPCS C2617		M00534320  -  STENT BILIARY DUODENAL BEND 10FR 5CM PRELOAD RAPEX DELIVERY	BOTH IP/OP	$324.83 	$240.37	$0.00	$264.58	$148.83	$148.83	$0.00	$0.00	$0.00	$67.70	$241.09	$241.09	$0.00	$0.00	$67.69	$0.00	$192.13	$192.13	$0.00	$165.36	$261.94	$264.58	$0.00		$0.00	$51.76	$0.00	$0.00	$52.65	$0.00	$0.00	$0.00	$0.00	$0.00
M00534330	SUP	HCPCS C2617		M00534330  -  STENT BILIARY DUODENAL BEND 10FR 7CM PRELOAD RADIOPQ MARKER	BOTH IP/OP	$324.83 	$240.37	$0.00	$264.58	$148.83	$148.83	$0.00	$0.00	$0.00	$67.70	$241.09	$241.09	$0.00	$0.00	$67.69	$0.00	$192.13	$192.13	$0.00	$165.36	$261.94	$264.58	$0.00		$0.00	$51.76	$0.00	$0.00	$52.65	$0.00	$0.00	$0.00	$0.00	$0.00
M00534340	SUP	HCPCS C2617		M00534340  -  STENT BILIARY DUODENAL BEND 10FR 9CM PRELOAD RADIOPQ MARKER	BOTH IP/OP	$324.83 	$240.37	$0.00	$264.58	$148.83	$148.83	$0.00	$0.00	$0.00	$67.70	$241.09	$241.09	$0.00	$0.00	$67.69	$0.00	$192.13	$192.13	$0.00	$165.36	$261.94	$264.58	$0.00		$0.00	$51.76	$0.00	$0.00	$52.65	$0.00	$0.00	$0.00	$0.00	$0.00
M00534350	SUP	HCPCS C2617		M00534350  -  STENT BILIARY DUODENAL BEND 10FR 12CM PRELOAD TEMPORARY	BOTH IP/OP	$324.83 	$240.37	$0.00	$264.58	$148.83	$148.83	$0.00	$0.00	$0.00	$67.70	$241.09	$241.09	$0.00	$0.00	$67.69	$0.00	$192.13	$192.13	$0.00	$165.36	$261.94	$264.58	$0.00		$0.00	$51.76	$0.00	$0.00	$52.65	$0.00	$0.00	$0.00	$0.00	$0.00
M00534360	SUP	HCPCS C1726		M00534360  -  STENT BILIARY DUODENAL BEND 10FR 15CM PRELOAD TEMPORARY	BOTH IP/OP	$324.83 	$240.37	$0.00	$264.58	$179.58	$179.58	$0.00	$0.00	$0.00	$67.70	$241.09	$241.09	$0.00	$0.00	$67.69	$0.00	$192.13	$192.13	$0.00	$165.36	$261.94	$264.58	$0.00		$0.00	$51.76	$0.00	$0.00	$52.65	$0.00	$0.00	$0.00	$0.00	$0.00
M00545170	SUP	Custom 27203596		AUTOTOME RX 44-20MM	BOTH IP/OP	$518.20 	$383.47	$0.00	$888.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.01	$384.61	$384.61	$0.00	$0.00	$107.99	$0.00	$306.52	$306.52	$0.00	$555.00	$879.12	$888.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545170	SUP	HCPCS C1769		M00545170  -  SPHINCTEROTOME ESCP 4.4FR 20MM STRL 5MM ATME RX CANNULATE	BOTH IP/OP	$518.20 	$383.47	$0.00	$888.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.01	$384.61	$384.61	$0.00	$0.00	$107.99	$0.00	$306.52	$306.52	$0.00	$555.00	$418.60	$888.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545190	SUP	Custom 27203597		AUTOTOME RX 39-20MM	BOTH IP/OP	$518.20 	$383.47	$0.00	$888.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.01	$384.61	$384.61	$0.00	$0.00	$107.99	$0.00	$306.52	$306.52	$0.00	$555.00	$879.12	$888.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545190	SUP	HCPCS C1769		M00545190  -  SPHINCTEROTOME ESCP 3.9FR 20MM STRL 5MM ATME RX CANNULATE	BOTH IP/OP	$518.20 	$383.47	$0.00	$888.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.01	$384.61	$384.61	$0.00	$0.00	$107.99	$0.00	$306.52	$306.52	$0.00	$555.00	$418.60	$888.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545261	SUP	Custom 27203010		M00545261  -  SYSTEM CHLGM RX LCK DEV BX CAP DISP OLMPS FUJIFILM G5 SER	BOTH IP/OP	$22.58 	$16.71	$0.00	$18.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.76	$16.76	$0.00	$0.00	$4.71	$0.00	$0.00	$0.00	$0.00	$11.53	$18.26	$18.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545550	SUP	Custom 27803070		RX STENT / 7 X 5CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545550	SUP	HCPCS C2617		M00545550  -  STENT BIL DDNL BND 7FR 5CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545560	SUP	HCPCS C2617		M00545560  -  STENT BIL DDNL BND 7FR 7CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$205.22	$115.44	$115.44	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$128.26	$203.17	$205.22	$0.00		$0.00	$40.15	$0.00	$0.00	$40.84	$0.00	$0.00	$0.00	$0.00	$0.00
M00545570	SUP	Custom 27803081		RX STENT / 7 X 10CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545570	SUP	HCPCS C2617		M00545570  -  STENT BIL DDNL BND 7FR 10CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545580	SUP	Custom 27803072		RX STENT / 7 X 12CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$198.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545580	SUP	HCPCS C2617		M00545580  -  STENT BIL DDNL BND 7FR 12CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$123.75	$203.17	$198.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545610	SUP	Custom 27803074		RX STENT / 10 X 7CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545610	SUP	HCPCS C2617		M00545610  -  STENT BIL DDNL BND 10FR 7CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545620	SUP	Custom 27803075		RX STENT / 10 X 10CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545620	SUP	HCPCS C2617		M00545620  -  STENT BIL DDNL BND 10FR 10CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545630	SUP	Custom 27803076		RX STENT / 10 X 12CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545630	SUP	HCPCS C2617		M00545630  -  STENT BIL DDNL BND 10FR 12CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545650	SUP	Custom 27803077		RX STENT / 8.5 X 5CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545650	SUP	HCPCS C2617		M00545650  -  STENT BIL DDNL BND 8.5FR 5CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545660	SUP	Custom 27803078		RX STENT / 8.5 X 7CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545660	SUP	HCPCS C2617		M00545660  -  STENT BIL DDNL BND 8.5FR 7CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545670	SUP	Custom 27803079		RX STENT / 8.5 X 10CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545670	SUP	HCPCS C2617		M00545670  -  STENT BIL DDNL BND 8.5FR 10CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545680	SUP	Custom 27803080		RX STENT / 8.5 X 12CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545680	SUP	HCPCS C2617		M00545680  -  STENT BIL DDNL BND 8.5FR 12CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$0.00	$0.00	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545700	SUP	HCPCS C2617		M00545700  -  STENT BIL DDNL BND 11.5FR 5CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$54.45	$54.45	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
M00545700	SUP	HCPCS C2625		RX STENT / 11.5 X 5	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$54.45	$54.45	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
M00545710	SUP	HCPCS C2617		M00545710  -  STENT BIL DDNL BND 11.5FR 7CM RX DLV SYS DISP ACPT .035IN GW	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$54.45	$54.45	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
M00545710	SUP	HCPCS C2625		RX STENT / 11.5 X 7CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$54.45	$54.45	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
M00545720	SUP	HCPCS C2617		M00545720  -  STENT BIL DDNL BND 11.5FR 10CM RX DLV SYS DISP ACPT .035IN	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$54.45	$54.45	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
M00545720	SUP	HCPCS C2625		RX STENT / 11.5 X 10CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$54.45	$54.45	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
M00545730	SUP	HCPCS C2617		M00545730  -  STENT BIL DDNL BND 11.5FR 12CM RX DLV SYS DISP ACPT .035IN	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$54.45	$54.45	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
M00545730	SUP	HCPCS C2625		RX STENT / 11.5 X 12CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$54.45	$54.45	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
M00545740	SUP	HCPCS C1876		M00545740  -  STENT BIL DDNL BND 11.5FR 15CM RX DLV SYS DISP ACPT .035IN	BOTH IP/OP	$254.25 	$188.15	$0.00	$203.17	$54.45	$54.45	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$203.17	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
M00545740	SUP	HCPCS C2625		RX STENT / 11.5 X 15CM	BOTH IP/OP	$254.25 	$188.15	$0.00	$188.70	$54.45	$54.45	$0.00	$0.00	$0.00	$52.99	$188.70	$188.70	$0.00	$0.00	$52.99	$0.00	$150.39	$150.39	$0.00	$60.50	$95.83	$96.80	$0.00		$0.00	$18.94	$0.00	$0.00	$19.26	$0.00	$0.00	$0.00	$0.00	$0.00
M00545840	SUP	Custom 27203599		NEEDLEKNIFE RX	BOTH IP/OP	$487.50 	$360.75	$0.00	$390.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$243.75	$386.10	$390.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545900	SUP	Custom 27203112		RX DILATATION BLN 4-4/5.8/180	BOTH IP/OP	$595.55 	$440.71	$0.00	$578.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.13	$442.02	$442.02	$0.00	$0.00	$124.11	$0.00	$352.27	$352.27	$0.00	$361.25	$572.22	$578.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545900	SUP	HCPCS C1726		M00545900  -  CATHETER BLNDIL 12 ATM 4MM 180CM 4CM HRCN RX LOPRFL RADOPQ	BOTH IP/OP	$595.55 	$440.71	$0.00	$578.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.13	$442.02	$442.02	$0.00	$0.00	$124.11	$0.00	$352.27	$352.27	$0.00	$361.25	$477.62	$578.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545920	SUP	Custom 27203113		RX DILATATION BLN 6-4/5.8/180	BOTH IP/OP	$595.55 	$440.71	$0.00	$578.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.13	$442.02	$442.02	$0.00	$0.00	$124.11	$0.00	$352.27	$352.27	$0.00	$361.25	$572.22	$578.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545920	SUP	HCPCS C1726		M00545920  -  CATHETER BLNDIL 11 ATM 6MM 180CM 4CM HRCN RX LOPRFL RADOPQ	BOTH IP/OP	$595.55 	$440.71	$0.00	$578.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.13	$442.02	$442.02	$0.00	$0.00	$124.11	$0.00	$352.27	$352.27	$0.00	$361.25	$477.62	$578.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545960	SUP	Custom 27203115		RX DILATATION BALLOON 10-5.8/180	BOTH IP/OP	$595.55 	$440.71	$0.00	$578.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.13	$442.02	$442.02	$0.00	$0.00	$124.11	$0.00	$352.27	$352.27	$0.00	$361.25	$572.22	$578.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00545960	SUP	HCPCS C1726		M00545960  -  CATHETER BLNDIL 8 ATM 10MM 180CM 4CM HRCN RX LOPRFL RADOPQ	BOTH IP/OP	$595.55 	$440.71	$0.00	$578.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.13	$442.02	$442.02	$0.00	$0.00	$124.11	$0.00	$352.27	$352.27	$0.00	$361.25	$477.62	$578.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00546900	SUP	HCPCS C1726		M00546900  -  CATHETER SPEC RTRVL .035IN 6-7FR 9-12MM 200CM STRL LTX XTRT	BOTH IP/OP	$395.06 	$292.34	$0.00	$316.05	$214.52	$214.52	$0.00	$0.00	$0.00	$82.34	$293.22	$293.22	$0.00	$0.00	$82.33	$0.00	$233.68	$233.68	$0.00	$197.53	$312.89	$316.05	$0.00		$0.00	$61.83	$0.00	$0.00	$62.89	$0.00	$0.00	$0.00	$0.00	$0.00
M00546910	SUP	HCPCS C1726		M00546910  -  CATHETER SPEC RTRVL .035IN 7-6FR 12-15MM 200CM STRL LTX XTRT	BOTH IP/OP	$395.06 	$292.34	$0.00	$316.05	$214.52	$214.52	$0.00	$0.00	$0.00	$82.34	$293.22	$293.22	$0.00	$0.00	$82.33	$0.00	$233.68	$233.68	$0.00	$197.53	$312.89	$316.05	$0.00		$0.00	$61.83	$0.00	$0.00	$62.89	$0.00	$0.00	$0.00	$0.00	$0.00
M00546920	SUP	Custom 27203101		EXTRACTOR RX 15-18MM ABOVE	BOTH IP/OP	$395.06 	$292.34	$0.00	$318.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.34	$293.22	$293.22	$0.00	$0.00	$82.33	$0.00	$233.68	$233.68	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00546920	SUP	HCPCS C1769		M00546920  -  CATHETER SPEC RTRVL .035IN 7-6FR 15-18MM 200CM STRL LTX XTRT	BOTH IP/OP	$395.06 	$292.34	$0.00	$318.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.34	$293.22	$293.22	$0.00	$0.00	$82.33	$0.00	$233.68	$233.68	$0.00	$198.75	$312.89	$318.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00547000	SUP	Custom 27203010		M00547000  -  CATHETER BALDILAT 7-6FR 9-12MM 200CM 3 LUMEN SPECIMEN	BOTH IP/OP	$356.55 	$263.85	$0.00	$293.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.63	$264.63	$0.00	$0.00	$74.31	$0.00	$0.00	$0.00	$0.00	$183.13	$290.07	$293.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00547010	SUP	Custom 27203010		M00547010  -  CATHETER BALDILAT 7-6FR 12-15MM 200CM 3 LUMEN SPECIMEN	BOTH IP/OP	$356.55 	$263.85	$0.00	$293.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.63	$264.63	$0.00	$0.00	$74.31	$0.00	$0.00	$0.00	$0.00	$183.13	$290.07	$293.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00547020	SUP	Custom 27203010		M00547020  -  CATHETER BALDILAT 7-6FR 15-18MM 200CM 3 LUMEN SPECIMEN	BOTH IP/OP	$356.55 	$263.85	$0.00	$293.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.63	$264.63	$0.00	$0.00	$74.31	$0.00	$0.00	$0.00	$0.00	$183.13	$290.07	$293.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00551591	SUP	HCPCS C1769		M00551591  -  GWIRE ENDSCP .018IN 450CM EXCH SHP PTHFND BIL STRL DISP	BOTH IP/OP	$317.83 	$235.19	$0.00	$254.26	$172.58	$172.58	$0.00	$0.00	$0.00	$66.24	$235.89	$235.89	$0.00	$0.00	$66.24	$0.00	$188.00	$188.00	$0.00	$158.92	$251.72	$254.26	$0.00		$0.00	$49.74	$0.00	$0.00	$50.60	$0.00	$0.00	$0.00	$0.00	$0.00
M00553650	SUP	HCPCS C1874		M00553650  -  STENT PNCR 15MM 24MM 10MM 146MM 138MM 10.8FR CAUT	BOTH IP/OP	"$11,000.00 "	"$8,140.00"	$0.00	"$8,950.00"	"$5,034.38"	"$5,034.38"	$0.00	$0.00	$0.00	"$2,292.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,292.40"	$0.00	"$5,423.00"	"$5,423.00"	$0.00	"$5,593.75"	"$8,860.50"	"$8,950.00"	$0.00		$0.00	"$1,750.84"	$0.00	$0.00	"$1,781.05"	$0.00	$0.00	$0.00	$0.00	$0.00
M00553750	SUP	HCPCS C1874		M00553750  -  STENT BIL 10MM 10.8FR 146CM 10MM 21MM LUM SDL AXS	BOTH IP/OP	"$9,500.00 "	"$7,030.00"	$0.00	"$7,750.00"	"$4,359.38"	"$4,359.38"	$0.00	$0.00	$0.00	"$1,980.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,979.80"	$0.00	"$4,683.50"	"$4,683.50"	$0.00	"$4,843.75"	"$7,672.50"	"$7,750.00"	$0.00		$0.00	"$1,516.09"	$0.00	$0.00	"$1,542.25"	$0.00	$0.00	$0.00	$0.00	$0.00
M00556021	SUP	HCPCS C1769		M00556021  -  GUIDEWIRE ENDSCP STR .035IN 260CM HIGH PERFORMANCE RAPEX	BOTH IP/OP	$423.74 	$313.57	$0.00	$342.99	$232.80	$232.80	$0.00	$0.00	$0.00	$88.32	$314.50	$314.50	$0.00	$0.00	$88.31	$0.00	$250.64	$250.64	$0.00	$214.37	$339.56	$342.99	$0.00		$0.00	$67.10	$0.00	$0.00	$68.26	$0.00	$0.00	$0.00	$0.00	$0.00
M00556041	SUP	HCPCS C1769		M00556041  -  GUIDEWIRE ENDSCP STR .035IN 450CM HIGH PERFORMANCE RAPEX	BOTH IP/OP	$423.74 	$313.57	$0.00	$342.99	$232.80	$232.80	$0.00	$0.00	$0.00	$88.32	$314.50	$314.50	$0.00	$0.00	$88.31	$0.00	$250.64	$250.64	$0.00	$214.37	$339.56	$342.99	$0.00		$0.00	$67.10	$0.00	$0.00	$68.26	$0.00	$0.00	$0.00	$0.00	$0.00
M00556621	SUP	HCPCS C1769		M00556621  -  GUIDEWIRE ENDSCP STANDARD STR TRIM .038IN 260CM HIGH	BOTH IP/OP	$240.35 	$177.86	$0.00	$195.71	$132.84	$132.84	$0.00	$0.00	$0.00	$50.09	$178.39	$178.39	$0.00	$0.00	$50.09	$0.00	$142.17	$142.17	$0.00	$122.32	$193.75	$195.71	$0.00		$0.00	$38.29	$0.00	$0.00	$38.95	$0.00	$0.00	$0.00	$0.00	$0.00
M00558330	SUP	Custom 27203090		CRE DILATION BALLOON CRE 6-8MM 8CM F/G	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$272.12	$272.12	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00558340	SUP	Custom 27203091		CRE DILATION BALLOON 8-10MM 8CM F/G	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00558350	SUP	Custom 27203092		CRE DILATION BALLOON 10-12MM 8CM F/G	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00558360	SUP	Custom 27203094		CRE DILATION BALLOON 15-18MM 8CM F/G	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00558370	SUP	HCPCS C1726		M00558370  -  CATHETER BALDILAT 6FR 15-18MM 180CM 8CM FIX WIRE HIGH	BOTH IP/OP	$460.05 	$340.44	$0.00	$375.16	$254.64	$254.64	$0.00	$0.00	$0.00	$95.89	$341.45	$341.45	$0.00	$0.00	$95.87	$0.00	$272.12	$272.12	$0.00	$234.48	$371.41	$375.16	$0.00		$0.00	$73.39	$0.00	$0.00	$74.66	$0.00	$0.00	$0.00	$0.00	$0.00
M00558380	SUP	Custom 27203095		CRE DILATION BALLOON 18-20MM 8CM F/G	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$272.12	$272.12	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00558380	SUP	HCPCS C1726		M00558380  -  CATHETER BALDILAT 6FR 18-20MM 180CM 8CM FIX WIRE HIGH	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$272.12	$272.12	$0.00	$281.25	$371.41	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00558410	SUP	HCPCS C1726		M00558410  -  DILATOR ENDSCP 7.5FR 10-12MM 180CM 5.5CM CRE PEBAX ESOPHAGUS	BOTH IP/OP	$530.33 	$392.44	$0.00	$427.48	$290.15	$290.15	$0.00	$0.00	$0.00	$110.53	$393.61	$393.61	$0.00	$0.00	$110.52	$0.00	$313.69	$313.69	$0.00	$267.18	$423.21	$427.48	$0.00		$0.00	$83.63	$0.00	$0.00	$85.07	$0.00	$0.00	$0.00	$0.00	$0.00
M00558420	SUP	HCPCS C1726		M00558420  -  DILATOR ENDSCP 7.5FR 12-15MM 180CM 5.5CM CRE PEBAX ESOPHAGUS	BOTH IP/OP	$530.33 	$392.44	$0.00	$427.48	$290.15	$290.15	$0.00	$0.00	$0.00	$110.53	$393.61	$393.61	$0.00	$0.00	$110.52	$0.00	$313.69	$313.69	$0.00	$267.18	$423.21	$427.48	$0.00		$0.00	$83.63	$0.00	$0.00	$85.07	$0.00	$0.00	$0.00	$0.00	$0.00
M00558450	SUP	HCPCS C1769		M00558450  -  DILATOR ENDSCP 7.5FR 6-8MM 240CM 5.5CM INFLATE CRE PEBAX	BOTH IP/OP	$530.33 	$392.44	$0.00	$427.48	$290.15	$290.15	$0.00	$0.00	$0.00	$110.53	$393.61	$393.61	$0.00	$0.00	$110.52	$0.00	$313.69	$313.69	$0.00	$267.18	$423.21	$427.48	$0.00		$0.00	$83.63	$0.00	$0.00	$85.07	$0.00	$0.00	$0.00	$0.00	$0.00
M00558480	SUP	HCPCS C1769		M00558480  -  DILATOR ENDSCP 7.5FR 12-15MM 240CM 5.5CM INFLATE CRE PEBAX	BOTH IP/OP	$530.33 	$392.44	$0.00	$427.48	$290.15	$290.15	$0.00	$0.00	$0.00	$110.53	$393.61	$393.61	$0.00	$0.00	$110.52	$0.00	$313.69	$313.69	$0.00	$267.18	$423.21	$427.48	$0.00		$0.00	$83.63	$0.00	$0.00	$85.07	$0.00	$0.00	$0.00	$0.00	$0.00
M00558500	SUP	HCPCS C1726		M00558500  -  CATHETER BALDILAT 7.5FR 18-20MM 240CM 5.5CM WIRE GUIDE CRE	BOTH IP/OP	$530.33 	$392.44	$0.00	$427.48	$290.15	$290.15	$0.00	$0.00	$0.00	$110.53	$393.61	$393.61	$0.00	$0.00	$110.52	$0.00	$313.69	$313.69	$0.00	$267.18	$423.21	$427.48	$0.00		$0.00	$83.63	$0.00	$0.00	$85.07	$0.00	$0.00	$0.00	$0.00	$0.00
M00558660	SUP	HCPCS C1726		M00558660  -  DILATOR ESCP 7.5FR 6-8MM 240CM STRL LF 5.5CM CRE INFL BLN	BOTH IP/OP	$530.33 	$392.44	$0.00	$427.48	$290.15	$290.15	$0.00	$0.00	$0.00	$110.53	$393.61	$393.61	$0.00	$0.00	$110.52	$0.00	$313.69	$313.69	$0.00	$267.18	$423.21	$427.48	$0.00		$0.00	$83.63	$0.00	$0.00	$85.07	$0.00	$0.00	$0.00	$0.00	$0.00
M00558670	SUP	HCPCS C1726		M00558670  -  DILATOR ESCP 7.5FR 8-10MM 240CM STRL LF 5.5CM CRE INFL BLN	BOTH IP/OP	$530.33 	$392.44	$0.00	$427.48	$290.15	$290.15	$0.00	$0.00	$0.00	$110.53	$393.61	$393.61	$0.00	$0.00	$110.52	$0.00	$313.69	$313.69	$0.00	$267.18	$423.21	$427.48	$0.00		$0.00	$83.63	$0.00	$0.00	$85.07	$0.00	$0.00	$0.00	$0.00	$0.00
M00558680	SUP	HCPCS C1726		M00558680  -  DILATOR ESCP 7.5FR 10-12MM 240CM STRL LF 5.5CM CRE INFL BLN	BOTH IP/OP	$530.33 	$392.44	$0.00	$427.48	$290.15	$290.15	$0.00	$0.00	$0.00	$110.53	$393.61	$393.61	$0.00	$0.00	$110.52	$0.00	$313.69	$313.69	$0.00	$267.18	$423.21	$427.48	$0.00		$0.00	$83.63	$0.00	$0.00	$85.07	$0.00	$0.00	$0.00	$0.00	$0.00
M00558690	SUP	HCPCS C1726		M00558690  -  DILATOR ESCP 7.5FR 12-13.5-15MM 240CM STRL LF 5.5CM CRE INFL	BOTH IP/OP	$530.33 	$392.44	$0.00	$427.48	$290.15	$290.15	$0.00	$0.00	$0.00	$110.53	$393.61	$393.61	$0.00	$0.00	$110.52	$0.00	$313.69	$313.69	$0.00	$267.18	$423.21	$427.48	$0.00		$0.00	$83.63	$0.00	$0.00	$85.07	$0.00	$0.00	$0.00	$0.00	$0.00
M00558700	SUP	HCPCS C1726		M00558700  -  DILATOR ESCP 7.5FR 15-16.5-18MM 240CM STRL LF 5.5CM CRE INFL	BOTH IP/OP	$530.33 	$392.44	$0.00	$427.48	$290.15	$290.15	$0.00	$0.00	$0.00	$110.53	$393.61	$393.61	$0.00	$0.00	$110.52	$0.00	$313.69	$313.69	$0.00	$267.18	$423.21	$427.48	$0.00		$0.00	$83.63	$0.00	$0.00	$85.07	$0.00	$0.00	$0.00	$0.00	$0.00
M00558710	SUP	HCPCS C1726		M00558710  -  DILATOR ESCP 7.5FR 18-20MM 240CM STRL LF 5.5CM CRE INFL	BOTH IP/OP	$530.33 	$392.44	$0.00	$427.48	$290.15	$290.15	$0.00	$0.00	$0.00	$110.53	$393.61	$393.61	$0.00	$0.00	$110.52	$0.00	$313.69	$313.69	$0.00	$267.18	$423.21	$427.48	$0.00		$0.00	$83.63	$0.00	$0.00	$85.07	$0.00	$0.00	$0.00	$0.00	$0.00
M00560071	SUP	HCPCS C1726		M00560071  -  CATHETER ELHMST 7FR 300CM STRL GLDPRB BP RND DIST TIP FIRM	BOTH IP/OP	$303.35 	$224.48	$0.00	$246.26	$167.15	$167.15	$0.00	$0.00	$0.00	$63.23	$225.15	$225.15	$0.00	$0.00	$63.22	$0.00	$179.43	$179.43	$0.00	$153.91	$243.80	$246.26	$0.00		$0.00	$48.17	$0.00	$0.00	$49.01	$0.00	$0.00	$0.00	$0.00	$0.00
M00560150	SUP	Custom 27203010		M00560150  -  CATHETER ELHMST 7FR 25GA .24MM 210CM INJ GLDPRB BP RND DIST	BOTH IP/OP	$557.75 	$412.74	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.96	$413.96	$0.00	$0.00	$116.24	$0.00	$0.00	$0.00	$0.00	$375.00	$420.81	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00560150	SUP	Custom 27203118		INJECTION GOLD PROBE 7FR	BOTH IP/OP	$557.75 	$412.74	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.96	$413.96	$0.00	$0.00	$116.24	$0.00	$0.00	$0.00	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00560160	SUP	Custom 27203117		INJECTION GOLD PROBE 10FR	BOTH IP/OP	$557.75 	$412.74	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.25	$413.96	$413.96	$0.00	$0.00	$116.24	$0.00	$329.91	$329.91	$0.00	$375.00	$594.00	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00560160	SUP	HCPCS C1726		M00560160  -  CATHETER ELECTROHEMOSTASIS 10FR 210CM BIPOL STANDARD PLUG	BOTH IP/OP	$557.75 	$412.74	$0.00	$600.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.25	$413.96	$413.96	$0.00	$0.00	$116.24	$0.00	$329.91	$329.91	$0.00	$375.00	$420.81	$600.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00561831	SUP	Custom 27203010		M00561831  -  SNARE ENDSCP MINI STANDARD OVAL 2.4MM 195CMX20MM POLYPECTOMY	BOTH IP/OP	$46.48 	$34.40	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.50	$34.50	$0.00	$0.00	$9.69	$0.00	$0.00	$0.00	$0.00	$23.50	$37.22	$37.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00562321	SUP	Custom 27203010		M00562321  -  SNARE ESCP MED OVL 2.4MM 240CM 27MM CPTVTR STF DISP PLYP	BOTH IP/OP	$33.68 	$24.92	$0.00	$27.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.00	$25.00	$0.00	$0.00	$7.02	$0.00	$0.00	$0.00	$0.00	$17.03	$26.97	$27.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00562391	SUP	Custom 27203010		M00562391  -  SNARE ENDSCP THIN JUMBO OVAL 2.4MM 240CM 30MM FLEXIBLE WIRE	BOTH IP/OP	$33.68 	$24.92	$0.00	$27.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.00	$25.00	$0.00	$0.00	$7.02	$0.00	$0.00	$0.00	$0.00	$17.03	$26.97	$27.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00562401	SUP	Custom 27203010		M00562401  -  SNARE ENDSCP MEDIUM OVAL 2.4MM 240CM 27MM LOOP FLEXIBLE	BOTH IP/OP	$32.88 	$24.33	$0.00	$26.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.40	$24.40	$0.00	$0.00	$6.85	$0.00	$0.00	$0.00	$0.00	$16.46	$26.07	$26.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00562402	SUP	Custom 27203010		M00562402  -  SNARE ENDSCP STANDARD OVAL 2.4MM 240CMX27MM FLEXIBLE	BOTH IP/OP	$21.19 	$15.68	$0.00	$17.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.72	$15.72	$0.00	$0.00	$4.42	$0.00	$0.00	$0.00	$0.00	$10.82	$17.13	$17.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00562671	SUP	Custom 27203010		M00562671  -  INTRODUCER SHTH 9.5FR HMSTS VLV SDPRT	BOTH IP/OP	$61.41 	$45.44	$0.00	$45.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.58	$45.58	$0.00	$0.00	$12.80	$0.00	$0.00	$0.00	$0.00	$22.50	$35.64	$36.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00565020	SUP	HCPCS C1876		M00565020  -  STENT DUODENAL 22-27MM 10FR 9CM 230CM DELIVERY SYSTEM	BOTH IP/OP	"$6,159.53 "	"$4,558.05"	$0.00	"$5,006.54"	"$2,816.18"	"$2,816.18"	$0.00	$0.00	$0.00	"$1,283.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,283.65"	$0.00	"$3,036.65"	"$3,036.65"	$0.00	"$3,129.09"	"$4,956.48"	"$5,006.54"	$0.00		$0.00	$979.40	$0.00	$0.00	$996.30	$0.00	$0.00	$0.00	$0.00	$0.00
M00565040	SUP	HCPCS C1874		M00565040  -  STENT COLONIC 25-30MM 10FR 60CM 230CM DELIVERY SYSTEM	BOTH IP/OP	"$6,159.53 "	"$4,558.05"	$0.00	"$5,006.54"	"$2,816.18"	"$2,816.18"	$0.00	$0.00	$0.00	"$1,283.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,283.65"	$0.00	"$3,036.65"	"$3,036.65"	$0.00	"$3,129.09"	"$4,956.48"	"$5,006.54"	$0.00		$0.00	$979.40	$0.00	$0.00	$996.30	$0.00	$0.00	$0.00	$0.00	$0.00
M00565050	SUP	HCPCS C1874		M00565050  -  STENT COLONIC 25-30MM 10FR 90CM 230CM DELIVERY SYSTEM	BOTH IP/OP	"$6,159.53 "	"$4,558.05"	$0.00	"$5,006.54"	"$2,816.18"	"$2,816.18"	$0.00	$0.00	$0.00	"$1,283.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,283.65"	$0.00	"$3,036.65"	"$3,036.65"	$0.00	"$3,129.09"	"$4,956.48"	"$5,006.54"	$0.00		$0.00	$979.40	$0.00	$0.00	$996.30	$0.00	$0.00	$0.00	$0.00	$0.00
M00565060	SUP	HCPCS C1874		M00565060  -  STENT COLONIC 25-30MM 10FR 120CM 230CM DELIVERY SYSTEM	BOTH IP/OP	"$6,159.53 "	"$4,558.05"	$0.00	"$5,006.54"	"$2,816.18"	"$2,816.18"	$0.00	$0.00	$0.00	"$1,283.80"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,283.65"	$0.00	"$3,036.65"	"$3,036.65"	$0.00	"$3,129.09"	"$4,956.48"	"$5,006.54"	$0.00		$0.00	$979.40	$0.00	$0.00	$996.30	$0.00	$0.00	$0.00	$0.00	$0.00
M00566461	SUP	Custom 27203010		M00566461  -  KIT PG 20FR 5ML STRL LF EVV PUL METH AMP TROC CNN RND XTRN	BOTH IP/OP	$219.16 	$162.18	$0.00	$194.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.66	$162.66	$0.00	$0.00	$45.67	$0.00	$0.00	$0.00	$0.00	$121.43	$192.35	$194.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00566471	SUP	HCPCS C1769		M00566471  -  KIT PG 11 20FR 22GA 1.5IN STRL LF EVV SFGLD CHLRPRP PUSH	BOTH IP/OP	$219.16 	$162.18	$0.00	$194.29	$131.88	$131.88	$0.00	$0.00	$0.00	$45.68	$162.66	$162.66	$0.00	$0.00	$45.67	$0.00	$129.63	$129.63	$0.00	$121.43	$192.35	$194.29	$0.00		$0.00	$38.01	$0.00	$0.00	$38.66	$0.00	$0.00	$0.00	$0.00	$0.00
M00566481	SUP	Custom 27203010		M00566481  -  KIT PG 24FR 5ML STRL LF EVV PUL METH AMP TROC CNN RND XTRN	BOTH IP/OP	$219.16 	$162.18	$0.00	$194.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.66	$162.66	$0.00	$0.00	$45.67	$0.00	$0.00	$0.00	$0.00	$121.43	$192.35	$194.29	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00566670	SUP	Custom 27203116		ENCORE 26 SINGLE	BOTH IP/OP	$182.50 	$135.05	$0.00	$146.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.25	$144.54	$146.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0056820	SUP	Custom 27203010		M0056820  -  KIT PG 20FR SIL PUL METH FENST DRP STD CLMP EVV 5ML	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00568201	SUP	Custom 27203010		M00568201  -  KIT PG 20FR SIL PUL METH FENST DRP STD CLMP EVV 5ML	BOTH IP/OP	$147.75 	$109.34	$0.00	$161.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.66	$109.66	$0.00	$0.00	$30.79	$0.00	$0.00	$0.00	$0.00	$101.00	$159.98	$161.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0056824	SUP	Custom 27203010		KIT PG 24FR PUL METH STD EVV	BOTH IP/OP	$137.50 	$101.75	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.75	$108.90	$110.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00568241	SUP	Custom 27203010		M00568241  -  KIT PG 24FR 6824	BOTH IP/OP	$147.75 	$109.34	$0.00	$161.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.66	$109.66	$0.00	$0.00	$30.79	$0.00	$0.00	$0.00	$0.00	$101.00	$159.98	$161.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00570360	SUP	HCPCS C1874		M00570360  -  STENT BIL .035IN 10MM 8.5FR 40MM 194CM WALLFLEX RMLM FLLY	BOTH IP/OP	"$6,198.75 "	"$4,587.08"	$0.00	"$5,038.32"	"$2,834.06"	"$2,834.06"	$0.00	$0.00	$0.00	"$1,291.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,291.82"	$0.00	"$3,055.98"	"$3,055.98"	$0.00	"$3,148.95"	"$4,987.94"	"$5,038.32"	$0.00		$0.00	$985.62	$0.00	$0.00	"$1,002.63"	$0.00	$0.00	$0.00	$0.00	$0.00
M00570370	SUP	HCPCS C1874		M00570370  -  STENT BIL .035IN 10MM 8.5FR 60MM 194CM WALLFLEX RMLM FLLY	BOTH IP/OP	"$6,198.75 "	"$4,587.08"	$0.00	"$5,038.32"	"$2,834.06"	"$2,834.06"	$0.00	$0.00	$0.00	"$1,291.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,291.82"	$0.00	"$3,055.98"	"$3,055.98"	$0.00	"$3,148.95"	"$4,987.94"	"$5,038.32"	$0.00		$0.00	$985.62	$0.00	$0.00	"$1,002.63"	$0.00	$0.00	$0.00	$0.00	$0.00
M00570380	SUP	HCPCS C1874		M00570380  -  STENT BIL .035IN 10MM 8.5FR 80MM 194CM WALLFLEX RMLM FLLY	BOTH IP/OP	"$6,198.75 "	"$4,587.08"	$0.00	"$5,038.32"	"$2,834.06"	"$2,834.06"	$0.00	$0.00	$0.00	"$1,291.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,291.82"	$0.00	"$3,055.98"	"$3,055.98"	$0.00	"$3,148.95"	"$4,987.94"	"$5,038.32"	$0.00		$0.00	$985.62	$0.00	$0.00	"$1,002.63"	$0.00	$0.00	$0.00	$0.00	$0.00
M00570520	SUP	HCPCS C1874		M00570520  -  STENT BILIARY 10MM 8.5FR 40MM RAPEX WALLFLEX PERMALUME	BOTH IP/OP	"$6,297.90 "	"$4,660.45"	$0.00	"$5,038.32"	"$2,834.06"	"$2,834.06"	$0.00	$0.00	$0.00	"$1,312.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.48"	$0.00	"$3,104.86"	"$3,104.86"	$0.00	"$3,148.95"	"$4,987.94"	"$5,038.32"	$0.00		$0.00	$985.62	$0.00	$0.00	"$1,002.63"	$0.00	$0.00	$0.00	$0.00	$0.00
M00570530	SUP	HCPCS C1769		M00570530  -  STENT BILIARY 10MM 8.5FR 60MM RAPEX SELF EXPAND WALLFLEX	BOTH IP/OP	"$6,297.90 "	"$4,660.45"	$0.00	"$5,038.32"	"$3,419.76"	"$3,419.76"	$0.00	$0.00	$0.00	"$1,312.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.48"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$3,148.95"	"$4,987.94"	"$5,038.32"	$0.00		$0.00	$985.62	$0.00	$0.00	"$1,002.63"	$0.00	$0.00	$0.00	$0.00	$0.00
M00570540	SUP	HCPCS C1874		M00570540  -  STENT BILIARY 10MM 8.5FR 80MM RAPEX SELF EXPAND WALLFLEX	BOTH IP/OP	"$6,297.90 "	"$4,660.45"	$0.00	"$5,038.32"	"$2,834.06"	"$2,834.06"	$0.00	$0.00	$0.00	"$1,312.64"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,312.48"	$0.00	"$3,104.86"	"$3,104.86"	$0.00	"$3,148.95"	"$4,987.94"	"$5,038.32"	$0.00		$0.00	$985.62	$0.00	$0.00	"$1,002.63"	$0.00	$0.00	$0.00	$0.00	$0.00
M00570640	SUP	HCPCS C1769		M00570640  -  STENT BIL 10MM 8FR 60MM 194CM WLSTNT UNCOVER INTGR RTRVL	BOTH IP/OP	"$4,133.58 "	"$3,058.85"	$0.00	"$3,372.50"	"$2,289.08"	"$2,289.08"	$0.00	$0.00	$0.00	$861.54	"$3,067.94"	"$3,067.94"	$0.00	$0.00	$861.44	$0.00	"$2,445.01"	"$2,445.01"	$0.00	"$2,107.81"	"$3,338.78"	"$3,372.50"	$0.00		$0.00	$659.75	$0.00	$0.00	$671.13	$0.00	$0.00	$0.00	$0.00	$0.00
M00570650	SUP	HCPCS C1769		M00570650  -  STENT BILIARY 10MM 8FR 80MM RAPEX DELIVERY SYSTEM WALLFLEX	BOTH IP/OP	"$4,133.58 "	"$3,058.85"	$0.00	"$3,372.50"	"$2,289.08"	"$2,289.08"	$0.00	$0.00	$0.00	$861.54	"$3,067.94"	"$3,067.94"	$0.00	$0.00	$861.44	$0.00	"$2,445.01"	"$2,445.01"	$0.00	"$2,107.81"	"$3,338.78"	"$3,372.50"	$0.00		$0.00	$659.75	$0.00	$0.00	$671.13	$0.00	$0.00	$0.00	$0.00	$0.00
M00570660	SUP	HCPCS C1769		M00570660  -  STENT BILIARY .035IN 10MM 8.5FR 100MM UNCOVERED RAPEX GWIRE	BOTH IP/OP	"$4,133.58 "	"$3,058.85"	$0.00	"$3,372.50"	"$2,289.08"	"$2,289.08"	$0.00	$0.00	$0.00	$861.54	"$3,067.94"	"$3,067.94"	$0.00	$0.00	$861.44	$0.00	"$2,445.01"	"$2,445.01"	$0.00	"$2,107.81"	"$3,338.78"	"$3,372.50"	$0.00		$0.00	$659.75	$0.00	$0.00	$671.13	$0.00	$0.00	$0.00	$0.00	$0.00
M00570720	SUP	HCPCS C1874		M00570720  -  STENT BILIARY .035IN 10MM 8.5FR 40MM 3.2MM RAPEX PARTIALLY	BOTH IP/OP	"$6,123.15 "	"$4,531.13"	$0.00	"$5,010.82"	"$2,818.59"	"$2,818.59"	$0.00	$0.00	$0.00	"$1,276.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,276.06"	$0.00	"$3,018.71"	"$3,018.71"	$0.00	"$3,131.76"	"$4,960.72"	"$5,010.82"	$0.00		$0.00	$980.24	$0.00	$0.00	$997.15	$0.00	$0.00	$0.00	$0.00	$0.00
M00570730	SUP	HCPCS C1874		M00570730  -  STENT BIL .035IN 10MM 8.5FR 60MM 3.2MM WALLFLEX FLRSCP MRKR	BOTH IP/OP	"$6,123.15 "	"$4,531.13"	$0.00	"$5,010.82"	"$2,818.59"	"$2,818.59"	$0.00	$0.00	$0.00	"$1,276.22"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,276.06"	$0.00	"$3,018.71"	"$3,018.71"	$0.00	"$3,131.76"	"$4,960.72"	"$5,010.82"	$0.00		$0.00	$980.24	$0.00	$0.00	$997.15	$0.00	$0.00	$0.00	$0.00	$0.00
M00573080	SUP	HCPCS C1769		M00573080  -  SPHINCTEROTOME ENDSCP .035IN 3.9FR 20MM 260CM CHOLANGIOGRAM	BOTH IP/OP	$750.00 	$555.00	$0.00	$605.66	$411.09	$411.09	$0.00	$0.00	$0.00	$156.32	$556.65	$556.65	$0.00	$0.00	$156.30	$0.00	$443.63	$443.63	$0.00	$378.54	$599.61	$605.66	$0.00		$0.00	$118.48	$0.00	$0.00	$120.53	$0.00	$0.00	$0.00	$0.00	$0.00
M00582120	SUP	Custom 27203010		M00582120  -  TUBE GSTRM STD RT ANG 14FR EVV BLN REPL BLSTR	BOTH IP/OP	$77.78 	$57.56	$0.00	$70.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.72	$57.72	$0.00	$0.00	$16.21	$0.00	$0.00	$0.00	$0.00	$43.79	$69.36	$70.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00582130	SUP	Custom 27203010		M00582130  -  TUBE GSTRM STD RT ANG 16FR EVV BLN REPL BLSTR	BOTH IP/OP	$77.78 	$57.56	$0.00	$70.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.72	$57.72	$0.00	$0.00	$16.21	$0.00	$0.00	$0.00	$0.00	$43.79	$69.36	$70.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00582160	SUP	Custom 27203010		M00582160  -  TUBE GSTRM STD RT ANG 24FR EVV BLN REPL BLSTR	BOTH IP/OP	$77.78 	$57.56	$0.00	$70.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.72	$57.72	$0.00	$0.00	$16.21	$0.00	$0.00	$0.00	$0.00	$43.79	$69.36	$70.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00583040	SUP	HCPCS C1769		M00583040  -  SPHINCTEROTOME ENDSCP .035IN 4.4FR 20MM 260CM CANN PRELOAD	BOTH IP/OP	"$1,002.23 "	$741.65	$0.00	$808.86	$549.01	$549.01	$0.00	$0.00	$0.00	$208.89	$743.85	$743.85	$0.00	$0.00	$208.86	$0.00	$592.82	$592.82	$0.00	$505.54	$800.78	$808.86	$0.00		$0.00	$158.23	$0.00	$0.00	$160.96	$0.00	$0.00	$0.00	$0.00	$0.00
M00583060	SUP	Custom 27203598		HYDRATOME RX 44-20MM / 450CM	BOTH IP/OP	"$1,002.23 "	$741.65	$0.00	$888.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.89	$743.85	$743.85	$0.00	$0.00	$208.86	$0.00	$592.82	$592.82	$0.00	$555.00	$879.12	$888.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00583060	SUP	HCPCS C1769		M00583060  -  SPHINCTEROTOME ENDSCP .035IN 4.4FR 20MM 450CM CANN PRELOAD	BOTH IP/OP	"$1,002.23 "	$741.65	$0.00	$888.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.89	$743.85	$743.85	$0.00	$0.00	$208.86	$0.00	$592.82	$592.82	$0.00	$555.00	$800.78	$888.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M00584040	SUP	HCPCS C1769		M00584040  -  SPHINCTEROTOME ENDSCP .035IN STR 4.4FR 260CM 20MM CANN	BOTH IP/OP	"$1,002.23 "	$741.65	$0.00	$808.86	$549.01	$549.01	$0.00	$0.00	$0.00	$208.89	$743.85	$743.85	$0.00	$0.00	$208.86	$0.00	$592.82	$592.82	$0.00	$505.54	$800.78	$808.86	$0.00		$0.00	$158.23	$0.00	$0.00	$160.96	$0.00	$0.00	$0.00	$0.00	$0.00
M0061453500	SUP	HCPCS C2617		M0061453500  -  STENT URETERAL PIGTAIL CURVE LP TAPER 4.8FR 22CM ATTACH	BOTH IP/OP	$524.30 	$387.98	$0.00	$419.44	$235.94	$235.94	$0.00	$0.00	$0.00	$109.28	$389.14	$389.14	$0.00	$0.00	$109.26	$0.00	$310.12	$310.12	$0.00	$262.15	$415.25	$419.44	$0.00		$0.00	$82.05	$0.00	$0.00	$83.47	$0.00	$0.00	$0.00	$0.00	$0.00
M0061453510	SUP	HCPCS C2617		M0061453510  -  STENT URETERAL PIGTAIL CURVE LP TAPER 4.8FR 24CM ATTACH	BOTH IP/OP	$524.30 	$387.98	$0.00	$419.44	$235.94	$235.94	$0.00	$0.00	$0.00	$109.28	$389.14	$389.14	$0.00	$0.00	$109.26	$0.00	$310.12	$310.12	$0.00	$262.15	$415.25	$419.44	$0.00		$0.00	$82.05	$0.00	$0.00	$83.47	$0.00	$0.00	$0.00	$0.00	$0.00
M0061453520	SUP	HCPCS C2617		M0061453520  -  STENT URETERAL PIGTAIL CURVE LP 4.8FR 26CM TAPER TIP BLADDER	BOTH IP/OP	$524.30 	$387.98	$0.00	$419.44	$235.94	$235.94	$0.00	$0.00	$0.00	$109.28	$389.14	$389.14	$0.00	$0.00	$109.26	$0.00	$310.12	$310.12	$0.00	$262.15	$415.25	$419.44	$0.00		$0.00	$82.05	$0.00	$0.00	$83.47	$0.00	$0.00	$0.00	$0.00	$0.00
M0061453530	SUP	HCPCS C2617		M0061453530  -  STENT URETERAL PIGTAIL CURVE LP TAPER 4.8FR 28CM ATTACH	BOTH IP/OP	$524.30 	$387.98	$0.00	$419.44	$235.94	$235.94	$0.00	$0.00	$0.00	$109.28	$389.14	$389.14	$0.00	$0.00	$109.26	$0.00	$310.12	$310.12	$0.00	$262.15	$415.25	$419.44	$0.00		$0.00	$82.05	$0.00	$0.00	$83.47	$0.00	$0.00	$0.00	$0.00	$0.00
M0061453610	SUP	HCPCS C2617		M0061453610  -  STENT URETERAL PIGTAIL CURVE LP TAPER 6FR 24CM ATTACH SUTURE	BOTH IP/OP	$524.30 	$387.98	$0.00	$419.44	$235.94	$235.94	$0.00	$0.00	$0.00	$109.28	$389.14	$389.14	$0.00	$0.00	$109.26	$0.00	$310.12	$310.12	$0.00	$262.15	$415.25	$419.44	$0.00		$0.00	$82.05	$0.00	$0.00	$83.47	$0.00	$0.00	$0.00	$0.00	$0.00
M0061752500	SUP	HCPCS C2617		M0061752500  -  STENT URETERAL TAPER 4.8FR 20CM BLADDER MARK HIGH COIL	BOTH IP/OP	$581.43 	$430.26	$0.00	$465.14	$261.64	$261.64	$0.00	$0.00	$0.00	$121.18	$431.53	$431.53	$0.00	$0.00	$121.17	$0.00	$343.91	$343.91	$0.00	$290.71	$460.49	$465.14	$0.00		$0.00	$90.99	$0.00	$0.00	$92.56	$0.00	$0.00	$0.00	$0.00	$0.00
M0061901340	SUP	HCPCS C2617		M0061901340  -  STENT URET 6FR 28CM W/O GWIRE DUAL DRMTR PLRS HDR+	BOTH IP/OP	$356.40 	$263.74	$0.00	$285.12	$160.38	$160.38	$0.00	$0.00	$0.00	$74.28	$264.52	$264.52	$0.00	$0.00	$74.27	$0.00	$210.81	$210.81	$0.00	$178.20	$282.27	$285.12	$0.00		$0.00	$55.78	$0.00	$0.00	$56.74	$0.00	$0.00	$0.00	$0.00	$0.00
M0061901440	SUP	HCPCS C2617		M0061901440  -  STENT URET 7FR 28CM W/O GWIRE DUAL DRMTR PLRS HDR+	BOTH IP/OP	$306.25 	$226.63	$0.00	$245.00	$137.81	$137.81	$0.00	$0.00	$0.00	$63.83	$227.30	$227.30	$0.00	$0.00	$63.82	$0.00	$181.15	$181.15	$0.00	$153.13	$242.55	$245.00	$0.00		$0.00	$47.93	$0.00	$0.00	$48.76	$0.00	$0.00	$0.00	$0.00	$0.00
M0061901520	SUP	HCPCS C2617		M0061901520  -  STENT URET 8FR 24CM W/O GWIRE PLRS HDR+	BOTH IP/OP	$306.25 	$226.63	$0.00	$245.00	$137.81	$137.81	$0.00	$0.00	$0.00	$63.83	$227.30	$227.30	$0.00	$0.00	$63.82	$0.00	$181.15	$181.15	$0.00	$153.13	$242.55	$245.00	$0.00		$0.00	$47.93	$0.00	$0.00	$48.76	$0.00	$0.00	$0.00	$0.00	$0.00
M0061901530	SUP	HCPCS C2617		M0061901530  -  STENT URET 8FR 26CM W/O GWIRE PLRS HDR+	BOTH IP/OP	$356.40 	$263.74	$0.00	$285.12	$160.38	$160.38	$0.00	$0.00	$0.00	$74.28	$264.52	$264.52	$0.00	$0.00	$74.27	$0.00	$210.81	$210.81	$0.00	$178.20	$282.27	$285.12	$0.00		$0.00	$55.78	$0.00	$0.00	$56.74	$0.00	$0.00	$0.00	$0.00	$0.00
M0061901540	SUP	HCPCS C2617		M0061901540  -  STENT URET 8FR 28CM W/O GWIRE PLRS HDR+	BOTH IP/OP	$359.98 	$266.39	$0.00	$287.98	$161.99	$161.99	$0.00	$0.00	$0.00	$75.03	$267.17	$267.17	$0.00	$0.00	$75.02	$0.00	$212.93	$212.93	$0.00	$179.99	$285.10	$287.98	$0.00		$0.00	$56.34	$0.00	$0.00	$57.31	$0.00	$0.00	$0.00	$0.00	$0.00
M0061921300	SUP	HCPCS C2617		M0061921300  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 20CM 2	BOTH IP/OP	$658.50 	$487.29	$0.00	$526.80	$296.33	$296.33	$0.00	$0.00	$0.00	$137.25	$488.74	$488.74	$0.00	$0.00	$137.23	$0.00	$389.50	$389.50	$0.00	$329.25	$521.53	$526.80	$0.00		$0.00	$103.06	$0.00	$0.00	$104.83	$0.00	$0.00	$0.00	$0.00	$0.00
M0061921310	SUP	HCPCS C1768		M0061921310  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 22CM 2	BOTH IP/OP	$658.50 	$487.29	$0.00	$526.80	$296.33	$296.33	$0.00	$0.00	$0.00	$137.25	$488.74	$488.74	$0.00	$0.00	$137.23	$0.00	$389.50	$389.50	$0.00	$329.25	$521.53	$526.80	$0.00		$0.00	$103.06	$0.00	$0.00	$104.83	$0.00	$0.00	$0.00	$0.00	$0.00
M0061921320	SUP	HCPCS C1768		M0061921320  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 24CM 2	BOTH IP/OP	$658.50 	$487.29	$0.00	$526.80	$296.33	$296.33	$0.00	$0.00	$0.00	$137.25	$488.74	$488.74	$0.00	$0.00	$137.23	$0.00	$389.50	$389.50	$0.00	$329.25	$521.53	$526.80	$0.00		$0.00	$103.06	$0.00	$0.00	$104.83	$0.00	$0.00	$0.00	$0.00	$0.00
M0061921330	SUP	HCPCS C1768		M0061921330  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 26CM 2	BOTH IP/OP	$658.50 	$487.29	$0.00	$526.80	$296.33	$296.33	$0.00	$0.00	$0.00	$137.25	$488.74	$488.74	$0.00	$0.00	$137.23	$0.00	$389.50	$389.50	$0.00	$329.25	$521.53	$526.80	$0.00		$0.00	$103.06	$0.00	$0.00	$104.83	$0.00	$0.00	$0.00	$0.00	$0.00
M0061921340	SUP	HCPCS C2617		M0061921340  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 28CM 2	BOTH IP/OP	$658.50 	$487.29	$0.00	$526.80	$296.33	$296.33	$0.00	$0.00	$0.00	$137.25	$488.74	$488.74	$0.00	$0.00	$137.23	$0.00	$389.50	$389.50	$0.00	$329.25	$521.53	$526.80	$0.00		$0.00	$103.06	$0.00	$0.00	$104.83	$0.00	$0.00	$0.00	$0.00	$0.00
M0061921410	SUP	HCPCS C2617		M0061921410  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 7FR 2.1FR 22CM 2	BOTH IP/OP	$658.50 	$487.29	$0.00	$526.80	$296.33	$296.33	$0.00	$0.00	$0.00	$137.25	$488.74	$488.74	$0.00	$0.00	$137.23	$0.00	$389.50	$389.50	$0.00	$329.25	$521.53	$526.80	$0.00		$0.00	$103.06	$0.00	$0.00	$104.83	$0.00	$0.00	$0.00	$0.00	$0.00
M0061921420	SUP	HCPCS C2617		M0061921420  -  STENT URETERAL 2 PIGTAIL CURVE TAPER 7FR 2.1FR 24CM 2	BOTH IP/OP	$658.50 	$487.29	$0.00	$526.80	$296.33	$296.33	$0.00	$0.00	$0.00	$137.25	$488.74	$488.74	$0.00	$0.00	$137.23	$0.00	$389.50	$389.50	$0.00	$329.25	$521.53	$526.80	$0.00		$0.00	$103.06	$0.00	$0.00	$104.83	$0.00	$0.00	$0.00	$0.00	$0.00
M0061921430	SUP	HCPCS C2617		M0061921430  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 7FR 2.1FR 26CM 2	BOTH IP/OP	$658.50 	$487.29	$0.00	$526.80	$296.33	$296.33	$0.00	$0.00	$0.00	$137.25	$488.74	$488.74	$0.00	$0.00	$137.23	$0.00	$389.50	$389.50	$0.00	$329.25	$521.53	$526.80	$0.00		$0.00	$103.06	$0.00	$0.00	$104.83	$0.00	$0.00	$0.00	$0.00	$0.00
M0061921440	SUP	HCPCS C2617		M0061921440  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 7FR 2.1FR 28CM 2	BOTH IP/OP	$658.50 	$487.29	$0.00	$526.80	$296.33	$296.33	$0.00	$0.00	$0.00	$137.25	$488.74	$488.74	$0.00	$0.00	$137.23	$0.00	$389.50	$389.50	$0.00	$329.25	$521.53	$526.80	$0.00		$0.00	$103.06	$0.00	$0.00	$104.83	$0.00	$0.00	$0.00	$0.00	$0.00
M0061921510	SUP	HCPCS C2617		M0061921510  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 8FR 2.1FR 22CM 2	BOTH IP/OP	$658.50 	$487.29	$0.00	$526.80	$296.33	$296.33	$0.00	$0.00	$0.00	$137.25	$488.74	$488.74	$0.00	$0.00	$137.23	$0.00	$389.50	$389.50	$0.00	$329.25	$521.53	$526.80	$0.00		$0.00	$103.06	$0.00	$0.00	$104.83	$0.00	$0.00	$0.00	$0.00	$0.00
M0061921520	SUP	HCPCS C2617		M0061921520  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 8FR 2.1FR 24CM 2	BOTH IP/OP	$658.50 	$487.29	$0.00	$526.80	$296.33	$296.33	$0.00	$0.00	$0.00	$137.25	$488.74	$488.74	$0.00	$0.00	$137.23	$0.00	$389.50	$389.50	$0.00	$329.25	$521.53	$526.80	$0.00		$0.00	$103.06	$0.00	$0.00	$104.83	$0.00	$0.00	$0.00	$0.00	$0.00
M0061921530	SUP	HCPCS C2617		M0061921530  -  STENT URETERAL 2 PIGTAIL CURVE TAPER 8FR 2.1FR 26CM 2	BOTH IP/OP	$658.50 	$487.29	$0.00	$526.80	$296.33	$296.33	$0.00	$0.00	$0.00	$137.25	$488.74	$488.74	$0.00	$0.00	$137.23	$0.00	$389.50	$389.50	$0.00	$329.25	$521.53	$526.80	$0.00		$0.00	$103.06	$0.00	$0.00	$104.83	$0.00	$0.00	$0.00	$0.00	$0.00
M0062101170	SUP	HCPCS C1726		M0062101170  -  CATHETER BLNDIL 17CM 30FR 55CM LF 12CM NPHRMX AMPTZ LOPRFL	BOTH IP/OP	"$1,077.18 "	$797.11	$0.00	$861.74	$584.91	$584.91	$0.00	$0.00	$0.00	$224.51	$799.48	$799.48	$0.00	$0.00	$224.48	$0.00	$637.15	$637.15	$0.00	$538.59	$853.13	$861.74	$0.00		$0.00	$168.58	$0.00	$0.00	$171.49	$0.00	$0.00	$0.00	$0.00	$0.00
M0062251020	SUP	HCPCS C1758		M0062251020  -  CATHETER BLNDIL 6MM 75CM LF 4CM URMT U QD-FOLD HI-PRS KINK	BOTH IP/OP	"$1,131.68 "	$837.44	$0.00	$905.34	$614.50	$614.50	$0.00	$0.00	$0.00	$235.87	$839.93	$839.93	$0.00	$0.00	$235.84	$0.00	$669.39	$669.39	$0.00	$565.84	$896.29	$905.34	$0.00		$0.00	$177.11	$0.00	$0.00	$180.16	$0.00	$0.00	$0.00	$0.00	$0.00
M0062251170	SUP	HCPCS C1758		M0062251170  -  CATHETER BALDILAT SHORT TAPER 5.8FR 18FR 75CM 10CM KINK	BOTH IP/OP	"$1,131.68 "	$837.44	$0.00	$905.34	$614.50	$614.50	$0.00	$0.00	$0.00	$235.87	$839.93	$839.93	$0.00	$0.00	$235.84	$0.00	$669.39	$669.39	$0.00	$565.84	$896.29	$905.34	$0.00		$0.00	$177.11	$0.00	$0.00	$180.16	$0.00	$0.00	$0.00	$0.00	$0.00
M0062502091	SUP	HCPCS C1894		M0062502091  -  SHEATH ACCES 2 TAPER 15FR 13FR 36CM KINK RESISTANT RADIOPQ	BOTH IP/OP	$94.17 	$69.69	$0.00	$75.33	$51.13	$51.13	$0.00	$0.00	$0.00	$19.63	$69.89	$69.89	$0.00	$0.00	$19.62	$0.00	$55.70	$55.70	$0.00	$47.08	$74.58	$75.33	$0.00		$0.00	$14.74	$0.00	$0.00	$14.99	$0.00	$0.00	$0.00	$0.00	$0.00
M0062601200	SUP	HCPCS C1769		M0062601200  -  DILATOR SURG 8-10FR 70CM 30CM KINK RESISTANT STYLET SHEATH	BOTH IP/OP	$236.20 	$174.79	$0.00	$188.96	$128.26	$128.26	$0.00	$0.00	$0.00	$49.23	$175.31	$175.31	$0.00	$0.00	$49.22	$0.00	$139.71	$139.71	$0.00	$118.10	$187.07	$188.96	$0.00		$0.00	$36.97	$0.00	$0.00	$37.60	$0.00	$0.00	$0.00	$0.00	$0.00
M0062602500	SUP	Custom 27203010		M0062602500  -  DILATOR SURG SHEATH SET AMPLATZ RENAL STERILE	BOTH IP/OP	"$1,131.68 "	$837.44	$0.00	$905.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$839.93	$839.93	$0.00	$0.00	$235.84	$0.00	$0.00	$0.00	$0.00	$565.84	$896.29	$905.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063201020	SUP	Custom 27203010		M0063201020  -  BASKET SPEC RTRVL 20MM 7FR 70CM SGR 4WR 0 TIP OVR GW	BOTH IP/OP	$528.75 	$391.28	$0.00	$423.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$392.44	$392.44	$0.00	$0.00	$110.19	$0.00	$0.00	$0.00	$0.00	$264.38	$418.77	$423.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063201040	SUP	Custom 27203010		M0063201040  -  BASKET SPEC RTRVL 3FR 16MM 90CM S-D 4WR STON LSR	BOTH IP/OP	$649.00 	$480.26	$0.00	$519.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$481.69	$481.69	$0.00	$0.00	$135.25	$0.00	$0.00	$0.00	$0.00	$324.50	$514.01	$519.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063301060	SUP	Custom 27203010		M0063301060  -  BASKET STON RTRVL HLCL 11MM 3FR 120CM STRL GMN 3 PR WRE SCR	BOTH IP/OP	$853.95 	$631.92	$0.00	$683.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$633.80	$633.80	$0.00	$0.00	$177.96	$0.00	$0.00	$0.00	$0.00	$426.98	$676.33	$683.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063311060	SUP	Custom 27203010		M0063311060  -  BASKET SPEC RTRVL 120CM 3FR 11MM STON 3WR HLCL 0 TIP PR GMN	BOTH IP/OP	$473.00 	$350.02	$0.00	$378.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$351.06	$351.06	$0.00	$0.00	$98.57	$0.00	$0.00	$0.00	$0.00	$236.50	$374.62	$378.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063401220	SUP	Custom 27203010		M0063401220  -  BASKET STON RTRVL HLCL 10MM 1.9FR 120CM STRL BGLY 3WR DISP	BOTH IP/OP	$853.95 	$631.92	$0.00	$683.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$633.80	$633.80	$0.00	$0.00	$177.96	$0.00	$0.00	$0.00	$0.00	$426.98	$676.33	$683.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063601000	SUP	HCPCS C1726		M0063601000  -  CATHETER SPEC RTRVL 3FR 120CM 60CM OVL LOOP	BOTH IP/OP	$455.50 	$337.07	$0.00	$364.40	$247.34	$247.34	$0.00	$0.00	$0.00	$94.94	$338.07	$338.07	$0.00	$0.00	$94.93	$0.00	$269.43	$269.43	$0.00	$227.75	$360.76	$364.40	$0.00		$0.00	$71.29	$0.00	$0.00	$72.52	$0.00	$0.00	$0.00	$0.00	$0.00
M0063801100	SUP	Custom 27203010		M0063801100  -  BASKET STON RTRVL 20MM 3FR 120CM STRL LF SGR HEMI PERMAFORM	BOTH IP/OP	$853.95 	$631.92	$0.00	$683.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$426.98	$676.33	$683.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063901010	SUP	Custom 27203010		M0063901010  -  BASKET STON RTRVL 12MM 2.4FR 120CM STRL LF 0TP 4WR FLT DIST	BOTH IP/OP	$921.93 	$682.23	$0.00	$737.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$684.25	$684.25	$0.00	$0.00	$192.13	$0.00	$0.00	$0.00	$0.00	$460.96	$730.17	$737.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063901020	SUP	Custom 27203010		M0063901020  -  BASKET STON RTRVL 16MM 3FR 90CM STRL LF 0TP 4WR FLT DIST	BOTH IP/OP	$921.93 	$682.23	$0.00	$737.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$684.25	$684.25	$0.00	$0.00	$192.13	$0.00	$0.00	$0.00	$0.00	$460.96	$730.17	$737.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063901050	SUP	Custom 27203010		M0063901050  -  BASKET STON RTRVL 12MM 1.9FR 120CM STRL LF 0TP 4WR FLT DIST	BOTH IP/OP	$939.48 	$695.22	$0.00	$751.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$697.28	$697.28	$0.00	$0.00	$195.79	$0.00	$0.00	$0.00	$0.00	$469.74	$744.07	$751.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063902000	SUP	Custom 27203010		M0063902000  -  BASKET STON RTRVL 1.9FR 90CM STRL LF ESCAPE SGR STD 4WR NTNL	BOTH IP/OP	"$1,158.53 "	$857.31	$0.00	$926.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$859.86	$859.86	$0.00	$0.00	$241.44	$0.00	$0.00	$0.00	$0.00	$579.26	$917.56	$926.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063902010	SUP	Custom 27203010		M0063902010  -  BASKET STON RTRVL 1.9FR 120CM STRL LF ESCAPE SGR STD 4WR	BOTH IP/OP	"$1,158.53 "	$857.31	$0.00	$926.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$859.86	$859.86	$0.00	$0.00	$241.44	$0.00	$0.00	$0.00	$0.00	$579.26	$917.56	$926.82	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063903100	SUP	Custom 27203010		M0063903100  -  COIL SPECIMEN RETRIEVAL 7MM 3FR 115CM LATEX FREE STONE CONE	BOTH IP/OP	"$1,112.15 "	$822.99	$0.00	$889.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$825.44	$825.44	$0.00	$0.00	$231.77	$0.00	$0.00	$0.00	$0.00	$556.08	$880.82	$889.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0063903200	SUP	Custom 27803010		M0063903200  -  COIL SPECIMEN RETRIEVAL 3FR 10MM 115CM SHEAQTH QUICK RELEASE	BOTH IP/OP	"$1,112.15 "	$822.99	$0.00	$889.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$825.44	$825.44	$0.00	$0.00	$231.77	$0.00	$0.00	$0.00	$0.00	$556.08	$880.82	$889.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0064002011	SUP	HCPCS C1758		M0064002011  -  CATHETER URETERAL 5FR 70CM 1 LUMEN OPEN END INJEC HUB LATEX	BOTH IP/OP	$921.45 	$681.87	$0.00	$737.16	$500.35	$500.35	$0.00	$0.00	$0.00	$192.05	$683.90	$683.90	$0.00	$0.00	$192.03	$0.00	$545.04	$545.04	$0.00	$460.73	$729.79	$737.16	$0.00		$0.00	$144.21	$0.00	$0.00	$146.69	$0.00	$0.00	$0.00	$0.00	$0.00
M0064201000	SUP	Custom 27203010		M0064201000  -  CATH SPBC FDRTP 14FR 15CM KIT BLN PNCT 5ML	BOTH IP/OP	$198.00 	$146.52	$0.00	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.96	$146.96	$0.00	$0.00	$41.26	$0.00	$0.00	$0.00	$0.00	$99.00	$156.82	$158.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M006580211	SUP	Custom 27203010		M006580211  -  UNIT ELECTROSURGICAL PROCEDURE SET GENESYS HTA	BOTH IP/OP	"$4,209.12 "	"$3,114.75"	$0.00	"$3,367.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,124.01"	"$3,124.01"	$0.00	$0.00	$877.18	$0.00	$0.00	$0.00	$0.00	"$2,104.56"	"$3,333.62"	"$3,367.30"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0066301001	SUP	HCPCS C1769		M0066301001  -  GWIRE ENDSCP .035IN 150CM STR FLX TP STF SHFT GLDWR HYDPHI 3	BOTH IP/OP	$137.89 	$102.04	$0.00	$110.31	$74.87	$74.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.95	$109.21	$110.31	$0.00		$0.00	$21.58	$0.00	$0.00	$21.95	$0.00	$0.00	$0.00	$0.00	$0.00
M0066301011	SUP	HCPCS C1769		M0066301011  -  GUIDEWIRE URO STD .038IN 150CM STRL 3CM GLDWR SFT FLXB STRG	BOTH IP/OP	$137.89 	$102.04	$0.00	$110.31	$74.87	$74.87	$0.00	$0.00	$0.00	$28.74	$102.34	$102.34	$0.00	$0.00	$28.74	$0.00	$81.56	$81.56	$0.00	$68.95	$109.21	$110.31	$0.00		$0.00	$21.58	$0.00	$0.00	$21.95	$0.00	$0.00	$0.00	$0.00	$0.00
M0066301101	SUP	HCPCS C1769		M0066301101  -  GWIRE ENDSCP .035IN 150CM ANG TIP FLX TP STF SHFT GLDWR PU 3	BOTH IP/OP	$201.16 	$148.86	$0.00	$160.93	$109.23	$109.23	$0.00	$0.00	$0.00	$41.93	$149.30	$149.30	$0.00	$0.00	$41.92	$0.00	$118.99	$118.99	$0.00	$100.58	$159.32	$160.93	$0.00		$0.00	$31.48	$0.00	$0.00	$32.02	$0.00	$0.00	$0.00	$0.00	$0.00
M0066301121	SUP	HCPCS C1769		M0066301121  -  GWIRE ENDSCP .038IN 150CM ANG TIP FLX TP STF SHFT GLDWR PU 3	BOTH IP/OP	$201.16 	$148.86	$0.00	$160.93	$109.23	$109.23	$0.00	$0.00	$0.00	$41.93	$149.30	$149.30	$0.00	$0.00	$41.92	$0.00	$118.99	$118.99	$0.00	$100.58	$159.32	$160.93	$0.00		$0.00	$31.48	$0.00	$0.00	$32.02	$0.00	$0.00	$0.00	$0.00	$0.00
M0066401041	SUP	HCPCS C1769		M0066401041  -  GUIDEWIRE URO STRG .035IN 145CM LF 7CM AMP SPST BNTSN FLX TP	BOTH IP/OP	$120.44 	$89.13	$0.00	$96.35	$65.40	$65.40	$0.00	$0.00	$0.00	$25.10	$89.39	$89.39	$0.00	$0.00	$25.10	$0.00	$71.24	$71.24	$0.00	$60.22	$95.39	$96.35	$0.00		$0.00	$18.85	$0.00	$0.00	$19.17	$0.00	$0.00	$0.00	$0.00	$0.00
M0066703051	SUP	HCPCS C1769		M0066703051  -  GUIDEWIRE ENDSCP STR FLOPPY .035IN 150CM 3CM HIGH	BOTH IP/OP	$968.75 	$716.88	$0.00	$775.00	$526.03	$526.03	$0.00	$0.00	$0.00	$201.91	$719.01	$719.01	$0.00	$0.00	$201.89	$0.00	$573.02	$573.02	$0.00	$484.38	$767.25	$775.00	$0.00		$0.00	$151.61	$0.00	$0.00	$154.23	$0.00	$0.00	$0.00	$0.00	$0.00
M0066703061	SUP	HCPCS C1769		M0066703061  -  GUIDEWIRE ENDSCP ANGLE FLOPPY .035IN 150CM 3CM HIGH	BOTH IP/OP	$193.75 	$143.38	$0.00	$155.00	$105.21	$105.21	$0.00	$0.00	$0.00	$40.38	$143.80	$143.80	$0.00	$0.00	$40.38	$0.00	$114.60	$114.60	$0.00	$96.88	$153.45	$155.00	$0.00		$0.00	$30.32	$0.00	$0.00	$30.85	$0.00	$0.00	$0.00	$0.00	$0.00
M0066703091	SUP	HCPCS C1769		M0066703091  -  GUIDEWIRE ENDSCP STR .038IN 150CM 3CM RADIOPQ FLEXIBLE TIP	BOTH IP/OP	$193.75 	$143.38	$0.00	$155.00	$105.21	$105.21	$0.00	$0.00	$0.00	$40.38	$143.80	$143.80	$0.00	$0.00	$40.38	$0.00	$114.60	$114.60	$0.00	$96.88	$153.45	$155.00	$0.00		$0.00	$30.32	$0.00	$0.00	$30.85	$0.00	$0.00	$0.00	$0.00	$0.00
M0066703101	SUP	HCPCS C1769		M0066703101  -  GUIDEWIRE ENDSCP ANGLE .038IN 150CM 3CM 2 FLEXIBLE TIP	BOTH IP/OP	$968.75 	$716.88	$0.00	$775.00	$526.03	$526.03	$0.00	$0.00	$0.00	$201.91	$719.01	$719.01	$0.00	$0.00	$201.89	$0.00	$573.02	$573.02	$0.00	$484.38	$767.25	$775.00	$0.00		$0.00	$151.61	$0.00	$0.00	$154.23	$0.00	$0.00	$0.00	$0.00	$0.00
M0067201001	SUP	Custom 27203010		M0067201001  -  SYSTEM PUMP IRRIGATION 1 HAND ACTION 1 WAY VALVE VACUUM	BOTH IP/OP	$212.74 	$157.43	$0.00	$170.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.90	$157.90	$0.00	$0.00	$44.34	$0.00	$0.00	$0.00	$0.00	$106.37	$168.49	$170.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0067301251	SUP	Custom 27203010		M0067301251  -  EVACUATOR UROLOGY UROVAC BLADDER	BOTH IP/OP	$107.98 	$79.91	$0.00	$86.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.14	$80.14	$0.00	$0.00	$22.50	$0.00	$0.00	$0.00	$0.00	$53.99	$85.52	$86.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0068318170	SUP	HCPCS C1781		M0068318170  -  MESH TRANSVAGINAL UPHOLD CAPIO	BOTH IP/OP	"$7,046.25 "	"$5,214.23"	$0.00	"$5,637.00"	"$3,170.81"	"$3,170.81"	$0.00	$0.00	$0.00	"$1,468.61"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,468.44"	$0.00	"$3,473.80"	"$3,473.80"	$0.00	"$3,523.13"	"$5,580.63"	"$5,637.00"	$0.00		$0.00	"$1,102.74"	$0.00	$0.00	"$1,121.76"	$0.00	$0.00	$0.00	$0.00	$0.00
M0068502110	SUP	HCPCS C1771		M0068502110  -  SLING TRANSVAGINAL 2.7MM CURVE SYSTEM DELIVERY DEVICE MESH	BOTH IP/OP	"$3,940.00 "	"$2,915.60"	$0.00	"$3,152.00"	"$1,773.00"	"$1,773.00"	$0.00	$0.00	$0.00	$821.19	"$2,924.27"	"$2,924.27"	$0.00	$0.00	$821.10	$0.00	"$1,942.42"	"$1,942.42"	$0.00	"$1,970.00"	"$3,120.48"	"$3,152.00"	$0.00		$0.00	$616.61	$0.00	$0.00	$627.25	$0.00	$0.00	$0.00	$0.00	$0.00
M0068503000	SUP	HCPCS C1771		M0068503000  -  SLING PUBOVAGINAL SLING SYSTEM LYNX FMALE SUPRAPUBIC	BOTH IP/OP	"$3,753.08 "	"$2,777.28"	$0.00	"$3,002.46"	"$1,688.88"	"$1,688.88"	$0.00	$0.00	$0.00	$782.23	"$2,785.53"	"$2,785.53"	$0.00	$0.00	$782.14	$0.00	"$1,850.27"	"$1,850.27"	$0.00	"$1,876.54"	"$2,972.44"	"$3,002.46"	$0.00		$0.00	$587.36	$0.00	$0.00	$597.49	$0.00	$0.00	$0.00	$0.00	$0.00
M0068505000	SUP	HCPCS C1771		M0068505000  -  SLING PUBOVAGINAL SLING SYSTEM NEEDLE OBTRYX HALO FMALE	BOTH IP/OP	"$3,187.50 "	"$2,358.75"	$0.00	"$2,550.00"	"$1,434.38"	"$1,434.38"	$0.00	$0.00	$0.00	$664.35	"$2,365.76"	"$2,365.76"	$0.00	$0.00	$664.28	$0.00	"$1,571.44"	"$1,571.44"	$0.00	"$1,593.75"	"$2,524.50"	"$2,550.00"	$0.00		$0.00	$498.84	$0.00	$0.00	$507.45	$0.00	$0.00	$0.00	$0.00	$0.00
M0068505110	SUP	HCPCS C1771		M0068505110  -  SLING PUBOVAGINAL NEEDLE OBTRYX II HALO MIDURETHRAL	BOTH IP/OP	"$3,500.00 "	"$2,590.00"	$0.00	"$2,800.00"	"$1,575.00"	"$1,575.00"	$0.00	$0.00	$0.00	$729.49	"$2,597.70"	"$2,597.70"	$0.00	$0.00	$729.40	$0.00	"$1,725.50"	"$1,725.50"	$0.00	"$1,750.00"	"$2,772.00"	"$2,800.00"	$0.00		$0.00	$547.75	$0.00	$0.00	$557.20	$0.00	$0.00	$0.00	$0.00	$0.00
M0613	SUP	Custom 25003010		ANTIBODY EMA CLONE E29 MS ANHMN .2ML LAB	BOTH IP/OP	$569.13 	$421.16	$0.00	$455.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$284.56	$450.75	$455.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0630	SUP	Custom 25003010		ANTIBODY CYKRTN CLONE 34BETAE12 MS IGG1 KAPPA MNCLN ANHMN .2	BOTH IP/OP	"$1,016.33 "	$752.08	$0.00	$813.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$508.16	$804.93	$813.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0634	SUP	Custom 25003010		ANTIBODY MLNSM CLONE HMB45 MS ANHMN .2ML LAB	BOTH IP/OP	"$1,900.00 "	"$1,406.00"	$0.00	"$1,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$950.00	"$1,504.80"	"$1,520.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0701	SUP	Custom 25003010		ANTIBODY CD45 LCA CLONE 2B11 PD7/26 MS IGG1 KAPPA ANHMN 1ML	BOTH IP/OP	$817.85 	$605.21	$0.00	$654.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.93	$647.74	$654.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0725	SUP	Custom 25003010		ANTIBODY VM CLONE V9 MS ANHMN 1ML LAB	BOTH IP/OP	"$1,187.50 "	$878.75	$0.00	$950.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$593.75	$940.50	$950.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0733	SUP	Custom 25003010		ANTIBODY CD15 CLONE C3D-1 MS IGM KAPPA ANHMN 1ML LAB	BOTH IP/OP	$861.60 	$637.58	$0.00	$689.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$430.80	$682.39	$689.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0750	SUP	Custom 25003010		ANTIBODY PSA CLONE ER-PR8 MS ANHMN 1ML LAB	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0751	SUP	Custom 25003010		ANTIBODY CD30 CLONE BER H2 MS IGG1 KAPPA ANHMN 1ML LAB	BOTH IP/OP	"$1,101.68 "	$815.24	$0.00	$881.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$550.84	$872.53	$881.34	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0755	SUP	Custom 25003010		ANTIBODY CD20CY CLONE L26 MS IGG2A KAPPA ANHMN 1ML LAB	BOTH IP/OP	"$1,213.70 "	$898.14	$0.00	$970.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$606.85	$961.25	$970.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0776	SUP	Custom 25003010		ANTIBODY SNPTSN CLONE SY38 MS IGG1 KAPPA ANHMN 1ML LAB	BOTH IP/OP	"$1,252.00 "	$926.48	$0.00	"$1,001.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$626.00	$991.58	"$1,001.60"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0781	SUP	Custom 25003010		ANTIBODY IGG1 KAPPA DAK-TG6 CLONE MS ANHMN MNCLN CULT SPRNT	BOTH IP/OP	$877.60 	$649.42	$0.00	$702.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$438.80	$695.06	$702.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0823	SUP	Custom 25003010		ANTIBODY CD31 CLONE JC/70A MS IGG1 .2ML 1ML LAB	BOTH IP/OP	"$1,072.33 "	$793.52	$0.00	$857.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$536.16	$849.29	$857.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M085401	SUP	Custom 25003010		ANTIBODY CMV CLONE CCH2 DDG9 MS ANHMN 1ML LAB	BOTH IP/OP	"$1,091.25 "	$807.53	$0.00	$873.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.63	$864.27	$873.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M0873	SUP	Custom 25003010		ANTIBODY NSE CLONE BBS/NC/6-H14 MS ANHMN .2ML LAB	BOTH IP/OP	"$1,556.85 "	"$1,152.07"	$0.00	"$1,245.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$778.43	"$1,233.03"	"$1,245.48"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M1599B	SUP	Custom 27203010		CABLE NIBP  INTERCONNECT 3.0M	BOTH IP/OP	$115.50 	$85.47	$0.00	$92.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.75	$91.48	$92.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M1900B	SUP	Custom 27203010		CABLE OXM 3MR 12TO 9 PIN D-SUB INPT CONNCTR SPO2 ADPR LF	BOTH IP/OP	$339.60 	$251.30	$0.00	$271.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.80	$268.96	$271.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M3526A	SUP	Custom 27203010		WIRE 3 LEAD SET SNAP	BOTH IP/OP	$340.00 	$251.60	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.00	$269.28	$272.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M3556	SUP	Custom 25003010		ANTIBODY CALPONIN CLONE CALP MS IGG1 KAPPA ANHMN 1ML LAB	BOTH IP/OP	"$1,900.00 "	"$1,406.00"	$0.00	"$1,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$950.00	"$1,504.80"	"$1,520.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M3569	SUP	Custom 25003010		ANTIBODY PR CLONE PGR 636 MS IGG1 KAPPA MNCLN ANHMN .2ML 1ML	BOTH IP/OP	"$3,115.03 "	"$2,305.12"	$0.00	"$2,492.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,557.51"	"$2,467.10"	"$2,492.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M3609	SUP	Custom 25003010		ANTIBODY INHIBIN ALPHA CLONE R1 MS ANHMN 1ML LAB	BOTH IP/OP	"$1,193.10 "	$882.89	$0.00	$954.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$596.55	$944.94	$954.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M365SC550040	SUP	HCPCS C1787		M365SC550040  -  KIT STIMULATOR PRECISION SPECTRA SPINE CORD CASE REMOTE CONT	BOTH IP/OP	"$2,000.00 "	"$1,480.00"	$0.00	"$1,600.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,484.40"	"$1,484.40"	$0.00	$0.00	$416.80	$0.00	$0.00	$0.00	$0.00	"$1,000.00"	"$1,584.00"	"$1,600.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M3717A	SUP	Custom 27203010		M3717A  -  PAD DFBR HRTSTRT MLFNC XTRN PLUG CONCTR PED LATEX FREE DISP	BOTH IP/OP	$60.16 	$44.52	$0.00	$48.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.65	$44.65	$0.00	$0.00	$12.54	$0.00	$0.00	$0.00	$0.00	$30.08	$47.65	$48.13	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M6275033/10.S	SUP	HCPCS A6209		M6275033/10.S  -  DRSG THK1CM LG 15X10CM NADH CMFT VRSTL PVA VAC WHITEFOAM	BOTH IP/OP	$23.48 	$17.38	$0.00	$18.78	$12.75	$12.75	$0.00	$0.00	$0.00	$4.89	$17.43	$17.43	$0.00	$0.00	$4.89	$0.00	$13.89	$13.89	$0.00	$11.74	$18.60	$18.78	$0.00		$0.00	$3.67	$0.00	$0.00	$3.74	$0.00	$0.00	$0.00	$0.00	$0.00
M6275034/10.S	SUP	HCPCS A6209		M6275034/10.S  -  DRSG THK1CM LG 15X10CM NADH CMFT VRSTL PVA VAC WHITEFOAM	BOTH IP/OP	$30.02 	$22.21	$0.00	$24.01	$16.30	$16.30	$0.00	$0.00	$0.00	$6.26	$22.28	$22.28	$0.00	$0.00	$6.26	$0.00	$17.76	$17.76	$0.00	$15.01	$23.78	$24.01	$0.00		$0.00	$4.70	$0.00	$0.00	$4.78	$0.00	$0.00	$0.00	$0.00	$0.00
M6275053/10.S	SUP	HCPCS A6209		M6275053/10.S  -  DRSG THK3.3CM MED 18X12.5CM NADH CMFT VRSTL PU VAC GFM FOAM	BOTH IP/OP	$135.29 	$100.11	$0.00	$108.23	$73.46	$73.46	$0.00	$0.00	$0.00	$28.20	$100.41	$100.41	$0.00	$0.00	$28.19	$0.00	$80.02	$80.02	$0.00	$67.64	$107.15	$108.23	$0.00		$0.00	$21.17	$0.00	$0.00	$21.54	$0.00	$0.00	$0.00	$0.00	$0.00
M6275096/10	SUP	Custom 27203010		DRESSING THK3.3CM MED 18X12.5CM 2 ADH DRP KT PU VAC GFM SLVR	BOTH IP/OP	$148.16 	$109.64	$0.00	$118.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.08	$117.34	$118.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M6275096/10.S	SUP	HCPCS A6209		M6275096/10.S  -  DRSG MED 18X12.5CM OPN PORE HDRPHB NEG PRSS KIT PU VAC GFM	BOTH IP/OP	$155.06 	$114.74	$0.00	$124.04	$84.19	$84.19	$0.00	$0.00	$0.00	$32.32	$115.08	$115.08	$0.00	$0.00	$32.31	$0.00	$91.72	$91.72	$0.00	$77.53	$122.81	$124.04	$0.00		$0.00	$24.27	$0.00	$0.00	$24.68	$0.00	$0.00	$0.00	$0.00	$0.00
M6275098/10	SUP	Custom 27203010		DRESSING THK3.3CM SM VAC GFM SLVR BLK 10X7.5CM M6275098/10	BOTH IP/OP	"$1,180.45 "	$873.53	$0.00	$944.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$590.23	$934.92	$944.36	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M6275098/10.S	SUP	HCPCS A6209		M6275098/10.S  -  DRSG SM 10X7.5CM 1 DRP PAD CONCTR PU VAC GFM SLVR FOAM BLK	BOTH IP/OP	$123.77 	$91.59	$0.00	$99.01	$67.20	$67.20	$0.00	$0.00	$0.00	$25.80	$91.86	$91.86	$0.00	$0.00	$25.79	$0.00	$73.21	$73.21	$0.00	$61.88	$98.03	$99.01	$0.00		$0.00	$19.37	$0.00	$0.00	$19.70	$0.00	$0.00	$0.00	$0.00	$0.00
M6275099/10	SUP	Custom 27203010		DRESSING THK3.3CM LG VAC GFM SLVR BLK 26X15CM M6275099/10	BOTH IP/OP	$179.29 	$132.67	$0.00	$143.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.65	$142.00	$143.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M6275099/10.S	SUP	HCPCS A6209		M6275099/10.S  -  DRSG LG 26X15CM 2 DRP SENSATRAC PAD CONCTR PU VAC GFM SLVR	BOTH IP/OP	$17.36 	$12.85	$0.00	$13.89	$9.43	$9.43	$0.00	$0.00	$0.00	$3.62	$12.89	$12.89	$0.00	$0.00	$3.62	$0.00	$10.27	$10.27	$0.00	$8.68	$13.75	$13.89	$0.00		$0.00	$2.72	$0.00	$0.00	$2.76	$0.00	$0.00	$0.00	$0.00	$0.00
M653G	SUP	Custom 27203010		M653G  -  SUTURE SS 5 CCS 18IN MFL NABSB	BOTH IP/OP	$133.64 	$98.89	$0.00	$99.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.19	$99.19	$0.00	$0.00	$27.85	$0.00	$0.00	$0.00	$0.00	$19.85	$31.45	$31.77	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M7001	SUP	Custom 27803010		M7001  -  CATHETER DRN SYS ASPT PLR	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$0.00	$0.00	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M7019	SUP	Custom 25003010		ANTIBODY CYKRTN 20 CLONE KS20.8 MS IGG2A KAPPA ANHMN 1ML LAB	BOTH IP/OP	"$1,013.43 "	$749.94	$0.00	$810.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$506.71	$802.64	$810.74	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M7047	SUP	Custom 25003010		ANTIBODY ER CLONE 1D5 MS IGG1 KAPPA MNCLN ANHMN .2ML 1ML LAB	BOTH IP/OP	"$2,638.43 "	"$1,952.44"	$0.00	"$2,110.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,319.21"	"$2,089.64"	"$2,110.74"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M7165	SUP	Custom 25003010		ANTIBODY CD34 CLONE QBEND MS IGG1 KAPPA ANHMN 1ML LAB	BOTH IP/OP	"$1,173.58 "	$868.45	$0.00	$938.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$586.79	$929.48	$938.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M7191	SUP	Custom 25003010		ANTIBODY PLAP CLONE 8A9 MS ANHMN .2ML LAB	BOTH IP/OP	"$1,018.50 "	$753.69	$0.00	$814.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$509.25	$806.65	$814.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M7240	SUP	Custom 25003010		ANTIBODY KI-67 CLONE MIB-1 MS IGG1 KAPPA ANHMN 1ML LAB	BOTH IP/OP	"$1,193.03 "	$882.84	$0.00	$954.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$596.51	$944.88	$954.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M7630-1A	SUP	Custom 27203010		MEDIA CYSL 60 LVISC CLR MOUNT	BOTH IP/OP	$319.08 	$236.12	$0.00	$255.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.54	$252.71	$255.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8275040/10.S	SUP	Custom 27203010		DRESSING MED SPIRAL FOAM V.A.C. SIMPLACE	BOTH IP/OP	$129.88 	$96.11	$0.00	$103.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.94	$102.86	$103.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8275041/5.S	SUP	HCPCS A6209		M8275041/5.S  -  KIT DRESSING THK1.75CM MEDIUM 7.5X11.5CM DRAPE PAD CONCTR	BOTH IP/OP	$93.58 	$69.25	$0.00	$74.86	$50.81	$50.81	$0.00	$0.00	$0.00	$19.50	$69.46	$69.46	$0.00	$0.00	$19.50	$0.00	$55.35	$55.35	$0.00	$46.79	$74.12	$74.86	$0.00		$0.00	$14.65	$0.00	$0.00	$14.90	$0.00	$0.00	$0.00	$0.00	$0.00
M8275051/10	SUP	HCPCS A6209		M8275051/10  -  DRSG THK3.3CM SM 10X7.5CM SENSATRAC PAD DRP HDRPHB FLXB OPN	BOTH IP/OP	$80.69 	$59.71	$0.00	$64.55	$43.81	$43.81	$0.00	$0.00	$0.00	$16.82	$59.89	$59.89	$0.00	$0.00	$16.82	$0.00	$47.73	$47.73	$0.00	$40.34	$63.91	$64.55	$0.00		$0.00	$12.63	$0.00	$0.00	$12.85	$0.00	$0.00	$0.00	$0.00	$0.00
M8275052/10	SUP	Custom 27203010		DRESSING THK3.3CM LG 18X12.5CM OPN PORE HDRPHB NEG PRSS KT	BOTH IP/OP	$109.07 	$80.71	$0.00	$87.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.54	$86.38	$87.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8275052/10.S	SUP	HCPCS A6209		M8275052/10.S  -  KIT DRESSING THK3.3CM MEDIUM STANDARD 18X12.5CM 2 ADHESIVE	BOTH IP/OP	$99.71 	$73.79	$0.00	$79.76	$54.14	$54.14	$0.00	$0.00	$0.00	$20.78	$74.00	$74.00	$0.00	$0.00	$20.78	$0.00	$58.98	$58.98	$0.00	$49.85	$78.97	$79.76	$0.00		$0.00	$15.60	$0.00	$0.00	$15.87	$0.00	$0.00	$0.00	$0.00	$0.00
M8275053/10	SUP	Custom 27203010		DRESSING THK3.3CM LG VAC GFM WHT 26X15CM HDRPHB KT PU STRL	BOTH IP/OP	$135.28 	$100.11	$0.00	$108.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.64	$107.14	$108.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8275053/10.S	SUP	HCPCS A6209		M8275053/10.S  -  KIT VAC GFM DRSG SENSATRAC PAD DRP HDRPHB FLXB OPN PORE PU	BOTH IP/OP	$122.79 	$90.86	$0.00	$98.23	$66.67	$66.67	$0.00	$0.00	$0.00	$25.59	$91.13	$91.13	$0.00	$0.00	$25.59	$0.00	$72.63	$72.63	$0.00	$61.39	$97.25	$98.23	$0.00		$0.00	$19.22	$0.00	$0.00	$19.55	$0.00	$0.00	$0.00	$0.00	$0.00
M8275057	SUP	Custom 27203010		CANISTER WND DRAIN PAD TBG CLMP CONNCTR SENSATRAC STRL LF	BOTH IP/OP	$48.03 	$35.54	$0.00	$38.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.64	$35.64	$0.00	$0.00	$10.01	$0.00	$0.00	$0.00	$0.00	$24.01	$38.04	$38.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8275057/10.S	SUP	Custom 27203010		M8275057/10.S  -  PAD WOUND DRAIN TUBE CLMP CONCTR SENSATRAC VAC STERILE	BOTH IP/OP	$42.59 	$31.52	$0.00	$34.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.61	$31.61	$0.00	$0.00	$8.87	$0.00	$0.00	$0.00	$0.00	$21.29	$33.73	$34.07	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8275063/10.S	SUP	Custom 27203010		M8275063/10.S  -  CANISTER WOUND DRAIN C500ML GEL TUBE CLMP CONCTR CHARCOAL	BOTH IP/OP	$82.68 	$61.18	$0.00	$66.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.37	$61.37	$0.00	$0.00	$17.23	$0.00	$0.00	$0.00	$0.00	$41.34	$65.48	$66.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8275065/5	SUP	HCPCS A6209		M8275065/5  -  DRSG THK1.5CM XL 60X30CM OPN PORE HDRPHB NEG PRSS KIT PU VAC	BOTH IP/OP	$253.80 	$187.81	$0.00	$203.04	$137.81	$137.81	$0.00	$0.00	$0.00	$52.90	$188.37	$188.37	$0.00	$0.00	$52.89	$0.00	$150.12	$150.12	$0.00	$126.90	$201.01	$203.04	$0.00		$0.00	$39.72	$0.00	$0.00	$40.40	$0.00	$0.00	$0.00	$0.00	$0.00
M8275080/5	SUP	Custom 27203010		KCI V.A.C. GRANU FOAM DRESSING ABDOMINAL	BOTH IP/OP	$801.14 	$592.84	$0.00	$640.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$400.57	$634.50	$640.91	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8275080/5.S	SUP	Custom 27203010		M8275080/5.S  -  DRSG NADH LYR SENSATRAC PAD TBG PU VAC GFM FOAM ABD	BOTH IP/OP	$793.52 	$587.20	$0.00	$634.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$396.76	$628.47	$634.81	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8275096/10	SUP	HCPCS A6209		M8275096/10  -  KIT DRESSING THK3.2CM MEDIUM 18X12.5CM 2 ADHESIVE DRAPE 1	BOTH IP/OP	$140.73 	$104.14	$0.00	$112.58	$76.42	$76.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.36	$111.46	$112.58	$0.00		$0.00	$22.02	$0.00	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00
M8275096/10.S	SUP	HCPCS A6209		M8275096/10.S  -  DRSG THK3.3CM MED 18X12.5CM SENSATRAC PAD DRP FLXB CNTOUR	BOTH IP/OP	$140.73 	$104.14	$0.00	$112.58	$76.42	$76.42	$0.00	$0.00	$0.00	$29.33	$104.45	$104.45	$0.00	$0.00	$29.33	$0.00	$83.24	$83.24	$0.00	$70.36	$111.46	$112.58	$0.00		$0.00	$22.02	$0.00	$0.00	$22.40	$0.00	$0.00	$0.00	$0.00	$0.00
M8275096/5.S	SUP	Custom 27203010		M8275096/5.S  -  DRSG THK3.3CM MED 18X12.5CM SENSATRAC PAD DRP FLXB CNTOUR	BOTH IP/OP	$172.74 	$127.83	$0.00	$138.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$128.21	$128.21	$0.00	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$86.37	$136.81	$138.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8275098/10	SUP	HCPCS A6209		M8275098/10  -  DRESSING FOAM THK3.3CM SMALL 10X7.5CM SENSATRAC PAD DRAPE	BOTH IP/OP	$112.33 	$83.12	$0.00	$89.86	$60.99	$60.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.16	$88.97	$89.86	$0.00		$0.00	$17.58	$0.00	$0.00	$17.88	$0.00	$0.00	$0.00	$0.00	$0.00
M8275098/10.S	SUP	HCPCS A6209		M8275098/10.S  -  DRSG THK3.3CM SM 10X7.5CM SENSATRAC PAD DRP FLXB CNTOUR	BOTH IP/OP	$112.33 	$83.12	$0.00	$89.86	$60.99	$60.99	$0.00	$0.00	$0.00	$23.41	$83.37	$83.37	$0.00	$0.00	$23.41	$0.00	$66.44	$66.44	$0.00	$56.16	$88.97	$89.86	$0.00		$0.00	$17.58	$0.00	$0.00	$17.88	$0.00	$0.00	$0.00	$0.00	$0.00
M8275099/10	SUP	HCPCS A6209		M8275099/10  -  DRESSING FOAM THK3.3CM LARGE 26X15CM ADHESIVE DRAPE	BOTH IP/OP	$170.41 	$126.10	$0.00	$136.33	$92.53	$92.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.20	$134.96	$136.33	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
M8275099/10.S	SUP	HCPCS A6209		M8275099/10.S  -  DRSG THK3.3CM LG 26X15CM DRP SENSATRAC PAD PU VAC GFM SLVR	BOTH IP/OP	$170.41 	$126.10	$0.00	$136.33	$92.53	$92.53	$0.00	$0.00	$0.00	$35.52	$126.48	$126.48	$0.00	$0.00	$35.51	$0.00	$100.80	$100.80	$0.00	$85.20	$134.96	$136.33	$0.00		$0.00	$26.67	$0.00	$0.00	$27.13	$0.00	$0.00	$0.00	$0.00	$0.00
M8275099/5	SUP	Custom 27203010		DRESSING THK3.3CM LG VAC GFM SLVR BLK 26X15CM M8275099/5	BOTH IP/OP	$199.48 	$147.62	$0.00	$159.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.74	$157.99	$159.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8275099/5.S	SUP	Custom 27203010		M8275099/5.S  -  DRSG THK3.3CM LG 26X15CM DRP SENSATRAC PAD PU VAC GFM SLVR	BOTH IP/OP	$206.04 	$152.47	$0.00	$164.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.92	$152.92	$0.00	$0.00	$42.94	$0.00	$0.00	$0.00	$0.00	$103.02	$163.18	$164.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8730	SUP	Custom 27203010		M8730  -  SUTURE NONABSORBABLE 8-0 BV130-5 18IN 2 ARM MONOFILAMENT	BOTH IP/OP	$202.54 	$149.88	$0.00	$164.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.32	$150.32	$0.00	$0.00	$42.21	$0.00	$0.00	$0.00	$0.00	$102.79	$162.82	$164.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8747	SUP	Custom 27203010		M8747  -  SUTURE PRLN 7-0 BV175-8 24IN MFL DBL ARM BLUE NABSB ETM8747	BOTH IP/OP	$137.60 	$101.82	$0.00	$110.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.80	$108.98	$110.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
M8805	SUP	Custom 27203010		SUTURE PRLN 6-0 BV-1 24IN MFL DBL ARM BLUE NABSB ET8805H	BOTH IP/OP	"$1,166.83 "	$863.45	$0.00	$933.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$583.41	$924.13	$933.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC	SUP	HCPCS V2632		MA30AC  -  LENS IOL 5 D +1 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.100	SUP	HCPCS V2632		MA30AC.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.105	SUP	HCPCS V2632		MA30AC.105  -  LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.110	SUP	HCPCS V2632		MA30AC.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.115	SUP	HCPCS V2632		MA30AC.115  -  LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.120	SUP	HCPCS V2632		MA30AC.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.125	SUP	HCPCS V2632		MA30AC.125  -  LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.130	SUP	HCPCS V2632		MA30AC.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.135	SUP	HCPCS V2632		MA30AC.135  -  LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.140	SUP	HCPCS V2632		MA30AC.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.145	SUP	HCPCS V2632		MA30AC.145  -  LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.150	SUP	HCPCS V2632		MA30AC.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.155	SUP	HCPCS V2632		MA30AC.155  -  LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.160	SUP	HCPCS V2632		MA30AC.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.165	SUP	HCPCS V2632		MA30AC.165  -  LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.170	SUP	HCPCS V2632		MA30AC.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.175	SUP	HCPCS V2632		MA30AC.175  -  LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.180	SUP	HCPCS V2632		MA30AC.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.185	SUP	HCPCS V2632		MA30AC.185  -  LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.190	SUP	HCPCS V2632		MA30AC.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.195	SUP	HCPCS V2632		MA30AC.195  -  LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.200	SUP	HCPCS V2632		MA30AC.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.205	SUP	HCPCS V2632		MA30AC.205  -  LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.210	SUP	HCPCS V2632		MA30AC.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.215	SUP	HCPCS V2632		MA30AC.215  -  LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.220	SUP	HCPCS V2632		MA30AC.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.225	SUP	HCPCS V2632		MA30AC.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.230	SUP	HCPCS V2632		MA30AC.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.235	SUP	HCPCS V2632		MA30AC.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.240	SUP	HCPCS V2632		MA30AC.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.245	SUP	HCPCS V2632		MA30AC.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.250	SUP	HCPCS V2632		MA30AC.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.255	SUP	HCPCS V2632		MA30AC.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.260	SUP	HCPCS V2632		MA30AC.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.265	SUP	HCPCS V2632		MA30AC.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.270	SUP	HCPCS V2632		MA30AC.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.275	SUP	HCPCS V2632		MA30AC.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.280	SUP	HCPCS V2632		MA30AC.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.285	SUP	HCPCS V2632		MA30AC.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.290	SUP	HCPCS V2632		MA30AC.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.295	SUP	HCPCS V2632		MA30AC.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA30AC.300	SUP	HCPCS V2632		MA30AC.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM	SUP	HCPCS V2632		MA50BM  -  LENS IOL 10 D +19.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.060	SUP	HCPCS V2632		MA50BM.060  -  LENS IOL 10 D +6 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.065	SUP	HCPCS V2632		MA50BM.065  -  LENS IOL 10 D +6.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.070	SUP	HCPCS V2632		MA50BM.070  -  LENS IOL 10 D +7 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.075	SUP	HCPCS V2632		MA50BM.075  -  LENS IOL 10 D +7.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.080	SUP	HCPCS V2632		MA50BM.080  -  LENS IOL 10 D +8 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.085	SUP	HCPCS V2632		MA50BM.085  -  LENS IOL 10 D +8.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.090	SUP	HCPCS V2632		MA50BM.090  -  LENS IOL 10 D +9 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.095	SUP	HCPCS V2632		MA50BM.095  -  LENS IOL 10 D +9.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.100	SUP	HCPCS V2632		MA50BM.100  -  LENS IOL 10 D +10 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.105	SUP	HCPCS V2632		MA50BM.105  -  LENS IOL 10 D +10.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.110	SUP	HCPCS V2632		MA50BM.110  -  LENS IOL 10 D +11 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.115	SUP	HCPCS V2632		MA50BM.115  -  LENS IOL 10 D +11.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.120	SUP	HCPCS V2632		MA50BM.120  -  LENS IOL 10 D +12 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.125	SUP	HCPCS V2632		MA50BM.125  -  LENS IOL 10 D +12.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.130	SUP	HCPCS V2632		MA50BM.130  -  LENS IOL 10 D +13 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.135	SUP	HCPCS V2632		MA50BM.135  -  LENS IOL 10 D +13.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.140	SUP	HCPCS V2632		MA50BM.140  -  LENS IOL 10 D +14 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.145	SUP	HCPCS V2632		MA50BM.145  -  LENS IOL 10 D +14.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.150	SUP	HCPCS V2632		MA50BM.150  -  LENS IOL 10 D +15 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.155	SUP	HCPCS V2632		MA50BM.155  -  LENS IOL 10 D +15.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.160	SUP	HCPCS V2632		MA50BM.160  -  LENS IOL 10 D +16 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.165	SUP	HCPCS V2632		MA50BM.165  -  LENS IOL 10 D +16.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.170	SUP	HCPCS V2632		MA50BM.170  -  LENS IOL 10 D +17 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.175	SUP	HCPCS V2632		MA50BM.175  -  LENS IOL 10 D +17.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.180	SUP	HCPCS V2632		MA50BM.180  -  LENS IOL 10 D +18 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.185	SUP	HCPCS V2632		MA50BM.185  -  LENS IOL 10 D +18.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.190	SUP	HCPCS V2632		MA50BM.190  -  LENS IOL 10 D +19 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.195	SUP	HCPCS V2632		MA50BM.195  -  LENS IOL 10 D +19.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.200	SUP	HCPCS V2632		MA50BM.200  -  LENS IOL 10 D +20 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.205	SUP	HCPCS V2632		MA50BM.205  -  LENS IOL 10 D +20.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.210	SUP	HCPCS V2632		MA50BM.210  -  LENS IOL 10 D +21 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.215	SUP	HCPCS V2632		MA50BM.215  -  LENS IOL 10 D +21.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.220	SUP	HCPCS V2632		MA50BM.220  -  LENS IOL 10 D +22 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.225	SUP	HCPCS V2632		MA50BM.225  -  LENS IOL 10 D +22.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.230	SUP	HCPCS V2632		MA50BM.230  -  LENS IOL 10 D +23 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.235	SUP	HCPCS V2632		MA50BM.235  -  LENS IOL 10 D +23.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.240	SUP	HCPCS V2632		MA50BM.240  -  LENS IOL 10 D +24 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.245	SUP	HCPCS V2632		MA50BM.245  -  LENS IOL 10 D +24.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.250	SUP	HCPCS V2632		MA50BM.250  -  LENS IOL 10 D +25 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.255	SUP	HCPCS V2632		MA50BM.255  -  LENS IOL 10 D +25.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.260	SUP	HCPCS V2632		MA50BM.260  -  LENS IOL 10 D +26 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.265	SUP	HCPCS V2632		MA50BM.265  -  LENS IOL 10 D +26.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.270	SUP	HCPCS V2632		MA50BM.270  -  LENS IOL 10 D +27 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.275	SUP	HCPCS V2632		MA50BM.275  -  LENS IOL 10 D +27.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.280	SUP	HCPCS V2632		MA50BM.280  -  LENS IOL 10 D +28 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.285	SUP	HCPCS V2632		MA50BM.285  -  LENS IOL 10 D +28.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.290	SUP	HCPCS V2632		MA50BM.290  -  LENS IOL 10 D +29 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.295	SUP	HCPCS V2632		MA50BM.295  -  LENS IOL 10 D +29.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA50BM.300	SUP	HCPCS V2632		MA50BM.300  -  LENS IOL 10 D +30 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.060	SUP	HCPCS V2630		MA60AC.060  -  LENS IOL 10 D +6 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.065	SUP	HCPCS V2632		MA60AC.065  -  LENS IOL +6.5 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.070	SUP	HCPCS V2632		MA60AC.070  -  LENS IOL 10 D +7 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.075	SUP	HCPCS V2632		MA60AC.075  -  LENS IOL +7.5 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.080	SUP	HCPCS V2632		MA60AC.080  -  LENS IOL +8 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.085	SUP	HCPCS V2632		MA60AC.085  -  LENS IOL 10 D +8.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.090	SUP	HCPCS V2632		MA60AC.090  -  LENS IOL 10 D +9 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.095	SUP	HCPCS V2632		MA60AC.095  -  LENS IOL 10 D +9.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.100	SUP	HCPCS V2632		MA60AC.100  -  LENS IOL +10 DIOP 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.105	SUP	HCPCS V2632		MA60AC.105  -  LENS IOL +10.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.110	SUP	HCPCS V2632		MA60AC.110  -  LENS IOL 10 D +11 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.115	SUP	HCPCS V2632		MA60AC.115  -  LENS IOL +11.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.120	SUP	HCPCS V2632		MA60AC.120  -  LENS IOL +12 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.125	SUP	HCPCS V2632		MA60AC.125  -  LENS IOL +12.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.130	SUP	HCPCS V2632		MA60AC.130  -  LENS IOL 10 D +13 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.135	SUP	HCPCS V2632		MA60AC.135  -  LENS IOL +13.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.140	SUP	HCPCS V2630		MA60AC.140  -  LENS IOL 10 D +14 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.145	SUP	HCPCS V2632		MA60AC.145  -  LENS IOL +14.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.150	SUP	HCPCS V2630		MA60AC.150  -  LENS IOL 10 D +15 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.155	SUP	HCPCS V2630		MA60AC.155  -  LENS IOL +15.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.160	SUP	HCPCS V2632		MA60AC.160  -  LENS IOL 10 D +16 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.165	SUP	HCPCS V2632		MA60AC.165  -  LENS IOL +16.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.170	SUP	HCPCS V2632		MA60AC.170  -  LENS IOL 10 D +17 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.175	SUP	HCPCS V2632		MA60AC.175  -  LENS IOL +17.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.180	SUP	HCPCS V2630		MA60AC.180  -  LENS IOL 10 D +18 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.185	SUP	HCPCS V2630		MA60AC.185  -  LENS IOL +18.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.190	SUP	HCPCS V2630		MA60AC.190  -  LENS IOL 10 D +19 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.195	SUP	HCPCS V2630		MA60AC.195  -  LENS IOL +19.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.200	SUP	HCPCS V2630		MA60AC.200  -  LENS IOL 10 D +20 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.205	SUP	HCPCS V2630		MA60AC.205  -  LENS IOL +20.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.210	SUP	HCPCS V2630		MA60AC.210  -  LENS IOL 10 D +21 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.215	SUP	HCPCS V2630		MA60AC.215  -  LENS IOL +21.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.220	SUP	HCPCS V2630		MA60AC.220  -  LENS IOL 10 D +22 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.225	SUP	HCPCS V2630		MA60AC.225  -  LENS IOL +22.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.230	SUP	HCPCS V2632		MA60AC.230  -  LENS IOL 10 D +23 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.235	SUP	HCPCS V2632		MA60AC.235  -  LENS IOL +23.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.240	SUP	HCPCS V2630		MA60AC.240  -  LENS IOL 10 D +24 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.245	SUP	HCPCS V2632		MA60AC.245  -  LENS IOL 10 D +24.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.250	SUP	HCPCS V2632		MA60AC.250  -  LENS IOL 10 D +25 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.255	SUP	HCPCS V2632		MA60AC.255  -  LENS IOL +25.5 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.260	SUP	HCPCS V2632		MA60AC.260  -  LENS IOL +26 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.265	SUP	HCPCS V2632		MA60AC.265  -  LENS IOL 10 D +26.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.270	SUP	HCPCS V2632		MA60AC.270  -  LENS IOL +27 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.275	SUP	HCPCS V2632		MA60AC.275  -  LENS IOL +27.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.280	SUP	HCPCS V2632		MA60AC.280  -  LENS IOL +28 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.285	SUP	HCPCS V2632		MA60AC.285  -  LENS IOL +28.5 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.290	SUP	HCPCS V2632		MA60AC.290  -  LENS IOL 10 D +29 DIOPTER BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.295	SUP	HCPCS V2632		MA60AC.295  -  LENS IOL 10 D +29.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60AC.300	SUP	HCPCS V2632		MA60AC.300  -  LENS IOL 10 D +30 DIOPTER BICNVX 6MM 13MM MULTIPIECE	BOTH IP/OP	$372.50 	$275.65	$0.00	$298.00	$167.63	$167.63	$0.00	$0.00	$0.00	$77.64	$276.47	$276.47	$0.00	$0.00	$77.63	$0.00	$220.33	$220.33	$0.00	$186.25	$295.02	$298.00	$0.00		$0.00	$58.30	$0.00	$0.00	$59.30	$0.00	$0.00	$0.00	$0.00	$0.00
MA60MA.000	SUP	HCPCS V2632		MA60MA.000  -  LENS IOL 5 D +0 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60MA.010	SUP	HCPCS V2632		MA60MA.010  -  LENS IOL 5 D +1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60MA.030	SUP	HCPCS V2632		MA60MA.030  -  INTRAOUCLAR LENS MA60MA  3.0D	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60MAN010	SUP	HCPCS V2632		MA60MAN010  -  LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60MAN020	SUP	HCPCS V2632		MA60MAN020  -  LENS IOL 5 D -2 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60MAN030	SUP	HCPCS V2632		MA60MAN030  -  LENS IOL 5 D -3 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60MAN040	SUP	HCPCS V2632		MA60MAN040  -  LENS IOL 5 D -4 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MA60MAN050	SUP	HCPCS V2632		MA60MAN050  -  LENS IOL 5 D -5 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
MAJ-210	SUP	Custom 27203010		VALVE BIOP BSCP NOMENCLATURE DISP	BOTH IP/OP	$166.85 	$123.47	$0.00	$133.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.84	$123.84	$0.00	$0.00	$34.77	$0.00	$0.00	$0.00	$0.00	$83.43	$132.15	$133.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MAL-0002	SUP	Custom 27803010		MAL-0002  -  EXPANDER OPHTHALMIC 7MM SAVES CONSIDERABLE TIME DISPOSABLE	BOTH IP/OP	"$1,937.50 "	"$1,433.75"	$0.00	"$1,550.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,438.01"	"$1,438.01"	$0.00	$0.00	$403.78	$0.00	$0.00	$0.00	$0.00	$968.75	"$1,534.50"	"$1,550.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MAP111	SUP	HCPCS C1725		MAP111  -  VALVE HEMOSTASIS 9FR MAP INSERTION TOOL ACCES-9 METAL	BOTH IP/OP	$33.25 	$24.61	$0.00	$26.60	$18.05	$18.05	$0.00	$0.00	$0.00	$6.93	$24.68	$24.68	$0.00	$0.00	$6.93	$0.00	$19.67	$19.67	$0.00	$16.63	$26.33	$26.60	$0.00		$0.00	$5.20	$0.00	$0.00	$5.29	$0.00	$0.00	$0.00	$0.00	$0.00
MAP500	SUP	HCPCS C1769		MAP500  -  DEVICE TORQUE LATEX FREE PIN VISE SALMON PTFE HYDPHI ACCEPTS	BOTH IP/OP	$0.44 	$0.33	$0.00	$0.36	$0.24	$0.24	$0.00	$0.00	$0.00	$0.09	$0.33	$0.33	$0.00	$0.00	$0.09	$0.00	$0.26	$0.26	$0.00	$0.22	$0.35	$0.36	$0.00		$0.00	$0.07	$0.00	$0.00	$0.07	$0.00	$0.00	$0.00	$0.00	$0.00
MAXA	SUP	Custom 27203010		SENSOR ADLT OXMX OXM ADH STRAP CBL LF DISP 18IN	BOTH IP/OP	$34.93 	$25.85	$0.00	$27.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.46	$27.66	$27.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MAXIICRTDMMAM	SUP	HCPCS C1882		MAXIICRTDMMAM  -  MAXIMO II CRT-D ADVANCED SYSTEM	BOTH IP/OP	"$60,500.00 "	"$44,770.00"	$0.00	"$48,400.00"	"$27,225.00"	"$27,225.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$12,608.20"	$0.00	"$29,826.50"	"$29,826.50"	$0.00	"$30,250.00"	"$47,916.00"	"$48,400.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
MAXIIDRMMEM	SUP	HCPCS C1882		MAXIIDRMMEM  -  MAXIMO II DR SYSTEM	BOTH IP/OP	"$49,812.50 "	"$36,861.25"	$0.00	"$39,850.00"	"$22,415.63"	"$22,415.63"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$10,380.93"	$0.00	"$24,557.56"	"$24,557.56"	$0.00	"$24,906.25"	"$39,451.50"	"$39,850.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$7,930.15"	$0.00	$0.00	$0.00	$0.00	$0.00
MAXIIVREMEM	SUP	HCPCS C1882		MAXIIVREMEM  -  MAXIMO II VR SYSTEM	BOTH IP/OP	"$43,750.00 "	"$32,375.00"	$0.00	"$35,000.00"	"$19,687.50"	"$19,687.50"	$0.00	$0.00	$0.00	"$9,118.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,117.50"	$0.00	"$21,568.75"	"$21,568.75"	$0.00	"$21,875.00"	"$34,650.00"	"$35,000.00"	$0.00		$0.00	"$6,846.88"	$0.00	$0.00	"$6,965.00"	$0.00	$0.00	$0.00	$0.00	$0.00
MAX-N	SUP	Custom 27203010		SENSOR NEO 18IN OXM ADH SPO2	BOTH IP/OP	$30.80 	$22.79	$0.00	$24.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.40	$24.39	$24.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MAX-P	SUP	Custom 27203010		SENSOR PED OXMX OXM ADH STRAP CBL LF DISP 18IN	BOTH IP/OP	$34.93 	$25.85	$0.00	$27.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.46	$27.66	$27.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MAXR	SUP	Custom 27203010		CABLE SENSOR PULSE OXIMETRY DISPOSABLE ADULT NASAL 18IN  F/O	BOTH IP/OP	$30.80 	$22.79	$0.00	$24.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.40	$24.39	$24.64	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MAXX-1915	SUP	HCPCS C1874		MAXX-1915  -  STENT ESPH 19MM 24FR 150MM 90CM ENDOMAXX OTW FLLY COVERED	BOTH IP/OP	"$7,000.00 "	"$5,180.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,458.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,458.80"	$0.00	"$3,451.00"	"$3,451.00"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
MAXX-197	SUP	HCPCS C1874		MAXX-197  -  STENT ESPH 19MM 24MM 70MM ENDOMAXX FLLY COVERED	BOTH IP/OP	"$7,000.00 "	"$5,180.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,458.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,458.80"	$0.00	"$3,451.00"	"$3,451.00"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
MAXX-2310	SUP	HCPCS C1874		MAXX-2310  -  STENT ESOPHAGEAL 23MM 24FR 90CM 100CM FULLY COVERED OTW LP	BOTH IP/OP	"$7,000.00 "	"$5,180.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,458.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,458.80"	$0.00	"$3,451.00"	"$3,451.00"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
MAXX-237	SUP	HCPCS C1874		MAXX-237  -  STENT ESPH 28MM 23MM 24FR 70MM 90CM ENDOMAXX OTW FLLY CVR	BOTH IP/OP	"$7,000.00 "	"$5,180.00"	$0.00	"$4,600.00"	"$2,587.50"	"$2,587.50"	$0.00	$0.00	$0.00	"$1,458.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,458.80"	$0.00	"$3,451.00"	"$3,451.00"	$0.00	"$2,875.00"	"$4,554.00"	"$4,600.00"	$0.00		$0.00	$899.88	$0.00	$0.00	$915.40	$0.00	$0.00	$0.00	$0.00	$0.00
MB3555	SUP	HCPCS C1713		MB3555  -  DISC INTVRTB 15MM 15X5MM STRL MOBI-C FLT SPHRCL PLT MBL INS	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
MB3556	SUP	HCPCS C1713		MB3556  -  DISC INTVRTB 15MM 15X6MM STRL MOBI-C FLT SPHRCL PLT MBL INS	BOTH IP/OP	"$13,750.00 "	"$10,175.00"	$0.00	"$11,000.00"	"$6,187.50"	"$6,187.50"	$0.00	$0.00	$0.00	"$2,865.84"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,865.50"	$0.00	"$6,778.75"	"$6,778.75"	$0.00	"$6,875.00"	"$10,890.00"	"$11,000.00"	$0.00		$0.00	"$2,151.88"	$0.00	$0.00	"$2,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00
MB3575	SUP	HCPCS C1713		MB3575  -  DISC INTVRTB 15MM 17X5MM STRL MOBI-C FLT SPHRCL PLT MBL INS	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
MB3595	SUP	HCPCS C1713		MB3595  -  DISC INTVRTB 15MM 19X5MM STRL MOBI-C FLT SPHRCL PLT MBL INS	BOTH IP/OP	"$11,250.00 "	"$8,325.00"	$0.00	"$9,000.00"	"$5,062.50"	"$5,062.50"	$0.00	$0.00	$0.00	"$2,344.78"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,344.50"	$0.00	"$5,546.25"	"$5,546.25"	$0.00	"$5,625.00"	"$8,910.00"	"$9,000.00"	$0.00		$0.00	"$1,760.63"	$0.00	$0.00	"$1,791.00"	$0.00	$0.00	$0.00	$0.00	$0.00
MB46G	SUP	Custom 27203010		MB46G  -  SUTURE NONABSORBABLE 5 V-40 30IN 4 STRAND BRAID ETHIBOND	BOTH IP/OP	$45.35 	$33.56	$0.00	$36.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.66	$33.66	$0.00	$0.00	$9.45	$0.00	$0.00	$0.00	$0.00	$23.02	$36.46	$36.83	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MC*PE28131YB	SUP	HCPCS C1725		MC*PE28131YB  -  CATH INTVN .021IN 2.8FR .027IN 130CM MCTH HYDPHI PROGREAT	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,080.00"	$705.90	$705.90	$0.00	$0.00	$0.00	$291.80	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$828.10	$828.10	$0.00	$675.00	"$1,069.20"	"$1,080.00"	$0.00		$0.00	$211.28	$0.00	$0.00	$214.92	$0.00	$0.00	$0.00	$0.00	$0.00
MC011502	SUP	HCPCS C1751		MC011502  -  CATHETER TRIPLE LUMEN  SIZE 20	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
MC011503	SUP	HCPCS C1751		MC011503  -  CATHETER CV 24CM 3 LUM	BOTH IP/OP	$287.50 	$212.75	$0.00	$230.00	$129.38	$129.38	$0.00	$0.00	$0.00	$59.92	$213.38	$213.38	$0.00	$0.00	$59.92	$0.00	$170.06	$170.06	$0.00	$143.75	$227.70	$230.00	$0.00		$0.00	$44.99	$0.00	$0.00	$45.77	$0.00	$0.00	$0.00	$0.00	$0.00
MC011505	SUP	HCPCS C1750		MC011505  -  SET CATH 15.5FR 32CM 3 LUM BSC GW DIL SCPL HMDIAL	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
MC061402	SUP	HCPCS C1752		MC061402  -  SET CATH 14FR 15CM SLX 2 LUM BSC INTRO NDL GW DIL	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MC061404	SUP	HCPCS C1752		MC061404  -  SET CATH 14FR 24CM SLX 2 LUM BSC INTRO NDL GW DIL	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MC061405	SUP	HCPCS C1751		MC061405  -  SET CATH 14FR 30CM SLX 2 LUM BSC STY INTRO NDL DIL	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
MC-125	SUP	Custom 27203010		FILTER BCTR/VIR DISP	BOTH IP/OP	$6.20 	$4.59	$0.00	$4.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.10	$4.91	$4.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MC172150SX	SUP	HCPCS C1725		MC172150SX  -  CATHETER BLNOCC MIC STRG 2.4-1.7FR .017IN 150CM HEADWAY SMTH	BOTH IP/OP	"$1,911.55 "	"$1,414.55"	$0.00	"$1,529.24"	"$1,037.97"	"$1,037.97"	$0.00	$0.00	$0.00	$398.41	"$1,418.75"	"$1,418.75"	$0.00	$0.00	$398.37	$0.00	"$1,130.68"	"$1,130.68"	$0.00	$955.78	"$1,513.95"	"$1,529.24"	$0.00		$0.00	$299.16	$0.00	$0.00	$304.32	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.100	SUP	HCPCS V2632		MC40BD.100  -  LENS IOL 5 D +10 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.105	SUP	HCPCS V2632		MC40BD.105  -  LENS IOL 5 D +10.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.110	SUP	HCPCS V2632		MC40BD.110  -  LENS IOL 5 D +11 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.115	SUP	HCPCS V2632		MC40BD.115  -  LENS IOL 5 D +11.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.120	SUP	HCPCS V2632		MC40BD.120  -  LENS IOL 5 D +12 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.125	SUP	HCPCS V2632		MC40BD.125  -  LENS IOL 5 D +12.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.130	SUP	HCPCS V2632		MC40BD.130  -  LENS IOL 5 D +13 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.135	SUP	HCPCS V2632		MC40BD.135  -  LENS IOL 5 D +13.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.140	SUP	HCPCS V2632		MC40BD.140  -  LENS IOL 5 D +14 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.145	SUP	HCPCS V2632		MC40BD.145  -  LENS IOL 5 D +14.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.150	SUP	HCPCS V2632		MC40BD.150  -  LENS IOL 5 D +15 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.155	SUP	HCPCS V2632		MC40BD.155  -  LENS IOL 5 D +15.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.160	SUP	HCPCS V2632		MC40BD.160  -  LENS IOL 5 D +16 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.165	SUP	HCPCS V2632		MC40BD.165  -  LENS IOL 5 D +16.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.170	SUP	HCPCS V2632		MC40BD.170  -  LENS IOL 5 D +17 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.175	SUP	HCPCS V2632		MC40BD.175  -  LENS IOL 5 D +17.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.180	SUP	HCPCS V2632		MC40BD.180  -  LENS IOL 5 D +18 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.185	SUP	HCPCS V2632		MC40BD.185  -  LENS IOL 5 D +18.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.190	SUP	HCPCS V2632		MC40BD.190  -  LENS IOL 5 D +19 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.195	SUP	HCPCS V2632		MC40BD.195  -  LENS IOL 5 D +19.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.200	SUP	HCPCS V2632		MC40BD.200  -  LENS IOL 5 D +20 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.205	SUP	HCPCS V2632		MC40BD.205  -  LENS IOL 5 D +20.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.210	SUP	HCPCS V2632		MC40BD.210  -  LENS IOL 5 D +21 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.215	SUP	HCPCS V2632		MC40BD.215  -  LENS IOL 5 D +21.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.220	SUP	HCPCS V2632		MC40BD.220  -  LENS IOL 5 D +22 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.225	SUP	HCPCS V2632		MC40BD.225  -  LENS IOL 5 D +22.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.230	SUP	HCPCS V2632		MC40BD.230  -  LENS IOL 5 D +23 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.235	SUP	HCPCS V2632		MC40BD.235  -  LENS IOL 5 D +23.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.240	SUP	HCPCS V2632		MC40BD.240  -  LENS IOL 5 D +24 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.245	SUP	HCPCS V2632		MC40BD.245  -  LENS IOL 5 D +24.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.250	SUP	HCPCS V2632		MC40BD.250  -  LENS IOL 5 D +25 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.255	SUP	HCPCS V2632		MC40BD.255  -  LENS IOL 5 D +25.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.260	SUP	HCPCS V2632		MC40BD.260  -  LENS IOL 5 D +26 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.265	SUP	HCPCS V2632		MC40BD.265  -  LENS IOL 5 D +26.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.270	SUP	HCPCS V2632		MC40BD.270  -  LENS IOL 5 D +27 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.275	SUP	HCPCS V2632		MC40BD.275  -  LENS IOL 5 D +27.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.280	SUP	HCPCS V2632		MC40BD.280  -  LENS IOL 5 D +28 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.285	SUP	HCPCS V2632		MC40BD.285  -  LENS IOL 5 D +28.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.290	SUP	HCPCS V2632		MC40BD.290  -  LENS IOL 5 D +29 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.295	SUP	HCPCS V2632		MC40BD.295  -  LENS IOL 5 D +29.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC40BD.300	SUP	HCPCS V2632		MC40BD.300  -  LENS IOL 5 D +30 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD	SUP	HCPCS V2632		MC50BD  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.100	SUP	HCPCS V2632		MC50BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.110	SUP	HCPCS V2632		MC50BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.120	SUP	HCPCS V2632		MC50BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.130	SUP	HCPCS V2632		MC50BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.140	SUP	HCPCS V2632		MC50BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.150	SUP	HCPCS V2632		MC50BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.160	SUP	HCPCS V2632		MC50BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.170	SUP	HCPCS V2632		MC50BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.180	SUP	HCPCS V2632		MC50BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.190	SUP	HCPCS V2632		MC50BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.200	SUP	HCPCS V2632		MC50BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.210	SUP	HCPCS V2632		MC50BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.220	SUP	HCPCS V2632		MC50BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.230	SUP	HCPCS V2632		MC50BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.240	SUP	HCPCS V2632		MC50BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.250	SUP	HCPCS V2632		MC50BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.260	SUP	HCPCS V2632		MC50BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.270	SUP	HCPCS V2632		MC50BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.280	SUP	HCPCS V2632		MC50BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.285	SUP	HCPCS V2632		MC50BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.290	SUP	HCPCS V2632		MC50BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC50BD.295	SUP	HCPCS V2632		MC50BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD	SUP	HCPCS V2632		MC60BD  -  LENS IOL 5D BCNVX 6MM 13.5MM STRL SLANT 1 PC UV ABS PMMA PC	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.100	SUP	HCPCS V2632		MC60BD.100  -  LENS IOL 5 D +10 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.105	SUP	HCPCS V2632		MC60BD.105  -  LENS IOL 5 D +10.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.110	SUP	HCPCS V2632		MC60BD.110  -  LENS IOL 5 D +11 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.115	SUP	HCPCS V2632		MC60BD.115  -  LENS IOL 5 D +11.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.120	SUP	HCPCS V2632		MC60BD.120  -  LENS IOL 5 D +12 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.125	SUP	HCPCS V2632		MC60BD.125  -  LENS IOL 5 D +12.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.130	SUP	HCPCS V2632		MC60BD.130  -  LENS IOL 5 D +13 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.135	SUP	HCPCS V2632		MC60BD.135  -  LENS IOL 5 D +13.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.140	SUP	HCPCS V2632		MC60BD.140  -  LENS IOL 5 D +14 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.145	SUP	HCPCS V2632		MC60BD.145  -  LENS IOL 5 D +14.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.150	SUP	HCPCS V2632		MC60BD.150  -  LENS IOL 5 D +15 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.155	SUP	HCPCS V2632		MC60BD.155  -  LENS IOL 5 D +15.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.160	SUP	HCPCS V2632		MC60BD.160  -  LENS IOL 5 D +16 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.165	SUP	HCPCS V2632		MC60BD.165  -  LENS IOL 5 D +16.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.170	SUP	HCPCS V2632		MC60BD.170  -  LENS IOL 5 D +17 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.175	SUP	HCPCS V2632		MC60BD.175  -  LENS IOL 5 D +17.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.180	SUP	HCPCS V2632		MC60BD.180  -  LENS IOL 5 D +18 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.185	SUP	HCPCS V2632		MC60BD.185  -  LENS IOL 5 D +18.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.190	SUP	HCPCS V2632		MC60BD.190  -  LENS IOL 5 D +19 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.195	SUP	HCPCS V2632		MC60BD.195  -  LENS IOL 5 D +19.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.200	SUP	HCPCS V2632		MC60BD.200  -  LENS IOL 5 D +20 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.205	SUP	HCPCS V2632		MC60BD.205  -  LENS IOL 5 D +20.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.210	SUP	HCPCS V2632		MC60BD.210  -  LENS IOL 5 D +21 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.215	SUP	HCPCS V2632		MC60BD.215  -  LENS IOL 5 D +21.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.220	SUP	HCPCS V2632		MC60BD.220  -  LENS IOL 5 D +22 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.225	SUP	HCPCS V2632		MC60BD.225  -  LENS IOL 5 D +22.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.230	SUP	HCPCS V2632		MC60BD.230  -  LENS IOL 5 D +23 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.235	SUP	HCPCS V2632		MC60BD.235  -  LENS IOL 5 D +23.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.240	SUP	HCPCS V2632		MC60BD.240  -  LENS IOL 5 D +24 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.245	SUP	HCPCS V2632		MC60BD.245  -  LENS IOL 5 D +24.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.250	SUP	HCPCS V2632		MC60BD.250  -  LENS IOL 5 D +25 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.255	SUP	HCPCS V2632		MC60BD.255  -  LENS IOL 5 D +25.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.260	SUP	HCPCS V2632		MC60BD.260  -  LENS IOL 5 D +26 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.265	SUP	HCPCS V2632		MC60BD.265  -  LENS IOL 5 D +26.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.270	SUP	HCPCS V2632		MC60BD.270  -  LENS IOL 5 D +27 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.275	SUP	HCPCS V2632		MC60BD.275  -  LENS IOL 5 D +27.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.280	SUP	HCPCS V2632		MC60BD.280  -  LENS IOL 5 D +28 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.285	SUP	HCPCS V2632		MC60BD.285  -  LENS IOL 5 D +28.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.290	SUP	HCPCS V2632		MC60BD.290  -  LENS IOL 5 D +29 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.295	SUP	HCPCS V2632		MC60BD.295  -  LENS IOL 5 D +29.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MC60BD.300	SUP	HCPCS V2632		MC60BD.300  -  LENS IOL 5 D +30 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MCEN133	SUP	Custom 27203010		ELEVATOR SURG 11CM 2MM 2.5MM WORMALD BLNT SCT MLBL FRNTL SIN	BOTH IP/OP	"$1,332.50 "	$986.05	$0.00	"$1,066.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$666.25	"$1,055.34"	"$1,066.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MCPE28131YB	SUP	HCPCS C1725		MCPE28131YB  -  CATHETER INTERVENTIONAL MICRO 2.8FR .027IN 130CM MARKER BAND	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,040.00"	$705.90	$705.90	$0.00	$0.00	$0.00	$291.80	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$828.10	$828.10	$0.00	$650.00	"$1,029.60"	"$1,040.00"	$0.00		$0.00	$203.45	$0.00	$0.00	$206.96	$0.00	$0.00	$0.00	$0.00	$0.00
MCR-0007	SUP	Custom 27203010		MCR-0007  -  RETRACTOR SRG STRL MST CPSL RTRCTR	BOTH IP/OP	$283.33 	$209.66	$0.00	$226.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.29	$210.29	$0.00	$0.00	$59.05	$0.00	$0.00	$0.00	$0.00	$141.67	$224.40	$226.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MCSK3	SUP	Custom 27203010		HOOK 152MM RTRCT VRT MLBL KNDY	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MCSK5	SUP	Custom 27203010		TIP SCT MCFR KN 6FR MLBL	BOTH IP/OP	$380.00 	$281.20	$0.00	$304.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$190.00	$300.96	$304.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MD800F	SUP	HCPCS C1880		MD800F  -  FILTER CARDIO MRDN VC FEM DLV KIT	BOTH IP/OP	"$4,151.00 "	"$3,071.74"	$0.00	"$3,320.80"	"$1,867.95"	"$1,867.95"	$0.00	$0.00	$0.00	$865.17	"$3,080.87"	"$3,080.87"	$0.00	$0.00	$865.07	$0.00	"$2,046.44"	"$2,046.44"	$0.00	"$2,075.50"	"$3,287.59"	"$3,320.80"	$0.00		$0.00	$649.63	$0.00	$0.00	$660.84	$0.00	$0.00	$0.00	$0.00	$0.00
MD800J	SUP	HCPCS C1880		MD800J  -  FILTER CARDIO MRDN VC JUG DLV KIT	BOTH IP/OP	"$4,151.00 "	"$3,071.74"	$0.00	"$3,320.80"	"$1,867.95"	"$1,867.95"	$0.00	$0.00	$0.00	$865.17	"$3,080.87"	"$3,080.87"	$0.00	$0.00	$865.07	$0.00	"$2,046.44"	"$2,046.44"	$0.00	"$2,075.50"	"$3,287.59"	"$3,320.80"	$0.00		$0.00	$649.63	$0.00	$0.00	$660.84	$0.00	$0.00	$0.00	$0.00	$0.00
MDRT4101	SUP	HCPCS Q4105		MDRT4101  -  GRAFT SKIN 10X4IN MESHED DERMAL REGENERATION TEMPLATE BOVINE	BOTH IP/OP	"$17,768.95 "	"$13,149.02"	$0.00	"$16,153.60"	"$9,086.40"	"$9,086.40"	$0.00	$0.00	$0.00	"$3,703.49"	"$13,188.11"	"$13,188.11"	$0.00	$0.00	$25.37	$0.00	"$8,760.09"	"$8,760.09"	$0.00	"$10,096.00"	"$15,992.06"	"$16,153.60"	$0.00		$0.00	$24.15	$0.00	$0.00	"$3,214.57"	$0.00	$0.00	$0.00	$0.00	$0.00
MDRT8101	SUP	HCPCS Q4105		MDRT8101  -  GRAFT SKIN 25X20CM MESH DERMAL REGENERATION TEMPLATE	BOTH IP/OP	"$28,137.80 "	"$20,821.97"	$0.00	"$25,579.82"	"$14,388.65"	"$14,388.65"	$0.00	$0.00	$0.00	"$5,864.62"	"$20,883.88"	"$20,883.88"	$0.00	$0.00	$25.37	$0.00	"$13,871.94"	"$13,871.94"	$0.00	"$15,987.39"	"$25,324.03"	"$25,579.82"	$0.00		$0.00	$24.15	$0.00	$0.00	"$5,090.38"	$0.00	$0.00	$0.00	$0.00	$0.00
MH443	SUP	Custom 27011340		MH443  -  VALVE SCT RED BTN EVIS 140 VID IMG SYS STRL DISP	BOTH IP/OP	$183.78 	$136.00	$0.00	$147.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.40	$136.40	$0.00	$0.00	$38.30	$0.00	$0.00	$0.00	$0.00	$91.89	$145.55	$147.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MHC1434	SUP	Custom 27203010		RETAINER TBGRP E 10MR NTR DRSG	BOTH IP/OP	$93.33 	$69.06	$0.00	$74.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.66	$73.92	$74.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MHC1439	SUP	Custom 27203010		RETAINER TBGRP G 10MR NTR DRSG STRL	BOTH IP/OP	$117.60 	$87.02	$0.00	$94.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.80	$93.14	$94.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MIS-7F11	SUP	HCPCS C1894		MIS-7F11  -  SET INTROD .018IN MICRO STR 7FR 21GA 11CM 2.75IN 1 END GWIRE	BOTH IP/OP	$152.50 	$112.85	$0.00	$122.00	$82.81	$82.81	$0.00	$0.00	$0.00	$31.78	$113.19	$113.19	$0.00	$0.00	$31.78	$0.00	$90.20	$90.20	$0.00	$76.25	$120.78	$122.00	$0.00		$0.00	$23.87	$0.00	$0.00	$24.28	$0.00	$0.00	$0.00	$0.00	$0.00
MMSLED-42	SUP	HCPCS C1713		MMSLED-42  -  WIRE FIX 42MM SLED MEDIAL MALLEOLAR	BOTH IP/OP	"$1,887.50 "	"$1,396.75"	$0.00	"$1,510.00"	$849.38	$849.38	$0.00	$0.00	$0.00	$393.40	"$1,400.90"	"$1,400.90"	$0.00	$0.00	$393.36	$0.00	"$1,116.46"	"$1,116.46"	$0.00	$943.75	"$1,494.90"	"$1,510.00"	$0.00		$0.00	$295.39	$0.00	$0.00	$300.49	$0.00	$0.00	$0.00	$0.00	$0.00
MMSLEDW	SUP	HCPCS C1713		MMSLEDW  -  WASHER ORTHOPEDIC SLED MEDIAL MALLEOLAR	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$185.63	$185.63	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.060	SUP	HCPCS V2632		MN60AC.060  -  LENS IOL 10 D +6 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.065	SUP	HCPCS V2632		MN60AC.065  -  LENS IOL 10 D +6.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.075	SUP	HCPCS V2632		MN60AC.075  -  LENS IOL 10 D +7.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.085	SUP	HCPCS V2632		MN60AC.085  -  LENS IOL 10 D +8.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.095	SUP	HCPCS V2632		MN60AC.095  -  LENS IOL 10 D +9.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.100	SUP	HCPCS V2632		MN60AC.100  -  LENS IOL 10 D +10 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.105	SUP	HCPCS V2632		MN60AC.105  -  LENS IOL 10 D +10.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.110	SUP	HCPCS V2632		MN60AC.110  -  LENS IOL 10 D +11 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.115	SUP	HCPCS V2632		MN60AC.115  -  LENS IOL 10 D +11.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.120	SUP	HCPCS V2632		MN60AC.120  -  LENS IOL 10 D +12 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.125	SUP	HCPCS V2632		MN60AC.125  -  LENS IOL 10 D +12.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.130	SUP	HCPCS V2632		MN60AC.130  -  LENS IOL 10 D +13 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.135	SUP	HCPCS V2632		MN60AC.135  -  LENS IOL 10 D +13.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.140	SUP	HCPCS V2632		MN60AC.140  -  LENS IOL 10 D +14 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.145	SUP	HCPCS V2632		MN60AC.145  -  LENS IOL 10 D +14.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.150	SUP	HCPCS V2632		MN60AC.150  -  LENS IOL 10 D +15 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.155	SUP	HCPCS V2632		MN60AC.155  -  LENS IOL 10 D +15.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.160	SUP	HCPCS V2632		MN60AC.160  -  LENS IOL 10 D +16 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.165	SUP	HCPCS V2632		MN60AC.165  -  LENS IOL 10 D +16.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.170	SUP	HCPCS V2632		MN60AC.170  -  LENS IOL 10 D +17 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.175	SUP	HCPCS V2632		MN60AC.175  -  LENS IOL 10 D +17.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.180	SUP	HCPCS V2632		MN60AC.180  -  LENS IOL 10 D +18 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.185	SUP	HCPCS V2632		MN60AC.185  -  LENS IOL 10 D +18.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.190	SUP	HCPCS V2632		MN60AC.190  -  LENS IOL 10 D +19 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.195	SUP	HCPCS V2632		MN60AC.195  -  LENS IOL 10 D +19.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.200	SUP	HCPCS V2632		MN60AC.200  -  LENS IOL 10 D +20 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.205	SUP	HCPCS V2632		MN60AC.205  -  LENS IOL 10 D +20.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.210	SUP	HCPCS V2632		MN60AC.210  -  LENS IOL 10 D +21 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.215	SUP	HCPCS V2632		MN60AC.215  -  LENS IOL 10 D +21.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.220	SUP	HCPCS V2632		MN60AC.220  -  LENS IOL 10 D +22 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.225	SUP	HCPCS V2632		MN60AC.225  -  LENS IOL 10 D +22.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.230	SUP	HCPCS V2632		MN60AC.230  -  LENS IOL 10 D +23 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.235	SUP	HCPCS V2632		MN60AC.235  -  LENS IOL 10 D +23.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.240	SUP	HCPCS V2632		MN60AC.240  -  LENS IOL 10 D +24 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.245	SUP	HCPCS V2632		MN60AC.245  -  LENS IOL 10 D +24.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.250	SUP	HCPCS V2632		MN60AC.250  -  LENS IOL 10 D +25 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.255	SUP	HCPCS V2632		MN60AC.255  -  LENS IOL 10 D +25.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.260	SUP	HCPCS V2632		MN60AC.260  -  LENS IOL 10 D +26 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.265	SUP	HCPCS V2632		MN60AC.265  -  LENS IOL 10 D +26.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.270	SUP	HCPCS V2632		MN60AC.270  -  LENS IOL 10 D +27 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.275	SUP	HCPCS V2632		MN60AC.275  -  LENS IOL 10 D +27.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.280	SUP	HCPCS V2632		MN60AC.280  -  LENS IOL 10 D +28 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.285	SUP	HCPCS V2632		MN60AC.285  -  LENS IOL 10 D +28.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.290	SUP	HCPCS V2632		MN60AC.290  -  LENS IOL 10 D +29 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.295	SUP	HCPCS V2632		MN60AC.295  -  LENS IOL 10 D +29.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60AC.300	SUP	HCPCS V2632		MN60AC.300  -  LENS IOL 10 D +30 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60MA.000	SUP	HCPCS V2632		MN60MA.000  -  LENS IOL 5 D +0 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60MA.010	SUP	HCPCS V2632		MN60MA.010  -  LENS IOL 5 D +1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60MA.030	SUP	HCPCS V2632		MN60MA.030  -  LENS IOL 5 D +30 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60MA.040	SUP	HCPCS V2632		MN60MA.040  -  LENS IOL 5 D +4 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60MA.050	SUP	HCPCS V2632		MN60MA.050  -  LENS IOL 5 D +5 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60MAN010	SUP	HCPCS V2632		MN60MAN010  -  LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60MAN020	SUP	HCPCS V2632		MN60MAN020  -  LENS IOL 5 D -2 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60MAN030	SUP	HCPCS V2632		MN60MAN030  -  LENS IOL 5 D -3 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60MAN040	SUP	HCPCS V2632		MN60MAN040  -  LENS IOL 5 D -4 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MN60MAN050	SUP	HCPCS V2632		MN60MAN050  -  LENS IOL 5 D -5 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
MPIS-501-NT-SST	SUP	HCPCS C1894		MPIS-501-NT-SST  -  SET INTROD 40CM 5FR MPNCH .018IN NTNL GWIRE 10CM VLNK STRL	BOTH IP/OP	$47.50 	$35.15	$0.00	$38.00	$25.79	$25.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.75	$37.62	$38.00	$0.00		$0.00	$7.43	$0.00	$0.00	$7.56	$0.00	$0.00	$0.00	$0.00	$0.00
MPQ-2.5	SUP	HCPCS L8603		MPQ-2.5  -  AGENT BULKING MACROPLASTIQUE SILICONE ELASTOMER 2.5 ML	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MR17035101	SUP	HCPCS C1751		MR17035101  -  SET CATHETER 5FR 60CM 1 LUMEN PICC BASIC GWIRE INTROD NEEDLE	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
MR17035201	SUP	HCPCS C1751		MR17035201  -  SET CATHETER 5FR 55CM PICC 2 LUMEN BASIC GWIRE INTROD NEEDLE	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
MRCT15004M	SUP	HCPCS C1750		MRCT15004M  -  5F MINI ATTACHABLE CATHETER	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
MRDP50ASN	SUP	HCPCS C1750		MRDP50ASN  -  5F MINI ATTACHABLE CATHETER	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
MRDP66AMN	SUP	HCPCS C1788		MRDP66AMN  -  6.6F DIGNITY PORT	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
MRN-420	SUP	HCPCS L8606		MRN-420  -  NEEDLE ESCP 3.8FR MACROPLASTIQUE URTH	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$0.00	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MRPP80AFS	SUP	HCPCS C1751		MRPP80AFS  -  CATHETER CENTRAL VENOUS PRO-FUSE TRINIFLEX OD8 FR ATTACHABLE	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$225.00	$225.00	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
MS DC5020	SUP	Custom 27203010		MS DC5020  -  BIT DRILL 5IN 2MM QRLSE STRL	BOTH IP/OP	$66.30 	$49.06	$0.00	$53.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.21	$49.21	$0.00	$0.00	$13.82	$0.00	$0.00	$0.00	$0.00	$33.15	$52.51	$53.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS03	SUP	Custom 27203010		MS03  -  STOCKINETTE CAST 25YDX3IN WATER REPELLENT 3M SYNTH	BOTH IP/OP	$24.00 	$17.76	$0.00	$42.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.81	$17.81	$0.00	$0.00	$5.00	$0.00	$0.00	$0.00	$0.00	$13.68	$42.49	$21.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-1106ST	SUP	HCPCS C1769		MS-1106ST  -  WIRE FIX .045IN KWIRE	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$3.65	$12.99	$12.99	$0.00	$0.00	$3.65	$0.00	$10.35	$10.35	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
MS-2213	SUP	Custom 27203010		MS-2213  -  TIP SCRDRVR CRCIFRM	BOTH IP/OP	$470.00 	$347.80	$0.00	$376.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.83	$348.83	$0.00	$0.00	$97.95	$0.00	$0.00	$0.00	$0.00	$235.00	$372.24	$376.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MSC9023Z	SUP	HCPCS A6196		MSC9023Z  -  DRESSING GRMCDL 3.125X2.375IN LF ARGLS ANMC FLM TRNS IONIC	BOTH IP/OP	$26.69 	$19.75	$0.00	$21.35	$14.49	$14.49	$0.00	$0.00	$0.00	$0.00	$19.81	$19.81	$0.00	$0.00	$5.56	$0.00	$0.00	$0.00	$0.00	$13.35	$21.14	$21.35	$0.00		$0.00	$4.18	$0.00	$0.00	$4.25	$0.00	$0.00	$0.00	$0.00	$0.00
MSC97310	SUP	Custom 27203010		MSC97310  -  DRESSING FOAM 10X3.5IN GENTLE POSTOPERATIVE STRIP	BOTH IP/OP	$58.60 	$43.36	$0.00	$46.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.49	$43.49	$0.00	$0.00	$12.21	$0.00	$0.00	$0.00	$0.00	$29.30	$46.41	$46.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MSC9736	SUP	Custom 27203010		MSC9736  -  DRESSING FOAM 6X3.5IN 7 DAY ADHESIVE ANTIMICROBIAL FLEXIBLE	BOTH IP/OP	$45.48 	$33.66	$0.00	$50.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.75	$33.75	$0.00	$0.00	$9.48	$0.00	$0.00	$0.00	$0.00	$22.74	$50.59	$36.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-CT21	SUP	Custom 27203010		MS-CT21  -  TAP 2.1MM SURG	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$0.00	$0.00	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-CT27	SUP	Custom 27203010		MS-CT27  -  TAP 2.7MM SURG	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$0.00	$0.00	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-CTL21	SUP	Custom 27100030		MS-CTL21  -  TAP 2.7MM LNG BONE TIP SURG ELB ACUMED	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-CTL27	SUP	Custom 27100030		MS-CTL27  -  TAP 2.7MM LNG BONE TIP SURG ELB ACUMED	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$0.00	$0.00	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-D761	SUP	Custom 27203010		MS-D761  -  BIT DRL 6.1MM	BOTH IP/OP	$215.00 	$159.10	$0.00	$172.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.57	$159.57	$0.00	$0.00	$44.81	$0.00	$0.00	$0.00	$0.00	$107.50	$170.28	$172.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-DC15	SUP	Custom 27203010		MS-DC15  -  BIT DRL 1.5MM	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MSDC-20	SUP	Custom 27203010		MSDC-20  -  BIT DRILL 5IN 2MM LNG QRLSE STRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-DC28	SUP	Custom 27203010		MS-DC28  -  DRILL SRG 2.8MM 5IN QRLSE	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MSDC-35	SUP	Custom 27203010		MSDC-35  -  BIT DRILL 5IN 3.5MM ACTRK2 ORTH QRLSE STRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-DC35	SUP	Custom 27203010		MS-DC35  -  DRILL SRG 3.5MM 5IN QRLSE	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MSDC-5020	SUP	Custom 27203010		BIT DRILL 5IN 2MM QRLSE STRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-DC5020	SUP	Custom 27203010		MS-DC5020  -  DRILL SRG 2MM 5IN QRLSE	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MSDCL15	SUP	Custom 27203010		DRILL SURG QRLSE 1.5MM	BOTH IP/OP	$95.00 	$70.30	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.50	$75.24	$76.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MSDCL20	SUP	Custom 27203010		BIT DRILL 2MM RADL ELB	BOTH IP/OP	$80.00 	$59.20	$0.00	$64.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.00	$63.36	$64.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-DCL28	SUP	Custom 27203010		MS-DCL28  -  BIT DRILL 2-8MM 2.8MM LNG QRLSE STRL	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-DCR20	SUP	Custom 27203010		MS-DCR20  -  BIT DRILL 5IN 2MM QRLSE STRL	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-DCSB32	SUP	Custom 27203010		MS-DCSB32  -  DRILL SURG SURGIBIT 3.2MM NONSTRL	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-DG23	SUP	Custom 27203010		MS-DG23  -  GUIDE 2MM DRILL DEPTH GA SURG	BOTH IP/OP	$842.50 	$623.45	$0.00	$674.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.30	$625.30	$0.00	$0.00	$175.58	$0.00	$0.00	$0.00	$0.00	$421.25	$667.26	$674.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-DG28	SUP	Custom 27203010		MS-DG28  -  GUIDE DRILL 2.8MM ASMBLY NONSTRL	BOTH IP/OP	$890.00 	$658.60	$0.00	$712.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$660.56	$660.56	$0.00	$0.00	$185.48	$0.00	$0.00	$0.00	$0.00	$445.00	$704.88	$712.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-DG40	SUP	Custom 27203010		MS-DG40  -  GUIDE DRILL 4MM ASMBLY NONSTRL	BOTH IP/OP	$925.00 	$684.50	$0.00	$740.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$686.54	$686.54	$0.00	$0.00	$192.77	$0.00	$0.00	$0.00	$0.00	$462.50	$732.60	$740.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-DG46	SUP	Custom 27203010		MS-DG46  -  GUIDE DRILL 4.6MM ASMBLY NONSTRL	BOTH IP/OP	"$1,185.00 "	$876.90	$0.00	$948.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$879.51	$879.51	$0.00	$0.00	$246.95	$0.00	$0.00	$0.00	$0.00	$592.50	$938.52	$948.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-DS2835	SUP	Custom 27203010		MS-DS2835  -  SLEEVE DRILL 2.8/3.5MM LAG SCR	BOTH IP/OP	$277.50 	$205.35	$0.00	$222.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.96	$205.96	$0.00	$0.00	$57.83	$0.00	$0.00	$0.00	$0.00	$138.75	$219.78	$222.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-LDC20	SUP	Custom 27203010		MS-LDC20  -  DRILL SRG LNG 2MM QRLSE	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MSLDC28	SUP	Custom 27203010		BIT DRILL 2.8MM LNG QC STRL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-LDC28	SUP	Custom 27203010		MS-LDC28  -  DRILL SRG LNG 2.8MM QRLSE	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-LTT27	SUP	Custom 27203010		MS-LTT27  -  DRILL SRG LNG 2.7MM TPR	BOTH IP/OP	$565.00 	$418.10	$0.00	$452.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$419.34	$419.34	$0.00	$0.00	$117.75	$0.00	$0.00	$0.00	$0.00	$282.50	$447.48	$452.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MSLTT35	SUP	HCPCS C1713		MSLTT35  -  SCREW BONE 3.5MM ORTH TPR	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$84.38	$84.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
MS-LTT35	SUP	HCPCS C1713		MS-LTT35  -  SCREW BONE 2.7MM 35MM LNG CORT LNG TAP QCK CPLR NONSTRL 3.5	BOTH IP/OP	$565.00 	$418.10	$0.00	$452.00	$254.25	$254.25	$0.00	$0.00	$0.00	$117.76	$419.34	$419.34	$0.00	$0.00	$117.75	$0.00	$334.20	$334.20	$0.00	$282.50	$447.48	$452.00	$0.00		$0.00	$88.42	$0.00	$0.00	$89.95	$0.00	$0.00	$0.00	$0.00	$0.00
MS-PH28	SUP	Custom 27203010		MS-PH28  -  BIT DRL 2.8MM	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-PH40	SUP	Custom 27203010		MS-PH40  -  BIT DRL 4MM CANC	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-PH46	SUP	Custom 27203010		MS-PH46  -  DRILL SURG 4.6MM CANC CANC SCR STRL	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-PHBCD	SUP	Custom 27203010		MS-PHBCD  -  BIT DRILL CLRNC	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-PIN20	SUP	Custom 27203010		MS-PIN20  -  PIN FIX 2MM STNM QCK CPLR	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-PIN28	SUP	Custom 27203010		MS-PIN28  -  PIN DRILL 2.8MM LNG HUM ELB QRLSE DRILL GUIDE CLMP NONSTRL	BOTH IP/OP	$202.50 	$149.85	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.30	$150.30	$0.00	$0.00	$42.20	$0.00	$0.00	$0.00	$0.00	$101.25	$160.38	$162.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MSS4022	SUP	Custom 27203010		MSS4022  -  DRESSING HYALOMATRIX 5X5CM BILAYER FLXB SEMIPERM	BOTH IP/OP	$686.93 	$508.33	$0.00	$549.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$509.84	$509.84	$0.00	$0.00	$143.16	$0.00	$0.00	$0.00	$0.00	$343.46	$544.05	$549.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MS-T35S	SUP	HCPCS C1713		MS-T35S  -  SCREW BONE 3.5MM SHRT CORT SLFTAP	BOTH IP/OP	$330.00 	$244.20	$0.00	$264.00	$148.50	$148.50	$0.00	$0.00	$0.00	$68.78	$244.93	$244.93	$0.00	$0.00	$68.77	$0.00	$195.20	$195.20	$0.00	$165.00	$261.36	$264.00	$0.00		$0.00	$51.65	$0.00	$0.00	$52.54	$0.00	$0.00	$0.00	$0.00	$0.00
MT-1000	SUP	Custom 27203010		MT-1000  -  MINNIE TIE	BOTH IP/OP	$379.79 	$281.04	$0.00	"$3,646.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.88	$281.88	$0.00	$0.00	$79.15	$0.00	$0.00	$0.00	$0.00	"$2,278.75"	"$3,609.54"	"$3,646.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MT2000	SUP	Custom 27203010		LENS IRR MRGN MDGL THRP	BOTH IP/OP	$49.95 	$36.96	$0.00	$39.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.98	$39.56	$39.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0	SUP	HCPCS V2630		MTA3U0  -  LENS IOL +21 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.050	SUP	HCPCS V2630		MTA3U0.050  -  LENS IOL +5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.060	SUP	HCPCS V2630		MTA3U0.060  -  LENS IOL +6 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.070	SUP	HCPCS V2630		MTA3U0.070  -  LENS IOL +7 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.080	SUP	HCPCS V2630		MTA3U0.080  -  LENS IOL +8 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.090	SUP	HCPCS V2630		MTA3U0.090  -  LENS IOL +9 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.100	SUP	HCPCS V2630		MTA3U0.100  -  LENS IOL +10 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.105	SUP	HCPCS V2630		MTA3U0.105  -  LENS IOL +10.5 DIOP 12.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.110	SUP	HCPCS V2630		MTA3U0.110  -  LENS IOL +11 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.115	SUP	HCPCS V2630		MTA3U0.115  -  LENS IOL +11.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.120	SUP	HCPCS V2630		MTA3U0.120  -  LENS IOL +12 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.125	SUP	HCPCS V2630		MTA3U0.125  -  LENS IOL +12.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.130	SUP	HCPCS V2630		MTA3U0.130  -  LENS IOL +13 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.135	SUP	HCPCS V2630		MTA3U0.135  -  LENS IOL +13.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.145	SUP	HCPCS V2630		MTA3U0.145  -  LENS IOL +14.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.150	SUP	HCPCS V2630		MTA3U0.150  -  LENS IOL +15 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.155	SUP	HCPCS V2630		MTA3U0.155  -  LENS IOL +15.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.160	SUP	HCPCS V2630		MTA3U0.160  -  LENS IOL +16 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.165	SUP	HCPCS V2630		MTA3U0.165  -  LENS IOL +16.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.170	SUP	HCPCS V2630		MTA3U0.170  -  LENS IOL +17 DIOP 12.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.180	SUP	HCPCS V2630		MTA3U0.180  -  LENS IOL +18 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.185	SUP	HCPCS V2630		MTA3U0.185  -  LENS IOL +18.5 DIOP 12.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.190	SUP	HCPCS V2632		MTA3U0.190  -  INTRAOCULAR LENS  MTA3U0   19.0D	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.200	SUP	HCPCS V2632		MTA3U0.200  -  INTRAOUCLAR LENS  MTA3U0  20.0D	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.205	SUP	HCPCS V2630		MTA3U0.205  -  LENS IOL +20.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.210	SUP	HCPCS V2630		MTA3U0.210  -  LENS IOL +21 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.215	SUP	HCPCS V2630		MTA3U0.215  -  LENS IOL +21.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.220	SUP	HCPCS V2630		MTA3U0.220  -  LENS IOL +22 DIOP 12.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.230	SUP	HCPCS V2630		MTA3U0.230  -  LENS IOL +23 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.235	SUP	HCPCS V2630		MTA3U0.235  -  LENS IOL +23.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.240	SUP	HCPCS V2630		MTA3U0.240  -  LENS IOL +24 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.245	SUP	HCPCS V2630		MTA3U0.245  -  LENS IOL +24.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.250	SUP	HCPCS V2630		MTA3U0.250  -  LENS IOL +25 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.255	SUP	HCPCS V2630		MTA3U0.255  -  LENS IOL +25.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.260	SUP	HCPCS V2630		MTA3U0.260  -  LENS IOL +26 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.265	SUP	HCPCS V2630		MTA3U0.265  -  LENS IOL +26.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.270	SUP	HCPCS V2630		MTA3U0.270  -  LENS IOL +27 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.275	SUP	HCPCS V2630		MTA3U0.275  -  LENS IOL +27.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.280	SUP	HCPCS V2630		MTA3U0.280  -  LENS IOL +28 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.285	SUP	HCPCS V2630		MTA3U0.285  -  LENS IOL +28.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.290	SUP	HCPCS V2630		MTA3U0.290  -  LENS IOL +29 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.295	SUP	HCPCS V2630		MTA3U0.295  -  LENS IOL +29.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA3U0.300	SUP	HCPCS V2630		MTA3U0.300  -  LENS IOL +30 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0	SUP	HCPCS V2630		MTA4U0  -  LENS IOL +6.5 DIOP CNVXPLN 5.5MM 13MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.015	SUP	HCPCS V2630		MTA4U0.015  -  LENS IOL +15 DIOP 13MM 5.5MM ANTER CHAM CNVXPLN 1 PC PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.050	SUP	HCPCS V2630		MTA4U0.050  -  LENS IOL +5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.055	SUP	HCPCS V2630		MTA4U0.055  -  LENS IOL +5.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.060	SUP	HCPCS V2630		MTA4U0.060  -  LENS IOL +6 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.065	SUP	HCPCS V2630		MTA4U0.065  -  LENS IOL +6.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.070	SUP	HCPCS V2630		MTA4U0.070  -  LENS IOL +7 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.075	SUP	HCPCS V2630		MTA4U0.075  -  LENS IOL +7.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.080	SUP	HCPCS V2630		MTA4U0.080  -  LENS IOL +8 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.085	SUP	HCPCS V2630		MTA4U0.085  -  LENS IOL +8.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.090	SUP	HCPCS V2630		MTA4U0.090  -  LENS IOL +9 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.095	SUP	HCPCS V2630		MTA4U0.095  -  LENS IOL +9.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.100	SUP	HCPCS V2630		MTA4U0.100  -  LENS IOL +10 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.105	SUP	HCPCS V2630		MTA4U0.105  -  LENS IOL +10.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.110	SUP	HCPCS V2630		MTA4U0.110  -  LENS IOL +11 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.115	SUP	HCPCS V2630		MTA4U0.115  -  LENS IOL +11.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.120	SUP	HCPCS V2630		MTA4U0.120  -  LENS IOL +12 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.125	SUP	HCPCS V2630		MTA4U0.125  -  LENS IOL +12.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.130	SUP	HCPCS V2630		MTA4U0.130  -  LENS IOL +13 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.135	SUP	HCPCS V2630		MTA4U0.135  -  LENS IOL +13.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.140	SUP	HCPCS V2630		MTA4U0.140  -  LENS IOL +14 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.145	SUP	HCPCS V2630		MTA4U0.145  -  LENS IOL +14.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.155	SUP	HCPCS V2630		MTA4U0.155  -  LENS IOL +15.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.160	SUP	HCPCS V2630		MTA4U0.160  -  LENS IOL +16 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.165	SUP	HCPCS V2632		MTA4U0.165  -  INTRAOCULAR LENS  MTA4U0  16.5 D	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.170	SUP	HCPCS V2632		MTA4U0.170  -  INTRAOCULAR LENS  MTA4UO  17.0D	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.175	SUP	HCPCS V2630		MTA4U0.175  -  LENS IOL +17.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.180	SUP	HCPCS V2630		MTA4U0.180  -  LENS IOL +18 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.185	SUP	HCPCS V2630		MTA4U0.185  -  LENS IOL +18.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.190	SUP	HCPCS V2630		MTA4U0.190  -  LENS IOL +19 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.195	SUP	HCPCS V2632		MTA4U0.195  -  INTRAOCULAR LENS  MTA4U0  19.5D	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.200	SUP	HCPCS V2630		MTA4U0.200  -  LENS IOL +20 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.205	SUP	HCPCS V2632		MTA4U0.205  -  INTRAOCULAR LENS MTA4U0  20.5D	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.210	SUP	HCPCS V2630		MTA4U0.210  -  LENS IOL +21 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.215	SUP	HCPCS V2630		MTA4U0.215  -  LENS IOL +21.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.220	SUP	HCPCS V2630		MTA4U0.220  -  LENS IOL +22.0 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.225	SUP	HCPCS V2630		MTA4U0.225  -  LENS IOL +22.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.230	SUP	HCPCS V2630		MTA4U0.230  -  LENS IOL +23 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.235	SUP	HCPCS V2630		MTA4U0.235  -  LENS IOL +23.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.240	SUP	HCPCS V2630		MTA4U0.240  -  LENS IOL +24 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.245	SUP	HCPCS V2630		MTA4U0.245  -  LENS IOL +24.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.250	SUP	HCPCS V2630		MTA4U0.250  -  LENS IOL +25 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.255	SUP	HCPCS V2630		MTA4U0.255  -  LENS IOL +25.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.260	SUP	HCPCS V2630		MTA4U0.260  -  LENS IOL +26 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.265	SUP	HCPCS V2630		MTA4U0.265  -  LENS IOL +26.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.270	SUP	HCPCS V2630		MTA4U0.270  -  LENS IOL +27 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.275	SUP	HCPCS V2630		MTA4U0.275  -  LENS IOL +27.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.280	SUP	HCPCS V2630		MTA4U0.280  -  LENS IOL +28 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.285	SUP	HCPCS V2630		MTA4U0.285  -  LENS IOL +28.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.290	SUP	HCPCS V2630		MTA4U0.290  -  LENS IOL +29 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA4U0.300	SUP	HCPCS V2630		MTA4U0.300  -  LENS IOL +30 DIOP CNVXPLN 5.5MM 13MM CLR STRL KLMN MULTIFLEX	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0	SUP	HCPCS V2630		MTA5U0  -  LENS IOL +13.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.050	SUP	HCPCS V2630		MTA5U0.050  -  LENS IOL +5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.060	SUP	HCPCS V2630		MTA5U0.060  -  LENS IOL +6 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.070	SUP	HCPCS V2630		MTA5U0.070  -  LENS IOL +7 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.080	SUP	HCPCS V2630		MTA5U0.080  -  LENS IOL +8 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.085	SUP	HCPCS V2630		MTA5U0.085  -  LENS IOL +8.5 DIOP CNVXPLN 13.5MM 5.5MM ANTER CHAM	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.095	SUP	HCPCS V2630		MTA5U0.095  -  LENS IOL +9.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.100	SUP	HCPCS V2630		MTA5U0.100  -  LENS IOL +10 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.105	SUP	HCPCS V2630		MTA5U0.105  -  LENS IOL +10.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.115	SUP	HCPCS V2630		MTA5U0.115  -  LENS IOL +11.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.125	SUP	HCPCS V2630		MTA5U0.125  -  LENS IOL +12.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.135	SUP	HCPCS V2630		MTA5U0.135  -  LENS IOL +13.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.140	SUP	HCPCS V2630		MTA5U0.140  -  LENS IOL +14 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.145	SUP	HCPCS V2630		MTA5U0.145  -  LENS IOL +14.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.150	SUP	HCPCS V2630		MTA5U0.150  -  LENS IOL +15 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.155	SUP	HCPCS V2630		MTA5U0.155  -  LENS IOL +15.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.160	SUP	HCPCS V2630		MTA5U0.160  -  LENS IOL +16 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.165	SUP	HCPCS V2632		MTA5U0.165  -  LENS IOL +16.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.170	SUP	HCPCS V2630		MTA5U0.170  -  LENS IOL +17 DIOP 13.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.175	SUP	HCPCS V2630		MTA5U0.175  -  LENS IOL +17.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.180	SUP	HCPCS V2630		MTA5U0.180  -  LENS IOL +18 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.185	SUP	HCPCS V2630		MTA5U0.185  -  LENS IOL +18.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.190	SUP	HCPCS V2630		MTA5U0.190  -  LENS IOL +19 DIOP 13.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.195	SUP	HCPCS V2630		MTA5U0.195  -  LENS IOL +19.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.200	SUP	HCPCS V2630		MTA5U0.200  -  LENS IOL +20 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.210	SUP	HCPCS V2630		MTA5U0.210  -  LENS IOL +21 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.215	SUP	HCPCS V2630		MTA5U0.215  -  LENS IOL +21.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.220	SUP	HCPCS V2630		MTA5U0.220  -  LENS IOL +22 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.225	SUP	HCPCS V2630		MTA5U0.225  -  LENS IOL +22.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.230	SUP	HCPCS V2630		MTA5U0.230  -  LENS IOL +23 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.235	SUP	HCPCS V2630		MTA5U0.235  -  LENS IOL +23.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.240	SUP	HCPCS V2630		MTA5U0.240  -  LENS IOL +24 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.250	SUP	HCPCS V2630		MTA5U0.250  -  LENS IOL +25 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.260	SUP	HCPCS V2630		MTA5U0.260  -  LENS IOL +26 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.270	SUP	HCPCS V2630		MTA5U0.270  -  LENS IOL +27 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.280	SUP	HCPCS V2630		MTA5U0.280  -  LENS IOL +28 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.285	SUP	HCPCS V2630		MTA5U0.285  -  LENS IOL +28.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.290	SUP	HCPCS V2630		MTA5U0.290  -  LENS IOL +29 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.295	SUP	HCPCS V2630		MTA5U0.295  -  LENS IOL +29.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTA5U0.300	SUP	HCPCS V2630		MTA5U0.300  -  LENS IOL +30 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN	BOTH IP/OP	$212.50 	$157.25	$0.00	$170.00	$95.63	$95.63	$0.00	$0.00	$0.00	$44.29	$157.72	$157.72	$0.00	$0.00	$44.29	$0.00	$125.69	$125.69	$0.00	$106.25	$168.30	$170.00	$0.00		$0.00	$33.26	$0.00	$0.00	$33.83	$0.00	$0.00	$0.00	$0.00	$0.00
MTLS-30060-TS	SUP	HCPCS C1713		MTLS-30060-TS  -  SCREW BN 3MM 6MM NS MULTITHREAD LCK TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTLS-30080-TS	SUP	HCPCS C1713		MTLS-30080-TS  -  SCREW BN 3MM 8MM NS MULTITHREAD LCK TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTLS-30100-TS	SUP	HCPCS C1713		MTLS-30100-TS  -  SCREW BN 3MM 10MM NS MULTITHREAD LCK TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTLS-30120-TS	SUP	HCPCS C1713		MTLS-30120-TS  -  SCREW BN 3MM 12MM NS MULTITHREAD LCK TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTLS-30140-TS	SUP	HCPCS C1713		MTLS-30140-TS  -  SCREW BN 3MM 14MM NS MULTITHREAD LCK TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTLS-30160-TS	SUP	HCPCS C1713		MTLS-30160-TS  -  SCREW BN 3MM 16MM NS MULTITHREAD LCK TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTLS-30180-TS	SUP	HCPCS C1713		MTLS-30180-TS  -  SCREW BN 3MM 18MM NS MULTITHREAD LCK TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTNL-30060-TS	SUP	HCPCS C1713		MTNL-30060-TS  -  SCREW BN 3MM 6MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTNL-30080-TS	SUP	HCPCS C1713		MTNL-30080-TS  -  SCREW BN 3MM 8MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTNL-30100-TS	SUP	HCPCS C1713		MTNL-30100-TS  -  SCREW BN 3MM 10MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTNL-30120-TS	SUP	HCPCS C1713		MTNL-30120-TS  -  SCREW BN 3MM 12MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTNL-30140-TS	SUP	HCPCS C1713		MTNL-30140-TS  -  SCREW BN 3MM 14MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTNL-30160-TS	SUP	HCPCS C1713		MTNL-30160-TS  -  SCREW BN 3MM 16MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTNL-30180-TS	SUP	HCPCS C1713		MTNL-30180-TS  -  SCREW BN 3MM 18MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
MTP-F010	SUP	Custom 27203010		MTP-F010  -  REAMER SURG CNCV JNT	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MTP-F012	SUP	Custom 27203010		MTP-F012  -  REAMER SURG 12MM CNCV MTP	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MTP-F014	SUP	Custom 27203010		MTP-F014  -  REAMER SRG 14MM CNCV	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MTP-F016	SUP	Custom 27203010		MTP-F016  -  REAMER SURG 16MM CNCV MTP	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MTP-F020	SUP	Custom 27203010		MTP-F020  -  REAMER SRG 20MM CNCV	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MTP-F024	SUP	Custom 27203010		MTP-F024  -  REAMER SURG 24MM CNCV MTP	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MTP-M010	SUP	Custom 27203010		MTP-M010  -  REAMER SURG 10MM CNVX MTP	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MTP-M012	SUP	Custom 27203010		MTP-M012  -  REAMER SURG 12MM CNVX MTP	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MTP-M014	SUP	Custom 27203010		MTP-M014  -  REAMER SURG 14MM CNVX MTP	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MTP-M016	SUP	Custom 27203010		MTP-M016  -  REAMER SURG 16MM CNVX MTP	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MTP-M020	SUP	Custom 27203010		MTP-M020  -  REAMER SURG 20MM CNVX MTP FRFT MIDFT LG	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MTP-M024	SUP	Custom 27203010		MTP-M024  -  REAMER SURG 24MM CNVX MTP	BOTH IP/OP	"$1,120.00 "	$828.80	$0.00	$896.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.26	$831.26	$0.00	$0.00	$233.41	$0.00	$0.00	$0.00	$0.00	$560.00	$887.04	$896.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MWCE-35-5/3-TORNADO	SUP	Custom 27803010		MWCE-35-5/3-TORNADO  -  COIL EMBOLIZATION TORNADO .035IN PLATINUM 5-3MM	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MWM4051	SUP	HCPCS C9363		MWM4051  -  DRESSING BIOLOGICAL 5X4IN MESHED ADHERENT BILAYER MATRIX	BOTH IP/OP	"$11,030.65 "	"$8,162.68"	$0.00	"$10,027.86"	"$5,640.67"	"$5,640.67"	$0.00	$0.00	$0.00	$0.00	"$8,186.95"	"$8,186.95"	$0.00	$0.00	"$2,298.79"	$0.00	$0.00	$0.00	$0.00	"$6,267.41"	"$9,927.59"	"$10,027.86"	$0.00		$0.00	"$1,961.70"	$0.00	$0.00	"$1,995.54"	$0.00	$0.00	$0.00	$0.00	$0.00
MX0100	SUP	HCPCS C1782		MX0100  -  TISSUE MORCELLATOR	BOTH IP/OP	"$3,567.27 "	"$2,639.78"	$0.00	"$2,853.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,647.63"	"$2,647.63"	$0.00	$0.00	$743.42	$0.00	$0.00	$0.00	$0.00	"$1,783.64"	"$2,825.28"	"$2,853.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MX563	SUP	Custom 27203010		MX563  -  SUTURE NONABSORBABLE 2-0 SH 30IN 2 ARM 4 STRAND BRAID	BOTH IP/OP	$124.00 	$91.76	$0.00	$92.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.04	$92.04	$0.00	$0.00	$25.84	$0.00	$0.00	$0.00	$0.00	$21.40	$33.90	$34.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
MX6740	SUP	HCPCS C1760		MX6740  -  DEVICE CLSR BLK GRN 6-7FR MYNX ACE .035IN VASC LCK SYR	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD	SUP	HCPCS V2632		MZ30BD  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.100	SUP	HCPCS V2632		MZ30BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.110	SUP	HCPCS V2632		MZ30BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.120	SUP	HCPCS V2632		MZ30BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.130	SUP	HCPCS V2632		MZ30BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.140	SUP	HCPCS V2632		MZ30BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.150	SUP	HCPCS V2632		MZ30BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.160	SUP	HCPCS V2632		MZ30BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.170	SUP	HCPCS V2632		MZ30BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.180	SUP	HCPCS V2632		MZ30BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.190	SUP	HCPCS V2632		MZ30BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.200	SUP	HCPCS V2632		MZ30BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.210	SUP	HCPCS V2632		MZ30BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.220	SUP	HCPCS V2632		MZ30BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.225	SUP	HCPCS V2632		MZ30BD.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.235	SUP	HCPCS V2632		MZ30BD.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.245	SUP	HCPCS V2632		MZ30BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.255	SUP	HCPCS V2632		MZ30BD.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.265	SUP	HCPCS V2632		MZ30BD.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.275	SUP	HCPCS V2632		MZ30BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.285	SUP	HCPCS V2632		MZ30BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ30BD.295	SUP	HCPCS V2632		MZ30BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.100	SUP	HCPCS V2632		MZ40BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.105	SUP	HCPCS V2632		MZ40BD.105  -  LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.110	SUP	HCPCS V2632		MZ40BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.115	SUP	HCPCS V2632		MZ40BD.115  -  LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.120	SUP	HCPCS V2632		MZ40BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.125	SUP	HCPCS V2632		MZ40BD.125  -  LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.130	SUP	HCPCS V2632		MZ40BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.135	SUP	HCPCS V2632		MZ40BD.135  -  LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.140	SUP	HCPCS V2632		MZ40BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.145	SUP	HCPCS V2632		MZ40BD.145  -  LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.150	SUP	HCPCS V2632		MZ40BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.155	SUP	HCPCS V2632		MZ40BD.155  -  LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.160	SUP	HCPCS V2632		MZ40BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.165	SUP	HCPCS V2632		MZ40BD.165  -  LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.170	SUP	HCPCS V2632		MZ40BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.175	SUP	HCPCS V2632		MZ40BD.175  -  LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.180	SUP	HCPCS V2632		MZ40BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.185	SUP	HCPCS V2632		MZ40BD.185  -  LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.190	SUP	HCPCS V2632		MZ40BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.195	SUP	HCPCS V2632		MZ40BD.195  -  LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.200	SUP	HCPCS V2632		MZ40BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.205	SUP	HCPCS V2632		MZ40BD.205  -  LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.210	SUP	HCPCS V2632		MZ40BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.215	SUP	HCPCS V2632		MZ40BD.215  -  LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.220	SUP	HCPCS V2632		MZ40BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.225	SUP	HCPCS V2632		MZ40BD.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.230	SUP	HCPCS V2632		MZ40BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.235	SUP	HCPCS V2632		MZ40BD.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.240	SUP	HCPCS V2632		MZ40BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.245	SUP	HCPCS V2632		MZ40BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.250	SUP	HCPCS V2632		MZ40BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.255	SUP	HCPCS V2632		MZ40BD.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.260	SUP	HCPCS V2632		MZ40BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.265	SUP	HCPCS V2632		MZ40BD.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.270	SUP	HCPCS V2632		MZ40BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.275	SUP	HCPCS V2632		MZ40BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.280	SUP	HCPCS V2632		MZ40BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.285	SUP	HCPCS V2632		MZ40BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.290	SUP	HCPCS V2632		MZ40BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.295	SUP	HCPCS V2632		MZ40BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ40BD.300	SUP	HCPCS V2632		MZ40BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD	SUP	HCPCS V2632		MZ60BD  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.040	SUP	HCPCS V2632		MZ60BD.040  -  LENS IOL 5 D +4 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.050	SUP	HCPCS V2632		MZ60BD.050  -  LENS IOL 5 D +5 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.060	SUP	HCPCS V2632		MZ60BD.060  -  LENS IOL 5 D +6 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.070	SUP	HCPCS V2632		MZ60BD.070  -  LENS IOL 5 D +7 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.080	SUP	HCPCS V2632		MZ60BD.080  -  LENS IOL 5 D +8 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.090	SUP	HCPCS V2632		MZ60BD.090  -  LENS IOL 5 D +9 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.100	SUP	HCPCS V2632		MZ60BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.110	SUP	HCPCS V2632		MZ60BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.120	SUP	HCPCS V2632		MZ60BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.130	SUP	HCPCS V2632		MZ60BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.140	SUP	HCPCS V2632		MZ60BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.150	SUP	HCPCS V2632		MZ60BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.160	SUP	HCPCS V2632		MZ60BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.170	SUP	HCPCS V2632		MZ60BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.180	SUP	HCPCS V2632		MZ60BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.190	SUP	HCPCS V2632		MZ60BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.200	SUP	HCPCS V2632		MZ60BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.210	SUP	HCPCS V2632		MZ60BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.220	SUP	HCPCS V2632		MZ60BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.230	SUP	HCPCS V2632		MZ60BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.240	SUP	HCPCS V2632		MZ60BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.245	SUP	HCPCS V2632		MZ60BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.250	SUP	HCPCS V2632		MZ60BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.260	SUP	HCPCS V2632		MZ60BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.270	SUP	HCPCS V2632		MZ60BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.280	SUP	HCPCS V2632		MZ60BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.290	SUP	HCPCS V2632		MZ60BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.300	SUP	HCPCS V2632		MZ60BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.320	SUP	HCPCS V2632		MZ60BD.320  -  LENS IOL 5 D +32 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60BD.340	SUP	HCPCS V2632		MZ60BD.340  -  LENS IOL 5 D +34 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60MD	SUP	HCPCS V2632		MZ60MD  -  LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60MD.000	SUP	HCPCS V2632		MZ60MD.000  -  LENS IOL 5 D +0 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60MD.010	SUP	HCPCS V2632		MZ60MD.010  -  LENS IOL 5 D +1 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60MD.020	SUP	HCPCS V2632		MZ60MD.020  -  LENS IOL 5 D +2 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60MD.030	SUP	HCPCS V2632		MZ60MD.030  -  LENS IOL 5 D +3 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60MDN010	SUP	HCPCS V2632		MZ60MDN010  -  LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60MDN020	SUP	HCPCS V2632		MZ60MDN020  -  LENS IOL 5 D -2 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60MDN030	SUP	HCPCS V2632		MZ60MDN030  -  LENS IOL 5 D -3 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60PDN040	SUP	HCPCS V2632		MZ60PDN040  -  LENS IOL 5 D -4 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60PDN050	SUP	HCPCS V2632		MZ60PDN050  -  LENS IOL 5 D -5 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60PDN060	SUP	HCPCS V2632		MZ60PDN060  -  LENS IOL 5 D -6 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60PDN070	SUP	HCPCS V2632		MZ60PDN070  -  LENS IOL 5 D -7 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60PDN080	SUP	HCPCS V2632		MZ60PDN080  -  LENS IOL 5 D -8 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60PDN090	SUP	HCPCS V2632		MZ60PDN090  -  LENS IOL 5 D -9 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
MZ60PDN100	SUP	HCPCS V2632		MZ60PDN100  -  LENS IOL 5 D -10 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$73.13	$73.13	$0.00	$0.00	$0.00	$33.87	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$96.12	$96.12	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$25.43	$0.00	$0.00	$25.87	$0.00	$0.00	$0.00	$0.00	$0.00
N103A	SUP	Custom 27203010		N103A  -  NEEDLE DSCT MIC STRG 3CM LF CO HEAT RST TIP UL SHRP TUNG	BOTH IP/OP	$90.13 	$66.70	$0.00	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.89	$66.89	$0.00	$0.00	$18.78	$0.00	$0.00	$0.00	$0.00	$122.50	$194.04	$196.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
N143001	SUP	HCPCS C1769		N143001  -  GWIRE VASC 15D .014IN 300CM 5CM INT STY A SHP TIP NTRX NTNL	BOTH IP/OP	$281.67 	$208.44	$0.00	$225.33	$152.94	$152.94	$0.00	$0.00	$0.00	$58.71	$209.05	$209.05	$0.00	$0.00	$58.70	$0.00	$166.61	$166.61	$0.00	$140.83	$223.08	$225.33	$0.00		$0.00	$44.08	$0.00	$0.00	$44.84	$0.00	$0.00	$0.00	$0.00	$0.00
N1526	SUP	Custom 25003010		ANTIBODY DESMIN CLONE D33 MS ANHMN 11ML LAB	BOTH IP/OP	"$1,320.00 "	$976.80	$0.00	"$1,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$660.00	"$1,045.44"	"$1,056.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
N1580	SUP	Custom 25003010		ANTIBODY CD3 RBT PLYCLN ANHMN 7ML LAB	BOTH IP/OP	"$1,320.00 "	$976.80	$0.00	"$1,056.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$660.00	"$1,045.44"	"$1,056.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
N181805	SUP	HCPCS C1769		N181805  -  GWIRE ENDSCP .018IN 180CM HPRFR STF ANG TIP FLXB EXC TRQ	BOTH IP/OP	$216.67 	$160.34	$0.00	$173.33	$117.65	$117.65	$0.00	$0.00	$0.00	$45.16	$160.81	$160.81	$0.00	$0.00	$45.15	$0.00	$128.16	$128.16	$0.00	$108.33	$171.60	$173.33	$0.00		$0.00	$33.91	$0.00	$0.00	$34.49	$0.00	$0.00	$0.00	$0.00	$0.00
N2031-3	SUP	Custom 27203010		HOLDER LOOP BRSS INSL HNDL 8IN	BOTH IP/OP	$56.90 	$42.11	$0.00	$45.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.45	$45.06	$45.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
N7695	SUP	HCPCS A7520		N7695  -  TUBE ET SYR CK	BOTH IP/OP	$11.13 	$8.24	$0.00	$8.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.26	$8.26	$0.00	$0.00	$2.32	$0.00	$0.00	$0.00	$0.00	$5.56	$8.81	$8.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
N8254	SUP	Custom 27203010		CANNULA CPAP NEO BN ARWY RDC IRRIT SIL LF DISP 4CM 2.5MM	BOTH IP/OP	$28.25 	$20.91	$0.00	$22.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.13	$22.37	$22.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
N8304	SUP	Custom 27203010		CANNULA CPAP NEO BN ARWY RDC IRRIT SIL LF DISP 4CM 3MM	BOTH IP/OP	$28.25 	$20.91	$0.00	$22.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.13	$22.37	$22.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NAV2076	SUP	Custom 27203010		NAV2076  -  BIT DRL 2.9MM STRL VRTX DISP	BOTH IP/OP	"$1,950.00 "	"$1,443.00"	$0.00	"$1,560.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,447.29"	"$1,447.29"	$0.00	$0.00	$406.38	$0.00	$0.00	$0.00	$0.00	$975.00	"$1,544.40"	"$1,560.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NB5STFLP	SUP	Custom 27203010		NB5STFLP  -  TROCAR LAPSCOP STANDARD LP 5MM FIX SMOOTH ENTRY DIRECTIONAL	BOTH IP/OP	$50.75 	$37.56	$0.00	$40.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.67	$37.67	$0.00	$0.00	$10.58	$0.00	$0.00	$0.00	$0.00	$25.38	$40.19	$40.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NC9822012	SUP	Custom 27203010		KIT FTL CELL STN BLOOD BANK 300 TST	BOTH IP/OP	$505.00 	$373.70	$0.00	$404.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.50	$399.96	$404.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP2009X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP2012X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP2015X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP2021X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP22506X	SUP	HCPCS C1725		CATHETER BALDILAT 2.25MM 6MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP22512X	SUP	HCPCS C1725		CATHETER BALDILAT 2.25MM 12MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP22521X	SUP	HCPCS C1725		CATHETER BALDILAT 2.25MM 21MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP2506X	SUP	HCPCS C1725		CATHETER BALDILAT 2.5MM 6MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP2509X	SUP	HCPCS C1725		CATHETER BALDILAT 2.5MM 9MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP2512X	SUP	HCPCS C1725		CATHETER BALDILAT 2.5MM 12MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP2515X	SUP	HCPCS C1725		CATHETER BALDILAT 2.5MM 15MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP2521X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP2527X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP27506X	SUP	HCPCS C1725		CATHETER BALDILAT 2.7MM 6MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP27509X	SUP	HCPCS C1725		CATHETER BALDILAT 2.75MM 9MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP27512X	SUP	HCPCS C1725		CATHETER BALDILAT 2.75MM 12MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP27515X	SUP	HCPCS C1725		CATHETER BALDILAT 2.75MM 15MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP27521X	SUP	HCPCS C1725		CATHETER BALDILAT 2.75MM 21MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP3006X	SUP	HCPCS C1725		CATHETER BALDILAT 3MM 6MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP3009X	SUP	HCPCS C1725		CATHETER BALDILAT 3MM 9MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP3012X	SUP	HCPCS C1725		CATHETER BALDILAT 3MM 12MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP3015X	SUP	HCPCS C1725		CATHETER BALDILAT 3MM 15MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP3021X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP3027X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP32506X	SUP	HCPCS C1725		CATHETER BALDILAT 3.25MM 6MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP32509X	SUP	HCPCS C1725		CATHETER BALDILAT 3.25MM 9MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP32512X	SUP	HCPCS C1725		CATHETER BALDILAT 3.25MM 12MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP32515X	SUP	HCPCS C1725		CATHETER BALDILAT 3.25MM 15MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP32521X	SUP	HCPCS C1725		CATHETER BALDILAT 3.25MM 21MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP3506X	SUP	HCPCS C1725		CATHETER BALDILAT 3.5MM 6MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP3509X	SUP	HCPCS C1725		CATHETER BALDILAT 3.5MM 9MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP3512X	SUP	HCPCS C1725		CATHETER BALDILAT 3.5MM 12MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP3515X	SUP	HCPCS C1725		CATHETER BALDILAT 3.5MM 15MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP3521X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP3527X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP37506X	SUP	HCPCS C1725		CATHETER BALDILAT 3.75MM 6MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP37509X	SUP	HCPCS C1725		CATHETER BALDILAT 3.75MM 9MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP37512X	SUP	HCPCS C1725		CATHETER BALDILAT 3.75MM 12MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP37515X	SUP	HCPCS C1725		CATHETER BALDILAT 3.75MM 15MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP37521X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP4006X	SUP	HCPCS C1725		CATHETER BALDILAT 4MM 6MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP4009X	SUP	HCPCS C1725		CATHETER BALDILAT 4MM 9MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP4012X	SUP	HCPCS C1725		CATHETER BALDILAT 4MM 12MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP4015X	SUP	HCPCS C1725		CATHETER BALDILAT 4MM 15MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP4021X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP4027X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP4515X	SUP	HCPCS C1725		CATHETER BALDILAT 4.5MM 15MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP4521X	SUP	HCPCS C1725		BALLON SPRINTER NC  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
NCSP5015X	SUP	HCPCS C1725		CATHETER BALDILAT 5MM 15MM RAPEX NC NC SPNTR ANGIOPLST	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
NL8505061	SUP	Custom 27203010		NL8505061  -  SHUNT CARDIO 5MM 3.5MM SUNDT CRTD INTNL LOOP CONICAL SPRG	BOTH IP/OP	"$1,035.00 "	$765.90	$0.00	$828.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.18	$768.18	$0.00	$0.00	$215.69	$0.00	$0.00	$0.00	$0.00	$517.50	$819.72	$828.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NL850-5063	SUP	Custom 27803010		NL850-5063  -  SHUNT CARDIO 10CM 3.5-4MM SUNDT CRTD XTRN NREIN SEG SIL STRL	BOTH IP/OP	"$1,120.13 "	$828.90	$0.00	$896.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$831.36	$831.36	$0.00	$0.00	$233.43	$0.00	$0.00	$0.00	$0.00	$560.06	$887.14	$896.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NL8505065	SUP	Custom 27803010		NL8505065  -  SHUNT CARDIO 10CM 3X4MM SUNDT CRTD INTNL LOOP SFT CONICAL	BOTH IP/OP	$867.78 	$642.16	$0.00	$694.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$644.06	$644.06	$0.00	$0.00	$180.84	$0.00	$0.00	$0.00	$0.00	$433.89	$687.28	$694.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NL850-5067	SUP	Custom 27803010		NL850-5067  -  SHUNT CARDIO 10CM 4X5MM SUNDT CRTD INTNL LOOP SFT CONICAL	BOTH IP/OP	$867.78 	$642.16	$0.00	$694.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$644.06	$644.06	$0.00	$0.00	$180.84	$0.00	$0.00	$0.00	$0.00	$433.89	$687.28	$694.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NL8505070	SUP	Custom 27803010		NL8505070  -  SHUNT CARDIO 30CM 4X3MM SUNDT CRTD XTRN LOOP SFT CONICAL	BOTH IP/OP	$965.63 	$714.57	$0.00	$772.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$716.69	$716.69	$0.00	$0.00	$201.24	$0.00	$0.00	$0.00	$0.00	$482.81	$764.78	$772.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NL8505071	SUP	Custom 27803010		NL8505071  -  SHUNT CARDIO 30CM 3X5MM SUNDT CRTD XTRN LOOP SFT CONICAL	BOTH IP/OP	"$1,221.03 "	$903.56	$0.00	$906.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$906.24	$906.24	$0.00	$0.00	$254.46	$0.00	$0.00	$0.00	$0.00	$482.81	$764.78	$772.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NL850-5072	SUP	Custom 27803010		NL850-5072  -  SHUNT CARDIO 30CM 5X4MM SUNDT CRTD XTRN LOOP SFT CONICAL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.00	$0.00	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NL850-5076	SUP	Custom 27803010		NL850-5076  -  SHUNT NS SUNDT CRTD 30CM NREIN XTRN LOOP SIL 4MM 3MM STRL	BOTH IP/OP	$1.00 	$0.74	$0.00	$0.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.74	$0.74	$0.00	$0.00	$0.21	$0.00	$0.00	$0.00	$0.00	$0.50	$0.79	$0.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NL8505078	SUP	Custom 27803010		NL8505078  -  SHUNT CARDIO 30CM 4MM 5MM SUNDT CRTD XTRN LOOP NREIN CNTR	BOTH IP/OP	"$1,507.68 "	"$1,115.68"	$0.00	"$1,119.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,119.00"	"$1,119.00"	$0.00	$0.00	$314.20	$0.00	$0.00	$0.00	$0.00	$594.83	$942.20	$951.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NL865	SUP	Custom 27203010		NL865  -  BLADE WIRE SAW 12IN ROUND SPIRAL LOOPED END LATEX FREE GIGLI	BOTH IP/OP	$121.50 	$89.91	$0.00	$97.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.18	$90.18	$0.00	$0.00	$25.32	$0.00	$0.00	$0.00	$0.00	$60.75	$96.23	$97.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NN-8004	SUP	Custom 27011340		NN-8004  -  HANDPIECE ELECTROSURGICAL 13GA 13CM MYRIAD	BOTH IP/OP	"$8,235.00 "	"$6,093.90"	$0.00	"$5,922.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,716.17"	$0.00	$0.00	$0.00	$0.00	"$3,701.25"	"$5,862.78"	"$5,922.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NN-8011	SUP	HCPCS C1894		NN-8011  -  SHEATH ENDSCP 13.5MM 50MM GROUNDBREAK ACCES TECHNOLOGY	BOTH IP/OP	"$5,535.00 "	"$4,095.90"	$0.00	"$4,108.08"	"$2,701.43"	"$2,701.43"	$0.00	$0.00	$0.00	"$1,153.63"	"$4,108.08"	"$4,108.08"	$0.00	$0.00	"$1,153.49"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,487.50"	"$3,940.20"	"$3,980.00"	$0.00		$0.00	$778.59	$0.00	$0.00	$792.02	$0.00	$0.00	$0.00	$0.00	$0.00
NN-8012	SUP	HCPCS C1894		NN-8012  -  SHEATH ENDSCP 13.5MM 60MM GROUNDBREAK ACCES TECHNOLOGY	BOTH IP/OP	"$2,767.50 "	"$2,047.95"	$0.00	"$2,054.04"	"$1,350.71"	"$1,350.71"	$0.00	$0.00	$0.00	$576.82	"$2,054.04"	"$2,054.04"	$0.00	$0.00	$576.75	$0.00	"$1,636.98"	"$1,636.98"	$0.00	"$1,243.75"	"$1,970.10"	"$1,990.00"	$0.00		$0.00	$389.29	$0.00	$0.00	$396.01	$0.00	$0.00	$0.00	$0.00	$0.00
NN-8013	SUP	HCPCS C1894		NN-8013  -  SHEATH ENDSCP 13.5MM 75MM GROUNDBREAK ACCES TECHNOLOGY	BOTH IP/OP	"$5,125.00 "	"$3,792.50"	$0.00	"$4,108.08"	"$2,701.43"	"$2,701.43"	$0.00	$0.00	$0.00	"$1,153.63"	"$4,108.08"	"$4,108.08"	$0.00	$0.00	"$1,153.49"	$0.00	"$3,094.73"	"$3,094.73"	$0.00	"$2,487.50"	"$3,940.20"	"$3,980.00"	$0.00		$0.00	$778.59	$0.00	$0.00	$792.02	$0.00	$0.00	$0.00	$0.00	$0.00
NN-8016	SUP	Custom 27203010		NN-8016  -  VALVE MRCLTR .5MM STRL LF NICO MYRIAD INFS MTR LN DISP	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NN-8030	SUP	Custom 27203010		NN-8030  -  SHEATH ESCP 13.5MM 95MM STRL BRAINPATH ATRM TIP LCK FRST	BOTH IP/OP	"$2,562.50 "	"$1,896.25"	$0.00	"$1,901.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,901.89"	"$1,901.89"	$0.00	$0.00	$534.03	$0.00	$0.00	$0.00	$0.00	$621.88	$985.05	$995.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NON28226	SUP	HCPCS C1713		NON28226  -  CAP BOUF REG LG 24IN FLG LF PR MULTIPLY ELC CLSR LTWT LINT	BOTH IP/OP	$0.22 	$0.16	$0.00	$0.17	$0.10	$0.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.11	$0.17	$0.17	$0.00		$0.00	$0.03	$0.00	$0.00	$0.03	$0.00	$0.00	$0.00	$0.00	$0.00
NON28234P	SUP	HCPCS C1713		NON28234P  -  CAP BOUF REG LG 24IN LF PR MULTIPLY ELC CLSR LTWT LINT FR PP	BOTH IP/OP	$150.88 	$111.65	$0.00	$347.88	$195.68	$195.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.43	$119.50	$347.88	$0.00		$0.00	$23.61	$0.00	$0.00	$69.23	$0.00	$0.00	$0.00	$0.00	$0.00
NONB12STF	SUP	Custom 27203010		NONB12STF  -  TROCAR LAPSCP STD 12MM STRL VPRT+ FX CNN BLDLS INS TIP TISS	BOTH IP/OP	$68.08 	$50.38	$0.00	$54.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.04	$53.92	$54.46	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NPAS-100	SUP	HCPCS C1894		NPAS-100  -  GWIRE VASC .018IN 7FR 22GA 20CM 15CM INTROD NDL NEFF SS PERC	BOTH IP/OP	$170.84 	$126.42	$0.00	$136.67	$92.76	$92.76	$0.00	$0.00	$0.00	$35.61	$126.79	$126.79	$0.00	$0.00	$35.60	$0.00	$101.05	$101.05	$0.00	$85.42	$135.31	$136.67	$0.00		$0.00	$26.74	$0.00	$0.00	$27.20	$0.00	$0.00	$0.00	$0.00	$0.00
NR-09903-S	SUP	HCPCS C1894		INTRODUCER SHTH 9FR 10CM INTGR HMSTS VLV SDPRT TISS DILAT	BOTH IP/OP	$75.38 	$55.78	$0.00	$60.30	$40.93	$40.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.69	$59.70	$60.30	$0.00		$0.00	$11.80	$0.00	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00
NSLX120L	SUP	Custom 27203010		NSLX120L  -  SEALER BP 13MM 20CM ENSEAL X1 CRV LG JAW	BOTH IP/OP	"$2,180.86 "	"$1,613.84"	$0.00	"$1,744.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,618.64"	"$1,618.64"	$0.00	$0.00	$454.49	$0.00	$0.00	$0.00	$0.00	"$1,090.43"	"$1,727.24"	"$1,744.69"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NTSE-030115-UDH-MB	SUP	Custom 27203010		NTSE-030115-UDH-MB  -  XTRT STON 115CM 3FR 1.8CM TPLS MOD BSKT NCRCL NTNL	BOTH IP/OP	$458.25 	$339.11	$0.00	$366.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.11	$340.11	$0.00	$0.00	$95.50	$0.00	$0.00	$0.00	$0.00	$229.13	$362.93	$366.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
N-VVDC-01-ABRM	SUP	Custom 27803010		N-VVDC-01-ABRM  -  CATHETER XTRN DRN 3MM 33CM EVM VNTRC	BOTH IP/OP	$144.00 	$106.56	$0.00	$115.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.88	$106.88	$0.00	$0.00	$30.01	$0.00	$0.00	$0.00	$0.00	$72.00	$114.05	$115.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
NWL214066H	SUP	HCPCS C1785		NWL214066H  -  PACEMAKER SENSIA DR CARD SEDR01 NWL214066H	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	"$3,825.00"	"$3,825.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00		$0.00	"$1,330.25"	$0.00	$0.00	"$1,353.20"	$0.00	$0.00	$0.00	$0.00	$0.00
OHOOKR-8	SUP	HCPCS C1713		OHOOKR-8  -  PLATE BN RT OFST OLCRN HK PLT CORT	BOTH IP/OP	"$2,212.50 "	"$1,637.25"	$0.00	"$1,770.00"	$995.63	$995.63	$0.00	$0.00	$0.00	$461.14	"$1,642.12"	"$1,642.12"	$0.00	$0.00	$461.09	$0.00	"$1,308.69"	"$1,308.69"	$0.00	"$1,106.25"	"$1,752.30"	"$1,770.00"	$0.00		$0.00	$346.26	$0.00	$0.00	$352.23	$0.00	$0.00	$0.00	$0.00	$0.00
OM-10000	SUP	Custom 27203010		OM-10000  -  STABILIZER SURGICAL ACROBAT I SUCTION POD MALLEABLE FOOT	BOTH IP/OP	"$4,092.50 "	"$3,028.45"	$0.00	"$3,274.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,046.25"	"$3,241.26"	"$3,274.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
OMST12BT	SUP	Custom 27203010		OMST12BT  -  TROCAR LAPSCOP 5-10MM 12MM BLUNT TIP BUILT IN CONVERTER	BOTH IP/OP	"$1,089.22 "	$806.02	$0.00	$871.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$808.42	$808.42	$0.00	$0.00	$226.99	$0.00	$0.00	$0.00	$0.00	$544.61	$862.66	$871.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
OMS-T12BT	SUP	Custom 27203010		OMS-T12BT  -  TROCAR LAPSCOP 12MM SPCMKR BLNT TIP BLN STRL DISP PRPERITN	BOTH IP/OP	$318.05 	$235.36	$0.00	$254.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.06	$236.06	$0.00	$0.00	$66.28	$0.00	$0.00	$0.00	$0.00	$159.03	$251.90	$254.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
OMST12T	SUP	Custom 27203010		OMST12T  -  BALLON TIP TROCAR	BOTH IP/OP	"$1,645.90 "	"$1,217.97"	$0.00	"$1,316.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,221.59"	"$1,221.59"	$0.00	$0.00	$343.01	$0.00	$0.00	$0.00	$0.00	$822.95	"$1,303.55"	"$1,316.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ONB12LGF	SUP	Custom 27203010		ONB12LGF  -  TROCAR LAPSCP LNG 12MM 150MM STRL LF VRSPRT V2 FX CNN BLDLS	BOTH IP/OP	$450.75 	$333.56	$0.00	$360.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$334.55	$334.55	$0.00	$0.00	$93.94	$0.00	$0.00	$0.00	$0.00	$225.38	$356.99	$360.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ONXACE-19	SUP	Custom 27803010		ONXACE-19  -  VALVE AOR 19MM ONX	BOTH IP/OP	"$14,875.00 "	"$11,007.50"	$0.00	"$11,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,099.95"	$0.00	$0.00	$0.00	$0.00	"$7,437.50"	"$11,781.00"	"$11,900.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ONXACE-21	SUP	Custom 27803010		ONXACE-21  -  VALVE AOR 21MM ONX	BOTH IP/OP	"$14,875.00 "	"$11,007.50"	$0.00	"$11,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,099.95"	$0.00	$0.00	$0.00	$0.00	"$7,437.50"	"$11,781.00"	"$11,900.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ONXACE-23	SUP	Custom 27803010		ONXACE-23  -  VALVE AOR 23MM ONX	BOTH IP/OP	"$14,875.00 "	"$11,007.50"	$0.00	"$11,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,099.95"	$0.00	$0.00	$0.00	$0.00	"$7,437.50"	"$11,781.00"	"$11,900.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ONXACE-25	SUP	Custom 27803010		ONXACE-25  -  VALVE AOR 23.4MM 25MM 17.4MM ONX CNFRM-X SW RING PROS	BOTH IP/OP	"$14,875.00 "	"$11,007.50"	$0.00	"$11,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,099.95"	$0.00	$0.00	$0.00	$0.00	"$7,437.50"	"$11,781.00"	"$11,900.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ONXACE-25/33	SUP	Custom 27803010		ONXACE-25/33  -  ON-X AORTIC VALVE SIZE 25/33	BOTH IP/OP	"$14,875.00 "	"$11,007.50"	$0.00	"$11,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,099.95"	$0.00	$0.00	$0.00	$0.00	"$7,437.50"	"$11,781.00"	"$11,900.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ONXACE-27/29	SUP	Custom 27803010		ONXACE-27/29  -  VALVE AOR 23.4MM 27/29MM 17.4MM ONX CNFRM-X SW RING PROS	BOTH IP/OP	"$14,875.00 "	"$11,007.50"	$0.00	"$11,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,099.95"	$0.00	$0.00	$0.00	$0.00	"$7,437.50"	"$11,781.00"	"$11,900.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
OS-401	SUP	Custom 27804086		OS-401  -  FILLER BN VOID 4CC	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
OSN-50	SUP	HCPCS C1713		OSN-50  -  WIRE FX 50MM SLED NTRL OLCRN	BOTH IP/OP	"$2,150.00 "	"$1,591.00"	$0.00	"$1,720.00"	$967.50	$967.50	$0.00	$0.00	$0.00	$448.11	"$1,595.73"	"$1,595.73"	$0.00	$0.00	$448.06	$0.00	"$1,271.73"	"$1,271.73"	$0.00	"$1,075.00"	"$1,702.80"	"$1,720.00"	$0.00		$0.00	$336.48	$0.00	$0.00	$342.28	$0.00	$0.00	$0.00	$0.00	$0.00
OSN-70	SUP	HCPCS C1713		OSN-70  -  WIRE FIX 70MM SLED NEUTRAL OLECRANON	BOTH IP/OP	"$2,412.50 "	"$1,785.25"	$0.00	"$1,930.00"	"$1,085.63"	"$1,085.63"	$0.00	$0.00	$0.00	$502.83	"$1,790.56"	"$1,790.56"	$0.00	$0.00	$502.77	$0.00	"$1,426.99"	"$1,426.99"	$0.00	"$1,206.25"	"$1,910.70"	"$1,930.00"	$0.00		$0.00	$377.56	$0.00	$0.00	$384.07	$0.00	$0.00	$0.00	$0.00	$0.00
OSW	SUP	HCPCS C1713		OSW  -  WASHER ORTHOPEDIC LP FIX OLECRANON STERILE	BOTH IP/OP	$687.50 	$508.75	$0.00	$550.00	$309.38	$309.38	$0.00	$0.00	$0.00	$143.29	$510.26	$510.26	$0.00	$0.00	$143.28	$0.00	$406.66	$406.66	$0.00	$343.75	$544.50	$550.00	$0.00		$0.00	$107.59	$0.00	$0.00	$109.45	$0.00	$0.00	$0.00	$0.00	$0.00
P100510	SUP	HCPCS C1781		P100510  -  GRAFT SFT TIS THK1MM 10X5CM STRL PERMACOL PRCN DRML CLGN	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$22.05	$22.05	$0.00	$0.00	$0.00	$10.21	$36.37	$36.37	$0.00	$0.00	$10.21	$0.00	$28.98	$28.98	$0.00	$24.50	$38.81	$39.20	$0.00		$0.00	$7.67	$0.00	$0.00	$7.80	$0.00	$0.00	$0.00	$0.00	$0.00
P101010	SUP	HCPCS C9364		P101010  -  GRAFT SFT TIS THK1MM 10X10CM STRL PERMACOL PRCN DRML CLGN	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
P101015	SUP	HCPCS C9364		P101015  -  GRAFT SFT TIS THK1MM 15X10CM STRL PERMACOL PRCN DRML CLGN	BOTH IP/OP	"$7,500.00 "	"$5,550.00"	$0.00	"$6,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,563.00"	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$5,940.00"	"$6,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
P101828	SUP	HCPCS C9364		P101828  -  GRAFT SFT TIS THK1MM 28X18CM STRL PERMACOL PRCN DRML CLGN	BOTH IP/OP	"$27,720.00 "	"$20,512.80"	$0.00	"$22,176.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,776.85"	$0.00	$0.00	$0.00	$0.00	"$13,860.00"	"$21,954.24"	"$22,176.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
P151015	SUP	HCPCS C9364		P151015  -  GRAFT SFT TIS THK1.5MM 15X10CM STRL PERMACOL PRCN DRML CLGN	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
P151020	SUP	HCPCS C9364		P151020  -  GRAFT SFT TIS THK1.5MM 10X20CM STRL PERMACOL PRCN DRML CLGN	BOTH IP/OP	$73.50 	$54.39	$0.00	$58.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.55	$54.55	$0.00	$0.00	$15.32	$0.00	$0.00	$0.00	$0.00	$36.75	$58.21	$58.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
P151520	SUP	HCPCS C9364		P151520  -  GRAFT SFT TIS THK1.5MM 20X15CM STRL PERMACOL PRCN DRML CLGN	BOTH IP/OP	$49.00 	$36.26	$0.00	$39.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.37	$36.37	$0.00	$0.00	$10.21	$0.00	$0.00	$0.00	$0.00	$24.50	$38.81	$39.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
P152030	SUP	HCPCS C9364		P152030  -  GRAFT SFT TIS THK1.5MM 30X20CM STRL PERMACOL PRCN DRML CLGN	BOTH IP/OP	$53.90 	$39.89	$0.00	$43.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.00	$40.00	$0.00	$0.00	$11.23	$0.00	$0.00	$0.00	$0.00	$26.95	$42.69	$43.12	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
P152040	SUP	HCPCS C9364		P152040  -  GRAFT SFT TIS THK1.5MM 40X20CM STRL PERMACOL PRCN DRML CLGN	BOTH IP/OP	"$43,120.00 "	"$31,908.80"	$0.00	"$34,496.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,986.21"	$0.00	$0.00	$0.00	$0.00	"$21,560.00"	"$34,151.04"	"$34,496.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
P224PC8T	SUP	HCPCS C1725		P224PC8T  -  CATHETER  CENTRAL VENOUS	BOTH IP/OP	$124.88 	$92.41	$0.00	$99.90	$67.81	$67.81	$0.00	$0.00	$0.00	$26.03	$92.68	$92.68	$0.00	$0.00	$26.02	$0.00	$73.86	$73.86	$0.00	$62.44	$98.90	$99.90	$0.00		$0.00	$19.54	$0.00	$0.00	$19.88	$0.00	$0.00	$0.00	$0.00	$0.00
P350	SUP	Custom 27203010		P350  -  PUNCH SURG 3MM SS DRML BIOP RZR SHRP RB HNDL ACPNCH STRL	BOTH IP/OP	$7.56 	$5.59	$0.00	$6.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.78	$5.99	$6.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
P4676-110	SUP	Custom 27203010		PIPETTE SERO PLST 10ML GRAD PLG MOLD TIP STRL DISP .1ML	BOTH IP/OP	$33.00 	$24.42	$0.00	$26.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.50	$26.14	$26.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
P82012001	SUP	HCPCS C1725		CATHETER  POLAR DILATOR BALLOON 8X20X120	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$814.50	$814.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
PALS-25100-CC	SUP	HCPCS C1713		PALS-25100-CC  -  SCREW BN 2.5MM 10MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
PALS-25120-CC	SUP	HCPCS C1713		PALS-25120-CC  -  SCREW BN 2.5MM 12MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
PALS-25140-CC	SUP	HCPCS C1713		PALS-25140-CC  -  SCREW BN 2.5MM 14MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
PALS-25160-CC	SUP	HCPCS C1713		PALS-25160-CC  -  SCREW BN 2.5MM 16MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
PALS-25180-CC	SUP	HCPCS C1713		PALS-25180-CC  -  SCREW BN 2.5MM 18MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
PALS-25200-CC	SUP	HCPCS C1713		PALS-25200-CC  -  SCREW BN 2.5MM 20MM GEMINUS CNN LCK PA COCR DIST VOLR RDS	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
PALS-25220-CC	SUP	HCPCS C1713		PALS-25220-CC  -  SCREW BN 2.5MM 22MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
PALS-25240-CC	SUP	HCPCS C1713		PALS-25240-CC  -  SCREW BN 2.5MM 24MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
PALS-25260-CC	SUP	HCPCS C1713		PALS-25260-CC  -  SCREW BN 2.5MM 26MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
PALS-25280-CC	SUP	HCPCS C1713		PALS-25280-CC  -  SCREW BN 2.5MM 28MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
PALS-25300-CC	SUP	HCPCS C1713		PALS-25300-CC  -  SCREW BN 2.5MM 30MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$157.50	$157.50	$0.00	$0.00	$0.00	$72.95	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$207.03	$207.03	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$54.78	$0.00	$0.00	$55.72	$0.00	$0.00	$0.00	$0.00	$0.00
PANL-35080-TS	SUP	HCPCS C1713		PANL-35080-TS  -  SCREW BN 3.5MM 8MM NLCKG TI CORT	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
PANL-35090-TS	SUP	HCPCS C1713		PANL-35090-TS  -  SCREW BN 3.5MM 9MM NLCKG TI CORT	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
PANL-35100-TS	SUP	HCPCS C1713		PANL-35100-TS  -  SCREW BN 3.5MM 10MM BLU NS GEMINUS PA TI CORT VOLR DIST RDS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
PANL-35110-TS	SUP	HCPCS C1713		PANL-35110-TS  -  SCREW BN 3.5MM 11MM BLU NS GEMINUS PA TI CORT VOLR DIST RDS	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
PANL-35120-TS	SUP	HCPCS C1713		PANL-35120-TS  -  SCREW BN 3.5MM 12MM NS GEMINUS PA NLCKG TI CORT DIST VOLR	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
PANL-35130-TS	SUP	HCPCS C1713		PANL-35130-TS  -  SCREW BN 3.5MM 13MM NS GEMINUS PA NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
PANL-35140-TS	SUP	HCPCS C1713		PANL-35140-TS  -  SCREW BN 3.5MM 14MM NS GEMINUS PA NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
PANL-35150-TS	SUP	HCPCS C1713		PANL-35150-TS  -  SCREW BN 3.5MM 15MM NS GEMINUS PA NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
PANL-35160-TS	SUP	HCPCS C1713		PANL-35160-TS  -  SCREW BN 3.5MM 16MM NS GEMINUS PA NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
PANL-35170-TS	SUP	HCPCS C1713		PANL-35170-TS  -  SCREW BN 3.5MM 17MM NS GEMINUS PA NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
PANL-35180-TS	SUP	HCPCS C1713		PANL-35180-TS  -  SCREW BN 3.5MM 18MM NS GEMINUS PA NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
PAPS1	SUP	Custom 27203010		PUMP SCT PK	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PC02520OS	SUP	HCPCS C1781		PC02520OS  -  MESH SURG PARIETEX 10X8IN VNTRL HERN OPN SKRT RECT PLSTR	BOTH IP/OP	"$3,925.00 "	"$2,904.50"	$0.00	"$3,140.00"	"$1,766.25"	"$1,766.25"	$0.00	$0.00	$0.00	$818.07	"$2,913.14"	"$2,913.14"	$0.00	$0.00	$817.97	$0.00	"$1,935.03"	"$1,935.03"	$0.00	"$1,962.50"	"$3,108.60"	"$3,140.00"	$0.00		$0.00	$614.26	$0.00	$0.00	$624.86	$0.00	$0.00	$0.00	$0.00	$0.00
PC1016SN	SUP	HCPCS C1768		PC1016SN  -  PATCH CARDIO 16X10CM APEX PROCESSING SUPPLE PERI-GUARD	BOTH IP/OP	"$1,767.10 "	"$1,307.65"	$0.00	"$1,413.68"	$795.19	$795.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.55	"$1,399.54"	"$1,413.68"	$0.00		$0.00	$276.55	$0.00	$0.00	$281.32	$0.00	$0.00	$0.00	$0.00	$0.00
PC-1016SN	SUP	HCPCS C1768		PC-1016SN  -  PATCH CV 16X10CM SP PRGRD APX PRC BVN PRICRD	BOTH IP/OP	"$2,027.50 "	"$1,500.35"	$0.00	"$1,504.81"	$795.19	$795.19	$0.00	$0.00	$0.00	$422.58	"$1,504.81"	"$1,504.81"	$0.00	$0.00	$422.53	$0.00	"$1,199.27"	"$1,199.27"	$0.00	$883.55	"$1,399.54"	"$1,413.68"	$0.00		$0.00	$276.55	$0.00	$0.00	$281.32	$0.00	$0.00	$0.00	$0.00	$0.00
PC111	SUP	Custom 27803010		PC111  -  LEGEND FN2-DISS TO M-SCHR(UK)	BOTH IP/OP	$405.90 	$300.37	$0.00	$324.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.26	$301.26	$0.00	$0.00	$84.59	$0.00	$0.00	$0.00	$0.00	$202.95	$321.47	$324.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PCA-15	SUP	HCPCS C1713		"PCA-15  -  LOCKING PLATE, CURVED A, 15-HOLE"	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	"$1,456.88"	"$1,456.88"	$0.00	$0.00	$0.00	$674.78	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	"$1,596.09"	"$1,596.09"	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$506.67	$0.00	$0.00	$515.41	$0.00	$0.00	$0.00	$0.00	$0.00
PCB10	SUP	HCPCS C1713		PCB10  -  PLATE BN CRV B NS 10 HL LCK	BOTH IP/OP	"$2,587.50 "	"$1,914.75"	$0.00	"$2,070.00"	"$1,164.38"	"$1,164.38"	$0.00	$0.00	$0.00	$539.30	"$1,920.44"	"$1,920.44"	$0.00	$0.00	$539.24	$0.00	"$1,275.64"	"$1,275.64"	$0.00	"$1,293.75"	"$2,049.30"	"$2,070.00"	$0.00		$0.00	$404.94	$0.00	$0.00	$411.93	$0.00	$0.00	$0.00	$0.00	$0.00
PCB15	SUP	HCPCS C1713		PCB15  -  PLATE BN CRV B NS 15 HL LCK	BOTH IP/OP	"$3,375.00 "	"$2,497.50"	$0.00	"$2,700.00"	"$1,518.75"	"$1,518.75"	$0.00	$0.00	$0.00	$703.43	"$2,504.93"	"$2,504.93"	$0.00	$0.00	$703.35	$0.00	"$1,663.88"	"$1,663.88"	$0.00	"$1,687.50"	"$2,673.00"	"$2,700.00"	$0.00		$0.00	$528.19	$0.00	$0.00	$537.30	$0.00	$0.00	$0.00	$0.00	$0.00
PCDT1	SUP	HCPCS C1781		PCDT1  -  MESH SRG OVL 13X10IN STRL PRC FLXB TISS SEP LTWT MFL PRLN	BOTH IP/OP	"$6,122.25 "	"$4,530.47"	$0.00	"$4,897.80"	"$2,755.01"	"$2,755.01"	$0.00	$0.00	$0.00	"$1,276.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,275.88"	$0.00	"$3,018.27"	"$3,018.27"	$0.00	"$3,061.13"	"$4,848.82"	"$4,897.80"	$0.00		$0.00	$958.13	$0.00	$0.00	$974.66	$0.00	$0.00	$0.00	$0.00	$0.00
PCO12	SUP	HCPCS C1781		PCO12  -  MESH SRG RND 4.8IN PARIETEX COMP 3D WV RND PLSTR VNTRL HRN	BOTH IP/OP	"$1,322.03 "	$978.30	$0.00	"$1,057.62"	$594.91	$594.91	$0.00	$0.00	$0.00	$275.54	$981.21	$981.21	$0.00	$0.00	$275.51	$0.00	$781.98	$781.98	$0.00	$661.01	"$1,047.05"	"$1,057.62"	$0.00		$0.00	$206.90	$0.00	$0.00	$210.47	$0.00	$0.00	$0.00	$0.00	$0.00
PCO12X	SUP	HCPCS C1781		PCO12X  -  MESH SURG ROUND 12CM 2X4.8IN 2 SIDE OPTIMIZE COMPOSITE LARGE	BOTH IP/OP	$951.10 	$703.81	$0.00	$966.20	$543.49	$543.49	$0.00	$0.00	$0.00	$198.23	$705.91	$705.91	$0.00	$0.00	$198.21	$0.00	$562.58	$562.58	$0.00	$603.88	$956.54	$966.20	$0.00		$0.00	$189.01	$0.00	$0.00	$192.27	$0.00	$0.00	$0.00	$0.00	$0.00
PCO1510OS	SUP	HCPCS C1781		PCO1510OS  -  MESH SRG RECT 6X4IN PARIETEX RSRB COMP PLSTR VNTRL HRN	BOTH IP/OP	"$1,704.65 "	"$1,261.44"	$0.00	"$1,363.72"	$767.09	$767.09	$0.00	$0.00	$0.00	$355.29	"$1,265.19"	"$1,265.19"	$0.00	$0.00	$355.25	$0.00	"$1,008.30"	"$1,008.30"	$0.00	$852.33	"$1,350.08"	"$1,363.72"	$0.00		$0.00	$266.78	$0.00	$0.00	$271.38	$0.00	$0.00	$0.00	$0.00	$0.00
PCO15X	SUP	HCPCS C1781		PCO15X  -  MESH SURG ROUND 15CM OPTIMIZE COMPOSITE PROPRIETARY TEXTILE	BOTH IP/OP	"$1,244.88 "	$921.21	$0.00	"$1,264.40"	$711.23	$711.23	$0.00	$0.00	$0.00	$259.46	$923.95	$923.95	$0.00	$0.00	$259.43	$0.00	$736.34	$736.34	$0.00	$790.25	"$1,251.76"	"$1,264.40"	$0.00		$0.00	$247.35	$0.00	$0.00	$251.62	$0.00	$0.00	$0.00	$0.00	$0.00
PCO2015X	SUP	HCPCS C1781		PCO2015X  -  MESH SURG RECTANGLE OVAL 20X15CM OPTIMIZE COMPOSITE 2 SIDE	BOTH IP/OP	"$1,525.73 "	"$1,129.04"	$0.00	"$1,549.94"	$871.84	$871.84	$0.00	$0.00	$0.00	$318.00	"$1,132.39"	"$1,132.39"	$0.00	$0.00	$317.96	$0.00	$902.47	$902.47	$0.00	$968.71	"$1,534.44"	"$1,549.94"	$0.00		$0.00	$303.21	$0.00	$0.00	$308.44	$0.00	$0.00	$0.00	$0.00	$0.00
PCO20X	SUP	HCPCS C1781		PCO20X  -  MESH SURG ROUND 20CM 8IN COMPOSITE OPTIMIZE PROPRIETARY	BOTH IP/OP	"$1,830.70 "	"$1,354.72"	$0.00	"$2,564.92"	"$1,442.77"	"$1,442.77"	$0.00	$0.00	$0.00	$381.56	"$1,358.75"	"$1,358.75"	$0.00	$0.00	$381.52	$0.00	"$1,082.86"	"$1,082.86"	$0.00	"$1,603.08"	"$2,539.27"	"$2,564.92"	$0.00		$0.00	$501.76	$0.00	$0.00	$510.42	$0.00	$0.00	$0.00	$0.00	$0.00
PCO2520OS	SUP	HCPCS C1781		PCO2520OS  -  MESH SRG RECT RND 10X8IN STRL LF PARIETEX OPN SKRT OPTIMIZE	BOTH IP/OP	"$4,387.38 "	"$3,246.66"	$0.00	"$3,509.90"	"$1,974.32"	"$1,974.32"	$0.00	$0.00	$0.00	$914.44	"$3,256.31"	"$3,256.31"	$0.00	$0.00	$914.33	$0.00	"$2,162.98"	"$2,162.98"	$0.00	"$2,193.69"	"$3,474.80"	"$3,509.90"	$0.00		$0.00	$686.62	$0.00	$0.00	$698.47	$0.00	$0.00	$0.00	$0.00	$0.00
PCO2520X	SUP	HCPCS C1781		PCO2520X  -  MESH SURG RECTANGLE OVAL 25X20CM 2 SIDE OPTIMIZE COMPOSITE	BOTH IP/OP	"$2,318.93 "	"$1,716.01"	$0.00	"$2,355.72"	"$1,325.09"	"$1,325.09"	$0.00	$0.00	$0.00	$483.32	"$1,721.11"	"$1,721.11"	$0.00	$0.00	$483.26	$0.00	"$1,371.64"	"$1,371.64"	$0.00	"$1,472.33"	"$2,332.16"	"$2,355.72"	$0.00		$0.00	$460.84	$0.00	$0.00	$468.79	$0.00	$0.00	$0.00	$0.00	$0.00
PCO3020	SUP	HCPCS C1781		PCO3020  -  MESH SRG RECT 12X8IN PARIETEX RSRB COMP SKRT RECT PLSTR	BOTH IP/OP	"$4,471.20 "	"$3,308.69"	$0.00	"$3,576.96"	"$2,012.04"	"$2,012.04"	$0.00	$0.00	$0.00	$931.91	"$3,318.52"	"$3,318.52"	$0.00	$0.00	$931.80	$0.00	"$2,204.30"	"$2,204.30"	$0.00	"$2,235.60"	"$3,541.19"	"$3,576.96"	$0.00		$0.00	$699.74	$0.00	$0.00	$711.82	$0.00	$0.00	$0.00	$0.00	$0.00
PCO3020X	SUP	HCPCS C1781		PCO3020X  -  MESH SURG RECTANGLE OVAL 30X20CM OPTIMIZE COMPOSITE TEXTILE	BOTH IP/OP	"$3,170.33 "	"$2,346.04"	$0.00	"$3,220.64"	"$1,811.61"	"$1,811.61"	$0.00	$0.00	$0.00	$660.77	"$2,353.02"	"$2,353.02"	$0.00	$0.00	$660.70	$0.00	"$1,562.97"	"$1,562.97"	$0.00	"$2,012.90"	"$3,188.43"	"$3,220.64"	$0.00		$0.00	$630.04	$0.00	$0.00	$640.91	$0.00	$0.00	$0.00	$0.00	$0.00
PCO3728	SUP	HCPCS C1781		PCO3728  -  MESH SRG RECT 14.5X11IN LF PARIETEX 3D WV RSRB COMP PLSTR	BOTH IP/OP	"$5,309.55 "	"$3,929.07"	$0.00	"$4,247.64"	"$2,389.30"	"$2,389.30"	$0.00	$0.00	$0.00	"$1,106.64"	"$3,940.75"	"$3,940.75"	$0.00	$0.00	"$1,106.51"	$0.00	"$2,617.61"	"$2,617.61"	$0.00	"$2,654.78"	"$4,205.16"	"$4,247.64"	$0.00		$0.00	$830.94	$0.00	$0.00	$845.28	$0.00	$0.00	$0.00	$0.00	$0.00
PCO8OSX	SUP	HCPCS C1781		PCO8OSX  -  PARIETEX DUAL MESH POLYESTER SKIRTED 8 CM ROUND	BOTH IP/OP	"$1,147.35 "	$849.04	$0.00	$917.88	$516.31	$516.31	$0.00	$0.00	$0.00	$239.14	$851.56	$851.56	$0.00	$0.00	$239.11	$0.00	$678.66	$678.66	$0.00	$573.68	$908.70	$917.88	$0.00		$0.00	$179.56	$0.00	$0.00	$182.66	$0.00	$0.00	$0.00	$0.00	$0.00
PCO9	SUP	HCPCS C1781		PCO9  -  MESH SRG RND 3.6IN STRL PARIETEX RND RSRB 3D WV PLSTR VNTRL	BOTH IP/OP	$958.53 	$709.31	$0.00	$766.82	$431.34	$431.34	$0.00	$0.00	$0.00	$199.78	$711.42	$711.42	$0.00	$0.00	$199.76	$0.00	$566.97	$566.97	$0.00	$479.26	$759.16	$766.82	$0.00		$0.00	$150.01	$0.00	$0.00	$152.60	$0.00	$0.00	$0.00	$0.00	$0.00
PCO9X	SUP	HCPCS C1781		PCO9X  -  MESH SURG ROUND 9CM OPTIMIZE COMPOSITE PROPRIETARY TEXTILE	BOTH IP/OP	$231.17 	$171.07	$0.00	$234.84	$132.10	$132.10	$0.00	$0.00	$0.00	$48.18	$171.57	$171.57	$0.00	$0.00	$48.18	$0.00	$136.74	$136.74	$0.00	$146.78	$232.49	$234.84	$0.00		$0.00	$45.94	$0.00	$0.00	$46.73	$0.00	$0.00	$0.00	$0.00	$0.00
PCP 050 120 130	SUP	HCPCS C1725		PCP 050 120 130  -  CATHETER BLNDIL 5MM 130CM 120MM PCFC + OTW LOPRFL COAX	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$305.44	$305.44	$0.00	$0.00	$0.00	$117.24	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$332.72	$332.72	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$88.03	$0.00	$0.00	$89.55	$0.00	$0.00	$0.00	$0.00	$0.00
PD0606	SUP	Custom 27803010		PD0606  -  PATCH BIOLOGICAL L6 CM X W6 CM W PORCINE DERMIS SOFT TISSUE	BOTH IP/OP	"$1,566.00 "	"$1,158.84"	$0.00	"$1,252.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,162.29"	"$1,162.29"	$0.00	$0.00	$326.35	$0.00	$0.00	$0.00	$0.00	$783.00	"$1,240.27"	"$1,252.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PD0808	SUP	Custom 27803010		PD0808  -  PATCH BIOLOGICAL L8 CM X W8 CM W PORCINE DERMIS SOFT TISSUE	BOTH IP/OP	"$2,784.00 "	"$2,060.16"	$0.00	"$2,227.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,066.28"	"$2,066.28"	$0.00	$0.00	$580.19	$0.00	$0.00	$0.00	$0.00	"$1,392.00"	"$2,204.93"	"$2,227.20"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PD0822	SUP	Custom 27803010		PD0822  -  PATCH BIOLOGICAL L22 CM X W8 CM W PORCINE DERMIS SOFT TISSUE	BOTH IP/OP	"$7,656.00 "	"$5,665.44"	$0.00	"$6,124.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,595.51"	$0.00	$0.00	$0.00	$0.00	"$3,828.00"	"$6,063.55"	"$6,124.80"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PD1010	SUP	Custom 27803010		PD1010  -  PATCH BIOLOGICAL L10 CM X W10 CM W PORCINE DERMIS SOFT TISSU	BOTH IP/OP	"$4,350.00 "	"$3,219.00"	$0.00	"$3,480.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,228.57"	"$3,228.57"	$0.00	$0.00	$906.54	$0.00	$0.00	$0.00	$0.00	"$2,175.00"	"$3,445.20"	"$3,480.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PD1016	SUP	Custom 27803010		PD1016  -  PATCH BIOLOGICAL L10 CM X W16 CM W PORCINE DERMIS SOFT TISSU	BOTH IP/OP	"$6,960.00 "	"$5,150.40"	$0.00	"$5,568.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,450.46"	$0.00	$0.00	$0.00	$0.00	"$3,480.00"	"$5,512.32"	"$5,568.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PD1025	SUP	Custom 27803010		PD1025  -  PATCH BIOLOGICAL L10 CM X W25 CM W PORCINE DERMIS SOFT TISSU	BOTH IP/OP	"$10,875.00 "	"$8,047.50"	$0.00	"$8,700.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,266.35"	$0.00	$0.00	$0.00	$0.00	"$5,437.50"	"$8,613.00"	"$8,700.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PD1620	SUP	Custom 27803010		PD1620  -  PATCH BIOLOGICAL L16 CM X W20 CM W PORCINE DERMIS SOFT TISSU	BOTH IP/OP	"$13,920.00 "	"$10,300.80"	$0.00	"$11,136.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,900.93"	$0.00	$0.00	$0.00	$0.00	"$6,960.00"	"$11,024.64"	"$11,136.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PD2020	SUP	Custom 27803010		PD2020  -  PATCH BIOLOGICAL L20 CM X W20 CM W PORCINE DERMIS SOFT TISSU	BOTH IP/OP	"$17,400.00 "	"$12,876.00"	$0.00	"$13,920.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,626.16"	$0.00	$0.00	$0.00	$0.00	"$8,700.00"	"$13,780.80"	"$13,920.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PD2025	SUP	Custom 27803010		PD2025  -  PATCH BIOLOGICAL L25 CM X W20 CM W PORCINE DERMIS SOFT TISSU	BOTH IP/OP	"$21,750.00 "	"$16,095.00"	$0.00	"$17,400.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,532.70"	$0.00	$0.00	$0.00	$0.00	"$10,875.00"	"$17,226.00"	"$17,400.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PD2035	SUP	Custom 27803010		PD2035  -  PATCH BIOLOGICAL L35 CM X W20 CM W PORCINE DERMIS SOFT TISSU	BOTH IP/OP	"$30,450.00 "	"$22,533.00"	$0.00	"$24,360.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,345.78"	$0.00	$0.00	$0.00	$0.00	"$15,225.00"	"$24,116.40"	"$24,360.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PD3030	SUP	Custom 27803010		PD3030  -  PATCH BIOLOGICAL L30 CM X W30 CM W PORCINE DERMIS SOFT TISSU	BOTH IP/OP	"$39,150.00 "	"$28,971.00"	$0.00	"$31,320.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,158.86"	$0.00	$0.00	$0.00	$0.00	"$19,575.00"	"$31,006.80"	"$31,320.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PD-31-200	SUP	HCPCS C1713		PD-31-200  -  CAGE SPNL B STRL DTRAX TI CRV	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
PD-31-201	SUP	HCPCS C1713		PD-31-201  -  CAVUX CERVICAL CAGE B 5MM	BOTH IP/OP	"$4,375.00 "	"$3,237.50"	$0.00	"$3,500.00"	"$1,968.75"	"$1,968.75"	$0.00	$0.00	$0.00	$911.86	"$3,247.13"	"$3,247.13"	$0.00	$0.00	$911.75	$0.00	"$2,156.88"	"$2,156.88"	$0.00	"$2,187.50"	"$3,465.00"	"$3,500.00"	$0.00		$0.00	$684.69	$0.00	$0.00	$696.50	$0.00	$0.00	$0.00	$0.00	$0.00
PD-32-301	SUP	HCPCS C1713		PD-32-301  -  DTRAX BONE SCREW	BOTH IP/OP	"$1,000.00 "	$740.00	$0.00	$800.00	$450.00	$450.00	$0.00	$0.00	$0.00	$208.43	$742.20	$742.20	$0.00	$0.00	$208.40	$0.00	$591.50	$591.50	$0.00	$500.00	$792.00	$800.00	$0.00		$0.00	$156.50	$0.00	$0.00	$159.20	$0.00	$0.00	$0.00	$0.00	$0.00
PD3535	SUP	Custom 27803010		PD3535  -  PATCH BIOLOGICAL L35 CM X W35 CM W PORCINE DERMIS SOFT TISSU	BOTH IP/OP	"$52,925.00 "	"$39,164.50"	$0.00	"$42,340.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$11,029.57"	$0.00	$0.00	$0.00	$0.00	"$26,462.50"	"$41,916.60"	"$42,340.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PDG-AIM-015	SUP	HCPCS C1713		PDG-AIM-015  -  GUIDE SURG 1.5MM AIMING GEMINUS VOLAR DISTAL RAD	BOTH IP/OP	$75.00 	$55.50	$0.00	$60.00	$33.75	$33.75	$0.00	$0.00	$0.00	$15.63	$55.67	$55.67	$0.00	$0.00	$15.63	$0.00	$44.36	$44.36	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
PF-20	SUP	HCPCS C1729		PF-20  -  CATHETER DRN 20FR STRL ACT CLRNC TCH PLEURAFLOW CHST TUBE	BOTH IP/OP	$968.75 	$716.88	$0.00	$775.00	$526.03	$526.03	$0.00	$0.00	$0.00	$201.91	$719.01	$719.01	$0.00	$0.00	$201.89	$0.00	$573.02	$573.02	$0.00	$484.38	$767.25	$775.00	$0.00		$0.00	$151.61	$0.00	$0.00	$154.23	$0.00	$0.00	$0.00	$0.00	$0.00
PF-24	SUP	HCPCS C1729		PF-24  -  CATHETER DRN 24FR STRL PLEURAFLOW ACT CLRNC TCH CHST TUBE	BOTH IP/OP	$912.50 	$675.25	$0.00	$730.00	$495.49	$495.49	$0.00	$0.00	$0.00	$190.19	$677.26	$677.26	$0.00	$0.00	$190.17	$0.00	$539.74	$539.74	$0.00	$456.25	$722.70	$730.00	$0.00		$0.00	$142.81	$0.00	$0.00	$145.27	$0.00	$0.00	$0.00	$0.00	$0.00
PF-28	SUP	HCPCS C1729		PF-28  -  CATHETER DRN 28FR STRL ACT CLRNC TCH PLEURAFLOW CHST TUBE	BOTH IP/OP	$912.50 	$675.25	$0.00	$730.00	$495.49	$495.49	$0.00	$0.00	$0.00	$190.19	$677.26	$677.26	$0.00	$0.00	$190.17	$0.00	$539.74	$539.74	$0.00	$456.25	$722.70	$730.00	$0.00		$0.00	$142.81	$0.00	$0.00	$145.27	$0.00	$0.00	$0.00	$0.00	$0.00
PF-32	SUP	HCPCS C1729		PF-32  -  CATHETER DRN 32FR PLEURAFLOW ACT CLRNC TCH	BOTH IP/OP	$912.50 	$675.25	$0.00	$730.00	$495.49	$495.49	$0.00	$0.00	$0.00	$190.19	$677.26	$677.26	$0.00	$0.00	$190.17	$0.00	$539.74	$539.74	$0.00	$456.25	$722.70	$730.00	$0.00		$0.00	$142.81	$0.00	$0.00	$145.27	$0.00	$0.00	$0.00	$0.00	$0.00
PFF0025	SUP	HCPCS C1713		PFF0025  -  SCREW PFF0025 25MM FACET FIXATION ANCHOR	BOTH IP/OP	"$5,940.00 "	"$4,395.60"	$0.00	"$4,752.00"	"$2,673.00"	"$2,673.00"	$0.00	$0.00	$0.00	"$1,238.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,237.90"	$0.00	"$2,928.42"	"$2,928.42"	$0.00	"$2,970.00"	"$4,704.48"	"$4,752.00"	$0.00		$0.00	$929.61	$0.00	$0.00	$945.65	$0.00	$0.00	$0.00	$0.00	$0.00
PFF0030	SUP	HCPCS C1713		PFF0030  -  SCREW PFF0030 30MM FACET FIXATION ANCHOR	BOTH IP/OP	"$5,940.00 "	"$4,395.60"	$0.00	"$4,752.00"	"$2,673.00"	"$2,673.00"	$0.00	$0.00	$0.00	"$1,238.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,237.90"	$0.00	"$2,928.42"	"$2,928.42"	$0.00	"$2,970.00"	"$4,704.48"	"$4,752.00"	$0.00		$0.00	$929.61	$0.00	$0.00	$945.65	$0.00	$0.00	$0.00	$0.00	$0.00
PFF0035	SUP	HCPCS C1713		PFF0035  -  SCREW PFF0035 35MM FACET FIXATION ANCHOR	BOTH IP/OP	"$5,940.00 "	"$4,395.60"	$0.00	"$4,752.00"	"$2,673.00"	"$2,673.00"	$0.00	$0.00	$0.00	"$1,238.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,237.90"	$0.00	"$2,928.42"	"$2,928.42"	$0.00	"$2,970.00"	"$4,704.48"	"$4,752.00"	$0.00		$0.00	$929.61	$0.00	$0.00	$945.65	$0.00	$0.00	$0.00	$0.00	$0.00
PFF0040	SUP	HCPCS C1713		PFF0040  -  SCREW PFF0040 40MM FACET FIXATION ANCHOR	BOTH IP/OP	"$5,940.00 "	"$4,395.60"	$0.00	"$4,752.00"	"$2,673.00"	"$2,673.00"	$0.00	$0.00	$0.00	"$1,238.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,237.90"	$0.00	"$2,928.42"	"$2,928.42"	$0.00	"$2,970.00"	"$4,704.48"	"$4,752.00"	$0.00		$0.00	$929.61	$0.00	$0.00	$945.65	$0.00	$0.00	$0.00	$0.00	$0.00
PGEN00506	SUP	Custom 27203010		PGEN00506  -  TIP APPLICATOR 6IN SPRAY EXTENDED ERGONOMIC APPLICATOR	BOTH IP/OP	"$1,390.00 "	"$1,028.60"	$0.00	"$1,031.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,031.66"	"$1,031.66"	$0.00	$0.00	$289.68	$0.00	$0.00	$0.00	$0.00	$425.00	$673.20	$680.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PGPS002	SUP	Custom 27203010		PGPS002  -  SEALANT PROGEL PLEURAL AIR LEAK	BOTH IP/OP	"$2,453.75 "	"$1,815.78"	$0.00	"$1,821.17"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,821.17"	"$1,821.17"	$0.00	$0.00	$511.36	$0.00	$0.00	$0.00	$0.00	"$1,037.50"	"$1,643.40"	"$1,660.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PHSE6	SUP	HCPCS C1781		PHSE6  -  MESH HERN POLYPRO 4 15/16INX2 5/32INX.5IN NABSB SFT KNTD	BOTH IP/OP	"$1,704.02 "	"$1,260.97"	$0.00	"$1,363.22"	$766.81	$766.81	$0.00	$0.00	$0.00	$355.16	"$1,264.72"	"$1,264.72"	$0.00	$0.00	$355.12	$0.00	"$1,007.93"	"$1,007.93"	$0.00	$852.01	"$1,349.58"	"$1,363.22"	$0.00		$0.00	$266.68	$0.00	$0.00	$271.28	$0.00	$0.00	$0.00	$0.00	$0.00
PHSM	SUP	HCPCS C1781		PHSM  -  MESH SURG 3IN 3D MEDIUM 2 15/16IN .75IN 3 15/16INX1.75INX.5	BOTH IP/OP	$882.48 	$653.04	$0.00	$705.99	$397.12	$397.12	$0.00	$0.00	$0.00	$183.93	$654.98	$654.98	$0.00	$0.00	$183.91	$0.00	$521.99	$521.99	$0.00	$441.24	$698.92	$705.99	$0.00		$0.00	$138.11	$0.00	$0.00	$140.49	$0.00	$0.00	$0.00	$0.00	$0.00
PHSM6	SUP	HCPCS C1781		PHSM6  -  MESH HERN POLYPRO 3 15/16INX1.75INX.5IN NABSB SFT KNTD PRLN	BOTH IP/OP	"$1,704.02 "	"$1,260.97"	$0.00	"$1,363.22"	$766.81	$766.81	$0.00	$0.00	$0.00	$355.16	"$1,264.72"	"$1,264.72"	$0.00	$0.00	$355.12	$0.00	"$1,007.93"	"$1,007.93"	$0.00	$852.01	"$1,349.58"	"$1,363.22"	$0.00		$0.00	$266.68	$0.00	$0.00	$271.28	$0.00	$0.00	$0.00	$0.00	$0.00
PHY1015V	SUP	HCPCS C1781		PHY1015V  -  MESH SURG 15X10CM FLEXIBLE COMPOSITE TISSUE SEPARATE LP	BOTH IP/OP	"$1,856.93 "	"$1,374.13"	$0.00	"$1,485.54"	$835.62	$835.62	$0.00	$0.00	$0.00	$387.03	"$1,378.21"	"$1,378.21"	$0.00	$0.00	$386.98	$0.00	"$1,098.37"	"$1,098.37"	$0.00	$928.46	"$1,470.69"	"$1,485.54"	$0.00		$0.00	$290.61	$0.00	$0.00	$295.62	$0.00	$0.00	$0.00	$0.00	$0.00
PHY1520V	SUP	HCPCS C1781		PHY1520V  -  MESH SURG 20X15CM FLEXIBLE COMPOSITE TISSUE SEPARATE LP OVAL	BOTH IP/OP	"$3,372.53 "	"$2,495.67"	$0.00	"$2,698.02"	"$1,517.64"	"$1,517.64"	$0.00	$0.00	$0.00	$702.92	"$2,503.09"	"$2,503.09"	$0.00	$0.00	$702.83	$0.00	"$1,662.65"	"$1,662.65"	$0.00	"$1,686.26"	"$2,671.04"	"$2,698.02"	$0.00		$0.00	$527.80	$0.00	$0.00	$536.91	$0.00	$0.00	$0.00	$0.00	$0.00
PHY2025V	SUP	HCPCS C1781		PHY2025V  -  MESH SURG 25X20CM FLEXIBLE COMPOSITE TISSUE SEPARATE LP	BOTH IP/OP	"$5,461.58 "	"$4,041.57"	$0.00	"$4,369.26"	"$2,457.71"	"$2,457.71"	$0.00	$0.00	$0.00	"$1,138.33"	"$4,053.58"	"$4,053.58"	$0.00	$0.00	"$1,138.19"	$0.00	"$2,692.56"	"$2,692.56"	$0.00	"$2,730.79"	"$4,325.57"	"$4,369.26"	$0.00		$0.00	$854.74	$0.00	$0.00	$869.48	$0.00	$0.00	$0.00	$0.00	$0.00
PHY2030R	SUP	HCPCS C1781		PHY2030R  -  MESH SURG 30X20CM FLEXIBLE COMPOSITE TISSUE SEPARATE	BOTH IP/OP	"$5,891.08 "	"$4,359.40"	$0.00	"$4,712.86"	"$2,650.98"	"$2,650.98"	$0.00	$0.00	$0.00	"$1,227.85"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,227.70"	$0.00	"$2,904.30"	"$2,904.30"	$0.00	"$2,945.54"	"$4,665.74"	"$4,712.86"	$0.00		$0.00	$921.95	$0.00	$0.00	$937.86	$0.00	$0.00	$0.00	$0.00	$0.00
PIC-301-IK	SUP	HCPCS C1729		PIC LINE 3FR	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
PIKA	SUP	Custom 27203010		PIKA  -  PERCUTANEOUS INSERTION KIT ARTERIAL	BOTH IP/OP	$157.63 	$116.65	$0.00	$126.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.99	$116.99	$0.00	$0.00	$32.85	$0.00	$0.00	$0.00	$0.00	$78.81	$124.84	$126.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PIKV	SUP	Custom 27203010		PIKV  -  KIT CATH INS .038IN 18GA 11 SCPL INS NDL SYR GW DIL VN PERC	BOTH IP/OP	$159.99 	$118.39	$0.00	$127.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.74	$118.74	$0.00	$0.00	$33.34	$0.00	$0.00	$0.00	$0.00	$79.99	$126.71	$127.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PJN1976284	SUP	HCPCS C1898		PJN1976284  -  LEAD PCMKR 58CM CP NV AV STRD-ELUT SIL BIPOL ACT PJN1976284	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$675.00	$675.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$234.75	$0.00	$0.00	$238.80	$0.00	$0.00	$0.00	$0.00	$0.00
PK-16	SUP	HCPCS V2790		PK-16  -  GRAFT SFT TIS THK50-100UM 16MM AMNIOGRAFT PROKERA AMNIO	BOTH IP/OP	"$2,372.50 "	"$1,755.65"	$0.00	"$1,790.00"	"$1,006.88"	"$1,006.88"	$0.00	$0.00	$0.00	$494.49	"$1,760.87"	"$1,760.87"	$0.00	$0.00	$494.43	$0.00	"$1,403.33"	"$1,403.33"	$0.00	"$1,118.75"	"$1,772.10"	"$1,790.00"	$0.00		$0.00	$350.17	$0.00	$0.00	$356.21	$0.00	$0.00	$0.00	$0.00	$0.00
PL-2080	SUP	HCPCS C1713		PL-2080  -  SCREW BN CNTRSNK CO CA	BOTH IP/OP	$352.50 	$260.85	$0.00	$282.00	$158.63	$158.63	$0.00	$0.00	$0.00	$73.47	$261.63	$261.63	$0.00	$0.00	$73.46	$0.00	$208.50	$208.50	$0.00	$176.25	$279.18	$282.00	$0.00		$0.00	$55.17	$0.00	$0.00	$56.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLA230300	SUP	Custom 27806190		PLA230300  -  GRAFT EVAS 23MM 19-21MM 3.3CM AORTA	BOTH IP/OP	"$8,932.50 "	"$6,610.05"	$0.00	"$6,350.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,861.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,861.53"	$0.00	"$4,403.72"	"$4,403.72"	$0.00	"$3,968.75"	"$6,286.50"	"$6,350.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PLA320400	SUP	HCPCS C1874		PLA320400  -  GRAFT EVAS 32MM 27-29MM 4.5CM XCLDR STNT XTD ABRSN RST	BOTH IP/OP	"$8,932.50 "	"$6,610.05"	$0.00	"$6,508.00"	"$3,660.75"	"$3,660.75"	$0.00	$0.00	$0.00	"$1,861.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,861.53"	$0.00	"$4,403.72"	"$4,403.72"	$0.00	"$4,067.50"	"$6,442.92"	"$6,508.00"	$0.00		$0.00	"$1,273.13"	$0.00	$0.00	"$1,295.09"	$0.00	$0.00	$0.00	$0.00	$0.00
PL-BG07	SUP	Custom 27203010		PL-BG07  -  BIT DRILL 7MM BNGFT HRVT	BOTH IP/OP	$852.50 	$630.85	$0.00	$682.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.73	$632.73	$0.00	$0.00	$177.66	$0.00	$0.00	$0.00	$0.00	$426.25	$675.18	$682.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PL-BSWDL	SUP	HCPCS C1713		PL-BSWDL  -  PLATE BN NS WDG LT 1ST MTP	BOTH IP/OP	"$1,592.50 "	"$1,178.45"	$0.00	"$1,274.00"	$716.63	$716.63	$0.00	$0.00	$0.00	$331.92	"$1,181.95"	"$1,181.95"	$0.00	$0.00	$331.88	$0.00	$941.96	$941.96	$0.00	$796.25	"$1,261.26"	"$1,274.00"	$0.00		$0.00	$249.23	$0.00	$0.00	$253.53	$0.00	$0.00	$0.00	$0.00	$0.00
PL-BSWDR	SUP	HCPCS C1713		PL-BSWDR  -  PLATE BN NS WDG TI RT MTRSL OSTM	BOTH IP/OP	"$1,592.50 "	"$1,178.45"	$0.00	"$1,274.00"	$716.63	$716.63	$0.00	$0.00	$0.00	$331.92	"$1,181.95"	"$1,181.95"	$0.00	$0.00	$331.88	$0.00	$941.96	$941.96	$0.00	$796.25	"$1,261.26"	"$1,274.00"	$0.00		$0.00	$249.23	$0.00	$0.00	$253.53	$0.00	$0.00	$0.00	$0.00	$0.00
PLC141400	SUP	HCPCS C1874		PLC141400  -  GRAFT EVAS 14.5MM 12-13.5MM 14CM GORE XCLDR CNTRLT LG AAA	BOTH IP/OP	"$12,695.00 "	"$9,394.30"	$0.00	"$9,246.00"	"$5,200.88"	"$5,200.88"	$0.00	$0.00	$0.00	"$2,645.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,645.64"	$0.00	"$6,258.64"	"$6,258.64"	$0.00	"$5,778.75"	"$9,153.54"	"$9,246.00"	$0.00		$0.00	"$1,808.75"	$0.00	$0.00	"$1,839.95"	$0.00	$0.00	$0.00	$0.00	$0.00
PLC161000	SUP	HCPCS C1876		PLC161000  -  GRAFT EVAS 16MM 13.5-14.5MM 9.5CM XCLDR STNT ABRSN RST	BOTH IP/OP	"$12,695.00 "	"$9,394.30"	$0.00	"$9,020.00"	"$5,073.75"	"$5,073.75"	$0.00	$0.00	$0.00	"$2,645.96"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,645.64"	$0.00	"$6,258.64"	"$6,258.64"	$0.00	"$5,637.50"	"$8,929.80"	"$9,020.00"	$0.00		$0.00	"$1,764.54"	$0.00	$0.00	"$1,794.98"	$0.00	$0.00	$0.00	$0.00	$0.00
PL-CL6SL	SUP	HCPCS C1713		PL-CL6SL  -  PLATE SM TI 6 HOLE LCK BONE LEFT CLVCL NONSTRL	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
PL-CL6SR	SUP	HCPCS C1713		PL-CL6SR  -  PLATE SM 5MM TI 6 HOLE LCK ACUMED BONE RIGHT CLVCL NONSTRL	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
PL-CL8JR	SUP	HCPCS C1713		PL-CL8JR  -  PLATE TI 8 HOLE J LCK SYS BONE RIGHT CLVCL SHLDR STRL	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
PL-CL8LL	SUP	HCPCS C1713		PL-CL8LL  -  PLATE LG TI 8 HOLE LCK BONE CLVCL STRL	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
PL-CL8LR	SUP	HCPCS C1713		PL-CL8LR  -  PLATE LG TI 8 HOLE LCK ACUMED BONE RIGHT CLVCL SHLDR STRL	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DL26	SUP	HCPCS C1713		PL-DL26  -  PLATE BN 26MM LT DRSL RADL	BOTH IP/OP	"$1,115.00 "	$825.10	$0.00	$892.00	$501.75	$501.75	$0.00	$0.00	$0.00	$232.39	$827.55	$827.55	$0.00	$0.00	$232.37	$0.00	$659.52	$659.52	$0.00	$557.50	$883.08	$892.00	$0.00		$0.00	$174.50	$0.00	$0.00	$177.51	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DMTPL	SUP	HCPCS C1713		PL-DMTPL  -  PLATE TI FSN BONE LEFT DORSAL MTP NONSTRL	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DMTPR	SUP	HCPCS C1713		PL-DMTPR  -  PLATE TI BONE RIGHT DORSAL 1ST MTP NONSTRL	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DR26	SUP	HCPCS C1713		PL-DR26  -  PLATE BN 26MM NS TI RT DIST DRSL RADL	BOTH IP/OP	"$1,115.00 "	$825.10	$0.00	$892.00	$501.75	$501.75	$0.00	$0.00	$0.00	$232.39	$827.55	$827.55	$0.00	$0.00	$232.37	$0.00	$659.52	$659.52	$0.00	$557.50	$883.08	$892.00	$0.00		$0.00	$174.50	$0.00	$0.00	$177.51	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DR30L	SUP	HCPCS C1713		PL-DR30L  -  PLATE BN NAR ACLC RDS LT DIST VOLR	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DR30R	SUP	HCPCS C1713		PL-DR30R  -  PLATE BN NAR ACLC RDS RT DIST VOLR	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DR50L	SUP	HCPCS C1713		PL-DR50L  -  PLATE BN STD ACLC RDS LT DIST VOLR	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DR50R	SUP	HCPCS C1713		PL-DR50R  -  PLATE BN STD ACLC RDS RT DIST VOLR	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PLDR60L	SUP	HCPCS C1713		PLDR60L  -  PLATE LNG STD BONE LEFT DISTAL RADL	BOTH IP/OP	"$1,737.50 "	"$1,285.75"	$0.00	"$1,390.00"	$781.88	$781.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$868.75	"$1,376.10"	"$1,390.00"	$0.00		$0.00	$271.92	$0.00	$0.00	$276.61	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DR60L	SUP	HCPCS C1713		PL-DR60L  -  PLATE LNG 60MM TI 6 HOLE ACLC BONE LEFT DISTAL VOLR RADL	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DR60R	SUP	HCPCS C1713		PL-DR60R  -  PLATE BN LNG ACLC RDS RT DIST VOLR	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DR65L	SUP	HCPCS C1713		PL-DR65L  -  PLATE XL ACLC BONE LEFT RADL DISTAL WR HND NONSTRL	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DR65R	SUP	HCPCS C1713		PL-DR65R  -  PLATE XLNG TI ACLC BONE RIGHT DISTAL RADL WR HND STRL	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DR70L	SUP	HCPCS C1713		PL-DR70L  -  PLATE W ACLC BONE LEFT DISTAL RADL WR HND STRL	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PL-DR70R	SUP	HCPCS C1713		PL-DR70R  -  PLATE BN W ACLC RDS RT DIST VOLR	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PLDS15	SUP	Custom 27203010		PLDS15  -  STAPLER INTNL ANG RT 15MM STRL LF LDS LNR CUT LKOUT PRELD TI	BOTH IP/OP	"$1,015.55 "	$751.51	$0.00	$812.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$753.74	$753.74	$0.00	$0.00	$211.64	$0.00	$0.00	$0.00	$0.00	$507.78	$804.32	$812.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PL-ELCLL	SUP	HCPCS C1713		PL-ELCLL  -  PLATE TI XTD BONE LEFT CORONOID NONSTRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-ELCLR	SUP	HCPCS C1713		PL-ELCLR  -  PLATE BN NS XTD LCK TI ELB RT CORONOID	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-ELCOL	SUP	HCPCS C1713		PL-ELCOL  -  PLATE BN SM NS TI ELB LT CORONOID	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-ELCOR	SUP	HCPCS C1713		PL-ELCOR  -  PLATE BN NS TI ELB RT CORONOID	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-ELLXL	SUP	HCPCS C1713		PL-ELLXL  -  PLATE XLNG TI BONE L/L EPCND ELB	BOTH IP/OP	"$1,847.35 "	"$1,367.04"	$0.00	"$1,477.88"	$831.31	$831.31	$0.00	$0.00	$0.00	$385.03	"$1,371.10"	"$1,371.10"	$0.00	$0.00	$384.99	$0.00	"$1,092.71"	"$1,092.71"	$0.00	$923.68	"$1,463.10"	"$1,477.88"	$0.00		$0.00	$289.11	$0.00	$0.00	$294.10	$0.00	$0.00	$0.00	$0.00	$0.00
PL-ELPO	SUP	HCPCS C1713		PL-ELPO  -  PLATE BN POST ELB	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-ELRD	SUP	HCPCS C1713		PL-ELRD  -  PLATE TI 7 HOLE BONE RADL HEAD NONSTRL	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
PL-ELT1027	SUP	Custom 27100030		PL-ELT1027  -  TAP 2.7MM 2.7MM QRLSE SURG ELB ACUMED 2MM SCR	BOTH IP/OP	$565.00 	$418.10	$0.00	$452.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$419.34	$419.34	$0.00	$0.00	$117.75	$0.00	$0.00	$0.00	$0.00	$282.50	$447.48	$452.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PL-ELT1035	SUP	HCPCS C1713		PL-ELT1035  -  PLATE TI 3.5MM SCR TAP BONE 3.5MM ELB NONSTRL DISP	BOTH IP/OP	$565.00 	$418.10	$0.00	$452.00	$254.25	$254.25	$0.00	$0.00	$0.00	$117.76	$419.34	$419.34	$0.00	$0.00	$117.75	$0.00	$334.20	$334.20	$0.00	$282.50	$447.48	$452.00	$0.00		$0.00	$88.42	$0.00	$0.00	$89.95	$0.00	$0.00	$0.00	$0.00	$0.00
PL-FIB11	SUP	HCPCS C1713		PL-FIB11  -  PLATE TI 11 HOLE BONE LAT MLR FIB NONSTRL	BOTH IP/OP	"$1,017.50 "	$752.95	$0.00	$814.00	$457.88	$457.88	$0.00	$0.00	$0.00	$212.07	$755.19	$755.19	$0.00	$0.00	$212.05	$0.00	$601.85	$601.85	$0.00	$508.75	$805.86	$814.00	$0.00		$0.00	$159.24	$0.00	$0.00	$161.99	$0.00	$0.00	$0.00	$0.00	$0.00
PL-FIB5	SUP	HCPCS C1713		PL-FIB5  -  PLATE TI 5 HOLE BONE FIB NONSTRL	BOTH IP/OP	"$1,017.50 "	$752.95	$0.00	$814.00	$457.88	$457.88	$0.00	$0.00	$0.00	$212.07	$755.19	$755.19	$0.00	$0.00	$212.05	$0.00	$601.85	$601.85	$0.00	$508.75	$805.86	$814.00	$0.00		$0.00	$159.24	$0.00	$0.00	$161.99	$0.00	$0.00	$0.00	$0.00	$0.00
PL-FIB7	SUP	HCPCS C1713		PL-FIB7  -  PLATE TI 7 HOLE BONE FIB NONSTRL	BOTH IP/OP	"$1,017.50 "	$752.95	$0.00	$814.00	$457.88	$457.88	$0.00	$0.00	$0.00	$212.07	$755.19	$755.19	$0.00	$0.00	$212.05	$0.00	$601.85	$601.85	$0.00	$508.75	$805.86	$814.00	$0.00		$0.00	$159.24	$0.00	$0.00	$161.99	$0.00	$0.00	$0.00	$0.00	$0.00
PL-FIB9	SUP	HCPCS C1713		PL-FIB9  -  PLATE TI 9 HOLE BONE LAT MLR FIB NONSTRL	BOTH IP/OP	"$1,017.50 "	$752.95	$0.00	$814.00	$457.88	$457.88	$0.00	$0.00	$0.00	$212.07	$755.19	$755.19	$0.00	$0.00	$212.05	$0.00	$601.85	$601.85	$0.00	$508.75	$805.86	$814.00	$0.00		$0.00	$159.24	$0.00	$0.00	$161.99	$0.00	$0.00	$0.00	$0.00	$0.00
PL-GLD3	SUP	HCPCS C1713		PL-GLD3  -  PLATE TI 3 HOLE GLD BONE MLR NONSTRL	BOTH IP/OP	"$1,017.50 "	$752.95	$0.00	$814.00	$457.88	$457.88	$0.00	$0.00	$0.00	$212.07	$755.19	$755.19	$0.00	$0.00	$212.05	$0.00	$601.85	$601.85	$0.00	$508.75	$805.86	$814.00	$0.00		$0.00	$159.24	$0.00	$0.00	$161.99	$0.00	$0.00	$0.00	$0.00	$0.00
PL-GLD5	SUP	HCPCS C1713		PL-GLD5  -  PLATE 5 HOLE GLD BONE	BOTH IP/OP	"$1,017.50 "	$752.95	$0.00	$814.00	$457.88	$457.88	$0.00	$0.00	$0.00	$212.07	$755.19	$755.19	$0.00	$0.00	$212.05	$0.00	$601.85	$601.85	$0.00	$508.75	$805.86	$814.00	$0.00		$0.00	$159.24	$0.00	$0.00	$161.99	$0.00	$0.00	$0.00	$0.00	$0.00
PL-GLD7	SUP	HCPCS C1713		PL-GLD7  -  PLATE TI 7 HOLE GLD BONE MLR NONSTRL	BOTH IP/OP	"$1,017.50 "	$752.95	$0.00	$814.00	$457.88	$457.88	$0.00	$0.00	$0.00	$212.07	$755.19	$755.19	$0.00	$0.00	$212.05	$0.00	$601.85	$601.85	$0.00	$508.75	$805.86	$814.00	$0.00		$0.00	$159.24	$0.00	$0.00	$161.99	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LE011	SUP	HCPCS C1713		PL-LE011  -  PLATE 11 HOLE LCK BONE OLCRN ELB	BOTH IP/OP	"$2,125.00 "	"$1,572.50"	$0.00	"$1,700.00"	$956.25	$956.25	$0.00	$0.00	$0.00	$442.90	"$1,577.18"	"$1,577.18"	$0.00	$0.00	$442.85	$0.00	"$1,256.94"	"$1,256.94"	$0.00	"$1,062.50"	"$1,683.00"	"$1,700.00"	$0.00		$0.00	$332.56	$0.00	$0.00	$338.30	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LE013	SUP	HCPCS C1713		PL-LE013  -  PLATE TI 13 HOLE LCK SYS BONE OLCRN ELB STRL	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LE09	SUP	HCPCS C1713		PL-LE09  -  PLATE STD TI 9 HOLE LCK BONE OLCRN NONSTRL	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEL10L	SUP	HCPCS C1713		PL-LEL10L  -  PLATE BN 100MM NS 10 HL LCK TI ELB L/L	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEL10R	SUP	HCPCS C1713		PL-LEL10R  -  PLATE BN 100MM NS 10 HL LCK TI ELB RL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEL14	SUP	HCPCS C1713		PL-LEL14  -  PLATE 14 HOLE SYS BONE RL ELB STRL	BOTH IP/OP	"$1,875.00 "	"$1,387.50"	$0.00	"$1,500.00"	$843.75	$843.75	$0.00	$0.00	$0.00	$390.80	"$1,391.63"	"$1,391.63"	$0.00	$0.00	$390.75	$0.00	"$1,109.06"	"$1,109.06"	$0.00	$937.50	"$1,485.00"	"$1,500.00"	$0.00		$0.00	$293.44	$0.00	$0.00	$298.50	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEL14L	SUP	HCPCS C1713		PL-LEL14L  -  PLATE TI 14 HOLE LCK BONE L/L ELB STRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEL14R	SUP	HCPCS C1713		PL-LEL14R  -  PLATE XLNG TI 14 HOLE BONE RL EPCND NONSTRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEL20L	SUP	HCPCS C1713		PL-LEL20L  -  PLATE TI 20 HOLE LCK BONE L/L EPCND NONSTRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEL20R	SUP	HCPCS C1713		PL-LEL20R  -  PLATE TI 20 HOLE LCK BONE RL ELB NONSTRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEL6L	SUP	HCPCS C1713		PL-LEL6L  -  PLATE TI 6 HOLE LCK BONE L/L ELB NONSTRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEL6R	SUP	HCPCS C1713		PL-LEL6R  -  PLATE TI 6 HOLE LCK BONE RL ELB NONSTRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEM12	SUP	HCPCS C1713		PL-LEM12  -  PLATE TI 12 HOLE LCK ACUMED BONE MDL ELB NONSTRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEM16	SUP	HCPCS C1713		PL-LEM16  -  PLATE BN 16 HL LCK	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEM7	SUP	HCPCS C1713		PL-LEM7  -  PLATE 84MM TI 7 HOLE LCK ACUMED BONE MDL ELB NONSTRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEM8	SUP	HCPCS C1713		PL-LEM8  -  PLATE 88MM TITANIUIM 8 HOLE LCK BONE MDL ELB NONSTRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEM9L	SUP	HCPCS C1713		PL-LEM9L  -  PLATE LNG TITANIUIM 9 HOLE LCK SYS BONE MDL ELB STRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEM9S	SUP	HCPCS C1713		PL-LEM9S  -  PLATE SHRT TI 9 HOLE LCK BONE MDL ELB STRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEO11	SUP	HCPCS C1713		PL-LEO11  -  PLATE BN NS 11 HL LCK PRECONTOUR TI ELB OLCRN	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEO13	SUP	HCPCS C1713		PL-LEO13  -  PLATE TI 13 HOLE LCK SYS BONE OLCRN ELB STRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEO13E	SUP	HCPCS C1713		PL-LEO13E  -  PLATE BN 13 HL XTD ELB	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEO17L	SUP	HCPCS C1713		PL-LEO17L  -  PLATE BN NS 17 HL LCK PRECONTOUR TI ELB LT OLCRN	BOTH IP/OP	"$2,562.50 "	"$1,896.25"	$0.00	"$2,050.00"	"$1,153.13"	"$1,153.13"	$0.00	$0.00	$0.00	$534.09	"$1,901.89"	"$1,901.89"	$0.00	$0.00	$534.03	$0.00	"$1,263.31"	"$1,263.31"	$0.00	"$1,281.25"	"$2,029.50"	"$2,050.00"	$0.00		$0.00	$401.03	$0.00	$0.00	$407.95	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEO17R	SUP	HCPCS C1713		PL-LEO17R  -  PLATE BN NS 17 HL LCK PRECONTOUR TI OLCRN RT	BOTH IP/OP	"$2,562.50 "	"$1,896.25"	$0.00	"$2,050.00"	"$1,153.13"	"$1,153.13"	$0.00	$0.00	$0.00	$534.09	"$1,901.89"	"$1,901.89"	$0.00	$0.00	$534.03	$0.00	"$1,263.31"	"$1,263.31"	$0.00	"$1,281.25"	"$2,029.50"	"$2,050.00"	$0.00		$0.00	$401.03	$0.00	$0.00	$407.95	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LEO9	SUP	HCPCS C1713		PL-LEO9  -  PLATE STD TI 9 HOLE LCK BONE OLCRN NONSTRL	BOTH IP/OP	"$2,252.50 "	"$1,666.85"	$0.00	"$1,802.00"	"$1,013.63"	"$1,013.63"	$0.00	$0.00	$0.00	$469.48	"$1,671.81"	"$1,671.81"	$0.00	$0.00	$469.42	$0.00	"$1,332.35"	"$1,332.35"	$0.00	"$1,126.25"	"$1,783.98"	"$1,802.00"	$0.00		$0.00	$352.52	$0.00	$0.00	$358.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-LL8LR	SUP	HCPCS C1713		PL-LL8LR  -  PLATE LNG 8 HOLE BONE RIGHT CLVCL	BOTH IP/OP	"$1,862.50 "	"$1,378.25"	$0.00	"$1,490.00"	$838.13	$838.13	$0.00	$0.00	$0.00	$388.19	"$1,382.35"	"$1,382.35"	$0.00	$0.00	$388.15	$0.00	"$1,101.67"	"$1,101.67"	$0.00	$931.25	"$1,475.10"	"$1,490.00"	$0.00		$0.00	$291.48	$0.00	$0.00	$296.51	$0.00	$0.00	$0.00	$0.00	$0.00
PL-MCPL	SUP	HCPCS C1713		PL-MCPL  -  PLATE BN RND NS FSN TI 1ST MCP LT	BOTH IP/OP	"$1,017.50 "	$752.95	$0.00	$814.00	$457.88	$457.88	$0.00	$0.00	$0.00	$212.07	$755.19	$755.19	$0.00	$0.00	$212.05	$0.00	$601.85	$601.85	$0.00	$508.75	$805.86	$814.00	$0.00		$0.00	$159.24	$0.00	$0.00	$161.99	$0.00	$0.00	$0.00	$0.00	$0.00
PL-MCPR	SUP	HCPCS C1713		PL-MCPR  -  PLATE TI BONE RIGHT MCP	BOTH IP/OP	"$1,017.50 "	$752.95	$0.00	$814.00	$457.88	$457.88	$0.00	$0.00	$0.00	$212.07	$755.19	$755.19	$0.00	$0.00	$212.05	$0.00	$601.85	$601.85	$0.00	$508.75	$805.86	$814.00	$0.00		$0.00	$159.24	$0.00	$0.00	$161.99	$0.00	$0.00	$0.00	$0.00	$0.00
PL-MPJL	SUP	HCPCS C1713		PL-MPJL  -  PLATE BN NS 4 HL FSN TI 1ST MTP LT	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
PL-MPJR	SUP	HCPCS C1713		PL-MPJR  -  PLATE SHRT BONE RIGHT MTP	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
PL-MTPL	SUP	HCPCS C1713		PL-MTPL  -  PLATE TI FSN BONE LEFT 1ST MTP NONSTRL	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
PL-MTPLR	SUP	HCPCS C1713		PL-MTPLR  -  PLATE BN NS 6 HL REV FSN TI 1ST MTP LT	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
PL-MTPR	SUP	HCPCS C1713		PL-MTPR  -  PLATE BN NS 4 HL FSN TI 1ST MTP RT	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
PL-MTPRR	SUP	HCPCS C1713		PL-MTPRR  -  PLATE TI FSN BONE RIGHT GRT TOE	BOTH IP/OP	"$1,275.00 "	$943.50	$0.00	"$1,020.00"	$573.75	$573.75	$0.00	$0.00	$0.00	$265.74	$946.31	$946.31	$0.00	$0.00	$265.71	$0.00	$754.16	$754.16	$0.00	$637.50	"$1,009.80"	"$1,020.00"	$0.00		$0.00	$199.54	$0.00	$0.00	$202.98	$0.00	$0.00	$0.00	$0.00	$0.00
PLP10342	SUP	HCPCS C1713		PLP10342  -  PLATE BN 1.3MM NS ANCHORAGE 6 HL LOPRFL PIN FX HL VRSN V1 TI	BOTH IP/OP	"$2,760.75 "	"$2,042.96"	$0.00	"$2,940.60"	"$1,654.09"	"$1,654.09"	$0.00	$0.00	$0.00	$575.41	"$2,049.03"	"$2,049.03"	$0.00	$0.00	$575.34	$0.00	"$1,361.05"	"$1,361.05"	$0.00	"$1,837.88"	"$2,911.19"	"$2,940.60"	$0.00		$0.00	$575.25	$0.00	$0.00	$585.18	$0.00	$0.00	$0.00	$0.00	$0.00
PLP10462	SUP	HCPCS C1713		PLP10462  -  PLATE BN LNG 1.3MM NS ANCHORAGE 8 HL LOPRFL PIN FX HL VRSN V	BOTH IP/OP	"$2,760.75 "	"$2,042.96"	$0.00	"$2,940.60"	"$1,654.09"	"$1,654.09"	$0.00	$0.00	$0.00	$575.41	"$2,049.03"	"$2,049.03"	$0.00	$0.00	$575.34	$0.00	"$1,361.05"	"$1,361.05"	$0.00	"$1,837.88"	"$2,911.19"	"$2,940.60"	$0.00		$0.00	$575.25	$0.00	$0.00	$585.18	$0.00	$0.00	$0.00	$0.00	$0.00
PLP20342	SUP	HCPCS C1713		PLP20342  -  PLATE BN 0MM STP 1.5MM NS ANCHORAGE LOPRFL PIN FX THRD HL TI	BOTH IP/OP	"$2,760.75 "	"$2,042.96"	$0.00	"$2,940.60"	"$1,654.09"	"$1,654.09"	$0.00	$0.00	$0.00	$575.41	"$2,049.03"	"$2,049.03"	$0.00	$0.00	$575.34	$0.00	"$1,361.05"	"$1,361.05"	$0.00	"$1,837.88"	"$2,911.19"	"$2,940.60"	$0.00		$0.00	$575.25	$0.00	$0.00	$585.18	$0.00	$0.00	$0.00	$0.00	$0.00
PLP30201	SUP	HCPCS C1713		PLP30201  -  PLATE BN LG 1.5MM NS ANCHORAGE LOPRFL PIN FX THRD HL TI LT 3	BOTH IP/OP	"$2,760.75 "	"$2,042.96"	$0.00	"$2,940.60"	"$1,654.09"	"$1,654.09"	$0.00	$0.00	$0.00	$575.41	"$2,049.03"	"$2,049.03"	$0.00	$0.00	$575.34	$0.00	"$1,361.05"	"$1,361.05"	$0.00	"$1,837.88"	"$2,911.19"	"$2,940.60"	$0.00		$0.00	$575.25	$0.00	$0.00	$585.18	$0.00	$0.00	$0.00	$0.00	$0.00
PLP40160	SUP	HCPCS C1713		PLP40160  -  PLATE BN STRG 16MMX1.5MM NS ANCHORAGE 2 HL LOPRFL UTL SMTR	BOTH IP/OP	"$2,300.63 "	"$1,702.47"	$0.00	"$2,449.20"	"$1,377.68"	"$1,377.68"	$0.00	$0.00	$0.00	$479.51	"$1,707.52"	"$1,707.52"	$0.00	$0.00	$479.45	$0.00	"$1,360.82"	"$1,360.82"	$0.00	"$1,530.75"	"$2,424.71"	"$2,449.20"	$0.00		$0.00	$479.12	$0.00	$0.00	$487.39	$0.00	$0.00	$0.00	$0.00	$0.00
PLP40220	SUP	HCPCS C1713		PLP40220  -  PLATE BN STRG 22MMX1.5MM NS ANCHORAGE 3 HL LOPRFL UTL SMTR	BOTH IP/OP	"$2,300.63 "	"$1,702.47"	$0.00	"$2,449.20"	"$1,377.68"	"$1,377.68"	$0.00	$0.00	$0.00	$479.51	"$1,707.52"	"$1,707.52"	$0.00	$0.00	$479.45	$0.00	"$1,360.82"	"$1,360.82"	$0.00	"$1,530.75"	"$2,424.71"	"$2,449.20"	$0.00		$0.00	$479.12	$0.00	$0.00	$487.39	$0.00	$0.00	$0.00	$0.00	$0.00
PL-PHGL	SUP	HCPCS C1713		PL-PHGL  -  PLATE LG TI PLRS BONE LEFT PROX HUM NONSTRL	BOTH IP/OP	"$3,747.50 "	"$2,773.15"	$0.00	"$2,998.00"	"$1,686.38"	"$1,686.38"	$0.00	$0.00	$0.00	$781.07	"$2,781.39"	"$2,781.39"	$0.00	$0.00	$780.98	$0.00	"$1,847.52"	"$1,847.52"	$0.00	"$1,873.75"	"$2,968.02"	"$2,998.00"	$0.00		$0.00	$586.48	$0.00	$0.00	$596.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-PHGR	SUP	HCPCS C1713		PL-PHGR  -  PLATE BN LG HUM RT	BOTH IP/OP	"$3,747.50 "	"$2,773.15"	$0.00	"$2,998.00"	"$1,686.38"	"$1,686.38"	$0.00	$0.00	$0.00	$781.07	"$2,781.39"	"$2,781.39"	$0.00	$0.00	$780.98	$0.00	"$1,847.52"	"$1,847.52"	$0.00	"$1,873.75"	"$2,968.02"	"$2,998.00"	$0.00		$0.00	$586.48	$0.00	$0.00	$596.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-PHSL	SUP	HCPCS C1713		PL-PHSL  -  PLATE BN SM HUM LT PROX	BOTH IP/OP	"$3,747.50 "	"$2,773.15"	$0.00	"$2,998.00"	"$1,686.38"	"$1,686.38"	$0.00	$0.00	$0.00	$781.07	"$2,781.39"	"$2,781.39"	$0.00	$0.00	$780.98	$0.00	"$1,847.52"	"$1,847.52"	$0.00	"$1,873.75"	"$2,968.02"	"$2,998.00"	$0.00		$0.00	$586.48	$0.00	$0.00	$596.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-PHSR	SUP	HCPCS C1713		PL-PHSR  -  PLATE SM TI PLRS BONE RIGHT PROX HUM NONSTRL	BOTH IP/OP	"$3,747.50 "	"$2,773.15"	$0.00	"$2,998.00"	"$1,686.38"	"$1,686.38"	$0.00	$0.00	$0.00	$781.07	"$2,781.39"	"$2,781.39"	$0.00	$0.00	$780.98	$0.00	"$1,847.52"	"$1,847.52"	$0.00	"$1,873.75"	"$2,968.02"	"$2,998.00"	$0.00		$0.00	$586.48	$0.00	$0.00	$596.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-PHXGL	SUP	HCPCS C1713		PL-PHXGL  -  PLATE XLNG TI PLRS BONE LEFT PROX HUM NONSTRL	BOTH IP/OP	"$3,747.50 "	"$2,773.15"	$0.00	"$2,998.00"	"$1,686.38"	"$1,686.38"	$0.00	$0.00	$0.00	$781.07	"$2,781.39"	"$2,781.39"	$0.00	$0.00	$780.98	$0.00	"$1,847.52"	"$1,847.52"	$0.00	"$1,873.75"	"$2,968.02"	"$2,998.00"	$0.00		$0.00	$586.48	$0.00	$0.00	$596.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-PHXGR	SUP	HCPCS C1713		PL-PHXGR  -  PLATE XLNG TI PLRS BONE RIGHT PROX HUM	BOTH IP/OP	"$3,747.50 "	"$2,773.15"	$0.00	"$2,998.00"	"$1,686.38"	"$1,686.38"	$0.00	$0.00	$0.00	$781.07	"$2,781.39"	"$2,781.39"	$0.00	$0.00	$780.98	$0.00	"$1,847.52"	"$1,847.52"	$0.00	"$1,873.75"	"$2,968.02"	"$2,998.00"	$0.00		$0.00	$586.48	$0.00	$0.00	$596.60	$0.00	$0.00	$0.00	$0.00	$0.00
PL-PTACK	SUP	Custom 27803010		PL-PTACK  -  HOLDER IMPL FRFT MIDFT TEMP FIX TACK PLT	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.80	$66.80	$0.00	$0.00	$18.76	$0.00	$0.00	$0.00	$0.00	$45.00	$71.28	$72.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SA06L	SUP	HCPCS C1713		PL-SA06L  -  PLATE BN NS 6 HL TI SCAPULAR LT ACROMION	BOTH IP/OP	"$3,592.50 "	"$2,658.45"	$0.00	"$2,874.00"	"$1,616.63"	"$1,616.63"	$0.00	$0.00	$0.00	$748.77	"$2,666.35"	"$2,666.35"	$0.00	$0.00	$748.68	$0.00	"$1,771.10"	"$1,771.10"	$0.00	"$1,796.25"	"$2,845.26"	"$2,874.00"	$0.00		$0.00	$562.23	$0.00	$0.00	$571.93	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SA06R	SUP	HCPCS C1713		PL-SA06R  -  PLATE BONE RIGHT ACROMION	BOTH IP/OP	"$3,592.50 "	"$2,658.45"	$0.00	"$2,874.00"	"$1,616.63"	"$1,616.63"	$0.00	$0.00	$0.00	$748.77	"$2,666.35"	"$2,666.35"	$0.00	$0.00	$748.68	$0.00	"$1,771.10"	"$1,771.10"	$0.00	"$1,796.25"	"$2,845.26"	"$2,874.00"	$0.00		$0.00	$562.23	$0.00	$0.00	$571.93	$0.00	$0.00	$0.00	$0.00	$0.00
PLS-AIM-0910	SUP	Custom 27203010		"PLS-AIM-0910  -  GUIDE PLS AIMING, .9MM X 10?"	BOTH IP/OP	$110.00 	$81.40	$0.00	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.64	$81.64	$0.00	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SG04L	SUP	HCPCS C1713		PL-SG04L  -  PLATE 4 HOLE BONE LEFT GLND SCAPULA STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SG04R	SUP	HCPCS C1713		PL-SG04R  -  PLATE 4 HOLE BONE RIGHT GLND SCAPULA NONSTRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
PLSL3012	SUP	HCPCS C1713		PLSL3012  -  SCREW BN T8 3MM 12MM BLU NS ANCHORAGE TX HD LCK TI FT/ANKL	BOTH IP/OP	$392.63 	$290.55	$0.00	$418.08	$235.17	$235.17	$0.00	$0.00	$0.00	$81.83	$291.41	$291.41	$0.00	$0.00	$81.82	$0.00	$232.24	$232.24	$0.00	$261.30	$413.90	$418.08	$0.00		$0.00	$81.79	$0.00	$0.00	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00
PLSL3016	SUP	HCPCS C1713		PLSL3016  -  SCREW BN T8 3MM 16MM BLU NS ANCHORAGE TX HD LCK TI FT/ANKL	BOTH IP/OP	$392.63 	$290.55	$0.00	$418.08	$235.17	$235.17	$0.00	$0.00	$0.00	$81.83	$291.41	$291.41	$0.00	$0.00	$81.82	$0.00	$232.24	$232.24	$0.00	$261.30	$413.90	$418.08	$0.00		$0.00	$81.79	$0.00	$0.00	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00
PLSL3516	SUP	HCPCS C1713		PLSL3516  -  SCREW BN T8 3.5MM 16MM YLW NS ANCHORAGE TX HD LCK TI FT/ANKL	BOTH IP/OP	$392.63 	$290.55	$0.00	$418.08	$235.17	$235.17	$0.00	$0.00	$0.00	$81.83	$291.41	$291.41	$0.00	$0.00	$81.82	$0.00	$232.24	$232.24	$0.00	$261.30	$413.90	$418.08	$0.00		$0.00	$81.79	$0.00	$0.00	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00
PLSL3518	SUP	HCPCS C1713		PLSL3518  -  SCREW BN T8 3.5MM 18MM YLW NS ANCHORAGE TX HD LCK TI FT/ANKL	BOTH IP/OP	$392.63 	$290.55	$0.00	$418.08	$235.17	$235.17	$0.00	$0.00	$0.00	$81.83	$291.41	$291.41	$0.00	$0.00	$81.82	$0.00	$232.24	$232.24	$0.00	$261.30	$413.90	$418.08	$0.00		$0.00	$81.79	$0.00	$0.00	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00
PLSL3530	SUP	HCPCS C1713		PLSL3530  -  SCREW BN T8 3.5MM 30MM YLW NS ANCHORAGE TX HD LCK TI FT/ANKL	BOTH IP/OP	$384.75 	$284.72	$0.00	$418.08	$235.17	$235.17	$0.00	$0.00	$0.00	$80.19	$285.56	$285.56	$0.00	$0.00	$80.18	$0.00	$227.58	$227.58	$0.00	$261.30	$413.90	$418.08	$0.00		$0.00	$81.79	$0.00	$0.00	$83.20	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SLB10L	SUP	HCPCS C1713		PL-SLB10L  -  PLATE BN 10 HL LT SCAPULA LAT	BOTH IP/OP	"$4,570.00 "	"$3,381.80"	$0.00	"$3,656.00"	"$2,056.50"	"$2,056.50"	$0.00	$0.00	$0.00	$952.50	"$3,391.85"	"$3,391.85"	$0.00	$0.00	$952.39	$0.00	"$2,253.01"	"$2,253.01"	$0.00	"$2,285.00"	"$3,619.44"	"$3,656.00"	$0.00		$0.00	$715.21	$0.00	$0.00	$727.54	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SLB10R	SUP	HCPCS C1713		PL-SLB10R  -  PLATE 10 HOLE BONE SCAPULAR	BOTH IP/OP	"$4,570.00 "	"$3,381.80"	$0.00	"$3,656.00"	"$2,056.50"	"$2,056.50"	$0.00	$0.00	$0.00	$952.50	"$3,391.85"	"$3,391.85"	$0.00	$0.00	$952.39	$0.00	"$2,253.01"	"$2,253.01"	$0.00	"$2,285.00"	"$3,619.44"	"$3,656.00"	$0.00		$0.00	$715.21	$0.00	$0.00	$727.54	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SMB09L	SUP	HCPCS C1713		PL-SMB09L  -  PLATE BN 9 HL MED LT SCAPULA	BOTH IP/OP	"$4,235.00 "	"$3,133.90"	$0.00	"$3,388.00"	"$1,905.75"	"$1,905.75"	$0.00	$0.00	$0.00	$882.68	"$3,143.22"	"$3,143.22"	$0.00	$0.00	$882.57	$0.00	"$2,087.86"	"$2,087.86"	$0.00	"$2,117.50"	"$3,354.12"	"$3,388.00"	$0.00		$0.00	$662.78	$0.00	$0.00	$674.21	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SMB09R	SUP	HCPCS C1713		PL-SMB09R  -  PLATE 9 HOLE BRDR BONE RIGHT MDL SCAPULA NONSTRL	BOTH IP/OP	"$4,235.00 "	"$3,133.90"	$0.00	"$3,388.00"	"$1,905.75"	"$1,905.75"	$0.00	$0.00	$0.00	$882.68	"$3,143.22"	"$3,143.22"	$0.00	$0.00	$882.57	$0.00	"$2,087.86"	"$2,087.86"	$0.00	"$2,117.50"	"$3,354.12"	"$3,388.00"	$0.00		$0.00	$662.78	$0.00	$0.00	$674.21	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SMB13L	SUP	HCPCS C1713		PL-SMB13L  -  PLATE 13 HOLE BRDR BONE LEFT MDL SCAPULA	BOTH IP/OP	"$4,570.00 "	"$3,381.80"	$0.00	"$3,656.00"	"$2,056.50"	"$2,056.50"	$0.00	$0.00	$0.00	$952.50	"$3,391.85"	"$3,391.85"	$0.00	$0.00	$952.39	$0.00	"$2,253.01"	"$2,253.01"	$0.00	"$2,285.00"	"$3,619.44"	"$3,656.00"	$0.00		$0.00	$715.21	$0.00	$0.00	$727.54	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SMB13R	SUP	HCPCS C1713		PL-SMB13R  -  PLATE 13 HOLE BRDR LCK BONE RIGHT MDL SCAPULAR NONSTRL	BOTH IP/OP	"$4,570.00 "	"$3,381.80"	$0.00	"$3,656.00"	"$2,056.50"	"$2,056.50"	$0.00	$0.00	$0.00	$952.50	"$3,391.85"	"$3,391.85"	$0.00	$0.00	$952.39	$0.00	"$2,253.01"	"$2,253.01"	$0.00	"$2,285.00"	"$3,619.44"	"$3,656.00"	$0.00		$0.00	$715.21	$0.00	$0.00	$727.54	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SR27	SUP	Custom 27203010		PL-SR27  -  REAMER SRG MN FSN PLT SLV WRST	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SR29	SUP	HCPCS C1776		PL-SR29  -  HEAD RMR MN WRST FSN PLT	BOTH IP/OP	$552.50 	$408.85	$0.00	$442.00	$248.63	$248.63	$0.00	$0.00	$0.00	$115.15	$410.07	$410.07	$0.00	$0.00	$115.14	$0.00	$326.80	$326.80	$0.00	$276.25	$437.58	$442.00	$0.00		$0.00	$86.47	$0.00	$0.00	$87.96	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SR30	SUP	Custom 27203010		PL-SR30  -  REAMER SRG MN ASMB	BOTH IP/OP	"$1,690.00 "	"$1,250.60"	$0.00	"$1,352.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,254.32"	"$1,254.32"	$0.00	$0.00	$352.20	$0.00	$0.00	$0.00	$0.00	$845.00	"$1,338.48"	"$1,352.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SR38	SUP	HCPCS C1776		PL-SR38  -  HEAD RMR NS HBCP SHFT HND WRST	BOTH IP/OP	$587.50 	$434.75	$0.00	$470.00	$264.38	$264.38	$0.00	$0.00	$0.00	$122.45	$436.04	$436.04	$0.00	$0.00	$122.44	$0.00	$347.51	$347.51	$0.00	$293.75	$465.30	$470.00	$0.00		$0.00	$91.94	$0.00	$0.00	$93.53	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SR39	SUP	HCPCS C1776		PL-SR39  -  HEAD RMR HBCP WRST FSN PLT	BOTH IP/OP	$630.00 	$466.20	$0.00	$504.00	$283.50	$283.50	$0.00	$0.00	$0.00	$131.31	$467.59	$467.59	$0.00	$0.00	$131.29	$0.00	$372.65	$372.65	$0.00	$315.00	$498.96	$504.00	$0.00		$0.00	$98.60	$0.00	$0.00	$100.30	$0.00	$0.00	$0.00	$0.00	$0.00
PL-SR41	SUP	Custom 27203010		PL-SR41  -  WRENCH SRG RMR HD HUB CAP	BOTH IP/OP	$270.00 	$199.80	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.39	$200.39	$0.00	$0.00	$56.27	$0.00	$0.00	$0.00	$0.00	$135.00	$213.84	$216.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3016	SUP	HCPCS C1713		PLSS3016  -  SCREW BN STD T8 3MM 16MM BLU NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$271.13 	$200.64	$0.00	$287.04	$161.46	$161.46	$0.00	$0.00	$0.00	$56.51	$201.23	$201.23	$0.00	$0.00	$56.50	$0.00	$160.37	$160.37	$0.00	$179.40	$284.17	$287.04	$0.00		$0.00	$56.15	$0.00	$0.00	$57.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3018	SUP	HCPCS C1713		PLSS3018  -  SCREW BN STD T8 3MM 18MM BLU NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$271.13 	$200.64	$0.00	$287.04	$161.46	$161.46	$0.00	$0.00	$0.00	$56.51	$201.23	$201.23	$0.00	$0.00	$56.50	$0.00	$160.37	$160.37	$0.00	$179.40	$284.17	$287.04	$0.00		$0.00	$56.15	$0.00	$0.00	$57.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3020	SUP	HCPCS C1713		PLSS3020  -  SCREW BN STD T8 3MM 20MM BLU NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$265.50 	$196.47	$0.00	$420.00	$236.25	$236.25	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$262.50	$415.80	$420.00	$0.00		$0.00	$82.16	$0.00	$0.00	$83.58	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3022	SUP	HCPCS C1713		PLSS3022  -  SCREW BN STD T8 3MM 22MM BLU NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$265.50 	$196.47	$0.00	$287.04	$161.46	$161.46	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$179.40	$284.17	$287.04	$0.00		$0.00	$56.15	$0.00	$0.00	$57.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3024	SUP	HCPCS C1713		PLSS3024  -  SCREW BN STD T8 3MM 24MM BLU NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$265.50 	$196.47	$0.00	$287.04	$161.46	$161.46	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$179.40	$284.17	$287.04	$0.00		$0.00	$56.15	$0.00	$0.00	$57.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3026	SUP	HCPCS C1713		PLSS3026  -  SCREW BN STD T8 3MM 26MM BLU NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$265.50 	$196.47	$0.00	$287.04	$161.46	$161.46	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$179.40	$284.17	$287.04	$0.00		$0.00	$56.15	$0.00	$0.00	$57.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3028	SUP	HCPCS C1713		PLSS3028  -  SCREW BN STD T8 3MM 28MM BLU NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$265.50 	$196.47	$0.00	$287.04	$161.46	$161.46	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$179.40	$284.17	$287.04	$0.00		$0.00	$56.15	$0.00	$0.00	$57.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3514	SUP	HCPCS C1713		PLSS3514  -  SCREW BN STD T8 3.5MM 14MM YLW NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$265.50 	$196.47	$0.00	$287.04	$161.46	$161.46	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$179.40	$284.17	$287.04	$0.00		$0.00	$56.15	$0.00	$0.00	$57.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3516	SUP	HCPCS C1713		PLSS3516  -  SCREW BN STD T8 3.5MM 16MM YLW NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$265.50 	$196.47	$0.00	$287.04	$161.46	$161.46	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$179.40	$284.17	$287.04	$0.00		$0.00	$56.15	$0.00	$0.00	$57.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3520	SUP	HCPCS C1713		PLSS3520  -  SCREW BN STD T8 3.5MM 20MM YLW NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$265.50 	$196.47	$0.00	$287.04	$161.46	$161.46	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$179.40	$284.17	$287.04	$0.00		$0.00	$56.15	$0.00	$0.00	$57.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3522	SUP	HCPCS C1713		PLSS3522  -  SCREW BN STD T8 3.5MM 22MM YLW NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$265.50 	$196.47	$0.00	$287.04	$161.46	$161.46	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$179.40	$284.17	$287.04	$0.00		$0.00	$56.15	$0.00	$0.00	$57.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3526	SUP	HCPCS C1713		PLSS3526  -  SCREW BN STD T8 3.5MM 26MM YLW NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$265.50 	$196.47	$0.00	$287.04	$161.46	$161.46	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$179.40	$284.17	$287.04	$0.00		$0.00	$56.15	$0.00	$0.00	$57.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLSS3532	SUP	HCPCS C1713		PLSS3532  -  SCREW BN STD T8 3.5MM 32MM YLW NS ANCHORAGE TX HD TI FT/ANKL	BOTH IP/OP	$265.50 	$196.47	$0.00	$287.04	$161.46	$161.46	$0.00	$0.00	$0.00	$55.34	$197.05	$197.05	$0.00	$0.00	$55.33	$0.00	$157.04	$157.04	$0.00	$179.40	$284.17	$287.04	$0.00		$0.00	$56.15	$0.00	$0.00	$57.12	$0.00	$0.00	$0.00	$0.00	$0.00
PLT-1030	SUP	HCPCS C1713		PLT-1030  -  PLATE MAXFACL 7X7 HOLE MESH BIODEG 1.5 MM SCR BONE CPS TI	BOTH IP/OP	"$2,833.13 "	"$2,096.52"	$0.00	"$2,266.50"	"$1,274.91"	"$1,274.91"	$0.00	$0.00	$0.00	$590.49	"$2,102.75"	"$2,102.75"	$0.00	$0.00	$590.42	$0.00	"$1,396.73"	"$1,396.73"	$0.00	"$1,416.56"	"$2,243.84"	"$2,266.50"	$0.00		$0.00	$443.38	$0.00	$0.00	$451.03	$0.00	$0.00	$0.00	$0.00	$0.00
PL-TACK2	SUP	HCPCS C1713		PL-TACK2  -  PLATE BN 3.75IN TEMP	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$40.50	$40.50	$0.00	$0.00	$0.00	$18.76	$66.80	$66.80	$0.00	$0.00	$18.76	$0.00	$53.24	$53.24	$0.00	$45.00	$71.28	$72.00	$0.00		$0.00	$14.09	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00
PL-TIBAM	SUP	HCPCS C1713		PL-TIBAM  -  PLATE TI BONE ANT MLR NONSTRL	BOTH IP/OP	"$1,017.50 "	$752.95	$0.00	$814.00	$457.88	$457.88	$0.00	$0.00	$0.00	$212.07	$755.19	$755.19	$0.00	$0.00	$212.05	$0.00	$601.85	$601.85	$0.00	$508.75	$805.86	$814.00	$0.00		$0.00	$159.24	$0.00	$0.00	$161.99	$0.00	$0.00	$0.00	$0.00	$0.00
PL-TIBMM	SUP	HCPCS C1713		PL-TIBMM  -  PLATE TI BONE MDL MLR NONSTRL	BOTH IP/OP	"$1,017.50 "	$752.95	$0.00	$814.00	$457.88	$457.88	$0.00	$0.00	$0.00	$212.07	$755.19	$755.19	$0.00	$0.00	$212.05	$0.00	$601.85	$601.85	$0.00	$508.75	$805.86	$814.00	$0.00		$0.00	$159.24	$0.00	$0.00	$161.99	$0.00	$0.00	$0.00	$0.00	$0.00
PL-TMT14	SUP	HCPCS C1713		PL-TMT14  -  PLATE TI 4 HOLE CNGR BONE MIDFT NONSTRL	BOTH IP/OP	"$1,222.50 "	$904.65	$0.00	$978.00	$550.13	$550.13	$0.00	$0.00	$0.00	$254.80	$907.34	$907.34	$0.00	$0.00	$254.77	$0.00	$723.11	$723.11	$0.00	$611.25	$968.22	$978.00	$0.00		$0.00	$191.32	$0.00	$0.00	$194.62	$0.00	$0.00	$0.00	$0.00	$0.00
PL-TMT24	SUP	HCPCS C1713		PL-TMT24  -  PLATE CNGR BONE MIDFT NONSTRL	BOTH IP/OP	"$1,222.50 "	$904.65	$0.00	$978.00	$550.13	$550.13	$0.00	$0.00	$0.00	$254.80	$907.34	$907.34	$0.00	$0.00	$254.77	$0.00	$723.11	$723.11	$0.00	$611.25	$968.22	$978.00	$0.00		$0.00	$191.32	$0.00	$0.00	$194.62	$0.00	$0.00	$0.00	$0.00	$0.00
PL-TMT5	SUP	HCPCS C1713		PL-TMT5  -  PLATE TI 5 HOLE BONE TARSOMETATARSAL NONSTRL	BOTH IP/OP	"$1,222.50 "	$904.65	$0.00	$978.00	$550.13	$550.13	$0.00	$0.00	$0.00	$254.80	$907.34	$907.34	$0.00	$0.00	$254.77	$0.00	$723.11	$723.11	$0.00	$611.25	$968.22	$978.00	$0.00		$0.00	$191.32	$0.00	$0.00	$194.62	$0.00	$0.00	$0.00	$0.00	$0.00
PL-UL06	SUP	HCPCS C1713		PL-UL06  -  PLATE BN SHRT STRL 6 HL TI ULNA OSTM	BOTH IP/OP	"$1,790.00 "	"$1,324.60"	$0.00	"$1,432.00"	$805.50	$805.50	$0.00	$0.00	$0.00	$373.08	"$1,328.54"	"$1,328.54"	$0.00	$0.00	$373.04	$0.00	"$1,058.79"	"$1,058.79"	$0.00	$895.00	"$1,417.68"	"$1,432.00"	$0.00		$0.00	$280.14	$0.00	$0.00	$284.97	$0.00	$0.00	$0.00	$0.00	$0.00
PL-UL06-S	SUP	HCPCS C1713		PL-UL06-S  -  PLATE TI 6 HOLE SHTNG ACUMED BONE WRST ULN HAND STRL	BOTH IP/OP	"$1,790.00 "	"$1,324.60"	$0.00	"$1,432.00"	$805.50	$805.50	$0.00	$0.00	$0.00	$373.08	"$1,328.54"	"$1,328.54"	$0.00	$0.00	$373.04	$0.00	"$1,058.79"	"$1,058.79"	$0.00	$895.00	"$1,417.68"	"$1,432.00"	$0.00		$0.00	$280.14	$0.00	$0.00	$284.97	$0.00	$0.00	$0.00	$0.00	$0.00
PL-VO47	SUP	HCPCS C1713		PL-VO47  -  PLATE 47MM TI BONE VOLR RADL NONSTRL	BOTH IP/OP	"$1,020.00 "	$754.80	$0.00	$816.00	$459.00	$459.00	$0.00	$0.00	$0.00	$212.59	$757.04	$757.04	$0.00	$0.00	$212.57	$0.00	$603.33	$603.33	$0.00	$510.00	$807.84	$816.00	$0.00		$0.00	$159.63	$0.00	$0.00	$162.38	$0.00	$0.00	$0.00	$0.00	$0.00
PL-VO60	SUP	HCPCS C1713		PL-VO60  -  PLATE 60MM TI BONE VOLR RADL NONSTRL	BOTH IP/OP	"$1,020.00 "	$754.80	$0.00	$816.00	$459.00	$459.00	$0.00	$0.00	$0.00	$212.59	$757.04	$757.04	$0.00	$0.00	$212.57	$0.00	$603.33	$603.33	$0.00	$510.00	$807.84	$816.00	$0.00		$0.00	$159.63	$0.00	$0.00	$162.38	$0.00	$0.00	$0.00	$0.00	$0.00
PLVW-14.0-38	SUP	HCPCS C1892		PLVW-14.0-38  -  SET INTROD 15.5CM 14FR PLWY PERC STRL DISP	BOTH IP/OP	$104.40 	$77.26	$0.00	$83.52	$56.69	$56.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.20	$82.68	$83.52	$0.00		$0.00	$16.34	$0.00	$0.00	$16.62	$0.00	$0.00	$0.00	$0.00	$0.00
PL-WF33	SUP	HCPCS C1713		PL-WF33  -  PLATE BN MN NS HBCP 3 CRNR FSN TI WRST	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PL-WF40	SUP	HCPCS C1713		PL-WF40  -  PLATE BN NS HBCP TI WRST	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PL-WF44	SUP	HCPCS C1713		PL-WF44  -  PLATE MINI TI 4 CRNR FSN HBCP BONE WRST NONSTRL	BOTH IP/OP	"$2,047.50 "	"$1,515.15"	$0.00	"$1,638.00"	$921.38	$921.38	$0.00	$0.00	$0.00	$426.75	"$1,519.65"	"$1,519.65"	$0.00	$0.00	$426.70	$0.00	"$1,211.10"	"$1,211.10"	$0.00	"$1,023.75"	"$1,621.62"	"$1,638.00"	$0.00		$0.00	$320.43	$0.00	$0.00	$325.96	$0.00	$0.00	$0.00	$0.00	$0.00
PL-WF50	SUP	HCPCS C1713		PL-WF50  -  PLATE TI FSN POST HBCP BONE WRST	BOTH IP/OP	$82.50 	$61.05	$0.00	$66.00	$37.13	$37.13	$0.00	$0.00	$0.00	$17.20	$61.23	$61.23	$0.00	$0.00	$17.19	$0.00	$48.80	$48.80	$0.00	$41.25	$65.34	$66.00	$0.00		$0.00	$12.91	$0.00	$0.00	$13.13	$0.00	$0.00	$0.00	$0.00	$0.00
PL-WF60	SUP	HCPCS C1713		PL-WF60  -  PLATE TI SCR HBCP BONE WRST NONSTRL	BOTH IP/OP	$237.50 	$175.75	$0.00	$190.00	$106.88	$106.88	$0.00	$0.00	$0.00	$49.50	$176.27	$176.27	$0.00	$0.00	$49.50	$0.00	$140.48	$140.48	$0.00	$118.75	$188.10	$190.00	$0.00		$0.00	$37.17	$0.00	$0.00	$37.81	$0.00	$0.00	$0.00	$0.00	$0.00
PM010-A	SUP	Custom 27200555		PM010-A  -  KIT DRUG DELIVERY 3.5IN 2.5IN CATHETER ANTIMICROBIAL NEEDLE	BOTH IP/OP	$89.00 	$65.86	$0.00	$66.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.06	$66.06	$0.00	$0.00	$18.55	$0.00	$0.00	$0.00	$0.00	$11.50	$18.22	$18.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PM020	SUP	Custom 27200555		PM020  -  SYSTEM DRG DLV ONQ PNBSTR SKR XPD KIT CATH TPL NDL 5IN 6IN	BOTH IP/OP	$116.00 	$85.84	$0.00	$123.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.10	$86.10	$0.00	$0.00	$24.17	$0.00	$0.00	$0.00	$0.00	$77.25	$122.36	$123.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PM020-A	SUP	Custom 27200555		PM020-A  -  SYSTEM DRG DLV T 5IN 6IN ONQ PNBSTR SLSKR TPL XPD CATH NDL	BOTH IP/OP	$116.00 	$85.84	$0.00	$86.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.10	$86.10	$0.00	$0.00	$24.17	$0.00	$0.00	$0.00	$0.00	$14.75	$23.36	$23.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PM040-A	SUP	Custom 27200555		PM040-A  -  SYSTEM DRG DLV ONQ SLSKR CATH XPD KIT TPL NDL 10IN 8IN	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$0.00	$0.00	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PM1110	SUP	HCPCS C1786		PM1110  -  PACEMAKER CRD THK6MM 52X42MM 9.5ML ACT 1 CHMBR IS-1 CNCT PLS	BOTH IP/OP	"$7,425.00 "	"$5,494.50"	$0.00	"$5,940.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,547.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,547.37"	$0.00	"$3,660.53"	"$3,660.53"	$0.00	"$3,712.50"	"$5,880.60"	"$5,940.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PM1210	SUP	HCPCS C1785		PM1210  -  PACEMAKER CRD THK6MM 52X52MM 12.8ML ACT 1 CHMBR IS-1 CNCT RF	BOTH IP/OP	"$8,775.00 "	"$6,493.50"	$0.00	"$7,020.00"	"$3,948.75"	"$3,948.75"	$0.00	$0.00	$0.00	"$1,828.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,828.71"	$0.00	"$4,326.08"	"$4,326.08"	$0.00	"$4,387.50"	"$6,949.80"	"$7,020.00"	$0.00		$0.00	"$1,373.29"	$0.00	$0.00	"$1,396.98"	$0.00	$0.00	$0.00	$0.00	$0.00
PM2110	SUP	HCPCS C1785		PM2110  -  PACEMAKER CRD THK6MM 52X46MM 10.5CC ACT 2 CHMBR IS-1 CNCT	BOTH IP/OP	"$8,550.00 "	"$6,327.00"	$0.00	"$6,840.00"	"$3,847.50"	"$3,847.50"	$0.00	$0.00	$0.00	"$1,782.03"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,781.82"	$0.00	"$4,215.15"	"$4,215.15"	$0.00	"$4,275.00"	"$6,771.60"	"$6,840.00"	$0.00		$0.00	"$1,338.08"	$0.00	$0.00	"$1,361.16"	$0.00	$0.00	$0.00	$0.00	$0.00
PM2210	SUP	HCPCS C1785		PM2210  -  PACEMAKER CARDIAC THK6MM 52X52MM 2 CHAMBER INDUCTIVE	BOTH IP/OP	"$10,575.00 "	"$7,825.50"	$0.00	"$8,460.00"	"$4,758.75"	"$4,758.75"	$0.00	$0.00	$0.00	"$2,204.09"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,203.83"	$0.00	"$5,213.48"	"$5,213.48"	$0.00	"$5,287.50"	"$8,375.40"	"$8,460.00"	$0.00		$0.00	"$1,654.99"	$0.00	$0.00	"$1,683.54"	$0.00	$0.00	$0.00	$0.00	$0.00
PM3210	SUP	HCPCS C2621		PM3210  -  PACEMAKER CRD THK6MM 58X52MM 13.7ML ANTHEM RF 2 CHMBR IS-1	BOTH IP/OP	"$14,750.00 "	"$10,915.00"	$0.00	"$11,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,073.90"	$0.00	$0.00	$0.00	$0.00	"$7,375.00"	"$11,682.00"	"$11,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PMG-18SP-60-COPE	SUP	HCPCS C1769		PMG-18SP-60-COPE  -  GWIRE VASC .018IN 60CM 7CM ANG SFT CP MDRL SS STRL DISP	BOTH IP/OP	$82.39 	$60.97	$0.00	$65.91	$44.74	$44.74	$0.00	$0.00	$0.00	$17.17	$61.15	$61.15	$0.00	$0.00	$17.17	$0.00	$48.73	$48.73	$0.00	$41.19	$65.25	$65.91	$0.00		$0.00	$12.89	$0.00	$0.00	$13.12	$0.00	$0.00	$0.00	$0.00	$0.00
PMH	SUP	HCPCS C1781		PMH  -  MESH SURG FLAT 6X6IN KNIT NONABSORBABLE NONREACTIVE PROLENE	BOTH IP/OP	$164.86 	$122.00	$0.00	$133.87	$75.30	$75.30	$0.00	$0.00	$0.00	$34.36	$122.36	$122.36	$0.00	$0.00	$34.36	$0.00	$97.52	$97.52	$0.00	$83.67	$132.53	$133.87	$0.00		$0.00	$26.19	$0.00	$0.00	$26.64	$0.00	$0.00	$0.00	$0.00	$0.00
PMII	SUP	HCPCS C1781		PMII  -  MESH SURG FLAT 6X3IN KNIT NONABSORBABLE NONREACTIVE LATEX	BOTH IP/OP	$149.00 	$110.26	$0.00	$120.98	$68.05	$68.05	$0.00	$0.00	$0.00	$31.06	$110.59	$110.59	$0.00	$0.00	$31.05	$0.00	$88.13	$88.13	$0.00	$75.61	$119.77	$120.98	$0.00		$0.00	$23.67	$0.00	$0.00	$24.07	$0.00	$0.00	$0.00	$0.00	$0.00
PML	SUP	HCPCS C1781		PML  -  MESH SURG FLAT 12X12IN KNIT MONOFILAMENT SOFT PROLENE	BOTH IP/OP	$374.24 	$276.94	$0.00	$303.88	$170.93	$170.93	$0.00	$0.00	$0.00	$78.00	$277.76	$277.76	$0.00	$0.00	$77.99	$0.00	$221.36	$221.36	$0.00	$189.93	$300.85	$303.88	$0.00		$0.00	$59.45	$0.00	$0.00	$60.47	$0.00	$0.00	$0.00	$0.00	$0.00
PMXS	SUP	HCPCS C1781		PMXS  -  MESH SURG FLAT 4X1IN KNIT NONABSORBABLE NONREACTIVE PROLENE	BOTH IP/OP	$117.33 	$86.82	$0.00	$93.86	$52.80	$52.80	$0.00	$0.00	$0.00	$24.45	$87.08	$87.08	$0.00	$0.00	$24.45	$0.00	$69.40	$69.40	$0.00	$58.66	$92.93	$93.86	$0.00		$0.00	$18.36	$0.00	$0.00	$18.68	$0.00	$0.00	$0.00	$0.00	$0.00
PN-152836002	SUP	Custom 27203010		PN-152836002  -  CONCTR EKG ATR VNTRC ASMBLY	BOTH IP/OP	$45.05 	$33.34	$0.00	$36.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.44	$33.44	$0.00	$0.00	$9.39	$0.00	$0.00	$0.00	$0.00	$22.53	$35.68	$36.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PND6F070956	SUP	HCPCS C1757		PND6F070956  -  CATHETER DELIVERY SYSTEM STR 6FR .07IN 95CM 6CM LUMEN	BOTH IP/OP	"$1,587.50 "	"$1,174.75"	$0.00	"$1,270.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$330.87	"$1,178.24"	"$1,178.24"	$0.00	$0.00	$330.84	$0.00	$939.01	$939.01	$0.00	$793.75	"$1,257.30"	"$1,270.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PND6F1056	SUP	HCPCS C1757		PND6F1056  -  CATHETER DELIVERY SYSTEM .035IN .038IN 6FR .053IN 105CM 6CM	BOTH IP/OP	"$1,587.50 "	"$1,174.75"	$0.00	"$1,270.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$330.87	"$1,178.24"	"$1,178.24"	$0.00	$0.00	$330.84	$0.00	$939.01	$939.01	$0.00	$793.75	"$1,257.30"	"$1,270.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PND6F1156	SUP	HCPCS C1757		PND6F1156  -  CATHETER DELIVERY SYSTEM .035IN .038IN STR 6FR .053IN 115CM	BOTH IP/OP	"$1,587.50 "	"$1,174.75"	$0.00	"$1,270.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$330.87	"$1,178.24"	"$1,178.24"	$0.00	$0.00	$330.84	$0.00	$939.01	$939.01	$0.00	$793.75	"$1,257.30"	"$1,270.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG220	SUP	HCPCS C9352		PNG220  -  GUIDE NERVE 2MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE	BOTH IP/OP	"$3,125.68 "	"$2,313.00"	$0.00	"$2,500.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$651.47	"$2,319.88"	"$2,319.88"	$0.00	$0.00	$651.39	$0.00	"$1,540.96"	"$1,540.96"	$0.00	"$1,562.84"	"$2,475.54"	"$2,500.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG230	SUP	HCPCS C9352		PNG230  -  GUIDE NERVE 2MM 3CM SEMIPERMEABLE NEURAGEN COLLAGEN MATRIX	BOTH IP/OP	"$4,202.28 "	"$3,109.69"	$0.00	"$3,361.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$875.86	"$3,118.93"	"$3,118.93"	$0.00	$0.00	$875.75	$0.00	"$2,071.72"	"$2,071.72"	$0.00	"$2,101.14"	"$3,328.21"	"$3,361.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG320	SUP	HCPCS C9352		PNG320  -  GUIDE NERVE 3MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE	BOTH IP/OP	"$3,125.68 "	"$2,313.00"	$0.00	"$2,500.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,562.84"	"$2,475.54"	"$2,500.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG-320	SUP	HCPCS C9352		PNG-320  -  GUIDE NERVE 3MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE	BOTH IP/OP	"$3,125.68 "	"$2,313.00"	$0.00	"$2,500.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$651.47	"$2,319.88"	"$2,319.88"	$0.00	$0.00	$651.39	$0.00	"$1,540.96"	"$1,540.96"	$0.00	"$1,562.84"	"$2,475.54"	"$2,500.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG330	SUP	HCPCS C9352		PNG330  -  GUIDE NERVE 3MM 3CM FLEXIBLE ABSORBABLE TUBE BIOCOMPATIBLE	BOTH IP/OP	"$4,202.28 "	"$3,109.69"	$0.00	"$3,361.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$875.86	"$3,118.93"	"$3,118.93"	$0.00	$0.00	$875.75	$0.00	"$2,071.72"	"$2,071.72"	$0.00	"$2,101.14"	"$3,328.21"	"$3,361.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG420	SUP	HCPCS C9352		PNG420  -  GUIDE NERVE 4MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE	BOTH IP/OP	"$3,125.68 "	"$2,313.00"	$0.00	"$2,500.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$651.47	"$2,319.88"	"$2,319.88"	$0.00	$0.00	$651.39	$0.00	"$1,540.96"	"$1,540.96"	$0.00	"$1,562.84"	"$2,475.54"	"$2,500.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG430	SUP	HCPCS C9352		PNG430  -  GUIDE NERVE 4MM 3CM FLEXIBLE ABSORBABLE TUBE BIOCOMPATIBLE	BOTH IP/OP	"$4,202.28 "	"$3,109.69"	$0.00	"$3,361.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$875.86	"$3,118.93"	"$3,118.93"	$0.00	$0.00	$875.75	$0.00	"$2,071.72"	"$2,071.72"	$0.00	"$2,101.14"	"$3,328.21"	"$3,361.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG520	SUP	HCPCS C9352		PNG520  -  GUIDE NERVE 5MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE	BOTH IP/OP	"$3,125.68 "	"$2,313.00"	$0.00	"$2,500.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,562.84"	"$2,475.54"	"$2,500.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG-520	SUP	HCPCS C9352		PNG-520  -  GUIDE NERVE 5MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE	BOTH IP/OP	"$3,125.68 "	"$2,313.00"	$0.00	"$2,500.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$651.47	"$2,319.88"	"$2,319.88"	$0.00	$0.00	$651.39	$0.00	"$1,540.96"	"$1,540.96"	$0.00	"$1,562.84"	"$2,475.54"	"$2,500.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG530	SUP	HCPCS C9352		PNG530  -  GUIDE NERVE 5MM 3CM FLEXIBLE ABSORBABLE TUBE NEURAGEN	BOTH IP/OP	"$4,202.28 "	"$3,109.69"	$0.00	"$3,361.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$875.86	"$3,118.93"	"$3,118.93"	$0.00	$0.00	$875.75	$0.00	"$2,071.72"	"$2,071.72"	$0.00	"$2,101.14"	"$3,328.21"	"$3,361.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG620	SUP	HCPCS C9352		PNG620  -  GUIDE NERVE 6MM 2CM NEURAGEN PERIPHERAL	BOTH IP/OP	"$3,125.68 "	"$2,313.00"	$0.00	"$2,500.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,562.84"	"$2,475.54"	"$2,500.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG-620	SUP	HCPCS C9352		PNG-620  -  GUIDE NERVE 6MM 2CM NEURAGEN PERIPHERAL	BOTH IP/OP	"$3,125.68 "	"$2,313.00"	$0.00	"$2,500.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$651.47	"$2,319.88"	"$2,319.88"	$0.00	$0.00	$651.39	$0.00	"$1,540.96"	"$1,540.96"	$0.00	"$1,562.84"	"$2,475.54"	"$2,500.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG630	SUP	HCPCS C9352		PNG630  -  GUIDE NERVE 6MM 3CM FLEXIBLE ABSORBABLE TUBE BIOCOMPATIBLE	BOTH IP/OP	"$4,202.28 "	"$3,109.69"	$0.00	"$3,361.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$875.86	"$3,118.93"	"$3,118.93"	$0.00	$0.00	$875.75	$0.00	"$2,071.72"	"$2,071.72"	$0.00	"$2,101.14"	"$3,328.21"	"$3,361.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG720	SUP	HCPCS C9352		PNG720  -  GUIDE NERVE 7MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE	BOTH IP/OP	"$3,125.68 "	"$2,313.00"	$0.00	"$2,500.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,562.84"	"$2,475.54"	"$2,500.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG-720	SUP	HCPCS C9352		PNG-720  -  GUIDE NERVE 7MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE	BOTH IP/OP	"$3,125.68 "	"$2,313.00"	$0.00	"$2,500.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$651.47	"$2,319.88"	"$2,319.88"	$0.00	$0.00	$651.39	$0.00	"$1,540.96"	"$1,540.96"	$0.00	"$1,562.84"	"$2,475.54"	"$2,500.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNG730	SUP	HCPCS C9352		PNG730  -  GUIDE NERVE 7MM 3CM EXCELLENT HANDLING SEMIPERMEABLE SIMPLE	BOTH IP/OP	"$4,202.28 "	"$3,109.69"	$0.00	"$3,361.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$875.86	"$3,118.93"	"$3,118.93"	$0.00	$0.00	$875.75	$0.00	"$2,071.72"	"$2,071.72"	$0.00	"$2,101.14"	"$3,328.21"	"$3,361.82"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PNML6F088904M	SUP	HCPCS C1892		PNML6F088904M  -  SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 90CM 4CM NEURON MXSS	BOTH IP/OP	"$1,137.50 "	$841.75	$0.00	$910.00	$617.66	$617.66	$0.00	$0.00	$0.00	$237.08	$844.25	$844.25	$0.00	$0.00	$237.06	$0.00	$672.83	$672.83	$0.00	$568.75	$900.90	$910.00	$0.00		$0.00	$178.02	$0.00	$0.00	$181.09	$0.00	$0.00	$0.00	$0.00	$0.00
PNS5F120BER	SUP	HCPCS C1757		PNS5F120BER  -  CATH THRMB 120CM 5FR .4IN NEURON SLCT .035IN .038IN BER	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PP17/10	SUP	HCPCS C1894		DEVICE 17GA 10CM ECHTP COAX THNWL PP INTROD BIOP	BOTH IP/OP	$33.88 	$25.07	$0.00	$27.10	$18.39	$18.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.94	$26.83	$27.10	$0.00		$0.00	$5.30	$0.00	$0.00	$5.39	$0.00	$0.00	$0.00	$0.00	$0.00
PP1715	SUP	HCPCS C1894		DEVICE 17GA 15CM ECHTP COAX THNWL PP INTROD BIOP	BOTH IP/OP	$40.50 	$29.97	$0.00	$32.40	$21.99	$21.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.25	$32.08	$32.40	$0.00		$0.00	$6.34	$0.00	$0.00	$6.45	$0.00	$0.00	$0.00	$0.00	$0.00
PP19/10	SUP	HCPCS C1894		DEVICE 19GA 10CM ECHTP COAX THNWL PP INTROD BIOP	BOTH IP/OP	$33.75 	$24.98	$0.00	$27.00	$18.33	$18.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.88	$26.73	$27.00	$0.00		$0.00	$5.28	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00
PP1915	SUP	HCPCS C1894		DEVICE 19GA 15CM ECHTP COAX THNWL PP INTROD BIOP	BOTH IP/OP	$33.75 	$24.98	$0.00	$27.00	$18.33	$18.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$16.88	$26.73	$27.00	$0.00		$0.00	$5.28	$0.00	$0.00	$5.37	$0.00	$0.00	$0.00	$0.00	$0.00
PP196	SUP	Custom 27203010		NEEDLE BIOP 19GA 6CM ECHTP COAX THNWL PP INTROD	BOTH IP/OP	$32.38 	$23.96	$0.00	$29.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.03	$24.03	$0.00	$0.00	$6.75	$0.00	$0.00	$0.00	$0.00	$18.71	$29.64	$29.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PP9031	SUP	Custom 27203010		PP9031  -  KIT ESCP STRL LF PNPT PAQ DISP	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PRE1001US.S	SUP	HCPCS A6212		PRE1001US.S  -  UNIT THERAPEUTIC INCISION MANAGEMENT SYSTEM PEEL PLACE KIT	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$671.96	$671.96	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
PRE1101US	SUP	Custom 27011340		PRE1101US  -  SYSTEM NEG PRSS 13CM PREVENA PEEL AND PLC PTCH	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PRE2001US	SUP	Custom 27203010		PRE2001US  -  KIT DRESSING 125 THERAPY UNIT CARRYING CASE CANISTER	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PRE4001US	SUP	HCPCS C1713		PRE4001US  -  SYSTEM NEG PRSS -125 MMHG 150ML PREVENA + VIS ADBL ALRM REPL	BOTH IP/OP	"$1,625.00 "	"$1,202.50"	$0.00	"$1,300.00"	$731.25	$731.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$812.50	"$1,287.00"	"$1,300.00"	$0.00		$0.00	$254.31	$0.00	$0.00	$258.70	$0.00	$0.00	$0.00	$0.00	$0.00
PROTECTACRTDMMAM	SUP	HCPCS C1721		PROTECTACRTDMMAM  -  PROTECTA CRT-D ADVANCED SYSTEM	BOTH IP/OP	"$60,500.00 "	"$44,770.00"	$0.00	"$48,400.00"	"$27,225.00"	"$27,225.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$12,608.20"	$0.00	"$29,826.50"	"$29,826.50"	$0.00	"$30,250.00"	"$47,916.00"	"$48,400.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
PROTECTADRMMEM	SUP	HCPCS C1721		PROTECTADRMMEM  -  PROTECTA DR SYSTEM (INCLUDING DF4 HEADER)	BOTH IP/OP	"$49,812.50 "	"$36,861.25"	$0.00	"$39,850.00"	"$22,415.63"	"$22,415.63"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$10,380.93"	$0.00	"$24,557.56"	"$24,557.56"	$0.00	"$24,906.25"	"$39,451.50"	"$39,850.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$7,930.15"	$0.00	$0.00	$0.00	$0.00	$0.00
PROTECTAVREMEM	SUP	HCPCS C1721		PROTECTAVREMEM  -  PROTECTA VR SYSTEM (INCLUDING DF4 HEADER)	BOTH IP/OP	"$43,750.00 "	"$32,375.00"	$0.00	"$35,000.00"	"$19,687.50"	"$19,687.50"	$0.00	$0.00	$0.00	"$9,118.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,117.50"	$0.00	"$21,568.75"	"$21,568.75"	$0.00	"$21,875.00"	"$34,650.00"	"$35,000.00"	$0.00		$0.00	"$6,846.88"	$0.00	$0.00	"$6,965.00"	$0.00	$0.00	$0.00	$0.00	$0.00
PRT-FSP-DU	SUP	HCPCS C1713		PRT-FSP-DU  -  PLATE BN PRTN FRAG ULNA DISTAL	BOTH IP/OP	"$2,190.00 "	"$1,620.60"	$0.00	"$1,752.00"	$985.50	$985.50	$0.00	$0.00	$0.00	$456.45	"$1,625.42"	"$1,625.42"	$0.00	$0.00	$456.40	$0.00	"$1,295.39"	"$1,295.39"	$0.00	"$1,095.00"	"$1,734.48"	"$1,752.00"	$0.00		$0.00	$342.74	$0.00	$0.00	$348.65	$0.00	$0.00	$0.00	$0.00	$0.00
PRT-FSP-LR	SUP	HCPCS C1713		PRT-FSP-LR  -  PLATE BN PRTN FRAG ULNA DIST DOUBLE HOCKEY STICK	BOTH IP/OP	"$1,970.00 "	"$1,457.80"	$0.00	"$1,576.00"	$886.50	$886.50	$0.00	$0.00	$0.00	$410.60	"$1,462.13"	"$1,462.13"	$0.00	$0.00	$410.55	$0.00	"$1,165.26"	"$1,165.26"	$0.00	$985.00	"$1,560.24"	"$1,576.00"	$0.00		$0.00	$308.31	$0.00	$0.00	$313.62	$0.00	$0.00	$0.00	$0.00	$0.00
PRT-FSP-YS	SUP	HCPCS C1713		PRT-FSP-YS  -  PLATE BN PRTN FRAG ULNA DIST Y	BOTH IP/OP	"$1,970.00 "	"$1,457.80"	$0.00	"$1,576.00"	$886.50	$886.50	$0.00	$0.00	$0.00	$410.60	"$1,462.13"	"$1,462.13"	$0.00	$0.00	$410.55	$0.00	"$1,165.26"	"$1,165.26"	$0.00	$985.00	"$1,560.24"	"$1,576.00"	$0.00		$0.00	$308.31	$0.00	$0.00	$313.62	$0.00	$0.00	$0.00	$0.00	$0.00
PS11055	SUP	Custom 27803010		PS11055  -  GRAFT SFT TIS 5X5CM GRFX PRM ALGRF PLCNT MEMBR	BOTH IP/OP	"$6,875.00 "	"$5,087.50"	$0.00	"$5,500.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,432.75"	$0.00	$0.00	$0.00	$0.00	"$3,437.50"	"$5,445.00"	"$5,500.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PS12055	SUP	Custom 27803010		PS12055  -  GRAFT SFT TIS 5X5CM GRFX COR PLCNT MEMBR ALGRF	BOTH IP/OP	"$6,900.00 "	"$5,106.00"	$0.00	"$5,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,437.96"	$0.00	$0.00	$0.00	$0.00	"$3,450.00"	"$5,464.80"	"$5,520.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PS60005	SUP	Custom 27803010		PS60005  -  GRAFT SFT TIS 4X2CM STRAVIX ALGRF PLCNT TISS	BOTH IP/OP	"$4,512.50 "	"$3,339.25"	$0.00	"$3,610.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,349.18"	"$3,349.18"	$0.00	$0.00	$940.41	$0.00	$0.00	$0.00	$0.00	"$2,256.25"	"$3,573.90"	"$3,610.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PS60008	SUP	Custom 27803010		PS60008  -  GRAFT SFT TIS 6X3CM STRAVIX ALGRF PLCNT TISS	BOTH IP/OP	"$7,956.25 "	"$5,887.63"	$0.00	"$6,365.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,658.08"	$0.00	$0.00	$0.00	$0.00	"$3,978.13"	"$6,301.35"	"$6,365.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PSC026	SUP	HCPCS C1757		PSC026  -  CATHETER THROMBECTOMY 3.9-2.8FR .026IN 154CM 150CM	BOTH IP/OP	"$3,725.00 "	"$2,756.50"	$0.00	"$2,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$776.38	"$2,764.70"	"$2,764.70"	$0.00	$0.00	$776.29	$0.00	"$2,203.34"	"$2,203.34"	$0.00	"$1,862.50"	"$2,950.20"	"$2,980.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PSC041	SUP	HCPCS C1757		PSC041  -  CATHETER THROMBECTOMY 4.1FR .041IN 141CM REPERFUSION	BOTH IP/OP	"$3,725.00 "	"$2,756.50"	$0.00	"$2,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$776.38	"$2,764.70"	"$2,764.70"	$0.00	$0.00	$776.29	$0.00	"$2,203.34"	"$2,203.34"	$0.00	"$1,862.50"	"$2,950.20"	"$2,980.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PSC054	SUP	HCPCS C1757		PSC054  -  CATHETER THROMBECTOMY 6-5FR .054IN 132CM 136CM REPERFUSION	BOTH IP/OP	"$3,725.00 "	"$2,756.50"	$0.00	"$2,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$776.38	"$2,764.70"	"$2,764.70"	$0.00	$0.00	$776.29	$0.00	"$2,203.34"	"$2,203.34"	$0.00	"$1,862.50"	"$2,950.20"	"$2,980.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PSD 6002-UN	SUP	Custom 27203010		PSD 6002-UN  -  STAPLER INTNL 60MM UNV 2 FRNG 1 GEL TUBE STRL LF DISP PRSTRP	BOTH IP/OP	$368.75 	$272.88	$0.00	$273.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$273.69	$273.69	$0.00	$0.00	$76.85	$0.00	$0.00	$0.00	$0.00	$61.46	$97.35	$98.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PSD 6006-UV	SUP	Custom 27203010		PSD 6006-UV  -  STAPLER INTNL STRL LF PRSTRP DR 6 FRNG GEL TUBE LNR VRTS	BOTH IP/OP	$67.99 	$50.31	$0.00	$54.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.46	$50.46	$0.00	$0.00	$14.17	$0.00	$0.00	$0.00	$0.00	$33.99	$53.85	$54.39	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PSD 8006-UN	SUP	Custom 27203010		PSD 8006-UN  -  STAPLER INTNL ENDSCP LNR CTR 6 FRNG PRSTRP DR	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PSE45A	SUP	Custom 27203010		PSE45A  -  STAPLER INTERNAL 45MM 340MM LINEAR CUTTER ARTICULATION	BOTH IP/OP	"$8,484.68 "	"$6,278.66"	$0.00	"$6,787.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,768.21"	$0.00	$0.00	$0.00	$0.00	"$4,242.34"	"$6,719.87"	"$6,787.74"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PSEE45A	SUP	Custom 27203010		PSEE45A  -  STAPLER INTNL STD 340MM 45MM ECHLN FLX PWR + LNR CTR ESCP	BOTH IP/OP	"$1,661.12 "	"$1,229.23"	$0.00	"$1,328.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,232.88"	"$1,232.88"	$0.00	$0.00	$346.18	$0.00	$0.00	$0.00	$0.00	$830.56	"$1,315.61"	"$1,328.89"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PSEE60A	SUP	Custom 27203010		PSEE60A  -  STAPLER INTERNAL BENT 60MM 440MM RIDGE ASYMMETRICAL LEG LINE	BOTH IP/OP	"$1,993.34 "	"$1,475.07"	$0.00	"$2,700.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,505.39"	"$2,505.39"	$0.00	$0.00	$703.48	$0.00	$0.00	$0.00	$0.00	"$1,687.81"	"$2,673.50"	"$2,700.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PSS-6F-4MT	SUP	HCPCS C1894		PSS-6F-4MT  -  INTRODUCER SHEATH SHORT 6FR 4CM NO WIRE PRELUDE GREEN	BOTH IP/OP	$47.50 	$35.15	$0.00	$35.25	$23.08	$23.08	$0.00	$0.00	$0.00	$9.90	$35.25	$35.25	$0.00	$0.00	$9.90	$0.00	$28.10	$28.10	$0.00	$21.25	$33.66	$34.00	$0.00		$0.00	$6.65	$0.00	$0.00	$6.77	$0.00	$0.00	$0.00	$0.00	$0.00
PSS-7F-4MT	SUP	HCPCS C1894		PSS-7F-4MT  -  INTRODUCER SHEATH SHORT 7FR 21GA 4CM ORANGE HUB TUBING	BOTH IP/OP	$47.50 	$35.15	$0.00	$35.25	$4.62	$4.62	$0.00	$0.00	$0.00	$9.90	$35.25	$35.25	$0.00	$0.00	$9.90	$0.00	$28.10	$28.10	$0.00	$4.25	$6.73	$6.80	$0.00		$0.00	$1.33	$0.00	$0.00	$1.35	$0.00	$0.00	$0.00	$0.00	$0.00
PTA5-35-135-7-14.0	SUP	HCPCS C1725		PTA5-35-135-7-14.0  -  CATH BALDILAT .035IN 5FR 7MM 135CM 14CM 2 LUM PTA LP GWIRE	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$278.29	$278.29	$0.00	$0.00	$0.00	$106.82	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$303.14	$303.14	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$80.21	$0.00	$0.00	$81.59	$0.00	$0.00	$0.00	$0.00	$0.00
PTB124275	SUP	HCPCS C1874		PTB124275  -  GORE VIATORR TIPS ENDOPROSTHESIS	BOTH IP/OP	"$10,500.00 "	"$7,770.00"	$0.00	"$8,400.00"	"$4,725.00"	"$4,725.00"	$0.00	$0.00	$0.00	"$2,188.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,188.20"	$0.00	"$5,176.50"	"$5,176.50"	$0.00	"$5,250.00"	"$8,316.00"	"$8,400.00"	$0.00		$0.00	"$1,643.25"	$0.00	$0.00	"$1,671.60"	$0.00	$0.00	$0.00	$0.00	$0.00
PTB126275	SUP	HCPCS C1874		PTB126275  -  GORE VIATORR TIPS ENDOPROSTHESIS	BOTH IP/OP	"$10,500.00 "	"$7,770.00"	$0.00	"$8,400.00"	"$4,725.00"	"$4,725.00"	$0.00	$0.00	$0.00	"$2,188.46"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,188.20"	$0.00	"$5,176.50"	"$5,176.50"	$0.00	"$5,250.00"	"$8,316.00"	"$8,400.00"	$0.00		$0.00	"$1,643.25"	$0.00	$0.00	"$1,671.60"	$0.00	$0.00	$0.00	$0.00	$0.00
PTB128275	SUP	HCPCS C1874		PTB128275  -  GORE VIATORR TIPS ENDOPROSTHESIS	BOTH IP/OP	"$9,750.00 "	"$7,215.00"	$0.00	"$7,800.00"	"$4,387.50"	"$4,387.50"	$0.00	$0.00	$0.00	"$2,032.14"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,031.90"	$0.00	"$4,806.75"	"$4,806.75"	$0.00	"$4,875.00"	"$7,722.00"	"$7,800.00"	$0.00		$0.00	"$1,525.88"	$0.00	$0.00	"$1,552.20"	$0.00	$0.00	$0.00	$0.00	$0.00
PTB8106275	SUP	HCPCS C1874		PTB8106275  -  STENT EPRSTH 10MM 6CM STRL 2CM GORE VTR SLF XPD RADOPQ 2 LUM	BOTH IP/OP	"$12,855.00 "	"$9,512.70"	$0.00	"$9,888.00"	"$5,562.00"	"$5,562.00"	$0.00	$0.00	$0.00	"$2,679.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,678.98"	$0.00	"$6,337.52"	"$6,337.52"	$0.00	"$6,180.00"	"$9,789.12"	"$9,888.00"	$0.00		$0.00	"$1,934.34"	$0.00	$0.00	"$1,967.71"	$0.00	$0.00	$0.00	$0.00	$0.00
PTB8108275	SUP	HCPCS C1874		PTB8108275  -  STENT EPRSTH 10MM 8CM STRL 2CM GORE VTR SLF XPD RADOPQ 2 LUM	BOTH IP/OP	"$12,855.00 "	"$9,512.70"	$0.00	"$9,888.00"	"$5,562.00"	"$5,562.00"	$0.00	$0.00	$0.00	"$2,679.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,678.98"	$0.00	"$6,337.52"	"$6,337.52"	$0.00	"$6,180.00"	"$9,789.12"	"$9,888.00"	$0.00		$0.00	"$1,934.34"	$0.00	$0.00	"$1,967.71"	$0.00	$0.00	$0.00	$0.00	$0.00
PTH-MP	SUP	Custom 27203010		MAS PTH TRI-LEVEL CONTROL 6X3ML	BOTH IP/OP	$275.00 	$203.50	$0.00	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.50	$217.80	$220.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PV014300	SUP	HCPCS C1769		PV014300  -  JETWIRE JETSTREAM	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,696.88"	"$1,696.88"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,848.44"	"$1,848.44"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
PV2014L016N	SUP	HCPCS C1751		PV2014L016N  -  CATHETER ART LN 4FR 16CM PICCO GW NTNL	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
PV2014L022N	SUP	HCPCS C1751		PV2014L022N  -  CATHETER ART LN 4FR 22CM PICCO GW ADLT FEM ART BRACHIA	BOTH IP/OP	$62.50 	$46.25	$0.00	$50.00	$28.13	$28.13	$0.00	$0.00	$0.00	$13.03	$46.39	$46.39	$0.00	$0.00	$13.03	$0.00	$36.97	$36.97	$0.00	$31.25	$49.50	$50.00	$0.00		$0.00	$9.78	$0.00	$0.00	$9.95	$0.00	$0.00	$0.00	$0.00	$0.00
PV2015L20N	SUP	HCPCS C1751		PV2015L20N  -  CATH ART 5FR .028IN 7.78IN FEM PICCO ADLT STD	BOTH IP/OP	"$3,125.00 "	"$2,312.50"	$0.00	"$2,500.00"	"$1,406.25"	"$1,406.25"	$0.00	$0.00	$0.00	$651.33	"$2,319.38"	"$2,319.38"	$0.00	$0.00	$651.25	$0.00	"$1,540.63"	"$1,540.63"	$0.00	"$1,562.50"	"$2,475.00"	"$2,500.00"	$0.00		$0.00	$489.06	$0.00	$0.00	$497.50	$0.00	$0.00	$0.00	$0.00	$0.00
PV3116F	SUP	HCPCS C1714		PV3116F  -  CATHETER ATHRCM JETSTREAM NAVITUS ROT	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	"$4,615.50"	"$4,615.50"	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,771.40"	$0.00	$0.00	$0.00	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00		$0.00	"$1,330.25"	$0.00	$0.00	"$1,353.20"	$0.00	$0.00	$0.00	$0.00	$0.00
PV3118F	SUP	HCPCS C1714		PV3118F  -  CATHETER ATHRCM .014IN 7FR 2.4/3.4MM 120CM JETSTREAM NAVITUS	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	"$4,615.50"	"$4,615.50"	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,771.40"	$0.00	$0.00	$0.00	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00		$0.00	"$1,330.25"	$0.00	$0.00	"$1,353.20"	$0.00	$0.00	$0.00	$0.00	$0.00
PV31300	SUP	HCPCS C1714		PV31300  -  CATHETER ATHRCM JETSTREAM NAVITUS ROT	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	"$4,615.50"	"$4,615.50"	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,771.40"	$0.00	$0.00	$0.00	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00		$0.00	"$1,330.25"	$0.00	$0.00	"$1,353.20"	$0.00	$0.00	$0.00	$0.00	$0.00
PV4046	SUP	HCPCS C1751		PV4046  -  KIT ART LN INJECTATE TEMP SNSR HSNG PICCO	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$371.25	$371.25	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$0.00	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$412.50	$653.40	$660.00	$0.00		$0.00	$129.11	$0.00	$0.00	$131.34	$0.00	$0.00	$0.00	$0.00	$0.00
PV41340	SUP	HCPCS C1714		PV41340  -  CATHETER ATHRCM .014IN 7FR 2.4/3.4MM 120CM LF JETSTREAM	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	"$4,615.50"	"$4,615.50"	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,771.40"	$0.00	$0.00	$0.00	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00		$0.00	"$1,330.25"	$0.00	$0.00	"$1,353.20"	$0.00	$0.00	$0.00	$0.00	$0.00
PVE35A	SUP	Custom 27203010		PVE35A  -  STAPLER INTERNAL 320MM 35MM POWER ADVANCE PLACEMENT TIP	BOTH IP/OP	$990.33 	$732.84	$0.00	$792.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$735.02	$735.02	$0.00	$0.00	$206.38	$0.00	$0.00	$0.00	$0.00	$495.16	$784.34	$792.26	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PVPS	SUP	HCPCS C1781		PVPS  -  MESH SURG 4.3X4.3CM SELF EXPAND PRTL ABSORBABLE FLEXIBLE	BOTH IP/OP	"$1,462.90 "	"$1,082.55"	$0.00	"$1,170.32"	$658.31	$658.31	$0.00	$0.00	$0.00	$304.90	"$1,085.76"	"$1,085.76"	$0.00	$0.00	$304.87	$0.00	$865.31	$865.31	$0.00	$731.45	"$1,158.62"	"$1,170.32"	$0.00		$0.00	$228.94	$0.00	$0.00	$232.89	$0.00	$0.00	$0.00	$0.00	$0.00
PWL229997H	SUP	HCPCS C1785		PWL229997H  -  PACEMAKER SENSIA DR CARD SEDR01 PWL229997H	BOTH IP/OP	"$22,500.00 "	"$16,650.00"	$0.00	"$18,000.00"	"$10,125.00"	"$10,125.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$11,250.00"	"$17,820.00"	"$18,000.00"	$0.00		$0.00	"$3,521.25"	$0.00	$0.00	"$3,582.00"	$0.00	$0.00	$0.00	$0.00	$0.00
PWL242945H	SUP	HCPCS C1785		PWL242945H  -  PACEMAKER SENSIA 2CH CARD PWL242945H	BOTH IP/OP	"$19,655.00 "	"$14,544.70"	$0.00	"$15,724.00"	"$8,844.75"	"$8,844.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,827.50"	"$15,566.76"	"$15,724.00"	$0.00		$0.00	"$3,076.01"	$0.00	$0.00	"$3,129.08"	$0.00	$0.00	$0.00	$0.00	$0.00
PWL243503H	SUP	HCPCS C1785		PWL243503H  -  PACEMAKER SENSIA 2CH CARD PWL243503H	BOTH IP/OP	"$19,207.50 "	"$14,213.55"	$0.00	"$15,366.00"	"$8,643.38"	"$8,643.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,603.75"	"$15,212.34"	"$15,366.00"	$0.00		$0.00	"$3,005.97"	$0.00	$0.00	"$3,057.83"	$0.00	$0.00	$0.00	$0.00	$0.00
PWR224751H	SUP	HCPCS C1785		PWR224751H  -  PACEMAKER SENSIA 2CH CARD PWR224751H	BOTH IP/OP	"$18,900.00 "	"$13,986.00"	$0.00	"$15,120.00"	"$8,505.00"	"$8,505.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,450.00"	"$14,968.80"	"$15,120.00"	$0.00		$0.00	"$2,957.85"	$0.00	$0.00	"$3,008.88"	$0.00	$0.00	$0.00	$0.00	$0.00
PWR230180H	SUP	HCPCS C1785		PWR230180H  -  PACEMAKER SENSIA DR CARD SEDR01 PWR230180H	BOTH IP/OP	"$7,237.50 "	"$5,355.75"	$0.00	"$5,790.00"	"$3,256.88"	"$3,256.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,618.75"	"$5,732.10"	"$5,790.00"	$0.00		$0.00	"$1,132.67"	$0.00	$0.00	"$1,152.21"	$0.00	$0.00	$0.00	$0.00	$0.00
PXC121000	SUP	Custom 27806189		PXC121000  -  GRAFT EVAS LOPRFL 12MM 10CM XCLDR STNT XTD DLV SYS SL CUF	BOTH IP/OP	"$11,275.00 "	"$8,343.50"	$0.00	"$9,020.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,349.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,349.71"	$0.00	"$5,558.58"	"$5,558.58"	$0.00	"$5,637.50"	"$8,929.80"	"$9,020.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PXSLIM045	SUP	HCPCS C1757		PXSLIM045  -  CATHETER DELIVERY SYSTEM 45D MICRO 2.95FR .025IN 150CM 2 TIP	BOTH IP/OP	"$2,210.00 "	"$1,635.40"	$0.00	"$1,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$460.62	"$1,640.26"	"$1,640.26"	$0.00	$0.00	$460.56	$0.00	"$1,307.22"	"$1,307.22"	$0.00	"$1,105.00"	"$1,750.32"	"$1,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PXSLIM090	SUP	HCPCS C1757		PXSLIM090  -  CATHETER DLV SYS 90D 0-.025IN MIC 2.6-2.95FR 150CM PX SLIM 2	BOTH IP/OP	"$2,210.00 "	"$1,635.40"	$0.00	"$1,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$460.62	"$1,640.26"	"$1,640.26"	$0.00	$0.00	$460.56	$0.00	"$1,307.22"	"$1,307.22"	$0.00	"$1,105.00"	"$1,750.32"	"$1,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PXSLIM130	SUP	HCPCS C1757		PXSLIM130  -  CATHETER DELIVERY SYSTEM 130D 0-.025IN MICRO 2.6-2.95FR 150	BOTH IP/OP	"$2,210.00 "	"$1,635.40"	$0.00	"$1,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$460.62	"$1,640.26"	"$1,640.26"	$0.00	$0.00	$460.56	$0.00	"$1,307.22"	"$1,307.22"	$0.00	"$1,105.00"	"$1,750.32"	"$1,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PXSLIMSTR	SUP	HCPCS C1757		PXSLIMSTR  -  CATHETER DLV SYS 0-.02IN MIC STRG 2.6-2.95FR .025IN 150CM PX	BOTH IP/OP	"$2,210.00 "	"$1,635.40"	$0.00	"$1,768.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$460.62	"$1,640.26"	"$1,640.26"	$0.00	$0.00	$460.56	$0.00	"$1,307.22"	"$1,307.22"	$0.00	"$1,105.00"	"$1,750.32"	"$1,768.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PXX52	SUP	Custom 27203010		PXX52  -  SUTURE NONABSORBABLE THK1/16IN 2-0 V-5 30IN .25X1/8IN 2 ARM	BOTH IP/OP	$195.26 	$144.49	$0.00	$158.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$144.93	$144.93	$0.00	$0.00	$40.69	$0.00	$0.00	$0.00	$0.00	$99.10	$156.97	$158.55	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
PXX77	SUP	Custom 27203010		PXX77  -  SUTURE NONABSORBABLE THK1/16IN 2-0 V-7 30IN .25X1/8IN 2 ARM	BOTH IP/OP	$211.39 	$156.43	$0.00	$169.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.90	$156.90	$0.00	$0.00	$44.05	$0.00	$0.00	$0.00	$0.00	$105.70	$167.42	$169.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Q50-65P	SUP	Custom 27204833		Q50-65P  -  CATHETER OCL 10-50MM 65CM Q50 + BLN STNT GFT DLV FLX TP	BOTH IP/OP	"$1,212.50 "	$897.25	$0.00	$970.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$899.92	$899.92	$0.00	$0.00	$252.69	$0.00	$0.00	$0.00	$0.00	$606.25	$960.30	$970.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
QC-12-30-HELIX	SUP	HCPCS C2628		QC-12-30-HELIX  -  COIL EMBL .3683MM HLX 12MM .0145IN 30CM AXIUM DTCH PLTN	BOTH IP/OP	"$1,802.50 "	"$1,333.85"	$0.00	"$1,442.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$375.69	"$1,337.82"	"$1,337.82"	$0.00	$0.00	$375.64	$0.00	"$1,066.18"	"$1,066.18"	$0.00	$901.25	"$1,427.58"	"$1,442.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
QC-12-40-3D	SUP	Custom 27803010		QC-12-40-3D  -  COIL EMBL .3683MM 3D 12MM .0145IN 40CM AXIUM DTCH PLTN	BOTH IP/OP	"$2,432.50 "	"$1,800.05"	$0.00	"$1,946.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,805.40"	"$1,805.40"	$0.00	$0.00	$506.93	$0.00	$0.00	$0.00	$0.00	"$1,216.25"	"$1,926.54"	"$1,946.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
QS70406	SUP	Custom 27203010		QS70406  -  ADHESIVE SKIN DERMA FLEX QS	BOTH IP/OP	$40.63 	$30.07	$0.00	$32.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.15	$30.15	$0.00	$0.00	$8.47	$0.00	$0.00	$0.00	$0.00	$20.31	$32.18	$32.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
QTX321256	SUP	Custom 27203010		QTX321256  -  ROPE TRC 10FT STRL LF	BOTH IP/OP	$203.10 	$150.29	$0.00	$156.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.74	$150.74	$0.00	$0.00	$42.33	$0.00	$0.00	$0.00	$0.00	$97.89	$155.06	$156.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R020	SUP	HCPCS C1768		R020  -  GRAFT SFT TIS CRYOARTERY FEM POPLT ART	BOTH IP/OP	"$16,250.00 "	"$12,025.00"	$0.00	"$13,000.00"	"$7,312.50"	"$7,312.50"	$0.00	$0.00	$0.00	"$3,386.91"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,386.50"	$0.00	"$8,011.25"	"$8,011.25"	$0.00	"$8,125.00"	"$12,870.00"	"$13,000.00"	$0.00		$0.00	"$2,543.13"	$0.00	$0.00	"$2,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00
R0450	SUP	Custom 27203010		CURETTE 4MM ADSP DRML LOOP TIP SURG SS STRL DISP	BOTH IP/OP	$3.75 	$2.78	$0.00	$3.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.88	$2.97	$3.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R1212	SUP	Custom 27203010		DRESSING WOUND PROCELLERA ANTIMICROBIAL 12X12	BOTH IP/OP	$562.50 	$416.25	$0.00	$720.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R21121	SUP	Custom 27203010		DISK BTYRT ESTRS M CATRRHL ID	BOTH IP/OP	$148.80 	$110.11	$0.00	$119.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.40	$117.85	$119.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R30859602	SUP	Custom 27203010		KIT WLCGN BCTR AG RPD LTX AGGL MCBLTST 30 TST	BOTH IP/OP	$59.03 	$43.68	$0.00	$47.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.51	$46.75	$47.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R30950801	SUP	Custom 27203010		REAGENT MCBL STRP GRP C LTX AGGL STREPTEX 50 TST	BOTH IP/OP	$4.05 	$3.00	$0.00	$3.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$2.03	$3.21	$3.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R30951001	SUP	Custom 27203010		REAGENT MCBL XTRT ENZM SPL VL STREPTEX 25 TST	BOTH IP/OP	$3.85 	$2.85	$0.00	$3.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.93	$3.05	$3.08	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R30951201	SUP	Custom 27203010		REAGENT MCBL STRP GRP G LTX AGGL STREPTEX 50 TST	BOTH IP/OP	$3.98 	$2.95	$0.00	$3.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.99	$3.15	$3.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R314II	SUP	Custom 27203010		CABLE EKG 3 LEAD SHLD CONNCTR .059IN	BOTH IP/OP	$172.08 	$127.34	$0.00	$137.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.04	$136.29	$137.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R324II	SUP	Custom 27203010		CABLE EKG 3 LEAD CONNCTR 3 SHLD .059IN	BOTH IP/OP	$186.63 	$138.11	$0.00	$149.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.31	$147.81	$149.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R32611	SUP	Custom 27203010		CABLE  ECG/PATIENT LIFEPACK .059IN 3 LEAD CONFIGURATION 3B C	BOTH IP/OP	$164.63 	$121.83	$0.00	$131.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.31	$130.39	$131.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R390.003	SUP	Custom 27203010		R390.003  -  DEVICE EXFIX ROD ATTCH LG EXFIX 4-6 MM SCHNZ SCR NONSTRL	BOTH IP/OP	$632.50 	$468.05	$0.00	$506.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$469.44	$469.44	$0.00	$0.00	$131.81	$0.00	$0.00	$0.00	$0.00	$316.25	$500.94	$506.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R390.005	SUP	HCPCS C1713		CLAMP COMBO MR CONDITIONAL CNTRL EXFIXA LG NSTRL	BOTH IP/OP	$0.03 	$0.02	$0.00	$0.02	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.02	$0.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R390.008	SUP	HCPCS C1713		CLAMP OPN ADJ MR CONDITIONAL CNTRL EXFIXA LG NSTRL	BOTH IP/OP	$0.03 	$0.02	$0.00	$0.02	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.02	$0.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R390.009	SUP	HCPCS C1713		PIN CLMP ROD 4 PSTN ADJ CNTRL EXFIXA LG NSTRL	BOTH IP/OP	$0.03 	$0.02	$0.00	$0.02	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.02	$0.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R390.010	SUP	Custom 27203010		R390.010  -  CLAMP EXFIX LG 6 PSTN PIN NONSTRL	BOTH IP/OP	$705.00 	$521.70	$0.00	$564.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$523.25	$523.25	$0.00	$0.00	$146.92	$0.00	$0.00	$0.00	$0.00	$352.50	$558.36	$564.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R390.012	SUP	HCPCS C1713		PIN 11MM ADJ CNTRL ROD POST OTRGR EXFIXA 30D NSTRL	BOTH IP/OP	$0.03 	$0.02	$0.00	$0.02	$0.01	$0.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.01	$0.02	$0.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R390.051	SUP	Custom 27203010		R390.051  -  CLAMP EXFIX 4MM DISTAL RADL ADJ NONSTRL	BOTH IP/OP	"$1,127.50 "	$834.35	$0.00	$902.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$836.83	$836.83	$0.00	$0.00	$234.97	$0.00	$0.00	$0.00	$0.00	$563.75	$892.98	$902.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R394.85	SUP	Custom 27203010		R394.85  -  ROD EXFIX 300MM 11MM CARFBR SLFDRILL MR CONDITIONAL SET	BOTH IP/OP	$355.00 	$262.70	$0.00	$284.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.48	$263.48	$0.00	$0.00	$73.98	$0.00	$0.00	$0.00	$0.00	$177.50	$281.16	$284.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R395.786	SUP	Custom 27203010		R395.786  -  ROD EXFIX 240MM 8MM DISTAL RADL CARFBR NONSTRL	BOTH IP/OP	$232.50 	$172.05	$0.00	$186.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.56	$172.56	$0.00	$0.00	$48.45	$0.00	$0.00	$0.00	$0.00	$116.25	$184.14	$186.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
R6515-01	SUP	Custom 25803010		R6515-01  -  SOLUTION IRR 2L LTX PHYSIOLYTE PIC 5% MNTL	BOTH IP/OP	$30.61 	$22.65	$0.00	$24.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.72	$22.72	$0.00	$0.00	$6.38	$0.00	$0.00	$0.00	$0.00	$15.31	$24.24	$24.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RA-04020	SUP	HCPCS C1729		RA-04020  -  KIT ARTERIAL LINE .018IN 20GA 22GA 1.75IN CATHETER RADIOPQ	BOTH IP/OP	$39.45 	$29.19	$0.00	$29.28	$15.64	$15.64	$0.00	$0.00	$0.00	$8.22	$29.28	$29.28	$0.00	$0.00	$8.22	$0.00	$23.33	$23.33	$0.00	$14.40	$22.81	$23.04	$0.00		$0.00	$4.51	$0.00	$0.00	$4.58	$0.00	$0.00	$0.00	$0.00	$0.00
RAN-811-OT	SUP	Custom 27203010		RAN-811-OT  -  NEEDLE IO 8GA 11CM DLV OPN TIP	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$0.00	$0.00	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RBY2C0725	SUP	Custom 27803010		RBY2C0725  -  COIL EMBL STD .02IN 7MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG	BOTH IP/OP	"$2,475.00 "	"$1,831.50"	$0.00	"$1,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,836.95"	"$1,836.95"	$0.00	$0.00	$515.79	$0.00	$0.00	$0.00	$0.00	"$1,237.50"	"$1,960.20"	"$1,980.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RBY2C0825	SUP	Custom 27803010		RBY2C0825  -  COIL EMBL STD .02IN 8MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG	BOTH IP/OP	"$2,475.00 "	"$1,831.50"	$0.00	"$1,980.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,836.95"	"$1,836.95"	$0.00	$0.00	$515.79	$0.00	$0.00	$0.00	$0.00	"$1,237.50"	"$1,960.20"	"$1,980.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RBY2C0840	SUP	Custom 27803010		RBY2C0840  -  COIL EMBL STD .02IN 8MM 40CM PENUMBRA COIL 400 RUBY CMPLX LG	BOTH IP/OP	"$3,225.00 "	"$2,386.50"	$0.00	"$2,580.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,393.60"	"$2,393.60"	$0.00	$0.00	$672.09	$0.00	$0.00	$0.00	$0.00	"$1,612.50"	"$2,554.20"	"$2,580.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RBYPOD8	SUP	Custom 27803010		RBYPOD8  -  COIL EMBL 8MM 60CM RUBY POD CMPLX OCCULUSION DEV	BOTH IP/OP	"$4,475.00 "	"$3,311.50"	$0.00	"$3,580.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,321.35"	"$3,321.35"	$0.00	$0.00	$932.59	$0.00	$0.00	$0.00	$0.00	"$2,237.50"	"$3,544.20"	"$3,580.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RBYPODJ60	SUP	Custom 27803010		RBYPODJ60  -  COIL EMBL J-SFT 60CM STRL LF POD PK	BOTH IP/OP	"$3,225.00 "	"$2,386.50"	$0.00	"$2,580.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,393.60"	"$2,393.60"	$0.00	$0.00	$672.09	$0.00	$0.00	$0.00	$0.00	"$1,612.50"	"$2,554.20"	"$2,580.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RC-15	SUP	HCPCS C1760		SYSTEM EMBL PRTC VC FLTR 2LVL REM 12FR RCVR CN	BOTH IP/OP	"$1,312.50 "	$971.25	$0.00	"$1,050.00"	$590.63	$590.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$205.41	$0.00	$0.00	$208.95	$0.00	$0.00	$0.00	$0.00	$0.00
RC41-12027	SUP	Custom 27203010		RC41-12027  -  CIRCUIT BRTHG ANES HEAT WIRE 40IN NEO INF	BOTH IP/OP	$66.67 	$49.34	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.48	$49.48	$0.00	$0.00	$13.89	$0.00	$0.00	$0.00	$0.00	$33.33	$52.80	$53.33	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RCFW-5.0-35	SUP	HCPCS C1894		RCFW-5.0-35  -  SET INTROD 13CM 5FR CHK-FLO PRFRMR SDARM FIT SIDE CONNECT LN	BOTH IP/OP	$47.15 	$34.89	$0.00	$37.72	$25.60	$25.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.58	$37.34	$37.72	$0.00		$0.00	$7.38	$0.00	$0.00	$7.51	$0.00	$0.00	$0.00	$0.00	$0.00
RCP3	SUP	HCPCS C1713		RCP3  -  PLATE BN NS RADL CLMN PIN PLT 3 HL PIN CLMN RADL	BOTH IP/OP	"$1,550.00 "	"$1,147.00"	$0.00	"$1,240.00"	$697.50	$697.50	$0.00	$0.00	$0.00	$323.06	"$1,150.41"	"$1,150.41"	$0.00	$0.00	$323.02	$0.00	$916.83	$916.83	$0.00	$775.00	"$1,227.60"	"$1,240.00"	$0.00		$0.00	$242.58	$0.00	$0.00	$246.76	$0.00	$0.00	$0.00	$0.00	$0.00
RCP5	SUP	HCPCS C1713		RCP5  -  PLATE BN NS RADL CLMN PIN PLT 5 HL PIN CLMN RADL	BOTH IP/OP	"$1,550.00 "	"$1,147.00"	$0.00	"$1,240.00"	$697.50	$697.50	$0.00	$0.00	$0.00	$323.06	"$1,150.41"	"$1,150.41"	$0.00	$0.00	$323.02	$0.00	$916.83	$916.83	$0.00	$775.00	"$1,227.60"	"$1,240.00"	$0.00		$0.00	$242.58	$0.00	$0.00	$246.76	$0.00	$0.00	$0.00	$0.00	$0.00
RF-310F	SUP	HCPCS C1760		SYSTEM EMBL PRTC 48CM VC FLTR FEM DLV KT 7FR G2	BOTH IP/OP	"$2,750.00 "	"$2,035.00"	$0.00	"$2,200.00"	"$1,237.50"	"$1,237.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,375.00"	"$2,178.00"	"$2,200.00"	$0.00		$0.00	$430.38	$0.00	$0.00	$437.80	$0.00	$0.00	$0.00	$0.00	$0.00
RFP-400	SUP	Custom 25003010		SOLUTION DLYST 140 MEQ NA 2 MEQ K 3 MEQ CALCIUM 1 MEQ MG 111	BOTH IP/OP	$118.75 	$87.88	$0.00	$95.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$94.05	$95.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RFP-401	SUP	Custom 25003010		SOLUTION DLYST 140 MEQ NA 4 MEQ K 3 MEQ CALCIUM 1 MEQ MG 113	BOTH IP/OP	$118.75 	$87.88	$0.00	$95.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.38	$94.05	$95.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RG*ES1818SP	SUP	HCPCS C1769		RG*ES1818SP  -  GUIDEWIRE VASCULAR STR .018IN 180CM 25CM SHAPEABLE SHAFT	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$215.84	$215.84	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
RG*GA1818SP	SUP	HCPCS C1769		RG*GA1818SP  -  GUIDEWIRE VASCULAR 45D .018IN 180CM 25CM GLIDEWIRE GT HYDPHI	BOTH IP/OP	$46.50 	$34.41	$0.00	$34.51	$23.35	$23.35	$0.00	$0.00	$0.00	$9.69	$34.51	$34.51	$0.00	$0.00	$9.69	$0.00	$27.50	$27.50	$0.00	$21.50	$34.06	$34.40	$0.00		$0.00	$6.73	$0.00	$0.00	$6.85	$0.00	$0.00	$0.00	$0.00	$0.00
RH1	SUP	Custom 27203010		RH1  -  HANDLE INST RUBY DTCH COIL	BOTH IP/OP	$595.00 	$440.30	$0.00	$476.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$441.61	$441.61	$0.00	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$297.50	$471.24	$476.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RL-3019-S	SUP	HCPCS C1713		RL-3019-S  -  ROD ORTH 190MM 3MM LEFT RADL WR HND RAD IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
RL-3021-S	SUP	HCPCS C1713		RL-3021-S  -  ROD ORTH 210MM 3MM LEFT RADL WR HND RAD IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
RL-3023-S	SUP	HCPCS C1713		RL-3023-S  -  ROD ORTH 230MM 3MM LEFT RADL WR HND TI RAD IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
RL-3619-S	SUP	HCPCS C1713		RL-3619-S  -  ROD ORTH 190MM 3.6MM LEFT RADL FRARM RAD IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
RL-3621-S	SUP	HCPCS C1713		RL-3621-S  -  ROD ORTH 210MM 3.6MM LEFT DISTAL RADL FRARM RAD IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
RL-3623-S	SUP	HCPCS C1713		RL-3623-S  -  ROD ORTH 230MM 3.6MM LEFT RADL FRARM RAD IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
RMT3130	SUP	Custom 27203010		RMT3130  -  REAMER SURG 3.1MM THDL ROD SYS WR HND 300MM STRL	BOTH IP/OP	$497.50 	$368.15	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.75	$394.02	$398.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RMT-3130	SUP	Custom 27203010		RMT-3130  -  REAMER SURG 3.1MM THDL ROD SYS WR HND 300MM STRL	BOTH IP/OP	$497.50 	$368.15	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$369.24	$369.24	$0.00	$0.00	$103.68	$0.00	$0.00	$0.00	$0.00	$248.75	$394.02	$398.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RMT-3137	SUP	Custom 27203010		RMT-3137  -  REAMER SRG 3.7MM THDL DISP FRARM ROD SYS	BOTH IP/OP	$497.50 	$368.15	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$369.24	$369.24	$0.00	$0.00	$103.68	$0.00	$0.00	$0.00	$0.00	$248.75	$394.02	$398.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RMT3730	SUP	Custom 27203010		RMT3730  -  REAMER SURG 3.7MM THDL WR HND DISP	BOTH IP/OP	$497.50 	$368.15	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$369.24	$369.24	$0.00	$0.00	$103.68	$0.00	$0.00	$0.00	$0.00	$248.75	$394.02	$398.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RMT7340	SUP	Custom 27203010		RMT7340  -  REAMER SURG 7.3MM THDL 400MM	BOTH IP/OP	$497.50 	$368.15	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$369.24	$369.24	$0.00	$0.00	$103.68	$0.00	$0.00	$0.00	$0.00	$248.75	$394.02	$398.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RMT8340	SUP	Custom 27203010		RMT8340  -  REAMER SURG 8.3MM THDL 400MM	BOTH IP/OP	$497.50 	$368.15	$0.00	$398.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$369.24	$369.24	$0.00	$0.00	$103.68	$0.00	$0.00	$0.00	$0.00	$248.75	$394.02	$398.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RPC-35-260	SUP	HCPCS C1769		RPC-35-260  -  GWIRE VASC .035IN 260CM ANG STD TPR STF SHFT EXCH RDRR PC	BOTH IP/OP	$81.40 	$60.24	$0.00	$65.12	$44.20	$44.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.70	$64.47	$65.12	$0.00		$0.00	$12.74	$0.00	$0.00	$12.96	$0.00	$0.00	$0.00	$0.00	$0.00
RR-3019-S	SUP	HCPCS C1713		RR-3019-S  -  ROD ORTH 190MM 3MM RIGHT RADL WR HND RAD IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
RR-3021-S	SUP	HCPCS C1713		RR-3021-S  -  ROD ORTH 210MM 3MM RIGHT RADL WR HND RAD IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
RR-3023-S	SUP	HCPCS C1713		RR-3023-S  -  ROD ORTH 230MM 3MM RIGHT RADL FRARM RAD IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
RR-3619-S	SUP	HCPCS C1713		RR-3619-S  -  ROD RADIUS 3.6MM 90MM RIGHT	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
RR-3621-S	SUP	HCPCS C1713		RR-3621-S  -  ROD RADIUS 3.6MM 210MM RIGHT	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
RR-3623-S	SUP	HCPCS C1713		RR-3623-S  -  ROD ORTH 230MM 3.6MM RIGHT RADL WR HND RAD IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
RRT08030040L	SUP	HCPCS C1768		RRT08030040L  -  GRAFT VASCULAR THIN WALL RING STANDARD 8MM 40CM 30CM	BOTH IP/OP	"$1,830.00 "	"$1,354.20"	$0.00	"$1,464.00"	$823.50	$823.50	$0.00	$0.00	$0.00	$381.42	"$1,358.23"	"$1,358.23"	$0.00	$0.00	$381.37	$0.00	"$1,082.45"	"$1,082.45"	$0.00	$915.00	"$1,449.36"	"$1,464.00"	$0.00		$0.00	$286.40	$0.00	$0.00	$291.34	$0.00	$0.00	$0.00	$0.00	$0.00
RRT08070070L	SUP	HCPCS C1768		RRT08070070L  -  GRAFT VASCULAR THIN WALL RING 8MM 70CM 70CM GORE-TEX	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
RRT10030030L	SUP	HCPCS C1768		RRT10030030L  -  GRAFT VASCULAR THIN WALL 10MM 30CM 30CM REMOVABLE RING LINE	BOTH IP/OP	"$2,302.50 "	"$1,703.85"	$0.00	"$1,842.00"	"$1,036.13"	"$1,036.13"	$0.00	$0.00	$0.00	$479.90	"$1,708.92"	"$1,708.92"	$0.00	$0.00	$479.84	$0.00	"$1,361.93"	"$1,361.93"	$0.00	"$1,151.25"	"$1,823.58"	"$1,842.00"	$0.00		$0.00	$360.34	$0.00	$0.00	$366.56	$0.00	$0.00	$0.00	$0.00	$0.00
RRT10070070L	SUP	HCPCS C1768		RRT10070070L  -  GRAFT VASCULAR THIN WALL 10MM 70CM 70CM REMOVABLE RING LINE	BOTH IP/OP	"$3,002.50 "	"$2,221.85"	$0.00	"$2,402.00"	"$1,351.13"	"$1,351.13"	$0.00	$0.00	$0.00	$625.80	"$2,228.46"	"$2,228.46"	$0.00	$0.00	$625.72	$0.00	"$1,480.23"	"$1,480.23"	$0.00	"$1,501.25"	"$2,377.98"	"$2,402.00"	$0.00		$0.00	$469.89	$0.00	$0.00	$478.00	$0.00	$0.00	$0.00	$0.00	$0.00
RS22	SUP	Custom 27203010		RS22  -  SUTURE NONABSORBABLE 5MM CTX 12IN 2 ARM MERSILENE WHITE	BOTH IP/OP	$80.02 	$59.21	$0.00	$64.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.39	$59.39	$0.00	$0.00	$16.68	$0.00	$0.00	$0.00	$0.00	$40.61	$64.33	$64.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RS317	SUP	Custom 27203010		CABLE  ECG/PATIENT 3 LEAD FOR SRS SERIES HP 345P	BOTH IP/OP	$93.75 	$69.38	$0.00	$75.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.88	$74.25	$75.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RSB501	SUP	HCPCS C1894		RSB501  -  INTRODUCER SHTH 5FR 6CM 2.5CM PNCL RADOPQ DIL NO MN GW	BOTH IP/OP	$62.88 	$46.53	$0.00	$46.67	$25.45	$25.45	$0.00	$0.00	$0.00	$13.10	$46.67	$46.67	$0.00	$0.00	$13.10	$0.00	$37.19	$37.19	$0.00	$23.44	$37.13	$37.50	$0.00		$0.00	$7.34	$0.00	$0.00	$7.46	$0.00	$0.00	$0.00	$0.00	$0.00
RSB502	SUP	HCPCS C1894		RSB502  -  INTRODUCER SHTH 5FR 10CM 2.5CM PNCL RADOPQ DIL NO MN GW	BOTH IP/OP	$68.50 	$50.69	$0.00	$50.84	$29.05	$29.05	$0.00	$0.00	$0.00	$14.28	$50.84	$50.84	$0.00	$0.00	$14.28	$0.00	$40.52	$40.52	$0.00	$26.75	$42.37	$42.80	$0.00		$0.00	$8.37	$0.00	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$0.00
RSB503	SUP	HCPCS C1894		RSB503  -  INTRODUCER SHTH 5FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST	BOTH IP/OP	$87.15 	$64.49	$0.00	$64.68	$35.30	$35.30	$0.00	$0.00	$0.00	$18.16	$64.68	$64.68	$0.00	$0.00	$18.16	$0.00	$51.55	$51.55	$0.00	$32.50	$51.48	$52.00	$0.00		$0.00	$10.17	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$0.00
RSB602	SUP	HCPCS C1894		RSB602  -  INTRODUCER SHTH 6FR 10CM 2.5CM PN RO2 DIL RADOPQ KINK RST	BOTH IP/OP	$68.50 	$50.69	$0.00	$50.84	$29.05	$29.05	$0.00	$0.00	$0.00	$14.28	$50.84	$50.84	$0.00	$0.00	$14.28	$0.00	$40.52	$40.52	$0.00	$26.75	$42.37	$42.80	$0.00		$0.00	$8.37	$0.00	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$0.00
RSB603	SUP	HCPCS C1894		RSB603  -  INTRODUCER SHTH 6FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST	BOTH IP/OP	$87.15 	$64.49	$0.00	$64.68	$35.30	$35.30	$0.00	$0.00	$0.00	$18.16	$64.68	$64.68	$0.00	$0.00	$18.16	$0.00	$51.55	$51.55	$0.00	$32.50	$51.48	$52.00	$0.00		$0.00	$10.17	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$0.00
RSB702	SUP	HCPCS C1894		RSB702  -  INTRODUCER SHTH 7FR 2.5CM 10CM DILAT RADIOPQ MRKR	BOTH IP/OP	$68.50 	$50.69	$0.00	$50.84	$29.05	$29.05	$0.00	$0.00	$0.00	$14.28	$50.84	$50.84	$0.00	$0.00	$14.28	$0.00	$40.52	$40.52	$0.00	$26.75	$42.37	$42.80	$0.00		$0.00	$8.37	$0.00	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$0.00
RSB703	SUP	HCPCS C1894		RSB703  -  INTRODUCER SHTH 7FR 2.5CM 25CM DILAT RADIOPQ MRKR	BOTH IP/OP	$87.15 	$64.49	$0.00	$64.68	$35.30	$35.30	$0.00	$0.00	$0.00	$18.16	$64.68	$64.68	$0.00	$0.00	$18.16	$0.00	$51.55	$51.55	$0.00	$32.50	$51.48	$52.00	$0.00		$0.00	$10.17	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$0.00
RSB802	SUP	HCPCS C1894		RSB802  -  INTRODUCER SHTH 8FR 2.5CM 10CM GWIRE DILAT RADIOPQ	BOTH IP/OP	$68.50 	$50.69	$0.00	$50.84	$29.05	$29.05	$0.00	$0.00	$0.00	$14.28	$50.84	$50.84	$0.00	$0.00	$14.28	$0.00	$40.52	$40.52	$0.00	$26.75	$42.37	$42.80	$0.00		$0.00	$8.37	$0.00	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$0.00
RSB803	SUP	HCPCS C1894		RSB803  -  INTRODUCER SHTH 8FR 2.5CM 25CM DILAT RADIOPQ MRKR	BOTH IP/OP	$87.15 	$64.49	$0.00	$64.68	$35.30	$35.30	$0.00	$0.00	$0.00	$18.16	$64.68	$64.68	$0.00	$0.00	$18.16	$0.00	$51.55	$51.55	$0.00	$32.50	$51.48	$52.00	$0.00		$0.00	$10.17	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$0.00
RSB902	SUP	HCPCS C1894		RSB902  -  INTRODUCER SHTH 9FR 10CM 2.5CM PN RO2 DIL RADOPQ KINK RST	BOTH IP/OP	$68.50 	$50.69	$0.00	$50.84	$29.05	$29.05	$0.00	$0.00	$0.00	$14.28	$50.84	$50.84	$0.00	$0.00	$14.28	$0.00	$40.52	$40.52	$0.00	$26.75	$42.37	$42.80	$0.00		$0.00	$8.37	$0.00	$0.00	$8.52	$0.00	$0.00	$0.00	$0.00	$0.00
RSB903	SUP	HCPCS C1894		RSB903  -  INTRODUCER SHTH 9FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST	BOTH IP/OP	$87.15 	$64.49	$0.00	$64.68	$35.30	$35.30	$0.00	$0.00	$0.00	$18.16	$64.68	$64.68	$0.00	$0.00	$18.16	$0.00	$51.55	$51.55	$0.00	$32.50	$51.48	$52.00	$0.00		$0.00	$10.17	$0.00	$0.00	$10.35	$0.00	$0.00	$0.00	$0.00	$0.00
RSR01	SUP	HCPCS C1887		RSR01  -  INTROD SHTH 6FR 45CM GUID STR XCUT VLV PN DSTN HYDPHI PTFE	BOTH IP/OP	$261.25 	$193.33	$0.00	$193.90	$112.24	$112.24	$0.00	$0.00	$0.00	$54.45	$193.90	$193.90	$0.00	$0.00	$54.44	$0.00	$154.53	$154.53	$0.00	$103.35	$163.71	$165.36	$0.00		$0.00	$32.35	$0.00	$0.00	$32.91	$0.00	$0.00	$0.00	$0.00	$0.00
RSR02	SUP	HCPCS C1887		RSR02  -  SHEATH GD HS CRV 6FR 45CM 5CM PN DSTN XCUT VLV RADOPQ SS NYL	BOTH IP/OP	$261.25 	$193.33	$0.00	$193.90	$111.32	$111.32	$0.00	$0.00	$0.00	$54.45	$193.90	$193.90	$0.00	$0.00	$54.44	$0.00	$154.53	$154.53	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
RSR14	SUP	HCPCS C1894		RSR14  -  SHEATH GD LIMA CRV 6FR 45CM 5CM PN DSTN XCUT VLV RADOPQ SS	BOTH IP/OP	$261.25 	$193.33	$0.00	$193.90	$111.32	$111.32	$0.00	$0.00	$0.00	$54.45	$193.90	$193.90	$0.00	$0.00	$54.44	$0.00	$154.53	$154.53	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
RSS001	SUP	HCPCS C1894		RSS001  -  INTRODUCER SHEATH .035IN 10FR 10CM 2.5CM GWIRE DILAT KINK	BOTH IP/OP	$27.18 	$20.11	$0.00	$20.17	$11.88	$11.88	$0.00	$0.00	$0.00	$5.66	$20.17	$20.17	$0.00	$0.00	$5.66	$0.00	$16.07	$16.07	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
RSS005	SUP	HCPCS C1894		RSS005  -  INTRODUCER SHEATH 10FR 25CM 2.5CM DILAT KINK RESISTANT	BOTH IP/OP	$59.38 	$43.94	$0.00	$44.07	$27.08	$27.08	$0.00	$0.00	$0.00	$12.38	$44.07	$44.07	$0.00	$0.00	$12.37	$0.00	$35.12	$35.12	$0.00	$24.94	$39.50	$39.90	$0.00		$0.00	$7.81	$0.00	$0.00	$7.94	$0.00	$0.00	$0.00	$0.00	$0.00
RSS503	SUP	HCPCS C1894		RSS503  -  SHEATH INTRO 5FR 10CM 2.5CM PNCL DIL KINK RST PERI ACPT .038	BOTH IP/OP	$27.18 	$20.11	$0.00	$20.17	$11.88	$11.88	$0.00	$0.00	$0.00	$5.66	$20.17	$20.17	$0.00	$0.00	$5.66	$0.00	$16.07	$16.07	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
RSS505	SUP	HCPCS C1894		RSS505  -  SHEATH INTRO 5FR 25CM 2.5CM PNCL DIL KINK RST SS HDRPH PTFE	BOTH IP/OP	$59.38 	$43.94	$0.00	$44.07	$27.08	$27.08	$0.00	$0.00	$0.00	$12.38	$44.07	$44.07	$0.00	$0.00	$12.37	$0.00	$35.12	$35.12	$0.00	$24.94	$39.50	$39.90	$0.00		$0.00	$7.81	$0.00	$0.00	$7.94	$0.00	$0.00	$0.00	$0.00	$0.00
RSS601	SUP	HCPCS C1894		RSS601  -  INTRODUCER SHEATH .035IN 6FR 10CM 2.5CM MINI GWIRE DILAT	BOTH IP/OP	$27.18 	$20.11	$0.00	$20.17	$11.88	$11.88	$0.00	$0.00	$0.00	$5.66	$20.17	$20.17	$0.00	$0.00	$5.66	$0.00	$16.07	$16.07	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
RSS603	SUP	HCPCS C1894		RSS603  -  SHEATH INTRO 6FR 10CM 2.5CM PNCL DIL KINK RST PERI ACPT .038	BOTH IP/OP	$271.75 	$201.10	$0.00	$201.69	$118.78	$118.78	$0.00	$0.00	$0.00	$56.64	$201.69	$201.69	$0.00	$0.00	$56.63	$0.00	$160.74	$160.74	$0.00	$109.38	$173.25	$175.00	$0.00		$0.00	$34.23	$0.00	$0.00	$34.83	$0.00	$0.00	$0.00	$0.00	$0.00
RSS605	SUP	HCPCS C1894		RSS605  -  INTRODUCER SHEATH .035IN 6FR 25CM 2.5CM GWIRE DILAT KINK	BOTH IP/OP	$59.38 	$43.94	$0.00	$44.07	$27.08	$27.08	$0.00	$0.00	$0.00	$12.38	$44.07	$44.07	$0.00	$0.00	$12.37	$0.00	$35.12	$35.12	$0.00	$24.94	$39.50	$39.90	$0.00		$0.00	$7.81	$0.00	$0.00	$7.94	$0.00	$0.00	$0.00	$0.00	$0.00
RSS606	SUP	HCPCS C1894		RSS606  -  INTRODUCER SHEATH 6FR 25CM 2.5CM DILAT KINK RESISTANT	BOTH IP/OP	$42.88 	$31.73	$0.00	$34.30	$23.28	$23.28	$0.00	$0.00	$0.00	$8.94	$31.82	$31.82	$0.00	$0.00	$8.94	$0.00	$25.36	$25.36	$0.00	$21.44	$33.96	$34.30	$0.00		$0.00	$6.71	$0.00	$0.00	$6.83	$0.00	$0.00	$0.00	$0.00	$0.00
RSS705	SUP	HCPCS C1894		RSS705  -  SHEATH INTRO 7FR 25CM 2.5CM PNCL DIL KINK RST SS HDRPH PTFE	BOTH IP/OP	$593.75 	$439.38	$0.00	$440.68	$270.82	$270.82	$0.00	$0.00	$0.00	$123.75	$440.68	$440.68	$0.00	$0.00	$123.74	$0.00	$351.20	$351.20	$0.00	$249.38	$395.01	$399.00	$0.00		$0.00	$78.05	$0.00	$0.00	$79.40	$0.00	$0.00	$0.00	$0.00	$0.00
RSS706	SUP	HCPCS C1894		RSS706  -  INTRODUCER SHEATH 7FR 25CM 2.5CM DILAT KINK RESISTANT SMOOTH	BOTH IP/OP	$42.88 	$31.73	$0.00	$34.30	$23.28	$23.28	$0.00	$0.00	$0.00	$8.94	$31.82	$31.82	$0.00	$0.00	$8.94	$0.00	$25.36	$25.36	$0.00	$21.44	$33.96	$34.30	$0.00		$0.00	$6.71	$0.00	$0.00	$6.83	$0.00	$0.00	$0.00	$0.00	$0.00
RSS803	SUP	HCPCS C1894		RSS803  -  INTRODUCER SHEATH .035IN 8FR 10CM 2.5CM DILAT KINK RESISTANT	BOTH IP/OP	$27.18 	$20.11	$0.00	$20.17	$11.88	$11.88	$0.00	$0.00	$0.00	$5.66	$20.17	$20.17	$0.00	$0.00	$5.66	$0.00	$16.07	$16.07	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
RSS805	SUP	HCPCS C1894		RSS805  -  INTRODUCER SHTH 8FR 25CM 2.5CM PNCL DIL MN GW KINK RST PERI	BOTH IP/OP	$59.38 	$43.94	$0.00	$44.07	$27.08	$27.08	$0.00	$0.00	$0.00	$12.38	$44.07	$44.07	$0.00	$0.00	$12.37	$0.00	$35.12	$35.12	$0.00	$24.94	$39.50	$39.90	$0.00		$0.00	$7.81	$0.00	$0.00	$7.94	$0.00	$0.00	$0.00	$0.00	$0.00
RSS903	SUP	HCPCS C1894		RSS903  -  SHEATH INTROD .038IN 9FR 10CM 2.5CM GWIRE DILAT KINK	BOTH IP/OP	$27.18 	$20.11	$0.00	$20.17	$11.88	$11.88	$0.00	$0.00	$0.00	$5.66	$20.17	$20.17	$0.00	$0.00	$5.66	$0.00	$16.07	$16.07	$0.00	$10.94	$17.33	$17.50	$0.00		$0.00	$3.42	$0.00	$0.00	$3.48	$0.00	$0.00	$0.00	$0.00	$0.00
RSZ-3004	SUP	Custom 27203010		RSZ-3004  -  SIZER IMPL P4.5CM HI PRFL RND 11.1CM 300ML STRL MEMORYGEL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RSZ-3504	SUP	Custom 27203010		RSZ-3504  -  SIZER IMPL P4.8CM HI PRFL RND 11.7CM 350ML STRL MEMORYGEL	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$0.00	$0.00	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RSZ-8004	SUP	Custom 27803010		RSZ-8004  -  SIZER IMPL P6CM HI PRFL RND 15.5CM 800ML STRL MEMORYGEL GEL	BOTH IP/OP	"$2,325.00 "	"$1,720.50"	$0.00	"$1,860.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,725.62"	"$1,725.62"	$0.00	$0.00	$484.53	$0.00	$0.00	$0.00	$0.00	"$1,162.50"	"$1,841.40"	"$1,860.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RT500-853	SUP	Custom 27203010		CIRCUIT BRTHG HEAT RESP PORTLESS WYE PRLL WIRE CSTM 5FT ADLT	BOTH IP/OP	$31.25 	$23.13	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.63	$24.75	$25.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
RU510418	SUP	HCPCS C1758		RU510418  -  CATHETER URETHERAL SZ 18	BOTH IP/OP	$7.51 	$5.56	$0.00	$6.01	$4.08	$4.08	$0.00	$0.00	$0.00	$1.57	$5.57	$5.57	$0.00	$0.00	$1.57	$0.00	$4.44	$4.44	$0.00	$3.76	$5.95	$6.01	$0.00		$0.00	$1.18	$0.00	$0.00	$1.20	$0.00	$0.00	$0.00	$0.00	$0.00
RU510420	SUP	HCPCS C1729		RU510420  -  CATHETER ROBINSON URETHERAL SZ 20	BOTH IP/OP	$7.81 	$5.78	$0.00	$6.25	$4.24	$4.24	$0.00	$0.00	$0.00	$1.63	$5.80	$5.80	$0.00	$0.00	$1.63	$0.00	$4.62	$4.62	$0.00	$3.90	$6.19	$6.25	$0.00		$0.00	$1.22	$0.00	$0.00	$1.24	$0.00	$0.00	$0.00	$0.00	$0.00
RV80510	SUP	HCPCS C1725		RV80510  -  CATHETER BLNDIL 5MM 80CM 10CM RIVAL CK 2 LUM TPR TIP LOPRFL	BOTH IP/OP	$575.00 	$425.50	$0.00	$460.00	$312.23	$312.23	$0.00	$0.00	$0.00	$119.84	$426.77	$426.77	$0.00	$0.00	$119.83	$0.00	$340.11	$340.11	$0.00	$287.50	$455.40	$460.00	$0.00		$0.00	$89.99	$0.00	$0.00	$91.54	$0.00	$0.00	$0.00	$0.00	$0.00
S0412-00	SUP	Custom 27203010		KIT FTL MTRN BLOOD HMTLTST 950ML 300 TST	BOTH IP/OP	$625.25 	$462.69	$0.00	$500.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.63	$495.20	$500.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-0793-HA42	SUP	Custom 27803010		S-0793-HA42  -  CUP ACETAB 42MM 22MM CEMENTED ODC ALL POLY HIP	BOTH IP/OP	$822.00 	$608.28	$0.00	$657.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.09	$610.09	$0.00	$0.00	$171.30	$0.00	$0.00	$0.00	$0.00	$411.00	$651.02	$657.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-0793-HA46	SUP	Custom 27803010		S-0793-HA46  -  CUP ACETAB 46MM 22MM CEMENTED ODC ALL POLY HIP	BOTH IP/OP	$822.00 	$608.28	$0.00	$657.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.09	$610.09	$0.00	$0.00	$171.30	$0.00	$0.00	$0.00	$0.00	$411.00	$651.02	$657.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-0793-HA50	SUP	Custom 27803010		S-0793-HA50  -  CUP ACETAB 50MM 22MM CEMENTED ODC ALL POLY HIP	BOTH IP/OP	$822.00 	$608.28	$0.00	$657.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.09	$610.09	$0.00	$0.00	$171.30	$0.00	$0.00	$0.00	$0.00	$411.00	$651.02	$657.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-0793-HA54	SUP	Custom 27803010		S-0793-HA54  -  CUP ACETAB 54MM 22MM CEMENTED ODC ALL POLY HIP	BOTH IP/OP	$822.00 	$608.28	$0.00	$657.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.09	$610.09	$0.00	$0.00	$171.30	$0.00	$0.00	$0.00	$0.00	$411.00	$651.02	$657.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-0793-HA58	SUP	Custom 27803010		S-0793-HA58  -  CUP ACETAB 58MM 22MM CEMENTED ODC ALL POLY HIP	BOTH IP/OP	$822.00 	$608.28	$0.00	$657.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.09	$610.09	$0.00	$0.00	$171.30	$0.00	$0.00	$0.00	$0.00	$411.00	$651.02	$657.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S0809	SUP	Custom 27203010		REAGENT AB DILU DAKO 125ML INVIT DX IMMUN	BOTH IP/OP	$162.20 	$120.03	$0.00	$129.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.10	$128.46	$129.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S100000	SUP	Custom 27203010		S100000  -  NEEDLE INSFL 14GA 100MM STP TROC BLDLS RADL EXPANDABLE SLV	BOTH IP/OP	$111.14 	$82.24	$0.00	$82.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.49	$82.49	$0.00	$0.00	$23.16	$0.00	$0.00	$0.00	$0.00	$20.19	$31.97	$32.30	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-101	SUP	HCPCS C1763		S-101  -  GRAFT SFT TIS 3X3IN MEDISKIN PIG DRML CLGN MTRX SHT	BOTH IP/OP	$321.00 	$237.54	$0.00	$256.80	$144.45	$144.45	$0.00	$0.00	$0.00	$66.90	$238.25	$238.25	$0.00	$0.00	$66.90	$0.00	$189.87	$189.87	$0.00	$160.50	$254.23	$256.80	$0.00		$0.00	$50.24	$0.00	$0.00	$51.10	$0.00	$0.00	$0.00	$0.00	$0.00
S1020GH	SUP	HCPCS C1884		S1020GH  -  PARTICLES EMBL 900-1200UM MCSPH 1ML PUR EMBSPH PREFL SYR	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
S-104	SUP	HCPCS C1763		S-104  -  DRESSING WND .25SQ FT PRCN	BOTH IP/OP	$175.78 	$130.08	$0.00	$140.62	$79.10	$79.10	$0.00	$0.00	$0.00	$36.64	$130.46	$130.46	$0.00	$0.00	$36.63	$0.00	$103.97	$103.97	$0.00	$87.89	$139.22	$140.62	$0.00		$0.00	$27.51	$0.00	$0.00	$27.98	$0.00	$0.00	$0.00	$0.00	$0.00
S1-1500U	SUP	Custom 27803010		S1-1500U  -  STENT LCRML DCT .64MM 40MM STRL MN MNK DIL PLG INSRTR SIL	BOTH IP/OP	$145.83 	$107.91	$0.00	$116.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.24	$108.24	$0.00	$0.00	$30.39	$0.00	$0.00	$0.00	$0.00	$72.92	$115.50	$116.67	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1399-HH22	SUP	Custom 27803010		S-1399-HH22  -  HEAD FEM HIP MRS TPR INTLK ION	BOTH IP/OP	"$1,147.00 "	$848.78	$0.00	$917.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$851.30	$851.30	$0.00	$0.00	$239.03	$0.00	$0.00	$0.00	$0.00	$573.50	$908.42	$917.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1399-HH31	SUP	Custom 27803010		S-1399-HH31  -  HEAD FEM HIP MRS TPR INTLK ION	BOTH IP/OP	"$1,147.00 "	$848.78	$0.00	$917.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$851.30	$851.30	$0.00	$0.00	$239.03	$0.00	$0.00	$0.00	$0.00	$573.50	$908.42	$917.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1399-HH32	SUP	Custom 27803010		S-1399-HH32  -  HEAD FEM HIP MRS TPR INTLK ION	BOTH IP/OP	"$1,147.00 "	$848.78	$0.00	$917.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$851.30	$851.30	$0.00	$0.00	$239.03	$0.00	$0.00	$0.00	$0.00	$573.50	$908.42	$917.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1399-HH34	SUP	Custom 27803010		S-1399-HH34  -  HEAD FEM 34MM HIP MRS TPR INTLK	BOTH IP/OP	"$1,147.00 "	$848.78	$0.00	$917.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$851.30	$851.30	$0.00	$0.00	$239.03	$0.00	$0.00	$0.00	$0.00	$573.50	$908.42	$917.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1399-HH62	SUP	Custom 27803010		S-1399-HH62  -  HEAD FEM 62MM HIP MRS TPR INTLK	BOTH IP/OP	"$1,147.00 "	$848.78	$0.00	$917.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$851.30	$851.30	$0.00	$0.00	$239.03	$0.00	$0.00	$0.00	$0.00	$573.50	$908.42	$917.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1399-HH64	SUP	Custom 27803010		S-1399-HH64  -  HEAD FEM 64MM HIP MRS TPR INTLK	BOTH IP/OP	"$1,147.00 "	$848.78	$0.00	$917.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$851.30	$851.30	$0.00	$0.00	$239.03	$0.00	$0.00	$0.00	$0.00	$573.50	$908.42	$917.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1399-HH82	SUP	Custom 27803010		S-1399-HH82  -  HEAD FEM 82MM HIP MRS TPR INTLK	BOTH IP/OP	"$1,147.00 "	$848.78	$0.00	$917.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$851.30	$851.30	$0.00	$0.00	$239.03	$0.00	$0.00	$0.00	$0.00	$573.50	$908.42	$917.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1399-HH83	SUP	Custom 27803010		S-1399-HH83  -  HEAD FEM 83MM HIP MRS TPR INTLK ION	BOTH IP/OP	"$1,147.00 "	$848.78	$0.00	$917.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$851.30	$851.30	$0.00	$0.00	$239.03	$0.00	$0.00	$0.00	$0.00	$573.50	$908.42	$917.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1399-HH84	SUP	Custom 27803010		S-1399-HH84  -  HEAD FEM 84MM HIP MRS TPR INTLK	BOTH IP/OP	"$1,147.00 "	$848.78	$0.00	$917.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$851.30	$851.30	$0.00	$0.00	$239.03	$0.00	$0.00	$0.00	$0.00	$573.50	$908.42	$917.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1400-HH22	SUP	Custom 27803010		S-1400-HH22  -  HEAD FEMORAL +2.5MM C TAPER 22MM LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1400-HH31	SUP	Custom 27803010		S-1400-HH31  -  HEAD FEM -2.5MM OFST CTPR 32MM STRL LFIT INTMD NK COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1400-HH32	SUP	Custom 27803010		S-1400-HH32  -  HEAD FEMORAL +2.5MM 32MM C TAPER NECK PRIM LFIT TRIDENT COCR	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1400-HH34	SUP	Custom 27803010		S-1400-HH34  -  HEAD FEM +7.5MM OFST CTPR 32MM STRL LFIT INTMD NK COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1400-HH62	SUP	Custom 27803010		S-1400-HH62  -  HEAD FEMORAL +2.5MM 26MM C TAPER INTERLOK LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1400-HH64	SUP	Custom 27803010		S-1400-HH64  -  HEAD FEMORAL +7.5MM 26MM C TAPER INTERLOK LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1400-HH82	SUP	Custom 27803010		S-1400-HH82  -  HEAD FEMORAL +2.5MM OFFST C TAPER 28MM LFIT TRIDENT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1400-HH84	SUP	Custom 27803010		S-1400-HH84  -  HEAD FEMORAL C TAPER INTERLOCK LFIT COCR HIP	BOTH IP/OP	$862.50 	$638.25	$0.00	$690.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$640.15	$640.15	$0.00	$0.00	$179.75	$0.00	$0.00	$0.00	$0.00	$431.25	$683.10	$690.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1539-HA46	SUP	Custom 27803010		S-1539-HA46  -  CUP ACETAB 26MM ODC ALPLY	BOTH IP/OP	$822.00 	$608.28	$0.00	$657.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.09	$610.09	$0.00	$0.00	$171.30	$0.00	$0.00	$0.00	$0.00	$411.00	$651.02	$657.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1539-HA50	SUP	Custom 27803010		S-1539-HA50  -  CUP ACETAB 50MM 26MM ODC ALL POLY HIP	BOTH IP/OP	$822.00 	$608.28	$0.00	$657.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.09	$610.09	$0.00	$0.00	$171.30	$0.00	$0.00	$0.00	$0.00	$411.00	$651.02	$657.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1539-HA54	SUP	Custom 27803010		S-1539-HA54  -  CUP ACETAB 54MM 26MM ODC ALL POLY HIP	BOTH IP/OP	$822.00 	$608.28	$0.00	$657.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.09	$610.09	$0.00	$0.00	$171.30	$0.00	$0.00	$0.00	$0.00	$411.00	$651.02	$657.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1539-HA58	SUP	Custom 27803010		S-1539-HA58  -  CUP ACETAB 58MM 26MM ODC ALL POLY HIP	BOTH IP/OP	$822.00 	$608.28	$0.00	$657.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.09	$610.09	$0.00	$0.00	$171.30	$0.00	$0.00	$0.00	$0.00	$411.00	$651.02	$657.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-1645-HF01	SUP	HCPCS C1776		S-1645-HF01  -  STEM FEM MOD HYDRXAPT 1 HIP	BOTH IP/OP	"$5,300.00 "	"$3,922.00"	$0.00	"$4,240.00"	"$2,385.00"	"$2,385.00"	$0.00	$0.00	$0.00	"$1,104.65"	"$3,933.66"	"$3,933.66"	$0.00	$0.00	"$1,104.52"	$0.00	"$2,612.90"	"$2,612.90"	$0.00	"$2,650.00"	"$4,197.60"	"$4,240.00"	$0.00		$0.00	$829.45	$0.00	$0.00	$843.76	$0.00	$0.00	$0.00	$0.00	$0.00
S1699	SUP	Custom 27203010		REAGENT TRGT RTRVL SOL 500ML CONCEN IMMUN	BOTH IP/OP	$773.05 	$572.06	$0.00	$618.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$386.53	$612.26	$618.44	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S17-45	SUP	Custom 27803010		S17-45  -  GRAFT ENDOVASCULAR SHEATH ABDOMINAL AORTIC ANEURYSM	BOTH IP/OP	"$1,247.50 "	$923.15	$0.00	$998.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$925.89	$925.89	$0.00	$0.00	$259.98	$0.00	$0.00	$0.00	$0.00	$623.75	$988.02	$998.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S195	SUP	Custom 27203010		STAIN GMS 8OZ STK SOL HMTL	BOTH IP/OP	$246.25 	$182.23	$0.00	$197.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.13	$195.03	$197.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S1967	SUP	Custom 27203010		REAGENT CLEAN SOL DAB-AWAY 1.25L HMTL	BOTH IP/OP	$347.30 	$257.00	$0.00	$277.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.65	$275.06	$277.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S20SFRN8	SUP	Custom 27803010		S20SFRN8  -  CLIP SHRT INTNL UCLP FLXB REG NDL	BOTH IP/OP	"$6,210.00 "	"$4,595.40"	$0.00	"$4,968.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,294.16"	$0.00	$0.00	$0.00	$0.00	"$3,105.00"	"$4,918.32"	"$4,968.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2646	SUP	Custom 27803010		S-2301-2646  -  INSERT ACETAB 46-48MM 26MM 10D KNEE ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2648	SUP	Custom 27803010		S-2301-2648  -  INSERT ACETAB 48MM 28MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2650	SUP	Custom 27803010		S-2301-2650  -  INSERT ACETAB 50-52MM 26MM 10D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2652	SUP	Custom 27803010		S-2301-2652  -  INSERT ACETAB 52MM 26MM 10D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2654	SUP	Custom 27803010		S-2301-2654  -  INSERT ACETAB 54-56MM 26MM 10D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2656	SUP	Custom 27803010		S-2301-2656  -  INSERT ACETAB 56MM 26MM 10D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2658	SUP	Custom 27803010		S-2301-2658  -  INSERT ACETAB 58-60MM 26MM 10D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2662	SUP	Custom 27803010		S-2301-2662  -  INSERT ACETAB 61-72MM 26MM 10D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2846	SUP	Custom 27803010		S-2301-2846  -  INSERT ACETAB 46-48MM 28MM 10D ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2848	SUP	Custom 27803010		S-2301-2848  -  INSERT ACETAB 48MM 28MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2850	SUP	Custom 27803010		S-2301-2850  -  INSERT ACETAB 50MM 28MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2852	SUP	Custom 27803010		S-2301-2852  -  INSERT ACETAB 52MM 28MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2854	SUP	Custom 27803010		S-2301-2854  -  INSERT ACETAB 54MM 28MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2856	SUP	Custom 27803010		S-2301-2856  -  INSERT ACETAB 56MM 28MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2858	SUP	Custom 27803010		S-2301-2858  -  INSERT ACETAB 58-60MM 28MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2862	SUP	Custom 27803010		S-2301-2862  -  INSERT ACETAB 61-72MM 28MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2866	SUP	Custom 27803010		S-2301-2866  -  INSERT ACETAB 66-68MM 28MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2870	SUP	Custom 27803010		S-2301-2870  -  INSERT ACETAB 70-72MM 28MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-2874	SUP	Custom 27803010		S-2301-2874  -  INSERT ACETAB 74MM 28MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-3250	SUP	Custom 27803010		S-2301-3250  -  INSERT ACETAB 50-52MM 32MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-3252	SUP	Custom 27803010		S-2301-3252  -  INSERT ACETAB 52MM 32MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-3254	SUP	Custom 27803010		S-2301-3254  -  INSERT ACETAB 54-56MM 32MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-3256	SUP	Custom 27803010		S-2301-3256  -  INSERT ACETAB 56MM 32MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-3258	SUP	Custom 27803010		S-2301-3258  -  INSERT ACETAB 58-60MM 32MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-3262	SUP	Custom 27803010		S-2301-3262  -  INSERT ACETAB 61-72MM 32MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-3266	SUP	Custom 27803010		S-2301-3266  -  INSERT ACETAB 66-68MM 32MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-3270	SUP	Custom 27803010		S-2301-3270  -  INSERT ACETAB 70-72MM 32MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301-3274	SUP	Custom 27803010		S-2301-3274  -  INSERT ACETAB 74MM 32MM 10D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-2846	SUP	Custom 27803010		S-2301C-2846  -  INSERT ACETAB 10D 46MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-2848	SUP	Custom 27803010		S-2301C-2848  -  INSERT ACETAB 10D 48MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-2850	SUP	Custom 27803010		S-2301C-2850  -  INSERT ACETAB 10D 50MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-2852	SUP	Custom 27803010		S-2301C-2852  -  INSERT ACETAB 10D 52MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-2854	SUP	Custom 27803010		S-2301C-2854  -  INSERT ACETAB 10D 54MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-2856	SUP	Custom 27803010		S-2301C-2856  -  INSERT ACETAB 10D 56MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-2858	SUP	Custom 27803010		S-2301C-2858  -  INSERT ACETAB 10D 58-60MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-2862	SUP	Custom 27803010		S-2301C-2862  -  INSERT ACETAB 10D 62MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-2866	SUP	Custom 27803010		S-2301C-2866  -  INSERT ACETAB 10D 66MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-2870	SUP	Custom 27803010		S-2301C-2870  -  INSERT ACETAB 10D 70MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-2874	SUP	Custom 27803010		S-2301C-2874  -  INSERT ACETAB 10D 74MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-3250	SUP	Custom 27803010		S-2301C-3250  -  INSERT ACETAB 10D 50MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-3252	SUP	Custom 27803010		S-2301C-3252  -  INSERT ACETAB 10D 52MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-3254	SUP	Custom 27803010		S-2301C-3254  -  INSERT ACETAB 10D 54MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-3256	SUP	Custom 27803010		S-2301C-3256  -  INSERT ACETAB 10D 56MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-3258	SUP	Custom 27803010		S-2301C-3258  -  INSERT ACETAB 10D 58-60MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-3262	SUP	Custom 27803010		S-2301C-3262  -  INSERT ACETAB 10D 62MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-3266	SUP	Custom 27803010		S-2301C-3266  -  INSERT ACETAB 10D 66MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-3270	SUP	Custom 27803010		S-2301C-3270  -  INSERT ACETAB 10D 70MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2301C-3274	SUP	Custom 27803010		S-2301C-3274  -  INSERT ACETAB 74MM 32MM 10D HIP ECNTRC OMFT	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2646	SUP	Custom 27803010		S-2302-2646  -  INSERT ACETAB 46-48MM 26MM 20D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2648	SUP	Custom 27803010		S-2302-2648  -  INSERT ACETAB 48MM 26MM 20D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2650	SUP	Custom 27803010		S-2302-2650  -  INSERT ACETAB 50-52MM 26MM 20D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2652	SUP	Custom 27803010		S-2302-2652  -  INSERT ACETAB 52MM 26MM 20D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2654	SUP	Custom 27803010		S-2302-2654  -  INSERT ACETAB 54-56MM 26MM 20D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2656	SUP	Custom 27803010		S-2302-2656  -  INSERT ACETAB 56MM 26MM 20D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2658	SUP	Custom 27803010		S-2302-2658  -  INSERT ACETAB 58-60MM 26MM 20D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2662	SUP	Custom 27803010		S-2302-2662  -  INSERT ACETAB 61-72MM 26MM 20D HIP ECNTRC	BOTH IP/OP	"$2,299.38 "	"$1,701.54"	$0.00	"$1,839.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.60"	"$1,706.60"	$0.00	$0.00	$479.19	$0.00	$0.00	$0.00	$0.00	"$1,149.69"	"$1,821.11"	"$1,839.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2846	SUP	Custom 27803010		S-2302-2846  -  INSERT ACETAB 46-48MM 28MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2848	SUP	Custom 27803010		S-2302-2848  -  INSERT ACETAB 48MM 28MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2850	SUP	Custom 27803010		S-2302-2850  -  INSERT ACETAB 50-52MM 28MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2852	SUP	Custom 27803010		S-2302-2852  -  INSERT ACETAB 52MM 28MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2854	SUP	Custom 27803010		S-2302-2854  -  INSERT ACETAB 54-56MM 28MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2856	SUP	Custom 27803010		S-2302-2856  -  INSERT ACETAB 56MM 28MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2858	SUP	Custom 27803010		S-2302-2858  -  INSERT ACETAB 58-60MM 28MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2862	SUP	Custom 27803010		S-2302-2862  -  INSERT ACETAB 61-72MM 28MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2866	SUP	Custom 27803010		S-2302-2866  -  INSERT ACETAB 66-68MM 28MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2870	SUP	Custom 27803010		S-2302-2870  -  INSERT ACETAB 70-72MM 28MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-2874	SUP	Custom 27803010		S-2302-2874  -  INSERT ACETAB 74MM 28MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-3250	SUP	Custom 27803010		S-2302-3250  -  INSERT ACETAB 50-52MM 32MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-3252	SUP	Custom 27803010		S-2302-3252  -  INSERT ACETAB 52MM 32MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-3254	SUP	Custom 27803010		S-2302-3254  -  INSERT ACETAB 54-56MM 32MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-3256	SUP	Custom 27803010		S-2302-3256  -  INSERT ACETAB 56MM 32MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-3258	SUP	Custom 27803010		S-2302-3258  -  INSERT ACETAB 58-60MM 32MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-3262	SUP	Custom 27803010		S-2302-3262  -  INSERT ACETAB 61-72MM 32MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-3266	SUP	Custom 27803010		S-2302-3266  -  INSERT ACETAB 66-68MM 32MM 20D HIP ECNTRC	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-3270	SUP	Custom 27803010		S-2302-3270  -  INSERT ACETAB 70-72MM 32MM 20D ECNTRC 8MM	BOTH IP/OP	"$2,125.50 "	"$1,572.87"	$0.00	"$1,700.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,577.55"	"$1,577.55"	$0.00	$0.00	$442.95	$0.00	$0.00	$0.00	$0.00	"$1,062.75"	"$1,683.40"	"$1,700.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302-3274	SUP	Custom 27803010		S-2302-3274  -  INSERT ACETAB 74MM 32MM HIP ECNTRC	BOTH IP/OP	"$1,421.88 "	"$1,052.19"	$0.00	"$1,137.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,055.32"	"$1,055.32"	$0.00	$0.00	$296.32	$0.00	$0.00	$0.00	$0.00	$710.94	"$1,126.13"	"$1,137.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-2846	SUP	Custom 27803010		S-2302C-2846  -  INSERT ACETAB 20D 46MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-2848	SUP	Custom 27803010		S-2302C-2848  -  INSERT ACETAB 20D 48MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-2850	SUP	Custom 27803010		S-2302C-2850  -  INSERT ACETAB 20D 50MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-2852	SUP	Custom 27803010		S-2302C-2852  -  INSERT ACETAB 20D 52MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-2854	SUP	Custom 27803010		S-2302C-2854  -  INSERT ACETAB 20D 54MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-2856	SUP	Custom 27803010		S-2302C-2856  -  INSERT ACETAB 20D 56MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-2858	SUP	Custom 27803010		S-2302C-2858  -  INSERT ACETAB 20D 58MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-2862	SUP	Custom 27803010		S-2302C-2862  -  INSERT ACETAB 20D 62MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-2866	SUP	Custom 27803010		S-2302C-2866  -  INSERT ACETAB 20D 66MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-2870	SUP	Custom 27803010		S-2302C-2870  -  INSERT ACETAB 20D 70MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-2874	SUP	Custom 27803010		S-2302C-2874  -  INSERT ACETAB 20D 74MM 28MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-3250	SUP	Custom 27803010		S-2302C-3250  -  INSERT ACETAB 20D 50MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-3252	SUP	Custom 27803010		S-2302C-3252  -  INSERT ACETAB 20D 52MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-3254	SUP	Custom 27803010		S-2302C-3254  -  INSERT ACETAB 20D 54MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-3256	SUP	Custom 27803010		S-2302C-3256  -  INSERT ACETAB 20D 56MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-3258	SUP	Custom 27803010		S-2302C-3258  -  INSERT ACETAB 20D 58MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-3262	SUP	Custom 27803010		S-2302C-3262  -  INSERT ACETAB 20D 62MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-3266	SUP	Custom 27803010		S-2302C-3266  -  INSERT ACETAB 20D 66MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-3270	SUP	Custom 27803010		S-2302C-3270  -  INSERT ACETAB 20D 70MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2302C-3274	SUP	Custom 27803010		S-2302C-3274  -  INSERT ACETAB 20D 74MM 32MM ECCENTRIC XFIRE HIP	BOTH IP/OP	"$3,105.00 "	"$2,297.70"	$0.00	"$2,484.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,304.53"	"$2,304.53"	$0.00	$0.00	$647.08	$0.00	$0.00	$0.00	$0.00	"$1,552.50"	"$2,459.16"	"$2,484.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2337-HF04	SUP	HCPCS C1776		S-2337-HF04  -  STEM FEMORAL 4 100MM COLLAR ARC PRESS FIT SECFIT HA TITANIUM	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
S-2337-HF05	SUP	HCPCS C1776		S-2337-HF05  -  STEM FEMORAL 5 110MM COLLAR ARC PRESS FIT SECFIT HA TITANIUM	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
S-2337-HF06	SUP	HCPCS C1776		S-2337-HF06  -  STEM FEMORAL 6 COLLARED SECFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
S-2337-HF07	SUP	HCPCS C1776		S-2337-HF07  -  STEM FEMORAL 7 COLLARED SECFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
S-2337-HF08	SUP	HCPCS C1776		S-2337-HF08  -  STEM FEMORAL 8 COLLARED SECFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
S-2337-HF09	SUP	HCPCS C1776		S-2337-HF09  -  STEM FEMORAL COLLARED ARC DEPOSITED SECFIT HYDRXAPT	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
S-2337-HF10	SUP	HCPCS C1776		S-2337-HF10  -  STEM FEMORAL 10 COLLARED SECFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
S-2337-HF11	SUP	HCPCS C1776		S-2337-HF11  -  STEM FEMORAL 11 COLLARED SECFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
S-2337-HF12	SUP	HCPCS C1776		S-2337-HF12  -  STEM FEMORAL 12 COLLAR ARC DEPOSITED SECFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
S-2337-HF13	SUP	HCPCS C1776		S-2337-HF13  -  STEM FEMORAL 13 COLLARED ARC DEPOSITED SECFIT HYDRXAPT HIP	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
S-2337-HF14	SUP	HCPCS C1776		S-2337-HF14  -  STEM FEMORAL 14 180MM COLLAR ARC PRESS FIT SECFIT HA	BOTH IP/OP	"$5,180.00 "	"$3,833.20"	$0.00	"$4,144.00"	"$2,331.00"	"$2,331.00"	$0.00	$0.00	$0.00	"$1,079.64"	"$3,844.60"	"$3,844.60"	$0.00	$0.00	"$1,079.51"	$0.00	"$2,553.74"	"$2,553.74"	$0.00	"$2,590.00"	"$4,102.56"	"$4,144.00"	$0.00		$0.00	$810.67	$0.00	$0.00	$824.66	$0.00	$0.00	$0.00	$0.00	$0.00
S2368	SUP	Custom 27203010		REAGENT TRIS EDTA BUFF 500ML PH 9 TRGT RTRVL SOL HISTOLGY	BOTH IP/OP	$243.68 	$180.32	$0.00	$194.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.84	$192.99	$194.94	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S2369	SUP	Custom 27203010		REAGENT TRGT RTRVL SOL CITR 500ML PH 6 CONCEN HISTOLGY	BOTH IP/OP	"$1,109.15 "	$820.77	$0.00	$887.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$554.58	$878.45	$887.32	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-2651-0711	SUP	HCPCS C1776		S-2651-0711  -  NECK FEMORAL 7 -5MM STR 11MM 155MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$11,937.50 "	"$8,833.75"	$0.00	"$9,550.00"	"$5,371.88"	"$5,371.88"	$0.00	$0.00	$0.00	"$2,488.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,487.78"	$0.00	"$5,885.19"	"$5,885.19"	$0.00	"$5,968.75"	"$9,454.50"	"$9,550.00"	$0.00		$0.00	"$1,868.22"	$0.00	$0.00	"$1,900.45"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2651-0713	SUP	HCPCS C1776		S-2651-0713  -  NECK FEMORAL 7 -5MM STR 13MM 155MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$11,937.50 "	"$8,833.75"	$0.00	"$9,550.00"	"$5,371.88"	"$5,371.88"	$0.00	$0.00	$0.00	"$2,488.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,487.78"	$0.00	"$5,885.19"	"$5,885.19"	$0.00	"$5,968.75"	"$9,454.50"	"$9,550.00"	$0.00		$0.00	"$1,868.22"	$0.00	$0.00	"$1,900.45"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2651-0812	SUP	HCPCS C1776		S-2651-0812  -  NECK FEMORAL 8 -5MM STR 12MM 155MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$11,937.50 "	"$8,833.75"	$0.00	"$9,550.00"	"$5,371.88"	"$5,371.88"	$0.00	$0.00	$0.00	"$2,488.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,487.78"	$0.00	"$5,885.19"	"$5,885.19"	$0.00	"$5,968.75"	"$9,454.50"	"$9,550.00"	$0.00		$0.00	"$1,868.22"	$0.00	$0.00	"$1,900.45"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2651-0814	SUP	HCPCS C1776		S-2651-0814  -  NECK FEMORAL 8 -5MM STR 14MM 155MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$11,937.50 "	"$8,833.75"	$0.00	"$9,550.00"	"$5,371.88"	"$5,371.88"	$0.00	$0.00	$0.00	"$2,488.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,487.78"	$0.00	"$5,885.19"	"$5,885.19"	$0.00	"$5,968.75"	"$9,454.50"	"$9,550.00"	$0.00		$0.00	"$1,868.22"	$0.00	$0.00	"$1,900.45"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2651-0913	SUP	HCPCS C1776		S-2651-0913  -  NECK FEMORAL 9 -5MM STR 13MM 155MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$11,937.50 "	"$8,833.75"	$0.00	"$9,550.00"	"$5,371.88"	"$5,371.88"	$0.00	$0.00	$0.00	"$2,488.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,487.78"	$0.00	"$5,885.19"	"$5,885.19"	$0.00	"$5,968.75"	"$9,454.50"	"$9,550.00"	$0.00		$0.00	"$1,868.22"	$0.00	$0.00	"$1,900.45"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2651-0915	SUP	HCPCS C1776		S-2651-0915  -  STEM FEMORAL 9 -5MM STR 15MM 155MM REDUCE NECK RSTOR HA	BOTH IP/OP	"$11,937.50 "	"$8,833.75"	$0.00	"$9,550.00"	"$5,371.88"	"$5,371.88"	$0.00	$0.00	$0.00	"$2,488.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,487.78"	$0.00	"$5,885.19"	"$5,885.19"	$0.00	"$5,968.75"	"$9,454.50"	"$9,550.00"	$0.00		$0.00	"$1,868.22"	$0.00	$0.00	"$1,900.45"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2651-1014	SUP	HCPCS C1776		S-2651-1014  -  NECK FEMORAL 10 -5MM STR 14MM 155MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$11,937.50 "	"$8,833.75"	$0.00	"$9,550.00"	"$5,371.88"	"$5,371.88"	$0.00	$0.00	$0.00	"$2,488.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,487.78"	$0.00	"$5,885.19"	"$5,885.19"	$0.00	"$5,968.75"	"$9,454.50"	"$9,550.00"	$0.00		$0.00	"$1,868.22"	$0.00	$0.00	"$1,900.45"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2651-1016	SUP	HCPCS C1776		S-2651-1016  -  NECK FEMORAL 10 -5MM STR 16MM 155MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$11,937.50 "	"$8,833.75"	$0.00	"$9,550.00"	"$5,371.88"	"$5,371.88"	$0.00	$0.00	$0.00	"$2,488.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,487.78"	$0.00	"$5,885.19"	"$5,885.19"	$0.00	"$5,968.75"	"$9,454.50"	"$9,550.00"	$0.00		$0.00	"$1,868.22"	$0.00	$0.00	"$1,900.45"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2651-1115	SUP	HCPCS C1776		S-2651-1115  -  NECK FEMORAL 11 -5MM STR 15MM 155MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$11,937.50 "	"$8,833.75"	$0.00	"$9,550.00"	"$5,371.88"	"$5,371.88"	$0.00	$0.00	$0.00	"$2,488.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,487.78"	$0.00	"$5,885.19"	"$5,885.19"	$0.00	"$5,968.75"	"$9,454.50"	"$9,550.00"	$0.00		$0.00	"$1,868.22"	$0.00	$0.00	"$1,900.45"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2651-1117	SUP	HCPCS C1776		S-2651-1117  -  NECK FEMORAL 11 -5MM STR 17MM 155MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$11,937.50 "	"$8,833.75"	$0.00	"$9,550.00"	"$5,371.88"	"$5,371.88"	$0.00	$0.00	$0.00	"$2,488.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,487.78"	$0.00	"$5,885.19"	"$5,885.19"	$0.00	"$5,968.75"	"$9,454.50"	"$9,550.00"	$0.00		$0.00	"$1,868.22"	$0.00	$0.00	"$1,900.45"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2651-1216	SUP	HCPCS C1776		S-2651-1216  -  NECK FEMORAL 12 -5MM STR 16MM 155MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$11,937.50 "	"$8,833.75"	$0.00	"$9,550.00"	"$5,371.88"	"$5,371.88"	$0.00	$0.00	$0.00	"$2,488.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,487.78"	$0.00	"$5,885.19"	"$5,885.19"	$0.00	"$5,968.75"	"$9,454.50"	"$9,550.00"	$0.00		$0.00	"$1,868.22"	$0.00	$0.00	"$1,900.45"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2651-1218	SUP	HCPCS C1776		S-2651-1218  -  NECK FEMORAL 12 -5MM STR 18MM 155MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$11,937.50 "	"$8,833.75"	$0.00	"$9,550.00"	"$5,371.88"	"$5,371.88"	$0.00	$0.00	$0.00	"$2,488.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,487.78"	$0.00	"$5,885.19"	"$5,885.19"	$0.00	"$5,968.75"	"$9,454.50"	"$9,550.00"	$0.00		$0.00	"$1,868.22"	$0.00	$0.00	"$1,900.45"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-0812	SUP	HCPCS C1776		S-2652-0812  -  NECK FEMORAL 8 -5MM STR 12MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-0814	SUP	HCPCS C1776		S-2652-0814  -  NECK FEMORAL 8 -5MM STR 14MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-0913	SUP	HCPCS C1776		S-2652-0913  -  NECK FEMORAL 9 -5MM STR 13MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-0915	SUP	HCPCS C1776		S-2652-0915  -  NECK FEMORAL 9 -5MM STR 15MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-1014	SUP	HCPCS C1776		S-2652-1014  -  NECK FEMORAL 10 -5MM STR 14MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-1016	SUP	HCPCS C1776		S-2652-1016  -  NECK FEMORAL 10 -5MM STR 16MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-1115	SUP	HCPCS C1776		S-2652-1115  -  NECK FEMORAL 11 -5MM STR 15MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-1117	SUP	HCPCS C1776		S-2652-1117  -  STEM FEMORAL 11 -5MM STR 17MM 205MM REDUCE NECK RSTOR HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-1216	SUP	HCPCS C1776		S-2652-1216  -  NECK FEMORAL 12 -5MM STR 16MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-1218	SUP	HCPCS C1776		S-2652-1218  -  STEM FEMORAL 12 -5MM STR 18MM 205MM REDUCE NECK RSTOR HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-1317	SUP	HCPCS C1776		S-2652-1317  -  NECK FEMORAL 17 -5MM STR 13MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-1319	SUP	HCPCS C1776		S-2652-1319  -  NECK FEMORAL 13 -5MM STR 19MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-1418	SUP	HCPCS C1776		S-2652-1418  -  NECK FEMORAL 14 -5MM STR 18MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-1420	SUP	HCPCS C1776		S-2652-1420  -  NECK FEMORAL 14 -5MM STR 20MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2652-1422	SUP	HCPCS C1776		S-2652-1422  -  NECK FEMORAL 14 -5MM STR 22MM 205MM REDUCE RSTOR TITANIUM HA	BOTH IP/OP	"$12,645.00 "	"$9,357.30"	$0.00	"$10,116.00"	"$5,690.25"	"$5,690.25"	$0.00	$0.00	$0.00	"$2,635.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,635.22"	$0.00	"$6,233.99"	"$6,233.99"	$0.00	"$6,322.50"	"$10,014.84"	"$10,116.00"	$0.00		$0.00	"$1,978.94"	$0.00	$0.00	"$2,013.08"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-0812-L	SUP	HCPCS C1776		S-2653-0812-L  -  STEM FEM LEFT HIP 255MM 12-8MM STR DISTAL SLOT RED NECK REV	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-0812-R	SUP	HCPCS C1776		S-2653-0812-R  -  STEM FEM RIGHT HIP 255MM 12-8MM STR DISTAL SLOT RED NECK REV	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-0913-L	SUP	HCPCS C1776		S-2653-0913-L  -  STEM FEM LEFT HIP 255MM 13-9MM STR DISTAL SLOT RED NECK REV	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-0913-R	SUP	HCPCS C1776		S-2653-0913-R  -  STEM FEM RIGHT HIP 255MM 13-9MM STR DISTAL SLOT RED NECK REV	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-1014-L	SUP	HCPCS C1776		S-2653-1014-L  -  STEM FEM LEFT HIP 255MM 14-10MM STR DISTAL SLOT RED NECK REV	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-1014-R	SUP	HCPCS C1776		S-2653-1014-R  -  STEM FEM RIGHT HIP 255MM 14-10MM STR DISTAL SLOT RED NECK	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-1115-L	SUP	HCPCS C1776		S-2653-1115-L  -  STEM FEM LEFT HIP 255MM 15-11MM STR DISTAL SLOT RED NECK REV	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-1115-R	SUP	HCPCS C1776		S-2653-1115-R  -  STEM FEM RIGHT HIP 255MM 15-11MM STR DISTAL SLOT RED NECK	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-1216-L	SUP	HCPCS C1776		S-2653-1216-L  -  STEM FEM LEFT HIP 255MM 16-12MM STR DISTAL SLOT RED NECK REV	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-1216-R	SUP	HCPCS C1776		S-2653-1216-R  -  STEM FEM RIGHT HIP 255MM 16-12MM STR DISTAL SLOT RED NECK	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-1317-L	SUP	HCPCS C1776		S-2653-1317-L  -  STEM FEM LEFT HIP 255MM 17-13MM STR DISTAL SLOT RED NECK REV	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-1317-R	SUP	HCPCS C1776		S-2653-1317-R  -  STEM FEM RIGHT HIP 255MM 17-13MM STR DISTAL SLOT RED NECK	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-1418-L	SUP	HCPCS C1776		S-2653-1418-L  -  STEM FEM LEFT HIP 255MM 18-14MM STR DISTAL SLOT RED NECK REV	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2653-1418-R	SUP	HCPCS C1776		S-2653-1418-R  -  STEM FEM RIGHT HIP 255MM 18-14MM STR DISTAL SLOT RED NECK	BOTH IP/OP	"$13,222.63 "	"$9,784.75"	$0.00	"$10,578.10"	"$5,950.18"	"$5,950.18"	$0.00	$0.00	$0.00	"$2,755.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,755.60"	$0.00	"$6,518.75"	"$6,518.75"	$0.00	"$6,611.31"	"$10,472.32"	"$10,578.10"	$0.00		$0.00	"$2,069.34"	$0.00	$0.00	"$2,105.04"	$0.00	$0.00	$0.00	$0.00	$0.00
S-2722-2210	SUP	Custom 27803010		S-2722-2210  -  HEAD FEM HIP MRS TPR COCR LFIT	BOTH IP/OP	"$1,147.00 "	$848.78	$0.00	$917.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$851.30	$851.30	$0.00	$0.00	$239.03	$0.00	$0.00	$0.00	$0.00	$573.50	$908.42	$917.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S2801	SUP	Custom 27203010		CONTROL PASCAL QUAL STRP HISTOLGY	BOTH IP/OP	$302.50 	$223.85	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.25	$239.58	$242.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S3006	SUP	Custom 27203010		REAGENT WSH BUFF DUOCISH 1L IMMUN 10X	BOTH IP/OP	$192.45 	$142.41	$0.00	$153.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.23	$152.42	$153.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S302030-2	SUP	Custom 27203010		ENZYME LAB PRTNS K PREDIL 110ML	BOTH IP/OP	$890.68 	$659.10	$0.00	$712.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.34	$705.42	$712.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S3417	SUP	Custom 27203010		LABEL SLD RL RBN CLEAN PEN KT SEYMOUR	BOTH IP/OP	"$1,058.50 "	$783.29	$0.00	$846.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$785.62	$785.62	$0.00	$0.00	$220.59	$0.00	$0.00	$0.00	$0.00	$529.25	$838.33	$846.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S3425	SUP	Custom 27203010		VIAL STN REAGENT	BOTH IP/OP	$156.73 	$115.98	$0.00	$125.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$78.36	$124.13	$125.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S420GH	SUP	HCPCS C1884		S420GH  -  PARTICLES EMBOLIZATION 300-500UM MICROSPHERE .038IN PREFILL	BOTH IP/OP	$607.50 	$449.55	$0.00	$486.00	$273.38	$273.38	$0.00	$0.00	$0.00	$126.62	$450.89	$450.89	$0.00	$0.00	$126.60	$0.00	$359.34	$359.34	$0.00	$303.75	$481.14	$486.00	$0.00		$0.00	$95.07	$0.00	$0.00	$96.71	$0.00	$0.00	$0.00	$0.00	$0.00
S-55-150-120-P6	SUP	HCPCS C1876		S-55-150-120-P6  -  STENT VASCULAR 5.5MM 6FR 150MM 120CM OTW SELF EXPANDABLE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
S620GH/C	SUP	HCPCS C1884		S620GH/C  -  PARTICLES EMBL 500-700UM RND 2ML 20ML RD STRL EMBSPH SAL SYR	BOTH IP/OP	$515.00 	$381.10	$0.00	$412.00	$231.75	$231.75	$0.00	$0.00	$0.00	$107.34	$382.23	$382.23	$0.00	$0.00	$107.33	$0.00	$304.62	$304.62	$0.00	$257.50	$407.88	$412.00	$0.00		$0.00	$80.60	$0.00	$0.00	$81.99	$0.00	$0.00	$0.00	$0.00	$0.00
S-65-080-120-P6	SUP	HCPCS C1876		S-65-080-120-P6  -  STENT VASCULAR 6.5MM 6FR 80MM 120CM OTW SELF EXPANDABLE	BOTH IP/OP	"$2,062.50 "	"$1,526.25"	$0.00	"$1,650.00"	$928.13	$928.13	$0.00	$0.00	$0.00	$429.88	"$1,530.79"	"$1,530.79"	$0.00	$0.00	$429.83	$0.00	"$1,219.97"	"$1,219.97"	$0.00	"$1,031.25"	"$1,633.50"	"$1,650.00"	$0.00		$0.00	$322.78	$0.00	$0.00	$328.35	$0.00	$0.00	$0.00	$0.00	$0.00
S7150	SUP	Custom 27203010		REAGENT TSTK XP FRML 3 SET HISTOLGY	BOTH IP/OP	$660.00 	$488.40	$0.00	$528.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$330.00	$522.72	$528.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S7439-12	SUP	Custom 27203010		STAIN CLRFR 2 4GL HPRFR WKG SOL RA HEMATOX CYTO	BOTH IP/OP	$58.28 	$43.13	$0.00	$46.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.14	$46.16	$46.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S7439-3	SUP	Custom 27203010		STAIN HMTX 2 4PT HPRFR HISTOLGY	BOTH IP/OP	$67.03 	$49.60	$0.00	$53.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.51	$53.09	$53.62	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S7439-33	SUP	Custom 27203010		STAIN MOD HRS HMTX 1GL HG FR WKG SOL HISTOLGY	BOTH IP/OP	$209.35 	$154.92	$0.00	$167.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$104.68	$165.81	$167.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S7439-39	SUP	Custom 27203010		STAIN MOD PAP OG-6 1GL CYTO	BOTH IP/OP	$187.10 	$138.45	$0.00	$149.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.55	$148.18	$149.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S7439-4	SUP	Custom 27203010		STAIN EOSIN Y 4PT HPRFR WKG SOL HISTOLGY	BOTH IP/OP	$242.15 	$179.19	$0.00	$193.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.08	$191.78	$193.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S7439-7A	SUP	Custom 27203010		STAIN BLUING SGNTR 1GL WKG SOL REAGENT HMTL	BOTH IP/OP	$99.58 	$73.69	$0.00	$79.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.79	$78.87	$79.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S820GH	SUP	HCPCS C1884		S820GH  -  PARTICLES EMBL 700-900UM MCSPH 2ML GRN EMBSPH PREFL SYR	BOTH IP/OP	$607.50 	$449.55	$0.00	$450.89	$231.75	$231.75	$0.00	$0.00	$0.00	$126.62	$450.89	$450.89	$0.00	$0.00	$126.60	$0.00	$359.34	$359.34	$0.00	$257.50	$407.88	$412.00	$0.00		$0.00	$80.60	$0.00	$0.00	$81.99	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.100	SUP	HCPCS V2632		SA30AT.100  -  LENS IOL 0 D +10 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.105	SUP	HCPCS V2632		SA30AT.105  -  LENS IOL 0 D +10.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.110	SUP	HCPCS V2632		SA30AT.110  -  LENS IOL 0 D +11 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.115	SUP	HCPCS V2632		SA30AT.115  -  LENS IOL 0 D +11.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.120	SUP	HCPCS V2632		SA30AT.120  -  LENS IOL 0 D +12 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.125	SUP	HCPCS V2632		SA30AT.125  -  LENS IOL 0 D +12.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.130	SUP	HCPCS V2632		SA30AT.130  -  LENS IOL 0 D +13 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.135	SUP	HCPCS V2632		SA30AT.135  -  LENS IOL 0 D +13.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.140	SUP	HCPCS V2632		SA30AT.140  -  LENS IOL 0 D +14 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.145	SUP	HCPCS V2632		SA30AT.145  -  LENS IOL 0 D +14.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.150	SUP	HCPCS V2632		SA30AT.150  -  LENS IOL 0 D +15 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.155	SUP	HCPCS V2632		SA30AT.155  -  LENS IOL 0 D +15.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.160	SUP	HCPCS V2632		SA30AT.160  -  LENS IOL 0 D +16 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.165	SUP	HCPCS V2632		SA30AT.165  -  LENS IOL 0 D +16.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.170	SUP	HCPCS V2632		SA30AT.170  -  LENS IOL 0 D +17 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.175	SUP	HCPCS V2632		SA30AT.175  -  LENS IOL 0 D +17.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.180	SUP	HCPCS V2632		SA30AT.180  -  LENS IOL 0 D +18 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.185	SUP	HCPCS V2632		SA30AT.185  -  LENS IOL 0 D +18.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.190	SUP	HCPCS V2632		SA30AT.190  -  LENS IOL 0 D +19 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.195	SUP	HCPCS V2632		SA30AT.195  -  LENS IOL 0 D +19.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.200	SUP	HCPCS V2632		SA30AT.200  -  LENS IOL 0 D +20 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.205	SUP	HCPCS V2632		SA30AT.205  -  LENS IOL 0 D +20.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.210	SUP	HCPCS V2632		SA30AT.210  -  LENS IOL 0 D +21 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.215	SUP	HCPCS V2632		SA30AT.215  -  LENS IOL 0 D +21.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.220	SUP	HCPCS V2632		SA30AT.220  -  LENS IOL 0 D +22 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.225	SUP	HCPCS V2632		SA30AT.225  -  LENS IOL 0 D +22.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.230	SUP	HCPCS V2632		SA30AT.230  -  LENS IOL 0 D +23 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.235	SUP	HCPCS V2632		SA30AT.235  -  LENS IOL 0 D +23.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.240	SUP	HCPCS V2632		SA30AT.240  -  LENS IOL 0 D +24 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.245	SUP	HCPCS V2632		SA30AT.245  -  LENS IOL 0 D +24.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.250	SUP	HCPCS V2632		SA30AT.250  -  LENS IOL 0 D +25 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.255	SUP	HCPCS V2632		SA30AT.255  -  LENS IOL 0 D +25.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.260	SUP	HCPCS V2632		SA30AT.260  -  LENS IOL 0 D +26 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.265	SUP	HCPCS V2632		SA30AT.265  -  LENS IOL 0 D +26.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.270	SUP	HCPCS V2632		SA30AT.270  -  LENS IOL 0 D +27 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.275	SUP	HCPCS V2632		SA30AT.275  -  LENS IOL 0 D +27.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.280	SUP	HCPCS V2632		SA30AT.280  -  LENS IOL 0 D +28 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.285	SUP	HCPCS V2632		SA30AT.285  -  LENS IOL 0 D +28.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.290	SUP	HCPCS V2632		SA30AT.290  -  LENS IOL 0 D +29 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.295	SUP	HCPCS V2632		SA30AT.295  -  LENS IOL 0 D +29.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA30AT.300	SUP	HCPCS V2632		SA30AT.300  -  LENS IOL 0 D +30 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA4644	SUP	Custom 27203010		BLADDER TOP CCB SA4694	BOTH IP/OP	$716.08 	$529.90	$0.00	$572.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$358.04	$567.14	$572.86	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SA4645	SUP	Custom 27203010		BLADDER BOTTOM CCB SA4645	BOTH IP/OP	$733.23 	$542.59	$0.00	$586.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$366.61	$580.72	$586.58	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SA4901	SUP	Custom 27203010		FOAM CCB #SA4901	BOTH IP/OP	$171.38 	$126.82	$0.00	$137.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.69	$135.73	$137.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SA60AT.290	SUP	HCPCS V2632		SA60AT.290  -  LENS IOL 0 D +29 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA60AT.310	SUP	HCPCS V2632		SA60AT.310  -  LENS IOL 0 D +31 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60AT.350	SUP	HCPCS V2632		SA60AT.350  -  LENS IOL 0 D +35 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA60AT.360	SUP	HCPCS V2632		SA60AT.360  -  LENS IOL 0 D +36 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA60AT.370	SUP	HCPCS V2632		SA60AT.370  -  LENS IOL 0 D +37 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA60AT.380	SUP	HCPCS V2632		SA60AT.380  -  LENS IOL 0 D +38 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA60AT.390	SUP	HCPCS V2632		SA60AT.390  -  LENS IOL 0 D +39 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA60AT.400	SUP	HCPCS V2632		SA60AT.400  -  LENS IOL 0 D +40 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$375.00 	$277.50	$0.00	$300.00	$168.75	$168.75	$0.00	$0.00	$0.00	$78.16	$278.33	$278.33	$0.00	$0.00	$78.15	$0.00	$221.81	$221.81	$0.00	$187.50	$297.00	$300.00	$0.00		$0.00	$58.69	$0.00	$0.00	$59.70	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF	SUP	HCPCS V2632		SA60WF  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.060	SUP	HCPCS V2632		SA60WF.060  -  LENS IOL 0 D +6 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.065	SUP	HCPCS V2632		SA60WF.065  -  LENS IOL 0 D +6.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.070	SUP	HCPCS V2632		SA60WF.070  -  LENS IOL 0 D +7 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.075	SUP	HCPCS V2632		SA60WF.075  -  LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.080	SUP	HCPCS V2632		SA60WF.080  -  LENS IOL 0 D +8 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.085	SUP	HCPCS V2632		SA60WF.085  -  LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.090	SUP	HCPCS V2632		SA60WF.090  -  LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.095	SUP	HCPCS V2632		SA60WF.095  -  LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.100	SUP	HCPCS V2632		SA60WF.100  -  LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.105	SUP	HCPCS V2632		SA60WF.105  -  LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.110	SUP	HCPCS V2632		SA60WF.110  -  LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.115	SUP	HCPCS V2632		SA60WF.115  -  LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.120	SUP	HCPCS V2632		SA60WF.120  -  LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.125	SUP	HCPCS V2632		SA60WF.125  -  LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.130	SUP	HCPCS V2632		SA60WF.130  -  LENS IOL 0 D +13 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.135	SUP	HCPCS V2632		SA60WF.135  -  LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.140	SUP	HCPCS V2632		SA60WF.140  -  LENS IOL 0 D +14 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.145	SUP	HCPCS V2632		SA60WF.145  -  LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.150	SUP	HCPCS V2632		SA60WF.150  -  LENS IOL 0 D +15 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.155	SUP	HCPCS V2632		SA60WF.155  -  LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.160	SUP	HCPCS V2632		SA60WF.160  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.165	SUP	HCPCS V2632		SA60WF.165  -  LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.170	SUP	HCPCS V2632		SA60WF.170  -  LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM CLR STRL LF ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.175	SUP	HCPCS V2632		SA60WF.175  -  LENS IOL 0 D +17.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.180	SUP	HCPCS V2632		SA60WF.180  -  LENS IOL 0 D +18 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.185	SUP	HCPCS V2632		SA60WF.185  -  LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.190	SUP	HCPCS V2632		SA60WF.190  -  LENS IOL 0 D +19 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.195	SUP	HCPCS V2632		SA60WF.195  -  LENS IOL 0 D +19.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.200	SUP	HCPCS V2632		SA60WF.200  -  LENS IOL 0 D +20 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM 1	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.205	SUP	HCPCS V2632		SA60WF.205  -  LENS IOL 0 D +20.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.210	SUP	HCPCS V2632		SA60WF.210  -  LENS IOL 0 D +21 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.215	SUP	HCPCS V2632		SA60WF.215  -  LENS IOL 0 D +21.5 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.220	SUP	HCPCS V2632		SA60WF.220  -  LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.225	SUP	HCPCS V2632		SA60WF.225  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.230	SUP	HCPCS V2632		SA60WF.230  -  LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.235	SUP	HCPCS V2632		SA60WF.235  -  LENS IOL 0 D +23.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.240	SUP	HCPCS V2632		SA60WF.240  -  LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.245	SUP	HCPCS V2632		SA60WF.245  -  LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.250	SUP	HCPCS V2632		SA60WF.250  -  LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.255	SUP	HCPCS V2632		SA60WF.255  -  LENS IOL 0 D +25.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.260	SUP	HCPCS V2632		SA60WF.260  -  LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.265	SUP	HCPCS V2632		SA60WF.265  -  LENS IOL 0 D +26.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.270	SUP	HCPCS V2632		SA60WF.270  -  LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.275	SUP	HCPCS V2632		SA60WF.275  -  LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.280	SUP	HCPCS V2632		SA60WF.280  -  LENS IOL 0 D +28 DIOP ASYM BCNVX 6MM 13MM ACRSF STABLEFORCE	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.285	SUP	HCPCS V2632		SA60WF.285  -  LENS IOL 0 D +28.5 DIOP BCNVX 118.4 A-CNST 6MM 13MM ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.290	SUP	HCPCS V2632		SA60WF.290  -  LENS IOL 0 D +29 DIOP ASYM BCNVX 6MM 13MM ACRSF STABLEFORCE	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.295	SUP	HCPCS V2632		SA60WF.295  -  LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA60WF.300	SUP	HCPCS V2632		SA60WF.300  -  LENS IOL 0 D +30 DIOP BCNVX 118.4 A-CNST 6MM 13MM ACRSF	BOTH IP/OP	$335.00 	$247.90	$0.00	$268.00	$150.75	$150.75	$0.00	$0.00	$0.00	$69.82	$248.64	$248.64	$0.00	$0.00	$69.81	$0.00	$198.15	$198.15	$0.00	$167.50	$265.32	$268.00	$0.00		$0.00	$52.43	$0.00	$0.00	$53.33	$0.00	$0.00	$0.00	$0.00	$0.00
SA8630	SUP	Custom 27203010		COVER MATTRESS /5J:4K	BOTH IP/OP	$919.10 	$680.13	$0.00	$735.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$459.55	$727.93	$735.28	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SAK 4689	SUP	Custom 27203010		BLADE MCTM ACED LOW PROFILE	BOTH IP/OP	$580.05 	$429.24	$0.00	$464.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.03	$459.40	$464.04	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SAX02D	SUP	HCPCS C1768		SAX02D  -  GRAFT VASC 90CM 8MM GRTX AXLBFM STRCH REM RING THNWL INTGR	BOTH IP/OP	"$6,235.00 "	"$4,613.90"	$0.00	"$4,988.00"	"$2,805.75"	"$2,805.75"	$0.00	$0.00	$0.00	"$1,299.53"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,299.37"	$0.00	"$3,073.86"	"$3,073.86"	$0.00	"$3,117.50"	"$4,938.12"	"$4,988.00"	$0.00		$0.00	$975.78	$0.00	$0.00	$992.61	$0.00	$0.00	$0.00	$0.00	$0.00
SB6AL10	SUP	HCPCS C1887		CATHETER GUID AL1 CURVE 6FR SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6AL10SH	SUP	HCPCS C1887		CATHETER GUID AL1 CURVE 6FR SH SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6AL20	SUP	HCPCS C1887		CATHETER GUID AL2 CURVE 6FR SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6AL20SH	SUP	HCPCS C1887		CATHETER GUID AL2 CURVE 6FR SH SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6AL75	SUP	HCPCS C1887		CATHETER GUID AL7.5 CURVE 6FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6AR10	SUP	HCPCS C1887		CATHETER GUID AR1 CURVE 6FR SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6EBU35	SUP	HCPCS C1887		CATHETER GUID XB3.5 CURVE 6FR SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6HS1	SUP	HCPCS C1887		CATHETER GUID HS1 CURVE 6FR SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6HS1SH	SUP	HCPCS C1887		"SA6MP1  -  CATHETER GUIDING SHERPA NX, 6FRX 100CM MP1"	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$23.45	$83.50	$83.50	$0.00	$0.00	$23.45	$0.00	$66.54	$66.54	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6JL35	SUP	HCPCS C1887		CATHETER GUID JL3.5 CURVE 6FR SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6JL40	SUP	HCPCS C1887		CATHETER GUID JL4 CURVE 6FR SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6JL40SH	SUP	HCPCS C1887		CATHETER GUID JL4 CURVE 6FR 100CM SH SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6JR35	SUP	HCPCS C1887		CATHETER GUID JR3.5 CURVE 6FR SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB6JR40	SUP	HCPCS C1887		CATHETER GUID JR4 CURVE 6FR SHR NX BAL	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
SB6JR40SH	SUP	HCPCS C1887		CATHETER GUID JR4 CURVE 6FR SH SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7AL10	SUP	HCPCS C1887		CATHETER GUID AL1 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7AL20	SUP	HCPCS C1887		CATHETER GUID AL2 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7AL75	SUP	HCPCS C1887		CATHETER GUID AL.75 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7AR10	SUP	HCPCS C1887		CATHETER GUID AR1 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7AR10SH	SUP	HCPCS C1887		CATHETER GUID AR1 CURVE 7FR 100CM SH SHR NX BAL	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
SB7EBU30	SUP	HCPCS C1887		CATHETER GUID XB3 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7EBU35	SUP	HCPCS C1887		CATHETER GUID XB3.5 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7EBU40	SUP	HCPCS C1887		CATHETER GUID XB4 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7HS1	SUP	HCPCS C1887		CATHETER GUIDING VISTA BRITE TIP 7FR X .078IN HS	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
SB7HS1SH	SUP	HCPCS C1887		CATHETER GUID HS1 CURVE 7FR SH SHR NX BAL	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
SB7IMA	SUP	HCPCS C1887		CATHETER GUID IM CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
SB7IMASH	SUP	HCPCS C1887		CATHETER GUID IM CURVE 7FR 100CM SH SHR NX BAL	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
SB7JL35	SUP	HCPCS C1887		CATHETER GUID JL3.5 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
SB7JL40	SUP	HCPCS C1887		CATHETER GUID JL4 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7JL40SH	SUP	HCPCS C1887		CATHETER GUID JL4 CURVE 7FR 100CM SH SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7JL50	SUP	HCPCS C1887		CATHETER GUID JL5 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7JR35	SUP	HCPCS C1887		CATHETER GUID JR3.5 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
SB7JR40	SUP	HCPCS C1887		CATHETER GUID JR4 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7JR4SH	SUP	HCPCS C1887		CATHETER GUIDING VISTA BRITE TIP 7FR X 100CM JR4 SH	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7JR50	SUP	HCPCS C1887		CATHETER GUID JR5 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7LCB	SUP	HCPCS C1887		CATHETER GUID LCB CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB7MP1	SUP	HCPCS C1887		CATHETER GUID MP1 CURVE 7FR 100CM SHR NX BAL	BOTH IP/OP	$112.50 	$83.25	$0.00	$90.00	$61.09	$61.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.25	$89.10	$90.00	$0.00		$0.00	$17.61	$0.00	$0.00	$17.91	$0.00	$0.00	$0.00	$0.00	$0.00
SB8AL20	SUP	HCPCS C1887		CATHETER GUID AL2 CURVE 8FR 100CM CORON SHR NX BAL	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
SB8EBU40	SUP	HCPCS C1887		CATHETER GUID XB4 CURVE 8FR 100CM CORON SHR NX BAL	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
SBFS045	SUP	Custom 27203010		SBFS045  -  KIT TRMA FX 1.1MM .045IN SBFS	BOTH IP/OP	"$1,015.00 "	$751.10	$0.00	$812.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$753.33	$753.33	$0.00	$0.00	$211.53	$0.00	$0.00	$0.00	$0.00	$507.50	$803.88	$812.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SBFS062	SUP	Custom 27203010		SBFS062  -  KIT IM NL .062IN SLT AWL LK DV BNDRG TL CAP SM BN FX SYS	BOTH IP/OP	"$1,015.00 "	$751.10	$0.00	$812.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$753.33	$753.33	$0.00	$0.00	$211.53	$0.00	$0.00	$0.00	$0.00	$507.50	$803.88	$812.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SBM-4963	SUP	HCPCS C1765		"SBM-4963  -  BLANKET SECTION MED (MUST ORDER MIN 4 BX, MED OR SM)"	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$0.00	$0.00	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SBRAR20	SUP	HCPCS C1887		CATHETER GUIDING VISTA BRITE TIP 7FR X 100CM AR2	BOTH IP/OP	$125.00 	$92.50	$0.00	$100.00	$67.88	$67.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.50	$99.00	$100.00	$0.00		$0.00	$19.56	$0.00	$0.00	$19.90	$0.00	$0.00	$0.00	$0.00	$0.00
SBT1602D	SUP	HCPCS C1768		SBT1602D  -  GRAFT VASCULAR STANDARD WALL THIN WALL 2 BRANCH 16MM 8MM 50	BOTH IP/OP	"$2,852.50 "	"$2,110.85"	$0.00	"$2,282.00"	"$1,283.63"	"$1,283.63"	$0.00	$0.00	$0.00	$594.53	"$2,117.13"	"$2,117.13"	$0.00	$0.00	$594.46	$0.00	"$1,406.28"	"$1,406.28"	$0.00	"$1,426.25"	"$2,259.18"	"$2,282.00"	$0.00		$0.00	$446.42	$0.00	$0.00	$454.12	$0.00	$0.00	$0.00	$0.00	$0.00
SBT1802D	SUP	HCPCS C1768		SBT1802D  -  GRAFT VASC STD WL THNWL 2 BRCH 18MM 9MM 50CM STRL STRCH GRTX	BOTH IP/OP	"$2,852.50 "	"$2,110.85"	$0.00	"$2,282.00"	"$1,283.63"	"$1,283.63"	$0.00	$0.00	$0.00	$594.53	"$2,117.13"	"$2,117.13"	$0.00	$0.00	$594.46	$0.00	"$1,406.28"	"$1,406.28"	$0.00	"$1,426.25"	"$2,259.18"	"$2,282.00"	$0.00		$0.00	$446.42	$0.00	$0.00	$454.12	$0.00	$0.00	$0.00	$0.00	$0.00
SBT2002D	SUP	HCPCS C1768		SBT2002D  -  GRAFT VASCULAR STANDARD WALL THIN WALL 2 BRANCH 20MM 10MM 50	BOTH IP/OP	"$2,852.50 "	"$2,110.85"	$0.00	"$2,282.00"	"$1,283.63"	"$1,283.63"	$0.00	$0.00	$0.00	$594.53	"$2,117.13"	"$2,117.13"	$0.00	$0.00	$594.46	$0.00	"$1,406.28"	"$1,406.28"	$0.00	"$1,426.25"	"$2,259.18"	"$2,282.00"	$0.00		$0.00	$446.42	$0.00	$0.00	$454.12	$0.00	$0.00	$0.00	$0.00	$0.00
SC-1110-02	SUP	HCPCS L8688		SC-1110-02  -  NEUROSTIMULATOR IMPLTABLE PRCS PLS GNTR SC-1110	BOTH IP/OP	"$36,900.00 "	"$27,306.00"	$0.00	"$29,520.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$18,450.00"	"$29,224.80"	"$29,520.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SC-2218-50	SUP	Custom 27203010		KIT STM 50CM LINEAR 8 CNTCT LEAD	BOTH IP/OP	"$4,780.00 "	"$3,537.20"	$0.00	"$3,824.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,390.00"	"$3,785.76"	"$3,824.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SC-4385-50	SUP	Custom 27203010		SC-4385-50  -  KIT STM 50CM STY CAP	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SC-4400	SUP	HCPCS L8688		SC-4400  -  NEUROSTIMULATOR IMPLTABLE PLS GNTR PLG PORT	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SC-5500-2	SUP	Custom 27203010		KIT STM PRCS LINEAR PT PRGMR NEUROMASCULAR	BOTH IP/OP	"$2,380.00 "	"$1,761.20"	$0.00	"$1,904.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,190.00"	"$1,884.96"	"$1,904.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SC-6412	SUP	Custom 27203010		KIT STM SPNL CORD CHRGR ONLY	BOTH IP/OP	"$5,980.00 "	"$4,425.20"	$0.00	"$4,784.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,990.00"	"$4,736.16"	"$4,784.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SCD13	SUP	Custom 27011340		SCD13  -  DISSECTOR LAPSCOP US HNDPC 13CM SONICISION DISP	BOTH IP/OP	"$4,777.50 "	"$3,535.35"	$0.00	"$3,822.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,545.86"	"$3,545.86"	$0.00	$0.00	$995.63	$0.00	$0.00	$0.00	$0.00	"$2,388.75"	"$3,783.78"	"$3,822.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SCD26	SUP	Custom 27011340		SCD26  -  DISSECTOR ENDSCP STR JAW HND SWCH CRDLS US 26CM 5	BOTH IP/OP	"$4,777.50 "	"$3,535.35"	$0.00	"$3,822.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,545.86"	"$3,545.86"	$0.00	$0.00	$995.63	$0.00	$0.00	$0.00	$0.00	"$2,388.75"	"$3,783.78"	"$3,822.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SCREWTEST	SUP	HCPCS C1713		SCREWTEST  -  SCREW SUPPLY TEST NEW ITEM	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$22.50	$22.50	$0.00	$0.00	$0.00	$10.42	$37.11	$37.11	$0.00	$0.00	$10.42	$0.00	$29.58	$29.58	$0.00	$25.00	$39.60	$40.00	$0.00		$0.00	$7.83	$0.00	$0.00	$7.96	$0.00	$0.00	$0.00	$0.00	$0.00
SD242.003	SUP	HCPCS C1713		SD242.003  -  PLATE BN STRG 170MM NS LCP SS WRST 2.4MM SCR	BOTH IP/OP	"$7,192.50 "	"$5,322.45"	$0.00	"$5,754.00"	"$3,236.63"	"$3,236.63"	$0.00	$0.00	$0.00	"$1,499.10"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,498.92"	$0.00	"$3,545.90"	"$3,545.90"	$0.00	"$3,596.25"	"$5,696.46"	"$5,754.00"	$0.00		$0.00	"$1,125.63"	$0.00	$0.00	"$1,145.05"	$0.00	$0.00	$0.00	$0.00	$0.00
SE5423WV	SUP	Custom 27203010		SE5423WV  -  PACK 23 GA POSTERIOR WIDE-FIELD ELITE	BOTH IP/OP	$887.50 	$656.75	$0.00	$710.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$658.70	$658.70	$0.00	$0.00	$184.96	$0.00	$0.00	$0.00	$0.00	$443.75	$702.90	$710.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SE5425WVB	SUP	Custom 27203010		SE5425WVB  -  PACK VITRTM 25GA STRL LF STELLARIS ELT 2 BLDE CTR W FLD POST	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$0.00	$0.00	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SE5427MVB	SUP	Custom 27203010		SE5427MVB  -  PACK 27 GA. BI-BLADE VITREOUS CUTTER POSTERIOR MID-FIELD STE	BOTH IP/OP	$987.50 	$730.75	$0.00	$790.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$732.92	$732.92	$0.00	$0.00	$205.80	$0.00	$0.00	$0.00	$0.00	$493.75	$782.10	$790.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SECOC 28/28	SUP	Custom 27803010		SECOC 28/28  -  OUTER SMALL FRAGMENT CLAMP	BOTH IP/OP	$537.50 	$397.75	$0.00	$430.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$398.93	$398.93	$0.00	$0.00	$112.02	$0.00	$0.00	$0.00	$0.00	$268.75	$425.70	$430.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SECURADRMMEM	SUP	HCPCS C1721		SECURADRMMEM  -  SECURA DR SYSTEM (INCLUDING DF4 HEADER)	BOTH IP/OP	"$49,812.50 "	"$36,861.25"	$0.00	"$39,850.00"	"$22,415.63"	"$22,415.63"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$10,380.93"	$0.00	"$24,557.56"	"$24,557.56"	$0.00	"$24,906.25"	"$39,451.50"	"$39,850.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$7,930.15"	$0.00	$0.00	$0.00	$0.00	$0.00
SECURAVREMEM	SUP	HCPCS C1721		SECURAVREMEM  -  SECURA VR SYSTEM (INCLUDING DF4 HEADER)	BOTH IP/OP	"$43,750.00 "	"$32,375.00"	$0.00	"$35,000.00"	"$19,687.50"	"$19,687.50"	$0.00	$0.00	$0.00	"$9,118.59"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,117.50"	$0.00	"$21,568.75"	"$21,568.75"	$0.00	"$21,875.00"	"$34,650.00"	"$35,000.00"	$0.00		$0.00	"$6,846.88"	$0.00	$0.00	"$6,965.00"	$0.00	$0.00	$0.00	$0.00	$0.00
SECX-10-7-30-135	SUP	HCPCS C1876		SECX-10-7-30-135  -  STENT VASC 30MM 10/7MM 6FR PRTG .014IN 8.5-9.5MM PERI CRTD	BOTH IP/OP	"$5,127.50 "	"$3,794.35"	$0.00	"$4,102.00"	"$2,307.38"	"$2,307.38"	$0.00	$0.00	$0.00	"$1,068.70"	"$3,805.63"	"$3,805.63"	$0.00	$0.00	"$1,068.57"	$0.00	"$2,527.86"	"$2,527.86"	$0.00	"$2,563.75"	"$4,060.98"	"$4,102.00"	$0.00		$0.00	$802.45	$0.00	$0.00	$816.30	$0.00	$0.00	$0.00	$0.00	$0.00
SECX-10-7-40-135	SUP	HCPCS C1876		SECX-10-7-40-135  -  STENT VASC 40MM 10/7MM 6FR PRTG .014IN 8.5-9.5MM PERI CRTD	BOTH IP/OP	"$5,127.50 "	"$3,794.35"	$0.00	"$4,102.00"	"$2,307.38"	"$2,307.38"	$0.00	$0.00	$0.00	"$1,068.70"	"$3,805.63"	"$3,805.63"	$0.00	$0.00	"$1,068.57"	$0.00	"$2,527.86"	"$2,527.86"	$0.00	"$2,563.75"	"$4,060.98"	"$4,102.00"	$0.00		$0.00	$802.45	$0.00	$0.00	$816.30	$0.00	$0.00	$0.00	$0.00	$0.00
SECX-8-6-30-135	SUP	HCPCS C1876		SECX-8-6-30-135  -  STENT VASC 8/6MM 6/8FR 30MM 135CM .014IN RAPEX TPR EXPRT	BOTH IP/OP	"$5,127.50 "	"$3,794.35"	$0.00	"$4,102.00"	"$2,307.38"	"$2,307.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,563.75"	"$4,060.98"	"$4,102.00"	$0.00		$0.00	$802.45	$0.00	$0.00	$816.30	$0.00	$0.00	$0.00	$0.00	$0.00
SECX-8-6-40-135	SUP	HCPCS C1876		SECX-8-6-40-135  -  STENT VASC 40MM 8/6MM 6FR PRTG .014IN 6.5-7.5MM PERI CRTD	BOTH IP/OP	"$5,127.50 "	"$3,794.35"	$0.00	"$4,102.00"	"$2,307.38"	"$2,307.38"	$0.00	$0.00	$0.00	"$1,068.70"	"$3,805.63"	"$3,805.63"	$0.00	$0.00	"$1,068.57"	$0.00	"$2,527.86"	"$2,527.86"	$0.00	"$2,563.75"	"$4,060.98"	"$4,102.00"	$0.00		$0.00	$802.45	$0.00	$0.00	$816.30	$0.00	$0.00	$0.00	$0.00	$0.00
SEDR01	SUP	HCPCS C1786		SEDR01  -  PACEMAKER CARDIAC 2.8V 1.2AH 7.5MM 47.9X44.7MM IMPLTABLE 2	BOTH IP/OP	"$8,500.00 "	"$6,290.00"	$0.00	"$6,800.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,771.61"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,771.40"	$0.00	"$4,190.50"	"$4,190.50"	$0.00	"$4,250.00"	"$6,732.00"	"$6,800.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SEG1411	SUP	HCPCS C1769		SEG1411  -  GWIRE VASC .014IN 190CM 8CM ANG SEGWAY HYDPHI	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$169.69	$169.69	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
SEG1412	SUP	HCPCS C1769		SEG1412  -  STR GUIDEWIRE .014X180 SEGWAY GT	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$169.69	$169.69	$0.00	$0.00	$0.00	$65.13	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$184.84	$184.84	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$48.91	$0.00	$0.00	$49.75	$0.00	$0.00	$0.00	$0.00	$0.00
SENSH1428W	SUP	HCPCS C1894		SENSH1428W  -  SHEATH INTROD 28CM GWIRE FLEXIBILITY REINFORCED COIL RADIOPQ	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
SENSH1628W	SUP	HCPCS C1894		SENSH1628W  -  SHEATH INTRO .035IN 16FR 28CM SENTRANT RADOPQ REINF COIL DIL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
SENSH1828W	SUP	HCPCS C1894		SENSH1828W  -  SHEATH INTRO .035IN 18FR 28CM SENTRANT RADOPQ REINF COIL DIL	BOTH IP/OP	$500.00 	$370.00	$0.00	$400.00	$271.50	$271.50	$0.00	$0.00	$0.00	$104.21	$371.10	$371.10	$0.00	$0.00	$104.20	$0.00	$295.75	$295.75	$0.00	$250.00	$396.00	$400.00	$0.00		$0.00	$78.25	$0.00	$0.00	$79.60	$0.00	$0.00	$0.00	$0.00	$0.00
SENSH2028W	SUP	HCPCS C1894		SENSH2028W  -  SHEATH INTROD 28CM RADIOPQ MARKER BAND REINFORCED COIL DILAT	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$339.38	$339.38	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
SENSH2228W	SUP	HCPCS C1894		SENSH2228W  -  SHEATH INTRO 22FR 28CM SENTRANT HDRPH AAA	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$339.38	$339.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
SENSIADRK2	SUP	HCPCS C2619		SENSIADRK2  -  SENSIA DR SYSTEM	BOTH IP/OP	"$12,500.00 "	"$9,250.00"	$0.00	"$10,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,605.00"	$0.00	$0.00	$0.00	$0.00	"$6,250.00"	"$9,900.00"	"$10,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SENSIASRK2	SUP	HCPCS C2620		SENSIASRK2  -  PACEMAKER CARDIAC THK7.5MM 42.9X40.2MM IMPLTABLE 1 CHAMBER	BOTH IP/OP	"$5,992.50 "	"$4,434.45"	$0.00	"$4,810.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,248.84"	$0.00	$0.00	$0.00	$0.00	"$3,006.25"	"$4,761.90"	"$4,810.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SESR01	SUP	HCPCS C1786		SESR01  -  PACEMAKER CARDIAC 2.8V .97AH 7.5MM 42.9MMX40.2MM 1 CHAMBER	BOTH IP/OP	"$5,000.00 "	"$3,700.00"	$0.00	"$4,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,042.13"	"$3,711.00"	"$3,711.00"	$0.00	$0.00	"$1,042.00"	$0.00	"$2,465.00"	"$2,465.00"	$0.00	"$2,500.00"	"$3,960.00"	"$4,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SF-2500-6101	SUP	HCPCS C1713		SF-2500-6101  -  PIN HALF 500MM NONSTRL DISPOSABLE	BOTH IP/OP	"$5,250.00 "	"$3,885.00"	$0.00	"$4,200.00"	"$2,362.50"	"$2,362.50"	$0.00	$0.00	$0.00	"$1,094.23"	"$3,896.55"	"$3,896.55"	$0.00	$0.00	"$1,094.10"	$0.00	"$2,588.25"	"$2,588.25"	$0.00	"$2,625.00"	"$4,158.00"	"$4,200.00"	$0.00		$0.00	$821.63	$0.00	$0.00	$835.80	$0.00	$0.00	$0.00	$0.00	$0.00
SFR-4-15	SUP	Custom 27203010		SFR-4-15  -  DEVICE THROMBECTOMY SOLITARE FR 4X15	BOTH IP/OP	"$15,250.00 "	"$11,285.00"	$0.00	"$12,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,178.10"	$0.00	$0.00	$0.00	$0.00	"$7,625.00"	"$12,078.00"	"$12,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SFR-4-20	SUP	Custom 27203010		SFR-4-20  -  DEVICE THRMB 31MM 4MM SOLITAIRE FR REVSC	BOTH IP/OP	"$15,250.00 "	"$11,285.00"	$0.00	"$12,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,178.10"	$0.00	$0.00	$0.00	$0.00	"$7,625.00"	"$12,078.00"	"$12,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SFR-6-20	SUP	Custom 27203010		SFR-6-20  -  DEVICE THRMB 31MM 6MM SOLITAIRE FR REVSC	BOTH IP/OP	"$15,250.00 "	"$11,285.00"	$0.00	"$12,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,178.10"	$0.00	$0.00	$0.00	$0.00	"$7,625.00"	"$12,078.00"	"$12,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SFR-6-30	SUP	Custom 27203010		SFR-6-30  -  DEVICE THRMB 42MM 6MM SOLITAIRE FR REVSC	BOTH IP/OP	"$15,250.00 "	"$11,285.00"	$0.00	"$12,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,178.10"	$0.00	$0.00	$0.00	$0.00	"$7,625.00"	"$12,078.00"	"$12,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SGL-1	SUP	Custom 27203010		SGL-1  -  SUTURE CR SURGITIE 0 21IN LGT LOOP DLV SYS ABS	BOTH IP/OP	$607.98 	$449.91	$0.00	$486.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$303.99	$481.52	$486.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
S-H00703	SUP	HCPCS C1776		S-H00703  -  STEM FEM HDNK OMFT LNG HIP	BOTH IP/OP	"$3,866.00 "	"$2,860.84"	$0.00	"$3,092.80"	"$1,739.70"	"$1,739.70"	$0.00	$0.00	$0.00	$805.77	"$2,869.35"	"$2,869.35"	$0.00	$0.00	$805.67	$0.00	"$1,905.94"	"$1,905.94"	$0.00	"$1,933.00"	"$3,061.87"	"$3,092.80"	$0.00		$0.00	$605.03	$0.00	$0.00	$615.47	$0.00	$0.00	$0.00	$0.00	$0.00
SH-0713-S	SUP	HCPCS C1776		SH-0713-S  -  STEM HUM 130MM 7MM MDLR SHRT SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-0813-S	SUP	HCPCS C1776		SH-0813-S  -  STEM HUM 130MM 8MM MDLR SHRT SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-0818-S	SUP	HCPCS C1776		SH-0818-S  -  STEM HUM 180MM 8MM LNG SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-0820	SUP	HCPCS C1776		SH-0820  -  STEM HUM 200MM 8MM PLRS LNG SHLDR STRL	BOTH IP/OP	"$4,987.50 "	"$3,690.75"	$0.00	"$3,990.00"	"$2,244.38"	"$2,244.38"	$0.00	$0.00	$0.00	"$1,039.52"	"$3,701.72"	"$3,701.72"	$0.00	$0.00	"$1,039.40"	$0.00	"$2,458.84"	"$2,458.84"	$0.00	"$2,493.75"	"$3,950.10"	"$3,990.00"	$0.00		$0.00	$780.54	$0.00	$0.00	$794.01	$0.00	$0.00	$0.00	$0.00	$0.00
SH-0820-S	SUP	HCPCS C1776		SH-0820-S  -  STEM HUM 200MM 8MM PLRS LNG SHLDR STRL	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-0822-S	SUP	HCPCS C1776		SH-0822-S  -  STEM HUM 220MM 8MM MDLR LNG SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-0824-S	SUP	HCPCS C1776		SH-0824-S  -  STEM HUM 240MM 8MM MDLR PLRS LNG SHLDR STRL	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-0826-S	SUP	HCPCS C1776		SH-0826-S  -  STEM HUM 8MM 260MM STRL MDLR SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-0828-S	SUP	HCPCS C1776		SH-0828-S  -  STEM HUM 280MM 8MM MDLR LNG SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-0913-S	SUP	HCPCS C1776		SH-0913-S  -  STEM HUM 130MM 9MM TI SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1013-S	SUP	HCPCS C1776		SH-1013-S  -  STEM HUM 130MM 10MM PLRS TI SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1018-S	SUP	HCPCS C1776		SH-1018-S  -  STEM HUM 180MM 10MM MDLR LNG SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1020-S	SUP	HCPCS C1776		SH-1020-S  -  STEM HUM 200MM 10MM MDLR LNG SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1022-S	SUP	HCPCS C1776		SH-1022-S  -  STEM HUM 220MM 10MM MDLR LNG SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1024-S	SUP	HCPCS C1776		SH-1024-S  -  STEM HUM 240MM 10MM MDLR LNG SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1026-S	SUP	HCPCS C1776		SH-1026-S  -  STEM HUM 260MM 10MM MDLR SHLDR STRL	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1028-S	SUP	HCPCS C1776		SH-1028-S  -  STEM HUM 280MM 10MM MDLR LNG SHLDR STRL	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1213-S	SUP	HCPCS C1776		SH-1213-S  -  STEM HUM 130MM 12MM MDLR SHRT SHLDR STRL	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1313-S	SUP	HCPCS C1776		SH-1313-S  -  STEM HUM 130MM 13MM MDLR SHRT SHLDR STRL	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1340L-S	SUP	HCPCS C1776		SH-1340L-S  -  HEAD HUM 13MM LEFT SHLDR BODY ASMBLY MDLR PLRS STRL	BOTH IP/OP	"$5,910.00 "	"$4,373.40"	$0.00	"$4,728.00"	"$2,659.50"	"$2,659.50"	$0.00	$0.00	$0.00	"$1,231.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,231.64"	$0.00	"$2,913.63"	"$2,913.63"	$0.00	"$2,955.00"	"$4,680.72"	"$4,728.00"	$0.00		$0.00	$924.92	$0.00	$0.00	$940.87	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1340R-S	SUP	HCPCS C1776		SH-1340R-S  -  STEM HUM 13MM ASMBLY TI RIGHT SHLDR	BOTH IP/OP	"$5,910.00 "	"$4,373.40"	$0.00	"$4,728.00"	"$2,659.50"	"$2,659.50"	$0.00	$0.00	$0.00	"$1,231.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,231.64"	$0.00	"$2,913.63"	"$2,913.63"	$0.00	"$2,955.00"	"$4,680.72"	"$4,728.00"	$0.00		$0.00	$924.92	$0.00	$0.00	$940.87	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1413-S	SUP	HCPCS C1776		SH-1413-S  -  STEM HUM 130MM 14MM MDLR SHRT SHLDR	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1513-S	SUP	HCPCS C1776		SH-1513-S  -  STEM HUM 130MM 15MM MDLR SHRT SHLDR STRL	BOTH IP/OP	"$4,055.00 "	"$3,000.70"	$0.00	"$3,244.00"	"$1,824.75"	"$1,824.75"	$0.00	$0.00	$0.00	$845.16	"$3,009.62"	"$3,009.62"	$0.00	$0.00	$845.06	$0.00	"$1,999.12"	"$1,999.12"	$0.00	"$2,027.50"	"$3,211.56"	"$3,244.00"	$0.00		$0.00	$634.61	$0.00	$0.00	$645.56	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1540L-S	SUP	HCPCS C1776		SH-1540L-S  -  STEM HUM 15MM MDLR BODY ASMBLY LEFT SHLDR STRL	BOTH IP/OP	"$5,910.00 "	"$4,373.40"	$0.00	"$4,728.00"	"$2,659.50"	"$2,659.50"	$0.00	$0.00	$0.00	"$1,231.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,231.64"	$0.00	"$2,913.63"	"$2,913.63"	$0.00	"$2,955.00"	"$4,680.72"	"$4,728.00"	$0.00		$0.00	$924.92	$0.00	$0.00	$940.87	$0.00	$0.00	$0.00	$0.00	$0.00
SH-1540R-S	SUP	HCPCS C1776		SH-1540R-S  -  STEM HUM 15MM MDLR BODY ASMBLY RIGHT SHLDR	BOTH IP/OP	"$5,910.00 "	"$4,373.40"	$0.00	"$4,728.00"	"$2,659.50"	"$2,659.50"	$0.00	$0.00	$0.00	"$1,231.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,231.64"	$0.00	"$2,913.63"	"$2,913.63"	$0.00	"$2,955.00"	"$4,680.72"	"$4,728.00"	$0.00		$0.00	$924.92	$0.00	$0.00	$940.87	$0.00	$0.00	$0.00	$0.00	$0.00
SH-3916-S	SUP	HCPCS C1776		SH-3916-S  -  HEAD HUM 39MM 16MM SHLDR MDLR PLRS STRL	BOTH IP/OP	"$3,462.50 "	"$2,562.25"	$0.00	"$2,770.00"	"$1,558.13"	"$1,558.13"	$0.00	$0.00	$0.00	$721.67	"$2,569.87"	"$2,569.87"	$0.00	$0.00	$721.59	$0.00	"$1,707.01"	"$1,707.01"	$0.00	"$1,731.25"	"$2,742.30"	"$2,770.00"	$0.00		$0.00	$541.88	$0.00	$0.00	$551.23	$0.00	$0.00	$0.00	$0.00	$0.00
SH-3920-S	SUP	HCPCS C1776		SH-3920-S  -  HEAD HUM 39MM 20MM SHLDR MDLR STRL	BOTH IP/OP	"$3,462.50 "	"$2,562.25"	$0.00	"$2,770.00"	"$1,558.13"	"$1,558.13"	$0.00	$0.00	$0.00	$721.67	"$2,569.87"	"$2,569.87"	$0.00	$0.00	$721.59	$0.00	"$1,707.01"	"$1,707.01"	$0.00	"$1,731.25"	"$2,742.30"	"$2,770.00"	$0.00		$0.00	$541.88	$0.00	$0.00	$551.23	$0.00	$0.00	$0.00	$0.00	$0.00
SH-4317-S	SUP	HCPCS C1776		SH-4317-S  -  HEAD HUM 43MM 17MM SHLDR TI	BOTH IP/OP	"$3,462.50 "	"$2,562.25"	$0.00	"$2,770.00"	"$1,558.13"	"$1,558.13"	$0.00	$0.00	$0.00	$721.67	"$2,569.87"	"$2,569.87"	$0.00	$0.00	$721.59	$0.00	"$1,707.01"	"$1,707.01"	$0.00	"$1,731.25"	"$2,742.30"	"$2,770.00"	$0.00		$0.00	$541.88	$0.00	$0.00	$551.23	$0.00	$0.00	$0.00	$0.00	$0.00
SH-4321-S	SUP	HCPCS C1776		SH-4321-S  -  HEAD HUM 21MM 43MM SHLDR	BOTH IP/OP	"$3,462.50 "	"$2,562.25"	$0.00	"$2,770.00"	"$1,558.13"	"$1,558.13"	$0.00	$0.00	$0.00	$721.67	"$2,569.87"	"$2,569.87"	$0.00	$0.00	$721.59	$0.00	"$1,707.01"	"$1,707.01"	$0.00	"$1,731.25"	"$2,742.30"	"$2,770.00"	$0.00		$0.00	$541.88	$0.00	$0.00	$551.23	$0.00	$0.00	$0.00	$0.00	$0.00
SH-4718-S	SUP	HCPCS C1776		SH-4718-S  -  HEAD HUM 47MM 18MM SHLDR PLRS TI	BOTH IP/OP	"$3,462.50 "	"$2,562.25"	$0.00	"$2,770.00"	"$1,558.13"	"$1,558.13"	$0.00	$0.00	$0.00	$721.67	"$2,569.87"	"$2,569.87"	$0.00	$0.00	$721.59	$0.00	"$1,707.01"	"$1,707.01"	$0.00	"$1,731.25"	"$2,742.30"	"$2,770.00"	$0.00		$0.00	$541.88	$0.00	$0.00	$551.23	$0.00	$0.00	$0.00	$0.00	$0.00
SH-4722-S	SUP	HCPCS C1776		SH-4722-S  -  HEAD HUM 47MM 22MM STRL MDLR SHLDR	BOTH IP/OP	"$3,462.50 "	"$2,562.25"	$0.00	"$2,770.00"	"$1,558.13"	"$1,558.13"	$0.00	$0.00	$0.00	$721.67	"$2,569.87"	"$2,569.87"	$0.00	$0.00	$721.59	$0.00	"$1,707.01"	"$1,707.01"	$0.00	"$1,731.25"	"$2,742.30"	"$2,770.00"	$0.00		$0.00	$541.88	$0.00	$0.00	$551.23	$0.00	$0.00	$0.00	$0.00	$0.00
SH-5119-S	SUP	HCPCS C1776		SH-5119-S  -  HEAD HUM 19MM 51MM SHLDR MDLR STRL	BOTH IP/OP	"$3,462.50 "	"$2,562.25"	$0.00	"$2,770.00"	"$1,558.13"	"$1,558.13"	$0.00	$0.00	$0.00	$721.67	"$2,569.87"	"$2,569.87"	$0.00	$0.00	$721.59	$0.00	"$1,707.01"	"$1,707.01"	$0.00	"$1,731.25"	"$2,742.30"	"$2,770.00"	$0.00		$0.00	$541.88	$0.00	$0.00	$551.23	$0.00	$0.00	$0.00	$0.00	$0.00
SH-5123-S	SUP	HCPCS C1776		SH-5123-S  -  HEAD HUM 51MM 23MM SHLDR MDLR PLRS	BOTH IP/OP	"$3,462.50 "	"$2,562.25"	$0.00	"$2,770.00"	"$1,558.13"	"$1,558.13"	$0.00	$0.00	$0.00	$721.67	"$2,569.87"	"$2,569.87"	$0.00	$0.00	$721.59	$0.00	"$1,707.01"	"$1,707.01"	$0.00	"$1,731.25"	"$2,742.30"	"$2,770.00"	$0.00		$0.00	$541.88	$0.00	$0.00	$551.23	$0.00	$0.00	$0.00	$0.00	$0.00
SH-R1307	SUP	Custom 27203010		SH-R1307  -  REAMER SURG 13MM 7MM SHLDR	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$0.00	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SH-R1308	SUP	Custom 27203010		SH-R1308  -  REAMER SURG 13MM 8MM SHLDR	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$0.00	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SH-R1309	SUP	Custom 27203010		SH-R1309  -  REAMER SURG 13MM 9MM SHLDR	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$0.00	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SH-R1310	SUP	Custom 27203010		SH-R1310  -  REAMER SURG 13MM 10MM SHLDR	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$0.00	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SH-R1311	SUP	Custom 27203010		SH-R1311  -  REAMER SURG 13MM 11MM SHLDR	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$0.00	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SH-R1312	SUP	Custom 27203010		SH-R1312  -  REAMER SURG 13MM 12MM SHLDR	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$0.00	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SH-R1313	SUP	Custom 27203010		SH-R1313  -  REAMER SURG 13MM 13MM SHLDR	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$0.00	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SH-R1514	SUP	Custom 27203010		SH-R1514  -  REAMER SURG 15MM 14MM SHLDR	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$0.00	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SH-R1515	SUP	Custom 27203010		SH-R1515  -  REAMER SURG 15MM 15MM SHLDR	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$0.00	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SH-R1716	SUP	Custom 27203010		SH-R1716  -  REAMER SURG 17MM 16MM SHLDR	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$0.00	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SH-R1717	SUP	Custom 27203010		SH-R1717  -  REAMER SURG 17MM 17MM SHLDR	BOTH IP/OP	$735.00 	$543.90	$0.00	$588.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.52	$545.52	$0.00	$0.00	$153.17	$0.00	$0.00	$0.00	$0.00	$367.50	$582.12	$588.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SIG-3616	SUP	Custom 25003010		ANTIBODY CA 19-9 PRF MNCLN LAB	BOTH IP/OP	"$1,827.50 "	"$1,352.35"	$0.00	"$1,462.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$913.75	"$1,447.38"	"$1,462.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SIG45CTAVM	SUP	Custom 27203010		SIG45CTAVM  -  RELOAD STPLR 2MM 2.5MM 3MM 45MM TN STRL LF EGIA ARTC KNF	BOTH IP/OP	"$3,073.20 "	"$2,274.17"	$0.00	"$2,458.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,536.60"	"$2,433.97"	"$2,458.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SILSPT12	SUP	Custom 27203010		SILSPT12  -  PORT ENDSCP 5MM 12MM FLEXIBLE CANNU OBTURATOR LATEX FREE	BOTH IP/OP	"$1,205.31 "	$891.93	$0.00	$964.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$894.58	$894.58	$0.00	$0.00	$251.19	$0.00	$0.00	$0.00	$0.00	$602.66	$954.61	$964.25	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SK-0480-C	SUP	Custom 27203010		STAIN KT COMBO 480 TST HISTOLGY	BOTH IP/OP	$106.25 	$78.63	$0.00	$85.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.13	$84.15	$85.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SK200	SUP	Custom 27203010		SK200  -  KIT VASC 175CM 2MM 2.3-3FR AGN MIC NTNL INTROD TRQ DEV CATH	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$0.00	$0.00	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SK400	SUP	Custom 27203010		SK400  -  SNARE VASC 175CM 4MM 2.3-3FR AGN MIC NTNL MCTH KIT 150CM	BOTH IP/OP	"$1,400.00 "	"$1,036.00"	$0.00	"$1,120.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,039.08"	"$1,039.08"	$0.00	$0.00	$291.76	$0.00	$0.00	$0.00	$0.00	$700.00	"$1,108.80"	"$1,120.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SMC-5060	SUP	Custom 27203010		SMC-5060  -  SHAFT SM 60MM FXTR BONE	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$0.00	$0.00	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SMC-5090	SUP	HCPCS C1713		SMC-5090  -  SCREW BONE 90MM SM SHFT FXTR	BOTH IP/OP	$205.00 	$151.70	$0.00	$164.00	$92.25	$92.25	$0.00	$0.00	$0.00	$42.73	$152.15	$152.15	$0.00	$0.00	$42.72	$0.00	$121.26	$121.26	$0.00	$102.50	$162.36	$164.00	$0.00		$0.00	$32.08	$0.00	$0.00	$32.64	$0.00	$0.00	$0.00	$0.00	$0.00
SMT-5060	SUP	Custom 27203010		SMT-5060  -  ROD EXFIX STABLELOC RADL SS SM BONE FIX SYS STRL	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$0.00	$0.00	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SMT-5090	SUP	Custom 27203010		SMT-5090  -  ROD EXFIX 90MM STABLELOC SS SM BONE FIX SYS STRL	BOTH IP/OP	$387.50 	$286.75	$0.00	$310.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.60	$287.60	$0.00	$0.00	$80.76	$0.00	$0.00	$0.00	$0.00	$193.75	$306.90	$310.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN 7016X	SUP	Custom 27203010		SN 7016X  -  DEVICE BIOP 10CM 14GA MNPTY 22MM INSTR AUTO STRL DISP	BOTH IP/OP	$85.00 	$62.90	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.50	$67.32	$68.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT	SUP	HCPCS V2632		SN60AT  -  LENS IOL 0D MOD L BCNVX 6MM 13MM STRL ACRSF N STABLEFORCE 1	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.060	SUP	HCPCS V2632		SN60AT.060  -  LENS IOL 0 D +6 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.070	SUP	HCPCS V2632		SN60AT.070  -  LENS IOL 0 D +7 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.075	SUP	HCPCS V2632		SN60AT.075  -  LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.080	SUP	HCPCS V2632		SN60AT.080  -  LENS IOL 0 D +8 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.085	SUP	HCPCS V2632		SN60AT.085  -  LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.090	SUP	HCPCS V2632		SN60AT.090  -  LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.095	SUP	HCPCS V2632		SN60AT.095  -  LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.100	SUP	HCPCS V2632		SN60AT.100  -  LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.105	SUP	HCPCS V2632		SN60AT.105  -  LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.110	SUP	HCPCS V2632		SN60AT.110  -  LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.115	SUP	HCPCS V2632		SN60AT.115  -  LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.120	SUP	HCPCS V2632		SN60AT.120  -  LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.125	SUP	HCPCS V2632		SN60AT.125  -  LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.130	SUP	HCPCS V2632		SN60AT.130  -  LENS IOL 0 D +13 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.135	SUP	HCPCS V2632		SN60AT.135  -  LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.140	SUP	HCPCS V2632		SN60AT.140  -  LENS IOL 0 D +14 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.145	SUP	HCPCS V2632		SN60AT.145  -  LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.150	SUP	HCPCS V2632		SN60AT.150  -  LENS IOL 0 D +15 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.155	SUP	HCPCS V2632		SN60AT.155  -  LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.160	SUP	HCPCS V2632		SN60AT.160  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.165	SUP	HCPCS V2632		SN60AT.165  -  LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.170	SUP	HCPCS V2632		SN60AT.170  -  LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.175	SUP	HCPCS V2632		SN60AT.175  -  LENS IOL 0 D +17.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.180	SUP	HCPCS V2632		SN60AT.180  -  LENS IOL 0 D +18 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.185	SUP	HCPCS V2632		SN60AT.185  -  LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.190	SUP	HCPCS V2632		SN60AT.190  -  LENS IOL 0 D +19 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.195	SUP	HCPCS V2632		SN60AT.195  -  LENS IOL 0 D +19.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.200	SUP	HCPCS V2632		SN60AT.200  -  LENS IOL 0 D +20 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.205	SUP	HCPCS V2632		SN60AT.205  -  LENS IOL 0 D +20.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.210	SUP	HCPCS V2632		SN60AT.210  -  LENS IOL 0 D +21 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.215	SUP	HCPCS V2632		SN60AT.215  -  LENS IOL 0 D +21.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.220	SUP	HCPCS V2632		SN60AT.220  -  LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.225	SUP	HCPCS V2632		SN60AT.225  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.230	SUP	HCPCS V2632		SN60AT.230  -  LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.235	SUP	HCPCS V2632		SN60AT.235  -  LENS IOL 0 D +23.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.240	SUP	HCPCS V2632		SN60AT.240  -  LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.245	SUP	HCPCS V2632		SN60AT.245  -  LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.250	SUP	HCPCS V2632		SN60AT.250  -  LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.255	SUP	HCPCS V2632		SN60AT.255  -  LENS IOL 0 D +25.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.260	SUP	HCPCS V2632		SN60AT.260  -  LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.265	SUP	HCPCS V2632		SN60AT.265  -  LENS IOL 0 D +26.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.270	SUP	HCPCS V2632		SN60AT.270  -  LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.275	SUP	HCPCS V2632		SN60AT.275  -  LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.280	SUP	HCPCS V2632		SN60AT.280  -  LENS IOL 0 D +28 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.285	SUP	HCPCS V2632		SN60AT.285  -  LENS IOL 0 D +28.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.295	SUP	HCPCS V2632		SN60AT.295  -  LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.300	SUP	HCPCS V2632		SN60AT.300  -  LENS IOL 0 D +30 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.310	SUP	HCPCS V2632		SN60AT.310  -  LENS IOL 0 D +31 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.320	SUP	HCPCS V2632		SN60AT.320  -  LENS IOL 0 D +32 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.330	SUP	HCPCS V2632		SN60AT.330  -  LENS IOL 0 D +33 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.340	SUP	HCPCS V2632		SN60AT.340  -  LENS IOL 0 D +34 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.350	SUP	HCPCS V2632		SN60AT.350  -  LENS IOL 0 D +35 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.360	SUP	HCPCS V2632		SN60AT.360  -  LENS IOL 0 D +36 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.370	SUP	HCPCS V2632		SN60AT.370  -  LENS IOL 0 D +37 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.380	SUP	HCPCS V2632		SN60AT.380  -  LENS IOL 0 D +38 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.390	SUP	HCPCS V2632		SN60AT.390  -  LENS IOL 0 D +39 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60AT.400	SUP	HCPCS V2632		SN60AT.400  -  LENS IOL 0 D +40 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N	BOTH IP/OP	$472.50 	$349.65	$0.00	$378.00	$212.63	$212.63	$0.00	$0.00	$0.00	$98.48	$350.69	$350.69	$0.00	$0.00	$98.47	$0.00	$279.48	$279.48	$0.00	$236.25	$374.22	$378.00	$0.00		$0.00	$73.95	$0.00	$0.00	$75.22	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF	SUP	HCPCS V2632		SN60WF  -  LENS IOL 0D MOD L BCNVX 6MM 13MM STRL ACRSF IQ 1 PC FLD ANT	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.065	SUP	HCPCS V2632		SN60WF.065  -  LENS IOL 0 D +6.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.075	SUP	HCPCS V2632		SN60WF.075  -  LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.085	SUP	HCPCS V2632		SN60WF.085  -  LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.090	SUP	HCPCS V2632		SN60WF.090  -  LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.095	SUP	HCPCS V2632		SN60WF.095  -  LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.100	SUP	HCPCS V2632		SN60WF.100  -  LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.105	SUP	HCPCS V2632		SN60WF.105  -  LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.110	SUP	HCPCS V2632		SN60WF.110  -  LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.115	SUP	HCPCS V2632		SN60WF.115  -  LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.120	SUP	HCPCS V2632		SN60WF.120  -  LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.125	SUP	HCPCS V2632		SN60WF.125  -  LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.135	SUP	HCPCS V2632		SN60WF.135  -  LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.145	SUP	HCPCS V2632		SN60WF.145  -  LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.155	SUP	HCPCS V2632		SN60WF.155  -  LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.160	SUP	HCPCS V2632		SN60WF.160  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.165	SUP	HCPCS V2632		SN60WF.165  -  LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.170	SUP	HCPCS V2632		SN60WF.170  -  LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.185	SUP	HCPCS V2632		SN60WF.185  -  LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.215	SUP	HCPCS V2632		SN60WF.215  -  LENS IOL 0 D +21.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.220	SUP	HCPCS V2632		SN60WF.220  -  LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.225	SUP	HCPCS V2632		SN60WF.225  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.230	SUP	HCPCS V2632		SN60WF.230  -  LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.240	SUP	HCPCS V2632		SN60WF.240  -  LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.245	SUP	HCPCS V2632		SN60WF.245  -  LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.250	SUP	HCPCS V2632		SN60WF.250  -  LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.260	SUP	HCPCS V2632		SN60WF.260  -  LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.270	SUP	HCPCS V2632		SN60WF.270  -  LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.275	SUP	HCPCS V2632		SN60WF.275  -  LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.280	SUP	HCPCS V2632		SN60WF.280  -  LENS IOL 0 D +28 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.290	SUP	HCPCS V2632		SN60WF.290  -  LENS IOL 0 D +29 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.295	SUP	HCPCS V2632		SN60WF.295  -  LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WF.300	SUP	HCPCS V2632		SN60WF.300  -  LENS IOL 0 D +30 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS	SUP	HCPCS V2632		SN60WS  -  LENS IOL 0D BCNVX 6MM 13MM STRL ACRSF IQ NTR STABLEFORCE	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.060	SUP	HCPCS V2632		SN60WS.060  -  LENS IOL 0 D +6 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.065	SUP	HCPCS V2632		SN60WS.065  -  LENS IOL 0 D +6.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.070	SUP	HCPCS V2632		SN60WS.070  -  LENS IOL 0 D +7 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.075	SUP	HCPCS V2632		SN60WS.075  -  LENS IOL 0 D +7.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.080	SUP	HCPCS V2632		SN60WS.080  -  LENS IOL 0 D +8 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.085	SUP	HCPCS V2632		SN60WS.085  -  LENS IOL 0 D +8.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.090	SUP	HCPCS V2632		SN60WS.090  -  LENS IOL 0 D +9 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.095	SUP	HCPCS V2632		SN60WS.095  -  LENS IOL 0 D +9.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.100	SUP	HCPCS V2632		SN60WS.100  -  LENS IOL 0 D +10 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.105	SUP	HCPCS V2632		SN60WS.105  -  LENS IOL 0 D +10.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.110	SUP	HCPCS V2632		SN60WS.110  -  LENS IOL 0 D +11 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.115	SUP	HCPCS V2632		SN60WS.115  -  LENS IOL 0 D +11.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.120	SUP	HCPCS V2632		SN60WS.120  -  LENS IOL 0 D +12 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.125	SUP	HCPCS V2632		SN60WS.125  -  LENS IOL 0 D +12.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.130	SUP	HCPCS V2632		SN60WS.130  -  LENS IOL 0 D +13 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.135	SUP	HCPCS V2632		SN60WS.135  -  LENS IOL 0 D +13.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.140	SUP	HCPCS V2632		SN60WS.140  -  LENS IOL 0 D +14 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.145	SUP	HCPCS V2632		SN60WS.145  -  LENS IOL 0 D +14.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.150	SUP	HCPCS V2632		SN60WS.150  -  LENS IOL 0 D +15 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.155	SUP	HCPCS V2632		SN60WS.155  -  LENS IOL 0 D +15.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.160	SUP	HCPCS V2632		SN60WS.160  -  LENS IOL 0 D +16 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.165	SUP	HCPCS V2632		SN60WS.165  -  LENS IOL 0 D +16.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.170	SUP	HCPCS V2632		SN60WS.170  -  LENS IOL 0 D +17 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.175	SUP	HCPCS V2632		SN60WS.175  -  LENS IOL 0 D +17.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.180	SUP	HCPCS V2632		SN60WS.180  -  LENS IOL 0 D +18 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.185	SUP	HCPCS V2632		SN60WS.185  -  LENS IOL 0 D +18.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.190	SUP	HCPCS V2632		SN60WS.190  -  LENS IOL 0 D +19 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.195	SUP	HCPCS V2632		SN60WS.195  -  LENS IOL 0 D +19.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.200	SUP	HCPCS V2632		SN60WS.200  -  LENS IOL 0 D +20 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.205	SUP	HCPCS V2632		SN60WS.205  -  LENS IOL 0 D +20.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.210	SUP	HCPCS V2632		SN60WS.210  -  LENS IOL 0 D +21 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.215	SUP	HCPCS V2632		SN60WS.215  -  LENS IOL 0 D +21.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.220	SUP	HCPCS V2632		SN60WS.220  -  LENS IOL 0 D +22 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.225	SUP	HCPCS V2632		SN60WS.225  -  LENS IOL 0 D +22.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.230	SUP	HCPCS V2632		SN60WS.230  -  LENS IOL 0 D +23 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.235	SUP	HCPCS V2632		SN60WS.235  -  LENS IOL 0 D +23.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.240	SUP	HCPCS V2632		SN60WS.240  -  LENS IOL 0 D +24 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.245	SUP	HCPCS V2632		SN60WS.245  -  LENS IOL 0 D +24.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.250	SUP	HCPCS V2632		SN60WS.250  -  LENS IOL 0 D +25 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.255	SUP	HCPCS V2632		SN60WS.255  -  LENS IOL 0 D +25.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.260	SUP	HCPCS V2632		SN60WS.260  -  LENS IOL 0 D +26 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.265	SUP	HCPCS V2632		SN60WS.265  -  LENS IOL 0 D +26.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.270	SUP	HCPCS V2632		SN60WS.270  -  LENS IOL 0 D +27 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.275	SUP	HCPCS V2632		SN60WS.275  -  LENS IOL 0 D +27.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.280	SUP	HCPCS V2632		SN60WS.280  -  LENS IOL 0 D +28 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.285	SUP	HCPCS V2632		SN60WS.285  -  LENS IOL 0 D +28.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.290	SUP	HCPCS V2632		SN60WS.290  -  LENS IOL 0 D +29 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.295	SUP	HCPCS V2632		SN60WS.295  -  LENS IOL 0 D +29.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN60WS.300	SUP	HCPCS V2632		SN60WS.300  -  LENS IOL 0 D +30 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR	BOTH IP/OP	"$1,202.50 "	$889.85	$0.00	$962.00	$541.13	$541.13	$0.00	$0.00	$0.00	$250.63	$892.50	$892.50	$0.00	$0.00	$250.60	$0.00	$711.28	$711.28	$0.00	$601.25	$952.38	$962.00	$0.00		$0.00	$188.19	$0.00	$0.00	$191.44	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT3.150	SUP	HCPCS V2787		SN6AT3.150  -  DRILL SRG 2.1MM 110MM CNN TI	BOTH IP/OP	$995.00 	$736.30	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$738.49	$738.49	$0.00	$0.00	$207.36	$0.00	$0.00	$0.00	$0.00	$497.50	$788.04	$796.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT3.210	SUP	HCPCS V2787		SN6AT3.210  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT3.215	SUP	HCPCS V2787		SN6AT3.215  -  LENS IOL 0 D +21.5 DIOP +1.5 CYL BCNVX 6MM 13MM STRL ACRSF	BOTH IP/OP	$995.00 	$736.30	$0.00	$796.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$738.49	$738.49	$0.00	$0.00	$207.36	$0.00	$0.00	$0.00	$0.00	$497.50	$788.04	$796.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT5.145	SUP	HCPCS V2632		SN6AT5.145  -  LENS IOL 0 D +14.5 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$310.03	"$1,104.02"	"$1,104.02"	$0.00	$0.00	$310.00	$0.00	$879.86	$879.86	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT5.150	SUP	HCPCS V2632		SN6AT5.150  -  LENS IOL 0 D +15 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	"$1,487.50 "	"$1,100.75"	$0.00	"$1,190.00"	$669.38	$669.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$743.75	"$1,178.10"	"$1,190.00"	$0.00		$0.00	$232.79	$0.00	$0.00	$236.81	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT5.165	SUP	HCPCS V2787		SN6AT5.165  -  LENS IOL 0 D +16.5 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT5.185	SUP	HCPCS V2787		SN6AT5.185  -  LENS IOL 0 D +18.5 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT5.220	SUP	HCPCS V2787		SN6AT5.220  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT5.225	SUP	HCPCS V2787		SN6AT5.225  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT6.175	SUP	HCPCS V2787		SN6AT6.175  -  LENS IOL 0 D +17.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT6.195	SUP	HCPCS V2632		SN6AT6.195  -  LENS IOL 0 D +19.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT6.205	SUP	HCPCS V2632		SN6AT6.205  -  LENS IOL 0 D +20.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT6.215	SUP	HCPCS V2787		SN6AT6.215  -  LENS IOL 0 D +21.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT6.245	SUP	HCPCS V2632		SN6AT6.245  -  LENS IOL 0 D +24.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT6.250	SUP	HCPCS V2632		SN6AT6.250  -  LENS IOL +25 DIOPTER +3.75 CYLINDER 0 D BICNVX 6MM 13MM 1	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$257.93	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$731.98	$731.98	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT7.115	SUP	HCPCS V2632		SN6AT7.115  -  LENS IOL 0 D +11.5 DIOP +4.5 CYL BCNVX 6MM 13MM STRL ACRSF	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT7.205	SUP	HCPCS V2632		SN6AT7.205  -  LENS IOL 0 D +20.5 DIOP +4.5 CYL BCNVX 6MM 13MM STRL ACRSF	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$556.88	$556.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$193.67	$0.00	$0.00	$197.01	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT7U230	SUP	HCPCS V2787		SN6AT7U230  -  LENS IOL 0 D +23 DIOP +4.5 CYL BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT8.160	SUP	HCPCS V2787		SN6AT8.160  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT8U150	SUP	HCPCS V2787		SN6AT8U150  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE ACRYLIC 0 D +1	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT9.165	SUP	HCPCS V2787		SN6AT9.165  -  LENS IOL 0 D +16.5 DIOP +6 CYL BICNVX 13MM 6MM	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT9.170	SUP	HCPCS V2787		SN6AT9.170  -  LENS IOL 0 D +17 DIOP +6 CYL BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	"$1,237.50 "	$915.75	$0.00	$990.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.47	$918.47	$0.00	$0.00	$257.90	$0.00	$0.00	$0.00	$0.00	$618.75	$980.10	$990.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SN6AT9U210	SUP	HCPCS V2632		SN6AT9U210  -  LENS IOL 0 D +21 DIOP +6 CYL BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$995.00 	$736.30	$0.00	$796.00	$447.75	$447.75	$0.00	$0.00	$0.00	$207.38	$738.49	$738.49	$0.00	$0.00	$207.36	$0.00	$588.54	$588.54	$0.00	$497.50	$788.04	$796.00	$0.00		$0.00	$155.72	$0.00	$0.00	$158.40	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS	SUP	HCPCS V2632		SN6CWS  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.060	SUP	HCPCS V2632		SN6CWS.060  -  LENS IOL 0 D +6 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.065	SUP	HCPCS V2632		SN6CWS.065  -  LENS IOL 0 D +6.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.070	SUP	HCPCS V2632		SN6CWS.070  -  LENS IOL 0 D +7 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.075	SUP	HCPCS V2632		SN6CWS.075  -  LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.080	SUP	HCPCS V2632		SN6CWS.080  -  LENS IOL 0 D +8 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.085	SUP	HCPCS V2632		SN6CWS.085  -  LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.090	SUP	HCPCS V2632		SN6CWS.090  -  LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.095	SUP	HCPCS V2632		SN6CWS.095  -  LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.100	SUP	HCPCS V2632		SN6CWS.100  -  LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.105	SUP	HCPCS V2632		SN6CWS.105  -  LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.110	SUP	HCPCS V2632		SN6CWS.110  -  LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.115	SUP	HCPCS V2632		SN6CWS.115  -  LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.120	SUP	HCPCS V2632		SN6CWS.120  -  LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.125	SUP	HCPCS V2632		SN6CWS.125  -  LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.130	SUP	HCPCS V2632		SN6CWS.130  -  LENS IOL 0 D +13 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.135	SUP	HCPCS V2632		SN6CWS.135  -  LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.140	SUP	HCPCS V2632		SN6CWS.140  -  LENS IOL 0 D +14 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.145	SUP	HCPCS V2632		SN6CWS.145  -  LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.150	SUP	HCPCS V2632		SN6CWS.150  -  LENS IOL 0 D +15 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.155	SUP	HCPCS V2632		SN6CWS.155  -  LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.160	SUP	HCPCS V2632		SN6CWS.160  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.165	SUP	HCPCS V2632		SN6CWS.165  -  LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.170	SUP	HCPCS V2632		SN6CWS.170  -  LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.175	SUP	HCPCS V2632		SN6CWS.175  -  LENS IOL 0 D +17.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.180	SUP	HCPCS V2632		SN6CWS.180  -  LENS IOL 0 D +18 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.185	SUP	HCPCS V2632		SN6CWS.185  -  LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.190	SUP	HCPCS V2632		SN6CWS.190  -  LENS IOL 0 D +19 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.195	SUP	HCPCS V2632		SN6CWS.195  -  LENS IOL 0 D +19.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.200	SUP	HCPCS V2632		SN6CWS.200  -  LENS IOL 0 D +20 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.205	SUP	HCPCS V2632		SN6CWS.205  -  LENS IOL 0 D +20.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.210	SUP	HCPCS V2632		SN6CWS.210  -  LENS IOL 0 D +21 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.215	SUP	HCPCS V2632		SN6CWS.215  -  LENS IOL 0 D +21.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.220	SUP	HCPCS V2632		SN6CWS.220  -  LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.225	SUP	HCPCS V2632		SN6CWS.225  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.230	SUP	HCPCS V2632		SN6CWS.230  -  LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.235	SUP	HCPCS V2632		SN6CWS.235  -  LENS IOL 0 D +23.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.240	SUP	HCPCS V2632		SN6CWS.240  -  LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.245	SUP	HCPCS V2632		SN6CWS.245  -  LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.250	SUP	HCPCS V2632		SN6CWS.250  -  LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.255	SUP	HCPCS V2632		SN6CWS.255  -  LENS IOL 0 D +25.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.260	SUP	HCPCS V2632		SN6CWS.260  -  LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.265	SUP	HCPCS V2632		SN6CWS.265  -  LENS IOL 0 D +26.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.270	SUP	HCPCS V2632		SN6CWS.270  -  LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.275	SUP	HCPCS V2632		SN6CWS.275  -  LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.280	SUP	HCPCS V2632		SN6CWS.280  -  LENS IOL 0 D +28 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.295	SUP	HCPCS V2632		SN6CWS.295  -  LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SN6CWS.300	SUP	HCPCS V2632		SN6CWS.300  -  LENS IOL 0 D +30 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ	BOTH IP/OP	$397.50 	$294.15	$0.00	$318.00	$178.88	$178.88	$0.00	$0.00	$0.00	$82.85	$295.02	$295.02	$0.00	$0.00	$82.84	$0.00	$235.12	$235.12	$0.00	$198.75	$314.82	$318.00	$0.00		$0.00	$62.21	$0.00	$0.00	$63.28	$0.00	$0.00	$0.00	$0.00	$0.00
SOFT33	SUP	Custom 27203010		SOFT33  -  INSERT CLMP 33MM SOFTJAW SET ATRAUMATIC OCCLUSION HIGH FLOW	BOTH IP/OP	$32.50 	$24.05	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.12	$24.12	$0.00	$0.00	$6.77	$0.00	$0.00	$0.00	$0.00	$16.25	$25.74	$26.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SOFT61	SUP	Custom 27203010		SOFT61  -  INSERT CLMP 61MM SOFTJAW SET ATRAUMATIC OCCLUSION HIGH FLOW	BOTH IP/OP	$37.50 	$27.75	$0.00	$30.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.83	$27.83	$0.00	$0.00	$7.82	$0.00	$0.00	$0.00	$0.00	$18.75	$29.70	$30.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SOFT86	SUP	Custom 27203010		SOFT86  -  INSERT CLMP FGRTY SFJW 86MM ATRM OCL HFLO RBR STRL LATEX	BOTH IP/OP	$40.00 	$29.60	$0.00	$29.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$29.69	$0.00	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$16.38	$25.94	$26.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SP-1863	SUP	HCPCS C1713		SP-1863  -  COVER BURR HOLE 18.5MM SLOT TEFLON PI	BOTH IP/OP	$835.00 	$617.90	$0.00	$668.00	$375.75	$375.75	$0.00	$0.00	$0.00	$174.03	$619.74	$619.74	$0.00	$0.00	$174.01	$0.00	$493.90	$493.90	$0.00	$417.50	$661.32	$668.00	$0.00		$0.00	$130.68	$0.00	$0.00	$132.93	$0.00	$0.00	$0.00	$0.00	$0.00
SP-1864	SUP	HCPCS C1713		SP-1864  -  PLATE BONE 26MM 2X4 HOLE MATRIX ORAL CRANIOMAXILLOFACIAL	BOTH IP/OP	$870.00 	$643.80	$0.00	$696.00	$391.50	$391.50	$0.00	$0.00	$0.00	$181.33	$645.71	$645.71	$0.00	$0.00	$181.31	$0.00	$514.61	$514.61	$0.00	$435.00	$689.04	$696.00	$0.00		$0.00	$136.16	$0.00	$0.00	$138.50	$0.00	$0.00	$0.00	$0.00	$0.00
SP-1865	SUP	HCPCS C1713		SP-1865  -  MESH CRNL .2MM NS LORENZ TRAUMAONE MDFC ORBT FLR 1.5MM SCR	BOTH IP/OP	"$3,670.00 "	"$2,715.80"	$0.00	"$2,936.00"	"$1,651.50"	"$1,651.50"	$0.00	$0.00	$0.00	$764.92	"$2,723.87"	"$2,723.87"	$0.00	$0.00	$764.83	$0.00	"$1,809.31"	"$1,809.31"	$0.00	"$1,835.00"	"$2,906.64"	"$2,936.00"	$0.00		$0.00	$574.36	$0.00	$0.00	$584.26	$0.00	$0.00	$0.00	$0.00	$0.00
SP-1889	SUP	Custom 27203010		SP-1889  -  BLADE SURG 7X2MM REDX	BOTH IP/OP	$757.50 	$560.55	$0.00	$606.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.22	$562.22	$0.00	$0.00	$157.86	$0.00	$0.00	$0.00	$0.00	$378.75	$599.94	$606.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SP-1942	SUP	HCPCS C1713		SP-1942  -  PLATE SHUNT MEDIUM 18.5MM SPECIALTY X-DRIVE THINFLAP	BOTH IP/OP	$847.50 	$627.15	$0.00	$678.00	$381.38	$381.38	$0.00	$0.00	$0.00	$176.64	$629.01	$629.01	$0.00	$0.00	$176.62	$0.00	$501.30	$501.30	$0.00	$423.75	$671.22	$678.00	$0.00		$0.00	$132.63	$0.00	$0.00	$134.92	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2032	SUP	HCPCS C1713		SP-2032  -  SCREW BONE 2.5MM 6MM SLFDRILL REDX BLADE BYRD LORENZ	BOTH IP/OP	"$1,032.50 "	$764.05	$0.00	$826.00	$464.63	$464.63	$0.00	$0.00	$0.00	$215.20	$766.32	$766.32	$0.00	$0.00	$215.17	$0.00	$610.72	$610.72	$0.00	$516.25	$817.74	$826.00	$0.00		$0.00	$161.59	$0.00	$0.00	$164.37	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2256	SUP	HCPCS C1713		SP-2256  -  PLATE BONE 1MM SPECIALTY TRAUMAONE MANDIB	BOTH IP/OP	"$1,847.50 "	"$1,367.15"	$0.00	"$1,478.00"	$831.38	$831.38	$0.00	$0.00	$0.00	$385.07	"$1,371.21"	"$1,371.21"	$0.00	$0.00	$385.02	$0.00	"$1,092.80"	"$1,092.80"	$0.00	$923.75	"$1,463.22"	"$1,478.00"	$0.00		$0.00	$289.13	$0.00	$0.00	$294.12	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2258	SUP	Custom 27203010		SP-2258  -  TAP SURG 2.3MM	BOTH IP/OP	"$1,592.50 "	"$1,178.45"	$0.00	"$1,274.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,181.95"	"$1,181.95"	$0.00	$0.00	$331.88	$0.00	$0.00	$0.00	$0.00	$796.25	"$1,261.26"	"$1,274.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2276	SUP	HCPCS C1713		SP-2276  -  PLATE BONE THK2.6MM SMALL SPECIALTY SYSTEM LORENZ	BOTH IP/OP	"$9,147.50 "	"$6,769.15"	$0.00	"$7,318.00"	"$4,116.38"	"$4,116.38"	$0.00	$0.00	$0.00	"$1,906.57"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,906.34"	$0.00	"$4,509.72"	"$4,509.72"	$0.00	"$4,573.75"	"$7,244.82"	"$7,318.00"	$0.00		$0.00	"$1,431.58"	$0.00	$0.00	"$1,456.28"	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2277	SUP	HCPCS C1713		SP-2277  -  PLATE BONE THK2.6MM MEDIUM SPECIALTY SYSTEM LORENZ	BOTH IP/OP	"$9,945.00 "	"$7,359.30"	$0.00	"$7,956.00"	"$4,475.25"	"$4,475.25"	$0.00	$0.00	$0.00	"$2,072.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,072.54"	$0.00	"$4,902.89"	"$4,902.89"	$0.00	"$4,972.50"	"$7,876.44"	"$7,956.00"	$0.00		$0.00	"$1,556.39"	$0.00	$0.00	"$1,583.24"	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2284	SUP	HCPCS C1713		SP-2284  -  PLATE BONE 1MM 4 HOLE STR LORENZ TRAUMAONE TITANIUM MANDIB	BOTH IP/OP	"$1,582.50 "	"$1,171.05"	$0.00	"$1,266.00"	$712.13	$712.13	$0.00	$0.00	$0.00	$329.83	"$1,174.53"	"$1,174.53"	$0.00	$0.00	$329.79	$0.00	$936.05	$936.05	$0.00	$791.25	"$1,253.34"	"$1,266.00"	$0.00		$0.00	$247.66	$0.00	$0.00	$251.93	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2292	SUP	HCPCS C1713		SP-2292  -  PLATE BONE 2MM SPECIALTY TRAUMAONE MANDIB	BOTH IP/OP	"$2,492.50 "	"$1,844.45"	$0.00	"$1,994.00"	"$1,121.63"	"$1,121.63"	$0.00	$0.00	$0.00	$519.50	"$1,849.93"	"$1,849.93"	$0.00	$0.00	$519.44	$0.00	"$1,474.31"	"$1,474.31"	$0.00	"$1,246.25"	"$1,974.06"	"$1,994.00"	$0.00		$0.00	$390.08	$0.00	$0.00	$396.81	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2371	SUP	HCPCS C1713		SP-2371  -  PLATE BONE SPECIALTY LORENZ MIDFAC	BOTH IP/OP	$910.00 	$673.40	$0.00	$728.00	$409.50	$409.50	$0.00	$0.00	$0.00	$189.67	$675.40	$675.40	$0.00	$0.00	$189.64	$0.00	$538.27	$538.27	$0.00	$455.00	$720.72	$728.00	$0.00		$0.00	$142.42	$0.00	$0.00	$144.87	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2375	SUP	HCPCS C1713		SP-2375  -  PLATE BONE 1MM LORENZ MANDIB	BOTH IP/OP	"$1,677.50 "	"$1,241.35"	$0.00	"$1,342.00"	$754.88	$754.88	$0.00	$0.00	$0.00	$349.63	"$1,245.04"	"$1,245.04"	$0.00	$0.00	$349.59	$0.00	$992.24	$992.24	$0.00	$838.75	"$1,328.58"	"$1,342.00"	$0.00		$0.00	$262.53	$0.00	$0.00	$267.06	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2376	SUP	HCPCS C1713		SP-2376  -  PLATE BONE 1MM LORENZ MANDIB	BOTH IP/OP	"$1,677.50 "	"$1,241.35"	$0.00	"$1,342.00"	$754.88	$754.88	$0.00	$0.00	$0.00	$349.63	"$1,245.04"	"$1,245.04"	$0.00	$0.00	$349.59	$0.00	$992.24	$992.24	$0.00	$838.75	"$1,328.58"	"$1,342.00"	$0.00		$0.00	$262.53	$0.00	$0.00	$267.06	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2377	SUP	HCPCS C1713		SP-2377  -  PLATE BONE 2MM LORENZ TRAUMAONE MIDFAC	BOTH IP/OP	"$2,450.00 "	"$1,813.00"	$0.00	"$1,960.00"	"$1,102.50"	"$1,102.50"	$0.00	$0.00	$0.00	$510.64	"$1,818.39"	"$1,818.39"	$0.00	$0.00	$510.58	$0.00	"$1,449.18"	"$1,449.18"	$0.00	"$1,225.00"	"$1,940.40"	"$1,960.00"	$0.00		$0.00	$383.43	$0.00	$0.00	$390.04	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2465	SUP	HCPCS C1713		SP-2465  -  PLATE BONE THK1.6MM LONG Y GRADE II TRAUMAONE LORENZ GOLD	BOTH IP/OP	"$2,017.50 "	"$1,492.95"	$0.00	"$1,614.00"	$907.88	$907.88	$0.00	$0.00	$0.00	$420.50	"$1,497.39"	"$1,497.39"	$0.00	$0.00	$420.45	$0.00	"$1,193.35"	"$1,193.35"	$0.00	"$1,008.75"	"$1,597.86"	"$1,614.00"	$0.00		$0.00	$315.74	$0.00	$0.00	$321.19	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2467	SUP	HCPCS C1713		SP-2467  -  PLATE BONE THK2.6MM SMALL STR ANGLED LORENZ MAGENTA MANDIB	BOTH IP/OP	"$4,520.00 "	"$3,344.80"	$0.00	"$3,616.00"	"$2,034.00"	"$2,034.00"	$0.00	$0.00	$0.00	$942.08	"$3,354.74"	"$3,354.74"	$0.00	$0.00	$941.97	$0.00	"$2,228.36"	"$2,228.36"	$0.00	"$2,260.00"	"$3,579.84"	"$3,616.00"	$0.00		$0.00	$707.38	$0.00	$0.00	$719.58	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2468	SUP	HCPCS C1713		SP-2468  -  PLATE BONE THK2.6MM 7 HOLE TRAUMAONE LORENZ MAGENTA MANDIB	BOTH IP/OP	"$4,075.00 "	"$3,015.50"	$0.00	"$3,260.00"	"$1,833.75"	"$1,833.75"	$0.00	$0.00	$0.00	$849.33	"$3,024.47"	"$3,024.47"	$0.00	$0.00	$849.23	$0.00	"$2,008.98"	"$2,008.98"	$0.00	"$2,037.50"	"$3,227.40"	"$3,260.00"	$0.00		$0.00	$637.74	$0.00	$0.00	$648.74	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2469	SUP	HCPCS C1713		SP-2469  -  PLATE BONE THK2.6MM 16 HOLE STR TRAUMAONE LORENZ MAGENTA	BOTH IP/OP	"$6,870.00 "	"$5,083.80"	$0.00	"$5,496.00"	"$3,091.50"	"$3,091.50"	$0.00	$0.00	$0.00	"$1,431.88"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,431.71"	$0.00	"$3,386.91"	"$3,386.91"	$0.00	"$3,435.00"	"$5,441.04"	"$5,496.00"	$0.00		$0.00	"$1,075.16"	$0.00	$0.00	"$1,093.70"	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2470	SUP	HCPCS C1713		SP-2470  -  PLATE BONE THK2.6MM SMALL 7 HOLE CVD LORENZ MAGENTA MANDIB	BOTH IP/OP	"$4,075.00 "	"$3,015.50"	$0.00	"$3,260.00"	"$1,833.75"	"$1,833.75"	$0.00	$0.00	$0.00	$849.33	"$3,024.47"	"$3,024.47"	$0.00	$0.00	$849.23	$0.00	"$2,008.98"	"$2,008.98"	$0.00	"$2,037.50"	"$3,227.40"	"$3,260.00"	$0.00		$0.00	$637.74	$0.00	$0.00	$648.74	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2472	SUP	HCPCS C1713		SP-2472  -  PLATE BONE L CRNMXF LEFT 8X10 HOLE XRIGID 1.5/1MM	BOTH IP/OP	$737.50 	$545.75	$0.00	$590.00	$331.88	$331.88	$0.00	$0.00	$0.00	$153.71	$547.37	$547.37	$0.00	$0.00	$153.70	$0.00	$436.23	$436.23	$0.00	$368.75	$584.10	$590.00	$0.00		$0.00	$115.42	$0.00	$0.00	$117.41	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2473	SUP	HCPCS C1713		SP-2473  -  PLATE BN L 8X10 HL XRIGID CRNMXF RT 1.5/1MM SCR	BOTH IP/OP	"$1,242.50 "	$919.45	$0.00	$994.00	$559.13	$559.13	$0.00	$0.00	$0.00	$258.97	$922.18	$922.18	$0.00	$0.00	$258.94	$0.00	$734.94	$734.94	$0.00	$621.25	$984.06	$994.00	$0.00		$0.00	$194.45	$0.00	$0.00	$197.81	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2526	SUP	HCPCS C1713		SP-2526  -  PLATE BONE CURVE CRNMXF 5 HOLE 1MM SCR	BOTH IP/OP	"$2,892.50 "	"$2,140.45"	$0.00	"$2,314.00"	"$1,301.63"	"$1,301.63"	$0.00	$0.00	$0.00	$602.87	"$2,146.81"	"$2,146.81"	$0.00	$0.00	$602.80	$0.00	"$1,426.00"	"$1,426.00"	$0.00	"$1,446.25"	"$2,290.86"	"$2,314.00"	$0.00		$0.00	$452.68	$0.00	$0.00	$460.49	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2566	SUP	HCPCS C1713		SP-2566  -  PLATE BONE STR 2MM 6 HOLE TRAUMAONE BLUE TITANIUM MANDIB	BOTH IP/OP	"$2,290.00 "	"$1,694.60"	$0.00	"$1,832.00"	"$1,030.50"	"$1,030.50"	$0.00	$0.00	$0.00	$477.29	"$1,699.64"	"$1,699.64"	$0.00	$0.00	$477.24	$0.00	"$1,354.54"	"$1,354.54"	$0.00	"$1,145.00"	"$1,813.68"	"$1,832.00"	$0.00		$0.00	$358.39	$0.00	$0.00	$364.57	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2575	SUP	HCPCS C1713		SP-2575  -  PLATE BONE 100D MEDIUM 3X3 HOLE L RIGID TRAUMAONE LORENZ	BOTH IP/OP	$877.50 	$649.35	$0.00	$702.00	$394.88	$394.88	$0.00	$0.00	$0.00	$182.89	$651.28	$651.28	$0.00	$0.00	$182.87	$0.00	$519.04	$519.04	$0.00	$438.75	$694.98	$702.00	$0.00		$0.00	$137.33	$0.00	$0.00	$139.70	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2576	SUP	HCPCS C1713		SP-2576  -  PLATE BONE 100D MEDIUM 3X3 HOLE L RIGID TRAUMAONE LORENZ	BOTH IP/OP	$877.50 	$649.35	$0.00	$702.00	$394.88	$394.88	$0.00	$0.00	$0.00	$182.89	$651.28	$651.28	$0.00	$0.00	$182.87	$0.00	$519.04	$519.04	$0.00	$438.75	$694.98	$702.00	$0.00		$0.00	$137.33	$0.00	$0.00	$139.70	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2585	SUP	HCPCS C1713		SP-2585  -  PLATE .6MM MANDIB 4 HOLE STR 2/2.3MM SCR BONE	BOTH IP/OP	"$1,817.50 "	"$1,344.95"	$0.00	"$1,454.00"	$817.88	$817.88	$0.00	$0.00	$0.00	$378.81	"$1,348.95"	"$1,348.95"	$0.00	$0.00	$378.77	$0.00	"$1,075.05"	"$1,075.05"	$0.00	$908.75	"$1,439.46"	"$1,454.00"	$0.00		$0.00	$284.44	$0.00	$0.00	$289.35	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2630	SUP	HCPCS C1713		SP-2630  -  PLATE BONE THK1.6MM STR 2X7 HOLE MATRIX GRADE II TRAUMAONE	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2631	SUP	HCPCS C1713		SP-2631  -  PLATE BONE THK1.6MM 7X2MM CVD MATRIX GOLD MANDIB 2/2.3MM	BOTH IP/OP	"$2,625.00 "	"$1,942.50"	$0.00	"$2,100.00"	"$1,181.25"	"$1,181.25"	$0.00	$0.00	$0.00	$547.12	"$1,948.28"	"$1,948.28"	$0.00	$0.00	$547.05	$0.00	"$1,294.13"	"$1,294.13"	$0.00	"$1,312.50"	"$2,079.00"	"$2,100.00"	$0.00		$0.00	$410.81	$0.00	$0.00	$417.90	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2665	SUP	HCPCS C1713		SP-2665  -  PLATE BONE THK1.6MM 7 HOLE 2Y GRADE II TRAUMAONE LORENZ	BOTH IP/OP	"$1,515.00 "	"$1,121.10"	$0.00	"$1,212.00"	$681.75	$681.75	$0.00	$0.00	$0.00	$315.76	"$1,124.43"	"$1,124.43"	$0.00	$0.00	$315.73	$0.00	$896.12	$896.12	$0.00	$757.50	"$1,199.88"	"$1,212.00"	$0.00		$0.00	$237.10	$0.00	$0.00	$241.19	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2703	SUP	HCPCS C1713		SP-2703  -  PLATE STR 1.6MM 6 HOLE GAP BONE	BOTH IP/OP	"$2,450.00 "	"$1,813.00"	$0.00	"$1,960.00"	"$1,102.50"	"$1,102.50"	$0.00	$0.00	$0.00	$510.64	"$1,818.39"	"$1,818.39"	$0.00	$0.00	$510.58	$0.00	"$1,449.18"	"$1,449.18"	$0.00	"$1,225.00"	"$1,940.40"	"$1,960.00"	$0.00		$0.00	$383.43	$0.00	$0.00	$390.04	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2834	SUP	HCPCS C1713		SP-2834  -  SCREW BONE L8 MM OD2.4 MM RIB SELF DRILL LOCK	BOTH IP/OP	$625.00 	$462.50	$0.00	$500.00	$281.25	$281.25	$0.00	$0.00	$0.00	$130.27	$463.88	$463.88	$0.00	$0.00	$130.25	$0.00	$369.69	$369.69	$0.00	$312.50	$495.00	$500.00	$0.00		$0.00	$97.81	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2889	SUP	HCPCS C1713		SP-2889  -  PLATE BN STRG STERNALOCK BLU 24 HL STRNM PRM CLSR SYS	BOTH IP/OP	"$3,760.00 "	"$2,782.40"	$0.00	"$3,008.00"	"$1,692.00"	"$1,692.00"	$0.00	$0.00	$0.00	$783.68	"$2,790.67"	"$2,790.67"	$0.00	$0.00	$783.58	$0.00	"$1,853.68"	"$1,853.68"	$0.00	"$1,880.00"	"$2,977.92"	"$3,008.00"	$0.00		$0.00	$588.44	$0.00	$0.00	$598.59	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2890	SUP	HCPCS C1713		SP-2890  -  PLATE BN HEX STERNALOCK BLU 6 HL STRNM PRM CLSR SYS	BOTH IP/OP	"$2,210.00 "	"$1,635.40"	$0.00	"$1,768.00"	$994.50	$994.50	$0.00	$0.00	$0.00	$460.62	"$1,640.26"	"$1,640.26"	$0.00	$0.00	$460.56	$0.00	"$1,307.22"	"$1,307.22"	$0.00	"$1,105.00"	"$1,750.32"	"$1,768.00"	$0.00		$0.00	$345.87	$0.00	$0.00	$351.83	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2891	SUP	HCPCS C1713		SP-2891  -  PLATE BN JL STRG STERNALOCK BLU 8 HL STRNM PRM CLSR SYS	BOTH IP/OP	"$1,945.00 "	"$1,439.30"	$0.00	"$1,556.00"	$875.25	$875.25	$0.00	$0.00	$0.00	$405.39	"$1,443.58"	"$1,443.58"	$0.00	$0.00	$405.34	$0.00	"$1,150.47"	"$1,150.47"	$0.00	$972.50	"$1,540.44"	"$1,556.00"	$0.00		$0.00	$304.39	$0.00	$0.00	$309.64	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2899	SUP	HCPCS C1713		SP-2899  -  PLATE BN STRG STERNALOCK BLU 6 HL STRNM PRM CLSR SYS	BOTH IP/OP	"$1,962.50 "	"$1,452.25"	$0.00	"$1,570.00"	$883.13	$883.13	$0.00	$0.00	$0.00	$409.03	"$1,456.57"	"$1,456.57"	$0.00	$0.00	$408.99	$0.00	"$1,160.82"	"$1,160.82"	$0.00	$981.25	"$1,554.30"	"$1,570.00"	$0.00		$0.00	$307.13	$0.00	$0.00	$312.43	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2913	SUP	HCPCS C1713		SP-2913  -  PLATE BN 70D L STERNALOCK BLU 8 HL STRNM PRM CLSR SYS	BOTH IP/OP	"$1,692.50 "	"$1,252.45"	$0.00	"$1,354.00"	$761.63	$761.63	$0.00	$0.00	$0.00	$352.76	"$1,256.17"	"$1,256.17"	$0.00	$0.00	$352.72	$0.00	"$1,001.11"	"$1,001.11"	$0.00	$846.25	"$1,340.46"	"$1,354.00"	$0.00		$0.00	$264.88	$0.00	$0.00	$269.45	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2914	SUP	HCPCS C1713		SP-2914  -  PLATE BN Y STERNALOCK BLU 12 HL STRNM PRM CLSR SYS	BOTH IP/OP	"$3,332.50 "	"$2,466.05"	$0.00	"$2,666.00"	"$1,499.63"	"$1,499.63"	$0.00	$0.00	$0.00	$694.58	"$2,473.38"	"$2,473.38"	$0.00	$0.00	$694.49	$0.00	"$1,642.92"	"$1,642.92"	$0.00	"$1,666.25"	"$2,639.34"	"$2,666.00"	$0.00		$0.00	$521.54	$0.00	$0.00	$530.53	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2927	SUP	HCPCS C1713		SP-2927  -  PLATE BN STRG 1.6MM STERNALOCK BLU 16 HL STRNM PRM CLSR SYS	BOTH IP/OP	"$2,870.00 "	"$2,123.80"	$0.00	"$2,296.00"	"$1,291.50"	"$1,291.50"	$0.00	$0.00	$0.00	$598.18	"$2,130.11"	"$2,130.11"	$0.00	$0.00	$598.11	$0.00	"$1,414.91"	"$1,414.91"	$0.00	"$1,435.00"	"$2,273.04"	"$2,296.00"	$0.00		$0.00	$449.16	$0.00	$0.00	$456.90	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2984	SUP	HCPCS C1713		SP-2984  -  PLATE BN 100D X STERNALOCK BLU 8 HL STRNM	BOTH IP/OP	"$2,445.00 "	"$1,809.30"	$0.00	"$1,956.00"	"$1,100.25"	"$1,100.25"	$0.00	$0.00	$0.00	$509.60	"$1,814.68"	"$1,814.68"	$0.00	$0.00	$509.54	$0.00	"$1,446.22"	"$1,446.22"	$0.00	"$1,222.50"	"$1,936.44"	"$1,956.00"	$0.00		$0.00	$382.64	$0.00	$0.00	$389.24	$0.00	$0.00	$0.00	$0.00	$0.00
SP-2985	SUP	HCPCS C1713		SP-2985  -  PLATE BN 100D Y STERNALOCK BLU 6 HL STRNM	BOTH IP/OP	"$2,445.00 "	"$1,809.30"	$0.00	"$1,956.00"	"$1,100.25"	"$1,100.25"	$0.00	$0.00	$0.00	$509.60	"$1,814.68"	"$1,814.68"	$0.00	$0.00	$509.54	$0.00	"$1,446.22"	"$1,446.22"	$0.00	"$1,222.50"	"$1,936.44"	"$1,956.00"	$0.00		$0.00	$382.64	$0.00	$0.00	$389.24	$0.00	$0.00	$0.00	$0.00	$0.00
SP-3001	SUP	HCPCS C1713		SP-3001  -  PLATE BN 13MM STERNALOCK BLU STRNM JL G	BOTH IP/OP	"$2,070.00 "	"$1,531.80"	$0.00	"$1,656.00"	$931.50	$931.50	$0.00	$0.00	$0.00	$431.44	"$1,536.35"	"$1,536.35"	$0.00	$0.00	$431.39	$0.00	"$1,224.41"	"$1,224.41"	$0.00	"$1,035.00"	"$1,639.44"	"$1,656.00"	$0.00		$0.00	$323.96	$0.00	$0.00	$329.54	$0.00	$0.00	$0.00	$0.00	$0.00
SP-3022	SUP	HCPCS C1713		SP-3022  -  PLATE BN LG .6MM 4 HL CNTR MESH STRNL 1.5MM SCR EZ	BOTH IP/OP	"$1,677.50 "	"$1,241.35"	$0.00	"$1,342.00"	$754.88	$754.88	$0.00	$0.00	$0.00	$349.63	"$1,245.04"	"$1,245.04"	$0.00	$0.00	$349.59	$0.00	$992.24	$992.24	$0.00	$838.75	"$1,328.58"	"$1,342.00"	$0.00		$0.00	$262.53	$0.00	$0.00	$267.06	$0.00	$0.00	$0.00	$0.00	$0.00
SP-3060	SUP	HCPCS C1713		SP-3060  -  SCREW BN 2MM 9MM OMNIMAX MXLMNDB SD XD	BOTH IP/OP	"$2,172.50 "	"$1,607.65"	$0.00	"$1,738.00"	$977.63	$977.63	$0.00	$0.00	$0.00	$452.80	"$1,612.43"	"$1,612.43"	$0.00	$0.00	$452.75	$0.00	"$1,285.03"	"$1,285.03"	$0.00	"$1,086.25"	"$1,720.62"	"$1,738.00"	$0.00		$0.00	$340.00	$0.00	$0.00	$345.86	$0.00	$0.00	$0.00	$0.00	$0.00
SP-3142	SUP	HCPCS C1713		SP-3142  -  PLATE BN 60D JL STERNALOCK BLU STRNM	BOTH IP/OP	"$2,977.50 "	"$2,203.35"	$0.00	"$2,382.00"	"$1,339.88"	"$1,339.88"	$0.00	$0.00	$0.00	$620.59	"$2,209.90"	"$2,209.90"	$0.00	$0.00	$620.51	$0.00	"$1,467.91"	"$1,467.91"	$0.00	"$1,488.75"	"$2,358.18"	"$2,382.00"	$0.00		$0.00	$465.98	$0.00	$0.00	$474.02	$0.00	$0.00	$0.00	$0.00	$0.00
SP-3192	SUP	HCPCS C1713		SP-3192  -  PLATE BN W STERNALOCK BLU 8 HL STRNL	BOTH IP/OP	"$3,537.50 "	"$2,617.75"	$0.00	"$2,830.00"	"$1,591.88"	"$1,591.88"	$0.00	$0.00	$0.00	$737.30	"$2,625.53"	"$2,625.53"	$0.00	$0.00	$737.22	$0.00	"$1,743.99"	"$1,743.99"	$0.00	"$1,768.75"	"$2,801.70"	"$2,830.00"	$0.00		$0.00	$553.62	$0.00	$0.00	$563.17	$0.00	$0.00	$0.00	$0.00	$0.00
SP-3215	SUP	HCPCS C1713		SP-3215  -  PLATE BN XW 80MM MESH CRNM CHIARI	BOTH IP/OP	"$2,977.50 "	"$2,203.35"	$0.00	"$2,382.00"	"$1,339.88"	"$1,339.88"	$0.00	$0.00	$0.00	$620.59	"$2,209.90"	"$2,209.90"	$0.00	$0.00	$620.51	$0.00	"$1,467.91"	"$1,467.91"	$0.00	"$1,488.75"	"$2,358.18"	"$2,382.00"	$0.00		$0.00	$465.98	$0.00	$0.00	$474.02	$0.00	$0.00	$0.00	$0.00	$0.00
SP719521	SUP	Custom 27203010		REAGENT .8% RBC RSLV 3ML PNL B BLOOD BANK	BOTH IP/OP	$391.75 	$289.90	$0.00	$313.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.88	$310.27	$313.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SP721380	SUP	Custom 27203010		REAGENT ANTI-JK LTTL A BCLN 3ML MNCLN RARE GRP BLOOD BANK	BOTH IP/OP	$47.50 	$35.15	$0.00	$38.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.75	$37.62	$38.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPD2-US-040-320	SUP	HCPCS C1884		SPD2-US-040-320  -  SYSTEM EMBL PRTC 320CM .014IN FLTR CPTR WIRE GUID CATH 4MM	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
SPD2-US-050-320	SUP	HCPCS C1884		SPD2-US-050-320  -  SYSTEM EMBL PRTC 320CM .014IN FLTR CPTR WIRE GUID CATH 5MM	BOTH IP/OP	"$2,875.00 "	"$2,127.50"	$0.00	"$2,300.00"	"$1,293.75"	"$1,293.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,437.50"	"$2,277.00"	"$2,300.00"	$0.00		$0.00	$449.94	$0.00	$0.00	$457.70	$0.00	$0.00	$0.00	$0.00	$0.00
SPD2-US-060-320	SUP	HCPCS C1773		SPD2-US-060-320  -  SYSTEM EMBL PRTC 3.2-4.2FR 6MM 320CM 190CM SPIDERFX CPTR WRE	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	"$1,893.71"	"$1,893.71"	$0.00	$0.00	$0.00	$726.88	"$2,588.42"	"$2,588.42"	$0.00	$0.00	$726.80	$0.00	"$2,062.86"	"$2,062.86"	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$545.79	$0.00	$0.00	$555.21	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100200-20	SUP	Custom 27803010		SPH100200-20  -  COIL EMBL 2MM 2.5CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,497.15 "	"$1,847.89"	$0.00	"$1,997.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,853.38"	"$1,853.38"	$0.00	$0.00	$520.41	$0.00	$0.00	$0.00	$0.00	"$1,248.58"	"$1,977.74"	"$1,997.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100250-20	SUP	Custom 27803010		SPH100250-20  -  COIL EMBL 2.5MM 3.3CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,530.45 "	"$1,872.53"	$0.00	"$2,024.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,878.10"	"$1,878.10"	$0.00	$0.00	$527.35	$0.00	$0.00	$0.00	$0.00	"$1,265.23"	"$2,004.12"	"$2,024.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100300-20	SUP	Custom 27803010		SPH100300-20  -  COIL EMBL 3MM 5.4CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,530.45 "	"$1,872.53"	$0.00	"$2,024.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,878.10"	"$1,878.10"	$0.00	$0.00	$527.35	$0.00	$0.00	$0.00	$0.00	"$1,265.23"	"$2,004.12"	"$2,024.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100350-20	SUP	Custom 27803010		SPH100350-20  -  COIL EMBL 3.5MM 6.6CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,530.45 "	"$1,872.53"	$0.00	"$2,024.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,878.10"	"$1,878.10"	$0.00	$0.00	$527.35	$0.00	$0.00	$0.00	$0.00	"$1,265.23"	"$2,004.12"	"$2,024.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100500-20	SUP	Custom 27803010		SPH100500-20  -  COIL EMBL 5MM 9.7CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,563.73 "	"$1,897.16"	$0.00	"$2,050.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,902.80"	"$1,902.80"	$0.00	$0.00	$534.28	$0.00	$0.00	$0.00	$0.00	"$1,281.86"	"$2,030.47"	"$2,050.98"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100600-20	SUP	Custom 27803010		SPH100600-20  -  COIL EMBL 6MM 11.9CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,597.03 "	"$1,921.80"	$0.00	"$2,077.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,927.51"	"$1,927.51"	$0.00	$0.00	$541.22	$0.00	$0.00	$0.00	$0.00	"$1,298.51"	"$2,056.85"	"$2,077.62"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100620-20	SUP	Custom 27803010		SPH100620-20  -  COIL EMBL 6MM 20CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT	BOTH IP/OP	"$2,730.20 "	"$2,020.35"	$0.00	"$2,184.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,026.35"	"$2,026.35"	$0.00	$0.00	$568.97	$0.00	$0.00	$0.00	$0.00	"$1,365.10"	"$2,162.32"	"$2,184.16"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100700-20	SUP	Custom 27803010		SPH100700-20  -  COIL EMBL 7MM 13.9CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,630.33 "	"$1,946.44"	$0.00	"$2,104.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,952.23"	"$1,952.23"	$0.00	$0.00	$548.16	$0.00	$0.00	$0.00	$0.00	"$1,315.16"	"$2,083.22"	"$2,104.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100720-20	SUP	Custom 27803010		SPH100720-20  -  COIL EMBL 7MM 20CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT	BOTH IP/OP	"$2,730.20 "	"$2,020.35"	$0.00	"$2,184.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,026.35"	"$2,026.35"	$0.00	$0.00	$568.97	$0.00	$0.00	$0.00	$0.00	"$1,365.10"	"$2,162.32"	"$2,184.16"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100800-20	SUP	Custom 27803010		SPH100800-20  -  COIL EMBL 8MM 16.1CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,663.63 "	"$1,971.09"	$0.00	"$2,130.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,976.94"	"$1,976.94"	$0.00	$0.00	$555.10	$0.00	$0.00	$0.00	$0.00	"$1,331.81"	"$2,109.59"	"$2,130.90"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100825-20	SUP	Custom 27803010		SPH100825-20  -  COIL EMBL 8MM 25CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT	BOTH IP/OP	"$2,796.80 "	"$2,069.63"	$0.00	"$2,237.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,075.78"	"$2,075.78"	$0.00	$0.00	$582.85	$0.00	$0.00	$0.00	$0.00	"$1,398.40"	"$2,215.07"	"$2,237.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100900-20	SUP	Custom 27803010		SPH100900-20  -  COIL EMBL 9MM 18.4CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,696.93 "	"$1,995.73"	$0.00	"$2,157.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,001.66"	"$2,001.66"	$0.00	$0.00	$562.04	$0.00	$0.00	$0.00	$0.00	"$1,348.46"	"$2,135.97"	"$2,157.54"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH100925-20	SUP	Custom 27803010		SPH100925-20  -  COIL EMBL 9MM 25CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT	BOTH IP/OP	"$2,796.80 "	"$2,069.63"	$0.00	"$2,237.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,075.78"	"$2,075.78"	$0.00	$0.00	$582.85	$0.00	$0.00	$0.00	$0.00	"$1,398.40"	"$2,215.07"	"$2,237.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH101000-20	SUP	Custom 27803010		SPH101000-20  -  COIL EMBL SPHR 10MM 20.3CM MICRUSPHERE 10 MCIOL SPHRCL LOOP	BOTH IP/OP	"$2,730.20 "	"$2,020.35"	$0.00	"$2,184.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,026.35"	"$2,026.35"	$0.00	$0.00	$568.97	$0.00	$0.00	$0.00	$0.00	"$1,365.10"	"$2,162.32"	"$2,184.16"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH10103020	SUP	Custom 27803010		SPH10103020  -  COIL EMBL SPHR 10MM 30CM MICRUSPHERE 10 MCIOL SPHRCL LOOP	BOTH IP/OP	"$2,830.10 "	"$2,094.27"	$0.00	"$2,264.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,415.05"	"$2,241.44"	"$2,264.08"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH101030-20	SUP	Custom 27803010		SPH101030-20  -  COIL EMBL 30CM 10MM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,830.10 "	"$2,094.27"	$0.00	"$2,264.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,100.50"	"$2,100.50"	$0.00	$0.00	$589.79	$0.00	$0.00	$0.00	$0.00	"$1,415.05"	"$2,241.44"	"$2,264.08"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH181100-20	SUP	Custom 27803010		SPH181100-20  -  COIL EMBL 11MM 18.9CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,725.80 "	"$2,017.09"	$0.00	"$2,180.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,023.09"	"$2,023.09"	$0.00	$0.00	$568.06	$0.00	$0.00	$0.00	$0.00	"$1,362.90"	"$2,158.83"	"$2,180.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH181200-20	SUP	Custom 27803010		SPH181200-20  -  COIL EMBL 12MM 20.7CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,725.80 "	"$2,017.09"	$0.00	"$2,180.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,023.09"	"$2,023.09"	$0.00	$0.00	$568.06	$0.00	$0.00	$0.00	$0.00	"$1,362.90"	"$2,158.83"	"$2,180.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH181300-20	SUP	Custom 27803010		SPH181300-20  -  COIL EMBL 13MM 22.6CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,725.80 "	"$2,017.09"	$0.00	"$2,180.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,023.09"	"$2,023.09"	$0.00	$0.00	$568.06	$0.00	$0.00	$0.00	$0.00	"$1,362.90"	"$2,158.83"	"$2,180.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH181400-20	SUP	Custom 27803010		SPH181400-20  -  COIL EMBL 14MM 24.3CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,761.68 "	"$2,043.64"	$0.00	"$2,209.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,049.72"	"$2,049.72"	$0.00	$0.00	$575.53	$0.00	$0.00	$0.00	$0.00	"$1,380.84"	"$2,187.25"	"$2,209.34"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH181500-20	SUP	Custom 27803010		SPH181500-20  -  COIL EMBL 15MM 26CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,797.53 "	"$2,070.17"	$0.00	"$2,238.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,076.32"	"$2,076.32"	$0.00	$0.00	$583.00	$0.00	$0.00	$0.00	$0.00	"$1,398.76"	"$2,215.64"	"$2,238.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH181600-20	SUP	Custom 27803010		SPH181600-20  -  COIL EMBL 16MM 27.9CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,797.53 "	"$2,070.17"	$0.00	"$2,238.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,076.32"	"$2,076.32"	$0.00	$0.00	$583.00	$0.00	$0.00	$0.00	$0.00	"$1,398.76"	"$2,215.64"	"$2,238.02"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH181700-20	SUP	Custom 27803010		SPH181700-20  -  COIL EMBL 17MM 30CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,833.40 "	"$2,096.72"	$0.00	"$2,266.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,102.95"	"$2,102.95"	$0.00	$0.00	$590.48	$0.00	$0.00	$0.00	$0.00	"$1,416.70"	"$2,244.05"	"$2,266.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPH181800-20	SUP	Custom 27803010		SPH181800-20  -  COIL EMBL 18MM 30CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH	BOTH IP/OP	"$2,833.40 "	"$2,096.72"	$0.00	"$2,266.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,102.95"	"$2,102.95"	$0.00	$0.00	$590.48	$0.00	$0.00	$0.00	$0.00	"$1,416.70"	"$2,244.05"	"$2,266.72"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPL15006X	SUP	HCPCS C1725		SPL15006X  -  CATH BALDILAT 1.5MM 6MM RAPEX SMCPNT SPNTR LGND	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL15010X	SUP	HCPCS C1726		SPL15010X  -  CATHETER BLNDIL 21CM .02IN 1.5MM 142CM LF 10MM SPNTR LGND	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$223.99	$223.99	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
SPL15012X	SUP	HCPCS C1725		CATHETER BLN 1.5MM 12MM RAPEX LGND SPNTR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL15015X	SUP	HCPCS C1725		CATHETER BLN 1.5MM 15MM RAPEX LGND SPNTR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL15020X	SUP	HCPCS C1725		CATHETER BLN 1.5MM 20MM RAPEX LGND SPNTR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL20006X	SUP	HCPCS C1726		SPL20006X  -  CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 6MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL20010X	SUP	HCPCS C1726		SPL20010X  -  CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 10MM SPNTR LGND	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$223.99	$223.99	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
SPL20012X	SUP	HCPCS C1725		CATHETER BLN 2MM 12MM RAPEX LGND SPNTR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL20015X	SUP	HCPCS C1725		CATHETER BLN 2MM 15MM RAPEX LGND SPNTR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL20020X	SUP	HCPCS C1725		CATHETER BLN 2MM 20MM RAPEX LGND SPNTR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL20025X	SUP	HCPCS C1726		SPL20025X  -  CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 25MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL20030X	SUP	HCPCS C1726		SPL20030X  -  CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 30MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL22506X	SUP	HCPCS C1726		SPL22506X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 6MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL22510X	SUP	HCPCS C1726		SPL22510X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 10MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL22512X	SUP	HCPCS C1726		SPL22512X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 12MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL22515X	SUP	HCPCS C1726		SPL22515X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 15MM SPNTR LGND	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$223.99	$223.99	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
SPL22520X	SUP	HCPCS C1726		SPL22520X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 20MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL22525X	SUP	HCPCS C1726		SPL22525X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 25MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL250010X	SUP	HCPCS C1726		SPL250010X  -  CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 10MM SPNTR LGND	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$223.99	$223.99	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
SPL25006X	SUP	HCPCS C1726		SPL25006X  -  CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 6MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL25012X	SUP	HCPCS C1725		CATHETER BLN 2.5MM 12MM RAPEX LGND SPNTR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL25015X	SUP	HCPCS C1725		CATHETER BLN 2.5MM 15MM RAPEX LGND SPNTR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL25020X	SUP	HCPCS C1725		CATHETER BLN 2.5MM 20MM RAPEX LGND SPNTR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL25025X	SUP	HCPCS C1726		SPL25025X  -  CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 25MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL25030X	SUP	HCPCS C1726		SPL25030X  -  CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 30MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL27506X	SUP	HCPCS C1726		SPL27506X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 6MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL27512X	SUP	HCPCS C1726		SPL27512X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 12MM SPNTR LGND	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$223.99	$223.99	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
SPL27515X	SUP	HCPCS C1726		SPL27515X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 15MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL27520X	SUP	HCPCS C1726		SPL27520X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 20MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL27525X	SUP	HCPCS C1726		SPL27525X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 25MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL30006X	SUP	HCPCS C1726		SPL30006X  -  CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 6MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL30010X	SUP	HCPCS C1726		SPL30010X  -  CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 10MM SPNTR LGND	BOTH IP/OP	$412.50 	$305.25	$0.00	$330.00	$223.99	$223.99	$0.00	$0.00	$0.00	$85.98	$306.16	$306.16	$0.00	$0.00	$85.97	$0.00	$243.99	$243.99	$0.00	$206.25	$326.70	$330.00	$0.00		$0.00	$64.56	$0.00	$0.00	$65.67	$0.00	$0.00	$0.00	$0.00	$0.00
SPL30012X	SUP	HCPCS C1725		CATHETER BLN 3MM 12MM RAPEX LGND SPNTR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL30015X	SUP	HCPCS C1725		CATHETER BLN 3MM 15MM RAPEX LGND SPNTR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL30020X	SUP	HCPCS C1725		CATHETER BLN 3MM 20MM RAPEX LGND SPNTR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$237.56	$237.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
SPL30025X	SUP	HCPCS C1726		SPL30025X  -  CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 25MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL30030X	SUP	HCPCS C1726		SPL30030X  -  CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 30MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL32512X	SUP	HCPCS C1726		SPL32512X  -  CATHETER BLNDIL 21CM .023IN 3.25MM 142CM LF 12MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL32515X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL32520X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL35006X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL35010X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL35012X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL35015X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL35020X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL35025X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL35030X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL37512X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL37515X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL37520X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL40006X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL40010X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL40012X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL40015X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL40020X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPL40025X	SUP	HCPCS C1726		SPL40025X  -  CATHETER BLNDIL 21CM .024IN 4MM 142CM LF 25MM SPNTR LGND	BOTH IP/OP	$425.00 	$314.50	$0.00	$340.00	$230.78	$230.78	$0.00	$0.00	$0.00	$88.58	$315.44	$315.44	$0.00	$0.00	$88.57	$0.00	$251.39	$251.39	$0.00	$212.50	$336.60	$340.00	$0.00		$0.00	$66.51	$0.00	$0.00	$67.66	$0.00	$0.00	$0.00	$0.00	$0.00
SPL40030X	SUP	HCPCS C1725		BALLON SPRINTER LEGEND  RX	BOTH IP/OP	$12.50 	$9.25	$0.00	$10.00	$6.79	$6.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.25	$9.90	$10.00	$0.00		$0.00	$1.96	$0.00	$0.00	$1.99	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20100-TS	SUP	HCPCS C1713		SPLS-20100-TS  -  PEG FX 2MM 10MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20120-TS	SUP	HCPCS C1713		SPLS-20120-TS  -  PEG FX 2MM 12MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20140-TS	SUP	HCPCS C1713		SPLS-20140-TS  -  PEG FX 2MM 14MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20160-TS	SUP	HCPCS C1713		SPLS-20160-TS  -  PEG FX 2MM 16MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20170-TS	SUP	HCPCS C1713		SPLS-20170-TS  -  PEG FX 2MM 17MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20180-TS	SUP	HCPCS C1713		SPLS-20180-TS  -  PEG FX 2MM 18MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20190-TS	SUP	HCPCS C1713		SPLS-20190-TS  -  PEG FX 2MM 19MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20200-TS	SUP	HCPCS C1713		SPLS-20200-TS  -  PEG FX 2MM 20MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20210-TS	SUP	HCPCS C1713		SPLS-20210-TS  -  PEG FX 2MM 21MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20220-TS	SUP	HCPCS C1713		SPLS-20220-TS  -  PEG FX 2MM 22MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20230-TS	SUP	HCPCS C1713		SPLS-20230-TS  -  PEG FX 2MM 23MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20240-TS	SUP	HCPCS C1713		SPLS-20240-TS  -  PEG FX 2MM 24MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20260-TS	SUP	HCPCS C1713		SPLS-20260-TS  -  PEG FX 2MM 26MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20280-TS	SUP	HCPCS C1713		SPLS-20280-TS  -  PEG FX 2MM 28MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20300-TS	SUP	HCPCS C1713		SPLS-20300-TS  -  PEG FX 2MM 30MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPLS-20320-TS	SUP	HCPCS C1713		SPLS-20320-TS  -  PEG FX 2MM 32MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
SPMTS4014	SUP	Custom 27203010		REAGENT ANTI-IGG C3D ID MTS GEL CRD 6 TST ANALY	BOTH IP/OP	$160.70 	$118.92	$0.00	$128.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.35	$127.27	$128.56	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPMTS4024	SUP	Custom 27203010		REAGENT ANTI-IGG ID MTS GEL CRD PLYCLN 6 TST ANALY	BOTH IP/OP	$494.85 	$366.19	$0.00	$395.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.43	$391.92	$395.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SPS0121K	SUP	HCPCS C1713		SPS0121K  -  SPACER HUM 99MMX16MM 41MM 7MM INTSPC SM SHLDR PMMA	BOTH IP/OP	"$9,975.00 "	"$7,381.50"	$0.00	"$7,980.00"	"$4,488.75"	"$4,488.75"	$0.00	$0.00	$0.00	"$2,079.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,078.79"	$0.00	"$4,917.68"	"$4,917.68"	$0.00	"$4,987.50"	"$7,900.20"	"$7,980.00"	$0.00		$0.00	"$1,561.09"	$0.00	$0.00	"$1,588.02"	$0.00	$0.00	$0.00	$0.00	$0.00
SR-0620-CS	SUP	HCPCS C1876		SR-0620-CS  -  STENT VASC STRG 6MM 20MM 57CM ENROUTE UBER FLX DLV SYS ANG	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
SR-0630-CS	SUP	HCPCS C1876		SR-0630-CS  -  STENT VASC 6MM .065IN 30MM 57CM ENROUTE UBER FLX DLV SYS ANG	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
SR-0640-CS	SUP	HCPCS C1876		SR-0640-CS  -  STENT VASC 6MM 40MM 57CM ENROUTE UBER FLX DLV SYS ANG TIP	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
SR-0730-CS	SUP	HCPCS C1876		SR-0730-CS  -  STENT VASC 7MM .065IN 30MM 57CM ENROUTE UBER FLX DLV SYS ANG	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
SR-0740-CS	SUP	HCPCS C1876		SR-0740-CS  -  STENT VASC 7MM .065IN 40MM 57CM ENROUTE UBER FLX DLV SYS ANG	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
SR-0830-CS	SUP	HCPCS C1876		SR-0830-CS  -  STENT VASC 8MM .065IN 30MM 57CM ENROUTE UBER FLX DLV SYS ANG	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
SR-0840-CS	SUP	HCPCS C1876		SR-0840-CS  -  STENT VASC 8MM .065IN 40MM 57CM ENROUTE UBER FLX DLV SYS ANG	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
SR-0930-CS	SUP	HCPCS C1876		SR-0930-CS  -  STENT VASC 9MM 30MM 57CM ENROUTE UBER FLX DLV SYS ANG TIP	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
SR-0940-CS	SUP	HCPCS C1876		SR-0940-CS  -  STENT VASC 9MM .078IN 40MM 57CM ENROUTE UBER FLX DLV SYS ANG	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
SR-1030-CS	SUP	HCPCS C1876		SR-1030-CS  -  STENT VASC SHRT STRG 10MM 6FR 30MM 57CM ENROUTE UBER FLX	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
SR-1040-CS	SUP	HCPCS C1876		SR-1040-CS  -  STENT VASC 10MM .078IN 40MM 57CM ENROUTE UBER FLX DLV SYS	BOTH IP/OP	"$6,750.00 "	"$4,995.00"	$0.00	"$5,400.00"	"$3,037.50"	"$3,037.50"	$0.00	$0.00	$0.00	"$1,406.87"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,406.70"	$0.00	"$3,327.75"	"$3,327.75"	$0.00	"$3,375.00"	"$5,346.00"	"$5,400.00"	$0.00		$0.00	"$1,056.38"	$0.00	$0.00	"$1,074.60"	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140306-20	SUP	Custom 27803010		SRC140306-20  -  COIL EMBL 3MM 6CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,785.85 "	"$2,061.53"	$0.00	"$2,228.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,067.66"	"$2,067.66"	$0.00	$0.00	$580.57	$0.00	$0.00	$0.00	$0.00	"$1,392.93"	"$2,206.39"	"$2,228.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140406-20	SUP	Custom 27803010		SRC140406-20  -  COIL EMBL 4MM 6CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,785.85 "	"$2,061.53"	$0.00	"$2,228.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,067.66"	"$2,067.66"	$0.00	$0.00	$580.57	$0.00	$0.00	$0.00	$0.00	"$1,392.93"	"$2,206.39"	"$2,228.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140408-20	SUP	Custom 27803010		SRC140408-20  -  COIL EMBL 4MM 8CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,829.38 "	"$2,093.74"	$0.00	"$2,263.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,099.96"	"$2,099.96"	$0.00	$0.00	$589.64	$0.00	$0.00	$0.00	$0.00	"$1,414.69"	"$2,240.87"	"$2,263.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140445-20	SUP	Custom 27803010		SRC140445-20  -  COIL EMBL 4MM 4.5CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,785.85 "	"$2,061.53"	$0.00	"$2,228.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,067.66"	"$2,067.66"	$0.00	$0.00	$580.57	$0.00	$0.00	$0.00	$0.00	"$1,392.93"	"$2,206.39"	"$2,228.68"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140507-20	SUP	Custom 27803010		SRC140507-20  -  COIL EMBL 5MM 7CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,829.38 "	"$2,093.74"	$0.00	"$2,263.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,099.96"	"$2,099.96"	$0.00	$0.00	$589.64	$0.00	$0.00	$0.00	$0.00	"$1,414.69"	"$2,240.87"	"$2,263.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140512-20	SUP	Custom 27803010		SRC140512-20  -  COIL EMBL 5MM 12CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,829.38 "	"$2,093.74"	$0.00	"$2,263.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,099.96"	"$2,099.96"	$0.00	$0.00	$589.64	$0.00	$0.00	$0.00	$0.00	"$1,414.69"	"$2,240.87"	"$2,263.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140609-20	SUP	Custom 27803010		SRC140609-20  -  COIL EMBL 6MM 9CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,829.38 "	"$2,093.74"	$0.00	"$2,263.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,099.96"	"$2,099.96"	$0.00	$0.00	$589.64	$0.00	$0.00	$0.00	$0.00	"$1,414.69"	"$2,240.87"	"$2,263.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140615-20	SUP	Custom 27803010		SRC140615-20  -  COIL EMBL 6MM 15CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,872.90 "	"$2,125.95"	$0.00	"$2,298.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,132.27"	"$2,132.27"	$0.00	$0.00	$598.71	$0.00	$0.00	$0.00	$0.00	"$1,436.45"	"$2,275.34"	"$2,298.32"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140711-20	SUP	Custom 27803010		SRC140711-20  -  COIL EMBL 7MM 11CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,829.38 "	"$2,093.74"	$0.00	"$2,263.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,099.96"	"$2,099.96"	$0.00	$0.00	$589.64	$0.00	$0.00	$0.00	$0.00	"$1,414.69"	"$2,240.87"	"$2,263.50"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140717-20	SUP	Custom 27803010		SRC140717-20  -  COIL EMBL 7MM 17CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,959.95 "	"$2,190.36"	$0.00	"$2,367.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,196.87"	"$2,196.87"	$0.00	$0.00	$616.85	$0.00	$0.00	$0.00	$0.00	"$1,479.98"	"$2,344.28"	"$2,367.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140812-20	SUP	Custom 27803010		SRC140812-20  -  COIL EMBL 8MM 12CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,872.90 "	"$2,125.95"	$0.00	"$2,298.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,132.27"	"$2,132.27"	$0.00	$0.00	$598.71	$0.00	$0.00	$0.00	$0.00	"$1,436.45"	"$2,275.34"	"$2,298.32"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140820-20	SUP	Custom 27803010		SRC140820-20  -  COIL EMBL 8MM 20CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$3,003.48 "	"$2,222.58"	$0.00	"$2,402.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,229.18"	"$2,229.18"	$0.00	$0.00	$625.92	$0.00	$0.00	$0.00	$0.00	"$1,501.74"	"$2,378.76"	"$2,402.78"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140914-20	SUP	Custom 27803010		SRC140914-20  -  COIL EMBL 9MM 14CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,959.95 "	"$2,190.36"	$0.00	"$2,367.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,196.87"	"$2,196.87"	$0.00	$0.00	$616.85	$0.00	$0.00	$0.00	$0.00	"$1,479.98"	"$2,344.28"	"$2,367.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC140922-20	SUP	Custom 27803010		SRC140922-20  -  COIL EMBL 9MM 22CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$3,003.48 "	"$2,222.58"	$0.00	"$2,402.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,229.18"	"$2,229.18"	$0.00	$0.00	$625.92	$0.00	$0.00	$0.00	$0.00	"$1,501.74"	"$2,378.76"	"$2,402.78"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC141016-20	SUP	Custom 27803010		SRC141016-20  -  COIL EMBL 10MM 16CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$2,959.95 "	"$2,190.36"	$0.00	"$2,367.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,196.87"	"$2,196.87"	$0.00	$0.00	$616.85	$0.00	$0.00	$0.00	$0.00	"$1,479.98"	"$2,344.28"	"$2,367.96"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC141025-20	SUP	Custom 27803010		SRC141025-20  -  COIL EMBL 10MM 25CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$3,047.03 "	"$2,254.80"	$0.00	"$2,437.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,261.50"	"$2,261.50"	$0.00	$0.00	$635.00	$0.00	$0.00	$0.00	$0.00	"$1,523.51"	"$2,413.25"	"$2,437.62"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC141118-20	SUP	Custom 27803010		SRC141118-20  -  COIL EMBL 11MM 18CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$3,003.48 "	"$2,222.58"	$0.00	"$2,402.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,229.18"	"$2,229.18"	$0.00	$0.00	$625.92	$0.00	$0.00	$0.00	$0.00	"$1,501.74"	"$2,378.76"	"$2,402.78"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC141127-20	SUP	Custom 27803010		SRC141127-20  -  COIL EMBL 11MM 27CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$3,090.55 "	"$2,287.01"	$0.00	"$2,472.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,293.81"	"$2,293.81"	$0.00	$0.00	$644.07	$0.00	$0.00	$0.00	$0.00	"$1,545.28"	"$2,447.72"	"$2,472.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC141219-20	SUP	Custom 27803010		SRC141219-20  -  COIL EMBL 12MM 19CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$3,003.48 "	"$2,222.58"	$0.00	"$2,402.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,229.18"	"$2,229.18"	$0.00	$0.00	$625.92	$0.00	$0.00	$0.00	$0.00	"$1,501.74"	"$2,378.76"	"$2,402.78"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRC141230-20	SUP	Custom 27803010		SRC141230-20  -  COIL EMBL 12MM 30CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH	BOTH IP/OP	"$3,134.08 "	"$2,319.22"	$0.00	"$2,507.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,326.11"	"$2,326.11"	$0.00	$0.00	$653.14	$0.00	$0.00	$0.00	$0.00	"$1,567.04"	"$2,482.19"	"$2,507.26"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRE-CV-320S	SUP	Custom 27803010		SRE-CV-320S  -  EXPANDER TISSUE WALL CHART CURVILINEAR EXTREMITY SOFTSPAN	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	$0.00	$0.00	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRE-CV-720S	SUP	Custom 27803010		SRE-CV-720S  -  EXPANDER TISSUE CURVILINEAR 26.2X9CM WALL CHART EXTREMITY	BOTH IP/OP	"$1,825.00 "	"$1,350.50"	$0.00	"$1,460.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,354.52"	"$1,354.52"	$0.00	$0.00	$380.33	$0.00	$0.00	$0.00	$0.00	$912.50	"$1,445.40"	"$1,460.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SRS-003-FSP	SUP	HCPCS C1713		SRS-003-FSP  -  CEMENT BONE NRN SRS FST ST 3ML PTTY STRL	BOTH IP/OP	"$2,018.60 "	"$1,493.76"	$0.00	"$1,614.88"	$908.37	$908.37	$0.00	$0.00	$0.00	$420.73	"$1,498.20"	"$1,498.20"	$0.00	$0.00	$420.68	$0.00	"$1,194.00"	"$1,194.00"	$0.00	"$1,009.30"	"$1,598.73"	"$1,614.88"	$0.00		$0.00	$315.91	$0.00	$0.00	$321.36	$0.00	$0.00	$0.00	$0.00	$0.00
SRS-005-FSP	SUP	HCPCS C1713		SRS-005-FSP  -  CEMENT BONE NRN SRS FST ST 5ML PTTY STRL	BOTH IP/OP	"$3,315.05 "	"$2,453.14"	$0.00	"$2,652.04"	"$1,491.77"	"$1,491.77"	$0.00	$0.00	$0.00	$690.94	"$2,460.43"	"$2,460.43"	$0.00	$0.00	$690.86	$0.00	"$1,634.32"	"$1,634.32"	$0.00	"$1,657.53"	"$2,625.52"	"$2,652.04"	$0.00		$0.00	$518.81	$0.00	$0.00	$527.76	$0.00	$0.00	$0.00	$0.00	$0.00
SRS-010-FSP	SUP	HCPCS C1713		SRS-010-FSP  -  CEMENT BONE NRN SRS FST ST 10ML PTTY STRL	BOTH IP/OP	"$6,518.20 "	"$4,823.47"	$0.00	"$5,214.56"	"$2,933.19"	"$2,933.19"	$0.00	$0.00	$0.00	"$1,358.56"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,358.39"	$0.00	"$3,213.47"	"$3,213.47"	$0.00	"$3,259.10"	"$5,162.41"	"$5,214.56"	$0.00		$0.00	"$1,020.10"	$0.00	$0.00	"$1,037.70"	$0.00	$0.00	$0.00	$0.00	$0.00
SRS-015-FSP	SUP	HCPCS C1713		SRS-015-FSP  -  CEMENT BONE NRN SRS FST ST 15ML PTTY STRL	BOTH IP/OP	"$9,567.20 "	"$7,079.73"	$0.00	"$7,653.76"	"$4,305.24"	"$4,305.24"	$0.00	$0.00	$0.00	"$1,994.04"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,993.80"	$0.00	"$4,716.63"	"$4,716.63"	$0.00	"$4,783.60"	"$7,577.22"	"$7,653.76"	$0.00		$0.00	"$1,497.27"	$0.00	$0.00	"$1,523.10"	$0.00	$0.00	$0.00	$0.00	$0.00
SSSA-EW-09	SUP	Custom 27203010		SSSA-EW-09  -  ADAPTER INTRO LNG 9FR SFSHTH SL XTD WNG VASC ATN	BOTH IP/OP	$110.00 	$81.40	$0.00	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.64	$81.64	$0.00	$0.00	$22.92	$0.00	$0.00	$0.00	$0.00	$55.00	$87.12	$88.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ST-030	SUP	Custom 27203010		BLANKET 30X24IN MED WT PED THRMPLST HPR/HPO H2O CIRC LMNT	BOTH IP/OP	$107.00 	$79.18	$0.00	$85.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.50	$84.74	$85.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ST09875	SUP	HCPCS C1729		CATHETER TWIST LOCK CATH-GUARD  CONTAMINATION SHIELD	BOTH IP/OP	$38.93 	$28.81	$0.00	$31.14	$21.14	$21.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.46	$30.83	$31.14	$0.00		$0.00	$6.09	$0.00	$0.00	$6.20	$0.00	$0.00	$0.00	$0.00	$0.00
ST5678	SUP	HCPCS C1713		ST5678  -  SET SCREW	BOTH IP/OP	$250.00 	$185.00	$0.00	$200.00	$112.50	$112.50	$0.00	$0.00	$0.00	$52.11	$185.55	$185.55	$0.00	$0.00	$52.10	$0.00	$147.88	$147.88	$0.00	$125.00	$198.00	$200.00	$0.00		$0.00	$39.13	$0.00	$0.00	$39.80	$0.00	$0.00	$0.00	$0.00	$0.00
STRAP25	SUP	HCPCS C1781		STRAP25  -  DEVICE FX 5MM SECURESTRAP 25 ABS STRAP MESH DISP HRN REPR	BOTH IP/OP	"$1,527.95 "	"$1,130.68"	$0.00	"$1,222.36"	$687.58	$687.58	$0.00	$0.00	$0.00	$318.46	"$1,134.04"	"$1,134.04"	$0.00	$0.00	$318.42	$0.00	$903.78	$903.78	$0.00	$763.98	"$1,210.14"	"$1,222.36"	$0.00		$0.00	$239.12	$0.00	$0.00	$243.25	$0.00	$0.00	$0.00	$0.00	$0.00
SU16030	SUP	Custom 27203010		HOLDER 8IN HGR NDL NAR	BOTH IP/OP	$84.63 	$62.63	$0.00	$67.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.31	$67.03	$67.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SW46	SUP	Custom 27203010		SOCK ABS 46X3IN SPC UNV APL	BOTH IP/OP	$200.60 	$148.44	$0.00	$160.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.30	$158.88	$160.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SXP77	SUP	Custom 27203010		SXP77  -  SUTURE NONABSORBABLE THK1.5MM 2-0 V-7 30IN 7X3MM 2 ARM BRAID	BOTH IP/OP	$197.33 	$146.02	$0.00	$160.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.46	$146.46	$0.00	$0.00	$41.12	$0.00	$0.00	$0.00	$0.00	$100.15	$158.63	$160.23	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
SYNCRACRTPMEAM	SUP	HCPCS C2621		SYNCRACRTPMEAM  -  SYNCRA CRT-P ADVANCED SYSTEM	BOTH IP/OP	"$20,177.50 "	"$14,931.35"	$0.00	"$16,470.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,204.99"	$0.00	$0.00	$0.00	$0.00	"$10,293.75"	"$16,305.30"	"$16,470.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T1002	SUP	Custom 27203010		T1002  -  RETRACTOR SRG 10IN 30MM POST GLND NK TTH SHLDR OSTM	BOTH IP/OP	$653.13 	$483.32	$0.00	$522.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$484.75	$484.75	$0.00	$0.00	$136.11	$0.00	$0.00	$0.00	$0.00	$326.56	$517.28	$522.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T12BA20D	SUP	Custom 27203010		T12BA20D  -  TOOL LGD T12CM 2MM BALL DIAM	BOTH IP/OP	$412.25 	$305.07	$0.00	$329.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.97	$305.97	$0.00	$0.00	$85.91	$0.00	$0.00	$0.00	$0.00	$206.13	$326.50	$329.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T12BA30D	SUP	Custom 27203010		T12BA30D  -  TOOL LGD T12CM 3MM BALL DIAM	BOTH IP/OP	$412.25 	$305.07	$0.00	$329.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$305.97	$305.97	$0.00	$0.00	$85.91	$0.00	$0.00	$0.00	$0.00	$206.13	$326.50	$329.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T12MH15	SUP	Custom 27203010		T12MH15  -  TOOL LEGEND 12CM 1.5MM MH	BOTH IP/OP	$320.88 	$237.45	$0.00	$256.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.15	$238.15	$0.00	$0.00	$66.87	$0.00	$0.00	$0.00	$0.00	$160.44	$254.14	$256.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T12MH20	SUP	Custom 27203010		T12MH20  -  TOOL LEGEND 12CM 2MM MH	BOTH IP/OP	$320.88 	$237.45	$0.00	$256.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.15	$238.15	$0.00	$0.00	$66.87	$0.00	$0.00	$0.00	$0.00	$160.44	$254.14	$256.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T12MH20D	SUP	Custom 27203010		T12MH20D  -  TOOL LEGEND 12CM 2MM DIAM	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.66	$258.66	$0.00	$0.00	$72.63	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T12MH25	SUP	Custom 27203010		T12MH25  -  TOOL LEGEND 12CM 2.5MM MH	BOTH IP/OP	$320.88 	$237.45	$0.00	$256.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.15	$238.15	$0.00	$0.00	$66.87	$0.00	$0.00	$0.00	$0.00	$160.44	$254.14	$256.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T12MH25D	SUP	Custom 27203010		T12MH25D  -  TOOL LEGEND 12CM 2.5MM DIAM	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.66	$258.66	$0.00	$0.00	$72.63	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T12MH30D	SUP	Custom 27203010		T12MH30D  -  TOOL LEGEND 12CM 3MM DIAM	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.66	$258.66	$0.00	$0.00	$72.63	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T12MH35D	SUP	Custom 27203010		T12MH35D  -  TOOL LEGEND 12CM 3.5MM DIAM	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.66	$258.66	$0.00	$0.00	$72.63	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T12MH45D	SUP	Custom 27203010		T12MH45D  -  TOOL LEGEND 12CM 4.5MM DIAM	BOTH IP/OP	$348.50 	$257.89	$0.00	$278.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$258.66	$258.66	$0.00	$0.00	$72.63	$0.00	$0.00	$0.00	$0.00	$174.25	$276.01	$278.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T1415A	SUP	Custom 27203010		T1415A  -  NEEDLE BIOP STANDARD 14GA 15CM COAXIAL HANDLE TEMNO	BOTH IP/OP	$227.32 	$168.22	$0.00	$168.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.71	$168.71	$0.00	$0.00	$47.37	$0.00	$0.00	$0.00	$0.00	$81.15	$128.54	$129.84	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T14BA20	SUP	Custom 27203010		T14BA20  -  TOOL LEGD 14CM TELESC 2MM BALL	BOTH IP/OP	$331.50 	$245.31	$0.00	$265.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$246.04	$246.04	$0.00	$0.00	$69.08	$0.00	$0.00	$0.00	$0.00	$165.75	$262.55	$265.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T14BA30	SUP	Custom 27203010		T14BA30  -  TOOL LEGD 14CM TELESC 3MM BALL	BOTH IP/OP	$331.50 	$245.31	$0.00	$265.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$246.04	$246.04	$0.00	$0.00	$69.08	$0.00	$0.00	$0.00	$0.00	$165.75	$262.55	$265.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T14BA40	SUP	Custom 27203010		T14BA40  -  TOOL LEGEND 14CM TELESC 4MM BALL	BOTH IP/OP	$331.50 	$245.31	$0.00	$265.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$246.04	$246.04	$0.00	$0.00	$69.08	$0.00	$0.00	$0.00	$0.00	$165.75	$262.55	$265.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T14MH25	SUP	Custom 27203010		T14MH25  -  TOOL LEGEND 14CM 2.5MM MH	BOTH IP/OP	$357.00 	$264.18	$0.00	$285.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.97	$264.97	$0.00	$0.00	$74.40	$0.00	$0.00	$0.00	$0.00	$178.50	$282.74	$285.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T14MH30D	SUP	Custom 27203010		T14MH30D  -  TOOL LEGEND 14CM 3MM MH DIAM	BOTH IP/OP	$391.00 	$289.34	$0.00	$312.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.20	$290.20	$0.00	$0.00	$81.48	$0.00	$0.00	$0.00	$0.00	$195.50	$309.67	$312.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T15MH25	SUP	Custom 27203010		T15MH25  -  TOOL LEGEND 15CM 2.5MM MH	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T15MH30D	SUP	Custom 27203010		T15MH30D  -  TOOL LEGEND 15CM 3MM DIAM	BOTH IP/OP	$367.63 	$272.05	$0.00	$294.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.85	$272.85	$0.00	$0.00	$76.61	$0.00	$0.00	$0.00	$0.00	$183.81	$291.16	$294.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T16X12	SUP	HCPCS C1894		T16X12  -  SHEATH DLV ONQ TNL SYS 12IN 16GA DISP	BOTH IP/OP	$69.00 	$51.06	$0.00	$140.00	$95.03	$95.03	$0.00	$0.00	$0.00	$14.38	$51.21	$51.21	$0.00	$0.00	$14.38	$0.00	$40.81	$40.81	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
T17MH30D	SUP	Custom 27203010		T17MH30D  -  TOOL LEGEND 17CM 3MM DIAM	BOTH IP/OP	$365.50 	$270.47	$0.00	$292.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.27	$271.27	$0.00	$0.00	$76.17	$0.00	$0.00	$0.00	$0.00	$182.75	$289.48	$292.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T17X8	SUP	HCPCS C1894		T17X8  -  TUNNELER SRG 17GA 8IN STRL LF ONQ SHTH DISP	BOTH IP/OP	$69.00 	$51.06	$0.00	$60.00	$40.73	$40.73	$0.00	$0.00	$0.00	$14.38	$51.21	$51.21	$0.00	$0.00	$14.38	$0.00	$40.81	$40.81	$0.00	$37.50	$59.40	$60.00	$0.00		$0.00	$11.74	$0.00	$0.00	$11.94	$0.00	$0.00	$0.00	$0.00	$0.00
T18MH25	SUP	Custom 27203010		T18MH25  -  TOOL MATCH HEAD 2.5 MM 18 CM	BOTH IP/OP	$333.63 	$246.89	$0.00	$266.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.62	$247.62	$0.00	$0.00	$69.53	$0.00	$0.00	$0.00	$0.00	$166.81	$264.23	$266.90	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T18MH30D	SUP	Custom 27203010		T18MH30D  -  TOOL MATCH HEAD 3.0 MM DIAMOND	BOTH IP/OP	$367.63 	$272.05	$0.00	$294.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.85	$272.85	$0.00	$0.00	$76.61	$0.00	$0.00	$0.00	$0.00	$183.81	$291.16	$294.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T4031	SUP	Custom 27203010		GRINDER TISS LG 50ML CNTRF TUBE PCTV SLV PEEL PCH STRL DISP	BOTH IP/OP	$28.70 	$21.24	$0.00	$22.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.35	$22.73	$22.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T43101	SUP	Custom 27804086		T43101  -  GRAFT BN .5ML GRFTN PTTY JR DBM	BOTH IP/OP	$312.50 	$231.25	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.94	$231.94	$0.00	$0.00	$65.13	$0.00	$0.00	$0.00	$0.00	$156.25	$247.50	$250.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T43102	SUP	Custom 27804086		T43102  -  GRAFT BONE PUTTY JAR GRAFTON DEMINERALIZED BONE MATRIX 1ML	BOTH IP/OP	$350.00 	$259.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.77	$259.77	$0.00	$0.00	$72.94	$0.00	$0.00	$0.00	$0.00	$175.00	$277.20	$280.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T43103	SUP	Custom 27804086		T43103  -  GRAFT BN 2.5ML GRFTN PTTY JR DBM	BOTH IP/OP	"$1,190.00 "	$880.60	$0.00	$952.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.22	$883.22	$0.00	$0.00	$248.00	$0.00	$0.00	$0.00	$0.00	$595.00	$942.48	$952.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T43105	SUP	Custom 27804086		T43105  -  GRAFT BONE PUTTY JAR GRAFTON DEMINERALIZED BONE MATRIX 5ML	BOTH IP/OP	"$2,162.50 "	"$1,600.25"	$0.00	"$1,730.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,605.01"	"$1,605.01"	$0.00	$0.00	$450.67	$0.00	$0.00	$0.00	$0.00	"$1,081.25"	"$1,712.70"	"$1,730.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T9MH15	SUP	Custom 27203010		T9MH15  -  TOOL LEGEND 9CM 1.5MM MH	BOTH IP/OP	$318.75 	$235.88	$0.00	$255.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.58	$236.58	$0.00	$0.00	$66.43	$0.00	$0.00	$0.00	$0.00	$159.38	$252.45	$255.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T9MH20	SUP	Custom 27203010		T9MH20  -  TOOL LEGEND 9CM 2MM MH	BOTH IP/OP	$318.75 	$235.88	$0.00	$255.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.58	$236.58	$0.00	$0.00	$66.43	$0.00	$0.00	$0.00	$0.00	$159.38	$252.45	$255.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T9MH25	SUP	Custom 27203010		T9MH25  -  TOOL LEGEND 9CM 2.5MM MH	BOTH IP/OP	$318.75 	$235.88	$0.00	$255.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.58	$236.58	$0.00	$0.00	$66.43	$0.00	$0.00	$0.00	$0.00	$159.38	$252.45	$255.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T9MH25D	SUP	Custom 27203010		T9MH25D  -  TOOL LEGEND 9CM 2.5MM DIAM	BOTH IP/OP	$361.25 	$267.33	$0.00	$289.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.12	$268.12	$0.00	$0.00	$75.28	$0.00	$0.00	$0.00	$0.00	$180.63	$286.11	$289.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T9MH30D	SUP	Custom 27203010		T9MH30D  -  TOOL LEGEND 9CM 3MM MH DIAM	BOTH IP/OP	$361.25 	$267.33	$0.00	$289.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.12	$268.12	$0.00	$0.00	$75.28	$0.00	$0.00	$0.00	$0.00	$180.63	$286.11	$289.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T9MH35D	SUP	Custom 27203010		T9MH35D  -  TOOL LEGEND 9CM 3.5MM DIAM	BOTH IP/OP	$361.25 	$267.33	$0.00	$289.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.12	$268.12	$0.00	$0.00	$75.28	$0.00	$0.00	$0.00	$0.00	$180.63	$286.11	$289.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
T9MH45D	SUP	Custom 27203010		T9MH45D  -  TOOL LEGEND 9CM 4.5MM DIAM	BOTH IP/OP	$361.25 	$267.33	$0.00	$289.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.12	$268.12	$0.00	$0.00	$75.28	$0.00	$0.00	$0.00	$0.00	$180.63	$286.11	$289.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TA3035L	SUP	Custom 27203010		TA3035L  -  RELOAD STPLR 30MMX3.5MM BLU STRL LF 1.5MM DST TA 2 ROW LNR	BOTH IP/OP	$89.75 	$66.42	$0.00	$72.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.61	$66.61	$0.00	$0.00	$18.70	$0.00	$0.00	$0.00	$0.00	$45.55	$72.15	$72.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TA3035S	SUP	Custom 27203010		TA3035S  -  STAPLER INTERNAL 30MMX3.5MM 1.5MM 2 ROW 2 ACTION HANDLE	BOTH IP/OP	$204.93 	$151.65	$0.00	$166.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.10	$152.10	$0.00	$0.00	$42.71	$0.00	$0.00	$0.00	$0.00	$104.00	$164.74	$166.40	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TA3048S	SUP	Custom 27203010		TA3048S  -  STAPLER INTERNAL 30MMX4.8MM 2MM 2 ROW 2 ACTION HANDLE LINEAR	BOTH IP/OP	$216.93 	$160.53	$0.00	$173.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.01	$161.01	$0.00	$0.00	$45.21	$0.00	$0.00	$0.00	$0.00	$108.47	$171.81	$173.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TA30V3L	SUP	Custom 27203010		TA30V3L  -  RELOAD STPLR 30MMX2.5MM WHT STRL LF 1MM DST TA 3 ROW LNR CTR	BOTH IP/OP	$102.77 	$76.05	$0.00	$82.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.27	$76.27	$0.00	$0.00	$21.42	$0.00	$0.00	$0.00	$0.00	$51.38	$81.39	$82.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TA30V3S	SUP	Custom 27203010		TA30V3S  -  STAPLER INTERNAL 30MM 3 ROW 2 ACTION HANDLE LINEAR CUTTER	BOTH IP/OP	$249.36 	$184.53	$0.00	$199.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.68	$197.49	$199.49	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TA6035L	SUP	Custom 27203010		TA6035L  -  RELOAD STPLR 60MMX3.5MM BLU STRL LF 1.5MM DST TA 2 ROW LNR	BOTH IP/OP	$100.93 	$74.69	$0.00	$81.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.91	$74.91	$0.00	$0.00	$21.03	$0.00	$0.00	$0.00	$0.00	$51.22	$81.13	$81.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TA6035S	SUP	Custom 27203010		TA6035S  -  STAPLER INTERNAL 60X3.5MM STAPLE 2 ACTION HANDLE LINEAR	BOTH IP/OP	$211.95 	$156.84	$0.00	$172.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.31	$157.31	$0.00	$0.00	$44.17	$0.00	$0.00	$0.00	$0.00	$107.56	$170.38	$172.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TA6048S	SUP	Custom 27203010		TA6048S  -  STAPLER INTERNAL 60X4.8MM STAPLE 2 ACTION HANDLE LINEAR	BOTH IP/OP	$217.44 	$160.91	$0.00	$173.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.72	$172.21	$173.95	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TA9035L	SUP	Custom 27203010		TA9035L  -  RELOAD STPLR 90MMX3.5MM BLU STRL LF 1.5MM DST TA 2 ROW LNR	BOTH IP/OP	$106.55 	$78.85	$0.00	$86.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.08	$79.08	$0.00	$0.00	$22.21	$0.00	$0.00	$0.00	$0.00	$54.07	$85.65	$86.52	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TA9035S	SUP	Custom 27203010		TA9035S  -  STAPLER INTERNAL 90X3.5MM STAPLE 2 ACTION HANDLE LINEAR	BOTH IP/OP	$223.78 	$165.60	$0.00	$181.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.09	$166.09	$0.00	$0.00	$46.63	$0.00	$0.00	$0.00	$0.00	$113.57	$179.89	$181.71	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TA9048L	SUP	Custom 27203010		TA9048L  -  RELOAD STPLR 90MMX4.8MM GRN STRL LF 2MM DST TA 2 ROW LNR CTR	BOTH IP/OP	$109.32 	$80.90	$0.00	$87.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.66	$86.58	$87.45	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TA9048S	SUP	Custom 27203010		TA9048S  -  STAPLER INTERNAL 90X4.8MM STAPLE 2 ACTION HANDLE LINEAR	BOTH IP/OP	$263.98 	$195.35	$0.00	$211.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.92	$195.92	$0.00	$0.00	$55.01	$0.00	$0.00	$0.00	$0.00	$131.99	$209.07	$211.18	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TB-1550K-S	SUP	HCPCS C1713		TB-1550K-S  -  PIN TNSNBND SYS 50MM ORTH SS STRL	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
TB-1570K-S	SUP	HCPCS C1713		TB-1570K-S  -  PIN TNSNBND KIT 70MM ORTH SS STRL	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
TB-1590K-S	SUP	HCPCS C1713		TB-1590K-S  -  PIN TNSNBND SYS 90MM ORTH SS STRL	BOTH IP/OP	$510.00 	$377.40	$0.00	$408.00	$229.50	$229.50	$0.00	$0.00	$0.00	$106.30	$378.52	$378.52	$0.00	$0.00	$106.28	$0.00	$301.67	$301.67	$0.00	$255.00	$403.92	$408.00	$0.00		$0.00	$79.82	$0.00	$0.00	$81.19	$0.00	$0.00	$0.00	$0.00	$0.00
TC003	SUP	HCPCS C1729		TC003  -  CATH IU THRMCH BLN ABLT EXCESSIVE MENSTRUAL BLD	BOTH IP/OP	"$2,472.50 "	"$1,829.65"	$0.00	"$1,978.00"	"$1,342.57"	"$1,342.57"	$0.00	$0.00	$0.00	$515.33	"$1,835.09"	"$1,835.09"	$0.00	$0.00	$515.27	$0.00	"$1,462.48"	"$1,462.48"	$0.00	"$1,236.25"	"$1,958.22"	"$1,978.00"	$0.00		$0.00	$386.95	$0.00	$0.00	$393.62	$0.00	$0.00	$0.00	$0.00	$0.00
TC7465	SUP	Custom 27203010		TRACHEOSTOMY TRAY	BOTH IP/OP	$255.98 	$189.43	$0.00	$204.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.99	$202.74	$204.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TDF010U	SUP	HCPCS C1721		TDF010U  -  PARADYM 9550 RF DR	BOTH IP/OP	"$38,750.00 "	"$28,675.00"	$0.00	"$31,000.00"	"$17,437.50"	"$17,437.50"	$0.00	$0.00	$0.00	"$8,076.47"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,075.50"	$0.00	"$19,103.75"	"$19,103.75"	$0.00	"$19,375.00"	"$30,690.00"	"$31,000.00"	$0.00		$0.00	"$6,064.38"	$0.00	$0.00	"$6,169.00"	$0.00	$0.00	$0.00	$0.00	$0.00
TDF011U	SUP	HCPCS C1722		TDF011U  -  PARADYM 9250 RF VR	BOTH IP/OP	"$33,750.00 "	"$24,975.00"	$0.00	"$27,000.00"	"$15,187.50"	"$15,187.50"	$0.00	$0.00	$0.00	"$7,034.34"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,033.50"	$0.00	"$16,638.75"	"$16,638.75"	$0.00	"$16,875.00"	"$26,730.00"	"$27,000.00"	$0.00		$0.00	"$5,281.88"	$0.00	$0.00	"$5,373.00"	$0.00	$0.00	$0.00	$0.00	$0.00
TDF012U	SUP	HCPCS C1882		TDF012U  -  PARADYM RF CRT 9750	BOTH IP/OP	"$45,500.00 "	"$33,670.00"	$0.00	"$36,400.00"	"$20,475.00"	"$20,475.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,482.20"	$0.00	"$22,431.50"	"$22,431.50"	$0.00	"$22,750.00"	"$36,036.00"	"$36,400.00"	$0.00		$0.00	"$7,120.75"	$0.00	$0.00	"$7,243.60"	$0.00	$0.00	$0.00	$0.00	$0.00
TDF012U SYSTEM	SUP	HCPCS C1882		TDF012U SYSTEM  -  PARADYM RF CRT 9750 SYSTEM	BOTH IP/OP	"$60,500.00 "	"$44,770.00"	$0.00	"$48,400.00"	"$27,225.00"	"$27,225.00"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$12,608.20"	$0.00	"$29,826.50"	"$29,826.50"	$0.00	"$30,250.00"	"$47,916.00"	"$48,400.00"	$0.00		$0.00	"$7,751.33"	$0.00	$0.00	"$8,138.89"	$0.00	$0.00	$0.00	$0.00	$0.00
TE-1000	SUP	Custom 27203010		TE-1000  -  TOOL INSERTION EMBEDDING CURVED PLASTIC HANDLE TITANIUM TIP	BOTH IP/OP	$332.50 	$246.05	$0.00	$266.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$246.78	$246.78	$0.00	$0.00	$69.29	$0.00	$0.00	$0.00	$0.00	$166.25	$263.34	$266.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TECR1510	SUP	HCPCS C1781		TECR1510  -  MESH SRG RECT 6X4IN PARIETEX 2D FLT SHT RGD PLSTR HRN	BOTH IP/OP	$179.68 	$132.96	$0.00	$143.74	$80.85	$80.85	$0.00	$0.00	$0.00	$37.45	$133.35	$133.35	$0.00	$0.00	$37.44	$0.00	$106.28	$106.28	$0.00	$89.84	$142.31	$143.74	$0.00		$0.00	$28.12	$0.00	$0.00	$28.60	$0.00	$0.00	$0.00	$0.00	$0.00
TECT1510AL	SUP	HCPCS C1781		TECT1510AL  -  MESH SRG 6X4IN PARIETEX FLXB ANTM PLSTR LT HRN	BOTH IP/OP	$294.83 	$218.17	$0.00	$314.48	$176.90	$176.90	$0.00	$0.00	$0.00	$61.45	$218.82	$218.82	$0.00	$0.00	$61.44	$0.00	$174.39	$174.39	$0.00	$196.55	$311.34	$314.48	$0.00		$0.00	$61.52	$0.00	$0.00	$62.58	$0.00	$0.00	$0.00	$0.00	$0.00
TECT1510AR	SUP	HCPCS C1781		TECT1510AR  -  MESH SURG PARIETEX 6X4IN RIGHT HERN 3D FLXB LTWT ANTM	BOTH IP/OP	$294.83 	$218.17	$0.00	$340.10	$191.31	$191.31	$0.00	$0.00	$0.00	$61.45	$218.82	$218.82	$0.00	$0.00	$61.44	$0.00	$174.39	$174.39	$0.00	$212.56	$336.70	$340.10	$0.00		$0.00	$66.53	$0.00	$0.00	$67.68	$0.00	$0.00	$0.00	$0.00	$0.00
TEM1208GL	SUP	HCPCS C1781		TEM1208GL  -  MESH SURG 4.7X3IN LEFT FLAP SELF FIXATING ANATOMIC	BOTH IP/OP	$613.08 	$453.68	$0.00	$591.52	$332.73	$332.73	$0.00	$0.00	$0.00	$127.78	$455.02	$455.02	$0.00	$0.00	$127.76	$0.00	$362.63	$362.63	$0.00	$369.70	$585.60	$591.52	$0.00		$0.00	$115.72	$0.00	$0.00	$117.71	$0.00	$0.00	$0.00	$0.00	$0.00
TEM1208GR	SUP	HCPCS C1781		TEM1208GR  -  MESH SURG 4.7X3IN RIGHT FLAP SELF FIXATING ANATOMIC	BOTH IP/OP	$613.08 	$453.68	$0.00	$591.52	$332.73	$332.73	$0.00	$0.00	$0.00	$127.78	$455.02	$455.02	$0.00	$0.00	$127.76	$0.00	$362.63	$362.63	$0.00	$369.70	$585.60	$591.52	$0.00		$0.00	$115.72	$0.00	$0.00	$117.71	$0.00	$0.00	$0.00	$0.00	$0.00
TEST	SUP	Custom 27203010		STENT URETERAL RESONANCE METALLIC 6.0 X 26CM	BOTH IP/OP	"$2,425.00 "	"$1,794.50"	$0.00	"$1,940.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,212.50"	"$1,920.60"	"$1,940.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TET1309	SUP	HCPCS C1781		TET1309  -  MESH SRG RECT 5.2X3.6IN LF PARIETEX 3D HCMB WV KNIT FLT SHT	BOTH IP/OP	$206.50 	$152.81	$0.00	$220.26	$123.90	$123.90	$0.00	$0.00	$0.00	$43.04	$153.26	$153.26	$0.00	$0.00	$43.03	$0.00	$122.14	$122.14	$0.00	$137.66	$218.06	$220.26	$0.00		$0.00	$43.09	$0.00	$0.00	$43.83	$0.00	$0.00	$0.00	$0.00	$0.00
TF-19A	SUP	Custom 27803010		TF-19A  -  VALVE AORTIC 15MM 24MM 19MM TRIFECTA 12MM TISS ANNULUS LTRM	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TF-21A	SUP	Custom 27803010		TF-21A  -  VALVE AORTIC 16MM 21MM 26MM TRIFECTA 13MM TISS ANNULUS LTRM	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TF-23A	SUP	Custom 27803010		TF-23A  -  VALVE AOR 13MM 23MM 38IN 17MM TRIFECTA LINX AC BPRTH STNT	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TF-25A	SUP	Custom 27803010		TF-25A  -  VALVE AORTIC 18MM 25MM 31MM TRIFECTA 14MM TISS ANNULUS LTRM	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TF-27A	SUP	Custom 27803010		TF-27A  -  VALVE AOR 27MM 27MM 33MM 19MM TRIFECTA LINX FTG RST STNT	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TF-29A	SUP	Custom 27803010		TF-29A  -  VALVE AORTIC 20MM 29MM 35MM TRIFECTA 16MM TISS ANNULUS LTRM	BOTH IP/OP	"$15,000.00 "	"$11,100.00"	$0.00	"$12,000.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,126.00"	$0.00	$0.00	$0.00	$0.00	"$7,500.00"	"$11,880.00"	"$12,000.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TH90G01	SUP	HCPCS C1787		TH90G01  -  KIT STM NS LF PRX HNDST GU REUSE	BOTH IP/OP	"$4,875.00 "	"$3,607.50"	$0.00	"$3,900.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,437.50"	"$3,861.00"	"$3,900.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
THD155024/2	SUP	HCPCS C1751		THD155024/2  -  CATHETER CV STD 14.5FR 19CM HMGLD PRMCTH STAR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
THD155028/3	SUP	HCPCS C1751		THD155028/3  -  CATHETER CV STD 14.5FR 23CM HMGLD PRMCTH STAR	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$196.88	$196.88	$0.00	$0.00	$0.00	$91.19	$324.71	$324.71	$0.00	$0.00	$91.18	$0.00	$258.78	$258.78	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$68.47	$0.00	$0.00	$69.65	$0.00	$0.00	$0.00	$0.00	$0.00
THD155032	SUP	HCPCS C1750		THD155032  -  SET CATH 32CM 15.5FR TTN HD 2 LUM HMDIAL	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
THD155036	SUP	HCPCS C1750		THD155036  -  SET CATH 90D STRG 15.5FR 36CM TTN HD INTRO NDL GW DIL SCPL	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
THD155040	SUP	HCPCS C1750		THD155040  -  SET CATH 90D STRG 15.5FR 40CM TTN HD INTRO NDL GW DIL SCPL	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
THD155055	SUP	HCPCS C1750		THD155055  -  SET CATH 55CM 15.5FR TTN HD 2 LUM LTRM HMDIAL	BOTH IP/OP	$475.00 	$351.50	$0.00	$380.00	$213.75	$213.75	$0.00	$0.00	$0.00	$99.00	$352.55	$352.55	$0.00	$0.00	$98.99	$0.00	$280.96	$280.96	$0.00	$237.50	$376.20	$380.00	$0.00		$0.00	$74.34	$0.00	$0.00	$75.62	$0.00	$0.00	$0.00	$0.00	$0.00
THSF-35-145-AUS	SUP	HCPCS C1769		THSF-35-145-AUS  -  GWIRE VASC .035IN 145CM 8CM STR FLX TP AMPTZ ULT STF SS PTFE	BOTH IP/OP	$59.45 	$43.99	$0.00	$47.56	$32.28	$32.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.73	$47.08	$47.56	$0.00		$0.00	$9.30	$0.00	$0.00	$9.46	$0.00	$0.00	$0.00	$0.00	$0.00
TKFV-2	SUP	Custom 27203010		TKFV-2  -  CLAMP SURG MIC 2 DISP 15GM GRN .2-1MM VN	BOTH IP/OP	$178.75 	$132.28	$0.00	"$1,430.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.67	$132.67	$0.00	$0.00	$37.25	$0.00	$0.00	$0.00	$0.00	$893.75	"$1,415.70"	"$1,430.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TKMV-1	SUP	Custom 27203010		TKMV-1  -  CLAMP SURG 30GM/SQ MM MEDIUM HEMISPHERE BIOVER POLYCARBONATE	BOTH IP/OP	$87.50 	$64.75	$0.00	$70.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.94	$64.94	$0.00	$0.00	$18.24	$0.00	$0.00	$0.00	$0.00	$43.75	$69.30	$70.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TKMV-2	SUP	Custom 27203010		TKMV-2  -  CLAMP SRG 30GM/SQ MM MED HMSPHR BIOVER 2 PLYCRB VN	BOTH IP/OP	$162.50 	$120.25	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.61	$120.61	$0.00	$0.00	$33.87	$0.00	$0.00	$0.00	$0.00	$81.25	$128.70	$130.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TKS100	SUP	Custom 27203010		TKS100  -  TUBING SCT STRL NEURO	BOTH IP/OP	$23.76 	$17.58	$0.00	$19.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.63	$17.63	$0.00	$0.00	$4.95	$0.00	$0.00	$0.00	$0.00	$11.88	$18.00	$19.01	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TN30MCD	SUP	Custom 27203010		TN30MCD  -  BURR SURG 3MM MATCH FLUTED DIAMOND COARSE TRANSNASAL STERILE	BOTH IP/OP	$904.50 	$669.33	$0.00	$723.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$671.32	$671.32	$0.00	$0.00	$188.50	$0.00	$0.00	$0.00	$0.00	$452.25	$716.36	$723.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TN30MFL	SUP	Custom 27203010		TN30MFL  -  BURR SURG 3MM MATCH FLUTED TRANSNASAL STERILE	BOTH IP/OP	$904.50 	$669.33	$0.00	$723.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$671.32	$671.32	$0.00	$0.00	$188.50	$0.00	$0.00	$0.00	$0.00	$452.25	$716.36	$723.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TN7115	SUP	Custom 27203010		PROCESSOR TISS PREPRC SOL TSTK XP	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TN7120	SUP	Custom 27203010		FIXATIVE TSTK XP 3.8L MOL HISTOLGY	BOTH IP/OP	$111.25 	$82.33	$0.00	$89.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.63	$88.11	$89.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TO-FTRT	SUP	Custom 27203010		TO-FTRT  -  RTRCTR TOBY 2.5MM 4MM SM LG FNL SHOHN TNDN SHTH SURG	BOTH IP/OP	$908.38 	$672.20	$0.00	$726.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$674.20	$674.20	$0.00	$0.00	$189.31	$0.00	$0.00	$0.00	$0.00	$454.19	$719.44	$726.70	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TP-14	SUP	HCPCS C1713		TP-14  -  PEG FIX 2.5MM 14MM PTHRD	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
TP-16	SUP	HCPCS C1713		TP-16  -  PEG 2.5MM 16MM LNG THRD	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$36.47	$129.89	$129.89	$0.00	$0.00	$36.47	$0.00	$103.51	$103.51	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
TP20	SUP	HCPCS C1713		TP20  -  PEG FIXAT 2.5MM 20MM ORTH THRD	BOTH IP/OP	$175.00 	$129.50	$0.00	$140.00	$78.75	$78.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$138.60	$140.00	$0.00		$0.00	$27.39	$0.00	$0.00	$27.86	$0.00	$0.00	$0.00	$0.00	$0.00
TP341-M01	SUP	Custom 27203010		TP341-M01  -  2.0-2.5MM BROKEN SCREW HEAD	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TP342-M01	SUP	Custom 27203010		TP342-M01  -  TIP XTRT 2.5-4 MM BRKN SCR	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TP343-M01	SUP	Custom 27203010		TP343-M01  -  3.5-5.0MM BROKEN SCREW HEAD	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TP344-M01	SUP	Custom 27203010		TP344-M01  -  4.5-6.0MM BROKEN SCREW HEAD	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TP345-M01	SUP	Custom 27203010		TP345-M01  -  5.5-7.0MM BROKEN SCREW HEAD	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TP346-M01	SUP	Custom 27203010		TP346-M01  -  7.0-8.0MM BROKEN SCREW HEAD	BOTH IP/OP	$562.50 	$416.25	$0.00	$450.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.49	$417.49	$0.00	$0.00	$117.23	$0.00	$0.00	$0.00	$0.00	$281.25	$445.50	$450.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TP347-M01	SUP	Custom 27203010		TP347-M01  -  2.0-2.5MM STRIPPED SCREW HEAD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TP348-M01	SUP	Custom 27203010		TP348-M01  -  2.5-3.5MM STRIPPED SCREW HEAD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TP349-M01	SUP	Custom 27203010		TP349-M01  -  3.5-4.5MM STRIPPED SCREW HEAD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TP350-M01	SUP	Custom 27203010		TP350-M01  -  4.5-5.5MM STRIPPED SCREW HEAD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TP351-M01	SUP	Custom 27203010		TP351-M01  -  5.0-6.5MM STRIPPED SCREW HEAD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TP352-M01	SUP	Custom 27203010		TP352-M01  -  6.0-7.0MM STRIPPED SCREW HEAD	BOTH IP/OP	$512.50 	$379.25	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.38	$380.38	$0.00	$0.00	$106.81	$0.00	$0.00	$0.00	$0.00	$256.25	$405.90	$410.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TPEG-14	SUP	HCPCS C1713		TPEG-14  -  PEG FIX 14MM THREAD LOCK TORX WRIST VOLAR	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
TPEG-16	SUP	HCPCS C1713		TPEG-16  -  PEG FIX 16MM THREAD LOCK TORX WRIST VOLAR	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
TPEG-18	SUP	HCPCS C1713		TPEG-18  -  PEG FIX 18MM THREAD LOCK TORX WRIST VOLAR	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
TPEG-20	SUP	HCPCS C1713		TPEG-20  -  PEG FIX 20MM THREAD LOCK TORX WRIST VOLAR	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
TPEG-22	SUP	HCPCS C1713		TPEG-22  -  PEG FIX 22MM THREAD LOCK TORX WRIST VOLAR	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
TPEG-24	SUP	HCPCS C1713		TPEG-24  -  PEG FIX 24MM THREAD LOCK TORX WRIST VOLAR	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
TPEG-28	SUP	HCPCS C1713		TPEG-28  -  PEG FIX 28MM THREAD LOCK TORX WRIST VOLAR	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23100-TS	SUP	HCPCS C1713		TPLS-23100-TS  -  PEG FX 2.3MM 10MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23120-TS	SUP	HCPCS C1713		TPLS-23120-TS  -  PEG FX 2.3MM 12MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23140-TS	SUP	HCPCS C1713		TPLS-23140-TS  -  PEG FX 2.3MM 14MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23160-TS	SUP	HCPCS C1713		TPLS-23160-TS  -  PEG FX 2.3MM 16MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23170-TS	SUP	HCPCS C1713		TPLS-23170-TS  -  PEG FX 2.3MM 17MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23180-TS	SUP	HCPCS C1713		TPLS-23180-TS  -  PEG FIX 2.3MM 18MM THREADED LOCKING GEMINUS TITANIUM DISTAL	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23190-TS	SUP	HCPCS C1713		TPLS-23190-TS  -  PEG FX 2.3MM 19MM NS THRDLK TI GEMINUS VOLR PLT SYS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23200-TS	SUP	HCPCS C1713		TPLS-23200-TS  -  PEG FX 2.3MM 20MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23210-TS	SUP	HCPCS C1713		TPLS-23210-TS  -  PEG FX 2.3MM 21MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23220-TS	SUP	HCPCS C1713		TPLS-23220-TS  -  PEG FX 2.3MM 22MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23230-TS	SUP	HCPCS C1713		TPLS-23230-TS  -  PEG FX 2.3MM 23MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23240-TS	SUP	HCPCS C1713		TPLS-23240-TS  -  PEG FX 2.3MM 24MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23260-TS	SUP	HCPCS C1713		TPLS-23260-TS  -  PEG FX 2.3MM 26MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23280-TS	SUP	HCPCS C1713		TPLS-23280-TS  -  PEG FX 2.3MM 28MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23300-TS	SUP	HCPCS C1713		TPLS-23300-TS  -  PEG FX 2.3MM 30MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPLS-23320-TS	SUP	HCPCS C1713		TPLS-23320-TS  -  PEG FX 2.3MM 32MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPM002U	SUP	HCPCS C1786		TPM002U  -  REPLY SR	BOTH IP/OP	"$6,962.50 "	"$5,152.25"	$0.00	"$5,570.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,451.16"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,450.99"	$0.00	"$3,432.51"	"$3,432.51"	$0.00	"$3,481.25"	"$5,514.30"	"$5,570.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TPM002U SYSTEM	SUP	HCPCS C1786		TPM002U SYSTEM  -  REPLY SR SYSTEM	BOTH IP/OP	"$8,205.00 "	"$6,071.70"	$0.00	"$6,564.00"	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,710.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,709.92"	$0.00	"$4,045.07"	"$4,045.07"	$0.00	"$4,102.50"	"$6,498.36"	"$6,564.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TPNL-27100-TS	SUP	HCPCS C1713		TPNL-27100-TS  -  PEG FX 2.7MM 10MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPNL-27120-TS	SUP	HCPCS C1713		TPNL-27120-TS  -  PEG FX 2.7MM 12MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPNL-27140-TS	SUP	HCPCS C1713		TPNL-27140-TS  -  PEG FX 2.7MM 14MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPNL-27160-TS	SUP	HCPCS C1713		TPNL-27160-TS  -  PEG FX 2.7MM 16MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPNL-27180-TS	SUP	HCPCS C1713		TPNL-27180-TS  -  PEG FX 2.7MM 18MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPNL-27200-TS	SUP	HCPCS C1713		TPNL-27200-TS  -  PEG FIX 2.7MM 20MM THREADED NONLOCKING GEMINUS TITANIUM	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
TPNL-27220-TS	SUP	HCPCS C1713		TPNL-27220-TS  -  PEG FIX 2.7MM 22MM THREADED NONLOCKING GEMINUS TITANIUM	BOTH IP/OP	$247.50 	$183.15	$0.00	$198.00	$111.38	$111.38	$0.00	$0.00	$0.00	$51.59	$183.69	$183.69	$0.00	$0.00	$51.58	$0.00	$146.40	$146.40	$0.00	$123.75	$196.02	$198.00	$0.00		$0.00	$38.73	$0.00	$0.00	$39.40	$0.00	$0.00	$0.00	$0.00	$0.00
TPNL-27240-TS	SUP	HCPCS C1713		TPNL-27240-TS  -  PEG FX 2.7MM 24MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPNL-27260-TS	SUP	HCPCS C1713		TPNL-27260-TS  -  PEG FX 2.7MM 26MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPNL-27280-TS	SUP	HCPCS C1713		TPNL-27280-TS  -  PEG FX 2.7MM 28MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPNL-27300-TS	SUP	HCPCS C1713		TPNL-27300-TS  -  PEG FX 2.7MM 30MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPNL-27320-TS	SUP	HCPCS C1713		TPNL-27320-TS  -  PEG FX 2.7MM 32MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS	BOTH IP/OP	$217.50 	$160.95	$0.00	$174.00	$97.88	$97.88	$0.00	$0.00	$0.00	$45.33	$161.43	$161.43	$0.00	$0.00	$45.33	$0.00	$128.65	$128.65	$0.00	$108.75	$172.26	$174.00	$0.00		$0.00	$34.04	$0.00	$0.00	$34.63	$0.00	$0.00	$0.00	$0.00	$0.00
TPT1000	SUP	Custom 27203010		TRAY DRAIN 4.75IN 8FR 15GA PU NDL THOR PARA 1.5IN STRL LTX	BOTH IP/OP	$75.25 	$55.69	$0.00	$60.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.63	$59.60	$60.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TR-H200L-S	SUP	HCPCS C1776		TR-H200L-S  -  HEAD RADL 20MM LEFT ELB	BOTH IP/OP	"$6,015.00 "	"$4,451.10"	$0.00	"$4,812.00"	"$2,706.75"	"$2,706.75"	$0.00	$0.00	$0.00	"$1,253.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,253.53"	$0.00	"$2,965.40"	"$2,965.40"	$0.00	"$3,007.50"	"$4,763.88"	"$4,812.00"	$0.00		$0.00	$941.35	$0.00	$0.00	$957.59	$0.00	$0.00	$0.00	$0.00	$0.00
TR-H200R-S	SUP	HCPCS C1776		TR-H200R-S  -  HEAD RADL 4D 20MM RT ELB	BOTH IP/OP	"$6,015.00 "	"$4,451.10"	$0.00	"$4,812.00"	"$2,706.75"	"$2,706.75"	$0.00	$0.00	$0.00	"$1,253.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,253.53"	$0.00	"$2,965.40"	"$2,965.40"	$0.00	"$3,007.50"	"$4,763.88"	"$4,812.00"	$0.00		$0.00	$941.35	$0.00	$0.00	$957.59	$0.00	$0.00	$0.00	$0.00	$0.00
TR-H220L-S	SUP	HCPCS C1776		TR-H220L-S  -  HEAD RADL ANG 22MM STRL ACUMED ARH ANTM ELB LT	BOTH IP/OP	"$6,015.00 "	"$4,451.10"	$0.00	"$4,812.00"	"$2,706.75"	"$2,706.75"	$0.00	$0.00	$0.00	"$1,253.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,253.53"	$0.00	"$2,965.40"	"$2,965.40"	$0.00	"$3,007.50"	"$4,763.88"	"$4,812.00"	$0.00		$0.00	$941.35	$0.00	$0.00	$957.59	$0.00	$0.00	$0.00	$0.00	$0.00
TR-H220R-S	SUP	HCPCS C1776		TR-H220R-S  -  HEAD RADL 22MM RT	BOTH IP/OP	"$6,015.00 "	"$4,451.10"	$0.00	"$4,812.00"	"$2,706.75"	"$2,706.75"	$0.00	$0.00	$0.00	"$1,253.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,253.53"	$0.00	"$2,965.40"	"$2,965.40"	$0.00	"$3,007.50"	"$4,763.88"	"$4,812.00"	$0.00		$0.00	$941.35	$0.00	$0.00	$957.59	$0.00	$0.00	$0.00	$0.00	$0.00
TR-H240R-S	SUP	HCPCS C1776		TR-H240R-S  -  HEAD RADL ANG 24MM STRL ACUMED ARH ANTM ELB RT	BOTH IP/OP	"$6,015.00 "	"$4,451.10"	$0.00	"$4,812.00"	"$2,706.75"	"$2,706.75"	$0.00	$0.00	$0.00	"$1,253.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,253.53"	$0.00	"$2,965.40"	"$2,965.40"	$0.00	"$3,007.50"	"$4,763.88"	"$4,812.00"	$0.00		$0.00	$941.35	$0.00	$0.00	$957.59	$0.00	$0.00	$0.00	$0.00	$0.00
TR-H260L-S	SUP	HCPCS C1776		TR-H260L-S  -  HEAD RADL ANG 26MM STRL ACUMED ARH ANTM ELB LT	BOTH IP/OP	"$6,015.00 "	"$4,451.10"	$0.00	"$4,812.00"	"$2,706.75"	"$2,706.75"	$0.00	$0.00	$0.00	"$1,253.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,253.53"	$0.00	"$2,965.40"	"$2,965.40"	$0.00	"$3,007.50"	"$4,763.88"	"$4,812.00"	$0.00		$0.00	$941.35	$0.00	$0.00	$957.59	$0.00	$0.00	$0.00	$0.00	$0.00
TR-H260R-S	SUP	HCPCS C1776		TR-H260R-S  -  HEAD RADL 26MM 4D RIGHT ANTM STRL	BOTH IP/OP	"$6,015.00 "	"$4,451.10"	$0.00	"$4,812.00"	"$2,706.75"	"$2,706.75"	$0.00	$0.00	$0.00	"$1,253.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,253.53"	$0.00	"$2,965.40"	"$2,965.40"	$0.00	"$3,007.50"	"$4,763.88"	"$4,812.00"	$0.00		$0.00	$941.35	$0.00	$0.00	$957.59	$0.00	$0.00	$0.00	$0.00	$0.00
TR-H280L-S	SUP	HCPCS C1776		TR-H280L-S  -  HEAD RADL 28MM ACUMED LEFT ELB TOT STRL	BOTH IP/OP	"$6,015.00 "	"$4,451.10"	$0.00	"$4,812.00"	"$2,706.75"	"$2,706.75"	$0.00	$0.00	$0.00	"$1,253.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,253.53"	$0.00	"$2,965.40"	"$2,965.40"	$0.00	"$3,007.50"	"$4,763.88"	"$4,812.00"	$0.00		$0.00	$941.35	$0.00	$0.00	$957.59	$0.00	$0.00	$0.00	$0.00	$0.00
TR-H280R-S	SUP	HCPCS C1776		TR-H280R-S  -  HEAD RADL 28MM STRL RT	BOTH IP/OP	"$6,015.00 "	"$4,451.10"	$0.00	"$4,812.00"	"$2,706.75"	"$2,706.75"	$0.00	$0.00	$0.00	"$1,253.68"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,253.53"	$0.00	"$2,965.40"	"$2,965.40"	$0.00	"$3,007.50"	"$4,763.88"	"$4,812.00"	$0.00		$0.00	$941.35	$0.00	$0.00	$957.59	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0600-S	SUP	HCPCS C1776		TR-S0600-S  -  STEM RADL 0MM 6MM STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0602-S	SUP	HCPCS C1776		TR-S0602-S  -  STEM RADL 2MM 6MM STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0604-S	SUP	HCPCS C1776		TR-S0604-S  -  STEM RADL 4MM 6MM STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0606-S	SUP	Custom 27203010		TR-S0606-S  -  BNDG NUSTIMWRAP 36X2.5IN CMPR	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	$0.00	$0.00	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0608-S	SUP	HCPCS C1776		TR-S0608-S  -  STEM RADL 6MM 8MM STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0700-S	SUP	HCPCS C1776		TR-S0700-S  -  STEM RADL 0MM 7MM ELB	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0702-S	SUP	HCPCS C1776		TR-S0702-S  -  STEM RADL 2MM 7MM STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0704-S	SUP	HCPCS C1776		TR-S0704-S  -  STEM RADL 7MM 4MM ELB TOT STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0706-S	SUP	HCPCS C1776		TR-S0706-S  -  STEM RADL 7MM 6MM	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0708-S	SUP	HCPCS C1776		TR-S0708-S  -  STEM RADL 8MM 7MM ELB TOT STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0800-S	SUP	HCPCS C1776		TR-S0800-S  -  STEM RADL 8MM 4MM ELB TI HEAD TOT STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0802-S	SUP	HCPCS C1776		TR-S0802-S  -  STEM RADL 8MM 2MM ELB HEAD STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0804-S	SUP	HCPCS C1776		TR-S0804-S  -  STEM RADL 4MM 8MM ELB TI HEAD STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0806-S	SUP	HCPCS C1776		TR-S0806-S  -  STEM RADL 6MM 8MM HEAD	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0808-S	SUP	HCPCS C1776		TR-S0808-S  -  STEM RADL 8MM 8MM ELB TOT STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0900-S	SUP	HCPCS C1776		TR-S0900-S  -  STEM RADL 0MM 9MM STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0902-S	SUP	HCPCS C1776		TR-S0902-S  -  STEM RADL 9MM 2MM ELB SYS STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0904-S	SUP	HCPCS C1776		TR-S0904-S  -  STEM RADL 9MM 4MM ELB TOT STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0906-S	SUP	HCPCS C1776		TR-S0906-S  -  STEM RADL 9MM 6MM TI STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S0908-S	SUP	HCPCS C1776		TR-S0908-S  -  STEM RADL 9MM 8MM ELB STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S1000-S	SUP	HCPCS C1776		TR-S1000-S  -  STEM RADL 0MM 10MM STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S1002-S	SUP	HCPCS C1776		TR-S1002-S  -  STEM RADL 2MM 10MM STRL ELB	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S1004-S	SUP	HCPCS C1776		TR-S1004-S  -  STEM RADL 4MM 10MM STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S1006-S	SUP	Custom 27203010		TR-S1006-S  -  BNDG NUSTIMWRAP 36X6IN CMPR	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	$0.00	$0.00	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TR-S1008-S	SUP	HCPCS C1776		TR-S1008-S  -  STEM RADL 10MM 8MM 8MM TR ELB TI STRL	BOTH IP/OP	"$3,610.00 "	"$2,671.40"	$0.00	"$2,888.00"	"$1,624.50"	"$1,624.50"	$0.00	$0.00	$0.00	$752.41	"$2,679.34"	"$2,679.34"	$0.00	$0.00	$752.32	$0.00	"$1,779.73"	"$1,779.73"	$0.00	"$1,805.00"	"$2,859.12"	"$2,888.00"	$0.00		$0.00	$564.97	$0.00	$0.00	$574.71	$0.00	$0.00	$0.00	$0.00	$0.00
TRX2.3-10	SUP	HCPCS C1713		TRX2.3-10  -  SCREW BONE 2.3MM 10MM ANKLE CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
TRX2.3-12	SUP	HCPCS C1713		TRX2.3-12  -  SCREW BONE 2.3MM 12MM ANKLE CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
TRX2.3-14	SUP	HCPCS C1713		TRX2.3-14  -  SCREW BONE 2.3MM 14MM ANKLE CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
TRX2.3-16	SUP	HCPCS C1713		TRX2.3-16  -  SCREW BONE 2.3MM 16MM ANKLE CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
TRX2.3-18	SUP	HCPCS C1713		TRX2.3-18  -  SCREW BONE 2.3MM 18MM ANKLE CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
TRX2.3-20	SUP	HCPCS C1713		TRX2.3-20  -  SCREW BONE 2.3MM 20MM CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
TRX2.3-22	SUP	HCPCS C1713		TRX2.3-22  -  SCREW BONE 2.3MM 22MM ANKLE CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
TRX2.3-24	SUP	HCPCS C1713		TRX2.3-24  -  SCREW BONE 2.3MM 24MM ANKLE CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
TRX2.3-26	SUP	HCPCS C1713		TRX2.3-26  -  SCREW BONE 2.3MM 26MM ANKLE CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
TRX2.3-28	SUP	HCPCS C1713		TRX2.3-28  -  SCREW BONE 2.3MM 28MM CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
TRX2.3-30	SUP	HCPCS C1713		TRX2.3-30  -  SCREW BONE 2.3MM 30MM CORTICAL	BOTH IP/OP	$225.00 	$166.50	$0.00	$180.00	$101.25	$101.25	$0.00	$0.00	$0.00	$46.90	$167.00	$167.00	$0.00	$0.00	$46.89	$0.00	$133.09	$133.09	$0.00	$112.50	$178.20	$180.00	$0.00		$0.00	$35.21	$0.00	$0.00	$35.82	$0.00	$0.00	$0.00	$0.00	$0.00
TS101DC	SUP	Custom 27203010		TS101DC  -  SET TBG DIEGO ELT DECLOG	BOTH IP/OP	$117.64 	$87.05	$0.00	$94.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.31	$87.31	$0.00	$0.00	$24.52	$0.00	$0.00	$0.00	$0.00	$58.82	$93.17	$94.11	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TT12	SUP	Custom 27203010		TT12  -  TUBE LEGEND 12CM T12 TELE STRAIGHT	BOTH IP/OP	"$1,486.25 "	"$1,099.83"	$0.00	"$1,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,103.09"	"$1,103.09"	$0.00	$0.00	$309.73	$0.00	$0.00	$0.00	$0.00	$743.13	"$1,177.11"	"$1,189.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TT12A	SUP	Custom 27203010		TT12A  -  TUBE LEGEND 12CM T12 TELE ANGLED	BOTH IP/OP	"$1,486.25 "	"$1,099.83"	$0.00	"$1,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,103.09"	"$1,103.09"	$0.00	$0.00	$309.73	$0.00	$0.00	$0.00	$0.00	$743.13	"$1,177.11"	"$1,189.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TT12C	SUP	Custom 27203010		TT12C  -  TUBE LEGEND 12CM T12 TELE CURVED	BOTH IP/OP	"$1,486.25 "	"$1,099.83"	$0.00	"$1,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,103.09"	"$1,103.09"	$0.00	$0.00	$309.73	$0.00	$0.00	$0.00	$0.00	$743.13	"$1,177.11"	"$1,189.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TT12F	SUP	Custom 27203010		TT12F  -  TUBE LEGEND 12CM T12 TELE CURVED	BOTH IP/OP	"$1,486.25 "	"$1,099.83"	$0.00	"$1,189.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,103.09"	"$1,103.09"	$0.00	$0.00	$309.73	$0.00	$0.00	$0.00	$0.00	$743.13	"$1,177.11"	"$1,189.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TT14A	SUP	Custom 27203010		TT14A  -  TUBE LEGEND 14CM T14 TELE ANGLED	BOTH IP/OP	"$1,590.80 "	"$1,177.19"	$0.00	"$1,272.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,180.69"	"$1,180.69"	$0.00	$0.00	$331.52	$0.00	$0.00	$0.00	$0.00	$795.40	"$1,259.91"	"$1,272.64"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TT15	SUP	Custom 27203010		TT15  -  TUBE LEGEND 15CM T15 TELE STRAIGHT	BOTH IP/OP	"$1,521.10 "	"$1,125.61"	$0.00	"$1,216.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,128.96"	"$1,128.96"	$0.00	$0.00	$317.00	$0.00	$0.00	$0.00	$0.00	$760.55	"$1,204.71"	"$1,216.88"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TT15H	SUP	Custom 27203010		TT15H  -  TUBE LEGEND 15CM T15 TELE HOODED	BOTH IP/OP	"$2,144.30 "	"$1,586.78"	$0.00	"$1,715.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,591.50"	"$1,591.50"	$0.00	$0.00	$446.87	$0.00	$0.00	$0.00	$0.00	"$1,072.15"	"$1,698.29"	"$1,715.44"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TT17	SUP	Custom 27203010		TT17  -  TUBE LEGEND 17CM T17 TELE STRAIGHT	BOTH IP/OP	"$1,596.95 "	"$1,181.74"	$0.00	"$1,277.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,185.26"	"$1,185.26"	$0.00	$0.00	$332.80	$0.00	$0.00	$0.00	$0.00	$798.48	"$1,264.78"	"$1,277.56"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TT18H	SUP	Custom 27203010		TT18H  -  TUBE LEGEND 18CM T18 TELE HOODED	BOTH IP/OP	"$2,207.85 "	"$1,633.81"	$0.00	"$1,766.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,638.67"	"$1,638.67"	$0.00	$0.00	$460.12	$0.00	$0.00	$0.00	$0.00	"$1,103.93"	"$1,748.62"	"$1,766.28"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TT9	SUP	Custom 27203010		TT9  -  TUBE LEGEND 9CM T9 TELE STRAIGHT	BOTH IP/OP	"$1,250.50 "	$925.37	$0.00	"$1,000.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$928.12	$928.12	$0.00	$0.00	$260.60	$0.00	$0.00	$0.00	$0.00	$625.25	$990.40	"$1,000.40"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TT9C	SUP	Custom 27203010		TT9C  -  TUBE LEGEND 9CM T9 TELE CURVED	BOTH IP/OP	"$1,330.45 "	$984.53	$0.00	"$1,064.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$987.46	$987.46	$0.00	$0.00	$277.27	$0.00	$0.00	$0.00	$0.00	$665.23	"$1,053.72"	"$1,064.36"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TU1101	SUP	Custom 27203010		CONTROL MLANLT TMKR LVL 1 ASY 3ML IMMUN	BOTH IP/OP	$83.33 	$61.66	$0.00	$66.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.66	$66.00	$66.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TU2202	SUP	Custom 27203010		CONTROL MLANLT TMKR LVL 2 ASY 3ML IMMUN	BOTH IP/OP	$83.33 	$61.66	$0.00	$66.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.66	$66.00	$66.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TU3303	SUP	Custom 27203010		CONTROL MLANLT TMKR LVL 3 ASY 3ML IMMUN	BOTH IP/OP	$83.33 	$61.66	$0.00	$66.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.66	$66.00	$66.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TVI07	SUP	HCPCS C1894		TVI07  -  TOOL INSERTION 7FR TRANSVALVULAR	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20	$4.89	$4.89	$0.00	$0.00	$0.00	$1.88	$6.68	$6.68	$0.00	$0.00	$1.88	$0.00	$5.32	$5.32	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$1.41	$0.00	$0.00	$1.43	$0.00	$0.00	$0.00	$0.00	$0.00
TVI-07	SUP	HCPCS C1894		TVI-07  -  TOOL INSERTION 7FR TRANSVALVULAR	BOTH IP/OP	$9.00 	$6.66	$0.00	$7.20	$4.89	$4.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.50	$7.13	$7.20	$0.00		$0.00	$1.41	$0.00	$0.00	$1.43	$0.00	$0.00	$0.00	$0.00	$0.00
TVTRL	SUP	HCPCS C1771		TVTRL  -  SLING GYNECOLOGICAL GYNECARE TVT SECUR STRESS URINARY	BOTH IP/OP	"$2,262.00 "	"$1,673.88"	$0.00	"$1,809.60"	"$1,017.90"	"$1,017.90"	$0.00	$0.00	$0.00	$471.46	"$1,678.86"	"$1,678.86"	$0.00	$0.00	$471.40	$0.00	"$1,337.97"	"$1,337.97"	$0.00	"$1,131.00"	"$1,791.50"	"$1,809.60"	$0.00		$0.00	$354.00	$0.00	$0.00	$360.11	$0.00	$0.00	$0.00	$0.00	$0.00
TW173016	SUP	Custom 27203010		TW173016  -  ENDO STITCH 10 MM SUTURING DEVICE	BOTH IP/OP	$836.10 	$618.71	$0.00	$668.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$620.55	$620.55	$0.00	$0.00	$174.24	$0.00	$0.00	$0.00	$0.00	$418.05	$662.19	$668.88	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
TYPE 14C	SUP	HCPCS L8610		RING FIXAT 24-28MM MORCHER 11-13MM CPSLR TNSN EXPANDABLE	BOTH IP/OP	$447.50 	$331.15	$0.00	$358.00	$201.38	$201.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$223.75	$354.42	$358.00	$0.00		$0.00	$70.03	$0.00	$0.00	$71.24	$0.00	$0.00	$0.00	$0.00	$0.00
U202H	SUP	Custom 27203010		U202H  -  SUTURE ABSORBABLE 5-0 RB-1 27IN MONOFILAMENT CHROMIC	BOTH IP/OP	$294.60 	$218.00	$0.00	$239.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.65	$218.65	$0.00	$0.00	$61.39	$0.00	$0.00	$0.00	$0.00	$149.51	$236.82	$239.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
U2295-40	SUP	Custom 27203010		STAIN TCHRM BLUE PRPK 500ML BHOSPHATE BUFF PRSTLGY	BOTH IP/OP	$537.15 	$397.49	$0.00	$429.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.58	$425.42	$429.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
U2295-5	SUP	Custom 27203010		STAIN TCHRM PRPK WHEATLEY 500ML PRSTLGY	BOTH IP/OP	$369.73 	$273.60	$0.00	$295.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.86	$292.83	$295.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
U2316-2	SUP	Custom 27203010		SLIDE GSTCLT GCB HMTLTST	BOTH IP/OP	$332.45 	$246.01	$0.00	$265.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.23	$263.30	$265.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UA1329-S	SUP	Custom 27203010		UA1329-S  -  GUIDE NEEDLE DUAL READY TO USE INDIVIDUALLY STERILE	BOTH IP/OP	$900.00 	$666.00	$0.00	$720.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$667.98	$667.98	$0.00	$0.00	$187.56	$0.00	$0.00	$0.00	$0.00	$450.00	$712.80	$720.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UAB-260	SUP	Custom 27203010		CONTROL MAS LVL 2 ABN 60ML UA	BOTH IP/OP	$56.25 	$41.63	$0.00	$45.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.13	$44.55	$45.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UFH-624-R	SUP	HCPCS C2617		UFH-624-R  -  STENT URET 6FR 24CM W/O GWIRE SET TETH STRAIGHTENER RADIOPQ	BOTH IP/OP	$281.25 	$208.13	$0.00	$225.00	$152.72	$152.72	$0.00	$0.00	$0.00	$58.62	$208.74	$208.74	$0.00	$0.00	$58.61	$0.00	$166.36	$166.36	$0.00	$140.63	$222.75	$225.00	$0.00		$0.00	$44.02	$0.00	$0.00	$44.78	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-36-22	SUP	Custom 27803010		UH1-36-22  -  HEAD BIPOL 36MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-38-22	SUP	Custom 27803010		UH1-38-22  -  HEAD BIPOL 38MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-40-22	SUP	Custom 27803010		UH1-40-22  -  HEAD BIPOL UNIVERSAL 40MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-41-22	SUP	Custom 27803010		UH1-41-22  -  HEAD BIPOL UNIVERSAL 41MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-41-26	SUP	Custom 27803010		UH1-41-26  -  HEAD BIPOL UNIVERSAL 41MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-42-22	SUP	Custom 27803010		UH1-42-22  -  HEAD BP UNV 42MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-42-26	SUP	Custom 27803010		UH1-42-26  -  HEAD BIPOL UNIVERSAL 42MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-42-28	SUP	Custom 27803010		UH1-42-28  -  HEAD BIPOL UNIVERSAL 42MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-43-22	SUP	Custom 27803010		UH1-43-22  -  HEAD BIPOL UNIVERSAL 43MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-43-26	SUP	Custom 27803010		UH1-43-26  -  HEAD BIPOL UNIVERSAL 43MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-44-22	SUP	Custom 27803010		UH1-44-22  -  HEAD BIPOL UNIVERSAL 44MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-44-26	SUP	Custom 27803010		UH1-44-26  -  HEAD BIPOL UNIVERSAL 44MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-44-28	SUP	Custom 27803010		UH1-44-28  -  HEAD BIPOL UNIVERSAL 44MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-45-22	SUP	Custom 27803010		UH1-45-22  -  HEAD BIPOL UNIVERSAL 45MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-45-26	SUP	Custom 27803010		UH1-45-26  -  HEAD BIPOL UNIVERSAL 45MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-45-28	SUP	Custom 27803010		UH1-45-28  -  HEAD BP 45MM 28MM UHR HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-46-22	SUP	Custom 27803010		UH1-46-22  -  HEAD BIPOL UNIVERSAL 46MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-46-26	SUP	Custom 27803010		UH1-46-26  -  HEAD BIPOL UNIVERSAL 46MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-46-28	SUP	Custom 27803010		UH1-46-28  -  HEAD BIPOL UNIVERSAL 46MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-47-22	SUP	Custom 27803010		UH1-47-22  -  HEAD BIPOL UNIVERSAL 47MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-47-26	SUP	Custom 27803010		UH1-47-26  -  HEAD BIPOL UNIVERSAL 47MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-47-28	SUP	Custom 27803010		UH1-47-28  -  HEAD BP UNV 47MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-48-22	SUP	Custom 27803010		UH1-48-22  -  HEAD BIPOL UNIVERSAL 48MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-48-26	SUP	Custom 27803010		UH1-48-26  -  HEAD BIPOL UNIVERSAL 48MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-48-28	SUP	Custom 27803010		UH1-48-28  -  HEAD BP 48MM 28MM UHR HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-48-32	SUP	Custom 27803010		UH1-48-32  -  HEAD BIPOL UNIVERSAL 48MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-49-22	SUP	Custom 27803010		UH1-49-22  -  HEAD BIPOL UNIVERSAL 49MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-49-26	SUP	Custom 27803010		UH1-49-26  -  HEAD BIPOL UNIVERSAL 49MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-49-28	SUP	Custom 27803010		UH1-49-28  -  HEAD BIPOL UNIVERSAL 49MM 28MM UHR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-49-32	SUP	Custom 27803010		UH1-49-32  -  HEAD BIPOL UNIVERSAL 49MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-50-22	SUP	Custom 27803010		UH1-50-22  -  HEAD BIPOL UNIVERSAL 50MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-50-26	SUP	Custom 27803010		UH1-50-26  -  HEAD BIPOL UNIVERSAL 50MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-50-28	SUP	Custom 27803010		UH1-50-28  -  HEAD BIPOL UNIVERSAL 50MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-50-32	SUP	Custom 27803010		UH1-50-32  -  HEAD BIPOL UNIVERSAL 50MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-51-22	SUP	Custom 27803010		UH1-51-22  -  HEAD BIPOL UNIVERSAL 51MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-51-26	SUP	Custom 27803010		UH1-51-26  -  HEAD BIPOL UNIVERSAL 51MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-51-28	SUP	Custom 27803010		UH1-51-28  -  HEAD BIPOL UNIVERSAL 51MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-51-32	SUP	Custom 27803010		UH1-51-32  -  HEAD BIPOL UNIVERSAL 51MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-52-22	SUP	Custom 27803010		UH1-52-22  -  HEAD BIPOL UNIVERSAL 52MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-52-26	SUP	Custom 27803010		UH1-52-26  -  HEAD BIPOL UNIVERSAL 52MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-52-28	SUP	Custom 27803010		UH1-52-28  -  HEAD BP 52MM 28MM UHR HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-52-32	SUP	Custom 27803010		UH1-52-32  -  HEAD BIPOL UNIVERSAL 52MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-53-22	SUP	Custom 27803010		UH1-53-22  -  HEAD BIPOL UNIVERSAL 53MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-53-26	SUP	Custom 27803010		UH1-53-26  -  HEAD BIPOL UNIVERSAL 53MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-53-28	SUP	Custom 27803010		UH1-53-28  -  HEAD BP 53MM 28MM UHR HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-53-32	SUP	Custom 27803010		UH1-53-32  -  HEAD BIPOL UNIVERSAL 53MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-54-22	SUP	Custom 27803010		UH1-54-22  -  HEAD BIPOL UNIVERSAL 54MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-54-26	SUP	Custom 27803010		UH1-54-26  -  HEAD BIPOL UNIVERSAL 54MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-54-28	SUP	Custom 27803010		UH1-54-28  -  HEAD BIPOL UNIVERSAL 54MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-54-32	SUP	Custom 27803010		UH1-54-32  -  HEAD BIPOL UNIVERSAL 54MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-55-22	SUP	Custom 27803010		UH1-55-22  -  HEAD BIPOL UNIVERSAL 55MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-55-26	SUP	Custom 27803010		UH1-55-26  -  HEAD BIPOL UNIVERSAL 55MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-55-28	SUP	Custom 27803010		UH1-55-28  -  HEAD BP 55MM 28MM UHR HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-55-32	SUP	Custom 27803010		UH1-55-32  -  HEAD BIPOL UNIVERSAL 55MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-56-22	SUP	Custom 27803010		UH1-56-22  -  HEAD BIPOL UNIVERSAL 56MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-56-26	SUP	Custom 27803010		UH1-56-26  -  HEAD BIPOL UNIVERSAL 56MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-56-28	SUP	Custom 27803010		UH1-56-28  -  HEAD BIPOL UNIVERSAL 56MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-56-32	SUP	Custom 27803010		UH1-56-32  -  HEAD BIPOL UNIVERSAL 56MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-58-22	SUP	Custom 27803010		UH1-58-22  -  HEAD BIPOL UNIVERSAL 58MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-58-26	SUP	Custom 27803010		UH1-58-26  -  HEAD BIPOL UNIVERSAL 58MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-58-28	SUP	Custom 27803010		UH1-58-28  -  HEAD BIPOL UNIVERSAL 58MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-58-32	SUP	Custom 27803010		UH1-58-32  -  HEAD BIPOL UNIVERSAL 58MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-61-22	SUP	Custom 27803010		UH1-61-22  -  HEAD BIPOL UNIVERSAL 61MM 22MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-61-26	SUP	Custom 27803010		UH1-61-26  -  HEAD BIPOL UNIVERSAL 61MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-61-28	SUP	Custom 27803010		UH1-61-28  -  HEAD BIPOL UNIVERSAL 61MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-61-32	SUP	Custom 27803010		UH1-61-32  -  HEAD BIPOL UNIVERSAL 61MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-64-26	SUP	Custom 27803010		UH1-64-26  -  HEAD BIPOL UNIVERSAL 64MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-64-28	SUP	Custom 27803010		UH1-64-28  -  HEAD BIPOL UNIVERSAL 64MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-64-32	SUP	Custom 27803010		UH1-64-32  -  HEAD BIPOL UNIVERSAL 64MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-68-26	SUP	Custom 27803010		UH1-68-26  -  HEAD BIPOL UNIVERSAL 68MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-68-28	SUP	Custom 27803010		UH1-68-28  -  HEAD BIPOL UNIVERSAL 68MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-68-32	SUP	Custom 27803010		UH1-68-32  -  HEAD BIPOL UNIVERSAL 68MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-72-26	SUP	Custom 27803010		UH1-72-26  -  HEAD BIPOL UNIVERSAL 72MM 26MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-72-28	SUP	Custom 27803010		UH1-72-28  -  HEAD BIPOL UNIVERSAL 72MM 28MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UH1-72-32	SUP	Custom 27803010		UH1-72-32  -  HEAD BIPOL UNIVERSAL 72MM 32MM UHR COCR UHMWPE HIP	BOTH IP/OP	"$1,150.00 "	$851.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$853.53	$853.53	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$575.00	$910.80	$920.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UL-3021-S	SUP	HCPCS C1713		UL-3021-S  -  ROD ORTH 210MM 3MM ULN WR HND ULNA IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
UL-3023-S	SUP	HCPCS C1713		UL-3023-S  -  ROD ORTH 230MM 3MM ULN ULNA IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
UL-3025-S	SUP	HCPCS C1713		UL-3025-S  -  ROD OTHOPEDIC 250MM 3MM ULN WR HND ULNA IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
UL-3027-S	SUP	HCPCS C1713		UL-3027-S  -  NAIL 3MM 27CM ULN IM TI NONSTRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
UL-3621-S	SUP	HCPCS C1713		UL-3621-S  -  NAIL 3.6MM 21CM ULN IM STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
UL-3623-S	SUP	HCPCS C1713		UL-3623-S  -  ROD ORTH 230MM ULN ULNA IM IMPL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
UL-3625-S	SUP	HCPCS C1713		UL-3625-S  -  ROD ORTH 250MM 3.6MM ULN WR HND ULNA IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
UL-3627-S	SUP	HCPCS C1713		UL-3627-S  -  ROD OTHOPEDIC 270MM 3.6MM ULN WR HND ULNA IM IMPL STRL	BOTH IP/OP	"$2,690.00 "	"$1,990.60"	$0.00	"$2,152.00"	"$1,210.50"	"$1,210.50"	$0.00	$0.00	$0.00	$560.66	"$1,996.52"	"$1,996.52"	$0.00	$0.00	$560.60	$0.00	"$1,326.17"	"$1,326.17"	$0.00	"$1,345.00"	"$2,130.48"	"$2,152.00"	$0.00		$0.00	$420.99	$0.00	$0.00	$428.25	$0.00	$0.00	$0.00	$0.00	$0.00
ULTRA O-RNG RPL	SUP	Custom 27803010		ULTRA O-RNG RPL  -  O RING OPTH BLK ULFL REPL SIL	BOTH IP/OP	$135.00 	$99.90	$0.00	$108.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.20	$100.20	$0.00	$0.00	$28.13	$0.00	$0.00	$0.00	$0.00	$67.50	$106.92	$108.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UM-04018	SUP	Custom 27203010		UM-04018  -  KIT ARTERIAL LINE 18GA 20GA 16CM 1.5IN INDWELL CATHETER	BOTH IP/OP	$75.50 	$55.87	$0.00	$104.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.04	$56.04	$0.00	$0.00	$15.73	$0.00	$0.00	$0.00	$0.00	$65.61	$103.93	$104.98	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UOCP	SUP	HCPCS C1713		UOCP  -  PLATE BN SHTNG ULNA	BOTH IP/OP	"$2,150.00 "	"$1,591.00"	$0.00	"$1,720.00"	$967.50	$967.50	$0.00	$0.00	$0.00	$448.11	"$1,595.73"	"$1,595.73"	$0.00	$0.00	$448.06	$0.00	"$1,271.73"	"$1,271.73"	$0.00	"$1,075.00"	"$1,702.80"	"$1,720.00"	$0.00		$0.00	$336.48	$0.00	$0.00	$342.28	$0.00	$0.00	$0.00	$0.00	$0.00
UPA3030	SUP	HCPCS C1781		UPA3030  -  MESH SURG ULTRAPRO ADV 30X30CM PRTL ABS LTWT	BOTH IP/OP	$619.33 	$458.30	$0.00	$495.46	$278.70	$278.70	$0.00	$0.00	$0.00	$129.08	$459.66	$459.66	$0.00	$0.00	$129.07	$0.00	$366.33	$366.33	$0.00	$309.66	$490.51	$495.46	$0.00		$0.00	$96.92	$0.00	$0.00	$98.60	$0.00	$0.00	$0.00	$0.00	$0.00
UPA31015	SUP	HCPCS C1781		UPA31015  -  MESH SRG RECT 15X10CM BLU STRP ULTRAPRO ADV PRT ABS LTWT HI	BOTH IP/OP	$310.66 	$229.89	$0.00	$248.53	$139.80	$139.80	$0.00	$0.00	$0.00	$64.75	$230.57	$230.57	$0.00	$0.00	$64.74	$0.00	$183.75	$183.75	$0.00	$155.33	$246.04	$248.53	$0.00		$0.00	$48.62	$0.00	$0.00	$49.46	$0.00	$0.00	$0.00	$0.00	$0.00
UPC510	SUP	Custom 27203010		PACK PRNTR 5 7/8INX8 3/8IN SNY COLOR INK RBN UP-50 UP-50	BOTH IP/OP	$2.25 	$1.67	$0.00	$1.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.13	$1.78	$1.80	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
UPEG-14	SUP	HCPCS C1713		UPEG-14  -  PEG FIX 14MM UNTHREADED VOLAR	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
UPEG-16	SUP	HCPCS C1713		UPEG-16  -  PEG FIX 14MM UNTHREADED VOLAR	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
UPEG-18	SUP	HCPCS C1713		UPEG-18  -  PEG FIX 18MM UNTHREADED VOLAR	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
UPEG-20	SUP	HCPCS C1713		UPEG-20  -  SCREW BONE 20MM PEG UNTHREADED TRX	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
UPEG-22	SUP	HCPCS C1713		UPEG-22  -  PEG FIX 22MM UNTHREADED VOLAR	BOTH IP/OP	$262.50 	$194.25	$0.00	$210.00	$118.13	$118.13	$0.00	$0.00	$0.00	$54.71	$194.83	$194.83	$0.00	$0.00	$54.71	$0.00	$155.27	$155.27	$0.00	$131.25	$207.90	$210.00	$0.00		$0.00	$41.08	$0.00	$0.00	$41.79	$0.00	$0.00	$0.00	$0.00	$0.00
UPLUG403	SUP	HCPCS C1781		UPLUG403  -  MESH SURG 14X7CM ONLAY PLUG ULTRAPRO 40MM	BOTH IP/OP	$674.33 	$499.00	$0.00	$539.46	$303.45	$303.45	$0.00	$0.00	$0.00	$140.55	$500.48	$500.48	$0.00	$0.00	$140.53	$0.00	$398.86	$398.86	$0.00	$337.16	$534.07	$539.46	$0.00		$0.00	$105.53	$0.00	$0.00	$107.35	$0.00	$0.00	$0.00	$0.00	$0.00
UPLUG553	SUP	HCPCS C1781		UPLUG553  -  MESH SURG 14X7CM ONLAY PLUG ULTRAPRO 55MM	BOTH IP/OP	$674.33 	$499.00	$0.00	$539.46	$303.45	$303.45	$0.00	$0.00	$0.00	$140.55	$500.48	$500.48	$0.00	$0.00	$140.53	$0.00	$398.86	$398.86	$0.00	$337.16	$534.07	$539.46	$0.00		$0.00	$105.53	$0.00	$0.00	$107.35	$0.00	$0.00	$0.00	$0.00	$0.00
USA-FDX	SUP	Custom 27203010		USA-FDX  -  ASPIRATOR SCT 72IN LF FLD DMD TUBE DISP	BOTH IP/OP	"$1,350.00 "	$999.00	$0.00	"$1,080.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,001.97"	"$1,001.97"	$0.00	$0.00	$281.34	$0.00	$0.00	$0.00	$0.00	$675.00	"$1,069.20"	"$1,080.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
V1205	SUP	Custom 27203010		REAGENT .45% NA CHLOR BTL 1L ANALY	BOTH IP/OP	$12.08 	$8.94	$0.00	$9.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$6.04	$9.57	$9.66	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
V402G	SUP	Custom 27203010		V402G  -  SUTURE ABS 9-0 BV100-3 5IN VIOL VCL MFL COAT	BOTH IP/OP	$46.45 	$34.37	$0.00	$37.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.48	$34.48	$0.00	$0.00	$9.68	$0.00	$0.00	$0.00	$0.00	$23.57	$37.34	$37.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
V4900	SUP	HCPCS C1729		CATHETER DLYS PRTNL TROCATH ADLT	BOTH IP/OP	$125.75 	$93.06	$0.00	$100.60	$68.28	$68.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.88	$99.59	$100.60	$0.00		$0.00	$19.68	$0.00	$0.00	$20.02	$0.00	$0.00	$0.00	$0.00	$0.00
V4908(SUB)	SUP	Custom 27203010		V4908(SUB)  -  SET PERITONEAL DIALYSIS	BOTH IP/OP	$201.93 	$149.43	$0.00	$161.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.87	$149.87	$0.00	$0.00	$42.08	$0.00	$0.00	$0.00	$0.00	$100.96	$159.93	$161.54	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAC6000M	SUP	Custom 27203010		VAC6000M  -  VACUUM EXTRACTION 6MM CUP MUSHROOM TRACTION FORCE INDICATOR	BOTH IP/OP	$139.98 	$103.59	$0.00	$111.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.99	$110.86	$111.99	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAC-6000M	SUP	Custom 27203010		VAC-6000M  -  VACUUM EXTRACTION 6MM CUP MUSHROOM TRACTION FORCE INDICATOR	BOTH IP/OP	$61.48 	$45.50	$0.00	$49.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.74	$48.69	$49.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF2626C100TU	SUP	Custom 27803010		VAMF2626C100TU  -  GRAFT STNT 26MM 100MM VALIANT PROX MAIN SECT FREEFLO CLS WEB	BOTH IP/OP	"$42,487.50 "	"$31,440.75"	$0.00	"$33,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,854.40"	$0.00	$0.00	$0.00	$0.00	"$21,243.75"	"$33,650.10"	"$33,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF2824C150TU	SUP	Custom 27803010		VAMF2824C150TU  -  GRAFT STNT STRG TPR SINUSOIDAL 25FR 24MM 112MM 100MM VALIANT	BOTH IP/OP	"$46,237.50 "	"$34,215.75"	$0.00	"$36,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,635.90"	$0.00	$0.00	$0.00	$0.00	"$23,118.75"	"$36,620.10"	"$36,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF3026C150TU	SUP	Custom 27803010		VAMF3026C150TU  -  GRAFT STNT TPR 30MM 26MM 150MM VALIANT CAPTIVIA THRX	BOTH IP/OP	"$46,237.50 "	"$34,215.75"	$0.00	"$36,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,118.75"	"$36,620.10"	"$36,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF3228C150TU	SUP	Custom 27803010		VAMF3228C150TU  -  GRAFT STNT TPR 28MM 150MM VALIANT CAPTIVIA DLV SYS	BOTH IP/OP	"$46,237.50 "	"$34,215.75"	$0.00	"$36,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$23,118.75"	"$36,620.10"	"$36,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF3430C150TU	SUP	Custom 27803010		VAMF3430C150TU  -  GRAFT STNT TPR 34MM 30MM 150MM VALIANT CAPTIVIA EVAS	BOTH IP/OP	"$46,237.50 "	"$34,215.75"	$0.00	"$36,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,635.90"	$0.00	$0.00	$0.00	$0.00	"$23,118.75"	"$36,620.10"	"$36,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF3434C150TU	SUP	Custom 27803010		VAMF3434C150TU  -  GRAFT STNT STRG 34MM 150MM VALIANT PROX MAIN SECT CLS WEB	BOTH IP/OP	"$46,237.50 "	"$34,215.75"	$0.00	"$36,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,635.90"	$0.00	$0.00	$0.00	$0.00	"$23,118.75"	"$36,620.10"	"$36,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF3434C200TU	SUP	Custom 27803010		VAMF3434C200TU  -  GRAFT STNT STRG SINUSOIDAL 34MM 24FR 200MM 212MM VALIANT SYS	BOTH IP/OP	"$48,737.50 "	"$36,065.75"	$0.00	"$38,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$10,156.90"	$0.00	$0.00	$0.00	$0.00	"$24,368.75"	"$38,600.10"	"$38,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF3632C150TU	SUP	Custom 27803010		VAMF3632C150TU  -  GRAFT STNT STRG TPR 32MM 36MM 150MM STRL LF VALIANT CAPTIVIA	BOTH IP/OP	"$46,237.50 "	"$34,215.75"	$0.00	"$36,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,635.90"	$0.00	$0.00	$0.00	$0.00	"$23,118.75"	"$36,620.10"	"$36,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF3636C150TU	SUP	Custom 27803010		VAMF3636C150TU  -  GRAFT STNT SINUSOIDAL STRG 36MM 24FR 167MM 150MM VALIANT	BOTH IP/OP	"$46,237.50 "	"$34,215.75"	$0.00	"$36,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,635.90"	$0.00	$0.00	$0.00	$0.00	"$23,118.75"	"$36,620.10"	"$36,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF3636C200TU	SUP	Custom 27803010		VAMF3636C200TU  -  GRAFT STNT STRG 36MM 200MM 207MM VALIANT PROX FREEFLO EVAS	BOTH IP/OP	"$48,737.50 "	"$36,065.75"	$0.00	"$38,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$10,156.90"	$0.00	$0.00	$0.00	$0.00	"$24,368.75"	"$38,600.10"	"$38,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF3838C200TU	SUP	HCPCS C2625		VAMF3838C200TU  -  GRAFT STNT SINUSOIDAL STRG 38MM 24FR 207MM 200MM VALIANT	BOTH IP/OP	"$48,737.50 "	"$36,065.75"	$0.00	"$38,990.00"	"$21,931.88"	"$21,931.88"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$10,156.90"	$0.00	"$24,027.59"	"$24,027.59"	$0.00	"$24,368.75"	"$38,600.10"	"$38,990.00"	$0.00		$0.00	"$7,627.42"	$0.00	$0.00	"$7,759.01"	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF4242C150TU	SUP	Custom 27803010		VAMF4242C150TU  -  GRAFT STNT SINUSOIDAL STRG 42MM 25FR 157MM 150MM VALIANT	BOTH IP/OP	"$46,237.50 "	"$34,215.75"	$0.00	"$36,990.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$9,635.90"	$0.00	$0.00	$0.00	$0.00	"$23,118.75"	"$36,620.10"	"$36,990.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VAMF4242C200TU	SUP	HCPCS C1768		VAMF4242C200TU  -  GRAFT STNT SINUSOIDAL STRG 42MM 25FR 207MM 200MM VALIANT	BOTH IP/OP	"$48,737.50 "	"$36,065.75"	$0.00	"$38,990.00"	"$21,931.88"	"$21,931.88"	$0.00	$0.00	$0.00	"$9,417.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$10,156.90"	$0.00	"$24,027.59"	"$24,027.59"	$0.00	"$24,368.75"	"$38,600.10"	"$38,990.00"	$0.00		$0.00	"$7,627.42"	$0.00	$0.00	"$7,759.01"	$0.00	$0.00	$0.00	$0.00	$0.00
VBH060502	SUP	HCPCS C1874		VBH060502  -  STENT ENDOPRSTH 6MM 7FR 5CM 120CM .035IN HEP BIOACTIVE SRFC	BOTH IP/OP	"$7,097.50 "	"$5,252.15"	$0.00	"$5,678.00"	"$3,193.88"	"$3,193.88"	$0.00	$0.00	$0.00	"$1,479.30"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,479.12"	$0.00	"$3,499.07"	"$3,499.07"	$0.00	"$3,548.75"	"$5,621.22"	"$5,678.00"	$0.00		$0.00	"$1,110.76"	$0.00	$0.00	"$1,129.92"	$0.00	$0.00	$0.00	$0.00	$0.00
VBH061002	SUP	HCPCS C1874		VBH061002  -  STENT ENDOPRSTH 6MM 10CM 120CM .035IN DLV SYS TIP TO HUB DPL	BOTH IP/OP	"$8,122.50 "	"$6,010.65"	$0.00	"$6,498.00"	"$3,655.13"	"$3,655.13"	$0.00	$0.00	$0.00	"$1,692.93"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,692.73"	$0.00	"$4,004.39"	"$4,004.39"	$0.00	"$4,061.25"	"$6,433.02"	"$6,498.00"	$0.00		$0.00	"$1,271.17"	$0.00	$0.00	"$1,293.10"	$0.00	$0.00	$0.00	$0.00	$0.00
VBH080502	SUP	HCPCS C1874		VBH080502  -  STENT ENDOPRSTH 8MM 5CM 120CM .035IN DLV SYS TIP TO HUB DPL	BOTH IP/OP	"$6,737.50 "	"$4,985.75"	$0.00	"$5,390.00"	"$3,031.88"	"$3,031.88"	$0.00	$0.00	$0.00	"$1,404.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,404.10"	$0.00	"$3,321.59"	"$3,321.59"	$0.00	"$3,368.75"	"$5,336.10"	"$5,390.00"	$0.00		$0.00	"$1,054.42"	$0.00	$0.00	"$1,072.61"	$0.00	$0.00	$0.00	$0.00	$0.00
VBH081002	SUP	HCPCS C1874		VBH081002  -  STENT ENDOPRSTH 8MM 10CM 120CM .035IN DLV SYS TIP TO HUB DPL	BOTH IP/OP	"$7,737.50 "	"$5,725.75"	$0.00	"$6,190.00"	"$3,481.88"	"$3,481.88"	$0.00	$0.00	$0.00	"$1,612.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,612.50"	$0.00	"$3,814.59"	"$3,814.59"	$0.00	"$3,868.75"	"$6,128.10"	"$6,190.00"	$0.00		$0.00	"$1,210.92"	$0.00	$0.00	"$1,231.81"	$0.00	$0.00	$0.00	$0.00	$0.00
VBH081502	SUP	HCPCS C1874		VBH081502  -  STENT ENDOPRSTH 8MM 15CM 120CM .035IN DLV SYS TIP TO HUB DPL	BOTH IP/OP	"$8,900.00 "	"$6,586.00"	$0.00	"$7,120.00"	"$4,005.00"	"$4,005.00"	$0.00	$0.00	$0.00	"$1,854.98"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,854.76"	$0.00	"$4,387.70"	"$4,387.70"	$0.00	"$4,450.00"	"$7,048.80"	"$7,120.00"	$0.00		$0.00	"$1,392.85"	$0.00	$0.00	"$1,416.88"	$0.00	$0.00	$0.00	$0.00	$0.00
VBH090502	SUP	HCPCS C1874		VBH090502  -  STENT ENDOPRSTH 5CM DELIVERY SYSTEM TIP TO HUB DEPLOYMENT	BOTH IP/OP	"$7,487.50 "	"$5,540.75"	$0.00	"$5,990.00"	"$3,369.38"	"$3,369.38"	$0.00	$0.00	$0.00	"$1,560.58"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,560.40"	$0.00	"$3,691.34"	"$3,691.34"	$0.00	"$3,743.75"	"$5,930.10"	"$5,990.00"	$0.00		$0.00	"$1,171.79"	$0.00	$0.00	"$1,192.01"	$0.00	$0.00	$0.00	$0.00	$0.00
VBH091002	SUP	HCPCS C1874		VBH091002  -  STENT ENDOPRSTH 10CM DELIVERY SYSTEM TIP TO HUB DEPLOYMENT	BOTH IP/OP	"$8,237.50 "	"$6,095.75"	$0.00	"$6,590.00"	"$3,706.88"	"$3,706.88"	$0.00	$0.00	$0.00	"$1,716.90"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,716.70"	$0.00	"$4,061.09"	"$4,061.09"	$0.00	"$4,118.75"	"$6,524.10"	"$6,590.00"	$0.00		$0.00	"$1,289.17"	$0.00	$0.00	"$1,311.41"	$0.00	$0.00	$0.00	$0.00	$0.00
VBH100502	SUP	HCPCS C1874		VBH100502  -  STENT EPRSTH 10MM 11FR 5CM 120CM VBHN DLV SYS TIP TO HUB DPL	BOTH IP/OP	"$6,737.50 "	"$4,985.75"	$0.00	"$5,390.00"	"$3,031.88"	"$3,031.88"	$0.00	$0.00	$0.00	"$1,404.26"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,404.10"	$0.00	"$3,321.59"	"$3,321.59"	$0.00	"$3,368.75"	"$5,336.10"	"$5,390.00"	$0.00		$0.00	"$1,054.42"	$0.00	$0.00	"$1,072.61"	$0.00	$0.00	$0.00	$0.00	$0.00
VBH101002	SUP	HCPCS C1874		VBH101002  -  STENT ENDOPRSTH 10MM 10CM 120CM .035IN DLV SYS TIP TO HUB	BOTH IP/OP	"$7,737.50 "	"$5,725.75"	$0.00	"$6,190.00"	"$3,481.88"	"$3,481.88"	$0.00	$0.00	$0.00	"$1,612.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,612.50"	$0.00	"$3,814.59"	"$3,814.59"	$0.00	"$3,868.75"	"$6,128.10"	"$6,190.00"	$0.00		$0.00	"$1,210.92"	$0.00	$0.00	"$1,231.81"	$0.00	$0.00	$0.00	$0.00	$0.00
VBH101002A	SUP	HCPCS C1874		VBH101002A  -  STENT EPRSTH 10MM 11FR 10CM 120CM VBHN DLV SYS TIP TO HUB	BOTH IP/OP	"$9,807.50 "	"$7,257.55"	$0.00	"$7,692.00"	"$4,326.75"	"$4,326.75"	$0.00	$0.00	$0.00	"$2,044.13"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,043.88"	$0.00	"$4,835.10"	"$4,835.10"	$0.00	"$4,807.50"	"$7,615.08"	"$7,692.00"	$0.00		$0.00	"$1,504.75"	$0.00	$0.00	"$1,530.71"	$0.00	$0.00	$0.00	$0.00	$0.00
VBHR080502A	SUP	HCPCS C1874		"VBHR080502A  -  VIABAHN ENDOPROSTHESIS , 8X5"	BOTH IP/OP	"$8,940.00 "	"$6,615.60"	$0.00	"$7,012.00"	"$3,944.25"	"$3,944.25"	$0.00	$0.00	$0.00	"$1,863.32"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,863.10"	$0.00	"$4,407.42"	"$4,407.42"	$0.00	"$4,382.50"	"$6,941.88"	"$7,012.00"	$0.00		$0.00	"$1,371.72"	$0.00	$0.00	"$1,395.39"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ050502	SUP	HCPCS C1874		VBJ050502  -  STENT ENDOPRSTH 5CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 5	BOTH IP/OP	"$7,737.50 "	"$5,725.75"	$0.00	"$6,190.00"	"$3,481.88"	"$3,481.88"	$0.00	$0.00	$0.00	"$1,612.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,612.50"	$0.00	"$3,814.59"	"$3,814.59"	$0.00	"$3,868.75"	"$6,128.10"	"$6,190.00"	$0.00		$0.00	"$1,210.92"	$0.00	$0.00	"$1,231.81"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ051002	SUP	HCPCS C1874		VBJ051002  -  STENT ENDOPRSTH 10CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 5	BOTH IP/OP	"$8,487.50 "	"$6,280.75"	$0.00	"$6,790.00"	"$3,819.38"	"$3,819.38"	$0.00	$0.00	$0.00	"$1,769.01"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,768.80"	$0.00	"$4,184.34"	"$4,184.34"	$0.00	"$4,243.75"	"$6,722.10"	"$6,790.00"	$0.00		$0.00	"$1,328.29"	$0.00	$0.00	"$1,351.21"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ051502	SUP	HCPCS C1874		VBJ051502  -  STENT ENDOPRSTH 15CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 5	BOTH IP/OP	"$9,737.50 "	"$7,205.75"	$0.00	"$7,790.00"	"$4,381.88"	"$4,381.88"	$0.00	$0.00	$0.00	"$2,029.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,029.30"	$0.00	"$4,800.59"	"$4,800.59"	$0.00	"$4,868.75"	"$7,712.10"	"$7,790.00"	$0.00		$0.00	"$1,523.92"	$0.00	$0.00	"$1,550.21"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ052502	SUP	HCPCS C1874		VBJ052502  -  STENT ENDOPRSTH 25CM BIOACTIVE SURFACE CATHETER LOWER	BOTH IP/OP	"$15,987.50 "	"$11,830.75"	$0.00	"$12,790.00"	"$7,194.38"	"$7,194.38"	$0.00	$0.00	$0.00	"$3,332.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,331.80"	$0.00	"$7,881.84"	"$7,881.84"	$0.00	"$7,993.75"	"$12,662.10"	"$12,790.00"	$0.00		$0.00	"$2,502.04"	$0.00	$0.00	"$2,545.21"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ060502	SUP	HCPCS C1874		VBJ060502  -  STENT ENDOPRSTH 5CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 6	BOTH IP/OP	"$7,737.50 "	"$5,725.75"	$0.00	"$6,190.00"	"$3,481.88"	"$3,481.88"	$0.00	$0.00	$0.00	"$1,612.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,612.50"	$0.00	"$3,814.59"	"$3,814.59"	$0.00	"$3,868.75"	"$6,128.10"	"$6,190.00"	$0.00		$0.00	"$1,210.92"	$0.00	$0.00	"$1,231.81"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ061002	SUP	HCPCS C1874		VBJ061002  -  STENT EPRSTH 6MM 6FR 10CM 120CM VBHN DLV SYS HEP SPRFC FEM	BOTH IP/OP	"$8,487.50 "	"$6,280.75"	$0.00	"$6,790.00"	"$3,819.38"	"$3,819.38"	$0.00	$0.00	$0.00	"$1,769.01"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,768.80"	$0.00	"$4,184.34"	"$4,184.34"	$0.00	"$4,243.75"	"$6,722.10"	"$6,790.00"	$0.00		$0.00	"$1,328.29"	$0.00	$0.00	"$1,351.21"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ061502	SUP	HCPCS C1874		VBJ061502  -  STENT ENDOPRSTH 15CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 6	BOTH IP/OP	"$9,737.50 "	"$7,205.75"	$0.00	"$7,790.00"	"$4,381.88"	"$4,381.88"	$0.00	$0.00	$0.00	"$2,029.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,029.30"	$0.00	"$4,800.59"	"$4,800.59"	$0.00	"$4,868.75"	"$7,712.10"	"$7,790.00"	$0.00		$0.00	"$1,523.92"	$0.00	$0.00	"$1,550.21"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ062502	SUP	HCPCS C1874		VBJ062502  -  STENT ENDOPRSTH 25CM BIOACTIVE SURFACE CATHETER LOWER	BOTH IP/OP	"$15,987.50 "	"$11,830.75"	$0.00	"$12,790.00"	"$7,194.38"	"$7,194.38"	$0.00	$0.00	$0.00	"$3,332.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,331.80"	$0.00	"$7,881.84"	"$7,881.84"	$0.00	"$7,993.75"	"$12,662.10"	"$12,790.00"	$0.00		$0.00	"$2,502.04"	$0.00	$0.00	"$2,545.21"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ070502	SUP	HCPCS C1874		VBJ070502  -  STENT ENDOPRSTH 5CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 7	BOTH IP/OP	"$7,737.50 "	"$5,725.75"	$0.00	"$6,190.00"	"$3,481.88"	"$3,481.88"	$0.00	$0.00	$0.00	"$1,612.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,612.50"	$0.00	"$3,814.59"	"$3,814.59"	$0.00	"$3,868.75"	"$6,128.10"	"$6,190.00"	$0.00		$0.00	"$1,210.92"	$0.00	$0.00	"$1,231.81"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ071002	SUP	HCPCS C1874		VBJ071002  -  STENT ENDOPRSTH 10CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 7	BOTH IP/OP	"$8,487.50 "	"$6,280.75"	$0.00	"$6,790.00"	"$3,819.38"	"$3,819.38"	$0.00	$0.00	$0.00	"$1,769.01"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,768.80"	$0.00	"$4,184.34"	"$4,184.34"	$0.00	"$4,243.75"	"$6,722.10"	"$6,790.00"	$0.00		$0.00	"$1,328.29"	$0.00	$0.00	"$1,351.21"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ071502	SUP	HCPCS C1874		VBJ071502  -  STENT ENDOPRSTH 15CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 7	BOTH IP/OP	"$9,737.50 "	"$7,205.75"	$0.00	"$7,790.00"	"$4,381.88"	"$4,381.88"	$0.00	$0.00	$0.00	"$2,029.54"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,029.30"	$0.00	"$4,800.59"	"$4,800.59"	$0.00	"$4,868.75"	"$7,712.10"	"$7,790.00"	$0.00		$0.00	"$1,523.92"	$0.00	$0.00	"$1,550.21"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ072502	SUP	HCPCS C1874		VBJ072502  -  STENT ENDOPRSTH 25CM BIOACTIVE SURFACE CATHETER DELIVERY	BOTH IP/OP	"$15,987.50 "	"$11,830.75"	$0.00	"$12,790.00"	"$7,194.38"	"$7,194.38"	$0.00	$0.00	$0.00	"$3,332.19"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,331.80"	$0.00	"$7,881.84"	"$7,881.84"	$0.00	"$7,993.75"	"$12,662.10"	"$12,790.00"	$0.00		$0.00	"$2,502.04"	$0.00	$0.00	"$2,545.21"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ080202	SUP	HCPCS C1874		VBJ080202  -  STENT ENDOPRSTH 2.5CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM	BOTH IP/OP	"$7,355.00 "	"$5,442.70"	$0.00	"$5,884.00"	"$3,309.75"	"$3,309.75"	$0.00	$0.00	$0.00	"$1,532.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,532.78"	$0.00	"$3,626.02"	"$3,626.02"	$0.00	"$3,677.50"	"$5,825.16"	"$5,884.00"	$0.00		$0.00	"$1,151.06"	$0.00	$0.00	"$1,170.92"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ080502	SUP	HCPCS C1874		VBJ080502  -  STENT ENDOPRSTH 8MM 7FR 5CM 120CM DELIVERY SYSTEM VIABAHN	BOTH IP/OP	"$7,737.50 "	"$5,725.75"	$0.00	"$6,190.00"	"$3,481.88"	"$3,481.88"	$0.00	$0.00	$0.00	"$1,612.69"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,612.50"	$0.00	"$3,814.59"	"$3,814.59"	$0.00	"$3,868.75"	"$6,128.10"	"$6,190.00"	$0.00		$0.00	"$1,210.92"	$0.00	$0.00	"$1,231.81"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ081002	SUP	HCPCS C1874		VBJ081002  -  STENT ENDOPRSTH 8MM 7FR 10CM 120CM DELIVERY SYSTEM VIABAHN	BOTH IP/OP	"$8,950.00 "	"$6,623.00"	$0.00	"$7,160.00"	"$4,027.50"	"$4,027.50"	$0.00	$0.00	$0.00	"$1,865.40"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,865.18"	$0.00	"$4,412.35"	"$4,412.35"	$0.00	"$4,475.00"	"$7,088.40"	"$7,160.00"	$0.00		$0.00	"$1,400.68"	$0.00	$0.00	"$1,424.84"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJ081502	SUP	HCPCS C1874		VBJ081502  -  STENT ENDOPRSTH 15CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 8	BOTH IP/OP	"$9,660.00 "	"$7,148.40"	$0.00	"$7,728.00"	"$4,347.00"	"$4,347.00"	$0.00	$0.00	$0.00	"$2,013.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,013.14"	$0.00	"$4,762.38"	"$4,762.38"	$0.00	"$4,830.00"	"$7,650.72"	"$7,728.00"	$0.00		$0.00	"$1,511.79"	$0.00	$0.00	"$1,537.87"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJR050502A	SUP	HCPCS C1874		VBJR050502A  -  STENT EPRSTH 5MM 5CM STRL 120CM VBHN FLXB SLF XPD RADOPQ HEP	BOTH IP/OP	"$9,207.50 "	"$6,813.55"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,919.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,918.84"	$0.00	"$4,539.30"	"$4,539.30"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJR051002A	SUP	HCPCS C1874		VBJR051002A  -  STENT ENDOPRSTH 5MM 10CM 120CM FLEXIBLE SELF EXPAND RADIOPQ	BOTH IP/OP	"$10,072.50 "	"$7,453.65"	$0.00	"$7,900.00"	"$4,443.75"	"$4,443.75"	$0.00	$0.00	$0.00	"$2,099.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,099.11"	$0.00	"$4,965.74"	"$4,965.74"	$0.00	"$4,937.50"	"$7,821.00"	"$7,900.00"	$0.00		$0.00	"$1,545.44"	$0.00	$0.00	"$1,572.10"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJR060502A	SUP	HCPCS C1874		VBJR060502A  -  STENT EPRSTH 6MM 6FR 5CM 120CM VBHN DLV SYS HEP SPRFC FEM	BOTH IP/OP	"$9,207.50 "	"$6,813.55"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,919.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,918.84"	$0.00	"$4,539.30"	"$4,539.30"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJR061002A	SUP	HCPCS C1874		VBJR061002A  -  STENT EPRSTH 6MM 6FR 10CM 120CM VBHN DLV SYS HEP SPRFC	BOTH IP/OP	"$10,072.50 "	"$7,453.65"	$0.00	"$7,900.00"	"$4,443.75"	"$4,443.75"	$0.00	$0.00	$0.00	"$2,099.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,099.11"	$0.00	"$4,965.74"	"$4,965.74"	$0.00	"$4,937.50"	"$7,821.00"	"$7,900.00"	$0.00		$0.00	"$1,545.44"	$0.00	$0.00	"$1,572.10"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJR061502A	SUP	HCPCS C1874		"VBJR061502A  -  VIABAHN ENDOPROSTHESIS, 6MMX 15CM"	BOTH IP/OP	"$11,225.00 "	"$8,306.50"	$0.00	"$8,804.00"	"$4,952.25"	"$4,952.25"	$0.00	$0.00	$0.00	"$2,339.57"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,339.29"	$0.00	"$5,533.93"	"$5,533.93"	$0.00	"$5,502.50"	"$8,715.96"	"$8,804.00"	$0.00		$0.00	"$1,722.28"	$0.00	$0.00	"$1,752.00"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJR062502A	SUP	HCPCS C1874		VBJR062502A  -  STENT ENDOPRSTH 6MM 25CM 120CM FLEXIBLE SELF EXPAND RADIOPQ	BOTH IP/OP	"$18,450.00 "	"$13,653.00"	$0.00	"$14,470.00"	"$8,139.38"	"$8,139.38"	$0.00	$0.00	$0.00	"$3,845.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,844.98"	$0.00	"$9,095.85"	"$9,095.85"	$0.00	"$9,043.75"	"$14,325.30"	"$14,470.00"	$0.00		$0.00	"$2,830.69"	$0.00	$0.00	"$2,879.53"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJR070202A	SUP	HCPCS C1874		VBJR070202A  -  STENT EPRSTH 7MM 2.5CM STRL 120CM VBHN FLXB SLF XPD RADOPQ	BOTH IP/OP	"$9,207.50 "	"$6,813.55"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,919.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,918.84"	$0.00	"$4,539.30"	"$4,539.30"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJR070502A	SUP	HCPCS C1874		"VBJR070502A  -  LOW-PROFILE, VIABAHN 7MMX 5CM"	BOTH IP/OP	"$9,207.50 "	"$6,813.55"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,919.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,918.84"	$0.00	"$4,539.30"	"$4,539.30"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJR071002A	SUP	HCPCS C1874		VBJR071002A  -  STENT ENDOPRSTH SPRFC FEM ART ILIUM 10CM 7MM 7FR	BOTH IP/OP	"$10,072.50 "	"$7,453.65"	$0.00	"$7,900.00"	"$4,443.75"	"$4,443.75"	$0.00	$0.00	$0.00	"$2,099.36"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,099.11"	$0.00	"$4,965.74"	"$4,965.74"	$0.00	"$4,937.50"	"$7,821.00"	"$7,900.00"	$0.00		$0.00	"$1,545.44"	$0.00	$0.00	"$1,572.10"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJR071502A	SUP	HCPCS C1874		VBJR071502A  -  STENT ENDOPRSTH 7MM 7FR 15CM 120CM DELIVERY SYSTEM VIABAHN	BOTH IP/OP	"$11,225.00 "	"$8,306.50"	$0.00	"$8,804.00"	"$4,952.25"	"$4,952.25"	$0.00	$0.00	$0.00	"$2,339.57"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,339.29"	$0.00	"$5,533.93"	"$5,533.93"	$0.00	"$5,502.50"	"$8,715.96"	"$8,804.00"	$0.00		$0.00	"$1,722.28"	$0.00	$0.00	"$1,752.00"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJR072502A	SUP	HCPCS C1874		VBJR072502A  -  STENT ENDOPRSTH 7MM 25CM 120CM FLEXIBLE SELF EXPAND RADIOPQ	BOTH IP/OP	"$18,450.00 "	"$13,653.00"	$0.00	"$14,470.00"	"$8,139.38"	"$8,139.38"	$0.00	$0.00	$0.00	"$3,845.44"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,844.98"	$0.00	"$9,095.85"	"$9,095.85"	$0.00	"$9,043.75"	"$14,325.30"	"$14,470.00"	$0.00		$0.00	"$2,830.69"	$0.00	$0.00	"$2,879.53"	$0.00	$0.00	$0.00	$0.00	$0.00
VBJR080502A	SUP	HCPCS C1874		"VBJR080502A  -  VIABAHN ENDOPROSTHESIS, 8MMX 5CM"	BOTH IP/OP	"$9,207.50 "	"$6,813.55"	$0.00	"$7,222.00"	"$4,062.38"	"$4,062.38"	$0.00	$0.00	$0.00	"$1,919.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,918.84"	$0.00	"$4,539.30"	"$4,539.30"	$0.00	"$4,513.75"	"$7,149.78"	"$7,222.00"	$0.00		$0.00	"$1,412.80"	$0.00	$0.00	"$1,437.18"	$0.00	$0.00	$0.00	$0.00	$0.00
VBP32	SUP	HCPCS C1713		VBP32  -  PIN FIX 32MM BUTTRESS TITANIUM VOLAR	BOTH IP/OP	$937.50 	$693.75	$0.00	$750.00	$421.88	$421.88	$0.00	$0.00	$0.00	$195.40	$695.81	$695.81	$0.00	$0.00	$195.38	$0.00	$554.53	$554.53	$0.00	$468.75	$742.50	$750.00	$0.00		$0.00	$146.72	$0.00	$0.00	$149.25	$0.00	$0.00	$0.00	$0.00	$0.00
VCP740D	SUP	Custom 27203010		VCP740D  -  SUTURE ABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND	BOTH IP/OP	$32.80 	$24.27	$0.00	$26.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.34	$24.34	$0.00	$0.00	$6.83	$0.00	$0.00	$0.00	$0.00	$16.40	$25.98	$26.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VE220GS	SUP	HCPCS C1884		VE220GS  -  PARTICLES EMBL 100-300UM 2ML YLW LC BEAD VL	BOTH IP/OP	"$4,237.50 "	"$3,135.75"	$0.00	"$3,390.00"	"$1,906.88"	"$1,906.88"	$0.00	$0.00	$0.00	$883.20	"$3,145.07"	"$3,145.07"	$0.00	$0.00	$883.10	$0.00	"$2,089.09"	"$2,089.09"	$0.00	"$2,118.75"	"$3,356.10"	"$3,390.00"	$0.00		$0.00	$663.17	$0.00	$0.00	$674.61	$0.00	$0.00	$0.00	$0.00	$0.00
VE420GS	SUP	HCPCS C1884		VE420GS  -  PARTICLES EMBL 300-500UM 2ML BLU LC BEAD LBL	BOTH IP/OP	"$4,037.50 "	"$2,987.75"	$0.00	"$3,230.00"	"$1,816.88"	"$1,816.88"	$0.00	$0.00	$0.00	$841.52	"$2,996.63"	"$2,996.63"	$0.00	$0.00	$841.42	$0.00	"$1,990.49"	"$1,990.49"	$0.00	"$2,018.75"	"$3,197.70"	"$3,230.00"	$0.00		$0.00	$631.87	$0.00	$0.00	$642.77	$0.00	$0.00	$0.00	$0.00	$0.00
VE620GS	SUP	Custom 27203010		PARTICLES EMBL 500-700UM 2ML LBL LC BEAD RD	BOTH IP/OP	"$3,487.50 "	"$2,580.75"	$0.00	"$2,790.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,743.75"	"$2,762.10"	"$2,790.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VEDR01	SUP	HCPCS C1785		VEDR01  -  PACEMAKER CARDIAC 2.8V 1.3AH 7.5MM 47.9X7.5X44.7MM IMPLTABLE	BOTH IP/OP	"$6,002.50 "	"$4,441.85"	$0.00	"$4,900.00"	"$2,756.25"	"$2,756.25"	$0.00	$0.00	$0.00	"$1,251.07"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,250.92"	$0.00	"$2,959.23"	"$2,959.23"	$0.00	"$3,062.50"	"$4,851.00"	"$4,900.00"	$0.00		$0.00	$958.56	$0.00	$0.00	$975.10	$0.00	$0.00	$0.00	$0.00	$0.00
VERSADRK2	SUP	HCPCS C1785		VERSADRK2  -  PACEMAKER CARDIAC THK7.5MM 47.9X44.7MM IMPLTABLE 2 CHAMBER	BOTH IP/OP	"$7,987.50 "	"$5,910.75"	$0.00	"$6,520.00"	"$3,667.50"	"$3,667.50"	$0.00	$0.00	$0.00	"$1,664.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,664.60"	$0.00	"$3,937.84"	"$3,937.84"	$0.00	"$4,075.00"	"$6,454.80"	"$6,520.00"	$0.00		$0.00	"$1,275.48"	$0.00	$0.00	"$1,297.48"	$0.00	$0.00	$0.00	$0.00	$0.00
VG-0108N	SUP	HCPCS C1768		VG-0108N  -  PATCH CARDIO TAPER 8X.8CM APEX PROCESS VASCU-GUARD BOVINE	BOTH IP/OP	$525.28 	$388.71	$0.00	$396.08	$222.80	$222.80	$0.00	$0.00	$0.00	$109.48	$389.86	$389.86	$0.00	$0.00	$109.47	$0.00	$310.70	$310.70	$0.00	$247.55	$392.12	$396.08	$0.00		$0.00	$77.48	$0.00	$0.00	$78.82	$0.00	$0.00	$0.00	$0.00	$0.00
VG-0209N	SUP	HCPCS C1768		VG-0209N  -  PATCH CARDIO 9X2CM TPR VSGRD BVN PRICRD PERI	BOTH IP/OP	$532.50 	$394.05	$0.00	$426.00	$239.63	$239.63	$0.00	$0.00	$0.00	$110.99	$395.22	$395.22	$0.00	$0.00	$110.97	$0.00	$314.97	$314.97	$0.00	$266.25	$421.74	$426.00	$0.00		$0.00	$83.34	$0.00	$0.00	$84.77	$0.00	$0.00	$0.00	$0.00	$0.00
VG1CPAR10P	SUP	HCPCS C1762		VG1CPAR10P  -  GRAFT BONE 12X14.5X10MM ANTERIOR CERV FUSION PARALLEL SOLID	BOTH IP/OP	"$2,495.63 "	"$1,846.77"	$0.00	"$2,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$520.15	"$1,852.25"	"$1,852.25"	$0.00	$0.00	$520.09	$0.00	"$1,476.16"	"$1,476.16"	$0.00	"$1,497.50"	"$2,372.04"	"$2,396.00"	$0.00		$0.00	$468.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VG1CPAR5P	SUP	HCPCS C1762		VG1CPAR5P  -  GRAFT BONE VG1 CERV	BOTH IP/OP	"$2,495.63 "	"$1,846.77"	$0.00	"$2,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$520.15	"$1,852.25"	"$1,852.25"	$0.00	$0.00	$520.09	$0.00	"$1,476.16"	"$1,476.16"	$0.00	"$1,497.50"	"$2,372.04"	"$2,396.00"	$0.00		$0.00	$468.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VG1CPAR6P	SUP	HCPCS C1762		VG1CPAR6P  -  GRAFT BONE 12X14.5X6MM ANTERIOR CERV FUSION PARALLEL SOLID	BOTH IP/OP	"$2,495.63 "	"$1,846.77"	$0.00	"$2,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$520.15	"$1,852.25"	"$1,852.25"	$0.00	$0.00	$520.09	$0.00	"$1,476.16"	"$1,476.16"	$0.00	"$1,497.50"	"$2,372.04"	"$2,396.00"	$0.00		$0.00	$468.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VG1CPAR7P	SUP	HCPCS C1762		VG1CPAR7P  -  GRAFT BONE 12X14.5X7MM ANTERIOR CERV FUSION PARALLEL SOLID	BOTH IP/OP	"$2,495.63 "	"$1,846.77"	$0.00	"$2,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$520.15	"$1,852.25"	"$1,852.25"	$0.00	$0.00	$520.09	$0.00	"$1,476.16"	"$1,476.16"	$0.00	"$1,497.50"	"$2,372.04"	"$2,396.00"	$0.00		$0.00	$468.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VG1CPAR8P	SUP	HCPCS C1762		VG1CPAR8P  -  GRAFT BONE 12X14.5X8MM ANTERIOR CERV FUSION PARALLEL	BOTH IP/OP	"$2,495.63 "	"$1,846.77"	$0.00	"$2,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$520.15	"$1,852.25"	"$1,852.25"	$0.00	$0.00	$520.09	$0.00	"$1,476.16"	"$1,476.16"	$0.00	"$1,497.50"	"$2,372.04"	"$2,396.00"	$0.00		$0.00	$468.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VG1CPAR9P	SUP	HCPCS C1762		VG1CPAR9P  -  GRAFT BONE 12X14.5X9MM ANTERIOR CERV FUSION PARALLEL SOLID	BOTH IP/OP	"$2,495.63 "	"$1,846.77"	$0.00	"$2,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$520.15	"$1,852.25"	"$1,852.25"	$0.00	$0.00	$520.09	$0.00	"$1,476.16"	"$1,476.16"	$0.00	"$1,497.50"	"$2,372.04"	"$2,396.00"	$0.00		$0.00	$468.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VG1C-T46P	SUP	HCPCS C1762		VG1C-T46P  -  GRAFT BONE 7D 6MM 4MM 1 PIECE LORDOSIS SOLID CENTRL VOID	BOTH IP/OP	"$2,495.63 "	"$1,846.77"	$0.00	"$2,662.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$520.15	"$1,852.25"	"$1,852.25"	$0.00	$0.00	$520.09	$0.00	"$1,476.16"	"$1,476.16"	$0.00	"$1,663.75"	"$2,635.38"	"$2,662.00"	$0.00		$0.00	$520.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VG1C-T57P	SUP	HCPCS C1762		VG1C-T57P  -  GRAFT BONE 7D 7MM 5MM 1 PIECE LORDOSIS SOLID CENTRL VOID	BOTH IP/OP	"$2,495.63 "	"$1,846.77"	$0.00	"$2,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$520.15	"$1,852.25"	"$1,852.25"	$0.00	$0.00	$520.09	$0.00	"$1,476.16"	"$1,476.16"	$0.00	"$1,497.50"	"$2,372.04"	"$2,396.00"	$0.00		$0.00	$468.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VG1C-T68P	SUP	HCPCS C1762		VG1C-T68P  -  GRAFT BONE 7D 12X14.5X8MM 6MM ANTERIOR CERV FUSION PRESERVON	BOTH IP/OP	"$2,495.63 "	"$1,846.77"	$0.00	"$2,662.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$520.15	"$1,852.25"	"$1,852.25"	$0.00	$0.00	$520.09	$0.00	"$1,476.16"	"$1,476.16"	$0.00	"$1,663.75"	"$2,635.38"	"$2,662.00"	$0.00		$0.00	$520.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VG1C-T79P	SUP	HCPCS C1762		VG1C-T79P  -  GRAFT BONE 7D 12X14.5X9MM 7MM ANTERIOR CERV FUSION PRESERVON	BOTH IP/OP	"$2,495.63 "	"$1,846.77"	$0.00	"$2,598.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$520.15	"$1,852.25"	"$1,852.25"	$0.00	$0.00	$520.09	$0.00	"$1,476.16"	"$1,476.16"	$0.00	"$1,623.75"	"$2,572.02"	"$2,598.00"	$0.00		$0.00	$508.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VG1C-T810P	SUP	HCPCS C1762		VG1C-T810P  -  GRAFT BONE 7D 12X14.5X10MM 8MM ANTERIOR CERV FUSION	BOTH IP/OP	"$2,495.63 "	"$1,846.77"	$0.00	"$2,396.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$520.15	"$1,852.25"	"$1,852.25"	$0.00	$0.00	$520.09	$0.00	"$1,476.16"	"$1,476.16"	$0.00	"$1,497.50"	"$2,372.04"	"$2,396.00"	$0.00		$0.00	$468.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VG2C-T57P	SUP	Custom 27803010		VG2C-T57P  -  LIFENET HEALTH 5.75 X 7.22MM CERVICAL LORDOTIC	BOTH IP/OP	"$2,630.63 "	"$1,946.67"	$0.00	"$2,598.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,952.45"	"$1,952.45"	$0.00	$0.00	$548.22	$0.00	$0.00	$0.00	$0.00	"$1,623.75"	"$2,572.02"	"$2,598.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VG501	SUP	Custom 27203010		"CONTROLLER, V-GRIP DETACHMENT"	BOTH IP/OP	$437.50 	$323.75	$0.00	$350.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.75	$346.50	$350.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VH - 2004	SUP	Custom 27203010		VH - 2004  -  SYSTEM VSL HRVT SHRT BLNT CONE 30ML VSVW TROC ESCP CNN SL	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,113.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$656.25	"$1,039.50"	"$1,050.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VKML	SUP	HCPCS C1781		VKML  -  MESH SURG FLAT 12X12IN KNIT VICRYL POLYGLACTIN 910 WOVEN	BOTH IP/OP	"$1,899.22 "	"$1,405.42"	$0.00	"$1,542.16"	$867.47	$867.47	$0.00	$0.00	$0.00	$395.84	"$1,409.60"	"$1,409.60"	$0.00	$0.00	$395.80	$0.00	"$1,123.39"	"$1,123.39"	$0.00	$963.85	"$1,526.75"	"$1,542.16"	$0.00		$0.00	$301.69	$0.00	$0.00	$306.89	$0.00	$0.00	$0.00	$0.00	$0.00
VL1060031	SUP	Custom 27203010		KIT OC VAP GRD PKG	BOTH IP/OP	$3.03 	$2.24	$0.00	$2.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$1.51	$2.40	$2.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLBPL-11-7	SUP	HCPCS C1713		VLBPL-11-7  -  PLATE BONE 11 HOLE 7 PEG LOCKING VOLAR BEARING PLATE	BOTH IP/OP	"$5,187.50 "	"$3,838.75"	$0.00	"$4,150.00"	"$2,334.38"	"$2,334.38"	$0.00	$0.00	$0.00	"$1,081.20"	"$3,850.16"	"$3,850.16"	$0.00	$0.00	"$1,081.08"	$0.00	"$2,557.44"	"$2,557.44"	$0.00	"$2,593.75"	"$4,108.50"	"$4,150.00"	$0.00		$0.00	$811.84	$0.00	$0.00	$825.85	$0.00	$0.00	$0.00	$0.00	$0.00
VLBPL-3-7	SUP	HCPCS C1713		VLBPL-3-7  -  PLATE BONE 3 HOLE 7 PEG LOCKING VOLAR BEARING PLATE TITANIUM	BOTH IP/OP	"$2,700.00 "	"$1,998.00"	$0.00	"$2,160.00"	"$1,215.00"	"$1,215.00"	$0.00	$0.00	$0.00	$562.75	"$2,003.94"	"$2,003.94"	$0.00	$0.00	$562.68	$0.00	"$1,331.10"	"$1,331.10"	$0.00	"$1,350.00"	"$2,138.40"	"$2,160.00"	$0.00		$0.00	$422.55	$0.00	$0.00	$429.84	$0.00	$0.00	$0.00	$0.00	$0.00
VLBPL-5-5	SUP	HCPCS C1713		VLBPL-5-5  -  PLATE BONE 5 HOLE 5 PEG LOCKING VOLAR BEARING PLATE TITANIUM	BOTH IP/OP	"$2,962.50 "	"$2,192.25"	$0.00	"$2,370.00"	"$1,333.13"	"$1,333.13"	$0.00	$0.00	$0.00	$617.46	"$2,198.77"	"$2,198.77"	$0.00	$0.00	$617.39	$0.00	"$1,460.51"	"$1,460.51"	$0.00	"$1,481.25"	"$2,346.30"	"$2,370.00"	$0.00		$0.00	$463.63	$0.00	$0.00	$471.63	$0.00	$0.00	$0.00	$0.00	$0.00
VLBPL-5-7	SUP	HCPCS C1713		VLBPL-5-7  -  PLATE BONE 5 HOLE EDGE FREE CNTOUR VOLAR BEARING PLATE LEFT	BOTH IP/OP	"$2,962.50 "	"$2,192.25"	$0.00	"$2,370.00"	"$1,333.13"	"$1,333.13"	$0.00	$0.00	$0.00	$617.46	"$2,198.77"	"$2,198.77"	$0.00	$0.00	$617.39	$0.00	"$1,460.51"	"$1,460.51"	$0.00	"$1,481.25"	"$2,346.30"	"$2,370.00"	$0.00		$0.00	$463.63	$0.00	$0.00	$471.63	$0.00	$0.00	$0.00	$0.00	$0.00
VLBPL-7-7	SUP	HCPCS C1713		VLBPL-7-7  -  PLATE BONE 7 HOLE EDGE FREE CNTOUR VOLAR BEARING PLATE LEFT	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	"$1,456.88"	"$1,456.88"	$0.00	$0.00	$0.00	$674.78	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	"$1,596.09"	"$1,596.09"	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$506.67	$0.00	$0.00	$515.41	$0.00	$0.00	$0.00	$0.00	$0.00
VLBPL-9-7	SUP	HCPCS C1713		VLBPL-9-7  -  PLATE BN VOLR BRNG PLT 9 HL 7 PG LCK TI LT WRST	BOTH IP/OP	"$4,225.00 "	"$3,126.50"	$0.00	"$3,380.00"	"$1,901.25"	"$1,901.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,112.50"	"$3,346.20"	"$3,380.00"	$0.00		$0.00	$661.21	$0.00	$0.00	$672.62	$0.00	$0.00	$0.00	$0.00	$0.00
VLBPR-11-7	SUP	HCPCS C1713		VLBPR-11-7  -  PLATE BONE VOLAR BEARING PLATE TITANIUM RIGHT WRIST 11 HOLE	BOTH IP/OP	"$5,187.50 "	"$3,838.75"	$0.00	"$4,150.00"	"$2,334.38"	"$2,334.38"	$0.00	$0.00	$0.00	"$1,081.20"	"$3,850.16"	"$3,850.16"	$0.00	$0.00	"$1,081.08"	$0.00	"$2,557.44"	"$2,557.44"	$0.00	"$2,593.75"	"$4,108.50"	"$4,150.00"	$0.00		$0.00	$811.84	$0.00	$0.00	$825.85	$0.00	$0.00	$0.00	$0.00	$0.00
VLBPR-3-7	SUP	HCPCS C1713		VLBPR-3-7  -  PLATE BONE 3 HOLE 7 PEG LOCKING VOLAR BEARING PLATE TITANIUM	BOTH IP/OP	"$2,700.00 "	"$1,998.00"	$0.00	"$2,160.00"	"$1,215.00"	"$1,215.00"	$0.00	$0.00	$0.00	$562.75	"$2,003.94"	"$2,003.94"	$0.00	$0.00	$562.68	$0.00	"$1,331.10"	"$1,331.10"	$0.00	"$1,350.00"	"$2,138.40"	"$2,160.00"	$0.00		$0.00	$422.55	$0.00	$0.00	$429.84	$0.00	$0.00	$0.00	$0.00	$0.00
VLBPR-5-5	SUP	HCPCS C1713		VLBPR-5-5  -  PLATE TI 5 HOLE 5 PG LCK VOLR BRNG PLT BONE RIGHT	BOTH IP/OP	"$2,962.50 "	"$2,192.25"	$0.00	"$2,370.00"	"$1,333.13"	"$1,333.13"	$0.00	$0.00	$0.00	$617.46	"$2,198.77"	"$2,198.77"	$0.00	$0.00	$617.39	$0.00	"$1,460.51"	"$1,460.51"	$0.00	"$1,481.25"	"$2,346.30"	"$2,370.00"	$0.00		$0.00	$463.63	$0.00	$0.00	$471.63	$0.00	$0.00	$0.00	$0.00	$0.00
VLBPR-5-7	SUP	HCPCS C1713		VLBPR-5-7  -  PLATE BONE STANDARD 5 HOLE PEG VOLAR BEARING PLATE RIGHT	BOTH IP/OP	"$2,962.50 "	"$2,192.25"	$0.00	"$2,370.00"	"$1,333.13"	"$1,333.13"	$0.00	$0.00	$0.00	$617.46	"$2,198.77"	"$2,198.77"	$0.00	$0.00	$617.39	$0.00	"$1,460.51"	"$1,460.51"	$0.00	"$1,481.25"	"$2,346.30"	"$2,370.00"	$0.00		$0.00	$463.63	$0.00	$0.00	$471.63	$0.00	$0.00	$0.00	$0.00	$0.00
VLBPR-7-7	SUP	HCPCS C1713		VLBPR-7-7  -  PLATE BONE STANDARD 7 HOLE PEG VOLAR BEARING PLATE RIGHT	BOTH IP/OP	"$3,237.50 "	"$2,395.75"	$0.00	"$2,590.00"	"$1,456.88"	"$1,456.88"	$0.00	$0.00	$0.00	$674.78	"$2,402.87"	"$2,402.87"	$0.00	$0.00	$674.70	$0.00	"$1,596.09"	"$1,596.09"	$0.00	"$1,618.75"	"$2,564.10"	"$2,590.00"	$0.00		$0.00	$506.67	$0.00	$0.00	$515.41	$0.00	$0.00	$0.00	$0.00	$0.00
VLBPR-9-7	SUP	HCPCS C1713		VLBPR-9-7  -  PLATE BONE 9 HOLE 7 PEG LOCKING VOLAR BEARING PLATE TITANIUM	BOTH IP/OP	"$4,225.00 "	"$3,126.50"	$0.00	"$3,380.00"	"$1,901.25"	"$1,901.25"	$0.00	$0.00	$0.00	$880.60	"$3,135.80"	"$3,135.80"	$0.00	$0.00	$880.49	$0.00	"$2,082.93"	"$2,082.93"	$0.00	"$2,112.50"	"$3,346.20"	"$3,380.00"	$0.00		$0.00	$661.21	$0.00	$0.00	$672.62	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCL0315	SUP	Custom 27203010		VLOCL0315  -  DEVICE CLSR 2-0 GS-21 .5 CRC 12IN GRN 37MM V-LOC 180 TPR PNT	BOTH IP/OP	$65.75 	$48.66	$0.00	$52.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.80	$48.80	$0.00	$0.00	$13.70	$0.00	$0.00	$0.00	$0.00	$32.88	$52.07	$52.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCL0316	SUP	Custom 27203010		VLOCL0316  -  DEVICE CLOSURE 0 GS-21 .5 CIR 12IN 37MM TAPER POINT	BOTH IP/OP	$7.89 	$5.84	$0.00	$6.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.86	$5.86	$0.00	$0.00	$1.64	$0.00	$0.00	$0.00	$0.00	$3.95	$6.25	$6.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCL0325	SUP	Custom 27203010		VLOCL0325  -  DEVICE CLOSURE 2-0 GS-21 .5 CIR 18IN 37MM TAPER POINT	BOTH IP/OP	$72.53 	$53.67	$0.00	$58.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.83	$53.83	$0.00	$0.00	$15.11	$0.00	$0.00	$0.00	$0.00	$36.26	$57.44	$58.02	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCL0346	SUP	Custom 27203010		VLOCL0346  -  DEVICE CLSR 0 GS-21 9IN GRN V-LOC 180 ABS TPR PNT	BOTH IP/OP	$75.89 	$56.16	$0.00	$728.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.32	$56.32	$0.00	$0.00	$15.81	$0.00	$0.00	$0.00	$0.00	$455.31	$721.22	$728.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCL0604	SUP	Custom 27203010		VLOCL0604  -  DEVICE CLSR 3-0 V-20 6IN GRN V-LOC 180 SURGALLOY ABS TPR PNT	BOTH IP/OP	$62.63 	$46.35	$0.00	$50.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.48	$46.48	$0.00	$0.00	$13.05	$0.00	$0.00	$0.00	$0.00	$31.31	$49.60	$50.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCL0614	SUP	Custom 27203010		VLOCL0614  -  DEVICE CLOSURE 3-0 V-20 .5 CIR 12IN 26MM TAPER POINT	BOTH IP/OP	$789.00 	$583.86	$0.00	$631.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$585.60	$585.60	$0.00	$0.00	$164.43	$0.00	$0.00	$0.00	$0.00	$394.50	$624.89	$631.20	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCL0615	SUP	Custom 27203010		VLOCL0615  -  DEVICE CLSR 2-0 V-20 12IN GRN V-LOC 180 TPR PNT ABS 2 ANG	BOTH IP/OP	$65.75 	$48.66	$0.00	$52.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.80	$48.80	$0.00	$0.00	$13.70	$0.00	$0.00	$0.00	$0.00	$32.88	$52.07	$52.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCM0315	SUP	Custom 27203010		VLOCM0315  -  DEVICE CLOSURE 2-0 GS-21 .5 CIR 12IN 37MM TAPER POINT	BOTH IP/OP	$7.89 	$5.84	$0.00	$6.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.86	$5.86	$0.00	$0.00	$1.64	$0.00	$0.00	$0.00	$0.00	$3.95	$6.25	$6.31	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCM0345	SUP	HCPCS C1760		VLOCM0345  -  WOUND CLOSURE DEVICE ABSORB V LOC 90 2-0 GS-21	BOTH IP/OP	$73.68 	$54.52	$0.00	$58.94	$33.15	$33.15	$0.00	$0.00	$0.00	$15.36	$54.68	$54.68	$0.00	$0.00	$15.35	$0.00	$43.58	$43.58	$0.00	$36.84	$58.35	$58.94	$0.00		$0.00	$11.53	$0.00	$0.00	$11.73	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCM0604	SUP	Custom 27203010		VLOCM0604  -  DEVICE CLSR 3-0 V-20 6IN VIOL V-LOC 90 SURGALLOY ABS TPR PNT	BOTH IP/OP	$62.63 	$46.35	$0.00	$50.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.48	$46.48	$0.00	$0.00	$13.05	$0.00	$0.00	$0.00	$0.00	$31.31	$49.60	$50.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCM0804	SUP	Custom 27203010		VLOCM0804  -  DEVICE CLSR 3-0 CV-23 6IN VIOL V-LOC 90 ABS	BOTH IP/OP	$753.48 	$557.58	$0.00	$602.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$559.23	$559.23	$0.00	$0.00	$157.02	$0.00	$0.00	$0.00	$0.00	$376.74	$596.76	$602.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCM1904	SUP	Custom 27203010		VLOCM1904  -  DEVICE CLSR 3-0 CV-23 6IN UD 17MM V-LOC 90 SURGALLOY ABS	BOTH IP/OP	$62.63 	$46.35	$0.00	$50.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.48	$46.48	$0.00	$0.00	$13.05	$0.00	$0.00	$0.00	$0.00	$31.31	$49.60	$50.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLOCM1944	SUP	Custom 27203010		VLOCM1944  -  DEVICE CLSR 3-0 CV-23 .5 CRC 9IN UD 17MM V-LOC 90 SURGALLOY	BOTH IP/OP	$62.63 	$46.35	$0.00	$50.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.48	$46.48	$0.00	$0.00	$13.05	$0.00	$0.00	$0.00	$0.00	$31.31	$49.60	$50.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLS03AF	SUP	Custom 27011340		VLS03AF  -  LINER TRC AIRFLO SHRT HEAD SYNTH	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$0.00	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VLS05AF	SUP	Custom 27011340		VLS05AF  -  HALTER TRC BREMER AIRFLO TALL CERV LINR LTWT VAC FRM	BOTH IP/OP	$255.00 	$188.70	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.26	$189.26	$0.00	$0.00	$53.14	$0.00	$0.00	$0.00	$0.00	$127.50	$201.96	$204.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VN1004040	SUP	HCPCS C1874		VN1004040  -  STENT ENDOPRSTH 10MM 4CM 40CM EXPANDABLE PULL LINE SOLID	BOTH IP/OP	"$7,695.00 "	"$5,694.30"	$0.00	"$6,156.00"	"$3,462.75"	"$3,462.75"	$0.00	$0.00	$0.00	"$1,603.83"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,603.64"	$0.00	"$3,793.64"	"$3,793.64"	$0.00	"$3,847.50"	"$6,094.44"	"$6,156.00"	$0.00		$0.00	"$1,204.27"	$0.00	$0.00	"$1,225.04"	$0.00	$0.00	$0.00	$0.00	$0.00
VN1006040	SUP	HCPCS C1874		VN1006040  -  STENT ENDOPRSTH 10MM 6CM 40CM EXPANDABLE PULL LINE SOLID	BOTH IP/OP	"$7,695.00 "	"$5,694.30"	$0.00	"$6,156.00"	"$3,462.75"	"$3,462.75"	$0.00	$0.00	$0.00	"$1,603.83"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,603.64"	$0.00	"$3,793.64"	"$3,793.64"	$0.00	"$3,847.50"	"$6,094.44"	"$6,156.00"	$0.00		$0.00	"$1,204.27"	$0.00	$0.00	"$1,225.04"	$0.00	$0.00	$0.00	$0.00	$0.00
VN1008040	SUP	HCPCS C1874		VN1008040  -  STENT ENDOPRSTH 10MM 8CM 40CM EXPANDABLE PULL LINE HOLE	BOTH IP/OP	"$7,695.00 "	"$5,694.30"	$0.00	"$6,156.00"	"$3,462.75"	"$3,462.75"	$0.00	$0.00	$0.00	"$1,603.83"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,603.64"	$0.00	"$3,793.64"	"$3,793.64"	$0.00	"$3,847.50"	"$6,094.44"	"$6,156.00"	$0.00		$0.00	"$1,204.27"	$0.00	$0.00	"$1,225.04"	$0.00	$0.00	$0.00	$0.00	$0.00
VN1010040	SUP	HCPCS C1874		VN1010040  -  STENT ENDOPRSTH 10MM 10CM 40CM EXPANDABLE PULL LINE HOLE	BOTH IP/OP	"$7,695.00 "	"$5,694.30"	$0.00	"$6,156.00"	"$3,462.75"	"$3,462.75"	$0.00	$0.00	$0.00	"$1,603.83"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,603.64"	$0.00	"$3,793.64"	"$3,793.64"	$0.00	"$3,847.50"	"$6,094.44"	"$6,156.00"	$0.00		$0.00	"$1,204.27"	$0.00	$0.00	"$1,225.04"	$0.00	$0.00	$0.00	$0.00	$0.00
VP40101-070	SUP	Custom 27011340		VP40101-070  -  IMMOBILIZER ORTH UNV 24IN QCK WRP REINF POST STAY ELC HKLP	BOTH IP/OP	$37.45 	$27.71	$0.00	$31.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.80	$27.80	$0.00	$0.00	$7.80	$0.00	$0.00	$0.00	$0.00	$19.85	$31.44	$31.76	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VP-C328	SUP	Custom 25003010		ANTIBODY CD10 CLONE 56C6 MS IGG1 KAPPA ANHMN 1ML LAB	BOTH IP/OP	"$1,512.50 "	"$1,119.25"	$0.00	"$1,210.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$756.25	"$1,197.90"	"$1,210.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VPPL-5-7	SUP	HCPCS C1713		VPPL-5-7  -  PLATE BN NS VOLR FA PLT 5 HL 7 PG WRST LT VOLR	BOTH IP/OP	"$1,950.00 "	"$1,443.00"	$0.00	"$1,560.00"	$877.50	$877.50	$0.00	$0.00	$0.00	$406.43	"$1,447.29"	"$1,447.29"	$0.00	$0.00	$406.38	$0.00	"$1,153.43"	"$1,153.43"	$0.00	$975.00	"$1,544.40"	"$1,560.00"	$0.00		$0.00	$305.18	$0.00	$0.00	$310.44	$0.00	$0.00	$0.00	$0.00	$0.00
VR702	SUP	Custom 27203010		VR702  -  REG PRFSN PMP KIT EXTN	BOTH IP/OP	"$1,500.00 "	"$1,110.00"	$0.00	"$1,200.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.30"	"$1,113.30"	$0.00	$0.00	$312.60	$0.00	$0.00	$0.00	$0.00	$750.00	"$1,188.00"	"$1,200.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VS0602	SUP	Custom 27203010		"VIVASPIN 6 @ 10,000 MWCO"	BOTH IP/OP	$877.50 	$649.35	$0.00	$702.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$438.75	$694.98	$702.00	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VS101000	SUP	Custom 27203010		VS101000  -  SLEEVE LAPSCOP 12MM 100MM RADIAL EXPAND BLADELESS TROCAR	BOTH IP/OP	$112.30 	$83.10	$0.00	$91.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.35	$83.35	$0.00	$0.00	$23.40	$0.00	$0.00	$0.00	$0.00	$56.99	$90.27	$91.19	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VS101005	SUP	Custom 27203010		VS101005  -  CANNULA ESCP 5MM BLU STRL LF VRSTP BLDLS TROC DIL RADL XPD	BOTH IP/OP	$106.55 	$78.85	$0.00	$85.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.08	$79.08	$0.00	$0.00	$22.21	$0.00	$0.00	$0.00	$0.00	$53.28	$84.39	$85.24	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VS150000	SUP	Custom 27203010		VS150000  -  NEEDLE INSFL LNG 14GA 150MM VRSTP BLDLS TROC EXPANDABLE SLV	BOTH IP/OP	$39.95 	$29.56	$0.00	$31.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.65	$29.65	$0.00	$0.00	$8.33	$0.00	$0.00	$0.00	$0.00	$19.98	$31.64	$31.96	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VTP2201	SUP	HCPCS C9356		VTP2201  -  PROTECTOR TENDON VERAWRAP HYALURONIC ACID ALGINATE 2X2 TENDO	BOTH IP/OP	"$4,900.00 "	"$3,626.00"	$0.00	"$3,920.00"	"$2,205.00"	"$2,205.00"	$0.00	$0.00	$0.00	"$1,021.28"	"$3,636.78"	"$3,636.78"	$0.00	$0.00	"$1,021.16"	$0.00	"$2,415.70"	"$2,415.70"	$0.00	"$2,450.00"	"$3,880.80"	"$3,920.00"	$0.00		$0.00	$766.85	$0.00	$0.00	$780.08	$0.00	$0.00	$0.00	$0.00	$0.00
VU-CTE-520	SUP	HCPCS C1789		VU-CTE-520  -  XPD TISS 520-780ML TXTR CNTER PRFL DERMASPAN P4.5-7CM	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$894.38	$894.38	$0.00	$0.00	$0.00	$414.24	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	"$1,175.61"	"$1,175.61"	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$311.04	$0.00	$0.00	$316.41	$0.00	$0.00	$0.00	$0.00	$0.00
VU-CTE-720	SUP	Custom 27803010		VU-CTE-720  -  EXPANDER TISS P4.7-7.5CM CURVILINEAR 26.2X9CM 720-1080CC	BOTH IP/OP	"$1,987.50 "	"$1,470.75"	$0.00	"$1,590.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,475.12"	"$1,475.12"	$0.00	$0.00	$414.20	$0.00	$0.00	$0.00	$0.00	$993.75	"$1,574.10"	"$1,590.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
VXH13300	SUP	HCPCS C1874		VXH13300  -  STENT CORON 3MM 13MM 137CM .014IN RAPEX RPTRL DLV SYS BX VLC	BOTH IP/OP	$2.50 	$1.85	$0.00	$2.00	$1.13	$1.13	$0.00	$0.00	$0.00	$0.52	$1.86	$1.86	$0.00	$0.00	$0.52	$0.00	$1.48	$1.48	$0.00	$1.25	$1.98	$2.00	$0.00		$0.00	$0.39	$0.00	$0.00	$0.40	$0.00	$0.00	$0.00	$0.00	$0.00
W0400D	SUP	Custom 27203010		BRACE WLK S/MED LOW PROFILE ANKL LEG HTOP RCKR SOLE HK/LOP	BOTH IP/OP	$163.13 	$120.72	$0.00	$130.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.56	$129.20	$130.50	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
W4200	SUP	HCPCS C1760		W4200  -  CLIP LG INTNL HRZN TI ENDSCP LIGAT STRL DISP LATEX FREE ORNG	BOTH IP/OP	$15.59 	$11.54	$0.00	$12.47	$7.02	$7.02	$0.00	$0.00	$0.00	$3.25	$11.57	$11.57	$0.00	$0.00	$3.25	$0.00	$9.22	$9.22	$0.00	$7.80	$12.35	$12.47	$0.00		$0.00	$2.44	$0.00	$0.00	$2.48	$0.00	$0.00	$0.00	$0.00	$0.00
WA22706S	SUP	Custom 27203010		WA22706S  -  ELECTRODE ELECTROSURGICAL OLYMPUS PLASMA LOOP 30 D MEDIUM DI	BOTH IP/OP	"$1,157.59 "	$856.62	$0.00	$859.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$859.16	$859.16	$0.00	$0.00	$241.24	$0.00	$0.00	$0.00	$0.00	$535.92	$848.91	$857.48	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
WA22760S	SUP	Custom 27203010		WA22760S  -  ELECTRODE ELECTROSURGICAL OLYMPUS PLASMA BUTTON MEDIUM DISPO	BOTH IP/OP	"$1,209.74 "	$895.21	$0.00	$897.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$897.87	$897.87	$0.00	$0.00	$252.11	$0.00	$0.00	$0.00	$0.00	$560.06	$887.14	$896.10	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
WA425600	SUP	Custom 27203010		KIT IMMUN TST CNTRL CLBRT ELISA VZV IGG 2 96 TST	BOTH IP/OP	$779.73 	$577.00	$0.00	$623.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.86	$617.55	$623.78	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
WBTN-2750-T	SUP	HCPCS C1713		WBTN-2750-T  -  WASHER ORTH 5MM 27MM NS GEMINUS TI DIST VOLR RDS FOSSA	BOTH IP/OP	$100.00 	$74.00	$0.00	$80.00	$45.00	$45.00	$0.00	$0.00	$0.00	$20.84	$74.22	$74.22	$0.00	$0.00	$20.84	$0.00	$59.15	$59.15	$0.00	$50.00	$79.20	$80.00	$0.00		$0.00	$15.65	$0.00	$0.00	$15.92	$0.00	$0.00	$0.00	$0.00	$0.00
WHV-4	SUP	HCPCS C1713		WHV-4  -  VOLAR HOOK PLATE	BOTH IP/OP	"$1,812.50 "	"$1,341.25"	$0.00	"$1,450.00"	$815.63	$815.63	$0.00	$0.00	$0.00	$377.77	"$1,345.24"	"$1,345.24"	$0.00	$0.00	$377.73	$0.00	"$1,072.09"	"$1,072.09"	$0.00	$906.25	"$1,435.50"	"$1,450.00"	$0.00		$0.00	$283.66	$0.00	$0.00	$288.55	$0.00	$0.00	$0.00	$0.00	$0.00
WHV-6	SUP	HCPCS C1713		WHV-6  -  VOLAR HOOK PLATE	BOTH IP/OP	"$2,075.00 "	"$1,535.50"	$0.00	"$1,660.00"	$933.75	$933.75	$0.00	$0.00	$0.00	$432.48	"$1,540.07"	"$1,540.07"	$0.00	$0.00	$432.43	$0.00	"$1,227.36"	"$1,227.36"	$0.00	"$1,037.50"	"$1,643.40"	"$1,660.00"	$0.00		$0.00	$324.74	$0.00	$0.00	$330.34	$0.00	$0.00	$0.00	$0.00	$0.00
WIRE-0.7/080	SUP	HCPCS C1713		WIRE-0.7/080  -  WIRE FX .7MM 80MM KRSH SS	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$22.50	$22.50	$0.00	$0.00	$0.00	$10.42	$37.11	$37.11	$0.00	$0.00	$10.42	$0.00	$29.58	$29.58	$0.00	$25.00	$39.60	$40.00	$0.00		$0.00	$7.83	$0.00	$0.00	$7.96	$0.00	$0.00	$0.00	$0.00	$0.00
WIRE-0.8/120	SUP	HCPCS C1713		WIRE-0.8/120  -  WIRE FX .8MM 120MM KRSH SS	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$22.50	$22.50	$0.00	$0.00	$0.00	$10.42	$37.11	$37.11	$0.00	$0.00	$10.42	$0.00	$29.58	$29.58	$0.00	$25.00	$39.60	$40.00	$0.00		$0.00	$7.83	$0.00	$0.00	$7.96	$0.00	$0.00	$0.00	$0.00	$0.00
WIRE-0.9	SUP	HCPCS C1713		WIRE-0.9  -  WIRE FIX .9MM KWIRE STAINLESS STEEL	BOTH IP/OP	$37.50 	$27.75	$0.00	$30.00	$16.88	$16.88	$0.00	$0.00	$0.00	$7.82	$27.83	$27.83	$0.00	$0.00	$7.82	$0.00	$22.18	$22.18	$0.00	$18.75	$29.70	$30.00	$0.00		$0.00	$5.87	$0.00	$0.00	$5.97	$0.00	$0.00	$0.00	$0.00	$0.00
WIRE-0.9/100	SUP	HCPCS C1713		WIRE-0.9/100  -  WIRE FX .9MM 100MM NS KRSH	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$22.50	$22.50	$0.00	$0.00	$0.00	$10.42	$37.11	$37.11	$0.00	$0.00	$10.42	$0.00	$29.58	$29.58	$0.00	$25.00	$39.60	$40.00	$0.00		$0.00	$7.83	$0.00	$0.00	$7.96	$0.00	$0.00	$0.00	$0.00	$0.00
WIRE-1.1	SUP	HCPCS C1713		WIRE-1.1  -  WIRE FX 1.1MM NS KRSH	BOTH IP/OP	$40.00 	$29.60	$0.00	$32.00	$18.00	$18.00	$0.00	$0.00	$0.00	$8.34	$29.69	$29.69	$0.00	$0.00	$8.34	$0.00	$23.66	$23.66	$0.00	$20.00	$31.68	$32.00	$0.00		$0.00	$6.26	$0.00	$0.00	$6.37	$0.00	$0.00	$0.00	$0.00	$0.00
WIRE-1.6/100	SUP	HCPCS C1713		WIRE-1.6/100  -  WIRE FX 1.6MM 100MM NS KRSH	BOTH IP/OP	$50.00 	$37.00	$0.00	$40.00	$22.50	$22.50	$0.00	$0.00	$0.00	$10.42	$37.11	$37.11	$0.00	$0.00	$10.42	$0.00	$29.58	$29.58	$0.00	$25.00	$39.60	$40.00	$0.00		$0.00	$7.83	$0.00	$0.00	$7.96	$0.00	$0.00	$0.00	$0.00	$0.00
WN-1104ST	SUP	HCPCS C1769		WN-1104ST  -  GUIDEWIRE ORTH .045IN 4IN SS	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$48.87	$48.87	$0.00	$0.00	$0.00	$18.76	$66.80	$66.80	$0.00	$0.00	$18.76	$0.00	$53.24	$53.24	$0.00	$45.00	$71.28	$72.00	$0.00		$0.00	$14.09	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00
WN-2020	SUP	HCPCS C1769		WN-2020  -  GWIRE ORTH 20IN 2MM SGL TROCAR TIP	BOTH IP/OP	$187.50 	$138.75	$0.00	$150.00	$101.81	$101.81	$0.00	$0.00	$0.00	$39.08	$139.16	$139.16	$0.00	$0.00	$39.08	$0.00	$110.91	$110.91	$0.00	$93.75	$148.50	$150.00	$0.00		$0.00	$29.34	$0.00	$0.00	$29.85	$0.00	$0.00	$0.00	$0.00	$0.00
WN-2020ST	SUP	HCPCS C1769		WN-2020ST  -  GUIDEWIRE ORTH 2MM 20IN TROC TIP NTNL	BOTH IP/OP	$230.00 	$170.20	$0.00	$184.00	$124.89	$124.89	$0.00	$0.00	$0.00	$47.94	$170.71	$170.71	$0.00	$0.00	$47.93	$0.00	$136.05	$136.05	$0.00	$115.00	$182.16	$184.00	$0.00		$0.00	$36.00	$0.00	$0.00	$36.62	$0.00	$0.00	$0.00	$0.00	$0.00
WS0450090	SUP	HCPCS C1876		WS0450090  -  STENT INTRCRAN 4.5MM 9MM WINGSPAN	BOTH IP/OP	"$15,980.00 "	"$11,825.20"	$0.00	"$12,784.00"	"$7,191.00"	"$7,191.00"	$0.00	$0.00	$0.00	"$3,330.63"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,330.23"	$0.00	"$7,878.14"	"$7,878.14"	$0.00	"$7,990.00"	"$12,656.16"	"$12,784.00"	$0.00		$0.00	"$2,500.87"	$0.00	$0.00	"$2,544.02"	$0.00	$0.00	$0.00	$0.00	$0.00
WS1406ST	SUP	HCPCS C1769		WS1406ST  -  GUIDEWIRE ORTH 6IN .054IN ACTRK SS 1 TROC TIP	BOTH IP/OP	$25.00 	$18.50	$0.00	$20.00	$13.58	$13.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.50	$19.80	$20.00	$0.00		$0.00	$3.91	$0.00	$0.00	$3.98	$0.00	$0.00	$0.00	$0.00	$0.00
WS-1504STT	SUP	HCPCS C1769		WS-1504STT  -  GWIRE ORTH 4IN .054IN SS THRD	BOTH IP/OP	$122.50 	$90.65	$0.00	$98.00	$66.52	$66.52	$0.00	$0.00	$0.00	$25.53	$90.92	$90.92	$0.00	$0.00	$25.53	$0.00	$72.46	$72.46	$0.00	$61.25	$97.02	$98.00	$0.00		$0.00	$19.17	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00
WS1505-DT	SUP	HCPCS C1769		WS1505-DT  -  WIRE FIX .062IN KWIRE FSN	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$9.50	$9.50	$0.00	$0.00	$0.00	$3.65	$12.99	$12.99	$0.00	$0.00	$3.65	$0.00	$10.35	$10.35	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
WS-1606	SUP	HCPCS C1771		WS-1606  -  GWIRE ORTH 6IN .062IN SS	BOTH IP/OP	$17.50 	$12.95	$0.00	$14.00	$7.88	$7.88	$0.00	$0.00	$0.00	$3.65	$12.99	$12.99	$0.00	$0.00	$3.65	$0.00	$10.35	$10.35	$0.00	$8.75	$13.86	$14.00	$0.00		$0.00	$2.74	$0.00	$0.00	$2.79	$0.00	$0.00	$0.00	$0.00	$0.00
WS2009ST	SUP	HCPCS C1769		WS2009ST  -  GUIDEWIRE ORTH 9IN 2IN SHLDR ELB SS	BOTH IP/OP	$25.00 	$18.50	$0.00	$20.00	$13.58	$13.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.50	$19.80	$20.00	$0.00		$0.00	$3.91	$0.00	$0.00	$3.98	$0.00	$0.00	$0.00	$0.00	$0.00
WS-2020	SUP	HCPCS C1769		WS-2020  -  GWIRE ORTH 20IN .078IN PLRS HUM SHLDR SS	BOTH IP/OP	$147.50 	$109.15	$0.00	$118.00	$80.09	$80.09	$0.00	$0.00	$0.00	$30.74	$109.47	$109.47	$0.00	$0.00	$30.74	$0.00	$87.25	$87.25	$0.00	$73.75	$116.82	$118.00	$0.00		$0.00	$23.08	$0.00	$0.00	$23.48	$0.00	$0.00	$0.00	$0.00	$0.00
WS-2409STT	SUP	HCPCS C1769		WS-2409STT  -  GWIRE ORTH 9IN .094IN 1 TROCAR THRD	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$48.87	$48.87	$0.00	$0.00	$0.00	$18.76	$66.80	$66.80	$0.00	$0.00	$18.76	$0.00	$53.24	$53.24	$0.00	$45.00	$71.28	$72.00	$0.00		$0.00	$14.09	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00
WT-0906STT	SUP	HCPCS C1769		WT-0906STT  -  GWIRE ORTH 6IN .035IN TI THRD	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$48.87	$48.87	$0.00	$0.00	$0.00	$18.76	$66.80	$66.80	$0.00	$0.00	$18.76	$0.00	$53.24	$53.24	$0.00	$45.00	$71.28	$72.00	$0.00		$0.00	$14.09	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00
WT-1606STT	SUP	HCPCS C1769		WT-1606STT  -  GWIRE ORTH 5.75IN .062IN ACTRK TI 1 TROCAR TIP THRD	BOTH IP/OP	$90.00 	$66.60	$0.00	$72.00	$48.87	$48.87	$0.00	$0.00	$0.00	$18.76	$66.80	$66.80	$0.00	$0.00	$18.76	$0.00	$53.24	$53.24	$0.00	$45.00	$71.28	$72.00	$0.00		$0.00	$14.09	$0.00	$0.00	$14.33	$0.00	$0.00	$0.00	$0.00	$0.00
X0411407	SUP	HCPCS C1713		X0411407  -  CONNECTOR ROD 10MM CD HORIZON CROSSLINK GDLH LIBERTY SEXTANT	BOTH IP/OP	"$4,822.50 "	"$3,568.65"	$0.00	"$3,858.00"	"$2,170.13"	"$2,170.13"	$0.00	$0.00	$0.00	"$1,005.13"	"$3,579.26"	"$3,579.26"	$0.00	$0.00	"$1,005.01"	$0.00	"$2,377.49"	"$2,377.49"	$0.00	"$2,411.25"	"$3,819.42"	"$3,858.00"	$0.00		$0.00	$754.72	$0.00	$0.00	$767.74	$0.00	$0.00	$0.00	$0.00	$0.00
X0590	SUP	Custom 27203010		BLOTTER EPHRS BIOTN 15ML	BOTH IP/OP	$386.53 	$286.03	$0.00	$309.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$193.26	$306.13	$309.22	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
X42200	SUP	HCPCS C1713		X42200  -  SUB BNGFT 10X2.5CM GRFTN DBM PLIF	BOTH IP/OP	"$4,926.25 "	"$3,645.43"	$0.00	"$3,941.00"	"$2,216.81"	"$2,216.81"	$0.00	$0.00	$0.00	"$1,026.75"	"$3,656.26"	"$3,656.26"	$0.00	$0.00	"$1,026.63"	$0.00	"$2,428.64"	"$2,428.64"	$0.00	"$2,463.13"	"$3,901.59"	"$3,941.00"	$0.00		$0.00	$770.96	$0.00	$0.00	$784.26	$0.00	$0.00	$0.00	$0.00	$0.00
X42210	SUP	HCPCS C1713		X42210  -  SUB BNGFT 5X2.5CM GRFTN DBM PLIF	BOTH IP/OP	"$3,053.75 "	"$2,259.78"	$0.00	"$2,266.49"	$765.62	$765.62	$0.00	$0.00	$0.00	$636.48	"$2,266.49"	"$2,266.49"	$0.00	$0.00	$636.40	$0.00	"$1,505.50"	"$1,505.50"	$0.00	$850.69	"$1,347.49"	"$1,361.10"	$0.00		$0.00	$266.27	$0.00	$0.00	$270.86	$0.00	$0.00	$0.00	$0.00	$0.00
X44135	SUP	HCPCS C1713		X44135  -  SUB BNGFT GRFTN LG DFCT DBM OTHBLND JAR 15ML	BOTH IP/OP	"$3,080.00 "	"$2,279.20"	$0.00	"$2,745.60"	"$1,544.40"	"$1,544.40"	$0.00	$0.00	$0.00	$641.95	"$2,285.98"	"$2,285.98"	$0.00	$0.00	$641.87	$0.00	"$1,518.44"	"$1,518.44"	$0.00	"$1,716.00"	"$2,718.14"	"$2,745.60"	$0.00		$0.00	$537.11	$0.00	$0.00	$546.37	$0.00	$0.00	$0.00	$0.00	$0.00
X44145	SUP	HCPCS C1713		X44145  -  SUB BNGFT GRFTN SM DFCT DBM OTHBLND JAR 5ML	BOTH IP/OP	"$2,340.00 "	"$1,731.60"	$0.00	"$1,872.00"	"$1,053.00"	"$1,053.00"	$0.00	$0.00	$0.00	$487.71	"$1,736.75"	"$1,736.75"	$0.00	$0.00	$487.66	$0.00	"$1,384.11"	"$1,384.11"	$0.00	"$1,170.00"	"$1,853.28"	"$1,872.00"	$0.00		$0.00	$366.21	$0.00	$0.00	$372.53	$0.00	$0.00	$0.00	$0.00	$0.00
X523H	SUP	Custom 27203010		X523H  -  SUTURE NABSB 2-0 SH 36IN GRN EBND 2 ARM BRD	BOTH IP/OP	$387.23 	$286.55	$0.00	$314.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.40	$287.40	$0.00	$0.00	$80.70	$0.00	$0.00	$0.00	$0.00	$196.52	$311.28	$314.43	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
X559H	SUP	Custom 27203010		X559H  -  SUTURE NONABSORBABLE 2-0 SH-2 36IN 2 ARM BRAID ETHIBOND	BOTH IP/OP	$416.10 	$307.91	$0.00	$337.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.83	$308.83	$0.00	$0.00	$86.72	$0.00	$0.00	$0.00	$0.00	$211.17	$334.49	$337.87	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
X833H	SUP	Custom 27203010		X833H  -  SUTURE NABSB 2-0 SH 30IN GRN EBND BRD	BOTH IP/OP	$5.31 	$3.93	$0.00	$153.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.94	$3.94	$0.00	$0.00	$1.11	$0.00	$0.00	$0.00	$0.00	$95.66	$151.53	$153.06	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
XA3816KT	SUP	HCPCS C1751		XA3816KT  -  KIT CATHETER 8.5FR 16CM 3 LUMEN EXPAND CHLORAPREP SAFETY	BOTH IP/OP	$825.00 	$610.50	$0.00	$660.00	$371.25	$371.25	$0.00	$0.00	$0.00	$171.95	$612.32	$612.32	$0.00	$0.00	$171.93	$0.00	$487.99	$487.99	$0.00	$412.50	$653.40	$660.00	$0.00		$0.00	$129.11	$0.00	$0.00	$131.34	$0.00	$0.00	$0.00	$0.00	$0.00
XA3820KT	SUP	HCPCS C1751		XA3820KT  -  CATHETER CV 20CM PEDIASAT 3 LUM OXM CNT SCVO2 MNTR PED	BOTH IP/OP	"$1,125.00 "	$832.50	$0.00	$900.00	$506.25	$506.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$562.50	$891.00	$900.00	$0.00		$0.00	$176.06	$0.00	$0.00	$179.10	$0.00	$0.00	$0.00	$0.00	$0.00
XBR001002	SUP	HCPCS C1713		XBR001002  -  WIRE FX OLV 1.2MM 65MM KRSH SMTH TROC TIP	BOTH IP/OP	$209.95 	$155.36	$0.00	$280.04	$157.52	$157.52	$0.00	$0.00	$0.00	$43.76	$155.82	$155.82	$0.00	$0.00	$43.75	$0.00	$124.19	$124.19	$0.00	$175.03	$277.24	$280.04	$0.00		$0.00	$54.78	$0.00	$0.00	$55.73	$0.00	$0.00	$0.00	$0.00	$0.00
XC200	SUP	Custom 27803010		XC200  -  CLIP SUT STRL LF LPR TY VCL 1 PC ABS POLY	BOTH IP/OP	$352.00 	$260.48	$0.00	$489.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$261.25	$261.25	$0.00	$0.00	$73.36	$0.00	$0.00	$0.00	$0.00	$176.00	$489.50	$281.60	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
XF0012002	SUP	Custom 27203010		XF0012002  -  BIT DRL 2MM AO	BOTH IP/OP	$490.85 	$363.23	$0.00	$392.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$364.31	$364.31	$0.00	$0.00	$102.29	$0.00	$0.00	$0.00	$0.00	$245.43	$388.75	$392.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
XFO082001	SUP	Custom 27203010		XFO082001  -  BIT DRL 2MM 3MM SCR	BOTH IP/OP	$287.30 	$212.60	$0.00	$392.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.23	$213.23	$0.00	$0.00	$59.87	$0.00	$0.00	$0.00	$0.00	$245.43	$388.75	$392.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
XFO082501	SUP	Custom 27203010		XFO082501  -  BIT DRL 2.5MM 3.5MM SCR	BOTH IP/OP	$287.30 	$212.60	$0.00	$392.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.23	$213.23	$0.00	$0.00	$59.87	$0.00	$0.00	$0.00	$0.00	$245.43	$388.75	$392.68	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
XHAT45	SUP	Custom 27203010		KIT IMMUN TST ELISA ANTI-PF4 45 TST	BOTH IP/OP	"$1,181.73 "	$874.48	$0.00	$945.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$590.86	$935.93	$945.38	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
XL-105914	SUP	HCPCS C1776		XL-105914  -  LINER ACETAB 24 36MM HIGH WALL RINGLOC ARCOMXL HIP	BOTH IP/OP	"$6,575.00 "	"$4,865.50"	$0.00	"$5,260.00"	"$2,958.75"	"$2,958.75"	$0.00	$0.00	$0.00	"$1,370.39"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,370.23"	$0.00	"$3,241.48"	"$3,241.48"	$0.00	"$3,287.50"	"$5,207.40"	"$5,260.00"	$0.00		$0.00	"$1,028.99"	$0.00	$0.00	"$1,046.74"	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.0204S	SUP	HCPCS C1763		XM106.0204S  -  GRAFT SFT TIS 4X2CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK	BOTH IP/OP	$485.00 	$358.90	$0.00	$388.00	$218.25	$218.25	$0.00	$0.00	$0.00	$101.09	$359.97	$359.97	$0.00	$0.00	$101.07	$0.00	$286.88	$286.88	$0.00	$242.50	$384.12	$388.00	$0.00		$0.00	$75.90	$0.00	$0.00	$77.21	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.0407S	SUP	HCPCS C1763		XM106.0407S  -  GRAFT SFT TIS 7X4CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK	BOTH IP/OP	"$1,732.50 "	"$1,282.05"	$0.00	"$1,386.00"	$779.63	$779.63	$0.00	$0.00	$0.00	$361.10	"$1,285.86"	"$1,285.86"	$0.00	$0.00	$361.05	$0.00	"$1,024.77"	"$1,024.77"	$0.00	$866.25	"$1,372.14"	"$1,386.00"	$0.00		$0.00	$271.14	$0.00	$0.00	$275.81	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.0416S	SUP	HCPCS C1763		XM106.0416S  -  GRAFT SFT TIS 16X4CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK	BOTH IP/OP	"$4,790.00 "	"$3,544.60"	$0.00	"$3,832.00"	"$2,155.50"	"$2,155.50"	$0.00	$0.00	$0.00	$998.36	"$3,555.14"	"$3,555.14"	$0.00	$0.00	$998.24	$0.00	"$2,361.47"	"$2,361.47"	$0.00	"$2,395.00"	"$3,793.68"	"$3,832.00"	$0.00		$0.00	$749.64	$0.00	$0.00	$762.57	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.0516S	SUP	HCPCS C1763		XM106.0516S  -  GRAFT SFT TIS 16X5CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK	BOTH IP/OP	"$5,985.00 "	"$4,428.90"	$0.00	"$4,788.00"	"$2,693.25"	"$2,693.25"	$0.00	$0.00	$0.00	"$1,247.42"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,247.27"	$0.00	"$2,950.61"	"$2,950.61"	$0.00	"$2,992.50"	"$4,740.12"	"$4,788.00"	$0.00		$0.00	$936.65	$0.00	$0.00	$952.81	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.0612S	SUP	HCPCS C1763		XM106.0612S  -  GRAFT SFT TIS 12X6CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK	BOTH IP/OP	"$4,455.30 "	"$3,296.92"	$0.00	"$3,564.24"	"$2,004.89"	"$2,004.89"	$0.00	$0.00	$0.00	$928.60	"$3,306.72"	"$3,306.72"	$0.00	$0.00	$928.48	$0.00	"$2,196.46"	"$2,196.46"	$0.00	"$2,227.65"	"$3,528.60"	"$3,564.24"	$0.00		$0.00	$697.25	$0.00	$0.00	$709.28	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.0616S	SUP	HCPCS C1763		XM106.0616S  -  GRAFT SFT TIS 16X6CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK	BOTH IP/OP	"$5,939.73 "	"$4,395.40"	$0.00	"$4,751.78"	"$2,672.88"	"$2,672.88"	$0.00	$0.00	$0.00	"$1,237.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,237.84"	$0.00	"$2,928.28"	"$2,928.28"	$0.00	"$2,969.86"	"$4,704.27"	"$4,751.78"	$0.00		$0.00	$929.57	$0.00	$0.00	$945.60	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.0620S	SUP	HCPCS C1763		XM106.0620S  -  GRAFT SFT TIS 20X6CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK	BOTH IP/OP	"$8,977.50 "	"$6,643.35"	$0.00	"$7,182.00"	"$4,039.88"	"$4,039.88"	$0.00	$0.00	$0.00	"$1,871.14"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,870.91"	$0.00	"$4,425.91"	"$4,425.91"	$0.00	"$4,488.75"	"$7,110.18"	"$7,182.00"	$0.00		$0.00	"$1,404.98"	$0.00	$0.00	"$1,429.22"	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.0812S	SUP	HCPCS C1763		XM106.0812S  -  GRAFT SFT TIS 12X8CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK	BOTH IP/OP	"$5,939.73 "	"$4,395.40"	$0.00	"$4,751.78"	"$2,672.88"	"$2,672.88"	$0.00	$0.00	$0.00	"$1,237.99"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,237.84"	$0.00	"$2,928.28"	"$2,928.28"	$0.00	"$2,969.86"	"$4,704.27"	"$4,751.78"	$0.00		$0.00	$929.57	$0.00	$0.00	$945.60	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.0816S	SUP	HCPCS C1763		XM106.0816S  -  GRAFT SFT TIS 16X8CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK	BOTH IP/OP	"$7,920.30 "	"$5,861.02"	$0.00	"$6,336.24"	"$3,564.14"	"$3,564.14"	$0.00	$0.00	$0.00	"$1,650.79"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$1,650.59"	$0.00	"$3,904.71"	"$3,904.71"	$0.00	"$3,960.15"	"$6,272.88"	"$6,336.24"	$0.00		$0.00	"$1,239.53"	$0.00	$0.00	"$1,260.91"	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.0820S	SUP	HCPCS C1763		XM106.0820S  -  GRAFT SFT TIS 20X8CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK	BOTH IP/OP	"$9,898.88 "	"$7,325.17"	$0.00	"$7,919.10"	"$4,454.49"	"$4,454.49"	$0.00	$0.00	$0.00	"$2,063.17"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,062.93"	$0.00	"$4,880.15"	"$4,880.15"	$0.00	"$4,949.44"	"$7,839.91"	"$7,919.10"	$0.00		$0.00	"$1,549.17"	$0.00	$0.00	"$1,575.90"	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.1016S	SUP	HCPCS C1763		XM106.1016S  -  GRAFT SFT TIS 16X10CM XCM BIOLOGIC THK PIG DERM XCLR MTRX	BOTH IP/OP	"$9,898.88 "	"$7,325.17"	$0.00	"$7,919.10"	"$4,454.49"	"$4,454.49"	$0.00	$0.00	$0.00	"$2,063.17"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,062.93"	$0.00	"$4,880.15"	"$4,880.15"	$0.00	"$4,949.44"	"$7,839.91"	"$7,919.10"	$0.00		$0.00	"$1,549.17"	$0.00	$0.00	"$1,575.90"	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.1020S	SUP	HCPCS C1762		XM106.1020S  -  DD-XCM BIOLOGIC TISSUE MATRIX 10CM X 20CM/THICK-STERILE	BOTH IP/OP	"$12,373.60 "	"$9,156.46"	$0.00	"$9,898.88"	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,578.97"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$2,578.66"	$0.00	"$6,100.18"	"$6,100.18"	$0.00	"$6,186.80"	"$9,799.89"	"$9,898.88"	$0.00		$0.00	"$1,936.47"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.1220S	SUP	HCPCS C1763		XM106.1220S  -  GRAFT SFT TIS 20X12CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK	BOTH IP/OP	"$14,848.33 "	"$10,987.76"	$0.00	"$11,878.66"	"$6,681.75"	"$6,681.75"	$0.00	$0.00	$0.00	"$3,094.76"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$3,094.39"	$0.00	"$7,320.22"	"$7,320.22"	$0.00	"$7,424.16"	"$11,759.88"	"$11,878.66"	$0.00		$0.00	"$2,323.76"	$0.00	$0.00	"$2,363.85"	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.1620S	SUP	HCPCS C1762		XM106.1620S  -  DD-XCM BIOLOGIC TISSUE MATRIX 16CM X 20CM/THICK-STERILE	BOTH IP/OP	"$19,795.80 "	"$14,648.89"	$0.00	"$15,836.64"	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,125.94"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,125.44"	$0.00	"$9,759.33"	"$9,759.33"	$0.00	"$9,897.90"	"$15,678.27"	"$15,836.64"	$0.00		$0.00	"$3,098.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.1625S	SUP	HCPCS C1763		XM106.1625S  -  GRAFT SFT TIS 25X16CM XCM BIOLOGIC THK PIG DERM HDRT XCLR	BOTH IP/OP	"$23,201.73 "	"$17,169.28"	$0.00	"$18,561.38"	"$10,440.78"	"$10,440.78"	$0.00	$0.00	$0.00	"$4,835.82"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$4,835.24"	$0.00	"$11,438.45"	"$11,438.45"	$0.00	"$11,600.86"	"$18,375.77"	"$18,561.38"	$0.00		$0.00	"$3,631.07"	$0.00	$0.00	"$3,693.71"	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.2020S	SUP	HCPCS C1763		XM106.2020S  -  GRAFT SFT TIS 20X20CM XCM BIOLOGIC THK PIG DERM XCLR MTRX	BOTH IP/OP	"$24,745.23 "	"$18,311.47"	$0.00	"$19,796.18"	"$11,135.35"	"$11,135.35"	$0.00	$0.00	$0.00	"$5,157.52"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$5,156.90"	$0.00	"$12,199.40"	"$12,199.40"	$0.00	"$12,372.61"	"$19,598.22"	"$19,796.18"	$0.00		$0.00	"$3,872.63"	$0.00	$0.00	"$3,939.44"	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.2025S	SUP	HCPCS C1763		XM106.2025S  -  GRAFT SFT TIS 25X20CM XCM BIOLOGIC THK PIG DERM MTRX STRL	BOTH IP/OP	"$30,933.00 "	"$22,890.42"	$0.00	"$24,746.40"	"$13,919.85"	"$13,919.85"	$0.00	$0.00	$0.00	"$6,447.21"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,446.44"	$0.00	"$15,249.97"	"$15,249.97"	$0.00	"$15,466.50"	"$24,498.94"	"$24,746.40"	$0.00		$0.00	"$4,841.01"	$0.00	$0.00	"$4,924.53"	$0.00	$0.00	$0.00	$0.00	$0.00
XM106.2030S	SUP	HCPCS C1763		XM106.2030S  -  GRAFT SFT TIS 30X20CM XCM BIOLOGIC THK PIG DERM HDRT XCLR	BOTH IP/OP	"$37,116.85 "	"$27,466.47"	$0.00	"$29,693.48"	"$16,702.58"	"$16,702.58"	$0.00	$0.00	$0.00	"$7,736.08"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$7,735.15"	$0.00	"$18,298.61"	"$18,298.61"	$0.00	"$18,558.43"	"$29,396.55"	"$29,693.48"	$0.00		$0.00	"$5,808.79"	$0.00	$0.00	"$5,909.00"	$0.00	$0.00	$0.00	$0.00	$0.00
XP-5000	SUP	Custom 27203010		XP-5000  -  STABILIZER SRG YLW ACRB-I VAC PSTNR	BOTH IP/OP	"$2,467.50 "	"$1,825.95"	$0.00	"$1,974.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,233.75"	"$1,954.26"	"$1,974.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
XT-7542	SUP	HCPCS C1725		XT-7542  -  CATHETER BLNDIL .035IN 5FR 4MM 75CM 2CM OPTPLST XT 2 LUM	BOTH IP/OP	$497.50 	$368.15	$0.00	$398.00	$270.14	$270.14	$0.00	$0.00	$0.00	$103.69	$369.24	$369.24	$0.00	$0.00	$103.68	$0.00	$294.27	$294.27	$0.00	$248.75	$394.02	$398.00	$0.00		$0.00	$77.86	$0.00	$0.00	$79.20	$0.00	$0.00	$0.00	$0.00	$0.00
Y3462	SUP	Custom 27203010		MEDIA CULT YST BROTH SENSITITRE	BOTH IP/OP	$65.20 	$48.25	$0.00	$52.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.60	$51.64	$52.16	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
YO-9	SUP	Custom 27203010		KIT MYCTST YEASTONE ANIDULAFUNGIN MICAFUNGIN PLT	BOTH IP/OP	$791.78 	$585.92	$0.00	$633.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$395.89	$627.09	$633.42	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Z117H	SUP	Custom 27203010		Z117H  -  SUTURE ABSORBABLE 6-0 BV-1 30IN 2 ARM MONOFILAMENT PDS II	BOTH IP/OP	$39.65 	$29.34	$0.00	$31.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.43	$29.43	$0.00	$0.00	$8.26	$0.00	$0.00	$0.00	$0.00	$19.83	$31.40	$31.72	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Z126H	SUP	Custom 27203010		Z126H  -  SUTURE ABSORBABLE 5-0 C-1 30IN 2 ARM MONOFILAMENT PDS II	BOTH IP/OP	$46.32 	$34.28	$0.00	$37.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.38	$34.38	$0.00	$0.00	$9.65	$0.00	$0.00	$0.00	$0.00	$23.51	$37.23	$37.61	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Z135H	SUP	Custom 27203010		Z135H  -  SUTURE ABSORBABLE 7-0 BV-1 30IN 2 ARM MONOFILAMENT PDS II	BOTH IP/OP	$40.04 	$29.63	$0.00	$32.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.72	$29.72	$0.00	$0.00	$8.34	$0.00	$0.00	$0.00	$0.00	$20.02	$31.71	$32.03	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Z137H	SUP	Custom 27203010		Z137H  -  SUTURE ABSORBABLE 4-0 V-5 36IN 2 ARM MONOFILAMENT PDS II	BOTH IP/OP	$25.17 	$18.63	$0.00	$20.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.68	$18.68	$0.00	$0.00	$5.25	$0.00	$0.00	$0.00	$0.00	$12.58	$19.93	$20.14	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Z60353	SUP	HCPCS L8614		Z60353  -  IMPLANT COCHLEAR FREEDOM CNTOUR ADVANCE NUCLEUS CI24RE	BOTH IP/OP	"$39,847.50 "	"$29,487.15"	$0.00	"$31,878.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$8,304.22"	$0.00	$0.00	$0.00	$0.00	"$19,923.75"	"$31,559.22"	"$31,878.00"	$0.00		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
ZBM12060	SUP	HCPCS C2625		ZBM12060  -  STENT BIL 12MM 6FR 60MM 80CM .035IN SLF XPD DLV SYS LMNX	BOTH IP/OP	"$3,883.20 "	"$2,873.57"	$0.00	"$3,106.56"	"$1,747.44"	"$1,747.44"	$0.00	$0.00	$0.00	$809.36	"$2,882.11"	"$2,882.11"	$0.00	$0.00	$809.26	$0.00	"$1,914.42"	"$1,914.42"	$0.00	"$1,941.60"	"$3,075.49"	"$3,106.56"	$0.00		$0.00	$607.72	$0.00	$0.00	$618.21	$0.00	$0.00	$0.00	$0.00	$0.00
ZTEG-2P-28-120-PF-US	SUP	HCPCS C1874		ZTEG-2P-28-120-PF-US  -  GRAFT EVAS 120MM 28MM 22FR ZNTH TX2 THOR AORTIC ANRSM PROX	BOTH IP/OP	"$30,235.00 "	"$22,373.90"	$0.00	"$24,188.00"	"$13,605.75"	"$13,605.75"	$0.00	$0.00	$0.00	"$6,301.73"	"$4,181.12"	"$4,181.12"	$0.00	$0.00	"$6,300.97"	$0.00	"$14,905.86"	"$14,905.86"	$0.00	"$15,117.50"	"$23,946.12"	"$24,188.00"	$0.00		$0.00	"$4,731.78"	$0.00	$0.00	"$4,813.41"	$0.00	$0.00	$0.00	$0.00	$0.00
100	EAP	CPT® 00100		"PR ANESTH,SALIVARY GLAND W/BX"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
103	EAP	CPT® 00103		"PR ANESTH,BLEPHAROPLASTY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
120	EAP	CPT® 00120		"ANESTH,EAR SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
124	EAP	CPT® 00124		"ANESTH,EAR EXAM"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
140	EAP	CPT® 00140		"PR ANESTH,PROCEDURES ON EYE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
142	EAP	CPT® 00142		"ANESTH, LENS SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
144	EAP	CPT® 00144		"PR ANESTH,CORNEAL TRANSPLANT"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
145	EAP	CPT® 00145		"ANESTH, VITREORETINAL SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
160	EAP	CPT® 00160		"PR ANESTH,NOSE,SINUS SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
162	EAP	CPT® 00162		"PR ANESTH,NOSE,RADICAL SINUS SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
170	EAP	CPT® 00170		"PR ANESTH,PROCEDURE ON MOUTH"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
190	EAP	CPT® 00190		"PR ANESTH,FACIAL BONE SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
192	EAP	CPT® 00192		"PR ANESTH,RADICAL FACIAL BONE SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
210	EAP	CPT® 00210		"PR ANESTH,OPEN HEAD SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
211	EAP	CPT® 00211		"PR ANESTH, INTRACRANIAL HEMATOMA EVACUATION"	OP	$90.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
214	EAP	CPT® 00214		"PR ANESTH,SKULL SURG BURR HOLE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
215	EAP	CPT® 00215		"PR ANESTH, CRANIOPLASTY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
216	EAP	CPT® 00216		"PR ANESTH,HEAD VESSEL SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
220	EAP	CPT® 00220		"PR ANESTH,INTRACRAN PROC; CSF SHUNT PROC"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
300	EAP	CPT® 00300		"PR ANESTH,SKIN SURG HEAD/NECK"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
320	EAP	CPT® 00320		"PR ANESTH,NECK ORG PROC; NOS, AGE 1 YR/OLD"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
326	EAP	CPT® 00326		"PR ANESTH,LARYNX/TRACH PROC; CHILDREN <1 YR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
350	EAP	CPT® 00350		"PR ANESTH,NECK VESSEL SURGERY NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
352	EAP	CPT® 00352		"PR ANESTH,NECK VESSEL SURG SIMPL LIGAT"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
400	EAP	CPT® 00400		"PR ANESTH,SKIN SURG THORAX/EXTR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
402	EAP	CPT® 00402		"PR ANESTH,SURG BREAST RECONSTRUCTIVE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
404	EAP	CPT® 00404		"PR ANESTH,SURG BREAST RAD MASTEC"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
410	EAP	CPT® 00410		"PR ANESTH,CORRECT HEART RHYTHM"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
450	EAP	CPT® 00450		"PR ANESTH,SURG CLAVICLE/SCAPULA"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
470	EAP	CPT® 00470		"PR ANESTH,PARTIAL RIB RESECTN"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
500	EAP	CPT® 00500		"PR ANESTH,ESOPHAGEAL SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
520	EAP	CPT® 00520		"PR ANESTH,CHEST PROC CLOSED,NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
528	EAP	CPT® 00528		"PR ANESTH,MEDIASTINOSCOPY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
529	EAP	CPT® 00529		"PR ANESTH, CHEST PARTITION VIEW"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
532	EAP	CPT® 00532		"PR ANESTH,CENTRL VASCULAR ACCESS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
534	EAP	CPT® 00534		"PR ANESTH,CARDIOVERTER/DEFIB"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
540	EAP	CPT® 00540		"PR ANESTH,CHEST SURGERY,THORACOTOMY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
541	EAP	CPT® 00541		"PR ANESTH,THORACOTOMY PROC, W/1 LUNG VENT"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
542	EAP	CPT® 00542		"PR ANESTH,CHEST DECORTICATION"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
560	EAP	CPT® 00560		"PR ANESTH,OPEN HEART; W/O PUMP OXYEGENATOR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
562	EAP	CPT® 00562		"PR ANESTH,OPEN HEART SURGERY+PUMP"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
566	EAP	CPT® 00566		"PR ANESTH,DIRECT CABG W/O PUMP OXYGENATOR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
567	EAP	CPT® 00567		"PR ANESTH, DIRECT CABG W PUMP OXYGENATOR"	OP	$90.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
600	EAP	CPT® 00600		"PR ANESTH,CERV SPINE,CORD SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
620	EAP	CPT® 00620		"PR ANESTH,THOR SPINE,CORD SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
630	EAP	CPT® 00630		"PR ANESTH,LUMBAR SPINE,CORD SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
635	EAP	CPT® 00635		"PR ANESTH,LUMBAR PUNCTURE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
670	EAP	CPT® 00670		"PR ANESTH,EXTENSIVE SPINE,CORD PROCED"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
700	EAP	CPT® 00700		"PR ANESTH,ABD WALL,UPER ANTER,SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
702	EAP	CPT® 00702		"PR ANESTH,FOR LIVER BIOPSY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
731	EAP	CPT® 00731		PR ANESTHESIA UPPER GI ENDOSCOPIC PX NOS	OP	$90.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
732	EAP	CPT® 00732		PR ANESTHESIA UPPER GI ENDOSCOPIC PX ERCP	OP	$90.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
750	EAP	CPT® 00750		"PR ANESTH,REPAIR UPPER ABD HERNIA NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
752	EAP	CPT® 00752		"PR ANESTH,REPAIR UP HERNIA LUMBAR/VENTR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
770	EAP	CPT® 00770		"PR ANESTH,MAJOR ABD BLOOD VESSEL REPAIR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
790	EAP	CPT® 00790		"PR ANESTH,SURG UPPER ABDOMEN"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
792	EAP	CPT® 00792		"PR ANESTH,PARTIAL LIVER REMOVAL"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
794	EAP	CPT® 00794		"PR ANESTH,PANCREAS REMOVAL"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
800	EAP	CPT® 00800		"PR ANESTH,ABD WALL,LOWER ANT,SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
802	EAP	CPT® 00802		"PR ANESTH,FAT LAYER REMOVAL"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
811	EAP	CPT® 00811		PR ANESTHESIA LOWER INTST ENDOSCOPIC PX NOS	OP	$90.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
812	EAP	CPT® 00812		PR ANESTHESIA LOWER INTST ENDOSCOPIC PX SCR COLSC	OP	$90.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
813	EAP	CPT® 00813		PR ANESTHESIA COMBINED UPPER&LOWER GI ENDOSCOPIC PX	OP	$90.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
830	EAP	CPT® 00830		"PR ANESTH,REPAIR LO ABD HERNIA NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
832	EAP	CPT® 00832		"PR ANESTH,REPAIR LO HERNIA VENTR/INCIS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
840	EAP	CPT® 00840		"PR ANESTH,SURG LOWER ABDOMEN"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
851	EAP	CPT® 00851		"PR ANESTH,TUBAL LIGATION/TRANSECTION"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
860	EAP	CPT® 00860		"PR ANESTH,SURG LOW ABD,EXTRAPERINTONEAL"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
862	EAP	CPT® 00862		"PR ANESTH,KIDNEY,PROX URETER SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
864	EAP	CPT® 00864		"PR ANESTH,REMOVAL OF BLADDER"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
865	EAP	CPT® 00865		"PR ANESTH,REMOVAL OF PROSTATE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
866	EAP	CPT® 00866		"PR ANESTH,REMOVAL OF ADRENAL"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
902	EAP	CPT® 00902		"PR ANESTH,ANORECTAL SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
904	EAP	CPT® 00904		"PR ANESTH,RADICAL PERINEAL SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
906	EAP	CPT® 00906		"PR ANESTH,REMOVAL OF VULVA"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
910	EAP	CPT® 00910		"PR ANESTH,TRANSURETHRAL SURG,NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
912	EAP	CPT® 00912		"PR ANESTH,XURETHRAL BLADDER TUMOR SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
914	EAP	CPT® 00914		"PR ANESTH,XURETHRAL REMOVAL OF PROSTATE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
918	EAP	CPT® 00918		"PR ANESTH,STONE RMVOVAL"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
920	EAP	CPT® 00920		"PR ANESTH,MALE GENITALIA SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
926	EAP	CPT® 00926		"PR ANESTH,RADICAL REMV TESTIS,INGUINAL"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
930	EAP	CPT® 00930		"PR ANESTH,TESTIS SUSPENSION"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
940	EAP	CPT® 00940		"PR ANESTH,VAGINAL PROCEDURES"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
942	EAP	CPT® 00942		"PR ANESTH,COLPOT,VAGINECT,COLPORR,URETH PRO"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
944	EAP	CPT® 00944		"PR ANESTH,VAGINAL HYSTERECTOMY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
948	EAP	CPT® 00948		"PR ANESTH,REPAIR OF CERVIX"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
952	EAP	CPT® 00952		"PR ANESTH,HYSTEROSCOPY/VAG BX"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1112	EAP	CPT® 01112		"PR ANESTH,BONE MARROW ASP/BX ILIAC CRST"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1120	EAP	CPT® 01120		"PR ANESTH,BONY PELVIS SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1160	EAP	CPT® 01160		"PR ANESTH,PUBIS,SACROILIAC OPEN PROC"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1170	EAP	CPT® 01170		"PR ANESTH,PUBIS,SACROILIAC CLOSED PROC"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1173	EAP	CPT® 01173		"PR ANESTH, FX REPAIR, PELVIS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1200	EAP	CPT® 01200		"PR ANESTH,HIP JOINT PROCEDURE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1202	EAP	CPT® 01202		"PR ANESTH,ARTHROSCOPY OF HIP"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1210	EAP	CPT® 01210		"PR ANESTH,HIP JOINT SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1214	EAP	CPT® 01214		"PR ANESTH,TOTAL HIP ARTHROPLASTY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1215	EAP	CPT® 01215		"PR ANESTH,REVISE TOTAL HIP ARTHROPLASTY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1220	EAP	CPT® 01220		"PR ANESTH,CLOSED PROC UPPER 2/3 FEMUR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1230	EAP	CPT® 01230		"PR ANESTH,OPEN PROC UPPER 2/3 FEMUR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1232	EAP	CPT® 01232		"PR ANESTH,AMPUTATION OF FEMUR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1250	EAP	CPT® 01250		"PR ANESTH,UPPER LEG SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1260	EAP	CPT® 01260		"PR ANESTH,UPPER LEG VEINS SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1270	EAP	CPT® 01270		"PR ANESTH,THIGH ARTERIES SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1320	EAP	CPT® 01320		"PR ANESTH,KNEE AREA SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1360	EAP	CPT® 01360		"PR ANESTH,LOWER 1/3 FEMUR,OPEN PROC"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1380	EAP	CPT® 01380		"PR ANESTH,KNEE JOINT,CLOSED PROCEDURE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1390	EAP	CPT® 01390		"PR ANESTH,UPPER LEG,CLOSED PROCEDURE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1392	EAP	CPT® 01392		"PR ANESTH,UPPER LEG,OPEN PROCEDURE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1400	EAP	CPT® 01400		"PR ANESTH,KNEE JOINT; NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1402	EAP	CPT® 01402		"PR ANESTH,TOTAL KNEE ARTHROPLASTY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1430	EAP	CPT® 01430		"PR ANESTH,KNEE VEINS SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1440	EAP	CPT® 01440		"PR ANESTH,KNEE ARTERIES SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1462	EAP	CPT® 01462		"PR ANESTH,LOWER LEG,CLOSED PROCEDURE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1470	EAP	CPT® 01470		"PR ANESTH,LOWER LEG,OPEN SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1472	EAP	CPT® 01472		"PR ANESTH,ACHILLES TENDON SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1480	EAP	CPT® 01480		"PR ANESTH,LOWER LEG BONE SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1482	EAP	CPT® 01482		"PR ANESTH,RADICAL LEG RESECTION"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1500	EAP	CPT® 01500		"PR ANESTH,LOWER LEG ARTERIES SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1502	EAP	CPT® 01502		"PR ANESTH,LOWER LEG EMBOLECTOMY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1520	EAP	CPT® 01520		"PR ANESTH,LOWER LEG VEIN SURG,NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1610	EAP	CPT® 01610		"PR ANESTH,SURGERY OF SHOULDER"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1620	EAP	CPT® 01620		"PR ANESTH,SHOULDER,CLOSED PROCEDURE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1630	EAP	CPT® 01630		"PR ANESTH,SHOULDER JOINT,NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1638	EAP	CPT® 01638		"PR ANESTH,SHOULDER REPLACEMENT"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1650	EAP	CPT® 01650		"PR ANESTH,SHOULDER ARTERY SURG,NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1656	EAP	CPT® 01656		"PR ANESTH,AXILL-FEM BYPASS GRFT SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1710	EAP	CPT® 01710		"PR ANESTH,ELBOW AREA SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1712	EAP	CPT® 01712		"PR ANESTH,UPPERARM TENDON SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1716	EAP	CPT® 01716		"PR ANESTH,BICEPS TENDON REPAIR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1740	EAP	CPT® 01740		"PR ANESTH,ELBOW,NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1744	EAP	CPT® 01744		"PR ANESTH,HUMERUS REPAIR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1770	EAP	CPT® 01770		"PR ANESTH,UPPERARM ARTERY SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1772	EAP	CPT® 01772		"PR ANESTH,UPPERARM EMBOLECTOMY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1810	EAP	CPT® 01810		"PR ANESTH,LOWER ARM SURGERY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1820	EAP	CPT® 01820		"PR ANESTH,FOREARM BONES,CLOSED PROC"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1830	EAP	CPT® 01830		"PR ANESTH,DISTAL RADIUS/ULNA WRIST/HAND,NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1840	EAP	CPT® 01840		"PR ANESTH,LOWER ARM ARTERY SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1844	EAP	CPT® 01844		"PR ANESTH,LOWER ARM,VASC SHUNT SURG"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1916	EAP	CPT® 01916		"PR ANESTH,DX ARTERIOGRAPHY/VENOGRAPHY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1920	EAP	CPT® 01920		"PR ANESTH,CARDIAC CATH W/CORON ART & VENT"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1922	EAP	CPT® 01922		"PR ANESTH,CAT/MRI SCAN,RADIATN THERAPY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1924	EAP	CPT® 01924		"PR ANESTH,INTER RAD,ARTERIAL SYS,NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1925	EAP	CPT® 01925		"ANESTH,INTER RAD, ARTERIAL, CAROTID/CORONARY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1926	EAP	CPT® 01926		"ANESTH,INTER RAD,ARTERIAL, INTRACRA/INTRACAR/AORT"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1930	EAP	CPT® 01930		"PR ANESTH,INTER RAD,VENOUS/LYMPH SYS,NOS"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1931	EAP	CPT® 01931		"ANESTH,INTER RAD,VENOUS/LYMPH,INTRAHEPAT/PORTAL CIRC"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1932	EAP	CPT® 01932		"ANESTH,INTER RAD,VENOUS/LYMPH,INTRATHORACIC/JUGULAR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1933	EAP	CPT® 01933		"ANESTH,INTER RAD,VENOUS/LYMPH,INTRACRANIAL"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1941	EAP	CPT® 01941		PR ANES PERQ IMG NEUROMD/NTRVRT PX SPI/SP CRV/THRC	OP	$90.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1942	EAP	CPT® 01942		PR ANES PERQ IMG NEUROMD/NTRVRT PX SPI/SP LMBR/SAC	OP	$90.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
1951	EAP	CPT® 01951		"PR ANESTH,BURN TX, <4% TBSA"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1952	EAP	CPT® 01952		"PR ANESTH,BURN TX, 4-9% TBSA"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1958	EAP	CPT® 01958		"PR ANESTH, ANTEPARTUM MANIPUL"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1960	EAP	CPT® 01960		"PR ANESTH,VAGINAL DELIVERY ONLY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$90.00	$0.00	$90.00
1961	EAP	CPT® 01961		"PR ANESTH,CESAREAN DELIVERY ONLY"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$90.00	$0.00	$90.00
1965	EAP	CPT® 01965		"PR ANESTH, INCOMP/MISSED AB PROC"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1966	EAP	CPT® 01966		"PR ANESTH, INDUCED AB PROCEDURE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1967	EAP	CPT® 01967		"ANESTH, NEURAXIAL LABOR, PLAN VAG DEL"	OP	$480.00 	$0.00	$0.00	$480.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$480.00	$94.50	$0.00	$94.50
1968	EAP	CPT® 01968		"ANESTH,CES DEL AFTER NEURAXIAL ANESTH"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$90.00	$0.00	$90.00
1990	EAP	CPT® 01990		"PR PHYS SUPPORT,BRAIN-DEAD ORGAN DONOR"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1991	EAP	CPT® 01991		PR ANES DX/THER NRV BLK/NJX OTH/THN PRONE POS	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
1992	EAP	CPT® 01992		PR ANES DX/THER NERVE BLOCK/INJECTION PRONE POS	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$0.00	$90.00
10005	EAP	CPT® 10005		PR FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION	OP	$224.00 	$0.00	$0.00	$168.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.69	$0.00	$26.87	$0.00
10006	EAP	CPT® 10006		PR FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL	OP	$154.00 	$0.00	$0.00	$114.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.87	$0.00	$36.67	$0.00
10021	EAP	CPT® 10021		PR FINE NEEDLE ASP;W/O IMAGING GUIDANCE	OP	$173.00 	$0.00	$0.00	$160.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.56	$126.80	$58.42	$126.80
10030	EAP	CPT® 10030		PR IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE	OP	$431.00 	$0.00	$0.00	$389.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.58	$0.00	$431.00	$0.00
10035	EAP	CPT® 10035		PR PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE	OP	$266.00 	$0.00	$0.00	$200.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.87	$0.00	$266.00	$0.00
10060	EAP	CPT® 10060		PR DRAIN SKIN ABSCESS SIMPLE	OP	$325.00 	$0.00	$0.00	$222.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.32	$93.51	$46.70	$93.51
10061	EAP	CPT® 10061		PR DRAIN SKIN ABSCESS COMPLIC	OP	$563.00 	$0.00	$0.00	$412.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$412.05	$163.98	$85.09	$163.98
10080	EAP	CPT® 10080		PR DRAIN PILONIDAL CYST SIMPL	OP	$319.00 	$0.00	$0.00	$235.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.83	$155.44	$55.43	$155.44
10081	EAP	CPT® 10081		PR DRAIN PILONIDAL CYST COMPLIC	OP	$533.00 	$0.00	$0.00	$389.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.91	$239.26	$101.56	$239.26
10120	EAP	CPT® 10120		PR REMOVE FOREIGN BODY SIMPLE	OP	$318.00 	$0.00	$0.00	$237.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$237.65	$125.50	$53.59	$125.50
10121	EAP	CPT® 10121		PR REMOVE FOREIGN BODY COMPLIC	OP	$576.00 	$0.00	$0.00	$426.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$426.81	$235.80	$105.61	$235.80
10140	EAP	CPT® 10140		PR DRAINAGE OF HEMATOMA/FLUID	OP	$369.00 	$0.00	$0.00	$272.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.03	$130.38	$56.30	$130.38
10160	EAP	CPT® 10160		PR PUNCTURE DRAINAGE OF LESION	OP	$293.00 	$0.00	$0.00	$220.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.53	$108.87	$49.13	$108.87
10180	EAP	CPT® 10180		"PR COMPLEX DRAINAGE, WOUND"	OP	$688.00 	$0.00	$0.00	$411.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$411.92	$204.03	$81.67	$204.03
11004	EAP	CPT® 11004		"PR DEBRIDE NECROTIC SKIN/ TISSUE, GENIT & PERINM"	OP	"$1,804.00 "	$0.00	$0.00	"$1,342.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,342.44"	$543.65	$341.95	$543.65
11005	EAP	CPT® 11005		"PR DEBRIDE NECROTIC SKIN/ TISSUE, ABD WALL"	OP	"$2,457.00 "	$0.00	$0.00	"$1,815.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,815.23"	$730.88	$466.14	$730.88
11008	EAP	CPT® 11008		REMOVE MESH FROM ABD WALL FOR INFECTION	OP	$864.00 	$0.00	$0.00	$638.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$638.33	$266.02	$175.12	$266.02
11010	EAP	CPT® 11010		PR DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ	OP	$861.00 	$0.00	$0.00	$645.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$645.45	$420.46	$174.46	$420.46
11011	EAP	CPT® 11011		PR DEBRIDE ASSOC OPEN FX/DISLOC SKIN/MUSCLE	OP	$940.00 	$0.00	$0.00	$691.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$691.01	$488.04	$216.41	$488.04
11012	EAP	CPT® 11012		PR DEBRIDE ASSOC OPEN FX/DISLO SKIN/MUS/BONE	OP	"$1,308.00 "	$0.00	$0.00	$986.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$986.84	$696.19	$298.94	$696.19
11042	EAP	CPT® 11042		"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM"	OP	$334.00 	$0.00	$0.00	$142.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.29	$68.18	$43.80	$68.18
11043	EAP	CPT® 11043		"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM"	OP	$601.00 	$0.00	$0.00	$358.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$358.82	$244.83	$105.38	$244.83
11044	EAP	CPT® 11044		"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM"	OP	$737.00 	$0.00	$0.00	$534.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$534.26	$328.20	$142.06	$328.20
11045	EAP	CPT® 11045		"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM"	OP	$83.00 	$0.00	$0.00	$60.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.17	$0.00	$18.27	$0.00
11046	EAP	CPT® 11046		"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ CM"	OP	$175.00 	$0.00	$0.00	$129.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.03	$0.00	$31.72	$0.00
11047	EAP	CPT® 11047		"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,EACH ADD 20 SQ CM"	OP	$309.00 	$0.00	$0.00	$229.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.94	$0.00	$52.14	$0.00
11055	EAP	CPT® 11055		"PR TRIM HYPERKERATOTIC SKIN LESION, ONE"	OP	$56.00 	$0.00	$0.00	$40.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.01	$40.13	$13.27	$40.13
11056	EAP	CPT® 11056		"TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4"	OP	$72.00 	$0.00	$0.00	$52.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.28	$49.68	$17.66	$49.68
11057	EAP	CPT® 11057		"TRIM BENIGN HYPERKERATOTIC SKIN LESION,>4"	OP	$112.00 	$0.00	$0.00	$68.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.36	$60.99	$19.61	$60.99
11102	EAP	CPT® 11102		PR TANGENTIAL BIOPSY SKIN SINGLE LESION	OP	$121.00 	$0.00	$0.00	$91.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.58	$0.00	$59.83	$0.00
11103	EAP	CPT® 11103		PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION	OP	$70.00 	$0.00	$0.00	$53.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.03	$0.00	$32.27	$0.00
11104	EAP	CPT® 11104		PR PUNCH BIOPSY SKIN SINGLE LESION	OP	$151.00 	$0.00	$0.00	$114.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.90	$0.00	$75.21	$0.00
11105	EAP	CPT® 11105		PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION	OP	$82.00 	$0.00	$0.00	$62.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.67	$0.00	$36.98	$0.00
11106	EAP	CPT® 11106		PR INCISIONAL BIOPSY SKIN SINGLE LESION	OP	$183.00 	$0.00	$0.00	$139.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.77	$0.00	$91.03	$0.00
11200	EAP	CPT® 11200		"PR REMOVAL OF SKIN TAGS, UP TO 15"	OP	$227.00 	$0.00	$0.00	$168.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.33	$69.39	$34.68	$69.39
11301	EAP	CPT® 11301		"PR SHAV SKIN LES 6-10MM TRUNK,ARM,LEG"	OP	$162.00 	$0.00	$0.00	$123.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.72	$75.78	$40.01	$75.78
11310	EAP	CPT® 11310		"PR SHAV SKIN LES <5MM FACE,FACIAL"	OP	$145.00 	$0.00	$0.00	$109.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.23	$70.70	$37.62	$70.70
11312	EAP	CPT® 11312		"PR SHAV SKIN LES 11-20MM FACE,FACIAL"	OP	$235.00 	$0.00	$0.00	$180.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.69	$101.58	$55.26	$101.58
11313	EAP	CPT® 11313		"PR SHAV SKIN LES >21MM FACE,FACIAL"	OP	$305.00 	$0.00	$0.00	$232.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.05	$130.75	$72.22	$130.75
11400	EAP	CPT® 11400		"PR EXC SKIN BENIG <5MM TRUNK,ARM,LEG"	OP	$297.00 	$0.00	$0.00	$184.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.40	$104.64	$54.50	$104.64
11401	EAP	CPT® 11401		"PR EXC SKIN BENIG 0.6-1CM TRUNK,ARM,LEG"	OP	$320.00 	$0.00	$0.00	$238.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.19	$123.81	$65.86	$123.81
11402	EAP	CPT® 11402		"PR EXC SKIN BENIG 1.1-2CM TRUNK,ARM,LEG"	OP	$354.00 	$0.00	$0.00	$262.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.20	$137.69	$76.22	$137.69
11403	EAP	CPT® 11403		"PR EXC SKIN BENIG 2.1-3CM TRUNK,ARM,LEG"	OP	$457.00 	$0.00	$0.00	$339.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$339.32	$159.08	$89.41	$159.08
11404	EAP	CPT® 11404		"PR EXC SKIN BENIG 3.1-4CM TRUNK,ARM,LEG"	OP	$504.00 	$0.00	$0.00	$373.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$373.68	$181.21	$100.41	$181.21
11406	EAP	CPT® 11406		"PR EXC SKIN BENIG >4CM TRUNK,ARM,LEG"	OP	$767.00 	$0.00	$0.00	$568.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$568.25	$250.10	$123.49	$250.10
11420	EAP	CPT® 11420		PR EXC SKIN BENIG <5MM REMAINDR BODY	OP	$253.00 	$0.00	$0.00	$187.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.64	$103.76	$53.05	$103.76
11421	EAP	CPT® 11421		PR EXC SKIN BENIG 0.6-1CM REMAINDR BODY	OP	$338.00 	$0.00	$0.00	$252.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.63	$132.63	$69.99	$132.63
11422	EAP	CPT® 11422		PR EXC SKIN BENIG 1.1-2CM REMAINDR BODY	OP	$420.00 	$0.00	$0.00	$311.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.40	$147.67	$79.92	$147.67
11423	EAP	CPT® 11423		PR EXC SKIN BENIG 2.1-3CM REMAINDR BODY	OP	$481.00 	$0.00	$0.00	$361.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.86	$174.18	$97.74	$174.18
11424	EAP	CPT® 11424		PR EXC SKIN BENIG 3.1-4CM REMAINDR BODY	OP	$553.00 	$0.00	$0.00	$413.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.87	$199.24	$110.88	$199.24
11426	EAP	CPT® 11426		PR EXC SKIN BENIG >4CM REMAINDR BODY	OP	$853.00 	$0.00	$0.00	$633.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$633.41	$286.55	$151.46	$286.55
11440	EAP	CPT® 11440		"PR EXC SKIN BENIG <5MM FACE,FACIAL"	OP	$318.00 	$0.00	$0.00	$236.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.96	$117.79	$63.31	$117.79
11441	EAP	CPT® 11441		"PR EXC SKIN BENIG 0.6-1CM FACE,FACIAL"	OP	$403.00 	$0.00	$0.00	$302.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.66	$143.77	$77.11	$143.77
11442	EAP	CPT® 11442		"PR EXC SKIN BENIG 1.1-2CM FACE,FACIAL"	OP	$448.00 	$0.00	$0.00	$334.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$334.70	$160.74	$87.24	$160.74
11443	EAP	CPT® 11443		"PR EXC SKIN BENIG 2.1-3CM FACE,FACIAL"	OP	$549.00 	$0.00	$0.00	$410.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.88	$195.74	$111.00	$195.74
11444	EAP	CPT® 11444		"PR EXC SKIN BENIG 3.1-4CM FACE,FACIAL"	OP	$702.00 	$0.00	$0.00	$523.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$523.19	$247.49	$138.12	$247.49
11446	EAP	CPT® 11446		"PR EXC SKIN BENIG >4CM FACE,FACIAL"	OP	"$1,001.00 "	$0.00	$0.00	$750.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$750.36	$331.47	$171.89	$331.47
11450	EAP	CPT® 11450		"PR EXC SWEAT GLAND LESN AXILL,SIMPL"	OP	$870.00 	$0.00	$0.00	$580.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$580.56	$307.97	$141.47	$307.97
11462	EAP	CPT® 11462		"PR EXC SWEAT GLAND LESN INGUIN,SIMPL"	OP	$758.00 	$0.00	$0.00	$554.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$554.28	$303.45	$132.65	$303.45
11602	EAP	CPT® 11602		"PR EXC SKIN MALIG 1.1-2CM TRUNK,ARM,LEG"	OP	$501.00 	$0.00	$0.00	$377.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$377.10	$196.05	$100.13	$196.05
11603	EAP	CPT® 11603		"PR EXC SKIN MALIG 2.1-3CM TRUNK,ARM,LEG"	OP	$599.00 	$0.00	$0.00	$451.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$451.68	$225.57	$113.39	$225.57
11621	EAP	CPT® 11621		PR EXC SKIN MALIG 0.6-1CM REMAINDR BODY	OP	$462.00 	$0.00	$0.00	$346.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.52	$182.70	$96.19	$182.70
11622	EAP	CPT® 11622		PR EXC SKIN MALIG 1.1-2CM REMAINDR BODY	OP	$525.00 	$0.00	$0.00	$396.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$396.33	$205.84	$112.06	$205.84
11623	EAP	CPT® 11623		PR EXC SKIN MALIG 2.1-3CM REMAINDR BODY	OP	$652.00 	$0.00	$0.00	$490.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$490.94	$244.84	$129.99	$244.84
11719	EAP	CPT® 11719		PR TRIM NAIL(S)	OP	$42.00 	$0.00	$0.00	$17.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.70	$16.84	$10.91	$16.84
11720	EAP	CPT® 11720		"PR DEBRIDEMENT OF NAIL(S), 1-5"	OP	$45.00 	$0.00	$0.00	$33.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.78	$26.32	$15.92	$26.32
11721	EAP	CPT® 11721		"PR DEBRIDEMENT OF NAILS, 6 OR MORE"	OP	$78.00 	$0.00	$0.00	$57.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.06	$38.87	$24.95	$38.87
11730	EAP	CPT® 11730		PR REMOVAL OF NAIL PLATE	OP	$170.00 	$0.00	$0.00	$117.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.36	$84.36	$39.56	$84.36
11740	EAP	CPT® 11740		PR DRAIN BLOOD FROM UNDER NAIL	OP	$97.00 	$0.00	$0.00	$75.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$36.70	$20.59	$36.70
11750	EAP	CPT® 11750		PR REMOVAL OF NAIL BED	OP	$315.00 	$0.00	$0.00	$315.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.00	$179.52	$85.23	$179.52
11760	EAP	CPT® 11760		PR RECONSTRUC OF NAIL BED	OP	$356.00 	$0.00	$0.00	$268.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.76	$167.40	$65.44	$167.40
11765	EAP	CPT® 11765		"PR EXCISION OF NAIL FOLD, TOE"	OP	$286.00 	$0.00	$0.00	$216.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.05	$101.52	$32.69	$101.52
11771	EAP	CPT® 11771		PR REMV PILONIDAL LESION EXTENS	OP	"$1,378.00 "	$0.00	$0.00	"$1,000.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,000.31"	$452.96	$248.56	$452.96
11772	EAP	CPT® 11772		PR REMV PILONIDAL LESION COMPLIC	OP	"$1,804.00 "	$0.00	$0.00	"$1,327.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,327.97"	$565.13	$292.85	$565.13
11900	EAP	CPT® 11900		"INJECTION INTO SKIN LESIONS, UP TO 7"	OP	$94.00 	$0.00	$0.00	$72.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.30	$45.68	$22.75	$45.68
11901	EAP	CPT® 11901		"INJECTION INTO SKIN LESIONS, 8 OR MORE"	OP	$147.00 	$0.00	$0.00	$111.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.66	$57.04	$32.44	$57.04
11920	EAP	CPT® 11920		PR CORRECT SKIN COLR DEFCT <6SQ CM	OP	$466.00 	$0.00	$0.00	$261.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$261.99	$188.85	$73.42	$188.85
11970	EAP	CPT® 11970		PR REPLACEMENT TISSUE EXPANDER W/PERMANENT IMPLANT	OP	"$1,905.00 "	$0.00	$0.00	"$1,401.87"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,401.87"	$540.40	$316.48	$540.40
11971	EAP	CPT® 11971		PR REMOVAL TISSUE EXPANDER W/O INSERTION IMPLANT	OP	"$1,295.00 "	$0.00	$0.00	$733.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$733.35	$443.39	$141.20	$443.39
11976	EAP	CPT® 11976		PR REMOVAL OF CONTRACEPTIVE CAPSUL	OP	$295.00 	$0.00	$0.00	$216.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.03	$133.13	$74.28	$133.13
11981	EAP	CPT® 11981		PR INSERTION DRUG DELIVERY IMPLANT	OP	$365.00 	$0.00	$0.00	$189.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.99	$121.07	$70.63	$121.07
11982	EAP	CPT® 11982		PR REMOVAL DRUG IMPLANT DEVICE	OP	$405.00 	$0.00	$0.00	$230.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$321.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.91	$141.05	$80.43	$141.05
11983	EAP	CPT® 11983		PR REMOVAL W/ REINSERT DRUG IMPLANT DEVICE	OP	$600.00 	$0.00	$0.00	$400.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$402.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$400.47	$212.43	$129.89	$212.43
12001	EAP	CPT® 12001		PR REPR SUPERF WND BODY <2.5CM	OP	$222.00 	$0.00	$0.00	$136.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.94	$136.61	$72.72	$136.61
12002	EAP	CPT® 12002		PR REPR SUP NPTERF WND BODY 2.6-7.5	OP	$269.00 	$0.00	$0.00	$144.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.00	$144.99	$80.01	$144.99
12004	EAP	CPT® 12004		PR REPR SUPERF WND BODY 7.6-12.5	OP	$334.00 	$0.00	$0.00	$170.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.64	$170.01	$95.41	$170.01
12005	EAP	CPT® 12005		PR REPR SUPERF WND BODY 12.6-20	OP	$352.00 	$0.00	$0.00	$218.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$218.03	$212.09	$118.48	$212.09
12007	EAP	CPT® 12007		PR REPR SUPERF WND BODY >30CM	OP	$500.00 	$0.00	$0.00	$338.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$338.15	$297.36	$169.54	$297.36
12011	EAP	CPT® 12011		PR REPR SUPERF WND FACE <2.5CM	OP	$269.00 	$0.00	$0.00	$144.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.74	$144.40	$77.38	$144.40
12013	EAP	CPT® 12013		PR REPR SUPERF WND FACE 2.6-5	OP	$315.00 	$0.00	$0.00	$158.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.05	$158.87	$87.75	$158.87
12014	EAP	CPT® 12014		PR REPR SUPERF WND FACE 5.1-7.5	OP	$362.00 	$0.00	$0.00	$187.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$171.53	$187.37	$103.99	$187.37
12015	EAP	CPT® 12015		PR REPR SUPERF WND FACE 7.6-12.5	OP	$473.00 	$0.00	$0.00	$235.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.60	$235.25	$131.45	$235.25
12020	EAP	CPT® 12020		PR CLOSURE SUPERF WND DEHIS SIMPLE	OP	$587.00 	$0.00	$0.00	$448.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$448.76	$242.70	$105.67	$242.70
12031	EAP	CPT® 12031		"PR LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM"	OP	$471.00 	$0.00	$0.00	$353.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$353.07	$181.32	$88.61	$181.32
12032	EAP	CPT® 12032		"PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM"	OP	$640.00 	$0.00	$0.00	$450.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$450.48	$247.47	$100.96	$247.47
12034	EAP	CPT® 12034		"PR LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM"	OP	$639.00 	$0.00	$0.00	$477.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$477.33	$242.38	$120.27	$242.38
12035	EAP	CPT® 12035		"PR LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM"	OP	$751.00 	$0.00	$0.00	$555.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$555.05	$325.75	$138.44	$325.75
12036	EAP	CPT® 12036		"PR LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM"	OP	$881.00 	$0.00	$0.00	$644.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$644.48	$363.96	$179.63	$363.96
12041	EAP	CPT® 12041		PR LAYR CLOS WND REST BODY <2.5 CM	OP	$456.00 	$0.00	$0.00	$347.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$347.37	$196.50	$98.74	$196.50
12042	EAP	CPT® 12042		PR LAYR CLOS WND REST BODY 2.6-7.5 CM	OP	$610.00 	$0.00	$0.00	$463.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$463.13	$234.63	$111.07	$234.63
12044	EAP	CPT® 12044		PR LAYR CLOS WND REST BODY 7.6-12.5 CM	OP	$666.00 	$0.00	$0.00	$495.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$495.86	$258.28	$127.50	$258.28
12045	EAP	CPT® 12045		PR LAYR CLOS WND REST BODY 12.6-20 CM	OP	$839.00 	$0.00	$0.00	$624.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$624.57	$333.93	$149.53	$333.93
12046	EAP	CPT® 12046		PR LAYR CLOS WND REST BODY 20.1-30 CM	OP	$982.00 	$0.00	$0.00	$716.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$716.22	$399.01	$189.89	$399.01
12051	EAP	CPT® 12051		"PR LAYR CLOS WND FACE,FACIAL <2.5 CM"	OP	$524.00 	$0.00	$0.00	$396.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$396.41	$222.72	$102.28	$222.72
12052	EAP	CPT® 12052		"PR LAYR CLOS WND FACE,FACIAL 2.5-5 CM"	OP	$621.00 	$0.00	$0.00	$471.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$471.14	$239.19	$114.65	$239.19
12053	EAP	CPT® 12053		"PR LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM"	OP	$671.00 	$0.00	$0.00	$503.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$503.15	$257.34	$128.25	$257.34
12054	EAP	CPT® 12054		"PR LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM"	OP	$687.00 	$0.00	$0.00	$514.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$514.11	$280.59	$150.59	$280.59
13101	EAP	CPT® 13101		PR REPR CMPL WND TRUNK 2.6-7.5CM	OP	$772.00 	$0.00	$0.00	$586.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$586.92	$331.18	$155.13	$331.18
13102	EAP	CPT® 13102		"PR REP,SKIN,TRUNK,CMPLX,+5CM/<"	OP	$227.00 	$0.00	$0.00	$172.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.47	$93.25	$44.65	$93.25
13120	EAP	CPT® 13120		"PR REPR CMPL WND SCALP,EXTR 1.1-2.5"	OP	$722.00 	$0.00	$0.00	$546.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$546.75	$282.98	$131.02	$282.98
13121	EAP	CPT® 13121		"PR REPR CMPL WND SCALP,EXTR 2.6-7.5"	OP	$811.00 	$0.00	$0.00	$619.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$619.56	$358.48	$174.55	$358.48
13122	EAP	CPT® 13122		"PR REP,SKIN,SCALP/EXTREM+5CM/<"	OP	$262.00 	$0.00	$0.00	$198.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.20	$110.54	$51.91	$110.54
13131	EAP	CPT® 13131		"PR REPR CMPL WND HEAD,FAC,HAND 1.1-2.5"	OP	$761.00 	$0.00	$0.00	$578.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$578.63	$309.97	$152.46	$309.97
13132	EAP	CPT® 13132		"PR REPR CMPL WND HEAD,FAC,HAND 2.6-7.5"	OP	$953.00 	$0.00	$0.00	$729.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$729.62	$476.91	$242.75	$476.91
13133	EAP	CPT® 13133		"PR REP,FACE,GENITAL,HAND,FT+5CM/<"	OP	$399.00 	$0.00	$0.00	$304.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$304.26	$146.93	$76.74	$146.93
13152	EAP	CPT® 13152		"PR REPR CMPL WND LID,NOS,EAR 2.5-7.5"	OP	"$1,139.00 "	$0.00	$0.00	$807.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$807.42	$474.21	$271.80	$474.21
13160	EAP	CPT® 13160		PR SECD CLOS SURG WND EXTEN/COMPLIC	OP	"$2,486.00 "	$0.00	$0.00	"$1,860.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,860.77"	$733.16	$361.36	$733.16
14020	EAP	CPT® 14020		"PR ADJ TISS XFER SCALP,EXTREM <10SQCM"	OP	"$1,736.00 "	$0.00	$0.00	"$1,312.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,312.56"	$622.70	$295.67	$622.70
14040	EAP	CPT® 14040		"PR ADJ TISS XFER HEAD,FAC,HAND <10SQCM"	OP	"$1,928.00 "	$0.00	$0.00	"$1,461.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,461.95"	$656.90	$351.83	$656.90
14041	EAP	CPT® 14041		"PR ADJ TISS XFER HEAD,FAC,HAND 10.1-30"	OP	"$2,364.00 "	$0.00	$0.00	"$1,799.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,799.34"	$892.45	$468.91	$892.45
14301	EAP	CPT® 14301		"PR ADJ TISS XFER ANY AREA,30.1-60 SQCM"	OP	"$2,705.00 "	$0.00	$0.00	"$2,040.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,040.92"	$0.00	$480.82	$0.00
14302	EAP	CPT® 14302		"PR ADJ TISS XFER ANY AREA,EA ADD 30.0 SQCM"	OP	$682.00 	$0.00	$0.00	$513.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$513.41	$0.00	$105.11	$0.00
14350	EAP	CPT® 14350		PR FILLET FINGR/TOE FLAP W PREP	OP	"$2,134.00 "	$0.00	$0.00	"$1,604.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,604.61"	$689.26	$366.93	$689.26
15002	EAP	CPT® 15002		"PR WOUND PREP, PED, TRK/ARM/LG 1ST 100 CM"	OP	$717.00 	$0.00	$0.00	$524.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$524.84	$296.50	$176.46	$296.50
15003	EAP	CPT® 15003		"PR WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM"	OP	$157.00 	$0.00	$0.00	$105.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.80	$65.73	$39.12	$65.73
15004	EAP	CPT® 15004		"PR WND PREP PED, FACE/NCK/HND/FT/GEN"	OP	$827.00 	$0.00	$0.00	$625.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$625.71	$357.74	$212.23	$357.74
15005	EAP	CPT® 15005		"PR WND PREP,PED, FACE/NCK/HND/FT/GEN ADD 100 CM"	OP	$288.00 	$0.00	$0.00	$210.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.84	$110.96	$65.22	$110.96
15050	EAP	CPT® 15050		PR SKIN PINCH GRAFT PROCEDURE <2CM	OP	"$1,415.00 "	$0.00	$0.00	"$1,026.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,026.44"	$470.11	$176.55	$470.11
15100	EAP	CPT® 15100		"PR SPLIT GRFT TRUNK,ARM,LEG <100SQCM"	OP	"$2,227.00 "	$0.00	$0.00	"$1,651.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,651.88"	$824.17	$339.15	$824.17
15101	EAP	CPT® 15101		"PR SPLIT GRFT,TRUNK,ARM,LEG EA 100SQCM"	OP	$501.00 	$0.00	$0.00	$257.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.40	$194.67	$73.11	$194.67
15110	EAP	CPT® 15110		PR EPIDRM AUTOGRFT TRNK/ARM/LEG <100SQCM	OP	"$2,158.00 "	$0.00	$0.00	"$1,606.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,606.10"	$805.68	$482.57	$805.68
15115	EAP	CPT® 15115		PR EPI AUTOGRFT FACE/NCK/HND/FT/GEN <100SQCM	OP	"$2,130.00 "	$0.00	$0.00	"$1,653.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.42"	$774.13	$452.12	$774.13
15120	EAP	CPT® 15120		"PR SPLIT GRFT,HEAD,FAC,HAND,FEET <100SQCM"	OP	"$2,157.00 "	$0.00	$0.00	"$1,613.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,613.85"	$826.16	$394.12	$826.16
15121	EAP	CPT® 15121		"PR SPLIT GRFT,HEAD,FAC,HAND,FEET EA 100SQCM"	OP	$716.00 	$0.00	$0.00	$307.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.34	$261.86	$117.47	$261.86
15260	EAP	CPT® 15260		"PR FULL THICK GRFT NOS,EAR,LID <20SQCM"	OP	"$2,615.00 "	$0.00	$0.00	"$1,987.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,987.35"	$828.94	$421.39	$828.94
15271	EAP	CPT® 15271		PR APP SKN SUB GRFT T/A/L AREA/<100SCM /<1ST 25 SCM	OP	$289.00 	$0.00	$0.00	$195.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.90	$0.00	$86.07	$0.00
15272	EAP	CPT® 15272		PR APP SKN SUB GRFT T/A/L AREA/<100SCM EA ADL 25SCM	OP	$55.00 	$0.00	$0.00	$40.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.10	$0.00	$16.23	$0.00
15273	EAP	CPT® 15273		PR APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM	OP	$629.00 	$0.00	$0.00	$468.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.21	$0.00	$176.55	$0.00
15274	EAP	CPT® 15274		PR APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM	OP	$143.00 	$0.00	$0.00	$106.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.52	$0.00	$41.62	$0.00
15275	EAP	CPT® 15275		PR SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM	OP	$310.00 	$0.00	$0.00	$221.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.01	$0.00	$92.25	$0.00
15276	EAP	CPT® 15276		PR SUB GRFT F/S/N/H/F/G/M/D /<100SCM EA ADL 25SCM	OP	$81.00 	$0.00	$0.00	$57.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.80	$0.00	$20.06	$0.00
15277	EAP	CPT® 15277		PR SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM	OP	$714.00 	$0.00	$0.00	$520.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$520.59	$0.00	$177.49	$0.00
15278	EAP	CPT® 15278		PR SUB GRFT F/S/N/H/F/G/M/D />100SCM ADL 100SCM	OP	$181.00 	$0.00	$0.00	$132.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.18	$0.00	$50.68	$0.00
15650	EAP	CPT® 15650		PR TRANSFER SKIN PEDICLE FLAP	OP	"$1,433.00 "	$0.00	$0.00	$881.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$881.63	$440.31	$214.59	$440.31
15734	EAP	CPT® 15734		"PR MUSCLE-SKIN FLAP,TRUNK"	OP	"$4,836.00 "	$0.00	$0.00	"$3,046.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,046.37"	"$1,426.93"	$779.44	"$1,426.93"
15736	EAP	CPT® 15736		"PR MUSCLE-SKIN FLAP,ARM"	OP	"$4,048.00 "	$0.00	$0.00	"$2,630.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,630.75"	"$1,310.27"	$701.25	"$1,310.27"
15738	EAP	CPT® 15738		"PR MUSCLE-SKIN FLAP,LEG"	OP	"$4,227.00 "	$0.00	$0.00	"$2,844.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,844.98"	"$1,383.32"	$707.30	"$1,383.32"
15757	EAP	CPT® 15757		PR FREE SKIN FLAP W MICROVASC ANAST	OP	"$8,489.00 "	$0.00	$0.00	"$5,317.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,317.20"	"$2,191.91"	"$1,446.97"	"$2,191.91"
15760	EAP	CPT® 15760		PR COMPOSITE SKIN GRAFT	OP	"$2,221.00 "	$0.00	$0.00	"$1,638.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,638.75"	$742.62	$384.16	$742.62
15771	EAP	CPT® 15771		PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS	OP	"$1,495.00 "	$0.00	$0.00	"$1,105.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,105.59"	$0.00	$353.43	$0.00
15772	EAP	CPT® 15772		PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC	OP	$475.00 	$0.00	$0.00	$326.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$326.37	$0.00	$111.49	$0.00
15777	EAP	CPT® 15777		PR IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT	OP	$676.00 	$0.00	$0.00	$493.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.82	$0.00	$126.78	$0.00
15821	EAP	CPT® 15821		PR REV LOWER EYELID EXTEN FAT PAD	OP	"$1,679.00 "	$0.00	$0.00	"$1,246.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,246.55"	$516.22	$305.31	$516.22
15830	EAP	CPT® 15830		"PR EXCISE EXCESS SKIN TISSUE,ABDOMEN"	OP	"$3,675.00 "	$0.00	$0.00	"$2,703.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,703.23"	"$1,067.02"	$622.78	"$1,067.02"
15839	EAP	CPT® 15839		"PR EXCISE EXCESS SKIN TISSUE,OTHER"	OP	"$2,297.00 "	$0.00	$0.00	"$1,701.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,701.42"	$735.38	$320.59	$735.38
15850	EAP	CPT® 15850		PR REM SUTURES W ANESTH SAME SURGEON	OP	$210.00 	$0.00	$0.00	$95.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.48	$0.00	$0.00	$0.00
15852	EAP	CPT® 15852		"PR DRESSING CHANGE,NOT FOR BURN"	OP	$145.00 	$0.00	$0.00	$108.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.26	$44.77	$44.21	$44.77
15860	EAP	CPT® 15860		PR IV INJ TO TEST BLOOD FLOW IN FLAP/GRAFT	OP	$339.00 	$0.00	$0.00	$255.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$255.74	$105.81	$75.42	$105.81
16000	EAP	CPT® 16000		PR INITIAL RX BURN(S) 1ST DEGREE	OP	$144.00 	$0.00	$0.00	$105.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.96	$64.69	$35.67	$64.69
16020	EAP	CPT® 16020		PR DRESS/DEBRID SMALL BURN NO ANES	OP	$169.00 	$0.00	$0.00	$124.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.76	$76.88	$34.17	$76.88
16025	EAP	CPT® 16025		PR DRESS/DEBRID MED BURN NO ANESTH	OP	$344.00 	$0.00	$0.00	$256.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.32	$134.89	$67.00	$134.89
16030	EAP	CPT® 16030		PR DRESS/DEBRID LARGE BURN NO ANESTH	OP	$415.00 	$0.00	$0.00	$308.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.36	$159.44	$84.08	$159.44
16035	EAP	CPT® 16035		PR ESCHAROTOMY	OP	$866.00 	$0.00	$0.00	$450.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$450.15	$203.21	$170.05	$203.21
16036	EAP	CPT® 16036		"PR INCISION OF BURN SCAB, EACH ADDNTL"	OP	$433.00 	$0.00	$0.00	$186.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.74	$80.77	$59.15	$80.77
17000	EAP	CPT® 17000		"PR DESTRUC PREMALIGNANT, FIRST LESION"	OP	$165.00 	$0.00	$0.00	$122.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.37	$62.75	$30.31	$62.75
17003	EAP	CPT® 17003		"PR DESTRUC PREMALIGNANT,2-14 LESIONS"	OP	$27.00 	$0.00	$0.00	$6.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.60	$6.72	$7.97	$6.72
17110	EAP	CPT® 17110		PR DESTRUCTION BENIGN LESIONS UP TO 14	OP	$207.00 	$0.00	$0.00	$160.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.38	$86.19	$30.72	$86.19
17111	EAP	CPT® 17111		DESTRUCTION BENIGN LESIONS 15 OR MORE	OP	$253.00 	$0.00	$0.00	$197.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.33	$102.36	$41.52	$102.36
17250	EAP	CPT® 17250		PR CHEM CAUTERY GRANULATN TISSUE	OP	$165.00 	$0.00	$0.00	$85.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.28	$65.52	$23.18	$65.52
17261	EAP	CPT® 17261		"PR DESTR MALIG TRUNK,EXTREM 0.6-1 CM"	OP	$269.00 	$0.00	$0.00	$210.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.74	$111.49	$58.87	$111.49
17262	EAP	CPT® 17262		"PR DESTR MALIG TRUNK,EXTREM 1.1-2 CM"	OP	$345.00 	$0.00	$0.00	$268.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.56	$137.13	$75.43	$137.13
19000	EAP	CPT® 19000		PR PUNC/ASPIR BREAST CYST	OP	$170.00 	$0.00	$0.00	$103.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.13	$103.74	$37.28	$103.74
19020	EAP	CPT® 19020		PR EXPLO/DRAIN BREAST ABSCESS	OP	$966.00 	$0.00	$0.00	$704.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$704.21	$381.55	$172.41	$381.55
19081	EAP	CPT® 19081		PR BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE	OP	$521.00 	$0.00	$0.00	$393.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.45	$0.00	$406.55	$0.00
19082	EAP	CPT® 19082		PR BX BREAST W DEVICE ADDL LESION STEREOTACT GUIDE	OP	$262.00 	$0.00	$0.00	$196.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.74	$0.00	$262.00	$0.00
19083	EAP	CPT® 19083		PR BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE	OP	$493.00 	$0.00	$0.00	$368.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$368.67	$0.00	$403.90	$0.00
19084	EAP	CPT® 19084		PR BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE	OP	$243.00 	$0.00	$0.00	$184.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.74	$0.00	$243.00	$0.00
19100	EAP	CPT® 19100		"PR BIOPSY OF BREAST, NEEDLE CORE"	OP	$343.00 	$0.00	$0.00	$161.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.58	$126.09	$71.30	$126.09
19110	EAP	CPT® 19110		PR NIPPLE EXPLORATION	OP	"$1,098.00 "	$0.00	$0.00	$788.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$788.03	$390.31	$214.89	$390.31
19120	EAP	CPT® 19120		PR REMOVAL OF BREAST LESION	OP	"$1,298.00 "	$0.00	$0.00	$953.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$953.27	$402.44	$214.35	$402.44
19125	EAP	CPT® 19125		PR EXCISE BREAST LES W XRAY MARKER	OP	"$1,441.00 "	$0.00	$0.00	"$1,059.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,059.59"	$442.65	$233.91	$442.65
19281	EAP	CPT® 19281		PR PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE	OP	$494.00 	$0.00	$0.00	$235.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.52	$0.00	$146.42	$0.00
19285	EAP	CPT® 19285		PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG	OP	$269.00 	$0.00	$0.00	$200.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.87	$0.00	$269.00	$0.00
19286	EAP	CPT® 19286		PR PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE	OP	$136.00 	$0.00	$0.00	$101.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.22	$0.00	$136.00	$0.00
19301	EAP	CPT® 19301		"PR MASTECTOMY, PARTIAL"	OP	"$2,061.00 "	$0.00	$0.00	"$1,506.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,506.78"	$367.13	$213.51	$367.13
19302	EAP	CPT® 19302		"PR MASTECTOMY,PARTIAL,  WITH AXILLARY LYMPHADENECTOMY"	OP	"$2,833.00 "	$0.00	$0.00	"$2,076.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,076.18"	$782.53	$451.61	$782.53
19303	EAP	CPT® 19303		"PR MASTECTOMY, SIMPLE, COMPLETE"	OP	"$3,011.00 "	$0.00	$0.00	"$2,333.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,333.18"	$799.24	$455.81	$799.24
19307	EAP	CPT® 19307		"PR MASTECTOMY, MODIFIED RADICAL"	OP	"$3,783.00 "	$0.00	$0.00	"$2,763.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,763.27"	"$1,013.43"	$584.82	"$1,013.43"
19316	EAP	CPT® 19316		PR SUSPENSION OF BREAST	OP	"$2,845.00 "	$0.00	$0.00	"$1,773.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,773.90"	$716.59	$478.02	$716.59
19318	EAP	CPT® 19318		PR BREAST REDUCTION	OP	"$4,322.00 "	$0.00	$0.00	"$2,540.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,540.70"	"$1,060.52"	$656.68	"$1,060.52"
19328	EAP	CPT® 19328		PR REMOVAL INTACT BREAST IMPLANT	OP	"$1,560.00 "	$0.00	$0.00	"$1,141.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,141.32"	$440.22	$228.54	$440.22
19342	EAP	CPT® 19342		PR INSJ/RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY	OP	"$2,896.00 "	$0.00	$0.00	"$2,125.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,125.73"	$830.06	$482.09	$830.06
19350	EAP	CPT® 19350		PR NIPPLE/AREOLA RECONSTRUCTION	OP	"$3,313.00 "	$0.00	$0.00	"$1,551.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,551.02"	$837.77	$427.60	$837.77
19357	EAP	CPT® 19357		PR TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION	OP	"$4,690.00 "	$0.00	$0.00	"$3,470.19"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,470.19"	"$1,401.46"	$724.19	"$1,401.46"
19370	EAP	CPT® 19370		PR REVISION PERI-IMPLANT CAPSULE BREAST	OP	"$2,161.00 "	$0.00	$0.00	"$1,580.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.09"	$615.51	$330.94	$615.51
19380	EAP	CPT® 19380		PR REVISION OF RECONSTRUCTED BREAST	OP	"$2,521.00 "	$0.00	$0.00	"$1,780.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,780.95"	$693.17	$390.19	$693.17
20100	EAP	CPT® 20100		"PR EXPLORE WOUND,NECK"	OP	"$1,889.00 "	$0.00	$0.00	"$1,406.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,406.03"	$563.04	$362.99	$563.04
20101	EAP	CPT® 20101		"PR EXPLORE WOUND,CHEST"	OP	"$1,684.00 "	$0.00	$0.00	$482.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$482.25	$349.76	$130.75	$349.76
20102	EAP	CPT® 20102		"PR EXPLORE WOUND,ABDOMEN/FLANK/BACK"	OP	"$1,946.00 "	$0.00	$0.00	$592.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$592.17	$424.39	$156.85	$424.39
20103	EAP	CPT® 20103		"PR EXPLORE WOUND,EXTREMITY"	OP	"$1,684.00 "	$0.00	$0.00	$804.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.41	$519.45	$202.42	$519.45
20200	EAP	CPT® 20200		PR MUSCLE BIOPSY	OP	$449.00 	$0.00	$0.00	$221.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.03	$171.27	$67.00	$171.27
20205	EAP	CPT® 20205		PR DEEP MUSCLE BIOPSY	OP	$636.00 	$0.00	$0.00	$361.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.01	$235.84	$122.12	$235.84
20206	EAP	CPT® 20206		"PR NEEDLE BIOPSY,MUSCLE"	OP	$561.00 	$0.00	$0.00	$261.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.55	$261.63	$65.24	$261.63
20220	EAP	CPT® 20220		"PR BONE BIOPSY,TROCAR/NEEDLE SUPERF"	OP	$561.00 	$0.00	$0.00	$196.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.92	$196.83	$84.82	$196.83
20225	EAP	CPT® 20225		"PR BONE BIOPSY,TROCAR/NEEDLE DEEP"	OP	"$1,123.00 "	$0.00	$0.00	$860.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.53	$860.38	$79.21	$860.38
20240	EAP	CPT® 20240		PR BIOPSY BONE OPEN SUPERFICIAL	OP	$618.00 	$0.00	$0.00	$357.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$357.33	$219.12	$139.99	$219.12
20245	EAP	CPT® 20245		PR BIOPSY BONE OPEN DEEP	OP	"$1,572.00 "	$0.00	$0.00	"$1,197.57"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,197.57"	$588.03	$182.69	$588.03
20520	EAP	CPT® 20520		PR REMOVAL OF FOREIGN BODY	OP	$456.00 	$0.00	$0.00	$337.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.13	$176.95	$102.69	$176.95
20526	EAP	CPT® 20526		PR INJECT CARPAL TUNNEL	OP	$178.00 	$0.00	$0.00	$132.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.41	$71.89	$0.00	$71.89
20550	EAP	CPT® 20550		PR INJECT TENDON SHEATH/LIGAMENT	OP	$159.00 	$0.00	$0.00	$96.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.41	$54.71	$44.01	$54.71
20551	EAP	CPT® 20551		PR INJECT TENDON ORIGIN/INSERT	OP	$159.00 	$0.00	$0.00	$98.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.07	$53.67	$41.64	$53.67
20552	EAP	CPT® 20552		"PR INJECT TRIGGER POINT, 1 OR 2"	OP	$168.00 	$0.00	$0.00	$87.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.63	$50.28	$41.64	$50.28
20553	EAP	CPT® 20553		"PR INJECT TRIGGER POINTS, > 3"	OP	$175.00 	$0.00	$0.00	$99.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.69	$56.45	$41.64	$56.45
20560	EAP	CPT® 20560		PR NEEDLE INSERTION W/O INJECTION 1 OR 2 MUSCLES	OP	$50.00 	$0.00	$0.00	$37.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.77	$0.00	$0.00	$0.00
20600	EAP	CPT® 20600		PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	OP	$150.00 	$0.00	$0.00	$81.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.96	$50.12	$34.28	$50.12
20604	EAP	CPT® 20604		PR ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT	OP	$143.00 	$0.00	$0.00	$106.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.02	$0.00	$43.42	$0.00
20605	EAP	CPT® 20605		PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	OP	$159.00 	$0.00	$0.00	$85.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.95	$54.57	$37.86	$54.57
20606	EAP	CPT® 20606		PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US	OP	$164.00 	$0.00	$0.00	$121.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.25	$0.00	$48.06	$0.00
20610	EAP	CPT® 20610		PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	OP	$178.00 	$0.00	$0.00	$105.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.96	$67.53	$44.28	$67.53
20611	EAP	CPT® 20611		PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US	OP	$187.00 	$0.00	$0.00	$142.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.07	$0.00	$55.44	$0.00
20612	EAP	CPT® 20612		PR ASPIRAT/INJECTION GANGLION CYST(S)	OP	$129.00 	$0.00	$0.00	$96.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.42	$54.15	$34.34	$54.15
20650	EAP	CPT® 20650		PR INSERT AND REMOVE BONE PIN	OP	$491.00 	$0.00	$0.00	$361.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.05	$177.83	$106.69	$177.83
20670	EAP	CPT® 20670		PR REMOVAL SUPERFICIAL IMPLANT	OP	$452.00 	$0.00	$0.00	$449.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$339.54	$449.34	$104.06	$449.34
20680	EAP	CPT® 20680		PR REMOVAL DEEP IMPLANT	OP	"$1,312.00 "	$0.00	$0.00	$978.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$978.63	$544.55	$166.73	$544.55
20690	EAP	CPT® 20690		"PR APPLY BONE UNIPLANE,EXT FIX DEV"	OP	"$1,862.00 "	$0.00	$0.00	"$1,372.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,372.38"	$239.61	$149.35	$239.61
20692	EAP	CPT® 20692		"PR APPLY BONE MULTIPLAN,EXT FIX DEV"	OP	"$3,491.00 "	$0.00	$0.00	"$2,584.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,584.64"	$395.29	$258.08	$395.29
20693	EAP	CPT® 20693		PR ADJUST EXTERN BONE FIX DEV W ANESTH	OP	"$1,380.00 "	$0.00	$0.00	"$1,029.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,029.65"	$435.09	$283.50	$435.09
20694	EAP	CPT® 20694		PR REMOVE EXTERN BONE FIX DEV W ANESTH	OP	"$1,051.00 "	$0.00	$0.00	$781.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$781.29	$417.28	$211.37	$417.28
20696	EAP	CPT® 20696		"PR COMP ASSIST MULTIPLANE EXT FIXATION, INITIAL"	OP	"$3,713.00 "	$0.00	$0.00	"$2,781.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,781.60"	$0.00	$597.04	$0.00
20700	EAP	CPT® 20700		PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV	OP	$264.00 	$0.00	$0.00	$195.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.60	$0.00	$52.12	$0.00
20702	EAP	CPT® 20702		PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE	OP	$439.00 	$0.00	$0.00	$325.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$325.41	$0.00	$86.73	$0.00
20703	EAP	CPT® 20703		PR REMOVAL INTRAMEDULLARY DRUG DELIVERY DEVICE	OP	$315.00 	$0.00	$0.00	$233.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$233.33	$0.00	$62.17	$0.00
20822	EAP	CPT® 20822		"PR REPLANTATION DIGIT DISTAL, COMPLT"	OP	"$5,541.00 "	$0.00	$0.00	"$4,142.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,142.82"	"$2,231.12"	"$1,259.66"	"$2,231.12"
20827	EAP	CPT® 20827		"PR REPLANTATION THUMB DISTAL,COMPLETE"	OP	"$5,693.00 "	$0.00	$0.00	"$4,225.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,225.61"	"$2,310.39"	"$1,325.42"	"$2,310.39"
20900	EAP	CPT® 20900		PR REMV BONE FOR GRAFT MINOR	OP	$711.00 	$0.00	$0.00	$552.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$439.73	$552.26	$227.12	$552.26
20902	EAP	CPT® 20902		PR REMV BONE FOR GRAFT MAJOR	OP	"$1,422.00 "	$0.00	$0.00	$662.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$662.51	$568.62	$329.36	$568.62
20910	EAP	CPT® 20910		PR REMV CARTILAGE FOR GRAFT COSTOCH	OP	"$1,460.00 "	$0.00	$0.00	$949.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$949.89	$400.98	$210.20	$400.98
20930	EAP	CPT® 20930		ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED	OP	$430.00 	$0.00	$0.00	$280.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.94	$0.00	$0.00	$0.00
20936	EAP	CPT® 20936		AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION	OP	$655.00 	$0.00	$0.00	$294.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$294.57	$0.00	$0.00	$0.00
20937	EAP	CPT® 20937		AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION	OP	"$1,142.00 "	$0.00	$0.00	$391.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$391.14	$166.73	$117.03	$166.73
20938	EAP	CPT® 20938		AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INCISION	OP	"$1,422.00 "	$0.00	$0.00	$431.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$431.39	$181.84	$128.15	$181.84
20969	EAP	CPT® 20969		"PR BONE-SKIN GRAFT, MICROVASCULAR"	OP	"$8,502.00 "	$0.00	$0.00	"$6,423.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,423.39"	"$2,684.23"	"$1,860.27"	"$2,684.23"
20982	EAP	CPT® 20982		PR ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE	OP	"$1,142.00 "	$0.00	$0.00	"$1,142.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.80	"$1,142.00"	"$1,142.00"	"$1,142.00"
21011	EAP	CPT® 21011		PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ < 2CM	OP	$798.00 	$0.00	$0.00	$599.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$599.22	$0.00	$143.61	$0.00
21012	EAP	CPT® 21012		PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2+CM	OP	"$1,051.00 "	$0.00	$0.00	$783.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$783.05	$0.00	$153.11	$0.00
21014	EAP	CPT® 21014		PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2+CM	OP	"$1,622.00 "	$0.00	$0.00	"$1,204.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,204.88"	$0.00	$236.42	$0.00
21025	EAP	CPT® 21025		"PR EXCISION OF BONE, LOWER JAW"	OP	"$2,418.00 "	$0.00	$0.00	"$1,757.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,757.42"	$888.16	$406.34	$888.16
21030	EAP	CPT® 21030		"PR EXCISION,BENIGN TUMOR,MAXILLA/ZYGOMA"	OP	"$1,624.00 "	$0.00	$0.00	$977.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$977.57	$428.39	$248.26	$428.39
21031	EAP	CPT® 21031		"PR EXCISION,TORUS MANDIBULARIS"	OP	$868.00 	$0.00	$0.00	$691.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$691.34	$328.02	$0.00	$328.02
21032	EAP	CPT® 21032		"PR EXCISION,MAXILLARY TORUS PALATINUS"	OP	$864.00 	$0.00	$0.00	$684.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$684.80	$334.01	$157.98	$334.01
21040	EAP	CPT® 21040		"PR EXCISION,BENIGN TUMOR,MANDIBLE"	OP	"$1,624.00 "	$0.00	$0.00	$979.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$979.19	$430.58	$114.40	$430.58
21044	EAP	CPT® 21044		PR REMV MALIG JAW BONE LESION	OP	"$2,867.00 "	$0.00	$0.00	"$2,039.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,039.93"	$812.79	$478.86	$812.79
21070	EAP	CPT® 21070		PR REMV CORONOID PROCESS	OP	"$3,420.00 "	$0.00	$0.00	"$1,420.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,420.13"	$595.15	$339.86	$595.15
21244	EAP	CPT® 21244		"PR RECONSTR MANDIBLE,BONE PLATE"	OP	"$4,836.00 "	$0.00	$0.00	"$2,485.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,485.52"	$950.01	$532.36	$950.01
21320	EAP	CPT® 21320		PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION	OP	$898.00 	$0.00	$0.00	$313.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$313.61	$216.63	$118.18	$216.63
21338	EAP	CPT® 21338		PR REPAIR NASOETHMOID FRACTURE	OP	"$2,418.00 "	$0.00	$0.00	"$1,673.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,673.60"	$741.37	$275.52	$741.37
21345	EAP	CPT® 21345		PR CLOSED RX NOSE/JAW FRAC+WIRES	OP	"$3,247.00 "	$0.00	$0.00	"$1,516.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,516.56"	$705.48	$0.00	$705.48
21347	EAP	CPT® 21347		PR OPEN RX NOSE/JAW FRACT/COMPLX	OP	"$4,940.00 "	$0.00	$0.00	"$2,633.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,633.73"	"$1,075.82"	$524.45	"$1,075.82"
21360	EAP	CPT® 21360		PR OPEN RX DEPRESS MALAR FRAC	OP	"$2,349.00 "	$0.00	$0.00	"$1,249.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,249.62"	$486.33	$295.95	$486.33
21365	EAP	CPT® 21365		PR OPEN RX COMPLX CHEEK BONE FRAC	OP	"$3,800.00 "	$0.00	$0.00	"$2,580.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,580.42"	"$1,024.61"	$620.07	"$1,024.61"
21386	EAP	CPT® 21386		"PR REPAIR EYE BLOWOUT,PERIORBITAL"	OP	"$2,902.00 "	$0.00	$0.00	"$1,605.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,605.78"	$616.47	$407.18	$616.47
21390	EAP	CPT® 21390		"PR REPAIR EYE BLOWOUT,PERIORB+IMPLNT"	OP	"$3,316.00 "	$0.00	$0.00	"$1,837.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,837.98"	$703.85	$461.79	$703.85
21407	EAP	CPT® 21407		PR OPEN RX FX ORBIT W IMPLANT	OP	"$3,040.00 "	$0.00	$0.00	"$1,494.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,494.26"	$590.89	$368.80	$590.89
21421	EAP	CPT® 21421		PR CLOSED RX LEFORTE I+WIRES	OP	"$2,073.00 "	$0.00	$0.00	"$1,483.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,483.76"	$597.47	$0.00	$597.47
21422	EAP	CPT® 21422		PR OPEN RX LEFORTE I	OP	"$2,764.00 "	$0.00	$0.00	"$1,564.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,564.97"	$623.82	$381.78	$623.82
21440	EAP	CPT® 21440		PR CLOSED RX DENTAL RIDGE FX	OP	"$1,562.00 "	$0.00	$0.00	"$1,095.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,095.20"	$418.35	$154.80	$418.35
21453	EAP	CPT® 21453		PR CLOSED RX MANDIBLE FX+DENTAL FIX	OP	"$2,651.00 "	$0.00	$0.00	"$1,828.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,828.88"	$682.24	$283.19	$682.24
21454	EAP	CPT® 21454		PR OPEN RX MANDIBLE FX+EXTERN FIX	OP	"$2,867.00 "	$0.00	$0.00	"$1,380.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,380.11"	$506.79	$292.66	$506.79
21461	EAP	CPT® 21461		PR OPEN RX MANDIBLE FX	OP	"$3,119.00 "	$0.00	$0.00	"$2,195.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,195.75"	"$1,403.48"	$386.03	"$1,403.48"
21462	EAP	CPT® 21462		PR OPEN RX MANDIBLE FX+DENTAL FIX	OP	"$5,611.00 "	$0.00	$0.00	"$2,445.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,445.36"	"$1,570.72"	$458.37	"$1,570.72"
21465	EAP	CPT® 21465		PR OPEN RX MANDIBLE CONDYLE FX	OP	"$4,145.00 "	$0.00	$0.00	"$2,230.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,230.34"	$853.49	$461.67	$853.49
21470	EAP	CPT® 21470		"PR OPEN RX MANDIBLE CONDYLE FX,COMPL"	OP	"$4,698.00 "	$0.00	$0.00	"$2,805.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,805.71"	"$1,102.02"	$667.07	"$1,102.02"
21480	EAP	CPT® 21480		PR REDUCE TEMPOROMANDIBL DISLOC	OP	$345.00 	$0.00	$0.00	$85.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.79	$85.97	$0.00	$85.97
21499	EAP	CPT® 21499		PR HEAD SURGERY PROC UNLISTED	OP	"$4,638.00 "	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
21501	EAP	CPT® 21501		PR I&D DEEP ABSC/HEMATOMA NECK/CHEST	OP	"$1,013.00 "	$0.00	$0.00	$744.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$744.98	$386.43	$157.40	$386.43
21552	EAP	CPT® 21552		PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ 3+CM	OP	"$1,394.00 "	$0.00	$0.00	"$1,033.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,033.70"	$0.00	$203.80	$0.00
21554	EAP	CPT® 21554		PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBFASCIAL  5+CM	OP	"$2,285.00 "	$0.00	$0.00	"$1,695.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,695.27"	$0.00	$334.68	$0.00
21555	EAP	CPT® 21555		"PR EXCISE LESN NECK/CHEST,SUBCUTAN"	OP	$950.00 	$0.00	$0.00	$708.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.41	$378.81	$168.71	$378.81
21600	EAP	CPT® 21600		PR PARTIAL REMOVAL OF RIB	OP	"$1,724.00 "	$0.00	$0.00	"$1,292.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,292.07"	$496.58	$315.85	$496.58
21601	EAP	CPT® 21601		PR EXCISION CHEST WALL TUMOR INCLUDING RIBS	OP	"$3,695.00 "	$0.00	$0.00	"$2,738.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,738.60"	$0.00	$729.80	$0.00
21620	EAP	CPT® 21620		PR PARTIAL REMOVAL OF STERNUM	OP	"$3,110.00 "	$0.00	$0.00	"$1,167.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,167.95"	$495.23	$345.75	$495.23
21685	EAP	CPT® 21685		PR HYOID MYOTOMY & SUSPENSION	OP	"$3,047.00 "	$0.00	$0.00	"$2,326.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,326.64"	$912.65	$557.25	$912.65
21750	EAP	CPT® 21750		"PR CLOSE MED STERNOTOMY SEP, W/WO DEBRIDE"	OP	"$2,304.00 "	$0.00	$0.00	"$1,587.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,587.00"	$674.13	$505.39	$674.13
21811	EAP	CPT® 21811		PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS	OP	"$1,865.00 "	$0.00	$0.00	"$1,417.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,417.88"	$0.00	$368.18	$0.00
21812	EAP	CPT® 21812		PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS	OP	"$2,275.00 "	$0.00	$0.00	"$1,700.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,700.13"	$0.00	$441.41	$0.00
21825	EAP	CPT® 21825		PR OPEN RX STERNUM FRACTURE	OP	"$1,920.00 "	$0.00	$0.00	"$1,253.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,253.52"	$533.60	$406.76	$533.60
21931	EAP	CPT® 21931		PR EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ 3+CM	OP	"$1,473.00 "	$0.00	$0.00	"$1,087.19"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,087.19"	$0.00	$213.19	$0.00
21936	EAP	CPT® 21936		PR RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>	OP	"$4,434.00 "	$0.00	$0.00	"$3,267.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,267.03"	$0.00	$653.27	$0.00
22015	EAP	CPT® 22015		"PR I&D, POST SPINE, LUMB/SACR/LUMBOSAC"	OP	"$2,950.00 "	$0.00	$0.00	"$2,138.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,138.31"	$812.99	$478.84	$812.99
22318	EAP	CPT® 22318		"PR ODONTOID FX,W/O GRAFT,OPEN"	OP	"$8,352.00 "	$0.00	$0.00	"$3,830.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,830.40"	"$1,460.66"	$874.74	"$1,460.66"
22325	EAP	CPT® 22325		"PR OPEN POST RX LUMB VERT FX,1 LVL"	OP	"$4,540.00 "	$0.00	$0.00	"$3,343.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,343.68"	"$1,264.54"	$701.90	"$1,264.54"
22326	EAP	CPT® 22326		"PR OPEN POST RX CERV VERT FX,1 LVL"	OP	"$4,800.00 "	$0.00	$0.00	"$3,472.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,472.14"	"$1,336.42"	$854.08	"$1,336.42"
22327	EAP	CPT® 22327		"PR OPEN POST RX THOR VERT FX,1 LVL"	OP	"$4,728.00 "	$0.00	$0.00	"$3,496.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,496.07"	"$1,310.42"	$829.94	"$1,310.42"
22328	EAP	CPT® 22328		PR OPEN POST REPAIR EA ADDN VERT FX	OP	"$1,382.00 "	$0.00	$0.00	$660.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$660.42	$272.52	$195.39	$272.52
22513	EAP	CPT® 22513		PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION	OP	"$1,604.00 "	$0.00	$0.00	"$1,251.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,251.65"	$0.00	"$1,604.00"	$0.00
22515	EAP	CPT® 22515		PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH	OP	$691.00 	$0.00	$0.00	$527.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$527.73	$0.00	$691.00	$0.00
22533	EAP	CPT® 22533		PR LAT LUMBAR SPINE FUSION	OP	"$7,234.00 "	$0.00	$0.00	"$3,843.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,843.41"	"$1,475.09"	$910.49	"$1,475.09"
22534	EAP	CPT® 22534		"PR LAT THOR/LUMB, ADDL SEG"	OP	"$3,596.00 "	$0.00	$0.00	$841.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$841.94	$357.83	$229.36	$357.83
22551	EAP	CPT® 22551		"PR ARTHRODESIS ANT INTERBODY INC DISCECTOMY, CERVICAL BELOW C2"	OP	"$5,339.00 "	$0.00	$0.00	"$3,997.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,997.10"	$0.00	"$1,018.02"	$0.00
22552	EAP	CPT® 22552		"ARTHRODESIS ANT INTERBODY INC DISCECTOMY, CERVICAL BELOL"	OP	"$1,249.00 "	$0.00	$0.00	$935.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$935.73	$0.00	$237.25	$0.00
22554	EAP	CPT® 22554		"PR CERV SPINE FUSN,ANTER,BELOW C2"	OP	"$6,283.00 "	$0.00	$0.00	"$2,925.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,925.44"	"$1,204.04"	$863.71	"$1,204.04"
22556	EAP	CPT® 22556		"PR THORAX SPINE FUSION,ANTER APPRCH"	OP	"$7,647.00 "	$0.00	$0.00	"$3,880.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,880.88"	"$1,536.50"	"$1,027.33"	"$1,536.50"
22558	EAP	CPT® 22558		"PR LUMBAR SPINE FUSION,ANTER APPRCH"	OP	"$7,027.00 "	$0.00	$0.00	"$3,584.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,584.04"	"$1,403.34"	$953.72	"$1,403.34"
22585	EAP	CPT® 22585		"PR SPINAL FUSION,ANT,EA ADNL LEVEL"	OP	"$1,767.00 "	$0.00	$0.00	$770.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$770.52	$331.94	$236.48	$331.94
22590	EAP	CPT® 22590		"PR CRANIOCERV FUSN,POST TECHNIQUE"	OP	"$6,820.00 "	$0.00	$0.00	"$3,687.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,687.84"	"$1,406.57"	$947.59	"$1,406.57"
22595	EAP	CPT® 22595		"PR CERV C1-2 FUSN,POSTER TECH"	OP	"$6,614.00 "	$0.00	$0.00	"$3,518.19"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,518.19"	"$1,336.69"	$906.37	"$1,336.69"
22600	EAP	CPT® 22600		PR ARTHRD PST/PSTLAT TQ 1NTRSPC CRV BELW C2 SEGMENT	OP	"$5,580.00 "	$0.00	$0.00	"$3,003.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,003.41"	"$1,142.40"	$758.86	"$1,142.40"
22610	EAP	CPT® 22610		PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC THORACIC	OP	"$5,477.00 "	$0.00	$0.00	"$2,941.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,941.74"	"$1,134.03"	$747.83	"$1,134.03"
22612	EAP	CPT® 22612		PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR	OP	"$7,027.00 "	$0.00	$0.00	"$3,700.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,700.10"	"$1,481.34"	$931.40	"$1,481.34"
22614	EAP	CPT® 22614		PR ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC	OP	"$1,984.00 "	$0.00	$0.00	$916.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$916.41	$387.99	$264.69	$387.99
22630	EAP	CPT® 22630		"PR LUMBAR SPINE FUSN,POST INTRBDY"	OP	"$7,027.00 "	$0.00	$0.00	"$3,654.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,654.42"	"$1,419.95"	$916.59	"$1,419.95"
22633	EAP	CPT® 22633		PR ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR	OP	"$5,803.00 "	$0.00	$0.00	"$4,319.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,319.13"	$0.00	"$1,104.51"	$0.00
22634	EAP	CPT® 22634		PR ARTHRODESIS CMBN TQ 1NTRSPC EACH ADDITIONAL	OP	"$1,558.00 "	$0.00	$0.00	"$1,163.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,163.24"	$0.00	$297.42	$0.00
22840	EAP	CPT® 22840		POSTERIOR NON-SEGMENTAL INSTRUMENTATION	OP	"$3,823.00 "	$0.00	$0.00	"$1,781.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,781.03"	$757.64	$470.20	$757.64
22842	EAP	CPT® 22842		POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG	OP	"$4,340.00 "	$0.00	$0.00	"$1,786.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,786.68"	$758.36	$466.54	$758.36
22843	EAP	CPT® 22843		POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG	OP	"$4,754.00 "	$0.00	$0.00	"$1,909.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,909.16"	$799.42	$512.88	$799.42
22845	EAP	CPT® 22845		ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS	OP	"$4,134.00 "	$0.00	$0.00	"$1,713.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,713.62"	$724.84	$458.28	$724.84
22846	EAP	CPT® 22846		ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS	OP	"$4,340.00 "	$0.00	$0.00	"$1,779.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,779.93"	$753.03	$499.18	$753.03
22848	EAP	CPT® 22848		PELVIC FIXATION OTHER THAN SACRUM	OP	"$1,984.00 "	$0.00	$0.00	$840.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$840.66	$359.13	$264.82	$359.13
22853	EAP	CPT® 22853		PR INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD	OP	$813.00 	$0.00	$0.00	$610.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$610.05	$0.00	$162.97	$0.00
22854	EAP	CPT® 22854		PR INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD	OP	"$1,053.00 "	$0.00	$0.00	$789.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$789.72	$0.00	$210.96	$0.00
22864	EAP	CPT® 22864		"PR REMOVE TOTAL DISC ARTHROPLASTY, CERVICAL, SINGLE"	OP	"$6,459.00 "	$0.00	$0.00	"$4,810.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,810.98"	$0.00	"$1,021.27"	$0.00
23030	EAP	CPT® 23030		"PR INCIS/DRAIN SHLDR ABSC/HEMA,DEEP"	OP	$776.00 	$0.00	$0.00	$590.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$590.94	$400.87	$165.11	$400.87
23040	EAP	CPT® 23040		PR DEEP INCIS SHLDR BONE CORTEX	OP	"$2,239.00 "	$0.00	$0.00	"$1,659.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,659.78"	$672.30	$450.76	$672.30
23071	EAP	CPT® 23071		PR EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3+CM	OP	"$1,314.00 "	$0.00	$0.00	$970.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$970.53	$0.00	$189.50	$0.00
23073	EAP	CPT® 23073		PR EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5+CM	OP	"$2,176.00 "	$0.00	$0.00	"$1,603.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,603.28"	$0.00	$314.01	$0.00
23107	EAP	CPT® 23107		PR EXPLORE SHOULDER JOINT	OP	"$2,304.00 "	$0.00	$0.00	"$1,519.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,519.65"	$619.89	$427.24	$619.89
23180	EAP	CPT® 23180		PR PART EXCIS CLAVICLE	OP	"$2,075.00 "	$0.00	$0.00	"$1,537.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,537.37"	$674.11	$406.43	$674.11
23335	EAP	CPT® 23335		PR PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT	OP	"$3,974.00 "	$0.00	$0.00	"$2,959.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,959.92"	$0.00	$776.60	$0.00
23350	EAP	CPT® 23350		PR INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI	OP	$209.00 	$0.00	$0.00	$155.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.17	$155.91	$126.50	$155.91
23395	EAP	CPT® 23395		"PR MUSCLE TRANSFER,SHOULDER/ARM,SINGLE"	OP	"$4,010.00 "	$0.00	$0.00	"$2,969.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,969.97"	"$1,202.37"	$683.14	"$1,202.37"
23430	EAP	CPT® 23430		PR REPAIR BICEPS LONG TENDON	OP	"$2,373.00 "	$0.00	$0.00	"$1,721.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,721.04"	$698.34	$442.98	$698.34
23472	EAP	CPT® 23472		PR RECONSTR TOTAL SHOULDER IMPLANT	OP	"$4,607.00 "	$0.00	$0.00	"$3,370.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,370.08"	"$1,426.17"	$787.19	"$1,426.17"
23473	EAP	CPT® 23473		PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT	OP	"$5,064.00 "	$0.00	$0.00	"$3,763.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,763.56"	$0.00	$974.63	$0.00
23485	EAP	CPT® 23485		PR OSTEOTOMY CLAVICLE W BONE GRAFT	OP	"$2,989.00 "	$0.00	$0.00	"$2,203.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,203.94"	$913.93	$591.67	$913.93
23500	EAP	CPT® 23500		PR CLOSED RX CLAVICLE FRACTURE	OP	$697.00 	$0.00	$0.00	$509.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$509.66	$188.55	$105.36	$188.55
23525	EAP	CPT® 23525		"PR CLOSED RX STERN-CLAV DISLOC,MANIP"	OP	"$1,116.00 "	$0.00	$0.00	$797.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$797.93	$311.38	$160.23	$311.38
23550	EAP	CPT® 23550		PR OPEN RX A-C JT DISLOC	OP	"$2,853.00 "	$0.00	$0.00	"$1,299.87"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,299.87"	$531.96	$351.63	$531.96
23552	EAP	CPT® 23552		"PR OPEN RX A-C JT DISLOC,FASCIAL GRFT"	OP	"$3,718.00 "	$0.00	$0.00	"$1,509.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,509.95"	$614.78	$377.39	$614.78
23570	EAP	CPT® 23570		PR CLOSED RX SCAPULA FX	OP	$745.00 	$0.00	$0.00	$548.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$548.16	$201.06	$109.72	$201.06
23585	EAP	CPT® 23585		PR OPEN RX SCAPULA FRACTURE	OP	"$3,059.00 "	$0.00	$0.00	"$2,265.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,265.15"	$644.91	$405.43	$644.91
23600	EAP	CPT® 23600		PR CLOSED RX PROX HUMERUS FRACTURE	OP	$964.00 	$0.00	$0.00	$705.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$705.23	$284.46	$159.64	$284.46
23615	EAP	CPT® 23615		OPEN TREATMENT PROX HUMERAL FRACTURE	OP	"$3,026.00 "	$0.00	$0.00	"$2,041.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,041.79"	$760.12	$451.32	$760.12
23620	EAP	CPT® 23620		PR CLOSED RX GR TUBEROSITY HUM FX	OP	$800.00 	$0.00	$0.00	$587.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$587.60	$230.63	$143.68	$230.63
23650	EAP	CPT® 23650		PR CLOSED RX SHLDR DISLOCATION	OP	$904.00 	$0.00	$0.00	$658.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$658.97	$265.86	$157.08	$265.86
23675	EAP	CPT® 23675		"PR CLOSED RX SHLDR DISLOC,PROX HUM FX"	OP	"$1,564.00 "	$0.00	$0.00	"$1,152.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,152.44"	$494.30	$275.62	$494.30
23700	EAP	CPT® 23700		PR MANIPULATN SHLDR JT W ANESTHESIA	OP	$811.00 	$0.00	$0.00	$453.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$453.00	$181.58	$118.69	$181.58
24000	EAP	CPT® 24000		PR EXPLORE/DRAIN ELBOW FOR INFECT	OP	"$2,104.00 "	$0.00	$0.00	"$1,097.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,097.66"	$437.03	$275.59	$437.03
24006	EAP	CPT® 24006		PR ARTHROTOMY/CAPULE RELEASE ELBOW JT	OP	"$2,220.00 "	$0.00	$0.00	"$1,628.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,628.00"	$664.79	$397.07	$664.79
24071	EAP	CPT® 24071		PR EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3+CM	OP	"$1,268.00 "	$0.00	$0.00	$938.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$938.63	$0.00	$184.01	$0.00
24075	EAP	CPT® 24075		"PR EXCIS TUMOR,SOFT TISS UP ARM/ELBOW,SUBQ"	OP	"$1,024.00 "	$0.00	$0.00	$762.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$762.08	$426.22	$192.77	$426.22
24076	EAP	CPT® 24076		"PR EXCIS TUMOR,SOFT TISS UP ARM/ELBOW,DEEP"	OP	"$1,697.00 "	$0.00	$0.00	"$1,253.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,253.81"	$432.71	$264.65	$432.71
24100	EAP	CPT® 24100		PR BIOPSY SYNOVIUM ELBOW JOINT	OP	"$1,721.00 "	$0.00	$0.00	$962.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$962.64	$367.83	$234.41	$367.83
24102	EAP	CPT® 24102		PR EXPLOR ELBOW JT/REMOV SYNOVIUM	OP	"$2,754.00 "	$0.00	$0.00	"$1,420.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,420.16"	$574.78	$378.56	$574.78
24149	EAP	CPT® 24149		"PR RADICAL RESECT ELBOW, CONTRAC RELEAS"	OP	"$3,664.00 "	$0.00	$0.00	"$2,711.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,711.37"	"$1,061.66"	$612.80	"$1,061.66"
24201	EAP	CPT® 24201		"PR REMOVAL ARM/ELBOW F.B.,DEEP"	OP	"$1,130.00 "	$0.00	$0.00	$832.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$832.74	$528.59	$225.84	$528.59
24300	EAP	CPT® 24300		PR MANIPULATE ELBOW W/ANESTH	OP	"$1,324.00 "	$0.00	$0.00	$961.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$961.22	$362.46	$219.86	$362.46
24341	EAP	CPT® 24341		PR MUSC/TENDON REPAIR EACH; ARM/ELBOW	OP	"$2,601.00 "	$0.00	$0.00	"$1,721.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,721.10"	$659.37	$351.51	$659.37
24342	EAP	CPT® 24342		"PR REINSERT BI/TRICEPS TENDON,DISTAL"	OP	"$2,716.00 "	$0.00	$0.00	"$1,789.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,789.04"	$741.36	$475.64	$741.36
24343	EAP	CPT® 24343		PR REPR ELBOW LAT LIGMNT W/TISS	OP	"$2,601.00 "	$0.00	$0.00	"$1,627.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,627.07"	$654.61	$394.81	$654.61
24345	EAP	CPT® 24345		PR REPR ELBW MED LIGMNT W/TISS	OP	"$2,601.00 "	$0.00	$0.00	"$1,621.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,621.29"	$650.90	$394.81	$650.90
24359	EAP	CPT® 24359		PR TENOTOMY ELBOW LATERAL/MEDIAL DEBRIDE REPAIR	OP	"$2,064.00 "	$0.00	$0.00	"$1,518.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,518.95"	$0.00	$315.81	$0.00
24430	EAP	CPT® 24430		PR REPAIR NON/MALUNION HUMERUS	OP	"$3,298.00 "	$0.00	$0.00	"$2,439.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,439.42"	$960.74	$606.05	$960.74
24500	EAP	CPT® 24500		PR CLOSED RX MID HUMERUS FRACTURE	OP	"$1,023.00 "	$0.00	$0.00	$747.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$747.62	$307.14	$183.43	$307.14
24515	EAP	CPT® 24515		PR OPEN FIXATN MID HUMERUS FRACTURE	OP	"$2,998.00 "	$0.00	$0.00	"$2,021.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,021.82"	$823.37	$509.91	$823.37
24516	EAP	CPT® 24516		PR OPEN ROD FIXATN HUMERAL SHAFT FX	OP	"$3,634.00 "	$0.00	$0.00	"$1,985.91"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,985.91"	$815.98	$515.45	$815.98
24530	EAP	CPT® 24530		PR CLOSED RX HUMERAL SUPRACONDYLAR FX	OP	"$1,077.00 "	$0.00	$0.00	$790.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$790.07	$331.33	$203.17	$331.33
24535	EAP	CPT® 24535		"PR CLOSED RX HUM SUPRACONDYLR FX,MANIPU"	OP	"$1,767.00 "	$0.00	$0.00	"$1,302.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,302.54"	$563.45	$336.84	$563.45
24545	EAP	CPT® 24545		OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN	OP	"$3,179.00 "	$0.00	$0.00	"$2,145.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,145.09"	$744.88	$473.76	$744.88
24546	EAP	CPT® 24546		OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W XTN	OP	"$3,861.00 "	$0.00	$0.00	"$2,399.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,399.33"	"$1,055.24"	$636.51	"$1,055.24"
24575	EAP	CPT® 24575		OPEN TX HUMERAL EPICONDYLAR FRACTURE	OP	"$2,362.00 "	$0.00	$0.00	"$1,683.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,683.62"	$749.79	$436.14	$749.79
24579	EAP	CPT® 24579		OPEN TX HUMERAL CONDYLAR FRACTURE	OP	"$2,771.00 "	$0.00	$0.00	"$1,928.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,928.07"	$805.77	$482.07	$805.77
24586	EAP	CPT® 24586		PR OPEN RX PERIARTIC FX/DISLOC ELBOW	OP	"$3,634.00 "	$0.00	$0.00	"$2,501.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,501.15"	"$1,036.46"	$657.76	"$1,036.46"
24600	EAP	CPT® 24600		PR CLOSED RX ELBOW DISLOCATION	OP	"$1,050.00 "	$0.00	$0.00	$763.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$763.13	$337.43	$217.41	$337.43
24605	EAP	CPT® 24605		"PR CLOSED RX ELBOW DISLOCATN,ANESTHESIA"	OP	"$1,475.00 "	$0.00	$0.00	"$1,081.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,081.08"	$417.05	$206.78	$417.05
24635	EAP	CPT® 24635		OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW	OP	"$3,338.00 "	$0.00	$0.00	"$1,551.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,551.20"	"$1,035.85"	$666.96	"$1,035.85"
24640	EAP	CPT® 24640		"PR CLOSED RX RADIAL HEAD DISLOC,CHILD"	OP	$302.00 	$0.00	$0.00	$211.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.43	$111.55	$98.90	$111.55
24650	EAP	CPT® 24650		PR CLOSED RX RADIAL HEAD/NECK FX	OP	$752.00 	$0.00	$0.00	$549.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.99	$225.50	$149.04	$225.50
24665	EAP	CPT® 24665		OPEN TX RADIAL HEAD/NECK FRACTURE	OP	"$2,294.00 "	$0.00	$0.00	"$1,501.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,501.73"	$603.81	$375.56	$603.81
24666	EAP	CPT® 24666		OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC	OP	"$2,930.00 "	$0.00	$0.00	"$1,689.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,689.89"	$684.59	$453.66	$684.59
24675	EAP	CPT® 24675		CLOSED TX ULNAR FRACTURE PROX END W MANIPULATION	OP	"$1,296.00 "	$0.00	$0.00	$949.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$949.65	$409.98	$254.23	$409.98
24685	EAP	CPT® 24685		OPEN TX ULNAR FRACTURE PROX END	OP	"$2,453.00 "	$0.00	$0.00	"$1,507.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,507.25"	$632.28	$410.70	$632.28
24802	EAP	CPT® 24802		PR FUSION/GRAFT OF ELBOW JOINT	OP	"$4,542.00 "	$0.00	$0.00	"$2,259.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,259.89"	$944.83	$591.29	$944.83
25000	EAP	CPT® 25000		"PR INCIS TENDON SHEATH,RADIAL STYLOID"	OP	"$1,053.00 "	$0.00	$0.00	$774.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$980.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$774.03	$375.00	$191.35	$375.00
25024	EAP	CPT® 25024		"PR DECOMP FOREARM,2 COMPART,W/O DEBRIDE"	OP	"$2,441.00 "	$0.00	$0.00	"$1,781.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,781.37"	$693.70	$460.69	$693.70
25071	EAP	CPT® 25071		PR EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3+CM	OP	"$1,325.00 "	$0.00	$0.00	$983.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$983.07	$0.00	$192.83	$0.00
25075	EAP	CPT® 25075		"PR EXCIS TUMOR,SOFT TISS FOREARM/WRIST,SUBQ"	OP	"$1,087.00 "	$0.00	$0.00	$730.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$730.26	$358.77	$185.50	$358.77
25111	EAP	CPT® 25111		PR EXCIS PRIMARY GANGLION WRIST	OP	$999.00 	$0.00	$0.00	$735.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$735.95	$305.92	$178.80	$305.92
25150	EAP	CPT® 25150		"PR PART REMOVAL BONE,ULNA"	OP	"$1,824.00 "	$0.00	$0.00	"$1,302.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,302.99"	$579.58	$361.38	$579.58
25240	EAP	CPT® 25240		"PR EXCIS DISTAL ULNA,PART/COMPLETE"	OP	"$1,403.00 "	$0.00	$0.00	$982.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$982.62	$451.09	$284.83	$451.09
25260	EAP	CPT® 25260		"PR REPR FOREARM TEND/MUSC,FLEX,PRIM,EA"	OP	"$1,966.00 "	$0.00	$0.00	"$1,449.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,449.08"	$769.61	$391.51	$769.61
25270	EAP	CPT® 25270		"PR REPR FOREARM TEND/MUSC,EXTEN,PRIM,EA"	OP	"$1,534.00 "	$0.00	$0.00	"$1,124.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,124.69"	$648.94	$322.74	$648.94
25290	EAP	CPT® 25290		PR INCISE WRIST/FOREARM TENDON	OP	"$1,356.00 "	$0.00	$0.00	"$1,003.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,003.23"	$711.68	$312.09	$711.68
25310	EAP	CPT® 25310		PR TRANSPLANT FOREARM/WRIST TENDON	OP	"$2,279.00 "	$0.00	$0.00	"$1,425.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,425.68"	$772.01	$434.78	$772.01
25312	EAP	CPT® 25312		"PR XPLANT FOREARM TENDON,W TENDON GRFT"	OP	"$2,455.00 "	$0.00	$0.00	"$1,646.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,646.13"	$861.75	$486.15	$861.75
25320	EAP	CPT® 25320		"PR REVISE WRIST JOINT,CARPAL INSTABIL"	OP	"$3,064.00 "	$0.00	$0.00	"$2,271.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,271.93"	$901.23	$477.55	$901.23
25405	EAP	CPT® 25405		PR REPAIR NONUNION RADIUS OR ULNAW/GRAFT	OP	"$3,239.00 "	$0.00	$0.00	"$2,390.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,390.93"	"$1,187.61"	$696.10	"$1,187.61"
25447	EAP	CPT® 25447		PR REPAIR INTERCARP/CARP-METACARP JT	OP	"$2,630.00 "	$0.00	$0.00	"$1,905.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,905.00"	$752.18	$476.97	$752.18
25500	EAP	CPT® 25500		PR CLOSED RX RADIAL SHAFT FX	OP	$784.00 	$0.00	$0.00	$574.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$574.77	$229.25	$152.65	$229.25
25505	EAP	CPT® 25505		"PR CLOSED RX RADIAL SHAFT FX,MANIPULATN"	OP	"$1,428.00 "	$0.00	$0.00	"$1,056.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,056.71"	$450.84	$268.65	$450.84
25515	EAP	CPT® 25515		OPEN TREATMENT RADIAL SHAFT FRACTURE	OP	"$2,087.00 "	$0.00	$0.00	"$1,541.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,541.49"	$651.49	$411.00	$651.49
25525	EAP	CPT® 25525		OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE	OP	"$2,639.00 "	$0.00	$0.00	"$1,807.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,807.98"	$874.63	$549.71	$874.63
25530	EAP	CPT® 25530		PR CLOSED RX ULNA SHAFT FX	OP	$744.00 	$0.00	$0.00	$544.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$544.35	$222.40	$146.18	$222.40
25535	EAP	CPT® 25535		"PR CLOSED RX ULNA SHAFT FX,MANIPULATN"	OP	"$1,410.00 "	$0.00	$0.00	"$1,038.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,038.78"	$431.24	$264.92	$431.24
25545	EAP	CPT® 25545		OPEN TREATMENT OF ULNAR SHAFT FRACTURE	OP	"$1,989.00 "	$0.00	$0.00	"$1,434.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,434.29"	$644.08	$402.54	$644.08
25560	EAP	CPT® 25560		PR CLOSED RX RAD/ULNA SHAFT FX	OP	$790.00 	$0.00	$0.00	$574.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$574.83	$232.51	$152.44	$232.51
25565	EAP	CPT® 25565		"PR CLOSED RX RAD/ULNA SHAFT FX,MANIP"	OP	"$1,462.00 "	$0.00	$0.00	"$1,078.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,078.01"	$471.98	$296.36	$471.98
25575	EAP	CPT® 25575		OPEN TX RADIAL & ULNAR SHAFT FX FIX RADIUS AND ULNA	OP	"$2,812.00 "	$0.00	$0.00	"$2,077.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,077.41"	$830.18	$488.12	$830.18
25600	EAP	CPT® 25600		PR CLOSED RX DIST RAD/ULNA FX	OP	$979.00 	$0.00	$0.00	$710.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$710.48	$255.35	$167.28	$255.35
25605	EAP	CPT® 25605		"PR CLOSED RX DIST RAD/ULNA FX,MANIPUL"	OP	"$1,665.00 "	$0.00	$0.00	"$1,177.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,177.85"	$543.76	$293.51	$543.76
25606	EAP	CPT® 25606		"PR PERCUT SKELETAL FIX, DISTAL RADIUS FX"	OP	"$2,066.00 "	$0.00	$0.00	"$1,526.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,526.51"	$636.93	$378.04	$636.93
25607	EAP	CPT® 25607		"PR OPEN RX DISTAL RADIUS FX, EXTRA-ARTICULAR"	OP	"$2,292.00 "	$0.00	$0.00	"$1,692.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,692.74"	$642.48	$377.52	$642.48
25608	EAP	CPT® 25608		"PR OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 2 FRAG"	OP	"$2,571.00 "	$0.00	$0.00	"$1,898.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,898.00"	$734.14	$430.91	$734.14
25609	EAP	CPT® 25609		"PR OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 3+ FRAG"	OP	"$3,272.00 "	$0.00	$0.00	"$2,413.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,413.40"	$936.62	$548.96	$936.62
25622	EAP	CPT® 25622		PR CLOSED RX NAVICULAR FX	OP	$872.00 	$0.00	$0.00	$634.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$634.47	$261.60	$159.66	$261.60
25628	EAP	CPT® 25628		OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE	OP	"$2,242.00 "	$0.00	$0.00	"$1,659.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,659.75"	$664.44	$383.36	$664.44
25630	EAP	CPT® 25630		PR CLOSED RX CARPAL FX	OP	$879.00 	$0.00	$0.00	$642.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$642.21	$268.33	$166.64	$268.33
25635	EAP	CPT® 25635		"PR CLOSED RX CARPAL FX,MAIPULATN"	OP	"$1,301.00 "	$0.00	$0.00	$872.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$872.90	$395.18	$242.38	$395.18
25650	EAP	CPT® 25650		PR CLOSED RX ULNA STYLOID FX	OP	$941.00 	$0.00	$0.00	$687.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$687.38	$279.49	$176.60	$279.49
25670	EAP	CPT® 25670		PR OPEN REPAIR WRIST DISLOCATION	OP	"$1,896.00 "	$0.00	$0.00	"$1,395.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,395.42"	$572.40	$366.53	$572.40
25671	EAP	CPT® 25671		"PR PERCUT SKELETAL FIX,DIST RADIOULN DISLOC"	OP	"$1,654.00 "	$0.00	$0.00	"$1,219.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,219.92"	$476.60	$418.56	$476.60
25695	EAP	CPT® 25695		PR OPEN REPAIR LUNATE DISLOCATION	OP	"$1,979.00 "	$0.00	$0.00	"$1,459.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,459.79"	$593.11	$379.64	$593.11
25810	EAP	CPT® 25810		PR FUSION/GRAFT WRIST JOINT	OP	"$3,492.00 "	$0.00	$0.00	"$1,997.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,997.94"	$823.26	$505.32	$823.26
25920	EAP	CPT® 25920		PR AMPUTATE THRU WRIST	OP	"$2,436.00 "	$0.00	$0.00	"$1,598.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,598.99"	$638.37	$386.08	$638.37
26010	EAP	CPT® 26010		"PR DRAIN FINGER ABSCESS,SIMPLE"	OP	$429.00 	$0.00	$0.00	$315.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.59	$250.54	$90.83	$250.54
26020	EAP	CPT® 26020		PR DRAIN HAND TENDON SHEATH	OP	"$1,726.00 "	$0.00	$0.00	$997.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$997.10	$391.18	$266.59	$391.18
26025	EAP	CPT® 26025		"PR DRAINAGE PALM BURSA,SINGLE"	OP	"$1,310.00 "	$0.00	$0.00	$971.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$971.19	$383.74	$280.61	$383.74
26035	EAP	CPT® 26035		"PR DECOMPRESS FINGERS/HAND,INJECT INJ"	OP	"$2,766.00 "	$0.00	$0.00	"$1,966.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,966.94"	$734.48	$442.24	$734.48
26037	EAP	CPT® 26037		PR DECOMPRESS FASCIOTOMY FINGR/HAND	OP	"$1,765.00 "	$0.00	$0.00	"$1,304.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,304.75"	$527.15	$366.39	$527.15
26055	EAP	CPT® 26055		PR INCISE FINGER TENDON SHEATH	OP	"$1,027.00 "	$0.00	$0.00	$712.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,711.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$712.32	$597.39	$172.83	$597.39
26075	EAP	CPT® 26075		PR EXPLORE & TREAT METACARPO-PHAL JT	OP	"$1,185.00 "	$0.00	$0.00	$764.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$764.03	$288.36	$241.79	$288.36
26080	EAP	CPT® 26080		"PR EXPLORE/TREAT INTERPHALANGEAL JT,EA"	OP	"$1,223.00 "	$0.00	$0.00	$896.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$896.79	$349.56	$251.48	$349.56
26115	EAP	CPT® 26115		PR EXCIS SOFT TISSUE LESION HAND SUBCUT	OP	"$1,028.00 "	$0.00	$0.00	$765.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$765.47	$607.90	$186.06	$607.90
26116	EAP	CPT® 26116		PR EXCIS SOFT TISSUE LESION HAND DEEP	OP	"$1,636.00 "	$0.00	$0.00	"$1,212.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,212.77"	$440.72	$296.88	$440.72
26145	EAP	CPT® 26145		"PR RAD EXCIS JT LINING,FLEXOR,EACH"	OP	"$1,601.00 "	$0.00	$0.00	"$1,175.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,175.78"	$472.56	$350.97	$472.56
26160	EAP	CPT® 26160		"PR EXCIS TENDON SHEATH LESION, HAND/FINGER"	OP	$977.00 	$0.00	$0.00	$766.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$766.79	$561.00	$172.03	$561.00
26235	EAP	CPT® 26235		"PR PART REMV BONE,PROX/MID PHALANX"	OP	"$1,535.00 "	$0.00	$0.00	"$1,134.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,134.14"	$457.99	$310.01	$457.99
26350	EAP	CPT® 26350		"PR REPAIR FLEXOR TENDON,HAND,W/O GRAFT,EA"	OP	"$2,250.00 "	$0.00	$0.00	"$1,612.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,612.62"	$734.02	$383.54	$734.02
26356	EAP	CPT® 26356		"PR REPAIR FLEX TENDON,ZONE 2,HAND"	OP	"$2,530.00 "	$0.00	$0.00	"$2,012.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,012.28"	"$1,033.52"	$464.19	"$1,033.52"
26370	EAP	CPT® 26370		"PR REPAIR PROFUNDUS TENDON,PRIMARY"	OP	"$2,376.00 "	$0.00	$0.00	"$1,715.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,715.79"	$793.20	$428.18	$793.20
26410	EAP	CPT® 26410		"PR REPAIR EXTEN TENDON,DORSUM HAND,EA"	OP	"$1,790.00 "	$0.00	$0.00	"$1,281.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,281.69"	$587.31	$287.27	$587.31
26418	EAP	CPT® 26418		"PR REPAIR EXTEN TENDON,DORSUM FINGR,EA"	OP	"$1,841.00 "	$0.00	$0.00	"$1,308.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,308.08"	$587.73	$282.40	$587.73
26442	EAP	CPT® 26442		"PR TENOLYSIS FLEX TENDON,PALM & FINGER,EA"	OP	"$3,002.00 "	$0.00	$0.00	"$2,186.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,186.94"	$921.30	$412.55	$921.30
26445	EAP	CPT® 26445		"PR TENOLYSIS EXT TENDON,HAND/FINGER,EA"	OP	"$1,817.00 "	$0.00	$0.00	"$1,304.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,304.90"	$611.00	$298.50	$611.00
26485	EAP	CPT® 26485		PR TRANSPLANT PALM TENDON	OP	"$2,534.00 "	$0.00	$0.00	"$1,829.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,829.96"	$826.60	$448.37	$826.60
26492	EAP	CPT® 26492		"PR THUMB TENDON TRANSFER,GRAFT"	OP	"$2,832.00 "	$0.00	$0.00	"$1,978.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,978.86"	$853.74	$487.29	$853.74
26541	EAP	CPT® 26541		"PR FIX COLLAT LIG,MC-P JT,GRAFT"	OP	"$2,526.00 "	$0.00	$0.00	"$1,816.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,816.59"	$801.41	$465.37	$801.41
26560	EAP	CPT® 26560		"PR REPAIR OF WEB FINGER,EACH"	OP	"$1,888.00 "	$0.00	$0.00	"$1,269.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,269.92"	$554.70	$289.64	$554.70
26591	EAP	CPT® 26591		PR REPAIR MUSCLES OF HAND	OP	"$1,410.00 "	$0.00	$0.00	$985.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$985.86	$454.82	$217.25	$454.82
26600	EAP	CPT® 26600		PR CLOSED RX METACARPAL FX	OP	$871.00 	$0.00	$0.00	$633.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$633.89	$232.37	$131.24	$232.37
26605	EAP	CPT® 26605		"PR CLOSED RX METACARPAL FX,MANIP"	OP	$914.00 	$0.00	$0.00	$671.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$671.27	$282.35	$179.88	$282.35
26608	EAP	CPT® 26608		"PR CLOSED RX METACARPAL FX,PERCUT"	OP	"$1,762.00 "	$0.00	$0.00	"$1,094.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,094.48"	$441.42	$249.22	$441.42
26615	EAP	CPT® 26615		OPEN TX METACARPAL FRACTURE SINGLE EA BONE	OP	"$1,938.00 "	$0.00	$0.00	"$1,325.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,325.54"	$408.45	$261.14	$408.45
26676	EAP	CPT® 26676		"PR PERCUT FIX CARPOMETACAR DISLOC,NON-THUMB"	OP	"$1,572.00 "	$0.00	$0.00	"$1,149.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,149.24"	$463.72	$275.79	$463.72
26685	EAP	CPT® 26685		OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB	OP	"$2,064.00 "	$0.00	$0.00	"$1,325.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,325.63"	$506.13	$320.40	$506.13
26706	EAP	CPT® 26706		PR PERCUT RX MC-P DISLOC	OP	"$1,374.00 "	$0.00	$0.00	"$1,010.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,010.67"	$393.92	$235.28	$393.92
26715	EAP	CPT® 26715		OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION 1	OP	"$1,888.00 "	$0.00	$0.00	"$1,315.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,315.32"	$432.04	$263.49	$432.04
26720	EAP	CPT® 26720		PR CLOSE RX PROX/MID FING SHFT FX	OP	$575.00 	$0.00	$0.00	$421.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.28	$168.24	$81.03	$168.24
26725	EAP	CPT® 26725		"PR CLOSE RX PROX/MID FING SHFT FX,MANIP"	OP	$944.00 	$0.00	$0.00	$695.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$695.07	$306.16	$146.76	$306.16
26727	EAP	CPT® 26727		PR PERCUT RX PROX/MID FING SHFT FX	OP	"$1,466.00 "	$0.00	$0.00	"$1,076.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,076.81"	$434.70	$234.53	$434.70
26735	EAP	CPT® 26735		OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA	OP	"$1,850.00 "	$0.00	$0.00	"$1,372.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,372.05"	$443.47	$266.69	$443.47
26742	EAP	CPT® 26742		"PR CLOSE RX FINGR ARTICULAR FX,MANIP"	OP	"$1,042.00 "	$0.00	$0.00	$765.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$765.62	$334.43	$208.72	$334.43
26746	EAP	CPT® 26746		OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA	OP	"$2,312.00 "	$0.00	$0.00	"$1,706.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,706.61"	$436.26	$274.88	$436.26
26750	EAP	CPT® 26750		PR CLOSE RX DIST FINGR FX	OP	$578.00 	$0.00	$0.00	$421.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$421.31	$157.47	$83.25	$157.47
26755	EAP	CPT® 26755		"PR CLOSE RX DIST FINGR FX,MANIPULATN"	OP	$851.00 	$0.00	$0.00	$623.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$623.57	$281.91	$133.49	$281.91
26765	EAP	CPT® 26765		OPEN TX DISTAL PHALANGEAL FRACTURE EACH	OP	"$1,559.00 "	$0.00	$0.00	"$1,151.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,151.58"	$328.64	$199.71	$328.64
26770	EAP	CPT® 26770		PR CLOSED RX IP JT DISLOCATION	OP	$801.00 	$0.00	$0.00	$581.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$581.84	$238.98	$126.41	$238.98
26775	EAP	CPT® 26775		"PR CLOSED RX IP JT DISLOCATION,ANESTH"	OP	"$1,077.00 "	$0.00	$0.00	$792.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$792.51	$336.14	$182.82	$336.14
26785	EAP	CPT® 26785		OPEN TX INTERPHALANGEAL JOINT DISLOCATION 1	OP	"$1,699.00 "	$0.00	$0.00	"$1,259.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,259.03"	$334.85	$204.81	$334.85
26860	EAP	CPT® 26860		PR FUSION FINGER JOINT	OP	"$1,888.00 "	$0.00	$0.00	"$1,278.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,278.42"	$569.23	$279.58	$569.23
26910	EAP	CPT® 26910		PR AMPUTATE METACARPAL+FINGER	OP	"$2,286.00 "	$0.00	$0.00	"$1,633.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,633.73"	$694.83	$374.63	$694.83
26951	EAP	CPT® 26951		PR AMPUTATION FINGER/THUMB	OP	"$2,070.00 "	$0.00	$0.00	"$1,482.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,482.29"	$586.73	$258.35	$586.73
26952	EAP	CPT® 26952		PR AMPUTATION FINGER/THUMB+FLAPS	OP	"$2,044.00 "	$0.00	$0.00	"$1,461.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,461.78"	$650.56	$325.62	$650.56
26989	EAP	CPT® 26989		PR HAND/FINGER SURGERY UNLISTED	OP	$965.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27071	EAP	CPT® 27071		PR PARTIAL EXCISION DEEP PELVIS	OP	"$3,849.00 "	$0.00	$0.00	"$2,115.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,115.12"	$854.40	$557.78	$854.40
27086	EAP	CPT® 27086		"PR REMOVE PELV/HIP F.B.,SUBCUTANEOUS"	OP	$521.00 	$0.00	$0.00	$382.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$382.67	$234.62	$98.64	$234.62
27096	EAP	CPT® 27096		PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMAGE	OP	$592.00 	$0.00	$0.00	$195.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.50	$194.66	$249.29	$194.66
27125	EAP	CPT® 27125		PR PARTIAL HIP REPLACEMENT	OP	"$7,993.00 "	$0.00	$0.00	"$2,621.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,621.66"	"$1,048.50"	$687.58	"$1,048.50"
27130	EAP	CPT® 27130		PR TOTAL HIP ARTHROPLASTY	OP	"$11,250.00 "	$0.00	$0.00	"$3,138.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,138.59"	"$1,356.54"	$928.69	"$1,356.54"
27132	EAP	CPT® 27132		PR CONV PREV HIP SURG TO TOT HIP ARTHROPLAS	OP	"$13,322.00 "	$0.00	$0.00	"$3,876.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,876.54"	"$1,591.56"	"$1,066.58"	"$1,591.56"
27134	EAP	CPT® 27134		PR REVISE TOTAL HIP REPLACEMENT	OP	"$14,506.00 "	$0.00	$0.00	"$4,438.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,438.61"	"$1,856.70"	"$1,290.58"	"$1,856.70"
27137	EAP	CPT® 27137		PR REVISE ACETABULAR PART OF TOTAL HIP	OP	"$11,546.00 "	$0.00	$0.00	"$3,410.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,410.25"	"$1,412.06"	$975.17	"$1,412.06"
27187	EAP	CPT® 27187		PR REINFORCE HIP BONES	OP	"$6,513.00 "	$0.00	$0.00	"$2,290.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,290.70"	$941.28	$642.06	$941.28
27197	EAP	CPT® 27197		PR CLSD TX PELVIC RING FX W/O MANIPULATION	OP	$398.00 	$0.00	$0.00	$269.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.57	$0.00	$71.34	$0.00
27215	EAP	CPT® 27215		"PR OPEN FIX ILIAC FX,INTERN FIXATN"	OP	"$3,611.00 "	$0.00	$0.00	"$1,441.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.92"	$689.70	$478.64	$689.70
27216	EAP	CPT® 27216		PR PERCUT FIX POST PELV RING FX	OP	"$2,869.00 "	$0.00	$0.00	"$2,136.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,136.53"	$993.21	$540.91	$993.21
27217	EAP	CPT® 27217		PR OPEN INTERN FIX ANTER PELV RING FX	OP	"$3,789.00 "	$0.00	$0.00	"$2,004.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,004.93"	$957.68	$643.85	$957.68
27218	EAP	CPT® 27218		PR OPEN INTERN FIX POST PELV RING FX	OP	"$4,164.00 "	$0.00	$0.00	"$2,770.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,770.49"	"$1,274.51"	$784.82	"$1,274.51"
27220	EAP	CPT® 27220		PR CLOSED RX ACETABULAR FX	OP	"$1,322.00 "	$0.00	$0.00	"$1,211.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,211.37"	$478.81	$275.04	$478.81
27226	EAP	CPT® 27226		PR OPEN INTERN FIX ACETABULAR WALL FX	OP	"$3,302.00 "	$0.00	$0.00	"$2,442.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,442.80"	$927.37	$677.15	$927.37
27227	EAP	CPT® 27227		PR OPEN INTERN FIX ACETABULAR FX	OP	"$5,175.00 "	$0.00	$0.00	"$3,840.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,840.78"	"$1,574.19"	$983.91	"$1,574.19"
27228	EAP	CPT® 27228		PR OPEN INTERN FIX COMPLEX ACETABUL FX	OP	"$7,498.00 "	$0.00	$0.00	"$4,379.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,379.33"	"$1,808.94"	"$1,097.38"	"$1,808.94"
27235	EAP	CPT® 27235		PR PERCUT FIX PROX/NECK FEMUR FX	OP	"$4,233.00 "	$0.00	$0.00	"$2,101.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,101.89"	$859.86	$565.30	$859.86
27236	EAP	CPT® 27236		"PR FEMORAL FX, OPEN TX"	OP	"$4,381.00 "	$0.00	$0.00	"$2,767.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,767.73"	"$1,105.25"	$711.98	"$1,105.25"
27244	EAP	CPT® 27244		"PR TREAT INTER/SUBTROCH FX,W/PLATE/SCREW"	OP	"$4,085.00 "	$0.00	$0.00	"$2,848.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,848.62"	"$1,096.57"	$714.62	"$1,096.57"
27245	EAP	CPT® 27245		"PR OPEN FIX INTER/SUBTROCH FX,IMPLNT"	OP	"$4,479.00 "	$0.00	$0.00	"$2,847.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,847.86"	"$1,346.88"	$846.17	"$1,346.88"
27252	EAP	CPT® 27252		"PR CLOSED RX TRAUMA HIP DISLOC,ANESTH"	OP	"$2,360.00 "	$0.00	$0.00	"$1,751.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,751.33"	$706.04	$385.64	$706.04
27254	EAP	CPT® 27254		PR OPEN RX HIP DISLOC/ACETABULAR FX	OP	"$3,981.00 "	$0.00	$0.00	"$2,931.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,931.20"	"$1,198.44"	$738.87	"$1,198.44"
27275	EAP	CPT® 27275		PR MANIPULATION HIP JOINT W ANESTHESIA	OP	$878.00 	$0.00	$0.00	$418.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$418.68	$169.08	$110.36	$169.08
27299	EAP	CPT® 27299		PR PELVIS/HIP JOINT SURGERY UNLISTED	OP	"$2,870.00 "	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
27301	EAP	CPT® 27301		"PR INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP"	OP	"$1,573.00 "	$0.00	$0.00	"$1,156.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,156.80"	$622.36	$334.92	$622.36
27310	EAP	CPT® 27310		"PR EXPLOR/DRAIN KNEE,INFECTN"	OP	"$2,309.00 "	$0.00	$0.00	"$1,687.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,687.01"	$674.44	$439.73	$674.44
27331	EAP	CPT® 27331		PR ARTHROTOMY/EXPLORE/TREAT KNEE JOINT	OP	"$2,040.00 "	$0.00	$0.00	"$1,094.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,094.30"	$439.49	$293.46	$439.49
27334	EAP	CPT® 27334		"PR RMV KNEE SYNOVIUM,ANT/POST"	OP	"$2,810.00 "	$0.00	$0.00	"$1,575.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,575.69"	$634.61	$421.54	$634.61
27337	EAP	CPT® 27337		PR EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3+CM	OP	"$1,310.00 "	$0.00	$0.00	$967.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$967.34	$0.00	$190.01	$0.00
27360	EAP	CPT® 27360		PR PART REMV FEMUR/PROX TIB/FIB	OP	"$2,739.00 "	$0.00	$0.00	"$1,962.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,962.72"	$799.58	$531.82	$799.58
27364	EAP	CPT® 27364		PR RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/>	OP	"$4,890.00 "	$0.00	$0.00	"$3,617.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,617.24"	$0.00	$713.73	$0.00
27372	EAP	CPT® 27372		"PR REMV FOREIGN BODY,KNEE/THIGH,DEEP"	OP	"$1,253.00 "	$0.00	$0.00	$930.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$930.30	$560.83	$239.61	$560.83
27380	EAP	CPT® 27380		"PR FIX INFRAPATELLA TENDON,PRIMARY"	OP	"$1,895.00 "	$0.00	$0.00	"$1,368.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.41"	$556.50	$350.32	$556.50
27381	EAP	CPT® 27381		"PR FIX PATELLA TENDN,SECONDARY"	OP	"$2,525.00 "	$0.00	$0.00	"$1,836.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,836.74"	$755.33	$487.76	$755.33
27385	EAP	CPT® 27385		"PR FIX QUAD/HAMSTR MUSC RUPT,PRIMARY"	OP	"$2,247.00 "	$0.00	$0.00	"$1,324.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,324.62"	$596.54	$377.90	$596.54
27403	EAP	CPT® 27403		"PR ARTHROTOMY,OPEN REPAIR MENISCUS"	OP	"$2,765.00 "	$0.00	$0.00	"$1,476.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,476.08"	$601.90	$397.16	$601.90
27405	EAP	CPT® 27405		"PR REPAIR COLLAT LIGAMT/CAPSULE,KNEE"	OP	"$2,713.00 "	$0.00	$0.00	"$1,554.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,554.89"	$632.10	$422.26	$632.10
27407	EAP	CPT® 27407		"PR REPAIR CRUCIATE LIGAMENT,KNEE"	OP	"$3,111.00 "	$0.00	$0.00	"$1,792.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,792.74"	$728.49	$460.07	$728.49
27416	EAP	CPT® 27416		PR OSTEOCHONDRAL KNEE AUTOGRAFT	OP	"$3,064.00 "	$0.00	$0.00	"$2,260.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,260.83"	$0.00	$470.88	$0.00
27427	EAP	CPT® 27427		"PR LIGMT REVISION,KNEE,EXTRA-ARTIC"	OP	"$4,147.00 "	$0.00	$0.00	"$1,642.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,642.25"	$672.25	$447.08	$672.25
27430	EAP	CPT® 27430		PR REVISION QUADRICEPS	OP	"$2,419.00 "	$0.00	$0.00	"$1,705.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,705.61"	$694.88	$443.04	$694.88
27447	EAP	CPT® 27447		PR TOTAL KNEE ARTHROPLASTY	OP	"$6,498.00 "	$0.00	$0.00	"$3,137.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,137.78"	"$1,459.64"	$982.35	"$1,459.64"
27457	EAP	CPT® 27457		"PR OSTEOTOMY PROX TIB,AFTR EPIPHY CLOS"	OP	"$3,214.00 "	$0.00	$0.00	"$2,186.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,186.58"	$919.01	$605.56	$919.01
27466	EAP	CPT® 27466		PR LENGTHENING OF FEMUR	OP	"$4,839.00 "	$0.00	$0.00	"$2,724.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,724.08"	"$1,117.23"	$721.72	"$1,117.23"
27470	EAP	CPT® 27470		PR FIX NON/MALUNION FEMUR BELOW NECK	OP	"$3,681.00 "	$0.00	$0.00	"$2,717.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,717.55"	"$1,111.51"	$752.66	"$1,111.51"
27472	EAP	CPT® 27472		"PR FIX NON/MALUNION FEMUR,W GRAFT"	OP	"$3,975.00 "	$0.00	$0.00	"$2,920.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,920.11"	"$1,206.39"	$834.99	"$1,206.39"
27487	EAP	CPT® 27487		"PR REVISE KNEE JOINT REPLACE,ALL PARTS"	OP	"$7,604.00 "	$0.00	$0.00	"$4,070.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,070.55"	"$1,683.66"	"$1,146.70"	"$1,683.66"
27488	EAP	CPT® 27488		PR REMOVAL OF KNEE PROSTHESIS	OP	"$4,147.00 "	$0.00	$0.00	"$2,776.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,776.83"	"$1,124.03"	$720.61	"$1,124.03"
27495	EAP	CPT® 27495		PR REINFORCE FEMUR	OP	"$3,525.00 "	$0.00	$0.00	"$2,607.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,607.23"	"$1,073.37"	$740.73	"$1,073.37"
27500	EAP	CPT® 27500		PR CLOSED RX FEMUR SHAFT FX	OP	"$1,498.00 "	$0.00	$0.00	"$1,105.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,105.37"	$471.80	$358.92	$471.80
27503	EAP	CPT® 27503		PR CLOSED RX CONDYLAR FX+MANIP	OP	"$2,500.00 "	$0.00	$0.00	"$1,852.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,852.79"	$749.86	$456.15	$749.86
27506	EAP	CPT® 27506		PR OPEN RX FEMUR FX+INTRAMED ROD	OP	"$4,179.00 "	$0.00	$0.00	"$3,094.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,094.37"	"$1,243.12"	$761.87	"$1,243.12"
27507	EAP	CPT® 27507		PR OPEN RX FEMUR FX+PLATE/SCREW	OP	"$3,813.00 "	$0.00	$0.00	"$2,249.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,249.16"	$935.63	$650.22	$935.63
27508	EAP	CPT® 27508		"PR CLOSED RX FEMUR,DISTAL"	OP	"$1,546.00 "	$0.00	$0.00	"$1,137.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,137.18"	$477.19	$288.34	$477.19
27509	EAP	CPT® 27509		PR PERCUT FIX DISTAL FEMUR	OP	"$2,215.00 "	$0.00	$0.00	"$1,480.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,480.22"	$606.93	$324.52	$606.93
27511	EAP	CPT® 27511		OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O EXTENSION	OP	"$3,813.00 "	$0.00	$0.00	"$2,305.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,305.74"	$963.56	$642.40	$963.56
27513	EAP	CPT® 27513		OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W EXTENSION	OP	"$4,358.00 "	$0.00	$0.00	"$2,871.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,871.48"	"$1,282.58"	$782.38	"$1,282.58"
27514	EAP	CPT® 27514		OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE	OP	"$3,886.00 "	$0.00	$0.00	"$2,236.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,236.01"	"$1,252.95"	$755.03	"$1,252.95"
27524	EAP	CPT® 27524		PR OPEN RX PATELLA FX	OP	"$2,488.00 "	$0.00	$0.00	"$1,736.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,736.70"	$710.93	$455.96	$710.93
27530	EAP	CPT® 27530		PR CLOSED RX TIBIAL PLATEAU FX	OP	$881.00 	$0.00	$0.00	$644.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$644.09	$352.16	$216.60	$352.16
27532	EAP	CPT® 27532		PR CLOSED RX TIB PLAT FX+MANIP	OP	"$1,798.00 "	$0.00	$0.00	"$1,329.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,329.30"	$565.79	$320.81	$565.79
27535	EAP	CPT® 27535		OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR	OP	"$2,807.00 "	$0.00	$0.00	"$2,074.91"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,074.91"	$837.62	$538.90	$837.62
27536	EAP	CPT® 27536		PR OPEN RX BILAT TIB PLAT FX	OP	"$3,714.00 "	$0.00	$0.00	"$2,752.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,752.62"	"$1,113.22"	$641.03	"$1,113.22"
27540	EAP	CPT® 27540		OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE	OP	"$2,724.00 "	$0.00	$0.00	"$1,869.17"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,869.17"	$886.96	$553.36	$886.96
27560	EAP	CPT® 27560		PR CLOSED RX KNEECAP DISLOCATN	OP	"$1,068.00 "	$0.00	$0.00	$765.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$765.00	$320.01	$192.86	$320.01
27562	EAP	CPT® 27562		PR CLOSED RX KNEECAP DISLOC+ANESTH	OP	"$1,515.00 "	$0.00	$0.00	"$1,079.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,079.22"	$410.47	$257.43	$410.47
27570	EAP	CPT® 27570		PR MANIPULATN KNEE JT+ANESTHESIA	OP	$663.00 	$0.00	$0.00	$348.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.81	$135.48	$92.39	$135.48
27590	EAP	CPT® 27590		"PR AMPUTATE THIGH,THRU FEMUR"	OP	"$2,651.00 "	$0.00	$0.00	"$1,874.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,874.63"	$771.07	$530.28	$771.07
27594	EAP	CPT® 27594		"PR AMPUTATE THIGH,SECONDRY CLOSUR"	OP	"$1,599.00 "	$0.00	$0.00	"$1,180.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,180.74"	$473.80	$300.20	$473.80
27598	EAP	CPT® 27598		PR AMPUTATE LOWER LEG AT KNEE	OP	"$2,905.00 "	$0.00	$0.00	"$1,684.17"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,684.17"	$698.51	$489.15	$698.51
27600	EAP	CPT® 27600		PR DECOMPRESS ANT/LAT LEG CMPART	OP	"$1,266.00 "	$0.00	$0.00	$953.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$953.97	$398.70	$260.55	$398.70
27602	EAP	CPT® 27602		PR DECOMPRESS ANT/LAT+POST LEG CMPART	OP	"$1,811.00 "	$0.00	$0.00	"$1,145.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,145.07"	$490.62	$310.72	$490.62
27603	EAP	CPT® 27603		PR DRAIN LOWER LEG DEEP ABSC/HEMATOMA	OP	"$1,214.00 "	$0.00	$0.00	$898.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$898.67	$475.73	$294.89	$475.73
27606	EAP	CPT® 27606		PR INCIS ACHILLES TENDON+GEN ANESTH	OP	$864.00 	$0.00	$0.00	$654.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$654.72	$286.55	$216.34	$286.55
27610	EAP	CPT® 27610		PR EXPLORE/TREAT ANKLE JOINT	OP	"$2,099.00 "	$0.00	$0.00	"$1,504.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,504.52"	$614.54	$389.57	$614.54
27620	EAP	CPT® 27620		PR EXPLOR ANKLE JOINT	OP	"$2,222.00 "	$0.00	$0.00	"$1,049.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,049.09"	$438.26	$294.57	$438.26
27640	EAP	CPT® 27640		PR PARTIAL REMOVAL OF TIBIA	OP	"$2,757.00 "	$0.00	$0.00	"$1,927.85"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,927.85"	$849.78	$562.82	$849.78
27641	EAP	CPT® 27641		PR PARTIAL REMOVAL OF FIBULA	OP	"$2,469.00 "	$0.00	$0.00	"$1,545.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,545.51"	$684.74	$462.67	$684.74
27650	EAP	CPT® 27650		"PR REPAIR ACHILLES TENDON,PRIMARY"	OP	"$2,552.00 "	$0.00	$0.00	"$1,522.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,522.58"	$669.22	$435.65	$669.22
27652	EAP	CPT® 27652		PR REPAIR/GRAFT ACHILLES TENDON	OP	"$3,045.00 "	$0.00	$0.00	"$1,580.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,580.30"	$714.05	$468.42	$714.05
27658	EAP	CPT® 27658		"PR REPAIR FLEX LEG TENDON,PRIM,EA"	OP	"$1,440.00 "	$0.00	$0.00	$862.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$862.22	$365.37	$293.59	$365.37
27659	EAP	CPT® 27659		"PR REPAIR FLEX LEG TENDON,SECOND,EA"	OP	"$1,852.00 "	$0.00	$0.00	"$1,113.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,113.63"	$483.88	$364.43	$483.88
27680	EAP	CPT® 27680		"PR RELEASE TIB/FIB/ANKLE FLEX TENDON,EA"	OP	"$1,321.00 "	$0.00	$0.00	$992.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$992.73	$416.56	$262.26	$416.56
27685	EAP	CPT® 27685		"PR LENGTH/SHORT LEG/ANKL TENDON,SINGLE"	OP	"$1,482.00 "	$0.00	$0.00	"$1,073.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,073.72"	$546.33	$283.30	$546.33
27695	EAP	CPT® 27695		"PR REPAIR 1 COLLAT ANKLE LIGMNT,PRIMARY"	OP	"$2,346.00 "	$0.00	$0.00	"$1,098.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,098.41"	$475.24	$330.49	$475.24
27698	EAP	CPT® 27698		"PR REPAIR COLLAT ANKLE LIGMNT,SECONDARY"	OP	"$3,087.00 "	$0.00	$0.00	"$1,482.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,482.60"	$630.56	$442.11	$630.56
27705	EAP	CPT® 27705		PR OSTEOTOMY TIBIA	OP	"$2,881.00 "	$0.00	$0.00	"$1,754.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,754.61"	$728.47	$493.81	$728.47
27715	EAP	CPT® 27715		PR LENGTHENING TIBIA/FIBULA	OP	"$4,939.00 "	$0.00	$0.00	"$2,475.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,475.62"	"$1,005.36"	$643.85	"$1,005.36"
27720	EAP	CPT® 27720		RPR NON/MALUNION TIBIA	OP	"$3,704.00 "	$0.00	$0.00	"$2,021.57"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,021.57"	$832.01	$575.24	$832.01
27724	EAP	CPT® 27724		RPR NON/MALUNION TIBIA+AUTOGRAFT	OP	"$4,321.00 "	$0.00	$0.00	"$2,925.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,925.90"	"$1,218.98"	$703.02	"$1,218.98"
27726	EAP	CPT® 27726		PR RPR FIBULA NONUNION/MALUNION W INT FIXATION	OP	"$2,991.00 "	$0.00	$0.00	"$2,236.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,236.56"	$0.00	$0.00	$0.00
27750	EAP	CPT® 27750		PR CLOSED RX TIBIA SHAFT FX	OP	"$1,001.00 "	$0.00	$0.00	$729.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$729.83	$303.83	$199.15	$303.83
27752	EAP	CPT® 27752		"PR CLOSED RX TIBIA SHAFT FX,MANIPULATN"	OP	"$1,646.00 "	$0.00	$0.00	"$1,141.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,141.82"	$488.50	$308.50	$488.50
27758	EAP	CPT® 27758		"PR OPEN RX TIBIA SHAFT FX,SCREWS"	OP	"$3,781.00 "	$0.00	$0.00	"$2,057.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,057.54"	$832.94	$559.19	$832.94
27759	EAP	CPT® 27759		"PR TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT"	OP	"$4,048.00 "	$0.00	$0.00	"$2,308.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,308.98"	$949.19	$632.67	$949.19
27760	EAP	CPT® 27760		PR CLOSED RX MED MALLEOLUS FX	OP	$953.00 	$0.00	$0.00	$698.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$698.76	$293.13	$181.34	$293.13
27766	EAP	CPT® 27766		OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE	OP	"$2,135.00 "	$0.00	$0.00	"$1,409.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,409.97"	$612.79	$380.32	$612.79
27769	EAP	CPT® 27769		PR OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE	OP	"$2,276.00 "	$0.00	$0.00	"$1,685.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,685.99"	$0.00	$334.54	$0.00
27780	EAP	CPT® 27780		PR CLOSED RX PROX/SHAFT FIBULA FX	OP	$874.00 	$0.00	$0.00	$639.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$639.96	$260.63	$139.92	$260.63
27784	EAP	CPT® 27784		OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE	OP	"$2,218.00 "	$0.00	$0.00	"$1,653.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,653.59"	$532.22	$322.10	$532.22
27786	EAP	CPT® 27786		PR CLOSED RX DIST FIBULA FX	OP	$892.00 	$0.00	$0.00	$656.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$656.84	$278.09	$176.54	$278.09
27788	EAP	CPT® 27788		"PR CLOSED RX DIST FIBULA FX,MANIP"	OP	"$1,200.00 "	$0.00	$0.00	$883.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.82	$385.46	$235.82	$385.46
27792	EAP	CPT® 27792		OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS	OP	"$2,269.00 "	$0.00	$0.00	"$1,507.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,507.70"	$569.38	$353.98	$569.38
27808	EAP	CPT® 27808		CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANIP	OP	$941.00 	$0.00	$0.00	$689.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$689.12	$290.55	$189.33	$290.55
27810	EAP	CPT® 27810		CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP	OP	"$1,557.00 "	$0.00	$0.00	$973.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$973.67	$433.06	$285.08	$433.06
27814	EAP	CPT® 27814		OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE	OP	"$2,936.00 "	$0.00	$0.00	"$1,783.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,783.56"	$756.66	$486.83	$756.66
27822	EAP	CPT® 27822		OPEN TX TRIMALLEOLAR ANKLE FX W/O FIX PST LIP	OP	"$3,425.00 "	$0.00	$0.00	"$1,942.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,942.32"	$866.88	$734.97	$866.88
27823	EAP	CPT® 27823		OPEN TX TRIMALLEOLAR ANKLE FX W FIX PST LIP	OP	"$4,048.00 "	$0.00	$0.00	"$2,206.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,206.01"	$982.75	$835.43	$982.75
27824	EAP	CPT® 27824		PR CLOSED RX WEIGHT BEAR DIST TIBIA	OP	$946.00 	$0.00	$0.00	$700.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$700.05	$274.22	$198.71	$274.22
27825	EAP	CPT® 27825		"PR CLOSED RX WEIGHT BEAR DIST TIB,MANIP"	OP	"$1,779.00 "	$0.00	$0.00	"$1,136.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,136.69"	$502.93	$336.50	$502.93
27826	EAP	CPT® 27826		OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA	OP	"$3,559.00 "	$0.00	$0.00	"$1,920.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,920.75"	$672.99	$690.85	$672.99
27827	EAP	CPT® 27827		OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY	OP	"$3,692.00 "	$0.00	$0.00	"$2,496.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,496.68"	"$1,088.86"	$891.52	"$1,088.86"
27828	EAP	CPT® 27828		OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA	OP	"$4,226.00 "	$0.00	$0.00	"$2,993.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,993.58"	"$1,234.24"	$971.22	"$1,234.24"
27829	EAP	CPT® 27829		OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION	OP	"$2,184.00 "	$0.00	$0.00	"$1,578.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,578.98"	$469.57	$487.14	$469.57
27831	EAP	CPT® 27831		PR CLOSED RX PROX TIB/FIB DISLOC+ANESTH	OP	"$1,257.00 "	$0.00	$0.00	$902.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$902.46	$347.36	$207.94	$347.36
27842	EAP	CPT® 27842		"PR CLOSED RX ANKLE DISLOCATN,ANESTH"	OP	"$1,535.00 "	$0.00	$0.00	"$1,142.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,142.54"	$443.34	$227.70	$443.34
27846	EAP	CPT® 27846		PR OPEN RX ANKLE DISLOCATN	OP	"$2,669.00 "	$0.00	$0.00	"$1,676.91"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,676.91"	$697.37	$439.39	$697.37
27860	EAP	CPT® 27860		PR MANIPULATION ANKLE JT W ANESTHESIA	OP	$656.00 	$0.00	$0.00	$404.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$404.28	$166.34	$105.83	$166.34
27870	EAP	CPT® 27870		"PR ARTHRODESIS,ANKLE,OPEN"	OP	"$4,226.00 "	$0.00	$0.00	"$2,383.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,383.89"	$991.05	$635.96	$991.05
27880	EAP	CPT® 27880		PR AMPUTATION LOW LEG THRU TIB/FIB	OP	"$3,003.00 "	$0.00	$0.00	"$2,145.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,145.62"	$857.69	$508.02	$857.69
27882	EAP	CPT® 27882		"PR AMPUTATION LOW LEG,CIRCULAR"	OP	"$2,447.00 "	$0.00	$0.00	"$1,406.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,406.78"	$614.52	$427.98	$614.52
27884	EAP	CPT® 27884		"PR AMPUTATION LOW LEG,SECOND CLOSURE"	OP	"$1,792.00 "	$0.00	$0.00	"$1,347.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,347.66"	$551.55	$344.92	$551.55
27886	EAP	CPT® 27886		PR RE-AMPUTATION LOWER LEG	OP	"$2,980.00 "	$0.00	$0.00	"$1,539.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,539.30"	$628.40	$418.05	$628.40
27894	EAP	CPT® 27894		"PR DECOMPRESS LEG,ANT/LAT & POST"	OP	"$2,630.00 "	$0.00	$0.00	"$1,978.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,978.40"	$776.29	$397.40	$776.29
28039	EAP	CPT® 28039		PR EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ 1.5+CM	OP	"$1,075.00 "	$0.00	$0.00	$813.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$813.11	$0.00	$217.53	$0.00
28046	EAP	CPT® 28046		PR RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM	OP	"$2,236.00 "	$0.00	$0.00	"$1,691.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,691.48"	$756.48	$407.33	$756.48
28060	EAP	CPT® 28060		PR PART EXCIS PLANTAR FASCIA	OP	"$1,204.00 "	$0.00	$0.00	$826.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$826.61	$427.05	$248.27	$427.05
28100	EAP	CPT® 28100		PR REMV TALUS/HEEL BENIGN BONE LESN	OP	"$1,480.00 "	$0.00	$0.00	$955.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.59	$523.86	$286.85	$523.86
28104	EAP	CPT® 28104		PR REMV TARSAL/METATARSAL BENIGN BONE LESN	OP	"$1,204.00 "	$0.00	$0.00	$817.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$817.56	$424.14	$246.32	$424.14
28111	EAP	CPT® 28111		PR FULL EXCIS 1ST METATARSAL HEAD	OP	"$1,239.00 "	$0.00	$0.00	$756.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$756.18	$441.56	$269.86	$441.56
28112	EAP	CPT® 28112		"PR FULL EXCIS 2,3 OR 4TH METATAR HEAD"	OP	"$1,170.00 "	$0.00	$0.00	$725.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$725.97	$407.45	$229.71	$407.45
28113	EAP	CPT® 28113		PR FULL EXCIS 5TH METATARSAL HEAD	OP	"$1,317.00 "	$0.00	$0.00	$984.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$984.87	$473.79	$241.85	$473.79
28120	EAP	CPT® 28120		PR PART REMV TALUS OR CALCANEUS	OP	"$1,550.00 "	$0.00	$0.00	"$1,154.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,154.12"	$500.13	$303.86	$500.13
28126	EAP	CPT® 28126		"PR RESEC ONE TOE PHALANGEAL BASE,EA"	OP	$860.00 	$0.00	$0.00	$575.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$575.82	$311.85	$197.97	$311.85
28190	EAP	CPT® 28190		"PR REMV FOOT FOREIGN BODY,SUBCUTANEOUS"	OP	$508.00 	$0.00	$0.00	$309.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$309.99	$207.60	$108.49	$207.60
28192	EAP	CPT® 28192		"PR REMV FOOT FOREIGN BODY,DEEP"	OP	$974.00 	$0.00	$0.00	$728.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$728.49	$399.12	$206.05	$399.12
28272	EAP	CPT® 28272		"PR CAPSULOTOMY I-P JT,FOOT,EA"	OP	$784.00 	$0.00	$0.00	$589.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$589.62	$320.27	$175.82	$320.27
28285	EAP	CPT® 28285		"PR REPAIR OF HAMMERTOE,ONE"	OP	"$1,183.00 "	$0.00	$0.00	$874.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$874.40	$380.07	$232.62	$380.07
28400	EAP	CPT® 28400		PR CLOSED RX HEEL FX	OP	$805.00 	$0.00	$0.00	$525.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.15	$221.10	$160.72	$221.10
28405	EAP	CPT® 28405		"PR CLOSED RX HEEL FX,MANIPULATN"	OP	"$1,309.00 "	$0.00	$0.00	$824.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$824.57	$362.37	$237.57	$362.37
28406	EAP	CPT® 28406		PR PERCUT RX HEEL FX	OP	"$1,762.00 "	$0.00	$0.00	"$1,207.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,207.62"	$503.41	$309.27	$503.41
28415	EAP	CPT® 28415		OPEN TREATMENT CALCANEAL FRACTURE	OP	"$3,491.00 "	$0.00	$0.00	"$2,558.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,558.36"	"$1,175.78"	$892.58	"$1,175.78"
28430	EAP	CPT® 28430		PR CLOSED RX TALUS FX	OP	$652.00 	$0.00	$0.00	$486.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$486.38	$207.89	$153.38	$207.89
28435	EAP	CPT® 28435		"PR CLOSED RX TALUS FX,MANIPULATN"	OP	"$1,007.00 "	$0.00	$0.00	$655.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$655.92	$281.67	$197.93	$281.67
28445	EAP	CPT® 28445		OPEN TREATMENT TALUS FRACTURE	OP	"$3,235.00 "	$0.00	$0.00	"$2,457.47"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,457.47"	"$1,083.34"	$438.43	"$1,083.34"
28450	EAP	CPT® 28450		"PR CLOSED RX TARSAL FX,EACH"	OP	$743.00 	$0.00	$0.00	$444.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$444.65	$190.68	$137.83	$190.68
28465	EAP	CPT® 28465		OPEN TX TARSAL FRACTURE XCP TALUS &CALCANEUS EA	OP	"$2,190.00 "	$0.00	$0.00	"$1,441.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,441.52"	$509.10	$465.19	$509.10
28470	EAP	CPT® 28470		PR CLOSED RX METATARSAL FX	OP	$632.00 	$0.00	$0.00	$472.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$472.94	$192.16	$134.39	$192.16
28476	EAP	CPT® 28476		PR PERCUT RX METATARSAL FX	OP	"$1,510.00 "	$0.00	$0.00	$814.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$814.14	$317.27	$183.11	$317.27
28485	EAP	CPT® 28485		OPEN TREATMENT METATARSAL FRACTURE EACH	OP	"$1,963.00 "	$0.00	$0.00	"$1,214.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,214.99"	$423.65	$423.89	$423.65
28510	EAP	CPT® 28510		PR CLOSED RX TOE FX	OP	$369.00 	$0.00	$0.00	$278.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.96	$102.00	$57.72	$102.00
28525	EAP	CPT® 28525		OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE	OP	"$1,256.00 "	$0.00	$0.00	$923.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$923.18	$405.16	$287.27	$405.16
28576	EAP	CPT® 28576		PR PERCUT RX TALOTARSAL DISLOCATION	OP	"$1,208.00 "	$0.00	$0.00	$900.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$900.38	$333.26	$191.44	$333.26
28605	EAP	CPT® 28605		"PR CLOSED RX TAR-METATAR DISLOC,ANESTH"	OP	$927.00 	$0.00	$0.00	$676.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$676.79	$231.92	$159.40	$231.92
28606	EAP	CPT® 28606		PR PERCUT RX TAR-METATAR FOOT DISLOC	OP	"$1,334.00 "	$0.00	$0.00	$913.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$913.44	$371.63	$310.17	$371.63
28615	EAP	CPT® 28615		OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION	OP	"$2,534.00 "	$0.00	$0.00	"$1,826.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,826.31"	$646.11	$516.11	$646.11
28635	EAP	CPT® 28635		"PR CLOSED RX MT-PHAL TOE DISLOC,ANESTH"	OP	$667.00 	$0.00	$0.00	$303.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$303.44	$153.79	$94.80	$153.79
28660	EAP	CPT® 28660		"PR CLOSED RX I-P JT,TOE DISLOCATION"	OP	$315.00 	$0.00	$0.00	$205.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$205.10	$95.08	$79.81	$95.08
28665	EAP	CPT® 28665		"PR CLOSED RX I-P JT,TOE DISLOC,ANESTH"	OP	$440.00 	$0.00	$0.00	$302.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$302.63	$133.65	$92.34	$133.65
28675	EAP	CPT® 28675		OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION	OP	"$1,257.00 "	$0.00	$0.00	$953.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$953.55	$377.52	$231.46	$377.52
28725	EAP	CPT® 28725		"PR FUSION FOOT BONES,SUBTALAR"	OP	"$3,675.00 "	$0.00	$0.00	"$1,799.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,799.96"	$776.70	$508.31	$776.70
28730	EAP	CPT® 28730		"PR FUSION FOOT BONES,MIDTARSAL,MULTI"	OP	"$3,121.00 "	$0.00	$0.00	"$1,695.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,695.90"	$794.38	$473.27	$794.38
28740	EAP	CPT® 28740		"PR FUSION FOOT BONE,MIDTARSAL,1 JT"	OP	"$2,416.00 "	$0.00	$0.00	"$1,442.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,442.48"	$761.89	$360.40	$761.89
28805	EAP	CPT® 28805		"PR AMPUTATION FOOT,TRANSMETATARSAL"	OP	"$2,256.00 "	$0.00	$0.00	"$1,702.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,702.80"	$695.88	$366.11	$695.88
28810	EAP	CPT® 28810		"PR AMPUTATION METATARSAL+TOE,SINGLE"	OP	"$1,611.00 "	$0.00	$0.00	"$1,004.57"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,004.57"	$420.48	$271.64	$420.48
28820	EAP	CPT® 28820		"PR AMPUTATION TOE,MT-P JT"	OP	"$1,762.00 "	$0.00	$0.00	$920.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$920.78	$472.17	$231.39	$472.17
28825	EAP	CPT® 28825		"PR AMPUTATION TOE,I-P JT"	OP	"$1,510.00 "	$0.00	$0.00	$863.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$863.07	$406.10	$202.43	$406.10
29075	EAP	CPT® 29075		PR APPLY FOREARM CAST	OP	$190.00 	$0.00	$0.00	$143.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.91	$77.24	$69.38	$77.24
29105	EAP	CPT® 29105		PR APPLY LONG ARM SPLINT	OP	$145.00 	$0.00	$0.00	$136.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.64	$78.68	$58.98	$78.68
29125	EAP	CPT® 29125		"PR APPLY FOREARM SPLINT,STATIC"	OP	$124.00 	$0.00	$0.00	$90.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.93	$60.23	$45.30	$60.23
29130	EAP	CPT® 29130		"PR APPLY FINGER SPLINT,STATIC"	OP	$92.00 	$0.00	$0.00	$65.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.84	$36.60	$22.72	$36.60
29445	EAP	CPT® 29445		PR APPLY RIGID LEG CAST	OP	$537.00 	$0.00	$0.00	$240.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.36	$136.45	$128.96	$136.45
29505	EAP	CPT® 29505		PR APPLY LONG LEG SPLINT	OP	$207.00 	$0.00	$0.00	$115.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$115.01	$69.25	$59.12	$69.25
29515	EAP	CPT® 29515		PR APPLY LOWER LEG SPLINT	OP	$154.00 	$0.00	$0.00	$114.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.23	$61.62	$50.37	$61.62
29580	EAP	CPT® 29580		PR APPLY OF PASTE BOOT	OP	$116.00 	$0.00	$0.00	$82.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$82.01	$46.19	$34.11	$46.19
29700	EAP	CPT® 29700		PR REMV/REVISN BOOT/BODY CAST	OP	$104.00 	$0.00	$0.00	$77.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.04	$56.08	$25.80	$56.08
29806	EAP	CPT® 29806		"PR SHLDR ARTHROSCOP,SURG,CAPSULORRHAPHY"	OP	"$3,415.00 "	$0.00	$0.00	"$2,455.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,455.16"	"$1,005.32"	$675.25	"$1,005.32"
29822	EAP	CPT® 29822		PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2	OP	"$2,244.00 "	$0.00	$0.00	"$1,310.19"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,310.19"	$543.18	$375.91	$543.18
29824	EAP	CPT® 29824		"PR SHLDR ARTHROSCOP,SURG,DIS CLAVICULECTOMY"	OP	"$2,104.00 "	$0.00	$0.00	"$1,541.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,541.70"	$626.70	$411.10	$626.70
29826	EAP	CPT® 29826		PR SHOULDER SCOPE BONE SHAVING	OP	"$2,903.00 "	$0.00	$0.00	$635.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.94	$635.79	$442.62	$635.79
29827	EAP	CPT® 29827		"PR SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR"	OP	"$3,343.00 "	$0.00	$0.00	"$2,442.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,442.81"	"$1,038.33"	$641.30	"$1,038.33"
29828	EAP	CPT® 29828		PR ARTHROSCOPY SHOULDER SURGICAL BICEPS TENODESIS	OP	"$2,868.00 "	$0.00	$0.00	"$2,107.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,107.82"	$0.00	$445.82	$0.00
29870	EAP	CPT® 29870		"PR KNEE SCOPE,DIAGNOSTIC"	OP	"$1,277.00 "	$0.00	$0.00	$952.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$952.88	$382.12	$230.39	$382.12
29874	EAP	CPT® 29874		"PR KNEE SCOPE,REMV LOOSE BODY"	OP	"$2,508.00 "	$0.00	$0.00	"$1,241.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,241.75"	$502.75	$339.05	$502.75
29875	EAP	CPT® 29875		"PR KNEE SCOPE,PART SYNOVECT"	OP	"$2,475.00 "	$0.00	$0.00	"$1,144.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,144.73"	$467.06	$309.25	$467.06
29877	EAP	CPT® 29877		"PR KNEE SCOPE,SHAVE ARTICULAR CART"	OP	"$2,640.00 "	$0.00	$0.00	"$1,438.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,438.50"	$571.41	$354.65	$571.41
29880	EAP	CPT® 29880		PR ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING	OP	"$3,629.00 "	$0.00	$0.00	"$1,299.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,299.75"	$639.50	$404.86	$639.50
29881	EAP	CPT® 29881		PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG	OP	"$3,002.00 "	$0.00	$0.00	"$1,252.43"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,252.43"	$595.68	$372.49	$595.68
29882	EAP	CPT® 29882		"PR KNEE SCOPE,MED OR LAT MENIS REPAIR"	OP	"$3,250.00 "	$0.00	$0.00	"$1,620.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,620.12"	$643.07	$410.59	$643.07
29883	EAP	CPT® 29883		"PR KNEE SCOPE,MED+LAT MENIS REPAIR"	OP	"$4,223.00 "	$0.00	$0.00	"$1,946.06"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,946.06"	$793.97	$446.06	$793.97
29884	EAP	CPT® 29884		"PR KNEE SCOPE,LYSIS OF ADHESNS"	OP	"$2,475.00 "	$0.00	$0.00	"$1,421.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,421.51"	$569.21	$361.86	$569.21
29888	EAP	CPT® 29888		"PR KNEE SCOPE,AID ANT CRUCIATE REPAIR"	OP	"$5,312.00 "	$0.00	$0.00	"$2,281.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,281.11"	$937.92	$649.63	$937.92
29889	EAP	CPT® 29889		"PR KNEE SCOPE,AID POST CRUC REPAIR"	OP	"$5,312.00 "	$0.00	$0.00	"$2,826.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,826.81"	"$1,139.90"	$627.98	"$1,139.90"
29916	EAP	CPT® 29916		PR ARTHROSCOPY HIP W/LABRAL REPAIR	OP	"$3,199.00 "	$0.00	$0.00	"$2,344.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,344.56"	$0.00	$618.58	$0.00
30117	EAP	CPT® 30117		PR EXCIS/DEST INTRANAS LESION; INT APP	OP	"$1,024.00 "	$0.00	$0.00	$787.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$787.35	$638.46	$150.88	$638.46
30118	EAP	CPT® 30118		PR EXCIS/DEST INTRANAS LESION; EXT APP	OP	"$2,389.00 "	$0.00	$0.00	"$1,773.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,773.12"	$699.44	$410.29	$699.44
30130	EAP	CPT® 30130		PR EXCISION TURBINATE	OP	"$1,219.00 "	$0.00	$0.00	$878.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$878.70	$333.83	$137.96	$333.83
30140	EAP	CPT® 30140		"PR EXCISION TURBINATE,SUBMUCOUS"	OP	"$1,251.00 "	$0.00	$0.00	"$1,017.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,017.71"	$365.64	$180.29	$365.64
30300	EAP	CPT® 30300		PR REMOVE NASAL FOREIGN BODY	OP	$349.00 	$0.00	$0.00	$244.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.19	$205.38	$54.18	$205.38
30420	EAP	CPT® 30420		PR RECONSTR NOSE+MAJ SEPTAL REPAIR	OP	"$4,594.00 "	$0.00	$0.00	"$3,158.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,158.34"	"$1,268.24"	$713.99	"$1,268.24"
30465	EAP	CPT® 30465		PR REPAIR NASAL CAVITY STENOSIS	OP	"$3,229.00 "	$0.00	$0.00	"$2,259.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,259.26"	$893.22	$554.69	$893.22
30520	EAP	CPT® 30520		PR REPAIR OF NASAL SEPTUM	OP	"$2,497.00 "	$0.00	$0.00	"$1,437.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,437.32"	$510.11	$267.67	$510.11
30580	EAP	CPT® 30580		PR REPAIR ORO-MAXILLARY FISTULA	OP	"$1,665.00 "	$0.00	$0.00	"$1,185.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,185.74"	$557.94	$283.75	$557.94
30801	EAP	CPT® 30801		"PR CAUTER TURBINATE MUCOSA,SUPERFICIAL"	OP	$443.00 	$0.00	$0.00	$315.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.36	$192.68	$55.27	$192.68
30901	EAP	CPT® 30901		"PR CTRL NOSEBLEED,ANTER,SIMPLE"	OP	$208.00 	$0.00	$0.00	$130.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.73	$95.10	$56.51	$95.10
30903	EAP	CPT® 30903		"PR CTRL NOSEBLEED,ANTER,COMPLEX"	OP	$308.00 	$0.00	$0.00	$186.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.12	$161.84	$71.31	$161.84
30920	EAP	CPT® 30920		PR LIGATE INTERN MAXILL ARTERY	OP	"$2,830.00 "	$0.00	$0.00	"$1,925.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,925.61"	$741.27	$432.43	$741.27
30930	EAP	CPT® 30930		PR THERAPEUTIC FRACTURE INFER TURBINATE	OP	$364.00 	$0.00	$0.00	$284.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$284.37	$108.05	$57.63	$108.05
31225	EAP	CPT® 31225		PR REMV UPPER JAW-MAXILLECTOMY	OP	"$5,641.00 "	$0.00	$0.00	"$4,326.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,326.92"	"$1,636.08"	$843.79	"$1,636.08"
31231	EAP	CPT® 31231		"PR NASAL ENDOSCOPY,DX"	OP	$270.00 	$0.00	$0.00	$165.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.21	$165.55	$61.55	$165.55
31237	EAP	CPT® 31237		"PR NASAL SCOPE,BX/RMV POLYP/DEBRID"	OP	$970.00 	$0.00	$0.00	$374.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.39	$299.44	$141.60	$299.44
31238	EAP	CPT® 31238		"PR NASAL/SINUS SCOPY,W/CONTROL NASAL HEM"	OP	$629.00 	$0.00	$0.00	$392.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$392.04	$309.45	$156.20	$309.45
31240	EAP	CPT® 31240		"PR NASAL/SINUS SCOPY,RMV CONCHA BULL"	OP	$719.00 	$0.00	$0.00	$373.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$373.53	$159.14	$112.27	$159.14
31253	EAP	CPT® 31253		PR NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL	OP	"$1,558.00 "	$0.00	$0.00	"$1,154.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,154.12"	$0.00	$308.53	$0.00
31254	EAP	CPT® 31254		"PR NASAL SCOPY,REMV PART ETHMOID"	OP	"$1,276.00 "	$0.00	$0.00	$632.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$632.78	$273.93	$201.18	$273.93
31255	EAP	CPT® 31255		"PR NASAL SCOPY,REMV TOTL ETHMOID"	OP	"$1,743.00 "	$0.00	$0.00	$927.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$927.32	$406.36	$301.51	$406.36
31256	EAP	CPT® 31256		"PR NASAL SCOPY,OPEN MAXILL SINUS"	OP	"$1,006.00 "	$0.00	$0.00	$458.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$458.63	$198.28	$142.50	$198.28
31257	EAP	CPT® 31257		PR NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY	OP	"$1,387.00 "	$0.00	$0.00	"$1,027.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,027.41"	$0.00	$274.60	$0.00
31267	EAP	CPT® 31267		"PR NASAL SCOPY,RMV TISS MAXILL SINUS"	OP	"$1,509.00 "	$0.00	$0.00	$736.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$736.29	$320.36	$227.03	$320.36
31276	EAP	CPT® 31276		"PR NASAL SCOPY,EXPLOR FRONTAL SINUS"	OP	"$1,509.00 "	$0.00	$0.00	"$1,170.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,170.48"	$512.46	$345.44	$512.46
31287	EAP	CPT® 31287		"PR NASAL SCOPY,SPHENOIDOTOMY"	OP	"$1,258.00 "	$0.00	$0.00	$538.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$538.08	$233.40	$169.84	$233.40
31288	EAP	CPT® 31288		"PR NASAL SCOPY,REMV TISS SPHENOID"	OP	"$1,384.00 "	$0.00	$0.00	$623.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$623.13	$270.75	$198.30	$270.75
31297	EAP	CPT® 31297		PR NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS	OP	$446.00 	$0.00	$0.00	$372.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$372.71	$0.00	$446.00	$0.00
31500	EAP	CPT® 31500		PR INSERT EMERGENCY ENDOTRACH AIRWAY	OP	$448.00 	$0.00	$0.00	$253.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.50	$107.86	$74.55	$107.86
31502	EAP	CPT® 31502		PR TRACH TUBE CHANGE	OP	$274.00 	$0.00	$0.00	$81.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.11	$34.15	$39.91	$34.15
31525	EAP	CPT® 31525		"PR LARYNGOSCOPY,DIRECT,DIAGNOSTIC"	OP	$629.00 	$0.00	$0.00	$373.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$373.52	$230.40	$117.19	$230.40
31535	EAP	CPT® 31535		"PR LARYNGOSCOPY,DIRCT,OP,BIOPSY"	OP	$916.00 	$0.00	$0.00	$442.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$442.53	$187.68	$136.52	$187.68
31536	EAP	CPT® 31536		"PR LARYNGOSCOPY,DIRCT,OP SCOPE,BIOPSY"	OP	"$1,102.00 "	$0.00	$0.00	$492.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$492.33	$210.59	$154.16	$210.59
31541	EAP	CPT® 31541		"PR LARYNGOSCOPY,DIRCT,OP SCOP,EXC TUMR"	OP	"$1,316.00 "	$0.00	$0.00	$616.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$616.73	$265.28	$190.70	$265.28
31545	EAP	CPT® 31545		"PR LARYNGOSCOPY,DIR,OP,EXC TUMR,LCL FLAP"	OP	"$1,545.00 "	$0.00	$0.00	$846.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$846.32	$353.12	$234.30	$353.12
31571	EAP	CPT® 31571		"PR LARYNGOSCOPY,DIRECT,SCOPE,INJ CORDS"	OP	"$1,202.00 "	$0.00	$0.00	$583.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$583.79	$249.63	$182.13	$249.63
31573	EAP	CPT® 31573		PR LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI	OP	$456.00 	$0.00	$0.00	$345.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$345.41	$0.00	$160.34	$0.00
31575	EAP	CPT® 31575		PR LARYNGOSCOPY FLEXIBLE DIAGNOSTIC	OP	$300.00 	$0.00	$0.00	$177.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.74	$108.80	$64.69	$108.80
31600	EAP	CPT® 31600		"PR TRACHEOSTOMY, PLANNED"	OP	"$1,018.00 "	$0.00	$0.00	$922.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$922.14	$389.39	$153.09	$389.39
31610	EAP	CPT® 31610		"PR TRACHEOSTOMY,FENESTRATN+FLAPS"	OP	"$2,950.00 "	$0.00	$0.00	"$1,656.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,656.00"	$649.59	$398.08	$649.59
31611	EAP	CPT® 31611		PR CREATE T-E FISTULA+SPEECH PROSTHESIS	OP	"$1,891.00 "	$0.00	$0.00	"$1,250.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,250.58"	$479.25	$308.76	$479.25
31613	EAP	CPT® 31613		"PR TRACH REVISION,SIMPLE"	OP	"$1,346.00 "	$0.00	$0.00	"$1,053.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,053.20"	$395.98	$226.25	$395.98
31615	EAP	CPT® 31615		PR TRACHEOBRNCHSC THRU EST TRACHS INC	OP	$582.00 	$0.00	$0.00	$298.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$298.13	$171.28	$107.05	$171.28
31622	EAP	CPT® 31622		PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX	OP	$735.00 	$0.00	$0.00	$334.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$334.14	$308.23	$137.38	$308.23
31623	EAP	CPT® 31623		PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS	OP	$771.00 	$0.00	$0.00	$339.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$339.26	$338.45	$140.42	$338.45
31624	EAP	CPT® 31624		PR BRNCHSC W/BRNCL ALVEOLAR LAVAGE	OP	$771.00 	$0.00	$0.00	$342.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.50	$314.65	$135.93	$314.65
31625	EAP	CPT® 31625		PR BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES	OP	$786.00 	$0.00	$0.00	$392.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$392.19	$335.51	$154.46	$335.51
31626	EAP	CPT® 31626		PR BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT	OP	"$1,854.00 "	$0.00	$0.00	$489.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.86	$0.00	$198.86	$0.00
31627	EAP	CPT® 31627		PR BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION	OP	"$2,878.00 "	$0.00	$0.00	$225.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.65	$0.00	$550.26	$0.00
31628	EAP	CPT® 31628		PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE	OP	$873.00 	$0.00	$0.00	$436.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$436.59	$398.65	$174.43	$398.65
31629	EAP	CPT® 31629		PR BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON	OP	"$1,018.00 "	$0.00	$0.00	$652.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$462.12	$652.92	$132.57	$652.92
31630	EAP	CPT® 31630		"PR BRONCHOSCOPY,TRACH/BRONCH DILATN"	OP	$931.00 	$0.00	$0.00	$464.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$464.09	$205.33	$153.87	$205.33
31632	EAP	CPT® 31632		PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE	OP	$436.00 	$0.00	$0.00	$114.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.15	$72.95	$44.31	$72.95
31633	EAP	CPT® 31633		PR BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE	OP	$436.00 	$0.00	$0.00	$147.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$147.08	$86.71	$54.27	$86.71
31634	EAP	CPT® 31634		PR BRONCHOSCOPY BALLOON OCCLUSION	OP	$597.00 	$0.00	$0.00	$478.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$478.43	$0.00	$597.00	$0.00
31635	EAP	CPT® 31635		PR BRONCHOSCOPY W/REMOVAL FOREIGN BODY	OP	"$1,455.00 "	$0.00	$0.00	$436.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$436.97	$354.00	$149.44	$354.00
31640	EAP	CPT® 31640		"PR BRONCHOSCOPY,EXCIS LESN"	OP	"$1,455.00 "	$0.00	$0.00	$590.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$590.09	$261.52	$199.79	$261.52
31641	EAP	CPT® 31641		"PR BRONCHOSCOPY,RX STENOSIS"	OP	"$1,891.00 "	$0.00	$0.00	$598.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$598.35	$255.81	$202.81	$255.81
31645	EAP	CPT® 31645		"PR BRONCHOSCOPY,RX ASPIR PULM TREE"	OP	$786.00 	$0.00	$0.00	$373.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$373.80	$302.83	$125.03	$302.83
31646	EAP	CPT® 31646		PR BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ	OP	$786.00 	$0.00	$0.00	$323.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$323.18	$276.08	$107.82	$276.08
31652	EAP	CPT® 31652		PR BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX	OP	"$1,690.00 "	$0.00	$0.00	$542.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$542.45	$0.00	$547.09	$0.00
31653	EAP	CPT® 31653		PR BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX	OP	"$1,798.00 "	$0.00	$0.00	$598.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$598.68	$0.00	$581.51	$0.00
31654	EAP	CPT® 31654		PR BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES	OP	$275.00 	$0.00	$0.00	$156.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.66	$0.00	$87.09	$0.00
31730	EAP	CPT® 31730		PR INTRO WINDPIPE WIRE/TUBE	OP	$468.00 	$0.00	$0.00	$400.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$343.64	$400.50	$122.27	$400.50
31785	EAP	CPT® 31785		"PR EXCIS TRACH LESN,CERVICAL"	OP	"$3,346.00 "	$0.00	$0.00	"$2,522.43"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,522.43"	"$1,034.69"	$660.28	"$1,034.69"
31820	EAP	CPT® 31820		PR SURG CLOSURE TRACH/FISTULA	OP	"$1,010.00 "	$0.00	$0.00	$761.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$761.30	$381.07	$230.17	$381.07
32100	EAP	CPT® 32100		PR THORACOTOMY WITH EXPLORATION	OP	"$2,922.00 "	$0.00	$0.00	"$1,879.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,879.58"	$923.98	$561.09	$923.98
32110	EAP	CPT® 32110		PR THORCOM CTRL TRAUMTC HEMRRG&/RPR LNG TEAR	OP	"$4,586.00 "	$0.00	$0.00	"$3,396.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,396.18"	"$1,385.88"	$612.33	"$1,385.88"
32120	EAP	CPT® 32120		PR THORACOTOMY POSTOPERATIVE COMPLICATIONS	OP	"$3,653.00 "	$0.00	$0.00	"$2,022.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,022.84"	$817.93	$539.51	$817.93
32160	EAP	CPT® 32160		PR THORACOTOMY W/CARDIAC MASSAGE	OP	"$3,653.00 "	$0.00	$0.00	"$1,832.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,832.61"	$704.53	$421.55	$704.53
32408	EAP	CPT® 32408		PR CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG	OP	$459.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
32480	EAP	CPT® 32480		PR RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT	OP	"$4,932.00 "	$0.00	$0.00	"$3,434.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,434.79"	"$1,453.98"	$811.66	"$1,453.98"
32484	EAP	CPT® 32484		PR RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY	OP	"$4,481.00 "	$0.00	$0.00	"$3,340.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,340.49"	"$1,400.13"	$885.74	"$1,400.13"
32550	EAP	CPT® 32550		PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER	OP	$646.00 	$0.00	$0.00	$515.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$515.76	$0.00	$453.26	$0.00
32551	EAP	CPT® 32551		PR TUBE THORACOSTOMY INCLUDES WATER SEAL	OP	$493.00 	$0.00	$0.00	$394.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$394.37	$0.00	$91.41	$0.00
32554	EAP	CPT® 32554		PR THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING	OP	$280.00 	$0.00	$0.00	$208.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.07	$0.00	$280.00	$0.00
32555	EAP	CPT® 32555		PR THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	OP	$348.00 	$0.00	$0.00	$261.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$261.21	$0.00	$348.00	$0.00
32557	EAP	CPT® 32557		PR PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING	OP	$476.00 	$0.00	$0.00	$357.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$357.59	$0.00	$476.00	$0.00
32561	EAP	CPT® 32561		"PR INSTILL VIA CHEST TUBE AGENT FOR FIBRINOLYSIS, 1ST DAY"	OP	$211.00 	$0.00	$0.00	$158.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.94	$0.00	$43.86	$0.00
32601	EAP	CPT® 32601		PR THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX	OP	"$1,096.00 "	$0.00	$0.00	$717.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$717.87	$303.56	$227.86	$303.56
32607	EAP	CPT® 32607		PR THORACOSCOPY W/DX BX OF LUNG INFILTRATE UNILATRL	OP	$965.00 	$0.00	$0.00	$718.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$718.59	$0.00	$187.02	$0.00
32608	EAP	CPT® 32608		PR THORACOSCOPY W/DX BX OF LUNG NODULES UNILATRL	OP	"$1,185.00 "	$0.00	$0.00	$880.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$880.91	$0.00	$229.64	$0.00
32650	EAP	CPT® 32650		PR THORACOSCOPY SURG W/PLEURODESIS	OP	"$2,995.00 "	$0.00	$0.00	"$1,547.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,547.55"	$668.37	$479.09	$668.37
32651	EAP	CPT® 32651		PR THORACOSCOPY SURG PART PULM DECORT	OP	"$3,421.00 "	$0.00	$0.00	"$2,548.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,548.46"	$996.57	$583.81	$996.57
32652	EAP	CPT® 32652		PR THORACOSCOPY SURG TOT PULM DECORT	OP	"$5,191.00 "	$0.00	$0.00	"$3,865.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,865.70"	"$1,503.30"	$807.77	"$1,503.30"
32653	EAP	CPT® 32653		PR THORACOSCOPY SURG REMOV FB INTRAPLEU	OP	"$3,317.00 "	$0.00	$0.00	"$2,462.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,462.27"	$965.78	$572.85	$965.78
32655	EAP	CPT® 32655		PR THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL PX	OP	"$3,470.00 "	$0.00	$0.00	"$2,223.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,223.09"	$897.76	$607.49	$897.76
32662	EAP	CPT® 32662		PR THORACOSCOPY SURG EXC MEDIAST MASS	OP	"$4,201.00 "	$0.00	$0.00	"$2,075.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,075.18"	$904.51	$730.42	$904.51
32663	EAP	CPT® 32663		PR THORACOSCOPY W/LOBECTOMY SINGLE LOBE	OP	"$4,749.00 "	$0.00	$0.00	"$3,259.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,259.11"	"$1,345.62"	$818.75	"$1,345.62"
32666	EAP	CPT® 32666		PR THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT	OP	"$2,712.00 "	$0.00	$0.00	"$2,025.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,025.68"	$0.00	$527.19	$0.00
32667	EAP	CPT® 32667		PR THORACOSCOPY W/THERA WEDGE RESEXN ADDL IPSILATRL	OP	$490.00 	$0.00	$0.00	$366.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$366.11	$0.00	$94.89	$0.00
32669	EAP	CPT® 32669		PR THORACOSCOPY W/SEGMENTECTOMY	OP	"$4,200.00 "	$0.00	$0.00	"$3,132.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,132.68"	$0.00	$811.49	$0.00
32674	EAP	CPT® 32674		PR THORCOSCPY W/MEDIASTINL &REGIONL LYMPHADENECTOMY	OP	$674.00 	$0.00	$0.00	$502.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.80	$0.00	$130.09	$0.00
33016	EAP	CPT® 33016		PR PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED	OP	$741.00 	$0.00	$0.00	$548.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$548.22	$0.00	$146.34	$0.00
33020	EAP	CPT® 33020		PR INCIS HEART SAC REMV CLOT/FB	OP	"$3,421.00 "	$0.00	$0.00	"$2,044.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,044.64"	$833.32	$590.12	$833.32
33025	EAP	CPT® 33025		PR INCIS HEART SAC WINDW FOR DRAIN	OP	"$3,497.00 "	$0.00	$0.00	"$1,856.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,856.27"	$773.42	$583.63	$773.42
33120	EAP	CPT® 33120		PR REMOVAL HEART LESION INTERN	OP	"$8,553.00 "	$0.00	$0.00	"$4,882.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,882.67"	"$1,508.75"	"$1,181.24"	"$1,508.75"
33207	EAP	CPT® 33207		PR INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR	OP	"$1,505.00 "	$0.00	$0.00	"$1,143.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,143.56"	$523.36	$377.29	$523.36
33208	EAP	CPT® 33208		PR INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT	OP	"$2,091.00 "	$0.00	$0.00	"$1,237.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,237.97"	$489.02	$382.78	$489.02
33210	EAP	CPT® 33210		PR INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH	OP	$760.00 	$0.00	$0.00	$415.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$415.98	$173.90	$135.87	$173.90
33212	EAP	CPT® 33212		PR INS PM PLS GEN W/EXIST SINGLE LEAD	OP	"$1,406.00 "	$0.00	$0.00	$774.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$774.69	$337.33	$256.03	$337.33
33213	EAP	CPT® 33213		PR INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS	OP	"$1,597.00 "	$0.00	$0.00	$807.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$807.48	$383.20	$280.43	$383.20
33225	EAP	CPT® 33225		PR INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN	OP	"$1,863.00 "	$0.00	$0.00	"$1,087.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,087.23"	$442.65	$262.00	$442.65
33227	EAP	CPT® 33227		PR REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD	OP	"$1,062.00 "	$0.00	$0.00	$813.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$813.98	$0.00	$202.45	$0.00
33241	EAP	CPT® 33241		PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY	OP	$798.00 	$0.00	$0.00	$530.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$530.00	$231.62	$150.46	$231.62
33244	EAP	CPT® 33244		PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ	OP	"$3,649.00 "	$0.00	$0.00	"$2,018.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.34"	$858.44	$551.38	$858.44
33249	EAP	CPT® 33249		PR INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR	OP	"$3,725.00 "	$0.00	$0.00	"$2,152.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,152.53"	$886.85	$636.20	$886.85
33259	EAP	CPT® 33259		"PR ABLATE/ RECONSTUCT ATRIA, W OTHER PROCED EXTENS W/ BYPASS"	OP	"$2,637.00 "	$0.00	$0.00	"$1,964.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,964.28"	$0.00	$451.12	$0.00
33262	EAP	CPT® 33262		PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD	OP	"$1,171.00 "	$0.00	$0.00	$894.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$894.06	$0.00	$219.95	$0.00
33263	EAP	CPT® 33263		PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD	OP	"$1,218.00 "	$0.00	$0.00	$929.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$929.28	$0.00	$228.60	$0.00
33270	EAP	CPT® 33270		PR INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD	OP	"$1,777.00 "	$0.00	$0.00	"$1,373.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,373.25"	$0.00	$359.53	$0.00
33274	EAP	CPT® 33274		PR TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG	OP	"$1,527.00 "	$0.00	$0.00	"$1,138.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,138.29"	$0.00	$306.54	$0.00
33286	EAP	CPT® 33286		PR REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR	OP	$274.00 	$0.00	$0.00	$203.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$203.30	$0.00	$81.68	$0.00
33300	EAP	CPT® 33300		PR REPAIR HEART WOUND	OP	"$7,686.00 "	$0.00	$0.00	"$5,702.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,702.72"	"$2,085.13"	$788.20	"$2,085.13"
33405	EAP	CPT® 33405		PR RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT	OP	"$8,209.00 "	$0.00	$0.00	"$5,283.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,283.98"	"$2,282.69"	"$1,373.55"	"$2,282.69"
33427	EAP	CPT® 33427		PR MITRALPLASTY W RADICAL RECONSTR	OP	"$7,654.00 "	$0.00	$0.00	"$5,690.87"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,690.87"	"$2,466.31"	"$1,514.42"	"$2,466.31"
33430	EAP	CPT® 33430		PR REPLACEMENT OF MITRAL VALVE	OP	"$8,777.00 "	$0.00	$0.00	"$6,514.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,514.37"	"$2,622.15"	"$1,447.31"	"$2,622.15"
33464	EAP	CPT® 33464		PR VALVULOPLAS TRICUS W RING INSERT	OP	"$8,175.00 "	$0.00	$0.00	"$5,685.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,685.27"	"$2,240.25"	"$1,275.55"	"$2,240.25"
33508	EAP	CPT® 33508		"PR ENDOSCOPY W/VIDEO-ASST VEIN HARVEST,CABG"	OP	$349.00 	$0.00	$0.00	$37.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.58	$16.04	$9.95	$16.04
33517	EAP	CPT® 33517		"PR CABG, ARTERY-VEIN, SINGLE"	OP	$629.00 	$0.00	$0.00	$436.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$436.50	$174.70	$109.56	$174.70
33518	EAP	CPT® 33518		"PR CABG, ARTERY-VEIN, TWO"	OP	"$1,293.00 "	$0.00	$0.00	$959.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.37	$371.82	$206.77	$371.82
33519	EAP	CPT® 33519		"PR CABG, ARTERY-VEIN, THREE"	OP	"$1,747.00 "	$0.00	$0.00	"$1,268.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,268.76"	$500.39	$303.35	$500.39
33533	EAP	CPT® 33533		"PR CABG, ARTERIAL, SINGLE"	OP	"$7,493.00 "	$0.00	$0.00	"$4,350.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,350.89"	"$1,914.38"	"$1,209.37"	"$1,914.38"
33641	EAP	CPT® 33641		PR REPR ASD W BYPASS	OP	"$5,764.00 "	$0.00	$0.00	"$3,841.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,841.50"	"$1,519.09"	$992.10	"$1,519.09"
33880	EAP	CPT® 33880		PR ENDOVASC TAA REPR INCL SUBCL	OP	"$5,631.00 "	$0.00	$0.00	"$4,234.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,234.28"	"$1,785.02"	"$1,086.54"	"$1,785.02"
33947	EAP	CPT® 33947		PR ECMO/ECLS INITIATION VENO-ARTERIAL	OP	"$1,076.00 "	$0.00	$0.00	$788.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$788.61	$0.00	$209.08	$0.00
33952	EAP	CPT® 33952		PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ	OP	"$1,343.00 "	$0.00	$0.00	"$1,001.69"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,001.69"	$0.00	$263.65	$0.00
33954	EAP	CPT® 33954		PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN	OP	"$1,495.00 "	$0.00	$0.00	"$1,119.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,119.98"	$0.00	$294.54	$0.00
33967	EAP	CPT® 33967		PR INSERT INTRA-AORTIC BALLOON ASST DEVICE	OP	$812.00 	$0.00	$0.00	$604.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$604.59	$257.13	$173.02	$257.13
33984	EAP	CPT® 33984		PR ECMO/ECLS RMVL PRPH CANNULA OPEN 6 YRS & OLDER	OP	$892.00 	$0.00	$0.00	$666.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$666.08	$0.00	$175.35	$0.00
34101	EAP	CPT® 34101		"PR REMV ART CLOT AXILL-BRACH,ARM INCIS"	OP	"$1,880.00 "	$0.00	$0.00	"$1,422.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,422.42"	$619.04	$399.72	$619.04
34111	EAP	CPT® 34111		"PR REMV ART CLOT ARM,ARM INCIS"	OP	"$3,715.00 "	$0.00	$0.00	"$1,417.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,417.71"	$619.47	$334.77	$619.47
34201	EAP	CPT® 34201		"PR REMV ART CLOT ILIAC-POP,LEG INCIS"	OP	"$3,225.00 "	$0.00	$0.00	"$2,438.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,438.99"	$948.92	$388.47	$948.92
34502	EAP	CPT® 34502		"PR RECONSTRUCT, VENA CAVA"	OP	"$5,386.00 "	$0.00	$0.00	"$3,602.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,602.76"	"$1,545.44"	"$1,020.24"	"$1,545.44"
34705	EAP	CPT® 34705		PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT	OP	"$4,817.00 "	$0.00	$0.00	"$3,546.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,546.99"	$0.00	$955.61	$0.00
34713	EAP	CPT® 34713		PR PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT	OP	$393.00 	$0.00	$0.00	$299.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$299.25	$0.00	$80.58	$0.00
35045	EAP	CPT® 35045		"PR REPR ANEURYSM/GRFT INS,RADIAL/ULNAR"	OP	"$3,076.00 "	$0.00	$0.00	"$2,346.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,346.90"	$983.78	$498.08	$983.78
35206	EAP	CPT® 35206		"PR REPR BL VES DIRECT,UP EXTREM"	OP	"$2,453.00 "	$0.00	$0.00	"$1,829.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,829.55"	$779.63	$418.00	$779.63
35207	EAP	CPT® 35207		"PR REPR BL VES DIRECT,HAND/FINGR"	OP	"$2,353.00 "	$0.00	$0.00	"$1,755.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,755.65"	$697.35	$468.83	$697.35
35216	EAP	CPT® 35216		"PR REPR BL VES DIRECT,CHEST"	OP	"$6,499.00 "	$0.00	$0.00	"$4,794.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,794.27"	"$1,760.54"	$746.36	"$1,760.54"
35221	EAP	CPT® 35221		"PR REPR BL VES DIRECT,ABD"	OP	"$4,612.00 "	$0.00	$0.00	"$3,420.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,420.32"	"$1,404.75"	$620.47	"$1,404.75"
35226	EAP	CPT® 35226		"PR REPR BL VES DIRECT,LOW EXTREM"	OP	"$2,614.00 "	$0.00	$0.00	"$1,967.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,967.07"	$865.31	$421.09	$865.31
35231	EAP	CPT® 35231		"PR REPR BL VES VEIN GRFT,NECK"	OP	"$3,936.00 "	$0.00	$0.00	"$2,862.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,862.62"	"$1,182.45"	$527.02	"$1,182.45"
35236	EAP	CPT® 35236		"PR REPR BL VES VEIN GRFT,UP EXTREM"	OP	"$3,156.00 "	$0.00	$0.00	"$2,314.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,314.05"	$993.42	$474.34	$993.42
35256	EAP	CPT® 35256		"PR REPR BL VES VEIN GRFT,LOW EXTREM"	OP	"$3,221.00 "	$0.00	$0.00	"$2,408.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,408.33"	"$1,050.51"	$509.01	"$1,050.51"
35261	EAP	CPT® 35261		"PR REPR BL VES GRAFT,NECK"	OP	"$3,075.00 "	$0.00	$0.00	"$2,500.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,500.02"	"$1,042.29"	$504.59	"$1,042.29"
35266	EAP	CPT® 35266		"PR REPR BL VES GRAFT,UP EXTREM"	OP	"$2,717.00 "	$0.00	$0.00	"$2,058.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,058.36"	$873.34	$461.01	$873.34
35281	EAP	CPT® 35281		"PR REPR BL VES GRAFT,ABDOMEN"	OP	"$5,117.00 "	$0.00	$0.00	"$3,816.47"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,816.47"	"$1,604.72"	$698.44	"$1,604.72"
35286	EAP	CPT® 35286		"PR REPR BL VES GRAFT,LOW EXTREM"	OP	"$4,024.00 "	$0.00	$0.00	"$2,212.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,212.62"	$963.13	$518.34	$963.13
35355	EAP	CPT® 35355		PR THROMBOENDARTECTMY ILIOFEMORAL	OP	"$3,250.00 "	$0.00	$0.00	"$2,453.87"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,453.87"	"$1,071.99"	$667.91	"$1,071.99"
35371	EAP	CPT® 35371		PR THROMBOENDARTECTMY FEMORAL COMMON	OP	"$2,569.00 "	$0.00	$0.00	"$1,941.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,941.11"	$852.21	$503.26	$852.21
35518	EAP	CPT® 35518		"PR VEIN BYPASS GRAFT,AXILL-AXILL"	OP	"$3,653.00 "	$0.00	$0.00	"$2,745.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,745.42"	"$1,216.31"	$657.08	"$1,216.31"
35556	EAP	CPT® 35556		"PR VEIN BYPASS GRAFT,FEM-POP"	OP	"$4,405.00 "	$0.00	$0.00	"$3,322.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,322.55"	"$1,396.63"	$871.57	"$1,396.63"
35566	EAP	CPT® 35566		"PR VEIN BYPASS GRAFT,FEM-TIBIAL"	OP	"$5,257.00 "	$0.00	$0.00	"$3,964.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,964.70"	"$1,676.86"	"$1,079.48"	"$1,676.86"
35583	EAP	CPT® 35583		"PR VEIN IN SITU BYPASS GRAFT,FEM-POP"	OP	"$4,543.00 "	$0.00	$0.00	"$3,433.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,433.53"	"$1,447.06"	$921.12	"$1,447.06"
35587	EAP	CPT® 35587		"PR VEIN IN SITU BYPASS GRAFT,POP-TIB"	OP	"$4,289.00 "	$0.00	$0.00	"$3,238.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,238.56"	"$1,435.91"	$850.28	"$1,435.91"
35656	EAP	CPT® 35656		"PR BYPASS GRAFT OTHR,FEM-POP"	OP	"$3,397.00 "	$0.00	$0.00	"$2,573.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,573.55"	"$1,116.93"	$794.07	"$1,116.93"
35661	EAP	CPT® 35661		"PR BYPASS GRAFT OTHR,FEM-FEM"	OP	"$3,408.00 "	$0.00	$0.00	"$2,574.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,574.56"	"$1,119.47"	$573.11	"$1,119.47"
35666	EAP	CPT® 35666		"PR BYPASS GRAFT OTHR,FEM-TIBIAL"	OP	"$4,004.00 "	$0.00	$0.00	"$3,007.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,007.44"	"$1,311.66"	$843.83	"$1,311.66"
35685	EAP	CPT® 35685		"PR BYPASS GRAFT VEIN PATCH/CUFF,SYNTHETIC"	OP	$929.00 	$0.00	$0.00	$470.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$470.60	$208.51	$0.00	$208.51
35800	EAP	CPT® 35800		"PR EXPLOR POSTOP BLEED,INFEC,CLOT-NECK"	OP	"$2,252.00 "	$0.00	$0.00	"$1,677.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,677.42"	$479.49	$283.19	$479.49
35820	EAP	CPT® 35820		"PR EXPLOR POSTOP BLEED,INFEC,CLOT-CHST"	OP	"$6,303.00 "	$0.00	$0.00	"$4,689.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,689.26"	"$1,696.32"	$473.87	"$1,696.32"
35903	EAP	CPT® 35903		"PR EXCISION, INFEC GRAFT, EXTREMITY"	OP	"$1,775.00 "	$0.00	$0.00	"$1,337.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,337.96"	$590.00	$409.35	$590.00
36000	EAP	CPT® 36000		PR PLACE NEEDLE IN VEIN	OP	$146.00 	$0.00	$0.00	$26.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.69	$26.45	$13.11	$26.45
36002	EAP	CPT® 36002		PR INJECTION RX EXTREMITY PSEUDOANEURYSM	OP	$366.00 	$0.00	$0.00	$248.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.79	$173.41	$0.00	$173.41
36005	EAP	CPT® 36005		"PR INJECTION PROC,EXTREMITY,VENOGRAPHY"	OP	$214.00 	$0.00	$0.00	$214.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$113.03	$214.00	$197.41	$214.00
36010	EAP	CPT® 36010		PR INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA	OP	$549.00 	$0.00	$0.00	$549.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.07	$549.00	$90.88	$549.00
36011	EAP	CPT® 36011		"PR PLACE CATH IN VEIN,SELECT"	OP	$610.00 	$0.00	$0.00	$610.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$367.20	$610.00	$106.97	$610.00
36012	EAP	CPT® 36012		"PR PLACE CATH IN VEIN,SUBSELECT"	OP	$732.00 	$0.00	$0.00	$732.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.39	$732.00	$123.88	$732.00
36014	EAP	CPT® 36014		PR PLACE CATH IN LT/RT PULM ART	OP	$732.00 	$0.00	$0.00	$732.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$350.69	$732.00	$106.08	$732.00
36015	EAP	CPT® 36015		PR PLACE CATH IN SUBSEGMT PULM ART	OP	$854.00 	$0.00	$0.00	$854.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$401.55	$854.00	$124.10	$854.00
36140	EAP	CPT® 36140		PR INTRO NEEDLE/INTRACATH EXTREMITY ARTERY	OP	$458.00 	$0.00	$0.00	$458.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$240.89	$458.00	$70.78	$458.00
36200	EAP	CPT® 36200		PR INTRODUCTION CATHETER AORTA	OP	$687.00 	$0.00	$0.00	$687.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$358.31	$687.00	$112.50	$687.00
36215	EAP	CPT® 36215		"PR PLACE CATH SELECTIVE ART,NECK"	OP	$732.00 	$0.00	$0.00	$732.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.21	$732.00	$157.71	$732.00
36216	EAP	CPT® 36216		"PR PLACE CATH SUBSELECT ART,NECK"	OP	$946.00 	$0.00	$0.00	$946.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$643.67	$946.00	$177.81	$946.00
36217	EAP	CPT® 36217		"PR PLACE CATH SUBSUBSELECT ART,NECK"	OP	"$1,099.00 "	$0.00	$0.00	"$1,099.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$765.42	"$1,099.00"	$214.24	"$1,099.00"
36218	EAP	CPT® 36218		"PR PLACE CATH ADDN SUBSELEC ART,NECK"	OP	$244.00 	$0.00	$0.00	$211.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.14	$211.17	$34.73	$211.17
36222	EAP	CPT® 36222		PR SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART	OP	$886.00 	$0.00	$0.00	$689.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$689.78	$0.00	$865.63	$0.00
36223	EAP	CPT® 36223		PR SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART	OP	$993.00 	$0.00	$0.00	$753.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$753.86	$0.00	$947.04	$0.00
36224	EAP	CPT® 36224		PR SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART	OP	"$1,128.00 "	$0.00	$0.00	$839.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$839.34	$0.00	"$1,028.71"	$0.00
36225	EAP	CPT® 36225		PR SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY	OP	$990.00 	$0.00	$0.00	$742.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.82	$0.00	$940.10	$0.00
36226	EAP	CPT® 36226		PR SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY	OP	"$1,112.00 "	$0.00	$0.00	$841.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$841.67	$0.00	"$1,048.75"	$0.00
36227	EAP	CPT® 36227		PR SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC	OP	$369.00 	$0.00	$0.00	$265.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$265.65	$0.00	$150.43	$0.00
36228	EAP	CPT® 36228		PR SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT	OP	$755.00 	$0.00	$0.00	$543.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$543.29	$0.00	$720.08	$0.00
36245	EAP	CPT® 36245		PR SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH	OP	$763.00 	$0.00	$0.00	$763.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$591.29	$763.00	$165.66	$763.00
36246	EAP	CPT® 36246		PR SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH	OP	$854.00 	$0.00	$0.00	$854.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$629.15	$854.00	$180.81	$854.00
36247	EAP	CPT® 36247		PR SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH	OP	"$1,068.00 "	$0.00	$0.00	"$1,068.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$744.06	"$1,068.00"	$213.80	"$1,068.00"
36248	EAP	CPT® 36248		PR SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH	OP	$198.00 	$0.00	$0.00	$177.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$116.39	$177.86	$35.15	$177.86
36251	EAP	CPT® 36251		PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN	OP	$812.00 	$0.00	$0.00	$658.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$658.01	$0.00	$812.00	$0.00
36253	EAP	CPT® 36253		PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I	OP	"$1,120.00 "	$0.00	$0.00	$883.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.67	$0.00	"$1,120.00"	$0.00
36410	EAP	CPT® 36410		PR VNPNXR 3 YEARS/> PHYS/QHP SKILL	OP	$89.00 	$0.00	$0.00	$21.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.69	$17.66	$11.76	$17.66
36415	EAP	CPT® 36415		ROUTINE VENIPUNCTURE	OP	$18.00 	$0.00	$0.00	$4.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$4.32	$0.00	$0.00	$0.00
36430	EAP	CPT® 36430		PR BLOOD TRANSFUSION SERVICE	OP	$123.00 	$0.00	$0.00	$79.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.25	$38.09	$24.14	$38.09
36465	EAP	CPT® 36465		PR NJX NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN	OP	$376.00 	$0.00	$0.00	$276.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.78	$0.00	$376.00	$0.00
36473	EAP	CPT® 36473		PR ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN	OP	$560.00 	$0.00	$0.00	$401.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$401.42	$0.00	$560.00	$0.00
36475	EAP	CPT® 36475		"PR ENDOVENOUS RF, 1ST VEIN"	OP	"$3,422.00 "	$0.00	$0.00	"$1,993.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$657.08	"$1,993.28"	"$1,399.48"	"$1,993.28"
36478	EAP	CPT® 36478		"PR ENDOVENOUS LASER, 1ST VEIN"	OP	"$2,726.00 "	$0.00	$0.00	"$1,820.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$653.28	"$1,820.48"	"$1,288.06"	"$1,820.48"
36500	EAP	CPT® 36500		PR VENOUS SELECT SAMPLING W CATH	OP	$572.00 	$0.00	$0.00	$424.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.79	$180.25	$94.25	$180.25
36555	EAP	CPT® 36555		PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y	OP	$675.00 	$0.00	$0.00	$294.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$273.90	$294.79	$204.63	$294.79
36556	EAP	CPT® 36556		PR INSERT NON-TUNNEL CV CATH	OP	$591.00 	$0.00	$0.00	$280.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.11	$275.89	$194.80	$275.89
36558	EAP	CPT® 36558		PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>	OP	"$1,841.00 "	$0.00	$0.00	$899.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$645.69	$899.04	$434.13	$899.04
36561	EAP	CPT® 36561		PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>	OP	"$3,007.00 "	$0.00	$0.00	"$1,244.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$825.38	"$1,244.41"	$827.72	"$1,244.41"
36569	EAP	CPT® 36569		PR INSERTION PICC W/O IMG GDN 5 YR/>	OP	$706.00 	$0.00	$0.00	$310.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.02	$310.93	$217.01	$310.93
36571	EAP	CPT® 36571		PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>	OP	"$3,222.00 "	$0.00	$0.00	"$1,342.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$752.90	"$1,342.71"	$965.13	"$1,342.71"
36573	EAP	CPT® 36573		PR INSERTION PICC W/RS&I 5 YR/>	OP	$265.00 	$0.00	$0.00	$196.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.77	$0.00	$0.00	$0.00
36581	EAP	CPT® 36581		PR RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP	OP	"$1,688.00 "	$0.00	$0.00	$800.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$457.98	$800.28	$399.64	$800.28
36582	EAP	CPT® 36582		PR RPLCMT COMPL TUN CTR VAD W/SUBQ PORT	OP	"$2,618.00 "	$0.00	$0.00	"$1,089.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$713.91	"$1,089.78"	$751.81	"$1,089.78"
36589	EAP	CPT® 36589		PR REMOVAL TUNNELED CV CATH	OP	$429.00 	$0.00	$0.00	$320.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.48	$166.57	$107.32	$166.57
36590	EAP	CPT® 36590		PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ	OP	$596.00 	$0.00	$0.00	$477.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$477.29	$257.79	$232.24	$257.79
36595	EAP	CPT® 36595		PR MECH REMOV TUNNELED CV CATH	OP	"$1,657.00 "	$0.00	$0.00	$702.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$429.75	$702.46	$547.56	$702.46
36598	EAP	CPT® 36598		"PR CONTRAST INJ CENT VEN CATH, INC FLOURO"	OP	$116.00 	$0.00	$0.00	$116.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.98	$116.00	$78.92	$116.00
36600	EAP	CPT® 36600		PR WITHDRAWAL OF ARTERIAL BLOOD	OP	$136.00 	$0.00	$0.00	$36.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.15	$30.09	$15.25	$30.09
36620	EAP	CPT® 36620		"PR INSERT CATH,ART,PERCUT,SHORTTERM"	OP	$308.00 	$0.00	$0.00	$118.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.05	$51.21	$37.52	$51.21
36625	EAP	CPT® 36625		"PR INSERT CATH,ART,CUTDOWN,SHORTTERM"	OP	$331.00 	$0.00	$0.00	$241.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$241.91	$102.68	$65.93	$102.68
36680	EAP	CPT® 36680		"PR INSERT NEEDLE,INTRAOSSEOUS INFUSN"	OP	$188.00 	$0.00	$0.00	$135.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$135.45	$62.85	$48.21	$62.85
36819	EAP	CPT® 36819		"PR AV ANAST,UP ARM BASILIC VEIN TRANSPOSIT"	OP	"$2,300.00 "	$0.00	$0.00	"$1,733.67"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,733.67"	$798.09	$486.69	$798.09
36820	EAP	CPT® 36820		"PR AV ANAST,FOREARM VEIN TRANSPOSITION"	OP	"$2,293.00 "	$0.00	$0.00	"$1,729.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,729.10"	$798.88	$535.30	$798.88
36821	EAP	CPT® 36821		"PR ANASTOMOSIS,AV,ANY SITE"	OP	"$2,088.00 "	$0.00	$0.00	"$1,571.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.52"	$529.89	$360.45	$529.89
36825	EAP	CPT® 36825		"PR CREAT AV FISTULA,AUTOGENOUS GRAFT"	OP	"$2,579.00 "	$0.00	$0.00	"$1,895.06"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,895.06"	$577.76	$434.17	$577.76
36830	EAP	CPT® 36830		"PR CREAT AV FISTULA,NON-AUTOGENOUS GRAFT"	OP	"$2,595.00 "	$0.00	$0.00	"$1,581.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,581.05"	$663.00	$483.09	$663.00
36831	EAP	CPT® 36831		"PR THROMBECTOMY,AV FISTULA DIALYS GRFT"	OP	"$1,936.00 "	$0.00	$0.00	"$1,461.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,461.11"	$458.22	$242.16	$458.22
36832	EAP	CPT® 36832		"PR REVISE AV FISTULA,W/O THROMBECTOMY"	OP	"$2,376.00 "	$0.00	$0.00	"$1,793.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,793.25"	$584.90	$404.28	$584.90
36901	EAP	CPT® 36901		PR INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I	OP	$530.00 	$0.00	$0.00	$337.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.37	$0.00	$344.49	$0.00
36902	EAP	CPT® 36902		PR INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP	OP	$751.00 	$0.00	$0.00	$502.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$502.43	$0.00	$732.58	$0.00
36903	EAP	CPT® 36903		PR INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT	OP	$995.00 	$0.00	$0.00	$687.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$687.51	$0.00	$995.00	$0.00
36904	EAP	CPT® 36904		PR PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH	OP	"$1,162.00 "	$0.00	$0.00	$791.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$791.66	$0.00	"$1,068.12"	$0.00
36905	EAP	CPT® 36905		PR PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP	OP	"$1,393.00 "	$0.00	$0.00	$993.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$993.54	$0.00	"$1,366.82"	$0.00
36906	EAP	CPT® 36906		PR PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT	OP	"$1,609.00 "	$0.00	$0.00	"$1,159.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,159.35"	$0.00	"$1,609.00"	$0.00
36907	EAP	CPT® 36907		PR TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I	OP	$460.00 	$0.00	$0.00	$289.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.23	$0.00	$438.35	$0.00
36909	EAP	CPT® 36909		PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I	OP	$631.00 	$0.00	$0.00	$411.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$411.86	$0.00	$631.00	$0.00
37182	EAP	CPT® 37182		PR INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT	OP	"$2,569.00 "	$0.00	$0.00	"$1,949.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,949.12"	$851.21	$550.15	$851.21
37184	EAP	CPT® 37184		PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST	OP	"$4,860.00 "	$0.00	$0.00	"$2,729.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,079.04"	"$2,729.27"	"$1,966.53"	"$2,729.27"
37187	EAP	CPT® 37187		PR PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN	OP	"$4,493.00 "	$0.00	$0.00	"$2,653.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$955.29	"$2,653.73"	"$1,914.21"	"$2,653.73"
37191	EAP	CPT® 37191		PR INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I	OP	"$5,669.00 "	$0.00	$0.00	$559.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$559.02	$0.00	"$1,605.38"	$0.00
37193	EAP	CPT® 37193		PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I	OP	"$1,096.00 "	$0.00	$0.00	$857.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$857.34	$0.00	"$1,025.68"	$0.00
37197	EAP	CPT® 37197		PR PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING	OP	$945.00 	$0.00	$0.00	$740.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$740.57	$0.00	$945.00	$0.00
37200	EAP	CPT® 37200		PR TRANSCATHETER BIOPSY	OP	$903.00 	$0.00	$0.00	$514.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$514.34	$224.55	$138.78	$224.55
37211	EAP	CPT® 37211		PR THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX	OP	"$1,214.00 "	$0.00	$0.00	$936.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$936.39	$0.00	$240.57	$0.00
37212	EAP	CPT® 37212		PR THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX	OP	"$1,061.00 "	$0.00	$0.00	$823.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$823.65	$0.00	$212.38	$0.00
37214	EAP	CPT® 37214		PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL	OP	$386.00 	$0.00	$0.00	$317.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.51	$0.00	$87.24	$0.00
37215	EAP	CPT® 37215		PR TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ	OP	"$3,141.00 "	$0.00	$0.00	"$2,353.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,353.94"	"$1,076.38"	$666.35	"$1,076.38"
37217	EAP	CPT® 37217		PR TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE	OP	"$3,393.00 "	$0.00	$0.00	"$2,576.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,576.40"	$0.00	$687.20	$0.00
37218	EAP	CPT® 37218		PR TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE	OP	"$2,570.00 "	$0.00	$0.00	"$1,926.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,926.74"	$0.00	$506.58	$0.00
37221	EAP	CPT® 37221		PR REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY	OP	"$9,986.00 "	$0.00	$0.00	"$1,201.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,201.49"	$0.00	"$2,788.99"	$0.00
37222	EAP	CPT® 37222		PR REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL	OP	$586.00 	$0.00	$0.00	$440.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$440.55	$0.00	$543.42	$0.00
37224	EAP	CPT® 37224		PR REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI	OP	"$7,903.00 "	$0.00	$0.00	"$1,076.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,076.13"	$0.00	"$2,267.07"	$0.00
37226	EAP	CPT® 37226		PR REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL	OP	"$1,638.00 "	$0.00	$0.00	"$1,264.56"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,264.56"	$0.00	"$1,638.00"	$0.00
37228	EAP	CPT® 37228		PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI	OP	"$11,232.00 "	$0.00	$0.00	"$1,314.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,314.24"	$0.00	"$3,227.81"	$0.00
37230	EAP	CPT® 37230		PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL	OP	"$5,769.00 "	$0.00	$0.00	"$1,675.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,675.62"	$0.00	"$4,988.73"	$0.00
37232	EAP	CPT® 37232		PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL	OP	$631.00 	$0.00	$0.00	$477.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$477.54	$0.00	$631.00	$0.00
37236	EAP	CPT® 37236		PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL	OP	"$1,399.00 "	$0.00	$0.00	"$1,065.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,065.44"	$0.00	"$1,399.00"	$0.00
37238	EAP	CPT® 37238		PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST	OP	$961.00 	$0.00	$0.00	$738.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$738.24	$0.00	$961.00	$0.00
37239	EAP	CPT® 37239		PR OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL	OP	$479.00 	$0.00	$0.00	$351.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$351.33	$0.00	$479.00	$0.00
37241	EAP	CPT® 37241		PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I	OP	"$9,350.00 "	$0.00	$0.00	"$1,058.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,058.09"	$0.00	"$2,770.05"	$0.00
37242	EAP	CPT® 37242		PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I	OP	"$15,755.00 "	$0.00	$0.00	"$1,158.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,158.86"	$0.00	"$4,667.57"	$0.00
37243	EAP	CPT® 37243		PR VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT	OP	"$1,764.00 "	$0.00	$0.00	"$1,368.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,368.78"	$0.00	"$1,764.00"	$0.00
37244	EAP	CPT® 37244		PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE	OP	"$2,088.00 "	$0.00	$0.00	"$1,602.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,602.27"	$0.00	"$2,088.00"	$0.00
37248	EAP	CPT® 37248		PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN	OP	$935.00 	$0.00	$0.00	$708.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$708.96	$0.00	$893.78	$0.00
37249	EAP	CPT® 37249		PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN	OP	$459.00 	$0.00	$0.00	$347.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$347.64	$0.00	$383.03	$0.00
37252	EAP	CPT® 37252		PR INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL	OP	$284.00 	$0.00	$0.00	$215.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.88	$0.00	$284.00	$0.00
37253	EAP	CPT® 37253		PR INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL	OP	$228.00 	$0.00	$0.00	$172.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.65	$0.00	$131.39	$0.00
37565	EAP	CPT® 37565		PR LIGATN NECK VEIN	OP	"$2,264.00 "	$0.00	$0.00	"$1,696.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,696.92"	$670.67	$182.02	$670.67
37605	EAP	CPT® 37605		"PR LIGATN NECK ARTERY,ICA,CCA"	OP	"$2,318.00 "	$0.00	$0.00	"$1,873.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,873.05"	$810.20	$260.71	$810.20
37607	EAP	CPT® 37607		PR LIGATN ANGIOACCESS AV FISTULA	OP	"$1,175.00 "	$0.00	$0.00	$886.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$886.55	$373.86	$227.41	$373.86
37609	EAP	CPT® 37609		PR TEMPORAL ARTERY LIGATN OR BX	OP	$742.00 	$0.00	$0.00	$483.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.83	$281.55	$151.42	$281.55
37616	EAP	CPT® 37616		PR LIGATN OF CHEST ARTERY	OP	"$3,463.00 "	$0.00	$0.00	"$2,570.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,570.13"	"$1,042.45"	$596.18	"$1,042.45"
37617	EAP	CPT® 37617		PR LIGATN OF ABDOMEN ARTERY	OP	"$4,177.00 "	$0.00	$0.00	"$3,123.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,123.81"	"$1,264.50"	$564.36	"$1,264.50"
37618	EAP	CPT® 37618		PR LIGATN OF EXTREMITY ARTERY	OP	"$1,214.00 "	$0.00	$0.00	$900.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$900.03	$363.56	$216.83	$363.56
37650	EAP	CPT® 37650		PR LIGATN FEMORAL VEIN	OP	"$1,437.00 "	$0.00	$0.00	"$1,193.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,193.90"	$498.99	$215.19	$498.99
37660	EAP	CPT® 37660		PR LIGATN COMMON ILIAC VEIN	OP	"$4,145.00 "	$0.00	$0.00	"$2,721.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,721.72"	"$1,193.43"	$393.61	"$1,193.43"
37700	EAP	CPT® 37700		PR LIGATN LONG SAPHENOUS VEIN AT SEPH-FEM JUNC	OP	$838.00 	$0.00	$0.00	$587.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$587.52	$249.73	$168.15	$249.73
37765	EAP	CPT® 37765		PR PHLEB VEINS - EXTREM - TO 20	OP	"$1,193.00 "	$0.00	$0.00	"$1,057.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,057.61"	$447.44	$280.05	$447.44
37766	EAP	CPT® 37766		PR PHLEB VEINS - EXTREM 20+	OP	"$1,612.00 "	$0.00	$0.00	"$1,292.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,292.10"	$541.26	$340.09	$541.26
37780	EAP	CPT® 37780		PR LIGATN SHORT SAPHEN	OP	$871.00 	$0.00	$0.00	$598.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$598.67	$255.91	$150.10	$255.91
38100	EAP	CPT® 38100		"PR REMOVAL SPLEEN, TOTAL"	OP	"$4,392.00 "	$0.00	$0.00	"$2,680.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,680.74"	$988.60	$486.17	$988.60
38102	EAP	CPT® 38102		"PR REMOVAL SPLEEN, TOTAL W OTHR PROC"	OP	"$2,196.00 "	$0.00	$0.00	$609.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$609.56	$247.73	$165.59	$247.73
38115	EAP	CPT® 38115		PR REPAIR OF RUPTURED SPLEEN	OP	"$4,148.00 "	$0.00	$0.00	"$2,942.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,942.58"	"$1,096.45"	$508.77	"$1,096.45"
38222	EAP	CPT® 38222		PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS	OP	$242.00 	$0.00	$0.00	$180.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.27	$0.00	$103.15	$0.00
38500	EAP	CPT® 38500		"PR BIOPSY/EXCISION, LYMPH NODE(S)"	OP	$878.00 	$0.00	$0.00	$589.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$589.16	$285.11	$116.87	$285.11
38505	EAP	CPT® 38505		"PR NEEDLE BIOPSY, LYMPH NODE(S)"	OP	$488.00 	$0.00	$0.00	$165.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.78	$118.45	$72.50	$118.45
38510	EAP	CPT® 38510		"PR BX/REMV,LYMPH NODE,DEEP CERV"	OP	"$1,464.00 "	$0.00	$0.00	$976.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$976.82	$461.70	$174.69	$461.70
38525	EAP	CPT® 38525		"PR BX/REMV,LYMPH NODE,DEEP AXILL"	OP	"$1,373.00 "	$0.00	$0.00	"$1,012.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,012.23"	$373.85	$184.53	$373.85
38531	EAP	CPT® 38531		PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES	OP	"$1,354.00 "	$0.00	$0.00	"$1,011.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.12"	$0.00	$0.00	$0.00
38572	EAP	CPT® 38572		"PR LAP,PELVIC LYMPHADENECTOMY/BX"	OP	"$4,636.00 "	$0.00	$0.00	"$2,154.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,154.60"	$913.45	$524.43	$913.45
38724	EAP	CPT® 38724		"PR REMOVAL NODES, NECK,CERV MOD RAD"	OP	"$5,856.00 "	$0.00	$0.00	"$3,383.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,383.73"	"$1,249.68"	$685.68	"$1,249.68"
38746	EAP	CPT® 38746		PR REMOVE THOR LYMPH NODES RAD REGNL	OP	"$1,244.00 "	$0.00	$0.00	$501.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$501.23	$254.43	$155.37	$254.43
38790	EAP	CPT® 38790		PR INJECTION FOR LYMPHATIC XRAY	OP	$830.00 	$0.00	$0.00	$192.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.69	$77.64	$319.60	$77.64
38792	EAP	CPT® 38792		PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE	OP	$732.00 	$0.00	$0.00	$92.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.55	$37.03	$0.00	$37.03
38900	EAP	CPT® 38900		PR INTRAOPERATIVE SENTINEL LYMPH NODE ID W DYE INJECTION	OP	$436.00 	$0.00	$0.00	$320.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.66	$0.00	$80.58	$0.00
39501	EAP	CPT® 39501		PR REPAIR DIAPHRAGM LACERATION	OP	"$4,392.00 "	$0.00	$0.00	"$1,969.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,969.50"	$783.42	$541.60	$783.42
39540	EAP	CPT® 39540		PR REPAIR DIAPHR HERNIA TRAUMA ACUTE	OP	"$5,563.00 "	$0.00	$0.00	"$2,009.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,009.76"	$797.16	$567.25	$797.16
40490	EAP	CPT® 40490		PR BIOPSY OF LIP	OP	$220.00 	$0.00	$0.00	$170.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.30	$109.38	$54.33	$109.38
40650	EAP	CPT® 40650		"PR REPAIR LIP,FULL THICK,VERMILION"	OP	$969.00 	$0.00	$0.00	$698.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$698.39	$384.75	$184.97	$384.75
40652	EAP	CPT® 40652		"PR REPAIR LIP,<1/2 VERT HEIGHT"	OP	"$1,279.00 "	$0.00	$0.00	$819.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$819.72	$448.00	$220.57	$448.00
40800	EAP	CPT® 40800		"PR DRAIN MOUTH ABSC/CYST/HEMATOMA,SIMPL"	OP	$385.00 	$0.00	$0.00	$311.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$311.84	$163.01	$54.98	$163.01
40801	EAP	CPT® 40801		"PR DRAIN MOUTH ABSC/CYST/HEMAT,COMPLX"	OP	"$1,047.00 "	$0.00	$0.00	$526.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.25	$256.36	$104.24	$256.36
40804	EAP	CPT® 40804		"PR REMOVAL FOREIGN BODY,MOUTH,SIMPLE"	OP	$367.00 	$0.00	$0.00	$276.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.23	$174.67	$61.00	$174.67
40808	EAP	CPT® 40808		PR BIOPSY OF MOUTH LESION	OP	$310.00 	$0.00	$0.00	$257.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$257.07	$143.18	$51.11	$143.18
40818	EAP	CPT® 40818		PR EXCISE ORAL MUCOSA FOR GRAFT	OP	$841.00 	$0.00	$0.00	$643.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$643.14	$298.75	$0.00	$298.75
40820	EAP	CPT® 40820		PR DESTRUC MOUTH LESION/SCAR	OP	$517.00 	$0.00	$0.00	$408.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$408.14	$204.81	$0.00	$204.81
40830	EAP	CPT® 40830		"PR REPAIR MOUTH LACERATION,<2.5CM"	OP	$523.00 	$0.00	$0.00	$389.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.82	$209.02	$73.58	$209.02
40845	EAP	CPT® 40845		PR RECONSTRUC MOUTH COMPLEX	OP	"$3,768.00 "	$0.00	$0.00	"$2,867.93"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,867.93"	"$1,356.15"	$798.15	"$1,356.15"
41005	EAP	CPT® 41005		"PR I&D MOUTH/TONG INTRA,SUBLING,SUPERF"	OP	$401.00 	$0.00	$0.00	$295.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.65	$179.43	$57.38	$179.43
41007	EAP	CPT® 41007		"PR I&D MOUTH/TONG INTRA,SUBMENTAL"	OP	$977.00 	$0.00	$0.00	$572.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$572.91	$311.80	$142.07	$311.80
41008	EAP	CPT® 41008		"PR I&D MOUTH/TONG INTRA,SUBMANDIBULAR"	OP	$977.00 	$0.00	$0.00	$638.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$638.60	$313.04	$0.00	$313.04
41009	EAP	CPT® 41009		"PR I&D MOUTH/TONG INTRA,MASTICATOR"	OP	$886.00 	$0.00	$0.00	$692.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$692.55	$333.89	$160.19	$333.89
41015	EAP	CPT® 41015		"PR I&D MOUTH/TONG EXTRA,SUBLING"	OP	$965.00 	$0.00	$0.00	$829.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$829.64	$362.85	$144.45	$362.85
41016	EAP	CPT® 41016		"PR I&D MOUTH/TONG EXTRA,SUBMENTAL"	OP	"$1,073.00 "	$0.00	$0.00	$833.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$833.64	$374.13	$0.00	$374.13
41017	EAP	CPT® 41017		"PR I&D MOUTH/TONG EXTRA,SUBMANDIBUL"	OP	"$1,066.00 "	$0.00	$0.00	$837.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$837.63	$376.32	$153.76	$376.32
41018	EAP	CPT® 41018		"PR I&D MOUTH/TONG EXTRA,MASTICATOR"	OP	"$1,239.00 "	$0.00	$0.00	$978.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$978.87	$433.30	$212.31	$433.30
41100	EAP	CPT® 41100		"PR BIOPSY TONGUE,ANTER 2/3"	OP	$327.00 	$0.00	$0.00	$254.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.18	$144.44	$72.62	$144.44
41116	EAP	CPT® 41116		PR EXCIS FLOOR MOUTH LESION	OP	"$1,172.00 "	$0.00	$0.00	$521.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$521.67	$263.49	$121.35	$263.49
41120	EAP	CPT® 41120		"PR PART REMOVAL TONGUE,<1/2"	OP	"$3,286.00 "	$0.00	$0.00	"$2,558.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,558.60"	$956.97	$407.06	$956.97
41153	EAP	CPT® 41153		"PR EXCIS TONGUE,MOUTH,NECK"	OP	"$7,399.00 "	$0.00	$0.00	"$5,692.43"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,692.43"	"$2,142.74"	"$1,048.30"	"$2,142.74"
41252	EAP	CPT® 41252		"PR REPAIR TONGUE LACER,2.6CM+/COMPLX"	OP	"$1,456.00 "	$0.00	$0.00	$494.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$494.40	$262.82	$130.79	$262.82
41800	EAP	CPT® 41800		PR DRAINAGE OF GUM LESION	OP	$472.00 	$0.00	$0.00	$346.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.73	$161.67	$54.75	$161.67
41823	EAP	CPT® 41823		"PR EXCIS OSSEOUS TUBER,DENTOALV"	OP	"$1,110.00 "	$0.00	$0.00	$768.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$768.48	$356.59	$156.63	$356.59
41825	EAP	CPT® 41825		PR EXCIS DENTOALVEOLAR LESION	OP	$391.00 	$0.00	$0.00	$289.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.76	$169.93	$72.38	$169.93
41874	EAP	CPT® 41874		PR REPAIR TOOTH SOCKET	OP	$821.00 	$0.00	$0.00	$608.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$608.91	$311.73	$142.84	$311.73
41899	EAP	CPT® 41899		PR DENTAL SURGERY PROCEDURE	OP	$350.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
42000	EAP	CPT® 42000		PR DRAINAGE ABSCESS PALATE/UVULA	OP	$401.00 	$0.00	$0.00	$244.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$244.67	$140.16	$59.44	$140.16
42100	EAP	CPT® 42100		PR BIOPSY PALATE/UVULA	OP	$391.00 	$0.00	$0.00	$259.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.10	$129.01	$62.73	$129.01
42140	EAP	CPT® 42140		PR EXCISION OF UVULA	OP	$821.00 	$0.00	$0.00	$364.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$364.83	$203.86	$87.65	$203.86
42330	EAP	CPT® 42330		"PR REMOVAL SALIVARY STONE,UNCOMPLIC"	OP	$586.00 	$0.00	$0.00	$387.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$387.68	$201.54	$92.14	$201.54
42409	EAP	CPT® 42409		PR DRAINAGE SUBLING SALIVARY CYST	OP	$977.00 	$0.00	$0.00	$519.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$519.80	$280.81	$133.64	$280.81
42415	EAP	CPT® 42415		"PR EXC PAROTD,LAT LOBE,DISSECT 5TH NERV"	OP	"$3,712.00 "	$0.00	$0.00	"$2,465.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,465.15"	"$1,058.17"	$682.79	"$1,058.17"
42440	EAP	CPT® 42440		PR EXCISION SUBMAXILLARY GLAND	OP	"$2,989.00 "	$0.00	$0.00	$963.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.68	$434.53	$318.06	$434.53
42505	EAP	CPT® 42505		PR REPAIR SALIVARY DUCT COMPLICATED	OP	"$2,345.00 "	$0.00	$0.00	"$1,063.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,063.95"	$497.57	$0.00	$497.57
42650	EAP	CPT® 42650		PR DILATION OF SALIVARY DUCT	OP	$178.00 	$0.00	$0.00	$137.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.58	$70.99	$0.00	$70.99
42700	EAP	CPT® 42700		PR INC/DRAIN PERITONSIL ABSCESS	OP	$417.00 	$0.00	$0.00	$317.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.93	$161.03	$76.43	$161.03
42720	EAP	CPT® 42720		"PR INC/DRAIN RETROPHARYNG ABSCESS,ORAL"	OP	"$1,206.00 "	$0.00	$0.00	$918.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$918.21	$412.05	$199.91	$412.05
42800	EAP	CPT® 42800		PR BIOPSY OROPHARYNX	OP	$348.00 	$0.00	$0.00	$262.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.31	$134.84	$68.07	$134.84
42826	EAP	CPT® 42826		"PR REMOVAL OF TONSILS,12+ Y/O"	OP	$957.00 	$0.00	$0.00	$588.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$588.77	$235.91	$160.60	$235.91
42831	EAP	CPT® 42831		"PR REMOVAL ADENOIDS,PRIMARY,12+ Y/O"	OP	$713.00 	$0.00	$0.00	$524.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$524.70	$205.40	$117.80	$205.40
42900	EAP	CPT® 42900		PR SUTURE INJURY/WND PHARYNX	OP	"$1,034.00 "	$0.00	$0.00	$789.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$789.18	$329.25	$214.82	$329.25
42962	EAP	CPT® 42962		"PR CONTROL THROAT BLEED,SURG INTERVENTN"	OP	"$1,590.00 "	$0.00	$0.00	"$1,213.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,213.40"	$485.48	$301.60	$485.48
43191	EAP	CPT® 43191		PR ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH	OP	$479.00 	$0.00	$0.00	$359.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.87	$0.00	$77.36	$0.00
43197	EAP	CPT® 43197		PR ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC	OP	$498.00 	$0.00	$0.00	$193.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$193.37	$0.00	$111.85	$0.00
43198	EAP	CPT® 43198		PR ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY	OP	$436.00 	$0.00	$0.00	$231.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.86	$0.00	$124.82	$0.00
43200	EAP	CPT® 43200		PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC	OP	$630.00 	$0.00	$0.00	$219.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.27	$206.63	$116.83	$206.63
43202	EAP	CPT® 43202		PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY	OP	$687.00 	$0.00	$0.00	$271.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$255.38	$271.44	$123.34	$271.44
43205	EAP	CPT® 43205		PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES	OP	$945.00 	$0.00	$0.00	$344.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$344.66	$204.72	$135.02	$204.72
43213	EAP	CPT® 43213		PR ESOPHAGOSCOPY RETROGRADE DILATE BALLOON/OTHER	OP	$809.00 	$0.00	$0.00	$620.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$620.75	$0.00	$747.87	$0.00
43220	EAP	CPT® 43220		PR ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM	OP	$773.00 	$0.00	$0.00	$290.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.75	$117.44	$85.30	$117.44
43227	EAP	CPT® 43227		PR ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL	OP	$945.00 	$0.00	$0.00	$402.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$402.38	$193.94	$145.67	$193.94
43235	EAP	CPT® 43235		PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	OP	$630.00 	$0.00	$0.00	$301.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.23	$281.43	$142.74	$281.43
43239	EAP	CPT® 43239		PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE	OP	$730.00 	$0.00	$0.00	$339.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$339.77	$321.44	$147.69	$321.44
43242	EAP	CPT® 43242		PR EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY	OP	$887.00 	$0.00	$0.00	$633.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$633.80	$386.91	$199.85	$386.91
43244	EAP	CPT® 43244		PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES	OP	$973.00 	$0.00	$0.00	$592.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$592.04	$270.04	$166.08	$270.04
43245	EAP	CPT® 43245		PR EGD DILATION GASTRIC/DUODENAL STRICTURE	OP	$859.00 	$0.00	$0.00	$427.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$427.04	$172.74	$137.30	$172.74
43246	EAP	CPT® 43246		PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE	OP	"$1,260.00 "	$0.00	$0.00	$483.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$483.93	$231.20	$175.61	$231.20
43247	EAP	CPT® 43247		PR EGD FLEXIBLE FOREIGN BODY REMOVAL	OP	$859.00 	$0.00	$0.00	$430.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$430.43	$183.50	$137.30	$183.50
43248	EAP	CPT® 43248		PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS	OP	$759.00 	$0.00	$0.00	$404.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$404.90	$172.07	$127.39	$172.07
43249	EAP	CPT® 43249		PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM	OP	$830.00 	$0.00	$0.00	$374.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$374.33	$158.98	$117.03	$158.98
43250	EAP	CPT® 43250		PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS	OP	$945.00 	$0.00	$0.00	$413.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.37	$173.89	$129.58	$173.89
43251	EAP	CPT® 43251		PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH	OP	$612.00 	$0.00	$0.00	$475.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$475.46	$199.65	$149.64	$199.65
43255	EAP	CPT® 43255		PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD	OP	$626.00 	$0.00	$0.00	$486.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$486.00	$258.17	$177.42	$258.17
43259	EAP	CPT® 43259		PR EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM	OP	$759.00 	$0.00	$0.00	$546.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$546.29	$276.10	$180.43	$276.10
43260	EAP	CPT® 43260		PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING	OP	"$1,059.00 "	$0.00	$0.00	$773.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$773.52	$317.34	$233.29	$317.34
43262	EAP	CPT® 43262		PR ERCP W/SPHINCTEROTOMY/PAPILLOTOMY	OP	"$1,660.00 "	$0.00	$0.00	$856.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$856.20	$391.84	$298.41	$391.84
43264	EAP	CPT® 43264		PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT	OP	"$1,135.00 "	$0.00	$0.00	$872.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$872.30	$470.60	$348.50	$470.60
43270	EAP	CPT® 43270		PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE	OP	$701.00 	$0.00	$0.00	$561.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$561.47	$0.00	$439.15	$0.00
43273	EAP	CPT® 43273		PR ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC	OP	$375.00 	$0.00	$0.00	$281.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$281.84	$0.00	$74.56	$0.00
43274	EAP	CPT® 43274		PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT	OP	"$1,445.00 "	$0.00	$0.00	"$1,105.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,105.14"	$0.00	$294.95	$0.00
43275	EAP	CPT® 43275		PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT	OP	"$1,175.00 "	$0.00	$0.00	$901.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$901.97	$0.00	$243.22	$0.00
43276	EAP	CPT® 43276		PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE	OP	"$1,504.00 "	$0.00	$0.00	"$1,150.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,150.89"	$0.00	$306.83	$0.00
43277	EAP	CPT® 43277		PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA	OP	"$1,181.00 "	$0.00	$0.00	$906.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$906.80	$0.00	$244.71	$0.00
43280	EAP	CPT® 43280		"PR LAP,ESOPHAGOGAST FUNDOPLASTY"	OP	"$6,794.00 "	$0.00	$0.00	"$2,513.55"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,513.55"	$975.75	$656.46	$975.75
43282	EAP	CPT® 43282		"PR LAP, REPAIR PARAESOPHAGEAL HERNIA, INCL FUNDOPLASTY W/ MESH"	OP	"$5,475.00 "	$0.00	$0.00	"$4,037.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,037.03"	$0.00	$803.04	$0.00
43288	EAP	CPT® 43288		PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ	OP	"$11,876.00 "	$0.00	$0.00	"$8,694.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$8,694.90"	$0.00	"$2,333.73"	$0.00
43410	EAP	CPT® 43410		"PR SUTURE ESOPHAGUS WOUND,CERV APPRCH"	OP	"$3,177.00 "	$0.00	$0.00	"$2,446.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,446.46"	$914.34	$473.82	$914.34
43450	EAP	CPT® 43450		PR DILATE ESOPHAGUS	OP	$263.00 	$0.00	$0.00	$199.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.34	$149.39	$54.63	$149.39
43611	EAP	CPT® 43611		PR EXCIS STOAMCH MALIG	OP	"$3,853.00 "	$0.00	$0.00	"$2,840.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,840.27"	"$1,074.35"	$499.88	"$1,074.35"
43631	EAP	CPT® 43631		"PR REMV STOMACH,PART,DISTAL,GASTRODUOD"	OP	"$4,575.00 "	$0.00	$0.00	"$3,366.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,366.54"	"$1,295.31"	$720.97	"$1,295.31"
43653	EAP	CPT® 43653		"PR LAP,GASTROSTOMY,W/O TUBE CONSTR"	OP	"$1,963.00 "	$0.00	$0.00	"$1,329.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,329.66"	$486.12	$308.69	$486.12
43752	EAP	CPT® 43752		PR PLACEMENT NG/OG TUBE BY PHYSICIAN	OP	$207.00 	$0.00	$0.00	$94.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.82	$38.82	$0.00	$38.82
43761	EAP	CPT® 43761		REPOSITION GASTRIC FEEDING TUBE THRU DUODENUM	OP	$344.00 	$0.00	$0.00	$238.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$238.61	$116.68	$65.45	$116.68
43762	EAP	CPT® 43762		PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC	OP	$119.00 	$0.00	$0.00	$87.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.41	$0.00	$119.00	$0.00
43820	EAP	CPT® 43820		PR GASTROJEJUNOSTOMY	OP	"$4,237.00 "	$0.00	$0.00	"$3,114.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,114.60"	"$1,115.30"	$447.50	"$1,115.30"
43830	EAP	CPT® 43830		"PR GASTROSTOMY,OPEN,W/O TUBE CNSTR"	OP	"$2,210.00 "	$0.00	$0.00	"$1,624.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,624.16"	$603.92	$296.25	$603.92
43840	EAP	CPT® 43840		PR REPAIR PERF DUOD/GAST ULC-WND/INJ	OP	"$4,290.00 "	$0.00	$0.00	"$3,155.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,155.48"	"$1,137.28"	$446.02	"$1,137.28"
43870	EAP	CPT® 43870		"PR CLOSURE OF GASTROSTOMY,SURGICAL"	OP	"$2,236.00 "	$0.00	$0.00	"$1,652.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,652.46"	$615.81	$295.02	$615.81
43999	EAP	CPT® 43999		PR STOMACH SURGERY PROCEDURE UNLISTED	OP	"$1,500.00 "	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
44005	EAP	CPT® 44005		"PR FREEING BOWEL ADHESION,ENTEROLYSIS"	OP	"$3,445.00 "	$0.00	$0.00	"$2,540.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,540.13"	$969.16	$505.51	$969.16
44015	EAP	CPT® 44015		"PR INSERT TUBE-BOWEL,ENTERAL ALIMENT"	OP	"$1,243.00 "	$0.00	$0.00	$331.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.04	$135.11	$108.33	$135.11
44120	EAP	CPT® 44120		"PR RESECT SMALL INTEST,SINGL RESEC/ANAS"	OP	"$3,853.00 "	$0.00	$0.00	"$2,841.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,841.71"	"$1,071.99"	$537.97	"$1,071.99"
44121	EAP	CPT® 44121		"PR RESECT SMALL INTEST,EACH ADDNL"	OP	"$1,261.00 "	$0.00	$0.00	$563.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$563.90	$229.06	$153.30	$229.06
44130	EAP	CPT® 44130		PR BOWEL TO BOWEL ANASTOMOSIS	OP	"$4,140.00 "	$0.00	$0.00	"$3,049.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,049.79"	"$1,088.64"	$468.32	"$1,088.64"
44139	EAP	CPT® 44139		PR MOBILIZE SPLENIC FLEX	OP	$381.00 	$0.00	$0.00	$282.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.41	$114.63	$76.99	$114.63
44140	EAP	CPT® 44140		PR PART REMOVAL COLON W ANASTOMOSIS	OP	"$4,225.00 "	$0.00	$0.00	"$3,116.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,116.15"	"$1,199.50"	$674.02	"$1,199.50"
44141	EAP	CPT® 44141		PR PART REMOVAL COLON W COLOSTOMY	OP	"$5,736.00 "	$0.00	$0.00	"$4,244.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,244.00"	"$1,527.82"	$743.30	"$1,527.82"
44143	EAP	CPT® 44143		PR PART REMOVAL COLON W END COLOSTOMY	OP	"$5,235.00 "	$0.00	$0.00	"$3,869.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,869.15"	"$1,471.20"	$767.24	"$1,471.20"
44145	EAP	CPT® 44145		PR PART REMOVAL COLON W COLOPROCTOSTOMY	OP	"$5,198.00 "	$0.00	$0.00	"$3,853.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,853.49"	"$1,504.41"	$837.10	"$1,504.41"
44150	EAP	CPT® 44150		PR REMOVAL COLON/ILEOSTOMY	OP	"$5,857.00 "	$0.00	$0.00	"$4,347.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,347.51"	"$1,613.46"	$830.24	"$1,613.46"
44160	EAP	CPT® 44160		PR REMVL COLON & TERM ILEUM W/ILEOCOLOSTOMY	OP	"$6,255.00 "	$0.00	$0.00	"$2,885.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,885.09"	"$1,098.89"	$617.84	"$1,098.89"
44180	EAP	CPT® 44180		"PR LAP, SURG ENTEROLYSIS"	OP	"$2,897.00 "	$0.00	$0.00	"$2,133.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,133.32"	$824.02	$496.39	$824.02
44188	EAP	CPT® 44188		"PR LAP, SURG COLOSTOMY"	OP	"$3,833.00 "	$0.00	$0.00	"$2,849.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,849.45"	"$1,079.37"	$634.48	"$1,079.37"
44202	EAP	CPT® 44202		"PR LAP,SURG,ENTERECTOMY,RESECT & ANAST"	OP	"$4,363.00 "	$0.00	$0.00	"$3,223.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,223.31"	"$1,242.00"	$800.12	"$1,242.00"
44204	EAP	CPT® 44204		"PR LAP,SURG,COLECTOMY, PARTIAL, W/ANAST"	OP	"$4,834.00 "	$0.00	$0.00	"$3,575.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,575.97"	"$1,392.72"	$906.06	"$1,392.72"
44205	EAP	CPT® 44205		"PR LAP,SURG,COLECTOMY,W/REMVL TERM ILEUM"	OP	"$4,199.00 "	$0.00	$0.00	"$3,110.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,110.16"	"$1,218.00"	$802.47	"$1,218.00"
44207	EAP	CPT® 44207		"PR LAP,SURG,COLECTOMY,W/ANAST"	OP	"$5,699.00 "	$0.00	$0.00	"$4,232.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,232.73"	"$1,660.06"	$975.87	"$1,660.06"
44213	EAP	CPT® 44213		"PR LAP, SURG MOBIL SPLENIC FL DUR PTL COLECTOMY"	OP	$587.00 	$0.00	$0.00	$437.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$437.87	$180.68	$113.37	$180.68
44300	EAP	CPT® 44300		PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN	OP	"$2,654.00 "	$0.00	$0.00	"$1,955.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,955.48"	$739.84	$348.34	$739.84
44320	EAP	CPT® 44320		PR COLOSTOMY	OP	"$3,775.00 "	$0.00	$0.00	"$2,790.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,790.54"	"$1,056.65"	$514.29	"$1,056.65"
44360	EAP	CPT® 44360		PR ENDOSCOPY UPPER SMALL INTESTINE	OP	$999.00 	$0.00	$0.00	$351.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$351.12	$142.88	$117.91	$142.88
44366	EAP	CPT® 44366		PR ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING	OP	"$1,427.00 "	$0.00	$0.00	$579.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$579.98	$237.03	$200.56	$237.03
44372	EAP	CPT® 44372		PR ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE	OP	$999.00 	$0.00	$0.00	$578.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$578.87	$235.76	$201.19	$235.76
44378	EAP	CPT® 44378		PR ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING	OP	"$1,676.00 "	$0.00	$0.00	$921.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$921.27	$377.64	$272.79	$377.64
44384	EAP	CPT® 44384		PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT	OP	$480.00 	$0.00	$0.00	$368.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$368.69	$0.00	$0.00	$0.00
44388	EAP	CPT® 44388		PR COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX	OP	"$1,070.00 "	$0.00	$0.00	$380.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.39	$304.61	$163.88	$304.61
44389	EAP	CPT® 44389		PR COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE	OP	"$1,248.00 "	$0.00	$0.00	$417.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$417.50	$366.94	$180.29	$366.94
44392	EAP	CPT® 44392		PR COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS	OP	"$1,462.00 "	$0.00	$0.00	$479.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$479.94	$395.21	$214.76	$395.21
44394	EAP	CPT® 44394		PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE	OP	"$1,462.00 "	$0.00	$0.00	$545.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$545.07	$461.90	$236.08	$461.90
44602	EAP	CPT® 44602		"PR SUTURE SM INTEST,SINGLE PERF"	OP	"$4,444.00 "	$0.00	$0.00	"$3,281.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,281.04"	"$1,193.36"	$407.09	"$1,193.36"
44603	EAP	CPT® 44603		"PR SUTURE SM INTEST,MULTPL PERF"	OP	"$5,099.00 "	$0.00	$0.00	"$3,762.84"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,762.84"	"$1,360.61"	$519.74	"$1,360.61"
44604	EAP	CPT® 44604		PR SUTURE LRG INTEST	OP	"$3,329.00 "	$0.00	$0.00	"$2,456.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,456.09"	$944.98	$512.16	$944.98
44605	EAP	CPT® 44605		PR SUTURE LRG INTEST W COLOSTOMY	OP	"$4,102.00 "	$0.00	$0.00	"$3,033.05"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,033.05"	"$1,168.52"	$565.14	"$1,168.52"
44620	EAP	CPT® 44620		PR CLOSE ENTEROSTOMY	OP	"$2,721.00 "	$0.00	$0.00	"$2,017.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,017.34"	$757.37	$393.20	$757.37
44625	EAP	CPT® 44625		"PR CLOSE ENTEROSTOMY,RESEC+ANAST"	OP	"$3,178.00 "	$0.00	$0.00	"$2,362.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,362.89"	$903.00	$508.53	$903.00
44626	EAP	CPT® 44626		"PR CLOSE ENTEROSTOMY,RESEC+COLOREC ANAS"	OP	"$5,032.00 "	$0.00	$0.00	"$3,726.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,726.50"	"$1,448.52"	$788.46	"$1,448.52"
44650	EAP	CPT® 44650		PR REPAIR BOWEL-BOWEL FISTULA	OP	"$4,549.00 "	$0.00	$0.00	"$3,369.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,369.41"	"$1,307.41"	$536.49	"$1,307.41"
44700	EAP	CPT® 44700		"PR EXCLUSION,SMALL BOWEL FROM PELVIS"	OP	"$3,143.00 "	$0.00	$0.00	"$2,370.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,370.29"	$920.16	$557.24	$920.16
44850	EAP	CPT® 44850		PR SUTURE OF MESENTERY	OP	"$2,345.00 "	$0.00	$0.00	"$1,745.31"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,745.31"	$656.94	$353.18	$656.94
44955	EAP	CPT® 44955		"PR APPENDECTOMY,W OTHR PROC"	OP	"$1,029.00 "	$0.00	$0.00	$195.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.24	$79.77	$63.20	$79.77
44970	EAP	CPT® 44970		"PR LAP,APPENDECTOMY"	OP	"$1,900.00 "	$0.00	$0.00	"$1,395.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,395.38"	$520.36	$315.06	$520.36
45100	EAP	CPT® 45100		PR BIOPSY OF RECTUM	OP	$935.00 	$0.00	$0.00	$693.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$693.99	$246.06	$161.79	$246.06
45300	EAP	CPT® 45300		"PR PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS"	OP	$149.00 	$0.00	$0.00	$125.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.33	$74.43	$38.28	$74.43
45305	EAP	CPT® 45305		PR PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE	OP	$227.00 	$0.00	$0.00	$182.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$182.94	$141.38	$51.25	$141.38
45330	EAP	CPT® 45330		PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD	OP	$228.00 	$0.00	$0.00	$131.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.03	$121.99	$52.46	$121.99
45331	EAP	CPT® 45331		"PR SIGMOIDOSCOPY,BIOPSY"	OP	$531.00 	$0.00	$0.00	$168.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.81	$157.63	$71.53	$157.63
45334	EAP	CPT® 45334		PR SIGMOIDOSCOPY FLX CONTROL BLEEDING	OP	$623.00 	$0.00	$0.00	$290.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.03	$149.47	$114.02	$149.47
45335	EAP	CPT® 45335		PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST	OP	$699.00 	$0.00	$0.00	$192.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.77	$192.44	$88.49	$192.44
45338	EAP	CPT® 45338		PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ	OP	$720.00 	$0.00	$0.00	$295.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.58	$286.03	$126.88	$286.03
45340	EAP	CPT® 45340		PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT	OP	$242.00 	$0.00	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$195.20	$242.00	$0.00	$242.00
45349	EAP	CPT® 45349		PR SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION	OP	$620.00 	$0.00	$0.00	$479.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$479.24	$0.00	$0.00	$0.00
45378	EAP	CPT® 45378		PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD	OP	$862.00 	$0.00	$0.00	$448.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$448.02	$368.36	$203.67	$368.36
45379	EAP	CPT® 45379		PR COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S)	OP	$884.00 	$0.00	$0.00	$576.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$576.50	$464.40	$247.98	$464.40
45380	EAP	CPT® 45380		PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	OP	"$1,070.00 "	$0.00	$0.00	$485.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$485.90	$437.54	$220.97	$437.54
45381	EAP	CPT® 45381		PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST	OP	"$2,829.00 "	$0.00	$0.00	$485.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$485.96	$425.07	$238.33	$425.07
45382	EAP	CPT® 45382		PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD	OP	"$1,010.00 "	$0.00	$0.00	$624.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$624.87	$583.57	$287.26	$583.57
45384	EAP	CPT® 45384		PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS	OP	"$1,073.00 "	$0.00	$0.00	$550.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$550.58	$432.27	$248.03	$432.27
45385	EAP	CPT® 45385		PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ	OP	"$1,073.00 "	$0.00	$0.00	$613.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$613.53	$493.47	$282.15	$493.47
45388	EAP	CPT® 45388		PR COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES	OP	"$1,126.52 "	$0.00	$0.00	$651.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$651.06	$0.00	$0.00	$0.00
45390	EAP	CPT® 45390		PR COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION	OP	"$1,037.00 "	$0.00	$0.00	$795.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$795.38	$0.00	$0.00	$0.00
45393	EAP	CPT® 45393		PR COLONOSCOPY FLEXIBLE WITH DECOMPRESSION	OP	$791.00 	$0.00	$0.00	$608.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$608.33	$0.00	$0.00	$0.00
45395	EAP	CPT® 45395		"PR LAP, SURG PROCTECTOMY W COLOSTOMY"	OP	"$6,152.00 "	$0.00	$0.00	"$4,597.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,597.52"	"$1,780.30"	"$1,055.31"	"$1,780.30"
45562	EAP	CPT® 45562		PR EXPLOR/REPAIR RECTUM INJURY	OP	"$3,539.00 "	$0.00	$0.00	"$2,598.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,598.83"	$961.28	$457.11	$961.28
45990	EAP	CPT® 45990		"PR SURG DIAGNOSTIC EXAM, ANORECTAL"	OP	$332.00 	$0.00	$0.00	$249.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.38	$98.64	$63.83	$98.64
46020	EAP	CPT® 46020		"PR PLACEMENT,SETON"	OP	$737.00 	$0.00	$0.00	$543.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$543.20	$208.35	$152.42	$208.35
46030	EAP	CPT® 46030		PR REMOVAL OF RECTAL MARKER	OP	$280.00 	$0.00	$0.00	$208.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.85	$103.08	$64.99	$103.08
46040	EAP	CPT® 46040		PR I&D PERIRECTAL ABSCESS	OP	"$1,315.00 "	$0.00	$0.00	$959.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$959.70	$417.89	$196.63	$417.89
46050	EAP	CPT® 46050		"PR I&D PERIANAL ABSCESS,SUPERFICIAL"	OP	$375.00 	$0.00	$0.00	$225.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.05	$146.55	$72.44	$146.55
46220	EAP	CPT® 46220		PR REMOVAL OF ANAL TAB	OP	$444.00 	$0.00	$0.00	$274.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$274.70	$151.82	$58.90	$151.82
46221	EAP	CPT® 46221		PR LIGATION OF HEMORRHOID(S)	OP	$597.00 	$0.00	$0.00	$440.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$440.07	$196.41	$74.93	$196.41
46250	EAP	CPT® 46250		"PR HEMORRHOIDECTOMY,EXTERNAL"	OP	$994.00 	$0.00	$0.00	$730.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$730.65	$363.95	$200.59	$363.95
46260	EAP	CPT® 46260		"PR HEMORRHOIDECTOMY,INT/EXT,COMPLX"	OP	"$1,500.00 "	$0.00	$0.00	"$1,101.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,101.26"	$385.93	$298.78	$385.93
46270	EAP	CPT® 46270		"PR REMOVAL ANAL FISTULA,SUBCUTANEOUS"	OP	"$1,236.00 "	$0.00	$0.00	$907.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$907.76	$380.92	$165.09	$380.92
46280	EAP	CPT® 46280		"PR REMOVAL ANAL FISTULA,COMPLEX/MULTI"	OP	"$1,483.00 "	$0.00	$0.00	"$1,086.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,086.24"	$373.73	$257.50	$373.73
46288	EAP	CPT® 46288		"PR REPAIR  ANAL FISTULA,RECT ADV FLAP"	OP	"$1,724.00 "	$0.00	$0.00	"$1,273.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,273.77"	$443.27	$260.21	$443.27
46505	EAP	CPT® 46505		PR CHEMODENERVATION ANAL SPHINCTER	OP	$764.00 	$0.00	$0.00	$552.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$552.84	$230.03	$136.01	$230.03
46600	EAP	CPT® 46600		PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD	OP	$174.00 	$0.00	$0.00	$94.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.86	$75.46	$23.41	$75.46
46601	EAP	CPT® 46601		PR ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT	OP	$293.00 	$0.00	$0.00	$217.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$217.35	$0.00	$0.00	$0.00
46606	EAP	CPT® 46606		PR ANOSCOPY AND BIOPSY	OP	$235.00 	$0.00	$0.00	$176.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.64	$171.31	$33.01	$171.31
46607	EAP	CPT® 46607		PR ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX	OP	$395.00 	$0.00	$0.00	$292.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$292.77	$0.00	$0.00	$0.00
46612	EAP	CPT® 46612		"PR ANOSCOPY,REMOVE LESIONS"	OP	$459.00 	$0.00	$0.00	$282.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.39	$282.59	$98.26	$282.59
46900	EAP	CPT® 46900		"PR DESTRUCT,ANAL LESN(S),SIMPLE,CHEM"	OP	$424.00 	$0.00	$0.00	$317.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$317.64	$177.67	$86.26	$177.67
46910	EAP	CPT® 46910		"PR ELECTRODESSICATN,ANAL LESN(S)"	OP	$415.00 	$0.00	$0.00	$310.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.05	$188.44	$90.57	$188.44
46916	EAP	CPT® 46916		"PR CRYOSURGERY, ANAL LESION(S)"	OP	$439.00 	$0.00	$0.00	$331.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$331.50	$191.82	$86.86	$191.82
46922	EAP	CPT® 46922		PR SURG EXCISION OF ANAL LESION(S)	OP	$502.00 	$0.00	$0.00	$313.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$313.14	$201.45	$99.27	$201.45
46924	EAP	CPT® 46924		"PR DESTRUCTION,ANAL LESION(S),EXTENSIVE"	OP	"$2,401.00 "	$0.00	$0.00	$433.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$424.86	$433.70	$149.11	$433.70
46945	EAP	CPT® 46945		PR INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN	OP	"$1,041.00 "	$0.00	$0.00	$522.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$522.47	$215.90	$99.74	$215.90
46946	EAP	CPT® 46946		PR INT HRHC BY LIGATION 2+ HROID W/O IMG GDN	OP	"$1,174.00 "	$0.00	$0.00	$521.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$521.24	$246.07	$135.20	$246.07
46948	EAP	CPT® 46948		PR INT HRHC TRANSANAL HROID DARTLZJ 2+ W/US GDN	OP	"$1,374.00 "	$0.00	$0.00	"$1,021.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,021.35"	$0.00	$271.43	$0.00
47000	EAP	CPT® 47000		PR BIOPSY LIVER NEEDLE PERCUTANEOUS	OP	$456.00 	$0.00	$0.00	$239.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$239.66	$222.58	$145.84	$222.58
47015	EAP	CPT® 47015		PR INJECT/ASPIRATE LIVER CYST/ABSCESS	OP	"$3,674.00 "	$0.00	$0.00	"$2,659.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,659.32"	$991.02	$377.29	$991.02
47350	EAP	CPT® 47350		PR REPAIR BLEED LIVER/SUTURE WOUND	OP	"$4,313.00 "	$0.00	$0.00	"$3,180.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,180.71"	"$1,205.02"	$470.65	"$1,205.02"
47360	EAP	CPT® 47360		PR REPR BLEED LIVER/COMPLX SUTURE WND	OP	"$5,926.00 "	$0.00	$0.00	"$4,318.40"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,318.40"	"$1,642.02"	$651.77	"$1,642.02"
47361	EAP	CPT® 47361		"PR EXPLOR LIVER WOUND,EXTENSIV DEBRIDE"	OP	"$9,553.00 "	$0.00	$0.00	"$7,019.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,019.58"	"$2,721.55"	"$1,061.54"	"$2,721.55"
47362	EAP	CPT® 47362		"PR RE-EXPLORE LIVER WOUND,REMV PACKING"	OP	"$4,578.00 "	$0.00	$0.00	"$3,365.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,365.72"	"$1,239.59"	$423.48	"$1,239.59"
47531	EAP	CPT® 47531		PR NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS	OP	$221.00 	$0.00	$0.00	$221.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.00	$0.00	$221.00	$0.00
47534	EAP	CPT® 47534		PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT	OP	"$1,165.00 "	$0.00	$0.00	$945.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$945.81	$0.00	$997.21	$0.00
47536	EAP	CPT® 47536		PR EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I	OP	$415.00 	$0.00	$0.00	$344.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$344.06	$0.00	$415.00	$0.00
47542	EAP	CPT® 47542		PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT	OP	$428.00 	$0.00	$0.00	$310.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.19	$0.00	$312.38	$0.00
47543	EAP	CPT® 47543		PR ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT	OP	$455.00 	$0.00	$0.00	$390.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$390.21	$0.00	$455.00	$0.00
47562	EAP	CPT® 47562		"PR LAP,CHOLECYSTECTOMY"	OP	"$2,964.00 "	$0.00	$0.00	"$1,526.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,526.54"	$646.61	$417.96	$646.61
47563	EAP	CPT® 47563		"PR LAP,CHOLECYSTECTOMY/GRAPH"	OP	"$3,162.00 "	$0.00	$0.00	"$1,658.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,658.48"	$671.23	$449.60	$671.23
47564	EAP	CPT® 47564		"PR LAP,CHOLECYSTECTOMY/EXPLORE"	OP	"$3,513.00 "	$0.00	$0.00	"$2,584.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,584.79"	$780.05	$533.76	$780.05
47600	EAP	CPT® 47600		PR REMOVAL GALLBLADDER	OP	"$3,371.00 "	$0.00	$0.00	"$2,478.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,478.12"	$910.71	$433.59	$910.71
48000	EAP	CPT® 48000		PR PLACE DRAIN ABD FOR PANCREATITIS	OP	"$5,951.00 "	$0.00	$0.00	"$4,344.06"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,344.06"	"$1,661.60"	$525.36	"$1,661.60"
48140	EAP	CPT® 48140		"PR PART REMV PANCREAS,DISTAL SUBTOTAL"	OP	"$4,929.00 "	$0.00	$0.00	"$3,629.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,629.03"	"$1,378.61"	$771.72	"$1,378.61"
48150	EAP	CPT® 48150		"PR PART REMV PANC,PROX+REMV DUOD+ANAST"	OP	"$9,830.00 "	$0.00	$0.00	"$7,228.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,228.58"	"$2,779.88"	"$1,546.87"	"$2,779.88"
49000	EAP	CPT® 49000		PR EXPLORATORY OF ABDOMEN	OP	"$2,420.00 "	$0.00	$0.00	"$1,789.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,789.41"	$687.40	$430.51	$687.40
49002	EAP	CPT® 49002		PR REOPEN RECENT ABD EXPLORATORY	OP	"$3,292.00 "	$0.00	$0.00	"$2,428.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,428.37"	$866.87	$391.50	$866.87
49010	EAP	CPT® 49010		PR EXPLORATORY RETROPERITONEAL	OP	"$2,908.00 "	$0.00	$0.00	"$2,167.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,167.71"	$838.16	$456.69	$838.16
49013	EAP	CPT® 49013		PR PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA	OP	"$1,375.00 "	$0.00	$0.00	"$1,018.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,018.53"	$0.00	$271.54	$0.00
49020	EAP	CPT® 49020		PR DRAIN ABD ABSCESS OPEN	OP	"$5,014.00 "	$0.00	$0.00	"$3,694.61"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,694.61"	"$1,404.93"	$544.99	"$1,404.93"
49082	EAP	CPT® 49082		PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE	OP	$365.00 	$0.00	$0.00	$172.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.77	$0.00	$98.20	$0.00
49083	EAP	CPT® 49083		PR ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE	OP	$336.00 	$0.00	$0.00	$253.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.32	$0.00	$185.31	$0.00
49084	EAP	CPT® 49084		PR PERITONEAL LAVAGE W/WO IMAGING GUIDANCE	OP	$342.00 	$0.00	$0.00	$252.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.08	$0.00	$58.39	$0.00
49180	EAP	CPT® 49180		"PR PERCUT BIOPSY, ABDOMINAL MASS"	OP	$623.00 	$0.00	$0.00	$199.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.34	$170.97	$127.56	$170.97
49203	EAP	CPT® 49203		PR EXCISION/DESTRUCTION OPEN ABDOMINAL TUMORS 5 CM	OP	"$3,751.00 "	$0.00	$0.00	"$2,778.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,778.71"	$0.00	$562.03	$0.00
49255	EAP	CPT® 49255		PR REMOVAL OF OMENTUM	OP	"$2,472.00 "	$0.00	$0.00	"$1,835.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,835.25"	$693.67	$398.05	$693.67
49320	EAP	CPT® 49320		"PR LAP,DIAGNOSTIC ABDOMEN"	OP	"$1,418.00 "	$0.00	$0.00	$754.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$754.55	$297.16	$207.81	$297.16
49322	EAP	CPT® 49322		"PR LAP,ABDOMEN,ASPIRATE CYST"	OP	"$1,609.00 "	$0.00	$0.00	$852.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$852.47	$341.41	$230.06	$341.41
49324	EAP	CPT® 49324		PR LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER	OP	"$1,226.00 "	$0.00	$0.00	$905.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$905.96	$349.50	$0.00	$349.50
49326	EAP	CPT® 49326		PR LAP OMENTOPEXY ADD-ON	OP	$597.00 	$0.00	$0.00	$440.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$440.55	$172.63	$0.00	$172.63
49402	EAP	CPT® 49402		PR REMOVE PERITONEAL FOREIGN BODY	OP	"$2,696.00 "	$0.00	$0.00	"$1,987.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,987.53"	$753.19	$432.33	$753.19
49405	EAP	CPT® 49405		PR IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ	OP	$618.00 	$0.00	$0.00	$493.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.55	$0.00	$529.06	$0.00
49406	EAP	CPT® 49406		PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ	OP	$617.00 	$0.00	$0.00	$493.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$493.55	$0.00	$528.84	$0.00
49422	EAP	CPT® 49422		PR REMOVAL TUNNELED INTRAPERITONEAL CATHETER	OP	"$1,149.00 "	$0.00	$0.00	$883.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$883.40	$352.93	$233.52	$352.93
49423	EAP	CPT® 49423		PR DRAINAGE CATHETER EXCHANGE	OP	"$1,801.00 "	$0.00	$0.00	$555.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.97	$555.36	$52.90	$555.36
49424	EAP	CPT® 49424		"PR CONTRAST INJ,ABSCESS/CYST VIA CATH TUBE"	OP	$498.00 	$0.00	$0.00	$156.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.22	$156.80	$27.03	$156.80
49428	EAP	CPT® 49428		PR LIGATION OF ABD-VENOUS SHUNT	OP	"$1,360.00 "	$0.00	$0.00	"$1,001.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,001.78"	$403.68	$92.02	$403.68
49440	EAP	CPT® 49440		PR INSERT GASTROSTOMY TUBE PERCUTANEOUS	OP	$807.00 	$0.00	$0.00	$516.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$516.90	$0.00	$0.00	$0.00
49441	EAP	CPT® 49441		PR INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ	OP	$756.00 	$0.00	$0.00	$598.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$598.25	$0.00	$730.57	$0.00
49446	EAP	CPT® 49446		PR CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ	OP	$574.00 	$0.00	$0.00	$379.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$379.31	$0.00	$574.00	$0.00
49450	EAP	CPT® 49450		PR REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS	OP	$207.00 	$0.00	$0.00	$156.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$156.68	$0.00	$207.00	$0.00
49452	EAP	CPT® 49452		PR REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS	OP	"$2,572.00 "	$0.00	$0.00	$326.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$326.31	$0.00	$553.80	$0.00
49465	EAP	CPT® 49465		PR CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE	OP	$96.00 	$0.00	$0.00	$72.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.36	$0.00	$94.35	$0.00
49505	EAP	CPT® 49505		"PR REPAIR ING HERNIA,5+Y/O,REDUCIBL"	OP	"$1,640.00 "	$0.00	$0.00	"$1,207.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,207.52"	$452.36	$254.67	$452.36
49507	EAP	CPT® 49507		"PR REPAIR ING HERNIA,5+Y/O,STRANG"	OP	"$1,855.00 "	$0.00	$0.00	"$1,357.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,357.11"	$559.48	$317.72	$559.48
49520	EAP	CPT® 49520		"PR REPAIR RECURR INGUIN HERN,REDUCIBL"	OP	"$1,990.00 "	$0.00	$0.00	"$1,465.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,465.76"	$555.93	$314.98	$555.93
49521	EAP	CPT® 49521		"PR REPAIR RECURR INGUIN HERN,STRANG"	OP	"$2,259.00 "	$0.00	$0.00	"$1,660.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,660.95"	$681.28	$363.87	$681.28
49525	EAP	CPT® 49525		PR REPAIR SLIDING INGUINAL HERNIA	OP	"$1,807.00 "	$0.00	$0.00	"$1,328.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,328.27"	$501.42	$291.91	$501.42
49540	EAP	CPT® 49540		PR REPAIR LUMBAR HERNIA	OP	"$2,124.00 "	$0.00	$0.00	"$1,556.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,556.39"	$596.76	$333.75	$596.76
49550	EAP	CPT® 49550		"PR REPAIR FEMORAL HERNIA,REDUCIBLE"	OP	"$1,819.00 "	$0.00	$0.00	"$1,333.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,333.82"	$504.81	$277.96	$504.81
49553	EAP	CPT® 49553		"PR REPAIR FEMORAL HERNIA,STRANG"	OP	"$2,102.00 "	$0.00	$0.00	"$1,463.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,463.45"	$551.94	$298.29	$551.94
49560	EAP	CPT® 49560		"PR REPAIR INCISIONAL HERNIA,REDUCIBLE"	OP	"$2,425.00 "	$0.00	$0.00	"$1,710.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,710.68"	$656.75	$366.38	$656.75
49561	EAP	CPT® 49561		"PR REPAIR INCISIONAL HERNIA,STRANG"	OP	"$2,930.00 "	$0.00	$0.00	"$2,157.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,157.66"	$825.64	$426.73	$825.64
49565	EAP	CPT® 49565		"PR REPAIR RECURR INCIS HERNIA,REDUC"	OP	"$2,789.00 "	$0.00	$0.00	"$1,781.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,781.30"	$676.70	$376.71	$676.70
49568	EAP	CPT® 49568		PR IMPLANT MESH HERNIA REPAIR/DEBRIDEMENT CLOSURE	OP	$844.00 	$0.00	$0.00	$621.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$621.42	$251.95	$168.88	$251.95
49585	EAP	CPT® 49585		"REPAIR UMBILICAL HERN,5+Y/O,REDUC"	OP	"$1,819.00 "	$0.00	$0.00	"$1,030.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,030.79"	$381.18	$221.93	$381.18
49587	EAP	CPT® 49587		"REPAIR UMBILICAL HERN,5+Y/O,STRANG"	OP	"$2,102.00 "	$0.00	$0.00	"$1,102.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,102.80"	$453.54	$250.43	$453.54
49650	EAP	CPT® 49650		"PR LAP,INGUINAL HERNIA REPR,INITIAL"	OP	"$1,940.00 "	$0.00	$0.00	$993.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$993.08	$372.62	$242.05	$372.62
49652	EAP	CPT® 49652		"PR LAP, VENTRAL HERNIA REPAIR,REDUCIBLE"	OP	"$2,346.00 "	$0.00	$0.00	"$1,726.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,726.71"	$0.00	$422.96	$0.00
49653	EAP	CPT® 49653		"PR LAP, VENTRAL HERNIA REPAIR,INCARCERATED"	OP	"$2,929.00 "	$0.00	$0.00	"$2,153.43"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,153.43"	$0.00	$528.11	$0.00
49654	EAP	CPT® 49654		"PR LAP, INCISIONAL HERNIA REPAIR,REDUCIBLE"	OP	"$2,664.00 "	$0.00	$0.00	"$1,961.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,961.81"	$0.00	$485.50	$0.00
49905	EAP	CPT® 49905		"PR OMENTAL FLAP,INTRA-ABDOMINAL"	OP	"$1,617.00 "	$0.00	$0.00	$821.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$821.10	$336.24	$226.37	$336.24
49999	EAP	CPT® 49999		PR ABDOMEN SURGERY PROC UNLISTED	OP	"$1,000.00 "	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
50045	EAP	CPT® 50045		PR EXPLORATION OF KIDNEY	OP	"$3,409.00 "	$0.00	$0.00	"$2,222.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,222.39"	$894.02	$568.20	$894.02
50080	EAP	CPT® 50080		PR PERQ NL/PL LITHOTRP SIMPLE UP TO 2 CM 1 LOCATION	OP	"$3,674.00 "	$0.00	$0.00	"$2,008.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,008.94"	$842.71	$594.36	$842.71
50081	EAP	CPT® 50081		PR PERQ NL/PL LITHOTRP COMPLEX >2 CM MLT LOCATIONS	OP	"$4,224.00 "	$0.00	$0.00	"$2,948.78"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,948.78"	"$1,236.44"	$817.88	"$1,236.44"
50200	EAP	CPT® 50200		PR RENAL BIOPSY PRQ TROCAR/NEEDLE	OP	$606.00 	$0.00	$0.00	$330.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$330.41	$144.65	$101.12	$144.65
50220	EAP	CPT® 50220		"PR REMV KIDNEY,W/RIB RESECTION"	OP	"$3,334.00 "	$0.00	$0.00	"$2,418.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,418.99"	$992.83	$658.17	$992.83
50230	EAP	CPT® 50230		"PR REMV KIDNEY,RADICAL"	OP	"$4,167.00 "	$0.00	$0.00	"$2,960.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,960.60"	"$1,240.35"	$848.42	"$1,240.35"
50240	EAP	CPT® 50240		PR PARTIAL REMOVAL OF KIDNEY	OP	"$4,205.00 "	$0.00	$0.00	"$3,058.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,058.65"	"$1,272.40"	$840.39	"$1,272.40"
50382	EAP	CPT® 50382		PR RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ	OP	$804.00 	$0.00	$0.00	$804.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$630.03	$804.00	$804.00	$804.00
50384	EAP	CPT® 50384		PR REMOVAL INDWELLING URETERAL STENT PRQ	OP	$719.00 	$0.00	$0.00	$719.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$572.15	$719.00	$719.00	$719.00
50387	EAP	CPT® 50387		PR RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH	OP	$263.00 	$0.00	$0.00	$263.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$226.67	$263.00	$263.00	$263.00
50389	EAP	CPT® 50389		PR REMOVE RENAL TUBE W/FLUORO	OP	$168.00 	$0.00	$0.00	$168.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.17	$168.00	$168.00	$168.00
50390	EAP	CPT® 50390		PR PERCUT DRAIN/INJECT RENAL CYST	OP	$436.00 	$0.00	$0.00	$225.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.06	$96.44	$71.13	$96.44
50430	EAP	CPT® 50430		PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS	OP	$482.00 	$0.00	$0.00	$389.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$389.19	$0.00	$315.27	$0.00
50431	EAP	CPT® 50431		PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS	OP	$203.00 	$0.00	$0.00	$154.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.50	$0.00	$98.04	$0.00
50432	EAP	CPT® 50432		PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I	OP	$645.00 	$0.00	$0.00	$514.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$514.61	$0.00	$511.40	$0.00
50433	EAP	CPT® 50433		PR PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I	OP	$801.00 	$0.00	$0.00	$634.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$634.31	$0.00	$688.33	$0.00
50434	EAP	CPT® 50434		PR CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ	OP	$602.00 	$0.00	$0.00	$486.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$486.42	$0.00	$544.70	$0.00
50435	EAP	CPT® 50435		PR EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I	OP	$312.00 	$0.00	$0.00	$236.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.49	$0.00	$285.94	$0.00
50436	EAP	CPT® 50436		PR PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG	OP	$471.00 	$0.00	$0.00	$351.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$351.35	$0.00	$93.74	$0.00
50500	EAP	CPT® 50500		PR REPAIR OF KIDNEY WOUND	OP	"$3,884.00 "	$0.00	$0.00	"$2,952.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,952.83"	"$1,132.09"	$735.46	"$1,132.09"
50543	EAP	CPT® 50543		"PR LAP,PARTIAL NEPHRECTOMY"	OP	"$4,652.00 "	$0.00	$0.00	"$3,435.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,435.63"	"$1,440.37"	$828.75	"$1,440.37"
50545	EAP	CPT® 50545		"PR LAP, RADICAL NEPHRECTOMY"	OP	"$5,171.00 "	$0.00	$0.00	"$3,096.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,096.02"	"$1,311.47"	$899.02	"$1,311.47"
50546	EAP	CPT® 50546		PR NEPHRECTOMY	OP	"$3,762.00 "	$0.00	$0.00	"$2,780.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,780.01"	"$1,159.86"	$660.67	"$1,159.86"
50600	EAP	CPT® 50600		PR EXPLORATION OF URETER	OP	"$2,932.00 "	$0.00	$0.00	"$2,179.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,179.01"	$907.44	$574.97	$907.44
50693	EAP	CPT® 50693		PR PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT	OP	$640.00 	$0.00	$0.00	$508.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$508.95	$0.00	$640.00	$0.00
50785	EAP	CPT® 50785		"PR REIMPLANT URETER,VESICOPSOAS HITCH"	OP	"$3,791.00 "	$0.00	$0.00	"$2,803.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,803.46"	"$1,166.42"	$774.35	"$1,166.42"
51040	EAP	CPT® 51040		PR INCISE/DRAIN BLADDER	OP	"$3,867.00 "	$0.00	$0.00	$667.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$667.64	$278.16	$203.21	$278.16
51050	EAP	CPT® 51050		"PR OPEN BLADDER,REMV CALCULUS"	OP	"$4,640.00 "	$0.00	$0.00	"$1,090.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,090.20"	$446.61	$298.78	$446.61
51065	EAP	CPT® 51065		"PR CYSTOTOMY,EXTRACT &/OR FRAG URETER CALC"	OP	"$5,413.00 "	$0.00	$0.00	"$1,335.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,335.24"	$549.13	$352.59	$549.13
51565	EAP	CPT® 51565		"PR PART REMV BLADDER,REIMPLNT URETER"	OP	"$8,506.00 "	$0.00	$0.00	"$3,003.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,003.98"	"$1,249.28"	$812.58	"$1,249.28"
51600	EAP	CPT® 51600		PR INJECTION FOR BLADDER X-RAY	OP	$290.00 	$0.00	$0.00	$209.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.83	$209.38	$175.26	$209.38
51610	EAP	CPT® 51610		PR INJECT FOR RETROGRADE URETHOCYSTO	OP	$348.00 	$0.00	$0.00	$148.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.86	$119.37	$188.59	$119.37
51700	EAP	CPT® 51700		PR IRRIGATION OF BLADDER	OP	$155.00 	$0.00	$0.00	$103.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.59	$91.13	$62.86	$91.13
51701	EAP	CPT® 51701		"PR INSERT,NON-INDWELLING BLADDER CATHETER"	OP	$147.00 	$0.00	$0.00	$72.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.28	$72.23	$36.05	$72.23
51702	EAP	CPT® 51702		"PR INSERT,TEMP INDWELLING BLAD CATH,SIMPLE"	OP	$147.00 	$0.00	$0.00	$90.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.93	$90.16	$57.05	$90.16
51703	EAP	CPT® 51703		"PR INSERT,TEMP INDWELLING BLAD CATH,COMP"	OP	$241.00 	$0.00	$0.00	$188.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.06	$151.54	$106.48	$151.54
51705	EAP	CPT® 51705		"PR CHANGE OF BLADDER TUBE,SIMPLE"	OP	$329.00 	$0.00	$0.00	$120.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.78	$120.08	$54.01	$120.08
51710	EAP	CPT® 51710		"PR CHANGE OF BLADDER TUBE,COMPLICATED"	OP	"$1,025.00 "	$0.00	$0.00	$184.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.92	$173.53	$91.13	$173.53
51720	EAP	CPT® 51720		PR INSTILL ANTICANCER AGENT IN BLADDER	OP	"$1,005.00 "	$0.00	$0.00	$184.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.82	$121.01	$92.38	$121.01
51729	EAP	CPT® 51729		COMPLEX CYSTOMETROGRAM W/ VOIDING PRESSURE STUDIES	OP	$980.00 	$0.00	$0.00	$775.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$775.89	$0.00	$147.43	$0.00
51741	EAP	CPT® 51741		PR COMPLEX UROFLOWMETRY	OP	$217.00 	$0.00	$0.00	$77.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.27	$77.70	$40.65	$77.70
51785	EAP	CPT® 51785		"PR ANAL/URINARY MUSCLE STUDY,NEEDLE"	OP	"$1,085.00 "	$0.00	$0.00	$603.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$603.03	$222.83	$59.20	$222.83
51797	EAP	CPT® 51797		PR VOIDING PRESS STUDY INTRA-ABDOMINAL VOID	OP	$475.00 	$0.00	$0.00	$265.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$255.17	$265.73	$61.13	$265.73
51798	EAP	CPT® 51798		"PR MEAS,POST-VOID RES,US,NON-IMAGING"	OP	$35.00 	$0.00	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.00	$17.12	$12.51	$17.12
51860	EAP	CPT® 51860		"PR REPAIR BLADDER WOUND/INJ,SIMPLE"	OP	"$3,044.00 "	$0.00	$0.00	"$1,722.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,722.23"	$703.49	$455.81	$703.49
51865	EAP	CPT® 51865		"PR REPAIR BLADDER WOUND/INJ,COMPLIC"	OP	"$3,913.00 "	$0.00	$0.00	"$2,067.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,067.32"	$860.88	$575.11	$860.88
51992	EAP	CPT® 51992		"PR LAP,SLING OPERATION"	OP	"$3,348.00 "	$0.00	$0.00	"$1,940.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,940.42"	$803.41	$461.46	$803.41
52000	EAP	CPT® 52000		PR CYSTOURETHROSCOPY	OP	$478.00 	$0.00	$0.00	$291.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$291.75	$208.78	$95.49	$208.78
52001	EAP	CPT® 52001		PR CYSTOURETHROSCOPY W/IRRIG & EVAC CLOTS	OP	$895.00 	$0.00	$0.00	$665.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$665.13	$392.98	$88.69	$392.98
52005	EAP	CPT® 52005		"PR CYSTOURETHROSCOPY,URETER CATHETER"	OP	$783.00 	$0.00	$0.00	$307.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.79	$295.39	$133.59	$295.39
52007	EAP	CPT® 52007		"PR CYSTOURETHROSCOPY,URETERAL BIOPSY"	OP	$870.00 	$0.00	$0.00	$664.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$383.28	$664.53	$115.19	$664.53
52204	EAP	CPT® 52204		"PR CYSTOURETHROSCOPY,BIOPSIES"	OP	$700.00 	$0.00	$0.00	$572.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$327.84	$572.80	$143.91	$572.80
52214	EAP	CPT® 52214		"PR CYSTOURETHROSCOPY,FULGURATN"	OP	$700.00 	$0.00	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.93	$700.00	$184.23	$700.00
52224	EAP	CPT® 52224		"PR CYSTOURETHROSCOPY,FULGUR <.5CM LESN"	OP	$737.00 	$0.00	$0.00	$737.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$471.38	$737.00	$170.72	$737.00
52234	EAP	CPT® 52234		"PR CYSTOURETHROSCOPY,FULGUR .5-2CM LESN"	OP	"$1,106.00 "	$0.00	$0.00	$569.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$569.57	$242.74	$236.74	$242.74
52235	EAP	CPT® 52235		"PR CYSTOURETHROSCOPY,FULGUR 2-5CM LESN"	OP	"$1,843.00 "	$0.00	$0.00	$668.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$668.37	$284.62	$274.51	$284.62
52240	EAP	CPT® 52240		"PR CYSTOURETHROSCOPY,FULGUR >5CM LESN"	OP	"$2,580.00 "	$0.00	$0.00	$907.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$907.67	$500.51	$445.55	$500.51
52260	EAP	CPT® 52260		"PR CYSTOSCOPY,DIL BLADDER,GEN ANESTH"	OP	$663.00 	$0.00	$0.00	$486.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$486.86	$206.20	$130.69	$206.20
52276	EAP	CPT® 52276		"PR CYSTOSCOPY,DIR VIS INT URETHROTOMY"	OP	"$1,364.00 "	$0.00	$0.00	$612.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$612.93	$261.24	$246.11	$261.24
52281	EAP	CPT® 52281		"PR CYSTOSCOPY,DIL URETHRAL STRICTURE"	OP	$663.00 	$0.00	$0.00	$351.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$351.96	$349.91	$130.14	$349.91
52282	EAP	CPT® 52282		"PR CYSTOSCOPY,INSERT URETHRAL STENT"	OP	"$1,054.00 "	$0.00	$0.00	$779.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$779.12	$332.04	$280.80	$332.04
52287	EAP	CPT® 52287		PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER	OP	$529.00 	$0.00	$0.00	$391.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$391.20	$0.00	$184.72	$0.00
52300	EAP	CPT® 52300		"PR CYSTOSCOPY,RESECT ORTHO URETEROCELE"	OP	$872.00 	$0.00	$0.00	$649.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$649.91	$278.44	$184.65	$278.44
52310	EAP	CPT® 52310		"PR CYSTOSCOPY,REMV CALCULUS,SIMPLE"	OP	$756.02 	$0.00	$0.00	$351.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$351.08	$272.70	$255.98	$272.70
52317	EAP	CPT® 52317		"PR REMOVE BLADDER STONE,<2.5CM"	OP	"$1,511.00 "	$0.00	$0.00	"$1,206.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$804.80	"$1,206.26"	$482.01	"$1,206.26"
52332	EAP	CPT® 52332		"PR CYSTOSCOPY,INSERT URETERAL STENT"	OP	"$1,238.30 "	$0.00	$0.00	$379.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.99	$379.61	$419.27	$379.61
52351	EAP	CPT® 52351		"PR CYSTO/URETERO/PYELOSCOPY, DX"	OP	"$1,500.00 "	$0.00	$0.00	$701.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$701.30	$308.39	$228.27	$308.39
52352	EAP	CPT® 52352		"PR CYSTO/URETERO/PYELOSCOPY, CALCULUS TX"	OP	"$2,667.00 "	$0.00	$0.00	$820.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$820.16	$362.47	$282.94	$362.47
52353	EAP	CPT® 52353		PR CYSTO/URETERO/PYELOSCOPY W/LITHOTRIPSY	OP	"$3,334.00 "	$0.00	$0.00	$907.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$907.67	$417.49	$327.79	$417.49
52354	EAP	CPT® 52354		"PR CYSTO/URETERO/PYELOSC,BX &/OR FULG LESN"	OP	"$1,800.00 "	$0.00	$0.00	$965.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$965.51	$385.94	$286.36	$385.94
52355	EAP	CPT® 52355		"PR CYSTO/URETERO/PYELOSCOPY,W/RESECT TUMOR"	OP	"$2,134.00 "	$0.00	$0.00	"$1,081.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,081.95"	$460.57	$336.00	$460.57
52356	EAP	CPT® 52356		PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT	OP	"$1,296.00 "	$0.00	$0.00	$963.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$963.08	$0.00	$251.08	$0.00
52601	EAP	CPT® 52601		PR TRANSURETHRAL ELEC-SURG PROSTATECTOM	OP	"$2,767.00 "	$0.00	$0.00	"$1,953.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,953.51"	$787.76	$511.87	$787.76
52630	EAP	CPT® 52630		"PR REMV RESID OBSTRUC PROSTATE,>1 YR"	OP	"$3,000.00 "	$0.00	$0.00	$923.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$923.16	$422.07	$327.96	$422.07
53020	EAP	CPT® 53020		PR INCISION OF URETHRAL MEATUS	OP	$561.00 	$0.00	$0.00	$224.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.18	$94.74	$94.29	$94.74
53405	EAP	CPT® 53405		"PR REVISE URETHRA, 2ND STAGE"	OP	"$3,929.00 "	$0.00	$0.00	"$2,017.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,017.16"	$845.38	$544.47	$845.38
53410	EAP	CPT® 53410		PR RECONSTRUC ANT MALE URETHRA	OP	"$4,490.00 "	$0.00	$0.00	"$2,258.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,258.90"	$948.21	$575.12	$948.21
53415	EAP	CPT® 53415		PR RECONSTRUC PROSTATIC URETHRA	OP	"$5,052.00 "	$0.00	$0.00	"$2,610.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,610.54"	"$1,080.85"	$690.20	"$1,080.85"
53440	EAP	CPT® 53440		"PR SLING OPERATION,CORRECTION,MALE INCONT"	OP	"$5,052.00 "	$0.00	$0.00	"$1,737.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,737.63"	$828.86	$530.24	$828.86
53446	EAP	CPT® 53446		"PR REMOVAL,INFLATABLE SPHINCTER"	OP	"$3,536.00 "	$0.00	$0.00	"$1,483.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,483.13"	$620.50	$472.37	$620.50
54015	EAP	CPT® 54015		"PR INCIS/DRAIN PENIS,DEEP"	OP	$955.00 	$0.00	$0.00	$716.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$716.03	$301.93	$214.46	$301.93
54050	EAP	CPT® 54050		"PR DESTR PENIS LESN,SIMPL,CHEMICAL"	OP	$323.00 	$0.00	$0.00	$242.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.33	$112.23	$57.90	$112.23
54056	EAP	CPT® 54056		"PR DESTR PENIS LESN,SIMPL,CRYOSURG"	OP	$337.00 	$0.00	$0.00	$256.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.04	$114.91	$65.33	$114.91
54060	EAP	CPT® 54060		"PR DESTR PENIS LESN,SIMPL,SURG EXCIS"	OP	$545.00 	$0.00	$0.00	$300.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.86	$187.14	$113.93	$187.14
54065	EAP	CPT® 54065		"PR DESTR PENIS LESN,EXTENSIVE"	OP	"$1,133.00 "	$0.00	$0.00	$399.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$399.74	$193.67	$141.41	$193.67
54100	EAP	CPT® 54100		"PR BX,PENIS (SEPARATE PROCEDURE)"	OP	$379.00 	$0.00	$0.00	$291.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$291.02	$178.76	$89.52	$178.76
54150	EAP	CPT® 54150		"PR CIRCUMCISION,CLAMP,NEWBORN W/ ANESTH"	OP	$417.00 	$0.00	$0.00	$225.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.59	$127.90	$108.37	$127.90
54160	EAP	CPT® 54160		"PR CIRCUMCISION,OTHER,<28 D/O"	OP	$471.00 	$0.00	$0.00	$336.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$336.72	$242.94	$139.06	$242.94
54161	EAP	CPT® 54161		"PR CIRCUMCISION, OLDER THAN 28 DAYS OLD"	OP	"$1,396.00 "	$0.00	$0.00	$454.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$454.20	$188.23	$122.62	$188.23
54220	EAP	CPT® 54220		"PR IRRIGAT CORPUS CAVERN,PRIAPISM"	OP	$577.00 	$0.00	$0.00	$310.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.04	$228.19	$94.74	$228.19
54235	EAP	CPT® 54235		"PR INJECT CORPORA CAVERN,PHARM AGNT"	OP	$227.00 	$0.00	$0.00	$169.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.70	$84.22	$44.02	$84.22
54300	EAP	CPT® 54300		PR STRAIGHTEN PENIS	OP	"$2,354.00 "	$0.00	$0.00	"$1,479.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,479.81"	$635.46	$415.65	$635.46
54400	EAP	CPT® 54400		PR INSERT SEMI-RIGID PENILE PROSTHESIS	OP	"$2,265.00 "	$0.00	$0.00	"$1,223.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,223.42"	$518.08	$0.00	$518.08
54405	EAP	CPT® 54405		"PR INSERT,INFLATABLE PENILE PROSTHESIS"	OP	"$3,287.00 "	$0.00	$0.00	"$1,866.87"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,866.87"	$782.61	$0.00	$782.61
54415	EAP	CPT® 54415		"PR REMOVAL,PENILE PROSTHESIS W/O REPLACMT"	OP	"$2,043.00 "	$0.00	$0.00	"$1,219.64"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,219.64"	$502.07	$0.00	$502.07
54430	EAP	CPT® 54430		PR CORPORA CAVER-SPONGIOSA SHUNT	OP	"$2,665.00 "	$0.00	$0.00	"$1,478.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,478.30"	$618.06	$400.34	$618.06
54437	EAP	CPT® 54437		PR REPAIR OF TRAUMATIC CORPOREAL TEAR(S)	OP	"$2,106.00 "	$0.00	$0.00	"$1,573.47"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,573.47"	$0.00	$414.36	$0.00
54440	EAP	CPT® 54440		PR REPAIR PENIS POST INJURY	OP	"$2,792.00 "	$0.00	$0.00	"$1,311.62"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,311.62"	$0.00	$335.97	$0.00
54450	EAP	CPT® 54450		PR PREPUTIAL STRETCHING	OP	$222.00 	$0.00	$0.00	$133.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.29	$76.71	$44.28	$76.71
54520	EAP	CPT® 54520		"PR REMOVAL TESTIS,SIMPLE"	OP	"$1,271.00 "	$0.00	$0.00	$753.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$753.18	$314.20	$223.03	$314.20
54530	EAP	CPT® 54530		"PR REMOVAL TESTIS,RADICAL"	OP	"$1,816.00 "	$0.00	$0.00	"$1,167.27"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,167.27"	$526.26	$342.20	$526.26
54620	EAP	CPT® 54620		PR FIXATN OF TESTIS OPP TORSN	OP	$935.00 	$0.00	$0.00	$696.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$696.90	$293.09	$186.73	$293.09
54640	EAP	CPT® 54640		PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH	OP	"$2,070.00 "	$0.00	$0.00	"$1,107.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,107.66"	$443.18	$297.79	$443.18
54690	EAP	CPT® 54690		"PR LAP,ORCHIECTOMY"	OP	"$2,070.00 "	$0.00	$0.00	"$1,707.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,707.72"	$639.14	$412.92	$639.14
54700	EAP	CPT® 54700		"PR INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM"	OP	$668.00 	$0.00	$0.00	$495.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$495.09	$206.66	$178.10	$206.66
54830	EAP	CPT® 54830		PR EXCIS EPIDIDYMIS LOCAL LESION	OP	"$1,235.00 "	$0.00	$0.00	$861.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$861.20	$348.47	$205.43	$348.47
54840	EAP	CPT® 54840		PR EXCIS SPERMATOCELE	OP	"$1,126.00 "	$0.00	$0.00	$742.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.17	$309.72	$216.34	$309.72
55000	EAP	CPT® 55000		"PR DRAINAGE OF HYDROCELE,TUNICA"	OP	$264.00 	$0.00	$0.00	$196.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.94	$128.32	$57.95	$128.32
55040	EAP	CPT® 55040		"PR REMOVAL OF HYDROCELE,TUNICA,UNILAT"	OP	"$1,452.00 "	$0.00	$0.00	$781.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$781.47	$322.34	$219.98	$322.34
55041	EAP	CPT® 55041		"PR REMOVAL OF HYDROCELE,TUNICA,BILAT"	OP	"$2,251.00 "	$0.00	$0.00	"$1,176.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,176.90"	$481.19	$317.64	$481.19
55100	EAP	CPT® 55100		PR DRAINAGE SCROTAL WALL ABSCESS	OP	$519.00 	$0.00	$0.00	$384.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$384.42	$224.10	$156.39	$224.10
55110	EAP	CPT® 55110		PR EXPLORE SCROTUM	OP	"$1,210.00 "	$0.00	$0.00	$895.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$895.58	$363.53	$211.69	$363.53
55175	EAP	CPT® 55175		"PR REVISION OF SCROTUM,SIMPLE"	OP	"$1,452.00 "	$0.00	$0.00	$837.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$837.17	$340.60	$213.40	$340.60
55250	EAP	CPT® 55250		PR REMOVAL OF SPERM DUCT(S)	OP	$745.00 	$0.00	$0.00	$524.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$524.63	$512.20	$201.32	$512.20
55500	EAP	CPT® 55500		"PR REMV HYDROCELE,SPERM CORD,UNILAT"	OP	"$1,228.00 "	$0.00	$0.00	$916.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$916.58	$359.60	$222.84	$359.60
55700	EAP	CPT® 55700		"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"	OP	$448.00 	$0.00	$0.00	$322.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$322.17	$245.08	$92.43	$245.08
55706	EAP	CPT® 55706		"PR BIOPSY OF PROSTATE,NEEDLE,TRANSPERINEAL"	OP	"$1,163.00 "	$0.00	$0.00	$862.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$862.65	$0.00	$234.70	$0.00
55821	EAP	CPT® 55821		"PR REMV PROSTATE,SUPRAPUBIC,SUBTOTAL"	OP	"$3,583.00 "	$0.00	$0.00	"$2,018.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,018.60"	$842.22	$577.75	$842.22
55866	EAP	CPT® 55866		"PR LAP,PROSTATECTOMY,RADICAL,W/NERVE SPARE,INCL ROBOTIC"	OP	"$4,510.00 "	$0.00	$0.00	"$3,242.34"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,242.34"	"$1,692.63"	$974.09	"$1,692.63"
55874	EAP	CPT® 55874		PR TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX	OP	$516.00 	$0.00	$0.00	$386.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$386.27	$0.00	$516.00	$0.00
55876	EAP	CPT® 55876		"PR PLACE RADIOTHER DEVICE/MARKER, PROSTATE"	OP	$315.00 	$0.00	$0.00	$232.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.38	$145.41	$86.63	$145.41
56405	EAP	CPT® 56405		PR I&D OF VULVA/PERINEUM ABSCESS	OP	$371.00 	$0.00	$0.00	$247.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.01	$104.61	$67.34	$104.61
56420	EAP	CPT® 56420		PR I&D BARTHOLIN GLAND ABSCESS	OP	$328.00 	$0.00	$0.00	$208.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.22	$131.63	$66.70	$131.63
56440	EAP	CPT® 56440		PR MARSUP BARTHOLIN GLAND CYST	OP	$656.00 	$0.00	$0.00	$415.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$415.62	$174.28	$136.06	$174.28
56501	EAP	CPT® 56501		"PR DESTRUCTION,LESION(S),VULVA,SIMPLE"	OP	$389.00 	$0.00	$0.00	$262.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$262.31	$124.57	$66.40	$124.57
56515	EAP	CPT® 56515		"PR DESTRUCTION,LESION(S),VULVA;EXTENSIVE"	OP	$864.00 	$0.00	$0.00	$460.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$460.47	$210.36	$100.69	$210.36
56605	EAP	CPT® 56605		"PR BIOPSY VULVA/PERINEUM,ONE LESN"	OP	$231.00 	$0.00	$0.00	$138.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.12	$81.12	$52.78	$81.12
56620	EAP	CPT® 56620		PR PART SIMPLE REMV VULVA	OP	"$1,729.00 "	$0.00	$0.00	"$1,193.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,193.99"	$501.91	$304.01	$501.91
56820	EAP	CPT® 56820		"PR COLPOSCOPY,VULVA"	OP	$267.00 	$0.00	$0.00	$198.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.99	$106.14	$72.79	$106.14
56821	EAP	CPT® 56821		"PR COLPOSCOPY,VULVA,W/BIOPSY(S)"	OP	$357.00 	$0.00	$0.00	$264.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.86	$142.82	$94.23	$142.82
57100	EAP	CPT® 57100		"PR BIOPSY OF VAGINA,SIMPLE"	OP	$255.00 	$0.00	$0.00	$153.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$153.26	$85.38	$45.02	$85.38
57107	EAP	CPT® 57107		PR REMOVE VAGINA TISSUE/PARTIAL	OP	"$4,492.00 "	$0.00	$0.00	"$3,338.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,338.66"	"$1,328.82"	$730.53	"$1,328.82"
57135	EAP	CPT® 57135		PR EXCIS VAGINAL CYST/TUMOR	OP	$705.00 	$0.00	$0.00	$395.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$395.45	$186.03	$116.01	$186.03
57150	EAP	CPT® 57150		PR TREAT VAGINA INFECTION	OP	$106.00 	$0.00	$0.00	$65.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.87	$57.17	$25.17	$57.17
57155	EAP	CPT® 57155		PR INSERTION UTERINE TANDEM&/VAGINAL OVOIDS	OP	"$1,656.00 "	$0.00	$0.00	$669.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$669.03	$413.85	$256.98	$413.85
57156	EAP	CPT® 57156		PR INSERT VAGINAL RADIATION DEVICE	OP	$465.00 	$0.00	$0.00	$337.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.16	$0.00	$88.94	$0.00
57160	EAP	CPT® 57160		PR FIT/INSERT INTRAVAG SUPPORT DEVICE	OP	$146.00 	$0.00	$0.00	$106.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.82	$72.27	$37.91	$72.27
57200	EAP	CPT® 57200		PR REPAIR OF VAGINA	OP	"$1,026.00 "	$0.00	$0.00	$690.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$690.50	$275.58	$156.76	$275.58
57210	EAP	CPT® 57210		PR REPAIR VAGINA/PERINEUM	OP	"$1,197.00 "	$0.00	$0.00	$837.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$837.69	$344.62	$197.58	$344.62
57240	EAP	CPT® 57240		"PR ANTER COLPORRHAPHY,BLAD/VAGINA"	OP	"$1,892.00 "	$0.00	$0.00	"$1,530.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,530.96"	$582.33	$268.74	$582.33
57250	EAP	CPT® 57250		"PR POST COLPORRHAPHY,RECTUM/VAGINA"	OP	"$1,904.00 "	$0.00	$0.00	"$1,539.77"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,539.77"	$572.64	$243.31	$572.64
57260	EAP	CPT® 57260		PR COMBINED ANT/POST COLPORRHAPHY	OP	"$2,426.00 "	$0.00	$0.00	"$1,897.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,897.11"	$730.09	$350.74	$730.09
57282	EAP	CPT® 57282		"PR REPR VAGINAL PROLAPSE,SACROSP LIG"	OP	"$1,748.00 "	$0.00	$0.00	"$1,141.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,141.76"	$476.08	$367.80	$476.08
57283	EAP	CPT® 57283		"PR REPR VAGINAL PROLAPSE,UTEROSACRAL"	OP	"$2,190.00 "	$0.00	$0.00	"$1,569.47"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,569.47"	$656.31	$410.00	$656.31
57288	EAP	CPT® 57288		PR SLING OPER STRES INCONTINENCE	OP	"$2,660.00 "	$0.00	$0.00	"$1,634.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,634.90"	$763.35	$505.24	$763.35
57410	EAP	CPT® 57410		PR PELVIC EXAMINATION W ANESTH	OP	$389.00 	$0.00	$0.00	$246.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$246.65	$100.99	$72.98	$100.99
57415	EAP	CPT® 57415		PR REMOVAL VAGINAL FOR.BODY W ANESTH	OP	$529.00 	$0.00	$0.00	$365.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$365.88	$147.28	$91.04	$147.28
57420	EAP	CPT® 57420		"PR COLPOSCOPY,ENTIRE VAGINA"	OP	$285.00 	$0.00	$0.00	$210.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.23	$111.50	$75.90	$111.50
57421	EAP	CPT® 57421		"PR COLPOSCOPY,ENTIRE VAGINA,W/BIOPSY(S)"	OP	$427.00 	$0.00	$0.00	$285.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$285.65	$152.30	$98.90	$152.30
57425	EAP	CPT® 57425		"PR LAPAROSCOPY, SURG, COLPOPEXY"	OP	"$3,062.00 "	$0.00	$0.00	"$2,210.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,210.24"	$906.10	$543.42	$906.10
57452	EAP	CPT® 57452		"PR COLPOSCOPY,CERVIX W/ADJ VAGINA"	OP	$286.00 	$0.00	$0.00	$211.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.34	$105.04	$48.38	$105.04
57454	EAP	CPT® 57454		"PR COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG"	OP	$650.00 	$0.00	$0.00	$310.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$310.19	$150.07	$62.53	$150.07
57455	EAP	CPT® 57455		"PR COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX"	OP	$450.00 	$0.00	$0.00	$252.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.98	$139.42	$91.06	$139.42
57456	EAP	CPT® 57456		"PR COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG"	OP	$342.00 	$0.00	$0.00	$235.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.32	$131.43	$86.15	$131.43
57460	EAP	CPT® 57460		"PR COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP BX"	OP	"$1,015.00 "	$0.00	$0.00	$371.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$371.97	$311.50	$111.63	$311.50
57461	EAP	CPT® 57461		"PR COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP CONIZ"	OP	"$1,015.00 "	$0.00	$0.00	$428.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$428.81	$344.27	$203.93	$344.27
57500	EAP	CPT® 57500		"PR BIOPSY CERVIX, 1 OR MORE, OR EXCISION OF LESION"	OP	$397.00 	$0.00	$0.00	$173.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$448.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.64	$134.55	$44.58	$134.55
57505	EAP	CPT® 57505		PR ENDOCERVICAL CURETTAGE	OP	$314.00 	$0.00	$0.00	$210.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$210.84	$97.70	$54.10	$97.70
57520	EAP	CPT® 57520		"PR CONIZATION CERVIX,KNIFE/LASER"	OP	$890.00 	$0.00	$0.00	$629.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$629.34	$299.15	$179.80	$299.15
57522	EAP	CPT® 57522		"PR CONIZATION CERVIX,LOOP ELECTRD"	OP	$850.00 	$0.00	$0.00	$555.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$555.63	$254.06	$160.13	$254.06
58100	EAP	CPT® 58100		PR BIOPSY OF UTERUS LINING	OP	$252.00 	$0.00	$0.00	$200.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$292.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.03	$106.97	$37.37	$106.97
58110	EAP	CPT® 58110		PR ENDOMET BIOPSY DONE W/COLPOSCOPY	OP	$149.00 	$0.00	$0.00	$93.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$93.15	$48.91	$31.37	$48.91
58120	EAP	CPT® 58120		"PR DILATION/CURETTAGE,DIAGNOSTIC"	OP	$709.00 	$0.00	$0.00	$499.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$499.74	$226.46	$149.21	$226.46
58140	EAP	CPT® 58140		"PR MYOMECTOMY 1-4,W/TOT 250GMS/<,ABD APPRCH"	OP	"$2,912.00 "	$0.00	$0.00	"$2,104.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,104.53"	$869.61	$522.56	$869.61
58145	EAP	CPT® 58145		"PR EXCIS UTERINE FIBROID,VAG APPRCH"	OP	"$1,756.00 "	$0.00	$0.00	"$1,250.96"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,250.96"	$515.38	$339.04	$515.38
58146	EAP	CPT® 58146		"PR MYOMECTOMY 5/>,TOT>250 GMS,ABD APPRCH"	OP	"$3,632.00 "	$0.00	$0.00	"$2,616.83"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,616.83"	"$1,110.36"	$657.56	"$1,110.36"
58150	EAP	CPT® 58150		PR TOTAL ABDOM HYSTERECTOMY	OP	"$3,445.00 "	$0.00	$0.00	"$2,316.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,316.42"	$938.61	$554.33	$938.61
58180	EAP	CPT® 58180		PR SUPRACERV ABD HYSTERECTOMY	OP	"$3,336.00 "	$0.00	$0.00	"$2,197.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,197.92"	$903.71	$558.49	$903.71
58200	EAP	CPT® 58200		PR TOTAL ABD HYSTEREC+LTD NODES	OP	"$4,860.00 "	$0.00	$0.00	"$3,143.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,143.10"	"$1,251.40"	$780.25	"$1,251.40"
58260	EAP	CPT® 58260		"PR VAGINAL HYSTERECTOMY,UTERUS 250 GMS/<"	OP	"$3,083.00 "	$0.00	$0.00	"$1,879.52"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,879.52"	$786.82	$463.09	$786.82
58262	EAP	CPT® 58262		"PR VAG HYST,RMV TUBE/OVARY"	OP	"$3,264.00 "	$0.00	$0.00	"$2,098.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,098.58"	$881.42	$512.70	$881.42
58300	EAP	CPT® 58300		PR INSERT INTRAUTERINE DEVICE	OP	$269.00 	$0.00	$0.00	$123.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$265.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.57	$0.00	$43.74	$0.00
58301	EAP	CPT® 58301		PR REMOVE INTRAUTERINE DEVICE	OP	$240.00 	$0.00	$0.00	$154.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$316.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.19	$95.76	$51.09	$95.76
58340	EAP	CPT® 58340		PR CATH/INJECT HYSTEROSALPINGOGRAM	OP	"$2,343.00 "	$0.00	$0.00	$140.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.55	$140.39	$134.18	$140.39
58350	EAP	CPT® 58350		"PR REOPEN FALLOPIAN TUBE,CHROMOTUBATION"	OP	$324.00 	$0.00	$0.00	$178.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$178.71	$93.80	$0.00	$93.80
58353	EAP	CPT® 58353		"PR ENDOMETRIAL ABLATION, THERMAL"	OP	"$1,487.00 "	$0.00	$0.00	"$1,327.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$498.38	"$1,327.53"	$937.98	"$1,327.53"
58543	EAP	CPT® 58543		"PR LAP, SUPRACERVIAL HYSTERECTOMY, >250G"	OP	"$2,635.00 "	$0.00	$0.00	"$1,886.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,886.66"	$899.14	$0.00	$899.14
58544	EAP	CPT® 58544		"PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, >250G"	OP	"$2,837.00 "	$0.00	$0.00	"$2,058.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,058.45"	$973.55	$0.00	$973.55
58545	EAP	CPT® 58545		"PR LAP,MYOMECTOMY 1-4,TOT WT 250 GMS"	OP	"$2,820.00 "	$0.00	$0.00	"$2,059.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,059.44"	$859.66	$528.79	$859.66
58546	EAP	CPT® 58546		"PR LAP,MYOMECTOMY 5/>,TOTAL WT >250 GMS"	OP	"$3,516.00 "	$0.00	$0.00	"$2,552.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,552.46"	"$1,091.03"	$666.60	"$1,091.03"
58550	EAP	CPT® 58550		"PR LAP,VAG HYST,UTERUS 250GMS/<"	OP	"$2,768.00 "	$0.00	$0.00	"$2,007.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,007.23"	$845.72	$518.55	$845.72
58552	EAP	CPT® 58552		"PR LAP,VAG HYST,UTERUS 250GMS/<,SALP-OOPH"	OP	"$3,085.00 "	$0.00	$0.00	"$2,253.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,253.26"	$934.38	$514.99	$934.38
58553	EAP	CPT® 58553		"PR LAP,VAG HYST,UTERUS >250GMS"	OP	"$3,537.00 "	$0.00	$0.00	"$2,587.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,587.74"	"$1,095.77"	$662.57	"$1,095.77"
58555	EAP	CPT® 58555		"PR HYSTEROSCOPY,DX,SEP PROC"	OP	$728.00 	$0.00	$0.00	$431.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$431.43	$216.68	$130.53	$216.68
58558	EAP	CPT® 58558		"PR HYSTEROSCOPY,W/ENDO BX"	OP	"$3,500.00 "	$0.00	$0.00	$607.22	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$607.22	$279.39	$169.86	$279.39
58559	EAP	CPT® 58559		"PR HYSTEROSCOPY,LYSIS ADHESIONS"	OP	"$1,424.00 "	$0.00	$0.00	$777.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.50	$337.05	$217.47	$337.05
58561	EAP	CPT® 58561		"PR HYSTEROSCOPY,RMV MYOMA"	OP	"$4,427.00 "	$0.00	$0.00	"$1,243.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,243.28"	$541.58	$337.77	$541.58
58562	EAP	CPT® 58562		"PR HYSTEROSCOPY,RMV FB"	OP	"$1,424.00 "	$0.00	$0.00	$659.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$659.46	$301.99	$168.84	$301.99
58563	EAP	CPT® 58563		"PR HYSTEROSCOPY,W/ENDOMETRIAL ABLATION"	OP	"$10,220.00 "	$0.00	$0.00	"$2,124.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$776.78	"$2,124.30"	$224.64	"$2,124.30"
58570	EAP	CPT® 58570		PR LAPAROSCOPY W TOT HYSTERECT UTERUS 250 GRAM OR LESS	OP	"$2,487.00 "	$0.00	$0.00	"$1,773.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,773.89"	$0.00	$452.31	$0.00
58571	EAP	CPT® 58571		PR LAPAROSCOPY W TOT HYSTERECTUTERUS <=250 GRAM  W TUBE/OVARY	OP	"$2,805.00 "	$0.00	$0.00	"$2,052.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,052.09"	$0.00	$494.91	$0.00
58573	EAP	CPT® 58573		PR LAPAROSCOPY TOT HYSTERECTOMY UTERUS >250 GRAM W TUBE/OVARY	OP	"$3,789.00 "	$0.00	$0.00	"$2,777.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,777.16"	$0.00	$631.91	$0.00
58600	EAP	CPT® 58600		PR LIGATE FALLOPIAN TUBE	OP	"$1,631.00 "	$0.00	$0.00	$827.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$827.33	$348.36	$168.96	$348.36
58605	EAP	CPT® 58605		"PR LIGATE FALLOPIAN TUBE,POSTPARTUM"	OP	"$1,631.00 "	$0.00	$0.00	$749.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$749.45	$315.89	$159.05	$315.89
58611	EAP	CPT® 58611		"PR LIGATION,FALLOPIAN TUBE W/C-SECTION"	OP	$816.00 	$0.00	$0.00	$175.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.88	$76.70	$24.78	$76.70
58660	EAP	CPT® 58660		"PR LAP,LYSIS OF ADHESIONS"	OP	"$2,646.00 "	$0.00	$0.00	"$1,536.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,536.20"	$641.94	$395.49	$641.94
58661	EAP	CPT® 58661		"PR LAP,RMV  ADNEXAL STRUCTURE"	OP	"$2,538.00 "	$0.00	$0.00	"$1,482.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,482.66"	$622.91	$401.77	$622.91
58662	EAP	CPT® 58662		"PR LAP,FULGURATE/EXCISE LESIONS"	OP	"$2,900.00 "	$0.00	$0.00	"$1,617.41"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,617.41"	$678.80	$402.32	$678.80
58671	EAP	CPT® 58671		"PR LAP,TUBAL BLOCK BY DEVICE"	OP	"$1,631.00 "	$0.00	$0.00	$829.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$829.61	$347.51	$231.81	$347.51
58700	EAP	CPT® 58700		PR REMOVAL OF FALLOPIAN TUBE	OP	"$2,477.00 "	$0.00	$0.00	"$1,784.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,784.90"	$721.18	$272.27	$721.18
58720	EAP	CPT® 58720		PR REMOVAL OF OVARY/TUBE(S)	OP	"$2,538.00 "	$0.00	$0.00	"$1,684.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,684.37"	$680.14	$421.85	$680.14
58740	EAP	CPT® 58740		PR LYSIS ADNEXAL ADHESIONS	OP	"$2,808.00 "	$0.00	$0.00	"$2,016.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,016.54"	$833.92	$254.49	$833.92
58925	EAP	CPT® 58925		PR REMOVAL OF OVARIAN CYST(S)	OP	"$2,377.00 "	$0.00	$0.00	"$1,705.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,705.86"	$689.17	$410.77	$689.17
58950	EAP	CPT® 58950		PR RESEC OVAR MALIG+BILAT OVAR+OMENTUM	OP	"$3,534.00 "	$0.00	$0.00	"$2,595.99"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,595.99"	"$1,014.01"	$585.18	"$1,014.01"
58960	EAP	CPT® 58960		PR LAPAROTOMY FOR STAGING OVAR MALIG	OP	"$3,263.00 "	$0.00	$0.00	"$2,237.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,237.54"	$876.29	$587.71	$876.29
59000	EAP	CPT® 59000		"PR AMNIOCENTESIS,DIAGNOSTIC"	OP	$285.00 	$0.00	$0.00	$142.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.50	$128.63	$59.60	$128.63
59025	EAP	CPT® 59025		PR FETAL NON-STRESS TEST	OP	$99.00 	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.50	$41.67	$25.35	$41.67
59120	EAP	CPT® 59120		"PR TREAT ECTOPIC PREG,RMV TUBE/OVARY"	OP	"$2,540.00 "	$0.00	$0.00	"$1,270.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,270.00"	$755.18	$428.44	$755.18
59121	EAP	CPT® 59121		"PR TREAT ECTOPIC PREG,NON REMVAL"	OP	"$2,543.00 "	$0.00	$0.00	"$1,271.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,271.50"	$761.28	$403.84	$761.28
59151	EAP	CPT® 59151		"PR RX ECTOP PREG BY SCOPE,RMV TUBE/OVRY"	OP	"$2,406.00 "	$0.00	$0.00	"$1,203.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,203.00"	$725.34	$333.56	$725.34
59160	EAP	CPT® 59160		PR D&C AFTER DELIVERY	OP	$659.00 	$0.00	$0.00	$329.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$329.50	$226.04	$135.95	$226.04
59300	EAP	CPT® 59300		PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING	OP	$475.00 	$0.00	$0.00	$237.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$237.50	$183.78	$85.93	$183.78
59320	EAP	CPT® 59320		"PR REVISION CERVIX W PREG,VAG APPRCH"	OP	$709.00 	$0.00	$0.00	$354.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.50	$150.18	$94.38	$150.18
59400	EAP	CPT® 59400		"PR FULL ROUT OBSTE CARE,VAGINAL DELIV"	OP	"$6,654.00 "	$0.00	$0.00	"$3,327.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,327.00"	"$1,680.38"	"$1,522.91"	"$1,680.38"
59409	EAP	CPT® 59409		"PR OBSTETRICAL CARE,VAG DELIV ONLY"	OP	"$2,545.00 "	$0.00	$0.00	"$1,272.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,272.50"	$761.60	$558.20	$761.60
59410	EAP	CPT® 59410		"PR OBSTE CARE,VAG DELIV+POSTPARTUM"	OP	"$3,276.00 "	$0.00	$0.00	"$1,638.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,638.00"	$874.17	$630.70	$874.17
59412	EAP	CPT® 59412		PR ANTEPARTUM HEAD MANIPULATION	OP	$591.00 	$0.00	$0.00	$295.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$295.50	$101.84	$67.82	$101.84
59414	EAP	CPT® 59414		PR DELIVER PLACENTA	OP	$473.00 	$0.00	$0.00	$236.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.50	$91.05	$64.31	$91.05
59425	EAP	CPT® 59425		"PR ANTEPARTUM CARE ONLY, 4-6 VISITS"	OP	"$1,400.00 "	$0.00	$0.00	$700.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$700.00	$411.81	$330.48	$411.81
59426	EAP	CPT® 59426		"PR ANTEPARTUM CARE ONLY, >7 VISITS"	OP	"$2,500.00 "	$0.00	$0.00	"$1,250.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,250.00"	$734.59	$591.33	$734.59
59430	EAP	CPT® 59430		PR CARE AFTER DELIVERY ONLY	OP	$600.00 	$0.00	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.00	$135.43	$67.28	$135.43
59510	EAP	CPT® 59510		"PR FULL ROUT OBSTE CARE,CESAREAN DELIV"	OP	"$7,500.00 "	$0.00	$0.00	"$3,750.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,750.00"	"$1,898.60"	"$1,683.65"	"$1,898.60"
59514	EAP	CPT® 59514		PR CESAREAN DELIVERY ONLY	OP	"$2,876.00 "	$0.00	$0.00	"$1,438.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,438.00"	$900.11	$767.50	$900.11
59515	EAP	CPT® 59515		PR CESAREAN DELIVERY+POSTPARTUM CARE	OP	"$3,989.00 "	$0.00	$0.00	"$1,994.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,994.50"	"$1,053.09"	$840.00	"$1,053.09"
59525	EAP	CPT® 59525		PR REMOVE UTERUS AFTER CESAREAN	OP	"$1,525.00 "	$0.00	$0.00	$762.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$762.50	$477.89	$282.31	$477.89
59610	EAP	CPT® 59610		"PR ROUT OB CARE,VAG DELIV,PREV C-SEC"	OP	"$7,001.00 "	$0.00	$0.00	"$3,500.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,500.50"	"$1,759.20"	"$1,596.28"	"$1,759.20"
59612	EAP	CPT® 59612		"PR VAG DELIV ONLY,PREV C-SECTN"	OP	"$2,876.00 "	$0.00	$0.00	"$1,438.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,438.00"	$854.40	$574.03	$854.40
59614	EAP	CPT® 59614		"PR VAG DELIV+POSTPARTUM CARE,PREV C-SEC"	OP	"$3,574.00 "	$0.00	$0.00	"$1,787.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,787.00"	$951.57	$630.70	$951.57
59622	EAP	CPT® 59622		"PR C-SEC+POSTPARTUM CARE,PREV C-SEC"	OP	"$4,122.00 "	$0.00	$0.00	"$2,061.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,061.00"	"$1,142.25"	$840.00	"$1,142.25"
59812	EAP	CPT® 59812		PR SURG RX INCOMPLETE ABORTN	OP	$950.00 	$0.00	$0.00	$475.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$475.00	$284.67	$167.39	$284.67
59820	EAP	CPT® 59820		"PR SURG RX MISSED ABORTN,1ST TRI"	OP	"$1,163.00 "	$0.00	$0.00	$581.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$581.50	$355.41	$189.03	$355.41
59821	EAP	CPT® 59821		"PR SURG RX MISSED ABORTN,2ND TRI"	OP	"$1,153.00 "	$0.00	$0.00	$576.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$576.50	$362.58	$192.07	$362.58
59830	EAP	CPT® 59830		PR SURG RX SEPTIC ABORTN	OP	"$1,419.00 "	$0.00	$0.00	$709.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$709.50	$418.66	$238.84	$418.66
59840	EAP	CPT® 59840		PR INDUCED ABORTN BY D&C	OP	$978.00 	$0.00	$0.00	$489.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$489.00	$206.30	$161.73	$206.30
59870	EAP	CPT® 59870		PR EVACUATE MOLE OF UTERUS	OP	"$1,590.00 "	$0.00	$0.00	$795.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$795.00	$435.29	$167.53	$435.29
59871	EAP	CPT® 59871		PR REMOVE CERCLAGE SUTURE	OP	$416.00 	$0.00	$0.00	$208.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.00	$131.40	$92.01	$131.40
60100	EAP	CPT® 60100		"PR BIOPSY OF THYROID,PERCUT"	OP	$309.00 	$0.00	$0.00	$183.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.21	$108.22	$58.30	$108.22
60220	EAP	CPT® 60220		"PR THYROID LOBECTOMY,UNILAT"	OP	"$2,435.00 "	$0.00	$0.00	"$1,641.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,641.54"	$698.71	$425.69	$698.71
60240	EAP	CPT® 60240		PR THYROIDECTOMY	OP	"$3,002.00 "	$0.00	$0.00	"$2,133.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,133.53"	$901.17	$613.41	$901.17
60252	EAP	CPT® 60252		"PR THYROIDECTOMY,MALIG,LTD NECK SURG"	OP	"$4,337.00 "	$0.00	$0.00	"$3,066.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,066.38"	"$1,208.60"	$713.45	"$1,208.60"
60260	EAP	CPT® 60260		PR THYROIDECTOMY POST PREV THYR SURG	OP	"$3,401.00 "	$0.00	$0.00	"$2,538.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,538.03"	"$1,012.24"	$508.92	"$1,012.24"
60271	EAP	CPT® 60271		"PR THYROIDECTOMY=SUBSTERNAL,TRANSCERV"	OP	"$3,297.00 "	$0.00	$0.00	"$2,455.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,455.29"	$980.03	$605.55	$980.03
60500	EAP	CPT® 60500		PR EXPLORE PARATHYROID GLANDS	OP	"$3,069.00 "	$0.00	$0.00	"$2,238.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,238.00"	$924.12	$615.61	$924.12
60540	EAP	CPT® 60540		PR EXCISE ADRENAL GLAND	OP	"$3,355.00 "	$0.00	$0.00	"$2,456.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,456.25"	$977.78	$635.87	$977.78
60600	EAP	CPT® 60600		PR EXCISE CAROTID BODY LESION	OP	"$4,294.00 "	$0.00	$0.00	"$3,242.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,242.15"	"$1,343.65"	$738.42	"$1,343.65"
60650	EAP	CPT® 60650		"PR LAP,ADRENALECTOMY"	OP	"$3,744.00 "	$0.00	$0.00	"$2,765.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,765.70"	"$1,103.29"	$702.33	"$1,103.29"
61020	EAP	CPT® 61020		PR VENTRICULAR PUCTURE	OP	$440.00 	$0.00	$0.00	$235.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.28	$115.88	$75.29	$115.88
61070	EAP	CPT® 61070		PR BRAIN SHUNT TUBE/RESERV INJECTN	OP	$368.00 	$0.00	$0.00	$134.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.06	$75.53	$99.58	$75.53
61105	EAP	CPT® 61105		PR TWIST DRILL HOLE SUBDURAL/VENT PUNC	OP	"$1,842.00 "	$0.00	$0.00	"$1,066.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,066.29"	$387.23	$242.22	$387.23
61107	EAP	CPT® 61107		"PR TWIST HOLE SKULL,IMPLANT CATH/DEVICE"	OP	"$2,381.00 "	$0.00	$0.00	$742.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$742.58	$305.32	$230.02	$305.32
61140	EAP	CPT® 61140		PR BURR HOLE FOR BIOPSY	OP	"$3,953.00 "	$0.00	$0.00	"$2,966.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,966.15"	"$1,106.94"	$692.78	"$1,106.94"
61154	EAP	CPT® 61154		PR BURR HOLE EVAC SUBDUR/EXTRA HEMATOMA	OP	"$4,493.00 "	$0.00	$0.00	"$2,978.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,978.00"	"$1,095.68"	$695.79	"$1,095.68"
61210	EAP	CPT® 61210		PR BURR HOLE IMPLANT CATH/DEVICE	OP	"$2,453.00 "	$0.00	$0.00	$869.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$869.88	$355.19	$263.12	$355.19
61304	EAP	CPT® 61304		PR OPEN SKULL SUPRATENT EXPLORE	OP	"$5,247.00 "	$0.00	$0.00	"$3,859.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,859.37"	"$1,477.84"	"$1,001.08"	"$1,477.84"
61312	EAP	CPT® 61312		PR OPEN SKULL EVAC SUB/EXTRADUR BLOOD	OP	"$6,484.00 "	$0.00	$0.00	"$4,883.73"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,883.73"	"$1,827.99"	"$1,091.35"	"$1,827.99"
61313	EAP	CPT® 61313		PR OPEN SKULL EVAC INTRACEREBR BLOOD	OP	"$6,469.00 "	$0.00	$0.00	"$4,658.79"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,658.79"	"$1,749.64"	"$1,101.37"	"$1,749.64"
61320	EAP	CPT® 61320		PR OPEN SKULL DRAIN SUPRATENT ABSC	OP	"$6,290.00 "	$0.00	$0.00	"$4,463.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,463.51"	"$1,720.16"	"$1,055.26"	"$1,720.16"
61322	EAP	CPT® 61322		"PR OPEN SKULL,DECOMPRES,W/DURAPLASTY"	OP	"$7,430.00 "	$0.00	$0.00	"$5,582.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,582.63"	"$2,050.81"	"$1,068.91"	"$2,050.81"
61323	EAP	CPT® 61323		"PR OPEN SKULL,DECOMP,W/LOBECTOMY"	OP	"$7,487.00 "	$0.00	$0.00	"$5,649.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,649.50"	"$2,098.20"	"$1,106.41"	"$2,098.20"
61460	EAP	CPT® 61460		PR CRANIECT SECTN 1+ CRAN NERVES	OP	"$6,936.00 "	$0.00	$0.00	"$4,962.38"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,962.38"	"$1,855.56"	"$1,211.13"	"$1,855.56"
61510	EAP	CPT® 61510		PR EXCIS SUPRATENT BRAIN TUMOR	OP	"$8,087.00 "	$0.00	$0.00	"$5,125.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,125.20"	"$1,940.39"	"$1,250.24"	"$1,940.39"
61512	EAP	CPT® 61512		PR EXCIS SUPRATENT MENINGIOMA	OP	"$8,087.00 "	$0.00	$0.00	"$5,978.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,978.30"	"$2,317.41"	"$1,486.14"	"$2,317.41"
61514	EAP	CPT® 61514		PR EXCIS SUPRATENT BRAIN ABSCESS	OP	"$6,829.00 "	$0.00	$0.00	"$4,454.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,454.72"	"$1,703.14"	"$1,128.97"	"$1,703.14"
61519	EAP	CPT® 61519		PR EXCIS INFRATENT MENINGIOMA	OP	"$9,239.00 "	$0.00	$0.00	"$6,872.42"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,872.42"	"$2,693.06"	"$1,719.30"	"$2,693.06"
61570	EAP	CPT® 61570		PR REMOVE BRAIN FOREIGN BODY	OP	"$8,051.00 "	$0.00	$0.00	"$4,378.14"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,378.14"	"$1,639.70"	$983.79	"$1,639.70"
61580	EAP	CPT® 61580		"PR CRANIOFACIAL APPROACH,EXTRADURAL"	OP	"$7,628.00 "	$0.00	$0.00	"$5,843.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,843.48"	"$2,228.11"	"$1,191.11"	"$2,228.11"
61590	EAP	CPT® 61590		PR INFRATEMPORAL APPROACH/PREAURICULAR	OP	"$9,482.00 "	$0.00	$0.00	"$7,097.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$7,097.45"	"$2,843.05"	"$1,647.80"	"$2,843.05"
61619	EAP	CPT® 61619		PR REPAIR DURA POSTOP SK BASE-PEDICLE	OP	"$8,626.00 "	$0.00	$0.00	"$3,373.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,373.16"	"$1,348.23"	$838.86	"$1,348.23"
61624	EAP	CPT® 61624		"PR PERM OCCLUSION/EMBOLIZATION,PERCUT,CNS"	OP	"$5,750.00 "	$0.00	$0.00	"$2,659.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,659.80"	"$1,027.58"	$715.13	"$1,027.58"
61635	EAP	CPT® 61635		PR INTRACRANIAL BALLOON ANGIOPLSTY W/STENT	OP	"$4,543.00 "	$0.00	$0.00	"$3,326.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,326.36"	$0.00	$793.36	$0.00
61645	EAP	CPT® 61645		PR PERQ ART TRLUML M-THROMBEC &/NFS INTRACRANIAL	OP	"$2,616.00 "	$0.00	$0.00	"$1,807.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,807.71"	$0.00	$476.04	$0.00
61650	EAP	CPT® 61650		PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST	OP	"$1,786.00 "	$0.00	$0.00	"$1,207.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,207.04"	$0.00	$317.86	$0.00
61651	EAP	CPT® 61651		PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL	OP	$765.00 	$0.00	$0.00	$512.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$512.60	$0.00	$134.99	$0.00
61682	EAP	CPT® 61682		"PR BRAIN AVM SURG,SUPRATENT,COMPLX"	OP	"$13,377.00 "	$0.00	$0.00	"$9,767.70"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$9,767.70"	"$3,896.29"	"$2,401.82"	"$3,896.29"
61711	EAP	CPT® 61711		PR INTRA-EXTRACRANIAL ART ANASTOM	OP	"$8,103.00 "	$0.00	$0.00	"$6,088.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$6,088.89"	"$2,371.37"	"$1,571.14"	"$2,371.37"
61781	EAP	CPT® 61781		"PR STEREOTACTIC COMP ASSIST PROC,CRANIAL,INTRADURAL"	OP	$736.00 	$0.00	$0.00	$554.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$554.64	$0.00	$141.48	$0.00
61782	EAP	CPT® 61782		"PR STEREOTACTIC COMP ASSIST PROC,CRANIAL,EXTRADURAL"	OP	$542.00 	$0.00	$0.00	$410.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.00	$0.00	$116.45	$0.00
61783	EAP	CPT® 61783		"PR STEREOTACTIC COMP ASSIST PROC,SPINAL"	OP	$731.00 	$0.00	$0.00	$546.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$546.44	$0.00	$141.48	$0.00
62000	EAP	CPT® 62000		PR FIX SIMPL DEPRESS SKULL FX	OP	"$3,810.00 "	$0.00	$0.00	"$2,425.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,425.07"	$745.62	$423.02	$745.62
62010	EAP	CPT® 62010		"PR FIX DEPRESS SKULL FX,REPR DURA"	OP	"$5,894.00 "	$0.00	$0.00	"$3,588.24"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,588.24"	"$1,353.33"	$875.63	"$1,353.33"
62117	EAP	CPT® 62117		PR REDUCTN CRANIOMEG W RECONSTRUC	OP	"$6,138.00 "	$0.00	$0.00	"$3,797.10"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,797.10"	"$1,710.24"	"$1,101.35"	"$1,710.24"
62120	EAP	CPT® 62120		"PR REPAIR ENCEPHALOCELE,VAULT"	OP	"$6,555.00 "	$0.00	$0.00	"$3,884.33"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,884.33"	"$1,618.90"	$947.30	"$1,618.90"
62141	EAP	CPT® 62141		"PR REPAIR SKULL DEFECT,>5CM"	OP	"$5,643.00 "	$0.00	$0.00	"$2,662.28"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,662.28"	"$1,022.28"	$692.50	"$1,022.28"
62143	EAP	CPT® 62143		PR REPLACE SKULL PLATE/FLAP	OP	"$4,313.00 "	$0.00	$0.00	"$2,431.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,431.89"	$909.20	$546.18	$909.20
62161	EAP	CPT® 62161		"PR NEUROENDOSCOP,DISS ADHESION/FENESTRATION"	OP	"$4,719.00 "	$0.00	$0.00	"$3,568.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,568.98"	"$1,360.16"	$738.07	"$1,360.16"
62165	EAP	CPT® 62165		"PR NEUROENDOSCOP,EXC,PIT TUM,TRANSNAS/SPHEN"	OP	"$4,747.00 "	$0.00	$0.00	"$3,614.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,614.39"	"$1,394.03"	$802.89	"$1,394.03"
62223	EAP	CPT® 62223		PR CREATE SHUNT:VENTRIC-PERITONEAL	OP	"$4,852.00 "	$0.00	$0.00	"$2,455.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,455.50"	$907.86	$598.85	$907.86
62225	EAP	CPT® 62225		PR REPLACE/IRRIGATE VENTRIC CATH	OP	"$2,336.00 "	$0.00	$0.00	"$1,228.46"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,228.46"	$424.75	$243.78	$424.75
62230	EAP	CPT® 62230		"PR REPLACEMENT/REVISION,CSF SHUNT"	OP	"$3,414.00 "	$0.00	$0.00	"$1,973.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,973.75"	$735.35	$466.64	$735.35
62256	EAP	CPT® 62256		"PR REMOVAL,COMPLETE CSF SHUNT,W/O REPLACE"	OP	"$2,120.00 "	$0.00	$0.00	"$1,399.89"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,399.89"	$497.66	$307.92	$497.66
62267	EAP	CPT® 62267		PR PERCUT ASPIRATION VERTEBRAL DISC	OP	$491.00 	$0.00	$0.00	$370.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$370.68	$0.00	$142.04	$0.00
62270	EAP	CPT® 62270		PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE	OP	$263.00 	$0.00	$0.00	$180.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$180.66	$154.65	$75.10	$154.65
62272	EAP	CPT® 62272		PR THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF	OP	$342.00 	$0.00	$0.00	$193.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$193.89	$180.75	$82.28	$180.75
62273	EAP	CPT® 62273		"PR INJ,LUMB EPIDUR,BLOOD/CLOT PATCH"	OP	$575.00 	$0.00	$0.00	$263.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$263.75	$170.51	$77.18	$170.51
62284	EAP	CPT® 62284		PR INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR	OP	$675.00 	$0.00	$0.00	$228.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.37	$228.47	$98.92	$228.47
62321	EAP	CPT® 62321		PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN	OP	$334.00 	$0.00	$0.00	$254.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.67	$0.00	$150.32	$0.00
62323	EAP	CPT® 62323		PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	OP	$309.00 	$0.00	$0.00	$232.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.26	$0.00	$147.54	$0.00
62328	EAP	CPT® 62328		PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT	OP	$280.00 	$0.00	$0.00	$207.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.80	$0.00	$157.99	$0.00
62361	EAP	CPT® 62361		"INSERT/ PREPLACE INFUSN PUMP,NONPROGRAM"	OP	"$1,734.00 "	$0.00	$0.00	$836.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$836.84	$404.94	$194.71	$404.94
63001	EAP	CPT® 63001		"LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, CERVICAL"	OP	"$4,761.00 "	$0.00	$0.00	"$2,903.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,903.16"	"$1,096.20"	$740.05	"$1,096.20"
63005	EAP	CPT® 63005		"LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, LUMBAR"	OP	"$4,591.00 "	$0.00	$0.00	"$2,757.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,757.86"	"$1,050.03"	$695.66	"$1,050.03"
63015	EAP	CPT® 63015		"PR LAMINECTOMY,>2 SGMT,CERVICAL"	OP	"$5,849.00 "	$0.00	$0.00	"$3,471.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,471.68"	"$1,325.22"	$903.95	"$1,325.22"
63030	EAP	CPT® 63030		PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR	OP	"$5,203.00 "	$0.00	$0.00	"$2,256.65"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,256.65"	$870.61	$571.08	$870.61
63042	EAP	CPT® 63042		PR REDO EXCIS LUMBAR DISC	OP	"$5,849.00 "	$0.00	$0.00	"$3,018.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,018.51"	"$1,207.86"	$810.26	"$1,207.86"
63045	EAP	CPT® 63045		"LAMINEC/FACETECT/FORAMIN,CERVICAL 1 SEG"	OP	"$4,021.00 "	$0.00	$0.00	"$3,011.16"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,011.16"	"$1,141.97"	$774.11	"$1,141.97"
63046	EAP	CPT® 63046		"LAMINEC/FACETECT/FORAMIN,THORACIC 1 SEG"	OP	"$3,837.00 "	$0.00	$0.00	"$2,848.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,848.20"	"$1,093.72"	$740.73	"$1,093.72"
63047	EAP	CPT® 63047		"LAMINEC/FACETECT/FORAMIN,LUMBAR 1 SEG"	OP	"$3,449.00 "	$0.00	$0.00	"$2,571.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,571.32"	"$1,003.34"	$682.96	"$1,003.34"
63048	EAP	CPT® 63048		PR LAM FACETECTOMY&FORAMOT 1 VRT SGM EA ADDL SGM	OP	"$2,040.00 "	$0.00	$0.00	$495.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$495.27	$204.26	$144.70	$204.26
63051	EAP	CPT® 63051		"PR C-LAMINOPLASTY W/GRAFT/PLATE, 2 OR MORE"	OP	"$5,339.00 "	$0.00	$0.00	"$3,989.97"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,989.97"	"$1,530.60"	$974.39	"$1,530.60"
63052	EAP	CPT® 63052		PR LAM FACETEC/FORAMOT DRG ARTHRD LUMBAR 1 VRT SGM	OP	$778.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63053	EAP	CPT® 63053		PR LAM FACETEC/FORAMOT DRG ARTHRD LMBR EA ADDL SGM	OP	$582.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
63081	EAP	CPT® 63081		"PR REMV VERT BODY,CERV,ONE SGMT"	OP	"$6,019.00 "	$0.00	$0.00	"$4,102.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,102.86"	"$1,620.94"	"$1,101.40"	"$1,620.94"
63101	EAP	CPT® 63101		PR REMOVAL OF VERTEBRAL BODY	OP	"$7,822.00 "	$0.00	$0.00	"$5,406.03"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,406.03"	"$2,078.86"	"$1,283.88"	"$2,078.86"
63102	EAP	CPT® 63102		PR REMOVAL OF VERTEBRAL BODY	OP	"$7,822.00 "	$0.00	$0.00	"$5,298.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$5,298.72"	"$2,076.30"	"$1,283.88"	"$2,076.30"
63266	EAP	CPT® 63266		"PR EXCIS INTRASP LESN,XDURAL,THORACIC"	OP	"$5,441.00 "	$0.00	$0.00	"$4,018.44"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,018.44"	"$1,535.23"	$782.68	"$1,535.23"
63276	EAP	CPT® 63276		"PR BX/EXCIS SPINAL TUMOR,XDURAL,THOR"	OP	"$6,257.00 "	$0.00	$0.00	"$4,176.95"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,176.95"	"$1,598.34"	"$1,066.65"	"$1,598.34"
63300	EAP	CPT® 63300		"PR REMV VERT,EXDUR,CERV TUMOR"	OP	"$5,747.00 "	$0.00	$0.00	"$4,297.08"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$4,297.08"	"$1,657.83"	$999.77	"$1,657.83"
63308	EAP	CPT® 63308		"PR REMV VERT,EACH ADDNL SEGMENT"	OP	"$1,462.00 "	$0.00	$0.00	$760.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$760.28	$316.64	$211.96	$316.64
63707	EAP	CPT® 63707		"PR REPR,DURAL/CSF LEAK,NOT REQ LAMINECTOMY"	OP	"$5,101.00 "	$0.00	$0.00	"$2,142.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,142.54"	$810.43	$520.46	$810.43
63710	EAP	CPT® 63710		"PR DURAL GRAFT REPAIR,SPINE DEFECT"	OP	"$4,761.00 "	$0.00	$0.00	"$2,526.71"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,526.71"	$985.29	$580.97	$985.29
63741	EAP	CPT® 63741		"PR INSTALL SPINAL SHUNT,PERCUT"	OP	"$2,211.00 "	$0.00	$0.00	"$1,579.04"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,579.04"	$549.03	$370.21	$549.03
63744	EAP	CPT® 63744		PR REVISION OF SPINAL SHUNT	OP	"$2,123.00 "	$0.00	$0.00	"$1,571.09"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,571.09"	$576.15	$368.95	$576.15
64400	EAP	CPT® 64400		PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH	OP	$508.00 	$0.00	$0.00	$163.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.62	$106.75	$55.47	$106.75
64405	EAP	CPT® 64405		PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE	OP	$476.00 	$0.00	$0.00	$146.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.03	$100.72	$64.03	$100.72
64415	EAP	CPT® 64415		PR INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN	OP	$198.17 	$0.00	$0.00	$150.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.21	$146.13	$67.10	$146.13
64417	EAP	CPT® 64417		PR INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN	OP	$196.91 	$0.00	$0.00	$163.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.94	$152.15	$66.67	$152.15
64418	EAP	CPT® 64418		PR INJECTION AA&/STRD SUPRASCAPULAR NERVE	OP	$192.55 	$0.00	$0.00	$176.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.07	$138.47	$65.20	$138.47
64420	EAP	CPT® 64420		PR INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL	OP	$186.00 	$0.00	$0.00	$172.79	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.67	$172.79	$59.93	$172.79
64421	EAP	CPT® 64421		PR INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL	OP	$229.62 	$0.00	$0.00	$229.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.37	$229.62	$77.74	$229.62
64425	EAP	CPT® 64425		PR INJECTION AA&/STRD ILIOINGUINAL IH NERVES	OP	$212.87 	$0.00	$0.00	$212.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.87	$123.97	$72.07	$123.97
64445	EAP	CPT® 64445		PR INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN	OP	$217.44 	$0.00	$0.00	$167.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.01	$144.61	$73.63	$144.61
64447	EAP	CPT® 64447		PR INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN	OP	$166.00 	$0.00	$0.00	$152.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.63	$70.41	$46.52	$70.41
64450	EAP	CPT® 64450		PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH	OP	$157.57 	$0.00	$0.00	$105.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$216.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.41	$95.14	$53.35	$95.14
64451	EAP	CPT® 64451		PR INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG	OP	$248.00 	$0.00	$0.00	$184.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.05	$0.00	$127.89	$0.00
64454	EAP	CPT® 64454		PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG	OP	$255.00 	$0.00	$0.00	$189.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$189.71	$0.00	$129.17	$0.00
64455	EAP	CPT® 64455		PR NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES	OP	$108.00 	$0.00	$0.00	$80.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.36	$0.00	$29.04	$0.00
64461	EAP	CPT® 64461		PR PVB THORACIC SINGLE INJECTION SITE W/IMG GID	OP	$240.00 	$0.00	$0.00	$200.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.10	$0.00	$89.58	$0.00
64463	EAP	CPT® 64463		PR PVB THORACIC CONT CATHETER INFUSION W/IMG GID	OP	$259.00 	$0.00	$0.00	$193.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$193.70	$0.00	$97.49	$0.00
64483	EAP	CPT® 64483		PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL	OP	$794.00 	$0.00	$0.00	$322.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$261.57	$322.58	$123.84	$322.58
64484	EAP	CPT® 64484		PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL	OP	$397.00 	$0.00	$0.00	$154.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.65	$154.93	$114.53	$154.93
64486	EAP	CPT® 64486		PR TAP BLOCK UNILATERAL BY INJECTION(S)	OP	$175.00 	$0.00	$0.00	$146.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$146.24	$0.00	$74.89	$0.00
64488	EAP	CPT® 64488		PR TAP BLOCK BILATERAL BY INJECTION(S)	OP	$216.00 	$0.00	$0.00	$184.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.77	$0.00	$92.08	$0.00
64490	EAP	CPT® 64490		"CERVICAL/THORACIC FACET JT INJ, SINGLE LEVEL, INC CT/FL GUIDANCE"	OP	$329.00 	$0.00	$0.00	$247.02	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.02	$0.00	$76.69	$0.00
64491	EAP	CPT® 64491		"CERVICAL/THORACIC FACET JT INJ,2ND LEVEL, INC CT/FL GUIDANCE"	OP	$187.00 	$0.00	$0.00	$139.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.91	$0.00	$37.67	$0.00
64493	EAP	CPT® 64493		"LUMBAR FACET JT INJ, SINGLE LEVEL INC CT/FL GUIDANCE"	OP	$279.00 	$0.00	$0.00	$211.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.62	$0.00	$69.48	$0.00
64494	EAP	CPT® 64494		"LUMBAR FACET JT INJ, 2ND LEVEL, INC CT/FL GUIDANCE AKA ANE ARTERIAL LINE"	OP	$161.00 	$0.00	$0.00	$120.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.59	$0.00	$33.82	$0.00
64495	EAP	CPT® 64495		"LUMBAR FACET JT INJ, 3RD,ADDL LEVELS, INC CT/FL GIDANCE"	OP	$163.00 	$0.00	$0.00	$122.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.21	$0.00	$34.33	$0.00
64505	EAP	CPT® 64505		"PR INJECT NERV BLCK,SPHENOPALAT GANGLN"	OP	$302.00 	$0.00	$0.00	$201.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.11	$95.94	$62.49	$95.94
64510	EAP	CPT® 64510		"PR INJECT NERV BLCK,STELLATE GANGLION"	OP	$234.00 	$0.00	$0.00	$170.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.66	$157.96	$61.92	$157.96
64520	EAP	CPT® 64520		"PR INJECT NERV BLCK,PARAVERT SYMPATH"	OP	$257.00 	$0.00	$0.00	$215.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.50	$215.37	$78.41	$215.37
64530	EAP	CPT® 64530		"PR INJECT NERV BLCK,CELIAC PLEXUS"	OP	"$1,879.00 "	$0.00	$0.00	$213.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.27	$205.30	$81.40	$205.30
64566	EAP	CPT® 64566		"PR POST TIBIAL NEUROSTIMULATION,PERC NEEDLE ELECTRODE"	OP	$400.00 	$0.00	$0.00	$70.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.65	$0.00	$76.85	$0.00
64581	EAP	CPT® 64581		PR OPEN IMPLANTATION NEA SACRAL NERVE	OP	"$2,074.00 "	$0.00	$0.00	"$1,530.29"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,530.29"	$748.79	$501.50	$748.79
64590	EAP	CPT® 64590		PR IMPLANT GASTRIC NEUROSTIM/RECEIVER	OP	$542.00 	$0.00	$0.00	$370.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$370.70	$347.06	$0.00	$347.06
64600	EAP	CPT® 64600		"PR INJECT TRIGEM NERV,1ST BRANCH"	OP	$923.00 	$0.00	$0.00	$507.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$507.14	$438.86	$136.14	$438.86
64612	EAP	CPT® 64612		PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL	OP	$362.00 	$0.00	$0.00	$270.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.72	$157.33	$94.57	$157.33
64615	EAP	CPT® 64615		PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	OP	$385.00 	$0.00	$0.00	$287.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$287.63	$0.00	$85.27	$0.00
64616	EAP	CPT® 64616		PR CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA	OP	$340.00 	$0.00	$0.00	$251.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$251.87	$0.00	$73.72	$0.00
64624	EAP	CPT® 64624		PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG	OP	$458.00 	$0.00	$0.00	$340.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$340.26	$0.00	$247.01	$0.00
64625	EAP	CPT® 64625		PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN	OP	$605.00 	$0.00	$0.00	$449.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$449.61	$0.00	$301.89	$0.00
64630	EAP	CPT® 64630		PR DESTRUCT BY NEURO AGENT; PUDENDAL	OP	$588.00 	$0.00	$0.00	$445.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.82	$215.34	$120.88	$215.34
64633	EAP	CPT® 64633		PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA	OP	$699.00 	$0.00	$0.00	$526.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$526.40	$0.00	$270.60	$0.00
64634	EAP	CPT® 64634		PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA	OP	$212.00 	$0.00	$0.00	$159.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.23	$0.00	$124.17	$0.00
64635	EAP	CPT® 64635		PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	OP	$689.00 	$0.00	$0.00	$519.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$519.18	$0.00	$265.93	$0.00
64636	EAP	CPT® 64636		PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL	OP	$186.00 	$0.00	$0.00	$139.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.16	$0.00	$111.76	$0.00
64640	EAP	CPT® 64640		PR INJECT RX OTHER PERIPH NERVE	OP	$367.66 	$0.00	$0.00	$245.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.18	$245.73	$124.48	$245.73
64642	EAP	CPT® 64642		PR CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE	OP	$334.00 	$0.00	$0.00	$250.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.85	$0.00	$83.94	$0.00
64643	EAP	CPT® 64643		PR CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE	OP	$223.00 	$0.00	$0.00	$168.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.23	$0.00	$55.20	$0.00
64644	EAP	CPT® 64644		PR CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES	OP	$364.00 	$0.00	$0.00	$274.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$274.92	$0.00	$95.89	$0.00
64645	EAP	CPT® 64645		PR CHEMODENERVATION 1 EXTREMITY EA ADDL 5/< MUSCLES	OP	$256.00 	$0.00	$0.00	$192.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.96	$0.00	$67.55	$0.00
64646	EAP	CPT® 64646		PR CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES	OP	$359.00 	$0.00	$0.00	$270.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.78	$0.00	$90.31	$0.00
64680	EAP	CPT® 64680		PR INJECT RX CELIAC PLEXUS NERVE	OP	$769.00 	$0.00	$0.00	$384.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$384.63	$320.26	$107.36	$320.26
64708	EAP	CPT® 64708		"PR NEUROPLASTY OTHER ARM/LEG NERVE,OPEN"	OP	"$2,307.00 "	$0.00	$0.00	"$1,146.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,146.74"	$425.28	$281.77	$425.28
64712	EAP	CPT® 64712		"PR NEUROPLASTY SCIATIC NERVE,OPEN"	OP	"$2,691.00 "	$0.00	$0.00	"$1,325.75"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,325.75"	$493.01	$339.63	$493.01
64718	EAP	CPT® 64718		PR REVISE ULNAR NERVE AT ELBOW	OP	"$2,499.00 "	$0.00	$0.00	"$1,364.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,364.48"	$506.99	$279.46	$506.99
64719	EAP	CPT® 64719		PR REVISE ULNAR NERVE AT WRIST	OP	"$1,672.00 "	$0.00	$0.00	$922.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$922.55	$361.44	$223.34	$361.44
64721	EAP	CPT® 64721		PR REVISE MEDIAN N/CARPAL TUNNEL SURG	OP	"$1,769.00 "	$0.00	$0.00	$983.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$983.07	$386.40	$220.39	$386.40
64772	EAP	CPT® 64772		"PR TRANSECT OTHR SPINAL N,XTRADURAL"	OP	"$1,759.00 "	$0.00	$0.00	"$1,295.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,295.49"	$504.39	$317.93	$504.39
64782	EAP	CPT® 64782		PR EXCISE HAND/FOOT NEUROMA	OP	"$1,420.00 "	$0.00	$0.00	"$1,045.20"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,045.20"	$409.84	$241.04	$409.84
64820	EAP	CPT® 64820		"PR SYMPATHECTOMY,DIGITAL ARTERIES, EA"	OP	"$2,275.00 "	$0.00	$0.00	"$1,672.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,672.82"	$687.91	$418.86	$687.91
64831	EAP	CPT® 64831		PR REPAIR OF DIGIT NERVE	OP	"$2,148.00 "	$0.00	$0.00	"$1,582.17"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,582.17"	$665.95	$341.08	$665.95
64832	EAP	CPT® 64832		PR REPAIR EACH ADDNL DIGIT NERVE	OP	"$1,052.00 "	$0.00	$0.00	$782.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$782.88	$330.93	$186.40	$330.93
64835	EAP	CPT® 64835		SUTURE 1 NERVE MEDIAN MOTOR THENAR	OP	"$2,551.00 "	$0.00	$0.00	"$1,866.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,866.02"	$747.79	$416.61	$747.79
64857	EAP	CPT® 64857		PR REPAIR MAJOR PERIPHERAL NERVE	OP	"$3,292.00 "	$0.00	$0.00	"$2,439.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,439.39"	$977.53	$567.84	$977.53
64859	EAP	CPT® 64859		PR REPAIR ADDNL MAJ PERIPH NERVE	OP	"$1,192.00 "	$0.00	$0.00	$586.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$586.73	$250.70	$170.22	$250.70
64864	EAP	CPT® 64864		"PR REPR FACIAL NERVE,EXTRACRANIAL"	OP	"$2,685.00 "	$0.00	$0.00	"$2,039.90"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,039.90"	$821.69	$484.76	$821.69
64876	EAP	CPT® 64876		"PR REPAIR NERVE DELAY,SHORTEN BONE"	OP	$618.00 	$0.00	$0.00	$410.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$410.88	$190.02	$126.04	$190.02
64897	EAP	CPT® 64897		"PR NERV GRFT,ARM/LEG,MULT,=<4CM"	OP	"$3,967.00 "	$0.00	$0.00	"$2,879.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,879.76"	"$1,158.27"	$709.13	"$1,158.27"
64898	EAP	CPT® 64898		"PR NERV GRFT,ARM/LEG,MULT,>4CM"	OP	"$4,295.00 "	$0.00	$0.00	"$3,161.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,161.37"	"$1,260.33"	$774.21	"$1,260.33"
64902	EAP	CPT® 64902		"PR EA ADDNL NERVE GRAFT,MULTPL STRANDS"	OP	"$2,172.00 "	$0.00	$0.00	"$1,530.30"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,530.30"	$674.44	$491.56	$674.44
64905	EAP	CPT® 64905		"PR NERVE PEDICLE XFER,FIRST STAGE"	OP	"$3,191.00 "	$0.00	$0.00	"$2,379.35"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,379.35"	$895.42	$529.35	$895.42
64910	EAP	CPT® 64910		PR NERVE REPAIR W/ALLOGRAFT OR SYNTH	OP	"$2,458.00 "	$0.00	$0.00	"$1,905.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,905.60"	$645.63	$393.36	$645.63
64912	EAP	CPT® 64912		PR NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND	OP	"$2,849.00 "	$0.00	$0.00	"$1,799.13"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,799.13"	$0.00	$479.82	$0.00
64999	EAP	CPT® 64999		PR NERVOUS SYSTEM SURGERY UNLISTED	OP	"$6,000.00 "	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65093	EAP	CPT® 65093		PR REMOVE OCULAR CONTENTS W IMPLANT	OP	"$3,182.00 "	$0.00	$0.00	"$1,431.60"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,431.60"	$561.91	$358.27	$561.91
65101	EAP	CPT® 65101		PR REMOVAL OF EYE	OP	"$2,917.00 "	$0.00	$0.00	"$1,681.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,681.68"	$637.34	$365.32	$637.34
65103	EAP	CPT® 65103		PR REMOVE EYE W IMPLANT	OP	"$3,182.00 "	$0.00	$0.00	"$1,755.80"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,755.80"	$664.76	$386.97	$664.76
65105	EAP	CPT® 65105		PR REMOVE EYE W MUSC TO IMPLANT	OP	"$3,977.00 "	$0.00	$0.00	"$1,935.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,935.45"	$730.82	$425.39	$730.82
65205	EAP	CPT® 65205		"PR REMV F.B.,EYE,SUPERF CONJUNC"	OP	$220.00 	$0.00	$0.00	$100.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.71	$49.46	$83.16	$49.46
65220	EAP	CPT® 65220		"PR REMV F.B.,EYE,CORNEA,NO SLIT"	OP	$257.00 	$0.00	$0.00	$96.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.47	$50.07	$105.56	$50.07
65222	EAP	CPT® 65222		"PR REMV F.B.,EYE,CORNEA,SLIT LAMP"	OP	$271.74 	$0.00	$0.00	$119.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.24	$66.51	$92.00	$66.51
65235	EAP	CPT® 65235		"PR REMOVAL,FB,INTRAOCULAR,ANT CHAMBER/LENS"	OP	"$2,200.00 "	$0.00	$0.00	"$1,623.66"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,623.66"	$575.47	$314.48	$575.47
65265	EAP	CPT® 65265		"PR REMV F.B.,EYE,POST SGMT,NONMAGNETIC"	OP	"$3,977.00 "	$0.00	$0.00	"$2,469.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,469.68"	$905.84	$554.04	$905.84
65280	EAP	CPT® 65280		"PR REPAIR CORNEA LAC,PERF,NO UVEAL"	OP	"$3,182.00 "	$0.00	$0.00	"$1,532.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,532.94"	$556.27	$357.31	$556.27
65285	EAP	CPT® 65285		"PR REPAIR CORNEA LAC,PERF,RESEC UVEAL"	OP	"$4,243.00 "	$0.00	$0.00	"$2,531.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,531.25"	$870.17	$591.30	$870.17
65420	EAP	CPT® 65420		PR EXCIS PTERYGIUM	OP	"$1,153.00 "	$0.00	$0.00	$862.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$862.95	$465.62	$225.53	$465.62
65426	EAP	CPT® 65426		"PR EXCIS PTERYGIUM,W GRAFT"	OP	"$1,463.00 "	$0.00	$0.00	"$1,093.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,093.22"	$576.40	$268.75	$576.40
65710	EAP	CPT® 65710		"PR CORNEAL TRANSPLANT,LAMELLAR"	OP	"$3,444.00 "	$0.00	$0.00	"$2,525.49"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,525.49"	$927.56	$564.75	$927.56
65730	EAP	CPT® 65730		"PR CORNEAL TRANSPLANT,PENETRATING"	OP	"$3,810.00 "	$0.00	$0.00	"$2,800.92"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,800.92"	"$1,028.40"	$660.39	"$1,028.40"
65755	EAP	CPT® 65755		"PR CORNEAL TRANSPLANT,PEN,PSEUDOAPHAK"	OP	"$3,813.00 "	$0.00	$0.00	"$2,800.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,800.59"	"$1,040.66"	$690.01	"$1,040.66"
65756	EAP	CPT® 65756		"PR CORNEAL TRANSPLANT,ENDOTHELIAL"	OP	"$3,617.00 "	$0.00	$0.00	"$2,704.98"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,704.98"	$0.00	$590.88	$0.00
65757	EAP	CPT® 65757		PR PREP CORNEAL ENDOTHEL ALLOGRAFT	OP	$353.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
65778	EAP	CPT® 65778		PR PLACE AMNIOTIC MEMBRA OCULAR SURFACE W/O SUTURES	OP	$168.00 	$0.00	$0.00	$133.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.65	$0.00	$0.00	$0.00
65800	EAP	CPT® 65800		PR PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX	OP	$279.00 	$0.00	$0.00	$209.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$209.34	$133.82	$88.65	$133.82
65855	EAP	CPT® 65855		PR LASER SURGERY OF EYE	OP	"$1,406.00 "	$0.00	$0.00	$549.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$549.33	$297.11	$221.85	$297.11
65920	EAP	CPT® 65920		"PR REMVL,IMPLANT MATERIAL,ANT SEGMENT,EYE"	OP	"$2,419.00 "	$0.00	$0.00	"$1,800.23"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,800.23"	$657.06	$377.44	$657.06
66170	EAP	CPT® 66170		"PR GLAUCOMA SURG,TRABECU AB EXTERNO"	OP	"$3,346.00 "	$0.00	$0.00	"$2,216.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,216.22"	$985.36	$547.16	$985.36
66172	EAP	CPT® 66172		"PR GLAUCOMA SURG,TRAB AB EXT,PREV SCAR"	OP	"$3,644.00 "	$0.00	$0.00	"$2,796.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,796.50"	"$1,233.09"	$634.26	"$1,233.09"
66180	EAP	CPT® 66180		PR AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W/GRAFT	OP	"$3,486.00 "	$0.00	$0.00	"$2,596.32"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,596.32"	$984.14	$659.51	$984.14
66710	EAP	CPT® 66710		"PR DESTRUC,CILIARY BODY,CYCLOPHOTOCOAG"	OP	"$1,341.00 "	$0.00	$0.00	$897.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$897.20	$373.78	$258.08	$373.78
66761	EAP	CPT® 66761		"PR IRIDOTOMY/IRIDECTOMY BY LASER, PER SESSION"	OP	"$1,341.00 "	$0.00	$0.00	$539.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$539.33	$381.45	$197.11	$381.45
66762	EAP	CPT® 66762		PR IRIDOPLASTY BY PHOTOCOAG	OP	"$1,368.00 "	$0.00	$0.00	$973.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$973.91	$398.48	$217.84	$398.48
66821	EAP	CPT® 66821		"PR DISCISSION,2ND CATARACT,LASER"	OP	$953.00 	$0.00	$0.00	$710.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$710.66	$270.65	$117.73	$270.65
66850	EAP	CPT® 66850		"PR REMV LENS MATERIAL,PHACOFRAGMT"	OP	"$2,645.00 "	$0.00	$0.00	"$1,809.51"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,809.51"	$660.68	$404.32	$660.68
66852	EAP	CPT® 66852		"PR REMV LENS MATERIAL,PARS PLANAR APPRC"	OP	"$3,174.00 "	$0.00	$0.00	"$1,927.88"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,927.88"	$708.70	$440.99	$708.70
66982	EAP	CPT® 66982		PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP	OP	"$3,307.00 "	$0.00	$0.00	"$1,814.82"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,814.82"	$907.24	$594.62	$907.24
66984	EAP	CPT® 66984		PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP	OP	"$2,751.00 "	$0.00	$0.00	"$1,459.76"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,459.76"	$647.98	$451.05	$647.98
66985	EAP	CPT® 66985		PR INSERT LENS PROSTHESIS ONLY	OP	"$2,349.00 "	$0.00	$0.00	"$1,758.18"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,758.18"	$631.68	$373.61	$631.68
67005	EAP	CPT® 67005		"PR PART REMV VITREOUS,ANT APPRCH"	OP	"$2,417.00 "	$0.00	$0.00	"$1,079.57"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,079.57"	$392.36	$237.51	$392.36
67028	EAP	CPT® 67028		PR INJECT INTRAVITREAL PHARMCOLOGIC	OP	$524.00 	$0.00	$0.00	$228.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.81	$188.85	$192.54	$188.85
67036	EAP	CPT® 67036		"PR VITRECTOMY,MECHANICAL"	OP	"$3,894.00 "	$0.00	$0.00	"$2,058.45"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,058.45"	$814.31	$524.69	$814.31
67039	EAP	CPT® 67039		"PR VITRECTOMY,FOCAL LASER RX RETINA"	OP	"$4,297.00 "	$0.00	$0.00	"$2,204.21"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,204.21"	"$1,045.60"	$653.48	"$1,045.60"
67040	EAP	CPT® 67040		"PR VITRECTOMY,PANRETINAL LASER RX"	OP	"$4,566.00 "	$0.00	$0.00	"$2,382.12"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,382.12"	"$1,205.62"	$766.92	"$1,205.62"
67042	EAP	CPT® 67042		PR VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA	OP	"$3,518.00 "	$0.00	$0.00	"$2,632.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,632.53"	$0.00	$658.89	$0.00
67107	EAP	CPT® 67107		"PR REPAIR DETACH RETINA,SCLERAL BUCKLE"	OP	"$3,458.00 "	$0.00	$0.00	"$2,322.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,322.53"	"$1,017.58"	$678.37	"$1,017.58"
67108	EAP	CPT® 67108		"PR REPAIR DETACH RETINA,W VITRECTOMY"	OP	"$5,372.00 "	$0.00	$0.00	"$2,963.72"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,963.72"	"$1,357.11"	$943.29	"$1,357.11"
67113	EAP	CPT® 67113		PR REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL	OP	"$4,094.00 "	$0.00	$0.00	"$3,219.86"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,219.86"	$0.00	$694.72	$0.00
67145	EAP	CPT® 67145		PR PROPH RETINAL DTCHMNT W/O DRG PHOTOCOAGULATION	OP	"$1,565.00 "	$0.00	$0.00	"$1,137.54"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,137.54"	$437.14	$258.36	$437.14
67210	EAP	CPT® 67210		"PR DESTRUC RETINAL LESN,PHOTOCOAG"	OP	"$1,622.00 "	$0.00	$0.00	"$1,142.39"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,142.39"	$585.48	$391.08	$585.48
67228	EAP	CPT® 67228		"PR TX EXTENSIVE RETINOPATHY, PHOTOCOAGULATION"	OP	"$1,736.00 "	$0.00	$0.00	$918.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$701.82	$918.55	$514.02	$918.55
67311	EAP	CPT® 67311		"PR STABISMUS SURG,ONE HORIZ MUSCLE"	OP	"$1,894.00 "	$0.00	$0.00	"$1,365.53"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,365.53"	$501.05	$309.52	$501.05
67332	EAP	CPT® 67332		"PR STRABISMUS SURG,SCAR EXTRAOCUL MUSC"	OP	"$1,208.00 "	$0.00	$0.00	$760.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$760.01	$281.12	$284.97	$281.12
67400	EAP	CPT® 67400		PR EXPLORE EYE SOCKET	OP	"$3,014.00 "	$0.00	$0.00	"$2,121.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,121.36"	$808.74	$482.76	$808.74
67412	EAP	CPT® 67412		"PR EXPLORE EYE SOCKET,REMV LESN"	OP	"$2,823.00 "	$0.00	$0.00	"$1,941.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,941.48"	$760.41	$491.04	$760.41
67414	EAP	CPT® 67414		"PR EXPLORE EYE SOCKET,DECOMPRESS"	OP	"$4,280.00 "	$0.00	$0.00	"$3,024.26"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,024.26"	"$1,097.88"	$513.62	"$1,097.88"
67715	EAP	CPT® 67715		PR INCISION OF EYELID FOLD	OP	$328.00 	$0.00	$0.00	$248.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$248.25	$229.47	$51.00	$229.47
67800	EAP	CPT® 67800		"PR EXCIS CHALAZION,SINGLE"	OP	$315.00 	$0.00	$0.00	$236.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.16	$109.75	$109.19	$109.75
67805	EAP	CPT® 67805		"PR EXCIS CHALAZION,MULT,BOTH LIDS"	OP	$501.00 	$0.00	$0.00	$376.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$376.34	$173.44	$138.92	$173.44
67810	EAP	CPT® 67810		PR INCISIONAL BIOPSY EYELID SKIN & LID MARGIN	OP	$294.00 	$0.00	$0.00	$182.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.75	$182.54	$95.68	$182.54
67825	EAP	CPT® 67825		PR REVISE EYELASHES	OP	$371.00 	$0.00	$0.00	$277.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$277.44	$113.07	$125.79	$113.07
67840	EAP	CPT® 67840		PR REMOVE EYELID LESN (NOT CHALAZION)	OP	$482.00 	$0.00	$0.00	$361.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$361.88	$263.41	$130.95	$263.41
67875	EAP	CPT® 67875		PR TEMP CLOSURE EYELID BY SUTURE	OP	$405.00 	$0.00	$0.00	$222.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.36	$163.43	$147.80	$163.43
67900	EAP	CPT® 67900		PR REPAIR BROW PTOSIS	OP	"$2,432.00 "	$0.00	$0.00	"$1,164.17"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,164.17"	$569.44	$287.12	$569.44
67901	EAP	CPT® 67901		"PR FIX LID PTOSIS,FRONTALIS MUSC,SUT"	OP	"$2,006.00 "	$0.00	$0.00	"$1,317.68"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,317.68"	$517.30	$324.45	$517.30
67911	EAP	CPT® 67911		PR CORRECT LID RETRACTN	OP	"$1,715.00 "	$0.00	$0.00	"$1,284.63"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,284.63"	$453.56	$260.16	$453.56
67912	EAP	CPT® 67912		PR CORRECTION EYELID W/ IMPLANT	OP	"$3,243.00 "	$0.00	$0.00	"$1,122.11"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,122.11"	$871.78	$609.55	$871.78
67914	EAP	CPT® 67914		"PR FIX ECTROPION,SUTURE"	OP	"$1,581.00 "	$0.00	$0.00	$748.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$748.38	$357.30	$245.81	$357.30
67917	EAP	CPT® 67917		"PR FIX ECTROPION,ENTENSV LID REPAIR"	OP	"$2,310.00 "	$0.00	$0.00	"$1,047.02"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,047.02"	$524.59	$317.77	$524.59
67921	EAP	CPT® 67921		"PR FIX ENTROPION,SUTURE"	OP	$947.00 	$0.00	$0.00	$709.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$709.77	$341.25	$233.91	$341.25
67924	EAP	CPT® 67924		"PR FIX ENTROPION,EXTENSV LID REPAIR"	OP	"$2,351.00 "	$0.00	$0.00	"$1,047.06"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,047.06"	$528.63	$304.26	$528.63
67930	EAP	CPT® 67930		"PR SUTURE EYELID WOUND,PARTIAL THICK"	OP	$750.00 	$0.00	$0.00	$548.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$548.49	$333.65	$212.42	$333.65
67935	EAP	CPT® 67935		"PR SUTURE EYELID WOUND,FULL THICK"	OP	"$1,354.00 "	$0.00	$0.00	"$1,011.48"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,011.48"	$534.48	$340.68	$534.48
67961	EAP	CPT® 67961		"PR REVISION OF EYELID,< 1/4 LID MARGIN"	OP	"$2,229.00 "	$0.00	$0.00	"$1,039.01"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,039.01"	$518.69	$287.01	$518.69
68020	EAP	CPT® 68020		PR INCISE/DRAIN CONJUNCTIVA	OP	$336.00 	$0.00	$0.00	$252.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.35	$102.11	$102.47	$102.11
68110	EAP	CPT® 68110		"PR EXCIS CONJUNC LESN,=<1 CM"	OP	$452.00 	$0.00	$0.00	$339.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$339.47	$208.16	$130.70	$208.16
68115	EAP	CPT® 68115		"PR EXCIS CONJUNC LESN,>1 CM"	OP	$608.00 	$0.00	$0.00	$420.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$420.75	$293.14	$149.81	$293.14
68320	EAP	CPT® 68320		"PR REVISE CONJUNC,CONJUNC GRFT"	OP	"$2,432.00 "	$0.00	$0.00	"$1,231.94"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,231.94"	$634.85	$252.51	$634.85
68510	EAP	CPT® 68510		PR BIOPSY OF TEAR GLAND	OP	$893.00 	$0.00	$0.00	$668.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$668.39	$422.26	$267.62	$422.26
68700	EAP	CPT® 68700		PR REPAIR TEAR DUCTS	OP	"$2,711.00 "	$0.00	$0.00	"$1,379.15"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,379.15"	$501.92	$251.22	$501.92
68705	EAP	CPT® 68705		PR REVISE TEAR DUCT OPENING	OP	$506.00 	$0.00	$0.00	$380.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$380.49	$220.65	$131.38	$220.65
68720	EAP	CPT® 68720		PR CREATE TEAR SAC-NASAL FISTULA	OP	"$4,190.00 "	$0.00	$0.00	"$1,727.22"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,727.22"	$645.30	$405.27	$645.30
68761	EAP	CPT® 68761		"PR CLOSE TEAR DUCT OPENING BY PLUG,EA"	OP	$359.00 	$0.00	$0.00	$271.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.83	$130.64	$106.72	$130.64
69000	EAP	CPT® 69000		"PR DRAIN EXT EAR ABSC/BLOOD,SIMPLE"	OP	$375.00 	$0.00	$0.00	$275.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.34	$160.21	$57.93	$160.21
69020	EAP	CPT® 69020		PR DRAIN EXT AUD CANAL ABSCESS	OP	$434.00 	$0.00	$0.00	$330.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$330.23	$202.40	$61.05	$202.40
69105	EAP	CPT® 69105		PR BIOPSY OF EXT AUDITORY CANAL	OP	$302.00 	$0.00	$0.00	$148.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.04	$119.53	$43.57	$119.53
69200	EAP	CPT® 69200		PR REMV EXT CANAL FOREIGN BODY	OP	$221.00 	$0.00	$0.00	$113.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.31	$113.15	$36.65	$113.15
69205	EAP	CPT® 69205		"PR REMV EXT CANAL F.B.,GEN ANESTH"	OP	$886.00 	$0.00	$0.00	$235.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$235.89	$94.03	$55.20	$94.03
69209	EAP	CPT® 69209		PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	OP	$43.00 	$0.00	$0.00	$29.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.10	$0.00	$7.66	$0.00
69210	EAP	CPT® 69210		PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	OP	$106.00 	$0.00	$0.00	$75.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$134.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.51	$45.76	$29.62	$45.76
69222	EAP	CPT® 69222		"PR DEBRIDE MASTOID CAVITY,COMPLEX"	OP	$544.00 	$0.00	$0.00	$318.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$318.17	$194.12	$62.00	$194.12
69320	EAP	CPT® 69320		"PR REBUILD EXT AUD CANAL,CONG ANOMALY"	OP	"$4,700.00 "	$0.00	$0.00	"$3,593.91"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,593.91"	"$1,419.31"	$718.57	"$1,419.31"
69421	EAP	CPT® 69421		"PR INCISION EARDRUM,ASPIR,GEN ANESTH"	OP	$455.00 	$0.00	$0.00	$346.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$346.13	$142.16	$77.92	$142.16
69433	EAP	CPT® 69433		"PR CREATE EARDRUM OPENING,LOCAL ANESTH"	OP	$433.00 	$0.00	$0.00	$308.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$308.31	$172.45	$72.91	$172.45
69502	EAP	CPT® 69502		"PR MASTOIDECTOMY,COMPLETE"	OP	"$2,932.00 "	$0.00	$0.00	"$2,260.74"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,260.74"	$887.31	$561.09	$887.31
69631	EAP	CPT® 69631		PR TYMPANOPLASTY	OP	"$2,878.00 "	$0.00	$0.00	"$2,057.25"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,057.25"	$784.61	$455.07	$784.61
69645	EAP	CPT® 69645		"PR TYMPANOPLAS/MASTOIDEC,RADICAL/COMPLE"	OP	"$4,472.00 "	$0.00	$0.00	"$3,383.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$3,383.07"	"$1,340.94"	$742.12	"$1,340.94"
69661	EAP	CPT® 69661		"PR STAPEDECTOMY,FOOTPLATE DRILL OUT"	OP	"$3,708.00 "	$0.00	$0.00	"$2,811.59"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,811.59"	"$1,121.27"	$708.23	"$1,121.27"
69990	EAP	CPT® 69990		"PR MICROSURG TECHNIQUES,REQ OPER MICROSCOPE"	OP	$681.00 	$0.00	$0.00	$513.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$513.98	$212.40	$130.21	$212.40
70100	EAP	CPT® 70100		CHG X-RAY JAW <4 VW	OP	$28.00 	$0.00	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.00	$28.00	$18.23	$28.00
70110	EAP	CPT® 70110		CHG X-RAY JAW 4+ VW	OP	$41.00 	$0.00	$0.00	$41.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.00	$36.66	$22.66	$36.66
70160	EAP	CPT® 70160		PR X-RAY NASAL BONES	OP	$27.00 	$0.00	$0.00	$27.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.00	$27.00	$17.79	$27.00
70250	EAP	CPT® 70250		CHG X-RAY SKULL <4 VW	OP	$36.00 	$0.00	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.00	$35.93	$22.44	$35.93
70330	EAP	CPT® 70330		PR X-RAY TMJ BILAT	OP	$45.00 	$0.00	$0.00	$45.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.00	$44.66	$27.81	$44.66
70336	EAP	CPT® 70336		"PR MRI, TMJ"	OP	$227.00 	$0.00	$0.00	$227.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.00	$227.00	$0.00	$227.00
70355	EAP	CPT® 70355		PR ORTHOPANTOGRAM	OP	$32.00 	$0.00	$0.00	$29.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.46	$29.21	$20.00	$29.21
70360	EAP	CPT® 70360		PR X-RAY NECK SOFT TISSUE	OP	$32.00 	$0.00	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.00	$25.20	$15.55	$25.20
70450	EAP	CPT® 70450		"PR CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"	OP	$142.00 	$0.00	$0.00	$142.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$313.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.00	$142.00	$138.79	$142.00
70460	EAP	CPT® 70460		PR CT SCAN HEAD CONTRAST	OP	$187.00 	$0.00	$0.00	$187.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.00	$187.00	$170.14	$187.00
70470	EAP	CPT® 70470		PR CT SCAN HEAD COMBO	OP	$211.00 	$0.00	$0.00	$211.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.00	$211.00	$207.85	$211.00
70480	EAP	CPT® 70480		"PR CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,W/O"	OP	$223.00 	$0.00	$0.00	$223.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$223.00	$223.00	$152.39	$223.00
70481	EAP	CPT® 70481		PR CT SCAN SKULL CONTRAST	OP	$227.00 	$0.00	$0.00	$227.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$227.00	$227.00	$177.61	$227.00
70482	EAP	CPT® 70482		PR CT SCAN SKULL COMBO	OP	$237.00 	$0.00	$0.00	$237.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$237.00	$237.00	$213.56	$237.00
70486	EAP	CPT® 70486		"PR CT SCAN,MAXILLOFACIAL AREA,W/O CONTRAST"	OP	$195.00 	$0.00	$0.00	$195.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$379.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.12	$195.00	$147.99	$195.00
70487	EAP	CPT® 70487		"PR CT SCAN, FACE/JAW CONTRAST"	OP	$212.00 	$0.00	$0.00	$212.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.00	$212.00	$175.19	$212.00
70488	EAP	CPT® 70488		PR CT SCANS FACE/JAW COMBO	OP	$234.00 	$0.00	$0.00	$234.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$234.00	$234.00	$212.68	$234.00
70490	EAP	CPT® 70490		"PR CT SCAN,SOFT TISSUE NECK,W/O CONTRAST"	OP	$220.00 	$0.00	$0.00	$220.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$445.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$220.00	$220.00	$152.39	$220.00
70491	EAP	CPT® 70491		PR CT NECK TISSUE CONTRAST	OP	$224.00 	$0.00	$0.00	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.00	$224.00	$177.61	$224.00
70492	EAP	CPT® 70492		PR CT NECK TISSUE COMBO	OP	$250.00 	$0.00	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.00	$250.00	$213.33	$250.00
70496	EAP	CPT® 70496		"PR CT ANGIO,HEAD COMBO,INCL IMAGE PROCESS"	OP	$268.00 	$0.00	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.00	$268.00	$260.29	$268.00
70498	EAP	CPT® 70498		"PR CT ANGIO,NECK COMBO,INCL IMAGE PROCESS"	OP	$268.00 	$0.00	$0.00	$268.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.00	$268.00	$260.29	$268.00
70540	EAP	CPT® 70540		"PR MRI, FACE, NECK"	OP	$249.00 	$0.00	$0.00	$249.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.00	$249.00	$249.00	$249.00
70543	EAP	CPT® 70543		"PR MRI, FACE, NECK, COMBO"	OP	$328.00 	$0.00	$0.00	$328.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.00	$328.00	$328.00	$328.00
70544	EAP	CPT® 70544		"PR MR ANGIO, HEAD"	OP	$188.00 	$0.00	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.00	$188.00	$188.00	$188.00
70545	EAP	CPT® 70545		"PR MR ANGIO, HEAD W/CONTRAST"	OP	$209.00 	$0.00	$0.00	$209.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$209.00	$209.00	$209.00	$209.00
70546	EAP	CPT® 70546		"PR MR ANGIO, HEAD, COMBO"	OP	$228.00 	$0.00	$0.00	$228.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.00	$228.00	$228.00	$228.00
70547	EAP	CPT® 70547		"PR MR ANGIO, NECK"	OP	$185.00 	$0.00	$0.00	$185.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.00	$185.00	$185.00	$185.00
70548	EAP	CPT® 70548		"PR MR ANGIO, NECK W/CONTRAST"	OP	$230.00 	$0.00	$0.00	$230.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.00	$230.00	$230.00	$230.00
70549	EAP	CPT® 70549		"PR MR ANGIO, NECK, COMBO"	OP	$277.00 	$0.00	$0.00	$277.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$277.00	$277.00	$277.00	$277.00
70551	EAP	CPT® 70551		PR MRI BRAIN	OP	$256.00 	$0.00	$0.00	$256.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.00	$256.00	$256.00	$256.00
70553	EAP	CPT® 70553		PR MRI BRAIN COMBO	OP	$352.00 	$0.00	$0.00	$352.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.00	$352.00	$352.00	$352.00
71045	EAP	CPT® 71045		CHG RADIOLOGIC EXAM CHEST SINGLE VIEW	OP	$28.00 	$0.00	$0.00	$26.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.55	$0.00	$11.95	$0.00
71046	EAP	CPT® 71046		CHG RADIOLOGIC EXAM CHEST 2 VIEWS	OP	$34.00 	$0.00	$0.00	$34.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.00	$0.00	$18.33	$0.00
71048	EAP	CPT® 71048		CHG RADIOLOGIC EXAM CHEST 4+ VIEWS	OP	$50.00 	$0.00	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.00	$0.00	$25.14	$0.00
71101	EAP	CPT® 71101		"CHG X-RAY RIBS, CHEST 3+ VW"	OP	$46.00 	$0.00	$0.00	$46.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.00	$38.56	$24.44	$38.56
71110	EAP	CPT® 71110		CHG X-RAY RIBS 3 VW BILAT	OP	$47.00 	$0.00	$0.00	$47.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.00	$42.16	$27.34	$42.16
71111	EAP	CPT® 71111		"CHG X-RAY RIBS, CHEST 4+ VW"	OP	$54.00 	$0.00	$0.00	$54.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.00	$50.32	$31.56	$50.32
71120	EAP	CPT® 71120		CHG X-RAY STERNUM 2+ VW	OP	$34.00 	$0.00	$0.00	$34.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.00	$33.97	$21.78	$33.97
71250	EAP	CPT® 71250		CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST	OP	$192.00 	$0.00	$0.00	$192.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$393.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.00	$192.00	$177.05	$192.00
71260	EAP	CPT® 71260		CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST	OP	$202.00 	$0.00	$0.00	$202.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.00	$202.00	$202.00	$202.00
71270	EAP	CPT® 71270		CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+	OP	$224.00 	$0.00	$0.00	$224.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.00	$224.00	$224.00	$224.00
71271	EAP	CPT® 71271		CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-	OP	$157.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
71275	EAP	CPT® 71275		"PR CT ANGIO, CHEST (NON-CORON), COMBO, INCL IMG PROC"	OP	$279.00 	$0.00	$0.00	$279.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$279.00	$279.00	$279.00	$279.00
71550	EAP	CPT® 71550		"PR MRI, CHEST"	OP	$289.00 	$0.00	$0.00	$289.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.00	$289.00	$289.00	$289.00
71552	EAP	CPT® 71552		"PR MRI, CHEST, COMBO"	OP	$344.00 	$0.00	$0.00	$344.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$344.00	$344.00	$344.00	$344.00
72020	EAP	CPT® 72020		PR X-RAY SPINE ONE VIEW	OP	$25.00 	$0.00	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.00	$22.94	$14.89	$22.94
72040	EAP	CPT® 72040		CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS	OP	$36.00 	$0.00	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.00	$34.77	$21.33	$34.77
72050	EAP	CPT® 72050		CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS	OP	$48.00 	$0.00	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.00	$48.00	$31.11	$48.00
72052	EAP	CPT® 72052		CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS	OP	$55.00 	$0.00	$0.00	$55.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.00	$55.00	$38.26	$55.00
72070	EAP	CPT® 72070		CHG X-RAY THORACIC SPINE 2 VW	OP	$34.00 	$0.00	$0.00	$34.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.00	$34.00	$22.45	$34.00
72074	EAP	CPT® 72074		CHG X-RAY THORACIC SPINE 4 VW	OP	$38.00 	$0.00	$0.00	$38.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.00	$38.00	$28.92	$38.00
72080	EAP	CPT® 72080		CHG X-RAY THOR-LUMB SP 2 VW	OP	$36.00 	$0.00	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.00	$35.87	$22.90	$35.87
72081	EAP	CPT® 72081		CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW	OP	$41.00 	$0.00	$0.00	$41.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.00	$0.00	$23.17	$0.00
72082	EAP	CPT® 72082		CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW	OP	$50.00 	$0.00	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.00	$0.00	$37.24	$0.00
72100	EAP	CPT® 72100		CHG X-RAY LUMBAR SPINE 2/3 VW	OP	$35.00 	$0.00	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.00	$35.00	$22.90	$35.00
72110	EAP	CPT® 72110		CHG X-RAY LUMBAR SPINE 4 VW	OP	$50.00 	$0.00	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.00	$50.00	$31.56	$50.00
72114	EAP	CPT® 72114		PR RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6	OP	$59.00 	$0.00	$0.00	$59.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.00	$59.00	$39.81	$59.00
72120	EAP	CPT® 72120		PR RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS	OP	$35.00 	$0.00	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.00	$35.00	$28.48	$35.00
72125	EAP	CPT® 72125		"PR CT SCAN,CERVICAL SPINE,W/O CONTRAST"	OP	$177.00 	$0.00	$0.00	$177.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.00	$177.00	$177.00	$177.00
72126	EAP	CPT® 72126		PR CT SCAN CERV SPINE CONTRAST	OP	$188.00 	$0.00	$0.00	$188.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$188.00	$188.00	$188.00	$188.00
72127	EAP	CPT® 72127		PR CT SCAN CERV SP COMBO	OP	$201.00 	$0.00	$0.00	$201.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.00	$201.00	$201.00	$201.00
72128	EAP	CPT® 72128		"PR CT SCAN,THORACIC SPINE,W/O CONTRAST"	OP	$177.00 	$0.00	$0.00	$177.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.00	$177.00	$177.00	$177.00
72129	EAP	CPT® 72129		PR CT SCAN DORSAL SP CONTRAST	OP	$187.00 	$0.00	$0.00	$187.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.00	$187.00	$187.00	$187.00
72131	EAP	CPT® 72131		"PR CT SCAN,LUMBAR SPINE,W/O CONTRAST"	OP	$176.00 	$0.00	$0.00	$176.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$383.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.00	$176.00	$176.00	$176.00
72132	EAP	CPT® 72132		PR CT SCAN LUMBAR SP CONTRAST	OP	$187.00 	$0.00	$0.00	$187.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.00	$187.00	$187.00	$187.00
72133	EAP	CPT® 72133		PR CT SCAN LUMBAR SP COMBO	OP	$194.00 	$0.00	$0.00	$194.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.00	$194.00	$194.00	$194.00
72141	EAP	CPT® 72141		"PR MRI, CERV SPINE"	OP	$253.00 	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$253.00	$253.00	$253.00	$253.00
72146	EAP	CPT® 72146		"PR MRI, DORSAL SPINE"	OP	$236.00 	$0.00	$0.00	$236.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.00	$236.00	$236.00	$236.00
72147	EAP	CPT® 72147		"PR MRI, DORSAL SPINE CONTRAST"	OP	$301.00 	$0.00	$0.00	$301.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$301.00	$301.00	$301.00	$301.00
72148	EAP	CPT® 72148		"PR MRI, LUMBAR SPINE"	OP	$228.00 	$0.00	$0.00	$228.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.00	$228.00	$228.00	$228.00
72156	EAP	CPT® 72156		"PR MRI, CERV SPINE COMBO"	OP	$352.00 	$0.00	$0.00	$352.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.00	$352.00	$352.00	$352.00
72157	EAP	CPT® 72157		"PR MRI, DORSAL SPINE COMBO"	OP	$352.00 	$0.00	$0.00	$352.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.00	$352.00	$352.00	$352.00
72158	EAP	CPT® 72158		"PR MRI, LUMBAR SPINE COMBO"	OP	$352.00 	$0.00	$0.00	$352.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$352.00	$352.00	$352.00	$352.00
72170	EAP	CPT® 72170		CHG X-RAY PELVIS 1/2 VW	OP	$31.00 	$0.00	$0.00	$31.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.00	$27.39	$17.79	$27.39
72190	EAP	CPT® 72190		CHG X-RAY PELVIS 3+ VW	OP	$39.00 	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.00	$36.93	$22.69	$36.93
72192	EAP	CPT® 72192		"PR CT SCAN,PELVIS,W/O CONTRAST"	OP	$167.00 	$0.00	$0.00	$167.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.00	$167.00	$167.00	$167.00
72193	EAP	CPT® 72193		PR CT SCAN OF PELVIS CONTRAST	OP	$177.00 	$0.00	$0.00	$177.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$286.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.00	$177.00	$177.00	$177.00
72194	EAP	CPT® 72194		PR CT SCAN OF PELVIS COMBO	OP	$187.00 	$0.00	$0.00	$187.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.00	$187.00	$187.00	$187.00
72195	EAP	CPT® 72195		"PR MRI, PELVIS, W/O CONTRAST"	OP	$237.00 	$0.00	$0.00	$237.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$237.00	$237.00	$237.00	$237.00
72196	EAP	CPT® 72196		"PR MRI, PELVIS W/CONTRAST"	OP	$274.00 	$0.00	$0.00	$274.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$274.00	$274.00	$274.00	$274.00
72197	EAP	CPT® 72197		"PR MRI, PELVIS, COMBO"	OP	$335.00 	$0.00	$0.00	$335.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$335.00	$335.00	$335.00	$335.00
72200	EAP	CPT® 72200		CHG X-RAY SACROILIAC JTS <3 VW	OP	$29.00 	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.00	$28.13	$17.79	$28.13
72220	EAP	CPT® 72220		CHG X-RAY SACRUM/COCCYX 2+ VW	OP	$30.00 	$0.00	$0.00	$30.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.00	$29.85	$19.12	$29.85
73000	EAP	CPT® 73000		PR X-RAY CLAVICLE	OP	$26.00 	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.00	$26.00	$17.35	$26.00
73010	EAP	CPT® 73010		PR X-RAY SCAPULA	OP	$32.00 	$0.00	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.00	$28.13	$17.79	$28.13
73020	EAP	CPT® 73020		CHG X-RAY SHOULDER 1 VW	OP	$24.00 	$0.00	$0.00	$24.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.00	$24.00	$16.23	$24.00
73030	EAP	CPT® 73030		CHG X-RAY SHOULDER 2+ VW	OP	$32.00 	$0.00	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.00	$30.24	$19.33	$30.24
73060	EAP	CPT® 73060		CHG X-RAY HUMERUS	OP	$29.00 	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.00	$29.00	$19.12	$29.00
73070	EAP	CPT® 73070		CHG X-RAY ELBOW 2 VW	OP	$26.00 	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.00	$26.00	$17.13	$26.00
73080	EAP	CPT® 73080		CHG X-RAY ELBOW 3+ VW	OP	$28.00 	$0.00	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.00	$28.00	$19.12	$28.00
73090	EAP	CPT® 73090		CHG X-RAY FOREARM 2 VW	OP	$26.00 	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.00	$26.00	$17.35	$26.00
73100	EAP	CPT® 73100		CHG X-RAY WRIST 2 VW	OP	$26.00 	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.00	$26.00	$17.12	$26.00
73110	EAP	CPT® 73110		CHG X-RAY WRIST 3+ VW	OP	$28.00 	$0.00	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.00	$28.00	$18.01	$28.00
73120	EAP	CPT® 73120		CHG X-RAY HAND 2 VW	OP	$26.00 	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.00	$26.00	$17.12	$26.00
73130	EAP	CPT® 73130		CHG X-RAY HAND 3+ VW	OP	$28.00 	$0.00	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.00	$28.00	$18.01	$28.00
73140	EAP	CPT® 73140		CHG X-RAY EXAM OF FINGER(S)	OP	$22.00 	$0.00	$0.00	$22.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.00	$22.00	$14.45	$22.00
73200	EAP	CPT® 73200		"PR CT SCAN,UPPER EXTREMITY,W/O CONTRAST"	OP	$154.00 	$0.00	$0.00	$154.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.00	$154.00	$151.85	$154.00
73201	EAP	CPT® 73201		PR CT SCAN OF ARM CONTRAST	OP	$177.00 	$0.00	$0.00	$177.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.00	$177.00	$177.00	$177.00
73202	EAP	CPT® 73202		PR CT SCAN OF ARM COMBO	OP	$187.00 	$0.00	$0.00	$187.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.00	$187.00	$187.00	$187.00
73206	EAP	CPT® 73206		"PR CT ANGIO,UPPER EXTREM,COMBO"	OP	$275.00 	$0.00	$0.00	$275.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$275.00	$275.00	$246.00	$275.00
73218	EAP	CPT® 73218		"PR MRI, UPPER EXTREM"	OP	$208.00 	$0.00	$0.00	$208.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.00	$208.00	$208.00	$208.00
73220	EAP	CPT® 73220		"PR MRI UPPER EXTR, W/CONTRAST"	OP	$329.00 	$0.00	$0.00	$329.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$329.00	$329.00	$313.04	$329.00
73221	EAP	CPT® 73221		"PR MRI, JOINT UPPER EXTREM"	OP	$211.00 	$0.00	$0.00	$211.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$211.00	$211.00	$211.00	$211.00
73222	EAP	CPT® 73222		"PR MRI, JOINT UPPER EXTREM W/CONTRAST"	OP	$251.00 	$0.00	$0.00	$251.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$251.00	$251.00	$251.00	$251.00
73223	EAP	CPT® 73223		"PR MRI, JOINT UPPER EXTREM COMBO"	OP	$329.00 	$0.00	$0.00	$329.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$329.00	$329.00	$329.00	$329.00
73501	EAP	CPT® 73501		CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW	OP	$29.00 	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.00	$0.00	$17.65	$0.00
73502	EAP	CPT® 73502		CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS	OP	$35.00 	$0.00	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.00	$0.00	$24.68	$0.00
73503	EAP	CPT® 73503		CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS	OP	$42.00 	$0.00	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.00	$0.00	$30.85	$0.00
73521	EAP	CPT® 73521		CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS	OP	$35.00 	$0.00	$0.00	$35.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.00	$0.00	$23.62	$0.00
73522	EAP	CPT® 73522		CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS	OP	$45.00 	$0.00	$0.00	$45.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.00	$0.00	$29.14	$0.00
73523	EAP	CPT® 73523		CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS	OP	$49.00 	$0.00	$0.00	$49.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.00	$0.00	$33.82	$0.00
73551	EAP	CPT® 73551		CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW	OP	$26.00 	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.00	$0.00	$16.37	$0.00
73552	EAP	CPT® 73552		CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS	OP	$28.00 	$0.00	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.00	$0.00	$19.36	$0.00
73560	EAP	CPT® 73560		CHG X-RAY KNEE 1 OR 2 VIEW	OP	$28.00 	$0.00	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.00	$28.00	$17.79	$28.00
73562	EAP	CPT® 73562		CHG X-RAY KNEE 3 VIEW	OP	$29.00 	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.00	$29.00	$19.56	$29.00
73564	EAP	CPT® 73564		CHG X-RAY KNEE 4+ VIEW	OP	$37.00 	$0.00	$0.00	$37.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.00	$36.23	$21.78	$36.23
73590	EAP	CPT® 73590		"CHG X-RAY TIB + FIB, 2VW"	OP	$28.00 	$0.00	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.00	$27.76	$17.79	$27.76
73592	EAP	CPT® 73592		"CHG X-RAY LEG, INFANT"	OP	$25.00 	$0.00	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.00	$25.00	$17.12	$25.00
73600	EAP	CPT® 73600		CHG X-RAY ANKLE 2 VW	OP	$26.00 	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.00	$26.00	$17.12	$26.00
73610	EAP	CPT® 73610		CHG X-RAY ANKLE 3+ VW	OP	$28.00 	$0.00	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.00	$28.00	$18.01	$28.00
73620	EAP	CPT® 73620		CHG X-RAY FOOT 2 VW	OP	$25.00 	$0.00	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.00	$25.00	$17.12	$25.00
73630	EAP	CPT® 73630		CHG X-RAY FOOT 3+ VW	OP	$28.00 	$0.00	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.00	$28.00	$18.01	$28.00
73650	EAP	CPT® 73650		CHG X-RAY HEEL	OP	$25.00 	$0.00	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.00	$25.00	$16.68	$25.00
73660	EAP	CPT® 73660		CHG X-RAY TOE(S)	OP	$22.00 	$0.00	$0.00	$22.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.00	$22.00	$14.45	$22.00
73700	EAP	CPT® 73700		"PR CT SCAN,LOWER EXTREMITY,W/O CONTRAST"	OP	$154.00 	$0.00	$0.00	$154.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.00	$154.00	$151.85	$154.00
73701	EAP	CPT® 73701		PR CT SCAN OF LEG CONTRAST	OP	$177.00 	$0.00	$0.00	$177.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.00	$177.00	$177.00	$177.00
73702	EAP	CPT® 73702		PR CT SCAN OF LEG COMBO	OP	$186.00 	$0.00	$0.00	$186.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$186.00	$186.00	$186.00	$186.00
73706	EAP	CPT® 73706		"PR CT ANGIO,LOWER EXTREM,COMBO,IMAGE PRC"	OP	$288.00 	$0.00	$0.00	$288.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$288.00	$288.00	$246.00	$288.00
73718	EAP	CPT® 73718		"PR MRI, LOWER EXTREM"	OP	$207.00 	$0.00	$0.00	$207.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$207.00	$207.00	$207.00	$207.00
73719	EAP	CPT® 73719		"PR MRI, LOWER EXTREM W/CONTRAST"	OP	$250.00 	$0.00	$0.00	$250.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.00	$250.00	$250.00	$250.00
73720	EAP	CPT® 73720		"PR MRI, LOWER EXTR, W/O CONTRAST F/U BY CONTRAST"	OP	$328.00 	$0.00	$0.00	$328.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.00	$328.00	$313.04	$328.00
73721	EAP	CPT® 73721		"PR MRI LOWER EXTREM JT, W/O CONTRAST"	OP	$208.00 	$0.00	$0.00	$208.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$208.00	$208.00	$208.00	$208.00
73723	EAP	CPT® 73723		"PR MRI, JOINT OF LEG. COMBO"	OP	$329.00 	$0.00	$0.00	$329.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$329.00	$329.00	$329.00	$329.00
74018	EAP	CPT® 74018		CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW	OP	$28.00 	$0.00	$0.00	$28.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.00	$0.00	$16.42	$0.00
74019	EAP	CPT® 74019		CHG RADIOLOGIC EXAM ABDOMEN 2 VIEWS	OP	$36.00 	$0.00	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.00	$0.00	$20.03	$0.00
74022	EAP	CPT® 74022		CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES	OP	$51.00 	$0.00	$0.00	$51.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.00	$44.51	$27.76	$44.51
74150	EAP	CPT® 74150		"PR CT SCAN,ABDOMEN,W/O CONTRAST"	OP	$196.00 	$0.00	$0.00	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$406.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.00	$196.00	$171.89	$196.00
74160	EAP	CPT® 74160		PR CT SCAN OF ABDOMEN CONTRAST	OP	$219.00 	$0.00	$0.00	$219.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$540.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.00	$219.00	$202.49	$219.00
74170	EAP	CPT® 74170		PR CT SCAN OF ABDOMEN COMBO	OP	$236.00 	$0.00	$0.00	$236.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.00	$236.00	$236.00	$236.00
74174	EAP	CPT® 74174		PR CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES	OP	$335.00 	$0.00	$0.00	$335.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$335.00	$0.00	$335.00	$0.00
74175	EAP	CPT® 74175		"PR CT ANGIO, ABD, COMBO,INCL IMAGE PROC"	OP	$278.00 	$0.00	$0.00	$278.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.00	$278.00	$273.93	$278.00
74176	EAP	CPT® 74176		"CHG CT SCAN,ABDOMENT AND PELVIS,W/O CONTRAST"	OP	$267.00 	$0.00	$0.00	$267.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$370.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$267.00	$0.00	$128.75	$0.00
74177	EAP	CPT® 74177		"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"	OP	$280.00 	$0.00	$0.00	$280.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$920.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$280.00	$0.00	$202.47	$0.00
74178	EAP	CPT® 74178		"CHG CT SCAN,ABDOMENT AND PELVIS,COMBO"	OP	$307.00 	$0.00	$0.00	$307.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,030.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.00	$0.00	$256.29	$0.00
74181	EAP	CPT® 74181		"PR MRI, ABDOMEN (MRI)"	OP	$271.00 	$0.00	$0.00	$271.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.00	$271.00	$271.00	$271.00
74183	EAP	CPT® 74183		"PR MRI, ABDOMEN, COMBO"	OP	$335.00 	$0.00	$0.00	$335.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$335.00	$335.00	$335.00	$335.00
74220	EAP	CPT® 74220		CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY	OP	$92.00 	$0.00	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.00	$72.96	$42.89	$72.96
74221	EAP	CPT® 74221		CHG RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY	OP	$107.00 	$0.00	$0.00	$107.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.00	$0.00	$65.33	$0.00
74240	EAP	CPT® 74240		CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY	OP	$124.00 	$0.00	$0.00	$124.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.00	$93.96	$56.60	$93.96
74246	EAP	CPT® 74246		CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY	OP	$138.00 	$0.00	$0.00	$138.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.00	$104.11	$61.07	$104.11
74248	EAP	CPT® 74248		CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY	OP	$107.00 	$0.00	$0.00	$107.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.00	$0.00	$49.54	$0.00
74250	EAP	CPT® 74250		CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY	OP	$126.00 	$0.00	$0.00	$126.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.00	$81.00	$45.78	$81.00
74270	EAP	CPT® 74270		CHG RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY	OP	$159.00 	$0.00	$0.00	$159.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.00	$112.83	$62.62	$112.83
74420	EAP	CPT® 74420		PR X-RAY RETROGRADE PYELOGRAM	OP	$217.91 	$0.00	$0.00	$157.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.94	$0.00	$73.78	$0.00
74430	EAP	CPT® 74430		"X-RAY CYSTOGRAM, MIN 3 VIEW"	OP	$58.00 	$0.00	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.28	$58.00	$35.36	$58.00
74450	EAP	CPT® 74450		PR X-RAY URETHROCYSTOGRAM	OP	$61.00 	$0.00	$0.00	$61.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.00	$0.00	$45.19	$0.00
74455	EAP	CPT® 74455		PR X-RAY URETHROCYSTOGRAM+VOIDING	OP	$63.00 	$0.00	$0.00	$63.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.00	$63.00	$48.09	$63.00
74740	EAP	CPT® 74740		PR X-RAY HYSTEROSALPINGOGRAM	OP	$73.00 	$0.00	$0.00	$73.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.00	$71.22	$43.14	$71.22
75561	EAP	CPT® 75561		PR CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ	OP	$391.00 	$0.00	$0.00	$391.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$391.00	$0.00	$391.00	$0.00
75565	EAP	CPT® 75565		CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING	OP	$38.00 	$0.00	$0.00	$38.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.00	$0.00	$38.00	$0.00
75571	EAP	CPT® 75571		PR CT HRT W/O DYE W/CA TEST	OP	$89.00 	$0.00	$0.00	$89.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.00	$0.00	$40.15	$0.00
75572	EAP	CPT® 75572		PR CT HEART W 3D IMAGE	OP	$266.00 	$0.00	$0.00	$266.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$266.00	$0.00	$124.05	$0.00
75574	EAP	CPT® 75574		PR CT ANGIOGRAM HEART W 3D IMAGE	OP	$362.00 	$0.00	$0.00	$362.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$362.00	$0.00	$216.24	$0.00
75605	EAP	CPT® 75605		PR ANGIO AORTOGRAM THOR SERIAL	OP	$203.00 	$0.00	$0.00	$203.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.96	$203.00	$203.00	$203.00
75625	EAP	CPT® 75625		PR ANGIO AORTOGRAM ABD SERIAL	OP	$215.00 	$0.00	$0.00	$215.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.39	$215.00	$215.00	$215.00
75630	EAP	CPT® 75630		PR ANGIO AORTOBIFEMORAL W CATH	OP	$338.00 	$0.00	$0.00	$338.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.87	$338.00	$338.00	$338.00
75635	EAP	CPT® 75635		"PR CT ANGIO AORTOBIFEMORAL, COMBO"	OP	$471.00 	$0.00	$0.00	$471.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$471.00	$420.20	$298.80	$420.20
75705	EAP	CPT® 75705		PR ANGIO SPINAL SELECTV	OP	$422.00 	$0.00	$0.00	$422.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$326.93	$422.00	$368.07	$422.00
75710	EAP	CPT® 75710		PR ANGIO EXTREMITY UNILAT	OP	$265.00 	$0.00	$0.00	$265.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$219.63	$265.00	$265.00	$265.00
75716	EAP	CPT® 75716		PR ANGIO EXTERMITY BILAT	OP	$293.00 	$0.00	$0.00	$293.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$251.88	$293.00	$293.00	$293.00
75726	EAP	CPT® 75726		PR ANGIO VISCERAL SELECTV/SUBSELEC	OP	$301.00 	$0.00	$0.00	$301.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.77	$301.00	$301.00	$301.00
75736	EAP	CPT® 75736		PR ANGIO PELVIS	OP	$202.00 	$0.00	$0.00	$202.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$202.00	$202.00	$202.00	$202.00
75741	EAP	CPT® 75741		PR ANGIO PULMON UNILAT SELECT	OP	$253.00 	$0.00	$0.00	$253.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$203.10	$253.00	$253.00	$253.00
75756	EAP	CPT® 75756		PR ANGIO INTERN MAMMARY	OP	$203.00 	$0.00	$0.00	$203.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$203.00	$203.00	$203.00	$203.00
75774	EAP	CPT® 75774		PR ANGIO EA ADDNL SELECTV VESSEL	OP	$149.00 	$0.00	$0.00	$149.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.82	$149.00	$149.00	$149.00
75805	EAP	CPT® 75805		PR LYMPHANGIO ABD/PELV UNILAT	OP	$137.00 	$0.00	$0.00	$137.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.00	$0.00	$137.00	$0.00
75820	EAP	CPT® 75820		PR VENOGRAM EXTREM UNILAT	OP	$161.00 	$0.00	$0.00	$154.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.77	$87.16	$44.74	$87.16
75822	EAP	CPT® 75822		PR VENOGRAM EXTREM BILAT	OP	$201.00 	$0.00	$0.00	$184.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.58	$119.44	$68.24	$119.44
75825	EAP	CPT® 75825		PR VENOGRAM INFER VENA CAVA	OP	$170.00 	$0.00	$0.00	$170.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$170.00	$170.00	$170.00	$170.00
75827	EAP	CPT® 75827		PR VENOGRAM SUPER VENA CAVA	OP	$171.00 	$0.00	$0.00	$171.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$171.00	$171.00	$171.00	$171.00
75860	EAP	CPT® 75860		PR VENOGRAM SINUS/JUGULAR	OP	$172.00 	$0.00	$0.00	$172.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.00	$172.00	$172.00	$172.00
75889	EAP	CPT® 75889		PR VENOGRAM HEPATIC W HEMODYNAMICS	OP	$166.00 	$0.00	$0.00	$166.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.00	$166.00	$166.00	$166.00
75891	EAP	CPT® 75891		PR VENOGRAM HEPATIC	OP	$169.00 	$0.00	$0.00	$169.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.00	$169.00	$169.00	$169.00
75893	EAP	CPT® 75893		PR VENOUS SAMPLING BY CATHETER	OP	$83.00 	$0.00	$0.00	$83.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.00	$83.00	$83.00	$83.00
75894	EAP	CPT® 75894		PR TRANSCATHETER RX EMBOLIZATN	OP	$221.00 	$0.00	$0.00	$221.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.00	$0.00	$221.00	$0.00
75898	EAP	CPT® 75898		CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS	OP	$336.00 	$0.00	$0.00	$169.27	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.27	$0.00	$77.06	$0.00
75901	EAP	CPT® 75901		"PR REMOVE,OBST MATL,CVA DEV VIA SEP VEN ACC"	OP	$72.00 	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.00	$72.00	$0.00	$72.00
75956	EAP	CPT® 75956		PR ENDOVASC REPAIR THOR AORTA INCL SUBCLAVIAN	OP	"$1,060.00 "	$0.00	$0.00	$470.07	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$470.07	$0.00	$0.00	$0.00
75957	EAP	CPT® 75957		PR ENDOVASC REPAIR THOR AORTA EXCL SUBCLAVIAN	OP	$908.00 	$0.00	$0.00	$403.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$403.68	$0.00	$0.00	$0.00
75970	EAP	CPT® 75970		PR VASCULAR BIOPSY	OP	$133.00 	$0.00	$0.00	$133.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.00	$0.00	$0.00	$0.00
75984	EAP	CPT® 75984		CHANGE PERCUT TUBE/DRAIN CATH W CONTRAST MONIT	OP	$146.00 	$0.00	$0.00	$142.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.45	$110.00	$69.11	$110.00
76000	EAP	CPT® 76000		CHG FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME	OP	$48.00 	$0.00	$0.00	$48.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.00	$48.00	$36.56	$48.00
76080	EAP	CPT® 76080		"PR X-RAY FISTULA,ABSCESS,SINUS TRACT"	OP	$80.00 	$0.00	$0.00	$73.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$73.99	$65.17	$42.16	$65.17
76098	EAP	CPT® 76098		"PR X-RAY EXAM, BREAST SPECIMEN"	OP	$49.00 	$0.00	$0.00	$22.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.26	$22.24	$0.00	$22.24
76376	EAP	CPT® 76376		CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION	OP	$30.00 	$0.00	$0.00	$30.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.00	$30.00	$30.00	$30.00
76377	EAP	CPT® 76377		CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION	OP	$122.00 	$0.00	$0.00	$122.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.29	$122.00	$116.86	$122.00
76506	EAP	CPT® 76506		"PR US, HEAD, REAL TIME"	OP	$110.00 	$0.00	$0.00	$110.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$110.00	$94.74	$54.17	$94.74
76512	EAP	CPT® 76512		"US, EYE B-SCAN"	OP	$147.00 	$0.00	$0.00	$124.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.40	$109.65	$58.64	$109.65
76514	EAP	CPT® 76514		"US, EYE, FOR CORNEAL THICKNESS"	OP	$30.00 	$0.00	$0.00	$20.37	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.37	$12.08	$7.48	$12.08
76516	EAP	CPT® 76516		"US, EYE BIOMETRY"	OP	$98.00 	$0.00	$0.00	$98.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.00	$72.86	$47.98	$72.86
76519	EAP	CPT® 76519		"US, EYE BIOMETRY W LENS CALC"	OP	$96.00 	$0.00	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.00	$76.52	$47.98	$76.52
76536	EAP	CPT® 76536		"US, HEAD/NECK TISSUES,REAL TIME"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$89.99	$51.53	$89.99
76604	EAP	CPT® 76604		"PR US, CHEST,REAL TIME"	OP	$160.00 	$0.00	$0.00	$118.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.24	$78.66	$48.43	$78.66
76641	EAP	CPT® 76641		CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE	OP	$111.00 	$0.00	$0.00	$111.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.00	$0.00	$65.00	$0.00
76642	EAP	CPT® 76642		CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED	OP	$104.00 	$0.00	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$104.00	$0.00	$53.50	$0.00
76700	EAP	CPT® 76700		"PR US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"	OP	$132.00 	$0.00	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.00	$121.18	$72.20	$121.18
76705	EAP	CPT® 76705		"PR US, ABDOMEN LIMITED"	OP	$220.00 	$0.00	$0.00	$122.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$183.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.99	$89.29	$52.42	$89.29
76706	EAP	CPT® 76706		CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA	OP	$84.00 	$0.00	$0.00	$84.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.00	$0.00	$56.62	$0.00
76770	EAP	CPT® 76770		"PR US,RETROPERIT,REAL TIME,COMPLETE"	OP	$275.00 	$0.00	$0.00	$152.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$152.43	$117.39	$70.22	$117.39
76775	EAP	CPT® 76775		"US, RETROPERITNL ABD,  LTD"	OP	$140.00 	$0.00	$0.00	$88.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.79	$88.89	$52.20	$88.89
76776	EAP	CPT® 76776		"PR US,TRANSPLANTED KIDNEY, REAL TIME/ DOPPLER"	OP	$118.00 	$0.00	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.00	$118.00	$74.54	$118.00
76801	EAP	CPT® 76801		"CHG US, OB < 14 WKS, SINGLE FETUS"	OP	$153.00 	$0.00	$0.00	$153.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$153.00	$129.32	$56.88	$129.32
76802	EAP	CPT® 76802		"CHG US, OB < 14 WKS, ADD'L FETUS"	OP	$127.00 	$0.00	$0.00	$87.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.19	$80.19	$44.37	$80.19
76805	EAP	CPT® 76805		"CHG US, OB >/= 14 WKS, SNGL FETUS"	OP	$345.00 	$0.00	$0.00	$191.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.31	$134.09	$81.47	$134.09
76810	EAP	CPT® 76810		"CHG US, OB >/= 14 WKS, ADDL FETUS"	OP	$151.00 	$0.00	$0.00	$125.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.67	$95.77	$151.00	$95.77
76811	EAP	CPT® 76811		"CHG US,PREG UTER,FET & MAT,+ DETL FET EXM"	OP	$290.00 	$0.00	$0.00	$245.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$245.05	$228.00	$148.76	$228.00
76812	EAP	CPT® 76812		"CHG US,PREG UTER,FET & MAT,+ DETL FET,ADDL"	OP	$272.00 	$0.00	$0.00	$272.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$272.00	$148.77	$87.42	$148.77
76813	EAP	CPT® 76813		"CHG US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON"	OP	$181.00 	$0.00	$0.00	$163.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$163.10	$123.47	$74.24	$123.47
76815	EAP	CPT® 76815		"CHG US,PREGNANT UTERUS,LIMITED, 1/> FETUSES"	OP	$100.00 	$0.00	$0.00	$100.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$100.00	$87.62	$54.62	$87.62
76816	EAP	CPT® 76816		"CHG US,PREGNANT UTERUS,F/U,TRANSABD APP"	OP	$130.00 	$0.00	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.00	$94.10	$44.84	$94.10
76817	EAP	CPT® 76817		"CHG US,PREGNANT UTERUS,TRANSVAGINAL"	OP	$235.00 	$0.00	$0.00	$130.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.99	$96.08	$59.19	$96.08
76818	EAP	CPT® 76818		CHG FETAL BIOPHYSICAL PROFILE	OP	$160.00 	$0.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.00	$116.73	$63.26	$116.73
76819	EAP	CPT® 76819		"CHG FETAL BIOPHYS PROF,W/O NST"	OP	$118.00 	$0.00	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.00	$97.73	$60.35	$97.73
76820	EAP	CPT® 76820		CHG DOPPLER FETAL UMBILICAL ARTERY	OP	$77.00 	$0.00	$0.00	$77.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.50	$77.00	$57.99	$77.00
76821	EAP	CPT® 76821		CHG DOPPLER FETAL MID CEREBRAL  ARTERY	OP	$106.00 	$0.00	$0.00	$106.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.00	$98.16	$64.44	$98.16
76825	EAP	CPT® 76825		CHG SONO FETAL HEART	OP	$252.00 	$0.00	$0.00	$252.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$252.00	$175.08	$95.84	$175.08
76826	EAP	CPT® 76826		CHG SONO FETAL HEART F/U	OP	$126.00 	$0.00	$0.00	$126.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.00	$84.67	$47.37	$84.67
76827	EAP	CPT® 76827		PR SONO FETAL HEART DOPPLER	OP	$88.00 	$0.00	$0.00	$88.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.00	$87.62	$64.71	$87.62
76828	EAP	CPT® 76828		PR SONO FETAL HRT DOPPL F/U	OP	$85.00 	$0.00	$0.00	$72.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.06	$65.76	$45.48	$65.76
76830	EAP	CPT® 76830		"CHG ECHOGRAPHY,TRANSVAGINAL"	OP	$118.00 	$0.00	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.00	$100.81	$58.16	$100.81
76831	EAP	CPT® 76831		"PR SONO EXAM, HYSTEROSONOGRAPHY"	OP	$131.00 	$0.00	$0.00	$131.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.00	$103.10	$59.26	$103.10
76856	EAP	CPT® 76856		"PR US,PELVIC (NONOBSTETRIC),REAL TIME,COMPLETE"	OP	$105.00 	$0.00	$0.00	$105.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.00	$101.55	$58.16	$101.55
76857	EAP	CPT® 76857		"PR US,PELVIC (NONOBSTETRIC),REAL TIME,LIMITED"	OP	$76.00 	$0.00	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.01	$76.00	$37.33	$76.00
76870	EAP	CPT® 76870		"PR ECHO,SCROTUM & CONTENTS"	OP	$97.00 	$0.00	$0.00	$97.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.60	$97.00	$56.62	$97.00
76872	EAP	CPT® 76872		"PR ECHO,TRANSRECTAL"	OP	$103.00 	$0.00	$0.00	$103.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.00	$103.00	$58.38	$103.00
76873	EAP	CPT® 76873		"PR ECHO,TRANSRECTAL,PROSTATE VOL"	OP	$240.00 	$0.00	$0.00	$225.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.47	$165.91	$91.22	$165.91
76881	EAP	CPT® 76881		"CHG US,EXTREMITY,NONVASCULAR,REAL-TIME IMAGE,COMPLETE"	OP	$96.00 	$0.00	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.00	$0.00	$68.54	$0.00
76882	EAP	CPT® 76882		CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG	OP	$75.00 	$0.00	$0.00	$48.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$104.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.31	$0.00	$17.93	$0.00
76937	EAP	CPT® 76937		"CHG US GUIDE, VASCULAR ACCESS"	OP	$95.00 	$0.00	$0.00	$42.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.23	$33.43	$20.85	$33.43
76942	EAP	CPT® 76942		PR SONO GUIDE NEEDLE BIOPSY	OP	$126.00 	$0.00	$0.00	$106.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$81.55	$106.83	$57.72	$106.83
76946	EAP	CPT® 76946		PR SONO GUIDE AMNIOCENTESIS	OP	$87.00 	$0.00	$0.00	$66.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.05	$66.66	$48.50	$66.66
76975	EAP	CPT® 76975		PR GI ENDOSCOPIC ULTRASOUND	OP	$259.00 	$0.00	$0.00	$139.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.73	$0.00	$61.89	$0.00
76998	EAP	CPT® 76998		"PR ULTRASONIC GUIDANCE, INTRAOPERATIVE"	OP	$195.00 	$0.00	$0.00	$85.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.20	$0.00	$0.00	$0.00
77001	EAP	CPT® 77001		"PR FLUOROGUIDE CNTRL VEN ACCESS,PLACE,REPLACE,REMOVE"	OP	$162.00 	$0.00	$0.00	$94.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$94.05	$80.26	$49.83	$80.26
77002	EAP	CPT® 77002		CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON	OP	$105.00 	$0.00	$0.00	$105.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$334.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$105.00	$73.53	$44.85	$73.53
77003	EAP	CPT® 77003		CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON	OP	$322.00 	$0.00	$0.00	$114.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.43	$71.44	$43.42	$71.44
77012	EAP	CPT® 77012		PR CT GUIDANCE NEEDLE PLACEMENT	OP	$227.00 	$0.00	$0.00	$227.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$167.00	$227.00	$195.29	$227.00
77014	EAP	CPT® 77014		PR CT GUIDANCE PLACEMENT RAD THERAPY FIELDS	OP	$138.00 	$0.00	$0.00	$138.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.00	$136.96	$102.63	$136.96
77047	EAP	CPT® 77047		CHG MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL	OP	$246.00 	$0.00	$0.00	$246.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$246.00	$0.00	$153.79	$0.00
77049	EAP	CPT® 77049		CHG MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL	OP	$353.00 	$0.00	$0.00	$353.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$353.00	$0.00	$242.93	$0.00
77061	EAP	CPT® 77061		CHG DIGITAL BREAST TOMOSYNTHESIS UNILATERAL	OP	$472.00 	$0.00	$0.00	$171.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$171.96	$0.00	$0.00	$0.00
77063	EAP	CPT® 77063		CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI	OP	$92.00 	$0.00	$0.00	$74.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$149.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.00	$0.00	$33.31	$0.00
77065	EAP	CPT® 77065		CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	OP	$126.00 	$0.00	$0.00	$126.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.00	$0.00	$81.59	$0.00
77066	EAP	CPT® 77066		CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	OP	$154.00 	$0.00	$0.00	$154.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.00	$0.00	$102.24	$0.00
77067	EAP	CPT® 77067		CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	OP	$118.00 	$0.00	$0.00	$118.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$366.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.00	$0.00	$83.06	$0.00
77071	EAP	CPT® 77071		CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS	OP	$162.00 	$0.00	$0.00	$64.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$64.41	$28.65	$16.84	$28.65
77073	EAP	CPT® 77073		"PR X-RAYS, BONE LENGTH STUDIES"	OP	$42.00 	$0.00	$0.00	$42.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$42.00	$41.06	$25.29	$41.06
77074	EAP	CPT® 77074		"PR X-RAYS, BONE SURVEY, LIMITED"	OP	$68.00 	$0.00	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.00	$62.32	$38.26	$62.32
77075	EAP	CPT® 77075		"PR X-RAYS, BONE SURVEY COMPLETE"	OP	$85.00 	$0.00	$0.00	$85.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.00	$85.00	$53.42	$85.00
77077	EAP	CPT® 77077		"PR JOINT SURVEY, SINGLE VIEW"	OP	$53.00 	$0.00	$0.00	$52.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.81	$52.78	$32.52	$52.78
77080	EAP	CPT® 77080		"PR DEXA,BONE DENSITY,AXIAL SKELETON"	OP	$41.00 	$0.00	$0.00	$41.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.00	$41.00	$41.00	$41.00
77263	EAP	CPT® 77263		CHG RADIATION THERAPY PLAN COMPLEX	OP	$811.00 	$0.00	$0.00	$221.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.29	$157.43	$100.84	$157.43
77280	EAP	CPT® 77280		CHG SET RADN THERAPY FIELD SIMPLE	OP	$173.00 	$0.00	$0.00	$173.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$173.00	$173.00	$104.91	$173.00
77285	EAP	CPT® 77285		CHG SET RADN THERAPY FIELD INTERME	OP	$270.00 	$0.00	$0.00	$270.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.00	$270.00	$165.94	$270.00
77290	EAP	CPT® 77290		CHG SET RADN THERAPY FIELD COMPLEX	OP	$395.00 	$0.00	$0.00	$395.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$395.00	$384.94	$204.79	$384.94
77293	EAP	CPT® 77293		CHG RESPIRATORY MOTION MANAGEMENT SIMULATION	OP	$328.00 	$0.00	$0.00	$328.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$328.00	$0.00	$258.22	$0.00
77295	EAP	CPT® 77295		CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS	OP	$742.00 	$0.00	$0.00	$742.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$657.40	$742.00	$742.00	$742.00
77300	EAP	CPT® 77300		"CHG RADIATION THERAPY,DOSIMETRY PLAN"	OP	$101.00 	$0.00	$0.00	$89.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.21	$78.46	$51.52	$78.46
77301	EAP	CPT® 77301		CHG INTEN MOD RADIOTHER PLAN W/DOSE VOL HIST	OP	"$1,297.00 "	$0.00	$0.00	"$1,297.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,297.00"	"$1,297.00"	$973.28	"$1,297.00"
77306	EAP	CPT® 77306		CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION	OP	$228.00 	$0.00	$0.00	$200.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.25	$0.00	$86.42	$0.00
77307	EAP	CPT® 77307		CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY	OP	$472.00 	$0.00	$0.00	$386.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$386.71	$168.68	$169.16	$168.68
77316	EAP	CPT® 77316		CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL	OP	$228.00 	$0.00	$0.00	$228.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.00	$0.00	$110.87	$0.00
77317	EAP	CPT® 77317		CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL	OP	$300.00 	$0.00	$0.00	$300.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.00	$0.00	$145.05	$0.00
77321	EAP	CPT® 77321		CHG TELETHER ISO-PORT PLAN	OP	$157.00 	$0.00	$0.00	$157.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.30	$157.00	$126.44	$157.00
77332	EAP	CPT® 77332		CHG RADN TREATMENT AID(S) SIMPLE	OP	$75.00 	$0.00	$0.00	$75.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$75.00	$49.10	$75.00
77334	EAP	CPT® 77334		CHG RADN TREATMENT AID(S) COMPLX	OP	$196.00 	$0.00	$0.00	$196.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.00	$177.25	$116.45	$177.25
77338	EAP	CPT® 77338		CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN	OP	$697.00 	$0.00	$0.00	$680.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$680.70	$0.00	$224.85	$0.00
77427	EAP	CPT® 77427		"CHG RADIATION,MANGEMENT,5 TX'S"	OP	$811.00 	$0.00	$0.00	$247.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$247.86	$179.87	$98.74	$179.87
77470	EAP	CPT® 77470		PR SPECIAL TREATMENT PROCEDURE	OP	$510.00 	$0.00	$0.00	$438.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$209.05	$438.74	$331.70	$438.74
77770	EAP	CPT® 77770		CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL	OP	$318.00 	$0.00	$0.00	$318.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$318.00	$0.00	$192.80	$0.00
77771	EAP	CPT® 77771		CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL	OP	$617.00 	$0.00	$0.00	$617.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$617.00	$0.00	$358.76	$0.00
78012	EAP	CPT® 78012		CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT	OP	$29.00 	$0.00	$0.00	$29.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.00	$0.00	$29.00	$0.00
78014	EAP	CPT® 78014		CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS	OP	$75.00 	$0.00	$0.00	$75.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$0.00	$75.00	$0.00
78018	EAP	CPT® 78018		PR THYROID MET IMAGING BODY	OP	$141.00 	$0.00	$0.00	$141.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.00	$141.00	$141.00	$141.00
78070	EAP	CPT® 78070		CHG PARATHYROID PLANAR IMAGING	OP	$133.00 	$0.00	$0.00	$133.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.00	$133.00	$67.47	$133.00
78072	EAP	CPT® 78072		CHG PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT	OP	$236.00 	$0.00	$0.00	$236.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.00	$0.00	$46.58	$0.00
78201	EAP	CPT® 78201		PR LIVER IMAGING	OP	$98.00 	$0.00	$0.00	$98.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.00	$98.00	$70.16	$98.00
78215	EAP	CPT® 78215		PR LIVER AND SPLEEN IMAGING	OP	$92.00 	$0.00	$0.00	$92.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.00	$92.00	$85.14	$92.00
78226	EAP	CPT® 78226		PR HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER	OP	$111.00 	$0.00	$0.00	$111.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.00	$0.00	$111.00	$0.00
78227	EAP	CPT® 78227		PR HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ	OP	$137.00 	$0.00	$0.00	$137.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$137.00	$0.00	$137.00	$0.00
78264	EAP	CPT® 78264		PR GASTRIC EMPTYING STUDY	OP	$130.00 	$0.00	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.00	$130.00	$122.95	$130.00
78278	EAP	CPT® 78278		PR ACUTE GI BLOOD LOSS IMAGING	OP	$159.00 	$0.00	$0.00	$159.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.00	$159.00	$147.21	$159.00
78306	EAP	CPT® 78306		"PR BONE IMAGING, WHOLE BODY"	OP	$135.00 	$0.00	$0.00	$135.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$135.00	$135.00	$128.51	$135.00
78315	EAP	CPT® 78315		"CHG BONE IMAGING, 3 PHASE"	OP	$155.00 	$0.00	$0.00	$155.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.00	$155.00	$145.61	$155.00
78451	EAP	CPT® 78451		PR NM CARDIAC PERFUSION SINGLE	OP	$206.00 	$0.00	$0.00	$206.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.00	$0.00	$104.80	$0.00
78452	EAP	CPT® 78452		PR NM CARDIAC SCAN	OP	$242.00 	$0.00	$0.00	$242.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$242.00	$0.00	$179.12	$0.00
78453	EAP	CPT® 78453		CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS	OP	$153.00 	$0.00	$0.00	$153.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$153.00	$0.00	$91.22	$0.00
78472	EAP	CPT® 78472		"PR GATED HEART, PLANAR SINGLE"	OP	$148.00 	$0.00	$0.00	$148.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$148.00	$148.00	$148.00	$148.00
78580	EAP	CPT® 78580		PR PULMONARY PERFUSION IMAGING PARTICULATE	OP	$127.00 	$0.00	$0.00	$127.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.00	$127.00	$104.88	$127.00
78582	EAP	CPT® 78582		PR PULMONARY VENTILATION & PERFUSION IMAGING	OP	$161.00 	$0.00	$0.00	$161.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.00	$0.00	$161.00	$0.00
78606	EAP	CPT® 78606		BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW	OP	$130.00 	$0.00	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.00	$130.00	$112.11	$130.00
78610	EAP	CPT® 78610		PR BRAIN FLOW IMAGING ONLY	OP	$58.00 	$0.00	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.00	$58.00	$47.21	$58.00
78707	EAP	CPT® 78707		"PR RENAL IMAGING, MORPH W/ FLOW/FUNC"	OP	$145.00 	$0.00	$0.00	$145.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.00	$145.00	$136.49	$145.00
78708	EAP	CPT® 78708		"PR RENAL IMAGING, MORPH W/ FLOW/FUNC, PHARM, SINGLE"	OP	$197.00 	$0.00	$0.00	$197.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.00	$197.00	$142.84	$197.00
78803	EAP	CPT® 78803		CHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG	OP	$161.00 	$0.00	$0.00	$161.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.00	$161.00	$161.00	$161.00
78814	EAP	CPT® 78814		PET IMAGING CT FOR ATTENUATION LIMITED AREA	OP	$326.00 	$0.00	$0.00	$326.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$326.00	$0.00	$0.00	$0.00
78815	EAP	CPT® 78815		PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH	OP	$365.00 	$0.00	$0.00	$365.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$365.00	$0.00	$365.00	$0.00
78816	EAP	CPT® 78816		PET IMAGING FOR CT ATTENUATION WHOLE BODY	OP	$368.00 	$0.00	$0.00	$368.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$368.00	$0.00	$368.00	$0.00
78830	EAP	CPT® 78830		CHG RP LOCLZJ TUM SPECT W/CT 1 AREA/ACQUISJ 1DAY IMG	OP	$221.00 	$0.00	$0.00	$221.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.00	$0.00	$221.00	$0.00
78832	EAP	CPT® 78832		PR RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG	OP	$314.00 	$0.00	$0.00	$314.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$314.00	$0.00	$314.00	$0.00
79005	EAP	CPT® 79005		CHG NUC THERAPY INTRACAVITARY RADIOCOLLOID	OP	$271.00 	$0.00	$0.00	$184.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.40	$175.60	$123.17	$175.60
79101	EAP	CPT® 79101		CHG NUC THERAPY INTRA-ARTERIAL	OP	$302.00 	$0.00	$0.00	$192.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.48	$185.93	$128.48	$185.93
80299	EAP	CPT® 80299		CHG QUANTITATION DRUG NOT ELSEWHERE SPECIFIED	OP	$88.00 	$0.00	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.00	$0.00	$0.00	$0.00
81025	EAP	CPT® 81025		URINE PREGNANCY TEST	OP	$29.00 	$0.00	$0.00	$14.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.50	$0.00	$0.00	$0.00
82355	EAP	CPT® 82355		"CHG CALCULUS,QUALITATIVE ANALYSIS"	OP	$104.00 	$0.00	$0.00	$52.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.00	$0.00	$0.00	$0.00
82365	EAP	CPT® 82365		CALCULUS SPECTROSCOPY	OP	$107.00 	$0.00	$0.00	$53.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.50	$0.00	$0.00	$0.00
82668	EAP	CPT® 82668		ASSAY OF ERYTHROPOIETIN	OP	$127.00 	$0.00	$0.00	$63.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.50	$0.00	$0.00	$0.00
83020	EAP	CPT® 83020		HEMOGLOBIN ELECTROPHORESIS	OP	$92.00 	$0.00	$0.00	$46.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.00	$0.00	$0.00	$0.00
83021	EAP	CPT® 83021		HEMOGLOBIN CHROMOTOGRAPHY	OP	$118.00 	$0.00	$0.00	$59.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.00	$0.00	$0.00	$0.00
83026	EAP	CPT® 83026		"CHG HEMOGLOBIN, COPPER SULFATE"	OP	$18.00 	$0.00	$0.00	$9.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.00	$0.00	$0.00	$0.00
84165	EAP	CPT® 84165		PROTEIN ELECTROPHORESIS SERUM	OP	$91.00 	$0.00	$0.00	$45.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.50	$0.00	$0.00	$0.00
84443	EAP	CPT® 84443		ASSAY THYROID STIM HORMONE	OP	$92.00 	$0.00	$0.00	$46.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.00	$0.00	$0.00	$0.00
85018	EAP	CPT® 85018		HEMOGLOBIN	OP	$17.00 	$0.00	$0.00	$8.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$3.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.50	$0.00	$0.00	$0.00
85060	EAP	CPT® 85060		CHG BLOOD SMEAR INTERPRETATION	OP	$76.00 	$0.00	$0.00	$38.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$38.00	$22.76	$0.00	$22.76
85097	EAP	CPT® 85097		BONE MARROW EXAM	OP	$160.00 	$0.00	$0.00	$99.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$80.00	$99.49	$0.00	$99.49
85347	EAP	CPT® 85347		"CHG COAGULATION TIME, ACTIVATED"	OP	$27.00 	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00
86077	EAP	CPT® 86077		"CHG PHYS BLD BANK SERV,DIFF XMTCH"	OP	$158.00 	$0.00	$0.00	$79.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.00	$49.02	$0.00	$49.02
86078	EAP	CPT® 86078		TRANSFUSION REACTION	OP	$158.00 	$0.00	$0.00	$79.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$79.00	$50.86	$0.00	$50.86
86334	EAP	CPT® 86334		IMMUNOFIX E-PHORESIS SERUM	OP	$57.00 	$0.00	$0.00	$28.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.50	$0.00	$0.00	$0.00
86335	EAP	CPT® 86335		IMMUNOFIX E-PHORESIS/URINE/CSF	OP	$57.00 	$0.00	$0.00	$28.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$28.50	$0.00	$0.00	$0.00
86850	EAP	CPT® 86850		PRENATAL ANTIBODY SCREEN	OP	$37.00 	$0.00	$0.00	$18.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.50	$0.00	$0.00	$0.00
87070	EAP	CPT® 87070		CULTURE OTHER SPECIMEN AEROBIC	OP	$41.00 	$0.00	$0.00	$20.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.50	$0.00	$0.00	$0.00
87075	EAP	CPT® 87075		CULTURE BACTERIA EXCEPT BLOOD	OP	$46.00 	$0.00	$0.00	$23.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.00	$0.00	$0.00	$0.00
87101	EAP	CPT® 87101		FUNGUS CULTURE DERM	OP	$38.00 	$0.00	$0.00	$19.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.00	$0.00	$0.00	$0.00
87102	EAP	CPT® 87102		FUNGUS ISOLATION CULTURE	OP	$40.00 	$0.00	$0.00	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.00	$0.00	$0.00	$0.00
87116	EAP	CPT® 87116		MYCOBACTERIA CULTURE	OP	$46.00 	$0.00	$0.00	$23.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.00	$0.00	$0.00	$0.00
87210	EAP	CPT® 87210		SMEAR WET MOUNT SALINE/INK	OP	$20.00 	$0.00	$0.00	$10.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$10.00	$0.00	$0.00	$0.00
87220	EAP	CPT® 87220		CHG TISSUE EXAM BY KOH	OP	$24.00 	$0.00	$0.00	$12.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.00	$0.00	$0.00	$0.00
87430	EAP	CPT® 87430		CHG IAAD IA STREPTOCOCCUS GROUP A	OP	$28.00 	$0.00	$0.00	$14.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.00	$0.00	$0.00	$0.00
88020	EAP	CPT® 88020		"CHG AUTOPSY COMPL,W/O CNS"	OP	$824.00 	$0.00	$0.00	$412.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$412.00	$0.00	$0.00	$0.00
88104	EAP	CPT® 88104		"CHG CYTOPATH FLUIDS,SMEAR,INTERP"	OP	$89.00 	$0.00	$0.00	$55.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.50	$55.18	$0.00	$55.18
88108	EAP	CPT® 88108		"CHG CYTOPATH FLUIDS,CONCENTRATN,INTERP"	OP	$78.00 	$0.00	$0.00	$67.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.00	$67.63	$0.00	$67.63
88112	EAP	CPT® 88112		"CHG CYTOPATH, CELL ENHANCE TECH"	OP	$87.00 	$0.00	$0.00	$87.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.50	$87.00	$0.00	$87.00
88141	EAP	CPT® 88141		CHG CYTOPATH CERV/VAG INTERPRET	OP	$79.00 	$0.00	$0.00	$39.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.50	$23.43	$0.00	$23.43
88172	EAP	CPT® 88172		"CHG EVALUATION OF FNA SMEAR TO DETERMINE ADEQUACY, FIRST EVAL"	OP	$113.00 	$0.00	$0.00	$56.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.50	$50.55	$0.00	$50.55
88173	EAP	CPT® 88173		CHG INTERPRETATION OF FNA SMEAR	OP	$222.00 	$0.00	$0.00	$131.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$111.00	$131.71	$0.00	$131.71
88177	EAP	CPT® 88177		"CHG EVALUATION OF FNA SMEAR TO DETERMINE ADEQUACY, EA ADD EVAL"	OP	$69.00 	$0.00	$0.00	$34.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$34.50	$0.00	$0.00	$0.00
88187	EAP	CPT® 88187		FLOW CYTOMETRY READ	OP	$118.00 	$0.00	$0.00	$64.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.00	$64.96	$0.00	$64.96
88188	EAP	CPT® 88188		FLOW CYTOMETRY INTERP	OP	$198.00 	$0.00	$0.00	$99.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.00	$80.57	$0.00	$80.57
88189	EAP	CPT® 88189		FLOWCYTOMETRY READ 16 OR MORE	OP	$266.00 	$0.00	$0.00	$133.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$133.00	$105.19	$0.00	$105.19
88241	EAP	CPT® 88241		CHG FROZEN CELL PREPARATION	OP	$199.00 	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.50	$0.00	$0.00	$0.00
88302	EAP	CPT® 88302		"CHG SURG PATH,LEVEL II"	OP	$22.00 	$0.00	$0.00	$22.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.00	$22.00	$22.00	$22.00
88304	EAP	CPT® 88304		"CHG SURG PATH, LEVEL III"	OP	$36.00 	$0.00	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.00	$36.00	$21.13	$36.00
88305	EAP	CPT® 88305		"CHG SURG PATH, LEVEL IV"	OP	$118.00 	$0.00	$0.00	$100.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.00	$100.95	$46.12	$100.95
88307	EAP	CPT® 88307		"CHG SURG PATH,LEVEL V"	OP	$685.00 	$0.00	$0.00	$342.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$342.50	$188.01	$93.31	$188.01
88309	EAP	CPT® 88309		"CHG SURG PATH,LEVEL VI"	OP	$458.00 	$0.00	$0.00	$282.52	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$229.00	$282.52	$131.45	$282.52
88311	EAP	CPT® 88311		DECALCIFY TISSUE	OP	$43.00 	$0.00	$0.00	$21.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.50	$17.80	$10.82	$17.80
88312	EAP	CPT® 88312		STAIN MISC	OP	$83.00 	$0.00	$0.00	$83.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.50	$83.00	$30.37	$83.00
88313	EAP	CPT® 88313		STAIN MISC	OP	$38.00 	$0.00	$0.00	$38.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.00	$38.00	$31.44	$38.00
88331	EAP	CPT® 88331		"CHG PATH CONSULT IN SURG,W FRZ SEC"	OP	$196.00 	$0.00	$0.00	$98.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.00	$86.78	$52.33	$86.78
88332	EAP	CPT® 88332		"CHG PATH CONSULT IN SURG,W ADDN FRZ SEC"	OP	$100.00 	$0.00	$0.00	$50.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.00	$39.17	$26.27	$39.17
88333	EAP	CPT® 88333		"PR INTRAOPERATIVE CYTO PATH CONSULT, INITIAL SITE"	OP	$196.00 	$0.00	$0.00	$98.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$98.00	$87.55	$52.84	$87.55
88334	EAP	CPT® 88334		"CHG INTRAOPERATIVE CYTO PATH CONSULT, ADD SITES"	OP	$119.00 	$0.00	$0.00	$59.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.50	$51.29	$27.61	$51.29
88341	EAP	CPT® 88341		CHG IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE	OP	$89.00 	$0.00	$0.00	$44.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.50	$0.00	$40.17	$0.00
88342	EAP	CPT® 88342		CHG IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE	OP	$110.00 	$0.00	$0.00	$90.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.00	$90.36	$50.11	$90.36
88344	EAP	CPT® 88344		CHG IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE	OP	$120.00 	$0.00	$0.00	$60.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.00	$0.00	$0.00	$0.00
88356	EAP	CPT® 88356		"CHG ANALYSIS, NERVE"	OP	$401.00 	$0.00	$0.00	$289.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.50	$289.46	$142.13	$289.46
88360	EAP	CPT® 88360		CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL	OP	$132.00 	$0.00	$0.00	$110.32	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.00	$110.32	$0.00	$110.32
88361	EAP	CPT® 88361		CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST	OP	$140.00 	$0.00	$0.00	$140.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$70.00	$140.00	$0.00	$140.00
88364	EAP	CPT® 88364		CHG IN SITU HYBRIDIZATION EA ADDL PROBE STAIN	OP	$108.00 	$0.00	$0.00	$54.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.00	$0.00	$0.00	$0.00
88365	EAP	CPT® 88365		CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN	OP	$142.00 	$0.00	$0.00	$129.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.00	$129.45	$61.73	$129.45
90371	EAP	CPT® 90371		"PR HEPB IG, IM"	OP	$180.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
90471	EAP	CPT® 90471		"PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID"	OP	$64.00 	$0.00	$0.00	$32.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.00	$0.00	$0.00	$0.00
90472	EAP	CPT® 90472		"PR IMMUNIZ,ADMIN,EACH ADDL"	OP	$39.00 	$0.00	$0.00	$19.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.50	$10.24	$0.00	$10.24
90632	EAP	CPT® 90632		PR HEPA VACCINE ADULT IM	OP	$127.00 	$0.00	$0.00	$63.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.50	$0.00	$0.00	$0.00
90651	EAP	CPT® 90651		PR HUMAN PAPILLOMA VIRUS NONAVALENT HPV 3 DOSE IM	OP	$400.00 	$0.00	$0.00	$200.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.00	$0.00	$0.00	$0.00
90680	EAP	CPT® 90680		"PR ROTOVIRUS VACCINE, PENTAVAL, 3 DOSE, ORAL"	OP	$156.00 	$0.00	$0.00	$78.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$78.00	$0.00	$0.00	$0.00
90686	EAP	CPT® 90686		BPR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE	OP	$50.00 	$0.00	$0.00	$25.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$25.00	$0.00	$0.00	$0.00
90715	EAP	CPT® 90715		"PR TDAP VACCINE >7 YO, IM"	OP	$90.00 	$0.00	$0.00	$45.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$45.00	$0.00	$0.00	$0.00
90734	EAP	CPT® 90734		PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE	OP	$202.00 	$0.00	$0.00	$101.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.00	$0.00	$0.00	$0.00
90740	EAP	CPT® 90740		"PR HEP B VACCINE,DIAL/IMMUNOSUP, IM"	OP	$262.00 	$0.00	$0.00	$131.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$131.00	$0.00	$0.00	$0.00
90746	EAP	CPT® 90746		PR HEPATITIS B VACCINE ADULT 3 DOSE IM	OP	$175.00 	$0.00	$0.00	$87.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.50	$0.00	$0.00	$0.00
90791	EAP	CPT® 90791		PR PSYCHIATRIC DIAGNOSTIC EVALUATION	OP	$383.00 	$0.00	$0.00	$200.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$321.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$200.06	$0.00	$89.77	$0.00
90792	EAP	CPT® 90792		PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	OP	$429.00 	$0.00	$0.00	$221.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$359.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.81	$0.00	$73.76	$0.00
90832	EAP	CPT® 90832		PR PSYCHOTHERAPY W/PATIENT 30 MINUTES	OP	$192.00 	$0.00	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.00	$0.00	$37.25	$0.00
90833	EAP	CPT® 90833		PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN	OP	$264.00 	$0.00	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.00	$0.00	$24.65	$0.00
90834	EAP	CPT® 90834		PR PSYCHOTHERAPY W/PATIENT 45 MINUTES	OP	$255.00 	$0.00	$0.00	$127.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$184.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.50	$0.00	$0.00	$0.00
90836	EAP	CPT® 90836		PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN	OP	$252.00 	$0.00	$0.00	$126.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.00	$0.00	$0.00	$0.00
90837	EAP	CPT® 90837		PR PSYCHOTHERAPY W/PATIENT 60 MINUTES	OP	$382.00 	$0.00	$0.00	$191.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$271.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$191.00	$0.00	$37.25	$0.00
90839	EAP	CPT® 90839		PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES	OP	$399.00 	$0.00	$0.00	$199.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$199.50	$0.00	$0.00	$0.00
90847	EAP	CPT® 90847		PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	OP	$320.00 	$0.00	$0.00	$160.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.00	$110.02	$66.07	$110.02
90853	EAP	CPT® 90853		PR GROUP PSYCHOTHERAPY	OP	$78.00 	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.00	$30.92	$21.52	$30.92
90887	EAP	CPT® 90887		PR CONSULTATION WITH FAMILY	OP	$231.00 	$0.00	$0.00	$115.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$115.50	$0.00	$0.00	$0.00
90935	EAP	CPT® 90935		PR HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION	OP	"$1,231.00 "	$0.00	$0.00	$114.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$114.56	$68.44	$0.00	$68.44
90937	EAP	CPT® 90937		"PR HEMODIALYSIS, REPEATED EVAL."	OP	"$1,970.00 "	$0.00	$0.00	$164.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.29	$111.81	$0.00	$111.81
90945	EAP	CPT® 90945		PR DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL	OP	"$1,293.00 "	$0.00	$0.00	$135.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$135.88	$71.16	$0.00	$71.16
90947	EAP	CPT® 90947		PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS	OP	"$1,970.00 "	$0.00	$0.00	$196.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$196.13	$113.78	$0.00	$113.78
90969	EAP	CPT® 90969		"PR ESRD SERVICES, PER DAY, 12-19 YR OLD"	OP	$47.00 	$0.00	$0.00	$24.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.03	$0.00	$0.00	$0.00
91010	EAP	CPT® 91010		PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT	OP	$206.00 	$0.00	$0.00	$206.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.00	$202.77	$69.74	$202.77
91035	EAP	CPT® 91035		PR GERD TST W/ MUCOS PH ELECTROD	OP	$256.00 	$0.00	$0.00	$256.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.00	$256.00	$256.00	$256.00
91037	EAP	CPT® 91037		PR GERD TST W/ NASAL IMPEDENCE ELECTROD	OP	$155.00 	$0.00	$0.00	$155.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.00	$149.63	$95.22	$149.63
91110	EAP	CPT® 91110		PR GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R	OP	$396.00 	$0.00	$0.00	$396.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$396.00	$396.00	$396.00	$396.00
91111	EAP	CPT® 91111		PR GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R	OP	$185.00 	$0.00	$0.00	$185.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,479.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.00	$185.00	$0.00	$185.00
91120	EAP	CPT® 91120		"PR RECTAL SENSATION TEST, BALLOON"	OP	$813.00 	$0.00	$0.00	$673.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$673.01	$422.05	$289.14	$422.05
91122	EAP	CPT® 91122		PR ANAL PRESSURE RECORD	OP	$309.00 	$0.00	$0.00	$309.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$309.00	$244.02	$78.46	$244.02
91200	EAP	CPT® 91200		PR LIVER ELASTOGRAPHY W/O IMAG W/I&R	OP	$80.00 	$0.00	$0.00	$49.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.90	$0.00	$21.44	$0.00
92002	EAP	CPT® 92002		"PR EYE EXAM, NEW PATIENT,INTERMED"	OP	$145.00 	$0.00	$0.00	$75.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.55	$67.57	$38.00	$67.57
92004	EAP	CPT® 92004		"PR EYE EXAM, NEW PATIENT,COMPREHESV"	OP	$300.00 	$0.00	$0.00	$157.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.80	$122.06	$63.48	$122.06
92012	EAP	CPT® 92012		"PR EYE EXAM ESTABLISHED PT, INTERMED"	OP	$159.00 	$0.00	$0.00	$83.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.38	$61.47	$32.31	$61.47
92014	EAP	CPT® 92014		"PR EYE EXAM, EST PATIENT,COMPREHESV"	OP	$241.00 	$0.00	$0.00	$126.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$126.46	$91.21	$46.59	$91.21
92015	EAP	CPT® 92015		PR REFRACTION	OP	$59.00 	$0.00	$0.00	$30.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.75	$0.00	$0.00	$0.00
92018	EAP	CPT® 92018		PR NEW EYE EXAM & TREATMENT	OP	$439.00 	$0.00	$0.00	$230.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.04	$129.77	$47.90	$129.77
92020	EAP	CPT® 92020		"PR SPECIAL EYE EVAL,GONISCOPY"	OP	$64.00 	$0.00	$0.00	$33.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.04	$25.16	$21.20	$25.16
92025	EAP	CPT® 92025		PR CORNEAL TOPOGRAPHY	OP	$61.00 	$0.00	$0.00	$59.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.99	$29.06	$0.00	$29.06
92071	EAP	CPT® 92071		PR FIT CONTACT LENS TX OCULAR SURFACE DISEASE	OP	$102.00 	$0.00	$0.00	$53.18	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.18	$0.00	$22.32	$0.00
92083	EAP	CPT® 92083		"PR VISUAL FIELD EXAM,EXTENDED"	OP	$150.00 	$0.00	$0.00	$101.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.55	$71.98	$35.53	$71.98
92133	EAP	CPT® 92133		PR COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE	OP	$90.00 	$0.00	$0.00	$69.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$69.51	$0.00	$26.44	$0.00
92134	EAP	CPT® 92134		PR COMPUTERIZED OPHTHALMIC IMAGING RETINA	OP	$100.00 	$0.00	$0.00	$71.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.20	$0.00	$26.44	$0.00
92136	EAP	CPT® 92136		"PR OPHTHAL BIOMETRY,INTRAOC LENS POW CALC"	OP	$95.00 	$0.00	$0.00	$95.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.00	$80.55	$56.67	$80.55
92201	EAP	CPT® 92201		PR OPSCPY EXTND RTA DRAWING & SCL DEPRSN I&R UNI/BI	OP	$70.00 	$0.00	$0.00	$36.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.36	$0.00	$15.17	$0.00
92235	EAP	CPT® 92235		PR FLUORESCEIN ANGRPH W/MULTIFRAME I&R UNI/BI	OP	$132.00 	$0.00	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.00	$124.51	$62.85	$124.51
92285	EAP	CPT® 92285		PR EYE PHOTOGRAPHY	OP	$22.00 	$0.00	$0.00	$22.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.00	$22.00	$22.00	$22.00
92511	EAP	CPT® 92511		PR NASOPHARYNGOSCOPY	OP	$218.00 	$0.00	$0.00	$148.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.66	$148.68	$40.26	$148.68
92538	EAP	CPT® 92538		PR CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL	OP	$50.00 	$0.00	$0.00	$32.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.46	$0.00	$12.31	$0.00
92540	EAP	CPT® 92540		PR VESTIBULAR EVAL NYSTAG FOVL&PERPH STIM OSCIL TRACKING	OP	$245.00 	$0.00	$0.00	$160.74	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.74	$0.00	$44.61	$0.00
92551	EAP	CPT® 92551		"PR PURE TONE HEARING TEST, AIR"	OP	$37.00 	$0.00	$0.00	$19.09	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.09	$0.00	$5.64	$0.00
92552	EAP	CPT® 92552		"PR PURE TONE AUDIOMETRY, AIR"	OP	$96.00 	$0.00	$0.00	$49.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.44	$18.44	$10.93	$18.44
92553	EAP	CPT® 92553		"PR AUDIOMETRY, AIR & BONE"	OP	$117.00 	$0.00	$0.00	$59.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$59.00	$26.39	$16.07	$26.39
92557	EAP	CPT® 92557		PR COMPREHENSIVE HEARING TEST	OP	$101.00 	$0.00	$0.00	$52.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.01	$48.01	$29.43	$48.01
92567	EAP	CPT® 92567		PR TYMPANOMETRY	OP	$48.00 	$0.00	$0.00	$20.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.34	$20.53	$12.93	$20.53
92590	EAP	CPT® 92590		"PR HEARING AID EXAM, ONE EAR"	OP	$105.00 	$0.00	$0.00	$85.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.11	$0.00	$0.00	$0.00
92591	EAP	CPT® 92591		"PR HEARING AID EXAM, BOTH EARS"	OP	$134.00 	$0.00	$0.00	$108.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$108.06	$0.00	$0.00	$0.00
92592	EAP	CPT® 92592		"PR HEARING AID CHECK, ONE EAR"	OP	$42.00 	$0.00	$0.00	$33.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.61	$0.00	$0.00	$0.00
92593	EAP	CPT® 92593		"PR HEARING AID CHECK, BOTH EARS"	OP	$69.00 	$0.00	$0.00	$55.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.44	$0.00	$0.00	$0.00
92603	EAP	CPT® 92603		"PR DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG"	OP	$377.00 	$0.00	$0.00	$194.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.13	$90.03	$55.24	$90.03
92928	EAP	CPT® 92928		PR PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH	OP	"$1,854.00 "	$0.00	$0.00	$978.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$978.55	$0.00	$416.40	$0.00
92941	EAP	CPT® 92941		PR PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL	OP	"$2,084.00 "	$0.00	$0.00	"$1,096.81"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,096.81"	$0.00	$400.23	$0.00
92950	EAP	CPT® 92950		PR HEART/LUNG RESUSCITATION (CPR)	OP	$580.00 	$0.00	$0.00	$297.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$297.30	$289.32	$132.58	$289.32
92960	EAP	CPT® 92960		PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	OP	$462.00 	$0.00	$0.00	$295.97	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$194.51	$295.97	$96.74	$295.97
92961	EAP	CPT® 92961		PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX	OP	"$1,439.00 "	$0.00	$0.00	$419.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$419.25	$253.48	$141.33	$253.48
92978	EAP	CPT® 92978		PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL	OP	$503.00 	$0.00	$0.00	$443.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$443.76	$0.00	$170.92	$0.00
93000	EAP	CPT® 93000		PR ELECTROCARDIOGRAM COMPLETE	OP	$80.00 	$0.00	$0.00	$26.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.88	$24.10	$17.56	$24.10
93005	EAP	CPT® 93005		"PR ELECTROCARDIOGRAM, TRACING"	OP	$50.00 	$0.00	$0.00	$15.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.46	$15.62	$10.96	$15.62
93010	EAP	CPT® 93010		PR ELECTROCARDIOGRAM REPORT	OP	$30.00 	$0.00	$0.00	$13.41	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.41	$8.47	$6.61	$8.47
93015	EAP	CPT® 93015		PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R	OP	$410.00 	$0.00	$0.00	$120.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$130.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.54	$102.38	$69.34	$102.38
93016	EAP	CPT® 93016		PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R	OP	$90.00 	$0.00	$0.00	$35.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.23	$23.49	$16.76	$23.49
93017	EAP	CPT® 93017		"PR CARDIAC STRESS TST,TRACING ONLY"	OP	$230.00 	$0.00	$0.00	$63.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.38	$63.44	$40.45	$63.44
93018	EAP	CPT® 93018		"PR CARDIAC STRESS TST,INTERP/REPT ONLY"	OP	$90.00 	$0.00	$0.00	$22.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.94	$15.45	$12.14	$15.45
93024	EAP	CPT® 93024		PR CARDIAC DRUG STRESS TEST	OP	$186.00 	$0.00	$0.00	$177.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.14	$111.03	$74.69	$111.03
93042	EAP	CPT® 93042		"PR RHYTHM ECG, REPORT"	OP	$32.00 	$0.00	$0.00	$11.16	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$11.16	$7.71	$5.72	$7.71
93224	EAP	CPT® 93224		PR XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I	OP	$474.00 	$0.00	$0.00	$146.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$138.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$144.21	$146.57	$103.17	$146.57
93227	EAP	CPT® 93227		PR XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS	OP	$84.00 	$0.00	$0.00	$41.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.95	$27.01	$20.96	$27.01
93244	EAP	CPT® 93244		PR EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION	OP	$73.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93248	EAP	CPT® 93248		PR EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION	OP	$81.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
93261	EAP	CPT® 93261		PR INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB	OP	$115.00 	$0.00	$0.00	$95.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.84	$0.00	$36.70	$0.00
93270	EAP	CPT® 93270		"PR EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, RECORD"	OP	$140.00 	$0.00	$0.00	$39.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.59	$39.08	$29.72	$39.08
93271	EAP	CPT® 93271		"PR EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT"	OP	$660.00 	$0.00	$0.00	$270.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$270.40	$218.63	$57.16	$218.63
93279	EAP	CPT® 93279		PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP	OP	$100.00 	$0.00	$0.00	$78.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$78.43	$0.00	$33.29	$0.00
93280	EAP	CPT® 93280		PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER	OP	$119.00 	$0.00	$0.00	$91.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$91.85	$0.00	$39.38	$0.00
93281	EAP	CPT® 93281		PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER	OP	$132.00 	$0.00	$0.00	$107.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.56	$0.00	$46.05	$0.00
93282	EAP	CPT® 93282		PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB	OP	$132.00 	$0.00	$0.00	$99.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$99.14	$0.00	$42.55	$0.00
93283	EAP	CPT® 93283		PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB	OP	$180.00 	$0.00	$0.00	$128.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$128.83	$0.00	$51.81	$0.00
93284	EAP	CPT® 93284		PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB	OP	$195.00 	$0.00	$0.00	$142.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.25	$0.00	$60.67	$0.00
93285	EAP	CPT® 93285		PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON	OP	$145.00 	$0.00	$0.00	$66.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.66	$0.00	$28.76	$0.00
93288	EAP	CPT® 93288		PR INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON	OP	$65.00 	$0.00	$0.00	$58.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.25	$0.00	$25.77	$0.00
93289	EAP	CPT® 93289		PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB	OP	$116.00 	$0.00	$0.00	$103.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$103.05	$0.00	$39.60	$0.00
93294	EAP	CPT® 93294		PR REM INTERROG PM/LDLS PM <90 D PHYS/QHP	OP	$96.00 	$0.00	$0.00	$53.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.65	$0.00	$21.92	$0.00
93295	EAP	CPT® 93295		PR INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD DFB	OP	$118.00 	$0.00	$0.00	$106.71	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.71	$0.00	$39.59	$0.00
93298	EAP	CPT® 93298		PR REM INTERROG SCRMS <30 D PHYS/QHP	OP	$84.00 	$0.00	$0.00	$41.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$41.91	$0.00	$17.64	$0.00
93306	EAP	CPT® 93306		"PR ECHO HEART XTHORACIC,COMPLETE W DOPPLER"	OP	$225.00 	$0.00	$0.00	$225.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$367.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.00	$0.00	$159.24	$0.00
93307	EAP	CPT® 93307		"PR ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER"	OP	$139.00 	$0.00	$0.00	$139.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.00	$139.00	$129.79	$139.00
93308	EAP	CPT® 93308		"PR ECHO HEART XTHORACIC,LIMITED"	OP	$250.00 	$0.00	$0.00	$197.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$50.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$197.65	$106.47	$68.09	$106.47
93312	EAP	CPT® 93312		PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R	OP	$600.00 	$0.00	$0.00	$484.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$484.61	$284.62	$167.86	$284.62
93313	EAP	CPT® 93313		PR ECHO R-T 2D W/PROBE PLACEMENT ONLY	OP	$149.00 	$0.00	$0.00	$42.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.70	$42.63	$84.13	$42.63
93317	EAP	CPT® 93317		PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT	OP	$282.00 	$0.00	$0.00	$282.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$282.00	$0.00	$149.51	$0.00
93318	EAP	CPT® 93318		PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ	OP	$321.00 	$0.00	$0.00	$321.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$321.00	$0.00	$141.62	$0.00
93320	EAP	CPT® 93320		"PR DOPPLER ECHO HEART,COMPLETE"	OP	$130.00 	$0.00	$0.00	$85.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$85.89	$84.18	$56.78	$84.18
93321	EAP	CPT® 93321		"PR DOPPLER ECHO HEART,LIMITED,F/U"	OP	$27.00 	$0.00	$0.00	$27.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.00	$27.00	$27.00	$27.00
93325	EAP	CPT® 93325		PR DOPPLER COLOR FLOW VELOCITY MAP	OP	$65.00 	$0.00	$0.00	$65.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.46	$65.00	$65.00	$65.00
93350	EAP	CPT® 93350		"PR ECHO HEART XTHORACIC, STRESS/REST"	OP	$475.00 	$0.00	$0.00	$381.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$349.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$381.68	$169.42	$74.22	$169.42
93356	EAP	CPT® 93356		PR MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH	OP	$65.00 	$0.00	$0.00	$18.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$18.98	$0.00	$24.13	$0.00
93451	EAP	CPT® 93451		PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT	OP	$411.00 	$0.00	$0.00	$411.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$411.00	$0.00	$411.00	$0.00
93452	EAP	CPT® 93452		PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I	OP	$741.00 	$0.00	$0.00	$741.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$741.00	$0.00	$502.75	$0.00
93453	EAP	CPT® 93453		PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I	OP	$992.00 	$0.00	$0.00	$992.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$992.00	$0.00	$657.94	$0.00
93454	EAP	CPT® 93454		PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I	OP	$750.00 	$0.00	$0.00	$750.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$750.00	$0.00	$518.55	$0.00
93455	EAP	CPT® 93455		PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I	OP	$873.00 	$0.00	$0.00	$873.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$873.00	$0.00	$605.05	$0.00
93457	EAP	CPT® 93457		PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I	OP	"$1,101.00 "	$0.00	$0.00	"$1,101.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,101.00"	$0.00	$735.41	$0.00
93458	EAP	CPT® 93458		PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I	OP	"$2,730.00 "	$0.00	$0.00	"$1,708.36"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,708.36"	$0.00	$625.73	$0.00
93459	EAP	CPT® 93459		PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I	OP	"$1,049.00 "	$0.00	$0.00	"$1,049.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,049.00"	$0.00	$691.02	$0.00
93460	EAP	CPT® 93460		PR R & L HRT CATH WINJX HRT ART& L VENTR IMG	OP	"$2,496.00 "	$0.00	$0.00	"$2,024.58"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$2,024.58"	$0.00	$739.45	$0.00
93503	EAP	CPT® 93503		PR INSERT/PLACE FLOW DIRECT CATH	OP	$659.00 	$0.00	$0.00	$206.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.35	$133.51	$108.42	$133.51
93571	EAP	CPT® 93571		PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL	OP	$407.00 	$0.00	$0.00	$407.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$407.00	$0.00	$163.51	$0.00
93610	EAP	CPT® 93610		PR INTRA-ATRIAL PACING	OP	$513.00 	$0.00	$0.00	$353.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$353.81	$0.00	$143.19	$0.00
93641	EAP	CPT® 93641		PR EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN	OP	"$1,080.00 "	$0.00	$0.00	$995.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$995.20	$0.00	$412.21	$0.00
93660	EAP	CPT® 93660		PR TILT TABLE EVALUATION	OP	$305.00 	$0.00	$0.00	$249.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$249.91	$164.57	$108.36	$164.57
93880	EAP	CPT® 93880		"PR DUPLEX SCAN EXTRACRANIAL,BILAT"	OP	$122.00 	$0.00	$0.00	$122.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$122.00	$122.00	$112.31	$122.00
93882	EAP	CPT® 93882		"PR DUPLEX SCAN EXTRACRANIAL,LIMITED"	OP	$78.00 	$0.00	$0.00	$78.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$78.00	$78.00	$74.74	$78.00
93886	EAP	CPT® 93886		PR TRANSCRAN DOPPLER INTRACRAN ART	OP	$164.00 	$0.00	$0.00	$164.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.00	$164.00	$134.01	$164.00
93890	EAP	CPT® 93890		"PR TRANSCRAN DOPPL INTRACRAN, VASOREACT"	OP	$159.00 	$0.00	$0.00	$159.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.00	$148.19	$150.56	$148.19
93892	EAP	CPT® 93892		"PR TRANSCRAN DOPP INTRACRAN, EMBOLI W/O INJ"	OP	$185.00 	$0.00	$0.00	$185.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.00	$154.89	$160.24	$154.89
93893	EAP	CPT® 93893		"PR TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ"	OP	$185.00 	$0.00	$0.00	$185.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.00	$155.19	$157.09	$155.19
93922	EAP	CPT® 93922		PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 1-2 LEVEL	OP	$39.00 	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.00	$39.00	$39.00	$39.00
93923	EAP	CPT® 93923		PR NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVELS	OP	$68.00 	$0.00	$0.00	$68.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.00	$68.00	$68.00	$68.00
93924	EAP	CPT® 93924		"PR NON-INVASIVE LOWER EXTREM ART STRESS/REST, COMPLETE,BILATERAL"	OP	$76.00 	$0.00	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.00	$76.00	$76.00	$76.00
93926	EAP	CPT® 93926		PR DUPLEX LO EXTREM ART UNILAT/LTD	OP	$75.00 	$0.00	$0.00	$75.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$75.00	$75.00	$75.00
93930	EAP	CPT® 93930		PR DUPLEX UP EXTREM ART BILAT	OP	$123.00 	$0.00	$0.00	$123.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.00	$123.00	$114.62	$123.00
93931	EAP	CPT® 93931		PR DUPLEX UP EXTREM ART UNILAT/LTD	OP	$76.00 	$0.00	$0.00	$76.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$76.00	$76.00	$76.00	$76.00
93970	EAP	CPT® 93970		"PR DUPLEX EXTREM VENOUS,BILAT"	OP	$475.00 	$0.00	$0.00	$314.94	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$314.94	$186.23	$124.73	$186.23
93971	EAP	CPT® 93971		"PR DUPLEX EXTREM VENOUS,UNI OR LTD"	OP	$300.00 	$0.00	$0.00	$192.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$222.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.55	$118.64	$82.92	$118.64
93975	EAP	CPT® 93975		"PR DUPLEX ABD/PEL VASC STUDY,COMPLETE"	OP	$675.00 	$0.00	$0.00	$451.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$451.30	$242.84	$167.87	$242.84
93976	EAP	CPT® 93976		"PR DUPLEX ABD/PEL VASC STUDY,LIMITD"	OP	$139.00 	$0.00	$0.00	$139.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$139.00	$139.00	$112.20	$139.00
93978	EAP	CPT® 93978		"PR DUPLEX LARGE VESSEL(S),COMPLETE"	OP	$121.00 	$0.00	$0.00	$121.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$121.00	$121.00	$117.16	$121.00
93985	EAP	CPT® 93985		PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD	OP	$119.00 	$0.00	$0.00	$119.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.00	$0.00	$119.00	$0.00
93986	EAP	CPT® 93986		PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD	OP	$77.00 	$0.00	$0.00	$77.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.00	$0.00	$77.00	$0.00
93990	EAP	CPT® 93990		PR DUPLEX HEMODIALYSIS ACCESS	OP	$77.00 	$0.00	$0.00	$77.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.00	$77.00	$70.58	$77.00
94003	EAP	CPT® 94003		"PR VENT MANAGEMENT, INPATIENT, SUBSEQ DAY"	OP	$206.00 	$0.00	$0.00	$106.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.06	$62.88	$35.43	$62.88
94010	EAP	CPT® 94010		PR BREATHING CAPACITY TEST	OP	$26.00 	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.00	$26.00	$18.01	$26.00
94016	EAP	CPT® 94016		PR PATIENT-INITIATED SPIROMETRIC PHYS/QHP R&I ONLY	OP	$82.00 	$0.00	$0.00	$40.26	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.26	$25.18	$16.25	$25.18
94060	EAP	CPT® 94060		PR EVAL OF BRONCHOSPASM	OP	$46.00 	$0.00	$0.00	$46.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.00	$46.00	$34.69	$46.00
94375	EAP	CPT® 94375		PR RESPIRATORY FLOW VOLUME LOOP	OP	$47.00 	$0.00	$0.00	$47.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$47.00	$35.13	$22.20	$35.13
94618	EAP	CPT® 94618		PR PULMONARY STRESS TESTING	OP	$85.00 	$0.00	$0.00	$54.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.30	$0.00	$20.70	$0.00
94640	EAP	CPT® 94640		"PR INHAL RX, AIRWAY OBST/DX SPUTUM INDUCT"	OP	$56.00 	$0.00	$0.00	$29.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.20	$12.34	$12.08	$12.34
94664	EAP	CPT® 94664		"PR DEMO &/OR EVAL,PT USE,AEROSOL DEVICE"	OP	$51.00 	$0.00	$0.00	$27.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.51	$13.31	$11.83	$13.31
94726	EAP	CPT® 94726		PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST	OP	$135.00 	$0.00	$0.00	$83.64	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$83.64	$0.00	$32.24	$0.00
94728	EAP	CPT® 94728		PR AIRWAY RESISTANCE BY OSCILLOMETRY	OP	$39.00 	$0.00	$0.00	$39.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.00	$0.00	$25.29	$0.00
94729	EAP	CPT® 94729		PR DIFFUSING CAPACITY	OP	$150.00 	$0.00	$0.00	$86.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.46	$0.00	$32.07	$0.00
94760	EAP	CPT® 94760		PR NONINVASV OXYGEN SATUR;SINGLE	OP	$29.00 	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.03	$2.45	$6.36	$2.45
94761	EAP	CPT® 94761		"PR NONINVASV OXYGEN SATUR,MULTIPLE"	OP	$49.00 	$0.00	$0.00	$7.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.84	$4.79	$16.28	$4.79
95044	EAP	CPT® 95044		PR ALLERGY PATCH TESTS	OP	$26.00 	$0.00	$0.00	$8.96	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.96	$7.27	$4.91	$7.27
95250	EAP	CPT® 95250		"PR GLUCOSE MONITORING,72 HRS,SUB-Q SENSOR"	OP	$537.00 	$0.00	$0.00	$250.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$250.63	$144.91	$36.57	$144.91
95251	EAP	CPT® 95251		"PR GLUCOSE MONITOR, 72 HOUR, PHYS INTERP"	OP	$110.00 	$0.00	$0.00	$68.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.75	$38.55	$16.11	$38.55
95717	EAP	CPT® 95717		PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO	OP	$314.00 	$0.00	$0.00	$162.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$162.08	$0.00	$62.83	$0.00
95718	EAP	CPT® 95718		PR EEG PHYS/QHP 2-12 HR WITH VEEG	OP	$412.00 	$0.00	$0.00	$212.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$212.89	$0.00	$82.68	$0.00
95719	EAP	CPT® 95719		PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID	OP	$487.00 	$0.00	$0.00	$251.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$251.44	$0.00	$97.22	$0.00
95720	EAP	CPT® 95720		PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG	OP	$638.00 	$0.00	$0.00	$329.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$329.68	$0.00	$127.98	$0.00
95721	EAP	CPT® 95721		PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/O VIDEO	OP	$640.00 	$0.00	$0.00	$330.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$330.80	$0.00	$129.05	$0.00
95723	EAP	CPT® 95723		PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O VIDEO	OP	$793.00 	$0.00	$0.00	$409.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$409.51	$0.00	$160.03	$0.00
95810	EAP	CPT® 95810		PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND	OP	$495.00 	$0.00	$0.00	$495.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$495.00	$495.00	$371.84	$495.00
95811	EAP	CPT® 95811		PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND	OP	$525.00 	$0.00	$0.00	$525.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.00	$525.00	$386.68	$525.00
95812	EAP	CPT® 95812		"PR EEG,EXTENDED MONITORING,41-60 MINUTES"	OP	$177.00 	$0.00	$0.00	$177.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.00	$177.00	$82.78	$177.00
95813	EAP	CPT® 95813		PR EEG EXTENDED MONITORING 61-119 MINUTES	OP	$269.00 	$0.00	$0.00	$269.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.00	$265.94	$114.63	$265.94
95816	EAP	CPT® 95816		"PR EEG,W/AWAKE & DROWSY RECORD"	OP	$177.00 	$0.00	$0.00	$177.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$177.00	$177.00	$80.33	$177.00
95819	EAP	CPT® 95819		"PR EEG,W/AWAKE & ASLEEP RECORD"	OP	$179.00 	$0.00	$0.00	$179.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.00	$179.00	$68.89	$179.00
95822	EAP	CPT® 95822		"PR EEG,COMA/SLEEP RECORD ONLY"	OP	$179.00 	$0.00	$0.00	$179.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.00	$179.00	$77.59	$179.00
95829	EAP	CPT® 95829		PR SURGERY ELECTROCORTICOGRAM	OP	"$1,042.00 "	$0.00	$0.00	"$1,042.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,042.00"	"$1,042.00"	$222.33	"$1,042.00"
95860	EAP	CPT® 95860		EMG 1 EXT	OP	$161.00 	$0.00	$0.00	$161.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$161.00	$86.17	$44.40	$86.17
95861	EAP	CPT® 95861		EMG 2 EXT	OP	$255.00 	$0.00	$0.00	$255.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$255.00	$113.52	$75.58	$113.52
95867	EAP	CPT® 95867		"PR EMG,NEEDLE,CRANIAL NERVE SUPP MUS,UNILAT"	OP	$132.00 	$0.00	$0.00	$132.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.00	$66.30	$42.70	$66.30
95874	EAP	CPT® 95874		PR NEEDLE EMG GUIDANCE FOR CHEMODENERVATION	OP	$61.00 	$0.00	$0.00	$61.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.00	$33.40	$17.47	$33.40
95885	EAP	CPT® 95885		NCS/EMG  <=4 LIMB	OP	$57.00 	$0.00	$0.00	$57.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.00	$0.00	$33.45	$0.00
95886	EAP	CPT® 95886		NCS/EMG 5+ LIMB	OP	$142.00 	$0.00	$0.00	$142.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$142.00	$0.00	$52.31	$0.00
95887	EAP	CPT® 95887		EMG/NCS NON-EXT	OP	$117.00 	$0.00	$0.00	$117.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$117.00	$0.00	$46.64	$0.00
95907	EAP	CPT® 95907		NCS 1-2 NERVES	OP	$167.00 	$0.00	$0.00	$151.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$151.31	$0.00	$56.55	$0.00
95908	EAP	CPT® 95908		NCS 3-4 NERVES	OP	$208.00 	$0.00	$0.00	$187.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.76	$0.00	$69.76	$0.00
95909	EAP	CPT® 95909		NCS 5-6 NERVES	OP	$249.00 	$0.00	$0.00	$228.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$228.70	$0.00	$83.59	$0.00
95910	EAP	CPT® 95910		NCS 7-8 NERVES	OP	$333.00 	$0.00	$0.00	$304.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$304.91	$0.00	$110.01	$0.00
95911	EAP	CPT® 95911		NCS 9-10 NERVES	OP	$412.00 	$0.00	$0.00	$368.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$368.24	$0.00	$133.17	$0.00
95912	EAP	CPT® 95912		NCS 11-12 NERVES	OP	$491.00 	$0.00	$0.00	$411.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$411.85	$0.00	$155.91	$0.00
95913	EAP	CPT® 95913		NCS 13+ NERVES	OP	$583.00 	$0.00	$0.00	$471.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$471.19	$0.00	$180.69	$0.00
95937	EAP	CPT® 95937		RNS	OP	$142.00 	$0.00	$0.00	$129.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.00	$51.06	$31.37	$51.06
95938	EAP	CPT® 95938		PR SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMBS	OP	$143.00 	$0.00	$0.00	$143.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$143.00	$0.00	$143.00	$0.00
95939	EAP	CPT® 95939		PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LIMB	OP	$369.00 	$0.00	$0.00	$369.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$369.00	$0.00	$277.61	$0.00
95940	EAP	CPT® 95940		PR IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES	OP	$102.00 	$0.00	$0.00	$51.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.95	$0.00	$19.04	$0.00
95941	EAP	CPT® 95941		PR IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR	OP	$138.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
95992	EAP	CPT® 95992		"PR CANALITH REPOSITIONING PROCEDURE, PER DAY"	OP	$117.00 	$0.00	$0.00	$54.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.51	$0.00	$0.00	$0.00
96110	EAP	CPT® 96110		PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM	OP	$73.00 	$0.00	$0.00	$14.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$14.03	$12.16	$8.24	$12.16
96112	EAP	CPT® 96112		PR DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR	OP	$394.00 	$0.00	$0.00	$201.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$201.76	$0.00	$81.98	$0.00
96113	EAP	CPT® 96113		PR DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN	OP	$179.00 	$0.00	$0.00	$92.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$92.20	$0.00	$36.62	$0.00
96127	EAP	CPT® 96127		PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT	OP	$15.00 	$0.00	$0.00	$8.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$9.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$8.40	$0.00	$3.19	$0.00
96132	EAP	CPT® 96132		PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR	OP	$329.00 	$0.00	$0.00	$169.89	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.89	$0.00	$79.32	$0.00
96136	EAP	CPT® 96136		PR PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN	OP	$76.00 	$0.00	$0.00	$39.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.10	$0.00	$28.41	$0.00
96137	EAP	CPT® 96137		PR PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN	OP	$60.00 	$0.00	$0.00	$30.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$30.73	$0.00	$26.26	$0.00
96138	EAP	CPT® 96138		PR PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN	OP	$116.00 	$0.00	$0.00	$60.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$0.00	$23.02	$0.00
96139	EAP	CPT® 96139		PR PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN	OP	$116.00 	$0.00	$0.00	$60.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.69	$0.00	$23.02	$0.00
96156	EAP	CPT® 96156		PR HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT	OP	$272.00 	$0.00	$0.00	$140.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$140.23	$0.00	$59.20	$0.00
96160	EAP	CPT® 96160		PR PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM	OP	$25.00 	$0.00	$0.00	$7.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.31	$0.00	$0.00	$0.00
96161	EAP	CPT® 96161		PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM	OP	$35.00 	$0.00	$0.00	$7.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.31	$0.00	$0.00	$0.00
96360	EAP	CPT® 96360		"PR IV INFUSION, HYDRATION, 31-60 MIN"	OP	$114.00 	$0.00	$0.00	$90.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.38	$0.00	$33.74	$0.00
96361	EAP	CPT® 96361		"PR IV INFUSION, HYDRATION, EA ADD HOUR"	OP	$41.00 	$0.00	$0.00	$24.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.11	$0.00	$9.81	$0.00
96365	EAP	CPT® 96365		"PR IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR"	OP	$216.00 	$0.00	$0.00	$109.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.44	$0.00	$41.10	$0.00
96370	EAP	CPT® 96370		"PR SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR"	OP	$47.00 	$0.00	$0.00	$23.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$23.53	$0.00	$9.36	$0.00
96372	EAP	CPT® 96372		"PR INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT"	OP	$64.00 	$0.00	$0.00	$39.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.65	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.84	$0.00	$12.52	$0.00
96374	EAP	CPT® 96374		"PR INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG"	OP	$120.00 	$0.00	$0.00	$89.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$89.78	$0.00	$32.55	$0.00
96900	EAP	CPT® 96900		PR ULTRAVIOLET LIGHT THERAPY	OP	$68.00 	$0.00	$0.00	$32.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$32.58	$17.83	$9.61	$17.83
97597	EAP	CPT® 97597		PR DEBRIDEMENT OPEN WOUND 20 SQ CM<	OP	$114.00 	$0.00	$0.00	$50.43	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.95	$50.43	$30.13	$50.43
97598	EAP	CPT® 97598		PR DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM	OP	$80.00 	$0.00	$0.00	$63.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.94	$63.51	$38.25	$63.51
97602	EAP	CPT® 97602		PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS	OP	$118.00 	$0.00	$0.00	$53.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$53.59	$0.00	$23.88	$0.00
97605	EAP	CPT® 97605		PR NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM	OP	$80.00 	$0.00	$0.00	$36.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.53	$33.30	$21.22	$33.30
97606	EAP	CPT® 97606		PR NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM	OP	$87.00 	$0.00	$0.00	$39.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.61	$35.96	$22.82	$35.96
97607	EAP	CPT® 97607		PR NEG PRESSURE WOUND THERAPY NON DME </= 50 SQ CM	OP	$70.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97608	EAP	CPT® 97608		PR NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM	OP	$79.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
97802	EAP	CPT® 97802		"PR MED NUTR THER, 1ST, INDIV, EA 15 MIN"	OP	$104.00 	$0.00	$0.00	$51.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$67.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$51.51	$30.50	$0.00	$30.50
97803	EAP	CPT® 97803		"PR MED NUTR THER, SUBSQ, INDIV, EA 15 MIN"	OP	$88.00 	$0.00	$0.00	$43.66	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$58.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.66	$27.35	$0.00	$27.35
97804	EAP	CPT® 97804		"PR MED NUTR THER, GROUP, EA 30 MIN"	OP	$49.00 	$0.00	$0.00	$24.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.08	$14.55	$0.00	$14.55
98960	EAP	CPT® 98960		"PR SELF-MGMT EDUC & TRAIN, 1 PT, EA 30 MIN"	OP	$85.00 	$0.00	$0.00	$44.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.35	$0.00	$0.00	$0.00
98966	EAP	CPT® 98966		PR NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN	OP	$45.00 	$0.00	$0.00	$20.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$24.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.14	$0.00	$0.00	$0.00
98967	EAP	CPT® 98967		PR NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN	OP	$85.00 	$0.00	$0.00	$40.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$40.24	$0.00	$0.00	$0.00
98968	EAP	CPT® 98968		PR NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN	OP	$130.00 	$0.00	$0.00	$60.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$61.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$60.38	$0.00	$0.00	$0.00
99050	EAP	CPT® 99050		PR MEDICAL SERVICES AFTER HRS	OP	$57.00 	$0.00	$0.00	$29.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.69	$0.00	$14.00	$0.00
99080	EAP	CPT® 99080		PR SPECIAL REPORTS OR FORMS	OP	$53.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99140	EAP	CPT® 99140		PR EMERGENCY ANESTHESIA	OP	$16.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99152	EAP	CPT® 99152		PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS	OP	$330.00 	$0.00	$0.00	$19.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$19.54	$0.00	$30.86	$0.00
99153	EAP	CPT® 99153		PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS	OP	$32.00 	$0.00	$0.00	$17.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.40	$0.00	$6.60	$0.00
99156	EAP	CPT® 99156		PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS	OP	$240.00 	$0.00	$0.00	$119.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.90	$0.00	$45.78	$0.00
99157	EAP	CPT® 99157		PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS	OP	$196.00 	$0.00	$0.00	$90.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.91	$0.00	$34.71	$0.00
99170	EAP	CPT® 99170		PR ANOGENITAL XM MAGNIFY CHILD/SUSPECT TRAUMA W IMG	OP	$266.00 	$0.00	$0.00	$141.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.38	$127.19	$81.28	$127.19
99173	EAP	CPT® 99173		"PR VISUAL SCREENING TEST, BILAT"	OP	$20.00 	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$7.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$5.03	$0.00	$0.00	$0.00
99184	EAP	CPT® 99184		PR INITIAT SELECTIVE HEAD/BODY HYPOTHERMIA NEONATE	OP	$685.00 	$0.00	$0.00	$362.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$362.70	$0.00	$139.94	$0.00
99188	EAP	CPT® 99188		PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP	OP	$32.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.31	$0.00
99195	EAP	CPT® 99195		PR PHLEBOTOMY	OP	$308.00 	$0.00	$0.00	$158.34	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.34	$36.50	$10.73	$36.50
99202	EAP	CPT® 99202		PR OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES	OP	$189.00 	$0.00	$0.00	$87.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$204.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$87.10	$62.27	$90.40	$62.27
99203	EAP	CPT® 99203		PR OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES	OP	$273.00 	$0.00	$0.00	$132.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$314.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.99	$92.30	$90.40	$92.30
99204	EAP	CPT® 99204		PR OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES	OP	$416.00 	$0.00	$0.00	$225.04	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$467.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$225.04	$140.99	$90.40	$140.99
99205	EAP	CPT® 99205		PR OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES	OP	$527.00 	$0.00	$0.00	$292.47	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$618.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$292.47	$177.24	$90.40	$177.24
99211	EAP	CPT® 99211		PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP	OP	$46.00 	$0.00	$0.00	$19.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$65.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$15.96	$19.82	$46.00	$19.82
99212	EAP	CPT® 99212		PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN	OP	$116.00 	$0.00	$0.00	$43.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$159.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$43.54	$36.61	$90.40	$36.61
99213	EAP	CPT® 99213		PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN	OP	$184.00 	$0.00	$0.00	$88.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$254.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$88.36	$59.94	$90.40	$59.94
99214	EAP	CPT® 99214		PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN	OP	$271.00 	$0.00	$0.00	$135.62	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$358.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$135.62	$90.92	$90.40	$90.92
99215	EAP	CPT® 99215		PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN	OP	$365.00 	$0.00	$0.00	$192.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$505.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$192.06	$123.15	$90.40	$123.15
99217	EAP	CPT® 99217		PR OBSERVATION CARE DISCHARGE MANAGEMENT	OP	$222.00 	$0.00	$0.00	$125.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.85	$67.02	$0.00	$67.02
99218	EAP	CPT® 99218		PR INITIAL OBSERVATION CARE/DAY 30 MINUTES	OP	$305.00 	$0.00	$0.00	$172.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$172.36	$63.36	$0.00	$63.36
99219	EAP	CPT® 99219		PR INITIAL OBSERVATION CARE/DAY 50 MINUTES	OP	$414.00 	$0.00	$0.00	$234.40	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$234.40	$104.76	$0.00	$104.76
99220	EAP	CPT® 99220		PR INITIAL OBSERVATION CARE/DAY 70 MINUTES	OP	$565.00 	$0.00	$0.00	$320.33	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$320.33	$147.61	$0.00	$147.61
99221	EAP	CPT® 99221		PR 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES	OP	$312.00 	$0.00	$0.00	$175.29	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.29	$86.98	$0.00	$86.98
99222	EAP	CPT® 99222		PR 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES	OP	$421.00 	$0.00	$0.00	$236.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.76	$121.71	$0.00	$121.71
99223	EAP	CPT® 99223		PR 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES	OP	$618.00 	$0.00	$0.00	$350.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$350.31	$177.75	$0.00	$177.75
99224	EAP	CPT® 99224		PR SBSQ OBSERVATION CARE/DAY 15 MINUTES	OP	$150.00 	$0.00	$0.00	$68.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.70	$0.00	$0.00	$0.00
99225	EAP	CPT® 99225		PR SBSQ OBSERVATION CARE/DAY 25 MINUTES	OP	$222.00 	$0.00	$0.00	$125.83	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.83	$0.00	$0.00	$0.00
99226	EAP	CPT® 99226		PR SBSQ OBSERVATION CARE/DAY 35 MINUTES	OP	$319.00 	$0.00	$0.00	$181.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$181.67	$0.00	$0.00	$0.00
99231	EAP	CPT® 99231		PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES	OP	$120.00 	$0.00	$0.00	$68.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$68.08	$36.40	$0.00	$36.40
99232	EAP	CPT® 99232		PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES	OP	$221.00 	$0.00	$0.00	$124.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$124.58	$65.26	$0.00	$65.26
99233	EAP	CPT® 99233		PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES	OP	$318.00 	$0.00	$0.00	$179.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.78	$93.25	$0.00	$93.25
99234	EAP	CPT® 99234		PR HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN	OP	$408.00 	$0.00	$0.00	$231.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$231.25	$127.40	$0.00	$127.40
99235	EAP	CPT® 99235		PR HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN	OP	$516.00 	$0.00	$0.00	$292.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$292.06	$168.12	$0.00	$168.12
99236	EAP	CPT® 99236		PR HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN	OP	$664.00 	$0.00	$0.00	$376.14	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$376.14	$209.53	$0.00	$209.53
99238	EAP	CPT® 99238		PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<	OP	$223.00 	$0.00	$0.00	$125.28	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$125.28	$66.71	$0.00	$66.71
99239	EAP	CPT® 99239		PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN	OP	$438.00 	$0.00	$0.00	$185.44	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$185.44	$96.57	$0.00	$96.57
99241	EAP	CPT® 99241		PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN	OP	$127.00 	$0.00	$0.00	$56.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$56.46	$48.43	$0.00	$48.43
99242	EAP	CPT® 99242		PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES	OP	$208.00 	$0.00	$0.00	$118.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.46	$89.68	$0.00	$89.68
99243	EAP	CPT® 99243		PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES	OP	$291.00 	$0.00	$0.00	$165.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$165.73	$122.89	$0.00	$122.89
99244	EAP	CPT® 99244		PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	OP	$468.00 	$0.00	$0.00	$266.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$423.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$266.39	$181.27	$0.00	$181.27
99245	EAP	CPT® 99245		PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES	OP	$579.00 	$0.00	$0.00	$329.61	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$329.61	$224.86	$0.00	$224.86
99251	EAP	CPT® 99251		PR INITL INPATIENT CONSULT NEW/ESTAB PT 20 MIN	OP	$149.00 	$0.00	$0.00	$84.68	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$84.68	$46.88	$0.00	$46.88
99252	EAP	CPT® 99252		PR IP/OBS CONSLTJ NEW/EST PT SF MDM 35 MINUTES	OP	$227.00 	$0.00	$0.00	$129.49	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$129.49	$74.80	$0.00	$74.80
99253	EAP	CPT® 99253		PR IP/OBS CONSLTJ NEW/EST PT LOW MDM 45 MINUTES	OP	$349.00 	$0.00	$0.00	$198.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$198.88	$110.93	$0.00	$110.93
99254	EAP	CPT® 99254		PR IP/OBS CONSLTJ NEW/EST PT MOD MDM 60 MINUTES	OP	$508.00 	$0.00	$0.00	$289.12	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$289.12	$159.87	$0.00	$159.87
99255	EAP	CPT® 99255		PR IP/OBS CONSLTJ NEW/EST PT HIGH MDM 80 MINUTES	OP	$612.00 	$0.00	$0.00	$348.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$348.60	$198.98	$0.00	$198.98
99281	EAP	CPT® 99281		LEVEL 1-ED VISIT LIMITED/MINOR PROB	OP	$94.00 	$0.00	$0.00	$36.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.76	$19.83	$0.00	$19.83
99282	EAP	CPT® 99282		LEVEL 2-ED VISIT LOW/MODER SEVERITY	OP	$133.00 	$0.00	$0.00	$71.67	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$71.67	$38.17	$0.00	$38.17
99283	EAP	CPT® 99283		LEVEL 3-ED VISIT MODERATE SEVERITY	OP	$199.00 	$0.00	$0.00	$107.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$107.20	$61.92	$0.00	$61.92
99284	EAP	CPT® 99284		LEVEL 4-ED VISIT HIGH/URGENT SEVERITY	OP	$366.00 	$0.00	$0.00	$203.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$203.35	$113.05	$0.00	$113.05
99285	EAP	CPT® 99285		LEVEL 5-ED VISIT HIGH SEVERITY&THREAT	OP	$531.00 	$0.00	$0.00	$300.08	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.08	$169.20	$0.00	$169.20
99291	EAP	CPT® 99291		"PR CRITICAL CARE, E/M 30-74 MINUTES"	OP	$704.00 	$0.00	$0.00	$386.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$386.78	$259.17	$0.00	$259.17
99292	EAP	CPT® 99292		"PR CRITICAL CARE, ADDL 30 MIN"	OP	$352.00 	$0.00	$0.00	$193.72	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$193.72	$116.36	$0.00	$116.36
99307	EAP	CPT® 99307		PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES	OP	$134.00 	$0.00	$0.00	$77.38	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$77.38	$32.30	$0.00	$32.30
99308	EAP	CPT® 99308		PR SBSQ NURSING FACILITY CARE LOW MDM 15 MINUTES	OP	$211.00 	$0.00	$0.00	$119.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$119.75	$53.53	$0.00	$53.53
99309	EAP	CPT® 99309		PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES	OP	$278.00 	$0.00	$0.00	$157.84	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.84	$75.12	$0.00	$75.12
99310	EAP	CPT® 99310		PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES	OP	$410.00 	$0.00	$0.00	$234.56	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$234.56	$93.93	$0.00	$93.93
99335	EAP	CPT® 99335		PR DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES	OP	$291.00 	$0.00	$0.00	$164.55	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.55	$67.33	$0.00	$67.33
99341	EAP	CPT® 99341		PR HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES	OP	$167.00 	$0.00	$0.00	$95.13	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.13	$54.97	$0.00	$54.97
99342	EAP	CPT® 99342		PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES	OP	$239.00 	$0.00	$0.00	$136.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.86	$80.84	$0.00	$80.84
99343	EAP	CPT® 99343		PR HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES	OP	$393.00 	$0.00	$0.00	$224.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$224.59	$117.21	$0.00	$117.21
99344	EAP	CPT® 99344		PR HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES	OP	$557.00 	$0.00	$0.00	$314.87	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$314.87	$153.66	$0.00	$153.66
99345	EAP	CPT® 99345		PR HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES	OP	$678.00 	$0.00	$0.00	$381.73	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$381.73	$189.66	$0.00	$189.66
99347	EAP	CPT® 99347		PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES	OP	$167.00 	$0.00	$0.00	$95.76	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$95.76	$42.58	$0.00	$42.58
99348	EAP	CPT® 99348		PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES	OP	$256.00 	$0.00	$0.00	$145.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$145.45	$67.33	$0.00	$67.33
99349	EAP	CPT® 99349		PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES	OP	$393.00 	$0.00	$0.00	$221.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.60	$104.13	$0.00	$104.13
99350	EAP	CPT® 99350		PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES	OP	$547.00 	$0.00	$0.00	$307.48	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$307.48	$153.66	$0.00	$153.66
99354	EAP	CPT® 99354		PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR	OP	$372.00 	$0.00	$0.00	$160.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$160.75	$92.83	$0.00	$92.83
99355	EAP	CPT® 99355		PR PROLONGED SVC OUTPATIENT SETTING EA ADDL 30 MIN	OP	$280.00 	$0.00	$0.00	$155.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$155.85	$92.16	$0.00	$92.16
99356	EAP	CPT® 99356		PR PROLONGED SVC I/P OR OBS SETTING 1ST HOUR	OP	$282.00 	$0.00	$0.00	$158.99	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$158.99	$85.41	$0.00	$85.41
99357	EAP	CPT® 99357		PR PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN	OP	$285.00 	$0.00	$0.00	$157.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$157.75	$85.72	$0.00	$85.72
99358	EAP	CPT® 99358		PR PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR	OP	$341.00 	$0.00	$0.00	$187.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$187.85	$0.00	$0.00	$0.00
99360	EAP	CPT® 99360		PR PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES	OP	$186.00 	$0.00	$0.00	$106.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$106.19	$0.00	$0.00	$0.00
99367	EAP	CPT® 99367		PR TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN	OP	$171.00 	$0.00	$0.00	$97.58	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$97.58	$0.00	$0.00	$0.00
99381	EAP	CPT® 99381		"PR PREVENTIVE VISIT,NEW,INFANT < 1 YR"	OP	$278.00 	$0.00	$0.00	$132.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$256.75	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.57	$0.00	$0.00	$0.00
99382	EAP	CPT® 99382		"PR PREVENTIVE VISIT,NEW,AGE 1-4"	OP	$248.00 	$0.00	$0.00	$141.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$268.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$141.19	$0.00	$0.00	$0.00
99383	EAP	CPT® 99383		"PR PREVENTIVE VISIT,NEW,AGE5-11"	OP	$264.00 	$0.00	$0.00	$150.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$278.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.39	$0.00	$0.00	$0.00
99384	EAP	CPT® 99384		"PR PREVENTIVE VISIT,NEW,12-17"	OP	$311.00 	$0.00	$0.00	$176.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.77	$0.00	$0.00	$0.00
99385	EAP	CPT® 99385		"PR PREVENTIVE VISIT,NEW,18-39"	OP	$331.00 	$0.00	$0.00	$169.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$304.85	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$169.42	$0.00	$0.00	$0.00
99386	EAP	CPT® 99386		"PR PREVENTIVE VISIT,NEW,40-64"	OP	$363.00 	$0.00	$0.00	$206.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$354.25	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.23	$0.00	$0.00	$0.00
99387	EAP	CPT® 99387		"PR PREVENTIVE VISIT,NEW,65 & OVER"	OP	$389.00 	$0.00	$0.00	$221.59	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$221.59	$0.00	$0.00	$0.00
99391	EAP	CPT® 99391		"PR PREVENTIVE VISIT,EST, INFANT < 1 YR"	OP	$250.00 	$0.00	$0.00	$120.93	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$230.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$120.93	$0.00	$0.00	$0.00
99392	EAP	CPT® 99392		"PR PREVENTIVE VISIT,EST,AGE 1-4"	OP	$267.00 	$0.00	$0.00	$132.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$245.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.57	$0.00	$0.00	$0.00
99393	EAP	CPT® 99393		"PR PREVENTIVE VISIT,EST,AGE5-11"	OP	$267.00 	$0.00	$0.00	$132.57	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$245.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$132.57	$0.00	$0.00	$0.00
99394	EAP	CPT® 99394		"PR PREVENTIVE VISIT,EST,12-17"	OP	$292.00 	$0.00	$0.00	$150.39	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$269.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.39	$0.00	$0.00	$0.00
99395	EAP	CPT® 99395		"PR PREVENTIVE VISIT,EST,18-39"	OP	$299.00 	$0.00	$0.00	$154.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$274.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$154.70	$0.00	$0.00	$0.00
99396	EAP	CPT® 99396		"PR PREVENTIVE VISIT,EST,40-64"	OP	$321.00 	$0.00	$0.00	$168.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$292.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$168.19	$0.00	$0.00	$0.00
99397	EAP	CPT® 99397		"PR PREVENTIVE VISIT,EST,65 & OVER"	OP	$350.00 	$0.00	$0.00	$176.77	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$315.90	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$176.77	$0.00	$0.00	$0.00
99402	EAP	CPT® 99402		"PR PREVENT COUNSEL,INDIV,30 MIN"	OP	$153.00 	$0.00	$0.00	$86.54	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$86.54	$0.00	$0.00	$0.00
99406	EAP	CPT® 99406		PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES	OP	$38.00 	$0.00	$0.00	$21.46	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$27.95	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$21.46	$0.00	$0.00	$0.00
99407	EAP	CPT® 99407		PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES	OP	$80.00 	$0.00	$0.00	$44.78	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.78	$0.00	$0.00	$0.00
99408	EAP	CPT® 99408		PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN	OP	$101.00 	$0.00	$0.00	$57.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$57.69	$0.00	$0.00	$0.00
99411	EAP	CPT® 99411		"PR PREVENT COUNSEL,GROUP,30 MIN"	OP	$86.00 	$0.00	$0.00	$13.51	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.51	$0.00	$0.00	$0.00
99417	EAP	CPT® 99417		PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES	OP	$113.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99421	EAP	CPT® 99421		PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES	OP	$50.00 	$0.00	$0.00	$22.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.69	$0.00	$0.00	$0.00
99423	EAP	CPT® 99423		PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES	OP	$150.00 	$0.00	$0.00	$74.17	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$74.17	$0.00	$0.00	$0.00
99441	EAP	CPT® 99441		PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN	OP	$120.00 	$0.00	$0.00	$22.11	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$102.05	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$22.11	$0.00	$0.00	$0.00
99442	EAP	CPT® 99442		PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN	OP	$225.00 	$0.00	$0.00	$44.19	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$164.45	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.19	$0.00	$0.00	$0.00
99443	EAP	CPT® 99443		PR PHYS/QHP TELEPHONE EVALUATION 21-30 MIN	OP	$330.00 	$0.00	$0.00	$66.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$232.70	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$66.31	$0.00	$0.00	$0.00
99447	EAP	CPT® 99447		PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 11-20 MIN	OP	$111.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99448	EAP	CPT® 99448		PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 21-30 MIN	OP	$167.00 	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
99451	EAP	CPT® 99451		PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5/> MIN	OP	$113.00 	$0.00	$0.00	$63.81	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$63.81	$0.00	$0.00	$0.00
99453	EAP	CPT® 99453		PR REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP	OP	$70.00 	$0.00	$0.00	$33.31	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$33.31	$0.00	$0.00	$0.00
99454	EAP	CPT® 99454		PR REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D	OP	$220.00 	$0.00	$0.00	$109.88	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$109.88	$0.00	$0.00	$0.00
99457	EAP	CPT® 99457		PR REMOTE PHYSIOLOGIC MONITORING 1ST 20 MIN MONTH	OP	$105.00 	$0.00	$0.00	$55.23	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.23	$0.00	$0.00	$0.00
99458	EAP	CPT® 99458		PR REMOTE PHYSIOLOGIC MONITORING EA ADDL 20 MIN MO	OP	$105.00 	$0.00	$0.00	$55.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$55.82	$0.00	$0.00	$0.00
99460	EAP	CPT® 99460		"PR INITIAL NORMAL NEWBORN CARE, HOSPITAL OR BIRTH CENTER"	OP	$325.00 	$0.00	$0.00	$166.92	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$166.92	$0.00	$0.00	$0.00
99462	EAP	CPT® 99462		"PR SUBSEQUENT HOSPITAL CARE, NORMAL NEWBORN"	OP	$150.00 	$0.00	$0.00	$72.42	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.42	$0.00	$0.00	$0.00
99463	EAP	CPT® 99463		"PR INITIAL NORMAL NEWBORN CARE, SAME DAY DISCHARGE"	OP	$340.00 	$0.00	$0.00	$206.30	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.30	$0.00	$0.00	$0.00
99464	EAP	CPT® 99464		PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN	OP	$228.00 	$0.00	$0.00	$123.86	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$123.86	$0.00	$0.00	$0.00
99465	EAP	CPT® 99465		PR DELIVERY/BIRTHING ROOM RESUSCITATION	OP	$447.00 	$0.00	$0.00	$264.53	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$264.53	$0.00	$0.00	$0.00
99468	EAP	CPT® 99468		"PR INITIAL HOSP NEONATE 28 DAY OR LESS, CRITICALLY ILL"	OP	"$2,811.00 "	$0.00	$0.00	"$1,633.37"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,633.37"	$0.00	$0.00	$0.00
99469	EAP	CPT® 99469		"PR SUBSEQUENT HOSP NEONATE 28 DAY OR LESS, CRITICALLY ILL"	OP	"$1,217.00 "	$0.00	$0.00	$689.69	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$689.69	$0.00	$0.00	$0.00
99471	EAP	CPT® 99471		PR INITIAL PED CRITICAL CARE 29 DAY THRU 24 MO	OP	"$2,433.00 "	$0.00	$0.00	"$1,517.07"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,517.07"	$0.00	$0.00	$0.00
99472	EAP	CPT® 99472		PR SUBSEQUENT PED CRITICAL CARE 29 DAY THRU 24 MO	OP	"$1,230.00 "	$0.00	$0.00	$709.06	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$709.06	$0.00	$0.00	$0.00
99477	EAP	CPT® 99477		"PR INITIAL HOSP NEONATE 28 DAY OR LESS, NOT CRITICALLY ILL"	OP	"$1,068.00 "	$0.00	$0.00	$619.35	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$619.35	$0.00	$0.00	$0.00
99478	EAP	CPT® 99478		PR SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS	OP	$420.00 	$0.00	$0.00	$236.82	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.82	$0.00	$0.00	$0.00
99479	EAP	CPT® 99479		PR SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS	OP	$381.00 	$0.00	$0.00	$215.98	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$215.98	$0.00	$0.00	$0.00
99480	EAP	CPT® 99480		PR SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS	OP	$366.00 	$0.00	$0.00	$206.80	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$206.80	$0.00	$0.00	$0.00
99490	EAP	CPT® 99490		PR CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO	OP	$115.00 	$0.00	$0.00	$54.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$54.00	$0.00	$0.00	$0.00
99495	EAP	CPT® 99495		PR TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE	OP	$377.00 	$0.00	$0.00	$190.91	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$576.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$190.91	$0.00	$0.00	$0.00
99496	EAP	CPT® 99496		PR TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE	OP	$497.00 	$0.00	$0.00	$276.21	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$777.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$276.21	$0.00	$0.00	$0.00
99497	EAP	CPT® 99497		PR ADVANCE CARE PLANNING FIRST 30 MINS	OP	$241.00 	$0.00	$0.00	$136.24	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$236.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$136.24	$0.00	$0.00	$0.00
99498	EAP	CPT® 99498		PR ADVANCE CARE PLANNING EA ADDL 30 MINS	OP	$227.00 	$0.00	$0.00	$127.63	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$127.63	$0.00	$0.00	$0.00
0042T	EAP	CPT® 0042T		"CEREBRAL PERFUS ANALYSIS, CT W/CONTRAST"	OP	$600.00 	$0.00	$0.00	$525.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$525.00	$0.00	$0.00	$0.00
01967SA	EAP	CPT® 01967SA		"ANESTH, NEURAXIAL LABOR, PLAN VAG DEL; STANDALONE"	OP	$90.00 	$0.00	$0.00	$90.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$90.00	$90.00	$0.00	$90.00
0479T	EAP	CPT® 0479T		PR FRACTIONAL ABL LSR FENESTRATION FIRST 100 SQCM	OP	"$1,579.00 "	$0.00	$0.00	$789.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$789.50	$0.00	$0.00	$0.00
0480T	EAP	CPT® 0480T		PR FRACTIONAL ABL LSR FENESTRATION EA ADDL 100 SQCM	OP	$827.00 	$0.00	$0.00	$413.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$413.50	$0.00	$0.00	$0.00
A4649	EAP	HCPCS A4649		PR SURGICAL SUPPLIES	OP	$40.00 	$0.00	$0.00	$20.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$20.00	$0.00	$0.00	$0.00
D7140	EAP	HCPCS D7140		PR EXTRACTION ERUPTED TOOTH/EXR	OP	$150.00 	$0.00	$0.00	$75.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$75.00	$0.00	$0.00	$0.00
D7210	EAP	HCPCS D7210		PR REM IMP TOOTH W MUCOPER FLP	OP	$350.00 	$0.00	$0.00	$175.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.00	$0.00	$0.00	$0.00
D7220	EAP	HCPCS D7220		PR IMPACT TOOTH REMOV SOFT TISS	OP	$192.00 	$0.00	$0.00	$96.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$96.00	$0.00	$0.00	$0.00
D7230	EAP	HCPCS D7230		PR IMPACT TOOTH REMOV PART BONY	OP	$144.00 	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.00	$0.00	$0.00	$0.00
D7240	EAP	HCPCS D7240		PR IMPACT TOOTH REMOV COMP BONY	OP	$203.00 	$0.00	$0.00	$101.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$101.50	$0.00	$0.00	$0.00
D7241	EAP	HCPCS D7241		PR IMPACT TOOTH REM BONY W/COMP	OP	$300.00 	$0.00	$0.00	$150.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$150.00	$0.00	$0.00	$0.00
D7521	EAP	HCPCS D7521		INCISION/DRAIN ABSCESS EXTRA	OP	$237.00 	$0.00	$0.00	$118.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.50	$0.00	$0.00	$0.00
D8040	EAP	HCPCS D8040		PR LIMITED DENTAL TX ADULT	OP	$237.00 	$0.00	$0.00	$118.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$118.50	$0.00	$0.00	$0.00
D9239	EAP	HCPCS D9239		"PR IV SEDATION PER UNIT, 1ST 15 MIN MAC BILLING"	OP	$75.00 	$0.00	$0.00	$37.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.50	$0.00	$0.00	$0.00
D9243	EAP	HCPCS D9243		PR IV SEDATION EA AD 15 MIN MAC BILLING	OP	$75.00 	$0.00	$0.00	$37.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$37.50	$0.00	$0.00	$0.00
G0101	EAP	HCPCS G0101		PR CA SCREEN;PELVIC/BREAST EXAM	OP	$88.00 	$0.00	$0.00	$44.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$72.15	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.00	$35.21	$0.00	$35.21
G0105	EAP	HCPCS G0105		PR COLORECTAL SCRN; HI RISK IND	OP	$600.00 	$0.00	$0.00	$368.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$300.00	$368.36	$213.45	$368.36
G0121	EAP	HCPCS G0121		PR COLON CA SCRN NOT HI RSK IND	OP	$580.00 	$0.00	$0.00	$368.36	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$290.00	$368.36	$0.00	$368.36
G0168	EAP	HCPCS G0168		PR WOUND CLOSURE BY ADHESIVE	OP	$58.00 	$0.00	$0.00	$58.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$29.00	$58.00	$0.00	$58.00
G0179	EAP	HCPCS G0179		PR MD RECERTIFICATION HHA PT	OP	$124.00 	$0.00	$0.00	$62.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$62.00	$49.12	$0.00	$49.12
G0259	EAP	HCPCS G0259		PR INJECT FOR SACROILIAC JOINT	OP	$592.00 	$0.00	$0.00	$296.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$296.00	$0.00	$0.00	$0.00
G0279	EAP	HCPCS G0279		PR DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS	OP	$89.00 	$0.00	$0.00	$44.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$44.50	$0.00	$0.00	$0.00
G0402	EAP	HCPCS G0402		WELCOME TO MEDICARE -PREVENTIVE VISIT	OP	$426.00 	$0.00	$0.00	$213.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$304.20	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$213.00	$0.00	$0.00	$0.00
G0403	EAP	HCPCS G0403		EKG FOR INITIAL PREVENT EXAM	OP	$52.00 	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$26.00	$0.00	$0.00	$0.00
G0405	EAP	HCPCS G0405		EKG INTERPRET & REPORT PREVE	OP	$26.00 	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$13.00	$0.00	$0.00	$0.00
G0413	EAP	HCPCS G0413		PERCUTANEOUS SKELETAL FIXATION	OP	"$3,322.00 "	$0.00	$0.00	"$1,661.00"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,661.00"	$0.00	$0.00	$0.00
G0414	EAP	HCPCS G0414		PELVIC RING FX TREAT INT FIX	OP	"$3,137.00 "	$0.00	$0.00	"$1,568.50"	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	"$1,568.50"	$0.00	$0.00	$0.00
G0438	EAP	HCPCS G0438		FIRST ANNUAL WELLNESS VISIT-MEDICARE	OP	$518.00 	$0.00	$0.00	$259.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$468.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$259.00	$0.00	$0.00	$0.00
G0439	EAP	HCPCS G0439		SUBSEQUENT ANNUAL WELLNESS VIST-MEDICARE	OP	$351.00 	$0.00	$0.00	$175.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$366.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$175.50	$0.00	$0.00	$0.00
G0442	EAP	HCPCS G0442		"ANNUAL ALCOHOL MISUSE SCREENING, 15 MINUTES"	OP	$35.00 	$0.00	$0.00	$17.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.50	$0.00	$0.00	$0.00
G0443	EAP	HCPCS G0443		"BRIEF FACE-TO-FACE BEHAVIORAL COUNSELING FOR ALCOHOL MISUSE, 15 MINUTE"	OP	$72.00 	$0.00	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.00	$0.00	$0.00	$0.00
G0444	EAP	HCPCS G0444		"PR ANNUAL DEPRESSION SCREENING, 5 TO 15 MINUTES"	OP	$35.00 	$0.00	$0.00	$17.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$17.50	$0.00	$0.00	$0.00
G0447	EAP	HCPCS G0447		"FACE-TO-FACE BEHAVIORAL COUNSELING FOR OBESITY, 15 MINUS"	OP	$72.00 	$0.00	$0.00	$36.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$48.10	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$36.00	$0.00	$0.00	$0.00
G0453	EAP	HCPCS G0453		PR CONT INTRAOPERATIVE NEURO MONITORING EA 15M	OP	$99.00 	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$49.50	$0.00	$0.00	$0.00
G2212	EAP	HCPCS G2212		PR PROLONGED OUTPT/OFFICE VISIT; EA ADDL 15 MIN	OP	$92.00 	$0.00	$0.00	$46.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$46.00	$0.00	$0.00	$0.00
G6002	EAP	CPT® G6002		CHG GUIDANCE FOR LOC	OP	$63.00 	$0.00	$0.00	$31.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$31.50	$0.00	$44.63	$0.00
G6017	EAP	HCPCS G6017		PR INTRA-FRACTION LOCALIZATION AND TRACKING OF TARGET	OP	$359.00 	$0.00	$0.00	$179.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$179.50	$0.00	$0.00	$0.00
M0201	EAP	HCPCS M0201		PR COVID-19 VACCINE HOME ADMIN ADD-ON	OP	$105.00 	$0.00	$0.00	$52.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$52.50	$0.00	$0.00	$0.00
P3001	EAP	HCPCS P3001		PR SCREENING PAP SMEAR BY PHYS	OP	$79.00 	$0.00	$0.00	$39.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$39.50	$23.43	$0.00	$23.43
Q0091	EAP	HCPCS Q0091		PR OBTAINING SCREEN PAP SMEAR	OP	$70.00 	$0.00	$0.00	$39.01	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$35.00	$39.01	$0.00	$39.01
Q0111	EAP	HCPCS Q0111		PR WET MOUNTS/ W PREPARATIONS	OP	$25.00 	$0.00	$0.00	$12.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$12.50	$0.00	$0.00	$0.00
S2900	EAP	HCPCS S2900		PR ROBOTIC SURGICAL SYSTEM	OP	$675.00 	$0.00	$0.00	$337.50	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$337.50	$0.00	$0.00	$0.00